Iraqi Medical Journal

Iraqi Medical AssociationVolume 65, Number 1, January 2019,

imj Iraq Medical Journal — 2019-06-01

Editorial Director Prof. Abdul Ameer Mohsin Hussein FICMS, FACS, FRCS
Editor-in-Chief Prof. Haider Abdul Hussein Ahmed FICMS CABS
Executive Editorial Board
Usama S Al-Nasiri, DS, FRCS
Najib S Jabbo, FRCS
Bassam H Al-Jarrah, DL, FICMS
Jamal R Al-Rawi, MSc, FICMS (D&V)
Farqad B Hamdan, MSc PhD
Yasir M H Hamandi, FIBMS
Sabah M Fadhil, MD FICMS
Ali Al Sultany, DM CABM. FRCP
Mohammed H Al-Musawi FICMS
Ahmed S Alnuaimi PhD
Secretory;
Lina Rafia Mohamed Ali Al-Mukhtar
Iraqi Medical Journal (IMJ)
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Website of IMA: www.ima.org.iq
Website of IMJ: imj.edu.iq
E-mail: imj_ima@yahoo.com

Preoperative Risk Factors Affecting Conversion of Laparoscopic to Open Cholecystectomy Adil Rahman Faraj Al-Budaerany* FICMS, Muatez Mundhir Manhal* FIBMS, Jaber Qataa Jaber Al-Mohammedawi* FICMS

IMJ IMJ — 2019-06-15

ABSTRACT
Background: Conversion from laparoscopic cholecystectomy to an open procedure is necessary in 5-10% of patients, and is associated with increased morbidity, prolonged hospitalization and longer recovery compared to a laparoscopic approach.
Objectives: To evaluate the preoperative risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy.
Methods: A cross-sectional case series study included 100 patients who underwent laparoscopic cholecystectomy conducted in the surgical unit, department of surgery, Al-Khidhir Hospital in Al-Muthanna province during a period of 18 months from July 2016 to January 2018. Patients diagnosed with malignancy and patients with incomplete information with respect to anthropometry, laboratory investigations, and ultrasound findings were excluded from the study. Preoperative variables were compared between those patients who underwent laparoscopic surgery, and those that required conversion to open surgery. The operative findings and intraoperative complication was recorded.
Results: The most common cause of conversion from laparoscopic cholecystectomy to open cholecystectomy was dense adhesion with unclear Calot’s triangle (66.7%). The rate of conversion to open cholecystectomy was significantly higher among patients aged ≥ 50 years (17.1%, P=0.048), male patients (30.4%, P=0.002), patients with history of previous scar (66.7%, P=0.001), with a history of ERCP (37.5%, P=0.003), with gall bladder thickness of ≥ 4mm (44.4%, P=0.001), with dilated CBD (50%, P=0.001) and with previous attacks of acute cholecystitis (26.3%, P=0.003).
Conclusion: Major risks for conversions in this study is due to disturbed anatomy either from dense adhesions or anatomical variations, and in male gender, aging, previous abdominal scar, recurrent attacks of acute cholecystitis, history of ERCP and dilated CBD.

Histopathological Changes in the Placenta of Pregnant Women with Gestational Diabetes Mellitus and Fetal Outcome Miami Abdul Hassan Ali* FICOG, Eaman Marouf Muhammad FICOG ABOG, Sarah Salim Hasan MBChB, Thaeer Jawad Kadem** FIBMS

IMJ IMJ — 2019-06-15

ABSTRACT
Background: Proper fetal growth depends on proper development and function of the placenta. Gestational diabetes mellitus (GDM) lead to an abnormal placental development and affect its function.
Objective: To study histopathological changes in the placenta of pregnant women with GDM and to compare these changes with that of women of normal pregnancy.
Methods: This was a case-control study carried out at Al-Yarmouk Teaching Hospital, department of obstetrics and gynecology between January 1st 2016 and January 1st 2017. The study included 120 pregnant women, 60 with gestational diabetes mellitus (study group), and 60 women with normal pregnancy (control group), the placental tissues of all pregnant women were examined both grossly and histologically after delivery. The fetal outcomes were noted.
Results: Gross examination of the diabetic placenta showed increased weight, diameter, number of cotyledons, p value (<0.001). Microscopic examination of the diabetic placenta showed the following changes: villous edema, villous fibrin (focal and perivillous) and increased syncytial knotting, p value (<0.001). Fetal outcome include increased birth weight, macrosomia, p value (<0.001), and low Apgar score at 1 minute, p value (0.043) and low Apgar score at 5 minutes, p value (0.022).
Conclusion: Gestational diabetes mellitus lead to changes both grossly and histologically in the placenta and may affect its function and consequently fetal growth and development.

