About Journal

  The Iraqi Postgraduate Medical Journal is a medical journal issued in English; it is concerned in all medical specializations.It started from year 2000. It is a peer-reviewed based publication and it is approved for scientific promotion purposes. It is considered an important source for many researchers. It is published quarterly and available in paper and electronic forms. Our journal got the ISSN (print: 1608-8360 -  online:  9893 - 2708) of UNESCO in Paris. It is indexed in: - Directory of Medical Journals for the Middle East Region, In 2005, it was selected to be one of...
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Evaluation of Full-Thickness Skin Grafting with De-Epithelialization of the Wound Margin for Finger Defects with E xposed Tendon

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 3, Pages 187-193

ABSTRACT:
BACKGROUND:
Full-thickness skin grafts are generally considered unreliable for coverage of full-thickness finger
defects with exposed tendons, but there are some clinical reports of its use in this context. In this
study, covering the exposed tendon with FTSG with de-epithelialization of wound edges was
chosen.
OBJECTIVE:
To evaluate the reliability of FTSG survival on an exposed tendon in full thickness finger defects.
PATIENTS AND METHODS:
From January 2017 to May 2018, nine patients (5 males, 4 females), with tendon-exposed defects of
12 fingers managed with FTSGs.This included marginal de-epithelialization of the normal skin
surrounding the defect, and preservation of the subdermal plexus of the central graft, and partial
excision of the dermis along the graft margin. The donor site was from mastoid, wrist or groin
region.
RESULTS:
Most of grafts (10 of 12 fingers) survived without significant surgical complications and achieved
satisfactory functional and aesthetic results.
CONCLUSION:
In this study graft survival was good, with no additional surgical injury of the normal fingers, and
satisfactory functional and aesthetic outcomes. However, few disadvantages like depression and
graft hyperpigmentation were recorded. Therefore, FTSG is an option for treatment of full-thickness
finger defects with the exposed tendon.

New Modification of Chevron Osteotomy in the Treatment of Hallux Valgus

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 3, Pages 194-198

BACKGROUND:
The Corless original chevron osteotomy is a 60 degree V shaped cut which had been described in
1976 to address some of the drawbacks in Mitchell's procedure, several modifications since there
had been added both to extend the indications and to improve the stability of the cheveron
osteotomy. In our study, we used the 90 degrees angle cut but kept the original Corless V shaped
osteotomy in order to retain the stability.
OBJECTIVE:
To evaluate the mechanical and the clinical results of these modifications.
PATIENTS AND METHODS:
From January 2016 until June 2018, 15 patients (16 feet) have undergone new modification of
chevron osteotomy in medical city teaching hospitals, their ages were (25-50) year, the median
age±SD was (40±8.3), 2 male (3 feet), and 13 female, the patients included in this study have
intermetatarsal angles 12-20 and hallux valgus angle 23-46 degree all of them complaining of pain
or bursitis at the bunion site or discomfort in shoe wear, and followed clinically and radiologically
for at least 1 year.
RESULTS:
The 15 patients included in this study have completed at least 6 months of follow up, the point at
which the final assessment was done, two of them were male (3 feet )(13.3%) their ages (43,45 y)
median 44.0 ± 1.4y , and 13 female (86.7%) their age range (23-50y) the median 38.0 ± 8.7y.
Significant improvements were noted in HVA (P- value 9.7x10-12 and IMA (P-value 1.6x10₋ 10)
measurements, also similar improvement were obtained about the functional outcome represented by
the AOFAS score results (P-value 6.4 x 10-9).
CONCLUSION:
Modified chevron osteotomy was useful and safe to address mild to moderately severe cases of
hallux valgus, our new modification render it more stable with a high union rate.

Effect of Saline Flush and Hand Elevation on the Onset, Time and Duration of the Action of Rocuronium

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 3, Pages 199-204

BACKGROUND:
Nondepolarizing neuromuscular blocking drugs (NMBDs) were developed as alternatives to Succinylcholine due
to its serious side effects. Rocuronium bromide has been suggested as the drug of choice when Succinylcholine is
contraindicated. Shortening the onset time of NMBDs is important in some situations, which can be achieved by
several techniques as the priming principle.
OBJECTIVE:
To evaluate the effect of fluid (normal saline) flush after Rocuronium bolus on the onset and
duration of action.
PATIENTS AND METHODS:
Sixty patients were divided randomly into two groups; each group had 30 patients: group (A) and group (B). All
of them have undergone surgical operations under general anesthesia. Rocuronium without normal saline was
received in induction by 30 patients (Group A), while Rocuronium followed by 20 ml normal saline flush and
hand elevation were received in induction by the other 30 patients (Group B). A peripheral nerve stimulator was
used to measure a train-of-four (TOF) stimulation. The time from the disappearance of T1 until the appearance of
T3 is the duration of the action of Rocuronium.
RESULTS:
In this study, means of time of onset were significantly higher in Group A than that in Group B
(61.12 versus 44.41 sec, P= 0.001), and duration of action was higher in Group B than that in Group
A but statistically not significant (40.87 versus 34.61 mints, P= 0.063).
CONCLUSION:
A 20 ml saline flush and hand elevation immediately after administering a Rocuronium bolus of (0.6 mg/kg)
decreased the onset time but did not significantly increase the recovery phase of Rocuronium. Therefore, we
recommend to use 20 ml Normal Saline flush and hand elevation after Rocuronium injection as a safe method to
get rapid onset for intubation especially when Suxamethonium is contraindicated

