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اتجاه مرض التهاب السحايا للاطفال دون سن 51 عام في مستشفى حماية الطفل التعليمي ومستشفى الطفل المركزي التعليمي قبل وبعد ادخال اللقاح المستدمية النزلية نوع ب في البرنامج الوطني للقاح الاطفال من 2011 - الى 2014 == Trend of Meningitis in children below 15 years old in Welfare Teaching children Hospital and Central Children Teaching Hospital before and after introduction of Haemophillus influenza type b vaccine From 2011 To 2014

Author name: ميس حسن جاسب
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: Meningitis is serious threat to children health (esp. bacterial) particularly in developing countries. Early diagnosis and management may prevent children from death and serious complication ObjectivesTo determine type of meningitis and characteristic and outcome in children below 15 years old in a period before and after introduction of Haemophillus influenza type b (2011 - 2012 - 2013 - 2013(.Method A retrospective cross sectional study of children below 15 years old diagnosed with acute meningitis who were admitted to welfare children teaching hospital and central children teaching hospital in Baghdad for year : 2011 - 2012 - 2013 - 2014. Statistical analysis done by using SPSS version 23.ResultIn 290 patients, The mean age of children with meningitis was 32.46 month (2.6year). Bacterial meningitis was 25.2%, probable meningitis was 26.6%, and viral meningitis was 45.2%. The most frequent type of bacteria in 73 patient was streptococcal Pneumonia 47.9% followed by Neisseria meningitis 24.7% followed by E coli 9.6% then haemophillus influenza 6.8%. There was significant statistical association between type of meningitis with residence area. Case fatality rate was 4.8%, case fatality rate from bacterial meningitis was 10.9%, case fatality from streptococcal pneumonia was 11.4% and from Neisseria meningitis was 22.2%.Conclusion and recommendation Meningitis is more frequent in age below one year. Streptococcal pneumonia was the most frequent bacterial pathogen. The study recommend more study about misuse antibiotic.

تقييم وظائف البطين الايمن لمرضى العيب الاذيني للقلب قبل وبعد القسطرة العلاجية بواسطة تتبع ضربات القلب == Evaluation of RV functions in ASD patients pre & post transcatheter occlusion by speckle tracking

Author name: فينوس عبد الواحد علوان
Supervisor name: علاء عبد الحسين الانباري
General topic: Medicine
Specific topic: Diseases - Heart
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
Key words:
  • Atrial septal defect
  • Speckle tracking defect
  • Right ventricular function
First pages:
Abstract: Background : The atrial septal defect is a common congenital heart disease. Speckle tracking echocardiography is non - invasive diagnostic technique used in assessment of myocardial function. Aim of study : To evaluate the feasibility and reproducibility of right ventricular 2D Strain assessed by speckle tracking in patients undergoing atrial septal defect transcatheter occlusion compared with conventional markers before and after transcatheter occlusion.Patients and methods : A prospective follow up study conducted in Ibn AL - Bitar Specialized Center for Cardiac Surgery in Baghdad during the period from 1st of July, 2017 to 30th of June, 2018 on sample of 30 patients with atrial septal defect and sample of 30 healthy controls. All patients were investigated with echocardiography and speckle tracking one month before transcatheter occlusion and one month after the transcatheter occlusion.Results : Post transcatheter occlusion, there was a significant decrease in mean right ventricular end diastolic dimension (p<0.001) and a significant decrease in mean of tricuspid annular plain systolic excursion (p<0.001). There was a significant increase in global strain speckle tracking echocardiography mean post transcatheter occlusion (p<0.001). The global strain speckle tracking echocardiography mean was significantly higher among controls and atrial septal defect patients in post occlusion while lower among patients in pre - occlusion (p<0.001) with no significant difference in global strain mean between controls and patients in post occlusion (p=0.1). Conclusions : The speckle tracking echocardiography is a valuable diagnostic technique for evaluation of right ventricular function before and after transcatheter occlusion of atrial septal defect in adults

دراسة الوظائف الانقباضية والارتخائية للبطينين الايون والايسر لدى مرض ارتفاع ضغط الدم بواسطة التصوير بالدوبلر النسيجي لصدى القلب == Right Ventricular versus Left Ventricular Systolic and Diastolic Parameters using Tissue Doppler Echocardiography in Hypertensive patients

Author name: مصطفى عبد الامير حسين زاهد
Supervisor name: حسن علي الفرحان
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 : Hypertension is a heterogeneous disorder with a number of well defined as well as putative etiologies. It is a major risk factor for stroke and cardiovascular diseases, and is thus associated with significant morbidity and mortality.Arterial systemic hypertension may determine impairment of both left ventricular diastolic and systolic function, due to increased afterload but also to changes of left ventricular geometry and structure producing left ventricular remodelling and hypertrophy.Also the right ventricle might be involved in this process by structural and functional abnormalities. Right ventricular chamber diastolic dysfunction has been shown in uncomplicated arterial hypertension [30, 41, 42, 43]. To date, little information is available about functional changes of right ventricular walls in arterial systemic hypertension. This issue is crucial to better understanding of the mechanisms underlying right ventricular involvement in the hypertensive heart. Pulsed tissue Doppler has been used to analyze myocardial left ventricular wall motion abnormalities in several cardiac pathologies [45 - 50] and also appears suitable for assessing changes of right ventricular longitudinal function due to arterial hypertension.Aims : This study evaluates Right & Left ventricular functional and morphological changes in treated hypertensive patients using selected conventional and Tissue Doppler Echocardiographic methods, and Studies the relationship between changes in both Right & Left Ventricles of heart. Finally to determine the relationship between onset of disease and echocardiographic changes.Methods and Results : We selected one hundred and two treated hypertensive patients and 100 healthy age - and gender - matched controls, both study groups underwent echocardiographic examination using 2D, M Mode, Pulsed Doppler and Tissue Doppler imaging.Examination involved left ventricular septal and posterior wall thicknesses, internal dimensions, left atrial area, ejection fraction and LV mass, also Tissue Doppler derived waves' velocities S' , e', a' and e'\a' ratio. Right ventricular internal basal diastolic dimension, free wall thickness in diastole, right atrial area, TAPSE, PASP, fractional area change(FAC), PW tricuspid inflow waves' velocities e, a, and e\a ratio, Tissue Doppler derived myocardial performance index (MPI), S', e', a', and e'\a' ratio.Hypertensive patients had Higher than controls in : Left Ventricular walls' thicknesses, end diastolic dimension, LV mass, left atrial area, peak velocity S', a', Right Ventricular free wall thickness, Tricuspid inflow TV a wave velocity, right atrial area, PASP, TDI S' and a' waves velocities.Lower Values than controls in Left Ventricular TDI peak velocity of e' wave and e'\a' ratio, Right ventricular Tricuspid inflow PW e wave velocity, e\a ratio, internal diastolic dimension, TDI e' and e'\a' ratio.The systolic function of both ventricles was not reduced.The diastolic function of both left and right ventricles were impaired, the Tissue Doppler derived e'\a' ratios were strongly correlated in both ventricles.There was a strong correlation between LVH and both Tissue Doppler derived RV & LV diastolic dysfunction.By studying correlation of echocardiographic finding with disease duration there was a strong relationship with both LVH and RV tissue Doppler diastolic dysfunction.Conclusion : Systemic arterial hypertension causes morphological and functional changes in both ventricles, initially systolic function of LV and RV are not affected; diastolic dysfunction in LV is considered as one of the earliest functional changes, studying RV revealed diastolic dysfunction which was strongly correlated with LV diastolic dysfunction by using Tissue Doppler imaging, also with LVH were highly correlated with disease duration.

التقييم السريري ورصد قياس التاكسج خلال الليل للمرضى المعرضين لخطر توقف التنفس الانسدادي اثناء النوم == Clinical Evaluation and Overnight Oximetry Monitoring of High Risk Patients for Obstructive Sleep Apnea

Author name: محمد شاكر حسن
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: Obstructive sleep apnea OSA is a condition of sleep related pharyngeal collapse, in which recurrent episodes of upper airway occlusion occur during sleep causing diminution (hypopnea) or cessation of airflow (apnea) in the pharynx provoking arousals and sleep fragmentation , resulting in daytime sleepiness. Aim of study : To evaluate patients at high risk of OSA, by clinical parameters and overnight oximetry monitoring.Patients and Method : Cross sectional study of 20 patients, 12 male and 8 female with high probability of OSA, attended to respiratory clinic in Baghdad teaching hospital suffering from excessive daytime sleepiness, they were clinically evaluated plus using overnight oximetry as an objective testing method.Results : 20 patients only complete the study, 12 male (60%), 8 female (40%), 4 patients >60 years old (20%), 9 patients 40 - 59 (45%), and 7 patients 20 - 40 (35%), smokers were 11 (55%), patients with hypertension were 8 (40%) all of them with regular anti - hypertensive drugs , 2 (10%) patients were hypothyroidism according to thyroid function test .DI show significant correlation with AHI, BMI, Baseline SPO2 and gender, while no significant correlation with age.AHI show significant correlation with baseline SPO 2 and gender, and no correlation with BMI and age.Conclusion : Desaturation index assessed by nocturnal pulse oximetry maintain its utility as a screening method in the recognition of obstructive sleep apnea in morbidly obese patients with high clinical pretest suspicion, DI > 4% when combined with appropriate clinical evaluation, could be used as an initial diagnostic test for OSA.Obesity is a major risk factor and almost all suspected patients with OSA are obese.

الاعراض السميه في الجهاز الهضمي نتيجة للعلاج الشعاعي الجذري في منطقة الحوض, الانواع, الشده والتواتر == Acute Gastrointestinal radiation toxicities in pelvic radiation therapy; types, grade and frequency

Author name: هديل ماجد علي رشيد
Supervisor name: خضير جاسم صبيح الرواق
General topic: Medicine
Specific topic: Therapeutic Radiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
Key words:
  • acute toxicities
  • radiation therapy
  • pelvic organ cancer.
First pages:
Abstract: نوعية الحياة للناجين من السرطان قد تتضرربصورة مباشرة بسمية الامعاء؛ نتيجة للعلاج بالاشعاع في منطقة الحوض. 12000 مريض في المملكة المتحدة يعالج سنويا بالعلاج الاشعاعي الجذري لانواع الامراض السرطانية في منطقة الحوض؛ وهذا ينطوي على مخاطر كبيرة للاثار الجانبية للانسجة المحيطة العادي. الغرض من الدراسة الهدف من هذه الدراسة هو تحديد تواتر وانواع السمية المعدية المعوية الحادة في العلاج الاشعاعي الجذري لمنطقة الحوض في بلدنا وذلك ليمكننا من اجراء مقارنة مع الغرب في هذا الصدد, بطريقة تساعدنا في تطوير الاستراتيجيات الملائمة للوقاية والعلاج. المنهجية البحث عباره عن دراسه تحليليه مستقبليه, تم اجراءها في مركز العلاج النووي والعلاج الشعاعي/ مستشفى الاورام التعليمي في مجمع مدينة الطب في بغداد, من الاول من شهر كانون الثاني ولغاية الثلاثين من شهر نيسان لسنة 2016. الدراسه شملت 53 مريضا مؤكد بالزرع النسيجي مصابين بسرطان المثانة, الرحم، وسرطان عنق الرحم، والمستقيم، وسرطان البروستاتا، يتم علاجهم بالعلاج الاشعاعي الجذرية، التحقوا جميعا بالدراسة بعد موافقة عن علم وفقا لمعايير اشتمال واستبعاد. تم تقييم المرضى للتردد، وانواع ودرجة السمية المعدية المعوية الحادة وفقا لتصنيف معايير اثار الجانبية على اساس المنظمة الاوربية للبحوث والعلاج ولجنة معايير السمية مشتركة، في بداية، خلال وفي نهاية العلاج الشعاعي. وقد تم تحليل البيانات بواسطة برنامج البرمجيات "الحزمة الاحصائية" للعلوم الاجتماعية, اصدار 20).النتيجة من اصل 53 مريضا، 60.37% (n = 32) كانت انثى و39.62% (n = 21) من الذكور. سرطان بطانة الرحم تمثل 30.18% (n = 16) من الحالات، كانت سرطانات عنق الرحم 24.52% (ن = 13)، سرطان المستقيم 11.32% (n = 6)، سرطان المثانة 24.52% (ن = 13) وسرطان البروستاتا 9.43% (ن = 5) من مجموع الحالات. الاسهال لوحظ في 27 من اصل 53 مريضا(50.9%), 15 مريض كان يعاني من الالم (28.3%) بينما الامساك والغثيان والقي مثلوا (22.6%). كان معظم السميه متمثل بالمرحله الاولى ووجد فقط مريضان بوضع المرحله الثالثه (الاسهال 4.7%). الاستنتاج تواتر وشدة السمية الحادة في الجهاز الهضمي كانت ترتبط بزيادة جرعة الاشعاع، جنبا الى جنب مع استخدام العلاج الكيميائي, والتداخل الجراحي | Background : quality of life of cancer survivors is adversely impacted by bowel toxicity; result from pelvic radiation therapy. In the UK, 12000 patients are treated with radical radiation therapy for pelvic cancer, mostly with curative intent; this carries a considerable risk for normal surrounding tissues side effects.Objective : the aim of this study was to determine the frequency and types of acute gastrointestinal toxicity in radical pelvic radiation therapy in our patients so that a comparison could be made with the West in this aspect which would help us in developing appropriate strategies for its prevention and better management. Patients and Methods : a prospective analytic study was carried out in Radiotherapy department / Oncology teaching hospital / Medical city complex, from the 2nd of January to the 30th of April 2016.A total of 53 patients with histologically confirmed uterine, cervical, rectal, urinary bladder or prostatic cancer, treated by radical radiation therapy, were enrolled in the study after informed consent according to inclusion and exclusion criteria. Patients were assessed for the frequency, types and grade of acute gastrointestinal toxicities according to grading criteria of side effect based on RTOG (Radiation Therapy Oncology Group) /EORTC (European Organization for Research and Treatment) and CTC (Common Toxicities Criteria), at the start, during and at the end of the treatment. The data was analyzed by the Statistical Package for Social Sciences (SPSS, version 20) software.Result : Diarrhea occur in 27 out of 53 patients (50.9%), 15 patients had pain (28.3%) while constipation and nausea and vomiting were 22.6% (n=12/53) each. The majority had grade 1 toxicities and only 2 patients developed grade 3 diarrhea (4.7%).Conclusion : The frequency and severity of acute gastrointestinal radiation toxicities were associated with increase dose of radiation therapy, combined with the used of chemotherapy therapy and the presence of surgery.Background : quality of life of cancer survivors is adversely impacted by bowel toxicity; result from pelvic radiation therapy. In the UK, 12000 patients are treated with radical radiation therapy for pelvic cancer, mostly with curative intent; this carries a considerable risk for normal surrounding tissues side effects.Objective : the aim of this study was to determine the frequency and types of acute gastrointestinal toxicity in radical pelvic radiation therapy in our patients so that a comparison could be made with the West in this aspect which would help us in developing appropriate strategies for its prevention and better management. Patients and Methods : a prospective analytic study was carried out in Radiotherapy department / Oncology teaching hospital / Medical city complex, from the 2nd of January to the 30th of April 2016.A total of 53 patients with histologically confirmed uterine, cervical, rectal, urinary bladder or prostatic cancer, treated by radical radiation therapy, were enrolled in the study after informed consent according to inclusion and exclusion criteria. Patients were assessed for the frequency, types and grade of acute gastrointestinal toxicities according to grading criteria of side effect based on RTOG (Radiation Therapy Oncology Group) /EORTC (European Organization for Research and Treatment) and CTC (Common Toxicities Criteria), at the start, during and at the end of the treatment. The data was analyzed by the Statistical Package for Social Sciences (SPSS, version 20) software.Result : Diarrhea occur in 27 out of 53 patients (50.9%), 15 patients had pain (28.3%) while constipation and nausea and vomiting were 22.6% (n=12/53) each. The majority had grade 1 toxicities and only 2 patients developed grade 3 diarrhea (4.7%).Conclusion : The frequency and severity of acute gastrointestinal radiation toxicities were associated with increase dose of radiation therapy, combined with the used of chemotherapy therapy and the presence of surgery.

معرفة , اتجاه وسلوك النساء الحوامل عن فقر الدم خلال الحمل في مستشفي بغداد التعليمي 2016 == Knowledge, Attitudes and Practice of Pregnant Women about Anemia during Pregnancy in Baghdad Teaching Hospital - 2016

Author name: رؤى صفاء سعيد
Supervisor name: علياء مكي حسن الصافي
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: Back ground : Anemia constitutes a public health problem worldwide, in both developed and developing countries.Aims : 1) assess the level of knowledge, attitude and practice of pregnant women about anemia 2) assess the association between knowledge of pregnant women and their socio - demographic variances 3) assess the association between the practice of pregnant women and their socio - demographic variances. Methods : The study was cross - sectional, carried out in among pregnant Baghdad Teaching Hospital, from 25th February to 28th April, 2016. A total of 300 pregnant women participated in the study. The tool of study was questionnaire. Chi - square test was used to test the statistical significance (p - value< 0.05).Results : The study revealed 63.3% of pregnant women had good knowledge, positive attitude found in 65.3% and health practice in 59.3% among pregnant women regarding anemia, the study show association between the knowledge of the pregnant woman and educational level of her and her husband, also there is association between the practice of pregnant woman and her occupation.Conclusion : A noticeable general good level of knowledge , attitude and practice among pregnant women regarding anemia during pregnancy ,level of knowledge in pregnant woman associated with the educational level of her and her husband and healthy practice increase in employed pregnant woman.Recommendations : Raise the level of knowledge and practice for prevention, learn pregnant women healthy dietary habit and encourage pregnant women to early registration in primary health care center.

تقييم مرضى توسع القصبات من الناحية السريرية والاشعاعية == Bronchiectasis Clinical and Radiological Assessment

Author name: لمى جواد كاظم
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: BACKGROUND : Bronchiectasis is relatively common disease in developing countries, HRCT is the method of choice for the morphologic evaluation of patients with bronchiectasis.OBJECTIVE : To assess the clinical profile of patients with bronchiectasis and evaluate the clinical relevance of high - resolution CT findings in patients with bronchiectasis by using a quantitative high - resolution CT to assess extent of bronchiectasis, severity of disease, bronchial wall thickening, and presence of smallairway abnormalities and mosaic pattern. METHODS : A cross sectional study of 50 consecutive patients with bronchiectasis in respiratory department of Baghdad teaching hospital between 1st of September 2015 and end of April 2016, clinical features of bronchiectasis and results of HRCT were assessed and correlated. RESULTS : Mean age of participants (70% males, 30% females) was 53.44 ± 9.6 years and 52% of them were lifetime non - smokers. Most common identified causes of bronchiectasis were tuberculosis (48%), pneumonia (18.4%) and cystic fibrosis (4%).The predominant symptoms were productive cough (82%), dyspnea (94%), fever (74%) and chest pain (72%). The most common findings on chest examination were crackles (86%) and wheeze (74%). Types of bronchiectasis in HRCT were cystic in 62%, varicose in 32%, tubular 6%, Involvement was multilober in 46%, diffuse in 18%and right upper lobe in 18%. Of 50 patients, 92% have bronchial wall thickening, whereas 62% show small air way abnormalities, 56%have mosaic pattern. Patients with cystic disease have significant association with productive cough with large amount of sputum, hemoptysis, Crackle and Clubbing (p < 0.05), patients with small air way abnormalities in HRCT have significant correlation with chest pain, dyspnea and amount of sputum (p < 0.05). Patient with diffuse lobe distribution on HRCT have daily significant quantities of sputum production (P < 0.05), while multilober distribution have a significant association with dyspnea and wheeze (P < 0.05).CONCLUSION : Clinical finding in patients with bronchiectasis have significant correlation with HRCT chest finding which be used for monitoring activity of disease.Key words : bronchiectasis, HRCT, amount of sputum , bronchial wall thickening, mosaic pattern. Lobes distribution

المضاعفات الرئوية بعد عمليات البطن الجراحية في الردهات الجراحية لمستشفى بغداد التعليمي == Post - abdominal surgery respiratory complications at surgical wards of Baghdad teaching hospital

Author name: رغيد حازم فاضل
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: Background : Postoperative pulmonary complications (PPCs) followingabdominal surgery are frequent and associated with increased morbidity andmortality, and hospital length of stay.Study objective : The aim of the study was to identify pulmonarycomplications following abdominal surgical procedures and to identifyperioperative risk factors associated with the development of thesecomplications.Patients and Methods : this is a hospitalized - based cross - sectional study. Arandomly selected sample of 52 patients who developed pulmonarysymptom(s) following abdominal surgical procedures at surgical wards ofBaghdad teaching hospital from November 2015 to June 2016. Perioperativedata were collected through interview and char review, and their associationwith the occurrence of PPCs were analyzed. Cross tabulation and Chi - squaretest were used to analyze the discrete variables and their relationship to the PPCs while one way ANOVA was used to analyze the continuous variables and their relationship to the PPCs.Results : The following PPCs were identified : 33 pneumonia, 5 acute respiratory failure, 4 basal atelectasis, 3 pleural effusion, 3 pulmonary embolism, 3 exacerbation of COPD or asthma and 1 pulmonary edema.Perioperative risk factors associated with development of PPCs were identified : current smoking history (p value = 0.042), preexisting comorbid disease (p value = 0.001), emergency surgery (p value = 0.045), upper abdominal (p value = 0.012) or both upper/lower abdominal incisions (p value = 0.026), duration of surgery ≥ 3 hours (p value = 0.049) and NG tube placement postoperatively (p value = 0.043). Conclusions : The most common PPC following abdominal surgery is pneumonia. There is no significant difference between laparoscopy and laparotomy in term of PPCs following abdominal surgery. Six perioperative risk factors associated with the occurrence of PPCs following abdominal surgery were identified which are current smoking history, preexisting comorbid diseases, emergency surgery, upper abdominal or both upper/lower abdominal incisions, duration of surgery more than or equal to three hours and NG tube placement postoperatively.

تقييم استخدام مضادات التخثر الوقائي لمنع الجلطات الدموية الوريدية في المرضى البالغين الراقدين في مستشفى بغداد التعليمي == Assessment of Prophylactic anticoagulant use for prevention of venous thromboembolism in adult inpatients at Baghdad teaching hospital

Author name: عمار محمد عبد الرضا
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: Deep venous thrombosis is one of the most problems that faces hospitalized patients and if does not treated or prevented well may lead to pulmonary embolism and it ’s complications and as a consequence increase cost effectiveness, the duration of admission and mortality.Aim of study : Evaluate the use of prophylactic anticoagulants for prevention of DVT and PE in various medical, surgical, and gynecological wards.Patients and methods : Cross sectional study of 374 patients who are indicated for VTE prophylaxis admitted to medical, surgical and gynecological wards in Baghdad teaching hospital and were assessed wither they took VTE prophylaxis or not , had any contraindications and if they developed DVT and PE during admission.Results : 374 patients involved in the study, 152 males (41%) and 222 females (59%).195 patients (52%) received VTE prophylaxis and the rest 179 patients (48%) did not received it and from the latter only 25 patients (14%) had contraindications that prevent the use of VTE prophylactic.Only 4 patients developed DVT and 1 patient developed PE in those who received VTE prophylaxis compared to 13 patients developed DVT and 7 patients developed PE in those who did not received VTE prophylaxis.There was inverse relationship between receiving VTE prophylaxis and development of DVT and PE.Conclusion : The study reveals that there was an underuse of prophylactic anticoagulants for patients who are indicated for VTE prophylaxis in medical, surgical and gynecological wards

انتشار ومتنبات الاكتئاب لدى عينة من المرضى المصابين بداء الذاب الحمامي المجموعي == Prevalence and Predictors of Depression in a Sample of patients with Systemic Lupus Erythematosus

Author name: زهراء عدنان
Supervisor name: فائق ايشو كوريال | مشتاق طالب هاشم
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: المرضى والطرائق : شملت الدراسة المقطعية (60) مريضا مصابا بداء الذاب الحمامي المجموعي تم تشخيصهم حسب المعاييرالمطورة التشخيصية بواسطة الكلية الامريكية لامراض الرثية.تم جمع بيانات المرضى الديموغرافية والسريرية بما في ذلك العمر والجنس ومعيار كتلة الجسم وحالة التدخين والحالة الزوجية والحالة الوضيفية واعراض سابقة لشمول الجهاز العصبي المركزي ومدة المرض وفاعلية المرض بواسطة مقياس فاعلية المرض لداء الذاب الحمامي ,الادوية المستخدمة وتحاليل الدم وشاكلة الاضداد. تم تحري جميع المرضى بواسطة المعايير التشخيصية لنوبة الاكتئاب الرئيسية د س م 5 . النتائج : نسبة انتشار الاكتئاب كانت (31.7%),نسبة الاكتاب الحاد لوحظت في (13.3%) من الحالات بينما كانت نسبة الاكتئاب المتوسط الشدة (8.3%).علاوة على ذالك الحالات الفعالة حسب مقياس فاعلية المرض لداء الذاب الحمامي12< مثلت اعلى نسب الاكتئاب(40%).مقارنتا ب(20%) لحالات المرض الخفيفة الى متوسطة الشدة.لا توجد هناك اهمية اواحصائية معتد بها للفرق في معدل فاعلية المرض لداء الذاب الحمامي بين الفئات شديدة الاكتئاب) .(p>0.05المستوى التعليمي كانت له علاقة عكسية مع الاكتئاب معتد بها احصائيا,مرضى داء الذاب الحمامي من غير تعليم رسمي كانت لهم اعلى نسب الاكتئاب (85.7%)مقارنتا لمعدل مابين (21.7%و29.4%)لمن مستوى تعليمهم اعلى.خطورة الاصابة بالاكتئاب لم تكن مختلفة في حالة وجود اوغياب اعراض تخص شمولية الجهاز العصبي المركزي بالمرض(33.3%و3.35)على التوالي.العمر والجنس والحالة الزوجية والحالة الوظيفية لايوجد لهراابط ملحوظ او معتد احصائيا مع الاكتئاب.الادوية التي سبق للمريض تعاطيها والتي تشمل اي من البريدنيزولون ,هايدروكسي كلوروكوين,سايكلوفوسفامايد ,ازاثيوبرين ,مايكوفينوليت موفتيل ,ميثوتريكسيت ,كلوروكوين ,لا توجد لها اهمية او رابط احصائي معتد مع الاكتئاب.لا توجد اهمية ملحوضة او معتدة احصائيا لتاثير وجود نتيجة ايجابية لاضداد النوى ,اضداد دي ان اي ذو الطاقين وعوز المتممة (ج3و /او ج 4)على نسبة الاصابة بالاكتاب. الاستنتاجات : نسبة الاكتئاب لدى المرضى المصابين بداء الذاب الحمامي المجموعي شائعة نسبيا.وتزداد مع زيادة فعالية المرض. المستوى التعليمي كانت له علاقة عكسية مع الاكتئاب معتد بها احصائيا. | Background : Systemic lupus erythematosus (SLE) is a multi - systemic auto immune inflammatory disease in which genetic and environmental factors implicated in its pathogenesis. Depression is a potentially life - threatening disorder that affects hundreds of millions of people all over the world. The World Health Organization has ranked depression the 4th leading cause of disability worldwide.Objectives : The aim of this study was to evaluate the prevalence and predictors of depression in a sample of Iraqi patients with SLE if present. Patients and methods : This cross - sectional study involved 60 patients with SLE diagnosed according to revised American College of Rheumatology (ACR) classification criteria. Demographics and clinical data were collected including age, sex, BMI, smoking status, marital status, unemployment, educational status, crowding index, history of CNS involvement and disease duration. Disease activity for SLE was assessed with the SLE Disease Activity Index (SLEDAI). Medications used, blood investigations and autoantibody profile were collected, all subjects were screened for depression by using the Diagnostic and statistical manual of mental disorders - 5 ( DSM5) diagnostic criteria of depression.Results : The prevalence of depression was (31.7%). A severe form of depression was observed in 13.3% of SLE cases, while a mild degree of depression was elicited in 8.3% of the cases. Furthermore, cases with a severe form of disease evaluated by SLEDAI score >12 had an obviously higher rate of depression (40%) compared to 20% among those with mild or moderate disease. There was no important or statistically significant difference in median SLEDAI score between depression severity categories (p more than 0.05). Educational level had a statistically significant negative association with depression, SLE cases with no formal education had the highest rate of depression (85.7%) compared to a rate between 21.7% and 29.4% for higher level of educational attainment. The risk of having depression was not different in the presence or absence of central nervous system (CNS) involvement (33.3% and 31.3% respectively), age, gender, marital status and employment status had no obvious or statistically significant association with depression. The history of using each of prednisolone, hydroxychloroquine, cyclophosphamide, azathioprine, mycophenylate, methotrexate and chloroquine had no important or statistically significant association with depression. Also the presence of antinuclear antibodies and anti - double stranded Deoxyribo nucleic acid (DNA) antibodies and the decrease in complement (C3 and/or C4) had no important or statistically significant effect on the presence of depression.Conclusions : The prevalence of depression in SLE patients was relatively high. SLE disease severity increase depression rate. Educational level had statistically negative association with depression

