Iraqi Postgraduate Medical Journal

BACKGROUND:
Acute bacterial meningitis (ABM) is one of the most potentially serious infections occurring in
infants and older children. Indications for PICU admission are shock, markedly elevated intracranial
pressure (ICP), coma, and refractory seizures (1).
METHODS:
This cross sectional study enrolled children 2 months-12 years of age presented with (ABM) who
were admitted to Children Welfare Teaching Hospital (CWTH) -Medical City- Baghdad, including
those who needed Pediatric Intensive Care Units (PICUs) admission in CWTH Unit and Surgical
Specialty Hospital (SSH) Unit in the period from the 1 st of Feb 2004 to the 1 st of Feb 2006. The
diagnostic inclusion criteria of (ABM) were clinical symptoms and signs of meningitis plus a CSF
neutrophilic pleocytosis with a CSF cells count of more than 5 cells/mm3 (1). Data included history,
clinical examination, investigations, complications, PICU management, and outcome. Statistical
analysis was done by using SPSS version 13.0 computer facility, Chi-square test and T test were used
when needed and a P.value < 0.05 was considered significant.
RESULTS:
In the present study (ABM) in children 2 months -12 years constituted 7% of cases admitted to
PICUs. The majority of cases (77.2%) were below 2 years of age. The mean age of children with
(ABM) was 18.3+6.80 months. The PICU cases of (ABM) differed from the neurological ward cases
in their more acute onset, higher body temperature, higher peripheral WBCC, lower CSF glucose,
and higher CSF cell count, higher CSF protein, lower serum calcium and longer duration of stay and
all these characteristics showed highly significant differences The case fatality rate of children with
(ABM) is 13.3%.
CONCLUSION:
The study concluded the need for PICU admission in children with (ABM) with acute onset, higher
body temperature, higher peripheral WBCC, lower CSF glucose, and higher CSF cell count, higher
CSF protein, lower serum calcium, and recommended laboratory and PICU service expansion .

BACKGROUND:
Ear, nose, and throat (E.N.T) diseases are common in children. Early diagnosis and proper management
are essential to ensure adequate growth and development.
OBJECTIVE:
To determine patterns of E.N.T diseases in children and define risk factors affecting them.
METHODS:
A Cross- sectional study of 264 children under the age of 12 years attended E.N.T clinic/ Al-Kindy
Teaching Hospital/ Baghdad from the period of 1/10/2006 to 28/2/2007. We analyzed the following
data: age, gender, residence, family size, socio-economic status, parental educational level, family
history of atopy, presence of smoking, state of vaccination, presence of anemia or any concomitant
chronic illness, and final diagnosis. Statistical analysis was done through Chi-Square.
RESULTS:
Males outnumbered females (48.1% vs. 51.9%) (P>0.05).The encountered prevalent E.N.T problems
included those of pharynx and tonsils (41.7%), nose (18.6%), ear (16.3%), larynx (6.8%), adenoids
(6.0%), sinuses (5.3%), and miscellaneous disorders (5.3%). Overall, infections were the predominant
(57.9%) followed by foreign bodies impaction (11.7%) and allergy (6.0%). Statistical analysis revealed
that crowding, low socio-economic status, poor parental educational level, smoking, and anemia were
statistically significant risk factors (P<0.05).
CONCLUSION:
Pediatricians and E.N.T specialists share a combined responsibility in managing properly the
commonest pediatric E.N.T problems. Enhancement of educational and preventive programs targeting
the relevant risk factors is suggested.

BACKGROUND:
In Type 1 Diabetes Mellitus (T1DM), numerous changes in the cellular as well humoral immune response
have been identified. However, it is not known whether both the CD4+ and CD8+ subpopulation or only one
of these or CD19+contains increased numbers of activated cells.
OBJECTIVE:
The aim was to study the activated lymphocyte subpopulation by use of monoclonal antibodies to T-cell and
B-cell antigens which is known to be expressed on activated cells.
METHODS:
A total of 60 T1DM patients who had newly onset of the disease (diagnosed was from one week up to five
months) were included in the present study, all the patients were treated with daily replacement doses of
insulin. Fifty apparently healthy control subjects underwent the PBL phenotyping. Phenotyping of surface
antigens was done by direct Immunoflurocent (IFT) technique using mouse antihuman CD 3, CD4, CD8,
CD45RA, CD19, and activated markers CD45RO, DR-antigen and CD38.
RESULTS:
T1DM patients showed a remarkable lowering in CD3+, CD8+, and CD45RA+ cells (p<0.0001), but the
decrease in CD4+ cells percentage was not significant. In contrast, a significant elevation of activation
markers includes (CD45RO+, HLA-DR+ and CD38+ cells) were observed in patients in addition to a
significant increase of CD19+ cell percentage and CD4+: CD8+ ratio in the patients.
CONCLUSION:
This study provides evidence that abnormalities of T-cells regulation are detectable in patients with T1DM.