Maternal Serum Placental Leucine Aminopeptidase as a Predictor of Pregnancy Outcomes

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 3, Pages 0-0

BACKGROUND:
Placental leucine aminopeptidase is a glycoprotein, known as oxytocinase. It helps to maintain
normal pregnancy to term, also it is involved in fetal development, maintenance of homeostasis
during pregnancy, blood pressure regulation, memory retention, antigen presentation, and cancer
development.
OBJECTIVE:
To evaluate the value of maternal serum placental leucine aminopeptidase levels as a predictor of
pregnancy outcomes.
PATIENTS AND METHODS:
Hundred pregnant women were included in the study, they were divided into four groups, 25
pregnant women with hypertensive disorder of pregnancy, 25 pregnant women with gestational
diabetes and 25 pregnant women with intrauterine fetal death at a gestational age between 28 - 41
weeks, another 25 healthy pregnant women as a control group with gestational age range 37 - 40
weeks. Serum levels of placental leucine aminopeptidase were measured using Enzyme-linked
immunosorbent assay (ELISA) method for all study groups at the time of presentation. It is a case -
control study that was conducted at AL-Yarmook Teaching Hospital, department of obstetrics and
gynecology.
RESULTS:
Serum placental leucine aminopeptidase concentration significantly lower in pregnant women
presented with fetal death group was(mean ± SD)61.6 ± 15.8IU/ml compared to pregnant women
with hypertensive disorders in pregnancy, gestational diabetes mellitus and healthy pregnant women
were (83.2 ± 12.51IU/mL, 85.0 ± 13.11IU/mL and 108.9 ± 19.1IU/mL), respectively. Receiver
operating characteristic( ROC) curve analysis showed that the result of serum placental leucine
aminopeptidase level for predicting perinatal mortality among pregnant women was (optimal cut
point ≤78.98, sensitivity100%, specificity 73.3and accuracy 80.0%).
CONCLUSION:
Maternal serum placental leucine aminopeptidase was low among patients with hypertensive
disorders in pregnancy, gestational diabetes mellitus and much lower among patients presented with
fetal death compared to healthy pregnant women. Low serum placental leucine aminopeptidase level
had high sensitivity and specificity for predicting perinatal mortality.

Repair of Hypospadias Fistula Using a Penile Skin Advancement Flap with Penile Dartos Interposition

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 3, Pages 213-219

BACKGROUND:
Presence of various techniques in hypospadias repair is attributed to the relatively common
complications following those repairs which shown as an immediate and long term complication.
Urethrocutanous fistula is the commonest complication of the hypospadias repair , with a reported
incidence of 4-25%. The incidence is varying with severity of hypospadias, surgical techniques, and
experience of the operating surgeon.
OBJECTIVE:
To evaluate the efficacy of using a penile skin advancement flap with penile dartos Interposition to
repair hyposapadial fistula.
PATIENTS AND METHODS:
Between October 2017 and March 2018, eleven boys with urethrocutaneous fistula were included in
this study. Their age ranged between (3 years – 10 years ) . All were repaired with penile skin
advancement flap with dartos fascia as an interposed reinforcing layer in Al shaheed Ghazi
Al- Hariri hospital and Alwasity teaching hospital .
RESULTS:
Most of the patients showed no recurrence of fistulae after repair during follow up period which
extended for about 6 months postoperatively. Those pati-ents had good urine stream and straight
penis on erection without any torsion or deviation. No major complications were seen in all of these
patients.
CONCLUSION:
The penile skin advancement flap with interposition dartos is simple procedure which can be used
for surgical treatment of primary posthypospadias fistula of any size, site provided that there is
adequate pliable durable penile skin .

