Al-Kindy College Medical Journal

Background: Since the invention of laser in 1960, lasers have been developed and approved in many fields. Lasers can now be regarded as practical tools with unique properties that have been utilized effectively in several applications in fields of medical and biological sciences.Objectives: The aim of the current study was to preparation of vaccines (live attenuated and killed) by irradiation of the bacteria by the low level diode laser.Methods: six bacterial isolates were isolated from human samples of diabetic foot infections, which used for preparation of vaccines. The experiment was conducted on fifteen adult male rabbits; they were divided into three groups with 5 rabbits each. Blood samples were collected from the marginal ear vein of the rabbits after one month of the vaccination, for the purpose of measuring the concentration of the immunoglobulins which present in their serum, using Radial Immunodiffusion (RID) method by specialized kits (LTA-Italy).Results: After irradiation of the bacterial suspensions with the diode laser for different exposure times and different frequencies, and the wavelengths used were (660, 820, 915) nm, the growth of bacterial isolates decreased until killed of bacteria at 40 min. The results of IgA concentrations for the three groups were highly significant (P < 0.01) when comparing the attenuated with control group, while were significant (P < 0.05) between the killed vaccine and control groups, and not significant variations between the attenuated and killed groups,Conclusions: Wavelength (660) nm was more effective in killing the bacteria, and the variations were not significant between the live attenuated and the killed vaccine

Background: Historically the traditional medical program are divided into preclinical basic sciences course which taught separately (subject based) and clinical course which taught also as subject based, spoon feeding ,few delivery modes , no or few interactive session and the assessment solely based on examination and no weightage is given to the continuous assessment.Curricular reform: In the last few decades, there have been increasing pressures on medical educators for curriculum reform, and many accreditation bodies were established a guidelines for the medical schools. In many countries, the traditional approach has largely been modified towards a more integrated approach. An integrated approach is still subject centered but transcends the traditional subject boundaries. Teaching units from subject disciplines are fused together around themes/concepts such as body systems.Conclusions: For medical educators, it is of utmost important to be familiar with the current trends in program and curriculum design. Medical curricula need to be dynamic and responsive to external influences and changes if they are to ensure that the doctors of the future have the knowledge, skills and attitudes required by the communities which they serve

1.
Embryonic Origin of Neural Tube Defects.
Insaf Jasim Mahmoud
2.
Etiology of Neural Tube Defectss.
Ali Abdul Razzak Obed
3.
Epidemiology of Neural Tube Defects in Iraq.
Mahmood Dhahir Al-Mendalawi
4.
Surgical Management of Neural Tube Defects.
Laith Thamer Al-Ameri
5.
Prevention of Neural Tube Defects in Iraq.
Mahmood Dhahir Al-Mendalawi

Background: In the past, an association between Tuberculosis (TB) and Diabetes Mellitus (DM) was widely accepted, today the potential public health and clinical importance of this relationship seems to be largely ignored. The national clinical and policy guidance in the UK on the central of TB, for example, does not consider the relationship with DM.Objectives: To determine the risk of association between diabetes mellitus and pulmonary TB.Methods: A retrospective study conducted in Ibn Zuhr hospital for chest diseases from Jan 2008 – sep 2010 , included in the study 402 patients with TB divided into diabetic & non diabetic, 96 (23.8%) were diabetic while other 306 were TB not diabetic.Results: Risk of TB among DM patients were clear through its percentage (23.8), female patients increased in compares with non DM, also their age become older with mean change from 36.7 to 46.3 years in diabetic.Conclusions: DM is a big problem worldwide and efforts to diagnose, detect, and treat DM may have a beneficial impact on TB control.

