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العوامل المرتبطة مع سرطان الثدي وتاثيراتها في عينة من المرضى لمستشفى الامل الوطني لعلاج السرطان في بغداد == Factors associated with Breast Cancer Impact in a sample of Al - Amal National hospital for Cancer management in Baghdad

Author name: اسامة مدحت لفتة
Supervisor name: احمد سمير النعيمي
General topic: Medicine
Specific topic: Community Medicine
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Breast cancer (BC) known to be the most common cause of cancer - related death among females with excess of more than a million inflicted with this disease every year. In Iraq, breast cancer is the most common type of malignancy among the Iraqi population in general. The disease affects physical and mental health among breast cancer survivors. The true impact of a successful medical intervention could be understood by the degree to which the treatment has a positive influence on patient’s immediate and /or future well - being. Assessment of quality of life among breast cancer is vital to identify area of concerns to the patient and health professional, and to suggest means to improve disease outcome and reduce patient’s suffering. The current study aimed at measuring the impact of Breast Cancer on different aspects of health related quality of life. In addition, to studying the association between the impact of breast Cancer and sociodemographic characteristics or treatment modalities.A cross - sectional study was conducted on a total of 250 randomly selected females with an established diagnosis of breast cancer attending Al - Amal National hospital for Cancer management in Baghdad. Data collection took place during the period from January to April, 2016, each participant was asked to fill The questionnaire composed of three parts : The first one covered sociodemographic characteristics including : age, gender, educational attainment, marital status, living arrangement, finical status, BMI and blood pressure. The second part contained the ABCIS (Arabic Breast Cancer Impact Scale) with 14 questionnaire items. The third part of the questionnaire gathered data about disease associated factors like duration, treatment modalities. The answers that reflect the impact of the disease on specific life domains were anchored to a 5 points Likert - scale type rating scale. It ranges from large extent to no impact. Higher rating reflects higher negative impact. In addition, the importance of each domain rated on 4 points likert - scale ranges from very important to not important. Higher rating reflects greater importance.Breast cancer had negative impact on patients quality of life. The psychological domain was the most affected among the three domains of quality of life, while theviisocial domain was the least affected. The retest part of the study supported a high reliability for the tested instrument among Iraqi Breast Cancer patients. A quarter of study subjects described the quality of their life as poor. This group of females is at risk for bad prognosis and deterioration of their conditions later on.The study failed to detect an association between type of treatment (whether radio or chemo - therapy) and negative impact of breast cancer on quality of life. Most cancer patients in Iraq fail to cope with the new events and changes in their body image and daily activities that resulted from their disease, neither in their social or occupational life. This might be related to the lack of the psychological therapy and rehabilitation program, which should be provided in all stages of management.

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

Author name: وسام جاسم محمد
Supervisor name: بسام موسى صادق الموسوي
General topic: Medicine
Specific topic: Diseases - Genetics
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: 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.

الخصائص الوبائية لفتحات جدار القلب الخلقية للاطفال دون الخامسة الوافدين الى مستشفى ابن النفيس التعليمي، بغداد 2015 == Epidemiological characteristics of Under Five Children with Ventricular Septal Defects Attending Ibn - Nafees Teaching Hospital, Baghdad 2015

Author name: عمار حسن عبد القهار
Supervisor name: بتول علي غالب ياسين | علاء عبد الحسين الانباري
General topic: Medicine
Specific topic: Community Medicine
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Globally at least eight of every 1,000 infants born each year have a heart defect, and as Ventricular Septal Defect (VSD) is the commonest among Congenital Heart Defect (CHD), this study aimed to assess the impact of VSD among CHD and its association with certain factors, and to assess the anthropometrical measures among children with CHD as well as assess nutritional state of their mothers. A hospital based cross sectional study on 349 under five children with CHD attending Ibn Al - Nafees Teaching Hospital were subjected to questionnaires prepared by the researcher. The nutritional status of under five children was assessed through an anthropometric measures (height and weight) and compared with z - score of CDC 2000, meanwhile 296 Mother’s Body Mass Index (BMI) was assessed to point out an association with CHD and VSD.It was found that 54.7% of CHD were VSD, 29.2% were ASD and the combination of VSD and ASD was on the top of congenital heart malformation 61.4%.CHD had increase relation with Father’s and Mother’s education and indirect relation with Mother’s age, also was higher (84.2%) among 20 - 39 years Mother and appear more often in children under one year 64.2%. The studied factors had no obvious influence on VSD rather than other CHD.Nutritional status of the study sample showed that wasted children was almost three times over normal distribution which exhibit acuteness with no evidence on disease chronicity, as shown the study sample showed close frequency distribution regarding stunting and underweight. Mother’s BMI exhibit a problem as 37.2% were overweight and 26.4% were obese.Interfamily marriage express 58.5% positivity and only 8.3% report positive family history. Anemia reported in 33% of Mothers and 30.4% address febrile illness during first trimester.This study observed no significant associations between VSD and other congenital heart defects in term of socio - demographic characteristic; residency, mother’s age, child’s age, Father’s and Mother’s education and consanguinity. Also no associations were found regarding family history, febrile illness, passive smoking, certain medication received, anemia and DM.

الجملة الوعائية المجهرية لمخيخ الجرذ == Microvasculature of the Rat Cerebellum

Author name: حسنين عبد الجبار العبيدي
General topic: Medicine
Specific topic: Anatomy and Histology and Embryos
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: In spite of its various anatomical, functional, and phylogenetic divisions, the rat cerebellum remains constant throughout, in its cellular and laminar organization. The question remains whether the microvascular supply of the cerebellum is quantitatively homogenous or not.This study aims to investigate quantitatively whether the homogeneity in cerebellar cellular architecture is reflected on the functional vascular bed in different regions of the cerebellum and to provide reliable morphometric parameters that can be used for comparative purposes with other regions in the central nervous system.A sample of 20 adult male albino rats was used. Fresh frozen 20 μm thick sections in the sagittal plane were stained for microvascular alkaline phosphatase. Image analysis software (Global Lab Image), was used to measure circumscribed areas for the length and number density of their contained alkaline phosphatase positive microvascular profiles. Microvascular densities in the cortical layers of the cerebellum as a whole was (76.72±30.59 count/mm2) and (231.45±82.14 mm/mm3). There was a higher microvascular density in the granular layer in comparison to the molecular layer. This was significantly higher than the densities of the white matter core excluding the deep cerebellar nuclei. The densities in the deep cerebellar nuclei were (122.86±20.38 count/mm2) and (328.22±33.45 mm/mm3). Length density did not show obvious heterogeneity in the cortical layers between different divisions of the cerebellum. Number density was significantly higher within the cortical layers of the hemisphere when compared to the vermis. A comprehensive guide for identifying rat cerebellar regions was put foreword. This guide can be useful for identifying rat cerebellum sagittal sections regardless of the level of the section or the staining method used without the need to follow an entire series of sections.The differences in microvascularity on the laminar level was correlated with the functional necessity of neurons and synapses. Neurovascular coupling appeared in its best manifestation in the deep cerebellar nuclei where it was clear that dense microvascularity was concomitant with a densely synaptic and neuron - poor region.The cerebellar cortex as a whole, was homogenous in its microvascular length density in whichever division, anatomical, functional or phylogenetic.The predilection towards heterogeneity between vermian and hemispheric cortices as far as number density is concerned can be attributed to the complexity of branching for a given length of vessels.A combination of two morphometric parameters (microvascular length and number density) is a reasonable choice to explore the microvascular network in terms of functional needs and spatial composition.

التعبير الكيمياوي المناعي لمستقبلات الاستوجين والبروجستيرون Ki و67 Her2/neu لمرضى سرطان الثدي : دراسة سريرية باثولوجية == Immunohistochemical Expression of ER, PR, Her2/neu and Ki67 in Breast Carcinoma. Clinicopathological Study

Author name: فاطمة صبيح الصراف
Supervisor name: اسراء علي حسين
General topic: Medicine
Specific topic: Diseases
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Breast cancer is the most frequent cancer in women worldwide.In Iraq it is the most common cancer among females. According to the latest Iraqi Cancer Registry in 2010, breast cancer account for approximately one - third of the registered female cancers in Iraq, indicating that the breast cancer is the leading cause of death among females.Proliferation rates of neoplastic process can provide useful information on prognosis and aggressiveness of individual cancers including breast cancer and can be used to guide treatment protocols in clinical practice. Ki67 as a proliferative marker has been used to study proliferation rates in breast cancer and other tumors by Immunohistochemistry assessment of nuclear antigen which has a predictive and prognostic significant. Other important prognostic and predictive markers in breast cancer management including Estrogen and Progesterone receptors, Her2/neu have been used to predict the prognosis of breast cancer and to guide its therapy. Aim of study1. To evaluate the role of Ki67 as a proliferative index marker through analysing the associations between Ki67 intensity with the well - known clinicopathological parameters (age, breast tumor type, grade, size and lymph node involvement).2. To correlate the association of Ki67 with Estrogen receptor, progesterone receptor and Her2/neu expression. Patients, materials and methods This retrospective cross - sectional study was conducted from November 2013 to April 2014. A total number of fifty paraffin blocks were collected, (40) blocks belonging to patients with breast carcinoma (all were totally mastectomy), (thirty five cases were invasive ductal carcinoma, four cases invasive lobular carcinoma and one case was mixed type carcinoma) and (10) blocks with benign breast diseases were included. The cases were selected from archive files of the Department of Pathology of the Teaching Laboratories, Specialized surgical Hospital in Baghdad Medical City and private laboratories, and used for the immunohistochemical assessment of oestrogen receptor (ER) and progesterone receptors (PR), Her2/neu and Ki67.Results : In this study, patients’ age were ranged from (22 - 69) years, for forty malignant cases the age range was (34 - 69) years with a mean of (50.30±9) (mean± Standard deviation) years and the median age was (49) years, the peak age frequency was in the (35 - 50) years age group at time of diagnosis. The main histopathological type was invasive ductal carcinoma (87.5%). Grade II and T2 were reported in three quarters of the studied cases (30 cases out of 40). Axillary lymph node positive involvement was reported in (72.5%) of cases.For benign cases the age range was (22 - 60) years old, the mean age was (36.50±13.75) (mean± Standard deviation) years old.Hormone receptors positive malignant cases were (75%) and (72.5%) for estrogen and progesterone receptors respectively.Immounohistochemical expression of Ki67 was positive in (30) cases out of (40) (75%). Ki67 high score were demonstrated in (57.5%) of malignant cases.For Her2/neu expression more than (50%) of cases were with score 0, (17.5%) were with score 1+, (12.5%) were with score 2+ and (17.5%) were with score 3+.Regarding molecular subtypes of the malignant cases, Luminal B subtypes was the commonest among studied cases (42.5%).Conclusions : 1. In the current study invasive ductal carcinoma was the commonest histopathological type of breast carcinoma while most of the benign cases were fibrocystic disease cases, with a significant different mean age between malignant and benign cases.2. In this study Ki67 positive expression was observed in most of the studied malignant cases. Significant correlations were found between Ki67 expression and tumor grade, lymph node involvement and Her2/neu score.3. Luminal B subtype (Estrogen receptor +ve and /or Progesterone receptor +ve, Her2/neu +ve or Her2/neu - ve with Ki67 high score) was the most common molecular subtype of the studied breast cancer cases.

