Journal of the Faculty of Medicine Baghdad

Background: Techniques of Inguinal hernia repair have seen an evolution from the pure tissue repair to the prosthetic repair and in the recent years past to laparoscopic repair. High recurrence rates using fascia for the hernia repair or the use of sutures under tension prompted the development of polypropylene mesh to reinforce the posterior wall of the inguinal canal.The aim of this study is to compare the post operative results of Lichtenstein mesh technique with Dar ning repair.
Patients and methods:-A prospective study of "100" patients with inguinal hernia were conducted to evaluate two methods, of open repair of inguinal hernia Lichtenstein mesh technique with Traditional non-mesh technique (modified Bassini or Darning).Operation were done under general, epidural and local anaesthesia at the surgical units of Baghdad Teaching Hospital and Arbil Teaching Hospital.
Results: The study showed that Lichtenstein mesh technique is an effective operation for repair of inguinal hernia with low complication rate and less pain in comparison to the repair by traditional non-mesh technique. Also the results show that, mesh repair group returned to work earlier than non-mesh repair group.
Conclusion:Mesh repair of primary inguinal hernia repair is superior to non-mesh repair in term of early postoperative pain , return to the work and recurrence.

Summary
Background: surgical treatment of established carpal tunnel syndrome (CTS) can be accomplished by various operative modalities, epineurotomy of the median nerve plus carpal ligament release has been advocated by many authors, This study try to evaluate the role of epineurotomy on the outcome of operative treatment of CTS postoperatively, compared to simple release only .
Patients and Methods: 48 hands of 42 patients, 34 female and 8 male. where classified in to two groups, one group had a release of the transverse carpal ligament alone, group (1). and the other group had a release plus epineurotomy of the median nerve, group (2). Selection of patients was according to the same clinical criteria regarding physical finding, periods of symptoms preoperatively, as well as sex and age. Positive finding of (EMG) confirming established median nerve dysfunction due to compression, the operative procedure technically unified by the operating team. Clinical assessment of the patients carried out six month post operatively.
Results: 60% of group (1) and 56% in group (2) no longer had any symptoms referable to the dysfunction of the median nerve. Physical examination revealed average two–point discrimination of 5.1 mm in group (1) and 4.7 in group (2). The electrophysiological test (EMG) showed average sensory latency of 4.1 mil sec. in both groups. Evaluation of the patients six months postoperatively revealed no detectable significant differences between the two groups with regard to symptoms, objective finding, Tinel's sign. Phalen test, or (EMG) values.
Conclusion: epineurotomy of the median nerve add no benefit to the simple carpal ligament release of the transverse carpal ligament alone

Summary
Background:-Carotid body tumors is an uncommon disease entity in Iraq , presented with painless swelling below the angle of the mandible , and is usually benign .The author reviews his personal surgical challenge with eight cases having had this tumor during twelve years period .
Patients and Methods:-Eight patients with carotid body tumors were managed during twelve years period (1994- 2005) in the Thoracic and Vascular Department of the Medical City Teaching Hospital in Baghdad, Iraq.
Results:-These patients were retrospectively studied as regard their age, gender, clinical features, diagnostic methods, operative findings, surgical techniques and postoperative outcome.
Conclusion:-Early presentation and surgical intervention limit the number of inoperable patients thus avoiding local invasion and malignant changes and leading to fruitful surgical results.
Key Words: Carotid Body Tumor (CBT) , Common carotid Artery (CCA)

Background: dorsal spine intervertebral disc prolapse (IVDP) not a very common entity compared with cervical & lumbar region usually treated surgically.
Patients & method: 22 patients studied in the specialized surgical hospital neurosurgical department from Jan 2002 till Jan. 2006. the study included age, gender, cases. clinical features, diagnoses & surgical management.
Results: 22 patients were studied 76% of the patients are at the age of 30-60 with slight male predominance, all diagnosed by MRI & or CT scan, all managed surgically by laminectomy the results are compared with other studies.
Conclusion: posterior thoracic laminectomy at the dorsal region is a safe, simple procedure with good results if done early & meticolous.

