Iraqi Postgraduate Medical Journal

BACKGROUND:
Wilson’s disease (WD) is rare but curable hereditary metabolic disease presents in childhood in
different ways which make the diagnosis difficult and delayed.
OBJECTIVE:
To evaluate all cases of WD, modes of presentations, available diagnostic methods, treatment and
follow up in a sample of Iraqi children.
PATIENTS AND METHODS:
Clinical presentations and management of 24 patients with WD were studied after the exclusion of
other chronic liver diseases by thorough investigation. Low ceruloplasmin level and high copper
excretion in urine pre and post challenge with penicillamine, in addition to the presence of Kayser
Fleischer rings were the main stay of the diagnosis. The diversity of the results with the response to
treatment and side effects of drugs used were registered over 3 years period in the GIT & Hepatology
unit and consultation clinic at the Children Welfare Teaching Hospital, Medical city, Baghdad in the
period from the 1st of May 2003 till the 1st of may 2006.
RESULTS:
From the twenty four patients with WD included in the study, we had 17 patients (70.8%) with
hepatic manifestations (4 with acute hepatitis, 3 with fulminant hepatic failure and 10 as chronic liver
diseases). Only two patients (8.3%) had neurological symptoms. One patient had hepatic
manifestation + evidence of hemolysis (4.1%) and 4 (16.7%) asymptomatic siblings. The mean age
of presentation was less in hepatic than the neurologic presentation (7.5 and 9.2 years respectively).
The time interval between the symptoms and the diagnosis was more in the neurological than hepatic
cases (95 vs. 42 days). Low ceruloplasmin found in 70.1% & Kayser-Fleischer ring present in 47.1%
of hepatic cases and in all neurological cases. Family history was positive in 3 patients of the index
cases. On follow up after treatment one child had bone marrow depression and two patients had
thrombocytopenia. One patient died (4.2%) with fulminant hepatic failure, ascites and
encephalopathy.
CONCLUSION:
Acute hepatitis, chronic liver affection, fulminant hepatic encephalopathy acute hemolytic anemia
may be the presentation of Wilson disease in children. They also may exhibit a neurological
manifestation as tremor and ataxia. At least two of the three diagnostic criterion plus index of
suspicion, family history of affected sibling or death in the family of a jaundiced child raises the
possibility of WD after exclusion of other chronic liver diseases by investigations.

BACKGROUND:
Infants including newborn babies, experience pain similarly and probably more intensely than
older children and adult. They are also at risk of adverse long term effects on behavior and
development, through inadequate attention towards pain relief in early life. However, the issue of
analgesia in young babies has been largely neglected in most clinical setting, despite subjecting
them to painful diagnostic and therapeutic procedures.
OBJECTIVE:
To assess the knowledge of resident doctors regarding neonatal pain and to compare this with best
evidence-based medicine.
SUBJECTS & METHODS:
A survey study questionnaires was distributed to pediatric resident doctors (PRD) in three training
hospital centers in Baghdad (A- Al-Kademia teaching Hospital, B- Child central teaching hospital,
and C- Children Welfare teaching hospital/ medical city) during the period from first of February
to first of May, 2010. The questions were about the doctors` knowledge in treatment of pain in
neonates, specifically regarding the perception and the effects of pain, pain assessment tools, and
the safety and efficacy of treatments for both procedural and long-term pain.
RESULTS:
This study included 101 PRD, 29 were females and 72 were males. Doctors generally knew about
efficacy of skin to skin contact and massage , breast feeding and oral sucrose during short term
procedures, benefit and risk of use of morphine and midazolam, but less agreed that sedation does
not necessarily provide adequate pain relief into neonates. Doctors were supporting use of topical
anesthetic agents but not supporting the benefit of treating long term pain with opioid analgesic
outweigh the risk of neonates. About half of PRD knew the difference in long term effect between
neonates and older children. Pain assessment tools were not perceived to be reliable ,valid or
routinely used.
CONCLUSION:
The knowledge of resident doctors regarding neonatal pain was inadequate when compared with
developed countries studies and evidence based medicine, so we recommend to increased the
educational programs and training on neonatal pain management.

