Journal of the Faculty of Medicine Baghdad

Background: Mitral stenosis (MS) is the most common valve disease in developing countries and there
are many ways to deal with this condition. The aim of this study was to evaluate the immediate results of
percutaneous transvenous mitral commissurotomy (PTMC) in patients with severe symptomatic
rheumatic mitral stenosis.
Patients and Methods: From May 2006 to August 2007, 58 patients (17 male, 41 female) with age range
(16-57) years, underwent PTMC in Ibn AL- Bitar Hospital for Cardiac Surgery. All the patients were
symptomatic, their MVA 1.5 cm2 with NYHA class II-IV. Clinical evaluation and echocardiographic
examination were carried out before and after PTMC, mitral valve structures were assessed using Wilkins
score. The procedure was performed under local anesthesia, using the step-wise Inoue balloon technique
with the antegrade transvenous approach.
Results: The procedure was successful in 51(88%) of the patients and unsuccessful in the remaining
7(12%) patients. Successful result was defined as post procedure mitral valve area ( MVA) 1.5 cm² as
assessed by echocardiography and no mitral regurgitation (MR)>2 according to sellers classification.
Mitral valve area increased from 0.93 ±0.2 to 1.84±0.2 cm² after the procedure (P<0.001) as measured by
echocardiography. Severe MR was observed in 1(1.7%) patients, while new mild - moderate MR have
been detected in 9(17.6%) patients. Symptomatic improvement was seen in all patients who underwent
successful PTMC .There where no procedure related deaths, temponade or the need for emergent mitral
valve replacement.
Conclusion: percutaneous transvenous mitral commissurotomy by Inoue balloon technique is safe and
effective procedure for patients with severe and symptomatic rheumatic MS. The ideal candidate are
those patients with pliable valve ,but still most of patients with relatively high Wilkins echo score can get
considerable benefit.
Keywords: PTMC, mitral, Inoue.

Objectives: a study of surgical procedures used in the management of sciatic n injury & acomparism between them including comparism with other universal studies.Patients and methods: 62 patients collected from the neuro-surgical unit in the specialized surgical hospital from Jan-2004 till October 2007, all patients studied thoroughly regarding age, Gender, type of injury, time of injury & outcome.Results: 85% of our patients were پ‰, 45% were in the age of 21-30 years, most injured by bullet or shells, the delay in surgery was mostly 1-3m, the repair is by direct suture 45%, 29% release of adhesions 16%, excision of neuroma & suturing, 9.6% by nerve graft, the direct suturing carried the best results, & grafting the worse type, comparism done with universal studies.Conclusion: Direct suturing of neural sheath (Epineurium) caries the best results if done at proper time.

Background: uterine involution is the process by which the postpartum uterus returning to its
prepregnant state by the process of autolysis. The aim of the study is to fallow the uterine involution
sonographicly during the first two weeks of puerperium and clinical correlation of several puerperal
conditions was sought.
Patients and methods: One hundred full term women were delivered in one of Baghdad hospital
during a six month period were followed by serial sonogram during the first two weeks of the
puerperal period to show the normal process of uterine regression in relation to several condition .The
rate of uterine involution were shown as percentage drop in uterine volume at day (7) and day (14)
compared to day (1).
Results: 59 patient included in this project were delivered vaginally, and 41 patient delivered by
emergency C/S.
The mean percentage drop in uterine volume in vaginal delivery was 39.9% at 7 days postpartum &
62.7%at 14days postpartum and in those delivered by C/S was 27.9%at 7 days and 55.2 %at 14 days
postpartum.
24 patients had an abnormal offensive lochia and high vaginal swab was positive for the presence of
pathogenic organisms is 46% and negative in 54%inthe 7th postpartum day.
The mean percentage drop in uterine size was faster in women delivered infant less than 4
kg.(37%drop) compared to those delivered infant more than 4 kg.(26% drop) in the 1st 7 days
postpartum regardless to the mode of delivery but the body weight loses its effect in the 14th
Introduction:
day
postpartum.
Conclusion:The uterine involution is faster in women delivered vaginally compared to those
delivered by emergency C/S regardless to the weight of the newborn.The uterine involution is
delayed in women delivered newborns weighing more than 4 kg. , also the uterine involution is
delayed in women who are their high vaginal swab show presence of pathogenic organism. No
correlation was found between breast feeding &rate of uterine involution.
Key word: puerperal uterus, ultrasound, mode of delivery, lochia, foetal weight, type of infant
feeding