Prevalence of Exclusive Breastfeeding and Some of Its Determinants in Hilla City, 2018

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 3, Pages 220-225

BACKGROUND:
Health organizations recommended that mothers exclusively breast feed infants for the first six
months of life. Breastfeeding is a natural food that serves as a complete source of infant nutrition
for the first six months of life. It contains all the necessary nutrients provided in a bioavailable and
easily digestible form, protecting both mothers and children against illnesses and diseases with
immunological properties. Place of delivery in many study showed positive effect of rate of
exclusive breast feeding.
OBJECTIVE:
The study aimed to estimate the prevalence of breastfeeding in Hilla city and the rate of delivery in
different sites and to identify relationship between exclusive breastfeeding habit and place of
delivery.
PATIENTS AND METHODS:
This cross sectional study was conducted between the first of April and the first of July of 2018, in
which 520 mothers were included and attending vaccination unit in PHCC in Hilla city. A selfconstricted
questionnaire form was used to collect the required data. Data entry and analysis was
done by using SPSS program version 23.
RESULTS:
The mean age of mother’s was26 ±6.1 years, the percentage of exclusive breast feeding was
49.6%,the percent of delivery in the baby friend hospital was 30.6%.Mother age, type of delivery,
who attended the delivery, and the type of feeding used by the mother in her previous infant was the
factors that contributed for practicing exclusive breastfeeding.
CONCLUSION:
The prevalence of exclusive breast feeding in Hilla city is fair and agrees with the rate reported in
other parts in Iraq.

Prevalence and Risk Factors of Low Birth Weight in Al- Elwiya Maternity Teaching Hospital in Baghdad

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 3, Pages 226-230

BACKGROUND:
Low birth weight as a public health indicator and determinant of perinatal mortality should always
be monitored. Attempts to trace possible risk factors and prevalence of low birth weight should not
be wasted.
OBJECTIVE:
Finding the prevalence of low birth weight in Al-Elwiya maternity teaching hospital in Baghdad in
2011 and 2012 and studying risk factors associated with a sample of low weight neonates born in
the hospital.
PATIENTS AND METHODS:
Prevalence of low birth weight in Al-Elwiya maternity teaching hospital in 2011 and 2012 was
obtained through reviewing data registered in the hospital′s medical statistics unit and inpatient
medical records unit, while risk factors were traced through conducting a case control comparison
by collecting 100 cases and similar number of controls using direct interview questionnaire with
the mothers who laboured in the hospital.
RESULTS:
The calculated prevalence of low birth weight in Al Elwiya hospital was slightly higher than
the national figure, and the risk factors found statistically significant for low birth weight were;
multiparty, anaemia, urinary tract infection, chest infection, passive smoking and level of education.
While age, antepartum haemorrhage and pregnancy induced hypertension found insignificant.
CONCLUSION:
Prevalence of low birth weight in the hospital is slightly higher than the national figure although
the latter was not published, all factors affecting birth weight were controllable.

The Use of Limberg Flap in the Management of Sacrococcygeal Pilonidal Sinus

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 3, Pages 231-238

BACKGROUND:
Sacrococcygeal pilonidal sinus disease is a common condition that commonly seen in young adult
males. It is disease that have high rates of morbidity unless properly identified and treated.
OBJECTIVE:
To study the procedure of Limberg flap reconstruction and to evaluate the results and success of
Limberg flap reconstruction in pilonidal sinus disease management.
PATIENTS AND METHODS:
40 patients with pilonidal sinus disease selected randomly, rhomboid excision with Limberg flap
was done for them. Duration of operation, postoperative pain, duration of hospital stays and
postoperative complications were noted. Follow up of all patients was performed on an out-patient
basis.
RESULTS:
Our study consists of 40 patients, 35males (87.5%) and 5 females (12.5%), with a mean age of 27.2
years range (18-36 years). The mean duration of symptoms was 2.25 months (range 1–3 months).
Mean operative time was about 42.2 minutes (range 40-45 minutes), time to return to work and
normal activities from 3 to 4 weeks. Postoperative complications occur in 4 patients in the form of
wound infection and seroma.
CONCLUSION:
Limberg rhomboid flap in sacrococcygeal pilonidal sinus is useful in primary pilonidal sinus and in
recurrent cases, has been associated with lower complication rates, healing time, and recurrence
rates, and it is an easily mastered technique.