BACKGROUND:
Understanding the awareness and perception to infectious disease threats particularly among medical
students is important to assist improving educational programs.
OBJECTIVE:
This study aimed to assess students’ knowledge of the pandemic H1N1 influenza.
PATIENTS AND METHODS:
A cross-sectional study was conducted among medical students of Al-Nahrain Medical College in
Baghdad during February 2010. The data were collected through a self-administered anonymous
questionnaire and results were analyzed using SPSS version 16.
RESULTS:
A total of 217 medical students participated in this study with a mean age of 21.1 (± 1.7). Overall, the
mean score of students' knowledge was 69.95 (± 17.7) degrees. The main source of knowledge of
these students (37.8%) was from the mass media. Significantly females, fourth grade, passed the last
semester exams, and having educational activity dealt with swine flu scored higher.
CONCLUSION:
The awareness regarding pandemic H1N1 infection was adequate among the students regarding
causative agent, disease transmission, symptoms, control and preventive measures, vaccination, and
treatment. This result can be attributed to the immediate training given to these students as well as to
the mass media campaign which is important in pandemic situations to avoid its spread and
complications

BACKGROUND:
Congenital anomalies define as abnormalities of body structure that originated before birth, about
3% of all children are born with a serious structural defect that interferes with normal body
function and can lead to lifelong handicap or even early death. There is a variation in the frequency
of congenital anomalies in different populations.
OBJECTIVE:
To determine the prevalence of the easily identifiable congenital anomalies also to estimate the risk
factors which may predispose to anomalies and pattern of distribution of congenital anomalies of
newborn in Mosul city.
METHODS:
In a cross-sectional study, charts of forty six thousand and seven hundred seventy five deliveries
including live births and stillbirths in Al-Batool Teaching Hospital of Obstetrics and Gynecology ,
during the period from January -2009 to December-2010. The anomalies were then grouped
according to the organ, system involvement, gender, maternal age, consanguinity, mortality rate,
and mother’s natal history.
RESULT:
A total of 323 cases of fetal congenital anomalies were detected, central nervous system were the
most common abnormalities while complex congenital malformation was second in rank. The
prevalence of anomalies was 0.69%. The majority of fetal malformation was seen in primigravida
furthermore the maternal age between20-24years was the largest age group that had congenital
anomalies. Mean gestational age at delivery was 36 weeks as well as the mean gestational age at
diagnosis of anomaly by ultrasound was 30week. Fetal malformations had predilection to female
fetuses, with male to female ratio1:1.09, in addition to 2.167% of ambigunity. Overall perinatal
mortality rate was 79.25%.
CONCLUSION:
Congenital anomalies are one of the most important causes of fetal deaths. The present study
showed a high incidence of congenital malformations in the young age group and among primi
gravida woman. The commonest associated risk factors was consanguineous marriage the
frequency of which may be reduced by creating awareness regarding the avoidance of
consanguineous marriages . anencephaly was the most prevalent anomaly detected. So proper and
timely counseling, regular antenatal care. folate supplementation especially during the most
sensitive period of embryogenesis is essential to avoid major congenital malformation for future
pregnancy.

BACKGROUND:
It is well realized that breast cancer is the most terrifying cancer for females, the commonest
malignancy and the second leading cause of cancer death in women. Recent studies suggested
that the association of viral infection with breast cancer pathogenesis such as Epstein Barr virus
and mouse mammary tumor virus. In addition, human papilloma virus DNA sequences have
been isolated. There is relationship between human papilloma virus and other neoplasms
(anogenital, skin and 99.7% of cervicouterine carcinomas).
OBJECTIVE:
This study has been undertaken for detecting high risk group HPV genotypes in breast carcinoma
in different provinces in Iraq depending on molecular technique.
PATIENTS AND METHODS:
A total of 59 patients include both sexes (male and female) diagnosed histopathologically as
having breast cancer were included and studied during the period from January to August, 2010
in different regions in Iraq. In addition to 20 cases of benign breast lesion used as a control
group. Theses samples were represented by formalin-fixed paraffin embedded blocks and fresh
frozen tissue. A multiplex PCR analysis were done for the DNA extracted from these samples.
RESULT:
The mean age in this study was 45.5 years. Ninety three percentage were female and the
remaining were male. Fourty percentage of tumor present in the right side, 59.3% removed by
lumpectomy. Eighty six percentage were found to have infiltrating ductal carcinoma followed by
infiltrating lobular carcinoma (13.8%). Twelve HPV genotypes were used in this study which of
high risk group including (16,13,33,35,18,45,39,59,52,56,58 and 66). HPV type 39,59 and 52
were demonstrated among those patients and the result show about 16.9% of our patients (10 out
of 59) had positive HPV demonstrated by PCR in their breast tissue and 83.1% (49 out of 59)
were negative for HPV. All the benign breast cases were negative for HPV except one case of
fibrocystic disease which was positive for HPV type 39 which was not significant (p value
˃0.05).
CONCLUSION:
The study concluded that high risk group Human Papiloma virus genotypes 39, 59 and 52
genotype were present in breast cancer tissue in Iraqi patients.

