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Epidemiological And Clinical Study Of Haemorrhagicfever Cases Admitted To Ibnéal - Khateeb Hospital

Author name: al - khakani alia a . a .
General topic: Medicine
Specific topic: Community Medicine
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine - Department Of Community Medicine
University location: Baghdad
Key words:
  • /hemorrhagic fever/ /hemorrhagic fever,omsk/ /theses/

تقييم مؤشر ضغط الدم للكاحل نسبة الى العضد وتثخن بطانة الشريان السباتي باستخدام الامواج فوق الصوتية (دوبلر) لدى مرضى السكري من النوع الثاني

Author name: داليا عبد علي محمد
General topic: Medicine
Specific topic: Medical Physics
Degree: Master
University: University of Baghdad - Faculty Of Medicine
University location: Baghdad
Key words:
  • المستنصرية

السمنة وهرمون النحافة وداء السكر نوع 2 في عينة من النساء العراقيات خلال سن الياس

Author name: خزرج عباس فاضل
General topic: Medicine
Specific topic: Clinical Biochemistry
Degree: Master
University: University of Baghdad - Faculty Of Medicine - Department Of Biochemistry
University location: Baghdad
Key words:
  • المستنصرية

مرض الالتهاب المعدة والامعاء المتعدد العوامل في الاطفال الرضع == Infantile Gastroenteritis Multifactorial Disease

Author name: هدى صاحب عبد المحمد الروازق
Supervisor name: محمد عبد الاخوة حسن الفحام
General topic: Medicine
Specific topic: Microbiology
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Total no. of patient (100) stool samples were collected, during the period from February to the end of May of 2008, for children under two years old suffering from non-bloody and bloody diarrhea at (Children Welfare Teaching Hospital) in Baghdad.
The study evaluates the relationship between etiological agent of diarrhea and sex, age group, type of feeding, presence of blood in stool of the patients. All samples were examined microscopically to identify parasitic agent and serological test for Rotavirus to identify viral infection, also biochemical and serological tested for specimen's culture on different culture media and antibiotic sensitivity test.
Results show from 100 cases 64] represents the etiological agent of diarrhea and the most common of this agent was Rotavirus represent (37.5 %), respectively then Entamoeba histolytica (21.9 %), other agents were include Proteus (12.5 %), Enteropathogenic E.coli (10.9 %), Citrobacter braakii (7.8 %), Salmonella typhi (6.3 %), and Giardia lamblia (3.1 %). The remaining 36 isolates represent of unknown etiological agent for another's pathogen.
The prevalence ratio of infection in male (75.0 %) was more than in female (25.0 %), in the first year of age especially in the age group (0-6) months (42.2 %). children depending on artificial feeding represent about (57.8 %) higher natural and mixed feeding, the bloody diarrhea associated with Entamoeba histolytica (57.1 %) in contrast to some etiological agent of non-bloody diarrhea.
Eleven types of antibiotics were used for sensitivity test show all serotype of Enteropathogenic E.coli and Salmonella typhi are sensitive to Imipenem and Ciprofloxacin. The predominant serotypes of Enteropathogenic E.coli which represent serotype O111 and serotype O125 these strains show resistance to Cefotaxime (CTX), Trimethoprim-sulfamethaxazole (SXT), Ampicillin (AM), Metronidazole (MET), Cefoperazone (CEP), Cefixime (CFM), also the serotype O111 resistance to Gentamicin (CN) represent (45.0 %), while the most resistance of Salmonella was to Amikacin (100.0 %).
This may reflect the fact that the increased resistance in older children and adult may be associated with the development of immunity or the loss of receptors for some specific adhesion.
In Iraq Rotavirus infection is estimated to account for (10-29 %) in early childhood, While in neighboring countries the rate ranges between (19-46 %). The study show infected males more than female and the highest diarrheal infection was caused by Rotavirus, the Imipenem and Ciprofloxacin antibiotic was the most effective one against pathogenic strains of Enteropathogenic E.coli and Salmonella typhi while all isolates were resistant to Trimethoprim-Sulfamethaxazole, Ampicillin, Metronidazole.
Summary:
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دراسة الدهون الاسفنجية النشطة بايولوجيا والانزيمات الاستقلابية في كل من تضخم البروستات الحميد وسرطان البروستات الخبيث == Bioactive Sphingolipids and metabolizing enzymes in patients with benign prostate hyperplasia and malignant prostate cancer

Author name: رغدة عبد المنعم رزوقي
Supervisor name: رائد جاسم محمد التميمي | اسامة سليمان قدوري الناصري
General topic: Medicine
Specific topic: Medical Biochemistry
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Bioactive Sphingolipids an important molecules of structural and signaling lipids. In this study was highlight on new biomarkers uses to investigate prostate cancer by using new method HPLC fluorescence detector to measure concentration and activity enzymes sphingosine - 1 - phosphate lyase enzyme (SPL) and Acid Ceramidase enzyme (AC) by used new material (BODIPY) aromatic structural is binding with enzymes and give fluorophore product sensitive by HPLC fluorescence detector in patients have BPH and PC in serum and tissue and comparing with healthy men as (control). Eliza method was used to measured sphingosine - 1 - phosphate and Ceramide in patients (BPH and PC) in serum and tissue with controls in serum. Sphingolipids metabolites pathological processes, are established regulators of myriad cellular and sphingolipids research is intricate due to the role of these molecules in vastly different biologics, interconnected metabolic pathways and structural properties. Ceramide and sphingosine - 1 - phosphate (S1P), SGPL and AC have been defined as reciprocal regulators of cellular fate, and not surprisingly have been targeted for their role in cancer and their therapeutic potential, sphingolipid metabolic enzymes and lipids are metabolically interconnected and highlight recent findings to support the reciprocal role of Ceramide and S1P in cellular processes and in cancer. Studies show increase levels markers in serum and tissue in BPH and PC with healthy men and different Km and V max in AC and SPL between healthy, BPH and PC patients also this reaction was noncompetitive inhibition with enzyme because V max was change and Km was not change in all cases these results were accepted with studies in America and Spain (Liu, Y.Y.; Patwardhan, G.A.;et al. 2011).IXAim of study1 - 1 - The main aim of this study is found a new sensitive and specific bio markers for diagnosis prostatic cancer And other goals of conducting this study are : 2 - To measure activity of Acid ceramidase and Sphingosine - 1 - Phospate Lyase in sera and prostate tissue of patients with benign prostatic hyperplasia and prostate cancer and compare these activities of enzymes with normal controls.3 - To determine the concentration of bioactive Sphingolipids Ceramide and Sphingosine - 1 - phosphate in tissues and sera of the patients and control.4 - To correlate the level of bioactive lipids with serum PSA concentration to detect their use as additional biomarker for diagnosis and follow up of patient with prostate cancer.Methods : A case - control study design was employed in this study. On a total of 30 patients with confirmed PC, 30 patients with BPH and age matched 30 healthy men. Prostate tissue samples were obtained for patients were serum and urine samples were collected for patients and controls. Enzyme linked immune assay (Elisa) was used to measure S1P and Ceramide concentration in serum and tissue, while HPLC fluorescence detector was used to estimate activities of SPL and AC and measured Km and V max. Urine and serum samples were undergone biochemistry analysis. HbA1c was used to measure cumulative sugar for three groups. Protein in tissue was measure by brad ford method to PC and BPH patients.Results : The results showed that increase levels of Sphingosine 1 phosphate lyase and Acid ceramidase in serum and tissue in BPH and Malignant cancer in men these levels were different result in patient wereXtaken drugs or not and patients were taken chemotherapy or not and activity, Km and Vmax of enzyme SPL and AC were different in BPH and PC that men is inhibition enzymes was noncompetitive it had same Km but different data of control, BPH and PC men in tissue and serum.The concentration of S1P and Ceramide were different levels with control, and high levels in patients without any drugs or chemotherapy while levels of these markers still low with patients were taken drugs or chemotherapy and level of protein in tissue were raised. Results of biochemistry analysis still normal because we take patients without any D.M., renal failure, and hypertension.

تقييم الانزيمات المعدنية المحللة للبروتين - 9 MMP - 9 والانترلوكين - 18 (IL - 18) في دم الحبل السري والنسج البيني في الولادات القيصرية والمهبلية الطبيعية == Matrix Metalloproteinase - 9 and IL - 18 Level in Cord Blood and Tissue Matrix in Caesarean and Normal Vaginal Delivery

Author name: خوله عبد الحمزة شمران مشجل
Supervisor name: ريا سليمان صلاح الدين بابان | مي فاضل ماجد الحبيب
General topic: Medicine
Specific topic: Clinical Biochemistry
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: ماتركس ميتالوبروتياز Matrix metalloproteinases اختصارا (MMPs) وهي انزيمات تعتمد على الزنك وتحتوي على اندوبيبتيداز endopeptidases . هذه الانزيمات لها القدرة على احداث التحلل في جميع انواع البروتينات للمصفوفة خارج الخلية، ولكن ايضا يمكن معالجة عدد من الجزيئات النشطة بيولوجيا. ومن المعروفة انها تقوم بالمشاركة في انشقاق والانقسام لمستقبلات سطح الخلية، واطلاق المعقدات المسؤولة عن موت الخلية (مثل معقد FAS)، وعدم تفعيل السيتوكينات cytokines. وايضا خلال فترة الحمل تحدث تغيرات فسيولوجية خاصة مثل نضج عنق الرحم، وتمزق الاغشية الجنينية، وانفصال المشيمة والذي تتطلب اعادة تشكيل المصفوفة خارج الخلية (ECM) . السيتوكين مثل الانترلوكين (IL - 18)يلعب دورا حاسما في دفاع المضيف، وانها قد تكون جزء في توفير حاجز لعنق الرحم/ ساقطي ضد الغزو الميكروبي من السائل الذي يحيط بالجنين وقد يكون بمثابة علامة لعنق الرحم للعدوى داخل الامنيوتك Amniotic. الاجهاد التاكسدي، وهي حاله تتميز بعدم التوازن بين الجزيئات المؤكسدة، بما في ذلك الانواع الاكسجين التفاعلية (ROS)، وبين دفاع المضادات للاكسدة Antioxidant . هذه ROS قد يسبب اصابات الانسجة مما يؤدي الى تلف البروتينات الخلوية داخل الخلايا ، والحمض النووي DNA التي تورطت في مضاعفات الحمل في بوقت مبكر اثناء المخاض، ويمكن ان يؤثر على طريقة الولادة . استجابة الجسم المناعية تتضمن المضادات للاكسدة الانزيمية وغير الانزيمية التي تقلل من تاثير هذه الجذور الحرة. تهدف هذه الدراسة الى تقييم العلاقة بين مستويات انزيم ماتركس ميتالوبروتياز - 9 (MMP - 9 )ووضعية الحمل. الطرق : في هذه الدراسة تم تعيين ستة واربعين النساء الحوامل (31 حاملا خضعن للولادة الطبيعية، 33 حاملا خضعن للولادة القيصرية. . تم جمع نموذج الدراسة من صالات النسائية والتوليد في مدينة الامامين الكاظمين الطبية خلال فترة من حزيران من 2015 الى تموز من 2016.واخذت موافقة النساء الحوامل قبل الدخول لصالة العمليات, وتم اخذ عينات من الدم وقطعة من النسيج جمعت خلال خمس دقائق من الحبل السري. تم جمع عينات الانسجة الحبل السري ايضا اثناء الولادة. واستخدمت عينات دم وانسجة لقياس الفلزي المصفوفة (MMP - 9)، وانترلوكين 18 (IL - 18)، وايضا تم استخدام نماذج الدم لقياس معدل جهد التاكسد في مصل الدم والمضادات للاكسدة (SOD) والعناصر النزرة. النتائج : اظهرت النتائج ان تدهور في المستويات الحيوية ل( MMP - 9و IL - 18) في الدم النساء اللواتي خضعن الولادة الطبيعية. وكانت عالية في النساء اللواتي خضعن للعملية القيصرية وبالاضافة الى ذلك، فان مستويات الانزيمات المضادة للاكسدة الاقل بين النساء اللواتي خضعن للولادة الطبيعية واعلى بين النساء اللواتي خضعن للعمليات القيصرية. وذكرت في الدراسة ايضا انخفاض كبير في مستوى العناصر النزرة المؤشرات الحيوية (الزنك والنحاس والمغنيسيوم) في الدم النساء اللواتي خضعن للعملية القيصرية مقارنة مع مجموعة النساء اللواتي خضعن الولادة الطبيعية. الفحص النسيجي للنسيج الحبل السري من النساء الحوامل كشفه عن نتائج مطابقة لنتائج فحوصات الدم حيث بينت عن ارتفاع معنوي في تركيز انزيم MMP - 9 والانترلوكين IL - 18 في النساء اللواتي خضعن للعملية القيصرية مقارنة مع مجموعة النساء اللواتي خضعن الولادة الطبيعية.الاستنتاجات : ارتبط الولادة الطبيعية مع زيادة الاكسدة وانخفاض في النشاط المضادة للاكسدة وفي المقابل انخفاض الاجهاد التاكسدي وزيادة في النشاط الانزيمي المضادة للاكسدة (SOD) في الولادات القيصرية ،. واضاف لذلك ارتبط الولادة الطبيعية بانخفاض معنوي في مستويات انزيم MMP - 9 والسايتوكينات IL - 18 مقارنة مع مجموعة النساء اللواتي خضعن الولادة الطبيعية. ومن ناحه اخرى اظهر الفحص النسيجي هنالك تركيزات عالية MMP - 9 وIL - 18 في الانسجة الحبل السري للمراة التي تخضع للعملية القيصرية بالمقارنة مع النساء اللواتي الولادة الطبيعية. | Matrix metalloproteinases (MMPs) are calcium - dependent zinc - containing endopeptidases. These enzymes are capable of degrading all kinds of extracellular matrix proteins, but also can process a number of bioactive molecules. They are known to be involved in the cleavage of cell surface receptors, the release of apoptotic ligands (such as the FAS ligand), and cytokine inactivation. During pregnancy, specific physiological changes such as cervical ripening, rupture of the fetal membranes, and placental detachment require the remodeling of the extracellular matrix (ECM). Cytokine like Interleukin - 18(IL - 18) play a critical role in host defense, and it may participate in providing a cervical/decidual barrier against microbial invasion of the amniotic fluid and might serve as a cervical marker for intra - amniotic infection. Oxidative Stress, a state characterized by an imbalance between pro - oxidant molecules, including reactive oxygen species (ROS), with antioxidant defense. These ROS may cause tissue injury resulting in cytotoxic damage to cellular proteins, and DNA which has been implicated in early pregnancy complications and during ,labor and may effect on mode of labor. Body defense response involves enzymatic and non - enzymatic antioxidant buffering pathways which reduce the effect of these free radicals. This study aimed to assess the relationship between matrix metalloproteinase enzyme levels and delivery mode and also an attempt to assess the impact of oxidative stress on maternal antioxidant defense during labour and correlate it with mode of parturition. Methods : A case - control study design was employed in this study. Sixty four pregnant women were recruited 31 term pregnant women with normal vaginal delivery and 33 term pregnant women underwent cesarean section delivery. At the time of their admission to operation theatre, blood samples were taken and a piece of tissue was collected from umbilical cord after delivery . Blood and tissue samples were used to measure matrix metalloproteinase (MMP - 9), Interleukin - 18 (IL - 18), Superoxide Dismutase (SOD) activity and trace elements levels was determined in the umbilical cord blood only. Placental tissue was prepared and stained for histological assessment. Anti - MMP - 9 and Anti - IL - 18 monoclonal antibody laboratory kits were employed to demonstrate degradation and cytokine levels in umbilical cord tissue. Results : results showed that both blood MMP - 9 and IL - 18 levels were significantly higher in term women who underwent cesarean section compared with those women who underwent normal vaginal delivery. In addition, the enzymatic anti - oxidant SOD was significantly lowest among term women who underwent normal vaginal delivery when compared term women who underwent cesarean section. The present study also reported a significant decreases in level of trace elements (Zn, Cu and Mg) in blood of term women who underwent NVD compared those a with C/S labor (P<0.01). The histological examination of umbilical cord tissue revealed that term women underwent normal vaginal delivery group had the lowest reactivity with both anti - MMP - 9 and anti - IL - 18 monoclonal antibody in comparison to term women underwent cesarean section group. From the study it was concluded that term pregnancy women underwent normal vaginal delivery was associated with increased oxidative stress and decreased anti - oxidant activity. In contrast, term pregnancy underwent cesarean section was associated with low oxidative stress status and high enzymatic anti - oxidant activity (SOD). In other hand, pregnancy underwent with cesarean section was significantly associated with high levels of serum MMP - 9 and IL - 18 and high level of enzymatic anti - oxidant activity (SOD). While the Histological examination showed high MMP - 9 and IL - 18 concentrations in the umbilical cord tissue of term women underwent cesarean section in comparison to term women underwent normal vaginal delivery

دراسة كيميائية حياتية لارتباط المستضد بضاده الحيوي في مرضى داء CA19 - الكاربوهيدراتي 9 السكري من النوع الثاني باستخدام مقايسة الممتز المناعي المرتبط بالانزيم مع بعض التحويرات == Biochemical Studies of the Binding of CA 19 - 9 to its Antibody in Patients with type 2 Diabetes Mellitus using Enzyme - Linked Immunosorbent Assay with some Modifications

Author name: رسل رياض عباس
Supervisor name: حسن حسين طه السعيد | محمود شاكر خضير
General topic: Medicine
Specific topic: Medical Biochemistry
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Carbohydrate Antigen CA19 - 9 has been widely utilized for diagnosis of different kinds of cancer such as pancreatic cancer, cancer of upper gastrointestinal tract. It may also be used as an indicator of pancreatic tissue damage that may be caused by diabetes.The method of enzyme linked immunosorbent assay (ELISA) for measurement CA19 - 9 in sera of patients with type 2 diabetes mellitus was developed using external CA19 - 9 antibody (competitive sandwich ELISA technique) and found to be suitable for the determination of a dissociation constant (Kd) of the binding of CA19 - 9 to its antibody in type 2 diabetic patients using scatchard plot. Objectives : - This study was performed to assess CA19 - 9 levels in sera of patients with type 2 diabetes mellitus with non - cancerous tissue by enzyme - linked immunosorbent assays (ELISA) and define the normal range (cutoff value) for the same marker in this patients also investigated the possible relationships of CA19 - 9 with fasting plasma glucose and HbA1c.This study present a new method for determination the dissociation constant (Kd) of the binding of CA19 - 9 to its antibody in type 2 diabetic patients using scatchard plot through development of ELISA (competitive sandwich ELISA technique).Different factors affecting this binding were extensively studied such as divalent cations, different halides, and Polyethylene (PEG - 6000).

قيمة التتبع النقطي المقطع بالموجات فوق الصوتية لعضلة القلب للكشف عن مرض الشرايين التاجية مقابل تصوير الاوعية التاجية == Detection Of Coronary Artery Disease Using 2D - Regional (Segmental) Longitudinal strain (RLS) Comparing with Coronary Angiography in Patient with Acute Coronary Syndrome

Author name: عماد محمود حسين
Supervisor name: نزار ناصر عباس العتابي
General topic: Medicine
Specific topic: Echocardiography
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Speckle - tracking echocardiography is a new noninvasive ultrasound imaging technique that allows for evaluation of global and regional myocardial function.Aim of the Study : to evaluate the accuracy of regional(segmental) longitudinal strain by 2D - STE for pick up culprit vessels in ACS by detecting ischemic segments of the corresponding territories and its severity compared with coronary angiography as a gold standard, in patients with acute coronary syndrome .Patients and Methods : A cross sectional study was held in Baghdad teaching hospital from March 2017 to March 2018, consisted of patients with acute coronary syndrome(ACS) underwent 2D - STE for left ventricular regional longitudinal strain(RLS) immediately before invasive coronary angiography .Results : Fifty patients who fulfilled the inclusive criteria were enrolled in this study. The mean age 57.2 (± 7.9) years; and male : female ratio 1.9 : 1. Regional Longitudinal strain - speckle tracking showed 38 patients had CAD and 12 patients had no CAD, Versus coronary angiography which showed 29 patients had CAD while 21 patient had no CAD or non significant lesions.The validity of RLS according to coronary angiography showed sensitivity 100%, specificity 57.1% ,PPV 76.3%,NPV 100%, and accuracy 82%.Conclusion : The current study revealed that (RLS) Speckletracking echocardiography technique has high sensitivity but with relatively low specificity in diagnosis of coronary artery disease in patient with acute coronary syndrome.

صلاحية فحوصات الفسلجة العصبية بتنبؤ شدة متلاكمة غوليان باري وباستحقاق التنفس الاصطناعي == Validity of neurophysiological study in prediction of severity of Guillain - Barre syndrome and the indication for mechanical ventilation

Author name: بلال صادق عبد الباقي
Supervisor name: نجیب حسن محمد | زكي نوح حسن
General topic: Medicine
Specific topic: Neurophysiology
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Guillain - Barre syndrome is an acute monophasic, non - febrile postinfectious illness manifesting as ascending weakness, and areflexia.However, sensory, autonomic and brainstem abnormalities may also seen. It is one of the most common causes of acute motor paralysis. In addition to the clinical presentation, those patients may develop neurophysiological features suggestive of demyelinating neuropathy.However, an axonal form had been reported. Hence, the importance of electrophysiological study; nerve conduction study (NCS) and electromyography (EMG) in the neurological evaluation of the severity of Guillain - Barre syndrome and the indication for mechanical ventilation.This study aimed to evaluate the neurophysiological study in prediction the severity of GBS, assess the usefulness of neurophysiology in prediction of respiratory muscles involvement and find out whether the neurophysiological study of peripheral nerves can predict the indications of mechanical ventilation.Two groups of patients are involved in this study. 22 Patients with GBS in the neuromedical wards and 18 patients in the respiratory care units (RCU).The mean age of the two groups were (47+\ - 24 years) with female predominance (1.22 : 1).Each patient submitted to brief medical history, clinical examination and neurophysiological study. This study was conducted at the neuromedical wards and RCU departments of Hospital of neurosciences, Baghdad and ALyarmuk teaching hospitals in a period from December 2017 to June 2018.The neurophysiological assessments involve the following tests : 1. Sensory NCS of bilateral median, ulnar and sural nerves involve sensory latency and sensory nerve action potential (SNAP). 2. Motor NCS of bilateral median, ulnar, common peroneal and tibial nerves involve the motor latency, compound motor action potential (CMAP), motor nerve conduction velocity (MNCV), conductions block and temporal dispersion.3. Minimal F wave latency of bilateral median, ulnar, common peroneal and tibial nerves.4. Needle EMG for bilateral proximal and distal muscles of upper (first dorsal interosseous) and lower limbs (tibialis anterior and extensor digitorium brevis) in which insertional activity, spontaneous activity, motor unit action potential MUAP and interference pattern were applied.The results of this study reveal that F wave and distal motor latencies of the left median, left ulnar, left peroneal, left tibial, right ulnar, right peroneal and right tibial nerves are significantly different between studied groups. Where there are prolonged latencies which could be considered as an indicator for admission to the RCU.Moreover, the reduced compound motor action potential (CMAP) and decrease conductive velocity (CV) in nearly all nerves are significantly different between studied groups and can also increase the chance for admission to the RCU.Concerning sensory abnormalities recorded in this study there are a reduced sensory nerve action potential of left median nerve or a prolonged left ulnar sensory latency when compared to the right ulnar and median sensory study and also increase the risk for admission to the RCU. Interestingly, what was noticed in this study, there are asymmetrical findings in nerve conductive parameters of the same patient involving not only the motor nerves rather than the sensory nerves too.This study concluded that the neurophysiological study can predict the severity of Guillain - Barre syndrome mainly the prolongation of F wave and motor latencies. The peripheral neurophysiological findings are useful in prediction of respiratory muscles involvement by GBS depending on CMAP and conductive velocity. There are asymmetrical finding changes in the studied neurophysiological parameters more apparently involving the sensory nerves of the same patients. Extremes of an age (<30yrs and >50yrs) represent a risk factor if not an indicator for RCU admission.

تعدد الاشكال الجيني للكالكتين - ? في مرضى التهاب المفاصل الروماتويدي == Galectin - 8 Gene Polymorphism In Rheumatoid Arthritis Patients

Author name: طارق قادر طلاب
Supervisor name: محمد عبد الاخوة الفحام | فائق ايشو كوريال
General topic: Medicine
Specific topic: Microbiology - Immunology
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: التهاب المفاصل الروماتويدي هو مرض التهاب المفاصل الالتهابي المزمن مع معدلات كبيرة للمراضة والوفيات .التشخيص المبكر مهم للمعالجة وتحقيق افضل النتائج . لقد اجريت هذه الدراسة في الفترة ما بين بداية تشرين الثاني عام 2016 وحتى نهاية تشرين الثاني عام 2017 على 90 شخصا تم تشخيص 50 منهم على انهم مصابين بالتهاب المفاصل الروماتويدي (مجموعة المرضى) الذين كانوا يحضرون للعيادة الخارجية للمفاصل بمستشفى بغداد التعليمي وكان هناك ايضا 40 اخرون من مجموعة الاصحاء. تم جمع عينات الدم من المرضى والاصحاء لاكتشاف تعدد الاشكال الجيني للكالكتين - 8 والذي تم اجراؤه بواسطة تفاعل سلسلة البوليميريز الخاص بتضخيم الطفرة (ARMS - PCR)كما تم تقييم مستوى الكالكتين - 8 والاجسام المضادة لل CCP في مصل الدم بواسطة مقايسة الممتز المناعي المرتبط بالانزيم ELISA)). تم قياس بروتين سي التفاعلي( CRP) بواسطة nephlometer كما تم فحص العامل الروماتويدي RF) ) بواسطة طريقة تراص اللاتكس . كان مجموع مرضى الدراسة الحالية 50 مريضا، كان متوسط اعمارهم (10.4±46.5) سنة ، وكانت نسبة الاناث سائدة اكثر من الذكور في نسبة (F : M 2.6 : 1). لقد اوضحت الدراسة الحالية انه لم يكن هناك اختلاف كبير بين المرضى والاصحاء في ما يتعلق بتعدد الاشكال الجيني للكالكتين - 8 وكشفت الدراسة الحالية ان مستوى الكالكتين - 8 كان اعلى في مجموعة الاصحاء (87.83 ± 182.93) من مجموعة المرضى ( 36.68± 25.79 ) وهذا الفرق ذو دلالة احصائية (P<0.001 ) ,في ما يتعلق بالاجسام المضادة للCCP فقد تم اكتشافها في 45 من المرضى بينما كانت سالب في جميع عناصر مجموعة الاصحاء والفرق كان ذو دلالة احصائية P <0.001 ) ) ,كما اظهرت الدراسة ان بروتين سي التفاعلي كان موجبا في 25 مريضا وفي 11 فردا من مجموعة الاصحاء وهذا الفرق ذو قيمة احصائية (p= 0.03), كما كشفت النتائج الحالية ان اختبار العامل الروماتويدي كان موجبا في 25 مريضا وكذلك 9 افراد من مجموعة الاصحاء وهذا الفرق ذو دلالة احصائية (p= 0.007) ,كما ان معدل ترسيب الدم لمجموعة المرضى اعلى من مجموعة الاصحاء وذو دلالة احصائية عالية (P <0.0001 ) . لقد اوضحت الدراسة انه لم يكن هناك اي اختلاف ملحوظ بين مجموعة المرضى ومجموعة الاصحاء فيما يتعلق بتعدد الاشكال الجيني للكالكتين - 8كما بينت الدراسة ان لمستوى الكالكتين - 8 في مصل الدم نتائج ممتازة للتمييز بين مجموعة المرضى ومجموعة الاصحاء.ان مستويات الكالكتين - 8 كانت اعلى في مجموعة الاصحاء من مجموعة المرضى , كان هناك ارتباط كبير سلبي بين مستويات الكالكتين - 8 والاجسام المضادة للCCPومعدل ترسيب الدم والعامل الروماتزمي وهذا يشير الى ان مستوى منخفض من الكالاكتين - 8 يرتبط بشكل كبير مع مستوى عال ( مستوى متزايد) من الاجسام المضادة للCCPومعدل ترسيب الدم والعامل الروماتويدي ، وبالتالي يمكن ان يشير الى نشاط المرض وشدته. | Rheumatoid arthritis is chronic inflammatory arthritis disease with significant morbidity and mortality .Early diagnosis is important for beter treatment and outcome. Galectins are potent immune regulators and modulate a range of pathological processes, such as inflammation, autoimmunity, and cancer, Accumulated evidence shows that several family members of galectins play positive or negative roles in the disease development of RA, through their effects on T and B lymphocytes, myeloid lineage cells, and fibroblast - like synoviocytes. This case controls study assess the association between serum galactin - 8 gene polymorphism in RA and controls .And also measure the serum level of Galectin - 8 in RA patient and controls and its validity in early diagnosis. Patients and Methods : This study was conducted in the period between November 2016 till the end of November 2017 on ninety (90) subjects, fifty (50) of them (patient group) were diagnosed as established RA patients, who were attending the Rheumatology Outpatient Clinic of Baghdad Teaching hospital, and other forty (40) were apparently healthy control group. Blood samples were collected from patients and controls to assess serum galectin - 8 and ACCP by enzyme linked immunosorbent assay (ELISA), the CRP was measured by nephlometer, and RF by latex agglutination method, Whereas Galectin - 8 gene Polymorphism done by Amplification - Refractory Mutation System - PCR (ARMS - PCR).Results : 50 case study group included in the current study, their mean age 46.5±10.4 years, the females were predominant than males in a ratio (F : M 2.6 : 1). The current study revealed that serum levels of galectin - 8) higher in control group (182.93±87.83) than patient group (36.68±25.79) and this difference is statistically significant (P - value < 0.001).At the optimum cut off value of serum gal - 8 ≤ 95.7 we found that maximum accuracy was 95.6 , sensitivity 98.0%, specifity 92.5% and AUC was 0.971 this indicate that the biomarker has excellent valid results to differentiate bet patient and control. In the present study there was negative significant correlation between serum galectin - 8 and ESR,ACCP,RF. there was no significant difference between patients and controls regarding galectin - 8 gene polymorphism. TT allele had the highest association with RA while AT allele had the weakest association with RA, however; all these alleles did not associated significantly with RA.Anti - CCP antibodies were detected in 45 (90.0%) patients and were not detected only in 5 (10.0%) patients. Out of 40 healthy controls; the anti - CCP was negative in all healthy controls (100.0%), , with extremely statistical difference (P <0.001) between the patients and healthy control group. The present study showed that CRP was positive in 25 patients (50.0 %), and in 11 subjects (27.5%) from control group and this difference is statistically significant p - value= 0.03The present findings revealed that RF test was positive in only 25 patients (50.0%), and was positive in nine subjects (22.5%) from control group and this difference was statistically significant (P - Value = 0.007 ), Mean level of ESR of patient group higher than control group and is highly statistically significant (P - Value < 0.0001).Conclusions : The study shown that there was no significant difference between patient and controls regarding galectin - 8 gene polymorphism, and there was significantly less serum galectin - 8 in patient compared to control, also there was negative significant correlation between serum galectin - 8 and ESR,ACCP,RF.At the optimum cut off value of serum gal - 8 ≤ 95.7 we found that maximum accuracy was 95.6 , sensitivity, specifity and AUC was 0.971 this indicate that the biomarker has excellent valid results to differentiate between patient and control

