Al-Kindy College Medical Journal

Background: Fifteen percent of small for gestational age are small as a result of fetal growth restriction, which could be due to maternal, placental or fetal factors. It is an important clinical problem associated with increase perinatal mortality and morbidity. Leptin is a protein that produced by many tissues including the placenta (syncytiotropholoast). Dysregulation of leptin metabolism may be implicated in preeclampsia and IUGR pathogenesis.
Aim of the study: To study the trend of leptin level alteration in maternal serum and cord blood in pregnancies complicated by fetal growth restriction and its relation with fetal outcome.
Methods: An Analytic, cross- sectional study conducted in Al-Elwyia Maternity Teaching Hospital and Alkindy College of Medicine, from October 2009 to June 2010. Sixty seven pregnant women were included and they were divided into two groups: The first group (A) included 34 pregnant women with Intrauterine growth restricted fetuses with and without maternal diseases and the second group (B), included 33 pregnant women with normal pregnancies. Samples from maternal blood and umbilical cord blood were obtained at the time of delivery and leptin level was measured by Enzyme linked immunesorbant assey (ELISA) test.
Results:Umbilical cord leptin level was significantly lower in group A (medain1ng/ml) compared with group B (median10.2ng/ml); P<0.001, and maternal serum leptin was also significantly lower in group A (median19.8ng/ml) compared to control group B (median31.8ng/ml), P 0.042.
Newborn weight for age (Z score) and maternal body mass index were the most important and the only statistically significant determinants of cord blood leptin, while only maternal body mass index had a strong and statistically significant positive association with maternal serum leptin.
In group A, there was a linear correlation between cord blood leptin and placental weight, P<0.001, and a linear correlation between Apgar score at 5minutes and cord blood leptin level, P<0.001.
Conclusion: Women who had growth restricted fetuses had significantly lowered umbilical cord leptin level and maternal serum leptin level than women who had normal fetuses and the outcome of such fetuses could be related to leptin level.

Background: To elucidate the possible role of human cytomegalovirus in pregnancy loss through induction of certain pro-inflammatory adhesion molecules.
Methods: Paraffin embedded sections of curate samples were obtained from 34 women had spontaneous abortion, and 5 women had elective termination of pregnancy (as control), and then subjected for immunohistochemistry analysis to detect human cytomegalovirus (HCMV) early protein and VCAM-1 molecule.
Results: Nine out of 34 women with spontaneous abortion were positive for HCMV early protein, with a
significantly higher expression of VCAM-1 in HCMV positive cases as compared with HCMV negative and the control groups (p = 0.05, 0.001 respectively).
Conclusion: HCMV infection may play an important role in the pathology of pregnancy loss on multidirectional bases include inducing the surface expression of pro-inflammatory adhesion molecules like VCAM-1.

Background: migraine is a chronic neurovascular disorder characterized by intermittent attacks of sever headache with or without aura that can include various combinations of neurological, gastrointestinal tract (G.I.T), and autonomic changes, without evidence of primary structural abnormalities. The Autonomic nervous system involvement suggested by many symptoms and signs including nausea, diarrhea, constipation, coldness in the extremities, paroxysmal tachycardia and chest pain.
Objectives: To evaluate autonomic functions in patients with migraine and to clarify the autonomic dysfunction weather its sympathetic, parasympathetic, or combined. Also to assess the severity of this dysfunction and its relation to age, gender and type of migraine.
Methods: This study enrolled 60 patients with migraine, 42 females and 18 males with an age range between 14-45 y. with 30 healthy volunteer as control group, The using of a questionnaire paper, autonomic nervous system disability scale and set of autonomic cardiovascular reflexes test were also applied .
Results: The migraineurs with disabling attack may be prone to autonomic nervous system hypofunction which may be either a risk factor for migraine headache, or be a consequence of frequent disabling attacks, moreover autonomic nervous system dysfunction and migraine may share a common neural substrate. The Parasympathetic part of autonomic nervous system is affected more than sympathetic according to Ewing classification of autonomic function tests which is significant statistically in comparison to control, and 16(26.7%) of patients showed definite dysautonomia(score >2) while 44(73.3%) of patients were normal. Palpitation and postural dizziness are the most frequent symptoms in patients with migraine . Autonomic dysfunction among migraineurs is not rare also prolong course of illness is strongly correlated with autonomic dysfunction which is affect parasympathetic part more than sympathetic, for this reason the clinician should look carefully for the autonomic symptoms when they assess patient with migraine because most of those symptoms were disabling
Conclusions: The assessment of autonomic function tests should be a routine work in patient with migraine. The heart rate response to deep breath and valsalva are simple informative and beside to evaluate the parasympathetic part of autonomic nervous system

