Volume 11, Issue 2, Autumn 2015, Page 1-253


Circulating microRNA-182 overexpression as a biomarker for breast cancer

Shoroq Mohammed AL-Temimi

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 1-10

Background:- MiR-182 is one of the most frequently studied cancer-related gene miRs and plays a crucial role in tumorigenesis , progression and may become a potential therapeutic target and biomarker of tumor diagnosis and prognosis.
Aim of study:-Estimation of miR-182 gene expression levels in both fresh tissues and serum of same breast cancer patients by using stem-loop follow by Taq-Man real time PCR (RT-PCR) technique and correlate the miR-182 gene expression with ER,PR and Her-2 by IHC technique .
Material and methods:- Stem-loop RT-PCR was performed to identify the level of miR-182 gene expression in both fresh tissues and serum of same breast cancer patients . The expression levels of miR-182 relative to mRNA of GAPDH were determined using the livak method . IHC were done for ER,PR and HER-2 .
Results:- Mean fold change of miR-182 was statistical significantly higher in breast cancer from paraneoplastic tissues , mean fold change of miR-182 was statistical significantly higher in serum of patients from apparently healthy control and miR‑182 serum level of patients with ER,PR positive was statistical significantly lower compared with the negative patients.
Conclusion:- The miR‑182 as a new original diagnostic and prognostic biomarker for breast cancer

Correlation between Angiographic in-Stent Restenosis and Post-procedural Glycosylated Hemoglobin Level in Diabetic Patients underwent Percutaneous Coronary Intervention with Drug eluting Stent

Mazin Z Alshibani; Tariq Mutasher Swadi; Ali Fawzi Alzamily

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 11-22

Background: Diabetes mellitus is a common, complex, and chronic metabolic disorder act as an important modifiable risk factor for cardiovascular disease and has been shown to be an independent predictor for in-stent restenosis after percutaneous coronary intervention.
Objectives: To determine the influence of HbA1c level on the frequency of in-stent restenosis in diabetic patients after elective percutaneous coronary intervention.
Patients and Methods: 89 diabetic patients with recurrent ischemia had history of previous percutaneous coronary intervention and stented coronary arteries with drug eluting stent were admitted to the Iraqi Center for Heart Diseases for elective coronary catheterization with or without percutaneous coronary intervention in period between April 2013 and March 2014. All patients were evaluated thoroughly. 26 patients were excluded for different reasons. 63 patients were assessing for stent patency during catheterization. 29 patients with patent stents. 34 patients with in-stent restenosis were investigated with HbA1c level. Diabetes mellitus was defined as fasting blood sugar concentration ≥126 mg/dl, random blood sugar ≥200 mg/dl with suggestive symptoms or positive history of diabetes mellitus with diet control or use an oral hypoglycemic agent(s) or insulin at the time of admission. Patients with in-stent restenosis were categorized into two groups based on their HbA1c level, good glycemic control (HbA1c ≤ 7%) and poor glycemic control (HbA1c>7%).

Results: Males represent 19 (55.9%) and females represent 15 (44.1%) of diabetic patients with in-stent restenosis. In table 2, 27 (79.45%) diabetic patients with poor glycemic control more likely to have in-stent restenosis than 7 (20.6%) patients with good glycemic control, P.value < 0.005. In table 4 in-stent restenosis more likely to occur in non-proximal left anterior descending artery after elective PCI in 20 out of 27 patients with poor glycemic control, P.value < 0.005.
Conclusions: Our study reveals that there is a correlation between poor glycemic control and increased frequency of in-stent restenosis of drug eluting stents in diabetic patients. Poor glycemic controlled diabetic patients are more liable for in-stent restenosis of drug eluting stents after intervention in non-proximal left anterior descending artery.

Incidence and methods of diagnosis of postoperative Deep Vein Thrombosis in A symptomatic patients

Dheyaa Ali Hussein Al Sultani

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 23-30

This is prospective study which was carried on( 100) patients with one or more of risk factor for the development of DVT who were admitted in the surgical units in Hilla General Teaching Hospital during the period from of January 2010 to the december 2012. The Aim of the study was to identify the incidence of DVT in postoperative patients, To identify the clinicl presentation of patients with DVT, and to verify the best methods of diagnosis of the DVT.
This study was done on 100 patients who were divided into 3 groups according to the most common presentation .All patients with one or more risk factor for the development of DVT who were subjected postopretively for duplex study of lower limb veins and D.D.protein assay.
The incidence of development of postoperative DVT increase with age,weight,majorsurgery,long duration of surgical procedure, long period of hospitalization and in urgent surgeries.
The most common presentation were unilateral leg swelling ,calf pain , tenderness and homan"s sing.
There is a statistically significant correlation between the duplex study and D.D. protein and incidence of DVT.
The combination of the D.D. protein estimation and duplex study of lower limb vessels in patients with clinical features suggestive of DVT is the mainstay of diagnosis of DVT.

Laparoscopic appendectomy in comparison with open traditional surgery for suspected cases of acute appendicitis.

Mustafa Adil Abbas Hilmi; AbdulhameedJumaah Ali; Mussa F. AL mahdawi

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 31-36

Background For more than a century, open appendectomy remained the gold standard for the treatment of acute appendicitis. Now laparoscopic appendectomy has struggled to prove its superiority of performing general surgical procedure.
Objective is to compare the safety and benefits of laparoscopic appendectomy with open appendectomy.
Patients &Methods a prospective study has been done in AL- Yarmouk teaching hospital and private hospitals, 130 patients were selected from April, 2013 to April 2014. 30 patients excluded from the study and hundred patients were Divided into two groups, group A ( 40) patients with acute appendicitis treated by laparoscopic appendectomy) and group B ( 60) patients treated by open appendectomy), after taking informed consent. The main outcome measures included was operative time, postoperative complications, return to oral feeding and hospital stay.
Results 40 patients treated by laparoscopic appendectomy, there was no significant difference between two groups in age, body build, clinical and laboratory findings. Mean age group was 30 years, male to female ratio was 1.2:1 in compare to 1.3:1 in group B. Operating time was 45 min. with time range (35-55min), while in group B, operating time was 40 min. Postoperative analgesia requirement was 1.1 in group A, and 3.1 in group B. Five patients(12.5%) was converted to OA in group A. Mean hospital stay was one day in group A, and two days in group B. ConclusionLaparoscopic appendectomy is safe and effective, less postoperative pain, early return to normal work and better cosmetic scar than open appendectomy.

Potential Protective Effect of Local Ethanolic Extract of Propolis against Asthma A Biochemical study on Rats .