Background: There were definite changes in pathologies involving thyroid gland allover the world with increasing incidence of thyrotoxicosis and differentiated malignancies. Patients and methods: 224 patients were operated upon by the same surgeon during 15 years period. Those patients were divided into two groups (GI from June 1990 up to June 2000) and (GII from June 2000-June 2005).Results: female to male ratio was 3.3:1. The most common presentation among both groups was Multinodular goiter (MNG) 76.8%. toxic goiter was recorded in 24% of patient with increase among GII patients. A significant effect of stress on the increasing incidence of thyrotoxicosis was elicited in more than 50% of patients with thyrotoxicosis. Malignant thyroid tumors constituted 8.5% of the diseases and they were mostly papillary carcinoma. There was increase incidence of malignant thyroid tumors among GII patients (2.65% in GI versus 13.5% in GII). The trend toward more radical surgery was evident among GII patients Conclusion: thyroid malignancy and thyrotoxicosis are increasing in our country and stress factor might play a role in this rise. Due to the previous changes, the surgeon attitude had changed toward more radical surgery.

Background: Chronic obstructive pulmonary disease (COPD) is a common disease and it accounts for over 10% of all hospital medical admission. Cigarette smoking is the most important risk factor. Pulmonary arterial hypertension (PHT) is a common complication of COPD and the increase in pulmonary artery pressure is often mild to moderate. The presence of pulmonary arterial pressure and its severity is readily and reliably determined by transthoracic echocardiography in majority of COPD patients.
Patients and Methods: This study included 55 patients with mean age 65.6 ±8.2 years .The mean duration of symptoms was 18 ±10 months. 32 patients (58%) were current smoker, 18 patients (33%) were ex-smoker and 5 patients (9%) were non smoker. The mean intensity of smoking for smoker was 49.5 ± 22.2 pack- years. For all patients, history, clinical examination, ECG, CXR, and routine blood tests were done. For all patients pulmonary function tests were done and patients were classified according to GOLD criteria into 4 stages. Echocardiography was done for all patients; ventricular and atrial dimensions were taken, and using Doppler technique to detect tricuspid and pulmonary regurgitation, estimation of pulmonary artery systolic and/or diastolic pressure using special formulas was undertaken.Results: Tricuspid regurgitation (TR) jet was found in 70.9% of patients with COPD. Increased pulmonary artery systolic pressure was found in 51% of patients with TR (36% of total patients) and increased pulmonary vascular resistance was found in 48.7% of patients with TR (34.5% of total patients). There were significant associations between echo findings of increasing RV size, TR, increased pulmonary arterial pressure and pulmonary vascular resistance with decrease in FEV1, FEV1/VC and oxygen saturation. There was no significant association with decrease in vital capacity.Conclusions: There is a high prevalence of pulmonary arterial hypertension with increasing severity of chronic obstructive pulmonary disease.

Background: The use of the chest x-ray measurements which includes the cardiothoracic ratio(C-T) and frontal area (FA) of the heart by the CXR are useful measures for primary assessment of the cardiac dysfunction.
Patients and Methods: A Prospective study was done from the 1st of January 2005 to the 1st of October in the same year on a 120 consecutive patients who have been admitted for coronary and L.V angiogram at IBN-AL-BITAR hospital. The C-T ratio and the frontal area were measured.
Results: The study comprised 120 subjects who were admitted for coronary and L.V angiogram for diagnostic reasons. 89subjects (74.2%) are male and 31subjects (25.8%) are female .17(14%) subjects have left ventricular dysfunction and dilated L.V with EDV≥110 cm^2 by angiogram. (76) Subjects (71%) had LAD (Left anterior descending artery disease), (40) subjects (37%) had LCX (Left circumflex artery disease), 10subjects (9%) had LMS (Left main stem artery disease) and (38) subjects (34%) RCA (disease). 13subjects (10%) had valve disease , 2subjects (1%) of them have aortic stenosis , 5 subjects (4%) had A.I (aortic inche), 4 subjects (3%) had M.S(Mitral stenosis) , 6 subjects (5%) had M.R Mitral regurgitation and combined valve disease .The abnormal chest radiogram C/T Ratio had a sensitivity of 56.6%, a specificity of 78.6%, and positive ,negative predictive values and accuracy of 95.2% ,19.3% and 59.2% respectively, in the diagnosis of left ventricular dysfunction.while the abnormal chest radiogram FA/BSA £ had a sensitivity of 47.2%, specificity of 42.9%, and positive ,negative predictive values and accuracy of 86.2% ,9.7% and 46.7% respectively.
Conclusion: The radiological study of the thorax is not an accurate indicator of left ventricular dysfunction; its use as a screening method to initially approach the patient with ventricular dysfunction should be reevaluated.

