About Journal

  The Iraqi Postgraduate Medical Journal is a medical journal issued in English; it is concerned in all medical specializations.It started from year 2000. It is a peer-reviewed based publication and it is approved for scientific promotion purposes. It is considered an important source for many researchers. It is published quarterly and available in paper and electronic forms. Our journal is indexed in: - Directory of Medical Journals for the Middle East Region, In 2005, it was selected to be one of the sources of input of the  IMEMR, Index Medicus - Scientific site of Iraqi scientific...
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Impact of COVID-19 on Mental Health of Physicians in Baghdad, Iraq

Lubna Qays Naji; Hussein Ali Meften; Marwa Jameel Ahmed; Jawad Al-Diwan; Nesif Jasim Al Hemiary; Mushtaq Talib Hashim

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 2, Pages 134-137
DOI: 10.52573/ipmj.2021.174605

BACKGROUND:
Healthcare professionals are vulnerable to adverse mental health consequences explained by their working in close contacts with COVID-19 patients. Publication on mental health of healthcare professional in Iraq is scarce.
OBJECTIVE:
To comment on mental health disorders among healthcare professional dealing with COVID-19 patients.
METHODS:
A total of 100 healthcare professionals were included in the study. They were selected conveniently. Hospital anxiety and depression scale was used. Data collected by a physician.
RESULTS:
The age of participants was 35.5 ± 8.7 years with a male to female ratio of 1.7:1. Of the participants, 63% got COVID-19. Anxiety and depression rates were 80% and 64%, respectively. Age, sex, and job titles were not significantly associated with anxiety or depression (p = 0.5, 0.8 and 0.7, respectively).
CONCLUSION:
High rates of anxiety and depression among healthcare professionals

Knowledge about Osteoporosis among Primary Health Care Physicians in Baghdad

Najlaa Fawzi Jamil; Samara Ali Salman

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 2, Pages 138-147
DOI: 10.52573/ipmj.2020.174606

ABSTRACT:
BACK GROUND:
Osteoporosis (OP) is an important health, economic and social matter, which affects a major part of the population, therefore attentiveness among primary health care physicians is crucial for early detection and appropriate treatment.
OBJECTIVE:
The study was conducted to assess the knowledge of primary health care physicians in Baghdad regarding different aspects of Osteoporosis as well as to identify the impact of some socio demographic and qualification characteristic of the physicians upon their knowledge.
METHOD:
Cross sectional study was carried out in 30 primary health care centers in Baghdad for the period from 1st of February to end of May 2019.The study sample enclosed primary health care physicians working in the selected centers during the study period. Self-administered questionnaire was used for data collection. The questionnaire encompassed five domains to assess different aspect of OP, in addition the collected data covered some characteristics of physicians.
RESULTS:
The result showed that out of 180 physicians enrolled in the study giving an overall response rate of 81.8%., 97.8% of them had good overall knowledge on OP, and the mean score of the overall knowledge was 35.74±6.13 with range of (21-46). Highest rates (97.2%, 95%) of good knowledge were documented for domains two and one which recognized the knowledge on risk factors and general knowledge of physicians regarding OP respectively. While the least rate of good knowledge was reported in domain four that tested the knowledge of physicians regarding treatment options (76.7%). Better level of knowledge was accomplished by primary health care physicians belong to age group less than 45 years old as well as for those with less years of experience since graduation, the physician’s qualifications and specialties did not illustrate statistically significant influence on the level of knowledge.
CONCLUSION:
Despite very high-ranking level of knowledge of physicians in the present study. yet, there is still a need for continuous medical education and training of primary health care physicians to expand their knowledge as well as their skills in management of OP. 
 

Periorbital Defect Reconstruction Following Malignant Tumor Resection

Marwan M. AlQasem; Haider H. H. Jaleel

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 2, Pages 148-153
DOI: 10.52573/ipmj.2021.174609

BACKGROUND:
Since the ocular adnexa contains almost every tissue type, any malignancy may occur in this area, however, the majority are carcinomas, from which basal cell carcinomas (BCC) are the most frequent, followed by; squamous cell carcinoma (SCC), sebaceous gland carcinoma, malignant melanoma. Reconstructing periorbital defects should aim at restoring functional as well as aesthetic improvement (1). Planning of the surgical reconstruction is tempered by several factors including; nature of the defect, integrity of the surrounding tissues, in some cases multiple choices of repair available making planning more complex, as in the medial canthal area (2)
OBJECIVE:

Analyze the most suitable methods of reconstruction of different periorbital defects of different sizes and in different sites.
Analyzing the incidence of recurrence and complications of tumors after surgical excision.

METHODS:
Thirty patients presented with 34 malignant lesion in the periorbital area. The lesions were excised surgically, and the post-excisional defects were classified into five zones in the periorbital area, and were reconstructed using different modalities of reconstruction.
RESULTS:
Out of the 34 lesions, basal-cell carcinoma formed the majority (52.9%), mainly nodular type. Squamous-cell lesions come next in frequency forming (23.5%). Baso-squamous (15%), other tumors (9%). The most presenting symptoms were: ulceration with or without infection (38.2%). Primary closure was done for (26.4%) of cases, same number was reconstructed by STSG. FTSGs formed (17.6%). Local flap used in (23.5%).
CONCLUSION:
In reconstructing periorbital defects; size of the defect, site and state of the surrounding tissues determine the mode of reconstruction. Flaps are superior to grafts in term of lower incidence of complications and aesthetic outcome, whereas grafts remain better to detect early recurrence.
 