اثار حبوب منع الحمل الفومية احادية الطور على فعالية عامل التخثر السابع ومستوى ثنائي ال دي - دايمر في النساء الاصحاء والبدينات == The Effect of Regular Monophasic Oral Contraceptive Pills on Factor VII Activity and D - dimer Level in Healthy and Obese Women

Author name: اسراء سعدي عباس
Supervisor name: هيثم احمد الربيعي
General topic: Medicine
Specific topic: Diseases - Blood
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: The combined oral contraceptive pill includes a combination of estrogen and progestin. Clinical and epidemiological studies indicate that the use of these pills is associated with an increased risk of thrombotic disorder including both deep vein thrombosis and pulmonary embolism.The pathogenesis of increased thrombotic risk with pills use is that the estrogen content in the pills has many effects on coagulation system that results in shifting of the hemostatic balance toward a prothrombotic state.Obesity is defined as abnormal or excessive fat accumulation that may impair health. Body mass index is commonly used to classify overweight and obesity. It is an independent risk factor for venous thromboembolism and increases the risk of thrombosis 2 - fold, since obese individuals have higher levels of several procoagulant factors. There may be an additional risk of thrombosis caused by venous stasis that also occurs with obesity. Oral contraceptive use in conjunction with obesity increases the risk of thrombosis about 10 - fold.Aim of the studyTo assess the level of FVII activity, D - dimer level, and other hemostatic changes in healthy non - obese and obese women on contraceptive pills and compare them to that found in normal healthy non - user women.Patient, materials and methodsThis case - control study included 50 females attending the family planning clinic at Baghdad Teaching Hospital of Medical City. TheyIIIwere regularly using monophasic regular dose estrogen containing combined oral contraceptive pills (Microgynon® ED Fe) for at least 3 months. Their ages were between 18 and 45 years. Females on pills were divided into 2 groups :  Non - obese group : enrolled 25 females with BMI of < 30 kg/m2 (15/25 females were overweight, and 10/25 were of normal weight) Obese group : composed of 25 females with BMI of ≥ 30 kg/m2Twenty five healthy, non - obese (16/25 were overweight and 9/25 had normal weight), age - matched non - pregnant females neither on pills, nor taking any hormonal therapy and having no history of malignancy or previous thrombosis, were assigned as a control group.Relevant clinical data were collected from all participants. Weight and height were measured (in kilograms and centimeters, respectively), and then the BMI was calculated accordingly for each participant.Platelet counts were measured by a hematology auto - analyzer (Cell - DYN, RUBY ABBOTT Diagnostic, USA). Prothrombin time, activated partial thromboplastin time, and factor VII activity were measured using semi - automated coagulometer (STart4®, DIAGNOSTICA STAGO/France). D - dimer levels were measured by turbidimetric immunoassay using an automated analyzer (ARCHITECT c4000, Abbott Diagnostics, USA).ResultsThere was significant reduction in prothrombin time in the non - obese, obese, and pills users groups compared to that in the control group (P= 0.014, 0.020, and 0.006 respectively), while the activated partial thromboplastin time was insignificantly reduced in all of these groups.Moreover 22% of pills user cases had shortened prothrombin time compared to the lower limit of prothrombin time in the control group (11.8 sec), and 8% of them were found to have shortened activated partial thromboplastin time compared to the lower limit of activated partial thromboplastin time in the control group (24.6 sec).The correlations between the duration of pills use (< 1 year and > 1 year) and prothrombin time and activated partial thromboplastin time showed statistically insignificant differences in both study groups.The factor VII activity in the non - obese, obese, and pills users groups were significantly higher than that of the control group (P= 0.041, 0.001, and 0.004 respectively). It had been observed that 22% of pills user cases had FVII activity above the highest value of activity that was found in the control group (95%). Also there was a significant inverse correlation between the prothrombin time and factor VII activity with P - value of 0.008.The D - dimer levels were found to be significantly higher in the non - obese and obese group compared to that of the control group (P= 0.029 and 0.038, respectively). The mean D - dimer of the pills users group was insignificantly higher than that of the control group, P value = 0.053.The platelet count was insignificantly increased in the non - obese group when compared with that in the control group (P= 0.106), while it was significantly increased in the obese and pills users groups compared with that in the control (P = 0.027, and 0.034, respectively). There were no statistically significant differences in the means of prothrombin time, activated partial thromboplastin time, factor VII activity, D - dimer level, and platelet count between the non - obese and obese groups (P > 0.05).

تهدل الصمام الاكليلي تشخيصه ومدى حدوثه == Mitral Valve Prolapse Diagnosis and Incidence

Author name: نوري عودة مدحي
Supervisor name: حامد الجنابي
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: التمهيد والغرض : الصمام الاكليلي للقلب وهو الصمام التاجي الذي يسمح وينظم مرورالدم من الاذين الايسر الى البطين الايسر ولا يسمح بعكس ذلك.. وتهدل هذا الصمام حالة مرضية معروفة عند الناس حيث تصاب وريقات الصمام بارتخاء مع استطالة وفي بعض الاحيان تثخن وهذا يؤدي الى استرجاع الصمام عند انسداده (الى الاذين الايسر) عند انقباض البطين الايسر لمسافة 2ملم او اكثر عن مستوى الرابط الحلقي الليفي للصمام الاكليلي.والمصابون بمثل هذه الحالة قد لا يشكون من اي شيء اي يمضون حياتهم طبيعيا اي لا تاثير لتهدل الصمام على حياتهم. وهناك عدد من المصابين بتهدل الصمام الاكليلي يشكون من الم في الصدر او تعب وخفقان القلب او ضيق النفس وخاصة عند بذلهم لجهد معين... وقد تتطور هذه الحالة عند حصول مضاعفات في الصمام مثلا (التهاب الصمام وبطانة القلب) حيث يحصل عدم كفاءة الصمام الاكليلي، قد تتطور الى حالة عجز القلب...هذا البحث يتركز على طريقة تشخيص حالة تهدل الصمام الاكليلي وذلك باستعمال جهاز الايكو للقلب (فحص صدى القلب : اي استعمال الامواج فوق الصوتية لتشخيص الحالة)، واستبيان مدى حدوثه اي نسبة حدوثه عند الناس (المراجعين) الذين يراجعون عدد من مستشفيات بغداد..المرضى وطرق البحث : تم شمول 117 شخص (من الذين يراجعون المستشفيات المذكورة) والذين يشكون من الم الصدر او خفقان او خمول ....الخ. تم اختيار هؤلاء المراجعين في ثلاث مستشفيات في بغدادهي (م. ابن النفيس التعليمي للقلب، المركز العراقي التخصصي لامراض القلب، م. بغداد التعليمي (مدينة الطب)). تم فحص هؤلاء المراجعين بواسطة جهاز ايكو القلب حيث تم تشخيص حالة تهدل الصمام الاكليلي للقلب عند قسم منهم وذلك اعتماد على وجود استرجاع وريقات الصمام الاكليكلي (كليا او جزئيا) الى داخل الاذين اليسر عند انقباض البطين الايسر وانسداد الصمام مع وجود تثخن في تلك الوريقات (سمك ≥ 5 ملم) وخاصة في النوع النموذجي منه. النتائج : تم تشخيص 27 مريض (من اصل 117 شخص مفحوص) مصاب بتهدل الصمام وكانت نسبة حدوثه في المراجعين للمستشفيات المذكورة 23.1%، 63% منهم نساء، و37% منهم ذكور. التهدل النموذجي 33.3% والغير نموذجي 66.7% الاستنتاج : ان نسبة حدوث تهدل الصمام الاكليلي للقلب وجدت في هذا البحث هي 23.1% وان نسبة التهدل عند النساء اكثر منه عند الرجال، والتهدل النموذجي اقل من الغير نموذجي. | The mitral valve prolapse is a common condition which may be overestimated in general population.Aim of the studyDetermine the incidence of mitral valve prolapse.Materials and methods117 symptomatic patients aged (17 - 42) years were examined in the outpatient clinic of (Baghdad Teaching Hospital ,Iraqi Cardiac Center and Ibn Alnafis Hospital) by the use of 2 D echocardiography to assess the incidence of mitral valve prolapse .Results 27 patients out of 117 patients(23.1%) had mitral valve prolapse,(63%) of them were females and (37%) was males,the classical type (33.3%) and the non classical was (66.7%). Conclusion Incidence of mitral valve prolapse was 23.1%, the percentage of females was more than males, and the classical type was less than non classical.

العدوى المكتسبة في وحدات العناية المركزة في مستشفيات محافظة البصرة ،العراق 2013 == Nosocomial Infection in Intensive Care Units at Basra Hospitals, Iraq, 2013

Author name: زكي عبد السادة صغیر
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: Nosocomial infection is defined as infection not present and withoutevidence of incubation at the time of admission to health care setting. It isconsidered as a major public health problem worldwide, which is affectedboth developed and developing countries. It was contributed to highmorbidity and mortality, and will become even more important as a publichealth problem with increase economic and human impact. The patients inICUs are 5 - 10 time more likely to have NCI than other hospital patients. Thefrequency of NCI at different anatomical sites and the risk of infection varyby the type of ICU, while the frequency of specific pathogens varies byinfection sites.In Iraq, there was no accurate proportion and enforced surveillance of the NCIin the MOH, and few academic studies that dealt with this topic.The objectiveof this study, to determine the burden of NCI and distribution by anatomicalsites in the ICUs. We conveniently select (110) patients admitted to the ICUsof three major hospitals in Basra city from 15th May to 1st of August, 2013.A total number of 32( 29.1%) patients developed at least one nosocomialinfection. The urinary tract infection was the most frequent ICUs nosocomialinfection 39.6%, followed by Bloodstream infection 25%, Lower respireterytract infection 22.9% and lastly surgical site infection 12.5%. There are acertain specific risk factors play important role in occurrence of NCI in ICUssuch as use of the invasive devices, including endotracheal, tracheostomy,nasogastric intubation and urinary catheterization, which is consideredstatically significant association with NCI in the ICUs ( P< 0.05) also antherpositive correlation( r = 0.7) between rates of NCI and length of ICU stay hasbeen reported and high coverage of antibiotic as prophylaxis raise ofantibiotic - resistance NCI in the ICUs which considered as a risk factor, nosignificant association with NCI (P> 0.05). In spite of heavy use of antibioticVIIin the ICUs, we found heavy growth microorganisms in Urine, Blood, andsputum and swap cultures. Gram negative bacteria cause (83.3%) of infection,which is the most common cause of NCI in the ICUs, followed by Grampositive bacteria (9.8%) and fungus (5.9%). These pathogens are ubiquitousin health care sitting. The Kliebsiella ssp was the most common, followed byE.coli organism. It was concluded at intensive care units of the majorhospitals in Basra city had higher rate of the NCI, more than that in developedcountries and most of developing countries. The nosocomial urinary tractinfection was the most common NCI sites in ICUs, followed by blood streaminfection. Enhance surveillance system and Enforced implementation of ICCguidelines in ICUs should be emphasize.

دراسة مقارنة للجرعة الاشعاعية القلبية بانواع مختلفة من العمليات الجراحية لمرضى سرطان الثدي في مركز بغداد للعلاج الشعاعي == Comparative study of cardiac radiation dose with different types of surgery in breast cancer patients in Baghdad radiotherapy center

Author name: سجاد عباس خير الله
Supervisor name: خضير جاسم صبيح الرواق
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: Radiotherapy has been shown to decreases breast cancer recurrence as well as reduce in breast cancer mortality. The dose of radiation is important to be calculated accurately for both the site to be treated and for the organs to be protected such as the heart as it has major impact on morbidity and mortality on patients if received high dose of radiotherapy.Aim of study : To compare the mean heart dose of radiation in breast cancer patients between breast conserving surgery VS mastectomy, between different radiotherapy doses and fractionation schedules and between right and left breast cancer irradiation.Patients & Methods : This is a cross - sectional descriptive retrospective comparative study that was conducted in Baghdad Radiotherapy Center from January 2018 to June 2018 , carried on 174 breast cancer patients of different age groups selected randomly and their mean heart dose data collected from their files and database in Baghdad Radiotherapy Center. Patients are divided into two groups : Breast conserving surgery and modified radical mastectomy .each group is further subdivided according to dose of radiotherapy and side of breast cancer.VResults : The overall average of the mean dose was 372 cGy (range from 76.4 to 716.2).The greatest difference in the mean heart dose was between (BCS) patients who received 5000 cGy with regional nodal irradiation and (BCS) patients who received 4005 cGy also with regional nodal irradiation ( difference in the mean is 639.8 , the P - value <0.001 ) .In regard to the side of breast cancer , the greatest difference in mean heart dose seen between left and right breast cancer patients who did the same type of surgery (MRM) and received the same dose of radiotherapy (4256 cGy) (difference in the mean is 565cGy and the P - value <0.001 ) .No statistically significant difference in the mean dose between breast conserving surgery and mastectomy was recorded.Conclusion : The mean heart dose of radiotherapy is significantly increased in left sided breast cancer irradiation as compared to the right side. A dose of 5000 cGy has the greatest effect on the dose received by the heart especially in left breast cancer. The type of surgery whether breast conserving surgery or mastectomy did not affect the mean dose received by the heart

مقارنة الجرعة التي تستلمها الرئة من الاشعاع المستخدم في علاج سرطان الثدي حسب اختلاف نوع العملية الجراحية المستخدمة في مرضى مركز بغداد للعلاج الشعاعي : دراسة وصفية == Comparative study of lung radiation dose with different types of surgery in breast cancer patients in Baghdad radiotherapy center descriptive study)

Author name: يحيى علي دشر
Supervisor name: خضير جاسم صبيح الرواق
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: Background : Breast cancer is a complex , multifactorial disease that have different treatment approaches. Adjuvant radiation therapy is an important locoregional management , however it has many drawbacks and side effects on the adjacent organs including lung , heart and others .Objective : To compare the mean lung dose between breast conserving surgery and mastectomy, and their different radiation doses .Patients & Methods : This is a cross - sectional descriptive comparative study that was conducted in Baghdad Radiotherapy Center , carried on 174 patients, their ages range from 18 to 77 year old, all of them treated by mastectomy or breast conserving surgery, and radiotherapy offered for them with or without axillary irradiation.Results : The highest Mean Lung Dose seen in patients with Breast Conserving Surgery received 5000 cGy to chest and lymphatics (1483 cGy ± SD 133 ) followed by those with Modified Radical Mastectomy received 4005 cGy to chest wall and lymphatics (1285 cGy ± SD 138 ); there is a statistically significant difference (P = <0.001).Conclusions : The highest Mean Lung Dose seen in patients receiving higher radiotherapy dose regardless of type of surgery. There is Significant correlation between the mean lung dose and the lymphatic irradiation P - value > 0.001

انتشار نوبة الاكئاب العظمى عند النساء العراقيات المصابات بهشاشة العظم في فترة ما بعد انقطاع الطمث == Prevalence of Major Depressive Disorder Among Postmenopausal Iraqi women with Osteoporosis

Author name: سرى قاسم عباس
Supervisor name: نزار عبد اللطيف جاسم
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 : Osteoporosis is a reduction in bone mineral density thatincreases susceptibility to fractures. Major depressive disorder is one of themost prevalent psychiatric conditions characterized by depressive mood,anhedonia, and sleep abnormalities. They are chronic diseases that affectlarge population groups with great impact on morbidity, mortality andquality of life. In fact, little researches has focused on the relationshipbetween low BMD and depression.Objectives : The aim of this study was to evaluate the prevalence of majordepressive disorder among postmenopausal Iraqi women with osteoporosisand its association with osteoporotic vertebral fracture and other low traumafractures.Patients and methods : This cross sectional study involved 100 postmenopausalIraqi women with osteoporosis diagnosed according to WHOcriteria for classification of osteopenia and osteoporosis. Thoracolumbarspine x - ray (lateral view) were performed for all women and osteoporoticvertebral fracture assessed by using the semi - quantitative method. Allwomen were screened for major depressive disorder by using the DSM5diagnostic criteria of depression and severity of their depression wasassessed by using the Beck Depression Inventory scale .Results : the prevalence of major depressive disorder among postmenopausalIraqi women with osteoporosis was 18%. There is no statistically significantassociation between bone mineral density and major depressive disorder(p≥0.05), with statistically significant association (p=0.01) of majorVIIdepressive disorder with osteoporotic vertebral fracture in comparison toprevious history of other type of low trauma fractures or no fractures.Conclusions : The prevalence of major depressive disorder inpostmenopausal women with osteoporosis was 18% with statisticallysignificant association with osteoporotic vertebral fracture.

مدى تاثير العلاج الاشعاعي التلطيفي للدماغ في البقاء على قيد الحياة للمرضى الذين يعانون من ورم منتشر في الدماغ من مختلف انواع السرطانات == Impact of whole cranium Radiotherapy on Survival in Patients With Brain Metastasis of Different Cancers

Author name: زينب علاء مكي الربيعي
Supervisor name: خضير جاسم صبيح الرواق
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: Brain metastases are the most common intracranial brain tumor and a common complication of systemic cancer. The incidence ranges from 20% to 40% of all patients diagnosed with cancer ,The most common primary site is the lung followed by breast. Metastatic brain tumors outnumber primary brain tumors by a factor of 10 to 1 , The prognosis of brain metastases is poor and the impact on the patient’s quality of life is important as a result of the functional neurologic deficits associated. The mainstay of treatment for brain metastases has been corticosteroids and whole brain radiotherapy.Objective : the aim of the study to determined the impact of whole cranium irradiation (2000cGy) on median and mean survival of brain metastasis and to analyze prognostic factors affecting survival of patients receiving whole brain irradiation (WBI).Patients & Methods : This study retrospectively reviewed the records of 80 patients with BMs who were not eligible for surgical resection and who underwent WBRT in Baghdad oncology teaching hospital between 1stof July 2015 and 1st of January 2017. The patients enrolled in this study, About 47 Patients were diagnosed as primary breast cancer,20 patients as primary lung cancer and 13 patients from other site of body. All patients were treated with conventional external beam radiotherapy with atotal dose of 20 Gy in five fractions over 1 week for all patients.Results : Breast cancer represented the most common primary cancer type 47 patients (58.8%), followed by lung cancer 20 patients (25%) ,other types of primary represent 13 patients(16.3%), The median survival for the total population Who were receiving Whole cranium radiotherapy was 7 months and mean survival was 9.8 months,For breast cancer the median survival time was 8 months, for lung cancer patients was 6 months and for primary metastasis from other sites of body was 6 months, In general, the result is that patients with breast cancer had better survival than patients with other primary cancers. In regard of time to develop to brain metastasis ,median time for breast cancer, lung cancer and for other sites (22,5,12 months)respectively The breast cancer has the longest time before progress to brain metastasis, According to the stage of primary breast tumor, The highest frequency was seen among patients with T3A followed by T2B and T3B respectively, while the lowest frequency with T1B. Our study reported a strong correlation between the tumer stage and time to brain metastasis with significant P value = 0.033In regards of primary breast cancer metastasis ,The results showed that HER2 overexpressed were 19 patients (40.4%), Triple negative were 10 patients (21.3%) ,Luminal A - like were 9 patients (19.1%) and Luminal B - like were 9 patients (19.1%),. The highest frequency was seen among patients with HER2 overexpressed followed by triple negative.Our results showed a negative correlation between the molecular subtypes and time to develop of brain metastasis with P value = 0.482 which was statistically not significant

تقييم الكالسيوم في الدم في مرضى الدرن الرئوي النشط : دراسة مقدمة الى كلية الطب ولجنة الدراسات العليا لجامعة بغداد في جزء الاستيفاء لمتطلبات الحصول على درجة الدبلوم في طب الجهاز التنفسي == Assessment of serum calcium in active pulmonary Tuberculosis patients

Author name: هدى مؤيد حميد
Supervisor name: عدنان الجبوري
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: السل هو عدوى بكتيرية تسببها المتفطرة السلية ، وعادة ما تتميز هذه الامراض بتشكيل الاورام الحبيبية. الموقع الاكثر شيوعا للعدوى هو الرئة ، لكن الاجهزة الاخرى قد تكون متورطة. ينتشر عن طريق الهواء عند الاشخاص الذين يعانون من مرض السعال او العطس او البصاق. لا يزال مرض السل يمثل مشكلة صحية رئيسية في العالم ، حيث يتسبب في اعتلال الصحة بين ملايين الناس كل عام ، ويحتل المرتبة الثانية كسبب رئيسي للوفاة من جراء الامراض المعدية في جميع انحاء العالم.الهدف من الدراسة : تقييم مستوى الكالسيوم في الدم عند المرضى البالغين ومصابين بالسل الرئوي النشط.المرضى والطريقة : تم اجراء دراسة السيطره والضابطه في المركز المتخصص في امراض الصدر والجهاز التنفسي ، في الفترة من 1 كانون الاول / ديسمبر 2017 حتى نهاية ايار / مايو 2018. (80) تم تضمين المستجيبين في الدراسة الحالية وعددهم (80 شخصا) وتم تقسيمهم الى مجموعتين. : 40 مريضا مصابين بالسل ومجموعة اخرى تحتوي على 40 عنصر بصحه جيده كمجموعه ضابطه. تم تشخيص مرضى السل سابقا في المركز التنفسي والصدر.النتائج : كان نطاق السن بالنسبة لمجموعة السل من 17 - 59 سنة مع متوسط عمر 36.95 ± 12.6 سنة. تتراوح الفئة العمرية الرئيسية بين 30 - 39 عاما بينما تقل الفئة العمرية اقل من 20 عاما. حوالي 77.5 ٪ من مرضى السل كانوا في سن اقل من 50 سنة والبقية (22.5 ٪) في عمر اكبر من 50 سنة. الذكور كانت سائدة اكثر من الاناث حيث تمثل 22 (55٪) في مجموعة الحالات ، في الارضاء الى المجموعة الضابطة كانت المراة المهيمنة على الذكور (24٪) في المجموعات المدروسة ، فقد تراوح مستوى الكالسيوم في المصل بين (6.6 - 10.4مغ/مل). مع متوسط مستوى 8.99 ± 0.64 مغ / دل في المجموعة الضابطة ، تفاوت مستوى الكالسيوم في المصل من 8.2 الى 10.0 ملغم / ديسيلتر مع قراءة متوسطة قدرها 9.01 ± 0.43 ملغ / ديسيلتر. لم يكن هناك فرق معنوي في المستويات الوسطية بين مرضى السل ومجموعة المقارنة حسب هذه الدراسة الخلاصة : مستويات الكالسيوم في المصل تميل الى الهبوط في مرضى السل الرئوي النشط ولكن دون اختلافات احصائية كبيرة | Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis, usually characterized pathologically by the formation of granulomas. The most common site of infection is the lung, but other organs may be involved. It is spread through the air when people who have the disease cough, sneeze, or spit. Aim of the study : To assess the level of serum calcium in adult patients with active pulmonary tuberculosis.Patients and method : A case control study was carried out in respiratory and chest disease specialized center/medical city complex from the 1st of December 2017 to the end of May 2018. (80) Respondents were included in the current study and divided into 2 groups : 40 patients with pulmonary Tuberculosis and other group contain 40 healthy controls. TB patients were previously diagnosed in the Respiratory and chest center.Results : The range of age regarding to the Tuberculosis group were from 17 - 59 years old with the mean age of 36.95±12.6 years. The main age group is between 30 - 39 age group. Male were dominant than female in which it represents 22(55%) in the cases group. Serum calcium level in studied groups, it varied from (6.6 - 10.4 mg/dl) in Tuberculosis group with a mean level of 8.99±0.64 mg/dl. In control group, serum calcium level varied from 8.2 to 10.0 mg/dl with a mean reading of 9.01±0.43 mg/dl. There was no significant difference in mean levels between TB patients and comparison group according to this study (P > 0.05)Conclusion : Serum calcium levels tend to be lower in active pulmonary tuberculosis patients than normal (control) group but with no statistically significant differences

حياة مرضى سرطان الثدي العراقيات اللواتي عولجن بالعلاج الاشعاعي الثلاثي الابعاد الخالية من الانتكاسة المرضية في مركز بغداد للعلاج الاشعاعي في دائرة مدينة الطب == Progression Free Survival in Iraqi Breast Cancer patients treated by Adjuvant 3D Conformal Radiotherapy in Baghdad Radiation Oncology Center Medical City Complex

Author name: ايناس خضير البدير
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
Key words:
  • Adjuvant 3D conformal radiotherapy
  • Breast cancer
  • Progression free survival
  • Luminal A subtype
  • HER2 neu receptors
First pages:
Abstract: سرطانات النساء المسجلة وفقا لاخر احصائية مسجلة في العراق. العلاج الاشعاعي ذو فائدة من اجل السيطرة على سرطان الثدي الموضعي الراجع وايضا في الحفاظ على حياة النساء المصابات بسرطان الثدي المستقبلية بدون مضاعفات.اهداف البحث : هدفت الدراسة الى استخلاص PFS لمريضات سرطان الثدي اللاتي عولجن بواسطة العلاج الاشعاعي الثلاثي الابعاد ، ولمعرفة العلاقة التي تربط بين PFS مع الاعراض السريرية والمرضية .طرق البحث : استعرضنا باثر رجعي 299 حالة من النساء المصابات بسرطان الثدي اللواتي تم علاجهن في مركز بغداد لعلاج الاورام بالاشعاع في الفترة ما بين شهر اكتوبر 2017 وشهر ايار 2018. استخدمنا 4005 cGy في 15 جلسة على مدى 3 اسابيع كعلاج اشعاعي للمرضى اللاتي قمن باستئصال الثدي كاملة واستخدمنا 4005 cG في 15 جلسة مضافة اليها 1000cG في 5 جلسات كجرعة معززة للنساء اللاتي اجرين جراحة لازالة الورم فقط . النتائج : تراوحت اعمار المريضات في هذه الدراسة من 25 سنة الى 75 سنة مع متوسط اعمار 49.9 ± 10.99 سنة من النساء المصابات بسرطان الثدي. في المرحلة T ، وجدت انها تمثل المرحلة الاكثر شيوعا في دراستنا 156 (53.9٪) ، والتي كانت في معظمها نمطا A 105 (36.3٪) من المرضى. اظهرت نتائج هذه الدراسة ان نسبة عالية من N1 109 (37.2 %) من النساء عن جميع المراحل الاخرى وفيما يتعلق بالانواع الجزيئية لسرطان الثدي ، والتي تمثل Luminal A النمط الظاهري الرئيسي 69 (23.4 ٪). نتائج هامة تم الحصول عليها من معامل ارتباط بيرسون [(r) = 1] ، بين العمر ، ومؤشر كتلة الجسم ، ومراحل T عندما ترتبط بالانواع الجزيئية للمرض ، ER ومستقبلات HER2 neu في نساء سرطان الثدي. تم تطبيق منحنى البقاء على قيد الحياة (كابلان ميير (وتم تقدير PFS لمرضى سرطان الثدي وقد سجلنراجوع سرطان الثدي مرة اخرى في 35/299 حالة من المرضى في هذه الدراسة 11.7 ٪. في حين الرجوع الموضعي لسرطان الثدي في جدار الصدر حدثت في 9 (25.9 %) من الحالات. الاستنتاجات : ان العلاج الاشعاعي المساعد يقلل من الارتجاع الموضعي للمرض ، ويقلل ظهور الاورام الثانوية ، ويقلل معدل الوفيات وذلك من خلال التاثير في PFS . | Background : Breast cancer is one of the most common malignancies in Iraq, accounting one - third of female cancers in the latest Iraqi Cancer Registry. Radiotherapy of benefits for locoregional control and for progression free survival (PFS) of breast cancer.Objectives : The study aimed for asses progression free survival for patients treated by hypofractionated three dimensional conformal radiotherapy (3DCRT) and for correlation this progression with patients' clinical and pathological profiles. Methods : Retrospectively reviewed 299 females with breast cancer, treated at Baghdad Radiation Oncology Center and the study conducted in period between October 2017 and May 2018. 4005 cGy in 15 fractions over 3 weeks has been adopted as standard practice in radiotherapy for those done mastectomy and 4005 cG/15 fractions + 1000 cG/5 fractions as booster dose for women undergo breast conserving surgery (BCS). Results : Age in this study ranged from 25 years to 75 years with a mean (49.9±10.99 years) of breast cancer women. The most common stage was T2 156 (53.9%), which was mostly a luminal A phenotype as 105 (36.3%). The results showed high frequent of N1 staging 109 (37.2%) women overall other stages, with a luminal A 69 (23.4%). A significant results obtained from correlation coefficient [( r ) = 1], between age, BMI, and T stages when correlated to molecular subtypes, ER and HER2 neu receptors. Kaplan Meier survival curve performed and estimation of PFS. Relapsing of breast cancer occurred in 35/299 (11.7%). Chest wall relapse occurred in 9 (25.9%), which was the commonest pattern of relapsing. Conclusions : Adjuvant radiotherapy treatments reduce locoregional recurrence, distant metastasis and death rate by affecting progression free survival of patients.

