Medical Journal of Babylon

Objective: To study the effect of a combination of CC and LC in decrease of spermatozoal LP and
improvement sperm quality in obese male idiopathic subfertile normozoospermic patients.
Design: A prospective study.
Setting: Maternity and Childhood hospital.
Patient and Method(s): 35 proven obese male idiopathic subfertile normozoospermic patients were
given CC and LC for 3 months ,10 subfertile patient did not received any medication except
placebo.10 healthy proven fertile man served as control volunteers group. Their semen analyses and
spermatozoal Malondialdehyde (MDA) assay were carried out as an index of spermatozoal LP before
and after course of treatment.
Results: There is high statistically significant differences (P<0.05) in mean of MDA concentration in
post-treated group when compared to non-treated group of obese male idiopathic subfertile patients
and control group. Significant increase (P<0.05) in sperm vitality in combination post-treated group
when compared to non-treated group of obese male idiopathic normozoospermic subfertile patients
and control group.
Conclusion(s): This study suggests that a combination of CC and L-C reduced spermatozoal lipid
peroxidation (MDA) with improving sperm vitality in obese male idiopathic subfertile
normozoospermic patients.

A total of 87 consecutive women (mean age 26 years; SD 6 years) had history of abortion (single
or recurrent) ,were undergo details of their previous reproductive history and complete investigations in
order to detect an underlying cause of their pregnancy losses. All women were asked about if they
complained from infertility (primary or secondary) or had history of diabetes mellitus (type 1 or type 2).
Fasting blood sugar (FBS) was performed looking for any hidden cases of diabetes mellitus, while
abdominal ultrasonagraphy was done to determine if there is any abnormalities in there genital tract ,also
ELISA technique was used looking for anti-Toxoplasma and anti-cytomegalovirus antibodies in the sera of
those women who visited the gynecological department in AL-Hindia General hospital during the period
from November / 2009 to May / 2010.
We found that 27(31%) of those women had anti-Toxoplasma antibodies and 15(17.2%) had anti-
CMV antibodies in their sera; 11 (12.6%) women had anomalies in their genital tract (uterine anomalies
and cervical incompetence), 10 (11.4%) were infertile (primary or secondary); and 6(6.8%) were diabetic.
The rest of the studying group (18) were normal.

Background: Drug abuse is defined as using of drugs for a non-therapeutic or non-medical effect. In Iraq drug abuse is wide range problem because almost any drug can be easily obtained from pharmacies and drug stores. Sexual-enhancement drugs are widely used without a prescription.
The aim: The study was conducted to verify the abuse of sexual - enhancement drugs by people attending private pharmacies to purchase these drugs in Babylon.
Subjects and Method: Three-hundred and forty males who use these drugs of different ages were collected randomly in Babylon . Questionnaire included the following questions ; age, whether the drug is prescribed by physician or not, the reason for use, causes of impotence, type of drug used, also the subjects were asked about the dose, frequency dose of these drugs and lastly whether they had suffered side effects from these drugs or not.
Results: The results showed that 67% of subjects using these drugs were between 25-50 years old. The study also revealed that 84% of those subjects use these drugs without prescription and the reason for use, in 58% of subjects, was to increase the efficiency during sexual intercourse and not due to impotence and the impotence in 58% of impotent patient is due to disease . Furthermore the results showed that the most drug type used is Sildenafil (55%) and most of them used the highest dose. The study also showed that 71% of subjects use these drugs twice weekly and 65% of those subjects had developed moderate side effects from the use of these drugs.
Conclusion: The results indicate that there is an abuse of sexual enhancement drugs and most of them are not used on the therapeutic or scientific bases.

