The Medical Journal of Tikrit University

Background and objectives: Women’s Health Initiative demonstrated cardiovascular risk linked to the use of oral contraceptive pills therefore the aim of this study is to find out the prevalence of metabolic syndrome and the effect of oral contraceptives pills on lipid profile, blood pressure and body mass index in a group of women of reproductive age in Erbil city.
Materials and methods: This comparative cross-sectional study was conducted on 246 women of child bearing age (14-49 years) from the May 2015 to the April 2016 in maternity teaching hospital and primary health care centers of Erbil. They were divided in two groups: the first group involved 123 women used oral contraceptive pills; the second group involved 123 women age matched not using oral contraceptive pills. Waist circumference, Body Mass Index and blood pressure were measured in all subjects. Fasting levels of serum glucose, triglycerides, total cholesterol, high density lipoprotein cholesterol and low density lipoprotein cholesterol were obtained. Metabolic syndrome was diagnosed according to criteria made by the United Nation National Cholesterol Education Program Adult Treatment Panel III. Various parameters were compared among oral and control groups by using SPSS version 19.
Results: The prevalence of metabolic syndrome among users was significantly higher than that among non-users (71.5% and 5.7%, respectively) (p<0.001) and the prevalence of hyperlipidemia was significantly higher among users compared with non-users (p< 0.001). The oral contraceptive pill users were at higher risk for cardiovascular disease than non-users according to the atherogenic index (48% was compared to 5.7% respectively) (p< 0.001). Users showed that they are at high or very high risk of developing diabetes in comparison to non users (45.5%and 4.9%) respectively. There was no awareness of the long term effect of oral contraceptives on cardiovascular disease among women.
Conclusion: Using oral contraceptive pills by women in their reproductive age group increase significantly the risk of metabolic syndrome.

Background: Despite elective laparoscopic cholecystectomy has a low risk for infectious complications, many surgeons' still use prophylactic antibiotics. Prophylactic antibiotics administration has been recommended by the centers for disease control and prevention and commonly used in clean- contaminated surgery such as cholecystectomy to reduce surgical site infections. In contrast, several meta-analyses have recently concluded that antibiotic prophylaxis is not necessary in patients undergoing laparoscopic cholecystectomy.
0bjectives
The goal of our study was to prove the safety of omission of prophylactic antibiotics regarding development of postoperative surgical site infection in patients undergoing laparoscopic cholecystectomy.
Patient and Methods: This is a cross sectional study of ninety four patients underwent laparoscopic cholecystectomy in Baquba teaching hospital during the period from February 2014 to October 2015. The patients were randomly placed into 2 groups: (group A) 47 patients received prophylactic cefotaxime 1g intravenously at the time of induction of anesthesia, and (group B) 47 patients were not given prophylactic antibiotics. Postoperatively the antibiotics were omitted in both groups. Exclusion criteria were patients older than 60 years; when antibiotics used 7 days before surgery; acute cholecystitis in the 4 -6 weeks before to the procedure; evidence of cholangitis and/or obstructive jaundice and biliary pancreatitis; regular corticosteroid therapy; pregnancy or lactation; previous biliary tract surgery or previous endoscopic retrograde cholangio pancreatography; American society of anesthesia higher than score II; diabetes mellitus; body mass index higher than 30; and conversion to open cholecystectomy. The development of surgical site infection postoperatively was investigated and compared in the two groups.
RESULTS
No significant differences were found between group A and B regarding gender, age, body weight, American society of anesthesia score, conversion to open surgery, duration of operation , number of intraoperative gallbladder perforations and spill of bile or stones, number of positive bile cultures, mean postoperative hospital stay, or number of infectious complications. Group A had 1 (2.17%) superficial SSIs in the epigastric port site. Group B had 2(4.44%) superficial SSIs in the epigastric port site (P>0.05). There was no significant association between intraoperative gallbladder rupture or positive bile culture and SSI. The rate of gallbladder rupture in groups A and B were (19.56%) and (13.33%) respectively (P>0.05).
CONCLUSION
Perforation of the gall bladder and possible positive bile culture do not increase SSI rates if the contaminated site was irrigated well. Antibiotic prophylaxis does not seem to affect the incidence of surgical site infection and is not necessary for elective Laparoscopic cholecystectomy in low-risk patients.

