First pages:

دراسة معدل انتشار التدرن الكامن في سجن اصلاح الكبار في محافظة بابل == Prevalence of Latent Tuberculosis in Hilla Male Prison

Author name: مرتضى نجاح جواد

Supervisor name: قاسم محمد سلطان

General topic: Medicine

Specific topic: Diseases - Thoracic

Degree: Higher Diploma

University: University of Baghdad - Faculty Of Medicine

Language: English

University location: Baghdad

First pages:

Abstract: Background : Tuberculosis (TB) is one of the oldest diseases known toaffect humans, it caused by infection with Mycobacterium Tuberculosis(M.TB). M.TB is most commonly transmitted from a patient withinfectious pulmonary TB to other person by droplet nuclei .prisoners areexposed to a variety of infections, including TB. the standard test fordetecting Latent TB infection (LTBI) is tuberculin skin test (TST).Objectives : determination the prevalence of latent tuberculosis amongAL - Hilla male prisoners .and Assessing its correlations with various riskfactors.Methods : A stratified random sampling technique was used to select asample of 120 male prisoners aged >20years old from the AL - Hillaprison. The selected inmates were interviewed using a structured pretestedquestionnaire,5 units of PPD(0.1mL) had been injectedintradermally to the volar surface of forearm to be seen within 48 - 72hours. The test was considered positive if ( >=10mm induration)developed.Results : The study shows the rate of tuberculin reactivity amongprisoners is 23.3% (28/120). A significant relationship between age ofprisoner, mean area of accommodation per prisoner in the prison and TSTpositivity. The overall mean age of prisoners was (34.43± 12.70) yearsold and (47.5%) of the prisoners was aged between 20 - 30 years. Majority(77.5%) of the prisoners were living in urban area. (57.5%) of theprisoners were married. The alliterated prisoners were(53.3%). selfemployedprisoners were(61.7%). (53.3%) of prisoners had monthlyincome between 500 000 - 1 Million IQD. (39.2%) of prisoners spent oneyear of their prison period .The prevalence of smokers were(76.7%) andVIIonly (14.2%) of prisoners had contact with TB patients, meanwhile,(6.7%) of prisoners had contact with TB patients in prisons. Theprisoners had BCG vaccine signs were (74.2%).the prisoners who did notshare their house holding were (57.5%). The overall mean prisoners BMIwas (22.21± 3.19) kg/m2. The mean space of each cell in prison was(120.67± 85.38) m2, meanwhile the mean prisoners per each cell was(43.07± 17.72).So space of each prisoner approximately is : 2.8 m2 .Conclusion : significant relationship between age, area of accommodationfor each prisoner inside cell and positivity of TST.

تقييم كهروتشخيصي لمرضى اعتلال جذور الاعصاب العنقية == ELECTRODIAGNOSTIC ASSESSMENT IN PATIENTS WITH CERVICAL RADICULOPATHY

Author name: زينه سليم فخري

Supervisor name: نجيب محمد | احسان محمد

General topic: Medicine

Specific topic: Physiology

Degree: Doctorate

University: University of Baghdad - Faculty Of Medicine

Language: English

University location: Baghdad

First pages:

