The Medical Journal of Tikrit University

Hepatitis B is a global infectious disease with estimated two billions of the world population have
contracted the infection, of them there are 350 thousand with chronic infection. Hepatitis B disease may
lead to state of chronic carrier, liver cirrhosis and failure or hepatocellular carcinoma. This study aimed
to determine knowledge, attitude and practice of health workers and their vaccination status against
hepatitis B. This was a cross-sectional study which involved 48 medical staff and 60 paramedical staff,
data collection was performed by a suitable self-administered , close-ended questionnaire. Medical staff
members had better knowledge about hepatitis B than the paramedical staff. The positive attitude
toward vaccination among the medical staff is more than that of the paramedical staff ( 36 members
versus 28 members respectively). There are 27 of the medical staff and 13 of the paramedical had a
complete vaccination, the others either they did not receive the vaccine at all or they had incomplete
schedule

Leptin, a protein secreted by white adipocytes, plays a relevant role in the regulation of body weight and food intake. During pregnancy, leptin seem to act in an autocrine/paracrine fashion in the placenta and adipose tissue, playing a role in the maternal-fetal interface and contributing to glucose metabolism and fetal development. Leptin level, BMI, glucose and lipid profile were measured in 30 gestational diabetes mellitus and 30 non-diabetic pregnant women from January 2010 to June 2011. Blood samples were collected of the 1st, 2nd and 3rd trimester of pregnant women. Correlation measured between leptin level with BMI and lipid profile. Leptin level increased significantly (P < 0.01) in diabetic pregnant women during the three trimesters compared to the non-diabetic pregnant women. There was a positive correlation leptin level with BMI and lipid profile (except HDL-cholesterol) which increased in diabetic pregnant women. These increased in leptin level in diabetic pregnant women due to insulin resistant and hyperinsulinemia in gestational diabetes mellitus.

To compare the efficacy of oral dydrogesterone with that of vaginal micronized progesterone gel for prevention &treatment of threatened preterm labour. A total of 100 pregnant lady were divided into two groups, one group had received oral dydrogesterone and the other group had received vaginal micronized progesterone gel, selection criteria included: pregnant ladies with singleton viable pregnancy between 24-36 completed weeks of gestation with intact membranes. Demographic profile with pregnancy length &neonatal outcome.Vaginal micronized progesterone gel was more effective than oral dydrogesterone regarding prolongation of pregnancy and neonatal outcome. 9(18%) versus 14(28%), 5(10%) vrsus 8(16%) respectively. Conclusion:-Vaginal micronized progesterone gel deems promising drug for prevention and treatment of threatened preterm labour, although, further studies are needed to confirm our study fmdings.

The Measles vaccination is one of most effective vaccine that exist ;one jab is enough to protect for life. It is also thought to be the most cost-effective public health intervention in the world, which is why, it is used as a component of the MMR vaccine to this day. The World Health Organization (WHO) applied the vaccination schedule in major developing countries as follow: Measles vaccine at 9months, single dose of MMR vaccine at 18months & booster dose for <59months. In Iraq, after 1990 vaccination coverage declines gradually due to international sanction, no reliable data are available to show current level of immunization coverage. Official reported data in 1990 tends to overestimate coverage. Information on immunization coverage is used for a variety of purposes; to monitor the performance of immunization services at local, national & international levels, an accurate historical representation of immunization coverage is important to assess trends in immunization system performance, to better establish the relationship between immunization service delivery & disease occurrence to provide aframework for setting a future goals for coverage a achievement. A cross-sectional descriptive study done in Tikrit district- Salah aldeen government in Tikrit city. An official agreement taken fro m the manager before starting data collection from the records(from Jan. 2008- Dec. 2010) in department of health protection. Our research study was located in Tikrit district- Tikrit city, which is, the biggest city. The region is heterogeneous. The region still receives a high rate of immigration from different parts of the country. The annual —total population/ year for Tikrit district in Salahaldeen among routine immunization group of (1-2) years old children of MMR vaccination coverage were 67.8%, 127% & during 2008, 2009 & 2010, respectively. There are discrepancy in available data although in 2010 Apr. 0(0%) from total vaccination group & Jun. 716 (109.3%) which exceeds the total number of monthly target coverage rate (602). All the results obtained from MMR vaccination campaigns carried out in salahaldeen government accepted, achieved the goals of MOH This clue a good acceptance for vaccination from the community . There are (may be), some explanation for this discrepancy in that ,most vaccination teams did not scrutinize properly the previous vaccination status of the children, so extra efforts demand to channelize information, education, administration in order to achieve the desired vaccination coverage.

Diabetes Mellitus is a global disease with extreme effect on the quality of life of affected patients. Across- sectional study was conducted in Kirkuk General hospital and Azadi hospital from the period of beginning of January 2012 to the end of March /2012. The aim of the study was to determine the diabetic patients knowledge regarding its definition, causes, signs and symptoms, duration of illness, and treatment therapy and to found any relation between educational level and their knowledge concerning dietary habits of the disease. The study found hat most of the patients aged between 60-69 years (43.5%) with 6-15 years duration of illness and they on Insulin therapy (54.3%). Diabetic knowledge regarding its definition, causes and signs and symptoms was above cut- off point and there is a strong relation between educational level and their knowledge about dietary habits of the disease.
Conclusion, there are quite deficient in Diabetic knowledge and there was a socio-demographic factors affecting their knowledge. The current study recommended that an effective educational program regarding the dietary habits of the disease.

Objectives: The aim of this study is, to evaluate the frequency of p53 over-expression in ' urothelial carcinoma of the bladder, to correlate the over-expression with age and sex of the patients, and grade and stage of the tumor, and to compare the results with those of others.
Methods: The study was performed on 50 bladder cancers. Samples were obtained in a prospective and retrospective fashions (case series study). The samples were collected from Al-Jumhuri Teaching Hospital, during a period of 8 months from July 2011 through February 2012.
Results: The patients' age was in the range of 23 to 91 years with a mean of 62.64 year. Most of them were in the seventh decade (42%). P53 immunoreactivity was observed in 34% of the total cases, it was positive in 7/11 of PUNLMP cases, 6/23 of low grade cases, and in 4/15 of high grade cases, and was negative in the only case of papilloma. It's positivity was observed in 7/14 of cases with Ta stage, 5/ 21 of Ti stage, in 4/ 11 of T2 stage, and in 1/ 2 of Tis stage. It was negative in the 2 cases of T4. Statistically p53 over-expression was not significantly related to the age and sex of the patients, and grade, and stage of the tumors. It was mainly found in the 7th decade of life (41.2%), in males (88.2%), in PUNLMP grade (41.2%), and in stage Ta (41.2%).
Conclusions: P53 was over-expressed in 34% of urothelial carcinomas of the bladder, predominantly in PUNLMP (41.2%), followed by low grade tumors (35.3%), and high grade tumors (23.5%), while it was negative in papilloma. Statistically, p53 over-expression was neither significantly correlated with the age and sex of the patients nor with grade, or stage of the tumors.