BACKGROUND:
Juvenile delinquency is a sort of crimes that is committed by young persons under the age of 18
years.
OBJECTIVE:
Is to determine the psychosocial profile of juvenile offenders in Iraq.
METHODS:
This phenomenon was studied in Iraq from2003 -2005, to acquire a better understanding of it, 400
accused were assessed in the personality assessment bureau [P.A.B] using ICD -10 clinical based
interview sorted down with descriptive data.
RESULTS:
The highest age for the accused was 17 years, predominantly males with a socioeconomic history of
deprivation, premature labor, illiteracy, and limited primary education. Their families were living in
rather more or less similar conditions. Theft as a crime was on the top of the list.
CONCLUSION:
According to the [P.A.B], the majorities of the accused were not mentally ill, and before the juvenile
court were fully responsible. Half of the sample was recommended to juvenile rehabilitation centers,
and about one fifth of the accused were able to be released on legal bailing.

BACKGROUND:
A with disabled child have a great burden on caregiver is, they are under the risk of having
depression, anger, and can be under great stress. Caregivers have stroking emotional and behavioural
changes such as forgetfulness, depression, dependence, lack of motivation, often felt confined, and
fatigue from their responsibilities.
OBJECTIVES:
To assess the psychological burden of child with Cerebral Palsy (CP) upon his/ her caregivers.
METHODOLOGY:
A descriptive study was conducted in the Helena Center (HC) in Erbil Governorate for handicapped
children from 15th February to 15 th March 2005; Data were analyzed by using frequencies,
percentages, mean of scores, comparative significant, Pearson\'s correlation, and multi regression
analysis.
RESULTS:
Of the study indicate that (85%) of caregivers are child\'s mothers (68%) their age between (25–38)
years, (60%) are illiterate, (79%) come from low Socio Economic Status (SES), (46%) live in
crowded situations, (50%) of CP at preschool age, (54%) were males, (58%) of CP children
diagnosed at infant stage. (80%) of CP is spastic type, (34.4%) of CP children have mutism, and
(33.7%) has Mental Retardation (MR) accompanying CP.
CONCLUSION:
There is a highly significant association between the psychological burden and the age of caregiver,
crowding index, complications like mutism, MR and epilepsy.

BACKGROUND:
Visceral Leishmaniasis is an endemic protozoal disease in Iraq. Recovery from this disease confers a
solid and permanent immunity. Immunological assessment of our patients was carried out and the
results showed that a significant increase in phagocytic index in patients with VL in comparison with
control group.
AIM OF THE STUDY: Determining phagocytic index.
METHODS:
Blood samples were collected from 50 patients suffering from VL confirmed parasitologically by
bone marrow smears, 40 blood samples from apparently healthy children and 50 blood samples from
children in an endemic area (Al-Suwaira district).Their age was less than six years in all groups, and
who were apparently healthy.
RESULTS:
The immunological assessment of our patients was carried out and the result showed that a
significant increase in phagocytic index in patients with Visceral Leishmaniasis in comparison with
control group (p<0.01). While the result of endemic control group by ELISA, IFAT and IC were used to
test 50 serum samples from healthy children who lived in an endemic area. A total of 48 cases of them were
found to be negative at least by one of the above tests, IC showed the lowest cross reactivity rate (4%).
CONCLUSION:
Phagocytic index was higher in patients with Visceral Leishmaniasis in comparison with control
group.

