Al-Qadisiyah Medical Journal

Background
Unstable angina has considerable effect on homeostasis of thyroid gland with consequences effect in form of mortality and morbidity. Thyroid hormone has an important effect in the cardiovascular system. Small changes of the thyroid hormone within the normal physiological response have been an adverse effect on cardiovascular results.
Aim of study
The study was designed to assess the profile of thyroid hormonein patients with unstable angina who wereadmitted to the Coronary care unit and toevaluate short term affection.
Patients and methods
An observational study was enrolled 40 patients were admitted to the CCU of AL-Diwanyia Teaching Hospital during period from 1st of March 2017 to the 30 of November 2017. Thyroid function tests (FT3, FT4, TSH) were done by ELISA method within 48 hours of admission.
Results
Sick euothyroid syndrome was observed in 42%, subclinical hypothyroidism in 35% and subclinical hyperthyroidism in 23% of patients with abnormal thyroid hormone profile in 65%. A higher prevalence of abnormal thyroid hormone profile (54%) was seen in elderly age group >60 years.
Conclusion
There is statistical significant value of thyroid dysfunction in patients with unstable angina and age groups >60 years, but withno significant difference regarding the gender.

Aim of the study:
To explore the efficacy and safety of trans-scleral diode laser cyclophotocoagulationin the treatment of refractory Glaucoma as well as its effects on intra ocular pressure IOP and pain relief.
Material & Methods:-
19 patients, 20 eyes, one of patient both eyes were treated. 10 patients having neovascular Glaucoma, 5 patients PCAG and 4 patients DOAG followed up for about 6 months.
Results:
Mean intraocularpressure (IOP) for the 20 eyes at first visit was (38.1500 ± 13.63924) mmHgreducing to (15.1000± 3.56740) mmHg one week later.
Conclusion:
Trans-scleral diode laser cyclophotocoagulation is a safe andconvenient technique in the management of with refractory Glaucoma

Obesity is a major metabolic illness that results from increased body fat and leads to negative health consequences. Obesity increases the prevalence of various diseases, including diabetes mellitus, hypertension, coronary heart disease, sleep apnea, CVA, GERD disease, gall bladder disease, certain types of malignancy, and non-alcoholic fatty liver disease[1]. Moreover, it is also a major avoidable health detriment. Current therapeutic approaches to obesity are lifestyle changes, pharmacologic treatment, and bariatric surgery.
Patients and methods
Twenty-seven patients visited our obesity clinic in Al Dewania Teaching Hospital from September 2016 to September 2017 and selected for intra-gastric balloon insertion after discussion with the patients, all current bariatric operative options beside the discussion to choose different balloon types. Air filled balloon was chosen.
Result
female to male ratio 3.1:1, with mean age 34±6.1 and mean body mass index 40.48 ± 5.16 had excess body weight 38.93 ± 8.44 Kg, all patients had been received IGB heliosphere 720 ml as treatment of their obesity. Each patient has been followed up 6 months and weight loss patterns observed. Mean weight loss after six month 9.6 ± 4.8 Kg
Conclusion
In regards of patient selection to the procedure, Patients should be selected according to their commitment to the recommended diet and life style modification, thiswould largely affect the outcome.

Background:Candida albicans is considered as one of the normal flora that habitat human body and has a virulence capability to cause an opportunistic mycoses,especially in immune-compromised individuals.
Objective:To evaluate the emergence of resistance to azole antifungals in C.albicans associated with trailing growth phenomena.
Methods: Different isolates of C.albicans were identified and tested against azole agents using disk diffusion and microdilution methods to test the antifungals susceptibility profile and determine the resistant isolates depending on the presence of trailer growth phenomena in media after 24-72 hours of incubation .
Results:The antifungals susceptibility profile showed the emergence of trailing growth in C.albicans grown in Sabouraud dextrose agar after 24-48 hours of incubation when tested with azole agents(flucocanozole and ketoconazole) and most of the sensitive and intermediate isolates revealed a trailing growth phenomena.
Conclusion:The present study proved the capability ofC.albicans to resist the azole antifungals even the sensitive isolates when tested toward antifungal drugs .