Colorectal cancer is one of the most frequent cancers in the world. Colorectal cancer is the result of genetic and epigenetic alterations that cause disorders in cell growth, differentiation and apoptosis, resulting in transformation of normal epithelium to adenocarcinoma. Expression of Bcl-2 gene is believed to enhance tumor progression by countering apoptosis triggers, resist DNA damage-induced apoptosis, and undergo growth arrest in GO/GI or G2/M phases, which promotes tumor cell survival and oncogenic progressions, and may inhibit cell growth and proliferation. To evaluate Bcl-2 oncoprotein expression in colorectal epithelial neoplasms, to correlate the Bcl-2 immunopositivity with certain clinicopathological parameters and to compare the results with other studies. This is a cross sectional study of 50 cases of colorectal adenocarcinoma and 10 samples of colorectal adenomatous polyps. The samples were collected from Mosul Hospitals and some private lab. Patient's age and sex in addition to the site of the tumor was obtained from the archival histological reports. Hematoxylin and Eosin stained section from each case were revised regarding the histological type, grade and stage of the tumor. Immunohistochemical stain for Bcl-2 oncoprotein was performed. The staining assessment of Bcl-2 was done by using a semi-quantitative immunostaining score (ISS) for Bcl-2, taking both intensity and the percentage of stained cells to obtain an IS score that ranged from 0 to 4.0. The mean age of all cases was 53.8 years The Fifth decade takes the peak incidence, followed by the seventh decade. Male to female ratio was 1.4:1. Microscopically, 45 (90%) of cases were classical adenocarcinoma, 2 (4%) were mucinous adenocarcinoma, 2 (4%) were signet ring carcinoma and 1 (2%) was neuroendocrine carcinoma. Eight (16%) were well differentiated classical adenocarcinoma, 22(44%) were moderately differentiated, and 15(30%) were poorly differentiated tumor. Duke's staging, 1(2%) case was Duke's A, 18(36%) cases were Duke's B, 25(50%) cases were Duke's C and 6(12%) cases were Duke's D. The Bcl-2 Positivity was observed in 38% of colorectal carcinoma. No significant correlation identified between Bcl-2 expression and the patient's age and sex despite the finding of predominance of Bc1-2 immunoreactivity in young age group and in female. Bcl-2 positivity correlates significantly with the macroscopic type of the tumor with highest positivity in a polypoidal tumor. Bc1-2 expression seen only in colorectal adenocarcinoma classical (NOS) type, while it was negative in other types (p=0.045). An inverse significant correlation between Bc1-2 expression and histological grading was reported where Bcl-2 was reported mainly in well and moderately differentiated tumors (42.1 % and 52.7% respectively). No significance correlation identified between Bcl-2 expression and tumor Duke's stage.
Conclusion: Bc1-2 expression was found in 38% of cases. It was significantly correlated with tumor macroscopic types, histological types and grade. No correlation found between Bcl-2 and age, sex, site and stage of the tumors.

Objectives: To assess the gender and age distribution related to deformities & risk factors of osteoarthritis among patients in Salah aldin governorate.
Methodology: A 1668 knee joints of 1000 patient comprised in the study. All patients underwent full history, complete rheumatic clinical, radiological & laboratory examination to assess the demographic criteria and knee joints deformities. Age grouping was done in assessing various deformities.
Results: The age distribution in this study show that most of deformities develop after the age of 50 years and the females are predominantly affected 676(67.6%) while males were 324(32%). The rural inhabitant people were 718(71.8%) while those lived in urban 282(28%).; In this study the Genu varus deformity were 877(52.6%) knee joint, fixed flexion deformity were 556(33%) knee joint.
Regarding to the causes & risk factors of OA of the knee joint obesity were 326 (36.5%) of patients, traumatic injuries or fractures 23 (11.6%), genetic factor 114 (28.5%), inflammatory arthritis 9 (7.8%) and others.
Conclusion: Females affected twice more than males with OA of knee and its disabilities. Obesity is serious contributing factor. Genu varus are a significant deformities and then fixed flexion deformities specially in post-traumatic, post inflammatory process & knee instability syndromes or meniscus tear.

This is a case control study which included (40) patients with Balanitis Xerotica Obliterans (B.X.O.), from the 3rd of Feb. 2009 to the 3rd of Sept. 2011,(25)patients (Group A) were treated with topical Floucinolone Acetonide (0.025%) cream , the other (15) patients (Group B) did not receive any treatment. All patients were followed up for (30) days, in (Group A) 18(72%) patients showed an improvement in their symptoms and 20(80%) patients had a higher urine flow rates than before treatment, but those patients in (Group B) showed no improvement or became worse. 

Thyroid carcinoma (TC) is a relatively rare tumour, but it represents the most frequent form of cancer of the endocrine glands. Epidemiologically ascertained risk factors are ionizing radiation, the presence of thyroid adenoma, multinodular goiter (MNG) and family history of thyroid cancer, and personal history of goiter or thyroid nodule. We conducted the study to ascertain multinodularity of goiter should no longer be considered an indicator of probable benign disease. A cases series study was performed on patients operated of MNG at the Unit of surgery in AL jumhoory Teaching Hospital, AL Salam Teaching Hospital and at AL Zahrawy private Hospital (Mosul) from 1st May 2007 to 1St June 2011. The results of this study, demonstrate that in 18.3 % of the patients operated for MNG, the presence of a carcinoma was noticed in the definitive histopathological examination. Such incidence percentage of MNG is in accordance with the data reported in published reports. Thus, the authors conclude that the risk of malignancy in MNG has not to be underestimated (chi square test not significant at p value < 0.05), and that a dominant nodule in MNG should be valued as if it were a solitary nodule in an otherwise normal gland.

Background: Headache is the most common reason for seeking medical help. In fact there approximately 13 million visit each year in the United States to physician office, urgent care clinic and emergency department. Migraine affect about one in ten of population at some time of life.
Aims: Are to determine the prevalence rate of headache among students at Kirkuk University as defined by International Headache Society (IHS), and to identify symptoms that accompany the attack of headache and the effect of headache on student's college attendance.
Subjects and Methods: After taken the agreement of department of community medicine: about 1140 students ( 26% of the total university students),chosen randomly; across-sectional study was done during the academic year (2010-2011).A special questionnaire form designed and consist demographic data questions about headache and associated symptoms and possible effect of headache on university attendance was recorded.
Results: About 39.1% of the study sample had headache episodes unrelated to febrile illness in the year preceding the survey. The prevalence of migraine headache as well as non-migraine headache was higher among females than males' students and also higher among age group 19-21 years. Approximately more than one third of them were absent from the university due to headache.
Conclusion: Headache is prevalent among Kirkuk's university students and higher among females and it affects their academic performance.

