Journal of the Faculty of Medicine Baghdad

Summary:
Background: The critically ill patient is at risk of developing intensive care acquired infection, with the lungs being especially vulnerable. Ventilator associated pneumonia (VAP) occurring after two days of mechanical ventilation and it is the most nosocomial infection seen in the intensive care unit .The establishment of an accurate diagnosis of ventilator associated pneumonia remains problematic and yet there is still no accepted "gold standard" for the diagnosis.
Patients& Methods: This is a cross section study for 328 patients admitted to intensive care unit at medical city teaching hospital. Full history, physical examination and investigation were done after 48 hours of admission according to clinical pulmonary infection score using clinical criteria (body temperature, WBC count, oxygenation, chest radiography and tracheal aspiration).Arterial blood gases were taken for all patients.
Results: 40 patients developed ventilation associated pneumonia out of 328 patients (12.19%) treated intensive care unit. Most patients who developed pneumonia were at extreme of age and there was no association between the disease and gender. The presence of risk factors like invasive mechanical ventilation (97.5%) nasogastric intubation (90%), tracheostomy (75%), post-operative (30%),insertion of urinary catheter (75%) unconscious patients (57.5%) and vomiting (27.5%) were found as an important risk factors .Gram negative bacteria was the most frequently observed especially pseudomonas aeruginosa (40%) klebsiella (15%)..
Conclusion: ventilator associated pneumonia is an important cause of mortality. The clinical pulmonary infection score was found to be the reliable method for diagnosis of ventilator associated pneumonia. There is general agreement that rapid initiation of appropriate antimicrobial therapy will improve the outcome.
Keywords: Ventilator Associated Penumonia, Clinical pulmonary infection score

Summary:
Background: Study the correlation between the left ventricular end diastolic volume (LVEDV), ejection fraction (EF) and the development of arrhythmia.
Patients and methods: Two hundreds patients with documented acute coronary syndrome and myocardial infection with dysrhythmia documented by ECG and holter monitoring assessed at the cardiac department at Baghdad teaching hospital over the period Jan-Dec 2007. These dysrhythmias were corelated with left ventricular end diastolic volume and ejection fraction.
Results: The patients were divided into 4 groups according to LVEDD and EF. The 1st group, 40 patients (20%) found to have non sustained ventricular tachycardia was associated with higher LVEDD (62-72mm) and low EF (30-39%) in comparison with other groups. A 2nd group of 80 patients (40%) have occasionally ventricular ectopic, their left ventricular end diastolic dimension is (52-58 mm) and ejection fraction in higher than the 3rd group 10 patients (5%) who had atrial fibrillation were having normal left ventricular end diastolic volume but ejection fraction was 45%. A 4th group of 40 patients (20%) were having occasional atrial ectopic have both normal ejection fraction and left ventricular end diastolic volume, the remaining 30 patients (15%) from the total did not develop any arrhythmia and their left ventricular end diastolic volume and ejection fraction were normal considered an control groups.
Conclusion: It was found that the development of arrhythmia is very significantly correlated with the abnormal increased left ventricular end diastolic volume and more lowering of ejection fraction.
Key wards: Arrhythmia left ventricular end diastolic volume, ejection fraction.

Summary:
Background: Hypotonia is not a specific medical disorder, but a potential manifestation of many different diseases and disorders. The long-term effects of hypotonia on a child's development and later life depend primarily on the severity of the muscle weakness and the nature of the cause.
Patients &Methods: A prospective, cross sectional descriptive study in which 62 patients with hypotonia, age 3months to13 years, were evaluated in children welfare teaching hospital /Baghdad (a tertiary care center), over 4months Period (1st of January to 1st of May,2008 ) . Children were categorized into groups of central , peripheral& systemic hypotonia, and specific diagnosis of each of groups was made by clinical findings, neuroimaging, metabolic, muscular enzymes, Electromyography-Nerve conduction velocity, thyroid function tests, Serum Calicium&X- RAY of left wrist,& TORCH (Toxoplasmosis,others, rubella, CMV, herps simplex) assay in our medical teaching laboratories.
Results: The most common cause of hypotonia was central in 30 patients (48.4 %). (Four patient with unknown causes), the most common lesion was brain atrophy detected by CT scan examination in 23/30 (76.7%). Peripheral causes found in 14/58 (22.6%) which include myopathies in 7 patients (11.3%), anterior horn cell lesion in 7 patients (11.3%). Systemic causes were found in 14/58 (22.6%). Early Onset in 46/62 (74.2%), while late onset constituted 16/62 (25.8%).The most common mode of presentation is delayed mile stones found in 32 patients (51.6%).
Conclusions: The most common cause of hypotonia in children enrolled in the study is central lesion and commonly occurs in pre natal, natal & post natal periods. The most common finding is brain atrophy diagnosed by CT scan, while the most common presentation is delayed milestones, and most common type of weakness is proximal.
Keywords Hypotonia, presentation, central, peripheral, onset