BACKGROUND:
Nodal Osteoarthritis is a subset of OA characterized by polyarticularinterphalangeal and thumb base
OA ,Heberden’sand Bouchard’s nodes formation.C-reactive protein (CRP) is one of the first acute
phase response proteins to be elevated in an inflammatory processes.
OBJECTIVE:
The aim of this study is to investigate whether the inflammatory processes have roles in the
development of nodal osteoarthritis (NOA) in Iraqi femalepatients using serum highly sensitive Creactive protein as aninflammatory marker.
SUBJECTS AND METHODS:
The study included eighty four females, divided into two main groups,sixty were patients with
(NOA), and twenty-four represented the control group. Other subdivisions were applied according to
body mass index and menopause status. Measurement of serum (hsCRP), wasapplied to all subjects
included in this study, by ELISA sandwich method.
RESULTS:
Serum highly sensitive C-reactive protein (hsCRP) level was significantly higher (18.08±8.15) (P
value < 0.05) in patients with NOA in comparison to control group (2.23±1.73) .
CONCLUSION:
Highly significant elevated level of serum (hsCRP) observed in the NOA patients compared to
control suggest that the inflammatory processes have roles in the development of NOA.

BACKGROUND:
Osteoarthritis is a form of arthritis that features the breakdown and eventual loss of the cartilage of
one or more joints. Cartilage is a protein substance that serves as a "cushion" between the bones of
the joints. Among the over 100 different types of arthritis conditions, osteoarthritis is the most
common, affecting over 25 million people in the United States. Osteoarthritis occurs more
frequently as we age. Osteoarthritis is abbreviated as OA or referred to as degenerative arthritis or
degenerative joint disease (DJD). Osteoarthritis commonly affects the hands, feet, spine, and large
weight-bearing joints, such as the hips and knees. Osteoarthritis usually has no known cause and is
referred to as primary osteoarthritis. When the cause of the osteoarthritis is known, the condition is
referred to as secondary osteoarthritis.
OBJECTIVE:
The main objective of this study is to evaluate the association between the levels of Interleukin-8
and some antioxidant in patients with OA.
PATIENTS AND METHODS:
This study was performed during the period from April 2010 to February 2011, and included 50
patients with OA according to the American College of Rheumatology ACR 1990; their age range
from 40-60 years with mean age of 46.66 ± 2.83 years. These patients were matched by age and
sex to 25 healthy control subjects with the mean age of 48.32 ± 2.92 years. Blood samples were
taken from each individual and separated for the estimation of IL-8 and some antioxidants levels
using enzyme – liked immunosorbent assay (ElIZA) technique and colorimetric method. The
laboratory tests were done in Teaching Laboratories of the Medical City and the Department of
Physiological Chemistry / College of Medicine University of Baghdad.
RESULTS:
The level of IL-8 and Ceruloplasmin (CP) in serum of patients with OA was significantly higher
than in serum of healthy control while the level of Glutathione (GSH) and S.uric acid in serum of
OA patients was significantly higher than healthy control and there is no significant difference in
level of serum albumin between the patients and control.
CONCLUSION:
It is clear from this study that there is a relationship between the levels of IL-8, CP, GSH, and
S.uric acid concentrations and OA while there is no relationship between S.albumin concentration
and OA disease.

BACKGROUND:
Although stroke in pregnancy is uncommon, the risk of stroke is increased during pregnancy and
puerperium, and considered a major contributor to the serious morbidity and mortality of pregnancy
OBJECTIVE:
This study had been designed to find the frequency of stroke in relation to different periods of
pregnancy and puerperium, to assess the effect of variable risk factors and their association with stroke
and to verify which type of stroke is more frequent among pregnant ladies
METHODS :
This is a cross sectional study that enrolled 30 pregnant patients who had stroke either during
pregnancy or puerperium and being admitted to the Neurology words of Al-Yarmouk, Baghdad and Alkadhemia teaching hospitals during the period from the 1st of January, 2001, to the 31st of December,
2002. All of the patients, who had been included in this study, had been subjected to detailed history,
physical and neurological examinations and investigations.
RESULTS:
19 patients (63.3%) of the sample included in this study acquired stroke during pregnancy while 11
patients (36.3%) had developed stroke during puerperium. 2/3rd of the sample had ischemic stroke.
Impaired consciousness was the commonest presenting symptom with a frequency of 50% of the
sample, cerebellar signs were the least observed signs, in the other hand; all of the patient included in
this study had motor dysfunction during the disease course. 53.3% of the sample was hypertensive 6.7
% was diabetic, while 36.7% of them had no significant past medical history. Oral contraceptive pills
had been used by 50% of the sample, 2/3rd of those using oral contraceptive pills had ischemic stroke.
63.3% of the sample had cesarean delivery, 50% of the sample had history of abortion, 60% of whom
had positive history of recurrent abortion.
CONCLUSION:
This study revealed that most of stroke happened during the 3rd trimester and early weeks of
puerperium. Being hypertensive, whether pregnant related or not, is the most important risk factor, in
addition, other recognized risk factors included diabetes mellitus and use of oral contraceptive pills.