Abstract: Cervical radiculopathy can be defined as pain in a radicular pattern in one or both upper extremities related to compression and/or irritation of one or more cervical nerve roots. In the electrodiagnostic laboratory, various types of electrodiagnostic studies may be considered when evaluating a patient for cervical radiculopathy. Potential tests including (needle electromyography, motor and sensory nerve conduction studies, late responses, and somatosensory evoked potentials) serves to confirm the presence of radiculopathy, establish the involved nerve root level, determine if axon loss or conduction block is present, grade the severity of the process, estimate the age of the radiculopathy and exclude other peripheral nerve diseases that mimic radiculopathy.The aim of this study was to approve the usefulness of the electrodiagnostic studies (NCS, EMG and SSEP) in the diagnosis of cervical radiculopathy, asses the role and accuracy of the SSEP test (specifically spinal N13 component) in the diagnosis of cervical radiculopathy, identify the extent and distribution of cervical paraspinal muscles denervation in cervical radiculopathy and match the electrodiagnostic results with imaging data in the localization of the root lesion involved.This is case control study had been conducted during the period from April 2016 to October 2017. Ninety five (95) patients with cervical radiculopathy with a mean age of (48.4±11) years and twenty six (26) healthy control subjects with a mean age of (45.2±10.1) years involved in the study. Each subject submitted for medical history, clinical examination and electrophysiological study using Nicolete Viking Quest , EMG, NCS, EP measuring system.XIIFor SNCS, Onset latency, SNAP amplitude and conduction velocity, while for MNCS, distal motor latency, CMAP amplitude and conduction velocity, in addition to the minimal F wave latency (that assess the late response) of median and ulnar nerves are performed.Whereas for right and left sides median nerve SSEP test, the following peak and interpeak latencies (1) N9; (2) N13; (3) N20; (4) N9 - N20; (5) N9 - N13 ; (6) N13 - N20 are measured.Concerning the needle EMG, the following parameters; insertional activity, spontaneous activity and motor units action potential characteristics (duration and phases) of the right and left trapezius, rhomboids major, deltoid, biceps, triceps, extensor indicis and first dorsal interosseous muscles are considered and recorded. In addition to the assessment of the spontaneous activity of the cervical paraspinal muscles.The results of this study revealed that there are significant differences; higher values for the patients when compared with that of control groups regarding Rt and Lt sides N13 peak latency, N9 - N13 and N13 - N20 inter - peak latency. Moreover, the sensitivity of SSEP components in comparison with the MRI (as a gold standard) is the higher for that of spinal N13.From the EMG and MRI findings, C6 and C7 cervical roots are the most roots affected in respect to C5, C8 or C4 roots.Consequently, there are mismatching in the percentages of cervical radiculopathies when diagnosed by the MRI of the cervical spine, needle EMG of the upper limbs muscles and that of the cervical paraspinal muscles, in such a way that Rt C7 radiculopathy 71.6% by cervical spine MRI mismatched with that of upper limbs EMG (66.3%) and 5.3% by the cervical paraspinal muscles.However, the percentages of each level of cervical radiculopathy proved to be higher by the combination of the EMG abnormaities of the cervical paraspinalXIIImuscles with that of the upper limbs muscles than by using the EMG of the paraspinal muscles or upper limbs muscles in an isolation (for Rt C6 radiculopathy 4.2% by paraspinal muscles EMG, 66.3% by upper limb and 68.4% by combination.Furthermore, the sensitivity of the EMG in cervical radiculopathy (using the MRI as a gold standard) increases by the combination of the abnormalities of the cervical paraspinal muscles with that of the upper limbs muscles, for example the sensitivity of Lt C6 radiculopathies 89.9% by upper limbs EMG, 93.2% by the combination of the EMG of PSM with that of the upper limbs muscles.In conclusion, traditional electrodiagnostic tests (NCS, EMG and SSEP) proved to be useful and complementary to the clinical examination in the evaluation of patients with cervical radiculopathy. The benefit of SSEP test for the evaluation of radiculopathies is based on the fact that signs and symptoms in radiculopathies can usually be related to injury of the afferent fibers and the SSEP test can monitor injury to these fibers.In addition to, spinal N13 is a sensitive technique suitable for detecting early and mild symptomatic cervical nerve root lesion.Moreover, cervical paraspinal muscles EMG is complementary to the upper limbs muscles EMG since that significant percentages of cervical radiculopathy will be missed if the examination of PSM is not part of the electrodiagnostic evaluation of patients with suspected radiculopathy. Furthermore, the sensitivity of the needle EMG is increased by the combination of the EMG of the paraspinal muscles with that of the upper limbs muscles, without paraspinal muscles needle EMG the screen of cervical radiculopathy misses much of its sensitivity. Finally, EMG and MRI are valuable and complementary diagnostic tools in the localization and extent of the cervical roots lesion.

