Al-Qadisiyah Medical Journal

Objectives: Depression is commonly found as a comorbid condition in chronic medical illnesses in general, and diabetes mellitus (DM) in particular. Patients with diabetes are twice as likely to suffer from depression as compared to the general population. The aims of the study were to estimate: the prevalence of depression in type 2diabetic patients and its severity, the rate of depression in type 2 diabetes in relation to socio-demographic variables, and to find out the correlation of depression with some diabetes variables
Methods:100 Iraqi patients with type 2 DM compared with 100 persons from general population as control group participated in across sectional study. Participants were interviewed using: a semi-structured interview schedule based on ICD-10, diagnostic criteria for depression ,Beck depression inventory II for severity of depression and socio demographic questionnaire.
Results: The prevalence rate of depression in type 2 diabetes was 44%. The rate of depression was higher for females, married, housewife ,those of secondary level education, in age group(50-59),those of poor glycemic control, with long duration of diabetes, in patients on insulin and those with cardiovascular complication.
Conclusions: Depression is more common in type2 diabetic patients than in normal individuals. This will necessitate the need for more attention and screening for such conditions, which plays a role in the patients state physically and mentally.

Background: Type 1 diabetes mellitus (T1DM) is an autoimmune multifactorial disease characterized by progressive destruction of pancreatic beta cells by genetic and environmental factors which leads to an absolute dependence of insulin for survival and maintenance of health. Materials and methods: One polymorphic sites of PTPN22 gene was genotyped in 64 patients with T1DM, and 25 healthy controls. Genotypes were determined by the polymerase chain restriction fragment length polymorphism (PCR-RFLP) method. Results: The single nucleotide polymorphisms T/T, of the PTPN22 gene may be participate in the susceptibility of T1DM in the Iraqi population. Conclusion: Although PTPN22-T/T polymorphism not associated with T1DM in many population, our study confirmed significant correlation between PTPN22 and T1DM.

Background: Acute myocardial infarction is world wild leading cause of death and the incidence of mortality have declined dramatically over the last 30 years, with the advent of the coronary care unit, fibrinolytic therapy, catheter-based reperfusion including primary percutaneous coronary intervention, and statin therapy. Early revascularization is critically important in the management of patients presenting with acute myocardial infarction.
Aim: To assess the benefit of delayed in comparison with early primary percutaneous coronary intervention in patients with acute ST elevation myocardial infarction.
Methods: This prospective study included 82 patients with acute ST elevation myocardial infarction they were selected from those who had admitted to the coronary care unit of Shaheed Al-Mehrap cardiac center in Babylon-Iraq during a period between November 2013 and November 2014, they divided in to two groups according to the time of intervention that done, first group include patients underwent primary percutaneous coronary intervention within less than 12 hours from the onset of acute myocardial infarction and second group include patients underwent primary percutaneous coronary intervention between 12 and 48 hours from the onset. Ejection fraction, left ventricle end diastolic dimension, and functional class compared at presentation, after 2 and 6 months.
Results: The mean ejection fraction in first group were 55%, 59% and 60% at presentation, after 2 and 6 months respectively with statistical analysis that shows significant improvement in ejection fractions with P-value < 0.05. The mean ejection fraction in second group were 48%, 50% and 50% at presentation and after 2 and 6 months respectively with no significant improvement in the ejection fraction, P-value > 0.05% . The mean left ventricular end diastolic dimension divided by patient`s height in first group were 3.02 cm/m, 3.20 cm/m and 3.25 cm/m at presentation and after 2 and 6 months respectively and in second group were 2.94 cm/m, 3.09 and 3.19 at presentation, and after 2 and 6 months respectively. The statistical analysis shows significant difference between both groups regarding mean left ventricular end diastolic dimension at presentation and after 2 months, P-value < 0.05, while there is no significant difference after 6 months, P-value > 0.05. In the second group, there is significant improvement in the ejection fraction of subgroup (at presentation and after 6 months) between 30 and 39%, P-value < 0.05. There is significant improvement in functional class of second group after 6 months, P-value < 0.05.
Conclusions: In case of ST-elevation myocardial infarction, delayed primary percutaneous coronary intervention may improve functional class, left ventricular size and even ejection fraction. Primary percutaneous coronary intervention, indicate more improvement in left ventricular ejection fraction, size and remodeling, and functional class