BACKGROUND:
The electrodiagnostic studies are useful adjuncts to the clinical examination of the peripheral nervous
system. Electromyography (EMG) records the physiologic status of muscle function. Needle
electromyography help localize abnormalities along peripheral nerves or lower motor neurons.
OBJECTIVE:
To establish the normal electrophysiological values of the common upper and lower limbs muscles in
sample of healthy adult population in Iraq using standard temperature control, and to compare with
those data published in other studies.
MATERIAL AND METHODS:
This is a cross sectional study conducted in Al-Kadhmiya Teaching Hospital during the period from
July 2008 to December 2009. The study included 43 healthy individuals, aged 20-50 years (15 women
and 28 men). Using the standardized technique, underwent electrophysiological studies for EMG
studies for the commonly tested muscles.
RESULTS:
Forty-three individuals (include15 women and 28 men) participated in the study, and conventional
EMG successfully done with good cooperation. EMG parameters results corresponded with those
previously published in other studies.
CONCLUSION:
This study helps establish the normative electrophysiological parameters of the commonly tested
muscles in the upper and lower limbs for our EMG laboratory in Iraq. The results compared favorably
with existing literature data.

BACK GROUND:
Primary intracerebral hemorrhage (ICH) is one of the common vascular insults with a relatively high
rate of morbidity and mortality and there are many factors which influence the outcome.
OBJECTIVE:
The aim of this study is to determine potential early predictors of outcome within first six days of
primary spontaneous supratentorial hemorrhage and to evaluate the influence of those various factors
on the mortality and morbidity of patients with intracerebral hemorrhage (ICH).
METHOD:
70 patients (48 men and 22 women) were admitted to Baghdad teaching hospital, for the period from
January 2010 to January 2011. They were diagnosed with supratentorial hemorrhage by brain CT. Total
Serum cholesterol, the vital signs and the size of hematoma were arranged for each patient at the time
of admission, then a modified Rankin scale (mRS) was calculated at 6th day after the onset of this
catastrophe.
RESULT:
Of the 70 patients (48 men and 22 women) consecutively admitted with ICH, 24 (38%) were died in the
hospital: 31.5% on the first and second days and 82.5% by the fourth, fifth and sixth day of the event.
The mRS outcome results were as follow: 8 (12.9%) good outcome mRS = (2), 38 (62.9%) were
dependent mRS= (3-5) and 24 (34.3%) were died mRS = (6).
CONCLUSION:
High mortality and morbidity (high mRS scores value) were observed in patient with large hematoma
size, low serum cholesterol, and high vital signs readings.

BACKGROUND:
Fistula in ano is common surgical condition that is treated by different surgical modalities.
OBJECTIVE:
Is to compare the outcome and complications of fistulotomy and fistulectomy as primary treatment of
low fistula in ano.
PATIENTS AND METHODS:
A prospective randomized study was done on 76 patients of low fistulae in ano who were admitted to
the surgical department at Alkindy teaching hospital from January 2009-January 2010.
Fistulotomy was done in 32 patients, and fistulectomy was done in 44 patients.
Patients were followed up post operatively for one year and the healing time was estimated in both
groups and complication rate was recorded including bleeding, infection, incontinence and recurrence.
RESULTS:
Out of 76 patients included in this study,65 patients( 85.53%) were found intraoperatively to have
intersphincteric fistulae and 11 patients(14.47%) were low tansphincteric fistulae.
The operating time for fistulotomy (15-25 minutes) was shorter than that for fistulectomy (20-35
minutes).
The healing time was found to be shorter in fistulotomy group (26.38 days) than that of
fistulectomy(38.64 days).
The complications which were recorded include bleeding occurred in only one out of 44 patients
(2.27%) following fistulectomy, while no bleeding developed following fistulotomy.
Infection developed in one case out of 32 (3.12%) following fistulotomy and one case out of 44
(2.27%) following fistulectomy.
Two cases out of 32 (6.25%) developed minor incontinence following fistulotomy and 5 cases out of 44
(11.36%) following fistulectomy.
Recurrence developed in 2 cases out of 32 (6.25%) of fistulotomy and 3 cases out of 44 (6.82%)
following fistulectomy. The recurrence in both groups developed within 4-6 weeks following surgery.
CONCLUSION:
Fistulotomy can be used as a primary treatment of low fistula in ano as the operating time is shorter and
it takes shorter period of time for the wound to heal and the incidence of complications is comparable to
that of fistulectomy.

