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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

العلامات البيولوجية لسايتوم النواة الصغيرة الشدقي في عينة من المرضى العراقيين المصابين بداء الذئبة الحمامية المجموعية == Buccal Micronucleus Cytome Assay in Patients with Systemic Lupus Erythematosus

Author name: احمد خالد محمد
Supervisor name: زياد شفيق الراوي | 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: داء الذئبة الحمامية المجموعية هو مرض مجموعي منيع للذات مع تداخل عوامل وراثية وبيئية في عملية امراض الداء. عدة دراسات اكدت وجود تضرر في الدنا عند مرضى داء الذئبة الحمامية المجموعية.الهدف : لتقييم المورفولوجيا الخلوية والنووية لعينة من مرضى داء الذئبة الحمامية المجموعية من خلال المقايسة العددية للنواة الصغيرة الشدقية ولتقييم اثر خصائص المرضى على التغيرات النووية ان وجدت.المرضى والطرائق : شملت الدراسة 58 مريضا عراقيا مصابا بداء الذئبة الحمامية المجموعية و58 شخصا سويا كمجموعة ضبط متوافقة من حيث العمر والجنس.تم اخذ التاريخ المرضي الكامل واجراء الفحص السريري التام لكل افراد المجموعتين. ووثقت خصائص المرضى (العمر، والجنس، ومعيار كتلة الجسم، ومدة المرض، ومعامل مجموعة تقدير الذئبة للجزر البريطانية (بيلاج) لعام 2004، والتاريخ العائلي للامراض المنيعة للذات، والادوية المستعملة). تكون بروتوكول المقايسة العددية للنواة الصغيرة الشدقية من : جمع الخلايا من كلا الشدقين بواسطة ملوق خشبي وتحضير مباشر للشرائح مع تثبيت الخلايا بواسطة الكحول المطلق بواقع شريحتين لكل شخص. احتسبت 1000 خلية لكل شخص لتقدير تكرار النوى الصغيرة لديه. تم تلوين الخلايا بواسطة طريقة الفولغين - الثينوين المختصة بالدنا. تم التحري في الخلايا المفحوصة عن التشوهات النووية (النوى الصغيرة، والبراعم النووية، وازدواجية النواة، والخلايا القاعدية والمتخصصة، والكروماتين المكثف، والخلايا ممزقة النواة، والخلايا المتغلظة والخلايا حالة النواة).النتائج : اظهر مرضى الذئبة الحمامية المجموعية ارتفاعا واضحا في تكرار الخلايا ذات النوى الصغيرة (القيمة الاحتمالية اقل من 0.0001)، والبراعم النووية (القيمة الاحتمالية اقل من 0.0001)، وازدواج النواة (القيمة الاحتمالية اقل من 0.0001)، والخلايا القاعدية (القيمة الاحتمالية اقل من 0.0001)، والكروماتين المكثف (القيمة الاحتمالية اقل من 0.0001)، والخلايا ممزقة النواة (القيمة الاحتمالية اقل من 0.0001)، والخلايا المتغلظة (القيمة الاحتمالية=0.012)، والخلايا حالة النواة (القيمة الاحتمالية اقل من 0.0001) اكثر مما لدى مجموعة الضبط. لم يكن هناك تاثير معتد به للعمر او معياركتلة الجسم او مدة المرض او معامل مجموعة تقدير الذئبة للجزر البريطانية 2004 او الادوية المستعملة على عدد النوى الصغيرة ضمن مجموعات المرضى. كما اظهر البحث ان فحص المقايسة العددية للنواة الصغيرة الشدقية حساس ومعتد به في التحري عن داء الذئبة الحمامية المجموعية (القيمة الاحتمالية اقل من 0.01).الاستنتاج : مرضى الذئبة الحمامية المجموعية لديهم ارتفاع ذو اعتداد عال في الوسمات الحيوية لضرر الدنا وعيوب الحرائك الخلوية والكوامن التكاثرية والموت الخلوي بالمقارنة مع مجموعة الضبط. لا يوجد تاثير لخصائص المرضى على التشوهات النووية. فحص المقايسة العددية للنواة الصغيرة الشدقية هو طريقة حساسة وغير باضعة وبسيطة جدا يمكن استعمالها في التحري عن داء الذئبة الحمامية المجموعية | Systemic lupus erythematous (SLE) is a systemic autoimmune disease with both genetic and environmental factors implicated in disease pathogenesis. Several studies have addressed the presence of deoxynuclic acid (DNA) damage in SLE patients.ObjectivesTo assess cellular and nuclear morphology in a sample of SLE patients by buccal micronucleus cytome assay and to evaluate effect of patients' disease characteristics on nuclear abnormalities if present.Patients and methodsFifty eight Iraqi SLE patients and 58 healthy controls matched in age and sex were included in this study. Full history was taken and complete physical examination was done for individuals in both groups. Patients' baseline characteristics [Age, sex, body mass index (BMI), disease duration, British Isles Lupus Assessment Group (BILAG) 2004 score, family history of autoimmune diseases, and medications used] were recorded. The buccal micronucleus cytome assay protocol consisted of : cell collection from both cheeks with a wooden spatula; direct slide preparation and fixation with absolute alcohol. Two slides were prepared for every subject and 1000 cells were evaluated per subject to determine the micronucleus (MN) frequencies. Slides were stained with the DNA - specific Feulgen - thionin method. Cells were screened for nuclear abnormalities : micronuclei, nuclear buds, binucleation, basal and differentiated cells, condensed chromatin, karyorrhectic cells, pyknotic cells, and karyolytic cells.ResultsPatients with SLE showed significantly higher frequencies of micronuclei (p<0.0001), nuclear buds (p<0.0001), binucleated cells (p<0.0001), basal cells (p<0.0001), cells with condensed chromatin (p<0.0001), karyorrhectic cells (p<0.0001), pyknotic (p<0.012) and karyolytic cells (p<0.0001) than the control group. Patient's age, BMI, SLE disease duration, BILAG2004 score, and drugs used had no significant effect on micronucleus groups (p>0.05). Buccal micronucleus cytome was significant and sensitive method for SLE screening (p<0.01).ConclusionsSLE patients had a highly significant increase in the biomarkers of DNA damage, cytokinetic defects, proliferative potential, and cell death compared to controls. No significant effect of patients' baseline characteristics on nuclear abnormality. Buccal micronucleus cytome was a sensitive, non - invasive, and very simple method that can be used for SLE screening.

تقييم وظيفة اليدين لدى عينة من المرضى العراقيين المصابين بالتهاب المفاصل الروماتويدي == Assessment of Hand Function in a Sample of Iraqi Patients with Rheumatoid Arthritis

Author name: محمد صاحب حسن
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: التهاب المفاصل الروماتويدي هو احد الامراض المنيعة للذات المجموعية المزمنة التي تؤثر على الغشاء الزليلي للمفاصل وكذلك الاجهزة والاعضاء الاخرى. يؤثر هذا المرض عادة على مفاصل اليدين والقدمين الصغيرة ويؤدي الى ضرر للمفاصل متعذر العكس مع التشوه والاعتلال الوظيفي.وظيفة اليدين تشكل ميدانا هاما من الحالة الصحية لمرضى التهاب المفاصل الروماتويدي واحد المحددات الرئيسة لنوعية حياتهم. لذلك فان تقييم وظيفة اليد هو جزء اساسي في متابعة مرضى التهاب المفاصل الروماتويدي وقياس استجابتهم للعلاج.وقد وضعت العديد من المقاييس لتقييم وظيفة اليد. هذه المقاييس هي اما استبيانات تقرير ذاتي، او اختبارات قائمة على الاداء، او مزيج من الاثنين معا. لكل مقياس منها نقاط قوة ونقاط ضعف. احد المقاييس المقبولة على نطاق واسع، والمذكور في كتاب منهجي شائع، يشمل اختبارات سريرية بسيطة لتقييم وظيفة اليد : قبضة المفتاح، مسكة الكرة، مسكة القلم، قوة القرص، وقوة القبضة.الاهدافتهدف هذه الدراسة الى تحديد العوامل التي تؤثر على وظيفة اليدين في عينة من المرضى العراقيين المصابين بالتهاب المفاصل الروماتويدي، وتقييم ترابط اختبارات وظيفة اليد السريرية مع بعضها البعض في نفس العينة.المرضى والطرائقتم اجراء دراسة مقطعية على 116 مريضا عراقيا مصابا بالتهاب المفاصل الروماتويدي، تم اختيار المرضى عشوائيا، جميعهم استوفوا معايير الكلية الامريكية لامراض المفاصل لتصنيف التهاب المفاصل الروماتويدي لعام 1987 المعدلة، ومعايير الكلية الامريكية لامراض المفاصل / الرابطة لاوروبية ضد الروماتيزم لتصنيف التهاب المفاصل الروماتويدي لعام 2010. تم استبعاد المرضى الذين يعانون من امراض وحالات اخرى التي قد تؤثر على وظيفة اليد.تم تقييم المرضى وجمع المعلومات التالية : العمر، سيادة اليد، محيط الساعدين، مدة المرض، مدة التيبس الصباحي، العلاج الحالي، تشوهات اليدين، درجة فعالية المرض (DAS28)، العامل الروماتويدي (RF)، ومرحلة ستاينبروكر (Steinbrocker) لتقدم المرض اعتمادا على التصوير الشعاعي. تم احتساب درجة تشوه اليدين لجمع كل تشوهات اليدين في قيمة واحدة.تم تقييم وظيفة اليدين من خلال ثلاثة اختبارات شخصانية (قبضة المفتاح، مسكة القلم ومسكة الكرة) واختبارين موضوعيين (قوة القرص وقوة القبضة، مقاستان باجهزة قياس متخصصة).اجري التحليل الاحصائي باستخدام برامج الكمبيوتر المتخصصة.النتائجاظهرت الدراسة ان لاختبارات وضائف اليد الموضوعية (معدل قوة القبضة ومعدل قوة القرص) ترابطا عكسيا معتدا معتدل القوة مع درجة تشوه اليدين (r= - 0.459 , p<0.001 او افضل) ودرجة فعالية المرض (DAS28) (, p<0.001 r= - 0.572او افضل) ، وترابطا عكسيا معتدا ضعيفا مع مدة المرض (, p<0.001 r= - 0.248او افضل) ومدة التيبس الصباحي (, p<0.001 r= - 0.312او افضل) ومرحلة ستاينبروكر لتقدم المرض شعاعيا (p<0.001 r= - 0.36 ,او افضل)، وترابطا طرديا معتدا ضعيفا مع محيط الساعدين (p<0.001 r= - 0.312 ,او افضل).كما اظهرت الدراسة ان اختبارات وضائف اليد الموضوعية تتحسن كلما طالت فترة تعاطي العقار البيولوجي اتانرسبت (Etanercept) في المرضى الذين يستخدمون هذا العلاج، الا ان هذا الترابط لم يكن معتدا به احصائيا عند احتساب جميع المرضى في عينة الدراسة.واظهرت الدراسة ان لمتوسط رتبة الاعاقة في اختبارات وضائف اليد الشخصانية ترابطا طرديا معتدا ضعيفا مع درجة تشوه اليدين (p=0.002 او اقل،r=0.283 او اكثر)، ودرجة فعالية المرض (DAS28) (p=0.013 او اقل،r=0.296 او اكثر)، ومدة التيبس الصباحي (p=0.015 او اقل،r=0.226 او اكثر)، ومدة العلاج بعقار الاتانرسبت (Etanercept) (p=0.046 او اقل،r=0.186 او اكثر).لم يكن لاختبارات وضائف اليد الشخصانية ترابط معتد به مع عمر المريض، مدة المرض، ومرحلة ستاينبروكر لتقدم المرض شعاعيا. كما لم يكن هناك فرق معتد به في اختبارات وضائف اليد الموضوعية والشخصانية بين اليد السائدة وغير السائدة، وبين المرضى ذوي نتيجة ايجابية للعامل الروماتويدي وذوي النتيجة السلبية.و اظهر البحث ان لجميع اختبارات وضائف اليد ترابطا معتدا به مع بعضها البعض (p<0.001 ،r=0.334 او افضل) وخصوصا ترابط قوة القبضة مع قوة القرص اذ كان الاقوى (p<0.001 ، r=0.788 ). | Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease affecting the synovium of joints as well as other organs. It commonly affects the small joints of the hands and feet, and results in irreversible joint damage, deformity, and functional impairment. Hand function is an important domain of the health status of RA patients and a key determinant of their quality of life. Assessment of hand function, therefore, is an essential part in the follow - up of RA patients and in gauging their response to treatment.Numerous measures were developed to evaluate the hand function. These measures are either self - report questionnaires, performance - based tests, or combinations of both. Each measure has its own strengths and weaknesses. One widely accepted measure, suggested by a popular textbook, includes simple clinical tests to assess hand function : Key grip, ball grasp, pen grasp, pinch grip and grip strength.ObjectivesThis study aims to determine the factors affecting the hand function in a sample of Iraqi patients with rheumatoid arthritis, and to evaluate the correlation between the clinical tests of hand function in the same sample.Patients and methodsA cross - sectional study was conducted on 116 randomly selected Iraqi patients with rheumatoid arthritis fulfilling the 1987 Revised ACR Criteria for Classification of Rheumatoid Arthritis and the 2010 ACR / EULAR criteria for rheumatoid arthritis. Patients with other conditions that can affect the hand function were excluded.Patients were evaluated for age, hand dominance, forearm circumference, duration of illness, duration of morning stiffness, current treatment, fixed hand deformities, DAS28, RF seropositivity and Steinbrocker’s radiographic progression stage. A novel score was used to combine all hand deformities into one value.Hand function was assessed by three subjective tests (key grip, pen grasp and ball grasp) and two objective tests (pinch strength and grip strength, measured by specialized dynamometers).Statistical analysis was conducted using SPSS 20 and Excel 2013 computer software.ResultsObjective hand function tests (mean grip strength and mean pinch strength) had a significant moderate negative correlation with the score of hand deformities (p<0.001, r= - 0.459 or better) and DAS28 (p<0.001, r= - 0.572 or better), and a significant weak negative correlation with disease duration (p<0.001, r= - 0.248 or better), duration of morning stiffness (p<0.001, r= - 0.312 or better) and Steinbrocker’s radiographic progression stage (p<0.001, r= - 0.36 or better), and a significant weak positive correlation with forearm circumference (p<0.001, r=0.344 or better).Objective hand function parameters seemed to improve with the duration of Etanercept therapy among patients using Etanercept, although this correlation was not statistically significant for the whole study sample.The mean ranks of impairment of subjective hand function tests showed a significant weak positive correlation with the score of hand deformities (p=0.002 or less, r=0.283 or more), DAS28 (p=0.013 or less, r=0.296 or more), duration of morning stiffness (p=0.015 or less, r=0.226 or more) and duration of Etanercept therapy (p=0.046 or less, r=0.186 or more). The mean ranks of impairment of subjective hand function tests showed mostly no significant correlation with age, disease duration and Steinbrocker’s radiographic progression stage. There was no significant difference in both objective and subjective hand function parameters between the dominant and non - dominant hand and between RF positive and RF negative patients.All five hand function tests showed a significant correlation with each other (p<0.001, r= - 0.334 or better) with the strongest correlation being between pinch strength and grip strength (p<0.001, r=0.788).

