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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The Evaluation of Targeting Retrogassarian versus Root Entry Zone in Gamma Knife Radiosurgery for Trigeminal Neuralgia

Ahmed Maan Taha; Abd Al-Ameer Jasim Al-Khafaji

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 3, Pages 263-268
DOI: 10.52573/ipmj.2021.175758

BACKGROUND: 
The advantage of gamma knife radiosurgery is lack of major side effects. It is preferred over microvascular decompression in elderly patients who are poor candidates for general anesthesia or those unwilling to undergo an open neurosurgical procedure.
PATIENTS AND METHODS:
This is a comparative study conducted at Dr. Saad Alwitry Neuroscience Hospital, Gamma Knife Department. 20 patients were included in the study, divided into 2 groups in which 10 are treated with dorsal root entry zone DREZ and the another 10 treated with retrogasserian RG, starting from July 2019 to March 2020. The new target (retrogasserian zone) was targeted for the first time in Iraq, were compared to those patients treated with root entry zone as their target. The follow up time was 4 months. The DREZ target received 80 Gray in 50% isodose, while the RG target received 90 Gray in 50% isodose.
RESULTS:
The mean age is 54.3 years for DREZ and 59 years for RG, most of the treated patients are female with male to female ratio 2.2-1, pain intensity was assessed by BNI scale pre and post Gamma Knife that targeted both DREZ and RG, pain intensity with DREZ, mean improvement is 3.2. Pain is significantly improved.
Pain intensity with RG, mean improvement is 3.2, pain is significantly improved. Pain frequency was less in postGK for both the DREZ & RG with mild superiority in the RG.
CONCLUSION:
GK is considered as being both a safe and effective procedure to treat medically resistant trigeminal neuralgia. GK is the least invasive procedure in treating medically resistant trigeminal neuralgia MRTN, with the least and less serious complications. GK targets (DREZ & RG) both can achieve a good pain control with decrease in medication and improving overall life quality. RG target shows slight further reduction in pain frequency than DREZ.
 

Role of Ultrasound Guided Core Needle Biopsy in Diagnosis of Pediatric Renal and suprarenal Tumors

Yasir Qahtan Noman Alkhatib; Ahmed. A. Khalaf

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 3, Pages 269-273
DOI: 10.52573/ipmj.2021.175759

BACKGROUND:
Core Needle Biopsy involves introducing large hollow needle through the skin to collect a tissue for investigation. It’s become a well-established method as the standard sampling procedure. It’s              a relatively safe, minimal invasive procedure with diagnostic accuracy comparable to open surgical biopsy.
AIM OF STUDY:
Assess the accuracy and safety of core needle biopsy in diagnosis of renal and suprarenal tumors.
METHODS:
This is a prospective interventional study. Core needle biopsy was done for 42 patients; 38 patients were included. Biopsy done by activation of needle biopsy device that introduced into the tumor under ultrasound guidance and collection of sample.
RESULTS:
Wilms tumor was positive in 71.1 % (n=27), 23.6 % (n=9) were neuroblastoma and 5.3 % (n=2) were non-conclusive. Only 18.4% (n=7) developed hematuria while intra-abdominal bleeding was not observed in any patient. For Wilms tumor the sensitivity is 93.1 % and the specificity is 100 % and diagnostic accuracy is 94.7 %. The sensitivity, specificity and diagnostic accuracy for neuroblastoma are 100 %.
CONCLUSION:
It is a simple, safe and efficient method for diagnosing renal and suprarenal tumors, complications occur infrequent, and most are easily treated or self-limiting.
 

A Comparative Study of Single Dose versus Multiple Dose Prophylactic Ceftriaxone in Laparoscopic Cholecystectomy

Sanaa Nasser Husein; Ali Abbas Al-Gharawi; Mowafaq Mohammad Ghareeb

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 3, Pages 274-279
DOI: 10.52573/ipmj.1970.175760

