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الارتباط بين الموجات فوق الصوتية للوريد البابي الكبدي والنتائج التنظيرية في دوالي المرئ == Correlation between portal vein Doppler ultrasound and endoscopic findings in esophageal varices

Author name: اسراء مزاحم ذاكر
Supervisor name: ليث احمد خلف
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: خلفية عن الموضوع : دوالي المريء ، وهو احد المضاعفات الرئيسية لتليف الكبد ، يمكن ان يؤدي الى تهيدد للحياة نتيجة نزيف الجهاز الهضمي.الهدف من البحث : تقييم الاداة التشخيصية للكشف عن دوبلر الوريد البابي (سرعة ، قطر ، مؤشر الازدحام ، وحجم الطحال) للتنبؤ بدوالي المريء.الطرائق : تم تضمين 51 مريضا بالغا يعانون من تليف الكبد في الدراسة. خضع جميع الاشخاص الى الموجات فوق الصوتية في البطن وتنظير المريء. تضمنت مؤشرات الوريد البابي التي تمت دراستها مؤشر الاحتقان الكبدي ، وقطر الوريد البابي ، سرعة الوريد البابي وحجم الطحال. تم حساب حساسيتها ونوعيتها والقيم التنبؤية باستخدام التنظير المريء كمعيار ذهبيالنتائج : كانت الارتباط بين سرعة الوريد البابي ومؤشر الاحتقان الكبدي مع وجود دوالي المريء ذات دلالة احصائية (قيمة p <0.05). كان سرعة الوريد البابي اعلى حساسية 92.7 ٪ للكشف عن وجود دوالي المريء. وكان مؤشر الاحتقان الكبدي اعلى خصوصية من 99 ٪ واعلى قيمة تنبؤية ايجابية من 99 ٪. كانت القيمة التنبؤية السلبية اعلى سرعة الوريد البابي بنسبة 66.7 ٪.استنتاج : يمكن ان يكون دوبلر بالموجات فوق الصوتية بديلا سهلا ، رخيصا وامنا . حيث لا يتوفر تنظير المريء . مؤشرات دوالي الوريد البوابي مفيدة للكشف عن دوالي المريء وافضل مؤشرات الدوبلر سرعة الوريد البابي ومؤشر الاحتقان الكبدي ، في حين ان قطر الوريد البابي قد يكون لها قيمة محدودة للتنبؤ بدوالي المريء | Background : Esophageal varices, a major complication of liver cirrhosis, can lead to life threatening gastrointestinal bleeding.Objective : Evaluate the diagnostic utility of portal vein Doppler findings (velocity, diameter, congestion index ) and spleen size to predict esophageal varices.Methods : A cross sectional study of 51 adult patients with cirrhosis were included in the study. All of them underwent an abdominal ultrasound and esophageal endoscopy. The portal vein indices that were studied included hepatic congestion index, portal vein diameter portal vein velocity and splenic size. Their sensitivity, specificity and predictive values were calculated using esophageal endoscopy as a gold standard. Results : Association of PVV and HCI with presence of EV was statistically significant (p - value <0.05). PVV had the highest sensitivity 92.7% for detecting the presence of EV. HCI had the highest specificity of 99% and the highest positive predictive value of 99%. Negative predictive value was highest for PVV at 66.7%.Conclusion : Doppler Ultrasound can be an easy, cheap and safe alternative, where esophageal endoscopy is not available, available, for triaging patients for referral for esophageal endoscopy. Portal vein Doppler indices are useful for detecting esophageal varices, the best Doppler indices PVV and HCI, while PVD may have a limited value for predicting esophageal varices.

تضمين مؤشر ديوك لفحص اجهاد القلب على سعة انتشار اصابة الشرايين التاجية من خلال الفحص القسطاري == The Implication of Duke Treadmill Score (DTS) on The Extent of Coronary artery Lesions by angiography

Author name: طارق مطشر الثويني
Supervisor name: حسن يوسف النجار | حسن علي الفرحان
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: خلفية : يعتبر فحص اجهاد القلب من الوسائل المفيدة في تشخيص امراض الشرايين التاجية للقلب للمرضى اللذين يعانون من الذبحة الصدرية اضافة الى حساب اختطارهم المستقبلي. ان مؤشر ديوك لفحص اجهاد القلب يعد من المؤشرات التي تعطي فكرة جيدة عن تشخيص الذبحة الصدرية اضافة الى تصنيف المرضى حسب نسبة الخطورة والمضاعفات المستقبلية. وتعتمد هذه العلامة على احتساب مدة الفحص ,الام الذبحة اثناء الفحص والتغيرات الحاصلة على تخطيط القلب الكهربائي.الاهداف : لتحديد فائدة مؤشر ديوك في تشخيص امراض الشرايين التاجية للقلب اضافة الى تطبيقها على سعة انتشار الاصابة للمرضى اللذين يعانون من الذبحة الصدرية.طريقة العمل : تم انتخاب عينة من المرضى المحالين الى المركز العراقي لامراض القلب في مجمع مدينة بغداد الطبية /بغداد - العراق للفترة من شهر مايس 2013 الى نهاية شهر نيسان 2014 واللذين يعانون من الام الصدر للاشتباه باصابتهم بالذبحة الصدرية .تمت اجراء المعاينة الاولية للمرضى من ثم اجراء فحص اجهاد القلب حسب بروتوكول بروس القياسي لفحص اجهاد القلب ثم فحص قسطرة الشرايين التاجية التشخيصية وحسب ضوابط الكلية الامريكية لامراض القلب والجمعية الامريكية للقلب.تم تقسيم مؤشر ديوك الى : مؤشر عالي الخطورة اقل من - 11 ومؤشر متوسط الخطورة ويتراوح من اقل من - 11 الى +5 اما المؤشر الاعلى من +5 يعتبر قليل الخطورة.بالنسبة لاصابة الشرايين التاجية تم اعتبار نسبة التضييق ≥70% في الشرايين التاجية,ونسبة تضيق≥50% في الجذع الايسر الرئيسي ذات اهمية. في حين تم اعتبار الاصابة ذات الاهمية في الجذع الايسر الرئيسي او ثلاثة من الشرايين الاخرى الرئيسية اصابة واسعة. النتائج : اظهرت نتائج البحث التالي : معظم المرضى في مجموعة المؤشر العالي (38 مريض من مجموع اربعين ) اي نسبة 95% كانوا مصابين بنسبة ذات اهمية في الشرايين التاجية, و13 مريض كانوا مصابين اصابة واسعة. على العكس من المرضى في مجموعة المؤشر غير العالي كانت النتائج كالتالي : اكثر من نصف المرضى (23 مريض ) لم يتم العثور على اصابة في الشرايين التاجية , 17 مريض كانوا يعانون من اصابة ذات اهمية , ومريض واحد فقط كان يعاني من اصابة واسعة | Background : Exercise testing is a useful tool in the diagnosis of patients with coronary artery disease and predicting their future risk of cardiac events. The Duke treadmill score (DTS) is a composite index that was designed to provide diagnostic and prognostic estimates based on results from the exercise test, including ST - segment deviation, chest pain, and exercise duration.Aim of the study : To assess the diagnostic and the prognostic value of the Duke treadmill score (DTS) in the evaluation and the risk stratification of patients with coronary artery disease.Patients and methods : A cross sectional study was used to assess patients who were referred to The Iraqi Centre for Heart diseases for the evaluation of chest pain by Exercise test followed by coronary angiography for risk stratification according to the ACC/AHA guidelines, during the period from May 2013_ April 2014. A standard Bruce treadmill protocol was used as the exercise technique with calculation of the Duke treadmill score( DTS) as the following : DTS= exercise time (minute) ̶ 5 ×(maximum ST deviation) ̶ 4× ( treadmill angina index), angina index = 0 if no anginal pain, 1 for nonlimiting anginal pain, 2 if angina was why the test terminated.A (DTS) of ≤ - 11 was defined as high risk , a DTS of > - 11 to + 5 was defined as intermediate risk , while a score of > +5 was defined as low risk. A significant coronary artery lesion was defined as follows : ≥ 50% left main stem stenosis or, ≥70% stenosis in other epicardial vessels. The presence of a significant lesion in the left main stem or three epicardial vessels was labeled as extensive coronary artery disease, while non extensive coronary artery disease indicates a significant lesion in one or two epicardial vessels . Results : There were 80 patients included in the study (40 patients were with high risk DTS, the other 40 were with non high risk DTS). The mean age 55.6 ±9.6 years. 61 patients were males (76.0%) and 19 were females (24.0%). There was no significant difference in age groups and means between males and females(p>0.05) . The main risk factors for coronary artery diseases among study participants were hypertension (65%), diabetes mellitus (34.0%) and smoking (43.0%). Participants who had one risk factor represented 40%, those who had two risk factors represented 26.0%, those who had no risk factors represented 18.0%, and those who had three risk factors represented 16.0%. Almost all patients in the high risk group,( 38 patients of the 40) (95%) had a significant coronary artery disease ,whereas thirteen patients of them (32.0%) had extensive coronary artery disease. Conversely more than half of the patients in the non high risk group(23 of total 40 patients) (58%) had no lesions by angiography, and only 17 patients (42%) had a significant coronary artery disease with only one patient of them had an extensive coronary artery disease (P˂0.001) . It had been significantly found that high risk DTS group had more ST - depression than those of non high risk group, the mean ST - depression value was 2.4 ± 0.5 mm for the high risk group patients vs. 1.4 ± 0.5, for the non high risk group patients ,(p<0.001).Conclusion : The composite DTS provides diagnostic and prognostic information for the evaluation of symptomatic patients for clinically suspected ischemic heart disease

تصنيف المرضى العراقيين المصابين بالاورام العصبيه الغديه وتقدير مدى استجابتهم لعقارالساندوستاتين (الاوكتيريوتايد) == NEUROENDOCRINE TUMORS CLASSIFICATION AND RESPONSE TO LONG ACTING SOMATOSTATIN ANALOGUE; AN IRAQI EXPERIENCE

