Iraqi Postgraduate Medical Journal

BACKGROUND:
Transvaginal sonography is performed as part of a pelvic sonogram in postmenopausal women and
images of the endometrium are frequently obtained . In asymptomatic postmenopausal women
without vaginal bleeding, the threshold separating normal from abnormally thickened endometrium
is not known.
OBJECTIVE:
To determine an endometrial thickness threshold using transvaginal sonography for prediction of
endometrial cancer in postmenopausal women without vaginal bleeding (asymptomatic) .
METHOD:
The study group includes 100 asymptomatic postmenopausal women without vaginal bleeding,
We measure the sensitivity and specificity of trasvaginal sonography in the prediction of cancer in
asymptomatic postmenopausal women without vaginal bleeding at endometrial thickness ≤5mm
,5-10 mm &>10mm ,
RESULTS:
Four cases (4) of cancer were detected at >10mm endometrial thickness. In asymptomatic
postmenopausal women without vaginal bleeding the sensitivity 100% ,specificity 47.91%
,positive predictive values 7.40% and negative predictive values 100% at 10mm endomtrial
thickness while at 5mm endomtrial thickness,the sensitivity 100% ,specificity 9.3% ,positive
predictive values 4% and negative predictive values 100%
CONCLUSION:
In asymptomatic postmenopausal women promotion for endometrial sampling if endometrial
thickness >10mm seen by trasvaginal sonography give better positive predictive value, sensitivity
& specificity than>5mm endometrial thickness.

BACKGROUND:
The spontaneous abortion is considered as one of the important clinical problems that may affects
pregnant women during the 1st 20-22 weeks of pregnancy causing dangers to the mother and her
fetus. The present study was designed to focus on some spontaneous abortion causes and
intrauterine fetal death.
OBJECTIVE:
Study certain risk factors that may play a role in abortion such as serum level of , progesterone
hormone , estradiol hormone , interlukine-6 and perform a histological study on placenta to
identify any specific histopMETHODS:
Seventy (70) Women were selected to represent the samples of spontaneous aborted women. The
women were classified into two groups , the first represented aborted women during the first
trimester of pregnancy (52) and the second were females in the second trimester of pregnancy (18)
, in comparison with result of (20) normally delivered pregnancies. The samples (sera and placenta)
were collected during the period from November 2008 to April 2009 in Baghdad.
RESULTS:
Significant decrease (p<0.01) in the level of progesterone and estradiol hormone was found in all
aborted women at different stages of pregnancy compared with control. There was no significant
difference (p>0.05) in level of IL-6 between aborted women and control. There was a correlation
(positive) between progesterone with IL-6 in first and second trimester (p<0.05, p<0.01),
respectively. And progesterone with estradiol (p<0.05) in second trimester. The histological study
shows hydropic degeneration fibroids with hyalinization of fibrinosis changes.
CONCLUSION:
These results suggest an important role of progesterone, estradiol and IL-6 in spontaneous abortion
women during first and second trimester. And apparition of the histological changes corresponding
to the aborted women.

BACKGROUND:
Cytomegalovirus is the commonest cause of congenital viral infection in the developed and developing
countries. It is a symptomatic in 90% of infected females. Forty percent of pregnant females transmit
the virus to their fetus. Ten percent of born infants whom gain the virus will get the clinical signs plus
its neurological sequelae.
OBJECTIVE:
To outline the relationship between Cytomegalovirus infection among pregnant women and its
influence upon their pregnancy outcome.
PATIENTS AND METHODS:
A case-control study was carried out was carried out in the teaching laboratories – medical city,
Baghdad through a period from June 2010 till March 2011; upon 165 pregnant women whom taken as a
patient group. Blood samples were taken from them and Cytomegalovirus-IgM antibodies plus
Cytomegalovirus-IgG antibodies levels were measured via Elisa technique in both to evaluate the viral
infection if present or not.
RESULTS:
The usual age whom attended the gynea-obestetric clinics were the age group from 11-19 years old 73
cases (44.24%); Next came the age group from 20-29 years old 66 cases (40.00%), thirdly was the age
group from 30-39 years old 20 cases (12.12%), Lastly was the age group from 40-49 years old 6 cases
(3.64%). The concentration of CMV-IgG among females whom attended clinics were seropositive in
nearly half the included cases 66/165 (40.0%); while the CMV-IgM concentration was within the
seronegative limits. Secondly came another group of patients with seronegative limits regarding both
the CMV-IgM and CMV-IgG antibodies 56/165 cases (33.94%), next 30/165 cases (18.18%) were
seropositive in their results pointing to both CMV-IgM and IgG limits; and this might be a middle point
distance between the previous group and the last group were the CMV-IgM was positive and the CMVIgG concentration was negative 13/165 cases (7.88%).
CONCLUSION:
Cytomegalovirus-IgG antibodies got important role as a protective agent against gestation abortion, if
Cytomegalovirus-IgM antibodies are seropositive alone this is a risky factor to the pregnancy outcome.

