Al-Kindy College Medical Journal

Objectives: To report the Cesarean section rate in Al-
Batool Maternity Teaching Hospital and to identify
how many of them were done for maternal and fetal
condition.
Design: A statistical cross sectional study.
Setting: The study was conducted at Al-Batool
Maternity Teaching Hospital (13000 deliveries per
year).
Participants: The patients group consists of 4556
patients admitted for delivery (vaginal and abdominal)
during a period of four months commencing from
January 2003.
Main outcome measures: calculation of all live
births, calculation of cesarean section rate, percentage
of the primary cesarean sections and the repeat
cesarean sections and listing the indications of the
operation according to maternal and fetal condition
with their percentage.
Results: Total births during the period of this study
were 4556 births, 3732 vaginal deliveries and 824
cesarean sections. Cesarean section rate was found to
be 17.94% of total live births, the most frequent
indication for cesarean section was malpresentation
(24.3%). Primary cesarean sections contribute to 75%
of cases.
Conclusions: A primary cesarean section is one of the
most important causes of high cesarean section rate.
Decreasing the incidence of primary operations will
help in reducing cesarean section rate.

Objective: To investigate and prove that aspirin
protects, or at least attenuates amikacin ototoxicity in
humans.
Method: This study was conducted in 60 patients that
completed all
requirements .The patients were divided into two
groups:
• Control group: receive placebo treatment.
• Drug–treated group: They receive aspirin
coated tablets (1.5gm/ day), 500mg 8 hourly.
Both groups had similar aspects regarding the gender,
age and weight. The duration of therapy was 7 days
and dosage of amikacin was 1gm/day (500mg 12
hourly).
Results: Comparison of Audiometry test in
Ear/Nose/Throat (E.N.T.) Department (Pure Tone
Audiometry) at 1000 Hertz (Hz), 2000 Hz, 4000 Hz,
and 8000 Hz showed significant differences between
mean Audiometry at 250Hz was significantly different
only at 8th and 15th day while at the frequency of 500Hz
the difference was significant at the 15thday only.
Conclusion: In present study, we had shown that
aspirin can protect the patients who are receiving
amikacin therapy from it\' s ototoxicity.

Background: Squamous cell carcinoma of the oral
cavity (OSCC) is a highly invasive neoplasm. Many
MMPs play role in human cancer invasion and
metastases.
Aim: Estimating The MMp-7 expression level in
HPV-16 positive and HPV-16 negative OSCC
paraffin embedded sections.
Method: Biopsies from thirty three patients with oral
squamous cell carcinoma (OSCC) were obtained and
investigated for the presence of HPV-16 RNA with
the application of ISH and the MMP-7 expression
level using IHC .
Results: Expression level of MMP-7 found to be high
in OSCC sections 29 (87.8%) cases with no
significant difference in its expression level between
HPV-16 positive and HPV-16 negative OSCC cases
p= 1.00.
Conclusion: MMp-7 found to be expressed in high
level in OSCC with no significant relevance to HPV-
16.

Back ground: In the present study Pinealoctomy
was used to study the sympathetic innervations of
the pineal gland by the superior cervical ganglion
(SCG) of the albino rat.
Objective: Following Pinealoctomy, it is
expected to observe the Chromatolysis reaction in
some neurons of the SCG if they were to innervate
the pineal gland (i.e. retrograde Chromatolysis
changes).
Methods: Fifty albino rats were used in this study,
Pinealoctomy was done, then after a different time
interval ganglionectomy was done, in order to
study the Chromatolysis in their cell body.
Result: The present study has demonstrated that
the most obvious Chromatolysis reaction in the
neurons which innervate the pineal gland appeared
one day following Pinealoctomy in the young and
adult rats. In the SCG of animal, one week
following Pinealoctomy,
the number of the Chromatolysis neurons was
much less than these seen in the previously
mentioned one
day animals. In (2 – 6) weeks following
Pinealoctomy, the number of the Chromatolysis
neurons kept a constant decline.
Conclusion: The work presented in this study
showed that the method of tracing the innervations
of the pineal gland by removing the target tissue
(the pineal gland in this study) appeared to be
justified and conclusive.
It has also shown that younger animals, subjected
to Pinealoctomy, would react more vigorously with
respect to Chromatolysis than adult animals. The
present study has also demonstrate that the
distribution of these Chromatolysis neurons and for
all age groups all over the ganglion being
inspected. However they were more abundant in
the rostral 2/3 of these ganglions.

