Iraqi Postgraduate Medical Journal

BACKGROUND:
Non alcoholic fatty liver disease is now recognised as the most common liver disease. insulin ressistance,
Increase serum free fatty acids and oxidants incorporate in the pathogenesis leading to a syndrome
extended from Simple mild steatosis to steatohepatitis to cirrhosis.
OBJECTIVE:
The aim to evaluate the effect of orlistat on features of fatty liver disaese in addition to glucose and lipid
profile.
METHODS:
This is A prospective study of 60 type2 diabetic obese patients had evidence of non alcoholic fatty liver
disease on ultrasound examination followed for 4 months with orlistat therapy, and asses BMI, waist
circumfrence, glucose control, liver function, lipid profile and ultrasound features before and after 4
months.
RESULTS:
Orlistat therapy decrease BMI, liver size, echogenisity by U/S, and triglyceride level significantly and
increase
HDL also significantly,but also decrease FPG, 2hPG, HbA1c, serum cholesterol,ALT and waist
circumference with insignificant statistical value, while had no effect on prothrombin time and total serum
protein.
CONCLUSION:
Orlistat therapy is beneficial adjuvant therapy in obese type 2 diabetics , it reduce BMI, and U/S
manifestations
of NAFLD, it also correct dyslipidemia and possibly had positive effect on glucose control and liver
enzymes.

BACKGROUND:
Ramadan fasting is one of the pillaris of islam. The fasting time is about 12-19 hours depending on
the season in which Ramadan falls and the geographic position of the country. It is often a subject
of discussion nether or not Ramadan fasting confer any harmful effect on the body.
OBJECTIVES:
The aim of this study was to evaluate the effect of Ramadan fasting on some clinical, biochemical
and Immunological aspects of the healthy and type two Diabetes mellitus patients.
METHODS:
The study was performed on (30) healthy fasting and (30) patients with type two diabetes mellitus
in the month of Ramadan (2005). Blood samples were obtained on the second and fourth week's of
Ramadan and were analyzed for fasting blood sugar, urea, uric acid, lipid profile, Immunoglobulins
and complement component concentration, in addition, lymphocyte was separated to study the
lymphocyte transformation assay in vitro compared with healthy non-fasting.
RESULTS:
There was slight elevation in the HDL-C, B. urea, S. Triglyceride, VLDL, S. uric acid and slight
reduction in LDL-C at the end of fasting. There was slight reduction but the difference was nonsignificant (P>0.05) in the value of immunoglobulins (IgA, IgG, IgM) and (C3, C4) also, there was
no difference in the sensitization rate of lymphocyte transformation in both healthy and type two
diabetic patients compared with healthy non-fasting control.
CONCLUSION:
Slight elevation of HDL-C and slight elevation of B. urea, S. uric acid, S. Triglyceride, VLDL and
there is non significant changes in Immunoglobulins and complement concentration and
sensitization rate of lymphocyte transformation. Thus, Ramadan is safe for type two diabetic
patients with the proper education of diabetic management.

BACKGROUND:
Hysteroscopy have gained general acceptance as a method for the investigation of infertility. The main
advantage of hysteroscopy is the capability of inspecting the uterine cavity. Transvaginal sonography (TVS)
is a noninvasive modality that provide excellent imaging of the uterus and of endometrial abnormalities.
The present study was designed to evaluate the use of TVS as the initial diagnostic procedure before
hysteroscopy for detecting intrauterine disorders.
METHODS:
Seventy-eight infertile women were examined by TVS and diagnostic hysteroscopy in the late follicular
phase of the menstrual cycle and the results were compared.
RESULTS:
The uterine cavity abnormalities were present in 19.2% of the infertile females involved in the study. The
Transvaginal sonography had 87.5% sensitivity, 100% specificity for detecting endometrial polyps while it
had 100% sensitivity and 100% specificity for detecting other intrauterine cavity abnormalities including
intrauterine adhesions, uterine septae and submucosal myomas.
CONCLUSION:
Examination of the uterine cavity is an integral part of any thorough evaluation of an infertile woman.
Transvaginal sonography, when performed during the follicular phase, can detect most uterine cavity
abnormalities. It was an accurate tool in the identification of intrauterine adhesions, uterine septae and
submucosal fibroids.

