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تاثير العلاج الشعاعي لمرضى سرطان الثدي على المنسوب القذفي لعضلة القلب

Author name: زينب محمد دخيل علي
Supervisor name: خضير جاسم صبيح الرواق
General topic: Medicine
Specific topic: Diagnostic Radiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: ان سرطان الثدي في الوقت الحالي يعتبر من اكثر انواع السرطانات شيوعا واصابة للنساء حول العالم وكذلك يعتبر السبب الرئيسي للموت للمراه بسبب السرطان حول العالم .في العراق يعتبر سرطان الثدي من اكثر انواع السرطانات انتشارا بين النساء , حيث تصل نسبة الحصائيات لسنه 2011 الى 18,96% , وان احد اهم الخطوات في علاجه هو العلاج بالاشعاع .الغرض من الدراسهتسليط الضوء على تاثير العلاج الشعاعي لسرطان الثدي في المنسوب القذفي لعضلة القلب .المرضى وطرق البحثان هذه الدراسه هي دراسه جدوليه منظوريه وان المعلومات الخاصه بمرضى سرطان الثدي وفحوصات القلب قد تم جمعها من مستشفى الاورام التعليمي منذ بداية شهر شباط/2016 ولغاية شهر كانون الثاني/2017.النتائجان هذه الدراسه التي تضمنت (50) مريضا جميعهم من النساء اللاتي تتراوح اعمارهم مابين 32 - 70 سنه , وقد اظهرت نتائجها وجود تاثر للمنسوب القذفي لعضل القلب بعد اربعة اشهر من العلادج الشعاعي مقارنة بنسبته ماقبل العلاج.حيث انه تم ملاحظة ان المريضات اللاتي يعانين من سرطان الثدي الايسر واللاتي قد استلمن جرعة من العلاج الشعاعي بمقدرا4260 سينتي غرايو لديهن النسبه الاعلى في التغير وبمعدل وسط حسابي مقداره 66% قبل العلاج و65,5% مابعد العلاج .و كذلك لاحظنا ان المريضات اللاتي استلمن جرعه شعاعيه مقدارها 5000 سينتي غراي سواء للثدي الايمن او الايسر , كان لديهن نسبة تغيير بمعدا حسابي للثدي الايمن ومقداره 66,3% قبل العلاج الشعاعي الى 64,3 % بعد العلاج الشعاعي , اما بالنسبه للثدي الايسر فكانت النسبه بمقدار 66,8% قبل العلاج الشعاعي الى 65,2% بعده . الاستنتاجاتان المرضات اللاتي يعانين من سرطان الثدي واللاتي عولجن بالعلاج الشعاعي ثلاثي الابعاد الموحد سواء كان لنسيج الثدي او لجدار القفص الصدري , وبعد المتابعه لفحوصات القلب التي تمت , قد لوحظ ان هناك تغيرا في المنسوب القذفي لعضلة القلب وخصوصا بين الثدي الايمن والثدي الايسر وكذلك بين مقدار الجرعه الشعاعيه المستلمه والسبب على الاغلب في الاشعاع المتطاير الواصل للشرايين المحيطه بالقلب اثناء العلاج | Breast cancer now represents the most common female malignancy in both developing and developed world, and is the primary cause of death in woman globally. In Iraq breast cancer constitute 18.96 % of all other types of cancers up to 2011. One of the main steps in the management of early breast cancer is radiotherapy.Aim of studyTo shade the light on the radiation therapy effect on the ejection fraction of the heart in breast cancer patients.Patients and methodsThis is a prospective observational study that was conducted in Radiotherapy and nuclear medicine center of the oncology teaching hospital/medical city complex using Echo cardiograph for following up the patients. Data recruitment included patients received Adjuvent 3D conformal radiotherapy as a whole breast irradiation or as a chest wall irradiation from August/2016 to January/2017 and followed with Echo study four months later until January/2017.ResultsIn our registry 50 patients were recorded; patient’s age was between 32 and 70 years old female gender. We found that there was a significant effect of radiation on the ejection fraction percentage of pre radiotherapy and post radiotherapy of both radiotherapy doses (P - value=0.001).2We noticed that patients with left sided breast whom received 4260 centigray had the highest significant result of a mean difference of pre - radiation =66%, and post radiotherapy =65.5 %.Also we noticed that patients whom had received 5000 centigray of either left or right sided breast cancer, have substantial difference between pre - radiotherapy of 66.3% and 66.8% to 64.3% and65.2% for right and left side respectively.ConclusionIn patients with breast cancer treated with adjuvant 3D conformal radiotherapy as a whole breast irradiation or as a chest wall irradiation, an evaluation for the cardiac ejection fraction after four months of completing their radiotherapy, to either right sided or left sided breast, there was a marked difference in the ejection fraction size between the left sided treated BC and right sided BC, and between different doses mainly due to scattered and transmitted irradiation to the coronary arteries.

استخدام تعقب الوصلة النقطية للاجهاد الاذيني الايسر لتقييم خطر الانصمام الدماغي في مرضى الارتجاف الاذيني غير الصمامي في مركز قلبي واحد == USING SPECKLE TRACKING STRAIN OF LEFT ATRIUM FOR RISK STRATIFICATION OF EMBOLIC STROKE IN NON VALVULAR ATRIAL FIBRILLATION IN SINGLE CARDIAC CENTER

Author name: اسماعيل عطية حسين
Supervisor name: غازي فرحان حاجي
General topic: Medicine
Specific topic: Diseases - Heart
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Atrial fibrillation (AF) is the most common arrhythmia treated in clinical practice and the most common arrhythmia for which patients are hospitalized. AF is associated with an approximately five fold increase in the risk for stroke and a two fold increase in the risk for allcause mortality.Objective of study : To investigate myocardial deformation of the left atrium (LA) assessed by two - dimensional speckle tracking echocardiography in patients with nonvalvular atrial fibrillation and its value for risk stratification of embolic stroke. Patient and Methods : A prospective cohort study in Baghdad teaching hospital cardiac center from June 2016 to May 2017 We recruited 107 consecutive patients who were referred to echocardiography unit for evaluation by 2D full echocardiographic study with speckle tracking strain of left atrium. These patients were divided into two groups control and AF. those with AF further divided into two groups according to the presence or absence of stroke .Results : The left atrial strain among patients with AF and stroke had significantly reduced from those patient with AF without stroke(9.8 ±3.0 ,18.5±5.6 respectively).P - value= 0.001.Where as left atrial volume index and left ventricular filling index( E/Eratio) did not show significant differences .After multi - variant analysis, global LA strain were independently associated with stroke in patients with AF. Those with LA GLS <12.8 % had a significantly higher rates of stroke than those with LA GLS > 12.8 %.Conclusion : This study demonstrated that LA deformation reduced inpatients with AF and stroke. Global LA strain measured by speckle tracking echocardiography can be used for risk stratification for stroke in patients with AF and has incremental diagnostic values in addition to clinical risk stratification.Keywords : Atrial fibrillation, Left atrial Strain, , Stroke

عادة الشيشة بين طلاب كلية الطب وكلية طب الاسنان - جامعة بغداد == Shisha Habit among Medical Students at College Of Medicine & College Of Dentistry - Baghdad University

Author name: حسن خلف عبد
Supervisor name: بتول علي غالب یاسین
General topic: Medicine
Specific topic: Community Medicine
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Tobacco is a preventable cause of morbidity and mortality across the globe. Low and middle income countries (LMICs) are the most severely affected (1). The shisha is used to smoke specially made tobacco by heating the tobacco indirectly, usually with burning charcoal or embers, filtering the smoke through a bowl of water (sometimes mixed with other liquids such as wine) and then drawn to a mouthpiece through a rubber hose (6). Shisha has been shown to be associated with a wide range of detrimental health effects and smoking shisha is associated with three main detrimental health effects : CV damage, infection and cancer formation (30)P.The Objective of this study is to measure the prevalence of shisha smoking among medical students at College of Medicine & College of Dentistry - Baghdad University, Identify the characteristics of Shisha smokers that have numerous public health and clinical implications and to identify factors associated with shisha smoking.Subjects and Methods : A cross - sectional study was conducted on a sample of 654 students at the College of Medicine and College of Dentistry in Baghdad University from the 1st of February till the 30th of June 2017. Under graduate students from the selected colleges were included. A questionnaire was used to gather the necessary information and filled by the study participants themselves. It included questions to gather information on certain socio - demographic variables, the family of the participants, and believes about smoking. Information about shisha smoking, medical history and habits of the participants and their parents were gathered.Results : This study involved 654 students. The mean age of the participants was 20.6±1.93 years; 64.7% were females; 95.9% were currently single; and 90.6% were from Baghdad.About 44.6% were in the 2nd stage; 91.4% were living with family; 70.4% were living with crowding index 1 - 2. Regarding parents of participants, 90.9% of fathers andII81.2% of mothers were highly educated; 82.8% of fathers and 88.6% of mothers were present and live with; and 49.1% of fathers and 49.4% of mothers were governmental employees.The prevalence of shisha smoking was 12.1%; 57.5% of them were smoking for more than three years, 76.2% preferred café for smoking; 87.5% preferred friends for smoking with. The factors that significantly associated with prevalence of shisha smoking were (gender, address, marital status, living condition, presence of private work, parents smoking history, and belief about which type of smoking is more harmful).Conclusion : Although the prevalence of shisha smoking was still not high (12.1%), it was increasing during the last few years and becoming a community acceptable behavior, especially among college students. There was a significant positive effect for male gender, being divorced or widowed, living alone and outside Baghdad, and having own job on smoking prevalence among students. Also parent's positive history of tobacco smoking and students beliefs about shisha and cigarette harm were significantly associated with the use of shisha.