BACKGROUND:
Recurrent miscarriage is a common complication of pregnancy and when the cause is unknown;
relationship of autoimmune thyroid disease to pregnancy loss has been the object of considerable
interest.
OBJECTIVE:
To estimate whether thyroid auto-antibodies (thyroglobulin and thyroid peroxidase antibodies)
could be used as a marker for detection of abortion in cases with unexplained recurrent
miscarriage.
METHODS:
This study was carried out at the department of obstetrics and gynecology in AL- Kadhymia
Teaching Hospital from March 2008 through September 2009. Fifty pregnant women in their first
trimester (7th – 12th weeks) were followed up till 20th weeks of gestation by the researcher himself
(they have three previous unexplained first and second trimester miscarriages).Thyroid peroxidase
(TPOAB) measurement by ELISA and thyroglobulin antibodies (TGAB) by slide methods with
flourescein were done to the patients, cases with abortions were reported and the status of thyroid
antibodies was evaluated. Free T3; free T4, TSH measured by RIA technique.
RESULTS:
In eighteen patients the antibody titer was positive while thirty-two had negative tests for thyroid
auto-antibodies. TGABS (thirty-six) were negative, (thirty-three) continue pregnancy and only
(three) aborted. TGABS (fourteen) were positive, (four) cases continue and (ten) aborted. TPOABS
(forty-one) were negative (thirty-nine) cases continue pregnancy and only (two) aborted. TPOABS
(nine) cases were positive, (seven aborted and only (two) cases continue pregnancy. This study
showed a significant association between AB. Positivity and maternal age.
CONCLUSION:
Thyroid auto antibodies can serve as a useful biochemical marker for cases with unexplained
recurrent miscarriage and there is a positive relation with increasing maternal age (thyroid auto
antibodies).

BACKGROUND:
Medical abortion becomes the 1st choice for early 1st and 2nd trimester termination of pregnancy
in many countries although dilatation and evacuation is commonly used in USA ,Medical abortion
has been more patchy in its introduction in England and Walse and there continuous to be
significant variation in its provision across health authorities .Medical method are often favored
because they appear more physiological ,like a miscarriage and avoid the need for uterine
instrumentation and also share the advantages of low rate of complication and failure.
OBJECTIVE:
To evaluate the effect of different media ( acetic acid , normal saline or dry)on the efficacy of
intravaginal misoprostol used for induction of first and second trimester abortion.
PATIENTS AND METHOD:
During the 12 months of the study period, 90 pregnant women seeking termination of early
pregnancy loss up to 24 weeks, as an indication for induction of abortion, their mean age were
27.7±5.5 years, and mean weight 72.3±3.9 kg.The first 30 pregnant patients received intravaginal
400μg misoprostol moistened with 2 ml of 5% acetic acid for 4hours interval up to 5 doses for 24
hours ,if the participant failed to achieve abortion the same regimen repeat for the next 24 hours,
including 8 primiparous and 22 multiparous. Next 30 patients received intravaginal 400μg
misoprostol moistened in 2ml of normal saline for 4 hours interval up to 5 doses for 24 hours ,if
abortion failed then the trial repeated once again , including 15 primiparous and 15 multiparous.
The last 30 patients received dry intravaginal 400μg misoprostol , 4hours intervals up to 5 doses
for 24 hours. if abortion failed the same regimen repeat for the next 24 hours, including 10
primiparous and 20 multiparous.
RESULT:
All patients aborted within 48 hour. Significantly shorter induction –abortion interval for the
moistened misoprostol tablet in acetic acid ( mean 8.3 ±2.2 hours), P value (0.000) ,than inductionabortion interval for moistened misoprostol tablet in normal saline (mean 19.5±7.7 hours) , and
dry misoprostol tablet (mean23.1± 8.8hours) .
The number of doses required to achieve response for moistened misoprostol in acetic acid was
significantly less(mean 1.5±0.5), P value (0.000),than that required for moistened misoprostol in
normal saline( mean 3.1±0.8),and for the dry misoprostol tablet (mean 3.7±0.8). The side effects
being of no statistical significant.
CONCLUSION:
Acidic medium enhance the effect of misoprostol administered for induction of abortion.
Moistening intra vaginal misoprostol may affect the pharmacokinetics of the drug to achieve a
constant plasma profile.