Summary:
Background: Common complications of subcutaneous insulin injection include lipoatrophy and lipohypertrophy which may lead to erratic absorption of the insulin with the potential for poor glycemic control and unpredictable hypoglycemia. Other cutaneous complications are local and systemic insulin allergy.
Patients and methods: The study included 150 patients with type1 diabetes mellitus attending thediabetic clinic of Children Welfare Teaching Hospital who were assessed for cutaneous omplications of insulin therapy especially at the sites of the injections. Data collected evaluated using chi square and Pvalue.
Results: Out of 150 patients, the male to female ratio was 1:1.3, with mean age of 11.34 years ± 4.461SD.The cutaneous complications of insulin therapy present in (56.7%) of patients, (94.1%) of them had lipohypertrophy and (5.9%) had allergy to insulin while lipoatrophy and other cutaneous complications were not reported.The cutaneous complications were associated with increase in the incidence of other complications of diabetes mellitus (72.9%).Most of cutaneous complications developed in the upper arms (69.4%) especially in those who did not change the sites and those with wrong technique of injections.
Conclusions: The cutaneous complications developed because of poor education about the proper use of insulin or failure to follow the instructions, as the school achievement of the person who injects the insulin for the patient had no role. So I recommend proper education about the sites and the technique of insulin injection and the maintenance of this education.
Key words: Type1diabetes mellitus, cutaneous complications, insulin therapy, lipohypertrohy

Summary:
Background: cholecystectomy is one of the most frequently performed operations. Open cholecystectomy has been the gold standard for over 100 years .laparoscopic cholecystectomy was introduced in 1980s.
Patient and methods: Two hundred patients admitted to first surgical unit in Baghdad teaching hospital from first May 2007- first May 2009 with gall stone disease both symptomatic and asymptomatic, of both genders and any age were evaluated by history, examination and investigations and data was collected.
Results: Two hundred patients underwent LC in the study period. 181(90.5%)were females and 19(9.5%)were males. The most common age group was between 21-40 years (55%), bleeding was the commonest complication, occurring from trocar site in 11(5.5%) cases, vascular injury in Calot's triangle in 9(4.5%) cases and liver bed in 23(11.5%) cases. Spilled gall stones occurred in 32(16%) cases, biliary leak in 7(3.5%) cases including common bile duct injury in one case. Port site infection was seen in 11(5.5%). There was no bowel injury or port site hernia and there was no mortality.
Conclusion: LC is a safe and effective procedure in almost all patients with cholelithiasis. Good training and dealing with the complications makes this procedure with good results and less complication.
Keywords: laparoscopy, cholecystectomy, complications.

Summary:
Background: To compare the diagnostic value of hysteroscopy with conventional curettage and to evaluate the sensitivity of both methods to detect intrauterine endometrial pathology in patients with abnormal uterine bleeding.
patients and Methods: This prospective study carried on 100 patients underwent diagnostic hysteroscopy as well as dilatation and curettage for abnormal uterine bleeding in two teaching hospitals, Al Yarmouk and Al Kadhmiya Teaching hospital / Baghdad from the period of Jan. 2002 to Dec. 2003, endometrial specimens were sent for separate histological study, the sensitivity of both methods were assessed according to the operative and histological findings.
Results: High sensitivity and positive predictive values of hysteroscopy and directed taken biopsy for almost all pathological causes of uterine bleeding except for atrophic endometrium (66.7%) and hyperplasia (33.1%). The sensitivity of dilatation and curettage is very low compared with hysteroscopy.
Conclusion: Hysteroscopy was more sensitive than dilatation and curettage in detecting endometrial polyp, submucuse fibroid, carcinoma but less sensitive than dilatation and curettage in detecting endometrial hyperplasia and atrophic endometrial . Hysteroscopy with directed biopsy taken provided high sensitivity in detecting pathological state of the endometrium.
Key words: Hysteroscopy, dilatation and curettage, abnormal uterine bleeding

Summary:

Background: Promotion of bone health is particularly important for young women at reproductive age group, as the critical years for building bone mass are from pre-adolescence to about age 30 years.
patients and Methods: This cross sectional study was performed on three groups, first group of 30 women who had used combined pills for more than 2 years, second group of 30 women who had used Depo-Provera for more than 2 years, last group contain 30 women who had used barrier method or they didn’t use any contraceptive as a control group.Bone mineral density (BMD) of lumbar spine (L2-L4), right proximal femur was determined by dual energy x-ray absorptiometry in (femoral neck, greater trochanter, ward’s triangle, and shaft of femur). Evaluation of serum calcium was performed.
Results: The results of three groups were compared to predict the influence of using hormonal contraceptive measures on bone mineral density. The study showed significant increase in BMD among women using combined pills, and decrease in BMD among women using Depo-Provera in all anatomical sites
Conclusions: The use of combined pills protects or increases BMD, while Depo-Provera diminishes BMD. In essence, improving BMD While using combined pills can be regarded as one of the benefits of this method.
Keywords: bone density, combined pills Depo-Provera.