Background :Ear, nose and throat (ENT) foreign body (FB) injuries represent an emerging problem of population because of their human and social costs. Foreign body in ear nose and throat are commonly encountered by otolaryngologists, pediatricians and primary care physicians. They account to about 11% of cases of emergencies in Otorhinolaryngology. Foreign bodies were most common in younger children less than five years of age. Certain factors are responsible leading to foreign body insertion in ear, nose and throat like curiosity or desire to explore orifices especially by children in addition to accidental causes.
Patients and methods:This is a prospective study carried out in Azadi Teaching Hospital involving the patients and it ran from 1st of October 2014until 6th March 2015.
Information from 110 patients were collected, and each one of them was interviewed using a questionnaire. The questionnaire sought information regarding age, sex, site and location, type of management of foreign bodies, number of trial to remove the foreign bodies, presence of complication or not and types of foreign bodies seen.
Results :Concerning the site and location of foreign bodies 40.9% were found in ear while 39.1% in nose and the remaining 20% were in throat. The study showed higher percentage of foreign bodies among children less than 5 years old and male patient .Also it was noted that most of the foreign bodies were removed from fist trial and that only 31,8% of the patients had experienced complications .
Conclusions: From this study we conclude that foreign bodies are common in adult and pediatric ear, nose and throat. They can potentially be associated with significant complications if not taken care of immediately. Several trials may be needed to remove the foreign body.

Placentae from 50 pregnant women were collected from Albatool Obstetrics and Gynecology Teaching Hospital in Mosul-Iraq. Thirty of them belonged to anaemic pregnant women associated with intrauterine growth restriction (IUGR), while the other 20 belonged to uncomplicated pregnancy (as a control group). The parameters studied were mean gestational age, birth weight of babies, mean placental weight, diameter, surface area, and mean placental volume. The main findings in the placentae from anaemic women were compared to the control group.
Results reveal that there is a significant decrease in mean birth weight, mean placental weight, diameter, surface area and mean volume of the placentae in anaemia of pregnancy group associated with IUGR as compared with control group.
Alterations in various parameters may be due to compensatory phenomena to fulfill the demand of O2 to fetus, subsequently affecting the growing fetus. Appropriate precautions if taken during pregnancy, complications due to anaemia can be reduced.
In conclusion, this study demonstrated that severe anaemia in pregnant women alters the placental morphology, leading to fetal growth restriction and prompt treatment of anaemia must be taken to improve placental growth and a favorable obstetric outcome.

ALKAPTONURIA (AKU) It is an autosomal recessive disorder due to deficiency of homogentisic acid oxidase, The homogentisic acid retained in the body is deposited as a pigmented polymer in the cartilage, skin and sclera in addition passing dark urine or when fresh urine turns black on standing or on alkalization. The darkening of the tissues by this pigment is designated Ochronosis
This is across sectional study carried on 7500 patients presented with low back pain in Rzgary General Teaching Hospital and private clinic in the period from May 2005- march 2010 (57 months) ,in Erbil Governorate ,Iraq.
The study was conducted to record information regarding the gender, age, race, incidence, frequency of joint involvement.
Complete history were taken from all patients of passing dark urine or when fresh urine turns black on standing or on alkalization ,and finding of characteristic radiographic changes to the spine
The lumber spine and hip joint were the most frequently affected joints in the study group while sacroiliac joint and peripheral joints were spared
CONCLUSIONS:
This study indicates that AKU also present in Erbil-Iraq .a question for urine colure changes is advise when taking history from patients with low back pain specially when diagnosing patients with ankylosing spondylitis. Early detection is important for prevention and treatment of multisystem. As the administration of unnecessary drugs can be avoided

