Thi-Qar Medical Journal

Objective:
We evaluated the efficacy and safety of tadalafil, a potent, selective phosphodiesterase 5
inhibitor, for the treatment of erectile dysfunction in diabetic patients.
Patients And Methods:
Between September 2008 to July 2010, 124 men their mean age was 49.8 years with a clinical
diagnosis of type 1 or type 2 diabetes (mean duration 11.7 years), a minimum 3-month history
of mild-to-severe ED, (60.5%) of them had moderate ED of ≥1 year's duration were randomly
allocated to one of two groups: the first group receive placebo (n = 61), the second group
receive tadalafil 20 mg as needed (n = 63) for 12 weeks the dose taken as needed without
food restrictions. Changes from baseline of erectile dysfunction to the ability to complete
successful sexual intercourse and the side effect of the drug was noticed and fallowed.
Results:
Atotal of 109 (88%) of 124 patients completed the study. Patients receiving 20 mg tadalafil
experienced a significant mean improvement, 75% of them were successfully completed
intercourse attempts compared with 28% in the control group (p <0.001). Compared with
placebo, tadalafil significantly improve the outcomes. Tadalafil was consistently efficacious
across disease severities and etiologies, as well as in patients of all ages. Tadalafil was well
tolerated, and the most common adverse events were headache (11.2%), dyspepsia (6.0% ),
nasopharyngitis (4.7% ), and flushing (2.8%) .
Conclusions:
Tadalafil therapy significantly enhanced erectile function and was well tolerated by men with
diabetes and ED

Background Atrial fibrillation is a well known manifestation of hyperthyroidism , we
studied whether subclinical hyperthyroidism in clinically euothyroid persons is a risk factor
for atrial fibrillation .
Method we studied 267 persons , the subject was classified into 3 groups according to
the serum TSH
group I: ( 174 ) persons compromised those with normal values of serum TSH ( 0.25– 5
μU/ml) and T3 , T4 within normal limit , this group considered as control group.
group II: ( 61 ) persons those with low serum TSH ( < 0.25 μU/ml) and with elevated
serum T3 and T4 i.e overt hyperthyroidism.
group III: ( 32 ) persons those with low serum TSH ( < 0.25 μU/ml ) and T3 and T4
within normal limit i. e. sub clinical hyperthyroidism .
Result: Atrial fibrillation ( AF ) was presented in 4 only from 174 with a percent of ( 2.3
%) in group I ,but 9 only from 61 persons with a percent of ( 13.8 %) were presented in
group II , while 4 only from 32 persons with a percent of ( 12.7 %) in group III .
There is significant difference ( P < 0.01 ) between group I when it compared with other
groups .
Conclusion: Low serum thyrotropin concentration is associated with more than 5 fold
higher likely hood for the presence of AF with no significance difference between subclinical
and overt hyperthyroidism .

Background:
LASIK which stands for laser in-situ keratomileusis is the procedure that
involves creating corneal flap to ablate mid stromal tissue directly with an excimer laser beam,
ultimately flattening the cornea to treat myopia and steepening the cornea to treat hypermetropia,
whereas earlier techniques of keratomileusis consisted of removing a corneal flap and resecting
stromal tissue manually, technologic advancements have revolutionized this procedure into
highly automated process. In general the goals of the refractive surgery are to reduce or eliminate
the need for glasses or refractive lenses without altering the quality of the vision or best corrected
vision. Most improvement in refractive errors is measured in term of visual acuity (Snellen
chart) .
Aim Of The Study:
is to have a clinico-statistical assessment of LASIK surgery in AL
Nasirya city, since it is a recent surgery in Iraq started for the first time three years ago in
Almosawi Hospital.
Patients And Methods:
In this study a 510 cases of ametropic patients (myopia, hypermetropia, and astigmatism) with
visual acuity of 6\24 or worse underwent LASIK surgery for correction of refractive error in Al
Mosawi private hospital from a period between August 2007– August 2010. Each patient
examined preoperatively for visual acuity, type of refractive error, corneal thickness
(packymetry), and corneal surface shape (topography) to decide the suitable candidates for
surgery. Postoperatively the patient examined for visual acuity.
Results:
In this study we noticed that from 510 cases, 300 (58.82%) were female, while the remaining
210 cases (41.176) were male. Regarding the age distribution of the cases, 152 (29.8%) of the
cases lies between 23-27 year , which is the predominant age group. The second most
predominant age group was between 28-32 year, 126 cases (24.7%) lies in this age group. One
hundred two cases (20%) were between 18- 22 years. Seventy cases (13.7%) were between 33-37
years. Regarding the refractive error, most of the cases operated on had low myopic astigmatism
the number of the cases was two hundred two (39.6%). The second most frequent refractive error
was low myopia representing 156 cases (30.58%). high myopia was the third most common
refractive error representing 86 cases (16.86%). Fourth group was high myopic astigmatim
representing 10.58% (54 cases). The last group was hypermetropia representing 2.35% (twelve
cases).
Regarding the visual acuity 81.81% (832 eyes) had uncorrected visual acuity of 6\6 or
better, 95.083% (967 eyes) had uncorrected visual acuity of 6\9 or better, and 100% (1017 eyes)
had visual acuity of 6\12 or better.

