Journal of the Faculty of Medicine Baghdad

Background: The neonatal deaths account for two-third of all deaths in the first year of life, and 40% of under-five mortality. Extreme prematurity, respiratory distress syndrome , neonatal infections , and congenital malformations are among the common causes of neonatal deaths. Methods: We retrospectively studied 668 neonates who died over 5 years period from first of Jan. 2000 to the end of Dec. 2004 in neonatal care unit of children Welfare Teaching Hospital-medical city, by obtaining data from reviewing their medical records and death certificates.
Results: The death rate in neonates admitted to SCBU (special Care baby Unit) during the period of study was (10.7%), male constituted 432 (64.7%) and female 236 (35.3%) with male to female ratio 1.8:1. The major causes of death were congenital malformations (41.6%), neonatal infections (33.4%),and prematurity (10.3%).
Conclusions: There was no decline in the neonatal death rate in our hospital especially from sepsis and prematurity and low birth weight. Death due to late onset sepsis was lower than that due to early onset sepsis .There was a significant increase in the death from congenital malformations.

Background: Malnutrition is an adverse prognostic factor in the outcome of children with standard risk acute lymphoblastic leukemia due to a significantly higher rate of bone marrow relapse in the malnourished patients. The event free survival of children with acute lymphoblastic leukemia in developed countries has increased substantially in the last two decades as treatment with intensive protocols has brought the estimated probability of event free survival at 5 years close to 75%. Although the prognosis of acute lymphoblastic leukemia has also been improved in underdeveloped countries, the figures for event free survival are lower, even when aggressive protocols are used. Unfavorable socioeconomic factors could contribute to this observation.
Patients and Method: A retrospective study was done on cases of childhood acute Lymphoblastic Leukemia admitted to the Pediatrics Oncology Ward in AL-Kadhimiyia Teaching Hospital over a period of one year from 1st of June 2007 to end of May 2008.Fifty five patients were collected .Informations were taken from the case sheets of the patients and their records in the Pediatric Oncology Clinic. Weight and height were recorded, Using charts of height for age (Ht/Age) and the Z score = -1.28 (10th percentile), the patients were divided into two groups, malnourished and well nourished.
Results: Of the studied group, 28 patients (51%) were between 1-10 years. Thirty two patients (58.2%) were males and 23 (41.8%) were females, with male to female ratio of 1.39:1. Thirty Six (65.45%) patients were below 10th percentile (with Z score below – 1.28) i.e. malnourished, and 19 (34.55%) patients above 10th percentile (Z score above – 1.28) i.e. well nourished. Of the malnourished patients, 26(81.2%) patients achieved complete remission, while in comparison to well nourished patients, 16(84.2%) patients achieved complete remission. The result is statistically not significant (p. value > 0.05). During follow up, of the 42(82.3%) patients that achieved complete remission, 12(28.57%) relapsed, 9(34.62%) of them were malnourished. Death occurred in 7 (16.67%) patients, 6 (23.08%) of them were malnourished. Three patients (7.14%) discontinue treatment, 1(3.84%) of them was malnourished. Twenty (47.62%) patients remained with continuous complete remission, 10 (38.46%) patients were malnourished and another 10(62.5%) were well nourished. Using the Chi square, the results were statistically not significant (p. value> 0.05).
Conclusion: From this study, it was concluded that malnutrition in children with acute lymphoblastic leukemia is considered an important risk factor. Although malnourished children achieved complete remission but a high percentage of them relapsed or died.
Key words: Malnutrition, childhood, Acute Lymphoblastic Leukemia

Background: Civil violence in Iraq has reached an epidemic level during the last few years, and an increasing number of urological injuries were faced in dealing with unprotected civilians who were exposed daily to violence in streets, at homes, and at work. Bladder injuries are an example of injuries which were faced rarely before but increasingly now, if not dealt with properly such injuries may end with serious morbidity and even crippling, on the other hand proper management will greatly decrease morbidity and mortality of such injuries.
Patients and method: over the period from March 2004 to June 2005 all the patients triaged to the emergency unit of Medical City with genitourinary trauma were included in the study, those with bladder injury discovered pre-operatively or per-operatively were involved in the study, for all patients the mechanism, grade, site, associated other organ injury, and outcome were defined. Data collected and statistically analyzed.
Results: The total number of patients sustained genitourinary tract injuries was 197, only 73 (37%) of them had bladder injuries, the majority were males (87.6%) in their active life (67% aged 20-40 years). Most of the injuries were caused by bullets (50.6%) and shells (25.3%), were sever (82.1% had grades III and IV), and affecting the dome of the bladder (39.7%). The gastrointestinal tract was the commonest system to be injured in association with the bladder (87.6%), but the mortality rate was associated only with affection of chest, head, and vascular systems. The over all mortality rate was 9.5% and the morbidity rate was 12.3%.
Conclusion: the incidence of bladder injury in urological trauma is high in civilian casualties because of lack of protection, they are usually severe and of high grade, and associated with other organ injuries. Bullets are the main causative factor, and the dome is the mostly affected site. The mortality rate is low (9.2%) and is related to the associated organ injury, but not related to the severity of injury.
We need to continuously evaluate our experience in trauma management, and to establish specialized trauma centers to cope with the increasing number of civilian victims.