Objective: this study compare the effect of combination of simvastatin with combined oral contraceptive (COCP) versus COCP alone on PCOS women with hirsutism
simvastatin plus COCP , then COCP alone .group II use COCP alone then COCP with simvastatin . Each treated for 12 weeks and assessment done before and after each treatment period. All the patients are attending the medical consultation center of niniva collage of medicine.
Results: Patients in group I have 20.3% improvement in ferriman and Gallwey score (FGS) ,and 49.62 % decrease in testosterone (T) after treatment with simvastatin and COCP for 12 weeks compared with 16.9 % improvement in FGS and 21.84 % decline in T after COCP treatment. Patient in Group II develops 13.4% decrease in FGS and15.97 % reduction in T after treatment with COCP alone compared to 28.92% reduction in FGS and 20% decline in testosterone after treatment with simvastatin and COCP, with significant difference at P value less than 0.05 and 0.01.
In group I : Total cholesterol, LDL decreased by 14.8% ,12.14% in the combined treatment compared with 7.94 % ,2.76% in the COCP with significant difference at p value of 0.05 and 0.01.TG decreased by 10 % compared to 11% increase in the COCP alone treatment. HDL increased by 10.5 % in the combined treatment compared to the 5.92 % increase in the COCP group with significant difference at p value of 0.05 and 0.01.
In group II : there is no significant difference in the decrease in cholesterol ,LDL level between COCP and combined treatment, cholesterol tend to decrease by 12.58 % and 12.1% and LDL by 9.9 % and 8.4 %. Triglyceride tend to be decreased by simvastatin and COCP treatment by 14.3 %, and to increased by 0.02 % by COCP with statistical significant difference at P value less than 0.05 and 0.01 .HDL tend to be increased by 8.9% by simvastatin and COCP and 8.7 % increase by COCP with no statistical significant difference. Conclusion: the use of simvastatin combined with COCP can exert a beneficial effects on both endocrine and metabolic aspects of PCOS . simvastatin can improve hyperandrogenisim and hirsutism more than COCP alone and it have beneficial effect on lipid profile unlike COCP.

The objective of this study are todescribe the technique,evaluate the effectiveness of TCLDCR with diode laser in the treatment of epiphora in adult and to review the published results after TCLDCR. A prospective , interventional case series was designed in28 patients presenting with epiphora due to NLD Obstruction .Materials and Methods: At private sector as a day case surgery in Kirkuk citythe procedure was performed under general anesthesia. We achieved osteotomy by applying laser energy via an optic fiber, using a 980 nm diode laser with power of 10 Watts. At the last step bicanalicular silicone stent was inserted . Success of procedure was absence of epiphora (subjective), or patency of the lacrimal drainage system on irrigation (objective). Results: We performed 28 successive transcanalicular laser (TCL-DCR) with bicanalicular silicone tube intubation in 26 patients and momocanalicular silicone tube intubation in 2 cases. The average procedure time was 20 min. The silicone stents were removed three to six months after surgery. We observed absence of epiphora and a patent nasolacrimal duct on irrigation in 23 out of 28 treated eyes after six to thirty six months after operation. Five patients had epiphora despite an initial successful nasolacrimal duct intubation. This yields a success rate of 82%, with an average follow-up period of 12 months. Conclusions: The 980 nm EL-DCR with silicone tube intubation is a new contribution to the field of lacrimal surgery. It is a minimally invasive quick procedure yielding a high success rate.

Background: infertility is defined as not being able to get pregnant. Hormonal disorders of female reproductive system are comprised of a number of problems resulting from aberrant dysfunction of hypothalamic- pituitary-ovarian axis. These relatively common disorders often lead to infertility.
Aims: This study aimed to evaluate the concentrations of a group of hormones, They acted as a marker to make the functional changes in ovaries or caused the infertility or Sub Infertility in some women . the study involved estimating the concentration of the prolactin ( PRL) , follicle stimulating hormone ( FSH) , luteinizing hormone (LH) , estrogen (E2) and cortisol in addition to assess the concentrations of thyroid stimulating hormone (TSH) , thyroxin (T4) and Triodeothyronin(T3) as well as find the correlations between prolactin hormones and the studied hormones, the study covered (30) samples of infertility women ranged their age between (28-48) compared with (15) healthy samples treated as a control group .
Result :The results of study showed a significant increase (P<0.05) in concentrations of prolactin (PRL) , follicle stimulating hormone (FSH) , luteinizing hormone (LH) , cortisol and the thyroid stimulating hormone (TSH) in the patients whereas these results also indicated to a significant decrease (P<0.05) in concentrations of estrogen (E2) , (T4)and (T3) .The results of the correlations showed a positive correlation between prolactin hormone and ( TSH ) at probability level ( p <0.01 ) and with )FSH( (LH), and cortisol at probability level ( p<0.05 ) whereas the correlation was negative between prolactin hormone and estrogen (E2) , (T4) and (T3).

