Al-Kindy College Medical Journal

Background:The document on hypertension in the elderly promoted by the American college of cardiology and the American heart association (ACCF/AHA) was written with the intent to be a complete reference at the time of publication on the topic of managing hypertension in the elderly. More recently, the European society of hypertension (ESH) and the European society of cardiology (ESC) issued the 2013 ESH/ESC Guidelines for the management of arterial hypertension, followed by The 2014 Canadian Hypertension Education Program (CHPE), and the Eighth Report of the Joint National Committee (JNC8), all of which has endorsed specific recommendations for the management of elderly hypertensive patients.

Cesarean section, which was introduced into clinical practice as a lifesaving procedure for both the mother and the baby, is one of the most common surgeries performed in modern obstetrics. Formerly it was performed in interest of the mother; currently it is frequently done for fetal indication. As other procedures of some complexity, its use follows the health care inequity pattern of the world; underuse in low income setting, and adequate or even unnecessary use in middle and high income setting (1).
The first modern cesarean section was performed by German gynecologist Ferdinand Adolf Kehrer in 1881. Cesarean section is often performed when a vaginal delivery would put the baby's or mother's life or health at risk. Many are also performed upon request (2).
Pregnancy and delivery are considered a normal physiological state in women; however, of all deliveries approximately 10% are considered high risk, some of which may require Cesarean section (3).
The cesarean delivery rate has increased throughout the world. Cesarean rates have increased over the past 40 years from approximately 5% to more than 30% in many industrialized countries (4). The cesarean rate is approximately 21.1% for the most developed regions of the globe, 14.3% for the less developed regions, and 2% for the least developed regions (5).
Recent studies reaffirm earlier recommendations of the world health organization (WHO), about optimal C-section rates, addressing that the best outcomes of mothers and babies appear to occur with C-section rates of 5% to 10%, while rates above 15% seem to do more harm than good (6).
In US the cesarean rate increased dramatically during the 1970s and early 1980s this may be accredited to the improved technology in detecting pre-birth distress, and began to decline in the late 1980s (based on data from the National Hospital Discharge Survey). Between 1989 and 1996 the total cesarean rate decreased as a result of a decrease in the primary rate and an increase in the rate of vaginal birth after Cesarean (VBAC). Since 1996, these trends have reversed, and increases have been rapid and sustained for primary and repeat Cesareans over the past decade (7).
According to the Iraq Multiple Indicator Cluster Survey 2006 (Iraq MICS 2006) (8), about 20% of births were delivered by C-section (Table 1). Moreover, a brief and rapid survey of C-sections in Baghdad Teaching Hospital, a tertiary referral hospital, indicated that the emergency C-sections account only for 62.2% of the total number of C-sections performed outside the working hours during April 2010 (9).

Background .To know the incidence of adenoid hypertrophy in adults causing nasal obstruction and other nasal complains.
Methods.Prospective studyof(140 ) adult patientstheir main chief complaint were nasal obstruction , presented to Otolaryngology department at Aljumhory Teaching Hospital in Mosul , from the period (september 2010 to september 2011) ,their age ranged from (21 to 53) years . They were investigated clinically, radiologicaly ,and nasal endoscopic examination was carried out (rigid and fibro-optic ) . Adenoidectomy was performed for those with adenoid hypertrophy and sent for histopathological study .
Results:. we found adenoid enlargement in(24) patients (17.14%),in addition to nasalobstruction they were also complaining of Post nasal discharge (19) patients, followed by snoring (17) patients , headache and facial pain (15) patients, deafness and tinnitus (8) patients and other rhinologicalsymtoms. The patients were followed up for a period ranged from (4 -16) months. We found that (91.6%) were relieved of their nasal obstruction, (82.3%) were relieved from snoring .
Other nasal symptoms ; post nasal discharge, headache and facial pain, sore throat and tonsillitis, deafness , tinnitus ,rhinorrhia, Rhinolaliaclausa, otalgia were improved in (68.4% - 50%).
Conclusions:Nasal obstruction ,snoring ,post-nasal discharge ,and aural symptoms were often caused by adenoid enlargements in adults .
Because the examination of the nasopharynx was inadequate ,many cases of enlarged adenoid were misdiagnosed. Adenoid enlargements in adults should always borne in mind as a cause of nasal obstruction and other rhinological symptoms. Nasal endoscopic examination including the nasopharynx should be done for proper diagnosis.

Background: Differentiation between malignant and benign vertebral compression fracture is often problematic. This is precisely difficult in elderly who are predisposed to benign compression caused by osteoporosis .Establishing correct diagnosis is of great importance in determining the treatment andprognosis.A study was performed to determine which magnetic resonance imaging findings are useful in discrimination between metastatic and acute osteoporotic compression fractures of the spine. Recently MRI is being increasingly used for evaluation of these fractures.Objectives: The aim of this study is to establish the correct diagnosis of malignant and benign compression vertebral fracture by MRI to determine treatment and prognosis.Methods: MRI of (45 )patients with vertebral compression fracture who underwent MRI of spine during 2 years period ( 2004-2006) in Neuro surgical hospital were retrospectively reviewed by an expedient radiologist , A collapsed vertebra were considered to be acute if there was recent history of back pain of less than 3moths. All MRI sequences needed for spine examination was done( T1WI SE, T2WI GE STIR, and Mylography ) and Gadolinium contrast medium was given to all patients..Results: Of total 45 patients (31male, 14 female, their age range between 18-72years) , The criteria used to differentiate between benign andmalignant collapse spine on MRI was based on the signal intensity, morphology and contrast enhancement for the correct diagnosis. Homogenous and diffuse abnormal signal intensity, posterior convexity and involvement of pedicles are sign that are strongly suggestive of malignant collapse .Conversely, a band like area of low signal intensity adjacent to depressed end plateand preservation of signal intensity of vertebra suggest benign nature of the collapse.Conclusions: We found that MRI features is helpful in differentiation of malignant and benign compression fractures in majority of cases, and if initial MRI finding are equivocal correlation with other images technique, follow up and biopsy in selected cases helpful in arriving correct diagnosis

