Al-Kindy College Medical Journal

The aims of the lecture should be clearly defmed. These will help to define the teaching methods and the structure. If, for example, the purpose of the lecture is to introduce new knowledge and concepts, then a classic lecture structure might be most appropriate. On the other hand, if the purpose is to make the students aware of different approaches to a particular clinical problem, a problem oriented design in which alternative approaches are presented and discussed might be a more appropriate fonnat.
Lectures are still a common teaching methOd in both undergraduate and postgraduak medical education. Properly done, the lectwe is a creative and personal work by the teachll:l modeled upon his intellectual scaffolding. Few other fonns of instructional method demand such a high degree of originality from tire teachers, making it both challenging adtl rewarding for them. Their continued popularity is due to the fact that they represent cr;; effective and efficient means of teaching net' concepts and knowledge.

have been notable developments in the field of
r.ldical education in the country and in the region.
The most significant of which is a general awarness
that has been created about the need for and
relevance of changes.There is however a basic
question that posses itself and becomes clearly
relevant
in the context of effort .Today, to recognize health
care services in the developing countries in the light
of realigned priorities This ensure to bring about
learning outcomes as a tocurriculum changes to meet
this demand.

Background: Hemorrhoids are one of the most
common surgical conditions .Conventional
haemorrhoidectomy was the traditional operation for
the treatment of hemorrhoids. Other modalities of
treatment had been used as an alternative operations
including CO2 laser haemorrhoidectomy.
Objectives: To determine the outcome of treatment
of hemorrhoids by using CO2 laser
haemorrhoidectomy and its advantages over
conventional surgery
Methods: This is a retrospective comparative
interventional study of 1024 case of third degree
haemorhoids selected out of 1300 case of
hemorrhoids of different degrees, admitted to
ALKINDY, ALYERMOUK teaching hospitals and
ABD ALMAGEED private hospital, from May 1998
to July 2002,they were treated by CO2 laser
haemorrhoidectomy and conventional surgery. They
are divided into 2 groups randomly, 512 cases treated
by CO2 laser (group A), 512 cases treated by
conventional surgery (group B). Both groups were
studied regarding operative time, hospital stay,
healing time, post operative complications and cost
effectiveness.
Results: In GROUP A, the operative time ranged
from 10 to 20 minutes with an average of 13 minutes.
The hospital stay ranged from 4 to 12 hours with a
mean time of 10 hours as all cases were treated as
day cases. Post operative pain was minimal in 50% of
patients and required simple analgesia for treatment
while 50% had no pain. Bleeding occurred in less
than 1% of cases, anal stenosis 3.3%, Infection
recorded in 0.58% of patients.In GROUP B, The
operative time ranged from 15 to 25 minutes with an
average time of (19) minutes, hospital stay ranged
from 24 to 48 hours with a mean time of 28 hours
.Post operative pain recorded in all the patients
(100%) and required narcotic analgesia for treatment,
25 patients (4.8%) had varying degrees of bleeding,
40 patients (7.8%) had infection, 25 patients (4.8%)
had anal stenosis.In group A due to shorter hospital
stay, earlier healing of wounds, earlier return to work
which was within 7 to 10 days, the surgical treatment
proved to be cost effective

Back ground: One out of six children in the
world today is involved in child labor, doing
work that is damaging to his or her mental,
physical and emotional development.
Objective: Assessment of some health
problems among the studied working children.
Method; A cross-sectional study was
conducted in Al Amen Primary Health Care
(PHCC) during the period from January to
August 2009, a sample of 6048 children were
selected randomly(3218girls and2866 boys age
between 5-17 years ) and interviewed to collect
information using a structured questionnaire
form, information related to different aspects
of child labor prevention were included in the
form as well as a general medical examination
and laboratory assessment.
Results:. The frequency of child labor was
10.95% among the children study, and the
detection of work related illnesses among
working children was observed in 402 working
children(60.36%).While work related accidents
was 264(39.63%).Both sexes showed
difference in frequency of labor (77% boys
and 23% girls).there was association
between malnutrition and child labor(x2
=64.11
,df=1,p-value<0.05)also such a association
with smoking habit (x2
=98.53,df=1,p-value
<0.05) .The highest frequency of child labor
(32%)was found among 15-17 years age group
of boys. While the highest frequency of child
labor (11.71%)was found among 9-11 years
age group of girls. Out of 666 working
children there are 26 child with lead
poisoning(3.90%).
Conclusion: Child labor can induce many
health problems among the studied working
children

