The Medical Journal of Tikrit University

Effective control of pathogenic bacteria and dental plaque is key to the prevention and treatment of
Dental caries. Worldwide, hundreds of plants are used in traditional medicine as treatment for bacterial
infections. Since the discovery of S. mutans as an etiological agent of dental caries, much attention was
and vaccine preparation. The antimicrobial activities of 4 traditional plant extract against Streptococcus
mutans by agar diffusion methods were tested. The results of the present study showed that alcohol &
aqueous extract of green tea had antimicrobial activity against Streptococcus mutans. This indicates the
presence of potent antibacterial activity, which confirms its use as antibacterial agents. Both the ethanol and
water extract of green tea and clove produced inhibitory actions against Streptococcus mutans, but the zones
of inhibition of alcohol extract were less than aqueous extract. This tends to show that the active ingredients
in the leaves were better extracted with ethanol than water. The alcohol and aqueous extracts of the four
plants used in the present study have antibacterial activity against S. mutans, therefore, can be used in mouth
rinses and toothpastes and can be beneficial in controlling dental caries.

Background: Pre-eclampsia is a common problem in pregnancy. Women with pre-
eclampsia have high blood pressure, protein in their urine, and may develop other symptoms and problems. The more severe pre-eclampsia associated with serious complications to both mother and baby. Pre-eclampsia is detected through blood pressure measurement and urine tests.
Aim: The study is conducted to assess the epidemiological characteristics of preeclamptic women in Tikrit teaching hospital.
Objectives:
1. Recognize the relation between preeclampsia and (age, parity, body mass index,
residence, occupation, socioeconomic state, baby gender, duration of pregnancy, mode of delivery, and fetal-maternal complications).
2. Identify the previous obstetrical history, recent pregnaney and family history of
preeclamptie women.
Subject and method: The current work represents a descriptive individual type of
epidemiological study which is a cross sectional study. The study was conducted in Tikrit Teaching Hospital from 10th of November 2011 to 10th of November 2012. The sample included 91 delivered pre eclamptie women within purperium period and excluded birth before 24 weeks of gestation. Data was collected from delivered women by a questionnaire also maternal height measured and they asked about their weight before pregnaney.
Results: From 6744 births in Tikrit teaching hospital during study period there were
91(1.3%) cases of preeclampsia, preeclampsia lower at age <20 and >40 years old about 4(44%), 6(6.6%) subsequently. Preeclampsia more frequent 40(44%) among (2-5) parity group, and more among women lived in urban area 53(58.2%). Regarding prepregnancy BMI, the result showed that 36(39.6%) of preeclamptic women had overweight before pregnancy.
The study showed that 47(51.6%) of preeclamptic women delivered
before term, and 41(45.1%) of preeclamptic women delivered by cesarean section,
High frequency of maternal and fetal complications 16(59.3%), 13(43.3%)among preeclamptie women who had no antenatal care.
Conclusion: The study concluded that preeclampsia cases more frequent among women with middle age, parity 2-5, overweigh, worker, low socioeconomic level, and they complained from many complications with their fetuses.
Recommendation: Encouraging early booking as well as regular attendance at the antenatal clinic for early diagnosis and prevention of complications.

Background:
Changes in the level of lipid profile had been suggested as a risk factor
for those patients, developing an ischemic stroke opposite to that with
haemornhgic stroke.
Patients and Methods:
This study was included by (50) patients who experienced an ischemic
stroke and (50) patients with haemorrhgie stroke of either sex during their
admission to Azadi teaching hospital through period of 10th of October 2013 and
10th of October 2014, with an acute onset after full clinical examination and
radiological investigation.
The aim of the study was for evaluation of lipid profile with 8-12 hours overnight fasting. By enzymatic colorimetric method.
Results:
For those patients with an ischemie stroke (40%) of them had high total
cholesterol followed by (14%) of same group with low level of high density
lipoproten cholesterol.
Triglyceride level was nearly same in both an ischemic and haemorrhgic
study groups with no different in between them regarding low density
cholesterol.
Conclusion:
An ischemic stroke patients had higher level of total cholesterol and lower
level of high density cholesterol level, than those with haemorrhgic stroke.

The present investigation evaluates the antimicrobial activity of crude extracts from the rinds of Punica granatum against gram negative, diarrhea-genic E.coli. in this study we investigated in vitro antimicrobial activity of dry rinds of Punica granatum in different solvent in 3 different concentra-tions, the solvent used are alcoholic ethanol and aqueous, in this study we found that the activity of Punica granatum extract against diarrheagenie E. coli increased by increasing
concentration, and watery solvent is better in its action than alcoholic solvent.

Background: Acute peripheral arterial occlusion (upper and lower- extremity) is responsible for a wide variety of complications culminating in limb loss or death. Acute arterial occlusion of the extremities with the high tendency for major limb loss and death are very common peripheral vascular problems that require emergency management.
Aims and Objective: The aim of the study was to evaluate the patients who were performed surgical treatment due to acute peripheral arterial occlusion.
Material and Method: This study was conducted at the department of cardiothoracic and vascular surgery, sulaimanyah teaching hospital. Between January 2006 and October 2011, 120 patients (70 males, 50 females; mean age 68.1
years; range 35 to 90 years) who underwent surgical treatment due to acute peripheral arterial occlusion were included in this study.
Kesults: Among the 120 patients, 55(45.8%) were admitted within the first arterial occlusion was on the upper extremity in 45 patients (on the right upper lower extremity in 35 patients). Embolectomy was performed on all patients.
Reembolectomy was done for 10 patients (8.3%) with recurrent ischemia.
Amputation was performed on seven patients (5.8%). Mortality rate was 4.2% with
five cases.
Conclusion: Acute peripheral arterial occlusion is associated with a high risk of limb loss and death. The high mortality rate is as much a function of the multiplicity of baseline comorbidities as it is a result of the insult from the peripheral ischemia and reperfusion.

