Issue 1

"Kohl" Use for Infants

Luay Abdulla Muhiddin AL-Nouri

Iraqi Postgraduate Medical Journal, 2008, Volume 7, Issue 1, Pages 1-5

Kohl is still being used for the eyes of infants. The habit is of concern to paediatritians because of the
serious toxic effects.
1.To determine how frequent kohl was being used for infants eyes, the reasons for its use and the
method of application.
2. To estimate the blood and urine level of lead in infants, and in kohl samples from the local market.
3. To document kohl induced encephalopathy.
Mothers of 150 children under a year of age were interviewed and samples of 40 infants' blood and
urine were analyzed for their lead content.
Kohl was used for 47% of infants. Forty percent of town mothers and 57% of rural mothers were
applying it to their infants eyes. Fifty percent of illiterate mothers and 33% of college graduates were
applying it.
The habit started in the neonatal period: 40% of which on the third day after birth. The reasons for the
use were: cosmetic 54%, improving vision 41% and prevention of eye infection 4%.
The mean blood and urine levels of lead were higher among kohl user, but it did not reach statistical
significance. The lead contents of kohl samples varied from 0.4% to 54%. In two infants encephalitis
was present, the most likely cause was kohl use.
Kohl use is common during infancy. Its lead content could be high. I t was usually applied to the
conjunctival side of the eyelid where a higher chance of absorption into the blood stream was
expected. Kohl use for infants could lead to encephalopathy. Active means should be adopted to
educate mothers about the hazards of kohl use for infants, and possibly banning the sales of lead
containing kohl.

Some Anthropometric Measurements of Normal Full Term Neoborns at Birth

Kholod Dhaher Habib Alshemeri

Iraqi Postgraduate Medical Journal, 2008, Volume 7, Issue 1, Pages 6-11

All health personnel working in child health care should be familiar with normal patterns of growth, so
that they can recognize any deviations from the normal range and try to deal with the underlying
disorders which could be nutritional, socio economic or infectious diseases.
I undertook this study to find some anthropometric measurements like length, weight and
occipitofrontal circumference of normal healthy Iraqi neonates at birth which can be used in future to
draw an Iraqi growth chart.
The Study carried out from 1st of May 2005 to30th of April 2006 at Fatema AL-Zahra Teaching
Hospital. The study was performed on 1001 live born neonates with gestational age (37-42 week) were
all born in Fatema AL-Zahra teaching hospital in Baghdad. Babies of mothers with risk factors
(gestational hypertension, gestational diabetes mellitus, cigarette smoking and multiple gestation
,number of party more than 5,mother age less than 17 years, or more than 35 years, mother body
weight less than 45kilogram(kg) or more than 90 kg, mother height less than 150 centimeter(cm)),
premature, and malformed babies were all excluded. The study was performed by measuring the
length, weight and (&) occipitofrontal circumference (OFC ) of these babies.
The Results showed that the mean length at birth(male & female) was 50.888 (+/- 1.1004) cm ,(male ;
female was51 cm(+/- 1.055) ; 50.72 cm (+/_0.953)). The mean OFC(male & female) was 34.678(+/-
1.189) cm ( male ;female ,34.719(+/- 1.1305) cm ; 34.621(+/-1.074)cm ) .The mean birth weight (male
& female) was 3.291 (+/-0.346)kg (male ; female was 3.30(+/-0.356) kg ; 3.28(+/-0.336)kg ).
The study concluded that the mean length at birth(male & female) was 50.888 (+/- 1.1004) , The mean
OFC(male & female) was 34.678(+/-1.189) cm . .The mean birth weight (male & female) was
3.291(+/-0.346) kg.