Background: The coexistence of renal and heart failure carries an extremely bad prognosis. The exact cause of deterioration of kidney function and the mechanism underlying this interaction are complex, multifactorial in nature, and still not completely understood. Both the heart and the kidney act in tandem to regulate blood pressure, vascular tone, diuresis, natriuresis, etc.
Patients and methods: Sixty patients mean age 65.5 year were complaining heart failure duo to different causes assessed for renal function (blood urea &creatinine) and cardiac function by echocardiography in day 0 and 10 day after treatment of heart failure.
Results: The mean value (±S.D) of blood urea and serum creatinine on day 0 were 64.17mg/dL (±30.72) and 1.75mg/dL(±0.68) respectively. There is significant correlation between the severity of heart failure and the degree of renal impairment (P.value <0.05). after 10 days of treatment there was improvement in symptoms of heart failure but no significant correlation was found between the improvement of cardiac function and renal failure after 10 days treatment(51% patients has high blood urea>43mg/dL after 10 days&58% patients has high creatinine after 10 days although improvements in ejection fraction)(P.value >0.05).
Conclusion: Renal dysfunction is common in heart failure and has strong prognostic value. the classical treatment of heart failure dose not improve renal dysfunction duo to intrinsic renal disease, renal vascular disease , nephron loss (age, renal disease), inadequate renal perfusion, hypovolemia, inadequate cardiac output ( vasoconstriction/pump failure), hypotension , abnormally high central venous pressure and by drug induced e.g.( ACEI, ARB). So patients were advice to take adenosine, A1receptor blocker, vasopressin antagonists, other intervention include earlier use of dialysis and ultrafiltration and left ventricular assist devices.
Keywords: Renal impairment, heart failure, ejection fraction, urea, creatinine.

Background: Extradural hematoma (epidural hematoma) result from tearing of dural or skull vessels caused by deformation of the skull or fracture. Epidural hematoma can occur at all ages but are seen primarily in patients younger than 60 years.
Patients and Methods: this prospective study was conducted on 50 patients (38 male, 12 female) suffering from head injury and has a CT scan evidence of extradural hematoma during the period from 1 January 2006 to 31 December 2008 in Neurology surgery hospital.
Results: There were 4 patients above 50years, the cause of injury was fall in50%, assault24%, RTA20%and bullet injury 6%.the commonest site was temporal region 42%.surgical treatment were done to 39 patients, Middle meningeal artery and its branches was the source of bleeding in 42%, full recovery achieved in 62%, post operatively 4patients suffered from anaemia, one of them required blood transfusion. Conclusion: Extradural hematomas are life-threatening injury should be treated by surgery and conservative treatment only for small EDH with no symptoms and remain so or disappear by Serial follow-up CT scan Extradural hematoma.

Background: Population studies suggest that 3–8% of asymptomatic adults have thyroid nodules. Nodules have a 5–15% prevalence of malignancy. Fine-needle aspiration cytology is the primary and frequently initial tool for assessing the risk of malignancy in thyroid nodules and selecting patients for thyroid surgery.
Patients and Methods: This prospective study was done during the period from June 2007 to November 2008. The study includes 141 patients with palpable solitary or multiple thyroid nodules. Only patients with normal or low TSH values were referred for ultrasound examination and ultrasound guided FNAC, which were done using fine needles (G 20).
Results: eleven patients (7.8%) have insufficient or non-diagnostic aspirates and were excluded from the study. Of the remaining 130 patients that were included in our study, only 20 patients had thyroid carcinoma (15.3%). Seventy-nine patients (60.7%) had solitary nodule larger than 10 mm in largest dimension and 51 patients (39.3%) had two or more such nodules. The rate of cancer in males with thyroid nodules was higher than in females. The prevalence of thyroid cancer did not differ between patients with a solitary thyroid nodule (12 of 79 patients, 15.1%) and patients with multiple nodules (8 of 51 patients, 15.7%), the deference is statistically insignificant (P = 0.95). A nodule that is one of several nodules had a lower likelihood of being malignant than did a solitary nodule: (8.9% versus 15.1%) (P < 0.001).
Conclusion: Ultrasound guided FNAC is the primary and frequently initial tool for assessing the risk of malignancy in thyroid nodules. The prevalence of thyroid cancer did not differ between patients with a solitary thyroid nodule and those with multiple thyroid nodules. FNAC have limited role in cytological diagnosis of follicular carcinomas, unless it is confirmed by histopathological diagnosis.

