Iraqi Postgraduate Medical Journal

BACKGROUND:
Gallstones are a major cause of morbidity worldwide, and cholecystectomy is the most commonly
performed abdominal surgery in medicine. Gallstone-induced complications have a limited and
overlapping pattern of clinical presentation. In this article, morphology, composition of gallstones as well
as diagnosis and therapeutic options employed in their management are reviewed.
OBJECTIVE:
The study is to defin the different types of gallstones,and to identify their characteristics and chemical
coemposition in 150 patients
PATIENTS AND METHODS:
A retrospective study was performed on one hundred and fifty patients who were subjected to
cholecystectomy during the period from January 1992 to January 2007, in the gastro-enterology &
hepatology center and Al-Mustansyria Private Hospital in Baghdad by one consultant surgeon.
RESULTS:
The female: male ratio was 4:1 and the peak age group was that between 41-50 years. Thirteen percent of
patients required explorations of the common bile duct (CBD), 72.7% of them were jaundiced, and 27.3%
of those who had CBD exploration were not jaundiced. Ninety point seven percent of cholecystectomies
were performed for calculus cholecystitis and 9.3% were for acalculus cholecystitis.
Of the 136 patients with calculus cholecystitis, 19.9% had a solitary stone, and 32.4% had 2-10 stones; the
highest number of stones was 250. Forty nine percent of stones were less than one centimeter in size; with
the biggest stone being 4.5 cm in size.
Unlike what is expected of "mixed stones ", they were not more than 30.9% of cases, while "cholesterol
stones "constituting 40.4% of cases." pigment stones" constituted only 8.8% of stones; with "combined
stones" constituting 17.6% of cases.
CONCLUSION:
There is an increased prevalence of gallstones in females and the frequency of gallstones increases with
age in both sexes.
In this article, there has been recognized three types of gallstones, cholesterol, mixed and pigment (black
and brown) stones. The cholesterol stones account for more than 40% (the highest percentage of
gallstones in the study).

BACKGROUND :
For decades there has been a discussion whether thyroid disorders could cause gallstone disease .
Particularly, there are several explanations for a possible relation between hypothyroidism and
gallstone disease , these explanations include the known link between thyroid failure and
disturbances of lipid metabolism that may consecutively lead to a change of the composition of the
bile , motility of biliary tract and it's effect on sphincter of Oddi .
OBJECTIVE:
To show the relation between serum levels of thyroid stimulating hormone (TSH) and cholesterol and
types of gallstone .
PATIENT AND METHOD :
A prospective analysis of 150 cases with cholecystectomy , were studied in Al _ Sadar teaching
hospital in AL _ Najaf goverment between 1st of January 2008 till end of December 2008 , for each
studied patient with gall stone serum was taken for measuring the levels of TSH and cholesterol ,
stone was taken after cholecystectomy and sent for chemical analysis.
RESULTS :
There was a remarkable gender difference with predominance of female gender as it constitutes 132
(88%) versus 18 (12%) males . Abnormal high levels of serum TSH and cholesterol were reported in
12 cases ( 8% ) and in 15 cases (10% ) respectively . Types of gallstones , were cholesterol stones in
95 cases (63%) , pigmented stone in 33 cases (22 %) and mixed stone in 22 cases (15%) .
CONCLUSION :
There was relationship between high serum levels of TSH and cholesterol with types of gallstones .

BACKGROUND:
Endoscopic stenting has become widely accepted procedure for the relief of jaundice in patients with
malignant biliary obstruction. It may offer lower morbidity and mortality, shorter hospitalization, and
diminished overall cost compared with surgical or radiological approaches.
OBJECTIVE:
To assess the efficacy of the self expendable metallic stents in treatment of the patients with biliary
stricture due to malignant tumors, and to compare this efficacy between proximal and distal obstruction.
PATIENTS AND METHODS:
SEMS were deployed during endocopic retrograde cholangiopancreatography (ERCP) in a total of
41patients with malignant biliary obstruction (proximal or distal) . Clinical success was defined as the
improvement of the laboratory data and a decrease of the bilirary dilatation by follow up ultrasound
imaging. Stent dysfunction was defined as recurrence of jaundice or cholangitis, is confirmed by ERCP or
simply by elevated cholestatic parameters and treated by insertion of a plastic stent or second metallic
stent inside the old one.
RESULTS:
Stent placement was achieved in 38 of 41 patients (92.7%) with malignant bile duct obstruction. SEMS
was failed to be placed in 3 patients (1 with pancreatic cancer and 2 with proximal
cholangiocarcinoma).Clinical improvement was seen in 36 of 38 patients (94.7%). In 4 patients (10.5%)
cholangitis had developed.The overall stent patency time was 37.88 + 18.59 weeks (range 16-76 week).
Analysis in subgroup of patients classified according to the site of obstruction (34with distal and 7 with
proximal biliary obstruction).The overall success (technical and clinical) was significantly higher in the
distal group (33/34, 97.1%) than in the proximal group (3/7, 42.9%); p-value was 0.02.
CONCLUSION:
SEMS implantation is a feasible , palliative method for inoperable malignant biliary obstruction. The
clinical and the technical success of biliary drainage by SEMS is better achieved in distal than in
proximal tumors with hilar infiltration by the tumor.