Applying P40 and TTF-1 in the Subtyping of Poorly Differentiated Non-Small Cell Lung Carcinoma in Bronchoscopic Biopsy

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 3, Pages 239-245

BACKGROUND:
Lung cancer is the leading cause of cancer-related deaths worldwide, regardless of gender. It is
categorized into two main groups: small cell lung carcinoma (SCLC, 15% of all lung cancers) and
non-SCLC (NSCLC, 85% of all lung cancer). Increasing knowledge of the molecular pathology of
lung cancers has led to their classification into specific subtypes according to appropriate treatments
and molecular-targeted therapies.
OBJECTIVE:
Evaluation of the expression of P40 and TTF-1 in randomly selected samples from Iraqi patients
who have NSCLC and correlate their expression with the clinicopathological variables.
PATIENTS AND METHODS:
This is a retrospective study of 40 patients who were diagnosed to have NSCLC. Formalin fixed,
paraffin embedded tissue blocks.P40 and TTF-1 immunoreactivity and pattern of staining were
evaluated in immunohistochemical stained slides and correlated the results with clinicopathological
parameters.
RESULTS:
55% of the tumors were squamous cell carcinoma while 45% were adenocarcinoma. The sensitivity
and specificity of P40 for the SQC diagnosis were 100% while the sensitivity of TTF-1 for ADC
diagnosis was 88.9% and specificity was 100%.
CONCLUSION:
P40 and TTF-1 can be used as a reliable minimalistic panel for accurate subtyping of NSCLC.

Classical Laparoscopic Cholecystectomy (CLC) versus Mini Laparoscopic Cholecystectomy(MLC). Is It Worthy?

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 3, Pages 246-251

BACKGROUND:
Laparoscopic chohecystectomy is the standard operation for cholelithiasis and replaced the classical
open cholecystectomy as it has better outcome.
OBJECTIVE:
The purpose of this study is to make a comparison between classical laparoscopic cholecystectomy
(CLC)and Mini laparoscopic cholecystectomy (MLC).
PATIENTS AND METHODS:
This study was conducted in Al-Jumhoori Teaching Hospital during the period from 10th February
till 15th may 2019. It involved 30 patients with symptomatic gallstones randomly divided into
2 groups (the first group treated with CLC while the second group treated with MLC);the intra and
post operative complications were recorded for comparison.
RESULTS:
Thirty patients involved in this study and divided randomly in two groups ;Group (A) age (average
38 years )and their BMI (average 36 kgm2) underwent CLC ,while group (B) age (average 28 years)
and their BMI (average 31kgm2). The mean operative time in CLC was 42 minute while MLC
recorded time was 51minutes. The MLC group has less post operative pain, better cosmetic results
with comparable hospital stay ,but two cases converted from MLC to CLC.
CONCLUSION:
MLC can be performed safely and although it takes more time than CLC ,but has less post operative
pain and more patient satisfaction with comparable hospital stay

Sutureless Total Abdominal Hysterectomy Using Marclamp® IQ : A Prospective Cross-Sectional Study

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 3, Pages 252-259

BACKGROUND:
Hysterectomy, the second most common surgical procedure performed in female patients, is
associated with various complications like other major surgical procedure.To reduce such
complications and shorten both ,the operating time and the intraoperative blood loss, sutureless
hysterectomy was recently practiced using novel vessel sealing devices as marClamp® IQ and
LigaSure.
OBJECTIVE:
To compare the outcomes of marClamp® total abdominal hysterectomy (TAH) versus total
abdominal hysterectomies performed by LigaSure and suture ligature techniques of other studies.
PATIENTS AND METHODS:
A total of 47 female patients presenting with various benign and malignant uterine and malignant
ovarian diseases were suturelessly hysterectomised using marClamp® .
Main outcome measures: The primary outcome measures were: the operating time and blood loss
while the secondary outcome measures were: intraoperative and post-operative complications,
hospital stay and histopathologic results of the removed specimens.
RESULTS:
Operating time of marClamp®: TAH only, TAH +bilateral salpingo-oopherectomy (BSO),
TAH+BSO+ infracolic omentectomy and total study group were: mean±SD = 60.91±8.31minute
(m) ,75.93±14.61m, 83.89±13.18 m and 73.94±15.11m respectively (P-value =0.001, it was
statistically significant ). The intraoperative blood losses of marClamp®: TAH only, TAH + BSO,
TAH+BSO +infracolic omentectomy and total study group were: mean±SD = 64.09±8.61 mililiter
(ml) , 85.74±17.30 ml ,103.33±20.62 ml and 84.04±20.71 ml respectively (P-value =0.000, it was
statistically significant ). Hospital stay of this study was mean±SD =2.08±0.59 day. This study had
no intraoperative complications .Its postoperative complication rate was 10.63 %. Premenopausal
simple endometerial hyperplasia with / without atypea was the most common histopathologic variety
(51%) .This study had no mortality during the follow-up period.
CONCLUSION:
The use of marClamp® IQ device can reduce operating time, intraoperative blood loss,
intraoperative and postoperative complication rates and the hospital stay. Thus it is cost-effective.
It allows quick and secured hemostasis compared with the conventional suture ligature technique.