Author name: زياد طارق ملغوث

Supervisor name: قاسم محمد سلطان

General topic: Medicine

Specific topic: Diseases - Thoracic

Degree: Higher Diploma

University: University of Baghdad - Faculty Of Medicine

Language: English

University location: Baghdad

First pages:

الاستكشاف السريع للاسترواح الصدري بواسطة جهاز السونار في المريض المتعدد الاصابات == Rapid detection of pneumothorax by Ultrasonography in patient with multiple traumas

Author name: فاضل خليفة موسى

Supervisor name: قصي عبد فهد

General topic: Medicine

Specific topic: Diagnostic Radiology

Degree: Master

University: University of Baghdad - Faculty Of Medicine

Language: English

University location: Baghdad

First pages:

Abstract: الغرض من الدراسة هو لمعرفة قابلية طبيب الاشعة لاستكشاف الاسترواح الصدري في مرضى الاصابات المتعددة والطارئة في شعبة الطوارئ في جهاز السونار ومقارنة النتائج مع نتائج المفراس. تم البحث خلال فترة عشرة اشهر وتم اجراء فحص السونار الى 37 مصاب على شكل 30 (81%) منهم رجال و7(19%) نساء وباعمار تتراواح مابين 30 - 50 سنة. واظهرت النتائج انه يمكن فحص المرضى ذوات الاصابات المتعددة بجهاز سونار الطوارئ ومعرفة وجود الاسترواح الصدري حيث اظهرت النتائج ان دقة الكشف تتناسب مع كمية الهواء الموجود داخل غشاء الجنب. حيث كلمزاادت الكمية زادت قابلية الكشف وبتناسب طردي. الغرض من هذا البحث هو امكانية الاستغناء عن المفراس لبحلزوني واشعة الصدر في الكشف عن الاسترواح الصدري وخاص في الكميات المتوسطة والكبيرة من الهواء. | Early detection of pneumothorax in multiple trauma patients is critically important. It can be argued that the efficacy of ultrasonography (US) for detection of pneumothorax is enhanced if it is performed and interpreted directly by the clinician in charge of the patients.The aim of this study was to assess the ability of clinician to perform bedside US to detect and assess the size of the pneumothorax in patients with multiple trauma.MethodsOver a 10 month period, patients with multiple traumas treated in the emergency department were enrolled in this prospective study. Bedside US was performed in emergency department.Portable supine chest radiography (CXR) and computed tomography (CT) were obtained within an interval of three hours. Using CT and chest drain as the gold standard, the diagnostic efficacy of US and CXR for the detection of pneumothorax, defined as rapidity and accuracy (sensitivity, specificity, positive predictive value, negative predictive value), were compared. The size of the pneumothorax (small, medium and large) determined by US was also compared to that determined by CT.Results : The study included 37 patients 30 (81%) of them were males and 7 (19%) were females.The average age was 42 ± 11.6 years. All patients presented trauma, including explosives and missiles injuries (37.8%) RTA (24.3%), falls (16.2%), and others (21.6%).Out of the 37 trauma patients, 32 did had pneumothorax according to the gold standard (CT scanning) and five patients did not, according to the ultrasonography findings of those patients, 30 patients did had pneumothorax (true positive) and 2 patients missed by ultrasonography, while 5 patients did not have pneumothorax on CT, ultrasound correctly identify 4 of them as negative (true negative), so the sensitivity and specificity and accuracy of ultrasonography were 93.7%, 80% and 92% respectively.The size of pneumothorax which had been determined by ultrasonography (17) patient had identified as large pneumothorax, (9) patients as moderate and (4) patients as mild, while CT findings were (17,9 and 6) respectively, when a kappa agreement test had been performed, it had been significantly found that US agreement with the CT was directly associated with the size of pneumothorax, US has more agreement, more sensitivity and more specificity in large and moderate pneumothorax rather than mild pneumothorax in trauma patients, P< 0.05.Conclusion My US examination provides a reliable tool and has the advantages of being simple and rapid as compared with CT and CXR and having high sensitivity as compared to CXR for the detection of pneumothorax in patients with multiple trauma.