BACKGROUND:
Dermabrasion is an abrasive process used to remove the epidermis and superficial dermis to treat a
variety of skin conditions.
OBJECTIVE:
To evaluate sandpaper as a tool for dermabrasion for the treatment of acne scar and amateur tattoo.
PATIENTS AND METHODS:
This is an open labeled therapeutic trial. It was conducted at the outpatient department of
Dermatology and Venereology - Baghdad Teaching Hospital, during the period between January
2003 and December 2004.
Ten patients (seven males and 3 females) were enrolled in this work. Their ages ranged from 20-34
years with the a mean ± SD of 26.80 ± 4.34 years. Five with acne scars on their faces and 5 with
amateur tattoos in the upper extremities.. From each patient history was taken and physical
examination was performed. Pre-operative medications and instructions were given to each patient.
The procedure was done under local anesthesia. Postoperatively all patients were instructed to use
steroid-antibiotic ointment and hydroquinon-tretinoin thereafter. Follow up was done after 1weak,
1month, and 3 months. Repeated sessions may be needed 1 month apart.
Acne scars: Lesions were assessed for correction of contour (unchanged, partially changed, or
completely changed), and for complications that might follow.
Amateur tattoos: Lesions were assessed for percentage of pigments removal (70%, 80%, 90%, and
100%), and for complications that might follow.
RESULTS:
Ten patients completed the study.
Acne scar group: Three patients achieved partial change of contour after 2 sessions, while complete
change of contour was noticed in 2 patients after 4, and 6 sessions respectively. The procedure
resulted in very fine, less noticeable scar with smooth contour of the skin which was acceptable in all
patients.
Amateur tattoos group: Complete removal of pigments was achieved in one patient, more than 90%
in 3 patients, and more than 80% in 1 patient.
No significant complications were seen apart from mild erythema and mild infection in one patient
with amateur tattoo. Temporary post inflammatory hypopigmentation in two patients with tattoo.
Three patients had mild scar after removal of tattoo.
CONCLUSION:
Sandpaper dermabrasion is an effective mode of treatment for acne scar and amateur tattoo. It is
safe in dark skinned people.

BACKGROUND:
Cardio vascular involvement is fatal and critical complication of the systemic lupus erythematosus.
Serum lipid profile and carotid Doppler studies can be used to evaluate premature atherosclerosis
among patients with systemic lupus erythematosus .
OBJECTIVE:
The purpose of this study was to detect premature atherosclerosis among Iraqi patients with systemic
lupus erythematosus by estimation of fasting serum lipid profiles and Doppler Carotid studies.
PATIENTS AND METHODS:
Fifty Iraqi patients (45 females and 5 males) who fulfilled the American College of Rheumatology
(ACR) 1997 revised criteria for classification of SLE were studied . Another 50 healthy (45 females
and 5 males) individuals matched for age and sex were collected from relatives and accompanying
persons with patients attending the Rheumatology Clinic and studied serving a control group.
Full history was taken and complete clinical examination was done for all patients and control group
.The levels of serum cholesterol , low and high density lipoprotein and triglycerides were estimated
and Doppler studies for common carotid arteries were done for individuals in both groups.
The patients were classified according to clinical presentation to four groups:
Group 1: Patients with mucocutaneous and musculoskeletal manifestation only.
Group 2 : Patients with mucocutanous,musculoskeletal manifestation and serositis.
Group 3: Patients with mucocutanous, musculoskeletal, serositis and lupus nephritis without
cerebritis.
Group 4: Patients with Mucocutanous , musculoskeletal, serositis and lupus cerebritis without
nephritis.
RESULTS:
There were no significant differences in total cholesterol level in group 1 patients compared
to control group, but there were significant differences in group 2,3,4 patients compared to
control group.There were significant differences in cholesterol, low density lipoproteins
(LDL),high density lipoproteins (HDL),and triglyceride (TG) levels between SLE patients
compared to control group which is positively correlated with disease duration .There were
no significant differences in intimal media thickness(IMT)in group1and2 compared to
control group but there were significant differences in IMT in group 3 and 4 compared to
control group and the significant differences in IMT were positively correlated with disease
duration.
CONCLUSION:
The results showed that SLE patients mostly have hyperlipidemia as well as ultrasonic
markers of atherosclerosis.

BACKGRAUND:
Different congenital heart diseases could affect children growth.
AIM OF STUDY:
To assess the growth (Weight, height and head circumference) in patients with different types of
congenital heart disease (CHD).
METHODS:
The growth of one hundred ninety six patients with CHD, attending the out patient department of
the Central Teaching Hospital of Pediatrics and Ibn Al Betaar Center for Cardiac Surgery, aged
0-24 months, between February and June 2002 was assessed.
They were grouped according to cardiac diagnosis:
Group I: Acyanotic CHD without heart failure (HF) or pulmonary hypertension(PH);
Group II: Acyanotic CHD with HF;
Group III: Acyanotic CHD with PH;
Group IV: cyanotic CHD.
RESULTS:
It was found that 29.6 % of patients with CHD had acute malnutrition (AM) and 21.9% had
chronic malnutrition (CM). The acute malnutrition was more in group I of CHD (39.2%) while
chronic malnutrition was more in group III of CHD (26.3%). The acute malnutrition was more
obvious in infants (31.7%) than in those in the second year, while chronic malnutrition was more
obvious in second year of life (34.7%).
CONCLUSION AND RECOMMENDATIONS:
In all patients with congenital heart disease( cyanotic and a cyanotic),the growth is affected.
Because of the delay in surgical correction in our patients, so we suggest a better nutritional
counseling and possible earlier surgical correction to optimize the growth in our patients.