Background: Ultrasonography has been used to examine the thickness of the lower uterine segment in women with previous cesarean sections in an attempt to predict the risk of scar dehiscence during subsequent pregnancy. The predictive value of such measurement has not been adequately assessed. Objectives: To correlate lower uterine segment thickness measured by trans abdominal ultrasound in pregnant women with previous cesarean section with that measured during cesarean section by caliper and to find out minimum lower uterine segment thickness indicative of integrity of the scar.Methods: A prospective observational study at Elwyia Maternity Teaching Hospital, from January 2011 to January 2012. A total of 143 women were enrolled in the study. Those women who were included were pregnant with gestational age (36-40) weeks, all had history of previous one or more cesarean section. Transabdominal ultrasound measurement of thickness uterine segment thickness done with moderately full bladder before delivery and correlated with these measured directly during operation using a caliper. The sensitivity and specificity of ultrasound calculated with positive and negative predictive value. Results: The sensitivity and specificity of trans abdominal ultrasound in detecting patient at risk of scar dehiscence in patient with previous and cesarean section not starting uterine contractions were very high 90%and 92% respectively with positive and negative predictive value of 90% and 92% respectively with a cut off value of uterine segment thickness of 4.5 mm. It was also has high sensitivity and positive predictive value of 93.4% and 93% respectively with patients that started labor but with low specificity and negative predictive value of 50% and 38% respectively with the same cut off value.Conclusions: Sonographic lower uterine segment thickness is a strong predictor for uterine scar defect in women with prior Caesarean section. However, no ideal cut-off value can yet be recommended, whenever uterine contractions started. But this method carries a high sensitivity and specificity in patients who did not start uterine contractions with a cut-off value of 4.5 mm.

Background: Febrile convulsions are the most frequent type of seizures in children under 6 years of age. Significant percentage of these children will later suffer from recurrence of febrile convulsion.Objectives: To identify the main risk factors for recurrent febrile convulsions in children.Methods: we carried out a case control study involving 89 children those who experienced first attack of febrile convulsions and 92 children with recurrent attack of febrile convulsions. The study was conducted in Central Children Teaching Hospital, Baghdad during the period 2006- 2007. Results: Compared to children with first attack of febrile convulsion, children with recurrent seizures were younger at onset (4- 12m) (67% vs. 44%), mainly male (70% vs. 51%) and had more often family history (first degree relative) history of epilepsy, low degree of temperature (45% vs. 23%) and frequent febrile illnesses (83% vs. 50%). second degree family history of febrile convulsion and onset of febrile convulsion in relation to onset of fever and type of convulsion (simple vs. complex) were not significant risk factors.Conclusions: Awareness of these risk factors should lead pediatricians to suggest administration of short course of diazepam at onset of each febrile illness to prevent recurrent febrile convulsions. Also, public education on recurrent febrile convulsions is needed.

Background: Helicobacters are motile curved, oxidase and catalase positive,
gram negative rods similar in morphology to vibrios. The cells have polar flagella
and are often attached at their ends given pairs "S" shapes or seagull
appearance.
Object i ves: The present study was undertaken to estimate the serodiffusion of
H. pylori and hepatitis A virus (HAV) in 300 patients attending two centers in
Baghdad.
Metthods:: HAV was determined by the detection of HAV-IgM in the serum samples. Detection of H. pylori was by ELISA and endoscopic examination.
Resul t s: The serodiffusion of H. pylori was 40% (n=120). Out of the 120
patients infected with H. pylori, 50(41 .6%) patients were diagnosed clinically to
have gastric antraum, the remaining 70 (58.4%) patients were apparently free of
any disease. The present findings showed that the serodiffusion of anti hepatitis
A virus (HAV) antibody was 30 % (n=90).
Concllusiions:: This study shows relatively high serodiffusion of H. pylori and HAV in the studied group. None of the cases had co-infection with both H. pylori and HAV; this may be due to the small size number of the patients under study.

