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عسر شحميات الدم اعتلال المفاصل الصدفي الفعال : دراسة حالة ضابط == Dyslipidemia in Active Psoriatic Arthropathy Case Control Study

اسم المؤلف: منار هشام صابر
اسم المشرف: عبد اللطيف جاسم
الموضوع العام: الطب
السنة: 2018
الموضوع الدقيق: الامراض - المفاصل
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Psoriasis is a chronic inflammatory skin condition characterized by scaly erythematous plaques on body surfaces. Psoriatic arthritis (PsA) is a unique, clinically heterogeneous type of inflammatory arthritis associated with skin psoriasis.Atherogenic dyslipidemia comprises a triad of increased blood concentrations of small, dense low‐density lipoprotein (LDL), decreased high‐density lipoprotein (HDL) particles, and increased triglycerides. Most recently, a relationship between psoriasis and increased risk of myocardial infarction, cerebrovascular disease, and peripheral vascular (cardiovascular) disease has been reported.Objectives : This study aimed to shed the light on dyslipidemia in psoriatic arthropathy patients and to determine any association between lipid abnormalities and disease activity.Patients and Methods : This study is a case control study which was conducted on 84 patients in Rheumatology and Dermatology department/ Baghdad Teaching hospital and 90 healthy controls for 8 months' period from August 2017 to April 2018. All patients with confirmed cases of Psoriatic arthritis according to CASPAR criteria. Data collected and analyzed according to patient history and Physical examination were including age, gender, body mass index, education level, occupation, smoking status, disease duration and disease activity score ,presence or history of dactylitis and enthesitis, history of diabetes, hypertension and hypercholesterolemia, cardiovascular diseases, and drug history of Disease - modifying antirheumatic drugs (DMARDs) and (anti - TNF agents), lipid lowering drug ,use of fish oil with its duration . Laboratory parameters were also taken including ESR and lipid profile.Results : Total number of the patient in this study was 84 and controls were ninety.The mean age was (42.6)years, 51% were male . There was no significant difference in age, gender and BMI between patients and control. Cholesterol, triglyceride and LDL were significantly higher in patients compared to controls p value <0.001 . There was no significant difference in the (Cholesterol, TG, HDL, LDL, and Atherogenic index) between low and moderate to high disease activity. There was direct significant correlation between cholesterol with TNFI duration p value (0.039 ) Conclusions Patients with psoriatic arthritis had elevated levels of cholesterol, TG, LDL and atherogenic index. There is a direct association between high level of cholesterol and the duration of TNF inhibitor treatment. The current study shows that, no relation between disease activity and lipidprofile abnormality

صلاحية معيار بروتين سي التفاعلي في تقييم شدة مرض الانسداد الرئوي المزمن : دراسة مستندة الى المستشفى == VALIDITY OF C - REACTIVE PROTEIN TITER IN ASSESSMENT OF SEVERITY CHRONIC OBSTRUCTIVE PULMONARY DISEASE (HOSPITAL STUDY BASE)

اسم المؤلف: رشا مناور عبد
اسم المشرف: محمد وهيب سلمان العبيدي
الموضوع العام: الطب
السنة: 2018
الموضوع الدقيق: الامراض - الصدرية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Chronic Obstructive Pulmonary Disease (COPD) : is one of the most important causes of morbidity and mortality all over the world.C - Reactive Protein (CRP) : a biomarker of systemic inflammation and as an indicator of malnutrition or severity of Chronic Obstructive Pulmonary Disease (COPD). An assessment the relationship between serum C - reactive protein (CRP) levels and well - known clinical parameters in severity of Chronic Obstructive Pulmonary Disease (COPD) considering the impact of smoking behavior.Aim of study : To evaluate the interrelationship between C - reactive protein and chronic obstructive pulmonary diseaseMethodsWe studied (69) diagnosed COPD patients according to GOLDstages all patients didspirometry, body mass index andserum CRP titer levels were investigated in diseased COPD patients.Results : Patients sample, 72.5% male and 27.5% female, the ratio (3 to 1) of COPD included (75.4%) had positive CRP and (24.6%) had negative CRP. CRP titer levels were higher in severe COPD patients and there’s inversely relationship between Body Mass and the incidence of the C - Reactive Protein. There’s close relationship between cigarette smoking, body mass and chronic obstructive pulmonary disease.Conclusion : The circulating levels of the inflammatory marker CRP are significantly elevated in patients with COPD, supporting the view that COPD is in part an inflammatory disorder. This risk increase with increased severity of disease and cigarette smoking and this level elevated with decreasing body mass index.

قرحة الضغط قرحة الفراش في عينة من المرضى العراقيين المصابيين باصابات الحبل الشوكي == Pressure Ulcers in A Sample of Iraqi Patients with Spinal Cord Injury

اسم المؤلف: شهد عصام رؤوف
اسم المشرف: خضير زغير معيوف البدري
الموضوع العام: الطب
السنة: 2018
الموضوع الدقيق: الامراض - المفاصل
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Pressure injury are most common preventable secondary complication of spinal cord injury and may lead to serious sequences include but not limited to infection , tissue loss and surgical intervention with all its complication in addition to psychological and financial burden on patients and their families.Aim of the studyTo determine the prevalence, grade, number and most common sites of pressure ulcer in people with spinal cord injury. Patients and method : This study carried out at Ibn Alkuff Spinal Cord Injury Rehabilitation Hospital (Baghdad) during the period from 1st of November 2017 to the 1st of July 2018. A total sample of 100 Iraqi patients were included in this descriptive cross sectional study, 85 males (85%) and 15 females (15%), mean age of 31.7 ± 14.6 (range : 5 - 81) years, and the median duration since injuries was 8 months with an interquartile range of 4 - 24 months. Full history was taken and complete clinical examination was done for all patients. Pressure ulcer was diagnosed by physical examination and graded according to classification system for pressure ulcer by the European Pressure Ulcer Advisory Panel (EPUAP). Special scale was included in this study to assess spinal cord injury impairment (American spinal injury association scale (ASIA).Results : Forty patients were having pressure ulcer. The sites of these ulcers were as following : 46.9% ulcers in the sacral region, 28.6% in the gluteal region, 8.2% in the thigh (lateral aspect), 6.1% in the heel and 10.2% ulcers in other sites. This study showed that pressure ulcers more frequent in ASIA score (A) followed by (B) and (C); (49.3%, 45.5% and 5.9%, respectively). The results showed no statistical significant association between age, gender, duration of spinal cord injury and causes of spinal cord injury in determining the presence of pressure ulcer (p=0.089, p=0.57, p=0.214 and p=0.57 respectively).Conclusions : Pressure ulcers are one of common secondary complication that occur in 40%of Iraqi patients with spinal cord injury with more frequency in ASIA scale A andB spinal cord injury especially in sacral area and most of them with one ulceronly.

دراسة عدوى التدرن الكامن في مرضى السكري البالغين == Study of latent tuberculosis infection in adult diabetic patients at Baghdad teaching hospital

اسم المؤلف: شهد حامد مكي
اسم المشرف: مصطفى نعمة عبد علي
الموضوع العام: الطب
الموضوع الدقيق: الامراض - الصدرية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Latent TB is state of persistent immune response to stimulation by Mycobacterium tuberculosis antigens without evidence of clinically manifested active TB. The WHO reports that 10% of TB cases around the world are linked to diabetes. The course of the infections is also more complicated in this patient group. One of the possible causes of this increased prevalence of infections is defects in immunity.Aim of the study : This study tested for relationship between LTBI and DM and attempted to determine if DM status influenced the result of LTBI. Materials and Methods : - The study was comparative case control with analytical elements.The data collection was carried out in medical clinic in Baghdad teaching hospital at Baghdad city, Iraq. The data collection was done between the 1stOctobar 2017 to 1st March 2018, two days weekly, four hours per day. Total sample was 102 participants, 51 diabetic patients and 51 non diabetic patients. Results : - Total of 102 patients were involved in the study. The age and body mass index (BMI) of patients of both groups was matched and there was a significant difference of the mean years of age of the patients with positive TST and those with negative TST, while no such significant difference was found between the BMI of the patients with positive TST and those with negative TST significant association was found between diabetic history and latent tuberculosis which identify by positive result of TST, while no association found between smoking history and educational level with latent tuberculosis.Conclusion : - This study show significant relation between DM and development of latent TB.

اثار نمط اللباس المختلفة على كثافة معادن العظم في الشابات الاصحاء == Effects of Different Dress Styles on Bone Mineral Density of Young Healthy Women

اسم المؤلف: هاشم خالد كاظم
اسم المشرف: محمد هادي العصامي
الموضوع العام: الطب
السنة: 2018
الموضوع الدقيق: الامراض - المفاصل
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Osteoporosis is a disease characterized by reduction in the bone mass and disruption of bone architecture leading to impaired skeletal strength and increased susceptibility of fractures. Bone mineral density (BMD) measurement by dual energy X - ray absorptiometry (DXA) is the most commonly used of all methods available for fracture risk assessment.Objective : To investigate the differences in BMD in veiled and unveiled Iraqi women in premenopausal age group.Patients and Methods : A total of 80 Iraqi women were enrolled in this study. They were divided into two groups. Group - 1 consisted of 40 cases with an open clothing style, while the 40 women in group - 2, preferred the covered clothing style. Women were questioned in terms of the risk factors for osteoporosis. The body mass index (BMI) was calculated and the BMD of lumbar spine and left hip was measured by DXA. Z scores were obtained.Results : In the lumbar spine, the mean BMD was measured 0.95 gm/cm2 in cases with Hijab clothing style while it was measured 1 gm/cm2 in cases with no Hijab clothing style (P = 0.038). In the left hip, the mean BMD was measured 0.86 gm/cm2 in cases with Hijab clothing style ,while it was measured 0.91gm/cm2 in cases with no Hijab clothing style (P = 0.12). Although adecrease in BMD values was observed in both regions with Hijab clothing style, only the change in the lumbar spine BMD measurements was statistically significant.Conclusions : These data are suggestive of widespread low BMD in Iraq especially in the veiled women with possible adverse effects of totally or near totally covering dress styles on bone mineralization in the long run.

تحليل نتائج ناظور القصبات المرن في وحدة الامراض الصدريه والتنفسيه في مستشفى الحسين ع التعليمي في محافظة كربلاء للسنتين 2016 - 2017 == Analysis of fiberoptic bronchoscopic findings in Al - Hussain teaching hospital in Karbalaa Governorate in 2016 - 2017

اسم المؤلف: عمار عباس نعمة
اسم المشرف: محمد وهيب سلمان العبيدي
الموضوع العام: الطب
الموضوع الدقيق: الامراض - الصدرية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Fiber - Optic bronchoscopy is a safe and useful diagnostic andtherapeutic tool for the management of many pulmonary diseases.Aim of study : To analyse the outcome of fiberoptic bronchoscopy in respiratoryunit at Al - hussain teaching hospital in Karbalaa governorate in years 2016 - 2017.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. 105 patients underwent bronchoscopies in the respiratory unit in Al - hussain teaching hospital in Karbalaa governorate in 2016 - 2017.Results : Amongst the 105 patients where 54.3% of them was female and 45.7% was male, 61% of total number was non - smoker, 26.7% currently smoker and ex - smoker of 12.4 %.The highest percentage (30.5%) of partiptants fall to age group of 60 - 69 years followed by age group 0f 70 - 79 years (22.9%), 50 - 59 years (17.1%) and the remains fall to other age groups in lower percentages.Commonest indication of bronchoscopy was radiological opacity found in 79.05% of patients, followed by productive cough (11.34%) and hemoptysis (9.52%) as the second and third indications respectively.The most common finding on bronchoscopy was abnormal bronchial mucosa found in about 65.7% of patients. Malignancy was seen in 29.5% of the cases, while Tuberculosis seen in 17.1%.In the 105 patient the bronchoscopy done with neither death nor serious complications occurrence likes pneumothorax or cardiac arrest.Conclusion : Fiberoptic bronchoscopy is extremely useful in finding specific etiologies of various lung diseases.

التصورات والممارسات والمعتقدات التقليدية نحو اليرقان الولادي وادارته بين الامهات العراقيات في بغداد\ الكرخ == Perceptions, Practices and Traditional Beliefs toward Neonatal Jaundice and Its Management among Iraqi Mothers in Baghdad Al - Karkh 2018

اسم المؤلف: ياسمين خالد يوسف
اسم المشرف: علياء مكي حسن الصافي
الموضوع العام: الطب
السنة: 2018
الموضوع الدقيق: طب العائلة
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Neonatal jaundice is one of the most common neonatal disorders worldwide. It is still a main cause of avoidable brain damage, physical and mental impairment, and probable death in newborns.Aim of the study : To assess mothers' perceptions toward neonatal jaundice. To assess mothers' practices and traditional beliefs toward neonatal jaundice. To identify the relationship between mothers' perceptions with their beliefs and their socio - demographic variables such as mothers' age, occupation, residence and level of education.Method : A cross - sectional study was conducted from February - May 2018, at postnatal care clinics in ten primary health care centers in Baghdad AL - Karkh.Mothers who gave birth in less than one month before the study, using a structured questionnaire to gather data on socio - demographic character, there knowledge toward this condition, its causes, complication and their practices and traditional beliefs relating its management.Results : (61%) of the participants had acceptable level of perception toward NNJ and (30.8%) had good level of perception toward it..Two variables were found to have significant association toward their perception according to this condition : occupation status (working) (p - value 0.05) and those who had informed about the condition (p - value 0.013) Conclusion : There are still misconceptions on the risk factors, treatments and mothers practices and traditional beliefs towards this condition. Special educational programs are needed to increase the awareness of mothers

العلاقة بين جودة النوم وضغط الدم الحملي في بغداد, العراق,2018 == THE ASSOCIATION BETWEEN SLEEP QUALITY AND GESTATIONAL HYPERTENSION IN BAGHDAD, Iraq, 2018

اسم المؤلف: اندلس عادل محمود
اسم المشرف: فارس حسن اللامي
الموضوع العام: الطب
السنة: 2018
الموضوع الدقيق: طب العائلة
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Hypertensive disorders in pregnancy are the most common medical complications of pregnancy and are an important cause of maternal and perinatal morbidity and mortality worldwide. The development of sleep disorder breathing in pregnancy is considered a consequence of necessary physiologic adaptations that occur in pregnancy, such as dramatic hormonal and subsequent physical changes. The objective of this study was to identify the role of sleep disorder as a risk factor of hypertension among a sample of pregnant women in Baghdad. Method : this case control study was conducted in two hospitals and one Primary health care center in Baghdad. The cases were pregnant women of >20 weeks of gestation with a diagnosis of gestational hypertension, and the controls were pregnant women of >20 weeks of gestation but free from hypertension. The controls to cases ratio was 2 : 1. All the participants were directly interviewed using questionnaire to gather data on socio - demographics, clinical and risk factors. The sleep quality was assessed using The Pittsburgh Sleep Quality Index (PSQI). A score of ≥5 indicates poor sleep quality.Result : The total number of cases was 103 and the controls was 206. Poor sleep quality index was observed in 58 (56.3 %) of the cases and 88 (42.7%) of the controls (P=0.024 OR 1.728, 95%CI 1.968 - 1.488).Two other variables were also found significant risk factors after logistic regression analysis : working status (employed) (P - value 0.025, OR 1.89, 95%CI 1.103 - 2.440) and increasing gravida (P - value 0.023, OR 1.330, 95%CI 1.177 - 1.501).Conclusions : Sleep disorder is an important risk factor of gestational hypertension. It is important to consider this association upon screening, prevention and treatment of gestational hypertension.

عنصر المغنسيوم في الدم مؤشر على مستوى شدة الربو القصبي والانتكاسات الحادة للمرضى == Evaluation of Serum Magnesium as Indicator of Asthma Severity in Stable Asthma and Acute Exacerbation

اسم المؤلف: طاهر بلاش محمد
اسم المشرف: محمد وهيب سلمان العبيدي
الموضوع العام: الطب
السنة: 2018
الموضوع الدقيق: الامراض - الصدرية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Asthma is a chronic inflammatory disorder of the airways characterized by marked variability in airflow obstruction that is often reversible, either spontaneously or with treatment.Magnesium is the second most abundant intracellular cataion after potassium.Magnesium has been shown to relax bronchial smooth muscles and influence the function of respiratory muscles.Aim : To assess the serum magnesium levels in asthmatic patients during stable and exacerbating clinical condition and to compare serum magnesium values in asthmatic patient and healthy subjects.Patients and methods : 110 Subjects were enrolled, 70 patients diagnosed with asthma and 40 healthy individuals as a control group. The asthmatic patients were divided into : (I) stable asthma group (II) acute exacerbation asthma group.Blood had been taken from all subjects and serum magnesium measured by spectrometer.Results : Serum magnesium levels were significantly lower in asthmatic patients compared with healthy subjects.Conclusion : There is a significant association between lower serum magnesium level and asthma.