Background: In many developing countries the haemoglobinopathies form a major genetic problem and many thalassemia persons frequently suffer through all their life and may die unnecessarily from thalassemia, in addition to the lifelong treatment costs and the invasive interventions. The objectives of this study are to highlight the impact of thalassemia major and its management in Ninevah Governorate, to analyze the cost of caring for children with 13-thalassemia major in Mosul and to dig for the socio-economic consequences of this preventable health problem. Methods: The data were obtained partly in a straight line to thalassemia center records. A cross-sectional survey of 292 13-thalassemic patient's through a direct face-to-face interview using specially designed simple open-ended questionnaire instrument. Results: The total number of 13- thalassemia patients registered in our province is 1028 patients, 50 to 76 children born as (3-thalassemia per annum and average 13 deaths /year. About 80% of them are children <15 years, relatively low socio-economic population status. 84.9% of the surveyed families had mis-knowledge or no knowledge about the disease causation, 90.4% of them did not expect the disease occurrence, in spite of 89.4% of them have heard about this disease. Marriage among relatives was prominent. Almost one third of studied thalassemic patient's families' fall below line of poverty that is beside the terrible sociological and emotional possessions upon family. Each thalassemia patient cost the health institution $4320055 as a total average direct medical cost / annually. Conclusion: The majority of thalassemic patients are relatively of low socio-economic status. Most of the surveyed families were in need for authentic information about disease causation. Almost one third of thalassemic patients families in our province fall below the line of poverty. The average cost of management bypasses the cost of prevention by 196 times. All these necessitate the setting up of a supported optimum treatment, community education and routine premarital screening for thalassemia.

The prevalence of Celiac disease(CD) ,Thyroiditis in 120 Iraqi child and adolescence with type one diabetes (T1DM),age 2-18year old, with 67male(55.83%) and 53 femal(44.16%),selected from Almansor Hospital for children,their serum samples were analyzed in the immunology and biochemistry departments of the Central public health laboratory in Baghdad to detect any significant antibodies titer related to T1DM,CD,and thyroiditis .The percents of autoimmune T1DM,CD, Thyroditis were found to be 70.83%,15.83%,9.16% respectively. Celiac disease (CD) is one of the most frequent autoimmune disorders occurring in T1DM, the clinical presentation of CD in T1DM is classified as Symptomless in approximately half of cases, but a more accurate analysis often discloses a wide array of symptoms suggestive of CD.. The thyroid is a frequent target of autoimmune problem,Hashimoto's thyroiditis and Graves' disease are two of the most common autoimmune diseases.Recently Autoimmune polyendocrine Syndromes (APS), also referred to as Autoimmune Polyglandular Syndromes, are a family of diseases that involve several endocrine organs becoming deficient as a result of the failure of the immune system to properly distinguish between self and enemy. Patients with APS are diagnosed based on the co-occurrence of several diseases, such as T1DM disease, thyroiditis, CD, and others which taken together indicate that there has been a large scale failure of the immune system. The three conditions shows the same genetic background. screening for CD, thyroditis, should be performed in all T1DM patients by means of tissue transglutaminase auto-Ab(anti-t TG auto- Abs) , antigliadin autoantibody(antiGL Abs), antithyroid-peroxidas-autoantibody (antiTPO), antithyroglobulin-autoantibody-(antiTG). wh le, T1DM-autoAb(anti-insulin,anti-glutamic-acid-decarboxylase'anti-GAD',anti-pancrease,anti-tyrosine-phosphatase-autoantibody'anti-IA2'). T3, T4, & TSH measurements revealed abnormal values in 24 samples where only three of them showing increased antiTG, antiTPO antibodies Objectives ;To shade a light on the prevalence of thyroiditis and celiac disease in 120 diabetic type one Iraqi children .SETTING; Central public health laboratory(CPHL)-Iraqi ministry of Health. Patients & Methods; 120 diabetic type lchild and young adolescents from almansor hospital( aged 2-18year with 67male and 53 female)were screened for DM,CD, Thyroiditis autoantibodies titers using ELISA-system except for antipancrease autoantibody in which we used IFAT principal. T3,T4,TSH were measured in all samples using radioimmuno assay principal through gamma counter system. Results; From 120, only 91 samples shows positive autoantibodies (62 of DM,13of both DM and CD,9 of both DM and Thyroiditis, one for DM'CD' and Thyroiditis,5 for CD only, and in the last sample we found only autoantibodies concerned with thyroiditis). The remaining 29 cases doesn't explore any antibodies. Conclusion; There are an increased association of autoimmune disorders among T1DM.

The cross sectional study was designed to investigate the effect of antioxidant therapy vitamin C 500mg daily dose on prehypertension patient (systolic blood pressure 120-139 and diastolic blood pressure 80-89mmHg) for nine months. The study was performed on 100 patient in both male and female.
The result of this study shows that vitamin C was significantly decreased systolic and diastolic blood pressure after six and nine months of treatment.
There is some side effect appear in some patient during the course of study as nausea, vomiting, heartburn, fatigue, flushing, headache, insomnia, diarrhea, drowsiness.

Schools are considered as one of the sources of health education and information to the students and to the whole community. Teaching institutes are considered as the foundation that builds the teachers who will build the coming generations. So it is necessary to study the presence of Risky Health Behaviors among Students of Teaching Institutions in Tikrit City. In Iraq, no available data or previous studies about health risk behaviors and protective factors among adolescents have been executed. This is a pioneer study in this time and field. This study was done to provide data concerning knowledge, attitude and practices of risky health behaviors & protective factors among Students of Teaching Institutes in Tikrit. A descriptive cross-sectional study carried out on simple randomly selected (231) students, in Tikrit from 20/11/2006-2013/2007 by using a modified questionnaire according to Iraqi circumstances for male and female teaching institutes in Tikrit city. A sample of 231 secondary school students was studied, of which 69.5% were 16 years and older. Nineteen percent (19.48%) of students were from families displaced due to sectarian causes. It is found that 125 (54%) of the students were of urban residence. It is also found that none of the students in the female institute were smokers, nor tried alcohol and drugs, but that a significant number of students in the male institute did (28.6%, 11.4%, 2.9%, and 12.4% respectively). The study concluded that risky health behaviors are prevalent among teaching institutions students in Tikrit.

To evaluate the diagnostic and prognostic significant of CA 125 test , within a fallow up of three months , and its role for monitoring response to treatment by chemotherapy . To evaluate serum C-reactive protein (CRP) as a prognostic variable in patients with ovarian cancer . This study was conducted in Mosul . Iraq from January 2007 through July 2009 . A sample of 44 consecutive women aged from (35-55 years) and suffering from ovarian cancer with control group of 45 women were included in this study . A pre-tested questionnaire was employed to obtain information on family history to this disease , laporatomy treatment if present , asking for benign disease of the uterus , liver and gastro intestinal tract and benign tumors of ovaries & uterus if present specially for control group . Physical examination by C.T. scans and ultra sounds were then done . Blood samples were collected for 89 women and measurement of CAl25 and CRP were performed . Serum from 44 patients participant were analyzed for CAl25 and CRP before and after treatment with chemotherapy and laporatomy if present at three months interval for fallow up mean ± SD for these patients before chemotherapy course was 78.42 ± 14.6 U/ml for CAl25 in which CRP concentration for 37 patients of this group at the same period of time was 96 mg/dl 84.1% (group 1) and the remainder 7 patients was 48 mg/di 15.9 % (group 2) . There was a significant differences for CAl25 value in patients before therapy and according to period of therapy at P<0.01 . CRP concentration was 96 mg/dl still high after one month of chemotherapy , its value was decrease in the second and third month of chemotherapy . Preoperative determination of CA 125 may play a good role the prognosis of post operative chemotherapy . It may be useful to included this test in the diagnosis of ovarian cancer with the help of physical examination in future .

