Al-Kindy College Medical Journal

Back ground: The gender related difference
may be the result of pregandiol excretion in the
latter half of pregnancy.
Aim: This study is to evaluate the effects of fetal
gender on serum human chorionic gonadotropin
[HCG] and testosterone in normotensive and
preeclamptic pregnancies
Methods: The study consisted of fifty women with
singleton pergnancy in their third trimester. Twenty
five pregnancies were uncomplicated Among those
there were thirteen male, and twelve female fetuses
Twenty five pregnancies were complicated by
preeclampsia. Among those thirteen were with male,
and twelve were with female fetuses. Human
chorionic gonadotropin and total testosterone were
measured in maternal peripheral blood.
Results: In male bearing pregnancies, maternal
HCG and testosterone serum levels were significantly
higher in preeclamptic than in normotensive mothers.
In female bearing pregnancies, testosterone levels
were significantly higher in preeclamptic than
normotensive mothers, whereas the HCG levels were
not significantly different.Male Bearing preeclamptic
women had significantly higher testosterone levels
than female Bearing preeclamptic women, whereas
the HCG levels were not significantly different. In
uncomplucated pregnancies the HCG levels
significantly higher in female bearing than in male
bearing mothers,
Conclusion: In preeclamptic pregnancies with male
fetuses; the maternal serum HCG levels were
significantly higher than in uncomplicated
pregnancies. Total testosterone level were
significantly higher in pregnancies whether with
male or female fetuses. It was also significantly
higher in male bearing than female bearing
pregnancies. This may indicate an androgen
influence on the pathophysiologic of preeclampsia

Background: Acute myocardial infarction
(AMI) is one of the most common diagnoses
in hospitalized patients. The stimulus that
initiates the acute inflammatory process in AMI
has not been identified. Conventional risk
factors account only for approximately half of
the patients with clinically apparent
atherosclerosis which can leads to AMI.
Recently a potential link between infectious
agents and atherosclerosis has been suggested
Objective: To find a possible association
between Helicobacter pylori (H. Pylori)
infection and AMI.
Method: We studied the prevalence of antiH. pylori antibodies in 94 patients who were
admitted with the diagnosis of AMI and a
similar number of healthy individuals who were
age and sex matched. This was done using
ELISA technique.
Results: Overall prevalence of anti-H. pyroli
antibodies in patients with AMI was 82.9%
whereas the prevalence in the control group
was 78.7% . This difference yielded an odd ratio
of 1.317. Chi square test shows that this
difference was insignificant statistically (p-value
0.458)
Conclusion: We feel that our results do not
support the hypothesis which stated that chronic
infection with H. pylori is a major risk factor for
AMI.

Background: There is plenty of evidence
suggesting that involvement of several groups of
viruses in the development and / or acceleration of
Type 1 Diabetes Mellitus (T1DM).
Objective: To analyze the T- cell proliferation in
the presence of Coxsackie virus B5 (CVB5), Polio
and Adenovirus antigens in addition to assessment
of Interferon- gamma (IFN-γ), Interleukins (IL-10
and IL-6).
Methods: In 60 Iraqi T1DM children with recent
onset of T1DM, Lymphocyte proliferation was
analyzed using Methylthiazol tetrazolium (MTT)
assay by culturing Peripheral Blood Lymphocytes
(PBLs) with Coxsackie Virus B5 (CVB5),
Adenovirus, and Polio vaccine. Serum Interferon-γ,
IL-10 and IL-6 were quantified by sandwich
ELISA.
Results: No significant differences were shown
in the PBL proliferative percentage in response to
Con-A mitogen and tested viruses (CVB5 and
Adenovirus) between T1DM and healthy controls,
but it showed a significant decline in patients in
response to Polio vaccine. Higher significant serum
levels of IFN-γ, IL-10, and Il-6 were observed in
the investigated patients compared to controls
(p<0.05). Mean PBL proliferative percentage in
response to tested viral antigens was correlated with
the serum IFN-γ, IL-6 and IL-10 levels.
Conclusions: In children with new- onset
diabetes, mean proliferative percentage of
Peripheral Blood Lymphocytes was generally
decreased. A significant elevation of serum levels
of IFN-γ, IL-10 and IL-6 were observed, which is
significantly correlated to mean proliferative
responses of PBL to viral antigens.