Background: Direct measurement of intracellular magnesium using erythrocytes has been suggested as a sensitive indicator for the estimation of body magnesium store. Marked depletion in plasma and erythrocyte magnesium levels was particularly evident in diabetic patients with advanced retinopathy and poor diabetic control. While insulin has been shown to stimulate erythrocyte magnesium uptake, hyperglycemia per se suppressed intracellular magnesium in normal human red cells.
Aim of the study: To investigate the erythrocyte magnesium level in Iraqi type I and II diabetic patients, with specific emphasis on the effect of both, metabolic control and the type of antidiabetic treatments.
Methods: Sixty two diabetic patients (7 with type I and 55 with type II diabetes mellitus) recruited from the outpatient diabetes clinic at the Specialized Center For Endocrine Diseases-Baghdad, during the period from 1st October 2005 to 28th February 2006. Eighteen non-diabetic normomagnesemic healthy controls matched for age and sex were participated in this study. Of the diabetics, 22 were using insulin (7 with type I and 15 with type II diabetes mellitus), 40 were taking oral antidiabetic agents (All with type II diabetes mellitus) and none were using both. Serum and erythrocyte magnesium concentration were measured for both groups, and Glycated hemoglobin levels were estimated only for diabetics.
Results : Mean serum and erythrocyte magnesium levels were significantly (p<0.001) lower in the diabetic group as compared to controls. Serum level of magnesium was not a significant predictor of erythrocyte magnesium concentration. No significant correlation was observed between HbA1c and erythrocyte magnesium. Significantly (p<0.001) lower serum magnesium levels were consistently evident through the entire diabetic subgroups as compared to controls. Erythrocyte magnesium contents were significantly (p<0.001) reduced in patients with type I , type II and type II receiving oral antidiabetic agents, but not in patients with type II receiving insulin (p= 0.120 ), as compared to controls. Significant difference in erythrocyte magnesium levels was observed between patients with type II receiving oral antidiabetic agents and those receiving insulin (p<0.001). The frequency of magnesium deficiency in diabetic patients, as judged by a lower serum magnesium reference limit was constantly 100% in all subgroups. While, judgments based upon a lower erythrocyte magnesium reference limit, discloses variable frequencies in diabetic subgroups.
conclusion: The near normal erythrocyte magnesium levels in type II insulin-receiving patients, could be credited to the stimulatory action of exogenous insulin on cellular magnesium uptake and may indicate a possible role of insulin treatment as a potential implications on health policy, by ameliorating cellular magnesium depletion in the continuously expanding diabetic population.

Background: Mondor's disease means superficial thrombophlibitis of the chest wall in human, treatment is entirely symptomatic. Hot, wet dressing and anodynes may be used for pain relief.
Objective: To evaluate the role of systemic and transdermal action of diclofenac (olfen) with respect to the symptom and sign (pain, erythema along the superficial vein), and the use of Doppler ultrasonography which is a colored ultrasound used for assessment of flow of blood in vessels.
Method: The study was performed on 12 cases with Mondor's disease in middle age female patients with the involvement of lnframammary veins in all of the them (commonly affected), 4 cases had reassurance only, 4 cases had reassurance with systemic diclofenac, and the other 4 cases had reassurance with topical olfen patch.
Results: Olfen patch exerts a strong and rapid action in topical olfen cases, regarding it is role in subsiding the inflammatory process of the veins and so relieving pain with fastening the healing rate as minimum as possible (1 week), thereby abolishing the role of surgery in resistant cases.
Conclusion: Olfen patches play a major role in treating cases with mondor's disease by reducing inflammatory process through its transdermal migration action of diclofenac and within a short time by achieving a high local concentration.

Objective: to evaluate the results of (Modification of Russe method) in treatment of nonunion fracture scaphoid bone by bone graft with external splintage (plaster of paris cast (pop ).
Methods:Prospective study done on 26 patients (24 male, 2 female), age range between 25-42 years (mean age 34 years), fracture site at middle 1/3 with minimal displacements with no carpal bone or radial bone injury, technique of Matte- Russe method (explore the bone through volar approach using bone graft from iliac crest (cortico-cancellous peg plus cancellus bone) with thumb spica for 90 days with period of follow up 12-18 months.
Results: out of 26 patients treated by this method , 23 patients (88.5%) union was achieved radiologically by the end of 3rd month &progressed over the next 3 months, range of motion of the wrist & power of grip increased gradually became almost comparable to the normal side by the end of sixth month , 5-7 degrees loss of dorsiflexion was residual in 6 patients . Three patients (11.5%) did not show union radiolgically after sixth postoperative month, their local symptoms were better than before surgery ,they were not keen to have another operation .No complications were noticed, wound healed well ,patient tolerance was good
Conclusion: the use of cancellous bone graft with plaster of paris (p.o.p.) splint is less demanding surgically& less coasty and resulted in good results(88.5% healed well ).we recommend this treatment as a method for treating nonunion of carpal scaphoid bone