Background: Appendicitis is one of the most common surgical emergencies
encountered by surgeons, and appendectomy is the most common surgical
emergency operation done by general surgeons. At the teaching hespital, the
surgical residents are actively involved in all aspects of patient care including
preoperative preparation, operatively as the primary surgeon in appendectomy
and postoperative follow up. Senior resident surgeons typically serve as teaching
assistants for the appendectomy cases under attending supervision. In contrast, no
residents are present at the nonteaching institutions, and the attending surgeon
performs all aspects of patient care.
Objectives: to determine the outcomes of appendicitis between a teaching
and nonteaching hospital, in order to document the effect of residents acting as the surgeon for a surgical procedure .
Methods: A prospective study involved all patients with acute appendicitis,
aged (10-50) years admitted either to Tikrit Teaching Hospital (TTH), or to Shirqat
General Hospital (SGH) , which is nonteaching, during the period from January
2013, to June 2014. Patient's factors including: age, gender, and the presence of
perforation were collected. Outcome variables were 30-day morbidity including
wound infection, postoperative abscess drainage, and re-admission and length of
hospitalization (LOH) recorded and compared between the two hospitals. Patients
with perforated appendicitis treated nonoperatively were excluded from the
analysis.
Results: One thousand, six hundreds, eighty-four (1684) patients were
treated at the teaching institution(TTH) with mean age was 15.6 years, 58% males,
and 738 patients at the nonteaching SGH with mean age of 17 years, 61% male.
The perforated appendicitis rate was 20.3% at the teaching institution and 19.9%
at the nonteaching institution. A 45 (13%) patients with perforated appendicitis
were successfully treated nonoperatively at TTH and 8 (5.5%) at SGH.
For nonperforated appendicitis, rates of wound infection & postoperative
abscess drainage were higher at the non teaching hospital with ( 2.7% vs.
1.8% ,and 1.3% vs. 0.6% respectively), the 30 days re-admission was higher at the
teaching institution (2.2% vs. 2.0%). LOH was shorter in the teaching institution
(1.0 € 1.4 vs. 1.8 ‡ 1.2 days). For perforated appendicitis, lower rates of wound
infection ( 10% vs. 24.4%) and abscess drainage (9.8% vs.11.5%) at TTH. The
LOH is shorter at TTH(2.5 + 4.2d) vs. (3.3 5d). The 30 days re-admission is the
same (10.8%).
Conclusions: This study found that LOH was shorter in TTH than in SGH
for both perforated and non perforated appendicitis. Regarding patients with
perforated appendicitis, there was a lower rate of wound infection, with a higher
percentage for those who were successfully treated non-operatively. So, the
presence of surgical residents did not adversely affect the quality of care for
patients with appendicitis.

Homelessness or as they called street children in the community, is a term for children experiencing who live on the streets of a city. The screening of this group of society is important to help in providing health care and good education. This study is designed to assess the nutritional state by depending on body mass index measurement, knowledge about immunization and education among homeless children in Tikrit city.
The study is cross section conducted in Tikrit city from March 15 2014 to April 15 2014 which included 60 homeless children chosen randomly. Data collected by direct interview of group members with homeless children, then data presented by simple tables and figures.
The study found that (83,4%) of homeless children were male, and about 32(53.3%) at (6-12) years old. (56.7%) of then had primary education and 26(43.3%) had knowledge about immunization. Finally we conclude that the knowledge of homeless children about PHC role about vaccination was moderately good, their parents were still married, and unemployed. Homeless children lived in crowded
houses.

The study recommended to do surveillance for young homeless children, monitoring of school attendance and academic performance, and assessment of mental status for homeless adolescents are recommended to facilitate early identification of problems and delivery of necessary interventions. For
young children, providers of health care to the homeless should be well networked into the carly intervention in their locality. Given the multiplicity of needs for homeless families, which of course includes help finding affordable housing, health care providers serving this population should also develop linkages with community agencies, including those that can help parents develop the skills necessary for cconomic self-sufficiency.

Back ground: Dark pigmentation and skin laxity of lower eyelids attributed to many
factors including thin translucent skin, prominent vasculatures and excessive melanin deposition which is difficult to treated in this study we used nanofat injection in the lower eyelids as a treatment for dark pigmentation and skin rejuvenation, the aspirated fat was mechanically emulsified so fat fragments altered into liquid emulsion, and the color turned from yellow to whitish, then injected intradermally in the lower eyelids, all procedures
performed in an outpatient clinic. The objectives is to study the effect Nanofat injection for the treatment of skin rejuvenation and dark pigmentation of the lower eyelids • This prospective study conducted in the period of February 2015 to November 2015 included as an outpatient clinic procedure in Kirkuk province in Iraq. 22 female patients were recruited aged from 20 to 40 years, all were treated with Intradermal Nano fat injection in the lower eyelids, and only 4 patients underwent lower eyelid blepharoplasty as they had excess skin in the lower eyelids. All patients had nanofat injection for skin rejuvenation and deep dark pigmentation of the lower eyelids, Assessment of the results by the surgeon were good in 50%.
fair 36.4 and poor 13.6; patient satisfaction was taken into consideration and almost more than half of the them expressed satisfaction (good resule in 59.1% fair result in 31.8%). Only 2 patients (9.1%) had minimal postoperative complications. Nano fat injection may consider au affordable option as an outpatient procedures that can be performed with ease in clinics to relive deep dark pigmentation and skin rejuvenation of the lower eyelids.