BACKGROUND:
Urinary tract infections are the most frequent nosocomial and community-acquired infections.
Cephalosporins have a role in treating urinary tract infections, but are not recommended for
empiric therapy because of the relatively high rates of resistance and low efficacy. Effective
management of urinary tract infections has been hampered by the fact that many strains have
developed resistance to several antimicrobial agents.
OBJECTIVE:
A. To demonstrate the common local bacterial pathogens and, B. To test the in-vitro the
susceptibility to cephalosporinsin women with urinary tract infections.
PATIENTS AND METHODS:
One hundred and twenty women from the outpatient department ofAlbatoolMaternity Teaching
Hospital from the coauthor's private clinic with signs and symptoms of uncomplicated acute
urinary tract infections with no previous history of antibiotic intake were included in the study.
Culture and sensitivity tests to cephalosporins and other antibiotics were done to all of them.
RESULTS:
Six types of bacterial species were isolated from the urine samples. E. coli was isolated from 49
cases (40.83%), Klebsiella was found to be the second most common bacteria isolated in 31cases
(25.83%).About one third of E. coli, Klebsiella, Proteus and Citrobacterwere resistant to
cephalosporins.E. coli and Klebsiella resist most cephalosporins.
CONCLUSION:
Many types of bacteria cause urinary tract infection, most of these bacteria resist cephalosporins.
Cephalosporins should not be used as first line therapy and when used have to be preceded by
culture and sensitivity testing.

BACKGROUND:
Fungal urinary tract infections are an increasing problem in hospitalized patients. There are specific
criteria for evaluating urinary tract infections caused by bacteria.There are also specific guidelines
for prevention of catheter associated bacteruria. No such criteria or recommendations are available
for fungal urinary tract infections.
OBJECTIVE:
To evaluate the incidence of catheter associated fungal infection among all patients with catheter
associated urinary tract infection and its risk factors.
MATERIALS AND METHODS:
From January 2009 to March 2011 (72) patients with indwelling urinary catheter for different
indications with significant pyuria presented to urologic department at Al-Ramadi teaching hospital
were included in this prospective study, all patients were subjected to urine culture for bacteria and
fungi. The following information was obtained: age, sex, antibiotic therapy, immunosuppressive
therapy, duration of catheterization and the presence of diabetes mellitus. The type of growth
whether bacterial or fungal was noted. The age of patients ranges from 2 to 70 years.
RESULTS:
The age of patients ranged from 2 to 70 years (mean 34.6). Of 72 patients, 12 had diabetes
mellitus, 18 patients were on long term antibiotic use and 15 patients on immunosupressants.
Bacterial infection accounted for 70.9% of catheter associated urinary infection with E. coli is the
most commonly isolated organism(41.6%), fungal infection accounted for 16.6% and mixed
fungal and bacterial infection account for 12.5.Risk factors among patients with fungal infection
were diabetes mellitus (47.6%), long term antibiotic use (42.8%) , immunosuppressive therapy
(9.5%), and prolonged duration of catheterization (85.7%).
CONCLUSION:
Fungal infection constitutes a significant proportion of all catheter associated urinary tract infection
and diabetes mellitus, long term antibiotic use, immunosuppressive therapy, and prolonged
duration of catheterization are the most common risk factors.

BACKGROUND:
Fracture of the penis is a relatively rare condition that is defined as a rupture of the tumescent
corpora cavernosa as a result of blunt trauma, most commonly during sexual intercourse or
masturbation, which needs urgent surgical intervention to achieve good postoperative outcome.
OBJECTIVE:
To study the etiology and outcome of early surgical repair in patients presenting with fracture of
penis.
MATERIAL AND METHODS:
This study carried out in the surgical departments of Al-Kindy teaching Hospital from June 2005 to
March 2011. Patients with the clinical diagnosis of fracture penis were admitted and operated. All
patients were admitted to the hospital 2 to 10 hours after injury. No invasive investigation was used
for diagnosis. The treatment was surgical in all cases with subcoronal circumferential degloving
incision, evacuation of hematoma and primary suturing of the tunica tear with absorbable suture. No
drain was used and a light compression dressing was done in all patients. Catheter was removed on
the second postoperative day. All patients had were followed up for 3-12 months postoperatively.
RESULT:
During the study period 30 patients aged 19 to 42 years, presented with a penile fracture were
operated for fracture penis. Mean age at presentation was 31 years. The commonest cause of fracture
penis was due to sexual intercourse. The commonest mode of presentation was with a cracking
sound, local pain and immediate detumescence (90%, 96% & 100% respectively). All patients
showed penile haematoma. None of the patients had urethral bleeding. All patients were surgically
treated; at the time of surgery unilateral albugineal rupture was found in all cases. With follow up all
cases were able to achieve an adequate erection. No complications such as deformations, penile
plaque or erectile dysfunction were reported. Average hospital stay was 3.4 days.
CONCLUSION:
The commonest cause of fracture penis is due to sexual intercourse. The best treatment option is
immediate surgical repair to obtain better functional outcome and to avoid potential complications.