Summary:
Background: Unilateral sinonasal disease is commonly encountered during the practice of the otolaryngologists, the etiology include a wide variety of diseases ranging from simple acute inflammation to highly malignant diseases. The clinical, computed tomography and histopathology differs between inflammatory and neoplastic diseases.
Patients and Methods: A prospective study carried out at the Otolaryngology department, Baghdad Medical City, Hospital of specialized surgeries between Jan.2007 to Nov.2008.The study involved 114 patients with symptoms and signs of unilateral sinonasal disease, a careful history, complete clinical examination and radiological investigations were done to all patients as well as flexible nasoendoscopic examination. Sinonasal surgery under general or local anaesthesia with histopathological examination of the removed tissues was done to all patients.
Results: Chronic rhinosinusitis with or without nasal polyposis is the commonest cause of a unilateral sinonasal disease (33.3%), followed by antrochoanal polyp (20%) , mucor mycosis (16.7%), benign tumors (13.1%), allergic fungal sinusitis (9.6%) and then malignant tumors (7.6%) in that order. Male gender and the right side were predominant. Purulent discharge and foul odor were the commonest presenting symptoms under inflammatory conditions, while frequent epistaxis, facial swelling and exophthalmos were the main symptoms in neoplastic diseases. Calcifications were observed on CT scan mainly in patients with allergic fungal sinusitis, while bony erosion and destruction was detected in both malignant tumors as well as mucor mycosis, the pattern and extent of bony destruction is more sever in malignant tumors.
Conclusion: Chronic rhinosinusitis with or without nasal polyposis is the commonest cause of unilateral sinonasal disease. History, clinical examination, endoscopic as well as radiological examinations are important to reach the diagnosis. However, histopathological confirmation remains obligatory.
Keywords: Unilateral sinonasal disease, unilateral sinus opacity, sinus surgery.

Summary:
Background: A comparism study for management of deep seated small brain tumors less than 4 cm in the 3 diameters between cases managed by Brain lab navigator and those without it.
Patients and methods: We took 20 patients from the retrospecture data before the use of Navigator in our country compared with the 20 patients managed after the use of navigator in our hospital (specialized surgical hospital) in the neuro-surgical. Unit since 2002 till now. From 1/8/2002 till 31/12/2007 the study included the type of tumor & surgery & the result of surgery & time & complications ((morbidity & mortality)).
Results: There was a significant increase of the safety of surgery by using the navigator including morbidity & mortality. But it was a time consuming procedure.
Conclusion: The brain lab navigator is very useful safe device in the surgical management of deep-seated small diameter less than 4mm. brain tumors.
Keywords: Brain Tumor, Navigator.

Summary:
Background: periodontal disease are the major risk factors for tooth loos in aged persons. Clinically, patients with gingivitis or periodontitis usually suffer from gingival bleeding and periodontal probing.
Material and method: The human sample consisted of five hundred and ninety eight students, 208 males and 390 females. Russel's periodontal index (PI) plaque index (PI. I) and the periodental treatment need system (PTNS) were scored.
Results: The mean PI and P1.I for males were 1.94, 1.72 respectively. For females the corresponding values were 1.73. 1.49. From the total sample 2.4% males and 6.1% females were in no need of periodontal therapy.A comparison between first and final year students showed for all indices used a statistically highly significant differences (P<0.01).
Conclusions: Although an improvement in all indices does occur, but still more emphasis should be placed on prevention through out the dental on curriculum.

Key words: Periodontal health status, treatment need, Iraqi.

Summary:
Background: Emergency ambulance personnel (EAP) are vulnerable to PTSD. In Iraq, EAPs were exposed to life threatening situation during political violence conflict post 2003 Gulf war. This study was carried out to report on PTSD among EAP.
Patients and Methods: A total of 189 male EAPs were selected randomly from the Dept. of ambulance in Baghdad. A questionnaire form was filled for each EAP. The form included the symptoms of PTSD according to DSM- IV (intrusive, avoidance and hyperarousal symptoms). Demographic data and exposure to violence accident, type of accident and duration of damage were included, also.
Results: The mean age of EAP was 38.5 ± 9.4 years. There was 122 (64.5%) had PTSD. Age, education, married status and years in emergency ambulance dept. were significantly associated with PTSD.
Conclusion: High rate of PTSD among EAPs was reported. Measures to prevent PTSD and to give further support to EAP are needed. Further studies will clarify the situation of PTSD in Iraq.
Keywords: Post- traumatic stress disorder, Baghdad, emergency ambulance personnel, widespread violence

Summary:
Background: Faith healing is common in Arab culture. Obsessive-compulsive disorder is linked to religious beliefs and this can affect its management as patients may seek help from faith healers rather than mental health professionals.
Patients and methods: Patients who received a diagnosis of OCD according to DSM-IV-TR completed a questionnaire containing questions about age, gender, marital state, residence, income, level of education, and occupation. Also, data was collected on help-seeking from a faith healer and on religiosity. The data was analyzed by using the statistical package of the social sciences (SPSS).
Results: 58.5% of OCD patients had sought help from faith healers and this was significantly associated with being religious (p value .003). There was no association with other variables.
Conclusion: Iraqi mental health professionals should be aware of patient’s experience of faith healing as this is common among OCD patients. The findings also raise interesting questions regarding the need for a dialogue between health professionals and faith healers in the interest of providing optimal care to OCD patients.
Key words: faith healing, Iraq, Obsessive-compulsive disorder.