Road traffic accident is considered as a major cause of death worldwide, it has been rapidly increasing to become one of the common causes of increasing mortality and morbidity in the population. A cross-sectional study for a 1 month period of all road traffic accidents and injuries was conducted in Emergency Hospital for the period 1st December 2008 to 1st January, 2009. A total of 180 injuries were encountered at the Emergency Hospital Department. The majority of victims were males, with a male to female ratio of 2.6:1. This study on road traffic accidents reveled that, out of 180 victims, 11% were under 10 years, 53.8% between 11 and 30 years and 41.1% were more than 30 years. Only 25% of those involved in accidents were wearing a seat belt. Most of the accidents and injuries occurred from 8.00 am to 4.00 pm (74%). Head injury was the most frequently noted type of injury (51.8%), followed by lower limbs injury (27.1 %), upper limbs (14.1%), chest (4.7%) and back (2.4%). Road traffic accidents are a major but neglected public health challenge that requires concerted efforts for effective and sustainable prevention. It is mostly affecting young age groups that need comprehensive health educations regarding safety measures of driving in addition to addressing road safety measures to policy makers.

Background: Estrogen have many important functions regarding the genital tract, central nervous system, the breast, the development of the secondary sex characteristics and many other functions the most important here is its effect on the bone by increasing deposition of bone and its role in epiphysial closure.
Aims: The aim of the study is to determine serum estrogen concentration in normal healthy non pregnant women in Tikrit city.
Subjects & Methods: This study was carried out during a period extending from January to July 2012 in Tikrit University. Two hundred normal healthy women were participated in this study, their ages from 20 up to 65 years. About five ml blood was drawn from each participant using a tourniquet, and then blood sample was put into plan tube without anticoagulant for serum separation. Serum estrogen was measured by using kit from Roche (Germany) which was used on cobas e 411 analyzers —disk system.
Results: The first group aged 20 to 29 years has a serum estrogen concentration of 939 ± 78 pg/ml, this group of women have the highest serum estrogen concentration as compare with other groups (P<0.01). Also, there is significant reduction in serum estrogen concentration in group aged 30-39 years (377.42 ± 28.4 pg/ml) as compare with group 20-29 years ( 939 ± 78 pg/ml). Moreover, there is significant reduction in serum estrogen concentration in group aged 40-49 years (168.07 ± 29.3 pg/ml) as compare with group 20-29 years ( 939 ± 78 pg/ml). Furthermore, there is significant reduction in serum estrogen concentration in group aged 50-59 years (53.16 ± 13.4 pg/ml) as compare with group 20-29 years (939 ± 78 pg/ml). Meanwhile, there is significant reduction in serum estrogen concentration in women group aged above 60 years (28.4 ± 7.4 pg/ml) as compare with group 20-29 years ( 939 ± 78 pg/ml).
Conclusion: The present study concludes that there is significant reduction in serum estrogen in women as advance in age. The most sever reduction in age group above 50 years. The present study recommend the followings;- Regular assessment of serum estrogen in women above 45 years & study the relation between reduction in serum estrogen & bone density in women.

Background: Infertility is defined as the failure of a couple to conceive after one year of regular unprotected intercourse. Infertility is a problem of global proportions. Several studies with questionable results have focused on the value of serum FSH and AMH to predict the status of spermatogenesis in the testes. Also, possible relationship between seminal plasma inhibin B and spermatogenesis in patients with azoospermia. Aim: The aim of the present study is to compare some serum biomarkers of infertile men with normal fertile men to find the significant value of hormonal assay marker in predication of male infertility.
Patients & Methods: A cross sectional study in which samples were obtained from urology clinic in Tikrit teaching hospital, private clinic, from 1-9- 2011 to 1-9-2012. Ninety subjects were participated in the present study (Fifty infertile men & forty fertile subjects). Semen parameters were measured for infertile men & control fertile men. Serum concentrations of FSH, LH, testosterone, AMH & prolactin were measured.
Results: There is significant (p< 0.01) reduction in sperm count, motility, viability of infertile men, as compared with same parameters of normal fertile men. Also, there is significant increase in serum MDA (6.811± 0.53 !Anal) in infertile men as compared with fertile men, (2.454 ± 0.54**). However, there is significant reduction in serum glutathione (p<0.01) in infertile patients (7.1 ± 1.2 !molt!) as compared with fertile men, (10.123 ± 1.21**). Serum FSH, LH, and testosterone levels were found significantly differences between infertile men (11.35 ± 2.4 mIU/ml, 9.956 ± 2.87 mIU/ml & 5.07 ± 0.62 ng/ml respectively) as compared with serum FSH, LH, and testosterone levels of fertile men (5.53 ± 2.3*, 5.973 ± 0.92** and 9.16 ± 0.749**) respectively. The present study show that there is significant reduction in serum AMH in infertile men (1.40 ± 0.11 ng/ml), as compare with fertile men, (4.17 ± 0.67). However, regarding serum prolactin, there is no significant differences between infertile men (4.26 ± 2.17 ng/ml) as compare with control fertile men (3.91± 1.52).
Conclusion & Recommendation: The present study concludes that there is significant reduction in serum testosterone & AMH of infertile men as compare with fertile men. However, there is significant increase in serum FSH & LH in infertile men. There is negative correlation between AMH & serum testosterone in infertile men. The present study recommend the followings;-
Proper selection of patients with respect to hormonal assays which reduces the costs and burden on the infertile patients, & the routine assessment of thyroid hormones and antibodies in infertile men are not recommended.