Background: Sexual dysfunction in patients with schizophrenia was reported as one of the most distressing antipsychotics drug adverse effects and it is directly related to treatment compliance, but the subject seldom touched in the field of psychiatry in Iraq previously.Objectives: To assess and find out the impact of schizophrenia on Sexuality of the patient, and illustrate effect of anti-schizophrenic on sexual activityMethods: using DSM4-TR and ASEX scale questionnaires for 104 male participants from out 155schizophrenic patient were studied in sex clinic in Al-Rashad teaching hospital for psychiatric disease in Baghdad. The study extended for 22 months from 1st of July 2010 to the 1st of April 2012, t test and chi square test were used for statistical analysis. P ≤0.05 used as cutoff point of significance.Results: fifty-five percent of schizophrenic male in this study got sexual dysfunction, their ages extended from (18-66 y) with mean 47year,there was significant association between age and sexual function (p- 0.018), although only 17%(18 out of 104) got secondary school education or higher ,but there is significant association between getting better educational level and better sexual function (p 0.001), results showed that low socioeconomic status got worse effect on sexual function(p 0.044) and so when being unemployed (p 0.001)combination of antipsychotic with antidepressants, may cause sexual dysfunction (P 0.036) ,and the more the duration of treatment the worse the effect on sexuality(P 0.001). When patients classified by type of sexual disorder:-desire disorder 19%, arousal disorder 28%, orgasm disorder 24%and sexual dissatisfaction with partner 29%.Conclusions: sexual dysfunction in schizophrenics is rather common though shadowed in our community for cultural, religious reasons and stigma of schizophrenia itself, so that evaluating sexual dysfunction should be routinely inquired from patients with schizophrenia receiving antipsychotics medication during follow up and dosage adjustment.

Background: Various studies conducted in many parts of the world suggest that there is lack of public awareness and knowledge of various aspects related to diabetes. With proper education, awareness, earlier detection and better care, many complications and co-morbidities can be reduced in diabetic population.Objectives: to evaluate the level of awareness of diabetes mellitus type 2 patients regarding their disease and its' complications.Methods: Cross – sectional survey was conducted during November and December 2011, in the Medical centers of Al Baladiat, Mustansyria and Zuafranya, including 145 type 2 diabetic patients (58.6 % males, 41.4% females) who were subjected to self–structured questionnaires regarding different aspects of the disease Results: Medical staff was the main source of information in 75% of patients, poor proportion of correct responses (25.5%) regarding disease etiology, symptomatology of feeling hungry (42.7%), generalized weakness (33.1%) also (44.8% & 30.1%) knew about the target blood sugar and blood pressure respectively. The proportions of correct responses regarding disease complications were not acceptable especially for myocardial infarction (18.6%), also poor daily blood sugar monitoring (11.03%). The knowledge of patients regarding management of disease by life style modifications was poor regarding physical exercise (40.6%) and weight reduction (40%) and (46.8%) of patients knew their drugs name , doses and side effects.Conclusions: Generally, poor awareness of patients regarding diabetes mellitus and its complications

Background: Many structural or functional abnormalities can impair the production of thyroid hormones and cause hypothyroidism.Objectives: to identify the main etiological causes of hypothyroidism among patients visiting Specialized Center for Diabetes and Endocrinology.Methods: This study was conducted in the Specialized Center for Diabetes and Endocrinology on 217 patients with proved hypothyroidism, from 2006 to 2008. Every patient was tested with thyroid function tests, Ultrasound examination, thyroid autoantibodies, fine needle aspiration, radiology of skull, isotopes scan, also checking adrenal and gonadal function. Results: Out of these 217 patients 120 patients have thyroiditis 33 patients had been undergone thyroidectomy. 39 patients had received radioactive iodine, 19 patients had congenital causes. One patient had Pituitary cause, 5 patients had graves diseases.Conclusions: It was found that the common causes of hypothyroidism are either chronic autoimmune thyroiditis or destructive treatment for thyrotoxicosis. The results of this study suggest an increase in autoimmune thyroid disease similar to the rising prevalence of type1 DM possibly indicating a rising incidence of autoimmunity in young people

