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الكشف عن العلامات السطحية باستخدام تقنية التدفق الخلوي عند المرضى العراقيين المصابين بالداء الزلاقي == DETECTION OF SURFACE MARKERS BY FLOW CYTOMETRY IN IRAQI PATIENTS WITH COELIAC DISEASE

Author name: كرار علي محمد حسن الساكني
Supervisor name: هيفاء سلمان الحديثي | باسم احمد عسكر
General topic: Medicine
Specific topic: Microbiology
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: الداء الزلاقي هو مرض مزمن، يحدد مناعيا من شكل الاعتلال المعوي الذي يؤثر في الامعاء الدقيقة عند الاطفال والبالغين ذوالميول الوراثي . وتظهر بشكل سريع عند ابتلاع الاطعمة التي تحتوي على الغلوتين. ويشار ايضا الى انه ذرب الاضطرابات الهضمية والحساسية من الغلوتين في الامعاء او غير ذرب الاستوائية. يمكن تعريف الغلوتين بانه كتلة البروتين المطاط الذي يبقى عندما يتم غسل عجين القمح لازالة النشا. مكونات البروتين الرئيسية في الغلوتين (غليادين وغلوتينين) وهي بروتينات التخزين في الحنطة. استجابة الخلايا المناعية للغليادين تشمل زيادة التعبير من المستقبلات السطحية. بعض من هذه المستقبلات تشمل HLA - DR ، جزيء التصاق ما بين الخلايا ، CD3 ( في خلايا Tالناضجة ) ، CD25 وCD69 ( في خلايا T المنشطة والخلايا القاتلة الطبيعية ) .هدف هذه الدراسة هو التحقيق في القيمة السريرية لستخدام علامات CD في تشخيص الداء الزلاقي . اشتملت هذه الدراسة على 40 مريضا (21 من الذكور و19 من الاناث) مصابين بالداء الزلاقي حضروا مستشفى الجهاز الهضمي والكبد التعليمي في مدينة الطب ، وخلال الفترة ما بين فبراير 2013 الى حزيران 2013. كذلك تالفت مجموعة السيطرة من 40 شخصا اصحاء الذين لم يشكو من اي مشكلة في الجهاز الهضمي. وتم اخذ عينات من الدم الوريدي لكل شخص ( الدماء الجديدة لاجراء اختبار الكشف عن العلامات السطحية باستخدام تقنية التدفق الخلوي والامصال لاجراء اختبار tTG الاضداد الذاتية باستخدام تقنية الاليزا ) . هذه الدراسة بينت ان اعمار المرضى المصابين بالداء الزلاقي في هذه الدراسة قد تراوحت ما بين سنتين الى ستة وخمسين سنة وبمتوسط عمر (15.6 ± 13.1) سنة. انخفاض مستوى الدم من خلاياT اللمفاوية الموجبة لعلامة CD3 بشكل ملحوظ في الحالات ( المرض الزلاقي ) التي تراوحت بين (7.6 - 62.3) بمتوسط (36.8 ± 16.7) مقارنة مع مجموعة السيطرة التي تراوحت بين (4.4 - 62.1) بمتوسط (41.9 ± 16.9). في حين ان مستوى الدم من خلايا T اللمفاوية الموجبة لعلامة CD6بزيادة كبيرة في مجموعة الحالات التي تراوحت بين(1.8 - 25.6) بمتوسط (10.5 ± 5.1) بالمقارنة مع مجموعة السيطرة التي تراوحت بين(1 - 9.4) بمتوسط (3.6 ± 2.2) . كما اثبتت الدراسة الحالية ان هناك فروقات ذات دلالة احصائية في مستويات المصل الذي يحتوي اضداد ذاتية tTG - A (p < 0.001) والمصل الذي يحتوي اضداد ذاتية tTG - G (p < 0.007) بين الحالات والسيطرة. اخيرا استنتجنا ان علامة CD69 هي اداة دقيقة لتشخيص اولي للداء الزلاقي . كذلك هناك ارتباط كبيربين كل من المصل الذي يحتوي اضداد ذاتية tTG - A والمصل الذي يحتوي اضداد ذاتية tTG - G مع خلايا Tاللمفاوية الموجبة لعلامة CD69 في المرضى الذين يعانون من الداء الزلاقي | Coeliac disease is a chronic, immunologically determined form of enteropathy affecting the small intestine in genetically predisposed children and adults. It is precipitated by the ingestion of gluten - containing foods. It is also referred to as coeliac sprue, gluten - sensitive enteropathy, or non tropical sprue. Gluten can be defined as the rubbery protein mass that remains when wheat dough is washed to remove starch. The major protein components of gluten—gliadin and glutenin—are storage proteins in wheat. The response of immune cells to gliadins includes the increased expression of surface receptors. Some of these receptors include HLA - DR, intercellular adhesion molecule, CD3 (in mature T - cells), CD25 and CD69 (in activated T - cells and natural killer cells). This study conducted to investigate the clinical value of using CD markers in diagnosis of coeliac disease. A total of 40 patients (21 males & 19 females) with coeliac disease attending the Gastroenterology and Hepatology Teaching Hospital in the Baghdad Medical City, during the period between February 2013 - June 2013.The control group consisted of 40 apparently healthy individuals who were not complaining of any gastro - intestinal problem. Venous blood samples were taken from each subject (fresh blood tested for detection of surface markers by flow cytometry and sera tested for Anti - tissue transglutaminase auto - antibodies by Enzyme Link Immune Sorbent Assay).This study shows that the age of coeliac disease patients in this study was ranged between (2 - 56) years with the mean age of (15.6 ± 13.1) years. Blood level of CD3 positive T - lymphocytes was not significantly decreased in cases group that ranged between (7.6 - 62.3) with mean (36.8 ± 16.7) when compared with controls group that ranged between (4.4 - 62.1) with mean (41.9 ± 16.9), While the blood level of CD69 positive T - lymphocytes was significantly increased in cases group that ranged between (1.8 - 25.6) with mean (10.5 ± 5.1) when compared with controls group that ranged between (1 - 9.4) with mean (3.6 ± 2.2). Also the current study has been demonstrated that there were a statistical significant difference in the serum levels of tissue transglutaminase - A auto - antibodies (p < 0.001) and tissue transglutaminase - G auto - antibodies (p < 0.007) between cases and controls. Finally this study concluded that CD69 marker is an accurate tool for the diagnosis of coeliac disease. There were significant correlations between each of Serum tTG - A auto - antibodies and Serum tTG - G auto - antibodies with CD69 positive T - lymphocytes in coeliac disease patients.

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

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

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

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

دراسة جزيئية للطفرتين NPM1 - A وFLT3 - ITD مع التعبير النسخي للمورث الجزيئي FLT3 في نموذج من المرضى العراقيين البالغين المصابين بابيضاض الدم النقياني الحاد وعلاقتهما مع المؤشرات السريرية والمختبرية == Molecular Study of NPM1 - A, FLT3 - ITD Mutations and FLT3 Transcript Expression in a Sample of Iraqi Adult Acute Myeloid Leukemia Patients : Their Correlations with Clinicopathological Parameters