Focal Dermal Hypoplasia )Goltz Syndrome(

Luay Abdulla Al-Nouri

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 1, Pages 110-112

ABSTRACT:
BACKGROUND:
Focal Dermal Hypoplasia (FDH) is a condition of multiple features . It is important to recognize on clinical grounds , as it may show life threatening complications that need to be dealt with by properly timed interventions

The Role of Repaglinide in the Management of Type 2 Diabetes Mellitus

Abbas M Rahmah; Majid R Al-Zaidee; Roaa abbas

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 1, Pages 51-56

ABSTRACT:
BACKGROUND :
Repaglinide belongs to the meglitinide class of blood glucose-lowering drugs.
Repaglinide lowers blood glucose by stimulating the release of insulin from the pancreas.
It achieves this by closing ATP-dependent potassium channels in the membrane of the
beta cells. This depolarizes the beta cells, opening the cells' calcium channels, and the
resulting calcium influx induces insulin secretion.
OBJECTIVE:
To evaluate the effect of repaglinide as a monotherapy or in combination with metformin on
controlling the fasting plasma glucose, postprandial plasma glucose, HBA1C, and body weight in
61 patients with type 2 diabetes mellitus, (DM).
PATEINTS & METHODS:
During the period between February 2005 and October 2005, the effects of repaglinide
has been reviewed in 61 patients with uncontrolled Type 2 diabetes mellitus (T2DM),
they are divided into two groups depending on their previous treatment , the 1st group
included 43 of them were on metformin while the remaining 18 patients were on diet
only. Weight, HBA1c, FPG and PPG were checked after 3 and 6 months.
RESULTS:
It has been found that six months after using Repaglinide in combination with metformin or as a
monotherapy cause significant reduction in HBA1c, from 9.8 to 8.1% (P < 0.01) in 1st group, and
from 7.9 to 6.7%, (P < 0.01) in 2nd group and a significant reduction of FPG from 214.0 mg/dl to
148.5 mg/dl (P < 0.01) in 1st group and from 170.7 mg/dl to 130 mg/dl (P < 0.01) in 2nd group.
While the PPG shows a decrement from 255.6 mg/dl to 178.8 mg/dl, (P < 0.01) in 1st group and
from 248.3 mg/dl to166.1 mg/dl (P < 0.01) in 2nd group. There’s no significant weight gain thus
mean weight rose from 84.4 Kg to 84.6 Kg, (P > 0.2) in 1st group and from 75.1 kg to 76.1 kg (P >
0.2) in 2nd group .
CONCLUSION:
Repaglinide when used as monotherapy or in combination with metformin improve
overall glycemic control and significantly reduced HBA1c but have no significant
change in body weight

Troponin Positive Acute Coronary Syndrome with and without Significant Stenosis on Coronary Angiography

Mohammed Hilal AL-Ali; Hassan A. Farhan

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 2, Pages 237-243

ABSTRACT:
BACKGROUND:
Occasionally, coronary arteries without significant stenosis are observed during invasive treatment of acute coronary syndrome (ACS).
OBJECTIVE:
The aim was to study the frequency and to determine the most predictive factors of Troponin positive ACS without significant Stenosis on angiography.
METHODS:
The study involved one hundred twenty four patients admitted with Troponin positive ACS who underwent cardiac catheterization during hospitalization. The primary end-point was the estimation of coronary arteries without significant stenosis, and the secondary end-point was analysis of the most predisposing factors. In evaluating the primary end-point, the patients were divided into two groups according to the presence of ST elevation myocardial infarction (STEMI) or not. Also the patient who has no significant coronary artery Stenosis (< 50%) was subdivided to two groups:
a- Myocardial Infarction with No critical lesion in Coronary angiogram (MINC)
b- Normal coronary angiogram
RESULTS:
Overall, 20 patients (16%) had coronary arteries without significant lesions, from which 8 patients (6.4%) had MINC and 12 patients (9.6%) had normal coronary angiogram. The predictors were: female sex (P=0.008), age <45 years (P=0.001), and the absence of: diabetes (P=<0.001), hypertension (P=0.005) and absence of ST-segment elevation (P=0.001). Furthermore absence of regional wall motion abnormality (RWMA) is considered as another predictors for non-significant coronary artery lesion (P=0.008). Also the angiographic analysis of all lesions revealed that single vessels CAD are the commonest finding in Group I patients (P= 0.02). We further analyzed a suspicious angiographic lesions by using QCA {18 lesions (14.5%)} and FFR {6 lesions (4.8%)} technique.
CONCLUSION:
Overall, patients with Troponin positive ACS had non- significant coronary artery Stenosis on angiography, and female sex, age <45 years and the absence of diabetes, hypertension, ST- segment elevation or RWMA were all associated with coronary angiography showing no significant stenosis.