Background: Endoscopic treatment is widely accepted as the most effective method for controlling acute ulcer bleeding and preventing ulcer rebleeding.Objective: is to compare efficacy and safety of local endoscopic injection of adrenaline to normal saline in bleeding peptic ulcers and to identify the risk of rebleeding after successful endoscopic hemostasis.Patients and methods: This is a prospective study of 77 patients with bleeding peptic ulcers were treated by local endoscopic injection of adrenaline or NS. Patients who succeeded initial hemostasis were admitted and followed for rebleeding events. Rebleeding was confirmed by urgent endoscopy followed by referral to urgent surgery. Outcome was measured directly by rebleeding rate, need for surgery, and the mortality rate and indirectly by the number of blood transfusion units and days of hospitalization. All clinical and endoscopic data of patients were collected to stratify the risk of rebleeding.Results: The rebleeding rates (17.9% for NS group vs. 11.4% for adrenaline group), the need for emergency operation (10.2% vs. 5.7%), blood transfusion (3.2 units vs. 2.4 units), hospital stay (2.8 days vs. 2.7 days) and in-hospital mortality (5.6% vs. 5.7%) were not significantly different in both groups. Clinical and endoscopic analysis revealed that presence of shock, coexisting disease, large ulcer size (>2cm) and active bleeding were independent factors predicting rebleeding.Conclusion: local endoscopic injection of NS and adrenaline are equally safe and effective in stopping ulcer bleeding and rebleeding. Severe bleeding, comorbidities, large ulcer size, active bleeding all are predictors of rebleeding.

Background: Fibromyalgia syndrome is a common rheumatological syndrome with multiple systemic manifestations & associated with many diseases. The aim of the study is to assess the possible association between fibromyalgia syndrome (FMS) & chronic obstructive pulmonary disease (COPD), and to correlate this association with patient's age, age group, sex, marital status, duration of the disease, & its severity. Patients and Methods: Fifty patients with COPD & 50 healthy controls were included in this study. Full history was taken & complete physical examination was done for all patients in both groups. Disease characteristics [age, age group, sex, marital status, duration of the disease, & severity of COPD) were also documented. Pulmonary function tests and chest-X-ray were evaluated for all patients. The American College of Rheumatology (ACR) 1990 Criteria for the classification of FMS were applied to all patients & controls included in this study for diagnosis of FMS.Results: Four (8%) patients with COPD have FMS compared with 3(6%) controls (p=0.695). Also FMS was reported in 3 (16.7%) female patients with COPD compared with 1 (3.1%) male patient with COPD (p=0.04). There was no statistical significant association between FMS and: patient's age, age group, marital status, duration of the disease, & disease severity (p=0.816, p=0.481, p=0.702, p=0.178, p=0.181) respectively.Conclusions: FMS is more common in COPD patients compared to controls, but no statistical significant association between them. There was a statistical significant association between FMS & patient's sex only.