Author name: سارة محمد نجيب

Supervisor name: محمد هادي العصامي

General topic: Medicine

Specific topic: Diseases - Joints

Degree: Higher Diploma

University: University of Baghdad - Faculty Of Medicine

Language: English

University location: Baghdad

First pages:

دراسة فاعلية وسلامة التغيرات المختبرية ومعلمات التنبؤ للاستجابه لعقار الادالموماب في علاج عينة من المرضى العراقيين المصايين بمرض التهاب المفاصل الرماتويدي == Efficacy, Safety of Laboratory Changes and Predictors of Response to Adalimumab in Treatment of Patients with Active Rheumatoid Arthritis

Author name: خالد عبد الحسن غضبان

Supervisor name: خضير زغير معيوف البدري

General topic: Medicine

Specific topic: Diseases - Joints

Degree: Higher Diploma

University: University of Baghdad - Faculty Of Medicine

Language: English

University location: Baghdad

First pages:

Abstract: Background : Advances in the treatment of rheumatoid arthritis in recent years have profoundly muted the destructive potential of this disease. The safety profile of methotrexate has made earlier treatment possible, and biologic therapies have opened the door to combination rather than sequential therapy, with the result that treatment recommendations now aim for disease remission Objective : To evaluate the safety and efficacy and predictors of response to Adalimumab in the treatment of rhueumatoid arthritis.Patients and methods : Open labeled single group clinical trial was conducted on patients with an established diagnosis of rheumatoid arthritis who visited the Rheumatology Clinic in Baghdad Teaching Hospital from Oct. 2014 to March 2016 (17 months period).To be included, the patient should meet the 1987 American College of Rheumatology criteria for the classification of RA and the revised 2010 ACR criteria and the patients should have DAS28 score greater than or equal to 3.3(moderate - severe disease acvtivity).111 patients with RA were identified. However, only 64 patients met the inclusion/ exclusion criteria. Patients were given adalimumab (40mg) subcutaneously every other week from the start of the study to its end. For each patient, baseline data were collected during the first visit and all the participants werefollowed for six months, during which each patient was seen at monthly intervals. Demographic and clinical data were collected including age, sex, smoking history, duration of disease, history of steroids , DMARDS or other biologic treatment.Results : The age ranged between 20 and 62 years. Females constituted 87.5% of the study sample with a 7 to 1 female to male ratio. Only 4.7% were current smokers.One third (34.4%) of study subjects gave a history of past use of biologic agents, Another third (31.3%) used DMARDS &steroids were used by 67.2% of study participants. 3/4 of study subjects were classified as highly active disease (DAS28>5.1), while The remainingsubjects were classified as moderate disease activity (DAS28 3.3 to 5.1). At the end of 6 months of treatment, only 20% remained in the highly active disease category. (60%) of study subjects has shifted to the moderate disease activity category. A small proportion of study subjects (12%) are now classified as low disease activity and another 8% are in remission. (73.3%) experienced a significant reduction in DAS28 score (1.2 units or more). Another 5% experienced a smaller magnitude of treatment response, which was classified as moderate improvement. The remaining 21.7% of the treated cohort showed no improvement in DAS28 score compared to its pretreatment level (<0.6 units of reduction). Male gender, steroids and DMARDS increase the chance of having favorable response to treatment and achieving low disease activity while only steroids use have this favorable effect on achieving remission as a target and no factor affect the outcome of having significant reduction in DAS28.Hemoglobin and WBC count showed a statistically significant decrease after the full six months of treatment. Hb reduced by a mean of 0.8 gm/dl and the WBC count experienced a mean reduction of 939 x 106/mm3. In addition, both serum AST and ALT showed a statistically significant increase by a mean of 6.5 and 4.4 U/L respectively after six months of treatment. The remaining renal function tests parameters showed no important or statistically significant change after the full six months of treatment.Conclusions : Adalimumab is effective and relatively safe and well tolerated in treatment of RA patients.Male gender, steroids And DMARDS increase the chance of having favorable response to treatment and achieving low disease activity while only steroids use have this favorable effect on achieving remission as a target and no factor affect the outcome of having significant reduction in DAS28