Background: Breast cancer is the most common cancer in women .The incidence of breast cancer varies greatly around the world. Apoptosis occurs naturally at several stages of breast development. The gene caspase-8 (CASP8) plays a key role in the initiation of apoptosis. Suppression of apoptosis is one of the major mechanisms underlying the origin and progression of cancer. One variant in the CASP8 gene , D302H (rs1045485), has been confirmed to be associated with a reduced breast cancer risk.
Aim: to illustrate the role of the CASP8 gene variant with respect to breast cancer susceptibility. According to our knowledge, there is no previous association study concerning CASP8 gene variant (D302H) and breast cancer has been conducted in Iraq. So the frequency of this gene variant and its clinical impact on breast cancer was studied for the first time among Babylonian population.
Materials and methods: A genetic analysis was performed as single nucleotide polymorphism (SNP) to tag the D302H variant in four groups of Babylonian populations, including patients with breast cancer , healthy control people , first degree relatives, and patients with benign breast tumors.
Results: CASP8, D303H variant was shown to have a high degree of correlation with healthy control subjects in the present study in comparison with breast cancer patients. The presence of CASP8, D302H polymorphism not only diminishes the high risk of breast cancer, but also delays the onset of breast cancer until late age.
Conclusions: The CASP8 D302H polymorphism decreases the breast cancer risk and delays the onset of the disease.

Background: In hypothyroidism the heart muscle is weakened in both its contraction phase, and also its
relaxation phase. This means that the heart cannot pump as vigorously as it should, and the amount of
blood it ejects with each heart beat is reduced. In addition, because heart muscle does not relax normally
in between heart beats, a potentially serious condition called diastolic dysfunction may result.
Aim: To evaluate the Prevalence of cardiovascular disorders in patients with primary hypothyroidism,
and the relationship between these disorders and other factors like Age, Sex, BMI, and thyroid function
status.
Methods: From January 2010 to April 2010, 43 patients were involved in the study, (39 females and 4
males), aging from 41 to 77 years. They were known to have primary hypothyroidism and were
randomly chosen from the attendants of the unit of endocrinology at Al-Kadhmyia Teaching Hospital-
Baghdad. They approved to participate by filling a questionnaire form involved age, sex, weight, first
TSH reading, history of IHD, occurrence of hypertension, ECG, Arrhythmias, Chest X-ray,
Echocardiogram, and lipid profile. The collected data were statistically analyzed by using SPSS and
Chi-square test to compare discrete variables.
Results and Discussion: Patients participated in the study were of age ranging from 41-77 years (mean
56) which indicates the occurrence of hypothyroidism in old age group. They were 4 males and 39
females which suggests that hypothyroidism is a female disorder rather than of male. The patients of
the study were of body mass index ranging from 26-28 which refer to the overweight characteristic of
the disease. 79.1% of the patients were having mild elevation in TSH level (6.1-9.2mIU/L), and 20.9%
of them were having marked TSH elevation (10.4-12.8mIU/L). Hypertension occurred in 44.2% of
patients, 68.4% of them were of diastolic type due to that in hypothyroidism, the smooth muscles of the
blood vessels are contracted forcing the heart to push the blood through smaller openings in the vessels
resulting in raising the diastolic blood pressure. Hypothyroidism can results in worsening of coronary
artery disease, as 23.3% of patients were having history of IHD. By examining the ECG of patients
involved in the study, 32.6% of them showed atrial fibrillation as hypothyroidism prolongs the cardiac
action potential resulting in ventricular irritability, premature beats and bradycardias. Examination of
Chest X-ray and Echocardiogram of patients of the study reveals that 30.2% of them were having
Cardiomegaly and pericardial effusion respectively due to increased capillary permeability, impaired
lymphatic drainage and enhanced avidity for salt and water. Lipid profile for all patients of the study
showed elevation in the levels of total cholesterol and triglycerides over the normal ranges, and normal
level of HDL.
Conclusion: Primary hypothyroidism occurred in old, overweighed females, and associated with
cardiovascular manifestations which may be the only manifestations of thyroid dysfunction.

