Journal of the Faculty of Medicine Baghdad

Background: Birth trauma is defined as injury to neonates resulting from mechanical forces (such as compression or traction) during the process of birth. Birth injury is used to denote avoidable and unavoidable mechanical and hypoxic- ischemic injury incurred by neonates during labor and delivery. Maternal, labor and infant factors can predispose to birth traumas. Many types of birth traumas can be found including intra and extra cranial, spinal, peripheral nerves, fractures and visceral.
Patients and methods: A cross sectional study was done on 200 babies (100 babies for the study group and 100 babies for the control group), admitted to special care baby unit of Baghdad Teaching Hospital, during the period between 1st of October 2007 to the 30th of March 2008.
Results: There was an increased percentage of birth trauma in preterm babies, large birth weight, mothers who were primigravida, had history of contracted pelvis, diabetes mellitus, prolong second stage of labor, abnormal fetal presentation, and shoulder dystocia. Trauma of cranium was the most common type of birth trauma, of which caput succedaneum (68%) was the most common one.
Conclusions: Birth trauma is still a significant problem in this maternity ward causing some morbidity. The significant risk factors were macrosomia, prematurity and multiple pregnancies, primigravida, chronic maternal illness like diabetes mellitus, history of pelvic anomalies or contracted pelvis, prolonged labor especially the second stage, abnormal fetal presentation and shoulder dystocia. So we recommend assessment of the fetal weight, mother pelvis capacity and presentation before delivery, so that macrosomic fetus might be delivered by cesarean section, and prevent premature delivery, and better use of investigations like ultrasound,x-ray,CT scan for early diagnosis and further management of birth trauma

Background: Congenital defects in continuity of the intestine are morphologically divided into either stenosis or atresia and constitute one of the most common causes of neonatal intestinal obstruction.
Patients and methods: This is a prospective study for analyzing (60)neonates with jejunoileal atresia who were managed at Children Welfare Teaching Hospital in Baghdad over a three years peroid extending from 1st January 2004 to 1st January 2007.
Results: Thirty six patients (60%) had jejunal atresia while ileal atresia was in(24) patients(40%).The most common type of jejunoileal atresia was type IIIa (38.3%) of the cases and the second was the type II (25%).The clinical presentation for jejunal atresia was mainly bilious vomiting and occurred in(100%)of the cases, while failure of passing meconium in the first day of life was the most common presentation in ileal atresia and occurred in (91.7%). Abdominal distention is more frequent in ileal atresia (87.5%) in comparism to (50%) in jejunal atresia. The number of males was (35) and the number of females was (25) and the male: female ratio is 1.4:1. The most common surgical complications were anastomotic leak and wound infection. There are several other factors contributing to the increased mortality rate such as delayed in diagnosis, associated anomalies, neonatal septicemia and aspiration pneumonia.
Conclusion: Jejunal atresia most commonly presents with bilious vomiting while ileal atresia presents with abdominal distention and failure to pass meconium in first day of life. The most common type of the atresia in our study was type IIIa while type IV is the rarest. There are several surgical procedures used in the treatment of atresia but wide proximal resection and end to end anastomosis was the commonest procedure done.
Keywords: Jejunoileal Atresia

Background: Diabetes mellitus is a well known risk factor for acute coronary syndrome but the hypothesis that patients with acute phase hyperglycemia, regardless the previous diagnosis of diabetes, have worse prognosis than those with normal glucose values is controversial. This paper aims to estimate the prevalence of admission hyperglycemia, its effect on in-hospital prognosis of diabetic and non-diabetic patients with acute coronary syndrome, and to compare it with 2nd day fasting plasma glucose as a prognostic marker.Methods: One hundred patients, (59) diabetic and (41) non-diabetic, with documented acute coronary syndrome enrolled in this study over the period of June/ 2009-Jan./2010 from coronary care unit of Baghdad Teaching Hospital, who were thoroughly examined, hyperglycemia documented on admission and next day, then followed up daily during hospitalization for development of complications or death.Results: Heart failure and recurrent cardiac ischemic events were significantly more common in diabetic than non-diabetic patients (P-value:0.04 for both),while arrhythmias, cardiogenic shock and mortality rate were not significantly different between both study groups.Admission hyperglycemia more than 200mg/dl was associated with higher incidence of cardiogenic shock, recurrent ischemic events, heart failure, and death in non-diabetic patients (P-value 0.009, 0.022, 0.025, 0.026 respectively) but no more arrhythmias, and in diabetic patients admission hyperglycemia was only associated with more recurrent ischemic events (P-value 0.017).Second day fasting plasma glucose more than 126mg/dl was associated with higher incidence of heart failure in non-diabetic patients and more recurrent ischemic events in both study groups.Conclusion: Admission hyperglycemia is a poor in-hospital prognostic marker in non-diabetic & to lesser extend in diabetic patients suffering acute coronary syndrome.