تقييم برنامج رصد وفيات الامهات في محافظة واسط, العراق 2012 == Evaluation of Maternal Mortality Surveillance System in Wassit governorate, Iraq, 201211

Author name: وجدان سعيد عاصي
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:
Abstract: This cross sectional study was conducted on maternal deaths in Wassit governorate for 2012. The study was conducted to evaluate the surveillance system for maternal deaths in the hospitals and the MCH unit in the health directorate.Review of all the death registers in the hospitals, (6) hospitals, forensic medicine section, offices of birth and death registration from 365 dead women at reproductive age 22 was maternal death which included in the study.The study showed that the maternal deaths occur mainly in the younger age group, multiparum and resident in rural area. The main cause of death was hemorrhage, pulmonary embolism and septicemia. 73% of deaths occurred during delivery, 50% in the health institution. 77% of death refereed to the forensic medicine unit, 91% of the death certificates no pointing at the section of reproductive age.The sensitivity of the surveillance system to detect maternal deaths was 82% 18 deaths detected by the surveillance program befor implementation and RAPID test. The positive predictive value 100%. MMR was 46/100000 live births inWassit governorate for 2012.Evaluation of the surveillance programme at the level of hospitals showed some weak points in the structure, quality, support function and the core function which needs strengthen and re evaluation, the surveillance program at the level of the MCH unit was good so according to this results we recommend : 1 .Improving the quality & quantity of service provided to pregnant women during pregnancy and childbirth especially in the rural area. 2. Increase community awareness about the importance of delivery in health institutions and danger signs during pregnancy, delivery and purprium.3. Monitoring and evaluation of the surveillance system based on current priorities (structure, core function, quality) then strengthening and utilization of existing system for data collection, analysis and response.4. Training and retraining all the staff in the hospitals for detection and reporting maternal deaths.

معدل انتشار السمنة بين الطالبات المراهقات في المدارس الثانوية في مدينة الفلوجة 2017 == Prevalence of obesity among female adolescents in secondary schools in Al - Fallujah city 2017

Author name: رغد باسم عبد الرزاق
Supervisor name: علياء مكي حسن الصافي
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 : Obesity is a growing public health problem in both developed and developing societies. Changes in lifestyle, dietary habits, physical activity and the social and cultural environment are associated with the occurrence of obesity.Objectives : to estimate the prevalence of obesity among adolescent females in secondary schools in Al - Fallujah city and to highlight the possible factors that may be associated with obesity among the study sample.Methods : A cross - sectional study was conducted on the period from 1st - March till 1st - May - 2017, and involved a systematically chosen sample of 200 female students, 13 - 19 years old from a conveniently chosen two secondary public schools for females in Al - Fallujah city, Al - Anbar governorate. A questionnaire used to collect socio - demographic characteristics, dietary habits, daily physical activity and family history of obesity. Height and weight were measured to determine their BMI by using WHO BMI - for - age 2007 percentile references.Results : the prevalence of obesity for studied female students was 18% which was significantly associated with different age groups, positive family history of obesity, meals frequency (n/day), more sweets, potato crisps & carbonated beverages consumption, TV watching & playing videogames time (h/day) and home ownership.Conclusions : the prevalence of obesity was nearly one fifth of the studied population. So that health education programs about healthy lifestyle, healthy dietary habits and adverse health consequences of obesity and activation of the school sport lessons are essential to be implemented among secondary schools to help preventing obesity.

دور الدوبلر النسيجي لصدى القلب في تحديد مدى وشدة امراض شرايين القلب التاجية == Role of pulse tissue Doppler in determining the extent and the severity of coronary artery disease

Author name: علاء يوسف حسن
Supervisor name: هلال بهجت شوقي الصفار
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: Imaging (TDI) is affected by increasing severity of coronary artery disease (CAD) among patients with stable angina pectoris and preserved ejection fraction.AIM OF STUDYTo determine the role of tissue Doppler in determining extent and severity of coronary artery disease.MethodsThis study includes eighty two (82) patients with chronic stable angina pectoris referred to tertiary cardiac centre for coronary angiography, 50 cases were males and 32 females and all patients were examined by echocardiography at first then coronary angiography; all patients had normal ejection fraction > 50 % as part of inclusion criteria, also each patient had been examined for : 1) Mitral inflow pulse Doppler parameters with early diastole E, late diastole A and ratio of E/A2) Pulse tissue Doppler parameters of mitral annulus; E : early diastolic motion , A : late diastolic motion , S : systolic motion and ratio of E/A.3) The ratio of early diastole mitral valve inflow to early diastolic motion ofmitral annulus tissue Doppler ( E / E) as marker of left ventricular filling pressure.The pulse tissue Doppler parameters as above in number 2 had been examined at six mitral annulus regions ( septal , lateral , anterior , inferior , posterior and anteroseptal ).After that diagnostic coronary angiography was done for all patients and results of coronary angiography ≥ 70 % angiographic stenosised vessels were considered significantly diseased and named as patients group , below that value considered non significant including normal vessels so the latter was considered as control group .Number of the above patients group (45 patients), and the control group (37 patients).The patients group also classified as ; those with LAD disease was named one vessel disease , LAD + LCX ( or ≥ 50 % LMS) was named two vessel disease 32 ,33 , and three vessels disease includes LAD + LCX + RCA .The 45 patients in the patients group subdivided into subgroups as following : 1) Patients with one vessel disease (16 patients).2) Patients with two vessel disease (14 patients). 3) Patients with three vessel disease (15 patients).Each one of the above subgroups that significantly angiographic stenosed were compared with patients of the control group for tissue Doppler parameters ( E , A , E/A,S ) regionally and globally.Regionally mean each TD parameter from one of six regions of mitral annulus e.g septal , lateral,anterior , inferior, posterior and anteroseptal was compared between the patient subgroups and the control group.Globally mean for each tissue Doppler parameters E, A, E/A, S take mean value for all six annulus regions to be compare between the patient subgroups and the control group.Each patient with significant coronary disease was matched with a control of the same age, sex, body mass index, and status regarding diabetes and hypertension.ResultsThe mean age of the all eighty two patients (82) that included in this study was (53.5±8.4) years, range (40 - 67) years, (50) male patients (61%), and (32) female patients (39%).The patients group with significantly angiographic stenosis was (45) patients, mean age (57±7.7) years, range (50 - 67) years, (27) male patients (60%) , and (18) female patients (40%).The patients group divided into subgroups as following : one vessel disease 16 patients (36%), two vessel disease 14 (31%) patients, three vessel disease 15 (33%) patients.The control group was (37) patients, mean age (50±9.2) years ,range ( 40 - 58) years , (23) male patients (62%) and (14) female patients (37%).From comparison between patients group with the control group;No significant difference regarding clinical baseline characters was found between the patients group and the control group ( p value >0.05).Notably, no significant difference was observed with regards to LVEF, echo. dimensions of the left heart chambers or conventional diastolic parameters ( p value > 0.05).Differences were founded mainly in echo. Pulse TD parameters from comparison between the subgroups of patients and the control group as the following : A. Global TD diastolic parameters : 1. Significantly reduced ratio of E/A in one vessel disease ( p value 0.032).2. Near normal and normal E/A ratio in two and three vessel disease respectively (mean no significant differences p value 0.085, 0.12 respectively).3. Significantly increased E/E in three vessels disease only ( p value 0.016) .B. Global TD systolic parameters : Significantly reduced S in two and three vessels disease ( P value 0.043 ,0.001 respectively).C. Regional TD parameters : Show significant reduction of regional S with only three vessels coronary artery disease in anterior, lateral and inferior regions ( p value 0.036,0.022,0.047 respectively).ConclusionTDI performed at rest reveals both diastolic and systolic dysfunction in patients with stable angina pectoris with significant coronary artery stenosis even when the ejection fraction is preserved and the nature of the cardiac dysfunction correlate with number of significantly diseased vessels.

تقييم الفحص بالرنين المغناطيسي والامواج فوق الصوتية بالمقارنة مع الفحص النسيجي لورم الرحم الليفي == Evaluation of Uterine Fibroid Using MRI & U/S with Histopathological Correlation

Author name: زهراء هاشم محمود
Supervisor name: ليث احمد طعمة
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: Uterine fibroids, also known as leiomyomas, are the commonest uterine neoplasm's about 30% - 40% in the reproductive age , Although benign, they can be associated with significant morbidity and are the commonest indication for hysterectomy, they are often discovered incidentally when performing imaging for other reasons, usually first identified by USG which the cheapest, easiest, safe during pregnancy, they can be further characterized by MRI, they are usually easily recognizable, but degenerate fibroids can have unusual appearance, MRI is informative in excluding associated Adenomyosis. AimTo evaluate US &MRI sequences in patients with leiomyoma about detection, number, mapping, characterization &associated other lesions correlated with histopathological result after surgical treatment.Patients & methods A prospective study was done in the Radiological department of BAGHDAD teaching hospital from September 2012 through May 2013, about 65 females patients where imaged by MRI after physical examination & US, where 45 patients did operation myomectomy or hysterectomy.Resultsage of patients 19 - 69 years mean age 39.4y, The women presented with menorrhagia and a variety of symptomes,45 patients where followed up by hysterectomy & myomectomy which inter really in my study ,the remaining (20 patients) non operative treated medically and followed up by US, MRI detect more than US in 60 fibroids which not detected by US being MRI more sensitive 98%, specific93% &accurate 97% than US ,also MRI more specific (93.9%)&more accurate 97%in detecting single &multiple fibroids than us with low specificity (50%)&accuracy (63.9%), also MRI more sensitive in detecting smaller fibroid <1cm 95.2% compared with US sensitivity 15.5%, about mapping US was 89%agree with histopathology results while MRI was more agreement with histopathology 98%, about 7 patients from 45(15.6%) was found to have Adenomyosis with fibroids which all of them diagnosed by MRI, we depend on T2 sequence in detecting fibroids which show about 80%hypointense, MRI cannot differentiate between the type of degeneration which about 2/3 degenerated , 44%show contrast enhancement which is not important in detection and characterization , in most of cases fibroids are iso to hypointense in T1.Conclusion : Superior sensitivity and minimal measurement discrepancies suggest MR imaging superior to US in evaluation for uterine fibroid especially pre surgical study &to exclude other causes of large uterus & should be preferentially utilizedfor assessing fibroids .

مقارنة بين التصوير بالموجات فوق الصوتية والتصوير بالرنين المغناطيسي في وصف كتل ملحقات الرحم == Comparison of magnetic resonance imaging and Transvaginal ultrasound findings in evaluation of adnexal mass

Author name: اخلاص حميد علي
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: دراسة مقارنة مكونه من 45 حالة مرضية اجريت في مستشفى بغداد التعليمي في مجمع مدينة الطب خلال الفترة من اغسطس 2012 والى اغسطس لسنة 2013 وقد قورنت نتائج التصوير بالرنين المغناطيسي والتصوير بالموجات فوق الصوتية لوصف كتل ملحقات الرحمالنتائج : ان معظم ملحقات كتل الرحم كانت تابعة لحلات حميدة شائعة وقد شكل الكيس الوظيفي البسيط اعلى نسبة( 20%)ويتبعه كل من الكيس النزفي بنسبة( 17.7%) ومرض هجرة بطانة الرحم بنسبة ( 13.3%)على التوالي .كانت نتائج التصوير بالموجات فوق الصوتية من ناحية تحديد موقع الورم متوسطة التوافق مع التشخيص النهائي مقارنة بالرنين المغناطيسي كان التوافق جيد جدا مع التشخيص النهائي. كانت نتائج التصوير بالموجات فوق الصوتية لتحديد كون الكتل خبيثة او حميدة حساسة بنسبة(100 %) وكانت خصوصية بنسبة(52%) وكانت درجة الدقة (62%) مقارنة بنتائج التصوير بالرنين المغناطيسي كانت حساسة بنسبة(100 %) وكانت خصوصية بنسبة(91%) وكانت درجة الدقة (93%)الاستنتاجات : ان ملحقات كتل الرحم الغير محددة عند الفحص بالموجات فوق الصوتية الغير موكدة الموقع والصلبة والكيسية المعقدة ستستفيد من الفحص الاضافي بالرنين المغناطيسي والذي كان على درجة عالية من الدقة في تحديد منشا الكتلة وخصائصها. | Aim : To compare the findings of transvaginal ultrasound and pelvic magnetic resonance imaging in patients with adnexal mass.Patient and method : Comparative cross sectional study was conducted in radiological department of Bagdad Teaching Hospital in the medical city center in period from August 2012 to August 2013 ,forty five female patient was examined by magnetic resonance imaging after physical examination and trans vaginal ultrasound examination, and the result was correlated with histopathology in 29cases only.The aged from 18 - 70 years old ,the women present with variety of symptoms include irregular cycle , abdominal pain, dysmenhorria and menorrhagia . Results : forty five patients enrolled in this study,33 patients (73.3%) were in reproductive age and 12 (26.7%) were post menopause, benign condition more than malignant ,simple follicular cyst was the higher percent consist( 20% ),followed by hemorrhagic cyst (17.7% ),followed by endometrioma( 13.3%)Regarding the origin of mass magnetic resonance imaging had(k0.89) almost perfect agreement with final diagnosis whereas the transvaginal sonography had (k o.42) moderate agreement with final diagnosis.Regarding tissue characterization magnetic resonance imaging had ( k = 0.83) almost perfect agreement . magnetic resonance imaging had sensitivity of 100%, specificity of 91% for identifying malignant and benign lesion Whereas transvaginal sonography had sensitivity of 100%, specificity of 52% Conclusion : sonograpgically vague adnexal mass of uncertain origin and solid or complex content will be benefit from further evaluation by magnetic resonance imaging,which highly accurate for identifying the origin of the mass and characterization of its tissue content.

انتشار كتلة العضلة غير الطبيعي لدى المرضى العراقيين المصابين بفصال الركبة وتاثيرها على نوعية الحياة == Prevalence of Abnormal Muscle Mass in Iraqi Patients With Knee Osteoarthritis and its Effect on Quality of Life

Author name: رغد دريد يحيى
Supervisor name: 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: Age - related osteoarthritis is characterized by degradation of articular cartilage and substantial loss of matrix, as a consequence of senescence; Intra - articular cell senescence and cartilage matrix degradation, extraarticular loss of skeletal muscle mass and deteriorated proprioception contribute to development of osteoarthritis. Age - related degenerative loss of skeletal muscle mass and strength is referred to as Sarcopenia, skeletal muscle mass is the metabolically active body component, however, fat massis metabolically inactive, so that the changes of skeletal muscle mass and fat mass with aging can be one of the most relevant biomarkers of senescence.Aim of the study This study was conduc ted to assess the prevalence of abnormal muscle mass (sarcopenia) in Iraqi patients with knee osteoarthritis and to evaluate the effect of sarcopenia on knee osteoarthritis patient's quality of life.Patients and methods This was a cross sectional study conducted at Baghdad Teaching Hospital, Unit of Rheumatology during the period from august 2017 to the end of June 2018, a total of 150 Iraqi females aged 50 years old and older with knee osteoarthritis. Plain X - rays of the weight bearing bilateral knee joints were obtained from the anterio - posterior and lateral aspects with 30º of knee flexion, quality of life and disease impact assessment was done by using Western Ontario and McMaster Universities Osteoarthritis Index, Physical activity measurement was done by using The leisure - time Physical Activity Index. Assessment of sarcopenia was done by using a dual energy x - ray absorptiometry scan for the body composition analysis, fat mass, lean mass, and bone mineral density. Diagnosis of sarcopenia was made via measuring skeletal mass index which defined as appendicular skeletal muscle mass /height m², cut off point ≤ 5.6 kg/m² for female and handgrip strength was measured using a Dynamometer, cut off point < 20 kg. Body mass index (BMI) was measured. History of sociodemographic and medications including steroid and NSAIDs were taken.Results : The current study revealed that 14 (9.3%) of Iraqi women with knee osteoarthritis had sarcopenia. BMI appear to significantly predict sarcopenia (negative correlation), since the OR less than 1.0, both T score and Z predict sarcopenia (negative correlation) and T score appear to predict sarcopenia better than Z score (since the OR is lower in T score compared to Z score), LM and FMI negatively correlated with sarcopenia, gripe strength negatively correlated with sarcopenia.Age, menopausal duration, and sarcopenia appear to directly correlate with osteoporosis, while BMI, LM, FMI, negatively correlated with osteoporosis. Patients with sarcopenia had 7 folds increase risk of having osteoporosis. There was no significant association between WOMAC scoring (quality of life indicator) and sarcopenia and osteoporosis in women with knee osteoarthritis.

الارتباط الوثيق بين تكرار تضيق الشبكة بعد تلوين الاوعية الدموية ومستوى HbA1C بعد العملية في مرضى السكري الذين اجريت لهم عملية التداخل التاجي عن طريق الجلد مع زرع شبكة دوائية == CORRELATION BETWEEN ANGIOGRAPHIC IN - STENT RESTENOSIS AND POST - PROCEDURAL GLYCOSYLATED HEMOGLOBIN LEVEL IN DIABETIC PATIENTS UNDERWENT PECUTANEOUS CORONARY INTERVENTION WITH DRUG ELUTING STENT

Author name: مازن زامل الشباني
Supervisor name: امال نوري المراياتي
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: مرض السكري، شائع، معقد، وهو اضطرب ايضي مزمن ويعتبر كعامل خطورة مهم لامراض القلب والاوعية الدموية ،ممكن تعديله ويعتبر عامل تخميني مستقل لتكرار تضيق الشبكة بعد اجراء عملية التداخل التاجي عن طريق الجلد.الاهداف : تحديد تاثير مستوى (HbA1c) على نسبة تردد تضيق الشبكة الدوائية لدى مرضى السكري الذين اجريت لهم عملية التداخل التاجي الاختياري عن طريق الجلد . المرضى والطرق : تم تقييم 89 مريض كان قد اجري لهم عملية التداخل التاجيالاختياري عن طريق الجلد وتم وضع شبكة دوائية لهم، ادخلواالى المركز العراقي لامراض القلب لغرض اجراء قسطرة الشرايين التاجية الاختيارية مع او بدون تداخل قسطاريللفترة بين نيسان 2013 - مايس 2014 وتم تقيم حالتهم جيدا.تم استثناء26 مريض من الدراسة لاسباب متعددة . تم تقيم حالة 63 مريض لمعرفة انفتاح الشبكة خلال عملية اجراء القسطرة. 29 مريض كانت الشبكة لديهم غير متضيقة .34 مريض كان لديهم تضيق في الشبكة وتم اجرا تحليل HbA1c لهم. يعرف مرض السكري عندما يكون تركيز السكر بالدم في حالة الصوم dl/mg126 ≤، نسبة السكر العشوائي 200 ≤dl/mg مع اعراض ايحائية او وجود تاريخ مرضي موجب لمرض السكري مع حمية غذائية او في حالة استعمال الادوية المخفضة للسكر عن طريق الفم او زرق الانسولين اثناء فترة الرقود في المستشفى. تم تصنيف مرضى السكري الى مجموعتين طبقا الى معدل مستوى HbA1c، مستوى سيطرة سكري جيد (HbA1c ≥7%) ومستوى سيطرة سكري ضعيف (HbA1c > 7%).النتائج : تضيق الشبكة موجود عند 19((55.9% ذكور و(44.1%)15 اناث. في الجدول رقم 2 وجد وذو قيمة بان 27 (79.45%) من المرضى المصابين بالسكري ولديهم مستوى سيطرة ضعيف هم اكثر اصابة بتضيق الشبكة الدوائية (P.value <0.005). الجدول رقم 4، تضيق الشبكة اكثر حدوثا في الشريان الامامي النازل (الجزء الوسط والبعيد) بعد اجراء عملية التداخل التاجي الاختياري في20 مريض من اصل 7 2 في حالة وجود مستوى سيطرة ضعيف على السكري ((P.value <0.005.الاستنتاجات : تشير هذه الدراسة الى وجود ارتباط وثيق بين مستوى سيطرة ضعيف على السكري وبين زيادة تضيق الشبكة الدوائية عند المصابين بمرض السكري . ان مستوى السيطرة الضعيف على السكري يساعد على تضيق الشبكة الدوائية عند اجراء التداخل القسطاري في الشريان التاجي الامامي النازل (الجزء الوسط والبعيد)لدى المصابين بمرض السكري. | Diabetes mellitus is a common, complex, and chronic metabolic disorder act as an important modifiable risk factor for cardiovascular disease and has been shown to be an independent predictor for instent restenosis after percutaneous coronary intervention. Objectives : To determine the influence of HbA1c level on the frequency of instent restenosis in diabetic patients after elective percutaneous coronary intervention. Patients and Methods : 89 diabetic patients with recurrent ischemia had history of previous percutaneous coronary intervention and stented coronary arteries with drug eluting stent were admitted to the Iraqi Center for Heart Diseases for elective coronary catheterization with or without percutaneous coronary intervention in period between April 2013 and March 2014. All patients were evaluated thoroughly. 26 patients were excluded for different reasons. 63 patients were assessing for stent patency during catheterization. 29 patients with patent stents. 34 patients with instent restenosis were investigated with HbA1c level. Diabetes mellitus was defined as fasting blood sugar concentration ≥126 mg/dl, random blood sugar ≥200 mg/dl with suggestive symptoms or positive history of diabetes mellitus with diet control or use an oral hypoglycemic agent(s) or insulin at the time of admission. Patients with instent restenosis were categorized into two groups based on their HbA1c level, good glycemic control (HbA1c ≤ 7%) and poor glycemic control (HbA1c >7%).Results : Males represent 19 (55.9%) and females represent 15 (44.1%) of diabetic patients with instent restenosis. In table 2, 27 (79.45%) diabetic patients with poor glycemic control more likely to have instent restenosis than 7 (20.6%) patients with good glycemic control, P.value < 0.005. In table 4, instent restenosis more likely to occur in non - proximal left anterior descending artery after elective PCI in 20 out of 27 patients with poor glycemic control, P.value < 0.005.Conclusions : Our study reveals that there is a correlation between poor glycemic control and increased frequency of instent restenosis of drug eluting stents in diabetic patients. Poor glycemic controlled diabetic patients are more liable for instent restenosis of drug eluting stents after intervention in non - proximal left anterior descending artery.

دراسة الحصيلة التشخيصية لخزعة الرئة المفتوحة في المرضى المشتبه باصابتهم بمرض الرئة الخلالي == The Diagnostic Yield of Open Lung Biopsy in Patients with Suspected Interstitial Lung Disease

Author name: سجى علي حسين
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 : The diagnosis of interstitial lung disease (ILD) is frequently delayed, because clinical clues are neglected and respiratory symptoms are ascribed to more common pulmonary diagnosis such as chronic obstructive pulmonary disease in the primary care setting. Objective : The present study was aimed to evaluate the yield of open lung biopsy in patients with suspected ILD. Subjects and methods : Thirty five patients were admitted with suspected interstitial lung disease (ILD), and scheduled for open lung biopsy (OLB) in Ghazi AL - Hariri hospital for surgical specialty, were the cohort of this study. Data collected from the patients files (who subjected to open lung biopsies which had been histopathologically studied) in the period from 1st of January 2013 through 31st of May 2015 and were studied retrospectively.Results : There were 11 (31.4%) males and 24( 68.6%) females, the mean age was 46±14 years , dyspnea was the common presenting symptoms in patients 24(68.6%) , dry cough was the presenting symptoms in10 (28.6%)patients , bilateral diffuse crepetations were heard in 20 (57.2%) patients, bilateral fine basal crepitation were heard in 11 (31.4%) , clubbing with bilateral fine basal crepitations heard in 4 (11.4%) ,chestx - rays findings were : lower zone infiltration in 11 (31.4%),reticulonodular infiltration in 10 (28.6), nodular infiltration in8 (22.9%) and opacities in6 (17.1%). CT findings were : basal infiltration in11 (31.4%), reticulonodular infiltration in 10 (28.6%), nodular infiltration in 8 (22.9%) and ground glass appearance s in 6 (17.1%). Histopathological examination (obtained from Open lung biopsy) results were : had usual interstitial pneumonia (idiopathic pulmonary fibrosis) 21(60%) ,7 (20%) metastasis, 5 (14.3%) pulmonary TB and 2( 5.7%) broncho - alveolar cell carcinoma.Conclusion : Open lung biopsy can safely be performed in patients with suspected interstitial lung disease. It gave a high diagnostic yield and alters the diagnosis and management in a significant number of patients

تقييم عدم تزامن انقباضية البطين الايسر لدى مرضى ارتفاع ضغط الدم ممن يمتلكون قوة ضخ ضمن المعدل الطبيعي == Echocardiographic assessment of Left Ventricular Dyssynchrony in Hypertensive Patients with Normal Systolic Function

Author name: مروة طارق محمد
Supervisor name: علي ال ياسين
General topic: Medicine
Specific topic: Echocardiography
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: congestive heart failure,the majority of such patients have systemic hypertension. Recent studies have demonstrated Left Ventricular dyssynchrony among patients with heart failure and normal systolic function.The co - existence between Left Ventricular dyssynchrony and hypertension with normal systolic function (with no clinical evidence of heart failure), is less well understood.The Aim of study : To assess the Left Ventricular dyssynchrony among hypertensive patients with normal systolic function by using Tissue doppler imaging.To find out the associations between the LV dyssynchrony and other global echocardiographic findings like (LA volume index, LVmass index , LV sephericity and LV filling pressure E/E) .Patients and method Prospective case - control study conducted in Baghdad Teaching Hospital from 1st of June 2015 to 30th of May 2016 .Study included two groups of people, a 40 age_ matched healthy (control) group (group1) and 60 patients with established hypertension (group 2). A Complete 2 - D and TDI echocardiography studies with simulitnous ECG were performed for all patients. Examination involved LV septal and posterior wall thicknesses, internal dimensions, left atrial size, ejection fraction and tissue doppler derived waves velocities E', E/E.' Dyssynchrony was determined by measuring T - P max ( the maximal time difference from the onset of QRS to peak systolic velocity on TDI between any opposing LV wall in 3 apical views) .Results : The study included 40 age - matched control people, 27males (67.5%) and 13 females (32.5%) with a male to female ratio was 1.8 : 1, ranging from (42.4 - 58y) with mean age was (50.2 ±7.8y ) (group 1) and 60 hypertensive patients, 38 males (63.3%) and 22 females (36.7%) with a male to female ratio was 1.7 : 1, ranging from (48.5 - 66.5y) with mean age of (57.5± 9.0 y) (group 2) .Left Ventricular dyssynchrony was identified in 20 of 60 patients (33.3%) .Dyssynchrony had no significant association with age and BSA. Dyssynchrony was significantly associated with LA volume index (r = 0.61, p=0.001), LV mass index (r=0.52 ,p=0.001) , LV sphericity index (r= 0.5, p = 0.003) ) and LV filling pressure (r=0.6 , p value=0.001) . Dyssynchrony had significant negative correlation with ( E) velocity (r= - 0.7 ,P =0.001) .