BACKGROUND:
Carcinoma of Bladder is a common urological tumor. Urethral strictures with different grades are
frequently seen in patients with non muscle invasive bladder cancer .
OBJECTIVE:
To elicit the incidence of urethral strictures, their severity and correlation with different factors
in patients managed for non muscle invasive bladder tumor.
PATIENTS AND METHODS:
In a prospective study from January 2008 to January 2010 ,we followed 98 patients with superficial
bladder tumor ,they were all male their age ranged from 38-76 years, all patients diagnosed
endoscopically and histologically staged as superficial bladder tumor (excluding invasive bladder
tumor),we follow those patients with a history regarding any change in urinary stream then
urethrocystoscopically during a period of 1-2 years, we classify urethral strictures that was
urethroscopically diagnosed as mild, moderate and sever.
For each urethral stricture case we state the site and severity of the stricture, the number of
preceding cystoscopies, duration of TURBT procedure and number of preceding chemotherapy
sessions , the type of chemotherapy used and method of treatment required in each case.
RESULTS:
During the period of the study , a total of 23 urethral strictures (23.5%) were identified. They were
all in the bulbar urethra, they were mild in 10 patients (43.5%), Moderate in 6 patients (26.1%) and
sever in 7 patients (30.4%) and 14 patients with urethral stricture had also B.P.H(60.9%).
Prior to the occurrence of stricture; urethrocystocopy was done once in 55.5% of cases , twice in
26.1% and 3 or more in 17.4%.
Duration of TURBT procedure was≤20 mints in 30.4% and > 20 mints in 69.6%.
Intravesical chemotherapy sessions were 0-3 in 17.4% of patients, 6 in 43.5% and more than 6 in
39.1%.
The type of chemotherapeutic agent used was Doxorubicin in 56.5% of patients Mitomycin-c- in
26.1% and both of them (through multiple courses) in 13%.
CONCLUSION:
Urethral stricture associated with the management of non muscle invasive bladder tumors is a
common and important clinical problem that need to be considered and avoided as far as possible
,Factors that may had a positive impact on the incidence of stricture were : B.P.H , duration of
TURBT procedure, the number of intravesical chemotherapy sessions(6 and more) and doxorubicin
instillation.

BACKGROUND:
The Recent Studies have reported outstanding results concerning medical expulsive therapy (MET) for
distal ureterolithiasis in terms of stone expulsion and control of colic pain. While ureteral intracorporeal
lithotripsy and extracorporeal shock wave lithotripsy are recognized to be effective.
OBJECTIVE:
To evaluate the role of phosphodiesterase 5 inhibitor (tadalafil) 10mg in conservative therapy for patients
with lower ureteral stones.
PATIENTS AND METHODS:
From December 2009 to October 2010, 60 consecutive symptomatic patients with juxtavesical unilateral
lower ureterolithiasis from the urologic consultation department in Baghdad Medical City were enrolled
in this randomized prospective placebo controlled study (pilot study). Patients were randomly divided into
two groups, group 1 (n=30) and group 2 (n=30). Group 1 was given tadalafil 10mg. Group 2 was given
placebo. Tadalafil 10mg or placebo was administered once daily. The treatment duration was until stone
expulsion or 14 days. During this period, all patients were evaluated weekly by US and serum creatinine
level, and were asked whether they experienced acute colic pain, to score the intensity of pain according
to a visual analog scale, whether the calculus passed spontaneously, the day and time of stone expulsion,
number of analgesic use, and any drug side effects.
RESULTS:
The mean stone size was 7.91mm for treatment group and 7.55mm for placebo group (p> 0.05) .The stone
expulsion rate was 93% for treatment group and 67% for placebo group (P<0.05). Mean expulsion time
was 5.5 days for treatment group and 8.84 days for placebo group (P=0.001). Mean VAS was 3.9 for
treatment group and 7.9 for placebo group (P<0.0001). Mean number of indomethacin suppositories used
was 1.33 for treatment group and 7.9 for placebo group (P<0.05). The univariate analysis using Cox
proportional hazard model revealed that only therapy and stone size proved to be significantly predictive
factors of stone expulsion (P<0.0001 and 0.001) respectively, while gender and age did not have any
predictive value. Although side-effects occurred more in patients who were given tadalafil 10mg, no
significant side-effect was detected so as to require exclusion of a patient from the study.
CONCLUSION:
Medical Expulsive Therapy (MET) for lower ureterolithiasis with tadalafil during conservative treatment
period is safe and effective as demonstrated by the absence of serious side effects and increased stone
expulsion rate with early time. Also MET with tadalafil 10mg affords an outstanding control of pain for
patients while waiting for stone expulsion.

