Al-Qadisiyah Medical Journal

Introduction: radiation therapy carries an important role in the treatment of head and neck (H&N) cancers. Exposure of cells to ionizing radiation produces a variety of biological and molecular changes that may manifest clinically as tumor killing or normal tissue toxicity, the type and severity of these effects depend on variables such as the energy and type of radiation, the composition of target biologic tissue, the cellular and molecular response, duration of exposure, and cellular microenvironment. A sound signal in the environment is collected by the pinna, passes through external auditory canal and strikes the tympanic membrane_ Vibrations of the tympanic membrane are transmitted to stapes footplate through a chain of ossicles coupled to the tympanic membrane Movements of stapes footplate cause pressure changes in the labyrinthine flu ids which move the basilar membrane. This stimulates the hair cells of the organ of Corti. It is these hair cells which act as transducers and convert the mechanical energy into electrical impulses which travel along the auditory nerve.
Objective: to determine the effect of radiotherapy on hearing process.
Method: Prospective case control study on 45 patients (90 ears) in al diwaniyah teaching hospital from January 2013 to October 2016 with head and neck malignant tumors diagnosed by histopathological specimens, of both sexes and treated with radiotherapy are included in the study. Patient with history of hearing impairment (disabling or documented sever to profound hearing loss), chronic otitis media and those who receive chemotherapy previously are excluded from study. Pre radiotherapy pure tone audiogram and 6 month after when the patient come back to oncology unit for fellow up their condition those patients allocated in group A while group B (control) 45 healthy person (90 ears) are chosen from staff of hospital and college of medicine after announcement for volunteers in study pure tone audiogram done for them as in case group.
Results: Regarding the mean of age for group A was 53 years with range from 30-70 years , with male: female ratio 4:1while for control group(B) was 49 years with range 25-60 years and male to female ratio 2:1. Most common neoplasia was carcinoma of larynx followed by nasopharyngeal , oropharyngeal and hypo pharyngeal carcinoma, oral cavity and paranasal sinuses Regarding hearing about 38 (42.18%) of patients (group A) not affected by radiotherapy while 43 patients (47.75%) got worse hearing after radiotherapy, only 9 patients (9.99%) had hearing improvement. While in control group 73 (81.11%) not changed, 6(6.66%) deteriorate and 11(12.22%) had improve hearing.
Conclusions:
1. Radiotherapy induced hearing problems occur in significant number in patient with head and neck tumors.
2. Hearing morbidity post radiotherapy mainly sensory neural
3. Patient counselling before radiotherapy about hearing disabilities should be regarded.
4. Further long term studies and larger sample are needed.

Background:
Chronic subdural hematoma is a collection of liquefied blood between the dura and arachnoid layer of the brain which thought to result from injury to bridging veins crossing the subdural space. Patients with chronic subdural haematomas can present in a variety of ways, and symptom onset and progression may range from days to weeks. Surgical approach with standard methods is still controversial.
Objective: to compare patients outcome following two surgical approaches with or without closed system drainge.
Patients and methods: The present prospective cohort study included 40 patients with subdural hematoma throughout the period extending from January 2010 to August 2014. Two bur hole craniostomies (12 mm in diameter) were made in each patients; one in front of the coronal suture and the other behind the hematoma and the procedure was done without membranectomy. In 15 cases, closed system drainage was placed into the hematoma cavity for an average of 2 days (1 to 3 days) after irrigation with physiologic saline solution.
Results: The outcome after operation was as following: 5 out of 25 patients in the first group needed re-operation accounting for a rate of (20%). The rate was slightly lower in the second group; 2 out of 15 (13.3%). The difference in rate of re-operation was not significant (P> 0.05)
Conclusion: The use of subdural closed drainage system