Author name: مروة خالد عبد الفتاح
Supervisor name: منور عبد الاله النقاش
General topic: Medicine
Specific topic: Therapeutic Radiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: The lack of studies regarding the incidence of neuroendocrine tumors (NETs) is related to the rarity of these tumors (25/1,000,000). Chromogranin A is a useful tumor marker for NETs diagnosis & follow - up. Octereotide LAR is an established treatment for NETs by both providing symptomatic relief & inhibiting tumor growth. However, studies regarding incidence of NETs & their response to SAS - LAR are still insufficient.Aim of studyTo shade the light on the incidence of NETs, the clinico - pathologic characteristics of Iraqi patients with NETs & their response to long acting Octereotide.Patients & methodsThis is a cross - sectional observational study that was conducted in Oncology teaching hospital/medical city complex using patients’ follow - up sheets. Data recruitment included all NET patients diagnosed after October 2013 to April 2016.ResultsIn our registry, 38 patients were recorded; most patients (60.5%) were over the age of 50 years with male to female ratio (1.2 : 1). We found the gastroenteropancreatic tract being the most common primary organ followed by pelvis . With respect to the GI tract we found that pancreas (26.3 %) was the commonest primary organ. Metastatic disease at presentation was found in (44.7%) of patients with the Liver (15.8%)was the most common metastatic site.Notably, most of our patients presented with G3 disease (44.7%) & (13.2%) with G1 . Serial CgA tests were performed in (17/28) patients used SAS - LAR, with a change in mean value from (225.3 U/L) pre - using the agent to (17.5 U/L) two months after use & to (8.7 U/L) four months after use(p=0.001) while the change in mean of CgA level was from (205.9 U/L) to (200.9 U/L) in 10 patients who did not use octereotide.(p=0.2). After a period of 2 years ,the median time of remission following SAS - LAR administration was 3 months compared to 7 months in patients received other modalities of treatment. In our study, a statistically significant difference was demonstrated between the two groups of patients.(p=0.003).Conclusion Plasma CgA is the most reliable marker for NETs, reflecting the clinical evolution of the disease. Aids in diagnosis & response assessment to different therapies.Octreotide LAR provides symptomatic response & contributes to disease stabilization & tumor regression in both functional & non functional NETs.1 - INTRODUCTION Neuroendocrine tumors are thought to arise from cells throughout the diffuse neuroendocrine system that is composed of peptide - and amine - producing cells that may secrete different hormones depending on the site of origin. NETs are composed of monotonous sheets of small round blue cells with uniform nuclei and cytoplasm(1). They compromise a broad family of tumors, the most common of which are carcinoid tumors (most commonly arise in the lungs & bronchi, small intestine, appendix rectum, or thymus)& pancreatic NETOther neuroendocrine tumors arise from parathyroid, adrenal, pituitary gland, & in calcitonin - producing cells of the thyroid (causing medullary thyroid carcinoma)( 2).Most NETs seem to be sporadic; risk factors for sporadic NET are poorly understood. Risk factors for the development of midgut carcinoid tumors include age, male sex, and increased body mass index, and menopausal hormone therapy (1).NET may also arise in the context of inherited genetic syndromes, include multiple endocrine neoplasia (MEN) types 1& 2 (2).The incidence of gastrointestinal (GI) NETs is 6.2 per 100,000 populations and has been steadily increasing. The increasing incidence of NETs reportedIn many studies is likely multifactorial and includes increased awareness and improved endoscopic methods of detection.As these tumors are indolent and patients survive a long time, the prevalence is quite high, making them the second most prevalent GI tract tumor, second only to colon cancer. Some are clinically silent and have been detected only at autopsy (incidence 8%). Further ,patients with GI NETs have a higher risk of other noncarcinoid primary tumors. The overall 5 - year survival rate of all patients with GI NETs is 28.5%.(1) Of all NETs ∼25% are located in the respiratory tract. Typical carcinoids (TCs) comprise ∼1% - 2% and atypical carcinoids (ACs) only 0.1% - 0.2% of pulmonary neoplasms. According to the surveillance, epidemiology and end results program (SEER) database from 2003, the combined incidence has been 1.57/100 000 inhabitants . The prevalence of thymic NET is ∼3% of the total number of NETs at all sites. In the last SEER database, a reported incidence of thymic NETs is 0.02/100 000 population per year . They constitute ∼5% of all thymic tumors. Both bronchial and thymic NETs may be part of multiple endocrine neoplasia type 1 syndrome (MEN - 1, 5% - 15%). The median age at diagnosis for bronchial NETs is 64 years and for thymic NETs 59 years.(3) The incidence of G1NET increased from 2.0 to 3.0; there was a large increase in G2NET from 0.01 in 1990 to 0.2 in 2010, and of the G3 - LCNET from 0.01 to 1.8, respectively. In G3 - SCNET incidence in men decreased from 21.3 to 10.1, whereas in women it increased from 4.5 to 7.7.(4).

تاثير عمر الام على نتائج الحمل == Effect of maternal age on pregnancy outcome

Author name: حلا نعمان محمدعلي
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: خلفية البحث : في العقود القليلة الماضية ،كان هناك تاخير في الحمل الاول ، ومعدل عمر النساء في وقت الولادة تزايدت. يرافق المراهقات الحوامل والحوامل المتقدمات بالعمرمضاعفات اثناء الحمل والولادة. هدف الدراسة : لدراسه تاثير عمر الام على صحه الام والوليد .المنهجية : دراسة مقطعية اجريت في مستشفى بغداد التعليمي للفترة من بداية شهراذار وحتى بداية شهر حزيران من سنة 2016 ،العينة متكونة من( 500امراة) اختيرت بطريقة العينات العشوائية المنتظمة من ملفات المرضى في قسم الاحصاء .تمت جمع المعلومات من قبل الباحثة من فايلات المرضى اللذين دخلوا او رقدوا في ردهات قسم النسائية لسنة 2015 ، ثم تم تصنيفهم حسب العمر الى ستة فئات عمرية المجموعة(<20 )، المجموعة (20 - 24 ) ،المجموعة (25 - 29) ،المجموعة (30 - 34 ) المجموعة(35 - 39)،المجموعة (40≤) .النتائج : اظهرت الدراسة بان هناك فروق ذات دلالة احصائية بين المجاميع العمرية المختلفة ،بالنسبة لوجود ارتفاع ضغط الدم اثناء الحمل ،داء السكري الولادة المبكرة ،وزن الوليد ،التشوهات الولادية ، وفاة الجنين داخل الرحم ،وطريقة الولادة. ولايوجد فروق ذات دلالة احصائية بالنسبة لوجود الاسقاط ،ولادة جنين ميت ،فقر الدم ،والحمل المتعدد. الاستنتاج : اثبتت الدراسة ان مضاعفات الحمل والولادة والمشاكل المتعلقة بالجنين عند الولادة تكون نسبتها اعلى عندالمراهقات الحوامل والنساء المتقدمات بالعمر . | Background : In the last few decades, there has been a delay in first - time pregnancies, and the average age of women at the time of delivery has increased in many countries. Teenage and advanced maternal ages are associated with adverse pregnancy outcomes.Objective : To demonstrate the effect of maternal age on pregnancy outcomes in different age groups mothers.Subjects and methods : Across sectional study was conducted in Baghdad Teaching Hospital, data was collected in obstetric \gynecology department from 1st of March until 1st of June 2016 .Total of 500 women were included in the study using the systemic random sampling, every 10th case was selected, then divided into six age groups, a list of information was taken from hospital record at statistic department.Results : The results showed that there was statistically significant association among different age group, regarding presence of pregnancy induced hypertension, diabetes mellitus, preterm delivery, birth weight, congenital anomalies, IUD, mode of delivery (p value<0.05). Interestingly there was no statistically significant association regarding presence of fetal loss (miscarriage, stillbirth), anemia, and multiple pregnancies (p value> 0.05).Conclusion : Maternal and neonatal complications are higher during the teenage years and advanced maternal age.Keywords : Maternal age, outcome of pregnancy

دور فحص المرونة وسرعة الموجات المقصوصة في التفريق بين الاورام الحميدة والخبيثة في الثدي == USE OF SHEAR WAVE ELASTOGRAPHY TO DIFFERENTIATE BETWEEN BENIGN AND MALIGNANT BREAST MASS

Author name: اوان حكمت محمد
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: Shear wave elastography is a new method of obtaining elastography images based on the combination of a radiation force induced in a tissue by an ultrasonic beam and an ultrafast imaging sequence capable of catching in real time the propagation of the resulting shear waves.Aim of studyTo assess the performance of shear wave elastography in differentiating between the malignant and benign breast tumors. Patients and Methods A cross sectional study carried out in Breast Clinic at Oncology Teaching Hospital - Baghdad Medical city for period from 1st of November, 2015 to end of June, 2016 convenient sample of 80 women with suspected breast tumor. After full history and examination, enrolled women were examined with ultrasound by the researcher with help of Radiologist.ResultsA highly significant association was observed between women with BIRADS V and high shear wave elastography ratio (p<0.001). Women with BIRADS V had significantly malignant fine needle aspiration findings of breast (p<0.001) and women with high shear wave elastography ratio were significantly had malignant FNA findings (p<0.001). The cutoff shear wave elastography ratio of 3.75 had good validity results (87% sensitivity, 82.4 % specificity).Conclusions Shear wave elastography is non - invasive reliable diagnostic method facilitating characterization of breast tumor.