BACKGROUND:
The posterior interosseous artery flap is now increasingly considered as an alternative to the radial and
ulnar forearm flap because the later required disruption of major arterial supply of the hand.
OBJECTIVE:
To evaluate the posterior interosseous artery faciocutaneous flap in reconstruction of hand defects as
regard to durability, color match and donor site morbidity.
METHODS:
During a period of 21 months, 10 patients with age ranging between 22-54 years underwent
reconstruction of hand defects by distally based posterior interosseous artery flap in Al-Wasity Teaching
Hospital.
RESULT:
All the flaps survived completely. One case developed partial graft failure due to early mobilization. Two
cases developed temporary weakness of extensor muscles of the hand due to neuropraxia of the posterior
interosseous nerve. The over all result is good functionally and acceptable aesthetically.
CONCLUSION:
Posterior interosseous flap is a good option in well selected patients and meticulous planning and delicate
dissection as well as adequate immobilization minimize the complications like nerve injury, edema and
graft loss.

BACKGROUND :
Adenosine deaminase ADA catalyzes the deamination of adenosine in purine metabolism .
Adenosine deaminase deficiency is an inborn error resulting in immunodeficiency condition . clinical
interest in this enzyme has been revived by the discovery of a syndrome of severe humoral and
cellular immunodeficiency associated with deficiency of ADA in somatic erythrocyte cell .
AIM OF STUDY:
The aim of present study is conducted to find the relationship between human hyperthyroid activities
and immune etiology in graves disease.
MATERIALS AND METHODS :
Forty individuals with hyperthyroidism autoimmune state were included in this study in comparison
with forty normal persons .
Thyroid hormones levels were estimated by HPLC and serum ADA specific activity was estimated
using spctrophotometric method at 265 nm . Serum protein value was determined by Bradford
method .
RESULTS :
Serum ADA activity was measured for 40 hyperthyroid patients as well as 40 normal individuals .
The mean activity of ADA in patients was higher than in the controls . A significant increase in T3 /
T4 ratio and level of TSH were noticed .
CONCLUSION :
A positive correlation between thyroid level and ADA enzyme activity was noticed .

BACKGROUND:
The role of a routine second transurethral resection in evaluating and management of patients with
bladder tumor is defined.
PATIENTS AND METHOD:
From January 2004 to October 2006, 100 patients with new or recurrent bladder tumors underwent
repeat transurethral resection within 4-6 weeks after the initial resection, and the results, including
the presence of residual tumor and tumor stage, were compared.
RESULTS:
Of 100 cases, 28 (28%) had no tumor and 72(72%) had residual tumor on repeat TUR. Out of 64
cases with superficial (Ta, Tis, T1) bladder tumors, 20(31%) had residual non-invasive tumor and
13 (20%) were upstaged to muscle invasive tumor. Among 36 patients with a muscle invasive
tumor, 10(28%) had no residual tumor on re-TURBT. Results of second resection had changed
treatment option in 39 patients (39%) from the initial treatment recommendation which was given
after the first TUR.
CONCLUSION:
many patients with bladder tumor have residual tumor present after an initial TUR. Routine repeat
resection is advised to control noninvasive tumors and to detect residual tumor invasion.

OBJECTIVE:
To study the frequency of schistosomiasis in pathologic urinary bladder specimens and the
contribution of transitional cell and squamous cell types to the schistosoma – associated and non
schistosoma – associated bladder cancer among Iraqi patients.
METHODS:
This is a retrospective study in which 1092 pathologic records of 933 patients, who underwent
urinary bladder biopsies from bladder tumors or suspicious lesions discovered incidentally during
endoscopic evaluation and those who ultimately had radical cystectomy and urinary diversion for
invasive bladder cancer, were reviewed in Surgical Specialties Hospital, Baghdad, Iraq between June
2000 and June 2007.
RESULTS:
In this study 933 patients aged 2-100 years with a mean age of 56.87±14.3 years. Pathologic review
showed schistosomiasis in 81 (8.68%) patients of whom schistosoma associated bladder cancer was
reported in 49 (60.5%) patients and schistosomiasis with no pathologic evidence of malignancy in 32
(39.5%) patients. The cell type of schistosoma associated bladder cancer was transitional cell
carcinoma (TCC) in 26 (53%), squamous cell carcinoma (SCC) in 19 (38.7%), adenocarcinoma in 1
(2%), and undifferentiated in 3 (6.12%) patients. Out of 852 patients with no pathologic evidence of
schistosomiasis, 563 were reported to have non schistosoma associated bladder cancer. The cancer
cell type was TCC in 491 (87.21%), SCC in 45 (7.99%), adenocarcinoma in 15 (2.66%),
undifferentiated in 11 (1.95%) and sarcoma in 1 (0.18%) patients.
CONCLUSION:
Schistosoma associated bladder cancer is still a problem in Iraq as well as other endemic countries.
Although the major histological cell type of such cancer in Iraq was SCC, there is a trend for
increasing frequency of TCC among patients infected with schistosomiasis.

