Lung cancer is most common malignancy and is the first cause of death in Iraq. To assess the progression free survival (PFS), and to describe the role of maintaining pemetrexed drug. Retrospective study conducted in Oncology Teaching Hospital /Medical city complex. The period from January 2014 to June 2017. A total of forty seven patients with non-small cell lung cancer, treated by chemotherapy enrolled. Patients assessed for age, gender, histopathological subtypes, first line chemotherapy protocol and progression free survival. The progression free survival was 18.6 months with (95% Confidence Interval (CI)). The progression free survival for adenocarcinoma and squamous cell carcinoma were 19.6, 9.8(months). The maintenance pemetrexed showed a better Progression free survival than other patients. Patients with adenocarcinoma histology have better Progression free survival than other subtypes

Spinal trauma is very common in orthopedic practice. There is a debate as to whether the surgical or conservative approach is more effective in the treatment of spine fractures. We in the present study tried to evaluate the outcomes of patients with spinal fractures treated with the conservative treatment and surgical treatment and overall outcome of treatment in the patients. Methods: In this prospective cross-sectional study conducted in the Department of orthopedics, MGM hospital attached to Kakatiya Medical College. A total of 30 patients were included in the study of which (n=15) patients were treated with conservative treatment based on the presentation of fractures and similarly (n=15) were taken for operative treatment depending on the type of fractures. A Detailed history of the injury was obtained they were clinically and radiologically evaluated for the thoracolumbar fracture. The radiographs included the anteroposterior and lateral views. Laboratory investigations were carried out before the surgery. CT and MRI scans were carried out to evaluate the relationship and instability of the spine. Results: The L1 vertebra was the most common to get fractured and most of the fractures (74%) were appeared at T12 and L1. AO type, A fractures were only studied with the majority of the fractures (66.6) were falling into AO type A3 (burst fractures). DENIS pain scale scores in conservative treatment, category 8 (53.3%) of patients were in the P3 category similarly in operative treatment 46.67 % of patients were in P1 category...

Fulminant myocarditis (FM) is a life-threatening disease with a rapid, progressive course of deterioration. The prognosis is favorable with appropriate management in the initial vulnerable stages. Here we report the first occurrence of FM in a healthy primigravid woman. We report the case of a previously healthy 30-year-old woman with FM in whom cardiac function normalized within 4 days with aggressive pharmacological support using positive inotropic drugs, intravenous steroids, high-dose immunoglobulin, and intravenous antibiotics. FM remains a challenging disease for diagnosis and treatment in clinical practice. This case serves to emphasize the importance of FM and its management. Myocardial failure due to FM can be reversible if treated early

Changes in maternal lipids and alkaline phosphatase (ALP) activity occur during normal pregnancy. There is scarce data in regards to atherogenic indices and relationship of lipids with ALP during pregnancy. The study therefore aimed at determining serum lipid levels, atherogenic indices, and ALP activity as well as their relationship in normal pregnancies. The case-control study compared the parameters of second (n=37) and third (n=40) trimester pregnancies with normal pregnant controls (n=40) aged 18-35 years. Results showed a significant (P<0.0005) rise in the levels of total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), very low density lipoprotein cholesterol (VLDL-C), triglycerides (TGs), non-high density lipoprotein cholesterol (nHDL-C) and ALP in the pregnant women compared to anthropometrically matched non-pregnant women. A significant (P<0.02) rise in Castelli’s risk index (CRI-1), atherogenic coefficient (AC), TG/HDL-C, atherogenic index of plasma (AIP) was observed in the pregnant women compared to the matched controls. Pearson correlation showed a positive correlation of gestation age with ALP (r=0.365), TC (r=0.450), HDL-C (r=0.311), VLDL-C (r=0.338), TGs (r=0.338), and nHDL-C (r=0.291). A positive correlation of ALP was observed with TC (r=0.689), LDL-C (r=0.608), VLDL-C (r=0.231), TGs (r=0.231), and nHDL-C (r=0.647). The atherogenic indices neither correlated with gestation age nor ALP. The present study shows that serum lipids increase in association with ALP during normal pregnancy. We recommend further studies in women with complicated pregnancies to gain insights into the patho-physiology of the association

Unexplained infertility refers to the absence of a definable cause for infertility despite a thorough evaluation. Subtle abnormalities like mild endometriosis, minor tubal dysfunction as evidenced by presence of peritubal adhesions or partial fimbrial phimosis, endometrial defects, may be unearthed by thorough investigations in these couples labelled with unexplained infertility. Primary objective of the study was to determine if IVF outcomes in unexplained infertility are different from other cause of infertility like male or tubal factor infertility. Secondary objectives were to find out what intrinsic or extrinsic factors in unexplained infertility influence IVF results. Based upon these factors, to help in prognosticating couples with unexplained infertility before they enter IVF. The study was explained to all eligible couples undergoing IVF at centre. They were offered participation in study and given a patient information sheet to understand the study. Those who accepted to take part in the study were enrolled in study. After applying inclusion and exclusion criteria, three cohorts of unexplained, male and tubal are formed according to their indication of IVF cycle. Age of female partner was the only variable which showed statistically difference. Mean age of female partner of unexplained group was 34.12 ± 3.69 years, and of tubal & male group it was 33.00 ± 4.2years 3, 32.13 ± 3.69 years respectively (p value 0.047 < 0.05). Laparoscopy and hysteroscopy offered not only to establish the diagnosis but also helping couple knowing their chances of successful pregnancy in IVF

Cerebral sinus venous thrombosis is a very common condition and it is an important cause of stroke especially in the peripartum setting and is one of the common causes of stroke in young patients. The present study has been undertaken to describe the clinical profile, diagnosis, and prognosis of CSVT. Methods: This cross-sectional prospective observational study was conducted in the Department of General Medicine, Prathima Institute of Medical Sciences, Nagunoor, Karimnagar. Based on the diagnosis 50 patients were included in the study, meticulous history, clinical examination, laboratory investigations including complete blood count, ESR, RBS, serum urea, serum creatinine, LFT, serum electrolytes, Urine electrolytes, ECG, CSF analysis were done in addition to imagining of the brain. Results: Out of 50 patients 25(50%) belong to the puerperal group and 25 (50%) belong to a non-puerperal group. Out of 25 non-puerperal patients 5 were female and 20 were male patients. The 25 puerperal cases the CSVT was seen in 18 cases in the first 10 days post-parturition and 5 cases were between 11-20 days and 1 case each of 21 -30 days and > 30 days were seen. In the present study, 24 (48%) of CSVT had a sub-acute presentation followed by 18 cases (36%) with an acute presentation. The clinical signs were hemiparesis and papilledema in 20(40%) of cases and pallor in 16(32%) and dysphasia was in 9(18%) of cases. In the study out of 50 patients, 17 were anemic, accounting for 34% and the mortality was higher when the degree of anemia was severe. Anticoagulant therapy with subcutaneous LMWH in 33 cases and intravenous unfractionated heparin infusion in 17 cases and later changed to oral anticoagulants. 5 patients required decompressive craniotomy out of which 1 patient died. Additional treatment included antiepileptics in 33 patients and anti-edema measures in 38 patients. Conclusion: CSVT is not an uncommon condition. Clinical presentation is extremely varied and symptoms may evolve over hours to few weeks. Neuroimaging plays a pivotal role in diagnosis MRI with MRV is the current diagnostic modality of choice. Management with unfractionated heparin, LMWH, and oral anticoagulation is appropriate. Surgical decompression is helpful in the cases of continuing deterioration, in spite of maximum medical management