تعبيرالعلامة المناعية النسيجية الكيميائية P57 في عذارية الخلد (الحمل العنقودي) الكامل والجزئي == Expression of P57 Immunohistochemical Marker In Complete and Partial Hydatidiform Mole by Using Tissue Microarray Technique

Author name: رحاب خالد عباس
Supervisor name: ختام رزاق كاظم الخفاجي
General topic: Medicine
Specific topic: Diseases
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: تعتبرعذارية الخلد الحمل العنقودي شكل غير طبيعي من الحمل ويمكن تقسيمه الى نوعين : الحمل العنقودي الكامل والحمل العنقودي الجزئي . ويبقى الفحص النسيجي المفصل هو الاساس في تشخيص الحمل العنقودي . ان عدم الدقة في اخذ العينات والتنخر النسيجي والتفريغ المبكر للرحم يمكن ان يؤدي الى عدم التاكد في التشخيص وكذلك فان المعايير غير الموضوعية تؤدي الى تقلب ملحوظ بين الفاحصين.ان العلامة النسيجية المناعية الكيميائية (P57KIP2) هي مطبوعة الجين ابويا ومعبر عنها اموميا ووجود منتج البروتين يخدم كمؤشربديل لوجود جينات النواة الامومية ، ولان الحمل العنقودي الكامل هو النوع الوحيد من الحمل الذي ينقصه الجينات الامومية ، لذلك فان الصبغة المناعية P57KIP2 غير موجودة فيه بينما تكون موجودة في الحمل العنقودي الجزئي والحمل الطبيعي.الهدف من الدراسة1 - لتقييم اهمية العلامة النسيجية المناعية الكيميائية P57KIP2 في تشخيص الحمل العنقودي الكامل والحمل العنقودي الجزئي.2 - لمقارنة نتائج العلامة النسيجية المناعية الكيميائية P57KIP2 مع نتائج الصبغة المعتادة هيماتوكسيلين وايوسين.المواد وطرق العمل تم جمع سبعين حالة من خزع بطانة الرحم وتم تقييم جميع الحالات نسيجيا باستعمال الصبغة المعتادة هيماتوكسيلين وايوسين (H &E ) ثم تم تصنيفها الى حمل عنقودي كامل وحمل عنقودي جزئي (30) لكل منها و(10) حالات حمل طبيعي (اجهاض) وكذلك تم استخدام شرائح السيطرة السلبية. وقد تم جمع هذه الحالات خلال الفترة من كانون الاول 2011 الى اب 2012 من مختبرات مختلفة في العراق . وقد تم اعتماد تقنية جديدة في هذا البحث وهي طريقة مجاميع نسيجية صغيرة بتقطيع اثني عشرثقب صغيرمن عينات انسجة مختارة وبقطر 3ملم وصبها في كتلة واحدة ثم اخذ مقاطع من كتلة المجاميع النسيجية الصغيرة باستخدام المايكروتوم ووضعها على شريحة المجهر ثم صبغها بالصبغة المعتادة هيماتوكسيلين وايوسين ثم صبغها مرة اخرى بالصبغة النسيجية المناعية الكيميائية P57KIP2)). النتائجتم تشخيص 70 حالة حمل عنقودي وحمل طبيعي بواسطة استخدام الهيماتوكسيلين وايوسين في هذا البحث وكان معدل العمر للمرضى بين 17 سنة و50 سنة على النحو التالي : ( معدل الاعمار29 سنة ، والعمرالوسطي 27 سنة واكثر عمر تكرر20 سنة ) وكانت الغالبية من الحالات (50%) تتراوح اعمارها بين (20 - 29) سنة ولكن فقط (10%) من الحالات كانت اصغر من 19سنة. وكان الارتباط الاحصائي بين عمر المرضى ونوع الحمل العنقودي غير ملحوظ وقد كانت درجات مرضى الحمل العنقودي الكامل باستخدام الهيماتوكسيلين والايوسين على النحو التالي : الدرجة الاولى 43.3% ، الدرجة الثانية 53.4% والدرجة الثالثة 3.3% ولم يرتبط التوزيع العمري لكل درجة ارتباطا احصائيا . فيما يتعلق بتعبير الصبغة المناعية النسيجية الكيميائية P57KIP2 عن حالات الحمل العنقودي الجزئي المشخصة سابقا بواسطة الهيماتوكسيلين والايوسين ، اظهرت 25 حالة من 30 حالة والتي تمثل 83.3% نتائج ايجابية ، بينما كانت نتائج الخمس حالات المتبقية والتي تمثل 16.7% سلبية ، وهذا يعني بانها كانت بالتاكيد حمل عنقودي كامل . وكانت هذه النتائج ذات دلالة احصائية عالية. ان نتائج تعبير الصبغة المناعية النسيجية الكيميائية P57KIP2 عن حالات الحمل العنقودي الكامل المشخصة سابقا بواسطة الهيماتوكسيلين والايوسين ، كانت 26 حالة من اصل 30 حالة والتي تمثل 86.7% اظهرت نتائج سلبية مما يثبت تشخيص الحمل العنقودي الكامل ، بينما كانت نتائج الاربع حالات المتبقية والتي تمثل 13.3% ايجابية . وكانت هذه النتائج ذات دلالة احصائية عالية.ووجد في هذه الدراسة بان التوزيع العمري للمرضى في مختلف درجات الحمل العنقودي الكامل والتي اعربت عن نتائج سلبية للصبغة المناعية النسيجية الكيميائية كان ( معدل الاعمار 28.5 سنة والعمرالوسطي 27 سنة واكثر عمر تكرر25 سنة ). وقد وجد بان غالبية المرضى من الدرجة الاولى كانوا من اعمار20 - 39 سنة ، وكانت غالبية المرضى من الدرجة الثانية من اعمار20 - 29 سنة ، بينما كانت حالة واحدة فقط من الدرجة الثالثة بعمر38 سنة . ونتيجة لذلك كان الارتباط الاحصائي بين درجات الحمل العنقودي الكامل وبين معدل اعمار المرضى غير ملحوظ .ان درجات الحمل العنقودي الكامل والتي كانت سلبية باستخدام الصبغة المناعية النسيجية الكيميائية P57KIP2 كانت اغلبها من الدرجة الثانية والتي كانت تمثل 53.4% وكانت الاقلية من الدرجة الثالثة والتي كانت تمثل 13.3% . وقد لوحظ بان جميع الحالات الاربعة والتي اعربت عن نتائج ايجابية باستخدام الصبغة P57KIP2 كانت من الدرجة الاولى وهي تمثل 13.3% . وكان الارتباط الاحصائي بين درجات الحمل العنقودي الكامل ونتائج الصبغة P57KIP2 ذات دلالة احصائية ملحوظة.الاستنتاجات1 - ان الصبغة المناعية النسيجية الكيميائية P57 عامل مفيد في التشخيص الصحيح للحمل العنقودي الكامل.2 - ان الاخطاء في التشخيص المظهري للحمل العنقودي الجزئي اكثر تواترا من الاخطاء في التشخيص للحمل العنقودي الكامل.3 - توجد اختلافات واضحة في التصنيف الصحيح للحمل العنقودي بين استخدام الصبغة المناعية النسيجية الكيميائية P57 واستخدام الصبغة العادية الهيماتوكسيلين والايوسين.4 - ان حالات الدرجة الاولى للحمل العنقودي الكامل مرتبطة بوضوح مع الاخطاء في التشخيص المظهري المؤدية الى المبالغة في تشخيص الحمل العنقودي الكامل.5 - الصبغة المناعية النسيجية الكيميائية P57 هي تقنية بسيطة يمكن استخدامها في مختبرات علم الامراض لتصحيح تشخيص الحمل العنقودي والتمييز بين الحمل العنقودي الكامل من اشباهه خصوصا في الحالات صعبة التشخيص. | Hydatidiform mole is an abnormal form of pregnancy divided in to two types; complete hydatidiform mole and partial hydatidiform mole. Detailed histopathologic examination remains to be the basis for the diagnosis of hydatidiform mole (HM). However, poor sampling, necrosis, and earlier uterine evacuation can lead to uncertainty in the diagnosis. Also, the criteria are subjective, resulting in considerable interobserver variability.The P57KIP2 gene is paternally imprinted and maternally expressed, and the presence of its protein product serves as an adjuvant marker for the nuclear maternal genome. Because a complete HM is the only type of conceptus lacking a maternal contribution, P57 KIP2 immunostaining is correspondingly absent, whereas it is present in partial HM and normal pregnancy. Aim of the study : 1.To evaluate the significance of the immunohistochemical marker P57KIP2 in the diagnosis of complete and partial hydatidiform mole . 2.To compare the P57KIP2 immunohistochemical marker results with that of ordinary Hematoxylin and Eosin slides histopathology results . Materials and Methods : Seventy cases of endometrial biopsies were obtained. Histologic evaluation of all cases was performed on routine sections stained with Hematoxylin and Eosin (H & E) and classified in complete and partial hydatidiform mole (30 each) and (10 cases) of normal product of pregnancy (abortion), and negative control slides were also used. These cases were collected during the period from December - 2011 to Augest - 2012. New technique is adopted in this research that is; Tissue microarray in which twelve small cores of representative tissue samples, each measure 3 mm in diameter Sections from microarray block are cut using a microtome, mounted on a single microscope slide and then analyzed by staining with Hematoxylin and Eosin, then another section made for the immunohistochemical staining with P57 KIP2 antibody. Results : • In this study of the 70 cases diagnosed as molar and normal pregnancies by H&E, the actual age range was from 17 to 50 years old, and the age distribution were; (mean 29 , median 27 , mode 20 years old), the majority of the cases (50%) were between the age of (20 - 29) years old whereas only (10%) of the cases were younger than 19 years old, the correlation between the age of the patients and the type of the Hydatidiform Mole (HM) was not significant. • Grades of patients with CHM based on H&E category were; 43.3% grade I, 53.4% grade II, and 3.3% grade III, and the age distribution for each grade was not statistically correlated. • Regarding the expression of p57KIP2 IHC Marker in cases of PHM diagnosed previously by H&E, 25 cases out of 30 cases which represented 83.3% expressed positive results. The remaining 5 cases which represented 16.7% expressed negative results, this means that they were definitely CHM. These findings were statistically highly significant.The results of P57KIP2 IHC Marker expression in cases of CHM diagnosed previously by H&E, were 26 cases out of 30 cases which represented 86.7%, expressed negative results this confirm the CHM diagnosis. The remaining 4 cases which represented 13.3%, expressed positive results this means that they were most probably PHM. These findings were statistically highly significant.• The age distribution of the patients in different grades of the CHM which expressed negative results for the IHC Marker p57KIP2 (Mean= 28.5, median=27, mode=25 years old), it was found that the majority of patients in grade I were from age 20 to 39 years old, and the majority of patients in grade II were from age 20 to 29 years old, while the only one case of grade III was 38 years old. The correlation between grades of CHM and patients ages was not significant.• The grades of the CHM which are negative for the IHC Marker p57KIP2, the majority of the patients were grade II which represent 53.4% and the minority of the patients were grade III which represent 3.3%. It was noticed that all four cases which expressed positive immunostaining for the IHC marker p57KIP2 were; grade I, and they represented 13.3%. The correlation between the grades of the CHM and the results of the p57KIP2 IHC marker was statistically significant.Conclusions : • P57KIP2 IHC marker is a useful adjunct, providing a definitive diagnosis of CHM. • Errors in morphologic analysis resulted primarily in over diagnosis of PHM are more frequent than in CHM.• There are significant differences in correct classification of hydatidiform mole between using P57KIP2 IHC marker and using H&E stain. • Cases in grade I of CHM were correlated significantly with the errors in morphological analysis resulted primarily in over diagnosis of CHM. • P57KIP2 IHC marker is a relatively simple method can be used in pathology laboratories to refining the diagnosis of molar pregnancy and distinguish CHM from its mimics in a subset of challenging cases.