المستويات المصلية للكلكتين - 4 وللمستقبل شبيه التول - 2 في النساء المصابات باورام الثدي == SERUM LEVELS OF GALECTIN - 4 AND TOLL - LIKE RECEPTOR - 2 (TLR - 2) IN WOMEN WITH BREAST TUMOR

Author name: هند حامد عبد العامري

Supervisor name: عائدة رشيد منصور الدرزي

General topic: Medicine

Specific topic: Microbiology

Degree: Master

University: University of Baghdad - Faculty Of Medicine

Language: English

University location: Baghdad

First pages:

Abstract: اشتملت هذه الدراسة على 30 مريضة مصابة بسرطان الثدي, وذات اعمار تتراوح مابين سبعة وعشرين سنة الى ستة وسبعين سنة, وبمتوسط عمر (11.8 50± ) سنة. وقد تم تشخيص هؤلاء المرضى سريريا وشعاعيا من قبل متخصصين, وقد كانوا من بين المرضى الذين حضروا للمركز الوطني للكشف المبكر عن الاورام - مدينة الطب /وزارة الصحة, خلال الفترة من تشرين الاول 2011 حتى شباط 2012.وتضمنت هذه الدراسة مجموعتا ضبط قياسية للمقارنة, المجموعة الاولى - مجموعة السيطرة المرضية لمريضات يعانون من ورم غدي ليفي حميد (الاورام الحميدة) وقد تم تشخيص هؤلاء المرضى ايضا سريريا وشعاعيا من قبل متخصصين, وقد كانوا من بين المرضى الذين حضروا للمركز الوطني للكشف المبكر عن الاورام - مدينة الطب /وزارة الصحة, خلال الفترة من تشرين الاول 2011 حتى شباط 2012., والمجموعة الثانية - مجموعة السيطرة الصحية والتي اشتملت على 20 امراة سليمة ظاهريا. وكشفت الدراسة عن النتائج الاتية : 1. اظهرت النتائج وجود فرق معنوي عالي جدا(P<0.001) في مستوى الكلكتين - 4 بين مرضى سرطان الثدي ومجموعة الضبط الصحية وحتى بين مجموعة السيطرة المرضية (الاورام الحميدة) ومجموعة السيطرة الصحية (P<0.001),ومع ذلك لم يكن هناك فروق ذات دلالة احصائية (P=0.92) بين المرضى ومجموعة السيطرة المرضية (الاورام الحميدة).لذلك لعدم وجود اختلافات ذات دلالة احصائية في القيم الوسيطية للكلكتين - 4 الموجود في المصل بين مرضى سرطان الثدي (الاورام الخبيثة) والمجموعة الضابطة (الاورام الحميدة), لذلك يمكن للمرء التعامل مع حالات اورام الثدي بشكل عام فيما يتعلق بالكلكتين - 4 الموجود في الانسان.2. ايضا هذه الدراسة اظهرت وجود فرق معنوي عالي جدا(P<0.001) في مستوى المستقبل شبيه التول - 2 بين مرضى سرطان الثدي ومجموعة الضبط الصحية وحتى بين مجموعة السيطرة المرضية (الاورام الحميدة) ومجموعة السيطرة الصحية (P<0.001) ومع ذلك لم يكن هناك فروق معنوية ذات دلالة احصائية (P=0.44) بين المرضى ومجموعة السيطرة المرضية (الاورام الحميدة).لذلك لعدم وجود اختلافات معنوية ذات دلالة احصائية في القيم الوسيطية للمستقبل شبيه التول - 2الموجود في المصل بين مرضى سرطان الثدي (الاورام الخبيثة) والمجموعة الضابطة (الاورام الحميدة), لذلك يمكن للمرء التعامل مع حالات اورام الثدي بشكل عام فيما يتعلق بالمستقبل شبيه التول - 2 الموجود في الانسان.3. تمت دراسة القيمة التكهنية للكلكتين - 4 المفحوص لتقييم نفاذية هذا المعامل وقد تم اثبات امتلاكه لاعلى دقة (98.8)مع حساسية 100%بقيم ثبوتية قطعية ( 0.44نانوغرام/مليليتر; ( لذلك ظهور النتائج الموجبة عند هذه القيمة الثبوتية القطعية سوف يساعد للتوصل الى تشخيص مؤكد من قبل الطبيب في العيادة مع نسبة ثقة (95.2% ( في وقت ان التشخيص الاولي للورم يساوي 50%) احتمالية قبل الاختبار ) ومع نسبة ثقة في العيادة (99.4%) في وقت التشخيص الاولي (على اساس تاريخ الحالة والفحص) للورم بنسبة احتمالية عالية (90% احتمالية قبل الاختبار(.4. تمت دراسة القيمة التكهنية للمستقبل شبيه التول - 2 المفحوص لتقييم نفاذية هذا المعامل وقد تم اثبات امتلاكه لاعلى دقة (97.5)مع حساسية 100% بقيم ثبوتية قطعية ( 0.14 نانوغرام/مليليتر; (لذلك ظهور النتائج الموجبة عند هذه القيمة الثبوتية القطعية سوف يساعد للتوصل الى تشخيص مؤكد من قبل الطبيب في العيادة مع نسبة ثقة (90.9% ( في وقت ان التشخيص الاولي للورم يساوي 50%) احتمالية قبل الاختبار) ومع نسبة ثقة في العيادة (98.9%) في وقت التشخيص الاولي (على اساس تاريخ الحالة والفحص ) للورم بنسبة احتمالية عالية (90%احتمالية قبل الاختبار(.5. اوضحت هذه الدراسة ارتفاعا ملحوظا بمتوسط تركيز الكلكتين - 4 (0.895 نانوغرام/مليليتر) بين