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

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

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

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

الجملة الوعائية المجهرية لمخيخ الجرذ == Microvasculature of the Rat Cerebellum

Author name: حسنين عبد الجبار العبيدي
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: In spite of its various anatomical, functional, and phylogenetic divisions, the rat cerebellum remains constant throughout, in its cellular and laminar organization. The question remains whether the microvascular supply of the cerebellum is quantitatively homogenous or not.This study aims to investigate quantitatively whether the homogeneity in cerebellar cellular architecture is reflected on the functional vascular bed in different regions of the cerebellum and to provide reliable morphometric parameters that can be used for comparative purposes with other regions in the central nervous system.A sample of 20 adult male albino rats was used. Fresh frozen 20 μm thick sections in the sagittal plane were stained for microvascular alkaline phosphatase. Image analysis software (Global Lab Image), was used to measure circumscribed areas for the length and number density of their contained alkaline phosphatase positive microvascular profiles. Microvascular densities in the cortical layers of the cerebellum as a whole was (76.72±30.59 count/mm2) and (231.45±82.14 mm/mm3). There was a higher microvascular density in the granular layer in comparison to the molecular layer. This was significantly higher than the densities of the white matter core excluding the deep cerebellar nuclei. The densities in the deep cerebellar nuclei were (122.86±20.38 count/mm2) and (328.22±33.45 mm/mm3). Length density did not show obvious heterogeneity in the cortical layers between different divisions of the cerebellum. Number density was significantly higher within the cortical layers of the hemisphere when compared to the vermis. A comprehensive guide for identifying rat cerebellar regions was put foreword. This guide can be useful for identifying rat cerebellum sagittal sections regardless of the level of the section or the staining method used without the need to follow an entire series of sections.The differences in microvascularity on the laminar level was correlated with the functional necessity of neurons and synapses. Neurovascular coupling appeared in its best manifestation in the deep cerebellar nuclei where it was clear that dense microvascularity was concomitant with a densely synaptic and neuron - poor region.The cerebellar cortex as a whole, was homogenous in its microvascular length density in whichever division, anatomical, functional or phylogenetic.The predilection towards heterogeneity between vermian and hemispheric cortices as far as number density is concerned can be attributed to the complexity of branching for a given length of vessels.A combination of two morphometric parameters (microvascular length and number density) is a reasonable choice to explore the microvascular network in terms of functional needs and spatial composition.

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

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

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

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

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

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

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

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

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

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

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

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

دراسة الانترلوكين - 6 ,عامل تنخر الورم - الفا وبعض العناصر النذرة في مصل مرضى متلازمة الالم العضلي الليفي == A Study of Serum Interleukin - 6, Tumor Necrosis Factor - ? and Some Trace Elements in Patients with Fibromyalgia Syndrome

Author name: رغد عماد الدين ناجي
Supervisor name: قسمة محمد تركي | محمد هادي العصامي
General topic: Medicine
Specific topic: Clinical Biochemistry
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: متلازمة الالم العضلي الليفي واحدة من اسباب الالم الشائع في الام الجهاز الهيكلي الذي ينتشر في اجزاء مختلفة من الجسم .تتميز هذه المتلازمة بانتشارها في الاناث وهي تصيب الفئات العمرية (۲۰ - ٧۰ ) سنة وتنخفض بعد هذا العمر . ترتبط هذه المتلازمة عادة باعراض متعلقة بالمرض وهي : التعب , تصلب العضلات , اضطراب النوم , ضعف التركيز , اضطرابات نفسية , والصداع .وعلى الرغم من ظهور الكثير من النظريات , الا ان اسباب المرض غير معروفة لحد الان .الهدف : لقياس مستوى تركيز الانترلوكين - ٦ , عامل تنخر الورم - الفا وعلاقتها باعراض الالم وقباس مستوى بض العناصر الندرة ( الزنك , النحاس , السيلينيوم ) لمرضى هذه المتلازمة.المكان : اجريت هذه الدراسة للفترة الزمنية من تشرين الثاني ۲۰١۰ الى تموز۲۰١١. وتم اختيار المرضى من المراجعين للعيادة الاستشارية الخارجية في مستشفى بغداد التعليمي لقسم امراض المفاصل والتاهيل . تم اجراء التحاليل في المختبرات التعليمية العائدة لمستشفى بغداد التعليمي ومركز السموم في مستشفى الجراحات التخصصي .الاشخاص : تضمنت الدراسة ٥٧ مريضا من مرضى متلازمة الالم العضلي الليفي ( ٤٩ انثى + ٨ ذكور ) تراوحت اعمارهم بين ( ٤٣٫۰١٧ ± ١۰٫٩٤٥ ) سنة ومجموعة المتبرعين الاصحاء عددهم ٣٤ (۲٨ انثى + ٦ ذكور ) .طرق العمل : تم قياس كل من الانترلوكين - ٦ , عامل تنخر الورم - الفا , البروتين التفاعلي - سي وهرمونات الغدة الدرقية باستخدام طريقة اليزا .اما العناصر الندرة ( الزنك , النحاس , السيلينيوم ) فقد تم استخدام طريقة الامتصاص الطيفي الحراري .تم التعبير عن النتائج بالمعدل ± معدل الغلط القياسي ومع احتمالية وقوع الغلط اقل من ( ۰٫۰٥ ) كمغزى احصائي .النتائج : اظهرت النتائج ان هناك فروقا معنوية بين مصل الانترلوكين - ٦ , عامل تنخر الورم - الفا , والبروتين التفاعلي - سي - عالي الحساسية , بين مرضى متلازمة الالم العضلي الليفي ومجموعة المتبرعين الاصحاء .اما تحاليل هرمونات الغدة الدرقية , فلم تكن هناك فروقات معنوية بين المرضى ومجموعة الاصحاء .وكانت هناك فروقات معنوية في نتائج العناصر الندرة ( الزنك , النحاس , السيلينيوم ) بين المرضى والاصحاء .الاستنتاج : البحوث السلوكية البايوكيميائية ركزت على فهم العلاقة بين متلازمة الالم العضلي الليفي والسايتوكينات , وهذا قد يقود الى فهم اكثر لاعراض هذه المتلازمة . ان ارتفاع مستوى الانترلوكين - ٦ , وعامل تنخر الورم - الفا لمصل مرضى المتلازمة يعد محفزا لاعراض التعب , زيادة الشعور بالالم , الكابة , وعامل التنخر واظهر ايضا ارتباطا بالتوتر العصبي واضطراب النوم .الميكانيكية المقترحة هي ان الانترلوكين - ٦ يحفز افرازات هرمونات قشرة الكظر المعتقد تتحفز بافراز هرمون الافراج عن الكورتيكوتروبين الفرز من قبل تحت المهاد. | Background : Fibromyalgia Syndrome (FMS) is a common chronic widespread pain syndrome , usually associated with other somatic and psychological symptoms including fatigue , sleep disturbance , and cognitive difficulties like difficult concentration . The prevalence of fibromyalgia is reported to be 2 - 4% with a female to male ratio of about 9 : 1, its prevalence increase with age from (30 - 50) , declining thereafter . The etiology and pathophysiology of fibromyalgia has not been clearly understood and that makes the disorder a frustrating condition for the patients and the physician . The etiopathology of fibromyalgia is not clear , though cytokines like interleukin - 6 is a potent stimulator of hypothalamic - pituitary axis via activation of the hypothalamic corticotrophin - releasing hormone (CRH) . Objective : To evaluate interleukin - 6 (IL - 6), tumor necrosis factor - alpha (TNF - α)and high sensitivity - C Reactive Protein (hs - CRP) and their relation with symptoms included in the underlying etiopathology of fibromyalgia patients since interleukin - 6 is a potent stimulator of hypothalamic pituitary axis via activation of the hypothalamic CRH .Setting : This cross sectional case - control study was performed at the Rheumatology and Rehabilitation Consultation unit , Baghdad Teaching hospital/medical City during the period from November 2010 to July 2011 . The laboratory tests were done in The Teaching Laboratory / Medical City , and The Toxicology Center / The Hospital of Specialized Surgeries Subjects : The study included 57 patients with FMS ( 49 females + 8 males ) , their mean age ( 43 ± 10.9) years , and 34 healthy control individuals ( 28 females + 6 males ) who their age and sex matching with the FMS patients . Methods : Serum levels of Interleukin - 6 , Tumor Necrosis Factor - α , high sensitivity - C Reactive Protein , and thyroid hormones were estimated by using ELISA technique . Zinc(Zn) , Copper(Cu) , and Selenium(Se) were estimated by Flame , and Flameless Atomic Absorption Spectrophotometric techniques. Results : The results show that the mean (± S.D.) values of serum IL - 6 , TNF - α , and hs - CRP concentrations were significantly higher in fibromyalgia patients than healthy control (p<0.05). Mean values of Sera of thyroid hormone levels were non - significant when compared with control group . The results of serum concentration of Zn , Cu , and Se of FMS patients were significantly different from that of control group ( p<0.05) .Conclusion : The elevated IL - 6 and TNF - α in FMS patients considered a promotion to fatigue , hyperalgesia , pain and depression . TNF - α is also associated with stress , rapid eye movement sleep and allodynia .