Background: Toxoplasma gondii is an obligate intracellular protozoan parasite that infects almost all-warm blooded animals and human beings. No really data is known of genetic diversity of T. gondii in human in Iraq. The aim of this study was to determine the genotypes of T. gondii isolates from human in Wasit province, east Iraq.
Methods: A total of 508 clinical specimens (blood 500 and placenta 8) of women were initially examined serologically by ELISA, and further tested by RT-PCR technique through B1 gene amplification to confirm the infection with T. gondii. Then the positive DNA samples were assayed for genetic characterizations depend upon nested PCR-RFLP of SAG2 gene.
Results: Out of 508 tested samples only 15 were confirmed positive T. gondii DNA. The genotyping assay revealed that 6.6% (1/15), 13.3% (2/15) and 80% (12/15) of examined isolates represent the genotypes of I, III and II respectively.
Conclusion: The type II appeared is a dominant picture in human being in Wasit province / Iraq.

Background:
Femoral neck fracture represent important subject because it has many complications and followed by morbidity , prospective study was done on (20) patient, The treatment options of femoral neck fracture are many ,we choose treatment with cannulated screws and evaluatethe result of it regarding the union rate and occurrence of the complications.
Patients and Methods:
This study was performed on 20 patients with femoral neck fractures in period between September 2009 and September 2010 in orthopedic department in the Hospital for Specialized Surgeries in medical city/ Baghdad ,we did preoperative assessment to them and including radiological examination ,laboratory investigations to identify medical diseases and treat them ,classify patient according garden classification and Treated by reduction of displaced fractures and capsulatomy and then fixation with three cannulated secrew
Results:
Twenty patients with femoral neck fractures 7 females 35%, and 13 males 65%, 12 patients were left-sided 60%, 8 patients were right-sided 40%.11 patients were with undisplaced femoral neck fractures (55%), 9 patients with displaced femoral neck fractures (45%). The age of the patients was ranging from 20 – 50year ,The result of our study was indicated that union rate of 85% , and 25% of vascular necrosis.
Conclusions:
the cannulated hip screws is a good method of fixation regarding union rate and low complication rate , the result of treatment is influenced mainly by the fracture displacement and quality of reduction and time of surgery.

Purpose: The purpose of this study is to estimate the peripheral retinal degenerations rate in myopic subjects, and compare the results between different degrees of myopia.
Methods: subjects with different degrees of myopia who attended the consultations in Al-Diwaniya teaching hospital during the period from 1st Dec. 2014 to 1st of March 2015 got involved in this study, they were examined and peripheral retinal degeneration assessed and recorded.
Results: The study included 237 patients with a mean age of 41.93 ±13.16 years and an age range of 18-65 years. Male patients accounted for 131 (55.3%) whereas female patients accounted for 106 (44.7%) with a male to female ratio of 1.24: 1. Mean refraction was -4.72 ± -3.05 D and ranged from -18.1 to -1.1 D. lattice degeneration was found in 64 patients (27.0%), while snail track degeneration was found in 11 patients (4.6%), results showed no significant relation between age, gender with the incidence of peripheral retinal degenerations while its clearly increasing in incidence with increasing degree of myopia .
Conclusion: The incidence of peripheral retinal degeneration is more in high myopia subjects , although Low& moderate myopic subject still have considerable rate of peripheral retinal degeneration .

Background: the condition of hallux valgus is considered as the most common deformities affecting females more than males, characteristically manifested as lateral deviation of the big toe and widening of first and second inter -metatarsal angle with a deformity of second toe in some severe cases.
Objective: to make a radiological and clinical assessment of two surgical methods of osteotomy used in treatment of hallux valgu and to compare between them: first one is the distal dome osteotomy, and second one is a distal wedge metatarsal osteotomy.
Patients and methods: a total of 36 feet of 28 patients suffer from hallux valgus, with mean age of 50.3 years were included in this study, followed for 6- 30 months ( mean follow-up of 8.8 months). Nineteen feet treated by dome osteotomy and seventeen feet treated by wedge osteotomy. All the cases were evaluated by the american orthopedics foot and ankle society (aofas) score, also, through the hallux valgus angle and intermetatarsal angle, both before and after surgery.
Results: by dome osteotomy, the preoperative mean result of aofas score was about 45.7, with hallux valgus angle (hva) of 33.2o and intermetatarsal angle (IMA) of 11.7º. Postoperatively, the mean result of AOFAS score was 82.8, with HVA of 14.3º and IMA of 7º, with about 94.7% satisfactory results. In the other hand, the method of wedge osteotomy showed a preoperative mean result for AOFAS score of 45.2, with HVA of 34º and IMA of 12.8º , compared with postoperative mean result of AOFAS score of about 80.7, with HVA of 15.8º and IMA of 7.7º, with about 82.8 % satisfactory results.
Conclusions: the two methods of osteotomy were used with very good outcome in radiological and clinical treatment of hallux valgus.

