Karbala Journal of Medicine

b
ackground: Deep burn involve upper and lower limbs may lead to functional
problems, interfere with patients life style, increase burn morbidity and mortality
which also correlate to burn wound infection and septicemia, early burn excision and
autografting minimize this risk, excision of burn wound need precise demarcation of non
viable eschar tissue from underlying viable tissue. Methylene Blue using aid in staining of
non viable burn eschar by blue color and not staining underling viable tissue this will provide
precise demarcation of nonviable tissue and facilitating wound excision and grafting thus will
increase graft take and dramatically decrease risk of burn wound infection and improve
patients survival
Objectives: To evaluate early surgical excision of upper & lower limbs deep burn (deep
second degree & third degree) & autograft aided by Methylene Blue with short term follow
up.
Patients and Methods: In this study 28 patients included, 16 males and 12 females, age
range from 10 years to 40 years, were treated by early surgical excision of burn wound aided
by Methylene Blue staining between April 2014 to October 2015 in Azadi teaching hospital
in Kirkuk city.
Results: All patients have single stage of early surgical excision of burn wound aided by
Methylene Blue staining and autograft ; family and patients satisfaction were taken in
consideration and almost all showed satisfaction, assessment of the results by the surgeon
was also accepted in all of the cases, 71.4% of the graft patients have more than 80% graft
take .Only 4 patients (14.2%) in this study had minimal postoperative complications.
Conclusion: early surgical excision of deep upper & lower limbs burn wound aided by
Methylene Blue staining and autograft is a reasonable treatment option for deep burn of upper
and lower limbs, this type of deep burn lead to functional and aesthetic problem and also
interfere with patients life style, using this technique improve graft take and decrease
hospitalization and risk of morbidity and mortality of burn trauma.

b
Background: The autonomic nervous system plays a major role in the regulation of
the cardiovascular system under both physiological and pathological conditions,
Subclinical autonomic dysfunction can, however, occur within a year of diagnosis, and
impaired autonomic function has been described in patients with chronic liver diseases from
different etiologies, the chronic viral hepatitis (CVH) is the principal cause of chronic liver
disease. Patients with CVH have many extrahepatic manifestations, and even with no clear
evidence of autonomic nervous system dysfunction. Consequently, the purpose of this study/
to evaluate the cardiovascular autonomic dysfunction in such patients.
Method: Sixty two CVH patients include in this study, (36 patients have CVH B and 26
patients have CVHC), compared with thirty normal, healthy control group in analysis of heart
rate, including heart rate in postural change, in deep breathing and valsalva maneuver, and the
parameter of blood pressure in the supine position, response to postural change, isometric
handgrip.
Result: The results point out to both parasympathetic and sympathetic efferent fibers
modulates cardiovascular function is affected, it has been found cardiac autonomic dysfunction
in analysis of results recorded in 55.56% of CVHB patients from these percentage 50% patients
had subclinical cardiac autonomic dysfunction and 50% had mild clinical cardiovascular
autonomic dysfunction, while the CVHC patients 69.23% had cardiovascular autonomic
dysfunction, from these percentage 44.44% patients had subclinical cardiac autonomic
dysfunction, and 55,56% had mild clinical cardiovascular autonomic dysfunction.
Conclusion: The cardiovascular autonomic neuropathy recorded in patients with CVH,
remains mild clinical or subclinical and explained by autonomic function tests.

b
Ackground: Pilonidal disease treatment should be minimal, minimal pain, short
hospitalization, low recurrence rate, minimal wound care, and allow rapid return to
normal activity. Unfortunately, no treatment meets all these ideal goals.
Aim: This study is conducted to find out a modality treatment for PNS that can achieve the
above goals.
Methodology: It is a retro and prospective study of 51 patients presented with PNS.
All were divided randomly into 3 groups; First group treated by excision of the sinuses and
laid the wound open. Second group treated by excision and marsupialization and third group
treated by excision of skin containing sinuses’ openings only and further undermined
(beneath the skin) resection of the infected tissues with flap forming with marsupialization of
flap margins to the sacral fascia .
Results: Healing time; Third group healed earlier.
Post-operative painkillers; Third group needed less painkillers for shorter time.
Return to daily activities; Third group return to their jobs and life activities earlier.
Infection: Third group had only one case of cellulitis.
Recurrent PNS; zero patient from third group had recurrent cellulitis.
Discussion: Third group modality will reduce the tension on sutures and reduce the
postoperative pain, and loosening sutures, also further reduces the recurrence rate.
Conclusion: Third group modality yields a promising results in term of reducing the healing
time, post-operative pain, recurrence of PNS and infection rates.
It could be widely adopted, and would be largely cost-effective modality, as it will reduce the
expenses of caring for wound, antibiotics use, painkiller use and the early return to the job.