Prevalence of Pressure Ulcers in Orthopaedic Patients

Ali M. Al-Shadedi

Iraqi Postgraduate Medical Journal, 2012, Volume 11, Issue 4, Pages 529-535

ABSTRACT:
BACKGROUND:
Pressure sore in orthopedic patients is a common problem with high expectation of occurrence on the ward, it should be watched for in any admitted patient having high liability for its development like, old age particularly those patients with dementia, patient with malnutrition or anemia and long stay in bed or complicated multiple surgeries.
Orthopedic staff should be familiar with measures required to prevent and reduce its occurrence.
OBJECTIVE:
To highlight the prevalence, onset, types and number and the most common sites of pressure sores, length of stay in hospital with various types of treatment delivered to these patients in orthopedic wards.
PATIENT AND METHODS:
215 patients were admitted with orthopedic problem for treatment and observed for the possibility of occurrence of pressure ulcer in orthopedic ward. The data collection period was over five years; these patients were treated for trauma to proximal femur, hip joint, pelvis and elective surgery at Al-Sader teaching Hospital of Kufa College of Medicine in Najaf City and Al-Yarmouk teaching Hospitals of Al-Mustanseria College of medicine in Baghdad city. Braden scale was used for predicting pressure ulcer and for assessing these patients.
RESULTS:
215 patients were assessed for being at risk of developing pressure sores by using Braden scale for predicting pressure ulcer. 60 patients with various levels of risk factors with prevalence of 27.90% developed the pressure sores. The age range of patients with pressure ulcer was 42-77 years, with mean age of 63.2 years. Female patients were 40 and male patients were Pressure sores developed in 42 [70%] patient with trauma out of 60 patient under study, 10 patient 16.6% with elective surgery patients, two patients 3.32% conservatively treated patients, and 6 patients 9.96% treated for removal of old implants.13 patients developed ulcer at the first week and 10 patients developed pressure ulcer at the second week of their stay in orthopaedic ward and the rest 37 patients developed it after the second week of their stay in the ward. .
CONCLUSION:
Prevention of pressure ulcer requires the collaboration of all the nursing and surgical staff from different specialty like orthopaedic surgery. Development of pressure sore is the cause behind delay of patient discharge after successful surgery. Expectation of the development of bed sore is significantly high in elderly or bed ridden and hemiplegic patients

“Cytomegalovirus Seroprevelance in Iraqi Pregnant Women”

Sajed Nader; Mohammed Ayad

Iraqi Postgraduate Medical Journal, 2012, Volume 11, Issue 3, Pages 303-307

ABSTRACT:
BACKGROUND:
Cytomegalovirus is the commonest cause of congenital viral infection in the developed and developing countries. It is a symptomatic in 90% of infected females. Forty percent of pregnant females transmit the virus to their fetus. Ten percent of born infants whom gain the virus will get the clinical signs plus its neurological sequelae.
OBJECTIVE:
To outline the relationship between Cytomegalovirus infection among pregnant women and its influence upon their pregnancy outcome.
PATIENTS AND METHODS:
A case-control study was carried out was carried out in the teaching laboratories – medical city, Baghdad through a period from June 2010 till March 2011; upon 165 pregnant women whom taken as a patient group. Blood samples were taken from them and Cytomegalovirus-IgM antibodies plus Cytomegalovirus-IgG antibodies levels were measured via Elisa technique in both to evaluate the viral infection if present or not.
RESULTS:
The usual age whom attended the gynea-obestetric clinics were the age group from 11-19 years old 73 cases (44.24%); Next came the age group from 20-29 years old 66 cases (40.00%), thirdly was the age group from 30-39 years old 20 cases (12.12%), Lastly was the age group from 40-49 years old 6 cases (3.64%). The concentration of CMV-IgG among females whom attended clinics were seropositive in nearly half the included cases 66/165 (40.0%); while the CMV-IgM concentration was within the seronegative limits. Secondly came another group of patients with seronegative limits regarding both the CMV-IgM and CMV-IgG antibodies 56/165 cases (33.94%), next 30/165 cases (18.18%) were seropositive in their results pointing to both CMV-IgM and IgG limits; and this might be a middle point distance between the previous group and the last group were the CMV-IgM was positive and the CMV-IgG concentration was negative 13/165 cases (7.88%).
CONCLUSION:
Cytomegalovirus-IgG antibodies got important role as a protective agent against gestation abortion, if Cytomegalovirus-IgM antibodies are seropositive alone this is a risky factor to the pregnancy outcome