One -stage septorhinoplasty is standard technique for correction of
deviated nose, but still two stages technique are used. This study compare septal
complications and functional outcomes between septorhinoplasty and first stage
only septoplasty, and study the surgical approaches for second stage
(rhinoplasty )for correction of deviated nose (patients with previous
septoplasty). A retrospective case study of 110 patients with deviated nose
underwent endonasal septorhinoplasty in the Tikrit Teaching Hospital during 6
years period. 72 male and 38 female, mean ages was 26 years. The patients
divided into two groups:
A. Patients with one-stage septorhinoplasty, were 97 patients
B. Patients with septoplasty (first stage), were 13 patients.
The surgical steps for correction of deviated nose in the patients with
septoplasty was studied. Follow up of the patients for a minimum 6 months for
the septal condition and functional outcomes. The results founds the late
complications of nasal septum are less in one-stage septorhinoplasty than in
only septoplsty. Septal perforation were (2%),(23%) respectively. Failure of
septal correction (8%), (31%), nasal saddling and columellar retraction (4),
(23%), intranasal adhesions (1%) (15%) respectively. Functional improvement
in one stage septorhinoplasty (92%), in only septoplasty (69%). Second stage for
patients with previous septoplasty, 6 patients was done for them rhinoplasty
with limited dorsal septal dissection, five do septorhinopisty, and two needs
augmentation rhinoplasty. conclusions: One -stage septorhinoplasty procedure
gives better functional results and less septal complications than only septoplasty
as first stage, which made subsequent rhinoplasty more difficult.

Background:
Small bowel obstruction is one of the most common surgical emergencies and causes of hospital admissions. Diatrizoate Meglumine Gastrografin has been used to triage patients with small bowel obstruction for an operative or a non-operative management.
Patients & Methods:
Sixty eight patients were selected. Patients with clinical & radiological evidences of adhesive small bowel obstruction were grouped into two groups, in which the members of the first group were given Gastrografin orally, while the members of the second group were not. Both groups were observed for 72 hours & managed accordingly.
Results:
Total of 68 patients; 27 responded well to conservative management with
gastrografin, 18 responded well to conservative management without gastrografin, while 23 patients required surgery with no postoperative complications or mortality.
Conclusions:
Orally administered Gastrografin is safe and reliable water-soluble contrast agent which can safely be used in patients with small bowel obstruction. Patients who received Gastrografin had a shorter hospital stay than those who did not, with good tolerance to an early oral diet.

Background: Ponseti method is the gold standard for treating clubfoot. Persistent equinus component sometimes requires adding Achilles tendon surgery to the serial manipulation and casting technique. The various methods for achieving this tendon release are yet to be appraised.
Objective: Comparison between complete tenotomy and sliding technique regarding the degree of correction of equinus deformity at the end 6 months follow-up in infants less than 1 year of age undergoing serial manipulation and casting for Talipesequinovarus.
Methods: During the period from January 2008 to July 2011 48 feet in 36 infant under 1 year with clubfeet undergoing Ponseti Manipulative treatment were subjected to tendo Achillis surgery to correct the persistent equinus deformity. Complete tenotomy was performed in 24 (50%) and sliding technique done for 24 (50%) of the feet. Correction of hindfoot equines was appraised at the end of 6 months follow up period.
Results: Optimum dorsiflexion of 15° or more was obtained in 20 (83.3%) infants treated with tenotomy and in 18 (75%) infants treated with tendon sliding. Unsatisfactory dorsiflexion of less than 0* was present in 1 (4.2%) infant in both groups. Intermediate results considered when dorsiflexion between 0-15° was possible and was the sequelea of 3 (12.5%) tenotomies and 5 (20.8%) sliding operations.
Conclusion: Tenotomy and sliding technique are good or satisfactory in 95.8% of the feet.
Tenotomy in younger infants was foundtechnically more convenient.

Cadavers were collected from the Forensic Medicine Unit of Kirkuk and Tikrit
Teaching Hospital between October (2012) to December(2013) Twenty Iraqi male neonate cadavers with age ranging from 0-28 days were obtained to study the histological features of their spinal cord Laminectomy of the cadavers and dissecting the meninges were performed. The cords were immersed in 10% fonnutin for hardened and fixation. Histological study showed the cross section area of the neonate spinal cord wus enveloped by thin layer of pia matter and separated from under lying white matter by sub pial space.
The white matter divided into three regions anterior, lateral and posterior funicului. White matter consisted of a large number of longitudinal nerve fibers, the diamcter was range from(4-10um), and blood capillary diameter (5-14 um) and dark glial cells(2-6 gm), which produce a myclin sheath around the nerve fibers to give supporting and isolating the fibers from each other. The largest number of longitudinal nerve fibers present in the anterior funicului of' white matter. The gray matter shape was similar to the (H) letter, and consisted of anterior and pusterior homs connected with transverse gray commissure and contained circular to oval- from(7-22 um). The largest number of ncurons were found in the cervical region, followed by the lumbar, thoracie and then sacral segment. Amultipolar pyramidal) ncurons with round nucleus, the cytoplasm and dendrites containing small dark Nissi body, whereas the hillock and axon lack from Nissi substance, were also clearly seen in the section.