Summary:
Background: Oral squamous cell carcinoma continues to be a major health problem in Iraq as well as in other countries. Many attempts were made to study molecular markers in oral squamous cell carcinoma and to link them to tumor grade, stage and prognosis, besides studying their role in carcinogenesis. The present study has been designed to detect mRNA of c-myc in oral squamous cell carcinoma compared to oral dysplasia and to link the marker to grade and degree of the two pathologies.
Materials and methods: Forty two cases, including 30 cases of oral squamous cell carcinoma and 12 cases of oral dysplasia were included in this study. Sections on positively charged slides were made from their paraffin blocks and were used for the detection of c-myc mRNA using in-situ hybridization technique.
Results: C-myc mRNA was detected in 9(75%) cases of oral dysplasis and in 24 (80%) cases of oral squamous cell carcinoma. A significant correlation was found between c-myc mRNA score and intensity from one side and the tumor grade from the other side and degree of dysplasia.
Conclusion: The results of this study confirm the role of c-myc in oral dysplasia and oral squamous cell carcinoma and the possible transfer from the former to the latter.
Key Words: Oral squamous cell carcinoma, oral dysplasia and c-myc.

Summary:
Background: Nodal osteoarthritis is one of the most common arthropathy worldwide, the etiology is uncertain but many biochemical markers are recognized. Many studies have shown that leptin might have a role in the pathogenesis of osteoarthritis, but little is known about the relation between serum leptin and nodal osteoarthritis.
Subjects and method: 52 women with nodal osteoarthritis and 40 apparently healthy women as a control were included in the study; serum leptin was measured in all subjects. Student t-test was applied to find out the significance of difference in the mean v
Results: There was a significant difference in the mean of serum leptin between patients and control groups.
Conclusion: the results of the current study suggest that leptin might have a role in the pathogenesis of nodal osteoarthritis
Keywords: leptin, nodal osteoarthritis, pathogenesis, Body Mass Index.

Summary:
Background: Autoimmune hepatitis (AIH) is an unresolving inflammation of the liver of unknown cause associated with interface hepatitis on histological examination,hypergammaglobulinemia and presence of circulating autoantibodies. Antibody-mediated tissue injury might be responsible for tissue injury in AIH therefore; a number of studies have been focused on the immunoglobulines in these patients .The aim of the study is to estimate the level of immunoglobulins (IgG, IgA and IgM ) in different types of Autoimmune hepatitis ( AIH).
Patients and Methods: The study was performed on 73 Iraqi patients with autoimmune hepatitis (AIH), attending the teaching hospital for gastroenterology and liver disease in a period between November 2003 and July 2004. : Anti- soluble liver ANA, SMA, LKM-1, and LC-1 Abs were detected using Enzyme-Linked Immunosorbent Assay (ELISA) technique. Anti-SLA/LP was detected using the Euroline method.Quantitation of serum IgG, IgA and IgM of the study groups were carried by single radial immudiffusion (SRID) test. Equal volume
Results: Significant differences was observed between AIH patients and healthy control group in the mean level of IgG ,IgA and IgM. In addition, level of IgA in the sera of patients with type 2 was lower than those of type 1 and 3.
Conclusion: It was conclude that in patients with AIH, the Immunoglobulin G was significantly higher in type-1, whereas IgA was significantly lower in AIH-2 patients compared to other types of the disease.
Summary:
Background: Autoimmune hepatitis (AIH) is an unresolving inflammation of the liver of unknown cause associated with interface hepatitis on histological examination,hypergammaglobulinemia and presence of circulating autoantibodies. Antibody-mediated tissue injury might be responsible for tissue injury in AIH therefore; a number of studies have been focused on the immunoglobulines in these patients .The aim of the study is to estimate the level of immunoglobulins (IgG, IgA and IgM ) in different types of Autoimmune hepatitis ( AIH).
Patients and Methods: The study was performed on 73 Iraqi patients with autoimmune hepatitis (AIH), attending the teaching hospital for gastroenterology and liver disease in a period between November 2003 and July 2004. : Anti- soluble liver ANA, SMA, LKM-1, and LC-1 Abs were detected using Enzyme-Linked Immunosorbent Assay (ELISA) technique. Anti-SLA/LP was detected using the Euroline method.Quantitation of serum IgG, IgA and IgM of the study groups were carried by single radial immudiffusion (SRID) test. Equal volume
Results: Significant differences was observed between AIH patients and healthy control group in the mean level of IgG ,IgA and IgM. In addition, level of IgA in the sera of patients with type 2 was lower than those of type 1 and 3.
Conclusion: It was conclude that in patients with AIH, the Immunoglobulin G was significantly higher in type-1, whereas IgA was significantly lower in AIH-2 patients compared to other types of the disease.
Keywords: Autoimmune hepatitis, Immunoglobulin G.