Association between Spontaneous Abortion and Human Papilloma Virus Infection in Mosul Province, Iraq May Majdi Abdulmaged* DGO

IMJ IMJ — 2019-06-15

ABSTRACT
Background: In pregnant women or in their partners, Human Papilloma Virus infection can be considered as a risk of preterm birth, abortions and virus transmission to the newborn.
Objectives: To find association between Human Papilloma Virus infection and spontaneous abortion and to detect the associated risk factors.
Methods: A case-control study that was conducted in Obstetrics and Gynecology Department of Al-Khansaa Teaching Hospital in duration of one year from Jun 2017 to May 2018. It included 60 pregnant women with spontaneous abortion (case group), and 60 pregnant women ended with viable full term pregnancy (Control group). Age < 18 years, chronic medical disease during pregnancy or multiple pregnancy, premature rupture of membrane or preterm or post term labor, history of previous three or more recurrent abortions were excluded. Human Papilloma Virus test was done by performing polymerase chain reaction test from a sample had been taken from each pregnant woman.
Results: The majority did not have Human Papilloma Virus infection (88.3%), while 11.7% had. Human Papilloma Virus infection presented in higher rate in women who had abortion that occurred in the 1st trimester (20.6%). Significant higher proportion of study patients with Human Papilloma Virus infection were ended with abortion (78.6%, P=0.022). Human Papilloma Virus infection was significantly seen among patients with previous history of abortion and in patients who currently use oral contraceptive pills (25.6%, P=0.001 and 20.5%, P=0.022 respectively).
Conclusion: Human Papilloma Virus prevalence is higher in pregnancy with spontaneous abortion compared to women experience a normal full term pregnancy. Previous history of abortion and current use of oral contraceptive pills were modifiable risk factors associated with Human Papilloma Virus infection.

Ultrasound-Guided Removal of Soft Tissue Foreign Bodies

IMJ IMJ — 2019-06-15

ABSTRACT
Background: Foreign bodies in the soft tissues are common, and usually consist of wooden or metal splinters or glass shards. Failure to remove foreign bodies (FBs) may lead to infection, inflammation or possible allergies.
Objectives: To study the advantage of using ultrasound guidance removal of foreign bodies in soft tissues, which at times mostly are difficult to access, costly and technically challenging.
Methods: This is a retrospective study, which was carried out at Ibn-Alnafees hospital in Baghdad from the first of January 2010 to the first of January 2017 on cases with suspected foreign bodies found in the soft tissues. Ultrasound systems were used with high-frequency linear-array probes to specify their locations in order to remove the foreign bodies.
Results: Forty-four patients (42 males and 2 females aged 6 to 68 years, with a mean age 33.4 years and SD ± 13.2 were included. One patient had 2 foreign bodies in his body, another patient had 3 foreign bodies (total 47 foreign bodies). These patients underwent ultrasound-guided removal of the foreign body; two patients were operated upon after few days to remove a foreign body for a second attempt under local anesthesia. Six patients had wound infections postoperatively.
Conclusions: Ultrasound-guided removal of a foreign body found in the soft tissues is a good alternative to surgery as it is relatively straightforward, inexpensive, repeatable and carries a low risk of complications. In addition, failure to remove a foreign body does not preclude traditional surgical removal.

Study of Methylene Tetrahydrofolate Reductase enzyme Activity in Diffuse Large B-cell Non-Hodgkin's Lymphoma Patients Ali Abdulhur Arnos* PhD, Waseem F Al Tameemi** MD CABM, Noor Mustafa Ali* PhD