To evaluate the prevalence of neonatal respiratory morbidity in term infants, especially babies delivered by elective Caesarean section, and to assess the influence of timing of elective Caesarean section on the respiratory outcome.
This was a cross sectional prospective study of all elective Caesarean sections on mothers with a gestational age of 37 weeks or more and vaginal deliveries, that were performed in Kirkuk general Hospital from 1 January 2015 to 31 June 2015.
Multiple pregnancies, fetuses with congenital anomalies, intrauterine deaths, and emergency Caesarean sections were excluded. The total number of infants delivered by elective cesarean section and vaginal delivery who were assessed for respiratory distress (RDS) and transient tachypnea of the newborn(TTN) were 6675.
Neonatal respiratory morbidity risk including RDS and TTN, were significantly higher in infant group delivered by elective caeserian delivery compared with vaginal delivery. The number of term neonates who were delivered by elective caeserian section and had respiratory morbidities was 20(2.1%) and for those delivered vaginally was35(0.61%) with a p. value of(0.032).
The combined respiratory morbidity and TTN of infants delivered by elective Caesarean section before 38 weeks of gestation was significantly increased.

The present study used 16 albino mice Mus musculus that divide randomly to four groups (each group consist 4 mice), the first group was control group administrated only normal diet and water, the second group injected intraperitoneally LD50 (5x105 CFU/ml), the third group injected with infectious dose of Candida albicans (8x104 CFU/ ml), the fourth group injected with infectious dose and treated with camel milk with dose (1 ml). The GOT and GPT levels were increased and showed high significant changes (P < 0.01) in groups that administrated with LD50% and infected dose compared with control group but its back to normal when treated with camel milk. The microscopic examination showed many changes in liver of groups that injected with lethal and infectious dose from C. albicans including degeneration, fibrosis, infiltration of lymphocytes, congestion and thickening wall of central veins. The liver tissue in group that injected with infectious dose and treated with camel milk showed enhancement in the arrangement of hepatocytes and the liver tissues return to the normal form and structure. It was concluded from this study that camel milk has amply good effect on liver enzymes and tissue.

Pyramidal lobe is an embryonic remnant of thyroglossal duct and it is observed as a structure arises upward from the right or the left thyroid lobe or its isthmus. The aim of this study was to determine a variable factors regarding the presence, location, shape and linear measurements of the pyramidal lobe of human thyroid gland. A sixty-four male and forty-one female cadavers with age range of (20-62) years were dissected at the neck region to explore the thyroid gland and clarified its
pyramidal lobe. This anatomical study was carried out at the institute of forensic medicine in Baghdad and the forensic medicine unit in Tikrit teaching hospital during the period from September 2013 to May 2014.
This study observed that the high prevalence of the pyramidal lobe was in females 60.9% than in males 56.3% with total prevalence 58.1% among the population of both genders. Also, it was obvious that the pyramidal lobe arises as extension on the left lobe of the thyroid gland with prevalence 62.3% and the most common shape of it recognized by this study was the pyramidal shape with 50.8%
followed by the triangular shape with 27.9%. The three linear parameters of the pyramidal lobe were measured showing the average length
of the pyramidal lobe was 14.6 +-2.0mm, the average width was 7.7 +- 1.2mm and the average thickness was 2.8 +- 0.9 mm; but there was no significant differences (p>0.05) between the two sexes.

This cross sectional study was designed to determine the prevalence of non communicable diseases and risk factors. The study was performed on 72 peoples in age between 20-45 years (36 males and 36 females) in Tuz district/Amirlee township from Jun till December/2013.
Results: The study show the prevalence rate of the behavioral information as tobacco was 22.2% and fruit and vegetable serving two time per day was 16.7% while three time per day was 4.2%, physical activity for two time per week was 13.9% and three time per week was 2.8%, body mass index as over
weight was 63.9% and obese was 18.1%, systolic hypertension was 25% while diastolic hypertension was 26.4% and fasting blood sugar was 20.8%.
Conclusions: These study was recorded the poor consumption of fruit and vegetable and low intensity physical activity. The distribution of behavioral risk factors show that smoking was more prevalent among males, the increasing impact of behavioral risk factors over the life course might have contributed to the high prevalence of hypertension and hyperglycemia.

This study aims at reducing morbidity and mortality among children under-five years by assessing the Knowledge of health providers towards Integrated Management of Neonate& Child Health strategy in PHCCs of Salahiddin Governorate after one year of implementation.
This was comparative cross-sectional study conducted from January, 12th to May, 29th, 2014. Data was collected from 84 health providers (42 trained and 42 non-trained) who are working in 20 Primary Health Care Centers (PHCCs); 7 of them were in Tikrit (Salahiddin's Capital) and the remaining 13 PHCCs were in the other districts of SA (Tooz, Beji, Dor, Samarra, Balad and Dijel), the aim is to assess knowledge, attitude and practice of those workers (HPs) towards Integrated Management of Neonate and Child Health (IMNCH).
The mean age of total respondents was (33.18 + 5.82Years) and more than half 44(52.4%) of them lies in age group of 30-39 Years old. The vast majority (75%) of participants,63, were females compared to 21(25.0%) of them who were males. More than two third (69.0%) of participants were paramedical, 58, compared to 26(31.0%) of them who were doctors. More than one third (41.7%) of participants,35, spent 5-10 years in their position compared to 27(32.1%) of them who spent less than five years and 22(26.2%) of them who spent more than ten years in their position. Healthcare providers had mean score of (73.10 $ 11.53) for knowledge. Results of this study revealed that the trained healthcare provides had statistically significantly higher knowledge (76.88 +- 12.99) compared to non- trained healthcare providers (69.29 +- 16.60 Other findings of this study showed that the trained medical staff had statistically significantly higher knowledge (89.77 + 4.53) compared to trained aramedical staff (71.10 11.25)
Furthermore, this study found that the trained healthcare providers from Tikrit city had statistically significantly higher knowledge (85.05 +- 6.60) compared trained healthcare providers from districts (70.13 +- 13.17 This study demonstrated that there was a significant difference in knowledge, attitude and practice in IMNCH among the trained and non-trained health providers and between those from different districts and between the doctors and other paramedical staff.