Background: The purpose of the study is to determine whether the pre-treatment clinical systemic variables and optical coherence tomographic (OCT) findings are associated with the subsequent response to the intravitreal Bevacisumab (IVB) in eyes with diabetic macular edema (DME).
Patients and Methods: 38 patients (45 eyes) with refractory diabetic macular edema. ; 16 females, 22 males and mean age was 57.5 year. All patients had DME not responded to other treatments. Complete eye examination; BCVA* (represented as LOGMAR for adequate statistical analysis), slit-lamp exam, intraocular pressure measurement, stereoscopic biomicroscopy of the macula, and morphologic patterns of diabetic macular edema demonstrated by OCT. All patients had intravitreal injection of 0.05mL =1.25 mg Bevacizumab (Avastin; Genentech, Inc.,San Francisco, CA), and followed up for 3 months. The pre and post-operative follow-up data were analyzed by Student-t test and Mann-Whitney test for two main outcome measures; visual acuity (LOGMAR) & central foveal thickness (CFT) changes over a period of three months, and data include demographic factors, type, duration and control of diabetes mellitus (HbA1C%), grade of diabetic retinopathy, renal function (serum creatinine level), serum cholesterol, blood pressure control and previous treatment by focal laser and/or intravitreal triamcinolone injection.
Results: The visual acuity and CRT improved in 30/45 eyes (67%) and 32/45 eyes (72%) respectively during a mean follow-up time of three months. The mean LogMAR visual acuities were 0.64 (SD ± 0.34), 0.61 (SD ± 0.31) and 0.60 (SD ± 0.32) at pre-injection, at 1 month post-injection and at 3 months post-injection respectively; but this mean increase in vision was statistically not significant (P value = 0.099). The mean foveal thicknesses were 444.95 µ (SD ± 127.36), 394.95 µ (SD ± 138.03) and 378.32 µ (SD ± 112.01) at pre-injection, 1 month post-injection and 3 months post-injection respectively, this decrease in the foveal thickness was statistically significant (P value < 0.001). The LogMAR and CFT values before and after IVB injection showed significant statistical correlations (p< 0.05) in relationship to variables of diabetic duration, diabetic control (HbA1c), and OCT pattern of macular edema, serum creatinine and cholesterol.
Conclusions: chronicity and inadequate control of diabetes mellitus, nephropathy, hyperlipidemia and presence of vitreomacular attachment (VMA) are factors associated with poor vision progress after intravitreal Bevacisumab injection.
Key words: CSME, Bevacisumab (Avastin), Systemic factors and OCT,
BCVA= BEST CORRECTED VISUAL ACUITY.

Background: the first stage ,labour is divided into early (latent phase )when uterine contractions are irregular and cervical effacement and dilatation are gradual, while the active phase of labour commences when cervical dilatation reaches (4) cm .and uterine contractions are more powerful . Our aim from this study is to see the effect of the timing of admission to labour room on mode of delivery and foetal outcome.
Patients and method: 240 nulliparous women at term pregnancy were diagnosed as labour pain and admitted to Baghdad Teaching Hospital from the first of January to the end of December 2006, they were followed during their course of labour to see the effect of admission to the labour room in latent phase in comparison to those in active phase of labour on the mode of delivery and fetal outcome.
Results: Rate of C/Section was significantly higher in those admitted in the latent phase (group 1) than those in active phase [group2] (65% vs16.6%) Major cause of C/Section in group (1) was dystocia (65.3%) while in the group (2) was fetal distress (55%) Rate of C/Section among women whose labour was augmented in group (1) greater than group (2) (74% vs20%) Conclusion: Later admission to labour room increased the rate of spontaneous vaginal delivery in low risk nulliparous women

Background: All medical colleges give students courses in epidemiology and biostatistics to help them in understanding medical data and to prepare them to conduct graduate and professional research. After graduation, understanding and correct application of the principles of epidemiology and biostatistics help the physicians in making better diagnostic and management decision based on best evidence.
Patients and Methods: A cross-sectional questionnaire-based survey was carried out among junior (chronic resident) doctors at several hospitals in Baghdad from the 1st of January till the 31st October 2009. A total of 212 physicians answered the questionnaire which covered demographic characteristics, average score of graduation, number of published or accepted to publish researches, reading health/medical journals, understanding the methods and statistical analysis of research and the answers of 25 multiple choice questions (MCQs) in basic epidemiology and biostatistics.
Results: No physician conducted or participated in any medical or health research. Only 19.34% of them read medical/health journals regularly, 29.72% read occasionally, and 50.94% not read. For those who read the medical/health journals regularly or occasionally (104 respondents), 42.31% not understand the methods and the statistical analysis of the researches. For those who not read (108 respondents), 61.11% blame the difficulty of the methods and statistics of researches as a main cause to flee from the journals. The mean of the MCQs exam was 62.38% (which is not very promising), more than 50% 0f the physician got score below 55%, and more over, about one third failed in the exam. Conclusion: Improving our students (who will become doctors) experience of learning and knowledge of epidemiology and biostatistics courses is an urgent need to meet the evidence based transition in medicine.

