Medical Journal of Babylon

This study was performed to determine the effect of intracoronal used bleaching agents on adhesion
of bonding agents to pulp chamber dentine.
Forty extracted human maxillary central incisors teeth were randomly divided into four groups of 10
teeth each. Bleaching agents were sealed in pulp chambers for 7 days, as in clinical use. Group
1(control): distilled water, group 2: 35% hydrogen peroxide, group 3: sodium perborate mixed with
water, group 4: sodium perborate mixed with 35% hydrogen peroxide. Teeth were stored in saline at 37
C for 7 days. After the bleaching agents was removed, teeth were leached in water for a further 7 days
prior to bonding. The crown was cut vertically from mesial to distal and the labial pulp chamber
dentine was prepared for bonding with Clearfil SE-Bond and filled resin composite (Clearfil AP-X).
The bonded specimens were kept moist at 37 C for 24 h. microtensile bond strengths were determined
using a universal testing machine. The mean values (±SD) of microtensile bond strength for the
experimental groups were: group 1: 5.29 ±2.21 MPa, group 2: 5.99 ±1.51 MPa, group 3: 9.17 ±1.65
MPa, and group 4: 3.99 ±1.31 MPa. Dentine treated with sodium perborate in water ( group 3) had
significantly higher mean bond strength when compared with the other three groups( p< 0.05, Tukey's
test). Mean bond strength was lowest when dentine was treated with sodium perborate plus hydrogen
peroxide (group 4).
Conclusions In terms of subsequent bond strength during restoration, sodium perborate mixed with
distilled water appears to be the best intracoronal bleaching agent.

Chromosomal analysis is an important etiological investigation in couples with repeated
spontaneous abortions as it helps in genetic counseling and deciding about further reproductive options.
Abortions ,specially first trimester abortions is a very common complication and a matter of
concern for couples planning pregnancy. Balanced chromosomal rearrangements in either parent is an
important cause of recurrent pregnancy loss particularly in the first trimester. In this study there is an
evaluation of the contribution of chromosomal anomalies in causing repeated spontaneous abortions.
To understand the cytogenetic causes in the couples with spontaneous abortions ,cytogenetic study
was done on 61 couples (122 individuals) with recurrent spontaneous abortions who were examined
for chromosomal abnormalities and aberrations. Women who had at least two abortions, or
spontaneous abortions preceded or followed by fetal deaths or birth of a malformed child. We have
found 9.83% of all cases carrying chromosomal aberrations and abnormalities included 7.37% of all
cases were structural aberrations & 2.45 of all cases were numerical anomalies.

elective tonsillectomy in the E.N.T. department of Al-Diwaniyah Teaching Hospital. The
following specimens were taken from each patient, throat swab after positioning the patient under
general anesthesia, core swab specimen after removal of tonsils for bacteriological examination.
Pathogens were detected in (90.4%) of core specimens versus (41%) in surface swab cultures.
Staphylococcus aureus was the most commonly grown bacteria in the core of the tonsils and/or surface
culture. Regarding antibiotics sensitivity, commonly used antibiotics yielded unsatisfactory results for
isolated pathogens.
In conclusion, there is discrepancy between tonsillar surface and tonsillar core culture results
in cases of chronic tonsillitis. Also the role of throat swab in management of chronic tonsillitis
doubtful.

Background :Retained or recurrent common bile duct stones ( CBD ) and cholangitis after open
exploration of common bile duct are major problems in biliary surgery . Repeated surgical
intervention on biliary tract to correct complications is a burden on both the patients in the form of
increased morbidity and mortality and on the surgeons in form of complex technical difficulties .
Objectives :The study aimed to compare the results of T-tube drainage versus
choledochoduodenostomy after open common bile duct exploration
Patients and methods : This is a retrospective study of 154 patients which compare two surgical
treatments of patients with choledocholithiasis from 1992 to 2009 . At the beginning of the study all
patients were treated by exploration of CBD with T-tube insertion , Group A which included 83
patients . In 1999 the surgeon analyzed and made an audit of the results of this operation .The audit
identified the incidence of retained or residual CBD stones and their risk factors . The risk factors were
multiples CBD stones , hugely dilated CBD , recurrent stones and papillary stenosis . The second
strategy were followed after holding an audit which implemented the use of choledochoduodenostomy
for patients with the above mentioned risk factors ( Group B ) which included 71 patients .The end
points were mainly retained stones and cholangitis . Analysis was performed to identify risk factors for
stone recurrence and whether the new implemented strategy resulted in decrease in prevalence of
retained CBD stones . Postoperative follow up was for 12 to 18 months . Statistical analysis with SPSS
data base using Chi-Square test and test of comparison of proportions was used to analyze the data of
this study .
Results: In group A " Pre-audit " , 7 patients developed retained CBD stones , 3 of them needed reoperation
and 3 were managed by endoscopic sphincterotomy while in group B " Post-audit " , two
patient developed cholangitis and improved on conservative treatment , no patient had residual stones
and no patients needed re-operation .Statistical analysis with SPSS data base with using Chi-square
test and test of comparison of proportions showed that multiple CBD stones , hugely dilated CBD and
papillary stenosis were found to be independently associated risk factors for retained or recurrent CBD
stones after open exploration of CBD which was significantly reduced by choledochodudenostomy in p
value <0.05 and 95% confidence interval .
Conclusions : This study demonstrated that with the new strategy " Choledochoduodenostomy " , the
incidence of CBD stones was reduced . Multiple CBD stones , hugely dilated CBD and papillary
stenosis were risk factors for retained CBD stones

