Iraqi Postgraduate Medical Journal

BACKGROUND:
Cervical cancer is the most common gynecologic cancer in women in the world, most arise from
infection with human papiloma virus. Other host factors also affect the neoplastic progression
following initial infection.
OBJECTIVE:
To determine characteristics of Iraqi women with carcinoma of the uterine cervix during the last 11
years in Iraq.
METHODS:
Retrospective study; done on records in Radiotherapy and Nuclear Medicine Hospital- Baghdad;
488 cases of cervical carcinoma referred for chemotherapy and or radiotherapy , from 1999 to
2009.Clinical and pathological data were reviewed and analyzed.
RESULTS:
The data that was obtained from the radiotherapy and nuclear medicine hospital showed that the
women with cervical carcinoma constitute only 2.1% of total women with malignancies during
1999-2009. Highest ;were in 2003 and 2004. Largest proportion presented in late stage
(62.32%)and only 37.67% with early stage. Squamous cell carcinoma counted 98.38 % and only
1.62% were adenocarcinoma . Median and mean age was 45-50. Median parity between 4 and 6.
Majority of patients from Baghdad (43.02%) , Basra (10.93%)and lowest percentage from North;
been collectively (10.46%).Only 6.55% had positive family history. (53.72%) with history of
smoking; significantly associated with late stage. Most common clinical presentation was vaginal
bleeding( 65.81%).The most common stage at time of presentation was stage II (36.51%). Most of
referred patients had surgical interventions as total abdominal hysterectomy with bilateral salpingooophorectomy(sub optimal surgery) 60.93%.
CONCLUSION:
Most patients with carcinoma of cervix in Iraq presented in late stage due to absence of screening
program.

BACKGROUND:
The diagnosis of placental abruption is mostly clinical, histopathological diagnosis is poorly
sensitive. Acute and chronic inflammatory processes had been proposed to cause placental
abruption evidences that supports this remains sparse
OBJECTIVE:
To assess the correlation between the clinical diagnosis and histopathological findings of
placental abruption and to examine the profile of chronic and acute histological lesions associated
with clinical abruption.
PATIENTS AND METHOD:
The study included fifty singleton pregnant women with a suspected clinical diagnosis of
placental abruption compared to fifty consecutive normal pregnancies ( control group), attending
AL -Yarmouk Teaching Hospital over a period of twelve months, from the first of April 2010 to
the end of march 2011 . Examination of the concordance between clinical indicators for placental
abruption with those of a histological diagnosis was done. The profile of acute and chronic
lesions was also examined histopathologically.
RESULTS:
Among the fifty clinically diagnosed placental abruption cases , thirteen percent (fifteen patients)
were confirmed as placental abruption based on gross and histological findings . The most
common indication leading to a clinical diagnosis of abruption was evidence of retroplacental
clot(s) or bleeding . Acute lesions that were associated with abruption with confirmed pathology
included chorioamnionitis , and chorionic villous hemorrhage . Among the chronic lesions,
chronic deciduitis, decidul vasculopathy, & dysmaturation were associated with pathologically
confirmed placental abruption.
CONCLUSION:
The relation between clinical & histological diagnosis of placental abruption remains weak.
Acute and chronic histological lesions were observed more frequently in placentas of pregnancies
complicated by placental abruption than the control cases.

BACKGROUND:
Endometrial carcinoma is a primary malignant epithelial tumor, usually with glandular differentiation,
arising in the endometrium with the potential to invade and metastasize. Hepatocyte growth factor
(HGF) and its receptor c- Met have been implicated in uterine development, pregnancy, and
endometrial disorders, such as endometriosis and carcinoma.
OBJECTIVE:
The goal of this study was to evaluate immunohistochemical (IHC) staining patterns of HGF and cMet in endometrial adenocarcinoma and to correlate staining with the biological behavior and outcome
of endometrial adenocarcinoma.
PATIENTS AND METHOD:
A retrospective study included 45 cases ,who underwent total abdominal hysterectomy and bilateral
salpingo-oopherectomy, between 2005-2010 samples ,were taken from Teaching Laboratories at
Baghdad Teaching Hospital/Medical City.
Thirty cases were diagnosed as adenocarcinoma of the endometrium, an additional 15 patients
diagnosed as to have uterine leiomyoma(fibroid) and who had normal endometrium were taken as a
control group. The patient's age ,tumor grading ,depth of myometrial invasion, presence of pelvic and
paraaortic LN metstases, vascular invasion ,and the stage of the disease were noted .
The specimens were already fixed in10% formalin , and paraffin embedded. Three sections (4 micron in
thickness ) were cut from each paraffin block. One section stained with Haematoxylin and Eosin
(H&E) stain , and the other two stained with HGF and c-Met immunostaining antibodies using
positively charged slides .
RESULTS:
The mean age of the patients with endometrial adenocarcinoma was 58.5years.
There was no statistically significant difference between HGF/c-Met expression and age, tumor grade,
stage , myometrial invasion and vascular invasion. There was a statistical significant correlation
between HGF and c-Met scores with cases showing no pelvic lymph nodes metastases.
There is a linear increase in HGF and c-Met expression in both the diseased and control group.A
statistical significant correlation was found in HGF and c-Met scores between the diseased group and
the control group.
CONCLUSION:
HGF and c-Met staining was significantly different between control group and diseased group.
HGF and c-Met Showed Linear increase Expression in both diseased and control group .
The c-Met is the high-affinity receptor for hepatocyte growth factor.