 

Palmoplantar Keratoderma: A clinico-Epidemiological Study

Hayder Raouf Al-Hamamy; Maysaa Mohammed Mahdi

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 2, Pages 154-160
DOI: 10.52573/ipmj.2021.174610

BACKGROUND:
palmoplantar keratoderma (PPK) is an umbrella term for any form of persistent thickening of                     the epidermis at palmar and/or plantar surfaces, and includes hereditary and acquired conditions.  PPK can manifest clinically as diffuse, focal and punctate forms.
OBJECTIVE:
To study the frequency, clinical features and etiological correlation of hereditary and acquired PPK.
PATIENTS AND METHODS:
The study is observational, descriptive and cross-sectional. It was conducted at the Dermatology Center, Medical City, Baghdad Teaching Hospital, during the period from February 2019 to April 2020 patients with hereditary and acquired PPK were included in this study. Detailed history, clinical examinations and investigations when appropriate were done to reach the diagnosis.
RESULTS:
Two hundred and eighty patients with PPK were enrolled in this study; 138 (49.3%) were males and 142 (50.7%) were females. Patients were divided into 2 groups; group A (hereditary PPK) included 22 patients (8%) with mean±SD age of 17.63±13.46 years. Group B (acquired PPK) included 258 patients (92%) with mean ±SD age of 31± 20.43 years. Both palms and soles were more commonly affected than palms or soles alone. The most common morphological type was focal (51%) followed by diffuse in (47%). The most common diagnosis in group A was ichthyosis (7 patients, 31.81%), while the most common cause in group B was psoriasis (116 patients, 44.96%). Itching was the predominant symptom in both groups. PPK was seen among housewives, students and manual workers. Family history was positive in 12 (54.55%) patients in group A and 82 (32%) patients in group B.
CONCLUSION:
PPK is frequently encountered among Iraqi patients. Psoriasis was found to be the most common cause. Clinically the most common type was focal. Itching was the most common reported symptom.
 

Factors that Necessitate Early Surgical Intervention in Patients with Enterocutaneous Fistula

Zeinab Abdulrahman Yahya; Haider Abdul Hussein Ahmed; Haider Salih Sultan

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 2, Pages 161-165
DOI: 10.52573/ipmj.2021.174624

BACKGROUND:
Most enterocutaneous fistulas are postoperative in origin. Sepsis, malnutrition, and hydroelectrolytic deficit are still the most important complications to which patients with enterocutaneous fistulas are exposed. Knowledge of prognostic factors related to specific outcomes is essential for therapeutic decision making processes.
OBJECTIVE:
A study of enterocutaneous fistula characteristics in terms of etiology, classification (Types), management with special consideration on risk factors necessating early intervention rather than delayed.
PATIENTS AND METHODS:
This study was conducted in the General Surgical department in Al-Imamain Al Kadhimain Medical City at Baghdad, Iraq from March 2018 to August 2020 .Fifty patients with enterocutaneous fistula were included in the study . Assessment of fistula site, output, and associated sepsis was done with focusing on the factors that require surgical intervention.
RESULTS:
50 patient were included in this study, 35 male (70%) and 15 female (30%) mean age was 45±12.4 yrs., Mean BMI was 30.5±4.2.  20 (40%) of the patients had fistula in the jejunum, while 25 (50%) in the ileum and the other 5 (10%) had colonic fistulas. 29 (58%) of patients had high output fistula, while 21 (42%) had low output fistula. Sepsis was present in 21 patients (42%). 12 out of 20 (60%) of patients with jujenal fistula needed surgical intervention, also 15 out of 29 (51.7%) of patients with high output fistula needed surgical intervention, while of the 21 patients who developed sepsis, 14 (66.6%) failed to heal without surgery.
CONCLUSION:
High output fistulas, fistulas associated with sepsis, fistulas of the jujenum required mostly surgical management and had high morbidity.

Shaving the Surgical Site and Infection in Lumbar Spine Surgery

Mazin S. Mohammed Jawad

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 2, Pages 166-170
DOI: 10.52573/ipmj.2021.174625

BACKGROUND:
Spine surgeons ordinarily shave the skin of the surgery locality before operation start. Nevertheless,  data from some surgical series proposes that preoperative shaving may enhance the post-surgical infection incidence.
OBJECTIVE:
To conclude whether shaving the surgical site before lumbar spine surgery induces infection in                     the post-operative period and whether presurgical shaving is compulsory.
METHODS:
A prospective cohort study had conducted over two years at the Department of neurosurgery, Medical City, Baghdad, Iraq, starting from July 2018. A total of 186 patients scheduled to undergo spinal   surgery were randomly allocated into 2 groups: those in whom the site of operation was shaved immediately before surgery (shaved group; 90 patients) and the patients in whom presurgical shaving was not performed (unshaved group; 93 patients). The mean duration of anesthesia and the infection rates in both groups were recorded and compared.
RESULTS:
The span of anesthesia did not deviate in the two assemblies (P > .05). Postoperative infection occurred in 9 patients in blade shaved group, 4 of them underwent Lumbar disc surgery (P <  .01).
CONCLUSION: 
The shaving of the incision site immediately before lumbar spinal surgery using blade may increase              the rate of post-operative infection.
 

Evaluation of Noninvasive Biomarkers in Staging of Hepatitis B-Related Fibrosis

Rasha Fawzi Salih; Hedef Elyasin; Raghad Jawad Al-Akayshee

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 2, Pages 171-176
DOI: 10.52573/ipmj.2021.174627

BACKGROUND:
Infection with hepatitis B virus (HBV) is a public health problem worldwide; it is the main cause of fibrosis, cirrhosis and hepatocellular carcinoma (HCC).  Early detection of significant fibrosis is essential for reaching antiviral therapy decisions. Considering the limitations of liver biopsy, noninvasive methods to identify significant fibrosis in chronically HBV infected patients are needed in clinical practice.
OBJECTIVE:
To evaluate the performance of aspartate aminotransferase (AST) to platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4) as simple noninvasive markers for staging of liver fibrosis in chronic hepatitis B in comparison with liver biopsy and to compare between the diagnostic performance of APRI and FIB-4 in staging of liver fibrosis.
PATIENTS AND METHODS:
A combined retrospective (38 case) and prospective (2 cases) study of the records of 40 patients with chronic hepatitis B (CHB) who attended the Gastroenterology and Hepatology Teaching Hospital in Baghdad during the period from (January 2016 - July 2019). All patients had a percutaneous liver biopsy for staging of liver fibrosis. The cases were divided into two groups, non significant fibrosis and significant liver fibrosis, according to histopathology stage of fibrosis.
Serum AST, alanine aminotransferase (ALT) levels and platelet counts were obtained from the results of blood samples taken on the same day of liver biopsy. Calculation of APRI and FIB4 indices was done for each pateint of the study .
RESULTS:
 the diagnostic performance of both indices in significant and non significant fibrosis was determined by Area Under Receiver Operating Curve (AUROC) .The value of AUROC for APRI index  was 0.992, ,P=0.0001,  specificity 100%, sensitivity 95.8% at cut-off value  0.41 and the value of AUROC for FIB4 index  was 0.997, P=0.0001, specificity  100%, sensitivity 95.7% at cut value  0.73.
CONCLUSION:
Both indices APRI and FIB-4 show good performance with high sensitivity and specificity as simple noninvasive markers for staging of liver fibrosis in CHB.
 