علاقة مستوى فيتامين د وهورمون النحافه مع مرض فصال الركبه الاولي في مجموعه من النساء العراقيات == ASSOCIATION OF VITAMIN )D( AND SERUM LEPTIN LEVELS WITH KNEE OSTEOARTHRITIS IN A SAMPLE OF IRAQI FEMALES

Author name: زهراء عبد الله
Supervisor name: سامي سلمان شهاب
General topic: Medicine
Specific topic: Diseases - Joints
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine - Internal Medicine Department
Language: English
University location: Baghdad
First pages:
Abstract: Osteoarthritis (OA) is a biomechanical process whereby joints respond pathologically mechanical stress, resulting in cartilage degradation and changes in subchondral bone. It has many risk factors as known female gender, obesity, and aging. Vitamin D may exert its effect on OA through bone; its deficiency could impair the ability of bone to respond optimally to insults. Leptin is a peptide hormone secreted by adipocytes and plays an important role in regulation of body weight, its level more in obese subjects and female gender regardless of obesity, so it may play a metabolic link between obesity and osteoarthritis. So both vitamin deficiency and increase leptin level may be risk factors for osteoarthritis Objective : To examine the cross - sectional association of vitamin D and serum leptin levels in a sample of Iraqi female with knee osteoarthritis.Method : A total of 180 women divided into 2 groups 90 subjects the first group for vitamin D levels and 90 subjects the second group for serum leptin levels and each group further classified into patients and equal number of their matched healthy controls in age and sex.In each group osteoarthritis was diagnosed according to ACR criteria for osteoarthritis and their body mass index (BMI) classified according to WHO classification of BMI into 3 groups : normal weight, overweight, obese Radiological grading done according to kellegren and Laurence radiological classification for osteoarthritis. Both vitamin D and leptin levels were assessed using ELIZA method.The first group (vitamin D and osteoarthritis) mean vitamin D levels in cases (45cases) were (0.309_+0.641) compared to (0.2614_+0.386) in controls. So vitamin D deficiency is prevalent among cases and controls and its level was inversely associated with body mass index, the deficiency was more severe among female in obese and overweight than normal weight.Associations of vitamin D levels with radiological grading, cases with grade ||| and |\/ are more deficiency than grade ||.The second group (serum leptin level and osteoarthritis), leptin was significantly higher in cases compared to controls, the mean serum leptin was (52.41_+28.26) and (40.39_+ 25.67) respectively. Its level directly correlated with body mass index, higher levels in obese and overweight than normal weight subjects, the difference was significant among both cases and controls.Association of leptin levels with radiological grading, the mean serum leptin was higher in cases with grade ||| , |\/ than grade ||.Conclusion : Vitamin D deficiency was prevalent among middle age Iraqi women, so it is difficult to establish a clear association between vitamin D deficiency and osteoarthritis in this study, and the deficiency was more in women with higher body mass index.Serum leptin level was higher in osteoarthritis women than their matched controls, and its level directly associated with increased in body mass index

تقييم كثافة العظام لدى مرضى المصابين بالانسداد الرئوي المزمن

Author name: سجا محمد كاظم
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:

نوعية الحياة لمرضى الفشل الكلوي المرحلة النهائية الذين يخضعون لغسل الكلى، بغداد، العراق 2017 == Quality of Life of End Stage Renal Disease Patients Undergoing Hemodialysis, Baghdad, Iraq, 2017

Author name: هند وليد خضر
Supervisor name: عدنان عبد العظيم | 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 : The quality of life is an important predictor of outcome in end stage renal disease patients. The quality of life needs to be regularly assessed. Our study describes quality of life, as well as demographic and clinical variables associated with quality of life in chronic haemodialysis patients in Baghdad, Iraq, 2017.Method : This was a descriptive cross sectional study conducted from March to May, 2017 at dialysis unit in Baghdad and Al - Karama teaching hospitals. The study participants were all patients available during data collecting period included. The participants were directly interviewed according to a special questionnaire designed for the purpose of the study; it contains items exploring socio - demographic data, clinical data. Data regarding assessment of effect of kidney disease on quality of life were collected by kidney disease quality of life - short form 1.3 versions .The maximum score of the total quality of life was 100 points. The score had been categorized as excellent > 80 score, good (61 - 80) score, moderate (40 - 60) score, and the poor score (< 40).Results The total number of participants was 248 patients. The mean of quality of life was 47.63±16.22. The total score was excellent in12 participants (4.8%), good in 47 (19%), moderate in 99 (39.9%), and poor in 90 participants (36.3%). The highest mean of quality of life domains was found for social support subscale, the low scores was reported for work status, role limitation due to physical problem, role limitation due to emotional problem, general health, and sexual function.Conclusions : The study had shown that the quality of life of hemodialysis patients was highly impaired and it clearly defines how the disease state adversely affects the physical and mental status of the patient. Regular and systematic monitoring for dialysis patients’quality of life must be considered as an effective tool of quality control in dialysis care

اضطرابات الغدة الدرقية في مرضى الذئبة الحمامي المجموعي

Author name: هند عدنان محمد
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: Thyroid hormone abnormalities had been shown to be more frequent in patients with systemic lupus erythematosus (SLE), hence, performance of thyroid function tests in patients with SLE, as a part of the biochemical and immunological profiles, may help in early detection of associated thyroid disorders.Aim of the Study : To assess the thyroid hormone abnormalities in a group of systemic lupus erythematosus Iraqi patients.Patients and Methods : A case - control study was conducted at Baghdad Teaching hospital, Department of Rheumatology during the period from September 2016 to July 2017. Including 58 SLE patients and 60 controls who met the inclusion criteria. After ethical approval, data were collected using a preconstructed data collection sheet, questionnaire included demographic and clinical data of the patients and controls. Thyroid function tests, complete blood count, ESR, anti - double - strand DNA and complement C3 and C4 test were performed. Statistical analysis was done using the statistical package for social sciences (SPSS) v.24.Results : The mean age of the studied groups was 28.26 ± 7.1 years and 29.18 ± 6.3 years in SLE and control groups, respectively. No statistically significant differences between both groups had been found in age, BMI, or other demographic variables (P>0.05). Abnormal thyroid function was significantly more frequent in SLE patients (25.9%) than controls (5%), (P< 0.05). Primary hypothyroidism and Subclinical hypothyroidism were the more frequent disorder in SLE patients; 6/15 nd 5/15, respectively, each of subclinical hyperthyroidism and primary hyperthyroidism was reported in 2/15 SLE patients. Prednisolone and Hydroxychloroquine were the more frequently used medications among the SLE patients and were insignificantly associated with abnormal thyroid function in SLE patients, (P>0.05). High ESR was reported,, Leucopenia , high Anti dsDNA , low C3 and low C4 and Lymphopenia were reported in SLE patients. While all of SLE patients were ANA +ve and none of them had thrombocytopenia.Conclusions : Thyroid dysfunction was more frequent in SLE Iraqi patients compared to healthy population and the primary hypothyroidism and subclinical hypothyroidism were the more frequent types.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

العلاقة مابين بعض العلامات الحيوية القلبية الحديثة مع درجة التكلس والتصلب في الشرايين التاجية المقاسة : متابعة علاجية بالستاتين == Association of Some Novel Biochemical Markers with Coronary Artery Calcium Score and Stenosis : Follow Up treatment with Statin