تقييم فرط مرونة المفاصل لدى المرضى العراقيين المصابين بمرض الفتق الاربي == Assessment of Joint Hypermobility in Iraqi Patients With Inguinal Hernia

Author name: وسيم كامل غيث
Supervisor name: 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: Joint hypermobility (JHM) is an excessive range of movement of the joint due to laxity of supporting connective tissue. Inguinal hernia is proposed due to weak supporting tissue that may be a clinical presentation of a more widespread problem of connective tissue.Objective : To assess JHM in Iraqi patients with inguinal hernia.Patients and methods : A total of 200 individuals were included in this study, 100 patients had inguinal hernia diagnosed by a surgeon based on clinical and abdominal ultrasound examination, and another 100 healthy individuals matched in age & sex were taken as a control group.A questionnaire paper consisted of personal data including : Age, sex, weight, height, and body mass index (BMI). The assessment of joint mobility was measured according to Beighton score method for all the participants in the study.Results : One hundred patients with inguinal hernia and 100 healthy control group, all of them were males. The mean age of patients was (35.5± 9.5) year and controls (33.2 ± 10.5) year. The mean BMI was (25.3 ± 3.1) kg/m2 for patients and (25.1 ± 3.8) kg/m2 for controls. No statistical significant difference between patients and controls (P>0.05).JHM was significantly more in inguinal hernia patients than in controls (55(55%) vs 20(20%), p<0.001, OR=4.9; 95% CI = 2.6 - 9.2). The total joint mobility score among inguinal hernia patients was significantly higher than controls and was associated with a higher risk of developing inguinal hernia. In addition JHM was significantly increased among older age and overweight patients (p<0.05).A multiple logistic regression model was statistically significant and able to predict the group membership with 64% accuracy. Having an average score for joint mobility (4 - 6) increased the risk of having inguinal hernia by 5.2 times compared to those with negative hypermobility (score<4). Increasing the joint mobility score further to (7 - 9) increased the risk of having inguinal hernia by 11.3 times compared to those with negative hypermobility (score<4) Conclusions : JHM was significantly more prevalent among Iraqi patients with inguinal hernia patients than controls. The total joint mobility score among inguinal hernia patients was higher than controls. A higher score for JHM was associated with a higher risk of developing inguinal hernia.JHM among older age and overweight patients may predict inguinal hernia.

تاثير مؤشر كتلة الجسم على الاستجابه السريريه لعقار افلكسماب عند مرضى التهاب الفقار المقسطط == Body Mass Index and Clinical Response to Infliximab in Ankylosing Spondylitis Patients

Author name: علي محمد علي الحمداني
Supervisor name: محمد هادي العصامي
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: axial skeleton(spine and sacroiliac joints) , peripheral joints, enthesitis and specific organ involvement such as anterior uveitis, aortic valve disease. The hall mark of AS is inflammatory back pain associated with radiographic sacroiliitis and often spondylitis. Obese patient and excess of body fat is associated with increase in the severity and prevalence of rheumatic diseases, a rough measure of obesity is the body mass index BMI which is the body weight in Kilogram divided by the square of the height in meter.Aim of the study : To evaluate body mass index as indicator of response to therapy in Ankylosing spondylitis patients receiving infliximab.Patient and method : This is a retrospective study, data were collected from the records of patients attending the rheumatology department in Baghdad hospital to receive infliximab for treatment of ankylosing spondylitis. All patient included were diagnosed with the modified New York criteria for classification of ankylosing spondylitis. Data include patient age , sex, dis duration, HLA - b27, smoking, and patient weight and height, clinical response assessment by bath ankylosing spondylitis disease activity index BASDAI at time of initiation of treatment and six month later, amount of non - steroidal anti - inflammatory drugs NSAID at time of initiation of treatment and six month later. Excluded from the study those who discontinue infliximab either because of non - availability or absence from treatment session, patients who had been taking steroid before treatment with infliximab and those on other disease modifying ant rheumatic drugs.Patient were categorized into three groups according to their BMI (normal <25kg/m2 , overweight<30kg/m2 and obese >30kg/m2) and clinical response were calculated for each group of patients.Results : Total number of patient in this study are 170, There are 158 male patient (92.9%) and 12 female patient (7.1%). 60 patients (35.3%) has normalVIbody weight, 59 patients (34.7%) were overweight and 51 patient (30.0%) were obese.At time of initiation of infliximab therapy all patient have active disease with mean BASDAI (5.5 for the normal weight group, 5.4 for the overweight group and 6.1 for the obese weight group) and a full dose of NSAID being used for the three categories.Multivariate analysis found that BMI was the only factor associated with statistically significant relation to response after six month of treatment. Higher BMI associated with a lower response for BASDAI50 (p value <0.001) and for NSAID50 (p value<0.001). this study show that other variables are not statically significant to predict response to treatment six months after initiation of Infliximab. Number of patient who didn’t respond to treatment with infliximab was higher among patients with higher BMI.

معدل عدوى الكلاميديا كسبب في الولادة المبكرة باستخدام طريقة اختبار سلسلة تفاعل البلمرة مقابل اختبار انزيم المناعية وتاثيره على نتيجة ولادة الجنين == The Rate of Chlamydia Infection as a Cause of Preterm Labour (Using PCR, Elisa) and effect on fetal birth out come

Author name: بان كاظم عبد الرحيم
Supervisor name: وسن وجدي ابراهيم
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: Background : Chlamydia trachomatis is an obligate intracellular bacterium characterized by biphasic developmental cycle of replication. The organism is recognized as one of the causes of preterm labour in our country.Aim of the study : Detection of Chlamydia trachomatis as acause of preterm labour by using PCR versus ELISA, and effect of infection on fetal birth outcome.Design : Prospective Case - control study. Patient and methods : Endocervical swabs were collected from 80 pregnant women, with gestational age 28th—36th+ 6 weeks ,estimated from 1st day of last menstrual period and /or by 1st or 2nd trimester uttrasonographic assessment. These specimens were processed using molecular (polymerase chain reaction, PCR) and enzyme immunoassay (EIASA).Result : By using polymerase chain reaction (PCR) has a sensitivity of 80% to 95% and a specificity of 99% . in this study ,PCR test is better than ELISA test for the diagnosis the chlamydia infection ( P value 0.0001) in preterm labour.Conclusions : Nucleic acid amplification test by using Polymerase chain reaction proved to be superior and more efficient in the diagnosis of Chlamydia trachomatis than Enzyme linked immune sorbent assay ,and Chlamydia infection did not affect fetal birth outcome .

تقييم عدم فعالية الكليه المزروعة عن طريق التصوير بالموجات فوق الصوتية ودوبلر الموجات فوق الصوتية == Evaluation of Renal Allograft Dysfunction by Ultrasonography and Doppler Ultrasound

Author name: مشتاق عوفي قاسم
Supervisor name: ليث احمد خلف | ضياء حسين لفته
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: Different complications may occur within months or years following kidney transplantation such as Renal artery thrombosis, Arterial stenosis which associated with the abrupt onset of hypertension, venous thrombosis, infection ureteral obstruction, fibrosis and nephrolithiasis. Ultrasound is the most valuable noninvasive imaging modality used in monitoring renal transplant. Duplex Doppler ultrasound is of particular value in detecting early signs of rejection and may be preceding the deterioration of the renal function estimated by serum creatinine by two days. Resistive Index (RI) obtained by Doppler spectral waveform analysis might give an important idea about the function of the transplanted kidney.Aims of the study : 1.To correlate between the serum creatinine level and the Resistive Index .2. Estimate a reliable and applicable way in the assessment and follow up of transplanted kidney function by gray scale ultra sound and Doppler ultrasound.Patients and Methods : A cross sectional study conducted at the radiology department of Al - Shaheed Ghazy Al - Hariri teaching hospital and the kidney transplantation center, during the period from 17th of August 2013 to the 30th of June 2014. A total of 45 patients with renal transplant of less than one year duration, and agreed to participate were recruited in this study regardless their age and gender and should have a recent serum creatinine test report prior to inclusion. Data were collected via direct interview with the patients using a data collecting sheet including ; the age, sex, duration of transplantation, laboratory data, including blood urea and serum creatinine, Ultrasonography and Doppler examination findings. All patient were examined, through aXIItransabdominal approach and in supine position for estimation of the resistive index of the transplanted kidney. The study protocol was approved and all official agreement were obtained in addition to the verbal consent of the patients. Statistical analysis was performed by using the statistical package for social sciences version 18, and the appropriate statistical tests were applied accordingly.Results : The mean age of the patients was 38 ± 9years (range, 17 to 65 years). The mean of RI was (.88 ± .96), it was normal in (33.3%) of the patients and high in (66.7%). The mean serum creatinine was 2.5 ± .47 and mean blood urea was 96 ± 8.6. Resistive index correlate significantly with serum creatinine , bloodurea, kidney size ,echogenicity and cortical thickness; P<0.05.Conclusion : A significant correlation had been found between Resistive index and each of serum creatinine and blood urea levels in transplanted kidney. There is a significant relationship between Resistive index value and duration of renal transplantation in transplanted kidney. Introduce the Doppler ultrasonography in the assessment of renal transplants as routine postoperative examination beside the lab renal function test and further prospective studies including larger number of patients are suggested

تحليل الاصابات الميكانيكية للسنوات 2010 - 2012 باستعمال المعلومات الماخوذة من البرنامج العراقي لرصد الاصابات == Analysis of Mechanically caused injuries for the years 2010 - 2012 using data from Iraqi Sentinel Injuries Surveillance System

Author name: عامر صادق سعودي
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: رصد الاصابات موضوع مهم في طب المجتمع لاعطاء معلومات عن عدد الاصابات وميزاتها مثل المكان والزمان والظروف المرافقة والتي هي بدورها مهمة لمعرفة عوامل الخطورة وطرق السيطرة عليها.الهدف من هذه الدراسة هي وصف دقيق للاصابات الميكانيكية حصرا من حيث العدد والعمر والجنس ونوعيتها ووقت الوصول ومعدل الوفيات.المعلومات الخاصة بهذه الدراسة ماخوذة من البرنامج العراقي لرصد الاصابات الذي بدا العمل به عام2010 .هذا البرنامج يجمع المعلومات المتعلقة بالمصاب من حيث الاسم - العمر - الجنس - العنوان - مكان وقوع الحادثة - التاريخ والزمان - نوعية الاصابة - الاحالة - طريقة الوصول - اسم المستشفى او الطب العدلي - العلاج الاولي - القصد.المعلومات تؤخذ مباشرة من المريض او الشهود من مسرح الاصابة باستعمال استمارة خاصة المعلومات الخاصة بالاصابات تخزن بالكومبيوتربواسطة موظفين ماهرين بشكل ابي - انفو سوفتوير .في هذه الدراسة المعلومات نقلت الى اكسل لاجراء التصنيف والتجميع وعمليات التنظيف.التحاليل الرياضية تمت بالكومبيوتر باستعمال ابي انفو .35 وspss 21 .توزيع الاعداد والجدول المتقاطع تم اجرائه لكن لم يتم اجراء الاختبار الهام لان المعلومات تمثل كل المجتمع.تشكل الاصابات الميكانيكية %73.2 من جميع الاصابات - احتمالية حدوث الاصابات الميكانيكية في الذكور هي (77.4%) اما في الاناث فهي (61.6%).الاصابات الميكانيكية قليلة في الاطفال بعمر اقل من 6 سنوات فهي (63.2 %). لكنها اكثر بالاعمارفي سن المدرسة (7 - 10)سنة والاعمار من (11 - 19)سنة فهي (77% - 77.7%) على التعاقب. الاصابات الميكانيكية تقل تدريجيا بتقدم العمر لتصل في الاعمار المتوسطة الى 73.1% وفي الاعمار المتقدمة الى .73.4%محافظة كربلاء تتقدم على بقية المحافظات من حيث الاصابات 83.4% اما السليمانية فهي اقل الحافظات .58.1%الاصابات الرضية هي الاكثر تليها حوادث الطرق ثم حوادث السقوط من علو. اكثر الاصابات الميكانيكية تصل الى المستشفيات بحدود الزمن ساعة واحدة.الوفيات تشكل 9.5% من كل الاصابات الميكانيكية فيها الوفيات في الذكور(9.8%) اكثربوضوح بالمقارنة من الاناث (8.5%) .اقل الاعمار تعرضا للوفيات هي الاعمار من (11 - 15 سنة) فهي (4.7%) واعمار الاطفال في سن المدرسة (5 - 10) سنة فهي( 5%) لكن بصورة عامة الوفيات الحاصلة من الاصابات الميكانيكية ترتفع تدريجيا مع التقدم في العمر.البيت والشوارع والطرق الخارجية هي اكثر الاماكن التي تحدث بها الاصابات.الوفيات النسبية مرتفعة في الشباب والبالغين الشباب ومنخفضة في مجموعة الكهول. وهي بالمقارنة اكثر بالذكور من الاناث . على العموم الدراسة الحالية بالامكان الاستعانة بها للتحضير للتقرير السنوي للبرنامج العراقي لرصد الاصابات . | Injury surveillance is a specific form of public health audit. It can be designed to generate information on both the numbers and characteristics of injuries, such as the injury location, circumstances, cause, and mechanism. This information is crucial for detecting trends in injury incidence, identifying risk factors, developing injury control measures, and assessing their impact. This process is thus an epidemiological means to prevention. The objective of current study is to describe the frequency distribution of the study sample by age, gender, type of accident and time of arrival and aassess case fatality rate among mechanically injured subjects in relation to these factors. In addition a list of a proportionate mortality ratio by age, gender, place of occurrence and type was also required. The study is cross sectional in design. The data is part of a program designed for injury surveillance in Iraq which was officially functioning at 2010. The program gathered informations about : patient's name, age, gender, address, place of injury, date and time of injury, type of injury, initial patient displacement, mode of arrival to the health facility, name of the health facility and intention. Data is directly extracted from injured patients or witnesses of injury scene using a special format. The filled paper format is fed to computers by trained personnel using Epi - info computer software.In this study data were transported into an Excel file for data reclassification, grouping and many cleaning processes. Statistical analysis was computer aided using Epi - info 5.3, Excel 13 and SPSS 21. Frequency distribution and cross - tabulations were done. No test of significance was used, since the data represented the total population.Mechanical injuries constituted the highest proportion of reported injuries (73.2%), figure 3.1. Male gender was associated with a higher probability of having a mechanical type of injuries (77.4%) compared to females (61.6%). Mechanical type of injuries was least frequent among preschool children (63.2%) and most frequent among school age and teenagers (77.7 and 77% respectively). The relative frequency of mechanical type of injuries out of total recorded injuries declines slightly with increasing age to reach its lowest among middle age and elderly age group (73.1% and 73.4% respectively). Mechanical type of injuries occupied the highest proportion of reported injury cases in Karbala (83.4%), while this type of injuries represented the lowest share of total injuries in Sulaimaniya (58.1%).The Trauma was the most frequent type of injury, followed by Road traffic injuries, Falls. Most of mechanically injured cases arrived to the health facility in approximate 1 hours. Case fatality rate for the overall registered cases was 9.5%. The case fatality rate was obviously higher in male (9.8%) compared to females (8.5%). The lowest fatality rate was recorded for teenagers (11 - 15) 4.7% and school age children (5 - 10) 5%. The case fatality rate showed a positive age trend. Home and (street, high way, road) are the common place of occurrence of mechanical injuries . The proportionate mortality ratio was highest for very young and young adults, and lowest for elderly age group. It was higher for males compared to females. To sum up the current study can be adopted as a template for preparing the Iraqi Sentinel Injury Surveillance System report on a yearly base

شيوع متلازمة الم الليف العضلي بين عينة من النساء العراقيات المصابات بالعقم == Prevalence of Fibromyalgia among a Sample of Women with Infertility

Author name: رسل عبد الامير شاكر
Supervisor name: نزار عبد اللطيف جاسم | الاء حازم بدر
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: Fibromyalgia is the current term for chronic widespreadmusculoskeletal pain for which no alternative cause can be identified, itfrequently affects women of fertile age. Fibromyalgia is a debilitating andfrustrating syndrome that is usually triggered by psychological orphysical stressful events. Infertility is failure to achieve pregnancy in a 12month period for patients under 35 years of age and failure to conceive ina 6 months period for the over 35 years that causes major psychosocialimpact on infertile person life whether male or female.Aims of the studyTo estimate the prevalence of fibromyalgia among a sample ofinfertile women; and to study its correlation with age, duration ofmarriage, and duration and type of infertility.Patients and MethodsA cross sectional study was conducted in Kamal Al - SamarraeeInfertility Center & Infertility Clinic in Baghdad Teaching Hospital on202 infertile women. Personal information, sociodemographic featuresand obstetrical history of each patient were recorded and fibromyalgiawas diagnosed according to 2012 Canadian Guidelines for Diagnosis andManagement of Fibromyalgia.ResultsFibromyalgia was reported in 48 women (23.8%). There wassignificant association between fibromyalgia and age (P=0.023), longerduration of marriage (P=0.001) and longer duration of infertilityVIII(P=0.04), but no significant association with type of infertility whetherprimary or secondary(P=0.32).ConclusionsThe prevalence of fibromyalgia among infertile women was higher than reported in general population and its occurrence was significantly associated with age, longer duration of marriage and infertility.

نوعية الحياة اثناء العلاج الشعاعي الخارجي للراس والرقبة == Quality of Life During Head and Neck External Beam Radiotherapy

Author name: علي غالب محمود
Supervisor name: خضير جاسم صبيح الرواق
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: Worldwide, head and neck carcinoma is the sixth most common cancer accounting for 2.8% of all malignancies. Radiotherapy plays an integral role in their management and it is used in approximately 60 - 70% of cases. Even withrecent advancements in the radiation therapy it is still associated with certain treatment - induced reactions that may affect the quality of life of patients during and after treatment. This study aim to evaluate the radiation induced early side effects in patients receiving external beam radiotherapy for the treatment of a head and neck carcinoma.Patients and methods This study is an observational descriptive cross - sectional survey, with the target population being patients whom had external beam radiotherapy for a head and neck tumor whom are within 180 days from starting treatment. Forty patientswere included, all received external beam radiotherapy to the head and neck region at the Oncology Teaching Center / Radiation Therapy Department at the Medical City Complex with either a radical or adjuvant intent. The data were collected from 1st of January 2016 to 1st of March 2016. All patients were evaluated for the early side effects of external beam radiotherapy to the head and neck region including fatigue, skin dermatitis, voice changes, xerostomia, altered taste, oral mucositis, and dysphagia. As well as the incidence of patients who required a tracheostomy and/or a gastrostomy after initiation of radiotherapy, and that of those who developed a significant weight loss (>10% of their initial weight).ResultsIn this study, dysphagia occurred in 88% of the studied patients, only 1 patient (3%) developed a grade 4 dysphagia and required a gastrostomy. Of the 40 patients who were studied, 14 patients (35%) had a significant weight loss ≥10% of their initial weight. Xerostomia occurred in 85% of the studied patients, while fatigue occurred in 83% of the studied patients. Oral mucositis and skin dermatitis had similar incidences, each occurring in 63% of the studied patients.Voice changes and altered taste occurred in 55% and 53% of the studied patients respectively.ConclusionsDysphagia and xerostomia were the two most common early side effects of radiotherapy to the head and neck region. More than half of patients with dysphagia had a grade 2 or higher dysphagia, and about three - quarters of those with xerostomia had a grade 2 or higher xerostomia. To spare the salivary glands and pharynx during radiotherapy plan preparations as much as possible is highly recommended to reduce those two side effects.Although fatigue ranked third in incidence after dysphagia and xerostomia, the majority of those patients complained of only a mild fatigue over baseline.Skin dermatitis and oral mucositis had a similar incidence occurring in 63% of the studied patients. More than half of those patients had only a mild reaction (grade 2 or less). Regular use of soothing agents is recommended to counteract these two side effects.

تاثير القلق او الاكتئاب او كلاهما على الالم والتيبس والوظيفة البدنية لعينة من المرضى المصابين بالفصال العظمي الاولي للركبة : دراسة مقطعية عرضية == Impact of Anxiety and/or Depression symptoms on Pain, Stiffness, and Physical Function in Patients with Primary Osteoarthritis of The Knee : A Cross Sectional Study

Author name: عياء عبد الامير محمد
Supervisor name: سامي سلمان شهاب
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: Background : Osteoarthritis is the most common articular disease of thedeveloped countries and a leading cause of pain and disability. The presenceof anxiety and depression symptoms in patients with osteoarthritis canadversely affect pain and physical function. There is also a proposed adverseeffect of anxiety and depression symptoms on joint stiffness.Objective : To examine the effect of anxiety and/or depression on pain,stiffness, and physical function in patients with knee osteoarthritis.Patients and Methods : A cross - sectional study was conducted on a totalof 101 patients with diagnosis of primary knee osteoarthritis according tothe American College of Rheumatology criteria. Each patient completed theWestern Ontario and McMaster Universities Osteoarthritis (WOMAC) Indexand the Hopkins Symptoms Checklist - 25 for anxiety and depression (HSCL - 25). The presence of anxiety and/or depressive symptoms was determined,and their effects on the WOMAC scores were assessed.Results : According to the study, 83.2% of patients were found to haveanxiety and/or depression symptoms while only 16.8% have no symptoms ofthese disorders. Patients with anxiety symptoms only had significantlyhigher mean pain score than those with none (p. value = 0.042). while theeffect of anxiety symptoms only on the mean physical function, stiffness,and total WOMAC scores was not statistically significant, (p .value = 0.18,0.87, 0.08) respectively. Patients with depression symptoms only hadsignificantly higher mean pain, physical function, and total WOMAC scoresas compared with those with none, (p .value = 0.044, 0.021, 0.013)respectively. While there is no statistically significant effect for the presenceof depression symptoms only on mean stiffness score (p. value = 0.094).Patients who have symptoms of both anxiety and depression had higherABSTRACTVIImean pain, physical function, stiffness, and total WOMAC scores comparedwith those with none , (p. value <0.001, <0.001, =0.013, <0.001). The totalnumber of patients with anxiety and/or depression symptoms hadsignificantly higher mean pain, physical function, stiffness, and totalWOMAC scores as compared with those with none, (p. value <0.001, <0.001, =0.01, <0.001) respectively. After performing multiple logistic regressions to control any confounding effect, the pain, Stiffness and total WOMAC scores were significantly associated with the presence of anxiety and or depression, (P. value<0.05), after adjustment for other variables.Conclusions : 1. According to anxiety and depression scores most of the patients with KOA had anxiety or depression symptoms or both.2. The presence of anxiety and/or depression symptoms was associated with significantly higher pain, stiffness, and total WOMAC scores, but the association with physical function scores was not significant.

مقارنة استعمال عقار الاوكسيتوسين عن طريق زرقه داخل وريد الحبل السري مقابل صرف الحبل المشيمي في معالجة المرحلة الثالثة من الولادة == UMBILICAL CORD DRAINAGE VERSUS INTRAUMBILICAL CORD OXYTOCIN INJECTION In MANAGEMENT OF THIRD STAGE OF LABOUR

Author name: فرح سامي داود
Supervisor name: نجمة محمود الخزعلي
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: نزيف ما بعد الولادة هو احد اهم اسباب الاعتلال والوفيات بين الامهات. هناك بعض الطرق الفعالة والفسيولوجية لمعالجة المرحلة الثالثة من الولادة. وتهدف هذه الدراسة الى تقييم ومقارنة فعالية حقن عقار الاوكسيتوسين داخل وريد الحبل السري والصرف الحبل المشيمي في معالجة المرحلة الثالثة من الولادة. : الاساليب في هذه التجربة السريرية تلقت 100 امراة 20 وحدة من الاوكسيتوسين بعد تخفيفه في 20 مل من محلول ملحي 0.9٪ وتم حقنه داخل وريد الحبل السري (المجموعة 1، عدد 30 )، وصرف الحبل المشيمي (المجموعة 2، عدد 34) او عدم التدخل (المجموعة 3، عدد 36). وكانت النتيجة الاولية تقليل مدة المرحلة الثالثة من الولادة. : النتائج وكانت المرحلة الثالثة من الولادة اقصر بكثير في مجموعة 1 و2 بالمقارنة مع مجموعة 3 مجموعة 1 تقصير مدة المرحلة الثالثة من الولادة بمقدار 3 دقائق والمجموعة 2 تقصير مدة المرحلة الثالثة من الولادة بمقدار 4.27 دقيقة لم تكن هناك تقارير عن الحاجة الى الازالة اليدوية للمشيمة او المشيمة المحتبسة.استنتاج : استخدام الحقن داخل الحبل السري الاوكسيتوسين والصرف الحبل المشيمي في المرحلة الثالثة من المخاض الى خفض كبير في مدة المرحلة الثالثة وبالتالي تقلل من احتمالية النزف بعد الولادة | Postpartum hemorrhage is an important cause of maternal morbidity and mortality. There are some active and physiologic methods for management of third stage of labor. This study is aimed to evaluate and compare the efficacy of intraumbilical vein injection of oxytocin and placental cord drainage in the management of third stage of labor. Methods : In this randomized controlled study , 100 women received 20 ml of a 0.9% saline solution with 20 units of oxytocin injected in the umbilical vein after clamping (Group 1 ,N = 30), placental cord drainage (Group 2, N = 34) or no intervention (Group 3, N= 36). The primary outcome was mean duration of third stage of labor. Results : The third stage of labor was significantly shorter in group 1 and 2 as compared to group 3 . Groups 1 shorten the duration of third stage of labor by 3 min. and group 2 shorten the duration of third stage of labor by 4.27 min. .There were no reports of need for manual removal of placenta or retained placenta. Conclusion : The use of intraumbilical injection of oxytocin and placental cord drainage in the third stage of labor significantly reduced the duration of the third stage.

تقييم المعرفة حول هشاشة العظام في عينة من النساء البالغات في بغداد, العراق, 2016 == Assessment of Knowledge about Osteoporosis among a Sample of adult Women in Baghdad, Iraq, 2016

Author name: هند صلاح محمد
Supervisor name: فارس حسن اللامي
General topic: Medicine
Specific topic: Family Medicine
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
Key words:
  • Osteoporosis
  • Iraq
  • OKAT
  • Adult women
First pages:
Abstract: Background : Osteoporosis is a global growing health problem and contributor of mortality and morbidity. It causes a significant personal and societal impact and increases the burden of healthcare services. The objective of this study is to assess the level of knowledge about osteoporosis among a sample of adult women in Baghdad, Iraq, 2016.Methods : A cross - sectional study conducted on a sample of adult women in Baghdad (age ≥ 25 years old) who attended consulting clinics in Baghdad Teaching Hospital. The estimated sample size was calculated to be 384. We used a questionnaire to gather socio - demographic data and life habits that may affect osteoporosis risk, and the Osteoporosis Knowledge Assessment Tool (OKAT) to measure osteoporosis knowledge of women. The maximum score of the total knowledge was out of 100 points. The score had been categorized as follow weak (<50%), moderate (50% - 75%), good (>75%).Results : The mean level of knowledge scores is 53.53±13.04, and the range is 5 - 85%. Around 70% had correctly answered half of the questions. On Binary analysis, we found the level of education and source of information were the only significant risk factors (p value=0.001). On application of Logistic regression analysis; educational status was the only significant (OR=1.41, 95% CI : 1.2 - 1.7).Conclusion : Iraqi women had moderate level of knowledge about osteoporosis.More work is needed to ensure more women having the right knowledge, attitudes and practices.