 

Which Is Better? Guy’s Versus S.T.O.N.E. Nephrolithometry Scoring Systems in Predicting the Outcomes of Ultrasonic Guided Percutaneous Nephrolithotomy (PCNL)

Hassan Majeed Abd-Alhassan; Ula Mohammed Al-Kawaz

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 2, Pages 177-183
DOI: 10.52573/ipmj.2021.174628

BACKGROUND:
Stone disease of the renal system is a challenging problem in urologic practice particularly in our area because of the large stone burden and recurrence. Scoring systems are beneficial to counsel the patients about the success and complication rates before surgery.
OBJECTIVE:
To compare two widely used scoring systems, namely Guy's and S.T.O.N.E. nephrolithometry scores in predicting the outcomes of ultrasound-guided PCNL.
MATERIALS AND METHODS:
In this prospective study, a total of 50 patients underwent PCNL in Al-Imamein Kadhimein Medical City from 1st of October 2018 to 1stof August 2019 and were enrolled. Guy's and S.T.O.N.E. scores were based on non-enhanced CT scan of abdomen and pelvis. Complications were graded using the Clavien-Dindo classification system. Ultrasound was used to guide PCNL in all cases.
RESULTS:
In our study the median age, body mass index (BMI) and stone size were 34.5 years, 31.4 kg/m2 and 765 mm2, respectively. The overall stone-free status was 82%. All complications were grades I-II (60%). The average operative time was 150 minutes. The stone-free status and complications rate were significantly associated with Guy’s score (P < 0.001, P < 0.001) and S.T.O.N.E. score (P < 0.001, P < 0.001), respectively. Moreover, there was a significant positive correlation between Guy's and S.T.O.N.E scores with length of hospital stay (r = 0.277, p < 0.001; r = 0.544, p < 0.001), operative time(r = 0.449, p = 0.001; r = 0.573, p < 0.001) and need for blood transfusion (r = 0.573, p < 0.001; r = 0.568, p < 0.001) respectively. In addition, both Guy's and S.T.O.N.E systems were significantly predictive of stone-free status, need for blood transfusion, operative time and length of hospital stay. The receiver operating characteristic (ROC) showed no significant difference in area under the Guy's and STONE curve (AUC = 0.877 vs. 0.821; p = 0.51).
CONCLUSION:
Both Guy’s and S.T.O.N.E. scoring systems showed a comparable efficacy in predicting the outcomes of  PCNL such as stone-free status, necessity for blood transfusion, operative time and length of hospital stay.

Allergic Fungal Rhinosinusitis in Patients with Nasal Polyposis

Sazan Rostem Azadeen; Mohammed D. Ahmed

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 2, Pages 184-189
DOI: 10.52573/ipmj.2021.174629

BACKGROUND:
Nasal polyps are considered to be the end results of a chronic inflammatory process in the sinonasal mucosa which are commonly seen in our routine ENT practice. Allergic fungal rhinosinusitis may be present with unilateral or bilateral polyps, it is important to be aware of the prevalence of allergic fungal rhinosinusitis in patients with nasal polyps.
OBJECTIVE:
To determine the frequency of allergic fungal rhinosinusitis among patients having nasal polyposis. 
METHODS:
This is a descriptive cross-sectional study carried out in Department of Otolaryngology, Head and Neck Surgery, Ghazi Al-Hariri Hospital for surgical sub-specialties, during October 2018 to October 2019. A total of 55 patients (31 male, 24 female) with nasal polyposis for at least 3 months were enrolled. All patients were assessed by detailed history, examination, investigation including total Ig E titer, and Computed tomography of the nose and paranasal sinuses. These patients underwent endoscopic sinus surgery and the specimens were sent for histopathology for identification of fungus.
RESULTS:
The mean age was (32.9±12.4) years. Nasal obstruction (100%) was recorded, smell disturbance (86%) and nasal discharge (84%) were the commonest clinical presentation. Out of 55 patients, fungal elements were detected by histopathological study in 20(36%) of patients.
CONCLUSION:
Allergic fungal rhinosinusitis is significantly associated in patients with nasal polyposis.
 
 

Risk Factors and Clinicopathological Characteristics among Patients with Gastric Cancer in Oncology Teaching Hospital

Sherin Ali Hussein; Azher Sabeh Alzubaidi

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 2, Pages 190-195
DOI: 10.52573/ipmj.2021.174630

BACKGROUND:
Gastric cancer is a rare tumor and one of the leading causes of death worldwide, unfortunately most of patient present late. 
PATIENTS AND METHODS:
Case -control study conducted on patients affected with gastric cancer presented to oncology teaching hospital. Data regarding their family history of gastric cancer, smoking and blood group were collected for patients and for participants in Control group matching in respect to age, sex, number and geographical area.          
OBJECTIVE:
Assess the most important risk factors of gastric cancer  Assess clinicpathologic and their histological subtypes
RESULT:
77 patients with stomach cancer and 77 control participants their age range from 27 up to 74. Mean age (SD) of (54 ± 13.8 and 55.1 ±13 years) respectively. A significant association between smoking and gastric cancer (62.3%) of index group compared to (39%) in control   (p=0.002). also a significant association between First degree family history of stomach cancer was found in 11.7% in index group compared to (0%) in control (p= 0.001). The most frequent site for cancer was antrum 31.1% of cases. diffuse subtype of adenocarcinoma(50.6%). Stage IV formed the majority of patients (62.4%).
CONCLUSION:
Smoking and family history of first degree relative have strong association with gastric cancer. Majority of patients present at advanced stage 4 and diffuse type of adenocarcinoma. Antrum is the most affected part of the stomach.
 