Author name: شيماء محمد عبد اللطيف
Supervisor name: ختام رزاق كاظم الخفاجي | علي محمد جواد
General topic: Medicine
Specific topic: Diseases - Blood
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Acute myeloid leukemia is a hematological malignancy of myeloid progenitor cells characterized by anomalous proliferation, inhibition of differentiation and extension of leukemic cells blocked at the early stage of hematopoiesis. It has a great variability in the pathogenesis, clinical features, and treatment outcomes. Detection of molecular markers has become a smart tool to further division of patients in acute myeloid leukemia subgroups.Nucleophosmin1 mutations are found in approximately 30% of adult acute myeloid leukemia patients and are associated with a good outcome when detected in absence of duplications in the Fms - like tyrosine kinase 3 gene. Over 50 molecular Nucleophosmin1 mutation variants have been recognized; the most common one is Nucleophosmin1 - A mutation.The Fms - like tyrosine kinase 3 receptor is expressed on the surface of hematopoietic stem cells and plays a vital role in normal hematopoiesis. Numerous studies have revealed that high levels of Fms - like tyrosine kinase 3 were expressed in patients with acute myeloid leukemia. Fms - like tyrosine kinase 3 - Internal tandem duplication mutations are found in around 20 - 25% of patients with acute myeloid leukemia and are associated with increased transcript level of Fms - like tyrosine kinase 3 and with a poor scenario in adult acute myeloid leukemia patients.Aim of the Study1. Detect the frequency of Nucleophosmin1 - A; Fms - like tyrosine kinase 3 - Internal tandem duplication along with assessment of Fms - like tyrosine kinase 3 transcript expression in a sample of newly diagnosed Iraqi adult acute myeloid leukemia patients.2. Study the relationship of Nucleophosmin1 - A, Fms - like tyrosine kinase 3 - Internal tandem duplication mutations and Fms - like tyrosine kinase 3VItranscript expression with various clinicopathological parameters and French - American - British subtypes of the disease as well as the correlation among the three markers.Materials and MethodsThis is a cross - sectional study, conducted during the period extending between April 2015 and September 2016. The bone marrow aspirate samples of 53 adult acute myeloid leukemia patients were collected at the time of diagnosis and prior to treatment at the Hematology Ward of Baghdad Teaching Hospital in Medical City compared with 53 control individuals. All the control bone marrows obtained from patients with anemia and idiopathic thrombocytopenic purpura and were negative for infiltrative lesions. The related clinical and laboratory data for each patient were registered at the time of diagnosis.The study was conducted at Main Laboratory of Baghdad Teaching Hospital/ Medical City, Clinical and Communicable Diseases Research Center/College of Medicine/ University of Baghdad and Postgraduate Laboratory of Pathology and FoThe RNA was extracted and was reverse transcribed into cDNA. Real time polymerase chain reaction technique was applied on bone marrow aspirate samples of acute myeloid leukemia and control groups to detect the frequency of Nucleophosmin1 - A mutation, Fms - like tyrosine kinase 3 expression using a TaqMan probe and SYBR green assays respectively and detection of Fms - like tyrosine kinase 3 - Internal tandem duplication mutation using gel electrophoresis post polymerase chain reaction procedure

تقييم مصل الابلين في المرضى الذين يعانون من المتلازمة التاجية الحادة == Evaluation of Serum Apelin in Patients with Acute Coronary Syndrome

Author name: بشار جواد حسين
Supervisor name: زينا حسن عبد القهار
General topic: Medicine
Specific topic: Clinical Biochemistry
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: يشير مصطلح المتلازمة التاجية الحادة الى اية مجموعة من الاعراض السريرية المتوافقة مع اقفار عضل القلب الحاد والتي تتضمن الذبحة اللامستقرة واحتشاء عضلة القلب غير المرتبط بمقطع ST ((NSTEMI وكذلك احتشاء عضلة القلب الناجم عن ارتفاع مقطع ST (STEMI).بالاضافة الى تقييم النتائج السريرية ونتائج مخطط كهربائية القلب, فقد تم تقييم العديد من الواصمات الكيميائية الحيوية لدى المرضى الذين يعانون من الام الصدر من اجل تشخيص اقفار عضل القلب; فيما لايزال باقي الواصمات تحت البحث.ان الابلين (apelin) هو احد الببتيدات المستحدثة داخلية المنشا التي تمتاز بخصائص تؤثر في التقلص العضلي وفي توسيع الاوعية. ظهر من خلال الفحص الكيميائي الهستولوجي المناعي بان الابلين يصنع في خلايا العضلات الملساء وفي خلايا الارومة الليفية (الفايبروبلاست) للشرايين التاجية. وعلى نحو مماثل, وجد مؤخرا بان مستوى الابلين في مصل الدم كان مماثلا لمستواه في الفحص الكيميائي النسيجي داخل الاوعية الدموية وانسجة القلب.الاهداف : لتقييم مستويات مصل الابلين فيما يتعلق بالانواع الفرعيه من المتلازمة التاجية الحادة.المرضى والمواد وطرائق العمل : اجريت هذه الدراسة خلال الفترة من شهر ايلول 2014 الى شهر اذار 2015. اشتملت الدراسة على 59 مريضا يعانون من المتلازمة التاجية الحادة وكالتالي (30 منهم يعانون من الذبحة اللامستقرة و15 من احتشاء عضلة القلب غير المرتبط بمقطع ST ((NSTEMI اضافة الى 14 ممن يعانون من احتشاء عضلة القلب الناجم عن ارتفاع مقطع ST (STEMI). اشتملت الدراسة ايضا على (28) شخصا سليما ظاهريا حيث تم استخدامهم كمجموعة ضابطة. تم الحصول على عينات الدم لقياس كل من (الابلين والتروبونين وانزيم كرياتنين كاينيز CK - MB وكذلك صورة الشحوم) لكافة الاشخاص المشتركين في البحث.النـتائـــجاظهرت نتائج قياس الابلين في مصل الدم انخفاضا احصائيا لدى كافة مرضى المتلازمة التاجية الحادة (1846,1±320,9 ng/ml) بالمقارنة مع المجموعة الضابطة (2719,4±272,5) (p<0.05). فيما يتعلق بالمجاميع الثانوية من المرضى, كان مستوى الابلين في المصل الاقل لدى مرضى احتشاء عضلة القلب غير المرتبط بمقطع ST ((NSTEMI (1729±480) و(1816±289) لدى مرضى احتشاء عضلة القلب الناجم عن ارتفاع مقطع ST (STEMI) و(1916±224,4) لدى مرضى الذبحة اللا مستقرة عند مقارنتهم مع المجموعة الضابطة.كان مستويات الكوليستيرول والبروتين الشحمي خفيض الكثافة LDL لدى المرضى اكثر من مجموعة الضبط ولكنها لم تكن فروقات معنوية. بينما وجدت فروقات ذات دلالة معنوية في نتائج كل من ثلاثي الغليسريد والبروتين الشحمي عالي الكثافة HDL والبروتينات الشحمية وضيعة الكثافة VLDL بين المرضى والمجموعة الضابطة على التوالي.سجلت نسبة توزيع عوامل الاختطار في مرضى المتلازمة التاجية الحادة اعلى مستوياتها بالنسبة للسمنة (< 80%), وارتفاع ضغط الدم (~ 70%) بينما تم تسجيل النسب الاقل بالنسبة للتدخين وتضخم البطين الايسر ونقص تروية القلب وكذلك شذوذ شحوم الدم (Dyslipidemia). | The term acute coronary syndrome (ACS) refers to a group of clinical symptoms compatible with acute myocardial ischemia including unstable angina (UA), Non - ST - segment elevation myocardial infarction (NSTEMI) & ST - segment elevation myocardial infarction (STEMI).In addition to clinical and electrocardiogram (ECG) findings, several Biochemical markers are considered in patients with chest pain to diagnose myocardial ischemia.Apelin is a novel endogenous peptide with inotropic and vasodilatory properties, immunohistochemically it was hown to be synthesized in smooth muscle cells and fibroblast cells of coronary arteries. it was recently reported that serum measurements of apelin were similar to its immunohistochemical data in vessels and heart tissues.Objectives : To evaluate serum levels of apelin in relation to the subtypes of ACS..Patients, Material & Methods : The present study was conducted during the period from September 2014 until March 2015. Fifty - nine patients with ACS are included as 30 unstable angina (UA), 15 non ST elevation myocardial infarction (NSTEMI), & 14 ST elevation myocardial infarction (STEMI) patients. The study included also (28) apparently healthy persons served as control. Blood samples were obtained for measurements of (apelin, Troponin, CK - MB, & Lipid Profile) for all participants.Results : Serum apelin levels were significantly decreased in total patients with ACS (1846.1±320.9 ng/ml) compared to control (2719.4±272.5) (p< 0.05). Regarding patients' subgroups; serum apelin was lowest in STEMI (1729.0±480.0), NSTEMI (1816.0±289.0), & UA (1916.0±224.4) when compared with control.Total cholesterol and LDL levels were higher in patients compared to control although the difference was not significant. While there were significant differences in TG, HDL and VLDL between ACS patients and control group.The percentage of risk factors' distribution in ACS recorded the highest for obesity (>80%), hypertension (~80%), and DM (~70%); while lesser percentages were recorded for smoking, left ventricular hypertrophy, ischemic heart disease, and dyslipidemia.Conclusion : Data obtained revealed a reduction in serum apelin levels in all patients groups especially STEMI. Since apelin acts as an indicator for the efficiency of heart function and coronary circulation, it could be used as a indicator for assessment of severity of ischemia in ACS patients.