العلاقة بين متلازمة الالم الليفي العضلي والبهاق : دراسة مقدمة الى كلية الطب - جامعة بغداد - قسم الامراض الباطنية == Relationship Between Fibromyalgia Syndrome and Vitiligo

Author name: علا سفير خضير
Supervisor name: عمار فيصل حميد
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 : Fibromyalgia syndrome (FMS) is a common, chronic, and highly disabling syndrome characterized with chronic widespread pain, fatigue, sleep disturbances, cognitive dysfunction and mood disorders. Vitiligo is an acquired pigment disorder which causes disfigurement to skin and negative effect on quality of life (QOL) for patients. There is no previous study on relationship between FMS and vitiligo.Objective : To assess relationship between FMS and vitiligo in a sample of Iraqi patients and to evaluate the predictors of this relationship if present.Patients and methods : A case controlled study involved 100 Iraqi patients with vitiligo and 200 healthy individuals matched for age and sex as a control group. The 2012 Canadian Guidelines criteria were used for the diagnosis of FMS and applied to all Vitiligo patients and controls included in the study. Baseline characteristics of patients with vitiligo and controls were recorded in form of : age, sex, employment condition, and marital status. Body mass index (BMI) was measured for both groups. Patients with vitiligo were fully assessed for : type, duration, severity of disease and medications used.Results : Prevalence of FMS in a sample of Iraqi patients with vitiligo was12% compared to 7% in controls (p=0.15, OR=1.81,95% CI=0.8 - 4.08). FMS symptoms in vitiligo patients were : fatigue 46%, diffuse body pain 34%, sleep disturbance 33%, cognitive dysfunction in 30%, mood disorders 23%, and visceral symptoms : central nervous system (CNS) 52%, skin 35%, gastrointestinal tract (GIT) 32%, cardiovascular system - respiratory system (CVS - RS) 16%, genitourinary tract(GUT) 8%, and ear nose throat (ENT) 7%).There was significant association between the FMS in vitiligo patients and : females with vitiligo 22.2% compared to none among males with vitiligo 0% (P

مشاهدات فحص الرنين المغناطيسي وتحديد دقتها بالاعتماد على ناظور الركبة في تشخيص اصابات الرباط الصليبي الامامي لمفصل الركبة == MRI FINDINGS VERSUS ARTHROSCOPY IN ANTERIOR CRUCIATE LIGAMENT TEAR INJURIES OF THE KNEE JOINT

Author name: لميس عبد الحسين عزيز
Supervisor name: ليث احمد خلف
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: فحص الرنين المغناطيسي لمفصل الركبه هومن الفحوص اليومية والمتكررة في قسم الاشعه .ان مفصل الركبة من المفاصل الكبيرة في الجسم ومع ذلك فان ثباته واستقراره يعتمد على مجموعه من الاربطه والعضلات لاسناده وخاصة الاربطه الصليبيه وتعد اصابات الرباط الصليبي الامامي اكثرها شيوعا خاصة في الحوادث الرياضية والتدريب العسكري وحوادث السيارات والدراجات النارية ومنها ما يترتب عليها من تعويضات مادية وقضائية.في الاونه الاخيرةان لفحص الرنين المغناطيسي دور متزايد في تشخيص امراض واصابات الجهاز العضلي الهيكلي نظرا لقدرته علي ابراز تباين الانسجة وتميزها عن بعضها وكونه خالي من مضار الاشعاع المؤين لذا فانه يشجعنا دراسة امكانيات استخدهمه في اصابات الرباط الصليبي الامامي. الهدف من الدراسة : لتحديد دقة فحص الرنين المغناطيسي في تشخيص اصابات الرباط الصليبي الامامي لمفصل الركبه بالاعتماد على ناظورالركبه التشخيصي والعلاجي .حيث ان اصابات اربطة الركبه تعتبر من الاصابات الشائعه التي توءثر على حياة ومماراسات المريض اليومية .لقد تم عمل هذه الدراسة خلال سنة 2014 - 2015 على 65 شخص متعرضين لاصابات في الركبه مع احتمال وجود تمزق في الرباط الصليبي الامامي تم فحصهم سريريا من قبل طبيب استشاري متخصص في امراض العضام والكسور بعد ذلك تم فحص الركبه باستخدام جهاز الرنين المغناطيسي في معهد الاشعة ثم تم التاءكد من نتيجة فحص الرنين باستخدام ناظورالركبه الذي يعتبر تشخيصا نهائيا وهو طريقة جراحية تتيح للطبيب المعالج مشاهدة ومعالجة الرباط الصليبي بشكل مباشر وباقل نسبة خطا ممكنه. الا ان الناظوريعد طريقة جراحية لها مخاطرها وغير سهلة للمرض مقارنة بالرنين المغناطيسي .وتم التوصل للاستنتاج التالي : لقد اظهرت الدراسة دقة عاليه لفحص الرنين المغناطيسي في تشخيص اصابات الرباط الصليبي الامامي (90.7 % ) وحساسية (91%) مما يمكن استخدامه كفحص اولي وبدقه عالية في اصابات اربطة الركبة ممه يغني عن دور التدخل الجراحي التشخيصي لناظور الركبة | Aim of the study : The study was done to analyze the validity of our MRI interpretation in the diagnosis of anterior cruciate ligament (ACL) tear injuries which is a common problem in many peoples impending their daily activities. Material and method : All patients presented to orthopedic consultation clinic with history of knee trauma and suspected anterior cruciate ligament tear injuries during 2014 - 2015 underwent knee joint MRI examination that followed by diagnostic and therapeutic arthroscopic knee surgery. The clinical diagnosis was confirmed during this procedure. From 65 patients MRI diagnose 58 patients as anterior cruciate ligament tears .The accuracy, sensitivity & specificity of MRI were calculated in correlation to arthroscopic finding. Results : our study showed high MRI accuracy (90.7%) , high sensitivity(91%) and specificity(100%) versus arthroscopy. Conclusion : Magnetic resonance imaging is an accurate non ionizing, multiplaner, non - invasive modality, it can be used as first line investigation in patient with soft tissue trauma to the knee & ligamentous injuries confidently that can replace diagnostic arthroscopy

طراز الامراض التنفسية في مستشفى الحسين التعليمي في مدينة السماوة == The Pattern of Respiratory Diseases in Al - Hussain Teaching Hospital in Samawa City

Author name: مثنى فيصل الظالمي
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 : Respiratory diseases are responsible for a major burden of morbidity and untimely death, with conditions such as asthma, pneumonia, tuberculosis, and chronic obstructive pulmonary disease the most important in world health terms..Objective : to estimate the pattern and to determine the incidence of respiratory diseases among patients admitted to medical wards.Patients and Methods : A retrospective study carried out at AL Hussain Teaching hospital in Samawa city )ALMuthana governoret) during a period from October 2013 to July 2014. 951 patient of both genders were enrolled in this study.Results : The mean age of the studied patients was 49.4 ± 18.1 (range : 15 - 99) years; the higher proportion of patients 244/951 (25.7%) aged > 60 years and the least proportion of patients 75/951 (7.9%) aged < 20 year females were the dominant gender among the studied group; 510/951 (53.6%) and the remaining 441/951 patients (46.4%) were males, with a female to male ratio of 1.16 : 1, Smoker patients were 263/951 represented 27.7% of the studied group, Asthma was the more frequent respiratory disease among the studied group (33.3%) followed by Pneumonia in (22.4%),andChronic obstructive pulmonary disease in (22.1%) . The higher mortality rate was reported among the patients with lung cancer (33.3%), followed by ILD (12.5%) .Conclusion : female was the dominant gender among studied group. Asthma was the more prevalent respiratory disease followed by Pneumonia, .the longer duration of admission was reported in patients with lung abscess.The higher mortality rate was reported in patient with Lung cancer followed by Interstitial Lung Disease and Chronic Obstructive Pulmonary Disease.

تقييم الوضيفة الانقباضية للبطين الايسر باستخدام السرعة الانقباضيه للصمام الاكليلي الحلقي لتصوير دوبلر النسيجي في مرضى احتشاء عضله القلب الحاد لاول مره == Evaluation of LV systolic function by using tissue Doppler Pulsed - Wave systolic Mitral annular Velocities(Sm) imaging after first acute myocardial infarction

Author name: عباس عبد لفتة عباس
Supervisor name: علي ال ياسين
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: على الرغم من الاستخدام الشائع لطريقه سمسون في تقيم الوظيفة الانقباضيه للبطين الايسر في مرضى احتشاء العضله القلبيه الحاد لاول مره الا ان لهذه الطريقة محددات عده في تقيم وظيفة وتحديد اماكن الاحتشاء اضافه الى استغراق وقت اكثر في الفحص بينما تقيم الوضيفة الانقباضيه للبطين الايسر هولاء المرضى باستخدام تصوير دوبلر النسيجي لقياس السرعة الانقباضيه للصمام الاكليلي الحلقي يكون اسهل مما قد تحصل عليه بواسطه طريقة سمسون.منهاج البحث : - الدراسه من نوع الحاله - الضابطه اجريت على 60 مريض لديهم احتشاء عضله القلب الحاد لاول مره و30 شخص سليم من (شهر تموز 2013 - شهر تموز 2014) تم قياس السرعه الانقباضيه للصمام الحلقي الاكليلي mS كعامل متغير باستحدام تصوير دوبلر النسيجي لتقيم الوظيفه الانقباضيه للبطين الايسر واجري الفحص خلال فتره اليوم الاول الى اليوم الثالث بعد الدخول المرضى لوحده العنايه المركزيه للقلب في مستشفى بغداد التعليمي بالنسبه للمرضى بينما الاشخاص السليمين تم فحصهم بوحده فحص الايكو(الطابق الثامن) من المستشفى ذاتها.النتائج : - شكل الذكور 65% من المرضى الذين شملتهم الدراسه مع متوسط العمر(45.7 ± 4.1) . اظهرت الدراسه ان نسبه مرضى احتشاء عضلة القلب الحاد الامامي(41.75%) من كل المرضى ,بينما( 28.3%) من المرضى يعانون من احتشاء عضلة القلب الحاد السفلي و(18.3%) من المرضى يعانون من احتشاء عضلة القلب للجدار الوحشي بينما (11.7%) كانوا يعانون من احتشاء عضله القلب للجدار بين البطينين.واظهرت الدراسة ان وظيفة القلب الانقباضيه للبطين الايسر قد اختلت في (60.6%) من مرضى احتشاء عضله القلب الامامي و(24.2%) من مرضى احتشاء عضله القلب السفلي و(9.1%)من مرضى احتشاء عضله الجدار الوحشي للقلب و6.1% من مرضى احتشاء الجدار الفاصل بين البطينين للقلب.كما لوحظ انخفاظا واضح في السرعه الانقباضيه العليا للصمام الاكليلي الحلقي خصوصا عند موضع الاحتشاء مقارنه بالاشخاص السليمين وتكون فروق معنويه احصائيا p value) (<0.05 الاستنتاجات : - ذروه سرعه الصمام الحلقي الاكليلي كما قيمت بواسطه تصوير دوبلر النسيجي انخفضت وتعكس انخفاضا موضعيا وكليا في الوظيفة الانقباضيه للبطين الايسر في مرضى احتشاء عضلة القلب الحاد لاول مره .الوظيفة الانقباضيه للبطين الايسر كانت اكثر اختلالا في مرضى احتشاء عضله القلب الامامي والسفلي.الكلمات الدليليهاحتشاء عضلة القلب الحاد ,الوظيفة الانقباضيه للبطين الايسر ,تصوير دوبلر النسيجي. | Background : - Acute myocardial infarction (MI) may be associated with regional or global left ventricular dysfunction. Although the Simpson’s method is widely used for the global assessment of left ventricular Ejection Fraction (EF) in acute MI, it has limitations of regional LV assessment and time consuming nature while evaluation of left ventricle systolic function (globally and regionally) can be get by measuring mitral annular systolic velocity (Sm) using tissue Doppler imaging (TDI). Aim : - Evaluation of left ventricular systolic function using tissue Doppler Pulsed - Wave systolic Mitral annular Velocities(Sm) imaging and its relation to ejection fraction by Simpson’s method in first acute MI. . Patients and Method : A case control study, from July 2013 - July 2014 was carried out. Total of 60 patients having acute myocardial infarction and 30 normal healthy subjects underwent measuring of Sm at (anterior, inferior, lateral and septal mitral annular sites) by TDI echocardiographic examination and ejection fraction by Simpson’s method as parameters of assessment of left ventricular systolic function (LVSF) on day 1 - 3 after admission with treatment, in CCU of Baghdad hospital (patients) while normal persons evaluated in out clinic of same hospital. . . Results : Total study sample was 90 persons, 30 normal subjects and 60 patients having acute myocardial infarction (MI). The sample was divided into 4 groups, i.e. anterior MI, inferior MI, septal MI, and lateral MI. The patients were 39 men, 21 women and mean age was 53.03 ± 4.64 years SD. There was a marked reduction in peak systolic (Sm) velocity at mitral annulus, especially at the infarction sites (p < 0.001). There was significant positive linear correlation mean Sm and ejection fraction among patients with MI (r =0.787, P = <0.001). Conclusion : Tissue Doppler Imaging is a reliable, and easily reproducible modality of echocardiography. The reduced peak systolic velocity seems to be an expression of regionally reduced systolic functions. While the reduced mean systolic velocity from 4 mitral annulus sites are expressions of globally reduced systolic functions and were correlated well with the ejection fraction. The Left ventricular systolic function was more impaired in anterior and inferior myocardial infarction. Key words : - Acute myocardial infarction, left ventricular systolic function, tissue Doppler imaging.