Summary:
Background: Homocysteine (Hcy) is a sulfur containing amino acid that is formed as an intermediary in methionine metabolism. Raised plasma homocysteine levels, which may contribute to the increased risk of chronic liver disease.
Patients and Methods: Sixty two patients with chronic liver disease and 26 healthy individuals were included as normal controls for the study. The HPLC system was used for the determination of Hcy and vitamin B12.
Results: A highly significant Hcy concentrations were noted in all patients with cirrhosis, chronic hepatitis or liver mass. There was a trendency towards higher Hcy concentrations in more advanced stages of liver disease. The study showed that the concentrations of total Hcy were significantly higher in the patients than in the normal control group, irrespective of the age or gender. Mean serum concentration of vitamin B12 were significantly increased in cirrhotic patients and those with liver cancer compared to the control subjects and chronic hepatitis symptomatic patients.
Conclusion: The serum levels of both homocystein (Hcy) and vit. B12 were significantly increased in cirrhotic patients and those with liver cancer compared to chronic hepatitis symptomatic patients.
Key words: chronic liver disease, homocysteine, vitamin B12.

Summary :
Background: The role of cytokines in cancer immunity and carcinogenesis in general has been well established, which play an important role in pathogenesis of many solid cancer. This study aimed to shed light on the possible role of IL-6 in pathogenesis of CRC and its relationship with serum CEA level.
Patients and methods: This study covered 50subjects. It comprised of 30 patients with CRC, compared with 20 healthy normal controls. Serum IL-6 and CEA analysis were performed by ELISA.
Results: This study revealed a significant elevation in serum IL-6 level among CRC patients (16.2 pg/ml) in comparison to that of healthy control (4.8 pg/ml) (p<0.001). As well as an interesting significant increase of mean serum CEA level in CRC patients (7.5± 6.62 ng/ml) as compared to healthy control (2.4±0.90 ng/ml). On the other hand there was strong linear correlation between serum CEA level and serum IL-6 level p<0.001.
Conclusion: There are a significant correlation between the elevation of the serum IL-6 and CEA levels and the progression of this cancer. Moreover, positive association was found between IL-6 and CEA and this may help us to understanding the pathogenesis of this disease and ultimately may be use in the development of a new therapeutic technique.
Key words: Colorectal Cancer, Interleukin -6, Carcinoembryonic antigen

Summary:
Background: Interleukin -6 (IL-6) as the key mediator of the acute phase reaction is of interest .elevated protein concentrations of IL-6 in the blood have been shown in patients with type 2 diabetes. This study aimed to investigate the association of IL-6 and type 2 diabetes.
Materials and Methods: Blood samples were collected from 40 patients with type 2 diabetes and 40 person apparently healthy control were examined for IL-6 level by Enzyme Linked Immune Sorbent Assay. HbA1c determined by high pressure liquid chromatography .total cholesterol, HDL cholesterol and triglyceride were determined enzymatically. Other risk factors study like age, sex and BMI.
Results: results shows that IL-6 was higher in patients than in control (p<0.006) and there is significant increase in triglyceride. HbA1c shows high levels in diabetic patients (mean 6.855±1.57%) than the healthy control (mean 4.650±o.673) and when comparing the three diabetic BMI groups with healthy control a significant higher serum IL-6 level was found p=0.008 in over weight group .
Conclusion: there is a significant elevation in serum IL-6 in type 2 diabetics when compared to healthy controls and there is a significant elevation of IL-6 in over weight.
Key words: Interleukin -6, Type 2 Diabetes, Hemoglobin A1c, Body Mass Index.

Summary:
Back ground: Visceral leishmaniasis is an endemic protozoan disease in Iraq. Recovery from this disease confers a solid and permanent immunity. Immunological assessment of our patients was carried out and the results showed a significant reduction in the percentage of CD3, CD56 and a significant increase in the percentage of CD19 in the peripheral blood lymphocyte of VL in comparison with control group.
Patients and methods: Indirect immunofluorescence technique analysis was performed to detect the percentage of CD3, CD19and CD56 positive lymphocytes.
Results: Our results in the patients groups showed decrease in the percentage of CD3, CD56 and increase in the percentage of CD19. Follow up of patients after treatment showed a significant increase in the percentage of CD3, CD56, but they were still lower than their normal range .
Conclusion:- CD3,CD56, were decreased in VL infection then increased after treatment but it was less than its normal range, while CD19 was increased in VL when compared with control group.
Key words: CD-Markers profile, leishmania donovani, amastigote form