BACKGROUND:
Information's on the potency of many medical plants against microorganisms are scanty, and in the
current wave of antimicrobial resistance against chemotherapeutic drugs, there is a need to search
for plants that could be resistance-free and affordable.
OBJECTIVE:
The objective of this study was to investigate the antibacterial effects of Parsley (Petroselinum
crispum) against uro-pathogens and to compare with the effect of some drugs used for the
treatment of urinary tract infection caused by different Gram positive and Gram negative bacteria.
MATERIALS & METHODS:
A total of thirty eight Gram positive and Gram negative bacteria(Escherichia coli ,Proteus
sp.,Enterobacter spp.,Pseudomonas aeruginosa, Klebsiella sp. , Staphylococcus aureus) isolated
from urine samples of different child patients between first of June 2011 to first of July 2011
admitted to Children Mel fare Teaching Hospital in Baghdad were tested against different dilutions
of Parsley (100%,1:1,1:5,1:10:1:15,1:20) to examine the inhibitory activity in vitro ,in addition
antibiotic susceptibility test was done.
RESULTS:
All isolates showed sensitivity to concentrated parsley 100% concentration except Pseudomonas
aeruginosa isolates, the highest effect observed on Proteus sp. and Staphylococcus aureus isolates,
while inhibitory effect stopped after 1:1 dilution against all isolates, while in antibiotics therapy
(29) isolates were resistant to Co-Trimoxazole and Cefotaxime and (30)isolates showed resistance
to Tri-imetheprim+clavulanic acid.
CONCLUSION:
It seems that Parsley has potent antibacterial activity against some uropathogens in vitro.

BACKGROUND:
The nature and indications for thyroid surgery vary and a perceived risk of postoperative
complications such as seroma , haematoma , wound infection and haemorrhage post-surgery is one
reason why wound drains are frequently inserted. They are generally used as a matter of the
surgeon’s habit or preference more than a matter of proven benefit in the patient’s postoperative
period.
OBJECTIVE:
To evaluate the differences in outcome and complications following thyroid surgery whether
draining the wound or not .
PATIENTS AND METHODS:
One hundred forty five patients with different thyroid diseases requiring surgical intervention
presenting to the first surgical unit in Baghdad teaching hospital between the first of October 2007
to the 31th of December 2009(27 months period) were enrolled. Patients were divided into two
groups : those who had their wounds drained postoperatively ; (the drain group DG) and those who
had their wounds closed without drain ; (the non drain group NG).
RESULTS:
Seroma occurred in three patients (3%) in the DG, and in two patients (4.4%) in the NG. Small
haematoma occurred in three patients (3%) in the DG, and in two patients (4.4%) in the NG. Large
haematoma occurred only in one patients (1%) in the DG, and it didn't occur in the NG. Wound
infection occurs only in two patients (2%) in the DG, and in one patient (2.2%) in the NG. The
mean of in-hospital stay was 2.07 days in the DG, and 1.06 days in the NG.
CONCLUSION:
The use of drain showed no effect on the prevention of wound infection , seroma , haematoma
formation or the need for re-exploration, indeed the use of drain had lengthened the in hospital
stay .So the Routine use of drains after thyroid surgery might be therefore not necessary, if not
detrimental.

BACKGROUND:
Acute appendicitis is the most common surgical cause of acute abdomen necessating surgical
intervention. Prophylactic drainage is commonly used in surgical practice, as in acute perforated
appendicitis.
OBJECTIVE:
To evaluate the advantages & disadvantages of the prophylactic drainage after appendectomy for
acute perforated appendicitis.
METHODS:
Eighty four patients of acute perforated appendicitis were enrolled in this prospective comparative
study done in Al-Kindy Teaching Hospital from October 2009 to March 2011. They were divided
into two groups; 46 patients (54.76%) drainage group & 38 patients (46.24%) non-drainage group.
Hospital stay time & postoperative wound infection were assessed in both groups. Statistical
analysis using Minitab software version 14 to calculate the P value was done.
RESULTS:
Patients’ age ranged from 6-50 years (mean27±12), male:female ratio was 2.6:1. The incidence of
perforation in acute appendicitis was 15.9% irrelevant to age or sex. Mean hospital stay time was 36
hours in the non-drainage group & mean of 58±4 in the drained group. Wound infection was
39.13% in the drainage group & 36.84% in the non-drainage group, with a P value was >0.05.
CONCLUSION:
postoperative wound infection & hospital stay were less in the non-drainage group for this
prophylactic drainage should be reconsidered.