Prevalence of Incomplete Vaccination Andassociated Factors in Children (2-5 Years) Attending Primary Health Care Centers in Diyala, 2019

Shaimaa Hussein Ali; Yousif Abdul Raheem

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 2, Pages 196-202
DOI: 10.52573/ipmj.2021.174631

BACKGROUND: 
Childhood immunization is one of the most cost-effective interventions in health care delivery.
OBJECTIVE:
Prevalence of vaccinated, partially vaccinated and unvaccinated  children  (2-5 years) attending Primary Health Care and the possible risk factors  for incomplete vaccination among them and to assess mothers’ knowledge about vaccination and finding out if it was associated with incomplete vaccination.
PATIENTS AND METHODS:
A cross-sectional survey carried out in three primary health care centers in Khanaqin district/ Diyala Province/ Iraq from the first of March until the end of June /2019. The immunization status of children was obtained from mothers and verified by their vaccination cards and records of vaccinations in the primary health care centers and other information obtained from mothers.
RESULTS:
This study included 242 children with their mothers. Vaccination status; 64.05% of children were vaccinated, 33.47% were partially vaccinated and 2.48% were unvaccinated, and incomplete vaccination was associated with low/poor economic status of the family, children living with one parent or others, long waiting times and poor  knowledge  of mothers.
CONCLUSION: 
Immunization coverage rate fell short for the World Health Organization recommended rate of at least 90%.
 

Statistical Analysis of Tympanometry, Otoendoscopy and Myringotomy of Pediatrics Otitis Media with Effusion

Sumaya Imad Oleiwi; Naser Edan Naser

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 2, Pages 203-212
DOI: 10.52573/ipmj.2021.174632

BACKGROUND:
Otitis media with effusion (OME) is a common treatable cause of hearing impairment in children. Although it is a self-limiting condition in the majority of cases, OME may become chronic to the extent that it affects child education and quality of life. Thus, early detection of this condition is a paramount issue for its treatment and improve the hearing of the effected child.
OBJECTIVE:
This study is aimed to evaluate the efficiency of tympanometry in the detection of fluid in the middle ear in comparison with myringotomy in children with OME as well as to evaluate the efficiency of otoendoscopy and to analyze the clinical data and predisposing factors for OME.
PATIENTS AND METHODS:
A total of 80 patients (160 ears) of children, with clinical features indicating OME were enrolled in this prospective study during the period from  April 2018 to the end of March  2019.  Patients were subjected to clinical assessment, and the middle ear examined with otoendoscopy and with tympanometry.  The presence or absence of OME was confirmed by myringotomy. The sensitivity, specificity of otoendoscopy, and tympanometry were calculated.
RESULTS:
The fluid was aspirated from the middle ear during myringotomy from 114 ears (71.15%) and the aspirate was serous in 54 ears (47.37%), mucoid in 60 ears (52.63%). Type B tympanometry was recorded in 108 ears with the rest 6 ears had other types of tympanometry (A or C). Thus, the sensitivity, specificity, and accuracy of tympanometry were 94.74%, 65.22%, and 86.25%, respectively. On the other hand, 98 ears with OME were detected depending on the changes in the middle ear observed by otoendoscopy. Therefore, the sensitivity, specificity, and accuracy of otoendoscopy were 85.96%, 60.87%, and 62.5% respectively.
CONCLUSION:
Both tympanometry and otoendoscopy, in general, have a high sensitivity and low specificity in the detection of OME, with the priority to tympanometry over otoendoscopy. Therefore, the definitive diagnosis of OME should be confirmed during myringotomy, and examined by tympanometry to identify the type of curve result and to assess the middle ear pressure.
 

Prevalence and Severity of Stress among Under Graduate Medical Students after Application of Integrated Curriculum in University of Kufa. A Comparative Cross Sectional Study

Ghufran Bayan Abd-Ali; Salam Jasim Mohammed

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 2, Pages 213-225
DOI: 10.52573/ipmj.2021.174633

BACKGROUND:
Stress is a process by which the environmental demands are more than the adaptive capability of                   a human leading to biological and psychological changes that make the individuals at risk for disorders. Medical students experience elevated stress level throughout their medical school life, and more liable to psychological distress and mental health problems than non-medical students, so that, stressors that confront medical students should be identified early for enabling interventions before development of more serious complications like burnout and depression.
OBJECTIVE:
Measure stress level among medical students of Kufa and Jabir ibn Hayyan medical colleges by using Kessler10 Psychological Distress scale (K10) questionnaire,Compare the levels of stress with different sociodemographic characters and Compare the level of stress among different college stages.
SUBJECTS AND METHOD:
Across sectional study was conducted on under graduate medical students in Kufa and Jabir ibn Hayyan medical colleges at Al Najaf city/Iraq. Medical students from all stages had been recruited for the study and selected by a systematic random sampling technique. We used a self-administered, pre-tested questionnaire form.
RESULTS:
A total of 842 students included in the study, the prevalence of stress is 84.56% expressed some degree of stress ranging between mild stress 21.5%, moderate 28.5% and severe 34.56%.
CONCLUSION:
High stress level among medical students in Kufa Medical College and Jabir ibn Hayyan Medical College. Female gender, living at home, delay or missing academic years were factors associated with stress.
 