Objective: In this study Klebsiella pneumonia where isolated from urine samples and detection of extended spectrum β-Lactamases by using mPCR technique.
Method: This isolated subjected to the antimicrobial susceptibility test (Disc diffusion) for some antibiotics following by multiplex PCR techniques for detection extended spectrum β-Lactamase genes (bla TEM, bla SHV, bla CTX-M and bla AMPC).
Results: The extended spectrum β-Lactamase genes by PCR techniques were given bla CTX-M (30/93.75%), bla SHV (25/78.12%), bla TEM (18/56.25%) and bla AMPC (22/68.15%), respectively.
Conclusion: K. pneumonia isolates of urinary tract infection patients highly associated with the emergence of bla CTX-M β-Lactamase that provides useful good treatment.

About 60 million people worldwide work in the textile or clothing industry. The conditions of working and the dust that produced from processing of cotton in industries can cause many morbidities to the health of workers. Many recent studies have found a high ratio of chronic diseases especially chronic obstructive pulmonary disease (COPD) in those workers. This study was done to assess the effect of working in textile industry from physiological and clinical points of view. A cross-sectional study was conducted among 75 randomly selected textile factory workers, all subjects were females. Information was collected through interview, in addition to physical examination and some needed investigations were performed including: packed cell volume (PCV),white blood cell count (WBC), erythrocyte sedimentation rate (ESR), random blood sugar (RBS), blood urea (Bur), serum creatinine (Scr), serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST), serum alkaline phosphatase (ALP), electrocardiography (ECG), echocardiography, chest x-ray (CXR) and general urine examination (GUE), in addition to pulmonary function tests (PFTs) using portable medical spirometer.
The results of this study was shown that the mean duration of exposure of workers to cotton dust was 15.67±4.86 years, the higher percentage of workers had low back pain (LBP) (85%), while lower percentage of them had contact dermatitis (27%), urinary tract infection (23%), while 2% of workers had left ventricular hypertrophy as revealed by ECG and echocardiography. Regarding the mean values of blood parameters, the study showed no significant difference between workers and control groups apart from ESR changes (26.8 ± 15.95 vs. 8.3 ± 3.3 with P ≤ 0.05). Regarding the respiratory findings, the highest percentage of workers complained from shortness of breath (45.3%), some of them had no symptoms (17.3%), severity of symptoms was moderate restriction in most workers (24%), the study also showed negative non-significant relation between duration of exposure and severity of respiratory impairment (r = 0.1, P= 0.2). In conclusion; this study provides evidence of a strong relationship between exposure to cotton dust and respiratory impairments, also there was a considerable percentage of workers had muscular and dermatological problems, despite no important effects on the hematological parameters except ESR.

Background:
The lacrimal sac infection common problem exposing the eyeball and the orbit into the risk of contaminations and the subsequent; orbital cellulitis, conjunctivitis, and even keratitis so it is an indirect sight threatening disorder and should be studied promptly.
Patient and methods
At Al-Diwaniya Teaching hospital, at the outpatient clinic of ophthalmology; after clinical diagnosis of dacryocystitis, a sixty tow samples of lacrimal sac contents were studied microbiologically (12 bilateral and 38 unilateral) .From June 2010 to June 2013.
Results and conclusions:
78%(39) of cases were with positive results, while the remainder were negative. No fungal infection recommended. The most common pathogen is the Staph species, and the most effective antibiotic is the Chloramphenicol, which is available and non coasty drug could be used as a first line therapy.

Promastigotes of genus Leishmania are transmitted by Phlebotomus sandflies bites. Cutaneous leishmaniasis (CL) is endemic in southern parts of Iraq. Lawsonia inermis (henna) leaves contain several active compounds that have antiprotozoal activity, as well as, Peganum harmala possess several alkaloids with antiprotozoal properties. In this study, MTT assay was used to assess the antileishmanial activity of L. inermis and P. harmala aqueous extracts in comparison to pentavalent antimonial drug( sodium stibogluconate) on in vitro promastigotes of Leishmania tropica. L. inermis and P. harmala extracts were prepared in concentrations of (5%, 2.5% and 1.25%) and (10%, 5% and 2.5%) respectively. Also, combinations of various concentrations were prepared to assess the synergistic effect of both plants on promastigotes. Inhibition rate was calculated for each extract concentration and their combinations. Statistical analysis showed a significant(P<0.01) inhibition of promastigotes of L.tropica by both extracts of low and moderate concentrations, while higher concentrations had no inhibitory effect in comparison to sodium stibogluconate solution.. The combination of extracts showed a strong inhibitory effect in comparison to individual extracts of plants. Synergism was obvious when both extracts were combined.