سرطان الثدي لدى النساء العراقيات في العقد الخامس من العمر == Iraqi Female Breast Cancer In Their Fifth Decade (Retrospective Study

Author name: ضحى محمد كاسب
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
Key words:
  • Iraqi breast cancer
  • molecular classification
  • Luminal A like
  • DFS
First pages:
Abstract: the United States, breast cancer remains the most frequent cancer in women and the second most frequent cause of cancer death.Breast cancer incidence generally increases with age. Age of the patients is an important factor both for the occurrence and management of the disease Objective : The aim of this study to assess Iraqi female breast cancer patients’ clinical profile in their fifth decade, Evaluate patients’ molecular profile and 5years DFS.Patients and methods This is aretrospective study was conducted in Baghdad oncology teaching hospital fromJanuary12012 toDecember122016, carried on979breast cancer female patients 285patients of them ranging between(40to49)years with their histopathology reports and immunohistochemichal (IHC) results including ER, PgR, HER2/neu The patients in this study underwent surgical intervention either by a biopsy or mastectomy with axillary clearance, and the formalin - fixed paraffin - embedded tissue blocks were sent to the hospital’s laboratory for H&E and IHC.ResultsThe mean age 45 years, the highest incidence of breast cancer among patients in 5th (40 - 49 years) and 6th (50 - 59 years) decades of life(29% and 28%)respectively , while the lowest incidence in 80 years and more female. Regarding the stage ;stage II and III were the most common stages at diagnosis (40.8% and 39.5%) respectively ,while CIS is the lowest stage(3.1%).XIILuminal A like were 124 patients (58.5%), Luminal B like were 30 patients (14.2%), Triple negative were 29 patients (13.7%) and HER2 overexpressed were 29 patients (13.7%). The highest frequency was seen among patients with Luminal A like followed by Luminal B - like . Denovo metastatic patients occupy only 6.7% from all studied group. DFS was 48 months with (95% CI : 41.4 - 54.5 months).ConclusionsHighest prevelance of breast cancer was seen in 5thand 6th decades. Stage II breast cancer is the most common stage at diagnosis. Luminal A was the most common molecular subtype of the breast cancer patients in the studied group.Her2overexpressed and triple negative were the lowest with the same percentage. Most patient s in our study were overweight or obese.Median DFS was 48 months.

التحري الوبائي المختبري التشخيصي عن اصابات السعال الديكي في محافظة المثنى , العراق اذار - ايلول/2013 == Lab - Based Surveillance of Pertussis in Al - Muthana Province, Iraq,Mar - Aug /2013

Author name: باسل صبر عودة
Supervisor name: علياء مكي حسن الصافي
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: المقدمة : السعال الديكي هو سبب مهم للوفاة في جميع انحاء العالم الرضع ، ويستمر الى ان يكون قلق على الصحة العامة حتى في البلدان ذات التغطية العالية . ، وكانت التقديرات لمنظمة الصحة العالمية تشير من انه في عام 2012 حوالي 200868من الحالات المبلغ عنها في جميع انحاء العالم من السعال الديكي حدثت في 90 ٪ منها في البلدان النامية، وتوفي حوالي 89،000 طفل من هذا المرض .الاهداف : هو تقدير معدل انتشار السعال الديكي بالاعتماد على التشخيص المختبري في اقضية محافظة المثنى ، اذار - ايلول،2013.الاساليب : اجريت الدراسة في خمس مناطق في المحافظة و121 مريضا يشتبه باصابتهم عند مراجعتهم للمستشفيات في الفترة من اذار - ايلول ، 2013. وقد تم عمل استبيان لكل الحالات المشتبه فيها . وقد تم اختبار ELISA لكل مريض للتاكد من تشخيص المختبري لمرض السعال الديكي.النتائج : 121 اشتباه فى اصابتهم بمرض السعال الديكي المسجلين في هذه الدراسة في محافظة المثنى كانت اعلى نسبة في الفئة العمرية 1 - 4 سنوات واقلها كان في اكثرمن 5 سنوات، لم يكن هناك سوى 27 ( 22.31 ٪ )حالة يشتبه المرضى السعال الديكي ايجابية ل اختبار ELISA حيث تم تلقيح 21 حالة مؤكدة ( 77.78 ٪ ) ووكان 61.90 ٪ لديهم ثلاث جرعات من اللقاح الثلاثي . كان متوسط اعمارهم (3.5 ) وبانحراف معياري ( 5.94 ) وكانت نسبة الذكور الى الاناث من الحالات المؤكدة ( 0.68 : 1 ) وكان 8 لكل 100000 من عدد السكان اقل من 14 سنة في الفترة من اذار - ايلول ، 2013.الاستنتاج : حدوث زيادة واضحة في احياء المثنى يشتبه الاصابة بالسعال الديكي وخصوصا الذين لا يتمتعون بالحماية حتى الان من التحصين النشط ،استخدمت ELISA اختبار الاليزا في التشخيص عن الاجسام المضادة ل مستضدات السعال الديكي لديه ميزة امكانات بشكل ملحوظ تحسين حساسية التشخيص ، لكنه لديها حاليا العديد من القيود والتي لا تتوفر للاستخدام السريري في العراق. ينبغي ان توجه كل الجهود لزيادة او الحفاظ على التغطية بالتحصين للقاح DPT وبنسبة لا تقل عن 90 ٪ في جميع الدوائر . تعزيز انظمة المراقبة وتشخيص العدوى للسعال الديكي وخاصة في الرضع عن طريق فحوصات PCR ، جنبا الى جنب مع فحوصات مصلية . هناك الحاجة لدراسات اضافية لصقل استراتيجية الوقاية من السعال الديكي | Background Pertussis is an important cause of death in infants worldwide, and continues to be a public - health concern even in countries with high vaccination coverage. Estimates from WHO suggest that in 2012 about 200868 reported cases of pertussis occurred worldwide, 90% of which were in developing countries, and about 89,000 children died from this disease.Objectives : is to estimate the prevalence of pertussis based on lab diagnosis at the districts of Al - Muthana province, March - August, 2013.Methods : The study was carried out in five districts in the province and 121 patients suspected involved where attending or admitted to three hospitals from March - August, 2013. A questionnaire was filled for each suspected cases. An ELISA test was done for each patient to confirm the diagnosis of pertussis.Results : 121 suspected pertussis patients enrolled in this study at Al - Muthana province the highest percentage was in 1 - 4 years age group and the least was in above 5 years, only 27 (22.31 %) suspected pertussis patients were positive to ELISA IgG test where 21 confirmed cases were vaccinated (77.78%) and 61.90 % have three doses of DPT. The mean of age was (3.5) with standard deviation of (5.94 ) and the male to female ratio of confirmed cases was (0.68 : 1 ) and was 8 per 100000 for less than 14 years old population from March - August, 2013.Conclusion : In the districts of almuthana a clear increase occurrence of suspected pertussis especially who are not protected yet by active immunization .ELISA test was used in the diagnosis for antibodies to B. pertussis antigens has the potential advantage of markedly improving diagnostic sensitivity, but it currently has several limitations of not availability for clinical use in Iraq. All efforts should be directed to increase or maintain high immunization coverage with DPT immunization at least 90% in all districts. Strengthened the surveillance systems and diagnosis of B. Pertussis infection particularly in infants by PCR, together with serological assays. Further studies are needed to fine - tune the pertussis prevention strategy.

العلاقة بين موقع المشيمة ومدة مراحل الولادة == Association between Site of Placenta and Duration of Stages of Labor

Author name: هناء محمد حيدر
Supervisor name: يسرى نعمان محمد
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: Childbirth is a complex physiological, sociological and psychologicalevent. The third and fourth stages of labor are usually uneventful;although significant compilations can occur in this period, sites placentae have a significant clinical effect on the progress of labour , particularly the duration of third stage.Aim of studyTo investigate how the location of the placenta at term pregnancies affects the duration of the third stage of labor.Patients & MethodsA cross sectional study was carried out in a obstetric department of Baghdad Teaching hospital for period from 1st of November, 2013, to 1st of June, 2014 on sample of 300 pregnant women at term who selected randomly by simple random sampling. The data were collected by the researcher in labor room after completing examination of the selected patient by direct interview and filling a prepared questionnaire included demographic information, obstetric information and information about placental site.ResultsThe fundal placental site represented only 25.7% of the studied patients, the mean duration of third stage of labor was 8±3 minutes. ANOVA analysis revealed a significant association between women with fundal site of placenta and shorter duration of third stage of labor (p < 0.001). A significant association was observed between women with posterior placenta and shorter gestational ages of pregnant women (p = 0.04). Women with posterior placenta were highly associated with previous abortions (p = 0.02). Women with posterior placenta were highly associated with fetal birth weight : S 3.5 Kg (p = 0.04).Conclusions & Recommendations A fundal site of placenta may be closely related to shorter duration of third stage of labor and a posterior site of placenta may be closely related to longer duration of third stage of labor. It is important to doctors, nurses and midwives to be aware of placental site and encouraging larger studies to confirm the relation between placental site and duration of third stage of labor.

التصنيف الجزيئي لعينة من مرضى سرطان الثدي العراقيين وعلاقته بحالة المرضى السريرية والنسيجية : دراسة وصفية == Molecular Classification of Iraqi Breast Cancer Patients and Its Correlation with Patients’ Profile (Observational Study)

Author name: مصطفى خضير جاسم
Supervisor name: منور عبد الاله النقاش
General topic: Medicine
Specific topic: Diseases
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
Key words:
  • Iraqi breast cancer
  • molecular classification
  • Luminal B like.
First pages:
Abstract: Background : Breast cancer is a complex, multifaceted disease encompassing a great variety of entities that show considerable variation in clinical, morphological and molecular attributes. Traditional classifications including histological assessment and clinical staging are used to guide patient management. In recent years, there has been exponential progress in molecular analysis with profound implications for our understanding of breast cancer biology and, hence, classification.Objective : The aim of this study to assess Iraqi breast cancer patients’ clinical profile (tumor size, lymph nodes, etc…). Evaluate patients’ molecular profile (Estrogen receptor, Progesterone receptor, HER2/neu and Ki - 67).Patients & Methods : This is a cross - sectional descriptive study was done in Baghdad oncology teaching hospital from the 1st of December 2015 to the 1st of April 2016, carried on 100 breast cancer female patients with their age range from 27 to 73 years old and with their histopathology reports and immunohistochemical (IHC) results including Estrogen (ER), Progesterone (PgR), HER2/neu and Ki - 67. The patients in this study underwent surgical intervention either by a biopsy or mastectomy with axillary clearance, and the formalin - fixed paraffin - embedded tissue blocks were sent to the hospital’s laboratory for H&E and IHC.Results : The mean age ± SD (51 ± 10) years, the highest incidence of breast cancer among patients in 5th (40 - 49 years) and 6th (50 - 59 years) decades of life and each group is (32%), while the lowest incidence in 3rd decade of life (2%). In regards of tumor size, T1 was (28%), T2 was (56%), T3 was (15%) and T4 was (1%). According to lymph nodes, Nx was (33%), N0 was (16%), N1 was (25%), N2 was (17%) and N3 was (9%). ER and PgR values were observed in 74% and 75% respectively, regarding ER receptor there were 14 patients (14%)XIwith +1, 17 patients (17%) with +2, 43 patients (43%) with +3, and 26 patients (26%) with negative score, while PgR receptor there were 11 patients (11%) with +1, 20 patients (20%) with +2, 44 patients (44%) with +3, and 25 patients (25%) with negative score. In regards of the immunohistochemicetry of Her2/neu there were 26 patients (26%), 28 patients (28%), 30 patients (30%) and 16 patients (16%) for score 0, +1, +2, +3 respectively, score +3 considered positive, score 0, +1 considered negative, while +2 equivocal, and 31 patients (31%) with Ki - 67 <14, while 69 patients (69%) with Ki - 67 ≥14. There was a negative correlation between the tumor size and Her2/neu, with statistically significant P value = 0.013, and there was a weak correlation between the lymph nodes and the tumor size with insignificant P value = 0.181. Also there was a strong correlation between ER and PgR with highly significant P value < 0.0001, and a strong correlation between ER and Her2 with significant P value = 0.009. On the other hand, our results reported a weak correlation between PgR and Her2 with insignificant P value = 0.165. Luminal B - like were 53 patients (53%), Luminal A - like were 29 patients (29%), Triple negative were 15 patients (15%) and HER2 overexpressed were 3 patients (3%). The highest frequency was seen among patients with Luminal B - like followed by Luminal A - like and triple negative, while the lowest frequency was seen among patients with HER2 overexpressed.Conclusions : Highest incidence of breast cancer in the studied patients was seen ≥ 40 years in the 5th & 6th decades of life, and the most common tumor size was T2, beside the most common assessed axillary lymph nodes were N1. Luminal B - like was the most common molecular subtype of the breast cancer patients in the studied group mostly due to high Ki - 67 index. Most of the breast cancer patients in the current study were ER and PgR (Hormonal) positive 74%, 75% respectively

التنبؤ بوسائل غير باضعة عن ارتفاع ضغط الدم الرئوي في مرض الانسداد الرئوي المزمن عن طريق تخطيط صدى القلب وعلاقته المشتركة مع شدة المرض في مستشفى بغداد التعليمي == Noninvasive Prediction of Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease By Echocardiography and It's co - Relation With The Severity of Disease (Hospital Based Study)

Author name: رنا احسان عبد الجبار
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: Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. It is a chronic condition which affects the respiratory system and worsens over time. Pulmonary hypertension, one of the major and under diagnosed complications of COPD which have a great impact on outcome of the disease and associated with frequent exacerbations and poor prognosis.Echocardiography provides a rapid, noninvasive, portable, and accurate method to evaluate changes related to pulmonary hypertension in COPD.Aim of Study : To study pulmonary artery systolic pressure and TAPSE(Tricuspid annular plane systolic excursion) in patients with COPD by 2D ECHO Doppler and correlate them with severity of COPD.Method : Cross sectional study was conducted on 50 COPD patients in Baghdad teaching hospital (age>40 year)from first of January to the end of June, 2017.First, the diagnosis of COPD was confirmed and evaluated for staging by history, clinical examination , and spirometry.All patients have undergone ECG and 2D echocardiography and systolic pulmonary artery pressure and Tricuspid Annular Plane Systolic Excursion (TAPSE) were calculated. Patients with other cardiac or respiratory problems (asthma, pulmonary TB, lung malignancy, connective tissue diseases, interstitial lung disease, ischemic heart disease, left side heart failure) were excluded from this study.VIIResults : Study of PASP by TR jet with the use of 2D ECHO on 50 patients with COPD showed that 20 patients had normal echo study , mild increase in PASP was found in 15 patients, moderate 11, and severe increase in 4 patients.Study of TAPSE by 2D ECHO showed that 35 patients had normal TAPSE values ,while others 15 had abnormal values classified as mild ,moderate, and severe : 3,9,3,respectively.There were significant associations between echo findings of increasing PASP and abnormal TAPSE, with decrease in FEV1, and oxygen saturation measured by pulse oximeter, duration since COPD was diagnosed and MRC dyspnea scale.Conclusion : There is a high incidence of pulmonary hypertension with increasing severity of COPD . Echocardiography is useful and effective tool for detection of PHT secondary to COPD.

تقييم الاضرار الجانبية المبكرة للعلاج الشعاعي في مرضى سرطان الثدي == Assessment of early side effects of radiotherapy in breast cancer patients

Author name: ايلاف علي حسين
Supervisor name: خضير جاسم صبيح الرواق
General topic: Medicine
Specific topic: Therapeutic Radiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
Key words:
  • Breast cancer
  • Conventional fractionation
  • Hypofractionation
  • Radiation Dermatitis
First pages:
Abstract: سرطان الثدي هو السرطان الاكثر شيوعا" عند النساء في العراق والعالم. العلاج الشعاعي يلعب دورا" اساسيا" في علاج سرطان الثدي. عند الممارسة العامة لعلاج الاورام بالاشعاع, سرطان الثدي نموذجيا" يشكل حوالي 25% من مجموع حالات المرضى.هذا يجعل فهم ماهية الضرر المتوقع من الاشعاع لسرطان الثدي وعلاجه ذو اهمية اولوية بما انه يؤثر على عدد قيم من المرضى يوميا".الاضرار الجانبية الناتجة عن الاشعاع في مرضى سرطان الثدي يمكن ان تنقسم الى اضرار جانبية مبكرة (حادة ومتوسطة) واخرى متاخرة. الاضرار الجانبية المبكرة تحدث خلال مدة المعالجة وحتى ستة اشهر بعد انتهاء العلاج.هذه الدراسة هي مسح استبياني ((cross - sectional survey مع مكونات تحليلية تهدف لتقييم الاضرار الجانبية المبكرة للعلاج الشعاعي الخارجي المساعد في 60 مريض بسرطان الثدي عولجوا في قسم العلاج الشعاعي في مستشفى الاورام والطب النووي في مدينة الطب من فترة كانون الثاني لنيسان 2016 بعد استئصال الثدي (44 مريض) او عمليات الحفاظ على الثدي (16 مريض).الاضرار الجانبية الناتجة عن الاشعاع الاكثر حدوثا" كانت تهيج جلدي 81.6%, ارهاق 70%, الم في المناطق المشععة 66.6%, حرقة البعوم 58.3%, غثيان 41.6%, صعوبة البلع 35% وتورم الذراع 28.3%.كان هناك فرق ذا قيمة احصائية بين حدوث التهيج الجلدي بين جرع الاشعاع الثلاث المستحدمة. تهيج الجلد الشديد (الدرجة الثانية والثالثة) كان حادثا"بصورة قيمة اكثر في المرضى المستلمين لجلسات الشعاع الاعتيادية (5000 cGy/25 F (CF)) منه في المرضى المستلمين لجلسات العلاج الشعاعي المختصرة (hypofractionation). وهذا متوافق مع المصادر.نسبة حدوث التهيج الجلدي كانت اكثر ايضا" في المرضى المعالجين بعمليات الحفاظ على الثدي 87.5% منها في الذين استاصلوا الثدي 79.5%, لكن العلاقة لم تكن ذات قيمة احصائية.استنتجنا ان هناك الكثير من الاضرار الجانبية الحادة تحدث بعد العلاج الشعاعي لمرضى سرطان الثدي ليس منها فوق الدرجة الثالثة. ولكنها تؤثر على جودة الحياة الصحية ويجب تجنبها ان امكن. تهيج الجلد كان اكثر اضرارالاشعاع الجانبية شيوعا وكان متعلقا بتقسيم الجرع. الارهاق كان الثاني وكان ذو صلة بمرحلة المرض. | Background : Breast cancer is the commonest cancer in women In Iraq and globally. Radiation plays an essential role in the management of breast cancer. In a general radiation oncology practice, breast cancer comprises approximately 25% of total patient caseload. This makes understanding what type of toxicity to expect from radiation for breast cancer and its management of prime importance since it affects significant numbers of patients daily. Radiation induced side effects (RISE) in breast cancer patients can be divided into early (acute and subacute) and late side effects. Early radiation toxicities occur during treatment time and up to six months after treatment has finished. Objectives : assessment of the early side effects of adjuvant external beam radiotherapy (EBRT) in breast cancer patients.Patients and Methods : A cross sectional survey with analytic component conducted on 60 patients treated in the radiotherapy department of oncology teaching hospital of medical city from the first of January to the 30th of April 2016 after mastectomy (44 patients) or breast conserving surgery (BCS) (16 patients).Results : The most prevalent RISE were radiation dermatitis (81.6%), fatigue (70%), pain in the irradiated area (66.6%), sore throat (58.3%), nausea (41.6%), dysphagia (35%), and arm edema (28.3%). There was a significant difference between prevalence of dermatitis with different radiation doses used. Dermatitis was more prevalent with conventional fractionation (CF), than in hypofractionated radiotherapy. The prevalence of dermatitis was also more in patient treated with BCS (87.5%) than those who had mastectomy (79.5%), but this relation was not statistically significant. Fatigue was found to be related to disease stage.Conclusion : Much acute toxicity were developed after radiotherapy to breast cancer patients, none of them was above grade 3; however they affect health related quality of life (HRQL) and should be avoided if possible. Dermatitis was the most common acute toxicity of radiotherapy in breast cancer patients. It was related to dose fractionation. Fatigue was the 2nd common. It was correlated with disease stage.

اهمية شد عضلة البطين الايسر في التنبؤ بالنتائج العكسية بعد عملية زرع الشرايين التاجية == The value of LV strain in predicting adverse outcome after coronary artery bypass surgery

Author name: ايمان رشيد محمد علي العبيدي
Supervisor name: باسل نجيب سعيد الدليمي | وسام صالح العبيدي
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: هناك الكثير من المرضى في جميع انحاء انحاء العالم اللذين يعانون من امراض الشرايين التاجيه، في حاجة الى التداخل القسطاري او الجراحي، كما هو معروف جيدا ان لوظيفة عضلة البطيين الايسر اهمية كبيرة ودور في نجاح عملية زرع شرايين القلب جراحيا، من ناحية اخرى هي مهمة لاختيار المرضى للعلاج جراحيا او دوائيا في حالة اعتلال عضلة القلب ومن اجل تقييم وظيفة العضلة استخدمت سابقا عدة عوامل (متغيرات) معظمها اما سريرية او تقليدية عبر فحص الموجات فوق الصوتية واخرى لا تجرى الا في مراكز متقدمة محدودة في العالم (كفحص رنين القلب او فحص عضلة القلب الاشعاعي).الهدف من الدراسة : - 1. اجراء مقارنة بين بعض المتغيرات التقليدية والحديثة عبر فحص الموجات فوق الصوتية ((Echocardiography امثلة للمتغيرات التقليدية : )Linear M. Mode LVEF ,LV septal wall thickness, MAPSE, LV SV indexed, MAPSE).2. اما المتغيرات الحديثة والمستخدمة في العراق لاول مرة هي فحص حديث عبر الموجات فوق الصوتية بحاجة الى برنامج خاص يقيس شد الياف عضلة القلب (strain & strain rate imaging) وهناك القليل من المراكز القلبية والاختصاصات الطبية الملمة بهذا الفحص، علما بانه تقدم الاف البحوث العالمية مستخدمة فحص (strain & strain rate imaging) والتي اكتشفت عام 1997. 3. بهذا الفحص يمكن قياس ليس فقط وظيفة عضلة القلب كليا وانما قياس (شد الياف عضلة القلب) اي نسبة التقلص والانبساط لالياف عضلة القلب حيث ان عضلة القلب مؤلفة من ثلاث طبقات لكل منها الياف باتجاهات مختلفه (طولية، محيطي ونصف قطري). تم التركيز في البحث على قياس شد الياف عضلة القلب الطولية (Longitudinal Strain) والمحيطية (Circumferential Strain) مع قياس سرعة شد الياف العضلة الطولية (Strain Rate). الطريقة : - 1. قياس نسبة (LVEDP) قسطاريا.2. تم قياس بعض العلامات البيولوجية كقياس نسبة مادة (NT - proBNP) في السيرم لتقييم وظيفة عضلة القلب واكتشاف بعض حالات عجز القلب الغير ظاهرة في فحوصات الموجات فوق الصوتية التقليدية.3. تم مقارنة المتغيرات العشر اعلاه واستنتج بان اكثر المتغيرات التكهنية فائدة لمرضى تصلب شرايين القلب قبل اجراء عملية زرع الشرايين والتي تقلل نسبة الوفيات والمضاعفات (عجز عضلة البطين الايسر) بعد العملية هي شد عضلة القلب الطولي(Longitudinal Strain)، شد عضلة القلب المحيطي (Circumferential Strain)، سرعة شد الياف العضلة الطولية (Strain Rate). 4. اما اهم المتغيرات المميزة هي شد عضلة القلب المحيطي (Circumferential Strain)، ونسبة مادة (NT - proBNP)، مع (MAPSE) وهي احدى الطرق التقليدية لقياس الوظيفة الطولية لعضلة القلب بالموجات فوق الصوتية.النتائج : - 1 - ان نسبة النتائج العكسيه او المضاعفات بعد عملية زرع شرايين القلب هي 36.5%.2 - هناك ثلاث متغيرات وهي شد عضلة القلب الطولي والمحيطي مع MAPSE, NT - proBNP.الاستنتاجات : - 1 - ان شد العضلة الطولي والمحيطي ونسبة NT - proBNP مع MAPSE هي من اهم المتغيرات الي من خلالها يمكن التنبؤ بالنتائج العكسيه بعد عملية زرع شرايين القلب. 2 - قد اثبتنا عمليا بان لهذا الفحص المتقدم اهمية كبيرة في تقليل الوفيات والمضاعفات في عمليات زرع شرايين القلب وفي اختيار الحالات التي يمكن ان تستفيد من هذا التداخل الجراحي.الكلمات الدليلية : - شد العضلة، النتائج العكسية، عملية زرع شرايين القلب | Compare the validity of global left ventricular (LV) strain and strain rate (SR) to conventional echo parameters and N - Terminal proBNP (Brain Natriuretic peptide) in a sample of patients with coronary artery disease (CAD) eligible (LV ejection fraction EF ≥ 45%) for Coronary Artery Bypass graft (CABG) ± MVR (Mitral valve replacement) in predicting early adverse outcome (death or dysfunctional LV).Aim : Comparing the conventional & advance echo parameters along with NT - proBNP in predicting adverse outcome post CABG.Patients &methods : A random sample of 104 patients with coronary artery disease ±Mitral regurgitation(CAD±MR) with LV EF ≥ 45% were recruited for the study from a pool of eligible patients consulting Ibn - Al - Bittar Cardiac Surgical Center during the period Dec. 2012 - March 2014. The patients were scheduled for CABG ± MVR. The mean age was 57±8 years. Males constituted two third of the study sample. Longitudinal and circumferential LV strain and strain rate were measured in addition to LVEF, LV end systolic volume indexed (LVESVI), MAPSE (Mitral Annular Plane Systolic Excursion), LV myocardial wall thickness (as a part of conventional echo parameters). NT - proBNP and LV End Diastolic Pressure (LVEDP) were additional parameters to evaluate cardiac function. All the measurements were performed a within one week prior ,1 - 4wk.s post surgery. Results : The incidence of early adverse outcome(1 - 4wk.s ) after surgery was 35.6%. The mean LV longitudinal strain was the single best parameter in predicting adverse outcome (ROC area = 0.99). MAPSE, global LV circumferential strain and strain rate followed closely in validity.The remaining conventional echo parameters in addition to NT - ProBNP had a lower validity in predicting the adverse outcome of surgery.Conclusion : The mean LV longitudinal, circumferential strain & strain rate provides a valuable tool for selecting candidates for CABG ± MVR assuring a plausible outcome after surgery. The study provided a statistical formula based on LV circumferential strain, MAPSE and NT - proBNP to predict cases that would otherwise end in poor outcome of surgery with an accuracy of 94.2%.

تقييم وظيفة البطين الايمن بواسطة دوبلرالانسجة في تخطيط صدى القلب للمرضى المصابين بضعف الوظيفة الانقباضية للبطين الايسر == Assessment of Right Ventricular Function by Tissue Doppler Echocardiography in Patients with Left Ventricular Systolic Dysfunction

Author name: مروة قاسم محمد
Supervisor name: معتز فوزي حسين
General topic: Medicine
Specific topic: Echocardiography
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine - Department Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Knowledge about the role of the right ventricle in health and disease historically has lagged behind that of the left ventricle. Less muscular, restricted in its role to pumping blood through a single organ, and less frequently or obviously involved than the left ventricle in diseases of high proportions such as myocardial ischemia, cardiomyopathy, or valvulopathy. Consequently, comparatively little attention has been devoted to how right ventricular dysfunction may be best detected and measured. Right ventricular function is related to left ventricular function by ventricular interdependence, so we should assessed its function carefully.The Aim of the StudyIs to assess the consequence of the left ventricular systolic dysfunction on the right ventricular systolic and diastolic function by Tissue Doppler Echocardiography.MethodsFrom October 2014 to May 2015 we enrolled 60 consecutive patients with left ventricular systolic dysfunction diagnosed by echocardiography with the mean left ventricular ejection fraction (LVEF) of (37.6±8.6%).For all, complete transthoracic echocardiography (TTE) was done, including assessment of left ventricular dimensions, systolic and diastolic function by two - dimensional (2 - D) and tissue Doppler echocardiography (TDI), assessment of right ventricular dimensions, systolic and diastolic function by (2 - D) and (TDI) echocardiography. And measurement of pulmonary artery systolic pressure (PASP) for all patients,and pulmonary vascular resistant (PVR) to about one third of patients.ResultsMean RV MPI was (0.60±0.23), 63.3% of patients have abnormal RV MPI. RVDD was found in 80% of patients. Mean TAPSE was (18.68±4.48Abstractmm),35% of them have abnormal TAPSE. Mean RVS' was (11.7±4.3 cm/sec),30% of patients have abnormal S'. RV dilatation was found in 35% of patients. PASP was abnormal in 28.3% of patients and PVR in 27.3%.Right ventricular myocardial performance index was the most sensitive parameter, its sensitivity to detect RV dysfunction was 100% and specificity 52%. While TAPSE was less sensitive more specific than RV MPI, its sensitivity was 38% and specificity 84%. The least sensitive one was the S' , 29% sensitivity and 82% specificity.ConclusionRight ventricular function is affected in patients with LVSD .And RV diastolic function is affected more than the global RV function represented by MPI and RV systolic function represented by TAPSE and S'.