BACKGROUND:
A Choledochal cyst is a rare biliary disease mostly presenting during childhood. Adult presentation
is rare and associated diseases and complications are common.
OBJECTIVE:
This study aims to review the management of patients who presented to our hospital with
choledochal cysts, focusing on their presentation, preoperative investigations, treatment given and
postoperative course.
METHODS:
A prospective and retrospective review of all our choledochal cysts patients from April 2000 to
November 2010 was performed
RESULTS:
There were twenty three patients, sixteen females and seven males the average age was 25.82
(range 4-70) years. The commonest presenting complaints were abdominal pain or jaundice. There
were eighteen Types I (78.2 %), two of the adult patients had concomitant cholangiocarcinoma
(8.6 %), and four patients had cholangitis (two of them had associated cystolithiasis). Fourteen
patients treated by total cyst excision with hepaticojejunostomy,
CONCLUSION:
Adult patients with choledochal cysts have associated biliary problems. In view of the high risk of
cholangiocarcinoma, early resection and not internal drainage is the appropriate treatment.

BACKGROUND :
Isolated capitellar fractures are uncommon. Authors continue to differ about the preferred method
of treatments and it's results on the post operative outcome.
OBJECTIVE:
Of This study: Is to evaluate the clinical and functional out come of operatively treated capitellar
fracture with K.Wire , and furthermore to define the impact of fracture type on the out come.
PATIENTS AND METHOD:
A retrospective study carried out on 15 patients Sustaind closed capitellar fracture , 11 females , 4
males. The main age (16 – 58 years). the Operative treatment performed at a mean of 10 days, by
open reduction through relatively limited lateral approach and internal fixation with k. wires. The
evaluation of the functional outcome was by clinical and radiographic examination . The range of
motion (ROM) by using of Mayo Elbow Performance Index (MEPI), and The American Shoulder
and Elbow Surgeons (ASES) scales , and self assessment questionnaires form.
RESULTS:
Eight patients type I , one type II , four type III , two type IV ,and three patients had ipsilateral
radial head fracture,. two in association with type III , and one with type IV. All fractures healed ,
with no significant clinical instability or weakness. The mean ulno-humeral motion (UHM) was
(95o-132o) . All patients had full forearm rotation, average flexion contracture was 15o (range (8o-
35o). (P=0.05). The mean (MEPI) was (90±10) points, with seven excellent results and six good ,
and the mean (ASES) was 36±3 (30 to 40 points) in seven patients. Ipsilateral radial head fracture
had no significant effect on the functional outcome.
CONCLUSION:
Good to excellent outcome with functional ulnohumeral motion (UHM) can be achieved following
open reduction and minimal fixation with k. wires in the treatment of capitellar fractures.

BACKGROUND:
Pressure sore in orthopedic patients is a common problem with high expectation of occurrence on
the ward, it should be watched for in any admitted patient having high liability for its development
like, old age particularly those patients with dementia, patient with malnutrition or anemia and
long stay in bed or complicated multiple surgeries.
Orthopedic staff should be familiar with measures required to prevent and reduce its occurrence.
OBJECTIVE:
To highlight the prevalence, onset, types and number and the most common sites of pressure sores,
length of stay in hospital with various types of treatment delivered to these patients in orthopedic
wards.
PATIENT AND METHODS:
215 patients were admitted with orthopedic problem for treatment and observed for the possibility
of occurrence of pressure ulcer in orthopedic ward. The data collection period was over five years;
these patients were treated for trauma to proximal femur, hip joint, pelvis and elective surgery at
Al-Sader teaching Hospital of Kufa College of Medicine in Najaf City and Al-Yarmouk teaching
Hospitals of Al-Mustanseria College of medicine in Baghdad city. Braden scale was used for
predicting pressure ulcer and for assessing these patients.
RESULTS:
215 patients were assessed for being at risk of developing pressure sores by using Braden scale for
predicting pressure ulcer. 60 patients with various levels of risk factors with prevalence of 27.90%
developed the pressure sores. The age range of patients with pressure ulcer was 42-77 years, with
mean age of 63.2 years. Female patients were 40 and male patients were Pressure sores developed
in 42 [70%] patient with trauma out of 60 patient under study, 10 patient 16.6% with elective
surgery patients, two patients 3.32% conservatively treated patients, and 6 patients 9.96% treated
for removal of old implants.13 patients developed ulcer at the first week and 10 patients developed
pressure ulcer at the second week of their stay in orthopaedic ward and the rest 37 patients
developed it after the second week of their stay in the ward. .
CONCLUSION:
Prevention of pressure ulcer requires the collaboration of all the nursing and surgical staff from
different specialty like orthopaedic surgery. Development of pressure sore is the cause behind
delay of patient discharge after successful surgery. Expectation of the development of bed sore is
significantly high in elderly or bed ridden and hemiplegic patients.