b
ackground: Hypocalcemia is a major post- operative complication of total
thyroidectomy, causing severe symptoms and increasing hospitalization time. The
primary cause is secondary hypo-parathyroidism following damage to, or
devascularisation of, one or more parathyroid glands during surgery.
Aim: Is to determine the incidence of hypocalcemia after thyroid surgery and find out the risk
factors involved leading to hypocalcemia regarding gender and body habitus ,clinical
diagnosis, extent of surgery, ligation of the inferior thyroid artery ,pathology report and the
experience of the surgeon.
Material and method: Prospective study of 100 patients in Al-Immamian Al-Kadhymian
Medical City in peroid between November 2012-November 2013 included in subtotal, near
total, total thyroidectomies. Serum calcium is estimated at day 1,2,3 postoperatively.
Results and discussion: Thirty patients developed hypocalcemia postoperatively ,in 24
patients it was transient and in six patients was permanent (three of those six patients had
underwent total thyroidectomy ,the other two had underwent near total thyroidectomy and the
last patient had underwent subtotal thyroidectomy).
Conclusion: Post-thyroidectomy hypocalcemia is relatively common phenomenon especially
after extensive thyroid surgery.

b
ackground: Upper GIT endoscopy is considered a safe procedure performed by a
doctor, a well-trained subspecialist who uses the endoscope to diagnose and, in some
cases, treat problems of the upper digestive system.
Aim: to set a guideline for indications for upper GIT endoscopy in AKadhymiah Teaching
Hospital.
Materials And Methods: Prospective study of 600 patients presented with upper GIT
symptoms and referred for upper GIT endoscopy.
Results & Discussion: The results suggest the importance of symptoms indicating upper GIT
endoscopy are in the following orders, dysphagia, acidity, melaena, vomiting, haematemesis,
heartburn, nausea, epigastric pain and dyspepsia.
The highest age incidence with positive endoscopic findings is between 30-40years ,male
more than female, (male/female ratio 2/1).
Conclusion: The duration of symptoms over 1 month found to be significant indication.
There is no relation between smoking, alcohol or drug intake with endoscopic findings in our
study

b
ackground: the expectant management has been considered possible alternative to
surgical treatment (dilatation & curettage) of 1st trimester pregnancy missed
miscarriage.
Aim of study: to determine the successfulness & safety of 2 weeks expectant
management for 1st trimester pregnancy missed miscarriage.
Patients & methods: in this study was selected early pregnancy missed miscarriage,
pregnant women ≤8weeks & pregnant women from 8-12 weeks.
150 cases of missed miscarriage were collected but only 128 women agreed for expectant
management after counseling. Which they are randomly selected managed expectantly over
7-14 days periods.
Results: The results were found that the expectant management being successful in 65.6%
(84/128) cases while being unsuccessful in 34.4% (44/128). 128 patients of this study
attended follow-up to the karballa maternity hospital and were triaged by assessments of
symptoms.
80 0f the patients ≤8 weeks the success rate was 100%,which is statistically highly
significant =0.001
while 48 of patients 8-12 weeks success rate only 8.3% (4/48) while not success
91.7%(40/44)
Discussion: Expectant management of 1st trimester missed miscarriage has been found now
days to be a good alternative to other methods for treatment of missed miscarriage.
It is safe, effective with good success rate which is 65.6% which is statistically highly
significant. P=0.001
Introduction
Conclusion: Expectant management appears to be sufficiently successful, safe and effective
to be offered as an option for women with 1st trimester missed miscarriage

b
ackground: Adding Metformin to clomiphene citrate in clomiphene –resistant PCOS
patients increases ovulatory response. However because of anti-estrogenic effects of
clomiphene it may be associated with lower pregnancy rate. Offsetting the ovulation
rate benefit, Letrazole is an aromatase inhibitor which induce ovulation without antiestogenic
effects.
Aim of Study: is to induce ovulation& increase the pregnancy rate and live birth rate in
patient with PCOS using a new era of therapy with less side effects, less complications and
better patient compliance.
Materials and Methods: The study is a single – blind randomized clinical trial , 120 ovarian
cycle were studied in 60 clomiphene – resistant patients with PCOS , who were chosen
among 115 PCOS patients attending infertility clinic in Samawa city – Iraq during the years
2011 – 2012 Infertile women with PCOS were randomly divided into Metformin –Letrazole
(29 patients) and Metformin – clomiphene groups (30 patients) after an initial 6 – 8 weeks of
metformin.They received either Letrazole (5mg) from2nd to 7th day orclomiphene citrate
(100mg)daily from 5th to 9th day of menstrualcycle . Estradiol (E2) level , number of follicles
and endometrial thickness were measured on the day of HCG administration .The pregnancy
rate of both groups also estimated.
Results: Mean total E2 and E2per mature follicle were significantly higher in clomiphene
group without a difference in mean number of follicles ≥ 18mm and ovulation rate .
Endometrialthickness was significantly higher in Letrazole group .Thepregnancy rate in
Letrazole group (10 patients, 34.50%) as compared with clomiphene group (5 patients
16.6%) did not show significant difference, whereas full – termpregnancies were higher in
Letrazole group (10 patients 34.5%) versus 3 patients (10%).
Conclusion: In clomiphene resistant PCOS, the combination of Letrazole and Metformin
leads to higher full term pregnanciesas compared with clomiphene and Metformin