Background: During Annual statistical report published by the Iraqi ministry of health the year 2004 showed that mortality rate was 0.15 per 1000 of diarrheal episodes among children under five years.Objectives: To study the occurrence of Shigellosis and Entamoeba histolytica in a sample of children from certain hospitals in Baghdad and determine its relation to some demographic factors.Methods: This cross sectional study was carried out in Baghdad city involving 400 children with bloody diarrhea under five years of age attending four hospitals, 130 cases from Central Pediatric Hospital, 110 cases from Al Mansoor Pediatric Hospital, 90 cases from Al Kadhimya Teaching Hospital and 70 cases from Mohammed Baaqir Al Hakeem Hospital for the period from the first of January through October 2005. Stool specimens were examined microscopically for detection the amoebic dysentery and negative cases were sent for stool culture for detection of Shigellosis. Results: The study revealed that Entamoeba histolytica was the most frequently identified cause of bloody diarrhea 362 (90.5%), while shigella was identified in 38 cases (9.5%). young children below two years of age were more liable to have diarrhea than other age group. Both shigella and amoebic cases shared the following risk factors, lack of breast feeding, unboiled water, low level of education of mother and overcrowding.Conclusions: Child health services should concentrate on health education of mother to encourage breast feeding, boiling of water, general personal and environmental hygiene to prevent spread of these infection.

Background: Studies discussing the correlation between biochemical markers of bone turnover and the diagnosis of osteoporosis in postmenopausal Iraqi women are rare. This study is devoted to find out the significance of serum osteocalcin (OC) and osteopontin (OPN) levels with the incidence of osteoporosis and its major complication (fracture).Objectives: to investigate the significance of bone turnover biochemical markers; serum osteocalcin and serum osteopontin in evaluating osteoporosis for postmenopausal Iraqi women with and without history of vertebral fracture, as well as to explore the relationship of these markers with bone mineral density (BMD).Methods: Fifty seven postmenopausal women whose ages are fifty years old and over, categorized into two groups: osteoporosis postmenopausal women (n=30), and healthy postmenopausal women (n=27). All sera samples were analyzed for serum alkaline phosphatase, calcium and phosphorous by using spectrophotometric kit. Serum OC and OPN levels were measured by immunoassay (ELISA) kits. BMD were measured by (DEXA). Results: BMD and T-score were significantly lower in osteoporotic postmenopausal group as compared with healthy group (p=0.0001). Serum OC levels and serum OPN levels were elevated significantly in osteoporotic postmenopausal group as compared with healthy group (p=0.0001).Conclusions: The levels of OC and OPN in serum could be used as a biochemical indicator in the early diagnosis of osteoporosis postmenopausal women

Background: Polycystic ovary syndrome is a heterogeneous disorder and its etiology appears to be complex and multifactorial; characterized by hyperandrogenism, chronic anovulation and infertility. It’s associated with evidence of low-grade chronic inflammation, as indicated by the presence of elevated levels of high sensitive C- reactive protein levels, interleukin-6 and tumor necrosis factor-α. The source of excess circulating tumor necrosis factor-α in obese Polycystic ovary syndrome patient is likely to be the adipose tissues while in lean women increased visceral adiposity has been proposed as a source of excess tumor necrosis factor-α.Objectives: to evaluate the levels of high sensitive C- reactive protein, tumor necrosis factor-α and interleukin-6 in patients with polycystic ovary syndrome before and after treatment with metformin; with emphasis on their relationship with the improvement in ovulation rate and body mass index in Iraqi women.Methods: 69 Iraqi females with PCOS, with mean age of 25.8±4.4 years, body mass index 31.14±2.23 kg/m2 and insulin resistant equal to 3.15±0.25. Additionally, 30 healthy fertile women BMI= 26.87±3.1 kg/m2 and mean age 23.4±2.8 years), the patients were treated with metformin 1500 mg/day for 3 months. Blood samples were obtained in the morning subsequent to an overnight fasting at baseline and at the end of the 12 weeks period of treatment, the samples were analyzed for plasma glucose level estimated by enzymatic colorimetric kit, while serum insulin , TNF-α, IL-6 , hs-CRP, Progesterone and sex hormone binding globulin . Results: BMI values were significantly increased at baseline value in patients (P<0.05) compared with healthy controls, then significantly decreased (12.9%) after treatment compared with baseline values, HOMA-IR index were significantly elevated in patients group at baseline compared with control, and significantly decreased by 17.4% after treatment. Regarding the influence of metformin on inflammatory markers, the present study demonstrated significant elevation of baseline levels (P<0.05) of TNF-α, hs-CRP and IL-6 compared with controls, and the baseline levels significantly decreased after treatment by 16%, 38% and 37% respectively. Meanwhile, sex hormone binding globulin levels were significantly decreased in PCOS patients compared with healthy controls, and significantly increased after treatment by 16.6%, also progesterone levels decline at baseline compared with control group, and it was increased significantly after treatment by 24%.Conclusions: The study detects an increased level of inflammatory cytokines, SHBG and decrease level of progesterone in Iraqi females with PCOS, and metformin therapy improves serum levels of the inflammatory cytokines associated with increased ovulation rate.