Meaad N. Hussein; Ferdous. A. Jabir

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 37-43

The present study is designed to investigate the effect of Local Ethanolic Extract of Propolis to inhibition of free radical , and effect in antioxidant defense in asthmatic rats . Sixty healthy adult Sprague-dawley males rats were used in this study, divided into four groups. Every group contained 15 male rats . The first group received distilled water once time daily for three weeks then injected with (subcutaneous) ( 0.5ml) saline one dose for three time on 1st,3rd,5thday .The second group was received distilled water for three weeks then injected (s.c.)three doses of 100μg of Egg albumin on 1st,3rd,5thday . The third group was received local EEP for three weeks at doses 200mg /kg .after that induced asthma by injected (s.c.) three doses of 100μg of egg albumin on 1st,3rd,5thday . The last group rats received local EEP at doses 200mg /kg for three weeks , then injected ( s.c.) with (0.5ml) saline one doses for three time on 1st,3rd,5thday. After 21 days the experiment finished and the serum samples were collected to determine the MDA content and Catalase activity.
This study showed a significantly (P < 0.05) increased in MDA content in asthmatic rats ,but there was significant(P < 0.05) decrease in MDA in third group who treated EEP before induced asthma ,and there activity of Catalase was significantly ( P < 0.05) decreased in asthmatic rats but there was increased in rats who received EEP .This result indicate that EEP had potential to inhibited free radical and it can provided and reactivated antioxidant activates .and can protective from asthma by using it as treatment .

External fixation of type I intertrochanteric fractures in elderly patients with high risk comorbid conditions.

Raad J. kadhim

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 44-49

In Al- diwaniya city as part of adeveloping country we have only one hospital and we have high number of intertrochanteric fracture patients which usually occurres in patients having medical illnesses which make them unfit for general anaesthesia or lengthy operation or keeping them for long time on conservative treatment in hospital. So due to these factors the treatment of high risk patients with intertrochanteric fracture is a challenge.
In this study we aim to evaluate the results of treatment of intertrochnanteric fractures of the femur by external fixation in a group of high risk geriatric patients in Al-diwaniya city /
Iraq.
Our study involves 40 patients with mean age of 73.5 years, and type I kyle classification with the average follow up time of 12 months.
Good fixation and early ambulation was achieved in most of the patients.
Complete fracture healing was achieved in all patient and the fixator was removed after an average of 95 days.
Twenty five patients developed superficial pin tract infection and six patients had an average shortening of 2cm due to varus angulation by impaction at fracture sites during weightbearing
Our study demonstrates that treatment of intertrochanetric fractures by external fixation is simple and can be done under local anaesthesia with or without narcotic analgesia and we think it is good alternative to internal fixation in medically high risk patients.

High Tibial Osteotomy Open Wedge Osteotomy versus Close Wedge Osteotomy in Relation to Patella Baja as Asequale to this Osteotomy

Zuhair Gheni Abd Ali

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 50-53

Study design :
Our study is aretrospective study to asses the level of the patella after valgus high tibial osteotomy in 2 groups of patients group A perform to them open wedge valgus high tibial osteotomy and groupB perform to them close wedge valgus high tibial osteotomy.
material and method :
Our study include 18 patients perform to them valgus high tibial osteotomy from January 2004 – October 2008 in multi center in Baghdad and alnajaf cities ,age between 40-60 years average 45 years 9 of them perform to them open wedge valgus high tibial osteotomy and 9 of them perform to them close wedge high tibial osteotomy.
Result:
The mechanical hip-knee-ankle angle improved from average 168 degree to average184 degree . patella baja observed in both groups of patients but it is more sever in group A than in group B i.e it is more sever in patients with open wedge valgus high tibial osteotomy than in close wedge valgus high tibial osteotomy .
conclusion :
Patella baja is common after valgus high tibial osteotomy , it is more sever in patient with open wedge valgus high tibial osteotomy than close wedge valgus high tibial osteotomy ,according to the blackburne – peel index and insall salvati index , this effect the function of the joint according to the severity of the patella baja in both groups of patients .

Outcome of surgical sperm retrieval and ICSI in Iraqi azoospermic patients

Saadeldeen G. Alessawi

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 54-59

Abstract:- Although ICSI technique represents the cornerstone in the management of infertility worldwide, this technique was only recently introduced to our country and this might be the first prospective study of its kind that done in Iraq which tries to evaluate the outcome of surgical sperm retrieval in azoospermic Iraqi patients using different methods of surgical sperm retrieval technique and to evaluate the pregnancy rate for those patients who tried ICSI.
Patients and methods:- This was a single center prospective study, which was performed at the reproductive and ICSI center, department of urology at AL-SADER MEDICAL CITY. The time of enrollment was from sixteenth of February to sixteenth of December 2011. A total of 146 azoospermic patients have been included in this study. Surgical methods which were used for sperm retrieval included PESA, TESA, simple TESE, open surgical epididymal sperm aspiration, open multiple TESE and Micro surgical TESE.
Results:- The aim of our treatment is to obtain and freeze sperm sufficient for at least two ICSI cycles. The total number of patients who had met the above criteria after surgical sperm retrieval (SSR) was 92 patients out of 146 patients included in the study. The overall success rate was 63%, this including 100% success rate in obstructive azoospermia and 45% success in NOA. For those patient who try ICSI at time of this study the fertilization rate was 85% , embryo transfer was done in 75% , and the pregnancy rate was 23%.
Conclusion:-Although the combination of surgical sperm retrieval (SSR) and ICSI may be the sole treatment available for male factor infertility with uncorrectable azoospermia, the overall success rate is limited particularly in NOA and ongoing pregnancies are obtained in <25% of ICSI cycles. However every azoospermic patients should offer such option of treatment and for those patients who had succeed sperm retrieval, multiple ICSI cycle trials may increase the chance of pregnancy without the need for repeated surgery. Open surgical methods of SSR, has been shown to increase the options available to the embryologist to use , select and cryopreserved sperms, however it will increase the surgical trauma to the testicles and increase the tissue extracted , the effects of these factors on the future testicular function needs to be investigated by further studies

Detection of Mycoplasma hominis and Ureaplasma Urealyticum in urethritis from sexual active men by Real-time PCR

Haider A. Muhammid; Habeeb S. Naher; Adnan H. AL-Hamadani

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 60-66

Background: Mycoplasma spp and Ureaplasma spp are unique microbes in they lack a cell wall and cause genitourinary tract infections ,these organisms are considered an intracellular parasites and difficult to cultivate in routine media due to the complexity of their nutritional requirements so , the molecular detection and identify these microorganisms by Real-Time PCR due to cost, time, reliability, specificity, and sensitivity.
Aim of study : To detect and differentiate Mycoplasma hominis and Ureaplasma urealyticum isolates from patients with urethritis by Real-Time PCR.
Methods: Ureathral swabs collected from 60 sexual active men from December 2012 to May 2013 who attending to AL- Diwanyia Teaching Hospital were tested by using DUPLICα RealTime PCR kit for the presence the of genital mycoplasmas (Mycoplasma hominis based on amplification of 16SrRNA gene and Ureaplsma uralyticum based on amplification of urease gene ) , the age of patients study with urethritis were (18-41) year old. . Results: Out of 60 Urethral samples there 28 were positive samples as 3 (10.7%) , 17 (60.7%) and 5 (17.8%) for M.hominis (as a single pathogen) ,U.urealyticum (as a single pathogen) an both of genital mycoplasma respectively the age group (30-35) years old was more significant (P<0.05) than other group ages
08