ABSTRACT:
BACKGROUND:
Central giant cell granuloma (CGCG) and peripheral giant cell granuloma (PGCG) are tumor like
lesions that affect jaw bones, while giant cell tumor (osteoclastoma) is a tumor that affects the long
bones (e.g. tubular bones). Its affection of the jaw bones is a matter of debate. Both are very similar in
their histopathological features while they vary in their clinical behavior. GCT shows a more aggressive
behavior than GCG.
OBJECTIVE:
To evaluate the expression of (Proliferating cell nuclear antigen) and (P53) in peripheral and central
giant cell lesion of the jaw and giant cell tumor of long bones with correlation to histopathological
parameters.
METHODS:
A total of 17 (GCT), 15 (CGCG) and 16 (PGCG) cases where enrolled in this study.
Immunohistochemical staining with PCNA and P53 monoclonal antibody was performed.
RESULTS:
A non-significant difference in proliferative activities was recorded among different histological giant
cell lesion subtypes. Giant cell granuloma expressed the same proliferative potential to that of giant cell
tumor, moreover PCNA expression was not statistically correlated to different histopathological
paramters of lesion subtype.
On the other hand. The anti-apoptotic potential of giant cell granuloma which expressed by anti P53
monoclonal antibody was the same of that of giant cell tumor.
CONCLUSION:
Results of this study proved that the biological behavior namely P53 and PCNA activities was
comparable between giant cell lesions and giant cell tumor. This suggest that these two conditions may
act as one disease entity with a spectrum of clinical behavior, possibly due to certain differences in
anatomical location which by itself affect its biological behavior. This hypothesis needs further
verification concerning the clonality of the lesion to be accepted or refused.

BACKGROUND:
To evaluate complement activation (C3) levels in all forms of acute coronary syndrome (ACS) and to find
whether there is any significant changes in C3 concentration at the 1st and 4th day after admission and its
relation to clinical outcome.
OBJECTIVE:
Comparing the degree of complement activation (C3 level) between ACS and stable pectoris.To know
whether there is any significant difference between the level C3 at first and fourth day. Any correlation
between CRP and C3 in patients with ACS.
PATIENT AND METHODS:
129 subjects (94 male and 35 female) age range (41-72 years, mean age 57 ± 10.6) were admitted in this
study over the period of Feb 2009-Jan 2010 categorized into three groups; 76 patients with acute coronary
syndrome (group A), 25 patients with stable angina (group B) and 28 healthy control (group C). Full
clinical, biochemical, electrocardiographic and echocardiographic studies liveredone. All patients were
followed to the fourth day of admission, Blood samples from peripheral veins were collected centrifuged
and Serum C3 levels were measured using immunokit based on single immunodiffusion.
RESULTS:
The sample of patients was (129) subjects (94 male 72.9%) and (35 female 27.1%). Troponin (I) was
positive in 35.7% and negative in 64.3% of the study sample (p. value 0.0005). C-reactive protein (CRP)
was significantly correlated with different groups (p. value 0.0004).the same with diabetes mellitus (p.
value 0.0003) but not in hypertensive and smokers (p. value 0.486 and 0. 368 respectively).C3levels was
significant in correlation to clinical status in both STEMI and NSYEMI 1st and 4th day. Correlation
between C3 and C-reactive protein level was insignificant with different groups.
CONCLUSION:
C3 levels was significantly elevated in correlation between ACS compared to patient with stable angina
and healthy control subjects. Also C3 level was significant at the fourth day of admission in patients with
NSTEMI in correlation to its level at the first day. However no significance associations between C3
levels and CRP in different studied groups.

BACKGROUND:
Acute myocardial infarction remains a major cause of adult mortality. A steady decline in the
mortality rate appears to be due to a fall in the incidence of acute myocardial infarction, a fall in the
case fatality rate, identifying those patients who are at increased risk, and more aggressive
prophylactic cardiovascular treatments to prevent it from occurring.
OBJECTIVE:
To identify, patients who have higher risk of in-hospital mortality after the first acute myocardial
infarction.
PATIENTS AND METHODS:
The hospital mortality for the first acute myocardial infarction (AMI) was evaluated for 112 patients
who were admitted to the coronary care unit in Baghdad Teaching Hospital during a total period of
six months duration, between March and Sept. 2001.
For each patient, history, clinical examination, electrocardiograms, fasting venous plasma glucose
were done.
RESULTS:
Total mortality was 16.1%. The following factors were associated with higher in-hospital mortality:
advanced age (more than 65 years), females, diabetic, and clinically evident heart failure. Other
variables were not associated with increase or decrease in mortality: hypertension, smoking,
admission heart rate, bundle branch block, previous angina pectoris, and the site of the infarction.
CONCLUSION:
Certain groups of patients tend to have higher mortality; patients older than 60 years, females,
diabetic and patients with clinical heart failure. Other factors didn’t affect survival; location of the
AMI, the presence of bundle branch block, hypertension, angina pectoris, smoking and the high
heart rate on admission.