Headache is one of the man's most common affection. The frequency of disabling headache is explain
in part by rich nerve supply to the head (including afferent nerve fibers from trigeminal,
glossopharngyal, vagus and upper three cervical nerves), and in part psychological implication of head
pain, causing anxiety about even modest headache, head pain can be result of either intra or extracranial
disease in the distribution of any of above nerves. The aim is To study the effect of headache on
cortical and gyral thickness in the pre-central and post-central regions.This prospective study was done
in the MRI unit of AL-kadhimyia teaching hospital from the period of April 2009 to September 2009.
The study included 2 groups: group 1 included 28 patients (17 females and 11males) suffering from
headache of variable duration, while group 2 included 28 normal subjects as a control. Measurements
of the cortical thickness of the pre-central and post-central regions as well as the thickness for the 2
groups were done from the sagittal T1 weighted spine echo image. Statistical significance was
indicated by a p value of less than 0.05.
A statistically significant Increase in cortical thickness of the post-central region was found in headache
patients (4.03± 0.77mm) compared with normal subjects .In patients suffering from headache a
statistically significant increase in cortical thickness of the post-central region (4.03± 0.77mm) when
compared with that of the pre-cenral region. the cortical thickness in pre- and post-central regions is
proportionally increased with the increased duration of headache.

A simple sensitive and reproducible spectrophotometric method have been developed for the
determination of Salbutamol in pure form or in a tablet. The proposed method is based on the oxidation
of hydroxyl group of Salbutamol with chromic acid. The green blue color of reduced Cr+3 ion were
measured at λmax 582 nm. Linearity was observed from 20 to 250 μg/ml with detection limit 10 μg/ml.
the method is successfully employed for determination of salbutamol in pharmaceutical formulation.
The proposed method offers the advantages of simplicity, reproducibility, rapidity and sensitivity
without the need for extraction or chemical derivatization. The method described could be applied to
routine quality control of tablets contain salbutamol. Statistical comparison of the results with the
reference method shows an excellent agreement, and indicates no significant difference in accuracy and
precision. The reliability of the methods has been ascertained by recovery studies.

At hemophilic centre in Merjan Teaching Hospital a ( 56) patients with severe hemophilia were
investigated using a pre-structured questionnaire,were measuring mainly (4) parameters: Factor
availability , academic achievement and work attendance , immediate and long term rehabilitation and
participation in sport and physical activities.
Due to perennial and then subsequent shortages of replacement therapy, and lacking of immediate and
long term rehabilitation measures , most of patients developed various form of chronic arthropathies
and disabilities with poor school and work attendance and most of them confined to their home with no
employment , and were not participated in sport or physical activities.

BACKGROUND: Esophageal Atresia presents a challenging congenital abnormality which is
incompatible with life and was referred to as "hopeless from the beginning and not of much practical
importance to the surgeon"(1) is now successfully repaired all over the world.
AIM OF THE STUDY: To study the clinical presentation, diagnosis, types, management and
complications of esophageal atresia in children admitted to welfare Teaching Hospital.
PATIENTS AND METHODS: A retrospective analysis of data of 100 neonates with esophageal atresia
with or without tracheoesophageal fistula treated and followed up in children welfare Teaching
Hospital, between January 2003 to January 2005 .
RESULTS: Prenatal history of Polyhydramnios was evident in 77(77%) cases.
(65%) were males and (35%) were females with male to female ratio was 1.8:1
The presenting features were frothy secretions from the mouth and failure to pass nasogastric tube in
98( 98%) cases , chocking after feeding in 87(87%)cases, dyspnea in 12 ( 12%)cases, cyanosis in
50(50%)cases, chest infection in 40( 40%)cases , most of the patients 92(92%) cases were of the
common type (proximal atresia with distal fistula), while 7 ( 7 % ) cases were of pure atresia
type(without fistula), 1(1%) case was of
H-type fistula.
Associated anomalies were present in 23(23%) cases.
Post operative complications were anastomotic leak seen in 24.6%, stricture seen in 18.5%, recurrent
tracheoesophageal fistula in 2. 4% and mortality rate was high constituted 65%.
CONCLUSION:Esophageal atresia with distal fistula was the commonest type in this study. Frothy
secretion from the mouth, failure to pass nasogastric tube, chocking after feeding and Radiological
study (Plain X-ray) were the main diagnostic features. Delay in diagnosis and associated anomalies
were responsible factors for increasing incidence of mortality and morbidity.

This paper describes a decreasing of Glutathione(GSH) concentration as antioxidant and increasing of
Malondialdehyde( MDA ) concentration as the end product of lipid peroxidation for victims of
traumas, we studied the victims of terrorism attack due to the importance of this attack on psychosomatic
disease and on the post traumatic stress disorder. 15 patients victims of trauma in terrorism
attack in jerif al-sakhar aged 12-40 years and 10 patients in animals market in Babylon city, aged 20-45
years, and 20 non terror-attack subjects aged 12-45 years, as a control group were recruited for this
study.

This study determines the alkaline phosphatase (ALP) and catalase activities in sera of hemorrhoid
patients compared with healthy controls. The design of the project includes (12) hemorrhoid patients
(males only) and (12) healthy males. The results shown significant decrease in alkaline phosphatase
activity in hemorrhoid patients compared with healthy controls(P= 0.0002). Catalase activity
significantly increased in hemorrhoid patients compared with healthy(P=0.0000) .The time effectual on
catalase activity was study and shown significantly decrease.

