The Medical Journal of Tikrit University

Background: Hyperglycemia is common in critically ill patients; it is no longer considered a benign condition in patients with critical illnesses. Hyperglycemia after acute myocardial infarction (AMI) is associated with an increased risk of in-hospital and long term mortalities in patients with and without diabetes. Although the mechanisms underlying this association are not fully understood, this may be due to impaired left ventricular function, increased incidence of the no-reflow phenomenon, and a tendency for aiThythmias. The aims of this study are to determine the frequency of hyperglycemia during AMI and to show the predictors of adverse events following AMI.

Patients and Methods: Hospital based cross-sectional study. That includes 160 patients with AMI who admitted to CCU in the Tikrit Teaching Hospital from December 2013 to July 2014. Hyperglycemia was defined as admission or non-fasting plasma glucose level equal or above 140 mg/dl (7.8 mmol/L) regardless of past history of diabetes. Patients were divided into 3 groups.

Group 1 (n=77 [48.1%]): Normoglycemic patients: Non-diabetic patients, without stress hyperglycemia and admission plasma glucose level <140 mg/d1 (7.8 mmoUL). Group 2 (n=33 [20.6%]): Non-diabetic patients with stress hyperglycemia with admission plasma glucose level equal or above 140 mg/dl (7.8 mmol/L) and Group 3 (n=50 [31.3%]): Diabetic patients, who had a history of treated diabetes mellitus or HbAlc measurement was > 6.5%.

Results: The results indicate that the mean age in normoglycemic, stress hyperglycemic and diabetes mellitus groups were 55.3, 55.1 and 54.4 years respectively with more males' affection in all thrt e groups without significant difference among them. The anterior wall was the most common site of AMI in all 3 groups but without significant difference among them. Killip class 2 was significantly higher in DM group, while Killip class 3 was significantly higher in stress hyperglycemic group. Odds ration and confidence intervals of many variables as predictors of adverse outcome obtained from this study.

Conclusion: This study indicates that admission hyperglycemia is a common finding in patients with AMI and admission hyperglycemia is a predictor of adverse events following ANIL plasma glucose level equal or above 140 mg/dl (7.8 mmoUL) regardless of past history.

A total of 63 patients with CSOM were collected in this study during the period from January 2013 to September 2013 at the unit of ENT in Tikrit Teaching Hospital. The results of the bacteriological study of the 63 cases obtained from CSOM patients showed 39 (80.9%) were from children and 24 (38.1%) were from adults. Fifty-one samples (68.6%) were pure cultures had a single organism isolate and 12 samples (19.0%) showed no growth. The peak incidence of COSM among patients was occurred in age group (0-4) years Table (l ).This study indicated that boys 34 (54.0%) showed higher rate of infection than girls 29(46.0%).The ratio of the present study was (1.7:1). The present study showed that the Gve — bacteria were 35(68.6%), Gve+ bacteria werel6 (31.4%). Among the Gve- bacteria Ps. aeruginosa 19(30.2%)was the main causative organisms, while S. aureus 8(12.0%) was being the predominant organism among Gve+ bacteria. .Antimicrobial susceptibility test were done to all bacterial isolates. Ps. aeruginosa isolates showed high sensitive (89.5%) to amikacin and gentamicin, and the high -ensitive rates of S. aureus isolates to same antibiotics were(87.5%) .The isolates of Ps. aeruginosa and S. aureus showed resistance to ciprofloxacin were 6(31.6%), 2(25%) respectively

Background: Tonsillitis is the commonest otolaryngological infection and many patient will end with surgery in the form of tonsillectomy which is till now one of the oldest and commonest operation done all over the world. The main indications for tonsillectomy are (recurrent infections, obstructive sleep apnea and peritonsillerabscess ) and there's no documentation about the familial tendency of tonsillitis

The aim of the this research is to establishment the association of family history as risk factors for developing tonsillitis and to study how it influences the decision of surgery.