BACKGROUND:
The most common definition of Small for gestational age (SGA) newborns refers to a birth weight below the 10th percentile for gestational age. Intrauterine growth retardation(IUGR) may be caused by maternal, placental, or fetal factors. However, no underlying etiology can be identified in at least 40 % of SGA infants.
OBJECTIVE:
To evaluate the risk factors of SGA births in a sample of Iraqi term newborns.
PATIENTS& METHODS:
A case control study extended over eight months from Dec. first 2007 to July 31st, 2008 . In this study, 100 SGA newborns &100 control newborns evaluated within the first day of life.
This study was performed in delivery rooms &neonatal special care birth unit in Baghdad Teaching Hospital in Medical City . Data were collected by direct interview of the mothers. Data included different variables related to mothers & neonates.
RESULTS:
There was a significant relationship between SGA births & maternal urinary tract infections (OR=5.231, P<0.0001) & with antepartum hemorrhage (8.6 time risk ,0R=8.609, P=0.0349).
The majority of SGA newborns(15%) occurred in multiple pregnancies (OR=17.471, P=0.0003). SGA newborns were more common among non employed mothers (OR=2.100, P=0.0355).
Also SGA newborns had significant relationships with mothers not attended antenatal care (OR=3.648, P=0.0001),those with maternal history of SGA births (OR=15.474, P<0.0001) , those mothers with anemia (OR=5.532, P<0.0001) & lastly with mothers suffering from hypertension (OR=8.877, P<0.0001).
CONCLUSION:
There was significant relationship between SGA births and :Multiple pregnancies& maternal history of SGA births, mothers suffering from hypertension& maternal history of APH and maternal anemia& UTI, mother not attended antenatal clinic & with no employment.

BACKGROUND:
Pre-labour rupture of the membrane is a common clinical problem, and the assessment of the woman
with possible membrane rupture is management issue faced in every day practice. When premature
rupture of membrane (PROM) occurs, the fetus loses the relative isolation and protection afforded
within the amniotic cavity.
OBJECTIVE:
To evaluate the reliability of vaginal washing fluid Beta-human chorionic gonadotropin for the
detection of premature rupture of membrane and to determine a cut-off value.
METHOD:
A prospective case-study includes 79 pregnant women subdividing into three groups (groupA: 20
pregnant women with confirmed premature rupture of membranes, group B: 19 pregnant women with
suspected premature rupture of membranes, group C: apparently healthy pregnant women without
any complaint) for which speculum examination for amniotic pooling, nitrazine paper test,
measurement of vaginal washing fluid Beta-human chorionic gonadotropin were performed.
RESULTS:
There was significant differences in mean vaginal washing fluid β-HCG concentration among the
three groups (p= 0.000), being higher in group A than the other two groups and the time interval
between sampling and delivery was significantly shorter among patient in group A than group B and
C.
CONCLUSION:
Vaginal fluid β-HCG determination is reliable, simple and rapid test for the detection of PROM.

BACKGROUND:
Current ultrasound assessment of placental calcification relies on Grannum grading. The ultrasonographic
appearance of grade III placental maturation, if it occurs before 37 weeks, may signify placental
dysfunction and is found to be associated with development of pre-eclampsia and low birth weight.
OBJECTIVE:
To look at the prevalence of a grade III placenta at 36 weeks’ gestation in a low-risk obstetric population,
and to explore the association between premature aging observed ultrasonographically and pregnancy
outcome.
METHODS:
Scans were performed at 36 weeks’ gestation in 591 low-risk pregnant women to determine placental
maturity. The prevalence of grade III placenta at 36 weeks’ gestation was determined. Follow-up was
performed for the group of women demonstrating a grade III placenta in comparison to those not
demonstrating a grade III placenta for determining pregnancy outcome.
RESULTS:
The prevalence of grade III placenta at 36 weeks’ gestation was 3.9%. A grade III placenta at 36 weeks’
gestation was significantly associated with young maternal age P = 0.01. The Grannum grade III of the
placenta at 36 weeks’ gestation was statistically associated with increased risk for development of
proteinuric pregnancy-induced hypertention (PIH) later in pregnancy (RR 4.94; 95% CI 1.15-21.26), P =
0.021. Women demonstrating a grade III placenta at 36 weeks’ gestation had a significant high risk of
induction of labour for suspected fetal compromise (RR 4.7; 95% CI 1.76-12.59), P = 0.001. The risk for
delivering a baby with a weight <10th centile at birth was significantly higher in women with grade III
placentas in comparison to those with grades 0-II (RR 3.19; 95% CI 1.23-8.27), P = 0.017.
CONCLUSION:
In a low-risk obstetric population, ultrasound detection of Grannum grade III placenta at 36 weeks’
gestation helps to identify at risk pregnancy. It appears to predict subsequent development of proteinuric
PIH and may help in identifying the growth-restricted baby.