Objective: The objective of this prospective case series study is to evaluate the clinical outcome of endonasal laser assisted Dacryocystorhinostomy (ENL-DCR) using diode laser 810 in patients
Material and Methods:Fifty four patients with age range from(10-55)years where included in the study which performed at Diwannyia teaching hospital(from April 2013 to June 2014).Patients were followed for 6-12 months.
. Success of procedure was absence of epiphora (subjective) or patency of lacrimal system on irrigation (objective).

Diabetes has long been associated with increased perinatal morbidity and mortality It's one of the commonest and important metabolic disorder that affect the health of both mother and infant .
Patient and methods
Total number of patient involved were one hundred eighty four , Ninety-nine of them were infants of diabetic mother , they were admitted to the NCU of AL-Diwaniya teaching hospital from the 1st of October 2013 to the end of march 2014. Eight-five neonates were also enrolled in this study as control (infants of non-diabetic mothers)
Objective
To determine the morbidities and mortality among infants of diabetic mother and to compare it to that of control.
Result
There is higher morbidity and mortality amongst IDM . Hypoglycemia was the commonest morbidity recorded (31.3%) followed by hyper bilirubinemia (13.3%) and respiratory distress (12.1%). More prolonged hospitalization had been seen amongst IDM.
Conclusion
There is higher frequency of morbidity and mortality amongst IDM , hence ascertain a good glycemic control to diabetic mother and providing optimal neonatal care is valuable to decrease these complications.

Cholera is an acute bacterial enteric disease characterized in a severe form by sudden onset, profuse painless watery stool (rice water stool) 1, nausea and profuse vomiting early in the course of illness. In untreated case, rapid dehydration, circulatory collapse, hypoglycemia in children, and renal failure can lead to death.
The aim of study was to get the level of Knowledge, practice and attitude of the population of Al-diwaniya Province and their relation with them socio-demographic characteristics.
Cross sectional study from 1st November 2015 to 1st march 2016 to get the knowledge, attitude and practice of dewaniyah population by interviewing them and filling the questionnaire excluding who worked in health sectors.
The results of study showed significant impact of level of education on the knowledge score in such a way that the higher the educational level, the better the knowledge; this finding agrees with Wahed T. et al. (2013) 1. This significant association may be explained by better understanding for disease process experienced by well-educated person and the more scientific thinking of those persons about disease prevention and treatment.
The educated persons were less affected by faulty knowledge presented by the society and general media like facebook and other social media technology.
National educational programs should be adopted by health authorities to satisfy two objectives; the first being global insight focused on the communicable diseases and the second being a fight against misleading knowledge adopted by uncontrolled media.

Design Of Study: prospective study.
Duration: From 2014 to 2015
Setting: Department of Urology, AL-Diwaniya teaching Hospital, Infertility clinic.
Patients & Methods: Over a period of one year hundred (100) patients with varicocele associated with male infertility over a 3-years period were included in this study. Pre- and postvaricocelectomy seminal fluid parameters evaluation according to the World Health Organization (WHO) criteria was performed at 6-month intervals.General anesthesia was given to all patients.
Results:
One hundred patients met the criteria their age range from 25 to 45 years with a mean age of 32± 3 years. The mean duration of infertility was 3years (range: 1.5–6).). Only the sperm motility of patients with normospermia showed a significant improvement postoperatively
Conclusion:
No significant improvement in sperm morphology may be obtained in
patients with clinical varicocele and preoperative normospermia.

Background: The complement system consists of more than 30 proteins that are either present as soluble proteins in the blood or present as membrane-associated proteins. Inappropriate complement activation and complement deficiencies are the underlying cause of the pathophysiology of many diseases.
Methods: A case-control study was conducted to asses role of complement system during toxoplasmosis in Najaf province. Thirty five sera of infected women with toxoplasmosis by investigation antibody against toxoplasmosis for IgG and IgM by ELISA technique were tested to determine the levels of C3 and C4 by using single radial immunodiffusion technique and compared with the ten of control sera of non infected subjects and non-aborted.
Results: The high C3 in significant differences(P<0.05) and C4 with no significant differences(P>0.05) levels were found in aborted toxo-positive women in compared with control. Likewise, it was found that association between concentration of C3,C4 and number of abortion.
Conclusion: complement were play role in immune response of pregnant women especially against toxoplasmosis that cause abortion to these women.