Background: Obesity is an evolving major health problem in both developed and developing countries. Traditional obesity indices as body mass index, waist circumference, waist-hip-ratio are well known measures to identify obese subjects, however, neck circumference as an index of upper-body obesity was found to be a simple and time-saving screening measure that can be used to identify obesity and the likelihood of developing metabolic syndrome in type 2 diabetic patients.
Aim: to investigate the relationship of neck circumference (NC) to obesity and metabolic syndrome in Iraqi subjects with type 2 diabetes.
Methods: The study group included 90 type 2 diabetic subjects (48 men and 42 women) aged 30-68 years. The subjects were those who attending The Specialized Center for Endocrinology and Diabetes/Baghdad. Main indicators studied included Neck Circumference (NC), waist circumference (WC), waist-to-hip ratio (WHR), body mass index (BMI), blood pressure, fasting blood glucose, and lipoprotein levels.
Results: Pearson's correlation coefficients indicated a significant association between NC and body circumference, and waist-hip-ren and from 0.014 to less than 0.0001 in women). Also NC is positively correlated with systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TGA), fasting blood glucose level (p value from 0.092 to less than 0.0001). Cross tabulation between NC and BMI indicated that NC identified obese persons with 100% sensitivity in men and 90% in women, also a cross tabulation between NC and metabolic syndrome indicated that NC can identify metabolic syndrome with 100% sensitivity in both men and women. Metabolic syndrome was identified according to a modified criteria proposed by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATPIII).
mass index, waist atio (p <0.0001 in m
Conclusion: Neck circumference is positively correlated with BMI, waist circumference, waist-hip-ratio, and positively correlated with components of metabolic syndrome in Iraqi individuals with type 2 diabetes. Accordingly, the measurement of neck circumference could be useful in clinical screening for obese persons and for persons who are at risk of developing metabolic syndrome.

Objective: Aimed to asses the role of PT estimation in early diagnosis and predicting the extent and the outcome of head injury with ICerH and/ or Contusion
Method :PT was measured by Digiclot 818
Group –1: One hundred consecutive head injured patients admitted at Neurosurgical and Al Ramadi teaching hospitals were initially estimated for prothrombin time and subsequently scanned
Group-2 : Two hundred twenty five consecutive non scanned head injured patients admitted to Neurosurgical and Al Ramadi teaching hospitals were estimated with prothrombin time at the time of insult and subsequently for the next two weeks Al – Kindy Col Med J 2012; Vol. 8 No. 1 P: 54
Clinical and neurological evaluation (GCS) score in addition to computerized tomography scan was done for both groups
Result :Group -1: Twenty eight (28%) of the initially estimated head injured patients had prolonged prothrombin time in which their subsequent CT scan revealed an ICer H and/or contusion
Seventy six (76%) percent of those with severely head injured patients (GCS≤8) were having an initial prothrombin time prolongation..While those with mild head injury (GCS≥12) only thirty (30%) of them were having the initial prothrombin time prolongation
Group-2 Those patients who survived the initial insult and subsequently thereafter (surgically or conservatively treated) even with a deficit.. Daily estimation of prothrombin time showed a decline within the 7-14 days
Those patients who finally died (surgically or conservatively treated) daily estimation of prothrombin time showed a persistent elevation or a fluctuation within the next 7-14 day
Conclusion Prothrmbin time is an important
parameter in :
1-Reflecting the severity of head injury (GCS)
3-Early detection of ICerH and /or contusion
2-Prognostic value in cases of of ICerH and /or contusion
Abb : ICerH = Intracerebral hematomas,SDH=subdural hematomas,EDH=epidural hematomas,SAH=subarachnoid hemorrhages,PT=Prothrombin time,Pts=Patients,CT scan=computarized tomography.

Background: Prelabour rupture of membranes is a problem that faces the obstetricians. It has many maternal and fetal sequale and its etiology and management still controversial.
Objective: To test the absolute nucleated red blood cells counts at birth in infants who are born after prelabour rupture of membranes.
Methods: A prospective study conducted in AL-Kadhymia Teaching Hospital. Hundred pregnant women were included in this study. Fifty pregnant women who had prelabour rupture of membranes considered as group (1), other fifty pregnant women with intact membranes considered as group (2) through a period of one year. Nucleated red blood cell counts of venous cord blood obtained within one hour of life from 50 infants who were born after prelabour rupture of membranes. The same procedure was applied for the control group.
Results: The nucleated red blood cell counts and Haematocrit were significantly higher in infants who were born after prelabour rupture of membrane than in the control group (P value <0.001 and 0.03 respectively).
Conclusion: Infants born after prelabour rupture of membrane have higher nucleated red blood cell counts at birth than the control group.