ackground: Escherichia coli is one of the most
important bacterial pathogen that can cause several
disease to human being . In our study we try to
investigate the sensitivity resistance pattern of
Escherichia coli against three antibiotics ( Amikacin,
Nalidixic acid and Cephalexin).
Methods: For this purpose we collected 51 clinical
isolates of Escherichia coli from stool and urine of
outpatient and inpatient patients from different wards
of AL-SADER Teaching Hospital in AL-NAJAF
AL-ASHRAf, IRAQ, and tested by culture and
sensitivity test .
Results: The results appeared that Amikacin show
the highest percentage of sensitivity ( 66.66 % ) ,
while Cephalexin show the lowest percentage of
sensitivity ( 6.34 % ) .
Conclusions: we conclude that Amikacin is the most
sensitive antibacterial drug for Escherichia Coli as
compared with Nalidixic acid and Cephalexin, while
Cephalexin is the most resistant antibacterial drug
for Escherichia Coli as compared with Amikacin and
Nalidixic acid.

Background: Cisplatin is one of the most
commonly used anti-cancer drugs , but its
clinical use was limited by its nephrotoxicity .
Methods: In this study we try to investigate the
renoprotective effect of captopril and
aminophylline against cisplatin induced
nephrotoxicity .For this purpose a 36 Sprague
Dawley rats was divided randomly to 6 groups ,
each group consist of 6 rats. The first group
given normal saline and act as control group,
while the other 5 groups given cisplatin ( 7.5
mg/kg ) , captopril ( 60 mg/kg ) , aminophylline
( 24 mg/kg ) , captopril with cisplatin and
aminophylline with cisplatin respectively. All
drugs are given as single dose through
intraperitonial route. After 6 days blood urea
and serum creatinine, malondialdehyde and
glutathione are measured and compared with
control group.
Results: The data show that both captopril and
aminophylline posses renoprotective effect
against cisplatin – induced nephrotoxicity, also
the data show that captopril renoprotective
effect is more than that produced by
aminophylline.
Conclusions: This data can help in increase the
dose of cisplatin in clinical uses together with
use of renoprotective agent , specially if the
patient already need such renoprotective drugs
for treatment of disease a way from cisplatin as
hypertension .Also more clinical studies
required for more assessment of the clinical
pattern of this renoprotective effect

Background: Fiber-optic endoscopy is an important
investigation of the large intestine, whether or not the
radiologist (barium enema) has discovered a lesion in
the bowel. Colonoscopy affords a unique opportunity
to direct visualization of entire colonic mucosa. At
the same time, the physician can obtain biopsy specimens, remove polyps, and decompress volvuli.
Most experienced endoscopists and well prepared
patients can reach the cecum in over 90% of patients.
If colonoscopy is properly performed, it has a low
risk of complications, such as perforation and bleeding.
Methods: A total of 70 consecutive patients admitted
to Endoscopy department at Al-Kindy Teaching hospital from September- 2008 to July-2009. Bowel
preparation was achieved with Polyethylene glycol
lavage solution and 165 cm Pentax colonoscope
EC_3385FK 4.2 was used in all cases. All patients
were not sedated or given any other medication
Results:Seventy colonoscopies were performed in
this study. Forty of them were male and the rest were
female. The mean age was 42 years ranging from 4
years to 85 years. The most common indication for
colonoscopy was rectal bleeding (44%) Polyethylene
glycol lavage solution was used in all patients for
bowel preparation. All patients did not receive premedications. Complete colonoscopy examination was
done in (12.8%) of patients, the most common cause
of incomplete examination was poor bowel preparation (50%). No complications were reported.
Conclusions: Rectal bleeding was the most common
indication for colonoscopy. Poor bowel preparation
was the main cause of incomplete colonoscopy.