Background: The highest concentrations of
blood glucose during the day are usually found
postprandialy. Postprandial hyperglycemia (PPH)
is likely to promote or aggravate fasting
hyperglycemia. Evidence in recent years suggests
that PPH may play an important role in functional
& structural disturbances in different body organs
particularly the cardiovascular system.
Objective: To evaluate the effect of (PPH) as a
risk factor for coronary Heart disease in Type 2
diabetic patients.
Methods: Sixty-three type2 diabetic patients
were included in this study. All have controlled
fasting blood glucose, with HbA1c correlation.
They were all followed for five months period
(from May to October 2008). A two hour
postprandial glucose (PPG) was done for all. Other
risk factors were taken in consideration such as
hypertension, obesity, and dyslipidemia. The study
was performed on those patients after at least three
months of controlled fasting blood glucose. ECG
was done to all of them.
Results : Out of the 63 type 2 diabetic patients,
20 had normal PPG and HbA1c levels, one of them
(5%), has ischemic changes on ECG twenty
patients had normal HbA1c & High PPG with 7
(35%) of them showed ischemic changes on ECG
17 patients showed a high PPG and a high HbA1c
with four of them showed ischemic changes on
ECG P<0.05. The remaining 6 patients had normal
PPG but high HbA1c & also only one of them
showed ischemic changes on ECG.
Conclusion This study showed that PPH is a
significant risk factor for ischemic heart disease
(IHD).

Background: The effect of garlic extracton fungal
growth and keratinolytic activity was studied in
Trichophytonmentagrophytes as one of the major
etiologic agents of human and animal dermatophytosis
in Baghdad and other parts of the World.
Objective: To investigated an alternative
antidermatophyte with minimum side effects which is
plant based and biodegradable natural product
Methods: Culture conditions for 30 isolates of T.
mentagrophytes isolated from human dermatophytosis
from both sexes with ages of 5-63 years in Central
Medical city for the period July 2009 to October 2009
were cultured on specific solid medium.
Results: The aqueous extract of garlic at various
concentrations inhibited the growth of T.
mentagrophytes. This inhibition reached to a maximum
of 100٪ for extract at 10٪concentration. Keratinase
synthesis was also inhibited by the extract about 91٪ at
8 ٪ concentration.
Conclusion: Fungal growth and keratinolytic activity
are important factors in pathogenesis of the
dermatophytes, their inhibition by garlic indicate that
this substance may have potential values for treatment
of human and animal dermatophytosis.

Background: Diabetes mellitus is a well
known metabolic and vascular illness associated
with high incidence of bacterial urinary tract
infections especially in diabetic complications
including both micro and macro-vascular types.
Objective: To study the incidence of bacterial
urinary tract infections in type 2 diabetic
patients, the type of micro-organism responsible
in relation to age, sex of patients, duration of the
disease & related micro & macrovascular
diabetic complications.
Methods: A prospective study of the diabetic
patients including 40 males with mean age of
54(±9) years and 50 females, mean age of 51(±7)
years and duration of the and sex matched
controls (27 males and 33 females).
Symptoms of urinary tract infections, general
urine examination, urine culture & ultrasound of
abdomen were studied & reported for both
groups.
Results: This study showed significant
increase in urinary tract infections among
diabetic patients with four fold rise in bacteriuria
especially among diabetic women & Escherechia
Coli was the predominant micro-organism in
85% of cases.
Conclusion: Urinary tract infection has
significant increase incidence in type 2 diabetic
patients with fourfold rise among diabetic
women.