IMJ IMJ — 2019-06-16

Background: Diffuse large B-cell lymphoma is a heterogeneous disease with recognized variability in clinical outcome, genetic features, and cells of origin. It is the most common lymphoid malignancy in adults, comprising almost 40% of all lymphoid tumors.
Objective: To study of methylene tetrahydrofolate reductase in diffuse large B cell non-Hodgkin lymphoma patients.
Methods: This case control study was conducted during the period from April 2015 to December 2015 on 55 patients 19 patients before treatment and 36 patients after treatment. The patients were diagnosed as having diffuse large B cell non-Hodgkin lymphoma. Those patients were attending the Medical City Hospital in Baghdad and Immammain Kadhimain Medical City Hospital, in addition to another 30 apparently healthy individuals as control group. Both patient and control groups were examined and reviewed clinically and assessed by basic laboratory investigation. High pressure liquid chromatography technique was used for the estimation of methylene tetrahydrofolate reductase level (μg/dl) in diffuse large B cell non-Hodgkin lymphoma patients and controls.
Results: Methylene tetrahydrofolate reductase enzyme level showed significant difference between patients and control (P value ≤ 0.05). It was significantly lower in advanced compared to limited stage large B-cell non-Hodgkin’s lymphoma; moreover methylene tetrahydrofolate reductase enzyme was significantly higher for both advanced and limited stage large B-cell non-Hodgkin's lymphoma patient after treatment compared to their level before treatment (P = 0.001) and (P value = 0.009), respectively.
Conclusion: Methylene tetrahydrofolate reductase enzyme level was inversely related to disease progression. Throughout course of treatment, the methylene tetrahydrofolate reductase activity was increased as the disease being under effect of chemotherapy. Therefore, folate supplementation may be useful to avoid metabolic disturbance and consequence of hyperhomocysteinemia and decrease of methionine.

Evaluation of the Levels of Serum Testosterone and Some Lipid Profile in Patients with Nodulocystic Acne Osama M Al-joboori* FICMS, Mohammed A Al-marsoome* FICMS, Hussain Fathel Khalel* MBChB

IMJ IMJ — 2019-06-15

ABSTRACT
Background: Acne is a chronic inflammatory skin disease that occurs when dead skin cells and sebum close hair follicles. It is characterized by seborrhoea, the formation of open and closed comedones (primary lesion of acne), erythematous papules and pustules and possible scarring. Acne mainly affects skin areas with a large number of sebaceous glands, these areas include the face, back and upper chest. The outcome appearance may lead to anxiety, reduced self-esteem, in severe cases, depression and suicidal thoughts. Genetic factors play an important role (as a primary cause of acne) in about 80% of patients. The role of sunlight exposure, cigarette smoking and diet is still unclear. Overgrowth of Propionibacterium acnes (Gram-positive bacteria) which is normally found in the skin and hair follicles also play an important role in pathogenesis of acne. After puberty, in male and female, acne often appears to be an increase in hormones such as testosterone.
Objective: To assess levels of serum testosterone and some lipid profile in patients with nodulocystic acne.
Methods: This is an open, comparative, controlled investigative study. A total of sixty patients were enrolled in this study. Sixty patients were divided into 2 groups; each one consists of thirty patients: Group A: Nodulocystic acne patients. Group B: Acne vulgaris patients (pathological control).
Results: Analysis of the levels of cholesterol, triglycerides and androgen hormone (testosterone) in patients with nodulocystic acne patients and acne vulgaris patients. The results of the laboratory analysis between the two groups showed no significant difference.
Conclusion: The available results in our study showed no significant difference in the present hormonal level of testosterone and lipid profile between nodulocystic acne patients and acne vulgaris patients.

Sonographic Myometrial Thickness for Prediction of Latency Interval in Preterm Premature Rupture of Membrane Shatha Sami Hussein* FICOG CABOG, Manal Madany Abdulqadar* FICOG CABOG, Ekhlass Hussam Sabri Al-Rawi** FICOG CABOG

IMJ IMJ — 2019-06-15

ABSTRACT
Background: Preterm labor still a main complication that may occur to the normal pregnancy in the presence of many risk factors and can lead to several health problems for both fetus and mother. Much effort done to prevent and decrease these complications.
Objective: To detect if measurement of myometrial thickness can be used to predict latency interval in preterm premature rupture of membrane.
Methods: Analytic-descriptive and case-control study conducted at Al-Yarmouk teaching hospital from the 1st of January, 2016 to the 1st of January 2017. Sixty pregnant women with gestational age from 28+0 - 40+6 weeks were involved in the study and were divided into two groups: (Group A) 30 pregnant women with PPROM, the case group, and (Group B) 30 term healthy pregnant women as control group. Amniotic membrane rupture was diagnosed by both speculum examination, and ultrasound proved the presence of oligohydramnios. Trans-abdominal ultrasound done for all patients by the same expert sonographist to measure the myometrial thickness at posterior, anterior and fundal uterine wall and amniotic fluid index. The interval from ultrasound time until delivery was calculated for all patient and result compared statistically.
Results: Descriptive analysis data between two groups revealed no significant differences regarding age, gravid, parity, while there was significant difference regarding gestational age P-value 0.0001. The difference between myometrial thicknesses between the two groups revealed that the mean of myometrial thickness in the mid anterior part of uterus was 10.64±0.60mm in preterm premature rupture of membrane group compared with 8.81±1.34 mm in group B (P-value 0.001). The mean of fundal myometrial thickness in group A was 11.23±0.88 compared with 8.41±1.12 in group B which was statistically significant (P-value 0.0001). The posterior myometrial was thicker in group A than group B. No significant relation with labor time and myometrial thickness in both studying group , p value were 0.062,0.061,0.776 for mid-anterior, fundal, posterior walls respectively in group A, while it was 0.443,0.191,0.475 for mid-anterior, fundal, posterior walls respectively in group B.
Conclusion: There was no significant correlation was found between myometrial thickness in fundal, anterior and posterior walls with latency period.