Author name: نور نصير نافع
Supervisor name: باسل عويد محمد صالح | صباح موسى فاضل
General topic: Medicine
Specific topic: Clinical Biochemistry
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: يعد مفراس شرايين القلب القسطاري من احدث الطرق لتشخيص امراض الشرايين التاجية من خلال التصوير المقطعي (CCTA ) للاوعية الدمويه التاجية، والذي يعد من احدث الطرق التي تطورت بشكل ملحوظ خلال العقد الماضي من خلال تلوين الشرايين التاجية بدون تدخل جراحي لتشخيص المرض وبدقة عالية تتناسب درجة مقياس التصلب (Ca - Score) مع شدة التصلب الشرايين التاجية ويحدد درجة تطور المرض فى المراحل الاولى، ويعد الفتيون اي (Fetuin - A) من احدى العوامل السلبية الحادة المتفاعلة الذي لايزال غير معروف من الناحية الوظيفية الفسلجية، وهنالك العديد من الدلائل والدراسات التي توضح دوره المهم في عملية تكلس الاوعية الدموية الاوستيونكتين (Osteonectin) هو بروتين سكري لاصق ويعتبر عامل نضير صماوي تم تشخيصه حديثا من خلال انعكاس دوره في الحالة المرضية للانسجة الدهنية ، مثل اعادة تجدد الاوعية الدموية. ويعد الفسفاتين (Visfatin) نوع من انواع الاديبوسايتوكينات المتعدد الاوجه والذي يلعب دورا مهما في العمليات الايضية من خلال الجزء الخارجي من تركيبه وكذلك دوره في مختلف الاثار الضارة على الاوعية الدموية من خلال الالتهاب والانتشار . وقد برز حديثا دور البنتراكسين 3 (Pentraxin 3) كعلامة جديدة يعتقد انها اكثر تحديدا في التهاب الاوعية الدموية من البروتينات الاخرى في عائلة البنتراكسين مثل ارتفاع البروتين سي الحاد التفاعلي (hs - CRP).الهدفلدراسة العلاقة مابين العلامات الحيوية القلبية الحديثة الفتيون اي والاوستيونكتين والفسفاتين والبنتراكسين 3 والبروتين سي الحاد التفاعلي(hs - CRP)(Pentraxin 3)(Visfatin)(Osteonectin)(Fetuin - A) في المرضى الذين يشتبه باصابتهم بامراض شرايين القلب التاجية الذين لديهم درجه خفيفة الى متوسطة من تكلس الشرايين التاجية ، ثم مقارنة النتائج مع المرضى للذين يشتبه باصابتهم بامراض شرايين القلب التاجية الذين لايعانون من وجود تصلب في الشرايين التاجية وايضا لدراسة دور هذه العلامات الحيوية الحديثة مع درجة التكلس (Ca - Score) ودرجة السمنة (BMI) ومستويات الدهون في الدم المتمثلة بقياس (Cholesterol,HDL,TG) ثم دراسة تاثير علاج الدهون الـ (Statin, atorvastatin 10 - 40 mg ) على مستوى كل من (العلامات الحيويه القلبية الحديثة ومستوى الدهون ) في المرضى المصابين بامراض تصلب شرايين القلب التاجية الذين يعانون من درجة تكلس خفيفة الى متوسطة ( Ca - Score =1 - 399 Agtaston score) .المواضيع اجريت هذه الدراسة في فرع الكيمياء الحياتية في كلية الطب - جامعة بغداد في المختبرات التخصصية لمستشفى ابن البيطار التخصصي لامراض القلب والشرايين خلال الفترة الممتدة من شباط 2013 الى كانون الاول 2013 من خلال تضمين 200 مريض مصاب بامراض تصلب شرايين القلب التاجية ثم ادراج 65 من المرضى المصابين بامراض تصلب شرايين القلب التاجية الذين لايعانون من وجود تصلب في الشرايين التاجية ولا يستخدمون علاج لدهون (Statin, atorvastatin 10 - 40 mg ) تم تشخيص شدة التكلس بالشرايين التاجية من خلال قياس درجة التكلس من خلال جهاز فليبس للانظمة الطبية 64 بريليناس . ثم تقسيم المرضى الى 65 مريضا وعلى ثلاثة اقسام بحسب درجة التكلس لديهم والى ثلاثة مجاميع : المجموعة الاولى تضمنت 20 مريض لديهم درجة تكلس تساوي صفر وتتراوح اعمارهم مابين (31 - 65) سنة، والمجموعة الثانية ذو درجة تكلس خفيفة الى متوسطة ( Ca - Score1 - 399) تتضمن (25) مريض وتتراوح اعمارهم مابين (47 - 74)سنة، والمجموعة الثالثة ذو درجة تصلب شديدة ( Ca - Score ≥400) وتراوح اعمارهم مابين (49 - 75) سنة. تم متابع تاثير علاج الدهون (Statin, atorvastatin 10 - 40 mg ) على مستوى العلامات الحيوية القلبية الحديثة ومستوى الدهون لدى(20) مريض من اصل (25) من المجموعة الثانية تحت اشراف الطبيب الاختصاص في امراض القلب (د.صباح موسى فاضل).النتائجكشفت نتائج هذه الدراسة انخفاض كبيرذو دلالة احصائية في مستويات تركيز كل من : (الاستيونكتين والفسفاتين) مقرون بارتفاع ملحوظ ذو دلادلة احصائية في مستوى تركيز فيتيون اي فضلا عن الارتفاع غير الملحوظ احصائيا في مستوى كل من (البنتراكسين والبروتين سي الحاد التفاعلي) في المرضى المصابين بامراض تصلب الشرايين التاجية المجموعة الثانية والثالثة ذو درجة تكلس الخفيفة الى شديدة مقارنة بالمرضى المصابين بامراض شرايين القلب التاجية الذين لايعانون من وجود تصلب في الشرايين التاجية.وقد اظهرت هذه الدراسة وجود ارتباط سلبي ذو دلالة احصائية لدى المرضى المصابين بامراض شرايين القلب التاجية الذين لايعانون من وجود تصلب في الشرايين التاجية بين الفسفاتين والبنتراكسين3 بينما لوحظ وجود ارتباط سلبي ذولالة احصائية بين الفسفاتين والاوستيونكتين في المرضى بامراض تصلب الشرايين التاجية المجموعة الثانية ذو درجة تكلس الخفيفة الى المتوسطة ولوحظ ايضا وجود ارتباط سلبي ذو دلالة احصائية مابين البنتراكسين والمقياس درجة السمنة من جهة في المرضى المصابين بامراض شرايين القلب التاجية الذين لايعانون من وجود تصلب في الشرايين التاجية مع وجود ارتباط ايجابي ذولالة احصائية مابين البنتراكسين 3 والبروتين سي الحاد التفاعلي لدى المرضى المصابين بامراض شرايين القلب التاجية الذين لايعانون من وجود تصلب في الشرايين التاجية مقارنة بالمرضى المصابين بامراض تصلب الشرايين التاجية المجموعة الثانية والثالثة ذو درجة تكلس خفيفة الى شديدة .وكذلك اظهرت هذه الدراسة ايضا وجود ارتباط سلبي ذو دلالة احصائية مابين الاوستيونكتين والكلوكوز لدى المرضى المصابين بامراض تصلب الشرايين التاجية للمجموعة الثالثة ذو درجة تكلس شديدة بينما وجد ارتباط سلبي ذو دلالة احصائية مابين الفتيون اي ومقياس درجة السمنة من جهة ومابين الفتيون اي ومستوى الكلوكوز من جهة اخرى لدى المرضى المصابين بامراض تصلب الشرايين التاجية ذو درجة تكلس خفيفة الى شديدة فضلا عن وجود ارتباط ايجابي ذو دلالة احصائية مابين البروتين سي الحاد التفاعلي ونسبة مستوى الكلكوز التراكمي بالدم مقارنتا بوجود ارتباط ايجابي ذو دلالة احصائية مع الكلسترول المفيد في الدم في المرضى المصابين بامراض شرايين القلب التاجية الذين لايعانون من وجود تصلب في الشرايين التاجية بينما لوحظ وجود ارتفاع ملحوظ في كل من ( قيمة نسبة مستوى الكلكوز التراكمي ومستوى الدهون الثلاثية) ومستوى كل من ( (non - HDL ,AIفي المرضى المصابين بامراض تصلب الشرايين التاجية المجموعة الثانية ذو درجة تكلس خفيفة الى شديدةو المجموعة الثالثة ذو درجة تكلس شديدة مقارنة بالمرضى المصابين بامراض شرايين القلب التاجية الذين لايعانون من وجود تصلب في الشرايين التاجية. وقد ظهرت هذه الدراسة دور علاج الدهون في انخفاض مستوى كل من الفتيون اي والبنتراكسين3 وزيادة مستوى الدهون المفيد للمرضى المصابين بامراض تصلب الشرايين التاجية المجموعة الثانية ذو درجة تكلس خفيفة الى المتوسطة بعد متابعتهم لمدة تتراوح مابين (6 - 8) شهور. ولوحظ وجود علاقة طردية مابين هذه العلامات القلبية الحيوية الحديثة مع( درجة التصلب وعدد الاوعية القلبية التي حدث فيها التصلب )مع وجود ارتباط مابين درجة التكلس المقاسة من خلال جهاز المفراس مع نسبة التصلب .الاستنتاجنظرا لكون درجة تكلس الشريان التاجي ذو علامة بديلة متزامنة مع امراض تصلب الشرايين التاجية لوحظ تزامن حدوثها مع ارتفاع مستوى الفتيون اي مقارنتا بانخفاض مستوى كل من الاوستيونكتين والفسفاتين مما جعلني اقترح دور هذه العلامات الحيووية القلبية الحديثة في تطور الناحية المرضية المسببة لتصلب الشرايين التاجية على الرغم من ارتفاع مستوى كل من البنتراكسين 3 والحاسة البروتين سي التفاعلي والتي تعكس الدور المهم للالتهاب كعامل اولي وسيط لتقدم المرض. ثم لوحظ دور علاج الدهون بخفض مستوى كل من الفتيون اي وتابنتراكسين 3من خلال (Pleotropic effect ) خلال فترة متابعة (20) من اصل( 25) من المرضى المصابين بامراض تصلب الشرايين القلبية التاجية ذو درجة تكلس خفيفة الى متوسطة لمدة (6 - 8) اشهر. | Coronary Computed Tomography Angiography (CCTA) is a rapidly growing, noninvasive imaging modality that developed quickly over the last decade, and its role for evaluation of Coronary Artery Disease (CAD ) becomes of great promise with high diagnostic accuracy. The presence and extent of Coronary Artery Calcification (CAC) correlates with the overall magnitude of coronary atherosclerotic plaque burden and with the development of subsequent coronary events. Human Fetuin A, is negative acute - phase reactant, its major physiologic functions are not fully understood. Several lines of evidence have suggested that it may play an important role in blood vessel calcification. Osteonectin is an adhesive glycoprotein; it is a newly identified autocrine/paracrine factor that could affect key functions in adipose tissue physiology and pathology through its implication in pathological condition of adipose tissue such as vascular remodelling. Visfatin is an multifaceted adipocytokine, It’s circulating levels are enhanced in different metabolic disease; extracellular part can exert various deleterious effects on vascular cells, including inflammation and proliferation. The Pentraxin - 3 (PTX3) has emerged as a novel marker thought to be more specific to vascular inflammation than other proteins in the PTX3 family such as high sensitive C - reactive protein (hs - CRP). Objective To study the relationship between novel cardiac biomarkers; Fetuin - A, osteonectin , visfatin, PTX3 and hs - CRP in patients with suspected CAD who have mild to severe degree of coronary artery calcification, Ca - Sore (1 - ≥400 ASU),then compare the results to patients with suspected CAD without calcification (Ca - Sore =zero ASU)and to explain the important role of these novel biomarkers in development of CAC , also to the study association of Coronary calcium score and novel biomarkers with obesity markers(BMI), and parameters of dyslipedemia(LDL - cholesterol,HDL - cholesterol).Finally, to demonstrat the effect of statin therapy (Atorvastatin 10 - 40 mg) on both novel biomarker and parameters of hyperlipidemia in patients with mild - to moderate degree of calcification with Ca - Score (1 - 399 )ASU.Subjects This study was conducted at the Department of physiol Biochemistry, College of Medicine, University of Baghdad and at the Cardiologic Clinics of Ibn - Al - Bitar Hospital, Baghdad, Iraq, during the period from February 2013 to November 2013. A total of 200 subjects with suspected Coronary Artery Disease (CAD) were encountered, 65 of them not on statin derivatives treatment were included in this study. These patients were investigated firstly for coronary artery calcium by using Multi - Slice Computed Tomography Scanner (Brilliance 64, Philips Medical Systems). The included 65 patients were classified according to their obtained values of coronary artery Ca score into three groups : Group I (GI) included 20 subjects who have coronary artery Ca score=0.0 Agatston Score unit (ASU), aged range (31 - 65 year) and considered as control group, Group II (GII) involved 25 patients with coronary artery Ca score of more than 1 - 399 ASU, aged range (47 - 74 year) and Group III (GIII) included 20 patients who have coronary artery Ca score of more than 400 ASU, aged range (49 - 75 year).Twenty patients of GII were followed after putting them on atorovastatin therapy (10 - 40 mg/day) for 6 - 8 months under supervision of the Consultant Cardiologist. Investigations included serum measurements of Fetuin A, Osteonectin, Visfatin, PTX3 and hs - CRP by using enzyme immunosorbent assay (ELISA) technique. HbA1c, fasting serum glucose and lipid profile parameters were also measured by using spectrophotometric methods. All investigations were performed in patients of the three groups (GI, GII and GIII) and also in patients post statin treatment. Results The results of this study revealed significant reduction in serum levels of visfatin (P=0.005) and osteonectin (P=0.0001) with significant increased of fetuin A in GIII compared with GI. In GII, serum level of osteonectin was significantly decreased, while Fetuin A significantly increased in comparison with those of GI(for both, P=0.0001). There was no significant differences between GII and GIII in the these three parameters.With regard to the changes in serum concentrations of pentraxin III and hs - CRP, the results found that both of these biochemical markers did not differ significantly among the three groups (GI, GII, and GIII).This study also showed that there was significant negative correlation between visfatin and pentraxin III in G I (r= - 0.495, P=0.027), while in GII, significant negative correlation was observed between visfatin and osteonectin (r= - 0.546, P=0.005). Pentraxin III also showed significant negative correlation with BMI in GI (r= - 0.528, P=0.017), significant positive correlation with BMI in GII (r=0.406, P=0.044) and significant positive correlation with with hs - CRP (r=0.482, P=0.031) in G I. In GIII, pentraxin III showed significant negative correlation with ostonectin (r= - 0.489, P=0.029). There is significant negative correlation of osteonectin with glucose in GIII (r=0.566, P=0.009) , In GII and GIII, Fetuin A showed significant negative correlation with BMI values (r= - 0.424, P=0.035)and with serum glucose (r= - .444, P=0.049) . Respectively in G I, hs - CRP concentration was found to be significantly positively correlated with HbA1c (r= - 0.509, P=0.022).The mean value of HbA1c was found to be significantly increased in GIII compared with GI (P=0.03). The serum level of TG was significantly increased in GIII and GII in comparison to G I (p= 0.019).The mean value of serum HDL - C levels of GIII was significantly decreased in comparison with that of GI (P=0.044). The serum level of VLDL is significantly decreased in both GI and GII compared to G III (P=0. 019.The mean value of non - HDL was significantly higher in GIII than in GII and that of GI (P=0. 0289), The mean values of atherogenic index of GIII and GII were significantly higher than in GI along with significant differences between that of GI and that of GII and III(P =0.0008).The present study showed the effect of complete course of statin treatment on the serum levels of novel cardiac biomarkers, the most effected one was serum PTX3 with significant decrease of its serum levels after treatment compared to that before treatment of the same patients group (P=0.0001) combined with significant decrease in serum level of Fetuin A (p=0.027) after complete course of statin treatment. In addition, there was significant increased of serum of HDL in patients after complete course of treatment compared to their concentration before starting treatment (P= 0.0001). Significant correlations were also observed between the novel studied biochemical markers and the degree and number of the major coronary arteries stenosis as well as between Ca score and stenosis.