Background: Neonatal screening for congenital hypothyroidism (CH) is an essential preventive public health program for early identification of disorders that can lead to potentially catastrophic health problems
Objectives: This is a pilot study conducted to determine the incidence of CH among infants born in two major maternity hospitals in Baghdad City and to build a model for nationwide screening program.
Methods: A prospective study on screening of all newborns was conducted in two major maternity hospitals in Baghdad, from 01.12.2001 - 31.12.2002. A total of 6949 neonates were screened for CH, cord blood samples were examined for serum TSH levels by immunoflourecent method (ELIZA) and reexamined for T4 using a cutoff sTSH value of 40 mIU/L.
Results: Three neonates were proved to have Congenital hypothyroidism (incidence of 1: 2275), forty eight (0.7%) neonates had sTSH > 40mIU/l. Females and neonates delivered by Cesarean sections and premature neonates had a higher predilection for hyperthyrotropinaemia.
Conclusion: The incidence of CH is notably approximate to the incidence of the disease in the nearby and surrounding countries and higher than other mountainous developing countries and much higher than the incidence of CH in Europe. The present study found that neonatal screening program can be handled in the hospitals and required further coordination to adopt a nationwide screening program which must be started in Iraq.
Keywords: Hypothyroidism; neonatal screening; thyrotropin, cord blood

Introduction

Neonatal screening is an essential preventive public health program for early identification of disorders that can lead to potentially catastrophic health problems (1).The purpose of neonatal screening programs is the commencement of treatment of selected patients within the first two weeks of life (2). The majority of European and Japanese programs conduct screening by means of primary sTSH measurement supplemented by T4 determination for those infants with elevated TSH value. Newer TSH assay techniques such as enzyme linked immunoassay offer the advantage of using non-radio labeled technique and greater sensitivity with the potential for better separation between normal and abnormal TSH concentration (3). The screening tests for congenital hypothyroidism (CH) appear to serve monitoring of iodine deficiency disorders, and prevent mental retardation in infants born with this condition in developing countries (4). The screening programs for CH showed differences between different countries in the detection of

Background: women with acute coronary syndrome have increased in-hospital morbidity & mortality as compared with men following percutaneous coronary intervention (PCI). It remains unclear if this difference secondary to the sex or other confounding variables.
Patients and Methods: We sought to examine the characteristics and outcomes of 71 consecutive women (49.2%) and men (50.7) undergoing PCI at The Iraqi Center of Heart Diseases from October 2005 to March 2006.
Results: There were significant differences in the baseline characteristics between both sexes. Women more frequently had SVD(single vessel desiease) (25.7% vs. 16.6%) and 2VD (37.1% vs. 16.6%) while Men were more frequently had 3VD(3 vessel disease) (66.6% vs. 31.4%) P value = 0.05. Women more frequently had LAD lesions (97.1% vs. 83.3%; P=0.05). Men had longer lesion length (13.60±7.75 vs. 12.42±5.12; P=0.03. The outcome of revascularization procedure reveal that the female cohort had a greater incidence of thrombosis (17.1% vs. 2.8% ; P=0.049) and myocardial ischemia (34.2% vs. 13.9%; P=0.044) during procedure and greater incidence of access site hematoma (31.4% vs. 2.7%; P=0.001), hypotension (25.7% vs. 5.6%; P=0.02), non-fatal MI (17.1% vs. 2.7%; P=0.044) and needed more repeated angiography and revascularization (17.1% vs. 5.5%; P=0.0049) during post procedural in-hospital period.
Conclusion: female gender is at greater risk for per procedural and post procedural in-hospital complication, these were not due to female sex itself, but because female have more co morbid diseases and risk factors with smaller body size and smaller blood vessels causing more risky PCI.