Patient and Methods: This is a cross-sectional study that has been done from the beginning of October 2013 to the 25th of 25th of March 2014at Azadi Teaching Hospital and Kirkuk hospital. The study involved 200 patients who underwent tonmsillectomy (case)as an indicator of patients having tonsillitis and 200 person not having any known criteria of tonsillitis (control). All patients were evaluated using history regarding (Family history , chronic disease, sinusitis and allergy )

Results and discussion :A total of 200 patients underwent tonsillectomy during the time period of the study. There were 98 male (43.4%) and 102(56.6%) female with mean age of (7) years and range in age from 3 to 12 years old .The family history was positive in (80.5%) in case group in contrast to (18.5%) in control group,The results of this study were compared with the control cases of the study itself and the studies of other researches,demonstrate that family history is a risk factor for recurrent tonsillitis.

Conclusion and Recommendation : From this study, it be concluded that the presence of family history is a risk factor although there's no role of genetic predisposition to explain this result so we should spread awareness about tonsillitis, the proper antibiotic, adequate course of treatment and the adequate dose which are the mainstay of the prevention of the recurrent of tonmsillitis thus reducing the complication and avoiding surgery .

Forty patients with open shaft of humerus fractures were treated with a monolateral external fixator. Five patients presented with nerve palsies. Two radial nerves were disrupted and required reaper. Three spontaneously recovered and one brachial plexus partially improved. All fractures healed. The average duration of external fixation was 24 weeks. Four patients required additional procedures prior to healing (external fixator reapplication - 2, plating and bone grafting. Eight patients developed pin tract infections, which all resolved with local care and antibiotics.

The results of treatment of closed humeral shaft fractures are excellent using a variety of techniques including bracingl,19,20,23, hanging casts6,8,17, plate fixation2,7,8,17,22, and intramedullary nailing4,12,21. There is less data available on the best technique of skeletal stabilization and ocutcome of patients with open humeral shaft fractures. Although open fractures are included in large series of humeral shaft fractures, analysis of this subgroup is often not reported separately2,4,7,12,19,20,22,23.

The purpose of this study was to determme the outcome of open humeral shaft fractures treated by a uniform technique of monolateral external fixation.

Background: Obsessions and compulsions are common phenomena in schizophrenia, the presence of OCD or significant OCS in patients with schizophrenia has been associated with more severe psychosis and depression, poorer social functioning, lesser likelihood of being employed, and poorer prognosis.

Aim of the study: The aim of the study is to determine the prevalence of obsessive compulsive symptoms in schizophrenic patient.

Material and Methods: 120 schizophrenic patients diagnosed according to DSM-IVTR criteria were included in this study. Yale -Brown obsessive compulsive scale was applied to detect the prevalence and the content of obsessive compulsive symptoms among these patients.

Results: The results of this study were 26.7% of schizophrenic patients had obsessive compulsive symptoms, according to type of schizophrenia, the obsessional symptoms were more frequent in paranoid schizophrenic disorders,26 (21.6%) and 28(23.3%) in the age group between seventeen and thirty seven years.

Conclusion: findings of this study are 26.7% of schizophrenic patients had obsessive compulsive symptoms. Type of obsessions and compulsions experienced by the patients are similar to those found in classical obsessive compulsive disorder.

Psoriasis is a disorder with genetic and immunologic background. Psoriasis is associate with many metabolic disorders like insulin resistance. Resistin can involve in development of psoriasis by acting as a pro-inflammatory factor leading to an increased mRNA expression of many chemokines and cytokines . Our primary goals is to study the serum level of Resistin in psoriasis patients, and relation between the Resistin serum levels and psoriasis severity. The study invelved 60 patients with psoriasis and 40 healthy controls. We analyzed plasma levels of Resistin in psoriasis patients and compared them with those of healthy control. Evaluation of plasma levels of Resistin was performed by enzyme immune sorbent assay (ELISA) . also we study the relation between Resistin serum with the severity of psoriasis that evaluated by psoriasis area and severity index (PASI) score. psoriasis patients have considerably higher serum levels of Resistin than heathy control. Resistin serum levels were 12.9 + 4.1 ng/ml , 7.2 + 2.1 ng/ml in patients and control group respectively .Also the Resistin levels were association with severity of psoriasis where serum levels of Resistin were 14.68 + 4.20 ng/ml and 10.87 + 2.9 ng/ml in severe and mild to moderate cases respectively . our results suggests that the Resistin has important role in development of psoriasis

Aim: To confirm the accuracy of updated imaging investigations in disorders of otorhinolaryngology and to support the commitment of the surgeon toward the proper surgical procedures of these disorders. Study design: A prospective and comparative study of updated imaging (CT scan and MRI) of otorhinolaryngological disorders in 72 patients with transversal cohort (2012-2014).