Background: foreign bodies Inhalation still a common problem in Iraq, occurring in both lay and professional segments of our society. Their successful removal is based on a collected experience of our thoracic surgical teams.
Patients&Methods: A prospective study of two hundred forty eight patients referred to the department of thoracic surgery of the surgical subspecialties hospital of the medical city teaching complex during the year (2007) due to witnessed or suspicion of foreign body inhalation. Patients were grouped into group 1 with definite history of foreign body inhalation and group 2 with no such history.
Results: In group 1, out of 203(81.85%) patients, about 169(83.25%) patients were proved to have foreign body inhalation by rigid bronchoscopy, while in group 2,foreign body inhalation were proved in 14(31.11%) patients out of 45(18.14%) patients. The commonest age group of foreign body Inhalation was 6 months - two years (63.93%), and males to female ratio was 1.8:1. The highest peaks were encounter in July and August. The results of chest X-ray were normal in (53.55%) of cases and the most common radiological abnormality was pneumonic consolidation which was seen in (15.84%) of cases. Organic foreign bodies were representing (86.3%), the commonest organic foreign body was watermelon seed (48.65%), and the common site of foreign body lodgment was the right main bronchus.
Conclusion: The mere suspicion of a foreign body Inhalation is a justification for bronchoscopy. A negative bronchoscopy is better than to leave it inside with its serious sequels.

Background: Bone healing of fractures is still an open field for research due to its biological complexity. Adequately adapted experimental model is essential for understanding the factors influencing the biological process of bone healing. Rabbits provide a good animal model for bone healing studies; its bone had Haversian system similar to human.
Material and Methods: Six young locally breaded New Zeeland male rabbits were used in this study, the study conducted in animal house in college of medicine at November and December 2009. Surgical fracture (osteotomy) induced operatively in right ulna under general anesthesia by a hand saw. At the end of fifth weeks, the animals' scarified and the specimens taken for radiological, computerized tomography (CT) scan densimetry and histological examination carried out for bone healing in site of osteotomy
Results: All bone osteotomy united at end of fifth weeks macroscopically and radiologically. There was no significant difference in serum calcium, serum phosphate, and serum alkaline phosphatase preoperatively and at end of fifth weeks. The callus density was measured in site of osteotomy by CT scan densimetry and its mean was 302 ± 142. The histological examination of the bone at site of osteotomy show healing with woven bone predominantly with some lamellar bone and cartilage. Conclusion: The present study demonstrated that the ulnar osteotomy without use of external splintage or internal fixation model is a new, easy to perform and can be used as a model for fractures healing studies.

