Al-Qadisiyah Medical Journal

This study aimed to investigate gram-positive bacteremia in febrile children according to some risk factors and to detect the type causative bacteria. One hundred sixty blood samples were collected from children under 2 years who were suffering from fever and admitted to emergency department of Babylon Maternity and Children Hospital in Hilla.
The results indicated that 31(19.4%) blood samples revealed positive cultures consisting of 21(68%) gram-positive bacterial isolates and 10(32%) gram-negative isolates*. Gram-positive isolates represented by; Staphylococcus aureus which accounted for 10(33%), Coagulase negative Staphylococci (CoNS) which accounted for 5 isolates(16%), Streptococcus pygenes 4 isolates(13%), Listeria monocytogenes and Micrococcus sp. 1 isolate(3%) for each.
The results showed that; infants under one months of age were more susceptible for bacteremia than other ages, in a rate of 32%. Males were found to be more susceptible than females, since the rates of infection were 52% and 48% respectively, with no significant correlation. The rate of infection in children living in rural area was found to be 67.7% while it was 32.2% in urban children with a significant correlation.

Fifty angina pectoris patients (APP) were clinically diagnosed in Mergan Hospital in Hillah city during the period from March to August 2009. While the control group were fifty normal subjects. APP and control groups were subjected to a battery of acute phase protein C, Anti DNA and IgM anti IgG to investigate the role of the auto-antibodies in the immunopathogenesis of angina pectoris (AP) . Thirty-five out of the fifty APP (70%) were positive for acute phase protein response with titre ranges of 18-128. while APP. were positive for Anti DNA and IgM anti IgG autoantibodies were 36% and 16% respectively with titre ranges of 16-32 and 4-32 respectively. The immunoprofile of APP was heterogeneic with eight different patterns. Aging and diabetic stats as clinical entities were associated with high anti DNA and IgM anti IgG autoantibody titres means reflecting the possible involvement of auto-immunity in the immunopathogenesis of AP. 16-36% of AP cases are expected to have an autoimmune origins.

A cross-sectional study was conducted , on 1048 adolescent pupils( 554 male &494 female) , in Al-Diwaniya Governorate , Iraq.
-Twelve intermediate and secondary schools were chosen consecutively as a study setting ( 6 from Diwaniya city as urban ; 3 from Shamiya &3 from Gammas as rural).
-All chosen pupils (aged 12–18years) were considered in the self reporting questionnaire & face to face interview during the period from the 1st of May to the 30th of November 2010.
-Out of 1048 adolescents assessed, 183 have positive mental disorders, giving a point prevalence of 17.46% .
-Among the examined pupils are (79) diagnosed with anxiety disorders which represent about 7.5% of the total adolescents under study, (41) with a depressive disorders which represent about 3.91% , (36) diagnosed with behavioral disorders which represent about 3.43% , and (27) with ADHD which represent about 2.57% of the total adolescents under study.

From 392 isolate of UTI inpatients were collected from maternity and pediatrics teaching hospital in Al-Diwanyia city, from September 2008 to June 2010. About 37 samples gave a positive cultures. Results also showed a high increment rate of UTI in the females that males 268 (68.2%) females & 124( 31.8%) males . E. coli was the major pathogen of UTI 276 (70.4%) of total cases, the second important pathogen was Proteus spp. (15.8%),
while the other causes of UTI were Candida albicans (6.12%), Staph. aureus ( 4.33%), Pseudomonas aerugenosa ( 1.53%), Streptococcus spp. (0.72%), Klebsiella spp. ( 0.5%) & Enterococcus spp. 0.5% .
Immunological findings included the determiation of serum levels of IgG, IgM and IgA , Tumor necrosis factor alpha and beta were also documented . Results showed that IgG concentrations significantly increased 7.765 in patients in comparison to health control groupwhich was 1.25 , While IgM concentrations was decreased in patients (3.76) in comparison to healthy control (13.89). IgA concentrations was increased too in patients (15.73) while in control group was 2.86 .
Tumor necrosis factor alpha levels was clearly increased (237.5) pg/ml in patients in comparison to control (10.5) pg/ml. Tumor necrosis factor beta concentration was also increased in patients (213.11) pg/ml and in control was (14.8) pg/ml. That’s explain the importance of studies on UTI and the importance of using an immunological parameters to monitor the disease development and effectivity of the antimicrobial chemotherapy against such diseases.