Chronic Renal Failure in Children Admitted to Children Welfare Teaching Hospital

Nariman Fahmi Ahmed

Iraqi Postgraduate Medical Journal, 2008, Volume 7, Issue 1, Pages 12-17

Chroic renal failure (CRF) is a devastating medical, psychological, social and economic problem for
patients and their families.
The aim of the present study was to determine the etiology, clinical presentations and highlight
treatment modalities used for patients with CRF admitted to children welfare teaching hospital.
A Retrospective study of all children with CRF admitted to children welfare teaching hospital during
the period from 1stof jan.2002 to 1st of jan.2007 were included in the study .CRF was defined as
having glomerular filtration rate less than 80m1 /min/1.73m2.
The study group included 50 patients with CRF below 17 years of age,29(58%) males and 21(42%)
females. Male: female ratio 1.38:1
Their age ranged between (1m -17 year).Twenty (40%) patients were above 10 years of age. In this
study the mean glomerular
Filtration rate was (29.5 + 18.5m1 /min/1.73m2).
Congenital abnormalities were the major cause of CRF, it was found in 18 patients (36%), followed
by hereditary conditions in 14 (28%) patients and glomerular diseases in 13 (26%) patients.
The most common presenting symptom was anemia. It was found in 16(32%) patients followed by
hypertension in 12 patients (24%) and failure to thrive in 12(24%) patients.
Twenty-one patients (42%) received peritoneal dialysis, four (8%) received hemodialysis. Renal
transplant was done to 3 patients (6%).
Congenital abnormalities was to the most common cause of CRF in our patients. Establishing registry
system that provide detailed information concerning the incidence, causes, and overall outcomes of
mild to severe renal functional impairment acquired during developmental age can clarify further the
natural history of the disease and the factors that influence its course.

Prevalence of Fibromyalgia in Iraqi People with Joint Hypermobility Syndrome

Khudhir Zghayer Mayouf Al-Bidri

Iraqi Postgraduate Medical Journal, 2008, Volume 7, Issue 1, Pages 18-21

Joint hypermobility occur when large or small joints in the body are able to extend beyond their
normal physiological limits. Fibromyalgia is characterized by chronic diffuse pain. Both conditions
are shared with various soft tissue problems and this draw the attention of a lot of researchers and
clinicians to look for possible relations between them.
To detect the correlation between firbomyalgia in Iraqi people with joint mobility.
One hundred Iraqi individuals with joint hypermobility syndrome according to the Beighton Score
were studied and compared with another hundred normal mobile individuals matched for age and sex
serving as control group. Full history was taken and complete clinical examination was done for all
individuals in both groups. The American College of Rheumatology 1990 Criteria for fibromyalgia
were applied for all individuals in both groups. They were quationed about presence of chronic
widespread pain, sleep disturbance, mood change and fatigue. Detection of at least 11 of 18 tender
points by digital palpation at specific soft tissue sites was needed for diagnosis of FMS.
There was statistically significant increase frequency of fibromyalgia among individuals with
hypermobile joints compared to normal mobile people. The frequency was 22% in the individuals
with hypermobile joints versus 11% in the individuals with normal mobile joints, which was reported
mainly in females between the age 30-59 years.
The results showed significant relationship between fibromyalgia and joint mobility.

The Role of Anticardiolipin and Anti-B2 Glycoprotein Antibodies in Clinical Complication of Lupus Nephritis

Nawar Abass Abud Noor

Iraqi Postgraduate Medical Journal, 2008, Volume 7, Issue 1, Pages 22-25

Although there was confliction regarding the association of raised anticardiolipin antibodies (ACL)
level with renal disease in systemic lupus erythematosus (SLE), the role of B2glycoprotein as a
cofactor for ACL binding is established.The presence of ACL &anti-B2GPІ may be directly
involved in pathogenesis of antiphospholipid antibodies associated symptoms like recurrent fetal
loss, thrombocytopenia and thrombosis.
To study the possible association between some auto antibodies with the most common clinical
complication of disease.
The study was conducted on 25 patients with lupus nephritis, attended the renal clinic in
specialized surgical hospital/ medical city /Baghdad, 25 lupus patients without nephritis and 25
healthy controls. Enzyme linked immunsorbant assay was used for detection for ACL, anti-B2GP.
Although there was no significant difference in mean concentrations of ACL and anti- B2GP
between lupus nephritis and without nephritis (P>0.05), lupus nephritis patients were more likely
positive for ACL. Positivity of 100% For ACL & anti- B2GPwere detected in thrombotic
complication, in fetal loss complication patients more likely to be positive for ACL (75%), anti-
B2GP (50%), in thrombocytopenia positivity of ACL &anti-B2GP (75%).
There was no association between anti-B2GP and renal disease and presence of both ACL &anti-
B2GP carry higher risk for thrombosis and recurrent fetal loss.