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

Author name: عذراء احمد محمد يعقوب
Supervisor name: هيفاء سلمان الحديثي | عقيل شاكر محمود
General topic: Medicine
Specific topic: Microbiology
Degree: Master
University: University of Baghdad - Faculty Of Medicine - Department Of Microbiology
Language: English
University location: Baghdad
First pages:
Abstract: 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.

تقييم التغيرات في البطين الايسر للحوامل في الثلث الاخير من الحمل في حالة الضغط الطبيعي وارتفاع الضغط اثناء الحمل باستخدام جهاز صدى القلب == EVALUATION OF ECHOCARDIOGRAPHIC CHANGES OF LEFT VENTRICLE DURING THE THIRD TRIMESTER IN NORMOTENSIVE AND GESTATIONAL HYPERTENSION

Author name: زينب عبد الخالق الركابي
Supervisor name: غسان ثابت سعيد | غازي فرحان الحاجي
General topic: Medicine
Specific topic: Physiology
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Pregnancy is considered as the “nature’s silent stress test” as it challenges the maternal cardiovascular system to undergo several cardiovascular adaptations. At the same time, it may reveal some hidden cardiac diseases. Furthermore, maladaptation of the mother’s cardiovascular system to these challenges can leads to several obstetric complications, more commonly, gestational hypertension which is the main cause of maternal death.The aims of this study are : to assess the maternal left ventricular structure and function during the last trimester of pregnancy and to find the impact of gestational hypertension on the maternal heart using transthoracic echocardiography.This cross sectional study was carried out in Baghdad teaching hospital. A total of 215 women were studied and 200 of them were included, they were classified into three groups : 100 women with mean age (29.83± 5.33 year) with gestational hypertension defined as increased systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90mmHg emerging after 20 weeks of gestation with no proteinuria, were considered as gestational hypertensive women group (GHW), 50 normotensive pregnant women with normal singleton pregnancy and mean age (28 ± 3.18 year) matched for gestational age with gestational hypertensive women were considered as normal pregnant women (NPW) group and 50 nulliparous normotensive women aged (30.1 ± 5.03 year) served as controls. All omen were submitted to a detailed medical history and physical examination focusing on hypertension risk factors. Their blood pressure was measured in the left lateral decubitus position and their body weight, height were measured to calculate bodymass index and body surface area. The left ventricle structure and function were evaluated using transthoracic echocardiography. The results of this study revealed that Gravidity was significantly higher and parity was significantly lower in GHW group compared to NPW group (P= 0.001 and P= 0.004 respectively). GHW had significantly higher BMI and BSA and 63% of them had edema. NPW had significantly higher LVIDd, IVST, PWT and RWT than controls with no significant change in EF, they also had higher LVMI over controls (P= 0.002, P= 0.0001, P= 0.0003, P= 0.0001 and P= 0.0002). 76% had normal LV geometry, 20% had eccentric hypertrophy and 4% had concentric remodeling. They also had larger LA area with higher A wave velocity and E/A ratio (P= 0.001, P= 0.001, P= 0.0012) and longer IVRT (P= 0.00013) with no significant change in Tei index.GHW compared to NPW had significantly higher IVST, PWT and RWT (P= 0.0001, P= 0.0003, P= 0.0001) they also had higher LVMI (P= 0.00022). 59% had abnormal LV geometry; of which : 34% had eccentric hypertrophy, 19% had concentric hypertrophy and 6% had concentric remodeling. 41% had normal LV geometry.The A wave velocity and E/A ratio were higher in GHW (P= 0.001, P= 0.0012) with significantly lower é velocity and higher E/é ratio (P= 0.0002 and P= 0.00012). Their IVRT and IVCT were significantly longer (P= 0.00013, P= 0.0003), with higher Tei index value (mean 0.56034 ± 0.07487) and P value of 0.001.In conclusion, pregnancy causes volume overload on the left ventricle which adapts through physiological hypertrophy with no further effect on the systolic and diastolic function of the heart. While, gestational hypertension adds the effect of pressure overload leading to further LV hypertrophy and remolding and might cause Grade I diastolic dysfunction.

المسح عن مسببات وطرق الوقاية من الجلطات الدموية الوريدية في مرضى مستشفى بغداد التعليمي == Screening of Venous thromboembolism risk factors and prophylaxis in Baghdad teaching hospital patients

Author name: صباح الشاوي
Supervisor name: ايمان عدنان القصير
General topic: Medicine
Specific topic: Community Medicine
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Deep vein thrombosis is the silent killer, which complicate many of the hospital admission and the cause for many re - admission. In Iraq, deep vein thrombosis is the iceberg where little is known about the risk with the availability of many risk factors in the Iraqi population. The right selection for the patients who need the prophylaxis decrease the rate of the Deep Venous Thrombosis and the complication, which happen through the first three months of the admission history. Assessment of deep venous thrombosis risk in the admitted patients reduce the risk of the disease and the complications. This study aimed to explore the risk of the Deep Venous Thrombosis and the selection of the right prophylaxis regimen to decrease the Deep Venous Thrombosis and complication outcome. A cross - sectional study conducted on 404 randomly selected admitted patients with various admission causes attending Baghdad teaching hospital in Baghdad. Data collection done through 1st of April to 1st of July 2017 , five to six patients were screened for the risk factors available which were divided in five groups of risk factors according to Capirini risk assessment form which used internationally for this reason .The total score then calculated and divided into three categories (mild, moderate and high). The score of 1 to 2 considered as mild with no need for prophylaxis, the score of 3 to 5 considered as moderate, the score of more than five considered as high - risk patients. Moderate and high - risk patients should have prophylaxis administered to them according to the international guidelines of Deep Venous Thrombosis prophylaxis. Statistical test is applied to find the percentage of the patients at risk of VTE in total and subgroup analysis to see the risk factors in the Medical, surgical & gynecological patients separately. Another statistical test done to compare the patients receiving the VTE prophylaxis versus the international guidelines recommendation. Deep Venous Thrombosis risk found to be high in the study population 65% and 35% were free from deep venous thrombosis risk , the survey include the medical, surgical and gynecological wards. The risk found to be highest in the gynecological patients with 77% at risk of Deep venous thrombosis followed by the surgical patients with 59% and then by the medical patients by 8%.The prophylaxis administration to the eligible patients found to be very low where the patients who received the prophylaxis was 27% from the medical patients and 41% from the surgical patients and 28% from the Obstetric and gynecological patients.

التقييم الكهروفسلجي للانواع الفرعيه لمتلازمة غوليان - باريه لشريحه من الاطفال العراقيين == ELECTROPHYSIOLOGICAL ASSESSMENT OF GUILLAIN - BARRE SUBTYPES IN A SAMPLE OF IRAQI CHILDREN

Author name: لميس منصور حسين
Supervisor name: نجيب حسن محمد
General topic: Medicine
Specific topic: Neurophysiology
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Guillain - Barre syndrome represents the most common cause of acute motor paralysis in children. It is clinically characterized by an acute non - febrile, post - infectious illness marked as ascending weakness, and areflexia. However; sensory, autonomic and brainstem abnormalities may also be seen.This study aimed to assess the role of electrophysiological study (NCS and EMG) in the diagnosis of Guillain - Barre syndrome subtypes in children, estimate the frequency of subtypes whether demyelinating or axonal form of Guillain - Barre syndrome and match the electrophysiological results with the findings of CSF protein analysis.Two groups of either sex are involved in this study, children with Guillain - Barre (19 males and 11 females) with a mean age of (5 ± 2) years and normal healthy children served as control group (16 males and 14 females) matched for gender and age with a mean age of (6 ± 3) years. Each child submitted to medical history, brief clinical examination, and electrophysiological study. This study was performed at the unit of neurophysiology of Baghdad teaching hospital and Nursing house hospital in a period from December/2015 to June/2016.The electrophysiological assessments involve the following tests : 1 - Sensory NCS for bilateral median, right ulnar and bilateral medial plantar nerves in which latency, sensory nerve action potential amplitude (SNAP) and sensory nerve conduction velocity (SNCV) were studied.2 - Motor NCS for bilateral median, right ulnar and bilateral common peroneal nerves (fibular nerve) in which, distal motor latency (DML),compound muscle action potential amplitude (CMAP), motor nerve onduction velocity (MNCV), conduction block and temporal dispersio were performed.3 - Minimal F - wave latency for bilateral median, right ulnar and bilateral fibular nerves.4 - H - reflex latency of bilateral tibial nerve.5 - Needle EMG for bilateral proximal and distal muscles of upper (first dorsal interosseous) and lower limbs (tibialis anterior and extensor digitorum brevis) in which insertional activity, spontaneous activity, motor unit action potential MUAP and interference pattern were applied.The results of this study revealed that acute inflammatory demyelinating polyneuropathy (AIDP) is the most frequent subtype followed by acute motor axonal neuropathy (AMAN) and acute motor sensory axonal neuropathy (AMSAN) respectively. Children with an age (3 - 6) years among other age groups are more vulnerable to develop GBS following infection in the preceding 3 months.The sensory nerve parameters (sensory latency is prolonged, SNAP is reduced and SNCV is slowed) are significantly changed between GBS children and control groups.The motor nerve parameters (DML is prolonged, CMAP is reduced and MNCV is slowed) are significantly changed between GBS children and control groups. Moreover among the GBS subtypes, there were significant differences in which the prolonged (DML) mostly in AIDP subtype, while the reduced (CMAP) mostly in axonal subtype was reported.Concerning minimal F - wave, it was absent in lower limbs more than upper limbs (46.6% and 26.6% respectively). Whereas H - reflex was absent in (73.3%) of children.Needle EMG had showed reduced recruitment in all GBS subtypes in addition to the evidence of spontaneous activity particularly in axonal subtype.In conclusion, this study detected that the AIDP was the most frequent subtype of GBS compared to others. Motor nerve conduction study is more useful than sensory nerve conduction study in GBS subtyping.Additionally Late responses (minimal F - wave and H - reflex) are very informative in the early course of the disease since they reflect the involvement of proximal nerve segment, which is more vulnerable to demyelination than terminal and intermediate nerve trunk segments, in addition CSF protein analysis showed no significant differences between GBS subtypes.

