Al-Qadisiyah Medical Journal

Abstract
Background: Retinal vein occlusion is the second most common cause of sudden vision loss from retinal vascular diseases, following diabetic retinopathy. The role of vitamin D in maintaining the vascular system is now being increasingly understood and the effect of Vitamin D deficiency on vascular endothelium could possibly have some role to play in the causation of retinal vein occlusion.
Objective:To estimate serum vitamin D3 (25 OH D) level in patients of retinal vein occlusion and compare it with age and gender -matched controls.
Subject and methods: This study is a hospital-based, case-control study conducted between October 2017 and February 2018 and included 35 cases of retinal venous occlusion (14 cases of branch retinal vein occlusion and 21 cases of central retinal vein occlusion, no cases of hemiretinal venous occlusion) with onset less than three months were enrolled. These cases were compared with 35 age and gender matched attendants of patients as controls, as they had comparable dietary and socioeconomic condition. Serum vitamin D3 (25 OH D) was done for cases and control group. Student’s t test was used to assess the significance of differences in mean vitamin D levels, while chi square test was used to assess the significance of association and comparison of frequencies in categorical variables. Level of significance of ≤ 0.05 considered as cutoff for significant difference or association.
Results: the mean serum vitamin D level was significantly lower in retinal vein occlusion group than controls, (14.21 ± 5.19) ng/ml and (22.70 ± 4.43) ng/ml, respectively, on the other hand, vitamin D level in these cases ranged (7 – 25.80) ng/ml which was also lower than that in controls (range: 14.89 – 33.60)ng/ml, the difference in mean vitamin D level between groups was highly significant (P< 0.001).There was no statistical difference in serum vitamin D between branch and central retinal vein occlusion (P. value 0.34 ).
Conclusion: Vitamin D deficiency was more common in patients with retinal vein occlusion in realtion to healthy population.

Abstract
Background:
Despite optimal therapy of patients with B- thalassemia major included regular blood transfusion program and iron chalation agents helped by increasing survival of these patients but remained major problem in adolescent of these patients such as growth failure and hypogonadisim.
Aim of study: To determine the association between iron over load and tanner stage retardation among female patients with B- thalassemia major in Thalassemia center of Diwaniyah maternity and children teaching Hospital.
Methods: The current study was carried out on all female patients diagnosed β-thalassemia major on the base of the blood investigations (peripheral blood counts and hemoglobin electrophoresis),with their age range from 13years to 16 years who registered in Thalassemia center of Diwaniyah maternity and children teaching hospital in Al- Diwaniyah Governorate, Republic of Iraq. The Data collection was carried out during the period from the 1st of April of 2016 to 30th of December of 2016. They were studied for determining the association between iron over load and tanner stage retardation among female patients with B- thalassemia major.
The following data were collected from the patients:
Name, age, address ,age of diagnosis of thalassemia, number of blood transfusion per year, types of chelating agent.
In the physical examination, the patients were assessed for weight, height, Tanner stages and body mass index(BMI) which recorded.
S. Ferritin value was used to assess iron load, pelvic ultrasound was checked to assess the size of uterus and both ovaries.
Results: Total numbers of B- thalassemia major female patients are 31 patient, aged 13-16 years (mean age: 14.13 ±1.20) . Age of patients at time of diagnosis of B- thalassemia major range from 0.17 to 5 year with Mean ± SD(1.40 ±1.30). Frequency of Blood transfusion (time/Year) range from 6 to 33 time/Year with Mean ± SD(16.68 ±4.98). Level of serum ferritin of the patients was ranged from 913-12000 ng/ml with Mean ± SD (4963.60 ±3580.39).
Tanner stage I was predominant accounting for 87% whereas stage II and III accounted for 10% and 3% respectively. There was no significant correlation between Tanner stage and age of patient and also no significant correlation with age at time of diagnosis (P>0.05). There was a significant negative correlation between frequency of blood transfusion and Tanner (r=-0.385, P= 0.045), so that the higher the frequency of transfusion, the lower the tanner stage is. No correlation was found between the dose of chelating agent and Tanner stage (P=0.599). Height and weight of patients were significantly correlated with Tanner stage (P=0.028 and P=0.007, respectively). No significant correlation was found between serum ferritin and Tanner stage (P=0.444). There was a significant correlation between Uterus size, ovarian size and Tanner stage (P=0.007and P=0.007, respectively).
Conclusion: These results showed that no significant correlation between tanner stages retardation and iron overload in female patients with β-thalassemia major measured by serum ferritin. Because of inflammation falsely increase serum ferritin or because of the relationship between body iron and level of serum ferritin is not always within the linear range especially in condition of inflammation or tissue damage. So that serum ferritin level is not a reliable indicator of total body iron stores in patients with thalassemia major, therefore; we needed another indicator to measure total body iron stores in patients with thalassemia major such as the liver iron concentration.