تقييم كفاءة بطانة الاوعية الدموية باستخدام الفحوصات == ASSESSMENT OF ENDOTHELIAL FUNCTION BY NON INVASIVE INVESTIGATIONS IN CORONARY ARTERY DISEASE

Author name: صبا فوزي صالح
Supervisor name: نجيب حسن محمد | عباس ناجي مسلم
General topic: Medicine
Specific topic: Physiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Arterial endothelial dysfunction is one of the key early events in atherogenesis, even preceding the structural atherosclerotic changes that might developed in systemic arteries. However, endothelial function can be assessed through flow mediated dilatation of brachial artery using an ultrasound - based method (Doppler) before and after the shear stress test which causes endothelium - dependent dilatation induced by endothelial Nitric Oxide release.Thus, flow mediated dilatation of brachial artery; the noninvasive endothelial function testing has provided valuable insights into an early atherogenesis and constitutes a helpful test in the detection of coronary atherosclerosis when compared with that of invasive testing of coronary endothelial function. On the other hand, an impairment of flow mediated dilatation in Brachial artery is related to the presence and / or extent and severity of Coronary Artery Disease. While, arterial stiffness index (SI) is widely used as a very sensitive indicator of endothelial dysfunction , arterial intima media thickness which reflects the structural vascular damage is established as a marker of atherosclerosis and has been associated with both incident and prevalent cardiovascular disease. This study was designed to : (1) Assess the role of flow mediated dilatation of brachial artery as a marker of systemic endothelial function,(2)Correlate between flow mediated dilatation of brachial artery with the presence, extent and severity of Coronary Artery Disease (CAD),(3)Find out the association between stiffness index (functional vascular damage) and intima media thickness (structural vascular damage) with the severity and extent of CAD,(4)Evaluate the effect of body mass index, waist to hip ratio and lipid profile on vascular endothelium.Sixty nine (69) patients with chest pain of either sex (46males, 23 females), in addition to 31 control subjects (15males, 16 females) with negative coronary CT angiography findings, all with an age range of (40 - 65years) were involved in this study. In addition to Demographic data and physical measurements, each subject was submitted to medical history, clinical examination, estimation of lipid profile, shear stress test, high - resolution external vascular Doppler ultrasound for brachial and carotid arteries (FMD%, stiffness index, intima media thickness), in addition to the computed tomography angiography (CT) scanning for the coronaries. The shear stress test involves occlusion of brachial artery in the upper arm for 5 minutes using a pressure cuff inducing reactive hyperemia after the cuff is released. However, this study was carried out in the Radiology Department at Al - Yarmook Teaching Hospital, Baghdad from October 2013 till March 2015.According to the coronary CT angiographic findings, patients were classified into three groups : single coronary lesion (SCL), multiple coronary lesion (MCL) and control groups. The results revealed that the FMD% in patients groups (SCL, MCL) is significantly lower than that of control group( P≤0.001, P≤0.01) respectively and it is inversely correlated with percentage of coronary artery stenosis in SCL group (P≤0.01, r=0.433) and with that of SI of both brachial and carotid arteries in both SCL, MCL groups, while a significant difference in SI is noticed between the MCL group and that of control regarding the carotid artery (P≤0.05). A positive statistical correlation is observed between the SI of brachial and carotidarteries among the studied groups, whereas a significant positive statistical correlation is found between the SI of carotid, brachial arteries with the percentage of coronary artery stenosis in SCL group (P≤0.05). Arterial IMT are significantly higher in MCL when compared with SCL (P≤0.0s) which is again significantly higher than control (P≤0.001). A positive correlation is observed between the arterial IMT with the percentage of coronary artery stenosis in SCL group(P≤0.05). Left anterior descending artery showed higher frequency of involvement by atheromatous stenosis (47%) when compared with that of Left main artery with a fequency of (13.72%). However, in MCL group, there was a higher frequency among males (88%) in respect to females (12%).In conclusion, the data of this study revealed that FMD is a useful, non invasive test for the assessment of vascular endothelial dysfunction. Arterial SI which reflects functional vascular damage is a good indicator of coronary artery disease. In addition, arterial intima media thickness can be used as a screening tool for coronary artery disease as it is sensitive indicator of structural vascular damage.

حدوث الاصابة بهشاشة العظام في مرضى الانسداد الرئوي المزمن في مستشفى بغداد وعلاقته بمختلف العوامل الخطره == Occurance of Osteoporosis in COPD Patients in Baghdad Teaching Hospital and Its Relation to Varios Risk Factors

Author name: عباس مصطفى حسن
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 syndrome of progressive airflow limitation caused by the abnormal inflammatory reaction of the airway and lung parenchyma. Osteoporosis is one of the major extrapulmonary manifestations of COPD. The, prevalence of osteoporosis in COPD patients in Iraqi population is unknown.Objectives : To study the incidence of osteoporosis among COPD patients and its relations to various risk factors.Materials and Methods : The study was done in Baghdad Teaching hospital.All the diagnosed cases of 70 COPD patients according to the GOLD guidelines were included in this study. The present study was a cross sectional study during a period of August 2014 - Octoper 2015 . A brief history of the patients was taken, especially regarding duration of illness, number of exacerbations in the past 3 years, smoking in pack years, and history of steroid use (both systemic and inhaled steroids) after which cumulative dose of steroids was calculated. Spirometry was done in all these patients to stage the severity of COPD according to GOLD criteria. DEXA scan of the lumbar spine was done using bone densitometer to determine osteoporosis. (WHO) criterion for definition of osteoporosis was applied and patients with T - score of below −2.5 standarddeviation (SD) were diagnosed to have osteoporosis, −1 SD to −2.5 SD were diagnosed to have osteopenia and more than −1 SD as normal.Results : A total of 70 COPD patients were included in this study, Among these, 36 patients (51.4%) had osteoporosis and 23 patients (32.8%) had osteopenia.Majority (94.4%) of the patients who had osteoporosis had stage III and stage IV COPD disease. It was observed that as the severity grade of COPD increased , the risk of osteoporosis also increased. The bone mineral density (BMD) showed a significant difference among different stages of COPD. It was also observed that patients with lower body mass index (BMI) had higher prevalence of osteoporosis (91.7%) as compared to overweight patients. On univariate analysis, it was observed that risk factors for osteoporosis were female sex, higher number of exacerbations, BMI, and severity of COPD. After using multivariate analysis, stage IV COPD , number of acute exacerbations >3 in the previous 3 years , and steroid cumulative dose >1000 mg were observed to be significant risk factors for osteoporosis in COPD patients.

ازدياد تعبيرالمعلمة الجزيئية miR - 21 التي تتوسط هبوط منتظم لجين PTEN في سرطان الثدي ومصاحبتها مع عوامل التنبؤ المعروفة == MicroRNA - 21 overexpression mediated phosphatase with homology to tensin (PTEN) downregulated in breast cancer in association with clinicopathological status

Author name: شروق محمد عباس التميمي
Supervisor name: سالم رشيد حمودي العبيدي | علي حسين الخفاجي
General topic: Medicine
Specific topic: Tissue Diseases
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: الخلفية : - سرطان الثدي هو الاكثر شيوعا في النساء في كل انحاء العالم . الموروث ( PTEN) هو الموروث المثبط للسرطان ,وهو منظم عكسي(اي مثبط)لاهم طريق لحدوث نمو وتكاثر الخلايا .المعلمة الجزيئية مثل ( miR - 21) هي الجزيئة الاولى التي تم اكتشافها التي تساعد على نمو وتكاثر الخلايا النامية وتمنع موت الخلايا ,اي تطيل من عمر الخلايا النامية. اذا حدث تغير في جزيئة ( miR - 21) وازداد عملها عن الحالة الطبيعية تؤدي الى حدوث نمو مستمر بدون موت الخلايا النامية مما يودي الى حدوث الخلايا السرطانية بالاضافة الى تاثيره على الموروث المثبط لنمو السرطان وهو (PTEN )الذي يعتبر موروث مستهدف له, بحيث يستطيع منع عمل هذا الموروث لذلك يؤدي الى حدوث سرطان الثدي .الهدف من الدراسة : - قياس تعبير المعلمة الجزيئية ( miR - 21) والموروث ((PTEN لمعرفة (زياده او نقصان) على اعتبارهم متغيرات حقيقية عن النسيج الطبيعي وعوامل التنبؤ لسرطان الثدي . المواد وطرائق العمل : - هذه الدراسة هي دراسة تجريبية من الشهر الاول سنة 2013 الى الشهر الاول سنه 2015.تم اخذ خمسين زوجا من العينات, وهذه العينات تؤخذ من سرطان الثدي ومن النسيج الطبيعي للثدي من النساء اللواتي تم استئصال ثديهن بسبب السرطان وهذه العينات تم اخذها في صالة العمليات وكانت العينات طازجة. تم استخلاص شريط ال RNA ثم بعد ذلك تم فحص جزيئة ال (miR - 21) وموروث(PTEN) . وتم تطبيق الواسم المناعي النسيجي الكيمياوي ((IHC لهرمون الاستروجين والبروجستين معher - 2 في العينات التي تم وضعها في بلوكات الشمع وبعد ذلك تم اختيار الحالات الموجبة ل(her - 2)وفحص تضاعف الموروث ( HER - 2) بواسطه تهجين موضعي ذي لونين .النتائج : - معظم الحالات كانت جزيئة ال( miR - 21) مرتفعة في النسيج السرطاني عن ماهو في النسيج الطبيعي وكانت احسن قيمة له (2.940 ) كدليل على ان الجزيئة تغيرت عن قيمته الطبيعية ,وكانت احسن قيمة له (4.156) في حالات انتشار السرطان في العقد اللمفاوية ,وقيمة (6.340 ) كدليل على المراحل المتقدمة من سرطان الثدي .بينما الموروث ( PTEN) كان في جميع الحالات منخفض عن النسيج الطبيعي واحسن قيمة له (0.210) كدليل لتغير تعبيرالموروث عن النسيج الطبيعي , وكانت القيمة) 0.175) دليل انتشاره الى الغدد اللمفاوية, وقيمة (0.098) تمثل المراحل المتقدمة من سرطان الثدي . هنالك علاقه عكسية بين جزيئة ال( miR - 21) والموروث ( PTEN) ولايوجد اي علاقة احصائية بين هذه المتغيرات وبين بقية عوامل التنبؤ الاخرى المعروفة في سرطان الثدي . الاستنتاجات : - التغير في التعبير كل من جزيئة ال ( miR - 21) والموروث (PTEN ) في جميع حالات سرطان الثدي وهنالك علاقة احصائية مع انتشار المرض الى العقد اللمفاوية ومع المراحل المتقدمة من سرطان الثدي . هنالك علاقة احصائية عكسية بين ازدياد التعبير للجزيئة (miR - 21) وانخفاض التعبيرللموروث (PTEN) في عينات سرطان الثدي . | Background : - Breast cancer is the most common cancer in women in worldwide. The phosphatase and tensin homolog gene is a tumor suppressor gene, and a key negatively regulator of cell signaling pathways that regulate growth and survival signaling pathways . More recently, microRNAs are small non protein coding RNAs involved in gene regulation. MicroRNA - 21 was one of the first oncogenic microRNAs and as an anti - apoptotic factor, to be characterized, being up - regulated in numerous tumors including breast cancer. The phosphatase and tensin homolog gene is one of microRNA - 21target genes Aim of the study : - To assess the validity of microRNA - 21 and phosphatase and tensin homolog (PTEN) gene expression as a diagnostic tool for gene alteration .Patients and Methods : - A prospective study , from January 2013 to January 2015. Fifty - pairs of fresh tissues from both breast cancer of invasive ductal carcinoma "NOS" and apparently normal adjacent tissues (from modify radical mastectomy) were by patients were recruited at the Surgical Department /Al - Diawania Teaching Hospital in Al - Diawania city . Total RNA extraction and real - time quantitative polymerize chain reaction technique were used for assessment of microRNA - 21 and phosphatase and tensin homolog gene expression. Tissue sample present in the paraffin embedded blocks belonging to tumor and normal adjacent tissue were used for Immunohistochemistry staining for (estrogen receptor, progesterone receptor and human epidermal growth factor receptor - 2) and dual color - chromogenic insitu hybridization technique for positive human epidermal growth factor receptor - 2 by Immunohistochemistry.Results : - Majority of cases 48(96%) ,were up regulated of microRNA - 21, indicating cancer tissue fold change of microRNA - 21 was significantly higher than that of normal adjacent breast tissue, and the best cutoff value for microRNA - 21 fold change in breast cancer tissues was (2.940)for diagnosis of gene alteration , (≥ 4.156) for positive lymph node involvement and (≥6.340) for higher stage (III,VI).All patients 50(100%) exhibit phosphatase and tensin homolog gene expression down regulation, indicating fold change of cancer tissue for phosphatase and tensin homolog gene expression was significantly lower than that of normal adjacent tissue and the best cutoff value for gene expressional alteration in breast cancer tissues was (0.210) for diagnosis of gene alteration, (≤ 0.175) for positive lymph node involvement and ( ≤ 0.098) for higher stage (III,VI) .Up - regulation of microRNA - A21 and down regulation of phosphatase and tensin homolog gene expression show no significantly correlate with other patients criteria like (age , grade ,size of tumor ,( estrogen receptor, progesterone receptor and human epidermal growth factor receptor - 2) by Immunohistochemical technique and human epidermal growth factor receptor - 2 gene amplification by dual color - chromogenic insitu hybridization technique . Identified significant negative correlation of up - regulation microRNA - 21 and down regulation of phosphatase and tensin homolog gene expression in breast cancer tissues.Conclusion : - gene expression of both microRNA - 21 and phosphatase and tensin homolog was significantly alterated in breast cancer tissues . It has been associated with positive lymph node involvement and higher tumor stage (III,VI)