Background: Preeclampsia occurs in 3-5% of
pregnancies and is a major cause (12-20 %) of
maternal mortality in developed countries. It is the
leading cause of preterm birth and intra-uterine
growth restrictions (IUGR).
Objective: The study was designed to determine and
demonstrate the ultra structural changes of
endothelial cells in placenta of women suffering from
hypertensive disease.
Patients & Methods: Placental samples were
obtained from two groups of pregnant women
groups (preeclamptic and normal pregnant women).
The specimens were fixed in 2.5% gluteraldehyde
and preceded for electron microscopic examination.
Results: Placenta of women with preeclampsia has
shown marked degenerative changes in both
endothelial and trophoblastic cells. These changes
were represented by precipitation of fibrin with the
accumulation of platelets in capillary lumen.
Abundance of collagen fibers precipitate in the apical
region of both endothelial cells and trophoblasts, with
thickening of endothelial basement membrane.
Conclusion: All histological changes or lesions
obstruct the continuous conduction from maternal
surface of the trophoblasts through fetal capillary
endothelium causing endothelial dysfunction

Background: Leishmaniasis is important public
health problem owing to its impact on morbidity
and mortality and difficulties in application of
effective control measures.
Objective: The aim of the study is to evaluate the
using of impregnate bed nets in the control of
leishmaniasis.
Methods: The study was conducted throughout
the years 2004 and 2005, in Diala Governorate
(about 60km north-east Baghdad). This is the first
study in Iraq for evaluation of the impregnated bed
net in control of leishmaniasis. Two villages were
selected to achieve this aim. The nets were
distributed for the first village to be used by their
population. The second village was served as
control.

Results: The results revealed that there was a significant
decline in the incidence of cutaneous leishmaniasis from
19.23 per 1000 (before net distribution) to 3.34 per 1000
(after net distribution). On other hand, there was no
significant difference in the incidence in the second
village (control) as it was 13.42 to 12.46 per 1000.
Conclusions: Impregnated bed net is effective in the
reduction of leishmaniasis incidence when used properly
as a control measures

Background: The immunogenetic predisposition
may be considered as an important factor for the
development of Type 1 Diabetes Mellitus (T1DM)
in association with the HLA antigens.
Objective:This study was designed to investigate
the role of HLA-class II antigens in the etiology of
type T1DM and in prediction of this disease in
siblings, and its effect on expression of glutamic
acid decarboxylase autoantibodies (GADA).
methods:Sixty children who were newly diagnosed
type 1 diabetes (diagnosed less than five months)
were selected. Their age ranged from 3-17 years.
Another 50 healthy siblings were available for this
study, their ages range from 3-16 years. Eighty
apparently healthy control subjects, matched with
age (4-17) years, sex and ethnic backgrounds
(Iraqi Arabs) underwent the HLA-typing
examination. Finally 50 healthy individuals were
selected randomly to undergo GADA test.
Results:At HLA-class II region, DR3 and DR4
were significantly increased in patients (53.33
vs.26.25% and 50.0 vs. 12.5% respectively) as
compared to controls. In
addition to that, T1DM was significantly associated
with DQ2 (33.33 vs.15%) and DQ3 (40.0 vs.20%)
antigens as compared to controls, suggesting that
these antigens had a role in disease susceptibility,
while the frequency of DR2 and DQ1 antigens were
significantly lowered in patients compared to
controls (6.66 vs.25% and 6.66 vs.22.5%
respectively). These molecules might have
protective effect. In siblings a significant increase
frequency of DR4 antigen (34.0 vs.12.5%) was
observed in comparison to controls, suggesting that
it might be much useful for predicting T1DM in
affected families.Anti-GAD autoantibodies were
present in 50% of Type 1Diabetic children, and in
16% of their siblings. High proportion of GADA
was found in the patients carrying HLA-DR3/DR4
heterozygous.
conclusion:Both the T1DM patients and their
siblings shared the HLA- DQ1 as protective
antigens, while DR3 and DR4 were susceptible one,
and high proportion of GADA was found in the
T1DM patients and siblings carrying HLADR3/DR4 heterozygous