b
ackground and objectives: Stress urinary incontinence(SUI) has a significant impact
on the quality of life for many women and it is caused by weakening of pelvic floor
muscle that support the bladder and urethra. It affects (1 of 3 women) and it is often
associated with childbearing and can be defined as a brief involuntary loss of urine due to
increase abdominal pressure in the absence of detrusor activity.
Injectable agents have been used to manage SUI for more than a decade but their application
has been limited by placement, durability, antigenicity and other compatibility issues.
Therefore, there is a continuous development of techniques and materials for newer bulking
agents. Our study was to evaluate the efficacy and safety of the urethral injectable agent
DEXELL SUI in women with stress urinary incontinence after 12 months follow up.
Materials and Methods: A prospective, cohort study conducted in Iraq from January 2014 – January 2016 and data for the study was including 25 female patients (20 -52) years old
with SUI due to intrinsic sphincter deficiency attending the department of Obstetrics and
Gynecology, Urological department, out patients and privet clinic in Al-Diwaniya and AL
Najaf cities. All patients were treated with DEXELL SUI periurethral injection under local
anesthesia. Patients were evaluated for efficacy and safety parameters at 6 weeks visit, 3
months and 12 months visit after injection.
Results: The mean stamey incontinence grade significantly decreased from 1.92 at baseline
visit to 0.28 at 12 months visit(P<0.001).None of the patients were dry at baseline,64% were
dry at 6 week visit, 80% at 3 months visit and 72% at 12 months visit. There was significant
reduction in number of pads used per 6 hours per day from 2.44 to 0.40 after 12 months
visit(P<0.001). Eight patients (32%)developed minor complications related to injection
procedure and all were treated successfully.
Conclusion: DEXELL SUI is effective urethral bulking agents with moderate adverse effects
used in the treatment of female SUI due to intrinsic sphincter deficiency with less invasive
technique.

b

b
ackground: human epidermal growth factor receptor-2 (her2/neu) is related to
growth factor receptors with alkaline kinase activity and it is regarded as important
prognostic and therapeutic factor that can depended on in breast cancer therapy.
HER2/neu expression by immunohistochemistry (IHC) is submitted to a great in terob server
inconsistency. Subsequently additional confirmatory tests for assessment of gene alterations
and amplification status are needed for patients with early or metastatic breast cancer. In situ
hybridization techniques and specifically Chromogenic in situ hybridization (CISH) was arise
as a practical, cost-effective, and alternative to fluorescent in situ hybridization in testing for
gene alteration
Aims of the study: was to determinate her2/neu gene amplification in (27) breast cancer
cases with equivocal her2/neu (2+) detected by IHC by using dual-color chromogenic in situ
hybridization (CISH) method and to compare the results with clinic-pathological parameters
of those patients like age, stage, grade, ER, PR and ki-67.
Methods: twenty seven breast-cancer cases with equivocal HER2-IHC(2+) test results were
prospectively collected and reanalyzedusing dual-color CISH (Zyto- Vision) detection kit for
further identification of her2/neu gene amplification.
Results: Cases with equivocal staining for her2/neu were about 27 cases; these cases were
involved in chromogenic in situ hybridization technique to determine the status of her2/neu
gene. After CISH study 12(44.4%)cases show her2/neu gene amplification (her2/neu/CEN17
ratio > 2.2).In15 (55.5%) cases out of 27 cases, no amplification of the HER2 gene was
shown (her2/neu/CEN17 ratio <1.8).
Conclusions: A significant proportion of patients with equivocal IHC(2+) test results show
amplification of the HER2 gene by ISH.CISH method has the advantage of diagnosis of gene
amplification and revealing tissue histopathology under light microscope

b
ackground: speciation of zinc means the determination of the concentration of
chemical formula of zinc species which is more indicated than total concentration of
zinc for clinical diagnosis. It was shown that atomic absortion spectrometry is good
technique for measuring of total concentration of zinc after digestion of the serum with
concentrated nitric acid and concentrated perchloricacid, while ionic concentration of zinc
was determined by visible spectrometry.
Study design and objective :this study was conducted control healthy people from the
workers in Tikrit teaching hospital,gendar (10male + 10 female) and their ages are between
(35-70(years. This study aimes to find relation between the concentration of bound zinc in
human blood serum and ischemaic heart disease.
Methods: bloods samples were collected from clincilay suspected patients who attend
teaching hospital in salah-aldingovernate with sign and symtoms of ischemic heart disease
(proven by specialist physician). Blood samples were centrifugated and serum was separated
to examine for speciation of zinc concentration
Results: the zinc was determined by two analytical methods. The first method is visible
spectrophotometry, the absorbance was measured at wavelength 578 nm and the zinc label as
ionic zinc. The second method is atomic absorption spectrophotometrymetry, the absorbance
was measurd at wavelength 213 nm and the zinc label as total zinc. The bound zinc was
mathmetical calculated, which is higher in patients than control groups
Conclusion:according to the study data, it was concluded that the level of total zinc higher
than ionic zinc in control and patient, and the levels of ionic and total zinc in patient groups
are lower than their levels in control groups
Introduction
List of abbreviation:
FAAS: Flame Atomic Absorption Spectrometry
GFAAS: Graphite Furnace Atomic Absorption Spectrometry