تقييم وظائف البطين الايسر والبطين الايمن باستخدام معامل كفائة عضلة القلب في مرضى انسداد الشعب الهوائية المزمن == Assessment of left and right ventricular functions by myocardia performance index in patients with chronic pulmonary disease

Author name: ازهر عباس ناصر
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: انسداد الشعب الهوائية المزمن هو كيان شائع في الممارسة السريرية. ان حدوث تضخم البطين الايمن للقلب وعجر القلب اليمن هو شائع في مثل هؤلاء المرضى. ومع ذلك يحدث بعض الاضطراب في وظيفة البطين الايسر بين هؤلاء المرضى.الارتباط بين انسداد الشعب الهوائية المزمن وعجز القلب قد تم وصفه سابقا. غير ان الارتباط بين مرض انسداد الشعب الهوائية المزمن والخلل الوظيفي للبطين الايسر بدون وجود اعراض هو اقل فهما.تاثيرات مرض انسداد الشعب الهوائية المزمن على وظائف البطين الايمن الانقباضية والانبساطية وعلى وظائف البطين الايسر الانبساطية ,قد تم اثباته. في حين ان معامل كفاءة عضلة البطين الايسر للقلب ، الذي يتضمن زمن قذف البطين وزمن الانبساط وزمن الانقباض ,هو مؤشر وظيفة البطين الشاملة، لم يتم تقييمه في مرض انسداد الشعب الهوائية المزمن.المرضى الذين لديهم ضغط مفرط في البطين الايمن غالبا ما لديهم فشل في وظيفة البطين الايسر الانبساطية.الهدف من الدراسة : تهدف هذه الدراسة الى تقييم الوظيفة الشاملة للبطين الايسر والبطين الايمن للقلب في المرضى الذين يعانون من مرض انسداد الشعب الهوائية المزمن مع او دون ارتفاع ضغط الدم الرئوي باستخدام معامل كفاءة عضلة البطين لمعرفة العلاقة بين نتائج ايكو القلب وشدة مرض انسداد الشعب الهوائية ، اذا كان هناك اي منها.المرضى وطريقة العمل : 60 مريضا يعانون من مرض انسداد الشعب الهوائية المزمن وغير مصابين بامراض القلب [30 مريضا لديهم مرض انسداد الشعب الهوائية المزمن بدون ارتفاع ضغط الدم الرئوي (المجموعة 2), و30 مريض لديهم مرض انسداد الشعب الهوائية المزمن مع ارتفاع ضغط الدم الرئوي (المجموعة 3)] و30 شخص سليم ومطابق للعمر والجنس تم ادراجهم في هذه الدراسة. خضع جميع المرضى للتقييم السريري، فحص وظائف الرئة، تخطيط القلب وفحص ايكوالقلب القياسي والدوبلر النسيجي. مختلف قياسات الايكو الخاصة بوظيفة البطين الايسر والبطين الايمن تم مقارنتها مع مؤشرات وظائف الرئتين وضغط الشرياني الرئوي. تم قياس معامل كفاءة عضلة البطين الايمن ومعامل كفاءة عضلة البطين الايسر للقلب باستخدام الدوبلر النسيجي النبضي.النتائج : 60 مريض قد تم ادراجهم في الدراسة. كان اعمارهم بين 56 - 68 سنة. كان متوسط العمر 61.47 عاما والانحراف المعياري ± 7.47 سنوات.كان هناك 83% ذكور و17% اناث في الدراسة. 19 مريض (63.3 %)من الذين لديهم مرض انسداد الشعب الهوائية المزمن مع ارتفاع ضغط الشريان الرئوي و15 مريض (50 %) من الذين لديهم مرض انسداد الشعب الهوائية المزمن دون ارتفاع ضغط الشريان الرئوي كان مرض انسداد الشعب الهوائية المزمن شديد بينما 11مريض (36.7 %) من الذين لديهم مرض انسداد الشعب الهوائية المزمن مع ارتفاع ضغط الشريان الرئوي و15 (50 %) من الذين لديهم مرض انسداد الشعب الهوائية المزمن دون ارتفاع ضغط الشريان كان مرض انسداد الشعب الهوائية معتدل. كان الانسداد القصبي شديد في المجموعة 1) حجم الزفير القسري49,973±5,303%) والمجموعة 2 (حجم الزفير القسري 44.58 ± 7.45% ) وليس هناك ضعف في فعالية التهوية في مجموعة الاشخاص السليمين.معامل كفاءة عضلة البطين الايمن كان اعلى في المجموعة 2 (0.57 ± 0.11) والمجموعة 3 (0.96 ± 0.05) من المجوعة 1 (0.42 ± 0.043001) (. P <), وكان اعلى في المجموعة 3 من المجموعة 2 (P <.001).معامل كفاءة عضلة البطين الايسركان اعلى في المجموعة 3 (0.7 ± 0.083) من المجموعة 1 (0.5 ± 0.034) والمجموعة 2 (0.56 ± 0.037) (P< .001).للمرضى المصابين بمرض انسداد الشعب الهوائية المزمن ، كان معامل كفاءة عضلة البطين الايسرمرتبط بعلاقة طردية مع العمر ,معدل نبضات القلب, ضغط الشرياني الرئوي الانقباضي ومعامل كفاءة عضلة البطين الايمن ويرتبط بشكل سلبي مع السيوح الانقباضي للمستوى الحلقي للصمام الثلاثي وحجم الزفير القسري في الثانية 1. في تحليل الانحدار الخطي المتعدد , (R=0.674) معامل كفاءة عضلة البطين الايسر ترتبط بصورة مستقلة بحجم الزفير القسري في ثانية واحدة(Beta =1.133, P = 0.007), ضغط الشرياني الرئوي الانقباضي(Beta= - 0.758, P=0.128) ومعامل كفاءة عضلة البطين الايمن (Beta=1.436, P=0.009). مؤشرات وظيفة البطين الايسر الانبساطية (A, E/A, and deceleration time of E) كانت ضعيفة في المجموعة 3 والمجموعة 2 بالمقارنة مع المجموعة1. نسبة السرعة الانبساطية المبكرة لحلقة الصمام الاكليلي الى السرعة الانبساطية المتاخرة(Em/Am) كانت اقل بكثير في مرضى انسداد الشعب الهوائية المزمن الذين لديهم ارتفاع ضغط الشريان الرئوي(0.77±0.066)،وكان وقت الاسترخاء للبطين الايسر اطول بكثير في المجموعة 3(105.43±4.21ms) والمجموعة 2(102.27±4.45ms) بالمقارنة مع مجموعةالسليمين(71.2±5.51ms).وظيفة البطين الايمن الانبساطية, نسبة السرعة الانبساطية المبكرة الى السرعة الانبساطية المتاخرة (E/A)اعلى في الاشخاص السليمين بالمقارنة مع مجموعات المرضى. وقد كان نسبة سرعات التدفق للصمام الثلاثي(نسبة السرعة الانبساطية المبكرة الى السرعة الانبساطية المتاخرة) اقل قيمة بكثير في مرضى انسداد الشعب الهوائية المزمن الذين لديهم ارتفاع ضغط الشريان الرئوي(0.84 ± 0.04) وكان وقت الاسترخاء اطول بكثير في المجموعة 3 (98.87 ± 8.41ms) والمجموعة2 (77.5 ± 4.57ms) بالمقارنة مع الاشخاص السليمين (75.37±5.2) . كان قطر البطين الايسر الانبساطي اقل بكثير في المجموعة 3 (40 ± 2.665) من المجموعة 1(46.2 ± 2.295) والمجموعة2 (44.2 ± 3.367). سرعة حلقة الصمام التاجي (s') كانت الاقل في المجموعة 3 . (9.64 ± 0.92) ولكن المؤشرات التقليدية للوظيفة الانقباضية وسمك الحاجزبين البطينين في الانبساط لا تختلف بين المجموعات.كانت اقطار البطين الايمن الانقباظية والانبساطية اعلى وكان التقصير الكسري للبطين الايمن اقل في المجموعة 3 من المجموعتين الاخريين. كانت حركة حلقة الصمام الثلاثي الانقباظية اقل بكثير في المجموعة 3 (16.07 ± 3.54) بالمقارنة مع المجموعة 1 (21.7 ± 2.71)والمجموعة2 (20.83 ± 2.69) ,ولكن الاختلافات بين المجموعة 1 و2 غير هامة احصائيا.الخاتمة : كانت كلا وظيفتي البطين الايسر الانقباظية والانبساطية عاجزة في مرض انسداد الشعب الهوائية المزمن خاصة في المرضى الذين لديهم ارتفاع ضغط الشريان الرئوي . هذا العجز يرتبط بصورة مستقلة بضغط الشريان الرئوي الانقباضي,معامل كفاءة عضلة البطين الايمن وحجم الزفير القسري في الثانية1.الوظيفة الانبساطية للبطين الايسر والبطين الايمن والوظيفة الشاملة للبطين الايسر والبطين الايمن تتاثر في مرضى انسداد الشعب الهوائية المزمن وخاصة مع تطور المرض. مرضى انسداد الشعب الهوائية المزمن والذين لديهم ارتفاع ضغط الدم الرئوي اكثر عرضة لعجز القلب الايسر والايمن الانبساطي والشامل من المرض الذين لديهم ضغط شريان رئوي طبيعي. دوبلر انسجة القلب هو اداة افضل في تقييم وظائف البطين الايسروالبطين الايمن | Development of right ventricular hypertrophy and eventual right side heart failure is common in patients with Chronic obstructive pulmonary disease (COPD). However, some disturbance in left ventricular (LV) function has been observed among such patients.The co - existence between chronic obstructive pulmonary disease (COPD) and heart failure has been previously described. However, the co - existence between COPD and subclinical LV dysfunction, without the presence of heart failure symptoms, is less well understood.The aim of the study : The aim of this study was to evaluate global function of the LV and RV in patients with chronic obstructive pulmonary disease (COPD) with or without pulmonary hypertension(PH) by using myocardial performance index (MPI) and find out the correlation between echocardiographic findings and severity of COPD.Patients and methods : Sixty patients with COPD without additional cardiac diseases [30 patients with COPD without PH (group 2), and 30 patients with COPD with PH (group 3)] and 30 age and sex - matched healthy subjects (group 1) were enrolled into the study. All patients underwent clinical evaluation, spirometry, electrocardiography and standard and tissue Doppler echocardiography. Various echocardiographic parameters of LV and RV functions were compared with indices of pulmonary function test and pulmonary arterial pressure. RV myocardial performance index (RVMPI) and LVMPI were obtained by pulsed wave Doppler tissue.Results : RVMPI was higher in both group 2 (0.57 ± 0.11) and group 3 (0.96 ± 0.05) than group 1 (0.42 ± 0.043) (P< .001), and was higher for group 3 than in group 2 (P< .001). LVMPI was higher for group 3 (0.7 ± 0.083) than in both group 1 (0.5 ± 0.034) and group 2 (0.56 ± 0.037) (P <.001). For patients with COPD, LVMPI was positively correlated with age, heart rate, pulmonary arterial systolic pressure and RVMPI and negatively correlated with tricuspid annular plane systolic excursion and forced expiratory volume in 1 second. In multiple linear regression analysis (R=0.674), LVMPI was independently associated with forced expiratory volume in 1 second (FEV1) (Beta =1.133, P = 0.007), pulmonary arterial systolic pressure (Beta= - 0.758, P=0.128), and RVMPI (Beta =1.436, p=0.009).LV diastolic function parameters (A, E/A, and deceleration time of E) were impaired for groups 2 and 3 compared with group 1. Mitral early diastolic and late diastolic annular velocities ratio (Em/Am), were significantly lowest in COPD patients with PH(0.77±0.066), and the isovolumetric relaxation time (IVRT) was significantly longer in group 3(105.43±4.21ms) and group 2(102.27±4.45ms) in relation to control group(71.2±5.51ms).RV diastolic function, E/A ratio was higher in the control subjects compared with the patient groups. The tricuspid inflow velocities ratio (E/A) was significantly lowest value in COPD patients with PH (0.84 ± 0.04) and the isovolumetric relaxation time (IVRT) was significantly longer in group 3(98.87 ± 8.41ms) and group 2(77.5 ± 4.57ms) in relation to control group (75.37±5.2). LV end - diastolic diameter was significantly lower for group 3 (40 ± 2.665) than group 1(46.2 ± 2.295) and group 2(44.2 ± 3.367). LV mitral valve annular velocity (S') was lowest in goup3 (9.64 ± 0.92). However, conventional systolic function parameters and IVSd were not different among the groups. Systolic and diastolic RV diameters were higher and RV fractional shortening was lower for group 3 than the other two groups. TAPSE was significantly lower for group 3(16.07 ± 3.54) compared with group 1(21.7 ± 2.71) and group2 (20.83 ± 2.69), but differences between groups 1 and 2 was not statistically significant. Conclusion : Both LV systolic and diastolic functions are impaired in COPD, especially in patients with PH. This impairment is independently associated with pulmonary arterial systolic pressure, RVMPI, and FEV1. Left and right ventricular diastolic function and LV and RV global function are affected in COPD patients especially with progression of the disease. COPD patients with pulmonary hypertension are more liable to LV and RV diastolic and global dysfunction than normal pulmonary pressure COPD patients. Doppler tissue echocardiography is a better tool in the assessment of LV, RV function.