A study was conducted from 1st June 2005 to 30th July 2006, in which a sample of 250 women in
childbearing age (15-45) years, were selected randomly from urban and rural regions of Babylon
Governorate. These women were selected from those attending Babylon Maternity and Children
Hospital, and Public Health Laboratory. This study has been carried out to determine anti-rubella
antibodies among women in childbearing age.
The women included in this study were tested by enzyme-linked immunosorbent assay for IgG
antibodies giving an overall prevalence of (77.6%), and hemagglutination-inhibition test for rubella
IgG and IgM antibodies giving an overall prevalence of (80.0%).
Regarding the sociodemographic variables, the study revealed that the highest rate of seropositivity was
in age group (25-29) years by ELISA and HAI tests (85.96% and 87.71% respectively), while the
lowest rate was in older age group ≥40 years (66.7%) for both tests. Also the study revealed that the
rate of seropositivity was higher among women who lives in urban areas by ELISA and HAI tests
(82.56% and 83.48% respectively), women with high educational level (88.9%) for both tests, and
employees women (94.44%) for both tests. Also, pregnant women had higher rate of seropositivity
(78.33%) than non-pregnant ones. However, pregnant women in the first trimester had highest rate of
seropositivity by ELISA and HAI tests (79.6% and 81.63% respectively) than women in the second and
third trimester. Regarding the parity, the study revealed that the multipara women with three children
had the highest rate of seropositivity (85.0%) for both tests than others.
The present study showed that the mean of the titer of anti-rubella antibodies by hemagglutinationinhibition
test, was high (1952 ± 1641.9) in women with age group (25-29) years, and low (280 ± 80)
in the older age women ≥40 years. Also, the mean of the titer was higher among women who live in
urban areas (1262.4 ± 1375.4), women with secondary educational level (1307.9 ± 1350.2), and
employees women (1496.5 ± 1683.3). While in pregnant women and non-pregnant ones, there is no
significant difference in the mean of the titer between them. However, the pregnant women in the
second trimester show high mean of the titer (1014.4 ± 1352.9) than others, and multipara women with
two children had high mean of the titer (1124.5 ± 1383) than others.

Epineural Repair Technique and Long – Term Results :
This study carried on 20 patients complaining of acute sciatic nerve
injury as a result of shell and bullet injuries from January 2002 – September
2007 , they underwent surgical intervension for sciatic nerve exploration 5 – 8
months post injury . The purpose of all nerve repair techniques is to restore
continuity of the nerve trunk , including all of it's elements in order to
achieve optimal and useful reinnervation of both sensory and motor end organs
. There are many accepted techniques for coaptation of the ends of a severed
nerve . No single repair method is appropriate for every instance of nerve
injury . The choice of repair technique depends on several overriding
anatomical factors [2] .

Brain neuronal disorders have the least outcomes to therapeutic response due to their complex and
delicate integration and lack of drug response upon damage in addition to difficult surgical approach to
CNS. These properties of brain cortical diseases elaborate more trials of finding an effective and safe
alternative treatment. Making a full use of the high responsiveness of neurons to the electrical currents
induced with magnetic fields allows an appreciable therapeutic approach to be evaluated. In a trial of
assessment of the neuronal repair effects of a time varying external magnetic field, rabbit model of
stroke was arranged with 10 minutes occluding the left middle cerebral artery of the anesthetized
rabbit. A follow up with right hind limb spasticity, EEG and eosin histopathological assessment of
neuronal reconnections in response to applying a 1000 Hz and 1000 gauss magnetic flux density
provided by an external solenoid magnet in comparison with untreated control group along 30 days of
daily applying the field on the left frontal lobe over the scalp for 30 minutes. There was a significant
reduction of spasticity score from 2.76 +/- 0.1 to 1.33 +/- 0.2 obtained with extracranial magnetic
stimulation ECM; P< 0.05 as compared with untreated group. Similar improvements in EEG criteria
were also recorded in ECM treated group in form of an increase in EEG amplitude from 4 microV to
32 microV whereas brain frequency over the affected area had significantly increased from 2 Hz to 9
Hz at P< 0.05. Histopathological assessment of the number of neuronal reconnections revealed 355 +/-
21 per high power field in comparison with just 105 +/- 19 in untreated group. In conclusion there
was a promising neuronal repair enhancement by applying a suitable extracranial magnetic field that
could improve the therapeutic outcomes of different treatments.

This is a preliminary experimental study on 30 human placentas as a model for microvascular practice .
two types of vascular anastamotic techniques were practiced , end – to end and – to – side anastamoses
on 78 vessels including both arteries and veins . vessels of different sizes where divided and
reanastamosed under the operative microscope . Absence of a dynamic circulation was the main
disadvantage of the human placenta when used as an alternative model for microvascular practice,
otherwise it was very practical , cheep and has many features in common with the clinical situation .
This study shows that arterial anastamoses is easier and less time consuming than venous anastamoses
and shows also that end – to – end anastamoses is technically easier and less time consuming than end
– to – side anastamoses using the same suture material and vessels of the same size group .