BACKGROUND AND OBJECTIVE:
Systemic Lupus Erythematosus (SLE) is a chronic progressive autoimmune disorder with a wide spectrum of clinical
and immunological abnormalities, predominantly developed in women of childbearing age, oxidative stress has been
postulated in many pathological conditions including atherosclerosis , inflammatory conditions and some
autoimmune disease such as multiple sclerosis , rheumatoid arthritis and Systemic Lupus Erythematosus (SLE).
The present study was conducted to support the idea of oxidative stress
during the pathogenesis of (SLE) among some Iraqi patients, comparing it with healthy controls group matched for
the same sex and age .
PATIENTS AND METHODS:
Twenty-three Iraqi Arab patients (21 females and 2 males) with Systemic Lupus Erythmatosus (SLE) admitted to
Baghdad Teaching Hospital were included in the present study ,and have been compared with 13 healthy controls .
The patients group were diagnosed as having SLE according to the basis of the revised criteria of the American
College of Rheumatology ,
Analysis of the parameters of oxidative stress , serum malondialdehyde (MDA) and glutathion (GSH) was performed
in all patients before starting any type of drug treatment and their levels were compared with those belong to healthy
controls.
RESULTS:
The results presented in this study showed elevated serum MDA concentration in the SLE patients group compared
to healthy control ; however , this elevation failed to reach the statistically significant (P<0.05).
Significant variation was also demonstrated in serum levels of glutathione between both patients group , in which
serum GSH level was significantly lower in the diseased group compared to healthy controls ( P<0.05).
CONCLUSION:
Oxidative stress mechanism can be proposed as a cause and / or consequence in the pathogenesis of SLE , supporting
the theory of free radical –induced tissue damage in this respect.

BACKGROUND:
Type A behavior has been related to coronary heart disease as an independent factor. Therefore,
ischemic electrocardiographic (ECG) changes may be more prominent Type A than in Type B
individuals .ECG abnormalities were assessed by the cardiac infarction injury score which has
predictive power for sudden death(1)
OBJECTIVES:
(1) To find out the relationship between length and severity of ischemia in Holter monitoring of
myocardial ischemia during daily life and personality (type A and type B) through a study of a
sample of patients during a stressful time.
(2)To compare between personality ( type A and type B ) in the findings of Holter monitoring.
METHOD:
Holter ECG was carried out on 80 patients suffering from an ischemic heart disease referred
consecutively to the Holter ECG out patient clinic in Al-Kadhmiya Teaching Hospital .
Wail's scale was employed on the patients to know the type of personality.
RESULT:
The results of the study show that there is a significant difference between patients with (personality
type A and those with type B) in episodes of painful ischemia but there is no significant difference in
terms of severity and length of ischemia between personality types.
DISCUSSION:
Mental stress –induced ischemia had longer total duration and more frequent episodes of ambulatory
ischemia episodes(2,3).The study showed that more than half patients were considered Type A
.Painful episodes of myocardial ischemia occurred more frequently in Type A patients during a
stressful period of ambulatory Holter monitoring compared with Type B.
CONCLUSION:
This study showed that during daily life period that type A personality has more episodes of painful
ischemia than type B.
Recommendation:
In light of these results, it is recommended that a further study on a larger sample for a longer time is
necessary in order to demonstrate more clearly the differences between personality type A and type
B.

BACKGROUND:
Primary Gastric Lymphoma is an uncommon malignancy among gastric malignancies. Histology of
the Primary Gastric Lymphoma is varied and the extranodal marginal zone B-cells lymphoma is
especially significant on account of its potential remission with antibiotic therapy.
OBJECTIVE:
To study the incidence, staging, clinical presentation, histological and management of Primary
Gastric Lymphoma in the North of Iraq.
PATIENTS AND METHODS:
From January 1988 to February 2005, A total number of 534 patients operated as gastric tumors, 34
(4%) diagnosed as Primary Gastric Lymphoma. at the surgical departments of Erbil and Mousl
teaching hospitals.
RESULTS:
Out of 34 Primary Gastric Lymphoma,24 cases (70.5%) were located in the distal part of the stomach
the most common cell type was B-cell type non-Hodgkin's lymphoma,.
Surgery was the main method of treatment and followed by chemotherapy and radiotherapy.
Helicobacter pylori were isolated from all 34 Patients.
All patients received antibiotics for eradication for H. Pylori infection for 4-6 weeks.
Long-term remission were induced in the low-grade MALT lymphomas in 73% of cases by the
successful eradication of the H. pylori infection Operative mortality rates was12 %
CONCLUSION:
surgical intervention was confined to stage I&II while patients with stage III surgery was indicated
mostly for complications like bleeding and perforation
Mucosa-associated lymphoid tissue tumor (MALT) had a better prognosis because it tends to be
localized with a long survival period.