Background
Women in the reproductive age group comprise a dangerous part of ur population because they face a double burden of communicable and non communicable diseases in addition to high risk of pregnancy complication. Thus an expected death of women in reproductive age had big trauma to family in psychological and social level of other member in family.
Objective
1-To find out the unrecorded maternal death in health institution
2- To throw alight on most common causes of death in reproductive age groups woman
Methods
A cross sectional description type study was carried out from 1st june to 28thjune 2013 at Diwanyia city. The study enrolled data about dead women of child bearing age 12-49 year that occurred in period from January 2011 to December of 2012. Studied different types of variables age, residence, cause of death.Data were analyzed by (SPSS) like proportion.
Result
A total of 450 deaths in reproductive age group women were reported, of which 18 (4%) were maternal death while 432 (96%) were due to non maternal cause. Majority of the deaths occurred in the age group of 40 – 49 years 169 (37.6%), and the most cause of death are ischemic heart disease 97 (21.6%) follow by cancer 81(18%).
Conclusion:
Control of modern life styles such as increase in weight, proper management of pregnancy complications might be decrease death rate in child bearing age women.

Introduction:Tooth decay in infants and toddlers is often referred to as Nursing Bottle Caries(NBC),and as a comprehensive address, referred to Early Childhood Caries(ECC), Children need strong, healthy teeth to chew their food, speak and have a good-looking smile, also it is important for their general health,The role of mothers in avoiding children with nursing Bottle caries is a large and fundamental ,mothersorientations and knowledge , is essential to reduce the percentage of children with tooth decay, developed countries are concerned with awareness and health education programs as a first step in achieving a healthy and disease-free society.
Objective:the purpose of this study was:
(a) To explore what mothers know about what the meaning of nursing bottle caries (NBC) and its effect on their children and which information they need.
(b)To identify mother’s attitude to maintain the health of their children teeth.
(c) To determine the level of health awareness by health programs in the Ministry of Health.
Methods:A cross sectional study was Included(85) mothers whom their children under the age of five and suffering from (NBC)who visit the primary health care centers within the primary health care sectorFor the purpose of following up the regular maternal and child health program, which were 9 centers in Baghdad/ Alkarkh,from February 2017 -April2017, Interviewer-administered questionnaire was used for data collection, the data was analyzed using SPSS software version 11.0.
Results:  Knowledge regarding risk and protective factors amongst parents was variable and sometimes at odds with contemporary evidence, the level of knowledge and procedures towards nursing bottle caries is not sufficient to protect the child, because of the poor health education programs that mothers receive at different levels of education.
Conclusions:  The results of this study have implications for efforts to prevent dental decay in this very young age group. Ministry of Health, including public health Institutions and its primary health care centers,need support to provide information and promote confidence with regard to basic health information about nursing bottle caries in children teeth and the necessary measures for prevention, including the importance of the presence of fluoride in drinking water and toothpaste, visit the dentist during the first year after the birth of the child, the effect of sugars in breast milk and natural juices. Attention should also be given to the contribution of early contact with females who are newly married in oral health education and promotion programs.

platelet-rich-plasma is increasingly used in tennis elbow. This study show the clinical outcomes of a single PRP injection .our study was done between Dec. 2015 and Oct. 2016, platelet-rich–plasma was administrated to thirty patients. All subjects underwent prospective clinical evaluation, including visual analog scale (VAS) for pain for six month follow up .most of the patient (VAS) significantly improve from (p > 0.05) after injection with platelet-rich –plasma .so as the result show the PRP injections in tennis elbow showed better improvement in outcomes .