تقييم هشاشة العظام في المرضى البالغين المصابين بابيضاض الدم الحاد == Evaluation of Osteoporosis In Adult Patients with Acute Leukemia

Author name: ميادة محمد جاسم
Supervisor name: محمد هادي العصامي | علاء الدين سهام
General topic: Medicine
Specific topic: Diseases - Joints
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: تقييم هشاشة العظام في المرضى البالغين المصابين بابيضاض الدم الحادالخلفيه العلميه : يعد مرض هشاشة العظام مشكله صحيه عامه متزايدة ذات تاثير طبي واجتماعي واقتصادي.اهداف الدراسة : معرفة امكانية حدوث هشاشة العظام في مرض ابيضاض الدم الحاد.المرضى والطرق : اجريت هذه الدراسة في العيادة الاستشاريةلامراض الدم والعيادة الاستشاريةلامراض المفاصل في مستشفى بغداد التعليمي خلال سنه من شهر تموز 2013ولغاية تموز 2014.الدراسة شملت 100 مريض تم تشخيصهم حديثا بابيضاض الدم الحاد وقبل بدء العلاج وعينه من 50 شخص اصحاء كانت اعمارهم متطابقة.المرضى كانت اعمارهم 20 - 50 سنه, وقد تم اخذ التاريخ المرضي الكامل والفحص السريري الكامل والفحوصات المختبرية وقياس كثافة العظم(DEXA).النتائج : من 100 ذكر وانثى في هذه الدراسه, متوسط العمر(30.49±7.7 )سنه,50ذكر وانثى عينه اصحاء متوسط العمر(27.30±5.87) سنه, كثافه العظم لعنق الفخذ والفقرات القطنيه في المرضى اقل من الاصحاء.(T - score) الفقرات القطنيه للمرضى مقابل الاصحاء طبيعيه في 47 شخص, قله كثافة العظم في 44 شخص, وهشاشة العظم في 9 اشخاص.فيما كانت (T - score) في عينة الاصحاء طبيعيه في 50 شخص. ( Z - score) للفقرات القطنية للمرضى مقابل الاصحاء طبيعي في 40 شخص, قلة كثافة العظم في 48 شخص, وهشاشة العظم في 12 شخص.فيما كانت (Z - score) في عينة الاصحاء طبيعية في 43 شخص, وقلة كثافة العظم في 7 اشخاص.(T - score) لعنق عظم الفخذ للمرضى مقابل الاصحاء 42, قلة كثافة العظم في 55 شخص, وهشاشة العظم في 3 اشخاص.اما في الاصحاء فكانت (Z - score) طبيعيه في 50 شخص.(Z - score) لعنق عظم الفخذ للمرضى مقابل الاصحاء طبيعيه في 34 شخص, قلة كثافة العظم في 55 شخص, وهشاشة العظم في 11 شخص.اما في الاصحاء فكانت (Z - score) طبيعيه في 45 شخص, وقلة كثافة العظم في 5 اشخاص.النتيجة : 1 - قلة كثافة العظم موجود في 4848)% (مريض, هشاشة العظم موجود في )1212%( في المرضى المصابين بابيضاض الدم الحاد بالاعتماد على (Z - score) للفقرات القطنية.2 - قلة العظم موجود في 55(55%) مريض, هشاشة العظم موجود في 11(11% ) في المرضى المصابين بابيضاض الدم الحاد بالاعتماد على (Z - score) لعنق عظم الفخذ. | Osteoporosis is a silent condition characterized by low bone density and deterioration of bone microarchitecture .ObjectiveTo study the association between osteoporosis and acute leukemias .Patient and methods This is a Cohort study was conducted in haematological department and Rheumatological department in Baghdad teaching hospital, over a period of one year from July 2013 to July 2014. The study included 100 patient who were newly diagnosed with acute leukemia before starting treatment, and 50 healthy controls, who were age and sex matched with the patients. Patients age between 20 year to 50 year. Full history was taken, complete clinical examination, and laboratory investigation were done, and Dual Energy X ray absorptiometry were performed for patient and control group.Exclusion criteriaDiabetes mellitus, thyroid and parathyroid diseases, smoking, drug induced osteoporosis.Result 100 adult Iraqi patients with acute leukemia included in this study, the mean age was 30.49 ± 7.76 year; 50 healthy individuals were included in this study, with mean age 27.30 ± 5.87year. The results of BMD femur and lumbar in patients were less than control. T - score lumbar spines of patients versus control were normal in 47(47%) patient, osteopenia in 44(44%) and osteoporosis in 9(9%). While in control all 50(100%) are normal. Z - score lumbar spines of patients versus control were normal in 40(40%), osteopenia in 48(48%) and osteoporosis in 12(12%). While in control 43(86%) are normal, 7(14%) osteopenia. T - score neck of femur in patients versus control was normal in 42(42%) patient, osteopenia in 55(55%) and osteoporosis in 3(3%). While in control all 50(100%) are normal. Z - score neck of femur in patients versus control was normal in 34(34%) patient, osteopenia in 55(55%) and osteoporosis in 11(11%). While in control 45(90%) were normal, 5(10%) osteopenia.Conclusion : Osteopenia was present in 48(48%) and osteoporosis in 12(12%) patients.Osteopenia was present in 55(55%) patient and osteoporosis in 11(11%) depending on Z - score of neck of femur

تقييم العمل الانقباضي للبطين الايسر باستخدام الايكو ذو البعد الرابع بالمقارنة مع طرق الايكو الخطية والحجمية الاخرى للمرضى ذوي القصور في الشرايين التاجية وامراض القلب الصمامية == ESTEMATION OF LEFT VENTRICULAR EJECTION FRACTION BY REAL - TIME THREE DIMENSIONAL ECHOCARDIOGRAPHY IN COMPARISON TO OTHER LINEAR AND VOLUMETRIC METHODS IN CORONARY AND VALVULAR HEART DISEASES

