العلم العراقي
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تقييم مؤشرات النمو لدى الاطفال المصابين بداء السكري من النوع الاول المراجعين لمستشفى حماية الاطفال التعليم / مدينة الطب بغداد / العراق 2017 == Evaluation of growth parametersamong children with Type 1 Diabetes Mellitus attending Diabetic clinic at Children Welfare Teaching Hospital / Medical City Baghdad - Iraq, 2017

اسم المؤلف: زينة ستار هادي
اسم المشرف: ايمان عدنان القصير
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: طب العائلة
الدرجة: دبلوم عالي
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease characterized by lack of insulin production, it is the most common type of diabetes in childhood. T1DM was listed among the causes of growth retardation in children. Glycemic control is an important factor in growth of children with T1DM.Objectives : To assess growth parameters (height, weight and body mass index [BMI] )in children with T1DM, and to study the impact of age at diagnosis, duration of disease, and glycemic control on growth indices.Patients and methods : A cross sectional study was conducted at diabetic clinic in Children Welfare Teaching hospital - Medical City - Baghdad, for the period from the 1st of February to the end of May 2017. A total of 100 children with T1DM between (2 - 14) years of both gender was included in the study, the information were obtained directly during interview including : relevant demographic data, disease information (age at diagnosis, duration of disease and type of presentation). Also each patient had two measurements for weight in kilogram and height in centimeter first one was measured by researcher at the time of interview and the second one obtained from their case file around the time of diagnosis.Results : A total of 100 children with T1DM included in this study showed that male to female ratio were equal. Peak age of children at diagnosis was less than 5 years. Most of patients presented with classical signs and symptom (64%). Of the total diabetic children in this study, (5%), (2%), and (5%) were stunted, wasted and underweight, respectively. Duration of T1DM was a significant determinant of growth indices (height and weight). Conclusions and Recommendations : Retarded growth indices (height and weight) were the highest growth problems among diabetic children. Duration of diabetes was an important determinant of growth parameters. We recommend for paying attention to anthropometric measurements in management of T1DM and participation of PHCC in the management plan.

دراسة جزيئية للطفرتين NPM1 - A وFLT3 - ITD مع التعبير النسخي للمورث الجزيئي FLT3 في نموذج من المرضى العراقيين البالغين المصابين بابيضاض الدم النقياني الحاد وعلاقتهما مع المؤشرات السريرية والمختبرية == Molecular Study of NPM1 - A, FLT3 - ITD Mutations and FLT3 Transcript Expression in a Sample of Iraqi Adult Acute Myeloid Leukemia Patients : Their Correlations with Clinicopathological Parameters

اسم المؤلف: شيماء محمد عبد اللطيف
اسم المشرف: ختام رزاق كاظم الخفاجي | علي محمد جواد
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - الدم
الدرجة: دكتوراه
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Acute myeloid leukemia is a hematological malignancy of myeloid progenitor cells characterized by anomalous proliferation, inhibition of differentiation and extension of leukemic cells blocked at the early stage of hematopoiesis. It has a great variability in the pathogenesis, clinical features, and treatment outcomes. Detection of molecular markers has become a smart tool to further division of patients in acute myeloid leukemia subgroups.Nucleophosmin1 mutations are found in approximately 30% of adult acute myeloid leukemia patients and are associated with a good outcome when detected in absence of duplications in the Fms - like tyrosine kinase 3 gene. Over 50 molecular Nucleophosmin1 mutation variants have been recognized; the most common one is Nucleophosmin1 - A mutation.The Fms - like tyrosine kinase 3 receptor is expressed on the surface of hematopoietic stem cells and plays a vital role in normal hematopoiesis. Numerous studies have revealed that high levels of Fms - like tyrosine kinase 3 were expressed in patients with acute myeloid leukemia. Fms - like tyrosine kinase 3 - Internal tandem duplication mutations are found in around 20 - 25% of patients with acute myeloid leukemia and are associated with increased transcript level of Fms - like tyrosine kinase 3 and with a poor scenario in adult acute myeloid leukemia patients.Aim of the Study1. Detect the frequency of Nucleophosmin1 - A; Fms - like tyrosine kinase 3 - Internal tandem duplication along with assessment of Fms - like tyrosine kinase 3 transcript expression in a sample of newly diagnosed Iraqi adult acute myeloid leukemia patients.2. Study the relationship of Nucleophosmin1 - A, Fms - like tyrosine kinase 3 - Internal tandem duplication mutations and Fms - like tyrosine kinase 3VItranscript expression with various clinicopathological parameters and French - American - British subtypes of the disease as well as the correlation among the three markers.Materials and MethodsThis is a cross - sectional study, conducted during the period extending between April 2015 and September 2016. The bone marrow aspirate samples of 53 adult acute myeloid leukemia patients were collected at the time of diagnosis and prior to treatment at the Hematology Ward of Baghdad Teaching Hospital in Medical City compared with 53 control individuals. All the control bone marrows obtained from patients with anemia and idiopathic thrombocytopenic purpura and were negative for infiltrative lesions. The related clinical and laboratory data for each patient were registered at the time of diagnosis.The study was conducted at Main Laboratory of Baghdad Teaching Hospital/ Medical City, Clinical and Communicable Diseases Research Center/College of Medicine/ University of Baghdad and Postgraduate Laboratory of Pathology and FoThe RNA was extracted and was reverse transcribed into cDNA. Real time polymerase chain reaction technique was applied on bone marrow aspirate samples of acute myeloid leukemia and control groups to detect the frequency of Nucleophosmin1 - A mutation, Fms - like tyrosine kinase 3 expression using a TaqMan probe and SYBR green assays respectively and detection of Fms - like tyrosine kinase 3 - Internal tandem duplication mutation using gel electrophoresis post polymerase chain reaction procedure

الكشف المبكر للخلل الوظيفي لعمل البطين الايسر الانقباضي في المرضى المصابين بارتجاع الصمام الابهر المزمن غير ذوي الاعراض باستخدام صدى القلب ثنائي الابعاد ذي التتبع النقطي == Early Detection of Left Ventricular Systolic Dysfunction In Asymptomatic Patients with Chronic Aortic Regurgitation by Two Dimensional Speckle Tracking Echocardiography

اسم المؤلف: ثامر عماد احمد
اسم المشرف: امال نوري المراياتي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: صدى القلب
الدرجة: دبلوم عالي
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Chronic aortic regurgitation (AR) is a left ventricular (LV) volume overload lesion with a long latency period prior to symptom development. Prior to symptoms, patients may exhibit normal exercise tolerance associated with LV remodeling and a preserved ejection fraction (EF).Conventional echocardiography has many limitations in prediction of early LV systolic dysfunction. Therefore; early detection of subclinical LV systolic dysfunction is crucial and could influence patients' prognosis by aiding the clinician to candidate patients for better management.Recently, 2 - D speckle tracking echocardiography have been shown to be useful noninvasive tools for detecting subtle LV contractile changes in the prior to reduced LVEF in patients with chronic AR .Aim of the Study : To detect early LV systolic dysfunction in asymptomatic patient with chronic aortic regurgitation by two dimensional speckle tracking echocardiography comparing that to conventional echocardiographic systolic parameters (EF by Simpson’s method and MAPSE ) and tissue Doppler echocardiographic systolic parameter ( s) .Patients and Methods : Sixty one asymptomatic patients with chronic aortic regurgitation, with no ischemic heart diseases ( by Angiography ) or conductive heart diseases, no diabetes mellitus, no hypertension, and no other valvular heart diseases (group 1) and fifty age and sex - matched healthy subjects (group 2) were enrolled into the study. Group (1) was further classified into 3 sub - groups according to 4 chosen parameters from the published guidelines of ASE into : Mild AR, Moderate AR, and Severe AR.All patients and controls underwent echocardiographic examination including conventional echocardiography, tissue Doppler study and 2 - D Speckle Tracking Echocardiography.Results : As compared to other systolic parameters ,global longitudinal strain measured by 2 - D speckle tracking echocardiography was the most useful tool to detect subtle LV systolic dysfunction with sensitivity and specificity of 75.4% and 99% respectively and AUC of 0.928 for a cut off value of > ( - 19.62).Moreover, GLS has highest sensitivity and specificity in detection of subtle LV systolic dysfunction in moderate AR .In moderate AR ,a cut off value of > ( - 19.62) has sensitivity and specificity of 91.3% and 95.5% respectively, with PPV and NPV of 87.5% and 96.9% respectively, AUC of 0.981 and a P value of <0.0001. In all types of AR, GLS had higher NPV than PPV which makes it a powerful screening tool for early detection of subtle LV systolic dysfunction.Conclusion : Global Longitudinal strain measured by 2 - D speckle tracking echocardiography is an excellent tool for early detection of subtle LV systolic dysfunction in asymptomatic patients with chronic AR.

ارتفاع ضغط الدم الرئوي في مرضى السل الرئوي النشط == Pulmonary Hypertension in Active Pulmonary Tuberculosis Patients