This study was performed from first of May to last of July 2015 investigate the prevalence rates of intestinal parasites and blood picture of patients who were suffering from different intestinal parasite in health center of Erbil city.
This study included 80 patients from both sexes and different ages. Stool samples examinations were performing for these cases, which include direct smear method and the Scotch Cellulose Tape Technique for examination about Enterobius vermicularis in children. Certain examinations of blood picture were conducted, which included total white blood cells count and Hb determination for 80 cases. The results of this study show that the total infection rate with intestinal parasites was45% This study record the prevalence rate of intestinal parasites as following Entamoeba histolytica 8 (22.22%), Giardia lamblia 11 (30.55%), A lumbricoides 2 (5.55%), H.nana 4 (11.11%) , E. vermicularis 11 (30.55 %). In relation with blood picture examinations, there was significant change of each of total number of W.B.Cs and number of Eosinophils for patients of parasitic infections in comparison with standard normal values. In addition, there was non significant decreasing Hb values for the patients' less than normal level of hemoglobin (Hb).

Amblyopia is a condition involving reduced acuity caused by abnormal visual input during a critical period beginning shortly after birth. Amblyopia is typically considered to be irreversible during adulthood. Here we provide a new strategy in the management of young adult amblyopia depending on the fact that amblyopia is not only central (brain) problem but also peripheral one (ocular).
The aim of this study was to compare between two new strategies in the
management of amblyopia in young adult patients. In this study we assessed 110 patients with different types of amblyopia, who attended the ophthalmology department - in Tikrit Teaching Hospital- for checking, at the period [July 2013- April 2014]. Full ocular examination was done, including visual acuity, ocular motility and fundus assessment.
The new strategies include plan (A) and plan (B). In plan (A) we choose (55)
patients on whom the classical treatment was used (glasses & patching) plus topical Bestoxol drops (topical taurine) & oral Visionace capsules for three months. While plan (B) used in the remaining (55) patients and includes plan (A) plus ocular exercises and ocular stimulation with video games for 3 months.
The age of patients was from 12 to 24 years from both sexes.
The results showed that plan effectiveness was 43.6 % (24) more than 3 lines
Snellen chart improvement, 27.3% (15) 2 lines improvement, 9.1% (5) no more than one line, and 20% (11) with no improvement. Regarding plan (B) the results was 70.9% (39) more than 3 lines Snellen chart improvement, 18.2% (10) 2 lines improvement, 7.3% (4) one line only and 3.6% (2) with no benefits.
No effect of gender on the results, but the younger patients had better results than the older.

Igm and IgG antibodies for Toxoplasma , Rubella virus, and Cytomegalovirus
infections were assessed in a total 100 diabetics and 30 non diabetics women
serum samples On the other hand IgG positive serum samples for Toxoplasma, Rubella virus, and Cytomegalovirus were evaluated by determination (GPT ,GOT, TSB and ALP). Results revealed increased levels activity of liver function tests in infected women, due to liver cell damage that have occur during virulent and low virulent infection. Increaed levels activity of liver function tests in infected women.
CONCLUSION
This study concluded that the higher prevalence of seropositivity for human
(Toxoplasma, Rubella virus and cytomegalo virus )in diabetic patients comparing with normal individuals which means that patients with diabetic were at high risk for these infections.

B-thalassemia is an inherited hemolytic disorder caused by partial or complete deficiency of a or B- globin chain synthesis. The disease leads to serious health problems unless treated by regular blood transfusion and iron chelating therapy. The present study carried out on ( 90) males and females their age from (12-30 ) years with ß - thalassemia during spring of 2014, there were (70 ) of them infected with ฿ - thalassemia ( major) , who registered at Center of thalassemia and inherited blood disorders, Shaheed Hemin teaching hospital, Sulaymaniyah, Kurdistan, Iraq, while ( 20) healthy used as a control group. The results present study showed that a significant decrease (p < 0.05 ) in number of red blood cells and the concentration of heamoglobin and packed cell volume ( PCV ) of infected patients with ß- thalassemia major compared with control group, while the results showed increase in the total number of white blood cells in infected objectives with the disease compared with the control group and this increase was a significant increase (P < 0.05 ), as the current research patients had blood group (O) were the most susceptible to the infection with B-thalassemia compared with the other blood groups, as the infected objectives who carry the factor rhesus positive (Rh+ ) were (% 76) higher than the patients with rhesus factor negative (Rh- ) (24 %).