Background:- The chemical constituents of ginger classified to volatile oils (including borneol, camphene, citral, eucalyptol, linalool, phenllandrene, zingiberine and zingiberol penols (gingerol, zingerone and shogaol) and resin) which constitutes (1-3%) mainly of zingeberene nonvolatile pungent compounds oleo-resin constitutes (4-7.5%) mainly gigerols and other constituents with more than 50% of starch.
Aim: The aim of this study is to examine the effect of ginger supplements on semen parameters & serum FSH, LH, & testosterone & of infertile men.
Patients & methods: A longitudinal study comprised 75 infertile men, their ages from 19-40 years. All infertile patients were married for at least two years and had no children. The Study samples were obtained from infertile clinic in Tikrit teaching hospital, private clinics in Kirkuk city, from 1-10- 2011 to 1-5-2012. This study involves clinical trial by treating the whole infertile patients with ginger. At least 2-3 semen analyses were done during 3 months of treatment for each patient before making a final conclusion regarding the base line sperm parameters. Serum concentrations of FSH, LH & testosterone were measured using ELISA.
Results: There was significant (p<0.01) increase in sperm count of infertile men after treatment with ginger as compared with that before treatment. With a % of increase in sperm count up to 16.2%. Also, the study record a significant (p<0.01) increase in sperm motility of infertile men after treatment with ginger, as compared with before treatment with a % of increase in sperm motility was recorded was up to 47.3%. Moreover, there was significant (p<0.01) increase in sperm viability & normal sperm morphology of infertile men after treatment with ginger as compared with before treatment, with increase in percentage of sperm viability up to 40.7 %. The study observed a significant increase in ejaculate volume of infertile men after treatment with ginger, as compared with before treatment with a increase in percentage of ejaculate volume was recorded up to 36.1%. There is significantly (p<0.01) reduction in serum MDA & significant increase in serum glutathione (p<0.01) in infertile men after treatment with ginger as compared with before treatment. There were significant increases in serum FSH, LH & testosterone levels in infertile men after treatment by ginger as compared with before treatment.
Conclusion: The present study conclude that after treatment with ginger, cause a significant reduction in serum MDA & significant increase in serum LH, FSH & testosterone. Treatment with ginger increase serum glutathione & reduce serum & seminal fluid MDA.
The present study recommends the use of ginger by Iraqi community as a food additive.

Objective: To study the role of sildenafil on the echogenic pattern of endometrium in infertile patients with bad endometrium. Setting: Infertility center in Basrah Maternity and Children hospital. Design: Case control prospective study.
Methodology: 28 patients had primary or secondary infertility with mature Graffian follicle and bad endometrial thickness (control group) in the previous cycle . The same patients were considered as study group in the present cycle after giving them sildenafil citrate (Erasma) (Mepha company) 25 mg vaginally every 6 hours for 5 days from day 8th of the cycle and those patients were reevaluated by TVS (7.5 MHZ) at day 8th and 13 th of cycle for endometrial thickness and pattern with number and size of Graffian follicle.
Result : A total of 28 infertile women were included in this study. The control group had a mean of endometrial thickness of 5.21+2.8 mm at time of ovulation. There was statistically significant increase in the endometrial thickness from day 8th to day 13th in study group as compared to that of the same patients in control group and the difference is highly significant. Vaginal sildenafil increase endometrial thickness to >7mm in about 35.7% of patients in the study group without any side effect. 71.4% of patients in study group had hyperechogenic endometrium which was higher than those in the control group but the difference is statistically not significant and the percentage for those with isoechogenic is higher in control group compared to the study group.
Conclusion: Vaginal sildenafil was significantly effective in improving endometrial thickness in patients receiving ovulation induction therapy with bad endometrial thickness in previous cycle. It causes no systemic side effect.

Nerve conductive studies are the most informative portion of the electrodiagnostic evaluation for a peripheral neuropathy. It is preferable to design a nerve conductive study for each type of disease or syndrome in our locality by answering specific questions. Recently, there is increased interest in quality of normative values for each test result and compare should be done between normal and patients regarding specific disease. So, the aim of the present study is to determine the normal values of nerve conductive study of tibial and peroneal nerves among normal healthy subjects in Tikrit city. The study has been conducted at rheumatology department neurophysiology unit at Tikrit teaching hospital at the period from 15th November 2011 to 15th of May 2012. Two hundred and ten (210) normal healthy volunteers
from medical students & medical staff from Tikrit teaching hospital (TTH) participates in the present study to evaluate the normal values of NCS for different age groups. The normal healthy subjects consist of 210 volunteers according to age groups:
Group 1 - Ninety subjects aged 20 to 29 years (50 male 40 female). Group 2- Forty subjects aged 30 to 39 years (20 male 20 female). Group 3- Forty subjects aged 40 to 49 years (20 male 20 female). Group 4- Forty subjects aged 50 to 59 years (20 male 20 female). The NCS was done by NIHON KOHDEN / Neuropack S1 EMG / EP Measuring System MEB-9400 Model 2009. In male subjects, there is no significant difference regarding conductive velocity between right & left tibial nerves at age group 30-39 as compare to 20-29 years.
However, there is significant reduction in NCV of both right & left tibial nerves at age group 40-49 years as compare to age group 20-29 years. Also, there significant reduction in NCV of right & left tibial nerves at age group 50-59 years (42.85 $ 9.1 * & 40.2 $ 5.8 ** respectively) as compare with right & left tibal nerves at age group 20-29 years (47.81 ‡ 5.41 & 46.84 $ 2.2 respectively). In female subjects, there is no significant difference regarding conductive velocity of left tibial nerve at age group 30-39 as compare with age group 20-29 years. However, there is significant reduction in NCV of right tibial nerve at age group 30-39 years (42.01 + 5.3** p=0.01) as compare to the same nerve at age group 20-29 years, (47.54 ‡ 5.33 m/sec). While, there is significant reduction in NCV of both right & left tibial nerves at age group 40-49 years (34.85 * 9.5**, 37.46 ‡ 5.65** respectively) as compare to age group 20-29 years (47.54 * 5.33 m/sec, 46.41 $ 2.53 respectively). Also, there significant reduction in NCV of right & left tibial nerves at age group 50-59 years (40.15 $ 9.1 * & 40.55 $ 7.46 ** m/sec respectively) as compare with right & left tibal nerves at age group 20-29 years
(47.54 + 5.33 & 46.41 # 2.53 m/sec respectively).

Controlled comparative clinical trial, conducted on the department of neurology, Ibin Sina teaching hospital, Mosul -Iraq, to evaluate the oxidative stress status in patient with multiple sclerosis. Thirty female patients diagnosed as multiple sclerosis enrolled in the study, thirty healthy individuals matched for age with patients group, kept as a control. Malondialdehyde (MDA) were measured in both groups as indicator of oxidative stress. The MDA level was higher in patients with multiple sclerosis than the
control group. The present study demonstrated that patients with multiple sclerosis have exaggerated oxidative stress, and indicate that treatment with antioxidants might theoretically prevent propagation of tissue damage and improve both survival and neurological outcome of the disease.

A prospective sndy of 30 patients with acute rtrcumatic fever (ARF) as diagnosed by the revised Duckett Jones criteria was conducted during the period fiom October 197- Febnrary 1998 in Mosul city- Special emphasis on the clinical presentation and laboratory investigation including thrcat culnne (IC) for streptococci and antistreptolysin O (ASO) titer were performed to assess the validity of both tests in patients with and without fieumatic carditis-
Arthritis was diagnosed in 24 patients (80/o) most commonly involving bigjoints. Carditis was a complication in 8 patients (26.6%). Fever. high erytfrmcyte sedimentalion rate (ESR), and high ASO titer were common for all patients. Throat culture was positive in 8 patients (26.6%) all without carditis, Those with carditis were negative for TC andlhere was no hisory of prior antibiotic administratioL It is concluded that TC for patients with c€rditis is not essential as evidence ofprevious streptococcal infection and raised ASO titer is enough.