Background: Adenosine mediates homodynamic
changes and resulted in the production of acute renal
failure (ARF) in female Albino-Wister rats, therefore,
adenosine level increases highly in ARF.
Objective: This experiment was designed to
investigate the effect of the adenosine antagonist
aminophylline and the adenosine agonist indomethacin on glycerol-induced ARF.
Method: Glycerol induced ARF was produced by a
single dose (10ml/kg, 50%v/v with distilled water i.m)
in rats, which were restricted to drinking water.
Aminophylline was used in our study in a dose of
25mg/kg, i.p) while the dose of indomethacin was
10mg/kg, i.p), assessment of renal function was done
by measuring blood urea
nitrogen (BUN), serum creatinine (Scr), and creatinine
clearance (Ccr)
Results: Aminophylline exert its protective effect
against glycerol induced-ARF by lowering the
elevation in concentrations of BUN, Scr, and mortality
rate with a markedly attenuation of the sever
impairment Ccr. On the other hand, indomethacin
potentiates glycerol induced-ARF by significantly
increase the elevation in concentrations of BUN, Scr
and mortality rate with severely suppressed the
decrement in Ccr.
Conclusion: Aminophylline has ameliorating effect on
glycerol induced ARF while the prostaglandin inhibitor
indomethacin has reversed effect

Background: Diabetes mellitus has been suggested
to be the most common metabolic disorder
associated with magnesium deficiency, and because
available data suggest that adverse outcomes are
associated with hypomagnesemia, it is prudent that
routine surveillance for hypomagnesemia be done
and the condition be treated whenever possible.
Aim of the study:To explore the serum Mg
concentrations of diabetic patients and healthy
controls in our locality.
Mehtods: One hundred and forty four diabetic
patients (22 with type I and 122 with type II diabetes
mellitus) recruited from the outpatient diabetes clinic
at the Specialized Center For Endocrine DiseasesBaghdad (62 patients), National Diabetes Center-Al
Mustansiria University (20 patients), and from
private endocrinologic practice clinics in Baghdad
(62 patients), during the period from 1st October
2005 to 30th April 2006. Ninety non-diabetic healthy
controls matched for age and sex were participated in
this study. Exclusion criteria for both groups
included diarrhea and loop diuretics. None were
taking Mg supplements. Level of Mg and Albumin
were determined spectrophotometerically in the
same serum samples.
Results: Mean serum Mg concentrations of the
diabetics was significantly lower than in controls
(p<0.001). Serum albumin was not a significant
predictor of serum Mg neither among diabetic
patients (r = 0.005) nor control subjects (r = 0.139).
In 88.9% of the diabetic patients and 11.1% of the
control subjects serum Mg concentrations were
below the normal reference range of 0.70 mmol/L.
The prevalence is increased when hypomagnesemia
is defined by a reference limit of 0.75 mmol/L
(98.6% and 28.9 % for diabetics and controls,
respectively), a further higher prevalence among
controls (91.1 %) was noted when 0.80 mmol/L is
adopted as the lower normal limit. All diabetics
(100%) and controls (100%) were identified as
hypomagnesemic with a lower reference limit of
0.90 mmol/L.
Conclusion: The tremendous hot climate of ours,
can be suggested as an influential cause for increased
Mg losses, and may provide a coherent explanation
for the exceedingly high prevalence of
hypomagnesemia observed in diabetic and control
subjects participated in this study. Which therefore
may suggest an inevitable requirement for
magnesium supplementation to avert
hypomagnesemia, not only among diabetics, but as
well for controls, particularly through the hot
summer episode