اسم المؤلف: مروة بسام عيدان
اسم المشرف: عدنان الجبوري
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - الصدرية
الدرجة: دبلوم عالي
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: الخلفية : السل الرئوي هو واحد من اكثر الامراض المعدية شيوعا التي تواجهها في الممارسة السريرية، واكثر من ذلك في البلدان النامية. وقد تم الابلاغ عن عدد قليل جدا من الدراسات بشان ارتفاع ضغط الدم الرئوي في السل الرئوي النشط اهداف الدراسة : لتقييم حدوث ارتفاع ضغط الدم الرئوي في مرضى السل الرئوي النشط في غياب امراض الرئة الاخرى او امراض القلب الاولية .المواد والطرق : خلال الفترة من 1 ديسمبر 2016 الى 30 مايو 2017 اجريت دراسة مستعرضة على 50 مريضا بالسل الرئوي النشط. لجميع المرضى، تاريخ مفصل، الفحص السريري الدقيق، تخطيط القلب , الاشعة السينية للصدر، واختبارات الدم الروتينية. جميع المرضى الذين تم تقييمهم عن طريق دوبلرصدى القلب خلال الصدر بما في ذلك تقدير الضغط الانقباضي الشريان الرئوي وثلاثي الشرف الحلقي خطة الحلقة الانقباضي النتائج : . وجد انه من 50 مريض بالسل الرئوي النشط، كان 4 (8٪) ضغط الشريان الانقباضي الشريان الرئوي ≥40 ملم زئبق، اثنان منهم كان تمدد البطين الايمن <16ملموكان هناك ارتباط كبير بين مرضى السل وارتفاع متوسط العمر، (ع = 0.01 )وارتفاع معدل تعديل ضيق مجلس البحث الطبي (ع <0.0001)، والام في الصدر (ع = 0.01)، وانخفاض تركيز الاوكسجين الدم (ع = 0.001) وتسارع دقات القلب الجيبي (ع = 0.01) وانصباب التامور (ع = 0.01). لا توجد فروق ذات دلالة احصائية بين مرضى السل مع وبدون ارتفاع ضغط الرئوي فيما يتعلق بتاريخ البتدخين واستنتاجات اشعة الصدر فيما يتعلق بالمشاركة من جانب واحد وثنائية الجانب وافة تجويفية.الاستنتاج : ارتفاع ضغط الدم الرئوي بين مرضى السل الرئوي النشط في غياب امراض الرئة الاخرى او امراض القلب الاولية ليس بالامرالغير شائع. | Background : Pulmonary tuberculosis is one of the commonest infectious diseases which are encountered in clinical practice, more so in developing countries. Very few studies have been reported regarding the pulmonary hypertension in active pulmonary tuberculosis. Aims of study : To assess the incidence of pulmonary hypertension in active pulmonary tuberculosis patients in the absence of other lung disease or primary cardiac disease. Materials and Methods : During the period from 1st of December 2016 to 30th of May 2017, a cross - sectional study was done on 50 patients with active pulmonary tuberculosis. For all patients, detailed history, careful clinical examination, electrocardiography (ECG), chest x ray (CXR), and routine blood tests were done. All patients evaluated by transthoracic Doppler echocardiography including estimation of pulmonary artery systolic pressure (PASP) and tricuspid annular plane systolic excursion (TAPSE). Results : Among 50 active pulmonary tuberculosis (PTB) patients, 4 had pulmonary artery systolic pressure (PASP) ≥40 mm Hg, 2 of them had right ventricular dilation and TAPSE <16mm. The incidence of pulmonary hypertension (PHT) among active pulmonary tuberculosis (PTB) patients was 8%.There was a significant association between PTB patients with PHT and higher mean age (p=0.01), higher Modified Medical Research Council dyspnea scale (p<0.0001), chest pain (p=0.01), lower oxygen saturation (SpO2) (p=0.001), sinus tachycardia (p=0.01) and Pericardial effusion (p=0.01). No significant differences between PTB patients with and without PHT regarding smoking history and CXR finding of pulmonary tuberculosis lesion regarding unilateral and bilateral involvement and cavitary lesion. Conclusion : Pulmonary hypertension among active pulmonary tuberculosis patients in the absence of other lung disease or primary cardiac disease is not uncommon in this study.

تاثير الفيتامينات B1,B6 and B12) على الاعتلال العصبي المحيطي : دراسة نسيجية، نسيجية كيميائية وكيميا نسيجية مناعية == The effect of vitamins B1, B6 and B12 on peripheral neuropathy , Histological , Histochemical and Immunohistological studies

اسم المؤلف: صالح مهدي علي
اسم المشرف: معن حمد الخالصي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: التشريح والانسجة والاجنة
الدرجة: دكتوراه
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Peripheral neuropathy is a nerve injury process by disease or so on leading to damage of peripheral nervous system . Diabetes mellitus and compression are most common causes of peripheral neuropathy. Vitamins (B1,B6 and B12) commonly used for treatment of peripheral neuropathy. The objective of this study is to compare the effect of vitamins (B1,B6 and B12) on nerve regeneration and recovery after induced sciatic nerve crush injury in experimental animal model.Seventy five male Swiss albino rats were divided randomly into five groups and each group consisted of 15 animals. Group A( which considered as control positive(with crush injury) received normal saline intramuscularly for 45days. Group B received vitamin B1 , group C received vitamin B6 , group D received vitamin B12 and group E which considered as control negative(no crush injury and no treatment) . All animals were injected vitamins intramuscularly for 45days. Tail flick test time was reduced in rats treated with vitamin B12 after crush injury to the Sciatic nerve. Mid thigh circumference (MTC) was significantly increase in B12 treated group after crush injury to the Sciatic nerve. Data analysis was performed by SPSS 20 software using descriptive statistics.IVHistological examination of rats sciatic nerves stain by H&E on day 15 showing degenerative nerve fibers with Schwann cell infiltration in all groups but it is less prominent in group D. On day 45 histological examination of rats gastrocnemius muscles exhibited separation of bundles muscle fibers by connective tissue, variation of fibers in size and shape with atrophy of muscle bundles in all groups .While these were less prominent in rats treated with B12.Van Giesons staining of rat sciatic nerves on day 45 after crush injury. In all groups experimental and control (B,C,D,A) showing degenerative nerve fibers in different areas but less in group D and better organized sciatic nerve fibers in group D.Finally, Immunohistochemical study of (anti S100 protein) of rat sciatic nerves on day 45showed strong activity for those rats treated with vitamin B12 while rats treated with vitamin B1 and B6 exhibited moderate and weak activities respectively .In conclusion vitamin B12 promote peripheral nerve regeneration more than vitamin B1and vitamin B6.

التقييم الجزيئي لعوامل الخطورة الوراثية لامراض القلب والاوعية الدموية لعينة من المرضى العراقيين المصابين بنقص التروية القلبية الحاد == Molecular Assessment of Cardiovascular Genetic Risk Factors among a Sample of Iraqi Patients with Ischemic Heart Diseases

اسم المؤلف: وسام جاسم محمد
اسم المشرف: بسام موسى صادق الموسوي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - الوراثة
الدرجة: ماجستير
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Ischemic heart disease (IHD) is a major cause of morbidity and mortality worldwide; its incidence is increasing in developing countries. It is estimated that 17.5 million individuals die from CVD each year, accounting for 31% of all deaths worldwide; more than 75% of these deaths occur in low to middle income population. Understanding the pathogenesis of IHD has been modified over the years and many new genetic risk factors have been recognized. Attention is now focused towards understanding the genetic basis of IHD. Enormous effort has been invested in understanding the genes and specific DNA sequence variations responsible for this heritability and genetic polymorphisms might be risk factors that predispose to IHD.Aim of Study : To analyze the genetic risk factors among Iraqi patients with acute IHD and to determine the frequency of each type of mutation / polymorphism.Patients, Materials & Methods : This is a cross sectional study that recruited 56 patients admitted to the Cardiac Care Unit (CCU) of Ibn Al - Nafees Teaching Hospital with a clinical diagnosis of acute ischemic heart disease (myocardial infarction and unstable angina) during a two - month period between December 8th, 2015 and February 8th, 2016. All cases <50 years with acute MI or angina were included, while those >50 years and those with documented hyperlipidemia were excluded.Demographic and clinical data of the enrolled patients were reported. Two - three ml of peripheral blood samples were aspirated from all recruited patients and collected in K2EDTA tube to be store at - 20oC for further DNA analysis. Molecular analysis to detect 12 commonIIImutations/ polymorphisms, namely : FV G1691A (Leiden), FV H1299R (R2), Prothrombin C20210A, Factor Xlll V34L, β - Fibrinogen - 455 G - A, PAI - 1 4G/5G, GPllla L33P (HPA - 1), MTHFR C677T, MTHFR A1298C, ACE l/D, Apo B R3500Q, and Apo E2/E3/E4 was performed by PCR amplification using biotinylated primers and hybridization of amplification products to a test strip containing allele - specific oligonucleotide probes immobilized as an array of parallel lines. The bound biotinylated sequences were detected using streptavidin - alkaline phosphatase and color substrates according to the manufacturers’ instructions.Results : The age range of patients was 18 - 50 years, with a mean ±SD of 40±7 years. The vast majority of enrolled cases were males (54/56 (96.4%). The traditional risk factors were frequently encountered in the current study (hypertension 21.4%, diabetes 26.8%, smoking 75%, family history of IHD 48.2%, and previous attack of ischemia 23.2%). Serum troponin was positive in 72.2% of cases. The study found that the genotype frequencies of 12 genetic mutations / polymorphisms were as follows :  MTHFR A1298C and C677T were the highest reported mutations among the study group (62.5%) and (50%) respectively, followed by β - fibrinogen gene mutation detected in (46.5%), and PAI - 1 4G/5G polymorphism which was detected in (75%) of patients, while PAI - 1 4G/4G was detected in (16.1%) of patients. Homozygous ACE D/D polymorphism was present in 35.7% in our cases and heterozygous HPA - 1(a/b) polymorphisms was present in 28.6%. The E4 allele of Apo E gene was present in 7.1% of the studied cases.IV Heterozygous factor XIII (FXIII) V34L variant was detected in 21.4% patients, while homozygous state was detected in 3.6% patients, i.e. 25% of selected cases had Leu allele,  Heterozygous FV R2 was detected in 12.5%, and factor V Leiden mutation was detected in 1.8%, while no abnormal homozygous alleles were detected.  Prothrombin G20210A mutation were detected in 1(1.8%) patient. Neither heterozygous nor homozygous states for the mutant Apo B allele were detected in this study. The study showed no statistically significant difference between age group I (<40 years) and age group II (40 - 50 years), but the study showed higher frequency for some genes like PAI - 1(4G) and Apo E4 alleles in group I than group II (100% versus 85.3%) and (13.6% versus 2.9%) respectively, while HPA - 1 (a/b) polymorphism was higher frequent in group II than group I (35.3% versus18.2%).Subgroup analysis of the studied traditional risk factors (hypertension, diabetes mellitus, smoking, family history of ischemic heart disease) showed that β - Fibrinogen mutation had higher frequency in smoker patients than nonsmokers (50% versus 35.71%), the D allele of ACE gene was more frequent in hypertensive than in non - hypertensive patients (91.7% versus 79.5%), and higher frequency of HPA - 1b allele in diabetic than non - diabetic patients 46.7% versus 22%).Genetic risk score (0 - 16) was established according to the number of risky alleles detected in each case; the results showed that all patients had at least 2 genetic risk factors and none had more than 8; the study also showed that patients with 4 or more risky genes represented 82.14% of the studied patients, and that the risk of IHD increases in those who carry 4 or more genetic risk factors when associated with at least one traditional risk factor.