Background: Osteoarthritis (OA) is a degenerative joint disease. It is one of the major causes of disability in developed and developing countries. Human leukocyte antigen (HLA) as part of immune system has a role in the disease process.Objectives: To investigate whether there is an association between HLA class II-DRB and OA.Methods: A case control study with 26 patients with osteoarthritis and 22 apparently healthy obese control persons matching in ethnicity were enrolled in this study during the period between October 2012 till March 2013. Direct interview was done with each patient and HLA typing was done by molecular method using Sequence Specific Primer (PCR-SSP) method using One Lambda Kit-USA. Results: The results showed that females were more affected than males with disease when compared with control. Odds ratio were used to test level of significance. This study showed that HLA DR4 (DRB1*04), DR2 (DRB1*15 and DRB1*16), DR9 (DRB1*09), DR10 (DRB1*10, DRB5*, DRB4* and DRB3*) (odds ratio: 14.26, 9, 9, 9, 14.26, 9.5 and 4.5) respectively are associated with OA.Conclusions: OA is highly associated with HLA class II DR4 (DRB1*04), DR2 (DRB1*15, DRB1*16), DR9 (DRB1*09), and DR10 (DRB1*10).DR5 (DRB1*05) is not associated with OA.

Background: Thalassemia is characterized by the decrease or absence of the synthesis of one or more globin chains of hemoglobin. Thalassemia is distributed worldwide and is characterized by; regular blood transfusion which is creating alloimmunization to erythrocyte antigens is one of the major complications of regular blood transfusions in thalassemia, particularly in patients who are chronically transfused.Objectives: The aims of this study are to understand the immune system profile as the triggering factor for thalassemia.Methods: Thirty patients aging between one year and four months and twenty two years, twenty two of them were boys and eight were girls. Twenty nine patients, their parents are relative except one and studied in the maternity and Children teaching Hospital of Al Samawa city. Belonging to Blood groups O+, B+, A+, O- and B- , showed,12,8,7,2 and 1 patients respectively compared to control group 30 persons with no relation to blood groups. High percentages of relative marriages as seen in my study (96.66%), from all Al muthana population how were visiting the hospital during 2010, in thalassemic center. Results: twenty six patients out of thirty patients studied suffer from cardiomegaly (86.66%) due to iron over load because of frequent blood transfusion and immune system disorder. Results also showed eight patients suffer also from Bronchopneumia (26.66%) and all patients had hepatomegaly, splenomegaly and hemoglobin were low in all patients compared to hemoglobin control average which was 10.72-14.76 g/dl. Facial and teeth deformities were recognized in twenty six patients (86.66%).Conclusions: hepatomegaly and splenomegaly, followed by cardiomegaly, facial and teeth deformities were the most persistently recognized features in thalassemic patients. Bronchopneumia is less frequent but not uncommon.

Background: Day case surgery has become widely accepted as a safe alternative to the inpatient care in up to 70% of the cases at a children’s hospital. It has the advantage of minimizing the psychological trauma of hospitalization, decreasing nosocomial infection, less costly and frees up hospital beds.Objectives: To assess the advantages and disadvantages of this type of surgery.Methods: this is a prospective study, in which two hundred thirty childhood tonsillectomies were performed as a day-case in the department of otolaryngology at Al Shaheed Gazi hospital, Medical City Complex during the period from October 2009 to September 2010. The patients age range from 3-12 years (Mean 7.2 years).Results: 46.08% males and 53.91% females were included. A total of two hundred twenty three patients were discharged home six hours after the operation. It's found that the incidence of reactionary hemorrhage was 0.8% and the cases presented within 5 hours after leaving the theater. In 99.2% of cases, there was no evidence of serious reactionary hemorrhage.Conclusions: day case tonsillectomy in children is likely to be safe if the patients are discharged after 6 hours period of postoperative observation in day-case unit.