Left Ventricular Function in Early Stages of Ischemia

Nadiya Younis Mohammed

Iraqi Postgraduate Medical Journal, 2008, Volume 7, Issue 1, Pages 26-29

Ischemic heart diseases are common diseases that influence the heart performance via the changes
occurring in cardiac muscles resulting from the disease. These changes can affect the left ventricular wall,
septum thickness and an eventual effect on the cardiac performance.
The merit of this work is to investigate the effects of left ventricular function on patients who suffer from
early ischemic heart.
Twenty five patients complaining from chest pain and diagnosed as angina were subjected to our
investigation, they were free from other cardiac diseases and have no previous heart attack their average
age was (52.85±12.69 years old). Eighteen normal individuals (control) with average age (48.33±12.55
years old) are chosen and are free from any disease. M-mode, 2- dimensional parasternal long axis view
was used in the measurements of LV interdiameter, septum and posterior wall thicknesses. Doppler
echocardiography tracing of four chamber apical view was obtained to indicate the ejection time and
mitral flow velocities at early diastole E and at atrial contraction (end of diastole) A.
The effect of early IHD was found on the interventricular septum (decreased by 44.18%), posterior left
ventricular wall (decreased by 47.62%), fractional shortening (decreased by 28.93%), and ejection fraction
(decreased by 20.05%). There was no significant change observed on the A/E ratio but a significant
change was seen on E wave only.
In early of IHD, ejection fraction and percentage changes of wall thickness indicate cardiac performance.
In addition reduced early mitral flow velocity is more frequent than the change in early to late mitral flow
velocity ratio.

Medico-legal and Serological Study of the Role of C- Reactive Protein and Anticholesterol Auto-antibodies in the Diagnosis of Ischemic Heart Disease

Nabeel Ghazi Hashim

Iraqi Postgraduate Medical Journal, 2008, Volume 7, Issue 1, Pages 30-39

No previous Iraqi study was done on the role of C - reactive protein (CRP) and anticholesterol
autoantibodies (ACHA) in the diagnosis of ischemic heart disease (IHD) especially from the medico-legal
point of view.
To determine the role of CRP and ACHA in the diagnosis of IHD particularly myocardial infarction (MI)
with special attention to the medico- legal aspect.
Forty four lived patients from Al- Kadhimiya hospital and 20 cadavers in medico-legal institute of
Baghdad were included in this study, in addition to 18 apparently healthy persons and 3 cadavers as
controls. A number of risk factors were studied such as age, sex, smoking, and others. CRP and ACHA
detected and estimated in the sera of the lived and dead patients. Histopathological examination was done
on cardiac tissue specimens taken from the cadavers.
Patients with anterior MI have higher CRP values than in patients with other types of MI. ACHA of IgM
type was higher in controls than in lived and patients, while that of IgG was higher in lived patients as
compared with dead patients and controls.
Elderly males are affected more by MI. CRP is elevated in acute coronary syndrome. ACHA are present
in healthy individuals, but high in CAD.

Congenital Right Intra-Thoracic Hiatal Hernia

Waleed Mustafa Hussain

Iraqi Postgraduate Medical Journal, 2008, Volume 7, Issue 1, Pages 40-46

Congenital right sided intra-thoracic hiatal hernia is an uncommon clinical
entity consisting of herniation of a viscous through congenitally abnormal esophageal hiatus into
an intra-thoracic location .
Is to present the diagnostic challenge and the surgical management of eight cases of this
uncommon congenital anomaly admitted during asix years period (2000 – 2005 ) to the medical
city teaching complex in Baghdad . Iraq and to compare the study with other international studies.
Eight patients were studied retrospectively in details as regard the age , sex , clinical
manifestations , radiological findings . Details of the operative findings and the surgical outcome .
All the patients had right sided intra-thoracic abdominal organ herniation mostly the stomach , all
the patients ahad large hiatus , the patients were managed successfully through laparatomy with
uneventful postoperative course .
This uncommon variety of the congenital hiatal hernia presented a diagnostic challenge to the
pediatrician , pediatric surgeon and the thoracic surgeon .Laparatomy was the procedure of
choice and adding an anti –reflux procedure is highly indicated