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

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

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

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

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

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

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

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

معدل انتشار الربو القصبي لدى طلاب المدارس الابتدائية في مدينه العمارة == Prevalence of Bronchial Asthma in Primary School Students in Amarah city

Author name: محمد سعيد ناجي
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: Background Asthma is a syndrome characterized by airflow obstruction that varies markedly, both spontaneously and with Treatment. Asthma has become more common in both children and adults around the world in recent decades. Its prevalence has been dramatically increased during last few years. Still no definite asthma prevalence is specified in Iraq. Objective To disclose the prevalence of bronchial asthma among primary school students in Amarah city with distribution the prevalence of bronchial asthma between gender, regions and between age groups and the relationship between body mass index and effect on asthma prevalence.Method In prospective study conducted on primary school students in Al Amarah city, from first of November 2013 to 31st March 2014. Four schools was randomly chosen, two for boys and other for girls, from both urban and rural area. Official approval was obtained from the appropriate authorities prior to the study. A sample of 181 randomly selected students (74 girls and 107 boys) underwent spirometry study to measure peak expiratory flow rate.ResultsOf the 200 questionnaires that we sent out, 181 completed questionnaires were returned, the study population ranged in age from 6 to 15 years, was in primary grades 1 - 6 and included 107 boys (59.1%) and girls 74 ( 40.9%) . the boys : girls ratio (53.1%).The mean age for the study sample is 9 years. Only 130 students have normal 71.8%, 13 students have support diagnosis of asthma 7.2% and 38 students have asthmatic 21.0%. Airway status is significantly associated with area of residence (p 0.001). There is relationship between body mass indexes associated with asthma.Conclusions1. High body mass index and history of allergen exposure are common associated factor reported by asthmatic.2. Spirometry and other pulmonary function tests are still not used in diagnosis, therapy and prognosis asthmatic patient.3. Since are children in dynamic process of variable growth, further studies of this nature are required. Usually larger sample sizes in each age group needed to establish reference standard and represent them as percentile charts for that region for a given age, weight, height of boys

التعبير الكيمياوي المناعي لمستقبلات الاستوجين والبروجستيرون Ki و67 Her2/neu لمرضى سرطان الثدي : دراسة سريرية باثولوجية == Immunohistochemical Expression of ER, PR, Her2/neu and Ki67 in Breast Carcinoma. Clinicopathological Study

Author name: فاطمة صبيح الصراف
Supervisor name: اسراء علي حسين
General topic: Medicine
Specific topic: Diseases
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Breast cancer is the most frequent cancer in women worldwide.In Iraq it is the most common cancer among females. According to the latest Iraqi Cancer Registry in 2010, breast cancer account for approximately one - third of the registered female cancers in Iraq, indicating that the breast cancer is the leading cause of death among females.Proliferation rates of neoplastic process can provide useful information on prognosis and aggressiveness of individual cancers including breast cancer and can be used to guide treatment protocols in clinical practice. Ki67 as a proliferative marker has been used to study proliferation rates in breast cancer and other tumors by Immunohistochemistry assessment of nuclear antigen which has a predictive and prognostic significant. Other important prognostic and predictive markers in breast cancer management including Estrogen and Progesterone receptors, Her2/neu have been used to predict the prognosis of breast cancer and to guide its therapy. Aim of study1. To evaluate the role of Ki67 as a proliferative index marker through analysing the associations between Ki67 intensity with the well - known clinicopathological parameters (age, breast tumor type, grade, size and lymph node involvement).2. To correlate the association of Ki67 with Estrogen receptor, progesterone receptor and Her2/neu expression. Patients, materials and methods This retrospective cross - sectional study was conducted from November 2013 to April 2014. A total number of fifty paraffin blocks were collected, (40) blocks belonging to patients with breast carcinoma (all were totally mastectomy), (thirty five cases were invasive ductal carcinoma, four cases invasive lobular carcinoma and one case was mixed type carcinoma) and (10) blocks with benign breast diseases were included. The cases were selected from archive files of the Department of Pathology of the Teaching Laboratories, Specialized surgical Hospital in Baghdad Medical City and private laboratories, and used for the immunohistochemical assessment of oestrogen receptor (ER) and progesterone receptors (PR), Her2/neu and Ki67.Results : In this study, patients’ age were ranged from (22 - 69) years, for forty malignant cases the age range was (34 - 69) years with a mean of (50.30±9) (mean± Standard deviation) years and the median age was (49) years, the peak age frequency was in the (35 - 50) years age group at time of diagnosis. The main histopathological type was invasive ductal carcinoma (87.5%). Grade II and T2 were reported in three quarters of the studied cases (30 cases out of 40). Axillary lymph node positive involvement was reported in (72.5%) of cases.For benign cases the age range was (22 - 60) years old, the mean age was (36.50±13.75) (mean± Standard deviation) years old.Hormone receptors positive malignant cases were (75%) and (72.5%) for estrogen and progesterone receptors respectively.Immounohistochemical expression of Ki67 was positive in (30) cases out of (40) (75%). Ki67 high score were demonstrated in (57.5%) of malignant cases.For Her2/neu expression more than (50%) of cases were with score 0, (17.5%) were with score 1+, (12.5%) were with score 2+ and (17.5%) were with score 3+.Regarding molecular subtypes of the malignant cases, Luminal B subtypes was the commonest among studied cases (42.5%).Conclusions : 1. In the current study invasive ductal carcinoma was the commonest histopathological type of breast carcinoma while most of the benign cases were fibrocystic disease cases, with a significant different mean age between malignant and benign cases.2. In this study Ki67 positive expression was observed in most of the studied malignant cases. Significant correlations were found between Ki67 expression and tumor grade, lymph node involvement and Her2/neu score.3. Luminal B subtype (Estrogen receptor +ve and /or Progesterone receptor +ve, Her2/neu +ve or Her2/neu - ve with Ki67 high score) was the most common molecular subtype of the studied breast cancer cases.

دراسة العلاقه بين ارتفاع ضغط الدم الشرياني ومرض الانسداد الرئوي المزمن : دراسة مستندة الى المستشفى == Study of relation between systemic arterial hypertension and Chronic Obstructive Pulmonary Disease (Hospital Based Study

Author name: زينب مهاوي هادي
Supervisor name: محمد وهيب سلمان العبيدي
General topic: Medicine
Specific topic: Diseases - Thoracic
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: ان مرض الانسداد الرئوي المزمن هو سبب رئيسي للوفاة في جميع انحاء العالم . ويسبب العديد من الامراض خارج الرئه مثل داء السكري وامراض القلب والاوعيه الدموية .الهدف من الدراسة : لتقييم العلاقة المتبادلة بين مرض الانسداد الرئوي المزمن وارتفاع ضغط الدم الشرياني طريقــــــــــــــة البحث : اجريت دراسة مقطعيه على مئة مريض مشخص مسبقا بالانسداد الرئوي المزمن في ( مستشفى بغداد التعليمي ) و( مستشفى البصرة التعليمي ) وبعمر (35سنة واكثر. المرضى المصابون بامراض الاضطرابات التنفسية والقلبية والغدد الصماء الاخرى والذين لديهم تاريخ بارتفاع ضغط الدم المشخص قبل مرض الانسداد الرئوي تم استثنائهم من هذه الدراسة .النتائـــــــــــج : الدراسةاجريت ل( 100) مريض تم تشخيصهم مسبقا بــمرض الانسداد الرئوي المــــــــــــــــــــــــزمن حيث تبين ان (23 ) مريضا لديهم تاريخ ايجابي لارتفاع ضغط الدم الشرياني تم تشخيصهم بعد تطور مرض الانسداد الرئوي ؛ و(77) مريضا لديهم تاريخ سلبي لارتفاع ضغط الدم الشرياني.وبعد قياس ضغط الدم لذوي التاريخ السلبي السابق في ارتفاع ضغط الدم الشرياني وجد ان (14) لديهم ضغط دم طبيعي و( 36 ) مريضا لديهم ارتفاع ضغط الدم الشرياني للمرحلة الثانية .كانت هناك علاقة بارزة بين زيادة حدة مرض الانسداد الرئوي المزمن وزيادة القراءة لضغط الدم. الاستــنــــــــــــــــتاج : توجد علاقة بارزة بين مرض الانسداد الرئوي المزمن وتطور ارتفاع ضغط الدم الشرياني.الكلمات الدالة : ارتفاع ضغط الدم الشرياني , مرض الانسداد الرئوي المزمن , ضغط الدم . | Background : Chronic obstructive airway disease (COPD) is a leading cause of death worldwide. And it cause various extrapulmonary comorbidities as diabetes mellitus and cardiovascular diseases .Aim of Study : To assess the correlation between COPD and systemic arterial hypertension .Method : Cross sectional study was conducted on 100 patients diagnosed previously as COPD in Baghdad teaching hospital and Basrah teaching hospital (age≥35 year), Patients with other chronic respiratory disorder and cardiac and endocrine diseases and who had history of systemic arterial hypertension diagnosed before COPD were excluded from this study.Results : The study done on 100 patients diagnosed previously with COPD and found 23 patients had positive history of systemic arterial hypertension diagnosed after COPD developed and 77 patients had negative history of systemic arterial hypertension. and after measured blood pressure for the patients with negative previous history of systemic arterial hypertension 14 patients found having normal reading and 36 patients had stage 2 systemic arterial hypertension . There were significant association between increase in severity of COPD and increase in blood pressure reading.Conclusion : There is significant association between COPD and development of systemic hypertension.Keyword : Systemic arterial hypertension , Chronic obstructive pulmonary disease , blood pressure.