BACKGROUND:
Pancreatic cystic neoplasms are relatively uncommon, and constitute about 1-2% of all primary
pancreatic tumors and are thought to account for approximately 10-15% of all pancreatic cystic
lesions. These tumors are composed of a variety of neoplasms with a wide range of malignant
potential
OBJECTIVE:
To define the clinical differences among different pathologic groups of cystic neoplasm of the
pancreas, distinguish these neoplasms from pancreatic pseudocysts, and benign from malignant or
premalignant varieties.
PATIENTS AND METHODS:
Retrospective study of 49 patients with clinical, laboratory and imaging features suggestive of
cystic neoplasms of the pancreas who were managed at the Gastroenterology and Hepatology
teaching Hospital over the period from September 2004 to January 2011. All the patients
underwent CT scanning and EUS. ERCP was performed for 16 patients.
RESULTS:
The mean age was 46 years, 31 patients' females and 18 males. (73%) were symptomatic, 32
lesions (65.3 %) were located in the pancreatic body and tail whereas 13 lesions (26.5 %) were
located in the pancreatic head, neck and uncinate process. The mean of maximum tumor diameter
was 8.76 cm. An attempted curative resection was undertaken for 21 patients. CT gave accurate
result in 9 out of 16 patients in SCN,16 out of 19 in MCN and 5 out of 6 in IPMN ,EUS including
EUS guided FNA gave accurate diagnosis in all patients.
CONCLUSION:
The role of imaging in detecting the cystic neoplasms of the pancreas and confirming their
locations and proximity to surrounding structures is well recognized and CT or MRI is the best for
this purpose. EUS including EUS-guided FNA for cytology and fluid studies has proven to be a
useful addition to the diagnostic armamentarium of the clinicians.

BACKGROUND:
Recurrent aphthous ulcer (RAU) is a common oral disease. It is treated by a variety of agents. Lactic
acid has been used in the treatment of many skin diseases.
OBJECTIVE:
To assess the therapeutic, prophylactic effectiveness and safety of 5% lactic acid mouthwash in
management of patients with RAU.
PATIENTS AND METHODS:
This single blind placebo controlled therapeutic study where 40 patients with early onset RAU were
recruited in Department of Dermatology -Baghdad Teaching Hospital from April 2005-April 2006.
Patients ages ranged 20-60 (29.6 ±9.6) years and were divided randomly into 2 groups (20 patients for
each one):Group A used 5% lactic acid mouthwash,5 ml twice daily. Group B was instructed to use
distilled water as placebo in a similar way to Group A. Short term assessment of each patient of both
groups was done to evaluate the therapeutic effect of drug by using oral clinical manifestation index
(OCMI), mean size of largest diameter of ulcers. A long term assessment was done for each patient to
evaluate the prophylactic effect of drug by using OCMI before, after 1, 2& 3 months of therapy.
RESULTS:
The mean of OCMI in group A started to decline directly after 4 days of therapy and to its lower level
after 8 days, and it was statistically significant (P value <0.05).The change in mean of OCMI of group
B after 4 and 8 days of therapy was also statistically significant (P value <0.05).The response rate after
4 days of therapy in Group A was 33.3% and in Group B was 6.44%, while the response rate after 8
days of therapy in Group A was 69.16% and in Group B was 44.98%. The difference in response rates
after 4 and 8 days between groups A and B was statistically significant (P value <0.05).The mean size
of ulcers in Group A started to decline directly after 4 days of therapy and to its lower level after 8 days
of therapy. It was statistically significant (P value <0.05). The change in mean size of ulcers of group B
after 4 and 8 days of therapy was also statistically significant (P value <0.05). The response rate after 4
days of therapy in group A was 44.92% and in Group B was 15.08%, while the response rate after 8
days of therapy in group A was 85.68% and in group B was 55.36%. The difference in response rates
after 4 & 8 days between Groups A and B was statistically significant (P value <0.05). The therapeutic
action of lactic acid mouth wash was statistically significant more effective than placebo. Lactic acid
mouth wash showed statistically significant prophylactic effect in comparison to placebo after 1,2&3
months from starting therapy using oral clinical manifestation index, (P value <0.05).
CONCLUSION:
Lactic acid 5% mouthwash is a new, safe effective therapeutic and prophylactic remedy in management
of RAU.