BACKGROUND:
Insulin is a hormone produced by the beta cells of the pancreas. Insulin is necessary for the uptake
of glucose into all cells in the body other than the Brain. C reactive protein (CRP) is a main
inflammatory factor that is produced by the liver during acute infection or inflammation and its
concentration in plasma can increase as much as 1000-fold during injury and infection. Interleukin-
6 (IL-6), a major regulatory proinflammatory cytokine, is produced by a variety of cells, including
leukocytes, adipocytes, and endothelial cells, and acts on the liver to stimulate the production of a
number of acute-phase proteins.
OBJECTIVE:
The present study was designed to examine the relationship between fasting plasma IL-6 and CRP
concentrations and insulin action in acute myocardial infarction patients.
SUBJECTS AND METHODS:
The study included 50 patients with acute Myocardial infarction (AMI) and forty healthy subjects
as control group. Levels of insulin, CRP and IL-6 were measured.
RESULTS:
The levels of insulin, IL-6 and CRP were significantly elevated in AMI patients with (p<0.001).
There was positive correlation between insulin with CRP and IL-6 in acute myocardial infarction
patients.
CONCLUSION:
The significant increase in insulin in AMI may be related to inflammation. Insulin positively
correlated with inflammatory markers (CRP and IL-6).

BACKGROUND:
Since the introduction of routine postpartum prophylaxis in the 1960s, the crude incidence of Rhesus
isoimmunization has been declined all over the world. Iraq and due to many years of sanctions and wars
had many occasions where there was a limited supply of this valuable injection.
OBJECTIVE
To evaluate the effectiveness of our preventive postnatal prophylactic protocol for Rhesus
isoimmunization.
METHODS:
A Cohort observational study conducted at a private clinic and AL-Elwyia Maternity Teaching Hospital
between the start of April 2010 till the end of June 2011. A total of 500 women were enrolled in the
study; who were Rhesus D-ve pregnant women, married to Rhesus D+ve husbands, and had a Rhesus
D+ve neonate and received the usual postpartum prophylactic dose after the previous deliveries when
needed. Maternal plasma level of IgG-D concentration was determined by performing Indirect Coomb’s
test to the mother on admission and neonatal blood group and plasma level of IgG-D concentration was
determined by performing direct Coomb’s test to the neonate.
All the previous and current relevant obstetrical and gynecological events were included in the study
and analyzed. Data analysis was done using SPSS which included percentages according to cross
tabulation of background of sample groups and Chi- square test for the associations.
RESULTS:
The prevalence rate of positive Indirect Coomb’s test in the study sample was (10.4%) (95% confidence
interval ranging between 7.9 to 13.5%), and it was strongly related to gravidity, were gravidity group
(G5+) increased the rate of positive Indirect Coomb’s test to (25.4%), which is significantly higher than
that of primigravida(G1). A positive past history of early pregnancy loss significantly increased the rate
of having a positive Indirect Coomb’s test by (29.9%).
CONCLUSION:
There is an urgent need in our country to improve our current postnatal prophylactic program based on
the high sensitization rate which is so far from the global rate.

BACKGROUND:
Patients with heart failure show a wide spectrum of changes in left ventricular volume, mass, and
function.
OBJECTIVE:
The aims of this study were to define the patterns of left ventricular structural and functional
remodeling and consider their clinical implications in patients with chronic heart failure.
PATIENTS AND METHODS:
Two-dimensional echocardiograms were obtained for patients with chronic heart failure in Baghdad
teaching hospital during the period from February 2009 to February 2011 and were used to calculate
left ventricular volume, mass, geometry, and ejection fraction. Inclusion required the diagnosis of heart
failure in symptomatic patients on medical therapy. Measures of left ventricular size or function were
not used as inclusion or exclusion criteria.
RESULTS:
Two hundred and eighty (280) patients were included in this study of whom 154 were males and 126
were females. The mean age of patients was 58 ± 17 years. Plots of ejection fraction against left
ventricular end-diastolic volume showing an inverse curvilinear relation allowed a description of 4
remodeling patterns. Pattern A (n = 58) was defined as normal end-diastolic volume (<91 ml/m2) and
normal ejection fraction (>50%); 67.24% of these patients showed left ventricular hypertrophy or
concentric remodeling. Pattern B (n = 58) was defined as normal end-diastolic volume and depressed
ejection fraction; hypertrophy or concentric remodeling was present in 65.51%. Pattern C (n = 153) was
defined as increased end-diastolic volume and depressed ejection fraction; eccentric hypertrophy was
present in 94.77%. Pattern D (n = 11) was defined as increased end-diastolic volume and normal
ejection fraction; eccentric hypertrophy was present in 81.81%.
CONCLUSION:
These patterns of remodeling encompass a wide spectrum of geometric changes with different clinical
and pathophysiologic features and possibly different management strategies.

