Journal of the Faculty of Medicine Baghdad 2019-12-21T21:02:58+00:00 prof. Tharwat I. Sulaiman Open Journal Systems <h3>Journal of the Faculty of Medicine – University of Baghdad</h3> <h3>A peer-reviewed journal published Quarterly by the college of medicine –Baghdad University</h3> <h3>ISSN:&nbsp; &nbsp;0041-9419</h3> <h3>EISSN: 2410-8057</h3> <h3>The Journal interested in the publication of clinical and basic medical research.</h3> <h3>The first issue of this Journal was published under the name of (Journal of the Royal Iraqi Medical College) in April /1936, approved by the council of the College as a general journal dealing with the news of the college and few scientific articles to encourage the teaching staff for research publication. The journal was published randomly and ceased during World War II due to financial difficulties.</h3> <h3>In 1946 Prof. Dr. Hashim Al Witri, the college dean, assigned republication of the journal and urged the teaching staff to participate and publish their research in the journal. Despite his effort, the journal remained irregular in publication. In 1959&nbsp; Prof. Dr. Faisal Al-Sabih became the Editor in Chief of the journal when he returned from the United Kingdom and appointed on the teaching staff, restructured the journal and changed its name to (The Journal of the Faculty of Medicine) and used a new scientific system for publication of articles.</h3> <h3>The first issue of the new series started in June 1959. The journal continued to be published on a regular basis since then without interruption in (four issues during the year). The journal became registered the international number (ISSN) in 2000 and entered in many important international indexes.</h3> <h3>After 2003 the journal continued despite the difficulties involved in every aspect of the country and by the beginning of 2004, the journal progressed through a series of changes to reach a level that can be recognized internationally.</h3> <h3>After 2010 the journal became published electronically of the same edited issues.</h3> Retinoblastoma in Iraqi Children, the Experience of Children Welfare Teaching Hospital 2019-12-11T16:44:11+00:00 Areej Emad Kadhom <p><strong>Background</strong>: Retinoblastoma is the most common intraocular tumor affecting young children.</p> <p><strong><br>Patients and Methods</strong>: A review of 32 children with retinoblastoma, diagnosed and treated at the Oncology Unit, Children Welfare Teaching Hospital, Medical City, Baghdad from 1999 to 2006.</p> <p><strong>Objectives</strong>: To review the clinical presentation and treatment outcome of retinoblastoma in children treated at the Children Welfare Teaching Hospital, Baghdad.</p> <p><strong>Results</strong>: Among 32 patients, 56.25% were males and 43.75% were females with a median age of 34.5 months. Unilateral disease was observed in 19 patients. Leukocoria was the most common presenting feature. Advanced stages were predominant in half of the patients. Chemotherapy following eye enucleation was the mainstay of treatment. The disease-free survival was 23.33% while the mortality rate was 26.67%.</p> <p><strong>Conclusions</strong>: This single center study reported a poor outcome and a low disease-free survival due to high frequency of advanced stages and abandoning treatment by the parents.</p> <p><strong>Keywords:</strong> Retinoblastoma, children, outcome.</p> 2019-12-07T16:42:17+00:00 ##submission.copyrightStatement## Prevention of CSF leak from the spinal operation site due to either traumatic or iatrogenic injury to the Dura. 2019-12-11T16:44:11+00:00 Hayder Alhemiary <p>&nbsp;</p> <p><strong>Background: </strong>Cerebrospinal fluid leak is a relatively common problem ranging from 0.5% to 18% with traumatic or incidental injury to the Dura intra-operatively<sup>1, 2</sup>. Traumatic injury mostly occurs due to mechanical trauma with subsequent thecal sac laceration mainly in the thoracolumbar region. Incidental Dural injury commonly happens in patients undergoing spinal surgery for any reason.</p> <p><strong>Objective: </strong>Introduce a maneuver to be used during operations when the patients have either traumatic or iatrogenic injury to the Dura which would prevent CSF leak post-operatively.</p> <p><strong>Method: </strong>A case series study conducted in Baghdad, medical city, between June 2014 and March 2018 on 250 patients (45 females and 205 males) who had either traumatic or iatrogenic injury to the Dura. The operative technique introduced by Perry was used as a reference<sup>1</sup>. The maneuver used in this study to manage CSF leak intra-operatively described here in this study for comparison with other articles.</p> <p><strong>Results: </strong>In this study 250 cases out of 2500 spinal surgery cases, were diagnosed intra-operatively to have Dural injury either post-traumatic or incidentally during surgery. Dural injury occurred in 70 electively operated cases either incidentally or in cases of Dural exploration for different spine pathologies, of whom 13 patients (5.2%) had spinal surgery at the same site previously. &nbsp;</p> <p><strong>Conclusions: </strong>Proper identification of intraoperative CSF leak is crucial for prevention of post-operative complications. CSF leakage can be prevented by applying and reinforcing all surgical field layers with watertight sutures.