Background: Chronic cough is often the key
symptom not only of chronic pulmonary diseases
but for other important extrapulmonary
pathologies, in particular upper airway and
gastrointestinal diseases.
Objective: This study was designed to
determine the etiology of chronic cough and the
usefulness of the available diagnostic tests in
reaching its causes.
Methods: One hundred patients presenting with
chronic cough at Baghdad Teaching Hospital
Outpatient Clinic were enrolled in this study. The
patients underwent a full clinical interview,
physical examination with indicated diagnostic
test(s) (such as chest x ray, bronchoscope, PFT,
GIT study, sinus X ray or CT).
Results: An etiology of chronic cough was
determined in 93% of the patients. Post nasal drip
is the leading cause of chronic cough reported in
31% of the patient, while asthma gastroesophageal
reflux disease, and chronic bronchitis
seen in (26, 20, and 6 % respectively).
The diagnosis of chronic cough can be reached by
comprehensive history, proper physical
examination, and chest X ray findings in 66 %
patients, further more sophisticated and invasive
tests like: PFT, upper GIT study , expectorated
sputum examination (AFB, Gram staining,
cytology), fibrooptic bronchoscope, and full ENT
evaluation including sinuses X ray or sinuses CT
scanning, are need in the rest.
Conclusion: The etiology of chronic cough can
often be diagnosed safely with a simple initial
evaluation (history, physical examination and
chest X-ray). Postnasal drip, asthma and
gastroesophageal reflux disease account for the
etiology in more than three quarter of the patients.

Background: Childhood meningitis is a major
cause of morbidity and mortality, Hemophilus
influenza b (Hib) is the most common cause in
many countries, especially below 5 years and
before the development of conjugated Hib vaccine,
it is followed by Streptococcus Pneumonia, and
then N. meningitides, in addition to other
microorganisms.
Objective: To identify the causative organisms
of bacterial meningitis and to identify the factors
predisposing significantly to the incidence of
bacterial meningitis.
Method: This cross sectional , study was done in
Al-Elwia Pediatric Hospital during the period 1st
of January 2007 to 30th of June 2007.Eighty four
patients with presumptive diagnosis of meningitis
were included in this study, from the age of 2
months -12 years, History about some risk factors
were taken in details. Analysis of cerebrospinal
Fluid (CSF) with Gram stains & cultures were
done in all cases.
Results: The number of cases of meningitis was
50 (20 proved meningitis & 30 partially treated
meningitis), while 34 patients are found to have no
meningitis.
Streptococcus pneumoniae was identified in
45%, Hemophilus Influenza b in 20%, while
Nisseria meningitides 5%, other organisms include
Escherichia coli, Staphylococcus aureus,
Klebsiella, & salmonella.
Many factors affecting the occurrence of
bacterial meningitis & these include: age, sex,
residence, body weight and home overcrowding.
Conclusions: Streptococcus pneumoniae was
found to be the predominant microorganism
causing bacterial meningitis in children aged 2
months-12 years, followed by Hemophilus
influenza b, while N. meningitides were one of the
rare bacteria which had been identified. E. coli was
found to be the major cause in cases of ventriculoperitoneal
(VP) shunt meningitis.

Background: Excessive crying in early
infancy is a common condition that causes a
great deal of concern to the parents and
physician.
Objective: The aim of this study is to find
the underlying etiology of excessive crying in
infancy and to determine how the history,
physical examination, and laboratory
investigations contribute to the final diagnosis.
Method: A prospective study done on 150
afebrile infants less than 4 months of age
visited Al-Elwia hospital for children
complaining of excessive crying of more than
two hours.
The study done over a one year period from
the first of January 2009 to the end of
December 2009.
All febrile infants and those with acute illness
preceding the onset of crying were excluded
from the study.
Results: Of 150 afebrile infants with
excessive crying 95 cases (63.3%) diagnosed
as having idiopathic colic, 55 cases (36.7%)
have a secondary underlying disorder.
The most common associated disorders
include constipation, 12 cases (8%), gastroesophageal
reflux in 9 cases (6%), and feeding
problems in 9 cases (6%).
Urinary tract infection was the most common
underlying serious etiology found in 4 cases
(2.7%).
History and physical examination contribute to
the final diagnosis in 85% of cases.
Conclusion: Accurate diagnosis of infants
with colic or excessive crying requires a
thorough history and physical examination to
exclude underlying etiology.
Screening laboratory tests apart from urine
analysis and culture is of little help.