Background:The most common pattern of dyslipidemia in diabetic patients is increased triglyceride (TG) and decreased HDL cholesterol level, The concentration of LDL cholesterol in diabetic patients is usually not significantly different from non diabetic individuals, Diabetic patients may have elevated levels of non-HDL cholesterol [ LDL+VLDL]. However type 2 diabetic patients typically have apreponderance of smaller ,denser LDL particles which possibly increases atherogenicity even if the absolute concentration of LDL cholesterol is not significantly increased. The Third Adult Treatment Panel of the National Cholesterol Education Program (NCEP III) and the American Heart Association (AHA ) have designate diabetes as a coronary heart disease (CHD) equivalent and recommended treatment of LDL-c to < 2.6 mmoll (<100 mgldl)Objectives: We assessed the treatment ,type and control of dyslipidemia among adults with diabetes mellitus.Methods:This is a prospective study conducted in the Neurosurgical Hospital in Baghdad, Iraq, during the period from January 1999 to January 2001. Any patient admitted during the period of the study with clinical history, signs, symptoms, and contrast enhanced MRI suggesting a cerebral glioma and confirmed by postoperative histopathological results of glioma has been included in this study. While multifocal lesions, long-lasting epilepsy, use of antiepileptic therapy, multiple cranial lesions, previous cranial surgery, any chronic illness, and histopathological result of other tumors were exclusion criteria. All patients were at their first operation for brain tumors. Patients were examined by analyzing several functional domains (intelligence, executive functions, memory, language, praxis, gnosis and mood state) in order to establish the effect of tumor and surgery on cognition.Results:29 patients who fulfilled the selection criteria were included. Mean duration of clinical history was 5 months (range 1–9 months). At baseline, using test- and domain-based criteria, 79% and 38% of patients, respectively, were impaired, the former related to tumor factors such as edema (P <0.05), larger size (P <0.05) and higher grade (P = 0.001). Verbal memory, visuospatial memory and word fluency were the most frequently affected functions, partly associated with depression. Postoperatively, 38% and 55% of patients, respectively, were unchanged, 24% and 21% improved, and 38% and 24% worsened; 24% and 62% of patients were intact, respec¬tively.Conclusions:The extent of removal did not influence the outcome. Improvement involved previously impaired functions and was correlated with high-grade tumors. Worsening regar-ded executive functions was related to tumor size and was partly explained by radiological findings on postoperative MRI. This prospective study, focusing on the effects of tumor and surgery, showed that tumor significantly affects cognitive func¬tions, mainly due to the mass effect and higher grading. Surgical treatment improved the functions most frequently affected preoperatively and caused worsening of execu¬tive functions soon after operation, leaving the overall cognitive burden unchanged and capable of improvement prospectively

Background: Obesity is becoming the healthcare epidemic world wide.Obesity is associated with reduced life expectancy, increased morbidity and mortality, and greater healthcare costs.Bariatric surgery is the only effective treatment for morbid obesity and is gaining increasing popularity. There has been a steady rise in the numbers and types of bariatric operations done worldwide in recent years butnon of prove to be ideal .Animal studies and use of animal models are significant element in the evolution of medical knowledge and the use of animals as a model for bariatric surgery is of importance to study the mechanisms of these operationsa and also help to develop new technique in management of obesity.Objectives:Study of effects of sleeve gastrectomy as bariatric surgery procedures on weight of dietary induced obese rats (DIO).Methods:Eighteen adult rats with diet induced obesity (DIO) divided into two groups, the first (n=9) group exposed to sleeve gasterectomy (SG)under general anesthesia , the second(n=9) is the sham (control) group. Postoperative care of the animals done as required and the weight of the rats were measured weekly for 6 weeks .Results:. Follow up for 6 weeks post-operative . Four rats from SG group were died: two in the first day , second and 6th post operative day .Postmortem done with evidence of gastric leak in two of them. Two sham operated rats were died. The dead rats were cancelled from the study when body weight calculated. Average weight were 425gram and 420gram for SG and Sham respectively before surgery. Both groups experience some weight loss in the first week after surgery while the SG group start losing more weight , while the sham group are starting to maintain its normal weight until the end of the experiment.Conclusions:. Sleeve Gastrectomy as a bariatric procedure are successfully reduce the weight of DIO rats . Development of animal model for bariatric procedure is of great importance to test the effects of different bariatric procedures on the weight, and translate these procedures on human.