Pregnancy with Stroke

Abathar Qahtan

Iraqi Postgraduate Medical Journal, 2012, Volume 11, Issue 4, Pages 490-495

ABSTRACT:
BACKGROUND:
Although stroke in pregnancy is uncommon, the risk of stroke is increased during pregnancy and puerperium, and considered a major contributor to the serious morbidity and mortality of pregnancy
OBJECTIVE:
This study had been designed to find the frequency of stroke in relation to different periods of pregnancy and puerperium, to assess the effect of variable risk factors and their association with stroke and to verify which type of stroke is more frequent among pregnant ladies
METHODS :
This is a cross sectional study that enrolled 30 pregnant patients who had stroke either during pregnancy or puerperium and being admitted to the Neurology words of Al-Yarmouk, Baghdad and Al-kadhemia teaching hospitals during the period from the 1st of January, 2001, to the 31st of December, 2002. All of the patients, who had been included in this study, had been subjected to detailed history, physical and neurological examinations and investigations.
RESULTS:
19 patients (63.3%) of the sample included in this study acquired stroke during pregnancy while 11 patients (36.3%) had developed stroke during puerperium. 2/3rd of the sample had ischemic stroke. Impaired consciousness was the commonest presenting symptom with a frequency of 50% of the sample, cerebellar signs were the least observed signs, in the other hand; all of the patient included in this study had motor dysfunction during the disease course. 53.3% of the sample was hypertensive 6.7 % was diabetic, while 36.7% of them had no significant past medical history. Oral contraceptive pills had been used by 50% of the sample, 2/3rd of those using oral contraceptive pills had ischemic stroke. 63.3% of the sample had cesarean delivery, 50% of the sample had history of abortion, 60% of whom had positive history of recurrent abortion.
CONCLUSION:
This study revealed that most of stroke happened during the 3rd trimester and early weeks of puerperium. Being hypertensive, whether pregnant related or not, is the most important risk factor, in addition, other recognized risk factors included diabetes mellitus and use of oral contraceptive pills.

The Outcome of Two Modes of Treatments in Patients with Posterior Urethral Valve

Saad Dakhil Farhan Daraji

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 2, Pages 203-208

ABSTRACT:
BACKGROUND:
The obstructive effect of the posterior urethral valve (PUV) can manifest along a spectrum of severity, ranging from disease incompatible with postnatal life to conditions that have such minimal impact that they may not manifest until later in life.
OBJECTIVE::
To compare the outcome of patients with PUV underwent both techniques of PUV incision and primary urinary diversion (with a delayed PUV incision).
PATIENTS AND METHODS:
A prospective and retrospective study of twenty-eight children with posterior urethral valve was conducted. Details of age, presenting symptoms, serum creatinine, ultrasound and Voiding cystographic (VCUG) findings, the presence or absence of vesicoureteric reflux and the type of surgical interventions done were recorded. On the follow-up between 1- 2 year period, the patients were assessed by progression of the clinical state, biochemical analysis and ultrasound of the abdomen. Outcomes of surgery and further surgical intervention also assessed in addition to the assessment of the bladder function for older children.
RESULT:
The primary treatment of the PUV was with incision of the PUV in 13 cases (46.4%) while the primary treatment with urinary diversion and delayed incision of the PUV was performed in 15 cases (53.3%). A posterior urethral valve incision was cured in 46% of patients, while the primary diversion and the delayed incision operation was cured in 26.6%; Most of the patients (60.7%) still needed further urological intervention. There was no statistical significance between the results of both surgical procedures. Renal impairment and poor bladder function were more common with diversion operation.
CONCLUSION:
There is no convincing evidence to support any procedure as a way of improving long-term renal function or long-term bladder function. Therefore, urinary diversion is to be considered in selected cases with clear goals and endpoints in mind as it has an important place in the management of boys with PUV.

Pulmonary Function Test in Cement Workers in Iraq

Haider Noori Dawood; Abdul Razak Makki Abd Lrazak; Adnan Majeed Muhasen

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 1, Pages 85-89

ABSTRACT:
BACKGROUND:
Exposure to cement dust has long been associated with the prevalence of respiratory symptoms and decline in pulmonary function.
OBJECTIVE:
This study assessed the effect of exposure to cement dust on lung function in cement factory workers in Iraq , by measuring Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), FEV1/FVC ratio and Forced Expiratory Flow 50% (FEF50%).
PATIENTS AND METHODS
180 workers enrolled in the study , 171 , are male (93.44%) and only 12 are female(6.56%). and 100 workers controls (non exposed) were selected.The age of the subjects ranged between 20-50 years. Both groups were smokers and non smokers, had no chronic pulmonary diseases or symptoms during the time of study. Spirometeric study was used to measure FEV1, FVC, FEV1/FVC ratio and FEF50% .
RESULTS:
Statistically, significant reduction in FEV1 and the FEV1/FVC ratio were found in exposed workers when compared to control. Lung
function indices were found to be not affected with increasing duration ofexposure to cement dust nor with smoking.
CONCLUSION:
Exposure to Portland cement dust may result in reduction in the pulmonary function and may lead to respiratory diseases.Implementing measures to control dust and providing adequate personal respiratory protective equipment for the production workers are highly recommended