Summary:
Background: There is a general acceptance which illustrated that auto antibodies act as a central immunological disturbance in most of the auto immune diseases, among these auto immune disease lies the SLE
Patients and Methods: Thirty five patients with SLE were compared to twenty age and sex matched, control subjects and studied for the presence of auto antibodies, plus IL-4 and IL-6 using Elisa method and immune fluorescent method (for ANA only)
Results: Data showed that IL-6 detectable levels were statistically significant in patients with positive anti ds-DNA, but not significant statistically in ANA positive patients although it was detected in 24 (70.6%) of positive ANA patients, while there was no statistically significant correlation between IL-4 detectable level and autoantibodies production.
Conclusion: There is apparently a positive correlation between IL-6 and anti ds DNA production in lupus patients.
Key words: Autoantibodies, Interleukin-4, Interleukin-6, systemic lupus erythematosus

Summary:
Background: Hepatitis is a disease of the liver caused by the infectious and non-infectious agents.
Patients &methods: A total of 600 blood donors attending blood bank at Baghdad city were included in this study , they were screened by Enzyme Immune sorbent Assay for detection of HBs Ag and anti-HCV ,that confirmed by recombinant immunoblot assay .the possible influence of the various factors on the prevalence was analyze too.
Results: Form the total donors there were 37(6.2%)and 6(1.7%)positive for HBV &HCV respectively .peak prevalence for HBs Ag was noticed in age groups (20-29)years .
Conclusion: Screening blood donors for both HBV and HCV is indispensable for safe blood transfusion. . In general, formulation of safe blood transfusion policy and implementation of standard screening protocols should be practiced.
Keywords: Prevalence of hepatitis B, C.

Summary:

Background: A number of investigators have carried out experimental infections of hydatidosis, using albino mice as an experimental animal model, but there was disagreement on the effect of strain, sex and age of this model.
Materials and Methods: Two hundred and forty mice (120 males and 120 females) were injected intraperitoneally with a single dose of 2000 protoscolices (PSCs) /mouse at four ages (3-4, 7-8, 10 and 20 weeks). Each age group consisted of 60 mice (30 males and 30 females); in which 15 animals of each sex were the treated group, while the other 15 animals were a control group (injected with normal saline). Five animals from each age and sex were sacrificed at one, two and four month post-injection, and their livers and spleens were collected for histopathological examination.
Results: the highest numbers of cysts and the most severe histopathological changes in livers and spleens of mice were observed at the age 3-4 weeks in both sexes. These changes increased with time post-infection. The changes became more severe in males than females in the age 7-8 weeks, but at the age 20 weeks, the females showed the most severe histopathological changes, while the age 10 weeks showed the lowest changes in both sexes.
Conclusion: The age and the sex of the host can modify the course of infection with hydatidosis, and the present results suggest that, mice at the ages 3-4 (in both sexes) and 7-8 weeks old (males) produce the most severe pathological changes in these organs. The more resistant age to hydatidosis was observed at 10 weeks old in both sexes.
Keywords: Histopathological Changes, hydatidosis, liver and spleen, albino mice, effect of ages and sexes.

Summery:
Background: Rosacea is a chronic disease that requires long-term systemic and or local therapy, which carries risk for systemic complications and adverse reactions and high recurrence rate.
Patient and methods: Two groups of rosacea patient with at least 8 inflammatory papules and pustules, moderate to severe facial erythema (22 patient treated with oral azithromycin versus 18 patient treated with oral metronidazole) were studied at single medical center (medical city of Baghdad: department of dermatology and venereology , both for 60 days, Subjects were evaluated monthly for up to three months to determine the relapse rate. Main outcome measures: Inflammatory papules and pustules were counted at each visit, relapse were determined by the appearance of a clinically significant increase in number of papules and pustules. Erythema were classified to three grades: - 0=Nil, 1=mild to moderate, 2=severe. Patient satisfaction also classified to three grades: 0=no satisfaction, 1=partial satisfaction, 2=full satisfaction.
Results: Most of the patients respond to treatment measured by at least 70% reduction in the number of inflammatory lesions. (21 patient versus 14 patient) completed the study and compare by assessing:- erythema improvement and papule and pustule count reduction and percentage of occurrence of side effects and relapse, and subjective assessment of the degree of patients satisfaction with their treatment Erythema were reduced after two months of treatment:- (56.6% to 33.3% for azithromycin group versus 43.5% to 66.7% for metronidazole group).Mean papules count reduced from (36.9 to 10 for azithromycin group versus 25.8 to 11 for metronidazole group). Mean pustule count reduced from (2.95 to 0.33 for azithromycin group versus 2.92 to 0.5 for metronidazole group). The percentage of relapse was 16.7% versus 83.3% for azithromycin and metronidazole group respectively. Complete satisfactions were 70% versus 30% and side effect were 20% versus 80% for azithromycin and metronidazole group respectively.
Conclusion: For the above results treatment of rosacea by azithromycin is more effective, safer thanmetronidazole, although the coast is little higher.
Key Words: Azithromycin , Rosacea .