Background: Prolonged jaundice is a type of neonatal jaundice, which occurs in infants with high bilirubin levels (>10 mg/dl) persisting beyond day 14 of life in term neonates, and beyond day 21 in preterm neonates. Prolonged jaundice may be caused by predominantly conjugated or unconjugated hyperbilirubinemia. Distinguishing between these types of jaundice helps to determine the risk for pathological causes of prolonged jaundice.
Phenobarbital has been used to treat neonatal jaundice since the 1960s. Numerous clinical trials have shown that both administration of phenobarbital to pregnant mothers before delivery and phenobarbital administration to neonates after delivery limit the severity of unconjugated hyperbilirubinemia, reduce the peak serum total bilirubin concentrations caused by physiologic jaundice by 50%, and the need for exchange transfusion.
Objective: The aim of this study was to evaluate the role of phenobarbital in reducing the total serum bilirubin(TSB) in neonates with prolonged unconjugated hyperbilirubinemia.
Methods: This is a prospective clinical trial study that was performed in Karbala teaching hospital for children from 18th of December 2017 to the end of December 2018. A total of 101 neonate with prolonged unconjugated hyperbilirubinemia were included in this study. All neonates who included in this study received phenobarbital tablet (5 mg /kg/day) twice a day for 10 days and some of them need phototherapy according to American Academy Of Pediatrics Guidelines for phototherapy,
Results: There was a highly statistically significant decrease in TSB for the patients who were treated with phenobarbital compared to the baseline level, mean baseline TSB 14.57± 2.31 mg/dl versus TSB after phenobarbital 6.79±1.62 mg/dl (P value <0.001). There was a highly statistically significant decrease in TSB for the patients who were treated with phototherapy in addition to phenobarbital compared to the baseline level, mean baseline TSB 19.94±1.36 mg/dl versus TSB after phototherapy and phenobarbital 6.33±1.37 mg/dl (P value <0.001).
Conclusions:
1. Oral phenobarbital supplementation in the neonates with prolonged unconjugated hyperbilirubinemia can significantly accelerate reduction in serum bilirubin levels.
2. Phenobarbital was safe, tolerable and no obvious adverse effects had been reported.
3. No need for cessation of breast feeding in cases of presumed breast milk jaundice.

Background: Many cytogenetic abnormalities were detected in CLL, one of them. Deletion of 13q14 region which is found in more than 50% of CLL patient. 13q deletion is the most common cytogenetic abnormality detected by fluorescence in situ hybridization (FISH) and has historically been associated with good prognosis. During the last years, several studies have revealed some insights in the candidate genes located at 13 q that could be responsible for CLL pathogenesis,as well as in the prognostic heterogeneity of 13q- deleted patients.
Aim of the study: evaluation of the prognostic value of 13q chromosome deletion in patients with CLL in correlation to complete blood picture, absolute lymphocyte count, prolymphocyte count and modified Rai staging.
Patients and method: This cross-sectional study was conducted on thirty adult with newly diagnosed and Denovo B-CLL patients tested for the expression of 13q deletion using Fluorescence Insitu Hybridization, from March 2018 to July 2018 and the diagnosis was document on the morphology and immunephenotyping of the peripheral blood sample using a four-color flow cytometer in the Nursing Home Hospital / flow cytometry department of the Medical City in Baghdad.
Results: XL DLEU/LAMP (13q14 deletion) was seen in 7 (23.3 %). 13q14 deletion was not significantly correlated to age, gender, splenomegaly, lymphadenopathy or hepatomegaly. There was highly significant difference in mean Hb between CLL patients with positive 13q14 deletion and those with no deletion (P = 0.001), being higher in patients with positive 13q14 deletion than those without deletion, 12.96 ± 1.41 g/dl versus 10.14 ±1.74 g/dl, respectively. In addition, all CLL patients with positive 13q14 deletion were free of anemia, whereas anemia (Hb < 11 g/dl) was seen in 17 (73.9 %) of patients with no deletion; the variation in 13q14 deletion according to anemia was highly significant (P = 0.001).
Conclusion: indirectly, one can suppose that chromosome 13q.14 deletion carry good prognosis in CLL patients; however, it appears better to link such deletion to survival rate in order to get better idea about its prognostic significance.

