Iraqi Postgraduate Medical Journal

BACKGROUND:
Acute viral bronchiolitis is a common respiratory infectious disease of children.
OBJECTIVE:
To study the relationship between bronchiolitis and breastfeeding in children below 2 years of age.
MATERIAL AND METHODS:
A prospective study was carried out with100 child aged up to 24 months to evaluate their
breastfeeding status as possible risk factors for unfavourable evolution in department of pediatric
in AL-Kahdimiya Teaching Hospital during the period from first of October 2008 to the end of
March 2009.
RESULTS:
Hundred cases of bronchiolitis were included in this study. Most of them ( 78 %) were below one
year. Male children were 70%, female children were 30%. Fifty-four of the children were
exclusively breastfeeding. Eighty of the children were admitted to the hospital because of severe
attack. The median length of hospital stay was four days and of oxygen-use was three days.
CONCLUSION:
The duration of exclusive breastfeeding was inversely related to the length of oxygen-use and the
length of hospital stay. Shorter exclusive breastfeeding was observed in children who were
assigned to a pediatric ward or to an intensive care unit. Longer duration of breastfeeding was
associated with better clinical outcomes.

BACKGROUND:
The rising level of obesity has been called the most urgent challenge to public health for the 21st
century. While many social institutions should be involved in addressing this problem, family
physicians have an important role in identifying and managing obesity.
OBJECTIVE:
To assess and compare the knowledge , attitudes and practice regarding obesity management among
family and non family physicians working in primary health care centers.
Methodology :
A cross-sectional survey has recruited a randomly selected sample of primary health care physicians
working in primary health care centers in Baghdad in 2010. A structured self-administered
questionnaire was used to collect data from 232 physicians. These include family medicine board
certified and other non-family medicine certified physicians. The questionnaire had four main parts:
personal data, knowledge, attitude and practice.
RESULTS:
The majority of the respondents depend on the waist circumference to diagnose obesity with 100%
among the family physicians and (74.2%) among non-family physicians. The majority of the
respondents think that obesity is a major health problem in Iraq with 49 (96.08%) among the family
physicians and132 (72.93%) among non family physicians. About (84.3%, 72.5% and 41.2%) of
family physicians agreed to prescribe Weight reduction medication when BMI >30, Patient not on
diet and on patient request respectively. Almost all family physicians (92.1%) agreed that is it better
to have a training course in obesity management compared to 49.46% among non- family
physicians.
CONCLUSION:
Both the family and nonfamily physicians working in the primary health centers need to improve
their knowledge and skills regarding obesity management.

BACKGROUND :
Neonatal septicemia is a major cause of morbidity and mortality in developing countries.
OBJECTIVE:
The study is to determine the prevalence , the pattern of organisms and the mortality of neonatal
septicemia in a neonatal care unit.
PATIENTS AND METHODS:
All the cases of neonatal septicemia diagnosed and treated in the neonatal care unit at al-kadimiya
teaching hospital for the period january-june 2010 were included in this study. The collected data
were : Gender, Birth weight, Gestational age, Onset of sepsis, Place of delivery and Outcome of
disease.
RESULTS:
Out of 589 newborns admitted, 73(12.4%) were confirmed cases of neonatal septicemia. The
mortality from neonatal sepsis was 16.4%.Low birth weight and prematurity were independent
factors associated with death (P value=0.004 and 0.020 respectively).There were 24 cases (32.9%)
of early onset sepsis and 49 cases (67.1%) cases of late onset sepsis. The most common pathogens
were gram- negative bacilli causing early-onset sepsis (54%) and late onset sepsis (59%). Only 6
cases out of the total 73 cases of neonatal septicemia were caused by staphylococus aureus (8.2%) .
Over 50% of gram-negative bacilli are antibiotic resistant.
CONCLUSION:
The high rate of gram-negative septicemia and the antibiotic resistance to both ampicillin and
gentamycin indicate that the infection was most probably nosocomial in origin.

BACKGROUND:
Delayed childbirth has become a common phenomenon in the developed world as a result of social,
educational, and economic factors .
OBJECTIVE:
To demonstrate the effect of age on the pregnancy course and outcome among young and old
mothers.
Subjects &methods:
A cross sectional study was conducted at Al-Kadhimia Teaching Hospital. Data was collected by a
trained medical students during the period from first of February to April 2010 .Total of 230
women were included in the study using a convenient random sample technique, the sample was
divided into two groups,128 women < 30 years old (group A) and 102 women ≥ 35 years old
(group B), and were taken from obstetric department in Al-kadhimiya teaching hospital .
Information were directly obtained from the mother herself and filled in a well designed
questionnaire form.
RESULTS:
The results showed that there was no significant difference between the two groups regarding some
sociodemographic characteristics like address, education, occupation, antenatal care. There was a
significant increase in the presence of medical &obstetric complication, parity, history of abortion
and No of abortion in the older age group mothers. As to the outcome of pregnancy, twin delivery
and low birth weight babies were significantly higher in older age group mothers. Interestingly,
there was no significant difference regarding presence of congenital anomalies in babies of mothers
in both groups.
CONCLUSION:
Mothers ≥35 years old showed higher rate of obstetric complication than young age group of
mothers, while congenital anomalies were higher but not significant among young age group of
mothers (≤30 years old).