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

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

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

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

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

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

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

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

العوامل المرتبطة مع سرطان الثدي وتاثيراتها في عينة من المرضى لمستشفى الامل الوطني لعلاج السرطان في بغداد == Factors associated with Breast Cancer Impact in a sample of Al - Amal National hospital for Cancer management in Baghdad

Author name: اسامة مدحت لفتة
Supervisor name: احمد سمير النعيمي
General topic: Medicine
Specific topic: Community Medicine
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Breast cancer (BC) known to be the most common cause of cancer - related death among females with excess of more than a million inflicted with this disease every year. In Iraq, breast cancer is the most common type of malignancy among the Iraqi population in general. The disease affects physical and mental health among breast cancer survivors. The true impact of a successful medical intervention could be understood by the degree to which the treatment has a positive influence on patient’s immediate and /or future well - being. Assessment of quality of life among breast cancer is vital to identify area of concerns to the patient and health professional, and to suggest means to improve disease outcome and reduce patient’s suffering. The current study aimed at measuring the impact of Breast Cancer on different aspects of health related quality of life. In addition, to studying the association between the impact of breast Cancer and sociodemographic characteristics or treatment modalities.A cross - sectional study was conducted on a total of 250 randomly selected females with an established diagnosis of breast cancer attending Al - Amal National hospital for Cancer management in Baghdad. Data collection took place during the period from January to April, 2016, each participant was asked to fill The questionnaire composed of three parts : The first one covered sociodemographic characteristics including : age, gender, educational attainment, marital status, living arrangement, finical status, BMI and blood pressure. The second part contained the ABCIS (Arabic Breast Cancer Impact Scale) with 14 questionnaire items. The third part of the questionnaire gathered data about disease associated factors like duration, treatment modalities. The answers that reflect the impact of the disease on specific life domains were anchored to a 5 points Likert - scale type rating scale. It ranges from large extent to no impact. Higher rating reflects higher negative impact. In addition, the importance of each domain rated on 4 points likert - scale ranges from very important to not important. Higher rating reflects greater importance.Breast cancer had negative impact on patients quality of life. The psychological domain was the most affected among the three domains of quality of life, while theviisocial domain was the least affected. The retest part of the study supported a high reliability for the tested instrument among Iraqi Breast Cancer patients. A quarter of study subjects described the quality of their life as poor. This group of females is at risk for bad prognosis and deterioration of their conditions later on.The study failed to detect an association between type of treatment (whether radio or chemo - therapy) and negative impact of breast cancer on quality of life. Most cancer patients in Iraq fail to cope with the new events and changes in their body image and daily activities that resulted from their disease, neither in their social or occupational life. This might be related to the lack of the psychological therapy and rehabilitation program, which should be provided in all stages of management.

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

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

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

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

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

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

الارتباط بين الموجات فوق الصوتية للوريد البابي الكبدي والنتائج التنظيرية في دوالي المرئ == Correlation between portal vein Doppler ultrasound and endoscopic findings in esophageal varices

Author name: اسراء مزاحم ذاكر
Supervisor name: ليث احمد خلف
General topic: Medicine
Specific topic: Diagnostic Radiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: خلفية عن الموضوع : دوالي المريء ، وهو احد المضاعفات الرئيسية لتليف الكبد ، يمكن ان يؤدي الى تهيدد للحياة نتيجة نزيف الجهاز الهضمي.الهدف من البحث : تقييم الاداة التشخيصية للكشف عن دوبلر الوريد البابي (سرعة ، قطر ، مؤشر الازدحام ، وحجم الطحال) للتنبؤ بدوالي المريء.الطرائق : تم تضمين 51 مريضا بالغا يعانون من تليف الكبد في الدراسة. خضع جميع الاشخاص الى الموجات فوق الصوتية في البطن وتنظير المريء. تضمنت مؤشرات الوريد البابي التي تمت دراستها مؤشر الاحتقان الكبدي ، وقطر الوريد البابي ، سرعة الوريد البابي وحجم الطحال. تم حساب حساسيتها ونوعيتها والقيم التنبؤية باستخدام التنظير المريء كمعيار ذهبيالنتائج : كانت الارتباط بين سرعة الوريد البابي ومؤشر الاحتقان الكبدي مع وجود دوالي المريء ذات دلالة احصائية (قيمة p <0.05). كان سرعة الوريد البابي اعلى حساسية 92.7 ٪ للكشف عن وجود دوالي المريء. وكان مؤشر الاحتقان الكبدي اعلى خصوصية من 99 ٪ واعلى قيمة تنبؤية ايجابية من 99 ٪. كانت القيمة التنبؤية السلبية اعلى سرعة الوريد البابي بنسبة 66.7 ٪.استنتاج : يمكن ان يكون دوبلر بالموجات فوق الصوتية بديلا سهلا ، رخيصا وامنا . حيث لا يتوفر تنظير المريء . مؤشرات دوالي الوريد البوابي مفيدة للكشف عن دوالي المريء وافضل مؤشرات الدوبلر سرعة الوريد البابي ومؤشر الاحتقان الكبدي ، في حين ان قطر الوريد البابي قد يكون لها قيمة محدودة للتنبؤ بدوالي المريء | Background : Esophageal varices, a major complication of liver cirrhosis, can lead to life threatening gastrointestinal bleeding.Objective : Evaluate the diagnostic utility of portal vein Doppler findings (velocity, diameter, congestion index ) and spleen size to predict esophageal varices.Methods : A cross sectional study of 51 adult patients with cirrhosis were included in the study. All of them underwent an abdominal ultrasound and esophageal endoscopy. The portal vein indices that were studied included hepatic congestion index, portal vein diameter portal vein velocity and splenic size. Their sensitivity, specificity and predictive values were calculated using esophageal endoscopy as a gold standard. Results : Association of PVV and HCI with presence of EV was statistically significant (p - value <0.05). PVV had the highest sensitivity 92.7% for detecting the presence of EV. HCI had the highest specificity of 99% and the highest positive predictive value of 99%. Negative predictive value was highest for PVV at 66.7%.Conclusion : Doppler Ultrasound can be an easy, cheap and safe alternative, where esophageal endoscopy is not available, available, for triaging patients for referral for esophageal endoscopy. Portal vein Doppler indices are useful for detecting esophageal varices, the best Doppler indices PVV and HCI, while PVD may have a limited value for predicting esophageal varices.