Cancer of the ovary is one of the most common types of women cancer in the world. In Iraq, it is seventh cancer in Iraqi women. Nanomedicine emerged as a possible alternative for cancer therapy. Many nanoparticles have been tested on different cancer cell lines with promising results. Gold nanoparticles (AuNPs) showed interesting biocompatibility properties such as selective accumulation in tumor cells. The currentwork was aimed to study cytotoxicity and cell death induced by AuNPson ovarian cancer cells. Methods: Cytotoxicity of AuNPs was assessed by MTT viability assay. Results: AuNPs nanoparticles from 25 up to 100 µg/mL for 72 hours exerted concentration-dependent cytotoxicity. Conclusion: Gold nanoparticles induce cytotoxicity in ovarian cancer cells and Induce cell death and considered promising as cancer therapy.

Background: Hypotension may accompany cystoscopy during spinal anesthesia for which a variety of measures have been considered and none of which has accepted wide agreement. For that reason the present study was conducted.

Aim of the study: The objective was to study the changes in blood pressure during cystoscopy under spinal anesthesia in two groups of patients, one on ephedrine and the other on phenylephrin.
Patients and Methods: 100 patients were randomly assigned to two equal groups (n = 50). Randomization was done according to surgery list. Group 1 received ephedrine while group 2 received phenylephrine.
Results: Regarding systolic blood pressure, there was no significant difference in mean systolic blood pressure at baseline reading (P> 0.05); however, it was significantly higher in group 2 than in group 2 during follow up. Regarding diastolic blood pressure, there was no significant difference in mean diastolic blood pressure at baseline reading (P> 0.05); however, it was significantly higher in group 2 than in group 1 during follow up (P< 0.05). Regarding heart rate, there was no significant difference in mean heart rate at baseline reading (P> 0.05); however, it was significantly lower in group 2 than in group 1 during follow up (P< 0.05).
Conclusion: Phenylephrine is better than ephedrine in controlling hypotension after spinal anesthesia in cystoscopy.

Abstract
Objective
To evaluate the frequency of maternal complications during spinal anesthesia and within 48 hour post C/S .

Patients and Methods :-
The Study was conducted in the department of gynecology in AL-Zahra'a Teaching Hospital . The Study comprised of 300 patients who underwent caesarean section under spinal anesthesia alone or with use of assisted drugs for sedation during induction of spinal anesthesia .
Patients were followed within 48hre post – operative to see any complication which were documented .

Result
48.33% (n = 145) were between 17 – 25 years , 27% (n = 81) were between 26 – 30 y . Regarding mode of admission 61.33% (n = 184) booked while 38.67% (n = 116) were unbooked . parity distribution revealed 65% (n = 195) multigravida and 35% (n = 105) primigravida .
35% (n = 105) suffered from hypotension (Intra – operatively) 15.33% (n = 46) from hypotension (post operatively) .
Other complication occur shortly after operation include , headache 11% (n = 33) , shiveriy 7% (n = 21) , Backache 4% (n = 12) , Bradycardia 2.33% (n = 7) and urinary retention 2% (n = 6) .
However , 38 , 67% (n = 116) had no complication of spinal anaesthesia .
Conclusion
Spinal anaesthesiaconveyssignificant advantages due to the simplicity of its use and rapid onset of action.

Background : PCOS is associated with anovalation and a common cause of infertility affecting 4-6 % women in reproductive age , Clomiphene citrate has traditionally used as a drug of choice in treating women with anovulatory PCOS , in the last decade letrozole , an aromatase inhibitor has emerged as an alternative ovulation induction agent .
Objective : to compare letrozole and clomiphene citrate as an ovulation induction drug in infertile PCOS women .
study design : prospective study .
Patient and method : PCOS women were treated randomly with 5mg letrozole or 100mg clomiphene citrate day 2 to day 6 menstrual cycle .
Main outcome : ovulation rate , mono or multi follicular rate , days to ovulation , endometrial thickness , serum estrogen and pregnancy rate .
Results: there is statistically significant LH and prolactin levels were significantly higher in Letrozole group but still within normal levels, and letrozole group was higher in number of responsive when compared with CC group but still not significant .
In letrozole group the number of monofollicle cycle was higher (69.57%) and multifollicles cycle was low (30.43%) when are comparing with that of CC group.
Conclusion:
Letrozole in patients with PCOS is as effective as Clomiphene citrate in inducing ovulation , ovulation rate and the incidence of pregnancy was higher with letrozole than that with Clomiphene citrate.
Apart from that, Letrozole treatment is prone to a production of monofollicles and hence leads to reduced incidences of the adverse pregnancy outcome of multiple fetuses as compared to treatment with Clomiphene citrate.
Aim of the study
This is prospective randomized central trial drugs study was carried out to compare the effects of 5mg of letrozole with 100mg CC as ovulation induction drug in treatment of sub fertile PCOS women.