Rate of Prescribing Statins for Primary Prevention of Atherosclerotic Cardiovascular Disease in Diabetic Patients

Wathiq Kh. Mohammed; Sarah J. Alwash

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 2, Pages 226-235
DOI: 10.52573/ipmj.2021.174634

BACKGROUND:
Cardiovascular diseases are the major contributor to morbidity and mortality in patients with diabetes. Dyslipidemia, a com­mon condition coexisting with type 2 diabetes, is a major cause of atherosclerosis and a risk factor for cardiovascular disease. Statin therapy plays an important role in the primary and secondary prevention of cardiovascular events in populations at elevated risk.
OBJECTIVE:
This study aims to examine the extent to which statins are used for primary prevention of atherosclerotic cardiovascular disease by diabetic patients, to identify gaps between guidelines and current daily practice, and to offer rational approach toward enhancing guideline adherence and improving quality of care.
MATERIALS AND METHOD:
A cross sectional study conducted from April 2019 to May 2020. Participants took part in a face to face personal interview in the outpatient clinic of Alsuwairah General Hospital. Patients included were those with type 1 or type 2 diabetes mellitus, aged 40-75 years, without a history of atherosclerotic cardiovascular disease.
RESULTS:
We included a total of 236 patients with diabetes mellitus, more than 2 thirds of them were ≥50 years of age. The majority (64.8%) were females. Patients with type 2 diabetes constitute 97.5% of                     the sample. Eighty six percent of patients have had diabetes for ≥2 years. Only 35 participants (14.8%) were on statin therapy. Among statin users, 62.9% have been doing so for less than 2 years. Use of statins was slightly more frequent in women than in men and it increases consistently with age; however, statistically non-significant. There was a significant association between statin prescription and increased duration of diabetes (P value 0.010).
CONCLUSION:
Statin prescription for primary prevention of ASCVD in diabetic patients is suboptimal. This finding underscores a major gap in addressing public health and cardiovascular disease burden in                              a population considered to be at high risk, and highlights an urgent need for optimising statin therapy and global risk factor control in diabetic patients without a known atherosclerotic cardiovascular disease.
 

Effect of Chronic Use of Proton Pump Inhibitors on Bone Mineral Density

Qusay Jassam Shandookh; Khudair Albedri; Nada Naji Abdullateef

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 2, Pages 236-242
DOI: 10.52573/ipmj.2021.174635

BACKGROUND:
Proton pump inhibitors (PPIs) are widely used drugs for the treatment of many diseases. Prolonged use was believed to have an effect on bone mineral metabolism.
OBJECTIVE:
To investigate the effect of PPIs on bone mineral density and to identify risk factors affecting bone mineral density among users of PPIs.
PATIENTS AND METHODS:
A cross sectional study was conducted in Rheumatology Consultancy Clinic of Baghdad Teaching Hospital /Baghdad Medical City during the period from 1st of November, 2017 to 31st of October, 2018 on convenient sample of 100 patients were selected; first group was 50 PPI users and 50 PPI non-users. The bone mineral density of patients was assessed using dual energy x-ray absorptiometry (DXA) scan.
RESULTS:
A significant reduction in serum calcium, vitamin D and serum inorganic phosphorus levels of PPIs users with elevated level of alkaline phosphatase activity. All scores of DXA scan like T-scores L2-L4, Z-scores L2-L4 and total scores were significantly reduced among PPIs users in comparison to PPIs-non users (P<0.05).
CONCLUSION:
The proton pump inhibitors have a profound effect on bone mineral density and long term use of proton pump inhibitors is commonly related with osteoporosis and osteopenia development of lumbar spines.

The Relationship of Urocortin 2 with Insulin Resistance, Clinical, and Biochemical Hyperandrogenism in Women with Polycystic Ovary Syndrome

Alia Jasim Mohamad Ali; Najah Shaker Yassen

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 2, Pages 243-249
DOI: 10.52573/ipmj.2021.174636

BACKGROUND: 
Polycystic ovary syndrome is the most common endocrine and metabolic disorder in women. Urocotin-2 is thought to be involved in the pathophysiology of Polycystic ovary syndrome by paracrine and autocrine pathways.
OBJECTIVE:  
To assess the Urocortin-2 level in women with Polycystic ovary syndrome and to assess the relation of urocotin-2 with insulin resistance, clinical and biochemical hyperanderogenism.
PATIENTS AND METHOD: 
a case control study that involved; forty-five polycystic ovary patients according to Rotterdam criteria as a case group, and forty-five healthy women as a control group. Ferriman-Gallwey score was used to evaluate hirsutism, in addition to measurement of Body mass index and Waist/Hip ratio, levels of: Follicle stimulating hormone, luteinizing hormone, Prolactin, testosterone, insulin, fasting blood sugar, homeostatic model assessment of insulin resistance and urocotine-2 also assessed.      
RESULT:
urocotin-2 was significantly higher in Polycystic ovary syndrome compared to control women using Receiver Operating Characteristic Curve  analysis.
CONCLUSION:  
Urocortin-2 may have a role in the pathogenesis of Polycystic ovary syndrome for its correlation with testosterone, homeostatic model assessment of insulin resistance, serum insulin, and Body Mass Index, since there was higher levels than that of normal women.

Prognostic Significance of Plasma APRIL Level in Patients with Chronic Lymphocytic Leukemia

Haithem Ahmed AL-Rubaie; Zainab Mudheher Hasan

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 2, Pages 250-254
DOI: 10.52573/ipmj.2021.174637

BACKGROUND:
A proliferation-inducing ligand (APRIL) is a member of tumor necrosis factor family which plays an important role in B-cell development. It activates chronic lymphocytic leukemia (CLL) cells by reacting with its receptors, enhancing immune recognition, proliferation, and survival of the leukemia cells.
OBJECTIVE:
To assess the level of APRIL in newly diagnosed CLL patients in comparison with the control group and to correlate between the plasma APRIL level and hematological parameters and clinical Binet stages.
PATIENTS AND METHODS:
This case-control study was conducted on 40 adult newly diagnosed CLL patients with 40 healthy individuals served as controls.  Plasma APRIL levels were tested by ELISA.
RESULTS:
plasma APRIL level in CLL patients was significantly higher than those of healthy control group (P-value < 0.001). There were statistically insignificant correlations between APRIL level and hematological parameters. There was significant association between absence of splenomegaly and higher APRIL level (P=0.011), while no significant statistical differences were found with lymphadenopathyand hepatomegaly. There was no significant association between plasma APRIL level and Binet stages (P=0.180).
CONCLUSION:
There were insignificant correlations between APRIL level and hematological parameters and Binet stage. APRIL level was not found to be a useful marker to predict prognosis in patients with CLL.
 