b
ackground: In 2012, the prevalence rate of Type II diabetes among American
population was 29.1 million, or 9.3% of population. As many as 1 in 3 American
adults will have diabetes (Type I or Type II) in 2050 if present trends continue.
Higher perceived severity and susceptibility of its risky factors may cause a higher
level of attitudes toward practicing healthy behaviors among these subjects.
Objective: The aim of this study was to determine the constructs’ status, knowledge about
Type II diabetes, and their related factors among college students.
Methods: This cross-sectional study was carried out on 223 undergraduate students who
enrolled in Southern Illinois University at Carbondale (SIUC) in a non- random convenience
way. A questionnaire was used for data collection which measured the perceived severity and
susceptibility and knowledge regarding Type II diabetes. Subjects’ demographic variables
such as age, sex, race/ethnicity, family history of diabetes, exercise level, and BMI were also
recorded.
Results: 1.85 and 2.10 out of 4 were revealed as grand means of perceived susceptibility and
perceived severity, respectively. Participants’ chances of suffering from Type II Diabetes in
the next few years as great was perceived at the highest level of susceptibility and concerning
about the likelihood of having Type II diabetes in the future was at the lowest level. Whole
life would be change due to having Type II diabetes was at the highest level of perceived
severity while dyeing within 10 years due to having Type II diabetes was at the lowest level.
Family history was the best predictor of perceived susceptibility to Type II diabetes.
Conclusion: Despite the fact that belief in the seriousness of the disease among subjects was
at favorable level, their perceived susceptibility was low. Increasing perceived susceptibility
and severity may induce an increase in practicing healthy behaviors among college students.

b
ackground: cisplatin is a potent chemotherapeutic agent that is currently used in
management of many and various types of tumors. Cisplatin causes dose-related
nephrotoxicity that significantly affects kidney function and limits cisplatin use with
maximum required dose and usefulness. This study was to assess the protective and
ameliorativen effect of zinc sulfate on kidney function and nephrotoxicity caused by cisplatin
in cancer patients.
Patients and methods: 41 patients were enrolled in the study and were randomized into two
groups. Patients in group I (N=20) received cisplatin based regimen every 21 days for six
consecutive cycles. Patients in group II (N=21) received zinc sulfate plus cisplatin based
regimen during the six consecutive cycles of treatment. Serum urea, creatinine and
magnesium levels were measured at base line and 21 days after 1, 2, 4 and 6 cycles of
cisplatin based regimen. The glomerular filtration rate of patients was calculated according to
updated version of the Modification of Diet in renal Diseases formula.
Results: In group I, cisplatin based regimen after 6 cycles of treatment caused significant
(P<0.05) increment in serum urea and creatinine and significant (P<0.05) decline in The
glomerular filtration rate and magnesium in comparison to base line levels. Serum urea and
creatinine levels of group II were significantly (P<0.05) lower than that of group I while
glomerular filtration rate and magnesium were significantly (P<0.05) higher than that of
group I.
Conclusion: zinc sulfate significantly ameliorated nephrotoxicity and improving kidney
function in cisplatin-treated patients

b
ackground: Propolis is a natural resinous product that honeybees collect from several
plants and mix it with bees wax and salivary enzymes that is also called bee glue.
Propolis has many properties that make it is chief in the medicine including
antibacterial, antiviral, antifungal, antitumor and immunodulatory properties.
Aim: The aim of this study was to evaluate immune adjuvant activity of propolis against
Methicillin Resistant Staphylococcus aureus MRSA in vivo.
Materials and Methods: Twenty male white New Zealand rabbits included in this study, that
divided into tow groups (10 rabbits at each one), group I received orally one milliliter of
Ethanolic Exract Propolis (EEP) at 20% concentration per day for lasting 20 days, while
group II have no received any thing as control group. After 10 days from last dose of
adminstration of EEP, all animals injected in intraperitonial (IP) with six doses of 108 cfu/
ml of killed somatic antigen of Staphylococcus aureus. Blood samples were taken by heart
puncture from all animals to detect the immunological parameters by ELISA technique.
Results: Results revealed to significantly increased the mean value of total leukocytes counts
(TLCs) in group I (5705 cells/mm3) as comparing with group II (4600 cells/mm 3), at level p
˂ 0.05, as well as the results pointed to increased significantly the percentage of neutrophil
cells in group I (42%) as compared with group II (34%), in contrast to lymphocytes results
that show significantly decrease in group I ( 54% ) as compared with group II ( 61%), in
addition, monocytes, eosinophil and basophil were have no differences among the testing
groups. Phagocytic activity result shows increased significantly in group I (55.47%) as
compared with group II (43.94%). The results of complement component C3 revealed increased
significantly in group I (69.76 pg/mL) as compared with group II (18.61 pg/mL), while the results of
C4 concentration pointed to increase significantly in group I (4.20 pg/ml) as compared with group II
(2.38 pg. /ml). IFN-γ concentration results revealed increased significantly in group I (22.18 pg/mL)
as compared with group II (18.05 pg/mL. IL-2 results referred to increased significantly in group I
(32.42 pg/mL) as compared with group II (24.27 pg/mL). On the other hand, the level of perforin was
increased significantly in group I (0.23 ng/ mL) as compared with group II (0.12 ng/ mL).
Conclusion: It was concluded that propolis improve immune responses as adjuvant against MRSA
antigen via increase the levels of cellular immunity elements

