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.