Background: intravenous regional anaesthesia (IVRA) is an effective method of producing anaesthesia of the extremities. Disadvantages are the rapid loss of anaesthesia after the deflation of the tourniquet and the rapid development of postoperative pain. It is important to search for agents with longer durations of action, better nerve fibre selectivity, lesser degrees of motor blockade and lower incidences of systemic toxicity.Objectives: This study was designed to evaluate and compare the clinical effects of intravenous regional anaesthesia, with lidocaine alone, or in a combination with ketamine and atracurium for better analgesia, and to examine the possible clinical advantages of using muscle relaxants (i.e., atracurium) with intravenous regional anaesthesia.Methods: In prospective, randomized study, sixty patient ASA physical status I, aged 20-50years underwent surgeries on distal regions of upper limbs, patient assigned randomly into 3 groups each of 20 patients, group I received 30ml of 0.5% lidocaine (150mg), group II received 30ml of mixing 0.5% of lidocaine (100mg) plus 30mg ketamine, while group III received 30ml of mixing 0.5% lidocaine (100mg) plus 30mg ketamine plus 2mg atracurium. All the results were tabulated and analyzed statistically with student's unpaired t-test and chi-square test. Results: Addition of 30mg of ketamine to 0.5% lidocaine resulted in rapid onset of sensory block, motor block, and lower visual analogue scale scores for pain compared with the group that received lidocaine only. The addition of atracurium to the combination of lidocaine and ketamine resulted in improved operating conditions and rapid onset of both sensory and motor blocks with less pain during surgery.Conclusions: drug combination of ketamine, atracurium and low dose of lidocaine lead to rapid onset of sensory block, motor block, lower VAS score for pain, and decrease adverse effect of Bier’s block accompany lidocaine alone, decrease drowsiness which accompany ketamine use alone in IVRA

Background: Quality of life in brain tumor patients is an emerging issue and has prompted neurosurgeons to recon¬sider the need for cognitive assessment in the course of treatment. To date there has been a lack of comprehensive neuropsychological assessment performed preoperatively and in the acute postoperative period in our hospitals.Objectives: to establish the effects of tumors and their surgical treatment, from a neuropsychological perspective, on cognitive functioning in patients with cerebral Gliomas. Methods: This is a prospective study conducted in the Neurosurgical Hospital in Baghdad, Iraq, during the period from January 1999 to January 2001. Any patient admitted during the period of the study with clinical history, signs, symptoms, and contrast enhanced MRI suggesting a cerebral glioma and confirmed by postoperative histopathological results of glioma has been included in this study. While multifocal lesions, long-lasting epilepsy, use of antiepileptic therapy, multiple cranial lesions, previous cranial surgery, any chronic illness, and histopathological result of other tumors were exclusion criteria. All patients were at their first operation for brain tumors. Patients were examined by analyzing several functional domains (intelligence, executive functions, memory, language, praxis, gnosis and mood state) in order to establish the effect of tumor and surgery on cognition.Results: 29 patients who fulfilled the selection criteria were included. Mean duration of clinical history was 5 months (range 1–9 months). At baseline, using test- and domain-based criteria, 79% and 38% of patients, respectively, were impaired, the former related to tumor factors such as edema (P < 0.05), larger size (P < 0.05) and higher grade (P = 0.001). Verbal memory, visuospatial memory and word fluency were the most frequently affected functions, partly associated with depression. Postoperatively, 38% and 55% of patients, respectively, were unchanged, 24% and 21% improved, and 38% and 24% worsened; 24% and 62% of patients were intact, respec-tively.Conclusions: The extent of removal did not influence the outcome. Improvement involved previously impaired functions and was correlated with high-grade tumors. Worsening regar¬ded executive functions was related to tumor size and was partly explained by radiological findings on postoperative MRI. This prospective study, focusing on the effects of tumor and surgery, showed that tumor significantly affects cognitive func¬tions, mainly due to the mass effect and higher grading. Surgical treatment improved the functions most frequently affected preoperatively and caused worsening of execu¬tive functions soon after operation, leaving the overall cognitive burden unchanged and capable of improvement prospectively.

