Muthanna Medical Journal

C-reactive protein (CRP) is an acute phase protein synthesized by hepatocytes. In response to infection or tissue inflammation, CRP production is rapidly stimulated by cytokines, particularly interleukin (IL)-6, IL-1 and tumor necrosis factor. The aim of the present study is to evaluate the prognostic value of CRP levels at admission as an indicator of the severity or complication of CAP. Fifty patients with primary diagnosis of community-acquired pneumonia during March 2013 to February 2014. A 25 patients were males and 25 females. The CRP measured by CRP-latex Slide agglutination method. Also patient underwent chest-x ray and patients were categorized into patients with CRP ≥ 100 mg/L and CRP < 100 mg/L22, and the complications (pleural effusion and lung abscess) were correlated to possible risk factors (HT, DM) and smoking. There is a significant increase in complication of CAP in patients with high CRP level (CRP ≥ 100 mg/L) ,so that CRP is highly sensitive, specific and accurate test to predict complication in CAP. The CRP affected by gender (female), age and diabetes mellitus in patient with CAP. There is no significant correlations between CRP level and smoking and hypertension in patient with CAP.

Multidrug-resistant tuberculosis (MDR-TB) is a global problem that many countries are
challenged with. Rapid and accurate detection of MDR-TB is critical for appropriate treatment
and controlling of TB. the aims of study at using Polymerase Chain Reaction for detection of
multidrug-resistant Tuberculosis from cultured samples A total of 30 M. tuberculosis isolates
from cases with diagnosed TB by GeneXpert, AFB and Culture on L. J media after incubation
period from 3-8 weeks, DNA extraction from bacteria colonies. Resistant isolates were tested
for characterization of mutations in the rpoB, KatG InhA1 and IhA2 genes by Real Time PCR .
The results of the real time PCR showed that mutations of genes (rpoB, katG, inhA1 and
inhA2) that were responsible for resistance to rifampicin and isoniazid. The test showed
positive results for resistance genes (20%, 10%, 6.6%, 10% Respectively) as well as note that
the values of Ct for this test ranged from (12-38.25), and the melting points of the genes were
between (85-88.5 Co). Real time PCR results identified three mutations of MDR (rifampicin
and isoniazid) resistance genes, whereas there was one MDR mutation of molecular
diagnostic results with the GeneXpert MTB/RIF test for rifampicin. When comparing the results
of the Real time PCR and GeneXpert tests at the level of the genetic mutation with rifampicin,
the real time PCR test showed four resistance mutations for the rpoB gene for both new cases
and relapse tuberculosis as well as one rpoB mutant for under treatment patient. Both
molecular tests have agreed to identify one rpoB mutant in the case of failure TB treatment.

The vaporizer based on specific saturated vapor pressure for each inhalation anesthetic agent. The purpose this study is to determine the precise corresponding sevoflurane concentrations when halothane vaporizer is used for supplying it. This study is carried out by using a mathematical equation based on the difference in saturated vapor pressure, splitting ratio of halothane and sevoflurane at different delivered concentration dial of halothane vaporizer. The data of this study provides a comparative table that help to use halothane vaporizer to provide a precise known delivered sevoflurane concentration. The results concluded that halothane vaporizer is suitable to deliver sevoflurane concentrations (up to 347) that can be used for maintaining general anesthesia.

The aim of this study is to present a new technique in surgical management, we called it MELT
(multiple encircling ligatures around intersphincteric tract of fistula). The study was done
between April 2012 to April 2015 and includes all patients with complex high transphincteric
and recurrent fistulas. Study includes all age groups and both genders. Operative details are
recorded and compared with other well-known procedures. Post-operative outcomes were
analyzed. Out of 56 cases, 41 were males (69%) and 17 were females (31%), with mean age
group of 38 years. 10 (18%) cases are recurrent complex fistulas and the rest are high
transphincteric type around anorectal ring. Recurrence recorded in 5 cases (9%), mild
incontinence reported in 6 cases (11%), no major incontinence occurred, 2 cases of mild
bleeding and two cases of post-operative urine retention during 18 months of post-operative
follow up. We concluded that our technical easier with relatively lower complication rates in
comparison with other well-known surgical operations for fistula-in-ano.

Surgical scrubbing with antibacterial solutions is an important step in surgical operations to reduce the incidence of surgical site infection. The aim of study is to evaluated superiority of one of three surgical scrubbing solutions commonly used (povidone iodine, chlorhexidine and aqueous alcohol) by studying their antibacterial action on the skin of the hands of the operating personale. Ninety hands of surgeons, assistants and nurses were included in this study at Al Kindy Teaching Hospital from 1 June, 2011 to 1 Feb, 2012. Divided into three groups each with 30 hands according to the antiseptic solution used for scrubbing (chlorhexidine ( group 1); povidone iodine (group 2) and ethanol alcohol (group 3), hand prints were cultured as a baseline, immediately and 30 minutes after scrubbing for both gram +ve and gram –ve bacteria and a total of 540 culture medias were studied. In our study Staphylococcus aureus was the only gram positive transient bacteria found in the culture medias with a baseline ranged (0-5) colonies in group 1, (0-5) colonies in group 2 and (0-7) colonies in group 3 and all were removed immediately after scrubbing with all antiseptic solutions. Staphylococcus epidermidis was the only residents bacteria found in all the hands with a baseline ranged (10-60) colonies in group 1, (12-62) colonies in group 2 and (10-56) colonies in group 3. This bacterium was reduced to low levels immediately after scrubbing with all antiseptic solutions and completely removed after 30 min in group 2, 3 and reduced to lowest level in group 1. Gram –ve bacteria was not found in the entire three groups. In addition to that, fungi were found in all our study groups in a range of (0-7) colonies in groups 1, (0-8) colonies in group 2 and (0-8) colonies in group 3 and all of them were removed by scrubbing with all antiseptic solutions. We concluded that Povidone iodine was more effective in eradicating or reducing of both gram +ve resident and transient bacteria and fungi.