Tracheastomy is one of few ancient surgical procedures which is still widely used nowadays. There is an old famous statement (when you think about tracheastomy, it is time to do it). This statement is far away from reality with the emergence of new less invasive methods of securing airway.
Aim: to evaluate the indications of tracheastomy in Najaf.
Patients and methods: a cross-sectional analytic study of 87 tracheastomy operations had been done in the period between January 2008 to February 2011 in Al-Sadar teaching hospital in Najaf.
Results : The mean age of our 87 patient was (52.4). Most of our patients were males 59(67.8%). The main indication for tracheastomy was upper airway obstruction 59 patients (67.8%), While the least indication was subglottic stenosis 2,2%. Among upper airway obstruction causes, carcinomas of the larynx and hypopharynx were the main indications for tracheastomy 67.7%. From 20 patients reqired tracheastomy for assisted ventilation 65% had head injury. In those six patients whom the main indication of tracheastomy was for bronchial toilet, 83.3% had head injuries (5patients).
Conclusions : our indications for tracheastomy in Najaf is quite different from those over all the world. While still relieving of upper airway obstruction is the most common indication in our study, replacement of prolong intubation represent the first indication in developed countries.

Background:- Many years ago, clinicians treating couples for infertility by using ovarian stimulants drugs, which produce their action on reproductive hormones, a variety of medications can temporarily correct ovulatory problems and increase a woman's ability to become pregnant.
Objectives:- To identify the effect of different type of ovarian stimulents modalities on serum level of reproductive hormone which will eventually affect the out come of the cycle ( follicular maturation and ovulation).
Methods:- Forty-five patients were enrolled in this study all of them suffer from primary infertility, the patients were randomized into three groups.
The first group consist of fifteen patient they use clomiphene only as ovulation stimulant drug (starting from cycle day two and for five days), the second group also fifteen patient they use human menopausal gonadotropins injection (HMG) as ovulation induction drug(starting from cycle day two), and the third group also fifteen patient use both drugs for ovulation induction(first they took clomiphene from cycle day two and for five days followed by HMG injection from cycle day seven).
Results:- Showed a significant increase in the serum concentration of follicular stimulating hormone and Luteinizing hormone in the third group more than the first and second groups. The rates of the follicular maturation were significantly higher in the second group more than the first and third groups. The serum concentrations of the progesterone and estrogen hormones were significantly higher in the first group more than the second and third groups.
Conclusion:-Careful selection of treatment modality, dosing combined with appropriate levels of monitoring may result in excellent maturation rate.

Our purpose was to investigate the mammaglobin overexpression in tissue breast cancer and to determine its correlations with conventional prognostic parameters. There were investigated 60 patients with breast carcinoma, and slides from paraffin blocks were stained with an antibody against mammaglobin. The immunohistochemical reaction was scored based on the percentage of positive tumor cells in tumors. Positive reaction for mammaglobin was diffused cytoplasmic staining foundin 75% of tissue breast carcinoma. A significant correlation was found between the mammaglobin expression in the breast cancer and grades of the tumor. Out results suggest that mammaglobin is a good prognostic marker forbreast carcinoma
Aim of study:-this study was to investigate the mammaglobin overexpression in tissue breast cancer and to determine its correlations with prognostic significant.