Background: Tuberculosis is a disease of worldwide distribution. This disease is known to caused by Mycobacterium tuberculosis, however several environmental and genetic factors can affect the occurrence and progression of the disease. Toll-like receptor 2 (TLR2) has a particular importance in immune response against this bacteria.
Aims: This study aimed to investigate the association of two single nuclotide polymorphisms(SNPs) in TLR2 gene which are Arg677Trp and Arg753Gln with the incidence of TB in Iraqi patients.
Subject and Methods: A case-control study was conducted which involved 55 patients with confirmed pulmonary TB and other age-matched unrelated 30 healthy individuals as control group. Blood samples were obtained from each subject and DNA was extracted. The gene of TLR2 was amplified with polymerase chain reaction (PCR) using specific sets of primers. Genotyping was achieved by direct sequencing.
Results: Only the SNPArg753Gln appeared in two genotypes which were GG and AG in both TB patients and control groups. In TB patients, these genotypes account for 44 (85.45%) and 11 (14.55%) respectively, compared with 29 (96.7%) and 1 (3.3%) respectively in control group with significant difference (OR =7.251 95% CI=1.008-59.211, P = 0.035). The SNP Arg677Trp had only one genotype which was CC.
Conclusion: The allele A of the SNP Arg753Gln could be considered as a risk factor for TB among Iraqi patients.

objective:
The objective of this study was to prospectively evaluate the accuracy of MRI and myelogram for the demonstration of foramina nerve root impingement in cervical spondylitis radiculopathy
Patients And Methods
Between January 2012 and May 2014. Eighty five patients referred to the department of Hilla teaching hospital with. cervical spondylitis radiculopathy were imaged with conventional MM and with MR myelogram . The diagnostic accuracy of these imaging strategies for the demonstration of exit foraminal stenosis was calculated relative to a gold standard of the combination of conventional MRI and MR myelogram
Results:
Conventional MRI had a sensitivity of 88.9%, specificity of 99.1%, and diagnostic accuracy of 94.5% for the demonstration of exit foraniinal disease. MR myelography alone had a sensitivity of 84.4%, a specificity of 90.1%, and diagnostic accuracy of 88%.
Conclusion:
However, the addition of MR myelography increased the diagnostic yield of the MR examination for the detection of forantinal stenotic disease. MR myelography is a useful adjunct to conventional MN in the investigation of cervical spondylotic radiculopathy.

This prospective study was carried out on 160 patients with acute intestinal obstruction admitted to the surgical unit at Al-Diwaniyah Teaching Hospital from January 2012 to June 2013 .The patients were divided, according to the results of treatment , into two groups : (1) patients who received early operation (76 patients ) , and (2) patients who received initial conservative treatment with nasogastric decompression and observation (84 patients). The conservative treatment was successful in 52 patients but in 32 patients, delayed operation was required .There were 54 cases of strangulated intestinal obstruction (33.75%) and 106 cases of simple obstruction (66.25%) .The causes of obstruction were adhesions in 52.5%, obstructed external hernia in 20%, tumor in 10% ,intussusception in 5% and miscellaneous group of causes which accounts for 12.5% of patients. There was positive correlation between bowel strangulation and the following factors: constant abdominal pain, feculent vomiting ,generalized tenderness ,rebound tenderness , rigidity ,absent bowel sounds, tachycardia (PR >110 min.) , fever (temperature >38˚C), signs of shock (systolic BP <90 mmHg) and WBC count above 18000mm3.The mean period of conservative treatment was 48 hours and the period of hospitalization was shorter in the conservative group as compared with the operative group . The morbidity was less in the conservative group than in the operative group. There was no death in the conservative group, while in the operative group the mortality rate was 7.4%. The mortality was closely related to the age, and the state of bowel involved by obstruction , since most deaths occurred in old aged patients and in patients with gangrenous bowel.