BACKGROUND:
Perineal trauma is a common event, affecting up to 90% of first time mothers. It is a cause for
concern for many women and in some countries has led to a large increase in the numbers of
women requesting elective caesarean section.
OBJECTIVE:
To highlight when episiotomy can be useful in preventing anal sphincter injury in primiparous
women.
MATERIALS AND METHODS:
This study is a prospective interventional clinical study conducted at AL-Elwiya Maternity
Teaching Hospital in Baghdad throughout the period between Jan. 2009- Dec. 2009.
Three hundred term primiparous ladies at time of their delivery with cephalic presentation were
collected and subdivided into 3 equal groups randomly.
The first group, women who were subjected to routine mediolateral episiotomy, while the second
group of the participants were delivered without doing episiotomy, and the third group, a
mediolateral episiotomy was done selectively to them when we found it is necessary (selective
episiotomy).
State of the perineum, length of 2nd stage, weight of the baby, fetal head position and the
occurrence of anal sphincter injury were all notified and carefully recorded on special form
designed for the study.
RESULTS:
Selective episiotomy was found to be more useful than routine episiotomy in preventing anal
sphincter injury (the incidence of anal sphincter injury was 2% for those in whom episiotomy was
performed selectively, while it is 8% for those with routine episiotomy and 7% for those delivered
without episiotomy), and the difference is statistically significant (P value 0.045).
There was a significant effect of the length of second stage of labour on the incidence of anal
sphincter injury (P value 0.017), similarly for the weight of baby (P value 0.017).
CONCLUSION:
Selective episiotomy is more useful intervention than routine episiotomy in protecting the anal
sphincter when delivering a primiparous lady.

BACKGROUND:
Leptin is a protein that regulates energy expenditure and food intake. It is found that maternal leptin
level increases progressively during gestation. However, in other hypothesis, rapid increase in
maternal leptin concentration disproportional to gestational week is a marker for hyperemesis
gravidarum.
OBJECTIVE:
To assess the maternal serum leptin , the adjusted leptin levels in first trimester women with
hyperemesis gravidarum and with normal pregnancy and to find the correlation between leptin level
and thyroid hormones in the two groups.
PATIENTS AND METHODS:
A case-control study conducted in AL- Yarmouk teaching hospital /department of obstetrics and
gynaecology for one year from March 2009 to March 2010.
A hundred pregnant women were enrolled in this study. Fifty women with hyperemesis gravidarum
and fifty women without hyperemesis gravidarum as a control group were included in the study.The
two groups were compared for age, parity, body mass index. Fasting serum thyroid stimulating
hormone ,free thyronine hormone, free thyroxine hormone and leptin levels were measured . The
adjusted leptin level (ALL ) : maternal serum leptin level / gestational week , was calculated in each
case.
RESULTS:
Body mass index was found significantly lower in the hyperemesis gravidarum group than in the
control group(p = 0.018) .The mean leptin level in the hyperemsis gravidarum group was14.78+4.46
ng /ml which was significantly higher (p = 0.035) than the mean leptin level in the control group
which was12.51+4.08 ng/ml.The mean adjusted leptin level in the hyperemsis gravidarum group was
1.86+0.23 which was significantly higher (p<0.001) than the mean adjusted leptin level in the control
group which was1.38+0.20 . Serum thyroid stimulating hormone was significantly lower (p = 0.001)
and free thyronine hormone , free thyroxin hormone levels were significantly higher (p <0.001,
<0.001 respectively) in the hyperemesis gravidarum group than in the control group.
CONCLUSION:
Maternal serum leptin level was significantly higher in the HG group. ALL was also significantly
higher in the HG group and there was no significant correlation between leptin level and thyroid
hormones.