Background: Several trials have compared (single chamber) ventricular pacing with dual chamber
pacing. Dual chamber pacing is believed to have an advantage over ventricular pacing.
Objective: The aim of the study was to determine whether patients with implanted pacemaker (PM) for
complete atrioventricular block (AVB) gain significant benefit from dual chamber compared with single
chamber ventricular demand.
Design: The study was cross sectional parallel, all results were expressed as means (SD); a P value less
than 0.05 were regarded as significant. Pair T - test was used to study all the variations. All data were
processed with SPSS 18.
Setting: Al-nasyria heart center, Dhyqar.
Patients; sixty patients with high grade AVB who already underwent permanent pacemakers implant
(single or dual chamber) were attending heart center for following up their devices.
Methods: the patients completed a (within-patient) comparison of symptoms, clinical finding,
programming data, and echocardiographic finding during long term dual (VDD, DDD) pacing and long
term ventricular demand (VVI) pacing.
Results: the study involved sixty patients, 23(38.3%) were males and 37(61.7%) were females. Thirty
three (55%) patients had dual and twenty seven (45%) patients had single chamber PM. 36(60%)
patients were hypertensive while 23.3(14%) patients were diabetic and the number of the smokers was
only 7(11.7%). Majority of the patients from both groups lied within the age group (40-80y). The most
common indication was complete heart block. The incidence of symptoms, systolic (but not diastolic)
BP, and echocardiographic characteristics in both groups were parallel.
Conclusion: In patients with advanced AVB, there was no superiority of dual over single chamber PM
concerning symptoms, systolic (but not diastolic) BP, programming data, and echocardiographic
characteristics.

Vulvar pruritius is a common complaint in females of all ages. However, little has been published on
pruritius vulvae in children as a primary symptom. A total of 70 cases of pre pubertal girls collected
from private clinics, aged 8 months to 9 years at the time period from June 2009 to January
2010.History was taken regarding family history, economic state, present history and presence of other
diseases. The chief complaint of them was pruritius vulvae ,from which 20 cases (28.57%) had
dysuria, as well as clinical examination reveled; redness of vulvae was found in 48 cases (68.57%),
vaginal discharge in 10 cases (14.28%) and vaginal bleeding in two case( 2.8%).Vulval and perianal
Molloscum contagiosum lesion in 8 cases (11.4%)while the least vulval and perianal genital warts in
(7.1%).On laboratory diagnosis using tape test searching for pin worm ova ,only30cases( 42.9%) out of
the 70 cases had positive result. Gram stain of swabs have been taken from the 10 cases of vaginal
discharge who were suspected sexually abused children reveals gram negative diplococcic of gonorrhea
in 6 cases and demonstration of pseudohyphae on the smear was taken from the red vulvae on 4 cases.
Isolation and identification of bacterial isolates were found in 18 cases, and Candida species in 4
cases. The most frequently isolated bacteria were Streptococcus faecalis and Neisseria gonorrheae in
6cases (21.4%), Escherichia coli 4cases (14.3%), Staphylococcus aureus 3cases (10.7%), Streptococcus
agalagtiae and Streptococcus pyogenes 2cases (7.1%) for each, Proteus mirabilis 1case (3. 6%) and
Candida spp.4cases (14. 3%).

A total of 60 samples from patients with postoperative wound infection were included in this study.
Only 50 (83%) patients with positive bacterial culture and 10 (17%) patients with negative culture.
Different types of bacteria were isolated from post-operative wound infections. The predominant bacteria
for gram negative was E. coli. In this study (13) isolates of E. coli were identified (37.14%) followed by (6)
isolates of Proteus vulgaris (17.14%), while (5) isolates of Enterobacter cloacae (14.28%) were found, (4)
isolate of both Klebsiella pneumoniae (11.42%) and Pseudomonas aeruginosa (11.42%) were found, (2)
isolates Acinetobacter spp. (5.7%), and (1) isolated of Citrobacter spp. (2.85%) were isolated. All isolates
were subjected to produce colanic acid extracellularly. It was found that colanic was produced at high level
by Klebsiella pneumoniae (97 μg\ml); followed by E. coli (82 μg\ml) and then Enterobacter cloacae (73
μg\ml), whereas Acinetobacter and Citrobacter produced this acid sugar at low level (16 μg\ml) and (4
μg\ml) respectively, on contract to Proteus vulgaris which failed to produce it extracellularly. Cytotoxic
necrotizing facter-1 gene obtained from E. coli was used as PCR marker for detection of CNF-1 in E. coli
and other gram negative bacteria which are isolated in the present study. Besides, this factor was detected in
whole DNA genome and also in DNA plasmid. It was observed that amplicons were found in all bacterial
DNA extracted from E. coli, Klebsiella, Enterobacter and Proteus. At the same time, amplicons were
detected in plasmids extracted from Enterobacter and Proteus.