Background:
There has been great progress in reconstructive surgery of the male urethra in the last decades. Several complex techniques were developed to correct urethral defects with great variations in the success rate. However, there is no an ideal substitute for the male urethra as good as the urethra to our knowledge at this time .
Human male urethra has a large capacity to extend under traction. This extensibility is the principle of urethral advancement technique used to correct urethral defect in hypospadias by using the urethra itself.
The objective of this study was to evaluate the urethral advancement and glanuloplasty (UGPI) procedure in hypospadias repair.
During a period of 1 year, 20 boys ranging between 2-16 years old underwent repair of glanular to midshaft hypospadias by UGPI procedure. At or near the tip meatus was accomplished in 75% of the patients, with 85% adequate meatal size, 85% straight penis and 70% of conical glans shape. While the complications were 15% meatal stenosis (MS), 25% meatal retraction (MR), 5% fistula , 35% bleeding and haematoma, 10% for cellulites and UTI (infection), 20% wound dehiscence, and 10% abnormal urine stream.
Adequate mobilization of the urethra for advancement decreases the incidences of complications of MR and MS.
The lower incidence of fistula in UGPI procedure support the sentence of "There is no an ideal substitute for the male urethra as good as the urethra".

Introduction: The main purpose of this study was to investigating the presence of qnr-genes among clinical isolates of K. pneumoniae recovered from Najaf hospitals.
Material and methods: A total of 1590 clinical specimens were obtained from three main hospitals. The Klebsiella spp. were identified by traditional biochemical tests, and confirmed by API 20E system.Theisolates that exhibited reduce susceptibility to quinolones were examined for the presence of PMQR qnr (qnrA, qnrB, and qnrS qnrC, and qunD).
Results: The qnr genes were detected in 20 (63.5%) isolates qnrB, qnrA and qnrS were identified in 17 (23%), 2 (2.7%) and 1 (1.4%) respectively.
Conclusion: K. pneumoniae isolates harboring PMQR are currently widely distributed in Najaf hospitals.

In Diwanyah city more than 30 % of women admitted for labor in Diwanyah maternity teaching hospital between January 2013 and January 2014 delivered by cesarean section , the rate of cesarean section is high in Diwanyah city & is increasing in other cities of Iraq , it is also increasing all over the world including the developing & developed countries

Open Cholecystectomy, is associated with high pain score post op.
TAP block provides effective post op analgesia
Aim
The aim is to evaluate the effectiveness of US guided subcostal TAP block for post op pain in open cholecystectomy
Patients were divided into two groups. Thirty patients received subcostal TAP block after commencing GA. Another thirty patients did not receive the block.
Post operative pain was recorded in both groups , so as any possible complications like nausea and vomiting .
We found that subcostal TAP block is effective , simple , and reliable as analgesia in open cholecystectomy post operatively
Patients and Methods
A total of 60 patients undergoing emergency and elective cholecystectomy were allocated into two groups : U/S guided subcostal TAP block , the A group , and the non TAP block group , the B group.
All patients received same general anaesthesia drugs and technique.The A group received subcostal TAP block 5 minutes before starting surgery , a total of 20 ml , 10 ml 1% lidocaine and 10 ml 0,25% bupivacaine
Rescue post op analgesia was in the form of I.V tramal and diclofenac.
Pain score was recorded post op , using VAS ( Visual Analogue Score ).

Results
Group A ( 30 patients ) , received subcostal TAP block 5 minutes prior to starting surgery , and Group B ( 30 patients ) did not received TAP block. Post op pain score recorded in both groups , and showed pain score 0-2 in group A , and 6-8 in group B which received rescue analgesia
Conclusion
Subcostal TAP block is effective analgesic technique with opioid –sparing effect in open cholecystectomy post operatively

Background : Truncus arteriosus (TA) is an uncommon congenital cardiovascular anomaly that is characterized by a single arterial trunk arising from the normally formed ventricles by means of a single semilunar valve (ie, truncal valve).
Case presentation : A 3-month-old female infant product of spontaneous vaginal delivery complaining from dyspnea , tachypnea , mild cyanosis since birth , decrease in feeding and activity ,She was admitted twice in different hospitals and diagnose as a case of VSD with pulmonary hypertention , given treatment but no response , the family picked her to Babylon for maternity and children hospital . ECHO and cardiac CT- angiography was done were revealed truncus arteriosus.
She was treated by anti failure and drug which lower pulmonary vascular resistance, her condition improve and become stable . after that they went to turkey where operation was done in specialized cardiac centre before age of six month.
Conclusion : In any infant with signs and symptoms of congestive heart failure and mild cyanosis truncus arteriosus shoud be suspected.