BACKGROUND:
Hypertension in postmenopausal women is a risk factor for endometrial hyperplasia.
OBJECTIVE:
To examine whether the endometrium of hypertensive postmenopausal women is thicker than that
of non hypertensive postmenopausal women, to determine whether this thickening is directly
related to the antihypertensive drugs and whether is associated with abnormal pathology.
METHODS:
A Case control study of Forty five hypertensive asymptomatic postmenopausal women was
conducted in Al Yarmouk Teaching Hospital, (22) were treated with B- blockers combination
medication and (23) were treated with other medications. They were compared with each and with
(25) non hypertensive women. All women were interviewed; blood tests were performed and
endometrial thickness in antero-posterior diameter was measured by vaginal ultrasonography.
Endometrial sampling had been taken for those with increased endometrial thickness more than
5mm.
RESULTS:
24.44% of hypertensive women and 4.00% of non hypertensive women had an endometrial
thickness more than 5mm. There was no statistically significant difference between those who
treated with medication including B- blocker and those who were treated with other medication.
The histological findings were mainly of endometrial hyperplasia for those with thickened
endometrium.
CONCLUSION:
Hypertension may have a role in endometrial thickness. We were unable to substantiate an
association between the type of treatment administered and the increase in endometrial thickness.
Those with increased endometrial thickness more than 5mm, the histological findings were mainly
of endometrial hyperplasia.

BACKGROUND:
Idiopathic thrombocytopenic purpura is an acquired chronic autoimmune disease .Treatment when
indicated is usually by corticosteroids,then splenectomy if no acceptable response,with variable
response rate to both types of treatment.
OBJECTIVE:
To look for the effects of certain variables on the type of response to steroid therapy in patients with
adult idiopathic thrombocytopenic purpura, and to study the outcome of splenectomy in relation to
previous steroid therapy.
METHOD:
A prospective study on 80 patients, presented with bleeding and a platelet count of ≤ 30 X 109 / L.
Initially treated with prednisolone and the response was studied in relation to gender , age , duration of
bleeding and platelet count on presentation. Patients who failed to maintain permanent complete
remission were advised to have splenectomy.
RESULTS:
Of the 80 patients, 62 (77.5 %) were females and 18 (22.5%) were males. Mean age was 23 ± 10.1
years. Ten (12.5%) patients only had permanent complete remission after steroid therapy. While 70
(87.5%) patints failed. Response to steroid therapy was significantly related to duration of bleeding but
not to gender, age and platelet count. Thirty seven (46%) patients underwent splenectomy, permanent
complete remission were achieved in 29 (78.2%).
CONCLUSION:
1. Duration of bleeding of ≤ 3 weeks is a good predictor of successful steroid therapy.
2. Results after splenectomy is not related to previos steroid therapy.

BACKGROUND:
Adiponectin is thought to be exclusively synthesized by adipocytes; however, a recent suggestion
stated that adiponectin is also synthesized and secreted by human cardiomyocytes. Adipose tissue
is increasingly recognized as a key regulator of energy balance, playing an active role in lipid
storage and buffering, and synthesizing and secreting a wide range of endocrine products that may
be directly involved in the pathogenesis of the complications associated with obesity. So obesity
consider the major independent risk factor for atherosclerotic cardiovascular disease Acute
Myocardial Infarction (AMI), is the interruption of blood supply to part of the heart, causing some
heart cells to die. Insulin is a very important hormone as it regulates the level of glucose, in the
blood. Troponin is a complex of three regulatory proteins that is integral to muscle contraction in
skeletal and cardiac muscle.
OBJECTIVE:
To monitor adiponectin level and its effect on lipid profile and Troponin levels in Acute
Myocardial infarction patients.
SUBJECTS AND METHODS:
The study included 50 patients with Acute Myocardial infarction and forty healthy subject as
control group. This study designed to measure adiponectin, lipid profile and troponin levels.
RESULTS:
Levels of adiponectin, cholesterol, LDL-C and Troponin were significantly elevated with
(p<0.001), while HDL-C was significantly lower with (p<0.001), There was negative correlation
between adiponectin with , cholesterol LDL-C, triglyceride and VLDL, and there was positive
correlation between adiponectin with HDL in acute myocardial infarction.
CONCLUSION:
The significant increase in adiponectin in AMI may be related to inflammation. From the relation
of adiponectin with lipid profile, adiponectin can increase level of HDL and decrease level of
triglyceride so this suggested that adiponection have anti-atherosclerosis properties.