Conclusion :Real-PCR shows a rapid and high accuracy in detection and differentiation of M. hominis and U. urealyticum from clinical samples. Keywords: Mycoplasma , Ureaplasma , Real-Time PCR , Urethritis

The Effect Of Maintaining Normal Mean Arterial Blood Pressure On The Incidence Of Intraoperative Emetic Episodes During Spinal Anaesthesia

Basim Hrez Ali Al-Sudani

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 67-73

Objective : To evaluate the effect of maintaining normal mean arterial blood pressure on the incidence of intraoperative emetic episodes in patient undergoing lower limbs orthopaedic surgeries under spinal anaesthesia .
Method : .60 Patients were randomly divided into two groups each composed of 30 patients . Group( A) received ephedrine 15 mg intravenously immediately after spinal anaesthesia with 2ml Bupivacaine 0.5% while group ( B ) received normal saline instead of ephedrine immediately after spinal anaesthesia with the same local anaesthetic . Baseline and frequent subsequent reading of mean arterial blood pressure , pulse rate , oxygen saturation , number and severity of intraoperative emetic episodes were noted .
Results : No significant difference between the two groups regarding the incidence of emetic episodes that need a treatment with an anti-emetics . However the total number of cases associated with an intraoperative emetic episodes is obviously less in group (A) than group ( B) .
Conclusion : the anti-emetic drug(s) as a prophylactic for intraoperative emetic episodes is necessary even when the mean arterial blood pressure is maintained during spinal anaesthesia .Further studies in this aspect is needed .

Psychiatric Comorbidity among Children with Autism Spectrum Disorders in Najaf Province

Arafat H. Al-Dujaily

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 74-84

خلفية الدراسة: مقارنآ مع العديد من اضطرابات الطفولة المزمنة الأخرى، اضطراب طيف التوحد (ASD) هي مجموعة خطيرة ومعيقة من الاضطرابات العصبية النمائية. وقد أعطيت اهتماما قليلا نسبيا وخاصة في
العالم العربي في الكشف المبكر عنها والاضطرابات النفسية المرضية المصاحبه لها .
الأهداف : الهدف الرئيسي للدراسة الحالية هو تحديد الاضطرابات النفسية المشتركة لدى الأطفال الذين يعانون
من اضطرابات طيف التوحد ( ASD ) ومعرفة الخصائص الديموغرافية المرتبطة بهذا الاضطراب .
المنهجية : أجريت الدراسة خلال الفترة من 1 كانون الثاني 3112 إلى 21 كانون الاول 3112 .المشاركون في
الدراسة هم الأطفال المراجعين الذين تتراوح أعمارهم بين 13 2 سنة )العدد الكلي = 111 ( في وحدة الطب -
النفسي لمستشفى الحكيم العام في النجف الاشرف. شملت الدراسه استبيان شبه منظم لمختلف الخصائص
الديموغرافية والأكاديمية بما في ذلك العمر والجنس والتحصيل الدراسي للوالدين والمهنة الخ. استخدمت
تصنيفات الطبعة الرابعة للدليل التشخيصي الإحصائي (DSM –IV) كتشخيص ااولي لاضطراب طيف التوحد ،
في حين تم تقييم الاضطرابات النفسية المشتركة باستخدام المقابلة التشخيصية المنظمه، المقابلة السريرية
المنظمه للدليل التشخيصي الإحصائي الطبعة الرابعة - DSM- IV) ، الخاصة بالاطفال . (KID – SCID) تم
إجراء التحليل الإحصائي بواسطة الحزمة الإحصائية للعلوم الاجتماعية. (SPSS)
النتائج : اظهرت الدراسه الحالية ان الغالبية العظمى من المرضى تتراوح اعمارهم مابين 11 5 سنوات. كما -
بينت الدراسة ان نسبة ذات دلالة إحصائية من الأطفال الذين يعانون من اضطراب طيف التوحد هم من الذكور
الذين يعيشون في المدينة ، ودخل أسرهم يكفي لسد الحاجة مع حجم أسرهم صغيرة ، كما أن المستوى التعليمي
للابوين جيدا ولكن والدتهم ربة منزل . تسعة وخمسون طفلا من الاطفال الذين يعانون من اضطراب طيف
التوحد) 55 %( صنفوا على ان لديهم واحدة على الاقل من الاضطرابات النفسيه المصاحبة لاضراب طيف
التوحد. ومع ذلك، كان الأطفال الذين يعانون من اضطراب طيف التوحد لديهم أكثرنسبه من الاضطرابات النفسية
الاستيعابية)الداخلية( ) 25 ٪( مقارنة بالاضطرابات النفسية الخارجية )اضطراب المعارضة و/ أو اضطراب
السلوك ( .)31%( وبشكل أكثر تحديدا ، كان الأطفال الذين يعانون من اضطراب طيف التوحد لديهم ارتفاع
معدلات اضطرابات القلق ) 21 ٪ ( اكثر من اضطرابات المزاج .
الاستنتاجات :أكدت الدراسة الحالية ان الكثير من مرضى اضطراب طيف التوحد يعانون من اضطرابات نفسية
أخرى ، لذلك لابد من الأطباء المعرفة والبحث عن الاضطرابات المشتركه ، والنظر في العلاج لمثل هذه
الاضطرابات المرضية . بالإضافة إلى ذلك، هناك حاجة ماسه إلى المزيد من الأبحاث حول وبائيات ومأل
الاضطرابات الطبية والنفسية المرتبطة بالتوحد .

The Role of Protamine 1 Gene Polymorphism and Anti FSH Antibody in Infertile Couples

Manal M. Khadhim; Taghreed S. Al-quizwini; Thaer A. Hussian

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 85-91

Background: Infertility is a worldwide problem which affects approximately 15% of all couples, and is defined as, inability to conceive after twelve months of contraceptive-free unprotected intercourse. Materials and methods: Optical density of anti follicle stimulation hormone antibody in the serum was detected by enzyme–linked immunosorbent assay technique and from which anti follicle stimulation hormone antibody concentrations were evaluated according to cut-off. One polymorphic sites of Protamine 1 Gene was genotyped on 72 couples suffering from infertility. Another group consist of 20 couples apparently healthy individuals. Genotypes were determined by the polymerase chain restriction fragment length polymorphism (PCR-RFLP) method. Results: Anti FSH antibody result demonstrated differences in antibody values between the patients and the control group with significant statistically, the frequency of the reported SNP was no significantly different compared to normal fertile males, which suggest that such SNP may not serve as a good molecular marker for genetic diagnosis of male infertility. Conclusion: The SNP G197T are completely absent and are not associated with male infertility with aforementioned, therefore these SNPs may not represent as a molecular marker for the diagnosis of genetic cause of male infertility in our studied population.

