Thi-Qar Medical Journal

Background and aims: Coagulopathy after snake bite in Thi–Qar is one of the challenge to
health services in the last few years .different types of snakes are present ,the most dangerous
one is belong to vipradea family is Echis Craniatus stimmler.
Patients and method: Retrospective study of patients who admitted to Al-Imam Al
Hussiens teaching hospital January 2002– October 2011 ,308 , victims , (254 of them
experienced bleeding ).
Results: Female mostly were bitten in their upper limbs, while lower limbs among male.
Death more among female, those who present late . DIC is the unique cause of death. No
DIC occur after 7 days of the onset bite. All those who received blood from surviving DIC
persons were survived. Use of available polyvalent Antivenom shows decrease mortality
rate but not statistically significant.
Discussion: Early admission and receive medical care may improve prognosis. Formation of
auto antibodies around the end the first week may explain survival and no death after
this time ,which also explain the benefit to those who receive their blood .Further studies
needed .

Introduction: HbA1c is well now as predictor for hyperglycaemia due to accumulation of
sugar on the Hb. The aim of this study is to now the relationship between HbA1c level and
hyperlipidaemia. Patient and methods: this study was done in the diabetic and endocrine
centre between 2010-2011 in which 187 patients involved, all of them had DM we send them
for B.sugar,HbA1c, lipid profile including s.cholestrol, s.triglyceride, HDL, LDL and VLDL,
renal function test. We divide them according to their sex, age, residency, work, family
history of DM, past medical history of HT, atherosclerosis, IHD, smoking habit, type of drug
used, albuminuria and type of DM. we use the chi square and exact test and SPSS 17 for
statistics.
Results: 187 patients were involved in this study. 79(42%) were male and 108(58%) were
female, there age was 3(1%) were less than 15 years, 74(40%) were in between 15-45 years
and 110(59%) were more than 45years, HbA1c was divided into three groups the first one
was less than 6 20(11%), 7-8 was 26(14%) and more than 8 was 141(75%). Strong relation
ship between level of HbA1c and HDL (p=0.001), VLDL (p=0.027), s.cholestrol (p=0.004),
s.triglyceride (p=0.05) and LDL (p=0.029).
Conclusion: strong correlation was found between HbA1c and all component of lipid profile
in patients with DM, there fore HbA1c is a good predictor for hyperlipidaemia in DM

Background: Fecundity followed by pregnancy is the fundamental process to sustain life
and require a close interplay between normally functioning and adapting endocrine and
immune system (1). Pregnancy represents one of the most significant areas of study for the
immunobiologist (2), the reasons for the success of gestation in both normal and abnormal
pregnancies remain unclear because of the antigenically dissimilarity between the fetus and
the mother (3).
Patients and methods: This study included 180 females who were selectively collected
and were suffering from infertility and 70 healthy fertile females as control group, that
attending Al-Zahraa Teaching Maternity and Pediatrics hospital, and Al-Sader Teaching
hospitals in Al-Najaf Al-Ashraf Governorate from November 2007 to June 2008. All the
females were in their fertile age.
Results: The range of the women's age was between 18 years and 41 years with mean age of
27.1 years. In spite of the only slightly increased incidence of antithyroglobulin antibodies in
the group of primary unexplained infertility (12.5%), there is significant raise in secondary
unexplained infertile women (26.67%) compared to the fertile group (8.57%) as shown in
table 3.16. Our results, however, show a highly significant correlation (P < 0.005)
statistically.
Conclusions and recommendations: There was a significant correlation between
women who are suffering from infertility and the presence of antithyroglobulin antibody in
their serum whether they were suffering from thyroid diseases or not. So it is recommended to
do an autoantibody survey particularly antithyroid antibody for females who are suffering
from infertility specially those of unexplained type or those with failed therapy of unknown
cause.