Anthropometric Measurements as Cardio-Metabolic Risk Factors Did Not Associate with Echocardiography Determinants in Type 2 Diabetes Ismail Ibrahim Hussein* PhD

IMJ IMJ — 2019-06-15

ABSTRACT
Background: Obesity and type 2 diabetes are risk factors for cardiovascular events. Anthropometric measurements are considered as independent risk factors for these events.
Objectives: To assess the link between anthropometric measurements that are considered as risk factors for cardiovascular events and echocardiography determinants in type 2 diabetes.
Methods: A total number of 50 type 2 diabetes patients (20 males and 30 females) with a mean age of 58.8 years were included in this study. Anthropometric measurements that related to the cardio-metabolic risk factors were determined. These included height, weight, waist circumference, hip circumference, neck circumference and mid-thigh. Echocardiography investigation using B-mode (2-4 MHz frequency) was established. The following echocardiography data were obtained: shortening fraction (%), stroke volume (ml), ejection fraction (%), end systolic volume (ml), end diastolic volume (ml), left ventricular posterior wall (systole). Left ventricular diastolic function assessed by measuring E/A ratio using pulse wave Doppler.
Results: Forty seven (94%) patients have value of BMI 32.5 kg/m2 and 64% have waist circumference ≥ 102 cm. Low mid-thigh and high neck circumferences were found in 88% and 72%, respectively. Echocardiography data showed the patients have the lower limit of normal ejection fraction (%). Abnormal E/A ratio have been observed in 10% of cases. Ejection fraction, stroke volume, end systolic, and diastolic volume did not correlate with anthropometric measurements which are related to cardio-metabolic risk factors.
Conclusion: Abnormal echocardiograph data in type 2 diabetes are unlikely to be attributed to the impact of obesity or to the any anthropometric measurements that linked to cardio-metabolic risk factors.

Acute Myocardial Infarction in Baghdad: Admission Rate and Risk Factors Samir Ali Khudhur* MBChB-DM, Ali Abdul-Kadhim Alsultany* CABM, FRCP

IMJ IMJ — 2019-06-15

ABSTRACT
Background: The incidence of acute myocardial infarction (AMI) among young population in Iraq has increased in last decades causing great burden on national health system.
Objectives: To estimate the admission rate of young age acute myocardial infarction (45 years and less) among AMI patients admitted to coronary care unit in Iraq and to identify the common risk factors related to young age acute myocardial infarction.

Methods: This study was a hospital based, inpatient study conducted in coronary care unit (CCU) of Ibn Al-Nafees Hospital in Baghdad between 1st of July, 2017 to the 31st of December, 2017 on sample of 100 patients with acute myocardial infarction. The acute myocardial infarction was defined according to the criteria of American college of cardiology foundation and American heart association.

Results: Admission rate of AMI among patients admitted to CCU with acute myocardial infarction was 39%. The significant risk factors related to acute myocardial infarction in young patients were male gender, singles, smoking and family history of coronary artery disease. Conclusions: The occurrence of acute myocardial infarction among young adults was high and smoking was the most prominent risk factor.

Atrial Septal Defect Ostium Secundum: A Comparative Study Between Surgical and Transcatheter Management Hammood Naser Mohsin* FIBMS, Jassim Mohammed Mahdy FIBMS, Talat Rifat Rahman* FIBMS