BACKGROUND:
CA-125 is a glycoprotein, its origin is uncertain during pregnancy. It rises during the first trimester and
returns to a non-pregnancy range in late pregnancy.
OBJECTIVE:
To compare CA-125 levels between tubal ectopic and normal intrauterine pregnancy, and to find it’s
usefulness in differentiating intact from ruptured tubal ectopic pregnancy.
METHODS:
This prospective case-control study was carried out on sixty healthy women with single normal
intrauterine pregnancy (NIUP) of 6-10 weeks gestation and sixty women with tubal ectopic pregnancy
of same gestational age which were further subdivided into twenty-five women with ruptured tubal
ectopic pregnancy (REP) and thirty-five women with unruptured tubal ectopic pregnancy (UREP). The
levels of CA-125 were compared between these groups.
RESULTS:
The mean level of CA-125 in ruptured ectopic pregnancy group was 49.04±33.63 IU/ml and in
unruptured ectopic pregnancy group was 24.3±16.89 IU/ml. The mean level of CA-125 in normal
pregnant women (control group) was 53.95±31.2 IU/ml. There was a statistically significant difference
between mean serum CA-125 levels of ruptured ectopic pregnancy and unruptured ectopic pregnancy
group (p< 0.05), also there was a statistically significant difference between mean of CA-125 level of
unruptured ectopic pregnancy group and control group (p <0.05), while there was no statistically
significant difference between ruptured ectopic pregnancy group and control group (p > 0.05).
CONCLUSION:
CA-125 level is significantly elevated in ruptured tubal ectopic pregnancy than the intact tubal ectopic
pregnancy, this increase in CA-125 levels can be used as additional test to identify tubal rupture.

BACKGROUND:
Type 1 diabetes is characterized by a complete or near-complete insulin deficiency caused by an
immune-mediated selective destruction of the insulin-producing β-cells in the Islets of
Langerhans. Inflammatory mechanisms play a key role in the pathogenesis of type 1 diabetes.
Many findings suggest that the Islet autoantibody status in type 1 diabetes is linked to disease
activity.
OBJECTIVE:
To investigate the hypothesis that the systemic immunoregulatory balance, as defined by levels of
circulating cytokines, is associated with Islet autoantibody status.
METHODS:
Cytokines (IL-2, IL-4, IL-5,IL-10, TNF-β and INF-γ) and Islet autoantibodies (ICA, GADA, IA-2)
were measured in 56 patients with insulin dependent diabetes mellitus (IDDM) and 20 healthy
control patients.
RESULTS:
The three proinflammatory cytokines measured [interleukin-2 (IL-2) , interferon gamma (IFN-γ)
and tumor necrosis factor-β (TNF-β)], both TNF-β (50.0 ±5.9) (63.4± 5.4) and INF-γ (13.8 ± 10.9)
(13.7 ± 5.5) showed a significant increase (P <0.05) with Islet autoantibody positivity, while the
other three cytokines,(IL-4,IL-5 and IL-10), only IL-4 showed a positive increase (54.4 ± 1.4) with
Islet autoantibody positivity although it is non- significant association.
CONCLUSION:
The study reveals the possibility of the of Islet autoantibodies in the domination of
proinflammatory cytokines over the immunoregulatory cytokines.