Background : Shoulder pain is a common problem that can pose difficult diagnostic and therapeutic challenges for the family physician It is the third most common musculoskeletal complaint in the general population, and account for 5% of all general practitioners musculoskeletal consults
Objective: To determine the diagnostic performance of ultrasonography compared with the physical examination for detection of rotator cuff tears in painful shoulder syndrome.
Method: Prospective study was done on seventy patients (48 male, 22 female), age ranged between 30-70 years (mean age 50 years), From February 2007 to July 2011, were subjected to comparative study in Al-Kindy teaching hospital with rotator cuff tears, including physical and ultrasonographic examination.
Result: Ultrasound examination confirmed the presence of rotator cuff tear in 58 patients (82.8%), about two third of them below age 40 (65.7%) and male gender (68.6%).
Conclusion: Ultrasonography which is non-invasive, safe; cheap with no known risk like radiation is a sensitive and accurate method of identifying patients with rotator cuff tears, and should be used wherever possible to improve diagnosis and treatment of painful shoulder disorders.

Objective: To compare the efficacy and safety of isosorbide mononitrate (IMN) versus misoprostol used to induce labour for overdue pregnancy.
Setting: A prospective randomized clinical study conducted at AL-Elwiya Maternity Teaching Hospital in Baghdad from Jan. 2008 to Dec. 2008.
Method: One hundred and fifty women with over due pregnancy (past date and posterm pregnancy) referred for induction of labour with Bishop scores <_ 5 were randomly allocated to receive either forty mg isosorbide mononitrate (IMN) tablet as a single vaginal dose (n=75) or fifty mcg misoprostol vaginally (n=75) every six hrs for a maximum of three doses. Amniotomy and/or oxytocin infusion is considered when Bishop scores frankly progressed (augmentation) or used when no improvement achieved after 24 hour (induction). Adverse effects of medications, induction - delivery interval, mode of delivery and neonatal outcome were recorded and subjected to statistical analysis.
Results: Isosorbide mononitrate was associated with less adverse effects than misoprostol especially regarding uterine tachysystol (0 with isosorbide mononitrate vs 12% with misoprostol, P<0.01) and hyperstimulation (0 with isosorbide mononitrate vs 16% with misoprostol, p<0.01) but the induction - delivery interval with isosorbide mononitrate group was significantly longer compared with misoprostol (26.3±7.3hrs vs 15.4±5.4 hrs , p<0.01). Oxytocin was added to 70 women (93.3%) used isosorbide mononitrate while to 15 women (20%) used misoprostol (p<0.001). Caesarean rate was not significantly different between the two groups, but the indications were different, dystocia is the major cause (73.3%) with isosorbide mononitrate while persistent non-assuring fetal heart rate pattern (64%) in the misoprostol group.
Conclusion: Cervical ripening and induction of labour using isosorbide mononitrate resulted in fewer adverse effects but it was less effective than misoprostol.

Back ground: Chronic total occlusion (CTO) of coronary arteries remains one of the most challenging lesion subsets in interventional cardiology even with the development of medical devices and operator expertise. Successful revascularization results in improved in angina status ,increased exercise capacity and reduces the need for lat CABG surgery .
Objectives: This study sought to determine the overall procedural success rate of percutaneous coronary intervention (PCI) for CTOs and to examine the relation between variables such as; patients’ characteristics, risk factors, lesion characteristics and procedural success rate.
Methods: In this study ,clinical and coronary angiography data of (80) patients with CTO who underwent PCI between May 2009 and May 2010 in Ibn Al-Baitar Hospital for cardiac surgery and Al-Nassryia cardiac center were prospectively analyzed . The clinical data were collected using the patients files and angiographic data by review of their films.
Results: There were (80) Patients with CTO ,They included 62 men (77.5%) and 18 women (22.5%) ,Age range 36-76 year with mean age 55±8.75 and male to female ratio was 3:1 .The procedural success rate of PCI was 66 patients (82.5%). All 23patients(100%) with lesionlength less than 15 mm had successful PCI compared to 43 out of 57 patients in whom the lesion was more than 15mm (75.4%) p value < 0.01. The procedure was successful in 54 patients out of 60 with tapered stump(90%) compared to 12 out of 20 patients with abrupt stump(60%) p value <0.005.In CTO lesion with angulations less than 45 degree ,the procedure was successful in 27 patients out of 28 (96.4%)compared to 39 out of 52 patients in whom the angulations was more than 45 degree 52(75%) p value<0.01. The most common cause of procedural un success was inability of guide wire crossing through the totally occluded segments which represented 11(78.5%), Inability to cross the lesion with a balloon in 2 patients(14.2%) and inability to dilate balloon in one patient (7.1%) P<0.001.
Conclusion: Percutaneous coronary intervention of chronic total occlusion is an effective therapeutic procedure with high success rate 82.5%. The length of chronic total occlusion ,degree of angulations and stump morphology are strong predictors of success procedure.