Background: Daily exposed of children to violence portrayed in videogames and TV shows consider as a general public alarm.
Objective: to determine the prevalence of children’s exposure to violent video games and media in a sample of primary school children in Baghdad city.
Methods: study was conducted in Baghdad city during the period from the first of February through December 2015. A multistage probability sampling was adopted to collect 1000 student from 55 primary school. Information about favorite video games played and TV programs shows were taken through direct interview with each child.
Results: the prevalence of playing video games was 94.6%, number of boys who said that they play electronic games was 664 (97.4 % of all boys) and girls 282 (88.7% of all girls) regarding (days of playing games); 64.8 % of the children were playing daily, 2.2% were playing two or three times, 3.7% once a week, 18.5% at weekend, and 8.6% play only during holidays (midyear and summer holiday). Most popular and favorite video games that played by 47.6% of boys was found to be of violent type (Grand Thief Auto GTA, open world action games) while in girls’ non-violent, simulation games (Girl games) was found in higher percentage (25.1%). Action movies reported as the favorite TVs scenes in boys and Indian drama series as the most favorites in girls.
More than half of children under study were reported playing violent games and watch violent TV Boys prefer to play violent games more than girls. GTA, Call of duty and counter were their favorite’s games.
Conclusion: violent video games and TV programs were prevalent among primary school children.

Beta-thalassemia probably is the most common single gene disorder causing a major genetic health problem in the world. People of Mediterranean, Middle Eastern, African, and Southeast Asian descent are at higher risk of carrying the genes for thalassaemia. Endocrine complications in Thalassaemia Major Patients with multi-transfused Thalassaemia Major develop severe endocrine complications. The aim of the study is to determine the relation between serum circulating ferritin and thyroid gland function in Thalassemic patients. Patients & methods:- A cross sectional study was conducted on β-thalassaemia major patients whom attended the thalassaemia center in Tikrit Teaching Hospital (TTH) from beginning of January to the mid of June 2014. Fifty six β- thalassemia major female patients aged 10 to 16 were participated in the study. Thirty nine female subjects apparently healthy, with no family history of hereditary blood disease attendants to out-patient pediatric clinic, who were assessed by a pediatrician, all control healthy subjects aged 10 to 16 years. Body weight & height and serum ferritin, serum TSH, T3, & T4 were measured. Results:- There was a highly significant increase in serum circulating ferritin concentration in female thalassemic patients as compare with control subjects. Also, there is significant increase in serum Thyroid stimulating hormone (TSH) concentration in female thalassemic patients. However, there is significant reduction in serum T3 and T4 concentrations in female thalassemic patients as compare with female control subjects. Conclusion; Thalassemic female patients had a lower T3 & T4 as compare with normal healthy female control subjects of same age.

Non steroidal anti-inflammatory drugs(NSAIDs) it is anti-inflammatory drugs .Many people take an anti- inflammatory drug for arthritis, muscular pains & to protect against blood clots form. These drugs sometimes affect the mucus barrier of the stomach and allow acid to cause an ulcer. About 2 in 10 stomach ulcers are caused by anti- inflammatory drugs. The discovery that the primary mechanism behind NSAID-associated upper GI side-effects was through systemic inhibition of COX-1-mediated prostaglandin synthesis in the gastric mucos. COX-2 selective NSAIDs, continues to carry significant risk of injury to the gastro-duodenal mucosa possibly because COX-2 selective NSAIDs are not totally COX-2 specific, but also inhibit COX-1 to a certain degree. Acidic NSAIDs, including aspirin, may also have a topical irritant effect on the gastric mucosa. Indeed, there is evidence of significant localized foci and damaged cells only 16 minutes after administration of aspirin. Patients & methods.A three hundred-forty four patient including by this study all of them complaining of signs symptoms of peptic ulcer & the diagnosis confirm by endoscopy examination .Results:- A 170(49.4%) patients with gastric ulcer & 174(50.6%) patients with duodenal ulcer. A gastric ulcer patients. A forty seven (27.65%) patients were consider as NSAIDs users .the duration of using NSAIDs was divided into acute(less than 3 months) & chronic states so 28(59.6)% was acute user while 19(40.4)% was chronic user .A duodenal ulcer patients . A twenty-two (12.7%) patients were consider as NSAIDs users .the duration of using NSAIDs was divided into acute & chronic states so 12(54.5)% was acute user while 10(45.5)%was chronic user . A significant difference was detected between gastric ulcer & duodenal ulcer which indicate that NSAIDs mostly cause gastric ulcer than duodenal ulcer & this is due to the fact that these agents affecting the defense mechanism of gastric mucosa in both topical & systemic administration. Conclusion:-A high causing rate of NSAIDs in inducing peptic ulcer .Reducing the administration of analgesia as possible as & to be limiting to really indication .It is better to used anti-ulcer agent in combine with the NSAIDs agents especially in long term therapy .