Background: the protective effect of and the association between breastfeeding and asthma has raised substantial interest and is a subject of debate.
Objectives: to study the relationship between asthma and feeding pattern in children up to the age of 12 years in Diwaniah, Iraq with a focus on breast feeding.
Patients and methods: this is a prospective study accomplished in the maternity and children teaching hospital in Diwaniah ,Iraq during the period from January 2015 to March 2016. The study involves 1242 patients with the diagnosis of asthma and control group of 1350 healthy infants and children were chosen for comparison. The pattern of feeding and the period of breast feeding in both groups were recorded together with other variables.
Results: sixty six percent( 688 out of 1041) of patients with asthma ≤ 5 years were artificially fed and only 13.5% of them were breast fed. the rate of asthma is significantly less in children with breast feeding especially when the age interval under five years is taken into consideration.
Conclusion: early, exclusive and prolonged breastfeeding protects against asthma in children particularly in those less than 5 years of age.

risk factors can play a role in its pathogenesis; DM, HT, dyslipidemia, obesity smoking and microalbuminuria are common known risk factors. Microalbuminuria is independently considered as a risk factor of CHD in patients with diabetes. Its task as a predictor for CHD has not been well examined, and its predictive implication is uncertain.
Aim of study: The purpose of our study was to determine the using of microalbuminuria as a predictor test for detection of silent ischemia in type II DM.
Patient and methods: Selection of 169 patients with type II DM who had neither old nor recent IHD and they hadn’t chest pain. According to the results of microalbuminuria, we were dividing those patients into two groups, with and without microalbuminuria. Group one consist of 74 patients with microalbuminuria while group two consist of 92 patients without microalbuminuria. Treadmill test (TMT) or holter studies were done for all patients of both groups after taking their agreement.
Results: the result would reveal that diabetic patients with microalbuminuria are at high risk of ischemia than those without microalbuminuria independently to other risk factors. 16 of 74 patients from group one and only three of 95 from group two show positive features of ischemia during exercise test with statistically significant (p value < 0.001).
Conclusion: In diabetic patients, microalbuminuria is associated with high CHD risk, independently to other known risk factors. As such, any patient with diabetes mellitus type two had microalbuminuria should search for latent IHD independently to other risk factors. So detection of microalbuminuria and trating of other risk factors is mandatory for improved outcome of CHD risk.
Recommendation: Closely follow up of diabetic patients with tight glycemic control in order to reduce incidence of microalbuminuria and any patient with microalbuminuria should search for CHD.

BACKGROUND; Congenital anomalies can be defined as structural or functional abnormalities present at birth. They are an important cause of morbidity and mortality in infants. Various risk factors have been identified as contributing factors to these defects. The objectives of the present study are to determine the frequency of different structural congenital anomalies and possible risk factors responsible for these anomalies.
METHODS; This case - control study was carried out in the neonatal intensive care unit of Kerbala teaching hospital for children in Karbala / Iraq. The study was conducted over 18 month’s period from January 1, 2014 to May 31, 2015. All babies admitted to neonatal care unit with congenital anomalies during this period were included apart from neonate with suspicion of inborn error of metabolism and those with chromosomal abnormalities because there are no facilities for definite diagnosis of these diseases.
Seventy seven newborns with congenital anomalies included in this study, males 47(61.04%) and females 30 (38.96%) and 100 newborn without congenital anomalies, male 59 (59%) and female 41 (41%), selected randomly as a control.
The statistical method which used to signify the risk factors is relative risk (RR). [RR = 1 no effect, RR > 1 is a risk factor, and RR < 1 is protective]
RESULTS; In present study, the congenital anomalies related to the cardiovascular system (CVS) were the most common 33(42.86%). Males 47(61.04%) were more commonly affected than females 30 (38.96%). Cases of congenital anomaly were found in 60 (77.92%) of multiparas, whereas 17 (22.08%) in primiparas. It has been seen that 45 (58.44%) of the mothers were 20 - 30 years old, 15 (19.48%) of the mothers were between 30 - 40 years old, and 6 (7.79%) of the mothers were over the 40 years old.
In the present study, 54 (70.13%) mothers of babies delivered with congenital anomalies had a history of consanguinity. Also, 6 (7.79%) mothers of babies delivered with congenital anomalies had a history of diabetes mellitus.