Background: laparoscopic cholecystectomy is standard treatment in gallbladder disease. Acute cholecystitis has been relative contraindication of laparoscopic cholecystectomy. With the accumulation of experience in laparoscopic surgery, laparoscopic cholecystectomy is being gradually applied for the treatment of acute cholecystitis .Objective: to evaluate and compare the outcome of laparoscopic cholecystectomy in acute and chronic cholecystitis in terms of complications, conversion rates, reason of conversion, need for special modifications of the operative technique, and hospital stay.
Methods: A prospective study done Between April 2007 and January 2010, in the department of general surgery, medical city teaching hospital, Baghdad. Evaluation of all patients admitted with symptomatic gall bladder disease, who underwent laparoscopic cholecystectomy were included in this study. They were classified as group A (having acute cholecystitis) and group B (having chronic cholecystitis), The diagnosis of AC was based on clinical, ultrasonographic, and operative finding; also histological diagnosis.
Results: A total of 197 patients. 46 (23%) had acute cholecystitis (group A) while 151 patients (76.6%) had chronic cholecystitis (group B). In group A, Gall bladder decompression was required in 4 (8.7%) patients. One patient (2.2%) had wound infection, and one patient (2.2%) developed a subhepatic biliary collection. While epigastric port hernia occurs in one patient (2.2%). In group B, One patient (0.7%) had wound infection, and one patient (0.7%) had umbilical port hernia. Conversion rate was 3(6.5%) for group A and 0% for group B. There was no procedure related mortality in either group. The hospital stay (6-24 hours) was the same for both groups (group A; mean 9.13±6.89 hours, group B; mean 15.77±8.99 hours).
Conclusion: laparoscopic cholecystectomy is safe in all patients presented with symptomatic gall bladder disease.

CT scan features of Malignant Meningioma
Objective: Meningioma which is a common benign Brain tumor can be malignant, but the final decision is by biopsy. However CT. Scan features can help to evaluate malignancy of a lesion. The aim of this retrospective study is to look for the malignant features of a malignant meningioma .
Patients and Methods: This is a retrospective study of 50 malignant meningiomas in the neuro-surgical unit in the specialized surgical hospital (previously AL-Shaheed Adnan hospital), for the period from March 1992 to March 2007. We search specially for Malignant features on the CT scan study of the patients.
Results: 94%of the patients had different features of malignant meningioma, only 6% CT scan did not show any malignant features, we also evaluated the results of surgery .
Conclusion: CT scan is one of the most important diagnostic procedures for diagnosis of brain tumor; however final diagnosis can only be emphasized by the histo-pathological studies.

Summary:
Background: Open access gastroduodenoscopy allows general practitioners to request gastroduodenos-copy without prior referral to a specialist. Endoscopy of the upper gastrointestinal tract in experienced hands has definite advantages over conventional barium-meal examination.
Patients and Methods: A total of 266 patients who were referred directly from general practitioner or a specialist attending for esophagogastroduodenoscopy (EGD) to the Endoscopy Unit At Al-Kindi Teach-ing Hospital from September- 2008 to Feb-2010 as an open access policy. Six inclusion criteria were used to include patients in our study group , while 136 patients had underwent EGD were referred from outpatient clinics of the hospital by specialist after screening and filtration were included in the study. Data were obtained from patients include chief complaint and duration and full history of present illness with special emphasis on age, gender, symptoms (abdominal pain, vomiting, loss of weight or appetite, hematemesis, melena, dysphagia), and history of present medications. EGD was done for all patients with gastroscope Pentax EG-2985K2.8.
Results: Two hundred sixty six patients were included in the study and underwent EGD . One hundred thirty EGDs were done in this study as an open access EGD policy while 136 EGD were done for patients who were referred from outpatient clinics of the hospital. In open access EGD policy, 66.15% of patients were males and 33.85% patients were females. The most commonly affected age group which showed abnormal endoscopic findings were in the second decade of life (20-29 years) 22.31% of cases; the chief complaint was epigastric pain in 87.69% of patients. Normal EGD was found in 23.07% of patients while pathological lesions were seen in 76.93% of patients.
Gastro esophageal reflux disease (GERD) was the most common condition encountered by EGD (33.08%). While 136 patients referred from outpatient clinics of the hospital underwent EGD, 68.38% of patients were males and 31.62% of patients were females, most of the patients were in the third decade of life (28.67%), normal EGD was found in 44.12% of patients. Chronic active DU and GERD were the most common diagnoses 12.5%, 11.76% respectively.
Conclusions: The clinical assessment and the strict application of the six inclusion criteria in open ac-cess EGD policy increase the yield of diagnosis of pathological lesions and decrease the number of un-necessary EGDs in our study.