b
ackground: Islets of langerhans adapts to changing insulin demands in the
body. One of the most amazing reversible islets of langerhansadaptations
occurs during pregnancy and postpartum conditions. During pregnancy,β-cells
mass expand by increasing their number and size . and they are rapidly reversed at
end of pregnancy by β- cell apoptosis and retained to normal level .
Objectives: This study attempt to demonstrate the changes of the islets of
langerhans that happen during pregnancy and lactation including changes in the
general morphological and histological features, changes in the certain islets’
parameters e.g. number ,diameter and mean areas, and changes in the β – cells
mass.
Material and Methods: We were used thirty female mice which divided into (3)
groups ten for each group. Group(A): served as a control. Group(B) was pregnant group
(at day 15 of gestation). Group(C) was lactating group (at day 4 of Postpartum).
Tissues were processed for both paraffin block and semithin plastic sections .
Tissue sections were stained with H&E stain, Gomoritri chrome stain and NDS. Two
digital image analysing soft wares were used in this study: Image J program and Image
Scope program
Results: It was demonstrated that the formation of new islets, enlargement of islets
by union of adjacent small islets and by increased their cellularity were common
features of pregnant group. also it was showed that in postpartum group, apoptosis
of beta -cells started to restore the beta- cell number to normal level. The
morphometric analysis of the islets parameters in this study showed a highly
significant differences among the studied groups with P value
0.001. The mean
number , mean diameter and mean area of islets were significantly higher in
pregnant group, intermediate in lactating group and lowest in control group. In this
study, the result also showed that the β-cell mass rose near the doubled during
pregnancy as compared with control group, then decreased by 25% at 4th day of
postpartum.
This study conclude that islets of langerhans subjected to natural
compensatory changes during pregnancy then they retain to normal state when
pregnancy ended

b
ackground: Hypertension management is paramount important in diabetic patients
for cardiovascular events reduction. The utilization patterns of antihypertensive
agents in diabetic patients must be consistent with recommended guidelines practice
to produce a positive metabolic effect on glycemic control with proper control blood pressure
and good compliance.
Objectives: The study aims to evaluate utilization prescribing pattern of five groups of
antihypertensive agents among Type2 diabetic hypertensive patients and to explore the
adherence to prescribing existing guidelines and their impacts on glycemic control.
Design: retrospective descriptive ,cross sectional study
Patients and Methods: A total of 230 Hypertensive Type2 diabetes patients on diet ,
Metformin and sulphonylureas drugs were enrolled in the study in diabetic clinic at Imam
Al-Hussien medical city . The study was done between Jan 2009 And Jan 2014. The
attendants' patients used five groups of the Anti-Hypertensive agents in single or in
combinations patterns Angiotensin Converting enzymes inhibitor(ACEI), Angiotensin
Receptor Blocker(ARB), Calcium Channels Antagonist(CCA), Beta Blocker(BB),
Diuretics(Thiazide)). The study followed five groups of antihypertensive drugs for three
months to evaluate prescribing patterns accordance to the evidence base guidelines and
compare their impact on glycemic control. The study include gender, Age, age distribution,
Glycemic control. The study excluded endocrine, liver, and renal diseases, and patients using
steroids.
Results: The majority of the patients on Antihypertensive drugs 191 patients (83%) were
receiving monotherapy including ACEI 77 ( 33.5%) patient, ARB 46( 20%)patient, BB
60(26.1%) patint, CCB 6 patients (2.6%),Thiazide 2 (0.9%) patients, while two or three
drugs combined patterns formed 39 ( 16.95%) patient.
The proper and adequate glycemic control of both genders are 25.2% . The proper glycemic
control of males 40.9% and in females16,7%( P˂0.05) , There were no significant differences
of the impact on glycemic control compared between five groups, ACE or ARB compared
with single BB (Atenolol, Metaprolol) or CCB, Diuretics, as monotherapy or polytherapy
combination patterns.
Conclusion; The utilization patterns of Antihypertensive agents (ACEI,ARBS,BBS) were
more commonly prescribed followed by CCB, Thiazide Diuretics ,irrespective of mono or
polytherapy. The majority of the patients were on monotherapy pattern.
There was no significant difference among the five groups of Antihypertensive drugs
regarding the impact on glycemic control.