Background: Cervical erosion (CE) is a common finding on routine pelvic examination during the fertile years. Published articles on CE in Iraq are scarce; therefore this study was carried out. Methods: A total of 100 non pregnant women had CE attending a private clinic in Al-Sader city, Baghdad, was included in this study. Pelvic examination was done; demographic data and gynaecological history were obtained.
Results: The age of women was 27.1 ± 5.9 years with 7.3 ±2.9 educational years. Mucopurlent vaginal discharge was a complaint in 49% of women, and a watery vaginal discharge was a complaint in a similar percent. Thirty four of women were oral contraceptive users and 11% were using intrauterine contraceptive device. Women had equal or more than 4 children constituted 90%.
Conclusion: women with CE were at fertile age, had an early marriage and a high party and with a low educational status. The symptoms were vaginal discharge (mucopurlent or watery) and backache. Women with CE were either current or recent oral contraceptives users or using IUCD

Background: Aphaeresis is a term that means to separate or to take away. The basic idea of aphaeresis is efficient removal of a circulating cellular blood component, either cells (Cytopheresis) or plasma solute (plasmapheresis, plasma exchange).Thus, the treatment goal of aphaeresis is to remove the circulating cell or substance directly responsible for the disease process. Acceleration and development of aphaeresis applications had taken place with the arrival of automated cell separators in 1970s that ensure selectively removal of one or more of blood components from the blood and return the remainder to the individual. Plasmapheresis is separation of plasma from blood cells which are returned to the body. It is accompanied by multiple changes in haemostatic system. As many coagulation factors are removed during procedure, changes in selective parameters: Prothrombin Time (PT), Partial Thromboplastin Time (PTT), Thrombin Time (TT), Fibrinogen (FNG) & platelets count are found when the replacement fluids devoid from coagulation factor are used.
Patients and Methods: This clinico-haematological study conducted during a period of six months, from February 2004 to July 2004 at the National Blood Transfusion Center (NBTC) in Baghdad & 50 patients underwent Therapeutic Plasma Exchange (TPE) for various disorders with the use of two types of automated blood cell separators (Haemonetics MCS + which represent an intermittent flow centrifugation technique – IFC & Fresenius AS. TEC 204 which represent the continuous flow centrifugation technique - CFC) in this study, but no instrument type influenced the coagulation screening tests.
Results: The changes in all selective parameter: Prothrombin Time (PT), Partial Thromboplastin Time (PTT), Thrombin Time (TT), Fibrinogen (FNG), Platelets count, Haemoglobin (Hb) and Packed Cell Volume (PCV) were significant after Therapeutic Plasma Exchange (TPE). There was no significant difference in changes in crystalloid group from that in Fresh Frozen Plasma group. In crystalloid group, significant correlation was observed between Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), Thrombin Time (TT) & volume of Plasma Exchanged (PE) /session, while spacing between sessions and the number of sessions is significantly correlated with Thrombin Time (TT). Plasma fibrinogen concentration and platelets count were decreased in the patients included in our current study.
Conclusion: There is no significant difference in changes in haemostatic system whether crystalloid or diluted Fresh Frozen Plasma (FFP) was used as replacement fluid. Thus, crystalloid, solution devoid of coagulation material can be used as a replacement fluid in the Therapeutic Plasma Exchange (TPE) if the volume of Plasma Exchanged (PE) is small. These results are of vital importance from the practical & public health point of view in minimizing the usage of blood components((i.e. Fresh Frozen Plasma (FFP) which is a potential source of Transfusion Transmissible Infections (TTIs) worldwide)) & replaced by crystalloid solution as a safer replacement fluid substitute in Therapeutic Plasma Exchange (TPE) process.

Background: Idiopathic autoimmune thrombocytopenia purpura (ITP) is an isolated thrombocytopenia in a patient with no clinically apparent associated conditions or factors that can cause thrombocytopenia. The syndrome of ITP is caused by platelet-specific auto-antibodies that bind to autologous platelets. The diagnosis of ITP is usually a diagnosis of exclusion based on a demonstration of peripheral thrombocytopenia. Steroids are the conventional first-line therapy for adult ITP. Most patients demonstrate a response to steroids within 2 to 4 weeks, but a late response is possible.
Patients and Methods: A prospective study on 50 patients with diagnosis consistent with ITP, initially treated by steroid, patients who were non responders to steroids or relapsed following its withdrawal offered splenectomy
Results: Ten patients (20 %) had permanent satisfactory remission following steroid therapy, while other 40 patients (80 %) were either non responders (20 patients, 40 %) or relapsed (20 patients, 40%). Twenty patients (40%) underwent splenectomy, all of them initially responded, after 3-6 months, 17 patients of them (85%) were still in complete remission, while 3 patients (15%) were refractory ITP and required further treatment.
Conclusion: Steroid therapy is less effective in achieving satisfactory remission in adult patient with ITP; on the other hand, splenectomy had more sustained response after steroid failure.

Background: Except for the tight correlation to nasopharyngeal carcinoma, accumulating evidences show that Epstein-Barr virus (EBV) is correlated to other carcinomas. This study was to investigate the association of EBV with colorectal tumors.
Materials & methods: Forty paraffin embedded blocks of colorectal tumors (thirty were adenocarcinoma and ten were benign tumors) were all examined for the presence of EBV DNA with the application of In Situ hybridization.
Results: In Situ EBV DNA signals was detected in 6 out of 30 (20%) of colorectal carcinoma with no observed signals in the sections from benign group.
Conclusion: Our results showed that infection of EBV exists in human colorectal adenocarcinoma, which indicates that EBV may be involved in the carcinogenesis process.
Key words: EBV, In Situ Hybridization, colorectal tumors.