العوامل المصاحبة للرضاعة من الثدي الغير حصرية : دراسة مقطعية (ممارسات ومعارف واتجاهات) == Factors Associated with Non - Exclusive Breast Feeding a Cross Sectional KAP Study

Author name: الهام رشيد حميد
Supervisor name: احمد سمير النعيمي
General topic: Medicine
Specific topic: Community Medicine
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: ان لموضوع الرضاعه الحصرية من الثدي صلة بمجموعة من الابعاد المختلفة في حياة الام وهي من المواضيع ذات الاولوية بالنسبة لمنظمة الصحة العالمية في مسعاها لتقليل الامراض والوفيات بين الاطفال في شتى انحاء العالم . صممت هذه الدراسة المقطعية العرضية لتقييم انتشار الرضاعة من الثدي الغير حصرية بين 317 من الامهات العراقيات من اللواتي يمتلكن طفلا واحدا على الاقل يبلغ عمره (6 - 24) شهرا والذي كانت رضاعته من الثدي على الدوام. علاقة مواقف ومعرفة الام بممارسة الرضاعة الحصرية من الثدي . جمعت البيانات من خلال المقابلة المباشرة مع كل ام على حدة . اجريت الدراسة للفترة من الخامس عشر من شباط الى الخامس عشر من نيسان لسنة 2014 في مدينة بغداد / العراق في مركز السلام للرعاية الصحية الا ولية .البيانات تتعلق بالعوامل الاجتماعيه والديموغرافيه للام ومواقف الام ومعرفتها بالرضاعة من الثدي مثل العمر والمهنه, وقت البدء بالرضاعه من الثدي, الفتره المثلى للرضاعه الحصرية من الثدي, تكرار الرضاعه من الثدي, والرضاعه من الثدي بالعلن وبيانات اخرى. كشفت الدراسة بان النسبة المئوية للرضاعة الحصرية من الثدي كانت 14.5% وشكلت نسبة الرضاعه من الثدي غير الحصرية 85.5% من عينة الدراسة (مع وجود فترة ثقة تبلغ 95% من نسبة 81.6% - 89.4 % من السكان المرجعية) . كان التردد النسبي بين الامهات ممن قمن بالرضاعة من الثدي غير الحصرية اعلى على نحو واضح داخل المجتمعات ذات المستوى الاقتصادي والاجتماعي العالي حيث بلغ (89.3%) واقل بين الامهات داخل المجتمعات ذات المستوى الاقتصادي والاجتماعي المنخفض حيث بلغ (78.8%) . توضح الدراسة بان متوسط درجة الموقف للامهات اللواتي قمن بالرضاعة الحصرية من الثدي كان (76.2) اعلى بكثير منه بالنسبة للامهات اللواتي قمن بالرضاعة من الثدي الغير الحصرية (67.1 ). وكان متوسط درجة المعرفة بين الامهات اللواتي قمن بالرضاعة الحصرية من الثدي (32.1) اعلى بوضوح منه بالنسبة للامهات اللواتي قمن بالرضاعة الغير الحصرية من الثدي (28.8) غير ان الفروقات في المتوسط فشلت قليلا بالنسبة للدلالة الاحصائية .كان التردد النسبي للامهات اللواتي قمن بالرضاعة غير الحصرية من الثدي اقل بين الامهات الاكبر سنا (35 - 44) سنه. لم نكن هناك اية علاقة بين توفر المساعدة ( الدعم) من الاسرة والاقارب او الجيران في العناية بالطفل مع الرضاعة الحصرية من الثدي . كان التردد النسبي بين الامهات اللواتي يتلقين النصائح من الكوادر الطبية ضد اعطاء السوائل للطفل المولود حديثا اعلى بصورة ملحوضة داخل مجموعة الامهات اللواتي قمن بالرضاعـــة الحصرية من الثدي حيث بلغ (19.6%) من الامهات اللواتي قمن بالرضاعة غير الحصرية من الثدي والذي بلغ (7.7%). هنالك علاقة كبيرة بين الرضاعة من الثدي العلنية مع الاختطار الاقل للرضاعة غير الحصرية من الثدي. | The topic of exclusive breast feeding is related to a combination of different dimensions of mother's life. It's one of the priority topics for World Health Organization in its quest to reduce childhood morbidity and mortality worldwide.This cross sectional study was designed to assess the prevalence of non exclusive breast feeding among 317 Iraqi mothers with at least one baby aged (6 - 24) months who were ever breastfeed, the association of mother's attitude and knowledge on the practice of exclusive breast feeding.Data was collected through a direct interview with each mother. Those data include sociodemographic factors and concepts related to breastfeeding knowledge and attitude like age, occupation, time of initiation of breastfeeding, optimum duration of exclusive breastfeeding, breastfeeding frequency, breastfeeding in public and others. The study was conducted from the 15th of February to the 15th of April 2014, in Baghdad/ Iraq in Al - Salam primary health care center.The study revealed that the rate of exclusive breastfeeding was 14.5%. Non - exclusive breastfeeding constituted 85.5% of study sample (with a 95% confidence interval of 81.6% - 89.4 in the reference population). The relative frequency of non exclusive breastfeeding mothers was obviously higher among mothers in high SES (89.3%) and lowest for mothers with low socioeconomic status (78.8%). The study illustrates that the mean attitude score for mothers with exclusive breast feeding (76.2) was significantly higher than that for non exclusive breastfeeding mothers (67.1). Mean knowledge score for mothers with exclusive breastfeeding (32.4) was obviously higher than that for non exclusive breastfeeding mothers (28.8), but the differences in mean failed short of statistical significance. The relative frequency of non exclusive breastfeeding mothers was lowest among older age mothers (35 - 44 ) years. The availability of assistance (support) from family, relatives or neighbors in caring for the baby had no association with exclusive breastfeeding. The relative frequency of mothers having advice from medical staff against administration of fluids to the newborn was noticeably higher among exclusive breastfeeding group (19.6%) than those with non exclusive breast feeding (7.7%). Breastfeeding in public is significantly associated with a lower risk of non exclusive breastfeeding.

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

Author name: سفانه علي عثمان الراوي
Supervisor name: باسل عويد محمد صالح | منور عبد الاله النقاش
General topic: Medicine
Specific topic: Clinical Biochemistry
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: 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

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

Author name: فهد عباس عبد الرحمن
Supervisor name: عفان عزت حسن
General topic: Medicine
Specific topic: Physiology
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: 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.

دراسة في تاثير بعض العقاقير والنباتات الطبية في شفاء الحروق المحدثه بالحرارة == Study the Effects of Some Drugs and Medicinal Plants on the Healing of Thermally - Induced Burns in Rabbits

Author name: ناديه عبد الله نجم
Supervisor name: فاروق حسن الجواد
General topic: Medicine
Specific topic: Medicines and Toxins
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Burn represents a major health problem worldwide, that affect people of all ages, and associated with high mortality and morbidity and economic loss.Failure of the current treatment strategies to control many cases of burns, the local and systemic adverse effects that are produced by many topical antibiotics, especially in infants, children, pregnant ladies, and elderly people, and the delay of healing caused by many antiseptics, make a strong motive to find out a new safe and effective topical products.Many recent studies were done to find out natural products that have antimicrobial properties, and enhance the healing process.Aims : to find out if there is a possible beneficial therapeutic effects of cod liver oil, olive oil, liquorice and pomegranate ointments, when used alone or in combination with silver sulfadiazine (SSD) cream, on the healing of thermally induced burns.Materials and methods : thermal burns were induced in 60 rabbits, by application of hot metal rod of 300 degree C on the skin for 4 seconds. The burn wounds were treated by topical application of Vaseline (control group), SSD cream 1% (treatment control), cod liver oil, olive oil, liquorice and pomegranate peel ointments in combination with SSD cream were used in Part I, and these agents were used alone in Part II. The burn wounds surface areas and the duration of healing were used as parameters for comparision. Serum albumin, zinc and copper levels were measured for rabbits in Part I only.ثResults : all the tested agents (both alone and in combination with SSD cream), showed significant reduction in the mean burn wounds surface areas, and the mean duration of healing of these wounds. Serum albumin and zinc levels were significantly reduced after burn induction, then gradually increased with healing, and the topical application of the tested agents accelerated their improvement.Conclusions : topical application of each of the tested agents was significantly effective for treatment of burn wounds (both alone and in combination with SSD cream), and there was no significant difference between the use of each of these agents alone or in combination with SSD cream.

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

Author name: عقيل حاتم محمود
Supervisor name: سرمد محمد حسين الزيني | عقيل شاكر محمود
General topic: Medicine
Specific topic: Microbiology
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: 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.

مستوى المستند المصلي الخاص بالبروستات مقارنة مرضية سريرية للنساء المصابات بسرطان الثدي == Serum PSA level with Clinicopathological Correlation in women with breast cancer

Author name: ايناس عبد المجيد رشيد
Supervisor name: يعرب ادريس خطاب
General topic: Medicine
Specific topic: Diseases
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Prostate - specific antigen (PSA) is a serine protease expressed at high levels in prostate epithelium & elevated PSA in serum is well established marker of prostate cancer. Recently, the relative proportions of free PSA & PSA complexes to α1 - antichymotrypsine have become important variables in distinguishing between prostate cancer & benign prostatic hyperplasia (BPH). Numerous studied have demonstrated the production of PSA in female tissues e.g. breast & low levels of PSA are present in female sera.In this prospective study, we measured the levels of total PSA by mini VIDAS machine in the sera of 45 newly diagnosed breast cancer female patients & correlated these with selected clinicopathological variables includes : - Patient’s age, menopausal status, tumor size & volume, histological type & grade of the tumor , lymph node status & steroid hormone receptor status.The detected level of total PSA in the sera of healthy control was <0.07 ng/ml. About 35.6% of the total cases of women with breast cancer showed a higher levels (≥0.07 ng/ml) of total serum PSA.Chi - square & T - tests were used to identify the significance of association between total serum PSA levels & the clinicopathological variables. However, it has been found a significant association (P<0.05) between the level of total serum PSA & patient’s age, menopausal status, lymph node status & steroid hormone receptors (estrogen/ progesterone receptors).On the other hand, it has been identified there was no significant association (P>0.05) between the levels of total serum PSA & tumor size & volume, & histological type & grade of the tumors.We concluded that total serum PSA cannot be used as a screening program for early detection of breast cancer, but may be useful in close follow up the patients & may have a prognostic guide to response to the type of treatment.According to the results of our study, we recommend further study include larger sample size, combination of total serum PSA with other tumor marker.