The present study has been designed to quantitate the mRNA expression level of testicular Inha, Inhba, and Inhbb genes at pre- and post-pubertal stages of male Wister rats. Fifty male Wister rats (25 immature and 25 mature) were used in the present study. At pre-pubertal stage, 5 male rats of 25, 30, 35, 40, and 45 days old, and at post-pubertal stage, 5 male rats of 55, 60, 65, 70, and 75 days old were anasthetized and testis were obtained for molecular study to investigate the expression levels of Inha, Inhba, and Inhbb genes using qRT- PCR. The expression level of Inha gene in testis decreased as the age progress until 40 day period, and then slightly increased at 45 day period. At 55 day period, the expression significantly increased. At 60 and 65 periods, the levels recorded no increase, but 70 and 75 day periods recorded significant increase. The expression level of Inhba gene increased significantly as the age progress at the pre-pubertal stage, where the highest level was recorded at 45 day. At 55, 60, and 65 day periods, the highest expression level has been recorded, thenafter, the levels decreased at 70 and 75 day periods. The expression level of Inhbb gene increased significantly at 30, 35, 40, and 45 day periods of the pre-pubertal stage. At 55 and 60 day periods, no significant difference was recorded compared with 45 day period. At 65 day period, the highest level was recorded, thenafter, the levels decreased at 70 and 75 day periods. It can be concluded that fold changes of Inha, Inhba, and Inhbb genes in testis, correlated with the alterations of inhibins and activins concentrations at different periods of pre- and post-pubertal stages of male Wister rats life.

A total of 100 individuals were included in this study, 50 patients with alopecia areata and 50 healthy controls. There was no significant difference between alopecia areata patients and controls according to gender and age groups. No significant difference between alopecia areata patients and controls according to age groups. HLA-DQB1 alleles were studied in those patients and compared with HLA-DQB1 in healthy controls. A significant decreased frequency of HLA-DQB1*020101 and HLA-DQB1*030201 alleles in patients with alopecia areata comparing with healthy controls (P < 0.05, OR= 0.76, 95% CI= 0.65-0.89) and (P < 0.05, OR= 0.72, 95% CI= 0.61-0.86) respectively. HLA-DQB1*030101, HLA-DQB1*060101 and HLA-DQB1*060201 showed significant increased frequencies in alopecia areata patients comparing with healthy controls, (< 0.05, OR= 0.24, 95% CI= 0.06-1.10), (P < 0.05, OR= 1.23, 95% CI= 0.97-1.56) and (P < 0.05, OR= 1.46, 95% CI= 1.05-2.02) respectively. There was no significant difference in HLA-DQB1 alleles in patients with family history of alopecia areata and patients without family history of alopecia areata. Patients with alopecia areata showed increased homozygousity in HLA-DQB1 when compared with controls (P <0.005, OR= 0.05, 95% CI= 0.01-0.23). Combination of HLA-DQA1*0103 – HLA-DQB1*0301 showed higher frequency in comparison with other HLA-DQA1-HLA-DQB1 alleles combinations

Background: For the treatment of symptomatic gall stone, laparoscopic cholecystectomy has taken the place of open cholecystectomy as the norm. However, switching from a laparoscopic to an open cholecystectomy is still necessary in many cases. This study set out to identify the primary factors that led to laparoscopic cholecystectomy conversion to open surgery.
Methods: 150 patients who underwent laparoscopic cholecystectomy between January 1, 2013, and January 1, 2015 were prospectively followed at the time of surgery by collecting information on the patient's age, sex, length of time from the introduction of laparoscopic ports until the decision to convert, and the cause of conversion, if any, at the time at Al-Diwnaniya teaching hospital.
Results: 9 conversions, or 6% of the 150 laparoscopic cholecystectomy procedures, actually took place. Vascular injuries were the most frequent causes. Two individuals each with gall bladder empyema and extreme obesity
patient, abnormal position of gall bladder: 1 patient, and dense adhesions and disturbed anatomy: 3 patients. Three patients of conversions are males from 25 male patients underwent laparoscopic cholecystectomy, 6 cases are females from 125 female patients underwent laparoscopic cholecystectomy so the percentage of conversion for male patients is 12% while for female patients is 4.8%.
Conclusions: The study's overall conversion rate was 6%, with dense adhesions, empyema of the GB, and severe bleeding being the most prevalent reasons for conversion. The conversion rate was greater in male patients.