Osteocalcin is a small protein (49 amino acids) mainly synthesized by mature osteoblasts, remains the most specific marker of osteoblastic activity. Serum osteocalcin values are higher in children than in adults, rising during puberty and decreasing to adult leveis. Most studies show a higher concentration of osteocalcin in adult males than in adult females, but there are no data available regarding the levels in osteocalcin during human ageing. The aim of the study is to measure serum osteocalcin as a bone turnover marker in women before & after menopause in relation to steroid hormones in Tikrit city. The study included 95 female
subjects who attended to Dejla hospital for measurement of bone mineral. Fifty subjects from the total 95 subjects are postmenopausal women. Subjects distributed according age into four subgroups ;- Fourteen women in group 1 aged less than forty years, 27 subjects in group 2 aged 40-49 years, 27 subjects in group 3 aged 50-59 years, & 27 subjects in group 4 aged 60 years & above. Serum osteoclacin was measured by the lectrochemiluminescence immunoassay (ECLIA) is intended by use on Elecsys and Cobas (e411 (Roch Device) immunoassay analyzers. There is no significant difference in regard to serum osteocalcin concentration between group aged 40-49 years (15.63 $ 6.54 ng/ml) as compare to age group less than 40 years (16.229 $ 4.7 ng/ml). However, there is significant increase in serum osteocalcin concentration in group aged 50-59 years (20.95 ‡ 13.6 ng/ml) as compare to age
group less than 40 years (16.229 # 4.7 ng/ml). Also, there is significant increase in serum osteocalcin concentration in group aged 60-69 years (18.06 $ 7.32 ng/ml) as compare to age group less than 40 years (16.229 $ 4.7 ng/ml). There are fifty postmenopausal women, they have a significant increase in serum osteocalcin concentration (23.32 ‡ 14.1 ng/ml), as compare to age group less than 40 years (16.229 $ 4.7 ng/ml) & group 40-49 years (15.63 ‡ 6.54 ng/ml). The present study shows that there is significant increase in serum osteocalcin concentration associated with increase in age of women.

Background: Stroke is one of the leading causes of death in the world. Knowledge about predictors of early fatality is essential for optimizing stroke survival strategies- Studies on predictors of survival witfrin the first week after stroke are few and address only some of the potential factors associated with early fatality.
Aim: To identifr the mortality rate for shoke, its types and to determine predictors of one- month mortality.
Prtien8 and Methods:
Descriptive (case series) study was conducted in the Tikrit Teaching Hospital for (140)
included in this
study. Stroke caused by trauma, epidurar, subdurar hematoma
-lst august 201I
fiom the study as well as patients who had vasculitis, tumors and coagulopathy- CT scan of brain was performed routinely for every patient within T2hours of admission to determine type of stroke. Twenty five patients send for MRI of brain,
Results: A total of 140 persons (90 male and 50 female) with first ever stroke, ischemic stroke was represent (687o), and hernorrhagic tjpe was e2%a. T\e mean age of patients was 64+5 yean. Regarding risk factors were anaryzed according to type ofstroke, in ischemic, the hypertension (6E.4%o) was commonest risk factor for stroke followed by diabetes mellitus (63 -l%), whereas for hemorrhagic type, the h)rpertension stirr remained the commonest risk factor (77.7Yo\ followed by smoking (44.44%). hemorrhagic stroke associated with severe GCS on admission S 8 occurs n (73.3o/o), while in ischemic type (10.5%). one_month mortality was 23.1o/o for all strnke patients, and the majority were pari€nts with hemorrhagic stroke (33.3%), while ischemic stroke (15.7%).
conclusions: Hypertension was the commonest risk factor for both type of stroke in-hospital mortality rate of stroke in Tikrit Teaching Hospital was relatively similar compared to other studies. The independent risk factors were hemorrhagic stroke and Glasgow coma scale S g on admission.

Background. Folliculitis is inflammation of hair follicle caused by infection, chemical irritation or physical injury. Case series of scalp folliculitis in Iraqi female children (unreported previously) were identified; all patients had a history of mechanical traction. Objectives. To evaluate and charac- terize a new entity of scalp “Traction Folliculitis” apart from well known Traction Alopecia. Patients and Methods. A series of 45 patients with clinically diagnosed scalp folliculitis were observed to have “Traction Folliculitis” during the period from October 2008 and October 2011 in private practice using an observational study. History was obtained about age, residence, gender, previous similar lesions, type of hair style, coloring agents and associated signs and symptoms. Results. A total of 45 patients with clinically diagnosed scalp folliculitis were observed to have “Traction Folliculitis” of scalp, con- sisting of fine scalp scales, perifollicular erythema and pustules, associated with prominent hair casts. The presenting symptoms were pain (especially during cleaning and combing the hair), itching . There were lymphadenopathy in 7 patients (15.6%). No other similar skin lesions in nearby area in the neck or face, no nits of pediculosis capitis, no fragile crustation of impetigo. The disease from the first im- pression looks as if scalp pediculosis (pediculosis capitis), but there are no nits. Surprisingly the pa- tients were all females with an age group between (1.5-11 year) (4.82+ 2.42). The color of hair was brown in 38 patients (84.5%), black in 6 patients (13.3%) and only one blond girl (2.2%). Types of hair styles were ponytails (horsetail) with hair-cutters in 28 patients (62.2%), 2 lateral braids in 16 pa- tients (35.6%) and one patient (2.2%) with 5 posterior braids. All patients were giving history of sus- tained severe hair traction. No curly hair, no black patients were observed. One patient (2.2%) men- tioned using hair dye (Henna dye) as a coloring agent. This issue was solved and managed by chang- ing the hairstyle, undo the traction, using mild antiseptic soaps and non irritant shampoos, some re- quired systemic antibiotics for one week. It is unreported before as a separate entity as Traction Fo- liculitis and could easily passed or categorized as pediculosis capitis due to the similarity of hair casts with nits. The age group was mainly preschool age 33 patients (73.3%) and few primary school ages 12 patients (26.7%).

The QT interval is closely related to venticular action potent ial and is a good noninvasive measure of ventricular repolarization and myocardial homogeneity. Prolonged QT intewal has been reported to be associated with higher mortality in stroke patients. The aim of this study is to asses whether QT interval is prolonged in patienS with acute stroke, and whether this prolongation ifpresent is related to the type, location, and size of stroke. The study included 60 patients with acute stroke admitted to Tikrit teaching hospital from July 201 1 to February 2012 and 12leads ECGs were recorded at the time of artmission, to measure the corrected QTc interval (QTc manual and QTc automared). A 30 age matched individuals (control group) were included for comparison. The QTc interval measurement was significantly longer in patients with acute stroke than control group. The QTc interval was significantly higher with big infarct or large hemorrhage than small lesions. There was no significant difference between right and left sided stoke regarding QTc interval values. It was concluded that QT interval was prolonged in acute stroke and this prolongation was related to the size but not the q/pe or location of stroke.