Author name: كوثر علي عبد
Supervisor name: امال نوري المراياتي
General topic: Medicine
Specific topic: Echocardiography
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: ان قياس العمل الانقباضي للبطين الايسر يعد مؤشرا مهما جدا لمعرفة حدة امراض القلب حيث ان حجم البطين الايسر يعطي معلومات تشخيصية دقيقة ومفيدة في اختيار العلاج المناسب او تحديد الوقت المناسب لاجراء التداخل الجراحي .وحيث ان هناك طرق عديدة لهذا الغرض ,فطريقة (ام - مود ) القديمة لاتزال تستخدم في بلدنا بالرغم من كونها تعتمد قياس مساحة سطح واحد وهذا لا يكفي لتحديد حجم البطين الايسر المخروطي ,اما الايكو ذو البعد الثنائي فهو الطريقة الاكثر شيوعا لقياس حجم وكفاءة القلب ,الا ان هناك العديد من النواقص في قياسها لذلك ,حيث انها تعتمد على حساب الحجم بالهندسة الافتراضية (لكونها تعتمد على بعدين فقط ).الايكو ذو البعد الرابع اصبح متوفرا منذ العقدين الماضيين ,وبالرغم من ان استخدام هذه الطريقة لم تحصل على الانتشار الواسع الا انها تستطيع التغلب على نواقص الايكو ذو البعد الثنائي انفة الذكر وذلك لانها لا تعتمد على الهندسة الافتراضية في قياس الحجم وكفاءة العمل الانقباضي للبطين الايسر. ولقد اثبتت العديد من الدراسات انه الاكثر دقة وموضوعية بالنسبة لقياس حجم البطين وعمله الانقباضي. فقد قمنا باجراء دراسة على ٦٠ مريض ممن لديه امراض القلب الصمامية وكان محضرا لعملية تبديل الصمام وكانوا ۲۲مريض والباقي ممن لديه امراض الشرايين التاجية وكان محضرا لعملية زراعة الشرايين التاجية ‚ وذلك بقياس كفاءة العمل الانقباضي للبطين الايسر بطريقة (ام - مود), الايكو ثنائي الابعاد ذو السطحين ,الايكو ثلاثي الابعاد ذو السطوح الثلاثة والايكو رباعي الابعاد‚ وقياس الوقت الذي تحتاجه كل طريقة من هذه الطرق لاكمال عملية قياس كفاءة الفعل الانقباضي للبطين الايسر. هدفنا من هذه الدراسة ذلك لمعرفة مدى دقة وصحة الطرق الشائعة (ام - مود) والايكو ثنائي الابعاد ثنائي السطوح - والايكو ثلاثي الابعاد ثلاثي السطوح بالمقارنة مع الايكو ذو البعد الرابع في قياس حجم وكفاءة العمل الانقباضي للبطين الايس مع دراسة خصوصيتها وحساسيتها بالنسبة للايكو ذو البعد الرابع بالاعتماد على التوافق العالي بين الايكو رباعي الابعاد والرنين المغناطيسي القلبي والذي يعتبر الطريقة القياسية الذهبية في قياس حجم وكفاءة العمل الانقباضي للبطين الايسر٠ ان نتائج البحث اثبتت ان الطريقة الاقرب الى الايكو ذو البعد الرابع هي الايكو ثلاثي الابعاد ذو السطوح الثلاثة في امراض القلب الصمامية وامراض الشرايين التاجية كما ان حساسيتها وخصوصيتها في كشف ضعف او عدم كفاءة العمل الانقباضي للبطين الايسر عالية لانها لا تعتمد على الهندسة الافتراضية اما بالنسبة للايكو ثنائي الابعاد ذو السطحين فكان هناك اختلاف ملحوظ بينه وبين الايكو رباعي الابعاد في كل من امراض القلب االصمامية وامراض الشرايين التاجية , الا ان حساسيتها وخصوصيتها في كشف عدم كفاءة او ضعف العمل الانقباضي كان عاليا ,واما الطريقة الاكثر شيوعا في بلدنا وهي (ام - مود)فتبين من خلال هذه الدراسة ان هناك فرقا ملحوظا بينها وبين الايكو رباعي الابعاد في كل من امراض القلب الصمامية وامراض الشرايين التاجية بالاضافة الى ان خصوصيتها في معرفة العمل الانقباضي الطبيعي للبطين الايسر عالية الا ان حساسيتها في كشف الاعتلال او ضعف العمل الانقباضي للبطين الايسر كانت متوسطة | Left ventricular volumes and ejection fraction are important predictor of cardiac morbidity and mortality. It provides valuable prognostic information which is particularly useful in the selection of therapy or determination of the optimal time for surgery. Two - dimensional echocardiography is the most widely used non - invasive method for assessment of cardiac function, two dimensional echocardiography has however several limitations in measuring left ventricular volumes and ejection fraction since the formulas for quantifications are based on geometrical assumptions. Three - dimensional echocardiography has been available for almost two decades, although the use of this modality has not gained wide spread acceptance. Three dimensional echocardiography can overcome the above mentioned limitation in left ventricular volume and ejection fraction evaluation since it is not based on geometrical assumption. Aim of study : Is to investigate the accuracy of linear﴾ M - MODE﴿ and volumetric (BIPLANE AND TRIPLANE) echocardiographic method versus the REAL - TIME three dimensional echocardiography in assessment of regional and global left ventricular systolic function.METHOD : Prospective study evaluating left ventricular systolic function for sixty patients ,38 patients with coronary heart disease prepared for Coronary artery bypass graft and 22 patients have valvular heart disease prepared for valve replacement , LV EF% was measured according to the American society of echocardiography guidelines for all of them by four methods 2D guided M - mode ,2D Biplane (Simpson ,s method ),Three Dimensional Guided - Triplane and Real time - three dimensional echocardiography(4D) , also the total time (acquisition and analysis) needed for each one of these methods was calculated.RESULTS : It was found that 2D Guided M - mode sensitivity and specificity in detection of LV systolic dysfunction i.e ejection fraction <55% was 74.3% , 95.2% respectively giving negative predictive value of 66.6% and positive predictive value 96.6%, 2D - Biplane sensitivity and specificity was 97.4% ,95.2% respectively , giving negative predictive value of 95.2% and positive predictive value of 97.4% while 3D - guided triplane was 97.4%,100% respectively, giving negative predictive value 95.2% and positive predictive value of 97.4% . (We considered RT - 3DE as standard method depending on its high agreement with Cardiac magnetic resonance which represents the gold standard method for assessment of LV systolic function worldwide although it is not available in our country). From other point of view the mean value of difference in ischemic heart disease between RT - 3DE and 2D - Guided M - mode, 2D - Biplane ,3D Guided - Triplane, was(<0.001 ,0.004, 0.481 )respectively. While the mean value of difference in valvular heart disease between RT - 3DE and 2D - Guided M - mode, 2D - Biplane, 3D - Guided Triplane was (< 0.001, 0.025, 0.266) respectively. Also the time need for ﴾data acquisition and analysis﴿ for 2D - guided M - mode ,2D - Biplane ,3D - guided Triplane and RT - 3DE was﴾2 min ,4 min ,5 min ,5min﴿ respectively.Conclusion : M - mode method has high specificity but modest sensitivity to detect LV dysfunction while 2D - Biplane ,and 3D - guided Triplane has high specificity and sensitivity in detection of LV systolic dysfuction. There is a significant difference between RT - 3DE and both 2D - guided M - mode, 2D - Biplane method in assessment of LV global and regional systolic dysfunction, while there is no significant difference between RT - 3DE and 3D - guided Triplane method . Also the time need for data acquisition for each three method is nearly similar while it is shorter by M - MODE

مقارنة المقاطع السهمية لسلسلتي الرنين المغناطيسي : استرداد الانقلاب قصير T1 وT2 الموزونة ذوات صدى الانفتال السريع في الكشف عن افات الحبل الشوكي الناجمة عن تصلب الاعصاب المتعدد == A Comparison of Sagittal Sections of Short T1inversion Recovery and T2 Weighted Fast Spin Echo Magnetic Resonance Sequences for Detection of Multiple Sclerosis Spinal Cord Lesions

Author name: شيماء فاضل عبيد
Supervisor name: امير شاكر هادي
General topic: Medicine
Specific topic: Diagnostic Radiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Multiple sclerosis (MS) is a chronic autoimmune inflammatory demyelinating disease of the CNS of unknown etiology. Age of onset is 20 - 50 years in 50 - 60% of cases, with female propensity. MRI of the spinal cord is thought reliable for investigation lesions. Different techniques and MRI sequences are widely used and compared to each other to improve the detection of MS lesions in the spinal cord. Objective : To evaluate the ability of MRI STIR sequences in improvement of MS spinal cord lesion detection when compared to T2 WI sequences.Patients and Methods : A cross sectional study conducted during the period from 15th of August 2013 to 30th of June 2014. A total of 22 MS patients who had clinically definite MS with clinical features suggestive of spinal cord involvement, and had no contraindication for MRI examination were included. Spinal cord lesions which had artifacts significantly reduce the reading confidence of the images or those which did not show the typical characteristics of MS spinal cord plaques and lesions due to spondyloticmyelopathy were excluded. Patients were imaged with unified MRI protocol for all patients and two MRI sequences were used in imaging; sagittal STIR sequences and sagittal T2 weighted. All images were read by the same radiologist. The study protocol was approved by the ethical committee and the data of the patients were kept confidentially.Results : The mean age of the patients was 32.5 ± 6.7 (range : 23 - 45) years and 54.5% of the patients aged 30 - 39 years. Females were the dominant and represented 72.7% with a female to male ratio of 2.7 : 1. The total number of spinal cord MS lesions was 44,of them 86.4% in the cervical spine, 68.2% of the lesions had less than one vertebra extension,79.6% of the lesions did not associated with changes in the spinal cord morphology. There was a significant upgrading in the lesions conspicuity at STIR sequence comparingto T2 WI, P<0.001. A significant difference had been found in artifact grading between both sequences; P<0.001.Conclusions and Recommendations : STIR MRI sequence improves detection of MS spinal cord plaques compared with T2 WI and it increases the conspicuity of the visualized T2 WI lesions, but also it accentuates the artifacts more than T2WI. The STIR sequence should be included in the standard spinal cord MR imaging protocols and should be obtained routinely with T2 WI. Further studies are suggested.