Background : It has been suggested that pretreatment with a statin agent prior to
myocardial infarction limits myocardial
creatine kinase release, and thus may act to
limit myocardial infarct size in humans.
Objective : To examine the effect of very
early statin initiation for acute myocardial
infarction (AMI), to the extent of
myonecrosis as manifested by peak serum
creatine kinase levels.
Methods : Patients with AMI admitted to AlKindy teaching hospital cardiac care unit
from 1st February 2007 to 28th February
2008, who fulfilled the inclusion criteria
cited in the present study, were randomly
assigned into two study groups. The statin
group patients have received a single oral
dose of 40 mg atorvastatin at time of
admission and repeated for the next days
until discharge, patients not receiving statin
were considered as controls, blood samples
were obtained on admission and every 8 h for
another three consecutive samples to identify
peak creatine kinase levels.
Results : Patients who had statin therapy
initiated immediately after hospital
admission have similar peak creatine kinase
concentrations as compared to those not
receiving statin therapy ( P= 0.332).
Conclusion : statin initiation in AMI patients
fails to show any observable effect on
creatine kinase release, the need of an
extended period for the statin agent to
achieve the predictable outcome may suggest
the necessity of statin pretreatment in
patients at high risk for AMI

Background: Infection with sexually
transmitted diseases is broad and includes
bacterial, viral and protozoa infection.
Large number of infected people goes
untreated because of symptomatic or
unrecognized infections.
Patients and methods: Forty five
patients was complaining from infertility
(primary or secondary), consulting
Kammal El-Sammari Hospital for
infertility from May - 2008 to February -
2009. Control group consisted of twenty
fertile women that consulting private clinic
for checking. Four swabs were taken from
each woman in two groups. Two swabs
were taken from posterior fornix of the
vagina (High vaginal swab) and the last
two were taken from endocervical canal.
First swab (vagina and cervix) was
examined directly under light microscope
(wet mount) and stained by Gram stain.
The other swab was cultured on Blood and
Chocolate agar.
Results: The patients group consisted
from forty-five female patients, their aged
ranged from (22-45 years), (X= 32.9).
Direct examination (wet mount) and Gram
staining of high vaginal swab showed
significant increased in leukocyte (pus
cells) and epithelial cells in infertile group
than normal one. The isolated bacteria
from culture of high vaginal swab were
Streptococcus agalactiae (group B
streptococci) which was significantly
increased than fertile group. This bacteria
was sensitive to Cephaloxtin and
Cephotaxime and resistant to Penicillin
Conclusions: The isolated bacteria from
culture of high vaginal swab were
Streptococcus agalactiae (group B
streptococci). This bacteria was sensitive
to Cephaloxtin and Cephotaxime and
resistant to Penicillin .

Background: Frozen shoulder affects 2-5% of the
general population, and around 10-30% of diabetic
patients. It affect mainly the non-dominant shoulder,
and has more incidence in patients with poor
glycemic control.
Objective: To detect the incidence of frozen
shoulder in type 2 diabetic patients attending the
Specialized Center for Endocrinology and Diabetes
in Baghdad.Patients and methods: One hundred
patients with frozen shoulder were included in the
study from a total number of 580 type 2 diabetics
over a period of six months. 70 patients were
females and 30 patient were males. All were
investigated for fasting blood
glucose and HbA1c.
Results: The non-dominant shoulder was
involved in 60 patients (60%), the dominant
shoulder in 35 patients (35%) and bilateral
involvement in 5 patients (5%). 60 patients
(60%) had poor glycemic control (HbA1c > 8%).
Conclusion Diabetes mellitus is one of the
predisposing factors for the development of
frozen shoulder which affect 17.2% of type 2
diabetic patients in our study, most of them were
overweight- obese and had poor glycemic
control