Part ΙΙ: diltiazem, at both concentrations (0.5% and 0.25%) caused highly significant reduction (P < 0.01) in IOP at 5th and 10th days post treatment.
Conclusions: Diltiazem exerted a detectable ocular hypotensive effect on the eye of rabbits when applied at concentration (0.5%) or (0.25%) 3 times daily.
Background; Glaucoma is a multifactorial disease involving progressive optic neuropathy and altered intraocular hemodynamics; furthermore, glaucoma can cause blindness if it is left untreated.
Aim of the study: To explore effects of topical diltiazem on intraocular pressure (IOP) in each of normal and ocular hypertensive rabbits.
Materials and methods: A group of 54 males of the rabbits were included in the present study. Induction of ocular hypertension was achieved by injection of hydroxy propyl methylcellulose in the anterior chamber of rabbits right eye. In addition to distilled water (as negative control), each of timolol (as positive control) and diltiazem (the tested drug) eye drops were instilled 3 times daily to right eye prophylactically for 4 days and therapeutically
Results: Part Ι: Diltiazem (0.5%) caused highly significant (P < 0.01) reduction in intraocular pressure of right eye .

This in vitro study aimed to evaluate the effectiveness of Caffeic acid against the viability of Leishmania tropica promastigotes in vitro. The result showed that Caffeic acid had a fatal effect on the viability of Leishmania tropica promastigotes with the use of different concentrations leading to a gradual decreasing of living promastigotes number with the increase of Caffeic acid concentration. The mean parasiticidal effect of Caffeic acid was (24×104, 30×104, 38×104, 44×104, 53×104) promastigote /ml at concentrations (10, 15, 20, 25, 30) mg/ml respectively after three days of incubation. It can be concluded that Caffeic acid posses a cidal effect on the Leishmania tropica promastigotes in vitro." P < 0.01 ".

Recent researches into diabetes and impaired glucose metabolism has created a new array terminology
And definitions relating to glucose metabolism in clinical practice.
To study the role Glucose Tolerance Test (OGTT) in diagnosis of different hyperglycemic classess.
in diwaniya.
Four hundred patients were studied for the existance of diabetic state using the Oral Glucose Tolerance Test.
Only (37.5%) patients had frank diabetic state after 2h OGTT.
(50%) patients ranging between Impaired Fasting Glucose ( IFG), and Impaired Glucose Tolerance Test.
(12.5%), patients had no diabetes.
Overlap between results makes these readings not applicable for all population,therfore using
2H OGTT..is warranted.

In this study, one-hundred vaginal swabs and cervical smears were obtained randomly from women admitted to Al-Diwaniya Maternity and Pediatrics Teaching Hospital in Al-Qadisyia Province; samples from private clinics were also included. The samples were taken from married women. Women who were pregnant, with vaginal bleeding, and who recently have used vaginal suppositories were excluded from the study. The samples were collected from November, 2010 to March, 2011.
The study involved culturing and isolation of most common microorganisms that cause vaginitis and their association with cellular changes of the cervix.
The most common organisms isolated were Staphylococcus aureus( 29.7%) , Escherichia coli (17.6%),and Candida albicans (25.7%). These isolates were associated with cellular changes in (27.2%),(46%), and (21.1%) respectively. In comparison with patients' culture results that revealed normal flora (11%), Pap smear results were normal.
The study conclude that any persistent inflammation of the cervix induced by infectious or non-infectious agents and remain untreated will progress into cervical dysplasia and then into cervical cancer. . This may be explained, when cervical metaplasia disrupted by external influences leads to disordered squamous epithelium called dysplastic epithelia. Also cytokines that are released after stimulation of immune response that is caused by bacterial infections or inflammation of various origins may have mutagenic effect and contribute to carcinogenic changes.

Objective:-to compare the usage of transurethral urinary diversion and that of suprapubic cystostomy after distal shaft hypospadias repair by tubulerized incised urethroplasty.
Method: - between December 2008 to October 2010 a 48 boys who had primary hypospaidais under went surgical repair by tubulerised incised urethroplasty, they divided into two groups according to the type of urinary diversion that used post operatively; group A with suprapubic diversion and group B with transurethral nasogasteric tube diversion.
Result: - 48 boys aged between 3-21years with hypospadais had divided in to two equal groups according to type of post operative urinary diversion (suprapubic and transurethral), the distribution of hypospadais type similar in both groups.
Urinary diversion was more effective , post operative complication were rare ,no trigon irritation and excellent cosmetic result (100%) were recorded following transurethral diversion with nasogasteric feeding tube ,conversely the creation of suprapubic cystostomy increased incidence of trigon irritation (12.5%) and fistula formation( 4.17 %).
Conclusion: - transurethral urinary diversion was very effective and gave better result than suprapubic cystostomy in distal type hypospadias repair.