One hundred child with isolated non complicated femoral shaft fracture included in this clinical
comparative study ,between 2005-2007 in Aldiwania teaching hospital. 50 child treated by immediate
application of hip spica cast under general anesthesia and discharge of the child at the same day. Other
50 child treated by preliminary skin traction in the hospital for a period 2-3 weeks then after application
of hip spica under general anesthesia.
After removal of the cast from all the children (6-8 weeks),shorting was seen in all children treated by
immediate cast (43 case less than 2 cm ,7 cases more than 2 cm which regarded as a failure) while in
other group shorting less than 2 cm was seen in 46 case , and more than 2 cm in 4 cases only.(p value
more than 0.05, non significant).
After 2 years ,at the last follow up, limb length discrepancy was found only in 5 cases in children
treated by immediate casting and in 4 cases treated by delay casting .which is non significant in both
group. there’s no significant angulations in both groups on short or late follow up. so we concluded that
immediate hip spica cast application as definitive treatment for femoral shaft fracture in children
between 2-10 years old represent an a good alternative method for the traditional method of
preliminary traction in hospital and then hip spica. In addition its economic , safe, with short hospital
stay and rapid return of the child to family.

methods but the superiority of one over the other has not been clearly demonstrated
Design: prospective, comparative study.
Aim: To compare the morbidity associated with tonsillectomy using two different technique s for
haemostasis silk ligation versus diathermy.
Patients and Methods: This is a prospective, comparative study at ENT department of AL –sadder
teaching hospital, College of Medicine, University of Kufa , from June 2008 – November 2009; where
250 patients were enrolled in this study. The results of the two groups i.e. tonsillectomy using silk
ligation or diathermy for haemostasis was studied.
Results: Tonsillectomy of 250 patients were performed ; 160 male (64%) and 90 (36%) female .the
mean operation time was 20 minutes with bipolar diathermy as compared to 30 minutes with silk
ligation ,analgesic requirement during the first 24 hours post operatively was equal with both
techniques .
Primary bleeding was noticed in 6 patients (2.4%) with bipolar diathermy haemostasis as compared to
13 patients (5.2%) with silk ligation .Secondary bleeding was encountered in 10 patients (4%) with
bipolar diathermy and in 7 patients (2.9%) with silk ligation
Conclusions: Less operative time was taken by bipolar diathermy as compared to silk ligation. The
incidence of primary post-operative bleeding was more with silk ligation while the secondary
haemorrhage was significantly less with silk ligation.

Background: This Study is to demonstrate the adverse hepatic effects of MTX in patients taking MTX
for treatment of RA and psoriasis taking in consideration the following variables: BMI, gender,
cumulative dose, age, weekly dose, duration of treatment, serum level of cholesterol and creatinine.
Patients and methods:This is a prospective study of 85 patients with RA and 50 patients with psoriasis.
All patients were analyzed by history, clinical examination and investigations in the form of liver
enzymes, blood sugar, serum cholesterol, serum creatinine, HBS Ag and anti HCV antibody.
Persistently elevated level of liver enzymes 2 to 3 times the upper limit of normal on two occasions 3
months apart indicate hepatic toxicity
Results:The study results found that 7 patients with psoriasis and 6 patients with RA have significant
elevated liver enzymes which reflect MTX hepatotoxicity
Conclusion: Our study showed that patients with psoriasis at significantly greater risk of elevated liver
enzymes than patient with RA (14% and 7% respectively) were BMI, cumulative dose; weekly dose
and serum cholesterol level are risk factors for hepatic toxicity due to MTX therapy.

Background :Inappropriate antibiotic use refers to improper administration with respect to drug dose,
interval duration (whether singly or collectively) in the light of proper clinical situations and/or
financial considerations. The recognized effects of inappropriate use (whether overuse or underuse) of
antibiotics are multiple: (1) rapid emergence of resistance, (2) selection pressure on resistant
microorganisms, (3) adverse reactions, (4) treatment failures, (5) occurrence of preventable morbidity
and mortality and (6) waste of resources.
One of the triggers for using self-medication may be past experience with antibiotics prescribed by
health professionals. We examined the association between prescribed use and self-medication with
antibiotics.
Aim:To estimate irrational self-medication with antibiotics by a population in Annajaf / IRAQ
Design of study: Interview -based questionnaire study.
Methods: In total, 1041 respondents were interviewed on their attitudes towards appropriateness of
self-medication with antibiotics and situational use of antibiotics, beliefs about antibiotics for minor
ailments, knowledge about the effectiveness of antibiotics on viruses and bacteria and awareness about
antibiotic resistance.
Public knowledge, beliefs, and experiences of antibiotics, as well as predictors of accurate
knowledge of antibiotic effectiveness, were measured using 28 questions with sub-items. The
questionnaire was given to a Annajaf /Iraq community-based 1041 individuals. Of these, 1041 eligible
responders were invited to participate; 835 responders (82%) completed the questionnaire.
Results: Of the 1041 respondents questioned, 853 (82%) well-informed antibiotic and 188(18%) misinformed
antibiotics. From well-informed only 558(65.4%) were self-medicated and 295(34.6%). The
most frequently used agents were amoxycillin (50.2%), Cephalosporins (13.1%), Aminoglycosides
(2.9%), Tetracycline's (0.9%), co-trimoxazole (0.8%), Macrolides (0.6%), and Quinolones (0.5%).
Conclusions: Our study shows consistent associations between prescribed use and self-medication
with antibiotics. Preventing leftovers may be one effective way of preventing self-medication. This can
be achieved by ensuring that the amount dispensed corresponds to the amount prescribed, by educating
patients and by making doctors aware that prescribing for minor ailments may increase the risk of selfmedication
for such ailments.