قياس مستوى الهوموسستين ومقاومة الانسولين في بلازما مرضى متلازمة تكيس المبايض == Plasma Homocysteine and Insulin Resistance in Patients with Polycystic Ovary Syndrome

Author name: ظلال قاسم محمد
Supervisor name: حواء عبد الرزاق الظاهر | صباح مهدي حسين
General topic: Medicine
Specific topic: Physiology
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: خلفية البحث - : ان متلازمة تكيس المبايض هي اكثر انواع اعتلال الغدد الصماء شيوعا عند النساء في سن الانجاب ومن الممكن ان تكون مترابطة مع مقاومة الانسولين . الهوموسستين ممكن ان يكون مرتبطا مع تكيس المبايض ويساهم في العوامل الخطرة للاصابة بامراض القلب والاوعية الدموية وكذلك الاسقاط المبكر.الهدف - : لدراسة العلاقة بين الهوموسستين ومقاومة الانسولين في المريضات المصابات بمتلازمة تكيس المبايض.منهجية البحث - : خمسة وتسعون مريضة مسجلة في هذه الدراسة قد ارتدن عيادة العقم في مستشفى اليرموك التعليمي للفترة من تشرين الثاني 2013 - ايار 2014. مجموعة المريضات تتضمن النساء المصابات بتكيس المبايض وعددهن 55 مريضة وكانت اعمارهن تتراوح من 18 - 40 سنة بمعدل ( 26.95± 5.5) ومــعدل معامل الكــتلة (32.63± 4.27).المجموعة الثانية تتضمن النساء السليمات (المجموعة الضابطة) وعددهن 40 امراة وهن متقاربات في العمر ومعامل الكتلة مع النساء السليمات. قيمت كل مريضة من خلال التاريخ المرضي الكامل والفحص السريري، اما عينات الدم فقد سحبت من النساء في وقت مبكر من الدورة الشهرية (اليوم الثاني - اليوم الخامس) لقياس الهرمون اللوتيني (LH) والهرمون المحفز للمبايض (FSH) وكذلك الهرمون المحفز للغدة الدرقية (TSH) وهرمون الحليب (prolactin) والهرمون الذكري (testosterone). خضعت كل مريضة ايضا الى الفحص بالموجات فوق الصوتية (السونار) لقياس حجم المبايض ووجود التكيسات الصغيرة في محيط المبايض او عدم وجودها.الهرمون اللوتيني والهرمون المحفز للمبايض والهرمون الذكري قيست بواسطة جهاز ال(MINIVIDUS) اما هرمون الحليب والهرمو المحفز للغدة الدرقية قيست بواسطة جهاز ال (GAMMA) في مختبرات مستشفى اليرموك التعليمي.وبعد تشخيص المريضات المصابات بمتلازمة تكيس المبايض من النساء السليمات تم سحب الدم في الصباح بعد 12 ساعة من الصيام لقياس نسبة الدهون، نسبة السكر، نسبة الانسولين ونسبة الهوموسستين في الدم.نسبة الدهون والسكر في الدم قيست بطريقة ال (Auto - Analyzer) اما نسبة الانسولين قيست بطريقة الـ (ELISA) وحسبت مقاومة الانسوليين بمعادلة الـ (HOMA - IR) : - نسبة الانسولين (µU/ml) × نسبة السكر (mg/dl) /405 . مقاومة الانسولين الطبيعية ≤ 3، مقاومة الانسولين المتوسطة 3 - 5، مقاومة الانسولين الشديدة >5 . الهوموسستين كذلك قيس بطريقة الـELISA) ) والقراءة الاكثر من 13 تعتبر زيادة في نسبة الهوموسستين. النتائج : - نسبة الانسولين ومقاومة الانسولين والهوموسستين اختلفت احصائيا بين المجموعتين وكانت اعلى في النساء المصابات(17.64 ± 9.3) (4.15 ± 2.54), (12.84 ± 6.98), بالتعاقب بالمقارنة مع النساء السليمات (8.02 ± 2.19) (1.69 ± 0.54) ( 9.51 ± 1.92) بالتعاقب، ولكن لا يوجد اي اختلاف احصائي في هذه المتغيرات بين النساء ذات الوزن العالي والنساء السمينات في مجموعة النساء المصابات بمتلازمة تكيس المبايض. هناك اختلافا احصائيا المتعلق بالهرمون المحفز للمبايض والهرمون اللوتيني ونسبة الهرمون اللوتيني الى هرمون المحفز للمبايض بين مجموعة المريضات المصابات بتكيس المبايض والنساء السليمات وكانت نسبة الهرمون المحفز للمبايض اقل في المريضات المصابات(5.8 ± 1.8) مقارنة مع النساء السليمات(7.15 ± 1.59) بينما كان الهرمون اللوتيني ونسبة الهرمون اللوتيني الى الهرمون المحفز للمبايض اكثر في المريضات المصابات (1.75±1.22), (9.5 ± 5.9) مقارنة بالنساء السليمات (0.76 ± 0.28) (5.45 ± 2.16), بالتعاقب لكن لا يوجد اختلاف احصائي في الهرمون الذكري بين المجموعتين.لا يوجد اي اختلاف احصائي المتعلق بهرمون الحليب والهرمون المحفز للغدة الدرقية ولكن يوجد اختلاف واضح في نسبة السكر وتكون اعلى في المريضات المصابات (5.11± 0.6) مقارنة مع النساء السليمات(4.73±0.62).نسبة الدهون اختلفت احصائيا بين المجموعتين وكانت اعلى في النساء المصابات بتكيس المبايض بالنسبة للكولسترو(4.75 ± 0.68),، الدهون الثلاثية (1.67 ± 0.72) والبروتينات الدهنية منخفضة الكثافه (2.24 ± 0.47) اما البروتينات الدهنية مرتفعة الكثافة كانت اقل (1.08 ± 0.3) بالمقارنة مع النساء السليمات.في مجموعةالنساء المصابات بتكيس المبايض كانت العلاقةايجابيه ولكنها لاتمتلك دلالة احصائية بين مقاومة الانسولين وكل من(الهرمون اللوتيني (r=0.044, p=0.752)، نسبة الهرمون اللوتيني الى الهرمون المحفز للمبايض (r= 0.043, p= 0.756)، نسبة قياس الخصر الى قياس الورك (r=0.013, p=0.924).(في مجموعة النساء المصابات بتكيس المبايض كانت العلاقة ايجابية ولكنها لا تمتلك دلالة احصائية بين الهوموسستين و(الهرمون اللوتيني (r=0.062, p=0.653),, نسبة قياس الخصر الى قياس الورك (r=0.061, p=0.661),) . توجد علاقة ضعيفه بين الهوموسستين ونسبة الهرمون اللوتيني الى الهرمون المحفز للمبايض (r= 0.009, p= 0.756).لانوجد علاقة احصائية واضحه بين الهوموسستين ومقاومة الانسولين في المريضات المصابات بتكيس المبايض(r= - 0.003, p=0.983)..الاستنتاج : - في هذه الدراسة تبين ان هناك علاقة بين مقاومة الانسولين ومتلازمة تكيس المبايض وعلاقة اخرى بين الهوموسستين وتكيس المبايض ولكن لا توجد علاقة بين الهوموسستين ومقاومة الانسولين في المريضات المصابات بتكيس المبايض ومن الممكن ان يكون لكل متغير عمله الخاص. | Polycystic ovary syndrome (PCOS) is the most common endocrine disease among women in fertility age and may be associated with sever insulin resistance. Homocysteine may be associated with of polycystic ovary syndrome and it has been implicated as a significant risk factor for cardiovascular disease, pre - eclampcia, and recurrent pregnancy loss.Aims of the study : - Examine the correlation between serum homocysteine level and insulin resistance in PCOS patients attending infertility center.Patients and method : - Ninety - five women attending the infertility center in AL - Yarmook Teaching Hospital were enrolled in this study, in the period from January 2014 to May 2014. Women who had PCOS were selected as patients group (n=55). Their ages were between18 - 40 years (mean 26.95± 5.5 year) and their mean body mass index (BMI ) was (32.63± 4.27 kg/m2) and women who had no PCOS considered as control group(n=40) who had age and BMI approximately matched with the first group. Each patient was assessed by full history and physical examination. Blood samples were aspirated during the early follicular phase (cycle day2 - 5) of the menstrual cycle for hormonal assessment : - follicular stimulating hormone (FSH), luteinizing hormone (LH), thyroid stimulating hormone (TSH), total testosterone, and serum prolactin. The serum levels of FSH, LH, and total testosterone were examined by MINIVIDUS device while TSH and prolactin were examined by GAMMA device. Pelvic ultrasound was done to evaluate the size of the ovary and the presence or absence of small multi - follicles on the periphery of the ovary. After The diagnosis of PCOS patients, fasting blood sample was collected for the measurement of lipid profile [cholesterol, triglyceride, high density lipoprotein (HDL), low density lipoprotein (LDL)], fasting blood sugar (FBS), insulin, and homocysteine. Lipid profile and FBS were measured by Auto - analyzer method while the insulin was measured by ELIZA method and insulin resistance was calculated by Homeostatic Model Assessment of IR (HOMA - IR) according to this equation : - Insulin Resistance (IR) = (Blood glucose (mg/dl)× serum insulin (µU/ml) )/405 Normal IR ≤ 3, moderate IR 3 - 5, sever IR>5. Homocysteine also measured by ELISA method and the level > 13 considered as hyperhomocysteinemia.Results : - Insulin, IR, and homocysteine, differed significantly being higher in patients (17.64 ± 9.3), (4.15 ± 2.54), (12.84 ± 6.98) respectively, than control, (8.02 ± 2.19), (1.69 ± 0.54), ( 9.51 ± 1.92), but there was no significant difference in these variables between overweight and obese patients within the PCOS group. There was a significant difference in FSH, LH, LH/FSH ratio being lower FSH (5.8 ± 1.8) and higher LH (9.5 ± 5.9), LH/FSH (1.75 ± 1.22) ratio in PCOS group as compared to control (7.15 ± 1.59), (5.45 ± 2.16), (0.76 ± 0.28) respectively, but there was no difference related to total testosterone levels. There was no significant difference between patients and control related to prolactin and TSH while there was significant difference in fasting blood sugar (FBS) being higher in PCOS (5.11 ±0.6) than control (4.73 ± 0.62). In term of lipid profile (cholesterol, triglyceride, LDL, HDL) which differed significantly between PCOS group and the control being higher cholesterol (4.75 ± 0.68), triglyceride (1.67 ± 0.72), LDL (2.24 ± 0.47) and lower HDL (1.08 ± 0.3) in PCOS group than control (3.95 ± 0.54), (1.1 ± 0.34), (1.85 ± 0.35), (1.28 ± 0.13) respectively. Insulin resistance was found to correlate positively but not significantly with LH (r=0.044, p=0.752), LH/FSH ratio (r= 0.043, p= 0.756), and waist/hip ratio in PCOS group (r=0.013, p=0.924). Homocysteine had non - significant positive correlation with LH (r=0.062, p=0.653), and waist/hip ratio (r=0.061, p=0.661), but there was weak positive correlation with LH/FSH ratio (r= 0.009, p= 0.756) In PCOS group. There was no obvious correlation between insulin resistance and homocysteine in PCOS patients (r= - 0.003, p=0.983).Conclusion : - Insulin resistance and homocysteine were increased significantly in PCOS patients as compared to control, but there was no correlation between homocysteine and IR within the PCOS group, the two variables may have a different mechanism of action.