Background: Angioplasty and stenting; Percutaneous coronary intervention (PCI) has become important tool of Reascularizing patients with stable angina and Acute ST-Elevation Myocardial Infarction, while their role in Non ST-elevation Acute coronary syndrome is expanding. The aim was to study the outcome of complete and incomplete Revascularization, by PCI, of pts with NSTE-ACS, and the effect of the traditional risk factors and their relation to the number of stents.
Patients and Methods:- After stabilization 115 out of 142 consecutive hospital admissions with Non St-Elevation Acute Coronary Syndrome were revascularized Percutanously.
Results:-Apart from two pts, who had advanced disease, PCI had succeeded in reascularizing the remaining 113 pts, (98%); 93 of them had Complete revascularization (81%) with elimination of all stenotic lesions, while 20 pts had Incomplete Revascularization The later consisted of fifteen Patients who had dilatation of the culprit lesion/s only (group a) and 5 pts who had dilatation of all lesions except uncrossable lesion/s despite painstaking attempts (group b). cardiac events:-Five of the 93 pts with complete revascularization (5.4%) had Major Cardiac Events compared to 4 of the 15 pts in group a; Culprit-lesion-only Revascularization (27%), suggesting that leaving behind angioplastable lesion/s might not be feasible, yet the sample is small. Risk Factors:- The likelihood of achieving Complete Revascularization was inversely linked the no. of risk factors. It had dropped from 100%, to 85%, 79%, and 67% in pts with nil, 1, 2, and 3-5 Risk Factors respectively. Conversely the no. of stents deployed was directly linked to the number of Risk Factors reflecting a more severe underlying disease.
Conclusion: Early PCI in had achieved complete revascularization of 81% of pts with NSTE-ACS. Complete Revascularization was associated with much lower Major Cardiac events than Revascularization of the Culprit lesion only. Frequency of Complete revascularization had proportionately increased with the no. risk factors reaching 100% in without risk factors (100%). The no. stents had proportionately increased with the no. of Risk factors suggesting more severe underlying disease.

Background: The importance of essential trace elements plays a major role in medicine mainly cardiovascular diseases.
Methods: The study involved 305 patients with either myocardial infarction ( MI ) , angina pectoris ( AP ) or hypertension ( HT ) for evaluation of these trace elements level ( Se & Cr ) as compared with 100 control subjects in Ibin Al Bitar hospital for cardiac surgery between July 2003 and May 2005 by using Atomic Absorption Spectrophotometer ( AAS ) done in the laboratories of ministry of Sciences and Technology in Baghdad.
Result: The total numbers of patients enrolled in this study were 305 patients, Ml contributes to 70 patients, 55 male and 25 female with mean age of 60 ± 20 and 58 ± 19 years respectively. Unstable angina contribute to 105 patient in which 70 of them were male with mean age of 63 ± 20 years and 35 female with mean age of 60 ± 19 years and 120 hypertensive patient in which male contribute to 90 with mean age of 64 ± 19 years and the other 30 were female with mean age of 48 ± 13 years, those 305 patients were compared with 100 normotensive control subject in which 65 of them were male with mean age of 56 ± 20 years and the remaining 35 were female with mean age of 46 ± 13 years. The analysis of results show that the level of Se and Cr were significantly lower in both sexes in patient with MI, AP and HT as compared with control, and the concentrations of Se were even much lower in acute MI as compared with AP.
Conclusion: The concentrations of trace elements Se and Cr were significantly lower in patients having MI, AP and HT as compared with controlled normotensive persons, besides the concentration of Se was much lower in MI as compared with cases of AP.