تقييم كفاءة بطانة الاوعية الدموية باستخدام الفحوصات == ASSESSMENT OF ENDOTHELIAL FUNCTION BY NON INVASIVE INVESTIGATIONS IN CORONARY ARTERY DISEASE

Author name: صبا فوزي صالح
Supervisor name: نجيب حسن محمد | عباس ناجي مسلم
General topic: Medicine
Specific topic: Physiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Arterial endothelial dysfunction is one of the key early events in atherogenesis, even preceding the structural atherosclerotic changes that might developed in systemic arteries. However, endothelial function can be assessed through flow mediated dilatation of brachial artery using an ultrasound - based method (Doppler) before and after the shear stress test which causes endothelium - dependent dilatation induced by endothelial Nitric Oxide release.Thus, flow mediated dilatation of brachial artery; the noninvasive endothelial function testing has provided valuable insights into an early atherogenesis and constitutes a helpful test in the detection of coronary atherosclerosis when compared with that of invasive testing of coronary endothelial function. On the other hand, an impairment of flow mediated dilatation in Brachial artery is related to the presence and / or extent and severity of Coronary Artery Disease. While, arterial stiffness index (SI) is widely used as a very sensitive indicator of endothelial dysfunction , arterial intima media thickness which reflects the structural vascular damage is established as a marker of atherosclerosis and has been associated with both incident and prevalent cardiovascular disease. This study was designed to : (1) Assess the role of flow mediated dilatation of brachial artery as a marker of systemic endothelial function,(2)Correlate between flow mediated dilatation of brachial artery with the presence, extent and severity of Coronary Artery Disease (CAD),(3)Find out the association between stiffness index (functional vascular damage) and intima media thickness (structural vascular damage) with the severity and extent of CAD,(4)Evaluate the effect of body mass index, waist to hip ratio and lipid profile on vascular endothelium.Sixty nine (69) patients with chest pain of either sex (46males, 23 females), in addition to 31 control subjects (15males, 16 females) with negative coronary CT angiography findings, all with an age range of (40 - 65years) were involved in this study. In addition to Demographic data and physical measurements, each subject was submitted to medical history, clinical examination, estimation of lipid profile, shear stress test, high - resolution external vascular Doppler ultrasound for brachial and carotid arteries (FMD%, stiffness index, intima media thickness), in addition to the computed tomography angiography (CT) scanning for the coronaries. The shear stress test involves occlusion of brachial artery in the upper arm for 5 minutes using a pressure cuff inducing reactive hyperemia after the cuff is released. However, this study was carried out in the Radiology Department at Al - Yarmook Teaching Hospital, Baghdad from October 2013 till March 2015.According to the coronary CT angiographic findings, patients were classified into three groups : single coronary lesion (SCL), multiple coronary lesion (MCL) and control groups. The results revealed that the FMD% in patients groups (SCL, MCL) is significantly lower than that of control group( P≤0.001, P≤0.01) respectively and it is inversely correlated with percentage of coronary artery stenosis in SCL group (P≤0.01, r=0.433) and with that of SI of both brachial and carotid arteries in both SCL, MCL groups, while a significant difference in SI is noticed between the MCL group and that of control regarding the carotid artery (P≤0.05). A positive statistical correlation is observed between the SI of brachial and carotidarteries among the studied groups, whereas a significant positive statistical correlation is found between the SI of carotid, brachial arteries with the percentage of coronary artery stenosis in SCL group (P≤0.05). Arterial IMT are significantly higher in MCL when compared with SCL (P≤0.0s) which is again significantly higher than control (P≤0.001). A positive correlation is observed between the arterial IMT with the percentage of coronary artery stenosis in SCL group(P≤0.05). Left anterior descending artery showed higher frequency of involvement by atheromatous stenosis (47%) when compared with that of Left main artery with a fequency of (13.72%). However, in MCL group, there was a higher frequency among males (88%) in respect to females (12%).In conclusion, the data of this study revealed that FMD is a useful, non invasive test for the assessment of vascular endothelial dysfunction. Arterial SI which reflects functional vascular damage is a good indicator of coronary artery disease. In addition, arterial intima media thickness can be used as a screening tool for coronary artery disease as it is sensitive indicator of structural vascular damage.

حدوث الاصابة بهشاشة العظام في مرضى الانسداد الرئوي المزمن في مستشفى بغداد وعلاقته بمختلف العوامل الخطره == Occurance of Osteoporosis in COPD Patients in Baghdad Teaching Hospital and Its Relation to Varios Risk Factors

Author name: عباس مصطفى حسن
Supervisor name: عدنان محمد 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 : Chronic obstructive pulmonary disease (COPD) is a syndrome of progressive airflow limitation caused by the abnormal inflammatory reaction of the airway and lung parenchyma. Osteoporosis is one of the major extrapulmonary manifestations of COPD. The, prevalence of osteoporosis in COPD patients in Iraqi population is unknown.Objectives : To study the incidence of osteoporosis among COPD patients and its relations to various risk factors.Materials and Methods : The study was done in Baghdad Teaching hospital.All the diagnosed cases of 70 COPD patients according to the GOLD guidelines were included in this study. The present study was a cross sectional study during a period of August 2014 - Octoper 2015 . A brief history of the patients was taken, especially regarding duration of illness, number of exacerbations in the past 3 years, smoking in pack years, and history of steroid use (both systemic and inhaled steroids) after which cumulative dose of steroids was calculated. Spirometry was done in all these patients to stage the severity of COPD according to GOLD criteria. DEXA scan of the lumbar spine was done using bone densitometer to determine osteoporosis. (WHO) criterion for definition of osteoporosis was applied and patients with T - score of below −2.5 standarddeviation (SD) were diagnosed to have osteoporosis, −1 SD to −2.5 SD were diagnosed to have osteopenia and more than −1 SD as normal.Results : A total of 70 COPD patients were included in this study, Among these, 36 patients (51.4%) had osteoporosis and 23 patients (32.8%) had osteopenia.Majority (94.4%) of the patients who had osteoporosis had stage III and stage IV COPD disease. It was observed that as the severity grade of COPD increased , the risk of osteoporosis also increased. The bone mineral density (BMD) showed a significant difference among different stages of COPD. It was also observed that patients with lower body mass index (BMI) had higher prevalence of osteoporosis (91.7%) as compared to overweight patients. On univariate analysis, it was observed that risk factors for osteoporosis were female sex, higher number of exacerbations, BMI, and severity of COPD. After using multivariate analysis, stage IV COPD , number of acute exacerbations >3 in the previous 3 years , and steroid cumulative dose >1000 mg were observed to be significant risk factors for osteoporosis in COPD patients.

تقييم وظائف البطين الايسر والبطين الايمن باستخدام معامل كفائة عضلة القلب في مرضى انسداد الشعب الهوائية المزمن == Assessment of left and right ventricular functions by myocardia performance index in patients with chronic pulmonary disease