Backgrround:: Cholera is gastroenteritis caused by enterotoxin producing Vibrio cholera. Cholera is predominantly a waterborne disease especially in countries with inadequate sanitation. Several rapid methods have been developed and used to detect V. cholerae serotypes directly from stools.
Objjecttiives:: to evaluate a rapid and accurate method for the diagnosis of cholera caused by V. cholerae O1 and O139 serogroups d to find the incidence of sporadic cases of cholera in Baghdad.
Metthods:: Sixty four stool samples were collected from four hospitals in Baghdad. The age of patients ranging from two months to 12 years, 26 were females and 38 males. Immunochromatographic visual test for qualitative detection of O1 and /or O139 serogroups was used as well as routine culture procedure for isolation of V. cholerae.
Resulltts:: Immunochromatographic visual test shows that, out of 64 stool samples only 16 was positive (23.4%). Fifteen of them belong to O1 serotype and one belong O139 serotype. Stool sample culture on alkaline peptone water and then on Thiosulfate Citrate Bile salts Sucrose (TCBS) agar enhance the growth of 11(68.75%) V. cholerae isolates out of 16 that were positive by using immunochromatographic visual test. Sensitivity of culture and immunochromatographic test was 68.75% and 100% respectively.
Concllusiions:: V. cholerae O1 is more predominant than V. cholerae O139 among V. cholerae strains isolated from sporadic cases of cholera in Baghdad. Immunochromatographic test is rapid, accurate and more sensitive than culture method in recover V. cholerae strains.

Background: Job satisfaction remains as an important concern for both employer and employee. A high-quality teaching staff is the cornerstone of a successful educational system. One step in developing a high quality faculty understands the factors associated with teaching quality and retention. One of these factors is job satisfaction, which has been studied widely by organizational researchers.Objectives: To evaluate the extent of job satisfaction of teaching staff working at AL-Kindy College of medicine and to identify some work-related factors associated with job satisfaction.Methods: A cross- sectional study was carried out. A convenient sample of 50 teaching staff, who had a teaching job at different scientific departments at AL-Kindy college of Medicine. The data was collected using a questionnaire form which includes information under three main headings: information related to the socio-demographic characteristic; the work motivators and the work environmentsResults: the study shows that 60% of the academic staff were generally satisfied with their job, the general satisfaction were more among those with age more than 50 years, males, singles, those with no children, and those living near their work place with the following percentage 68, 78, 87, 87 and 87, respectively. It also revealed that positive criticism, promotion, training, growth in work, increase income, new responsibilities, were the most motivators to work.Conclusions: Most of the academic staff were generally satisfied with their job. Most of the academic staff were satisfied to the studied work motivator and environment factors.

Bac kground:
Failure is the state or condition of not meeting a desirable or intended objective, and may be viewed as the opposite of success; students always have a question "Why did I get this grade. On the contrary success leads towards new sources of earning, in fact there are a lot of interacting factors play such extrinsic and extrinsic to reach success.
Objec t i ves :
To explore internal and external factors causing students failure in medical college and to reconnoiter factors improve academic performance.
Methods: A cross-sectional study, conducted in Al Kindy College of Medicine, for the period from November 8th 2012 to May 1st 2013. Formal ethical considerations were obtained about participation and methodology. A sample of 152 students were included and classified according to their year in the college, a questionnaires about students opinion, include a lot of factors in the all fields of educational process and socio-demographic linked with final outcome of the students.
Resul t s : success was more in females, fifth year (83%), student wellness (78%), practical teaching method (75%), regularity in attendees (80%), all lecture attendees (85%), 3-5 family number (78%), 6-10 studying hours (82%), and 25 reading hours weekly (100%), also result of student opinion about crowded weekly schedule (80%), daily quizzes influence (76%), comprehensive material (85%), long lecture duration (74%), headache as cause of failure (23%), consult doctors if there is health problem (88%), and internet uses (72%). These result come in consistent with international studies and researches.
Conc lus ions : applying new techniques in medical education good health monitoring can improve students' academic outcome.