IMJ IMJ — 2019-06-15

ABSTRACT
Background: Atrial septal defect is one of the more commonly recognized congenital cardiac anomalies presenting in adulthood. Atrial septal defect is characterized by a defect in the interatrial septum allowing pulmonary venous return from the left atrium to pass directly to the right atrium .Atrial septal defects can be closed either by surgical or transcatheter closure.
Objectives: To provide a comparison between the surgical and transcatheter closure of atrial septal defects and study accuracy of transesophageal echocardiography in demonstrating atrial septal defect size and morphology.
Methods: Sixty patients their age ranged from one years to 46 years, median age was 25.33 years, 30 patients underwent surgical repair of atrial septal defects and 30 patients underwent transcatheter closure of atrial septal defects. Their data were collected and retrospective studied from 1/6/2013 to 1/6/2014 at Ibn- Alnafees teaching hospital for cardiothoracic surgery in Baghdad, Iraq. A comparison create between two groups according to age, sex, pre closure pulmonary hypertension, size of atrial septal defects, present of multiple atrial septal defects, procedure time, hospital stay time and post closure morbidity and mortality. Transesophageal echocardiograph findings were evaluated in relation of operative observations.
Results: There was no death in two groups, mortality was 0% in both groups. Residual shunt was not observed in any group. Failure rate of closure was much higher in transcatheter group than surgical group, 13.33% versus 0%. Cardiac tamponade was seen in one patient in transcatheter group 3.33% versus 0% in surgical group.
Conclusions: Surgical closure is the standard option for management of atrial septal defects. Transcatheter closure is limited to isolated atrial septal defects secundum with size less than 20 mm and a rim of 5 mm and over, there is no role of transcatheter closure in ostium primum and sinus venosus defects.

One-Year Experience of Cardiac Devices Implantation in Baghdad Teaching Hospital and Review of Their Indications and Related Early Complications

IMJ IMJ — 2019-06-22

ABSTRACT
Background: Arrhythmias can cause a range of problems for patients, from palpitations and dizzy spells, to blackouts and sudden cardiac arrest. Cardiac rhythm management including device implantation is the treatment for special type of arrhythmias.
Objective: To evaluate the practice of trans-venous permanent devices (pacemaker single ventricle, biventricular and intra-cardiac defibrillator) implantation.
Methods: A group of 150 patients with different indications for permanent pacemaker and intra-cardiac defibrillator implantation who were referred to Baghdad Teaching Hospital - catheterization unit during the period from December 2016 to December 2017 were enrolled in this study. Case sheets of all patients were studied carefully and their indications for devices implantation were re-evaluated. The implantation procedures log were reviewed and short-term complications (within two weeks of the implantation) were studied.
Results: The mean age of the enrolled patients was 62 ±3 years. The most common presentation were dizziness (62%) syncope (36.6%) and the least common presentation was disturbed level of consciousness. Complete heart block was the most common ECG finding (30.6%). Left bundle branch block was (23.3%) and ventricular tachycardia was (8%). The indications for devices implantation were compatible with American 2012 guidelines for (single or bi ventricular pacing and intra-cardiac defibrillator implantation). The single ventricle lead pacemaker mode was (20.66%), while dual leads pacemaker mode was (36.66%). Defibrillator lead device was implanted in 49 patients (32.66%) and biventricular pacing implanted in 15 patient (10%). Total complications occurred in (2.6%) of the all procedures. Hypertension and ischemic heart diseases appeared to be the strongest associated factor (68.6%) in this study.
Conclusion: Dizziness and syncope were the main presentation. Hypertension and ischemic heart diseases are main associate factors, minimal complication were reported in the current study and most of them were transient.

Tuberculin Skin Test Positivity in Hospitalized Patients in Baghdad Teaching Hospital Wathiq Mohammed FICMS, Faleh Albayati MRCP

IMJ IMJ — 2019-06-24

ABSTRACT
Background: One third of earth population are infected with Mycobacterium tuberculosis. In the majority, infection is asymptomatic (latent) and is detected by positive tuberculin skin test. It constitutes an important source of infection and may activate later in life. Iraq has been identified as middle-TB burden country in the world.
Objectives: To determine the frequency of latent tuberculosis infection among patients admitted to a medical ward in Baghdad teaching hospital.
Methods: One hundred and thirty three adult patients of both genders free of any evidence of active tuberculosis were included in the study. The Mantoux technique was used and two units of purified protein derivative were applied by an intradermal injection in the middle third of the inner forearm. Skin reaction was quantified 48 to 72 hours after the injection and considered positive with induration of ≥10 mm.
Results: A positive tuberculin skin test result was observed in 13 patients (9.8%). Two patients (15.4%) were ≤ 45 year old, 8 patients (61.5 %) between ages of 46-65 and 3 patients (23.1%) older than 65 years. Eight responders (61.5%) were males. Among TST positive group, six patients (46.2%) had spent some time in prison, whereas only three patients (2.5%) of TST negative group reported such story.
Conclusion: History of incarceration is the only factor associated with significant tuberculin reactivity among hospitalized patients in a single medical unit in Baghdad teaching hospital

Functional Outcome Following Proximal Humeral Derotation Osteotomy in Erb’s Palsy Falah Kadhim Hasan FIBMS, Ali Eskander Dagher MRCS