The present paper reports selected results of 184 surgical patients in Basrah. They were 82
males and 102 females. Their ages ranged between 22-84 years. From those, 100 patients had
different malignancies. 43% from the total number, of malignant tumors with gastrointestinal
GIT cancer, while breast cancer and malignancy of urinary systems each represents 18%. And
the other types of malignancy were 21%. The remaining 84 patients were suffering from
surgical ailments other than malignancy. Their serum vitamin C were measured.
The results showed high significant reduction in serum Vitamin C in all type of malignancy ,
specifically in GIT (P< 0,00l)in respect to age mainly at the age less than 45 and between 45
65 years old, as well as sex and nutritional habit mainly among those consuming fruit and
Vegetables less than 3 times per week. Therefore, we conclude that serum Vitamin C are
measurable biochemical indices that can be used as predictors for following those patients
during and after treatments.

Objectives : A study conducted at Al-Habbobi General Hospital in Annassirriya city
South of Iraq since April 2008 till Aug.2009 to show the characteristics of Atrophic rhinitis
in patients attending the ENT-outpatient clinic .
Method : Thecommon characteristics of primary atrophic rhinitis were studied in 71 Iraqi
patients by the maintenance of age and sex data of all patients, the mode of presentation and
most common presenting symptom defined , then nasoendoscopic examination done . Also
all patients were subjected to routine blood work-up " Hemoglobin level , ESR , Blood
grouping and Rh . "
Results :From history and demographic data the female to male ratio was found to be 1.08
to 1 , Most of them were urban .The main complaints affecting the life quality were nasal
blockade , crustation, anosmia , epistaxis, foul smell and showing that there is a seasonal
variation in symptoms. The results of the blood tests did not elucidate anemia or nutritional
deficiency .
Conclusion : Although many factors have been cited previously as the possible cause of
atrophic rhinitis, the common characteristics found in our patients indicate that environmental
factors and possibly infective and allergic/immunologic disorders .

Background:
Portal hypertensive gastropathy (PHG) refers to changes in the mucosa of the stomach in
patients with liver cirrhosis, it may present with a wide variety of manifestations ranging from
asymptomatic to severe upper GIT bleeding.
Patient and method:
50 patients with histological proven liver cirrhosis involved in this study .35patients (70%)
were male while 15 patients(30%) were female. OGD was done for them which revealed 46%
of them were affected with PHG irrespective to the cause of liver cirrhosis. all kinds of liver
cirrhosis was taken in the study apart from those who took NSAIDs in the last two weeks to
exclude other causes of erosive gastritis.
Results:
PHG was found in 46% of the patients , it range from gastric fold edema in 12% to ,erosive
hemorrhagic gastritis in 16% erythematous mucosa in 24%, petechiae in 30% to snake skin
appearance in 36%.
Conclusion:
PHG is well known complication of liver cirrhosis that can be asymptomatic or cause other
manifestations from dyspepsia to severe upper GIT bleeding that must be treated.