تحليل نتائج وخز الرئة القطعي لاربعين مريض في مستشفى بغداد التعليمي == Analysis of Tru - Cut Biopsy Findings In Forty Patients with PERIPHERAL Lung Lesions in Baghdad Teaching Hospital

اسم المؤلف: احسان سلمان
اسم المشرف: مصطفى نعمة عبد علي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - الصدرية
الدرجة: دبلوم عالي
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: وخزة الرئة التحت الجلدية هي من اكثر الطرق شيوعا في الوقت الحالي معها العديد من الطرق المستخدمة في امراض الجهاز التنفسي .واحده من اهم الطرق هي طريقة الوخز القطعي بمساعدة المفراس الحلزوني .اهداف دراسة البحثلاجل تحليل النتائج من جراء عملية الوخز القطعي في مستشفى بغداد التعليمي لسنة 2015 - 2016.الطرق والمرضىاجريت دراسة مرجعه عن هذه الطريقة ووجدت كثير من النتائج ما يخص الديموغرافية والدلائل الاشعاعية والتشخيص والمضاعفات الناتجة من المرضى الذين اجروا هذه العملية الوخز القطعي تحت السيطرة للمفراس الحلزوني .النتائجاربعون مريض كانوا تحت الدراسة الخاصة للبحث ثلاثون مريض كانوراجال وعشر مرضى نساء .اعمار المرضى تتراوح ما بين 18 - 80 ومعدل العمر للمرضى هو 14.1 سنه . ±58.6 21 مريض من الرجال حاليا مدخنين و6 غير مدخنين و3 مدخنين سابقين بينما من النساء كانوا 3 مدخنين حاليا و5 غير مدخنين و2 مدخنين سابقات .اكثر الاعراض شيوعا بين المرضى في البحث هي ضيق التنفس والسعال ونفث الدم وقلة وزن الجسم.اكثر الدراسات الهستوبايولوجي للمرضى الذين اجروا هذه العملية كانت مسرطنه بنسبة 70% ,شامل بنسبة 12.5%, حميد بنسبة 7.5 % , ذات الرئة بنسبة 7.5%, تحليل غير كافي بنسبة 2.5%.من اكثر المضاعفات شيوعا بين المرضى كانت الاسترواح الصدري ونفث الدم.الاستنتاجعملية الوخز القطعي مع مساعدة المفراس الحلزوني يعتبر من اكثر العمليات الكفؤة في الكشف عن الاوليات والاسباب التي تخص امراض الرئة المحيطية. | Percutaneous lung biopsy is now a common procedure in pulmonary medicine, and several different techniques are in use. The most important one is the use of a tru - cut biopsy under computed tomography (CT) guidance.Aim of Study : To analyze the outcome of tru - cut biopsy in patients with peripheral pulmonary lesions in Baghdad teaching hospital 2016.Patients and Methods : A cross sectional study was done to find out the demographic profiles, indications, radiological findings, diagnosis and complications of the patients who were underwent tru - cut biopsy under CT guided. Forty patients underwent tru - cut biopsy under CT guided in Baghdad teaching hospital( 2015 - 2016).Results : Forty patients were included in our study.Thirty patients (75%) were males, 10 patients (25%) were females. The patients age range from 18 to 80 years, the mean age of the patients was 58.6±14.1 years. In males, 21 patients were current smokers, 6 patients were non smokers and 3 patients ex smokers. In females, 3 patients were current smokers, 5 patients were non smokers and 2 patients were ex smokers. Most common clinical presentation of the patients was chest pain (30%), dyspnea (17.5%), cough (15%), hemoptysis (7.5%), and weight loss (12.5%). The commonest histopathological result of the lesions was malignancy (70%), inconclusive (12.5%), benign (7.5%), organizing pneumonia (7.5%) and inadequate sample (2.5%). The most common complication was pneumothorax (10%) and haemoptysis (5%).Conclusion : Tru - cut biopsy under CT guided is extremely useful in finding specific etiologies of peripheral lung lesions

الندرونيت الصوديوم في الفصال العظمي للمفصل الظنبوبي : تاثيره على معلمات بناء وانحلال الغضروف, لبتين والفعاليات الفيزيائية للمرضى العراقيين == ALENDRONATE SODIUM IN KNEE OSTEOARTHRITIS : EFFECTS ON ANABOLIC AND CARTILAGE DEGRADATIVE MARKERS, CIRCULATING LEPTIN AND THE CLINICAL ACTIVITY IN IRAQI PATIENTS

اسم المؤلف: سيناء عبد الامير كاظم
اسم المشرف: حيدر مهدي جواد | سامي سلمان شهاب
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الادوية والسموم
الدرجة: دكتوراه
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: المقدمة : الفصال العظمي من الامراض الاكثر شيوعا في العالم والذي يصيب النساء اكثر من الرجال ويتميز هذا المرض بانه يحدث نتيجة لخلل في جميع مكونات المفصل متمثلا بانحلال الغضروف وتهشم العظم الملاصق له والتهاب الغلاف المحيط بالمفصل. متسببا في تقليل عرض الحيز الانسي للمفصل.الهدف من الدراسة : تقييم دور عقار الندرونيت الصوديوم ALN)) لمرضى الفصال العظمي للمفصل الظنبوبي ومعرفة تاثيره على مستوى الفعاليات الحياتية للمرضى التي تتمثل بمستوى الالم ومستوى تيبس المفصل وتاثيره على مستوى وظيفة المفصل الظنبوبي. وتقييم مدى تاثيره على معلم البناء 1β TGF , معلم انحلال الغضروف CTXII, مستوى لبتين في الدم, مايلوبيروكسيدييز MPO, الكالسيوم, مستويات الدهون بانواعه وفوسفات الالكلاين والبروتين التفاعلي C.طريقة العمل : ادخل 116 مريضا مصابا بمرض الفصال العظمي للمفصل الظنبوبي ضمن هذه الدراسة وكانوا بعمر من 45 سنة او اكثر وبالدرجة الثانية من المؤشر الشعاعي لكلكرين ولورنس (KL) مع قياس الوزن والطول, عرض الحيز الانسي للمفصل الظنبوبي, التغييرات الكيمياوية المختبرية المتمثلة بمستوى الكالسيوم, مستويات الدهون بانواعه متمثلة بقياس نسبة الكولسترول , الدهون الثلاثية, البروتينات الدهنيه عالية الكثافة والبروتينات الدهنية واطئة الكثافة , فوسفات الالكلاين والبروتين التفاعلي C وقياس المعلمات المناعية بطريقة الالايزا لكل من معلم البناء 1β TGF , معلم انحلال الغضروف CTXII, مستوى لبتين في الدم, مايلوبيروكسيدييز MPO. حيث تم قياس المستويات المذكوره اعلاه قبل البدا باخذ العلاج. تم اعطاء المرضى 10 ملغم من عقار الندرونيت الصوديوم (ALN) واعيد تقييم حالة المرضى بعد اكمال الاشهر الثلاثة من العلاج.النتائج : لوحظ ان هناك تحسن معتد على الفعاليات الفيزيائية واعراض الفصال العظمي , مع انخفاض معتد في معلم TGF β 1 (لاتوجد مقارنة بين تغيره وتحسن حالة المرضى, غير ان له علاقة بزيادة كتلة الجسم) , معلم انحلال الغضروف ) CTXIIحيث له علاقة بتحسن الفعاليات الحياتيه للمرضى), مستوى لبتين في الدم. مع تغير غير معتد في عرض الحيز الانسي للمفصل, مستوى الكالسيوم, مايلوبيروكسيدييز, مستويات الدهون بانواعه متمثلة بنسبة الكولسترول , الدهون الثلاثية, البروتينات الدهنيه عالية الكثافة والبروتينات الدهنية واطئة الكثافة , فوسفات الالكلاين والبروتين التفاعلي C. الاستنتاج : عقارالندرونيت صوديوم له فعالية كبيرة في تحسين الفعاليات الحياتية لمرضى الفصال العظمي وتقليل الالم الناتج من المرض دون تاثير معتد على تغير تركيب المفصل على الرغم من تقليله لمعلم اضمحلال الغضروف. عدم تاثير العقار على مستويات الدهون في الجسم المتمثلة بنسبة الكولسترول , الدهون الثلاثية, البروتينات الدهنية عالية الكثافة والبروتينات الدهنية واطئة الكثافة يجعله امنا نسبيا للمرضى المصابين باختلال نسبة الدهون. | Background : Osteoarthritis is a common arthritic disorder and responsible for 2 % of disability of people in all world. Osteoarthritis has believed to be principally a cartilage defect associated with focal articular cartilage degradation. Alendronate sodium (ALN) interferes with normal bone formation and turnover cycle in the body by slowing bone loss with elevating bone mass. . Aims of the study : This study was done to evaluate the effects of alendronate sodium on disease activity and physical function in patients with knee osteoarthritis, to evaluate the biochemical parameters in osteoarthritis patients including serum alkaline phosphate, calcium, c - reactive protein and lipid profile in form of analysis of serum cholesterol, triglyceride, low density lipoprotein and high density lipoprotein. Also to study the impact of ALN on anabolic in form analysis of serum transforming growth factor beta 1 (TGF - β1) , cartilage degradative in form of C - terminal cross linked - telopeptide of type II collagen (CTXII), Myloperoxidase (MPO) and leptin markers in osteoarthritis patients and to determine its effectiveness in slowing progression of disease. .Patients and methods : The patients were habitants of the cities of Al - Diwaniyhia (consulting the Rheumatologic Unit in Al - Diwanyhia Teaching Hospital) and Baghdad (consulting the Rheumatologic Unit in Baghdad Teaching Hospital). From those patients, 116 osteoarthritic patients 45 years old and more with Kellgren and Lawrence X - ray grade II and more with knee pain were enrolled in this study. Base line assessment was done including measurement of joint space width, assessment of WOMAC scoring(pain, function and stiffness), body mass index and the biochemical parameters (serum alkaline phosphate, calcium, c - reactive protein and lipid profile in form of analysis of serum cholesterol, triglyceride, low density lipoprotein and high density lipoprotein) with enzyme - linked immunosorbent assay (ELISA) analysis of serum (transforming growth factor beta 1 (TGF - β1) , C - terminal cross linked - telopeptide of type II collagen (CTXII), MPO and Leptin. They were instructed to take ALN 10 mg daily. Reassessment was done after 3 months of treatment. Results : A significant symptomatic improvement in WOMAC scoring regarding pain and stiffness (P<0.001) were observed associated with non significant improvement in function, significant reduction (P<0.001) in serum CTXII, Leptin and TGF - β1. A nonsignificant reduction in serum calcium and MPO, associated with no significant changes in serum Alkaline phosphatase, C - reactive protein, lipid profile(serum cholesterol, triglyceride, low density lipoprotein and high density lipoprotein) and joint space width were also reported. CTX II after treatment showed no significant correlation with BMI, however it showed significant positive correlations with WOMAC score. On the other hand, TGF - β1 showed significant positive correlation with BMI, but no significant correlations with WOMAC score. Conclusion : Alendronate sodium in patients with osteoarthritis has clinical efficacy in reducing symptoms especially pain through inhibition of leptin and CTXII with no significant structural improvement despite reduction of CTXII and TGF - β1 with no effects on inhibition of further disease progression. Relatively safe in old patients with dyslipidemia since there is no associated lipid disturbances with ALN. The reduction in level of CTX - II in the present study may be considered as one of the mode of actions of alendronate in patients with osteoarthritis

قيمة العلامات المصلية في فحص وتشخيص التطور في فحص وتشخيص التطور لسرطان القولون == The Value of Serological Markers (CA19 - 9 and CCSA - 4) in Screening and Prognosis of Colon Cancer