Background: Chronic total occlusions (CTOs) are considered as the most complex lesions to treat via percutaneous coronary intervention (PCI), due to the indications, costs and technical difficulties related to these procedures. As a consequence, only about 10% of all CAD patients, clinically eligible for CTO-PCI, are currently being treated via PCI. The majority is treated either medically or via coronary artery bypass graft (CABG) surgery.
Aims of the study: estimate the success rate and clinical predictor of outcome in patients with chronic total occlusion.
Patients and methods: One hundred patients with chronic total occlusion were enrolled in this study for the period October 2014 - May 2015 were enrolled who were attending Iraqi center for heart disease. Descriptive analyses were performed using SPSS Statistics to assess the relationship between procedural success and any of the demographic and/or clinical characteristics. The level of significance was set at 95% or higher.
Results: Sixty-one patients out of 100 patients (61%) had a successful PCI. Univariate analyses showed significant differences for gender and Electrocardiography with success rate.
Conclusion: From this study we can concluded that female gender ,ECG changes and single vessels diseased artery were the early predictor for success of chronic total occlusion.
*Assistant prof. cardiology , college of medicine , University of Baghdad ** Interventional cardiologist , Medical city of Baghdad

Background: Many adolescents‘ health problems are predominantly caused by risky behaviors which contribute to the morbidity and mortality in this age group. The adverse health consequences of these behaviors have been recognized as important public health issues.
Objective: The aim of this study was to assess the rates of some health risk behaviors among male students of four secondary schools in Kirkuk city and to find out association of factors with those risk behaviors.
Methods: We designed a cross-sectional study. A self-administer questionnaire to collect the data from students of four secondary schools from Januarys 10th, 2016 to July 10th, 2016. 278 students were chosen randomly out of 1000 males' secondary school students.
Results: Violation of safety behaviors were the most commonly found in our study: 52.5% of the students were in a vehicle driven by alcohol drinking person, almost half of them never wore a helmet (51.1%) followed by a habit of texting message while driving (48.9%). Feeling sad and hopelessness were recognized in 40.6% of our study population followed by cigarette smoking (29.1%), physical fighting (24.5%), violence (15.8%) and alcohol drinking (7.6%) respectively. The least common risk behavior is drug abuse (0.4%). There was a significant association between age and alcohol drinking, safety and tobacco, also a positive association between weapon carrying and physical fighting with various indicators of substance use.
Conclusion: The highest health risk behavior among all male students in secondary schools in Kirkuk City was safety. This study suggests that prevention efforts aimed at high-risk youth during early adolescence need such a multi-problem focus, because this co-occurrence of problem behaviors is already evident among junior high school students.