In this study 180 endocervical swabs were taken from women attending to Babylon Hospital for Maternity
and Children in Hilla city suffering from cervicitis.They divided into two groups: 90 samples taken from
IUCDs users and the other 90 sample taken from non-IUCDs users.
The study showed that the rate of infection with N. gonorrhoeae and E. coli in women with IUCDs was
less than women without IUCDs and the most common age group of women with IUCD was (31-35) year.
The rate of infection with Actinomyces was higher in women that used IUCDs in comparison with
women that not used IUCDs,there for we can regard the IUCDs preferable to use in women exposed to
infection with N. gonorrhoeae ,as well as we should advice to use the IUCDs in women that in age group
35 year and more.
N. gonorrhoeae isolates were subjected for antibiotic susceptibility test. It was seen that all isolates were
sensitive to Ceftriaxone and in lesser degree to Cefixime and also isolates showed resistance to
Tetracycline.

The present study included 152 samples collected from different clinical cases and environmental
samples in Hilla General Teaching Hospital during the period from October 2010 to January 2011. The
age of the patients ranged from (6 to 65) years. The samples were immediately inoculated on
pseudomonas isolation agar plates. All plates were incubated aerobically at 37ºC for 24-48 hrs. Results
of morphological and biochemical characterization tests revealed that only 48(31.57%) isolates were Ps.
aeruginosa, while other 104(68.43%) represented other bacterial genera. Antibiotic susceptibility test
for all the isolates was determined by using disc diffusion test (DDT) and rapid iodiometric methods.
The results showed that, the Ps. aeruginosa isolates were fully resistant (100%) for each the following
antibiotics; ampicillin, Cefotaxime, chloramphenicol, penicillin, doxycycline, and Erythromycin, while
they exhibited moderate resistance to Amikacin 19(39.5%), ciprofloxacin 15(31.26%) and Polymyxine
29(40 %), and were sensitive to Pipracillin, Ticarciline in a percentage rate(20.08%)for each antibiotic.
The bacterium was found to carry beta lactamase enzymes with high rate of resistance (66.6%).

Degenerative lumbar stenosis is a common source of pain and disability in middle age and elderly. It presents
clinically with a variety of symptoms, though neurogenic claudication is the hallmark. There is a
multifactorial pathogenesis to lumbar spinal stenosis and its symptoms. Epidural steroid injections are
commonly utilized to help reduce radicular pain in lumbar spinal stenosis. It can be accomplished by one of
three methods: caudal (C), interlaminar (IL), or transforaminal (TF).
In this study we sought to determine the efficacy of fluoroscopically guided caudal and transforaminal
epidural steroid injections for the management of radicular pain associated with lumbar spinal stenosis. The
outcome measures of this study are patient satisfaction, pain relief, improved function and walking tolerance.
Of 42 patients included in this study 71.4% of the patients had partial to complete pain relief at 1 month
compared to 57.1% at 6 months and 45.2% at 12 months. 64.2% had full or improved function at 1 month
compared to 50% at 6 months and 33.3% at 12 months. 66.6% of the patients were completely or somewhat
satisfied at 1 month compared to 59.5% at 6 months and 38% at 12 months.
When weighing the surgical alternatives and associated risk, cost, and outcomes, lumbar epidural steroid
injections are a reasonable nonsurgical option in select patients especially in those patients who are unwilling
to do surgery or in whom surgery is contraindicated.