BACKGROUND:
Although laparoscopic cholecystectomy became the gold standard for the treatment of gallstone disease, there is some risk of surgical site infection that required prophylactic antibiotic. Prophylaxis for low risk patients is still controversial as well as whether single or multiple doses is needed.
AIM OF STUDY:
Compare between single vs. multiple dose of antibiotic prophylaxis in laparoscopic cholecystectomy in terms of post-operative infection and cost.
METHODS:
A prospective study conducted at Baghdad Teaching Hospital, from January 2017 to March 2018. 200 patients admitted for elective laparoscopic cholecystectomy randomly divided in two equal groups: single dose (SD) group was given ceftriaxone (2gm) intravenously at induction of anesthesia, and multiple doses (MD) group was given ceftriaxone (2gm) intravenously at induction of anesthesia followed by ceftriaxone (1gm) intravenously twice a day for two days postoperatively. Surgical site infection and treatment cost in two groups compared and analyzed.
 RESULTS:
 Postoperative infection rate was 1% in both groups; the difference was not significant (p=1).                 The cost was higher in MD group.
CONCLUSION:
Single dose prophylactic antibiotic administered at induction of anesthesia, is equally effective as multiple doses to prevent post-operative infection in low risk patients undergoing laparoscopic cholecystectomy and is cost effective.
 

Outcome of Frontline Therapy of Hodgkin’s Lymphoma Patients in Baghdad Hematology Centering the Medical City

Safa Mohammed Shaukat Mohammed Khalid; Mohammed Saleem Abbas

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 3, Pages 280-287
DOI: 10.52573/ipmj.2021.175761

BACKGROUND:
Hodgkin’s lymphoma is one of most curable lymphoid malignancy. Here we conducted in this study the outcome of frontline therapy in adult Hodgkin’s lymphoma patients.
AIM OF STUDY:  
1. To evaluate   the results of first line treatment with ABVD chemotherapy protocol in patients with Hodgkin’s lymphoma in this study.
2. To find predictors associated with poor outcome of   first line treatment with ABVD chemotherapy protocol in patients with Hodgkin’s lymphoma in this study.
METHODS:  
This  is  a    retrospective and prospective study  in which  information  was gathered from Baghdad  hematology  center involving 50  patients  who  were  diagnosed  with Hodgkin’s lymphoma   from 1/1/ 2017  until  mid of  2019 and treated with frontline therapy, ABVD chemotherapy protocol.
RESULTS:  
The mean age of diagnosis was 29.6 ±12.12 year.  Nodular sclerosis   was the predominant subtypes constituted   (62%) of patients.  Advanced stage disease involved 86% of patients.  At  interim  evaluation by imaging studying including either ultrasound and CT scan or Pet scan according to availability ,  complete  remission, partial  remission and   progressive  disease involving    58% , 26%  and  16% of patients respectively. Two years progression free survival was 68.95%. There was a strong correlation between lymphocytopenia and progression free survival.  In  this  study,  univariate  analysis  showed  that  initial    lymphocytopenia was poorly associated with chance of achieving complete  remission    at  end  of treatment.
CONCLUSION:
The  outcome  of  ABVD  in  this  study  shows    lymphocytopenia was poorly associated with complete  remission    at  end  of treatment of patients.
 
 

Immunohistochemical Expression of Cyclin D1 in Prostate Carcinoma

Lubna Abdulsalam Kamil; Muhsin Abd Ali Sahib

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 3, Pages 288-292
DOI: 10.52573/ipmj.2021.175786

BACKGROUND:
Prostate carcinoma is one of the most common malignant tumors in men older than 50 years of age and is characterized by a highly variable clinical course. Cyclin D1 proto-oncogene is an important regulator of G1 to S phase progression in many different cell types
AIM OF STUDY:
To study the expression of cyclin D1 in prostate adenocarcinoma, and to evaluate the relationship of this protein with clinicopathological features (histological grade, perineural invasion, and preoperative PSA level).
MATERIALS AND METHODS :
This is retrospective study including 50 cases, forty cases diagnosed histopathology as prostate adenocarcinoma and 10 cases as a benign prostatic hyperplasia. These cases were collected from laboratory department of AL Shaheed Ghazi ALhariri hospital from November 2018 to May 2019. Type of biopsy is a needle core biopsy.
RESULTS:
The immunohistochemical expression of cyclin D1 was negative in benign prostatic hyperplasia, while in prostate adenocarcinoma 52.5% were positive .There was significant correlation between histological grade of prostate adenocarcinoma and immunohistochemical expression of cyclin D1 There was no association between immmunohistochemical expression of cyclin D1 in prostate adenocarcinoma with the presence of perineural invasion, and the pre –operative PSA level.
CONCLUSION:
Cyclin D1 expressed in prostate carcinoma and not in benign prostate hyperplasia.
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Dermatological Referred Consultations from Various Departments of Baghdad Medical City to Baghdad Center of Dermatology and Venereology