Abstract
Background For both the patient and the gynecologist, abnormal uterine bleeding (AUB) is one of the most common and confusing conditions. Until the pathology basic menorrhagia is precisely analyzed, legitimate treatment is not really imaginable..
Aim of study: The study's goals were to compare various pathologies among patient age groups and determine the types and frequencies of abnormal uterine bleeding pathologies.
Material and Methods: A retrospective review study concentrate on in which H&E segments of endometrial curretings and hysterectomy examples of 70 patients were assessed. The cases were collected at random from Al-Hilla Teaching Surgical Hospital between July 2013 and March 2014. The morphological findings and the clinical history were used to make the diagnosis.
Results Out of 70 cases of AUB, 44 (62.86%) were caused by organic factors, while 26 (37.14%) were caused by non-organic factors (DUB) Liomyoma was the organic cause in 16 cases (36.36%), followed by pregnancy-related conditions in 14 cases (31.82%), and proliferative endometrium was the non-organic cause in 14 cases (53). 84%), secretory endometrium 8 (30.67%), and so on.
Conclusions The proliferative endometerium (53.84%) and liomyoma (36.36%) were the most common causes of AUB in our study, with the majority of cases occurring in pre- and per-menopausal age groups.

Objectives:
thyrotoxicosis during pregnancy is not uncommon condition and difficult to be treated due to lack of availability and the expense of the available medication .L.carnitine may have a promising role in the management.
Method:
A prospective study of thirty one women ; nineteen of them are pregnant and the remaining are not. All patients were prescribed L –carnitine 4g/day as a management for their thyroid problem. After 1.5-2 months; re-evaluation is done to all patients regarding clinical and laboratory response. Patient compliance and side effects of the medication were monitored in each follow up visit. For non-compliant patients; the causes of non-compliance were identified.
Results
A three ( 15.8%) pregnant women showed a poor responded to 4g / day of L- carnitine with their Thyroid function test and heart rate did not improved by the treatment; therefor the dose of L- carnitine increased to 6 g daily with or without addition of propranolol daily orally to minimize symptoms of hyperthyroidism especially heart rate .In the non-pregnant group; only one woman (8.3%) are not responded to the treatment.
Regarding the changes in the thyroid function test; both groups showed significant increase in TSH while both showed insignificant changes in free T3and T4.
Most patients in both groups were complained from the high cost of therapy, which may decrease the adherence of patients to the treatment and resulted in discontinuation of therapy in some patients and the preference to thyroidectomy in others.
Conclusion:
The addition of 2-4 grams of oral L-carnitine daily is an effective tool for reducing symptoms of thyrotoxicosis. It could be used alone or in conjunction with anti-thyroid drugs or alternative medicine, so L-carnitine is considered as welcomed addition for the management of hyperthyroidism.

Abstract
Background: transcatheter closure of patent ductus arteriosus (PDA) evolve rapidly and there are many changes in design of device using for closure, percutanuose transcatheter PDA closure in symptomatic infant as an alternative method for surgery with less complication
Objective: to evaluate the safety and effectiveness of vascular plug type 2 in closure of moderate to large PDA in compare to ADO1so increase the chance of transcatheter PDA closure in such age and weight instead of surgical closure which difficult and high risk of death in our country
Patient and method: Seventy-eight infants below 6kg of weight with symptomatic PDA visited the Iraqi center for heart disease from June 2012 to June 2013 transcatheter closure was attempted with either ADO1 or AVPs type 2 randomly
Result: Data collected from 78 babies (mean weight 4.32 kg, range: 2.75-6.5; mean age 7.53 months, range: (2-11.5) of them 55.1% female and 49.1% male ,those babies divided in two group randomly 37 cases(47.4%) trial for closed by AVPs type 2 and 41cases (52.6%)trial for closure by ADO 1 the Implantation of occluder was successful for total cases whatever the type of occluder used was 87.2% where as the success rate for cases closed by ADO1 were 31cases 75.6% and failure to closure in 10 cases 24.4% the cause behind that failure were in 70% of failure aortic obstruction, small peripheral vein in 20% and left pulmonary artery obstruction in 10% , all failed cases to close by ADO1 reclosed by AVPs type 2 so the success rate for cases closed by AVPs was 100% one cases closed by AVPs embolized and easily retrieve then replaced by larger size in same session, all cases of ADO 1 closed from antegrade rout while AVPs in (83.8%) from antegrade route and (16.2%) from retrograde route, the cases divided into three group according to degree of pulmonary hypertension, 11.5% as mild degree of PHT, 34.6% with moderate degree of PHT and 53.9% severe degree of PHT, the most size of ADO1 occluder used are (10/8mm in 53.7% and 8/6mm in 43.9%) while in vascular plug (8mm in 54.1% and 10mm in 32.4%) the most effective variable of failure or success were the weight of patient ,type of occluder and size of occluder
Conclusion: although percutaneous transcatheter closure of PDA with ADO1 if feasible and effective in infant with symptomatic PDA but with high rate of complication so we must look for new occluder this occluder that solve the problem is AVPs type 2 which cheaper, more effective and safer with more soft delivery system and easily to retrieve if embolized.