تقييم فرط مرونة المفاصل لدى المرضى العراقيين المصابين بمرض الجزر المعدي المريئي == Assessment of Joint Hypermobility in Iraqi Patients With Gastro - esophageal Reflux Disease

Author name: ايمن رزاق علي
Supervisor name: زياد شفيق الراوي | فائق ايشو كوريال
General topic: Medicine
Specific topic: Diseases - Joints
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: فرط مرونة المفاصل هو حركة المفصل الى خارج الحد الطبيعي لحركته .وان مرض الجزر المعدي المريئي هو الاسترجاع غير الطبيعي لمحتويات المعده الى المرئ . ان خلل او اعتلال النسيج الرابط المتسبب في فرط مرونة المفصل قد يكون هو نفسه المتسبب في الجزر المعدي المريئي .الهدف : تقييم فرط مرونة المفاصل لدى المرضى العراقيين المصابين بمرض الجزر المعدي المريئي .المرضى ومنهاج البحث : تضمنت الدراسة 100 مريض عراقي مصاب بالجزر المعدي المريئي الذي تم تشخيصه بالفحص السريري والفحص الناظوري و100 فرد سوي كعينة ضبط متطابقتين في العمر والجنس .تم ملا استمارة استبانه لكل مريض وتحتوي على معلومات عامه عن المريض ومدة اصابته بالمرض وشدة المرض المثبته ناظوريا ونتيجة الفحص السريري لفرط مرونة المفاصل .تم اعتماد نتائج فرط مرونة المفاصل باستخدام ضوابط بايتون على العينتين .النتائج : اظهرت الدراسة ان 46 (71.9%) من المرضى المصابين بالجزر المعدي المريئي لديهم فرط مرونة المفاصل, وان 18(28.1%) من الاصحاء لديهم فرط مرونة المفاصل( p<0.001) كذلك اظهرت الدراسة ان مجموع مقياس مرونة المفاصل حسب ضوابط بايتون للمرضى المصابين بالجزر المعدي المريئي كان اعلى بكثير من مجموع ناتج نفس المقياس لدى الاصحاء (p<0.001) .كذلك اوضحت الدراسه ان العمر المبكر للافراد (≤ 30 year) الذين لديهم فرط مرونة المفاصل هو عامل ذو جدوى احصائي للاصابة بداء الجزر المعدي المريئي .الاستنتاجات : ان ظاهرة فرط مرونة المفاصل اكثر شيوعا عند المرضى المصابين بالجزر المعدي المريئي , مجموع مقياس فرط مرونة المفاصل لدى مرضى الجزر المعدي المريئي اكثر من مجموع المقياس ذاته لدى الاصحاء وان العمر الاصغر((≤ 30 سنة عامل متنبئ للاصابه بفرط مرونة المفاصل في مرض الجزر المعدي المريئي. | Joint hypermobility is the movement of a joint beyond it,s normal range of motion due to joints laxity. Gastro - esophageal reflux disease (GERD) is an abnormal reversed movement of gastric contents into the esophagus due to many mechanisms, one of them is the laxity of lower esophageal sphincter. Probably, a defective connective tissue matrix is the link between both disorders.Objective : To assess joint hypermobility in Iraqi patients with GERD.Patients and methods : A total of 200 individuals were included in this study, 100 patients had GERD diagnosed by a gastro - enterologist upon clinical & endoscopic findings and 100 healthy individuals matched in age & sex as a control group.A questionnaire paper consisted of personal data including : Age, sex, weight, height, body mass index (BMI), upper gastro - intestinal symptoms, duration of GERD, severity of GERD by endoscopic grading, and total score of joint mobility. The assessment of joint mobility were measured according to Beighton score method for all the participants in the study.Results : One hundred patients with GERD, 57 female & 43 male, and 100 healthy control group, 64 females and 36 males. The mean BMI was (24 ± 2.9) kg/m2 for patients and (24 ± 3.4) kg/m2 for controls. No statistical significant difference between patients and controls (P>0.05).JHM was significantly more in GERD patients than in controls (46(71.9%) of vs 18(28.1%), p<0.001, OR=3.88; 95% CI = 2.04 - 7.39).The total mobility scores for all GERD patients was 341 compared to 125 in the control group (p<0.001).A younger age(≤ 30 year) was significant predictor for JHM in GERD (p=0.000, odd=1.243, 95%CI : 1.124 - 1.376).Conclusions : JHM was more prevalent among patients with GERD, the total mobility score was much higher in GERD patients, and patients with younger age ≤30 year were a significant associate with JHM in GERD patients.

نسبة وفيات الامهات في قسم النسائية والتوليد في مستشفى بغداد التعليمي للعام 2013 == Causes of Maternal Mortality in Obstetrics& Gynecology Department in Baghdad Teaching Hospital for the Year 2013

Author name: سجى زيدان ضمد
Supervisor name: حيدر باقر الشماع
General topic: Medicine
Specific topic: Obstetrics and Gynecology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Maternal deaths is the death of a women while pregnant or within 42days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental cause.Aim of study : To study the causes and risk factors related to maternal deaths in obstetrics &gynecology department in Baghdad teaching hospital & to provide information to improve maternal care.Objective : To study causes of maternal mortality in Baghdad teaching hospital and the possible measures that may be taken to reduce mortality rate. Study design : A retrospective study.Setting : The study was carried out in the Department of Gynecology and Obstetrics at Baghdad teaching hospital for the period 1st of January to end of December 2013.Method : A retrospective study carried out on 8 died women ,who referred to Baghdad teaching hospital with serious morbidity ,6 of them delivered by CS and 2 of them delivered vaginally, each case studied in depth to determine the most likely cause of death.Result : The total maternal deaths for Baghdad Teaching hospital in 2013 were 8 women and the live births were 10488; as a result, the maternal mortality ratio per 100000 live births was 76.3, many Factors analyzed included the sociodemographic characteristics of the women who died the main causes of death, pattern of health - seeking behavior for antenatal care / delivery, and place of labor and delivery.There is statistically significant difference for some of these factors as between employment and unemployment also there is significant difference between vaginal and cesarean delivery.Conclusion : Major causes of deaths in Baghdad teaching hospital was hemorrhage ,as agreed by WHO estimates of causes of maternal death.This provide stimulus for health providers, hospital managers ,individuals and government to maintain downward trends in our maternal mortality ratios to meet the expectation of the millennium goal of reduction of 75% in maternal deaths in 2015

استخدام معامل التغير DP/DT في مرض متلازمة قصور الشرايين التاجية الطارئة == Use of Doppler Derived Index DP/DT in Acute Coronary Syndrome

Author name: هدى جميل ابراهيم
Supervisor name: معتز فوزي حسين
General topic: Medicine
Specific topic: Diseases - Heart
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: متلازمة الشريان التاجي الحادة (ACS) هي مظهر من المظاهر السريرية لامدادات الدم في تقلص الشرايين التاجية. في متلازمة الشريان التاجي الحادة ، يتم استخدام تخطيط صدى القلب من خلال تقييم حركة الجدار في كل من شرائح البطين الايسر (LV). وينبغي ان يشمل تقييم وظيفة البطين الايسر ايضا تقييما لابعاد البطين الايسر، والمورفولوجيا والوظيفة الانقباضية والانبساطية للبطين الايسر. معامل التغير dP/dtالذي يمثل معدل تغير الضغط خلال الزمن هو واحد من المؤشرات الاكثر حساسية للانقباض.الهدف من الدراسة لتقييم فائدة معامل التغير dP/dt في تقييم وظيفة البطين الايسر في المرضى الذين يعانون من متلازمة الشريان التاجي الحادة وعلاقتها ببعض المظاهر السريرية وتخطيط صدى القلب.المرضى والطرق شملت هذه الدراسة خمسين مريضا تم ادخالهم في وحدة العناية القلبية في المستشفيات التعليمية بغداد والشهيد غازي مع تشخيص متلازمة الشريان التاجي الحادة في الفترة 2/2/2013 الى 5/3/2014. تم القيام بالفحص السريري وجرى تخطيط صدى القلب في جميع المرضى وتم حساب المشتقة دوبلرdP/dt . واعتبرت المستويات اقل من 1000 منخفضة. وجاء التحليل الاحصائي باستخدام Med Calc النسخة 12.5.0.0و باستخدام برنامج Microsoft Office Excel 2010.واختبار Chi scure لدراسة العلاقة بين المجموعات المختلفة فيما يتعلق بالقيمة P ,و اعتبرت القيمة اقل من 0.05 ذات دلالة احصائية.النتائج كان متوسط عمر المرضى الذين يعانون من انخفاض معامل التغير ) dP/dt 1000) يساوي (65.62±5) سنوات وفي المرضى الذين كانت قراءة dP/dt عادية(1000) كان(63.38 ±5) سنوات وويشكل الذكور 62٪ من عينة الدراسة. وقد تم العثور على قيمة منخفضة من dP/dt 42 مريضا (84) ٪. وتم العثور على قيم dP/dt منخفضة اكثر في الفئة العمرية (51 - 60) عاما . ارتبط انخفاض قيمة dP/dt بشكل كبير مع التدخين والتاريخ العائلي.الاستنتاج استخدام معامل التغير dP/dt مفيد لتقييم وظيفة البطين الايسر في المرضى الذين يعانون من متلازمة قصور الشريان التاجي الحادة. | Background : Acute coronary syndrome (ACS) is the clinical manifestation of a diminished coronary arterial blood supply. In the ACS, echocardiography is used by assessing wall motion in each of the left ventricle (LV) segments. The assessment of regional LV function should also include an assessment of LV dimensions, morphology and global LV systolic and diastolic function. dP/dt which represents the rate of change of pressure during ejection is one of the most sensitive indices of contractility.Aims of study : To evaluate the usefulness of dP/dt in evaluating left ventricular function in patients with acute coronary syndrome and mitral regurgetation and its relation to certain clinical and echocardiographic features.Patients and Methods : This study included fifty patients who were admitted to the coronary care units of Baghdad and Al - Shaheed Gazy teaching hospitals with the diagnosis of acute coronary syndrome with ischemic mitral regurgitation for the period from 2/2/2013 to 5/3/2014. History and clinical examination were done and echocardiography was done in all patients and Doppler - derived dP/dt was calculated. Levels less than 1000 were considered low. Statistical analysis was made using Med Calc version 12.5.0.0. and Microsoft Office Excel 2010. Chisquare test was used to study relation among different groups with regard to numeric variables. P - value less than 0.05 was considered statistically significant.Results : The mean age of patients with low dP/dt (<1000) was (65.62 ± 5yrs) and that of patients with normal (dP/dt ≥ 1000) was (63.38 ± 5 yrs) (p value 0.9296). Males constituted 62% of study sample. Low dP/dt value was found in 42 patients (84%). Low dP/dt values were found more in the age group (51 - 60 yrs) (P = 0.0110). Low dP/dt value was significantly associated with smoking and positive family history. It was significantly associated with LV diastolic dysfunction (P value= 0.0005), left atrial size (P value < 0.0001), left atrial pressure (P value = 0.0006), and left ventricular size (P value < 0.0001). Conclusions : The use of dP/dt is useful for evaluating left ventricular function in patients with acute coronary syndrome