Background: The incidence of maternal mortality in
placenta previa accrete is 7%,and its preoperative
diagnosis is of a great value.
Objective: to evaluate the efficacy of transabdominal
color Doppler ultrasound in diagnosing placenta
previa accreta and inccreta. Color Doppler imaging
criteria used in: includes diffuse parenchymal
placental lacunar flow, focal intra parenchymal
placental lacunar flow and bladder uterine serosa
interphase hyper-vascularity.
Design: Prospective study on patients from
January2007 to January 2008.
Patients and method: 48patients with one caesarean
section or more and with persistent anterior placenta
previa diagnosed by transabdominal ultrasound were
examined by color Doppler at 32 or more weeks of
gestation to determine the possibility of myometrial
invasion depending on the above color Doppler
criteria.
Results: Out of 48 patients eleven exhibited
characteristic Doppler imaging pattern highly specific
for placenta accreta and inccreta according to
preceding criteria , one patient had false positive color
Doppler imaging result, 5 patients underwent
caesarian hysterectomy , the remaining five were
treated conservatively by uterine artery ligation and
other conservative measures because of bleeding
from the lower uterine segment.
Conclusion Color Doppler sonography is highly
sensitive and
specific in the antenatal diagnosis of placenta previa
accreta .If a strong suspicion is found before delivery
,appropriate location and timing for delivery should be
considered ,to allow access to adequate surgical
personel and equipment ,preoperative blood
preparation to reduce morbidity and mortality.
Journal title
Ultrasound in obstetric and gynecology ISSUN 0960-
7692 Source 2000 Vol 15 In 1 PP. 28-35 (22rel)

Background: Directly observed therapy-short course (DOTS) had been adopted by World Health Organization (WHO) as hopeful strategy for treatment of tuberculosis (TB) since early nineties. Iraqi health authorities started DOTS implementation since 2001 in Baghdad. Coverage expanded gradually till 100% in 2004. War and unstable security condition hit Iraq since March 2003. Objective: The objective of this study was To evaluate the DOTS implementation program in Baghdad in different periods including 2 unstable periods for proper assessment of war and instability on treatment of TB. Patients and methods: This study had been conducted in Baghdad during four different periods (before and during 2003 war, after war; without and with DOTS). Direct interview with patients, and follow up of their treatment were done. Results: The results reveled that78% of patients were in active age groups, 62% of them were males. Surprisingly, direct observation was not achieved in those who were treated under DOTS in the whole periods. Patients treated under DOTS in the 1st and 4th periods showed much better sputum conversion rate after 2 month treatment (88.7 %in 1st and86.5% in 4th periods` patients) than those treated under DOTS during war (45.9% or Non-DOTS 75.6%). A better cure rate also found in patients of both periods (64.9% in 1st and 63% in 4th period) than patients in other periods ( 11% in 2nd% and 43.6% in the 3rd one) .Conclusions: DOTS strategy played important role in improving registration and curing of TB cases in Baghdad. War and unstable security conditions got a destructive effect on treatment of TB patients regardless the followed strategy. Involvement of private medical sector and other governmental and nongovernmental organization can improve TB treatment outcome.