This cross sectional study was carried out to determine asymptomatic urinary tract infection
among pregnant women with special emphasis to personal hygiene practice during sexual
activity, mid stream specimen from healthy pregnant women was collected and cultured
following standard microbiological technique. Colony count yielding bacterial growth 105/mil
or more was considered significant. Out of 215 healthy pregnant woman 38 (17.7%) had
asymptomatic urinary tract infection, educational level for pregnant women was taken and it
was found statistically significant in relation to asymptomatic urinary tract infection. Urinary
tract infection increase with increasing gestational age, in second trimester it was found to be
(11.6%) while in third trimester (37.7%). Personal hygiene, washing before and after sexual
activity, drying after urination, changing under clothing, direction of wash, has no significant
relationship to asymptomatic urinary tract infection. Frequency of sexual activity increase
prevalence of asymptomatic urinary tract infection. 31.9% of pregnant women who had a
history of previous UTI had a positive growth with high significant differences as compared
with those who had no history of UTI. Fluid intake decreases prevalence of urinary tract
infection among pregnant women (significant relationship). Bacterial pathogens isolated were
predominantly E. Coli (36%) and klebsiella pneumonia (15%), while enterococcus,
streptococcus and staphylococcus account only for (7.8%) for each. Candida (3.8%) and
mixed pathogens (7.8%)

Background :
Acavity is a gas-containing space surrounded by complete wall which is 3mm or greater
in thickness. Fleischner socity defines a cavity as a gas filled space within a zone of
pulmonary consolidation , mass or nodule. Cavities are commonly encountered lesions in the
lungs on chest radiography and chest computed tomography. The differential diagnosis of
such lesions is broad because many different processes of congenital or acquired origin can
cause these abnormalities .
The aim of this study :
To assess the role and value of CT in dignosing the nature and causes of pulmonary cavitary
lesions.
Patients and methods :
Thirty-six patients ((16 (44.5 %) male and 20 (55.5 %) female, range in age from 1– 80 years
with mean age (35.6 % years) )) were enrolled for this prospective cross sectional study.
Three sets of CT images were obtained (lung , mediastinal & bone windows ) to all
patients. Sixteen patient underwent surgery, the resected specimens were sent for
histopathology examination. Bronchoscopy was performed for 27 patient, bronchial wash sent
for cytology, AFB, in addition to culture and sensitivity test.

HYDATID disease is caused by infestation by larvae of the tapeworm Echinococcus
granulosus. The disease is endemic in parts of the world in which sheep are raised. In 2 to 3%
of cases CNS involvement occurs. Alveolar echinococcosis is caused by Echinococcus
multilocularis. The foxes and dogs are the main host for the adult parasite known as
Echinococcus alveolaris. Humans are affected either by direct contact with foxes or dogs or
by contamination from plants or water. The liver is the primary organ affected by the disease.
The clinical behavior of the disease is aggressive and is regarded as a potential malignancy.
Iraq is located in a geographic zone that is endemic for this parasite. Hydatid disease
(Echinococcus granulosus) is endemic in the Middle East as well as other parts of the world,
including India, Africa, South America, New Zealand, Australia, Turkey and Southern
Europe. Infestation by hydatid disease in humans most commonly occurs in the liver (55
70%) followed by the lung (18-35%); the two organs can be affected simultaneously in about
5-13% of cases. Even though hydatid cysts can occur in any organ, it is very rare to see the
disease in the regions reported in this paper. Considerable morbidity and even mortality can
be caused by this benign disease, as seen in this report and the literature reviewed. The
purpose of this paper is to emphasize the fact that this disease should be suspected in cystic
lesions affecting any ‘organ in the body, especially in endemic areas of the world.

SUMMARY
Introduction: It is well known that occupation environment can have a negative impact on
health. From academic point of view, it is mandatory to carry out descriptive and analytical
scientific research extensively to provide the required knowledge to form efficient database
that helps the occupational healthcare service suppliers to conduct the activities of
occupational healthcare services aiming at achieving the objectives of occupational health.
This is the “Why” of this study. Method: A sample, from the staff/ employees of two major
factories in Nasriya City, were interviewed. They answered a questionnaire about their health
status. Results: Frequency tables and descriptive statistics were obtained. Prevalence rates
were compared according, to the type of work, to each other. Conclusions: some patterns of
morbidity were found to be statistically significantly associated with the type of job of the
employees/ staff.