BACKGROUND:
There are many cutaneous signs in diabetes mellitus (DM) which is the most common endocrine
disorder among the general population. Diabetic Dermopathy (DD) or Shin Spots are the most
common cutaneous signs of diabetes. Although they occur individually in people who do not have
diabetes, if four or more are present the specificity is high for microvascular disease in other tissues.
OBJECTIVE:
This study was done to evaluate frequency of diabetic dermopathy among diabetic patients and use
this obvious subtle clinical sign as marker for early detection of atherosclerotic changes in diabetic
patients including myocardial infarction
PATIENTS AND METHOD:
This study was done at diabetic center in Sulaimani intensive care unit(IUC) in teaching hospital of
Suliamani during the period from November 2008 to June 2009. A total of 384 patients with
Diabetes mellitus were included in this descriptive case series hospital-based study. All patients were
diagnosed by specialist diabetician as a case of DM depending on classic diagnostic criteria of DM.
All patients were thoroughly assessed regarding the age, sex, skin color, duration of diabetes mellitus
and treatment regime. Careful skin examinations has been performed for diabetic dermopathy,
diabetic wet gangrene of foot. Diagnosis of myocardial infarction was done either by
electrocardiographic changes or by plasma biochemical marker.
RESULTS:
Eighty four (21.9%) case with DD were reported in our study; fifty four (64.3%) case of them were
females while the remaining 30 (35.7%) cases were male.
Diabetic patients with myocardial infarction were 44(11.5%) cases, 36 cases as acute MI. while the
other eight cases were old cases of MI. Of these 44 cases 16(36.4%) had DD while 28(63.6%) had no
DD.
CONCLUSION:
There was a statistically significant association between the myocardial infarction and the frequency
of diabetic dermopathy and we should use this obvious subtle clinical sign as marker for early
detection of atherosclerotic changes in diabetic patients including myocardial infarction. Wet
gangrene of the foot is also considered a marker of bad glycemic control.

BACKGROUND:
Second-generation sulfonylureas (SU) are efficacious, generally well-tolerated, cost-effective
options for the medical management of diabetes. Glimepiride which is sometimes classified as a
third-generation has benefits over other in that it has a considerably lower binding affinity for the
B-cell receptor, result in a modulation of insulin release, and a decreased potential for inducing
hypoglycemia.
OBJECTIVE:
This study was designed to evaluate the outcome of using glimepiride and glibenclamide in type 2
diabetic patients.
PATIENTS AND METHODS:
A single blinded randomized clinical trial was adopted, in which 64 already diagnosed diabetic
patients (regardless disease duration) were recruited from Al-Yarmouk hospital, and randomized
into two groups; 1 st group (32 patients) treated with 5 mg glibenclamide, and 2nd group (32
patients) treated with 3 mg glimepride for 4 months. Fasting blood sugar (FBS), glycosylated
hemoglobin (HbA1c) level, triglyceride, cholesterol, serum electrolyte (Na, K, Ca) level and pulse
rate were measured at zero time (first visit)and at the end of the study (after 4 months).
RESULTS:
The result showed that both Fasting blood sugar, glycosylated hemoglobin, serum total cholesterol,
triglyceride levels were decreased significantly in both treatment group but with greater reduction
in group 2, serum electrolytes were not significantly affected, except calcium level which was
increased significantly in glimepiride group only. Moreover, no significant effect observed
regarding pulse rate compared to pretreatment period.
CONCLUSION:
Glimepride provide more potent glycemic control and better lipid profile compared to
glibenclamide in type 2 diabetic patients.

BACKGROUND :
Magnesium (( Mg )) is a mineral that is involved in over 300 reactions in the body. Magnesium is a
Potent vasodilation ,and plays an important role in muscle contraction. It has been early
documented that Mg deficiency can precipitate ventricular arrhythmias and treatment with Mg has
some anti arrythmic effect. Moreover there is an ample evidence that a significant percentage of
patients with IHD suffer from Mg deficiency.
OBJECTIVE :
The objective of the present study is to measure Mg levels in serum and RBCs of patients with
some forms of IHD.
PATIENTS AND METHODS:
The study was conducted in Baghdad hospital and Ibn – Al-Bitar Hospital.The 180 patients with
IHD were divided into Two groups. Group I, 80 patients with Ischemic Heart Failure (IHF)
(EF˂30) aged 65.75±5.97 year (50 males and 30 females), group II, 100 patients with
Muocardial Infarction
(MI)(EF˂50) aged 50.34±6.36 year (58 males and 42 females). Serum Mg and RBCs Mg were
measured in all patient groups by Atomic Absorption Spectrophotometer.
RESULTS:
The(mean ±SD) value of serum and RBCs Mg in patients with both groups Ischemic Heart Disease
(IHD) was significantly lower when compared with that of controls (p<0.05).The serum Mg levels
(0.81±SD mmol/L) are significantly lower in the IHF group and in MI group (0.96±0.18 mmol/L)
when compared with that of controls (1.00±0.17 mmol/L) (p˂ 0.001).
CONCLUSION:
The data obtained in present study revealed the decrease of Mg level in serum and RBCs in both
patients groups, which affect the contractility of heart muscle and cardiac performance .