Background: Benign Prostate Hypertrophy(BPH)is a common urological problem worldwide which is defined as denomatous hyperplasia of the periurethralpart of prostate gland that occurs especially in men over 50 years old and that tend to obstruct urination by constriction the urethra Objectives: The study was aimed to investigate the level of Malondialdehyde (MDA), Nitric Oxide (NO) and Superoxide Dismutase (SOD) as an antioxidant, besides other factors such as the level of Lipids Profile (Total Chlosterol (TC), High Density Lipoprotein Cholesterol (HDL-C), Low Density Lipoprotein Cholesterol (LDL-C), Very Low Density Lipoprotein Cholesterol (VLDL-C), and Triglyceride (TG))in patients suffer from BPH . Methods: In this study ;clinical ,specific prostate antigen and sonongraphy data of 80 persons were prospectively analyzed ; they are divided into two groups (40) male patients with Benign Prostate Hypertrophy (BPH) was previously diagnosed and another (40) healthy males as a control group .The study was performed at Al-Khadhmyah teaching hospital during the period from March 2001 till April 2003Results: The evaluated data recorded a significant increase in the levels of (MDA) and (NO), while a significant decrease in the level of (SOD) (P  0.001) in patients complain from BPH in comparison with the control group. Moreover, the results showed a significant increase in the levels of (TC), (TG) , (LDL-C) and a significant decrease in the level of (HDL-C) (P  0.001) in comparison with the control groupConclusions: Benign Prostate Hypertrophy (BPH) is the most common benign tumor in men and Malondialdehyde (MDA), Nitric Oxide (NO) ,Superoxide Dismutase and Lipid profile are beneficial markers to evaluate patients with BPH in comparison with those without BPH

Background. Echinococcosis/ hydatitdosis is a zoonotic parasitic disease caused by the infestation of the larval form of the tapeworm of the genus Echinococcus .The Liver, lungs, and kidneys are the common areas of infestation.Objectives: To describe hydatid disease in hospitalized patients from a clinico-epidemiological perspectives.Methods:: A retrospective study was conducted over a period of 6 months extending from 15th of November 2011 to the 15th of May 2012 by reviewing records of 125 patients who were hospitalized at Baghdad Teaching Hospital during 2011and received medical and surgical treatment for hydatid cyst disease. The information covered the socio-demographic and clinical characteristics of the patientsResults:.The present study included 40(32%) males and 85(68%) females. The highest percentage was in the 3rd decade about 32(25.6%). The highest number of patients 87(69.6%), were from Baghdad city, 85(68%) of patients were referred from public departments, 106(85%) of patients had a negative family history for hydatid disease.Majority of patients 109(88%) were symptomatic. Abdominal pain was the most common presenting symptom in 104(95.4%) of symptomatic patients. The liver alone was affected in118 (94.4%) of patients.. The treatment was by medications alone in 125(100%) patients or with addition of surgical treatment 82(65.5%) of patients which was by conservative procedure (partial pericystectomy). The basic investigations needed were complete blood picture (CBP), liver function test( LFT), Ultrasound applied to all patients 125(100)%, chest x-ray CXR 75(60%), computerized tomographyCT 44(35%) while endoscopic retrograde cholangio- pancreatography ERCP was done in only1(0.8%) patientConclusions: Hydatidosis is still an important and persistent health problem in Iraq ,further studies are needed involving multi- hospitals covering all Iraqi governorates .

Background :The incidence of bile ducts injuries( BDI )has risen from) 0.1 to 0.2%( to) 0.4 to 0.6% ( between the era of open cholecystectomy( O C) and the age of laoaroscopic cholycystectomy( LC.) The aim of the study is to review the management and surgical outcome of the bile duct injuries in gastroenterology and hepatology teaching hospital .Methods: This study is Prospective, done in G.I.T hospital ,From January 2008 –to –February 2011, patients included in this study had prevouse history of cholecystectomy which followed by sign and symptoms of bile duct injures .Most patients have been reffered from other hospitals,supprting therapy were given to them and investigations performed to evaluate the the type of injureis ,minor injuries managed conservatively and by using ERCP while major injuries reconstructive surgery done in form of Roux en y bilioenteric anastomosis,All patients followed up for 8 -50 months by doing liver function tests ,abdominal US and MRCP for some patients .Assesment the out come of the patients using Treblanche grading to good,fair and poor Results: The total number of patients are 53 , female were 37 patients (70.5%) 16 patients (29%) were male.The range of age group from 18 -65 years.Average age is 29 years .Patient with minor BDI treated with drainage and ERCP, while 36 patients had major BDI treated by surgical reconstruction by elective manner using a technique Roux en Y (HJ). Follow up done for (8—50 months). (69.4%) have good result, (25%) got fair result and (5.5%) had poor results which mainly occur in E3 and E4 type injuriesConclusions: .If the diagnosis of BDI occurrence is delayed more than 24h , any attempt of primary reconstruction should be avoided and early referral of the patient to a tertiary care centre with experienced hepatobiliary surgeons and skilled interventional radiologists to assure optimal short-term and long-term outcome