IMJ IMJ — 2019-06-24

ABSTRACT
Background: Obstetric brachial plexus palsy is an injury to the nerves of the upper
extremity of the newborn that happens during labor. Erb’s palsy (C5, 6) is the most common
type of obstetric brachial plexus palsy. Most of the infants with Erb’s palsy will show
spontaneous full recovery, however 20 -30 % will have residual neurological defects, some
of them will have residual weakness of shoulder’s external rotation, which will result in an
internal rotation deformity of the affected shoulder in these children. If this internal rotation
deformity is not repaired, it may progress to posterior dislocation of the shoulder joint with
bony deformity of the glenoid.
Objective: To present functional outcome and results from patients with Erb’s palsy who
underwent external rotational humeral osteotomy.
Methods: Proximal humeral osteotomy was done for fourteen patients to correct deformity
during age ranging from 13 to 20 years. Preoperative; early postoperative and late
postoperative functional assessments were compared using mallet-grading system.
Results: Preoperatively out of 14 patients 10 (seven females, 3 males) were grade 2 mallet
grading system range (8-12 points), four were grade 3 range (12-18 points) mallet grading
system (2 males, 2 females). One month follow up post operatively patients with grading
two (10 patients) mallet system preoperatively seven patients of them became grade 4
(70%). After one year, three patients became grade 3 (15 points) (30%). Two years follow
up, 13 patients out of 14 were in grade 4 (20 points), one patient with grade 3 (15 points).
Eight of the 14 patients were followed up 3 years postoperatively all of them had grade 4 in
comparison between pre-operative function of the shoulder joint and 2 years post proximal
humeral osteotomy, 9 out of 14 (64%) patients upgrade from grade 2 into grade 4, and 5
out of 14 (36%) patients upgrade from grade 3 to grade 4.
Conclusions: Proximal humeral osteotomy gives good function of shoulder movement and
patient satisfaction. The gaining of functional improvement was clear in early and late time
following rotational humeral osteotomy

Depression among Type 2 Diabetics Attending the National Diabetes Center Nooralhuda Faik, Dheyaa J Kadhim, Tawfeeq Fakher Al-Auqbi

IMJ IMJ — 2019-06-24

ABSTRACT

Background: Diabetes mellitus is a common health, medical and economic problem. There were 1.2 million cases of diabetes in Iraq in 2015. Depression is known as a concurrent condition associated with diabetes.

Objectives: To find the prevalence of depression in type 2 diabetes patients; and, observe the socio-demographic and disease-related factors.

Methods: A case-control study was conducted in the National Diabetes Center, Al-Mustansiriya University, Al-Yarmook Teaching Hospital Campus, Baghdad/Iraq; on 100 type 2 diabetes patients and 100 apparently healthy participants as the control group. The Arabic version of the Patient Health Questionnaire-9 (PHQ-9) was used to assess depression in patients and controls. Results: The overall depression (mild, moderate, moderately-severe and severe) among patients in the current study was 91%. Absences of depression and mild depressions were more prevalent among control group compared to diabetic patients. In contrast, moderate, moderately severe, and severe depression were more among diabetic patients compared to control group. The mean PHQ-9-score of diabetic patients (12.89 ± 5.82) was significantly higher than that of the control group (8.47 ± 5.27).

Conclusions: The study shows high prevalence of depression in type 2 diabetes mellitus patients attending the National Diabetes. Very high significant association between depression and personal charecteristics. The overall prevalence of depression much higher than what reported by other similar studies.

Depression among Type 2 Diabetics Attending the National Diabetes Center Nooralhuda Faik*, Dheyaa J Kadhim**, Tawfeeq Fakher Al-Auqbi

IMJ IMJ — 2019-06-26

ABSTRACT

Objectives: To find the prevalence of depression in type 2 diabetes patients; and, observe the socio-demographic and disease-related factors. Methods: A case-control study was conducted in the National Diabetes Center, Al-Mustansiriya University, Al-Yarmook Teaching Hospital Campus, Baghdad/Iraq; on 100 type 2 diabetes patients and 100 apparently healthy participants as the control group. The Arabic version of the Patient Health Questionnaire-9 (PHQ-9) was used to assess depression in patients and controls.

Results: The overall depression (mild, moderate, moderately-severe and severe) among patients in the current study was 91%. Absences of depression and mild depressions were more prevalent among control group compared to diabetic patients. In contrast, moderate, moderately severe, and severe depression were more among diabetic patients compared to control group. The mean PHQ-9-score of diabetic patients (12.89 ± 5.82) was significantly higher than that of the control group (8.47 ± 5.27).