دراسة مقارنة بين نتائج الدوبلر والاعراض السريرية في مرضى القدم السكري == CORRELATION STUDY OF TRIPLEX ULTRASOUND AND CLINICAL FINDINGS IN DIABETIC FOOT PATIENTS

Author name: رمزي حلوان طعين
Supervisor name: ليث احمد خلف | مؤيد عباس فاضل
General topic: Medicine
Specific topic: Diagnostic Radiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Diabetes mellitus is a common ailment in our community, diabetes affects about 10% of our population and the prevalence of diabetes varies form 5.3% to 16.2%. Diabetic foot disease is a common cause of admission in the surgical wards and sometimes the first presentation of this debilitating disease. Foot ulcers carry a 25% risk of major amputation. The diabetic foot disease classified according to Wagner’s Classification, and to manage it according to the standard protocols. The ultrasound scanning for lower limb arteries clearly show that it can provide information about the vascularity of the lower limb arteries. It is established as a valuable noninvasive method to investigate lower limb arteries. Objective : Evaluation of Doppler ultrasound finding in correlation with clinical finding (Wagner's classification ) of diabetic foot. Patient and method : A cross sectional study from August 2012 to August 2013, for 58 patients referring to ultrasound unit for triplex ultrasound examination of lower limbs at medical city complex in Baghdad. Patient were randomly selected and consisted of 21 female and 37 male. Age ranged between 40 and 75 year. Result : The mean age of patients was 57.9±7.8 years with predominance ofIIImale gender (63.8%) and type II DM(8602%). Mean duration of DM for selected patients in our study was 12.33±6.2 years. . In the present study approximately half of the diabetic patients were in fourth Wagner grades. Doppler USG revealed a pathological finding of lower limbs arteries in 89.7% of the patients. The most frequent site of occlusion was found in the dorsalis paedis artery (12.1%). There is a significant association of impaired blood flow diagnosed by Doppler USG and clinical deterioration of DM detected by Wagner's grade (p<0.001).The normal blood flow in all arteries of lower limbs had been found in 10.3% with Wagner's grade II, III and IV. Conclusion : There is correlation between clinical finding of diabetic foot (Wagner grade ) and Doppler finding (degree of stenosis) which mean when increase Wagner's grade, this is associated with increase degree of stenosis, therefor lower extremity artery triplex US is an excellent method, which can monitor the grade of Diabetic foot. The normal blood flow in all arteries of the lower limbs was 10.3% in spite of patient present with Wagner grade II, III and IV, these should be remembered during management of diabetic foot.

العوامل التي تؤثر على مرضى الفشل في علاج مرضى التدرن في بغداد، العراق، 2009 - 2012 == Factors associated with Tuberculosis Treatment Failure in Baghdad, Iraq, 2009 - 2012

Author name: ليث عبد اللطيف كريم
Supervisor name: سهير محمد محمود الجبوري
General topic: Medicine
Specific topic: Applied Epidemiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:

حدوث مرض الاسهال الحاد بين الاطفال دون سن الخامسة للاطفال في بغداد قبل وبعد التطعيم بلقاح الفيروس العجلي حزيران 2013 == Occurrence of Acute Diarrheal Disease among under Five Years Children in Baghdad before and after Rota Virus Vaccination, June 2013

Author name: سنان اكرم عقراوي
Supervisor name: بتول علي غالب ياسين
General topic: Medicine
Specific topic: Applied Epidemiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Approximately 39% of the global diarrhea deaths in children aged 5 years may be attributable to rotavirus infection. Two rotavirus vaccines were recently introduced to the market, with evidence of efficacy in the USA, Europe and Latin America. We sought to estimate the effectiveness of these vaccines against rotavirus morbidity and mortality.Objectives : To determine the association between infant rotavirus vaccination in Baghdad and the occurrence of acute diarrheal diseases, the rate of hospital admission for gastroenteritis and mortality among under five years children Methods : An observational, cross - sectional study of two time periods : 1 January - 31 August 2011 (prior to initiating rotavirus vaccination) and 1 January - 31 August 2013 (one year after introducing rotavirus vaccination). All cases of acute diarrhea among infants and under five years children during 2011 and 2013 were retrieved from surveillance section /CDC Baghdad, from Health and Vital statistics Department - MOH - Iraq and Pediatrics Hospital’s Statistical Units and analyzed. Discrete variables were presented as numbers and percentages. Z test for difference between two proportions was calculated with a 95% confidence interval (95% CI) Findings with P value less than 0.05 were considered significant.Results : The current study revealed a 32.7% decrease of acute diarrhea among under five years children (Z value= 7.967, p <0.0001, C.I. =0.0087 - 0.0143) and a decrease by 33.2% acute diarrhea infants (Z value= 41.4458, p > 0.0001, C.I. =0.0362 - 0.0398). The disease burden decreased by 51.9% for under five years and 28.2% for infants reductions in hospitalizations due to acute diarrhea and the case fatality rate decreased by 23% for under five years.Conclusions : A noticeable reduction in the occurrence of acute diarrhea among infants and under five years children, in hospital utilization and to less extent in the mortalities due to acute diarrhea after implementing the Rota virus vaccination for infants in Iraq.

دور فحص المرونة النسيجية للخصيتين لمرضى العقم والدوالي == The role of Testicular Elastography in patients with varicocele and infertility

Author name: بشارعبد الرزاق مولان
Supervisor name: سعد داخل فرحان | سلام محمد جوري
General topic: Medicine
Specific topic: Diagnostic Radiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: To assess the value of Real - time Elastography (RTE) in evaluation of the effect of varicocele on the elasticity of the testicular interstitium and ability to predict the effect of varicocele on the sperm motility.Methods : In total of 73 candidate. 50 patient with varicocele and 23 control normal volunteer were examined by ultrasound B mode gray scale, color Doppler and elastography . Elasticity images of the testicles were assigned the color - coded score of Itoh , according to the distribution of strain induced by light compression. RTE findings were analyzed and compare the result of affected patient with normal volunteer.Results : Most of the testicles of the varicocele patient showed elevated elastography ratio as compared with the same side of normal volunteer, also there was positive correlation between the varicocele grade and the elasto ratio. When I compared the percentage of active motile sperm with elasto ratio I found negative correlation.Conclusions : RTE is non - invasive, bed side test, useful technique in assessing the changes which happen in the interstitium of the affected testicles with varicocele and in the prediction of the active motile sperm status.This is relevant in clinical practice allowing expectant management according to elasto ratio in selected cases.(as the testicular elasto ratio will predict the outcome of varicocele operation in at the point of sperm quality improvement).