استخدام تقنيات صدى القلب للكشف عن امراض القلب لمرضى التهاب المفاصل الرثوي == ECHOCARDIOGRAPHIC MANIFESTATIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Author name: سرى عدنان رحيم
Supervisor name: هلال بهجت شوقي الصفار
General topic: Medicine
Specific topic: Echocardiography
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: تعتبر امراض القلب والاوعية الدموية من اهم الاسباب التي تؤدي الى تدهور الحالة الصحيه والوفيات للمرضى الذين يعانون من التهاب المفاصل الرثوي. لذلك، الكشف المبكر للمرض بالاعتماد على التقنيات الحديثه المستخدمه لتشخيص امراض القلب والاوعية الدموية لها دور كبير وفعال في اعطاء العلاج المبكر والذي بدوره يؤدي الى تفادي امراض القلب بشكل عام .اهداف البحث : يهدف هذا البحث الى اجراء فحص صدى القلب لمجموعه من المرضى الذين تم اختيارهم عشوائيا والذين يعانون من التهاب المفاصل الرثوي . الاساليب : اخترنا خمسون مريضا يعانون من التهاب المفاصل الرثوي وتم اجراء فحص صدى القلب لهم. حيث تم قياس سمك عضلة القلب، الابعاد الداخلية، قياس وظيفتي البطين الايسر الانبساطي والانقباضي، وظيفة البطين الايمن الانقباضي، حساب ضغط الشريان الرئوي الانقباضي والكشف عن وجود ارتجاع او تضيق الصمامات.النتائج : اظهرت نتائج فحص صدى القلب ان هناك نسبه 82% من مرضى التهاب المفاصل الرثوي يعانون من حالات مختلفة من امراض القلب والمتضمنه 24%من المرضى مصابون بتشوهات في الصمام التاجي.بالاضافه الى ذلك, اشارت النتائج الى وجود اعتلال في عضلة القلب الانبساطي بنسبة 18% وعدم كفاءة الصمام الثلاثي بنسبة 18%. اما بالنسبه للصمام الابهر فكانت نسبة التشوهات الحاصلة فيه 16% و6% من المرضى مصابون بتثخن في عضله البطين الايسر. الاستنتاج : اظهرت دراستنا ان الاصابة بامراض القلب يعد امر شائع في مرضى التهاب المفاصل الرثوي وخاصة تشوهات الصمامات ويليها اعتلال عضله القلب الانبساطي. | Cardiovascular disease is an important cause of morbidity and mortality in rheumatoid arthritis patients. So, early disease detection with the use of noninvasive cardiac and vascular diagnostic technology.is important especially in the setting of therapeutic advances, resulting in longer life expectancy,Objective : To study the prevalence of echocardiographic findings in unselected population of patients with rheumatoid arthritis (RA).Methods : We selected fifty RA patients the study group underwent echocardiographic examination using 2D, M Mode, Pulsed Doppler and Tissue Doppler imaging. Examination involved left ventricular septal and posterior wall thicknesses, internal dimensions, left atrial size, ejection fraction and E/A ratio measurements, also Tissue Doppler derived waves velocities e', a'. Right ventricular internal basal and mid diastolic dimensions, right atrial size, TAPSE, PASP. Assessment for any evidence of LV regional wall motion abnormalities, presence of valvular regurgitation and stenosis.Results : Two - dimensional echocardiography demonstrates that Cardiac abnormalities in rheumatoid arthritis patients in this research equals to 82% that includes : 24% mitral valve abnormalities, Left ventricular diastolic dysfunction and tricuspid regurgitation accounts for 18% for each abnormality, 16% Aortic valve abnormality and 6% of them showed left ventricular hypertrophy (LVH).Conclusion : Our study demonstrated that cardiac involvement, particularly of valvular heart diseases is the most common finding in RA patients followed by diastolic dysfunction.

اتجاه سرطان القولون والمستقيم في العراق من 2003 - 2011 == Trend of Colorectal Cancer in Iraq from 2002 - 2011

Author name: صفاء الدين عبد الرحمن الدهان
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 : Colorectal cancer is a very heterogeneous disease that is caused by interaction of genetic and environmental factors. It is the third most common cancer in men and the second in women worldwide and affects men and women of all racial and ethnic groups and most often found in people aged 50 years or older.Objectives : Since there is no published data about its trend in Iraq. This study is to identify the pattern of Colorectal Cancer, to calculate the incidence; and to determine the demographical and geographical distribution of cancer in Iraq from 2002 - 2011.Methods : Descriptive cross - sectional study design, data were collected from Iraq Cancer Board and Directorate of planning and human resources /Ministry of Health Iraq from 2002 - 2011 and from Al Amal national hospital for cancer management in Baghdad include; basic demographic /clinical data, and data on histological types, site and grade, stage of tumor, Microsoft excel sheet and epi info software used for data entry and analysisResults : Total of 7246 cases of Colorectal Cancer were registered from the 2002 to 2011, The mean age was (53.9) years for males and females Male was more affected than female in all age groups and male to female ratio varied from 1.17 : 1 in 2002 to 1.28 : 1 in 2011.The peak age group affected was (40 - 59) year from 2002 - 2011 with the exception of 2006, 2010 and 2011 were the highest age group affected was 60 years &above.The Highest incidence rate was in Kirkuk, Najaf and Baghdad while the lowest incidence rate was in Salah Aden, Erbil and Wasit. The commonest site of cancer was Rectum, Adenocarcinoma was the most frequent histological type of Colorectal Cancer (84 %), most was of moderate differentiation. 26% were localized and 16% with distant metastasis.Conclusions : IRAQ is considered a country with a low Colorectal Cancer incidence particularly for older individuals. However, Colorectal Cancer incidence has been steadily increasing in the country over the period from 2002 to 2011.

تحليل نتائج ناظور القصبات المرن لردهة الامراض الصدرية والتنفسية في مستشفى بغداد التعليمي لسنة 2015 == Analysis of bronchoscopic findings in respiratory unit at Baghdad teaching hospital in 2015

Author name: حيدر منذر عبود
Supervisor name: محمد وهيب سلمان العبيدي
General topic: Medicine
Specific topic: Diseases - Thoracic
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine - Internal Medicine Department
Language: English
University location: Baghdad
First pages:
Abstract: Fiber - Optic bronchoscopy is a safe and useful diagnostic and therapeutic tool for the management of the pulmonary diseases. Aim of study : To analysis the outcome of fiberoptic bronchoscopy in respiratory unit at Baghdad teaching hospital in 2015.Patients and Methods : A retrospective study was done to find out the demographic profiles, indications, bronchoscopic findings, diagnosis and complications of the patients who underwent bronchoscopic examination. 151 patients underwent bronchoscopies in the respiratory unit at Baghdad teaching hospital in one year (2015).Results : Amongst the 151 patients, commonest indication of bronchoscopy was radiological opacity found in 70.20% of patients, followed by diffuse pulmonary infiltrates 18.54% of patients. Most common clinical presentation of the patients was Cough (91%), followed by dyspnea (59%).Out of 151 patients, 93 patients (61.59%) were males, 58 patients were current smokers, 23 patients were non - smokers and 12 patients were former smokers.A 58 patients (38.41%) were females, 18 patients were current smokers, 35 patients were non - smokers and 5 patients were former smokers.The patient's age range from 17 to 77 years, the mean age of males were 58 ± 9 and for females were 54 ± 12.The most common finding on bronchoscopy was endobronchial growth found in about 22.52% of patients. Malignancy was seen in 55.6% cases, while Tuberculosis seen in 10.5%.Conclusion : Fiberoptic bronchoscopy is extremely useful in finding specific etiologies of various lung diseases

خزعة نخاع العظم مقارنة بالرنين المغناطيسي لنخاع العظم للورم السرطاني للعقد اللمفاوية في الفقرات القطنية == BONE MARROW BIOPSY VERSUS MRI IN LYMPHOMA OF LUMBAR SPINE

Author name: زينب ثامر عبد الحسن
Supervisor name: سلام محمد جوري | بسام فرنسيس متي
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: الخلفية : اصابة نخاع العظم هو نتيجة متكررة الحدوث في الورم السرطاني للعقد اللمفاوية ولتحديد درجة هذا المرض خزعة نخاع العظم من القمة الخلفية للعظم الحرقفي تنجز عادة لتقييم درجة الاشارة الغير طبيعية لتصوير الرنين المغناطيسي لنخاع العظم وقد ثبتت ايضا لتكون مؤشر لاصابة نخاع العظم .الهدف من الدراسة : لتقييم قابلية الرنين المغناطيسي لتوثيق تاثر واصابة نخاع العظم لمرضى الورم السرطاني للعقد اللمفاوية.الطريقة : نموذج دراستنا يتضمن 80 مريض بالغ محال الى قسم الاشعة في مستشفى بغداد التعليم ,العراق. مابين اب 2012 واب 2013 اللذين انطبقت عليهم المواصفات المشمولة وشخصوا كمصابين بالورم السرطان للعقد اللمفاوية واثبت ذلك بالفحص النسيجي لخزعة العقد اللمفاوية، كلا من خزعة نخاع العظم والرنين المغناطيسي اجريت لهم . النتائج : 48 من الذكور (60%) و32 من الاناث (40%) قد فحصوا ونسبة الذكر للانثى 1 : 1,5. في 78% من هؤلاء المرضى، خزعة نخاع العظم والرنين المغناطيسي كانتا متفقتان تماما. في مريض واحد فشل الفحص النسيجي في اثبات اصابة نخاع العظم بالرغم من الاشارة الغير طبيعية للرنين المغناطيسي المخمنة لاصابة نخاع العظم. في خمسة مرضى، الرنين المغناطيسي كان طبيعيا كاملة بالرغم من ان الخزعة اثبتت اصابة نخاع العظم وان معدل السلبية الخاطئة (5\16) والايجابية الكاذبة (1\62) كانت قليلة جدا . الخاتمة : في الورم السرطاني للعقد اللمفاوية، الخزعة السالبة لنخاع العظم مع النتيجة الموجبة للرنين المغناطيسي يجب ان لا تستثني اصابة نخاع العظم وتحتاج الى تقييم اكثر بواسطة خزعة نخاع العظم من كلا الجانبين ولذلك نحن نستنتج انه الرنين المغناطيسي لنخاع العظم هو شكلية حساسة غير متداخلة وممكن ان يكون ذو قيمة قويةفي ايجاد اصابة نخاع العظم بالورم السرطاني للعقد اللمفاويةاللذي من الممكن ان يستعمل كمساعد مفيد للطريقة المثالية لقياس الدرجة.التوصيات : الرنين المغناطيسي لكل الجسم، يوصى به ليساعد في تقييم اصابة نخاع العظم بالورم السرطاني للعقد اللمفاوية | Background : Bone marrow involvement is a frequent finding in lymphoma. For the staging of lymphoma, a bone marrow biopsy of the posterior iliac crest is routinely performed. An abnormal magnetic resonance imaging (MRI) signals of bone marrow was also reported to be indicative of bone marrow involvement.Aim of the study : To assess the ability of MRI to document bone marrow infiltration and involvement in patient with lymphoma.patients and Methods : Our study sample consisted of 80 adult patients referred to the radiology department in Baghdad teaching hospital, Iraq, between August 2012 to August 2013 who met the inclusion criteria were diagnosed as lymphoma and proved by histological examination of LN biopsy, both bone marrow biopsy and MRI were done for them.Results : 48 male (60%) and 32 female (40%) were examined, with male : female ratio was (1.5 : 1). With mean age was(52.25 ± 7.3)years. 67 patients of them have NHL and the remaining 13 patients have HD. Among 62 patients with MRI positive findings, 39 patients (63%) showed diffuse infiltration and 23 patients (37%) showed multifocal infiltration. In 78 % of patients bone marrow biopsy and MRI agreed completely. Only in one patient, histological sections of bone marrow biopsy failed to show any evidence of bone marrow involvement despite abnormal MRI signals suggestive of bone marrow involvement by lymphoma infiltration. In five patients, MRI was completely normal despite biopsy proven bone marrow infiltration .False negativity (5/16) and false positivity (1/64 ) rates were very low .Conclusion : In lymphoma, a negative bone marrow biopsy finding with positive MRI results should not exclude bone marrow involvement and needs further evaluation with bilateral bone marrow biopsy. Thus, we conclude that MRI of bone marrow is a fairly sensitive, non invasive modality and might be of potential value in detecting bone marrow infiltration in malignant lymphoid neoplasms which can be utilized as a useful adjunct to standard staging procedures. Recommendation : Total body MRI is recommended to help the assessment of bone marrow infiltration by lymphoma also bilateral biopsy is recommended in suspected cases that patients with positive MRI finding had negative biopsy results

العلامات البيولوجية لسايتوم النواة الصغيرة الشدقي في عينة من المرضى العراقيين المصابين بداء الذئبة الحمامية المجموعية == Buccal Micronucleus Cytome Assay in Patients with Systemic Lupus Erythematosus

Author name: احمد خالد محمد
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: داء الذئبة الحمامية المجموعية هو مرض مجموعي منيع للذات مع تداخل عوامل وراثية وبيئية في عملية امراض الداء. عدة دراسات اكدت وجود تضرر في الدنا عند مرضى داء الذئبة الحمامية المجموعية.الهدف : لتقييم المورفولوجيا الخلوية والنووية لعينة من مرضى داء الذئبة الحمامية المجموعية من خلال المقايسة العددية للنواة الصغيرة الشدقية ولتقييم اثر خصائص المرضى على التغيرات النووية ان وجدت.المرضى والطرائق : شملت الدراسة 58 مريضا عراقيا مصابا بداء الذئبة الحمامية المجموعية و58 شخصا سويا كمجموعة ضبط متوافقة من حيث العمر والجنس.تم اخذ التاريخ المرضي الكامل واجراء الفحص السريري التام لكل افراد المجموعتين. ووثقت خصائص المرضى (العمر، والجنس، ومعيار كتلة الجسم، ومدة المرض، ومعامل مجموعة تقدير الذئبة للجزر البريطانية (بيلاج) لعام 2004، والتاريخ العائلي للامراض المنيعة للذات، والادوية المستعملة). تكون بروتوكول المقايسة العددية للنواة الصغيرة الشدقية من : جمع الخلايا من كلا الشدقين بواسطة ملوق خشبي وتحضير مباشر للشرائح مع تثبيت الخلايا بواسطة الكحول المطلق بواقع شريحتين لكل شخص. احتسبت 1000 خلية لكل شخص لتقدير تكرار النوى الصغيرة لديه. تم تلوين الخلايا بواسطة طريقة الفولغين - الثينوين المختصة بالدنا. تم التحري في الخلايا المفحوصة عن التشوهات النووية (النوى الصغيرة، والبراعم النووية، وازدواجية النواة، والخلايا القاعدية والمتخصصة، والكروماتين المكثف، والخلايا ممزقة النواة، والخلايا المتغلظة والخلايا حالة النواة).النتائج : اظهر مرضى الذئبة الحمامية المجموعية ارتفاعا واضحا في تكرار الخلايا ذات النوى الصغيرة (القيمة الاحتمالية اقل من 0.0001)، والبراعم النووية (القيمة الاحتمالية اقل من 0.0001)، وازدواج النواة (القيمة الاحتمالية اقل من 0.0001)، والخلايا القاعدية (القيمة الاحتمالية اقل من 0.0001)، والكروماتين المكثف (القيمة الاحتمالية اقل من 0.0001)، والخلايا ممزقة النواة (القيمة الاحتمالية اقل من 0.0001)، والخلايا المتغلظة (القيمة الاحتمالية=0.012)، والخلايا حالة النواة (القيمة الاحتمالية اقل من 0.0001) اكثر مما لدى مجموعة الضبط. لم يكن هناك تاثير معتد به للعمر او معياركتلة الجسم او مدة المرض او معامل مجموعة تقدير الذئبة للجزر البريطانية 2004 او الادوية المستعملة على عدد النوى الصغيرة ضمن مجموعات المرضى. كما اظهر البحث ان فحص المقايسة العددية للنواة الصغيرة الشدقية حساس ومعتد به في التحري عن داء الذئبة الحمامية المجموعية (القيمة الاحتمالية اقل من 0.01).الاستنتاج : مرضى الذئبة الحمامية المجموعية لديهم ارتفاع ذو اعتداد عال في الوسمات الحيوية لضرر الدنا وعيوب الحرائك الخلوية والكوامن التكاثرية والموت الخلوي بالمقارنة مع مجموعة الضبط. لا يوجد تاثير لخصائص المرضى على التشوهات النووية. فحص المقايسة العددية للنواة الصغيرة الشدقية هو طريقة حساسة وغير باضعة وبسيطة جدا يمكن استعمالها في التحري عن داء الذئبة الحمامية المجموعية | Systemic lupus erythematous (SLE) is a systemic autoimmune disease with both genetic and environmental factors implicated in disease pathogenesis. Several studies have addressed the presence of deoxynuclic acid (DNA) damage in SLE patients.ObjectivesTo assess cellular and nuclear morphology in a sample of SLE patients by buccal micronucleus cytome assay and to evaluate effect of patients' disease characteristics on nuclear abnormalities if present.Patients and methodsFifty eight Iraqi SLE patients and 58 healthy controls matched in age and sex were included in this study. Full history was taken and complete physical examination was done for individuals in both groups. Patients' baseline characteristics [Age, sex, body mass index (BMI), disease duration, British Isles Lupus Assessment Group (BILAG) 2004 score, family history of autoimmune diseases, and medications used] were recorded. The buccal micronucleus cytome assay protocol consisted of : cell collection from both cheeks with a wooden spatula; direct slide preparation and fixation with absolute alcohol. Two slides were prepared for every subject and 1000 cells were evaluated per subject to determine the micronucleus (MN) frequencies. Slides were stained with the DNA - specific Feulgen - thionin method. Cells were screened for nuclear abnormalities : micronuclei, nuclear buds, binucleation, basal and differentiated cells, condensed chromatin, karyorrhectic cells, pyknotic cells, and karyolytic cells.ResultsPatients with SLE showed significantly higher frequencies of micronuclei (p<0.0001), nuclear buds (p<0.0001), binucleated cells (p<0.0001), basal cells (p<0.0001), cells with condensed chromatin (p<0.0001), karyorrhectic cells (p<0.0001), pyknotic (p<0.012) and karyolytic cells (p<0.0001) than the control group. Patient's age, BMI, SLE disease duration, BILAG2004 score, and drugs used had no significant effect on micronucleus groups (p>0.05). Buccal micronucleus cytome was significant and sensitive method for SLE screening (p<0.01).ConclusionsSLE patients had a highly significant increase in the biomarkers of DNA damage, cytokinetic defects, proliferative potential, and cell death compared to controls. No significant effect of patients' baseline characteristics on nuclear abnormality. Buccal micronucleus cytome was a sensitive, non - invasive, and very simple method that can be used for SLE screening.

تقييم وظيفة اليدين لدى عينة من المرضى العراقيين المصابين بالتهاب المفاصل الروماتويدي == Assessment of Hand Function in a Sample of Iraqi Patients with Rheumatoid Arthritis

Author name: محمد صاحب حسن
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: التهاب المفاصل الروماتويدي هو احد الامراض المنيعة للذات المجموعية المزمنة التي تؤثر على الغشاء الزليلي للمفاصل وكذلك الاجهزة والاعضاء الاخرى. يؤثر هذا المرض عادة على مفاصل اليدين والقدمين الصغيرة ويؤدي الى ضرر للمفاصل متعذر العكس مع التشوه والاعتلال الوظيفي.وظيفة اليدين تشكل ميدانا هاما من الحالة الصحية لمرضى التهاب المفاصل الروماتويدي واحد المحددات الرئيسة لنوعية حياتهم. لذلك فان تقييم وظيفة اليد هو جزء اساسي في متابعة مرضى التهاب المفاصل الروماتويدي وقياس استجابتهم للعلاج.وقد وضعت العديد من المقاييس لتقييم وظيفة اليد. هذه المقاييس هي اما استبيانات تقرير ذاتي، او اختبارات قائمة على الاداء، او مزيج من الاثنين معا. لكل مقياس منها نقاط قوة ونقاط ضعف. احد المقاييس المقبولة على نطاق واسع، والمذكور في كتاب منهجي شائع، يشمل اختبارات سريرية بسيطة لتقييم وظيفة اليد : قبضة المفتاح، مسكة الكرة، مسكة القلم، قوة القرص، وقوة القبضة.الاهدافتهدف هذه الدراسة الى تحديد العوامل التي تؤثر على وظيفة اليدين في عينة من المرضى العراقيين المصابين بالتهاب المفاصل الروماتويدي، وتقييم ترابط اختبارات وظيفة اليد السريرية مع بعضها البعض في نفس العينة.المرضى والطرائقتم اجراء دراسة مقطعية على 116 مريضا عراقيا مصابا بالتهاب المفاصل الروماتويدي، تم اختيار المرضى عشوائيا، جميعهم استوفوا معايير الكلية الامريكية لامراض المفاصل لتصنيف التهاب المفاصل الروماتويدي لعام 1987 المعدلة، ومعايير الكلية الامريكية لامراض المفاصل / الرابطة لاوروبية ضد الروماتيزم لتصنيف التهاب المفاصل الروماتويدي لعام 2010. تم استبعاد المرضى الذين يعانون من امراض وحالات اخرى التي قد تؤثر على وظيفة اليد.تم تقييم المرضى وجمع المعلومات التالية : العمر، سيادة اليد، محيط الساعدين، مدة المرض، مدة التيبس الصباحي، العلاج الحالي، تشوهات اليدين، درجة فعالية المرض (DAS28)، العامل الروماتويدي (RF)، ومرحلة ستاينبروكر (Steinbrocker) لتقدم المرض اعتمادا على التصوير الشعاعي. تم احتساب درجة تشوه اليدين لجمع كل تشوهات اليدين في قيمة واحدة.تم تقييم وظيفة اليدين من خلال ثلاثة اختبارات شخصانية (قبضة المفتاح، مسكة القلم ومسكة الكرة) واختبارين موضوعيين (قوة القرص وقوة القبضة، مقاستان باجهزة قياس متخصصة).اجري التحليل الاحصائي باستخدام برامج الكمبيوتر المتخصصة.النتائجاظهرت الدراسة ان لاختبارات وضائف اليد الموضوعية (معدل قوة القبضة ومعدل قوة القرص) ترابطا عكسيا معتدا معتدل القوة مع درجة تشوه اليدين (r= - 0.459 , p<0.001 او افضل) ودرجة فعالية المرض (DAS28) (, p<0.001 r= - 0.572او افضل) ، وترابطا عكسيا معتدا ضعيفا مع مدة المرض (, p<0.001 r= - 0.248او افضل) ومدة التيبس الصباحي (, p<0.001 r= - 0.312او افضل) ومرحلة ستاينبروكر لتقدم المرض شعاعيا (p<0.001 r= - 0.36 ,او افضل)، وترابطا طرديا معتدا ضعيفا مع محيط الساعدين (p<0.001 r= - 0.312 ,او افضل).كما اظهرت الدراسة ان اختبارات وضائف اليد الموضوعية تتحسن كلما طالت فترة تعاطي العقار البيولوجي اتانرسبت (Etanercept) في المرضى الذين يستخدمون هذا العلاج، الا ان هذا الترابط لم يكن معتدا به احصائيا عند احتساب جميع المرضى في عينة الدراسة.واظهرت الدراسة ان لمتوسط رتبة الاعاقة في اختبارات وضائف اليد الشخصانية ترابطا طرديا معتدا ضعيفا مع درجة تشوه اليدين (p=0.002 او اقل،r=0.283 او اكثر)، ودرجة فعالية المرض (DAS28) (p=0.013 او اقل،r=0.296 او اكثر)، ومدة التيبس الصباحي (p=0.015 او اقل،r=0.226 او اكثر)، ومدة العلاج بعقار الاتانرسبت (Etanercept) (p=0.046 او اقل،r=0.186 او اكثر).لم يكن لاختبارات وضائف اليد الشخصانية ترابط معتد به مع عمر المريض، مدة المرض، ومرحلة ستاينبروكر لتقدم المرض شعاعيا. كما لم يكن هناك فرق معتد به في اختبارات وضائف اليد الموضوعية والشخصانية بين اليد السائدة وغير السائدة، وبين المرضى ذوي نتيجة ايجابية للعامل الروماتويدي وذوي النتيجة السلبية.و اظهر البحث ان لجميع اختبارات وضائف اليد ترابطا معتدا به مع بعضها البعض (p<0.001 ،r=0.334 او افضل) وخصوصا ترابط قوة القبضة مع قوة القرص اذ كان الاقوى (p<0.001 ، r=0.788 ). | Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease affecting the synovium of joints as well as other organs. It commonly affects the small joints of the hands and feet, and results in irreversible joint damage, deformity, and functional impairment. Hand function is an important domain of the health status of RA patients and a key determinant of their quality of life. Assessment of hand function, therefore, is an essential part in the follow - up of RA patients and in gauging their response to treatment.Numerous measures were developed to evaluate the hand function. These measures are either self - report questionnaires, performance - based tests, or combinations of both. Each measure has its own strengths and weaknesses. One widely accepted measure, suggested by a popular textbook, includes simple clinical tests to assess hand function : Key grip, ball grasp, pen grasp, pinch grip and grip strength.ObjectivesThis study aims to determine the factors affecting the hand function in a sample of Iraqi patients with rheumatoid arthritis, and to evaluate the correlation between the clinical tests of hand function in the same sample.Patients and methodsA cross - sectional study was conducted on 116 randomly selected Iraqi patients with rheumatoid arthritis fulfilling the 1987 Revised ACR Criteria for Classification of Rheumatoid Arthritis and the 2010 ACR / EULAR criteria for rheumatoid arthritis. Patients with other conditions that can affect the hand function were excluded.Patients were evaluated for age, hand dominance, forearm circumference, duration of illness, duration of morning stiffness, current treatment, fixed hand deformities, DAS28, RF seropositivity and Steinbrocker’s radiographic progression stage. A novel score was used to combine all hand deformities into one value.Hand function was assessed by three subjective tests (key grip, pen grasp and ball grasp) and two objective tests (pinch strength and grip strength, measured by specialized dynamometers).Statistical analysis was conducted using SPSS 20 and Excel 2013 computer software.ResultsObjective hand function tests (mean grip strength and mean pinch strength) had a significant moderate negative correlation with the score of hand deformities (p<0.001, r= - 0.459 or better) and DAS28 (p<0.001, r= - 0.572 or better), and a significant weak negative correlation with disease duration (p<0.001, r= - 0.248 or better), duration of morning stiffness (p<0.001, r= - 0.312 or better) and Steinbrocker’s radiographic progression stage (p<0.001, r= - 0.36 or better), and a significant weak positive correlation with forearm circumference (p<0.001, r=0.344 or better).Objective hand function parameters seemed to improve with the duration of Etanercept therapy among patients using Etanercept, although this correlation was not statistically significant for the whole study sample.The mean ranks of impairment of subjective hand function tests showed a significant weak positive correlation with the score of hand deformities (p=0.002 or less, r=0.283 or more), DAS28 (p=0.013 or less, r=0.296 or more), duration of morning stiffness (p=0.015 or less, r=0.226 or more) and duration of Etanercept therapy (p=0.046 or less, r=0.186 or more). The mean ranks of impairment of subjective hand function tests showed mostly no significant correlation with age, disease duration and Steinbrocker’s radiographic progression stage. There was no significant difference in both objective and subjective hand function parameters between the dominant and non - dominant hand and between RF positive and RF negative patients.All five hand function tests showed a significant correlation with each other (p<0.001, r= - 0.334 or better) with the strongest correlation being between pinch strength and grip strength (p<0.001, r=0.788).