Avascular necrosis have always presented great challenges to orthopedic surgeons and patients, remain in many ways today the unsolved dilemma. Varieties of non-vascularized bone grafting techniques preceded by core decompression have been proposed with varying degrees of success. O bb j ee cc t i vv ee ss : The aim of this study is to review the the value of core decompression and non-vascularized tibial bone strip graft treatment for early stages of non-traumatic osteonecrosis stage II & III according to stein burg staging . M ee t hh oo dd ss : prospectively reviewed 26 patients (32 hips) with osteonecrosis of the femoral head between June 2006 and December 2013 at Imam Ali hospital in Sader city & Al-Wasity teaching hospital. Inclusion criteria were all patients ages 19 years to 50 years and in Stein burg stages II and III . Mean follow-up for 3 year. Exclusion criteria were stage I, IV, V and VI .We used Phemister technique to make a window at the posterior aspect of greater trochanter to remove necrotic bone and packed the excavated area with cortico-cancelloustibial bone strip graft. This study was taking into account ethical evaluation and approval by scientific committee of Arab board. R ee ss uu l t ss: The reported results of treatment for femoral head avascular necrosis was (87.6%) success rate of hips in our cohort of patients with core decompression &non-vascularized tibial bone strip C oo nn cc l uu ss i oo nn ss : None vascularized tibial bone graft effectively reduce donor site morbidity and may defer jointarthroplasty in selected patient stein burg staging

Avascular necrosis have always presented great challenges to orthopedic surgeons and patients, remain in many ways today the unsolved dilemma. Varieties of non-vascularized bone grafting techniques preceded by core decompression have been proposed with varying degrees of success. O bb j ee cc t i vv ee ss : The aim of this study is to review the the value of core decompression and non-vascularized tibial bone strip graft treatment for early stages of non-traumatic osteonecrosis stage II & III according to stein burg staging . M ee t hh oo dd ss : prospectively reviewed 26 patients (32 hips) with osteonecrosis of the femoral head between June 2006 and December 2013 at Imam Ali hospital in Sader city & Al-Wasity teaching hospital. Inclusion criteria were all patients ages 19 years to 50 years and in Stein burg stages II and III . Mean follow-up for 3 year. Exclusion criteria were stage I, IV, V and VI .We used Phemister technique to make a window at the posterior aspect of greater trochanter to remove necrotic bone and packed the excavated area with cortico-cancelloustibial bone strip graft. This study was taking into account ethical evaluation and approval by scientific committee of Arab board. R ee ss uu l t ss: The reported results of treatment for femoral head avascular necrosis was (87.6%) success rate of hips in our cohort of patients with core decompression &non-vascularized tibial bone strip C oo nn cc l uu ss i oo nn ss : None vascularized tibial bone graft effectively reduce donor site morbidity and may defer jointarthroplasty in selected patient stein burg staging

Background: Clinicians and investigators consider the normal range of bowel habit and frequency as between 3 to 21 motions per week . Stool frequency out side the normal range may be unusual but may not be abnormal in the sense of a disease . And according to the consistency, the normal stool ranges from porridge like to hard and pellety .Objectives: To establish a basic data about the bowel habits (consistency and frequency) in a sample of healthy Iraqi population; in addition to learn about their definition of constipation and diarrhea.Methods: Prospective study from Jan 2000- Jun 2000 at Al-Yarmouk teaching hospital, Baghdad. Questionnaires were distributed to 950 healthy persons of different age group .The questionnaire included: Detailed history of bowel habit with definitions of constipation and diarrheaResults: Five hundred and eighty eight (588) person responded to the questionnaire:Five hundred and twenty three (523) (94.6.6%) of the respondents had a normal frequency 3-21/week. Four hundred and sixty nine (469) (84.4%) have a doughy (normal) consistency. Most of the respondents who have less frequent stool were females (5.9%), comparable to the predominant male gender in the frequent loose stool group (2%).More than seven percent (7.7%) of the respondents had bleeding per rectum once or more in their life, less than half of them sought the advice of the doctor. Increased “liquidity” was the main definition of diarrhea while “straining” was the main definition of constipation.Conclusions:. This study showed that, most of the studied populations have a rather normal frequency and consistency of stool. Those subjects with less frequent and pellet stool were mainly female compared to more frequent motion number in male gender and frequent increase in the liquidity. Blood was not always an alarming feature to seek for medical advice

Background:This is a prospective study of three children presented to us in the Orbital clinic in AL ShahidGazi Al Hariri Hospital with painless proptosiswith suspension of Hydatid disease.Objectives: : Orbital hydatid disease is a rare lesion accounting for less than 1% of the total lesions of the body (1, 2). Orbital cysts presented as a primary lesion in our study which is rare to have such lesion without involvement of other organs (3). Humans represent the intermediate host where the commonly affected organ are liver and the lung (10-15%) (4). Methods:This is a prospective study of three Children presented to us in the Orbital clinic in Al Shahid Ghazi Alhariri Hospital with painless proptosis with suspension of Hydatid disease, depending on the cultural background and baseline investigation done elsewhere, during the period from Jan. 2012 to Jan. 2013.Results:Three children presented to us with painless proptosis one of them involving the right eyewhile the other two involve the left eye. One of patients male aged only three years while the other two were females aged nine and thirteen years of age. After radiological investigations two of the Children found to have a cystic extraconal lesion in superolateral angle of the orbit while the other one his lesions found in the superomedial angle of the orbit. The first two surgically approached by lateral orbitotomy while the other one by medial orbitotomy trying to avoid rupture of the cysts. After histopathological investigation of the lesions the diagnosis was confirmedasHydatidcyst.conclusions:Hydatid cyst of the Orbit is uncommon disease account for less than 1% of the total orbital lesions of the body.Haydatid disease of the orbit more common on the left side.The most common sites involved in the Orbit are the superolateral and superomedialangle.Haydatid disease of the orbit can present as a primary lesion without evidence of involvement of other part of the body.Haydatid disease of the orbit can present below 7 years of age.Haydatid cyst of the orbit can be removed intact with meticulous dissection