Background: Asymptomatic bacteriuria (ASB) is
defined as isolation of a specified quantitative count
of bacteria in an appropriately collected urine
specimen from an individual without symptoms or
signs of urinary tract infection.
Aim of study: To evaluate the frequency of
bacteriuria according to age, pregnancy, and type II
diabetes mellitus in a sample of Iraqi women.
Patients and Methods: A total of 125 female
individuals were involved. The study participants
were classified into the following groups: nonpregnant
women with type II diabetes mellitus,
pregnant women with type II diabetes mellitus,
pregnant women without type II diabetes mellitus, and
apparently healthy non-pregnant women. Urine and
blood specimens were tested to record positive urine
culture, pyuria, and blood glucose according to
standard microbiological and biochemical methods.
Results: Frequency of positive urine culture and
pyuria in the total pregnant women was 7 (14%) and
15 (30%), respectively, whereas frequency of positive
urine culture and pyuria in the total diabetic women
was 8 (16%) and 23 (46%), respectively. The bacterial
isolation rate in the studied groups was 13 (10%). Ecoli
recorded the highest isolation rate, 6(5%). There
was no significant culture positive of urine specimens
in the groups of diabetic non-pregnant, diabetic
pregnant, and women with normal pregnancy (Pvalue<
0.05). Pregnant women with culture positive
urine and pyuria were more likely to have perinatal
mortality. Sterile pyuria was detected in pregnant
women aged 18-45, those in third trimester, and in
multiparous pregnant women. There was significant
positive urine culture and a highly significant pyuria
in diabetic women with BMI > 25.
Conclusions: Asymptomatic bacteriuria is an
independent risk factor for perinatal mortality. Sterile
pyuria is a significant observation in pregnant and
diabetic women; therefore it should bring more
attention.
Recommendations Treatment of asymptomatic
bacteriuria is appropriate for pregnant women but it is
not recommended for diabetics. The study advised to
perform urine culture as a part of the antenatal checkup
for pregnant women.

Background: Salvia officinalis is a plant belong to
Labiatae family .The common name of Salvia is sage
which mean save. The leaves of Salvia have special
oil which is effective against filamentous fungi and
yeasts such as Candida albicans which is the
causative agent of vaginal candidiasis in women
Methods. Cultures from 50 swabs of Candida
albicans isolated from vagina of 70 patient women
who complains from vaginal problems, their ages
(24-43) years from Central City Hospital during
Febreoury 2009 to April 2009 were cultured on
Sabouraud Dextrose Agar (SDA) .Nystatin was used
as positive reference standard to determine the
sensitivity of this fungus . and less this concentration
there was no minimum inhibition for the Candida
Results: The aqueous extract of Salvia officinalis at
various concentrations inhibited the growth of C.
Albicans . This inhibitions reached to a maximum of
100% for extract at 25 mg / ml and the minimum
inhibition was 170 mm at 15 mg /ml for the extract .
While the minimum and maximum inhibition for
nystatin was at 50 μg/ml,and less concentration. There
was no minimum inhibition for the Candida
Conclutions : The findings provide support for the
use of this plant in traditional medicine for fungal
infections especially against candidiasis .