Background; Perforated duodenal ulcer (PDU) is a common surgical emergency that is associated with high mortality and morbidity. Early diagnosis and prompt surgical treatment is required to prevent grave complications.
Objective; The study was designed to evaluate the diagnostic accuracy of different radiological investigations in the diagnosis of perforated duodenal ulcer.
Methods; A prospective study of 185 pts with PDU at al kindy teaching hospital, Baghdad, Iraq from June 2008- august 2010. patients were examined clinically and investigated by blood test, chest x ray, plain X ray of the abdomen. Ultrasonography (U/S) and CT scanning done for those patients with negative X- ray finding. Resuscitation by intravenous fluid and antibiotic done. Explorative laparotomy done for all patients, repair of perforation done by simple omental patch. Data regarding radiological, ultrasonographic and CT finding and operative finding were recorded.
Results: The study of 185 pts with proven perforated DU revealed 162 (87.5%) male and 23 (12.5%) female with age ranging from 22-70 yrs ,the average was 38 years.
Crescentic shape air under diaphragm was seen in chest or abdominal plain X ray in 121 (65.4%) pts and negative in 64 (34.6%) pts. For those 64 pts, a positive finding of free air or fluid was seen by U/S in 16 (25%) pts and positive CT finding was seen in 62 (96.9%) pts.
The operative finding in those 64 pts were; a small perforation less than 0.5 cm in 24 pts, completely or partially sealed perforation in 19 pts, severe edema and narrowing of the pylorus in 15 pts and perforation larger than 1 cm but with little peritoneal soiling was seen in 6 pts.
Conclusions: Pneumoperitonium was detected radiologically in 65% of pts of perforated DU. CT scan was found to be superior to U/S study for the diagnosis in pts with negative X-ray finding. For pts with perforated DU Conservative treatmentcan be adopted in pts with negative radiological findings.

Background :Evening preparation for colonoscopy is often unsatisfactory and inconvenient. This study was performed to compare the efficacy of bowel preparation at two different timings: night before and morning of endoscopy and to compare the cecal intubation rate and disturbance of sleep hours between these two groups.
Methods: In this prospective randomized endoscopist- blinded trial, 150 patients were enrolled between March 2010 and August 2011. Patients aged between 18 to 80 years needing colonoscopy were included. Patients with prior bowel surgery, suspected bowel obstruction or those who didn't completely fulfill the preparation instructions were excluded. Patients received polyethyelen glycol electrolyte preparation in a morning and evening regimen. Bowel cleansing was scored using the Ottawa Bowel Preparation Quality Scale. Loss of sleep and cecal intubation rate was evaluated.
Results: Seventy five patients received morning regimen and 75 patients received evening regimen.
There was significant difference in total scores of bowel preparation for the two groups favoring the morning group (ρ < 0.0001) . Bowel cleansing for right and mid colon were significantly better in the morning group (ρ < 0.001), while the difference for the left colon was not significant. The cecal intubation rate was comparable for both groups ( ρ NS).Sleep was disturbed in 15 patients in morning group and in 42 patients in evening group (ρ = 0.003).
Conclusion: In conclusion, this study suggests that morning preparation provide better quality of bowel preparation for colonoscopy than evening preparation. Right and mid sided colonic preparation is superior in the patients who take the morning preparation than left sided preparation. Evening preparation is associated with a significant sleep disturbance. This would translate to considerable financial losses and patient discomfort.

Background: Nasopharyngeal carcinoma (NPC) is one of the most challenging tumors because of their relative inaccessibility and that their spread can occur without significant symptoms with few signs, but Radiotherapy (RT) has a role in treatment of it.
Objectives: To show that RT is still the modality of choice in the treatment of NPC, to study modes of presentations, commonest histopathological types and their percentages, to show differences in the sensitivities of these types to RT and to find out a 5 year survival rate(5YSR) and its relation with lymph node involvement.
Methods: This is a retrospective study of 44 patients with NPC who were treated with routine RT from 1988-2007 at the institute of radiology and nuclear medicine. All patients were treated with megavoltage x-ray with a total dose to the primary lesion was 60-70 Grays (1 Gray = 100 Rads) so we gave 6000-7000 Rads in 6-8 weeks and 50 Grays were applied to the cervical lymphatic chain bilaterally.
Results: 10 out of 44 patients treated have survived more than 5 years (with a 5YSR of 22.7%). In this series of cases, the 5- year overall survival rate is: 60% with stage I, 33.3% with stage II, 28.5% with stage III and 13.7% with stage IV. But, it should be noted that most of them were advanced with stages III and IV accounting for 36 patients i.e 81.8%.
Conclusion: Radiotherapy (RT) is the modality of choice in the treatment of NPC and we must irradiate areas of probable spread with the primary lesion because spread can occur without significant signs and symptoms .The most common histopathological type is undifferentiated carcinoma which is more sensitive to RT than squamous cell carcinoma (scc) or other types of carcinoma.
Also we see that stages III and IV NPC (advanced) comprises high number of the total and the 5-YSR decreases as the patient advances from stage I to stage IV, therefore, early detection and diagnosis is very important.