علاقة مستوى فيتامين د وهورمون النحافه مع مرض فصال الركبه الاولي في مجموعه من النساء العراقيات == ASSOCIATION OF VITAMIN )D( AND SERUM LEPTIN LEVELS WITH KNEE OSTEOARTHRITIS IN A SAMPLE OF IRAQI FEMALES

Author name: زهراء عبد الله
Supervisor name: سامي سلمان شهاب
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: Osteoarthritis (OA) is a biomechanical process whereby joints respond pathologically mechanical stress, resulting in cartilage degradation and changes in subchondral bone. It has many risk factors as known female gender, obesity, and aging. Vitamin D may exert its effect on OA through bone; its deficiency could impair the ability of bone to respond optimally to insults. Leptin is a peptide hormone secreted by adipocytes and plays an important role in regulation of body weight, its level more in obese subjects and female gender regardless of obesity, so it may play a metabolic link between obesity and osteoarthritis. So both vitamin deficiency and increase leptin level may be risk factors for osteoarthritis Objective : To examine the cross - sectional association of vitamin D and serum leptin levels in a sample of Iraqi female with knee osteoarthritis.Method : A total of 180 women divided into 2 groups 90 subjects the first group for vitamin D levels and 90 subjects the second group for serum leptin levels and each group further classified into patients and equal number of their matched healthy controls in age and sex.In each group osteoarthritis was diagnosed according to ACR criteria for osteoarthritis and their body mass index (BMI) classified according to WHO classification of BMI into 3 groups : normal weight, overweight, obese Radiological grading done according to kellegren and Laurence radiological classification for osteoarthritis. Both vitamin D and leptin levels were assessed using ELIZA method.The first group (vitamin D and osteoarthritis) mean vitamin D levels in cases (45cases) were (0.309_+0.641) compared to (0.2614_+0.386) in controls. So vitamin D deficiency is prevalent among cases and controls and its level was inversely associated with body mass index, the deficiency was more severe among female in obese and overweight than normal weight.Associations of vitamin D levels with radiological grading, cases with grade ||| and |\/ are more deficiency than grade ||.The second group (serum leptin level and osteoarthritis), leptin was significantly higher in cases compared to controls, the mean serum leptin was (52.41_+28.26) and (40.39_+ 25.67) respectively. Its level directly correlated with body mass index, higher levels in obese and overweight than normal weight subjects, the difference was significant among both cases and controls.Association of leptin levels with radiological grading, the mean serum leptin was higher in cases with grade ||| , |\/ than grade ||.Conclusion : Vitamin D deficiency was prevalent among middle age Iraqi women, so it is difficult to establish a clear association between vitamin D deficiency and osteoarthritis in this study, and the deficiency was more in women with higher body mass index.Serum leptin level was higher in osteoarthritis women than their matched controls, and its level directly associated with increased in body mass index

تقييم كثافة العظام لدى مرضى المصابين بالانسداد الرئوي المزمن

Author name: سجا محمد كاظم
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:

نوعية الحياة لمرضى الفشل الكلوي المرحلة النهائية الذين يخضعون لغسل الكلى، بغداد، العراق 2017 == Quality of Life of End Stage Renal Disease Patients Undergoing Hemodialysis, Baghdad, Iraq, 2017

Author name: هند وليد خضر
Supervisor name: عدنان عبد العظيم | فارس حسن اللامي
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 : The quality of life is an important predictor of outcome in end stage renal disease patients. The quality of life needs to be regularly assessed. Our study describes quality of life, as well as demographic and clinical variables associated with quality of life in chronic haemodialysis patients in Baghdad, Iraq, 2017.Method : This was a descriptive cross sectional study conducted from March to May, 2017 at dialysis unit in Baghdad and Al - Karama teaching hospitals. The study participants were all patients available during data collecting period included. The participants were directly interviewed according to a special questionnaire designed for the purpose of the study; it contains items exploring socio - demographic data, clinical data. Data regarding assessment of effect of kidney disease on quality of life were collected by kidney disease quality of life - short form 1.3 versions .The maximum score of the total quality of life was 100 points. The score had been categorized as excellent > 80 score, good (61 - 80) score, moderate (40 - 60) score, and the poor score (< 40).Results The total number of participants was 248 patients. The mean of quality of life was 47.63±16.22. The total score was excellent in12 participants (4.8%), good in 47 (19%), moderate in 99 (39.9%), and poor in 90 participants (36.3%). The highest mean of quality of life domains was found for social support subscale, the low scores was reported for work status, role limitation due to physical problem, role limitation due to emotional problem, general health, and sexual function.Conclusions : The study had shown that the quality of life of hemodialysis patients was highly impaired and it clearly defines how the disease state adversely affects the physical and mental status of the patient. Regular and systematic monitoring for dialysis patients’quality of life must be considered as an effective tool of quality control in dialysis care

اضطرابات الغدة الدرقية في مرضى الذئبة الحمامي المجموعي

Author name: هند عدنان محمد
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: Thyroid hormone abnormalities had been shown to be more frequent in patients with systemic lupus erythematosus (SLE), hence, performance of thyroid function tests in patients with SLE, as a part of the biochemical and immunological profiles, may help in early detection of associated thyroid disorders.Aim of the Study : To assess the thyroid hormone abnormalities in a group of systemic lupus erythematosus Iraqi patients.Patients and Methods : A case - control study was conducted at Baghdad Teaching hospital, Department of Rheumatology during the period from September 2016 to July 2017. Including 58 SLE patients and 60 controls who met the inclusion criteria. After ethical approval, data were collected using a preconstructed data collection sheet, questionnaire included demographic and clinical data of the patients and controls. Thyroid function tests, complete blood count, ESR, anti - double - strand DNA and complement C3 and C4 test were performed. Statistical analysis was done using the statistical package for social sciences (SPSS) v.24.Results : The mean age of the studied groups was 28.26 ± 7.1 years and 29.18 ± 6.3 years in SLE and control groups, respectively. No statistically significant differences between both groups had been found in age, BMI, or other demographic variables (P>0.05). Abnormal thyroid function was significantly more frequent in SLE patients (25.9%) than controls (5%), (P< 0.05). Primary hypothyroidism and Subclinical hypothyroidism were the more frequent disorder in SLE patients; 6/15 nd 5/15, respectively, each of subclinical hyperthyroidism and primary hyperthyroidism was reported in 2/15 SLE patients. Prednisolone and Hydroxychloroquine were the more frequently used medications among the SLE patients and were insignificantly associated with abnormal thyroid function in SLE patients, (P>0.05). High ESR was reported,, Leucopenia , high Anti dsDNA , low C3 and low C4 and Lymphopenia were reported in SLE patients. While all of SLE patients were ANA +ve and none of them had thrombocytopenia.Conclusions : Thyroid dysfunction was more frequent in SLE Iraqi patients compared to healthy population and the primary hypothyroidism and subclinical hypothyroidism were the more frequent types.

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

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

الحالة السريرية والمرضية النسيجية لمرضى سرطان الرئة في العراق وقت عرض الحالة == Clinical And Pathological Profile Of Iraqi Lung Cancer Patients At Time Of Presentation (An Observation Study)

Author name: هالة ساطع طه
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: الخلفية العلمية : في جميع انحاء العالم يمثل سرطان الرئة 13% (1.6 مليون) من مجموع حالات السرطان و18% (1.4 مليون) من الوفيات الناجمة عن السرطان على اساس تقديرات عام 2008 وسرطان الرئة في العراق سبب شائع في للوفاة في كلا الجنسين اهداف الدراسة : التقييم السريري والتصويري للحالة المرضية وايجاد علاقة بين الانواع الفرعية النسيجية المرضية وغيرها من معلومات المريض .طريقة البحث : تعتبر هذه الدراسة من نوع دراسة المراقبة (دراسة مقطعية) تتكون من 60 مريض يعانون من مرض سرطان الرئة متوسطة اعمارهم 60 عام 38 ذكور و22 اناث (نسبة الذكور الى الاناث 1.7 : 1) تم جمع حالات المرضى من العيادة الاستشارية في مستشفى الاورام التعليمي في مدينة الطب من شهر كانون الثاني الى شهر نيسان 2016 تم تقييم جميع الحالات واجراء الفحص السريري والتشخيصي والنسيجي.النتيجة . تم دراسة (60) مريضا اثبتت اصابتهم بسرطان الرئة سن الحد الادنى للمرضى هو 32 سنة والحد الاقصى 81 سنة بمتوسط عمر 60 عام 38 من الذكور و22 اناث معظم المرضى لديهم صعوبة التنفس في وقت العرض (21%)، ونفث الدم (20%). تليها السعال (16 %). اما المكان التشريحي الاكثر اصابة بسرطان الرئة الفص العلوي الايمن 14 (23%). ثم الفص العلوي الايسر 9 (15%). يعد الغسل القصبي اختبار الخلايا 22 (36%) اكثر وسيلة مستخدمة لتشخيص المرض يليها فحص الخلايا المسحوبة بواسطة الابرة الناعمة 9 (15 %)، طموح السائل الجنبي 8(13.3%) الخزعة الاستئصالية 7 (11.7%)، الخزعة الجراحية 5 (8.3%)، علم خلايا البلغم 4(6.7%)، الخزعة الماخوذة بمساعدة الجهازالطبقي المقطعي 2 (3.3%) النتيجة التشريحيةالمرضية الرئيسية هي سرطان الخلية الحرشفية (41.7%) ثم الغدية (36.7%) بعدها سرطان الرئة صغير الخلية ، ورم الظهارة المتوسطة (8.3%) اخيرا يمثل سرطان الخلايا القشرية هو الشائع في الذكور 20(52.6%) ولكنه في الاناث 5 (22.7%) ومع ذلك السرطانات الغدية هي الاكثر شيوعا في الاناث 12 (54.5%) من الذكور 10 (26.3%) هنالك علاقة طردية بين نسبة حدوث سرطان الرئة من نوع الخلايا الصغيرة مع التدخين حيث ان جميع المرضى هم مدخنين بينما في الخلايا الحرشفية فان (47.8%) هم مدخنين (P=0.003) اغلب المرضى لديهم ورم خبيث منتشر وقت تشخيص الحالة (56%) و(33.3%) لديهم استسقاء رئويالاستنتاجات : 1 - اكثر عارض مرضي يعاني منه مرضى السرطان في العراق هو ضيق التنفس ثم النفث الدموي.2 - الفص العلوي الايمن هو الاكثر اصابة بالمرض 3 - الغسل القصبي وفحص الخلايا هو اكثر طرق التشخيص شيوعا 4 - سرطان الخلايا الحرشفية هو النوع النسيجي المرضي السائد في الذكور بينما سرطان الرئة من نوع الغدي هو السائد في الاناث 5 - هناك علاقة ذات دلالة احصائية بين سرطان الخلايا الحرشفية والتدخين (P=0.003) واغلب المرضى يعانو من مراحل متقدمة في وقت عرض الحالة | Background; Carcinoma of the lung is currently the leading cause world wide of death . The disease has become an epidemic as incidence rates and lung cancer deaths have risen dramatically over the last century, Throughout the world, lung cancer accounts for 13% (1.6 million) of the total cases of cancer and 18% (1.4 million) of the cancer - related deaths based on 2008 estimates. Among males, lung cancer is the most commonly diagnosed cancer and leading cause of cancer death. Among females worldwide, it is the fourth most commonly diagnosed cancer and the second leading cause of cancer death.Aim of study : 1 - Identify the most common stages of lung cancer at time of presentation2 - Estimate the anatomical distribution of lung cancer according to histopathological subtypes3 - Find the acorrelation between histopathological subtypesAnd other parameters of patient profilePatients &Methods : Methods;An observation study ( A cross sectional study) of 60 patients with lung cancer with mean age of 60 years old.38 male;22 female (male : female 1.7 : 1). cases were collected from consultant clinic at the Oncology Teaching Center in Medical City. The data were collected from 1st January to 30th of April/2016. All patients were evaluated from history ,physical examination ,sent for investigations &review of histopathology samples.Results : A total of 60 lung cancer patients were studied,mean age of patients 60 yrs old , male : female ratio 1.7 : 1 ,most patients are smoker, Sequamous cell carcinoma is commonest type (41.9% ) of all patients, and its male predominant (33.3%) .Most patient diagnosed by bronchial wash and cytology (36%) ,Right upper zone is commonest site of malignancy (23.3%) ,most patients presented in advance stage and metastasis (56%).Conclusions*Lung cancer is commonest cause of cancer related death.*Proper stage of disease is recommended as mediastinscopy found 15% of occult lymph node metastasis in radiologically normal nodes.*Most patients have metastasis at time of presentation so we can use new radiological modalitiy to diagnosed occult metastasis.*use molecular biology to proper diagnose the histopathologiac subtypes and identify the response to treatment and give a prognosis idea*Active surveillance of primary small lung lesion

التاثيرات الصحية لداء الفقار المقسط على جودة الحياة والاداء الوظيفي للمرضى العراقيين == Health - Related Quality of Life and Work Outcome in Iraqi Patients with Ankylosing Spondylitis

Author name: نورا صباح مهدي
Supervisor name: نزار عبد اللطيف جاسم
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 (AS) is a chronic inflammatory rheumatic disease, mainly affecting the axial skeleton, and less frequently the peripheral joints, entheses as well as other extra - articular organs such as the eyes, heart and lungs. AS has a considerable effect on the individual’s healthrelated quality of life. Work disabled patients with AS experience a significantly reduced quality of life.Objective : To evaluate health - related quality of life and factors influencing it in patients with Ankylosing Spondylitis, as well as, to assess work outcome and its correlation with quality of life in AS patients.Patients and Methods : A case - control study was conducted at the Rheumatology Unit in Baghdad Teaching Hospital during the period from August 2017 to March 2018. A total of 168 patients (151 male : 17 female) with Ankylosing Spondylitis were enrolled in the study, all of them fulfilled the modified New York criteria for Ankylosing Spondylitis, and Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axial spondyloarthropathy, and compared with 169 healthy controls (149 male : 20 female) matched for age and sex. Socio - demographic and clinical data of the patients and controls were collected. Health - related quality of life and work outcome were evaluated by the medical outcome survey short form - 36 (SF - 36) and work productivity and activity impairment - specific health problem (WPAI - SHP) scores respectively.Results : the mean age of the studied groups was 37.4 ± 9.4 years and 36.9 ± 9.5 years in Ankylosing Spondylitis and control groups, respectively. The median disease duration in AS patients was 11.3 ± 7.6. The quality of life in Ankylosing Spondylitis patients on all the scales of the short form 36 (SF - 36), was significantly worse than in the control group. Mental health quality of life was mostly affected than physical health overall. Role - physical was the most affected subscale of the short form - 36 (SF - 36). Male gender, smoking,fatigue, bath Ankylosing Spondylitis functional index (BASFI), treatment with biologics (anti - tumor necrosis factor) were significantly associated with the components of physical & mental health - related quality of life. Of 168 patients, 126 were employed (75%). Patients with Ankylosing Spondylitis reported work absenteeism loss, work productivity loss, overall work impairment, and daily activity impairment of 9.19%, 48.17%, 36.19%, 50.82% respectively. Work productivity and activity impairment - specific health problem (WPAI - SHP) summary scores were significantly correlated with all scores of quality of life (short form - 36).Conclusions : Ankylosing Spondylitis has negative impact on patients’ healthrelated quality of life, affecting both physical & mental health. Male gender, smoking, fatigue, poor functional status, treatment with biologics were the most associated factors with better or worse quality of life in patients with Ankylosing Spondylitis. AS has a significant effect on working conditions, quality of life has a direct relationship with a patient’s ability to work.

تقييم نوعية الحياة لدى المرضى العراقيين المصابين بمرض بهجت وعلاقتها مع فاعلية المرض == Quality of life assessment in Iraqi patients with Behçet’s disease and its relationship with disease activity

Author name: میس عجیل جبار
Supervisor name: 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: Behçet’s disease is a multisystem inflammatory disorder characterized by recurrent exacerbations affecting mucocutaneous tissues, eyes, blood vessels, and several other tissues. Among them, vascular and nervous system involvement are the most common causes of mortality in Behçet’s disease. The previous studies have shown that Quality of Life in patients with Behçet disease was negatively affected by the disease.Aim of the study : To evaluate Quality of Life in patients with Behçet’s disease compared with healthy controls, To assess the correlation of Quality of Life with organ involvements of Behçet’s disease and To assess the effect of demographic and clinical features of Behçet’s disease on Quality of Life. Patients and Methods : A case - control study was conducted at the Rheumatology Unit of Baghdad Teaching Hospital in Medical City from July 2017 to January 2018 . A total of seventy - one consecutive patients (45 male : 26 female) were classified as Behçet’s disease by fulfilling the International Study Group criteria 1990 for Behçet’s disease and compared with seventy - one healthy controls (45 male : 26 female) matched for age and gender. After acquiring their consent, findings were gathered using a preconstructed data collection sheet for patients and controls that evaluate Age, gender, smoking status, disease duration, age at disease onset, Behçet’s disease organ involvements were reported. Disease activity was assessed using Behçet's disease current activity form and health - related quality - of - life was evaluated using The Short Form - 36 (SF - 36) .Results : All the components of Short Form - 36 (SF - 36) , it’s summary scores and Total Short Form - 36 (Total SF - 36) score was significantly lower ( p - value <0.001 ) in patients compared to control . Patients with eye involvement had significantly higher Physical functioning (p - value = 0.023), role - physical ( p - value <0.001), and bodily pain (p - value <0.010) subscores when compared to those without eye involvement. Patients with skin involvement did not show a significant impairment in all SF - 36 subscales when compared to those without skin involvement. Behçet's disease Patients with articular involvement, Physical functioning (p - value = 0.027), bodily pain (p - value <0.001), and general health (p - value = 0.018) subscores are significantly impaired when compared to those without articular involvement .Behçet’s disease patients with myalgia, Physical functioning (p - value = 0.001), bodily pain (p - value = 0.018), and vitality (p - value = 0.038) subscores are significantly impaired when compared to those without myalgia. patients with Central nervous system involvement, physical functioning (p - value = 0.006), rolephysical (p - value <0.001), bodily pain (p - value = 0.001) , general health (p - value = 0.001) and vitality (p - value = 0.042) subscores are significantly impaired when compared to those without Central nervous system involvement. There are certain demographic and treatment modalities had a significant positive impact on Total SF - 36 score : Male gender (p - value = 0.020) , use of cyclosporine (p - value = 0.043 ), use of infliximab (p - value = 0.001), and use of adalimumab (p - value = 0.001) . While others had a significant negative impact on Total SF - 36 score : Disease duration (pvalue = 0.019) , Behçet’s Disease Current Activity Form (BDCAF) (p - value = 0.043 ), and use of Mycophenolate mofetil (p - value = 0.043 ).

تقييم نسبة خلايا الدم المتعادلة الى الخلايا اللمفاوية وعرض توزيع الصفائح الدموية كعلامات التهابية في عينة من المرضى العراقيين المصابين بمتلازمة الالم الليفي العضلي == Evaluation of blood neutrophil - lymphocyte ratio and platelet distribution width as inflammatory markers in a sample of Iraqi patients with fibromyalgia

Author name: فادية علي شعلان
Supervisor name: زياد شفيق الراوي
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: Fibromyalgia syndrome is a diminished quality of life related to generalized body pain with physical and psychological symptoms that occurs in the absence of a clear pathologic cause. Neutrophil to lymphocyte ratio is a simple parameter to assess easily the inflammatory status of a subjects. Platelet distribution width is a regular parameter in blood routine examination which reflects variation of platelet size distribution. Mean platelet volume is a part of the complete blood count test and correlates with the platelets function and activation.Objective : To evaluate Neutrophil to lymphocyte ratio, Platelet distribution width and Mean platelet volume in patients with Fibromyalgia as an inflammatory markers.Patients and Methods : This case - controlled study was conducted at Baghdad Teaching Hospital, Unit of Rheumatology, from July 2017 till November 2017. A total of 100 Iraqi patients with Fibromyalgia diagnosed according to 2012 Canadian Guidelines in addition to 50 healthy subjects worked as a control group were recruited. Data were collected using a paper clinical research form through interview and questionnaires. It consisted of two parts : the first part for the demographic data and full history, the second part laboratory data when the samples collected and sent for laboratories to obtain Platelet distribution width and Mean platelet volume while Neutrophil/lymphocyte ratio was calculated manually.Results : The neutrophil to lymphocyte ratio was significantly higher among patients with fibromyalgia (2.18) compared to healthy controls (1.92) (p =0.033). The Mean platelet volume was significantly higher in patients with fibromyalgia (8.3) compared to healthy controls (8) (p =0.045). In contrast, the Platelet distribution width was significantly lower among patients with fibromyalgia (16.7) compared to healthy controls (17) (p=0.01). No statistically significant differences had been found in demographic variables. None of the tested parameters qualified as an acceptable test for predicting a diagnosis of fibromyalgia, since the Receiver operating characteristic area associated with any of them did not reach the minimum value of (0.65).Conclusions : The Neutrophil to lymphocyte ratio is significantly higher in fibromyalgia patients compared to the healthy controls. The Mean platelet volume is significantly higher in the patients compared to the controls. The Platelet distribution width was significantly lower among the patients compared to the healthy controls. None of these tested parameters qualified as an acceptable test for predicting a diagnosis of Fibromyalgia.

العلاقة بين الخصائص السريرية وبروز القرص القطني وانتقامة المثبت بفحص الرنين المغناطيسي == The Relationship between Clinical Features and Magnetic Resonance Imaging Proven Lumbar Disc Bulging and Herniation

Author name: ابان ناظم علي
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: Lumbar disc herniation is one of the commonest causes of low backpain. The Magnetic resonance imaging is a gold standard noninvasiveinvestigation for viewing lumbar anatomy and physiology in great details.Obesity is strongly linked to biomechanical changes that damage thespine and contribute to a range of spinal diseases including intervertebraldisc herniation.Aim of the studyTo evaluate the effects of body mass index and waist to hip ratio on thepresence, extent and severity of lumbar disc bulging and herniation as wellas to determine the relationship between clinical features and magneticresonance imaging proven lumbar disc bulging and herniation.Patients and methodsA cross - sectional study was conducted at Baghdad Teaching Hospital,Rheumatology Unit during the period from October 2017 to May 2018. Atotal of 100 patients with lumbar disc bulging and herniation proven by MRIwere included in this study. The patients were examined neurologically andtheir body mass index was calculated as well as the waist to hip ratio.ResultsThe magnetic resonance imaging findings demonstrated that (72%) ofthe studied group had disc bulge, (13%) had disc protrusion and (15%) haddisc extrusion with no cases of disc sequestration. Multiple discinvolvements were seen in (73%) of those patients. The correlation betweenbody mass index and the total disc bulge/extrusion score was statisticallysignificant. There was a significant association between neurological deficitand body mass index as well as between straight leg raising test, femoralVIstretch test, neurological deficit and the waist to hip ratio. On the other hand,there was no significant association between clinical features and nerve root compression for patients with both normal body mass index as well as overweight and obese ones, although the frequency of patients with positive clinical findings was higher in patients with nerve root compression but the difference did not reach the significant level (P - value >0.05). The sensitivity of straight leg raising test, femoral stretch test and crossed straight leg raising test were (39.6%), (25.3%) and (6.6%) respectively.ConclusionsThere is an increase in the likelihood of having lumbar disc herniation and its global severity in overweight and obese patients. The clinical findings were more severe in overweight and obese patients especially in patients with central obesity. There was no significant association between the clinical features and the nerve root compression in patients with both normal body mass index as well as overweight and obese ones. The type of disc displacement associated poorly with clinical signs and symptoms as well as with the obesity.

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

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

تقييم خدمات الفحص الطوعي الاسترشادي لمرض نقص المناعة المكتسب (الايدز) في بغداد ،2014 == Assessment of HIV/AIDS Voluntary Counseling and Testing Services in Baghdad 2014

Author name: نزار عبد المهدي ناهي
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:
Abstract: تعتبر خدمات الفحص الطوعي الاسترشادي ((VCT حجر الزاوية للوصول مبكرا الى الوقاية والرعاية لخدمات الدعم في مجال فيروس نقص المناعة البشرية / الايدز. وبالرغم من كون ان هذه الخدمة قد تم العمل بها في بعض المواقع منذ عام 2004، فاننا لا نملك اي دراسة لتقييم طريقة تنفيذ هذه المراكز او تقييم ادائها في العراق.الاهداف : تقييم مراكز الفحص الطوعي الاسترشادي في محافظة بغداد وفقا للمعايير الوطنية والدولية.الاساليب : تم استخدام دراسة مقطعية لما مجموعه (23) في بغداد بواسطة استبيان وقائمة من المؤشرات المعدلة لرصد وتقييم خدمات الفحص الطوعي الاسترشادي الخاصة بمنظمة الصحة العالمية ((WHO الايدز ومنظمة البرنامج الاممي لمرض نقص المناعة المكتسب ((UNAIDS.النتائج : بينت نتائج الدراسة بان الخطة الاستراتيجية الوطنية للبرنامج الوطني لمكافحة الايدز لا تزال قيد الاعداد، وليس هناك خطة واضحة لاجراء الدورات التدريبية لمقدمي خدمة الفحص الطوعي الاسترشادي، توفر جميع المواقع التي شملتها الدراسة اختبار فيروس نقص المناعة البشرية، بينما تقدم مشورة ما قبل الفحص في (73.9٪) من المراكز ، في حين ان (17.3٪) فقط من هذه المواقع يقدمون مشورة ما بعد الفحص لعملائها.قد تبين ايضا ضعف خدمات الاحالة من والى الخدمات الصحية الساندة الاخرى. الغالبية (62.5٪) من مقدمي خدمة المشورة هم فنيي المختبرات، ان (57٪) من المواقع تعطى النتائج لعملائها في مدة تزيد عن يوم واحد. فيما يتعلق بالتدريب فان (43٪) من مقدمي خدمة المشورة لم يتم تدريبهم لتقديم هذه الخدمة وان كل مقدمي الخدمة لم يتلقون اي تدريب تعزيزي خلال العام الماضي. يستخدم الاختبار السريع ((Raped test في (43٪) من المواقع التي شملتها الدراسة. في حين تستخدم المواقع المتبقية طريقة ال (ELIZA). لم تتوفر غرفة المشورة وخصوصية العميل في (82.6٪) من المواقع في حين ان المواد التعليمية والواقي الذكري متوفرة في (21.7٪) من المراكز. بينت الدراسة ايضا ان عدد المستفيدين من خدمة الفحص الطوعي الاسترشادي في المراكز التي تم مسحها هو(354) مستفيد في الاشهر الثلاثة التي سبقت الدراسة وان غالبية المستفيدين هم من الذكور وبنسبة (84٪) من العدد الكلي .الخلاصة : بينت الدراسة بان خدمات الفحص الطوعي الاسترشادي لمرض نقص المناعة المكتسب البشري في بغداد هي اقل من المعايير الوطنية والدولية الموصى بها.التوصيات : تم التوصية بتعزيز بناء القدرات والتدريب لجميع مقدمي خدمات المشورة والفحص لفيروس نقص المناعة البشرية ، تشجيع استخدام الاختبار السريع في جميع المواقع المسؤلة عن تقديم هذه الخدمة، تعزيز العمل بنظام الاحالة، انشاء نظام للرصد والتقييم، ضمان توافر غرف المشورة في جميع المراكز المعنية، وتعبئة المجتمع المحلي للاستفادة من هذا النوع من الخدمات. | Background : Voluntary Counseling and Testing of HIV (VCT) is a cornerstone for early access to prevention, care, and support services in the area of HIV/AIDS. Although VCT has been available at some sites across the Iraq since 2004, there has been no study conducted to evaluate its implementation and performance in Iraq.Objectives : To assess implementation of VCT services in Baghdad governorate according to the national and international standard.Methods : A cross sectional study to (23) VCT sites in Baghdad utilized indicators from the United Nations program on HIV/AIDS (UNAIDS) and the World Health Organization (WHO).Results : The national strategic plan for the National AIDS Program (NAP) is still under preparation, there was no clear Plan for conducting counselors training courses, all surveyed sites were providing HIV testing, 73.9% were providing pre - test counseling, and 17.3% were providing post test counseling. Weak linkage with other health services. 57% of the sites gave the results to their clients in more than one day. 43% of the counselors were not trained and no refresh training has been received by any counselor during the last year. Counseling room and client privacy was not available in 82.6% of the sites while Provision of VCT educational materials and condoms were only conducted in 21.7%. The study show low service utilization by local community with male client represents 84% of all clients.Conclusion The quality of VCT services in Baghdad is below the recommended national and international standards. Recommendations : Capacity - building of counselors according to the international training guideline, using rapid test in all VCT sites, enhancing referrals, establishing a monitoring and evaluation (M&E) system and ensuring availability of counseling rooms and community mobilization to utilize this kind of services.