Background: Glucose -6-phosphate (G6PD) deficiency seems to be a major cause of neonatal hyperbilirubinaemia. This study was carried out to determine the prevalence of G6PD deficiency among icteric neonates in western Iraq and to evaluate its association with hemolysis in neonatal jaundice.
Patients and Methods: All icteric neonates admitted to Al-Ramadi Maternity and Paediatrics hospital, Al-Anbar governorat, for the period from 1st Feb. to 1st Dec. 2006 were included in the study. Data collected from case records and includes age, sex, total serum bilirubin hemoglobin level, reticulocyte count, blood group and Rh of the mothers and neonates, direct coomb's test and peripheral smear. G6PD enzymewas measured also.
Results: eight out of 100 icteric neonates had G6PD deficiency, with male to female ratio of 7:1. A significant higher total serum bilrubin (TSB) level was among G6PD deficient icteric neonates than that among non deficient icteric neonates. Reticulocytes count and haemoglobin level was not significantly differ between G6PD deficient and non deficient icteric neonates.
Conclusion: Neonatal screening for G6PD deficiency is a need in order to control genetic blood diseases.

Background: Hodgkin’s Diseases is a group of cancers characterized by Reed- Sternberg cells, aneuoploid cells that usually express CD15 and CD30. Several epidemiological and serological studies support the role of Epstein –Barr virus in the pathogenesis of Hodgkin’s Diseases
Patients and Method: A retrospective study was done where by twenty cases were collected from the Pediatric Oncology Clinic in AL-Kadhyimia Teaching Hospital over a period of five years from the first of January 2002 – end of December 2006.Information was taken from the patient’s records in the Pediatric Oncology Clinic including age at presentation, sex, physical finding, histopathological subtypes, staging , treatment applied , outcome and follow up .
Results: Among the studied group 14 cases ( 70%) were males and 6 cases (30%) were females , male : female ratio equal to 2.3:1, rang of age was between 5- 16 years with a peak age at presentation was between 11- 15 years. The initial presentation was an enlarged cervical lymph node in 18 cases ( 90%), histopathologically , most of the patients had mixed cellularity subtype , 9 cases (45%), stage II and stage III comprise the majority of cases 8 cases for each (40%), B symptoms were reported in 13 cases ( 65%) . Chemotherapy was the mainstay of treatment with good response. The overall survival was (90%), 18 cases over a median period of follow up of 2-5 years. One case relapses two months after the end of treatment, no death.
Conclusion: Although mixed cellularity was encountered in most of our patients but the response to chemotherapy is good.

Background: Brain abscess is collection of pus in the brain parrynchima surrounded by a true capsule. Usually diagnosed by CT & MRI, & treated surgically by drainage by burr hole, or excision.
Objective: evaluate our work with brain abscess.
Patient& method: 74 Patients collected in the specialized surgical hospital neuro-surgical department, from Jan. 1995 till Jan. 2005 treated surgically, all cases fully evaluated clinically & radiologically & then evaluation of the surgical procedure.
Results: there is a slight male predominance & prevalence more in the 1st 2decades of life mostly in children with cong. heart disease, headache was the most common presenting feature, with other signs of infection diagnosis was mostly by CT scan, all cases were managed surgically & the out come is compared other studies.
Conclusion: Brain abscess a relatively common disease, each case should be managed individually & depending on surgeon experience.

Background: The level of parent education has an important role in making decision about their children oral hygiene.
Material and methods: A cross sectional descriptive study was conducted in Baghdad city, the total sample include 569 preschool children (318 males and 251females) aged 5-years, they were randomly selected from different kindergartens. For measuring oral cleanliness gingival condition and dental stain, Plaque index by Silness and Lِe gingival index by Lِe and Silness and stain index by Leung were used respectively.
Results: Results showed that the mean plaque index was (0.68 ± 0.018) results reveal a high prevalence of gingival inflammation (77%)with mild type was found to be the predominant, as males had a significantly higher mean gingival value than females. A higher mean gingival value was recorded among children with low level of parent education. The prevalence of extrinsic dental stain was 48.33 %.As yellow stain was the most prevalent and higher in anterior segment than posterior segment. The mean plaque index was significantly low among children who have no stain. A higher percentage of different types of tooth stain were reported in children with low level of parent education.
Conclusion: Mild type gingival inflamation and yellow stain was most prevalent at this age group.The extrinsic tooth stain was found to be predominant in children with low level of parent's education.