BACKGROUND:
Carnitine is highly concentrated in the epididymis and Spermatozoa, where it may serve as an
intramitochondrial vehicle for theAcyl group, a substrate of energy production. This study is aimed to
determine any correlation between male infertility and semen quality with Concentration of L- carnitine
in human seminal plasma.
OBJECTIVE:
This case-control study performed at the Institute of Embryo Research and Infertility, University of AlNaharin, Baghdad. Semen samples of 40 infertile men (azoospermia, n=12, oligoasthenozoospermia,
n=16, teratozoospermia, n=12) and 12 fertile men controls were collected.
METHODS:
The level of total L- carnitine in seminal plasma was determined by high performance liquid chromatography
and the results correlated with sperm parameters as sperm count, motility and morphology.
RESULTS:
The level of L-carnitine was significantly reduced in infertile male groups; azoospermia,
oligoasthenozoospermia and teratozoospermia in comparison with that of fertile male controls (P< 0.045,
P< 0.023 and P< 0.04; respectively). There was a borderline significant positive correlation between the
seminal L-carnitine and the sperm count in fertile group(r=0.63, P< 0.51).
CONCLUSION:
The results of this study indicated the significance of determination of seminal plasma L-carnitine in
evaluation of infertility in men and the importance of recognition of those infertile male who are benefit
from administration of carnitine supplement.

BACKGROUND:
Numerous studies have shown the presence of DNA strand breaks in human ejaculated
spermatozoa. The nature of this nuclear anomaly and its relationship to patient etiology is however
poorly understood.
OBJECTIVE:
This study was done to investigate the relationship between nuclear DNA damage, assessed using
the TUNEL assay and a number of biochemical parameters including zinc level, copper level, and
the malondialdehyde (MDA) level as an indicator of the lipid peroxidation and also the standard
general seminal fluid examination.
MATERIAL AND METHODS:
In this study 100 seminal samples were tested. Seventy five infertile patients aged (30.33±5.96)
and 25 normal people aged (29.84±6.434) were included as a control. All tests were done to all the
samples except the DNA fragmentation which was done to 60 samples only (45 patients and 15
normal).
RESULTS:
A positive relationship between DNA damage level and infertility was found. Also there were
higher levels of MDA level and DNA damage in spermatozoa of infertile patients (P=0.001). We
found also absence of difference in the copper level between the two groups. Regarding seminal
zinc level we found that there was a low zinc level in infertile patients (P=0.001). Non-significant
correlations between zinc level and the percentage of DNA fragmentation and the MDA levels
were obtained.
CONCLUSION:
This study suggested that sperm DNA analysis might be better discriminator between infertile and
fertile men than standard semen analysis also oxidative stress and sperm DNA damage contributed
to sperms dysfunction. The infertile samples associated with high levels of oxidative stress and low
seminal zinc levels.

BACKGROUND:
A woman's menstrual cycle (and accompanying hormonal changes) can cause variations in blood glucose
levels. Many women may note an increase in their blood glucose after ovulation, which then decreases
once menstruation starts. These changes are caused by the hormones estrogen and progesterone, which
occur at higher levels before period. They influence insulin in causing blood glucose to rise. It is
important to test blood glucose levels during this cycle to be certain that blood sugar variations are
attributed to menstruation.
OBJECTIVE:
To study the effect of sex hormones (testosterone, estradiol and progesterone) on the level of glucose; as
well as it may shed light on suitable dose of diabetic treatment during different phases of menstrual
cycle.
SUBJECTS & METHODS:
This study included 50 healthy female with regular menstrual cycle aged 25-40 years (control group) and
25 diabetic type2 (well controlled) female with regular menstrual cycle aged 30-40 years. Serum fasting
glucose and sex hormones (testosterone, progesterone and estradiol ) were evaluated in these two groups
of patients and controls during follicular and luteal phases of sexual cycle. Colorimetric method was used
in the serum glucose concentration determination, Enzyme Linked Immune Sorbent assay (ELISA) was
used in the determining sex hormones level.
RESULTS:
The results of the present revealed significant increase in mean (+SD) values of serum glucose (p<0.05)
and serum progesterone levels (p<0.05) with significant decrease of serum estradiol mean (+SD) values
(p<0.01) in lateual phase than follicular phase of menstrual cycle of healthy women.
Similar findings were found in diabetic women who have regular menstrual cycle .Serum glucose and
serum progesterone showed significant increase ,while serum estradiol showed significant decrease in the
luteal phase compared with follicular phase .
No significant difference was found serum testosterone level in the above studied groups between the
phases.
It was found that 22% of healthy women with regular menstrual cycle showed elevation in their serum
glucose concentration during the luteal phase of their sexual cycle.
CONCLUSION:
The study revealed that blood glucose level changes along the period of menstrual cycle , due to the
interaction between the hormones that control menstruation (estrogen and progesterone ) and the insulin
hormone .