Deliberate Self Harm Cases Presented to the Emergency Unit of Al-Hussein General Teaching Hospital in Karbala/ Iraq

Amir Al-Haidary; Sami Al-Badri

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 92-97

Aim:To study the socio-demographic characteristics of deliberate self harm (DSH)of patients presented to the emergency unit of Al-Hussein Teaching Hospital in Karbala governorate in Iraq and to study the methods they used and inquiring about the cause.
Subject and Method: From the period (1st of May 2011) to (1st of January 2012) all patients with DSHwho were presented to the emergency unit of Al-Hussein Teaching Hospital were referred to a psychiatrist to assess them. We collected 113 patients.Registering the socio-demographic variables and the methods of use, patients then were assessed for the presence of a mental illness. Mental illness diagnosis was based on the Diagnostic and Statistical Manual - IV (DSM-IV).Patients were also asked about their motives from the act.
Results:DSHwas more common in femalesthan in males in about four folds. The average age of patients was 24.68 years. DSH was more common in those with urban residency than those with rural residency in 3.3 folds. DSH was more common in the single, followed by the married, followed by the divorced. The two most common methods used were ingestion of drugs and ingestion of poisons.
DSH in males was found to be associated with mental illness more than in females, while DSH in females was found to be associated with family problems more than in males.
Conclusion:DSH is more common in young females. The most method used by both sexes was ingestion of drugs or poisons. Males got a tendency to use more violent methods except self-burning which is more common in females. DSH in males is more associated with a mental illness than in females. DSH in females is more associated with problems in the family. This goes well with previous studies that were done in our country.

Findings of magnetic resonance imaging of lumbosacral spine in chronic lower back pain

Jabir Hasan Obaid Al.Shami; Amjaad Majeed Hameed

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 98-104

Background :Magnetic resonance imaging (MRI) of the lumbar spine is a safe and painless scan that uses a magnetic field and radio waves to produce detailed pictures of the lumbar spine (the bones, disks, and other structures in the lower back), MRI of the lumbar spine can be useful in evaluating symptoms such as lower back pain, leg pain, numbness, tingling or weakness or problems with bladder and bowel control. It can also help to diagnose tumors, bleeding, swelling, developmental or structural abnormalities and infections or inflammatory conditions in the vertebrae or surrounding tissues.
Aim of study :To detect the cause of chronic lower back pain in patients referring from different departments in our hospital like Orthopaedics, Rheumatology , Surgery & neurology.
*Patients & method : About 50 patients selected from February 2011 to December 2011 all of them are complaining from chronic lower back pain referring from different departments. Average age from 23 to 70 year, 31 were male &19 were female, the patients were classified according to their age, sex, occupation, past history of trauma, medical disease & previous surgery.
*Results Twenty sex of patients (52%) were diagnosed as a PIVD (prolapsed intervertebral discs) at the level of L4-5 & L5-S1, ten(20%) of them diagnosed as degenerative disease of the discs, five patients (10%) diagnosed as Straitening of Spine ( Muscular Spasm), 2 (4%) of them diagnosed as secondary metastases in L1& 2 vertebral bodies, 3 (6%) of them diagnosed as infected disk with gibbus deformity in lower dorsal spines & 4 (8%) had normal lumbosacral spine .
*Conclusion:
1.High incidence of abnormal MRI study in patients with chronic low back pain .
2.Highest percent of patients with chronic back pain had disc herniation follow by other pathology .

Managements Of Enterocutaneous Fistula (ECF)

Majeed H. H.Alamiri

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 105-108

Background:- A fistula is an abnormal epithelialized tract Between two or Hollow organ to Another hollow organ or to the skin.
It is estimated that 90% of ECF arise after surgical procedures, The mortality rate about 37% in post-operative high output ECF.
Objectives:-The aim of present study to evaluate the standardized Guideline And prognostic factors for outcome of patients with ECF.
Patients &Methods:- A prospective clinical trial conducted from January 2002-July 2013. done in the surgical ward of Al-Yarmouk Teaching Hospital.
In this study a database was created consisting of 115 patients with ECF. All have Been treated according to the SOWATS guideline, which consists of the following Components, Sepsis, Optimization of nutritional state , Wound care, Anatomy of Fistula,Timing of surgery and Surgical strategy.
Results :- Data from 115 patients. Mean age 42 year(range from 8-76 year).
Postoperative fistula after initial surgery for any reason appeared after mean 20 day (range from 3-37 day). The mean length of hospital stay was 57 day(range from 8-106 day). Mean period of treatment was 80 day(range from 10-150day).
Conclusion:- The main lesson to be learned is that adherence to SOWATS Guideline can result in good patient outcome. Surgical repair is performed when the Patient is stable. Treatment of sepsis plays a key role and ongoing sepsis is still the Most important cause of death.

LAPAROSCOPIC INGUINAL HERNIA REPAIR : Introduction of our experience

Mohammed Al Taie; Salah al Janaby; Hayder Aziz

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 109-116

Background
Inguinal hernia repair by laparoscope is a new promising and continuously developing field for a very common surgical disorder requires in its treatment a greater combination of accurate anatomic knowledge, with surgical skills.
Objective:
This study aims to evaluate our experience of inguinal hernia repair by laparoscope and to compare it with the experience of other colleagues.
Patients and methods:
A 32 patients were operated upon in this study 27 patients had unilateral inguinal hernia, 17 of them had right inguinal hernia while 10 with had inguinal hernia and 5 had bilateral hernia. All of them had primary inguinal hernia. All of them operated on by one surgeon and in Al Hilla General Teaching hospital – Babel Health Directorate. A total extra peritoneal approach was chosen for all. A polypropylene mesh was used for repair.
Result:
All of the patients completed laparoscoically except two conversions were done to complete the operation. The rest passed smooth postoperative but two develop swelling due to simple seroma, recurrence was reported in one patient, no reported infection.
Conclusion:
This study advocate the benefit of laparoscopic approach for repair of inguinal hernia especially the bilateral one and it is simple easy to perform.

Serum Levels of Interferon-γ, Interleukin-12 and Interleukin-8 in Patients with Brucellosis

Thuraya Aamer Habeeb

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 116-122

Background: Brucellosis is one of the most common bacterial zonosis. Different cytokines have an important role in the pathogenesis of the causative bacteria. Interferon-γ (IFN-γ) and interleukin-12 (IL-12) are among the most essential cytokines required for the elimination of infection with Brucella.
Aims: The study aimed to measure serum levels of IFN-γ, IL-12 and IL-8 and correlation among these cytokines in patients with brucellosis.
Subjects and Methods: A total of 60 patients with brucellosis and 26 apparently healthy controls were enrolled in this study. From each participant, blood samples were collected from which serum was obtained. Enzyme-linked immunosorbent assay was used to estimate serum levels of IFN-γ, IL-12 and IL-8 in each serum sample.
Results: Serum levels of IFN-γ and IL-12 but not IL-8 were significantly higher in patients with brucellosis compared to control. Furthermore, serum levels of IFN-γ correlated positively with IL-12 and negatively with IL-8.
Conclusion: Both IFN-γ and IL-12 have a crucial role in the immunity and pathogenesis of Brucella and can be used as indication for chronic infection.