دراسة تجريبية لانزيمات البروتييز للزائفة الزنجارية المعزولة من المرضى العراقيين المصابين بتقرح القرنية ودورها في علاج تقرح القرنية المتسبب عن المكورات العنقودية == Experimental Study of Pseudomonas aeruginosa Proteases Isolated from Corneal Ulcer of Iraqi Patients and Their Role in the Treatment of Staphylococcus aureus Keratitis

Author name: عائدة حسين ابراهيم
Supervisor name: جاسم محمد كرحوت | منيرة جلوب اسماعيل
General topic: Medicine
Specific topic: Microbiology
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: One - hundred and twenty samples ( corneal scraping) were collected from patients diagnosed to have microbial keratitis (corneal ulcer) who attended Ibn Al - Haitham Teaching Eye Hospital from the period between May 2013 and November 2013, Pseudomonas aeruginosa was reported 26 (21.6%) from the total cases. All bacterial isolates were diagnosed by conventional and biochemical tests, and confirmed by Vitek 2 Compact System.The role of proteases enzymes ( Elastase ( LasB), LasA, Alkaline protease and Protease IV ) of Pseudomonas aeruginosa in the corneal ulcer was studied by using genetic and molecular biological method by real time PCR, and the results indicated that three bacterial isolates of Pseudomonas aeruginosa possessed elastase gene (LasB) (11.5%), and only one bacterial isolate of Pseudomonas aeruginosa harbored LasA protease gene ( 3.8%). All bacterial isolates of Pseudomonas aeruginosa were harbored alkaline protease gene (100%), and twenty bacterial isolates were harbored protease IV (76.9%).The results of real - time PCR analysis indicated that four bacterial isolates of Pseudomonas aeruginosa (15.3%) were harbored more than one gene of different proteases enzymes ( elastase, alkaline protease, and protease IV).On the other hand our results showed that one bacterial isolates (3.8%) harbored both LasA protease and alkaline protease genes, and twenty bacterial isolates of Pseudomonas aerugenosa (76.9%) were harbored alkaline protease and protease IV genes.The LasA protease was extracted from Pseudomonas aeruginosa isolate by cooling centrifuge and precipitated supernatant by ammonium sulfate at saturation (80%). The resulted extracted crude enzyme concentration was 60 μg/ml. Then the crude enzyme was partially purified by dialysis and gel filtration chromatography by using Sephadex G - 100. The concentration of partial purified enzyme reached 40μg/ml.IIISummaryThe results of the experimental treatment of bacterial keratitis ( in vivo) of infected eyes rabbits caused by Methicillin Sensitive Staphylococcus aureus showed that the efficacy of LasA protease was effective was as Lysostaphin in eradicating Methicillin Sensitive Staphylococcus aureus from the infected corneas after approximately 15 h after giving the drug at dose 100 μl ( concentration 1μg / ml ) . While Vancomycin gave us very little potency in eradicating S. aureusfrom corneas in comparison with potency of LasA protease and Lysostaphin duringthis time but showed good potency very late approximately after 3 days of applicationof treatment.The results of the experimental treatment in vitro (in the test tube ) that is caused by Methicillin Sensitive Staphylococcus aureus showed that the efficacy of LasA protease was similar to that of Lysostaphin drug in the killing of Methicillin Sensitive Staphylococcus aureus in the bacterial broth.

تضمين مؤشر ديوك لفحص اجهاد القلب على سعة انتشار اصابة الشرايين التاجية من خلال الفحص القسطاري == The Implication of Duke Treadmill Score (DTS) on The Extent of Coronary artery Lesions by angiography

Author name: طارق مطشر الثويني
Supervisor name: حسن يوسف النجار | حسن علي الفرحان
General topic: Medicine
Specific topic: Diseases - Heart
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: خلفية : يعتبر فحص اجهاد القلب من الوسائل المفيدة في تشخيص امراض الشرايين التاجية للقلب للمرضى اللذين يعانون من الذبحة الصدرية اضافة الى حساب اختطارهم المستقبلي. ان مؤشر ديوك لفحص اجهاد القلب يعد من المؤشرات التي تعطي فكرة جيدة عن تشخيص الذبحة الصدرية اضافة الى تصنيف المرضى حسب نسبة الخطورة والمضاعفات المستقبلية. وتعتمد هذه العلامة على احتساب مدة الفحص ,الام الذبحة اثناء الفحص والتغيرات الحاصلة على تخطيط القلب الكهربائي.الاهداف : لتحديد فائدة مؤشر ديوك في تشخيص امراض الشرايين التاجية للقلب اضافة الى تطبيقها على سعة انتشار الاصابة للمرضى اللذين يعانون من الذبحة الصدرية.طريقة العمل : تم انتخاب عينة من المرضى المحالين الى المركز العراقي لامراض القلب في مجمع مدينة بغداد الطبية /بغداد - العراق للفترة من شهر مايس 2013 الى نهاية شهر نيسان 2014 واللذين يعانون من الام الصدر للاشتباه باصابتهم بالذبحة الصدرية .تمت اجراء المعاينة الاولية للمرضى من ثم اجراء فحص اجهاد القلب حسب بروتوكول بروس القياسي لفحص اجهاد القلب ثم فحص قسطرة الشرايين التاجية التشخيصية وحسب ضوابط الكلية الامريكية لامراض القلب والجمعية الامريكية للقلب.تم تقسيم مؤشر ديوك الى : مؤشر عالي الخطورة اقل من - 11 ومؤشر متوسط الخطورة ويتراوح من اقل من - 11 الى +5 اما المؤشر الاعلى من +5 يعتبر قليل الخطورة.بالنسبة لاصابة الشرايين التاجية تم اعتبار نسبة التضييق ≥70% في الشرايين التاجية,ونسبة تضيق≥50% في الجذع الايسر الرئيسي ذات اهمية. في حين تم اعتبار الاصابة ذات الاهمية في الجذع الايسر الرئيسي او ثلاثة من الشرايين الاخرى الرئيسية اصابة واسعة. النتائج : اظهرت نتائج البحث التالي : معظم المرضى في مجموعة المؤشر العالي (38 مريض من مجموع اربعين ) اي نسبة 95% كانوا مصابين بنسبة ذات اهمية في الشرايين التاجية, و13 مريض كانوا مصابين اصابة واسعة. على العكس من المرضى في مجموعة المؤشر غير العالي كانت النتائج كالتالي : اكثر من نصف المرضى (23 مريض ) لم يتم العثور على اصابة في الشرايين التاجية , 17 مريض كانوا يعانون من اصابة ذات اهمية , ومريض واحد فقط كان يعاني من اصابة واسعة | Background : Exercise testing is a useful tool in the diagnosis of patients with coronary artery disease and predicting their future risk of cardiac events. The Duke treadmill score (DTS) is a composite index that was designed to provide diagnostic and prognostic estimates based on results from the exercise test, including ST - segment deviation, chest pain, and exercise duration.Aim of the study : To assess the diagnostic and the prognostic value of the Duke treadmill score (DTS) in the evaluation and the risk stratification of patients with coronary artery disease.Patients and methods : A cross sectional study was used to assess patients who were referred to The Iraqi Centre for Heart diseases for the evaluation of chest pain by Exercise test followed by coronary angiography for risk stratification according to the ACC/AHA guidelines, during the period from May 2013_ April 2014. A standard Bruce treadmill protocol was used as the exercise technique with calculation of the Duke treadmill score( DTS) as the following : DTS= exercise time (minute) ̶ 5 ×(maximum ST deviation) ̶ 4× ( treadmill angina index), angina index = 0 if no anginal pain, 1 for nonlimiting anginal pain, 2 if angina was why the test terminated.A (DTS) of ≤ - 11 was defined as high risk , a DTS of > - 11 to + 5 was defined as intermediate risk , while a score of > +5 was defined as low risk. A significant coronary artery lesion was defined as follows : ≥ 50% left main stem stenosis or, ≥70% stenosis in other epicardial vessels. The presence of a significant lesion in the left main stem or three epicardial vessels was labeled as extensive coronary artery disease, while non extensive coronary artery disease indicates a significant lesion in one or two epicardial vessels . Results : There were 80 patients included in the study (40 patients were with high risk DTS, the other 40 were with non high risk DTS). The mean age 55.6 ±9.6 years. 61 patients were males (76.0%) and 19 were females (24.0%). There was no significant difference in age groups and means between males and females(p>0.05) . The main risk factors for coronary artery diseases among study participants were hypertension (65%), diabetes mellitus (34.0%) and smoking (43.0%). Participants who had one risk factor represented 40%, those who had two risk factors represented 26.0%, those who had no risk factors represented 18.0%, and those who had three risk factors represented 16.0%. Almost all patients in the high risk group,( 38 patients of the 40) (95%) had a significant coronary artery disease ,whereas thirteen patients of them (32.0%) had extensive coronary artery disease. Conversely more than half of the patients in the non high risk group(23 of total 40 patients) (58%) had no lesions by angiography, and only 17 patients (42%) had a significant coronary artery disease with only one patient of them had an extensive coronary artery disease (P˂0.001) . It had been significantly found that high risk DTS group had more ST - depression than those of non high risk group, the mean ST - depression value was 2.4 ± 0.5 mm for the high risk group patients vs. 1.4 ± 0.5, for the non high risk group patients ,(p<0.001).Conclusion : The composite DTS provides diagnostic and prognostic information for the evaluation of symptomatic patients for clinically suspected ischemic heart disease