Materials and methods: Seventy-two patients attended Assalam Teaching Hospital, Cttorhinolaryngology department Mosul, Iraq, from January 2009 to November 2009. The patients were subjected to CT scan and/or MR imaging, included 32 patients with sinonasal disorders, 30 patients with laryngopharyngeal disorders, and 10 patients with otological disorders. The age distribution of the patients range from 2 months — 75 years, with a mean age of 38 years, with sex distribution of 52 males and 20 females. The objectives of this study are to evaluate the diagnostic value of CT scan and MRI in otorhinolaryngological disorders and to compare the result with the operative findings.

Result: For sinonasal tumors; in bone distraction, the accuracy of CT scan was 100 % and for MRI 66%. In intracranial extension the accuracy of CT scan was 50% and for MRI 87%. In tumor staging by CT scan, the accuracy was 75% and for MRI 87%. For bony hard lesion, the accuracy of CT scan 100% , were in 2 patients, one of them was un irrupted tooth, and the other was bilateral choanal atresia. For the larynx; Paraglottic space involvement, the accuracy of CT scan was 88% and for MRI 86%. Extra laryngeal spread the accuracy of CT scan was 75% and for MRI 71%. Cartilaginous invasion the accuracy of CT scan was 81% and for MRI 79%. For the ear; Bony erosion the accuracy of CT scan was 80% and for MRI 66%. Space occupying lesion (brain abscess) the accuracy of CT scan was 100% and for MRI 100%. Chronic mastoiditis (cholesteatoma) the accuracy of CT scan was 80% and for MRI 66%.we have concluded that, the updated imaging becomes a well-defined signs and has many fundamentals in relation to otorhinolaryngological disorders.

Conclusion: Updated imaging (CT and MRI) becomes a well-defined signs and has many fundamentals in relation to otorhinolaryngological disorders. Coronal and axial CT views are the most useful views in the nose and paranasal sinuses, also CT was superior to MRI in detecting neoplastic bone disorders especially with early bone erosion, While MRI is important to differentiate between retained secretions and neoplastic lesions (benign and malignant).

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.

The aim of this study was identification of most common microorganisms of vaginitis with effect of Alum & Gentian violet on them.

This study was performed between Feb. 2013 and Jan. 2014, involving 215 married women at 15-49 years who attending TTH and private clinic in Tikrit city, they were examined and taking high vaginal swab. For diagnosis, used Amsel's eriteria, Gram staining of vaginal discharge, culture, biochemical tests and APT system.

Vulvovaginal candidiasis is most common 70(32.6%) than BV associated Gardnerella vaginalis 18(8.4%), in our distinct. Candida albicans represent 32.6%, while E. coli and S. aureus were 11.6% and 7.4% respectively. The history of abortion and PTL in those patients was at 1st and 3rd trimester of gestational age. By disc diffusion method showed resistance 100% to metronidazole. There was a significant strong correlation between Alum and Gentian violet at concentrations (1% to 4%) and the inhibition growth zone of G. vaginalis and C. albicans with statistically significant result at p-value <0.001.

Epiphora and nasolacrimal duct obstruction is acommon problem and endoscopic DCR is the treatment of choice and it has the advantages that there is no external scar with good results and minimal complications.

The aim of this study to see the results of EDCR in Kirkuk and out come it is retrospective descriptive study otolaryngological department in Kirkuk general hospital from 2010 to 2012s.