The association of diastolic dysfunction with anaemia in patients with type 2 diabetes Mellitus

Ala; a Hadi Alessami

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 123-132

Background:
Anaemia is a common finding in patients with DM and constitutes an additional burden in patients with advancing age and co-morbid vascular disease. This study examines the association between diastolic dysfunction and anaemia in patients with type 2 DM.
Methods:
This is a cross-sectional study for diabetic patients who were attending the diabetic clinics in Ad Diwaniyah teaching hospital (number of patients was 37) and Al-sadir teaching hospital (number of patients was 28), Najaf from December 2009 to September 2010 to study the occurrence of adverse cardiac findings (diastolic dysfunction) in patients with type 2 diabetes mellitus and anaemia. A 65 type 2 diabetes patients were investigated using transthoracic echocardiography. Recordings and measurements were obtained according to the recommendations of the American Society of Echocardiography. The echocardiographic findings were correlated with Hb level. The patients with and without anaemia were compared.
Aim of the study:
This study was undertaken to show the relationship between anemia and diastolic dysfunction in patients with type 2 diabetes mellitus.
Results:
Diastolic dysfunction was diagnosed in 17 (81 %) of 21 diabetic patients with anaemia compared to 29 (66 %) out of 44 patients with a hemoglobin within the normal range.
Conclusion:
There is significant association between diastolic dysfunction and anaemia in type 2 diabetes patients, consequently this can be used to identify diabetic patients at increased risk of cardiac dysfunction.

Role of antioxidant therapy and cessation of smoking in treatment of infertile men.

Falah Mahdi Ali Al-khafaji; Jawad kadham Al-janabi; Mohammed Ali Ghadhban

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 133-142

Aim: To assess role of antioxidant therapy and cessation of smoking in infertile men .
Patients and Methods: This study was conducted at infertility unit at Al- Diwaniya gynecological hospital and private clinic from February 2012 to November 2013. Total number of patients was taken in study were 152. Thirty-five patients were secondarily infertile while 117 patients were primarily infertile. Range of duration of marriage was 1-8
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years. Each man smoked from 15-40 cigarette per day for 2-15 years. The study was include patients presented with various seminal fluid analytic pictures (oligospermia, teratospermia, asthenospermia, OAT syndrome). Ninety patients were treated by antioxidants without cessation of smoking and 62 patients were treated by antioxidants with cessation of smoking.
Results: Regarding 27 asthenospermic ceased smoking patients (mean motility percentage before treatment is 16.4 and mean motility percentage after treatment is 30.1), 53 asthenospermic non ceased smoking patients (mean motility percentage before treatment is 15.3 and mean motility percentage after treatment is 31), 23 oligospermic ceased smoking patients (mean count per million before treatment is 6.3 and mean count per million after treatment is 15.2), 33 oligospermic non ceased smoking patients ( mean count per million is 6.4 and mean count per million after treatment is 9.2). regarding 5 teretospermic ceased smoking patients ( mean percentage of abnormal morphology before treatment is 1.8 and mean percentage of abnormal morphology after treatment is 12.4) and 11 teretospermic non ceased smoking patients(mean percentage of abnormal morphology beforetreatment is 1.7 and mean percentage of abnormal morphology after treatment is 5.6).
Conclusion: use of antioxidant and cessation of smoking in selected patients (normal serum hormones ) gives good improvement regarding motility and count of sperms

The Effects of Combined Oral Antioxidants on Male Infertility

Ali Hadi Sabhan

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 143-151

Background
High reactive oxygen species (ROS) levels was considered as an important factor of male infertility that can result in DNA damage, decrease motility and damage membrane integrity. The role of antioxidants is to maintain the balance between ROS production and their clearance which improve sperm parameters and enhance male fertility.
Patients and methods
Sixty six male patients with median age of 29 years with a mean period of infertility of 1.5 year that attend the infertility clinic in Al-Diwaniya Maternity and Pediatric Hospital were selected randomly in this study which extend from January 2013 to October 2014 (22 months).The patients were selected to have idiopathic oligo-astheno-teratozoospermia, they underwent a detailed history, general and genital physical examination, Two semen analyses, baseline hormone profile and scrotal Doppler ultrasound examination . All
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patients were given a combination of oral antioxidants including vitamin E (400 IU. once daily), coenzyme Q10 ( 75 mg. tablet twice a day), zinc sulphate (15 mg. tablet three time a day) and L-carnitine ( 1000 mg. twice a day) for three months duration of treatment. Semen analysis was repeated after three months from initiation of therapy and was evaluated for changes in volume, concentration, motility and morphology in comparison with baseline semen analyses and any pregnancy was also documented.
Results
Thirteen patients (19%) get pregnancy after a period of 2 to 3 months, other patients show variable changes in their seminal analysis after 3 months. Thirty patients (45%) show increasing in seminal volume of 0.5 to 2 ml. , while the sperm concentration was increased in 28 patients(42%) . Twenty two patients (33%) show increasing in motility , morphology was increased in 34 patients (51%) .From all 66 patients; 6 patients (9 %) get improvement in all four parameters, while 9 patients (14 %) get improvement in only 3 parameters, 20 patients (30 %) get improvement in only 2 parameters, 23 patients (35 %) get improvement in only one parameter and 8 patients (12 %) had no improvement in any parameter.
Conclusion
This study demonstrates a possible role of combined oral antioxidants in the improvement of semen parameters and pregnancy rate for selected infertile men with superiority for the use of combination of antioxidants rather than single agent treatment.

Prevalence of bacterial vaginosis among women in Al-Diwaniya city by using Amsel’s criteria and Nugent’s scores

Rana S. Al-Taweel; Habeeb S. Naher; Abdaladeem Y. Albeldawi

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 152-158

This study has been conducted in Al-Diwaniya city through the period from December 2012 to December 2013, in order to investigate the prevalence of bacterial vaginosis, by using the clinical criteria and the scoring system. Results showed that only 6.25% had BV according to the clinical criteria. Accordingly, Amsel׳s criteria had low sensitivity (16.66%), but with high specificity (95.69%). The vaginal pH was the most sensitive criterion, while the most specific one was the clue cells (100% for both). According to Nugent׳s scores, 18 women in this group had BV (prevalence, 16.07%), 93 women were without this syndrome, and one women had unreported condition previously in Iraq; that is cytolytic vaginosis which is mainly characterize by low vaginal pH and an increase in numbers of lactobacilli.