Aim : To determine the incidence of endophthalmitis in our population following extracapsular cataract extraction over time(2003-2004) and to explore possible contributing factors , and to compare with incidence of endophthalmitis in other countries .
Patients and method :8479 patients who were operated on for cataract surgery during the period from January 2003 to December 2004 were reviewed and all cases of endophthalmitis were analyzed ,and possible risk factors identified
Results : During the study period ,as the technique of extra capsular cataract extraction (ECCE)with or without intraocular lens(IOL) implant whether posterior chamber(PC) intraocular lens or anterior chamber (AC) intraocular lens was performed .
There was 11:1000 incidence of endophthalmitis in general , with more incidence among diabetes (13.5:1000) and among who had previous trabeclectomy and underwent cataract surgery (20.8 :1000).Most cases of endophthalmitis occur in elderly (over 60) and as an early onset (76.76%).
Conclusion: Post cataract surgery endophthalmitis is not uncommon in our population and it is relatively higher than developed center in the world , and its age dependent and sex has insignificant role in determining the incidence. Special attention to the risks contributing to this disease to be taken in consideration whether pre, per ,post operative to prevent endophthalmitis.

Background : Doxorubicin based regimen is the most common treatment of breast cancer which is highly complicated by cardiotoxicity.
Aim : To clarify the possible effects of carvedilol on echocardiographic ejection fraction and fraction shortening in doxorubicin based regimen in females with breast cancer.
Patients and Methods : A total of 16 females with breast cancer were included in this study. The patients were randomized into 2 groups , 8 patients each. Group I included patients were treated with doxorubicin based regimen for 6 cycles with 21 day apart. Group II included patients were received doxorubicin based regimen with carvedilol 3.125 mg , orally , twice daily for 5 days , for 6 cycles. Echocardiography was done to measure ejection fraction and fraction shortening at zero time and 3 days after 2nd , 4th and 6th cycles.
Results: Treatment with CAF regimen caused highly significant decrease in echocardiographic ejection fraction and fraction shortening after 2nd , 4th and 6th cycles in comparison to baseline readings ( P < 0.01 ). Combined CAF + Carvedilol 3.125 mg orally twice daily for 5 days caused highly significant increment in echocardiographic ejection fraction and fraction shortening compared with that of CAF regimen group ( P < 0.01 ).
Conclusion: Carvedilol causes significant increase in echocardiographic ejection fraction and fraction shortening in doxorubicin treated patients.