A total number of 60 EDCR done in Kirkuk general hospital from February 2010

to January 2012 .Age of patients was from 3 to 60 years ,40 patients were female and 20 were male,all of them complaining of epiphora and some of them presented in addition to epiphora with abcess and mucocele.40 of them had unilateral eye involvement while 20 patient had symtoms bilaterally. All cases are diagnosed as nasolacrimal duct obstruction and confirmed by an ophthalmologist and then sent to us, All of them underwent EDCR with stent insertion.folow up of patients in our study was two years. The operative techniques descriped in details , 48 patients had complete disappearance of symptoms so success rate in our study was 80%,while 12 patients had recurrence of symptoms,so failure rate was 20%,4 patients underwent revision surgery with good results while others refused to do surgery again.the most common complication was adhesion of the nasal mucosa at the site of surgery,15 case develoed this complication,while 10 cases had extrution of the stent specially in children,which fortunately didn’t affect the result of surgery,in conclusion
EDCR is avalid surgey for correction of nasolacrimal duct obstruction with good out come and no scar

The effect of aqueous extract of Borago Officinalis and uranyl acetate on activity in oxidation — antioxidants system was designed to estimate (MDA , GSH ) as well as its effect on biochemical parameters (Total cholesterol, triglycerides , low and very low high density lipoproteins to cholesterol , Glucose ).

The study showed that given uranyl acetate produced a significant increment at level (p<0.05) in each average of the Glucose , Total cholesterol striglycerides , LDL-C,VLDL-C and MDA as compared with control group. Whereas there was a significant decrement at level (p<0.05) in each average of the HDL-C ,GSH as compared with control group . whereas the treatment of the albino males rabbits by uranyl acetate and aqueous extract resulted in a significant reduction at level (p<0.05) as compared with uranyl acetate group only through the average of the Glucose , Total cholesterol , triglycerides , LDL- C,VLDL-C, MDA .Whereas increment in average of High Density Lipoprotein — Cholesterol and GSH. The treatment of the albino males rabbits by aqueous extract only resulted in a significant increment at level (p<0.05) as compared with control group through the average of the Glucose triglycerides , LDL-C,VLDL-C, MDA , and resulted in a significant decrement through the average of HDL-C and GSH.

The current study aimed to compare the effects of alcoholic leaf extract of Heliotropium europiam and Vit. C as antioxidants on levels of hormones Testosterone, Prolactin,TSH ,T3 and T4 in blood of adult albino male rats exposed to oxidativ stress by hydrogen peroxide H202 (0.5%) in the drinking water throughout 30 days. For the purpose of the study preliminary experiments were carried out to find the most effective dose of pl PRL ant extracts and it was found that( 300mg / kg/ b.w). Rats (3-4 aged months) and weight (250-285g) were distributed H202+ Heliotropium europiam alcoholic leaf extract group, H202+ Vit. C group, H202+ Heliotropium europiam alcoholic leaf extract+Vit.C group. The plant extract of leaves as (300) mg / kg and Vit.C (250) mg / kg of body weight in a single daily dose.The results showed that the animals exposed to oxidative stress induced by hydrogen peroxide led to a significant decrease (p <0.05) in the levels of serum Testosterone, Prolactin and T3 and non significant difference in the TSH and T4 levels when compared with control. The treatment with H202+ plant extract showed a significant increase in the Testosterone level and a significant decrease in T3 andT4 levels, and lack of significant difference in the levels of Prolactin and TSH, while the treatmen of group H202+Vit.C led to asignificant increase in testo., PRLand TSH and a significant decrease inT3 and T4.While the group exposed to stress and treated with plant extract and Vit.C showed a significant increase in testosterone, prolactin levels and significant decrease in TSH and T4 levels with non significant difference in the T3 level when compared with hydrogen peroxide group.

The aim of this study was to evaluate the effectiveness of unilateral external fixator as primary and definitive treatment for tibial fractures, fractures with severe soft tissues injuries, and in multiply injured patients. Fifty tibial shaft fractures 50 patients) were treated. In open fractures, union was achieved in 25 weeks, while in closed in 21. There were 2 nonunion, 4 delayed unions, 4 malunions, 5 pin infections and (1) osteomyelitis. A reoperation was performed in 41 patients. . The external fixator was definitive treatment in 100%. Unilateral external fixators can be used as primary and definitive treatment for complicated tibia shaft fractures. Re-operation or change of the method must be performed only when there is a delay in callus formation.