Sensorineural Hearing Loss in Patients with Chronic Suppurative Otitis Media

Mazin Rajeh Jaber

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 159-163

introduction: The relationship between sensorineural hearing loss and Chronic Suppurative Otitis Media remains a controversial. damage of the cochlea and high-frequency sensorineural hearing loss was suggested to arise from passage of toxic substances and the drugs from the middle ear through the round window membrane into the inner ear.
Aim of study : To evaluate the incidence of sensorineural hearing loss in ears with chronic otitis media.
Method: This is prospective a study, consisted of 120 patients. They were 90 males and 30 females . they had been assessed at Otolaryngology department in Al-Diwania Teaching Hospital , in Al-Diwania city , Iraq, between January 2013 to December 2013, the age range from 10-60 years . inclusion criteria are as follows: unilateral continuous otorrhea through a perforated tympanic membrane for at least 3 months, normal tympanic membrane in the contralateral ear based on otoscopy. We do pure tone audiometry( PTA) for every Patient Exclusion criteria are history of head trauma or meningitis, previous tympanomastoid surgery, history of noise exposure ,systemic ototoxic drug therapy, family history of congenital or acquired sensorineural hearing loss, and post-traumatic tympanic membrane perforation. The control used was the contralateral ear with normal otoscopy.
Results: The mean bone conduction threshold in the diseased ear was 38.33 dB, and 10.1 dB in the control ear. The mean bone conduction threshold differences between the diseased and control ears range from 18.96 to 35.4dB across the frequencies 0.5,
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1.0, 2.0, and 4.0 kHz. These differences tended to increase with increasing frequency and were all significant (P < 0.05).
Conclusion: Patients with chronic suppurative otitis media had a significant degree of sensorineural hearing loss in this study. The higher frequencies were more affected

Blood group relationship with hypertension

Huda Jabbar Dibby

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 164-169

This study was carried out on two groups of subjects who are attending general medicine outpatient department in Al-diwaniya teaching hospital & some privet clinic during the period from September 2011 to October2013 . the age range of both group was 35- 70 years of both sexes . The Control group consist of normal 285 healthy subjects ,including 188 males and 97 females while the patients group consist of 210 patients who are suffering from hypertension of which 125 male & 85 females. determination of blood group using antisera was done for each subject. It was founded that blood group O is more predominant among hypertensive patients , no significant difference was founded between both sex among hypertensive patients.

Factors Associated With spectacle-wear compliance among hypermetropic pre-school children in Al-diwaniya Governorate, Iraq

Saif Abbas. Al-Shamarti

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 170-175

Background: Uncorrected refractive error are community health problem among pre-school children. It's also considered as the most common cause of avoidable visual impairment in children worldwide. Objective: This study intended to measure the extent of compliance of hypermetropic preschool children with spectacle wear and the factors connected with non-compliance.
Method: The study was carried out in my ophthalmology private clinic. One hundred and fourteen patients (114 patients) below 6 years old were enrolled this study. Each was interviewed by the author of correspondence. the possible factors associated with non-compliance with spectacle wear were identified.
Results: The total number of patients enrolled in this study was 114 among them 36% were compliance with spectacle wear while 73% were non compliance. The results also revealed that children less than 2 years were 12 and 35 in compliant and non compliant respectively. For gender distribution, there were 15 male and 26 female in complaint children while there were 39 male and 34 female in those who non complaint. Urban children showed high compliant for spectacle wear than rural one.
Conclusion: One of the risk factor for noncompliance with in the present study were region distribution and ignorance by family. More population based studies with larger sample should be conducted to assess the determinants of the spectacle use and the barriers to spectacle use should be addressed

Effectiveness and safety of the oxytocin antagonist( atosiban) versus beta-adrenergic agonists (salbutamol) in the treatment of preterm labor.

Yasamin H. Sharif Al-Shibany; Saba M. Swadi Al- Thuwainy

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 176-183

Background and Objectives: preterm labor complicates 5-10% of pregnancies and is a leading cause of neonatal morbidity and mortality worldwide and 70-80% of perinatal deaths occur in preterm infants. The aim of this study is to compare the effectiveness, safety and adverse effects of the oxytocin antagonist medication(atosiban) with those of beta-adrenergic agonist (salbutamol) in the treatment of patients with preterm labor.
Patients and Methods: one hundred pregnant women with preterm labor were enrolled in this study from the period of( January 2014 – January 2015) at Al-Diwaniya Maternity and Pediatrics Teaching Hospital-Iraq with a gestational age of 24-34 weeks, they were randomly assigned to receive tocolytics either salbutamol (n=50) or atosiban (n=50).Salbutamol was given by(intravenous infusion 10-50 microgram)for up to 48 hour. Atosiban was given by (intravenous bolus dose of 6.75 mg then 300microgram/minute for 3 hour and 100microgram/minute for up to 48hour). Retreatment with the study drugs or alternative tocolytic agents was allowed. Main outcome measures included were tocolytic effectiveness, which was assessed in terms of number of women undelivered after 48hour and 7 days. Tocolytic safety was assessed in terms of maternal and fetal side effects and neonatal morbidity.
Results: there were no significant differences between the salbutamol and the atosiban group in prolongation of pregnancy for 48 hour (44% versus
677
46%;p=0841)and 7 days(20% versus 32%;p=0.171) ,respectively. Maternal adverse events , including tachycardia occurred more frequently in the salbutamol group(22% versus 8%;p=0.050).Neonatal outcomes and complications were comparable between the two study groups(42% versus 32%;p=0.30).
Conclusions: the oxytocin antagonist (atosiban) was as effective as beta-agonist(salbutamol) in delaying threatened preterm birth , and found to be better tolerated by both the mother and fetus than salbutamol , with a comparable neonatal safety profil.This study supports the clinical use of atosiban as a first line tocolytic in the treatment of preterm labor

Detection of mec A gene in Staphylococcus aureus from Osteomyelitis infections

Osamah Faisal Kokaz

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 184-189

Background: Staphylococcus aureus is a major pathogen that associated with serious community acquired and nosocomial diseases. In view of the present problem the study aimed to isolation of S. aureus within osteomyelitis samples and amplified the mecA gene of some antibiotic resistant isolates.
Methodology: S. aureus were isolated from osteomyelitis and all isolates screened for antibiotic susceptibility test to detection of mecA gene.
Results: 29 swabs were taken from both sex patients related to Al- Sammawa Teaching hospital at period from September 2013 to march 2014. Only 14(48.27%) patients had S. aureus and 19 isolates yielded from all samples. These isolates showed pronounced resistance for a group of active antibiotics. Five isolates have full (100%) resistance to oxacillin, penicillin and cefoxitin so considered as Methicillin Resistant Staphylococcus aureus (MRSA). Genetic identification showed that five S. aureus isolates have mec A gene in their genome.
Conclusion: This study highlights the presence osteomyelitis infection in both sex with little incidence. S. aureus one of the important pathogens that have resistance to many antibiotics due to mecA gene.

The Relationship among Interlukin-10 ,Interlukin-6 with anti-cyclic citrullinated peptide antibody, C-reactive protein ,Rheumatoid factor in patients with Rheumatoid Arthritis

Ahmed Abbas Hasan

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 190-196

Rheumatoid arthritis (RA), the most severe disease affect the joint and also the most common systemic autoimmune disease, affecting approximately 1% of the adult population .We investigate the serum levels of IL-10 and IL-6 in patients with Rheumatoid arthritis. About forty patients with Rheumatoid arthritis (30 female and 10 male) with ages ranged between (20-70) years were taken from (Al-Hussein Medical City/Kerbala).Control group consisted of 20 healthy people were free from signs and symptoms of arthritis were matched in age and gender with patients, and had no history for any arthritis problem .IL-10 (IL-10-EASIA Kit, DIAsource) (IL-6 ELISA kit ,immunotech),(Anti CC-P ELISA kit ,Medizym/Germany ) ,(RF ELISA Kit Euroimmun/Germany) were measured using the enzyme-linked immunosorbent assay (ELISA) method and CRP Vital kit using quantitative turbidimetry method . t-test , ANOVA and Pearson correlation were used to analyze results by using SPSS version 22. P-value ≤ 0.05 was considered significant. IL10,IL6,Anti-CCP,CRP and RF were increased significantly (p< 0.05) in patients compared with control group, So increasing of IL10,IL6,Anti-CCP,CRP and RF values at mild stage (41.4±1.3),sever stage(54.8±0.8),sever stage(952±114), server stage(49.3±1),sever stage (181.3±11) respectively increased significantly value (p< 0.05) among the stages, The results revealed no significant value (p>0.05) among the age groups and according the gender groups, While there were highly significant correlation (p< 0.05) found among studded parameters