BACKGROUND:
There have been many attempts to develop screening tests or scoring systems that can identify
infected infants at the time of initial assessment, sparing others from invasive diagnostic
procedures, intravenous antibiotics therapy, mother-infant separation and parental anxiety.
OBJECTIVE:
Is to analyze hematological parameters and C - reactive protein so as to evaluate their diagnostic
value in neonatal sepsis.
PATIENTS AND METHODS:
A cross-sectional study was performed in the neonatal care unit (N.C.U) at the Central Teaching
Hospital for Pediatrics and Al-Habibiya Maternity and Children Teaching Hospital during a
period from the first of June 2005 to the first of January2006
One hundred neonates having clinical features of sepsis and 100 normal asymptomatic
neonates were evaluated with a set of investigations including C-reactive protein(CRP), White Blood cells
Count(WBC), Absolute Neutrophil count (ANC), Platelets count
(thrombocytopenia), Immature to Total neutrophil ratio (I/T ratio) and Erythrocyte
Sedimentation Rate (ESR) to diagnose neonatal sepsis.
RESULTS:
C-reactive protein (CRP) was positive in (82.4%) of group-A and (81.8%) of group-B and
had a specificity of 93.0%. ANC was the second most sensitive test having sensitivity of
61.8% for group-A and 48.5% for group-B and specificity of 86.0%.
The sensitivities of platelets count (thrombocytopenia), WBC, I/T ratio and ESR for group-A
were: 55.9%, 29.4%, 17.6% and 26.5% respectively, with specificities of 91.0%,
89.0%, 92.0% and 81.0% respectively. While group-B had sensitivities of 42.0%, 33.3%,
15.2% and 22.7% respectively with specificities of 91.0%, 89.0%, 92.0% and
81.0%respective ly.
CONCLUSION:
The implementation of CRP and other hematological parameters (ANC, Platelets count and
WBCs) are useful in early detection of neonatal sepsis and diagnosis of neonatal sepsis in
those who have false negative blood cultures.

BACKGROUND:
The stroke patient is at risk of developing hospital acquired infection, with the lungs being
especially vulnerable. Stroke associated pneumonia (SAP) occurring after two days of admission
and is the most nosocomial infection seen in the medical wards , pneumonia is the major cause of
morbidity and mortality after stroke .The establishment of an accurate diagnosis of stroke
associated pneumonia remains problematic and yet there is still no accepted "gold standard" for
diagnosis.
OBJECTIVE:
To determine the incidence and risk factors of stroke associated pneumonia.
METHODS:
This is prospective cohort study for 82 stroke patients admitted to medical wards .The study
conduct from the 1st July 2009 to the 10th January 2010. Initially stroke diagnosed clinically and by
CT scan. Theses cases are assessed after 48 hours after admission, full history, physical
examination and investigations were done using clinical criteria (body temperature, WBC count
and chest radiography ) for diagnosis of pneumonia.
RESULTS:
11(13.4%) patients developed stroke associated pneumonia from 82 stroke patients admitted to
medical wards. Most patients who were developed pneumonia were older than patients who did not
developed pneumonia . The incidence is higher in patient with infarction and older age groups than
patients with hemorrhagic stroke and younger age groups, and there is no association between the
disease and gender .The incidence of late onset is more common than early onset pneumonia.
Presence of dysphagia was present in (81.8%) nasogastric tube in (72.7%
),unconsciousness(54.5%),tobacco ,vomiting (36.6%) and fit (27.2%) were found as an important
risk factors .The mortality more in hemorrhagic(75%) than thrombotic stroke (14.3%).
CONCLUSION:
stroke associated pneumonia is an important cause of mortality. It is associated with older age,
dysphagia , NG intubation ,coma ,vomiting and fit .Simple assessment of these variables could be
used to identify patients at high risk of developing pneumonia after stroke.

BACKGROUND:
Tuberculous meningitis (TBM) is a medical emergency. Early diagnosis is of utmost importance to
minimize morbidity and mortality. Polymerase chain reaction (PCR) seems to be a promising test for
rapid and early diagnosis of TBM.
OBJECTIVE:
To investigate whether PCR detects tubercle bacilli in CSF specimens that are missed by direct
microscopy and culture, and if so whether PCR has significant diagnostic value compared to
conventional methods.
METHODS:
PCR, culture and acid- fast bacilli (AFB) were performed on CSF samples taken from 43 patients with
TBM (based on clinical features and cytochemical parameters of the CSF) and 15 with non- TBM as
control group.
RESULTS:
Of the 43 CSF specimens from highly probable TBM patients, 33 were positive by PCR (76.7%),
whereas only 5 was acid-fast microscopy (AFM) positive (11.6%) and 22 were culture positive
(55.2%). No positive results were found by AFM, culture or PCR in the non-tuberculous control group.
CONCLUSION:
The results of this study indicate that application of PCR is extremely useful for the diagnosis of
TBM.The PCR is superior to the currently available techniques for the diagnosis of tuberculous
meningitis in terms of sensitivity, specificity and rapidity and can play a critical role in the diagnosis of
suspected cases.