BACKGROUND:
Asthma is a chronic disease &the chronic disease states regardless etiology can cause growth failure in
infant &toddler.
OBJECTIVE :
To assess growth of asthmatic patients
PATIENT AND METHODS:
One hundred asthmatic children between (5-15 years) of age . Both asthmatic & control group studied in
term of height, weight & Skin fold thickness, all anthropometric measurements of height, weight &skin
fold thickness measured for both groups.
RESULT:
Height, weight &skin fold thickness were significantly retarded in asthmatic, the more severe the
disease &longer duration the more retardation in the height & weight.
The height was affected more than the weight by the disease duration & severity .The diminution in skin
fold thickness was retarded both with increase disease duration & severity but the female was less
retarded than male as the disease duration prolonged.
CONCLUSION:
All growth parameter (height, weight, SFT) affected by asthma (duration & severity), so the growth
parameters can be used in asthmatic children to evaluate the effect of treatment.

BACKGROUND:
There are wide ranges of causes behind global developmental delay in Iraqi children but most of these
causes were not diagnosed as a result of unavailable diagnostic tools.
OBJECTIVE:
To study the etiology of global developmental delay in Children Welfare Teaching Hospital / Baghdad.
PATIENTS AND METHODS:
A descriptive study was done on 75 patients, their age range from 8 months to 5.5 years with global
developmental delay, who consult Children Welfare Teaching Hospital/Baghdad, from 1 st of May 2010
to 1 st of October 2010. A full history, thorough physical examination, and developmental assessment
according to Denver Developmental Scale II were done to all cases. A group of selected investigations
including neuroimaging (CT & MRI), EMG, EEG, visual and hearing assessment, screen for metabolic
diseases, and thyroid function test were done as needed for the diagnosis.
RESULTS:
A total of 75(preschool) patients with age range from 8 months to 5.5 years were studied; 45(60%) of
them were males and 30(40%) were females,9(12%) were preterm, 26(34.6%) were born with LBW,
3(4%) of patients acquired the infection with TORCH from their mothers [2(2.7%)CMV,
1(1.3%)toxoplasmosis], 8(10.7%) had their mothers complained from chronic diseases (hypertension
and diabetes mellitus ), 11(14.7%) suffered birth asphyxia, 2(2.7%) with high bilirubin level exceeding
20mg/dl, 2(2.7%) patients suffered RDS and 1(1.3%) suffered sepsis diagnosed by blood culture during
neonatal period .Family history of developmental delay was reported in 11(14.7%) and consanguinity
was reported in 46(61.3%) of cases, in 33(43.9%) no cause could be identified, CNS infections 9(12%),
Down syndrome 7(9.3%), hypothyroidism 2(2.7%), intracranial hemorrhage 2(2.7%), infantile spasm
2(2.7%), phenylketonuria 2(2.7%), Myotonia Dystrophica 1(1.3%), and Seckel syndrome 1(1.3%).
CONCLUSION:
Global developmental delay in pediatric practice has wide etiology. The majority of cases were not
diagnosed because of deficient diagnostic tools like cytogenetic analysis. High percent of perinatal
etiology raises the importance of good maternal and neonatal care. Under diagnosis of inborn error of
metabolism due to lack of routine screening in neonatal period, aggravated the problem.

ACKGROUND:
Polycythemia is defined as a venous hematocrit above 65%.Polycythemia is sometimes associated
with hyper viscosity of blood .The etiology of polycythemia is related either to intra-uterine hypoxia
or secondary to fetal transfusion. Increased viscosity of blood is associated with symptoms of hypoperfusion. Clinical features related to hyper viscosity may affect all organ systems.
OBJECTIVE:
To evaluate the prevalence of polycythemia among neonates who were admitted to the nursery care
unit, to evaluate the difference between peripheral and central hematocrit (PCV) and to have an idea
about the main presentation and modes of treatment of polycythemia.
PATIENTS AND METHODS:
A case – control study was done in the nursery care unit of AL - Kadhyimia Teaching Hospital , one
hundred neonates (50 polycythemic and 50 control healthy neonates ) were taken , for each neonates ,
information regarding (name ,age , sex , gestational age , mode of delivery , body weight ,length, head
circumference , clinical presentation and risk factors ) were taken, investigations including
hematocrite (PCV) , random blood sugar and total serum bilirubin were done for all neonates.
RESULTS:
The prevalence of neonatal polycythemia was (2.2%) , male was affected more than female with male
: female ratio equal to ( 1.5:1) . The difference between peripheral and central PCV was (4 - 15%)
with a mean and standard deviation of
( 7 ± 0.33%). The main signs & symptoms were jaundice (58%), lethargy (30%) , respiratory distress
(26%) and hypoglycemia (26%) . Risk factors were preterm (36%) , neonates of diabetic mother
(20%) , small for gestational age (18%) , twin pregnancy (12%) and down's syndrome (10%) . Partial
exchange transfusion was done to 28 cases (56%).
CONCLUSION:
Males were affected more than females. Jaundice was the main presentation followed by lethargy,
respiratory distress and hypoglycemia .Higher risk in twin pregnancy ,neonates of diabetic mother ,
small for gestational age , preterm and down's syndrome while delivery by caesarian section reduce
the risk of polycythemia.