Background: H.pylori colonized gastric mucosal
epithelium will virtually develop gastritis and had the
capacity to persist for decades. Pathogenesis is
dependent upon strain, virulence host genetic
susceptibility, and environmental cofactors. Leptin is
a member of the class 1 cytokine family so altered
leptin production during ifnect and inflammation that
leptin part of the cytokine cascade ,which
orchestrates the defense mechanism.
Objective: Examin the effect of H.pylori infection
on serum leptin level.
Methods: One hundred and thirty(130) Patients
attending the Endoscopic Unit at "Gastroenterology
and Hepatology Teaching Hospital/ Baghdad Medical
City"were included in this study with ages range
from 18 years to 65 years are the source of specimens
to undergo oesophageal gastroduodenoscopy (OGD)
compared with twenty healthy control the study
began from April 2009 to the end of March 2010
were eligible for this study.Tow types of samples
were taken, biopsy for rapid urease test and
histopathological examination to detect H.pylori and
blood sample for estimation of serum leptin by
ELISA test.
Results: The results show significant increase in
serum leptin concentration(P<0.001)in gastritis
patients caused by H.pylori compared with patients
control and healthy control.
Conclusion: Increase of serum leptin concentration
explained the role of leptin in the immune response to
H.pylori infection that leptin consider as member of
cytokine

Background: Laparoscopic surgery for
appendicitis is now a well established and
advanced method of performing general surgical
procedures.
Objectives: To compare the outcome of
laparoscopic and open appendectomies in terms
of operative time, analgesic requirement,
postoperative complications, hospital stay, return
to normal activity and condition of scar.
Methods: This prospective study was carried
out from 1stMay 2008-1st January 2010, involving
110 patients (45 male and 65 female) with
features suggestive of acute appendicitis were
divided into 45 patients laparoscopic
appendectomy (LA) group and 65 patients open
appendectomy (OA) group, after taking informed
consent. LA was done with the help of three
trocars/cannulae creating pneumoperitoneum
with CO2 whereas OA was performed by grid
iron incision.
Results: Forty five patients were assigned to
the laparoscopic appendectomy group and 65
patients were assigned to the open appendectomy
group. Five patients were converted intraoperatively
from laparoscopic appendectomies to
open procedures. The operating times in OA and
LA were 20-110 minutes (mean 30) and 45-120
minutes (mean 55) respectively. Increased doses
of analgesics, antibiotics and antiemetics were
required in OA, as compared to LA. The mean
postoperative hospital stay in LA group was 1
day (range 1-3 days) where as it was; 2.2 days
(range 2-5 days) in OA group.
Conclusion: LA is safe and it has major
benefits like less postoperative pain, decreased
wound infection, early hospital discharge, early
return to work and a better cosmetic scar than
OA

Background: Bowel preparation prior to
colonic surgery usually includes antibiotic
therapy together with mechanical bowel
preparation which may cause discomfort to the
patients, prolonged hospitalization and water
& electrolyte imbalance.
Objective: to assess whether elective colon
and rectal surgery may be safely performed
without preoperative mechanical bowel
preparation.
Method: the study includes all patients who
had elective large bowel resection at Medical
City – Baghdad Teaching Hospital between
Feb, 2007 to Jan, 2010. Emergency operations
were not included. The patients were randomly
assigned to the 2 study groups (with or without
mechanical bowel preparation.
Results: A total of 165 patients participated
in the study, 82 with mechanical bowel
preparation and 83 without. The 2 groups
were similar in age, sex and type of surgical
procedure. 134 patients (81.2 %) underwent
surgery owing to colorectal cancer & 31
patients (18.8 %) owing to benign disease.
The hospitalization period was longer in the
bowel-prepared group (mean ± SD, 8.2 ± 5.1
days) as compared with the non prepared
group (mean ± SD, 8.0 ± 2.7 days). However,
this difference was not statistically significant.
The time until the 1st bowel movement was
similar between the 2 groups : a mean ± SD of
4.2 ± 1.3 days in the non prepared group as
compared with a men ± SD 4.3 ± 1.1 days in
the prepared group ( P = NS ).
Conclusion: Our results suggest that no
advantage is gained by preoperative
mechanical bowel preparation in elective
colorectal surgery.