تقييم القصور الكلوي عند مرضى الانسداد الرئوي المزمن == Assessment of renal impairment in patients with chronic obstructive pulmonary disease

Author name: مروة حمدي صالح
Supervisor name: محمد وهيب سلمان العبيدي
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: الخلفية : مرض الانسداد الرئوي المزمن هو احد الاسباب الرئيسية للمراضة والوفيات في جميع انحاء العالم. من المتوقع ان يرتبط مرض الانسداد الرئوي المزمن بشكل كبير مع الاعتلال المشترك ، وقد افادت بعض الدراسات عن وجود اختلال كلوي في مرض الانسداد الرئوي المزمن في مجموعات مختارة من السكان.الهدف من الدراسة : لتقدير وتيرة الضعف الكلوي في عدد السكان من مرضى مرض الانسداد الرئوي المزمن.المرضى والطريقة : تم اجراء دراسة الحالة والضابطه للفتره من 1 يونيو 2017 حتى نهاية ابريل 2018 في مستشفى بغداد التعليمي. اجريت الدراسه على 100 شخص تم تصنيفهم الى مجموعتين : مجموعة مرض الانسداد الرئوي المزمن 50) مريضا يعانون من مرض الانسداد الرئوي المزمن) والمجموعة الضابطة (50 شخص دون مرض طبي مزمن)في البداية تم تاكيد تشخيص مرض الانسداد الرئوي المزمن وتقييمه للتدريج حسب التاريخ والفحص السريري وقياس التنفس. وقد تم تقدير معدل الترشيح الكبيبي وتم تصنيف المرضى وفقا لوظيفة الكلى لديهم وظيفة الكلى المستقرة ، اختلال وظائف الكلى المخفي واختلال وظائف الكلى العلني.النتائج : في مجموعة مرض الانسداد الرئوي المزمن ، كان متوسط قيمة نيتروجين اليوريا في الدم هي 44±19.4 ، وكان متوسط تركيز الكرياتينين في المصل 1.25 ± 0.53 وكان متوسط معدل الترشيح الكبيبي التقديري 67.6 ± 27.5 في المجموعه الضابطه, وان متوسط قيمة قيمة نيتروجين اليوريا في الدم هي 28.5± 5.8 ، وكان متوسط تركيز الكرياتينين في المصل 0.7 ± 0.1 وكان متوسط معدل الترشيح الكبيبي هو 97.3 ± 16.8 ( قيمة بي (<0,001) للجميع مقارنة مرض الانسداد الرئوي المزمن) . وجد ان معدلات انتشار كل من : وظيفة الكلى مستقرة ، خلل وظيفي كلوي مخفي واختلال وظيفي كلوي علني في مجموعة مرض الانسداد الرئوي المزمن هي 29 ٪ ، 16 ٪ و26 ٪ على التوالي. كان معدل الانتشار العام للضعف الكلوي ) معدل الترشيح الكبيبي اقل من 60مل /دقيقه/1.73م2 )يساوي 42٪ في مجموعة مرض الانسداد الرئوي المزمن و2 ٪ في المجموعة الضابطة ( قيمة بي<0.001) كان هنالك ارتباط احصائي لمرض الانسداد الرئوي المزمن مع كلا من الخلل وظيفي المخفي والعلني.للكلى.وقد وجد ان العمر ، وحالة التدخين العلبه/ العام ، ومدة المرض وانخفاض متوسط حجم الزفير القسري ارتبطت بشكل كبير مع الخلل الكلوي العلني.الاستنتاجات : هنالك ارتباط ملحوظ بين زيادة شدة مرض الانسداد الرئوي المزمن وارتفاع اليوريا في الدم، كرياتينين المصل ونقصان معدل الترشيح الكبيبي. | Background : Chronic obstructive pulmonary disease is a leading cause of death worldwide. COPD is expected to be significantly associated with comorbidity, and some studies have reported renal impairments in COPD subjects in selected populationsAim of the study : To estimate the frequency of renal impairment in a population of COPD patients Patients and method : A case control study carried out from the 1st of Jun. 2017 to the end of April 2018 in Baghdad teaching hospital. This study was conducted on 100 persons who were classified into two groups : case group (50 patients with COPD) and control group (50 persons healthy without chronic medical illness). First, the diagnosis of COPD was confirmed and evaluated for staging by history, clinical examination and spirometry. The glomerular filtration rate was estimated and the patients were categorized according to their renal function as having stable renal function, concealed renal dysfunction and overt renal dysfunction. Results : in the COPD group, the mean Blood Urea Nitrogen value was 44±19.4, the mean serum creatinine concentration was 1.25 ±0.53 and the mean estimated GFR was 67.6±27.5.In the control group, the mean BUN value was 28.5±5.8, the mean serum creatinine concentration was 0.7 ±0.1 and the mean estimated GFR was 97.3±16.8 (P<0.001) for all in comparison with the COPD). The prevalence of stable renal function, concealed renal dysfunction and overt renal dysfunction in COPD group was 29%, 16% and 26% respectively.The overall prevalence of renal impairment (GFR<60ml/min/1.73 m2) was 42% in COPD group and 2% in control group (P<0.001).Chronic obstructive pulmonary disease was significantly associated with both concealed and overt renal dysfunction. Age, Pack/year, duration of disease and decrease of FEV1 were significantly associated with overt renal dysfunction(GFR <60 ml/min/1.73 m2 with elevated blood urea and serum creatinine). Conclusions : there is significant association between increased COPD severity and elevated blood urea, serum creatinine and reduced glomerular filtration rate.

تقييم مستوى مصل حمض البوليك لمرض الانسداد الرئوي المزمن وعلاقته بشدة المرض وتكرار الانتكاسات : دراسة الحالات والشواهد == ASSESSMENT OF SERUM URIC ACID LEVEL IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ITS RELATION TO DISEASE SEVERITY AND EXACERBATION FREQUENCY (Case - Control Study

Author name: الاء 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: Background : Chronic obstructive pulmonary disease (COPD) is a major contributor to morbidity worldwide,and lead to damage lung tissue and so lead to reduce oxygen intake resulting in tissue hypoxia.Tissue hypoxia induces the degradation of adenosine triphosphate, resulting in production of serum uric acid.Identification of prognostic biomarker for COPD as serum uric acid(sUA) may aid in improving survival .Objective of the study : Evaluate role of hyperuricemia in disease severity and exacerbation frequency in COPD patients.Method : Case - control study was conducted from 1st of December 2017 to 1st of June 2018, on 80 subjects in Baghdad teaching hospital\medical city, 40 subjects with COPD, other 40 subjects are healthy persons consider as control, all >40 years old<70 .Serum uric acid level measured for all study sample.Excluded from this study those with Hx of Diabetes mellitus, Hypertension, Malignancy, Cardiac disease, Gout and persons on drugs affect sUA level.Results : The mean age for COPD was 61.9 while for control was 49.3 years.Serum utic acid higher in male than female in both group. In COPD cases there are higher level of serum uric acid compared to control and COPD patients had 3.16 time more risk to developed high serum uric acid than persons without disease also there was a significant statistical association between mean sUA and duration and degree of COPD (P value<0.05).Conclusion : Patients with COPD have higher serum uric acid level than control group, which tend to increase with increase in duration and severity of disease.