Expression of p53 in Pancreatic Ductal Adenocarcinoma

Estabraq Ali Abdul Ameer; Kifah Hamdan Abdul Ghafour

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 2, Pages 255-259
DOI: 10.52573/ipmj.2021.174638

BACKGROUND:
Pancreatic adenocarcinoma is one of the major causes of cancer death in the world. Alterations in the p53 tumor suppressor gene stand out as the most common alteration in many cancers including 75% of pancreas cancer. Pancreatic adenocarcinoma in which p53 is mutated carry a poor prognosis, because of late-stage detection, the presence of vascular invasion, metastases, and ineffective treatment options.
OBJECTIVE:
To evaluate the expression of P53 in pancreatic ductal adenocarcinoma immunohistochemically and clinicopathologic correlation with grade and stage.
MATERIALS AND METHODS:
This is a retrospective study of 40 pancreatic biopsies (formalin fixed, paraffin embedded) were collected from archived materials from GIT and Hepatology teaching hospital in Baghdad medical city (from December 2018 to October 2019). Study group include 40 cases of Pancreatic adenocarcinoma, 20 were EUS guided core needle biopsy, and the other 20 were pancreatic tissue from patients sustained whipple surgery.
Two sections of 5μm thickness were taken from each block, the first was stained with H&E,                          the second was stained Immunohistochemical for P53.
RESULTS:
Forty cases are studied and show +ve staining for P53 (100%), 24(60.0%) were males and 16(40.0%) were females, The age of patients ranged from 35 to 70  years with mean ± SD of 56.28±10.2 years. Seventeen were score 4+, thirteen were score 3+, six were score 2+ and four were score 1+.
Tumors with low grade were 20 (50.0%) cases, moderate grade were 15 (37.5%) cases, and high grade were 5 (12.5%) cases.
20 cases were staged from patients underwent whipple surgery.
Tumors with stage T1 N0 Mx were 2(10%), stage T2 N0 Mx were 5(25%), stage T2 N1 Mx were 4(20%), stage T3 N0 Mx were 8(40%), and stage T3 N1 Mx were 1(5%)
CONCLUSION:
There was statistical correlation between P53 expression and tumor grade but not with stage.
 

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YASIR Mohammed Hasan HAMANDI

Iraqi Postgraduate Medical Journal, In Press
DOI: 10.52573/ipmj.2021.131393.1009

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Penetrating Injuries of the Neck

Musaed L. H. Albadri; Uday A. Albeiruty; Ahmed Abass Mossa

Iraqi Postgraduate Medical Journal, 2009, Volume 8, Issue 3, Pages 196-203

BACKGROUND:
Penetrating injuries of the neck are potentially dangerous, causing high rates of morbidity and mortality due to their association with sever bleeding and serious damage to the vital structures in the cervical region.
OBJECTIVE:
To know the incidence and distribution of these injuries on the anatomical zones of the neck and the damage of the vital structures in the cervical region and their early surgical management.
METHODS:
A prospective study on 52 patients of both civilian and military personnel with penetrating neck injuries attended the casualty department at Alyarmouk hospital over a period of 7 months from June-December 2006.
RESULTS:
Fifty patients (96.15%) were males. Twenty four patients (46.15%) were in their third decade. Twenty six patients (50%) were injured by shrapnel of explosives, 23 patients (44.21%) by bullets & 3 patients (5.77%) by unknown objects. Thirty six patients (69.23%) were injured at zone 2, 11 patients (21.15%) at zone 3 & 5 patients (9.62%) at zone 1. Twenty nine patients (55.77%) had laryngeal & tracheal injuries. Thirteen patients (25%) had pharyngeal & esophageal injuries. Four patients (7.7%) had recurrent laryngeal nerve injury. Nine patients (17.3%) had vascular injuries 6 arterial & 3 venous. One patient had vertebral & spinal cord injury. Forty one patients (78.86%) had tracheostomy operations, & 13, (25%) had neck exploration.Six patients (11.54%) treated conservatively. Nine patients (17.3%) have died.
CONCLUSION:
Male patients at their middle age were the predominant victims either by shrapnel or by bullets. Zone 2 was most commonly affected followed by zone 3 & zone 1. Laryngo – tracheal, pharyngo – esophageal & vascular structures were mostly involved. Tracheostomy & neck exploration were the main urgent operations performed for them. The high mortality reflected the serious nature of these injuries.

Peripapillary Retinal Nerve Fiber Layer Thickness by Optical Coherence Tomography in Patients with Unilateral Amblyopia

Noor Adnan Laylani; Salah Alasady

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 1, Pages 91-98
DOI: 10.52573/ipmj.2021.167831

BACKGROUND:
Amblyopia is a common cause of unilateral visual defect, affecting patients with history of strabismus, refractive errors, and those who had visual deprivation in the critical period of visual development.  Amblyopia may have an effect on various levels of the visual pathway. Cells atrophy in the lateral geniculate nucleus that receives information from the affected eye, and a shift in the dominance pattern in the visual cortex have been reported. Retinal involvement in amblyopia is controversial.
SUBJECTS AND METHODS:
This is a cross sectional study carried out in Al-Shaheed Ghazi al-Hareery Teaching Hospital in Medical City at Baghdad, Iraq .Forty-two patients with unilateral amblyopia were selected, 23 males and 19 females with age range of 12-40(mean age of 25.33 years) all of these patients had one amblyopic eye and the other eye normal.  OCT scan was done for both eyes of each patient and the RNFLT measured after complete ophthalmological examination ( VA, refraction, slit lamp, and funduscopic examination
RESULTS:
It has been noticed that the mean of NFLT in normal eyes was higher than that of amblyopic eyes (108.88 versus 105.05) but this difference was statistically not significant (P=0.074).
CONCLUSION:
OCT is a sensitive way to estimate RNFLT, we concluded that there is no statistically significant difference in NFLT between the amblyopic, compared to the normal eyes. Also NFLT seems not affected by: type of amblyopia, age of patients and also the severity of amblyopia as all these factors didn’t reach statistical significant.
 