Background Over the past decade there has been a growing awareness of, and interest in, the trace element concentration differences between normal and diseased tissues. Significant changes in tissue concentrations of Zinc (Zn) and Copper (Cu) have been previously reported in inflammation and cancer of certain human tissues.
Aim:(1)To correlate between Zn and Cu concentrations and the histological picture of normal and certain inflamed human tissues, namely the gall bladder (GB) the vermiform appendix (VA), visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). (2) to detect whether there is a difference in the above-mentioned parameters between VAT and SAT. (3) to obtain recordings for trace element levels in human tissues.
Methods: Diseased GB (10), VA (10), VAT (10) near these organs and SAT (10) were removed by surgery. Tissues from these organs were then processed for histopathology and analyzed for trace elements concentration by Atomic Absorption Flame-Emission Spectrophotometer.
Results: Zn concentration was high in VAT (0.410 μg/g ± 0.181), GB (0.478 μg/g ±0.531) and VA (0.419 μg/g ±0.123) when compared to its level in SAT (0.1329 μg/g ± 0.0129) and the difference was significant (<0.007,<0.056 and <0.000 respectively).
Cu concentration was high in VAT (0.640 μg/g ± 0.150) and GB (0.919 μg/g ± 0.564) when compared to SAT (0.3893 μg/g ± 0.0130) and the difference was significant (<0.005 and <0.011 respectively). Cu concentration in the VA was low (0.2055 μg/g ±0.0654) and significantly different from all the other tissues (VA vs VAT <0.000, VA vs GB <0.002 and VA vs SAT <0.000).
The histology findings were typical of chronic inflammatory reactions in the GB and of acute inflammation in the VA.
Conclusions: The increase in tissue concentrations of Zn in VAT, GB & VA is due to inflammation.
The high Cu level in chronically inflamed GB and neighboring VAT is due to the increased need for this element during inflammation.
Our results, together with findings reported by others, allow us to think of using trace elements, namely Zn and Cu, as tools for diagnosis and treatment in appropriate conditions.

Background : Bone infections is one of the most challenging orthopaedic complications, with considerable morbidity. There is significant impact on the life of the patients; socially, financially, physically, and mentally and it could be a limb-threatening complication. Osteomyelitis is a bone infection usually caused by bacteria, including mycobacteria, but mainly Staphylococcus aureus which is the most commonly responsible bacteria . Aim of study: To evaluate our management policy of chronic osteomylitis (C.O.M).
Methods : 32 patients presented with different types &forms of chronic osteomyelitis in many sites of long & flat bones such as tibia , femur, ,humerus ,iliac bones and knee joint , which are not response to previous management . patients age…. range from 17 to 45 years old. Our study period extended from 2003 to 2009 with about one year follow up. our management include radical local bone debridement with multiple bone drilling and multiple washing by many antiseptic agents plus post operative specific antibiotic regime include triple intravenous broad spectrum antibiotics for two weeks , followed by parentral another two antibiotic regime for minimum 1.5 month up to 3 months,
Results : From 32 patients involved in our study , 30 patients were found presented with non specific chronic osteomylitis in different form as following : 15 patients presented with tibial (C.O.M) & discharging sinus associated with offensive odder , 7 patients (21.8 % ) presented with (C.O.M) of femur, 7 patients (21.8 % ) presented with (C.O.M) of humerus mainly after internal fixation device application ( plate & screw )and one case (3.1 % ) presented with discharging pus from knee join as chronic septic arthritis . only two patients ( 6.2 % )presented with specific type of (C.O.M) such as T.B osteomylitis

Background: Bone cutter is widely used in the
Middle east area to cut the prepuce during circumcision.