b
ackground and Objective: GDM is a common condition during pregnancy which is
associated with negative short-term and long-term outcomes both for mothers and
offspring. Accumulating evidence links vitamin D deficiency with abnormal glucose
metabolism. We performed this survey to investigate the predictive value of vitamin D
deficiency as risk factor of GDM and, to evaluate the role of its replacement and incidence
of development of GDM.
Methods : Cohort study design was conducted in AL -Qadisia City .It included 60
pregnant women with previous history of GDM, and low level of vitamin D at this pregnancy
which measured using enzyme immunoassay with cut- off point less than 20 ng\ml . FBS
measured by photometric method .Then we divided the study population into : group1
include 30 women that given vitamin D from 16 weeks gestation till delivery. group2 include
also 30 women who did not received vitamin .
Result: In our study , low level of vitamin D (MS vitamin D was 11.65+3.23 ng/ml) and
normal FBS at 14-16 weeks gestation, the mean age of women was(28.83 +6.03 years). After
follow up: group 2 had significantly higher level of FBS than in group 1, 155.77+41.30
versus 110.10+36.86 (P<0.001), and the number and percentage of diabetic patients was also
significantly greater in group2 than in group 1, n=22 ,73.33% versus n=6 ,20%
(P<0.001).Conclusion: There is a statistically significant positive correlation between
vitamin D deficiency and subsequent risk of GDM and in addition, vitamin D replacement
significantly reduced the incidence of development of GDM in study population

B
ackground: Volvulus is twisting or axial rotation of a portion of bowel about its
mesentery, colonic volvulus accounts for 10% to 30% of all large-bowel obstructions
and occurs most commonly in the sigmoid colon.
Aim of study: To clarify factors contribute to the problem (large intestinal volvulus) and how
can we manage these factors in various modalities of surgical treatment.
Patients and methods: A prospective study included (22) patients with large intestinal
volvulus who were admitted to the emergency department and managed in the department
of General Surgery, Baghdad Teaching Hospital Medical city, Iraq, during the period Oct.
2007 to Dec. 2009. In addition to demographic data, types of volvulus, and predisposing
factors were identified. The diagnosis made according to the history, clinical features, and
investigations; plain abdominal X-ray, hematological investigations and colonoscopy.
Results: The mean age of the patients was 60.7± 23.4 (range 28-95) years. Males were
15/22 and females were 7/22. Sigmoid volvulus was the most common reported type in
(91%) of the patients while cecum volvulus in the remaining (9%). The main presenting
symptoms and signs were absolute constipation in 20 (91%) patients, generalized abdominal
distension in 20 (91%), and abdominal pain and tenderness in 19 (86%) patients. Emergency
surgery performed in (63.6%) of patients and the other (37.4%) were subjected to elective
surgery. During surgery viable bowel was found in (19) patients (86%), while non-viable
bowel was found in (3) patients (14%). Post-operative complications were detected in 4
patients (18%) and unfortunately one patient (4.5%) died.
Conclusion: Volvulus of the colon is more frequent in males. Old age individuals seems to
be the most affected group by sigmoid colon volvulus, Most cases can be treated
conservatively, at first; by lower GIT endoscopy or by insert rectal tube to do reduction of
colon then treated as elective definitive surgery after good preparation so can reduce the
postoperative complications, in emergency surgery, if have viable bowel and stable patient
we can do resection and primary anastomosis.

B
ackground: Urban and rural population have different life style, including diet,
physical activity, habits, and this can have an influence on the prevalence of chronic
none communicable diseases.
Objectives: To compare the prevalence of risk factors for chronic non-communicable
diseases between urban and rural population sin Kerbala governorate in Iraq.
Methods: A cross-sectional survey was conducted from 16th Jan throughout Feb 2006 on the
prevalence of none communicable diseases risk factors using the world health organization
STEPS instrument. Data collected by direct interview with the 150 individuals adults (25-65
years old) from different parts of Kerbala governorate, 100 living in urban areas and 50 living
in rural areas with nearly equal age and gender distribution. Data collected include
demographic characteristics, lifestyle and risk factors (tobacco use, dietary habits regarding
fruits and vegetables and oil or fat consumption, physical activity, and history of
hypertension or diabetes mellitus). Physical examinations performed to measure blood,
height, weight, body mass index, and waist circumference. Biochemical analysis tested the
levels of glucose, high-density-lipoprotein cholesterol, low-density lipoprotein cholesterol,
total cholesterol, and triglycerides.
Results: Income was lower in rural respondents. Smoking was more prevalent in rural
respondents (35.4% vs. 19.4%). Fruits and vegetables consumption was higher in rural
respondents. Participants consuming ≥ 5servings /day 27% in rural areas vs. 22.4% in urban
areas. Low physical activity was high in both urban and rural participants 37.8% in urban and
43.8% in rural areas. Obesity and overweight was more prevalent in urban participants 70.8%
vs 43.8% in rural participants. Hypertension was more prevalent in urban respondents 40%
vs. 34% in rural. Fasting blood glucose showed impaired blood glucose and diabetes mellitus
in
urban respondents respectively 32.6% and 9.5% vs. 25% and 4.5% in rural.
Hypercholesterolemia was more prevalent in urban participants 54% vs. 29.4% in rural while
high-density lipoprotein cholesterol was lower in rural than urban participants (51.3% vs.
38%). Serum triglyceride was nearly the same in both urban and rural participants.
Conclusion: Risk factors in urban participants that were higher than those in rural
participants were, low consumption of fruits and vegetables, high prevalence of overweight
and obesity, HT, impaired blood glucose and DM, and hypercholesterolemia.
Smoking and low HDL cholesterol in rural participants were higher than those in urban
participants.