تاثير التدخين المزمن على وظائف البطين الايمن للقلب لدئ فئة الذكور الشباب : دراسه صدئ القلب بطريق تعقب الوصلة النقطية للاجهاد == The Effects of Chronic Cigarette Smoking on the Right Ventricular Functions in Young Male Subjects : A Speckle Tracking Echocardiographic Study

Author name: شهيد حميد عيدان
Supervisor name: معتز فوزي حسين
General topic: Medicine
Specific topic: Diseases - Heart
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: الخلفية : يعتبر التدخين المزمن واحدا من اهم عوامل الخطورة للاصابة بامراض الشرايين التاجية ومع ذالك فان له تاثيرات جانبية اخرى على القلب غير معتمدة على تصلب الشرايين.الهدف من هذه الدراسة : لتقييم الاعراض الجانبية المحتملة من التدخين المزمن على وظاىف البطين الايمن للقلب الانقباضية والانبساطية بتعقب الوصلة النقطية للاجهاد بواسطة جهاز صدى القلب ثنائي الابعاد.طرائق البحث : تم اجراء هذه الدراسة في مستشفى بغداد التعليمي شعبة القسطرة \وحدة الايكو للفترة من حزيران 2017 الى ايار 2018 .حيث تم تقسيم المشاركين الى مجموعتين ,مجموعة المدخنين ومجموعة غير المدخنين وتم اجراء فحص صدى القلب للماشركين حسب البروتوكول القياسي ومن ثم تعقب الوصلة النقطية للاجهاد بواسطة صدى القلب ثنائي الابعاد لتقييم الاجهاد الطولي العام للبطين الايمن من القلب . النتائج : اربعين حالة من الذكور الشباب مع اربعين حالة مراقبة مطابقة في العمر تم تسجيلهم في هذه الدراسة حيث كانت الخصائص الاساسية لكلا المجموعتين متشابهة.وكان هنالك اختلاف بشكل ملحوظ للانحراف الانقباضي للحلقة الطائرة لثلاثي الحراشف (قيمه 0.04 > P) حيث انه كان منخفض بشكل ملحوظ لدى مجموعة المدخنين. قمة السرعة الانبساطية المتاخرة( موجه A )كانت مرتفعة بشكل ملحوظ لدى مجموعة المدخنين (قيمه 0.016 > P) وبالتالي فان نسبة قمة السرعة الانبساطية المتقدمة الى قمة السرعة الانبساطية المتاخرة كانت منخفظة بشكل ملحوظ لدى هذه المجموعة(قيمه 0.017 > P). ان تصوير الدوبلر للانسجة لجدار البطين الايمن الحر اظهر ان قمة السرعة الانقباضية لجدار البطين الايمن الحر وقمة السرعة الانبساطية كانتا منخفظتان بشكل ملحوظ لدى مجموعة المدخنين مقارنة بمجموعة المراقبة(قيمه 0.02 > P للحالتين ). وان الاجهاد الطولي العام كما تم تقييمه بتعقب الوصلة النقطية للاجهاد بواسطة جهاز صدى القلب ثنائي الابعاد كان منخفظا بشكل ملحوظ لدى مجموعة المدخنين (قيمه 0.04 > P). كانت هنالك علاقة مترابطة بشكل ملحوظ بين كمية التدخين والاجهاد العام للبطين الايمن بتعقب الوصلة النقطية للاجهاد بواسطة جهاز صدى القلب ثنائي الابعاد.الاستنتاج : اظهرت هذه الدراسة ان التدخين المزمن يسبب تغييرات في الوظائف الانقباضية الطولية والوظائف الانبساطية لبطين القلب الايمن لدى فئة الذكور الشباب وان هذه التغييرات يمكن اكتشافها بصورة مبكرة بتعقب الوصلة النقطية للاجهاد بواسطة صدى القلب ثنائي الابعاد. | Background : Chronic Cigarette smoking is one of the major risk factors for coronary artery disease. However, it has additional cardiac adverse effects independent of coronary atherosclerosis.Objectives of study : To assess the effects of chronic smoking on right ventricular systolic and diastolic functions using Two - Dimensional Speckle Tracking.Patient and methods : This study was carried out in Baghdad Teaching Hospital\ Echo unit from June 2017 to May 2018.The participants whom divided into two groups smoker vs nonsmoker were examined by standard echocardiography protocol which was followed by Two - Dimensional Speckle Tracking to assess the functions of the right ventricle.Results : Forty young smokers’ men and 40 age - matched nonsmoking controls enrolled in this study, the baseline characteristics of two groups were similar. There were significant differences regarding the Tricuspid Annular Plane Systolic Excursion ,P (<0.04) which were significantly reduced in smokers group. The peak late diastolic velocity (A wave) were significantly higher in smoker group P (0.016) and hence the E/A ratio were significantly lower P (0.017). The Tissue Doppler Imaging examination of right ventricular free wall reveal that the Peak systolic velocity of RV free wall (S’), and the peak early diastolic velocity of RV free wall (E’) were found significantly lower in smokers group when compared to control group (P <0.02 for both ). The Global Longitudinal Strain as assessed by 2D - Speckle Tracking Echocardiography were also significantly reduced in smoker group P (0.04). There were significant correlations between the amount of smoking and right ventricular global strain by 2 - D Speckle Tracking Echo study.Conclusion : This study demonstrated that chronic cigarette smoking causes alterations in long - axis systolic and diastolic functions of right ventricle in healthy young subjects. These changes can be early detected with 2 - D Speckle Tracking Echocardiography

تقييم التشخيص الكهروفسلجي الناتج عن خلل الوظيفة اللا ارادية في مرضى داء السكري == ELECTRODIAGNOSTIC EVALUATION OF AUTONOMIC DYSFUNCTION IN DIABETES MELL

Author name: نهال مهند لطفي
Supervisor name: عبد الناصر حسين امير
General topic: Medicine
Specific topic: Physiology
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Diabetic autonomic neuropathy is a serious and common complication of diabetes. The most studied and clinically important form of diabetic autonomic neuropathy is cardiovascular autonomic neuropathy.Aim of study : To assess the autonomic dysfunction in diabetics electrodiagnoctically using reliable tests by sympathetic skin response and R - R interval tests.A cross - sectional study was conducted in the Electromyography unit in Baghdad Teaching Hospital between (Feb/1/2018 - May/15/2018). It included all adult male and female with symptoms of neuropathy or autonomic dysfunction. Pregnant women were excluded from the study. Neurological tests were performed as sympathetic skin response, and R - R interval including normal and deep breath, Valsalva and tilt tests).Means of sympathetic skin response amplitude, R - R interval (Valsalva), and R - R interval (tilt) tests were significantly higher in non - diabetic patients than diabetics (2.19 versus 0.541, P= 0.001; 1.75 versus 1.48, P= 0.017; and 1.44 versus 1.01, P= 0.002 respectively). They were also significantly higher in controlled than in uncontrolled diabetic patients (1.69 versus 0.15, P= 0.044; 1.99 versus 1.31, P= 0.039; and 1.23 versus 0.941, P= 0.022 respectively). Cut points of these tests between controlled and uncontrolled diabetic patients were (0.81, 1.84, and 1.04 respectively). This mean that all patients with tests below these values can be considered uncontrolled diabetics.Sympathetic skin response amplitude, and R - R interval tests are good electro diagnostic tests to evaluate the autonomic dysfunction affected by diabetes, and to assess the severity of autonomic dysfunction in uncontrolled diabetes and differentiating them from those with controlled diabetes.

التقييم الوظيفي للبطين الايمن في مرضى ارتفاع الضغط الشرياني باستخدام تقنية شدة صدى القلب == Physiological Assessment of Right Ventricular Function in Patients with Systemic Hypertension Using Strain Echocardiography

Author name: حيدر عامر توفيق
Supervisor name: حنان لؤي العمري | غازي فرحان حاجي
General topic: Medicine
Specific topic: Physiology
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: البطين الايمن او البطين المنسي هو عبارة عن حجرة ذات شكل غير منتظم وتركيب هندسي معقد . على الرغم من ان التركيز كان في السابق على الجزء الايسر من القلب من الناحية الوظيفية والمرضية ، فهناك عدد متزايد من الادلة على اهمية البطين الايمن وخاصة اهميته في الحفاظ على استقرار الدورة الدموية للجسم ، مستوى النشاط في المرضى الذين يعانون من قصور القلب المزمن ومدى التحسن في المرضى الذين يعانون من امراض صمامات القلب.ارتفاع ضغط الدم الشرياني هو مشكلة صحية عامة رئيسية واسعة الانتشار على المستوى العالمي. تعرف امراض القلب الناتجة عن ارتفاع ضغط الدم باعتلال عضلة القلب الناتجة عن استجابة عضلة القلب للاجهاد الميكانيكي الناتج عن ارتفاع ضغط الدم وتاثير الهرمونات العصبية وعوامل النمو التي تؤدي الى تشوهات متنوعة تشمل تضخم البطين الايسر , الاضطراب الانقباضي والانبساطي ، ومضاعفاتها السريرية بما في ذلك عدم انتظام ضربات القلب وقصور القلب.في دراسة صدى القلب للبطين الايمن ، يجب اجراء التقييم الشامل باستخدام نوافذ صوتية متعددة وتقنيات مختلفة. ان طريقة تتبع البقع الصغيرة باستخدام تخطيط صدى القلب ثنائي الاتجاه هي طريقة جديدة لحساب تشوه عضلة القلب في الصور القياسية ذات المقياس الرمادي حيث كل قطعة صغيرة من عضلة القلب في صورة تخطيط صدى القلب لديها نمط فريد خاص بها من البقع.كان الهدف من هذه الدراسة هو : تقييم تاثير ارتفاع ضغط الدم الشرياني على وظيفة البطين الايمن الانقباضي والانبساطي مقارنة مع المجموعة الضابطة وتحديد تاثير ارتفاع ضغط الدم الشرياني على ميكانيكة البطين الايمن بقياس قيمة التشوه الطولي ثنائي البعد .وكان العدد الاجمالي المشمول في الدراسة ( 200 ) شخص من كلا الجنسين ( 118 من الرجال و82 من الاناث ) ، تتراوح اعمارهم من ( 40 - 60 ) سنة ، وتم تقسيمهم الى مجموعتين : 1 - 100 شخص من المرضى الذين يعانون من ارتفاع ضغط الدم الشرياني . 2 - 100 شخص من الاشخاص الاصحاء يمثلون المجموعة الضابطة. وقد تم اخذ التاريخ الطبي الكامل ، تخطيط القلب الكهربائي , قياس ضغط الدم , تصوير الصدر بالاشعة السينية وقياسات الطول والوزن لكل الاشخاص , تم اجراء تخطيط صدى القلب لجميع الاشخاص باستخدام جهاز GE Vivid E9® .نتائج هذه الدراسة اكدت وجود فرق معتد من الناحية الاحصائية فيما يتعلق بوظيفة البطين الايمن الانبساطية بين مجموعة المرضى والمجموعة الضابطة ( P = 0.001 ) .وفيما يتعلق في قياس قيمة التشوه في البطين الايمن كذلك اكدت الدراسة انخفاض قيمة التشوه في البطين الايمن للمرضى مقارنة بالمجموعة الضاغطة وكان الفرق معتد من الناحية الاحصائية ( P = 0.001 ) .و كشفت الدراسة ان نسبة الارجحية من الانحدار اللوجستي متعدد المتغيرات ان سمك الحاجز بين البطينين كان المؤثر الاكبر على قيمة التشوه في البطين الايمن .نتائج هذه الدراسة وضحت انخفاض نسبة التشوه الطولي للبطين الايمن وبالتالية تاثر الوظيفة الانقباضية عند مجموعة المرضى وعلاقة هذا التاثر القوية مع تضخم الحاجز بين البطينين الشيء الذي لم تستطع الفحوصات التقليدية في اكتشافه | The right ventricle or the forgotten chamber is multi - compartmental in orientation with a complex structural geometry. Although the focusing in cardiology was placed on left heart physiology and pathology in the past, there is a growing body of evidence for the importance of the RV especially the maintenance of normal body hemodynamics, exercise capacity in chronic heart failure and survival in patients with valvular heart disease. Arterial hypertension is a major public health problem due to its high prevalence globally. Hypertensive heart disease is the cardiomyopathy which result from myocardial response to the mechanical stress from elevated blood pressure , the influences of neurohormones , growth factors, and cytokines and then leads to variety of abnormalities includes left ventricular hypertrophy (LVH), systolic and diastolic dysfunction, and their clinical complication including arrhythmias and heart failure .In echocardiographic studies, a comprehensive assessment of the right ventricle should be performed using multiple acoustic windows and different image techniques .The two dimensions speckle tracking echocardiography is a novel non - invasive echocardiographic method to calculate myocardial deformation in standard grey - scale images in which every little piece of myocardium in echocardiography image has its own unique pattern of speckles. The aim of this study was to : evaluate the effect of systemic arterial hypertension on systolic and diastolic right ventricular function and to determine the effect of systemic arterial hypertension on right ventricle mechanics using two dimensional longitudinal strains.The total number of hypertensive patients and apparently healthy control subjects were (200) of either sex (118 male and 82 female), their age range from (40 - 60) year; they were divided into two groups : 100 Patients with hypertension, 100 apparently healthy control subjects. Each patient and control subject was submitted to full medical history, physical examination, ECG, chest X - Ray, blood pressure determination and subject’s anthropometry measurements. Echocardiography was performed for all subjects using a GE Vivid E9® system in which M - mode, two dimensional , color, pulse and continuous wave Doppler , tissue Doppler and speckle tracking imaging were obtained according to the American Society of Echocardiography guideline of using Echocardiography in Adult Hypertension.Trans - tricuspid E/A ratio was decreased in hypertensive group (1.10±0.12) versus (1.39±0.28) in normotensive group with statistically significant difference p value =0.001. The mean tricuspid E/ é ratio was (4.95±1.34) in hypertensive patients while was (3.90±0.98) in control group, the p value was 0.001 and there was significant difference between them. It was observed that the mean 2D - RVGLS was ( - 20.12 ± 3.80) % in hypertensive patients versus ( - 25.90 ± 2.18) in normal subjects, the P value was 0.001 and there was significant difference between the two groups. The odds ratio of multivariate logistic regression revealed that the diastolic interventricular septum thickness was the strongest factor affect RVGLS in this study, odds ratio for IVSD, RWT, and LVPW were respectively 2.418, 1.978, and 1.761. This study conclude that RV longitudinal strain is significantly impaired in hypertensive patients group and strongly correlates with heart remodeling and it is superior to more conventional functional parameters of RV systolic function.

دراسة تنشيط النطف البشرية باستخدام الوسط الزرعيHam's F - 12 ومادة البومين المصل البشري لمرضى العقم == An in vitro human sperm activation study Using Ham’s F - 12 medium and human serum albumin for infertile patients

Author name: محمد حسن شعبان
Supervisor name: محمد باقر محمد رشاد فخر الدين
General topic: Medicine
Specific topic: Obstetrics and Gynecology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: تهدف هذه الدراسة الى التحقق من كفاءة الوسط الزرعي (Ham's F - 12) كوسط لتحضير النطف, كذلك فعالية مادة البومين مصل الدم البشري ( (Human serum albumin; HSA كمادة منشطة للنطف لاستخدامها في عمليات التنشيط لمرضى العقم. شملت هذه الدراسة مائة واربعون مريضا من المصابين بالعقم بسبب وهن النطف(Asthenozoospermia) او قله عدد النطف) (Oligozoospermiaاو كلاهما) (Oligoasthenozoospermia. كان معدل اعمارهم هو) 4.32±35.62 (عاماومعدل فترة العقم هو (6.06±0.22) سنة. تمت الدراسة في مستشفى الحسين العام وعيادة المصطفى الطبية الشعبية في كربلاء واستغرقت للفترة من شهر تموز 2006 الى شهر تشرين الثاني 2006 .تم تنشيط النطف خارج الجسم ( (in vitro sperm activation حيث استخدم الوسط الزرعي ( (Ham's F - 12 كمجموعة سيطرة(ضابطة) واستخدمت ثلاث تراكيز من مادة ( (HSA 5% و7.5% و10% وبفترتي حضن 15 و30 دقيقة. قسمت نماذج المني الى قسمين حيث حضرت المجموعة الاولى( 70 نموذج ) بتقنية النبذ والسباحة Centrifugation swim - up technique)) والسبعون الاخرى بتقنية السباحة المباشرة (Direct swim - up technique).تم فحص السائل المنوي لجميع المرضى قبل عملية التنشيط ثم قورنت النتائج مع نتائج بعد التنشيط ولجميع المرض وقورنت كذلك بعد استخدام التراكيز الثلاث المضافة من مادة ( (HSA . اظهرت النتائج ايجابية الوسط الزرعي Ham's F - 12) )لاستخدامه كوسط لتحضير النطف حيث لوحظ زيادة في حركة النطف , وكذلك زيادة في نسبة فعالية النطف A,B وكذلك زيادة في نسبة النطف السوية . كذلك لوحظ زيادة في حركة ونسبة فعالية النطف A, B وزيادة في نسبة النطف السوية ايضا بعد اضافة مادة ( (HSA وكان التركيز الافضل هو 5% وبفترة حضن 30دقيقة . وان افضل النتائج كانت للمرضى المصابين بوهن النطف مقارنة مع نتائج المرضى المصابين بقلة النطف او بقلة ووهن النطف. نستنتج من هذه الدراسة ان الوسط الزرعي Ham's F - 12) ) ذو فعالية جيدة كوسط لتنشيط النطف كما ان مادة الالبومين( (HSA يمكن استخدامها كمادة منشطة للنطف للمرض المصابين وهن النطف. | medium as sperm preparation medium and the effectiveness of human serum albumin HSA as sperm stimulator in in vitro human sperm activation for infertile patients. One hundred forty (140) infertile males were shared in present study. The mean ages of infertile males were 35.62± 4.32 years. The mean duration of infertility of them was 6.06 ±0.22 years with range of 1 - 11 year.Ham’s F - 12 medium was used as control group and three different concentrations of HSA were used (5%, 7.5% and 10%), with two incubation periods (15 and 30 minuets). Seventy semen samples were prepared using centrifugation swim - up technique, and the other seventy semen samples prepared using direct swim - up technique. The comparison was done between parameters of semen of all treated groups post - activation with pre - activation parameters and control group (Ham’s F - 12 medium).The results of the present study showed that a significant improvement in seminal fluid analysis parameters especially sperm concentration, percentage of sperm agglutination and round cells concentration were reduced significantly (P<0.01) in both technique. In contrast, percentages of sperm motility, progressive sperm activity (grades A and B) and normal sperm morphology were increased significantly (P<0.05) using both techniques.With the usage of Ham’s F - 12 medium also significant enhancement were reported in compared to pre - activation Sperm concentration, sperm agglutination percentage and round cells concentration were reduced significantly(P<0.01) in both techniques. On the other hand, percentage of sperm motility, percentage of progressive sperm activity (grades A+B) and normal sperm morphology (%) were increased significantly (P<0.05) using both techniques.The results showed that the addition of HSA to the culture medium enhances sperm motility (%), percentage of progressive sperm activity (grades A and B) and normal sperm morphology (%) using both techniques. Moreover, the best results were reported with 5% HSA and 7.5% HSA after 30 minutes of incubation. In addition to that, the results of sperm activation were better with asthenozoospermic patients than oligozoospermic and oligoasthenozoospermic patients

تقييم كثافة المعادن العظمية وكتلة العجاف والكتلة الدهنية في المراة قبل وبعد انقطاع الطمث : دراسة مقارنة == Evaluation of Bone Mineral Density, Lean Mass and Fatty Mass in Pre and Postmenopausal Women A Comparative Study

Author name: علي حسين فالح
Supervisor name: غسان ثابت سعيد | فائق ايشو كوريال
General topic: Medicine
Specific topic: Physiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: The body composition (BC) describes the different components that makeup the human being and refers to the proportion of fat and fat - free mass inthe body. Aging processes are natural complex physiological alteration in thebody associated by weakness of the structure and functions in the organs.The alterations in body composition that occur with the aging process nothappen homogeneously. Although there are various techniques forassessment of body composition in research and clinical settings, DualX - ray absorptiometry (DXA) is the most commonly used methods forexamination and also preferred choice and golden clinical tool for thediagnosis of osteoporosis and assessment of its severity. This equipment isnoninvasive, widely available and currently the scanning of hip and spineused as the gold standard by a major number of clinicians. In recent years,there has been an increasing interest in BC measurement to assess the health.This is the first study in Iraq to assess healthy subjects.Objectives : to evaluate the changes of bone mineral density and fatty massand lean mass in postmenopausal period and to correlate them withanthropometric measurements. Also to correlate between BMD with serumcalcium, phosphate and alkaline phosphatase.Subjects and methods : This cross - sectional study was conducted at DXAUnit in Baghdad Teaching Hospital from November 2016 to December2017. Data were collected from (120) postmenopausal female subjects and(120) premenopausal female subjects with total of 240 females from age of40 - 69 years were randomly selected from the patients attending DXA unit inBaghdad Teaching Hospital. The postmenopausal female subjects weredefined as individuals with menopause at least one year since the last naturalmenstruation. Osteoporosis was diagnosed according to WHO criteriaIIT - score was used for postmenopausal subjects and Z - scores forpremenopausal subjects. Women were excluded from the study if they anycondition may affect the BMD or other constituents of BC.Results : a highly significant lower BMD of lumbar spine and both femurswere found in postmenopausal group. Although the mean of areas of ribs, lumbar spine, pelvis, legs and total body fat mass were higher in postmenopausal subjects but no significantly differences of body fat mass g̸cm² measured by DXA between the postmenopausal and premenopausal subjects. A highly significant difference of LM g ̸cm² measured by DXA between the postmenopausal and premenopausal subjects (p - value0.0004 - 0.001) in measurements of total LM and anatomical areas. Significant effects were found of total FM and total LM on BMD of lumbar spine and neck of both femurs in postmenopausal subjects but LM had more effect than FM.Conclusion : A highly significant lower BMD and LM were found with increased adiposity among postmenopausal women. Both FM and LM affect BMD of lumbar spine and both femurs but LM had more effect

مرض التدرن في مركز الامراض الصدرية والتنفسية في مدينة بلد صفات المرضى والنتائج منذ 2016 بعد البدء باستعمال الفحص الجيني للتشخيص ومعرفة المقاومة لعقار الريفامبسين == Tuberculosis in Pulmonary Diseases Center in Balad City, Patient characteristic and Outcome Since 2016 after Start Using MTB_RR Xpert gene

Author name: زينب اكرم سالم
Supervisor name: نادية عزيز ناصر
General topic: Medicine
Specific topic: Family Medicine
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Tuberculosis is a deadly infectious disease that caused around 1.7 million deaths in 2016 worldwide. X pert MTB - RR assay is a new test that is revolutionizing tuberculosis control by contributing to rapid diagnosis of disease and drug resistance.Objectives : To study tuberculosis patient characteristics, drug resistance, reaching conclusions about proper measures to control TB, and highlight importance of the new diagnostic method X - pert gene MTB - RR.Method : Cross sectional study was conducted among patient diagnosed with tuberculosis in Balad pulmonary disease center from January, 2016 to May,2018 using Gene X - pert as main diagnosis method, patient's characteristics were studied and information were analyzed using SPSS.Result : Tuberculosis incidence in Balad district was (40/100000) in 2017, and 6.9%(11/158) of patients in the study were found to had Rifampicin resistance.X - pert gene MTB - RR was found to be 100% sensitive and 85% specific Most important risks for relapse in tuberculosis patients with statistically significant p - value were diabetes, low level of education and far distance from health center. Conclusion : Gene X - pert MTB - RR is simple, rapid and accurate test for diagnosis of Tuberculosis and rifampicin resistance.Diabetes have significant statistically association with tuberculosis and relapse rate and this subgroup of patients need special care from TB health workers.

تاثير الخدمات الصحية على وفيات الولدان في بغداد 2012 - 2016 == The Impact of Health Services on Neonatal Deaths in Baghdad, 2012 - 2016

Author name: سالي سعد محمد علي باش
Supervisor name: جواد كاظم الديوان
General topic: Medicine
Specific topic: Community Medicine
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: الخلفية : وفيات الاطفال حديثي الولادة مؤشر لجودة الخدمات الصحية للام والطفل في المجتمع والوضع الاقتصادي. العراق لازال يعاني من حروب ووضع اقتصادي مزري نتيجة حصار سابق وانخفاض اسعار النفط وسيطرة الارهاب على اراضيه، وتزايد عدد النازحين داخل البلد. وظهرت تلك الاشكالات الاجتماعية على شكل صراعات.الاهداف : اجريت هذه الدراسة لمراجعة نسبة وفيات الاطفال حديثي الولادة في المستشفى حماية الاطفال التعليمي ومستشفى الاطفال الكاظمية من 2012 الى 2016..الطرق : جريت دراسة مستعرضة باثر رجعي. مستشفيات عشوائية مختارة من كل جانب من بغداد ، المستشفى حماية الاطفال التعليمي فيجانب الرصافة من مدينة بغداد ومستشفى الاطفال الكاظمية في جانب الكرخ من مدينة بغداد. تم جمع جميع سجلات حالات حديثي الولادة في وحدات الرعاية المركزة للولدان من عام 2012 الى عام 2016 في المستشفيات المذكورة. تحتوي السجلات على بيانات حول حديثي الولادة . ومن سجلات الادارة تم الحصول على اعداد الاطباء والكادر التمريضي ومن سجلات القسم الفني على اعداد الاجهزة الطبية.ظهرت الخدمات الصحية في عدد من اطباء اختصاص اطفال واطباء الدراسات العليا والكادر التمريضي الجامعي.النتائج : زيادة في دخولات حديثي الولادة في نهاية السنوات المدروسة بنسبة 25.9 ٪. كانت هناك زيادة في نسبة اطباء الاطفال ونسبة اطباء الدراسات العليا ونسبة الممرضين المتخرجين بمقدار 0.004 و0.2 و0.02 على التوالي. لم تتاثر نسبة وفيات المواليد الجدد بعدد اطباء الاطفال (P = 0.3) ، وطبيب الدراسات العليا (P = 0.2) ، وممرضة الدراسات العليا (P = 0.02). الاستنتاج : لوحظ ارتفاع معدل وفيات الولدان. الصراعات اثرت سلبا على الخدمات الصحية، واظهرت اسباب غير واضحة لذلك. | Background : Neonatal mortality is an indicator to evaluate and assess the maternal and neonatal health services system in the community. Neonatal mortality reflects the quality of socioeconomic status and health services of each country.Iraq has been suffering from wars, economic sanction, and internal displacement population.Conflicts lead to deterioration in health system which is in turn affect health status.Objectives : This study was carried out to review the neonatal mortality proportion in Children's Welfare Teaching hospital and Al - Kadhimiya children hospital from 2012 to 2016.Methodology : A retrospective cross - sectional study was conducted. A random chosen hospitals from each site of Baghdad, Children's Welfare Teaching hospital in Al - Rusafa side of Baghdad city and Al - Kadhimiya children hospital in Al - karkh side of Baghdad city. All cases records of newborns in neonatal intensive care units from 2012 to 2016 in the mentioned hospitals were collected. Records contain data about newborn, the health worker, and medical instrument.Health services were manifested in number of specialist pediatrician, postgraduate physicians and graduate nurse. Results : The admissions increased in the ending years of studied period by 25.9%. There was an increase in pediatrician proportion, postgraduate physician proportion and graduated nurse proportion by 0.004, 0.2, and 0.02 respectively. Neonatal mortality proportion wasn’t affected by number of pediatrician (P = 0.3), postgraduate physician (P = 0.2), and graduate nurse (P = 0.02).Conclusions : High neonatal mortality was observed. Conflicts mask the impact of the health services.Keyword : Neonatal mortality, Proportion, conflict, Iraq, neonatal intensive care unit.