BACKGROUND:
Intussusception is an invagination of one portion of the intestine into the lumen of an immediately
adjoining part.
OBJECTIVE:
To evaluate the sensitivity and specificity of ultrasound in the diagnosis of intussusception.
PATIENTS AND METHODS:
This is a prospective study of 50 cases of intussusception in the Central Child s Teaching Hospital
in the period between April 2008 and February 2010.
forty five patients (90%) were below 6 months and five patients ( 10%) were above 6 months
Male patients predominated and the male to female ratio was (1.2:1).
Seasonal variation was seen in primary intussusception (i.e. in age group of 6 to 24 months old)
with peak incidence in spring and summer.
Abdominal pain and vomiting were the most common symptoms in intussusception (92% and 88%
respectively), followed by bleeding per rectum (76%), abdominal mass was found in 66% and
constipation was found in 28%.
RESULTS:
The diagnostic tool used was the ultrasound for fifty patients; in forty five cases ,diagnosis was
made by a characteristic ultrasonic findings of intussusception (i.e. target sign or pseudokidney
sign), forty three patients of the group had a classical intussusceptions\' mass during operative
procedure, the rest (i.e. 2) had negative operative findings for intussusception.
5 of the patients, the ultrasonic findings were negative for intussusception preoperatively (no mass),
but during surgery we found an intussusception mass.
CONCLUSION:
So ultrasound study in our hospital gives us sensitivity of 95.5% to diagnose intussusception.

BACKGROUND:
The first acute demyelinating event without encephalopathy, termed a clinically isolated syndrome,
can manifest with signs and symptoms caused by a single lesion (monofocal clinically isolated
syndrome) or with polyfocal features, implicating multiple lesions. It is becoming increasingly
recognized that MS affects children and adolescents, with many of these patients receiving the
diagnosis and initiating therapy prior to their 18th birthday(2).
OBJECTIVE:
To evaluate the clinically isolated syndrome in individuals with early onset of multiple sclerosis.
MATERIALS AND METHOD:
The records of the multiple sclerosis centers in Baghdad teaching hospital have been surveyed. The
study enrolled 77 patients who had early multiple sclerosis (onset before age of 18 years), their
clinically isolated syndrome data have been analyzed.
RESULTS:
Two thirds of the patients were female (a female/male ratio of 1.6:1). Forty eight of the patient
where female (62.3%) and twenty nine patients where males (37.7 %). Mean age at onset was
14.95 years. Seven patients where children (age below 10years) (9.1%) and seventeen patients
where adolescents (age 10 to 18 years) (90.9%) at onset. The most common presenting clinically
isolated syndrome was optic neuritis (35.8%) followed by brain stem lesion. Fifty nine patients
had monofocal presentation (76.6%) and eighteen had polyfocal presentation (23.4%). forty seven
patients had complete improvement of the clinically isolated syndrome (61.0%), the rest had partial
or no improvement.
CONCLUSION:
The most common clinically isolated syndrome of early onset Multiple sclerosis is optic neuritis.
monofocal clinically isolated syndrome more than polyfocal. Complete improvement is high.

BACKGROUND:
Diabetes mellitus is a metabolic disorder; a clinical syndrome which occurs due to absolute or
relative insulin deficiency or insulin resistance. Direct association of trace elements, such as
magnesium in both type 1 and type 2 diabetes, alteration in the metabolism of these minerals has
been demonstrated in diabetes in many studies.
OBJECTIVE:
To evaluate magnesium, chromium, vanadium, and selenium levels in the serum of type 2
diabetic subjects.
METHODS:
The present study was conducted on fifty type 2 diabetic patients, and thirty age-sex-matched
healthy controls. In groups, those having renal failure, lipemic serum, or using diuretics,
antibiotics, and the pregnant, where excluded. Samples were analyzed using Inductively Coupled
Plasma Spectrometer.
RESULTS:
Serum levels of Mg in type 2 diabetic patients group were significantly lower than in the control
group p< 0.001; a similar result was observed for serum Vanadium level p< 0.05. Serum Cr levels
in both diabetic and control groups were below the reference range limits. Analysis of Se in
serum of controls and patients indicated no significant difference.
Gender did not significantly affected plasma Magnesium, Chromium, Vanadium, and Selenium
concentrations. Duration of the disease did not significantly affect plasma levels of (Mg, V, and
Cr), but it significantly inversely affected the plasma level of (Se); decreased with increasing
duration of diabetes (r = -0.3539) and p< 0.05.
CONCLUSION:
Diabetes mellitus can result in low levels of Mg and V especially in long standing and insulin
treated patients which may affect their management.