Objective: the calcium score is the best predictor for the coronary artery disease.
Patients: Fourty eight patients admitted to Al-Hussain General Teaching Hospital and to the Iraqi
medical center in karbala, and 18healthy controls were included in this study which lasted from
November/2010 to September/2011. The patients included 34males and 14 females, their ages ranged
from 19-84 years, witha mean age of 58.63 years. Those patients were divided into male and female
subgroups.As well as, the healthy controls were matched in age and sex with them.
The patients are classified in many groups according to the risk factors The ages of these groups are
divided as follows: the first group (30-50 years) ; the second group (≥51years) .
Results: This study demonstrated that The calcium score and the biochemical parameters (lipid profile
&glucose level), have highly significant to the coronary artery disease (p<0.000 ) and have also a
significant correlation between calcium score and dyslipidemia( p<0.001 ,p<0.002 ) according to the risk
factor taken, also shows significant increment in comparison with healthy controls ( p<0.000).
Calcium score have significant correlation with the age, weight &lipid elements p<0.000 that is reflected
the increasing incidence of the coronary artery disease with age and with the increasing the body weight
specially the central obesity.
The distribution of the coronary artery calcification is more frequent in the male sex than in female
(p<0.005).
Regarding the diabetes mellitus which has important changes in the Ca++ score & the biochemical's
results since there is strong correlation with Ca++ score & the dyslipidemia and then coronary artery
disease( p<0.000) while in non diabetic this is excluded.
In ex smoking have significant correlation between the Ca++ score and the coronary artery disease in
addition to that there is more strong correlation if there is association between ex smoking & diabetes
mellitus same thing apply to the lipid parameters in this group (p<0.007).
Coronary computed tomography with +ve result show very high significance with Ca++ score in
comparison to the normal coronary arteries which indicate the accuracy of the computed tomographic
angiogram in prediction of the coronary calcification & in turn coronary artery disease( p<0.000).
Conclusion:In view of the changes summarized, the presence or absence of the coronary calcification by
computed tomographic angiogram and biochemical parameters changes may be attributed to prediction of
the coronary artery disease due to atherosclerosis which arises mainly due to increase of accumulation of
the risk factors.

Background: Adolescent suicidal behavior is a neglected public health issue especially in middle and
low-income countries.
Objectives: The objectives of this study were to examine the prevalence of suicidal behavior among
secondary school students in Kut City and to identify some variables that might be associated with
suicidal behavior.
Methodology: A cross-sectional school-based study of 1067 students. Data were collected using the
supervised self-administered questionnaire based on a Global School-based Student Health Survey
‘‘GSHS’’ questionnaire.
Results: 8.3% (89 out of 1067) of the students had suicidal behavior (suicidal ideation and attempts).
Factors significantly related to adolescents’ suicidal behavior are [depression includes : feeling of
loneliness, felt sad or hopeless], anxiety, poor school grade, and subjected to corporal punishment at
home.
Conclusion: The suicidal behavior of adolescents may be influenced by psycho-social, educational
factors such as poor mental health, poor school grade, and subjected to corporal punishment.

Ninety five tonsil specimens and blood samples were collected from patients suffering from chronic
tonsillitis who had attended Al-Hussain General Teaching Hospital in Karbala during the period from
October 2010 to January 2011.The age of the patients ranged from (2 to 37) years. The biopsies were
immediately kept in 10% formalin. Blood samples (2-5)ml were separated into 2 parts for serological
analysis and lymphocyte studies.
Results of cytological test were revealed that from 80 tonsils biopsy,30 samples showed EBV
pathogenic changes (infectious mononucleosis)IM characterized by large nuclei in the lymphocytes as
the main characteristics of EBV infection, While 50 samples showed no IM.
Results of serological tests were included the ELISA technique which used IgA kit revealed that the
immune response to EBV showed each response to primary exposure during early childhood and
continued with life due to continuous activation of latent virus that was possibly related to recurrent
tonsillitis.