اسم المؤلف: عذراء احمد محمد يعقوب
اسم المشرف: هيفاء سلمان الحديثي | عقيل شاكر محمود
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الاحياء المجهرية
الدرجة: ماجستير
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Colonic cancer is a very common disease world - wide being fourth most common cancer characterized by abnormal proliferation of the epithelium of colon at beginning then taking full colon wall thickness then to surrounding lymph nodes and tissues and finally metastasis. It is one of most complicated diseases with debilitating symptoms which becomes more severe, prominent and specific with advancing stage with high percent of fatality and relatively short survival if diagnosed late or if left untreated.Therefore, finding an easy, non - invasive and readily available means (marker) of screening and diagnosing colonic cancer would be of great value particularly if the same biomarker can be used for diagnosis, screening, prognosis and monitoring the efficacy of different treatment modalities.Aims of study : - To investigate the efficacy and validity of serum Cancer Antigen 19 - 9 (CA19 - 9) and Colon Cancer Specific Antigen - 4 (CCSA - 4) levels in the screening and prognosis of colon cancer and their validity for this.Patients and methods : - This study was applied on 35 patients (17 females & 18 males) with colon cancer with ages ranged 53 - 82 years old ( 6 patients received chemotherapy and 5 of them have undergone surgical removal of the primary tumor and 4 different patients received immunotherapy) with 20 smokers and 4 alcoholic, 35 patients (19 females & 16 males) with benign polyps ages ranged 29 - 56 years old and 16 (7 females & 9 males) negative controls ages ranged 25 - 43 years age. According to DUKE's staging : 6 colon cancer patients were stage A, 12 were stage B, 12 were stage C and 5 were stage D.All individuals in this study (whom attended Baghdad Teaching Hospital and Gastroenterology and Hepatic Diseases Center) were subjected to blood sampling for measuring their serum CA19 - 9 and CCSA - 4 using Enzyme Linked ImmunoSorbent Assay (ELISA) technique which was done at microbiology unit / university of Baghdad.Results : - The present study has shown that colonic cancer patients were presented at ages between 53 - 82 years of age (mean 68.5±6.4 years of age).Serum levels of CCSA - 4 were significantly elevated in those patients with advancing stages (C & D) compared with stages (A & B) and lower levels found in patients who had surgical removal of tumor or received chemotherapy.Also a positive relation found between CCSA - 4 with alcohol intake and smoking, however, less significant levels and relations found with CA19 - 9.Conclusion : - Serum CCSA - 4 is sensitive and specific indicator for diagnosis, prognosis and screening of colonic cancer.

الاصابات المنزلية المميحة للنساء في العراق 2010 - 2015 == Fatal Domestic Injuries among Females, Iraq, 2010 - 2015

اسم المؤلف: ختام محسن علي
اسم المشرف: بتول علي غالب ياسين
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الوبائيات التطبيقية
الدرجة: دبلوم عالي
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Injuries and violence are among the most prominent public health problems in the world, as well as being a leading cause of mortality.Globally, each year more than 11,000 people are estimated to die within homes from preventable unintentional injuries. The majority (73%) of family victims were females.Objectives : This study is conducted to describe the epidemiological characteristics, estimate incidence and identify mechanism of fatal female domestic injuries (FFDI) in Iraq for the period of 2010 - 2015.Methods : A cross sectional study was conducted on all female home fatalities reported from all the coroner offices in Iraq for the period of 2010 - 2015 as part of Iraqi Injury Surveillance System (IISS). The injury surveillance form included detailed data on the demographics, injury circumstances and injury mechanisms. Populations' data of the country and the provinces were obtained from Ministry of Health (MOH) and Ministry of Planning.Results : The total number of FFDI during this period was 9,181with an average annual incidence of 11.9/100,000 female population (FP). FFDI represented 13.1% of total Fatal Injuries of IISS and 53.3% of domestic fatal injuries of IISS.Page II The incidence of FFDI decreased from 12.4/100,000FP in 2010 to 11/100,000FP in 2015. Mean age group was 47years, 55% occurred at the age group 10 - 29 years. The highest incidence 21.4/100,000FP was recorded at the age group 20 - 29 years. About 72% of FFDI were unintentional with average annual incidence 8.4 /100,000FP and 72% occurred during 6am - 5pm. The main causes of FFDI were : Burn (62%), electric injury (11.5%), and gun fire (7%) with average annual incidence 7.4, 1.3, and 0.7/100,000FP, respectively. The highest average incidence was reported in Erbil (22.3/100,000FP), Misan (20.2/100,000FP), and Sulaimaniya governorates (16.8/100,000FP) Conclusions : There is a need for implementing of effective community based preventive programs by regulatory measures, environmental changes, and education which may play a crucial role in the prevention of injuries in female home environments.

تقييم كفاءات مسؤولي الرصد الوبائي علي مستوى القطاعات، العراق 2017 == Assessment of Competencies of Surveillance Officers at District Level, Iraq 2017

اسم المؤلف: رفل علياء مكي الصافي
اسم المشرف: علياء مكي حسن الصافي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الوبائيات التطبيقية
الدرجة: دبلوم عالي
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Assessment of communicable diseases surveillance officers is regarded as one of important aspects for the detection of obstacles that prevent the development of surveillance system which would certainly affect the control programs of these diseases.Objective : To assess the background characteristics communicable diseases' surveillance officers at all district levels of all Iraqi provinces .Method : A cross sectional study from the 15th March to 30th September,2017 in which all the communicable diseases' surveillance officers (136) that are employed by MOH all over Iraq were included. A structured questionnaire developed by the researcher and explained during coordination meeting for the surveillance unit in DOH/ MOH. It was then sent by e mail to the surveillance focal persons in DOHs at the provinces level. The questionnaire form gathered demographic data, service characteristics and status of their competencies including : basic epidemiology, biostatistics, surveillance, outbreak investigation, rapid response to health incidence, laboratory models, developing scientific reports and the basic computers skills.Results : The response rate was 85.3%, about half of surveillance officers was responsible for less than 10 PHCC, while only 13.8% were responsible for 20 - 29 centres. More than half of surveillance officers (55.3%) were responsible for 1 - 2 hospitals, while only 9.6% were responsible for 3 - 4 hospitals. The age of study participants ranged between 21 and 62 years and the males constituted more than three quarters (78.4%) of the study sample, Diploma was the highest educational certificate. Those who did not attend any training activity constituted 15.6% of the study sample. Cholera was the most frequently reported incident investigated in an outbreak activity (53.8%). Food poisoning was the most frequently reported incident for a rapid response activity (43.8%).Microsoft word was the most frequently reported skill that reached the required level of proficiency (48.3%).Conclusions and recommendations : The health surveillance system in Iraq at district level was operated mainly by low qualified and under - trained health personnel. There is inequity in distribution of work load (regarding PHCCs and hospitals) and training sessions between surveillance officers in health offices, therefore redistribution is recommended which is the responsibility of health policy makers during the planning and implementing health programs.Supporting continuous training programs on epidemiology, biostatistics, outbreak investigation, computer skills and writing scientific research with increase incentives. Availability of computer and internet facilities must be financed.

تحليل نتائج ناظور القصبات المرن لردهه الامراض الصدريه والتنفسيه في مستشفى الديوانيه التعليمي للسنتين 2014 - 2015

اسم المؤلف: اثير محمود علي
اسم المشرف: محمد وهيب سلمان العبيدي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - الصدرية
الدرجة: دبلوم عالي
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:

دراسة حول قيم توسع الصدر بين الاصحاء البالغين في العراق == The chest expansion values among adult healthy Iraqi people

اسم المؤلف: محمد احمد رحمان
اسم المشرف: مصطفى نعمة عبد علي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - الصدرية
الدرجة: دبلوم عالي
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Chest expansion measurements are used to evaluate a patient’s baseline status, treatment effectiveness, and progression of disease with regards to chest wall mobility and respiratory muscle function.Objectives : To establishing basic information about normal range of chest expansion measures among healthy Iraqis and to establish the variation of the chest expansion among Iraqi population and exploration of the relationship with age, sex and body built.Methods : A stratified random sampling technique was used to select a sample of 1020 persons (530 male and 490 female) aged between 20 to 70 years old from Baghdad and Al - Najaf city, Participants without any neurological, orthopedic, rheumatological or respiratory diseases or having pneumonia during the last month and smokers were excluded from the study, the chest expansion measured in 2 sites , for upper , at the level of the fifth thoracic spinous process and the third intercostal space at the mid clavicular line and for the lower thoracic excursion, the tape measure was placed at the level of the 10th thoracic spinous process and the tip of the xiphoid process by using inelastic tape measure.Results : The study shows that male participants have significant higher chest expansion than female participants in upper thoracic (5±0.6cm, 4.2±0.7cm) for male and female respectively and at lower thoracic (4.5±0.6cm, 3.7±0.6cm) (p< 0.05) for male and female respectively.Chest expansion of male and female participants at both upper and lower thoracic peak at age 20 - 29 and decreases thereafter with increasing age. In female participants, chest expansion was significantly correlated with BMI, which is decreased in the obese female.Conclusion : It was concluded that chest expansion of both upper and lower thoracic increase with age increases until the 3rd decade of life, and then steadily declines after this. Male chest expansion was significantly higher than female participants

الوضع الوبائي لمرض الهيموفيليا في بغداد - العراق 2016 == Epidemiological Profile of Hemophilia in Baghdad - Iraq, 2016

اسم المؤلف: كمال عبد الرزاق كاظم
اسم المشرف: فارس حسن اللامي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الوبائيات التطبيقية
الدرجة: دبلوم عالي
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Hemophilia is an X - linked bleeding disorder that affects males mainly. Globally, there are about 400,000 people with hemophilia and only 25%of them receive adequate treatment. There is insufficient epidemiological data on hemophilia in Iraq, so this study was conducted to estimate the prevalence, incidence and other epidemiological characteristics of hemophilia patients in Baghdad, 2016.Methods : A cross sectional study was conducted by reviewing all records of hemophilia patients for 2016 that retrieved through visiting all hemophilia centers in Baghdad. Corresponding population data of Baghdad was obtained from the Ministry of Planning.Results : The total number of the registered hemophilia patients in Baghdad centers who are residents of Baghdad was 654. The current prevalence of hemophilia was 7.7/100,000 population and it was 3.6/100,000 population in 2007. The current incidence of hemophilia was 16.3/100,000 livebirths and it was 8.4/100,000 livebirths in 2007. Severe hemophilia represented 63.4% from all types and the male patients represented 97.1%. The prevalence of HCV was 22.9%, for HBV was 0.9% and 0.2% for HIV. Inhibitors werepositive in 11.6% of hemophilia patients. Target joints found among 45.1% of patients. About 27% of patients were on prophylactic therapy. Only one death was recorded among hemophilia patients in Baghdad, 2016.Conclusions : The prevalence and incidence of hemophilia in Baghdad was doubled in 10 years' period. We recommended establishing an electronic national registry to have a perfect database for hemophilia and enhancing the prophylactic treatment.