BACKGROUND:
Itching is the main symptom in urticaria and can cause a lot of suffering in chronic urticaria.
OBJECTIVE:
To measure the itch threshold in patients with chronic urticaria before and after treatment and
compare them with healthy control.
PATIENTS AND METHODS:
The study was conducted at the department of dermatology, medical city teaching hospital Baghdad
in the period from December 2009 to July 2010. A total of 30 patients with chronic urticaria (patients
group) and 25 healthy individuals (control group), were included in the study.
The age of patients ranged between 21years and 48 years with a mean of 30.96 years ± 6.09 years
(standard deviation). In control group the age ranged between 20 years and 45 years with a mean of
31.40 years ± 8.39 years (standard deviation). Regarding gender, in the patients group 19 were
females and 11 were males. While in the control group 14 were females and 11 were males.
Electrical skin itch threshold was measured by square wave DC electrical stimulator at 13 points on
the skin surface in patients and compared to the healthy controls. Doxepin was given to patients for 2
weeks, the itch threshold was then measured again. The severity of urticaria was also assessed before
and after treatment.
RESULTS:
Patients with chronic urticaria had significantly lower threshold than the control subjects .The lowest
threshold recorded in patients group was (1.292±0.399) volts in the left cheek, while in control group
the lowest electrical cutaneous threshold was recorded in the chin (1.89±0.490) volts then left cheek
(1.910±0.478). The P-value was significance in all skin spots. The electrical cutaneous threshold
increased after treatment in all spots tested after treatment. The increase was statistically significant
in all tested the skin spots except in the back of the neck and xyphoid point.
The total score decreased from 10.8 before treatment with doxepin to 1.5 after treatment. The
individual parameters also decreased significantly after treatment. There were no significant side
effects except drowsiness which improved after a few days even with continuation of treatment.
CONCLUSION:
Electrical skin itch threshold seems to be a simple test that aids in measuring the severity of itching in
urticaria and may be used in the evaluation of drugs used for the alleviation of itching in urticaria and
other skin diseases.

BACKGROUND:
Herpes simplex labialis is a common disease and is the major cause of erythema multiforme.
Recently post-herpes labialis leukoderma had been noticed on the lips of Iraqi patients
OBJECTIVE:
The aim of the present work is to assess this new pigmentary problem.
METHODS:
A total of 24 patients with post-herpes labialis leukoderma were included in this study. Full history
and a thorough physical examination were done for all patients.
RESULTS:
Fourteen females (58.37%) and 10 males (41.67%) were studied. Their ages ranged between 7-53
years. Koebner phenomenon was positive in 17 (70.83%) patients. Family history of vitiligo in
close relatives was positive in 13 (54.17%) of patients.
CONCLUSION:
The findings of the present work are in favor that this type of leukoderma is a variant of vitiligo
that may be induced by herpes-simplex labialis.

BACKGROUND:
Rheumatoid arthritis is a chronic systemic inflammatory disease affects many tissues and organs, but
principally attacks flexible (synovial) joints. Methotrexate is the most commonly used disease-modifying
antirheumatic drug for the treatment of rheumatoid arthritis.
OBJECTIVE:
The aim of this study was to evaluate the effect of methotrexate on serum levels of IL-1α and IL-8 in
rheumatoid arthritis.
SUBJECTS AND METHODS:
Blood samples were collected from 50 patients with rheumatoid arthritis (25 patients without treatment
and 25 patients are received methotraxate) and from 30 healthy age and sex matched individuals served as
controls. Serum IL-1α and IL-8 were measured by means of enzyme-linked immune-sorbent assay.
RESULTS:
The present results showed that serum levels of IL-1α and IL-8 were significantly higher in RA patients
than in healthy controls (P<0.01), furthermore, level of IL-1α was significantly decrease in patients
treated with methotraxate as compared to those patients who have received no treatment (P<0. 01). On the
other hand serum level of IL-8 did not showed any significant differences between patients treated with
methotraxate and those patients without treatment (P>0. 05).
CONCLUSION:
These finding demonstrate that methotrexate turns out to be a good inhibitor for IL-α production. In
addition, IL-1α and IL-8 may have a significant role in the pathogenesis of rheumatoid arthritis, and could
be use as .