دوبلر الشريان السباتي للمرضى المرشحيه لعملياث تبديل الشراييه التاجية == Doppler of Carotid Artery Assessment in Evaluation of Patients indicated for Coronary Artery Bypass Graft

Author name: فرج عبد الخالق زكي
Supervisor name: ليث احمد خلف | علي محسن حسن
General topic: Medicine
Specific topic: Diagnostic Radiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Atherosclerosis is a generalized disease, mainly manifested in all vascular trees. An association between carotid artery stenosis and coronary artery disease has been well established. Carotid artery stenosis is an important etiologic factor for cerebrovascular accidents, is associated with coronary artery disease .Methods;A prospective study of 86 patients, who were scheduled for CABG, was done at radiology department, Medical city Baghdad,Gazzi Al - Harirri hospital from Nov.2016 to July 2017. The majority were males, (73) and (13) were Females.All patients , after a clinical history was taken by the cardiac surgery team, they underwent a physical examinations ,and investigations ; chest x - ray , ECG , blood was taken for fasting blood suger and cholesterol study , Doppler ultrasonography for bilateral carotid arteries were performed by aspescailized radiologist for carotid artery atherosclerosis Results; The majority of the patients were above 50 years of age, 73 patients (84.45%) and only 15% were below the age of 50 years. Male affected by carotid artery atherosclerosis, (76.7%) more than females above the age of 50 years, while below the age of 50 years females (46.7%) more affected than males (9.58%). Risk factors were significantly correlated with both carotid and coronary artery stenosis like age, sex, smoking hypertension, cholesterol and diabetes mellitus.Doppler Ultrasonography was performed to screen the presence of carotid artery stenosis. Carotid artery atherosclerosis was present in 66 patients, (76.7%).Ten patients ( 15.1%) with one coronary artery disease , 17 (25.75%) with two coronary artery disease , and 39 patients ( 59.09%) with three coronary artery disease.The location of atherosclerosis is mostly in ICA, (53%), of which 15% in the bulb, in the CCA (32%) .Conclusions; Our finding indicated significant associations between carotid artery atherosclerosis and coronary artery disease.there is strong association between increase in intma media thickness of carotid arteries and the presence of coronary artery disease.

عرض توزيع الخلايا الحمراء ومتوسط حجم الصفائح الدموية لدى عينه من المرضى العراقيين البالغين المصابين بمرض التهاب الفقار اللاصق == Red cell Distribution Width and Mean Platelets Volume in sample of adult Iraqi patients with Ankylosing Spondylitis

Author name: علي مكي حسن
Supervisor name: فائق ايشو كوريال
General topic: Medicine
Specific topic: Diseases - Joints
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine - Internal Medicine Department
Language: English
University location: Baghdad
First pages:
Abstract: Ankylosing spondylitis (AS) is a chronic, progressive inflammatory rheumatic disease that affects the axial skeleton causing characteristic back pain, and lead to structural and functional impairment and decrease in the quality of life.Mean platelet volume (MPV) is a part of the complete blood count (CBC) test and correlates with the platelets function and activation. Red cell distribution width (RDW) is a part of the complete blood count (CBC) and estimates erythrocyte variability.Objective : To analyse RDW and MPV in patients with AS and to evaluate their relationships with acute phase reactants (APRs) and disease activity index.Patients and Methods : A total of 100 patients with AS (78 males : 22 females) diagnosed according to the modified New York classification criteria for AS and 146 (99male : 47female) healthy individuals matched in age and gender as controls enrolled in the study. Demographic data, disease activity scores using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), medical history, Creactive protein (CRP), erythrocytes sedimentation rate (ESR), and complete blood count (CBC) were all measured.Results : The mean age for patients and control was 38.0 ± 9.0 and 35.8 ± 9.0 years respectively (p=0.057). Both MPV and RDW were significantly higher in patients with AS (9.215 ± 1.570 p < 0.001 and 14.133 ± 1.613 p < 0.001 respectively) compared with controls (7.753 ± 0.857 p < 0.001 and 12.299 ± 1.031 p < 0.001 respectively). There was a direct correlation of (RDW and MPV with both ESR and CRP (P < 0.001 for RDW and 0.01 for MPV), RDW had r=0.38 for C - reactive protein (CRP) and 0.413 for ESR, and MPV had r=0.23 for CRP and 0.232 for Abstract VIESR. Also BASDAI was directly correlated with RDW (r=0.326 p<0.001) and MPV (r=0.333, p<0.001).Conclusion : Both MPV and RDW were higher in AS patients than in controls and are directly correlated with ESR, CRP, and BASDAI.

مدى صحة استخدام اختيار التحكم بالربو لتقييم شدة الربو القصبي في الاناث الحوامل في الثلث الثالث للحمل : دراسة سريرية == Validity of Asthma Control Test in assessment of asthmatic pregnant females in third trimester (Single center study)

Author name: زينب علاء عبد الحسين
Supervisor name: محمد وهيب سلمان العبيدي
General topic: Medicine
Specific topic: Diseases - Thoracic
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Asthma is a common chronic medical condition in pregnancy, with a worldwide prevalence estimated between 8 - 13%; The ACT has the added advantage that it does not require pulmonary function assessment.Aims of study : To assess asthma control through ACT score and to determine if the ACT can be as useful as the spirometry usage of FEV1 in assessment of asthma status in asthmatic pregnant female.Methods : A cross - sectional study with analytic elements recruiting 55 pregnant asthmatic patients aged 16 - 35 year old were seen in gynecology and obstetrics department of Baghdad Teaching Hospital between 1st of November 2016 and 1ST of April 2017 for pregnant females in third trimester. Asthma control was assessed using the ACT score and FEV1.Results : There were 55 pregnant females in third trimester with history of asthma enrolled in this study.According to ACT score 15 patients (27.3%) were with poorly controlled asthma, 19 patients (34.5%) moderately controlled and 21(38.2 %) well controlled asthma.Of these 55 patients 32 patients (58.2 %) where with ACT score of ≤ 19 and abnormal FEV1, only 2 patients (3.6%) with ACT score of ≤ 19 and normal FEV1, while there was 19 patients (34.5%) with ACT score of ˃19 and normal FEV1, and only 2 patients (3.60%) with ACT score of ˃ 19 and abnormal FEV1.Conclusion :  ACT can serve as an alternative reliable tool in assessing asthma control even without an aid of a spirometer

دراسة نسبة انتشار مرض التهاب الكبد الفايروسي نوعي - "بي" و"سي" بين طلاب كلية الطب جامعة بغداد للعام 2013

Author name: بشار عبد اللطيف عبد الرزاق
Supervisor name: بتول علي غالب ياسين
General topic: Medicine
Specific topic: Applied Epidemiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Hepatitis B virus and Hepatitis C virus infections have become a serious problem of public health and a major cause of morbidity and mortality, particularly in developing countries. Due to direct contact with patients, the risk of infection for health care workers is higher than for employees in other jobs. Health care workers can also be a source of infection for patients. This is also true for medical students in the framework of their education.Objectives : This study was conducted to estimate the prevalence of Hepatitis B virus and Hepatitis C virus infections amongst medical students at Baghdad University, College of Medicine.Subjects' and Methods : A Cross sectional descriptive analyticstudy conducted from the 1st of May to the 30th of June, 2013 at the College of Medicine, University of Baghdad.Data were collected through a self - administered questionnaire and through blood analysis for Hepatitis B surface antigen (HBsAg), antibodies to theHepatitis B coreantigen (anti - HBc), antibodies to theHepatitis B surfaceantigen (anti - HBs) and antibodies to the Hepatitis C virus (anti - HCV).Results : One student (0.6%) was positive for HBsAg, three (1.7%) were positive for anti - HBc, no one show positive result for anti - HCV (0%) and84 were positive for anti - HBs, giving an overall prevalence rate of (46.7%).Conclusions and Recommendations : This study showed a low prevalence of Hepatitis B virus and Hepatitis C virus infections markers among the medical student, which clearly indicates that the National Program of Immunization for hepatitis B is being efficient.Ninety six (53.3%) students were susceptible to the infection and required vaccination

نوعية حياة مرضى التدرن في بغداد 3102 == Quality of Life of Tuberculosis Patients, Baghdad /2013

Author name: اياد كريم حويز
Supervisor name: صالح جاسم علوان
General topic: Medicine
Specific topic: Applied Epidemiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:

معرفة وموقف وممارسات النساء اللواتي يحضرن الى مراكز الرعاية الصحيه الاوليه من فحص الثدي الذاتي في بغداد الكرخ 2018 == Knowledge, Attitude and Practices of Women Attending Primary Health Care Centers toward Breast Self - Examination in Al - Karkh Baghdad, 2018

Author name: هند احمد عبد العزيز
Supervisor name: جواد كاظم الديوان
General topic: Medicine
Specific topic: Family Medicine
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Breast cancer (BC) is the most prevalent form of cancer in Iraq, accounting for 21% of all female cancers. It is considered to be a progressive disease with a poor prognosis if detected late. The low level of knowledge and practice of breast self - examination is an important method of prevention.The objective of this study to assess knowledge of Iraqi women at Baghdad - Alkarkh about breast cancerrisk factor and their practices of breast self examination Aim of the study To assess knowledge of a sample of Iraqi women at baghdad - Alkarkh about breast cancer risk factors and their practices of breast self - examination , clinical breast examination and mamography .To assess the attitude and practices of breast cancer screening methods .Methods : Across - sectional study was conducted using interviweradmininstered qustionnaires. Samples of 400 feamales were systematic randomly selected from women attending primary health care centers at Baghdad - Alkarkh sector. Statistical package for social sciences(SPSS) version 25 was usedto study the statistical association between variables.Result : this study showed that two third of participiants had knowledge of BSE and poor practicing for BSE. The main sourse of information among all participants via PHCCs.Conclusion : good knowledge was noticed among women attending primery health care centers. Practicing of breast self examination was poor.