المرضى الذين قضوا مدة طويلة بالمرض (ثلاثة اشهر فمافوق) بالمقارنة مــــع المرضى حديثي الاصابة بالمرض (اقل من ثلاثة اشهر) بتركيز وسيطي (0.552 نانوغرام/مليليتر(ومع ذلك هذا الاختلاف لم يصل الى مستوى الدلالة الاحصائية (p=0.12 ( لذلك الملاحظة الاحصائية للعلاقة الخطية بين فترة المرض وارتفاع تركيز الكلكتين - 4 تعتبر ضعيفة (r=0.268, p=0.039).6. وقد لوحظ ايضا ارتفاعا ملحوظا بمتوسط تركيز المستقبل شبيه التول - 2(0.619نانوغرام/مليليتر) بين المرضى الذين قضوا مدة طويلة بالمرض (سنة فمافوق) بالمقارنة مع المرضى حديثي الاصابة بالمرض (اقل من ثلاثة اشهر) بتركيز وسيطي (0.343 نانوغرام/مليليتر( ومع ذلك هذا الاختلاف لم يصل الى مستوى الدلالة الاحصائية (p=0.049 ( لذلك الملاحظة الاحصائية للعلاقة الخطية بين فترة المرض وارتفاع تركيز الكلكتين - 4 تعتبر ضعيفة (r=0.16, p=0.22).7. كشفت هذه الدراسة وجودعلاقة ايجابية لكن ضعيفة وعلاقة احصائية خطية غير ملاحظة بين حجم الورم وتركيزالكلكتين - 4 فمقارنة بتصنيف حجم الورم والذي صنف حسب نتائج هذه الدراسة الى فئات, كان التركيز الوسيطي للكلكتين - 4 الموجود بمصل المرضى ذوي الحجم الفئة الرابعة (اعلى حجم) اعلى بوضوح (0.895 نانوغرام/مليليتر) مقارنة مـــــع (0.567 نانوغرام/مليليتر) ذوي الحجم الاول (اقل حجم). (r=0.046, p=0.76).8. اتضح وجود علاقة ايجابية لكن ضعيفة وعلاقة احصائية خطية غير ملاحظة بين حجم الورم وتركيز المستقبل شبيه التول - 2 فمقارنة بتصنيف حجم الورم والذي صنف حسب نتائج هذه الدراسة الى فئات, كان التركيز الوسيطي للمستقبل شبيه التول - 2الموجود بمصل المرضى ذوي الحجم الفئة الرابعة (اعلى حجم) اعلى بوضوح (0. 619 نانو غرام/مليليتر) مقارنة مع (0. 288 نانوغرام / مليليتر) ذوي الحجم الاول (اقل حجم). (r=0.145, p=0.34).9. واخيرا,تبين الدراسة الحالية عدم وجود فروق ذات دلالة احصائية في متوسط تركيز مصل الدم الحاوي كلا من الكلكتين - 4 والمستقبل شبيه التول - 2 للمرضى المصابين بسرطان الاقنية (الموضعي) والاخرون المصابين بالسرطان الارتشاحي (p =0.12, 0.64 على التوالي.( | Thirty patients with breast cancer were enrolled in this study, their ages ranged between (27 - 76) years; with the mean age was 50+ 11.8 years. Also, 30 patients with benign fibroadenoma as case control group their ages ranged between (19 - 52) years; with the mean age was 33.1+ 10.2 years. Those patients were diagnosed clinically, radiologically and cytologically and histopathologically by specialists, and they were among patients who attending the National Center For Early Detection Of Cancer - Medical City Complex / Ministry of Health, during the period from October 2011 to February 2012. Twenty apparently healthy subjects as a control group were included in the present study for comparison. Major findings of current study were the following : - 1. There was a statistical significant difference in the serum level of galectin - 4 between breast cancer patients and healthy control group (p > 0.001) and even between case control and healthy control groups (p>0.001), however , there was no statistical differences between patients and case control groups (p=0.92). Since no statistical significant differences in serum galectin - 4 median values between breast cancer patients (malignant tumors) and case control groups (benign tumors), therefore one can deal with breast tumor cases in general regarding serum galectin - 4.2. Also, The current study has been demonstrated that there was a statistical significant difference in the serum level of Toll like receptor - 2 between breast cancer patients and healthy control group (p > 0.001) and even between case control and healthy control groups (p >0.001), however, there was no statistical differences between patients and case control groups (p =0.44). Since no statistical significant differences in serum Toll like