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

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

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.

تقيم الوضع التغذوي بين الاطفال المصابين باعتلال طيف التوحد == Nutritional Status Assessment among Children with Autistic Spectrum Disorder Al - Najaf 2015

Author name: سرى حسن الحارس
Supervisor name: علياء مكي حسن الصافي
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 : Autism is a neurodevelopment disorder with symptoms arising that are apparent throughout the patient’s lifespan. Autism Spectrum Disorders (ASD) is characterized by impaired social and communication interactions as well as restricted, repetitive interests and behavior. . Epidemiological studies show that the incidence of autism is increasing, which may be due to the diagnostic category of ASD having been developed. There is vital importance in the treatment of autism, is early diagnosis which is conducive to more rapidly improving the quality of patients’ health.Aim of Study : To determine the nutritional status of ASD children in Al - Najaf province 2015 Methods : A descriptive cross - sectional study conducted to assess nutritional status in children with autism. A convenient sample of patients with autism in (Al Imam Al Husain Institute of Autism) and autistic patients in psychiatric department in AL - Hakeem hospital from 30th of April 30th of August 2015.The data were collected by questionnaire developed and filled by investigator through direct interview with autistic patient parents that visit psychiatric department in Al - Hakeem hospital and from case study sheet that present in AL - Imam Al Husain Institute of Autism which include ID, gender , residency, age of child (or date of birth??), the age level of education of parents, their occupation, and by measuring weight and height of children and compare with wt./age, wt/ht, ht/age & BMI/age growth charts .Epi - info software and Excel sheet for entry and analysis of data .Results : the sample size was 98 child, 86 boys and 12 girls & males to females ratio was 8 : 1, age groups were (28%) ≤ 5 yr ,(72%) more than 5 year in which (52%) of them were normal, (33.9%) were overweight and (14%) were underweight, (28%) of the ≤5yr. were (45%) of them were overweight (37%) of them had wasting,& (16%) were normal, no significant association between the nutritional state with gender, residency, age of father, age of mother, occupation of father, occupation of mother, educational level of fathers and but there were significant association between level of education of mother and age group. p value 0.03 .and between age group of children and NS p value less than 0.0000 (less than 0.05).Conclusion : most cases below and equal 5 yr were overweight& obese 45% and large percent of above 5years 33% were overweight & obese, there is significant associations between nutritional status and level of education on ofmothers for children >5 years and NS .

العنف الاسري بين النساء في محافظة النجف 2012 - 2014 == Domestic Violence among Women in Najaf Province /2012 - 2014

Author name: هديل جعفر كاظم
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 : Domestic Violence (DV) against women is a global problem without social, cultural, religious, geographic, economic or national boundaries.Worldwide, at least 1in 5 of the worlds female population has been physically or sexually abused by a man or men at some time in their life. In Arab and Islamic countries, the scope of DV is not yet considered a major concern despite its increasing frequency and serious consequences. In Iraq a family public health survey documented that 83.1% of women reporting at least one form of marital control.Objectives : 1. To explore complaining of women regarding domestic violence in Al - Najaf province for 3 years.2.To throw a light on the associated factors for domestic violence against women.Methodology : A cross sectional study was conducted in Al - Najaf province during period from June to Sept. 2015.A total number of 300 current women were accessed to computer record (2012 - 2014) not paper record about their exposure to domestic violence. Hundred married women from each year were included. The included women were with complete file case ready for the court.Results : Out of the total sample(300) from the Directorate of domestic violence in Al - Najaf province, 91.7% were complaining of physical violence and 8.3% were complaining of verbal abuse. Conclusions and Recommendations : High prevalence of physical Domestic violence among women in Al - Najaf province. Occupation of husband, Age of husbands with year had significant effect on violence. Deal with Domestic Violence as a public health problem. Identify the problem to public by media to educate the public to focus on girls 'education can be viewed as a type of longterm prevention.

انتشار اكتناف العين لدى عينة من المرضى العراقيين المصابين بالتصلب المجموعي == Prevalence of Ocular Involvement in a Sample of Iraqi Patients with Systemic Sclerosis

Author name: زينة يحيى جواد
Supervisor name: 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: Background : Systemic sclerosis (scleroderma, SSc) is a severe systemic chronic connective tissue disease. Many ocular manifestations of SSc have been described, some being well - known associations and others reported for the first time in case reportsObjectives : The aim of this study was to evaluate the prevalence and characteristics of ocular manifestations in a sample of Iraqi patients with SSc.Patients and methods : This cross - sectional study involved 50 patients with SSc diagnosed according to 2013 criteria developed by the American College of Rheumatology/European League Against Rheumatism for the classification of systemic sclerosis or the 1980 classification criteria for SSc, established by the American Rheumatism Society (now the American College of Rheumatology). 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, disease duration and subtype, age at diagnosis, scleroderma assessment questionnaire (SAQ), medications used, blood investigations and autoantibody profile were collected, and a full ophthalmic examination was conducted. Results : A total of 50 patients with systemic sclerosis (SSc) were enrolled in this study. Prevalence of dry eye symptoms was 74%, keratoconjunctivitis sicca (KCS) was 68%, eyelid skin stiffness and telangiectasia were observed in 56% and 36% respectively. Refractive errors were detected in about a quarter of cases (24%). Myopia was the most frequently identified type of refractive errors (18%), followed by astigmatism (6%) and hypermetropia (only 2% after excluding the age dependent presbyopia). Blepharitis was diagnosed in 18% of examined patients. Each of the following ocular manifestations, namely : subcapsular cataract, pterygium, conjunctival abnormalities, cataract - cortical type, uveitis (Anterior or posterior) and retinal microvascular abnormality were detected in less than 10% of cases. Positive serum anti - scleroderma 70 (anti - scl 70) antibodies significantly increased the risk of having KCS . also diffuse disease type significantly increased the risk of having eyelid skin stiffness . There were no significant correlation between patients with KCS, refractive error and eyelid skin stiffness with the other variables .Conclusions : Ocular manifestations in a sample of Iraqi patients with SSc were relatively common. The most common SSc - related ocular findings were dry eye symptoms, then KCS, followed by eyelid skin thickening and telangiectasia.

تقييم نظام ترصد الحصبة, دائرة صحة الرصافة,بغداد, العراق, 2013 == Evaluation of Measles Case - Based Surveillance System, Baghdad - Resafa, Iraq, 2013

Author name: اسعد مهدي اسعد
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
Key words:
  • ترصد الحصبة
  • قييم الرصد
  • مؤشرات تقييم الاداء
  • بغداد الرصافة
First pages:
Abstract: يتطلب التخلص من مرض الحصبة نظام ترصد رصين وذو جودة عالية. بدا نظام ترصد الحصبة في العراق في عام 2005, ومن خلال هذا النظام يجب الابلاغ عن كل حالة (حمى مع طفح جلدي) والتحري والتحقق منها على الفور. اجريت هذه الدراسة لتقييم نظام ترصد الحصبة في دائرة صحة بغداد/ الرصافة للفترة من 1/ايار/2013 ولغاية 31/ تموز/2013, وهو اول تقييم لهذا النظام بهذا الاسلوب في العراق.اهاف البحث : 1. تقييم جودة واداء النظام، 2. تحديد الفجوات الموجودة في النظام ومجالات تحسينها,3. صياغة التوصيات لغرض تحسين النظام.طريقة البحث : 1. تقييم نظام ترصد الحصبة من خلال الزيارات الميدانية لـ : شعبة الرصد الوبائي في مركز السيطرة على الامراض الانتقالية/بغداد, وحدة الامراض الانتقالية في دائرة صحة بغداد/الرصافة, وحدة الامراض الانتقالية في جميع القطاعات (7), مستشفيات اطفال عدد 2 ومراكز رعاية صحية اولية عدد 14 اختيرت عشوائيا. حيث تم اعتماد قائمة معدلة لمؤشرات معيارية تابعة لمنظمة الصحة العالمية والدلائل الارشادية لمراكز السيطرة على الامراض والوقاية منها في الولايات المتحدة الامريكية, حيث تمت دراسة هيكلية النظام (Structure), وظائفه الجوهرية (Core functions) والوظائف الداعمة (Support functions) بالاضافة الى نوعية النظام (Data quality or system attributes).2. وصف للمعلومات المسجلة في نظام ترصد الحصبة في العراق من عام 2008 ولغاية عام 2012 مع تحليل مؤشرات الاداء الموصى بها من قبل منظمة الصحة العالمية خلال هذه السنين.نتائج البحث : 1. نتائج التقييم : ا. معظم الوظائف الجوهرية للنظام (كشف وتسجيل وتاكيد الحالات المشتبه اصابتها بالحصبة والابلاغ عنها وعن الاوبئة والـتاهب لها) تفوق المعيار الافتراضي للاداء الجيد(80%). اما تحليل المعطيات وتفسيرها فكانت تتم فقط على مستوى شعبة الرصد الوبائي في بغداد وكذلك التغذية الاسترجاعية فانها دون المستوى في القطاعات (42,9%). ب‌. فيما يتعلق بالوظائف الساندة للنظام فالدلائل التوجيهية والمعيارية (Standards and guidelines) لنظام ترصد الحصبة ولسحب النماذج وعملية احالتها للمختبر موجودة في اغلب المؤسسات المزارة, اما نسبة الكوادر المدربة في القطاعات فكانت (62,5%) وفي المراكز الصحية (71,4%) ولا يوجد متخصصين في علم الاوبئة في كافة المستويات المزارة عدا شعبة الرصد الوبائي في مركز السيطرة/بغداد ودائرة صحىة بغداد/الرصافة. وعلى الرغم من ان الزيارات الاشرافية تجري من قبل المستويات العليا فان توثيق توصيات الزيارات كانت موجودة في (71,4%) من القطاعات و(50%) من المستشفيات المزارة و(42,9%) من المراكز الصحية المزارة. ت‌. اما اكتمال بيانات الترصد((completeness فقد كان يتراوح مابين (83% - 90,9%). وانية التوقيت (Timeliness) فيما يخص تسليم التقارير حول ترصد الحالات والاوبئة فكانت بنسبة (100%). بالاضافة لذلك, فان نظام الترصد تبين بانه مفيد وبسيط ومقبول وعلى درجة عالية من المرونة. اما حساسية النظام فكانت (92%) في المستشفيات المزارة و(95%) في المراكز الصحية المزارة. وكانت القيمة التنبؤية الايجابية (3,6%) في المستشفيات و(9,5%) في المراكز الصحية.2. فيما يخص المعلومات المسجلة في نظام ترصد الحصبة في العراق من عام 2008 ولغاية عام 2012 : ا. تراكميا, تم تسجيل (3,292) حالة اشتباه اصابة بمرض الحصبة في دائرة صحة بغداد/الرصافة للفترة من عام 2008 الى 2012. من بين هذه الحالات كانت هنالك (2,603) حالة مؤكدة, وحوالي (63,4%) منهم كانت اعمارهم (9 - 60 شهر) و(15,6%) هم اقل من (9 شهور). اما فيما يخص الموقف التلقيحي لهذه الحالات فكان (68,2%) منهم غير ملقحين, (22,4%) ملقحين والبقية كان موقفهم التلقحي غير معروف. من هؤلاء الملقحين, كان (99,3%) منهم ملقحين بجرعة واحدة فقط من لقاح الحصبة وكانت نسبة المعلومات المؤخوذة من كارت التلقيحات تمثل (0,2%) فقط. ب‌. على الرغم من انه تم تحقيق تقدم في معظم مؤشرات تقييم الاداء الموصى بها من قبل منظمة الصحة العالمية, فان هنالك ضعف في تحقيق بعض المؤشرات في بعض القطاعات. هذه المؤشرات هي "النسبة المئوية لحالات اشتباه الاصابة بمرض الحصبة التي تم التحقق منها بصورة كاملة", و"النسبة المئوية لحالات اشتباه الاصابة بمرض الحصبة مع عينة وردت في المختبر في غضون 7 ايام من جمع العينة" و"معدل حالات غير الحصبة وغيرالحصبة الالمانية لكل مئة الف نسمة". الاستنتاجات والتوصيات : اظهرت الدراسة بان نظام ترصد الحصبة ذو حساسية عالية وقد حقق اهدافه المعلنة, على الرغم من انه لم يكن مرضيا تماما على جميع المستويات ولاتزال هنالك بعض الفجوات في النظام.واوصت الدراسة بضرورة تكرار التقييم بصفة دورية, اجراء البحوث العملياتية وتقييم مستقل للتغطية بلقاح (MCV) وتعزيز التدريب والاشراف والتغذية الاسترجاعية. | Background : Measles Case - Based Surveillance (MCBS) was started in Iraq in 2005 and every case of fever and rash should be immediately notified and investigated. Evaluation of Baghdad - Resafa Directorate of Health (DOH) was conducted in 2013. Objectives : to evaluate the quality of system, its performance and to determine the gaps and areas for improvement.Methods : Field visits to surveillance section within Communicable Diseases Control Center/Directorate of Public Health and Primary Health Care/Ministry of Health - Iraq (Iraq - CDCC) and surveillance units at Baghdad - Resafa DOH, its seven districts, two pediatric hospitals and fourteen Primary Health Care Centers (PHCCs) using checklist consist of modified WHO proposed list of indicators for monitoring and evaluation. Epidemiological analysis of MCBS data was done from 2008 - 2012.Results : Case detection, registration, confirmation, reporting; and epidemic preparedness were performed well at all levels. Data analysis and interpretation was only performed routinely at national level. Feedback reports were maintained at national, DOH and in 42.9% of the districts. Standard and guidelines were present in most studied areas. Only 62.5 % of the districts and 71.4 % of the visited PHCCs had trained staff. Although supervision was conducted, documentation and recommendations of the visits were present at DOH level, 71.4% of the districts; and only 50% of the hospitals and 42.9% of PHCCs. Completeness of surveillance data was varied from 83% to 90.9%. Timeliness was 100% for surveillance report submissions and outbreak detection. The system was useful, simple, accepted; and flexible at most levels. Sensitivity of the system was 92% in visited hospitals and 95% in visited PHCCs. Predicted Value Positive (PVP) was 3.6% in visited hospitals and 9.5% in visited PHCCs.Cumulatively 3,292 suspected cases were reported in Baghdad - Resafa DOH during 2008 - 2012. Among these, 2,603 (79%) were confirmed measles cases. Around 63.4% were 9 - 60 months, 15.6% were under nine - months. Around 68.2% were not vaccinated, 22.4% were vaccinated and the rest were of unknown vaccination status. About 99.3% of the vaccinated had one dose only. Card retention rate was 0.2% only. Despite progress achieved for most of WHO performance indicators, there was weakness in “percentage of suspected measles cases with complete investigation”, “percentage of suspected measles cases with specimen received at lab within 7 days of collection” and “non - measles non - rubella rate” in some districts. Conclusion and recommendations : The system appeared highly sensitive and met its stated objectives; although it was not fully satisfactory at all levels and some gaps are still there. It was recommended to repeat the evaluation periodically; conduct operational researches and independent assessment of Measles Containing Vaccine (MCV) coverage and to enhance training, supervision, and feedback

نتائج الفحص بالرنين المغناطيسي لمرض سرطان المبايض بالارتباط مع الفحص النسيجي == Magnetic Resonance Imaging Findings Of Ovarian Malignancy In Correlation With Histopathology

Author name: صبا قيس عيسى
Supervisor name: خليل ابراهيم محسن
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: نبذة : التشخيص المبكر والعلاج من الاورام الخبيثة للمبيض مصحوبان بتنبؤات حياتية جيدة. التصوير بالرنين المغناطيسي له درجة عالية من الدقة في التصنيف المبكر لاورام المبيض.الهدف من الدراسة : لتحديد دقة التصوير بالرنين المغناطيسي في تشخيص الاورام الخبيثة في المبيض بالمقارنة مع التشريح المرضي كاختبار ذهبي.المرضى وطرق البحث : دراسة متابعة مستقبلية اجريت في وحدة التصوير بالرنين المغنطيسي في قسم الاشعة بمستشفى بغداد التعليمي في مجمع مدينة الطب في بغداد خلال الفترة من 1 فبراير 2017 الى 31 ديسمبر 2017 على عينة من 30 امراة مشتبهة بالاصابة بورم المبيض. تم فحص جميع المرضى مع التصوير بالرنين المغناطيسي الموزون الانتشار وتم جمع العينات لفحص التشريح المرضي.النتائج : كشف التصوير بالرنين المغنطيسي للنساء المصابات بورم خبيث في المبيض في 73.3٪ من النساء كما كشف تحليل الانسجة عن وجود ورم خبيث في المبيض في 73.3٪ من النساء. كانت نتائج صلاحية التصوير بالرنين المغنطيسي فيما يتعلق باورام المبيض الخبيثة حساسية (90.9٪) وخصوصية (75٪) وقيمة تنبؤيه موجبة (90.9٪) وقيمة تنبؤيه سالبة (75٪) ودقة (86.6٪). كانت قيمة القطع المناسبة لمعامل الانتشار الظاهر في التمايز بين الكتلة الضامة الخبيثة والحميدة 0.97 مع حساسية 100٪ وخصوصية 90.9٪.الاستنتاجات : ان التصوير بالرنين المغناطيسي الموزون الانتشار هو تقنية صالحة ويمكن الاعتماد عليها في تشخيص وتوصيف اورام المبيض. | Early diagnosis and treatment of adnexal malignancy is accompanied with good prognosis. The magnetic resonance imaging has high accuracy in early categorization of adnexal masses. Aim of study : To determine accuracy of magnetic resonance imaging in diagnosing ovarian malignancy in comparison to histopathology as golden test.Patients and methods : A prospective follow up study conducted in magnetic resonance imaging unit of Radiology Department in Baghdad Teaching Hospital in Baghdad Medical City Complex during the period from 1st of February, 2017 to 31st of December, 2017 on sample of 30 women with suspected adnexal masses. All patients were examined with diffusion - weighted magnetic resonance imaging and specimens were collected for histopathology examination.Results : The magnetic resonance imaging of women with adnexal mass revealed malignancy in (73.3%) of women and the histopathology revealed also malignancy in (73.3%) of women with adnexal mass. The validity results of magnetic resonance imaging regarding malignant adnexal mass were sensitivity (90.9%), specificity (75%), +ve predictive value (90.9%), - ve predictive value (75%) and accuracy (86.6%). The appropriate cut off value for apparent diffusion coefficient in differentiation between malignant and benign adnexal mass was 0.97 with (100%) sensitivity & 90.9% specificity.Conclusions : The diffusion - weighted magnetic resonance imaging among other MRI sequences that play valid and reliable role in diagnosis and characterization of adnexal masses. Keywords : Adnexal masses, Ovarian Malignancy Magnetic Resonance Imaging, Histopathology

دراسة اتجاهات مرض التهاب الكبد الفايروسي في العراق للسنوات 2007 - 2014 == Trends of Viral Hepatitis, Iraq 2007 - 2014

Author name: حسين محمود كاظم
Supervisor name: جواد كاظم الديوان
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 : Viral hepatitis is a serious global public health problem and a major cause of morbidity and mortality particularly in developing countries. There are five distinct types of hepatitis virus. Hepatitis A, B, C, D and E viruses. Globally, every year there are an estimated 1.4 million cases of hepatitis A, 20 million hepatitis E infections, over 3 million acute cases of hepatitis E, and 56 600 hepatitis E - related deaths. HBV affected 7% of world population and causing more than 1 million deaths annually, while HCV affected 3% of world population and causing 366,000 deaths, annually. In Iraq, the carrier rate of HBV and HCV is 1.6% and 0.4% respectively. Goal : To decrease the morbidity and mortality resulting from viral hepatitis infection.Objective : to identify the trends of viral hepatitis, Iraq, 2007 - 2014.Material & Methods : A descriptive cross - sectional study was conducted from1st June to 31st August 2015 at Communicable Diseases Control Center (CDC)/Iraq on all confirmed hepatitis cases and clinically diagnosed hepatitis cases registered in Iraq provinces during eight years period (2007 - 2014). Data were obtained from the computer stored registries of these cases in Viral Hepatitis Section and Surveillance Section in Communicable Diseases Control center (CDC)/Iraq. Results : the higher incidence rate of hepatitis A, B and C occurred in 2013 (were 31.58, 11.49, and 3.69 respectively), higher incidence rate of hepatitis E in 2011 was 1.17 while higher incidence rate of clinical hepatitis in 2010 was 55.38.Conclusion and Recommendation : High incidence rate of HAV, HEV, HBV and HCV. The peaks of HAV were noticed in 2010 and 2013. Looking for good sanitation, Screening for risk groups, Vaccination for HBV.

نسبة الصفيحات الدموية الى الخلايا اللمفاوية ونسبة الخلايا اللمفاوية الى الخلايا الوحيدة لدى عينة من المرضى العراقيين المصابين بمرض بهجت == Platelet - Lymphocyte Ratio and Lymphocyte - Monocyte Ratio in a Sample of Iraqi Patients with Behçet’s Disease

Author name: زهراء مصطفى كامل
Supervisor name: 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: Behçet’s disease is a multi - systemic disorder, characterized bya remission and relapse , associated with a major morbidity and mortality.the principal pathological process is inflammation of blood vessels of allsizes and types (variable - vessel vasculitis).Platelet - lymphocyte ratio (PLR) and lymphocyte - monocyte ratio(LMR)regards simple, cheap parameters and was introduced as a novel marker todetermine inflammation in other diseases.ObjectiveTo evaluate the association between activity of Behçet’s disease withplatelet - lymphocyte and lymphocyte - monocyte ratio.Patients and MethodsThis case - control study conducted at Baghdad Teaching Hospital,Unit of Rheumatology from July 2017 to the end of February 2018. A total of 66 Iraqi patients who were diagnosed with Behçet's disease and met the inclusion criteria, and 66 apparently healthy individuals matched in age and sex as controls were enrolled. After acquiring their consent, data were collected using a pre - constructed data collection sheet, questionnaire including demographic and clinical data of the patients. Disease activity was assessed using Behçet's disease current activity form. Total White Blood Cells count and differential , C - reactive protein (CRP), erythrocytes sedimentation rate (ESR) were measured. platelet - lymphocyte and lymphocyte - monocyte ratio was calculated manually after obtaining the results from laboratory

انتشار العدوى المتفطرة اللاسلية الرئوية المعزولة من المرضى في المختبر المرجعي الوطني في العراق == The Prevalence of pulmonary nontuberculous mycobacterial infection isolated in patients at National Reference Laboratory in Iraq

Author name: احمد سالم محمد
Supervisor name: مصطفى نعمة عبد علي
General topic: Medicine
Specific topic: Internal Medicine
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Non - tuberculous mycobacteria (NTM) considered mostly as colonizers or ignored as environmental contaminants in the past, are now increasingly recognized as important pulmonary pathogens in both immunocompromised and immunocompetent population. Globally, an increase in NTM infections has been reported from many countries around the world. However, there are no published epidemiologic studies of NTM in Iraq.ObjectiveIs to estimate the prevalence and pattern of resistance of pulmonary NTM infection in Iraq.MethodsThis was a retrospective study collected from the database of national reference laboratory of Iraq from 2015 to 2017

الوضع الوبائي لمتلازمة العوز المناعي في العراق من 1990 - 2017 == Epidemiological Profile of HIV in Iraq From 1990 - 2017

Author name: قيس عبد العزيز عبد المطلب
Supervisor name: جواد كاظم الديوان
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 : HIV/acquired immune deficiency syndrome (HIV/AIDS) is a disease of far greater demographic diversity, affecting all ages, sexes, races, and income levels; involving multiple transmission risk behaviors; and having a broad geographic distribution worldwide.Globally, there are about 36.7 million people living with HIV, and 1.81 million new HIV infections occurred worldwide in 2016. There is insufficient epidemiological data on HIV infection in Iraq, so this study was conducted to estimate the prevalence, incidence and other epidemiological characteristics of HIV patients in Iraq.Methods : Descriptive cross sectional study was conducted by reviewing all records of HIV patients that retrieved from the Iraqi HIV Surveillance Center from1990 - 2017. Corresponding population data of Iraqi population was obtained from the Ministry of Health (MOH) - Directorate of Planning and Resource Development - Health and Vital Statistics Department. Results : The total number of the registered HIV patients in the Iraqi HIV Surveillance Center from 1990 - 2017 were 385 documented HIV cases. The prevalence and incidence of HIV infection in Iraq in 2017 were 0.66/ 100,000 populations and 0.24/100,000 population respectively, and they increased gradually over the last 27 years.The mean age of patients with HIV at time of detection was 31±12 years. Most of the patients aged 25 years and above that account for (86.8%).Males showed much higher percentage of HIV infection than females about 82%.Most of the cases concentrated in Baghdad governorate (123 cases) that represent 52.8%, followed by Erbil governorate (21,8.4%).Clinically suspecting HIV infection was the main route for detecting cases (22.07%), followed by blood donation (20%) of the cases.Sexual activities represent the major role of transmission about 57%, followed by blood and blood products consumption that represent 22.5%.Conclusions : The prevalence and incidence of HIV infection continue to rise over the last 27 years especially in the last five years. We recommend paying more attention to the control and prevention measures and enhancement of surveillance system.Keywords : HIV, Iraq, Epidemiology, ART.

الوفيات والمراضة الناتجة عن حالات التهاب المعدة والامعاء بين الاطفال دون سن الخمسة سنوات في بابل, 2007 - 2017 == THE MORTALITY and MORBIDITY of GASTROENTERITIS in UNDER 5 YEARS CHILDREN, BABYLON PROVNCE (2007?2017)

Author name: رزاق هاشم محمد
Supervisor name: علياء مكي حسن الصافي
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 : Diarrhea is one of the main causes of morbidity and mortality among children in developing countries. It was the second leading cause of death in children under five years, accounting for 9 % of all deaths among children under age 5 worldwide in 2015. Despite the availability of simple effective treatment, about 1,400 young children die each day which is equivalent to 526,000 children a year. According to Multiple Indicator Cluster Survey (MICS - 4), the incidence of diarrhea in Iraq was 15% .The objective of this study was to identify the incidence and deaths of gastroenteritis in children under five year in Babylon, 2007 - 2017.Methods : A descriptive cross - sectional study by reviewing all reported cases of gastroenteritis in hospitals and districts of Babylon province between 2007 - 2017.Incidence, mortality rate and case fatality rate (CFR) for <5 years population were calculated.Results : The mean of cases was 69,436 patients. A mean of outpatient was 60,243(86.8%) and 9,194(13.2%) were admitted cases. Male to female ratio was 1.1 : 1. Incidence of gastroenteritis was 237.8/1,000, the highest incidence was in 2012(302 /1,000), the lowest was in 2016(163/1,000), most deaths occur in children <1year (82.1%). CFR was (1.1/10,000), the highest case fatality rate was in2007 (3.9/10,000), there was no deaths in 2013 and 2015, therefore CFR was 0%.Proportional mortality rate (PMR) the mean was (0.3%); the highest PMR was in 2007 (0.8%), because there was no deaths in 2013 and 2015 PMR (0%).The incidence was higher in infants (477/1,000), than1 - <5 years (168.2/1,000) as means, which represented 2.8 times more in infants.Conclusion Diarrhea is still a major cause of morbidity and mortality in children under five years, which need to pay more attention for PHC efforts and community cooperation, improvements of living situations and encouragement of Breast feeding.Key words : Gastroenteritis, Babylon, Under 5 years children, Incidence, Case fatality rate, Proportional mortality rate.
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