The Distally Based Radial Forearm Flap in Reconstruction of Complex Defects of the Hand

Osam Ahmed Ibraheem Al-Najjar

Iraqi Postgraduate Medical Journal, 2008, Volume 7, Issue 1, Pages 47-53

The hand is exposed to various types of trauma, the majority of which involve multiple tissues which
needs to be repaired in the most perfect way. The distally based radial forearm flap is one of the
commonly used flaps for reconstruction of hand defects.
The aim is to test the applicability and the versatility of the distally based radial forearm flap in
complex soft tissue reconstruction of the hand.
Nine patients were treated using distally-based radial forearm flaps. There were seven males and two
females, mean age was 21 year. Reconstructed sites involved the thumb, the first web, the
palm and dorsum of the hand. Neurofasciocutaneous flap was transferred in one case,
adipofascial flap in one case, all the remaining flaps were fasciocutaneous island flaps.
All the flaps survived completely. There were two donor sites complications, but no major
functional disturbances. No patient had symptoms of cold intolerance or other ischemic changes.
Distally based radial forearm flap is very useful in hand reconstruction especially when no suitable
local flaps can solve the problem and it can permit further surgical procedures to be done underneath
when indicated.

Unenhanced CT Scanning in Acute Flank Pain: Value of Secondary Signs of Ureteral Obstruction

May Khalid Ameen

Iraqi Postgraduate Medical Journal, 2008, Volume 7, Issue 1, Pages 54-59

To determine the value of secondary signs of ureteral obstruction on helical unenhanced CT in
diagnosing or excluding ureteral stone disease.
Over a period of 15 months, we prospectively analysed the CT scans of 283 patients with acute flank
pain for the presence of ureteral stones & associated signs of ureteral obstruction. 105 patients had no
confirmatory imaging studies or surgery & were unable to be contacted for follow up .These were
excluded from the study. In the remaining 178 patients confirmatory data were availabe & thus were
included in the study. Ureteral stone disease was confirmed to be present in 114 patients & absent in 64
patients. For each patient, we determined the presence or absence of ureteral stone, ureteral or
collecting system dilatation, perinephric stranding, &renal parenchymal thickening. We also noted the
presence or absence of the (" tissue rim" sign) surrounding ureteral stones & extraurinary calcifications.
Hydroureter was the sign with the highest sensitivity (92 %) & highest specificity (92%), While
hydroureter had the highest specificity (95 %) & highest PPV (97%). The combination of unilateral
hydroureter & unilateral perinephric stranding had both the highest PPV (98 %) & NPV (91 %)
compared with any individual sign alone . The tissue rim sign was present in (57 %) of urteral stones &
in none of the extraurinary calcifications.
In patients having acute flank pain with suspected ureteral stone disease imaged with unenhanced CT ,
secondary signs including hydroureter , hydronephrosis , perinephric fat stranding , & renal
parenchymal thickening are very common & provides supportive evidence that an acute obstructive
process is present & that the urinary tract is likely responsible for the patients' complaints even when
the ureteral stone itself could not be identified on CT .

Prevalence of Silent Bacteriuria in Patients with Diabetes Mellitus

Firas Elias Douri

Iraqi Postgraduate Medical Journal, 2008, Volume 7, Issue 1, Pages 60-64

Diabetes mellitus and it’s complications continue to carry a major health problem. There is evidence that
diabetics are more prone to urinary tract infection.
The study was done to assess the prevalence of significant bacteriuria in patients with no urinary
Midstream urine samples were collected from 200 diabetic patients. There were 102 females and 98 males
and 80 urine samples from non diabetic persons as control were screened for bacteriuria.
Out of 200 diabetic urine samples 18 patients [9%] had significant bacteriuria while 2 urine samples
[2.5%] of non diabetic samples has significant bacteriuria. Three types of bacteria were isolated from
urine samples,Escherchia coli, Staphylococcus, and Proteus and Escherchia coli was the high in number
among the other genera.
Analysis of the results showed significant bacteriuria in diabetic patients compared with non diabetic
patients {p value < 0.05}.