Background: Acne vulgaris is a common skin problem. It affects areas of high density of sebaceous glands like the face, chest and back. The penile skin is no exception, also can be affected with acne, however little was written on this subject.
Patients & Methods: This is a clinical epidemiological study conducted at the Department of Dermatology & Venereology- Baghdad Teaching Hospital, during the period between December 2007 and May 2008. Seventy six male patients with facial acne vulgaris were enrolled in the study. A full history includes age, age of onset of facial acne and any penile lesion observed by the patient Examination of the face was done for the severity of acne and grading it into mild, moderate, severe and very severe according to Allen and Smith method. The penis of each patient was examined for the presence of ectopic sebaceous glands and acne.
Results: A total number of 76 patients, their ages ranged between13 - 30 years with mean + 19.033 + 4.609. They were classified into 4 groups according to the grades of severity of acne vulgaris, 23 (30.26%), 20 (26.31%), 18 (23.68%) and 15 (19.73%) corresponding to mild, moderate, severe and very severe respectively. The frequency of ectopic sebaceous glands in these 4 groups were 15(65.21%),14(70%), 12(66.66%) and 9(60%) respectively with a total 65.78 % from all patients with facial acne. The frequency of penile acne in these 4groupswere4 (17.39%),3(15%),3(16.66%) and 2 (13.33%) with a total 15.87 % from all patients with facial acne. There was neither a statistical significant difference in the frequency of penile ectopic sebaceous glands nor of penile acne among the 4 grades of facial acne vulgaris. P value = 0.993 and 0.992 respectively. In all patients the ectopic sebaceous glands and lesions of penile acne were situated in the ventral surface of the penis. Most patients who were aware about penile lesions and afraid from having sexually transmitted disease were those having papules and pustules.
Conclusion: Penile ectopic sebaceous glands were a common skin condition and penile acne was not uncommon skin problem among Iraqi males.

Background: Plane warts represent a common dermatological problem encountered in daily practice with no uniformly effective treatment modality.
Patients and methods: This study was conducted at the Department of Dermatology and Venereology of Baghdad Teaching Hospital / Medical City from April 2005 to June 2006. Fifty patients enrolled in the study and 36 completed it. Patients were instructed to apply isotretinoin gel once daily and keep on regular follow up every 2 weeks for one month to assess the esponse and side effects. At the end of the first month those with complete cure were instructed to stop therapy and keep on regular follow up to detect any recurrence.Patients with no response were divided into 2 groups. One group continued on isotretinoin gel alone. In the second group oral zinc sulphate was added and both groups were reevaluated after one month.
Results: 22patients out of 36 (61.7%) showed complete cure after one month of isotretinoin gel therapy. In the group that continued on isotretinoin gel for another month cure rate was 42.8% (3 patients out of 7) while in the other group where oral zinc sulphate was added the cure rate was 71.4% (5 patients out of 7).The total number of patients with complete cure throughout the study was 30 patients (83.3%).The results also showed that the cure rate for warts located on the face is much higher than cure rate for those located in the limbs and hands.
Conclusions: The result of this study showed that isotretinoin gel is a new effective and well tolerated therapy for the treatment of plane warts.Adding oral zinc sulphate seems to increase the cure rate especially for those patients who did not respond to isotretinoin.