Background: Increasing interest in quality of life (QoL) is the new approach for understanding and improvement of health care. Although there are many studies about quality of life, there is deficiency of data about quality of life of peoples survived from terroristic explosions.Objectives: To study the QoL for peoples survived from terroristic explosions and compare it with that of a controlled people. Methods: This study was conducted between, 1st of July till 31st of December 2013. The sample of this study was collected from peoples attending the outpatient clinics in four primary health care centers, Baghdad city (2 from Rusafa and 2 from Karkh). 183 individuals proved to be exposed to terroristic explosion and 199 individual not exposed to such event were recruited and Arabic version of the World Health Organization (WHO) self-reporting questionnaire (WHO-QoL-BRIEF) was used to assess the QoL.Results: This study revealed that peoples exposed to event of terroristic explosion show a serious defect in all domains of QoL (physical, psychological, social and environmental) as compared with that for non exposed peoples to such accidents in the same areas of the study.Conclusions: This study showed that peoples survived from terroristic explosions have a low QoL indicators as compared with those not exposed to such trauma

B aa cc kk gg r oo uu nn dd : Very low birth weight (VLBW) neonates constitute approximately 4–7 percent of all live births and their mortality is very high. O bb j ee cc t i vv ee: to find out if there is a relationship between Very Low Birth Weight Neonates and increased neonatal mortality for age 0 to 7 days. M ee t hh oo dd ss A retrospective study of VLBW neonates admitted to NICU at Ibn Al- Baladi Pediatrics and Maternity hospital over one year (2012)were studied, study period was from April till August 2013. Exclusion criteria were: (1) neonates weighing less than 700 g and with gestational age less than 24 weeks (abortion) (2) death in the delivery room (3) neonates weighing more than 1500 g. (4) Postnatal age more than 7 days. The outcome measure was in-hospital death. Medical records were reviewed and data were analyzed. Results being considered as statistically significant when the P value was≤0.05.
R ee ss uu l t A total of 150 cases of very low birth weight (VLBW) neonates were enrolled, of which a total of 69 (46 %) babies died. The survival rate was found to increase with the increase in birth weight and gestational age (P value was highly significant). There is no relation between gender, postnatal age, mode of delivery and social class with number of death. Respiratory distress, gestational age, neonatal septicaemia are the factors directly responsible for neonatal mortality. Premature rupture of membranes (PROM), multiple pregnancy and Young mothers were the most common maternal risk factors associated with death in VLBW. C oo nn cc l uu ss i oo nn ss : Mortality rate in VLBW neonates was found to increase with the decrease in birth weight and gestational age. prematurity, RDS and infection are major causes of perinatal deaths. Advanced medical care must be available in each neonatal care unit including, Artificial ventilation, pulse oximetry and Surfactant.Obstetricians must be advised for Intense and regular follow up of at risk mothers( multiple pregnancy, PROM, IUGR, APH).

Background: Accurate detection of thyroid autoantibodies by enzyme linked immunosorbant assay technique namely thyroglobulin antibody, thyroid peroxides antibody is crucial in the differentiation of autoimmune thyroid disorders from other form of thyroid diseases.
Objective: Evaluation of the detection of thyroglobulin antibody and thyroid peroxides antibody in different thyroid diseases using enzyme linked immunosorbant assay technique.
Methods: - Seventy-five patients admitted to Surgical Units of Baghdad Medical City Hospital for the period between "October 2010 to June 2011" they were waiting to do thyroidectomy. They were chosen nonselectively for serological evaluation of above autoantibodies , and correlation of the results with histopathological diagnosis.
Results:- Clinical results; Colloid goiter is common cause of hyperthyroidism (19 were colloid goiter out of 30 total hyperthyroid patients ) (63%) , and still common thyroid surgery (56 were colloid goiter out of 75 thyroid surgery) (75%).
Histopathological results;- 56 cases (75%) had colloid goiter, 9 patients had Graves' disease (12%), and 3 had lymphocytic thyroiditis (4%), 7 had thyroid neoplasia (both benign and malignant) (9%).
The serological results; Antibodies positive results were 6 patients (10.7%) in colloid goiter ( p-> 0.05), 6 patients (66%) and 1 patient (33%) for GD, and lymphocytic thyroiditis respectively( P-< 0.05)., while its all were negative in thyroid neoplasia.
Conclusion:- Serum thyroid autoantibodies determination is valuable test in clinical practice of autoimmune thyroid diseases.