A trial of labour after caesarean should be considered in women who present for prenatal care with a history of previous caesarean birth. In certain situations, a trial labour after C.S will be contraindicated and a repeat caesarean section will be advised but in most, cases, a successiül vaginal birth can be satuy achieved tor both mother and infant. Current study was to identify the role of uterine scar thickness of previous C/S on next pregnancy outcome. A descriptive study of case series were carried from 1st of September 2012 to 30th 1st of August 2013 at Tikrit teaching hospital and 2 private hospitals in Tikrit city. 1 15 pregnant women with previous cesarean section enrolled in the study were followed to study the mode of delivery after C/S and birth out come. Scar thickness was measured by ultrasound and birth weight with Apgar score were done for newborn .Data collected and analyzed by soft wear program. It was found that 50 cases with previous scar from total (115) subjected to vaginal delivery and there was a significant relation between scar thickness of previous C/S and mode of delivery of current pregnancy, also the study result showed that the birth weighi and Apgar score of newborns had a significant relation with mode of delivery. Previous scar thickness plays a role in estimating the
subsequence of ne.xt pregnancy outcome

Hepatitis B virus (HBV) injection is one orthe major global human health problems. The spectrum of HBV- related disease ranges from acute hepatitis B, asymptomatic HBV carrier, and chronic hepatitis to rarely fulminant hepatitis. Hepatitis B surface antigen (HBsAg) is often used as the serological marker to screen for HBV infection. This study was performed in the central blood bank in Tikrit city for the period from 1st July to 30th April 2002 and included 1300 blood donors to evaluate the prevalence of HBsAg and association of it with the age group and blood group. The study demonstrated that the overall prevalence of HBsAg was 2.6% (34 out of 1300). The highest frequency of HBsAg was tliund in the blood group O, followed by blood group B, AB and blood group A. Most cases of HBsAg accumulated at the age group 30-39 year and the age group 20-29 year.

This study was performed in Tikrit City in General Saddam Hospital to assess the frequency of Proteus isolates in various samples (wound swabs, ear swabs, high vaginal swabs and urine samples) and their antibiotic susceptibility. The study included 538 bacterial isolates distributed as follows: 70 isolates from wound swabs, 73 isolates from ear swabs, 35 isolates from high vaginal swabs and 360 isolates from urine samples. The laboratory investigations revealed that the highest frequency of Proteus isolates was found in wound swabs (18.5%), followed by ear swabs (13.6 %), high vaginal swabs (11.4 %) and urine samples (9.2 0/0). Susceptibility testing revealed that gentamicin and cefotaxime are the most effective antibiotics while tetracycline and ampicillin are the least effective ones. It is concluded that the highest frequency of Proteus isolates is found in wound swabs and the most effective antibiotics are gentamicin and cetotaxime.

Introduction: Obesity is defined as increase in body weight due to excessive fat accumulation. It is the most common nutritional disorder in the affluent industrialized and developed world. A generally accepted definition of obesity is a body mass index more than 30kg/m. The World Health Organization
describes obesity as: "one of the most blatantly visible, yet most neglected public health problem that threaten to overwhelm both, more and less developed countries."
Aim: To determine the frequency of cesarean section in obese pregnant women.
Material and methods : It is a descriptive cross sectional study carried out in maternity teaching hospital in Erbil from April 2015 to April 2016.
Two hundred and forty four women were enrolled in this study. Both primigravida and multigravida with BMI 30 kg/m² or more, before 16 weeks of pregnancy were booked from out-patient department. Women with multiple pregnancies, previous cesarean section, pregnancies with medical disorders etc were excluded. Data was analyzed by using SPSS- 10 version.
Results: Out of 244 women recruited, one hundred and forty (57.4%) women were primigravida and 104 (42.6%) multigravida. Mean BMI was 31.18kg/m² ±SD 1.17. Spontaneous labor started in 154 (63.1%), while labor was induced in 77 (31.6%). Thirteen patients (5.3%) were delivered by elective
cesarean section. Spontaneous vaginal delivery occurred in 116 women (47.5%), instrumental delivery in 31(12.7%) and cesarean section in 97 women (39.8%). Mean BMI of patients delivered by spontaneous vaginal delivery (SVD) was 31.47kg/m², by instrumental 31.66kg/m2, by cesarean section 32.33 kg/m² (p<0.001).
Conclusion: Obesity significantly increased the frequency of cesarean section especially in primigravida.

This is a prospective study done to compare the effectiveness of local corticosteroid injection versus non-steroidal anti-inflammatory drug (diclofenac sodium) for initial treatment of new episode of tennis elbow. The patients were evaluated with a pain score (0 to 9) and clinical examination beit)re and 4 weeks after treatment. The selection of cases was done randomally. 18 patients were included in this study who attend orthopedics outpatient clinic in Samarra general hospital during the period from 1-1-2013 to I-11-2013. The first group include 9 patients were given an injection of 20 mg methylpredinsolone plus 0.5 ml lidocaine and the second group also include 9 patients were given diclofenac sodium 100mg daily for 2 weeks. After 4 weeks ; S patients (88%) in the injection group were completely better compared with 4 patients (44%) in the diclofenac sodium group(p <0.05) regarding pain scores also in the assessment of elbow function 5 patients (56%) had cornplete recovery in group of steroid injection while only one patient had complete recovery in the group treated with dicofenac sodium(11%) the p value < 0.05.

Objectives:-To know the maternal risk factors that affect the VLBW and to determine the outcome of the VLBW infants. Patients and methods: - A cross sectional study extended from january 2013 to June 2014. During which, about 100 mother with their babies were collected from delivery room, theatre and neonatal care unit of Tikrit teaching hospital. The data were taken by direct
interview with the mothers by a special questionnaire include variables in the maternal history considered as a major risk factors for VLBW infants like mothers age,parity, systemic
disease...etc..
Results:- A total sample of 100 singleton mothers with their babies were studied according to maternal and environmental factors, maternal past and recent obstetric histories and according to the characteristics of the newborns and their outcome.The sample distribution according to the general characteristics show that most of theVLBW babies were
born to mothers aged 26-35 years old,35(35%). Most of the VLBW born to non-smoker mothers, 44(44%) of babies born to mothers with drug supplement. About 76(76%) of the mothers were multiparous.About 63(63%) women were have no PTL, about 26(26%) of mothers had history of leaking liquor, while 33(33%) had history of fever, 76(76%) had NVD. The most common systemic disease was hypertension found among 25(25%) of mothers. The prevalence of died babies amongVLBW babies was43(43%),as compared with 57(57%) those who discharged well.
Conclusion: - The results of our study showed that variables which are regarded as maternal risk factors for VLBW are younger maternal age, maternal systemic diseases especially hypertension, maternal fever.