</p> <p><strong>Key words:</strong> CSF leak, Spine, Dura, Trauma, Iatrogenic.</p> 2019-12-07T17:13:03+00:00 ##submission.copyrightStatement## Incidental Thyroid Carcinoma in Patients Treated Surgically for Thyroid Disease 2019-12-21T21:02:58+00:00 Labeed S. Hamid Mohamad Q. AbdulJabbar Tharwat I Sulaiman <p><strong>Background:</strong> The occurrence of incidental thyroid cancer (ITC) has increased by three times during the last decades and this rise could be attributed to many factors. To limit the prevalence of ITC with goiter especially nodular goiter, total thyroidectomy can become a procedure of choice.</p> <p><strong>Objective:</strong> To determine the extent of incidental thyroid carcinoma (ITC) and to plan a proper preoperative diagnostic work up and a convenient operative procedure for patients with different thyroid diseases.</p> <p><strong><br>Results:</strong> ITC was found in 77 patients (19.15%). While, 63 patients with non-toxic MNG (15.6%), 12 patients with non-toxic solitary thyroid nodule (3%) and two patients (0.5%) with toxic MNG were observed in the study. Out of 77 patients with ITC, 56(72.7%) were ˂45 years and the remaining 21 (27.3%) ≥45 years. The 15 patients were males and 62 patients were females in these groups.</p> <p><strong>Material and Methods</strong>: A prospective study was conducted during the period from October 2013 to October 2016 at Baghdad teaching hospital (main tertiary hospital in Iraq), first surgical unit by a single surgeon and his trainees. The study included 473 patients who were referred for surgical treatment of different thyroid diseases. About 71 patients were excluded from the study due to the diagnosis of malignancy (MNG) by FNAC or history of surgery. The remaining 402 patients were evaluated for the presence of the cancer by post-operative pathological examination.</p> <p><strong>Conclusions: </strong>Although ITC in this study is relatively high especially in MNG; a more radical surgical treatment seems needed in the management of patients with presumably benign thyroid disease. The authors identify a potential benefit in performing total thyroidectomy instead of near or subtotal when considering management of MNG.</p> 2019-12-07T18:26:45+00:00 ##submission.copyrightStatement## Histological Classification of Thymoma 2019-12-11T16:44:10+00:00 Ibtisam Hussein Al Obaidi <p><strong>Background:</strong> Many thymoma classifications have been followed and have been updated by newer or alternative schemes. Many classifications were based on the morphology and histogenesis of normal thymus as the backbone, while other classifications have followed a more simplified scheme, whereby thymomas were grouped based on biological behavior. The WHO classification is currently the advocated one, which is based on “organotypical” features (i.e. histological characteristics mimicking those observed in the normal thymus) including cytoarchitecture (encapsulation and a “lobular architecture”) and the cellular composition, mostly the nuclear morphology is generally appreciated.</p> <p><strong>Objectives: </strong>This study aims to re-classify thymomas by establishing certain morphometric parameters to evaluate the epithelial cells nuclei. An appraisal of thymoma classification as cortical/ lymphocytic/ type B1 and B2 or medullary/ spindle cells/ type A will be attempted as objective re-evaluation of thymoma.</p> <p><strong>Patients:</strong> This study is a retrospective evaluation of 50 cases of thymoma, 20 cases of thymic hyperplasia and 10 cases of normal thymus (control group). Using a 5 µm formalin-fixed paraffin embeded tissue sections, stained with hematoxylin-eosin stain, these cases were previously classified histologically into lymphocytic (6 cases), lymphoepithelial (mixed) (28 cases) and epithelial (16 cases), including 2 cases of spindle cell thymoma.</p> <p><strong>Methods:</strong> Computer-assisted morphometry was performed for 80 cases. This involves digitization of the histopathological features and application of morphometric analysis through software. The morphometric parameters used are nuclear area, maximum nuclear diameter and Form factor of epithelial cells nuclei. Ten normal thymus glands from the archived cases were also evaluated as a control groups.</p> <p><strong>Results:</strong> The results showed that epithelial thymomas possess significantly different nuclear areas from that of a normal thymus, the maximum nuclear diameter (D-Max) follows the same pattern and adds no further outcomes. The numerical morphometric analysis showed no significant differences between lymphocytic predominant thymoma and those classified as cortical thymoma (Type B2). Thus it does not support such a re-classification. Form factor is an indication of pleomorphism, but it should be cautiously used when spindle cells are present since it may give a false indication of pleomorphism.</p> <p><strong>Conclusion:</strong> Computer-Assisted morphometric analysis provides an objective, reproducible and comparable results for thymoma histological classification.