انتشار مرض السل الكامن بين مرضى الربو الذين يستخدمون الستيرويدات كدواء اساسي في علاجهم == Prevalence of latent TB in Asthmatic Patients who are Using Steroids as Essential Drug of Their Management

اسم المؤلف: احمد عباس قدوري
اسم المشرف: محمد وهيب سلمان العبيدي
الموضوع العام: الطب
السنة: 2018
الموضوع الدقيق: الامراض - الصدرية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: ان مرض السل يعد من اخطر العوامل التي تسبب الوفاة خاصة في البلدان النامية وفقا لاحصائيات منظمة الصحة العالمية ومركز السيطرة على الامراض الانتقالية وتبين ان نسبة الاصابة تتناسب طرديا مع نقص مناعة المريض.وحسب النظرية التي تنص على ان المناعة ممكن ان تضعف بتناول جرعة لا تقل عن 15 غم يوميا ولمدة تزيد على اربعة اسابيع نجد ان مرضى الربو ممكن ان تزداد احتمالية اصابتهم بمرض السل بحوالي 8 اضعاف .الهدف من الدراسة معرفة مدى الاصابة بمرض االسل بين الاشخاص المصابين بالربو مستخدمي الستيرويدات كدواء اساسي ضمن علاجهم .طريقة اعداد البحثدراسة انية مصممة لاستيعاب مرضى الربو ممن يراجعون مستشفى مدينة بغداد الطبية التعليمي للفترة من نيسان 2017 الى نيسان 2018 بمركز التدرن الرئوي ووحدة المرضى الراقدين ومرضى العيادة الخارجية.تم اعداد استمارة الاستبيان الخاصة بالبحث لتسجيل اهم المعلومات المتوافقة مع الموضوع من قبل الباحث .النتائجتم اختيار 60 مريضا من مرضى الربو للدراسة خلال مدة سنة واحدة وكان عدد الاناث 41 مريضة واما عدد الذكور 19 مريضا ونسبة الذكور الى الاناث هو 7 : 3 على التوالي , 95 % منهم من سكنة المدن و5% منهم يسكنون في المناطق النائية , وكانت الاعمار بين سن 18 الى سن 60 سنة اي معدل العمر 31.4 .51.6% منهم كانوا يستخدمون الستيرويد بجهاز البخاخ وبالشكل الصحيح 40% من المرضى كانوا يستخدمون جهاز البخاخ بطريقة خاطئة بحيث يبتلعون المادة الستيرويدية دون استنشاقها و8.4 % منهم كان يستخدم جهاز البخاخ كعلاج مع الحبوب ولمدة لا تقل عن ستة اشهر . كانت نتائج فحص السلين بالجلد موجبة ل 7 ( 11.7 % )مرضى وكالتالي : شخص واحد فقط من مستخدمي جهاز البخاخ بطريقة خاطئة اي بلعا لمدة لا تقل عن 3 سنوات (1.7 %) ومريض واحد من مستخدمي البخاخ بطريقة صحيحة لمدة تزيد على 20 سنة (1.7 % ) و5 اشخاص ممن كانوا يستخدمون الستيرويد على شكل حبوب مضاف له البخاخ لمدة تزيد على 4 اشهر ( 8.3 % ) واما نتائج بقية ال 53 مريض كانت سالبة , على ان هنالك علاقة واضحة بين عمر المريض وزيادة نسبة الاصابة طرديا ( p=0.01)وايضا تزداد النسبة مع ازدياد الجرعة ومدة استخدام الستيرويد( p=0.001) الاستنتاجبعد تحليل النتائج المنتقاة من هذه الدراسة تبين لنا ما يلي : 1. تزداد خطورة الاصابة بداء السل مع ازدياد العمر 2. طريقة تناول الستيرويد له علاقة قوية مع معدل الاصابة بالسل 3. زيادة جرعة الستيرويد ووزيادة مدة تناوله يزيد من فرص الاصابة بالسل 4. ظهرت علاقة جديدة واضحة بين استخدام جهاز البخاخ بطريقة خاطئة من خلال بلع المادة الواجب استنشاقها وبين فحص السلين للجلد.5. تبين انه لا توجد علاقة واضحة بين فحص السلين وجنس المريض واما الزيادة في النتائج الموجبة بين الاناث فسببه هو ان عدد الاناث المصابات بالربو هو اصلا اعلى من الرجال . | Back ground Asthma is a common chronic inflammatory airways disease which need steroid as essential drug of its management. Latent TB is when person is infected with Mycobacterium.TB with no symptoms and it's not contagious as active TB. The risk of developing TB increases with the drop of immunity. Using of steroid >15 mg/day > 4 weeks is associated with drop in immunity, so asthmatic patient might be infect with TB.Aim of the study : To assess the impact of steroid treatment on the risk of developing latent TB in asthmatic patientsPatients and Methods : a cross - sectional study conducted between April 2017 to April 2018 at respiratory clinic and TB center of Baghdad Teaching Hospital. Convenient sample of 60 asthmatic patients on steroid include 19 males and 41 females. Results : the mean age of patients is 31±2, 41 females and 19 males, f / m ratio was 7 : 3. 31 used ICS correctly, 24 take ICS materials as wrong technique by swallowing it, and 5 are using oral and ICS as combined treatment modality. Regarding TST results, 6 persons were tested positive, 4 are from those who are using combined modality for more than 4 months, 1 from those who swallow the materials for more than 3 years, and 1 from those who using inhaler device correctly for more than 20 years. A significant correlations were found between TST and increasing age of the patient p=0.001, and the TST and the duration of use of steroids p=0.01.Conclusion : the prevalence of positive TST among asthmatic patients obviously related to type of steroid administration (orally is higher risk), aging and duration of steroid use

تقييم فائدة ايكو القلب في تشخيص عملية تغيير شكل البطين الايسر بين مرضى احتشاء عضلة القلب الحاد == Echocardiographic Assessment of Left Ventricular Remodeling Process among Acute Myocardial Infarction Patients

اسم المؤلف: ميادة ضياء الدين محسن
اسم المشرف: باسل نجيب سعيد الدليمي
الموضوع العام: الطب
السنة: 2015
الموضوع الدقيق: صدى القلب
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: تقييم جدوى ايكو القلب ثنائي الابعاد في الاستدلال عن تغيير شكل البطين الايسر وازدياد حجمه بعد احتشاء عضلة القلب الحاد.الاساليب والنتائجتم اجراء ايكو القلب ثنائي الابعاد في غضون خمسة ايام من دخول المستشفى لمئة مريض يعانون من احتشاء عضلة القلب الحاد. وقد تم تحليل عدة متغييرات سريرية ومختبرية بضمنها ايكو القلب ثنائي الابعاد اضافة الى البيانات الاساسية الديموغرافية، كضغط الدم والنبض وقد ثبتت القيمة التشخيصة لمختلف معايير ايكو القلب التقليدية كحجم البطين الايسر والكسر القذفي في الكشف المبكر عن تغير شكل ووظيفة البطين الايسر. وقد تبين من هذه الدراسة ان اتساع حجم الاحتشاء القلبي كان له الاثر الاكبر في زيادة حجم البطين الايسر وقصور عمله الوظيفي. كما ان هذا الاثر كان اكثر احتمالا للحدوث عند الاكبر سنا من المصابين وعند الذكور منهم, اضافة الى ان كمية العضلة المصابة وعلى الاخص الاحتشاء الذي يشتمل العضلة الامامية للقلب عما سواها من الجدران كان الاكثر تاثيرا على حجم البطين الايسر وتدهور عمله الوظيفي.الاستنتاجاتكان لفحص ايكو القلب ثنائي الابعاد لمرضى الجلطة القلبية الحادة قيمة فعلية في تحديد الاشخاص الاكثر عرضة لمضاعفات الاحتشاء وعلى الاخص زيادة حجم البطين الايسر وتدهور عمله الوظيفي | Echocardiography is useful for assessment of left ventricular remodeling after myocardial infarction, which is the focus of this thesis. We investigated the influence of various traditional echocardiographic parameters on the process of left ventricular remodeling such as left ventricular volumes and ejection fraction, wall motion score index, mitral regurgitation and diastolic dysfunctionAims To invistigate the usefulness of two - dimensional echocardiography for accurate evaluation of left ventricular (LV) remodeling after acute ST elevation myocardial infarctions (STEMI).Methods and results Two - dimensional echocardiography was performed within 5 days on a 100 patients admitted to the hospital with a first ST - elevation AMI. Several clinical and echocardiographic variables were analyzed. Baseline demographic data, blood pressure, and pulse were obtained. Various traditional echocardiographic parameters have been shown to provide diagnostic information, such as left ventricular volumes and ejection fraction, wall motion score index, mitral regurgitation and left atrial pressure. A left ventricular wall motion score index was derived from analysis of regional wall motion; an index of 1.5 or more within 5 days of admission identified patients at high risk for remodeling and LV dysfunction. Predictors of early LV remodeling were older age, male gender, history of diabetes mellitus or hypertension, high leukocyte count, high admission blood glucose level, high wall motion score and anterior location myocardial infarction.Conclusions After acute ST - elevation myocardial infarction, early determination of the wall motion score index by two - dimensional echocardiography is useful for identifying patients at high risk for complications and to differentiate patients with and without development of LV remodeling accurately and early on the basis of wall motion score index as a measure of infarct size, a highly predictive variable

تحديد دقة فحص السونار في تشخيص انظغاط العصب الوسطي لليد بالمقارنة مع مشاهدات العملية الجراحية == Accuracy of ultrasound in diagnosis of Carpal Tunnel Syndrome in correlation with operative findings

اسم المؤلف: ليث فاضل فرمان
اسم المشرف: ليث احمد خلف
الموضوع العام: الطب
السنة: 2015
الموضوع الدقيق: الاشعة التشخيصية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: انظغاط العصب الوسطي لليد يعد من اكثر الحالات شيوعا لامراض انظغاط الاعصاب , فحص السونار يستخدم كبديل عن فحص الاعصاب لتشخيص هذه الحالات ويمكنه ايضا معرفة الخواص التشريحية للعصب الوسطي لليد والانسجة المحيطة به والامراض التي بدورها سببت انظغاط العصب , يمكن اعتبار فحص السونار حاليا وسيلة فحص اولية لتشخيص انظغاط العصب الوسطي لليد مع دقة تشخيصيه مقاربة لفحص الاعصاب واكثر تقبلا من المرضى ايضا متوفر ومتواجد بسهولة , اقل كلفة مع قابليته لتحديد الصفات التشريحية للعصب الوسطي والقناة الرسغية وتوجيه التداخل الابري بدون مضرة العصب الوسطي اذا احتيج لذلك .الهدف : تحديد دقة تشخيص السونار لنظغاط العصب الوسطي لليد بالمقارنة مع مشاهدات العملية الجراحية . المرضى والطرق : دراسة استطلاعية اجريت في مستشفى الشهيد غازي الحريري التعليمي ومستشفى بغداد التعليمي في مدينة الطب في بغداد خلال الفترة من 20 كانون الاول 2014 الى 30 ايلول 2015 . شملت 65 مريض يعانون من انظغاط العص الوسطي لليد مشخصين بواسطة فحص الاعصاب وكحالات موثقة , جميعهم وافقوا على المشاركة في هذة الدراسة , تم مقابلة المرضي مباشرة وفحصهم واخذ بياناتهم التي تم جمعها باستخدام نموذج جمع البيانات واشتمل على البيانات الديموغلرافية والسريرية للمرضى من حيث العمر والجنس واليد المصابة وتاريخ الفحص وجهة الارسال ومن ثم تسجيل مشاهدات فحص السونار واذا تم اجراء تحرير العصب الوسطي للمريض تسجل مشاهدات العملية الجراحية .تم فحص المرضى بواسطة جهاز سونار نوع فلبس ) Philips HD 11XE®)بذراع فحص مستقيم وبقدرة 7,5 ميغا هيرتز المستخدم لفحص الانسجة الرخوه والسطحية .تم تحليل البيانات باستخدام الحزمة الاحصائية للعلوم الاجتماعية (SPSS)النسخة 17 , واستخدمت الاختبارات الاحصائية المناسبة لتقييم الاهمية الاحصائية للفروقات .النتائج : تراوحت اعمار المرضى بين ( 19 - 74 ) عاما مع متوسط عمر ( 45.9 ± 13 ) عام , نسبة الاناث الى الذكور ( 9 اناث الى 1 ذكر ) وبنسب تقارب ( 90%) اناث الى ( 10 % ) ذكور ,كانت نسبة اصابة اليد اليمى ( 55 % ) الى اليد اليسرى ( 30 % ) وكلتا اليدين ( 15 % ) تقريبا , عدد المرضى الذين اجريت لهم العملية ( 52 ) مريض ( 13 ) بدون عملية , من العدد الكلي ( 65 ) .كانت دقة تشخيص السونار من حيث اكتشاف تورم العصب الوسطي عند دخوله القناة الرسغية ( 87% ) دقة و( 88% ) حساسية و( 85 % ) تخصيصا بمقدار معامل الخطا ( 0,001 ) او يدعى الاهمية الاحصائية للتنبوء.ودقة تشخيص السونار من حيث ( استواء = انظغاط ) العصب الوسطي في القناة الرسغية ( 76 % ) دقة و( 76% ) حساسية و( 100% ) تخصيصا بمقدار معمل الخطا ( 0,0017 ) او يدعى الاهمية الاحصائية للتنبوء.اما دقة تشخيص السونار( بواسطة فحص حركة اليد ) من حيث تثبت وتقييد حركة العصب الوسطي في القناة الرسغية ( 71% ) دقة و( 38% ) حساسية و( 100% ) تخصيصا بمقدار معامل الخطا (0,005) او يدعى الاهمية الاحصائية للتنبوء .تم تجاهل دقة السونار من حيث فحص الاوتار العضلية والانسجة المحيطة بالعصب الوسطي مثل السوائل او التليف والدهون في العلاقات الاحصائية لان معامل الخطا كان كبيرا في النتائج ( 0,803) او يدعى الاهمية الاحصائية للتنبوء.ايضا تم تجاهل دقة فحص السونار من حيث اندفاع الرباط الرسغي الى الامام من العصب الوسطي لانه يتم قطعه اثناء العملية الجراحية ولا يحصل من ذلك مشاهدات مفيدة .الاستنتاجات : دقة فحص السونار في تشخيص انظغاط العصب الوسطي كانت مرتفعة وعالية الاهمية وتقارب دقة فحص العصب حساسية , حيث بلغت ( 87% ) , وان هناك علاقة واضحة وحقيقية لمشاهدات فحص السونار ومشاهدات العملية الجراحية لتحرير العصب الوسطي لليد . | Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, US can be used as an alternative to (NCS) for diagnosis of CTS.US can assess the anatomy of the carpal tunnel, median nerve and also identify pathology of the surrounding structures that may compress the nerve.US is proposed as the initial diagnostic test in CTS based on similar sensitivity and specificity to NC studies, higher patient acceptability, easy availability lower cost and additional capability to assess carpal tunnel anatomy and guide injection.Aims of the study : To assess the accuracy of US in the diagnosis of CTS in correlation with the operative findings.Patients and Methods : A prospective study was conducted at Al - Shaheed Ghazi Al - Hariri teaching hospital and Baghdad teaching hospital in Baghdad medical City, during the period from 20th of December 2014 to the 30th of September 2015. Total of 65 patients were enrolled in this study, all of them where already improved and documented to have CTS by NCS, appropriate statistical tests were applied to the data accordingly. X - square was used to test the relation between ultrasound and operative findings. P - Value of less than 0.05 was considered significant

تقييم السيطرة على الربو في مستشفى بغداد التعليمي == Assessment of Asthma Control in Baghdad Teaching Hospital

اسم المؤلف: يعرب مظلوم عباس
اسم المشرف: عدنان الجبوري
الموضوع العام: الطب
السنة: 2015
الموضوع الدقيق: الامراض - الصدرية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: الخلفية : الربو هو مشكلة صحية عالمية تصيب 300 مليون من الافراد من جميع الاعمار حول العالم. على الرغم من المبادئ التوجيهية الدولية،مزاالت السيطرة على الربو بعيدة عن الاهداف في مختلف انحاء العالم.اهداف الدراسة : لتحديد ما اذا كان اختبار السيطرة على الربو (ACT) يمكن ان تكون مفيدة مثل معايير المبادرة الدولية للربو (GINA)في تقييم السيطرة على الربو. طرائق البحث : دراسة مستعرضة تضمنت 64 مريضا اعمارهم> 18 سنة يعانون من الربو في عيادة الامراض الصدرية في مستشفى بغداد التعليمي بين شباط 2015 وايار 2015. وجرى تقييم السيطرة على الربو باستخدام المبادرة الدولية للربو ( (GINAواختبار السيطرة على الربو ACT)).النتائج : كان هناك 64 من المرضى المسجلين في هذه الدراسة، كان 44 مريضا(68.8٪) من الاناث وكان 20 مريضا (31.2٪) من الذكور. وفقا لاختبار السيطرة على الربو (ACT) 43 مريض (67.2٪) حصلوا على درجة (<15) و21 مريضا (32.8٪) حصلوا على درجة (15 - 19) . وفقا لتصنيف (GINA) 49 مريض (76.56٪) صنفوا كمرضى غير مسيطرين على الربو 15 مريض (23.44) صنفوا على انهم مسيطرين جزئيا على الربو . الاستنتاج : في دراستنا وجدنا اتفاق كبير بين اختبار السيطرة على الربو (ACT) وتصنيف (GINA) وبذلك ACT يمكن ان تكون بديلا لتصنيف (GINA)في تقييم السيطرة على الربو. | Background : Asthma is a global health problem that affects 300 million individuals of all ages around a world. Despite international guidelines, asthma control is short of the goal in different parts of the world. Aims of study : To determine if the ACT can be as useful as the GINA - guidelines criteria in assessing asthma control . Methods : A cross - sectional study recruiting 64 patients aged >18 years with asthma were seen at chest clinic of Baghdad Teaching Hospital between February 2015 and May 2015. Asthma control was assessed using the GINA algorithm and the ACT score . Results : There were 64 patients enrolled in this study, 44 patients (68.8%) were female and 20 patients (31.2%) were male . According to ACT score 43 patient (67.2%) had an ACT score of (<15) and 21 patients (32.8%) had an ACT score of (15 - 19) and none patients had ACT (20 - 25) . According to GINA classification , 49 patient (76.56%) classified as uncontrolled and 15 patients (23.44) classified as partly controlled and none patients classified as controlled .Conclusion : In our study we found high agreement between ACT score and GINA classification thus ACT score can substitute GINA in assessment of asthma control . Asthma control was also dependently associated with the individual patient's age group.