The Relationship Between The Type 1 Diabetes And Celiac Disease: A Study Based On Anti Tissue Transglutaminase Antibodies And Anti-Glidine Antibodies Screening

HammadiA.AL-Hilali; Bassim I. Mohammad; Ali H. Khlebos

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 197-204

Background: The present investigation aims to study the prevalence rate and clinical characteristics of celiac disease(CD)among Iraqi children with type1 diabetes mellitus using a combination of the most sensitive and specific screening serologic tests anti-tissue transglutaminase antibodies IgA,IgG(tTG)and anti-gliaden antibodies IgA,IgG(AGA) and to determine the lower cut-off value of anti-tTG and anti-AGA level that best predicts celiac disease in patient with type1 diabetes. Materials: Two patient groups have investigated (each to NO =30) in this study one with celiac disease and the other with type1 diabetes mellitus compared to third group of apparently healthy control group of 20 individuals. patient with positive anti-tTG titer and AGA titer (>18 U/ml) and patient with equivocal of anti-tTG and AGA titers(12–18 U/ml) and negative titers (<18 U/ml ) Results: The median calculation of Anti-gliadin IgA (Uml) were ;1.6 ,6.15 and 27.4 among healthy group ,type1 diabetes mellitus, and celiac disease patient respectively. An interesting ROC values (AUC 0.949-1.000) for this auto-antibodies as a perfect test in this aspect. In the same context, the IgG ,class of this auto-antibody occurred in median concentration of 3.05, 5.7 , and 21.85 among the three groups ,respectively. It significantly differed among this group and as compared to each other's. For anti-tissue transglutamenase assays ,Both IgA and IgG were provided with significant differentiation tools when compared among the three studied groups both classes provided had high ROC (0.947- 1.000). Conclusion: From the result of this study, we concluded the overlapping auto-antibodies profile celiac disease and type1 diabetes mellitus

The natural courses of keratometric, pachymetric and visual acuity outcomes during 1year follow up after corneal collagen cross-linking

Suzan Amana Rattan; Mahir Kadhim Mutashar

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 205-212

Background:
As photochemical reaction that can stiffen the cornea, CXL is the only promising method of preventing progression of keratectasia such as KC and secondary ectasia following refractive surgery. The aim of CXL is to stabilize the underlying condition with a small chance of visual improvement.
Setting: Lasik specialty center /Baghdad/Iraq.
Purpose: To show the sequences of changes in visual acuity and topographic outcomes during 1 year post CXL for patients with progressive Keratoconus.
Patients and methods:
CXL procedure was done for 45 eyes with progressive KC. The following parameters had been monitored pre operatively, 1, 3, 6 and 12 months postoperatively: K apex, K2, corneal thickness at thinnest location, anterior and posterior elevation points, BCVA and UCVA. Placido –Scheimpflug topography (Sirius) device had been used to monitor the corneal parameters of the study. One –way ANOVA and Paired sample T test was used for statistical analysis.
Results: At 1 year, an averages flattening of (2.11 D) diopter in K2 and (1.88 D) diopter in K apex were found. Mean BCVA improved by 1 line from (0.18) Log MAR to (0.13) Log MAR and mean UCVA improved by 3.5 lines from (0.89) to (0.64) log MAR. The corneal thickness at thinnest location was 5.71 Mm less than the baseline. All the above mentioned parameters showed a trend of worsening between the baseline and 1 month, and improvement
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thereafter. We found no statistically significant changes in the anterior elevation points while the posterior elevation point changed (increased) significantly.
Conclusions: Corneal collagen cross-linking seems to be effective in decreasing progression of KC , with improvements in optical measures in many patients. Post operative parameters discussed within this review followed a seemingly reproducible trend in there natural course over 12 months .Generally, the trend that observed was immediate worsening between baseline and 1 month resolution at approximately 3 months, and improvement thereafter.

Tamoxifen gynecological side effects

Ghufran .J. E.Alsereah

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 213-218

Prospective comparative study done in basrah maternity and child hospital over a period of two years from 2002- 2004 , on breast cancer patients treated with tamoxifen which is estrogen receptors modulators with paradoxical effects ( agonist on some tissue and antagonist on others. This study aimed To compare side effect of tamoxifen on both studied groups Premenopausal and postmenopausal .
This study included96 Symptomatic pre and postmenopausal breast cancer treated patients with tamoxifen assassed by history and then examination was performed
Then endometrium assessed by transabdominal ultrasound to check thickness then almost all patients subjected to endometrial biopsy under general anesthesia, about 45.8% of patients between 50-60 years of age 41.6% of patients had advanced stages of cancer , vaginal bleeding which is the most common symptom symptoms presented in 68.7% ,while 22.8% , 8.28% had vaginal discharge and pain respectively.
ultrasound findings showed 22.9% endometrial thickness less than 6mm , 41.6% endometrial thickness 1 cm and more ,10.3% showed polyps and fibroid . no
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statistical difference between pre and postmenopausal inUSS findings with p value = 7.81, x2= 13.7, df=3
21.2% showed atrophic endometrium, 16.9% showed endometrial hyperplasia , bulk 44.6% showed non secretory ( proliferative) , with no cases of endometrial carcinoma . No, statistical difference between pre and postmenopausal findingsP value = 9.49 , x2 8.652 , df= 4 .In conclusion the main sharing symptoms in both groups was vaginal bleeding, USS had a poor predictive value in detecting changes in both studied group
Our study did not confirm risk of endometrial carcinoma , with no statistical difference in risk of hyperplasia between pre and postmenopausal studied groups

Nd YAG LASER treatment for leukemic childhood blindness

Mustafa Twafeeq Hilbous

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 219-226

Abstract:
Aim of the study: is to study the rule of laser therapy by the (Nd-YAG) laser in the treatment of premacular haemorrhage in leukemic children
Method:
It is a prospective study was taken in department of ophthalmology in al hilla teaching hospital .eleven eyes of eight children 3 girls and 5 boys age between 7-14 years old and they have premacular haemorrhage due to leukaemia .family permission was taken after explaining to the family the surgical procedure .topical anesthesia by lidocaine and pupil dilatation by mydriacil and the Goldman 3 mirror and Nd –YAG laser was delivered the power was 5 mj and increased by 1 mj when the desired response not gained and the power should not exceed 11mj and the number of shoots should not exceed 10 per section and the pt was followed after 1 week then after 6 weeks then after 3 months.
Results:
Drainage of the premacular hemorrhage into the vitreous happened in 9 eyes of 11eyes after the end of the follow up period which is 3 months
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The mean force used was 6.5 mj
After 1 week the improvement in VA was between hand movement and 6/6 and the mean was 6/18
After 6 weeks the improvement in VA was between hand movement and 6/6 and the mean was 6/9
There is no big difference in improvement in VA after 3 months to that after 6 weeks
One pt who had lymphoblastic leukemia had clotted hemorrhage that could not be drained into the vitreous
And another pt who had myeloid leukemia had re-hemorrhage as a result of deterioration in his illness
Conclusion:
From the result of this study we can see that the use of Nd-YAG laser in the treatment of leukemic pts with premacular hemorrhage is safe and effective in comparing with parsplana vitrectomy under GA specially when we use good selection of pt especially those with bilateral premacular hemorrhage and we can consider the Nd-YAG laser as a routine therapy for the leukemic children with premacular hemorrhage.