This study was included the preparation of vaccine against fascioliasis from three Fasciola gigantica antigens, somatic antigen, excretory-secretory antigen and partially purified cathepsin antigen. Their vaccine efficacy was tested in rabbits, by using 12 Lepus lepus arabica rabbit, aged 2 months, similar weight.
The rabbits were subdivided to three groups each of four rabbits and was vaccinated with one antigen emulsified in freund adjuvant. In compare to control groups Which involved 4 rabbits vaccinated with PBS and other four left without vaccination, challenge infection was done by vaccination the animals with 90 metacercaria obtained from experimentally infected intermediate host. All animals were killed 12 weeks after challenge. Protein concentration of all prepared antigens and the molecular weight of P.P.CatA was also measured, which reached (1.5, 1.2 and 0.04) mg/ml in SA, ESA and P.P.CatA respectively, while P.P.CatA 26.7 KD.
Protection estimated by followed number of aspects, the first aspect of this study, was the determination the hepatic damage which was evaluated using gross morphometric observations depending upon the severity and intensity of lesions. Significant differences (p<0.05) was noted between vaccinated and control groups.
The second aspect was concerned with estimation of fluke number and reduction rate, the high rate (81.3%) recorded in animals vaccinated with P.P.CatA while (39.53%) of those vaccinated with SA. Significant differences (p<0.05) was documented in the length of fluke in animals vaccinated with P.P.CatA. No significant differences were noted in fluke burden (width, length, weight) and fecal egg counts, Significant differences (p<0.01) were noted in egg viability and reduction rate in the vaccinated animals in comparison with control group.
ELISA was used for monitoring of IgG levels in all vaccinated and control animals, before and after infection. The IgG increased in the sera of animals vaccinated with SA, ESA and P.P.CatA within 1 week after the first injection. A boosting of the antibody responses was observed in all groups following both the second and third immunization.
An increasing in the antibody titers in all vaccinated animals was observed within 2 weeks following challenge. IgG in all vaccinated groups remained high throughout the infection but decreased at approximately 6 weeks after infection, and then remained constant throughout the subsequent weeks. Antibodies to antigens in the sera of the control group increased within the first 2 to 4 weeks after infection but decreased at approximately 8 weeks and then remained constant throughout the subsequent weeks.
Accordingly, the results of these aspects could be consider a P.P.CatA as a first best vaccine then secondly ESA.

Background: Otitis Media (OM) is an inflammation of the middle ear drum and the inner ear, including a duct known as the eustachian tube. Otitis media is very common in children. Over 60 percent of the cases of otitis media are caused by bacteria. Urinary tract infection(UTI) refer to the presence of microbial pathogens within the urinary tract. A urinary tract infection is a condition where one or more structures in the urinary tract becomes infected after bacteria overcome its strong natural defenses. In spite of these defenses, urinary tract infections are the most common of all infections and can occur at any time in the life of an individual. Almost 95% of cases of UTIs are caused by bacteria that typically multiply at the opening of the urethra and travel up to the bladder.
Escherichia coli, K. pneumoniae and Proteus mirabilis are the bacteria most commonly cause UTI, followed by other gram-negative and gram-positive bacteria. A number of studies have reported on the prevalence of otitis media and urinary tract infection. However, majority of these studies have focused on clinical diagnosis with little or no report on the bacteriological etiology of otitis media and urinary tract infection so this study aimed to isolate, characterize and identify the bacteriological etiologic agents of otitis media and urinary tract and to select the best antibiotic for the treatment of such infections.
Objective: The study aimed to identify the aerobic pathogenic bacteria cause otitis media and urinary tract infection and to compare between pencillins, gentamicin, ciprofloxacin, refampicin, cefotaxim, trimethoprime, and nitrofurantoin effects on this bacteria.
Materials and methods: The study was carried out on 130 out patients (65 patients 36 male and 24 female infected with otitis media and 65 patients 24 male and 41 female infected with urinary tract infection). The specimens were collected with sterile swab sticks (for patient infected with O.M) and collected with sterile container (for patient infected with UTI) which were properly labeled for each patient. Specimens were inoculated onto Blood, Chocolate , MacConkey and Manitol salt agar plates. All plates were incubated immediately for 24 hours aerobically with the exception of Chocolate agar that was incubated in a candle jar. Emergent colonies were identified according to standard bacteriological methods
Results:From the 130 specimens from out patients (65 ear swab from patients infected with otitis media and 65 urine specimens from patients infected with urinary tract infection) , there were 60 bacterial isolates from patients infected with otitis media (36 male 60% and 24 female 40%) with 5 specimens no growth. Pseudomonas aeruginosa was the most prevalent bacteriological etiologic agent of otitis media (25 isolates 41.666%).While from the 65 urine specimens from patients infected with urinary tract infection , there were 65 bacterial isolates(24 male 36.923% and 41 female 63.077%) K. pneumoniae was the most prevalent etiologic agent of urinary tract infection (27 isolates 41.53%).
Conclusions:Nitrofurantoin antibiotic was active against all of the bacterial isolates from patients infected with otitis media and from patients infected with urinary tract infection. While Ampicillin and Pencillin were not active against most of bacterial isolates.
Recommendations: Otitis media and UTI characterized by the presence of many drug resistant cases due to different pathogenic bacteria involved in their etiology so further clinical studies are required to select the most appropriate and effective antibiotic in the treatment of such cases.