The study was performed to determine the effect of Sildenafil in treatment of pulmonary
hypertension in congenital heart disease for children following (15, 30, 45, 60, 75, 90)day
administration of (0.2, 0.4, 0.6, 0.8, 1) mg/kg/dose- 6 times daily. Resulting in a significant
decrease (p<0.05) in Pulmonary Artery pressure and Tricuspid pressure and a significant increase
(p<0.05) in percent of oxygen saturation in the blood and Pulmonary Artery Acceleration Time.
Result of this study says that sildenafil has a great effect in treatment of the secondary type of
pulmonary hypertension and has negligible effect on primary pulmonary hypertension.

Background: Smoking is an established risk factors for many diseases and is one of the most
important public health problems worldwide. The WHO has stated clearly that health professionals
can have a significant influence on the smoking habits of a community.
Objectives: To determine the prevalence of cigarette smoking among healthcare providers in Al-Hilla
city and the association between smoking and different variables.
Methodology: A cross-sectional study was done from April, 2011 through May, 2011 in three major
hospitals and four primary healthcare centers in Al-Hilla city. Data collection was done using an
anonymous, self-administered questionnaire.
Results: The study included 545 health care professionals. The mean age and standard deviation of
the study group is 35 ± 9.7. The male:female ratio is 2.2:1. The prevalence of current cigarette
smokers among male physicians, pharmacists, and paramedics are 30.9%, 40%, 23.4%, respectively.
The overall prevalence among male health professionals is 26%. While the current cigarette smoking
rate is 1.6% among female healthcare providers. Sixty four percent of smokers started their cigarette
smoking habit at the age range 10-20 years. About 1/3 of them smoke one cigarette pack or more per
day (heavy smokers). And half of them smoked for more than 10 years. 1/3 of the study group had
participated in seminars or courses against smoking habit.
Conclusion: in conclusion, we found that the prevalence rate of cigarette smoking was higher than
expected for persons who understand the related problems of smoking.

This study was designed to investigate the changes of some biochemical parameters in patients with
pulmonary tuberculosis in Babylon province. Ninty patients with pulmonary tuberculosis (45 males and 45
females) and 40 healthy controls (20 males and 20 females) included in present study. Patients were
classified into 3 groups: group1 included newly diagnosed patients, group 2 included patients after two
months from starting treatment and group 3 included patients after six months from starting treatment. The
mean age was 44 ± 2 years for patients and 42 ± 2 years for the control. It has been found that values of Creactive
protein (CRP), calcium and sodium for males zinc for both sexes were insignificantly changed but
for CRP, calcium and sodium for females were significantly changed in group 1 in comparison with group 2.
Values of zinc for both sexes were insignificantly changed while values of CRP, calcium and sodium for both
sexes were significantly changed in group 1 in comparison with group 3. This study showed that values of
CRP, calcium, zinc and sodium for both sexes were significantly changed in group 1 in comparison with
healthy controls. Values of zinc and potassium for both sexes, calcium and sodium for females were
insignificantly changed while values of CRP for both sexes, calcium and sodium for males were significantly
changed in group 2 in comparison with group 3. This study showed that values of potassium for both sexes
were insignificantly changed while values of CRP, calcium, zinc and sodium for both sexes were
significantly changed in group 2 in comparison with healthy controls. The results proved that values of CRP
and potassium for both sexes, calcium and sodium for males were insignificantly changed while values of
calcium and sodium and for females were significantly changed in group 3 in comparison with healthy
controls.