تقييم نقص الحديد لدى النساء الحوامل باستخدام مؤشر مستقبل التراسفيرين الذائب - الفيريتين == Assessment of iron deficiency in pregnant women by using soluble transferrin receptor - ferritin index

Author name: سارة كنعان علوان
Supervisor name: جعفر نوري جعفر ال السيد عيسى
General topic: Medicine
Specific topic: Diseases
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: نقص الحديد يمكن ان يؤثر تاثيرا سلبيا على صحة النساء الحوامل واجنتهن. في الوقت الحاضر، لا يمكن اعتبار اي علامة على انها مثالية للكشف عن فقر الدم بسبب نقص الحديد لدى النساء الحوامل. وقد اقترح بعض المؤلفين ان مؤشر المستقبلات القابلة للذوبان ترانسفيرين - فيريتين يمكن ان يكون علامة واعدة للكشف عن نقص الحديد خلال الاثلوث الثالث من الحمل.الهدف من الدراسةلدراسة قيمة مؤشر مستقبلات ترانسفيرين الذائب - الفريتين كعلامة لنقص الحديد خلال الاثلوث الثالث من الحمل.المرضى والمواد والطرقهذه دراسة مستعرضة اجريت في عيادة ما قبل الولادة في مستشفى الزهراء للامومة والاطفال ومستشفى بعقوبة التعليمي في محافظة ديالى / شرق - وسط العراق خلال الفترة من ۱٧ اذار ۲۰۱٦ وحتى نهاية اذار ۲۰۱٧ شملت الدراسة ٧٥ امراة حامل في الاثلوث الثالث تراوحت اعمارهن ۱٥ - ٤٥ سنة واللواتي انطبقت عليهن معايير الادراج. تم جمع البيانات باستخدام ورقة جمع البيانات التي تم اعدادها مسبقا، وتم توثيق جميع البيانات الديموغرافية والسريرية والمختبرية. تم جمع عينات الدم عن طريق الوريد باستخدام تقنية عقيمة ونظيفة وسحب ٥ مل من الدم الوريدي من كل امراة مشاركة وارسالها الى المختبر لاجراء فحص متثابتات الدم ، الفيريتين ، ترانسفيرين، مستقبلات الترانسفيرين ، ومؤشر مستقبلات ترانسفيرين الذائب - الفريتين. تمت الاخذ بالاعتبار جميع الامور الاخلاقية قبل واثناء اجراء الدراسة. تم اجراء تحليل البيانات باستخدام الحزمة الاحصائية للعلوم الاجتماعية (SPSS) الطبعة ۲٤ وتم تطبيق الاختبارات الاحصائية المناسبة وفقا لذلك.النتائجكان متوسط عمر النساء ۲٨,٣ ± ٦,٥ (المدى : ۱٦ - ٤٥) سنةوجدت الدراسة ان ٣۲% من مجموعة الدراسة كان لديهن فقر الدم لنقص الحديد. وكان مستوى الحديد والفريتين المصلي اقل بكثير في مجموعة فقر الدم لنقص الحديد في حين ان مستقبلات ترانسفرين الذائب (sTfR) ومؤشر ترانسفرين - فيريتين (sTfR - F ) كانت اعلى بكثير مقارنة بالمجموعة الطبيعية. وباستخدام تحليل منحنى خصائص التشغيل للمستقبل (ROC)، توصلت الدراسة الى ان المنطقة الواقعة تحت المنحنى (AUC) لمستقبلات ترانسفرين الذائب كانت(۰,٨۲٥) لمؤشر ترانسفرين - فيريتين (sTfR - F ) (۰,٨٤۲) ، وهذا يشير الى ان كلا المتغيرين كانا مؤشرين جيدين ودقيقين لفقر الدم لنقص الحديد (AUC = ۰,٩۱٣) في حين كان مستوى الفيريتين في الدم مؤشر ممتاز للكشف عن فقر الدم لنقص الحديد وكان له معدلات حساسية ونوعية ودقة اعلى من كلا من مستقبلات ترانسفرين الذائب ومؤشر ترانسفرين - فيريتين . بالاضافة الى ذلك، كانت معلمات الصلاحية لمؤشر ترانسفرين - فيريتين - اعلى منها لمستقبلات ترانسفرين الذائب.الاستنتاجاتكانت مستقبلات ترانسفرين الذائب ومؤشر مستقبلات ترانسفرين - فيريتين مؤشرات جيدة وصالحة للكشف عن فقر الدم لنقص الحديد جيدة ولها دقة جيدة للتنبؤ بالمرض في النساء الحوامل واظهرت حساسية جيدة، ونوعية عالية ودقة في الكشف عن فقر الدم لنقص الحديد. لم تجد الدراسة فروقا ذات دلالة احصائيا في الصلاحية بين مستقبلات ترانسفيرين الذائب ومؤشر مستقبلات ترانسفيرين / الفيريتين من حيث الصلاحية للكشف عن فقر الدم لنقص الحديد. | Iron deficiency could have an adverse effect on the health of pregnant women and their fetuses . At present, no marker could be considered as the ideal for the detection of Iron deficiency anemia in pregnant women. Some authors suggested that Soluble transferrin receptor - ferritin index could be a promising marker for iron deficiency during third trimester of pregnancy.Aim of the studyTo study the value of soluble transferrin receptor - ferritin index as a marker for iron deficiency during third trimester.Patients, materials and MethodsThis was a cross - sectional study conducted at the Antenatal clinic in Al Zahra’a maternity and children hospital and Baquba Teaching Hospital in Diyala province middle east of Iraq during the period from 17th march 2016 to the end of March 2017, seventy pregnant women aged 15 - 45 years in their third trimester who met the inclusion criteria were included. Data were collected using a pre - constructed data collection sheet , all demographic, clinical and laboratory data were reported .Blood samples were collected via aseptic clean technique venipuncture and 5 ml of venous blood was drawn from each participant woman and sent for hematological parameters , Serum ferritin, Transferrin, serum transferrin receptor , and Soluble Transferrin Receptor - Ferritin Index were assessed. All ethical issues were approved prior and during progressing of the study. Data analysis was performed using the statistical package for social sciences version 24 and the appropriate statistical tests were applied accordingly. ResultsThe mean age of the women was 28.3 ± 6.5 (range : 16 - 48) years . Iron deficiency anemia was reported in (32%) of the studied group . Serum Iron and ferritin were significantly lower in iron deficiency anemia group than normal group, (P<0.05). While the soluble transferrin receptor and soluble transferrin receptor - ferritin index were significantly higher in iron deficiency anemia group than the normal group (P<0.05). Using the receiver operating characteristics curve analysis the study found that the area under the curve of soluble transferrin receptor was (0.825) and soluble transferrin receptor - ferritin index was (0.842), indicated that both parameters were good and accurate predictors of id with good sensitivity, specificity and accuracy rates, however, serum ferritin showed larger area under the curve and better predictive value (area under the curve = 0.913) indicated that S. ferritin is excellent predictor of iron deficiency and had higher sensitivity, specificity and accuracy rates than soluble transferrin receptor and soluble transferrin receptor - ferritin index. Additionally, the validity parameters of soluble transferrin receptor - ferritin index was higher than that of soluble transferrin receptor.ConclusionsSolubled transferrind receptor and Soluble Transferrin Receptor/ferritin index were good, valid and accurate predictors for ID in pregnant women and showed good sensitivity, specificity and accuracy in detection of iron deficiency anemia. No significant differences in the validity between solubled transferrin receptor and Solubled Transferrind Receptor/ferritind index.

التعبير لجين التيلومريز البشري المورثي العكسي في المرضى الذين يعانون من ابيضاض الدم اللمفاوي المزمن نوع ب واثره على المعلمات الدموية والمؤشرات السريرية == The expression of Human Telomerase Reverse Transcriptase gene in patients with B - Cell chronic lymphocytic leukemia and its association with clinical staging and hematological parameters

Author name: علي عبد المحسن عبد الكريم
Supervisor name: جعفر نوري جعفر ال السيد عيسى
General topic: Medicine
Specific topic: Diseases - Blood
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: الخلفية : مرض ابيضاض الدم اللمفاوي المزمن هو سرطان الدم الاكثر شيوعا لدى المسنين حيث يتميز بتراكم تدريجي للخليا اللمفاوية الناضجة في نخاع العظم والدم المحيطي التي تميل الى ان تكون خالدة. بسسب كون المرض غير متجانس, نحن بحاجة الى معلمات لكي تتوقع تصرف المرض في المرضى. ان لتعبير جين التيلومريز البشري المورثي العكسي ترابط مع عدوانية المرض في الامراض السرطانية.الهدف من الدراسة : لاختبار التقييم الكمي للتعبير لجين التيلومريز البشري المورثي العكسي ونشاطه في المرضى الذين يعانون من ابيضاض الدم اللمفاوني المزمن نوع ب واثره على المؤشرات السريرية.المرضى وطرائق العمل : اجريت هذه الدراسة باستخدام تقنية ال لفحص جين التيلومريز العكسي في خلايا الدم الاحادية النواة ل 42 مريضا بمرض ابيضاض الدم اللمفاوي المزمن.النتائج : تم اكتشاف وجود التعبير لجين التيلومريز البشري المورثي العكسي في (79.1%) من مرضى ابيضاض الدم اللمفاوي المزمن ولم يكن هنالك اي تعبير في جميع حالات المراقبة. كان التعبير لجين التيلومريز البشري المورثي العكسي موجودا بنسب عالية لدى الحالات المتقمة لمرضى ابيضاض الدم اللمفاوي المزمن. ايضا كان التعبير للجين عالي في المرضى ذو الاعمار الكبيرة, المرضى الذين لديهم انخفاض في المعلمات الدموية, المرضى الذين يعانون من تضخم الطحال او الكبد, المرضى الذين لديهم ارتفاع ضغط الدم او داء السكري, والمرضى الذين لديهم نمط ظاهري مناعي عالي | The B - Cell chronic lymphocytic leukemia is a commonest leukemia in elderly individuals characterized by progressive accumulation of mature lymphocyte in bone marrow and peripheral blood that tend to be immortal. Due to the disease heterogeneous, we are still in need for markers to predict the disease behaver in patients. The identification of human telomerase reverse transcriptase (hTERT) has been correlated with disease aggressiveness in malignancies.Aim : To test hTERT gene expression in B - CLL patients and its prognostic value in correlation with clinical staging and hematological parameters of disease.Patients and Methods : This prospective study recruited patients attending hematology ward/out patients in Baghdad teaching hospital / medical city with laboratory and flow cytometry diagnoses of B - CLL patients during period from September 2017 to January 2018. The ethical committee approved this study at the College of Medicine, University of Baghdad, and informed consents were obtained from all participants. Whole blood samples collected from 42 B - CLL patients. Whole blood samples were drawn from 20 control individuals that matched age and sex were also collected.Inclusion criteria : 1 - Patients diagnosed with B - CLL according to IWCLL criteria11.2 - Don’t receive any medication for B - CLL.The detection of telomerase activity is done by using Repeated Amplification Protocol (TRAP) method to detected hTERT telomerase activity in B - CLL patients, by photometric enzyme immunoassay kit called Telo TAGGG Telomerase PCR ELISA, developed by Roche applied science.Results : The hTERT gene expression was detected in 78.6% of B - CLL patients and no positive expression in control group (P=0.001). The hTERT gene expression tends to be significantly higher in advanced B - CLL stage (P=0.0001). Also, the expression was higher among elderly patients, patients with lower hematological parameters, patients with splenomegaly or hepatomegaly, patients with a history of hypertension or diabetes mellitus, and patients with high immunophenotype score. Conclusion : 1. The Human Telomerase Reverse Transcriptase gene expression was significantly associated with B - cell chronic lymphocytic leukemia patients.2. The Human Telomerase Reverse Transcriptase gene expression was significantly associated with modified Rai high stage B - cell chronic lymphocytic leukemia patients.3. The Human Telomerase Reverse Transcriptase gene expression was increasingly with advancing patients age and high IPT score patients.4. The Human Telomerase Reverse Transcriptase gene expression was higher in B - CLL patients that having lower hematological parameters.5. The Human Telomerase Reverse Transcriptase gene expression was higher in patients who had a history of hypertension or diabetes mellitus