Background: Silymarin is a polyphenolic flavonoid
derived from milk thistle (Silybum marianum) that has
anti-inflammatory, cytoprotective, anticarcinogenic
and antioxidant effects. It has been used medicinally
to treat liver disorders including acute and chronic
viral hepatitis, toxin/drug induced hepatitis, and
alcoholic liver disease.
Objective: To evaluate the antinociceptive effect of
silymarin in experimental animal model of pain.
Methods: The efficacy and dose response effect of
silymarin (125, 250, and 500mg/kg) were assessed
against control using tail flick test in mice as a model
of nociceptive pain. In this model, all doses of
silymarin were given intraperitoneally 15 min before
immersion of tail in hot water 50°C, and Tail Flick
Latency was measured before, and after (15, 30, 60
and 120 min) administration of silymarin.
Result: Silymarin in 250 and 500mg/kg
significantly increase Tail Flick Latency after 15, 30,
60 and 120 min in a dose dependent manner that the
maximum effect seen after 120 min compared to
baseline value.
Conclusion: Silymarin as a herbal drug produce a
significant antinociceptive effect in experimental
animal model of pain, and beside its better
standardization, quality control, and safety profile, in
addition to its availability and relative low cost,
represent a good alternative choice for management of
pain.

Background: Intramedullary astrocytomas
account for about 1% of all CNS tumors and
6–8% of spinal cord tumors. The vast majority
of intramedullary astrocytomas are slowgrowing
lesions.
Objectives: The goal in this study was to
review a series of patients who underwent
surgical removal of intramedullary high-grade
astrocytomas, focusing on the functional
outcome and the effect of multimodality
treatment on the survival of patients with high
grade intramedullary astrocytoma.
Methods: Between June 1999 and June 2004,
22 patients underwent removal of
intramedullary high-grade astrocytomas in four
neurosurgical hospital in Baghdad/ Iraq
(Neurosurgical hospital, Al Shaheed Adnan
Hospital for Surgical Speeialticsa, Nursing
Home Hospital Lesions were located in the
cervical segment of the spinal cord in 12
patients, and patients.
Results: Histological examinations showed
10 Grade III astrocytomas and 12
glioblastomas. Only 2 of the 22 high-grade
astrocytomas could be completely removed. The
clinical postoperative status worsened in
14 patients (63.6%), was unchanged in seven
patients (31.8%), and there was one case of
intraoperative death (4.5%). None of the 22
patients showed improvement in their
neurological status postoperatively. In this series,
excluding the one intra-operative death, all
patients died of the progression of the
malignancy.
Conclusions: Surgical treatment did not
ameliorate the postoperative neurological status;
instead, in the majority of cases, it prompted a
worsening of the deficit. Radiotherapy and
chemotherapy have a little influence on the
length of survival. In this series, multimodality
treatment of intramedullary high-grade
astrocytomas has been shown to increase length
of survival without improving the neurological
status.

Background: Carpal tunnel syndrome
(CTS) is the most common neuropathy of the
upper limb due to compression of the median
nerve at the wrist.
Objectives: to test the benefit of steroid
irrigation of the wound to alleviate the post
operative pain.
Methods: Forty patients had carpal tunnel
release were divided into two groups with and
without steroid irrigation.
Results: Forty patients 38 female and 2 male
with forty CTS had open surgical release were
studied for postoperative pain at the wrist area.
Group 1 (patients treated with surgery alone)
and group 2 (patients treated with surgery and
steroid).In group1, 11 patients (55%) had
persistent agonizing pain at the ulnar side of
the wrist not responding to analgesic. In
group2 none of the patients experienced such
type of pain.
Conclusion: Steroid irrigation has beneficial
effect on post operative pain with no added
drawbacks.