Background: Several studies were carried out on association of infection with male infertility, which revealed great variations in the prevalence of genital infection in different parts of the world. This work was designed to study the effect of infection on semen parameters in a sample of Iraqi infertile males.Methods: A sample of 400 infertile male patients attending the High Institute for Embryo Research and Infertility Treatment for laboratory investigations and treatment were selected. This study was carried out during the period Nov. 2002 to April 2003, inclusive. Seminal fluid analysis was performed on samples obtained by masturbation into a glass container after 48 to 72 hours from of abstinence from sexual intercourse. Analysis (examination of volume, liquifaction, sperm count, motility percent, normal morphology percent and presence of pus cells) was performed within an hour after ejaculation. Results: Clinical infection was detected in 14% of infertile males and 29% had subclinical infection. Liquifcation time and leukocyte had significant variation between infected and non infected patients. Conclusion: Early diagnosis and treatment of genitourinary infection in necessary to reduce complication and infertility in future.

Background: Patient evaluation of the healthcare provided by his/her family doctor is a multidimensional concept, its main component being the doctor-patient interaction. Materials and Methods: a total of 200 client chosen by systematic random sampling were successfully interviewed immediately after having the contact with the family physician in the family medicine center. Results: The present study showed that the majority of the clients were young age, most of them were female, completed secondary education and the majorities were unemployed. This study determined the client general satisfaction the services provided by the physician the overall satisfaction was high (98%), the most significant statistical association was found between general satisfaction and the client age, gender and education. The evaluation of the physician interaction to the client was mostly positive regarding the doctor courtesy and humaneness, skills and continuity of care, comprehensiveness of care, in formativeness and doctor advice. Regarding client preferences most of the clients prefers female doctor, family physician specialty, and prefers being checked by the same doctor in each visit. Conclusion the client generally was satisfied with the services provided by the physician, a strong statistical association was found between satisfaction and some client sociodemographic characteristics like age, gender and the level education.

Background: Anaemia is one of commonest health problems in antenatal care units of developing countries and contributes significantly to increased maternal and fetal morbidity and mortality.
Patients and methods: During the period from 1st of July 2007 to the end of October 2007, hundred anaemic pregnant women attending the gynaecology and obstetrics department in Al- Yarmook teaching hospital in Baghdad and 20 apparently healthy pregnant women,aged between 17 - 46 years as a control were included in this study. Anaemic women included in this study fulfilled the criteria of haemoglobin concentration of less than 110 g/L in first trimester and 105g/L in the second and third trimesters, no history of acute or chronic illnesses, not receiving any treatment & without any family history of haematological disorders. These women were randomly selected in relation to age , parity ,trimester of pregnancy & social status. Ten mls of venous blood samples were aspirated from each pregnant women in the studied group , two mls were put in ethylendiaminetetra acetic acid (EDTA) tube and analyzed for peripheral blood smear , reticulocyte count & haemoglobin A2 ( Hb A2 )using standard methods for hematological investigation .While the remaining 8 ml were put in a plain tube to evaluate serum iron , total iron binding capacity & serum ferritin. Serum iron, total iron binding capacity was done by colometric method, while serum ferritin was done by immunoenzymatic assay and hemoglobin A2 (HbA2) level by haemoglobin electrophoresis.
Results: Peripheral blood smear study revealed a hypochromic microcytic anaemia in 81% of cases, 8% of cases showed macrocytic anaemia, 8% a normochromic normocytic anaemia while the remaining 3% of cases showed a dimorphic picture .Iron deficiency anemia constitutes 79% of the cases confirmed by serum ferritin. Only two cases ( 2% ) had elevated level of HbA2 .Serum iron, total iron binding capacity & serum ferritin had significant differences in those cases with low social status, increasing parity & increasing gestational age (trimesters).Iron deficiency anaemia was not found to have a significant association with increasing age , while patients with para 4 & more, in the third trimester & low social status were more significantly affected with iron deficiency anemia .
Conclusion: Iron deficiency anemia was found in 79% of anemic pregnant females confirmed by measurement of serum ferritin level. There were a significant difference between parity; social status and gestational age with the incidence of iron deficiency anemia.â-thalassaemia trait constitute only 2% of anemic cases in the studied sample.