receptor - 2 median values between breast cancer patient (malignant tumors) and case control groups (benign tumors), therefore one can deal with breast tumor cases in general regarding serum Toll like receptor - 2 .3. The predictive value of the tested galectin - 4 to detect the validity of this parameter was studied since it had the highest accuracy (98.8) with sensitivity 100% within the cut off value (0.44ng/ml); therefore, testing positive at this cut - off value will establish a possible diagnosis of tumor with (95.2%) confidence in a clinical setting where the primary diagnosis of tumor had equal odds probability (50% pretest probability), and with (99.4% )confidence in a clinical setting where the primary diagnosis (based on history and examination) of tumor had a high probability (90% pretest probability).4. The predictive value of the tested Toll like receptor - 2 to detected the validity of this parameter was studied since it had the highest accuracy (97.5) with sensitivity 100% within the cut off value (0.14ng/ml); therefore, testing positive at this cut - off value will establish a possible diagnosis of tumor with (90.9%) confidence in a clinical setting where the primary diagnosis of tumor had equal odds probability (50% pretest probability), and with (98.9% )confidence in a clinical setting where the primary diagnosis (based on history and examination ) of tumor had a high probability (90% pretest probability).5. The median concentration of serum galectin - 4 was obviously higher (0.895 ng/ml) among those patients with average to long duration of disease (3months +) in comparison to those with very recent disease (> 3 months) and whose median concentration of galectin - 4 was (0.552 ng/ml). The difference observed failed to reach the level of statistical significance (p value= 0.12); however, there was a statistic significant weak positive linear correlation between disease duration and human galectin - 4 (r=0.268, p=0.039).6. The median concentration of serum Toll like receptor - 2 was obviously higher (0.619 ng/ml) among those patients with average to long duration of disease (1years +) in comparison to those with very recent disease ( > 3 months) and whose median concentration of Toll like receptor - 2 was (0.343 ng/ml). The difference observed failed to reach the level of statistical significance (p value= 0.049); however, there was a statistically non significant weak positive linear correlation between disease duration and serum Toll like receptor - 2 (r=0.16, p=0.22).7. Concerning tumor size categories, the median concentration of serum galectin - 4 was obviously higher (0. 895 ng/ ml) among those patients who were within the fourth (highest) quartile in comparison to those within the first (lowest) quartile (0 .567 ng /ml). There was a weak positive and statistically not significant linear correlation between tumor size and serum galectin - 4 concentration (r=0.046, p=0.76).8. Concerning tumor size categories, The median concentration of serum Toll like receptor - 2 was obviously higher (0.619 ng/ ml) among those patients who were within the fourth (highest) quartile in comparison to those within the first (lowest) quartile (0.288 ng /ml). There was a weak positive and statistically not significant linear correlation between tumor size and Toll like receptor - 2 concentration (r=0.145, p=0.34).9. For both (Galectin - 4 and Toll like receptor - 2) there were no statistical differences in serum median concentration between ductal carcinoma in situ and infiltrative carcinoma (p =0.12, 0.64 respectively)