الصفات الوبائية لمرض الاسهال الحاد في الاطفال دون سن الخامسة في العراق 2016 == Epidemiological Characteristics of Acute Diarrhea in Children under Five Years in Iraq, 2016

اسم المؤلف: عمار عبد الله حمد
اسم المشرف: ايمان عدنان القصير
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الوبائيات التطبيقية
الدرجة: دبلوم عالي
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Diarrhea is one of the principle causes of morbidity and mortality among children in developing countries. It was the second leading cause of death in children under five years, accounting for 9 % of all deaths among children under age 5 worldwide in 2015. Despite the availability of simple effective treatment, about 1,400 young children die each day which is equivalent to 526,000 children a year. According to Multiple Indicator Cluster Survey (MICS - 4), the incidence of diarrhea in Iraq was 15% .Theobjective of this study was to identify the incidence and deaths of acute diarrhea in children under five year in Iraq, 2016. Methods : A descriptive cross - sectional study by reviewing all reported data from the directorate of health all over Iraq to the surveillance section in the Communicable Diseases Control Center in Baghdad. Incidence and case fatality rate (CFR) for <5 years population were calculated.Results : The total number of acute diarrheal cases was 251,388. A total of outpatient was 211,665(84%) and 39723(16%) was admitted cases. Male to female ratio was 1.1 : 1. Incidence of acute diarrhea was 47/1,000, the highest incidence was in Diwaniya (119.2 / 1,000), Erbil (89.8 /1,000), and Thiqar (77/1,000). The total death due to acute diarrhea was 154, male : female ratio was 1.2 : 1 and most deaths occur in children <1year (60.4%). CFR was 0. 77/1,000, the highest case fatality rate was in : Baghdad - Karkh (3.70/1,000), Diyala (2.49/1,000), and Diwaniya (1.14/1,000).Proportional mortality rate (PMR) was 7.7/1,000; the highest PMR was in Diwaniya (24.8/1,000), Salah aldin (18.9/1,000), and Diyala (17.5/1,000). Percentage of ORS used was 85%.The completeness of reported site for all provinces was 88%.Conclusion Diarrhea is still a major cause of morbidity and mortality in children under five years, which need to pay more attention for PHC intersectoral cooperation and community participation, and encouragement of Breast feeding.

تقييم ممارسات الجلسة التلقيحية في مراكز الرعاية الصحية الاولية - محافظة واسط, العراق 2017 == Assessment of Immunization Session Practices in Primary Healthcare Centers - Wasit Province, Iraq, 2017

اسم المؤلف: علي صادق جعفر
اسم المشرف: فارس حسن اللامي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الوبائيات التطبيقية
الدرجة: دبلوم عالي
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Vaccination is a great public health achievement in human history. Annually, vaccines prevent more than 2.5 million child deaths globally. In 2016, about 19.5 million infants worldwide were not covered by DTP3, 60% of them live in 10 countries including Iraq. According to WHO and UNICEF, one third of below one year infants did not complete their immunization schedule. Wasit is among the governorates with a large number of underimmunized children. High quality immunization session practices (ISPs) can ensure safer, more effective vaccination and higher coverage rates. Objectives : To assess ISPs in Primary Healthcare Centers (PHCs) in Wasit, and if ISPs are correlated to some PHCs’ characteristics.Methods : A cross sectional study was conducted on 14 PHCs. One fourth of PHCs in each district were selected using simple random sampling. Each PHC was visited once to assess ISPs, using a modified WHO immunization session checklists. Information on vaccinators and PHC’s were collected using two, self - designed questionnaires.Results : PHCs were scoring variably in ISPs, ranging from 0.52 to 0.78 with a mean of 0.68 ± 0.07. ISPs were grouped into seven domains (mean) : vaccine management (0.51), cold chain management (0.40), session equipment (0.88), communication (0.27), vaccine preparation and administration (0.72), registration (0.83) and waste management (0.84). Three of PHCs’ characteristics : population size, below one - year monthly target and average number of daily vaccinees showed statistically significant, negative correlation with ISPs which was of intermediate strength.Conclusion : None of the PHCs was practicing near standard ISPs. ISPs showed statistically significant, negative correlation, of intermediate strength with population size, below one - year monthly target and average number of daily vaccinees for each PHC

الاضطرابات النفسية لدى كبار السن بين مراجعي عيادة كبار السن في مدينة الطب بغداد/ العراق 2017 == Mental Disorders among the Elderly People Attending Geriatric Clinic of Baghdad Medical City, Baghdad/ Iraq, 2017

اسم المؤلف: احمد عبد الامير ابراهيم
اسم المشرف: جواد كاظم الديوان
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الوبائيات التطبيقية
الدرجة: دبلوم عالي
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : The aging population is currently one of the main issues facing international health care systems. Between 2015 and 2050, the proportion of the world’s population 60 years and over will increase from 12% to 22%. Iraqi population was exposed to wars and conflicts, which are in turn, affect their mental health. We conducted this study to measure the prevalence and identify types and potential associated factors of MDs among elderly people attending Geriatric Clinic of Baghdad Medical City. Methodology : A cross - sectional study conducted and a systematic random sampling technique was used to select 320 elderly people attending Geriatric Clinic of Baghdad Medical City for non - psychiatric complaints. We collected data on basic demographics and associated risk factors using a questionnaire filled through self - reported questionnaire.Mental disorders (MDs) were defined based on Kessler Psychological Distress Scale (K10) with a cutoff score of 20+. Accredited tools used by WHO were used to identify the types of MDs.Results : The prevalence of MDs in the study sample was 24.4%. The prevalence of MDs types were : Depression 16.6%, anxiety 12.8%, dementia 5.3%, substance abuse 2.5%, suicide thoughts 5.6%, and suicide attempts 2.5%. Logistic regression analysis was used to examine the determinant factors of elderly MDs revealed the following significant factors : Aging, smokers, living depends on others, loneliness and social isolation, visual impairment, economic state deterioration, neglect and mishandling, and chronic diseases are the determinant factors of elderly MDs.Conclusions : Mental disorders are wide spread among elderly people and enhanced elderly mental health care services should be provided

دراسة نسبة انتشار مرض التهاب الكبد الفيروسي نوعي "بي" و"سي" ومرض العوز المناعي بين مرضى الفشل الكلوي المرحلة النهائية الخاضعين للانفاذ الدموي == Prevalence of Viral Hepatitis (B), (C), and Human Immunodeficiency Virus (HIV) in End Stage Renal Disease Patients on Hemodialysis

اسم المؤلف: مروة انيس عبد العظيم
اسم المشرف: نادية عزيز ناصر
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: طب العائلة
الدرجة: دبلوم عالي
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:

معدل انتشار الداء السكري لدى مرضى الانسداد الرئوي المزمن في المرحلة الشديدة والشديدة جدا == The Prevalence of Diabetes Mellitus Type 2 in chronic obstructive pulmonary disease Patients with Severe and very severe Stage of the Disease

اسم المؤلف: نادية عبد الكريم حمدان
اسم المشرف: محمد وهيب سلمان العبيدي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - الصدرية
الدرجة: دبلوم عالي
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and mortality worldwide.. There is an evidence to support a connection between COPD and diabetes mellitus Type 2 (T2DM). T2DM affects 2 - 37% of COPD patients, with results being highly variable between studies.Objective : To determine the prevalence of T2DM among COPD patients in severe and very severe stages of COPD patients. To assess the risk factors affecting the prevalence of T2DM among COPD patients. Subjects and methods A cross sectional study was conducted on 140 patients with COPD attending Out - patient and Inpatient of Respiratory Unit at Baghdad Teaching Hospital. The data were collected between the10th of October 2016 to the 10th of August 2017. These data included demographic parameters such as : age, sex, educational status, body mass index (BMI), smoking habit, and respiratory parameters from history& clinical examination. Spirometry was used to assess the severity of COPD patients. Random blood sugar testing was used for identification of COPD patients having T2DM when they are not clear or not known as a case of T2DM previously.Results : The prevalence of T2DM among COPD patients was 19.38%. (The prevalence of DM in those with severe stage was 10.9%, while in very severe stage was 35.4%).The prevalence of T2DM was higher in males than in females. The prevalence of T2DM was increased in the elderly COPD patients (>61 years). Increasing with increased BMI, and also VIP a g eincreased more among current smokers followed in order by former smokers and never smokers. Lung function tests decline more in COPD patients with presence of T2DM.Conclusions : Diabetes Mellitus Type 2 is more prevalent among COPD patients; it increased with increased severity of the COPD patients and subjects with DM are at increased risk of declining pulmonary function among COPD patients.

تقييم الطفرات الوراثية ل BRAF, IDH1 وفقدان 1p/19q في الاورام الدبقية للمرضى القراقيين : دراسة نسيجية مناعية كيميائية مع التهجين الموضعي المتفلور == Assessment of BRAF, IDH1 mutations and 1p/19q loss in Gliomas in Iraqi patients. Immunohistochemical and Fluorescence in Situ Hybridization study

اسم المؤلف: زهراء مروان شعبان العمر
اسم المشرف: سالم رشيد حمودي العبيدي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - الوراثة
الدرجة: دكتوراه
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : - Gliomas account for almost 80% of primary malignant brain tumors, so, they considered the most common primary malignant brain tumors in adults. The major types of glial tumors are astrocytomas, oligodendrogliomas, and ependymomas. Isocitrate dehydrogenases 1, BRAFV600E and 1p/19q co - deletion are important molecular markers nowadays for diagnosis and prognosis of gliomas. Isocitrate dehydrogenase mutation might be encounter in the low - grade glioma, occurs in early stages of development and directs the progression of the tumor to a higher grade. BRAFV600E is a point mutation, resulting in a valine to glutamic acid substitution at position 600 and this mutation occurs more in pediatric gliomas but less frequent in adult gliomas. Co - deletion of 1p/19q results from a non - balanced translocation t (1 : 19) (q10 : p10) with subsequent loss of one of the derivative chromosomes and highly associated with oligodendroglial tumors morphology and improved survival.Aim of the study : - To assess the frequency of Isocitrate dehydrogenases 1 and BRAF mutations in Iraqi patients with gliomas by immunohistochemical study, to correlate their immunoreactivity with some clinicopathological parameters. To validate frequency of 1p/19q loss by Fluorescence in Situ Hybridization study and correlate the deletion with the some parameters.Patients and Methods : Formalin fixed, paraffin embedded tumor tissue from 66 patients with different grades of intracranial gliomas of both gender and all age groups in Baghdad city were collected in this retrospective selective study. Ten normal brain tissue samples in form of paraffin blocks took from forensic medicine unit. New technique used, that is manual tissue microarray, in which twenty - four small cores (each measure 2mm) of represented tissue made, then cut by microtome. IHC detection of Isocitrate dehydrogenases 1 and BRAFV600E antibodies did by Dako autostainer link 48. Assessment of co - deletion of 1p/19qAbstractIII