الخصائص الوبائية لحالات الحصبة المسجلة في محافظة النجف الاشرف للفترة من 2007 الى 2014 == Epidemiological Characteristic of Reported Measles Cases in AL - Najaf province /Iraq 2007 - 2014

Author name: عبد الامير حسين حسن الموسوي
Supervisor name: احمد سمير النعيمي
General topic: Medicine
Specific topic: Applied Epidemiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Measles is worldwide, and still epidemic and highly infectious and threatened the life of all populations, but is preventable by full immunization.The importance of this study in AL - Najef government because of previous outbreak. And also a mixing of social due to internal displace populations and religious events during the year.Objective study : to describe the epidemiological characteristics of all reported measles cases in the public health of Najaf government during 2007 - 2014.Method of study : cross sectional for all suspected measles cases that are reported retrospectively in the public health section of directorate of health in AL - Najaf province during 2007 - 2014, and the data collected from the notification and investigation form of measles then entered and analyzed by using EPI - Info and SPSS 21. The result showed 582 of suspected cases, 359 0f them were confirmed, 56% female, the peak age group <5 years.The seasonal distribution of the cases appears in JAN - MAY. There was highly obvious association between the numbers of doses of vaccination with the confirmed cases,The Odd Ratio for having a confirmed case for those with a single dose of vaccination is 0.18 compared to those unvaccinated. and the risk of having confirmed measles for those with unvaccinated increased 5.6 time compared to those with protected a single dose, during the outbreak period (2007 - 2009).We recommend promoting the active surveillance and good collection of notification form and keeping for study in future, improving complete MVC with a good cold - chain and periodic campaigns before winter

تحليل نتائج وخز الرئة القطعي لاربعين مريض في مستشفى بغداد التعليمي == Analysis of Tru - Cut Biopsy Findings In Forty Patients with PERIPHERAL Lung Lesions in Baghdad Teaching Hospital

Author name: احسان سلمان
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: وخزة الرئة التحت الجلدية هي من اكثر الطرق شيوعا في الوقت الحالي معها العديد من الطرق المستخدمة في امراض الجهاز التنفسي .واحده من اهم الطرق هي طريقة الوخز القطعي بمساعدة المفراس الحلزوني .اهداف دراسة البحثلاجل تحليل النتائج من جراء عملية الوخز القطعي في مستشفى بغداد التعليمي لسنة 2015 - 2016.الطرق والمرضىاجريت دراسة مرجعه عن هذه الطريقة ووجدت كثير من النتائج ما يخص الديموغرافية والدلائل الاشعاعية والتشخيص والمضاعفات الناتجة من المرضى الذين اجروا هذه العملية الوخز القطعي تحت السيطرة للمفراس الحلزوني .النتائجاربعون مريض كانوا تحت الدراسة الخاصة للبحث ثلاثون مريض كانوراجال وعشر مرضى نساء .اعمار المرضى تتراوح ما بين 18 - 80 ومعدل العمر للمرضى هو 14.1 سنه . ±58.6 21 مريض من الرجال حاليا مدخنين و6 غير مدخنين و3 مدخنين سابقين بينما من النساء كانوا 3 مدخنين حاليا و5 غير مدخنين و2 مدخنين سابقات .اكثر الاعراض شيوعا بين المرضى في البحث هي ضيق التنفس والسعال ونفث الدم وقلة وزن الجسم.اكثر الدراسات الهستوبايولوجي للمرضى الذين اجروا هذه العملية كانت مسرطنه بنسبة 70% ,شامل بنسبة 12.5%, حميد بنسبة 7.5 % , ذات الرئة بنسبة 7.5%, تحليل غير كافي بنسبة 2.5%.من اكثر المضاعفات شيوعا بين المرضى كانت الاسترواح الصدري ونفث الدم.الاستنتاجعملية الوخز القطعي مع مساعدة المفراس الحلزوني يعتبر من اكثر العمليات الكفؤة في الكشف عن الاوليات والاسباب التي تخص امراض الرئة المحيطية. | Percutaneous lung biopsy is now a common procedure in pulmonary medicine, and several different techniques are in use. The most important one is the use of a tru - cut biopsy under computed tomography (CT) guidance.Aim of Study : To analyze the outcome of tru - cut biopsy in patients with peripheral pulmonary lesions in Baghdad teaching hospital 2016.Patients and Methods : A cross sectional study was done to find out the demographic profiles, indications, radiological findings, diagnosis and complications of the patients who were underwent tru - cut biopsy under CT guided. Forty patients underwent tru - cut biopsy under CT guided in Baghdad teaching hospital( 2015 - 2016).Results : Forty patients were included in our study.Thirty patients (75%) were males, 10 patients (25%) were females. The patients age range from 18 to 80 years, the mean age of the patients was 58.6±14.1 years. In males, 21 patients were current smokers, 6 patients were non smokers and 3 patients ex smokers. In females, 3 patients were current smokers, 5 patients were non smokers and 2 patients were ex smokers. Most common clinical presentation of the patients was chest pain (30%), dyspnea (17.5%), cough (15%), hemoptysis (7.5%), and weight loss (12.5%). The commonest histopathological result of the lesions was malignancy (70%), inconclusive (12.5%), benign (7.5%), organizing pneumonia (7.5%) and inadequate sample (2.5%). The most common complication was pneumothorax (10%) and haemoptysis (5%).Conclusion : Tru - cut biopsy under CT guided is extremely useful in finding specific etiologies of peripheral lung lesions

تاثير التجميد بالتزجيج وطرق الاذابة المختلفة على حيوية وسلامة الحامض النووي للنطف == The Effect Of Laser Thawing After Vitrification On Sperm Motility And DNA Integrity

Author name: شذى صادق المراياتي
Supervisor name: غسان ثابت سعيد
General topic: Medicine
Specific topic: Physiology
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: ان التجميد بطريقة التزجيج تعتبر من طرق تجميد النطف البشرية وتعتمد على التجميد السريع للماء الى الحالة الزجاجية من خلال زيادة اللزوجة بدون تكوين بلورات داخلية (داخل الخلية). ان التجميد من الممكن ان يؤدي الى تاثيرات ضارة على تركيب ووظيفة النطف البشرية وان الاضرار الناتجة من التجميد من الممكن ان تؤثر على تركيب وسلامة الغشاء البلازمي. وان هذه الاضرار لا تقتصر على اضرار التجميد فقط بل تشمل ايضا على الاضرار الناتجة من عملية الاذابة بسبب اذابة او تبلور الثلج الناتج من التجميد. ان هذه العمليات ( التجميد والاذابة) من الممكن ان تؤثر سلامة الاحماض النووية وكذلك من الممكن ان تؤدي الى تغييرات في نواة النطف البشرية . ان التجميد قد يؤدي الى اجهاد تاكسدي للنطف البشرية كنتيجة الى انحلال الدهون التاكسدي وتقليل الية الدفاعية بواسطة الانزيمات المضادة للاكسدة. خلال عملية التجميد الخلايا والانسجة تخضع الى تغييرات كيميائية وفيزيائية . ان تاثير الليزر ومن خلال التحفيز الضوئي من الممكن ان يقاوم الاضرار الناتجة من التجميد للنطف البشرية وهذا من الممكن ان يؤدي الى تحسين نوعية النطف المجمدة وزيادة قابيلتها على الخصوبة. الهدف : دراسة تاثير الليزر كطريقة لاذابة النطف البشرية المجمدة وتاثيرها على سلامة الاحماض النووية والحركة مقابل الاذابة بدرجة حرارة الغرفة او عن طريق الحمام المائي. الموضوع والطرق : دراسة اجريت على 70 نموذج من النطف البشرية. كل نموذج قسم الى قسمين , قسم قد تم تحضيره بتقنية السباحة الى فوق والقسم الثاني بدون تحضير , وكل قسم قد قسم الى ثلاثة, جمدت, وتم اذابة كل جزء من النماذج بالليزر اوبدرجة حرارة الغرفة او بالحمام المائي بدرجة 37 درجة مئوية . تم دراسة سلامة الاحماض النووية وحركة النطف قبل وبعد التجميد , وكذلك قبل وبعد التحضير بتقنية السباحة الى فوق بطريقة الاكردين اونج (AOT) الحصول بالاعتماد على قياس المذنب (comet).النتائج : اظهرت النتائج ان الاذابة عن طريق الليزر لها تاثير معنوي (P<0.05 ) في تقليل تحطيم الاحماض النووية مع زيادة في الحركة الفعالة للنطف عند المقارنة مع الاذابة بدرجة حرارة الغرفة او بالحمام المائي.الاستنتاج : استنتجت هذه الدراسة ان تجميد الحيامن له اثار مؤذية تؤثر على سلامة الاحماض االنووية وحركة النطف البشرية. ان الاذابة بالليزر تحافظ على سلامة الاحماض النووية والحركة النشطة للنطف وان تقنية السباحة الى فوق كذلك تؤدي الى تنشيط النطف وتقليل تحطم الاحماض النووية. | Vitrification is a method of sperm freezing based on the rapid cooling of water to a glassy state through extreme elevation of viscosity without intracellular ice crystallization. Cryopreservation may lead to deleterious changes of sperm structure and function. Cryoinjury is not limited to the freezing process but may also occur during the thawing process as the ice melts or recrystallizes. It have been reported that cryopreservation/thawing significantly lead to alterations of sperm DNA integrity and could alter the quality of the spermatozoon’s nucleus. Cryopreservation induces oxidative stress in the spermatozoa due to increasing rate of lipid peroxidation and suppression of the antioxidant enzyme defense mechanism. These effects of cryopreservation lead to spermatozoa damage including nucleic acids. Subjects and methods : This prospective study carried on 70 cryopreserved semen samples. Each sample wasdivided into two parts, one part is unprepared and other part was prepared by swim - up technique and each part is divided into 3 parts, freezed and thawed by three methods of thawing by laser irradiation till melting for one part, and by room temperature and water bath at 37°C for the other two parts. The semen parameters were assessed by microscopical examination and the DNA integrity assessed by acridine orange test and comet assay before vitrification and after the three methods of thawing as well as before and after preparation. Result : The results of cryopreserved semen samples showed that laser irradiation thawing has a significant increase in sperm motility as well as a significant decreased DNA fragmentation (P < 0.05) versus room temperature and water bath thawing in addition sperm preparation by swim up method also lead to improve sperm motility and DNA integrity (P < 0.05).Conclusions : Vitrification has a deleterious effect on sperm DNA integrity and motility. Laser irradiation thawing methods of post freezing sperm improves post - thaw motility and DNA integrity. Sperm preparation by swim up technique for sperm preparation increasing motility and decrease DNA damage after thawing . The results of the acridine orange test and comet assay gave relatively similar predictive values for DNA fragmentation.

تواتر التدرن الكامن في المرضى المرشحين للعلاج البيولوجي في مستشفى بغداد التعليمي == The frequency of Latent tuberculosis infection in patients who are candidates for biological therapy in Baghdad Teaching hospital

Author name: امل خالد علي
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: Introduction : Tuberculosis remains one of the biggest global human killers accounting for 9.4 million new cases of active tuberculosis and 3 million tuberculosis - related deaths with an incidence of 140/100,000 inhabitants. More than 90% (up to 8 million) of total TB Tuberculosis cases occurring in developing countries and more than half of all deaths (2 million) occurring in Asia.Aim of the study : To assess the burden of latent TB in patients candidate for biological therapy.Patients and method : A descriptive cross sectional study conducted at Baghdad teaching hospital during the period from the 1st of April 2017 to the end of March 2018. A consecutive sampling included 150 respondents candidate for biological therapy were included in this study Results : The mean age of patients was 38.9±11.4 years. TST was positive in 23.3% of studied patients. Significant association between positive TST findings and middle age group (p=0.05). A significant association was observed between positive TST results and gender (p=0.001). Also significant association between prolonged duration of the disease, and positive TST.Conclusions : The TST were positive in about only one quarter of patients with chronic immunomediated diseases who are candidates for biological therapy, and significant associations were found between age group , and TST results.