Hormonal and Immunological Disturbances in Patients with Rheumatoid Arthritis and Systemic Lupus Erythematosus

Numman Hamed. Salih

Iraqi Postgraduate Medical Journal, 2008, Volume 7, Issue 1, Pages 65-70

Rheumatoid arthritis and systemic lupus erythematosus are multifactorial autoimmune diseases.
Some recent reports indicated a hormonal disturbances affected the balance between Th1 and Th2
lymphocyte response.
To investigate the immunological and hormonal disturbance in patient with rheumatoid arthritis
(RA) and systemic lupus erythematosus (SLE).
Serum samples, were collected from patients with RA, SLE and control, then the tests for
antinuclear antibodies, anti double strand DNA, anticardiolipin antibodies are done by using
Enzyme linked immuno assay (ELISA) method. Also, hormonal studies including estrogen,
progesterone and prolactin level are done by using the Radio immunoassay technique (RIA).
The results indicated the increasing of ANA, anti ds-DNA, and anticardiolipin antibodies. Also,
elevation in the levels of estrogen, progesterone and prolactin in patients with RA and SLE
comparing with control.
Immunological and hormonal disturbances in patients with RA and SLE were documented through
through the increasing of ANA, anti dsDNA anticardiolipin antibodies and elevation of the level of
estrogen, progesterone, and prolactin.

Hafnia Alvei Urinary Tract Infection

Jamela Ghadban Auda Al-Grawi

Iraqi Postgraduate Medical Journal, 2008, Volume 7, Issue 1, Pages 71-75

The genus Hafnia , a member of the family Enterobacteriaceae, consists of Gram negative bacteria
that are occasionally implicated in both intestinal and extraintestinal infections in human. This genus
contains only a single species (Hafnia alvei).
The above bacterium was identified from 250 bacterial strains which were isolated from 220 urine
samples of patients with urinary tract infection.
One H. alvei strain was isolated from an elderly patient, and identified by conventional biochemical
tests and API20E system at the first time in Iraq. Antimicrobial susceptibility test showed that this
strain is sensitive to Cefotaxime, Ciprofluxacine, Chloramphenicol, Doxycycline and Trimethoprimsulfamethaxzole,
while it is resistant to Penicillin, Oxacillin and Amoxicillin plus clavulanic acid.
H. alvei an important uropathogen that causing urinary tract infection in elderly and may be in
immunocompromised patients.

Status of Zinc and Copper Concentrations in Seminal Plasma of Male Infertility and Their Correlation with Various Sperm Parameters