مستوى فيتامين دال في الشابات العراقيات المحجبات وغير المحجبات == Vitamin D Level in Veiled and Unveiled Iraqi Young Females

Author name: مهند خليل احمد
Supervisor name: محمد هادي العصامي
General topic: Medicine
Specific topic: Diseases - Joints
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Vitamin D is one of the primary regulators of calcium (Ca) homeostasis in the body. Although a small amount of vitamin D is supplied from food, exposure of skin to the ultraviolet (UV) rays in sunlight is known to be the major source. Vitamin D is critically important for normal mineralization of bone.Aim of the studyThe aim of the study is to compare vitamin D status in veiled and unveiled healthy Iraqi women of reproductive age. Patients and methods A cross - sectional study was conducted at Baghdad TeachingHospital, Rheumatology unit. Between January and August 2018, A 100 healthy Iraqi volunteer women were recruited from the city of Baghdad at local hospitals. Informed consent was obtained from all subjects.ResultsThe laboratory testing of the serum 25 - Hydroxy vitamin D, serum calcium, serum phosphate and ALP of women in both groups revealed that veiled women had significantly lower 25 - Hydroxy vitamin D, than unveiled women.ConclusionsThe high prevalence of low vitamin D status in veiled females in comparism to unveiled females, calls for action to increase the population’s awareness and to develop strategies to reduce this risk among women, particularly those wearing dress styles that cover most or all of their skin

متلازمة القولون المتهيج بين طلاب المدارس الثانوية : نسبة الانتشار والاسباب 2017 - 2018 == Irritable Bowel Syndrome Among High School Students : Prevalence and Determinants 2017 - 2018

Author name: هناء فريق هزاع
Supervisor name: فارس حسن اللامي
General topic: Medicine
Specific topic: Community Medicine
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: الخلفية : ان متلازمة القولون المتهيج هي خلل وظيفي يصيب الامعاء الغليظة ويؤدي الى اعراض مزمنة في الجهاز الهضمي. وهو مرض واسع الانتشار يصيب كل الفئات العمرية لكنه اوسع انتشارا" بين فئة المراهقين والشباب.الهدف من الدراسة : هو معرفة نسبة انتشار المرض بين طلاب المدارس الثانوية وتحديد العوامل المؤثرة في زيادة نسبة انتشاره في محافظة بغداد 2017 - 2018 الاشخاص وطريقة العمل : هذه دراسة مقطعية اجريت على 12 مدرسة من المدارس الثانوية التابعة لمديريات تربية بغداد \ الكرخ. حيث تمت الدراسة عن طريق الاستبيان المباشرلاعراض المرض لجميع طلاب المرحلة السادسة في تلك المدارس , ذكورا"واناثا". وقد تم استبعاد الطلبة الذين يعانون من الاعراض التي تشير الى امراض اخرى قد تتداخل مع تشخيص المرض., وكذلك استبعاد الطلبة الذين سبق وان اجروا عملية سابقة او شخصوا باصابتهم بامراض اخرى في الجهاز الهضمي وقد تمت الدراسة بتطبيق نوعين مختلفين من الاستبيان, الاول لجمع المعلومات الاجتماعية والديموغرافية والعادات اليومية للطلبة, والاستبيان الثاني (Rome Criteria III) لتشخيص المرض ,ثم تصنيفه الى ثلاثة انواع (رابط الاسهال, رابط الامساك ,النوع المختلط) النتائج : شملت الدراسة 592 طالب وطالبة, وقد اظهرت الدراسة ان النسبة العامة لانتشارالمرض كانت 29,7% (فاصل الثقة 95% 29.4 - 30.1%) مع نسبة اعلى للانتشار بين الاناث عن الذكور بنسبة1 : 1.5 كما اظهرت الدراسة ان النوع المختلط من المرض هو النوع الاكثر شيوعا"(42.6%) يليه رابط الاسهال(33.5%), ثمرابط الامساك(23.9%). وكشف معامل الانحدار اللوجستي عوامل الخطورة التالية : الضغوط الحياتية) 3.93% (OR= والحساسية للاطعمة (2.89% OR=) والامراض المزمنة (2.22% (OR= والعامل الوراثي (2.04% OR=) والجنس (1.84% OR=) هي من اهم العوامل المؤثرة في زيادة نسبة انتشار المرض | Background : Irritable Bowel Syndrome (IBS) is a chronic functional gastrointestinal disorder. It's worldwide prevalent and causes a great challenge on the health system and patients' daily life activity. It affect all age groups but more common among adolescents and young age groups.Objectives : To estimate the prevalence and identify potential determinants of IBS among high school students in Baghdad, Iraq.Methods : This cross - sectional study was conducted on a cluster sample of 12 high schools in Baghdad. All students in the sixth grade were considered eligible. Students with "red flag" symptoms were excluded. Rome III criteria questionnaire was considered to define Irritable Bowel Syndrome. A self - administered questionnaire used to compile socio - demographics, personal habits and certain potential determinants.Statistical Analysis : Statistical Package for Social Sciences (SPSS) program, version 23 was used for data entry and analysis. The prevalence (and its 95% confidence interval) of Irritable Bowel Syndrome among high school students was calculated. Chi square and fisher's exact probability test were applied to test association of qualitative and categorical variables with IBS. Logistic regression analysis was used to identify the significant, independent and un - confounded risk factors.Result. Among 657 eligible high school students, 592 (90.1%) were enrolled. The prevalence of Irritable Bowel Syndrome was 29.7% (95% C.I. 29.4 - 30.1%). The most common type was mixed type (42.6%) followed by diarrhea - predominant (33.5%), then constipation - predominant (23.86%). Binary and logistic regression analyses revealed the following significant factors. Exposure to stressful life event (OR. 3.93; 95% CI. 2.64 - 4.85), food hypersensitivity (OR. 2.89; 95% CI. 1.59 - 3.27), chronic diseases (OR. 2.22; 95% CI. 1.24 - 3.95), family history of IBS (OR. 2.04;95% CI. 1.30 - 3.01) and female sex (OR. 1.84; 95% CI. 1.25 - 2.73). C - IBS was significantly more common among females (P=0.02) Conclusion : Irritable Bowel Syndrome is prevalent among high school students in Iraq, affected about one third of them. Stressful life events were the most important modified risk factor and it was the strongest factor affecting the prevalence of Irritable bowel syndrome. Food hypersensitivity, family history, chronic health problems and gender were the most important non - modified risk factors and Migraine was the most common comorbid chronic disease among students with Irritable Bowel Syndrome.

نتائج القسطرة القلبية لمرضى الذبحة القلبية المستقرة الذين لديهم تخطيط طبيعي او انسداد في الحزمة الكهربائية اليسرى او اليمنى == CORONARY ANGIOGRAPHIC FINDINGS IN PATIENTS WITH CHRONIC STABLE ANGINA AND NORMAL ECG, LBBB OR RBBB

Author name: زاهر عبد القادر حسين علي
Supervisor name: حسن علي الفرحان
General topic: Medicine
Specific topic: Diseases - Heart
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: الخلفية : الذبحة الصدرية المستقرة هي احد مظاهر الاصابة بامراض القلب في حوالي 20 الى 40٪ من المرضى ، والمريض النموذجي المصاب بالذبحة الصدرية يحدث في رجل اكبر من 50 عاما او امراة اكبر من 60 عاما من العمر ، والنتائج على مخطط القلب الكهربائي (ECG)قد يكون طبيعي في نصف المرضى الذين يعانون من الذبحة الصدرية المزمنة المستقرة. هدف الدراسة : لمعرفة نتائج القسطرة القلبية لمرضى الذبحة القلبية المستقرة الذين لديهم تخطيط طبيعي او انسداد في الحزمة الكهربائية اليسرى او اليمنى.المواد والعمل : اجريت دراسة مقطعية مستعرضة في المركز العراقي لامراض القلب. في الفترة من 15 يناير 2018 الى 15 يوليو 2018 والتي شملت المرضى الذين يعانون من الذبحة الصدرية المزمنة والمستقرة ولديهم تخطيط القلب كان طبيعيا او مع انسداد في الحزمة الكهربائية اليسرى او اليمنى. خضع جميع المرضى تخطيط صدى القلب, جميع المرضى قاموا بعمل تصوير الاوعية التاجية وتم اخذ البيانات من التقارير ، ثم التحليل الاحصائي.النتائج : في الدراسة الحالية ، كان متوسط عمر المرضى الذين كان تصوير الاوعية التاجية لهم غير طبيعي 57.7، وكان معظم المرضى من الذكور ، ومعظم المرضى كانوا من الذين يعانون من مرض السكري وكذلك معضم المرضى الذين لديهم تصوير الاوعية التاجية غير طبيعي كانوا لديهم علامات نموذجية لقصور الشرايين التاجية، والمرضى الذين كان لديهم تخطيط القلب طبيعيا كان لديهم انسداد في الشريان الايسر, 66 مريض من اجمالي 156 و72 في الشريان المحيطي و45 في الشريان الايمن, واما مرضى الحزمة الكهربائية اليسرى كان هناك 18مريض لدية انسداد في الشريان الايسرمن اصل 53, و14مريض لدية انسداد في الشريان المحيطي, و8 مرضى في الشريان الايمن. واما مرضى الحزمة الكهربائية اليمنى كان لديهم 6 مرضى مصابين بانسداد الشريان الايسر من اصل 41 و4 مرضى لديهم انسداد بالشريان المحيطي و6 بالشريان الايمن.في المرضى الذين كان لديهم تخطيط القلب طبيعيا كان لديهم 85 مريض لدية انسداد في شريان واحد و43 لديهم انسداد في شريانيين و17 لديهم انسداد في ثلاث شرايين.واما مرضى الحزمة الكهربائية اليسرى كان لديهم 37 مريض لدية انسداد في شريان واحد و13 مريض في شريانين ومريضان لديهم انسداد في ثلاث شرايين.والحزمة الكهربائية اليمنى 35 مريض لدية انسداد في شريان واحد و4 مرضى لديهم انسداد في شريانيين | Background : Stable angina is one of the manifestation of ischemic heart disease in about 20 to 40 % of patients, The typical patient with angina occurs in a man> 50 years or a women >60 years of age, Findings on the resting electrocardiogram (ECG) are normal in half of patients with chronic stable angina. (1)Aims of the study : To study the coronary angiographic findings in patients with chronic stable angina and normal ECG, LBBB or RBBB.Patients and methods : A cross sectional study conducted in the Iraqi center for heart diseases. In the period from 15 January 2018 to 15 July 2018 which included patients with chronic stable angina and had normal ECG or BBB either LBBB or RBBB. All patients underwent echocardiography, the ejection fraction and contractility of the heart had reported. A special form of questionnaire had been constructed by the researcher to comprise the required data. It include the general information such as : age, gender, as well as smoking habits and history of hypertension and diabetes and history of symptoms of chest pain either typical or atypical. All patients had done coronary angiography and data had been taken from reports, then statistical analysis done. Results : In the present study mean of age of the patients with abnormal coronary angiography was 57.5, most of the patients were male, and most of the patients with DM had abnormal coronary angiography and most of the typical symptoms had abnormal coronary angiography, patients with normal ECG had LAD lesion in 66 patients from total 156 and LCX 72 and RCA 45 and in patients with LBBB 18 had LAD, 14 LCX, 8 had RCA and in RBBB 6 had LAD, 4 had LCX, 6 had RCA, and most of lesion were critical then intermediate and less for subtotal and total.In patients with normal ECG 85 had one vessel 43 had two vessel 17 had three vessel and in LBBB 37 had one vessel 13 had two vessel and 2 had three vessel and in RBBB 35 had one vessel 4 had two vessel.Conclusions1 - The most predominant artery in patients with CSA and normal ECG is LCX then LAD.2 - Most of the lesion in CSA and normal ECG, LBBB, RBBB is critical then intermediate and less subtotal and total.3 - One or two even there vessel disease could occurs in patients with CSA and normal ECG/LBBB, RBBB, but most of the cases are with one then two vessel and less for three vessel.4 - In BBB no specific artery is related to BBB although predominance was for LAD.

سرطان الثدي عند النساء العراقيات من نوع HER2 +VE مع الفائدة من استخدام العقار المناعي Trastuzumzb بعد الانتكاسه السريريه لاستخدامه == Her2 positive Iraqi breast cancer women Use of trastuzumab beyond progression

Author name: وليد جاسم محمد
Supervisor name: منور عبد الاله النقاش
General topic: Medicine
Specific topic: Therapeutic Radiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in women. Her 2 positive disease carries worse prognosis and anti her 2 therapy is required in addition to chemotherapy which increase the cost of management of those patients especially in metastatic settingObjectives : The aim of this study to assess Iraqi breast cancer patients with HER2/neu molecular profile. Evaluate the role of using Trastuzumab in metastatic HER2/neu positive breast cancer patients beyond progression after its use in first line by changing the chemotherapeutic agent only.Patients & Methods : This is a retrospective study which was conducted in oncology teaching hospital - medical City complex from 1st of July 2017 to 1st of December 2017, carried out on 253 breast cancer female patients diagnosed within the period 2010 - 2017 with different age groups. Their histopathological reports, immunohistochemistry (IHC) results including ER, PR, HER2/neu and CISH test when indicated in addition to their clinical profile were collected. The subgroup of patients (253) with her2 positive disease were identified. From which patients with metastatic disease were analyzed for the use of trastuzumab beyond progression.Results : The mean age ± SD was (51.7 ± 11.1) years in HER2/neu positive patients, while it was (51.4 ± 13.8) in metastatic HER2/neu patients. The prevalence of HER2/neu positive 16.656 %( 95% CI : 16.468_16.843%). The mean of number of trastuzumab cycles used in patient that not metastatic HER2/neu was (16.6 ±3.9) and at metastatic HER2/neu was (16.1 ± 6.9). Median time to progression was 16 (95% CI : 11.009 - 20.991) months, after 6 months 92.8% had progression - free and after 12 month 53.8% had progression - free.Conclusion : HER2/neu positive disease constitutes 16.656% of Iraqi patients with breast cancer. And the median age for metastasis was (51.4 ± 13.8).Also Trastuzumab use beyond progression had a clinically significant metastatic free survival benefit. The cumulative incidence of metastasis to different body organs was lung (89.8%), liver (57.6%), and bone (45.8%), brain (27.8%).

احداث الشريان التاجي بعد عام واحد من اعادة التوعية تجربة مركز واحدة == Coronary artery events one year after revascularization : a single center experience

Author name: مروان كامل عبود
Supervisor name: حسن يوسف النجار
General topic: Medicine
Specific topic: Diseases - Heart
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: associated with concerns about their potential adverse effects. In - stent restenosis and stent thrombosis definitely affect the PCI outcome. However, review of recent relevant studies suggests that stent - related problems may have been somewhat overestimated when compared to coronary artery disease (CAD) progression at non stented coronary segments as causative factors of adverse cardiac clinical events late post - PCI.Both stent - related problems and native CAD progression have to be equally addressed to optimize the PCI clinical benefitAim of the study : To study the major adverse cardiac events and one year outcome after PCI.Patients & Methods : This study is cross - sectional study of all patients who were referred to Iraqi Center for heart disease, for further evaluation of suspected coronary artery disease (CAD) for the period January to July 2018. The total number of patients was fifty (50).Results : The total No. of patients were 50, mean age was 59.1±11.3, (22%) were below age 45 and (78%) equal and above age 45 year.54% were male and (46%) were female. The frequency risk factors were DM (62%), HT (56%), Dyslipidemias (52%), Obesity (21%) and Smoking (21%). The most common clinical presentations were chronic stable angina (98%) of cases and one case (2%) acute coronary syndrome. The outcome of PCI after one year divided in to four groups, group A : patients with ISR (5/50) (10 %), group B : patients with new stenosis (8/50) (16 %),group C : patients combined lesions (16/50) (32%) and group D (21/50) (42%) cases were normal.Conclusion : After one year from PCI there was high frequency of recurrence of symptoms exceeding half of the patients, most of them due to development of new lesion.

مستوى فيتامين د والكالسيوم في مصل الدم لدى النساء الحوامل اللواتي يعانين من القئ المفرط الحملي في مستشفى بغداد التعليمي == Serum Vitamin D and Calcium levels in Pregnant Women with Hyperemesis Gravidarum at Baghdad Teaching Hospital

Author name: نور جليل جبار الصائغ
Supervisor name: علياء مكي حسن الصافي
General topic: Medicine
Specific topic: Community Medicine
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: الخلفية : نقص فيتامين (د) ومستوى الكالسيوم في الدم له علاقة مع القيء المفرط الحملي. كان هدف الدراسة الحالي هو فحص مستويات فيتامين د والكالسيوم في مصل الدم لدى النساء الحوامل المصابات بالقيء المفرط الحملي وتاثيراته على صحة الانجاب لدى النساء الحوامل.طريقة البحث : هذه دراسة مقطعيه تشمل 97 مشاركة تشمل النساء الحوامل المصابات بالقيء المفرط الحملي تمت في مدينة الطب / بغداد / العراق. تم جمع البيانات من قبل الباحث بعد اعداد استبيان منظم لهذا الغرض بعد الحصول على الموافقة اللفظية من قبل المشمولين بالدراسة (عمر الامهات، الاقامة، الحالات الزوجية، الاقتصادية والاجتماعية، والتعليمية والمهنية، التاريخ الحملي السابق والحالي ومؤشر كتلة الجسم). اجريت التحاليل المختبرية بحساب نسبة فيتامين د والكالسيوم في مصل الدم.النتائج : ان اعمار النساء المشاركات بهذه الدراسة كان يتراوح بين 16 الى 41 عام، حيث ان 70% من المشاركات في هذه الدراسة كان متوسط اعمارهم يتراوح بين 25 الى 35 عام. ان اغلب المشاركات كانوا من متوسطي الدخل المعاشي (40%)، مستوى تعليم متوسط (54%)، ربات البيوت (77%) ونساء متعددات الولادات (1 الى 3 ولادات) (47%). حسب منظمة الصحة العالمية ان معدل الاسقاطات بين النساء للحوامل يمثل نسبة عالية تصل الى (25%) والنساء اللاتي يلدن ولادات ميتة ايضا يشكل نسبة مرتفعة (12%). كان مؤشر كتلة الجسم 56 ٪ من عينة الدراسة. فيما يتعلق بفقر الدم، كان معظم عينات الدراسة يعانين من فقر الدم (70 ٪) مع التاريخ الغذائي السيئ اثناء الحمل (61 ٪) وانخفاض التعرض للشمس (84 ٪). وجود فقر الدم (فيتامين د : ص = 1.0؛ الكالسيوم : ر = 1.0) والتاريخ الغذائي (فيتامين د : ص = 0.07، ع = 0.82؛ كالسيوم : ر = 1.0) اثناء الحمل، كان له ارتباط عالي غير مهم للانقسام من النساء مع نقص فيتامين (د) وانخفاض الكالسيوم في الدم.الاستنتاج : توصلت الدراسة الى ان نسبة عالية من النساء الحوامل اللواتي يعانين من القيء المفرط الحملي تعاني من نقص في فيتامين د ومستوى الكالسيوم في مصل الدم، وكشفت ايضا ان الامهات التي يعنين من نقص فيتامين د ومستوى الكالسيوم في مصل الدم اثناء الحمل واللواتي يعانين من القيء المفرط الحملي يرتبطان ارتباطا بشكل كبير مع ارتفاع خطر الاصابة بفقر الدم. ان خطر نقص في فيتامين د ومستوى الكالسيوم في مصل الدم النساء الحوامل اللواتي يعانين من القيء المفرط الحملي ارتفاع في النساء الحوامل اللواتي كن ربات البيوت وذوي الحالة الاجتماعية والاقتصادية المنخفضة وكذلك الاقل تعرض لاشعة الشمس، ومعدومة النشاط البدني، وكمية اقل من تناول المكملات التي تحتوي على فيتامين د ومكملات الكالسيوم | Background : Vitamin’D’deficiency has a close relation with hyperemesis’gravidarum and serum’calcium level.The current study objective was’to investigate the levels of vitamin D’and serum calcium in pregnant women’with hyperemesis gravedarum and their’effects on their obstetric health. Methodology : This is a’cross - sectional study including 97’pregnant woman with hyperemesis’gravedarum’conducted in’Baghdad Teaching Hospital from the period of seven month starting from November 2017 to May 2018. Data collection from direct interview for the pregnant women.The sociodemographic’data was collected by researcher following a’structured questionnaire about (maternal age, residency, marital, economic and social states, educational and occupation states, previous and current obstetrical history and body mass index were collected). Laboratory Investigations were’done to’estimation of vitamin D and serum calcium level. Results : The age of women included in the study ranged from 16 to 41 years and 70% of them were between 25 and 35 years. Most of the participants were medium socioeconomic state (40%), secondary educational level (54%), homemakers (77%), and multipara (1 - 3 para) (47%). History of miscarriage among pregnant females (23%) and history of fetal death was (12%). Body Mass Index was 56% of study sampl, which are obese women. Regarding the anemia, most of study sampl was anemic (70%) with bad dietary history during pregnancy (61%) and low sun exposure (84%). The presence of anemia (vitamin D : r=1.0; calcium : r=1.0) and dietary history (vitamin D : r=0.07, p= 0.82; calcium : r=1.0) during pregnancy, had non - significant high correlation to division of women with deficient Vitamin D and low serum calcium. Conclusion : The study findings that high percentage in pregnant women with Hyperemesis Gravidarum has deficiency in serum vitamin D and calcium level also revealed that’maternal vitamin D deficiency’and low serum calcium in pregnant women with Hyperemesis Gravedarum are’significantly associated with elevated’risk for anemia. The risk of’vitamin D deficiency and low’serum calcium was higher Hyperemesis Gravedarum pregnant women which were’housewives, and those with low’socioeconomic state and less exposure to’sunlight, no physical activity, and less’vitamin D and calcium supplement intake.

تقويم معدل الاستنبات ومستوى السايتوكينات في المريضات المصابات بالعقم الغير مفسر بعد الخضوع لخدش بطانة الرحم == Evaluation of Implantation Rate and Cytokines Level of unexplained Infertile Patients Undergoing Induced Endometrial Scratching

Author name: ايمان حسن فليح
Supervisor name: عفان عزت حسن | الفت محمد علي النقاش
General topic: Medicine
Specific topic: Obstetrics and Gynecology
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: العقم مشكلة عالمية تؤثر على الملايين من الازواج ،ان اقرب تعريف للعقم هو مرض يصيب الجهاز التناسلي ويؤدي الى الفشل في تحقيق الحمل السريري بعد مرور12 شهرا او اكثر من الجماع الجنسي غير المحمي.وقد اقترحت العديد من الدراسات وجود تاثير ايجابي في خدش بطانة الرحم المقصودة على معدل نجاح انغراس البيضة المخصبة، وخاصة في النساء اللاتي عانوا فشل متكرر او اجهاض متكرر او العقم بدون اسباب مبررة. احداث خدش في بطانة الرحم يعزز رد فعل التهابي وهو مفيد لتفضيل زرع الجنين. يتم تجنيد الخلايا القاتلة الطبيعية والبلاعم والخلايا الشجيرية في الموقع المصاب وكميات متزايدة من السايتوكينات وعوامل النمو والجاذبات الكيمياوية، مثل عامل النخر (TNF - α) وinterleukin - 6 (IL - 6) ، مما يعزز غرس ناجح.صممت الدراسة لتقصي تاثير خدش بطانة الرحم على افراز المصل والبطانة من TNF - α وIL - 6 ، وتاثيره على تعزيز عملية الزرع الناجحة. اجريت الدراسة في مستشفى العلوية التعليمي ومركزمتخصص لعلاج العقم في بغداد. سجلت هذه الدراسة مريضات يعانون من عقم غير مفسر لاكثر من سنة وبعمر اقل من 45 عاما. تم اجراء دراسة هرمونية اساسية ، وتم تقسيم عينة الدراسة كما هو محدد الى ثلاث مجموعات ، 31 (29.5 ٪) على الجماع العفوي الطبيعي ، 31 (29.5 ٪) للتلقيح داخل الرحم (IUI) و43 (41.0 ٪) للتخصيب الاصطناعي) الاخصاب خارج الجسم اوطفل الانبوب) ثم تعريض جميع المريضات الى خدش بطانة الرحم في اليوم 8 من الدورة الشهرية (الدورة التي سبقت دورة الاخصاب خارج الجسم اوطفل الانبوب في مجموعة الاخصاب الاصطناعي او طفل الانبوب) ، عن طريق استخدام الناظور الرحمي ، تم قياس TNF - α وIL - 6 في افرازات المصل والبطانة قبل وبعد الخدش.كانت معدلات الحمل 22 (33.33 ٪) ، 20 (30.30 ٪) ، و24 (36.4 ٪) عن مجموعة الجماع العفوي الطبيعي ، التلقيح داخل الرحم ، والتخصيب الاصطناعي، على التوالي ، وكانت حسابات الاختطار النسبي للحمل اعلى للمجموعة العفوية مع 1.194 RR ، 95٪ CI (0.892 - 1.1601) ، تليها مجموعة التلقيح داخل الرحم مع RR 1.038 ، 95٪ CI (0.757 - 1.423) ، وادنى في مجموعة التلقيح داخل الرحم ، مع RR 0.824 ، وCI 95٪ (0.600 - 1.131).من خلال قياس اثنين من اهم السيتوكينات في افرازات المصل والبطانة من المرضى المشاركين في هذه الدراسة قبل وبعد خدش بطانة الرحم ، وجد انه كان هناك فرق ذو دلالة احصائية (قيمة p <0.001) في TNF المصل والبطانة لانها كانت 3.84 ± 2.41 بيكوغرام / ديسيلتر ، و3.81 ± 2.30 بيكوغرام / ديسيلتر ، على التوالي ، وارتفعت الى 17.35 ± 6.39 بيكوغرام / ديسيلتر في المصل و22.84 ± 9.67 بيكوغرام / ديسيلتر في افرازات بطانة الرحم بعد خدش. كما اظهر IL6 اختلافا معنويا في المصل وفي افرازات بطانة الرحم ، حيث بلغ متوسط مستويات المصل IL6 4.27 ± 2.18 بيكوغرام / ديسيلتر قبل الخدش وارتفع الى 16.46 ± 4.27 بيكوغرام / ديسيلتر بعد الخدش ، في حين كان IL6 في افراز بطانة الرحم 3.86 ± 2.42 بيكوغرام / ديسيلتر قبل الخدش وزيادة الى 22.35 ± 9.14 بيكوغرام / ديسيلتر بعد الخدش.كان تاثير خدش بطانة الرحم على مؤشر النبض ذو دلالة احصائية مع فارق متوسط 0.893 ± 0.393 حيث كان 3.584 ± 0.373 قبل الخدش وانخفض الى 2.690 ± 0.357 بعد الخدش ، مع تغير متوسط النسبة بنسبة 24.54٪ ± 9.95٪.كانت هناك علاقة ارتباط معتدلة ذات دلالة احصائية مهمة بين تطور الحمل وارتفاع مستوى المصل والـ TNF ، وكانت اعلى في افرازات بطانة الرحم من TNF المصل ، ولكن بالنسبة لـ IL6 لم يكن هناك سوى علاقة ضعيفة ذات دلالة احصائية بين بطانة الرحم IL6 والحمل.وخلصت هذه الدراسة الى ان خدش بطانة الرحم يزيد معدل الحمل في جميع مجموعات الدراسة ولكن الحمل العفوي اكثر من التلقيح داخل الرحم، والاخير اكثر من التخصيب الاصطناعي. يسبب خدش بطانة الرحم زيادة كبيرة في تركيزات المصل وافرازات البطانة من TNF - α وIL - 6. وارتبط ارتفاع مستويات TNF - α وIL - 6 مع نتائج حمل افضل. ان خدش بطانة الرحم يقلل من معدل مؤشر المقاومة الشريانية للشريان الرحمي الذي يعني معدل تدفق افضل للدم وبالتالي تحسين نتيجة الحمل. | Infertility is a worldwide problem, affecting millions of couples, and never an old subject. Infertility is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Several studies have suggested a favorable effect of endometrial injury on the implantation success rate, especially in women with recurrent implantation failure or recurrent abortion or unexplained infertility. When local injury - induced in endometrial tissue this enhance an inflammatory reaction which is useful for favors implantation of embryo. Natural killer cells, macrophages, and dendritic cells are recruited to the injured site and increased quantities of cytokines, growth factors, and chemokines like Tumor necrosis factor - alpha, and interleukin - 6, all are secreted, thus resulting in a successful implantation. This prospective interventional study was designed to evaluate the effect of endometrial scratch on serum and endometrial secretion of Tumor necrosis factor - alpha and interleukin - 6, and its effect on promoting successful implantation. The study was done in Al - Alwia Teaching Hospital and privet infertility treatment center in Baghdad from January 2016 till December 2017. This study enrolled 105 female patients with unexplained infertility for more than 1 year and with age under 45 years. Basic hormonal study was done, and study sample was divided as indicated into three groups, 31 (29.5%) for natural conception, 31 (29.5%) for intrauterine insemination and 43 (41.0%) for in vitro fertilization program ,then all patients undergone endometrial scratch, at day 8 of menstrual cycle (in in vitro fertilization program group the scratch of endometrium done in the cycle that preceded the in vitro fertilization procedure ), by using hysteroscopy. Tumor necrosis factor - alpha, and interleukin - 6 was measured in serum and endometrial secretions before and after scratch. pregnancy rates for three groups was 22 (33.33%), 20 (30.30%), and 24 (36.4%) for Natural, Intra Uterine Insemination and In Vitro Fertilization , respectively and when calculate the relative risk (beneficial risk) for pregnancy it reveal that the highest for Natural conception group with 1.194 RR, 95% confidence interval (0.892 - 1.1601), followed by Intra Uterine Insemination group with RR of 1.038, 95% confidence interval (0.757 - 1.423), and lowest in In Vitro Fertilization group, with RR of 0.824, and 95% confidence interval (0.600 - 1.131). By measuring two of the most important cytokines in serum and endometrial secretions of patients involved in this study both before and after endometrial scratch, it was found that there was a highly significant difference (p - value <0.001) in serum and endometrial Tumor necrosis factor - alpha, as were 3.84 ± 2.41 pg/dl, and 3.81 ±2.30 pg/dl, respectively, and increased to 17.35 ±6.39 pg/dl in serum and 22.84 ±9.67 pg/dl in endometrial secretions after scratch. Also interleukin - 6 showed highly significant difference in serum and in endometrial secretions, as the mean serum levels of IL6 was 4.27 ±2.18 pg/dl before scratch and increased to 16.46 ±4.27 pg/dl after scratch, while the interleukin - 6 in endometrial secretion was 3.86 ±2.42 pg/dl before scratch and increased to 22.35 ± 9.14 pg/dl after scratch. The effect of endometrial scratch on pulsatility index was statistically significant with a mean difference of 0.893 ±0.393 as it was 3.584 ± 0.373 before scratch and decreased to 2.690 ± 0.357 after scratch, with mean percent change of 24.54% ± 9.95% reduction. There was a moderate statistically significant positive correlation between developing pregnancy and higher serum and endometrial Tumor necrosis factor - alpha, and that it was higher in endometrial secretions than serum Tumor necrosis factor - alpha , but for interleukin - 6 there was only a weak statistically significant correlation between endometrial interleukin - 6 and pregnancy. This study concluded that endometrial scratch increase pregnancy rate in all study groups but Natural conception is more than Intra Uterine Insemination and Intra Uterine Insemination is more than In vitro Fertilization - Embryo Transfer. Endometrial scratch causes a significant increment in serum and endometrial concentration of Tumor necrosis factor - alpha and IL - 6. Higher levels of Tumor necrosis factor - alpha and interleukin - 6 were associated with better pregnancy outcomes. Endometrial scratch decrease pulsatility index which mean better blood flow rate and good pregnancy outcome.