تقلص الشرايين التاجية نسبة الحدوث والخصائص خلال قسطرة الشرايين التاجية في المركز العراقي لامراض القلب == Coronary Artery Spasm; Frequency and Angiographic Findings in the Iraqi Centre for Heart Disease

اسم المؤلف: عمار زيدان عمران
اسم المشرف: حسن يوسف النجار
الموضوع العام: الطب
السنة: 2015
الموضوع الدقيق: الامراض - القلب
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: الخلفية : يعتبر تقلص الشرايين التاجية احد اهم انواع امراض الشرايين التاجية.في الاساس تقلص الشرايين التاجية الذي يحدث تلقائيا" يؤدي الى متلازمة برنزميتال .في الوقت الحاضر تقلص الشرايين التاجية صار اكثر حدوثا" خلال قسطرة الشرايين التاجية او التداخل القسطاري. هذه الظاهرة تحدث من 1 - 5% خلال قسطرة الشرايين التاجية . الاهداف : تهدف هذه الدراسة لدراسة نسبة حدوث تقلص الشرايين التاجية للمرضى المجرات لهم عملية قسطرة الشرايين التاجية (التشخيصية والعلاجية ) في المركز العراقي لامراض القلب ومعرفة الخصائص السريرية والقسطارية لهولاء المرضى . المواد والعمل : هذه دراسة استباقية ,جمعنا نتائج المرضى خلال ستة اشهر( من شهر اب 2014 الى شهر شباط 2015 ) الذين حصل لديهم تقلص الشرايين التاجية سواء كان تقلص الشرايين التاجية تلقائي الحدوث اوخلال القسطرة او التداخل القسطاري.هولاء المرضى يجب ان يحصل لهم تقلص واضح للشرايين التاجية والذي يعود الى وضعه الاولي اما تلقائيا" او عن طريق اعطاء النايتروكلسيرين من خلال الشرايين التاجية. النتائج : من مجموع 1247 مريض الذين تم ادخالهم الى المركز العراقي لامراض القلب لغرض اجراء عملية القطسرة او التداخل القسطاري,106 مرضى حصل لديهم تقلص الشرايين التاجية (8.3 %). ثلاثة ارباع المرضى كانوا بالغين تتراوح اعمارهم من 50 - 69 سنة (71.6%) ثلاثة ارباع المرضى كانوراجال (74.5%).التدخين عامل فعال لحدوث تقلص الشرايين التاجية, حصل في خمس المدخنين (19.7%) مقارنة مع حصوله في واحد من عشرين مريض غير مدخنين (4.8%) التقاء القسطار مع فوهة الشريان التاجي كان المسبب الاول لحدوث تقلص الشرايين التاجية في 52 مريض من اصل 106 مريض (49%), حصل تقلص الشرايين التاجية بسبب زرع الشبكات في 33 مريض (31.1%), بسبب سلك التداخل القسطاري في 17 مريض (16%), بسبب البالون في 4 مرضى (3.7%) بينما تقلص الشرايين التاجية التلقائي حدث في 7 مرضى (6.6%). تقلص الشرايين التاجية كان محدود الحدوث في 100 مريض (94.3%),منتشر في ثلاثة مرضى ومتعدد في ثلاثة مرضى اخرين .الشريان التاجي الايمن هو الاكثر الذي حدث فيه التقلص في 51 مريض(48%) يليه الشريان التاجي الامامي النازل الايسر في 29 مريض ( 27.3%) , بينما شريان الجذع الرئيسي الايسر في 13 مريض (12.2%), وهي نفس النسبة التي انشمل الشريان الايسر المنعكس بها.حصل تقلص الشرايين التاجية في الشرايين المصابة بالتصلب في 80 مريض(75.4%) بينما الشرايين التي على الاغلب غير مصابة بالتصلب في 26 مريض (24.5%). تقلص الشرايين التاجية في الشرايين التي على الاغلب غير مصابة بالتصلب كان اكثر حدوثا" في النظام الايمن للشرايين التاجية (65.3%) مقارنة بالنظام الايسر للشرايين التاجية (34.7%). | Coronary artery spasm (CAS), is an important form of the coronary artery disease. Originally coronary artery spasm occurs spontaneously leading to the syndrome of variant angina .Nowadays itfrequently occurs more commonly with coronary angiography and / percutaneous coronary intervention . It occur in about1 - 5 % of patients undergoing coronary angiography.Objectives : we review 106 patients with coronary artery spasm that occur during coronary angiography/or PCI and there risk factors in patients admitted to the Iraqi centre for heart disease . Methods : This is a cross sectional observational study, We prospectively collected the data of patients over six months period (from August 2014 till February 2015 ) who developed coronary artery spasm during cardiac catheterization (diagnostic and therapeutic).Those patients should have significant transient narrowing of the coronary artery that resolve spontaneously or by intracoronary nitroglycerin.Results : Out of 1274 patients who were admitted for diagnostic coronary angiography and/ percutaneous coronary intervention,106 patients developed coronary artery spasm(8.3%). 71.6% of patients were adult aged 50 - 69 years.74.5% patients were males).(P.V 0.0001)Smoking was a strong risk factor for the coronary artery spasm, as it has occurred in almost one fifth of smokers (19.7%),compared to one out of twenty of non smoker(4.8%).(P.V<0.0005)Engagementof catheter in the coronary artery ostia during angiography was the most common cause of spasm as it occurs in 52 patientsout of 106 patients(49%),(P.V0.0001).Spasmwas induced bystents in 33 patients (31.1%), by guide wire in 17 patients (16%),by balloon in 4 patients(3.7%) whilespontaneous spasm occurred in 7 patients only (6.6%).Spasm was localized to a small segment ;Focal in almost all patients 100 patients( 94.3%),diffuse in 3 patients and multifocal in another 3 patients.The right coronary artery was most frequently involved by spasm in51 patients (48%),compared to the left anterior descending in 29 patients( 27.3%).The left maininvolved by spasm in 13 patients (12.2%) and left circumflex has similar frequency of CAS to the left main (12.2%).(p.v 0.0008).Spasm occurred in a diseased vessels in 80 patients, and apparently disease - free vessels in 26 patients (75.5%, 24.5% respectively) .(p.v 0.0001).The frequency of spasm in apparently disease - free vessels was more in the right system (65.4%) compared to the left system(34.6%).In diseased vessels the frequency is comparable in both systems .Conclusions : This study has shown that the CAS is frequent during diagnostic cardiac catheterization andpercutaneous coronary interventionprocedures. it is more likely to occur in smokers, and it is mostly focal in nature .It is more frequent in atherosclerotic vessels than apparently normal vessels .In normal vessels the RCA was mostly affected, while in diseased vessels the frequency is comparable between left and right systems .

التنبؤات القسطارية لنتائج التداخل القسطاري للشرايين التاجية ذات الانسداد التام المزمن == Angiographic Predictors of Outcome in Patients with Coronary Chronic Total Occlusion

اسم المؤلف: زيد عبد الاله مصطفى النجار
اسم المشرف: هلال بهجت شوقي الصفار
الموضوع العام: الطب
السنة: 2015
الموضوع الدقيق: الامراض - القلب
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Chronic total occlusions (CTOs) are considered as the most complex lesions to treat via percutaneous coronary intervention (PCI), due to the indications, costs and technical difficulties related to these procedures. As a consequence, only about 10% of all CAD patients, clinically eligible for CTOPCI, are currently being treated via PCI. The majority is treated either medically or via coronary artery bypass graft (CABG) surgery.Aims of the study : estimate the value of application of J - CTO score as a model to stratify the complexity and predict expected success rates at Iraqi center for heart disease.Patients and methods : One hundred patients with chronic total occlusion were enrolled in this study for the period October 2014 - May 2015 who were consecutively Iraqi center for heart disease. Data was collected on demographic, clinical and angiographic characteristics by experienced CTO operators. Descriptive analyses were performed using SPSS Statistics to assess the relationship between procedural success and any of the demographic, angiographic and/or clinical characteristics. The level of significance was set at 95% or higher.Results : Sixty - one patients out of 100 patients (61%) had a successful PCI. Univariate analyses showed significant differences for gender and Electrocardiography with J - CTO score, and with success rate. Angiographically, a “blunt stump” (42 vs. 75%, p=0.001), “calcifications” (37 vs.70%, p=0.003), “tortuosity” (21 vs. 67%, p=0.001), “CTO length” (44 vs. 84%, p=0.000) and a “re - attempt” (33 vs. 65%, p=0.036) all had a significant negative impact on procedural outcome.Conclusion : The J - CTO score is valuable tool for predicting technical outcome in patients with CTO undergoing PCI.

تاثير عقار الانفلكسيماب على مستوى العامل الروماتويدي ومضاد الببتيد الموسوم بالسترولين لمرضى التهاب المفاصل الروماتويدي == Prospective cohort study of effects of infliximab on rheumatoid factor and anti - cyclic citrullinated peptide antibodies in patients with rheumatoid arthritis

اسم المؤلف: ميادة جبر عبد
اسم المشرف: سامي سلمان شهاب
الموضوع العام: الطب
السنة: 2014
الموضوع الدقيق: الامراض - المفاصل
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: التهاب المفاصل الروماتويدي هو مرض التهابي مزمن ذاتي المناعه ويشمل جميع اجهزة جسم الانسان. كل الفئات العرقية عرضة للاصابة بهذا المرض . والاناث معرضات للاصابة به بمرتين ونصف المرة اكثر من الرجال. تعتبراضداد الببتيد الحلقي الموسوم بالسترولين والعامل الروماتويدي من الفحوصات المهمة التي تساعد في التاكد من التشخيص وتساعد في تحديد خطة للعلاج.الهدف من الدراسه : البحث في تاثير عقار الانفلكسيماب على اضداد الببتيد الحلقي الموسوم بالسترولين والعامل الروماتويدي لمرضى التهاب المفاصل الروماتويدي.المرضى والعينات : خمس وثلاثون مريضا (10 رجال و25 انثى باعمار تتراوح بين 27 عام و77 عام ) مصابون بالتهاب المفاصل الروماتويدي المستعصي كانو محل هذه الدراسة التي امتدت من شهر ايلول 2013 الى شهر نيسان 2014 .6لقد تم اعطاء كل منهم 3 ملغم/كغم من عقار الانفلكسيماب عن طريق الوريد وبتسلسل زمني بالاسابيع0 - 2 - .Methotrexateثم كل 8 اسابيع لاحقا بالاضافة (15 - 20) ملغم من عقار الميثوتركسيت وفي الزيارة الاولى ثم الزيارة الثانية( بعد 24 اسبوع) لقد تم تحديد كل من سرعه تثفل كريات الدم الحمر,البروتين المتفاعل,ومقياس فعاليه المرض.وتم استخدام العينات التي اخذت من المصل في نقاط وقت متزامنة لقياس العامل الروماتويدي ومضاد ELIZAالببتيدالموسوم بالسترولين بطريقه.النتيجة : كان المعدل لقيمة العامل الروماتويدي في الزيارة الاولى (106.1 ± 25.2) وفي الزيارة الثانية قلت القيمة الى ( 60 ± 14.6) والفارق كان ملحوظا احصائيا.(P=0.038)كان معدل مضاد الببتيد الموسوم بالسترولين من الزيارة الاولى ( 466.5 ± 61.4 ) وفي الزيارة الثانية قلت القيمة الى ( 241.9 ± 36.6 ) والفارق كان .(P < 0.001) وقد حصل تغير ملحوظ في مقياس فعالية المرض , فمعدل المقياس في الزيارة الاولى هو ( 5.7 ± 1.1 ) ولوحظ ان المدى ان المدى لهذه القيمة يتراوح بين (2.7 - 8.6) , واما في الزيارة الثانية فقد كان المعدل لقيمة الفعالية هو ( 4.5 ± 1 ) ولمدى يتراوح بين ( 2.04 - 6.4 ) , وكذلك في الزيارة الثانية كان هناك هبوط في معدل تثفل كريات الدم الحمر وقيمة البروتين المتفاعل وكان الفارق ملحوظا احصائيا وهو0.001 > Ρ ) لكل منها | Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease that affects all ethnic groups throughout the world; Females are 2.5 times more likely to be affected than males. Anti - cyclic citrullinated peptide antibodies (ACPA) and rheumatoid factor (RF) are two important investigations that help in confirming the diagnosis and may help deciding strategies for the treatment.ObjectiveTo investigates the effect of infliximab, a tumor necrosis factor inhibitor on ACPA and RF in patients with rheumatoid arthritis.Patients and methodsThirty five Iraqi patients (10men and 25 women; age 27 - 77yrs), with established RA, were enrolled in this study between September 2013 - may 2014. They received 3 mg/kg infliximab intravenously at weeks 0, 2, 6, and every 8 weeks thereafter in combination with methotrexate (15 - 20) mg.At baseline, week 24, C - reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) were determined and the disease activity score (DAS28) was calculated. Serum samples collected at the same time points were used to measure ACPA (commercial second - generation ELISA), IgM - RF (ELISA).ResultsThe Rheumatoid Factor (RF) mean at the first visit was (106.1 ± 25.2) IU/ml and at the second visit it reduced to (60.1 ± 14.6) IU/ml and the difference was statistically significant, (P=0.038).The ACPA mean was (466.5 ± 61.4) U/ml at the first visit reduced significantly to reach (241.9 ± 36.6) U/ml at the second visit (P<0.001).A dramatic and significant change had been found in the disease activity; (P<0.001) the mean DAS28 was (5.7 ± 1.1) at the first visit with a range of (2.7 - 8.6), at the second visit the mean was (4.5 ± 1.0) and the range was (2.04 - 6.4). Also, at the second visit, there were statistically significant reductions in the mean values of ESR (P<0.001), CRP (P<0.001). ConclusionsThe findings of this study indicate that anti - TNF a treatment in rheumatoid arthritis results in decrease in the serum titers of RF and ACPA in patients with clinical improvement.

الاصابات المنزلية المميحة للنساء في العراق 2010 - 2015 == Fatal Domestic Injuries among Females, Iraq, 2010 - 2015

اسم المؤلف: ختام محسن علي
اسم المشرف: بتول علي غالب ياسين
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الوبائيات التطبيقية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Injuries and violence are among the most prominent public health problems in the world, as well as being a leading cause of mortality.Globally, each year more than 11,000 people are estimated to die within homes from preventable unintentional injuries. The majority (73%) of family victims were females.Objectives : This study is conducted to describe the epidemiological characteristics, estimate incidence and identify mechanism of fatal female domestic injuries (FFDI) in Iraq for the period of 2010 - 2015.Methods : A cross sectional study was conducted on all female home fatalities reported from all the coroner offices in Iraq for the period of 2010 - 2015 as part of Iraqi Injury Surveillance System (IISS). The injury surveillance form included detailed data on the demographics, injury circumstances and injury mechanisms. Populations' data of the country and the provinces were obtained from Ministry of Health (MOH) and Ministry of Planning.Results : The total number of FFDI during this period was 9,181with an average annual incidence of 11.9/100,000 female population (FP). FFDI represented 13.1% of total Fatal Injuries of IISS and 53.3% of domestic fatal injuries of IISS.Page II The incidence of FFDI decreased from 12.4/100,000FP in 2010 to 11/100,000FP in 2015. Mean age group was 47years, 55% occurred at the age group 10 - 29 years. The highest incidence 21.4/100,000FP was recorded at the age group 20 - 29 years. About 72% of FFDI were unintentional with average annual incidence 8.4 /100,000FP and 72% occurred during 6am - 5pm. The main causes of FFDI were : Burn (62%), electric injury (11.5%), and gun fire (7%) with average annual incidence 7.4, 1.3, and 0.7/100,000FP, respectively. The highest average incidence was reported in Erbil (22.3/100,000FP), Misan (20.2/100,000FP), and Sulaimaniya governorates (16.8/100,000FP) Conclusions : There is a need for implementing of effective community based preventive programs by regulatory measures, environmental changes, and education which may play a crucial role in the prevention of injuries in female home environments.

نظرة عامة عن انواع سرطان الرئه غير الحرشفي في مرضى سرطان الرئه العراقيين مع دراسة فترة البقاء على قيد الحياة بدون تقدم المرض لهم == Overview of non squamous cell subtypes of Iraqi lung cancer patients and their progression free survival

اسم المؤلف: بسام محمد جميل
اسم المشرف: منور عبد الاله النقاش
الموضوع العام: الطب
السنة: 2018
الموضوع الدقيق: الاشعة العلاجية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: سرطان الرئه هو اكثر سرطان يصيب الرجال وكذلك هو اول سبب من اسباب الوفاة في العراق , سرطان الرئه ذو الخلايا غير الصغيرة هو اكثر نوع نسيجي انتشارا من سرطان الرئه ,والنوع غير الحرشفي من سرطان الرئه هو اكثر نوع نسيجي يصيب مرضى سرطان الرئه من الانواع الاخرى.الغرض من الدراسة : الهدف من هذه الدراسة هو لتقييم البقاء على قيد الحياة بدون تقدم المرض بعد الخط العلاجي الاول لمرضى سرطان الرئه ذو الخلايا غير الصغيرة . ودور الاستمرار على دواء pemetrexed في علاج المرضى .المرضى وطريقة البحث : تم اجراء هذه الدراسة الاستقصائية في مستشفى الاورام التعليمي في مدينة الطب وللفترة من يناير 2014 ولغاية حزيران 2017 وتم اجراءهذه الدراسة على 47 مريض ومريضة مصابين بسرطان الرئه ذو الخلايا غير الصغيرة سبق وعولجوا بمختلف خطوط العلاج الكيميائي بعد اخذ الموافقة من المرضى على المشاركة في الدراسة , تم دراسة المرضى من حيث العمر والجنس والنوع النسيجي للمرض والخط العلاجي الاول المستخدم وفترة البقاء على قيد الحياة بدون تقدم المرض .النتائج : معدل فترة البقاء على قيد الحياة بدون تقدم المرض للمرضى المشمولين بهذه الدراسة كانت 18,6 شهر] 95% 25,6 - 11,6(CI ) [ ومعدل فترة البقاء على قيد الحياة بدون تقدم المرض للمرضى المصابين بسرطان الرئة النوع الغدي والحرشفي كانت 19,6 و9,8 شهرا على التوالي | Background : cancer of lung is the most common malignancy in male patients and also is the first cause of death in Iraq , non small cell lung cancer is more common histological type of cancer lung, non squamous type is more incidence type than other types. Objectives : the aim of this study was to assess the Progression free survival after 1st line treatment in , non small cell lung cancer , and to show the role of maintaining pemetrexed drug in , non small cell lung cancer .Study Design : a retrospective study.Place and Duration of Study : : Oncology Teaching Hospital /Medical city complex ,Baghdad ,Iraq from January 2014 to June 2017.Methodology : A total of forty seven patients with histological confirmed non small cell lung cancer, treated by different types of chemotherapy protocols were enrolled in the study after informed consent according to inclusion and exclusion criteria. Patients were assessed for their age, gender, histopathological subtypes, first line chemotherapy protocol used and their Progression free survival time. The data was analyzed by the Statistical Package for Social Sciences (SPSS, version 22) software.Results : The mean period for progression free survival was 18.6 months with [95% Confidence Interval (CI) (11.6 - 25.6)] ; Progression free survival mean for adenocarcinoma and squamous cell carcinoma were 19.6, 9.8(months) respectively. Conclusions : Patient on maintenance pemetrexed showed a better Progression free survival than other patients. Patients with adenocarcinoma histology have better Progression free survival than other subtypes.

