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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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