CONCLUSION; The congenital anomalies were cardiovascular system (CVS) 33(42.86%), gastrointestinal system 25 (32.47%), and central nervous system 14 (18.18%).
The main risk factors were consanguinity and maternal diabetes.

Normal intestinal microbiota are a reservoir for antibiotic resistance (genes) especially Escherichia coli (E. coli). The goal of this study was to investigate the prevalence of integrons class 1 and antibiotic resistance among commensal E. coli isolates and detect the association of integron class 1 with antibiotic resistance (single or multiple drug resistance) that may be transport horizontally to other bacteria. Three hundred one E. coli isolates from stools were obtained from healthy individuals (age from 1to 80 years). All isolates were tested for their susceptibility against 16 antimicrobial agents using standard disc diffusion method and for the presence of class 1 integrons by PCR. Integrase genes detected in 112 isolates (37%) out of 301 tested isolate. High resistance observed for most antibiotics especially ampicilln, amoxcillin, lincomycin, cephalexin while resistance to amikacin and gentamicin was less common. Furthermore resistance to cefotaxime, ciprofloxacin, oxytetracyclin, tetracycline and trimethoprim significantly associated (p < 0.05) with IntI1 gene positive isolates. All integrons positive isolates are resist to more than five antibiotics and significantly associated with many resistance patterns. In conclusion, increase antibiotic resistance among commensal E. coli in this population that companied with increase frequency of integron class 1 that significantly associated with resistance for single or multiple antibiotic agents.

Background:
liver iron concentration assessed by MRI T2* is the better indicator of total-body iron depositions and should be checked in frequent blood transfused patients. MRI T2* can be detect iron overload before iron toxicity becomes clinically apparent.
Aim of study: to prevalence of liver injury among patients with B- thalassemia major secondary to iron over load in Thalassemia center of Diwaniyah maternity and children teaching Hospital.
Methods: This a cross – sectional study was carried out on 58 patients (34 males and 24 females ) diagnosed β-thalassemia major on the base of the blood investigations (peripheral blood counts and hemoglobin electrophoresis), their age range from 9 years to 36 years. The study was conducted in Thalassemia center of Diwaniyah maternity and children teaching hospital in Al- Diwaniyah Governorate, Republic of Iraq. The Data collection was carried out during the period from the 30th of December 2015 to 11th of August 2016. They were studied for prevalence of liver injury among patients with thalassemia major secondary to iron over load.
Results: Total numbers of B- thalassemia major patients are 58 patient. The numbers of patients with ages less than 10 years are 3 (5.2%), patients with ages(10-18)years are 39 (67.2%), patients with ages(19-25)years are 12(20.7%). statistically significant correlation was found between liver function test (LFT) abnormality ( ALT, AST) and numbers of blood transfusion per year (P=0.001) and also LFT abnormality ( ALT, AST) and ferritin levels (P=0.01). In our study reported that liver iron concentration was presented normal in 23 patients (39.7%), mild iron concentration in 29 patients (50.0%) and moderate iron concentration in 6 patients (10.3%). There was a significant association between serum ferritin level and the liver iron concentration assess by liver MRI T2* (P=0.002).

Conclusion: These results showed that correlation between ferritin, LFT abnormality and liver iron storage detected by MRI T2 in patients with β-thalassemia major. MRI T2* has become the clinical standard to estimate liver iron overload.