تقييم كفاءات مسؤولي الرصد الوبائي علي مستوى القطاعات، العراق 2017 == Assessment of Competencies of Surveillance Officers at District Level, Iraq 2017

اسم المؤلف: رفل علياء مكي الصافي
اسم المشرف: علياء مكي حسن الصافي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الوبائيات التطبيقية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Assessment of communicable diseases surveillance officers is regarded as one of important aspects for the detection of obstacles that prevent the development of surveillance system which would certainly affect the control programs of these diseases.Objective : To assess the background characteristics communicable diseases' surveillance officers at all district levels of all Iraqi provinces .Method : A cross sectional study from the 15th March to 30th September,2017 in which all the communicable diseases' surveillance officers (136) that are employed by MOH all over Iraq were included. A structured questionnaire developed by the researcher and explained during coordination meeting for the surveillance unit in DOH/ MOH. It was then sent by e mail to the surveillance focal persons in DOHs at the provinces level. The questionnaire form gathered demographic data, service characteristics and status of their competencies including : basic epidemiology, biostatistics, surveillance, outbreak investigation, rapid response to health incidence, laboratory models, developing scientific reports and the basic computers skills.Results : The response rate was 85.3%, about half of surveillance officers was responsible for less than 10 PHCC, while only 13.8% were responsible for 20 - 29 centres. More than half of surveillance officers (55.3%) were responsible for 1 - 2 hospitals, while only 9.6% were responsible for 3 - 4 hospitals. The age of study participants ranged between 21 and 62 years and the males constituted more than three quarters (78.4%) of the study sample, Diploma was the highest educational certificate. Those who did not attend any training activity constituted 15.6% of the study sample. Cholera was the most frequently reported incident investigated in an outbreak activity (53.8%). Food poisoning was the most frequently reported incident for a rapid response activity (43.8%).Microsoft word was the most frequently reported skill that reached the required level of proficiency (48.3%).Conclusions and recommendations : The health surveillance system in Iraq at district level was operated mainly by low qualified and under - trained health personnel. There is inequity in distribution of work load (regarding PHCCs and hospitals) and training sessions between surveillance officers in health offices, therefore redistribution is recommended which is the responsibility of health policy makers during the planning and implementing health programs.Supporting continuous training programs on epidemiology, biostatistics, outbreak investigation, computer skills and writing scientific research with increase incentives. Availability of computer and internet facilities must be financed.

جفاف الفم الحاد الناتج من العلاج الاشعاعي للراس والرقبة == ACUTE XEROSTOMIA IN HEAD AND NECK RADIOTHERAPY

اسم المؤلف: داليا سعد عبود عبد الله
اسم المشرف: خضير جاسم صبيح الرواق
الموضوع العام: الطب
السنة: 2018
الموضوع الدقيق: الاشعة العلاجية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Xerostomia, the subjective experience of dry mouth, is among the most common complaints experienced by cancer patients treated with radiotherapy to the head and neck area. It is caused by salivary gland dysfunction as a result of damage in the field of radiation.Aim of this study : To identify the incidence and determinants of xerostomia and its grades in a section of HNC patients receiving radiotherapy in IraqMethods : A prospective observational study conducted in the Oncology Teaching Center/ Radiation Therapy Department at the Medical City Complex, Baghdad, Iraq during a period of six months from (Nov. 2017 to Apr. 2018). It involved 100 patients diagnosed with HNC and received radiotherapy. The data collection was done through daily visits and study patients were selected randomly. The dose of External Beam Radiotherapy used for the treatment of different patients was (30 Gray - 70 Gray), with a standard fractionation. The patients were assessed for symptoms and signs of xerostomia according to subjective experience of dry mouth and patients were classified by xerostomia grades into mild, moderate, and severe.Results : Total no. of patients was 100 and the mean age was 51.69 ± 13.7 years; 67% were males and 33% were females. Most of them were non - drinker and had no past medical history (91% and 80% respectively); 54% were former smokers. Nasopharyngeal tumor and larynx cancer were the commonest tumors diagnosed (29% and 28% respectively), 78% of the tumors were squamous cell carcinoma type and 53% of them were in stage III. Most of the study patients didn’t take chemotherapy during radiotherapy (90%), while 68% of them have previously received chemotherapy. The mean dose of radiotherapy used was 63.2 ± 9.65 GY. Post radiotherapy, the highest proportion of study patients were diagnosed with xerostomia grade I (37%), while 21%IIof them were free of xerostomia. Female gender, negative past medical history, site of tumor, stage of tumor and dose of radiation were significantly associated factors (P < 0.05) that increased prevalence of xerostomia. While tumor site was significant factor associated with grade of xerostomia.Conclusion : After radiotherapy, there is a high chance for developing xerostomia. Females, negative past medical history, advanced stage of tumor, high dose of radiation and site of tumor (oral, nasopharyngeal, and parotid) were significantly associated factors. Tumor site was a significant factor associated with the grade of xerostomia.

انزيم الفوسفاتيز القلوي ودوره كمؤشر حيوي لنتشار سرطان الثدي == ALKALINE PHOSPHATASE AS A BIOMARKER FOR METASTATIC BREAST CANCER

اسم المؤلف: هبة جمعة عبد الخالق
اسم المشرف: خضير جاسم صبيح الرواق
الموضوع العام: الطب
السنة: 2018
الموضوع الدقيق: الاشعة العلاجية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Breast cancer is the most common malignancy in women worldwide and the leading type of cancer among Iraqi women with a rapidly rising incidence. It is necessary to have non - invasive and sensitive methods for early detection. Alkaline phosphatases (ALP) are a group of hydrolase enzymes that catalyze the hydrolysis of phosphate esters in an alkaline environment. The increase in serum level of ALP is usually associated with certain diseases, including malignancy. Malignancy mayraise ALP level by several mechanisms, therefore, changes in serum ALP level may be useful in the diagnosis and follow up of breast cancer. Aim of the Study : To assess the relationship between increased serum ALP level and the occurrence of metastasis in breast cancer patients, and to assess the possibility to use this enzyme as a biomarker for the detection of metastasis in breast cancer.Methodology : This study is a case - control study conducted in Oncology Teaching Hospital in Medical City - Baghdad from 1st of December 2017 through 30th of April 2018 and included 140 patients with breast cancer.70 of them had metastasis (Group A) and 70 had no metastasis (Group B).Blood samples were collected to determine serum ALP level..Results : Age of participants ranged from 25 - 71 years, with mean age of 50 years, and 50.4% of them had disease stage IV. Mean ALP level of Group A (metastasis group) was (320.5 ± 254.9)IU/L with 15.7% of them within normal range, whereas the mean ALP level in Group B (control group) was (85.1 ± 34.9)IU/L with 85.7% within normal range. Statistical analysis have shown that there is statistically significant difference in the ALP level between the two groups. t(138)=7.65, P < 0.001.Conclusions : Serum Alkaline Phosphatase level is an important prognostic tool for monitoring of progression of breast cancer, and it could be used as a biomarker for detection of metastasis in breast cancer patients.Keywords : alkaline phosphatase, breast cancer, metastasis 1.1 IntroductionAlkaline phosphatases (ALP) are a group of hydrolase enzymes that catalyze the hydrolysis of phosphate esters in an alkaline environment. In healthy human adults, ALP is derived from certain tissues including bones, liver, placenta, intestines, and kidneys (Al - Mashhadani, Mukhlis and Al - Faraji, 2012). The increase in serum level of ALP is usually associated with certain diseases including hepatitis, intrahepatic cholestasis, extrahepatic bile obstruction, infiltrative liver diseases, and cancer. Higher levels of ALP are seen in more specific disease, such as primary biliary cirrhosis, primary sclerosing cholangitis, malignant biliary obstruction, hepatic lymphoma, and breast cancer.Therefore, changes in serum ALP level may be useful in the diagnosis and follow up of breast cancer (Singh et al., 2013). These enzymes are present on cell membrane outer layer, and their function is to catalyze the hydrolysis of the organic phosphate esters that are located in the extracellular space. Each catalytic site contains 3 ions made up of 2 zinc ions and one magnesium ion, which are considered important co - factors for the enzyme (Lowe and John, 2017). Alkaline phosphatases are considered true isoenzymes since they catalyze the same reaction throughout the different tissues of the body.They are classified into either tissue - specific or tissue - non - specific type.Tissue - specific type include alkaline phosphatases found in placenta, intestine, or germinal tissues. This means that they are present only in tissues where they are physiologically formed, and may occasionally 1contribute to the serum alkaline phosphatase in the circulation under certain circumstances. Tissue - non - specific alkaline phosphatase, on the other hand, is generally the main constituent of the circulating serum alkaline phosphatase, which gives it a particular clinical importance. It is formed mainly in bone, liver, and kidneys (Lowe and John, 2017; Millán, 2006).Breast cancer is the most common malignant disease in women worldwide (Stieber et al., 1992). It is considered the most common type of cancer in both developing and developed countries, and is the fifth cause of cancer mortality in the world (Ferlay et al., 2010). In Iraq it is the leading type of cancer among Iraqi women, accounting for one - third of the total registered female cancer patients in Iraq (Iraqi Cancer Board, 2010), with a rapidly rising incidence among Iraqi population (Al - Hashimi and Wang, 2014).Locally advanced breast cancer is usually diagnosed after the detection of a palpable mass within the breast. Symptoms may include pain (whether local or regional), bleeding, paresthesia or paresis. Breast cancer patients who are presented with locally advanced disease require management by a multidisciplinary team that utilizes diagnostic imaging, chemotherapy, surgical intervention, and pathological assessment. The outcome of treatment for each patient could depend on the level of integration of this multidisciplinary approach in addition to the experience of the team members. Coordination between those members is of particular importance in the management of those patients with locally advanced breast cancer, because those patients have a high risk ofrecuurence of the disease if no optimal treatment was provided. However, 2 the outcome of patients with locally advanced disease has improved recently with the routine use of chemotherapy. Before the routine use of chemotherapy there was a high rate of distant metastases and death among patients treated with mastectomy or radiation (Haagensen and Cooley, 1969).Breast cancer is classified histopathologically into either invasive ductal carcinomas (IDC), invasive lobular carcinoma (ILC), or not otherwise specified (NOS) (Viale, 2012). Intrinsic subtypes of breast cancer are described in Table 1 (Pudney et al., 2015).To investigate for the disease, a complete history is essential, followed by triple assessment which include physical examination, radiological investigation, and needle biopsy. It is preferred to use core biopsy rather than fine - needle aspiration since the core biopsy provides a histological diagnosis and can be used for differentiation between invasive and in situ carcinoma. Also it is possible to test for ER, PgR andHER2 status using biopsy specimen.

وفيات الامهات بسبب نزف ما بعد الولادة في العراق خلال 2015 - 2017 == Maternal Deaths due to Postpartum Hemorrhage in Iraq (2015 - 2017)

اسم المؤلف: اسمهان عبد الكاظم قاسم
اسم المشرف: بتول علي غالب ياسين
الموضوع العام: الطب
السنة: 2018
الموضوع الدقيق: طب العائلة
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : According to the world health organization, obstetrics hemorrhage causes 127,000 deaths annually worldwide and is the leading cause of maternal mortality. Post - Partum Hemorrhage (PPH) remains the number one killer of mothers and accounts about 28% of all maternal deaths in developing countries.There is an increase risk in the PPH even in developed countries due to number of changes in recent years. The current study aimed to thoroughly analyze the reported maternal deaths due to PPH, to identify factors associated with the occurrence of PPH.Methods : A cross sectional study was carried out at the Maternal and Child Health (MCH) Section, Public Health Directorate, MOH, Iraq, from Feb. to Jun, 2018. All records of maternal death during 2015 - 2017 that were available at the MCH section were reviewed and those who died because of PPH were retrieved and analyzed.Results : PPH as a cause of maternal death in Iraq during the period (2015 - 2017) ranged from 16.7 % among all reported maternal deaths during 2015 to 26.9% during 2016 and 20.1% during 2017. Half of women who passed because of PPH were among the young age group (20 - 35 years), 56.2% lived in urban areas, more than one third were from Baghdad city, 45.8% of the deceased women did not attend ANC services, 64.2% of them delivered their babies at hospitals, 87.1% of deaths took place at hospitals, uterine atony was the first cause for developing PPH 27.4%, delay 1 was on the top of the list (alone 31.3%, combined with other delays 70.2%), grand multiparous was the first risk reported in 31.8% of the records. Conclusion : Among all deceased during 2015 - 2017, PPH was the cause of death in 20.2%. PPH was higher among those aged 20 - 35, with low educational level, from urban residency, grand multiparous, with no ANC during pregnancy, more than 37 weeks of gestation. Uterine atony was the first cause of PPH followed by traumas (Cervical tear and ruptured uterus) and the least was placental complications. D1, alone or combined with others, was on the top of the list followed by D3 which indicated substandard care.Increased awareness about the importance of safe motherhood, timely decision to seek emergency obstetrics care, ensure that all deliveries should be attended by skilled birth attendance and improving the quality of emergency obstetrics will help in decreasing maternal death.

اختيار السيطرة على الربو مقاسة بالاستجواب مقارن مع قياس حجم الزفير الاجبار في الثانية الاولى العراق

اسم المؤلف: رؤوف عبيد حسين
اسم المشرف: مصطفى نعمة عبد علي
الموضوع العام: الطب
السنة: 2018
الموضوع الدقيق: الامراض - الصدرية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:

قياس محيط الراس بجهاز الامواج فوق الصوتية في التنبؤ بالمرحلة الثانية للولادة عند النساء الخروس (العديمات الاولاد) == Utrasound measurement of head circumference in prediction of 2nd stage duration of labor in nulliparous women

اسم المؤلف: وفاء عبد الكريم عبيد
اسم المشرف: معد مهدي شلال
الموضوع العام: الطب
السنة: 2014
الموضوع الدقيق: النسائية والتوليد
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: المرحلة الثانية الطويلة من الولادة، تؤدي الى نتائج سلبية للام والجنين .التقييم الاصبعي لموقف راس الجنين اثناء المخاض هو اداة ذاتية، وعرضة لخلاف كبير بين الفاحصين .الامهات الخروس العديمات الاولاد ذوات اجنة بمحيط راس كبير عرضة لزيادة خطر العملية القيصرية الاولية والولادة المهبلية المتعلقة بالعمليات الجراحية . لقد مكنت الموجات فوق الصوتية اثناء الولادة مزيد من الفهم للفسلجة المعقدة لولادة للجنين وقد قدرت التكهن للولادة المهبلية المتعلقة بالعمليات الجراحية والعملية القيصرية الاولية.الهدف من الدراسة : الغرض من هذه الدراسة هو تقييم قدرة الموجات فوق الصوتية اثناء الوضع للتنبؤ بوقت المرحلة الثانية من المخاض عند النساء الخروس ( عديمات الاولاد )عن طريق قياس محيط راس الجنين وكذلك لتقييم محيط الراس بعد الولادة ومدة المرحلة الثانية.مكان الدراسة ونوعهادراسة مقطعية عشوائية اجريت بالفترة ما بين الاول من يناير 2014 ولغاية الاول من شهر مارس 2014 في مستشفى بغداد التعليمي. | Prolonged second stage of labor, has been associated with adverse maternal and fetal outcomes. Digital assessment of fetal head station during labor is a subjective tool, prone to considerable disagreement among examiners. Nulliparous mothers of large - FHC infants are at increased risk of primary cesarean section and operative vaginal delivery . Intrapartum ultrasonography has enabled further understanding of the complex physiology of childbirth. It has been shown to provide objective information on the dynamics of different stages of labor, and has also been used to assess the prognosis for operative vaginal delivery and primary cesarean section. AIM OF STUDY : The purpose of this study is to assess the ability of intrapartum ultrasound to predict the duration of second stage of labour in nulliparous women by measuring fetal head circumference and also to assess head circumference post - delivery and second stage duration

قيمة السلالة الطولية مقابل تصوير الاوعية التاجية في الكشف عن مرض الشريان التاجي == The Value of Longitudinal Strain versus Coronary Angiography in Detection of Coronary Artery Disease

اسم المؤلف: حسان نوري محمود
اسم المشرف: معتز فوزي حسين
الموضوع العام: الطب
السنة: 2016
الموضوع الدقيق: صدى القلب
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Introduction : Coronary artery disease is characterized by atherosclerosis in the epicardial coronary arteries. The reduction in coronary artery flow may be symptomatic or asymptomatic, occurs with exertion or at rest, and culminate in a myocardial infarction or angina, depending on obstruction severity and the rapidity of development. Speckle - tracking echocardiography is a new noninvasive ultrasound imaging technique that allows for an objective and quantitative evaluation of global and regional myocardial function independently from the angle of insonation and from cardiac translational movements.Aim of the study : to assess the value of longitudinal strain versus coronary angiography in detection of coronary artery disease Patients and method : A cross sectional study was conducted in Ibn - Albitar hospital during the period between March 2015 and March 2016 and a sample of 72 patients was selected with positive coronary angiography. Results : The mean age of patients was 56.4 ± 10.1 years; furthermore, 73.6% of the patients aged more than 50 years. About half of the patients, (51.4%) were smokers, (73.6%) were diabetic, (33.3%) were hypertensive and (58.3%) had hyperlipidemia. the findings of 2D LV Longitudinal strain - speckle tracking, positive LADA (left anterior descending artery) stenosis was reported in (86.1%), the CX artery stenosis reported in (76.4%) and the RCA stenosis was found in (84.7%) of the patients. for the stenosis in LADA, the current study showed that the longitudinal strain was a good predictor with a sensitivity of (93.8%), specificity (75%) and accuracy (91.7%) compared with coronary angiography, with good performance of the test between tests, good predictive value and accuracy of the test.The longitudinal strain showed that there was a good performance in detection of stenosis in CXA with high sensitivity, specificity and accuracy. The performance and validity of 2D LV longitudinal strain in detection of RCA stenosis in comparison with angiography, it had a sensitivity of (93.5%), specificity of (70.0%) and accuracy of (90.3%).Conclusion : The current study revealed that the Speckle - tracking echocardiography technique has a good performance and validity in detection of coronary artery stenosis with very good agreement with angiography.