n each relapse. Objjec tt iiv es :: To sttudy diifffferentt ffacttors whiich miightt be associiatted or lleadiing tto
tthe occurrence off rellapse iin nephrottiic syndrome
Metthods:: A retrospective study of seventy patients with nephrotic syndrome with age range of 1-14 years, who were diagnosed and treated in Child's Central Teaching Hospital over the period of 1st of January and 1st of July 2008.
The patients were divided into three groups; frequent relapses group, infrequent relapses group and undetermined group. We compared between frequent relapses group and infrequent relapses group in regard to age, sex, type of presentation, biochemical findings which include; total serum protein, serum albumin and renal function test, precipitation factors, family history of renal disease, the time needed to respond to steroid therapy, duration of maintenance steroid therapy and type of renal biopsy.
Res ull tts :: The peak incidence of nephrotic syndrome was at 1-5 years, and male to female ratio was 2.3:1. There was significant correlation of age and type of steroid response in nephrotic syndrome(P 0.042), and no significant correlation regarding sex(P 0.571). The relation of frequent relapsing and infrequent relapsing type with age and sex was not significant(P 0.864, 0.69 respectively), but hematuria had significant relation(P 0.036). Family history of nephrotic syndrome, early response to steroid therapy and the prolonged duration of maintenance steroid therapy were statistically significant in correlation with frequent relapses and infrequent relapses of nephrotic syndrome(P 0.05, 0.016, 0.024 respectively). There was significant difference in correlation of type of steroid response and type of relapse(P 0.001), and focal segmental glomerulosclerosis is prominent in frequent relapsing type(66.7%), while the minimal change type was prominent in infrequent relapsing nephrotic syndrome(40%). Conc llus iions :: There was significant correlation between family history of nephrotic syndrome, hematuria, response to steroid therapy, short duration of maintenance steroid therapy and type of steroid therapy response with occurrence of frequent relapses in nephrotic syndrome. There was increasing incidence of focal segmental glomerulosclerosis in frequent relapses.

Bac kground:: Septal deviation is one of the commonest anatomical deformities of the nasal skeleton, this deviation is usually accompanied by compensatory hypertrophy of the inferior turbinate on the concave side that will accentuate the severity of nasal obstruction.
Objectives: To evaluate the effect of septoplasty on the size of the inferior turbinate in patients with nasal septum deviation.
Methods: This is a prospective study of 25 patients attending the otolaryngological department at Al-Jirahat teaching hospital from September 2011 to November 2013, complaining mainly of nasal obstruction. Otolaryngological examination had shown nasal septum deviation. The cross sectional areas of inferior turbinates were measured with computed tomography preoperatively & one year postoperatively. All the patients were treated by septoplasty alone without inferior turbinate surgery. Res ull tts :: The cross-sectional areas of inferior turbinates on the concave side were significantly decreased after 1 year of septoplasty, & significantly increased on the convex side. Conc llus iions :: Septoplasty alone without turbinate surgery in patients with nasal septum deviation & compensatory inferior turbinate hypertrophy may be effective in reversing the size of inferior turbinate.

Background: study the effect of various risk factors on reperfusion success after thrombolysis by measuring ST resolution.
Objectives: Early patency of the infarct-related artery is associated with reduced mortality. Thrombolytic therapy is frequently followed by rapid recanalization lead to reduction of infarct size, improve left ventricular function and increase survival by reopening of coronary artery . The reduction in ST-segment elevation on the standard 12 lead electrocardiogram 1-4 h after initiation of thrombolysis may be the simplest and most useful clinical tool to test the effectiveness of thrombolytic therapy.
Methods: Seventy patients with acute ST elevation myocardial infarction admitted to alkindy teaching hospital CCU were studied. Early reduction of ST-segment elevation (within 1-3 hours) by >50% on the standard 12 lead ECG with single lead was measured.
Results: 37(53%) of those who receive thrombolytic therapy had ST resolution within 3 hours of thrombolysis. No significant difference concerning gender with ST resolution. younger age patients respond better to thrombolysis than old significantly and with increasing number of risk factors. There is decreasing chance of early ST resolution in those with heart failure features where they had less ST resolution significantly. Serious dysrhythmia treated by DC conversion also show negative significant relation to ST resolution.
Conclusions: Younger age and abscences of cardiovascular risk factors associate more early ST resolution. While late resolution may associate heart failure, serious dysrhythmia and death.

Bac kground:: Multidrug resistant methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of nosocomial and community acquired infections. The glycopeptides vancomycin has been proposed as the drug of choice for treating such infections; this lead to the emergence of vancomycin intermediate sensitive S. aureus (VISA) and vancomycin resistant S.aureus (VRSA).
Objjec tt iiv es :: To identify the vancomycin resistance both phenotypically and genotypically among MRSA isolates from different hospitals and to determine the sensitivity of these isolates to different antimicrobial agents
Metthods:: A total of 204 S. aureus isolates were obtained randomly from various clinical specimens including (wound swab, burn swab, ear swab, urine, sputum, blood and other body fluids) from different inpatient and outpatient who were attending different hospitals in Baghdad. The susceptibility pattern of the S. aureus isolates to different antibiotics was determined by disk diffusion method and vancomycin minimum inhibitory concentration (MIC) for MRSA isolates were determined using broth dilution method following clinical laboratory standard institution (CLSI) guidelines. Van A gene was amplified by PCR using standard primers. Res ull tts :: All VRSA isolates were MRSA. Twelve VRSA isolates were positive for van A gene, while the remaining ten isolates were negative. All VRSA had a vancomycin MIC of 16μg/ml or more. In the present study, VRSA showed resistance to a wide range of antimicrobial agents (Ampicillin, Cefalothin, Cefoxitin, Erythromycin, Gentamycin, Oxacillin, Penicillin, Rifampin, Tetracycline and Trimethoprim). Conc llus iions :: There were high incidences of resistance to the commonly used antibiotics among VRSA isolates compared to VISA and VSSA. Further molecular studies such as PCR technique to identify genes rather than van A (e.g van HAX analogue) might be suitable to predict VRSA lacking the van A gene