This study was designated to estimate some clinical, biochemical and electrophysiological changes
in patients with diabetic peripheral neuropathy, since the changes in these parameters are important in
detecting, quantifying, identifying some possible risk factors and assessing patient’s response to treatment.
The study lasted from November/2008 to May/2009. The total number of study group was 225 persons who
fell into 105 patients and 120 controls. The patients were classified into two groups according to the type of
DM into: patients with type 1 DM (35 patients), their age range between 16-34 years and patients with type
2 DM (70 patients), their age range between 45-72 years. While control group was classified into diabetic
patients without neuropathy (60 patients), their age ranged between 18-52 years and normal healthy control
(60 persons), their age ranged between 18-70 years. The patients were recorded in Marjan’s teaching
hospital center of diabetes and had monthly visits. The patients and control were examined by specialist
doctors. The patients and controls enrolled in the study had undergone full assessment that included:-
clinical assessment (history and full examination), biochemical assessment (measurement of fasting blood
sugar, serum selenium and vitamin E), measurement of glycosylated hemoglobin and electrophysiological
assessment that included sensory and motor nerve conduction studies. Results of this study showed that
fasting blood sugar and HbA1c level were higher in patients with neuropathy than controls with statistically
significant differences (p<0.05) . While serum selenium and vitamin E level show significant decrease
(p<0.05) in patients with diabetic peripheral neuropathy than controls. Regarding electrophysiological
changes patients had shown significant increase in latency for sensory and motor nerves and significant
decrease in amplitude and conduction velocity for sensory and motor nerves in patients with peripheral
neuropathy than controls.
The study found out that hyperglycemia due to deficiency of insulin or resistance to its metabolic effect is
the most important and correctable risk factor for peripheral neuropathy, in addition to the role of
hyperglycemia, oxidative stress also plays role.

Back ground: Infertility is one of problems that affect women and one of its cause is increase androgen
level specially in women with Polycystic Ovary Syndrome (PCOS).
The aim is to assess the effect of metformin alone versus metformin with oral contraceptive and
antiandrogen on PCO patients.
Patients and method: The study was conducted in Babylon province,from the infertility center of maternity
and pediatrics teaching hospital. Women with PCOS were recruited from November 2008 to April 2009.
The subjects study consisted of (90) married women. (n=30) received metformin only. B.(n=30)received
Metformin+ ethinyloestradiol-cyproterone acetate(Diane)+cyproterone acetate (Androcur C. Thirty women
were normal, and fertile as a control group.
The results: The results show that the highest incidence of PCOS among adult women occurs in age group
(25-35) years and represent 58%, and 55% of patients have positive family history, and 65% of them had a
history of primary infertility and high geographical distribution of PCOS occurs in urban areas .Also there
is larger reduction in LH hormone in both treatment's regimes While in prolactin there is little increment
after (group B) regimes, this may be due to effect of Cyproterone acetate.
Conclusion: Our study showed significant response in both groups (more in group B)that support the effect
of metformin added to that of Diane together give a better response in PCO patients with moderate to sever
signs of hyperandrogenism.

The aim of this study is to investigate the changes of some hematological parameters in patients
affected with pulmonary tuberculosis in Babylon province. 90 patients with pulmonary tuberculosis (45
males and 45 females) and 40 healthy controls (20 males and 20 females) have included in present study.
Patients have been classified into 3 groups: group1 includes newly diagnosed patients, group 2 includes
patients after two months from starting treatment and group 3 includes patients after six months from
starting treatment. The mean of ages was 44 ± 2 years for patients and 42 ± 2 years for the control. This
study founded that values of Hb, PCV, platelets and ESR for both sexes were significantly changed in group
1 in comparison with group 2. Values of Hb, PCV, platelets and ESR for both sexes were significantly
changed in group 1 in comparison with group 3. This study has show that values of Hb, PCV, platelets and
ESR values for both sexes were significantly changed in group 1 in comparison with healthy controls.
Values of platelets and ESR for both sexes and values of PCV for males were insignificantly changed while
values of Hb for both sexes and values of PCV for females were significantly changed in group 2 in
comparison with group 3. This study showed that values of PCV for males were insignificantly changed
while values of Hb, platelets and ESR for both sexes and PCV for females were significantly changed in
group 2 in comparison with healthy controls. The results has proved that the values of platelets and ESR for
both sexes and Hb for females and PCV for males were insignificantly changed while values of Hb for
males and PCV for females were significantly changed in group 3 in comparison with healthy controls.