</p> <p><strong>Keywords</strong>: Thymoma, Histological classification, Grading, Morphometry, Computer-assistedmorphometry.</p> 2019-12-09T09:09:24+00:00 ##submission.copyrightStatement## Epidemiology, Clinical characteristics, Laboratory Findings Of Bronchiolitis In Hospitalized Children 2019-12-11T16:44:09+00:00 majeed saleh mohammed Shukr <p><strong>Background</strong>: Bronchiolitis is the most common disease of the lower respiratory tract during the first year of life. Which is usually caused by respiratory syncytial virus. The treatment is usually supportive, so epidemiology, clinical, laboratory, and radiologic findings might facilitate early diagnosis and treatment of bronchiolitis cases.</p> <p><strong>Objectives</strong>: The aim of our study was to evaluate the clinical characteristics and laboratory findings of children hospitalized due to bronchiolitis.</p> <p><strong>Patients and Methods</strong>: In this cross sectional study 143 patients with bronchiolitis were selected who age 1-24 months old who were admitted to the Fallujah teaching hospital for women and children, over the period of 6 months from 1<sup>st</sup> of October 2018 to 1<sup>st</sup> of April2019. The patients were selected from large number of cases admitted to Hospital according to bronchiolitis criteria.</p> <p><strong>Results</strong>: A total number of 143 patients were included in this study, 52.4% were male and 47.6% were female. The most common clinical findings were tachypnea, dyspnea, cough, fever, wheeze consecutively. Hyperinflation was the most common radiological study, while lymphocytosis was the most common laboratory finding.</p> <p><strong>Conclusions</strong>: In our study Bronchiolitis was mostly diagnosed in the first 6 months of age, most of patients from urban area, tachypnea was most common sign while hyperinflation was the most common radiological finding and lymphocytosis was most common CBC finding. These data might facilitate early diagnoses and treatment of bronchiolitis cases.</p> 2019-12-10T19:47:34+00:00 ##submission.copyrightStatement## Maternal and neonatel outcome among those with postdate pregnancy 2019-12-11T16:44:10+00:00 Saba Abd Al Mahdi Mohammed <p><strong>Background: </strong>&nbsp;Postdate pregnancy is that pregnancy, which goes beyond 40 weeks gestation being calculated from the first day of the last menstrual period and&nbsp; first trimester ultrasound. It occurs in approximately 10% of singleton pregnancies. Perinatal and maternal complications of such pregnancies have always been underestimated.</p> <p><strong>Methods:</strong> A prospective case-control study of (600) pregnant women fulfilling the inclusion criteria( included: Gestational age range between (37 - 42 completed&nbsp; weeks), history of&nbsp; regular menstrual cycles and&nbsp; known date of the last menstrual period and/or with early pregnancy ultrasound and a singleton pregnancy with vertex presentation ), divided into (250) pregnant women as case group (beyond 40weeks of &nbsp;gestation) and (350) pregnant women as control group (between 37 completed weeks to 40 weeks of gestation).These mothers were admitted to the labor room at &nbsp;Basrah &nbsp;Maternity and Child Hospital from [1<sup>st </sup>of January to 1<sup>st </sup>November 2018].</p> <p><strong>Objectives: </strong>The aim of this study is to identify whether the prolongation of pregnancy beyond the expected date of delivery has negative effects on the health of both the mothers and the neonate<strong>.</strong></p> <p><strong>Results:</strong> The majority of both cases and controls&nbsp; &nbsp;were between 18 and 30 years of age (62.4% and 56.3 % respectively).and multiparous (1_4) deliveries; 55.6% and 58% respectively). Among the cases<strong>,</strong> postpartum haemorrhage was the most frequent maternal complication (16.4%), followed by prolonged labour(15.2%), perineal tear (5.2%), cervical tear and shoulder dystocia (1.6% for both) . The newborns of postdate pregnancies tend to be heavier at birth, where (19.2 %) were macrosomic (birth weight ≥ 4000 g) and (51.6%) weighed (3500-4000g). The majority (77.6%) had an Apgar score of (≥ 7). Meconium stained liquor, meconium aspiration syndrome, admission to the neonatal intensive care unit and birth asphyxia occurred in (23.2%, 12.4%, 18.8% and 1.2%) respectively. There were no birth</p> <p>injuries, intrauterine growth retardation or stillbirth in both cases and controls.</p> <p><strong>Conclusion:</strong> In postdate pregnancies, there is a definitive risk on mother and baby.</p> 2019-12-09T10:23:37+00:00 ##submission.copyrightStatement## case report Intramuscular hemangioma 2019-12-11T16:44:10+00:00 TARA FAROOQ KAREEM, CABRA Rasha Thameen Fakhri AHMED MURAD MUHI, CABRA <p>Intramuscular hemangiomas are rare asymptomatic angiomatous tumors , showing a slow growing pattern . We reported a rare case of biceps muscle hemangioma &nbsp;in a 22-years-old man who presented with progressive swelling following a simple trauma four years ago , after examining the patient with ultrasound (US) ,computed tomography( CT) scan and magnetic resonance imaging (MRI), which was confirmed by histopathology later on .</p> 2019-12-10T19:33:15+00:00 ##submission.copyrightStatement##