Tissue plasminogen activator (t-PA) had improve the treatment of ST elevation myocardial infarction (STEMI). The aims considered assessment the response of patients with STEMI to t-PA (Alteplase) infusion by estimate the frequency of selected parameters. This is study that included 62 patients with STEMI who had been treated with t-PA infusion as a thrombolytic therapy. They had been selected from those who had been admitted to the Coronary Care Unit at Al-Diwaniya Teaching Hospital, Diwaniya city, Iraq during the period between 1st of March 2014 to the 31st of August 2015. Specific selected parameters used to assess effectiveness of t-PA. Parameters including: resolution of ST segment elevation (reduction in the ST elevation ≥ 50%), relieve of chest pain, occurrence of accelerated idioventricular rhythm (AIVR) and positive response for three parameters (simultaneously), observe within 90 minutes after t-PA infusion. After t-PA infusion, 59.6% of the patients had resolution of ST segment elevation, 56.4% getting relieve of chest pain, AIVR occur in 30.6% and positive response of all parameters in 9.6%. Patients less than 60 years old age constitutes 45.1% of patients who had ST segment resolution, 30.6% of patients who had relieve of chest pain, patients with AIVR in 22.5%, and patients with positive response of all three parameters in 9.6%, (significant p.value). Smokers patients getting ST segment resolution in 41.3% of patients, relieve of chest pain in 38.7%, AIVR in 16.12% and positive response for all selected parameters in 8.06% of patients, (significant p.value). 1.61% of patients with ST segment resolution and 11.29% of patients with relieve of chest pain seen with time to perfusion more than 6 hours. This study indicated that increasing age, obesity, diabetes mellitus (DM), and delay in reaching hospital after onset of ischemic chest pain considered as predictors for poor response to t-PA infusion among patients with STEMI. BMI has no significant consideration but smokers patients had been associated with better response to t-PA.

Background:
Regenerative wellbeing focused on Millennium Development Goals won\'t be accomplished without enhancing information and mindfulness and access to conceptive wellbeing. Most of the youngsters have almost no information on what sexual rights they are qualified for. This review was expected to survey learning of regenerative and sexual rights and in addition related elements among Al-Qadisia medicinal understudies.
Objectives:
1-To evaluate the consciousness of regenerative wellbeing among Al-Qadisia medicinal undergraduate medical students.
2-To distinguish the socio-statistic variables adding to sexual and regenerative wellbeing and family arranging.

Material and Methods
A cross sectional review was directed from December 2015 up to the March 2016 with a specific end goal to know familiarity with Al-Qadisia restorative understudies about the regenerative wellbeing.
A disproportional strata randomization sample of (387) students was taken from the six departments of the college.
Questionnaire was designed to measure the phenomena \" knowledge and awareness of students in college of medicine about the reproductive health\" the final copy of the questionnaire consists of twelve main parts, the first part concerning of demographic characteristics, while the second part of the checklist contain age of marriage and conception ,the third part contain knowledge about reproductive health and family planning ,and other parts contain awareness regarding factors related to infertility, knowledge about abortion and reproductive health, knowledge about route of transmission of STIs, etc … .
Results
The vast majority of the study sample (50%) with age ranging (<21) years ,about (78%) were female, (98%) of students were single , on other hand the level of ‘awareness’ was (86%) regarding age of marriage and (80%) regarding conception , also about the importance of the premarital investigations, the most important investigation they know was ABO compatibility.
Regarding sexual transmitted diseases about fifty percent know and other fifty percent they didn’t know the transmission of some disease between couples through sexual contact., one quarter nominated AIDS as the disease that could be transmitted sexually and about two thirds they don’t know any other diseases, 42.4% they believed that STDs could cause infertility and 52.7% they don’t know about that. More than half ( 56.6% ) believed that contraceptive uses cause infertility.
Conclusions and Recommendations:
The study found that the level of ‘awareness’ was ‘good’ regarding age of marriage and conception , also about the importance of the premarital investigations, the most important investigation they know was ABO compatibility. fifty percent know and other fifty percent they didn’t know sexual transmitted disease, more than half believed that contraceptive cause infertility .
Based on the finding of this study the researcher recommended further studies should be conducted with a wide range sample and hold Programs that provide information about the reproductive health awareness.