Mustafa Jawad Askar; Ihsan Alturfi

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 3, Pages 293-299
DOI: 10.52573/ipmj.2021.175789

BACKGROUND:
Dermatological problems are common in patients with other medical problems, they may provide clue to the diagnosis of medical diseases.
AIM OF THE STUDY:
To study consultations from different departments of Baghdad Medical City to Baghdad Center of Dermatology and Venereology regarding frequency causes of referral and final dermatological diagnosis, and to design a typical consultation form.
PATIENTS AND METHODS:
This is a cross – sectional observation study, it was conducted at Baghdad Center of Dermatology and Venereology, Baghdad Medical City, Iraq from October 2018 to January 2020 (15 months).
All consultations from other departments of Baghdad Medical City to dermatological department were included in the study.
RESULTS:
A total number of 998 consultations out of 39540 patients attended dermatological department during the same period of study (3% from total patients that consulted the department during this period), 694 (69.5%) patients were outpatients while 304 (30.5%) patients were inpatients. The age range was from 1day to 86 years old with a median age of 26. The most common consultations were referred from pediatric department with total number 256 (25.6%) patients, rheumatology department 220 (22%) patients followed by hematological department 157 (15.7%) patients. The most common dermatological disease group that was diagnosed by dermatologists was eczematous disorders 107 (10.7%) patients, viral infections 106 (10.6%) patients followed by parasitic infestation 87 (8.7%) patients. Scabies represents the most common disease that was referred to dermatological department (8.3% of all consultations).
CONCLUSION:
Consultations were referred from 23 different departments; the most common ones were from pediatric department. Dermatological opinion helped to reach the final dermatological diagnosis among referred patients.
 
 

Risk Factors for Transient Tachypnea of the Newborn in Full Term Neonates

Akrem M. Atrushi; Nibras Najeeb Qaqos

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 3, Pages 300-305
DOI: 10.52573/ipmj.2021.175790

BACKGROUND:
Transient tachypnea of the newborn (TTN) is a condition characterized by tachypnea that develops shortly after birth but resolves within 2 to 5 days. TTN has been reported to occur more frequently in Caesarean delivery, maternal sedation, perinatal asphyxia, maternal asthma, and birth of male infants.
AIM OF THE STUDY:
To assess the risk factors for transient tachypnea of newborn in Duhok.
METHODS:
This study included 100 cases with TTN and 100 controls who are full term neonates without any respiratory problems. All participants were chosen from deliveries in Maternity Hospital in Duhok from Nov. 2018 till Nov. 2019. The diagnosis of TTN was established with clinical and radiology data and by excluding other causes of respiratory distress.  Potential risk factors for TTN are selected as follows: maternal age, parity, history of infertility, pregnancy-induced hypertension, premature rupture of membranes, induction or augmentation or both of labor, mode of delivery, neonatal birth weight and Apgar score of the neonates.
RESULTS:
This study showed the risk factors that emerged to be significant in this study that included multigravida mother, pregnancy induced hypertension, birth weight <2,500grams , APGAR score<7 at 5min and delivery by Caesarean section( elective and emergency) .Other risk factors that were not significant included maternal age >35years ,maternal infertility, in vitro fertilization, maternal diabetes mellitus, maternal asthma, male gender, prolonged rupture of membrane, induction of labor and twin pregnancy.
CONCLUSION:
Low birth weight, APGAR score <7 at 5 minutes, delivery by Caesarean section, pregnancy induced hypertension in the mother and multiparty are significant predisposing factors for transient tachypnea of newborn.
 

Transdermal Scopolamine Alternative to Ondansetron for Prevention of Early 6 Hours Postoperative Laparoscopic Cholecystectomy Emetic Symptoms

Raghad Hannon Alsudani; Asmaa Khalid Al- Hayali

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 3, Pages 306-310
DOI: 10.52573/ipmj.2021.175793