Background: In breast carcinoma, amplification &/or over-expression of HER-2/neu has been associated with a group of unfavorable prognostic factors. The Food & Drug Administration Agency approved Trastuzumab (Herceptin) for the therapy of metastatic breast cancer but only in patients with amplification &/or over-expression of this gene. Because of these advances, evaluation of HER-2/neu status in breast cancer specimens is of vital importance.
Patients and methods: thirty eight females with breast carcinoma were included in this study. All histologic sections were stained routinely with the hematoxylin and eosin stains and immunohistochemically for HER2/neu. All cancers were graded and subcategorized into ductal and lobular carcinomas, with or without an insitu component, and with or without Paget disease. The assessment of HER-2/neu over-expression was quantitated.
Results: Of the twenty four cases of infiltrative duct carcinoma (IDC), HER-2/neu staining was positive in ten (41.7%) cases. None of the fourteen cases of infiltrative lobular carcinoma (ILC) showed a positive reaction. Statistical analysis revealed no significant differences in respect to HER2/neu expression between IDC with and without ductal carcinoma in situ (DCI). All cases of IDC with overlying Paget disease (5 cases; 13.2%) were positive for the stain. All grade I cancers were negative for HER-2/neu over-expression, in contradistinction to a positive staining in 41.7% grade II tumors and 62.5% grade III tumors.
Conclusion: there is significant correlation between HER2/neu overexpression and cancer histopathological type. The presence or absence of an in situ component had no effect on the marker overexpression. Significant correlation was observed between HER-2/neu overexpression and higher histological grades of IDC. No correlation was found between the positivity of the marker and axillary lymph node status. Similarly, no association was found with the other variables except the size of tumor. It is recommended that HER-2/neu assessment to be included as a routine test in the screening program of all breast cancer Iraqi patients.

Background: Rheumatoid arthritis (RA) is a chronic and debilitating autoimmune disease characterized by chronic inflammation with subsequent cartilage and bone destruction. Cytokines are key mediators of inflammation and can be found in abundance both in the joint and blood of patients. This study was designed to evaluate the role of pro- and anti-inflammatory cytokines in pathogenesis of RA, as well as study the correlation among these cytokines.
Patients and methods: Forty patients with RA and thirty age-matched healthy controls were included in this study. Serum cytokines were measured by enzyme-linked immunosorbent assay.
Results: The serum levels of pro-inflammatory cytokines (IL-1α, IL-2, IL-6, IL-8, IL-12 and TNF-α) were significantly higher in RA patients than in healthy controls (p<0.01, p<0.05). Moreover, these levels were significantly increased in active RA patients than in inactive RA (p<0.01, p<0.05). On the other hand, the serum levels of IFN-γ and anti-inflammatory cytokines (IL-4, IL-10) showed no significant differences between RA patients and healthy controls and neither between active RA patients and inactive RA (p>0.05). Interestingly strong positive correlation was found among each of (IL-1α, IL-2, IL-6, IL-8, IL-12 and TNF-α), p<0.05.While strong negative correlation was noticed between IL-6 and (IL4 and IL-0) and also between TNF-α and (IL4 and IL-0), p<0.05.
Conclusion: The current study suggests that serum levels of pro-inflammatory cytokines (IL-1α, IL-2, IL-6, IL-8, IL-12 and TNF-α) may play an important role in RA and may be used as a marker of disease activity. Moreover imbalance between pro- and anti-inflammatory cytokines may yield effective therapeutic targets in this inflammatory disease.
Key words: Rheumatoid arthritis, Pro-inflammatory cytokines, Anti- inflammatory cytokines.