Background: Fetal macrosomia represent a
continuing challenge in obstetrics and increasing in
it's occurrence as well as it is associated with maternal
and perinatal complications.
Objective : To determine the maternal and perinatal
outcome related to fetal macrosomia.
Design: A prospective case control study.
Patients and methods) :10th March-31st May, 2006
A prospective case control study had done over the
period from 10th March to 31st May, 2006 in Al-Batool
maternity teaching hospital in Mosul city .The study
group consisted from 633 singleton alive newborns
with gestational age ≥37weeks weighing 4000 grams
and heavier and mothers of these newborns compared
with control group which consisted from 4155
singleton alive newborn with gestational age
≥37weeks weighing 2500-3999 grams and mothers of
these newborns .The obstetrical outcome variables
which compared between the two groups include mode
of delivery, indication of caesarean section and
maternal and perinatal complications.
Results :
Macrosomic newborns (≥4000grams) delivered in this
study account for (12.45%) of total deliveries.
Newborns with a birth weight of ≥4500grams
constitute 2.65% from all deliveries .Male Newborns
(65.24%) was higher and statistically differed among
the study group (p value=0.001).
Instrumental vaginal delivery (P value=0.010,Odd
ratio :2.12, 95 %CI :1.19-3.76) and cesarean section
delivery (P value=0.000,Odd ratio:1.63, 95 %CI :
1.34-1.98), mainly the emergency cesarean section
(18.79%), were significantly different among the
study group .Failure of progress of labour and
cephalopelvic disproportion were the main indications
in study group and showed statistical significant
difference between the two groups.
Among the study group, there was neither maternal
death nor uterine rupture but there was higher
occurrence of postpartum hemorrhage, genital tract
trauma and shoulder dystocia which were significantly
different when it compared with control group .Erb's
palsy was the main perinatal complication and was
statistically different among macrosomic group (P
value=0.000) .
Conclusion: Fetal macrosomia was associated with
higher rate of instrumental vaginal delivery and
caesarean section mainly due to failure of progress of
labour and cephalopelvic disproportion .There were
higher rate of postpartum haemorrhage, genital tract
trauma as well as shoulder dystocia with neither
maternal death nor uterine rupture in study group .
Among macrosomic newborn, Erb's pulsy was the
main perinatal complication

Background: Symptoms related to the upper gastro-intestinal tract are very common. Attribution of these symptoms to upper G. I. T.diseases are usually done on clinical bases, which could be confirmed by Esophago Gastro Duodenoscopy (EGD). The use of such tools might increase the diagnosis accuracy for such complaints. The indications for upper G I endoscopy might decrease the negative results of endoscopies.Objective: To follow strict indications for Esophago Gastro Duodenoscopy in order to decrease the negative endoscopy results. Methods: One thousand eight hundred and ninety cases were subjected to EGD from Feb. 1999 to Feb 2009 at Alkindy Teaching Hospital and Abd-Al-Majeed private hospital in Baghdad, Iraq. A special endoscopy unit form was prepared containing data from patients, clinical complaint, indications for endoscopy request, and the endoscopic diagnosis, biopsies were taken when indicated and subjected to histopathological examination. All these data were studied and analyzed.Results: Out of the total 1890 patients there were 1114 males and 776 females with male to female ratio 3/2, the most common age group ranged from 21 to 50 years with a mean age of 32 years. Upper abdominal pain was the most common indication (30%), upper GI bleeding (27.94%), duodenal ulcer follow up (25.5%). The diagnosis of chronic DU was established in (40.21%) of cases, normal endoscopic results were found in (34.6%), duodenitis and gastritis in (15.2%).Conclusion: The high number of normal gastrointestinal endoscopies necessitates the need to follow strict indications before subjecting the patients for endoscopy.

Background : The hepatopulmonary syndrome (HPS) is defined as the triad of liver disease, arterial deoxygenation, and pulmonary vascular dilatation. The reported prevalence of HPS in cirrhotic patients varies between 5% -17.5%.Objective : To estimate the prevalence of hepatopulmonary syndrome among patients with chronic liver disease and portal hypertension and to study the correlation between HPS and the severity of liver disease.Patients and methods : Thirty patients were studied for the presence of HPS using transthoracic contrast echocardiography for detection of pulmonary vasodilatation. Arterial oxygen saturation (SaO2) was determined in erect and supine position using a pulse oximeter , (SaO2 ≤ 92 % in supine position and/or a decrease of ≥ 4% after change from supine to upright position) to detect hypoxia and ortheodeoxia.Result : Eleven of thirty patients (36.6%) with chronic liver disease and portal hypertension were found to have contrast echocardiographic evidence of intrapulmonary right-to-left shunting. Arterial oxygen desaturation was present in 3 patients (27.3%) of those with intra-pulmonary right-to-left shunting ,they were considered as clinically significant HPS ,the remaining 8 patients were considered as subclinical HPS. Dyspnoea was more often present in patients with clinically significant HPS (100%) compared with subclinical HPS (25%), and patients without HPS (9%). HPS correlated significantly with severity of liver disease according to the Child-Pugh score.Conclusion: hepatopulmonary syndrome is not uncommon , the prevalence of clinically significant hepatopulmonary syndrome (in this study) was 10% of patients with chronic liver disease and it correlated with disease severity according to the Child-Pugh score