دراسة الكشف المبكر لمرض الانسداد الرئوي المزمن في الذكور الخالين من الاعراض المدخنين والمدخنين السابقين == Early Detection of Chronic Obstructive Pulmonary Disease in Asymptomatic Male Current Smokers and Ex - smokers By Spirometry

Author name: حسام محمد علي صالح
Supervisor name: عبد الله جنجر الفرطوسي
General topic: Medicine
Specific topic: Diseases - Thoracic
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Chronic obstructive pulmonary disease is responsible for permanent morbidity, premature mortality and great burden to the healthcare system. The most commonly encountered risk factor is tobacco smoking. Without screening, patients usually overlook early symptoms of cough wheezes but commonly seek medical advice when they become dyspnic on mild to moderate exertion. By that time, half of their ventilatory reserves are lost. Spirometry remains the gold standard for diagnosing chronic obstructive pulmonary disease and monitoring its progression.Aim of study : Early detection of chronic obstructive pulmonary disease in asymptomatic male current smokers and ex - smokers by spirometry.Patients and methods : Consecutive asymptomatic male current smokers (n=100) and ex - smokers (n=100) were participated in screening. All Participants have no history of chronic obstructive pulmonary disease, asthma, chronic respiratory illness or active pulmonary symptoms. Also all of them not on bronchodilators, inhaled corticosteroids, Montelukast, or theophylline.Results : A total of 100 asymptomatic male current smokers and 100 asymptomatic male ex - smokers were screened by spirometry according to the American Thoracic Society and European Respiratory Society guidelines. Overall, airway obstruction was seen in 49 (49%) current smokers, mild obstruction was seen in 22 (22%) and moderate obstruction in 27 (27%) subjects, while in ex - smokers airway obstruction was seen in 52 (52%), mild obstruction was seen in 13 (13%) and moderate obstruction was seen in 39 (39%) subjects.Conclusions and recommendations : Early diagnosis of chronic obstructive pulmonary disease by spirometry will encourage smoking cessation and enable earlier interventions to help prevent exacerbations and hopefully preserve lung function, quality of life and decrease mortality

تاثير تدخين الشيشة الاركيله مقارنة بتدخين السكائر على اختبار وظائف الرئة بين الذكور في مدينة الناصرية == The Effect of Water Pipe (Negril) Smoking on Pulmonary Function Test in compare to cigarate smoking among Males in Al Nasiriya City

Author name: مهند عادل جايان
Supervisor name: قاسم محمد سلطان
General topic: Medicine
Specific topic: Diseases - Thoracic
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Shisha (wp) smoking is becoming a more prevalent form of tobacc consumption, and is growing worldwide, particularly among the young generation in the Middle East especially among urban youth, college students, and young professionals. However there is limited data about the effects of water - pipe smoking. Publicly considered as aharmless entertainment. Many studies have shown that water pipe smoking associated with development of varying degrees of reduction in the lung function.Objectives : The aim of this study is to assess the effect of water pipe smoking on pulmonary functions with regard to the duration and amount of smoking among different groups of male smokers : water pipe smokers, cigarette smokers, and compare it with a control (nonsmokers) group. Methods : This is a comparative crosssectional study which conducted on 300 male subjects, subdivided into two groups of smokers : 100 water pipe smokers, 100 cigarette smokers and 100 nonsmokers as a control group, all participants were apparently healthy and matched for gender, they were selected from random cafes in al nassirryha city. Data were collected through structured questionnaire and pulmonary function test was performed by portable Spiro lab III spirometer after gaining the participant consent. Results : There was significant differences between the mean ages of the study groups (p value<0.05).water pipe smokers (35.44±10.79) cigarette smokers (46.09±10.54), and nonsmokers (35.55±11.07). The present study revealed that there was a significant reduction in the parameters of the pulmonary function test ( FEV1 ), (FVC )(FEV1/FVC),(PEF),(FEF25 - 75%)and(MVV)for the two groups of smokers as compared to the control group ( P < 0.01 ) .Lung function impairments were very severe in water pipe smokers as compare with cigarette smokers( P < 0.05 ). There were significant inverse correlations between all PFT values and duration and total amount of WP smoking and number of WP smoked per week(P < 0.01) .Conclusion : The results from this study showed that there was a profound effect of WP smoking on PFT values, which were more severe to the effects of cigarette smoking.Keyword : water pipe smoker ,pulmonary function test, nassiryha - Iraq.

مشاهدات الرنين المغناطيسي لدى المرضى المصابين بفرط هرمون الحليب في الدم == MRI FINDINGS OF PITUITARY GLAND IN HYPERPROLACTINEMIC PATIENTS

Author name: رنا علاء الدين حسين
General topic: Medicine
Specific topic: Diagnostic Radiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine - Department Of Diagnostic Scans
Language: English
University location: Baghdad
First pages:
Abstract: تحليل مشاهدات الرينن المغناطيسي للغدة النخامية لدى المرضى المصابين بفرط هرمون الحليب (البرولاكتين)في الدم وايجاد توجيها ت عمل للحدود الدنيا لنسبة هرمون الحليب في الدم والتي على ضوئها تكون صورة الرنين المغناطيسي للغدة النخامية مطلوبة 0اساليب الدراسة قمنا بدراسة وصفية استطلاعية شملت ستون مريضا يعانون من فرط البرولاكتين وقمنا باخذ صورة الرنين المغناطيسي للغدة النخامية لهم للفترة من الاول من كانون الثاني ولغاية الثلاثون من شهر اب للعام 2015.النتائجتم فحص ستون مريضا, منهم ثمانية وعشرون اي مايعادل نسبة (46.7%) كان تصويرالرنين المغناطيسي طبيعيا للغدة النخامية, وخمسة عشراي مايعادل نسبة (25%)مر يض لديهم ورم غدة نخامية مايكروي و3منهم ورم غدة نخامية ماكروي. بالاضافة الى تسعة منهم كان لديهم تضخم الغدة النخامية بدون وجود لاي ورم.وقد وجدنا ان قطع القيمة الامثل المصاحب لورم الغدة النخامية (ميكروي /ماكروي )لهرمون الحليب هو (102.5)نانو غرام / ملليتر بمستوى حساسية (77.8%) ومستوى نوعية (95.2%).الاستنتاجاتكان هناك صلة ذات اهمية احصائية بين المرضى الذين يعانون من فرط هرمون الحليب وصورة الرنين المغناطيسي .هذا يدعو الى اجراء صورة الرنين المغناطيسي لجميع الحالات المصابة بفرط برولاكتين الدم عندما تكون نسبة الهورمون مساوية او اكثر من (102.5.نانوغم/مل)بعد استثناء اي سبب ثانوي ممكن يؤدي الى ارتفاع هرمون الحليب. | To analysis the MRI findings of pituitary gland in patients with hyperprolactinemia and establish guidelines for a minimal serum prolactin level for which pituitary MRI imaging is indicated .Methods : A descriptive study was conducted at of a AL - Shaheed Ghazi Hospital and Radiology Institute from 1st of January 30 of August 2015. Sixty patients with hyperprolactinemia underwent magnetic resonance imaging of brain for pituitary gland .Results : The result were based on the analysis of pituitary MRI findings for 60 patients , almost half of the sample were diagnosed as normal 28 (46.7%) ,18 (30%) as pituitary adenoma with macro adenoma being the smallest part 3(5% only).Pituitary hyperplasia account 9(15%) and empty sella 5(8.3%).there was significant statistically association between serum PRL and pituitary adenoma .The optimum cut - off value for serum PRL for any positive pituitary findings (adenoma , hyperplasia and empty sella) was 55.1ng/mL. While the optimum cut - off value of serum PRL for pituitary adenoma (micro/macro) was 102.5 ng/mL.Conclusion : MRI of the pituitary gland was significantly associated with serum PRL levels in patients with hyperprolactinemia .The optimum cut - off value of serum prolactin to predict pituitary adenoma (micro/macro) was 102.5 ng/mL. Therefore pituitary imaging should be obtained for all patients with serum PRL ( equal or higher than this value)after exclusion of any secondary causes of hyperprolactinemia.

تاثيرات عقاري المتفورمين والاناستروزول على شكل ووظيفة المبيض في بمتلازمة تكيس المبايض في الجرذان : دراسة شكلية قياسية، نسيجية، وكيميانسيجية == The Effects of Metformin and Anastrozole on the Morphology and Function of the Ovary in Polycystic Ovarian Syndrome Rat Model, Morphometrical, Histological, and Immunoistochemical Study

Author name: علي محسن عبد الامير
Supervisor name: معن حمد الخالصي
General topic: Medicine
Specific topic: Anatomy and Histology and Embryos
Degree: Doctorate
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:

الخصائص الوبائيه للحروق في مستشفى بغداد للحروق, بغداد, العراق 2015 == Epidemiological Characteristics of BurnInjuries in Baghdad Burn Hospital,Baghdad, Iraq, 2015

Author name: رنا خالد الناصر
Supervisor name: فارس حسن اللامي
General topic: Medicine
Specific topic: Applied Epidemiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Burns are a global public health problem, accounting for an estimated 265,000 deaths annually, in 2013 fire and heat resulted in 35 million injuries. This resulted in about 2.9 million hospitalizations and 238,000 deaths. This makes it the 4th leading cause of injuries after motor vehicle collisions, falls, and violence. About 90% of burns occur in the developing world. This has been attributed partly to overcrowding and an unsafe cooking situation. Iraq burn injuries are the second cause for visiting emergency room after gun fire according to World Health Organization (WHO) Injury Surveillance Pilot Project, Iraq, 2008.Objectives : To describe epidemiological and clinical characteristics, estimate the case fatality rate and identify the main determinants of death among burn cases in Baghdad Burn hospital, Baghdad, Iraq during 2015.Patients and Methods : A cross sectional study was conducted in Baghdad Burn Hospital. The study population was all the burn cases that were admitted to these hospitals during 2015. The files of the patients were obtained from the statistics department in the hospital. All burn patients with different types and degrees of burn injuries who were admitted to this hospital during 2015 were included in the study. Patients with minor superficial burns treated in the emergency department as out patients and cases that admitted for surgical treatment of old scars were excluded.Data was collected using a form included demographic data, etiology, burn type, anatomical location and percentage of body surface area burned, operating procedures and outcome were recorded.Results : This study involved 676 patients, 32.90% of them were females. 26.62% patients were below 10 years of age. Two thirds had less than 20% of body surface area burns (66.42%) and only 9.46% had more than 50% body surface area burns.Flame burns were the commonest (71.59%) followed by scalds (23.37%) and electrical 2.52%. Scalds were common in children. About 76.33% of patients improved 8.28% left on their responsibility and 2.07% shifted to other hospitals. Case fatality rate was 13.30%, Mortality was 44.4% with sepsis as the leading cause, multiple organ failure, and shock were other causes of mortality.Conclusions : Burns injury is a major public health concern and is associated with high mortality. Flame, scald and electrical burns are commonly a result of domestic and occupation accidents and are preventable. Strict follow up to the infection control guideline can minimize the high case fatality rate.

Epidemiological Characteristic of Multi - Drug Resistant Tuberculosis in Iraq July/2011 - July/2015

Author name: قيس قاسم ابراهيم
General topic: Medicine
Specific topic: Applied Epidemiology
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : Multi - Drug Resistant Tuberculosis (MDR - TB) is global and national public health problem that threatens the success of TB control programs.The aim of this study : To describe the epidemiologic characteristics of MDR - TB cases registered in Na0onal Tuberculosis Control Program (NTP) of Iraq during the period July 2011 - July 2015.Methods : A Cross - sectional, record based study was conducted at the Chest and Respiratory Diseases Specialized Center for all electronic records and patients’ forms available from July /2011 to July/2015. A form for collec0ng data was prepared by the researcher according to (MDR) patients Files which is provided by the NTP. Chi - square testing was used to measure the level of sta0s0cal significance set at p<0.05 and a confidence level of 95%.Results : A total of 319 cases, males were (72.6%); the mean age was 40.03±12.24 years, one third of the cases (31.7%) were from Baghdad. cases from urban area (57.8%); Cat - 2 Failure form (88.0%) of the MDR group; pulmonary were (98.3%) of the site of the disease; (17%) with Diabetes Mellitus; duration in days spend by the patient in the first line treatment, direct smear conversion negative and culture conversion nega0ve were (502±133.56), (117±77), (145±91) respec0vely; default was(28.5%) of the ceases; favorable outcome was sta0s0cally significant among middle age groups(30 - 49years) (χ2=8.548, df =2, P = 0.014).Recommendations : Increase attention for better managements of the patients in the first line treatment; give good education messages to patient of MDR - TB and Increase the number of labs capable for early diagnosis is the suitable strategy to control MDR - TB disease.