Background: Cutaneous small vessel vasculitis characterized by necrosis and inflammation of upper dermal blood vessels. It presents with ulcers and systemic manifestations after extensive acute onset. Many patients have a form of cutaneous vasculitis that presents with chronic painful ulcerations & purpuras involving the ankles without systemic manifestations, with some similarity in clinical presentation to livedoid vasculopathy. Patients and Methods: Thirteen patients were seen in the Department of Dermatology and Venereology, Baghdad Teaching Hospital, for a period extending from January 2004 to March 2005. They were evaluated clinically, histopathologically and other laboratory studies. In addition, evaluation of the clinical response to prednisolone 0.5mg/kg/day and azathioprine150mg/day was done.
Results: Thirteen patients were included in this study; eight females and five males, with male to female ratio of 1:1.6. Their ages ranged between 26-66 years with a mean ±SD of 42 ± 13.8 years. The duration of the disease ranged from 0.5 – 18 years with a mean ±SD of 38 ± 59.2 months.The clinical examination revealed multiple oval punched out ulcers, with an indurated base, and surrounded by a zone of erythema; affecting mainly the ankles and dorsa of feet. Histopathological evaluation showed upper dermal vessels' wall necrosis, fibrinoid deposition, obliteration of the lumen, extravasation of red blood cells, endothelial cells swelling with perivascular and vascular wall infiltration mainly by mononuclear cells.The treatment was started with prednisolone & azathioprine. The ulcers healed completely with residual hyperpigmentation - hypopigmentation, atrophy and scars within 10-15 weeks Conclusions: Chronic ulcerative cutaneous vasculitis is often a neglected and misdiagnosed variant of vasulitis. Histologically it has vascuiltic features, and clinically looks like livedoid vasculopathy.

Background: HROM agar Orientation is a chromogenic medium used for the detection and differentiation of Gram’s negative and Gram’s positive pathogenic microorganisms in urine samples.
Evaluation of CHROM agar Orientation for identification of urinary pathogens and susceptibility determinations in comparison to the ordinary media used.
Patients and Methods: A total of 375 midstream urine sample collected from patients with urinary tract infection (UTIs). CHROM agar Orientation, blood agar and macConkey agar media were used for direct inoculation.
Results: CHROM agar Orientation succeeded in detecting all the urine pathogens that were detected by the reference media, and antimicrobial Susceptibility tests were performed directly from primary isolates in all cases without the need for subcultures.
Conclusion: HROM agar Orientation medium excellent detection of urinary pathogens and antimicrobial Susceptibility tests without the need for subcultures. Therefore, can replace the standard primary plating media used in routine diagnosis of urinary tract infection.

Background: genetic factors were considered to play a possible role the development of autoimmune hepatitis.
Patients and methods: polymerase chain reaction-sequence specific primers (PCRSSP) was the method used to asses HLA-typing of 100 blood samples of 60 AIH patients and 40 healthy normal controls.
Results: comparison between AIH patients and healthy controls showed several antigens deviations in their frequencies. HLA-A*113 (A1/-/Null) observed to play a possible risk factor in this disease while significant loss of HLA-A*2 allele were clearly observed which prompt us to believe that it could act as a protective factor, on the other hand, increased frequency of HLA-B*8 & B*14 were statistically significant in AIH which is most likely to be considered as a rather risk factor, while most HLA-B*16 were lost which led us to think of being acting as a rather protective factor.
Conclusions: this finding reflects a preliminary picture that HLA antigens might play a role in AIH susceptibility and further studies are worth being carried out.
Key words: AIH, HLA antigen, PCR-SSP.

Background: Several biological factors such as bacterial infections and immunological status are implicated in predisposing individuals to bladder cancer. Bacterial infection of urinary tract has been related to increase the risk of bladder cancer.
Patients and Methods: Resected tumors of a total of 73 patients were obtained under sterile surgical conditions. Biopsy processing samples and culture procedures of biopsy samples were mentioned in the text.
Results: Bacterial growth was observed in 48 biopsy tissues of those patients represent (65.8%) while, 25(34.2%) yielded no growth (negative results).
It is obvious that E. coli is the most predominant organisms followed by K. pneumoniae and Ps. Aeruginosa. The other uropathogens isolated more or less of equal distribution.
Conclusion: High frequency and great variety of bacteria in cystectomy specimens removed from cancer of urinary bladder. They were often Gram-negative pathogens (primarily Enterobacteriaceae).

Background: Human Cytomegalovirus (HCMV) infects a wide range of human cells, including colonic epithelial cells that give rise to adenomas and adenocarcinomas. Persistent productive infection of tumor cells is essential for oncomodulation by HCMV.This study aimed to detect HCMV matrix protein using in situ hybridization technique (ISH) in colorectal adenocarcinoma compared to normal colon tissues, and to the presence of cytomegalovirus inclusion bodies in infected colorectal carcinomas.Patients and methods: Twenty six of colorectal adenocarcinomas were obtained in paraffin-blocks compared to 10 normal colon specimens which were age and sex matched as control group. Detection of HCMV was obtained by in situ hybridization technique.Results:The biotinylated probe specific for DNA encoded HCMV-matrix protein showed hybridization with nucleic acid in 20 cases out of (26) of colorectal adenocarcinomas representing (76.9%) compared to normal colon tissue which revealed no hybridization signals. Moderate to high scoring signals were detected in moderate to poorly differentiated groups. Inclusion bodies were detected in 11 (42.3%) cases with positive hybridization signals.Conclusion: HCMV may play a role in the colorectal adenocarcinoma pathogenesis. In situ hybridization test are considered the most sensitive and specific tools for detection of HCMV DNA in tissues. Epidemiological, histopathological identification of cytomegalic inclusion bodies and molecular studies are necessary to confirm the association of HCMV and colorectal tumorogenesis in Iraqi population.