BACKGROUND:
Acute leukemia is a hematological malignancy characterized by an uncontrolled proliferation of
hemopietic primitive cells. Presenting features of acute leukemia include fever, anemia, pallor;
hepatosplenomegaly &lymphadenopathy, bleeding tendency, bone pain&gum hypertrophy.
Intrathoracic manifestations of acute leukemia include infection,mediastinal widening , hemorrhage,
infiltration, embolism, edema, pericarditis ´ respiratory distress syndrome.
OBJECTIVE:
To describe the clinical &radiological respiratory features of acute leukemia at presentation,before
starting chemotherapy.
PATIENTS AND METHODS:
Patients with acute leukemia of age ranged from 15-75 years were incorporated in this study, patients
were excluded from the study if they had previous malignancy, lung disease, or if received cytotoxic
treatment. Every patient had a detailed history of pulmonary symptoms & chest examination,chest xray examination, sputum samples & pleural aspirates for relevant patients.
RESULTS:
Of 118 patients with actue leukemia at presentation, 60% of patients were males& 40% were
females. Respiratory symptoms including cough,dyspnea&chest pain were found in27.7% of patients
(cough 24.4% ,dyspnea 2.5%,chest pain 0.8%) . Respiratory signs including crepitations ,decreased
air entry & bronchial breathing were found in 12.5% of patients(crepitation 3.3%, decreased air entry
in 6.7%, bronchial breathing in 2.5%). Chest X-ray abnormalities were found in 14.3% of patients
,these include mediastinal widening in 5.9% of patients .Pleural effusion in 4.2% & parenchymal
infiltrates in 4.2% of patients
CONCLUSION:
The chest findings in patient with actue leukemia at presentation were not uncommon. mediastinal
widening was the commonest, pleural effusion&parenchymal infiltrates were less common findings.

BACKGROUND:
Detection of certain autoantibodies and other non-specific inflammatory markers were employed in
to predict an ongoing process of developing diabetes in first degree relatives of T1D patients.
OBJECTIVE:
The main objective of this study was to evaluate the value of monitoring of selected specific and non
specific serum markers in the presumptive prediction of Type 1 diabetes in first degree relatives of
diabetic patients.
PATIENTS AND METHODS:
First degree relatives of diagnostically confirmed diabetic patients were used as a test group. Type 1
diabetic patients and non-relatives healthy control groups of both genders were used for comparison.
Sera from all subjects were monitored for glutamic acid decarboxylase antibody, anti-insulin
antibody, complement C3 and C4, C-reactive protein and fasting blood sugar and the standardization
of the maximum and minimum limits of the studied markers level was plotted to reduce the
overlapping in the markers' values between each pair of the studied groups.
RESULTS:
The frequency of seropositivity for glutamic acid decarboxylase antibody was 24.0% in first degree
relatives group compared to 77.1% and 0% in patients and control groups respectively. For antiinsulin antibody and C-reactive protein, a very few members of the first degree relative group were
positive compared to those in the patients group. The results of C3 revealed a higher than normal
level in 44.0% of first degree relatives group, 65.7% in patients group and 0% in control group. In
contrast to that, C4 showed a lower than normal level in 28.0% of first degree relatives group
compared to 57.1% and 0% in patients and control groups respectively.
CONCLUSION:
Monitoring of glutamic acid decarboxylase antibody, C3 and C4, but not anti-insulin antibody and
C-reactive protein levels may be used as markers for a possible developing T1D in first degree
relatives that precede the elevation of fasting blood sugar in serum. a narrow scale border line in the
quantitative serum values of these markers is helpful in the standardization of this prediction.

BACKGROUND:
Carriage of Helicobacter Pylori in the human stomach is associated with increased risk of peptic ulcer
disease, distal gastric adenocarcinoma and gastric B-cell mucosa associated lymphoid tissue lymphoma.
OBJECTIVE:
To study the immunohistochemical expression of bcl-2, as apoptosis makers in the gastric mucosa of
patients infected with cagA Helicobacter Pylori demonstrated by insitu hybridization method.
PATIENTS MATERIALS AND METHODS:
Gastric antrum biopsies from 99 patients presented with dyspeptic symptoms (50 men, 49 women,
median age 40) were analysed for the presence of H. pylori, and were classified according to updated
Sydney system. Insitu hybridization technique was done to detect cagA H. pylori.
Immunohistochemical expression of bcl-2 using (Avidin- Biotin method) was performed on paraffin
embedded biopsy specimens.
RESULTS:
Forty four patients (44.44%) had H. pylori cagA positive starin. Atrophy of gastric mucosa was present
in 14 (14.14 %) patients. Intestinal metaplasia was present in 8 (8.08%) patients. The frequency of
atrophy and intestinal metaplasia were significantly higher in cagA H. pylori gastritis than non-cagA H.
pylori gastritis (p=0.023 and 0.041respectively). Bcl2 expression was not significantly higher in H.
pylori gastritis than non-H. pylori gastritis (p= 0.101). Bcl2 expression was significantly higher in the
presence of atrophy (p<0.001). Bcl2 expression was significantly higher in the presence of intestinal
metaplasia (p<0.001).
CONCLUSION:
The rate of apoptosis decreases when lesions (gastric atrophy and intestinal metaplasia) are present.