مجموعة التباين الوراثي احادي القاعدة للتلومريز, XPC وXRCC7 المتغيرة جينيا في المرضى المدخنين العراقيين المصابين بورم المثانة == Single Nucleotide Polymorphism (SNP) Panel for Telomerase, XPC, and XRCC7 Genes Variants in Iraqi Smoker Patients with Bladder Tumor

Author name: صالح علي محمود
Supervisor name: هدف ظافر الياسين | اسامة سليمان الناصري
General topic: Medicine
Specific topic: Clinical Biochemistry
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: سرطان المثانة هو واحد من اكثر الاورام الخبيثة شيوعا في المسالك البولية. يعتبر استهلاك التبغ لفترات طويلة احد العوامل الرئيسية المسببة لتطور سرطان المثانة ، والتي تسبب تلف الحمض النووي. ولذلك ، فان مسار اصلاح الحمض النووي هو من اهم النظم التي تحافظ على سلامة الجينات ومنع التسرطن. وكان الهدف من هذه الدراسة هو معرفة تاثير التباين الوراثي احادي القاعدة لثلاثة جينات مسؤولة عن اصلاح الحمض النووي TEP1 / rs2228041 , XPC / rs2228000) و( XRCC7 7003908 على الخطر بالاصابة بهذا المرض.الاهداف : ان الهدف الرئيسي من هذه الدراسة هو محاولة ايجاد علاقة بين التباين الوراثي احادي القاعدة الموجودة في ثلاثة جينات مختلفة مسؤولة عن اصلاح الحمض النووي والتحقق من تاثير تدخين التبغ على التباين الوراثي الموجود في جنات اصلاح الحمض النووي البشري TEP1 / rs2228041 ) ، XPC / rs2228000 و(XRCC7 7003908 في المرضى الذين يعانون من سرطان المثانة في وتاثيرها على تطور ومرحلة المرض.المرضى وطرق العمل : اشتملت هذه الدراسة على مجموع من 62 مريض مشخص بسرطان المثانة و38 شخص من الاصحاء مطابقين لهم بالعمر والجنس. تم جمع هذه العينات في الفترة من فبراير الى سبتمبر لسنة 2017 في دراسة مقارنة لمجموعه المرضى والاصحاء التي اجريت في قسم الكيمياء الحيوية في كلية الطب بجامعة بغداد.تم الكشف عن النمط الجيني لل TEP1 / rs2228041 (C> T) وXPC rs2228000 (C> T) باستخدام تفاعل البلمرة المتسلسل وطريقة سانجر في ايجاد تسلسل الحمض النووي.بينما كشف عن النمط الجيني للتباين الوراثي XRCC7 (T> G) باستخدام تفاعل البلمرة المتسلسل والمتحدد بطول القطعة المتباينة الشكل, (PCR - RFLP) وتاكيده تسلسل الحمض النووي باستخدام طريقة سانجر. تم حساب نسبة الارجحية (OR) ومجال الثقة 95 ٪ (CI) كمقياس للتاثير المشترك للتدخين السجائر ، والجينات اصلاح الحمض النووي المتباينة الشكل على خطر الاصابة بسرطان المثانة وتطوره ومراحلهه.النتائج : في هذه الدراسة ، اظهر الاليل T المتباين الشكل للجين TEP1 rs222804 علاقة معنوية في زيادة خطر الاصابة بسرطان المثانة (OR = 4.7, *p=0.04). ايضا ، اظهر الاليل T وجود علاقة معنوية في زيادة خطر الاصابة بسرطان المثانة بين الافراد المدخنين (OR =7.02, *p=0.01)علاوة على ذلك ، اظهر الاليل T علاقة معنوية لمرحلة T2 لسرطان المثانة ((OR=13.2, **p=0.001 اظهر النمط الوراثي المغاير الزيجة من XPC rs2228000 (C> T) زيادة كبيرة في خطر الاصابة بسرطان المثانة (OR=2.75, *p value<0.05). كذلك ، قد وجدت الدراسة ان المرضى الذين يعانون من الاليل متعدد الاشكال للنمط الجيني T قد زاد بشكل كبير من خطر الاصابة بسرطان المثانة (OR= 2.7; *p = 0.02).احصائيا, وجدت زيادة معنوية كبيرة في خطر الاصابة بسرطان المثانة عند الاشخاص المدخنين الحاملين للاليل T (OR= 4.3; **p = 0.004).علاوة على ذلك ، لوحظ ايضا ان الطرز الوراثية للاليل T ترتبط بزيادة ملحوظة في خطر T1 (OR= 3.9 **p = 0.005).في الدراسة الحالية ,ان خطر الاصابة بسرطان المثانة قد ازداد بشكل كبير لدى الاشخاص الحاملين للجين متعدد الاشكال متماثل الزيجة الوراثية (للنمط الجيني GG) (OR= 4.0; *p = 0.03) في حين ان النسبة بهذا الخطر قد قلت لدى الاشخاص الذين لديهم جين من النوع الطبيعي (للنمط الجيني TT). ايضا ، زيادة خطر الاصابة بسرطان المثانة زيادة كبيرة احصائيا بين الافراد الحاملين للاليل G(OR= 5.5; ***p = 0.0001). كما لوحظ ان النمط الوراثي للاليل G مرتبط بزيادة كبيرة بخطر الاصابة بالمرحلة T2 لسرطان المثانة (OR= 3.7; **p = 0.001) ، وايضا Ta (OR= 3.5; **p = 0.003).استنتاجتوحي الدراسة الحالية ان وجود الانماط الجينية المتباينة الاشكال لجينات اصلاح الحمض النووري للمروثات يمكن ان يزيد من خطر الاصابة بسرطان المثانة ويؤثر ايضا على تطور ومراحل المرض في حين ان النمط الجيني الطبيعي يمكن ان يقلل من خطر الاصابة بسرطان المثانة وزيادة معدل البقاء على قيد الحياة لمرضى سرطان المثانة. علاوة على ذلك ، يمكن لهذه الاشكال الجينية ان تكون اداة مفيدة لمعالجة المرض للافراد الذين لديهم مقاومة لعلاج السرطان. | XPC Xeroderma pigmentosum CXPG Xeroderma pigmentosum G AbstractBackgroundBladder cancer is one of the most common malignancies of the urinary tract. Prolonged tobacco consumption constitutes the major etiological factors for bladder cancer development, which induce DNA damage. Therefore, DNA repair pathway is a crucial system in maintaining genomic integrity and preventing carcinogenesis. The present work was aimed to predict the consequence of three polymorphisms of the DNA repair genes (TEP1/rs2228041, XPC/rs2228000, and XRCC7 7003908) on the disease predisposition.ObjectivesThe main objective of this study is attempted to find the association between SNPs in different DNA repair pathway and investigating the influence of active tobacco smoking on human DNA repair gene polymorphisms (TEP1/rs2228041, XPC/rs2228000 and XRCC7 7003908) in patients with bladder cancer in and the impact of these polymorphism on the staging and development of the disease.Subjects and MethodsA total of 62 of histo - pathologically confirmed diagnosed bladder cancer patients, and 38 age - matched healthy controls were involved in the study. All were recruited from February to September 2017 in a case - control study conducted at the Department of Biochemistry - College of Medicine University of Baghdad. Genotyping of the TEP1/rs2228041 (C>T) and XPC rs2228000 (C>T) was evaluated using polymerase chain reaction and fully genotyped by Sanger sequencing method. Genotyping of the XRCC7 polymorphism (T>G) was evaluated using a polymerase chain reaction - restricted fragment length polymorphism (PCR - RFLP) and confirmed by Sanger sequencing method. The odds ratio (OR) and 95% confidence interval (CI) were calculated as a measure of the combined effect of cigarette smoking, and DNA Repair Genes Polymorphisms on bladder cancer risk, staging.ResultsIn this study, the polymorphic T allele of the TEP1 rs222804 polymorphism showed a significant association in increase bladder cancer risk OR = 4.7, p=0.04. Also, the T allele showed a significant association in increase bladder cancer risk among smoker individuals OR= 7.02, p=0.01. Furthermore, the T allele showed a significant association for the T2 stage of bladder cancer (OR=13.2, p=0.001). Heterozygous genotype of the XPC rs2228000 (C>T) showed a significant increase in bladder cancer risk OR =2.75, p value<0.05. Also, the study found that patients with the polymorphic allele (T genotype) have significantly increased the risk of bladder cancer (OR= 2.7; p = 0.02). A statistically highly significant increased in bladder cancer risk was found in the smoker individuals who carrying T Allele (OR= 4.3; p = 0.004). Moreover, T Allele genotypes were also observed to be associated with a significantly increased risk of T1 (OR= 3.9; p = 0.005). In the current study, individuals with the homo polymorphic gene (GG genotype) have significantly increased the risk of bladder cancer (OR= 4.0; p = 0.03), while subjects having the homo wild - type gene (TT genotype) could decrease the risk of bladder cancer. Also, a statistically highly significant increased bladder cancer risk in the smoker individuals who carrying G Allele (OR= 5.5; p = 0.0001). G Allele genotypes were also observed to be associated with a significantly increased risk of T2 (OR= 3.7; p = 0.001), and for Ta (OR= 3.5; p = 0.003).ConclusionThe present study suggested that having polymorphic genotypes of DNA repair gene polymorphisms (TEP1/rs2228041, XPC/rs2228000 and XRCC7 7003908) could increase the risk of bladder cancer and also affect the development and staging of the disease while having the wild type genotypes could decrease the risk of bladder cancer and increase the survival rate of bladder cancer patients. Furthermore, these gene polymorphisms could be a useful tool to tackle these emerging problems and is an attractive target for individual anticancer treatment.

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

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

مستوى الكالبروتيكتين بروتين (S - 100) في مصل الدم للمرضى المصابين بالتهاب الفقار المقسط في العراق وعلاقته بالعلاج, نشاط المرض وتنميط.HLA == The Serum Level of Calprotectin (S - 100 protein) in Iraqi Patients with Ankylosing Spondylitis and its Relation with Treatment, Disease Activity and HLA Typing

Author name: خالد محمد عبد الواحد
Supervisor name: جاسم محمد كرحوت | محمد هادي العصامي
General topic: Medicine
Specific topic: Microbiology - Immunology
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: لقد اجريت هذه الدراسة في الفترة ما بين تشرين الاول عام 2016 وتشرين الاول عام 2017 على 90 شخصا تم تشخيص 60 منهم على انهم مصابين بالتهاب الفقار المقسط (مجموعة المرضى) وكان 30 منهم يتناولون العلاج التقليدي (الستيرويد و/او العقاقير السامة للخلايا) الذين كانوا يحضرون للعيادة الخارجية للمفاصل بمستشفى بغداد التعليمي في حين كان هناك 30 مريضا اخرين يتلقون العلاج البيولوجي Inliximab infusion)) وهم يحضرون ردهة العلاج البيولوجي وكان هناك ايضا 30 اخرون من مجموعة الاصحاء. تم جمع عينات الدم من المرضى والاصحاء لتقييم الكالبروتيكتين(Calprotectin) (Matrix(metalloproteinase - 3) في مصل الدم وتم الكشف عنها بواسطة مقايسة الممتز المناعي المرتبط بالانزيم ELISA)). تم قياس hs - CRP بواسطة nephlometer كما تم فحص HLA B - 27 بواسطة التفاعل المتسلسل للبوليميريز في الوقت الحقيقي RT - PCR)). كان مجموع مرضى الدراسة الحالية 60 مريضا، كان متوسط اعمارهم 40.05 ± 8.02 سنة ، وكانت نسبة الذكور سائدة اكثر من الاناث في نسبة (M : F 11 : 1). لقد اوضحت الدراسة الحالية ان مستويات الكالبروتيكتين في المصل كانت اعلى في مجموعة المرضى (89.23 ± 73.97) من مجموعة الاصحاء (54.94 ± 20.51) وكان هذا الفرق ذو دلالة احصائية (P= 0.0148) ، وكان اعلى ايضا في المرضى الذين عولجوا بالعلاج التقليدي مقارنة بالمرضى الذين عولجوا بالعلاج البيولوجي (infliximab infusion) وكان الفرق ذو دلالة احصائية (P = 0.0013) بينما لم يكن هناك فرقا احصائيا بين المرضى الذين كان BASDAI وBASFI < 4.0 وغيرهم من المرضى الذين كان BASDAI و4.0 ≤ BASFI ولا بين المرضى الذين HLA B - 27 ايجابية وغيرها سلبية. لقد كان متوسط مستوى المصل من مركب Metalloproteinase - 3 من المرضى اعلى من مجموعة الاصحاء وكان ذو دلالة احصائية عالية (P= 0.0093)وكان اعلى ايضا في المرضى الذين عولجوا بالعلاج التقليدي ، مقارنة بالمرضى في العلاج البيولوجي (infliximab infusion) والفرق كان ذو دلالة احصائية (P value = 0.0235). وفيما يتعلق باختبار hs - CRP الذي كشف ان متوسط مستوى hs - CRP في المصل للمرضى كان اعلى من مجموعة الاصحاء وكان ذو دلالة احصائية عالية (P= 0.0001) وكان اعلى ايضا في المرضى الذين عولجوا بالعلاج التقليدي ، مقارنة بالمرضى الذين كانوا يتلقون العلاج البيولوجي (infliximab infusion) وكان هذا الفرق ذو دلالة احصائية(P = 0.0235). لقد اظهرت الدراسة الحالية ان HLA B - 27 كان ايجابيا في 34 مريضا (56.7 ٪) ، ولم يكن موجبا في اي شخص من مجموعة الاصحاء وكان هذا الفرق ذو دلالة احصائية عالية (P < 0.0001) وكان هناك فرق كبير من hs - CRP بين مجموعات HLA B - 27 الايجابية والسلبية (P= 0.0437) ولم يتم الكشف عن اختلافات اخرى (ESR ، Calprotectin ، MMP - 3 ، BASDAI ، BASFI) بين مجموعة المرضى HLA B - 27 الايجابية والسلبية. فيما يتعلق بالعلاقة بين ESR وCalprotectin وMMP - 3 وhs - CRP في كلا المجموعتين من المرضى. كان هناك ارتباط مباشر كبير بين hs - CRP وESR (P value = 0.005) ولم يلاحظ اي ارتباط بين المعلمات الاخرى في كلتا المجموعتين من المرضى.لقد اوضحت الدراسة ان الكالبروتيكتين في المصل كان اعلى في مجموعة المرضى من مجموعة الاصحاء وكان اعلى في المرضى الذين يتلقون العلاج التقليدي مقارنة بالمرضى المعالجين بالعلاج البيولوجي ولم تكن هناك علاقة بين مستوى الكالبروتيكتين في المصل ونشاط المرض ولا بوجود HLA B - 27 . | patients were diagnosed as established ankylosing spondylitis patients, thirty (30) patients of them were on conventional treatment (steroid and/or cytotoxic drugs) who were attending the Rheumatology Outpatient Clinic of Baghdad Teaching Hospital, while the other thirty (30) patients were on biological treatment (infliximab infusion) attending biological therapy room and other thirty (30) were apparently healthy control group. Blood samples were collected from patients and controls to assess Serum calprotectin and matrix metalloproteinase - 3 which were detected by enzyme linked immunosorbent assay, the high sensitivity C - Reactive Protein was measured by nephelometer,, wherease Human Leucocyte Antigen B - 27 has been done by real time polymerase chain reaction. Out of 60 patients study group included in the current study, their mean age was 40.05 ± 8.02 years, the males were predominant than females in a ratio (M : F 11 : 1). The current study revealed that serum level of calprotectin is higher in patient group (89.23±73.97) than control group (54.94±20.51) and this difference is statistically significant (P - value =0.0148), and also is higher in patients treated with conventional treatment, than in patients treated with biological treatment (infliximab infusion) and the difference is statistically significant (P - value =0.0013) while the difference is not statistically significant between patients whose Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index < 4.0 and other patients whose Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index ≥ 4.0 nor between patients whose Human Leucocyte Antigen B - 27 positive and others negative. Mean serum level of matrix metalloproteinase - 3 of patients is higher than control group and is highly statistically significant (P - Value 0.0093) and also higher in patients treated with conventional treatment, than in patients on biological treatment (infliximab infusion) and the difference is statistically significant (P - value =0.0235). Regarding high sensitivity C - Reactive Protein test which revealed that mean serum level of high sensitivity C - Reactive Protein of patient higher than control group and is highly statistically significant (P - Value =0.0001) and also higher in patients treated with conventional treatment, than in patients on biological treatment (infliximab infusion) and this difference is statistically significant (P - value = 0.0235). The current study showed that Human Leucocyte Antigen B - 27 was positive in 34 (56.7 %) patients, and in no subject ( 0 %) from control group and this difference is highly statistically significant (P - Value < 0.0001) and there is a significant difference of high sensitivity C - Reactive Protein between positive and negative Human Leucocyte Antigen B - 27 groups (P - value =0.0437) and no other differences detected of (Erythrocyte Sedimentation Rate, Calprotectin, matrix metalloproteinase - 3, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index) between positive and negative Human Leucocyte Antigen B - 27 patients group. Regarding the correlation between Erythrocyte Sedimentation Rate, Calprotectin, matrix metalloproteinase - 3 and high sensitivity C - Reactive Protein in both patients groups; there is a significant direct correlation between high sensitivity C - Reactive Protein and Erythrocyte Sedimentation Rate (P - value=0.005) and no correlation is observed between the other parameters in both patients groups. The study had showed that serum Calprotectin is higher in patients group than control group and also higher in patients on conventional treatment than in patients on biological treatment, and there is no relation between serum calprotectin level and disease activity nor Human Leucocyte Antigen B - 27 typing

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

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

قياس الفعالية الانزيمية وتحديد الطفرات الجينية لانزيم الثايوبيورين الناقل لمجموع المثيل في عينة من الاطفال العراقيين المصابين بسرطان الدم اللمفاوي الحاد == Thiopurine S - Methyltransferase Phenotype and Genotype in a Sample of Iraqi Children with Acute Lymphoblastic Leukemia

Author name: نوار سمير محمد
Supervisor name: منال كمال رشيد | حسنين حبيب غالي
General topic: Medicine
Specific topic: Clinical Biochemistry
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : The most common childhood cancer is acute lymphoblastic leukemia which is only treated with chemotherapy alone.All modern protocols of acute lymphoblastic leukemia treatment used thiopurine drugs as an essential anti - cancer drug which used for a long period of time. The 6 - Mercaptopurine is an anti - cancer drug widely used for treating acute lymphoblastic leukemia patients. The patients with low Thiopurine S - Methyltransferase enzyme activity is with an increased risk of developing drug toxicity and consequently unsuccessful acute lymphoblastic leukemia outcome and even death.Thiopurine S - Methyltransferase is one of the main enzymes involved in 6 - mercaptopurine metabolism, and the low activity of this enzyme is strongly correlated to the Thiopurine S - Methyltransferase genetic polymorphism.Aim : Find out the three most common Thiopurine S - Methyltransferase enzyme polymorphism TPMT*3A, TPMT*3B and TPMT*3C in Iraqi pediatric patients with acute lymphoblastic leukemia, and its frequencies. Analyses of Thiopurine S - Methyltransferase activity in the serum of those patients, and compare the results with other population. Methods : This is a cross - sectional study included eighty - one (81) Iraqi pediatric patients with acute lymphoblastic leukemia during the maintenance phase of their UKALL protocol treatment, receiving 6 - Mercaptopurine drug with age range from 1.83 (1year and 10 months) to 16.25 (16 years and 3 months). Thiopurine S - Methyltransferase activity was measured in the patients’ serum by Enzyme - Linked Immunosorbent Assay technique and three of Thiopurine SMethyltransferase genetic polymorphisms were detected by allelespecific multiplex - PCR analysis after DNA extraction from the whole blood. Liver Function Tests were measured by calorimetric method; Alanine Aminotransferase, Aspartate Aminotransferase, Alkaline Phosphatase and Total Serum Bilirubin in addition to Complete BloodCount measured by automated hematology system. Results : There was significant difference in the mean of Thiopurine S - Methyltransferase activity between pediatric patients carrying the wild - type allele TPMT*1 (n=49), with allele frequencies of 60.4% and pediatric patients (n=32) carrying the mutant alleles (TPMT*3A or TPMT*3C) with allele frequencies of 81.2% and 18.7% respectively. The TPMT*3B allele was not detected in this group. The P - value was highly significant (P<0.000**).Conclusion : This study is the first to analyze Thiopurine SMethyltransferase mutant gene frequency in a sample of the Iraqi population, and it revealed the presence of TPMT*3A and TPMT*3C genetic polymorphism but not a TPMT*3B mutant allele. Thiopurine S - Methyltransferase activity was low in the patients with mutant gene as compared with the wild - type allele patients. Finally, genotype and phenotype of Thiopurine S - Methyltransferase enzyme is an essential predictor to reduce the cytotoxic effects of the anticancer drug and successful acute lymphoblastic leukemia treatment.

تركيزات البلازما والاداة المساعدة للتشخيص لعامل النمو البطاني الوعائي (VEGF) ، مصفوفة ميتالوبروتيناز - 2 (MMP - 2) ، مثبطات الانسجة لمركب الميتالوبروتيناز - 2 (TIMP - 2) والمستعمرة الضخمة (M - CSF) في النساء اللواتي يعانين من ورم الثدي : دراسة مقارنة مع م == Plasma Concentrations and Diagnostic Utility of Vascular Endothelial Growth Factor (VEGF), Matrix Metalloproteinase - 2 (MMP - 2), Tissue Inhibitors of Metalloproteinase - 2 (TIMP - 2), and Macrophage Colony Stimulating Factor (M - CSF) in Women with Brea

Author name: اسيل نبيل كامل
Supervisor name: باسل عويد محمد صالح | كفاح حمدان
General topic: Medicine
Specific topic: Clinical Biochemistry
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: سرطان الثدي هو الورم الخبيث الاكثر شيوعا في النساءويعتبرالسبب الرئيسي الثاني لوفاة مرضى السرطان في العالم. تعتبر الوقاية والكشف المبكر هوالطريقة الاكثر فعالية لمكافحة السرطان. خلال العقد الماضي ، جذبت الكثير من علامات البيوكيميائية لسرطان الثدي انتباه العديد من الباحثين. هذه العلامات يمكن استخدامها في مراقبة العلاج ، والتنبؤ بدرجة اصابة الانسجة ، وسلوك الورم ، ومدى انتشاره ، واحتمالية اصابةالعقد الليمفاوية. من بين هذه الواصمات الحيوية ، عامل نمو بطانة الاوعية الدموية (VEGF) ، خلايا البلعوم المحفزة للحفظ (M - CSF)، ومصفوفة الميتالوبروتنيز MMP - 2))، ومثبطات الانسجة لمركب الميتالوبروتينيز(TIMP - 2). تشير الدلائل المتزايدة الى ان قياس VEGF هو افضل مرشح لتشخيص سرطان الثدي (افضل من مستضد السرطانCA 15 - 3 ) خاصة في المرحلتين الاولى والثانية وكذلك في التمايز بين الورم الخبيث وورم الثدي الحميد. اظهرت الدراسات ان قياس VEGF لا سيما مع CA 15 - 3 ، اعلى فائدة وقوة تشخيصية في الكشف عن سرطان الثدي.وفي الاونة الاخيرة ، تم التوصل في البحوث الحديثة الى ان TIMP - 2 قد يكون ذو فائدة في التشخيص المبكر لسرطان الثدي في مراحله الاولى زتهدف هذه الدراسة الى : 1) قياس تركيزات البلازما لبعض المرقمات الحيوية الجديدة بما في ذلك : عامل نمو بطانة الاوعية الدموية (VEGF) ، ومصفوفة الميتالوبروتينيز ((MMP - 2 ، ومثبط الانسجة لمركب الميتالوبروتينيز ((TIMP - 2 ، وعامل تحفيز مستعمرة البلعم (M - CSF) بالاضافة الى مثبط السرطان 15 - 3 ( CA15 - 3) في النساء المرضى الذين يعانون من ورم الثدي بالمقارنة مع النساء الاصحاء.2) التحقيق في الاداة التشخيصية لكل من المرقم الحيوي المقاس (وبالاقتران مع بعضها البعض) في الكشف عن ورم الثدي و(3) مقارنة النتائج مع معلمات الهستوباثولوجي ( العمر, الجنس , الحالة الزوجية , سن الياس حجم الورم , مرحلة الورم السرطاني , مستقبل الاستروجين , مستقبل الروجيستيرون ومستقبلات 2 Her)المواد وطرق العمل : اشتملت الدراسة على 88 امراة عراقية تم تقسيمهم الى ثلاثة مجاميع : 38 امراة مصابة بسرطان الثدي (Group I, BC) ، 25 امراة مصابات بورم الثدي الحميد الغدي الليفي Fibroadenoma (FA) (Group II, FA benign ) اللواتي تم تشخيصهن من قبل مجموعة اخصائي الاورام و25 امراة سليمة (كمجموعة ضابطة). تم تشخيص ورم الثدي من قبل مجموعة من الاخصائيين في الاورام. حيث تم التشخيص بناء فحوصات تجرى على عينة تؤخذ من خزعة نسيجية من ورم الثدي او بعد استئصال الثدي. تم تنفيذ اجراءات التدريج العلاجي على اساس فحوصات الجسم والدم ، والتصوير الشعاعي للثدي ، وفحص الثدي بالموجات فوق الصوتية ، والاشعة السينية للصدر حسب توفرها وضرورتها. تم اجراء تصنيف الاورام وتدريجها اعتمادا على معايير الاتحاد الدولي لمكافحة سرطان الاورام - (UICC - TNM) واللجنة الامريكية المشتركة لمرحلة مكافحة السرطان. تم تقسيم النساء المصابات بسرطان الثدي الى مجموعات فرعية على اساس مراحل السرطان ؛ المجموعة (ا) : تشمل 12 امراة في المرحلة الاولى (T1N0M0) ، حيث حجم الورم <2 سم ، المجموعة ب : 14 امراة في المرحلة الثانية (T2N0M0 ، T2N1M0 ، T3N0M0) ، حجم الورم (2 - 5) سم ومجموعة C : تشمل 12 امراة في المرحلة الثالثة (T2N2M0 ، T3N1M0 ، T3N2M0 وT4N2M0) ، كما كان لديهم حجم الورم > 5 سم. في هذه الدراسة تم استبعاد النساء المصابات بسرطان الثدي في المرحلة المتقدمة (المرحلة الرابعة) ، والنساء اللواتي يعانين من المرض سابقا او اللواتي يعانين من انواع اخرى من السرطانات؛ السرطانات التناسلية الانثوية (سرطان المبيض ، سرطان عنق الرحم ، سرطان الرحم) ، اورام الكلى ، القولون والمستقيم ، البنكرياس ، الرئة والراس والعنق. ايضا ، تم استبعاد المدخنين والنساء اللواتي يتناولن المشروبات الكحولية من هذه الدراسة. تم سحب عينة الدم من كل امراة لقياس VEGF ، M - CSF ،TIMP - 2,MMP - 2 و3 CA15 - . ايضا تم قياس مصل 25 هيدروكسي فيتامين D (25OHD) ومعلمات الدهون بما في ذلك الكولسترول الكلي (TC) ، والدهون الثلاثية (TG) ، والكوليسترول الدهني عالي الكثافة (HDL - C) ، والكولسترول الدهني منخفض الكثافة (LDL - C) فقط في المجموعة الاولى والمجموعة الثانية | Breast cancer (BC) is the most common malignancy in women and the second leading cause of their death from cancer in the world. The most effective way to combat cancer is its prevention and early detection. During the last decade, biochemical markers of breast cancer have attracted the attention of many researchers. Among these biomarkers, the interest points to Vascular Endothelial Growth Factor (VEGF), Macrophage Colony Stimulating Factor (M - CSF), Matrix Metalloproteinase - 2 (MMP - 2), Tissue Inhibitors of Metalloproteinase - 2 (TIMP - 2). Growing evidence indicates that measurement of VEGF maybe the best candidate for BC diagnosis (better than CA 15 - 3) especially in stages I and II as well as in the differentiation between BC and benign breast tumor. More recently it has been reported that TIMP - 2 maybe useful in early diagnosis of BC and differentiation of breast cancer stages. The aim of this study are to : (1) Measure the plasma concentrations of some of new biomarkers including : Vascular Endothelial Growth Factor (VEGF), Matrix Metalloproteinase - 2 (MMP - 2), Tissue Inhibitor of Metalloproteinase - 2 (TIMP - 2) and Macrophage - Colony Stimulating Factor (M - CSF) in addition to CA 15 - 3 in women patients with breast tumor in compare son with healthy control women, (2) Investigate the diagnostic utility of each of the measured biomarker (and in combination with each other) in detection of breast tumor and (3) Correlate the findings with the clinicopathological parameters (age, menopause, marital status, stages, tumor size, Estrogen Receptor (ER), Progesterone Receptor (PR) and Her - 2/neu receptor) in those patients.Subjects and Methods : Eighty - eight Iraqi women were enrolled in the study; 38 women with primary breast cancer (BC, Group I), 25 women with Fibroadenoma (FA) benign breast tumor (FA, Group II) and 25 apparently healthy women (served as control group). The diagnosis of breast tumor was achieved by the Oncology group. Histopathology investigations were performed by Consultant Histopathologic based on tissue biopsy of mammary tumor or after mastectomy. Tumor classification and staging were performed depending on criteria of International Union against Cancer Tumor - Node - Metastasis (UICC - TNM) classification and the American Joint Committee on Cancer Staging. Accordingly, women with breast cancer were classified into subgroups based on the stage of their BC; Group A : 12 women with stage I, Group B : 14 women with stage II, and Group C : 12 women with stage III. Exclusion criterion includes those women with breast cancer of advanced stage (stage IV), a previous history of multiple type of cancers; female reproductive tract cancers (ovarian, cervical and endometrial cancers), renal, colorectal, pancreatic, lung, head and neck tumors. Blood sample was aspirated from each woman for the measurement of plasma VEGF, M - CSF, MMP - 2, TIMP - 2 and serum CA15 - 3 by using enzyme linked immunosorbent assay (ELISA). Also, serum vitamin D3 was measured in group I only using ELISA and serum lipid profile parameters were measured in group I and group II. Results : The mean (±SD) values of plasma levels of VEGF (p<0.001), MMP - 2 (p< 0.001), TIMP - 2 (p < 0.001), M - CSF (p < 0.05), and CA 15 - 3 (p<0.001) of group I was significantly higher compared to that of group II and controls. However, the mean value of plasma MMP - 2 was the only measured biochemical marker which was significantly increased in group II compared to controls (p<0.001). Regarding the BC stages, the mean values of all the measured biochemical markers were significantly higher in stage III than in stage I and stage II (p<0.001). Interestingly, the mean (± SD) value of plasma TIMP - 2 levels was the only biochemical marker of the measured ones which was significantly increased in stage II than in stage I (p=0.001). The cut - point value of plasma VEGF (>55.73 pg/ml) or TIMP - 2 (>102 ng/ml) (for both, AUC=1.0) was the excellent test in differentiating women with stage I of BC from healthy women. While that of VEGF (>55.73 pg/ml), TIMP - 2 (>102 pg/ml) or CA15 - 3 (>10.82 u/ml) (for all, AUC=1.0) was considered as the best test in discriminating the BC stage II from healthy women. While, the cut - point value of plasma TIMP - 2 (>142 ng/ml) which has the highest (AUC=1.0) considered as the excellent test in differentiating BC stage I from women with fibroadenoma benign tumor (FA). While that of VEGF (>88.67 pg/ml) or TIMP - 2 (>254 ng/ml) which has the highest (for each, AUC=0.991) was considered as the best test in discriminating the BC stage II from FA. In addition, the plasma measurement of VEGF has the superior diagnostic utility in differentiation of FA women and healthy control women (p<0.001, AUC=0.998).Conclusion : Measurement of plasma VEGF (cutoff >55.22pg/ml) or TIMP - 2 (cutoff >102 ng/ml) is the best biochemical marker in diagnosis of stage I or stage II BC and differentiates them from healthy women; they have more diagnostic utility than CA 15 - 3. Also, measurement of TIMP (cutoff > 142 ng/ml) has the excellent diagnostic utility in diagnosis and differentiation of stage I BC from benign tumor fibroadenoma (FA). Moreover, TIMP - 2 (cutoff > 254 ng/ml) or VEGF (cutoff > 88.67 pg/ml) has the superior diagnostic utility over that of CA 15 - 3 in diagnosis and differentiation of stage II BC from FA. Plasma measurement of TIMP - 2 was the best biochemical marker in studying early progression of BC; it can differentiate stage II from stage I BC. Furthermore, plasma measurement of VEGF was found to be the excellent parameter in differentiation between women with FA from healthy ones.