Background:The treatment of condylar process fractures has generated a great deal of discussion and controversy in oral and maxillofacial trauma and there are many different methods to treat this injury.
Aim of study:To evaluate the methods of treatment of displaced condylar fractures, open or closed and pointing out their indications and contraindication.
Materials and methodes:Forty patients (20-50 years old) were selected with displaced sub condylar fractures unilateral or bilateral from January 2009 to September 2009. All patients were treated in maxillofacial unit, hospital of specialized surgery, in Medical City, Bagdad. This study protocol involves all the types of displacement of sub condylar region which can be diagnosed clinically and plain x-ray.
By using all of above whether can evaluate the patients if need surgical or functional treatment (only mandibulo maxillary fixation).
Results:In our study we classified the displaced sub condylar fracture according to Row 1982 classification and we found the high percentage was medially displaced. We treated 12 patients from 40 patients surgically and 28 patients functionally and we found some of complications with the patients who were treated surgically as infection and visible scar, while the complications of displaced subcondylar fractures which are treated functionally are deviation during mouth opening, temporo mandibular joint pain, asymmetry of face and malocclusion.
Conclusion:With difficulties of follow up, for those patients with displaced sub condylar fractures which cannot be treated functionally (MMF) or still malocclusion evenly after using elastic band in MMF we preferred the open reduction with internal rigid fixation by extra oral approach.

Objective :To define the relationship between margin of clearance at sites of excision and the recurrence rate of basal cell carcinoma in head and neck region
Methods: This study was conducted on 65 patients in Al-Diwanyia teaching hospital who underwent surgery for basal cell carcinoma in the head neck region between 2007 and 2008 and followed up for a period of 3 years .The patients were evaluated according :site and type of Bcc ,whether or not the excision was complete ,tumor recurrence , gender and age of the patients .
The size of tumor was less than 2cm in all patients
Conclusion: a risk of recurrence in incompletely excised basal cell carcinoma was more common in younger age group patients and we recommend close clinical follow up for other patients .

Objective: to analyze and descrbe the prevalence of cigarette smoking, attitude among paramedical students.
Methods & materials: Across- Sectional study was done among the paramedical students in central medical institutes (as Institute of Medical Technology -Baghdad, institute of medical technology Al- Mansur- Baghdad. This study was conducted from October 2008 to April 2009. students ages 22 to 24 years, They were randomly selected from the first and second study level Global Adult Tobacco Survey based questionnaire.
Was used the first part of the questionnaire contained demographic data and the second part contained various questions about smoking habit and attitude.
Results: The study revealed that 50 (8.3%) of student were smoker. The prevalence of smoking was (19.6%) among males, and (0.0%) among females, smoking was more common in males than females (p=0.001), while the never smoked more among females than males (p< 0003).The main sources for initiating smoking habit are friends, parents, and media.
Conclusion: (19.6%) of males and (0.0%) of females paramedical students in institute of medical technology , anti tobacco education and awareness should be adopted in the curriculum of school and colleges.

A stereological study of a (middle piece) of ductus epididymis between normal adult human, bulls, rams, goats and buffalos was conducted using routine histological techniques. The following stereological parameters were determined; Stereocilia height, epithelial height, muscular wall thickness, lumen and tube diameters. The human epididymal stereocilia height is shorter than in goat only and higher than bulls and goats in both the epithelial height and muscular wall thickness. Human ductile diameter is smaller than in other animals. In conclusion, all human epididymal mid piece parameters in the present study differ significantly than in the other animals. Because human epididymis differs from other animals in fine structure and luminal contents, the present stereological study shows how structural data obtained from histological micrographs of the intact tissue and cells can be different between human and other animals mid peiece ductus epididymis.