اهمية حالة استخدام جهاز الاستنشاق في السيطرة على الربو عند البالغين == Importance of inhaler device use in the control of asthma in adult

Author name: حواء خالد علوان
Supervisor name: مصطفى نعمة عبد علي
General topic: Medicine
Specific topic: Respiratory System
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: الخلفية : يعتبر الربو من الامراض المزمنة العرضية للممرات الهوائية التي ينظر اليها بشكل افضل على انها متلازمة. في عام 1997 ، شمل المعهد الوطني للقلب والرئة والدم السمات التالية كجزء لا يتجزا من تعريف نوبات الربو المتكررة من الاعراض التنفسية ؛ انسداد تدفق الهواء المتغير الذي غالبا ما يكون قابلا للعكس ، اما بشكل عفوي او مع العلاج ؛ وجود تفاعل فرط مجرى الهواء. والاهم من ذلك ، التهاب المسالك الهوائية المزمن الذي تلعب فيه العديد من الخلايا والعناصر الخلوية دورا ، على وجه الخصوص ، الخلايا البدينة ، الحمضات ، اللمفاويات التائية ، الضامة ، العدلات ، والخلايا الظهارية.الهدف من الدراسة : لتقييم تقنية الاستنشاق المريض الربوالمرضى والطريقة : اجريت دراسة مقطعية مستعرضة في وحدة الامراض التنفسية في مستشفى بغداد التعليمي من 1 يوليو 2017 حتى نهاية فبراير 2018. واشتملت على 400 بالغ يعانون من الربو المستمر لمدة 6 اشهر على الاقل ، ووفقا للمبادرة العالمية لالمعايير الربو وادرجت في هذه الدراسة.النتائج : كانت اخطاء اعداد الجهاز موجودة في 47.2 ٪ من مرضى الربو ، وكان الفشل في الزفير قبل الاستنشاق في 80.2 ٪ من المرضى ، وزفير اثناء الاستنشاق كان موجودا في 10 ٪ من المرضى ، كان الوقت قصير للاستنشاق في 51.7 ٪ من المرضى ، والفشل في ان تحبس الانفاس لمدة 5 - 10 ثواني في 68٪ من المرضى ، ولم يكن الشطف بالماء بعد الاستنشاق موجودا في 85.5٪ من المرضى وكان التكرار اكثر من الموصى به في 22.8٪ من مرضى الربو . وجد ان هنالك ارتباط مهم للغاية بين المرضى الاصغر سنا ومسبار التركيز واجهزة الاستنشاق المقننة الجرعة.الاستنتاجات : هناك خطا في استخدام تقنية علاج الاستنشاق الربو. | Background : Asthma is a chronic, episodic disease of the airways that is best viewed as a syndrome. In 1997, the National Heart, Lung, and Blood Institute included the following features as integral to the definition of asthma recurrent episodes of respiratory symptoms; variable airflow obstruction that is often reversible, either spontaneously or with treatment; presence of airway hyper reactivity; and, importantly, chronic airway inflammation in which many cells and cellular elements play a role, in particular, mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial cells.Aim of the study : To assess the asthmatic patient's inhaler use technique,any error if present Any effect on asthma control from use technique error or type of inhaler.Patients and method : A cross sectional study conducted in consulting respiratory unit in Baghdad teaching hospital from the 1st of July 2017 to the end of February 2018. In which 400 adults with persistent asthma for at least 6 months duration, and according to the Global Initiative for Asthma criteria were included in this study. Results : Device preparing errors was present in 47.2% of asthmatic patients, failure to exhale before inhalation was present in 80.2% of patients, exhalation during inhalation was present in 10% of patients, short inhalation time was present in 51.7% of patients, failure to hold breath for 5 - 10 seconds in 68% of patients, not rinsing mouth with water after inhalation was present in 85.5% of patients and repetition more than recommended was present in 22.8% of asthmatic patients. Highly significant association between younger age patients and MDI & spacer,Conclusions : There is error in using the asthmatic inhalers treatment technique

اثار العلاج الاشعاعي على اختبار وظيفة الغدة الدرقية في سرطان الراس والعنق == Effects of Radiotherapy on Thyroid Function Test in Head and Neck Cancers

Author name: زينة عماد عمران
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 : Patients with head and neck cancers are often treated with external beam radiation therapy with or without surgery and / or chemotherapy. While radiation to the neck area may involve part or whole of thyroid gland ,the well - known side effect of hypothyroidism will subsequently ensue. Aim : to evaluate the risk of developing hypothyroidism after radiotherapy in patients with head & neck malignancies. Patients and methods : This is a prospective study of 40 patients of head and neck cancer, receiving radiotherapy in Baghdad center of radiotherapy from October 2017 to January 2018. TSH,T3 and T4 estimations were done at baseline and at 4 months following radiotherapy. Results : Before radiotherapy, all study patients showed normal T3, T4, and TSH levels with a mean of 1.88 ± 0.22, 123.92 ± 6.97, and 2.19 ± 0.67 respectively.After radiotherapy, all patients showed normal T3 and T4 with a mean of 1.8 ± 0.19 and 121.52 ± 8.86 respectively; while 12.5% of study patient showed elevated TSH level with a mean of 2.63 ± 1.44.The mean of TSH after radiotherapy was significantly higher than that before radiation (2.63 versus 2.19, P=0.044) while no statistical significant change in mean of T3 and T4 levels before and after radiation (P ≥ 0.05). The highest prevalence of elevated TSH level was seen in patients who had a history of surgery to head and neck (40%) with a significant association (P=0.047) between prevalence of elevated TSH level and past surgical history. There was no significant association (P ≥ 0.05) between prevalence of elevated TSH level and all other characteristics.Conclusions : The likelihood of thyroid dysfunction after radiation therapy is common and can initially manifested within 4 months and addition of surgery to radiation therapy can increase the risk of hypothyroidism by 40%.

المعارف والمواقف والممارسات المتعلقة باصابات وخز الابر بين العاملين في مجال الرعاية الصحية في بغداد == Knowledge, attitude and practices regarding needle stick injuries among health care workers in Baghdad

Author name: ميس علاء الدين علي
Supervisor name: سهير محمد محمود الجبوري
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 : Needle stick injuries are serious occupational hazards in thetransmission of a variety of bloodborne diseases, more than twenty pathogens canbe transmitted through NSI including hepatitis B virus, hepatitis C virus, and humanimmunodeficiency virus (AIDS) among healthcare workers.Objective : Determine the prevalence of needle stick injuries among healthcareworkers and its predisposing factors. Assess the knowledge, attitude and practice ofhealth care workers towards needle stick injuries.Methods : Cross - sectional descriptive study, a convenient sample of 300 health careworkers were selected from various hospitals and primary healthcare centers inBaghdad, Iraq. Data were collected by an anonymous questionnaire from Februaryto May 2018. The collected data was analyzed by using statistical package for thesocial sciences (SPSS version 24).Results : Among the studied sample, there were 218 (72.7%) nurse and 82 (27.3%)laboratory technician. Prevalence of needle stick injury among the health workerswas found to be 38.7%, which was higher in nurses (40.8% of nurses) compared to32.9% of laboratory technicians. The highest number of needle stick injuriesoccurred by recapping of needles (43.8%) followed by injuries during handling(25%) and (23.2%) injuries while withdrawing a blood. A high proportion (84.33%)of health care workers whom sustained needle stick injury had reported their Injury.The mean score of knowledge, attitude, and practice were 8.21, 7.07 and 7.19respectively. Nurses scored better than laboratory technicians. A considerable percentage of the participants (88.33%) were immunized against HBV.Conclusions : The study showed a high prevalence of NSIs among health care workers. The score of knowledge was high, acceptable responses were obtained in most attitude and practice statements, except for recapping of needles statements.Key Words : needle stick injury, sharp injuries, universal precautions,

نتائج فحص الدوبلر الملون لامراض الكلى المنتيه المزمنة ومقارنتها بنتائج الفحص النسيجي الخلوي == Significance of Doppler indices finding in renal parenchymal disease Correlated with histopathological findings

Author name: جنان حسين محمد
Supervisor name: طالب الزيدي | 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: Renal Doppler ultrasound is increasingly used in assessment of renal parenchymal diseases as investigation and for evaluation of renovascular disease and allograft dysfunction. We compared intrarenal Doppler indices measurment to biopsy findings of Mesangial hypercellularity, Membranous glumerulopathy, Minimum change disease, Segmental glumeriolosclerosis, chronic glomerulonephritis, chronic rejection, acute rejection and interstitial nephritis in sample of 84 patient Patients and Method A study was conducted between 1st of Dec - 2016 to 1st of Oct - 2017 at radiological department of Al Shaheed Ghazi Hospital in the renal disease and transplantation center (Baghdad Medical city complex) on 84 patient who are suffering from renal disease manifestation in both native and transplanted kidneys. Doppler blood indices (Resistive index,Pulsatility index and Acceleration time) were measured at same day before renal biopsy. Renal biopsy finding and Doppler study indices were compared to asses' if there were a correlation between parenchymal renal changes and the Doppler indices changes. Aim of study to evaluate renal vascular Doppler indices (Resistive index , Pulsatility index and Acceleration time) as indicator of accuracy and prediction in renal parenchymal diseases,severity and grading Results RI, was significantly higher in patients group with renal diseases which in comparison to control group (0.70 ± 0.07vs. 0.55 ± 0.04),the accuracy was 72.9%,while P.I and AT show less significant changes P.I was (1.61 ± 0.25vs. 1.47 ± 0.06) and AT (0.086 ± 0.023vs. 0.024 ± 0.058). PI accuracy was 59.9 %and for AT was 54.2% .as consequence the mean value of RI was significantly differed among different renal pathologies (p=0.001) but the PI and AT were not differed significantly (p<0.05 for both).Conclusions Our results suggest that Renal Doppler indices ,as example (resistive index)was significantly increased in patients with renal parenchymal disease which confirmed by pathological examination and higher accuracy than other indices pulsatility index and acceleration time so we can use resistive index as good marker for parenchymal renal disorders while other indices can use as complimentary.