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

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

تفاعل انزيم البلمرة المتسلسل النسخي العكسي ذي الوقت الواقعي كاداة تشخيصية جزيئية في التحري عن الجينات المدمجة الشائعة في عينة من الاطفال العراقيين المصابين بابيضاض الدم اللمفاوي الحاد == Real time reverse transcriptase polymerase chain reaction as diagnostic molecular tool in screening of common fusion genes in sample of Iraqi children with acute lymphoblastic leukemia

Author name: اريج عماد كاظم
Supervisor name: بان عباس عبد المجيد | سلمى عباس الحداد
General topic: Medicine
Specific topic: Diseases - Blood
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: ابيضاض الدم الليمفاوي الحاد عند الاطفال هو مرض متنوع له اصناف وراثية متعددة تستجيب بصورة مختلفة للعلاج الكيميائي. توجد الكثير من التغايرات الكروموسومية المؤدية الى انتاج جينات مدمجة مصاحبة لحدوث هذا المرض.اهداف الدراسة : لدراسة تعبير الجينات المدمجة الشائعة في ابيضاض الدم اللمفاوي الحاد عند الاطفال باستخدام تقنية تفاعل البلمرة المتسلسل ذي الزمن الواقعي وربط نتائج هذه الدراسة مع مختلف المؤشرات السريرية والمختبرية ثم تقييم هذا التعبير بعد العلاج الاولي.المرضى, المواد وطرق العمل : اجريت هذه الدراسة المستقبلية للحالات والشواهد باستخدام تقنية تفاعل البلمرة المتسلسل ذي الزمن الواقعي لدراسة تعبير الجينات المدمجة MLL - AF4 ,BCR - ABL1 ,E2A - PBX1 ,TEL - AML1 وSIL - TAL1 في ناضح نقي العظم ل 48 مريض بابيضاض الدم اللمفاوي الحاد قبل العلاج مع 46 شخوص ضابطة, تم جمعها من مستشفى حماية الطفل التعليمي / دائرة مدينة الطب للفترة من 1 تموز 2013 الى 31 حزيران 2014. استعمل جين GAPDH كجين مراقب داخلي لدراسة تعبير الجينات المذكورة بعد العلاج.النتائج : من اصل 48 مريض بابيضاض الدم اللمفاوي الحاد, كان هناك 21 ذكرا" و27 انثى مع نسبة ذكور الى الاناث 0.78 : 1 . تراوحت اعمارهم بين 2 شهر الى 13 عام مع متوسط عمر 5 اعوام . تراوحت اعمار 26 مريضا" بين 1 - 5 سنوات. اظهر الفحص الجزيئي الكشف عن نسخ الجينات المدمجة TEL - AML1، E2A - PBX1 وp190 1BCR - ABL في 20.8%, 16.7% و2.1% من المرضى، على التوالي، بينما لم يتم الكشف عن نسخ p210 1BCR - ABL ، MLL - AF4 وSIL - TAL1. بالاضافة الى ذلك، اظهر احد المرضى تعبير نسخي لكل من TEL - AML1 وE2A - PBX1 في الوقت نفسه. وجدت التعابير الجينية بعد بدء العلاج في 2 مرضى من اصل 12 مريض.الاستنتاجات : ان تقنية تفاعل البلمرة المتسلسل ذي الزمن الواقعي طريقة جزيئية دقيقة وقابلة للتطبيق في تصنيف ابيضاض الدم اللمفاوي الحاد في الاطفال. ان نتائج التصنيف الجزيئي للاطفال العراقيين المصابين بابيضاض الدم اللمفاوي الحاد مشابهة نوعا" ما للتقارير العالمية جاعلة TEL - AML1 الجين المدمج الاكثر انتشارا". | Pediatric acute lymphoblastic leukemia is a heterogeneous disease with various genetic subtypes that respond differently to treatment. Many chromosomal aberrations with resultant fusion genes are known to be associated with the disease.Objectives : To study the expression of common fusion genes in pediatric acute lymphoblastic leukemia using a quantitative real time polymerase chain reaction technique, correlate results with different clinical and laboratory findings and evaluate these expressions after initial treatment.Subjects, materials and methods : A case - control prospective study was conducted using qPCR technique to study the expression of TEL - AML1, E2A - PBX1, BCR - ABL1, MLL - AF4 and SIL - TAL1 fusion genes in bone marrow aspirates of 48 untreated acute lymphoblastic leukemia pediatric patients and 46 control subjects, were recruited at the Children Welfare teaching hospital / Medical City directorate for the period from 1st of July 2013 to 31st of June 2014. Post - induction transcripts’ evaluation for 12 ALL patients was done by comparative quantification method using GAPDH as a reference gene.Results : Out of 48 acute lymphoblastic leukemia patients, 21 were males and 27 were females with a male to female ratio of 0.78 : 1. Age ranged from (2 months to 13 years) with 26 patients aged between 1 - 5 years whereas the median age was 5 years. The mean age was 5.9 years + standard error of 0.51 years. Molecular screening demonstrated detection of TEL - AML1, E2A - PBX1 and BCR - ABL1 p190 transcripts in 20.8%, 16.7% and 2.1% of patients, respectively. BCR - ABL1 p210, MLL - AF4 and SIL - TAL1 transcripts were not expressed. One patient expressed both TEL - AML1 and E2A - PBX1 transcripts. Post induction transcripts were detected in 2 out of 12 patients.Conclusions : Real time PCR technique is an applicable molecular method in classifying and predicting prognosis in pediatric ALL. The molecular classification of Iraqi children with ALL is mostly similar to reports worldwide making TEL - AML1 fusion gene the most prevalent type

الاهمية السريرية لدراسة كهروفسلجـة القلب لدى مرضى التسارع الاذيني الانتيابي حول العقدة الاذينية البطينية == CLINICAL IMPORTANCE OF CARDIAC ELECTROPHYSIOLOGICAL STUDY IN PATEINTS WITH ATRIOVENTRICULAR NODAL REENTRANT TACHYCARDIA

Author name: امـين عبد الحسن مانع العـلواني
General topic: Medicine
Specific topic: Diseases - Heart
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: تعتبردراسة كهروفسلجة القلب من الفحوصات القسطارية الضرورية لدى المرضى المصابيين بالتسارع الاذيني الانتيابي والذي يحدث بسسب ظاهرة عودة الدخول الكهربائي حول العقده الاذينية البطينية. تهدف هذه الدراسة الى معرفة الاهمية السريرية لكهروفسلجة القلب في تقييم مرضى التسارع الاذيني الانتيابي حول العقده الاذينيه . لقد خضعوا جميع المرضى الى اجراء قسطرة كهربائية القلب وخلال هذه العملية تتم دراسة كهروفسلجة القلب حيث تم مراقبة التوصيل الكهربائي بين حزمة هز والبطينين وتثبيت سرعة التيار الكهربائي بين الاذين والبطين اثناء التسارع الانتيابي. وشملت هذه الدراسةتسعة وثلاثون مريض من كلا الجنسين وباعمار مختلفة. ومن خلال دراسة كهروفسلجة القلب لديهم تم تقسيمهم الى مجموعتيين المجموعه النموذجية الاكثر انتشارا حسب قياسات المسافة بين البطين والاذين اثناء التسارع الاذيني الانتيابي والتي تكون اقل من 60 مل/ثانيه. وكان عددهم ثلاثة وثلاثون مريض. والمجوعة الثانية وهي اللانموذجية والاقل شيوعا وكان عددهم ستة مرضى. والمسافة بين البطين والاذين اثناء التسارع الانتيابي اكثر من 60 مل/الثانيه. اظهرت النتائج الى ان اكثر من نصف المرضى تكون العقده الاذينيه الحبيبه ذات فيزيولجية ثنائية الذراع (البطيئ والسريع) 62% وهو الغالب في العادة، ولكن من خلال هذه الدراسة وجدت نسبة تكاد تكون عالية 38% نسبيا بين هولاء المرضى حيث كانت العقدة الاذينية البطينية ثلاثية او رباعية الذراع حيث يشترك اكثر من ذراع بطيئ في التسارع الانتيابي. بعد الاعتماد على نتائج الدراسة وتحديد نوع التسارع الاذيني الانتيابي يتم كوي الحزمه الكهربائية في الذراع البطيئ بعد تحديد مكان الذراع بالاعتماد على التشريح والموقع اثناء الدراسة. مع الاخذ بنظر الاعتبار ان جميع المرضى تم كوي الذراع لهم وبشكل ناجح ولكن القسم الاكبر 59% تم قطع الذراع بشكل تام حيث لاثوجد اي اشارات لكهروفسلجة القلب بعد الكوي والقسم الاخر تم كوي الذراع بشكل غير كامل او تغير في التركيب التشريحي للذراع وكانوا 41% من المرضى بالاعتماد على وجود بعض المواصفات من البداية من دون رجوع التسارع الاذيني الانتيابي بعد الكوي خلال تحفيز القلب بعد الكوي. وتم الاستنتاج من خلال الدراسة ان النساء يعانون بنسبة اكبر من تسارع فوق الاذيني المنتظم مقارنة بالرجال. مع وجود نسبة ليست بالقليلة والتي تصل الى ثمانية وثلاثون بالمئة من المرضى تكون فيها فزيولوجية العقده الاذينيه ثلاثية او رباعية الذراع مقارنة بالفيزيولوجية ثنائية الذراع وهو الشائع بالعادة. | AV nodal reentrant tachycardia (AVNRT) considered as the most common regular supraventricular arrhythmia in humans. It originates from a location within the heart above the bundle of His. It is more common in women than men. It represents an important cause of palpitations and to lesser extent, dizzy spells and syncope. An invasive electrophysiological study is a helpful procedure in the classification of AVNRT into common (typical) and uncommon (atypical) types. This study aims to : (1) Assess the role of electrophysiological study in the classification of AVNRT. (2) Explore the presence of multiple pathways in respect to the usual dual AV nodal pathways. And (3) Used EP study as predictor for successful ablation of the slow pathway. This study was conducted on Thirty nine (39) patients of either sex with paroxysmal supraventricular tachycardia corresponding to an AVNRT referred for catheter ablation. Each subject was submitted for history taking, examination, ECG, Echo study and basic invasive cardiac electrophysiological procedure that include right - sided cardiac catheterization through the femoral veins and programmed pacing was performed after localization of the catheters in the heart using the standard stimulation protocol to induce the tachycardia. In addition, His bundle study which involve measurement of atrial - His (AH) interval, Ventricular - atrial time (VA) as a baseline and after tachycardia induction, demonstration of the AH jump and/or echo beat (ectopic) pre and post ablation of the slow pathway using radiofrequency energy. However this study was conducted in Leipzig Heart Center/Germany from January 2013 to February 2014. The result of this study reveals that 33 (84.6%) of the patients developed typical AVNRT and 6 (15.4%) with atypical AVNRT. 25 patients (64.1%) were females (23 (92%) typical type and 2 (8%) atypical type) and 14 patients (35.9%) were males (10 (71.4%) typical type and 4 (28.6%) atypical type). Among the patients group with typical AVNRT the 91.7% discovered to have two AV nodal pathways and 84.6% with three pathways in respect to 8.3% with two AV nodal pathway and 15.4% with three pathways within the patients group with atypical AVNRT. Accordingly, 38.5% of all patients in this study discovered to have multiple pathways. Concerning ablation and modification of the slow pathway, complete ablation is achieved in 59% while modification of the pathways was noticed in 41%. In conclusion, this study concludes that an invasive electrophysiological study is a safe and reliable method for identification of patients with high risk of tachyarrhythmias. Moreover, most of the female patients discovered to have typical AVNRT. Unusually, higher percent of patients developed multiple pathways (more than two pathways) with respect to the usual dual pathways. The disappearance of post ablation EP data (AH jump and/or echo beat) reflect successful complete slow pathways ablation whereas the appearance of these data considered being a modification of the slow pathway

الدور الحتمل لكشف المستضد كالتومانان في مجال التشخيص المختبري من الرشاشيات الهوائية في مرضى نقص المانعة == The possible role of galactomannan antigen detection in laboratory diagnosis of invasive Aspergillosis in immunocompromised patients

Author name: رواء علي محمد
Supervisor name: وفاق محمود الوتار | علي محمد جواد
General topic: Medicine
Specific topic: Microbiology
Degree: Master
University: University of Baghdad - Faculty Of Medicine - Department Of Microbiology
Language: English
University location: Baghdad
First pages:
Abstract: This study was conducted to detect the invasive aspergillosis inimmunocompromised patients with rapid diagnostic method (ELISA).This study was conducted on 50 immunocompromised patients, theywere the attendants of Hematology / Oncology Department of BaghdadTeaching Hospital, pediatric oncology wards. The patients presented withfever which is not responding to antibiotics along with cough and sputumand abnormality on chest x - ray . And 11 healthy Iraqi individuals wereincluded in this study. from March 2013 till October 2013.Sputum and serum. initially direct microscopical examination donefor each sample and stained with gram stain. Sputum was immediatelycultured on Sabouraud dextrose agar (SAB) and Brain heart infusion agar(BHI) labeled with same code number of that sputum. Wet preparationwas down from colonies on Sabouraud dextrose agar plate or Brain heartinfution agar for isolation and identification of species of growingmould.This study showed that female to male ratio among patients studygroup was (1.2 : 1) .The age of the patients ranged from from 2 to 70 years with a meanage (31.8 ± 0.8) years. For the control the age ranged from 11 to 60 yearswith a mean age (31.1 ± 0.1) years. The peak mean age group (10 - 20)years with (5.1 ± 0.1).This study showed that 33( 66%) of patients were havingneutropenia which it is highly significant = 11.58 when the P value(P<0.01) , 10 ( 20% ) of patients were having neutrophilia and 7 (14%)of patients were having normal blood film results.IIThis study showed that sputum culture for Aspergillus positive in 18cases and it was negative in 17 patients, it was not done in 15 casesbecause some are from patients were sputum sampling was difficult to beobtained (pediatric), or have no sputum . And the Aspergillus speciesisolated from this culture showed that Aspergillus fumigatus is the most common species isolated from sputum culture 11 (61.1%) of positive culture results.The results showed high significant of AML diseases which composed 18 of 50 (36%) of patients , and most of the patients 24 of 50 (48%) of patients were on amphotericin B treatment.The results of the detection of galactomannan antigen detected by ELISA showed that the difference between the mean cutoff value of the patients and the control group was statistically significant (T = 0.135 and P value <0.05). In patient study group the ELISA test was positive in 39 of 50 (78% ) which it is highly significant when compared with noncancerous control group who were all negative 11 of 11 (100%) at p - value <0.001.Finally this study showed that (28 of 50) 56% of patients were dead because they are have invasive pulmonary aspergillosis (IPA) which is serious and potentially fatal disease that might kill the patients if any delay occurs in lab. diagnosis. So early diagnosis of invasive pulmonary aspergillosis may give higher cure rates.

دراسة التعبير الوراثي للجينات P53, KRAS, c - MYC & Her - 2/neu وانواع الرنا المايكريوية miR - 21, 34a, 92 & 98 على عينات ماخوذة من الغسول القصبي والانصباب الجنبي لمرضى مصابين بسرطان الرئة ومرضى مصابين بامراض رئوية مزمنة غير سرطانية == Expression of P53, KRAS, c - MYC, Her - 2/neu genes and microRNAs 21, 34a, 92 & 98 in cancerous and non - cancerous bronchial wash and pleural aspirate

Author name: حسين عبادي الجبوري
Supervisor name: بان عباس عبد المجيد | عدنان الجبوري
General topic: Medicine
Specific topic: Diseases
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Lung cancer is the leading cause of death from cancer in men all over the world. Most of newly diagnosed cases were in advanced stage and beyond radical treatment due to late appearance of worrying symptoms and absence of effective screening method for high risk groups. Nowadays, depending on recent advances in molecular studies researches are directed toward finding molecular markers for diagnostic, therapeutic and prognostic purposes. Aim of study : To investigate the possibility of using expression of P53, KRAS, Her - 2/neu, c - MYC and microRNAs 21, 34a, 92, and 98 as a molecular biomarkers for detection of lung cancer in samples of bronchial wash and pleural fluid. Material and Methods : A prospective case control study on a total of 120 samples, sixty bronchial washes and sixty pleural effusions. The samples were taken from patients recruited at the Thoracic Surgical Unit in the Specialized Surgery Hospital/ Medical City during the period from March 2012 to April 2014. The work was performed in the Department of pathology and forensic Medicine, Baghdad college of Medicine. The specimens were thirty bronchial wash and thirty pleural fluid samples positive for lung cancer cells by cytopathology, and similar number of negative samples. Studied genes were amplified using qRT - Realtime PCR. Housekeeping genes for normalization of mRNAs was GAPDH and RNU - 48 for microRNAs. Expression was calculated using equation; Expression = (2 - ΔΔCt). Results : Results of Ct values for each marker were obtained from Max Pro 5000 Agilent Technology PCR software and raw and standardized Ct values were analysed using SPSS - 22 software. The mean, standard deviation, t - test, ANOVA test and LSD (least significant difference) were obtained before and after normalization. A statistically significant differences in the expressions of p53, KRAS, c - MYC, Her - 2/neu and microRNAs, 21, 34a, 92, & 98 genes were found between positive and negative (control) samples with a significant p - values of <0.05. Conclusion : According to this study a conclusion could be reached; the study of expression profiles of mRNAs of P53, KRAS, c - MYC, Her - 2/neu and microRNAs 21, 34a, 92 and 98 genes can be used as a biomarker in the detection of lung cancer, differentiating subtypes, and screening of high risk groups

استخدام الصبغة المناعية p16INK4a والتهجين الموقعي وتاثيرها على فحوصات عنق الرحم الصحيحة والملتبسة == The Use of p16INK4a and In Situ Hybridization and Their Impact on the Healthy and Equivocal Pap Smears of the Cervix

Author name: ثناء جميل الخشالي
Supervisor name: ندى صالح امين | هدى مهدي الخطيب
General topic: Medicine
Specific topic: Anatomy and Histology and Embryos
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Throughout the past thirty years, the perception of cervicalcarcinoma has shifted from that of a mysteriously fatal disease, to one ofthe sexually transmitted, human papillomavirus (HPV) related infection.HPV DNA has been found in almost all cervical invasive and preinvasivecervical neoplasms.Conventional Pap smear, which was established in the early sixtiesreduced effectively the morbidity and mortality related to cervical cancer.Given the lower sensitivity of the Pap cytology test, new diagnosticparameters have been established. The histological features ofpreinvasive cervical neoplasia (CIN1, CIN2, and CIN3) are wellunderstood. However, misinterpretation of the morphological criteriacould lead to significant variability.The aim of this study is to identify women with equivocal and normalPap smear who are at risk for developing cervical cancer through the useof p16INK4a immunostaining and human papillomavirus (HPV) DNAtesting using in situ hybridization (ISH).Materials and MethodsIn order to identify human papillomavirus infection in minorcytological and histological abnormalities, biopsies collected from 60women 25 - 66 years of age with normal cervices and Pap smears (groupI), abnormal cervices and Pap smears (group II) and with cervicalcarcinoma (groupIII) referred to the Colposcopy Clinic in BaghdadTeaching Hospital - Medical City Complex, during the period from June2013 through July 2014. Cytology samples collected with ThinPrep forIVliquid base cytology (LBC), punch biopsy for histopathology formalinfixed and paraffin embedded. In situ hybridization (ISH) and p16INK4aimmunohistochemistry in addition to routine hematoxylin and eosin(H&E) stain were used to evaluate the histological specimens.ResultsThe age, age of marriage and parity of the three groups werestudied in relation to each of ISH and p16INK4a reactions. Agedistribution was highly significant among all age groups; in both ISH andp16 test results GI &GII (p=0.00), GI & GIII (p=0.00), GII &GIII(p=0.00) in both ISH and p16 test results. The age of marriage was notsignificant among the groups in both ISH and p16; GI & GII p (0.93), GI&GIII (0.12), GII &GIII (0.30). The effect of parity was insignificantamong all groups; GI & GII = (p = 0.66), GI & GIII (p = 0.82), GII &GIII (p = 0.79) in both ISH and p16 test resultsp16INK4a immunoreaction : Among group I there was a negativereaction in all the specimens collected. In specimens from group II, therewas a very mild or focal p16INK4a immunoreaction in one specimen(5%), a moderate immunoreactivity in 9 specimens (45%), and a highpositive reactivity in 10 specimens (50%) (p=0.000). Group III showedvery high immunoreaction in all the specimens collected.In situ hybridization (ISH) in group I was mild positive in 4specimens (20%) which showed diffuse signal pattern. A mild positivereaction with diffuse nuclear staining was noticed in 4 (20%) of thecervical specimens. Moderate positive reaction with diffuse staining ofthe nucleus was observed in 8 (40%) of the specimens. The remaining 8(40%) of the specimens showed both diffuse and punctate staining of theVnuclei. Among group III specimens, the nuclei in the epithelial cellsshowed both punctate and diffuse signal patterns.Chi square was done to compare results concerning ISH & variousgroups was highly significant (p= 0.00) ConclusionHPV infection is prevalent and can be missed by the conventional Pap smear. The severity of the disease was directly proportional with the age of women in this study. p16 overexpression was correlated with the positivity of ISH. This may support the use of either, or both, tests to improve the accuracy of cervical intraepithelial neoplasia (CIN) diagnosis, and help in the triage of women with equivocal lesions.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

التحليل الجزيئي للجين CYP21A2 في المرضى العراقيين المصابين بتضخم الغدة الكظرية الولادي == Molecular Analysis of CYP21A2 Gene in Iraqi Patients with Congenital Adrenal Hyperplasia

Author name: رقية غياث ياسين العبيدي
Supervisor name: بسام موسى صادق الموسوي
General topic: Medicine
Specific topic: Diseases - Genetics
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Congenital adrenal hyperplasia (CAH) is a group of autosomal - recessive disorders that result from a genetic defect in the pathway of steroidogenesis. The most common type is 21 - hydroxylase enzyme deficiency (21 - OHD), which accounts for 90 - 95% of cases and is categorized into two clinical forms : severe classic early onset (salt wasting and simple virilizing) and milder non - classic late onset forms. The molecular analysis of mutations affecting CYP21A2 gene coding for 21 - OH enzyme was not tried earlier in Iraqi patients.Aim of Study : To analyze the commonly expected mutations affecting CYP21A2 gene causing 21 - hydroxylase and thus congenital adrenal hyperplasia in Iraqi children and to determine the frequency of each type and their clinical impact.Patients, Materials & Methods : Fifty - four children with a clinical diagnosis of CAH were recruited from the Pediatric Endocrine Consultation Clinic / Children Welfare Hospital - Baghdad and the Genetic Consultation Clinic - Teaching Laboratories / Medical City - Baghdad during the period between September 14th, 2014 and March 14th, 2015. The clinical diagnosis of 21 - hydroxylase deficiency was made when the patients presented with ambiguous genitalia in females with or without dehydration, or vomiting and dehydration with normal male phenotype early in life, or pseudo - precocious puberty later in life.Peripheral blood samples were collected from all patients. Two samples were taken from those with ambiguous genitalia; one for chromosomal analysis and sex determination and the other for DNA analysis. For the other cases, a single sample was taken for DNA analysis.The other tests, namely electrolytes and hormonal assessment were sent for to be performed by another laboratory (governmental or private).Two cases with ambiguous genitalia showing male karyotypes were excluded from this study as they do not fit in the criteria of 21OHD.Molecular analysis of CYP21A2 gene was performed by PCR amplification using biotinylated primers and hybridization of amplification products to a test strip containing allele - specific oligonucleotide probes immobilized as an array of parallel lines. The bound biotinylated sequences are detected using streptavidin - alkaline phosphatase and color substrates according to the manufacturers’ instructions.Results : CYP21A2 gene was analyzed by CAH StripAssay® for detection of 11 common point mutations, and 50% of deletions and conversions in all 52 cases. Mutations (point mutations and deletions/conversions) were detected in 36 (69.2%) cases while 16 (30.8%) cases had undetected mutations. The most frequent mutations were : large deletions / conversions in 11 (21.15%), Q318X in 7 (13.46%), I2 Splice in 6 (11.54%), I172N in 5 (9.6%), Del 8bp in 1 (1.9%), V281L in 2 (3.85%), P453S in 1 (1.9%), R483P in 1 (1.9%) and multiple mutations in 2 cases (3.85%). Among those with large deletions/conversions, deletion/conversion (P30L, I2Splice, Del8bp) found in 3 (5.8%) cases, Deletion/conversion (P30L, I2 Splice, Del8bp, I172N) in 2 (3.85%) cases, Deletion/conversion (Cluster E6, V281L, L307 frameshift, Q318X, R356W) in 4 (7.7%) cases, complete gene deletion in 2 (3.85%) cases.Four mutations (namely P30L, R356W, Cluster E6, L307 frameshift) were not detected in any of our cases.Most cases demonstrated good correlations between genotypes and phenotypes. In the salt wasting group, the correlation was found in all cases with homozygous genotype, while among the simple virilizing group, the concordance of genotype/phenotype was found in all cases of group B (5 cases with homozygous I172N) and the single case in group A (homozygous I2 Splice), while it was absent in group null (one case withhomozygous deletion/conversion) and in group C (one case with homozygous V281L).Conclusions : 1. The majority of 21 - hydroxylase deficiency cases were females presented early in life with ambiguous genitalia with/without salt losing crisis, while a smaller number of patients were males with normal genitalia and salt wasting with/without precocious puberty; the patients have a high rate of parental consanguinity.2. There is a diversity of mutations affecting CYP21A2 gene in Iraqi 21 - hydroxylase deficiency patients, with a good percentage of undetected mutations.3. The diagnosis of 21 - OHD in CAH patients will be made more accurate when based on results of molecular testing.4. The data of molecular studies are useful in genetic counseling, in prenatal diagnosis and offering accurate treatment plan during pregnancy and in detection of carriers in families having previously affected child, diminishing the complications for these families

تاثير قطر دوالي الخصيه على نوعية السائل المنوي للمرضى المصابين بدوالي الخصية غير السريري == The Impact of the diameter of spermatic veins on Seminal fluid Analysis of patients with Subclinical Varicocele