Background; allergic rhinitis is common problem both in children and adults. Patients and methods; Retrospective study by which the skin test performed on (192) patients with allergic Rhinitis to determine the most common sensitizing allergen in our locality. Results; ln (39.6%) of patients (76 patients) the test was positive to single allergen and in (60.4%) of patients (t 16 patients) it was positive to multiple allergens. Two allergens positive skin test form (23.9/o), while the test was positive for three or above allergens (36.5%) of patients. Conclusion; House dust mite was the predominant allergen (19.1%) followed by mould I (17.5o/o).

The incidence of gastric and duodenal ulcer is characterized by pronounced geographical and temporal variations which suggest that important environmental factors must play a part in the etiology of both diseases. The aim of the present study is to determine the sociological risk factors in the development peptic ulcer in the study sample in Mosul city.
Study design: Age and sex matched case-control design.
Study period: 15th May 2009 to 15th May 2010.
One hundred eighty new cases of peptic ulcer were collected from endoscope unit in Ibn-Sena General Teaching Hospital in Mosul and 240 controls persons (not having peptic ulcer) community and hospital based age and sex matched control group include healthy peoples; medical students and their families and
friends also relatives of patients from other hospitals in the Mosul Medical City were also collected. Interview questionnaire was adopted as a data collection tool.
Outcome measures: Odd's ratio and its 95% confidence interval.
Results: The mean age of the study sample was 41.8 $ 6.45 years for cases and 39.9 $ 7.74 years for controls. Regarding social habits; cigarettes smoking was found to be highly associated with the development of peptic ulcer disease and it was dose-related (OR=2.30, 95% CI: 1.20; 4.39, p= 0.011 for heavy smokers), and also for coffee drink ≥ 3 cups /day (OR= 2.20, 95% CI: 1.11; 4.35, p= 0.021). Whereas, high fiber diet (vegetables, fruits, legumes and cereals fibers) appears to be protective against
occurrence of peptic ulcer disease (OR=0.52, 95% CI: 0.35; 0.77, p= 0.001). In respect to personal characteristics; positive family history and personality type A were found to have positive impact in the development of peptic ulcer disease (OR=2.94, 95% CI: 1.65; 5.26, p= 0.000) and (OR=1.72, 95% CI: 1.10; 2.80, p= 0.028) respectively, as well as stressful life events (OR=2.15, 95% CI: 1.45; 3.19, P- 0.000). While high crowding index, occupation, level of education, residence (urban or rural) and excessive tea drinking appear to do nothing in the occurrence of peptic ulcer disease.
Conclusion: The etiology of peptic ulcer disease is multifactorial. Cigarettes smoking, coffee drinking, positive family history of peptic ulcer disease, low fiber diet, stressful life events and personality type A were the main risk factors for incident peptic ulcer disease in Mosul studied sample.

To see whether the use of alfirzosin l0 mg will increase the success rate of trial without catheter (TWOC) after an attack of acute urinary retention (AUR) retated to benign prostatic hyperplasia (BPH). One hundred patients with acute urinar;r retention due to BPH were consented and enrolled in this prospective ,randomized ,placeb+controlled trial- After catheterization, 50 patients were given sustained release alfumsin l0 mg once daily,while the other 50 received placebo. The catheter was removed after three days of treahnent for trial without catheter (TWOC)- The main outcome measurements were succ€ss or failure of TWOC. After removal of the catheter, 64% of patients receiving alfirzosin voided successfully compared to 36yo of patients on placebo; the differences being statistically significant at (p<0-05). The mean age of patients who successfully voided, regardless of h€atment, was 67.6 years and 69.7 yats for those who failed to void which is statistically not silrrificant Regarding retention volume, there was a significant difference (P<0'05) between the two groups (8E7.5 ml vs. 994.4 ml). The present tudy coclude that trial without catheter after three days of catheterization is a good practice for BPH men with AUR - However, using alfuzosin l0 mg once daily prior to calheter removal considerably increased the chance of successful TWOC especially if used in patients with low r€tention volume and younger age group.

Background:Hypospadias is one of the most common congenital anomalies of male extemal genitalia, in which the external urethral meatus exits ventrally any where from the glans to the perineum.There are many surgical modalities for reconstruction but with different rates of success. Aim:ls to compare between Tubularized Incised Plate urethroplasty (Snodgrass technique) and Tubularized Plate urethroplasty(Thiersch-Duplay technique) in reconstructing distal penile and mid-shaft hypospadias regarding success rates,types and incidence of complications and advantages of each technique. Patients and Methods:Patients were blindly assigned into two random groups-Group A (20 patients) were repaired by Snodgrass technique
and group B (20 patients) were repaired by Theirsh-Duplay technique.All patients were followed up for one year. Results: 40 patients with distal penile and mid-shaft hypospadias were studied. The majority were between 2-4 years of age.MeataI stenosis and urethrocutaneous fistulae were the most frequently encountered complications.
Conclusions: Snodgrass technique is more superior than Thiersch-Duplay technique in terms of final aesthetic and functional results.

Women's health in general is affected by various important social, cultural, behavioral, and biological factors. Physical activity of women through various domestic and occupational works differs according to their age, education, pregnancy status, and general health status. The effect of physical activity on hemoglobin level should not be ignored specially when considering women's health during childbearing age (15-49) whether pregnant or non-pregnant as the women more prone to iron deficiency anemia due to largely loss of blood with menstruation, pregnancy, physical effort, and insufficient dietary iron. The aim of this study is to determine the relation between physical activity and anemia state of married women during childbearing age. A cross sectional study design was adopted of 912 married women were seen at four randomly selected primary health care centers. These centers were (Al-Sukar, Al-Sharqi, Al-Hadbaa and Al-Mansoor), during the period from 1st August 2007 to 1st of February 2008. The interview was face-to-face, utilization the International Physical Activity Questionnaire the long version, 2002 to determine the level of physical activity. The information included in the data collection tool include, the socio-demographic character, levels of physical activity, and measuring of hemoglobin level. The study shows that half of non-pregnant were anemic and half of the pregnants were anemic too. The study revealed that two thirds of the women who were having heavy activities and 53.2% of the women with moderate activities were suffering from anemia according to Hb level. This study concluded that half of the sample was anemic and had association with physical effort, so that women in childbearing age need special care by increasing the attention towards providing better health care services in antenatal care center.

Three hundreds thirty patients studied in Salah-Al-been consultant clinic for respiratory disease from 1st January to 1st December-2007. Pulmonary tuberculosis found in 114 of them, and falls in to two groups; 57.9% of them were negative sputum smear, and 42.1% of them had positive sputum smear. Regarding the mycobacterium load in the sputum smear, most of pulmonary tuberculosis cases had as following: 17 (14.9%) had -1-+, 20 (17.5%) had +++ of M. tuberculosis rodsand two patients (4.2%) had very little rods. Positive pulmonary tuberculosis was more common amongpatients aged <18 years old which found in seven (46.7%) and male constitute 48.5% of them and the odd ratio for male sex was 1.3. Regarding residence, positive pulmonary tuberculosis, 27 (38%) of patients were from rural areas in comparison to 21 (48.8%) of urban area. The odd ratio for urban area was 1.3 and for rural 0.8. Tuberculosis case detection rate was lower than expected, and the working group is mostly affected. Improvement in management of tuberculosis and rehabilitation programs needed.