Background:Hydrocephalus is dilatation of the ventricular system due to excessive production and/ or obstruction of cerebrospinal fluid (CSF) pathways. Different surgical procedure are used to treat this disease. Ventriculo peritoneal shunt is by far the most popular technique for CSF diversion..
Objective;To compare the programmable and non-programmable valves regarding the complications of both types
Methods:This study was conducted in the Neurosurgical hospital of Baghdad/Iraq over a period of 3 years from July 2008 to August 2011.
A special inclusion criteria has been tabulated for the selection of patients..
Results:.Fifty cases with hydrocephalus admitted and diagnosed by CT scan and treated by ventriculoperitoneal shunts (Codman type).There were 11 cases with programmable valves that demanded revision and 6 patients with fixed pressure valves required revision.
Conclusions:The programmable shunt had lower complication rate in adults and it should be used cautiously in infants because of the higher complication rates.

Introduction: Diabetic foot infections are one of the most severe complications of diabetes. This study was aimed to determine the common bacterial isolates of diabetic foot infections and the in vitro antibiotic susceptibility then treatment.
Methods: A swab was taken from the foot ulcer, and the aerobic bacteria were isolated and identified by cultural, microscopic and biochemical test, then by api-20E system. After that their antibiotic susceptibility pattern was determined. Then local and systemic treatment was used to treat the diabetic foot patients.
Results: Bacterial isolates belonging to twelve species were obtained from diabetic foot patients. Gram (-) bacteria were the predominant pathogens in the diabetic foot infections, high percentage recorded by Klebsiella pneumoniae (25.71%). Polymicrobial infection was observed in 72% patients. Imipenem was the most affected antibiotic in susceptibility test, except for Acinetobacter spp. that resist for all antibiotic used, followed by amikacin and ciprofloxacin. Local treatment gave more inhibitory effect on diabetic foot infections than the systemic treatment.
Conclusion: High prevalence of multi-drug resistant pathogens was observed. Gram (-) bacteria especially Klebsiella pneumoniae was the predominant pathogens in the diabetic foot infections, and Staphylococcus aureus was the most common of Gram (+) bacteria. Local treatment was the best for treatment of diabetic foot infection patients.

Background :The cotton factories have difference steps, spinning and weaving are van important parts of the factories. Cotton industry workers are exposed to various hazards in the different departments of textile factories. The major health problems associated with cotton dust are respiratory problems. Cotton workers display an excess of lung function abnormalities when compared to a community control population.
Aim of Study: This study assessed the effect of exposure to cotton dust in spinning and weaving workers on the lung function in Iraq, by measuring Forced Vital Capacity (FVC),Forced Expiratory Volume in the first second(FEV1), FEV1 ∕ FVC Ratio, and Forced Expiratory Flow 50%(FEF50%),with varying degree of reduction in lung function.
Methods:151 workers exposed to cotton dust were enrolled in the study, and 100 non exposed workers were selected as control. The age of the workers ranged between 20 to 60 years. Both groups were smokers and non smokers, has no chronic pulmonary disease or symptoms during the time of the study. Sprometric study was used for measuring the lung function.
Results: Statistically significant reduction in FEV1and FEF50%were found in exposed workers when compared to control. Lung function indices were not affected with increasing duration of exposure to cotton dust nor to smoking.
Conclusion: Exposure to cotton dust in spinning and weaving workers may result in reduction in the pulmonary function and may lead to respiratory diseases. So improvement in protective measures is recommended.

Background: Bell's palsy was defined as facial weakness of lower motor neuron type caused by idiopathic facial nerve involvement outside the central nervous system without evidence of aural or more widespread neurologic disease. The cause is unclear, but the disorder occurs more commonly in diabetics.Objectives: to differentiate cases of idiopathic Bell's palsy from diabetic mononeuropathy presented with Facial nerve palsy by assessing the taste, because they differ in etiology, management & prognosis.Patients &Methods: One hundred and fifteen consecutive patients were referred for the treatment of facial palsy, from May the 5th 2012 to April 12th 2013 in Al-Kindy Teaching Hospital and The Neurosciences Hospital, in Baghdad / Iraq. 70 diabetic patients and 45 non diabetics were involved to assay the taste.RESULTS: of the 115 patients with facial nerve palsy 70 (61%) were diabetics&45(39%) non-diabetics.No differences of age or gender were found between the two groups. From those 70 diabetic patients 15(34.9%) had change in taste, and , 55(76.4%)had no change in taste, while for non-diabetics; from total 45 patients 28(65.1) had change in taste, and 17 (23.6%) had no change, and this was statistically significant (p<0.001)CONCLUSION :Diabetic patients with isolated facial nerve palsy with sparing of taste sensation may be cases of diabetic mononeuropathy due to diabetic small vessel disease rather than concurrent cases of Bell’s palsy.