Background:
Rheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disorder that causes the immune
system to attack the joints. It is a disabling and painful inflammatory condition, which can lead to
substantial loss of mobility due to pain and joint destruction. RA is a systemic disease, often affecting
extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and muscles.
Patients and Methods: Enzyme immunoassay for Determination of human TNF- , IL-1 and GM-CSF
in serumsamples from50 patients with a diagnosis of rheumatoid arthritis
Results: of cytokines showed a significant increase in TNF-alpha, IL-1 beta and GM-CSF in patients
with rheumatoid arthritis (70.98 12.08) pg/ml,(238.6 116.4)pg/ml and (96.1 12.08)pg/ml respectively.
When compared with the control group (7.0 3.09)pg/ml, (15.4 3.8)pg/ml and (6.8 3.03)pg/ml
respectively.
Conclusion: Increased serum levels of proinflammatory cytokine such as TNF- , IL-1 and GM-CSF
probably play important role in driving inflammatory process and promoting joint destruction in
rheumatoid arthritis. Regulation of these cytokines is a crucial importance in the RA disease showing
pleiotropic actions and many different targets.
Keywords: Rheumatoid arthritis, TNF- , IL-1 and GM-CSF.

Background: Osteoarthritis (OA) is disorder of diarthrodial joints characterized clinically by pain and functional limitation. Rheumatoid factor (RF) represents one of routine laboratory tests that done for all patients have joint complaints. Chloroquine phosphate (CQP) is a disease modifying antirheumatic drug (DMARD) used for patients suffer from knee osteoarthritis (KOA) in order to reduce their RF value and improves the disease status. Objective: To evaluate the effect of chloroquine phosphate on rheumatoid factor (RF) level in serum of patients with knee osteoarthritis KOA) Design: case report.Subjects and methods: RF value were assessed quantitatively by ELISA technique before and after treatmtnt for a total of fifty five patients with KOA (30 femal and 25 male) their age ranged from (50-66 years) selected randomly from out patient clinic in Baghdad Teaching Hospital , Medical City Baghdad; suffering from KOA. All patients were treated with oral dosage form of CQP for one month twice daily.Results: Mean serum RF level was significantly reduced (p<0.05) in serum of patients after treatment with CQP for one month.Conclusion:CQP is a disease modifying antirheumatic drug (DMARD) used for patients suffering from KOA in order to reduce their RF value and improves the disease status.

Background: proteins, glycoproteins and fructose as parameters used to assess infertility in men.
Objective: To determine and correlate serum and seminal plasma of total proteins, glycoproteins and fructose with infertility in men.
Patients and Methods: The study was performed on 154 subjects; 109 infertile men (oligospermic and azoospermic) and 45 normal volunteers (normospermic men). All sera and seminal plasma were submitted for total proteins, glycoproteins and fructose levels measurment.
Results: No significant difference was noted in serum and seminal plasma of total proteins in oligospermic and azoospermic and that of normospermic men (P>0.05) compared to normospermic men.
Statistical significant reduction (P<0.05) was noted in seminal plasma glycoproteins in oligospermic as compared to normospermic and azoospermic men.
A significant elevation (P<0.05) of fructose levels were observed in seminal plasma of azoospermic when compared to others.
Conclusion: This study may indicate that the higher concentration of glycoprotein in seminal plasma the better quality of semen and a significant negative correlation (r=−0.749: P<0.05) were observed between seminal plasma fructose and sperm count of infertile men.