Diabetes mellitus induces a pattern of myocardial pathology known as a specific diabetic
cardiomyopathy and to evaluate the presence of this phenomenon we measured various parameters of
left ventricular function by echocardiography as it is available in merjan teaching hospital , and
these parameters including :
1. Ejection fraction
2. Fractional shortening
3. Inter-ventricular septal thickness
4. Posterior left ventricular wall thickness
The results of our study show that diabetic patients have left ventricular dysfunction as
compared with control group by a reduction in EF and FS and increase in the thickness of (IVS) and
(pw) of the left ventricle.(The results are statistically significant, P < 0.005) .
Although patients with non-insulin dependent diabetes developed
left ventricular dysfunction more than patients with insulin dependent
diabetes and female patients are more affected than male patients
especially in NIDDM ( the difference is statistically not significant, P > 0.1).
LVD occurs more frequently with prolonged duration of the disease in both types of
diabetes (the difference is statistically not significant, P > 0.1).

his type of exam, been developed
over several years as a method of
assessing clinical skills.
As candidates carry out a number of
different clinical skill at a different
station in circles, where each student or
candidate is observed by an examiner
who assesses the process of performing
the skill using a previously determined
checklist.
Several medical schools have used the
structured clinical examination for
long enough for it becomes the new
convention. It appears that it will be
adapted in an enthusiastic way.
This exam consists of a series of
stations around which students rotate,
at each station the student is required
to undertake a well defined clinical
task.
In some situations each station is
followed by one requiring the
answering of questions about the
previous station.
The length of time spent at a station is
usually about 5 to 10 minutes.
This type of exam allows a wide
selection of tasks to be assessed
including assessing technical skill,
laboratory skills, test interpretation and
physical examination performance.

Background: The principle of emptying the uterus as quickly and safely as possible remains the corner
stone of management of incomplete miscarriage. In many countries surgical uterine evacuation is the
standard treatment, expectant management has been advocated as an alternative in several
observational studies.
Objectives: To evaluate the effectiveness of expectant management of incomplete 1st trimester
miscarriage.
Study design and setting: Prospective observational study carried out at Babylon hospital for maternity
and pediatrics between feb.2009-jan. 2010.
Materials and methods: The study involved 120 clinically stable patients with incomplete 1st trimester
miscarriage (diagnosed by TVU), those patients subjected to conservative examination treatment (no
intervention) and follow up for 2 weeks by clinical examination and transvaginal ultrasound.
The main outcome measures were complete miscarriage (absence of vaginal bleeding and endometrial
thickness 15 mm by TVU), need for emergency curettage, infection and need for blood transfusion.
Result: Successful outcome without surgical intervention was seen in of 85% of cases infection
reported in 1.6% of cases, emergency curettage needed for 5 % (1.6% for infection and 3.3% for
excessive vaginal bleeding), 10% of cases required elective surgical evacuation (4.1% of them refused
follow up >1 week and 5.8% to failed to have complete miscarriage after 2 weeks of observation)
without reported complications.
Conclusion: Expectant management of clinically stable patients with retained product of conception
after 1st trimester incomplete miscarriage is safe, effective and well tolerated.

Background: Rosmarinus officinalis essential oil is a natural product it has been reported to be much
safer than antibiotic, and has abroad spectrum activity against gram positive and gram negative stain
bacteria. On the other hand it has been reported that the oil has no toxicity and lethality on laboratory
white mice therapeutic dose range.
Objective: Used of essential oil of Rosemary in plasmid curing for R-plasmid (antibiotic resistance
plasmid).
Methods: Used of minipreparation of plasmid DNA and cured plasmid with essential oil by
concentration (100μg/ml), the detection was performed by agarose gel electrophoresis.
Results: The essential oil has an active ability to curing plasmid as it is detected by DNA
electrophoresis and lost the phenotype of Antibiotic resistance.
Conclusion: In this study, essential oil of Rosemary used for plasmid curing in active way against
Escherichia coli pBR322 which contain R-plasmid which is resistant to Ampincilin, Tetracycline and
Streptomycin antibiotics this help to used essential oil as cofactor for antibiotics.
Key words: Rosmarinus officinalis, essential oil, plasmid curing.

Background : Diabetes mellitus (DM) is an important secondary cause of frozen shoulder (FS) .
Aim of study : to identify the prevalence of FS among diabetic patients and it's relation to age,
gender, duration and control of DM .
Patients and method : 198 randomly selected diabetic patients from the attendants of Al-Hakem
center of endocrinology at Al-Sader teaching hospital in Al-Najaf city during the period from July
2008-October 2009,each patient subjected to scratch test , BMI calculation and HbA1c measurement.
Results : prevalence of FS in DM was 17.2% . There was significant relationship between FS and age
of patients , duration of DM and control of DM at p value <0.05 .
Conclusion : FS is a common complication of DM in Al-Najaf city . It is directly related to age of
patient , duration of DM and inversely related to control of DM .

A 21 year-old male patient with progeria , the patient during an early age, affected by this disease &
develop many of the problems usually not seen till much later in life, such as atherosclerosis , baldness,
cardiovascular disease, loss of subcutaneous fat, and joint stiffness. In this case we stressed the
mucocutenous manifestations in the form of Pemphigus Vulgaris .

Objective:The aim of this study is to evaluate the risk of recurrent laryngeal nerve palsy (RLNP) after
thyroid surgery with routine identification of the recurrent laryngeal nerve (RLN) intra operatively.
Patients and Methods:Our study involved 379 patients who underwent 151 Near Total Thyroidectomy,
107 Sub Total Thyroidectomy, 82 total lobectomies and 39 total thyroidectomies, treated by three
surgeons. Individually temporary and permanent RLNP rates were analyzed for patient groups which
more classified into primary operation for benign thyroid disease, Thyroid cancer, Graves disease, and
reoperation. Two RLNs in 12 thyroid cancer patients already invaded were excluded from analysis.
Results:Three patients developed RLNP postoperatively. Complete recovery of RLN function was
documented for all (100 %) of these cases whose RLN integrity had been ensured intraoperatively.
Recovery from temporary RLNP was insured within 4 weeks to 3 months (mean 2 months). Overall
rate of temporary and permanent RLNP was 0.795 %and 0.00%, respectively. The rates of temporary
RLNP were 10%, 5.26%, 1.2%and 0.0% for groups classified according to thyroid cancer, reoperation,
Graves' disease and benign thyroid disease, respectively.
Conclusions:Thyroidectomy is a routine and safe surgical procedure with a low morbidity and
negligible mortality when performed by trained surgeons and most of the complications of
thyroidectomy may be avoided by careful surgical technique.
Significantly higher RLNP rates were demonstrated after operations for thyroid cancer, recurrent goiter
and Graves' disease . Total lobectomy with routine identification of the RLN is quite safe and we
suggest considering it as a basic procedure in a thyroid operation.