Surgical Correction of Caudal Septal Dislocation in Septoplasty and Septorhinoplasty

Emanuel Sargon Emanuel; Hiwa Asaad Abdulkareem

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 1, Pages 17-26
DOI: 10.52573/ipmj.2021.167821

BACKGROUND:
Several techniques and maneuvers for surgical correction of caudal septal dislocation have been
mentioned in the literature nevertheless the subject has still bearing different opinions and preferences
on which approach to be applied.
AIM OF STUDY:
to assess different surgical approaches and techniques that are used in the management of caudal septal
dislocation.
PATIENTS AND METHOD:
A prospective, observational study was conducted on 50 patients from 10 January 2018 to August 2018
with age range from (18-39 years) who underwent nasal surgery (septoplasty, septorhinoplasty). The
study conducted in Center of Otolaryngology- Head and Neck surgery/ Sulaymaniyah Teaching
Hospital and Azmar private hospital. Preoperative assessment data were gathered & compared with
postoperative assessment data after 3-6 months follow up. The data was analyzed statistically using
SPSS version 25.
RESULTS:
patients included in the study were 64% males and 36% females, 22% went through septoplasty while
78% went through septorhinoplasty. For the techniques that used in surgical correction of the caudal
dislocation (wedge resection, batten graft and L-strut graft) the results were significant postoperatively
while for scoring technique the results were insignificant postoperatively .
CONCLUSION:
There are different techniques used in surgical correction of caudal septal dislocation with good results
and according to each patient. The use of L-strut graft technique whenever it needed especially in
severe deviation .

Efficacy of Etanercept Treatment in Iraqi Patients with Moderate to Severe Psoriasis

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 1, Pages 9-15

ABSTRACT:
BACKGROUND:
Etanercept is a tumor necrosis factor (TNF) α inhibitor that has been approved for the treatment
psoriasis.
OBJECTIVE:
Assessing the efficacy of etanercept therapy in Iraqi patients with moderate to severe psoriasis.
PATIENTS AND METHODS:
This study was a therapeutic interventional study at Medical City; center of dermatology and
venereology (Baghdad, Iraq) from January 2017 till June 2018, with 53 patients, 31 (58.49%) males
and 22 (41.51%) females, with 51 patients having moderate to severe plaque psoriasis and 2 patients
with pustular psoriasis. All patients were given 50 mg subcutaneous injection of etanercept twice
weekly for 3 months, followed by single injection of etanercept weekly for the next 9 months.
Psoriasis area and severity index calculations were done every 3 months until 1year of treatment.
RESULTS:
The baseline PASI score changed from a mean ± standard deviation of 24.28 ± 14.56 to 1.62 ± 3.11
At the end of 12 months of treatment with a significant difference (P=0.001). Regarding the
reduction in the patients' PASI score: At 3 months of treatment, (71.4%) achieved PASI 50, (48.2%)
had PASI 75, and (5.35%) had PASI 90, at the 12th month of treatment (75.4%) reached PASI 90,
(86.79%) reached PASI 75, &(94.33%) had PASI 50. Side effects were mild and tolerable.
CONCLUSION:
Etanercept is an effective therapy in treating moderate to severe psoriasis with tolerable side effects.

Primary Repair of Unilateral Cleft Lip Nasal Deformity

Zakaria Y.Arajy; Ahmed A.M.Nawres

Iraqi Postgraduate Medical Journal, 2009, Volume 8, Issue 3, Pages 212-219

ABSTRACT:
BACKGROUND:
There is a growing attitude towards correcting the nasal deformity in conjunction with primary repair of cleft lip. Many studies had concluded that this repair will not affect the nasal cartilages growth; it usually reorients the deformed nasal cartilages into a near normal position, and will allow a better growth pattern.
OBJECTIVE:
This study was conducted to document the pattern of primary unilateral cleft lip nasal repair and to evaluate the medium term outcome.
METHODS:
A total of 33 babies with unilateral cleft lip deformities underwent simultaneous nasal correction with their lip closure, between March of 2004 and April of 2008.Through short nostril rim incision, alar suspension to the dorsal skin at the nasion and interdomal sutures were performed primarily. Alar transfixion stitches were used to maintain the new position of the suspended cartilages.
RESULTS:
The average follow up periods were 3 years (ranging from 1 – 5 years).The results were assessed by 4 parameters: Nostril asymmetry, nasal dome projection, alar buckling deformity, and flaring deformity of the alar base. Eleven patients had good results, 16 patients had acceptable results, and 6 patients had poor results.
CONCLUSION:
Alar suspension is a relatively simple effective procedure for the primary correction of cleft lip nasal deformity. Short nostril rim incision can be relied on to access the alar dome and facilitate insertion of suspension sutures. Weather it interferes with nasal growth or not, it is necessary to have a long period of follow up to answer this question.

Indications of IV Fluids in Medical City

Bassam Hameed Al-Jarrah; Zeena Muthafer Al-Nema

Iraqi Postgraduate Medical Journal, 2009, Volume 8, Issue 4, Pages 380-383

ABSTRACT:
BACKGROUND:
Intravenous (IV) fluids are the most commonly used drugs in the inpatient wards and the emergency units. They are not usually dealt with as a medication, and are frequently prescribed even by junior doctors and even the nursing staff. Serious side effects and complication may arise from this practice.
OBJECTIVES:
To evaluate the indications of IV fluid prescription in the Medical City.
METHODS:
A cross-sectional study of the use of IV fluids in surgical wards and emergency units in the Medical city in Baghdad during a period of ten weeks. Two hundreds and ninety three patients were collected. Studying the indication for prescription, monitoring of the patients, combinations and role of pharmacists.
RESULTS:
Most common IV fluid used was glucose water (28.3%). The most common indication in the emergency unit was vomiting and diarrhea (19.1%). While in the inpatient wards, routine postoperative hydration was the commonest indication for IV fluid (13.6%). Unnecessary or wrong uses were recorded in number of cases (36.8). Deficient monitoring of patients on IV fluids was noticed in most cases (95%). No apparent role for the clinical pharmacist in this respect was reported.
CONCLUSION:
There was a quiet high ratio of unnecessary or wrong use of IV fluids and also a high ratio of low or deficient monitoring of patients that necessitate more attention by the specialists and more supervision to the practice of IV fluid prescription.