BACKGROUND:
Transfer RNA is a type of RNA which during protein synthesis Act as an adaptor molecule ,matching
amino acids to their codons on mRNA . tRNA also functions in the formation of cross links during
peptidoglycan synthesis.
AIM OF THE STUDY:
The aim of this study is that, extraction of tRNA from uropathogenic Escherichia coli then detect the
presence of such molecules after extraction and measure the purity of the tRNA extract solutions.
METHODS:
Thirty uropathogenic E.coli isolates were isolated from hospitalized and non hospitalized patients,
complaining of urinary tract infections, of Al-Kadhymia Teaching Hospital and subjected to tRNA
extraction. A method of tRNA extraction was modified by adding sodium dodecyl sulfate (SDS)instead of
urea. Polyacrylamide gel electrophoresis and two methods of staining ,ethidium bromide staining and
silver staining ,as well as spectrophotometric detection were used.
RESULTS:
Ethidium bromide stained gel reveals bands with molecular weight less than yeast rRNA .Silver stained
gel shows bands with molecular weight less than ova albumin(45000 dalton ) but with approximate
molecular weight of chymotrpsinogen(24000 dalton).
CONCLUSION:
The tRNA extracts were relatively pure with the modified method of extraction. In the present study, a
modification of polyacrylamide gel electrophoresis to detect tRNA and to determine their molecular
weigh was applied.

BACKGROUND:
Nateglinide, structural derivative of the amino acid D-phenylalanine, is a stimulator that controls the
meal time spikes to restore of the early phase of insulin secretion lost in type II diabetes.
OBJECTIVE:
To evaluate the efficacy and tolerability of nateglinide in combination with metformin in a sample of
Iraqi type II diabetic individuals,and to look for its side effects.
Setting: The Specialized Center of Endocrinology and Diabetes-Baghdad.
Design: During the period between September 2001 and January 2002 a sample of ten type II diabetic
patients whose glycemic control is poor on metformin glibenclamide combination. Glibenclamide was
replaced by nateglinide. Postprandial plasma glucose levels were checked frequently, and glycosylated
hemoglobin (HBa1c) was evaluated in the 24th and 32nd week of the study period.
RESULTS:
It has been found that using nateglinide in a dose of 120 mg before each main meal three times daily
does not reduce plasma glucose HBa1c to the desired levels, but using it in a dose of 180 mg before
each meal results in gradual satisfactory decrement in plasma glucose and HBa1c. No adverse effects
were recorded and metformin - nateglinide combination was well tolerated.
CONCLUSION:
Nateglinide and metformin improve overall glycemic control. Nateglinide decreases meal time glucose
excursions. Their combination has a complementary effect, improving HBa1c and postprandial
hyperglycemia. No adverse effects were recorded and metformin - nateglinide combination was well
tolerated.

BACKGROUND:
Pedunculated type is a rare macroscopical form of
hepatocellular carcinoma.
CASE REPORT:
47 years old male complained from vague abdominal
pain, anorexia, weight loss and malena during the last
few months. Abdominal ultrasound and spiral CT
scan revealed a vascular mass 17x13 cm. in diameter
occupying the whole right side of the abdomen. On
exploration the mass was perforated into a segment
of ileum due to direct invasion and attached to the
liver by vascular pedicle. The mass was completely
excised with segment of ileum followed by end-end
anastomosis. Immunohistochemical study shows that
the tumor was stained by alpha-fetoprotein staining
confirming the diagnosis of pedunculated
hepatocellular carcinoma.
CONCLUSION:
pedunculated hepatocellular carcinoma should be
kept in mind in any differential diagnosis of large
intraperitoneal mass even if it is not related to the
liver by imagining study.