Author name: ازهر عباس ناصر
Supervisor name: باسل نجيب سعيد الدليمي
General topic: Medicine
Specific topic: Echocardiography
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: انسداد الشعب الهوائية المزمن هو كيان شائع في الممارسة السريرية. ان حدوث تضخم البطين الايمن للقلب وعجر القلب اليمن هو شائع في مثل هؤلاء المرضى. ومع ذلك يحدث بعض الاضطراب في وظيفة البطين الايسر بين هؤلاء المرضى.الارتباط بين انسداد الشعب الهوائية المزمن وعجز القلب قد تم وصفه سابقا. غير ان الارتباط بين مرض انسداد الشعب الهوائية المزمن والخلل الوظيفي للبطين الايسر بدون وجود اعراض هو اقل فهما.تاثيرات مرض انسداد الشعب الهوائية المزمن على وظائف البطين الايمن الانقباضية والانبساطية وعلى وظائف البطين الايسر الانبساطية ,قد تم اثباته. في حين ان معامل كفاءة عضلة البطين الايسر للقلب ، الذي يتضمن زمن قذف البطين وزمن الانبساط وزمن الانقباض ,هو مؤشر وظيفة البطين الشاملة، لم يتم تقييمه في مرض انسداد الشعب الهوائية المزمن.المرضى الذين لديهم ضغط مفرط في البطين الايمن غالبا ما لديهم فشل في وظيفة البطين الايسر الانبساطية.الهدف من الدراسة : تهدف هذه الدراسة الى تقييم الوظيفة الشاملة للبطين الايسر والبطين الايمن للقلب في المرضى الذين يعانون من مرض انسداد الشعب الهوائية المزمن مع او دون ارتفاع ضغط الدم الرئوي باستخدام معامل كفاءة عضلة البطين لمعرفة العلاقة بين نتائج ايكو القلب وشدة مرض انسداد الشعب الهوائية ، اذا كان هناك اي منها.المرضى وطريقة العمل : 60 مريضا يعانون من مرض انسداد الشعب الهوائية المزمن وغير مصابين بامراض القلب [30 مريضا لديهم مرض انسداد الشعب الهوائية المزمن بدون ارتفاع ضغط الدم الرئوي (المجموعة 2), و30 مريض لديهم مرض انسداد الشعب الهوائية المزمن مع ارتفاع ضغط الدم الرئوي (المجموعة 3)] و30 شخص سليم ومطابق للعمر والجنس تم ادراجهم في هذه الدراسة. خضع جميع المرضى للتقييم السريري، فحص وظائف الرئة، تخطيط القلب وفحص ايكوالقلب القياسي والدوبلر النسيجي. مختلف قياسات الايكو الخاصة بوظيفة البطين الايسر والبطين الايمن تم مقارنتها مع مؤشرات وظائف الرئتين وضغط الشرياني الرئوي. تم قياس معامل كفاءة عضلة البطين الايمن ومعامل كفاءة عضلة البطين الايسر للقلب باستخدام الدوبلر النسيجي النبضي.النتائج : 60 مريض قد تم ادراجهم في الدراسة. كان اعمارهم بين 56 - 68 سنة. كان متوسط العمر 61.47 عاما والانحراف المعياري ± 7.47 سنوات.كان هناك 83% ذكور و17% اناث في الدراسة. 19 مريض (63.3 %)من الذين لديهم مرض انسداد الشعب الهوائية المزمن مع ارتفاع ضغط الشريان الرئوي و15 مريض (50 %) من الذين لديهم مرض انسداد الشعب الهوائية المزمن دون ارتفاع ضغط الشريان الرئوي كان مرض انسداد الشعب الهوائية المزمن شديد بينما 11مريض (36.7 %) من الذين لديهم مرض انسداد الشعب الهوائية المزمن مع ارتفاع ضغط الشريان الرئوي و15 (50 %) من الذين لديهم مرض انسداد الشعب الهوائية المزمن دون ارتفاع ضغط الشريان كان مرض انسداد الشعب الهوائية معتدل. كان الانسداد القصبي شديد في المجموعة 1) حجم الزفير القسري49,973±5,303%) والمجموعة 2 (حجم الزفير القسري 44.58 ± 7.45% ) وليس هناك ضعف في فعالية التهوية في مجموعة الاشخاص السليمين.معامل كفاءة عضلة البطين الايمن كان اعلى في المجموعة 2 (0.57 ± 0.11) والمجموعة 3 (0.96 ± 0.05) من المجوعة 1 (0.42 ± 0.043001) (. P <), وكان اعلى في المجموعة 3 من المجموعة 2 (P <.001).معامل كفاءة عضلة البطين الايسركان اعلى في المجموعة 3 (0.7 ± 0.083) من المجموعة 1 (0.5 ± 0.034) والمجموعة 2 (0.56 ± 0.037) (P< .001).للمرضى المصابين بمرض انسداد الشعب الهوائية المزمن ، كان معامل كفاءة عضلة البطين الايسرمرتبط بعلاقة طردية مع العمر ,معدل نبضات القلب, ضغط الشرياني الرئوي الانقباضي ومعامل كفاءة عضلة البطين الايمن ويرتبط بشكل سلبي مع السيوح الانقباضي للمستوى الحلقي للصمام الثلاثي وحجم الزفير القسري في الثانية 1. في تحليل الانحدار الخطي المتعدد , (R=0.674) معامل كفاءة عضلة البطين الايسر ترتبط بصورة مستقلة بحجم الزفير القسري في ثانية واحدة(Beta =1.133, P = 0.007), ضغط الشرياني الرئوي الانقباضي(Beta= - 0.758, P=0.128) ومعامل كفاءة عضلة البطين الايمن (Beta=1.436, P=0.009). مؤشرات وظيفة البطين الايسر الانبساطية (A, E/A, and deceleration time of E) كانت ضعيفة في المجموعة 3 والمجموعة 2 بالمقارنة مع المجموعة1. نسبة السرعة الانبساطية المبكرة لحلقة الصمام الاكليلي الى السرعة الانبساطية المتاخرة(Em/Am) كانت اقل بكثير في مرضى انسداد الشعب الهوائية المزمن الذين لديهم ارتفاع ضغط الشريان الرئوي(0.77±0.066)،وكان وقت الاسترخاء للبطين الايسر اطول بكثير في المجموعة 3(105.43±4.21ms) والمجموعة 2(102.27±4.45ms) بالمقارنة مع مجموعةالسليمين(71.2±5.51ms).وظيفة البطين الايمن الانبساطية, نسبة السرعة الانبساطية المبكرة الى السرعة الانبساطية المتاخرة (E/A)اعلى في الاشخاص السليمين بالمقارنة مع مجموعات المرضى. وقد كان نسبة سرعات التدفق للصمام الثلاثي(نسبة السرعة الانبساطية المبكرة الى السرعة الانبساطية المتاخرة) اقل قيمة بكثير في مرضى انسداد الشعب الهوائية المزمن الذين لديهم ارتفاع ضغط الشريان الرئوي(0.84 ± 0.04) وكان وقت الاسترخاء اطول بكثير في المجموعة 3 (98.87 ± 8.41ms) والمجموعة2 (77.5 ± 4.57ms) بالمقارنة مع الاشخاص السليمين (75.37±5.2) . كان قطر البطين الايسر الانبساطي اقل بكثير في المجموعة 3 (40 ± 2.665) من المجموعة 1(46.2 ± 2.295) والمجموعة2 (44.2 ± 3.367). سرعة حلقة الصمام التاجي (s') كانت الاقل في المجموعة 3 . (9.64 ± 0.92) ولكن المؤشرات التقليدية للوظيفة الانقباضية وسمك الحاجزبين البطينين في الانبساط لا تختلف بين المجموعات.كانت اقطار البطين الايمن الانقباظية والانبساطية اعلى وكان التقصير الكسري للبطين الايمن اقل في المجموعة 3 من المجموعتين الاخريين. كانت حركة حلقة الصمام الثلاثي الانقباظية اقل بكثير في المجموعة 3 (16.07 ± 3.54) بالمقارنة مع المجموعة 1 (21.7 ± 2.71)والمجموعة2 (20.83 ± 2.69) ,ولكن الاختلافات بين المجموعة 1 و2 غير هامة احصائيا.الخاتمة : كانت كلا وظيفتي البطين الايسر الانقباظية والانبساطية عاجزة في مرض انسداد الشعب الهوائية المزمن خاصة في المرضى الذين لديهم ارتفاع ضغط الشريان الرئوي . هذا العجز يرتبط بصورة مستقلة بضغط الشريان الرئوي الانقباضي,معامل كفاءة عضلة البطين الايمن وحجم الزفير القسري في الثانية1.الوظيفة الانبساطية للبطين الايسر والبطين الايمن والوظيفة الشاملة للبطين الايسر والبطين الايمن تتاثر في مرضى انسداد الشعب الهوائية المزمن وخاصة مع تطور المرض. مرضى انسداد الشعب الهوائية المزمن والذين لديهم ارتفاع ضغط الدم الرئوي اكثر عرضة لعجز القلب الايسر والايمن الانبساطي والشامل من المرض الذين لديهم ضغط شريان رئوي طبيعي. دوبلر انسجة القلب هو اداة افضل في تقييم وظائف البطين الايسروالبطين الايمن | Development of right ventricular hypertrophy and eventual right side heart failure is common in patients with Chronic obstructive pulmonary disease (COPD). However, some disturbance in left ventricular (LV) function has been observed among such patients.The co - existence between chronic obstructive pulmonary disease (COPD) and heart failure has been previously described. However, the co - existence between COPD and subclinical LV dysfunction, without the presence of heart failure symptoms, is less well understood.The aim of the study : The aim of this study was to evaluate global function of the LV and RV in patients with chronic obstructive pulmonary disease (COPD) with or without pulmonary hypertension(PH) by using myocardial performance index (MPI) and find out the correlation between echocardiographic findings and severity of COPD.Patients and methods : Sixty patients with COPD without additional cardiac diseases [30 patients with COPD without PH (group 2), and 30 patients with COPD with PH (group 3)] and 30 age and sex - matched healthy subjects (group 1) were enrolled into the study. All patients underwent clinical evaluation, spirometry, electrocardiography and standard and tissue Doppler echocardiography. Various echocardiographic parameters of LV and RV functions were compared with indices of pulmonary function test and pulmonary arterial pressure. RV myocardial performance index (RVMPI) and LVMPI were obtained by pulsed wave Doppler tissue.Results : RVMPI was higher in both group 2 (0.57 ± 0.11) and group 3 (0.96 ± 0.05) than group 1 (0.42 ± 0.043) (P< .001), and was higher for group 3 than in group 2 (P< .001). LVMPI was higher for group 3 (0.7 ± 0.083) than in both group 1 (0.5 ± 0.034) and group 2 (0.56 ± 0.037) (P <.001). For patients with COPD, LVMPI was positively correlated with age, heart rate, pulmonary arterial systolic pressure and RVMPI and negatively correlated with tricuspid annular plane systolic excursion and forced expiratory volume in 1 second. In multiple linear regression analysis (R=0.674), LVMPI was independently associated with forced expiratory volume in 1 second (FEV1) (Beta =1.133, P = 0.007), pulmonary arterial systolic pressure (Beta= - 0.758, P=0.128), and RVMPI (Beta =1.436, p=0.009).LV diastolic function parameters (A, E/A, and deceleration time of E) were impaired for groups 2 and 3 compared with group 1. Mitral early diastolic and late diastolic annular velocities ratio (Em/Am), were significantly lowest in COPD patients with PH(0.77±0.066), and the isovolumetric relaxation time (IVRT) was significantly longer in group 3(105.43±4.21ms) and group 2(102.27±4.45ms) in relation to control group(71.2±5.51ms).RV diastolic function, E/A ratio was higher in the control subjects compared with the patient groups. The tricuspid inflow velocities ratio (E/A) was significantly lowest value in COPD patients with PH (0.84 ± 0.04) and the isovolumetric relaxation time (IVRT) was significantly longer in group 3(98.87 ± 8.41ms) and group 2(77.5 ± 4.57ms) in relation to control group (75.37±5.2). LV end - diastolic diameter was significantly lower for group 3 (40 ± 2.665) than group 1(46.2 ± 2.295) and group 2(44.2 ± 3.367). LV mitral valve annular velocity (S') was lowest in goup3 (9.64 ± 0.92). However, conventional systolic function parameters and IVSd were not different among the groups. Systolic and diastolic RV diameters were higher and RV fractional shortening was lower for group 3 than the other two groups. TAPSE was significantly lower for group 3(16.07 ± 3.54) compared with group 1(21.7 ± 2.71) and group2 (20.83 ± 2.69), but differences between groups 1 and 2 was not statistically significant. Conclusion : Both LV systolic and diastolic functions are impaired in COPD, especially in patients with PH. This impairment is independently associated with pulmonary arterial systolic pressure, RVMPI, and FEV1. Left and right ventricular diastolic function and LV and RV global function are affected in COPD patients especially with progression of the disease. COPD patients with pulmonary hypertension are more liable to LV and RV diastolic and global dysfunction than normal pulmonary pressure COPD patients. Doppler tissue echocardiography is a better tool in the assessment of LV, RV function.