BACKGROUND:
Nausea and vomiting are the commonest complication Post-operatively which are usually                         self-limiting; however, it can cause serious consequences. There are many drugs to manage                       Post-operative nausea and vomiting.
OBJECTIVE:
Compare the efficacy of transdermal scopolamine versus ondansetron for the prevention of                         post-operative laparoscopic cholecystectomy emetic symptoms.
PATIENTS AND METHODS:
One hundred patients who were candidate for undergoing laparoscopic cholecystectomy are divided in to two groups each of them have 50 patients, first group received an active TDS patch  (containing scopolamine 1.5 mg) 60 min before entering the operating room. The second group was administered ondansetron, 4 mg that was administered I.V near the end of the procedure, and all patients received                a standardized general anesthetic technique.
RESULTS:
There were no significant differences in any of the emetic outcomes orneed for rescue antiemetics between TDS and ondansetron groups inthe first 6 h after surgery.
CONCLUSION:
Premedication with TDS (1.5) mg was as effective as ondansetron (4 mg) in preventing nausea and vomiting in the early postoperative periods. Also less cost with TDS patch.
 

People's Perception towards Mental Health Problems

Rawnak Khudair Abass; Waleed Arif Al-Ani

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 3, Pages 311-317
DOI: 10.52573/ipmj.2021.175794

BACKGROUND:
Positive people’s perception determines their interaction and provides support to persons with mental health problems in order to express their own emotional problems and seeking care while negative perception results in avoidance, discrimination, stigma, and even low access to health services.
OBJECTIVE:
To assess the perception towards people with mental health problems, among people who attend Primary Health Care centers (PHCCs) in Baghdad, and to study the association of the level of perception with certain personal attributes.
METHODOLOGY:
A cross-sectional study was conducted on a sample of Primary Health Care centers (PHCCs) in Baghdad. Five centers from each side of Baghdad City (Karkh and Rusafa).The study was conducted on 400Iraqi adults attended the selected centers, for a period of four months extended from 1stFebruary to the end of May 2019.
RESULT:
The results revealed that 56.8% of the respondents were with fair perception, 32% with good perception and only a small proportion of the respondents (11.3%) have poor perception towards mental health problems. The educational level of respondents and their occupational status were found to be significantly associated with perception of mental health problems.
CONCLUSION:
In the current study, a small proportion of the respondents have poor perception towards mental health problems, and regarding the association of perception with different demographic characteristics, the educational level and the occupational status were found to be significantly associated with perception toward mental health problems.
 

Evaluation of Predictive Value of Placental Alpha Microglobulin-1 Compared to Fetal Fibronectin in Symptomatic Preterm Delivery

Gul Umit Abbas Awchi; Ayla Khedher Ghalib

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 3, Pages 318-325
DOI: 10.52573/ipmj.2021.175795

BACKGROUND:
Placental alpha microglobulin-1 (PAMG-1) is an important biomarker for the detection of preterm labor and premature rupture of fetal membrane, also fetal fibronectin leak observed into the vagina if                        a preterm delivery is likely to occur and can be measured by a screening test.
OBJECTIVE:
To compare the rapid bedside test for (placental alpha microglobulin-1) with the instrumented fetal fibronectin test for prediction of imminent spontaneous preterm delivery among women with symptoms of preterm labor.
PATIENT AND METHODS:
A prospective observational study, it included 86 pregnant women between 24 – 35 weeks of gestation with singleton pregnancy, viable fetus, intact membrane, and cervical dilatation ≤ 3 cm who attend to the labor room of the hospital complaining from signs and symptoms of spontaneous preterm labor.
Patients were tested for placental alpha microglobulin-1 with the instrumented fetal fibronectin test for prediction of imminent spontaneous preterm delivery.
RESULTS:
The positive predictive values for spontaneous preterm delivery within seven days for placental alpha microglobulin-1and fetal fibronectin were 25% (4/16) and 5.6% (2/36), respectively (P= 0.001 for placental alpha microglobulin-1 superiority), while the negative predictive values were 82.9% (58/70) and 72% (36/50) for placental alpha microglobulin-1 and fetal fibronectin, respectively (P= 0.02 for PAMG-1 superiority). The sensitivity and specificity of placental alpha microglobulin-1 were (25%, and 82.9% respectively), and of fetal fibronectin were (12.5%, and 51.4% respectively).
The PPVs for spontaneous preterm delivery within 14 days for placental alpha microglobulin-1 and fetal fibronectin were 43.8% (7/16) and 11.1% (4/36) respectively (P= 0.001 for placental alpha microglobulin-1 superiority), while the NPVs were 81.4% (57/70) and 68% (34/50) for placental alpha microglobulin-1 and FFN, respectively (P= 0.001 for placental alpha microglobulin-1 superiority).              The sensitivity and specificity of placental alpha microglobulin-1 were (35%, and 86.4% respectively), and of fetal fibronectin were (20%, and 51.6% respectively).
CONCLUSION:
Placental alpha microglobulin-1 performed the same as fetal fibronectin in ruling out spontaneous preterm delivery among contemporary cohort of symptomatic women but demonstrated statistical superiority in predicting it.
 