Results :One hundred twenty one male neonates
were included in this study.The mean operative
time (MOT) was 6 minutes, mean time of
healing (MTH) was 5 days, 7 cases (5.9%)
developed early & late complications, 2 (1.7%)
had bleeding, 3 (2.5%) developed infection, 2
(1.7%) developed late complications in the form
of meatal stenosis.
Settings:Al-Yarmouk Teaching Hospital and a
private surgical clinic.
Aim of the study: To assess the safety of
circumcision using bone cutter.
Methods: Over 6 years period from Jan. 2000
till Dec. 2005, one hundred twenty one male
neonates were circumcised under general
anesthesia (GA) using bone cutter.
Conclusions: Bone cutter circumcision is
feasible with a relatively lower complication
rate and Shorter MTH and MOT.

A case of angiolymphoid hyperplasia with eosinophilia (ALH) is reported in a 42-year-old woman who developed multiple nodules behind the ear. Angiolymphoid hyperplasia with eosinophilia usually occurs on the head and neck of young adults and is more common in women than in men. Characteristic histologic features of ALH present in this case included proliferation of thick-walled blood vessels lined by prominent endothelial cells, infiltration of the interstitium by chronic inflammatory cells (mainly eosinophils), and presence of lymphoid follicles with germinal centers. The patient referred for surgeon for complete excision. in this context , cases previously described in the literature, and the differential diagnosis of ALH are discussed.
Angiolymphoid hyperplasia with eosinophilia (ALH) is a rare benign vascular tumor characterized by solitary or multiple red to brown papules or nodules found mainly on the head and neck of young adults between 20 and 40 years of age,1 with a mean age at onset of 30 to 33 years.2 It has also been described in other tissues, including liver, orbit, spleen, palate, bone, heart, and blood vessels.1,3 It is more common in women than in men1 and is associated with peripheral blood eosinophilia of 6% to 34% in about 20% of patients.2,4 The lesions are often pruritic or painful and may coalesce into confluent plaques that are chronic, with little propensity for spontaneous resolution. Itching is significantly greater when the tumor is larger than 2 cm in diameter.1 A history of trauma is found in some patients (9% in the study by Olsen and Helwig4). The interval between trauma and the onset of the lesion ranges from 7 months to 20 years, with a median interval of 30 months.4 Lesion growth, tumor pulsation, and bleeding are other common presentations.2,4 Most intradermal lesions are small, with diameters of 0.5 to 2 cm; subcutaneous lesions may be much larger, up to 5 to 10 cm in diameter.2,5 The tumor is generally intradermal or subcutaneous, but it may involve deep soft tissues and vessels.1 Peripheral blood eosinophilia, enlargement of regional lymph nodes, and arteriovenous shunts have been reported but are variable features.4 We report a case of ALH that presentedas retroauricular nodules in 42-year-old woman.

Objective; swine flu is known to be caused by influenza A subtypes H1N1,H1N2, H2N3, H3N1, and H3N2, was first proposed to be a disease related to human flu during the 1918 flu pandemic, Iraq face the epidemic of 2009, many patients admitted to the medical word of alkindy teaching hospital, the clinical features were observed and managed according to WHO protocols.
The aim of the study; is to asses some features of morbidity and mortality of swine flu epidemic admitted patients in 2009 in alkindy teaching hospital.
Methods; A total 131 patients with suspected influenza
admitted to Alkindy Teaching Hospital all complain of
fever more than 38c, sore throat with or without cough.
The admitted patients are of two main
groups;a)seventeen secondary school pupils on their
return from US,b)one hundred fourteen patients
admitted from October till end of December 2009.
History ,clinical examination and routine investigations
for all patient in addition to blood samples and swabs
from nose and throat were taken and sent to the central
lab to test for H1N1 by PCR(real time).
Results; fifty three (42%) of our patients found to have swine flu by positive test (real time PCR). It show that there is no relation of age whether young or old to being infected with swine flu or non swine flu (p>0.05). Table 2 also show that gender had no relation to possibility of infection with both non swine flu and swine flu influenza (P <0.05). We found that there was no difference of mortality between swine flu and non swine flu types (p>0.05) and pneumonia are more commonly associate influenza of negative test for swine flu virus (p<0.001). headache is more common in swine flu while chill is more common in non swine flu (p<0.05) in addition diabetes is more commonly associate swine flu than other types of influenza (p<0.05).
Conclusion; This study concluded that mortality in
swine flu influenza is not different from mortality in
non swine flu influenza. Also age and gender had no
relation to possibility of having swine flu infection .
Pneumonia found to be more in non swine flu,
headache associate swine flu more than non swine flu
and chills associate swine flu. Diabetes associate swine
flu more than non swine flu but smoking had no
relation.