تاثير الفيتامينات B1,B6 and B12) على الاعتلال العصبي المحيطي : دراسة نسيجية، نسيجية كيميائية وكيميا نسيجية مناعية == The effect of vitamins B1, B6 and B12 on peripheral neuropathy , Histological , Histochemical and Immunohistological studies

Author name: صالح مهدي علي
Supervisor name: معن حمد الخالصي
General topic: Medicine
Specific topic: Anatomy and Histology and Embryos
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Peripheral neuropathy is a nerve injury process by disease or so on leading to damage of peripheral nervous system . Diabetes mellitus and compression are most common causes of peripheral neuropathy. Vitamins (B1,B6 and B12) commonly used for treatment of peripheral neuropathy. The objective of this study is to compare the effect of vitamins (B1,B6 and B12) on nerve regeneration and recovery after induced sciatic nerve crush injury in experimental animal model.Seventy five male Swiss albino rats were divided randomly into five groups and each group consisted of 15 animals. Group A( which considered as control positive(with crush injury) received normal saline intramuscularly for 45days. Group B received vitamin B1 , group C received vitamin B6 , group D received vitamin B12 and group E which considered as control negative(no crush injury and no treatment) . All animals were injected vitamins intramuscularly for 45days. Tail flick test time was reduced in rats treated with vitamin B12 after crush injury to the Sciatic nerve. Mid thigh circumference (MTC) was significantly increase in B12 treated group after crush injury to the Sciatic nerve. Data analysis was performed by SPSS 20 software using descriptive statistics.IVHistological examination of rats sciatic nerves stain by H&E on day 15 showing degenerative nerve fibers with Schwann cell infiltration in all groups but it is less prominent in group D. On day 45 histological examination of rats gastrocnemius muscles exhibited separation of bundles muscle fibers by connective tissue, variation of fibers in size and shape with atrophy of muscle bundles in all groups .While these were less prominent in rats treated with B12.Van Giesons staining of rat sciatic nerves on day 45 after crush injury. In all groups experimental and control (B,C,D,A) showing degenerative nerve fibers in different areas but less in group D and better organized sciatic nerve fibers in group D.Finally, Immunohistochemical study of (anti S100 protein) of rat sciatic nerves on day 45showed strong activity for those rats treated with vitamin B12 while rats treated with vitamin B1 and B6 exhibited moderate and weak activities respectively .In conclusion vitamin B12 promote peripheral nerve regeneration more than vitamin B1and vitamin B6.

التقييم الجزيئي لعوامل الخطورة الوراثية لامراض القلب والاوعية الدموية لعينة من المرضى العراقيين المصابين بنقص التروية القلبية الحاد == Molecular Assessment of Cardiovascular Genetic Risk Factors among a Sample of Iraqi Patients with Ischemic Heart Diseases

Author name: وسام جاسم محمد
Supervisor name: بسام موسى صادق الموسوي
General topic: Medicine
Specific topic: Diseases - Genetics
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Ischemic heart disease (IHD) is a major cause of morbidity and mortality worldwide; its incidence is increasing in developing countries. It is estimated that 17.5 million individuals die from CVD each year, accounting for 31% of all deaths worldwide; more than 75% of these deaths occur in low to middle income population. Understanding the pathogenesis of IHD has been modified over the years and many new genetic risk factors have been recognized. Attention is now focused towards understanding the genetic basis of IHD. Enormous effort has been invested in understanding the genes and specific DNA sequence variations responsible for this heritability and genetic polymorphisms might be risk factors that predispose to IHD.Aim of Study : To analyze the genetic risk factors among Iraqi patients with acute IHD and to determine the frequency of each type of mutation / polymorphism.Patients, Materials & Methods : This is a cross sectional study that recruited 56 patients admitted to the Cardiac Care Unit (CCU) of Ibn Al - Nafees Teaching Hospital with a clinical diagnosis of acute ischemic heart disease (myocardial infarction and unstable angina) during a two - month period between December 8th, 2015 and February 8th, 2016. All cases <50 years with acute MI or angina were included, while those >50 years and those with documented hyperlipidemia were excluded.Demographic and clinical data of the enrolled patients were reported. Two - three ml of peripheral blood samples were aspirated from all recruited patients and collected in K2EDTA tube to be store at - 20oC for further DNA analysis. Molecular analysis to detect 12 commonIIImutations/ polymorphisms, namely : FV G1691A (Leiden), FV H1299R (R2), Prothrombin C20210A, Factor Xlll V34L, β - Fibrinogen - 455 G - A, PAI - 1 4G/5G, GPllla L33P (HPA - 1), MTHFR C677T, MTHFR A1298C, ACE l/D, Apo B R3500Q, and Apo E2/E3/E4 was performed by PCR amplification using biotinylated primers and hybridization of amplification products to a test strip containing allele - specific oligonucleotide probes immobilized as an array of parallel lines. The bound biotinylated sequences were detected using streptavidin - alkaline phosphatase and color substrates according to the manufacturers’ instructions.Results : The age range of patients was 18 - 50 years, with a mean ±SD of 40±7 years. The vast majority of enrolled cases were males (54/56 (96.4%). The traditional risk factors were frequently encountered in the current study (hypertension 21.4%, diabetes 26.8%, smoking 75%, family history of IHD 48.2%, and previous attack of ischemia 23.2%). Serum troponin was positive in 72.2% of cases. The study found that the genotype frequencies of 12 genetic mutations / polymorphisms were as follows :  MTHFR A1298C and C677T were the highest reported mutations among the study group (62.5%) and (50%) respectively, followed by β - fibrinogen gene mutation detected in (46.5%), and PAI - 1 4G/5G polymorphism which was detected in (75%) of patients, while PAI - 1 4G/4G was detected in (16.1%) of patients. Homozygous ACE D/D polymorphism was present in 35.7% in our cases and heterozygous HPA - 1(a/b) polymorphisms was present in 28.6%. The E4 allele of Apo E gene was present in 7.1% of the studied cases.IV Heterozygous factor XIII (FXIII) V34L variant was detected in 21.4% patients, while homozygous state was detected in 3.6% patients, i.e. 25% of selected cases had Leu allele,  Heterozygous FV R2 was detected in 12.5%, and factor V Leiden mutation was detected in 1.8%, while no abnormal homozygous alleles were detected.  Prothrombin G20210A mutation were detected in 1(1.8%) patient. Neither heterozygous nor homozygous states for the mutant Apo B allele were detected in this study. The study showed no statistically significant difference between age group I (<40 years) and age group II (40 - 50 years), but the study showed higher frequency for some genes like PAI - 1(4G) and Apo E4 alleles in group I than group II (100% versus 85.3%) and (13.6% versus 2.9%) respectively, while HPA - 1 (a/b) polymorphism was higher frequent in group II than group I (35.3% versus18.2%).Subgroup analysis of the studied traditional risk factors (hypertension, diabetes mellitus, smoking, family history of ischemic heart disease) showed that β - Fibrinogen mutation had higher frequency in smoker patients than nonsmokers (50% versus 35.71%), the D allele of ACE gene was more frequent in hypertensive than in non - hypertensive patients (91.7% versus 79.5%), and higher frequency of HPA - 1b allele in diabetic than non - diabetic patients 46.7% versus 22%).Genetic risk score (0 - 16) was established according to the number of risky alleles detected in each case; the results showed that all patients had at least 2 genetic risk factors and none had more than 8; the study also showed that patients with 4 or more risky genes represented 82.14% of the studied patients, and that the risk of IHD increases in those who carry 4 or more genetic risk factors when associated with at least one traditional risk factor.