BACKGROUND:
Preoperative templating plays an important role in orthopaedic surgery for achieving a successful
outcome in THA. This includes not only selecting the type and size of implant, but also deciding
on the alignment, position, and orientation of these implants, relying on anatomically defined
landmarks
OBJECTIVE:
The first goal of this study was to evaluate the validity of preoperative templating technique in
terms of determining the final implant size and position.
The second goal was to investigate the interobserver and Intraobserver reliability of template
readings on conventional radiographs.
METHOD:
In Aljumhorei hospital, Mosul city a case series; pilot study has been carried for twenty-eight
patients had preoperative templating for total hip arthroplasty between 21/10/2009 to 16/5/2012
was carried by the operating surgeon. Preoperative templating by same two orthopedic surgeons
carried for 12 patients from the total. Preoperative templating for Seventeen patientsout of the total
were studied with the same operating surgeon after 2 years of experiences.
RESULTS:
29% compatibility for shell between preoperative templating with intraoperative for the operator,
P_ 0.023. While for stem 39%P_ 0.257. Second surgeon 58% compatibility with P_0.564, Stem
differences represent 33% (P_ 0.248). Differences with two years experiences for the operating
surgeon indicate 35% compatibility both for shell and the stem with non-significant differences.
CONCLUSION:
Preoperative templating appeared to be more accurate for femoral stem measurements than the
acetabular templating in determining the accurate sizes. Two years experienced added no more in
templating measurements. There were significant differences for interobserver measurements .

BACKGROUND:
Obesity currently affects nearly one-third of the population in the industrialized world.
Traditionally, anthropometric measures such as body mass index (BMI) or waist circumference
have been used to quantify overall adiposity; however, regional fat depots may be of greater
importance than overall adiposity. Several studies have highlighted pericardial fat and abdominal
visceral adipose tissue (VAT)as unique, pathogenic fat depot.
OBJECTIVE:
Recognize the relation of obesity to increase epicardial fat pad thickness in Iraqi patients.
METHODS:
Epicardial fat thickness was measured in 62 consecutive subjects (28 women 45%, 34 men 55%)
mean age of 47.77 years (SD 8.03),using routine transthoracic echocardiogram. Epicardial fat was
identified as the echo-free space between the outer wall of the myocardium and the visceral layer
of the pericardium, and its thickness was measured perpendicularly on the free wall of the right
ventricle at end-systole.
RESULTS:
The results show progressive increase of epicardial fat with increasing BMI which was very
significant statistically. High mean epicardial fat is significantly associate with increasing waist
circumference. No difference in those below and above 45 years of age in mean epicardial fat and
there is gender difference in epicardial fat, where males had more epicardial fat than females.
CONCLUSION:
There is increase in the epicardial fat pad thickness in overweight and obese (BMI≥25) patients if
compared to normal persons epicardial fat increase with increasing waist circumference more
likely in male obese and independent of age.

BACKGROUND:
Despite major advances in cancer treatment in the past two decades, the prognosis of patients with
lung cancer has improved only minimally. Although tumor stage is the most significant prognostic
factor, the variation in survival within staging groups requires information about additional factors
influencing the outcome. Among several genetic aberrations that have been implicated in lung
cancer, mutations in the p53 gene are the most common.
OBJECTIVE:
The aim of this study was to evaluate the expression of p53 in non-small cell lung cancer. To
correlate the relation of p53 with some clinico-pathological parameters. And to compare the results
with that of others.
PATIENTS AND METHODS:
Tumor tissues from 52 patients with non small cell lung cancer (NSCLC) were assessed by
immune-histochemistry for the expression of p53. The immunohistochemical study was performed
on formalin-fixed, paraffin-embedded sections using LSAB immune-peroxidase method.
RESULTS:
Thirty nine (75%) of 52 patients revealed aberrant immunostaining for p53. No significant
relation was observed between the p53 and patient age (P=0.596). A significant association
(P=0.048) was found between the p53 and the sex of the patient with higher expression in males
and the p53 was significantly (P=0.0345) associated with histopathological type of tumor.
Comparing p53 expression with grade resulted in a strong positive correlation (P= 0.0002). The
percentage of p53-positive tumors progressively increased from (2.56%) in well differentiation to
(53.85%) in poorly differentiated tumor.
CONCLUSION:
P53 was significantly association with sex, grade and histological type, the detection of p53 may be
important marker to predict the prognosis of the patients with NSCLC and for stratifying these
patients into more accurate prognostic group.