تصلب الشرايين متعدد الاماكن في انحاء الجسم في المركز العراقي لامراض القلب لدراسة مدى الاصابة في الاوعية الدموية الاخرى في المريض المصاب بمرض تصلب الشرايين التاجية == Multivascular Bed Atherosclerosis in Patients with Coronary Artery Disease in the Iraqi Center for Heart Disease (ICHD)

اسم المؤلف: هادي هلال حمزة
اسم المشرف: هلال بهجت شوقي الصفار
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - القلب
الدرجة: دبلوم عالي
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Atherosclerosis is very common disease involving large and medium size arteries result in morbidity and mortality depend on site of vascular involvement. Aim of the study : To study the extent of other vascular beds involvement in patient presented with coronary artery disease.Patients & Methods : This study is prospective cross - sectional study of all patients who were referred Iraqi Center for heart disease, for further evaluation of suspected coronary artery disease(CAD) for the period August 2016 to February 2017. The total number of patients was one hundred ninety (190) ,all underwent full clinical evaluation, laboratory investigation including ECG, biochemical testing, echocardiography, coronary angiography,. demographic characteristics were recorded for all patients including ,age, gender, BMI, conventional risk factors, carotid IMT measurement by Doppler ultrasound and ABI by Doppler stethoscope was calculated. The study sample was divided into two groups according to the results of coronary angiography : group A, those with normal CA and group B, those with abnormal CA. A comparison was made between group A and B as regard to the results of IMT and ABI measurement and then the relation to demographic characteristics and other conventional risk factors. Then we study the subgroup with abnormal ABI & IMT in both group A and B, comparison was made between both subgroup in form , gender, age groups , mean age, and the detail of risk factors like hypertension, smoking, diabetes mellitus , BMI, family history of premature CAD and hyperlipidemia . Results : The mean age, patients above 60 y and men gender were higher in group A( 58.82), (52.09%) and (76.4%) than in group B (52.93) ,(25.4%) and 45.07% (p value 0.010)The study of risk factors in both groups demonstrate more prevalence of hypertension in group A (63.05%) than in group B (47.8%) , ( p value 0.0499), also significance difference in prevalence of diabetes mellitus and smoking (52.9%) and (43.6%) in group A and (26.7%) and (15.4%) in group B ( p value 0.0276 and 0.0437) , prevalence of hyperlipidemia was significantly higher in group A (55.4%) than in group B( 35.3%) (p value 0.0418) . family history of premature CAD and BMI were higher in group A (41.1%) and (40.3%) than in group B (33.8%) and (26.7%) but not statistically significant (p value 0.194 and 0.154 ) respectively.The prevalence of abnormal ABI and IMT were higher and statistically significant in group A (36.9%) and (77.3%) than in group B (15.4%)and (30.9%) (p value 0.002 and 0.001). The no. patients with abnormal both carotid IMT and ABI were higher in group A (37/44, 84.09%) than in group B (8/11, 72.7% ) , (p value 0.041), the mean age is higher and statistically significant in group A (68.49) than in group B (57.5) ( p value 0.030) , the male gender is higher and statistically significant in group A(33/37, 75%) than in group B (4/8, 50%) ( p value 0.010). the prevalence of hypertension, hyperlipidemia and diabetes mellitus were higher and statistically significantly in group A (83.7%), (83.7%) and (75.6%) than in group B (75%) ,(62.5%) and (37.5%) (p value 0.0476, 0.0346 and 0.047) respectively. The prevalence of smoking , abnormal BMI and family history of premature CAD were higher but statistically insignificant in group A (67.5%) , (56.7%), and (48.6%) than in group B (37.5%), (37.5%) and (37.5%) (p value 0.0868, 0.146 and 0.2136) .Conclusion : Atherosclerosis is generalized process whenever found in certain vascular bed, we must think of other vascular beds involvement, the more risk factors burden the more likely involvement of other vascular bed and more sever disease to be expected.

مستوى هرمون الانتي موليرين في تقييم تاثير العلاج الكيميائي على المبايض لدى النساء المصابات بسرطان الثدي : دراسة متابعة == Serum Anti - Mullerian Hormone Levels in Evaluation of Chemotherapy Effect on Ovarian Reserve in Breast Cancer Women : A follow up study

اسم المؤلف: سفانه علي عثمان الراوي
اسم المشرف: باسل عويد محمد صالح | منور عبد الاله النقاش
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الكيمياء الحياتية السريرية
الدرجة: ماجستير
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: سرطان الثدي هو السرطان الاكثر شيوعا للنساء في سن الانجاب. وتخضع معظم الشابات المصابات بسرطان الثدي للعلاج الكيميائي، لان العلاج الكيميائي يحسن نتائج السرطان، ولكنه يؤدي ايضا الى ضرر المبيض عن طريق سمية مباشرة الى البويضات. ونتيجة لذلك، الشابات الناجيات من سرطان الثدي يواجهن مخاطر اعلى نتيجة للعقم المصاحب للعلاج الكيمياوي، وتلف المبايض وانقطاع الطمث في وقت مبكر.يتم انتاج هرمون الانتي موليرين (AMH) من قبل الخلايا الحبيبية التي تحيط بالبويضات الصغيرة ولها وظيفة رئيسية في تطوير ونضج البويضات. كما انها قادرة على قياس احتياطي المبيض الحقيقي، من خلال قياس كمية البويضات النشطة التي تنتجها، وبالتالي تعتبر اساس تقييم احتياطي المبيض.الهدف من هذه الدراسة : اهداف الدراسة الحالية هي دراسة دور مستوى هرمون الانتي موليرين في مصل الدم قبل العلاج الكيميائي (مستوى خط الاساس) في التنبؤ في تاثير العلاج الكيميائي على احتياطي المبيض (انقطاع الطمث الناتج عن العلاج الكيميائي) ضمن النساء المصابات بسرطان الثدي وتقييم الضرر الحاصل من نوع العلاج الكيميائي.المواضيع وطرق : قد اجريت هذه الدراسة في قسم الكيمياء الحياتية في كلية الطب بجامعة بغداد وفي عيادة الاورام بمستشفى الاورام التعليمي خلال الفترة من سبتمبر 2016 الى فبراير 2017. وشملت 58 امراة تم تشخيصهم حديثا بالاصابة بسرطان الثدي من قبل مجموعة اطباء الاورام ، الفئة العمرية المنتقاة للدراسة هي (25 - 45 سنة). وكانت جميع النساء ذوات دورة شهرية منتظمة. تم تصنيف النساء الى ثلاث مجموعات : المجموعة1(ج1) : ثلاثين امراة تم تشخيصهن حديثا بسرطان الثدي قبل بدء العلاج الكيميائي المجموعة 2 (ج2) : نفس النساء من المجموعة 1 بعد انهاء 4 دورات من العلاج الكيميائي انثراسيكلين (الكورس الاول) والمجموعة 3(ج3) التي شاركت ثماني وعشرون امراة اخرى تم الانتهاء من كل من دورات العلاج الكيميائي، (الكورس الاول) و4 دورات تاكسانس (الكورس الثاني). كانت مراحل سرطان الثدي لدى النساء المدروسات بين المرحلة 1 - 3. واستبعدت جميع الاورام المنتشرة. تم تحليل كل عينة من كل امراة من المجموعات الثلاث الى للهرمونات التالية : هرمون الانتي موليرين (AMH)، هرمون تحفيز الجريبات (FSH)، هرمون لوتيلزينغ (LH)، 17 بيتا استراديول (E2)، البرولاكتين (PRL) وهرمون التيستوستيرون (Testosterone). النتائج : انخفضت القيمة المتوسطة لمستويات هرمون الانتي موليرين بشكل ملحوظ في مجموعتي العلاج الثانية (0.06±0.01 نانوغرام/مل) والثالثة (0.06±0.01 نانوغرام/مل) عند مقارنتها مع المجموعة الاولى (2.05±0.28 نانوغرام/مل، p <0.0005). ومع ذلك، لم يكن هناك فرق كبير في مستويات هرمون الانتي موليرين بين المجموعة الثانية والثالثة. متوسط قيمة هرمون الانتي موليرين قبل العلاج الكيمياوي يكون اقل بشكل ملحوظ في النساء اللواتي تعرضن لانقطاع الطمث بعد انتهاء الكورس الاول (1.09±0.29 نانوغرام/مل) مقارنة مع متوسط قيمة الهرمون للنساء اللواتي حافظن على الدورة الشهرية (2.88±0.72 نانوغرام/مل، p<0.001). وقد انخفض متوسط قيمة هرمون الانتي موليرين في الدم بشكل ملحوظ لدى النساء التي تم علاجها بعقار دوكيتاكسيل (Docetaxel) (0.04±0.002 نانوغرام/مل) مقارنة بعقار باكليتاكسيل (Paciltaxel) (0.06±0.004 نانوغرام/مل، p <0.002).تم زيادة ملحوظة في متوسط القيم لهرمون (FSH) للمجموعة الثانية 46.9)±4.29 IU/L، p<0.0005) والمجموعة الثالثة (±79.834.81 IU/L ، p<0.0005) بالمقارنة مع المجموعة الاولى 0.5±5.8) IU/L). ايضا، كان متوسط قيمة لهرمون ال FSH في مصل الدم اعلى بكثير في المجموعة 3 مما كانت عليه في المجموعة الثانية (p<0.0005). لوحظ وجود زيادة في متوسط مصل هرمون (LH) في المجموعة الثانية (34.17±3.25 IU/L ، p<0.0005) والثالثة IU/L 2.94±39.28) ، p<0.0005) مقارنة بمستوى المجموعة الاولى (0.5±5.8). ومع ذلك، لم يكن لدى المجموعة الثالثة فرق كبير بالمقارنة مع المجموعة الثانية. وكان هناك انخفاض ملحوظ في متوسط قيمة هرمون (E2) في الجموعة الثانية 1.56±14.49) بيكوغرام/مل) والثالثة 0.65±6.88) بيكوغرام/مل) بالمقارنة مع المجموعة الاولى (3.25±50.06 بيكوغرام/مل، لكل منهم p<0.0005) . كذلك، كان الفرق كبيرا بين GΙΙ وغوي (p <0.016). اظهرت قيم المعدل لمستوى هرمون التيستوستيرون في المصل عدم وجود فرق معنوي بين المجموعات الثلاث. اظهرت الدراسة انخفاضا ملحوظا في معدل القيم لمصل هرمون البرولاكتين(PRL) في المجموعة الثانية (1.06±11.68 نانوغرام/مل، p<0.001) والثالثة (1.23±13.90 نانوغرام/مل، p<0.011) مقارنة مع المجموعة الاولى 2.39±20.18) نانوجرام/مل). لم يكن هناك فرق ملحوظ بين المجموعة الثانية والثالثة. واظهرت مستويات هرمون الانتي موليرين انخفاضا ملحوظا لدى النساء في عمر ≥40 سنة بالمقارنة مع النساء الاقل من 40 سنة (p<0.0005، p<0.012، p<0.031) في المجموعة الاولى والثانية والثالثة على التوالي.الاستنتاج : قد يكون قياس هرمون (AMH) في مصل الدم وسيلة كيميائية حياتية مفيدة لمدى الضرر الحاصل في المبيض وحدوث انقطاع للطمث، والمستويات العالية من (AMH) قبل العلاج قد يكون مؤشرا للحفاظ على الدورة الشهرية بعد العلاج. ويمكن ايضا تحديد سمية مشتقات تاكسان على المبيض من خلال قياس مصل الهرمون. قد يكون الجمع بين المصل (AMH)، (FSH)، (LH) وE2)) اكثر فائدة في اعطاء فكرة عن حالة المبايض. مصل هرمون (PRL) هو وسيلة جيدة لمتابعة النساء المصابات بسرطان الثدي. | Breast cancer is the most common cancer in reproductive - aged women. Most young women diagnosed with breast cancer will undergo chemotherapy. While chemotherapy improves cancer outcomes, it also induces ovarian damage by direct toxicity to the finite pool of ovarian follicles. Consequently, young breast cancer survivors face higher risks of primary ovarian insufficiency, infertility and early menopause.Anti Mullerian Hormone (AMH) is produced by the granulosa cells that surround the preantral and antral follicles and has a major function in the development and maturation of follicles. It can reflect true ovarian reserve, by estimating the active follicle pool being produced by ovaries and hence the basis of assessing ovarian reserve. The aim of study : To predict the ovarian reserve in breast cancer women after chemotherapy by measuring AMH pre, during and post chemotherapy and assessing the damage induced by different types of chemotherapy.Subjects and Methods : This cohort prospective study was carried out at the Biochemistry Department, College of Medicine, University of Baghdad and at Oncology Clinic, Oncology Teaching Hospital during the period from September 2016 to February 2017. It included 58 women who were already newly diagnosed by oncology group to have had breast cancer, their age range (25 - 45 years). All the Included women have had a regular menstrual cycle. The women were classified into three groups : (GI) : thirty women newly diagnosed with breast cancer before starting chemotherapy (CT) treatment, GII : the same thirty women of GI who finished 4 cycles of Anthracycline chemotherapy (course 1) and GΙΙΙ which involved another twenty eight women who were already finished both courses of chemotherapy, (course 1) and 4 cycles Taxanes (course 2). The stages of breast cancer of the studied women were between stages 1 - 3. All metastasized tumors were excluded. The separated serum sample from each woman of three groups was analyzed for Anti Mullerian Hormone, Follicular Stimulating Hormone (FSH), Lutilzing Hormone (LH), 17 - Beta Estradiol (E2), Prolactin (PRL) and total Testosterone. Results : The mean (±SEM) value of AMH levels was significantly decreased in both groups of treatment; GII (0.06±0.01 ng/ml) and GIII (0.06±0.05 ng/ml) when compared with GI (2.05±0.28 ng/ml, p<0.0005). However, there was no significant difference in serum AMH levels between GIΙ and GIIΙ. The mean (±SEM) value of the basal serum AMH (pre CT women) was significantly declined in those women who had amenorrhea after the first course of CT (1.09±0.29 ng/ml) compared to the mean AMH value of women who remained menstruating (2.88±0.72 ng/ml, p< 0.001).The mean value of serum AMH was significantly decreased in women received Docetaxel derivative CT (0.04±0.002 ng/ml) compared to Paclitaxel derivative one (0.06±0.004 ng/ml, p<0.002).The mean (±SEM) values of serum FSH levels were significantly increased in GΙΙ (46.9±4.29 IU/L, p<0.0005) and GΙΙΙ (79.83±4.81 IU/L, p<0.0005) in comparison to GΙ (5.8±0.5 IU/L). Also, the mean value of serum FSH was significantly higher in GΙΙI than in GΙΙ (p<0.0005). A significant increase in mean serum LH of GΙΙ (34.17±3.25 IU/L, p<0.0005) and GΙΙΙ (39.28±2.94 IU/L, p<0.0005) was observed compared to GΙ level (5.8±0.5 IU/L). However, GIII had no significant difference compared to GΙΙ. There was a significant decrease in the mean value of serum E2 in GΙΙ (14.49±1.56 pg/ml) and GΙΙΙ (6.88±0.65 pg/ml) in comparison to GΙ (50.06±3.25 pg/ml, for both p<0.0005). Also, the difference was significant between GΙΙ and GΙΙI (p<0.016). The mean (±SEM) values of serum Testosterone showed no significant difference among the three groups. The study displayed a significant decrease in the mean (±SEM) values of serum Prolactin in GΙΙ (11.68±1.06 ng/ml, p<0.001) and GΙΙΙ (13.90±1.23 ng/ml, p<0.011) compared to GΙ (20.18±2.39 ng/ml). There was no significant difference between GΙΙ and GΙΙΙ. Anti Mullerian Hormone levels showed a significant decrease in women of age of ≥40 years in comparison to women of <40 years (p< 0.0005, p< 0.012, p<0.031) in GI, GII and GIII, respectively.Conclusion : The measurement of serum AMH may be a useful biochemical marker of the extent of the ovarian reserve damage and the incidence of amenorrhea, high levels of AMH before chemotherapy may be an indicator for preservation of menstrual cycle post CT. The ovarian toxicity of Taxane CT derivatives can also be evaluated by measurement of serum AMH. The combination of serum AHM, FSH, LH and E2 may be more informative in the evaluation of ovarian reserve postchemotherapy than in an individual parameter. Serum PRL measurement is a good marker for chemotherapy follow up in women with breast cancer