تصنيف المرضى العراقيين المصابين بالاورام العصبيه الغديه وتقدير مدى استجابتهم لعقارالساندوستاتين (الاوكتيريوتايد) == NEUROENDOCRINE TUMORS CLASSIFICATION AND RESPONSE TO LONG ACTING SOMATOSTATIN ANALOGUE; AN IRAQI EXPERIENCE

Author name: مروة خالد عبد الفتاح
Supervisor name: منور عبد الاله النقاش
General topic: Medicine
Specific topic: Therapeutic Radiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: The lack of studies regarding the incidence of neuroendocrine tumors (NETs) is related to the rarity of these tumors (25/1,000,000). Chromogranin A is a useful tumor marker for NETs diagnosis & follow - up. Octereotide LAR is an established treatment for NETs by both providing symptomatic relief & inhibiting tumor growth. However, studies regarding incidence of NETs & their response to SAS - LAR are still insufficient.Aim of studyTo shade the light on the incidence of NETs, the clinico - pathologic characteristics of Iraqi patients with NETs & their response to long acting Octereotide.Patients & methodsThis is a cross - sectional observational study that was conducted in Oncology teaching hospital/medical city complex using patients’ follow - up sheets. Data recruitment included all NET patients diagnosed after October 2013 to April 2016.ResultsIn our registry, 38 patients were recorded; most patients (60.5%) were over the age of 50 years with male to female ratio (1.2 : 1). We found the gastroenteropancreatic tract being the most common primary organ followed by pelvis . With respect to the GI tract we found that pancreas (26.3 %) was the commonest primary organ. Metastatic disease at presentation was found in (44.7%) of patients with the Liver (15.8%)was the most common metastatic site.Notably, most of our patients presented with G3 disease (44.7%) & (13.2%) with G1 . Serial CgA tests were performed in (17/28) patients used SAS - LAR, with a change in mean value from (225.3 U/L) pre - using the agent to (17.5 U/L) two months after use & to (8.7 U/L) four months after use(p=0.001) while the change in mean of CgA level was from (205.9 U/L) to (200.9 U/L) in 10 patients who did not use octereotide.(p=0.2). After a period of 2 years ,the median time of remission following SAS - LAR administration was 3 months compared to 7 months in patients received other modalities of treatment. In our study, a statistically significant difference was demonstrated between the two groups of patients.(p=0.003).Conclusion Plasma CgA is the most reliable marker for NETs, reflecting the clinical evolution of the disease. Aids in diagnosis & response assessment to different therapies.Octreotide LAR provides symptomatic response & contributes to disease stabilization & tumor regression in both functional & non functional NETs.1 - INTRODUCTION Neuroendocrine tumors are thought to arise from cells throughout the diffuse neuroendocrine system that is composed of peptide - and amine - producing cells that may secrete different hormones depending on the site of origin. NETs are composed of monotonous sheets of small round blue cells with uniform nuclei and cytoplasm(1). They compromise a broad family of tumors, the most common of which are carcinoid tumors (most commonly arise in the lungs & bronchi, small intestine, appendix rectum, or thymus)& pancreatic NETOther neuroendocrine tumors arise from parathyroid, adrenal, pituitary gland, & in calcitonin - producing cells of the thyroid (causing medullary thyroid carcinoma)( 2).Most NETs seem to be sporadic; risk factors for sporadic NET are poorly understood. Risk factors for the development of midgut carcinoid tumors include age, male sex, and increased body mass index, and menopausal hormone therapy (1).NET may also arise in the context of inherited genetic syndromes, include multiple endocrine neoplasia (MEN) types 1& 2 (2).The incidence of gastrointestinal (GI) NETs is 6.2 per 100,000 populations and has been steadily increasing. The increasing incidence of NETs reportedIn many studies is likely multifactorial and includes increased awareness and improved endoscopic methods of detection.As these tumors are indolent and patients survive a long time, the prevalence is quite high, making them the second most prevalent GI tract tumor, second only to colon cancer. Some are clinically silent and have been detected only at autopsy (incidence 8%). Further ,patients with GI NETs have a higher risk of other noncarcinoid primary tumors. The overall 5 - year survival rate of all patients with GI NETs is 28.5%.(1) Of all NETs ∼25% are located in the respiratory tract. Typical carcinoids (TCs) comprise ∼1% - 2% and atypical carcinoids (ACs) only 0.1% - 0.2% of pulmonary neoplasms. According to the surveillance, epidemiology and end results program (SEER) database from 2003, the combined incidence has been 1.57/100 000 inhabitants . The prevalence of thymic NET is ∼3% of the total number of NETs at all sites. In the last SEER database, a reported incidence of thymic NETs is 0.02/100 000 population per year . They constitute ∼5% of all thymic tumors. Both bronchial and thymic NETs may be part of multiple endocrine neoplasia type 1 syndrome (MEN - 1, 5% - 15%). The median age at diagnosis for bronchial NETs is 64 years and for thymic NETs 59 years.(3) The incidence of G1NET increased from 2.0 to 3.0; there was a large increase in G2NET from 0.01 in 1990 to 0.2 in 2010, and of the G3 - LCNET from 0.01 to 1.8, respectively. In G3 - SCNET incidence in men decreased from 21.3 to 10.1, whereas in women it increased from 4.5 to 7.7.(4).

تاثير عمر الام على نتائج الحمل == Effect of maternal age on pregnancy outcome

Author name: حلا نعمان محمدعلي
Supervisor name: جواد كاظم الديوان
General topic: Medicine
Specific topic: Family Medicine
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: خلفية البحث : في العقود القليلة الماضية ،كان هناك تاخير في الحمل الاول ، ومعدل عمر النساء في وقت الولادة تزايدت. يرافق المراهقات الحوامل والحوامل المتقدمات بالعمرمضاعفات اثناء الحمل والولادة. هدف الدراسة : لدراسه تاثير عمر الام على صحه الام والوليد .المنهجية : دراسة مقطعية اجريت في مستشفى بغداد التعليمي للفترة من بداية شهراذار وحتى بداية شهر حزيران من سنة 2016 ،العينة متكونة من( 500امراة) اختيرت بطريقة العينات العشوائية المنتظمة من ملفات المرضى في قسم الاحصاء .تمت جمع المعلومات من قبل الباحثة من فايلات المرضى اللذين دخلوا او رقدوا في ردهات قسم النسائية لسنة 2015 ، ثم تم تصنيفهم حسب العمر الى ستة فئات عمرية المجموعة(<20 )، المجموعة (20 - 24 ) ،المجموعة (25 - 29) ،المجموعة (30 - 34 ) المجموعة(35 - 39)،المجموعة (40≤) .النتائج : اظهرت الدراسة بان هناك فروق ذات دلالة احصائية بين المجاميع العمرية المختلفة ،بالنسبة لوجود ارتفاع ضغط الدم اثناء الحمل ،داء السكري الولادة المبكرة ،وزن الوليد ،التشوهات الولادية ، وفاة الجنين داخل الرحم ،وطريقة الولادة. ولايوجد فروق ذات دلالة احصائية بالنسبة لوجود الاسقاط ،ولادة جنين ميت ،فقر الدم ،والحمل المتعدد. الاستنتاج : اثبتت الدراسة ان مضاعفات الحمل والولادة والمشاكل المتعلقة بالجنين عند الولادة تكون نسبتها اعلى عندالمراهقات الحوامل والنساء المتقدمات بالعمر . | Background : In the last few decades, there has been a delay in first - time pregnancies, and the average age of women at the time of delivery has increased in many countries. Teenage and advanced maternal ages are associated with adverse pregnancy outcomes.Objective : To demonstrate the effect of maternal age on pregnancy outcomes in different age groups mothers.Subjects and methods : Across sectional study was conducted in Baghdad Teaching Hospital, data was collected in obstetric \gynecology department from 1st of March until 1st of June 2016 .Total of 500 women were included in the study using the systemic random sampling, every 10th case was selected, then divided into six age groups, a list of information was taken from hospital record at statistic department.Results : The results showed that there was statistically significant association among different age group, regarding presence of pregnancy induced hypertension, diabetes mellitus, preterm delivery, birth weight, congenital anomalies, IUD, mode of delivery (p value<0.05). Interestingly there was no statistically significant association regarding presence of fetal loss (miscarriage, stillbirth), anemia, and multiple pregnancies (p value> 0.05).Conclusion : Maternal and neonatal complications are higher during the teenage years and advanced maternal age.Keywords : Maternal age, outcome of pregnancy