Background: Several factors render chronic lymphocytic leukemia (CLL) an interesting subject for study by researchers. These include marked progress in understanding the molecular biology of normal and neoplastic lymphocytes and recent advances in molecular genetics techniques. Among molecular markers, p53 cancer suppressor gene and the antiapoptotic gene Bcl-2 have been widely studied.
Patients and methods: A retrospective cross-sectional study done on 60 patients with chronic lymphocytic leukemia compared with 20 controls (anemic patients), all recruited at the Medical City Teaching Hospital laboratories from January 2004 to December 2007. The bone marrow biopsy of each was re-examined histologically. In situ hybridization was performed utilizing biotin labeled p53 and Bcl-2 cDNA probes.
Results: The frequency of p53 positive signals in the study group was 28.3% (17of 60 cases). A significantly larger number of patients, with high score for p53 signal, were associated with high-risk clinical stage than patients with low score (p = 0.005). There was a significant direct positive correlation between increasing scores of p53-positive chronic lymphocytic leukemia cells and advancing clinical stage of the disease (p =0.002).
The frequency of Bcl-2 positivity was 50% (30 of 60 cases). No significant correlations found between Bcl-2 scores and clinical stage of the disease.
Conclusion: Although p53 alteration may occur early in the course of the disease, as shown by the p53 positivity in a proportion of patients in low and intermediate-risk stage of the disease, the highest frequency p53-positive cells, has been observed in high-risk stage of the disease. Therefore, p-53 score is an important prognostic variable in patients with chronic lymphocytic leukemia. However, Bcl-2, as assessed by ISH, is not regarded as an important prognostic marker.

Background: The etiology of ischemic heart disease (IHD) is believed to have an immunological component. Association with human leukocyte antigens (HLAs) has been previously reported, particularly with DR6.Patients and methods: 75 cardiac patients were admitted to the coronary care unit, Baghdad Teaching Hospital over the period October 2008-May 2009 with the clinical diagnosis of acute coronary syndrome and STEMI myocardial infarction their ages range was (25-82) years the number of male was (55) (73.3%) and female was (20) (26.7%). All cases have routine ECG, cardiac marker’s measurements, routine haematological, Biochemical test and 2mls of blood reserved for HLA study.
Results: It was found that HLA-DR1 (8%) (P 0.001) has significant risk factor in the development of ischemic heart disease while HLA B (62%) (P 0.0009) has a protection factor in ischemic heart disease.
Conclusions: Our result suggests that strong relation between the incidence of acute ischemic episode (acute coronary syndrome and STEMS myocardial infarction and HLA-DR1) which mean that there may be predisposing genetic factor for the development ischemic heart disease.

Background: Vulvovaginal candiddiasis is an opportunistic mucosal infection caused by Candida albicans that affects large number of otherwise healthy women of child bearing age. Acute episodes often occur during pregnancy.
Patients and methods: This study was done on 50 pregnant women with Candida vulvovagnitis who were diagnosed by direct microscopic examination, culture technique, germ tube production, chlamydospore, and Api 20 candida system, at Baghdad Teaching Hospital in the period between October 2008 to February 2009.
Results: The study group included 50 pregnant women with Candida vulvovaginitis . The percentage of pregnant women with Candida albicans infection who their age is higher than 30 years old is 100 %( 23cases), while the percentage is high as 100 % (36cases) in pregnant women whom their gestational age more than 37 week gestation. On the other hand the percentage of pregnant women who have children more than 3 (100%) (12cases). Candida albicans was occurred more frequently when pregnant women suffered from diabetes mellitus 100 %( 14cases). Conclusion: Direct relationship was detected between the percentage of infection and the age of the mother, gestational age, parity, and the presence of diabetes mellitus, the higher the age of the mother, gestational age, parity, and the presence of diabetes mellitus, the higher percentage of infection with Candida albicans during pregnancy.