Background: Chronic suppurative otitis media (CSOM) is the result of aninitial episode of acute otitis media and is characterized by a persistent discharge from the middle ear through a tympanic perforation for at least 2 weeks duration. It is an important cause of preventable hearing loss, particularly in the developing world.Methods. 1. To get an overview on the bacterial ear infection profile in general 2. To assess the antibiotic resistance of Pseudomonal infection (PS) particularly since it is usually the commonest infection to cause otitis media and the most difficult to treat due to the problem of multi drug resistance... A cross sectional study was done which included 405 patient of CSOM patients196 (48%) case were males ,209 (52%)case were females. Swabs for aural discharge was taken from those patients. Discharge is cultured by inoculating it into blood , MacConkey agar , chocolate agars and Sabouraud agar (for fungi).If the isolate shows to be Pseudomonas isolate growth then another culture of the isolate is performed on Muller Hinton Agar. Then the antibiotic susceptibility and resistance of Pseudomonas isolate is assessed by (Kirby-Bauer Method)Results:196 (48%) case were males.209 (52%) case were females with a male to female ratio 1:1.1150 (73%) cases were infected with Pseudomonas species (PS) The sensitivity of the Pseudomonas isolates to the following antibiotics is shown below:Amikacin 91.7%Imipenem 89.7%Ceftazidime 81.8%Ciprofloxacin 73.7%Garamycin 72.9%Tobramycin 67.7%Ticarcillin 66.7%Cefoperazone 42.9%Conclusions: Pseudomonas species is the commonest microorganism in cases of CSOM.Microbiological identifications and antibiotic resistance determination of pathogens isolated from the middle ear in patients with CSOM not responding to empirical antibiotic treatment gives possibility of the choice of an effective antibiotic and its proper dosage. Cefoperazone ,a relatively new antibiotic that is used in Iraq to combat pseudomonal infections has proven to be poorly effective compared with other previously used antibiotics.

Back ground: primary nocturnal enuresis (PNE) is a socially distressing condition that can be troubling for children & their families. It affects 15-26% of five years olds. Several approaches are used to treat PNE including behavioral modification, alarms & drug therapy. Aim of the study: to determine the efficacy and safety of nasal desmopressin treatment in children with PNEPatients : fifty-four children with primary nocturnal enuresis with a mean age of ( 8.2) years ( range 6-15), underwent a 2 week observation period followed by entrance into a randomized controlled study, comparing desmopressin & placebo, lasting 4 weeks. The efficacy of the drug was measured in reduction of the number of wet nights per week. The enuretic status of the children was documented for 4 weeks after the treatment was stopped.Results: a significant reduction was found in the mean wet nights per week in the desmopressin group (p=0.001) as compared to placebo group (p = 0.83), from 4.3 wet nights during pretreatment to 0.6 & from 4.6 to 4.4 respectively, however this effect was not sustained after treatment was finished as only five children (18.5%) in the drug-treated group remained dry compared with one child (3.7%) in the placebo group. Side effects associated with the nasal adminstration of desmopressin were mild & infrequent.Conclusion: desmopressin has a clinically significant & safe effect on children with primary nocturnal enuresis

Background: Chronic otitis media (COM) of mucosal or squamous type is a common problem in otolaryngology practice, the active form of COM is characterized by discharge of pus and is treated by antibiotics to start with, the appropriate antibiotic should be prescribed to avoid antibiotic abuse and guarantee good outcome. Objectives:The objective of this study is to identify the causative organisms of active chronic active otitis media both (mucosal, squamous) type and test their sensitivity to various anti- microbial agents &compare with abroad studies.Methods:A prospective study was done on eighty patients, different ages and sexes were taken and carful history and examination was done, examination under microscope was done with carful suction to ensure absence of cholesteatoma, ear swabs were collected from middle ear discharge, bacteria identified by gram-staining and biochemical tests and antibiotic sensitivity were tested by using disc-perfusion method.Results:The culture results of eighty patients with chronic active otitis media, showed Pseudomonas aeroginosa from 26 patients (32.5%) and Proteus species from 18 patients (22.5%) and Staphylococcus aureus from 12 patients (15%), Providentia from 8 patients (10%) and Sarretia from 6 patients. (7.5%), mixed gram–ve bacteria isolated from 7.5% of patients, Klebsiella Ozaenae from 5%. of patients. no anaerobic bacteria were isolated in this study (table 1, 2).Antibiotic susceptibility showed sensitivity of Ps. Aeroginosa to menepem, third generation cephalosporin, ciprofluxacillin and resistance to gentamicin. Klebsiella Ozaenae showed resistant to many antibiotic also Serratia as shown in table 3. Conclusions:the microbial study of middle ear discharge is very important because the medical treatment is still a main part in treatment of chronic active otitis media so identifying the type of microorganisms and its sensitivity to antibiotics is give a good chance to successful control of the infection

backround: job satisfaction greatly determines the productivity and efficiency of human resorces for health job satisfaction in said to be linked with employees work environment

job resposibilties and time pressure among various health professionals