The Degree of Post-Mastectomy Upper Limb Lymphedema in Relation to the Extent of Axillary Lymph Nodes Involvement and Dissection Ahmed N Abdulnabi* CABS, Issam Merdan** FICMS CABS

IMJ IMJ — 2019-06-26

ABSTRACT
Background: Lymphedema of the upper extremity is a serious consequence of breast cancer surgery. Postmastectomy lymphedema of the upper limb is usually related to many risk factors like axillary surgery, radiotherapy, venous obstruction, obesity, and infection.
Objectives: To identify the relationship between the extent of axillary lymph nodes involvement and dissection on the development of upper limb lymphedema.
Methods: One hundred and seventy patients managed by modified radical mastectomy with axillary dissection for mammary invasive adenocarcinoma between January 2009 and December 2016 in Al-Fayhaa Teaching Hospital. The patients were divided in to three groups according to the number of lymph nodes involvement by pathology. The patients had been followed up for a minimum of two years and assessed by standard lymphedema assessment, then categorized in to three groups according to the severity of lymphedema.
Results: After the analysis of patient parameters, the highest age group was 36-45 years. More than 60% of the patients had 4-9 lymph nodes involvement. Forty one patients from the 170 developed lymphedema postoperatively. Forty patients had seroma and twenty one patients had wound infection postoperatively.
Conclusion: Postmastectomy lymphedema is sequelae of disease process related to the extent of lymph nodes involvement and resection rather than operative fault.

Laparoscopic Cholecystectomy in Situs Inversus Totalis: Challenges, Difficulties and Solutions A Case Series Study Saad Muwafaq Attash* CABMS

IMJ IMJ — 2019-06-26

ABSTRACT
Background: Situs inversus totalis is a rare autosomal recessive disorder which can cause diagnostic challenges in a lot of clinical conditions including calculous cholecystitis due to the reversed anatomical position of abdominal viscera.
This is a case series study including three patients who were diagnosed to have situs inversus totalis with gallstones between May 2012 and December 2013 at our laparoscopic unit at Mosul Medical City and underwent laparoscopic cholecystectomy. The 1st two patients were 43 and 51-year-old women, respectively while the 3rd one was a 38-year-old male. All had symptomatic gallstones and all were already diagnosed to have situs inversus totalis at time of referral to us. The three patients underwent laparoscopic cholecystectomy safely and easily after adjustment of the positions of the team members inside the operative theatre and of the port sites. All of them were discharged home after 24 hours and on regular follow up visits afterward they were doing well and free of symptoms.

Ten Facts about cancer

IMJ IMJ — 2019-06-26

Fact 1: About 16% of people die from cancer.
Fact 2: About 70% of all deaths from cancer occur in low- and middle-income countries.
Fact 3: Top 5 types of cancer killing men are (in order of frequency): lung, liver, stomach, colorectal and prostate cancers.
Fact 4: Top 5 types of cancer killing women are (in order of frequency): breast, lung, colorectal, cervical and stomach cancers.
Fact 5: Between 30-50% of cancers are preventable. Tobacco use is the single preventable cause of cancer in the world, and is responsible for approximately 22% of all cancer-related deaths.
Fact 6: Human papillomavirus (HPV) causes cervical cancer, and hepatitis B virus (HBV) causes liver cancer. Vaccination against these two viruses could prevent 1.1 million cancer cases of cancer.
Fact 7: In 2017, less than 30% of low-income countries reported treatment services were generally available, compared to more than 90% of high-income countries.
Fact 8: The total annual economic cost of cancer in 2010 was estimated at approximately US$ 1.16 trillion.
Fact 9: Worldwide, only about 14% of people who need palliative care currently receive it.
Fact 10: Only one in five low- and middle-income countries have the necessary data to drive policy.

المقدمة العربية

IMJ IMJ — 2019-06-26

المجلة الطبية العراقية
مجلة علمية دورية محكمة الترقيم الدولي 4564 - 0304
تصدر عن نقابة أطباء العراق
صدر العدد الأول منها عام 1953 المجلد 65 , العدد 1 , كانون الثاني 2019
المشرف العام: عبد الأمير محسن حسين
رئيس هيئة التحرير: حيدر عبد الحسين أحمد
هيئة التحرير التنفيذية:
أسامة سليمان الناصري
نجيب صليوه جبو
بسام حميد الجراح
جمال رشيد الراوي
فرقد بدر حمدان
ياسر محمد حسن حمندي
صباح موسى فاضل
علي عبد الكاظم السلطاني
محمد حسن الموسوي
أحمد سمير النعيمي
السكرتارية:
لينا رافع محمد علي المختار