Plasma Homocysteine and Insulin Resistance in Patients with Polycystic Ovary Syndrome

Zahraa Mohammed Ali Hussain; Anwar Khazal Jafar; Abdul Razak H. Al-Nakash

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 3, Pages 326-332
DOI: 10.52573/ipmj.2021.175814

BACKGROUND:
Polycystic Ovary Syndrome (PCOS) is an endocrine-metabolic disorder characterized by multiple hormonal imbalances, reflecting on a clinical presentation dominated by manifestations of hyperandrogenism and insulin resistance. Plasma homocysteine is a non-protein sulfur-containing                α-amino acid plays a role in cardiovascular morbidity and mortality due to its atherogenic and prothrombotic properties.
OBJECTIVE:
To assess the association between insulin resistance and homocysteine level in women suffering from polycystic ovary syndrome.
Study design: A case control study.
Setting: Department of Obstetrics and Gynecology at Al-Elwiya Maternity Teaching Hospital during the period from 1st of March 2017 to end of April 2018.
MATERIALS AND METHOD:
One hundred women suffering from polycystic ovary syndrome and same number of healthy women were included in the study.
After assessment according to questioner form, fasting blood sugar, serum insulin and plasma homocysteine were checked to find the association among them, the insulin resistance was calculated according to the following formula “IR= Fasting Glucose X Fasting Insulin/22.5= mmol/dl”.
RESULTS:
Increase in body mass index is found to be accompanied with increase in mean fasting blood sugar (6.4±2.7 mmol/L), Insulin resistance (11.6±10.7 mmol/L) and homocystiene level (14.9±1.6 µmol/L) when compared to control group whose mean values are (4.4±0.5 mmol/L, 3.6±1.5 mmol/L and 9±1.7 µmol/L) respectively were significantly higher. A noticeable significant association between obesity and high fasting blood sugar (p0.04), high insulin resistance (p0.009) and homocysteine level (p0.001) in women suffering PCOS.
CONCLUSION:
There are significant differences found in homocysteine level and insulin resistance among women suffering from PCOS when compared to control group. A significant positive association between increased homocysteine level and insulin resistance with increased body mass index in women              with PCOS.
 

Comparative Study between Classical Hemorrhoidectomy and Rubber Band Ligation in the Treatment of Hemorrhoid

Mohammed H. Al-Ali; Muthanna A. Al-Sharbaty; Abdulrahman S. Shwakat

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 3, Pages 333-393
DOI: 10.52573/ipmj.2020.175815

BACKGROUND:
Hemorrhoids are quite common disease affecting the anus and may require traditional surgical treatment, but the rubber band ligation (RBL) emerged as a less invasive and effective method of treatment.
AIM:
This study was performed to assess the efficacy of rubber band ligation as an option in the treatment of hemorrhoid in comparison to classical hemorrhoidectomy using (pain, bleeding, return to daily activities and recurrence) as parameters. 
METHOD:
A prospective study was conducted from January 2018 till July 2019 at Mosul teaching center, it compares the results of  RBL and classical hemorrhoidectomy. It includes 100 patients having grade two and three hemorrhoid who were selected randomly and divided into 2 groups of 50 patients each (hemorrhoidectomy group and RBL group). Patients with other lesions such as fissures and fistulae were excluded from the study. All data were recorded and subsequently analyzed.
RESULTS:
From 100 patient, the 50 patient whom were treated by rubber band ligation had less pain , less bleeding, early mobilization, and more cost effective as they were treated as an outpatient basis compared to hemorrhoidectomy group; however, the recurrence rate (after less than 6 months) were much higher in RBL group compared to Hemorrhoidectomy group.
CONCLUSION:
RBL can be used effectively in the treatment of grade 2 and 3 hemorrhoid as it has less postoperative complications (less pain and less bleeding) and should be considered as first line in patients who are unfit for surgery as it is done as an outpatient basis. However, patients may need multiple sessions (more recurrence rate) especially those with multiple hemorrhoids and with grade 3 hemorrhoid.
 