Back ground and purposes:
Ascites is the collection of free fluid in the peritoneal cavity , normally the peritoneal cavity
contain small amount of serous fluid for lubrication (less than 100 ml), free fluid exceeding
this amount ,considered ascites .Ascites may result from variety of medical & surgical
causes , clinically detectable ascites when its amount exceeding 1500 ml ,and when it is
clinically important to confirm the presence of suspected ascites, ultrasonography (US) or
computed tomography (CT) of abdomen is advisable , and the different CT signs of ascites
depend on the amount and distribution of the ascetic fluid .
The Aim:
is to study the early and the late signs of ascites on abdominal CT , and to estimate the
sensitivity of abdominal CT in diagnosing the cause of ascites
Patients and methods:
Eighty five patients of mean age 52.2±13.8 years had ascites ,diagnosed either clinically or
by US (all of them had an US examination ), been referred for spiral CT-scan of abdomen as
a further diagnostic step to confirm &identify the possible underlying cause of ascites
(patients with medical causes of ascites “heart failure, renal failure ” had been excluded ),
abdominal spiral CT scan has been done using 8mm slice thickness (patient took oral diluted
gastrografin 1.5-2hrs prior to the examination ) & two sets of CT examinations had been
done ( without I.V & with I.V omnipaque “350mg/ml.
Results:
This study showed that CT was as sensitive as US in detection of ascites , and the different
signs of ascites on CT images depended on the amount of ascetic fluid producing either (early
)or( late) signs , the late signs were more frequently seen in this study .
This study also showed that CT was more useful in identifying the underlying cause of
ascites (especially when related to the peritoneum , momentum or to the bowel ) and the
extent of the pathology and its proper staging .The frequency of the underlying causes of
ascites were as follows: 62% due to underlying neoplasm ,15.5%due to underlying liver
cirrhosis , 8.6% due to underlying inflammatory conditions & 3.4 % were post traumatic ,
however ,there were 10.3% of cases for which the CT scan didn’t give us an idea about the
underlying cause .
Conclusion:
CT was as sensitive as US in detection of ascites, and more useful in identifying the
underlying cause of it , but still about 10% of patients requires further investigative steps .

A seoepidemiological study was carried out in Thi-Qar governorate; Southern Iraq. The aim
was to estimate the prevalence of viral hepatitis B, C and HIV among selected group in Thi
Qar Governorate and to identify the risk factors among these infections. The study included
1128 blood donors, 126 cases, 100 healthcare workers and 162 patients with blood disorder
group. An Enzyme Linked Immunosorbent Assay {ELIZA} was used to estimate HBs
antigen, anti HCV antibody and anti HIV antibody. Prevalence of viral hepatitis B and C
collectively were (6.73%, 28%, 3%, and 35.2%) for the four groups respectively. The blood
disorder group showed a particularly high prevalence of HCV infection (40%). While the
prevalence for HIV was zero among all selected groups. Significant independent association
was found between the risk of hepatitis B and C infection and the following risk factors:
History of hepatitis infection, duration of infection, history of hospitalization, history of
contact with jaundice patient, history of drug addiction and history of complication.

Objectives: The present study was conducted to evaluate the prevalence of urolithiasis in
relation to patients six, age, and anatomical distribution of stones and to assess the chemical
composition of urinary stones qualitatively to identify common type of urinary stone which
prevalence in Nasiriyah city and how can provide the recurrence of stone formation if
possible.
Methods: Forty-four calculi obtained from 29 males and 15 females afflicted with
Urolithiasis and admitted at Al Hussein Teaching Hospital, Thi-Qar governorate, Nasiriyah
city, Iraq, from July 2010 to September 2011. Their ages ranged from 30 to 60 year. All
samples analyzed qualitatively for ammonia, magnesium, phosphate, magnesium ammonium
phosphate, carbonate, calcium salts (oxalate and non-oxalate), uric acid, xanthine, and cystine
by adopting standard methods.
Results: The study results showed that, the prevalence of stones was more in males (65.91%)
than females (34.09%) with male to female ratio of 1.93:1 and the high occurrence in patients
aged from 30 to 50 years. The anatomical distribution of urinary stones showed high percent
in kidneys 52.27 % (23 patients) and bladder 47.73 % (21 patients), but it is absent in ureters
and urethral (0.00 % ). All the stones were of mixed type, of these stones contained 42 (95.46
%) calcium salts (oxalate and non oxalate), uric acid, and ammonium ion, 41(93.18 %)
phosphate, 33 (75.00%) magnesium and magnesium ammonium phosphate (MAP), 29
(65.91%) carbonate, 26 (50.00) xanthine, and 7 (15.91 % ) cystine. In addition, there are no
differences in the chemical combustion between kidneys and bladder stones.
Conclusion: Urolithiasis in Nasiriyah is a problem with high frequency in men than women
and usually described as more frequent in age ranged 30 to 50 year and in kidneys and bladder
than ureters and urethral. The majority of urinary stones types had a mixed type in which
calcium salts (oxalate and non-oxalate), uric acid, ammonia phosphate and struvite were the
predominant constituents related that both the metabolic disturbances and bacterial infection
causes, which have the same majority and effect in the stone formation.