انواع الرضاعة والاستجابة للعلاج الضوئي كعلاج للاطفال حديثي الولادة المصابين بمرض اليرقان الغير مباشر في المستشفيات التعليمية في بغداد == Types of Infant Feeding and Response to Phototherapy as a Treatment for Fullterm Newborns with Neonatal Indirect Hyperbilirubinemia in Tertiary Teaching Hospitals in Baghdad

Author name: شيماء خضير عباس

Supervisor name: احمد سمير النعيمي

General topic: Medicine

Specific topic: Family Medicine

Degree: Higher Diploma

University: University of Baghdad - Faculty Of Medicine

Language: English

University location: Baghdad

First pages:

Abstract: Background : Neonatal jaundice remains the most common and the most controversial problem in full - term newborns during the immediate postnatal period.Aim of the study : To assess the association between types of feeding and response to phototherapy in full - term infants with indirect hyperbilirubinemia.Method : In the period from the 25th of January to the 22th of July 2016, 120 full - term newborns admitted to the neonatal care unit in Tertiary Teaching Hospitals (Pediatric Teaching Hospital in medical city, AI - Imamein Al - Kadhimein medical city and Child Center Teaching Hospital) were studied by cohort study. The newborns diagnosed by pediatrician as cases of indirect hyperbilirubinemia and phototherapy started when TSB level>14.9 mg/dl. TSB was measured twice daily and phototherapy terminated when TSB level< 10.8 mg/dl. All infants were weighed at start and end of phototherapy. The duration of phototherapy had been recorded.Results : The infants divided into three groups according to type of feeding; group1, Breast - fed infants (n=37); group2, Formula - fed infants (n=51); group3, Mixed - fed infants (n=32).Phototherapy was highly effective in reducing serum bilirubin concentration in all of three groups but with a significant less efficacy for breast - fed neonates ( mean duration of phototherapy 32.2± 2.1 hrs) in comparison to mix - fed neonates (30.4 ± 2.5 hrs) and formula - fed neonates (29.9± 2.7 hrs).There was a weight loss during phototherapy. There was significant difference in the weight loss in the three groups, the more weight loss in breast - fed neonates than mixed - fed and formula - fed neonates. Conclusion and recommendations : Phototherapy had effectively reduced bilirubin levels in breast - fed newborns with hyperbilirubinemia, but these patients showed a significantly slower response to this modality of treatment than mixed and formula - fed newborns. Therefore; in breast - fed infants with severe jaundice that requires phototherapy, the addition of formula - feeding will enhance the response to phototherapy without any interruption of breastfeeding.