Group A Streptococci (GAS) or Streptococcus pyogenes is an important pathogen which causes a wide-ranging of diseases for human. This study was carried out in Ear Nose Throat (ENT) department in Al–Habboby Teaching Hospital, Thi-Qar province, south of Iraq during the period from October 2015 to April 2016. Two hundred and ten swabs were collected from patients infected with pharyngitis. 152 (72.3 %) showed positive growth with S. pyogenes. GAS isolates were subjected to detect two virulence genes (scpA and sdaB) by conventional PCR technique using specific primer pairs and DNA sequencing analysis. The sequencing of PCR products produced from bacterial DNA showed significant alignments identities (96-99%) to the S. pyogenes which are located in BLAST-NCBI Genbank. The six sequences of Streptococcus pyogenes scpA and sdaB genes determined in this study have been deposited in the GenBank under the accession numbers MF49318-MF497323. Phylogenetic analysis of S. pyogenes based upon the neighbour-joining of partial scpA and sdaB gene sequences showed that these sequences were derived from Streptococcal genes. In addition, S. pyogenes can produce several exotoxins that have the potential to damage the host tissues either directly or through the stimulation of cytokine production.

Sonographic evaluation of the carotid arteries, both gray scale and Doppler is widely used for risk assessment for cerebrovascular accidents .This study was conducted to assess the state of carotid vessels in patients with acute ischemic stroke by assessing intima-media thickness of common carotid , internal carotid stenosis with the size of ischemic area that diagnosed by using computed tomography . : A total of 68 patient with stroke (21 females , 47 males) were assesed, Gray scale & Doppler US of the ipsilateral carotid arteries performed , measurement of IMT of CCA , the presence of any plaque recorded , the diameter reduction measurement PSV & EDV of the CCA & ICA . 36 patient have no stenosis (52.94%), 32 remaining patient have different degree of stenosis (47.05%),as follow .19 patient have mild stenosis (H1)(59.37%), 9 patient have moderate stenosis (H2)(28.12%) , 4 patient have sever stenosis(H3)(12.5%).40 patient showed increased IMT (58.82%), 28 patient had normal IMT (41.17%).42 patients are smokers (61.76%),So increased intimal media thickness of common carotid artery is associated with stroke .Large size ischemic stroke are more associated with high degree of internal carotid artery stenosis ,There is a significant relation between atheromatous plaque and size of brain infarction

AIH so far thought to be an auto-immune disease. One of the genetic predisposing factors is thought to be HLA-DR3 and DR4 genes. The present study aimed at investigation the frequencies of HLA-DR3, DR4 and HLA-B27 genes among the Real-time PCR were used for the HLA-genes. The age of the patients were ranged from 7- 69 years in AIH group and from 8-67 years in healthy controls group. On the context of genotyping of HLA- genes, DR3, DR4, and B27 were found to be differed in their frequencies significantly among AIH patients that creating high etiological fraction of 0.504, 0.583, and 0.129 respectively compared to healthy controls, with odd ratio (OR) 7.35 for DR3, high OR 8.0 for DR4 and 2.23 for B27. The frequencies of these genes in AIH patients, highly significant differed between patient group, for DR3 compared to healthy group which 58.3% and 16% respectively, and very high significantly differed between patient group for DR4 compared to healthy group which 66.7% and 20% respectively, while no significant differed between patient group compared to healthy group for B27 which 23.3% and 12% respectively.

The laser and nanoparticles representing the concourse of biological science with physical science and considering modern method that used as an antibacterial instead of conventional antibiotics. The present study is an attempt to illustrate how the use of laser or silver nanoparticles each of them individually, as an antibacterial agent against Escherichia coli (E. coli) as well as study the effective result from the absorption of Diode laser energy by these nanoparticles to kill or inhibition bacterial growth. The silver nanoparticles (AgNPs) are prepared by biological method E. coli were isolated and identified by use MacConkey agar and biochemical tests. Nanoparticles are tested against E. coli cultured on Muller Hinton agar but Diode laser or laser with nanoparticles are tested against E. coli that cultured in Nutrient broth. E. coli are irradiating by Diode laser with different times. Different concentrations of silver nanoparticles have been employed for killing and inhibition bacterial growth. Results showed E. coli was effected by nanoparticles (mainly highest concentration of nanoparticles) also detected that decrease bacterial availability with increase time of exposure to Diode laser.