انتشار اضطراب الكئابه العظمى لدى المرضى العراقيين المصابين بالتصلب المجموعي == Prevalence of Major Depressive Disorder in Iraqi Patients with Systemic Sclerosis

اسم المؤلف: رؤى ناجي سوادي
اسم المشرف: فائق ايشو كوريال | مشتاق طاب هاشم
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - المفاصل
الدرجة: دبلوم عالي
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Systemic sclerosis (SSc) is a connective - tissue disease characterized by excessive collagen deposition in the dermis and internal organs, and by vascular hyper - reactivity and obliterative microvascular phenomena. Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings, and sense of well - being.Objectives : The aim of this study was to evaluate the prevalence and predictors of major depressive disorder in Iraqi patients with SSc if present.Patients and methods : This case - control study involved 50 patients with SSc according to the criteria developed by the 2013 American College of Rheumatology/European League Against Rheumatism for the classification of systemic sclerosis ,and compared with another 51 healthy controls.Demographics and clinical data were collected including age, sex, BMI, smoking status, marital status, employment status, educational status, crowding index and disease duration. Disease activity for SSc was assessed with the SAQ. Medications used and autoantibody profile were collected.We applied DSM5 diagnostic criteria of all patients included .Results : The prevalence of major depressive disorder was (44% compared to control 2.0%), in which major depressive disorder 39.3 folds associated with SSc patients compared to control. A severe form of major depressive disorder was observed in (36.4 %) of SSc cases. Furthermore, cases with a severe form of disease evaluated by SAQ had an obviously higher rate of depression .Also the risk of having major depressive disorder was significantly correlated with smoking.Educational level had no statistically significant association with major depressive disorder, SSc cases with higher education(college) had the highest rate of major depressive disorder (36.4%) compared to a rate between 13.6% and 27.3% for lower level of educational attainment. The risk of having major depressive disorder was not different in the age, gender, marital status and employment status. The history of using each of prednisolone, DMARD and biological agents had statistically significant association with major depressive disorder. Also the presence of autoantibodies (anti centromer and anti Scl70 antibodies) had no statistically significant effect on the presence of major depressive disorder.Conclusions : The prevalence of major depressive disorder in systemic sclerosis patients was significantly higher in patients compared to controls.Severity of systemic sclerosis was increase the rate of major depressive disorder .

تقييم كفاءة البطين الايسر لمرضى ناضمات القلب الصناعية باستخدام تقنية تتبع النقط في تخطيط صدى القلب == ASSESSMENT OF LEFT VENTRICULAR FUNCTION IN PATIENTS WITH CARDIAC PACING USING SPECKLE TRACKING ECHOCARDIOGRAPHY