BACKGROUND:
Substance dependence frequently co-occurs with psychiatric morbidities. Among substances, nicotine
found to be the commonest substance of abuse among schizophrenic patients.
OBJECTIVE:
To assess the association of nicotine dependence with Schizophrenia.
METHOD:
112 schizophrenic patients and 374 non-schizophrenic patients were invited to answer a standard
clinical/demographic questionnaire and a questionnaire on nicotine dependence (modified Fagerstrom
Tolerance Questionnaire (mFTQ)).
RESULTS:
The rate of nicotine dependence was significantly higher among schizophrenic patients (44.64%) than
non-schizophrenic patients (23.52%) (P < 0.000). Male smokers outnumbered female smoker (P < 0.000)
in both groups. Male gender was a significant predictor for smoking among both groups of patients (OR =
55.878; P = 0.000 for schizophrenic patients; OR = 9.489; P = 0.000 for non-schizophrenic patients).
Increase in age was significant predictor for nicotine smoking in general (OR = 1.032; P = 0.001), and
among the schizophrenic group (OR = 1.116; P = 0.000), whereas, it was not a significant predictor for
nicotine smoking among non-schizophrenic patients (OR = 1.014; P = 0.185). Whole sample patients start
nicotine smoking before their psychiatric disorders onset (3.3 and 7.7 years earlier respectively) (P =
0.01). Both groups were highly nicotine dependents (mean mFTQ = 9.92 for schizophrenic patients; mean
mFTQ = 8.54 for non-schizophrenic patients) (P = 0.02).
CONCLUSION:
The rate and severity of nicotine dependence were higher among patients with schizophrenia than nonschizophrenic patients. Gender and age were significant predictors for nicotine smoking in whole
psychiatric patients. Both groups started their smoking habit before their psychiatric morbidity onsets.

BACKGROUND:
Premenstrual dysphoric disorder (PMDD) is a somatopsychic illness triggered by changing levels of
sex steroids that accompany an ovulatory menstrual cycle. It affects about 3% to 8% of women in
their reproductive years. The symptoms of this disorder are primarily affective. The disturbance
markedly interferes with work, school or with usual social activities and relationships with others.
OBJECTIVE:
Are to determine the prevalence and the sociodemographic factors in relation to PMDD and to find
out the characteristic features of premenstrual symptoms and their impact on daily living.
METHOD:
145 women aged between 18 and 55 years with regular menstrual cycles who met the diagnostic
criteria of PMDD out of 1792, were assessed regarding their premenstrual symptoms using the
Premenstrual Symptoms Screening Tool (PSST). The study was conducted in 1st August 2009 until
31thDecember 2009.
RESULTS:
The study revealed that 8.1% of women met the diagnostic criteria of PMDD. It was found more
common among younger females 36.5% (18-25years of age), the majority of them were married
(71%).
CONCLUSION:
PMDD is relatively common in women especially younger age group.

BACK GROUND:
Fibromyalgia (FMS) is a common, chronic widespread pain syndrome usually associated with
other somatic and psychologic symptoms including fatigue, sleep disturbances, cognitive
difficulties Oxidative stress means an alteration in the delicate balance between free radicals and
the scavenging capacity of antioxidant enzymes in favor of free radical in the body system.
OBJECTIVE:
To evaluate and compare the antioxidants and lipid peroxidation in patients with fibromyalgia and
healthy control.
PATIENTS AND METHOD;
The study has included sixty patients with FMS (40 females and 20 males) and thirty healthy
subjects. The subjects were selected from people attending the out patients clinic in Medical CityBaghdad Teaching Hospital- Rheumatology& Rehabilitation Consultation Unit. Laboratory
parameters included: uric acid,albumin,caeruloplasmin,total thaiol,malondiaaldehyde(MDA) and
peroxinitrate(ONOO¯ ).
RESULTS:
MDA and uric acid levels in serum of patients with fibromyalgia were significantly higher than in
the control group. While the levels of ONOO¯ GSH,CP,albumin in serum of patients with
fibromyalgia were significantly lower than in healthy control.
CONCLUSION:
oxidative stress may have a role in the pathophysiology of fibromyalgia syndrome.

BACKGROUND:
Fibromyalgia syndrome (FMS) is a chronic musculoskeletal syndrome; almost invariably, symptoms
persist at 5- and 10-year follow-ups. The degree of functional impairment is similar to that seen in
patients with moderate to severe rheumatoid arthritis. Anti-cyclic citrullinated peptide (anti-CCP)
antibody testing is particularly useful in the diagnosis of rheumatoid arthritis, with high specificity, in
the early disease process, with the ability to identify patients who are likely to have severe disease and
irreversible damage. CRP is a member of the class of acute-phase reactants that its levels rise
dramatically during inflammatory processes occurring in the body.
OBJECTIVE:
the main objective of this study is to determine the frequency of anti CCP- in patients with FM and
the association of anti-CCP level with C-RP.
PATIENTS & METHODS:
This study included 60 patients with FMS according to the ACR 1990 criteria. Their age range was
20-60 years. These patients were then matched by age and sex to 30 healthy control persons with
mean age 42.81 ± 2.16 years.
RESULTS:
The mean values of ACCP antibodies concentration in serum of patients with FMS were no
significant difference as compared to the level in serum of healthy controls (p>0.05), while the mean
values of C-RP concentration in serum of patients with FMS were significantly increased than the
level in serum of healthy control (p< 0.05).
CONCLUSION:
It is clear from this study that there is no relationship between the levels of ACCP concentration and
FMS while C-RP concentration in patients with FMS may be a good indicator to evaluate this
disease.