Back ground: There are about 100,000 hair follicles in the scalp, which have the capacity of growing
and re-growing hair several times in their life span. Hair loss is a natural phenomenon. Hair has to fall
out, so that there is place for new healthy hair to grow. Being mammals, we generally shed hair, during
the onset of winter. Seasonal hair loss has been observed in eight healthy women during spring.
Aim of the study:To assess the seasonality of hair loss.
Design: Prospective study of eight healthy women who complains of recurrent hair loss during spring
time.
Patients and method: Eight patients with recurrent hair loss during spring season were observed for 12
months for possible seasonal pattern of scalp hair loss. A careful examination of the patients was
carried out including hair pull test, performed twice monthly for 12 months. The test was done over
different sites of the scalp including the top and the sides. The hair is prepared by instructing the
patients not to wash their hair 24 hours before test.
Results:Telogen percentages by month of year showed an overall annual periodicity, manifested by a
maximal proportion of telogen hair in April.
Conclusion: These results confirm the findings of former authors who have indicated seasonal changes
in human hair growth, although the previous studies had shown a larger peak in July and a smaller peak
in April, this study had shown a larger peak during April. This may be due to difference in season’s
lengths between Iraq and other countries.

Background: Chronic otitis media is a major global cause of hearing impairment & this may have
serious long-term effects on language, auditory & cognitive development, & educational progress.
Objective: To study the sensorineural hearing loss (receptive hearing loss) associated with chronic
suppurative otitis media (CSOM).
Methods: 96 patients were clinically diagnosed with chronic suppurative otitis media (CSOM)
consulting us in Diwaniyah teaching hospital & my private clinic between September 2006 & April
2009. 66 cases of the total number were unilateral while the bilateral cases were 30. Audiological
assessments were done for all cases.
Results: The results showed a significant relationship between CSOM & SNHL mainly at high
frequencies, & it had been found that the longer duration at time of diagnosis the more percentage
affected & cases of CSOM associated with cholesteatomas were more affected by SNHL & the
frequency 8000Hz was the most affected one.
Conclusions: The presence of SNHL with CSOM may be explained by the presence of pus, local or
systemic treatment or may be due to labyrinthitis during the course of the disease; therefore, more
attention should be paid in the treatment of CSOM.

A cross-sectional study of 23336 blood donors in Babylon Governorate – Iraq was done during the period from February 2007 to February 2008 . The study revealed that 23122 cases were males (99.1 %), while 214 were female ( 0.9 % ) . All the donors has been investigated for HBS Ag (Hepatitis B surface Antigen ) and Anti – Hepatitis C Virus antibodies ( Anti – HCV ab ) ( ELISA test ) .287 of the total sample ( 1.2 % ) found to be seropositive for either HBs Ag and Anti – HCV ab (274 were males 95.5 % and 13 were females ( 4.5 % ) . The number of HBs Ag seropositive cases were 171 (59.6 %) while the number of seropositive of Anti – HCV ab were 116 (40.4 %). The seroprevalence of Hepatitis B virus infection among male donors was (0.7 % ) and for female donors was ( 4.7 %) , while the seroprevalence of HCV infection among male donors was (0.5 %) and for female donors was ( 1.4%) . The overall seroprevalence of HBs Ag among blood donors in Babylon governorate is ( 0.7 %) and for Anti – HCV ab is ( 0.5 %) and these results are parallel or relatively low if they were compared with some other Iraqi Governorates and some other countries .

Objectivew:e propose a regimen for safe and cost-effective short-stay hospitalization following
total/near-total thyroidectomy.
Patients and Methods:127 total/near-total thyroidectomies between 2006 and 2009 were studied to test
our short-stay thyroidectomy regimen. Patients were admitted the day of operation and observed
overnight. Serum calcium values were obtained at 8, and 20 hours after operation. 23 hour discharge
criteria included - stable vital signs, no wound or airway problems, up sloping serum calcium curve,
and tolerance of normal diet and activity and availability of the close relative.
Results:Of 127 patients underwent total/near-total thyroidectomy, 116 (%) met 23-hour discharge
criteria. No deaths (0 %) occurred. Overall morbidity 9 patients (7.08%) included four patients (3.14%)
with transient hypocalcaemia, two patients (1.56%) with transient recurrent laryngeal nerve palsy, one
patient (0.78%) with postoperative hemorrhage, one patient (0.78%) developed postoperative angina
and another one (0.78%) developed Postoperative bronchospasm in asthmatic patient. Two (1.56%)
patients didn’t have the Capability of home self-care activities, or didn’t have the close relative at home
to take care of them.
Conclusion:Significant airway obstruction and wound hematoma rarely developed beyond the first 12
to 18 hours after total /near total thyroidectomy so the practice of 23 hrs short stay thyroid surgery is
safe .
Serial serum calcium determinations used to construct a two-point calcium curve within 20 hours after
operation can reliably and safely identify patients at risk to have clinically significant hypocalcaemia.