Recurrent pregnancy loss (RPL) or habitual miscarriage is the loss of three or more consecutive pregnancies before or during the 20th week of gestation. The most important association between gestational loss and autoimmune phenomena is the presence of antiphospholipid antibodies (APA) represented by the lupus anticoagulants and or anticardiolipin antibodies (Antiphospholipid Antibody Syndrom). The antiphospholipid syndrome (APS) is an acquired autoimmune . The clinical features are thrombosis (venous, arterial and microvascular) and/or pregnancy complications; the most prominent of which is recurrent abortion. It is important to recognize the syndrome and to institute appropriate therapy to reduce the risk of recurrent pregnancy loss. Many treatment regimens introduced. Today anticoagulants and aspirin treatment is emerging as the treatment of choice for the APA syndrome associated with recurrent pregnancy loss.
Aim of the study
To investigate the efficacy of combined aspirin and low molecular heparin therapy as opposed to aspirin alone in the management of immunological recurrent abortion
Patients and methods
This is a prospective study of 70 female patients presented with recurrent pregnancy loss (RPL) or habitual miscarriage (loss of three or more consecutive pregnancies before the 20th week of gestation) and repeatedly positive test results for anticardiolipin and or lupus anticoagulant. The duration of the study was 3 years (February 2013-February 2016); the cases were presented both to the
private clinic and the hospital (Al-Batool teaching hospital). The patients were randomly put in two groups. In both groups the patients started receiving treatment as soon as they had a positive result on a pregnancy test. Group A (47 patients), the women given both low molecular weight heparin (LMW self-administered injection; 4000 IU/day) plus low-dose aspirin (81 mg/day). Group B (23 patients) assigned to receive aspirin alone (81mg/day). From 20th week of gestation, pregnancies were monitored by serial ultrasonography and Doppler studies of the umbilical artery circulation, fetal growth and wellbeing. The husbands were all fertile and had normal sperm parameters.
Results
There was a highly significant difference between Groups A and B in the rate of miscarriages (4 miscarriage in Group A (9%) versus 8 miscarriages in Group B (35%); p = 0.02). Most abortion in the two Groups occurred in the first trimester (3 in Group A and 5 in Group B). In the low-dose aspirin plus LMWH (Group A) there were a significantly greater number of live births (43/47(91%) versus 15/23(65%) in group B; p =0.02).
The mean gestational age and the neonatal birth weight were significantly higher in Group A than in Group B. The mean gestational age at delivery in Group A was 37.86± 1.8 versus 36.13 ±2.39 weeks in Group B; p= 0.005. The mean birth weight in Groups A was 3252 ±459 versus 2907 ± 618 g in Group B; p =0.03.

Significant difference in the mode of delivery. Nineteen (19) of the 58 women with successful pregnancies (33%) delivered prematurely (<37 weeks’ gestation). Eleven of them were in Group A [6/43 (14%) due to preterm labour, 4/43(9%) due to IUGR, and 1/43(2%) due to pre-eclampsia] and the remaining 8 were in Group B [3/15(20%) due to preterm labour, 3/15(20%) due to IUGR and 2/15 (13%) due to pre-eclampsia]. No woman developed a thromboembolic complication during pregnancy or the puerperium.
Both low dose aspirin and LMWH were well tolerated. Of those taking heparin, none developed thrombocytopenia or had symptomatic complications apart from mild bruising localized to the injection site.
Conclusion
Combination treatment with aspirin and LMWH leads to a high live birth rate among women with recurrent abortion and antiphospholipid antibodies. This combination may promote successful embryonic implantation in the early stages of pregnancy and protect against thrombosis of the uteroplacental vasculature after successful placentation.
Recommendation
Future studies should be aimed at refining the protocol used in this trial to determine the benefits of preconceptional administration of heparin and whether it can be stopped after 13 weeks of gestation without adversely affecting the rate of live births.
However, successful pregnancies are prone to a high risk of complications during all pregnancy. Close antenatal surveillance and planned delivery of these pregnancies in a unit with specialist obstetric and neonatal intensive care are indicated.