BACKGROUND:
Premature ejaculation (PE) is a worldwide problem. Selective serotonin reuptake inhibitors (SSRIs) are
widely used “off label” as pharmacotherapeutic agents in the treatment of PE.
OBJECTIVE:
Assess the efficacy of Tramadol for on-demand treatment of PE.
PATIENTS AND METHODS:
During the period December 2008 through November 2009, 60 married men visited the surgical
specialties hospital urology outpatient and consultancy clinics complaining of premature ejaculation
were enrolled in this study. Intravaginal ejaculation latency time (IVELT) was used as an objective tool
to assess the efficacy of the investigated treatment. Single-blind, placebo-controlled therapeutic trial
was conducted on 60 patients with lifelong PE. PE was defined as IVELT of <2 minutes in at least 80%
of intercourse episodes. The patients cohort was randomised into 2 equal sized groups. The intervention
group (n=30) used 50 mg tablet of Tramadol hydrochloride, while the control group (n=30) used a
placebo tablet for 8 weeks. Drugs were taken 1 –2 hours before sexual activity, and sexual intercourse
was required at least once per week. IVELT was timed by a stopwatch at each intercourse.
RESULTS:
The mean IVELT after tramadol and placebo significantly increased from 73.1 and 67.9 seconds to
approximately 442.1 and 113.3 seconds, respectively (P < 0.001). Sexual satisfaction was used to assess
the cut-off values of IVELT in defining the minimal and best clinical response to treatment. There was
no withdrawal symptoms recorded following the use of tramadol or placebo, but more adverse events
were associated with tramadol treatment
CONCLUSION:
Tramadol seems to provide significantly better results in terms of IVELT and intercourse satisfaction
versus placebo. Further studies are required to draw final conclusions on the efficacy of this drug in
premature ejaculation.

BACKGROUND:
Otalgia is defined as ear pain. It is one of the complaints which may occur at any age. The
etiology of the pain may be in the ear, structures around the ear or other head and neck structures
This is caused by the complex nervous connections in the head and neck areas, the ear, the
pharynx and the nose. objective: since understanding the etiologies of referred otalgia can help in
the assessment and treatment of the disease, this research was conducted to identify the
etiologies of referred otalgia in patients visiting the ENT Clinic in mosul , Iraq
OBJECTIVE:
Since understanding the etiologies of referred otalgia can help in the assessment and treatment of
the disease, this research was conducted to identify the etiologies of referred otalgia in patients
visiting the ENT Clinic in Mosul , Iraq. We have reviewed the complex neuroanatomic basis of
nonotogenic ear pain
PATIENT AND METHODS:
A prospective study of 211 patients with ear pain. During a 12 month period from 2010
to2011,two hundred and eleven patients with otalgia were studied, they were attendant of the
outpatient clinic of ENT department in Al-Jumhury Teaching Hospital. Patient age ,gender
,occupation, residence were recorded in a representative questionnaire form. All patients had a
normal otologic examination and diagnosed with causes for referred otalgia were categorized
according to distribution of cranial nerve, gender and age.
RESULTS:
The majority of causes of otalgia (64%)were due to referred pain, while only(35.5)of causes
were due to ear leasions. significantly referred pain affected patient above the age of 15yr more
than those below the age of 15yr .The most common cause for referred otalgia in Females was
Temporomandibular joint (TMJ) dysfunction (29.2%);while cervical spine lesion was
commonest in male. The trigeminal nerve was the major cranial nerve causing referred pain in
both gender (53.7)
CONCLUSION:
Since the early 1900s, referred otalgia has been a well-documented phenomenon in the ear, nose,
and throat (ENT) and neurosurgical literature. However, Essentially any pathology residing
within the sensory net of cranial nerves V, VII, IX, and X and upper cervical nerves C2 and C3
can potentially cause referred otalgia. A thorough understanding of the various sensorineural
pathways that dually innervate the ear and other sites and ongoing dialogue with our clinical
colleagues, will ensure that patients with referred otalgia will receive the best care in the head
and neck.

BACKGROUND:
Postoperative Nausea and vomiting is Common complication depending on the type of surgery,
technique and duration of anesthesia.
OBJECTIVE:
To evaluate the effect of Dexamethasone as antiemetic in comparison with Metoclopramide.
METHODS:
Is aprospective study carried on (100) patients undergone elective cholecystectomy in a period
from Jan. 2009 to April. 2010 in Baghdad Teaching Hospital / Medical city/Baghdad/Iraq.
The patients were allocated into two groups of 50 patients each. Group A received 8mg
Dexamethasone, group B received 10mg metoclopramide intravenously, both groups monitored
postoperatively for nausea and vomitting for 24 hours every 4 hours.
RESULT:
Regarding Nausea, for 24 hrs the results were not significant except at 24th hr., in which nausea
more significant in metoclopramide group.
Regarding Vomiting, there was no significant from postoperative period to 12hr, while from 16 hr.
to 24 hr. there were significant fewer incidences in dexamethasone group.
CONCLUSION:
A single dose of Dexamethasone is effective same as Metoclopramide in prevention of PONV ,
and it is better in late prevention postoperatively