BACKGROUND:
To review the pathologic analysis of urinary bladder biopsies and study the frequency and causes of
inconclusive biopsies among Iraqi patients.
METHODS:
This is a retrospective study in which 933 patients underwent 1047 urinary bladder biopsy procedures
during endoscopic evaluation, or transurethral resection of a known bladder cancer in Surgical
Specialties Hospital, Baghdad, Iraq between June 2000 and June 2007. Pathologic records of patients
were reviewed.
RESULTS:
In 933 patients aged 2-100 years with a mean age of 56.87±14.3 years who underwent 1047 urinary
bladder biopsy procedures, pathologic review showed bladder cancer in 655 (62.56%) biopsies, no
overt malignancy in 340 (32.47%) biopsies, no pathological diagnosis could be made in 43 (4.11%)
biopsies, and normal biopsy in 9 (0.86%) biopsies. In 238 bladder cancer biopsies, pathologic
analysis of muscle invasion was not carried out due to their lack of muscular tissue.
CONCLUSION:
Urinary bladder biopsy is one of the most common biopsies in urology practice. Every effort is made
to prevent technical defects of taking and processing such biopsies, to optimize pathologic analysis
and surgical management.

AIM OF THE STUDY :
To discuss skeletal manifestation of patients with multiple myeloma &the role of double energy X-ray
photometry study in the management of those patients .
PATIENTS & METHODS:
During period from the 1 st of April 2004 to 1 st of January 2005 we collected 32 patients who fulfilled
the criteria of diagnosis of multiple myeloma. .All our patients have detailed history & physical
examination including: Age, Sex, Bone pain, pathological fracture, Localized tenderness & Bone
swelling
RESULTS:
Pathological fracture found in (14) (43.75%), (10) were males (50%) of total males & (4) were females
(33.3%) of total females.Serum Alkaline Phosphatase ranging between (30-135KAU\L), mean
(75.218KAU\L), patients who got serum alkaline phosphatase level>80 KAU\L
are(13)(40.62%),(11)(84.6%) of them got localized tenderness &(11) (84.6%) of them got pathological
fracture ,but those who got serum alkaline phosphatase >100KAU|L all of them got pathological
fracture. DEXA study found to be significant in (24) (75%) & insignificant in (8) (25%).All the studied
patients with pathological fracture got significant DEXA.
Significant DEXA found in (12) (75%) of patients with positive skull X-ray, (17)(80.9%) with a
positive spine X-ray,(10) (71.42%) with apositive pelvic X-ray &(8) (80%) with apositive longe bone
X-ray. Significant DEXA found in (11) (91.66%) patients with S.Calcium >2.6mmol\L & those who
got S.Calcium >3.3 mmol\Lall got significant DEXA.
DISCUSSION & CONCLUSIONS:
The most common presenting feature is bone pain.
Pathological fractures were more common in males than females, all patients with serum alkaline
phosphatase >100KAU\L got pathological fractures & there is no relationship between localized
tenderness &pathological fracture. here is no patient with pathological fracture with insignificant
DEXA. The more advanced changes in DEXA study had higher risk of pathological fracture & needed
close observations &treatment to improve bone
T condition.