المجلة الطبية العراقية - الملخصات العربية

IMJ IMJ — 2019-06-26

_{المجلة الطبية العراقية}

_{الملخصات العربية}

Iraqi Medical Journal

Iraqi Medical AssociationVolume 65, Number 1, January 2019,

Preoperative Risk Factors Affecting Conversion of Laparoscopic to Open Cholecystectomy Adil Rahman Faraj Al-Budaerany* FICMS, Muatez Mundhir Manhal* FIBMS, Jaber Qataa Jaber Al-Mohammedawi* FICMS

Histopathological Changes in the Placenta of Pregnant Women with Gestational Diabetes Mellitus and Fetal Outcome Miami Abdul Hassan Ali* FICOG, Eaman Marouf Muhammad** FICOG ABOG, Sarah Salim Hasan** MBChB, Thaeer Jawad Kadem** FIBMS

Association between Spontaneous Abortion and Human Papilloma Virus Infection in Mosul Province, Iraq May Majdi Abdulmaged* DGO

Ultrasound-Guided Removal of Soft Tissue Foreign Bodies

Study of Methylene Tetrahydrofolate Reductase enzyme Activity in Diffuse Large B-cell Non-Hodgkin's Lymphoma Patients Ali Abdulhur Arnos* PhD, Waseem F Al Tameemi** MD CABM, Noor Mustafa Ali* PhD

Evaluation of the Levels of Serum Testosterone and Some Lipid Profile in Patients with Nodulocystic Acne Osama M Al-joboori* FICMS, Mohammed A Al-marsoome* FICMS, Hussain Fathel Khalel* MBChB

Sonographic Myometrial Thickness for Prediction of Latency Interval in Preterm Premature Rupture of Membrane Shatha Sami Hussein* FICOG CABOG, Manal Madany Abdulqadar* FICOG CABOG, Ekhlass Hussam Sabri Al-Rawi** FICOG CABOG

Anthropometric Measurements as Cardio-Metabolic Risk Factors Did Not Associate with Echocardiography Determinants in Type 2 Diabetes Ismail Ibrahim Hussein* PhD

Acute Myocardial Infarction in Baghdad: Admission Rate and Risk Factors Samir Ali Khudhur* MBChB-DM, Ali Abdul-Kadhim Alsultany* CABM, FRCP

Atrial Septal Defect Ostium Secundum: A Comparative Study Between Surgical and Transcatheter Management Hammood Naser Mohsin* FIBMS, Jassim Mohammed Mahdy** FIBMS, Talat Rifat Rahman*** FIBMS

One-Year Experience of Cardiac Devices Implantation in Baghdad Teaching Hospital and Review of Their Indications and Related Early Complications

Tuberculin Skin Test Positivity in Hospitalized Patients in Baghdad Teaching Hospital Wathiq Mohammed FICMS, Faleh Albayati MRCP

Functional Outcome Following Proximal Humeral Derotation Osteotomy in Erb’s Palsy Falah Kadhim Hasan FIBMS, Ali Eskander Dagher MRCS

Depression among Type 2 Diabetics Attending the National Diabetes Center Nooralhuda Faik*, Dheyaa J Kadhim**, Tawfeeq Fakher Al-Auqbi***

Depression among Type 2 Diabetics Attending the National Diabetes Center Nooralhuda Faik*, Dheyaa J Kadhim**, Tawfeeq Fakher Al-Auqbi

The Degree of Post-Mastectomy Upper Limb Lymphedema in Relation to the Extent of Axillary Lymph Nodes Involvement and Dissection Ahmed N Abdulnabi* CABS, Issam Merdan** FICMS CABS

Laparoscopic Cholecystectomy in Situs Inversus Totalis: Challenges, Difficulties and Solutions A Case Series Study Saad Muwafaq Attash* CABMS

Ten Facts about cancer

المقدمة العربية

المجلة الطبية العراقية - الملخصات العربية

Histopathological Changes in the Placenta of Pregnant Women with Gestational Diabetes Mellitus and Fetal Outcome Miami Abdul Hassan Ali* FICOG, Eaman Marouf Muhammad FICOG ABOG, Sarah Salim Hasan MBChB, Thaeer Jawad Kadem** FIBMS

Atrial Septal Defect Ostium Secundum: A Comparative Study Between Surgical and Transcatheter Management Hammood Naser Mohsin* FIBMS, Jassim Mohammed Mahdy FIBMS, Talat Rifat Rahman* FIBMS

Depression among Type 2 Diabetics Attending the National Diabetes Center Nooralhuda Faik, Dheyaa J Kadhim, Tawfeeq Fakher Al-Auqbi