Background: The hepatitis G virus( HGV), also called hepatitis GB virus, as a member of the Flaviviridae family distantly related to hepatitis C virus (HCV), Little is known about the frequency of HGV infection, the nature of the illness, or how to prevent it. What is known is that transfused blood containing HGV has caused some cases of hepatitis. They infect humans, but are not known to cause human disease. This virus can be transmitted efficiently by blood transfusion and by other parenteral mechanisms. Transient and long lasting infections with HGV have been documented in man.
Patients and methods: HBs Ag, Anti-HCV IgG and Anti-HGV IgG were detected by Enzyme-Linked Immunosorbent Assay (ELISA).HCV RNA on the other hand, has been detected using PCR technique in the serum of 75 Iraqi patients with chronic liver diseases in comparison to 15 healthy individuals.
Results: HGV infection was detected in 25% of blood donors, 30% of chronic hepatitis C, 25% of chronic hepatitis B, and 20% of cryptogenic chronic liver disease. HGV infected patients tended to be younger than non-infected patients but no differences concerning sex, possible source of infection, clinical manifestations, biochemical and virological parameters, or severity of liver lesions were found.
Conclusions: The percentage of HGV infection in chronic liver disease seems to be relatively high in our area 19 out of 90cases (21.11%). Infection with HGV does not seem to play a significant pathogenic role in patients with chronic liver disease related to chronic HBV or HCV infection, or in those with cryptogenic chronic liver disease.
Key words: HGV, chronic liver disease, blood donors.

Background: In Ulcerative colitis (UC), the presence of a persistently elevated number of T cells in the inflamed area with respect to the activity of the disease suggesting bad prognosis. This study was done to evaluate cellular immune response in different disease activity patterns and its possible implication in evaluation of disease activity.Materials and methods: This study included Forty seven archived paraffin-embedded samples of ulcerative colitis; these samples diagnosed and graded for disease activity. Then dual immunofluorescence staining was used for phenotyping of lymphocytic infiltrate (CD3- CD19) and (CD4-CD8). A total and differential T cell as well as plasma cell count was recorded in these UC tissue samples. Non parametric Kruskal-Wallis test was used to compare the median cell counts among different study groups.Results: There is higher lymphocytic infiltrate for all types of cells when UC samples compared with control samples with highly statistical significant difference, T cells represents the major constituents of colonic mucosal infiltrate (86.89%) and about 75.79% were CD4 positive T cells. T-cell subsets and plasma cell have high statistical significant difference (p≤0.001) according to histological grade. Furthermore, with the histological grade the highest association found with T lymphocytes (r=0.944) followed by T helper (r=0.821), T cytotoxic (r=0.653) and B lymphocyte (r=0.237).Conclusions: Qualitative and semi quantitative characterization of lymphocytes subsets was useful in the assessment of different histological grades of UC disease activity.

Background: Transitional cell carcinomas (TCC) of the bladder are a major health problem. Recently, some studies link high risk Human papilloma viruses' type 16 and type 18 with bladder carcinoma.
Materials and methods: Fifty formalin fixed, paraffin embedded tissues with TCC of the bladder from Specialized Surgical Hospital in Baghdad were included in this study. In addition, ten apparently normal bladder autopsies were collected from the Forensic Medicine Institute Archives and used as control group. Tissue blocks were sectioned and sticked on charged slides and used for the detection of HPV-16 and HPV-18.
Results: The expression of HPV-16 and HPV-18 DNA signals in TCC of the bladder tissues in the present study was 36% (18 out of 50) and 14% (7 out of 50) respectively, where strong correlation was found between expression of HPV-16 and TCC of the bladder while no correlation with HPV-18.
Conclusion: HPV-16 and HPV-18 might have an important role in the course of TCC of the bladder.
Key word: Transitional cell carcinomas of the bladder, High risk HPV, Carcinogenesis.

Background: IL-4 is an antibodies inflammatory cytokine which has an important role in protecting against the inflammatory reactions in most of diseases. Here, we try to highlights the role of this cytokine in chronic Rheumatic heart disease and its correlation with the extent of histopathological abnormalities.Patients and Methods: Rheumatic mitral valve surgical fragments were taken from a total of 48 Iraqi patients with chronic rheumatic heart disease under mitral valve replacement surgery in Ibn Al-Bitar Hospital for Cardiac Surgery-Iraq-Baghdad. Paraffin embedded mitral valve tissue sections were prepared. IL-4-expressing cells were detected by using immunohistochemical staining technique and histopathological picture was studied by using hematoxylin and eosin staining.
Results: There were lower numbers of IL-4 positive cells in all patients under study in general, but very lower IL-4 positive cells percentage was recorded in high risk group patients. There was no significant difference in the distribution of IL-4 mean positive cell’s count among all patients (p > 0.05). There was a correlation of IL-4 with the extent of histopathological abnormalities, and odds ratio results displayed that the histopathological abnormalities which recorded in the case group 4 times than that occurred in the control group.Conclusion: IL-4 plays an important role in regulating the inflammatory responses against the heart in chronic rheumatic heart disease