العلاقة بين التهاب الحلزونية البوابية وسرطان الرئة بالتحليل النسيجي المرضي == Helicobacter pylori infection related to lung cancer histopathologically

اسم المؤلف: غسان سماح محي
اسم المشرف: محمد وهيب سلمان العبيدي
الموضوع العام: الطب
الموضوع الدقيق: الامراض - الصدرية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:

نوعية حياة مرضى التدرن في المركز الوطني التخصصي للامراض الصدرية والتنفسية / بغداد 2017 == Quality of life of the tuberculosis patients attended The National Specialized Centre of the Chest and Respiratory Diseases / Baghdad 2017

اسم المؤلف: حيدر عبد الامام حميدان
اسم المشرف: عدنان الجبوري
الموضوع العام: الطب
الموضوع الدقيق: الامراض - الصدرية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Tuberculosis (TB) is one of the major public health problems. Apartfrom physical symptoms, TB patients have various general physical activities,social environmental and psychological problems. Which is important toconsider the overall TB on patients' perception of health and wellbeing.Aim of the study : To estimate the quality of life of TB patients, beside the routine clinical,radiological and bacteriological assessments and we want to determine theeffects of socioeconomic, demographic and the adjectives of the Tb diseases onthe domains of the quality of life (QOL).Methods : A cross sectional study involving 67 TB patients with or without comorbiddiseases, pulmonary and extra pulmonary Tb attending The NationalSpecialized Centre of the Chest and Respiratory Diseases in Baghdad. Dataobtained through direct interview using a standard questionnaire of WHOQOLBREF(26 questions) highlighting four domains : physical, psychological, socialand environmental, and also using of a structured form of identity information,socioeconomic and demographic information, we estimate the effects of variousaspect in this structured form on the four domains of WHOQOL - BREF (26questions) .Results : Regarding our results we found that general aspect of quality of life was(48.9%) of the quality of life rating, and (32.9%) of the general aspect of health satisfaction, concerning specific part of quality of life of TB patients, Physical domain (29.2 ± 12.3), Psychological domain (46.1±16.2), Social domain (47.4±20.6) and Environmental domain (38.6±13.8), with variation within each domain according to demographic and socioeconomic variation with significant correlation between domains of quality of life.Conclusions : Tb is a disease associated with low scoring of quality of life specially when associated with low socioeconomic state, while the marriage give positive effort to total perception of the QOL especially social domain. And the financial state of the TB patients is with direct effect on social domain of the QOL. And also highly educated TB patients and those with low crowded index have better environmental domain in their QOL among the other TB patients

تحليل نتائج ناظور القصبات المرن لردهه الامراض الصدريه والتنفسيه في مستشفى الديوانيه التعليمي للسنتين 2014 - 2015

اسم المؤلف: اثير محمود علي
اسم المشرف: محمد وهيب سلمان العبيدي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - الصدرية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:

دراسة حول قيم توسع الصدر بين الاصحاء البالغين في العراق == The chest expansion values among adult healthy Iraqi people

اسم المؤلف: محمد احمد رحمان
اسم المشرف: مصطفى نعمة عبد علي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - الصدرية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Chest expansion measurements are used to evaluate a patient’s baseline status, treatment effectiveness, and progression of disease with regards to chest wall mobility and respiratory muscle function.Objectives : To establishing basic information about normal range of chest expansion measures among healthy Iraqis and to establish the variation of the chest expansion among Iraqi population and exploration of the relationship with age, sex and body built.Methods : A stratified random sampling technique was used to select a sample of 1020 persons (530 male and 490 female) aged between 20 to 70 years old from Baghdad and Al - Najaf city, Participants without any neurological, orthopedic, rheumatological or respiratory diseases or having pneumonia during the last month and smokers were excluded from the study, the chest expansion measured in 2 sites , for upper , at the level of the fifth thoracic spinous process and the third intercostal space at the mid clavicular line and for the lower thoracic excursion, the tape measure was placed at the level of the 10th thoracic spinous process and the tip of the xiphoid process by using inelastic tape measure.Results : The study shows that male participants have significant higher chest expansion than female participants in upper thoracic (5±0.6cm, 4.2±0.7cm) for male and female respectively and at lower thoracic (4.5±0.6cm, 3.7±0.6cm) (p< 0.05) for male and female respectively.Chest expansion of male and female participants at both upper and lower thoracic peak at age 20 - 29 and decreases thereafter with increasing age. In female participants, chest expansion was significantly correlated with BMI, which is decreased in the obese female.Conclusion : It was concluded that chest expansion of both upper and lower thoracic increase with age increases until the 3rd decade of life, and then steadily declines after this. Male chest expansion was significantly higher than female participants

الوضع الوبائي لمرض الهيموفيليا في بغداد - العراق 2016 == Epidemiological Profile of Hemophilia in Baghdad - Iraq, 2016

اسم المؤلف: كمال عبد الرزاق كاظم
اسم المشرف: فارس حسن اللامي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الوبائيات التطبيقية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Hemophilia is an X - linked bleeding disorder that affects males mainly. Globally, there are about 400,000 people with hemophilia and only 25%of them receive adequate treatment. There is insufficient epidemiological data on hemophilia in Iraq, so this study was conducted to estimate the prevalence, incidence and other epidemiological characteristics of hemophilia patients in Baghdad, 2016.Methods : A cross sectional study was conducted by reviewing all records of hemophilia patients for 2016 that retrieved through visiting all hemophilia centers in Baghdad. Corresponding population data of Baghdad was obtained from the Ministry of Planning.Results : The total number of the registered hemophilia patients in Baghdad centers who are residents of Baghdad was 654. The current prevalence of hemophilia was 7.7/100,000 population and it was 3.6/100,000 population in 2007. The current incidence of hemophilia was 16.3/100,000 livebirths and it was 8.4/100,000 livebirths in 2007. Severe hemophilia represented 63.4% from all types and the male patients represented 97.1%. The prevalence of HCV was 22.9%, for HBV was 0.9% and 0.2% for HIV. Inhibitors werepositive in 11.6% of hemophilia patients. Target joints found among 45.1% of patients. About 27% of patients were on prophylactic therapy. Only one death was recorded among hemophilia patients in Baghdad, 2016.Conclusions : The prevalence and incidence of hemophilia in Baghdad was doubled in 10 years' period. We recommended establishing an electronic national registry to have a perfect database for hemophilia and enhancing the prophylactic treatment.

الصفات الوبائية لمرض الاسهال الحاد في الاطفال دون سن الخامسة في العراق 2016 == Epidemiological Characteristics of Acute Diarrhea in Children under Five Years in Iraq, 2016

اسم المؤلف: عمار عبد الله حمد
اسم المشرف: ايمان عدنان القصير
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الوبائيات التطبيقية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Diarrhea is one of the principle 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% .Theobjective of this study was to identify the incidence and deaths of acute diarrhea in children under five year in Iraq, 2016. Methods : A descriptive cross - sectional study by reviewing all reported data from the directorate of health all over Iraq to the surveillance section in the Communicable Diseases Control Center in Baghdad. Incidence and case fatality rate (CFR) for <5 years population were calculated.Results : The total number of acute diarrheal cases was 251,388. A total of outpatient was 211,665(84%) and 39723(16%) was admitted cases. Male to female ratio was 1.1 : 1. Incidence of acute diarrhea was 47/1,000, the highest incidence was in Diwaniya (119.2 / 1,000), Erbil (89.8 /1,000), and Thiqar (77/1,000). The total death due to acute diarrhea was 154, male : female ratio was 1.2 : 1 and most deaths occur in children <1year (60.4%). CFR was 0. 77/1,000, the highest case fatality rate was in : Baghdad - Karkh (3.70/1,000), Diyala (2.49/1,000), and Diwaniya (1.14/1,000).Proportional mortality rate (PMR) was 7.7/1,000; the highest PMR was in Diwaniya (24.8/1,000), Salah aldin (18.9/1,000), and Diyala (17.5/1,000). Percentage of ORS used was 85%.The completeness of reported site for all provinces was 88%.Conclusion Diarrhea is still a major cause of morbidity and mortality in children under five years, which need to pay more attention for PHC intersectoral cooperation and community participation, and encouragement of Breast feeding.

تقييم ممارسات الجلسة التلقيحية في مراكز الرعاية الصحية الاولية - محافظة واسط, العراق 2017 == Assessment of Immunization Session Practices in Primary Healthcare Centers - Wasit Province, Iraq, 2017

اسم المؤلف: علي صادق جعفر
اسم المشرف: فارس حسن اللامي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الوبائيات التطبيقية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Vaccination is a great public health achievement in human history. Annually, vaccines prevent more than 2.5 million child deaths globally. In 2016, about 19.5 million infants worldwide were not covered by DTP3, 60% of them live in 10 countries including Iraq. According to WHO and UNICEF, one third of below one year infants did not complete their immunization schedule. Wasit is among the governorates with a large number of underimmunized children. High quality immunization session practices (ISPs) can ensure safer, more effective vaccination and higher coverage rates. Objectives : To assess ISPs in Primary Healthcare Centers (PHCs) in Wasit, and if ISPs are correlated to some PHCs’ characteristics.Methods : A cross sectional study was conducted on 14 PHCs. One fourth of PHCs in each district were selected using simple random sampling. Each PHC was visited once to assess ISPs, using a modified WHO immunization session checklists. Information on vaccinators and PHC’s were collected using two, self - designed questionnaires.Results : PHCs were scoring variably in ISPs, ranging from 0.52 to 0.78 with a mean of 0.68 ± 0.07. ISPs were grouped into seven domains (mean) : vaccine management (0.51), cold chain management (0.40), session equipment (0.88), communication (0.27), vaccine preparation and administration (0.72), registration (0.83) and waste management (0.84). Three of PHCs’ characteristics : population size, below one - year monthly target and average number of daily vaccinees showed statistically significant, negative correlation with ISPs which was of intermediate strength.Conclusion : None of the PHCs was practicing near standard ISPs. ISPs showed statistically significant, negative correlation, of intermediate strength with population size, below one - year monthly target and average number of daily vaccinees for each PHC

الاضطرابات النفسية لدى كبار السن بين مراجعي عيادة كبار السن في مدينة الطب بغداد/ العراق 2017 == Mental Disorders among the Elderly People Attending Geriatric Clinic of Baghdad Medical City, Baghdad/ Iraq, 2017

اسم المؤلف: احمد عبد الامير ابراهيم
اسم المشرف: جواد كاظم الديوان
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الوبائيات التطبيقية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : The aging population is currently one of the main issues facing international health care systems. Between 2015 and 2050, the proportion of the world’s population 60 years and over will increase from 12% to 22%. Iraqi population was exposed to wars and conflicts, which are in turn, affect their mental health. We conducted this study to measure the prevalence and identify types and potential associated factors of MDs among elderly people attending Geriatric Clinic of Baghdad Medical City. Methodology : A cross - sectional study conducted and a systematic random sampling technique was used to select 320 elderly people attending Geriatric Clinic of Baghdad Medical City for non - psychiatric complaints. We collected data on basic demographics and associated risk factors using a questionnaire filled through self - reported questionnaire.Mental disorders (MDs) were defined based on Kessler Psychological Distress Scale (K10) with a cutoff score of 20+. Accredited tools used by WHO were used to identify the types of MDs.Results : The prevalence of MDs in the study sample was 24.4%. The prevalence of MDs types were : Depression 16.6%, anxiety 12.8%, dementia 5.3%, substance abuse 2.5%, suicide thoughts 5.6%, and suicide attempts 2.5%. Logistic regression analysis was used to examine the determinant factors of elderly MDs revealed the following significant factors : Aging, smokers, living depends on others, loneliness and social isolation, visual impairment, economic state deterioration, neglect and mishandling, and chronic diseases are the determinant factors of elderly MDs.Conclusions : Mental disorders are wide spread among elderly people and enhanced elderly mental health care services should be provided

عوامل الخطورة وتصنيــف اورام الرحــم وتدريجاتـه == Risk factors and histopathological types of uterine cancer 2016

اسم المؤلف: رشا زكــــي شكــــــر
اسم المشرف: خضير جاسم صبيح الرواق
الموضوع العام: الطب
السنة: 2016
الموضوع الدقيق: الاشعة العلاجية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: سرطان الرحم نسبيا يعتبر من الاورام الشائعه بين النساء حيث انه ياتي في المرتبه الرابعه بين الاورام الخبيثه التي تصيب النساء خاصة النوع الشبيه ببطانة الرحم.ان التصنيف حسب التشريح النسيجي المرضي ومرحلة الورم وعوامل الخطوره للمرض لم يتم تقييمها بصوره جيده في النساء العراقيات من اللواتي اصبن بهذا المرض.الغرض من الدراسةان الغرض من هذه الدراسة هو لمعرفة نوع الورم حسب التشريح النسيجي المرضي ومرحلة المرض عند تشخيص المرض وعوامل الخطوره للمرض بين المريضات العراقيات المرضى وطرق البحثتشمل هذه الدراسة خمسه واربعون مريضة مصابة بسرطان الرحم من مراجعات مستشفى الاورام التعليمي في مدينة الطب في بغداد للفترة من شهر كانون الثاني لغاية شهر نيسان 2016.لقد تم جمع المعلومات الضروريه من خلال الاستبيان المعد مسبقا من قبل فريق البحث وقد تم جمع المعلومات المطلوبه من فايلات المرضى المراجعين لمستشفى الاورام التعليمي في مدينة الطبالنتائجفي هذه الدراسة كانت 77.8% مريضة بعمر اكثر من 50 سنة ,86.7% من المريضات كان لديهن تاريخ احاظه مبكره,86.7% من المريضات كن في مرحلة سن الياس.كانت هناك نسبه قليله من المريضات ممن كان لدين تاريخ دوائي باستخدام الهورمونات او عدم الانجاب او وجود تاريخ مرضي للمرض في العائله وان نسبة 51% كن في المرحله الاولى من المرض اثناء تشخيص المرض ابتدائيا | Uterine cancer is relatively common; it’s the fourth most common malignancy in women. Histopathological types, staging and risk factors for uterine cancer are not yet well evaluated in Iraqi patients with uterine malignancy.Aim of study : - To classify uterine carcinoma patients according to histopathological type, risk factors and stageing.Patients and method : Cross - sectional study was conducted for 45 patients in Oncology Teaching Hospital, Medical city, Baghdad, Iraq between Jan.1st - April 1st2016. The data were collected from the medical records of patients with uterine cancer who’s attending to the hospital for completion of treatment through questionnaire which was developed by research team.Results : - The results of this current study on total of 45 patients showed that 77.8% 35 patients were older than 50 years, 86.7% 39 patients with history of early menarche, 86.7% 39 patients were in post - menopause phase, 33.3% of patients had history of hormonal therapy, infertility and family history of the disease. Endometrioid and Papillary serous types represented the highest percentage (42.2%, 28.9%) respectively. Highest percentages (51%) of patients were in stage one at the time of diagnosis.Recommendation : - - Further studies on uterine tumor. - Early detection programs should be activated. - Close follow up on patients from Stage 1. - Awareness programs on risk factors should be activated. - Patients educational sessions should be conducted regularly in the Hospitals.

معالجة اورام الدماغ في العراق 2016 == Management of brain Tumors in Iraq 2016

اسم المؤلف: هدير رياض سعيد
اسم المشرف: خضير جاسم صبيح الرواق
الموضوع العام: الطب
السنة: 2016
الموضوع الدقيق: الاشعة العلاجية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: CNS tumors constitute 2% of all cancers, and are observed in 4 - 5 in 100,000. CNS tumors exhibit different behaviors according to age, histology, and location.Aim of study1 - Detect the rate of incidence of CNS tumors in relation to age, sex, geographical distribution, environmental factors & genetic factors in our country2 - Explaining of the associated clinical features3 - Determine the effect of radiotherapy & chemotherapy on the patient’s outcome.Patients and methodsProspective study of CNS tumors started from the beginning of Jan 2016 to the end of Apr 2016. The patients were taken from the outpatient clinic of Oncology Teaching Hospital / Medical City in BaghdadAll patients (47) underwent surgery and the surgeons then sent them to our out patients clinic with their Histopathological reports seeking for further management.(42) Patients received Chemotherapy and/or Radiotherapy while the remaining (5) patients didn’t followed up after surgery because they didn’t attend to our out patients clinic according to their dates.The outcome of management was divided into : Good outcome, Fair outcome and Poor outcome.ResultsThe 5th decade is the most commonly involved age with male incidence more than females and the incidence is higher in the south of Iraq. There is little IIassociation of CNS tumors with family history and high association with environmental factors. Neurological deficit was the main chief compliant and headache was present in most of the patients at time of diagnosis. Frontal region was the commonest site for CNS tumors with size of 1 - 5cm and mostly associated with edema and +ve enhancement. Meningioma was the commonest histological type.Conclusions1 - There is a poor relationship between family history & CNS tumors2 - There is significant relationship between environmental factors & CNS tumors.3 - Headache is not the dominant chief compliant in compare with neurological deficit .4 - Total resection of the tumor followed by radio and/or chemotherapy has the best prognosis.Recommendations1 - Further researches with larger sample size to be collected from all oncology hospitals in Iraq are needed to generalize the results to national level .2 - Make the total resection of the brain tumor the aim of the surgeon because it is the golden stone in brain tumor management.3 - Use the new technique of radiotherapy like gamma knife and IMRT for the

العلاقة بين مختلف مؤشرات فعالية المرض والحالة الوظيفية في عينة من المرضى العراقيين المصابين بالتهاب الفقار المقسط == Correlation Among Different Disease Activity Parameters and Functional Status in a Sample of Iraqi Patients with Axial Spondyloarthritis

اسم المؤلف: اروى حمدان خضير
اسم المشرف: نزار عبد اللطيف جاسم
الموضوع العام: الطب
السنة: 2018
الموضوع الدقيق: الامراض - المفاصل
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Axial spondyloarthritis is an inflammatory rheumatic diseasethat comprises the whole spectrum of patients with radiographic sacroiliitis(ankylosing spondylitis or radiographic axial spondyloarthritis) and withoutradiographic sacroiliitis (non - radiographic axial spondyloarthritis). It ischaracterized predominantly by inflammatory back pain and involvement ofthe spine and sacroiliac joints. Disease activity scores like Bath AnkylosingSpondylitis Disease Activity Index and Ankylosing Spondylitis DiseaseActivity Score are used for monitoring the disease activity, while BathAnkylosing Spondylitis Functional Index is used to evaluate the functionalstate of the patients.Aim of the study : to assess the correlation among disease activity scoresand the functional status of patients with axial spondyloarthritis andevaluating the discriminative power of Ankylosing Spondylitis DiseaseActivity Score (ability to reflect disease activity).Patients and methods : A cross sectional study enrolled a total of 251patients with axial spondyloarthritis , all of them were fulfilling the modifiedNew York criteria for Ankylosing Spondylitis and Assessment ofSpondyloarthritis International Society classification criteria for diagnosingspondyloarthropathy. Demographic data, disease duration, type of treatment,Bath Ankylosing Spondylitis Disease Activity Index, AnkylosingSpondylitis Disease Activity Score and Bath Ankylosing SpondylitisFunctional Index were calculated for the patients. They were alsoinvestigated for C - reactive protein and erythrocyte sedimentation rate.VIIResults : The mean age of the patients was (37.2 ± 8)years, males constitute 90.4% of them and the median disease duration was 7 (0.25_42) years. The disease activity scores were positively correlated with each other and with Bath Ankylosing Spondylitis Functional Index with significant p values(<0.005). There was no significant difference between areas under the curve for both Bath Ankylosing Spondylitis Disease Activity Index & Ankylosing Spondylitis Disease Activity Score - Erythrocyte sedimentation rate(0.94 and 0.93 respectively) in comparison to Ankylosing Spondylitis Disease Activity Score - C - reactive protein with area under the curve 0.57, when using patient global assessment as a reference guide to evaluate the ability of the these scores to reflect disease activity.Conclusions : There was a positive correlation among disease activity scores and functional status measured by Bath Ankylosing Spondylitis Functional Index. Ankylosing Spondylitis Disease Activity Score - Erythrocyte sedimentation rate was as good as Bath Ankylosing Spondylitis Disease Activity Index in discrimination of disease activity, while Ankylosing Spondylitis Disease Activity Score - C - reactive protein showed less accuracy in reflecting disease activity.