BACKGROUND : Bifurcational coronary lesions are
frequent and amounts to almost one fifth of routine
practice concerning up to 15 – 20 % of cases .
Revascularization by percutaneous coronary
intervention ( PCI ), of bifurcational lesion has
become easier by stenting yet it remains a frequent
challenge.
OBJECTIVE : To evaluate the success and hospital
complications of two most frequent technique of stent
deployment in bifurcational PCI.
METHODS : We prospectively analysed the data of
140 consecutive patients with bifurcational PCI at
Ibn_Al-Bitar Hospital for cardiac surgery for the
period from July 2008 to July 2009 .
Depending on whether the side branch was stented or
not, the patient has fallen into two groups : -
Group A; stenting of the main vessel and angioplasty
of the branch.
Group B; stenting of both main vessel and its branch .
The early outcome of the bifurcational PCI and all
complications during hospitalization that include;
death, acute Myocardial infarction , emergency
percutaneous treatment and coronary artery bypass
graft (CABG) were evaluated in the studied groups.
RESULTS : The studied sample consisted of 140
patients,107(76.3%)were male and 33(23.7%) were
female. Group A consisted of 90 patients (64.3%)
while group B consisted of 50 patients(35.7%).Acute
procedural success was (94.2%) in group A and (80%)
in group B while hospital major adverse cardiac
event(MACE) were noted in 3.8% of group A and
20% of group B,(PV=0.04)
CONCLUSION: In bifurcational PCI stenting of the
side branch has made no extra advantage in term of
procedural success and early outcome.

Background: Fibromyalgia syndrome (FMS) is the
most common rheumatic cause of diffuse pain and
multiple regional musculoskeletal pain and disability.
Objective: is to assess the contribution of serum
lipoprotein (A) in the pathogenesis of FMS patients.
Methods: One hundred twenty two FMS patients
were compared with 60 healthy control individuals
who were age and sex matched. All FMS features and
criteria are applied for patients and controls; patients
with secondary FMS were excluded. Serum
Lipoprotein (A): [Lp(A)], body mass index (BMI), &
s.lipid profile were determined for both groups.
Results: There was a statistical significant difference
between patients &controls in serum lipoprotein (A)
(P=0.013). Also there was a statistical significant
correlations between serum Lp(A) & FMS patients'
age( r= 0.310, P=0.034 ); but not with: duration(r= -
0.222, P=0.133) , BMI(r= 0.128,P=0.390) & s.lipid
profile ( p> 0.05) of FMS patients.
Conclusion: s.lipoprotein (A) may play an important
role in pathogenesis of FMS patients.

Background: It has been accepted that in patients with CSOM, conductive deafness results from mechanical break-down of sound conduction ,whilist the cochlea remains unaffected.
Objectives: Our study aims to prove a sensorineural component in hearing loss in patients suffering from CSOM , which necissates early detection as it increases in severity with time.
Methods: A prospective study was done on 64 patients, all were diagnosed as having unilateral CSOM, their ages ranged from 18-40 years to exclude presbyacusis as a cause of sensorineural deafness.
These patients were divided into 4 groups according to the duration of discharge and further divided into 3 groups according to the pathology (simple perforation, granulation tissue or cholesteatoma).
Results: 62 patients showed some degree of sensorineural deafness in the affected ear accounting for 96.8% of the total number of patients,
While only 2 patients escaped the phenomenon. Worsening of bone conduction thresholds was noticed with increased duration of the disease.
The highest loss was in patients with severe pathology (cholesteatoma) and least in those with simple perforation.
Conclusion: This study indicates that the degree of sensorineural hearing loss in patients with CSOM relates with the duration and complications of the disease which is contrary to the traditionally accepted belief of the physicians that cochlea remains unaffected in CSOM.