BACKGROUND:
Various skin disorders are related to increase solar radiation exposure. These diseases mainly increase
in spring and summer months among general population due to an increase to sun light exposure and an
increase intensity of ultravaiolet radiation (UVR).
OBJECTIVE:
This study was done to evaluate different skin diseases related to study the frequency of the skin
diseases related to increase exposure to UV light in Sulaimania city.
METHODS:
This is a selective prospective study; the data collected during the period of the January 2006 to
September 2007 in Dermatology Department in Consulting Clinic in Sulaimania city, 391 cases were
collected in both sexes whose ages ranged between 5 and 73 years with a mean age of 39 years.
Full history and thorough physical examination was done for all patients.
RESULTS:
Three hundred ninety one patients were included in this study ; they were 190 (48.6%) males and 201
(51.4%) females, there ages ranged between 5-73 years with a mean age of 39 years. Sunburn 116
(29.7%) patients was the commonest condition seen, acne like eruption 84 (21.4%) patients, drug
photosensitivity: 74 (18.9%) patients, Polymorphous light eruption: 32 (8.1%) patients, Chronic actinic
dermatitis: 24 (6.1%) patients, Lichenoid dermatitis: 21 (5.3%) patients, Actinic prurigo like
polymorphic light eruption 18 (4.6%) patients, .Lichen planus actinicus: 15 (3.9%) patients, Solar
urticaria: 5 (1.2%) patients, Porokeratoses: 2 (0.6%) patients, The number of the cases variable during
the months from no cases in January and February to the highest numbers during the summer months
with a top (149) patients, in August.
CONCLUSION:
To best of our knowledge this is first study done about UVR exposure in Sulaimania city. There are
various dermatoses related to increase UVR exposure, as the UV index increases, the number of cases
increases. The highest number of cases occurs in summer (especially in July and August), because in
summer the UV index reaches its higher levels and the outdoor activities increase with inadequate
protective measures in Sulaimania without regular used of sunscreen.
We recommend strict use of sunscreen for males and females especially summer times and avoid going
out in specific times of the day especially in summer.
We recommend future studies about tumors, photoaging, DNA repair-defective disorders and
dermatoses aggravated by solar exposure like porphyria, SLE, pellagra, rosacea.

BACKGROUND:
Phytotherapy is an alternative for antibiotics therapy in these days since resistance to many antibiotics
used in treatment are increasing along with high cost of some antibiotics and side effect on patients.
Punica granatum and Vaccinium macrocarpon have antimicrobial properties. this paper suggest that P.
granatum and Vaccinium macrocarpon may be more effective than some antibiotics used in the
treatment of some Gram negative urinary tract pathogens.
OBJECTIVE:
Punica granatum juice, cranberry juice and antibiotics were used to investigate the antimicrobial
activity by using well diffusion method.
MATERIALS & METHODS:
A total of four different urinary tract causing pathogens collected from patients with urinary tract
infection (UTI).
RESULT:
The result indicate that extract obtained from Punica granatum pericarp exhibited antimicrobial activity
against all organisms almost similar to the effect of cranberry which is not grown in Iraq and that
Punica granatum and Vaccinium macrocarpon are more effective than some antibiotics used in the
treatment of urinary tract infection.
CONCLUSION:
The antibacterial activity of crude extract of P. granatum against urinary tract causing organisms is
reported for the first time and it showed similarity with the effect of cranberry juice that are not found
or imported to the local market. Further phytochemical elucidations are required to determine the nature
of compound(s) responsible for the antibacterial effects. This study is generally considered an effective
approach in the discovery of new antibacterial agents from P. granatum.

BACKGROUND:
More than half of all humans are colonized in their stomachs by Helicobacter pylori . That carriage was
nearly universal among adults in developing countries suggests that in earlier times most humans carried
these organisms.H. pylori was an important human pathogen that causes gastritis and is strongly
associated with gastric ulcers, gastric adenocarcinomas, and mucosa-associated lymphoid tissue
lymphomas. In response to H. pylori, interleukin-8 (IL-8) was secreted from host cells to attract
components of the innate and adaptive immune systems to the site of infection.CagA+ cells induce higher
levels of the proinflammatory IL-8 cytokine. That such effects are specific for CagA island genes had
been shown by our study.
OBJECTIVE:
To determine the role of incidence of H.pylori CagA positive strain in induce higher level of the
proinflammatory cytokine IL-8.
METHODS:
One hundred and fifty(150) Patients attended the Endoscopic Unit at"Gastroenterology and Hepatology
Teaching Hospital/ Baghdad Medical City"were included in this study with ages range from 18 years to
65 years . The source of specimens to undergo oesophageal gastroduodenoscopy (OGD) collected from
April 2009 to end of March 2010 were eligible for this study.Two types biopsy of samples for
histopathology to detect H.pylori and detection of CagA gene by In Situ hybridization(ISH) and blood
samples for estimation of serum IL-8 level by ELISA.
RESULTS:
There was a significant increase in IL-8 serum levels that P<0.05 due to the significant increase of Cag A
in H.pylori positive strains.
CONCLUSION:
Our study revealed that increased in CagA expression in H.pylori positive strains and induced higher
levels of the proinflammatory cytokines .