Background: Free radicals have been implicated in many pathological processes, including
ischemia, inflammation, and malignancy. The free radicals may affect tissues damage by lipid
peroxidation which generate malondialdehyde (MDA) as a by byproduct of the reaction. The
objective of this study is to examine the dynamics of lipid peroxidation in patients with
thyroid disorders using the measurement of malondialdehyde level as a marker for the degree of
thyroid disorder.
Methods: Two hundred and forty five subjects were enrolled in this study. Hundred and
ninety five were patients with different thyroid disorders (88 yperthyroidism, 63
hypothyroidism and 44 thyroid carcinoma) the remaining 50 subjects were healthy ones
without any apparent functional disorders served as a control. Malondialdehyde (MDA) level
was estimated in the sera of all subjects.
Results: A significant increase in the level of serum MDA concentration was observed in
patients with all types of thyroid disorders as compared with the control groups.
Conclusion: The findings obtained showed a high

Summary:
Background: Mitochondria play an important role in the regulation of physiological type of cell death (Apoptosis) this type of cell death can be stimulated by two major pathways: external (Fas-Fas ligand interaction) and internal mitochondrial pathway which require disruption of mitochondrial transmembrane potential (∆طm ) which leads to opening of mitochondrial channels that lead to release of cytochrome –C which would execute apoptotic process.
Patients and Methods:The study included 32 normal subjects; 2 ml of venous blood were aspirated from each of them and processed for peripheral blood lymphocytes separation (PBL)
Then lymphocyte apoptosis was studied before and after exposing (PBL) to hyperthermia by these three methods to compare which of them can detect earliest apoptotic changes: Cell count and viability, morphological changes (by acredine orange stain) and the changes in mitochondrial membrane potential by Mitolight Apoptosis Detection Kit.
Results: Our results showed that the percentage of lymphocyte apoptosis detected by mitolight was significantly higher than those detected by other two methods.
Conclusion: This study shows that mitochondrial changes can detect earlier apoptotic process than morphological features detected by DNA stains.

Background: Determine how do obesity and type2 diabetes intertwined? and what it takes to turn an obese person into a person with diabetes. That link may help to understand why some obese people never develop diabetes while many others do.Serum sugar level was used as indicator of insulin level; leptin level was used as indicator of leptin resistance.A total of 50 obese subjects were involved in this study, 25 obese subject (BMI >30) had diabetes mellitus type 2(no insulin dependant), selected from Baghdad teaching Hospital in Baghdad /Iraq. The remaining 25 obese (BMI >30) were normal healthy individuals.Patients and Methods: ELSA technique was used for the measurement of serum leptin. Blood sugar was determined by using colorimetric method. Data were expressed as mean ± SD results and were evaluated using the student t-test for paired data. Conventional methods were used for the correlation and regression analyses.Results: Obtained results showed that the level of serum leptin in healthy obese subjects were significantly lower than that of obese diabetes subjects. , serum sugar in non diabetic obese subjects was significantly lower than obese diabetes type2 subjects.Serum leptin correlated negatively with level of serum sugar at the same time had a positive correlation with BMI in non diabetic obese group whereas level of serum leptin correlated positively with each of BMI and serum sugar in diabetic type2 group. All results are thoroughly discussed in the text.Conclusion: The present study indicates the possibility of future development of a new class of anti diabetic agents that act centrally and independent of insulin action.

Backround: The Solid state fermentation has several advantage including absence of free water , reduced volume of production media utilized for high products and the relatively low costs of production.
Methods: Thirty local isolates of soil obtained from Genetic Engneering and Biotechnology Institute. Nutrient agar was used to growth strains examination to antibacterial agent and Wheat bran and fish meal were used in combination (0-100%of each )and divided in 10 gm lost /flask . Each flask is inoculated with different numbers of Streptomyces spores and incubated for 5 days at 28°C, then the supernet was extracted and were assayed as antibacterial
Results: The ability of 30 local isolates of Streptomyces and the standard strain S.griseus for antibacterial production were tested by grow in Muller Helton agar. The later isolate (standard isolates) showed highest antibacterial activity with inhibitory effect of (30 mm,24 mm ,20mm, 18mm ) compared with local isolates (S1 ,S2 , S3 ) resectively
Conclusion: only two soil isolates (among 30 isolates) and standard isolates of Streptomyces griseus were appears able to produce antibacterial agent under optimum condition . The optimum condition for the production of antibacterial is solid state fermentation included the use of wheat bran hydrate with distilled water pH=8 and the optimum hydration ratio was 1:3 (w:v) with an inoculum size of 6x109 spores/flask ( 10 gm wheat bran ) and incubation for 5 days at 28°C.