دراسة عن حالات التهاب الكبد الفيروسي ج عند مرضى التحال الدموي في وحدة غسيل الكلى في مستشفى بغداد التعليمي العراق == Hepatitis (C), virus infection among patients in Hemodialysis unit in Baghdad Teaching Hospital, Iraq, 2018

Author name: عادل عبد عنبر
Supervisor name: ايمان عدنان القصير
General topic: Medicine
Specific topic: Family Medicine
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Viral hepatitis C infection are important cause of morbidity and mortality in hemodialysis patients, and it's prevalence varies considerably among different areas of the world. Patients receiving maintenance hemodialysis are at high risk for acquiring hepatitis C virus infection than the general population. This study was conducted to estimate the prevalence rate and the possible associated factors responsible for hepatitis C viral infection among chronic hemodialysis patients in Baghdad.Iraq. 2018.Method : A cross - sectional study was carried out in hemodialysis unit in Baghdad Teaching Hospital for the period from 1st February to 30th April 2018. The study participants were all patients available during data collecting period. The participants were directly interviewed according to a special questionnaire designed for the purpose of the study. Data collected regarding patient's age, gender, duration of dialysis, number of sessions per week, history of blood transfusion, renal transplantation, previous surgery, history of tattoo, alcohol use, injecting drugs user, previous dialysis in another center, having diseases(Hypertension, Diabetes), and viral screen of all patients for hepatitis C and B viral infection. in addition of reviewing patient's medical records to confirm the laboratory results. Results : the total number of participants were 218 patients. The prevalence rate of Hepatitis C infection was 25.7%. male gender, age between 51 - 70 years, married and not worker patients were having higher prevalence rates of infection. Hemodialysis patients with diabetes mellitus and dental procedures were more prone to Hepatitis C infection while blood transfusion and frequency of transfusion was not a significant factor.Conclusion : High prevalence of Hepatitis C virus in hemodialysis patients in Baghdad teaching Hospital in Hemodialysis unit. The hepatitis C virus infection was significantly associated with Duration of dialysis, previous dialysis in another center, Diabetes mellitus, dental procedures and creatinine level. That need to follow the universal precaution to minimize nosocomial infection particularly at the hemodialysis unit.

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

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

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

Author name: رشا مناور عبد
Supervisor name: محمد وهيب سلمان العبيدي
General topic: Medicine
Specific topic: Diseases - Thoracic
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Chronic Obstructive Pulmonary Disease (COPD) : is one of the most important causes of morbidity and mortality all over the world.C - Reactive Protein (CRP) : a biomarker of systemic inflammation and as an indicator of malnutrition or severity of Chronic Obstructive Pulmonary Disease (COPD). An assessment the relationship between serum C - reactive protein (CRP) levels and well - known clinical parameters in severity of Chronic Obstructive Pulmonary Disease (COPD) considering the impact of smoking behavior.Aim of study : To evaluate the interrelationship between C - reactive protein and chronic obstructive pulmonary diseaseMethodsWe studied (69) diagnosed COPD patients according to GOLDstages all patients didspirometry, body mass index andserum CRP titer levels were investigated in diseased COPD patients.Results : Patients sample, 72.5% male and 27.5% female, the ratio (3 to 1) of COPD included (75.4%) had positive CRP and (24.6%) had negative CRP. CRP titer levels were higher in severe COPD patients and there’s inversely relationship between Body Mass and the incidence of the C - Reactive Protein. There’s close relationship between cigarette smoking, body mass and chronic obstructive pulmonary disease.Conclusion : The circulating levels of the inflammatory marker CRP are significantly elevated in patients with COPD, supporting the view that COPD is in part an inflammatory disorder. This risk increase with increased severity of disease and cigarette smoking and this level elevated with decreasing body mass index.

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

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

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

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

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

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

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

Author name: عمار عباس نعمة
Supervisor name: محمد وهيب سلمان العبيدي
General topic: Medicine
Specific topic: Diseases - Thoracic
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Fiber - Optic bronchoscopy is a safe and useful diagnostic andtherapeutic tool for the management of many pulmonary diseases.Aim of study : To analyse the outcome of fiberoptic bronchoscopy in respiratoryunit at Al - hussain teaching hospital in Karbalaa governorate in years 2016 - 2017.Patients and Methods : A retrospective study was done to find out the demographic profiles, indications, bronchoscopic findings, diagnosis and complications of the patients who underwent bronchoscopic examination. 105 patients underwent bronchoscopies in the respiratory unit in Al - hussain teaching hospital in Karbalaa governorate in 2016 - 2017.Results : Amongst the 105 patients where 54.3% of them was female and 45.7% was male, 61% of total number was non - smoker, 26.7% currently smoker and ex - smoker of 12.4 %.The highest percentage (30.5%) of partiptants fall to age group of 60 - 69 years followed by age group 0f 70 - 79 years (22.9%), 50 - 59 years (17.1%) and the remains fall to other age groups in lower percentages.Commonest indication of bronchoscopy was radiological opacity found in 79.05% of patients, followed by productive cough (11.34%) and hemoptysis (9.52%) as the second and third indications respectively.The most common finding on bronchoscopy was abnormal bronchial mucosa found in about 65.7% of patients. Malignancy was seen in 29.5% of the cases, while Tuberculosis seen in 17.1%.In the 105 patient the bronchoscopy done with neither death nor serious complications occurrence likes pneumothorax or cardiac arrest.Conclusion : Fiberoptic bronchoscopy is extremely useful in finding specific etiologies of various lung diseases.

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

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

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

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

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

Author name: طاهر بلاش محمد
Supervisor name: محمد وهيب سلمان العبيدي
General topic: Medicine
Specific topic: Diseases - Thoracic
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Asthma is a chronic inflammatory disorder of the airways characterized by marked variability in airflow obstruction that is often reversible, either spontaneously or with treatment.Magnesium is the second most abundant intracellular cataion after potassium.Magnesium has been shown to relax bronchial smooth muscles and influence the function of respiratory muscles.Aim : To assess the serum magnesium levels in asthmatic patients during stable and exacerbating clinical condition and to compare serum magnesium values in asthmatic patient and healthy subjects.Patients and methods : 110 Subjects were enrolled, 70 patients diagnosed with asthma and 40 healthy individuals as a control group. The asthmatic patients were divided into : (I) stable asthma group (II) acute exacerbation asthma group.Blood had been taken from all subjects and serum magnesium measured by spectrometer.Results : Serum magnesium levels were significantly lower in asthmatic patients compared with healthy subjects.Conclusion : There is a significant association between lower serum magnesium level and asthma.

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

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

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

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

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

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

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

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

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

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

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

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

تعبيرالعلامة المناعية النسيجية الكيميائية P57 في عذارية الخلد (الحمل العنقودي) الكامل والجزئي == Expression of P57 Immunohistochemical Marker In Complete and Partial Hydatidiform Mole by Using Tissue Microarray Technique