تاثير عقار الكولجسين بالاضافه الى الاسيتامينوفين مع الاسيتامينوفين وحده على مستوى الالم التصلب والوظيفة البدنية لمرضى فصال الركبه الاولى : دراسة مقارنة == Effects of Colchicine Plus Acetaminophen and Acetaminophen Alone on Pain, Stiffness and Physical Function in Patients with Primary Osteoarthritis of the Knees : A Comparative Study

Author name: كوثر رفيع حربي
Supervisor name: سامي سلمان شهاب
General topic: Medicine
Specific topic: Diseases - Joints
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Osteoarthritis (OA) is a chronic degenerative disorder of multifactorial etiology characterized by loss of articular cartilage. Basic calcium phosphate (BCP) and calcium pyrophosphate dihydrate (CPPD) crystals are commonly found in osteoarthritic joints. These crystals have been found in the synovial fluid of 60% of patients with knee OA. Inflammation in OA is frequently secondary to the presence of these crystals, and leads to the production of interleukin - 1 (IL - 1), an important mediator of cartilage breakdown in OA. Previous studies referred to a slow acting disease/structure - modifying effects of colchicine in knee OA. Aim of the studyTo examine the effect of combined colchicine plus acetaminophen compared with acetaminophen alone on pain, stiffness, and physical function in patients with knee osteoarthritis after a 1month treatment course, and after 1 month of stopping the treatment.Patients and methods A randomized, double blind study included 150 patients were diagnosed to have knee OA according to the American College of Rheumatology (ACR) criteria for classification of (KOA).Patients were randomly assigned to receive acetaminophen 500mg containing capsule twice daily in the 1stgroup (70 patients),and colchicine 0.5mg plus acetaminophen 500mg in one capsule twice daily in the 2ndgroup (80 patients). The efficacy outcome measure was the change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) including the pain, stiffness and physical function subscales.Results Both acetaminophen and acetaminophen plus colchicine groups showed significant reduction in the pain, stiffness , physical function and total WOMAC score in the 2nd visit (after 1 month of treatment regimen) (P<0.001).At the third visit one month after cessation of treatment these scores increased again to approximate the baseline value in group 1, while slightly increased in group2, the differences in these scores between the baseline and 3rd visit values were statistically insignificant, (P˃0.05) in group 1 while it still highly significant in group 2, (P<0.001).ConclusionBoth modes of treatment acetaminophen alone or acetaminophen plus colchicine are effective in symptomatic improvement in patients with primary osteoarthritis of the knee in term of pain, stiffness, physical function and total WOMAC score. But the better beneficial symptomatic effect and longer period of action was obtained when colchicine added to acetaminophen than acetaminophen alone.

انتشار اكتناف العين لدى عينة من المرضى العراقيين البالغين المصابين بمتلازمه فرط مرونه المفاصل الحميد == Prevalence of Ocular Involvement in a Sample of Iraqi Adult Patients With Benign Joint Hypermobility Syndrome

Author name: ايناس عدنان مجيد
Supervisor name: محمد هادي العصامي | نجاح كاظم القريشي
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: خلفية البحث : تعرف متلازمه فرط مرونه المفاصل الحميد بانها اضطراب النسيج الضام الوراثي الذي يتميز بالام عضليه هيكليه ونطاق المرونه المفرطه في المفاصل , الكثير من مظاهر العين موجوده عند مرضى متلازمه فرط مرونه المفاصل الحميد بعضها مشهورة الترابط مع المرض والاخرى مخبر عنها في تقارير حاله .الهدف : تقييم انتشار وخصائص اكتناف العين لدى عينة من المرضى العراقيين المصابين بمتلازمه فرط مرونه المفاصل الحميد .المرضى والطرائق : شملت الدراسة ( 300) فرد في الدراسه المقطعيه , )100( مريض بمتلازمه فرط المرونه و)200 (من الافراد الاصحاء وهم مطابقين في العمر والجنس للمجموعه التي اخذت كمجموعه تحكم .خضع كل المرضى للفحوصات العينيه والتي تضمنت تقييم حده البصر مع مخطط سنيل , فحص القطعه الاماميه والخلفيه للعين مع مصباح سلت , فحص شيرمر , صبغه الفلورسين القرنيه وتقدير ضغط داخل العين مع مقياس توتر العين بالنفث الهوائي . تم استبعاد المرضى اللذين لديهم رضح سابق في العين اوالمرضى المصابين بفرط ضغط الدم وداء السكري او تراكب مع امراض الانسجة الضامة الاخرى او التهاب المفصل الالتهابي . جمعت بيانات المرضى الديموغرافية والسريرية بما في ذلك العمر والجنس ومعيار كتلة الجسم ,مده الاعراض , بيانات مرتبطه بمظاهر المرض الريئسيه وميزات اخرى مرتبطه بمتلازمه فرط مرونه المفاصل الحميد . تم قياس تقدير مرونه المفاصل بالنسبه الى طريقه درجه بايتون لكل المشتركين في الدراسه .النتائج : من مجموع 100 مريضا مصابا بمتلازمه فرط مرونه المفاصل الحميد ممن التحقوا في هذه الدراسه . تم تحديد انتشار الاخطاء الانكسارية في (%78 (, وحسر)قصر البصر(في (49%) ثم لابوريه (20%) وطول البصرفي (9%) منهم.وجدت المظاهر العينيه الاخرى المحدده جفاف العين في (15%) , بينما التهاب الجفن الامامي والخلفي في (%5) و(4%)من المرضى على التوالي .شخصت متلازمه الصباغ التشتتي في (3 %) واخر المظاهر العينيه المحدده ساد في (2%) من مرضى متلازمه فرط مرونه المفاصل الحميد .ان كل النتائج السابقه ذات دلاله احصائيه ماعدا ساد حيث لم تصل الى حد الدلاله الاحصائيه .لايوجد رابط معتد بين العمر , الجنس , نوع المفصل الاكثر شيوعا ودرجه المفصل في حرز بايتون مع زياده خطر المظاهر العينيه . الاستنتاجات : مظاهر العين في عينة المرضى العراقيين المصابين بمتلازمه فرط مرونه المفاصل الحميد شائعه نسبيا. ان اكتشافات العين المتعلقة بمتلازمه فرط مرونه المفاصل الحميد الاكثر شيوعا هي حسر البصر ثم لابوريه ثم طول البصر .لقد كان جفاف العين , التهاب الجفن الامامي والخلفي ومتلازمه الاصباغ التشتتي وساد قليله الحدوث في متلازمه فرط مرونه المفاصل الحميد . | Background : Benign joint hypermobility syndrome (BJHS) is a hereditary connective tissue disorder, characterized by musculoskeletal pain and an excessive range of motion in joints . Many ocular manifestations of BJHS have been described, some being well - known associations and others reported for the first time in case reports .Objectives : The aim of this study was to evaluate the prevalence andcharacteristics of ocular involvement in a sample of Iraqi patients with BJHS. Patients and methods : A total of 300 individuals were included in this cross sectional study, 100 patients had benign hypermobility syndrome and another 200 healthy individuals matched in age and sex were taken as a control group.All patients undergone for opthalmological examination involved visual acuity assessment with Snellen chart, examination of anterior and posterior eye segments with the slit lamp, Schirmer test and corneal fluorescein staining and assessment of intraocular pressure with air puff tonometer.Patients had history of previous eye trauma, hypertension, diabetes mellitus, and overlap with other connective tissue diseases or inflammatory arthritis were excluded. Demographics and clinical data were collected including age, sex, BMI duration of symptom, data related to main disease manifestations and other related features to BJHS. The assessment of joint mobility was measured according to Beighton score method for all the participants in the study.Results : A total of 100 patients with (BJHS) enrolled in this study. Prevalence of refractive errors detected in 78% patients, myopia was detected in (49%), followed by astigmatism (20%) and hypermetropia (9% ) .The other identified ocular manifestation was dry eye (15%), While anterior & posterior blepharitis (5% and 4%) respectively. Pigment dispersion syndrome diagnosed in (3%) of patients and The last identified ocular manifestation was cataract which detected in about (2%) of BJHS patients.All previous findings were statistically significant except cataract not reach to statistically significant level. There were no significant correlation between age group, gender, type of common joint involved or degree of beighton score with increase risk of ocular manifestations .Conclusions : Ocular manifestations in a sample of Iraqi patients with BJHS were relatively common. The most common BJHS - related ocular findings were Myopia followed by, Astigmatism and hypermetropia. Dry eye symptoms, anterior and posterior blepharitis, pigment dispersion syndrome and cataract are rare in patients with BJHS.

الخصائص الوبائية لفتحات جدار القلب الخلقية للاطفال دون الخامسة الوافدين الى مستشفى ابن النفيس التعليمي، بغداد 2015 == Epidemiological characteristics of Under Five Children with Ventricular Septal Defects Attending Ibn - Nafees Teaching Hospital, Baghdad 2015

Author name: عمار حسن عبد القهار
Supervisor name: بتول علي غالب ياسين | علاء عبد الحسين الانباري
General topic: Medicine
Specific topic: Community Medicine
Degree: Master
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Globally at least eight of every 1,000 infants born each year have a heart defect, and as Ventricular Septal Defect (VSD) is the commonest among Congenital Heart Defect (CHD), this study aimed to assess the impact of VSD among CHD and its association with certain factors, and to assess the anthropometrical measures among children with CHD as well as assess nutritional state of their mothers. A hospital based cross sectional study on 349 under five children with CHD attending Ibn Al - Nafees Teaching Hospital were subjected to questionnaires prepared by the researcher. The nutritional status of under five children was assessed through an anthropometric measures (height and weight) and compared with z - score of CDC 2000, meanwhile 296 Mother’s Body Mass Index (BMI) was assessed to point out an association with CHD and VSD.It was found that 54.7% of CHD were VSD, 29.2% were ASD and the combination of VSD and ASD was on the top of congenital heart malformation 61.4%.CHD had increase relation with Father’s and Mother’s education and indirect relation with Mother’s age, also was higher (84.2%) among 20 - 39 years Mother and appear more often in children under one year 64.2%. The studied factors had no obvious influence on VSD rather than other CHD.Nutritional status of the study sample showed that wasted children was almost three times over normal distribution which exhibit acuteness with no evidence on disease chronicity, as shown the study sample showed close frequency distribution regarding stunting and underweight. Mother’s BMI exhibit a problem as 37.2% were overweight and 26.4% were obese.Interfamily marriage express 58.5% positivity and only 8.3% report positive family history. Anemia reported in 33% of Mothers and 30.4% address febrile illness during first trimester.This study observed no significant associations between VSD and other congenital heart defects in term of socio - demographic characteristic; residency, mother’s age, child’s age, Father’s and Mother’s education and consanguinity. Also no associations were found regarding family history, febrile illness, passive smoking, certain medication received, anemia and DM.

تاثير الارتجاع العضوي المزمن للصمام الاكليلي على وظيفة البطيي الايمن الانبساطية باستخدام دوبلر صدى القلب في عدة مراكز للقلب في بغداد == Impact of chronic organic mitral regurgitation on Right Ventricular Diastolic Function using Doppler echocardiographic study in Multi Cardiac Center in Baghdad

Author name: عطاء خليل طه
Supervisor name: غازي فرحان حاجي
General topic: Medicine
Specific topic: Echocardiography
Degree: Higher Diploma
University: University of Baghdad - Faculty Of Medicine
Language: English
University location: Baghdad
First pages:
Abstract: Background : To date, little is known regarding the effect of left ventricular volume overload on right ventricular diastolic function. We hypothesized that patients with chronic organic mitral regurgitation and preserved left ventricular systolic function might have subclinical right ventricular dysfunction, and related to pulmonary artery systolic pressure.Objective : To study the effect of left ventricular volume overload on right ventricular diastolic function by Doppler echocardiography in patients with chronic organic compensated mitral regurgitation.Patients and methods : A cross - sectional study held in multi cardiac center in Baghdad. From April 2015 to June 2016. Patients categorized in to two groups; Thirty - one were without pulmonary hypertension (group I, mean age 32±7.1 years) and thirty of patients were with pulmonary hypertension (group II, mean age 36.1±5.7years). All of them compared with sixty - one healthy individuals serving as a control group (group III, mean age 32.1±6.6 years). Transthoracic echocardiography (multiple views) M - mode, Two - dimensional and Doppler were done for all groups of study.Results : Conventional and tissue Doppler echocardiographic assessment of right ventricular diastolic function revealed impairment in up to 44.3% of patients, (19.4% in group I vs 70% in group II, P<0.001). Patients had lower right ventricular E - wave velocity, lower E/A ratio, and prolonged right ventricular isovolumic relaxation time compared to control. Tissue Doppler analysis showed lower E', and lower E'/A' ratio. All changes were statistically significant at P < 0.001). Patients with pulmonary hypertension were older with higher E/E' ratio in comparison to the other two groups (5.79±1.75 in group II vs 3.91±0.41, 4.08±0.93 in group III and I, respectively, P <0.001).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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