background: Menthol, which is primary component of the essential oil of peppermint,
is thought to be accountable for most. of peppermint properties. It is also thought to
have.an anesthetic action locally and be of use in musculoskeletal pain, but with no.
experimental evidence for analgesic activity regarding its leaves.
Methods: Forty Swiss mice of either. sex (weighing 20-25grams) was used in this study,
divided into five. groups each with eight animals. Group 1: receiving distilled water. Groups
2, 3&4: pre-treated.orally with aqueous extract of peppermint in doses 50, 75 and 100 mg/kg,
respectively. Group 5: pre-treated with .standard Ibuprofen drug 100 mg/kg, orally. The
analgesic activity. was determined using radiant heat Tail-flick method in mice and converted
(using special equation) to maximum. possible effect. The results are reported as mean ±
S.E.M and analyzed with ANOVA followed by Dunetts multiple comparison test. The
results. were significant at p<0.05.
Results: The Maximal. Possible Effect (%MPE) was significant when peppermint was. used
in a dose of 100mg/kg, and not significant when was used in doses of 50mg/kg &75mg/kg as
compared. to % MPE of Ibuprofen.
Conclusion: Aqueous extract of dried leaves of Peppermint has. analgesic effect when given
orally in a dose of 100mg/kg in mice.

b
ackground: Human Growth hormone (GH) is 191amino acids protein , gene
located on long arm of chromosome 17. its secretion is under control of 2
hypothalamic hormones: growth hormone releasing hormone(GHRH)
and
somatostatin. Growth hormone is a major promoter of anabolism, its effects on
growth are believed to be indirect ,being mediated through peptides called somatomedins or
insulin-like growth factors (IGFs) that in turn mediate many of the growth promoting effects
of Growth hormone . Recent advances have focused on biological actions of IGFs & their six
well defined binding proteins (IGFBPs), the major one is IGF-BP3 which decreased in GH
deficient children. IGFs are GH-dependent serum peptide with potent metabolic & mitogenic
activities believed to be responsible for growth effects of GH, they stimulate cellular
replication & differentiation .
Objective: To evaluate the difference in the response of the children with short stature (of
different causes) to a six months treatment with recombinant human GH .
Patients And Methods: this is a prospective study in which a total no. of 84 pt (with age
ranging from 4-20 years) were included. They were presenting to the endocrine clinic in Al
Mansour teaching hospital for children in 2002 with short stature & growth delay. After the
final diagnosis was made, all pt were treated by recombinant GH (in a dose of 0.1-0.2 unit/kg
/ day) by subcutaneous or intramuscular route at night time (7-8pm) , After completing 6
months of treatment with GH, the patients were evaluated again for height and height
velocity, weight, bone age, height age, sexual maturity rate, testicles and phallus in male.
Results: There was no significant difference in response to the therapy between male and
female ; the mean height velocity in male was 9.37 +/-3.99 cm / year (ranging from 1-19 cm)
and the mean height velocity in female was 9.90 +/-4.39 cm / year ranging from 3-20 cm .
Conclusion: Growth hormone therapy is effective in increasing the height velocity in most
patients with short stature and it should be initiated as early as possible to improve height as
much as possible.

b
ackground: Patients with acute coronary syndrome (ACS) are liable to death during
their hospitalization or thereafter. The Global Registry of Acute Coronary Events
(GRACE) score is a simple tool that can predict mortality
Objective: To develop a risk prediction tool for estimating death in ACS. This may facilitate
triage and management of patients with ACS
Design: Cross-sectional study
Setting: Azadi teaching hospital, Coronary Care Unit(CCU)
Patients and methods
400 patients with ACS admitted to CCU from Jan. 2012 to Jan. 2014 , were studied by
applying GRACE score which uses readily identifiable clinical parameters like cardiac arrest
on admission, age of the patient ,heart rate, systolic blood pressure and
heart
failure(according to Killip class), laboratory parameters like serum creatinine concentration,
elevated cardiac markers, and lastly electrocardiogram(ECG) changes like ST segment
elevation.
Results: According this score patients were grouped into low, medium and high risk groups
.Out of 400 patients enrolled in the study, 34(8.5%) died during the period of admission,
most of them in the medium and large groups
Conclusions This risk prediction tool is an easy method that can provide prediction of in
hospital mortality for ACS patients.