Background: The most important advances in medical education in the last decade are the shift in focus from learning objectives to learning outcomes. The advantages of active over passive learning are researched-based. The aim of this study was to evaluate the students reading habits; utilization of lectures, group study, resources utilized during study, and if there is a need to change the curriculum.
Methods: A prospective study was done in Medical City Teaching Hospital, from January 2007 to January 2008, including 438 students from the college of medicine, university of Baghdad. A questionnaire consist of 28 questions was given to them. These questionnaire elicited responses regarding reading habits, utilization of lectures, group study, and resources utilized during study. The t-test was used for statistical analysis, the results were considered significant if P value < 0.05.
Results: In this study students were dependant on passive learning mainly. There was greater use of the lecture notes, and less use of library, textbooks,
Journals and online sources. The willing of the students to have active learning was significant (P value < 0.05)
Conclusion: We would like to conclude that teaching methods are changing, and we should consider that in our curriculum, we should concentrate on active learning. There is a public expectation that we, in the academic and clinical community, will produce safe, ethical and professional doctors.

Background:Breast carcinoma is the most common malignant tumor and the leading cause of carcinoma death in women, with more than 1,000,000 cases occurring worldwide annually.(1) as a matter of fact , the mortality rate for breast carcinoma changed very little from the 1930s to the early 1990s, because of the combined action of earlier diagnosis and improved therapy .
Materials and methods: The prospective study included 500 cases of breast carcinoma who went total mastectomy , between October 2006- April 2007, where taken from private pathology laboratory , sections(4microns) are taken and stained with H&E stain and over-reviewed.
Results: Clinicopathological analysis of the 500 cases of breast carcinoma, including the age, clinical presentation, the site of the tumor, the mammography results, the microscopic morphology, the stage and the grade of the tumor. The age in relation to the morphological classification also analyzed.
Conclusion: The commonest breast carcinoma in women is invasive ductal carcinoma, followed by lobular carcinoma, with mean age 44.5 year, mainly in the left breast, and that mammography approach is so useful in early detection of breast carcinoma.

Background:It is widely assumed that cellular immune response and cytokine (especially proinflammatory cytokines) production play an important role in the course and treatment effectiveness of chronic hepatitis C infection.
Aim of the study: evaluate the level of Th-1 cytokines during treatment of chronic HCV infection and their dynamic changes in response to treatment.
Patients and methods: The study was performed on sixty patients with chronic HCV infection, the patients were recruited from medical city gastroenterology and hepatology teaching hospital for the period from February 2007 till February 2008 and 50 healthy control group. Diagnosis was made using third generation ELISA-based screening test, RIBA-based test and PCR-based test. On the other hand, Cytokines (serum level) were determined by ELISA method before, during (6, 12, 24 weeks) and after the treatment.
Results: This study showed that after 6 weeks from the initiation of the treatment by pegilated interferon-α in the combination with ribavirin, concentration of serum cytokines IL-1β, TNF- α and INF- γ have significantly changed and at the end of the treatment concentration of all cytokines have decreased and this change was statistically significant for all cytokines.Conclusion: dynamic changes of some cytokines during INF- α and ribavirin treatment may be used as a predictor factor for evaluation of the therapy effectiveness.

Objective: To determine the prevalence of hepatitis C virus (HCV) infection among blood donors and risky population in Diyala province.
Materials and methods: In this retrospective study, the records of HCV screening and confirmatory tests were reviewed for the period 1996-2001.Third generation Enzyme-linked immunosorbant assay (ELISA) and Enzyme immunoblot assay were used as screening and confirmatory tests respectively.
Results: The prevalence of HCV infection among blood donors was 0.15%, with the highest in 1997. The highest prevalence rates were found among multiple blood recipient; hemophilia, thalassemia and hemodialysis patients (27.3%, 16.9% & 14.3%) respectively. Whereas, the patients with chronic hepatitis B infection and those with acute icteric hepatitis showed slightly elevated prevalence (2.9% & 2.1%) respectively. The overall prevalence in the province was 9.9/105 population. The mean age of infected patients was 29.7 years and the male: female ratio was 3:1.
Conclusion: The prevalence of HCV infection in Diyala population is relatively low. However, the HCV infection is concentrated in certain risky groups, particularly multiple blood recipients.