Background: Lifesaving is not the only aim of surgery for acute abdomen but preservation of infertility is the main goal of each gynecological or pelvic surgery in reproductive age female. Infertility may results from these surgeries because of adhesions, tubal damage or blockage and its effects on ovarian reserve. The benefits of laparoscopy in the last years were recognized because of short recovery and hospital stay with minimal scars . Follow up studies of laparoscopy or laparotomy were for short period or few months. So the aims of this study are to recognize the differences between laparotomy and laparoscopy and their effect on ovarian reserve and infertility and to clarify the benefit of laparoscopy versus ultrasound in diagnosis of acute abdomen due to gynecological problems.
Patients and Methods: A longitudinal prospective study was done at teaching center and approved by scientific committee of the college of medicine. Two hundred seventeen patients had acute abdomen during study period and only (98) patients were excluded from the study according to its exclusion criteria . The remaining (119) patients were enrolled in the study. (57) patients were enrolled in laparoscopic group or group (1) and (62) patients in laparotomy group or group (2). Full history, general, abdominal ,pelvic examinations and basic investigations were done to all patients. Vaginal and abdominal ultrasound (2D) examinations were done to each patient before operation and after 1,3 months and 1 year during the period of follow up. Chest x- ray, abdominal x-ray ,MRI and CT scan were done to the patients on need. After stabilization of patient, surgery was done to her. Follow up of patients was for to 5 years to monitor below main outcomes measures.
Main outcomes measures: Operation time, recovery period, usage of injectable analgesia, drop in hemoglobin level, W.B.C count changes, antral follicles count (AFC) changes and ovarian volume changes.
Results: different pathological problems were found in relation to gynecological acute abdomen in reproductive age women, such as different ovarian cyst ,ectopic pregnancy, appendicitis, intestinal obstruction and acute cholecystitis. No significant changes were found in parameters of ovarian reserve in both surgeries.
Conclusions: multiple pathologies can cause acute abdomen due to gynecological problems in relation to pelvis at reproductive age and different factors would affect the outcomes of laparoscopy and laparotomy groups .

Background: “Polycystic ovary syndrome (PCOS) is often characterized by chronic oligo- or anovulation (usually manifested as oligo- or amenorrhea), and hyperandrogenism”. In addition, 30–40% of PCOS women have impaired glucose tolerance, and a defect in the insulin signaling pathway (inositol- containing phosphoglycan mediators) seems to be implicated in the pathogenesis of insulin resistance. PCOS patients are subfertile as a consequence of such ovulatory disorders and often need drugs, such as clomiphene citrate or follicle-stimulating hormone, for ovulation induction, which increases the risk of multiple pregnancy and ovarian hyperstimulation syndrome. We hypothesized that the administration of an isoform of inositol (myo-inositol), belonging to the vitamin B complex, would improve the insulin-receptor activity, restoring normal ovulatory function.
Materials and methods: Twenty-five PCOS women of childbearing age with oligo- or amenorrhea were enrolled in the study. Ovulatory disorder due to PCOS was apparently the only cause of infertility; no tubal defect or deficiency of male semen parameters was found. Myo-inositol 2 g twice a day was administered continuously. During an observation period of 6 months, ovulatory activity was monitored with ultrasound scan and hormonal profile, and the numbers of spontaneous menstrual cycles and eventually pregnancies were assessed.
Results: Twenty-two out of the 25 (88%) patients restored at least one spontaneous menstrual cycle during treatment, of whom 18 (72%) maintained normal ovulatory activity during the follow-up period. A total of 10 singleton pregnancies (40% of patients) were obtained. Nine clinical pregnancies were assessed with fetal heart beat at ultrasound scan. Two pregnancies evolved in spontaneous abortion.
Conclusion: “Myo-inositol is a simple and safe treatment that is capable of restoring spontaneous ovarian activity and consequently fertility in most patients with PCOS”. This therapy did not cause multiple pregnancies.

Background:
Recent onset of cerebrovascular disease of ischemic nature have electrocardiographic changes, in those patients who had no primary heart disease. We estimate the prevalence of electrocardiographic changes for being of significant one.
Material and Methods:
Descriptive study of one year duration through which (72) patients were rouled in this study whom they were admitted to Azadi teaching hospital as acute ischemic stroke of new onset with no previous heart disease. The result was compared with match group of (72) patients whom were admitted to other unit of the same hospital with no stroke as control group.
Results:
Of (72) patients of the study sample about (59.7%) were males and (40.3%) were Females, their mean of age (62.5 years) with the range of (40-85) year. The control group of patients was consisting of (52.7%) males and (47.3%) females mean age was (61.5%) years with range of (45- 80) year.
Frequency of electrocardiographic changes of the study sample was (59.9%) while with the control group of the patient was (26.4%)
Conclusion:
Observation of this study , was suggested that the electrocardiographic abnormalities are common among new onset of acute ischemic stroke in spite of normal functioning heart, predominantly as T inversion followed by ST depression and these changes are of significant value for these patients.
Cardiac abnormality, including coronary flow disturbance may play a role in causation of acute ischemic stroke and it is important as prognostic measures.