BACKGROUND:
Hormonal agents such as tamoxifen (TAM) and medroxyprogesterone acetate (MPA) are used widely
in the treatment of breast cancer . In this context, it is noteworthy to note that there is now much
experimental and clinical evidence suggesting that sex hormones can influence immune mechanisms
strongly
AIM:
Study the effect of tamoxifin on peripheral blood lymphocytes proliferation in breast cancer patients.
MATERIALS AND METHODS:
Seventy-three patients with breast tumor were included in this study. Sixty-two with malignant breast
cancer and 11 with benign breast tumor.The malignant breast tumor: Intraductal carcinoma (IDC) (8
patients),Lobular carcinoma (LC) (5), and infiltrative ductal carcinoma (49) which in turn divided
into 11 with Well differentiated ductal carcinoma (WDC), 12 patients with moderately differentiated
ductal carcinoma (MDC), 26 patients with Poorly differentiated ductal carcinoma (PDC). All cases
were admitted to Al-Yarmouk teaching Hospital, Saddam Medical City, during Dec 1999-Jan 2001.
The percentage of estrogen receptor positive patients( ER) recorded 37.0%, while progesterone
receptor(PR) positive patients were 51.6%. Peripheral blood lymphocytes were cultured with
different concentrations of tamoxifin and were assayed for proliferation using cytogenic analysis
assay.
RESULTS :
Results recorded that there were a clear reduction in blastogenic index and mitotic index ,P>0.05.
Both concentrations (0.25 and 0.5 mg/ml) of tamoxifen showed clear reduction in BI and MI values.
CONCLUTION:
TAM effect both ER+ and ER- patient in slight differences and in both concentrations.

OBJECTIVE:
To study the human benign and malignant prostatic testosterone receptors spectroscopically in the UV
region.
MATERIALS AND METHODS:
In this study, spectroscopic characterization in the UV region was carried out on purified testosterone
receptors by determining the polarity and pH effects on receptor UV spectra. Spectrophotometric pH
titration and the observation of the thermal stability of testosterone receptors were also included in the
present study.
RESULTS:
The UV spectra of purified testosterone receptors separated from benign prostatic tumors. BI receptor
has two peaks at 196nm and 256.4nm, BII purified receptor gives one peak at 195.5nm, MI purified
receptor gives one peak at 194nm and MII purified receptor gives one peak at 193.1nm.
CONCLUSION:
This study provides useful information about the spectroscopic characterization of testosterone receptors
isolated from two types of human prostatic tumors.

BACKGROUND:
Many compounds from natural sources, including silymarin, proved to have effective inhibitory
effects on cyclooxygenase (COX) and 5-lipoxygenase (5-LO) in vitro qnd experimental animals. The
exellent pharmacological pre-clinical profile of these compounds indicates a broad range antiinflammatory effectiveness devoid of the most troublesome side effects, which have at least impart
impaired the clinical use of the classical COX inhibitors, including the newer selective COX-2
inhibitors.
OBJECTIVES:
This project designed to evaluate the clinical utility of silymarin, as a dual inhibitor of COX and 5-
LO, as a single agent or in combination with non-steroidal anti-inflammatory drugs (NSAIDs) of
both types, selective and non-selective COX inhibitors, in the treatment of knee osteoarthritis (OA).
PATIENTS AND METHODS:
Randomized, double blinded clinical study was performed on 220 patients who have symptomatic
and radiologic evidence of painful OA of the knee. Patients were allocated into five groups, treated
with either meloxicam (15mg/day), piroxicam; (20mg/day), silymarin (300mg/day) + piroxicam
(20mg/day), silymarin (300mg/day) + meloxicam (15mg/day) or silymarin (300mg/day) alone. The
treatment was followed for 8 weeks through measurement of the clinical effects of drugs each 7 days,
using the Knee Injury and Osteoarthritis Outcome Score (KOOS) system.
RESULTS:
The results showed that silymarin, when used alone or in combination with NSAIDs resulted in
significant improvement in the components of KOOS, higher than that produced by meloxicam or
piroxicam when each used alone.
CONCLUSION:
In conclusion, oral administration of 300mg/day silymarin in OA patients produced very well
characterized analgesic and anti-inflammatory activities, and when co-administered with piroxicam
or miloxicam improves their therapeutic profile.