Background: Breast cancer is the most common
malignancy affecting females worldwide. The association
of Epstein-Barr virus (EBV) with this cancer is a longstanding
interest to this field.
Aim: to investigate the presence of EBV in breast tumor
tissue in relation to age.
Patients and Methods: Paraffin-embedded tissue blocks
from 45 female patients with breast tumors (ranged in age
from 28 to 85 years) were retrieved. The cases were
grouped into two categories: group (A): included 30 cases
with breast carcinoma and group (B): included 15 cases
with benign breast diseases as a control group .The
expression of EBV protein was examined
immunohistochemically.
Results: Twelve (40%) of the 30 breast cancer cases
(group A) were reported as positive for EBV expression
and significantly higher in patients less than 40 years age
(P= 0.026).
Conclusion: the results of the current study might refer to
the significance of EBV expression in breast tissue of
young patients with breast cancer.

Background: Patients requiring renal biopsies have various glomerular diseases according to their demographic characteristics.
Objective: To study types of glomerular disease among adult Iraqi patients in a single center in Baghdad/Iraq
Material and Methods: A total of 120 native kidney biopsies were studied. All biopsies were adequate and were processed for Light Microscopy.
The age range of the study patients was 17-67 years, with a mean of 38.5 years. The mean follow up period was 28 weeks (4-52 weeks)
Indication for biopsy included: Nephrotic syndrome (N=72; 60%), Asymptomatic proteinuria (N=21; 17.5%), acute nephritic presentation (N=17; 14.16%), asymptomatic haematuria (N=10; 8.33%).
Results: Primary glomerulonephritis (GN) was seen in 102 of 120 patients (85%), focal segmental glomerulosclerosis, and membranous nephropathy were the most common histological diagnosis (33.3% and 21.5% respectively).
Conclusion: The study further emphasize the need for national GN registry and long term follow up, to recognize the common pattern of GN, their natural history, the appropriate line of management, and to try to halt their progression to end stage renal disease (ESRD).

Background: Indeterminate colitis (IC), a term
originated by pathologists to characterize confounding
histopathlogic appearance of resected mucosa, has
become catch phrase for cases in which diagnostic
criteria at all levels elude classification as Crohn's
disease (CD) or ulcerative colitis (UC).
OBJECTIVES: evaluate the prevalence of pANCA
expression in the sera and its isotypes.
Patients and methods: PATIENTS GROUP
consisted of 60 patients (40 males and 20 females)
with indeterminate colitis and their age range was (19-
84 years). CONTROL GROUP consisted of 30 (15
males and 15 females) healthy volunteers and their
age range was (20- 66 years).
Antineutrophil cytoplasmic ( pANCA and cANCA)
testing was performed by an IIF technique on ethanol
fixed human EOH granulocytes as substrate
(EUROIMMUNE- Germany). Sigmoidoscope and
colonoscope examination were done for the patients
group and biopsies were taken from the patients for
histopathological examination.
Results:
Serological results of ANCA showed a significant
increased frequency of pANCA (63.3%) in
indeterminate colitis patients as compared to controls
(p=0.000). The highest percentage of this pANCA
titer was 1:10 (p=0.000) then 1:100 (p=0.008) and
most of them was IgG (53.3%) (p=0.000). Sensitivity
of pANCA was 60%, specificity of pANCA was 40%,
positive predictive value of pANCA was 61.1% and
negative predictive value of pANCA was 66.6%.
cANCA did not demonstrated in both groups.
Conclusions : pANCA was more prevalent in
indeterminate colitis and could be used as a predictive
serological marker for the outcome of disease.

We presented here a 65years old lady with an unusual presentation of a large epigastric hernia of twenty years duration .The swelling was occupying all the right hypochondrial region .The diagnosis was made on r^E^a-operative identification of the defect in the linea alba which wassutured after removal of the hernial sac and its contents .The postoperative course was uneventful and the patient remained with no complications or recurrence for more than two years follow up.