Author name: رحاب خالد عباس
Supervisor name: ختام رزاق كاظم الخفاجي
General topic: Medicine
Specific topic: Diseases
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: تعتبرعذارية الخلد الحمل العنقودي شكل غير طبيعي من الحمل ويمكن تقسيمه الى نوعين : الحمل العنقودي الكامل والحمل العنقودي الجزئي . ويبقى الفحص النسيجي المفصل هو الاساس في تشخيص الحمل العنقودي . ان عدم الدقة في اخذ العينات والتنخر النسيجي والتفريغ المبكر للرحم يمكن ان يؤدي الى عدم التاكد في التشخيص وكذلك فان المعايير غير الموضوعية تؤدي الى تقلب ملحوظ بين الفاحصين.ان العلامة النسيجية المناعية الكيميائية (P57KIP2) هي مطبوعة الجين ابويا ومعبر عنها اموميا ووجود منتج البروتين يخدم كمؤشربديل لوجود جينات النواة الامومية ، ولان الحمل العنقودي الكامل هو النوع الوحيد من الحمل الذي ينقصه الجينات الامومية ، لذلك فان الصبغة المناعية P57KIP2 غير موجودة فيه بينما تكون موجودة في الحمل العنقودي الجزئي والحمل الطبيعي.الهدف من الدراسة1 - لتقييم اهمية العلامة النسيجية المناعية الكيميائية P57KIP2 في تشخيص الحمل العنقودي الكامل والحمل العنقودي الجزئي.2 - لمقارنة نتائج العلامة النسيجية المناعية الكيميائية P57KIP2 مع نتائج الصبغة المعتادة هيماتوكسيلين وايوسين.المواد وطرق العمل تم جمع سبعين حالة من خزع بطانة الرحم وتم تقييم جميع الحالات نسيجيا باستعمال الصبغة المعتادة هيماتوكسيلين وايوسين (H &E ) ثم تم تصنيفها الى حمل عنقودي كامل وحمل عنقودي جزئي (30) لكل منها و(10) حالات حمل طبيعي (اجهاض) وكذلك تم استخدام شرائح السيطرة السلبية. وقد تم جمع هذه الحالات خلال الفترة من كانون الاول 2011 الى اب 2012 من مختبرات مختلفة في العراق . وقد تم اعتماد تقنية جديدة في هذا البحث وهي طريقة مجاميع نسيجية صغيرة بتقطيع اثني عشرثقب صغيرمن عينات انسجة مختارة وبقطر 3ملم وصبها في كتلة واحدة ثم اخذ مقاطع من كتلة المجاميع النسيجية الصغيرة باستخدام المايكروتوم ووضعها على شريحة المجهر ثم صبغها بالصبغة المعتادة هيماتوكسيلين وايوسين ثم صبغها مرة اخرى بالصبغة النسيجية المناعية الكيميائية P57KIP2)). النتائجتم تشخيص 70 حالة حمل عنقودي وحمل طبيعي بواسطة استخدام الهيماتوكسيلين وايوسين في هذا البحث وكان معدل العمر للمرضى بين 17 سنة و50 سنة على النحو التالي : ( معدل الاعمار29 سنة ، والعمرالوسطي 27 سنة واكثر عمر تكرر20 سنة ) وكانت الغالبية من الحالات (50%) تتراوح اعمارها بين (20 - 29) سنة ولكن فقط (10%) من الحالات كانت اصغر من 19سنة. وكان الارتباط الاحصائي بين عمر المرضى ونوع الحمل العنقودي غير ملحوظ وقد كانت درجات مرضى الحمل العنقودي الكامل باستخدام الهيماتوكسيلين والايوسين على النحو التالي : الدرجة الاولى 43.3% ، الدرجة الثانية 53.4% والدرجة الثالثة 3.3% ولم يرتبط التوزيع العمري لكل درجة ارتباطا احصائيا . فيما يتعلق بتعبير الصبغة المناعية النسيجية الكيميائية P57KIP2 عن حالات الحمل العنقودي الجزئي المشخصة سابقا بواسطة الهيماتوكسيلين والايوسين ، اظهرت 25 حالة من 30 حالة والتي تمثل 83.3% نتائج ايجابية ، بينما كانت نتائج الخمس حالات المتبقية والتي تمثل 16.7% سلبية ، وهذا يعني بانها كانت بالتاكيد حمل عنقودي كامل . وكانت هذه النتائج ذات دلالة احصائية عالية. ان نتائج تعبير الصبغة المناعية النسيجية الكيميائية P57KIP2 عن حالات الحمل العنقودي الكامل المشخصة سابقا بواسطة الهيماتوكسيلين والايوسين ، كانت 26 حالة من اصل 30 حالة والتي تمثل 86.7% اظهرت نتائج سلبية مما يثبت تشخيص الحمل العنقودي الكامل ، بينما كانت نتائج الاربع حالات المتبقية والتي تمثل 13.3% ايجابية . وكانت هذه النتائج ذات دلالة احصائية عالية.ووجد في هذه الدراسة بان التوزيع العمري للمرضى في مختلف درجات الحمل العنقودي الكامل والتي اعربت عن نتائج سلبية للصبغة المناعية النسيجية الكيميائية كان ( معدل الاعمار 28.5 سنة والعمرالوسطي 27 سنة واكثر عمر تكرر25 سنة ). وقد وجد بان غالبية المرضى من الدرجة الاولى كانوا من اعمار20 - 39 سنة ، وكانت غالبية المرضى من الدرجة الثانية من اعمار20 - 29 سنة ، بينما كانت حالة واحدة فقط من الدرجة الثالثة بعمر38 سنة . ونتيجة لذلك كان الارتباط الاحصائي بين درجات الحمل العنقودي الكامل وبين معدل اعمار المرضى غير ملحوظ .ان درجات الحمل العنقودي الكامل والتي كانت سلبية باستخدام الصبغة المناعية النسيجية الكيميائية P57KIP2 كانت اغلبها من الدرجة الثانية والتي كانت تمثل 53.4% وكانت الاقلية من الدرجة الثالثة والتي كانت تمثل 13.3% . وقد لوحظ بان جميع الحالات الاربعة والتي اعربت عن نتائج ايجابية باستخدام الصبغة P57KIP2 كانت من الدرجة الاولى وهي تمثل 13.3% . وكان الارتباط الاحصائي بين درجات الحمل العنقودي الكامل ونتائج الصبغة P57KIP2 ذات دلالة احصائية ملحوظة.الاستنتاجات1 - ان الصبغة المناعية النسيجية الكيميائية P57 عامل مفيد في التشخيص الصحيح للحمل العنقودي الكامل.2 - ان الاخطاء في التشخيص المظهري للحمل العنقودي الجزئي اكثر تواترا من الاخطاء في التشخيص للحمل العنقودي الكامل.3 - توجد اختلافات واضحة في التصنيف الصحيح للحمل العنقودي بين استخدام الصبغة المناعية النسيجية الكيميائية P57 واستخدام الصبغة العادية الهيماتوكسيلين والايوسين.4 - ان حالات الدرجة الاولى للحمل العنقودي الكامل مرتبطة بوضوح مع الاخطاء في التشخيص المظهري المؤدية الى المبالغة في تشخيص الحمل العنقودي الكامل.5 - الصبغة المناعية النسيجية الكيميائية P57 هي تقنية بسيطة يمكن استخدامها في مختبرات علم الامراض لتصحيح تشخيص الحمل العنقودي والتمييز بين الحمل العنقودي الكامل من اشباهه خصوصا في الحالات صعبة التشخيص. | Hydatidiform mole is an abnormal form of pregnancy divided in to two types; complete hydatidiform mole and partial hydatidiform mole. Detailed histopathologic examination remains to be the basis for the diagnosis of hydatidiform mole (HM). However, poor sampling, necrosis, and earlier uterine evacuation can lead to uncertainty in the diagnosis. Also, the criteria are subjective, resulting in considerable interobserver variability.The P57KIP2 gene is paternally imprinted and maternally expressed, and the presence of its protein product serves as an adjuvant marker for the nuclear maternal genome. Because a complete HM is the only type of conceptus lacking a maternal contribution, P57 KIP2 immunostaining is correspondingly absent, whereas it is present in partial HM and normal pregnancy. Aim of the study : 1.To evaluate the significance of the immunohistochemical marker P57KIP2 in the diagnosis of complete and partial hydatidiform mole . 2.To compare the P57KIP2 immunohistochemical marker results with that of ordinary Hematoxylin and Eosin slides histopathology results . Materials and Methods : Seventy cases of endometrial biopsies were obtained. Histologic evaluation of all cases was performed on routine sections stained with Hematoxylin and Eosin (H & E) and classified in complete and partial hydatidiform mole (30 each) and (10 cases) of normal product of pregnancy (abortion), and negative control slides were also used. These cases were collected during the period from December - 2011 to Augest - 2012. New technique is adopted in this research that is; Tissue microarray in which twelve small cores of representative tissue samples, each measure 3 mm in diameter Sections from microarray block are cut using a microtome, mounted on a single microscope slide and then analyzed by staining with Hematoxylin and Eosin, then another section made for the immunohistochemical staining with P57 KIP2 antibody. Results : • In this study of the 70 cases diagnosed as molar and normal pregnancies by H&E, the actual age range was from 17 to 50 years old, and the age distribution were; (mean 29 , median 27 , mode 20 years old), the majority of the cases (50%) were between the age of (20 - 29) years old whereas only (10%) of the cases were younger than 19 years old, the correlation between the age of the patients and the type of the Hydatidiform Mole (HM) was not significant. • Grades of patients with CHM based on H&E category were; 43.3% grade I, 53.4% grade II, and 3.3% grade III, and the age distribution for each grade was not statistically correlated. • Regarding the expression of p57KIP2 IHC Marker in cases of PHM diagnosed previously by H&E, 25 cases out of 30 cases which represented 83.3% expressed positive results. The remaining 5 cases which represented 16.7% expressed negative results, this means that they were definitely CHM. These findings were statistically highly significant.The results of P57KIP2 IHC Marker expression in cases of CHM diagnosed previously by H&E, were 26 cases out of 30 cases which represented 86.7%, expressed negative results this confirm the CHM diagnosis. The remaining 4 cases which represented 13.3%, expressed positive results this means that they were most probably PHM. These findings were statistically highly significant.• The age distribution of the patients in different grades of the CHM which expressed negative results for the IHC Marker p57KIP2 (Mean= 28.5, median=27, mode=25 years old), it was found that the majority of patients in grade I were from age 20 to 39 years old, and the majority of patients in grade II were from age 20 to 29 years old, while the only one case of grade III was 38 years old. The correlation between grades of CHM and patients ages was not significant.• The grades of the CHM which are negative for the IHC Marker p57KIP2, the majority of the patients were grade II which represent 53.4% and the minority of the patients were grade III which represent 3.3%. It was noticed that all four cases which expressed positive immunostaining for the IHC marker p57KIP2 were; grade I, and they represented 13.3%. The correlation between the grades of the CHM and the results of the p57KIP2 IHC marker was statistically significant.Conclusions : • P57KIP2 IHC marker is a useful adjunct, providing a definitive diagnosis of CHM. • Errors in morphologic analysis resulted primarily in over diagnosis of PHM are more frequent than in CHM.• There are significant differences in correct classification of hydatidiform mole between using P57KIP2 IHC marker and using H&E stain. • Cases in grade I of CHM were correlated significantly with the errors in morphological analysis resulted primarily in over diagnosis of CHM. • P57KIP2 IHC marker is a relatively simple method can be used in pathology laboratories to refining the diagnosis of molar pregnancy and distinguish CHM from its mimics in a subset of challenging cases.