Objectives: The current evaluating study was launched to assess endometrial thickness (ET), follicular growth (FG), and serum estradiol (SE) levels in spontaneous (fertile) vs induced (infertile) cycles via clomiphene or gonadotropin.
Patients and methods: The work included two groups; a study group (SG) and a control group (CG). The SG contained 196 patients who suffered infertility and was divided into two subgroups according to the treatment that the patients received, clomiphene (SGC) or gonadotrophin (SGG). The CG included 130 healthy, fertile, individuals who received no treatment. Transvaginal ultrasonography (TVU) was used to evaluate the treatment effects on the ET and FG plus ovulation. The SE levels of the group members were measured using a competitive radioimmunoassay (CRIA).
Results:A trilaminar endometrium was ultrasonically recognized in the SGC and the CGshowing three hyper-echogenic lines with inner hypo-echogenic regions. ET was significantly (p˂0.05)reduced in the SGCwhen compared with that in the CG.The follicular diameter (FD) was significantly (p˂0.05) larger in the SGs than that in the CG. However, the FD significantly (p˂0.05) increased in the SGG in comparison to that in the CG. The SE levels were significantly (p˂0.05) higher during the mid of the cycle in the SGs than those in the CG.
Conclusion: The assessed effects of the clomiphene or gonadotropin on the endometrial features, ovulation, and serum estradiol levels provide significant prognostic information regarding the use of those treatments in infertile women.

Abstract
Introduction
Pre-marital Screening (PMS) is define as a group of tests in which couples that are going to get married are tested for common genetic blood disorders. Hemoglobinopathies are predominantly single-gene autosomal recessive disorders passed down through families (inherited) that result in reduction in the synthesis of structurally normal globin (β-thalassemia) or a production of structurally abnormal hemoglobin variants.
Method
A record base cross sectional study enroll data of 19657 individuals that attendant centers of pre marriage screening in AL Diwanyia general hospital in Diwanyia governorate from January to December 2018.

Result
These study enroll 19657 partner attendant premarital screening centers. Mean age for women 23±5.6 years and for men 29±8.2.forty two percent of attendants examination were occurred in AL Diwanyia general hospital, 21% in Hamza general hospital, 22% of them in Shamia general hospital and 15% in Afaq general hospital
Conclusion
The benefit from encouragement the screening for heamoglobinopathies in premarital screening program not get till now.

Background: Laryngoscopy and endotracheal intubation are an integral part of general anesthesia for surgerical procedures. The hemodynamic response to the stress of laryngoscopy and endotracheal intubation does not present a problem for most patients. However, cardiac patients are more prone to develop hemodynamic instability on induction of anesthesia and endotracheal intubation and frequently respond to stress with an increase of blood pressure and heart rate. Melatonin has been suggested to attenuate such hemodynamic response.
Objective: The objective was to study the changes in blood pressure and heart rate during endotracheal intubation in patients undergoing general anesthesia in two groups (melatonin versus control).
Patients and Methods: Sixty patients were randomly assigned to two equal groups (n = 30). Group C (control group) received two placebo tablets 120 min before surgery. Group M (melatonin group) received oral melatonin tablets 6 mg (two tablets of 3 mg each), administered 120 min before surgery.
Results: Regarding systolic blood pressure ,diastolic blood pressure and heart rate there was no significant difference at baseline reading (P > 0.05); however, it was significantly lower in study group than in control group before and after induction of anesthesia and also at time of endotracheal intubation and 5 and 10 minutes after intubation (P < 0.001).
Conclusion: Melatonin is an effective drug to attenuate hemodynamic response to endotracheal intubation in patients undergoing general anesthesia.