BACKGROUND:
Coronary artery disease (CAD) is the main cause of mortality in industrial and developing
countries. New risk factors including infections are under investigation as potential factors. One
of these infectious agents is Toxoplasma gondii, few data have been published on the association
of atherosclerosis (the usual cause of ischemic heart disease) and Toxoplasma gondii infection.
The OBJECTIVE:
Was to investigate potential role of T.gondii infection as a risk factor for coronary atherosclerosis
in ischemic heart disease patients and the correlation between T.gondii with other cardiovascular
risk factors
PATIENTS AND METHODS:
This study was conducted on (58) patients with Ischemic Heart Diseases attended cardiac care
unite in Al-Hussein teaching hospital in Nasseriya city, southern Iraq and 32 healthy controls ,all
are free from clinically evident disease were attending the blood bank in Nasseriya city between
November 2010 to the end of August 2011. the sera of the patients and control groups were tested
for T.gondii antibodies using Enzyme-Linked Immunosorbent Assay (ELISA) technique. The
obtained data was analyzed and the results were tabulated.
RESULTS:
22(37.9 %) in the case group and 11(34.4 %) in the control group were seropositive for T.gondii
antibodies, odds ratio (OR) 1.167 . P= 0.915 . And there were no association between risk factors
and Toxoplasma gondii infection, (Table 2, 5). ( Figure 1).
CONCLUSION:
This study shows that there is no association between Toxoplasma gondii infection and ischemic
heart disease

BACKGROUND:
Advances in the current treatment of β-thalassemia major have contributed to improve prognosis,
and nowadays, an increasing number of patients do survive up to the third or fourth, decade.
Cardiac complications are still the most common cause of death in patients with major
thalassemia.
OBJECTIVE:
Assessment of Left ventricular systolic and diastolic parameters in β-Thalassemia Major patients
and its relation to ferritin level and to spleen status.
PATIENT AND METHODS:
A Cross -sectional descriptive study done at Ibn Al- Albalady Hospital for Children and
Maternity Baghdad city from beginning of January 2011-to the end of July 2011,( 427) patients
with β-thalassemia major were considered for analysis, all patients on regular blood transfusion
& chelation therapy. M-mode, 2D and Doppler echocardiographic parameters were averaged
over 3 cardiac cycles and all echocardiographic measurements were performed according to the
guidelines for performance of a pediatric echocardiogram by American Society of
Echocardiography
RESULTS:
LA, Aortic diameter ,LA/AO ratio, LV posterior wall thickness , interventricular wall thickness,
Left Ventricular end systolic and diastolic diameter were larger in β-thalassemic patients. Peak
E, peak A, isovolumic relaxation time were higher in thalassemic patient. There were no
difference in E/A flow ratio and E deceleration time. Strok volume, LV mass index and MPI
were higher in thalassemic patients. No change in Ejection Fraction and Fraction Shortening. No
effect found in all mitral valve Doppler parameters in relation to ferritine level. LV mass index
higher in splenctomized patients. No effect found in all mitral valve Doppler parameters in
relation to spleen status.
CONCLUSION:
The findings of this study shows that in β-Thalassemic patients there is good systolic function
but decrease in diastolic function and there was no correlation between ferritin level and LV
systolic and diastolic function.

BACKGROUND:
Despite being formally included in the assessment of patients presenting with lower urinary tract
symptoms (LUTS), transrectal ultrasonography (TRUS) is not routinely offered to these patients. Data
exist on the superiority of TRUS over transabdominal ultrasound in accurately predicting prostate
volume.
OBJECTIVE:
To evaluate which of these methods are more accurate in calculation of prostate volume. The volume is
most commonly measured using the formula, prostate volume=height×width×length /6, which is
derived considering the gland as ellipsoid,
PATIENTS AND METHODS:
Thirty five patients aged (60-75) years; with mean age (65.1±4.016) years and mean of serum prostate
specific antigen (PSA) (1.429±0.3149) complaining from LUTS due to benign prostatic hyperplasia
(BPH) underwent suprapubic prostatectomy .TRUS was performed in all patients preoperatively and
calculations of the prostate volume were made. These were compared with respective transabdominal
calculations of the prostate volume as well as the enucleated specimen weight.
RESULTS:
TRUS slightly underestimated weight by (8.6%).while transabdominal U/S overestimated it by
(94.3%). Pearson correlation analysis indicated TRUS as a better predictor of weight (0.661) at P-value
of <0.001 (extremely significant) followed by transabdominal U/S (0.465) at P-Value of <0.01 (highly
significant).
CONCLUSION:
TRUS is more accurate than transabdominal U/S in predicting adenoma volume in patients with BPH.