Background and Aims: Wedding night impotence or first night erectile dysfunction
(ED) is one kind of psychogenic ED which is not uncommon. Prevalence of this kind of ED is
higher in conservative communities especially the Muslim population. The study aims to
assess the role of Sildenafil, a phosphodiesterase inhibitor (PDE-5) in the management of
wedding night (psychogenic) impotence.
Methods:The study was conducted at private clinic. All patients having erectile
dysfunction (ED) after marriage with normal nocturnal erections were enrolled in this
prospective study for two years(2008-2009). They were visiting private clinic either directly
or referred from dermatologist colleague in Nassirya city. Reassurance & Sildenafil 100 mg at
bed time was given to every patient and dose reduced to 50 mg after 3 successful intercourses.
Patients who did not respond to PDE-5 inhibitor (3 doses), were given sex therapy(Master and
Johnson technique)and shifted to. Sildenafil after successful intercourse.
Results: Total number of patients was 45 with age range of 20-39 years. Mean duration
elapsed before seeking medical advice was 10±14 days. Eighty percent patients had
successful intercourse on first dose of Sildenafil with 95% confidence interval (CI) and 13%
patients responded to 2nd dose of Sildenafil. Twelve percent patients suffered mild, well
tolerable complications.
Conclusions: Wedding night impotence is not an uncommon condition in some special
population. Sildenafil proved to be effective, with high success rate and few tolerable
complications.

Objective: The aim of this study was to investigate the value of serum calcium (Ca),
phosphate (P), total protein (TP) and alkaline phosphatase (AIP) activities in elderly patients,
to know the levels of those biochemical p parameters and to clarify the relationships of these
finding with the diseases that having specially over the life
Study design:
Aprospective case control study conducted at the biochemistry Department, through a period
of 1 year from the first of October 1999 till the end of October 2000.Base line samples were
collected to measure S. Ca, P,TP and AIP activities in 110 elderly patients aged 72± 6.5 years
(62 males and 48 females) and the effects of biological factors (age, sex, and weight) and
large set of pathological conditions were examined and for comparison, another 100 subjects
aged 68±8 years (63 males and 37 females) whom, were found free of any disease and or
alcoholic and smoking habit considered as a control group.
Results:
The results of the study showed a significant decreased (p<0.05) in the concentrations of S.Ca
and TP and a significant increased (P<0.05) in the concentrations of S. P and AIP activity in
hypertensive and in patients how have renal failure. A significant increased (P<0.05) in the
S.Ca, P and AIP activity and a non– significant decrease (P>0.05) in the TP level, were
observed in the patients having bone and joint diseases. The values of S. P in the patients
having heart disease shows a significant increased (P<0.05) and non– significant changes
(P>0.05) in the concentrations of serum Ca, TP and AIP activity is often considered. Non
significant alterations (P>0.05) was observed in those biochemical parameters in relation to
diabetes mellitus or other pathological conditions.
Conclusion:
Weconclude that, the measurements of those biochemical's parameters in elderly populations
was useful to know some of theories of aging that might take place in the cell, an organ or
total organism with a passage of time, and also the sequential or progressive change in an
organism that leads to an increased risk of debility, disease and death.

This is a prospective study done in the period between the 1st of December 2003 to 30th of
November 2005, it includes 323 patient.
One hundred fifteen patients complaining of oral disorders, comprises 35.6% of all the
studied patients, while 208 patient had extra oral disorder (64.4%). From those with extra oral
diseases, 162 patients had otorhinolaryngological disorder comprises (78%), and the
remaining 46 patients had medical disease (22%).
The commonest cause of oral disorders was periodontal disease (42 patients = 37%), the
commonest cause of otolaryngological disorders was tonsillitis (39 patients =24%), while
commonest medical cause of halitosis was bronchitis (11 patients =24%).
The mean age pf presentation of halitosis caused by oral disease, was 46.2 year,
otolaryngological diseases was 27.9 years and for medical diseases was 46.6 years.
Commonly the patient with halitosis presented in the cold months (230 patients of them
presented in the period between October and April =71% from all the studied patients).

The aim of this study was to determine the prevalence and to identify the risk factors
associated with Giardia lamblia infection among diarrheic children who had been attended
outpatient department of maternity and children teaching hospital for acute diarrhea and
dehydration in Thi- Qar , Southern Iraq.
Fecal samples were collected from ( 396 ) children aged from( 0– 120 ) months and were
examined by direct wet preparation and floatation method . Data relating to sociodemographic
, environment and host were also collected by questionnaire. Giardia lamblia were present in
faces of ( 94) diarrheic children ( 23 . 7% ) . The age group ( 24– 48) month had the highest
rate of infection ( 33 .3% ). Male had higher rate of infection than female ( 24. 7% vs 22.5% )
respectively .
Living in rural area , low education level of mothers , drinking raw or municipal water , hot
seasons ,living with four or more house hold children were significantly associated with
Giardia lamblia infection
( p < 0.05 ). Based on the results of this study , it is
concluded that the high prevalence of Giardia lamblia infection among children with acute
diarrhea is a significant public health problem in Thi-Qar.