 

Study of the Frequency and the Histo-Pathological Characteristics of Skin Tumors and Tumor-Like Conditions

Mohammed Haider Al-Hamami; Adil R. Alsaadawi

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 3, Pages 340-348
DOI: 10.52573/ipmj.2020.175816

BACKGROUND:
Skin tumors and tumor like conditions constitute an important part of the work of the dermatopathologist. The incidence, the clinical and pathological characteristics differ in different countries due to genetic and environmental factors.
AIM OF THE STUDY: 
To evaluate the rates of skin tumors and tumor like conditions and to study the histopathological characteristics of 3 important malignant neoplasms (basal cell carcinoma, squamous cell carcinoma and malignant melanoma).
PATIENTS AND METHODS:
The study is a cross-sectional retrospective study. It was conducted at the Histopathology  Department, Teaching Laboratories, Baghdad Medical City during the period extending from the beginning of January 2018 till the end of December 2020. It included all skin biopsies sent from different departments.                        It included 243(37.97%) skin tumors and tumor-like conditions from 640 skin biopsies.
RESULTS:
Females were more commonly affected than males with a female to male ratio of (1.19:1). Malignant tumors (67.48%)) were more common than benign tumors (32.51%). The most common malignant tumor was basal cell carcinoma)(16.87%), followed by direct invasion by cancer (15.64%), then squamous cell carcinoma (9.87%). The most common benign tumors were intradermal nevus (3.7%), skin tag (3.7%%)and seborrheic keratosis (3.29%).
CONCLUSION:
Skin tumors and tumor like conditions constitute an important part of the work of the dermatopathologists. Malignant neoplasms were more frequently encountered than benign neoplasms in our laboratory. Basal cell carcinoma, direct local invasion by cancer and squamous cell carcinoma were the most frequently reported.
 

Reasons for Reluctance to Mammogram Examination among Women Attending Early Detection Clinics for Breast Cancer in Mosul

Najlaa Saadi Sheet AL-Safar

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 3, Pages 349-354
DOI: 10.52573/ipmj.1970.175817

BACKGROUND:
Cancer is the greatest cause of mortality in the world; Breast cancer claimed the lives of 2.26 million worldwide.
OBJECTIVE:
To determine the reasons for reluctance to examine the mammogram among women attending early detection clinics for breast cancer in the city of Mosul / Iraq
METHOD:
A cross-sectional study was carried out between January 2018 and December 2020. It was carried out in early detection clinics in Mosul's two major hospitals. Females who were diagnosed as breast cancer participants were   included in the study.
RESULTS: 
A Total of 384 women were diagnosed with breast cancer, (mean age 52.96 ±12.4 years) and                  the women are reluctance to examine the mammogram was 72.76 %. Reasons were unavailability of x-rays at 25.45%, fear at 20.43% and not knowing about a mammogram at 15.77%. There were 16.62%, 32.29%, and 17.18% of patients with stage-III breast cancer, 5.2%, 10.41%, 8.59% stage-II and 0.26%, 1.3%, 2.34% Stage-I who was discovered in the years 2018, 2019 and 2020 respectively. The percentage of cases with stage-IV decreased from 2% in 2018 to 1.3% in 2020.
CONCLUSION:
Unavailability of x-rays, fear and not knowing about mammography, were among the most important reasons for women reluctance to examine the mammogram. As well as the increase in                     the percentage of women who underwent examination in the second year of activating the early detection program for breast cancer, it was noted that the stage of the disease discovered in women gradually decreased during the research years.
There is an urgent need for more efforts to improve the early detection program for breast cancer and to classify women at risk of developing breast cancer according to risk factors.
 

The Association of Subclinical Thyroid Dysfunction with Vitiligo and Alopecia Areata Patients

Basman Medhat Fadheel; Duaa Naeem Khalaf

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 3, Pages 355-359
DOI: 10.52573/ipmj.2021.175818