Bac kground: The transfer of the tibialis posterior tendon to the anterior aspect
of the ankle not only replaces the function of the paralyzed muscles, but also
removes the deforming force on the medial aspect of the foot.
Objec t i ves : In this study, we evaluated patients who underwent tibialis
posterior tendon transfer for the treatment of foot drop, and comparison through
interosseous membrane route versus anterior to lower tibia route of tibialis
posterior tendon transfer, with evaluation of the results according to carayon
criteria
Methods: Nine patients with foot drop secondary to different causes treated with
tibialis posterior tendon transfer from January 2011 to January 2012 were
followed up for a mean of 12 months in Al Kindy Teaching Hospital. We use two
different techniques, first transfer the tendon through the interosseous
membrane (four patients), and the second technique transfer the tendon anterior
to tibia (five patients).
Resul t s : In general according to carayon evaluation criteria, the results were
excellent in two patients (22.2%), good in five patients (55.6%), and moderate in
two patients (22.2%). Through anterior to lower tibia route, 4 patients get
excellent to good result (80%), and through interosseous route, 3patients get
good to excellent result (75%).
Conc lus ions : Transfer of tibialis posterior tendon for the treatment of foot drop
deformity enables the patients to walk without the aid of orthosis and increase their
quality of life. With no differences between anterior to lower tibia route and through
interosseous membrane route.

Background: Dilated cardiomyopathy (DCM) is a well-recognized cause of cardiovascular morbidity and mortality.Objectives: To evaluate the prognostic implications of the restrictive left ventricular filling pattern (RFP) in dilated cardiomyopathy.Methods: Patients with DCM admitted to Ibn AL-Bitar Hospital for Cardiac Surgery, Baghdad-Iraq, from May 2006 to August 2008, underwent a full clinical evaluation and Doppler echocardiography study. Patients were classified into three groups: Group I had persistent restrictive filling pattern; Group II had reversible restrictive filling pattern; and Group III had nonrestrictive filling pattern. Results: The current study was conducted on a total number of 80 patients with DCM, fifty (62.5 %) were males and 30(37.5%) were females with a male to female ratio 1.6:1. Patients with restrictive filling pattern (Group I&II) were 51 (63.8%), while patients with nonrestrictive filling pattern (Group III) were 29 (36.2%). During follow up, patients with persistent restrictive filling pattern (30; 37.5%) had higher New York Heart Association (NYHA) class symptoms, low ejection fraction (EF) and higher mortality; 6 (20%) died within the first year, 6 (20%) died in the second year. Clinical improvement was significantly frequent in Group II and III than Group I.Conclusions: In patients with DCM, the persistence of restrictive filling at 3 months is associated with a high mortality the patients with reversible restrictive filling have a high probability of improvement and excellent survival.

Background: Chondrosarcoma is the second most frequent primary malignant tumor of bone. It is considered relatively an uncommon tumor. Generally it is not common for chondrosarcoma to attend huge size; however, one type was described as mesenchymal chondrosarcoma of low grade cartilaginous cells, with female predominance which can grow to exceptionally large size. Case Presentation: We report a case of Chondrosarcoma, in 30 years old woman of 4 years duration, with a huge mass (weighted 16 Kg) and roughly measured 40x30 x20cm, around the right shoulderInvestigations: Repeated MRI of the shoulder and trunk revealed a clear plane of cleavage between the tumor mass and the chest and abdominal walls and absence of invasion of the abdomen. Ultra sonography revealed clear abdominal cavity and CT of the chest revealed clear lungs of any metastasis.Treatment: A right forequarter amputation accomplished successfully and the whole tumor with the right upper extremity in one mass was removed.Outcome and Follow-up: The post operative period was uneventful. The pathological examination is consistent with well differentiated chondrosarcoma.Conclusions: It was difficult to decide whether the tumor was a primary or secondary; because of poor clinical history and her reluctance to seek medical advice, she is living in a small town 50 km south of Baghdad and there is good medical services in her area; this could reflects the social and psychological attitude towards amputation of a limb as a treatment.