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

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

الندرونيت الصوديوم في الفصال العظمي للمفصل الظنبوبي : تاثيره على معلمات بناء وانحلال الغضروف, لبتين والفعاليات الفيزيائية للمرضى العراقيين == ALENDRONATE SODIUM IN KNEE OSTEOARTHRITIS : EFFECTS ON ANABOLIC AND CARTILAGE DEGRADATIVE MARKERS, CIRCULATING LEPTIN AND THE CLINICAL ACTIVITY IN IRAQI PATIENTS

Author name: سيناء عبد الامير كاظم
Supervisor name: حيدر مهدي جواد | سامي سلمان شهاب
General topic: Medicine
Specific topic: Medicines and Toxins
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: المقدمة : الفصال العظمي من الامراض الاكثر شيوعا في العالم والذي يصيب النساء اكثر من الرجال ويتميز هذا المرض بانه يحدث نتيجة لخلل في جميع مكونات المفصل متمثلا بانحلال الغضروف وتهشم العظم الملاصق له والتهاب الغلاف المحيط بالمفصل. متسببا في تقليل عرض الحيز الانسي للمفصل.الهدف من الدراسة : تقييم دور عقار الندرونيت الصوديوم ALN)) لمرضى الفصال العظمي للمفصل الظنبوبي ومعرفة تاثيره على مستوى الفعاليات الحياتية للمرضى التي تتمثل بمستوى الالم ومستوى تيبس المفصل وتاثيره على مستوى وظيفة المفصل الظنبوبي. وتقييم مدى تاثيره على معلم البناء 1β TGF , معلم انحلال الغضروف CTXII, مستوى لبتين في الدم, مايلوبيروكسيدييز MPO, الكالسيوم, مستويات الدهون بانواعه وفوسفات الالكلاين والبروتين التفاعلي C.طريقة العمل : ادخل 116 مريضا مصابا بمرض الفصال العظمي للمفصل الظنبوبي ضمن هذه الدراسة وكانوا بعمر من 45 سنة او اكثر وبالدرجة الثانية من المؤشر الشعاعي لكلكرين ولورنس (KL) مع قياس الوزن والطول, عرض الحيز الانسي للمفصل الظنبوبي, التغييرات الكيمياوية المختبرية المتمثلة بمستوى الكالسيوم, مستويات الدهون بانواعه متمثلة بقياس نسبة الكولسترول , الدهون الثلاثية, البروتينات الدهنيه عالية الكثافة والبروتينات الدهنية واطئة الكثافة , فوسفات الالكلاين والبروتين التفاعلي C وقياس المعلمات المناعية بطريقة الالايزا لكل من معلم البناء 1β TGF , معلم انحلال الغضروف CTXII, مستوى لبتين في الدم, مايلوبيروكسيدييز MPO. حيث تم قياس المستويات المذكوره اعلاه قبل البدا باخذ العلاج. تم اعطاء المرضى 10 ملغم من عقار الندرونيت الصوديوم (ALN) واعيد تقييم حالة المرضى بعد اكمال الاشهر الثلاثة من العلاج.النتائج : لوحظ ان هناك تحسن معتد على الفعاليات الفيزيائية واعراض الفصال العظمي , مع انخفاض معتد في معلم TGF β 1 (لاتوجد مقارنة بين تغيره وتحسن حالة المرضى, غير ان له علاقة بزيادة كتلة الجسم) , معلم انحلال الغضروف ) CTXIIحيث له علاقة بتحسن الفعاليات الحياتيه للمرضى), مستوى لبتين في الدم. مع تغير غير معتد في عرض الحيز الانسي للمفصل, مستوى الكالسيوم, مايلوبيروكسيدييز, مستويات الدهون بانواعه متمثلة بنسبة الكولسترول , الدهون الثلاثية, البروتينات الدهنيه عالية الكثافة والبروتينات الدهنية واطئة الكثافة , فوسفات الالكلاين والبروتين التفاعلي C. الاستنتاج : عقارالندرونيت صوديوم له فعالية كبيرة في تحسين الفعاليات الحياتية لمرضى الفصال العظمي وتقليل الالم الناتج من المرض دون تاثير معتد على تغير تركيب المفصل على الرغم من تقليله لمعلم اضمحلال الغضروف. عدم تاثير العقار على مستويات الدهون في الجسم المتمثلة بنسبة الكولسترول , الدهون الثلاثية, البروتينات الدهنية عالية الكثافة والبروتينات الدهنية واطئة الكثافة يجعله امنا نسبيا للمرضى المصابين باختلال نسبة الدهون. | Background : Osteoarthritis is a common arthritic disorder and responsible for 2 % of disability of people in all world. Osteoarthritis has believed to be principally a cartilage defect associated with focal articular cartilage degradation. Alendronate sodium (ALN) interferes with normal bone formation and turnover cycle in the body by slowing bone loss with elevating bone mass. . Aims of the study : This study was done to evaluate the effects of alendronate sodium on disease activity and physical function in patients with knee osteoarthritis, to evaluate the biochemical parameters in osteoarthritis patients including serum alkaline phosphate, calcium, c - reactive protein and lipid profile in form of analysis of serum cholesterol, triglyceride, low density lipoprotein and high density lipoprotein. Also to study the impact of ALN on anabolic in form analysis of serum transforming growth factor beta 1 (TGF - β1) , cartilage degradative in form of C - terminal cross linked - telopeptide of type II collagen (CTXII), Myloperoxidase (MPO) and leptin markers in osteoarthritis patients and to determine its effectiveness in slowing progression of disease. .Patients and methods : The patients were habitants of the cities of Al - Diwaniyhia (consulting the Rheumatologic Unit in Al - Diwanyhia Teaching Hospital) and Baghdad (consulting the Rheumatologic Unit in Baghdad Teaching Hospital). From those patients, 116 osteoarthritic patients 45 years old and more with Kellgren and Lawrence X - ray grade II and more with knee pain were enrolled in this study. Base line assessment was done including measurement of joint space width, assessment of WOMAC scoring(pain, function and stiffness), body mass index and the biochemical parameters (serum alkaline phosphate, calcium, c - reactive protein and lipid profile in form of analysis of serum cholesterol, triglyceride, low density lipoprotein and high density lipoprotein) with enzyme - linked immunosorbent assay (ELISA) analysis of serum (transforming growth factor beta 1 (TGF - β1) , C - terminal cross linked - telopeptide of type II collagen (CTXII), MPO and Leptin. They were instructed to take ALN 10 mg daily. Reassessment was done after 3 months of treatment. Results : A significant symptomatic improvement in WOMAC scoring regarding pain and stiffness (P<0.001) were observed associated with non significant improvement in function, significant reduction (P<0.001) in serum CTXII, Leptin and TGF - β1. A nonsignificant reduction in serum calcium and MPO, associated with no significant changes in serum Alkaline phosphatase, C - reactive protein, lipid profile(serum cholesterol, triglyceride, low density lipoprotein and high density lipoprotein) and joint space width were also reported. CTX II after treatment showed no significant correlation with BMI, however it showed significant positive correlations with WOMAC score. On the other hand, TGF - β1 showed significant positive correlation with BMI, but no significant correlations with WOMAC score. Conclusion : Alendronate sodium in patients with osteoarthritis has clinical efficacy in reducing symptoms especially pain through inhibition of leptin and CTXII with no significant structural improvement despite reduction of CTXII and TGF - β1 with no effects on inhibition of further disease progression. Relatively safe in old patients with dyslipidemia since there is no associated lipid disturbances with ALN. The reduction in level of CTX - II in the present study may be considered as one of the mode of actions of alendronate in patients with osteoarthritis

قيمة العلامات المصلية في فحص وتشخيص التطور في فحص وتشخيص التطور لسرطان القولون == The Value of Serological Markers (CA19 - 9 and CCSA - 4) in Screening and Prognosis of Colon Cancer