Breast cancer is a malignant tumor that starts from cells . of the breast. A malignant tumor is a group of cancer cells that may grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body. The burden of breast cancer is increasing in both developed and developing countries, and in many regions of the world, it is the most frequently occurring malignant disease in women; comprising 18% of all female cancers, and worldwide, breast cancer is the fifth most common cause of cancer mortality. This case-control study was arranged to investigate the possible role of selected genetic and immunological parameters in a random samples of patients with breast cancer in the Al-Diwanyia province. Five ml blood samples obtained from fifty females with breast cancer in post-operative stage attending the outpatient department of psychiatry in Al-Diwaniyia teaching hospital have been recruited in the study and compared to 50 health control females without any cancer types, ages of patients and control were ranged between 18-80 years. 6ml blood samples were assessed for serum measurement CA-15.3 and CEA tumor markers by using Fully-auto chemiluminescence immunoassay – CMIA. In the association between breast cancer and selected immunological markers our results showed a significant association between serum concentration of tumor markers (CA-15.3 and CEA) and breast cancer disease (p<0.05) in comparison with control group. The mean serum CA-15.3 and CEA were significantly higher in patients as compared to both control groups P value <0.0001. The statistical results show no significant association between CA 15-3 and CEA in patients group (p= 0.185) , but moderate positive correlations is appeared (r = 0.2432). In the other hand the association between patients age and selected immunological markers study in our study (CA-15.3 and CEA) and the results showed to the serum concentrations of CA-15.3 and CEA not effected strongly by Age (r= 0.20 and r= 0.114 respectively ).

Background:
Obstructive Jaundice is a common surgical problem with variable causes ranging from benign causes like choledocholithiasis to malignant causes like carcinoma of head of pancrease,its clinical features vary according to its causes and the treatment vary from curative to palliative procedures. Many factors may affect the morbidity and mortality like the age of patients, depending etiology and the presence of associated comorbid diseases.
Aim of the study
To evaluate the management of obstructive jaundice in patient admitted to Al-Diwanyia Teaching Hospital.
Patients and Methods:
Prospective study was done in Al-Diwanyia Teaching Hospital between January 2011 and December 2014. 90 patients presented with obstructive jaundice admitted in AL-Dewanyia Teaching Hospital were included in this study. Data were collected regarding to the presenting clinical features, the diagnostic techniques, operative procedures and the causes of hospital mortality and morbidity and were analyzed so that a complete picture of these details can be assessed for obstructive jaundice in Al-Diwanyia teaching hospital.
Result
A total of 90 patients were studied. Female out numbered male by ratio of 1.5: 1. The majority of cases found in the age group 50-59 years. Most common etiology was choledocholithiasis.
Most patients with obstructive jaundice presented with jaundice and upper abdominal pain. The most frequent applied investigation was the liver function test which was done to all patients. Imaging techniques were applied variably with the US was the most applied while MRCP was the next; however, the accuracy was higher with the latter technique Intervention depends on the main etiology: for the choledocholithiasis, most common intervention was ERCP, for CA head of pancreas the most common operation done was by pass procedure and for complicated hepato biliary hydatid disease the CBD exploration with T-tube was the common.
The post-operative morbidity was 13.33% mostly due to respiratory complications, while mortality was 3.33 %
mostly due to sepsis .
Conclusion:
Most common cause of obstructive jaundice in patients referred to AlDiwanyia teaching hospital was choledocholithiasis and biliary stricture comes second.
U/S and MRCP are the most common applied imaging techniques in diagnosis of obstructive jaundice. The threshold for their application was high.
The most common applied intervention to treat obstructive jaundice was the therapeutic ERCP, while the least applied intervention was open surgical procedures