BACKGROUND:
The overactive bladder (OAB) is extremely common. The treatment of refractory overactive
bladder conditions has changed radically over the last decade. The efficacy of OAB treatment
protocols in improving patient symptoms are not satisfactory, so new agents such as botulinum-A
toxin must be investigated.
OBJECTIVE:
To evaluate the safety and efficacy of intradetrusor botulinum -A toxin injection in patients with
idiopathic detrusor overactivity resistant to anticholinergic drugs.
METHODS:
From March 2010 to September 2011, 38 women with refractory idiopathic detrusor overactivity
(IDO), from the urologic consultation department in Baghdad Medical City and Al-Ramadi
teaching hospital, were included in this prospective study. Their age ranged from 45 to 70 years.
Inclusion criteria were women with idiopathic detrusor overactivity not responding to different
anticholenergic treatments. Patients with urinary tract infection, mixed incontinence, bladder stone,
hematuria, neurogenic detrosur overactivity, high postvoiding residual urine volume (more than 50
ml) and history of bladder tumour were excluded from this study. Full clinical and urodynamic
evaluations were done before intradetrusor injection of 300 units of botulinum-A toxin and at 2
weeks and 24 weeks after injection.
RESULTS:
Thirty six patients achieved urinary continence (94.7%). The age ranged from 45 to 70 years (mean
56.67±7.34). There was significant clinical improvement after botulinum toxin injection at both 2
weeks and 24 weeks of follow up as reflected by statistically significant decrease in the daytime
frequency, nocturia and the incontinence episodes (p value <0.05).
There was significant urodynamic improvement after botulinum toxin injection at both 2 weeks
and 24 weeks of follow up as reflected by statistically significant increase in the maximum
cystometric bladder capacity and the bladder compliance and by statistically significant decrease in
the detrusor pressure at maximum flow rate (p value <0.05). Postvoiding residual urinary volume
shows statistically significant increase at both 2 weeks and 24 weeks of follow up (p value <0.05)
CONCLUSION:
The use of intradetrusor injection of botulinum toxin-A (BTX A) in refractory idiopathic detrusor
overactivity was well tolerated and demonstrated clinically meaningful and statistically significant
improvement in the clinical and urodynamic parameters of the patients. The effect was durable for
the period of study which is 6 months.

BACKGROUND:
Intestinal parasitic infestation represents a considerable medical and public health problem in the
developing countries and up to 10% of the population of the developing world is infected with
intestinal worms(1).
OBJECTIVE:
This study was initiated to investigate the prevalence of H. nana infection in rural environments
in Baghdad and to determine if the prevalence could be linked to the availability of water and
sanitation facilities.
MATERIAL AND METHODS:
This study included 300 patients in the Abu-Ghraib province. Stool smear were prepared for
each sample stool culture for Shigella spp. . Hemoglobin estimation was evaluated by
Cyanmethemoglobin method.
RESULTS:
From 300 patients only 20 ( 6.67 %) were positive for H.nana ,the male to female ratio was 14:6
, heamoglubulin range from 10.5 -13 g/dl.The age group 1–5 years had the highest rate (50%)
,While the age group more than 20 years were the lowest (5 %); boys have a higher rate (70%)
than girls. Other parasitic species found in fecal sample of these patients in association with
H.nana infection were Giardia lambli(10%), Entamoeba histolytica(5%) while (5%) of patients
were infecting with both Giardia lambli and Entamoeba histolytica, some of these patients
(15%) in microscopic examination revealed PMN cell and the stool culture of them were
positive for Shigella species.
CONCLUSION:
Our data suggested that ,the prevalence of H.nana infection was 6.67% in Abu -Ghraib city
and diagnosis and treatment of patients are the clue in eradication of H.nana.

BACKGROUND:
Emphysematous pyelonephritis is a life
threatening necrotizing infection of the kidney
characterized by accumulation of gas in the renal
parenchyma as well as within the surrounding
tissues(1,2). The common presentations are fever
(56%), vomiting (16%), abdominal pain (7%),
shock (16%) and confusion (24%) (1). The
pathogenesis is poorly understood. the condition
usually occurs in diabetic patients. Although
glucose fermentation may be a factor, the
explanation does not account for the rarity of
emphysematous pyelonephritis despite the high
frequency of gram-negative UTI in diabetic
patients, nor does it explain the rare occurrence of
the condition in nondiabetic patients. In addition
to diabetes, many patients have urinary tract
obstruction associated with urinary calculi or
papillary necrosis and significant renal functional
impairment.

The incidence of uterine fibroid tumor increase as
women grow older and they may occur in more
than 30 percent of women 40 to 60 years of age.
Risk factors include nulliparity, obesity, family
history, black race, and hypertension.
These neoplasms frequently cause abnormal
period, pelvic pain, and pressure symptoms. We
present a case report of a large leiomyoma in an
adult woman.