Author name: عذراء احمد محمد يعقوب
Supervisor name: هيفاء سلمان الحديثي | عقيل شاكر محمود
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: Colonic cancer is a very common disease world - wide being fourth most common cancer characterized by abnormal proliferation of the epithelium of colon at beginning then taking full colon wall thickness then to surrounding lymph nodes and tissues and finally metastasis. It is one of most complicated diseases with debilitating symptoms which becomes more severe, prominent and specific with advancing stage with high percent of fatality and relatively short survival if diagnosed late or if left untreated.Therefore, finding an easy, non - invasive and readily available means (marker) of screening and diagnosing colonic cancer would be of great value particularly if the same biomarker can be used for diagnosis, screening, prognosis and monitoring the efficacy of different treatment modalities.Aims of study : - To investigate the efficacy and validity of serum Cancer Antigen 19 - 9 (CA19 - 9) and Colon Cancer Specific Antigen - 4 (CCSA - 4) levels in the screening and prognosis of colon cancer and their validity for this.Patients and methods : - This study was applied on 35 patients (17 females & 18 males) with colon cancer with ages ranged 53 - 82 years old ( 6 patients received chemotherapy and 5 of them have undergone surgical removal of the primary tumor and 4 different patients received immunotherapy) with 20 smokers and 4 alcoholic, 35 patients (19 females & 16 males) with benign polyps ages ranged 29 - 56 years old and 16 (7 females & 9 males) negative controls ages ranged 25 - 43 years age. According to DUKE's staging : 6 colon cancer patients were stage A, 12 were stage B, 12 were stage C and 5 were stage D.All individuals in this study (whom attended Baghdad Teaching Hospital and Gastroenterology and Hepatic Diseases Center) were subjected to blood sampling for measuring their serum CA19 - 9 and CCSA - 4 using Enzyme Linked ImmunoSorbent Assay (ELISA) technique which was done at microbiology unit / university of Baghdad.Results : - The present study has shown that colonic cancer patients were presented at ages between 53 - 82 years of age (mean 68.5±6.4 years of age).Serum levels of CCSA - 4 were significantly elevated in those patients with advancing stages (C & D) compared with stages (A & B) and lower levels found in patients who had surgical removal of tumor or received chemotherapy.Also a positive relation found between CCSA - 4 with alcohol intake and smoking, however, less significant levels and relations found with CA19 - 9.Conclusion : - Serum CCSA - 4 is sensitive and specific indicator for diagnosis, prognosis and screening of colonic cancer.

تقييم التغيرات في البطين الايسر للحوامل في الثلث الاخير من الحمل في حالة الضغط الطبيعي وارتفاع الضغط اثناء الحمل باستخدام جهاز صدى القلب == EVALUATION OF ECHOCARDIOGRAPHIC CHANGES OF LEFT VENTRICLE DURING THE THIRD TRIMESTER IN NORMOTENSIVE AND GESTATIONAL HYPERTENSION

Author name: زينب عبد الخالق الركابي
Supervisor name: غسان ثابت سعيد | غازي فرحان الحاجي
General topic: Medicine
Specific topic: Physiology
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Pregnancy is considered as the “nature’s silent stress test” as it challenges the maternal cardiovascular system to undergo several cardiovascular adaptations. At the same time, it may reveal some hidden cardiac diseases. Furthermore, maladaptation of the mother’s cardiovascular system to these challenges can leads to several obstetric complications, more commonly, gestational hypertension which is the main cause of maternal death.The aims of this study are : to assess the maternal left ventricular structure and function during the last trimester of pregnancy and to find the impact of gestational hypertension on the maternal heart using transthoracic echocardiography.This cross sectional study was carried out in Baghdad teaching hospital. A total of 215 women were studied and 200 of them were included, they were classified into three groups : 100 women with mean age (29.83± 5.33 year) with gestational hypertension defined as increased systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90mmHg emerging after 20 weeks of gestation with no proteinuria, were considered as gestational hypertensive women group (GHW), 50 normotensive pregnant women with normal singleton pregnancy and mean age (28 ± 3.18 year) matched for gestational age with gestational hypertensive women were considered as normal pregnant women (NPW) group and 50 nulliparous normotensive women aged (30.1 ± 5.03 year) served as controls. All omen were submitted to a detailed medical history and physical examination focusing on hypertension risk factors. Their blood pressure was measured in the left lateral decubitus position and their body weight, height were measured to calculate bodymass index and body surface area. The left ventricle structure and function were evaluated using transthoracic echocardiography. The results of this study revealed that Gravidity was significantly higher and parity was significantly lower in GHW group compared to NPW group (P= 0.001 and P= 0.004 respectively). GHW had significantly higher BMI and BSA and 63% of them had edema. NPW had significantly higher LVIDd, IVST, PWT and RWT than controls with no significant change in EF, they also had higher LVMI over controls (P= 0.002, P= 0.0001, P= 0.0003, P= 0.0001 and P= 0.0002). 76% had normal LV geometry, 20% had eccentric hypertrophy and 4% had concentric remodeling. They also had larger LA area with higher A wave velocity and E/A ratio (P= 0.001, P= 0.001, P= 0.0012) and longer IVRT (P= 0.00013) with no significant change in Tei index.GHW compared to NPW had significantly higher IVST, PWT and RWT (P= 0.0001, P= 0.0003, P= 0.0001) they also had higher LVMI (P= 0.00022). 59% had abnormal LV geometry; of which : 34% had eccentric hypertrophy, 19% had concentric hypertrophy and 6% had concentric remodeling. 41% had normal LV geometry.The A wave velocity and E/A ratio were higher in GHW (P= 0.001, P= 0.0012) with significantly lower é velocity and higher E/é ratio (P= 0.0002 and P= 0.00012). Their IVRT and IVCT were significantly longer (P= 0.00013, P= 0.0003), with higher Tei index value (mean 0.56034 ± 0.07487) and P value of 0.001.In conclusion, pregnancy causes volume overload on the left ventricle which adapts through physiological hypertrophy with no further effect on the systolic and diastolic function of the heart. While, gestational hypertension adds the effect of pressure overload leading to further LV hypertrophy and remolding and might cause Grade I diastolic dysfunction.

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

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

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

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

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

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

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

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

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

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

تقييم مستويات فيتامين د في مصل الدم وتغاير الجين المشفر لمستقبلات فيتامين د لدى النساء المصابات بمتلازمة تكيس المبايض == Assessment of SerumVitamin D Levels and Vitamin D Receptor Gene Polymorphism in Women with Polycystic Ovary Syndrome

Author name: رنا علي حمدي
Supervisor name: زينا حسن عبد القهار
General topic: Medicine
Specific topic: Clinical Biochemistry
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Polycystic ovary syndrome is a common endocrinopathy in women of reproductive age with primary manifestations of infertility, menstrual irregularity, and clinical or biochemical evidence of hyperandrogenism.Insulin resistance is predominant in women with this disorder independently of obesity and is contributed to reproductive and metabolic defect seen in this syndrome.Vitamin D was assumed to have a physiological effect in reproduction through binding to nuclear receptors which have been distributed in the uterus, oviduct, ovary, placenta, and fetal membranes. Besides, genes included in vitamin D metabolism have been assumed as candidate genes for the polycystic ovary syndrome susceptibility. Vitamin D receptor gene polymorphisms were suggested to play an influential role on insulin secretion and sensitivity in women with this syndrome.Objective : This study was planned to evaluate serum 25 - hydroxy vitamin D3 levels in women with polycystic ovary syndrome and compare their levels with age and body mass index matched healthy controls. Also, assess the correlation between insulin resistance and 25 - hydroxy vitamin D3 among women with this syndrome. In addition, investigate the possible association between Cdx2 (G/A) single nucleotide polymorphism of vitamin D receptor gene and the risk of polycystic ovary syndrome.Materials and Methods : This case - control study involved eighty eight (88) women from 18 to 34 years of age. Women were attended to Infertility Center in Baghdad Teaching Hospital during the period from March 2017 to June 2017. Women were divided into two groups : group 1 - consisted of forty five (45) newly diagnosed women with polycystic ovary syndrome and group 2 - consisted of forty three (43) healthy women (as controls). Women with polycystic ovary syndrome were diagnosed according to Rotterdam criteria when two out of three following criteria are found, these include oligoovulation and/orIIIanovulation, clinical and/or biochemical hyperandrogenism and polycystic ovaries as defined by ultrasonography.Each serum sample was analyzed for measuring 25 - hydroxy vitamin D3, luteinizing hormone, follicle - stimulating hormone, free testosterone, and insulin by enzyme linked immunosorbent assay. While serum calcium and fasting serum glucose were measured by spectrophotometer. Moreover, DNA samples were amplified and analyzed for the Cdx2 polymorphism of vitamin D receptor gene using allele specific multiple - polymerase chain reaction.Results : Significantly lower levels and higher prevalence of vitamin D deficiency were found in women with polycystic ovary syndrome compared to age and body mass index matched healthy controls (p=0.0001). Also, significant negative correlations were found between serum 25 - hydroxy vitamin D3 levels and fasting serum glucose (r= - 0.484, p=0.01), insulin (r= - 0.422, p=0.04) and HOMA - IR (r= - 0.542, p=0.0001) in patients group. Besides, no significant difference in genotypic distribution of Cdx2 polymorphism of vitamin D receptor gene between patients and controls. GG carriers (p=0.141), GA carriers (p=0.189), and AA carriers (p=1). However, the results found significantly higher serum levels of luteinizing hormone (p=0.002) and luteinizing hormone/follicle - stimulating hormone ratio (p=0.003) in GG carriers than GA and AA carriers for patients group and lower levels of serum 25 - hydroxy vitamin D3 in GG carriers than GA and AA carriers for both patients (p=0.00001) and controls (p=0.00001).Conclusion : Cdx2 polymorphism of vitamin D receptor gene has an association with severity of clinical features seen in polycystic ovary syndrome, but not with risk of development of the disease meaning that genetic variation are not directly linked to risk of this syndrome but may indirectly affect disease development via regulation of vitamin D and/or calcium levels.
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