The Validity of Beck Depression Inventory –Short Version in Depressed Patients Diagnosed According to ICD10

Abdul-Rasoul Al-Yasiri; Yasir S. AbdKarkosh

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 4, Pages 603-613

ABSTRACT:
BACKGROUND :
Beck Depression Inventory (often abbreviated asBDI) is an instrument to measure the severity and depth ofdepression symptoms. BDI was developed in a novel way for its time by collating patients' verbatim descriptions of their symptoms and using these to construct a scale which could reflect the intensity or severity of a givensymptom.
OBJECTIVE:
To measure the validity of Beck depression Inventory short version using ICD 10 criteria for major depression as a gold standard
METHOD AND PATIENTS :
The study was carried out in IbnRushd and Baghdad Teaching Hospitals. The sample was selected purposely among patients diagnosed to have major depressive disorder according to the ICD- 10 criteria for major depressive disorder. For each patient a clinical interview was done using the ICD 10 criteria for major depressive episode after being given beck depression inventory – short version in a paper
RESULTS :
The overall result indicates ‘fair to good’ agreement between both Beck and ICD-10 suggesting that Beck Depression Inventory is valid in assessing the degree of severity of depression
CONCLUSION:
Beck Depression Inventory short version (13 item ) is adequate in assessing the severity of depression in patients with ICD-10 diagnosis of depression

Topical Nitroglycerin in Treatment of Plantar Fasciitis

Qais A. Adi; Sami Salman; JewadIbraheem Resheed

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 0, Pages 751-759

ABSTRACT:
BACKGROUND:
Planter fasciitis is the most common cause of inferior heel pain in adults; it is a degenerative process of the planter fascia at its origin on the calcaneus. Many treatment modalities are used including NSAIDs, orthotics, local steroid injection, extracorporeal shock wave therapy and others. Recent studies have shown that topical nitroglycerin has a healing and analgesic effect in other tendinopathies like: tennis elbow, suraspinatus tendinitis and Achilles tendinitis.
OBJECTIVE:
We want to establish the role of topical nitroglycerin in treatment of plantar fasciitis.
PATIENTS AND METHODS:
A double blind placebo controlled study included 54 patients, after taking medical history they were subjected to physical examination. Nitroderm TTSR 5 patches were used in the treatment group, similar placebo patches were used in the placebo group. The severity of the symptoms was quantified initially for each patient using the visual analogue scale (VAS). By using SPSS (statistical package for social sciences) software for windows, data of all patients were entered and analyzed with appropriate statistical tests according to the types and distribution of variables (Chi square test and Students’t test).
RESULTS:
Response to topical treatment was (76.7%) in the GTN group most of them with moderate and good response compared to (41.7%) in placebo group most of them with mild response.
CONCLUSION:
It was clear that NGT patches were superior to placebo patches in improving the symptoms of patients, so that topical NGT can enhance healing of planter fasciitis. This may be a useful alternative to the current modalities of treatment used for this common

Inhibitory Effect of Parsley (Petroselinum Crispum) Juice Against Some Urinary Pathogens in Vitro

Khalida Kareem Al-Kareemi

Iraqi Postgraduate Medical Journal, 2012, Volume 11, Issue 3, Pages 336-342

ABSTRACT:
BACKGROUND:
Information's on the potency of many medical plants against microorganisms are scanty, and in the current wave of antimicrobial resistance against chemotherapeutic drugs, there is a need to search for plants that could be resistance-free and affordable.
OBJECTIVE:
The objective of this study was to investigate the antibacterial effects of Parsley (Petroselinum crispum) against uro-pathogens and to compare with the effect of some drugs used for the treatment of urinary tract infection caused by different Gram positive and Gram negative bacteria.
MATERIALS & METHODS:
A total of thirty eight Gram positive and Gram negative bacteria(Escherichia coli ,Proteus sp.,Enterobacter spp.,Pseudomonas aeruginosa, Klebsiella sp. , Staphylococcus aureus) isolated from urine samples of different child patients between first of June 2011 to first of July 2011 admitted to Children Mel fare Teaching Hospital in Baghdad were tested against different dilutions of Parsley (100%,1:1,1:5,1:10:1:15,1:20) to examine the inhibitory activity in vitro ,in addition antibiotic susceptibility test was done.
RESULTS:
All isolates showed sensitivity to concentrated parsley 100% concentration except Pseudomonas aeruginosa isolates, the highest effect observed on Proteus sp. and Staphylococcus aureus isolates, while inhibitory effect stopped after 1:1 dilution against all isolates, while in antibiotics therapy (29) isolates were resistant to Co-Trimoxazole and Cefotaxime and (30)isolates showed resistance to Tri-imetheprim+clavulanic acid.
CONCLUSION:
It seems that Parsley has potent antibacterial activity against some uropathogens in vitro.

Anaesthesia for Anal Dilatation using Propofol Versus Sevoflurane in Peadiatric Patients

Sanaa Fareed Qassim

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 1, Pages 102-106

ABSTRUCT:
BACKGROUND:
Anal dilatation is streaching of the anal incision gently with special dilators as a part of follow up after posterior sagittal anorectoplasty (PSARP) and pull through operations in peadiatric patients . Sevoflurane has many of the features of an ideal volatile anaesthetic agent with rapid induction which make it particularly useful in children . Propofol is the most desirable intravenous agent in outpatient anaesthesia because of rapid induction and recovery.
OBJECTIVE:
Is to compare propofol with sevoflurane as a single anaesthetic agent for anal dilatation in peadiatric patients that produce more rapid turn over of cases.
Patients and methods: 50 peadiatric patients who had anal dilatation with Hegar dilators allocated into 2 groups according to the anaesthetic agent used sevoflurane (S) or propofol(P) . The variables measured are the induction time(T1) and the time needed to achieve good relaxation(T2).
RESULTS:
T1 was shorter in group P(mean 60 sec)than group S(mean 86 sec)p value0,000(highly significant),T2also shorter in group P(mean 99.5 sec)than group S(mean 121.3 sec)p value0.012(significant) so both variables measured were shorter in case of using propofol with statistical significancy.
CONCLUSION:
Propofol produces more rapid turn over of short cases than sevoflurane and with no risk of malignant hyperthermia.
.

Publisher: The Iraqi Board for Medical Specializations

Email:  iraqipostgradmedjrnl@gmail.com

Editor-in-chief: Prof. Yasir M.H. Hamandi

Managing Editor: prof. Yasir M.H. Hamandi

Print ISSN: 1608-8360

Online ISSN: 2706-9893

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