one hundred seven patients ( 51 male and 56 females ) suffering from renal failure admitted to
Mirjan Teaching Hospital were included . Twenty healthy individuals were included as control group.
Blood samples were collected and the sera were separated . It was found that renal failure was more
predominant among the patients age group rang from 40 – 70 years old. Besides , it was found out that
the mean values of some biochemical parameters importance for the detection of the disease which
were investigated in this study where higher than the normal . It was found that urea and creatinine
mean value for all patients were highly significant if compared to control group. The mean value (M ±
SD) of Adenosine deaminase activity was decreased significantly (14.30 ± 10.47) in all patients with
renal failure if compared to the control group (63.80 ± 22.98). On the other hand ,the mean of xanthine
oxidase activities also reduced but not significantly (4453.98 ± 694.86) if compared with control group
( 4669.45 ± 811.80 ) .

Background: Subclinical Keratoconus is a term used to indicate a patient with inferior or central
steepening of cornea on topography where the clinician suspects that it may progress to keratoconus.
Aim of the Study: Diagnosis of sub-clinical keratoconus among myopic patients seeking for correction
of their refractive errors by excimer laser, to avoid surgery for those patients and consider them at risk
of developing post operative corneal ectasia which is the most severe post operative complication in
photorefractive surgery.
Patients and methods: One thousand and two hundred myopic patients who attended laser unit/ Hilla
Teaching Hospital, during a 1.5 year duration, seeking for correction of their refractive errors. Many
investigations were done including visual acuity, slit lamp examination, corneal topography,
keratometry and pachymetry.
Results: Among those patients, 49 (4%) diagnosed as having subclinical keratoconus. Out of these (49)
cases, (27) (55%) were males and (22) (45%) were females. Forty one (83.6%) of the patients where
less than ( 25) years old.
Conclusion: Sub-clinical keratoconus is one of the challenging problems facing refractive surgeons and
is one of the most important and preventable causes of corneal ectasia following photorefractive
surgeries.

Background: Preeclampsia is a major cause of morbidity and mortality during pregnancy. Several
independent investigators have demonstrated the association of androgens with hypertension.
Objective:To determine whether maternal serum levels of testosterone and dehydroepiandrosterone
sulphate DHEA-S, are higher in patients with preeclampsia than in matched normotensive control
subjects.
Method: Case control study included 29 subjects in the 3rd trimester of pregnancy with documented
preeclampsia (including 10 cases of mild and19 cases of severe preeclampsia) and 20 healthy
normotensive women in the third trimester of pregnancy used as control group and for comparative
purpose another 13 patients with gestational hypertension were also included in our study. All cases
had singleton pregnancies. Cases of polycystic ovary syndrome (PCOS), diabetes, chronic
hypertension and chronic systemic diseases such as lupus and patients using steroid drugs were
excluded.
Serum levels of total testosterone were measured using testosterone enzyme immunoassay test kit,
Biocheck (USA), while dehydroepiandrosterone sulfate (DHEA-S) was measured using DHEA-S
enzyme immunoassay test kit, DRG (USA, Germany).
Results: Student t-test was used to analyze the difference in androgen levels between the different
groups. Serum total testosterone level was significantly higher in patients with severe pre-eclampsia
compared to control group (0.41ng/mL versus 0.31ng/mL, P value 0.005), while no significant
difference was found between cases of mild and severe pre-eclampsia. Again no significant difference
was found when comparing patients with mild pre-eclampsia with control group and cases of
gestational hypertension with control group.
Serum level of dehydroepiandrosterone sulfate (DHEA-S) was significantly higher in patients with
severe pre-eclampsia compared to patients with mild pre-eclampsia (1.03 μg/mL versus 0.32 μg/mL; P
value 0.005) and when compared with control group (1.03 μg/mL versus 0.59 μg/mL; P value 0.02),
while the level was not significantly higher when comparing cases of mild pre-eclampsia with control
group and cases of gestational hypertension with control group.
Conclusion: Levels of total testosterone and dehydroepiandrosterone sulfate (DHEA-S) were
significantly higher in women with severe preeclampsia than in normotensive women. The levels of
these androgens were higher in women severe pre-eclampsia when compared to women with mild preeclampsia
and those with gestational hypertension. This difference may indicate a role for androgens in
the pathogenesis of preeclampsia and stimulates research in the potential role of anti-androgens in the
management of preeclampsia.