Objective: The study aimed principally to evaluate the feasibility and accuracy of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of breast lumps by comparing the results with the histopathological diagnosis .
Methodology : data were pros-pectively collected from 103 female patients . All patients had palpable breast lumps for whom initially aspiration cytology of the lump has been done followed by partial or total surgical lump excision for final histopathological diagnosis and to compare the results .
Results : Of all FNAC specimens , 98 (95%) were adequate for cytological interpretation . Of those evaluated cytologically, 62 (62.8%) were benign, 9 (9%) were suspicious for malignancy and 27 (27.5%) were malignant . Of the surgical histopathological specimens , 40 (40.8%) were malignant.
Conclusion : The FNAC procedure is a rapid method, easy to perform, of little cost and easily accepted by the patients and it provides a high specificity and quite reasonable sensitivity rates that can be used for rapid diagnosis and screening .
Recommendation: FNAC results are better explained taking in mind the clinical finding and imaging technique to givethe best management for the patient and is better to be used with ultrasound guidance for better and adequate aspirates .

The study included collection of (70) blood samples of adults patients with Bacteremia and both Sex and different ages at the Imam AL-Hussain Teaching Hospital in the holy city of Kerbala, , the results showed of bacterial culture on media of MacConkey Agar , blood agar , diagnostic, Biochemical tests and confirmed the diagnosis using of Api20E , that 12 isolates belonging to bacteria Klebsiella pneumoniae. The results of the investigation of some of the virulence factors of K. pneumoniae showed that all isolates were surrounded by capsule ,and uncapable of producing Haemolycin enzyme while showed all isolates their ability to produce Urease enzyme and production Biofilm . Nine isolates (75%) showed ability to β-Lactamase enzyme ,The study also includes the qualitative detection of some active groups in Cinnamomum zeylanicun aqueous extract, The results showed that it is contained the Glycosides, Tannins, Resins, Saponins, and phenols, and is not containing alkaloids and Flavones .and it has pH (6.5). The Minimum Inhibitory Concentration (MIC ) was determined Cinnamomum zeylanicun aqueous extract (6.25) mg / ml for the bacterial isolates used, The results showed that the different concentrations of the Cinnamomum zeylanicun aqueous extract showed a variation in the diameters. The concentration was 50 mg / ml the highest diameter was 33mm and the lowest diameter was 25 mm. The concentration (25 mg / ml) the highest diameter was 30 mm and the lowest diameter was18 mm. The concentration (12.5 mg / ml) had the highest diameter inhibition of 28 mm and the least diameter of inhibition of 16 mm, the concentration of (6.25 mg / ml) had reached the diameter of the inhibition of 25 mm and less diameter of inhibition 12 mm ,compared to the control factor containing sterile distilled water. The results were compared with the most used antibiotics, and through the results Cinnamomum zeylanicun aqueous extract showed a high inhibitory effect compared to the antibiotics used in the study.

Objectives:the aim of this study was todetect whether routine stripping of the complications of varicose vein surgeryand the ways to prevent them.
Design:Randomized controlled trial. All operations done by a consultant vascular surgeon. Five year follow-up.
Materials and methods: The study was designed as a 5-year, clinical and duplex scan follow-up examination of a group of patients who undergo varicose vein surgery and their post-operativecomplications. The study was conducted in the vascular unit of imam Hussein medical city. Two hundred ninety six patients (317 legs) with varicose veins were randomized, and their complications was analyzed with the ways to prevent them from occurring in the future.
Results:Two hundredninety six patients,317 legs undergoing varicose vein surgery stripping and avulsion,204 female and 92 male,the results two major complications one case amputated leg and the other deep vein thrombosis with 10 minor complications including (36.82%)hematoma,(4.05%) skinecchymosis,(6.4%)wound infection,(2.03%)wound dehiscence,(10.47%)parasthesia,(2.7%)recurrence,(4.7%)persistent pain,(1.01%) leg swelling and (7.4%) Complications of spinal anesthesia.
Conclusion:although the varicose vein surgery is safe with minor complications but major complications can occur and may lead to loss of limb or life.so it is important to take a big carful when to do it specially in dealing with saphenofemoral and saphenopopliteal junctions.