Summary:
Background: Cytokines produced by inflammatory cells play a pivotal role in synovial inflammation and joint destruction in rheumatoid arthritis.
Patients and Methods: The cytokine serum levels were measured by EASIA (Enzyme amplified sensitivity immunoassay) in sera from 50 RA patients, and 40 healthy donors. Cytokine levels were compared in different RA subpopulations (positive or negative rheumatoid factor (RF), long term or recent onset disease, high or low disease activity). In addition, the possible association with other demographic and clinical parameters (gender, age, etc) was also analyzed.
Results: It was demonstrated that IL-2, IL-6 and IFN-δ levels were elevated in serum samples of RA patients as compared with apparently healthy controls. Maximum elevation of TNF-α was recorded in a few number of patient's sera. There were non significant differences between control and RA patient groups in serum TNF-α level.
Conclusions: Assessing the serum IL-2, IL-6, IFN-δ and TNF-α levels may be helpful in the confirmation of the RA activity. Due to the chronic course of this disease, other inflammatory markers must be identified in order to provide early therapeutic strategies to these patients.
Key words: Rheumatoid Arthritis, Interleukine-2, Interleukine-6, Tumor Necrosis Factor- α, Interferon- δ.

Summary:
Background: The development of non steroidal anti-inflammatory drugs (NSAIDs) was based principally on inhibiting cyclooxygenases (COX) activity. However, the identification of two COX- isoforms (i.e., COX-1 and COX-2) with different physiological effects has led to the development of COX-2 specific NSAIDs, with fewer adverse effects than traditional NSAIDs. Therefore, They are expected to produce anti-inflammatory activity with minimal adverse effects on GI mucosa, as well as, other structures and cells such as platelets. The aim of this study is to evaluate the effect of selectivity of COX-2 inhibitors on many organs and systems function such as the hepatobiliary system, platelets function, as well as, serum uric acid levels.
Patients and methods: Thirty six patients with osteoarthritis participated in this study. Twenty –four of them were treated with 400 mg celecoxib/day. The remainder received 15 mg meloxicam daily for 3 months .In addition to twelve apparently healthy subjects as a control . Measurement of serum alanine transaminase , serum alkaline phosphatase activity ,total serum protein, and serum albumin to evaluate hepatobiliary system . In addition to the estimation of bleeding time to evaluate the effect of selectivity of inhibitors to COX-2 on platelets function.
Results: The results showed minor variations in their effects on liver function tests. However, meloxicam, the relatively selective COX-2 inhibitor affects bleeding time more than does celecoxib, the purely COX-2 selective. Whereas, celecoxib elevated serum levels of uric acid more than meloxicam.
Conclusion: We could conclude that selectivity to COX-2 enzyme has different odds of risks on platelets function, such effects that could add more risk factors to patients due to their pharmacological action.
Key words: Hepatobiliary, COX-2 inhibitors, Platelet function.

Summary:
Background: This study is concerned with the effects of preeclampsia on the availability of the important enzymes in the full term placenta.For this purpose 2 groups of placentae were taken from the full term pregnant women immediately after labour, each group consists of 10 placentae, the first group are those placentae obtained from pregnant women having uneventful pregnancy with no history of any disease or complication (as a control group) while the second group includes those pregnant women having a history of preeclampsia, the results showed significant histochemical changes in the placentae of the second group when compared with the first group, such changes result from syncytial damage and destruction affecting the preeclamptic placentae of the second group, thus loss of alkaline phosphatase enzyme with increase in the amount of the degenerating acid phosphatase enzyme were observed in the placentae obtained from the preeclamptic group. the placentae have been implicated in the pathophysiology of preeclampsia.
Patients & Methods: The specimens were obtained from Al-Batool & Al-Khansaa Teaching Hospital in Mosul between February and July (2006) and studied in the Department of Anatomy, College of Medicine,University of Mosul. Two groups of placentae were taken from the full tem pregnant women immediately after labour, each group consists of 10 placentae, the first group was obtained from healthy pregnant women (control group) while the second group was obtained from pregnant women with history of preeclampsia (10 patients).
Results: the placental alkaline phosphatase enzyme is very important in trophoblastic transfer mechanism, this enzyme is abundant at term normal placenta. The human placenta contains this enzyme which is produced mainly by syncytiotropholast cells thus destruction of these cells which occurs in preeclampsia will lead to decrease in this enzyme activity and increase in degenerating acid phosphatase enzyme activity.
Conclusion: there is a disturbance in the level of acid and alkaline phosphatase enzymes in the preeclamptic full term placentae.
Key Words: Enzyme, Placenta.