Background: Ischemic heart diseases (I.H.D) become the most common cause of sudden death, and is also the most common reason for death of man and women over 20 years of age in the world. Many Factors Play a role in pathogenesis of I.H.D. among those could be Immune – inflammatory markers which may lead to development of this disease.The present study was conducted to obtain more clarification about the impact of some immuno – inflammatory markers (IL- 8 , IL- 4 and IFN- Ճ) on the Clinical expression of heart disease among Iraqi patients .
Patients and methods: Hundred Iraqi patient with I.H.D. (80 male and 20 female) ages ranged between 20 to 80 year were involved in this study, include 4 subgroups: 17 with heart failure (H. F) ; 26 with myocardial infraction (M.I) ; 12 with stable angina (S.A) and 45 with unstable angina (U.A) who attending the Iraqi Center for Heart Disease and Baghdad Hospital from December 2006 to march 2007 . For quantitative estimation of serum levels of IL- 8, IL- 4 and IFN- Ճ by Enzyme Amplified Sensitivity Immuno Assay (EASIA) technique for both patients and healthy control groups.
Results: Significant increased (P< 0.05) in the serum level of interleukin – 8 in all patient subgroups: H.F., M.I, S.A and U. A. respectively Compared with control group, also all patient subgroups: H. F., M. I, S.A and U. A. Consequently revealed Significant increased (P< 0.05) in the interleukin – 4 Concentration compared with control group. More over, highly Significant increased (P< 0.01) in the interferon – Ճ concentration in the patients Subgroups: H. F, M. I, S.A and U. A respectively compared with control group.
Conclusion: Elevated level of inflammatory Markers (IL- 8, IL- 4 and IFN – Ճ) in all patients of I.H.D reflects the importance immuno – inflammatory elements as risk factor in the pathogenesis of Heart Disease.
Keywords: Ischemic heart disease, Inflammation, IL – 8, IL- 4, IFN – Ճ.

Background Tinea versicolor is a common dermatological problem worldwide in distribution, caused by dimorphic fungus called Malassezia furfur, they exist at the very interface between commensal and pathogen and, as such, their interaction with the human immune system is of great interest. Immuno-inflamatory activity mediated by different cytokines could have a role in the etiology of tinea versicolor.
Patients and Method: The study covered 46 subjects .It comprised 26 patients with TV compared with 20 healthy normal controls. Serum IL-6 analysis was done by ELISA.
Results: The level of IL-6 was elevated in patients with tinea versicolor, when compared with healthy control. Conclusion: IL-6 increases during the infection and could be part of a complex immune response leading to fungal elimination from human body.

Background: Except for the tight correlation to nasopharyngeal carcinoma, accumulating evidences show that Epstein-Barr virus (EBV) is correlated to other carcinomas. This study was to investigate the association of EBV with colorectal tumors. Materials & methods: Forty paraffin embedded blocks of colorectal tumors (thirty were adenocarcinoma and ten were benign tumors) were all examined for the presence of EBV DNA with the application of In Situ hybridization.
Results: In Situ EBV DNA signals was detected in 6 out of 30 (20%) of colorectal carcinoma with no observed signals in the sections from benign group. Conclusion: Our results showed that infection of EBV exists in human colorectal adenocarcinoma, which indicates that EBV may be involved in the carcinogenesis process.

Background: Identification the relationship of pepsinogen test (pepsinogenI and I /pepsinogen II ratio) and gastric cancer patients make the gastric cancer early diagnosed and prolong the life surviving rate. Patients and Methods: Serum pepsinogen I and pepsinogen II (PG I and PG I / PG II ratio) measured in 50 patients with gastric cancer ,30 gastritis patients diagnosed , and 16 healthy control by using enzyme immunoassay in those study groups, and the results of PG I and PG I / PG II ratio were comparing to 50 gastric cancer patients whom diagnosed histopathologically according the stomach regions, while the gastritis patients diagnosed endoscopically.
Results: This study showed that the age of patients with gastric carcinoma range between 25 and 80 years with mean age of 47.5 in females and 66.5 years in males(P=0.004). Immunologically, this study revealed that the serum pepsinogen I level was reduced less than 70nmg/dl and it was detected in 37(74%, P=0.008), 17(56.6%) and 5(31.2) in gastric carcinomatose patients, gastritis patients and healthy control respectively. While PG I /PG II ratio was found < 3 in 34(68%, P=0.007) of the stomach cancer patients, 15(50%) in patients control and 4(25%) in healthy control. In this study there is a high prevalence of positive result of PGI (89.1%, P=0.00 highly significant) in corpus-fundus region of stomach as compared to PGI/PGII ratio(44.12%, P=0.493).This study showed that the PGI is more sensitive (74%),and more accuracy (72.72%)than PG I /PG II ratio,while it is more specific (75%) than PGI.
Conclusion: Pepsinogen I and pepsinogen II (PGI and PG I / PG II ratio) are useful as non-invasive method for diagnosis of the precancerous diseases in the stomach, and it is sensitive and specific test, but it did not precisely reflect disease dissemination and pathological type. Gastric cancer was significantly high in age group 45-65 years.

Background: Traditionally, evaluation of the results of immunohistochemistry was done by visual quantification. Materials and methods: for reliable evaluation, more time-efficient and user friendly method we used simple computer program with image analysis options as independent parameters for reading positive results. To test the validity of visually scored results, we compare and correlate the results of Digital image analysis (DIA) variables with the visual scores of 280 pictures taken from entire stained glioma tumor sections for Bcl-2 and P53 oncoproteins in different glioma tumor grades.
Results: In this study, rates expression of both oncoproteins was evaluated visually in glioma tumor samples (Bcl-2=72.41% and P53=82.76%), no statistical significant differences were observed according to pathologic grades. Similarly, these results were also explained by data obtained by DIA variables that has been closely correlated with visual scores. More importantly, the DIA variables explained little discrepancy in the visual scores of both oncoproteins. Conclusions: the quantitative DIA measurements of the immunohistochemically stained sections made the results more objective and supported pathomorphological diagnosis.