دور فحص المرونة وسرعة الموجات المقصوصة في التفريق بين الاورام الحميدة والخبيثة في الثدي == USE OF SHEAR WAVE ELASTOGRAPHY TO DIFFERENTIATE BETWEEN BENIGN AND MALIGNANT BREAST MASS

Author name: اوان حكمت محمد
Supervisor name: ليث احمد خلف
General topic: Medicine
Specific topic: Diagnostic Radiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine - Department Of Diagnostic Scans
Language: English
University location: Baghdad
First pages:
Abstract: Shear wave elastography is a new method of obtaining elastography images based on the combination of a radiation force induced in a tissue by an ultrasonic beam and an ultrafast imaging sequence capable of catching in real time the propagation of the resulting shear waves.Aim of studyTo assess the performance of shear wave elastography in differentiating between the malignant and benign breast tumors. Patients and Methods A cross sectional study carried out in Breast Clinic at Oncology Teaching Hospital - Baghdad Medical city for period from 1st of November, 2015 to end of June, 2016 convenient sample of 80 women with suspected breast tumor. After full history and examination, enrolled women were examined with ultrasound by the researcher with help of Radiologist.ResultsA highly significant association was observed between women with BIRADS V and high shear wave elastography ratio (p<0.001). Women with BIRADS V had significantly malignant fine needle aspiration findings of breast (p<0.001) and women with high shear wave elastography ratio were significantly had malignant FNA findings (p<0.001). The cutoff shear wave elastography ratio of 3.75 had good validity results (87% sensitivity, 82.4 % specificity).Conclusions Shear wave elastography is non - invasive reliable diagnostic method facilitating characterization of breast tumor.

العلاقة بين متلازمة الالم الليفي العضلي والبهاق : دراسة مقدمة الى كلية الطب - جامعة بغداد - قسم الامراض الباطنية == Relationship Between Fibromyalgia Syndrome and Vitiligo

Author name: علا سفير خضير
Supervisor name: عمار فيصل حميد
General topic: Medicine
Specific topic: Diseases - Joints
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Fibromyalgia syndrome (FMS) is a common, chronic, and highly disabling syndrome characterized with chronic widespread pain, fatigue, sleep disturbances, cognitive dysfunction and mood disorders. Vitiligo is an acquired pigment disorder which causes disfigurement to skin and negative effect on quality of life (QOL) for patients. There is no previous study on relationship between FMS and vitiligo.Objective : To assess relationship between FMS and vitiligo in a sample of Iraqi patients and to evaluate the predictors of this relationship if present.Patients and methods : A case controlled study involved 100 Iraqi patients with vitiligo and 200 healthy individuals matched for age and sex as a control group. The 2012 Canadian Guidelines criteria were used for the diagnosis of FMS and applied to all Vitiligo patients and controls included in the study. Baseline characteristics of patients with vitiligo and controls were recorded in form of : age, sex, employment condition, and marital status. Body mass index (BMI) was measured for both groups. Patients with vitiligo were fully assessed for : type, duration, severity of disease and medications used.Results : Prevalence of FMS in a sample of Iraqi patients with vitiligo was12% compared to 7% in controls (p=0.15, OR=1.81,95% CI=0.8 - 4.08). FMS symptoms in vitiligo patients were : fatigue 46%, diffuse body pain 34%, sleep disturbance 33%, cognitive dysfunction in 30%, mood disorders 23%, and visceral symptoms : central nervous system (CNS) 52%, skin 35%, gastrointestinal tract (GIT) 32%, cardiovascular system - respiratory system (CVS - RS) 16%, genitourinary tract(GUT) 8%, and ear nose throat (ENT) 7%).There was significant association between the FMS in vitiligo patients and : females with vitiligo 22.2% compared to none among males with vitiligo 0% (P

مشاهدات فحص الرنين المغناطيسي وتحديد دقتها بالاعتماد على ناظور الركبة في تشخيص اصابات الرباط الصليبي الامامي لمفصل الركبة == MRI FINDINGS VERSUS ARTHROSCOPY IN ANTERIOR CRUCIATE LIGAMENT TEAR INJURIES OF THE KNEE JOINT

Author name: لميس عبد الحسين عزيز
Supervisor name: ليث احمد خلف
General topic: Medicine
Specific topic: Diagnostic Radiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: فحص الرنين المغناطيسي لمفصل الركبه هومن الفحوص اليومية والمتكررة في قسم الاشعه .ان مفصل الركبة من المفاصل الكبيرة في الجسم ومع ذلك فان ثباته واستقراره يعتمد على مجموعه من الاربطه والعضلات لاسناده وخاصة الاربطه الصليبيه وتعد اصابات الرباط الصليبي الامامي اكثرها شيوعا خاصة في الحوادث الرياضية والتدريب العسكري وحوادث السيارات والدراجات النارية ومنها ما يترتب عليها من تعويضات مادية وقضائية.في الاونه الاخيرةان لفحص الرنين المغناطيسي دور متزايد في تشخيص امراض واصابات الجهاز العضلي الهيكلي نظرا لقدرته علي ابراز تباين الانسجة وتميزها عن بعضها وكونه خالي من مضار الاشعاع المؤين لذا فانه يشجعنا دراسة امكانيات استخدهمه في اصابات الرباط الصليبي الامامي. الهدف من الدراسة : لتحديد دقة فحص الرنين المغناطيسي في تشخيص اصابات الرباط الصليبي الامامي لمفصل الركبه بالاعتماد على ناظورالركبه التشخيصي والعلاجي .حيث ان اصابات اربطة الركبه تعتبر من الاصابات الشائعه التي توءثر على حياة ومماراسات المريض اليومية .لقد تم عمل هذه الدراسة خلال سنة 2014 - 2015 على 65 شخص متعرضين لاصابات في الركبه مع احتمال وجود تمزق في الرباط الصليبي الامامي تم فحصهم سريريا من قبل طبيب استشاري متخصص في امراض العضام والكسور بعد ذلك تم فحص الركبه باستخدام جهاز الرنين المغناطيسي في معهد الاشعة ثم تم التاءكد من نتيجة فحص الرنين باستخدام ناظورالركبه الذي يعتبر تشخيصا نهائيا وهو طريقة جراحية تتيح للطبيب المعالج مشاهدة ومعالجة الرباط الصليبي بشكل مباشر وباقل نسبة خطا ممكنه. الا ان الناظوريعد طريقة جراحية لها مخاطرها وغير سهلة للمرض مقارنة بالرنين المغناطيسي .وتم التوصل للاستنتاج التالي : لقد اظهرت الدراسة دقة عاليه لفحص الرنين المغناطيسي في تشخيص اصابات الرباط الصليبي الامامي (90.7 % ) وحساسية (91%) مما يمكن استخدامه كفحص اولي وبدقه عالية في اصابات اربطة الركبة ممه يغني عن دور التدخل الجراحي التشخيصي لناظور الركبة | Aim of the study : The study was done to analyze the validity of our MRI interpretation in the diagnosis of anterior cruciate ligament (ACL) tear injuries which is a common problem in many peoples impending their daily activities. Material and method : All patients presented to orthopedic consultation clinic with history of knee trauma and suspected anterior cruciate ligament tear injuries during 2014 - 2015 underwent knee joint MRI examination that followed by diagnostic and therapeutic arthroscopic knee surgery. The clinical diagnosis was confirmed during this procedure. From 65 patients MRI diagnose 58 patients as anterior cruciate ligament tears .The accuracy, sensitivity & specificity of MRI were calculated in correlation to arthroscopic finding. Results : our study showed high MRI accuracy (90.7%) , high sensitivity(91%) and specificity(100%) versus arthroscopy. Conclusion : Magnetic resonance imaging is an accurate non ionizing, multiplaner, non - invasive modality, it can be used as first line investigation in patient with soft tissue trauma to the knee & ligamentous injuries confidently that can replace diagnostic arthroscopy