BACKGROUND:
Infertility is defined as the inability to conceive after one year of unprotected sexual intercourse. Some
cases of male infertility are due to a specific cause whereas others are due to less obvious etiologies and
results in less drastic changes in semen parameters. Arylsulfatase A, arylsulfatase B and alkaline
proteinase have not been studied adequately in relation to male infertility.
OBJECTIVES:
To study the association between seminal plasma arylsulfatase A, arylsulfatase B and alkaline proteinase
enzyme activities and semen parameters in different Iraqi male infertile patients.
PATIENTS AND METHODS:
Sixty patients with male infertility were included in this study. The male patients were categorized
according to their seminal fluid parameters to oligospermia (n=32), azoospermia (n=22) and
asthenospermia (n=6). All results obtained were compared with age – matched healthy controls group
consisting of 39 subjects. The experiments were carried out in the laboratories of the physiological
chemistry department at the college of Medicine / Al – Nahrain University during the period from
November 2004 to July 2006.
RESULTS:
arylsulfatase A and arylsulfatase B were significantly decreased in all infertility groups. Seminal plasma
arylsulfatase A decreased 73.55% in oligospermia group, 75.14% in azoospermia group and 73.87% in
asthenospermia group in relation to the normal fertile group. Seminal plasma arylsulfatase B decreased
72.78% in oligospermic patients, 22.34% in azoospermic patients and 44.82% in asthenospermic patients
compared with the normal fertile group. On the contrary, seminal plasma alkaline proteinase increased
1.55, 1.86 and 2.11 fold in oligospermic, azoospermic and asthenospermic groups respectively from
normal group.
CONCLUSION:
It is possible to use seminal plasma arylsulfatase A, arylsulfatase B and alkaline proteinase as fertility
markers in the different male infertility types.

OBJECTIVES :
To evaluate the role of crude measurement of C-reactive protein in the diagnosis of acute appendicitis.
BACKGROUND:
Appendicectomy for suspected acute appendicitis is a common procedure. The rate of normal appendices
unnecessarily removed remain high(15%-30%) ; despite several techniques and investigations used to
improve the diagnostic accuracy . Many studies investigated the role of raised C-reactive protein (CRP ) in
improving the diagnosis of acute appendicitis, but with conflicting results.
PATIENTS AND METHODS :
This is a randomized prospective study from February to July 2006 . A total of 100patients were included
in this study that presented to our hospital with acute right iliac fossa pain and later on operated and had
appendicectomy .Blood for the measurement of serum C-reactive protein(CRP) was collected preoperatively
from all the patients. The patients divided in to two groups ,those who are positive appendicitis proved by
operative finding and histopathological examination and those with negative appendicitis proved by
histopathological examination.
RESULT:
A total of 100 patients were included in this study, and out of these 16 (16%) had normal appendix giving
an over all negative appendicectomy rate of 16% out of these 5 were males and 11 were females ,the age
range was (6-47 years) with a median age of ( 25.92) years . Among the 84 who had appendicitis, 64
patients had obstructive type of appendicitis which were noticed during the operation ,and CRP was positive
in all patients, but only 9 of them were with CRP negative . 4 perforated appendicitis were found in which
all of them were CRP positive, and 16 patients with catarrhal appendicitis were diagnosed by
histopathological examination and only 3 patients out of those had negative CRP while the remainder were
positive.
CONCLUSION:
The positivity of CRP was related to the severity of inflammation; but it is more reliable to depend on
negative results to postpone the operation and observe the patient .Thus unnecessary removal of normal
appendices may be reduced.

BACKGROUND:
Fungal infection of the skin is common disorder characterized by recurrent candidal skin infection, tinea
cruris ,tinea (pityriasis) versicolor and candidal infection of the nails in patients suffered of rheumatoid
arthritis (R.A.) and treated by methotrexate.
AIM OF THE STUDY:
To discover the fungal skin complications after usage of methotrexate in the treatment of patients with
Rheumatoid arthritis.
METHOD:
Thirty two patients with R.A. were enrolled in the study who received 7.5 mg methotrexate and daily
100mg diclofenac for six months in comparison to 32 patients with R.A. who received only daily100 mg
diclofenac as treatment.
RESULTS:
Ten patients (31.2%) developed fungal infection of the skin and nails, 5 [16%] patients with tinea
versicolor of the body, 3 [9%] patients with tinea cruris and [6%] two patients had paronychia .
The control group did not develop any skin or nails fungal disorders.
CONCLUSION:
Superficial fungal infection was a common problem among RA patients treated with methorexate.