الخصائص الوبائية لحالات الحصبة المسجلة في محافظة النجف الاشرف للفترة من 2007 الى 2014 == Epidemiological Characteristic of Reported Measles Cases in AL - Najaf province /Iraq 2007 - 2014

Author name: عبد الامير حسين حسن الموسوي
Supervisor name: احمد سمير النعيمي
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: Measles is worldwide, and still epidemic and highly infectious and threatened the life of all populations, but is preventable by full immunization.The importance of this study in AL - Najef government because of previous outbreak. And also a mixing of social due to internal displace populations and religious events during the year.Objective study : to describe the epidemiological characteristics of all reported measles cases in the public health of Najaf government during 2007 - 2014.Method of study : cross sectional for all suspected measles cases that are reported retrospectively in the public health section of directorate of health in AL - Najaf province during 2007 - 2014, and the data collected from the notification and investigation form of measles then entered and analyzed by using EPI - Info and SPSS 21. The result showed 582 of suspected cases, 359 0f them were confirmed, 56% female, the peak age group <5 years.The seasonal distribution of the cases appears in JAN - MAY. There was highly obvious association between the numbers of doses of vaccination with the confirmed cases,The Odd Ratio for having a confirmed case for those with a single dose of vaccination is 0.18 compared to those unvaccinated. and the risk of having confirmed measles for those with unvaccinated increased 5.6 time compared to those with protected a single dose, during the outbreak period (2007 - 2009).We recommend promoting the active surveillance and good collection of notification form and keeping for study in future, improving complete MVC with a good cold - chain and periodic campaigns before winter

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

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

تواتر التدرن الكامن في المرضى المرشحين للعلاج البيولوجي في مستشفى بغداد التعليمي == The frequency of Latent tuberculosis infection in patients who are candidates for biological therapy in Baghdad Teaching hospital

Author name: امل خالد علي
Supervisor name: مصطفى نعمة عبد علي
General topic: Medicine
Specific topic: Respiratory System
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Introduction : Tuberculosis remains one of the biggest global human killers accounting for 9.4 million new cases of active tuberculosis and 3 million tuberculosis - related deaths with an incidence of 140/100,000 inhabitants. More than 90% (up to 8 million) of total TB Tuberculosis cases occurring in developing countries and more than half of all deaths (2 million) occurring in Asia.Aim of the study : To assess the burden of latent TB in patients candidate for biological therapy.Patients and method : A descriptive cross sectional study conducted at Baghdad teaching hospital during the period from the 1st of April 2017 to the end of March 2018. A consecutive sampling included 150 respondents candidate for biological therapy were included in this study Results : The mean age of patients was 38.9±11.4 years. TST was positive in 23.3% of studied patients. Significant association between positive TST findings and middle age group (p=0.05). A significant association was observed between positive TST results and gender (p=0.001). Also significant association between prolonged duration of the disease, and positive TST.Conclusions : The TST were positive in about only one quarter of patients with chronic immunomediated diseases who are candidates for biological therapy, and significant associations were found between age group , and TST results.

دراسة الكشف المبكر لمرض الانسداد الرئوي المزمن في الذكور الخالين من الاعراض المدخنين والمدخنين السابقين == Early Detection of Chronic Obstructive Pulmonary Disease in Asymptomatic Male Current Smokers and Ex - smokers By Spirometry

Author name: حسام محمد علي صالح
Supervisor name: عبد الله جنجر الفرطوسي
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 : Chronic obstructive pulmonary disease is responsible for permanent morbidity, premature mortality and great burden to the healthcare system. The most commonly encountered risk factor is tobacco smoking. Without screening, patients usually overlook early symptoms of cough wheezes but commonly seek medical advice when they become dyspnic on mild to moderate exertion. By that time, half of their ventilatory reserves are lost. Spirometry remains the gold standard for diagnosing chronic obstructive pulmonary disease and monitoring its progression.Aim of study : Early detection of chronic obstructive pulmonary disease in asymptomatic male current smokers and ex - smokers by spirometry.Patients and methods : Consecutive asymptomatic male current smokers (n=100) and ex - smokers (n=100) were participated in screening. All Participants have no history of chronic obstructive pulmonary disease, asthma, chronic respiratory illness or active pulmonary symptoms. Also all of them not on bronchodilators, inhaled corticosteroids, Montelukast, or theophylline.Results : A total of 100 asymptomatic male current smokers and 100 asymptomatic male ex - smokers were screened by spirometry according to the American Thoracic Society and European Respiratory Society guidelines. Overall, airway obstruction was seen in 49 (49%) current smokers, mild obstruction was seen in 22 (22%) and moderate obstruction in 27 (27%) subjects, while in ex - smokers airway obstruction was seen in 52 (52%), mild obstruction was seen in 13 (13%) and moderate obstruction was seen in 39 (39%) subjects.Conclusions and recommendations : Early diagnosis of chronic obstructive pulmonary disease by spirometry will encourage smoking cessation and enable earlier interventions to help prevent exacerbations and hopefully preserve lung function, quality of life and decrease mortality

تاثير تدخين الشيشة الاركيله مقارنة بتدخين السكائر على اختبار وظائف الرئة بين الذكور في مدينة الناصرية == The Effect of Water Pipe (Negril) Smoking on Pulmonary Function Test in compare to cigarate smoking among Males in Al Nasiriya City

Author name: مهند عادل جايان
Supervisor name: قاسم محمد سلطان
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 : Shisha (wp) smoking is becoming a more prevalent form of tobacc consumption, and is growing worldwide, particularly among the young generation in the Middle East especially among urban youth, college students, and young professionals. However there is limited data about the effects of water - pipe smoking. Publicly considered as aharmless entertainment. Many studies have shown that water pipe smoking associated with development of varying degrees of reduction in the lung function.Objectives : The aim of this study is to assess the effect of water pipe smoking on pulmonary functions with regard to the duration and amount of smoking among different groups of male smokers : water pipe smokers, cigarette smokers, and compare it with a control (nonsmokers) group. Methods : This is a comparative crosssectional study which conducted on 300 male subjects, subdivided into two groups of smokers : 100 water pipe smokers, 100 cigarette smokers and 100 nonsmokers as a control group, all participants were apparently healthy and matched for gender, they were selected from random cafes in al nassirryha city. Data were collected through structured questionnaire and pulmonary function test was performed by portable Spiro lab III spirometer after gaining the participant consent. Results : There was significant differences between the mean ages of the study groups (p value<0.05).water pipe smokers (35.44±10.79) cigarette smokers (46.09±10.54), and nonsmokers (35.55±11.07). The present study revealed that there was a significant reduction in the parameters of the pulmonary function test ( FEV1 ), (FVC )(FEV1/FVC),(PEF),(FEF25 - 75%)and(MVV)for the two groups of smokers as compared to the control group ( P < 0.01 ) .Lung function impairments were very severe in water pipe smokers as compare with cigarette smokers( P < 0.05 ). There were significant inverse correlations between all PFT values and duration and total amount of WP smoking and number of WP smoked per week(P < 0.01) .Conclusion : The results from this study showed that there was a profound effect of WP smoking on PFT values, which were more severe to the effects of cigarette smoking.Keyword : water pipe smoker ,pulmonary function test, nassiryha - Iraq.

مشاهدات الرنين المغناطيسي لدى المرضى المصابين بفرط هرمون الحليب في الدم == MRI FINDINGS OF PITUITARY GLAND IN HYPERPROLACTINEMIC PATIENTS

Author name: رنا علاء الدين حسين
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: تحليل مشاهدات الرينن المغناطيسي للغدة النخامية لدى المرضى المصابين بفرط هرمون الحليب (البرولاكتين)في الدم وايجاد توجيها ت عمل للحدود الدنيا لنسبة هرمون الحليب في الدم والتي على ضوئها تكون صورة الرنين المغناطيسي للغدة النخامية مطلوبة 0اساليب الدراسة قمنا بدراسة وصفية استطلاعية شملت ستون مريضا يعانون من فرط البرولاكتين وقمنا باخذ صورة الرنين المغناطيسي للغدة النخامية لهم للفترة من الاول من كانون الثاني ولغاية الثلاثون من شهر اب للعام 2015.النتائجتم فحص ستون مريضا, منهم ثمانية وعشرون اي مايعادل نسبة (46.7%) كان تصويرالرنين المغناطيسي طبيعيا للغدة النخامية, وخمسة عشراي مايعادل نسبة (25%)مر يض لديهم ورم غدة نخامية مايكروي و3منهم ورم غدة نخامية ماكروي. بالاضافة الى تسعة منهم كان لديهم تضخم الغدة النخامية بدون وجود لاي ورم.وقد وجدنا ان قطع القيمة الامثل المصاحب لورم الغدة النخامية (ميكروي /ماكروي )لهرمون الحليب هو (102.5)نانو غرام / ملليتر بمستوى حساسية (77.8%) ومستوى نوعية (95.2%).الاستنتاجاتكان هناك صلة ذات اهمية احصائية بين المرضى الذين يعانون من فرط هرمون الحليب وصورة الرنين المغناطيسي .هذا يدعو الى اجراء صورة الرنين المغناطيسي لجميع الحالات المصابة بفرط برولاكتين الدم عندما تكون نسبة الهورمون مساوية او اكثر من (102.5.نانوغم/مل)بعد استثناء اي سبب ثانوي ممكن يؤدي الى ارتفاع هرمون الحليب. | To analysis the MRI findings of pituitary gland in patients with hyperprolactinemia and establish guidelines for a minimal serum prolactin level for which pituitary MRI imaging is indicated .Methods : A descriptive study was conducted at of a AL - Shaheed Ghazi Hospital and Radiology Institute from 1st of January 30 of August 2015. Sixty patients with hyperprolactinemia underwent magnetic resonance imaging of brain for pituitary gland .Results : The result were based on the analysis of pituitary MRI findings for 60 patients , almost half of the sample were diagnosed as normal 28 (46.7%) ,18 (30%) as pituitary adenoma with macro adenoma being the smallest part 3(5% only).Pituitary hyperplasia account 9(15%) and empty sella 5(8.3%).there was significant statistically association between serum PRL and pituitary adenoma .The optimum cut - off value for serum PRL for any positive pituitary findings (adenoma , hyperplasia and empty sella) was 55.1ng/mL. While the optimum cut - off value of serum PRL for pituitary adenoma (micro/macro) was 102.5 ng/mL.Conclusion : MRI of the pituitary gland was significantly associated with serum PRL levels in patients with hyperprolactinemia .The optimum cut - off value of serum prolactin to predict pituitary adenoma (micro/macro) was 102.5 ng/mL. Therefore pituitary imaging should be obtained for all patients with serum PRL ( equal or higher than this value)after exclusion of any secondary causes of hyperprolactinemia.