تقييم المعايير الالزاميه لسلامة المرضى في عينه من المستشفيات التعليميه في بغداد 2014 == Assessment of Critical Standards of Patients Safety in a Sample of Teaching Hospitals in Baghdad 2014

اسم المؤلف: هناء عبد اللطيف عبد الرزاق
اسم المشرف: فارس حسن اللامي
الموضوع العام: الطب
السنة: 2014
الموضوع الدقيق: الوبائيات التطبيقية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: سلامة المريض هو نظام الرعاية الصحية الجديد الذي يؤكد على التقارير والتحاليل والوقاية من الخطا الطبي الذي غالبا ما يؤدي الى احداث الرعاية الصحية السلبية . مع الاعتراف بان لاخطاء الرعاية الصحية الاثر في 1 من كل 10 مرضى في جميع انحاء العالم . تعتبر منظمة الصحة العالمية بان سلامة المريض قلق مستوطن . في عام 1970 حددت الابحاث الاضرار التي تصيب 36% من الراقدين في وحدات طبية عامة و13% من الراقدين في وحدات العناية المركزة من المرضى غالبا ما يكون نتيجة للعلاجات . الهدف من هذه الدراسة هو اجراء تقييم اساسي لتحديد الفجوات في المعيار الالزامي لسلامة المريض في بعض المستشفيات التعليمية في بغداد وذلك لغرض ملئ هذه الفجوات في هذه المستشفيات بحيث تصبح جاهزة للانضمام في مبادرة المستشفى الصديقة لسلامة المريض .الطرق : اجريت دراسة مقطعية وصفية مع العنصر التحليلي باستخدام دليل تقييم سلامة المريض لمنظمة الصحة العالمية لسنة 2011 كاستبيانات لتقييم المعايير الحرجة التي هي المعايير الالزامية التي يجب ان تمتثل لها المستشفى لتصبح جاهزة للانضمام في مبادرة المستشفى الصديقة لسلامة المرضى . اخذت عينة من اربعة مستشفيات تعليمية عامة في بغداد . تم استخدام الاساليب الاحصائية واتجاه واحد انوفا للتعرف على الاختلافات بين المتغيرات .النتائج : اظهرت الدراسة ان مستشفى غازي الحريري للجراحات التخصصية قد حققت نسبة عاليه 80% في حين حققت مستشفى بغداد التعليمي متوسط 67% من مجموع درجات المعايير الالزامية .الاستنتاج : تم تقييم مستوى الامتثال الكلي للبنية التحتية لسلامة المريض في المستشفيات بانها عالية لكن الحصول على 100% من المعايير الالزامية في المجالات الاربعه ضروريه كي تعتبر في المستوى الاساسي من المستشفى الصديقة لسلامة المريض . | emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse health care events. Recognizing that health care errors impact 1 in every 10 patients around the world, the WHO calls patient safety an endemic concern. In 1970, research identified that 36% of admissions to general medical units and 13% of admission to intensive care units followed adverse events in which patients had been harmed most often as result of medications. The objective of this study is to conduct a baseline assessment to identify the gaps in the critical standard of patient safety in a sample of teaching hospitals in Baghdad for fill in these gaps so that these hospitals become ready to be enrolled in the Patient Safety Friendly Hospital Initiative .Methodology : A descriptive cross sectional study with analytic element was conducted in a convenient sample of four public teaching hospitals in Baghdad governorate using the checklist of WHO patient safety assessment manual, 2011 as questionnaires to assess the critical standards which are compulsory standards with which a hospital has to comply to become enrolled in the PSFHI. Convenience sample of four public teaching hospitals in Baghdad. Statistical methods and one way anova were used to identify the differences among the variables.Results : the study showed that Gazi Al - Hareery Specialized Surgeries Hospital had the highest percentage 80% while Baghdad Teaching Hospital with average 67% of the total scores for critical standards.Conclusion : The overall compliance level of patient safety infrastructure was evaluated high in the studied hospitals but acquiring 100% of critical standards in the four domains are essential to be considered at the basic level of PSFHI

قياس كثافة معدن العظم ومستوى فيتاميهن د في عينة من المرض العراقيين المصابين بمرض بهجت == Bone Mineral Density and Serum Vitamin D Level in A Sample of Iraqi Patients with Behcet’s Disease

اسم المؤلف: نور حسن عبد الرسول
اسم المشرف: نزار عبد اللطيف جاسم
الموضوع العام: الطب
السنة: 2014
الموضوع الدقيق: الامراض - المفاصل
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Behcet’s disease (BD) is a multisystemic vasculitis characterized by recurrent orogenital aphthous ulcers , uveitis and skin lesions with chronic relapsing course. The chronicity and vasculitic background of Behcet's disease (BD) and the drugs used for its treatment may result in low bone mineral density. Low serum vitamin D status is closely associated with disease risk of BD.Aim of the study : To evaluate if there is a change in bone mineral density (BMD) and vitamin D level in Iraqi patients with BD.Patients and methods : In this case control study a forty two BD patients who were diagnosed according to International Study Group Criteria, and a total of 24 healthy persons recruited as a control group were enrolled in the study.Patients with histories of chronic disease affecting bone metabolism were excluded from the study. All female patients were premenopausal women.All BD patients and control group were subjected to detailed history taking & thorough clinical examination. Weights and heights of all subjects were recorded and body mass index (BMI) was calculated. A signed consent was taken from the individuals in both groups for admission in the study.Venous blood samples were obtained from all patients and controls for complete blood count, erythrocyte sedimentation rate (ESR), C - reactive protein (CRP), total serum calcium, total serum phosphorus and total serum alkaline phosphatase. Total serum 25 - hydroxyvitamin D (vitamin D) was assessed and levels ≥22 ng/ml were considered sufficient, while levels of <22 ng/ml were considered low. Bone mineral density measured in the lumbar spine (L2 - L4) and right femur neck using dual - energy x - ray absorptiometry (DXA) machine were performed.VIIResults : The mean age for BD patients was 34.2±9.6 years compared to 31.8±6.5 years in control group. Male represented 69% in BD and 70% of healthy controls. Mean disease duration for BD was 5.9±6.7 years.The mean BMI of BD patients was 27.1±4.5 Kg/m2 compared to 27.4±3.5 Kg/m2 in controls.The personal and clinical characteristics of study sample show no clinical significant difference between patients and controls apart from current smoking which was significantly associated with BD (P < 0.05). Osteoporosis and osteopenia that are found by T score at both spine (L2 - L4) and right femur neck were significantly higher in patients with BD (P<0.05). Serum vitamin D levels were significantly lower in patients with BD than controls (P<0.001). Serum vitamin D levels were significantly inversely correlated with BD duration.Conclusion : Osteoporosis, osteopenia and lower serum vitamin D levels are significantly more common in BD patients compared to controls.

الخصائص الوبائية لاصابات الحروق في بغداد, العراق 2017 == Epidemiological Characteristics of Burn Injuries in Baghdad, Iraq, 2017

اسم المؤلف: احمد جهاد تقي
اسم المشرف: فارس حسن اللامي
الموضوع العام: الطب
السنة: 2018
الموضوع الدقيق: طب العائلة
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Burn injuries are among the most devastating of all injuries and a major global public health crisis. Burns are the fourth most common type of trauma worldwide and account for 1% of the global burden of diseases. According to the latest report from WHO, there were about 6000 deaths in Iraq in 2015 from fire - related causes and 18,000 disability - related burns.Objectives : To describe epidemiological and clinical characteristics of burn injuries in Baghdad, Iraq 2017, to estimate the case fatality rate, Lethal Area 50 (LA50), Baux score 50 and Futility Point and to identify the main determinants of death among burn cases in Baghdad, Iraq, 2017.Patients and Methods : A cross sectional study was conducted in all the burn hospitals and wards in the public hospitals in Baghdad. The files of all burn patients with different types and degrees of burn injuries who were admitted to these hospitals during 2017 were obtained from the statistical department in these hospitals and included in the study. Patients with minor superficial burns treated in the emergency department as an outpatient and patients admitted for surgical treatment of old scars were excluded. A form was used to collect socio - demographic, clinical and epidemiological data of the patients.Results : The mean age of the patients was 21.08 ± 15.2 years; 55.6% were males; 71.8% were singles; and 86.3% were living in Baghdad, and around 95% had no past medical history. Flame was the cause of burn in 63.6% of the patients; trunk was the most common site affected (69.6%); 42% had second degree of burn, and 29% developed infection after burn. The proportion of mortality was 36.2%. Logistic regression analysis revealed the following significant risk factor : Low duration of

معدل انتشار الداء السكري لدى مرضى الانسداد الرئوي المزمن في المرحلة الشديدة والشديدة جدا == The Prevalence of Diabetes Mellitus Type 2 in chronic obstructive pulmonary disease Patients with Severe and very severe Stage of the Disease

اسم المؤلف: نادية عبد الكريم حمدان
اسم المشرف: محمد وهيب سلمان العبيدي
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - الصدرية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and mortality worldwide.. There is an evidence to support a connection between COPD and diabetes mellitus Type 2 (T2DM). T2DM affects 2 - 37% of COPD patients, with results being highly variable between studies.Objective : To determine the prevalence of T2DM among COPD patients in severe and very severe stages of COPD patients. To assess the risk factors affecting the prevalence of T2DM among COPD patients. Subjects and methods A cross sectional study was conducted on 140 patients with COPD attending Out - patient and Inpatient of Respiratory Unit at Baghdad Teaching Hospital. The data were collected between the10th of October 2016 to the 10th of August 2017. These data included demographic parameters such as : age, sex, educational status, body mass index (BMI), smoking habit, and respiratory parameters from history& clinical examination. Spirometry was used to assess the severity of COPD patients. Random blood sugar testing was used for identification of COPD patients having T2DM when they are not clear or not known as a case of T2DM previously.Results : The prevalence of T2DM among COPD patients was 19.38%. (The prevalence of DM in those with severe stage was 10.9%, while in very severe stage was 35.4%).The prevalence of T2DM was higher in males than in females. The prevalence of T2DM was increased in the elderly COPD patients (>61 years). Increasing with increased BMI, and also VIP a g eincreased more among current smokers followed in order by former smokers and never smokers. Lung function tests decline more in COPD patients with presence of T2DM.Conclusions : Diabetes Mellitus Type 2 is more prevalent among COPD patients; it increased with increased severity of the COPD patients and subjects with DM are at increased risk of declining pulmonary function among COPD patients.

حدوث الارتباط بين نمط شد البطين الايسر في تخطيط القلب الكهربائي والاصابة بامراض الشراين التاجية والجلطات الدماغية للمرضى المصابين بارتفاع ضغط الدم الشرياني == The Association of Electrocardiographic Left Ventricular Strain Pattern and Coronary Artery Disease and Cerebrovascular Accident in Systemic Hypertensive Patients

اسم المؤلف: قيس نعمة رحيم
اسم المشرف: حسن الفرحان
الموضوع العام: الطب
الموضوع الدقيق: الامراض - القلب
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: خلفية البحث : المرضى الذين يعانون من ارتفاع ضغط الدم وتضخم البطين الايسر قد يوجد لديهم تغيرات في التخطيط الكهربائي للقلب وهذه التغيرات قد تتمثل بعلامات تضخم البطين الايسر للقلب المتلازمة بعلامات الشد على البطين الايسر او بدونها وهولاء المرضى يكونون اكثر عرضة للاصابة بامراض شرايين القلب وجلطات الدماغ لذلك تعتبر هذه العلامات هي مؤشر للاصابة بامراض شرايين القلب والجلطات الدماغية, الهدف من الدراسة : اثبات ان التغيرات في التخطيط الكهربائي في القلبfixed ST depression) inversion in lead (I, avl, v5 and v6) (T التي تطرا على المرضى المصابين بارتفاع ضغط الدم وتضخم البطين الايسرتعتبر كمؤشر للاصابة بالجلطات الدماغية وامراض الشراين التاجية.المرضى والطرق : اجريت هذه الدراسة في المركز العراقي لامراض القلب, مدينة الطب, بغداد, العراق, للفترة من كانون الثاني 2012 لغاية الاول من كانون الثاني 2017 .المرضى اللذين تم تشخيص اصابتهم بمرض ارتفاع ضغط الدم واثبات اصابتهم بتضخم البطين الايسر تم شمولهم بهذه الدراسم الوصفية ,ايضا تم تشخيص بقية الامراض المصاحبة مثل اصابات الاوعية الدماغية وامراض الشراين التاجية. تم اجراء تخطيط القلب الكهربائي, الايكو والتداخل القسطاري لجميع المرضى.وقد جمعت كل المعلومات من ملفات المرضى الراقدين في المركز العراقي لامراض القلب ,مدينة الطب ,بغداد ,العراق. النتائج : شملت الدراسة 401 مريض [262 (65,3 %)ذكور و139 (34,7%)اناث] مصابين بمرض ارتفاع ضغط الدم. تراوحت الاعمار من (94 - 40) ومعدل الاعمار (54). بعد اجراء التداخل القسطاري وجد ان 207 (51,6%)من المرضى يعانون من امراض الشراين التاجية بينما 194 (%48,3)من المرضى لايعانون من امراض الشراين التاجية وكانت الدلالة الاحصائية (P= 0. 625). بالنسبة للاصابة بالجلطات الدماغية, وجد ان 280 (69,8%)مريض قد تعرضو لحدوث الجلطات الدماغية بينما 121 مريض لم يتعرضو لحدوث الجلطات الدماغية, والدلالة الاحصائية كانت (P <0.001). اما بالنسبة للتغيرات في التخطيط الكهربائي للقلب على مستوى المرضى فكانت النتيجة كالاتي, 301 (75%)مريض وجد لديهم تغيرات في التخطيط الكهربائي للقلب بينما 100 (25%)مريض لم يكن لديهم تغيرات في التخطيط الكهربائي للقلب. وكانت الدلالة الاحصائية (P <0.001). من ناحية اخرى اضهرت النتائج دلالة احصائية واضحة (P <0.001) عند المقارنة بين التغيرات في التخطيط الكهربائي للقلب ونتائج التداخل القسطاري للمرضى وكانت على النحو الاتي, 205 (51,1%)مريض لديهم تغيرات في التخطيط الكهربائي للقلب ولديهم امراض الشراين التاجية بينما 96 (23,9%)مريض لديهم تغيرات في التخطيط الكهربائي للقلب وليس لديهم امراض الشراين التاجية اثنان من المرضى ليس لديهم تيغيرات في التخطيط الكهربائي للقلب ولديهم امراض الشراين التاجية بينما 98 (24,4%)مريض ليس لديهم تغيرات في التخطيط الكهربائي للقلب ولم يشخصوا بامراض الشراين التاجية. من ناحية اخرى اضهرت النتائج دلالة احصائية(P <0.001) . خلال المقارنة بين التغيرات في التخطيط الكهربائي للقلب والاصابة بالجلطات الدماغية على مستوى المرضى وكانت النتيجة كالاتي, 279 (69,5%)مريض كانت لديهم تغيرات في التخطيط الكهربائي للقلب وتم تشخيصهم بالاصابة بالجلطة الدماغية بينما 22 (5.4%)مريض كانت لديهم تغيرات في التخطيط الكهربائي للقلب ولكن لم يصابو بالجلطة الدماغية. من ناحي اخرى وجد ان مريض واحد لم يجد لديه تغيرات في التخطيط الكهربائي للقلب ولكن تطورت حالته واصاب بالجلطة الدماغية بينما 99 (24,6%)مريض لم يجد لديهم تغيرات في التخطيط الكهربائي للقلب وايضا لم يصابو بالجلطة الدماغية. الاستنتاجات : تم التوصل الى ان معضم المرضى الذين لديهم تغيرات في التخطيط الكهربائي للقلب fixed ST depression وinversion in lead (I, avl, v5 and v6) (T هم مؤهلين للاصابة بالجلطات الدماغية وامراض الشراين التاجية ويمكن استخدام هذة التغيرات للتنبؤ بالاصابة بالجلطات الدماغية | Background : Patients diagnosed with hypertension and left ventricular hypertrophy could presented with electrocardiographic changes including criteria of left ventricular hypertrophy, and left ventricular strain pattern( fixed ST depression and T inversion in leads I, avL, V5&6) Aim of the study : To study the impact of electrocardiographic left ventricular strain pattern in hypertensive patient as predictor for coronary artery disease and cerebrovascular accident development.Patients and methods : a cross sectional hospital based study was conducted during 2012 - 2017 at Iraqi center for heart diseases including hypertensive patients with normal ECG or LV strain pattern criteria, all patients underwent coronary angiography and the data were collected from patients files including age, sex, history of hypertension, coronary artery disease and cerebrovascular accident. The result of electrocardiography, echocardiography and coronary angiography were reviewed and recorded. Results : The records of 401 hypertensive patients [262(65.3%) males/139(34.7%) females] were included in this study. The ages ranges 40 - 60year, while the ages mean ±SD of patients were (60.07 ± 10.83year). The results of coronary angiography showed that there are 207(51.6%) patients were positive for coronary artery disease while 194(48.3%) patients were with normal coronary angiography. History of cerebrovascular accident was found in 280(69.8%) patients, while 121 (30.1%) patients had no history of cerebrovascular accident.301(75%) patients had electrocardiographic changes of left ventricular strain pattern and 100 (25%) patients had no electrocardiographic changes of left ventricular strain pattern. The relation between electrocardiographic left ventricular strain pattern and Coronary Angiography among patients was analyzed. 205(51.1%) patients were positive to electrocardiographic left ventricular strain pattern strain and for coronary artery disease in coronary angiography. This study showed highly significant relation between electrocardiographic left ventricular strain pattern and coronary artery disease among studied group of patients (P <0.001). The relation between electrocardiographic left ventricular strain pattern and cerebrovascular accident among patients was analyzed. 279 (69.5%) patients were positive for electrocardiographic left ventricular strain pattern and cerebrovascular accident. The study shows highly significance in relation between electrocardiographic left ventricular strain pattern and cerebrovascular accident among studied group (P <0.001). Conclusions : The current study conclude that the electrocardiographic left ventricular strain in hypertensive patients is highly associated with coronary artery disease and cerebrovascular accident, therefore the electrocardiographic left ventricular strain could be considered a predictor for coronary artery disease & cerebrovascular accident development in patients with hypertension which could be considered as criteria for risk stratification of hypertensive patient mandate a close and precise follow up and control of patients risk factors