Preeclampsia is one of the most common diseases which occurs during the second and third
trimester of pregnancy. The incidence of this disease is 2-5% among pregnant women.
The aetiology is still in debate and many theories were introduced in this field by many
investigators in different countries. It is sometimes called disease of theories due to the contradictory
issues concerning its causes and consequences.
In this study we tried to elucidate the relationship between testosterone and some biochemical
constituents which vary during pregnancy (i.e , lipid profile, total protein, albumin and minerals (Ca &
Mg).
This work was carried out on fifty five pregnant women referred to Babylon Hospital for Obstetric
& Paediatrics for the period from November 2007 to May 2008 .The serum samples obtained from
those patients and control groups (55 healthy pregnant) were analyzed for lipids, protein and minerals
in addition to testosterone .The study group was subdivided into four subgroups as follows :
1.Group I is comprised of 25 preeclamptic patients in the second trimester of pregnancy .
2. Group II is comprised of 30 preeclamptic patients in the third trimester of pregnancy .
3.Group III includes 25 healthy pregnant women (2nd trimester) which served as control group .
4.Group IV represents 30 healthy pregnant subject in their third trimester of pregnancy
The results revealed a significant increase in serum testosterone levels in Group I and Group II
compared with Group III and IV (p<0.01). These were insignificant decrease in hormone level in
Group IV in comparison with GroupIII (p=0.36).
The results showed a significant increase in serum level of total cholesterol, TG, LDL, VLDL in
Group I and Group II compared with those in Group III and Group IV,(p<0.001), (p<0.01) at
respectively. However, there was a concomitant decrease in serum HDL level in Group I and Group II
when compared with Group III and Group IV.
The results showed also a significant decrease in the levels of total protein ,albumin ,Ca and Mg in
preeclamptic women compared with normotensive pregnants (p<0.05) .These changes were
insignificant when the results of these component in Group IV were compared with Group III (p>0.05). There were significant correlation between serum testosterone levels and lipid profile , protein and
minerals .This gives a preliminary idea about the role of testosterone in such changes. There were a
positive correlation between testosterone and lipid profile except HDL-C which decrease at increase
the testosterone in G1,G2 and G3 (p<0.01) and there were positive correlation between cholesterol /
albumin ratio and testosterone in G1,G2 and G3 (p<0.01) but a negative correlation in G4 (p<0.01).
There were inverse relationship between cholesterol and albumin (p<0.001).

Different techniques can be used to repair facial paralysis, in longstanding cases. Reconstruction is
achieved by dynamic suspension methods, microsurgical procedures or static slings. In this study 11
patients with unilateral facial palsy were reconstructed by static slings using fascial substitute which is
a chemically treated dermal collagen strips. In 9 patients the results were satisfactory for the
patients.Complications included detachment of the strip, undercorrection and scarring. No rejection
reaction or infection were recorded.

Background: Intrabiliary rupture is one of the common complications of hydatid cyst of the liver, with
its possible sequel of obstruction, cholangitis and post operative biliary fistula. It should be managed
properly, with accurate pre operative diagnosis and proper surgery, both for the cyst and some sort of
biliary drainage with the available alternatives common bile duct exploration and T-tube drainage,
choledochoduodenostomy or a pre operative endoscopic sphincterotomy, the choice is a matter of
controversy.
Objectives: To evaluate three methods of biliary drainage, (T-tube, choledochoduodenostomy,or
preoparative endoscopic sphincterotomy) during management of intrabiliary rupture of hydatid cyst of
the liver, in terms of morbidity and mortality rates.
Methods: During the period between October 2001 till October 2007. 92 patients attending Baghdad
and Al-Diwaniya Teaching Hospitals, presented with symptomatic intrabiliary rupture of hydatid cyst
liver disease were included in the study, they complained from abdominal pain and jaundice, all
patients were diagnosed preoperatively by ultrasonography, CT scan and Magnetic resonance
cholangiopancreatography (MRCP) was performed in selected patients, 42 patients were selected
randomly and subjected preoperatively to ERCP and sphincterotomy, in whom it was successful in
only 36 patients. During surgery, the cyst and the associated biliary communication was managed
according to the operative circumstances. The common bile duct was explored thoroughly and cleaned
of hydatid element. In patient with CBD diameter > 20 mm side to side choledochoduodenostomy was
performed ( 7 patients ) , while T- tube drainage was performed in younger age patients with mildly
dilated CBD ( 49 patients ) . Those patients in whom a preoperative ERCP and sphincterotomy was
successful, surgery was limited to hepatic hydatid cyst only (36 patients).
Results: The overall mortality was 1.1%, the morbidity rate was significantly higher in the CD (71.4%)
and pre operative ERCP group (47.2%) than the T-tube drainage group (26.5%). There was no
significant difference in the rate of development of biliary fistula in the 3 different procedures.
Conclusion: T-tube drainage is safe and effective method of biliary drainage during the management of
intrabiliary rupture of hydatid cyst of the liver, in terms of morbidity and mortality rates. Pre operative
endoscopic sphincterotomy is good alternative in experienced hands.

Objective: To prospective study determine the sensitivity and specificity of ultrasonography (US) for
detecting ureteric calculi and to establish the accuracy of US for determining the site ,size and number
of calculi in ureter .
Patients and Methods: Between June 2008 and December 2009, 100 consecutive patients (age range,
16-65 years; 60 male, 40 female) seen on our emergency department with ureteric colic suspected to
have ureteric stone by clinical examination ,underwent US evaluation included a careful search for
ureteral calculi. Presence of calculi ,site of calculi and obstruction and incidental diagnoses were
recorded .then patients undergo CT on same day or second day for compare the result. All CT studies
evaluated the ureter for presence of calculi .US and computed tomography (CT) examinations were
compared for the presence of ureteric calculi (site in ureter and size ). The sensitivity of US was
determined for presence of calculi in ureter findings were compared with computed tomography . The
size of calculi in longest axis were compared on US and CT images .
Results: US depicted 20 calculi identified at CT ,yielding sensitivity 20% and specificity 100 %,there
was no substantial difference for detecting calculi in left or right ureter ,the specificity of the
ultrasound examination was 100 %, but the sensitivity was 20 % except for the lower ureteric calculi
(sensitivity 28%). US find 6 calculi in upper ureter from 26 calculi (sensitivity 23 %) ,while 2 calculi
from 30 in middle ureter (sensitivity 6 %) ,and 12 calculi from 42 calculi in lower ureter (sensitivity
28 % ) identified at CT,
Conclusion: US is of limited value for detecting ureteric calculi specially in middle ureter