Background: Autoimmune hepatitis (AIH) is a rare chronic liver disease of known etiology, characterized by hypergammaglobulinemia, characteristic auto antibodies, and a favorable response to immunosuppressive treatment.Strong circumstantial evidences denoted that there is quite long list of environmental factors such as (food additives and drugs), viruses and toxins which play an important role in precipitating this disease.
Patients and Methods: the study was performed on 13 Iraqi patients with acute viral hepatitis, attending the Teaching Hospital for Gastroenterology and Liver Disease and Al-Khadymia Teaching Hospital in the period between November 2003 and July 2005. ANA, SMA and anti-LKM 1 were detected by immunoflurescent technique whereas SLA/LP Ab was detected by Euroline method.
Results: the thirteen patients with acute viral hepatitis were developing AIH after 3 months.Conclusion: acute viral hepatitis is a trigger of AIH.

Background: The study was conducted to investigate the association between hyperprolactinaemia and markers of human leukocyte antigen (HLA) system in a sample of Iraqi infertile females, together with the profile anti-nuclear antibodies (ANA).
Objectives: One hundred and seventy five female patients (age range: 20 -40 years) were recruited in this study. They were attending the Institute for Embryo Research and Infertility Treatment (Al-Nahrain University) during the period January 2005 - September 2006.
Results:After clinical and laboratry evaluations, it was found that 100 patients were hyperprolactinaemic, whereas the other 75 patients were euprolactinaemic, therefore, they were considered as a control group. Based on serum level of prolactin (22-29, 30-39 and ≥ 40 ng/ml), the total hyperprolactinaemic patients were divided into three groups; I (35 patients), II (40 patients) and III (25 patients), respectively. The HLA antigens showed significant variations between patients (total and groups) and controls. In total patients, B8 (25.0 vs. 9.3%), DR3 (48.0 vs. 17.3%) and DR4 (39.0 vs. 13.3%) showed significant increased frequencies, while B35 showed a significant decreased frequency (7.0 vs. 24%). The latter decrease was also observed (5.7 vs. 24.0%) in group I of patients, which also showed a significant increased frequency of DR3 (54.3 vs. 17.3%). In groups II and III of patients, only DR3 (45.0 and 56.0, respectively vs. 17.3%) and DR4 (37.5 and 56.0, respectively vs. 13.3%) showed significant increased frequencies. Autoantibody evaluation by ANA test revealed that 22% of the total patients was positive, while all control subjects were negative, and such positivity paralleled the increased level of serum prolactin.

Background: a rapid and accurate identification of Methicillim-Resistant Staphylococci (MRS) is of a particular clinical significance because they have cross-resistance to other antibiotics with high ability to be transmitted among hospitalized patients known as epidemic MRS.
Objectives: the detection of MRS and the susceptibility of isolates to antimicrobial agents, also to determine inducible and constitutive macrolide-lincosamide-streptogramin B (MLSB) resistance mechanisms by pharmacodynamic interpretative reading approaches.
Methods: standard disk diffusion method was performed for 30 Staphylococcus aureus and 10 Staphylococcus epidermidis isolated from wound, burn patients admitted to Ramadi General Hospital in Ramadi and eczema patients who attended the same hospital, from September 2005 to April 2006, against oxacillin 5µg disk and cefoxitin 30µg disk as indicators to detect the presence of MRS, and against selected antimicrobial agents, double disk tests (D-test) were performed to determine MLSB-inducible resistance mechanism.
Results: out of 40 isolates, 34 (85%) isolates considered to be MRS according to cefoxitin susceptibility results, but according to interpretative reading of -lactams susceptibility pattern with oxacillin 24 (60%) of isolates identified to be MRS. High percentage of isolates were non-susceptible to β-lactam antibiotics and 4 (10%) isolates were resistant to imipenem, also 4 (10%) isolates were resistant to vancomycin, the interpretative reading of the susceptibility pattern against erythromycin and clindamycin showed classical 21/40 (52.5%), MLSB-inducible 6/40 (15%, +ve D-test), MLSB-constitutive 6/40 (15%), and macrolide efflux-mechanism 7/40 (17.5%, -ve D-test).
Conclusion: high percentage (85%) of isolates was MRS, and 15% of them have MLSB-inducible and another 15% have MLSB-constitutive resistance mechanisms inferring the presence of erm gene, 17.5% may have macrolide efflux-mechanism encoded by the msrA gene. The presence of such resistance mechanisms implicates serious problem in hospital regarding control of infection and control of antibiotic use; thus, necessitate an appropriate protocol (to implement) for the control of infection and use of antibiotics.