BACKGROUND:
CD4+CD25+ regulatory T cells are known to suppress the immune response in general, these cells
were studied in the presence of streptococcal M protein which has an important role in the
pathogenesis of rheumatic heart disease.
OBJECTIVE:
The purpose of this study was to determine the role of streptococcal M protein in naturally
occurring CD4+CD25+ regulatory T cells (nTregs) function and development in rheumatic heart
disease Iraqi patients.
METHODS:
Streptococcus pyogenes was isolated for subsequent M protein extraction. Also, peripheral blood
nTregs and CD4+ T cells were isolated by using Magnetic Cell Separation System (MACS). Tissue
culture system for isolated cells was performed in the presence and absence of M protein
stimulation. Cell count was performed, also, TNF-α, and IL-4 were determined in culture
supernatant using ELISA system.
RESULTS:
It was found a highly significant positive association between the number of the cellular
proliferation for both nTregs and CD4+ T cells with or without streptococcal M protein stimulation
in isolated cell culture systems (p < 0.01), but, there found a highly significant negative correlation
between the mean number of nTregs and CD4+ T cells in mixed culture system in the absence of
M protein (r = -0.995). whereas, in the presence of M protein, there was a positive non-significant
association between the mean number of both nTregs and CD4+ T cells (r = 0.353) (p > 0.05).
Results obtained from ELISA test revealed that M protein-stimulated CD4+ T cells produced IL-4
in very little amounts (< 4 pg/ml) in all cultures of samples and there was no significant difference
among them. Whereas, TNF-α was produced in higher concentrations in the culture supernatants
when compared with IL-4.
CONCLUSION:
Streptococcal M protein has an important role in increasing the proliferation of both CD4+CD25+
regulatory T cells and CD4+ T cells, but the newer generation of CD4+CD25+ regulatory T cells in
the presence of M protein has lower suppressive activity against CD4+ T cells.

BACKGROUND:
Ischemic heart disease is the leading cause of death among adults. Broad based studies that include all
ED patients who received an ECG for the evaluation of chest pain syndromes found that 5% of these
patients were ultimately diagnosed with acute myocardial infarction (AMI) and an additional 10% had
non-AMI acute coronary syndromes (ACS). Thus, 85% of patients have non-ACS causes for their
symptoms.
OBJECTIVE:
To study the relation between the level of cardiac troponin I and creatine kinase (MB) in Acute
Myocardial infarction.
SUBJECT AND METHOD:
The present study was designed to investigate changes in serum cardiac biomarkers in patients with
acute myocardial infarction. The present study consists of 61 patients who were admitted to the hospital
with acute myocardial infarction. Serum levels of cardiac troponin I (cTnI) and creatine kinase (MB)
were determined on day 1 (within24 hours) and the 3rd day after acute myocardial infarction. Serum
cardiac biomarkers were compared between day 1 of acute myocardial infarction and the 3rd day after
the acute myocardial infarction with healthy subjects (control group). All measurements were taken
through September 2009 to April 2010 in department of medical and molecular biotechnology/
Biotechnology Research Center/ Al-Nahrain university and Ibn Al-Nafees Hospital Department of
Clinical Chemistry and Coronary Care Unit. Cardiac troponin I (cTnI) and CK-MB were measured by
using microtitre plate ELISA method, absorbance is measured spectrophotometrically at 450 nm.
Levels of serum cTnI and CK-MB for smoker patients who suffered from MI and other
diseases(diabetes mellitus, and hypertension) (group 4) higher than levels for patients who complained
from MI in addition to other diseases(group2), group 2 higher than levels for smoker patients who
suffered from MI (group 3) and group 3 higher than levels for patients who complained from only MI
(group 1).
RESULTS:
Results showed significant (p<0.01) decreases observed for the levels of cTnI in group 4 with group 1
and group 2 with group 1, and significant (p<0.05) decreases in group 4 with group 3. Significant
(p<0.05) decreases were observed for the levels of CK-MB in group 4 with group 1.
CONCLUSION:
Myocardial infarction patients with diabetes mellitus , hypertension and smoking suffer increase levels
of cTnI and CK-MB. This proved that cardiac risk factors increase risk for heart injury. However, such
results must be considered during the evaluation of the results of cardiac biomarker in patients of MI .