Background: Although many older people with diabetes are obese. a proportion is recognized | to have malnutrition or lesser degrees of nutritional impairment. This study aimed to assess the nutritional status of hospitalized elderly diabetic patient using the anthropometric measures Hospital based case control study in Tikrit teaching hospital with random sampling method of 50 hospitalized clderly diabetics compared with 50 hospitalized non-diabetics. (Nutritional assessment done depending on anthropometric measures : Height, weight, BMI, mid arm circumference , and calf cire umitrence. About 6% of diabetics had BMI <18.5 with odds ratio2.17 , 30% had BMI<22 as an indicator of high mortality with odds ratio 2.17, About ratio 12% of diabetic group had MAC <21 ¢m versus 4% for non- diabetic group, with odds | of 3.3. Calf circumference was <31em for 48% of diabetics, vs36% of the non-diabetic group, with odds ratio of 1.64. Hospitalized clderly diabetics had non-significant lower anthropometric measures than non-diabetics, indicating nutritional status affection and, the need for an overall nutritional assessment fool encompassing all areas of nutritional evaluation other than anthropometric measures among elderly patients.

To know the percentage of sinusitis among patients with self-described and physician
diagnosed as sinus headache, and differentiated from other causes of headache . A prospective study on 500 patients with headache presented with self-described or physician diagnosed as sinusitis, during three years period ( 2008 - 2010) at salah-ELdin governorate. A detailed history aboul the pain and associated nasal symptoms was taken. Anterior rhinoscopy , oropharyngeal and neck examinations, sinus X-ray occipito-mental view for signs of sinus infection was done. The International Headache Society (IHS) diagnostic criteria applied for diagnosis of the headache. Thirty patients (6%) were having sinusitis, 24 patients (8%) from patients presented with physician diagnosed, and 6 patients (3%) from patients with self described sinusitis. Migraine was found in 380 patients(76%),Tension-type headache in 70
patients (16%), other secondary headache was (l .6%). cluster headache was (0.8%). Four patients (13%) with sinusitis were found associated other causes of headache. Sinusitis is often over diagnosed. The presence of pain at site of paranasal sinuses. with nasal or ocular symptoms should not immediately diagnosed as sinusitis, Migraine should be excluded. The purulent nasal discharge, and positive radiological findings are important for diagnosis of sinusitis.

The vast majority of congenital heart disease (CHD) have no known cause, congenital heart defects are the most commonly occurring birth defect ,which happen during the first crucial eight weeks of the baby s development.CHD range from simple to complex problems ,some can be watched by the child s physicians and managed with medication and others will require surgery .early recognition has great implications on prognosis. Objectives: To study age, gender distribution and frequency of congenital heart disease in children referred to echocardiography
in Ibn-Seena Teaching Hospital. Method: This is a retrospective descriptive study on all patients with the suspected diagnosis of congenital heart disease referred for echocardiography over a period of two years from February 2008 to February 2010. Patients from day one of life till 14 years were included. The study was conducted in the pediatric cardiology clinic in Ibn_seena teaching Hospital. Result: A total of (676) children were included. There were 359 males (53.1%) and 317 females (46.8%) with a ratio of 1.13:1. About Eighty five percent ( 84.9%) of the children had a cyanotic cardiac lesions, Ventricular septal defect followed by atrial septal defect,
pulmonary valve stenosis and patent ductus arteriosus, were the most common A cyanotic congenital heart lesions. Fiveteen (15.09%) of them had cyanotic cardiac lesions, Tetralogy of Fallot (TOF) followed by transposition of the great arteries were the commonest cyanotic congenital heart lesions. There was a males dominance in AS ,P.S, TOF and Atrioventricular septal defect (69.2%,66.6%,65.5% and 64.2% respectively).More females had PDA (66.1%).

Conclusion: The majority of patients with CHD detected have non-cyanotic CHI). VSD is the commonest non- cyanotic lesion and TOF cyanotic lesion. In order to avoid
complications, early detection of congenital heart disease is of most importance for proper management 2D-echo with Doppler examination forms the gold standard for diagnosis

This study evaluates the morbidity and mortality, during hospitalimtion of 50 patients with acute right ventricular myocardial infarction who were admitted to coronary care unit of Mosul teaching hospital from 1996 — 1998. The patients were evaluated clinically, electrocardiographically, and by two dimensional echocardiography for the diagnosis of right ventricular infarction. The patients were followed up by continuous ECG monitoring for at least three days to detect rhythm and conduction disturbances. The patients were divided into three groups depending on presence or absence of complete heart block;
Group I; 15 patients with complete heart block.
Group II; 35 patients without complete heart block.
In this study patients in group I had significantly higher mortality rate than group II, 40% versus (p < 0.05). A third group (20) patients with inferior myocardial infarction and complete heart block without right ventricular infarction were evaluated, and the mortality rate was the same as in group II (p > 0.5).

Design: A cross section study the relationship between serum inhibin B level and Insulin Growth Factor I level, and the fertility outcome in Polycystic Ovarian Syndrome women. Setting: The study conduct at Tikrit Teaching Hospital, Department of Obstetrics and Gynecology between May 2010- May 2011.
Patient: Ninety women participate with study they were included in one of the following groups:
Group A: includes fifteen normal fertile women.
Group B: includes fifty infertile Polycystic Ovarian Syndrome women
Group C; includes twenty five fertile Polycystic arian Syndrome women.
Polycystic. ovary syndrome is diagnosed according to the ESHRE/ ASRM Rotterdam criteria for Polycystic Ovarian Syndrome 2004.
Methods: Clinical, anthropometric measurements, ultrasound study and laboratory determinations of Follicular Stimulating Hormone, Prolactin, inhibin B,
Leutanizing Hormone, Insulin like Growth Factor I.


Results: Serum inhibin B decreased in older infertile Polycystic Ovarian Syndrome women than fertile Polycystic Ovarian Syndrome women. Infertile Polycystic Ovarian Syndrome women have higher serum Insulin like Growth Factor I and Inhibin B than fertile PCOS and control group.
Conclusion: Infertile Polycystic Ovarian Syndrome women associated with elevated serum inhibin B and serum Insulin like Growth Factor I levels.

Morphine belongs to a group of medicines called analgesics. It is an opioid analgesic that acts by blocking pain and it has high addiction property. Therefore, morphine is commonly abused narcotic analgesic in the world besides to heroin which is synthesized as morphine derivative and came into use. This study investigated the role of morphine addiction on lipid peroxidation and alteration of blood cells in female rats. The experimental rats divided to two groups;
Control group and Morphine treated group (The rats were treated with i.v. injection
(150mg/kg) morphine sulfate twice weekly for two weeks). The Blood samples were taken for assessing blood cell variables and the sera were used for Malondialdehyde (MDA) evaluation. The data revealed a significant (P