Background and Objective : The presence of meconium in the amniotic fluid is
regard as abnormal and both the obstetrician and pediatrician must be alerted to possible fetal
or neonatal complication and presence of meconium in trachea may lead to meconium
aspiration syndrome ( MAS) .
Method : A prospective study was conducted on 155 symptomatic meconium aspiration
babies. The information of studay depend on clinical observation at intensive neonatal care
unit and delivery room notes.
Results : Meconium stained amniotic fluid ( MSAF) is found in (4.8%) of total deliveries
and usually in term (78%) , posterm (16%) and (6 % ) preterm . The incidence of MAS
among meconium stained (18.4 %) . Birth asphyxia, maternal toxaemia and breech
presentation were significant risk factors for severity of MAS and not only risk factors for
MAS. Most of babies had low apgar score at one minute, and thick meconium was associated
with lower apgar score and C.S added more to the problem. Male affacted little more than
female and immediate oropharynx suction was very valuable in reducing mortality rate ( M.R)
from 14% to 6 %.
(9) babies of MAS died ( 5.8%) because of recurrent seizure , respiratory failure and
asphyxia.
Conclusions: MAS is still a great problem in our locality causing a lot of morbidity and
mortality. Immediate intervention and oropharynx suction was very beneficial in reducing
M.R.

A prospective study to 125 babies complain from umbilical granuloma 64 males, 61
females they classify into 2 groups, first group (65 babies) are treated by cauterization
while second group (60 babies) are treated by double ligation between period 1st jun.
2009 31st dec. 2009 We found that the recurrence rate after double ligation (5 babies 8%)
while after cauterization about( 15 babies 23%) So we advice to use double ligation in
treatment of umbilical granuloma in newborn
babies which less recurrence and less
complications than ordinary cauterization.
Aims of the study
Comparison of two methods for managements of umbilical granuloma (cauterization vs
double ligation ) to be use the best method , less recurrence , less complications

The aims of this study were to determine the incidence of UTI in asymptomatic jaundiced
neonates in the first two weeks of life , and to determine which historical and laboratory
parameters are associated with UTI in those neonates.The study included 153 full-term
jaundiced neonates less than two weeks old who had been admitted in hospital for management
of jaundice. Work-up for hyperbilirubinemia as well as urinalysis and urine culture were
performed in all patients. Patients were considered to have UTI, if ≥100 000 colony- forming
unit per ml of single pathogen was isolated from urine samples collected by urine bags.
Sonography were requested to all cases with UTI Ten (6.5%) of 153 patients had UTI. The
isolated organisms were E. coli (60%) followed by Klebsiella (30%) and Proteus (10%).There
was no significant association between gender ,gestational age ,body weight, mode of feeding ,
total serum bilirubin(TSB) levels and UTI , but there was significant in onset of jaundice , direct
(conjugated) bilirubin level and mean of decrease serum bilirubin level with phototherapy
among neonates with and without UTI. One (10%)of 10 patients with UTI had abnormal
ultrasound result. In conclusion, the study revealed that UTIs can occur in asymptomatic
jaundiced neonates, and it seems better to perform urine cultures if they have high level of direct
bilirubin ,onset of jaundice after 8 days of life and slow decrease in serum bilirubin level with
phototherapy especially in male bottle-fed infants.

Some novel C-heterocycle-substituted phenoxazines having a pyrazolo[3,4-d]pyrimidine
nucleus have been synthesized by using the Biginelli multi-component cyclocondensation
elemental analysis. The products were evaluated for their antitubercular activity against
Mycobacterium tuberculosis H37 Rv.