Background: Palmoplantar psoriasis is a therapeutically challenging condition that can significantly impact patient quality of life as it directly affects activities. However, despite this impact, few clinical studies address treatment. Herbs and their extracts have been used for treatment of skin disease for centuries. One of the most popular herbs in our society is black cumin or seed of blessing oil (Nigella Sativa); this plant had diverse clinically useful activity.
Patients and Methods: This study was conducted in the Department of Dermatology and Venereology in Baghdad Teaching Hospital, Iraq during the period between January and October 2003. In this single-blind randomly controlled therapeutic study, thirty patients were enrolled, their ages ranged from 22-65 years. There were 18` females and 12 males. The patients were divided into 2 groups; group A (20 patient) instructed to use nigella sativa 10% ointment twice daily for 3 months, while group B (10 patient) used a control ointment(Vaseline) . Statistical analyses were carried out by computer using t-test, and chi-square when needed.
Results: twenty-four patients completed the study. In group A (18 patients), we noted a significantly reduction of the thickness and fissuring of the skin of the affected part which was also become very soft after 3 months of therapy. The response of patients to treatment was good in 50%, moderate in 27.8% and mild response in 22.2%. The satisfaction of patients with treatment was full in 61.1%, partial in 27.8%, and no satisfaction in 11.1%. In group B (6 patients), the lesions showed no significant reduction after 3 months and the response of patients to treatment was good in 16.6%, moderate in 33.4%, and mild response in 50%. The satisfaction of patients with treatment in this group was full in 16.6%, partial in 50%, and no satisfaction in 33.4%. The difference in outcome after 12 weeks between the 2 study groups was statistically significant.
Conclusion: The ointment of the black cumin is considered as a very good remedy for the palmoplantar psoriasis. This remedy is considered to be very safe, cheap and easy to prepare with no serious side effects as compared to the previous ointments for this type of psoriasis.
Key words: Black Cumin, Palmoplantar Psoriasis

Background: The study enrolled a total of 78 patients with acute and chronic kidney diseases for evaluation of the activity of enzymes, gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP) and amylase and compared with 42 normal healthy groups with normal albumin, creatinine and other kidney functions test and the samples were obtained from different hospitals in Baghdad.
Patients and methods: Three groups of patients were included. The first group consists of 15 patients with acute kidney diseases that occurs over days to weeks in which measurement of GGT, ALP and amylase were performed. Second group consists of 38 patients suffering from acute kidney diseases for 2-3 months in which serum GGT was evaluated .Third group consist of 25 patients with chronic kidney diseases used for estimation of GGT, ALP and amylase and other biochemical parameters, total cholesterol, urea, creatinine, uric acid and total protein.
Results: There was statistically highly significant difference in the activity of enzymes GGT, ALP and amylase P< 0.001 for three groups of patients with acute kidney diseases, and there was a remarkable difference in GGT activity with chronic kidney diseases (P < 0.001).
Conclusion: Acute and chronic kidney diseases in human was diagnosed by measurement of enzyme GGT, ALP, and amylase activities
Keyword: Chronic kidney disease, acute kidney disease, GGT, ALP, Amylase.

Background: Diabetes mellitus (DM) is a world-wide chronic metabolic disorder affects relatively high percentage of population. A few information is available in diabetes on the salivary content of enzymes GOT (AST) and GPT (ALT). Patients and methods: we studied 19 patients (NIDDM, type 2 diabetes mellitus aged 29-67 year). Colorimetric determination of salivary GPT and GOT activity was used.
Results: In the whole saliva of non-insulin-dependent (NIDDM, n=19) diabetic patients and from age- cross-matched healthy subjects (n=19). Saliva concentrations of GOT (43.92=12.8U/L) in NIDDM patients were higherly significant (P< 0.001) than those observed in normal subjects (23.0± 8.84 U/L). GPT was higher in NIDDM than in normal subjects (15.63±7.25, 10.2±7.31U/L respectively) too.
Conclusion: Determination of cytosolic enzymes GPT&GOT in saliva may be useful for monitoring the diabetic involvement.

Background: Fibromyalgia syndrome (FMS) is characterized by widespread musculoskeletal pain with associated symptoms including stiffness, fatigue, sleep disturbance and functional impairment. FMS is depicted by chronic pain for at least three months and tender points identified by the American Collage of Rheumatology (ACR). Although several hypotheses have been developed; the cause of FMS is currently unknown.
This study aims to evaluate the contribution of serum apolipoprotein (a) [Apo (a)], leptin, and serum lipid profile to the pathophysiology of FMS.
Subjects & Methods: The study has included 160 patients with FMS with age range (18-72) years and 60 control individuals who were age and sex matching with FMS patients: 29 patients with chronic musculoskeletal complaints but without FMS and 31 healthy controls. Elisa technique was used for the determination of Apo (a) and leptin. Colorimetric method was used to determine serum lipid profile. BMI was measured in all subjects. Results were evaluated using descriptive and inferential statistics; data were expressed as (mean ± SEM). P value of <0.05 was accepted as significant.
Results: Serum Apo (a) in FMS patients was significantly higher than healthy control group (P < 0.05). There were no significant differences among the three subject groups in serum lipid profile and leptin levels.
Conclusion: Apo (a) may play an important role in FMS pathogenesis. Lipid profile and leptin have no role in FMS patients as a cause or result of this syndrome.
Key words: Fibromyalgia, Apo (a), leptin, lipid profile.