BACKGROUND:
Chronic telogen effluvium is a non-scaring diffuse hair loss which lasts longer than 6 months. Low iron
stores are considered a possible cause of chronic diffuse telogen hair loss in women. Serum ferritin
concentration is an indicator of the status of iron stores.
OBJECTIVE:
This study was done to Compare the hemoglobin serum level and serum ferritin level in detecting low
iron store in adult menstruating females with chronic telogen effluvium and show the relation between
chronic telogen effluvium and iron deficiency.
PATIENTS AND METHOD:
Case-control study of 63 adult menstruating female subjects. Case group; 38 patients with chronic
telogen effluvium and control group; 25 healthy volunteers. Serum ferritin levels and hemoglobin were
estimated for the case group and some other investigations were done in selected cases as indicated. For
controls only measurements of hemoglobin and serum ferritin levels were done and were statistically
compared.
RESULTS:
The mean serum ferritin level was low in the case group (17.6ng/ml) in comparison with control group
(41.2ng/ml). The difference was statistically significant (P<0.001) between both groups. The mean
hemoglobin levels were similar in both groups and there was no significant statistical difference
(P=0.868) between both groups.
CONCLUSION:
There was a statistical association between low serum ferritin and chronic telogen effluvium.
Hemoglobin levels may not reflect the real iron state in patients with chronic telogen effluvium and
serum ferritin level is a better indicator for early detection of low iron store.

BACKGROUND:
Helicobacter pylori is recognized as an important human pathogen by virtue of its association with
peptic ulcer disease , gastric cancer , gastric lymphoma and high prevalence of infection
worldwide. Recently this organism was detected in tonsil and adenoid tissue after
adenotonsillectomy , as well as in mucosa of patients with chronic rhinosinusitis , but its
association with simple nasal polyposis has not been investigated yet in our country .
OBJECTIVE:
To investigate a possible contribution of Helicobacter pylori (H.pylori) in the etiopathogenesis of
simple nasal polyps .
Study Design: Prospective clinico –pathological investigation.
METHODS :
Twenty eight patients with nasal polyposis were studied for the presence of Helicobacter pylori in
the nasal polyp specimens by histopathological examination of serial sections stained by modified
Giemsa stain .
RESULTS:
Helicobacter pylori was detected in 10 (35%) of total 28 simple nasal polyps specimens.
CONCLUSION:
This study found a significant percentage 10/28 patients (35%) with Helicobacter pylori infection
in nasal polyps and to confirm the role of Helicobacter pylori in the etiopathogenesis of nasal
polyposis , extensive epidemiological studies would be necessary.

BACKGROUND:
P. aeruginosa remains an important cause of life-threatening bloodstream infection in
immunocompromised patients, particularly those with hematologic malignancies complicated by
neutropenia. One of the most worrisome characteristics of P. aeruginosa consists is its low
antibiotic susceptibility This low susceptibility is attributable to concerted action of
chromosomally-encoded multidrug efflux pumps genes. These genes are often controlled by
regulatory gene located on the same operon of efflux pump. One of particular significance is the
MexAB - OprM efflux system, which is expressed constitutively, thereby contributing to the
well-known intrinsic resistance of this organism to multiple antimicrobials.
OBJECTIVE:
To detect the occurrence of mexAB-OprM operom on the chromosomes of septicemic P.
aeruginosa(SPA).
METHODS:
This study was include 53 Pseudomonas aeruginosa isolates isolated from patients their ages ranging
from two days to 73 years,28 males and 25 females. Some of the isolates were isolated from acute,
15(28.3%), and chronic, 7 (13.2%), leukemic patients, 5 (9.4%) from each lymphoma and
gastrointestinal neoplasms patients. Nine (17%), 3(5.7%), 6 (11.3%) and 3(5.7%) from urogenital
neoplasms, breast cancer patients, septicemic patients due to burn infections and neonatal
septicemia respectively. Chromosomal DNA was extracted from SPA isolates and subjected to PCR to
amplify three genes of mexAB-OprM efflux pump.
RESULTS:
Multiplex PCR of mexAB-OprM efflux pump genes revealed that 53 (100%) were positive to all three
genes of operon, mexA, mexB and the regulatory gene, mexR.
CONCLUSION:
P. aeruginosa can cause septicemia in cancer patients and other compromised patients, like patients
suffering from extensive burns and neonatal infants. mexAB-OprM efflux pump genes are a
chromosomal encoded genes and can be used as a markers in identification of SPA by molecular
methods. These genes can be used individually or collectively in rapid identification of SPA, and rapid
detection for mexAB-OprM efflux pump occurrence on their chromosomes.