الخصائص الوبائيه للحروق في مستشفى بغداد للحروق, بغداد, العراق 2015 == Epidemiological Characteristics of BurnInjuries in Baghdad Burn Hospital,Baghdad, Iraq, 2015

Author name: رنا خالد الناصر
Supervisor name: فارس حسن اللامي
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 : Burns are a global public health problem, accounting for an estimated 265,000 deaths annually, in 2013 fire and heat resulted in 35 million injuries. This resulted in about 2.9 million hospitalizations and 238,000 deaths. This makes it the 4th leading cause of injuries after motor vehicle collisions, falls, and violence. About 90% of burns occur in the developing world. This has been attributed partly to overcrowding and an unsafe cooking situation. Iraq burn injuries are the second cause for visiting emergency room after gun fire according to World Health Organization (WHO) Injury Surveillance Pilot Project, Iraq, 2008.Objectives : To describe epidemiological and clinical characteristics, estimate the case fatality rate and identify the main determinants of death among burn cases in Baghdad Burn hospital, Baghdad, Iraq during 2015.Patients and Methods : A cross sectional study was conducted in Baghdad Burn Hospital. The study population was all the burn cases that were admitted to these hospitals during 2015. The files of the patients were obtained from the statistics department in the hospital. All burn patients with different types and degrees of burn injuries who were admitted to this hospital during 2015 were included in the study. Patients with minor superficial burns treated in the emergency department as out patients and cases that admitted for surgical treatment of old scars were excluded.Data was collected using a form included demographic data, etiology, burn type, anatomical location and percentage of body surface area burned, operating procedures and outcome were recorded.Results : This study involved 676 patients, 32.90% of them were females. 26.62% patients were below 10 years of age. Two thirds had less than 20% of body surface area burns (66.42%) and only 9.46% had more than 50% body surface area burns.Flame burns were the commonest (71.59%) followed by scalds (23.37%) and electrical 2.52%. Scalds were common in children. About 76.33% of patients improved 8.28% left on their responsibility and 2.07% shifted to other hospitals. Case fatality rate was 13.30%, Mortality was 44.4% with sepsis as the leading cause, multiple organ failure, and shock were other causes of mortality.Conclusions : Burns injury is a major public health concern and is associated with high mortality. Flame, scald and electrical burns are commonly a result of domestic and occupation accidents and are preventable. Strict follow up to the infection control guideline can minimize the high case fatality rate.

Epidemiological Characteristic of Multi - Drug Resistant Tuberculosis in Iraq July/2011 - July/2015

Author name: قيس قاسم ابراهيم
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 : Multi - Drug Resistant Tuberculosis (MDR - TB) is global and national public health problem that threatens the success of TB control programs.The aim of this study : To describe the epidemiologic characteristics of MDR - TB cases registered in Na0onal Tuberculosis Control Program (NTP) of Iraq during the period July 2011 - July 2015.Methods : A Cross - sectional, record based study was conducted at the Chest and Respiratory Diseases Specialized Center for all electronic records and patients’ forms available from July /2011 to July/2015. A form for collec0ng data was prepared by the researcher according to (MDR) patients Files which is provided by the NTP. Chi - square testing was used to measure the level of sta0s0cal significance set at p<0.05 and a confidence level of 95%.Results : A total of 319 cases, males were (72.6%); the mean age was 40.03±12.24 years, one third of the cases (31.7%) were from Baghdad. cases from urban area (57.8%); Cat - 2 Failure form (88.0%) of the MDR group; pulmonary were (98.3%) of the site of the disease; (17%) with Diabetes Mellitus; duration in days spend by the patient in the first line treatment, direct smear conversion negative and culture conversion nega0ve were (502±133.56), (117±77), (145±91) respec0vely; default was(28.5%) of the ceases; favorable outcome was sta0s0cally significant among middle age groups(30 - 49years) (χ2=8.548, df =2, P = 0.014).Recommendations : Increase attention for better managements of the patients in the first line treatment; give good education messages to patient of MDR - TB and Increase the number of labs capable for early diagnosis is the suitable strategy to control MDR - TB disease.

تاثير عقار الكولجسين بالاضافه الى الاسيتامينوفين مع الاسيتامينوفين وحده على مستوى الالم التصلب والوظيفة البدنية لمرضى فصال الركبه الاولى : دراسة مقارنة == Effects of Colchicine Plus Acetaminophen and Acetaminophen Alone on Pain, Stiffness and Physical Function in Patients with Primary Osteoarthritis of the Knees : A Comparative Study

Author name: كوثر رفيع حربي
Supervisor name: سامي سلمان شهاب
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: Osteoarthritis (OA) is a chronic degenerative disorder of multifactorial etiology characterized by loss of articular cartilage. Basic calcium phosphate (BCP) and calcium pyrophosphate dihydrate (CPPD) crystals are commonly found in osteoarthritic joints. These crystals have been found in the synovial fluid of 60% of patients with knee OA. Inflammation in OA is frequently secondary to the presence of these crystals, and leads to the production of interleukin - 1 (IL - 1), an important mediator of cartilage breakdown in OA. Previous studies referred to a slow acting disease/structure - modifying effects of colchicine in knee OA. Aim of the studyTo examine the effect of combined colchicine plus acetaminophen compared with acetaminophen alone on pain, stiffness, and physical function in patients with knee osteoarthritis after a 1month treatment course, and after 1 month of stopping the treatment.Patients and methods A randomized, double blind study included 150 patients were diagnosed to have knee OA according to the American College of Rheumatology (ACR) criteria for classification of (KOA).Patients were randomly assigned to receive acetaminophen 500mg containing capsule twice daily in the 1stgroup (70 patients),and colchicine 0.5mg plus acetaminophen 500mg in one capsule twice daily in the 2ndgroup (80 patients). The efficacy outcome measure was the change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) including the pain, stiffness and physical function subscales.Results Both acetaminophen and acetaminophen plus colchicine groups showed significant reduction in the pain, stiffness , physical function and total WOMAC score in the 2nd visit (after 1 month of treatment regimen) (P<0.001).At the third visit one month after cessation of treatment these scores increased again to approximate the baseline value in group 1, while slightly increased in group2, the differences in these scores between the baseline and 3rd visit values were statistically insignificant, (P˃0.05) in group 1 while it still highly significant in group 2, (P<0.001).ConclusionBoth modes of treatment acetaminophen alone or acetaminophen plus colchicine are effective in symptomatic improvement in patients with primary osteoarthritis of the knee in term of pain, stiffness, physical function and total WOMAC score. But the better beneficial symptomatic effect and longer period of action was obtained when colchicine added to acetaminophen than acetaminophen alone.

انتشار اكتناف العين لدى عينة من المرضى العراقيين البالغين المصابين بمتلازمه فرط مرونه المفاصل الحميد == Prevalence of Ocular Involvement in a Sample of Iraqi Adult Patients With Benign Joint Hypermobility Syndrome