دراسة فاعلية وسلامة التغييرات المختبرية ومعلمات التنبؤ للاستجابة لعقار الاداليموماب في علاج المرضى المصابين بالتهاب الفقار المقسط النشط == Efficacy, Safety of Laboratory Changes and Predictors of Response to Adalimumab in Treatment of Patients with Active Ankylosing Spondylitis

Author name: ليث محمود شاكر
Supervisor name: خضير زغير معيوف البدري
General topic: Medicine
Specific topic: Diseases - Joints
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Ankylosing Spondylitis belongs to a family of rheumatic diseases known as spondyloarthritides that characteristically cause spinal joint inflammation and bony fusion of the spine. Ankylosing spondylitis is the prototype of the Spondyloarthritides and is typified by ankylosis of the axial skeleton.There is no cure for ankylosing spondylitis, although treatments and medications are available to reduce joints pain and stiffness with subsequent improvement in quality of life.Adalimumab is a fully human monoclonal antibody of the Immunoglobulin G1isotype that neutralizes the biological function of tumor necrosis factor - α, has been used as effective treatment in ankylosing spondylitis in the last years.Objective : To assess the efficacy and safety of laboratory changes of Adalimumab in treatment of patients with active ankylosing spondylitis, as well as to assess the predictors of response to Adalimumab in treatment of patients with active ankylosing spondylitis.Patients and methods : An open labeled single group prospective study that was conducted over 17 months period on 61 Iraqi patients with ankylosing spondylitis diagnosed according to Modified New York criteria (1984) for diagnosis of ankylosing spondylitis and ASAS classification criteria for axial SpA .All the patients included in the study were given Adalimumab vial at a dose of 40 mg by subcutaneous injection every other week. Each patient was followed at regular intervals of baseline, 3 months and 6 months for disease activity including Bath Ankylosing Spondylitis Disease Activity Index and functional assessment including Bath Ankylosing Spondylitis Functional Index and for laboratory changes in hemoglobin, white blood cell count, aspartate aminotransferase, alanine aminotransferase, blood urea and serum creatinine . In addition, the study assessed eight different patients’ characteristics : age, gender, disease duration, human leukocyte antigensubtype B27, smoking, using steroids, using disease - modifying antirheumatic drugs (methotrexate, sulfasalazine), and drug history of using of other biological drugs (Etanercept, Infliximab) as predictors of response to Adalimumab treatment.Results : Data analysis showed that Bath Ankylosing Spondylitis Disease Activity Index 50% response rate was 59% after three month of treatment and reached to 85.6% after six months of treatment, the analysis also showed that the age and a positive history of using other biologic agents as apart from ( gender, disease duration, human leukocyte antigensubtype B27, smoking status , using steroids, and disease - modifying anti rheumatic drugs ) had a statistically significant association with reduced response to treatment, for each one year increase in age, the risk of being a respondent is decreased by 4% (P=0.026), and a positive history of using biologic agents is associated with decrease in the risk of being a respondent by 2.5 times (P=0.016) , all the variables were statistically significant effect on treatment and were evaluated as a strong effect (Cohen’s d>0.8). In Bath Ankylosing Spondylitis Functional Index ≥5 group, data analysis showed that their is statistically significant reduction by a mean of 2 units after three months of treatment and reached to a mean of 2.5 units after six months of treatment, the data analysis showed that increase age and a positive human leukocyte antigen - subtype B27 had a statistically significant association with reduced response to treatment, all the variables were statistically significant effects on treatment and were evaluated as a strong effect (Cohen’s d>0.8).In Bath Ankylosing Spondylitis Functional Index ˂5 group, data analysis showed that their is statistically insignificant reduction in the score of by a mean of 0.5 units after three months, and 0.6 units after six months of treatment, all the variables were statistically insignificant effects on treatment and were evaluated as a weak to moderate effect.The treatment effect of Adalimumab was evaluated as a moderately strong reduction in white blood cell count (Cohen’s d=0.43). While treatment effect on (hemoglobin, aspartate aminotransferase, alanine aminotransferase, blood urea and serum creatinine) was evaluated as week effects (Cohen’s d<0.3).Conclusion : Adalimumab drug is effective and relatively safe in treatment of patients with active ankylosing spondylitis. Increase in age, positive history of using of other biological drugs (Etanercept, Infliximab) and positive human leukocyte antigen - subtype B27 had significant correlation with reduced response to treatment.

جدوى قياس سرعة الانتشار في الشريان الابهر النازل كمعيار تنبؤي لامراض الشرايين التاجيه في اثنين من مراكز القلب في بغداد == The Value of Measuring Propagation Velocity Of The Descending Aorta as Predictor of Coronary Artery Disease in Two Cardiac Centers in Baghdad

Author name: دنيا حامد كاظم
Supervisor name: امال نوري المراياتي
General topic: Medicine
Specific topic: Echocardiography
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Elastic properties of the aorta affect the left ventricular function and epicardial arteries blood flow. Thats why several parameters are used to assess those properties in order to predict the likelihood of atherosclerotic coronary artery disease. Those parameters include aortic strain, aortic distensibility and early diastolic velocity of the anterior aortic wall.Objectives : Testing the value of aortic propagation velocity as a parameter of aortic stiffness in predicting coronary artery disease. The strength of this parameter in predicting the number of affected coronary arteries is also assessed.st of August 2015 to the 1 st Study population and methodology : From the 1 of July 2016, and after applying the inclusion and exclusion criteria, 120 patients were included in this comparative multi - center study. They were assessed for demographic criteria and risk factor profiles. Trans thoracic echocardiographic examination was done, all the needed measurements were obtained as well as measuring the carotid intima media thickness by Doppler, then the results of their coronary angiography were revised, 60 patients were included in the coronary artery disease group and another 60 in the non - coronary artery disease group.Results : Aortic propagation velocity was found to be related to the aortic distensibility, strain, early diastolic anterior aortic wall velocity and the overall carotid intima media thickness to a statistically significant level (r=+0.481, p<0.001; r=+0.548, p<0.001; r=+0.595, p<0.001; r= - 0.361, p<o.oo1 respectively). It was found that aortic propagation velocity predicts coronary artery disease (p<0.001) and correlates with the number of affected coronary arteries (r= - 0.711, p<0.001).Conclusion : Aortic propagation velocity is an easily applied echocardiographic parameter of aortic stiffness that can predict coronary artery disease caused by vascular atherosclerosis in a non - invasive way. It also correlates with the number of the affected coronary arteries.

المعلمات اللتي تزيد من خطر الاصابه بامراض الرئه الخلاليه في مريض التهاب المفاصل الرثياني == Parameters that Increase Risk of Interstitial Lung Disease in Rheumatoid Arthritis Patient

Author name: زينب عزيز
Supervisor name: عدنان الجبوري
General topic: Medicine
Specific topic: Diseases - Thoracic
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Several studies have been focused on interstitial lung disease among patients with established rheumatoid arthritis, with fluctuating incidence and prevalence depending on the methods used.Objective : This study has been carried out to determine the risk of developing of interstitial lung disease according patients’ socio - demographic characteristics and other study variables.Patients and Methods : A case - control study design was used in this study performed on 100 cases with RA (50 cases with ILD). Data were analyzed by using Statistical Package of Social Sciences (SPSS) version18. Categorical variables were presented as frequencies and percentages. Continuous variables were presented as means with their 95% confidence interval (CI) and standard deviation. The Pearson's chi - square test (x2) was used to determine the associations between categorical variables. A p - value of < 0.05 was considered as statistically significant.Results : The overall mean age patients with rheumatoid arthritis were (49.65±11.94) years old and majority (54.0%) and (58.0%) of rheumatoid arthritis patients with and without interstitial lung disease were between 41 - 60 years, respectively. Female gender with rheumatoid arthritis patients about (66%) without interstitial lung disease & only (50.0%) of rheumatoid arthritis patients with interstitial lung disease are female. There was significant association between rheumatoid arthritis patients with and without interstitial lung disease with residence, rheumatoid arthritis patients who lived away from generators and factories areas were 15 times more likely to be without interstitial lung disease.Conclusion : The present study finding was reported significant higher rate 15 times of interstitial lung disease in rheumatoid arthritis patients who live near area of generators and or factories, as well as, current smokers in present study were two times higher in presenting interstitial lung disease among rheumatoid arthritis patients as well as non - smokers were three times higher to be without interstitial lung disease.