BACKGROUND:
Immunological factors in the pathogenesis of idiopathic dilated cardiomyopathy (IDC) were
suggested previously on the basis of the demonstration of mononuclear cell infiltrates and
autoantibodies against the myocardium.
OBJECTIVE:
Was to determine the changes in the percentage of T cell subsets in peripheral blood in order to
investigate the role of cellular immunoregulation in patients with idiopathic dilated
cardiomyopathy.
PATIENT AND METHOD:
The surface markers of peripheral T and B lymphocytes were detected and percentages of helper
(CD4+) and suppressor (CD8+) T lymphocytes subsets in the peripheral blood and their ratio.
(CD4+/CD8+) were determined in 62 patients with IDC and in 50 healthy controls.
RESULTS:
There were no significant differences between IDC and control groups with respect to CD4+ T cell
subsets ( p=0.4). CD8+ T cell percentage was significantly decreased in patients with IDC than in
controls (p=0.005). CD4+/CD8+ ratio was markedly higher in patients with IDC than controls
(p=0.005).
CONCLUSION:
Decreased CD8+ T cell subset is the cause of increased CD4+/CD8+ ratio, which may imply
decreased self-tolerance and an immunoregulatory defect in the pathogenesis of IDC.

BACKGROUND:
Fractures of the humeral shaft account 3% of all fractures.
OBJECTIVE:
purpose of the present study is to study in a consecutive series of humeral shaft fractures; union rate, time
of union, rate of nonunion, evidence of malunion, shoulder and elbow joints function and symptoms after
each method, to confirm previously published results, and to study the effect of postoperative fracture
distraction in fracture union.
METHODS:
By using conservative and operative methods, we treated 54 patients who had a fracture of the humeral
shaft. 48 patients were available for follow-up, which ranged from 5 to 40 weeks.
RESULT:
The average age of patients was 31.39 yrs (ranges from 5 to 65 Yrs), 26 males and 22 females. From these
patients (42 were of close and 6 were of open fractures), the average time of union was 10.5 weeks for
conservative method and 8.4 weeks for operative method.
In non operative method approximately 41.66% of the patients (ten patients) had an excellent functional
result and an essentially full range of motion of the shoulder and elbow. 33.33% (eight patients) had a
good functional result but lacked 15 degrees of forward flexion of the shoulder, or less, or 5 to 15 degrees
of extension of the elbow. 8.3% (two patients) had a fair functional result but lacked more than 20 degrees
of motion in both shoulder and elbow joints (specially in elbow extension) with mild pain. 16.6% (four
patients) had a poor initial resulted secondary to instability that was due to nonunion of the fracture.
CONCLUSION:
Because of the low morbidity and high rate of success in conservative method and because statistically
there was no significant difference between the two methods (P value more than o.o5), we concluded that
the treatment of choice for diaphyseal fractures of the humerus is better to be by non operative method
unless there’s a clear indication for surgery.

BACKGROUND:
Major hepatectomies consider one of the most challenging procedure and did not become
commonplace until the dramatic improvement in periopertive care in the 1980s.
OBJECTIVE:
Review the outcome of liver resection performed recently in Gastroenterology& Hepatology
Teaching Hospital .
PATIENTS AND METHOD:
From June 2008 to March 2011, nine major anatomic hepatic resection was performed. Enucleation,
Non- anatomic or wedge resection was excluded from this study.
RESULTS:
There were 4 men, 4 women and one child. Age range between 5-43 years median age 40 years.
Nine major resection was done this include; extended right hepatectomy 1 patient, right hepatectomy
2 patients, left hepatectomy 3patients, left lateral lobectomy 2 patients, right anterior sectionectomy
one patient. The inflow pedicle was controlled either by extrahepatic approach in 6 patients or
intrahepatic pedicle ligation by vascular stapler in 3 patients. Post-operative hospitalization was 3-16
days, median 8 days. There were no mortality. Two patients developed bile leak in form of biloma
which was treated by percutaneous drainage under ultrasound for 2weeks. Two patients develop
intra-operative hypothermia that led to stop the operation for one hour until warming of the patient.
CONCLUSION:
Major liver resection can be performed in our hospital with acceptable morbidity rate.

BACKGROUND:
The level of PSA in serum is increased by inflammation of the prostate, urinary retention,prostatic
infection, benign prostatic hyperplasia,prostate cancer, and prostatic manipulation. [3]
OBJECTIVE:
To study the effect of acute urinary retention on the serum prostate-specific antigen (PSA)
concentration.
METHODS:
Blood samples for serum PSA measurement were obtained (PSA1), and an indwelling urethral
catheter was inserted for 2 weeks. Before catheter removal, a second blood sample for measurement
of serum PSA level (PSA2) was obtained. In patients who were able to void, a third sample was
obtained 3 weeks later (PSA3). In the first and second visits, digital rectal examinations (DRE1,
DRE2) were performed to assess prostate volume. Mean PSA levels (PSA1, PSA2, and PSA3) and
prostate volumes (DRE1, DRE2) were compared.
RESULTS:
Fourty-two patients with a mean age of 70.18 years (range 56 to 85 years) participated in this
study.mean PSA level at the time of AUR (PSA1) was 7.02 ng/mL (median, 5.8 ng/mL; range, 0.9 to
30.4 ng/mL). The mean PSA2 level was 5.5 ng/mL (median, 3.9 ng/mL; range, 0.7 to 39 ng/mL),
lower than the PSA1 level .This association was statistically non significant P > 0.05. The mean
prostate volume at the time of DRE1 (43.4 mL; median, 45 mL; range, 30 to 60 mL) was
significantly higher than at DRE2 (37.8 mL; median, 40 mL; range, 25 to 50 mL) (P < 0.001).
PSA3 was measured in 42 patients 4 weeks after retention (2 weeks after catheter removal). In this
group of patients, mean PSA2 and PSA3 levels were 5.5 ng/mL and 5.1 ng/mL, respectively (median,
3.9 and 3.5, respectively, P > 0.05).
CONCLUSION:
Acute urinary retention can increase serum PSA levels. In this series, we found that this effect may
continue up to 2 weeks.