Author name: ايناس عدنان مجيد
Supervisor name: محمد هادي العصامي | نجاح كاظم القريشي
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: خلفية البحث : تعرف متلازمه فرط مرونه المفاصل الحميد بانها اضطراب النسيج الضام الوراثي الذي يتميز بالام عضليه هيكليه ونطاق المرونه المفرطه في المفاصل , الكثير من مظاهر العين موجوده عند مرضى متلازمه فرط مرونه المفاصل الحميد بعضها مشهورة الترابط مع المرض والاخرى مخبر عنها في تقارير حاله .الهدف : تقييم انتشار وخصائص اكتناف العين لدى عينة من المرضى العراقيين المصابين بمتلازمه فرط مرونه المفاصل الحميد .المرضى والطرائق : شملت الدراسة ( 300) فرد في الدراسه المقطعيه , )100( مريض بمتلازمه فرط المرونه و)200 (من الافراد الاصحاء وهم مطابقين في العمر والجنس للمجموعه التي اخذت كمجموعه تحكم .خضع كل المرضى للفحوصات العينيه والتي تضمنت تقييم حده البصر مع مخطط سنيل , فحص القطعه الاماميه والخلفيه للعين مع مصباح سلت , فحص شيرمر , صبغه الفلورسين القرنيه وتقدير ضغط داخل العين مع مقياس توتر العين بالنفث الهوائي . تم استبعاد المرضى اللذين لديهم رضح سابق في العين اوالمرضى المصابين بفرط ضغط الدم وداء السكري او تراكب مع امراض الانسجة الضامة الاخرى او التهاب المفصل الالتهابي . جمعت بيانات المرضى الديموغرافية والسريرية بما في ذلك العمر والجنس ومعيار كتلة الجسم ,مده الاعراض , بيانات مرتبطه بمظاهر المرض الريئسيه وميزات اخرى مرتبطه بمتلازمه فرط مرونه المفاصل الحميد . تم قياس تقدير مرونه المفاصل بالنسبه الى طريقه درجه بايتون لكل المشتركين في الدراسه .النتائج : من مجموع 100 مريضا مصابا بمتلازمه فرط مرونه المفاصل الحميد ممن التحقوا في هذه الدراسه . تم تحديد انتشار الاخطاء الانكسارية في (%78 (, وحسر)قصر البصر(في (49%) ثم لابوريه (20%) وطول البصرفي (9%) منهم.وجدت المظاهر العينيه الاخرى المحدده جفاف العين في (15%) , بينما التهاب الجفن الامامي والخلفي في (%5) و(4%)من المرضى على التوالي .شخصت متلازمه الصباغ التشتتي في (3 %) واخر المظاهر العينيه المحدده ساد في (2%) من مرضى متلازمه فرط مرونه المفاصل الحميد .ان كل النتائج السابقه ذات دلاله احصائيه ماعدا ساد حيث لم تصل الى حد الدلاله الاحصائيه .لايوجد رابط معتد بين العمر , الجنس , نوع المفصل الاكثر شيوعا ودرجه المفصل في حرز بايتون مع زياده خطر المظاهر العينيه . الاستنتاجات : مظاهر العين في عينة المرضى العراقيين المصابين بمتلازمه فرط مرونه المفاصل الحميد شائعه نسبيا. ان اكتشافات العين المتعلقة بمتلازمه فرط مرونه المفاصل الحميد الاكثر شيوعا هي حسر البصر ثم لابوريه ثم طول البصر .لقد كان جفاف العين , التهاب الجفن الامامي والخلفي ومتلازمه الاصباغ التشتتي وساد قليله الحدوث في متلازمه فرط مرونه المفاصل الحميد . | Background : Benign joint hypermobility syndrome (BJHS) is a hereditary connective tissue disorder, characterized by musculoskeletal pain and an excessive range of motion in joints . Many ocular manifestations of BJHS have been described, some being well - known associations and others reported for the first time in case reports .Objectives : The aim of this study was to evaluate the prevalence andcharacteristics of ocular involvement in a sample of Iraqi patients with BJHS. Patients and methods : A total of 300 individuals were included in this cross sectional study, 100 patients had benign hypermobility syndrome and another 200 healthy individuals matched in age and sex were taken as a control group.All patients undergone for opthalmological examination involved visual acuity assessment with Snellen chart, examination of anterior and posterior eye segments with the slit lamp, Schirmer test and corneal fluorescein staining and assessment of intraocular pressure with air puff tonometer.Patients had history of previous eye trauma, hypertension, diabetes mellitus, and overlap with other connective tissue diseases or inflammatory arthritis were excluded. Demographics and clinical data were collected including age, sex, BMI duration of symptom, data related to main disease manifestations and other related features to BJHS. The assessment of joint mobility was measured according to Beighton score method for all the participants in the study.Results : A total of 100 patients with (BJHS) enrolled in this study. Prevalence of refractive errors detected in 78% patients, myopia was detected in (49%), followed by astigmatism (20%) and hypermetropia (9% ) .The other identified ocular manifestation was dry eye (15%), While anterior & posterior blepharitis (5% and 4%) respectively. Pigment dispersion syndrome diagnosed in (3%) of patients and The last identified ocular manifestation was cataract which detected in about (2%) of BJHS patients.All previous findings were statistically significant except cataract not reach to statistically significant level. There were no significant correlation between age group, gender, type of common joint involved or degree of beighton score with increase risk of ocular manifestations .Conclusions : Ocular manifestations in a sample of Iraqi patients with BJHS were relatively common. The most common BJHS - related ocular findings were Myopia followed by, Astigmatism and hypermetropia. Dry eye symptoms, anterior and posterior blepharitis, pigment dispersion syndrome and cataract are rare in patients with BJHS.

تاثير الارتجاع العضوي المزمن للصمام الاكليلي على وظيفة البطيي الايمن الانبساطية باستخدام دوبلر صدى القلب في عدة مراكز للقلب في بغداد == Impact of chronic organic mitral regurgitation on Right Ventricular Diastolic Function using Doppler echocardiographic study in Multi Cardiac Center in Baghdad

Author name: عطاء خليل طه
Supervisor name: غازي فرحان حاجي
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 : To date, little is known regarding the effect of left ventricular volume overload on right ventricular diastolic function. We hypothesized that patients with chronic organic mitral regurgitation and preserved left ventricular systolic function might have subclinical right ventricular dysfunction, and related to pulmonary artery systolic pressure.Objective : To study the effect of left ventricular volume overload on right ventricular diastolic function by Doppler echocardiography in patients with chronic organic compensated mitral regurgitation.Patients and methods : A cross - sectional study held in multi cardiac center in Baghdad. From April 2015 to June 2016. Patients categorized in to two groups; Thirty - one were without pulmonary hypertension (group I, mean age 32±7.1 years) and thirty of patients were with pulmonary hypertension (group II, mean age 36.1±5.7years). All of them compared with sixty - one healthy individuals serving as a control group (group III, mean age 32.1±6.6 years). Transthoracic echocardiography (multiple views) M - mode, Two - dimensional and Doppler were done for all groups of study.Results : Conventional and tissue Doppler echocardiographic assessment of right ventricular diastolic function revealed impairment in up to 44.3% of patients, (19.4% in group I vs 70% in group II, P<0.001). Patients had lower right ventricular E - wave velocity, lower E/A ratio, and prolonged right ventricular isovolumic relaxation time compared to control. Tissue Doppler analysis showed lower E', and lower E'/A' ratio. All changes were statistically significant at P < 0.001). Patients with pulmonary hypertension were older with higher E/E' ratio in comparison to the other two groups (5.79±1.75 in group II vs 3.91±0.41, 4.08±0.93 in group III and I, respectively, P <0.001).

التدخين بين الكوادر الطبية والصحية في مستشفيات بغداد 2016 == Smoking among Health Care Workers in Baghdad Hospitals, 2016

Author name: ولاء طالب یوسف
Supervisor name: ايمان عدنان القصير
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 : Smoking is the inhalation of the smoke of burning tobacco encased in cigarettes, pipes, shisha or argela and cigars. Smoking causes diminished overall health, increased absenteeism from work, and increased health care utilization and cost. Quitting smoking lowers the risk for smoking - related diseases and can add years to life. The global tobacco epidemic is predicted to kill 10million people annually over the next 20 to 30 years (mainly in developing countries). Health Workers have potential role in preventing smoking among patients as they are health educators and counselors for quitting smoking.Objectives : To determine smoking prevalence among Health Care Workers and to study HCWs knowledge and attitudes toward tobacco smoking during work.Methods : A cross sectional study was conducted on three general hospitals in Baghdad Al Karkh side that were chosen randomly and all Health Care Workers that agree to participate during time of visit to their hospitals were included in the study and they were 448; from end of June to end of August 2016; data collected through self - filled questionnaire then data was entered and analyzed by excel sheet and SPSS software. Results : Mean of age of participants was 35.6±10 years; the prevalence of current smoker was 12.5%; most of particip ates were aware about smoking complications (92%); most of participates expressed positive attitudes towards smoking control irrespective of their own smoking status; about 90% of participates were bothered from Second Hand Smoking; the mean of cigarette smoking was 20±12 cigarettes per day; the mean of 1st age for starting smoking was 21±8 years & the mean of period of smoking was 13.7±8 years. About 39% of smokers had signs of nicotine addiction.Conclusion : The prevalence of smoking was relatively low; males were significantly more prone to smoke (96%) compared to females; there was no significant association between smoking and profession; females were significantly bother from Second Hand Smoking; smokers that get sickness from smoking were more prone to stop smoking and there was significant association between periods of smoking with nicotine addiction.Recommendations : Activation of penalty fines on smoking during work or induce Official penalty & Provision of special places for smoking in work places.

نتائج تخطيط صدى القلب عند المرضى المصابين بمرض الانسداد الرئوي المزمن ومدى ارتباطها بشدة المرض == Echocardiographic Findings in Patients with Chronic Obstructive Pulmonary Disease and Their Correlation with Disease Severity

Author name: شذى سلمان كاظم
Supervisor name: عدنان محمد 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 : Chronic obstructive pulmonary disease (COPD) is a common disease and a leading cause of morbidity and mortality worldwide and result in an economic and social burden that is substantial and increasing.COPD has considerable effects on cardiac functions, including those of the right ventricle, left ventricle, and pulmonary blood vessels. Most of the increased mortality associated with COPD is due to cardiac involvement. Echocardiography(Echo) provides a rapid, noninvasive, portable, and accurate method to evaluate the cardiac changes.Aim of study : To assess cardiac changes secondary to COPD by echocardiography and to find if there is a correlation between echocardiographic findings and severity of COPD.Materials and Methods : A total 50 of patients with COPD were diagnosed and staged by pulmonary function test (PFT) according to GOLD criteria into 4 stages . For all patients,detailed history, carful clinical examination, electrocardiography(ECG), chest x ray(CXR), and routine blood tests were done. All patients evaluated by echocardiography.Results : On echocardiographic evaluation of COPD,40% of cases had normal echocardiographic parameters. Measurable tricuspid regurgitation (TR) was observed in 25/50 (50.0%) of cases . Pulmonary hypertension (PHT), which is defined as systolic pulmonary arterial pressure (sPAP)> 30 mmHg was observed in 14/25 (56.0%) of patients with TR (28.0% of total patients) , in which prevalence of mild, moderate, and severe PHT were 7/14 (50.0%), 4/14 (28.6%), and 3/14 (21.4%), respectively. The frequencies of PHT in mild, moderate, severe, and very severe COPD were 7.1%, 14.3 %, 35.7%, and 42.9%, respectively. Cor pulmonale was observed in 6/14 (42.9%) of cases (12.0% of total patients) ; The frequencies of cor pulmonale in patients with mild, moderate, and sever PHT were 0 , 75.0% ,100.0 % ,respectively ; 2.0% cases had left ventricle systolic dysfunction(LVSD) and 10.0% cases had evidence of left ventricle diastolic dysfunction(LVDD). Left ventricle hypertrophy (LVH) was found in 4.0% of cases. There was a significant decrease in forced expiratory volume in one second(FEV1) means associated with Echo findings especially with PHT and cor pulmonale.Conclusion : Prevalence of cardiovascular complications (especially PHT and cor pulmonale) is high among COPD patients and has a linear relationship with increasing severity of COPD. Echocardiography helps in early detection of cardiac complications in COPD cases giving time for early interventions.
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