Background: Psoriasis is a disorder with genetic and immunologic background. Leptin can involve in development of psoriasis by regulation the T-helper response.
Objective: Our primary goal is to study the effect of polymorphism (G-2548A) of the leptin (LEP) gene as a risk factor for predisposition of psoriasis, and relation between the leptin serum levels and leptin 2548 gene polymorphism.
Methods: The study involved 100 patients with psoriasis and 80 healthy controls. Analysis of G-2548A polymorphism of the LEP gene was made by the PCR and restriction fragment length polymorphism technique. The relationship between LEP gene polymorphism and the clinical features
of the patients was analysed. Serum leptin levels and proportions of comorbidities in patients vs controls were compared.
Results: In controls, the GA, AA and GG frequencies were 50%, 30% and 20%, respectively, while in patients, the distribution of genotypes was 48%, 20% and 32%, respectively, with significant difference between patients and controls. There were a significant differences in the genotype distribution of Leptin -2548 cytokines
examined with respect to its serum levels in patients group. the GG genotype mean of serum level was(23.4 ± 4.1ng/ml), and GA were 20.5 ± 6.84 and AA was (16.2 ± 5.86 ng/ml).
Conclusion: LEP G-2548A polymorphism could be a predictor for higher plasma leptin and increased risk of psoriasis and could be used as a marker for psoriasis-related comorbidity risk.

Study included nine hundred samples was randomly collected from in patient and out patient in Tikrit teaching hospital, Salahaldin general hospital and dijlla general hospital from November 2012 to August 2013.
Aim of study
1-isolation of salmonella spp from different samples.
2-study of antibiotic sensitivity against salmonella.
The study according to the age period the most common age period was in children (ID-2Y) with higher percentage of infection (26.82%). while in adult age period(20Y-40Y) was higher percentage of infection rate (29.2%), the study revealed the incidence of salmonella infection in female (60.97%) higher than percentage in male (39.2%). Through seasonal study and according to degree of temperature and months of year study revealed higher percentage of infection was in July 2013 (8.5%) and June 2013 (7.6%) but there was no infection in January 2013 and marked decrease in December 2012 (1.09%). In comparative study of salmonella infection and type of milk feeding in children there was higher percentage of infection in children who depending artificial milk feeding (63.63%) comparison to children who depend on natural milk feeding (36.36%). As percentage of infection according to living and breeders of animals there was higher percentage for who live in rural area (68.29%) comparison to who live in urban area (31.70%) there was high percentage of infection in who breeders of animals (60.97%) from
who not breeders of animals (39.02%). Through study of sensitivity of isolates to antibiotic all (100%) isolates was resistant to Amoxicillin and Ampicillin while higher percentage of isolates (82.92%) were sensitive to ciprofloxacin.

Sickle cell disease (SCD) is hematological disease that affect the endothelial
function, the hemoglobinopathy of this disease triggers erythrocyte polymerization. The sickling process leads to vascular occlusion, tissue hypoxia and subsequent reperfusion injury, thus inducing inflammation and ndothelial injury (EI). Thirty sickle diseas patients (15 females and 15 males) with a mean age of (27.0 ± 8.9) and 30 healthy cont ols (18 females and 12 males) with a mean age of (29.7 F 9.1) participated in the study Assessment of endothelial function done by studying biochemical parameters which includes; serum nitric oxide, serum endothelin-1, vascular cell
adhesion molecule-1, and serum nterlokin-6 The results showed that all the biochemical parameters that measured in this study were not significantly diffe rent between the patients with sickle cell disease and control
subjects, except the serum level of nitric oxide level in patients with sickle cell disease (2.90 ± 2.57) was significantly lower ( = 0.02) than that of controls (8.49 ± 9.36). From all these find ngs, we can conclude that SCD patients have some degree of impairment of endothelial functin.

Munchausen syndrome by proxy is a rare and serious form of child abuse and
psychological maltreatment, comprises both physical abuse and medical neglect. It is characterized by a child with symptoms and signs of an illness that have been fabricated by the mother or the caregiver. Ten children less than 7 years of age (eight males, two females) with Munchausen syndrome by proxy were seen in Al-Tifil Central hospital and Tikrit Teaching Hospital between 1998-2007. In three of the patients the mother was the only
offender, the child's aunt was the only offender in another one patient, the mother and her sister were the offenders in another patient, the mother and her aunt was the offender in another patient, and in the remaining 4 patients the mother's aunt was the offenders, who named here as the great perpetrator, because she was the perpetrator with 10 victims of different ages. In 9 patients, the relations was the offender's motivation in comparison
economic motivation in only one patient. One child died, while the other patient's lives were saved. Difficulties in diagnosis and management in this field are presented. This is a pioneer study for five reasons; 1st: it reveals existence of MSBP in Iraq for the first time, 2nd: it describes a novel type of MSBP, which caused by the great perpetrator, who had 10 victims of different ages; 3rd: it describes 2 patients of adult victims of MSBP, and 4th: describes
offenders who act in duet manner 5th: special problems unique to the Iraqi society has been described. Until now, no national legal guidelines exist in the Iraq to child abuse in general and MSBP in particular. Urgent guidelines, policies, and legal system are required. It is necessary to create awareness even in the medical community, to recognize this problem and should therefore be considered in the differential diagnosis of unusual illness with bizarre features, even if the parents' behavior appears normal.