Background: Knee osteoarthritis (KOA) is considered a major cause of physical disability, and because its
prevalence increases with age, the coexistence with other chronic diseases is common making further
impact on health and lifestyle.
Objective: To find out the correlation and frequencies of comorbidities( obesity, hypertension, diabetes
mellitus(DM), dyslipidemia and metabolic syndrome) in patients with KOA ,to compare the result with
that of individual without KOA, and to study how could these components impact pain in patients with
KOA.
Methods : sixty five patients (40 females and 25 males) with symptomatic KOA were enrolled in the study
in period between March 2010 to May 2011 at rehabilitation and rheumatologic clinic of Merjan teaching
hospital . The OA was diagnosed according to American college of rheumatology criteria(ACR) and
according to Kellegren-Lawrence radiographic grade for OA , Grade 2+ (definite osteophyte) was used as
definition of KOA. Similar number of individuals without KOA nearly matched for age and gender were
selected as a control group. Full medical history and physical examination were recorded. Body mass
index (BMI) ,waist circumference(WC), fasting blood sugar, total cholesterol, triglyceride, high density
lipoprotein( HDL) cholesterol, blood pressure were estimated for patients. and control groups.
Pain was measured in patients with KOA using visual analogue scale , (VAS).
Results: The frequency of co morbidities among patients with symptomatic KOA was as following:
obesity (55.38%), dyslipidemia (49.23%) DM (18.4%) hypertension (64.6%) and metabolic
syndrome(50.76% ).which were higher than control group.
Comparing these components patients with metabolic syndrome had higher pain impact measured by VAS
than patients without metabolic syndrome..
Conclusions: Metabolic risk factors or components of metabolic syndrome were associated closely with
KOA. Which need investigation, detection and early treatment when dealing with KOA.

Background and purposes:
lead aVR is an ignored lead in ECG, several studies showed that ST segment elevation in aVR
may predict left main stem or 3 vessels disease, and so suggest that ST- elevation in patient with acute
anterior myocardial infarction can be predictors for poor prognosis to confirm this; this study was
conducted.
Patients and Methods:
100 patients with acute anterior myocardial infarction were divided into two groups;1st group had
ST-segment elevation in lead aVR more than 0.5 mv and other group had no ST-segment elevation in
lead aVR. All patients were followed in hospital staying through history, examination ,and
investigations for risk factors of coronary vascular disease ,complications, and mortality.
Results:
ST-segment elevation in lead aVR was an important predictor of occurrence of adverse prognosis,
it occurred more in patients with increasing age. Also it occurred more in patients with more risk
factors for coronary vascular disease including diabetes mellitus ,hypertension ,smoking, and family
history of ischemic heart disease.
The study found that the occurrence of complications like shock, post myocardial infarction
angina, heart failure, arrythmia were more in patients with ST-segment elevation in lead aVR . It was
also found that mortality rate in patients with acute anterior myocardial infarction with ST-segment
elevation in lead AVR of more than o.5 mv was higher than patients without ST-segment elevation in
lead AVR.
Conclusion:
The results of this study showed the significance of ST-segment elevation in lead aVR as important
predictors of occurrence of complications in patients with acute anterior myocardial infarction and
determination which patient require more intensive care and early referral to invasive treatment.
Key words: acute anterior myocardial infarction ; lead aVR, electrocardiography

s affected by the total state of the learner
A training program must be organized so that students can acquire their professional skills under conditions similar to those in which they will later practice.
Teaching requires interactions between teacher and student under the teacher`s responsibility in order to bring about expected changes in the student`s behavior.