Background: Intravenous (I.V.) low osmolar contrast media (LOCM) is commonly used
during computerized tomography CT scan examinations, especially in diagnosis and staging
of tumours, trauma and abdominal examinations. Many radiologists are relactant to do
enhanced examination if patients had history of penicillin allergy. This study aims to evaluate
the incidence of LOCM-related side-effects in patients with penicillin allergy compared to
patients without penicillin allergy.
Methods and patients: Prospective study of 357 patients examined in CT scan unit in Al
Yarmouk teaching hospital, 44 of them had history of penicillin allergy, all given i.v. contrast
medium (LOCM), and the prevalence of LOCM related side effects calculated for both
groups.
Results: The prevalence of contrast medium related side effect was 0.64% in patients
without history of penicillin allergy, while of the 44 patients with penicillin allergy, no side
effects has been encountered.
Conclusion: No significant increase in LOCM related side effect was seen in patients with
penicillin allergy.

Background
little is known about the association of gallbladder disease and diabetes in Iraq. the aims of
this study are study the prevalence of GBD in patients with type two diabetes mellitus
attending Al-nasria diabetic center.
Patients and methods
Two hundred patients with type two diabetes mellitus were the test group consist of 116
female and 84 male with 57±22 years old in average and two hundred non-diabetic persons as
a control group consist of 120 female and 80 male with 52±32 years old in average. Both case
and control were examined by ultrasonograghic study to find the GBD.
Results
The frequency of GBD was 35% in patients with type two DM and 15% in non- diabetic
subjects. The frequency of GBD in diabetic patients whose BMI was more than 25 kg/m2
was significant increased. There is a significant increase in GBD with increase of duration of
diabetes and increased level of Hb A1c. There was no significant difference in effect of age ,
parity , family history of GBD between diabetes and non-diabetic subjects.
Conclusion
The prevalence of GBD increase with type two diabetes by two fold in comparison to that of
non-diabetic subjects. The risk of GBD increase with increased duration of diabetes mellitus
and HbA 1c level.

Bacterial agents associated with burn were determined in 50 burned patients were submitted
to Al- Hilla education hospital in Babylon province. 50 burned swabs were collected during
the period from October 2009– March 2010. These burn swabs revealed 60 bacterial isolates,
from which 43(71.66%) were gram– negative bacteria, distributed of 18(30%) P. aeruginosa,
12(20%) E.coli, 8(13.3%) Proteus mirabilis and 5(8.3%) K.oxytoca. On the other hand,
17(28.33%) gram– positive bacteria. Out of 50 burned swabs, 40(80%) revealed a single
pathogens and 10(20%) showed a mixed pathogens. Antimicrobial susceptibility of bacterial
burn isolates revealed that, P.aeruginosa were resistant to routine tested antibiotics, like
Ampicillin, Chloromphicol and Streptomycin in (88.8%), (72.2%) and (44.4%) respectively.
While most P.aeruginosa were sensitive to Meropenem, Imipenem, Oflaxacin and
Azithromycin as (100%), (100%), (60%) and (60%) respectively. On the other hand, another
gram– negative associated burn isolates were K.oxytoca, results of antimicrobial
susceptibility revealed that, isolates were resistance to Ampicillin, Streptomycin, and
Chloromphicol in (100%). While they were sensitive to Meropenem, Imipenem, Oflaxacin
and Azithromycin as (100%), (100%), (60%) and (60%) respectively.