Background: Fiber-optic endoscopy is an important
investigation of the large intestine, whether or not the
radiologist (barium enema) has discovered a lesion in
the bowel. Colonoscopy affords a unique opportunity
to direct visualization of entire colonic mucosa. At
the same time, the physician can obtain biopsy specimens, remove polyps, and decompress volvuli.
Most experienced endoscopists and well prepared
patients can reach the cecum in over 90% of patients.
If colonoscopy is properly performed, it has a low
risk of complications, such as perforation and bleeding.
Methods: A total of 70 consecutive patients admitted
to Endoscopy department at Al-Kindy Teaching hospital from September- 2008 to July-2009. Bowel
preparation was achieved with Polyethylene glycol
lavage solution and 165 cm Pentax colonoscope
EC_3385FK 4.2 was used in all cases. All patients
were not sedated or given any other medication
Results:Seventy colonoscopies were performed in
this study. Forty of them were male and the rest were
female. The mean age was 42 years ranging from 4
years to 85 years. The most common indication for
colonoscopy was rectal bleeding (44%) Polyethylene
glycol lavage solution was used in all patients for
bowel preparation. All patients did not receive premedications. Complete colonoscopy examination was
done in (12.8%) of patients, the most common cause
of incomplete examination was poor bowel preparation (50%). No complications were reported.
Conclusions: Rectal bleeding was the most common
indication for colonoscopy. Poor bowel preparation
was the main cause of incomplete colonoscopy

Background: Women with previous two or
more caesarean deliveries are usually
managed by elective cesarean section to avoid
the possible risks of labor.
Objective: To compare the relative risks of
maternal and fetal outcomes in emergency
versus elective previous two or more
caesarean deliveries
Design: Randomized prospective clinical
study
Setting: Al-Elweya Maternity Teaching
Hospital, from 1st of March to 31st of
September 2008.
Methods: The study groups, those who had
previous two or more caesarean deliveries,
were included from the hospital admissions.
The 1st group (102 women) presented in labor
and was managed by caesarean delivery as
soon as it was possible. The second group (78
women) was admitted for elective cesarean
delivery.
The main maternal outcomes were intra
operative complications, including
hysterectomy, scar dehiscence, bladder
injuries, uterine and internal iliac arteries
ligation, and blood transfusion. Postoperative
maternal outcomes were severe morbidity
including bleeding, fever, urinary tract
infection, blood transfusion, the need to
Intensive Care Unit admission and
readmission. The fetal outcomes measures
were Apgar score at one and five minutes,
respiratory distress syndrome (RDS),
admission to the neonatal intensive care unit
and fetal loss up to hospital discharge.
Results: Both groups were comparable in
demographic, social and past obstetric history
characteristics. Intra operative complications
showed significant difference in bowel
adhesions (RR 0.35, 95% CI 0.14- 0.88), and
blood transfusion (RR 0.51, 95% CI 0.28-
0.94). There was statistical significant
difference in the mobilization time 7.2 hours
and 9.3 hours in emergency and elective
groups respectively (p= 0.0009), also in
feeding time, it was shorter after emergency
caesarean section (P=0.0224), and in the
hospital stay 24.6 and 32.6 hours respectively
(p=0.0001). There was no statistical difference
in post operative complications. Fetal
outcomes showed no statistical significant
difference in fetal loss, respiratory distress and
readmission.
Conclusion: Women with previous two or
more caesarean deliveries can wait until
starting labor for doing cesarean delivery
without increasing risks to the mother and
fetus.