b
14 year old boy presented with a history of progressive nasal obstruction with
frequent bleeding episodes, for the last three months. The otolaryngological
examination revealed slight dilated and flattened nose with grey red lobulated mass
filling only the right side of the nose with no extension to the postnasal space. The mass
excised completely and send for histopathology and the result was highly suggestive of
chronic granulomatous inflammation of sinonasal cavity. The condition recurs six months
later and the patient presented with the same lesion filling both sides of the nose. The patient
underwent complete excision of the mass. The pathological report consistent with
rhinoscleroma. The patient received ciprofloxacin with good improvement. He has remained
asymptomatic up to the last visit six months following treatment and has shown no evidence
of recurrence. This case report to raise awareness of this condition among physicians and aid
in early diagnosis so as to reduce morbidity

b
ackground: Breast cancer is the most common malignant tumor in Iraqi females
accounting for a third of registered female cancers. Prognosis and management are
influenced by the classic variables such as histologic type and grade, in addition to
tumor size, lymph node status, status of hormone receptors of the tumor and HER-2/neu
status. HER-2/ neu, also known as c-erb B-2 (HER-2), a proto-oncogene located on
chromosome 17, is amplified and/or the protein (HER-2) overexpressed in 15% to 25% of
invasive breast carcinomas and is associated with a worse clinical outcome. The
interrelationship of ER(estrogen receptor), PR (progesterone receptor), and HER-2
expression in invasive breast cancer has come to have an important role in the management
of breast cancer. It has been shown that patients with breast carcinoma overexpressing HER-2
do not respond to tamoxifen therapy.
Objectives:
To
evaluate
HER-2/neu
overexpression
in
breast
by
immunohistochemical study and to study the correlation between HER-2/neu status and
expression of ER
cancer
and PR receptors and other clinicopathological features in invasive
breast carcinoma.
Patients and methods: Immunohistochemical analyses were performed successfully for
ER, PR, HER-2/neu by streptavidin biotin indirect immunohistochemical methods using
monoclonal antibodies for 41 specimens of formalin-fixed, paraffin embedded breast cancer
tissue.
Results:. There was a significant difference in HER-2/neu overexpression between invasive
ductal carcinoma of NOS (Not Otherwise Specified) type from other histopathologic types
(lobular, and specified type ductal carcinoma). No significant correlation was observed
between HER-2/neu overexpression and higher histological grades of invasive ductal
carcinoma. The expression of ER or PR was decreased significantly in HER-2/neu positive
tumors in comparison with HER-2 negative tumors .Only 7.3 % of all cases (3/41) were
negative for estrogen , progesterone receptors (ER/PR) and HER2/neu oncoprotein (Triple
negative breast cancers).The two cases of lobular carcinoma and the three cases of the
special-type carcinomas were negative for HER-2/neu.
Conclusions: HER-2/neu protein was expressed more in ductal carcinoma ( NOS type ) than
in lobular or in carcinoma of special type and frequently detected in higher-grade invasive
ductal carcinoma tumors.The expression of ER or PR was decreased significantly in HER
2/neu positive tumors. HER-2/neu positivity was not correlated with other clinico
pathological parameters like age of the patient, menopausal state, primary tumor size and
axillary lymph nodes status

b
ackground: GDM is glucose intolerance with onset or first recognition during
pregnancy, it has been associated with not only acute increased risk for complications
of pregnancy but also long-term disease risks for both mother and baby due to
inflammation that plays a key role in the pathogenesis of GDM. The need of a reliable early
test to diagnose and predict GDM earlier is important for development of useful intervention
therapies that may impact not only on the acute but long-term health outcomes.
Objective: We performed this survey to investigate the predictive value of the of first
trimester serum CRP as screening test of gestational diabetes mellitus and, to evaluate the
correlation between high CRP and body mass index (BMI).
Patients and Methods: A prospective cohort study design was conducted in AL -Qadisia
City in Iraq from January 2012 to January 2015. Data for the study was collected from
patients attending the department of Obstetrics and Gynaecology ,outpatient and private
clinic. It included 110 low risk pregnant women at first trimester(8-13 weeks). Study was
included after meeting inclusion and exclusion criteria. Venous blood was screened for
plasmatic C reactive protein by CLIA system to measure C reactive protein in values with
cut- off point of high level more than 3mg/L , fasting blood sugar by photometric method
and in addition to routine antenatal tests. They were followed up to delivery by continue to
measure fasting blood sugar between 24-28 week and after 28 week of gestation . Also for
assessing of complications (10 women were lost to follow ,so only 100 women were finally
available).
Results: In total, 100 low risk pregnant women at first trimester with high CRP(>3mg\L),
(mean+SD 5.33+1.61), 88% of them developed GDM, 53women developed between 24
28week(early GDM, group1),35women developed >28 week(late GDM ,group2),while 12 of
them remain normal(group3). CRP was significantly high in group1 comparing to group2
and group3 ( mean+SD 6.383+ 1.439 , p< 0.001). BMI was also significantly high in group1
comparing to group2 and group3 (100% versus14.8%). Maternal and fetal complications
were significantly less frequent in women with group1 than group2 (1.88%, 11.32% and
17.14%, 28.57%) (p=0.010, 0.040) respectively.
Conclusions: We did find a significant correlation between high maternal serum CRP level
at first trimester and subsequent development of gestational diabetes and also, our study
showed a significant correlation between pre-pregnancy BMI and CRP in early gestational
diabetic women