Author name: ابراهيم جاسم حمادي
Supervisor name: غسان ثابت سعيد | رعد حفظي توفيق
General topic: Medicine
Specific topic: Physiology
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: ان الصحة الانجابية هي انعكاس للحالة الصحية العامة والتي تشمل الصحة العقلية والفيزيائية والاجتماعية وليس مجرد مجموعه الامراض المتعلقة بالجهاز التناسلي ووظائفه وعليه يعد العقم مرضا يستحق التشخيص والعلاج . يعرف العقم على انه عدم القدرة على الانجاب بعد سنة من الزواج بدون وجود اي مانع للعلاقة بين الزوجين . يشمل العامل الذكري حوالي 25 - 30 % من كل حالات العقم وايضا 30% اخرى بالاشتراك مع العامل الانثوي . ان 60% من عقم الرجال ناتج عن عوامل جينية اما الاسباب الاخرى فقد تكون نتيجة لدوالي الخصيتين ، عوامل بيئية ، عقاقير طبية ، تعاطي الكحول او التعرض المستمر للحرارة العالية او المواد الكيميائية....الخ. يعد مرض دوالي الخصيتين من الامراض الشائعة بين الرجال الذين يعانون من العقم وهو عبارة عن توسع وتعرج الاورده الناقلة للدم الراجع من الخصيتين نتيجة لتلف الصمامات الوريدية وينعكس ذلك سلبا على الوظيفة الطبيعية للخصية نتيجة لارتفاع درجه حرارة الخصية بسبب تراكم الفضلات الكيميائية من الغدد فوق الكلوية وكذلك الكليتين اضافة الى اسباب اخرى. يشكل دوالي الخصية السريري حوالي 15% بين الرجال ويشخص سريريا بفحص الخصيتين . اما في حالات اخرى لايمكن تشخيص دوالي الخصيه عن طريق الفحص السريري فقط وعليه تستخدم وسائل اخرى للتشخيص حيث يتم استخدام اجهزه الفحص بالموجات فوق الصوتية (السونار) لغرض تشخيص حالات كهذه ويسمى الدوالي غير السريريه وهو موضوع البحث . اجريت الدراسة على 122مريضا في عيادة علاج العقم في مستشفى اليرموك التعليمي بغداد/العراق. وقد استثني من الدراسة اي مريض مصاب باي مرض ممكن ان يتعارض مع الخصوبة وقد اخذت معلومات عامة من المرضى كذلك تم قياس الطول والوزن وقد اجريت لهم بعض التحاليل المختبرية كتحليل السائل المنوي وقياس مستوى بعض الهرمونات في الدم والتي شملت الهرمون المحفز للحويصلات((FSH,هرمون الجسم الاصفر (LH) وهرمون الشحمون الذكري(Testosterone) .كذلك تم فحص السائل المنوي للتاكد من وجود جينFasL)) لمجموعه تتكون من 60 مريضا والذين يعانون من الدوالي غير السريريه في مختبرات جامعة مانشستر مترو بوليتان في المملكة المتحدة. قسم المرضى الى مجموعتين الاولى تشمل المرضى المصابين بالدوالي السرير ي والمجموعة الثانية وتشمل المرضى المصابين بالدوالي غير السريري وقد تم مقارنه النتائج مع 50 مريضا سليما وقادرا على الانجاب . لقد اجريت عمليات جراحيه لعلاج الدوالي غير السريريه ل 60 مريضا وملاحظه التغيرات التي قد تطرا على متغيرات السائل المنوي والهرمونات وكذلك حجم الخصية . اوضحت الدراسة تاثيرا سلبيا بين المرضى الذين يعانون من الدوالي السريريه ومتغيرات السائل المنوي حيث كان التاثير واضحا في قله اعداد الحيوانات المنوية وكذلك سرعتها وشكلها الطبيعي كما اثر سلبا على حجم الخصيه المصابة وكذلك اظهر الفحص زيادة معنويه في هرمون (FSH) ونقص واضح في الهرمون الذكري (T).دون التاثير على هرمون LH)). اظهرت الدراسة تاثير دوالي الخصية غير السريري على متغيرات ا لسائل المنوي حيث كان التاثير على عدد الحيوانات المنوية وكذلك على سرعه الحيوانات المنوية وعلى شكلها الطبيعي دون التاثير على حجم الخصية او على هرمونات FSH),) او LH)).مع تاثير معنوي واضح على هرمون التستوستيرون(T) وكانت نتائج فحص ال FasL))مرتفعه لدى مرضى المجموعه. يستنتج من هذه الدراسة ان دوالي الخصية غير السريريه له تاثير واضح على بعض متغيرات السائل المنوي والهرمون الذكري وان اجراء العملية الجراحية لبعض المرضى يساعد في تحسن مستوى الخصوبة لديهم | Reproductive health is a state of complete physical, mental and social well - being and not merely the absence of disease or infirmity in all matters relating to the reproductive system and to its functions and processes. Infertility should, therefore considered to be a disease process worthy of investigation and treatment. Infertility defined as the inability of a couple to conceive after 1 year of unprotected intercourse. Male factors alone constitute about 25% - 30% of all cases of infertility, and they contribute to another 30% in combination with female factors and about 60% of male factor infertility may be due to genetic causes, others could be due to varicocele, genitourinary infections, environmental agents drugs, alcohol, life style factors like age and obesity. Varicocele is a state of dilated, elongated and tortuous veins of the pampiniform plexus of the spermatic cord typically developed during adolescent and have been found in about 15٪ of the general populations This condition is pathophysiologically characterized by retrograde flow in testicular veins found clinically as the presence of a palpable, soft scrotal mass, could be associated with mild to moderate pain, and they can also be associated with infertility. The size of varicocele is variable according to the severity of the disease. It ranges from large palpable mass of veins easily felt by the patient to varicocele that is only discovered by ultrasound study called subclinical varicoele. The treatment of the large sized varicocele is recommended and known to cause relief of the symptoms and might cause improvement to the seminal fluid quality and the state of fertility while the subclinical varicoele treatment is still controversial as there are results of some studies that showed a significant improvement of fertility after surgical treatment otherwise the treatment in many centers is still not indicated. The study objectives were to determine the relationship between subclinical varicocel and male fertility parameters in addition to follow up treated subclinical patients to determine the effects of surgical treatment on the seminal fluid and fertility. Data analyzed for 122 patients included in this study , full comprehensive history was taken ,physical examination ,testicular color Doppler ultrasound examination , pre and post operative assessments of seminal fluid analysis also evaluation serum levels of some reproductive hormonal profile includes, Follicle stimulating hormone (FSH), Luteinizing hormone (LH) and Testosterone (T) in addition to the expression of FasL mRNA gene in seminal sperms of the patients with subclinical varicocele . The Doppler ultrasound was done to all included patients to measure the testicular volume and the accurate size of the dilated testicular veins to diagnose the subclinical cases , the veins diameter 2.5 mm was used as a cutoff point. Follow up was done for 60 patients of subclinical group pre and post varicocelectomy .Fifty healthy fertile male of similar age were included in this study as a control group.The study was done in male infertility clinic of Al - Yarmouk Teaching Hospital Baghdad, Iraq from the 1st of October 2013 to the end of December 2014 while the FasL expression of 60 samples of subclinical varicocele patients were studied in Manchester Metropolitan University . Health and science laboratories - UK. Results showed that the subclinical varicocele affects male fertility with a significant negative correlation between subclinical group and some of semen parameters including : sperm morphology, percentage of progressive motile sperms and also a significant positive correlation between sperm count and FasL gene. The results also supported the hypothesis of clinical varicocele effects on male fertility as there was a significant negative correlation with the total sperm count, percentage of progressive motile sperms and also there was a significant increase in FSH with decreased testosterone (T) and mild decrease in the testicular volume. From this study we can conclude that subclinical varicocele cause decrease in sperm count, motility and sperm morphology and to some extend hormonal serum levels but no significant changes for testicular volume. Samples of subclinical patients showed a significant expression of FasL RNA and the surgical treatment of such cases gave an improvement to the state of fertility.

علاقه بعض الحالات المرضيه بالاختلافات التشريحيه للقنوات الصفراويه في العراقيين باستخدام الرنين المغناطيسي الراسم للقنوات الصفراء والبنكرياس == Association of Some Pathological Conditions with the Anatomical Variations of the Biliary System in Iraqi People Using Magnetic Resonance Cholangiopancreatography(MRCP)

Author name: احمد سعد محسن
Supervisor name: نوفل خضير ياس الحديثي
General topic: Medicine
Specific topic: Anatomy and Histology and Embryos
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Anatomic variations of the bile ducts are important to identify beforehepatobiliary surgical procedures as inaccurate determination of existing biliaryanatomic variations may potentiate ligature or section of aberrant ducts, leadingto major complications such as leakage or atrophy of the residual liver.Moreover, abnormal anatomical pattern of the biliary tree may predispose toincreased incidence of certain pathologies like gallstones. Therefore, it isapparent that thorough preoperative knowledge and successful detection andrecognition of such anatomic variations can lead to decreased morbidity andmortality rates during hepatobiliary surgery. Although several methods, like CTor MR Cholangiopancreatograms, have become the modality of choice fornoninvasive evaluation of abnormalities of the biliary tract, they are notroutinely used in preoperative imaging evaluation of patients.Magnetic resonance cholangiopancreatography (MRCP) is a safe, non - invasivediagnostic imaging technique, with added value of imaging post processing,allows accurate identification of biliary anatomy.For this study, ―Yoshida classification‖ was used to classify the anatomicalvariations of the biliary tree by using MRCP, Yoshida divide these variationinto 7 types, Type 1 where the right posterior segmental duct (RPSD) unit withthe right anterior segmental duct (RASD) to form the right hepatic duct (RHD)which unite with the left hepatic duct (LHD) to form the common hepatic duct(CHD) which unite with the cystic duct to form the common bile duct. Type 2in which the RPSD,RASD and the LHD unite together in triple confluence toform the CHD. Type 3 in which the RPSD cross to the left side to unite with theLHD, in Type 4 the RPSD have a lower insertion into the CHD, in Type 5; thereis triple confluence of the RPSD, Left inferior segmental duct (LISD) and Leftsuperior segmental duct (LSSD), while the RASD join the formed RHD to formviiCHD, while in Type 6; the triple confluence is between RASD,RPSD,LSSD andthe LISD drain into the CHD, Finally; Type 7 resemble type 1 except that theLISD an inferior insertion into CHD.Aim of the study : 1. To determine the most common anatomical patterns of the biliary tree inpatients and define the incidence of each pattern and to relate thesedifferent anatomical patterns to the incidence of biliary pathology.2. To measure the length of different branches of the biliary tree and findthe range of length in each branch and to relate the length of differentbranches of the biliary tree to the incidence of biliary tree pathology.Patient and Method : This study was conducted in the X - ray Institute in Baghdad Medical City usingmagnetic resonance cholangiopancreatography (MRCP) to scan patients withrelated biliary pathology.108 patients were taken for the study and the datacollected over 8 months periods from 10th of September 2014 to 28th of April2015. Full history and examination were done to the patients with basicinvestigation. Patients prepared before the scan by fasting and simple sedation.The images were taken both in coronal and transverse section; the resulting scanwas printed on disk and interprets by microDICOM software which hasmultiple functions and facilities, the cases then categorized according to theanatomical pattern and according to the pathological finding, Finally; the resultwere analyzed statistically.Results : Typical biliary tree (Type I) anatomical pattern was found in 64.8%.Anatomicalvariation was found in 35.2% and the most common anatomical variation isviiiwhen the right anterior hepatic duct crosses to the other side to drains into theleft hepatic duct and it is called Type 3 and found in 20.4% of cases while eachof type 2 and 4 was found in 7.4% of cases. The length of different branches ofthe biliary tree was variable and each branch had a wide range of length whichwere being recorded and compared. Pathological changes were found in 90.7%of cases which were mainly Gallstones, strictures and tumors. Gallstones werethe most common pathological finding with incidence of 79.6% while strictures were found in 3.7% and tumors in 7.4%. Relation between the variant anatomical pattern and pathological finding was significant. Also relationbetween the change in the length of the left hepatic duct and incidence of three mentioned pathological finding was significant, and relation between the change of the cystic duct and incidence of tumors in the biliary regions was also significant.Conclusion : MRCP scan of patients with liver related symptoms is of high importance on both surgical and medical methods. It will show us the complete anatomical pattern of the biliary tree and if there are any pathological conditions, additionally; we can take measurement of the branches of the biliary tree. Define the anatomical pattern of the biliary tree can give us a clue about the risk of this patient to develop certain pathological conditions even if the scan was normal. So it is advisable to take MRCP to any patient with liver related problems who underwent other liver specific investigation like US for evaluation and further accurate identification of the biliary tree anatomical pattern and of any existing pathological conditions and also for estimation of developing other pathological conditions in the future.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

تقييم الهبسدي الفيريتين بروتين سي التفاعلي لدى مرضى فقر الدم للمرحلة النهائية للفشل الكلوي == Assessment of Hepcidin, Ferritin and CRP in Anemic End Stage Renal Disease Patients on Hemodialysis

Author name: ضلال صيول حسن
Supervisor name: هيثم احمد الربيعي | رائد احمد الربيعي
General topic: Medicine
Specific topic: Diseases - Blood
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Chronic kidney disease (CKD) is defined as kidney damage or glomerular filtration rate (GFR) <60 mL/min/1.73 m2 for 3 months or more.End stage renal disease corresponds to stage 5 chronic kidney disease with glomerular filtration rate <15 ml/min/1.73m2, all these patients require hemodialysis.Anemia of chronic disorders is a common normochromic or mildly hypochromic anemia that occurs in patients with chronic kidney disease.It is characterized by a reduced serum iron and iron binding capaci ty and normal or raised serum ferritin with adequate iron stores. The main cause of anemia is deficient erythropoietin synthesis. Blood loss is also a major contributory factor. Hepcidin plays a key role as mediator of anemia of inflammation.Aim of the study1 - To assess the types of anemia in end stage renal failure.2 - To compare the inflammatory parameters including hepcidin, ferritin, C - reactive protein and erythrocyte sedimentation rate between the two vascular accesses of hemodialysis (double lumen and arteriovenous fistula).Materials and methods This case control study was conducted at Al - Hayat center for hemodialysis in Al - Karama hospital, Baghdad, Iraq over 3 months from 1 November 2013 to 31 January 2014. The study populations consist of 60 [III]patients (44 males and 16 females). All patients were adult with documented end stage chronic kidney disease stage 5 on repeated hemodialysis with different durations of illness (1 month - 10 years).Hemodialysis patients were also divided into two groups depending on the vascular access of hemodialysis (double lumen and arteriovenous fistula).The following data were analyzed for all patients :  Age, gender, history of hypertension and diabetes mellitus, causes of renal failure, vascular access, duration and frequency of hemodialysis. Complete blood counts, blood film and reticulocyte percentage by auto analyzer machine. Blood urea, serum albumin, serum creatinine, and transferrin saturation percentage, serum hepcidin, ferritin, C - reactive protein by clinical chemistry analyzer. erythrocyte sedimentation rate Twenty normal healthy individuals (age and sex matched) had been included as a control group in this study. All were subjected to the same investigations of the patients.ResultsThe vascular access of hemodialysis was ʺarteriovenous fistulaʺ in (61.7%) of the patients and "double lumen" in (38.3%) of them. The mean duration of hemodialysis was (18.6 ± 2.5) months (range : 1 month - 10 years), high proportion (28.3%) of the patients were on hemodialysis for a duration of 11 - 15 months.There was a significant decrease of absolute lymphocyte count, red blood cell count, hematocrit, hemoglobin and platelets count in patients than controls, but there were insignificant differences for total white blood cell count, absolute neutrophil count and mean corpuscular volume.Also there was a significant increase of red cell distribution width levels in patients than controls (14.8 ± 1.9 vs. 13.3 ± 1.6 respectively), p<0.05.According to the levels of hemoglobin, anemia was reported in 95% of the 60 end stage renal disease. Anemia of chronic disorders was the most frequent type of anemia (45%) among the patients, iron deficiency anemia was found in only (11.7%) while combined anemia was found in (25%), and others who had not any type of previous types of anemia (13.3%). No significant difference was observed between anemic and non - anemic patients according to the vascular accesses of hemodialysis.The mean serum level of hepcidin for patients was (186.1± 28.4 ng/ml) and for controls was (4.7 ±0.9 ng/ml) with a significant difference between both groups. The mean serum ferritin level of the patients (280.8 ± 53.1 ng/ml) was significantly higher than controls, (83.6 ± 14.5). The mean serum C - reactive protein level was higher in patients than control, (8.6 ± 1.1 vs. 3.0 ± 0.2 mg/l) respectively, furthermore, the mean erythrocyte sedimentation rate level was higher in patients (42.3 ± 4.7 mm/1st hr.) than that of controls (6.2 ± 0.8).There was no significant association between levels of hepcidin, hemoglobin, ferritin, C - reactive protein and erythrocyte sedimentation rate of the patients with the duration of hemodialysis. There was no significant difference in the mean levels of hepcidin, ferritin, C - reactive protein and erythrocyte sedimentation rate of the patients according to the vascular accesses of hemodialysis, while there was a significant difference regarding the hemoglobin level. The mean C - reactive protein of patients with serum ferritin level ≥ 800 ng/ml was (16.5 ± 4.2 mg/L) and for those with serum ferritin level < 800 ng/ml it was (7.6 ± 1.1 mg/L), however, the difference

فعاليه جهاز مفراس القلب الملون في تشخيص امراض الشرايين التاجيه في بغداد / العراق 2013 == ACCURACY OF CORONARYCOMPUTED TOMOGRAPHY ANGIOGRAPHY IN THE DIAGNOSIS OF CORONARY ARTERY DISEASE, BAGHDAD - IRAQ, 2013

Author name: ميثاق حسن العكيلي
Supervisor name: ايمان القصير | هلال الصفار
General topic: Medicine
Specific topic: Community Medicine
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Various diagnostic tests, invasive and noninvasive, are used in the diagnosis of coronary artery disease (CAD). Recently, coronary computed tomography angiography (CCTA), being noninvasive and due to its high spatial and temporal resolution, are widely used particularly in patients with low to intermediate probability. Studies on accuracy of CCTA in Iraq are scarce; therefore this study was carried out. Methods : A total of 260 patients were included in this study, they were recruited from the Iraqi Centre for cardiac disease (medical city complex) and Ibn Al - Bitar Cardiac Surgery Center for the period from December 2012 to August 2013. Direct interview for those who referred for CCTA was done and case records of those who did invasive coronary angiography (ICA) were reviewed. Requested information regarding demographic data (age,gender, residence, etc.), history of smoking, alcohol consumption, hypertension, diabetes and present complaints, review of prior tests (electrocardiography (ECG), chest x ray (CXR), echocardiography, treadmill test “TMT”, etc.), referral indication as stated by the physician and outcome data, were filled in questionnaire for each patient.Results : The mean age of patients was 56.7 ± 10.2 with males were predominant (62.3%). There was significant difference between CCTA results with age (p=0.003), left ventricle ejection fraction (LVEF %) (p=0.01), sex (p=0.04) and hypertension (p=0.03). No significant association between CCTA results with diabetes and cholesterol level (P= 0.7, and 0.6 respectively). No significant association was found between TMT findings with CCTA results (p=0.6) or ICA results (p=0.2). Also there was no significant association between ICA findings according to CCTA results (p=0.3). The calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) values for CCTA was (80.7%, 0.0%, 70% and 0.0, respectively). There was significant association between CCTA results with the pretest probability of CAD (p=0.01).Conclusions : Low accuracy figures for CCTA were reported. Guidelines according to Iraqi situation may enhance accuracy

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

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

تحديد وحساب الخلايا البلعميه المعلمة بمادة (CD68) في مشيمية النساء الحوامل طبيعيا والمصابات بارتفاع الضغط الحملي == CD68 - labelled macrophages localization and counting in placentas of normal and pre - eclamptic women

Author name: لينا علي حسين
General topic: Medicine
Specific topic: Anatomy and Histology and Embryos
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: الخلفيه : تتكون المشيمه خلال عمليه معقده ومنسقه بين الانسجه التابعه لبطانه رحم الحامل والانسجه الجنينيه المحيطه. يوجد في المشيمه عدد من الخلايا البلعميه (البالعه) والتي يبدا ظهورها تقريبا في اليوم العاشر من بدايه الحمل. تشمل الخلايا البلعميه المشيميه خلايا هوفباورالتي توجد ضمن الزغابات (جزء المشيمه من جهه الجنين) والخلايا البلعميه الساقطه التي تقع ضمن الساقط القاعدي (جزء المشيمه من جهه غشاء الرحم). تتبنى هذه الخلايا نمطا ظاهريا متخصصا يلعب دوررائيسيا في عمليه الترسيخ المشيمي والجنيني, اضافه الى دورها في تنظيم المناعه الذاتيه للجسم تحت عوامل بيئيه مختلفه. ان السلوك الشاذ لهذه الخلايا يمكن ان يؤثر على وظيفه الارومه المغذيه وعلى نمو المشيمه وربما يؤدي الى مجموعه متنوعه من نتائج الحمل السلبيه. تاثير كل من تعدد الولادات وارتفاع الضغط الحملي على وظائف واعداد الخلايا البلعميه المشيميه لايزال موضوع جدل حتى الان.الهدف من الدراسه : ١) تحديد اماكن وجود وحساب اعداد الخلايا البلعميه ضمن المشيمات التابعه لنساء حامل للمره الاولى ونساء متعدده الولادات في مجموعه السيطره(الحمل الطبيعي) ومجموعه (ارتفاع الضغط الحملي) باستخدام تقنيه الكيمياء النسيجيه المناعيه (CD68 الاجسام المضاده الاوليه), لمعرفه تاثير تعدد الولادات على اعداد هذه الخلايا في المشيمه.٢) دراسه تاثير تعدد الولادات على بعض المتغيرات العينيه والمجهريه ضمن المشيمات التابعه لنساء حامل للمره الاولى ومتعدده الولادات في مجموعه السيطره(الحمل الطبيعي) ومجموعه (ارتفاع الضغط الحملي).المرضى والطرق : تم جمع ثلاثون مشيمه مولوده لحوامل تتراوح اعمارهم بين (٢٧ - ٣٢) سنه. استخدمت ست مشيمات للدراسه التجريبيه الاوليه, في حين قسمت الاربع والعشرون الاخرى الى مجموعتين : مجموعه السيطره ومجموعه ارتفاع ضغط الحمل ثم تم تقسيم كل مجموعه وفقا لتعدد الولادات الى مجموعات فرعيه (حامل للمره الاولى ومتعدده الولادات), (ست مشيمات لكل مجموعه فرعيه).تم فحص المشيمات عينيا من حيث (الشكل, موقع ادخال او ادراج الحبل السري, المحيط, القطر, السمك المركزي). بعد تثبيت ومعالجه وتقطيع العينات النسيجيه , تم صبغها باستخدام صبغه (الهيماتوكسيلين والايوسين) لدراسه المتغيرات المجهريه التاليه : عدد كل من ( الزغابات, العقد الخلويه, الاوعيه الشعريه الجنينيه), بالاضافه الى استخدام تقنيه الكيمياء النسيجيه المناعيه (CD68 الاجسام المضاده الاوليه) لحساب اعداد الخلايا البلعميه الموجوده ضمن الزغابات الجنينيه وتلك الموجوده ضمن الساقط الرحمي للمشيمات, كما اشتملت الدراسه على اجراء التحليل الاحصائي.النتيجه : يتراوح شكل المشيمات لمجموعتي السيطره وارتفاع الضغط الحملي من الدائري الى البيضوي. نسبه الادراج المركزي للحبل السري ارتفعت في مجموعه السيطره وخصوصا في (متعدده الولادات), في حين لوحظ زياده الادراج الطرفي للحبل السري في مجموعه ارتفاع الضغط الحملي وخصوصا في (الحامل للمره الاولى). كان هنالك انخفاض ملحوظ في قطر المشيمه في مجموعه ارتفاع الضغط الحملي للحامل للمره الاولى وكان ذلك متوافقا مع تناقص محيط المشيمه لنفس المجموعه كما كان هنالك زياده ملحوظه في السمك المركزي لمجموعه ارتفاع الضغط الحملي. التحليل الاحصائي للفحص المجهري ,اظهر زياده في عدد الزغابات الجنينيه, العقد الخلويه, والاوعيه الشعريه الجنينيه التي توافق زياده اعدادها مع ارتفاع الضغط الحملي وزياده الانجابيه. الزياده في اعداد الاوعيه الشعريه الجنينيه كان ملحوظا في (الحامل للمره الاولى) لمجموعه ارتفاع الضغط الحملي. اظهرت دراسه الكيمياء النسيجيه المناعيه زياده ملحوظه في اعداد الخلايا البالعه ذات الخاصيه الايجابيه للجزئ المنشط للمستقبلات ((CD68 ضمن الزغابات والساقط الرحمي لمشيمات مجموعه ارتفاع الضغط الحملي كما لوحظ توطن الخلايا البالعه ضمن الزغابات الجنينيه بالقرب من جدار الاوعيه الشعريه والارومه الغاذيه الخلويه في مجموعه ارتفاع الضغط الحملي وخصوصا في (الحامل للمره الاولى). | Background : formation of placenta occurs through a complex and coordinated effort between the fetus’s extraembryonic tissues and the gravid endometrial tissues. Many macrophages are present in the placenta throughout pregnancy and they have been detected as early as day 10 of pregnancy. Placental macrophages include hofbauer cells of the fetal villi and decidual macrophages of the maternal decidua basalis. They adopt a specialized phenotype that may hold a key role in implantation, placentation and parturition in both regulating and executing the body's own immune response under various environmental factors. Aberrant behavior of these macrophages can affect trophoblast function and placental development and potentially can lead to a spectrum of adverse pregnancy outcomes. Yet, the population and functions of placental macrophages in women with different parity and women with preeclampsia remain ill defined and subject of controversy.Aim of study : - • Localize and count the number of hofbauer cells and decidual macrophages in placentas of primiparous and multiparous of control and preeclamptic groups by using an immunohistochemical marker CD68 to find if parity can influence the number of placental macrophages. • Studying the influence of parity on some macroscopical and microscopical variables in placentas of primiparous and multiparous women of control and preeclamptic groups.Patients and Methods : A total of 30 placentas were collected from delivered women who were aging between 27 - 32 years. Six of them were used for preliminary pilot study while twenty four one were used for experimental study. Experimental placentas were grouped into two major groups (normal and preeclamptic) and each group was further subdivided according to parity into primi and multi subgroups (6 placentas for each subgroup). The placentas were grossly examined for their (shape, site of insertion of umbilical cord, circumference, diameter and central thickness). Then tissue samples were fixed, processed, sectioned and stained by heamatoxylin and eosin stain to study the following microscopical variables : number of (villi, syncytial knots and fetal capillaries). Additionally, immunohistochemical technique (CD68 primary antibody) was used to count the number of placental macrophages at fetal villi and maternal decidua. Statistical analysis (SPSS version20) was used in this study. Result : Studying placentas had circular to oval shape. The percentage of central insertion of umbilical cord was increased in control group, mainly in multi one. While marginal insertion was increased mainly in primi preeclamptic. There was a significant reduction in diameter of placentas of preeclamptic group, mainly in primi and it was positively correlated with placental circumference. The placental thickness was significantly increased in preeclampsia.Statistical analysis for histological variables revealed an increased number of villi, syncytial knots and fetal capillaries with preeclampsia and parity. The number of fetal capillaries was significantly increased with preeclampsia (mainly in primi subgroup). Immunohistochemical study revealed a significant increase in number of CD68 positive fetal and decidual macrophages in preeclamptic subgroups. CD68 positive fetal macrophages were seen to localize near fetal vessel wall and near syncytium which were significantly increased in primi preeclamptic subgroup. Conclusions : There were definite changes and correlations between macroscopical and microscopical variables in placentas of primi and multi subgroups of normal and preeclamptic groups. Immunohistochemically, the number of CD68 positive fetal and decidual macrophages were significantly increased in preeclamptic group in which hofbauer cells were mainly increased in primi subgroup. This could be attributed to factors like hypoxia and immunological maladaptation. These factors can induce a recruitment of macrophages to express different functions depend upon their locations.

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

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

تقييم التاثيرات الفيزيولوجية لحوض ماء ال (CO2) على القدم السكري == Evaluation of physiological Effect of (CO2) Water bath on diabetic Foot

Author name: غزوان رياض عبد الحمزة
Supervisor name: حنان لؤي العمري
General topic: Medicine
Specific topic: Physiology
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: تعتبر قرحة القدم السكرية واحدة من اكثر المضاعفات التي تقلق المصابين بمرض السكري غير المتحكم والمسيطر علية. حيث تعتبركواحدة من اهم ومن اكثر المضاعفات الشائعة والمعروفة لدى المصابين بهذا المرض وهي سبب رئيسي للاعاقة والمراضة والوفيات بين المرضى المصابين بمرض السكري ، وقد تم تقدير ان 15٪ من جميع الاشخاص المصابين بالسكري سيصابون بقرحة في بعض مراحل حياتهم العمرية . ان الهدف من هذة الدراسة هو تقييم تاثير علاج الماء المشبع بغازثاني اكسيد الكربون على قرحة القدم مرضى السكري ومقارنتها مع المرضى الذين يعانون من قرحة القدم السكري الذين يتعالجون بالعلاج التقليدي ، ان منهاج العمل لهذة الدراسة هو اخذ مئة مريض مصابين بمرض السكري ويعانون من قرحة القدم السكري (متوسط العمر 51.6 سنة ± 8.43 سنة ؛بتصنيف 59 ذكر و41 انثى) انقسما الى مجموعتين ،المجموعة الاولى بالعلاج التقليدي بالضمادات (التنظيف ، والكحول والشاش) والمضادات الحيوية ، في حين ان مجموعة الثانية هي ايضا بالعلاج التقليدي بالضمادات (التنظيف ، والكحول والشاش) والمضادات الحيوية مع اضافة العلاج بالماء المشبع بغاز ثاني اكسيد الكربون.تم اجراء هذه الدراسة في خلال فترة سبعة اشهرعلى الذين تم علاجهم باستخدام العلاج التقليدي كمجموعة والمجموعة الثانية باستخدام العلاج التقليدي بالضافة الى الماء المشبع بغاز ثاني اكسيد الكربون بواقع 4 ايام من بداية سبتمبر/ ايلول عام 2017 الى مارس / اذار 2018 في مركز القدم السكري Diabetic Foot Center في مدينة الصدر الطبية التابعة الى دائرة الصحة في النجف / وزارة الصحة العراقية ، في مدينة النجف / العراق . خلال الدراسة تم قياس مؤشر الكاحل العضدية ودراسة الدوبلر للشرايين ايضا ،و تم التقييم الكلي لحجم ولون والاحساس في منطقة التقرحية في قدم المريض المصاب بالسكري والمقارنة بينو وبين المريض المصاب بتقرح القدم السكري من المجموعة الثانية.واظهرت النتائج تحسن تدفق الدم الى القدم المصابة التي اظهرتها في اختلافات كبيرة في مؤشر الكاحل العضدية وفحص الدوبلر في مجموعة العلاج بالماء المشبع بغاز ثاني اكسيد الكربون قبل وبعد العلاج ثاني اكسيد الكربون. وكذلك تحسين الاحساس وحجم ولون المنطقة التقرحية. فاعلية هذه الطريقة في علاج قرحة القدم السكرية ويشير الى انها فائدة محتملة كشكل من اشكال العلاج الطبيعي في علاج قرحة القدم المصابة بالسكري والتي اظهرت ان هناك تحسنا كبيرا في مؤشر الكاحل العضدي وقياس فحص الدوبلر في المريض مع قرحة القدم السكري بعد العلاج الماء المشبع بغاز ثاني اكسيد الكربون ، كما اظهر تحسن كبير في حجم القرحة ، لون القرحة والاحساس بعد العلاج ثاني اكسيد الكربون في مرضى القدم السكري بعد العلاج ثاني اكسيد الكربون. تهدف هذه الدراسة الى تقييم تاثير علاج الماء المشبع بغاز ثاني اكسيد الكربون في تقييم تدفق الدم من خلال مراقبة مؤشر العضد في الكاحل وفحص الدوبلر وكذلك لتقييم تاثير علاج الماء المشبع بغاز ثاني اكسيد الكربون في فحص شفاء الجروح عن طريق دراسة حجم ولون القرحة والاحساس في مرضى السكري المصابين بتقرح القدم | Diabetic foot ulcer is considered one of the most anxious complications associated with uncontrolled diabetes mellitus. Foot ulcers are one of the most feared andxcommon complications ofxdiabetes. They are a majorxcause of disability, morbidity, and mortality amongxdiabetic patients, and it has been estimatedxthat 15% of all people withxdiabetes will have an ulcer at some stagexof their life, The aim is to evaluate the effect of carbon dioxide therapy on patients with diabetic foot ulcer and compare it with patients had diabetic foot ulcer on traditional therapy, Patients & Methods handred patients with diabetic foot ulcer (mean age 51.6 ± 8.43 years; 59 male and 41 femal) we divided into two groups , traditional treatment by dressings (cleaning, alcohol and gauze) and antibiotics, while carbon dioxide therapy group who were treated using a traditional treatment and carbon dioxide therapy this study was done in period of seven moths 4 days per start from Sumptember 2017 to March 2018 at Diabetic Foot Centre in Al Sadier Medical City / Najaf Directorat of Health, in Al - Najaf city. Ankle brachial index and Doppler were measured also, the size, color and sensation of the ulcerative area were all evaluated and compared between two groups. The results showed improvement of blood flow to the affected foot that shown in significant differences in Ankle brachial index and Doppler study in carbon dioxide group therapy pre and post carbon dioxide therapy (P <0.001). As well as improvement in the sensation, size and color of the ulcerative area. The effectiveness of this method in the treatment of diabetic foot ulcer and indicates it is potential utility as a form of physiotherapy in the treatment of diabetic foot ulcer which was showed there is significant improvement in Ankle brachial index and Doppler measurement in patient with diabetic foot ulcer after carbon dioxide therapy, It also was showed an significant improvement in the size of ulcer, color of ulcer and sensation after carbon dioxide therapy in diabetic foot patient after carbon dioxide therapy. The aims of this study is to evaluate the effect of carbon dioxide water bath therapy in assessing blood flow by monitoring ankle brachial index and Doppler study inxdiabetic foot ulcer patient and also To evaluate the effect of carbon dioxide water bath therapy in assaying wound healing by monitoring size and color of ulcer and the sensation in diabetic foot ulcer patient.