BACKGROUND :
Postoperative nausea and vomiting (PONV) is a common distressing experience in patients following
laparoscopic cholecystectomy.
OBJECTIVE:
This study was aimed at comparing the better timing of Ondansetron administration in prevention of
PONV in female patients underwent elective laparoscopic cholecystectomy done under general
anesthesia.
PATIENTS AND METHODS:
Fifty ASA physical status I and II female patients, aged 19 to 45 years, were enrolled in this prospective
study to receive 4mg IV Ondansetron preoperatively (Group A), or 4 mg IV Ondansetron
postoperatively (Group B), 25 patients each. A standardized general anesthetic technique was
employed. Any episode of PONV was assessed at 8 hours postoperative period, every 2 hours, starting
at time zone 0 (at post-anesthesia recovery unit), and ending at time zone 3 ( hour 8 postoperatively).
Complete response is defined as no PONV during 8 hours postoperative period. Incomplete response is
defined as developing of postoperative nausea only during 8 hours postoperative period. Failure of
prevention is defined as developing of PONV during 8 hours postoperative period.
RESULTS:
Complete response occurred in 60 and 64% in Groups A and B respectively. Incomplete response
occurred in 12 and 4% in Groups A and B respectively. Failure of prevention occurred in 28 and 32%
in Groups A and B respectively.
CONCLUSION:
There is no significant clinical difference between preoperative or postoperative Ondansetron
administration of the same dosage in both groups in prevention of postoperative nausea and vomiting.

BACKGROUND:
Effect of intravenously administered dexamethasone in reducing the incidence and severity of post
operative sore throat in patients receiving general anesthesia with endotracheal intubation.
OBJECTIVE:
To investigate the effect of dexamthasone administered intravenously preoperative in reducing post opretive sore throat
METHODS:
80 patients receiving general anesthesia with endotracheal intubation in randomized double blinded
placebo controlled were randomly assigned to two groups: group1(control) patients receiving
normal saline 2 mLiv and group 2 (D) patients received dexamethasone 8 mg iv. After surgery,
visual analogue scale(VAS) scores at rest and with effort (swallowing movment) for post operative
sore throat were recorded.
RESULTS:
This study revealed that post operative sore throat during the first 24 hr following surgery was
lower in dexamethasone group(D) compared to the control group(C).Nine (22.4%) patients in the
dexamethasone group had postoperative sore throat, compared to 23(57.5%)patients in the control
group (p<0.01). Postoperatively at one hour,threehours, six hours, 12 hours and 24 hours, the VAS
scores for postoperative sore throat at rest and during effort were lower in dexamethasone group
(D) compared to the control group(p<0.01) at corresponding time intervals.
CONCLUSION:
Preoperative administration of dexamethasone 8mh iv reduces the incidence and severity of
postoperative sore throat in patients receiving general anesthesia with endtacheal intubation.

Multilocular cystic renal cell carcinoma
(MCRCC) is a rare clear cell type of renal cell
carcinoma. Although cytologyically and
cytogenetically MCRCC is similar to clear cell
carcinoma, histology and behavior differ
markedly. Prognosis in MCRCC is excellent as
the tumour is of consistently low grade and
surgical resection is curative. We report here a
case of MCRCC in 44 year old female presented
with right loin pain, was miss-diagnosed as renal
hydatid cyst for 2years. Local excision of the
tumor mass only was done with no recurrence
after 30 months of follow up after. The
differentiation between renal hydatid cyst and
MCRCC may be difficult clinically and
radiologically.The tumor grows very slowly.The
outcome of the lesion is not affected adversely
by large tumor size. There is an increasing belief
that MCRCC should be renamed and reclassified
to indicate much more favorable prognosis than
the conventional clear renal cell carcinoma.

Hydatid cyst (HC) disease is zoonotic disease
caused by larvae of Echinococcus granulosus
which is commonly affecting liver and lung or
any organ or tissue in our body .central nervous
system (CNS) can be involved at any place with
or without brain involvement including skull
,orbit , vertebral column and spinal cord .Orbital
infestation is constituting less than 1% of all
hydatid disease cases .There are few reported
cases of orbital HC in the literatures that
presented with acute visual loss and proptosis. In
this article we are reporting a case of intramuscular orbital HC that presented with sever
and acute visual loss with proptosis following
trivial road traffic accident.