دراسة كمية للخواص الكيميانسيجية والشكلية لعضلات الطرف الخلفي للجرذ == Quantitative Study of the Histochemical and Morphometric Characteristics of the Rat Muscles of the Hind Limb

Author name: مثنى عبد الامير عبد اللطيف
General topic: Medicine
Specific topic: Anatomy and Histology and Embryos
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:

استظهار المعلمات المناعية النسيجة HepPar - 1 وArginase - 1 في سرطان القولون والمستقيم == Immunohistochemical expression of HepPar - 1 and Arginase - 1 in colorectal carcinoma

Author name: اسلام اياد جاسم
Supervisor name: امير ظاهر
General topic: Medicine
Specific topic: Diseases
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: الخلفية : يعتبر سرطان القولون ذو انتشار كثير في مناطق شمال اوربا, واميركا الشمالية وبريطانيا العظمى ولكن بنسب قليلة في افريقيا واسيا واميركا الجنوبية. يعتمد تشخيص سرطان القولون والمستقيم على مظهر الرؤية تحت المجهر وان استخدام المعلمات المناعية له دور ايضا بالتشخيص. هنالك الكثير من المعلمات المناعية التي تتفاعل مع انسجة القولون, فان كثير من سرطان القولون والمستقيم يتفاعل مع (mucin), كذلك يتفاعل سرطان القولون والمستقيم مع (cytokeratins) , وايضا مع CARCINOEMBRYONIC ANTIGEN (CEA).في هذه الدراسة سيتم تقييم اثنان من المعلمات في سرطان القولون والمستقيم واللذان هما : (HepPar 1) , حيث انه جسم مضاد احادي النسخة يتفاعل مع جسم مستضد غير معرف في سايتوبلازم خلايا الكبد الطبيعية والسرطانية وقد يضهر تفاعلا مع انسجة القولون والمستقيم سواء السرطانية او الغير سرطانية. وكذلك المعلم (Arginase 1) حيث يعتبر كمعلم حساس ومخصص لخلايا الكبد الورمية وغير الورمية.الهدف : لمعرفة مدى استظهار المعلمان المناعيان (HepPar 1, Arginase 1) في سرطان القولون والمستقيم .الاسلوب : ثمان وخمسين حالة (49 منها سرطان القولون والمستقيم و9 منها لنسيج القولون والمستقيم لغير الاورام السرطانية) للاعوام 2014, 2015 و2016 تشمل الذكور والاناث وتعتمد المستخرجات على السجلات الموجودة , الدراسة اجريت في مستشفى الجهاز الهضمي في مدينة الطب في بغداد قسم النسيج المرضي من تاريخ 1\10\2016 الى تاريخ 1\4\2017النتائج : ثمان وخمسون حالة ( تسع واربعون منها سرطان القولون والمستقيم وتسع حالات منها لخزعات للقولون والمستقيم لحالات غير السرطان) تم دراستها , فبالنسبة للمعلم (HepPar1) فان الاستظهار الايجابي كان بنسبة (8.2%) للانسجة السرطانية , بينما كانت الانسجة الغير سرطانية ليس هناك استظهار للمعلم المناعي المذكور , ولا توجد علاقة احصائية بين المعلم المناعي (HepPar - 1) وبين درجة التورم وموقع السرطان والعمر والجنس وذلك لان قيمة P اكثر من 0.05.اما بالنسبة للمعلم المناعي (Arginase 1) فان الاستظهار الايجابي كان سبعة حالات فقط من الحالات السرطانية (14.3%) , بينما كانت الانسجة الغير سرطانية ليس هناك استظهار للمعلم المناعي المذكور , ولا توجد علاقة احصائية بين المعلم المناعي (Arginase 1) وبين درجة التورم وموقع السرطان والعمر والجنس وذلك لان قيمة P اكثر من 0.05.الخلاصة : بالرغم من اعتبار HepPar - 1 وArginase 1 كملعمات اورام للكبد سواء النسيج الطبيعي او السرطاني , الا انه يمكن استظهاره في انسجة سرطانية اخرى ومثالا لها هذه الدراسة التي بينت نسبته في سرطان المستقيم والقولون بنسبة (8.2%) و(14.3%) على التوالي بينما لم يظهر في النسيج الغير سرطاني للمستقيم والقولون.مفاتيح الكلمات : HepPar - 1 , Arginase 1 , سرطان القولون , سرطان المستقيم | Colorectal carcinoma is 6th most common cancer in Iraq, and account nearly 5% of all cancers, in males it is the 5th commonest cancer and it is the 4th in females. The diagnosis of colorectal cancer is by routine morphologic appearance under microscope and the use of immunohistochemistry has a certain role. There are many immunohistochemical markers react to colonic tissue like CK and CEA.In this study the role of two markers is going to assessed in colorectal tumors which are : HepPar - 1 (which is a monoclonal antibody that reacts to an as yet unidentified cytoplasmic marker of normal and neoplastic hepatocytes) and Arginase - 1 (marker is both specific and sensitive to normal and malignant hepatocyte). Objectives : to see the expression of HepPar - 1 and Arginase - 1 (cytoplasmic markers of normal and neoplastic hepatocytes) in colorectal cancer.Patients and methods : Fifty - eight cases (49 with colorectal carcinoma and 9 cases of non - neoplastic colorectal tissues) were selected randomly of the years 2014, 2015 and 2016 depending on records which are selected randomly, the study is conducted in GIT specialized hospital in medical city / department of histopathology - Baghdad city.Results : Fifty - eight biopsies (forty - nine cases of colorectal carcinoma and nine cases of non - neoplastic colorectal biopsies) were studiedRegarding to HepPar - 1 the positivity in our study of the cases was (8.2%), and the control cases that have seen positive was none. No significant statistical correlation was found between HepPar - 1 expression and the tumor grade, site or sex, (P values >0.05).Regarding to Arginase 1 expression only seven cases (14.3%) of colorectal carcinoma express this marker, and the control cases that have seen positive was none. No significant statistical correlation was found between Arginase 1 expression and the tumor grade, sex, or site (P values >0.05) No one of the nonmalignant cases expressed Arginase 1. Conclusions : HepPar - 1 and Arginase - 1 can be expressed in colorectal carcinoma including 8.2% and 14.3% (HepPar - 1 and arginase - 1 respectively) of colorectal carcinoma, HepPar - 1 and Arginase - 1 are not expressed in normal colorectal tissue

العلاقة بين كمية الخلية الحرة في السائل الجريبي وعلاقته بنوعية الجنين لدى النساء المصابات بتكيس المبايض

Author name: هبة رشيد قاسم
Supervisor name: حنان لؤي العمري | شيماء جمال احمد
General topic: Medicine
Specific topic: Physiology
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Poly cystic ovary syndrome is still consider as the most contra versal disease that affect females at reproductive age. It accounts about (5 - 10%) of females worldwide and can cause primary or secondary infertility. Cell free DNA is found as a result of apoptosis and lately it is used as an indicator for embryo quality. It is found to be present in follicular fluid as a result of folliculogenesis of granulose cell of oocyte and then can be measured in blood to determine the quality of oocyte and embryo in the in vitro fertilization procedures to have a better and higher success rate in these procedures, since in vitro fertilization are considered expensive procedures and they are the last hope for families to have children .Aiming of this study is to find a non expensive, most reliable and most accurate way to determine oocyte and embryo quality for a good result during in vitro fertilization procedure this through measurment of cell free DNA in follicular fluid and correlating it with embryo quality.Sixty females have been participated in this research were (32)of them having Polycytic ovary syndrome as a cause of infertility, while (28) of them are considered control group having un - explained infertility. All patient had passed through the antagonist protocol of ovarian stimulation preparing for intracytoplasmic sperm injection procedureBlood samples were drawn before and after stimulation for the hormonal measurements. Follicular fluid have been collected at day 14 at time of oocyte retrieval ,DNA extracted from this follicular fluid and cf DNA have been calculated by electrophoresis.Cell free DNA was with no significant difference between control (2.49±1.41 ng/μl) and PCOS patient (2.15±1.31ng/μl) . The good quality oocyte has significantly lower cf DNA level than that in bad quality one (1.04±0.5ng/μl vs 3.58±0.68 ng/μl for control and 0.89±0.65ng/μl vs 3.17±0.77ng/μl for poly cysticIXovary syndrome ) (p value =˂o.oo1). At the same time 17 ß - estradiol level was measured at time of oocyte collection and it was found to have a negative correlation with cf DNA (r= ¬ 0.033 and p=0.869 for control and r= - 0.0238 and p=0.18 for poly cystic ovary syndrome) . cf DNA was significantly lower in top quality embryo for both control and poly cystic ovary syndrome females (r= - 0.874 ,p=˂0.001 for control and r= - 912 ,p=˂0.001 for poly cystic ovary syndrome females).There is no difference in quantity of cf DNA in the follicular fluid for control and poly cystic ovary syndrome females .cf DNA is a good predictor of the embryo quality being higher in follicular fluid of oocytes yeilding poor quality embryos.