Background: The periodic review conducted of acute bacterial meningitis in children younger than 5 years of age in Baghdad to reflect changes in the epidemiological pattern of this infection. Patients and Methods: Sixty patients with signs and symptoms suggestive of meningitis who were admitted to Central Teaching Hospital in Baghdad City were included in a prospective study started from the 1st October till the 30th of December 2009. By bacteriological study, biochemical and cytological study in the laboratory, WBCs in the blood with differential count was done to support the diagnosis of bacterial meningitis.
Results: Present study revealed that from (60) patients (6) cases (10.0 %) showed positive and (54) cases (90.0 %) negative cultures to CSF patients.
Conclusions: The administration of antibiotic before lumber puncture associated with false negative CSF culture. Most cases of meningitis were under one year of age occurred in male more than female with bottle feeding. Fever was the most common presenting symptom followed by vomiting and convulsion.

Background: Many etiological factors have been implicated in the pathogenesis of Asthma like; viruses, bacteria and Chlamydia pneumoniae. This study focuses on the role of Chlamydia pneumoniae in asthma pathogenesis.Patients and Methods: The detection of Anti-Chlamydia pneumoniae antibodies IgA, IgM and IgG in patients by ELISA, for 35 patients, 18 asthmatic patients, 12 patients with chest infection with no history of asthma, and 5 apparently healthy as control subjects.
Results: The results showed that 80% and 70% of the patients were negative for anti- Chlamydia pneumonia antibodies IgA and IgM respectively, while significantly (p<0.05) high number (73%) of patients were positive for IgG, of which significant number (p<0.05) of them, 63% were asthmatic and 36% were non-asthmatic chest infection.
Conclusion: this study may support the association between Chlamydia pneumoniae and asthma.

Background: The influence of glucose metabolism is seen in many infectious diseases, making diabetic patients more vulnerable to sepsis and other serious sequelae of bacterial invasion such as UTI and vaginitis.
Patients and method: sixty two patients (women) were suffering from GUTIs consulting Al-Elwya hospital from November- 2009 to March -2010. Two samples were taken from those patients (urine samples and vaginal swabs); these samples were cultured on Blood, Chocolate, and MacConkey's agar for isolation of bacteria.
Results: The study group consists of sixty two women suffering from (GUTI), their ages range from 18-55 years. Thirty eight of them were diabetic women and twenty four of them were non- diabetic women. Twenty two of diabetic women were pregnant and sixteen of them were non- pregnant. Fifteen of non-diabetic women were pregnant and nine of them were non- pregnant. Conclusion: Diabetes and pregnancy is a significant predisposing factor for GUTIs in women.

Background: The axillary artery is a direct continuation of the subclavian artery. The axillary artery is usually described as giving off six branches. The first part gives superior thoracic artery. The second part gives lateral thoracic (LT) and thoracoacromial(TAC) arteries. The third part gives three, subscapular(SS), anterior circumflex humeral(ACH)and posterior circumflex humeral(PCH) arteries. Anatomical variations in the branching pattern of axillary artery are quiet common and typically include the subscapular artery(SS), lateral thoracic artery(LT) and the posterior circumflex humeral artery(PCH). The variation of the axillary artery branching pattern has anatomical as well as clinical and surgical relevance given the proximity to the shoulder joint and humerus.
Patients & Method: Bilateral axilla dissection was conducted on 26 embalmed axillae (13 cadavers) to allow examination of the axillary artery and its branches. The study was carried out in Department of Human Anatomy, College of Medicine.
Results: The classical branching pattern of the LT originating from the axillary artery posterior to the pectoralis minor muscle and the SS producing the circumflex scapular (CS) artery and thoracodorsal(TD) occurred in 77%. The SS was observed originating from the LT 7% of the time. The LT was observed originating from the SS 5% of the time. The LT was observed producing the circumflex scapular artery and TD in the absence of SS 2.5% of the time. The PCH originated from four different sources, from the third part of axillary artery as is classically described in 77%. From the SS 11%. From deep brachial artery DB 9% and from LT 2%.
Conclusion: Vascular variation in the axillary artery and its branches is quiet common , This variation should be considered seriously as will implicate risk of bleeding during surgery in the axilla and also the difficulty in interpretation of the angiography after axillary catheterization .