معرفة ومواقف النساء الحوامل حول طرق الولادة == Knowledge and Attitudes of Pregnant Women towards mode of Delivery In Baghdad Teaching Hospital - 2016

Author name: هند عامر ناهي الخفاجي
Supervisor name: نادية عزيز ناصر
General topic: Medicine
Specific topic: Family Medicine
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Delivery is one of the most important issues for human being and generation in the world. The process through which childbirth naturally occurs is called natural vaginal delivery. Caesarean is delivery of child through incisions in abdominal wall (Laparotomy) or uterus (Histrotomy).Aim of the study : To assess the knowledge, attitude of pregnant women and the associated factors with attitude towards the mode of delivery.Patients and method : A cross sectional study conducted in prenatal clinic in Baghdad teaching hospital for four months duration from the 1st of Feb. 2016 to the end of the May 2016.Results : A total of 300 pregnant women were included in present study with mean age as 28.3±9.8 years; Most of studied women were housewives. More than half of pregnant women (54.3%) married at younger age. The information of pregnant women about delivery modes were obtained mainly from social relationships (82.6). Half of pregnant women had good knowledge of delivery modes, 90.3% of them had good attitude toward normal vaginal delivery, 51.3% of them had poor attitude toward cesarean section .A significant association was observed between older age women and poor knowledge of them regarding delivery modes (p=0.01). There was a significant association between employed women and good knowledge score.Conclusion : The knowledge of pregnant women regarding vaginal delivery was relatively low and the attitude was high, while their attitude toward cesarean section was low. The main associated factors for women's knowledge were women's age, job, educational level, husband's age and abortion history and the main factors for women's attitude were women's age, educational level of women and their husbands and history of previous cesarean section.

دقة فحص رنين قنوات الصفراء بالمقارنه مع ناظور قنوات الصفراء في تقييم انسداد قنوات الصفراء == ACCURACY OF MRCP VERSUS ERCP IN THEEVALUATION OF BILIARY OBSTRUCTION

Author name: ايمان سامي سوادي العطية
Supervisor name: ليث احمد خلف
General topic: Medicine
Specific topic: Diagnostic Radiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine - Department Of Diagnostic Scans
Language: English
University location: Baghdad
First pages:
Abstract: ان انسداد قنوات الصفراء من الحالات المتكرر مشاهدتها في قسمي الجراحه والباطنيه وان تشخيصها يحتاج الى الكثير من الفحوصات المختبريه والشعاعيه للتمكن من معالجتها واصبح فحص الرنين المغناطيسي من الفحوصات الاساسيه لغرض التشخيص الدقيق لاسباب الانسداد لتسهيل العلاج وفي بحثنا هذا اجريت مقارنه لنتائج فحص قنوات الصفراء بالرنين مع نتائج الفحص الناظوري الارتجاعي لللقنوات الصفرايه والبنكرياسيه باعتباره المعيار الذهبي لقد تم اجراء هذه الدراسه خلال الفتره من شهر كانون الاول لسنة 2015 لغاية شهر ايلول 2016 واجريت على 50 مريض اجري لهم فحص رنين قنوات الصفراء بعد الشك بوجود انسداد قنوات الصفراء بالاعتماد على نتائج فحص السونار او ارتفاع نسبة الماده الصفراء في الدم بعد ذالك اجريت لهم عمليه فحص القنوات الصفراء بالناظورالهدف من الدراسه : لغرض اثبات مدى دقة فحص الرنين المغناطيسي في تشخيص وجود انسداد في القنوات الصفراويه فقد تم فحص المرضى من قبل استشاري الامراض الباطنيه تخصص دقيق في امراض الجهاز الهضمي واحيلوا لفحص الرنين المغناطيسي في قسم الاشعه في مستشفى بغداد التعليمي او في معهد الاشعه وتمت مراجعه الفحص من قبل اخصائي الاشعه وتحدد سبب الانسداد اعتمادا على نتائج الرنين المغناطيسي بعد ذالك اجريت لهم عملية ناظور القنوات الصفراويه في الطابق السادس في مستشفى بغداد التعليمي او في مستشفى امراض الجهاز الهضمي والكبد من قبل استشاري امراض الجهاز الهضمي ثم تمت مقارنة النتائج لكلا الفحصين وقد تم التوصل ال مايلي : ان فحص الرنين المغناطيسي ذو كفاءه تصل الى ( 97.6بالمائه) مقارنة بنتائج الناظور لذلك يمكن استغلاله للتشيخص بحساسيه وكفاءه عاليه وابقاء الناظور للحالات التي يتوقع احتياج تداخل كسحب الحصى من القنوات الصفراويه او اخذ خزعه للفحص النسيجي او لوضع عباره خاصه في حالات التضيق او تلك التي لا يمكن فيها سحب الحصى | Biliary obstruction is one of the common problems in both medical and surgical departments and its diagnosis needs many investigations and radiological in order to reach the correct giagonsis to arrange for possible treatment Aim of the study : To assess the accuracy of MRCP versus ERCP in the evaluation of biliary obstruction as the ERCP is a gold standard and to asses the validity of row data and MIP sequences for evaluation of the final results of MRCP study. Materials and method : During the period from December 2015 to September 2016, 50 patients with initial diagnosis of biliary obstruction based on ultrasound, and or clinical and biochemical evidence of cholestatic jaundice, were examined in the radiology department in medical city hospitals with MRCP to evaluate the cause and site of obstruction followed by ERCP done within few days.Results : By comparing the MRCP and ERCP findings in identifying the cause of obstruction reveals that .The sensitivity, specificity and accuracy of MRCP versus ERCP was found to be 97.6%, 66% and 92% respectively the major cause of biliary obstruction ound to be intraluminal CBD stone , luminal stricture and ampullary tumors are other causes of obstruction, according to the site 0f obstruction , distal obstruction found to be more common than mid or proximal. Conclusion : MRCP was found to be of high diagnostic accuracy in diagnosing biliary obstructionAnd ERCP should be reserved for therapeutic intervention since it was found that the sensitivity and specificity of MRCP were high and it can precisely define the site and cause of obstruction when compared to ERCP

المعرفة والمواقف حول اجهزة منع الحمل داخل الرحم بين عينة من النساء في بغداد == KNOWLEDGE AND ATTITUDE CONCERNING INTRAUTERINE CONTRACEPTIVE DEVICE AMONG A SAMPLE OF WOMEN IN BAGHDAD

Author name: ميرفت عبد علي عبد الوهاب
Supervisor name: بتول علي غالب ياسين
General topic: Medicine
Specific topic: Family Medicine
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Although intrauterine contraceptive device (IUCD) is the most widely used of long acting reversible method of fertility regulation in the world today, only 10% of Iraqi women aged 15 to 44 were using IUCD in 2011..Objective : To assess the knowledge and attitude towards intrauterine contraceptive device among women in reproductive age in Baghdad city, and to identify the effect of certain factors on their knowledge and attitude.Methods : A cross sectional study was conducted in Baghdad Teaching Hospital and Al - Shaheed Abdul - Sahib Dakhil PHCC. Any woman aged (15 - 45 years) who agreed to participate was included in the study. Data was collected through direct interview with the participants and the scores of knowledge were classified into : Good, fair and poor for knowledge and positive, neutral and negative for attitude.Results : Assessing the knowledge and attitude of the 301 participants revealed that 97.3% knew what IUCD is and 96.6% were aware of the aim of using the Copper IUCD, 42.8% were aware of its side effects, whereas only 5.9% of them were aware of the types, 13.9% aware of complications and 3.3% aware of who is eligible for using IUCD. In spite of this only 1.0 % of the participants got good knowledge score and 76.1 % got poor scores. Regarding attitude 15.0% had a positive attitude toward the use of IUCD.Knowledge scores of the respondents increased with increasing age (p<0.001), level of education (P = 0.026), being married (P=0.008),number of children (P<0.001) and history of previous abortions (P=0.04). Friends, neighbors and relatives were the main source of knowledge (77.4 %(.Conclusions : Most of participants were with poor knowledge score and the main source of them were friends, neighbors and relatives.Attitude score of Less than one - fifth of them was positive
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