BACKGROUND: In 1972 complete description of the
inflammation of posterior third of the vocal cords was
done, with barium swallow confirming Gastro
Esophageal Disease [CRED] & subsequent successful
symptomatic treatment with antacid. The possible
association between GERD & chronic laryngitis was
initially known as acid laryngitis .2
*from the Department of ENT, Hawlear Medical College, Hawlear university. Department of ENT, Rezgary Teaching Hospital, Erbil.
Correspondence to :
Dr.Said Mustafa Said
Corespondence Address to : Dr.Said Mustafa Said _ E- mail: Email elaf3d@yahoo.com Mob. 07504563829
Recived at : 15 th Dec 2009 Accepted at : 3ed Nov 2010

OBJECTIVE: To record the common presentation
symptoms of laryngopharyngeal reflux LPR in
Kurdistan- Iraq. To study the significance of fibro optic
laryngoscope in diagnosis and improvement of
laryngopharyngeal reflux [LPR] and to evaluate the
effect of medical therapy on these nonspecific
symptoms and Laryngoscopic finding.
METHODS: A prospective study was conducted over
a two year period at Rizgary teaching hospital,
Kurdistan/lraq; on 132 patients who presented
primarily with Laryngopharyngeal symptoms .They
were evaluated using special questionnaire for
recording these symptoms: persistent chronic cough,
globus sensation, throat clearing, voice change,
regurgitation, heartburn, symptoms of peptic ulcer
disease, and any other non specific respiratory
symptom. These symptom and Laryngoscopic findings
pre and post anti-reflux therapy were recorded.
Esophagogastro - duodenoscopy findings were also
recorded but only on presentation.
RESULTS: A total of 132 patients were evaluated over
a two year period .Respiratory symptoms at
presentation were persistent irritative cough [92%],
itchy throat [85%], globus pharynges [83%], and
cricopharngeal spasm [57%]. Endoscope findings
revealed gastroduodenitis in 5%, non specific gastritis
in 9%, duodenal ulcer in 2%, and normal findings in
62.7%, while Laryngoscopic finding were mainly
posterior commissure injection 82%, vocal cord edema
74%, laryngeal erythema 77% and subglottic edema
24%. Patients were treated medically with antacids, H2
antagonists, proton pump inhibitors and were followed
up and reexamined by laryngoscope; all data about
improvement in symptom and in the laryngeal sign by
Laryngoscopic findings were collected following antireflux therapy and showed significant improvement in
both ,all were analyzed in special figures and tables.
CONCLUSION: Reflux laryngitis and LPR should be
a differential diagnosis in patient with pharyngeal and
laryngeal symptoms not associated with upper
respiratory disease in the presence or absence of GERD
or peptic ulcer symptom, dyspepsia, regurgitation. The
management should be multidisciplinary.
Laryngoscopic finding were of value in the diagnosis of
the changes in laryngeal mucosa pre and post medical
treatment by Proton Pump Inhibitors empirical therapy

Abstract 20 patients with osteoarthritis of the knee joint were treated by electrical stimulation in the form of 6 sessions every other day each sessions of diphase fixe (DF) for 4 minutes followed by rest for 4 minutes then treated with a monophase fixe (MF) for 2 minutes. By clinical & statistical analysis ( P value < 0.05) we conclude that the electrical stimulation is effective as one method in the treatment of osteoarthritis.

Back ground; Selective re-absorption and secretion are the functions of the collecting tubules and ducts, in addition to concentrate urine through ADH-regulated and ADH-independent water channels.Method; twenty four male rats were used, they were divided into two groups of animals: Group (A) included twelve rats of five weeks old age (before puberty) that were divided into three subgroups, four rats in each subgroup. Subgroup I was control one, subgroups II and III were treated orally with melatonin in a dose of 250 & 500 µg/kg body weights subsequently. Group (B) included twelve rats of seventeen weeks old age (after puberty) that were divided into the same subgroups and treated with the doses of melatonin as in the rats of group (A).Result; the exogenous melatonin induced structural changes on the collecting tubules, in dose dependent manner as well as onset-dependent manner whether used in pre- or post-puberty of male albino rats

This is an autosomal dominant disease. The gene STK11 on chromosome 19 has been found in proportions of patients with this condition, this consists of: A-Intestinal hamartomatosis. B-Melanosis of the oral mucous membrane and the lips.