BACKGROUND:
Mycobacterium tuberculosis causes the most common type of human tuberculosis worldwide .The
most common mode of transmission is by inhalation of droplet nuclei from expectorated respiratory
secretions.Active infection is diagnosed by documenting the presence of M tuberculosis in
respiratory secretions or other body fluids or tissues.Age is an important determinant of the risk for
the disease .The risk may increase in the elderly
OBJECTIVE:
To compare the effect of age between elderly and younger on clinical and radiological presentation in
patients with pulmonary tuberculosis in Iraq.
PATIENTS AND METHODS:
A prospective study was done for 251 patients with smear positive pulmonary tuberculosis in
outpatient's clinic in the Chest and Respiratory Disease Specialized Center in Baghdad.Collected
from January to May 2009.The following parameters were assessed:
Age, gender, symptoms, risk factors, radiological findings, and incidence of recurrent .The relation of
these parameters between elderly and younger was evaluated
RESULTS:
There were 174 young adult patients and 77 elderly patients .The elderly group age was between 60-
80years ,and younger adult age was between 17-59 years. There was no significant difference in the
symptoms between the two groups .Family history of pulmonary tuberculosis (p=0.009) was more
common in young adult, while DM (p=0.001) was more common in elderly .Comparison of
radiological findings in young adults vs. elderly patients shown a typical findings (p=0.036) which is
more in elderly .There was no significant difference in the incidence of recurrence between the two
groups.
CONCLUSION:
There was no significant difference in the symptoms between elderly and younger age groups .
Family history of PTB was more common in young adults, while DM was more common in elderly.
A typical radiological findings were more in elderly.There was no significant difference in the
incidence of recurrence between the two groups.

BACKGROUND:
Tuberculosis is the second infection in causing deaths from infectious agent in the world, currently in
Iraq approximately 67% of new cases of Tuberculosis involve the lung only ,cough is the most
common symptom of pulmonary Tuberculosis , pulmonary Tuberculosis nearly always causes
detectable abnormalities on chest film, but still atypical or absent radiologic findings can occur.
OBJECTIVE:
This study was designed to determine whether in patients with chronic cough normal chest X ray
exclude pulmonary tuberculosis.
PATIENTS AND METHODS:
One hundred seventy two patients attending the respiratory clinic, complaining from chronic cough and
they are suspected cases of tuberculosis, were enrolled in this study. A full medical history and physical
examination was done then a chest X ray was ordered, for those with normal chest X ray finding
(seventy seven patients), sputum smear for acid fast bacilli (AFB) ordered .
RESULTS:
47 females (61%), 30 males (39%) with chronic cough with females to male ratio = 1.56/1.The age
ranged between 17-67, with mean age of 37.16 years. The age of males ranged between 18-67 and the
mean was 39.32 years, the age of females ranged between 17-66 and the mean was 34.93 years. X ray
finding were negative in all the patients. Positive AFB in sputum smear examination by microscopy
was found in only one patient but with ENT examination it was proved to be a case of laryngeal
tuberculosis not pulmonary tuberculosis.
CONCLUSION:
Normal chest x ray in patients with chronic cough excludes pulmonary tuberculosis

BACKGROUND:
Exposure to Toxoplasma gondii may result in either chronic infection or acute infection, the latter being
asymptomatic or symptomatic. Toxoplasma infection stimulates humoral immune response ,in addition
to cellular mediated immunity. Also cytokines have a role in resistance to T.gondii like IL-5 which has
protective role during infection with the parasite.
OBJECTIVE:
This study aimed to assess the correlation between IgM and IgG Toxoplasma antibodies and IL-5 in
the course of acute toxoplasmosis .
PATIENTS AND METHODS :
45women suspected of having toxoplasmosis were tested by ELISA IgM and IgG toxoplasma
antibodies , and the level of serum IL-5 was tested using ELISA technique only on 32 women .
RESULTS:
The results showed that there are higher titer of IgM and IgG-Toxoplasma antibodies and higher levels
of serum IL-5 in women with Toxoplasma infection .
CONCLUSION:
Serum IL-5 can be used as indicator to predict the presence of acute toxoplasmosis in pregnant women
at high risk to toxoplasmosis.