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

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

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

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

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

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

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

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

تتبع مسار الارومات العصبية من منطقة ما تحت البطين باتجاه البصلة الشمية في ادمغة الفئران البالغة == TRACING THE PATHWAY OF THE NEUROBLASTS FROM THE SUBVENTRICULAR ZONE TO THE OLFACTORY BULB IN THE ADULT MICE BRAINS

Author name: زينب زاهد سعدون
Supervisor name: هدى مهدي الخطيب
General topic: Medicine
Specific topic: Anatomy and Histology and Embryos
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: لقد تم العثور على خلايا جذعية عصبية فريدة من نوعها في المناطق الرئيسية لتكوين الخلايا العصبية في ادمغة البالغين،سميت هذه المناطق بالاعشاش العصبية واكبر هذه المناطق هو منطقة ماتحت البطين للبطين الوحشي. يشار الى عملية تكوين الخلايا العصبية بانها العملية التي من خلالها تقوم الخلايا الجذعية العصبية، وذريتها من الارومات العصبية في توليد خلايا عصبية جديدة في الوضع الطبيعي والمرضي. ان دراسة هذه العملية وتتبع نتائجها مفيدة في وصف سلائف الخلايا العصبية وهجرتها خلال مساحات مقيدة في ادمغة الثدييات البالغة.اهداف الدراسة التعرف على الارومات العصبية على طول جدار البطين الوحشي في منطقة ما تحت البطين في دماغ الفار البالغ وكذلك تتبع هذه الخلايا على طول مسار خاص من منطقة ماتحت البطين حتى البصلة الشمية يعرف هذا المسار بالتيار المهاجر المنقاري. تم ذلك عبر التصبيغ النسيجي العادي باستخدام الهيماتوكسيلين والايوسين(H وE) والتصبيغ المناعى النسيجي الكيميائي باستخدام الجسم المضاد antidoublecortin المتخصص بتحديد الارومات العصبية. المواد والطرائق تم تنفيذ الدراسة في مبنى الحيوان، كلية الطب / جامعة بغداد. من خلال جمع وتربية 36 من الفئران الاناث والذكورنوع (Micromys minutus)، اربعة منها حديثة ولادة استخدمت لعرض الشاهد الايجابي لعمل الجسم المضاد. ال32 الاخرى كانت بالغة (اكبر من 60يوم) استخدمت سبعة منها لاجراء الدراسة الاستطلاعية. ال25 الاخرى استخدمت لاجراء الدراسة الحقيقية حيت تم تثبيت ادمغتها من خلال ارواء مادة البارافورمالدهيد عن طريق القلب مع جهاز مضخة صغيرة تم تصنيعه محليا لهذا الغرض ثم الحصول على ادمغتهم مباشرة بعد ذلك. بعد تشريح الادمغة اكليليا وسهميا تم تثبيتها لمدة 20 ساعة في نفس المادة المثبتة المستخدمة في الارواء. تمت المعالجة بالتجفيف في درجات متزايدة من الكحول الاثيلي والتصفية في الكلوروفورم ثم الغمر في البارافين. تم الاجتزاء بواسطة مشراح، بعد ذلك تمت ازالة البارافين بواسطة الزايلين والاماهة بدرجات متناقصة من الكحول الاثيلي ثم التصبيغ بواسطة صبغة الهيماتوكسيلين والايوسين. للتصبيغ المناعى،تمت حضانة الاجسام المضادة الاولية antidoublecortin مع النسيج لمدة 2 ساعة وللاجسام المضادة الثانوية لمدة 1 ساعة بدرجة حرارة 30°, ثم اضافة صبغة الداب كخطوة نهائية. وقد تم القيام برؤية النسيج المصبوغ من خلال المجهر الضوئي النتائج في المستوى الاكليلي المار بالبطين الوحشي بمسافة 1 ملم امام اليافوخ الامامي، تم تحديد منطقة ماتحت البطين. بالتصبيغ النسيجي العادي الهيماتوكسيلين والايوسين (H and E) ظهرت هذه المنطقة كتجمعات خلايا مجاورة لخلايا البطانة العصبية. مع التصبيغ المناعي الكيمائي، استطعنا ان نثبت بان كتل خلايا من هذه التجمعات تمثل الارومات العصبية وذلك لاخذها الصبغة الايجابية للاجسام المضادة antidoublecortin. على الرغم من هذا فان مجموعة من الخلايا المحيطة بكتل الارومات لم تعطي التصبيغ الايجابي لهذا الجسم المضاد لكنها ظهرت بوضوح وهي تنتشر بين كتل الارومات العصبية. جرى تتبع هذه الارومات سهميا من منطقة ما تحت البطين. وقد وجد انها تشارك في مسارملتزم يدعى التيار المهاجر المنقاري ، يبدا من الطرف الامامي للبطين الجانبي وينتهي في منتصف الفص الشمي . الارومات في التيار المهاجر المنقاري تصطف عرضيا بشكل موازي لسطح الدماغ وتدعم بعضها البعض لتشكيل ما يبدو انه شريط سلسلي من خلايا ممدودة الشكل ذات انوية مغزلية غامقة محاطة بشكل وثيق من قبل خلايا اخرى متعددة الاشكال لم تاخذ صبغة الجسم المضاد antidoublecortin. وقد تم ملاحظة شكل مميز وواضح للسلسلة ابتداءا من منبعها وحتى نقطة انتهائها. تشكل السلسلة تيار منحني بشكل حرف S ينقسم الى اربعة اجزاء مميزة : القمع والطرف العمودي والمرفق والطرف الافقي. علاوة على ذلك , تتخذ الارومات العصبية معالم شكلية مختلفة على طول الاجزاء الاربعة للتيار حيث يتغير شكلها من الشكل الممدود والانوية المغزلية في القمع والطرف العمودي الى الشكل البيضوي الاقل انتظاما في المرفق ثم الشكل الكروي في الطرف الافقي . غير التيار المهاجر المنقاري وضع الهجرة بالقرب من قطبه المنقاري من الوضع العرضي الى الوضع الشعاعي الذي تدخل به الارومات العصبية داخل البصلة الشمية. بالاضافة الى ذلك خضعت الارومات العصبية في التيار المهاجر المنقاري للانقسام الخيطي مما ادى الى زيادة عددها بالقرب من نهاية التيارالمهاجر | adult brain, these regions called neurogenic niches, the larger of which is the subventricular zone (SVZ) of the lateral ventricle. Adult neurogenesis is referred to the process in which neuronal stem cells, and their progeny the neuroblasts; generate new neurons in physiological and pathologic conditions. The study of this process and the tracing of its consequences are beneficial in describing the precursors of neurons and its migration through restricted territory in the adult mammalians brains. Aims of studyTo identify the neuroblasts, along the wall of the lateral ventricle, the SVZ, in the adult mouse brain and to trace them from the SVZ to the OB along the special pathway, the Rostral Migratory Stream (RMS), using routine stains the Hematoxylin and Eosin (H and E) and immunohistochemical staining with antidoublecortin antibody, the specific marker of the neuroblasts. Materials and methodsThe study have been executed at the animal house of College of Medicine \ Baghdad University; by collecting and breeding 36 male and female mice (Micromys minutus), 4 of them were neonates used for demonstrating positive control for the antibody, and the other 32 were adults (< 60 days old), seven of them were used for pilot study. The other 25 were used for proper study. They were perfused intracardially by paraformaldehyde solution with a mini - pump apparatus that has been constructed locally for this purpose then harvesting their brains immediately. After dissecting the brains coronally or sagittaly they were fixed for 20 hours in the same fixative used for the perfusion. Processing had been done by dehydrating in ascended grades of ethanol alcohol and clearing in chloroform then embedding in paraffin. Sectioning had been done with microtome; deparaffinization by xylene and rehydration with descended grades of ethanol alcohol then staining by H and E. For the immunohistochemical staining, the primary antibody “antidoublecortin antibody” was diluted to (1/1000) and incubated with the tissue for 2 hours at 30 C°. Incubation with the secondary antibody lasted for 1 hour. Application of DAB was the final step. Visualization had been done with a light microscope.Results At the coronal plane through the lateral ventricle "1 mm anterior to bregma", identification of the SVZ had been done. By the ordinary staining "H and E", the zone appeared as an aggregate of cells next to the ependymal layer. With the immunohistochemical staining, clusters of cells were proved to be the neuroblasts by staining positive for the antidoublecortin antibody; though groups of surrounding cells did not express the signal of this marker but apparently interspersed among the clusters of the neuroblasts. The neuroblasts were traced sagittaly from the SVZ and they have been found to be engaged in a committed pathway called RMS, began from the anterior tip of the lateral ventricle and ended at the core of the OB. The neuroblasts in the RMS oriented tangentially parallel to the brain surface and scaffolded each other forming what seemed to be a chain - like strip of cells which were elongated with dark spindle shaped nuclei and surrounded intimately by another cells, polymorphic in shape and did not take the signal of the antidoublecortin antibody. Distinct morphology of the chain had been encountered grossly from its emergence site till its termination point. It was forming a sigmoidal shape stream that could be divided as a whole into four distinct parts; infundibulum, vertical limb, elbow and horizontal limb. Furthermore, the neuroblasts took different morphological features along the stream. They changed from spindle shaped - nuclei cells in the infundibulum and the vertical limb to oval or irregular - shaped nuclei cells in the elbow and to more spherical - shaped nuclei in the horizontal limb. The RMS might change the mode of the migration near its rostral pole from the tangential parallel mode to the radial scattered mode by which the neuroblasts entered the olfactory bulb. In addition, the neuroblasts in the RMS revealed mitotic activity and increase their number near the termination of the stream.

دالات بيوكيماوية جديدة للساركوبينيا والضعف العضلي لكبار السن في العراق العام الدراسي 2016 - 2017 == Novel Biochemical Markers for Sarcopenia and Muscle Frailty in Iraqi Elderly

Author name: ولاء اسماعيل جاسم
Supervisor name: هدف ظافر الياسين | نزارعبد اللطيف
General topic: Medicine
Specific topic: Clinical Biochemistry
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: تعرف الساركوبينيا بانها النقصان التدريجي في قوة وكتلة العضلات الهيكلية وهذا يحصل بتقدم العمر. الساركوبينيا اما ان تكون ابتدائية سببها تقدم العمر فقط بدون وجود اي سبب اخر او ثانوية وسببها تقدم العمر الذي له علاقه بالفعالية , الامراض ولتغذية. العينات وطريقة العمل تم اخذ مجموعه عينات دم من اشخاص يرتادون المستشفى التعليمي في بغداد/قسم الروماتولوجي خلال الفترة من الاول من ايلول 2016 الى نهاية شباط 2017. تضمنت الدراسة 100 عينه لاشخاص يعانون من الساركوبينيا(50 امراه و50 رجل) و50 يبدون اصحاء كمجموعة سيطرة(25 امراه و25 رجل). اخذت المعلومات من جميع الاشخاص وقد تضمنت الجنس والعمر والاصابة بالامراض. ( استبعدالا شخاص الذين يعانون من الروماتيزم الرثوي, داء الذئبة الاحمراري، مرض السكري، امراض الغده الدرقية والاشخاص الذين يتعاطون ادويه تحتوي على ستيرويدات). تم تشخيص الاشخاص الذين يعانون من الساركوبينيا الابتدائية بواسطة اختبار الاداء الحركي لكبار السن وجهاز فحص هشاشة العظم (لتعيين مجموع كتلة عضلات الجسم وكتلة عضلات الهيكل العظمي، ومعامل كتلة الجسم. ). اجريت بعض التحاليل البيولوجية التي تضمنت تحاليل تخص الالتهابات مثل الانترلوكين - 6 والبروتين سي عالي الفعالية والالفا 1 انتي - كيموتربسين ولقياس تليفات العضلات (البروكولاجين تايب 3 ان ترمنل ببتايد) ولقياس التقاطع العضلي العصبي ( تركيز السي اكارين فركمنت )ولقياس نمو العضلات تم قياس المايوستاتين.كل المتغيرات البيولوجية قيست بواسطة استخدام تقنية الالايزا. النتائجمعدل قيم كل من كتلة عضلات الجسم والهيكل العظمي والالفا 1 انتي كيموتربسين في مجموعة السيطرة اعلى مما في مجموعة الساركوبينيا وفي الرجال اعلى من النساء وجميع القيم تقل بتقدم العمر. معدل قيم معامل كتلة الجسم ,الانترلوكين - 6 والبروتين سي عالي الفعالية، البروكولاجين تايب 3 ان ترمنل ببتايد وقياس تركيز السي اكارين فريكمنت والمايوستاتين في مجموعة السيطرة اقل من المجموعة المصابة بالساركوبينيا وفي النساء اعلى من الرجال وتزداد القيم بتقدم العمر. هنالك فروقات معنويه عالية في قيم جميع المتغيرات P≤0.01 بين مجموعة السيطره ومجموعة الساركوبينيهاما بالنسبة للفروقات المعنوية حسب الاعمار فهناك فروقات معنويه عالية بين كل المتغيرات البيولوجية P≤0.01ما عدا المايوستاتين حيث لا توجد فروقات معنويه بين قيمه P≥0.05اما بالنسبة للعلاقة بين المتغيرات اعتمادا على الجنس فهي ذات فروقات معنويه عالية P≤0.01 ماعدا قيم الفا 1انتي - كيموتربسين والسي اكارين فركمنت حيث كانت الفروفات معنويه P≤0.05 كما لم تكن هنالك فروقات معنويه بين البروكولاجين تايب 3 ان ترمنل ببتايد والسي اكارين فركمنت P≥0.05 المناقشه1 - معدل قيم كل من كتلة عضلات الجسم وكتله عضلات الهيكل العظمي والالفا 1 - كيموتربسين في مجموعة السيطرة اعلى مما في مجموعة الساركوبينيا وفي الرجال اعلى من النساء وجميع القيم تقل بتقدم العمر. السبب في ذلك قلة الالياف العضليه , قلة خلايا وحدة الحركه , قلةخلايا الارسال وزيادة كتلة الدهون في الاشخاص المصابين بالساركوبينيا. 2 - معدل قيم كل من الانترلوكين - 6 والسي بروتين عالي الفعالية يقلل من قوة العضلات في حين ان الالفا 1 - كيموتربسين يزيد من قوة العضلات عند الاشخاص المصابين بالساركوبينيا. والسبب في ذلك ان الالفا 1 - كيموتربسين تحمي العضلات من التلف اثناء الالتهابات ولكن زيادة معدل قيمة الانترلوكين - 6 يثبط عمل الالفا1 - كيموتربسين . وتزداد قيم السي بروتين عالي الفعاليه والانترلوكين - 6 بتقدم العمر وفي الرجال اكثر من النساء بسبب زيادة كتلة غضلات الجسم وكتلة عضلات الهيكل العظمي .3 - معدل قيم السي اكارين فركمنت في مجموعة الساركوبينيا اعلى منه في مجموغة السيطرة والسبب في ذلك عند اعادة بناء الخلايا العصبيه والعضليه عند كبار السن او المصابين بالساركوبينيا الاكارين ينقسم بواسطة انزيم الكيموتربسين ويطرح السي اكارين فركمنت الى الدم وتزداد فعالية الكيموتربسين وتقل قوة الخلايا العضليه والعصبيه.4 - معدل قيم البروكولاجين تايب 3 ان ترمنل ببتايد في مجموعة الساركوبينيا اعلى من مجموعة السيطرة والسبب انه خلال عملية اعادة بناء الخلايا العضليه العصبيه البروكولاجين تايب 3 ان ترمنل ببتايد قيمها ستزداد بسبب قلة الالياف العضلية وكذلك عملية ازالة التعصب مما يؤدي الى ضعف في الكتله العضليه.5 - المايوستاتين ينظم نمو العضلات سلبيا. المايوستاتين اساسا يثبط عمليه تصنيع المايوستاتين وعندما يزداد تركيز المايوستاتين يقل نمو وقوة العضلات.6 - في الاشخاص المصابين بالساركوبينيا معامل كتلة الجسم اعلى من مجموعة السيطرة. زيادة الدهون ووزن الجسم سببها هو قلة الاحتياج الى الطاقه, قلة فعالية الجسم, قله معدل الايض القاعدي واستخدام كمية سعرات اكثر من التي يحتاجها الجسم.7 - اكثر العوامل التي تؤثر على الساركوبينيا تباعا هي كتلة عضلات الجسم الهيكليه,كتلة عضلات الجسم, المايوستاتين, البروكولاجين تايب 3 ان ترمنل ببتايد , السي اكارين فركمنت ثم الالفا 1 - كيموتربسين. | Sarcopenia is defined as the progressive decline in skeletal muscle mass and strength that occurs with aging. Sarcopenia either primary which is age - related and with no other cause except ageing or secondary sarcopenia which is related to activity, disease and nutrition.Subjects and methodsA cross sectional, case - control study was done in Rheumatology Clinic in Baghdad Teaching Hospital (during the period from September first 2016 to the end of March 2017). It included 100 sarcopinic subjects (50 male and 50 female) and 50 non - sarcopinic subjects (25 male and 25 female). Information was taken from each subject including age, & gender and diseases. Patients with inflammatory diseases (rheumatoid arthritis, systemic lupus erythematosus), diabetes mellitus, thyroid disease and patients taking steroid therapy were excluded.Subjects with primary sarcopenia in this study were diagnosed by : Short Physical Performance Battery and dual - energy x - ray absorptiometry. appendicular skeletal muscle mass, total lean body mass and body mass index.The biomarkers studied were : inflammation : (interleukin - 6, hs - C - reactive protein and α1 - antichymotrypsin ), for markers of muscle fibrosis : (procollagen type III N - terminal peptide, for markers of functional neuromuscular junctions C - terminal Agrin fragment and myostatin

البريكابالين مقابل اميتريبتيلين في علاج فيبروميالجيا في المرضى العراقيين : دراسه مقارنه مزدوجه التعميه == Pregabalin Versus Amitriptyline in the Treatment of Fibromyalgia in Iraqi Patients (A Double Blind Comparative Study

Author name: لمى عيسى حمودي
Supervisor name: سامي سلمان شهاب | سامي سلمان
General topic: Medicine
Specific topic: Medicines and Toxins
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: فيبروميالغيا (FM) هواضطراب يتميز بالام العضلات الهيكليه على نطاق واسع ،و الم عند الضغط وتصلب المفاصل لمدة اطول من ثلاثة اشهر،يرافقها التعب، واضطرابات النوم والذاكرة والمزاج. يعتبرمرض الفايبرومايلغيا تقليديا غيرالتهابيا الا ان سببه مبهم وعلاجه لا يزال في طور البحث. وقداقترحت البيانات الناشئة مؤخرا دورالاكسدة كحدث ذو صلة في التسبب في الفايبرومايلغيا وتبين علاقته مع الاعراض السريرية.الهدف : دراسه مقارنه فعالية ونسبة تحمل الاميتربتلين والبريكابالين في المرضى العراقيين اللذين يعانون من الفايبرومايلغيا, ودور حالة الاكسده على المرض واعراضه وكذلك تاثر الاميتربتلين والبريكابالين على الحاله التاكسديه.المرضى والطرق البحث : اجريت هذه الدراسه المزدوجه التعميه المسيطر عليها على 123 مريض بالفايبرومايلغيا مشخصين بطريقة وولف 1990. بحيث اعيد تقييمهم على طريقه وولف 2010. وقد تلقى هؤلاء المرضى البريكابالين 75 ملغ في اليوم الواحد (62 مريض) او الاميتربتلين 25 ملغ في اليوم الواحد (61 مريض) بصوره عشوائيه ولمدة 12 اسبوع. اما طريقه الاستبيان المنقح لتاثير الفايبرومايلجيا فقد اجريت لتقييم 54 مريض من اللذين دخلوا الدراسه (27 مريض في كل مجموعه علاج). وتم متابعة المرضى كل 4 اسابيع يتم خلالها تقييم التحسن الحاصل على الاعراض السريريه بواسطه حساب المريض لعدد النقاط المسجله في كل زياره وعلى طريقه وولف والاستبيان المنقح لتاثير الفايبرومايلغيا. لقد تم اخذ عينه من دم المرضى في بدايه الدراسه وفي نهايتها وذلك لتقدير مستوى الكلوتاثايون والمالون داي الديهايد لبيان تاثير الادويه على الحاله التاكسديه | Fibromyalgia (FM) is a disorder characterized by widespread musculoskeletal pain, tenderness and joint stiffness for longer than three months, accompanied by fatigue, sleep disturbances, memory and mood disturbances. Although FM is traditionally considered as a non - inflammatory condition, however its etiology remains elusive and its treatment remain challenging. Recently emerging data have proposed the role of oxidative stress as a relevant event in the pathogenesis of FM and suggested its correlation with clinical symptoms.Objective : To compare the efficacy and tolerability of pregabalin to that of amitriptyline in the treatment of Iraqi patients suffering from FM. The role of oxidative stress and its association with symptoms as well as the effect of treatment on this status also was examined. Patients and methods : The present double blind controlled trial was conducted on 123 patients with FM fulfilling the Wolfe 2010criteria. These patients were randomized to receive either amitriptyline in a dose of 25 mg once daily (61patients) or pregabalin in a dose of 75 mg once daily (62patients) for a period of 12 weeks. The revised fibromyalgia impact questionnaire (FIQR) criteria were also used for the assessment of 54 patients entering the study (27 patients for each treatment group). Patients were followed up at 4 weeks intervals; clinical improvement was assessed by calculating the patient's scores at each follow up visit according to Wolfe 2010 and FIQR criteria. In order to study the drug effects on the oxidative status, blood samples were taken at the beginning of the study and at the end of the 12 weeks for the estimation of malondialdehyde and glutathion levels. Results : Amitriptyline 25 mg/day and pregabalin 75 mg/day significantly improved the symptoms of fibromyalgia. Improvement in the pain score wide pain index was significantly better with pregabalin than with amitriptyline (P=0.0001) at 4 weeks of treatment, but both drugs achieved comparable improvement at 8 and 12 weeks. Both drugs (amitriptyline and pregabalin) significantly reduced the somatic symptoms severity score (SSS), but with a highly significant difference (P=0.0001) in favour of pregabalin treatment at 4, 8 and 12 weeks respectively. Comparing the effects of the two drugs on the improvement of sleep, both drugs significantly improved sleep but with a substantial improvement with pregabalin over amitriptyline (P=0.0001). Improvement on revised fibromyalgia impact questionnaire total score was also achieved with both drugs, but again significantly more with pregabalin than in amitriptyline throughout the 12 week study period. The effect of both drugs on oxidative status was shown by a significant elevation of the glutathine and reduction of the malondialdehyde levels (P=0.0001) produced by the two drugs at the end of 12 weeks. Amitriptyline was better tolerated than pregabalin and patient compliance with treatment was better. The main reported adverse effects with amitriptyline were drowsiness and sleepiness, dry mouth and palpitation, while those reported with pregabalin were sleepiness and weakness.Conclusion : Both drugs effectively improved the symptoms of fibromyalgia. Pregabalin was shown to be better than amitriptyline concerning the drug effects on the symptoms severity score and sleep disturbances, but with a comparable effect on pain for both drugs scores at the end of 12 weeks. Clinical improvement with the two treatments was associated with reduction in oxidative stress. Amitriptyline was better than pregabalin concerning patient compliance and tolerability.

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

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

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

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

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

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

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

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

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

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

دراسة تاثير استخدام بعض الادوية والنباتات الطبية في منع او تقليل شدة التكلس الكلوي التجريبي في الارانب == A STUDY OF THE EFFECT OF SOME DRUGS AND MEDICINAL PLANTS IN PREVENTION OR ATTENUATION OF INDUCED NEPHROCALCINOSIS IN RABBITS

Author name: زينب عدنان حاتم العبادي
Supervisor name: فاروق حسن الجواد
General topic: Medicine
Specific topic: Medicines and Toxins
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: ينتج التكلس الكلوي من ترسب الكالسيوم بشكل فوسفات او اوكزالات الكالسيوم في الكلية والذي قد يؤدي الى فشل عمل الكلية من خلال تجمع هذه الجزيئات مع بعضها البعض وتكوين نواة قد تقود الى احداث مايسمى بحصى الكلى . اجريت هذه الدراسة لدراسة التاثير المدرر وكذلك التاثير المؤدي الى خفض او منع حدوث حالة التكلس الكلوي لكل من الرواتنكس والهيدروكلورثيازايد اضافة لبعض النباتات الطبية (كفشة الذرةوالكرفس والشعير والسنامكي)في هذا النموذج التجريبي من التكلس الكلوي .تم استخدام اثنان واربعون ارنبا" محليا" في هذه الدراسة" حيث قسمت الى سبعة مجاميع ,وكانت احداها مجموعة سيطرة .كما استخدم حامض الاوكزاليك بجرعة 333 ملغم /كغم من وزن الجسم لغرض احداث التكلس الكلوي ,اما بقية المجاميع فقد تمت معالجة كل مجموعة باحدى المواد المراد فحصها اعلاه وقبل اعطاء حامض الاوكزالك بساعتين .قيمت وظيفة الكلية من خلال قياس مستوى اليوريا نيتروجين في الدم ومستوى كل من الكرياتنين والبوتاسيوم والصوديوم في مصل الدم ثلاث مرات الاولى قبل بداية التجربة والثانية في اليوم التالي لاحداث التغيير والثالثة بعد مرور عشرة ايام ,بالاضافة الى قياس نسبة الكالسيوم في الادرار في اليوم العاشر من الدراسة مع اجراء فحص مجهري للادرار بالمجهر وبعد انتهاء فترةالدراسة يتم اجراء التقطيع النسيجي لكلية الحيوانات في مجاميع الدراسة لملاحظة الوقاية الحاصلة في الحالة بتاثيرالمواد المختبرة من خلال خفض نسبة التكلس في الكلية الى اقل حد ممكن . ان المعالجة اليومية بجرعة واحدة من الرواتنكس (200ملغم/يوميا"),تعطى فمويا"مع تكرارها لعشرة ايام متعاقبة بعد احداث التكلس الكلوي ادت الى انخفاض معتد لمستويات كل من اليوريا نيتروجين والكرياتنين والبوتاسيوم وارتفاع لمستوى الصوديوم في المصل عند مقارنته مع مجموعة السيطرة اضافة الى ارتفاع نسبة الكالسيوم في الادرار نتيجة للتاثير المدرر للرواتنكس كذلك فان نتيجة التقطيع النسيجي اشارت الى انخفاض شديد في نسبة التكلس الكلوي بتاثير استخدام هذا العلاج .كما ان المعالجةبالهيدروكلورثيازايد ( 1 ملغم / كغم / يوميا" ) بجرعة واحدة تعطى فمويا"قبل احداث التكلس الكلوي سبب نقصا" معتدا" في مستوى كل من اليوريا نيتروجين والكرياتنين والبوتاسيوم والكالسيوم في الادرار مع ارتفاع مستوى الصوديوم في المصل قياسا" مع مجموعة السيطرة كما ان التقطيع النسيجي لكلية الحيوانات المعالجة بهذا الدواء في اليوم العاشر من التجربة اظهر انخفاضا" واضحا" في نسبة المرض ولكن اقل مما احدثه العلاج بالرواتنكس . ان استخدام المستخلص المائي لكفشة الذرة بجرعة (1 غم /كغم )تعطى فمويا" قبل احداث التكلس وتكرار نفس الجرعة لمدة عشرة ايام بعد احداث مرض التكلس الكلوي سبب انخفاضا" معتدا لمستويات اليوريا نيتروجين والكرياتنين والبوتاسيوم مع ارتفاع لمستوى الصوديوم في مصل الدم وكذلك مستوى الكالسيوم في الادرار نتيجة التاثير المدرر مقارنة مع مجموعة السيطرة , كما ان نتيجة التقطيع النسيجي اشارت الى وجود تحسن ملموس من خلال انخفاض نسبة التكلس في كلية الحيوانات المعالجة باستخدام كفشة الذرة مقارنة مع مجموعة السيطرة . كماان المعالجة باستخدام الكرفس الطازج بجرعة ( 8 غم /كغم / يوميا" ) تضاف الى طعام الحيوانات قبل احداث التكلس الكلوي ومن ثم تكرار نفس الجرعة لمدة عشرة ايام سبب انخفاضا" معتدا" لمستويات كل من اليوريا نيتروجين والكرياتنين والبوتاسيوم وكذلك ارتفاع نسبة الصوديوم في المصل مع ارتفاع في مستوى الكالسيوم في الادرار كنتيجة للتاثير المدرر للنبات المستخدم , كما ان نتائج التقطيع النسيجي اوضحت وجود تحسن كبير متمثل في انخفاض مستوى التكلس في الكلية مقارنة مع مجموعة السيطرة .كما ان استخدام المستخلص المائي لنبات الشعير وبجرعة ( 1 ملغم /كغم /يوميا" ) تعطى فمويا" وكذلك نبات السنامكي وبجرعة ( 1 ملغم /كغم /يوميا" ) ايضا" تعطى فمويا" قبل احداث التكلس الكلوي وتكرار نفس الجرعة لمدة عشرة اشار الى ان كلا النباتين سبب انخفاضا" معتدا" لمستوى اليوريا نيتروجين والكرياتنين والبوتاسيوم في مصل الدم وارتفاع في مستوى الصوديوم في المصل والكالسيوم في الادرار بالمقارنة مع مجموعة السيطرة اما التقطيع النسيجي فقد اظهر ايضا" تاثيرا" لهذين النباتين من خلال خفض نسبة التكلس في الكلية بالمقارنة مع مجموعة السيطرة , ولكن على الرغم من هذه النتائج الايجابية فان استخدام نبات السنامكي كان مصحوبا" ببعض التاثيرات الجانبية المتمثلة بحدوث اسهال للحيوان نتيجة للتاثير المسهل لنبات السنامكي . وكخلاصة , فان النتائج السابقة لهذه الدراسة والتي استخدمت فيها مجموعة من الادوية والنباتات الطبية اشارت الى وجود تاثير مدرر لهذه المواد اضافة الى تاثيرها في خفض نسبة التكلس في الكلية بشكل واضح جدا" مما قد يعطي فرصا" علاجية او وقائية للمرضى المعرضين للاصابة بالتكلس الكلوي او قد يكون لهل تاثيرا" حتى في علاج مرض حصى الكلية عند اطالة فترة استخدامها . | Nephrocalcinosis is the deposition of calcium in the form of phosphate or oxalate within the renal tissue , which may lead to impaire the renal function . These crystals may aggregate and provide a nidus for the formation of renal stone ( Nephrolithiasis ). This study was performed to explore the diuretic effect of Rowatinex , Hydrochlorthiazide and some medicinal plants ( corn silk , celery , barley and senna ) , and there effect in attenuation or prevention of the development of nephrocalcinosis in an experimental model .Fourty - two local domestic rabbits were used in the present study , they were divided in to seven groups . One group was used as the control in which oxalic acid in a dose of 333 mg /kg orally was given to induced nephrocalcinosis . Other groups were treated two hours before induction by one of the above mentioned agents for each group . nephrocalcinosis was assessed by estimating blood urea nitrogen ( BUN) , serum creatinine , potassium and sodium , urine calcium inaddition to general urine examination on two occasions : 1 day and 10 day after induction , also the histopathological examination of the rabbits kidney in the last day of experiment to detect the improvement in the treated groups in comparison to the control group . Animals pretreated with Rowatinex ( 200 mg/day ) orally and continued on the same dose for successive 10 days after induction , had a significant lower level(p<0.05) of BUN, serum creatinine ,potassium and higher level of serum sodium also elevation of urine calcium due to the diuretic effect of Rowatinex , also the histopathological examination showed a well improvement in comparison with the control group . Pretreatment with Hydrochlorthiazide ( 1 mg/kg body weight ) orally in a single dose before induction caused a significant lowering (p<0.05) of BUN , serum creatinine and potassium and prevention of hyponatremia , also significant lowering of urine calcium also the histopathological examination which showed a notice improvement in comparison to the control group but it is less than that produced by Rowatinx. Aqueous extract of Corn Silk (1 gm /kg / day ) orally given before induction and continued for successive 10 days cause a significant lowering ( P<0.05 ) of BUN , serum creatinine , potassium and prevention of hyponatremia also elevation of urine calcium level due to it is diuretic effect . In addition to the histopathological examination which showed a significant improvement in this case .Pretreatment with aqeous extract of fresh Celery ( 8 gm /kg / day ) add to the animal food continued on the same dose for 10 days after induction produced a significant ( p<0.05 ) reduction in BUN , serum creatinine , potassium level and prevention of hyponatremia , while elevation of urine calcium level as a diuretic effect and the histopathological examination which showed an improvement and reduction of the severity of nephrocalcinosis .Pretreatment with aqeous extract of Barley ( 1 mg/kg /day ) given orally and aqeous extract of Senna ( 1 gm /kg /day ) given orally and continued for 10 successive days also showed a significant ( p<0.05 ) reduction of BUN , serum creatinine , potassium and prevention of hyponatremia in addition to increase urine calcium level . The histopathological examination showed a a notice improvement in comparison to the control group , but inspite of this improvement there is also a side effect compined with using Senna which is represented by diarrhea which is due to the known purgative effect of Senna . And as aconclusion , the results of the previously mentioned drugs and medicinal plants showed a significant diuretic and attenuating effect on the induced nephrocalcinosis at the tested doses , so there is a possibility of using these agents in the treatment of this model of nephrocalcinosis with apossible preventive opportunity in patients at ahigh risk of developing nephrocalcinosis and may also with a long course of treatment help patients with renal stone disease .