Background: Immunoassays are one of the oldest techniques used in diagnostic virology where a number of serologic techniques, with different degrees of sensitivity and specificity, for the detection of HCV antigens and their specific antibodies, have been developed.
Materials and methods: One hundred and four sera samples were collected from National Center for Blood Transfusion, Gastroenterology and Liver Diseases Hospital, Central Public Health Laboratories and Teaching Laboratories. According to the manufacturers practical instructions, many available methods for detecting Anti-HCV antibodies, including enzyme linked immunosorbent assay (ELISA), immunochromatographic assay (ICA), recombinant immunobloting assay (RIBA), were applied.
Results: Although RIBA test is expensive and little bit laborious, this technique proved to be a powerful laboratory technique with both very high sensitivity and specificity when compared to ELISA, since the latter gave false negative results that were found by RIBA to be repeatedly positive. The ICA test for anti-HCV Abs was found to be a test with a relatively comparable sensitivity and specificity results to EIA / ELISA.
Conclusion: RIBA is a trustful test in big laboratory centers for anti-HCV Abs screening well with or without ELISA test (if a laboratory personnel are feasible to be available and trained for this purpose).The ICA test for anti-HCV, that need no expensive instrumentation, was found as a rapid, simple and cheaper test that could be used with comparable results to ELISA, for mass screening, at least, in rural laboratory centers.

Summary:
Background: Decreased taste acuity to the four basic tastes is closely related to health problems (diseases & medications), aging, and smoking. This study aimed to determine taste detection and recognition thresholds to the four basic tastes in some physiological and pathological conditions, determine saliva flow rate, serum and saliva zinc levels in these groups.
Objective and Methods: The study includes 218 individuals (35–80) years old divided into six groups; the control, aging (subjects over 60 years), smokers, diabetics, haemodialysis patients and hypertensive patients on chronic use of captopril.The taste detection and recognition thresholds of sweet, salty, sour and bitter tastes, saliva flow rate were determined. Zinc concentration was assessed in serum and saliva spectrophotometricaly.
Results: The results showed a significant increase in the taste detection and recognition thresholds of the four basic tastes of all groups than in the control, except the salty taste thresholds of the haemodialysis group and the salty taste detection threshold of the diabetics.
Saliva flow rates, serum and saliva zinc levels decreased significantly at p<0.001 in study groups as compared to the control group.
Conclusions:The taste acuity was impaired in aged subjects, smokers, diabetics, haemodialysis patients, and hypertensive patients on chronic use of captopril.
Decreased saliva flow rate and saliva zinc concentration could be causative factors for hypogeusia.

Background: Breast cancer is the culmination of a multi-step process that occurs over a period of several
years or decades and as a cause of death, is a salient "free radical" disease. Aim: The present study aims
on investigating the possible protective role of antioxidant drugs (vitamins E and C) to cardiac cells
against the oxidative stress induced damage during doxorubicin chemotherapy in patients with breast
cancer.
Patients and methods: Thirty two patients with different stages of breast carcinoma attending to Baghdad
Teaching Hospital and ten healthy control subjects with age range between (29-61) years, mean
(43.6±1.37) were included in this study. The patients were randomized into 3 groups, they were treated
with either doxorubicin alone 60 mg/M² every 21 days, doxorubicin 60 mg/M² every 21 days +vitamin E
800IU/day for 42 days or a combination of vitamins E 800IU/day and vitamin C 1000mg/day for 42 days
+ doxorubicin 60 mg/M² every 21days. The oxidative stress and cardiac function parameters were
evaluated before starting treatment and after 21 and 42 days respectively including assessment of serum
levels of MDA, creatine kinase and lactate dehedrogenase activities.
Results: Using doxorubicin alone produce an elevation in the markers of oxidative stress and cardiac
damage that can be reduced when antioxidant drugs vitamin E alone or a combination of vitamin E and
vitamin C being added.
Conclusion: Antioxidant drugs, vitamin E or a combination of vitamins E and C when co-administered
with the antineoplastic drug doxorubicin reduces its cytotoxicity on cardiac cells in breast cancer patients.
Key words: Breast cancer, Doxorubicin, Vitamin E, Vitamin C, MDA, Cardiotoxicity