Assessment of Myocardial Infarction Risk among Patients in Babylon City

Hussam Abbas Dawood

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 227-238

Introduction
The idea of assessment of myocardial infarction risk factors among patients comes while Cardiovascular disease is the leading cause of death in Iraq.1 While myocardial infarction has been described to have an epidemic like spread all over the world with special emphasis on countries experiencing the transition to lifestyle, it is important to evaluate the life style and behaviors of those patients after the onset of myocardial infarction.2
Objectives
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Presented study aimed to assess and find out the frequency and significance of known risk factors in our patient population in Babylon City of myocardial infarction patients.
Materials and Methods
Descriptive design for risk factors of myocardial infarction among patients life in Babylon City were assessed.150 patients were a purposive sample from Babylon community to participate in this study (108 Male, 42 Female). Those are patients with myocardial infarction included from two main hospitals an Al-Hilla hospital n=100, Marchan hospital n=50, CCU unit. Microsoft Excel and SPSS software were used to analyze the data collected and to obtain results.
Results
Most of sample study participants were more than 40 years old. The majorities of participants live in Babylon city, finished their secondary level of education and illiteracy patients level. The results according to the gender were 64.81%of males and 66.67% of females of the study sample were diabetic, and 80.56% of males and 71.42% of female of the study sample were hypertensive, while 59.26% of males and 35.71% of females of the study sample electives had cardiac diseases. All participants were surveyed for diet, physical activity, smoking, knowledge, attitude, practice, and drugs compliance. Most of patients have no physical activity (86% of males and 98% of females), no control diet (65% of males and 48% of females), while percent of smoking patients were high according to their health situation (60% of males and 21% of females).
Conclusion
The political and economical situations of Patients in Babylon city, and lack of health information among patients and their families, were the major reason of the lifestyle impairment. Patients who survived acute myocardial infarction need more attention and rehabilitation programs, this needs the efforts of primary health care centers, Nurses and cardiologists.

Diagnosis and Assessment of Severity of Neonatal Hyperbilirubinæmia in Babylon Governorate, Incorporating Serum Albumin Level As A Sensitive Predictor of Outcome

Ameerah MA Al Hassan; Mazin J. Mousa; Safa W. Azeez

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 239-244

Neonatal jaundice is a common health problem in Iraqi neonates and oriental populations in general. Proper diagnosis and management is crucial to prevent brain damage by high concentrations of bilirubin (kernicterus). Neonatal jaundice is also regarded as the most common cause of hospitalization of neonates. It is widely agreed that the causes of neonatal jaundice is alteration of a panel of physiological factors including rapid postnatal destruction of excess red blood cells, derangement of liver clearance function and prematurity.
This study was designed to reveal the importance of determining serum albumin level as a predictor of liver function in neonates with jaundice. Sixty-four patients were included in this study during a period of four months. A ratio between bilirubin and albumin levels (B/A ratio) was depicted. A B/A ratio of < 2 showed no risk of exchange transfusion as a treatment modality in all four patients aged 5-12 days, noting that there are no neonates aging 2-5 days with a B/A ratio of < 2, reflecting the accelerated course in this age group. A ratio > 4 carried a high risk of exchange transfusion (18 out of 23 in those aging 5-12 days). The grey zone of B/A ratio lying between 2-4 needed further follow up and more clinical determinants to be treated properly, only 5 out 21 were treated by exchange transfusion aging 5-12 days, while only 1 out of 8 aging 2-5 days was subjected to exchange transfusion. It is clear that the B/A ratio is a good indicator of the severity of neonatal jaundice, predicting the modality of treatment options.

A comparison of conjunctival rotation flap and autoconjunctival graft techniques in pterygium surgery at aldiwaniah teaching hospital from 2007_2013

Hassanen abdalameer hadi; Hassanen hassan alrikabi

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 245-249

purpose: to compare the result of conjunictival flap and autograft in term of recurrence rate and complication in Pterygium surgery.
Methods: A total of sixty patients(twenty five male and thirty five female) operated for pterygium with conjunctival autografts(in 25 eyes) or conjuctival flap(in 35 eyes) technique at diwanyia teaching hospital and with 18 months follow-up were registered. Patients were called for voluntary examinations of their respective ocular surface status .
Result: Mean age was 42.5 years (range, 23–75), 58.33% of the patients were male, and 75% worked predominantly outdoors. Mean follow-up was 12 months (range, 3–18)
Recurrence rate was 8%in graft,8.6%in flap, however edema was less in flap and granuloma was nil in both.
Conclusions: After a long follow-up period for autograft and conjunctival flap pterygium surgery, there were no statistically significant differences in recurrence rates ,as well as flap is faster and easier technique with less postoperative edema.

Inferior rectal nerve block as analgesic for haemorroid surgery

Raad Abdullah Ali Al-Khafaji

Al-Qadisiah Medical Journal, Volume 11, Issue 2, Pages 250-253

Aim : Is to evaluate the effectiveness of Inferior Rectal Nerve block ( IRNB ) in hemorrhoid
surgery for post operative ( post op ) pain in the first 24 hours.
Aim:
The aim is to evaluate the effectiveness of IRNB as analgesic in haemorrhoid surgery in the
first 24 hours post op.
Methods:
Efficacy of IRNB for hemorrhoid surgeries was prospectively evaluated on 200 consecutive
patients over 14 months. Patients were divided into 2 groups. 100 patients received LA ( Twenty ml of local anesthetic ( 10 ml 0.25% bupivacaine and 10 ml 1% lignocaine with adrenaline was infiltrated into the anal sphincter under GA ( Group A ) , and 100 patients did not receive IRNB ( group B ). Rescue analgesia in the form of tramadol and diclofenac was available.
Duration of analgesia; postoperative pain based on verbal response score (VAS 0-10); and complications were analyzed and recorded.
Results:
200 open haemorrhoidectomies were performed. Injection was done just after commencing
GA , and 5 minutes onset time allowed before surgery started. Operative time ranged from 10-20 minutes .
In Group B, tramadol and diclofenac were administered as rescue analgesia.
Post op pain based on VAS was assessed during the next 24hours. Injection site hematoma (1%) was a reported complication in-group A.
Conclusions:
IRNB is effective, simple and effective analgesia in hemorrhoid surgery.