Background: Recurrent laryngeal nerve injury is
an important post-thyroidectomy complication for
which different modalities of treatment were
practiced to lower its incidence.
Objectives: To estimate the incidence of
recurrent laryngeal nerve injury in thyroid surgeries
in relation to type of surgery, type of gland diseases
& nerve identification.
Methods: Different types of goiters prepared
preoperatively by indirect laryngoscopy, operated
upon with different types of surgeries, postoperative
direct laryngoscopy by the anaesthetist were done
and indirect laryngoscopy done as needed.
Results: Of of 200 patients, the overall incidence
of recurrent laryngeal nerve injury was 9
Patients (4.5%), 7 patients (77.8%) were unilateral
nerve injury & 2 patients (22.2%) were bilateral
nerve injury. The percent of temporary nerve injury
was 8 patients (88.89%) & permanent injury 1
patient (11.11%).the incidence of injury in females
was (4.57%) & in males was (4%). Injury was 1
patient out of 13 (7.69%) in total thyroidectomy, 1
patient out of 11 (9.09%) in completion
thyroidectomy. Injury in malignant goiter was 2
patients (10%).finally it was higher if nerve was not
identified (6.15%) than if identified (1.42%).
Conclusion: Recurrent laryngeal nerve injury is
more in malignant goiters, in more extensive
surgery & if peroperative nerve identification was
not practiced.

Background: Posterior urethral rupture remains
one of the most difficult and controversial injuries
to treat and its management still controversial.
Aim: To assess the effect of primary
realignment of posterior urethral rupture.
Methods: in this study, 20 patients (mean age
24.7 years, range 12 to 39 years) were admitted to
al-kindey teaching hospital, Baghdad, Iraq, with
complete posterior urethral rupture associated with
fractured pelvis following trauma (3 cases of fall
from high, 17 cases of road traffic accidents). All
the patients were operated upon at the day of
accident to establish the alignment of the posterior
urethra on a Foley's catheter with bladder drainage
by suprapubic catheter. Patients were evaluated
post-operatively for urinary incontinence, erectile
dysfunction, and urethral stricture. They were
followed up for a mean period of 17 months
(range, 10 to 20 months).
Results: posterior urethral rupture was
associated with pelvic fractures in 18 of 20
patients (90%), and only one case had bladder
rupture (5%). Seven patients (35%) had evidence
of post operative stricture. Erectile dysfunction
was reported by 2 patients (10%). none of the
patients had urinary incontinence.
Conclusion: Primary realignment of PUR is a
simple procedure associated with low morbidity. It
is recommended for patients who are stable and
have no other significant intra-abdominal and
pelvic organ injuries.

Background A prospective clinical study was
performed to compare the efficacy of the use of lowmolecular-
weight heparin group (enoxparin group)
with control group in the prevention of deep-vein
thrombosis after total knee arthroplasty.
Aim of the study: to assess the prevalence of DVT
after total knee arthroplasty and evaluate the
importance of the use of low molecular weight
heparin in the prevention of this DVT.
Methods Thirty-three patients undergoing total
knee arthroplasty were randomly divided into two
groups. One group consisted of 12 patients who
received no prophylaxis with an anticoagulant (the
control group), other group consisted of 21 patients
who received the low-molecular-weight heparin
enoxparin (enoxparin group) 4000 I.U. S.C 6 hours
after surgery for two weeks after the operation then
aspirin 100 mg until 6th week after operation.
Bilateral duplex ultrasonography was performed
preoperatively and at (5-7) days postoperatively.
Results The prevalence of deep-vein thrombosis
was 58% in the control group, 38% in the enoxparin
group.
Conclusions Enoxaparin significantly lowered the
prevalence of deep-vein thrombosis after total knee
arthroplasty.

Background: Laparoscopic cholecystectomy
has become the standard of care for the
elective management of cholelithiasis. Little
information exists, however, regarding the
appropriateness of this procedure in the setting
of acute symptomatology.
Objective: This study was designed to
evaluate the outcome of laparoscopic
cholecystectomy in acute and severe acute
cholecystitis based on early and late biliary
complications, their incidence and
management, and conversion rates to open
surgery.
Methods: A prospective study done between
April 2007 and November 2010, in the
department of general surgery, medical city
teaching hospital, Baghdad. Includes patients
with acute cholecystitis admitted for
laparoscopic cholecystectomy; they were
divided into two groups, (group 1) including
patients with acute cholecystitis; (group 2)
including patients with severe acute
cholecystitis.
Results: 306 patients were admitted for
laparoscopic cholecystectomy, 71 (23.2%) of
them with acute cholecystitis and was involved
in this study; they were divided into two
groups, (group 1) patients with acute
cholecystitis 61(85.9%), (group 2) patients
with severe acute cholecystitis 10 (14%);
including gangrenous gallbladder 3(30%), and
empyematous gallbladder 7(70%). Patients in
group 2 were significantly older than in group
1. Female sex was more significant in group 1,
while male sex was more significant in group.
There was no procedure related mortality.
Conclusion: laparoscopic cholecystectomy
for acute cholecystitis is safe and associated
with a low morbidity, mortality, and a low
conversion rate.