طراز الامراض التنفسية في مستشفى الحسين التعليمي في مدينة السماوة == The Pattern of Respiratory Diseases in Al - Hussain Teaching Hospital in Samawa City

Author name: مثنى فيصل الظالمي
Supervisor name: عدنان الجبوري
General topic: Medicine
Specific topic: Diseases - Thoracic
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Respiratory diseases are responsible for a major burden of morbidity and untimely death, with conditions such as asthma, pneumonia, tuberculosis, and chronic obstructive pulmonary disease the most important in world health terms..Objective : to estimate the pattern and to determine the incidence of respiratory diseases among patients admitted to medical wards.Patients and Methods : A retrospective study carried out at AL Hussain Teaching hospital in Samawa city )ALMuthana governoret) during a period from October 2013 to July 2014. 951 patient of both genders were enrolled in this study.Results : The mean age of the studied patients was 49.4 ± 18.1 (range : 15 - 99) years; the higher proportion of patients 244/951 (25.7%) aged > 60 years and the least proportion of patients 75/951 (7.9%) aged < 20 year females were the dominant gender among the studied group; 510/951 (53.6%) and the remaining 441/951 patients (46.4%) were males, with a female to male ratio of 1.16 : 1, Smoker patients were 263/951 represented 27.7% of the studied group, Asthma was the more frequent respiratory disease among the studied group (33.3%) followed by Pneumonia in (22.4%),andChronic obstructive pulmonary disease in (22.1%) . The higher mortality rate was reported among the patients with lung cancer (33.3%), followed by ILD (12.5%) .Conclusion : female was the dominant gender among studied group. Asthma was the more prevalent respiratory disease followed by Pneumonia, .the longer duration of admission was reported in patients with lung abscess.The higher mortality rate was reported in patient with Lung cancer followed by Interstitial Lung Disease and Chronic Obstructive Pulmonary Disease.

تقييم الوضيفة الانقباضية للبطين الايسر باستخدام السرعة الانقباضيه للصمام الاكليلي الحلقي لتصوير دوبلر النسيجي في مرضى احتشاء عضله القلب الحاد لاول مره == Evaluation of LV systolic function by using tissue Doppler Pulsed - Wave systolic Mitral annular Velocities(Sm) imaging after first acute myocardial infarction

Author name: عباس عبد لفتة عباس
Supervisor name: علي ال ياسين
General topic: Medicine
Specific topic: Diseases - Heart
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: على الرغم من الاستخدام الشائع لطريقه سمسون في تقيم الوظيفة الانقباضيه للبطين الايسر في مرضى احتشاء العضله القلبيه الحاد لاول مره الا ان لهذه الطريقة محددات عده في تقيم وظيفة وتحديد اماكن الاحتشاء اضافه الى استغراق وقت اكثر في الفحص بينما تقيم الوضيفة الانقباضيه للبطين الايسر هولاء المرضى باستخدام تصوير دوبلر النسيجي لقياس السرعة الانقباضيه للصمام الاكليلي الحلقي يكون اسهل مما قد تحصل عليه بواسطه طريقة سمسون.منهاج البحث : - الدراسه من نوع الحاله - الضابطه اجريت على 60 مريض لديهم احتشاء عضله القلب الحاد لاول مره و30 شخص سليم من (شهر تموز 2013 - شهر تموز 2014) تم قياس السرعه الانقباضيه للصمام الحلقي الاكليلي mS كعامل متغير باستحدام تصوير دوبلر النسيجي لتقيم الوظيفه الانقباضيه للبطين الايسر واجري الفحص خلال فتره اليوم الاول الى اليوم الثالث بعد الدخول المرضى لوحده العنايه المركزيه للقلب في مستشفى بغداد التعليمي بالنسبه للمرضى بينما الاشخاص السليمين تم فحصهم بوحده فحص الايكو(الطابق الثامن) من المستشفى ذاتها.النتائج : - شكل الذكور 65% من المرضى الذين شملتهم الدراسه مع متوسط العمر(45.7 ± 4.1) . اظهرت الدراسه ان نسبه مرضى احتشاء عضلة القلب الحاد الامامي(41.75%) من كل المرضى ,بينما( 28.3%) من المرضى يعانون من احتشاء عضلة القلب الحاد السفلي و(18.3%) من المرضى يعانون من احتشاء عضلة القلب للجدار الوحشي بينما (11.7%) كانوا يعانون من احتشاء عضله القلب للجدار بين البطينين.واظهرت الدراسة ان وظيفة القلب الانقباضيه للبطين الايسر قد اختلت في (60.6%) من مرضى احتشاء عضله القلب الامامي و(24.2%) من مرضى احتشاء عضله القلب السفلي و(9.1%)من مرضى احتشاء عضله الجدار الوحشي للقلب و6.1% من مرضى احتشاء الجدار الفاصل بين البطينين للقلب.كما لوحظ انخفاظا واضح في السرعه الانقباضيه العليا للصمام الاكليلي الحلقي خصوصا عند موضع الاحتشاء مقارنه بالاشخاص السليمين وتكون فروق معنويه احصائيا p value) (<0.05 الاستنتاجات : - ذروه سرعه الصمام الحلقي الاكليلي كما قيمت بواسطه تصوير دوبلر النسيجي انخفضت وتعكس انخفاضا موضعيا وكليا في الوظيفة الانقباضيه للبطين الايسر في مرضى احتشاء عضلة القلب الحاد لاول مره .الوظيفة الانقباضيه للبطين الايسر كانت اكثر اختلالا في مرضى احتشاء عضله القلب الامامي والسفلي.الكلمات الدليليهاحتشاء عضلة القلب الحاد ,الوظيفة الانقباضيه للبطين الايسر ,تصوير دوبلر النسيجي. | Background : - Acute myocardial infarction (MI) may be associated with regional or global left ventricular dysfunction. Although the Simpson’s method is widely used for the global assessment of left ventricular Ejection Fraction (EF) in acute MI, it has limitations of regional LV assessment and time consuming nature while evaluation of left ventricle systolic function (globally and regionally) can be get by measuring mitral annular systolic velocity (Sm) using tissue Doppler imaging (TDI). Aim : - Evaluation of left ventricular systolic function using tissue Doppler Pulsed - Wave systolic Mitral annular Velocities(Sm) imaging and its relation to ejection fraction by Simpson’s method in first acute MI. . Patients and Method : A case control study, from July 2013 - July 2014 was carried out. Total of 60 patients having acute myocardial infarction and 30 normal healthy subjects underwent measuring of Sm at (anterior, inferior, lateral and septal mitral annular sites) by TDI echocardiographic examination and ejection fraction by Simpson’s method as parameters of assessment of left ventricular systolic function (LVSF) on day 1 - 3 after admission with treatment, in CCU of Baghdad hospital (patients) while normal persons evaluated in out clinic of same hospital. . . Results : Total study sample was 90 persons, 30 normal subjects and 60 patients having acute myocardial infarction (MI). The sample was divided into 4 groups, i.e. anterior MI, inferior MI, septal MI, and lateral MI. The patients were 39 men, 21 women and mean age was 53.03 ± 4.64 years SD. There was a marked reduction in peak systolic (Sm) velocity at mitral annulus, especially at the infarction sites (p < 0.001). There was significant positive linear correlation mean Sm and ejection fraction among patients with MI (r =0.787, P = <0.001). Conclusion : Tissue Doppler Imaging is a reliable, and easily reproducible modality of echocardiography. The reduced peak systolic velocity seems to be an expression of regionally reduced systolic functions. While the reduced mean systolic velocity from 4 mitral annulus sites are expressions of globally reduced systolic functions and were correlated well with the ejection fraction. The Left ventricular systolic function was more impaired in anterior and inferior myocardial infarction. Key words : - Acute myocardial infarction, left ventricular systolic function, tissue Doppler imaging.
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