BACKGROUND:
Fetal loss and abortion are responsible for significant emotional distress for couples desiring children.
There are many documents which support the role of some certain asymptomatic infections such as
Cytomegalovirus (CMV) in spontaneous abortion.
OBJECTIVE:
This study was aimed to evaluate the prevalence of seropositivity of specific IgM antibody for CMV
by ELISA in the sera of (108) women with recurrent abortion associated with obstetric complications.
METHODS:
This study was carried out in two central hospital in Baghdad (Al-Elwea& Baghdad teaching hospitals
)during (2009-2010).A number of (108) women with definite diagnosis of previous abortion ,35women
with recurrent abortion , 30 women with premature delivary and 43women with intra uterine death
.compered to (50)women with history of normal full term delivary and negative history of miscarrage
as control groups .Serum samples were collected and then tested by using ELISA for detection of antiCMV IgM antibodies .
RESULTS :
Cytomegalovirus (CMV)specific IgM antibody was detected in (15.7%) of the 108 women studied
,while the women with obstetric complications were positive for CMV specific IgM antibody these
compriesd
of(16.6%)with premature delivary ,(14%) with recurrent abortion and (16.2%) with intra uterine death .
these result statistically significant (P<0.05) .Our data faild to found asignificant association between
the Cytomegalovirus infection with age and residence of patients (p>0.01).
CONCLUSION :
Higher seropositivity for cytomegalovirus (CMV)in women with spontaneous abortion compared to
women with normal obstetric history suggests that cytomegalo virus Plays a sigificant role in abortion

BACKGROUND:
Antibiotics are generally beneficial in treating susceptible microbial infections but such beneficial
effects are counter balanced by rampant irrational use. In fact, the misuse of antibiotics leads to the
emergence of antibiotic-resistant bacteria. On the other hand, the consumption of foods
contaminated with some pathogenic microorganisms represents a serious health risk to humans.
OBJECTIVE:
Therefore the present study describes the comparison of antibacterial activity between two plants
which are known traditionally by their biological activities and used in Iraqi folk medicine as
antidiarrheal.
METHODS:
Agar – well diffusion method tested antibacterial activities of methanolic crud extracts with
different concentrations of the two plants on six types of bacteria strains which are:-:-
Lactobacillus sp., Staphylococcus aureus, Proteus sp. , Pseudomonas aeruginosa, Escherichia coli
,and Enterococcus sp.
RESULTS:
Two plants extract had antibacterial activity ,methanolic extract of Plantago major was more
active than methanolic extract of Ceratonia siliqua against the same tested bacteria. The biological
activity was determined by measuring the inhibition zone in millimeters, results were expressed as
means ± standard deviation of triplicate experiments.
CONCLUSION:
These results suggest that extract of two plants possesses antimicrobial and properties, and
therefore they can be used as a potential source of active ingredients for food, pharmaceutical
industry or preservatives.

Aneurysms of the superficial temporal artery
(STA) are a rare and potentially critical cause of
facial masses. Usually, these aneurysms are
Pseudoaneurysm and occur following blunt or
penetrating trauma to the head or following
surgery in the temporal region. Most cases (about
75%) are the result of blunt head injury. Only 11
cases of spontaneous aneurysms were reported.
These aneurysms are assumed to have been
congenital or arteriosclerotic. Pseudoaneurysm has
occurred mainly in the anterior branch of the STA.
The first case of a STA Pseudoaneurysm was
described by Thomas Bertholin in 1740 and since
then about 400 cases have been published in the
literatures. I present two cases of traumatic
pseudoaneurysm of the STA and I discuss
pertinent diagnosis and treatment options, as well
as provide a brief review of the anatomy and
histopathology of pseudoaneurysms