Basil Oied Mohammed Saleh

Iraqi Postgraduate Medical Journal, 2008, Volume 7, Issue 1, Pages 76-80

Human semen contains high concentrations of zinc (Zn) and copper (Cu) in bound and ionic forms .The
presence of abnormal levels of these trace elements may affect spermatogenesis with regard to production
, maturation , motility , and fertilizing capacity of the spermatozoa. The aim of this study is to evaluate
the levels of Zn and Cu in seminal plasma in different groups of male infertility and to correlate their
concentrations with various semen parameters.
Forty primary infertile male individuals ,who had regular unprotected intercourse for at least one year
without conception with their partners ,aged 25-40 years were involved in the present study .After seminal
plasma fluid analyses they were grouped as, azoospermic (n=12), oligoasthenozoospermic (n=16) ,and
teratozoospermic (n=12) .Twelve fertile males selected from general population and after seminal fluid
investigation were taken as normospermic control group .Zinc and Copper concentrations in separated
seminal plasma of each infertile male and fertile control subject were determined by atomic absorption
This study showed significant decrease of seminal plasma Zn mean (+SEM) value in
oligoasthenozoospermic infertile males than in fertile male controls (p<0.037) .In azoospermic males, the
mean (+SEM) value of seminal plasma Zn levels was decreased (but still beyond the significant
level,p=0.08) when compared with that of fertile males. With regard to seminal plasma copper level there
was insignificant decrease in its level in azoospermic males and insignificant increase in its concentration
in oligoasthenozoospermic and in teratozoospermic males when compared with that of healthy fertile
males.In addition, there was a significant decrease in seminal plasma copper concentration in azoospermic
males than in oligoasthenozoospermic males (p<0.035).The results also revealed a significant positive
correlation between the sperm motility values and the seminal plasma zinc levels in
oligoasthenozoospermic group(r=0.68, p<0.022) along with a significant negative correlation between
sperm morphology values and zinc seminal plasma levels in teratozoospermic group (r=-0.63,p<0.049).
On the basis of the findings of this study, it seems that the estimation of seminal plasma levels of zinc and
copper may aid in investigation and treatment of infertile males.

The Carmoisine-Sodium Acetate Acetic acid Formalin Stain- Preservative Technique in Identification of Intestinal Parasites

Shaharazad Abdual Sattar . AL-Janabi

Iraqi Postgraduate Medical Journal, 2008, Volume 7, Issue 1, Pages 81-95

Definitive diagnosis of the intestinal parasites requires the demonstration of the organisms or eggs in
feces or tissues. Stool specimens should be preserved and stained and microscopically examined.
• Stool samples were collected from patients complaining gastro-intestinal tract.
• Carmoisine red food color powder was dissolved in 2 solutions, sodium acetate acetic acid formalin
(C-SAformalin) solution, and 10% formal saline (C-10% formal saline) .
• Merthiolate-iodine-formalin (MIformalin) solution was prepared, (control solution).
• Eleven stool suspensions were prepared from one stool sample directly after the passage , 5 for each
serially diluted solution which mentioned above, and one for MIformalin solution.
• The suspensions of 64 positive stool samples were selected to this study and subjected to periodic
examination which programmed according to the schedule during one year.
• C-10% formal saline was inadequate in preservation of protozoan trophozoites.
• The most appropriate concentration of C-SAformalin solution was 2%wet/vol, this solution has the
ability to preserve the amoeba organisms( trophozoites and cysts ),Chilomastix mesnili (trophozoite
and cyst) ,Giardia lamblia (trophozoite and cyst), helminth eggs and the human elements for one
year when suspended in this solution, at the same time it has the ability to stain the parasitic and non
parasitic findings which mentioned above very efficiently.
• The protozoan trophozoites, protozoan cysts and leucocytes these cells were showed various levels of
stain uptake. All C-SAformalin solutions which were stored for periods between one day up to 18
months showed the same preservation and staining capability
The C-SAformalin solution with 2% wt/vol. concentration has proved to be highly efficient in
preservation for one year and staining of the intestinal protozoa (trophozoites and cysts), helminth eggs
and humane elements, which may be found in stool specimens.

Spondyloepiphysial Dysplasia

Dawood Sadik. Al-Obidi

Iraqi Postgraduate Medical Journal, 2008, Volume 7, Issue 1, Pages 96-99

A 13 years old girl from north of Iraq, presented
with gross deformity of her back & difficulty in
walking& then progressive difficulty in
breathing. A thoracic scoliotic deformity with rib
hump obvious on her back, it is a case report of
spondyloepiphyseal dysplasis(SED) with primary
involvement of the vertebrae & epiphyseal
centers all over the body.
To present a very rare case of (SED), including
the deformities& the complications that can be
presented with it.
Examining & survying a 13 years old Iraqi
female from north of Iraq.
A thoracic scoliotic deformity was found&
became more obvious on bending foreword, also
rib hump on the right side.Both hips in fixed
flexion deformity & limitation of abduction.
In SEDT the vertebral bodies are malformed&
flattened, 1st described by Nilssone
(1924).Wynne-Davies& Gormley(1985)
estimated the prevalence to be 1 per 100.000 in a
Scottish population.