Acute poisoning, a common pediatric emergency, is one of the important causes of morbidity and mortality in children, especially in developing countries. The patterns of poisoning usually differ from country to country and from province to another within the same country.
The purpose of this study was to clarify the characteristics of acute chemical and drug poisoning
cases admitted to the emergency department (ED) of maternity and children, teaching hospital in Al- Diwaniyah city and to compare poisoning characteristics between different age groups in the region. A review of medical records of 125 poisoning cases under 7 years of age, except for cases of food poisoning, snake bite, scorpion stings and cases with incomplete data were not included in this study, presenting to the Emergency Department (ED) during 2016 were determined .The mean age of all poisoned patients (mean ± standard deviation) was 2.26 ± 0.750.One hundred and twenty five children, forming 2.2% (125/5494) of total emergency unit admissions of all patients, were under seven years of age. Slightly more boys 71 (56.8%) than girls 54 (43.2%) were intoxicated with the male to female ratio of 1.3:1. The majority of all cases were due to accidental poisoning. In patients younger than one year of age 23(18.4%), of all poisonings were due to therapeutically error, 1 – 3 year 47 (37.6%), 4 – 7 year 55(44%). Chemical agents (58.4%) mostly kerosene (30.1%), agricultural pesticides/insecticides (19.1%), were the most frequent offending agent, followed by drugs comprised (41.6%), mostly due to Cold and cough medication (15.3%), The vast majority of these materials was stored in non-original containers, These drugs were available at home, being used either by the child or the parents and grandparents. The most common route of poisoning was ingestion of the poison (118 patients; 94.4%) and most were ingested inside the house (73.6%). No deaths were reported.
There were obvious seasonal variations and most cases were admitted during in summer (42.4%) and spring (29.6%). Patients from rural areas (57.6%) were more than the patients from the urban areas (42.4%). Effective health promotional programs for parents regarding poisoning hazards are needed to increase the awareness and reduce the incidence of poisoning among children in our region in addition correct dealing with the chemical materials. A relationship exists between the parents’ level of education and the occurrence of pediatric poisoning particularly mothers. Since the level of education in this study was lower in the mothers and for mothers are those
Who take primary care of children at home; they should be educated regarding care and prevention of lethal injuries to their children at home.

Aims: To constuct and evaluate a rapid semiautomated system in discriminating malignant from benign follicular thyroid neoplasms.
Methods: Sixty formalin fixed paraffin embeded blocks of follicular thyroid neoplasms were retreived and slides were prepared and H and E stained. A morphometric system was constructed to be as rapid as possible and was tested.
Results: No signficant difference was found in ratio of largest nuclear to smallest nuclear diameter between follicualr adenoma and follicualr carcinoma groups.
Conclusion: Rapid semiautomated morphometric analysis is of no help in predicting malignancy in follicular thyroid neoplasm.

Background: Local anesthetic inguinal hernia repair may be technically demanding. There are minimal data regarding the outcomes of local anesthetic hernia repair in comparison to general anesthesia.This study analyses the outcomes of mesh hernia repair under local anesthesia versus general anesthesia.
Patients and methods: A prospective randomized control study of mesh inguinal hernia repairs over a 22 months(Jan2009-Oct2010) period was performed. A total number of 205 patients with inguinal hernia were included in this study in Baghdad teaching hospital, patients were divided in two groups. Group1(study group) included 106 patients who had their hernia repaired under local anesthesia. Group2(control group) included 99 patients who had their hernia repaired under general anesthesia.
Results: A total of 215 hernia repairs were performed during the study period. Of these, 110(51.2%) repairs were performed under local anesthesia (LA) and 105(48.8%) repairs under general anesthesia (GA). early postoperative complications revealed no significant differences in both groups in the incidence of hematoma, wound infection and scrotal swelling. There were no pulmonary or urinary complications in study group(LA), in comparison to control group(GA), Five patients (4.7%)patients developed pulmonary complications and 4(3.8%)patients developed urinary complications in control group(GA). The day-case rates were significantly higher under LA compared to GA (80% versus 40%; P < 0.05). Patients operated under LA had lower postoperative analgesic requirements (P < 0.05). There were no recurrences at a median follow-up of 1 year (range 3-22months). Long term questionnaire revealed higher satisfaction rates with LA compared to GA repair.
Conclusions: The use of LA results in an increased day-case rates, lesser postoperative analgesic requirements and no pulmonary and micturition problems. Both anesthetic techniques were associated with good outcomes and satisfaction.