Background: Human cytomegalovirus (HCMV) infection during pregnancy causing serious problems through induction of viral genes that enhance the expression of different cellular factors ending in failure of pregnancy.
Patients and Methods: Paraffin embedded sections of curate samples were obtained from 34 women had spontaneous abortion, and 5 women had elective termination of pregnancy (as control), and then subjected for immunohistochemistry analysis to detect human cytomegalovirus (HCMV) early protein, and in situ hybridization technique to detect nuclear factor-κB (NF- κB) mRNA.
Results: Only nine out of 34 women with spontaneous abortion were positive for HCMV early protein, with a significantly higher expression of NF-κB in HCMV positive cases as compared with HCMV negative and the control group (p = 0.001).
Conclusion: This study strengthen the possibility that HCMV infection may play an important role in the pathology of pregnancy loss on multidirectional bases include inducing the expression of the transcriptional factor; NF-κB.

Back ground: Although adult stem cells possess plasticity that permit differentiation along new
lineages, production of exocrine and endocrine pancreatic cells and insulin-secreting beta-cells from
adult non pancreatic stem cells has been considered controversial. We present that highly purified
adult rat hepatic oval stem cells, which are capable of differentiation to hepatocytes and bile ducts
epithelium, can also trans-differentiate into pancreatic exocrine-endocrine tissue, when homogenized
hepatic tissue is implanted into subcutaneous tissue .
Methods and Materials: A total of 60 adult Swiss albino rats were divided into two groups . Group I
, control group (30 animals) was injected with normal saline into the subcutaneous and pancreatic
tissue, group II (30 animals) has been exposed to 90% subtotal pancreatectomy with implantation of
hepatic tissue homogenate into marked areas of subcutaneous tissue .
Results: During the first three weeks the animals of group II showed both high blood glucose and
serum AFP levels, then gradually started to decline and became normal around the period of six
weeks and continued being normal till the end of experiment. The histological study showed
regeneration and proliferation of small hepatic oval stem cells in the subcutaneous tissue around the
second week and trans-differentiation of these cells into islet like cells and acinar like cells around the
sixth week.
Conclusions: Hepatic oval stem cell has multipotent character and can differentiate into new-lineages
and formation of different clonal cells, such as islet-like cells and acinar cells of the pancreas.

Background: Extreme obesity is recognized to be a risk factor for coronary heart disease. It
is unclear whether overweight and normal weight also poses a risk.
Objective: The study aims to determine the effect of the body mass index on coronary
arteries and left ventricular functions in patients with post myocardial infarction (MI) angina
Method: The study included 50 patients with the diagnosis of post MI angina consecutively
admitted to the medical ward of Iraqi Center for Heart Disease. All patients underwent
coronary artery catheterization and Echocardiography for assessment of coronary artery and
left ventricular functions
Results: The results of the study showed that there is a significant difference in impaired
left ventricular systolic pressure between normal weight and overweight patients with post
MI angina .The study also revealed that (16.16%) of the patients with normal weight and
(30.76%) of the patients who are over weight had three vessels disease.
Conclusion: left ventricular functions reflected by ejection fraction and left ventricular wall
motion and state of coronary artery were better in normal weight patients than in over weight
patients.