“Cytomegalovirus Seroprevelance in Iraqi Pregnant Women”

Sajed Nader; Mohammed Ayad

Iraqi Postgraduate Medical Journal, 2012, Volume 11, Issue 3, Pages 303-307

ABSTRACT:
BACKGROUND:
Cytomegalovirus is the commonest cause of congenital viral infection in the developed and developing countries. It is a symptomatic in 90% of infected females. Forty percent of pregnant females transmit the virus to their fetus. Ten percent of born infants whom gain the virus will get the clinical signs plus its neurological sequelae.
OBJECTIVE:
To outline the relationship between Cytomegalovirus infection among pregnant women and its influence upon their pregnancy outcome.
PATIENTS AND METHODS:
A case-control study was carried out was carried out in the teaching laboratories – medical city, Baghdad through a period from June 2010 till March 2011; upon 165 pregnant women whom taken as a patient group. Blood samples were taken from them and Cytomegalovirus-IgM antibodies plus Cytomegalovirus-IgG antibodies levels were measured via Elisa technique in both to evaluate the viral infection if present or not.
RESULTS:
The usual age whom attended the gynea-obestetric clinics were the age group from 11-19 years old 73 cases (44.24%); Next came the age group from 20-29 years old 66 cases (40.00%), thirdly was the age group from 30-39 years old 20 cases (12.12%), Lastly was the age group from 40-49 years old 6 cases (3.64%). The concentration of CMV-IgG among females whom attended clinics were seropositive in nearly half the included cases 66/165 (40.0%); while the CMV-IgM concentration was within the seronegative limits. Secondly came another group of patients with seronegative limits regarding both the CMV-IgM and CMV-IgG antibodies 56/165 cases (33.94%), next 30/165 cases (18.18%) were seropositive in their results pointing to both CMV-IgM and IgG limits; and this might be a middle point distance between the previous group and the last group were the CMV-IgM was positive and the CMV-IgG concentration was negative 13/165 cases (7.88%).
CONCLUSION:
Cytomegalovirus-IgG antibodies got important role as a protective agent against gestation abortion, if Cytomegalovirus-IgM antibodies are seropositive alone this is a risky factor to the pregnancy outcome

Primary Repair of Unilateral Cleft Lip Nasal Deformity

Zakaria Y.Arajy; Ahmed A.M.Nawres

Iraqi Postgraduate Medical Journal, 2009, Volume 8, Issue 3, Pages 212-219

ABSTRACT:
BACKGROUND:
There is a growing attitude towards correcting the nasal deformity in conjunction with primary repair of cleft lip. Many studies had concluded that this repair will not affect the nasal cartilages growth; it usually reorients the deformed nasal cartilages into a near normal position, and will allow a better growth pattern.
OBJECTIVE:
This study was conducted to document the pattern of primary unilateral cleft lip nasal repair and to evaluate the medium term outcome.
METHODS:
A total of 33 babies with unilateral cleft lip deformities underwent simultaneous nasal correction with their lip closure, between March of 2004 and April of 2008.Through short nostril rim incision, alar suspension to the dorsal skin at the nasion and interdomal sutures were performed primarily. Alar transfixion stitches were used to maintain the new position of the suspended cartilages.
RESULTS:
The average follow up periods were 3 years (ranging from 1 – 5 years).The results were assessed by 4 parameters: Nostril asymmetry, nasal dome projection, alar buckling deformity, and flaring deformity of the alar base. Eleven patients had good results, 16 patients had acceptable results, and 6 patients had poor results.
CONCLUSION:
Alar suspension is a relatively simple effective procedure for the primary correction of cleft lip nasal deformity. Short nostril rim incision can be relied on to access the alar dome and facilitate insertion of suspension sutures. Weather it interferes with nasal growth or not, it is necessary to have a long period of follow up to answer this question.

Publisher: The Iraqi Board for Medical Specializations

Email:  ipmj2000@yahoo.com

Editor-in-chief: Prof. Yasir M.H. Hamandi

Managing Editor: Prof. Abdul Munem AL- Dabbagh

Print ISSN: 1608-8360

Online ISSN: 9893-2708

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