Summary:
Background: Preeclampsia, the de novo occurrence of hypertension and proteinuria after the 20th week of gestation, continues to exert an inordinate toll on mothers and children alike.
The idea that asymmetric dimethylarginine (ADMA) accumulation may be a cardiovascular risk factor in patients with preeclampsia was advanced in 2003. Furthermore, High ADMA levels have been associated with alterations in the regulation of cerebral blood flow and neural function, with insulin resistance, thyroid dysfunction, and alterations in bone homeostasis, fertility, and erectile function.
Subject and methods: the present study is a cross-sectional case-control study includes measurement of s.ADMA in 60 patients with preeclampsia. The results were compared with 60 apparently healthy pregnant women (as controls).
Results: showed a significant increase in serum ADMA in the preeclamptics as compared with the controls this was accompanied by a significant reduction of this parameter with advancing gestational age in normal pregnancy.
Conclusion: preeclamptics (in different gestational age groups) experienced vasospasm induced by inhibition of nitric oxide (which consider the natural vasodilator) when compared with healthy pregnant women matched with their age and gestational age; this was supported by the significant high level of s. ADMA, the endogenous inhibitor of NO .
Key words: preeclampsia, asymmetricdimethylarginine.

Summary:
Background: Diabetes mellitus is a major risk factor for coronary artery disease, with a higher incidence of myocardial infarction and sudden death. Left ventricular dysfunction is difficult to diagnose and to differentiate into diastolic and systolic dysfunction on the basis of medical history, physical examination, electrocardiography (ECC) and chest radiography. Two-dimensional, M-mode, and Doppler echocardiography are excellent for diagnosing left ventricular dysfunction. M-mode echocardiography was used for diagnosing left ventricular systolic dysfunction, while Doppler echocardiography has become well accepted as a reliable, reproducible and practical noninvasive method for the diagnosis of left ventricular diastolic dysfunction.
Subjects and methods: eighty four (84) males, type 2 diabetic patients with ischemic heart disease, their mean age was 60 ± 7 years, in addition to fourty six (46) non diabetics again with ischemic heart disease matched for sex and age served as control were involved in this study. Each patient was subjected to medical history, clinical examination, blood pressure measurement, physical measurement, lipid profile estimation, ECG, chest x-ray, M-mode and Doppler echocardiography to assess their left ventricular function, whether they suffer left ventricular diastolic dysfunction or systolic dysfunction and or combined systolic and diastolic dysfunction.
Results: The result of this study demonstrated that diabetic subjects were more prone to develop ST elevation myocardial infarction and isolated diastolic dysfunction of impaired relaxation type (74%). However, echocardiography clarify that small percentage of those patient suffer an isolated systolic dysfunction (26%).
Conclusion: Higher percent of diabetic subjects suffer ST elevation myocardial infarction and they were found to develop diastolic dysfunction.
Key words: left ventricular function, diabetes mellitus, ischemic heart disease.

Summary:
Background: The purpose of this study was to compare the parametric measurements of transient otoacoustic (TEOAEs) in normal hearing subjects between two clinical centers in Iraq and to examine the community effect on TEOAEs characteristics.
Patients and Methods: Transient otoacoustic emission (TEOAEs) were obtained from eighty subjects (160 ears)-males and females aged (10-20 years), with Forty (40) subjects in Baghdad audiology center and forty subjects in Sulaimania audiology center (North of Iraq)[ Kurdistan-Iraq], in standard, non-linear “Fast Screen” mode. Hearing thresholds, tympanometric, and TEOAE-parameters were recorded between two clinical center groups.
Results: The cross correlation (wave reproducibility) was constant between two groups. The mean Signal to noise ratio (SNRs) for all (160 ears) were well above 3 dB at frequencies 1K, 2K, 3K, 4K and 5 KHz. The Sulaimania –subjects group showed the lowest SNR in low frequency (1 KHz) and middle frequency (3 KHz) than the Baghdad-subjects group. No statistical difference was observed in other frequency bands, and in overall mean SNRs between two groups.
Conclusions: The observed differences of SNRs at low and middle frequency bands are most likely related to differences in ear canal volume and/or to differences in cochlear mechanisms. The values obtained in the present study can be used as normative data for screening and diagnostic purposes in Iraqi subjects aged (10-20 years).
Key words: Transient evoked otoacoustic emissions, Reproducibility, Signal to noise ratio, Baghdad –subjects group, Sulaimania subject group.

Summary:
Background: Hydatid disease remains an important & challenging medical problem.
Case report: A62 year old male patient was admitted complaining of upper abdominal discomfort. Six days earlier he suffered from acute pain in the right upper quadrant, mild systemic allergic manifestation, a fever of 38.5oC and chills. He was managed by a new surgical approach of myoplasty of the right hemidiaphragm combined with preoperative decompression of the bile duct by an endoscopic sphincterotomy. A case search identified study describing rupture of a hydatid cyst of the hepatic dome into biliary tract. The incidence of intrabiliary rupture of hepatic hydatid cysts is 25% in patients treated with external surgical drainage for liver hydatid cysts. Postporative external biliary fistula have been reported in 27.5%.
Conclusion: this procedure may require less time (because liver mobilization is not necessary) and allows for easier abdominal reoperation in the future. The simplicity of the technique allows for a more reliable alternative to the treatment of the hydatid cyst located over the superior-posterior aspects of the liver.
Key words: Hydatidosis- Hydatid disease- liver- omentoplasty- myoplasty technique- Echinococcus.