Background:
Cancer is a worldwide and national public health problem; the incidence of cancer is
increasing rapidly. In 2002 there were 11 million new cancer cases and nearly 7 million
cancer deaths worldwide, by 2020, more than 16 million new cancer cases and 10 million
deaths are expected and about 60% of all these new cases 70% of these deaths will likely
occur in developing country.
This study investigates trends of cancer in Maysan Province and compares it to randomly
selected provinces, finding are also compared with nearby countries.
Methods:
Adescriptive study based on Data that found in Iraqi cancer registry 2000– 2006, comparison
had been held between Maysan and 3 Iraqi Provinces selected randomly after classification of
Iraq in to 3 regions.
Results:
The total No. of cancer cases registered in Iraq during these 6 years was 79145, there is an
increase in overall cancer trend in Iraq over the last 15 years and especially during 2000
2006, Maysan shows relatively similar trends during 6 years while others shows slight
elevation in the disease trends, Maysan shows the lowest No of cases registered during 6
years (1251) while Kirkuk shows the highest (3018), Breast cancer was the top cancer
registered in Maysan, Kirkuk and Kerballa during all the six years, while in Thi Qar, cancer
of the urinary bladder was the top, The total No. of Breast Ca cases registered in Kirkuk since
2000 was about triple what registered in Maysan while what registered in ThiQar was double,
The total No. of leukemia registered in Maysan was the lowest (81) while ThiQar was the
highest (225).
Conclusion:
There is an increase of cancer trend in Iraq (in general) and Maysan shows the lowest trend
and cancer registration during the 6 years in comparison to the 3 selected provinces.

Background: Thallium is the most suitable agent for criminal poisoning of human being as it
is tasteless and odorless. It usually associated with typical clinical features mainly
dermatological and neurological manifestations.
Objective:
To report an two outbreaks of thallium poisoning in Basrah.
Patients and Methods:
This case descriptive study that was conducted in the Department of
Dermatology-Basrah Teaching Hospital from January 2009 to February 2010 ,where a
total of thirty two patients with thallium poisoning were enrolled in this study. At the first
outbreak, 17 patients were seen at January 2009 due to ingestion of cake while 15
patientswere seen at the second outbreak at February 2010 who were accidental ingestion of
rat poisons. A detailed history was taken from all patients regarding all demographics points
related to this poisoning. Full clinical examination was performed looking for skin
manifestationsin addition to other systemic involvement. Thallium in urine has been measured
using the colorimetric method and was positive in all of them.
Results:
Thirty two patients with thallium poisoning were evaluated. The first outbreak
including 17 patients ,with 13 males and 4 females, their ages ranged from 11-33 years with a
mean of 24 years , all those patients gave history of eating cakes laced with thallium. Whereas
the second outbreak that including 15 patients , 8 males and 7 females, their ages ranged from
5-30 years with a mean 15 years ,all those patients gave history of accidental ingestion of rat
poisons . Among both out breaks the dermatological findings were mainly anagen hair loss in
diffuse and patchy patternaffected the scalp and limbs. Also dusky ecchymotic red dermatitis
like rash was observed on the face especially perioral region and dorsum of hands and
legs.Neurologic manifestations, mainly of peripheral neuropathy, reported in 50% patients of
the second group while no one of the first group showed any of these finding.
Conclusion: Outbreak of thallium poisoning is now occurring in recurrent rate which may be
lethal to human being as a result of accidental ingestion or for criminal purposes. It gives
characteristic cutaneous, neurological and psychological features that can lead to the right
diagnosis.

This study was designed to evaluate and compare the results of semen parameters, sperm
membrane potential integrity and viability for non varicocelic and varicocelic infertile men
after varicocelectomy. Thirty semen samples (varicocelic) and twenty normozoospermic men
(non varicocelic) as a control group were collected by masturbation in the special semen room
collection and prepared by simple layering technique. The semen samples were analyzed and
prepared by standard semen parameters. Furthermore, sperm concentration, sperm motility,
progressive sperm motility, sperm agglutination, normal sperm morphology, sperm HOST,
and sperm Eosin stain were evaluated according to standard WHO criteria (1999). However,
direct immunobead assay was used to determine the presence of AS-AB bound on sperm
surface. For preparation technique, sperm prepared and incubated for 30 minute in 5% CO2 at
37ºC after in vitro sperm processing. The results of the present study indicate a highly
significant (P<0.001) differences in all sperm functions parameters of varicocelic infertile
men in AS-ABs positive (HOST and Eosin stain; negative) as compare with that noticed in
normozoospermic men in AS-AB negative (HOST and Eosin stain; positive). It was
concluded that there are a strong positive correlation between varicocele and antisperm
antibodies generation and between antisperm antibodies and semen characteristics and HOST
Vitality test. Further studies are recommended to assess the detrimental effect of AS-ABs on
DNA damage and embryo quality after in vitro fertilization and embryo transfer in assisted
reproductive technologies (IVF-ET-ART).
Key words: Male infertility, Varicocele, Antisperm antibody, Varicocelectomy