Objective: Detection the presumptive prevalence of
silent celiac disease in patients with type 1 diabetes
mellitus with determination of which gender more
likely to be affected.
Methods: One hundred twenty asymptomatic patients
[75 male , 45 female] with type 1 diabetes mellitus
with mean age ± SD of 11.25 ± 2.85 year where
included in the study . All subjects were serologically
screened for the presence of anti-tissue transglutaminase
IgA antibodies (anti-tTG antibodies) by Enzyme-
Linked Immunosorbent Assay (ELISA) & total IgA
was also measured for all using radial
immunodiffusion plate . Anti-tissue transglutaminase
IgG was selectively done for patients who were
expressing negative anti-tissue transglutaminase IgA
with low total IgA levels & results were compared
to that obtained from healthy 60 persons with mean
age ± SD for them was 15.25 ± 3.85 year .
Results : Fourteen out of one hundred twenty (11.66
% ) diabetic patients had expressed positivity to antitissue
transglutaminase IgA compared to 1/60 ( 1.66
%) of non diabetic patients who had expressed such
positivity , P value equals to 0.0221 & it is
considered to be statistically significant. Three out of
one hundred twenty (2.5 % ) diabetic patients had
expressed total IgA deficiency whereas all of non
diabetic patients were expressing total IgA within
the normal range , P value equals to 0.55 & it is
considered to be not statistically significant. All of
three diabetic patients with total IgA deficiency were
not showing positivity to anti-tissue transglutaminase
IgG . Six mals & Eight female of those with type 1
diabetes mellitus had expressed positivity to anti-tissue
transglutaminase IgA , P value equals to 0.1426 &
it is considered to be not statistically significant .
Conclusion : There is an increased prevalence of IgA antitissue transglutaminase antibodies ( 11.66 % ) in children & adolescent with type 1 diabetes mellitus in comparison with control group.

Background: It is important to achieve good glycemic control to avoid long-term diabetic complications. It has been largely debated about the role of correct way of insulin administration to get the desired glycemic control.
Objective: To evaluate the effect of teaching diabetic patients who are on insulin therapy the correct way of injecting insulin and its effect on glycemic control.
Methods: A non randomized clinical trial with 820 diabetic patients on insulin therapy on whom A1 c estimation was performed before and after three months of teaching them the right injection technique.
Results : Sixty seven patients (8.17%) had A1 c 6.5% before they were enrolled in the study while the majority (753 patents, 91.82%) had A1 c 6.5% and the last group showed the best benefit of teaching them the correct way of injection when compared with first group (P= 0.0001). Also patient with age 20-40years showed the best results (P=0.0001), while the poorest results were observed in those aged 40 years and above.
Conclusion: Teaching patients the right injection technique is important to achieve good glycemic control in those who already had poor one.

BackgroundCarcinoma of the larynx represent 10% of head & neck malignancies. The treatment of advanced carcinoma of larynx may include partial or total laryngectomy, with or without laser , radiotherapy,and or chemotherapy . Carcinoma of the larynx usually affect old age , heavy smoker with possible risk of pulmonary diseases & ischemic heart disease , which add risk to the general anaesthetic complication operative & postoperative - Objectives this study was designed to assess the feasibility of total laryngectomy under local anaesthesia in medically unfit patients for general anaesthesia & to re-establish practice doing total laryngectomy under local anaesthesia in those patients.
Methods a prospective study on 12 patients who underwent total laryngectomy under local anaesthesia in the otolaryngology department at Al-Jirahat hospital over a period from September 2007 to the end of July 2010.
Results all patients tolerated the surgical procedure under local anaesthesia without disturbing the general condition of the patient, or the technique of surgery , with good postoperative recovery & early mobility of patient .
Conclusion total laryngectomy can be done under local anaesthesia in case the patient is medically not fit for general anaesthesia , & in some other selected cases .

Background: Animal bites in humans are an important public health problem. Most of these bites are dog bites. Dog bites in humans are a complex problem embracing public health and animal welfare, both in developed and developing nations. .
Al-kindy Col Med J Vol.8 No.2 2012 P: 149
Objectives: in order to estimate the magnitude of the problem and to understand the epidemiological characteristics of dog bite victims registered in Baghdad city regarding their age, sex, number of registered dog bite victims per month and year along the studied period ( 2006-2010) and also to sniff out any seasonal variation in dog bite attacks .
Methods: A across-sectional study was carried out during January (2011), in the Anti-Rabies clinic of (Pasteur Institute) .Data pertaining to victims was collected from the registered monthly reports from January 1, 2006 and December31, 2010.
Results: The total number of registered dog bite victims per 5 years of the study was equal to 26795. The studied epidemiological characteristics showed highly significant differences towards male victims with monthly mean number (60.381), the age group (15-45) years as people at risk with monthly mean number (95.167) , the highest total number of registered dog bite victims during the year (2009), with a monthly mean number (56.056), also there was an evident increase in the number of dog bite attacks during the warm months (May and June) with a monthly mean number ( 50.82) Conclusion: The persistence of dog bite as public health problem in Baghdad city.