Background: Tympanometry findings are considered by many investigators to be associated with passive and active smoking.
Patients and methods: One hundred forty healthy adult men aged (20-50 years). 70 smokers and 70 non-smokers were recruited for the study. The examination included otoscopy, and screening tympanometry. Smoking history was ascertained by self –report. For each subject, age, smoking status and number of cigarettes per day were noted.
Results: There is a tendency for more negative middle ear pressure in smokers than in non-smokers though this difference may not clinically significant. There were no significant differences in ear canal volume, middle ear compliance and presence of Stapedial Reflex in both smokers and non-smokers groups. There was no correlation between middle ear pressure and duration of smoking and number of cigarettes smoked amongst smokers.
Conclusion; A definitive study with a larger sample size is needed to explore the effects of smoking on findings of tympanometry in healthy men

Background: Physical exercise is essential for performance of the immune system. The integrity of immune response is dependent on the intensity and duration of the exercise performed. During exercise the metabolic and hormonal changes that occurred can induce lymphocyte apoptosis. Dehydroepiandrosteron sulphate (DHEAS) is one of the hormones that is affected by exercise, it is an androgen released from the adrenal cortex in response to adrenocortiocotropin releasing hormone (ACTH). DHEAS is regarded as an anti-aging hormone; it is primarily immune enhancing, providing some degree of counterbalance to the potentially detrimental effects of catecholamine and cortisol which are immunosuppressive if chronically elevated, it also had a role in the elimination of harmful lymphocytes which may give rise to chronic inflammation and possibly to autoimmunity.
Methods: Sixty healthy subjects were involved in this study with a mean age of (37.05 ± 13.02) year. They were subjected to moderate exercise session which lasted for 60 min and repeated 3 times per week for 3 months. The exercise intensity was 50-60% of heart rate reserve (according to Karvonen formula). Two exercise stages were performed; the first stage include 30 minute of physical activity program and the second stage include 30 minute of treadmill exercise. Blood samples were collected before and after exercise to examine its effect on the level of DHEAS hormone and apoptosis of peripheral blood lymphocyte.
Results: This study showed significant increment (P < 0.05) in the level of DHEAS hormone and the percentage of lymphocyte apoptosis after exercise in comparison to pre exercise values for each week along the period of the test.Three months exercise showed a significant correlation with the levels of DHEAS hormone (P= 0.000, r= 0.75), and with percentage of lymphocyte apoptosis (P = 0.001, r= 0.701).
Conclusion: in this prospective study, following moderate exercise for three months; there was increase in the percentage of periphral blood lymphocyte apoptosis and increased level of DHEAS hormone in the first two months while in the third month this anti aging hormones had reached to a steady state after the subjects get trained to exercise.
Keywords: moderate exercise, DHEAS, lymphocyte apoptosis.

Background: This study has been performed to detect any structural changes in the testes of rabbits that have been exposed to formaldehyde vapor.
Materials and Methods: Eighteen male rabbits has been used in this study, 12 of them were exposed to formalin vapor for 2 month, while the other 6 were exposed to the vapor of distilled water for 2 month too. All animals were killed at the end of experiments, and then pieces of testes were prepared for light microscopic examination. Sections were collected from the paraffin wax blocks and stained by H & E and finally examined by Olympus light microscope.
Results: Most of the seminiferous tubules from the formaldehyde exposed group were atrophied with no evidence of spermatogonia and lined only by Sertoli cells, in addition some sections showed multinucleated giant cells. Conclusions: This is the first study to report that formaldehyde induces damage to spermatogenesis without a reduction in the number of Sertoli cells and Spermatogenic damage can be seen in most of the formaldehyde exposed rabbits.

Background: image processing of medical images is major method to increase reliability of cancer diagnosis.
Methods: The proposed system proceeded into two stages: First, enhancement stage which was performed using of median filter to reduce the noise and artifacts that present in a CT image of a human lung with a cancer, Second: implementation of k-means clustering algorithm.
Results: the result image of k-means algorithm compared with the image resulted from implementation of fuzzy c-means (FCM) algorithm.
Conclusion: We found that the time required for k-means algorithm implementation is less than that of FCM algorithm.MATLAB package (version 7.3) was used in writing the programming code of our work.
Keywords: CT, Image Segmentation, k-mean Clustering, Median Filtering

Background: penetrating foreign body is a common problem but penetration by screw driver is very uncommon
Patient & method: A nine years old boy presented with penetrating screw driver through the medial canthus of the eye
Result: the foreign body removed under GA with good result.
Conclusion: minimal invasive procedure are preferred when we have penetrating head injury.