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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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