تصلب الشرايين متعدد الاماكن في انحاء الجسم في المركز العراقي لامراض القلب لدراسة مدى الاصابة في الاوعية الدموية الاخرى في المريض المصاب بمرض تصلب الشرايين التاجية == Multivascular Bed Atherosclerosis in Patients with Coronary Artery Disease in the Iraqi Center for Heart Disease (ICHD)

اسم المؤلف: هادي هلال حمزة
اسم المشرف: هلال بهجت شوقي الصفار
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - القلب
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Atherosclerosis is very common disease involving large and medium size arteries result in morbidity and mortality depend on site of vascular involvement. Aim of the study : To study the extent of other vascular beds involvement in patient presented with coronary artery disease.Patients & Methods : This study is prospective cross - sectional study of all patients who were referred Iraqi Center for heart disease, for further evaluation of suspected coronary artery disease(CAD) for the period August 2016 to February 2017. The total number of patients was one hundred ninety (190) ,all underwent full clinical evaluation, laboratory investigation including ECG, biochemical testing, echocardiography, coronary angiography,. demographic characteristics were recorded for all patients including ,age, gender, BMI, conventional risk factors, carotid IMT measurement by Doppler ultrasound and ABI by Doppler stethoscope was calculated. The study sample was divided into two groups according to the results of coronary angiography : group A, those with normal CA and group B, those with abnormal CA. A comparison was made between group A and B as regard to the results of IMT and ABI measurement and then the relation to demographic characteristics and other conventional risk factors. Then we study the subgroup with abnormal ABI & IMT in both group A and B, comparison was made between both subgroup in form , gender, age groups , mean age, and the detail of risk factors like hypertension, smoking, diabetes mellitus , BMI, family history of premature CAD and hyperlipidemia . Results : The mean age, patients above 60 y and men gender were higher in group A( 58.82), (52.09%) and (76.4%) than in group B (52.93) ,(25.4%) and 45.07% (p value 0.010)The study of risk factors in both groups demonstrate more prevalence of hypertension in group A (63.05%) than in group B (47.8%) , ( p value 0.0499), also significance difference in prevalence of diabetes mellitus and smoking (52.9%) and (43.6%) in group A and (26.7%) and (15.4%) in group B ( p value 0.0276 and 0.0437) , prevalence of hyperlipidemia was significantly higher in group A (55.4%) than in group B( 35.3%) (p value 0.0418) . family history of premature CAD and BMI were higher in group A (41.1%) and (40.3%) than in group B (33.8%) and (26.7%) but not statistically significant (p value 0.194 and 0.154 ) respectively.The prevalence of abnormal ABI and IMT were higher and statistically significant in group A (36.9%) and (77.3%) than in group B (15.4%)and (30.9%) (p value 0.002 and 0.001). The no. patients with abnormal both carotid IMT and ABI were higher in group A (37/44, 84.09%) than in group B (8/11, 72.7% ) , (p value 0.041), the mean age is higher and statistically significant in group A (68.49) than in group B (57.5) ( p value 0.030) , the male gender is higher and statistically significant in group A(33/37, 75%) than in group B (4/8, 50%) ( p value 0.010). the prevalence of hypertension, hyperlipidemia and diabetes mellitus were higher and statistically significantly in group A (83.7%), (83.7%) and (75.6%) than in group B (75%) ,(62.5%) and (37.5%) (p value 0.0476, 0.0346 and 0.047) respectively. The prevalence of smoking , abnormal BMI and family history of premature CAD were higher but statistically insignificant in group A (67.5%) , (56.7%), and (48.6%) than in group B (37.5%), (37.5%) and (37.5%) (p value 0.0868, 0.146 and 0.2136) .Conclusion : Atherosclerosis is generalized process whenever found in certain vascular bed, we must think of other vascular beds involvement, the more risk factors burden the more likely involvement of other vascular bed and more sever disease to be expected.

انتشار اضطراب الكئابه العظمى لدى المرضى العراقيين المصابين بالتصلب المجموعي == Prevalence of Major Depressive Disorder in Iraqi Patients with Systemic Sclerosis

اسم المؤلف: رؤى ناجي سوادي
اسم المشرف: فائق ايشو كوريال | مشتاق طاب هاشم
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: الامراض - المفاصل
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Systemic sclerosis (SSc) is a connective - tissue disease characterized by excessive collagen deposition in the dermis and internal organs, and by vascular hyper - reactivity and obliterative microvascular phenomena. Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings, and sense of well - being.Objectives : The aim of this study was to evaluate the prevalence and predictors of major depressive disorder in Iraqi patients with SSc if present.Patients and methods : This case - control study involved 50 patients with SSc according to the criteria developed by the 2013 American College of Rheumatology/European League Against Rheumatism for the classification of systemic sclerosis ,and compared with another 51 healthy controls.Demographics and clinical data were collected including age, sex, BMI, smoking status, marital status, employment status, educational status, crowding index and disease duration. Disease activity for SSc was assessed with the SAQ. Medications used and autoantibody profile were collected.We applied DSM5 diagnostic criteria of all patients included .Results : The prevalence of major depressive disorder was (44% compared to control 2.0%), in which major depressive disorder 39.3 folds associated with SSc patients compared to control. A severe form of major depressive disorder was observed in (36.4 %) of SSc cases. Furthermore, cases with a severe form of disease evaluated by SAQ had an obviously higher rate of depression .Also the risk of having major depressive disorder was significantly correlated with smoking.Educational level had no statistically significant association with major depressive disorder, SSc cases with higher education(college) had the highest rate of major depressive disorder (36.4%) compared to a rate between 13.6% and 27.3% for lower level of educational attainment. The risk of having major depressive disorder was not different in the age, gender, marital status and employment status. The history of using each of prednisolone, DMARD and biological agents had statistically significant association with major depressive disorder. Also the presence of autoantibodies (anti centromer and anti Scl70 antibodies) had no statistically significant effect on the presence of major depressive disorder.Conclusions : The prevalence of major depressive disorder in systemic sclerosis patients was significantly higher in patients compared to controls.Severity of systemic sclerosis was increase the rate of major depressive disorder .

نتائج حمل المراهقة في العزيزية - محافظة واسط / العراق == Outcome of Teenage Pregnancy in Al - Azyzia - Wasit Province - Iraq2017

اسم المؤلف: رند رحيم رسن
اسم المشرف: جواد كاظم الديوان
الموضوع العام: الطب
السنة: 2017
الموضوع الدقيق: طب العائلة
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الكلمات الدلالية:
  • الحمل العكسية
  • مقارنة الحمل عند البالغات والمراهقات
  • مضاعفات حمل المراهقة.
الصفحات الاولى:
المستخلص: خلفية البحث : حمل المراهقات يعتبر مشكلة صحية شائعة في العراق حيث الزواج المبكر والحمل يشجع من قبل المجتمع بسبب الظروف الاقتصادية والخلفية الثقافية. الامهات المراهقات اللواتي يواجهن خلال الحمل وبعد الولادة معدلات اعتلال ووفيات اعلى مقارنة بالامهات البالغات.هدف الدراسة : هدف هذا العمل هو تقييم نتائج حمل المراهقات اثناء الحمل وما بعد الولادة.المنهجية : دراسة الحالات والشواهد طبقت في هذه الدراسة، حيث ان عينة مكونة من 600 حامل باكر جمعوا بطريقة العينات العشوائية المنظمة من قبل الباحثة من ملفات المرضى اللذين رقدوا في ردهات النسائية في مستشفى العزيزية العام - واسط خلال فترة الدراسة من بداية الشهر الثالث حتى نهايةالشهر السادس من عام 2017. المجموعة الاولى (الحالات) : 200 حامل باكر بسن المراهقة والمجموعة الثانية (الشواهد) : 400 حامل باكر بسن البلوغ.نتائج الحمل التي تمت ملاحظتها للامهات : طريقة الولادة، النزف ما بعد الولادة، اضطراب الضغط، السكر خلال الحمل والاسقاط.وكذلك النتائج التي تمت ملاحظتها للوليد : عمر الحمل عند الولادة ووزن الوليد، الولادات المبكرة، دخول الوليد للخدج، التشوهات الولادية نتيجة الولادة.النتائج : الامهات المراهقات اظهروا فروق ذات دلالات احصائية بالنسبة لوزن الطفل، الولادة المبكرة، النزف ما بعد الولادة والاسقاطات بالمقارنة مع الامهات البالغات واعتبرت مهمة احصائيا، حيث ان قيم P هي : 0.001, 0.003, 0.001 و0.008 بالتتابع تمثل حدوث اضطراب الضغط، التشوهات الولادية وسكر الحمل عند الامهات المراهقات اكثر من حدوثها عند الامهات البالغات، لكنها تعتبر غير مهمة احصائيا. كذلك، الاعتلال الولادي، سوء التغذية والاسقاط الطبيعي وجدت عند الامهات المراهقات اكثر من البالغات.الاستنتاج : هذه النتيجة تؤيد الراي المتعارف عليه بالنتائج السلبية للحمل بعمر المراهقة بسبب الاوضاع الاقتصادية، الزيارات الصحية الغير منتظمة خلال فترة الحمل وجهل الابوين بمخاطر الحمل المبكر وسوء التغذية خلال فترة الحمل | Background : Teenage pregnancy is a common health problem in Iraq where early marriage and child bearing is encouraged by communities due to many socioeconomic reasons and cultural backgrounds. Teenage mothers are facing higher maternal and prenatal morbidity and mortality than adult mothers.Objective : The objective of this work was evaluating obstetric, maternal and neonatal outcome.Method : In this study (case control study), a sample consisted of 600 records related to primigravida all gave birth at Al - Azyzia general hospital during the study period. First group (cases) 200 records related to primigravida teenage pregnant and second group (controls) 400 records related to primigravida adult pregnant. Pregnancy outcome were observed for mothers : mode of delivery, post - partum hemorrhage, hypertensive disorder, DM during pregnancy and abortion. While, for neonatal : gestational age at birth, birth weight, preterm labor, admission to neonatal care unit, congenital anomalies and neonatal outcome.Result : - Teenage mothers showed low birth weight, preterm labor, postpartum hemorrhage and abortion as compared with adult mothers and considered as significant statistically, where, P value respectively, 0.001, 0.003, 0.001 and 0.008 the incidence of hypertensive disorder, congenital anomaly and DM more in teenage mother, but not significant statistically. Congenital abnormality, malnutrition and spontaneous abortion were found to be more in teenage mothers also.Conclusion : - This finding challenges the accepted opinion adverse birth outcome associated with teenage pregnancy.Keywords : adverse pregnancy outcome, teenage - adult pregnancy comparison, teenage pregnancy complications.

الملف الوبائي لسرطان الثدي في بغداد / العراق 2009 - 2013 == Epidemiological Profile of Breast Cancer in Baghdad/Iraq 2009 - 2013

اسم المؤلف: اسراء عبد عبد الله
اسم المشرف: نادية عزيز ناصر
الموضوع العام: الطب
السنة: 2007
الموضوع الدقيق: الوبائيات التطبيقية
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Background : Breast cancer ranks as the fifth cause of death from canceroverall (522,000 deaths) and while it is the most frequent cause of cancer deathin women in less developed regions (324,000 deaths, 14.3% of total), it is nowthe second cause of cancer death in more developed regions (198,000 deaths,15.4%) after lung cancer. In Iraq, breast cancer is the commonest type offemale malignancy, accounting for approximately one - third of the registeredfemale cancers according to the Iraqi Cancer RegistryObjectives : Identify the burden and to highlight a database of epidemiologicaldata of breast cancers in Iraq.Patients and methods : A descriptive cross section study from the 1st of Marchto the end of September 2017, in which all registered patients with breastcancers in Iraq 2009 - 2013 were included.Results : A total of 19035 patients with breast tumor through the period 2009 - 2013. The incidence of breast tumor cases per year was as the followings; 2009(15.7%), 2010 (18.6%), 2011 (20.2%), 2012 (21.6%) and 2013 (23.9%), withthe mean age was 50.6±12.4 years. The main patients residence was in Baghdad(32.75), 10.2% of the patients were employed. Peri - canalicular fibro adenomahad significantly higher survival rate than other morphological types. Nosignificant relationship was observed between breast tumor outcome and breasttumor behavior. Grade II breast tumors was significantly associated with highersurvival rateConclusion : The incidence rate of breast tumors in Iraq at 2013 is higher thanprevious years and the incidence trend for period (2009 - 2013) are increasing.Introduction1INTRODUCTIONCancer is a group of disease that causes cells in the body to change andgrow out of control [1]. These are neoplastic disorders caused due toexcessive proliferation of cells. Cancer is one of the most dreaded noncommunicablediseases that have made them most important contributorto the global burden of disease [2]. Since, Cancer is a multi - cellulardisease that causes excessive proliferation of cells; continual future research on cancer trends is warranted to study the actual cancer scenario.Breast cancer ranks as the fifth cause of death from cancer overall (522,000 deaths) and while it is the most frequent cause of cancer death in women in less developed regions (324,000 deaths, 14.3% of total), it is now the second cause of cancer death in more developed regions (198,000 deaths, 15.4%) after lung cancer [3].The incidence of breast cancer varies markedly from country to country being highest in United States and Northern Europe and lowest in Asia. In developed countries the incidence of breast cancer is more than 1000 per million, whereas in developing countries, it is less than 200 per million women. However, cancer mortality is higher in developing countries than in the developed countries [3]. The mortality rates are less than that for incidence because of the more favorable survival of breast cancer in (high - incidence) developed regions, with rates ranging from 6 per 100,000 in East Asia to 20 per 100,000 in Western Africa [4].In Western Europe also, breast cancer incidence has reached more than 90 new cases per 100,000 women annually, compared with 30 per 100,000 in East Africa. In contrast, breast cancer mortality rates in these Introduction2two regions are almost identical, at about 15 per 100,000, which clearly points to a later diagnosis and much poorer survival in eastern Africa. An urgent need in cancer control today is to develop effective and affordable approaches to the early detection, diagnosis, and treatment of breast cancer among women living in less developed countries [5].In developing countries, patients have limited access to screening, or any effective awareness programs and consequently advanced disease. Thus, the growing incidence of breast cancer worldwide stresses the greater need for a study of its rise and the need for awareness about it in developing nations [6].Within the Eastern Mediterranean Region (EMR), cancer is the fourthranked cause of death, after cardiovascular Diseases, infectious diseases, and injuries, case fatality rates being highest in low resource countries [7]. Approximately 4.4 million women diagnosed with breast cancer in the last five years are still alive, making breast cancer the most prevalent cancer worldwide. The International Agency for Research on Cancer (IARC) estimated that 292,677cases of cancer were newly diagnosed among the female population in EMR during 2012, and176, 139 died of the disease [8].In Iraq, breast cancer is the commonest type of female malignancy, accounting for approximately one - third of the registered female cancers according to the Iraqi Cancer Registry [9].This shows that the breast is the leading cancer site among the Iraqi population in general, surpassing even bronchogenic cancer The latest Iraqi Cancer Registry [10] revealed that among an estimated population size of 32,500,000, a total of 21,101 new cases of cancer were registered in 2012 about 9,268 were in men and Introduction (11, 833) were women [11]. The crude incidence of all cancers was 61.69 per 100,000 (53.31 in men and 70.59 in women). During that year, 4,115 Cases of breast cancer were reported, accounting for 19.5% of all newly diagnosed malignancies and 34% of the registered female cancers, with an incidence approximating 22 per 100,000 female populations. As proposed by the World Health Organization, early detection and screening, especially when combined with adequate therapy, offer the most immediate hope for a reduction in breast cancer mortality [11].Rationale : It is the most commonly diagnosed malignancy among the Iraqi population in general constituting about one third of the registered female cancers and the leading cause of death from malignant neoplasm among women [9]

تحليل حمل اداء الارومة الغاذية في مستشفى بغداد التعليمي == Analysis of Gestational Trophoblastic Disease in Baghdad Teaching Hospital