انتشار الاضطراب الكربي التالي للرضح بين الافراد العسكريين في القوات المسلحة العراقية == Prevalence of posttraumatic stress disorder among military personnel in Iraqi military force

Author name: عبد الصاحب هادي عبد الكريم
Supervisor name: جواد كاظم الديوان
General topic: Medicine
Specific topic: Community Medicine
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Previous local studies showed that post - traumatic stress disorder (PTSD) is a highly prevalent disorder in Iraq. Up to our knowledge no published data on PTSD among Iraqi military personnel were available.Objective : to estimate the prevalence of PTSD among Iraqi military personnel that created by traumatic events.Methods : A total of 360 Iraqi soldiers were included in this study. Data collected between march and May 2017, they were selected by multistage random sample (Division, Brigade, Battalion then soldiers). Participants were requested to fill the form and complete questionnaire with the most suitable choice. the questionnaire is consisting of three elements : the first element is the socio - demographical information, the second element is the life event checklist (LEC - 5) and the third element is the Post - traumatic checklist (PCL - 5) which is according to DSM - 5 (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). Statistical tests were applied to examine the association of (PTSD, socio - demographic variables, substance abuse and life events). P - value <0.05 was considered significant.Results : PTSD was found in 67 of the participants, making a prevalence of 18.6 %. No significant effect of age on developing PTSD was noted (p value=0.3)., Accumulated exposure positively affected the symptoms of PTSD (p<0.05). the cigarette Smokers were (64 %) and substance users were 3.6%.Conclusion : Iraqi military personnel had experienced traumatic events, PTSD is very common among Iraqi military personnel.Key word : PTSD, Iraq, military personnel, DSM - 5

عامل النمو المشابه للانسولين, I - الانسولين , الاستروجين ومستوى الدهون كعوامل خطرة بسرطان == Insulin like growth Factor - ?, Insulin, Estrogen and lipid profile as a risk factors in breast cancer

Author name: اثار حسن عبد الله
Supervisor name: قسمة محمد تركي | منور عبد الاله النقاش
General topic: Medicine
Specific topic: Clinical Biochemistry
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: سرطان الثدي مسؤول عن موت ملايين النساء على نطاق العالم كل سنة . وهو واسع الانتشار في العالم والعراق حتى اصبح مشكلة حقيقية لدى جميع الاصحاء .اسباب هذا المرض غير معروفة .العوامل الجينية والهرمونية تشارك في تطور سرطان الثدي وتقدم هذا المرض . يعمل هرمون عامل النمو المشابه للانسولين - 1 بشكل اساسي على تنظيم التمايزالخلوي وتجدد الانسجة , من خلال احداث الانقسام الفتيلي ,منع الاستماتة وزيادة هجرة الخلية وهو بذلك يعزز تكون الاورام.الهدف : تقيم دور هرمون عامل النمو المشابه للانسولين - 1,الانسولين ,الاستروجين ومستوى الشحوم في دم المريضات المصابات بسرطان الثدي في نشوء هذا المرض.الاشخاص وطريقة العمل : - اجريت هذه الدراسة خلال الفترة من تشرين الاول 2011 الى شباط 2012 حيث تم اختيار الانساء بعد تشخيصهن في العيادة الاستشارية لمستشفى بغداد التعليمي في مدينة الطب / استشارية الاورام اجريت الفحوص المختبرية في المختبرات التعليمية في مدينة الطب.واخذت المعلومات حسب استمارة المعلومات المنظمة للدراسة. تضمنت هذه الدراسة (60)مريضة(30قبل سن الياس +30بعد سن الياس)تتراوح اعمارهن بين (29 - 70)سنة يعانيين من سرطان الثدي و(60)امراة من مجموعة الضبط (30قبل سن الياس +30بعد سن الياس ) متماثلات مع مجموعة المريضات من ناحية العمر. تم قياس كل من (عامل النمو المشابه للانسولين - 1,الانسولين والاستروجين ) بطريقة الالايزا في حين استعملت الطرق Iاللونية لقياس مستوى انواع الشحوم في مصل الدم كما تم قياس مؤشر كتلة الجسم مع محيط الخصرلجميع العينات في هذه الدراسة. النتائج : - اظهرت النتائج ان مستوى عامل النمو المشابه للانسولين - 1 والانسولين اعلى في مجموعة المرضى مقارنة بمجموعة الافراد الاصحاء( p<0.01), لكن عامل النمو المشابه للانسولين - 1 سجل اعلى مستوى لدى النساء قبل سن الياس نسبة النساء بعد سن الياس ومجموعة الضبط قبل وبعد سن الياس ( p<0.01) .كان مستوى هرمون الاستروجين اعلى لدى النساء المريضات قبل سن الياس مقارنة بالنساء بعد سن الياس ومجموعة الضبط قبل وبعد سن الياس. ويوجد اختلاف معنوي بين مجموعة المرضى ومجموعة الاصحاء في مستوى الشحوم (الكولسترول والشحوم قليلة الكثافة)في مصل الدم . بينما لم يظهر اختلاف في مستوى الشحوم عاليةالكثافة بين المرضى والاصحاء قبل سن الياس(P>0.05) ولكن هناك اختلاف معنوي عند النساء بعد سن الياس (P<0.01).الاستنتاجات : يرتفع مستوى هرمون عامل النمو المشابه للانسولين - 1 والاستروجين في النساء المصابات بسرطان الثدي قبل سن الياس ,من هذه النتائج يقترح استخدام هرمون عامل النمو المشابه للانسولين - 1والاستروجين كعلامة يمكن التنبا من خلالها على سرطان الثدي في النساء قبل سن الياس

دور العلامات المصلية (CA - 125, CA19 - 9) وIL - 6 في بطانة الرحم المهاجره == The Role of Serological Markers (CA - 125,CA19 - 9) and IL - 6 in Endometriosis

Author name: ثروه هادي حسن الطائي
Supervisor name: هيفاء سلمان الحديثي | هند صباح عبد السلام
General topic: Medicine
Specific topic: Microbiology - Immunology
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
Key words:
  • بطانة الرحم المهاجرة
  • علامات ورم
  • CA - 125
First pages:
Abstract: بطانة الرحم المهاجرة هو خلل مزمن يصيب الجهاز التناسلي للمراة ويتصف بوجود وانتشار غدة وسدى خارج تجويف الرحم حيث يصيب 10% من النساء اللاتي في سن الانجاب، ويعد هذا المرض احد اكثر الامراض تعقيدا وارباكا ومن اعراضه المرهقة الم دوري في الحوض مما يجعل حياة المريضة لا تطاق ان تركت الحالة بدون علاج. النساء المصابات بمرض بطانة الرحم المهاجرة في مرحلته الاولى او الثانية (الخفيفة الى المعتدلة) قد يعانين من اعراض اكثر الما من اللاتي في المرحلة الثالثة او الرابعة، حيث توجد بعض الادلة التي تفيد بان مرض بطانة الرحم المهاجرة الخفيف الى المعتدل قد يكون اكثر اشكال المرض نشاطا.ان امكانية تشخيص مرض بطانة الرحم بسهولة، وذلك باستخدام وسائل اقل تداخلا (العلامات البيولوجية)، من شانه ان يعكس قيمة كبيرة، وعلى وجه الخصوص في حال استخدام العلامات البيولوجية ذاتها في رصد العلاج بفاعلية.الهدف : - لتشخيص فاعلية مصل CA - 125 وCA19 - 9 وIL - 6 في مجال التكهن في بطانة الرحم المهاجرة واستخداماتها في قياس مدى خطورة المرض. الاشخاص والمواد والعمل : - طبقت تلك الدراسة على 51 امراة ممن اصبن بمرض بطانة الرحم المهاجرة (20 حالة حديثة و31 حالة تمت معالجتها) و33 امراة سليمة. خضع جميع الافراد الى اختبار اخذ عينات الدم بهدف قياس مصل CA - 125 وCA19 - 9 وIL - 6 وذلك باستخدام تقنية ELISA. النتائج : - خلصت دراستنا الى ان مريضات بطانة الرحم المهاجرة يعانين بشكل كبير في عمر يتراوح بين 28 - 37 (54%)، و(61%) من المريضات يراجعون بسبب الم مزمن في الحوض في حين ما تبقى (39%) يراجعون بسبب العقم. ووجدت زيادة بشكل ملحوظ في مستويات مصل CA - 125 وCA19 - 9 لدى المصابات بالمرض وعلى وجه الخصوص في المرحلتين الثالثة والرابعة واقل منه لدى المريضات اللاتي تمت معالجتهن مقارنة بالمجاميع غير المعالجة. اما مستوى مصل IL - 6 فقد انخفض بنحو كبير لدى المصابات اللاتي في المرحلة الرابعة، حيث ان مصل IL - 6 كان 100% نوعية في حين CA - 125كان اكثر حساسية. الاستنتاج : - يرتبط كل من CA - 125 وCA19 - 9 ايجابا ببطانة الرحم المهاجرة، وعلى ما يبدو ان تركيز اختبار مصل IL - 6 اكثر نوعية والذي يعد علامة مبكرة للكشف عن مرض بطانة الرحم المهاجرة. | Endometriosis is a common chronic gynecologic disorder characterized by the presence and proliferation of functional endometrial gland and stroma outside the uterine cavity, affecting approximately 10% of reproductive age women. It is one of the most complicated and baffling disease with debilitating symptoms of cyclical pelvic pain, which may render the patients life unbearable if left untreated.Endometriotic women with stage I or II (mild to moderate) may have more painful symptoms than a women with stage III or IV. there is some evidence that mild to moderate endometriosis may be the more active forms of the disease. Therefore, the ability to diagnose endometriosis more easily, using less invasive means ( marker), would be of great value, particularly if the same biomarker could be used to monitor treatment efficacy.Aim of study : - To evaluate the efficacy of serum CA - 125, CA19 - 9 and IL - 6 levels in the diagnosis of endometriosis and their uses in measuring the severity of the disease.Materials and methods : - This study was applied on 51 women with endometriosis (20 newly diagnosed and 31 treated cases) and 33 apparently healthy women.All individuals were subjected to blood sampling for measuring their serum CA - 125, CA19 - 9 and IL - 6 by using ELISA technique.Results : - Our study shows that endometriosis patient mainly presented at age between 28 - 37 (54%), 61% of them presented with chronic pelvic pain while the other (39%) presented due to infertility.Serum levels of CA - 125 and CA19 - 9 were significantly elevated in patients with endometriosis mainly those at stage III and IV and that there were much less in treated patients when compared to non treated group.Serum IL - 6 level was significantly decrease in those with stage IV endometriosis. IL - 6 has 100% specificity while CA - 125 has a higher sensitivity.Conclusion : - Serum CA - 125 and CA19 - 9 were positively correlated with severity of endometriosis. Reduction in serum IL - 6 concentration seems to be the highly specific
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