New-onset seizures represent the most common neurologic emergency of childhood, with approximately44 per 1000 of children and adolescent in under developed countries ( age 1day to 16 years old) presenting for evaluation of a newly occurring seizure disorder. The study aim to find the role of computed tomography and/or magnetic resonance imaging in children with seizure. Cross sectional study will be conducting in AL-Hilla Teaching hospital from period 1st of November 2018 to1st of July 2019, will be enrolling infants and children with new onset seizure( age 1 day to 16 years) to investigate brain imaging abnormalities in these patients by computed tomography and magnetic resonance imaging.
The study enrolled 50 patients presented with first attack of epilepsy. The mean age of patient was 11± 4.2 years with range 1 day – 16 years. My study reveal kinds of abnormality that seen by images modalities,16% of patients had congenital anomaly, 2% had gliosis, 4% genetic disorder, 2% had arteriovenous malformation, and 2% had brain tumor. MRI is the beneficial to evaluate the structural defect in brain that cause seizure and also give an idea to some extent need to surgical interference.While computed tomography is a good choice in emergency department.
Key words: Magnetic Resonance Imagining; Computed Tomography; Diffusion Weight Image; Apparent diffusion coefficient.

Anatomical variations in olfactory fossa depth and anterior ethmoid arteries (AEAs) course are of great importance during functional endoscopic sinus surgery (FESS) as they may result in iatrogenic damages thus surgical planning is tailored with the aid of a CT scan preoperatively. This study was conducted to assess the olfactory fossae depth according to Keros classification and to localize the course of AEAs in Iraqi patients using computerized tomography, a probable relationship between olfactory fossae depth and AEA location was assessed. A cross-sectional observational study involved 189 adult patients (99 females and 90 males) referred to our radiology department for evaluation of paranasal sinus. Patients were examined by the same CT device, excluding those with altered anatomy due to trauma, aggressive inflammation, or tumor and those less than 18 years old. The depth of the olfactory fossae was categorized according to Keros classification, and the location of the AEA was then determined.
The olfactory fossa depth ranged from 0.8 to 9.1 mm. Keros type II was the most common (72.8 % & 77.8 %) of male and female patients, respectively, without statistically significant gender difference. The AEA location was asymmetric in 48.7%. A significant correlation was found between AEA running beneath the skull and higher Keros type. About two-thirds of the studied Iraqi adult population showed asymmetric olfactory fossa depth with nearly half of AEA running below the skull base; therefore, Iraqi radiologists and Ear–Nose–Throat surgeons should be aware of this anatomical variation to avoid serious surgical complications.

BACKGROUND: Chronic lymphocytic leukemia a proliferative clinical heterogenic disease had shown a variable clinical course, so it is important to categorize the heterogeneity by development of clinical, genetic and biological parameters and to evaluate the prognosis of the patients with CLL.
OBJECTIVE: To evaluate the expression of CD49d in CLL patients, correlates them with Modified Rai staging system and find the significance of CD49d immunohistochemical expression in bone marrow biopsy as a prognostic marker.
PATIENTS AND METHODS: This is an analytic study conducted on sixty four formalin fixed paraffin embedded blocks of chronic lymphocytic leukemia cases collected from teaching laboratories of medical city in Baghdad, during November 2018 to June 2019. Bone marrow biopsy sections have been regularly processed and examined by a light microscope using immunohistochemical stain for CD49d, by using EnVision+ systems method.
RESULTS: Lymphadenopathy and splenomegaly were the main clinical findings, followed by hepatomegaly and pallor. Leukocytosis, absolute lymphocytosis and anemia, were primary laboratory results. Most of cases were within the intermediate risk group (51.6%) by applying modified Rai staging system. CD49d expression was detected in 43.75% our study has been revealed that there was no statistical association between CD49d expression and the clinical stage of the disease using Modified Rai system (P= 0.072). Furthermore, there was no statistical association between CD49d expression and clinical findings, and hematological parameter including Hb, PCV%, platelets, total white blood cell count and lymphocyte % in peripheral blood, while there was statistical association between CD49d expression and lymphocyte % in bone marrow (p=0.014). Also there was no statistical association between CD49d expression and bone marrow histological lymphocytes involvement.

Background: Recently the issue of individual variability in response to pharmacological agents in a variety of medical condition has been extensively discussed in published medical articles. Metoprolol is one of the major pharmacological agents used to control cardiovascular events by cardiologist and tailoring the dose of the drug according to patients has been suggested by significant number of authors in order to get optimum response based on gene polymorphism studies.
Aim of the study: To assess the role of pharmacogenomics in predicting metoprolol response in patients with cardiovascular disease.
Materials and methods: The current review was done in College of Medicine/ University of Al-Qadisiyah and involved the search in the Google search engine about the following key words: pharmacogenomics, heart failure, metoprolol. The studies that were published with this respect during the last 20 years were enrolled. Any article dealing with use of metoprolol for other indications other than heart failure was excluded.
Results: One previous meta-analysis has shown that “CYP2D6 PM have a greater reduction in HR compared to non‐PM by >3 beats/min when treated with metoprolol”. It is suggested that greater risk of bradycardia is expected in PM individuals. The clinical advantages of lowering resting heart rate have also been shown following post-myocardial infarction intervention, particularly when beta-blockers have been used.
Conclusion: individualization of the dose o metoprolol is required because response of the patients varies considerably based on gene polymorphism in a number of genes.