اسم المؤلف: حنان جواد كاظم
اسم المشرف: رغد عبد الحليم
الموضوع العام: الطب
السنة: 2014
الموضوع الدقيق: النسائية والتوليد
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Gestational trophoblastic diseases (GTD) are important and interesting part of gynecological oncology. Women diagnosed with GTD should be counseled that about 8% become malignant and GTN is a significant cause of morbidity, loss of fertility and, rarely, mortality in young women. All form of GTD produce B - hCG and monitoring this hormone is an accurate biomarker for screening, diagnosis, therapeutic response and follow up.(1) Objectives : To analyze and determine the types, complications, management and outcomes of gestational trophoblastic disease (GTD) and those with irregular follow - up in Baghdad Teaching Hospital through an observational descriptive based approach.Study design : Observational descriptive study Setting : Department of Obstetrics and Gynecology, Baghdad Teaching Hospital - Medical City, Baghdad, Iraq. Patients and methods : During the period from January 2013 to January 2014, (60) patients admitted to our hospital were diagnosed and registered to have GTD on the basis of histopathological report, were included in this study. During this period, analysis of patients′ data was done regarding their age, residence, parity, blood group, type of molar pregnancy, 1st clinical presentation, percentage of patients who developed persistent GTD and needed further management with chemotherapy and follow up, their outcome (remission, complications, lost to follow up), history of prior molar pregnancy, then complete medical and gynecological examination was done for each case. All patients were followed up by serial B - hCG titer according to WHO protocol except those who were lost to follow up. Each patient has a hand book in which her complete information about her condition is documented.Results : Thirty six patients out of 60 (60%) developed persistent gestational trophoblastic disease received chemotherapy, 20 patients (55.5%) out of those 36 patients required only single - agent chemotherapy (methotrexate). 12 patients (33.3%) required single then shifted to multi - agent chemotherapy while only 4 patients (11.1%) were required multi - agent chemotherapy since diagnosis, all 36 patients got complete remission after having their risk scoring system. Six cases (10%) got spontaneous remission following evacuation, while 18 patients (30%) had irregular or lost to follow up and presented later on with different presentation, One patient present with heavy vaginal bleeding and on examination and investigation cervical growth was diagnosed then hysterectomy was done followed by chemotherapy and got remission. Three patients presented with metastasis, one to the liver, another to the lung and both of them received multi - agent chemotherapy at oncology unite and got remission. Another one presented with advanced stage pulmonary metastasis and she unfortunately died due to adult respiratory distress syndrome and respiratory failure. Another patient presented many months later with heavy vaginal bleeding and large uterine size, also she died soon after admission. The results were established from the obtained data and then comparison was donewith other studies, two cases out of 18 died due to their neglection to our medical appropriate management and irregular follow up and presented later with advanced stage.Conclusion : The high proportion of GTD was in age group 15 - 25 years old, rural area, multiparity, blood group O, house wives. Complete molar pregnancy was the most common type of GTD in our study. Most of patients with irregular follow up are multiparous, from rural area, blood group A and below 18 years old.Chemotherapy is effective in treatment of persistent GTD. The management of gestational trophoblast disease in our hospital not differs from that protocol found in other centers in the world, However, Follow up of patients is the real problem for both patients and doctors because no special centers for GTD and no registration to a patients in proper way and poor knowledge and education of our population regarding this disease.

دراسة المضاعفات التنفسية من المرضى الذين يعانون من الاورام الخبيثة الدموية بعد العلاج الادوية السمة للخلايا في مستشفى بغداد التعليمي == Study of Respiratory Complications of Patients with Hematological Malignancies Following Cytotoxic Drugs Therapy in Baghdad Teaching Hospital

اسم المؤلف: مهند حسن جابر
اسم المشرف: عدنان الجبوري
الموضوع العام: الطب
السنة: 2014
الموضوع الدقيق: الطب النفسي
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: Hematological malignancies include lymphoblastic which divided into acute lymphoblastic leukemia is the commonest cancer in children andchronic lymphoblastic leukemia , myeloid leukemia also, acute and chronic , Hodgkin and non Hodgkin lymphoma and multiple myeloma all of these malignancies given cytotoxic drugs and most cytotoxic drugs cause pulmonary toxicity .Aim of study : To assess the respiratory complications following treatment with cytotoxic drugs in patients with hematological malignancies .Patients and method : A hospital based prospective study conducted between first of October 2015 to first of July 2016 in Baghdad teaching hospital hematology unit including 50 patients 25 male and 25 female .Patients information include their age ,sex, residence ,job address and smoking history name of hematological disease, type and duration of cytotoxic drug given.Inclusion criteria : 1 - All patients took chemotherapy mention name of drug , dose and duration of treatment.2 - All patients not have any respiratory signs or symptoms before taking chemotherapy but after took it will develop respiratory disease took the most common symptoms in respiratory disease which include cough ,shortness of breath, chest pain and hemoptysis.3 - All patient in our research have chest x - ray and CT scan findings All patients have oxygen saturation measurement by pulse oximeter .Exclusion criteria : - Exclude any patient have respiratory disease before taking cytotoxic drugs.Results : A total of 50 patients with diagnosis of respiratory disease after taking cytotoxic enrolled in study the mean age of patients was 39.7±18.2 years ( range 16 - 75 years) male to female ratio was 1 : 1 all these patients take cytotoxic drugs for treatment of their malignancies and develop respiratory signs and symptoms , we found that NHL was the most common malignancy in 17 (34%) patients and cytarabin was the most common cytotoxic drug use and cause respiratory complication, the most common respiratory symptom was shortness of breath in 44 patients , right lower zone most common site affected in 22 patients and patch was the commonest lesion in 26 patients, streptococcus viridance was the most significant microorganism in 11(22%) patients and we found only chest pain was significantly associated with deteriorated outcome (P <0.05).The Conclusion : We conclude from this study the following : - most of bacterial infection in hematological diseased patients causedby streptococcus viridance pneumonia were affect 11 patients (22.0%)from all 50 patients and induced by cytotoxic drugs and is the mostcommon cause for mortality and need careful monitoring and follow - up. - invasive fungal infection mostly caused by aspergillus fumigatus werefound in 4 patients and Candida albicans were also, found in 4 patientsand need careful monitoring . - also conclude from this study that pnemocystic jiroveci can affect hematological diseased patients which is found in one patients (2.00%) from 19 patients do cultures for them.

كثافة العظم المعدنية لدى المرضى العراقيين المصابين بسرطان الثدي == Bone Mineral Density inIraqi Patients with Breast Cancer

اسم المؤلف: رسل حاكم رحيم
اسم المشرف: زياد شفيق الراوي | فائق ايشو كوريال
الموضوع العام: الطب
السنة: 2014
الموضوع الدقيق: الامراض - المفاصل
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: ان كثافة العظم المعدنية هي معيار قياسي لتشخيص هشاشة العظام وتقدير خطر الكسر. وان مرض سرطان الثدي بحد ذاته قد يزيد من نشاط الخلايا الهادمة للعظم وبالتالي يعزز من انحلال العظم.الهدف : تقييم كثافة العظم المعدنية لدى المرضى العراقيين المصابين بسرطان الثدي.المرضى ومنهاج البحث : شملت هذه الدراسة (100) مريض عراقي مصاب بسرطان الثدي (99 امراة ورجل واحد فقط) ممن تم تشخيصهم استنادا الى الفحص السريري وتصوير الثدي والفحص الخلوي.تم ملئ استمارة استبانة لكل مريض تتكون من معلومات خاصة بالمريض ومعلومات خاصة بسرطان الثدي وتم عمل تقدير لخطر الكسر باستخدام اداة الفراكسوقياس قابلية حركة المفاصل كما تم عمل الفحوصات الاتية لكل مريض : نسبة الكالسيوم والفوسفوروالالكالاين فوسفاتيز وهورمون الباراثايرويد في الدم وكذلك قياس نسبة ترسيب كريات الدم الحمرو البروتين التفاعلي سيبالاضافة الى صورة الدم الكاملة.كما تم قياس كثافة العظم المعدنية باستخدام جهاز ال دكساللعمود الفقري القطني وعظم الفخذ الايمن . وتم تحليل كافة المعطيات باستعمال متعدد الانحدار اللوجستي (النمط الثنائي).النتائج : في عنق الفخذ : كانت نسبة المصابين بقلة العظام 29% ونسبة المصابين بهشاشة العظام 23% ، وفي العمود الفقري القطني 39% من المرضى كان لديهم قلة العظام و26% كان لديهم هشاشة العظام.ان العمر المتقدم للمريضة والعمر المتقدم عند انقطاع الطمث وارتفاع نتيجة اداة تقييم خطر الكسر فراكس وارتفاع نسبة البروتين التفاعلي سي في الدم كانت عوامل معتدة احصائيا لتوقع انخفاض كثافة العظم المعدنية في العمود الفقري القطني ، كما ان العمر المتقدم للمريض والعمر المبكر عند انقطاع الطمث وزيادة قابلية حركة المفاصل وارتفاع نتيجة فراكس كانت عوامل معتدة احصائيا لتوقع انخفاض كثافة العظم المعدنية في عنق الفخذ.الاستنتاجات : ازدياد نسبة انخفاض كثافة العظم المعدنية لدى المرضى العراقيين الناجين من سرطان الثدي . وان التقدم بالسن للمرضى وارتفاع نتيجة اداة تقييم خطر الكسر فراكس وزيادة قابلية حركة المفاصل وارتفاع نسبة البروتين التفاعلي سي في الدم كانت عوامل مشاركة هامة لانخفاض كثافة العظم لدى المرضى في حين كان العمر المتقدم عند انقطاع الطمث للمريضات عاملا وقائيا | Bone mineral density is a standard measure for the diagnosis of osteoporosis and assessment of fracture risk. Breast cancer itself may increase Osteoclastic activity and subsequently enhancing bone resorption.ObjectiveTo assess bone mineral density (BMD) in Iraqi patients with breast cancer.Patients and methodsA total of (100) Iraqi patients with breast cancer (99 females & 1male) diagnosed according to clinical examination, breast imaging, and cytological examination were included in the study. A questionnaire form consisted of personal Data, breast cancer related data, fracture risk assessment using the FRAX tool and joint mobility. Complete blood picture, erythrocyte sedimentation rate (ESR), C - reactive protein, serum calcium, serum phosphorus, serum alkaline phosphatase, and parathyroid hormone were done for each patient.BMD was measured using dual X - ray absorptiometry (DXA) machine at lumbar spine and right femur. All data were analyzed in the multiple logistic regression (binary) model.ResultsAt the right femur neck, the prevalence of osteopenia was 29% and that of Osteoporosis was 23% , whilst at lumbar spine, osteopenia was recorded in 39% and osteoporosis in 26% of patients .Old age patients, early age at menopause, FRAX score & increase CRP were significant predictors for low BMD at the spine.Also, patient's age, early age at menopause ,increased joint mobility Score & FRAX score were significant predictors for low BMD at femur neck.ConclusionsLow BMD was high in Iraqi breast cancer survivors. Older age females, high FRAX score, increased joint mobility score and increased levels of CRP were significant associates with low BMD, while advanced age at menopause was protective for low BMD.

المظاهر العينية لدى عينة من المرضى العراقيين المصابين بالتهاب الفقار المقسط == Ocular manifestations in a sample of Iraqi patients with Ankylosing Spondylitis

اسم المؤلف: سها كامل خيرالله
اسم المشرف: خضير زغير معيوف البدري | نجاح كاظم القريشي
الموضوع العام: الطب
السنة: 2014
الموضوع الدقيق: الامراض - المفاصل
الدرجة: دبلوم عالي
اللغة: الانكليزية
مكان الجامعة: بغداد
الصفحات الاولى:
المستخلص: الخلفية : التهاب الفقار المقسط مرض التهابي مزمن مترق يؤثر في المقام الاول على الهيكل المحوري، وبشكل اقل على المفاصل المحيطية بالاضافة الى الاعضاء غير المفصلية الاخرى كالعينين والجلد والجهاز القلبي الوعائي.اكثر المظاهر غير المفصلية شيوعا هي تلك التي تصيب العين.الهدف : تقييم الاكتشافات العينية لدى عينة من المرضى العراقيين المصابين بالتهاب الفقار المقسط.المرضى والطرائق : شملت الدراسة المقطعية (200) مريضا مصابا بالتهاب الفقار المقسط، جميعهم مشخصين حسب معايير نيويورك المعدلة لالتهاب الفقار المقسط.تم استبعاد المرضى المصابين بداء السكري، فرط ضغط الدم، امراض الغدة الدرقية، او تراكب مع داء مناعة ذاتية اخر، المرضى الذين تعاطوا سابقا عقاقير الستيرويد، او الذين يتعاطون حاليا عقار السلفاسالازين ((sulphasalazine او العقاقير المضادة لعامل نخر الورم ((TNF، والذين لديهم عدوى سابقة او رضح في العين.تم جمع بيانات المرضى الديموغرافية والسريرية كالعمر والجنس ووجود اكتناف الهيكل المحوري والمفاصل المحيطية والتهابات الارتكاز، كذلك مدة المرض، وجود اعراض حالية في العين، وجود سوابق عائلية للاصابة بالتهاب الفقار المقسط ومؤشر نشاط مرض التهاب الفقار المقسط لباث (BASDAI).تم اجراء فحص مستضد الكريات البيضاء البشري HLA - B27)) لجميع المرضى، كما جميعهم تم فحصهم من قبل طبيب عيون مختص.النتائج : شمل البحث 200 مريضا عراقيا مصابا بالتهاب الفقار المقسط، كان معدل العمر(35,2±8,6) سنة ونسبة الذكور للاناث (13,3 : 1) ومتوسط مدة المرض (10,9± 6,7) سنة. وجدت سوابق عائلية للاصابة بالتهاب الفقار المقسط في (26%) من المرضى، ومستضد الكريات البيضاء البشري HLA - B27)) تم استحصاله في (69,5%) من العدد الكلي للمرضى، بينما لم يتم استحصاله في (30,5%) منهم. ان مستضد الكريات البيضاء البشري HLA - B27)) كان ايجابيا في (43,2%) وسلبيا في (56,8%) من المرضى الذين تم استحصال نتيحة تحليل مستنضد الكريات البيضاء البشري HLA - B27)) لديهم.كانت التهابات الارتكاز موجودة في (48%) من المرضى، اما التهابات المفاصل المحيطية فكانت موجودة في (63,5%) منهم.اظهرت الدراسة ان المظاهر العينية موجودة في (21,5%) من المرضى من ضمنها التهاب العنبية الامامي بنسبة (14,5%)، التهاب الملتحمة بنسبة (3%)، جفاف العين بنسبة (2%) والساد بنسبة (2%).كما اظهرت الدراسة وجود ترابط معتد به بين المظاهر العينية مع كل من التهابات الارتكاز، التهابات المفاصل المحيطية، مستضد الكريات البيضاء البشري HLA - B27))، ووجود سوابق عائلية للاصابة بالتهاب الفقار المقسط، بينما لم تظهر وجود ترابط معتد به مع العمر، الجنس، مدة المرض ومؤشر نشاط مرض التهاب الفقار المقسط لباث (BASDAI).الاستنتاجات : ان معدل انتشار المظاهر العينية لدى عينة من المرضى العراقيين المصابين بالتهاب الفقار المقسط بلغت (21,5%). كان اكثرها شيوعا هو التهاب العنبية الامامي. الانواع الاخرى تضمنت التهاب الملتحمة، جفاف العين، والساد.كما اظهرت الدراسة وجود ترابط معتد به بين المظاهر العينية مع كل من التهابات الارتكاز، التهابات المفاصل المحيطية، مستضد الكريات البيضاء البشري HLA - B27))، ووجود سوابق عائلية للاصابة بالتهاب الفقار المقسط ، مع عدم وجود ترابط معتد به مع العمر، الجنس، مدة المرض ونشاطه. | Background : Ankylosing spondylitis (AS) is a chronic, progressive inflammatory disease that affects primarily the axial skeleton and less frequently the peripheral joints as well as extra - articular organs such as the eyes, skin, and cardiovascular system.The most common extra - articular manifestations of ankylosing spondylitis are represented by ocular manifestations.Objective : To evaluate the ocular findings in a sample of Iraqi patients with ankylosing spondylitis.Patients and methods : A cross sectional study was conducted on (200) AS patients, all were diagnosed according to the modified New York criteria for ankylosing spondylitis. Patients who had diabetes mellitus, hypertension, thyroid disease, or an overlap with other autoimmune diseases, those who received steroids, or currently on sulphasalazine or anti TNF alpha drugs, and those who had history of infection or trauma to the eye were excluded.Demographic and clinical data were collected including age, sex, presence of axial, peripheral involvement and enthesitis, duration of disease, presence of eye symptoms, family history of ankylosing spondylitis, and Bath ankylosing spondylitis disease activity index (BASDAI) score.All patients underwent HLA - B27 testing and were examined by an ophthalmologist. Results : A total of 200 Iraqi patients with ankylosing spondylitis (AS) were enrolled in this study, the mean age was (35.2 ± 8.6) years, male to female ratio (13.3 : 1), and mean disease duration was (10.9 ± 6.7) years.Family history of AS was positive in (26%) of patients. HLA - B27 was obtained in (69.5%) of the total number of the patients, and could not obtained in (30.5%) of patients. Among those patients in whom HLA - B27 test was obtained, (43.2%) had positive HLA - B27 and (56.8%) had negative HLA - B27. Enthesitis was found in (48%) of patients, and (63.5%) had peripheral arthritis. Ocular manifestations were found in (21.5%) of the patients in the form of anterior uveitis (14.5%), conjunctivitis (3%), ocular dryness (2%), and cataract (2%).The study revealed a significant correlation between ocular manifestations with each of enthesitis, peripheral arthritis, HLA - B27 positivity and positive family history of AS, but did not reveal a significant correlation with age, sex, disease duration and BASDAI.Conclusions : The prevalence of ocular manifestations in a sample of Iraqi patients with ankylosing spondylitis was (21.5%). The commonest form was anterior uveitis. Other forms included conjunctivitis, ocular dryness, and cataract.Ocular manifestations had significant correlation with enthesitis, peripheral arthritis, HLA - B27 positivity and positive family history of AS, but not with age, sex, disease duration and disease activity.
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