Background: Plesiomonas shigelloids a new member of the terobacteriaceae family is regards an emerging enteric pathogen, it is a water and soil organism and has been isolated from fresh water fish and many animals, and most isolates from humans have from stool cultures of patients with diarrhea.
Little is known about the prevalence of plesiomonas shigelloids infections in Salah Al-din city.
Furthermore this study design identification scheme for clinical laboratory to identify plesiomonas shigelloids. Study design and objectives: This study was performed to determine the prevalence of plesiomonas shigelloids in hospitalized (nosocomial) patients and out clinic patients that infected with
diarrhea in Tikrit Teaching Hospital, and out clinic centers during the period from May 2012 to the end April 2013. Also this study was performed the role of aquariums that spread in Salah Al-din city as a source of plesiomonas shigelloidsdiarrheal infection, by collecting water samples from these aquariums monthly in the same period of diarrheal cases collection.
Patients and water sampling: One hundred and ten diarrhea samples were collected, 24 samples from TikritTeaching Hospital as a nosocomial diarrheal infection and 86 samples were collected from out clinic centers in Tikrit and other cities. Also water samples were collected from 29 aquariums that diffuse in Salah Al-din cities as monthly. Identification method: This study used simple and short identification scheme for clinical laboratory diagnosis, by culturing the samples in blood agar as a first culture and S.S agar as a selective culture, and used Grams stain, Hanging drop test, Oxidase test, Stirring test, and Inositol fermentation test as a microscopic and biochemical identification tests.
Results: generally plesiomonasshigelloidsdiarrheal infection revealed the prevalence of this bacteria of the total examined stool samples, from 110 diarrheal cases 44(40%) cases with P. shigelloidesand 66(60%) cases with other bacteria, 7(29%) nosocomial diarrheal infection, were regarded
with P. shigelloidesinfection, and37(43%) from out clinic diarrheal infection, were infected with Р. shigelloides, these positive results were identified in the end of spring and summer months more than other seasons. Also from 29 aquarium water samples were collected monthly from each aquarium,
showed variant results from month to another, but most of the aquarium water samples were positive in spring and summer months. The patient's results showed that the adults were the most infected with Р.shigelloidesthan children or infants. Investigation of antibiotic susceptibility was done for
allplesiomonasshigelloidsisolates, the nosocomial diarrheal samples showed multidrug resistance to antibiotics than the out clinic and aquarium samples. Some of the virulence factors were determined in
this bacterium, like it is ability to produce some enzymes (DNase, lipase and lecithenase, urease. gelatinase) and to produce hemolysin toxin, the virulence factored results showed that the all isolates were produce lipase and hemolysin only.

Worldwide, malnutrition is common and is responsible directly or indirectly for
about a third of all deaths of children under 5 years of age. Restrictive diets may be iatrogenic as a result of exclusion diets or parental food fads, or may be due to parasitic infection like Giardia lamblia which is a zoonotic parasitic disease caused by the flagellate protozoan Giardia lamblia (also sometimes called Giardia intestinalis and Giardia duodenalis).
A descriptive cross sectional study was done on children attending the pediatric department, and nutrition department in General Pediatrics Hospital in Kirkuk from 15th of March to the last of August 2015. This study aims at : To evaluate the occurrence of infection by Giardia lamblia among the malnourished children under five years.
The study included 101 Children, their age from (2 months -5 years). Each child included in the study was assessed by a prepared questionnaire. Screening done by measuring weight for age, height for age, then diagnostic test done by depending on weight for height to confirm diagnosis or exclude malnutrition. Each malnourished case was sent for general stool examination. The total mumber of cases were 101 cases, males were (56.4 %) while female were 44 (43.6%) most of the cases were of 2-12 month for both females (47.4%) and males (54.5%) respectively.. Others findings for this study show all the cases were wasted (100%) followed by abdominal distention (60.4%) and finally most of the study cases were below 3rd percentile 73.3%. Regarding the general stool examination the laboratory examination show positive test for Giardia lamblia were 12 cases, the prevalence were 11.9% most of the study cases had normal Middle Arm Circumference (88.1%) and most of Giardia lamblia positive patient had weight for age less than 3rd percentile (83.3%) and most of the Giardia lamblia positive patients had height for age less than 3rd percentile while negative Giardia lamblia infection had normal height for age (100%).
Finally the present study concluded that Giardia lamblia is still prevalent among malnourished cases.

The presented study was carried out from May2015 to September 2015 in the Pediatric General Hospital in Kirkuk. A total of 102 samples from children detect some virulance factor of Escherichia coli,. The identification of these bacteria is depended on several biochemical tests including (indole test,
methyl red test, vogas proskaur test, citrate utilization test, urease test, oxidase test and motility test) and the identification was confirmed by using Analytical profile index (API 20 E system). Antibiotic Susceptibility test was done for these isolates to detect the ability of this bacteria to drug resistance
Finally the genes that are responsible for diarrhea in E.coli isolates (eae gene for EPEC, ial gene for EIEC, It gene for ETEC,stx gene for EHEC) detected using PCR E.coli were the most common pathogen isolated from children (30isolates), and pathogenic Ecoli was 11 isolated,4 was ETEC, 4EIEC,3EPEC, and absent of EHEC.