Background: The appropriate choice of antibiotics is a complex procedure that
requires clinical judgment and detailed knowledge of pharmacological and
microbiological factors. The irrational prescribing of antibacterial drugs will lead to the
emergence of bacterial resistance which in turn led to the development of adverse
effects; in addition to that, the irrational use of antibiotics is cost effective.
The principles of appropriate and effective antibiotic prescribing are widely and
simply outlined but practically they are difficult to implement, thus the treatment with
antibiotics should be reviewed to lower the irrational use of those drugs.
Aim: To determine the extent and the rationale of antibiotic prescriptions for
pediatric patients admitted with different respiratory tract infections in Mosul pediatric
hospitals and to discuss the pressure on physicians and health staff to overuse of
antibiotics.
Patients and Methods: A prospective observational study was conducted on
232 hospitalized pediatric patients with respiratory tract infections, those patients
selected randomly from Ibn-alatheer and al-Khansaa pediatric hospitals, their age
range from (0-11 years).The antibiotic prescriptions of patients were collected over a
period of 6 months and then analyzed to determine the antibiotic prescription habits
of medical staff in Mosul.
Results: two hundred thirty two pediatric patients were under study ,admitted with
pneumonia(20%),bronchitis(18%),lower respiratory tract infection and asthmatic
patient with chest infection (15%)and (16%)respectively. About (11 %) of patients
under study received antibiotics without documented reason. (74%) of children
receive prescription of one antibiotic and the remaining (26%) prescribed a
combinations of two antibiotics. Total of (304) antibiotic drugs were prescribed, with
high prescription rate for Ampiclox (50%) and Cefotaxime (29%).
The off- label status of antibiotic prescription is determined for diagnosis, age, route
and dose with most frequently off- label antibiotic prescription for diagnosis (different
indication) which is (64%).
Conclusion: The study demonstrated that, high percentage of antibiotic
prescriptions for pediatric patients with respiratory infections is inappropriate and this
mainly due to prescribing of antibiotics for conditions caused by viral infection, thus
an education strategies are required for both physicians and pharmacists to diminish
the effect of the problem.

Gallic acid and tannic acids are a naturally abundant plant phenolic compound in the human
diet and are known to have drug property for some diseases. In this study, the antidiabetic and
antioxidant effect of the mentioned acids in an animal model of alloxan induced diabetes were
investigated. Diabetes was induced in female local rabbits by injection of alloxan (150
mg/Kg body weight) . gallic and tannic acids and their mixture (1:1) were given as daily
injection doses at the levels of 100 mg/kg rabbits for a period of three weeks. The results
showed that blood glucose levels and serum malondialdehyde levels, marker of lipid
peroxidation, of G group (treated with gallic) were slightly , non significant, decrease as
compared with NC group ( without treatment). Whereas the decrease in these parameters were
significant in T group (treated with tannic) and GT group ( treated with their mixture) in
comparison with NC group. Serum total antioxidant capacity was significantly increased in T
and GT groups in comparison with its value in NC group. While the increase in the same
parameter was non significant in G group as compared with NC group. These experimental
findings prove the synergistic effect of each acid to other. Consequently their mixture is more
effective than each one of them as antidiabetic and antioxidant agents.

2-[4-hydroxy benz-1(propene-1-one)]Pyrrole II on treatment with phenyl thiourea, guanidine
carbonate, urea and thiourea in alcoholic KOH yielded compounds III, IV, V, VI which on
treatment with different aryl anilines gave compounds VII, VIII, IX, X which under goes
cyclisation with sulphur and iodine to give 2-[4-(10H-substituted phenoxazine-3-yl)-6
pyrimidin-2-phenylthiol/-ol/-amine/-thiol] pyrrole XI (a-j), XII (a-j), XIII (aj) and XIV (a-j)
respectively. The structural products were characterized by elemental analysis and spectral
data.

The antimicrobial activity of six different toothpastes Colgate Total ,Signal , Crust, Bio fresh,
Close up & Miswak were evaluated on some pathogenic oral microorganisms : Streptococcus
sp. (α- hemolytic), Staphylococcus aureus & Candida albicans. The preliminary antimicrobial
activity evaluation was performed using an agar well diffusion method and distilled water was
used as controls. The samples were tested in 0.5, 0.25, 0.125, 0.06, 0.03, 0.01,0.005,0.0025
g/ml. Inhibition zones were measured in millimeter after 24 hr. All tested toothpastes have
antimicrobial activity on bacterial & fungal type but antimicrobial activity on bacteria more
than activity on Candida albicans . Antimicrobial activity of all toothpastes on bacterial types
were approach one another . In conclusion the antimicrobial activity of Colgate Total ,Signal
&Crust were better than Bio fresh, Close up & Miswak .