اسم المؤلف: فهد عباس عبد الرحمن
اسم المشرف: عفان عزت حسن
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الفسلجة
الدرجة: ماجستير
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: ان نظام التوصيل الكهربائي للقلب يتالف من خلايا عضلة القلب والياف التوصيل (الياف غير عصبية) والتي تكون متخصصة في انشاء النبضات وايصالها بسرعة خلال القلب.هذه الخلايا والالياف تنشيء الدورة القلبية الطبيعية وتنظم انقباضات الحجرات القلبية.كلا الاذينين ينقبضان سويا وكذلك البطينين سويا ,لكن انقباضة الاذينين تحدث اولا . ان نظام التوصيل الكهربائي للقلب يوفر له ضربات ايقاعية تلقائية. ولاجل ان يضخ القلب الدم بكفائة , ولعمل الدورة الدموية الجهازية والدورة الدموية الرئوية بتزامن يجب ان تكون الاحداث في الدورة القلبية متزامنة .باستخدام الاختبارات غير المعقدة نسبيا (مثلا تخطيط صدى القلب ) التي من الممكن ان توفر المعلومات عن المرض ومعرفة تطور المرض مستقبلا ومدى تزامن الانقباضات القلبية والسعة الوظيفة للقلب ولجهاز الدوران باستعمال تخطيط صدى القلب (( Speckle Tracking ان هدف هذه الدراسة هو تقييم دور تخطيط صدى القلب في تحديد عدم التزامن ومستوى التزامن قبل وبعد زرع ناظمة القلب الصناعية ثنائية الحجرة اوعلاج اعادة التزامن القلبي والى حد الوصول الى توقع الاستجابة الى علاج اعادة التزامن القلبي والية الاستجابة مع التركيز بشكل خاص على المعلمات المستمدة من Speckle Tracking ، وغيرها من التدابير. ان هذه الدراسة قد شملت 18 مريض يعانون من القصور القلبي وتمت معالجتهم باعادة التزامن القلبي . لقد تم اجراء هذه الدراسة في الفترة بين كانون الاول 2016 وحزيران 2017 في مستشفى بغداد التعليمي ,مدينة الطب , مركز الدراسات العليا لامراض القلب وتخطيط صدى القلب . ان خطة هذه الدراسة تكونت من اخذ التاريخ المرضي بدقة (مع التاكيد على عوامل الخطورة المتعلقة بامراض القلب وهي ارتفاع ضغط الدم ,داء السكري, ارتفاع الدهون ) وبعد ذلك يتم الفحص السريري وبخاصة القلب وجهاز الدوران ومن ثم اخذ القياسات الفيزياوية للجسم والتي تشمل الوزن والطول مع احتساب معامل كتلة الجسم ,بالاضافة الى قياس ضغط الدم وحساب ضربات القلب بعد ذلك يتم اخذ تخطيط صدى القلب وهذه تمثل القيم الاساسية قبل عملية انظام ناظمة القلب الصناعية, حيث تمثل معلمات مزامنة القلب المعلومات الرئيسية لهذا الدراسة . فيما يخص تخطيط صدى القلب , تم اجراء تخطيط صدى القلب بشكل مفصل وفقا لبروتوكول شامل للحصول على الصور.حيث اجري تخطيط صدى القلب قبل وبعد 3 اشهر من عملية انظام ناظمة القلب الصناعية لجميع المرضى وشمل تخطيط صدى القلب على (التصوير ثنائي الابعاد القياسي، وتخطيط تدفق الالوان، دوبلر الموجة النبضية والموجة المستمرة ودوبلر تصوير الانسجة). وتم توصيل اقطاب تخطيط القلب الكهربائي التقليدية (الذراع اليمنى، الذراع اليسرى، والساق اليسرى) لكل مريض من اجل توفير تخطيط القلب الكهربائي للاطراف الاول والثالني والثالث.بعد ذلك يتم وضع المريض بوضعية شبه راقد على الجانب الايسر للتصوير القصري والقمي، ومستلق للتصوير تحت الضلع. لقد تم اختيار تخطيط القلب اثناء تصوير صدى القلب من اجل الحصول على صور اكثر وضوحا مع بداية QRS ، وبالتالي اعطات قياسات دقيقية . ان نتائج هذه الدراسة اظهرت ان 78 % قد استجابوا الى علاج اعادة التزامن القلبي فيما ان 22 % لم يستجيبو الى علاج اعادة التزامن القلبي حسب نتائج تصوير صدى القلب قبل وبعد عملية انظام ناظمة القلب الصناعية , علاوة على ذلك، لا يوجد فرق ذو دلالة احصائية بين المجموعتين في الخصائص الاولية (الديموغرافية، عوامل الخطر، معلمات تخطيط صدى القلب). فيما كانت احصائيات تاريخ مرض القلب الاقفاري وداء السكري اعلى احصائيا في مجموعة غير المستجيبين مقابل المستجيبين ( 0.0002p لمرض القلب الاقفاري ، 0.015 p لمض داء السكري ).اخيرا، معلمة واحدة من صدى القلب حول التزامن غير كافية للتنبؤ بالاستجابة لعلاج اعادة التزامن القلبي . ومع ذلك، فقد تم تحديد العديد من اليات الاستجابة لعلاج اعادة التزامن القلبي بواسطة تخطيط صدى القلب ،لهذا يبقئ تخطيط صدى القلب ذو اهمية قيمة في التقييم المسبق لكل المرضئ الذين يخضعون لعلاج اعادة التزامن القلبي .ان تخطيط صدى القلب ثنائي الابعاد (speckle Tracking ( تقنية مجدية غيرة معتمدة علئ زاوية معينة للتصوير مع معدل عالي من الاطر، وهي قادرة على اظهار اي التواء في اي اتجاه كان . ان قياس الالتواء الطولي بواسطة تخطيط صدى القلب (speckle Tracking ( ثلاثة اشهر بعد انظام ناضمة القلب الصناعية لديه دقة تنبؤية عالية لتحديد المرضى الذين من الممكن ان يضهروا في وقت لاحق قصور في البطين الايسر والناتج عن ناضمات القلب الصناعية .لذلك يعتبر قياس مدى الالتواء الطولي اداة مفيدة سريريا لتحديد مجموعة الاشخاص الذين من الممكن ان يظهروا قصور في كفاءة البطين الايسر بعد انظام ناضمات القلب الصناعية | The conducting system of the heart consists of cardiac muscle cells and conducting fibers (not nervous tissue) that are specialized for initiating impulses and conducting them rapidly through the heart. They initiate the normal cardiac cycle and coordinate the contractions of cardiac chambers. Both atria contract together, as do the ventricles, but atrial contraction occurs first. The conducting system provides the heart its automatic rhythmic beat. For the heart to pump efficiently and the systemic and pulmonary circulations to operate in synchrony, the events in the cardiac cycle must be coordinated” synchronized “ Simple investigation measure (echocardiography) can provide information, estimate prognosis and determine synchrony & functional capacity of the heart pumping using “speckle tracking” Echocardiography . The aims of the study were to assess the role of echocardiographic dyssynchrony parameters before & after implantation of cardiac resynchronization therapy & to the extent of prediction of response to resynchronization therapy & mechanisms of response, with a particular focus upon parameters derived from speckle tracking echocardiography, and other echocardiographic measures. This study involved Eighteen subjects (18) with History of Heart Failure & typical Left Bundle Branch Block treated with cardiac resynchronization therapy, This Cross sectional observational study was performed between December 2016 & June 2017 & conducted at Iraq - Baghdad , medical city, Baghdad Teaching Hospital, cardiology & Echocardiography Higher Education (Diploma) center.The plan of this study consisted of case history (with special emphasis regarding risk factors for Cardiovascular diseases) clinical & physical examination, physical measurement including Body mass index calculation, these measurements were followed echocardiography, Resynchronization forms the primary data set for this study. Detailed echocardiography was therefore performed according to a comprehensive protocol for image acquisition. Baseline & after 3 months of implantation echocardiography was performed in all subjects (standard 2D imaging, color flow mapping, pulsed wave (PW) and continuous wave (CW) Doppler and tissue Doppler imaging (TDI)). Conventional ECG electrodes (right arm, left arm, and left leg) were connected to the patient providing standard axial ECG limb leads I, II and III. The patient was positioned semi - recumbent in the left lateral position for parasternal and apical imaging, and in a supine position for subcostal imaging. The appropriate ECG lead to record during image acquisition was chosen in order to most clearly define the onset of the QRS complex, and therefore aid accuracy of subsequent measurements. The results of the study showed that seventy eight (78%) of subjects showed echocardiographic response to cardiac resynchronization therapy and considered as responders , whereas (22%) show no Echocardiographic Response to cardiac resynchronization therapy and considered as Non Responders . Furthermore, there is no statistical significant difference between the Two groups in baseline characteristics (demographic, risk factors, Echocardiography parameters); the history of Ischemic Heart disease and diabetes mellitus where statistically significant higher in the non - responders group versus responders (p 0.0002, p 0.015 respectively ).In conclusion, Single echocardiographic dyssynchrony parameters appear to have no role in the prediction of CRT response. However, several mechanisms of response to CRT are identified, each of which may be identified echocardiographically, and echocardiography therefore continues to have an important role in pre assessment of patients undergoing CRT. Two - dimensional STE is a feasible echocardiographic technique with an angle independency and high frame rate, which is capable of obtaining any directional strain. Global longitudinal strain (GLS) measured Three month after implantation has high predictive accuracy for identifying patients who later develop Pacemaker induced ventricular dysfunction. Global longitudinal Strain may represent a clinically useful tool to identify group of subjects who may benefit from heightened echocardiographic surveillance of LV dysfunction following pacemaker implantation.

قيمة العلامة المصلية اختيار مصل رباط محفز التكاثر نوع A في تشخيص سرطان القولون في المرضى العراقيين == The value of serological marker serum A proliferation Inducing Ligand test in the Diagnosis of colon cancer in Iraqi patients

اسم المؤلف: عقيل حاتم محمود
اسم المشرف: سرمد محمد حسين الزيني | عقيل شاكر محمود
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الاحياء المجهرية
الدرجة: ماجستير
الجامعة: جامعة بغداد - كلية الطب
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Colonic cancer is a very common disease world - wide being fourth most common cancer characterized by abnormal proliferation of the epithelium of colon at beginning then taking full colon wall thickness then to surrounding lymph nodes and tissues and finally metastasis. It is one of most complicated diseases with debilitating symptoms which becomes more severe, prominent and specific with advancing stage with high percent of fatality and relatively short survival if diagnosed late or if left untreated.Therefore, finding an easy, non - invasive and readily available means (marker) of diagnosing colonic cancer would be of great value particularly if the same biomarker can be used for diagnosis, screening, prognosis and monitoring the efficacy of different treatment modalities.Study objectives : -  To investigate the efficacy and validity of serum Carcinoembryonic Antigen (CEA) and serum A Proliferation inducing Ligand (sAPRIL) levels in the diagnosis of colon cancer as individual and as combined tests. Analyze the case - control differences in serum CEA and APRIL.  Evaluate the diagnostic performance of serum CEA and APRIL and their combination in predicting colon cancer and Assess the association between the two markers.  Suggest an optimum cut - off value for these two serum markers. Evaluate the effect of age, gender, tumor stage, alcohol and smoking habits, chemotherapy, surgical excision and immunotherapy on serum CEA and APRIL in cases with colon cancer. Patients and methods : - This study was applied on 35 patients (14 females & 21 males) withcolon cancer with ages ranged 58 - 88 years old (9 patients receivedchemotherapy and all of them have undergone surgical removal of the primarytumor and 4 different patients received immunotherapy which is monoclonalantibody) with 15 smokers and 7 alcoholic, 35 patients (19 females & 16 males)with benign polyps ages ranged 30 - 56 years old and 15 (7 females & 8 males)negative controls ages ranged 25 - 37 years age, samples were collected in theperiod between October 2016 and July 2017.According to DUKE's staging which is determined according histopathology after colonoscopy and few from surgery : 4 colon cancer patients were stage A, 9 were stage B, 12 were stage C and 10 were stage D.All individuals in this study (whom attended Baghdad Teaching Hospital and Gastroenterology and Hepatology teaching hospital) were subjected to blood sampling for measuring their serum CEA and sAPRIL using Enzyme Linked ImmunoSorbent Assay (ELISA) technique which was done at microbiology unit / university of Baghdad.Results : - The present study has shown that colonic cancer patients were presented at ages between 58 - 88 years of age ( 69 ± 8.2 years of age).Serum levels of CEA & sAPRIL were significantly elevated in those patients with advancing stages (C & D) compared with stages (A & B) and lower levels found in patients who had surgical removal of tumor or received chemotherapy.Also a positive relation found between CEA & sAPRIL from hand with alcohol intake & smoking on the other hand.
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