Objectives : A prospective study conducted in Basra General Hospital from April 2008 to
March 200٩ to find the cause-effect relationship between chronic suppurative otitis media
and sensorineural hearing loss .
Method : Hearing thresholds of hundred patients with chronic suppurative otitis media were
determined using Pure Tone Audiometry. All subjects were less than 40 years old (to exclude
Age related hearing loss) , unilateral cases selected (so as the contralateral healthy ear served
as a control) . All of them presented criteria of evaluation which exclude the other possible
causes of sensorineural hearing loss like : chronic medical illnesses , otological surgeries ,
hereditary causes , exposure to noise and exposure to systemic ototoxic drugs .
Results : The average loss in bone conduction threshold was determined between the affected
and healthy ear in relation to the disease duration and in relation to the extent of the
pathology .
Conclusion : We found that the longer the duration of the disease and the more complicated
the pathology, the more the loss in bone conduction .This loss is mostly at the higher
frequencies .

SUMMARY
( 192 ) patients with clinical thyroid enlaregment were studied over a period of 2 years (sep
2008/Sep 2010) in AL-HUSSAIN GENERALand AMAL PRIVATE hospitals in NASSYRIA to
evaluate the inferior approach as the best technique to achieve near total or total thyroidectomy.
patients was selected for surgery according to the classical indications.the mean age was( 36
year). female/male ratio was( 15/1). initial steps of thyroidectomy was the standerd……..strap
muscle division not routine,gland mobilization started from the lower pole rather than the
classical middle thyroid vein then upper and lower pole division . complications was less than the
classical percent :postoperative haemorrhage(0.52 percent). respiratory obstruction(0.52 percnt),
reccurent larengeal nerve paralysis(1.04 percent)and parathyroid insufficiency(1.04 percent).
conclucion......inferior approach of thyroidectomy was reliable ,rapid,and easy technique to
achieve near total or total thyroidectomy with less postoperative complications than the standard
technique
.

Pulmonary hydatid disease is prevalent in many parts of the world including Iraq . In our
small series of 6 patients[from sept.2010 to sept.2011]. all patients were diagnose with
clinical and of the patients was 29 year[range..18-43].all of them received 0ral albendazole 10
mg/kg/day after diagnosis.by applaying the principles of conventional surgery all patients
underwent video assisted thoracoscopy as a minimally invasive technique.double lumen
endotracheal intubation was utilized in all cases along with CO2 insuflation.complete
thoracoscopic removal was successful in all cases with no conversion to open thoracotomy.
all of them showed rapid recovery except in one patient in whom prolonged intercostal
drainage was present for 3 weeks.the average of the procedure was 90 min and the average
length of hospital stay was 8 days except case one which was discarged on day 21 due to
prolonge air leak.follow up of 2-13 months.all patients are asyptomatic and doing well.

SUMMARY
Over five months period , the incidence of rotaviral and protozoal infections in patients
receiving treatment for malignancy was investigated in the present study. A total of 58
patients [38 males and 20 females] were involved in this study. Formalin– ether
concentration method And direct smear method were used for diagnosis of stool samples.
Higher rates of infection were Found among those<2 years old ,and also among males than
Females . In this study higher rate of infection in rural than in urban area was found and
majority of them with mixed parasitic infections . All them with symptomatic and most
patient which positive for Rotavirus with chronic diarrhea (66.7 % ) higher than
discontinuous diarrhea (33.3 % ).

Cardiac surgery in our country is a major challenge through maintaining high quality of surgical
needs of a very long wait list of the patients while dealing with hindrance budgetary constraints.
It has been estimated that approximately 20000 patients ( adult & pediatric) per year need
operations all over Iraq . Around 1000 patients registrant in NHC however these figure are
unaudited statistically the problem could be large magnitude . 30 months of our cardiac surgery
department & 200 surgeries done till end of Oct 2011 more than half in participate with
foreigners teams. Although the surgical skills have become evolve the basic problem in chiefly
results matching those achieved in developed countries centers around finding the fund to run the
building programs & retaining trained staff to achieve excellency . We can afford cardiac surgery
as its known to developed world when we find the real support for sustenance .