BACKGROUND:
Hypoalbuminemia is considered as poor prognostic factor in patients with certain chronic diseases,
such as cancer and end-stage renal failure. Low serum albumin is common in patients with heart
failure; nevertheless, the relationship between serum albumin and heart failure prognosis has not
been well verified.
OBJECTIVE:
To elucidate the effect of serum albumin level on prognosis of patients with systolic heart failure.
METHODS:
This study included 250 patients with systolic heart failure who were admitted to Baghdad teaching
hospital between February 2008 and April 2010. Patients were divided into groups based on
presence of hypoalbuminemia (≤3.4 g/dL).
RESULTS:
The mean age of patients was 55 ± 14 years and the mean left ventricular ejection fraction [LVEF]
was 28 ± 11 %). The mean serum albumin was 3.9 ± 0.7 g/dL; 27.2 % of patients had
hypoalbuminemia. Patients with and without low serum albumin levels were similar in age, cause
of heart failure, and ejection fraction. Patients with hypoalbuminemia had higher New York Heart
Association (NYHA) class, higher serum urea, creatinine and C-reactive protein levels but lower
levels of sodium, hemoglobin, and cholesterol. In patients with body mass index (BMI) < 25
kg/m2, 26% had hypoalbuminemia compared to 20% in those with BMI ≥25 kg/m2 (P ≤ 0.01).
One-year survival was 64.71% in patients with and 85.72% in those without hypoalbuminemia (P
< 0.001). Risk-adjusted hazard ratio for 1-year mortality was 1.9 (1.5-2.4).
CONCLUSION:
Hypoalbuminemia is common in patients with heart failure and is independently associated with
increased mortality.

BACKGROUND:
Type 1 diabetes is a multifactorial disease caused by a complex interaction of genetics and
environmental factors. The Genetics factors involved consist of multiple susceptibility genes such
as protein tyrosine phosphoatase nonreceptor 22, which have been associated with T1DM in
different populations. Recent studies showed a genetic variation within protein tyrosine
phosphoatase nonreceptor 22 gene to be an additional risk factor.
OBJECTIVE:
To analyze the genetic association between protein tyrosine phosphoatase nonreceptor 22 and type
1 diabetes mellitus in some Iraqi population and correlation of Glutamic acid decarboxylase
antibodies and interleukin -2 receptor with type 1 diabetes.
METHODS:
A total of 50 type 1 diabetes patients from diabetes center were genotyped for protein
tyrosine phosphoatase nonreceptor 22 genes by using an restriction fragment length polymorphism
method. Level of Glutamic acid decarboxylase antibodies and interleukin -2 receptor were
determined using enzyme linked immunoassays.
RESULTS:
Glutamic acid decarboxylase antibodies were a highly significant increase (P<0.0001) in type 1
diabetes patients as compared with healthy control group. Circulating levels interleukin -2 receptor
were highly significant in diabetic patients than healthy subjects (P<0.001). The frequency of
protein tyrosine phosphoatase nonreceptor 2 gene among the 50 patients [ CT (33%) , TT(4%) ,
CT and TT (37%] compared with healthy control [ CT (18%) TT(1%), CT and TT (4%)], while
the percentage of T allele of patients (21%) and healthy control ( 10%). In addition, the protein
tyrosine phosphoatase nonreceptor 2 genotype was significantly associated with Glutamic acid
decarboxylase positivity (CT- 19%, CT and TT -24%).
CONCLUSION:
Strong association between protein tyrosine phosphoatase nonreceptor 2 gene and diabetes type 1.
In addition,The protein tyrosine phosphoatase nonreceptor 22 genes were associated with
Glutamic acid decarboxylase antibodies.

BACKGROUND:
The pandemic of central obesity has driven new interest in the relationship between thyroid
hormone and body weight distribution since it is well known that thyroid hormones play a key role
in regulating energy homeostasis and that subtle elevation in TSH as in subclinical hypothyroidism
(SCH)is associated with deficiency in resting energy expenditure and increased body weight.
OBJECTIVE:
The aim of our study was to assess possible associations of subclinical hypothyroidism with central
obesity in apparently healthy women.
METHODS:
133 apparently healthy, clinically euthyrotic women were included in this study; 91of them were
centrally obese and 42 were centrally non obese, Thyroid function tests and waist circumference
measurement were done in all participants.
RESULTS:
13.5 %( n=18) of the studied population had subclinical hypothyroidism.In the centrally obese
group the frequency was 17.5 %( n=16), while in the non obese it was 4.7% (n=2), the highest
frequency was found in the 40-49 years old women (38.8%).
Positive significant correlation was found between waist circumference and age, negative significant
correlation was found between age and T3.
CONCLUSION:
The frequency of SCH is more in centrally obese women. Assessment of thyroid function must be
regarded as part of the screening program in obese.

Aortopulmonary window is an uncommon
congenital heart defect. It is usually nonrestrictive
and conventionally treated surgically at an early
age to prevent the development of pulmonary
vascular obstructive disease .
Only in 10% of the cases it is restrictive and case
reports of it is transcatheter closure are mostly
limited to these patients.
We report transcatheter closure of large non
restrictive aortopulmonary window in a 2 years
old , 8 kg child. Using Amplatzer duct occluder
device.

One of the great challenges we face in clinical
neurology practice is stroke among children, which
is considered to be among the ten top causes of
death in the United States. The cardiac diseases are
the most common causes of strokes among
children; But a recurrent embolic stroke among
children is rarely reported to be due to giant cardiac
diverticulum originating from the left cardiac
chamber as presented in this paper.