Background: Patients with chronic kidney
disease have different grades of sensorineural
deafness .
Objective: To study the incidence of
sensorineural hearing loss and possible contributing
factors in patients with chronic kidney disease.
Methods: A total of 100 patients with chronic
kidney disease were studied. All of them were
males. 92 of them were on regular haemodialysis
programme. Only 8 patients were on conservative
management the age range of the study patients was
18-40 year patients were divided into three groups
according to age. All patients were assessed
clinically and were evaluated by audiometry , and
analysis was made on bone conduction threshold
.The mean follow up period was 28 weeks .
Results: 36 patients (36 %) showed sensorineural
hearing loss .The incidence of sensorineural
deafness was found to increase with the advancing
age and duration of chronic kidney disease but not
directly proportional to the number of
haemodialysis sessions .The number of
haemodialysis sessions did not show increase in the
degree of sensorineural deafness .
Conclusion: Patients with chronic kidney disease
have sensorineural deafness of some degree which
should be assessed and evaluated to halt its
progression.

Back ground: The innervations of the pineal
gland from the superior cervical ganglion have
shown some form of a chromatolysis reaction.
Objective:
1-Tracing the innervations of the pineal gland by
removing the target tissue (the pineal gland in
this study) i.e. (pinealoctomy) and removal of the
superior cervical ganglion i.e. (ganglionectomy).
2- The localization and total number of the
neurons which project into the rat pineal gland
3-The effect of pinealoctomy on the SCG after a
different time interval.
Methods: Twenty five 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 chromatolysis reaction in the neurons
following Pinealoctomy confirms the
innervations of the pineal gland from the SCG.
The present study has demonstrated that the most
obvious the Chromatolysis reaction occurred one
day after pinealoctomy.
Conclusion: This study confirms the
innervations of the pineal gland from the SCG,
the study shows that the distribution of the
Chromatolysis neurons; of all age group occurred
in all parts of the ganglion; although it was more
abundant in the rostal 2/3.

Background:-The Modified Alvarado Scoring
System (MASS) has been reported to be a cheap
and quick diagnostic tool in patients with acute
appendicitis. However, differences in diagnostic
accuracy have been observed if the scores were
applied to various populations and clinical settings.
Objectives:- The purpose of this study was to
evaluate the diagnostic value of Modified Alvarado
Scoring System in patients with acute appendicitis
in our setting.
Methods:-one hundre twenty eight patients, were
included in this study, admitted to Al-Kindy
teaching hospital from June 2009 to June 2010.
Patients’ age ranged from 8 to 56 years (21±10)
they were divided into three groups; paediatrics,
child bearing age females & adult males,. MASS
was calculated for each patient included as the
diagnosis & treatment were done on the bases of
surgeon's clinical decision,confirmation was done
by histopathological examination. Finally statistics
done included negative appendectomy rate,
sensitivity, specificity, positive predictive
value,negative predictive value & accuracy.
Results: - Our negative appendectomy rate was
19.5% (22.22% for paediatrics 40.9% for females
4.2% for males). MASS showed sensitivity of
61%(92.8% for paediatrics 38% for females & 58%
for males), specificity 80% (75% for paediatrics
88% for females & 50% for males), positive
predictive value 92%(92.8% for paediatrics 83%
for females 50% for males), negative predictive
value 33% (75%for paediatrics 50% for females
5% for males) & accuracy 65% (88.9% for
paediatrics 59% for females 58% for males).
Conclusion:- MASS was of limited help to junior
doctors in our setting,clinical assessment &
experience are still the gold standard for acute
appendicitis.