Background: Leukemias and lymphomas are malignant disorders that occur in the blood forming organs and lymphoid tissue respectively. They are classified to types and several subtypes such as acute or chronic, lymphocytic or myelocytic and T-cell or B-cell lymphocytic for leukemias and histologically into Hodgkin’s and Non-Hodgkin’s for lymphomas. Literatures do not contain many research work on magnesium in patients with these disorders, although this mineral is essential for many metabolic, enzymic, regulatory and immune reactions in the human body. Therefore, the present study was aimed to evaluate the level of magnesium in the sera of patients with different types of leukemia and lymphoma. Patients and Methods: Fifty five patients with leukemia and lymphoma and twenty five healthy controls were studied. The patients were attendants of Baghdad Teaching Hospital and Pediatric Teaching Hospital from September 2006 to January 2007. The diagnosis was confirmed by examination of both peripheral blood, lymph node biopsy and/or bone marrow examination. Patients were categorized according to French-American-British Criteria. Thirty five patients with ALL, one with CLL, six with AML, three with CML, three with HL and seven with NHL. Venous blood was collected from each patient or control person and sera were obtained by centrifugation. S[Mg] was measured by Atomic Absorption Flame Spectrophotometry.Results:The Mean ± SD of S[Mg] in mg/dl of all types of leukemic and lymphomatous patients was lower than the controls. There was a high statistically significant difference (P<0.01) in patients with ALL and significant difference (P<0.05) in patients with AML and NHL and non-significant difference (P>0.05) in patients with CML and HL, compared with the control. Total patients group showed high significant difference (P<0.01) compared with control group. The mean distribution of S[Mg] among total patients indicated decreased (58.2%), normal (38.2%) and increased (3.6%) levels.Conclusion:The present study disclosed the existence of normal to decreased level of S[Mg] in patients with leukemia and lymphoma suggesting an influence of many variable factors. Although the decreased S[Mg] was statistically significant, it was still within lower normal range.

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.
Key words; Body mass index; post myocardial infarction angina; heart function

Background: Sacrococcygeal teratoma is seen in 1 in every 35000 live births, and is the most common tumor presenting in newborn and children but also reported in adults.(1)Sacrococcygeal teratoma are the most common type of germ cell tumors (both benign and malignant) diagnosed in neonates , infants and children younger than 4 years.(2Case report: A 2 years old male child presented with a visible lump or mass under the skin at the top of the buttocks crease after falling on the ground on his buttocks, and the parents give a history that the child had a constipation since birth.The case was diagnosed as endodermal sinus tumor with yolk sac elements on the bases of clinical examination, ultrasonography, CTscan and fine-needle aspiration cytology..After diagnoses patient referred to the oncologist for multi-drug chemotherapy and surgical removal by the pediatric surgeon after shrinkage of the tumor mass.Conclusion: Infants and young children present with a palpable mass in the sacropelvic region have a greater likelihood of being malignant.

Background: clinically significant macular edema (CSME) is the commonest cause of visual loss in
patients with diabetes mellitus and laser focal photocoagulation is the golden standard for treating it.
Patients and Methods: A frequency doubled Nd: YAG laser was used to treat all eyes included in
this study with diabetic maculopathy. Thirty eyes of three insulin dependent and twenty six non
insulin dependent diabetic Iraqi patients were included. The study involved twenty six males, three
females and followed for one year. Their ages were ranging between 36- 59 years, all of them from
patients attending ophthalmic out-patient department in the medical city in the period between January
2005 and June 2006. Eyes divided in to two groups (fifteen eyes in each group) and the disease
severity was taken into account. The first group treated with 0.1 second and second group with 0.2
second pulse duration.
Results: In group (1) improvement of V.A occurred in 19.99% (Statistically significant) and 60%
(Statistically significant) in group (2). There was stabilization 80% (Statistically insignificant) in
group (1) and 33.33% Stabilization (Statistically significant) in group (2), while worsening only in
group (2) 6.67%(Statistically insignificant).
Conclusion: The frequency doubled Nd:YAG laser is effective in controlling diabetic macular
oedema when applied in focal treatment. The setting of 100μm 0.2sec., pulse exposure time show
more improvement in V.A. than 100μm 0.1sec.
Keywords: Laser, Focal, Photocoagulation.