BACKGROUND:
Alopecia areata is a common type of non-scarring hair loss. The typical clinical features are well circumscribed bald patches. Vitiligo is an acquired skin disease of progressive melanocyte loss which is clinically characterized by well-defined milky-white macules. alopecia areata and vitiligo are observed with other autoimmune diseases .among these diseases, the chance of coexistence with autoimmune thyroid diseases is high.
OBJECTIVE:
To determine whether vitiligo or alopecia areata has statistically significant association with subclinical thyroid dysfunction.
PATIENTS AND METHODS:
This case control study wascarried out on 69 vitiligo,  69 alopecia areata patients and 75 sex and age matched control. Serum samples from both patients and control were collected and assayed for triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH) then we compared                       the results between cases and control.
RESULTS:
Thyroid functional abnormalities were found in 18.8%, 13% of vitiligo and alopecia areata patients respectively, subclinical hypothyroidism constitutes 78%, 69% of them respectively .however when were compared with control group, there are no statistically significant differences in thyroid dysfunction between vitiligo or alopecia areata and control.
CONCLUSION:
There is no statistically significant difference in thyroid dysfunction between vitiligo or alopecia areata and control. Thyroid function test is unnecessary for alopecia areata or vitiligo patients unless                      the patient had signs and symptoms of thyroid disease, old age or severe clinical subtype of disease.
.   

Assessment of Knowledge and Attitudes of Medical Students on Tuberculosis

Arwa Zuheir Abbas; Salam Jasim Mohammed

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 3, Pages 360-367
DOI: 10.52573/ipmj.2021.175845

BACKGROUND:
Tuberculosis is one of the most common communicable diseases world wild and continues to be a major global health problem. It causes disease among millions of people each year, and, after HIV, it ranks as the second leading cause of death from an infectious disease worldwide. TB is a public health priority in Iraq. A report published by the World Health Organization highlighted ' the value of undergraduate tuberculosis training and outlined a systematic educational plan to ensure that students are provided with the necessary knowledge, skills, and attitudes essential to the effective management of tuberculosis.
AIM OF STUDY:
To assess the level of knowledge and attitude  of  medical students towards tuberculosis in the College              of Medicine /University of Kufa and College of Medicine /University of  Babylon in Iraq .
METHOD:
A cross-sectional study was done on medical students (4th ,5th,6th stages)  at College of Medicine/ University of  Kufa   and College  of Medicine / University  of Babylon in Iraq during one year. Data was entered and statistical analysis conducted using statistical package for the social sciences version 20 (SPSS).Chi square test(X2-test) used for categorical variables. P value of 0.05 or less considered statistically significant.
RESULTS:
The overall knowledge of all students(84.5%) and overall attitude (76%).There was a significant difference between male and female in regarding attitudes questions, male percent of good attitudes was (79.9%) higher than female percent(73.8%). The percent of Babylon medical students of good knowledge was (86.7%) higher than percent of good knowledge of Kufa medical students (81.9%), but there was no significant difference between  both  colleges.
CONCLUSION:
The overall knowledge and attitudes were high in the present study .The percent of knowledge for Babylon medical students were higher than the percent of knowledge for Kufa medical students. There was a low percent of correct answers in some aspects regarding knowledge about epidemiology, chemoprophylaxis, transmission isolation of active disease patients and treatment of tuberculosis patients with human immunodeficiency virus.
 
 

Evaluation of Family PHysicians knowledge, Attituds and Practice for Emergency Services

Shaimaa Salah Abdul-Mahdi; AbdulMuniem Y. Al-Dabbagh

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 3, Pages 362-372
DOI: 10.52573/ipmj.2021.175846

BACKGROUND:
Provision of emergency care is an integral part of general practice, and family health physicians play                       a crucial role in the management of medical emergencies.
OBJECTIVE:
To evaluate the emergency health care services delivery at PHC level in family Health centers in Baghdad city, in terms of knowledge, attitudes and practices of the physicians (service providers) towards emergency service.
METHODOLOGY:
A cross-sectional study done in 22 Family Healthcare Centers, targeting all doctors who work in these centers who accepted to participate, 86 out of 100 agreed to participate. A self-administered questionnaire was used to obtain the basic characteristics of participants in addition to assessing their knowledge, attitudes and practices.
RESULTS:
Fifty nine percent of participants disagreed that emergency cases can be effectively managed in primary health care settings while 52.3% had the feeling of adequate self-confidence to respond to emergency cases at the primary care level. Only thirty three percent of participants had positive attitude and 73.3% had fair/good practice, while there were no statistically significant associations between practice scores or attitude scores with other variables.
CONCLUSION:
lack of confidence among some of the interviewed Family physicians of their capabilities in providing emergency services, with fair practice levels and negative attitudes regarding management of emergency cases.
 

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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

Ihsan Al-Turfy; Shahad Abdulmunaf Hamza

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

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.

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

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.
.

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