BACKGROUND :
Hydatid disease, also known as echinococcosis or hydatidosis, is caused by infection with larva of
Echinococcus granulosus, which causes cystic hydatid disease. Surgery is the recommended treatment
for hydatid cysts; however, drug therapy and percutaneous drainage have recently been introduced as
alternative treatments. The scolicidal agents, including 3% hydrogen peroxide, 10% chlorhexidine, 20%
hypertonic saline have been used mainly during surgical manipulation of the cysts. Recently
cyclosporin A has been found to be lethal for E. granulosus protoscolices in vitro using cultured sheep
hydatid cyst.
METHOD:
The present work was designed to evaluate the effectiveness of different concentrations of cyclosporin
A as a scolicidal agent on protoscolices of Echinococcus granulosus in vitro. Hydatid cysts were
collected from 42 patients (10 males and 32 females with age range from 12–61 years) that have
hydatosis during the surgical operation for the removal of these cysts. Eeosin exclusion test was utilized
to examine the scolicidal activity of different concentrations of cyclosporin A compared to different
concentrations of hydrogen peroxide, in addition to the effects on the integrity of the germinal layer
compared to that produced by sodium hypochlorite.
RESULTS AND DISCUSSION:
The results indicated that cyclosporin A, when used in a concentration of 25 μg/ml, is more effective
and safer than 3% solution of hydrogen peroxide; it can be used with sodium hypochlorite for complete
scolicidal effect and melting of the germinal layer. In conclusion, cyclosporin A can be a good
candidate as a scolicidal agent during surgical removal of hydatid cysts.
CONCLUSION:
The present work indicated that cyclosporin A has a good scolicidal effect when used in a concentration
of 25 μg/ml, and it is more effective and safer than 3% solution of hydrogen peroxide, it can be used in
combination with sodium hypochlorite for complete scolicidal effect and melting of the germinal layer
of the hydatid cyst. This may give an opportunity for using this compound in percutaneous drainage

BACKGROUND:
Among most basic and clinical investigations for detection and genotyping HPV, only In Situ
Hybridization (ISH) is effective in studing the relation of HPV genome to that histopathological entity.
Tumor Infiltrating Lymphocytes (TILs) represent the local cellular immune response against both cervical
cancer and the associated HPV.
OBJECTIVE:
This study is aimed to investigate ISH in detection and genotyping of HPV and immunohistochemical
(IHC) study in phenotyping of TILs in Iraqi women with different grades of cervical neoplasia.
MATERIALS AND METHODS:
This retrospective research included a total number of 129 cervical tissue blocks , 64 with invasive and
27 with pre-invasive cervical neoplasia,12 with condylomata acuminata,11 with chronic cervicitis and 15
with apparently- healthy cervices .
Molecular detection and genotyping of HPV DNA were performed by using ISH whereas
immunophenotyping was done by IHC using monoclonal antibodies for that specific CD markers
representing some of TILs.
RESULTS:
The overall prevalence of HPV DNA in total group of invasive cervical neoplasia was 28.4% , 12 out of
48(25%) with squamous cell carcinoma(SCC) and 8 out of 16(50%) with adenocarcinoma (AC). HPV 16
constituted (58.3%) of HPV- positive invasive cervical SCC , where as HPV 31/33 and lastly HPV 18
constituted (25%) and (16.7%) , respectively .In AC group, HPV 16, 18, 31/33 occupied 50% , 25% ,
12.5% of this group, respectively .
The prevalence of HPV DNA in pre-invasive cervical neoplasia group was 22.2%. While no case with
HPV 18 was detected , HPV 16 and HPV 31/33 genotypes occupied 40% and 60% , respectively .
Although CD3+,CD4+and CD8+ lymphocytes showed high mean values , significant differences present
only between HPV DNA- positive tissue blocks and control group (p<0.05) . The CD20+and CD56+
lymphocytes showed low mean values.Compared to control group,however,statistical analysis showed
significant differences (p<0.05) regarding CD20+ and non-significant regarding CD56+ lymphocytes .
CONCLUSION:
Using ISH proved more powerful and sensitive tool in revealing precised effects of HPV in cervical
neoplasia compared to histopathological examination .High mean values of CD4+ and CD8+ versus low
mean values of CD20+ and CD56+ lymphocytes could reflect an important and specific role of these
cellular responses against HPV viruses during initiation and progression of HPV-associated cervical
cancers.