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

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

تاثير علاج CD 20 inhibitors مقارنة بعلاج TNF ? inhibitors IL - على 17 في مرضى التهاب المفاصل الروماتويدى الفعال == Effects of CD20 Inhibitor Therapy in Comparison to TNF ? Inhibitor Therapy on Serum IL - 17 in Patients with Active Rheumatoid Arthritis

Author name: محمد حنون داود
Supervisor name: هالة غازي محمود | محمد هادى العصامى
General topic: Medicine
Specific topic: Clinical Biochemistry
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Rheumatoid arthritis (RA) is a chronic , systemic , inflammatory disorder that may affect many tissues and organs ,but principally attacks flexible( synovial ) Joints , the pathogenesis of RA is not completely understood .Objective : To evaluate the effects of CD20 inhibitor therapy in comparison to effects of TNF α inhibitor therapy on serum IL - 17 in patients with active rheumatoid arthritis.Setting : This study was performed during the period from October 2012 to May 2013 . The subject were selected from the patients attending the out patients clinic in Medical city /Baghdad Teaching Hospital / Rheumatology unit and the laboratory tests were done inMedical City /Teaching Laboratories The study include 70 patients and 20 healthy control individuals , their age range from 20 - 68 years . The patients were divided into three groups : - Group (1)consist of 20 RA patients received disease modifying anti rheumatic drugs(DMARDs ) . - Group(2) consist of 25 RA patients received biological treatment Etanercept ( anti TNFα ). - Group(3) consist of 25 RA patients received biological treatment Rituximab ( anti CD20).Methods : Enzyme Linkade Immunosorbent Assay ( ELISA ) test was used for the determination of IL - 17 , Leptin and hsCRP , while colorimetric method was used for the determination of uric acid . Rheumatoid factor ( RF ) was detected by serological investigation . The only anthropometric parameter in this study was body mass index( BMI). The current results revealed that serum levels of hsC - RP , ESR and RF were significantly higher in patients than in healthy controls. While serum level of IL - 17 was significantly lower in patients who are undertreatment than in healthy control ( P < 0.05 ).There was significant difference among groups : serum level of IL - 17 : - in group 1 higer than in group 2 ( P < 0.05 ) - in group 2 higer than in group 3 ( P < 0.05 ) There was no significant difference between all the groups in this study regarding level of uric acid ( P > 0.05 ) and the level of the leptin ( P > 0.05 ) , also significant positive correlation among each of ESR , hsC - RP , IL - 17 ( P < 0.05 ) and ( 0 < r < 1+ ).Conclusion :  IL - 17 has a significant effect on the pathogenesis of RA . IL - 17 level is higher in normal people and people with RA receiving DMARDs compared to RA patients receiving biological treatment. In patients with biological treatment , these received TNFα inhibitor ( Etanercept ) has a high IL - 17 level compared to these received CD20 inhibitor ( Rituximab ) . IL - 17 can be used as a marker for RA activity.

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

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

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

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

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

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

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

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

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

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

دراسة كيميانسيجية مناعية لمعرفة التغيير العددي والسلوكي للخلايا الجذعية في المعدة لبعض الحالات المرضية == Immunohistochemical study to identify the changes in number and behavior of gastric stem cells in some pathological conditions

Author name: علي عبد المحسن سلمان الشافعي
Supervisor name: نوفل خضير ياس الحديثي
General topic: Medicine
Specific topic: Anatomy and Histology and Embryos
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: الخلايا الجذعية هي خلايا في اجسامنا لها القابلية على التكون الذاتي والتميز الى انواع مختلفة من الخلايا وذلك لبناءالانسجة والاعضاء. في العلم مازال هناك تحدي لفهم كيف للبيضة المخصبة ان تتطور الى طبقات جرثومية وانواع متددة من الخلايا والتي تتطور لاحقا الى انسجة متعددة واعضاء ذات وظائف حيوية مختلفة. هناك انواع عديدة من خلايا الجذعية, والخلايا الجذعية المعدية هي واحدة منها والتي هي خلية غير ناضجة شكليا ومسؤلة لتوليد انواع الخلايا الرئيسية في الغدة المعدية ويمكن ان يكون لها دور في تكوين سرطان المعدة. يظن ان هذه الخلايا تحافظ على مجاميع صغيرة وثابتة من الخلايا الجذعية التعددة القدرات (multipotent stem cells) في المعدة من خلال الانقسام المتماثل الغير متكرر. الخلايا الوليدة تتكون بواسطة الانقسام المتكرر الغير متماثل للخلايا الجذعية المتعددة القدرات لتعطي الخلايا الجذعية التي تتميز وتكون نسل مختلف انواع الخلايا الطلائية عندما تهاجر باتجاهين متعاكسين, اما عند تجويف الغدة العلوي او الى الغدة نفسها. تهدف الدراسة الى تحديد اعداد الخلايا الجذعية المعدية في حالة التهاب المعدة والقرحة والحالات ما قبل السرطانية ووسرطان المعدة ومقارنتها بالحالات الطبيعية وايضا دراسة تاثير الجنس والعمر على هذه الاعداد.تمت الدراسة باخذ 72 خزعة من المرضى الذين يجرى لهم ناظور للمعدة والامعاء في وحدة الناظور لمستشفى بغداد التعليمي لفترة 5 اشهر. وقد تم تقسيم المرضى حسب التشخيص النسيجي الى 5 مجاميع (طبيعي والتهاب المعدة وتقرح المعدة وحالات ما قبل السرطانية والحلات السرطانية). تم معالجة العينات وصبغت بمادتي الهيماتوكسلين والايوسين لغرض التشخيص النسيجي ومجموعة اخرى من السلايدات اعدت لغرض الدراسة الكيميانسيجية المناعية بواسطة الاجسام المضادة لل (lgr5).وقد اظهرت النتائج ان التعبير النسيجي الايجابي للخلايا الجذعية بواسطة ال(lgr5) يزداد مع الحالة المرضية. وان هذد الزيادة تصل الى الذروة في الحالات ما قبل السرطانية وتنخفض قليلا في حالة سرطان المعدة. وكان المتوسط العددي للخلايا الجذعية في معدة الانسان الطبيعي 7خلايا وفي حالة التهاب المعدة 18 خلية وفي قرحة المعدة 25 خلية وفي الحالا ما قبل السرطانية 35خلية واخيرا 28 خلية في حالات سرطان المعدة. ووجد ان اعلى معدل للخلايا الجذعية في معدة الانسان الطبيعي يكون في الاعمار المتوسطة (20 - 40 سنة) وينخفض مع تقدم العمر.وبالاستنتاج وجد ان الخلايا الجذعية المعدية تزداد مع المرض وان هذه الزيادة مرتبطة بشدة المرض نفسه من جهة (كما في التهاب المعدة وقرحة المعدة) واما اذا كانت الخلايا الجذعية تشارك في تكوين السرطان في المعدة من جهة اخرى (كما في الحالات ما قبل السرطانية وسرطان المعدة) | Background : Stem cells are a group of cells in our bodies, with the capacity to self - renew and differentiate to various types of cells, thus to construct tissues and organs. In science, it is still a challenge to understand how a fertilized egg develops germ layers and various types of cells, which further develop into multiple tissues and organs with different biological functions. There are many types of stem cells, gastric stem cells is one of these types, which are morphologically immature cell responsible for generating the major cell types of gastric gland and it may have a role in development of gastric cancer. These cells are thought to maintain a small, steady - state population of multipotent stem cells in the gastric unit through infrequent symmetric division. Daughter cells generated by much more frequent asymmetric division of these multipotent stem cells subsequently exit the stem cell niche and differentiate to generate the various epithelial cell lineages as they migrate bidirectionally toward the pit or gland.Aim of study : 1) Identify the gastric stem cells population in gastritis, gastric ulcer, premalignant conditions and gastric cancer and comparing them to normal mucosal stem cells. 2) Study the effect of sex and age on this population. Patients and methods : 72 biopsies were taken from patients underwent OGD in the endoscopic unit of Baghdad Teaching Hospital over a period of 5 months. Patients were divided histopathologically into 5 groups (normal, gastritis, gastric ulcer, premalignant conditions and gastric cancer). Specimens were processed & slides stained with H & E were examined histopathologically, a second set of slides were prepared for immunohistochemial study with Leucine - rich Repeat Containing G - Protein Coupled Receptor 5 (Lgr5) antibody.Results : The results showed that the expression of lgr5+ stem cells was increased with pathology. This increase reaches its maximum in premalignant conditions and slightly declines in gastric cancer. The average number of stem cells pre high power field in normal stomach was 7 cells, in gastritis was 18 cells /HPF, in gastric ulcer was 25 cells /HPF, in premalignant conditions was 35 cells /HPF and in gastric cancer was 28 cells /HPF. The highest number of stem cells in normal stomach was in middle age group and declines with aging.Conclusions : the number of gastric stem cells increase with pathology and this increase is related to aggressiveness of the disease on one hand (gastritis & gastric ulcer) & on whether stem cells participate in tumor pathogenesis on the other hand (premalignant conditions & gastric cancer).

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

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

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

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

دراسة المؤشر ات الحيوية للخلايا الجذعية السرطانية FOXM1, TAZ, EpCAM,CD47 في ما يتعلق بالمعلمات النسيجية لسرطان الثدي

Author name: رفاه محمد جعفر الخطیب
Supervisor name: سالم رشید حمودي العبیدي
General topic: Medicine
Specific topic: Tissue Diseases
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

البحث عن طفرة JAK2 وتحديد مستوى الارثروبويتين لمتبرعي الدم الذين لديهم حجم عالي لخلايا الدم الحمراء المضغوطة == Detection of JAK2 V617F Mutation and Estimation of Serum Erythropoietin among Blood Donors with High Hematocrit

Author name: مي احمد خضير
Supervisor name: هيثم احمد الربيعي
General topic: Medicine
Specific topic: Diseases - Blood
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: ليس من النادر وجود متبرعين بالدم لديهم تركيز خضاب الدم (الهيموغلوبين) او مستوى الكريات الحمر المضغوطة بقيم اعلى او قريبة للحد الاعلى للقيمة الطبيعية, ان التشخيص والتقييم السريري لهذه القيم المتغيرة عند متبرعي الدم قد يتعقد اكثر بسبب التبرع المنتظم بالدم والذي قد يخفي الاسباب المرضية المؤدية لهذه التغيرات. تم التحري عن هذه القيم من اجل نفي او اثبات وجود اسباب ثانوية لمرض كثرة الكريات الحمر اضافة الى ورم التكاثر النقوي مثل مرض كثرة كريات الدم الحمر الحقيقية. ان كثرة كريات الدم الحمر الحقيقية هي حالة تنتج من زيادة مستوى كريات الدم الحمر الدائرة في مجرى الدم والتي عادة ما تظهر على شكل زيادة في تركيز خضاب الدم مع/او زيادة مستوى الكريات الحمر المضغوطة٬ بينما كثرة كريات الدم الحمر النسبية تنتج من نقصان حجم البلازما وبدون زيادة في الحجم الكلي للكرية الحمراء. كل صنف في مرض كثرة كريات الدم الحمر الحقيقية من الممكن تقسيمه الى نوعين; اولي وثانوي. ان المرضى الذين لا يمكن تصنيفهم على انه لديهم كثرة كريات الدم الحمر الاولية او الثانوية قد جمعوا معا في صنف داء الكريات الحمر مجهول العلة. هورمون تكون كريات الدم الحمر (الارثروبويتين) هو عامل نمو مكون الدم وضروري للنضوج النهائي لسلف الخلايا الحمراء الى خلايا حمراء بالغة. ان تحديد مستوى الارثروبويتين في المصل ربما يكون مساعدا في التمييز بين الانواع المختلفة لكثرة كريات الدم الحمر. انتاج الارثروبويتين يمكن ان يرتفع في حالات (فقر الدم) او (نقص التاكسج). مرض كثرة كريات الدم الحمر الحقيقية هو ورم تكاثر نقوي يتصف بتكاثر مضطرد في العناصر المكونة للكريات الحمر٬ الخلايا النقوية والنوﱠاء في النخاع٬ زيادة عدد الخلايا في الدم المحيطي او زيادة حجم العنصر المكون للكرية الحمراء. ان سبب مرض كثرة كريات الدم الحمر الحقيقية لم يتم فهمه بصورة كاملة٬ تقريبا معظم المرضى المصابين بهذا المرض لديهم طفرة مكتسبة في المورث الجيني المسمى جاك ٢ في كروموسوم ٩ وموجود في الاغلبية العظمى من مرضى اورام التكاثر النقوي واصبح مؤشر ذو قيمة لتشخيص اورام التكاثر النقوي٬ ومع ذلك فان هذه الطفرة وجدت في امراض دم اخرى وحتى انه في بعض الدراسات تم اكتشاف وجود طفرة جاك ٢ في عينات دم طبيعية. هنالك تقنيات مختلفة من اجل التحري عن الطفرة الجينية المؤدية لطفرة جاك ٢ ٬ احدى هذه التقنيات هو بوليميراز تفاعل البوليميريس المتسلسل. باستعمال تفاعل البوليميريس المتسلسل هنالك تسلسلات محددة موجودة في الحمض النووي يمكن تضخيمها. يتم الحصول على القياس الكمي للمنتج المضخم باستعمال مجسات التلالا او الصبغات المرتبطة بالحمض النووي المتلالا وتقوم اجهزة البوليميريس المتسلسل الواقعي بقياس هذا التلالا خلال التغييرات الحرارية التي تحتاجها دورات تفاعل البوليميريس المتسلسل. هدف الدراسة : لمناقشة الاحتياج الواقعي للتخلص من دم المتبرعين والذين لديهم نسبة عالية من كريات الدم الحمر المضغوطة.المرضى والطرق : اجريت هذه الدراسة والمتعلقة بالحالة والحالة المسيطر عليها خلال فترة 7 اشهرابتداءا من ١٦ كانون الاول ٢٠١٢ وانتهت في ٨ تموز ٢٠١٣. جمعت عينات الدم الوريدي من (١١٦) متبرع بالدم واللذين قصدوا المركز الوطني لنقل الدم. كان المتبرعون جميعا ذكورا واعمارهم تتراوح ما بين ٢١ - ٦٢ سنة. كان حجم الدم المضغوط للمرضى تساوي او اكثر من ٤٨٪. تم استثناء ٢٢ متبرعا من الدراسة منهم ١٤ متبرعا كان هنالك فشل في استخراج الحمض النووي من عيناتهم والثمانية الباقون حدث فشل في قراءة تفاعل البوليميريس المتسلسل لعيناتهم. كذلك تحتوي الدراسة على المجموعة المسيطر عليها وهي ٢٠ مريضا مصابين بمرض كثرة كريات الدم الحمر الحقيقية مع طفرة جاك ٢ موجبة. تم تشخيص هؤلاء المرضى باتباع شروط الهيئة البريطانية للمعايير في امراض الدم. تم عمل التحاليل المختبرية التالية لكلا المجموعتين (المرضى والمسيطر عليها)٬ وتشمل : تعداد الدم الكامل٬ صورة الدم٬ مستوى الارثروبويتين في المصل وتفاعل البوليميريس المتسلسل. النتائج : - تمخضت الدراسة عن وجود نسبة طفرة معدودة عالية ومهمة لجاك ٢ في المجموعة المسيطر عليها والمصابين بمرض كثرة كريات الدم الحمر الحقيقية مقارنة بالمتبرعين والذين لديهم طفرة جاك ٢ موجبة٬ ومعدل القيمة (٪) هو ٥٨ ± ٩‚٢٦ مقابل ١١٫١٠ ± ٦‚١٢. - حوالي ٢١٪ من متبرعي الدم (٢٠ من ٩٤) لديهم طفرة جاك ٢ موجبة; ١٨ منهم (٩٠٪) كانوا مدخنين. - في ما يتعلق بتاثير التدخين وكميته على طفرة جاك٢ ٬ حوالي ٨‚٢٢٪ ( ١٨ من ٧٩) من المدخنين لديهم طفرة جاك٢ موجبة٬ بينما حوالي ٣‚١٣٪ (٢ من ١٥) من غير المدخنين كان لديهم طفرة جاك٢ موجبة. كذلك تكرار الطفرة الموجبة لجاك٢ كان اعلى ب(٢٫٢٤ طية) في مجموعة مؤشر التدخين المساوي او الاكثر من ١٠ عبوة سنة ومجموعة مؤشر التدخين اقل من ١٠ عبوة سنة . - هنالك ارتباط مهم بين الحكة مع طفرة جاك٢ الموجبة وذلك لان نسبة الحكة في مجموعة مرضى كثرة كريات الدم الحمر الحقيقية ٤٥٪ وهي اعلى بقليل من نسبة طفرة جاك٢ الموجبة في مجموعة متبرعي الدم (٤٠٪) . - هنالك اختلاف غير مهم لمستوى الارثروبويتين تحت الطبيعي بين طفرة جاك٢ الموجبة والسالبة في مجموعة متبرعي الدم وبين المجموعة المسيطر عليها والمصابين بمرض كثرة كريات الدم الحمر الحقيقية ولديهم طفرة جاك٢ موجبة. الاستنتاجات : ١ - ان تكرار طفرة جاك٢ كان اكثر بكثير من المتوقع للاشخاص الذين يرتادون المركز الوطني لنقل الدم من اجل التبرع بالدم٬ وهذا مؤشر مهم ان طفرة جاك٢ ربما تكون الاشارة المبكرة لتدل على اورام الدم وبضمنها مرض كثرة كريات الدم الحمر الحقيقية. ٢ - ليس بالضرورة ان يكون الدم المتبرع به من قبل المتبرعين والذين لديهم مستوى كريات الدم الحمر المضغوطة في اعلى مستوى للطبيعي يدل على الامان الكامل للدم باعتباره خال من طفرة جاك٢ . ٣ - ان وجود فروقات احصائية مهمة بين مجموعة متبرعي الدم والمجموعة المسيطر عليها (المصابين بمرض كثرة كريات الدم الحمر الحقيقية) يثير تساؤل حول اهمية الفحص والتحقق من طفرة جاك٢ في المتبرعين المتمتعين بصحة كاملة. هل يستوجب لهؤلاء المتبرعين ان يكونوا قلقين من وجود هذه الطفرة لديهم وتاثيرها على صحتهم المستقبلية وضرورة الحاجة الى المتابعة المستمرة. ٤ - خطر التدخين لاظهار طفرة جاك٢ هو ١٫٧ طية عن غير المدخنين٬ وان كمية التدخين تظهر زيادة خطورة ٢٫٢٤ طية لاظهار الطفرة لمتبرعي الدم في مجموعة مؤشر التدخين المساوي او الاكثر من ١٠ عبوة سنة عن مجموعة مؤشر التدخين اقل من ١٠ عبوة سنة. ٥ - ان تضمين مستوى الارثروبويتين الاقل من الطبيعي كشرط تشخيصي ثانوي لم يكن مثمرا

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

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

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

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

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

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

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

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

تقيين مدى فعالية قياس درجة الكالسيوم في تشخيص مرضى الشريان التاجي == The evaluation of calcium score validity in the diagnosis of patients with coronary artery disease

Author name: ابراهيم طارق ابراهيم
Supervisor name: انمار زكي صالح | عماد محمد حسين المشاط
General topic: Medicine
Specific topic: Medical Physics
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Coronary artery disease is one of important diseases as in many cases ends up with death. Among many types of coronary artery disease is the lipoprotein plaque deposition on the artery wall. Much research reports have been appeared in the literature concerning the causes, investigation, and treatment.Conventional angiography was very valuable procedure to investigate and assess the plaque in the walls of the coronary artery also the amount and position of occlusion.As the Computed Tomography scanners were developed a new noninvasive procedure was invented using the calcium present in the plaque as an indicator for the amount of plaques in the coronary artery. The procedure can also specify the position and the severity of the occlusion. The coronary artery assessment in the plaque is taken as calcium score which based on amount of calcium and plaque formation.In the present study we were aiming to investigate the validity of the calcium score in the diagnosis of coronary artery disease, and also to find the relation between calcium score with calcification and plaque formation.Sixty one patients were evaluated 40 male and 21 female who had symptoms chest pain to determine the prevalence and risk factor correlation of coronary artery calcification deposits as a marker of atherosclerosis.As History of hypertension, age, represents the characteristics of study. And Anthropometric measurements, weight in (kg), height (m), and body mass index (kg/m2). The level of lipid profile for fasting serum of normal and abnormal lipids were analyzed in (mmol/L) cholesterol, triglyceride, high density lipid, low density lipid, very low density lipid.Patients were advised to come fasting and before Computed Tomography Angiography examination.They have been given Beta blocker to reduce the heart rate to less than 60 beats/min. The patients were instructed to lie on the couch of CT scanner and stay relaxed. Contrast mediums were injected by means of injector in vein immediately before scanning.Results revel that not all patients show high calcium score in spite of chest pain on the other hand those patients with high calcium score they also have an increased plaque in their coronary artery .At low calcium score (0 - 100), Cholesterol, Triglyceride and High density lipoprotein are generally inversely proportional with calcium score with the exception of Low density lipoprotein remains virtually unchanged in the whole range of calcium score (0 > 300).While at high calcium score concentration > 300 these lipoproteins are directly proportional with calcium score in contrast with High density lipoprotein which is inversely proportional with calcium score.1 - Low or zero calcium score does not exclude definitely coronary artery disease in other word a person with low or zero may have a sever occlusion and needs further investigation.2 - The correlation between calcium score with High density lipoprotein, urea and creatinine is increased as the calcium score.3 - Its appears to be that the number of vessel involve calcium score different for different gender.

الكشف عن المعاملات السرطانية (مستضد السرطان 15 - 3 ومعامل السرطان 21 - 1) لدى النساء العراقيات المصابات بسرطان الثدي == Detection of Cytokeratin 19 fragment (TM 21 - 1) and CA 15 - 3 tumor markers in Iraqi women with breast cancer

Author name: سلام عادل رحيم
Supervisor name: زينا حسن عبد القهار | منور عبد الاله النقاش
General topic: Medicine
Specific topic: Clinical Biochemistry
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: سرطان الثدي مسؤول عن موت الاف النساء على نطاق العالم كل سنة. وهو واسع الانتشار في العالم والعراق حتى اصبح مشكلة حقيقية للصحة العامة. اسباب هذا المرض لا تزال تحت الدراسة. العوامل الجينية والهرمونية تشارك في تطور سرطان الثدي وانتشار هذا المرض. قد يلعب مستضد السرطان 15 - 3 ومعامل السرطان 21 - 1 دورا في الكشف عن سرطان الثدي.الهدف : 1 - لتقدير مستويات المصل من المعاملات السرطانية مستضد السرطان 15 - 3 ومعامل السرطان 21 - 1 في مجموعة من مرضى سرطان الثدي مقارنة مع مجموعة الضبط.2 - لربط المعاملات السرطانية مستضد السرطان 15 - 3 ومعامل السرطان 21 - 1 التي تم قياسها في المصل مع تقدم العمر، عدد الاطفال، مؤشر كتلة الجسم، درجة المرض، ومرحلة المرض لدى مرضى سرطان الثدي.3 - لتقييم الدور التشخيصي والتكهني لمعامل السرطان 21 - 1 ومستضد السرطان 15 - في الكشف عن حالات سرطان الثدي الغازية الموضعية والمنتشرة سريريا.الاشخاص وطريقة العمل : - اجريت هذه الدراسة خلال الفترة من كانون الثاني 2013 الى ايار 2013 حيث تم اختيار النساء بعد تشخيصهن في العيادة الاستشارية لمستشفى بغداد التعليمي في مدينة الطب/ استشارية الاورام. اجريت الفحوص المختبرية في المختبرات التعليمية في مدينة الطب. تضمنت هذه الدراسة (40) مريضة مصابات يعانين من سرطان الثدي الموضعي تتراوح اعمارهن بين (36 - 65) سنة و(20) مريضة يعانين من سرطان الثدي المنتشر و(30) امراة من مجموعة الضبط متماثلات مع مجموعة المريضات من ناحية العمر. تم قياس كل من (مستضد السرطان 15 - 3 ومعامل السرطان 21 - 1) بطريقة الالايزا كما تم قياس مؤشر كتلة الجسم لجميع النساء في هذه الدراسة. النتائج : - اظهرت النتائج ان مستويات مستضد السرطان 15 - 3 ومعامل السرطان 21 - 1 المقاسة في المصل لمريضات سرطان الثدي كانت اعلى بكثير من تلك المقاسة في المصل لمجموعة الضبط الاصحاء, ولكنها اظهرت كذلك بان هذه المستويات اعلى بكثير لدى المريضات المصابات بسرطان الثدي المنتشر مقارنة بالمريضات المصابات بسرطان الثدي الموضعي ومجموعة الضبط.الاستنتاجات : ترتفع مستويات مستضد السرطان 15 - 3 ومعامل السرطان 21 - 1 لدى النساء المصابات بسرطان الثدي المنتشر بصورة ملحوظة, من هذه النتائج يقترح استخدام مستضد السرطان 15 - 3 ومعامل السرطان 21 - 1 كعلامة يمكن التنبؤ من خلالها عن سرطان الثدي المنتشر | Breast cancer is responsible for the death of thousands of women worldwide every year. It is widespread in the world, in Iraq it has become a genuine problem for public health. The etiology of the disease is still under study. Genetic and hormonal factors are involved in the development of breast cancer and progression of the disease. Cancer Antigen (CA 15 - 3) and Tumor marker 21 - 1 (TM 21 - 1) have been involved in the detection of breast cancer. Objective : - 1 - To assess serum levels of TM 21 - 1 and CA15 - 3 tumor markers in a group of Breast cancer patients compared to controls.2 - To correlate the measured serum TM 21 - 1 and CA15 - 3 with age, parity, BMI, grade, and stage of disease in breast cancer patients.3 - To evaluate the diagnostic and prognostic role of TM 21 - 1 and CA15 - 3 in clinical assessment of locally invasive and metastatic breast cancer cases.Subjects, Materials and Methods : - This study was performed during the period from January 2013 to May 2013. The subjects were selected from patients attending the Outpatient Clinic in Baghdad Teaching Hospital / Medical City/ Oncology unit. The laboratory tests were done at Medical City /Teaching Laboratory. The Study included 40 female patients with localized breast cancer age ranged (36 - 65) years, 20 female patients with metastatic breast cancer age ranged (35 - 65) years and 30 apparently healthy females as controls matching their age with breast cancer patients. CA 15 - 3 and TM 21 - 1 were measured by ELISA. Body mass index (BMI) was measured for all subjects participated in the study. Results : - Serum CA 15 - 3 and TM 21 - 1 in breast cancer patients were significantly higher than healthy control group, and their levels were significantly higher in metastatic breast cancer patients when compared with localized breast cancer patients and control group

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

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