Background:Aluminum (Al) intoxication was initially reported in patients undergoing hemodialysis and then was linked to Alzheimer's disease. Man usually is exposed to Al containing antacids, vaccines or foods cooked in Al utensils. The assumption of ingesting sour juices as acetic acid or ethanol may affect favorably the degree of Al absorption is justified when taken in conjunction with the above mentioned appetizers.
Materials and methods: Four groups of 10 mature male rats each were used. The drinking water (DW) containing 5mM of Al2(SO4)3 with 1% glacial acetic acid and/or 10% ethanol made available ad-libidum. Weekly body weight and each other day drinking water volume were measured. Brain and plasma analysis at and Ca were determined from blood obtained by cardiac puncture, in addition to automated complete blood count (CBC), after 10 wks of treatments.
Results: The results of plasma Al levels indicated that, the addition of acetic acid or ethanol to Al containing drinking water enhanced significantly its absorption and even more when combined relative to control. This enhancement was evident as well in increased Al and Ca deposited in the brain while no change in plasma Ca. The CBC results showed highly significant thombocytopnia for the 1st time, in addition to microcytosis and hypochromia. Evidently, thrombocytopoietin synthesis, and/or action is blocked by Al from acting on the cellularity of bone marrow.Conclusion: The addition of acetic acid and/ or 10% ethanol to Al containing drinking solution enhanced Al absorption when acid is used and an addative effect when both are used. The toxic plasma level caused hypochromia, microcytosis and severe thrombocytopenia in addition to brain atrophy.

Background:The most principal mechanisms of cardiomyopathies are;high preload and afterload and low myocardial contractility, imbalance of trace elements may cause myocardial metabolic dysfunction and may have a role in aetiology of cardiomyopathy, particulary in IDC. Trace elements are being increasingly recognized as essential mediators of the development and progression of heart diseases.
Methods: Study design Multi case-control study and single center estimation of trace elements concentrations in a number of volunteer settings this study was conducted in the Department of Cardiology, Ibn Albitar Hospital, and in the Physiological Chemistry Department of the College of Medicine, Baghdad University, from June 2005 to July 2006. Subjects Twenty-five patients with IDC, 15 patients with ICM, 16 patients with coronary artery disease(CAD) who have normal LV function, and seventeen healthy individuals as controls were included in this study. Investigations included serum estimation of zinc (Zn), copper (Cu), and magnesium (Mg) concentrations in these groups of patients and controls.
Results: The mean (±SD) value of serum zinc was significantly decreased in CAD patients compared with controls (P< 0.003). Serum Cu values (mean±SD) were significantly higher in IDC, ICM and CAD groups than in controls (P< 0.0001, P< 0.002, and P< 0.007, respectively). Serum Mg (mean±SD) value was significantly decreased in ICM patients compared to controls (P<0.007). Furthermore, there was a significant positive correlation between serum Mg levels and the values of LVEF % in IDC patients (r=0.522, P< 0.007).
Conclusion: This study confirmed that heart failure (IDC and ICM) and CAD are associated with serum trace elements (Zn, C u, and Mg) abnormalities.

Background: Hydatidosis is a widespread chronic zoonotic disease caused by helminthic larval stage of tapeworm Echinococcus granulosus. It has a serious medical and public health problem. Recently many substances are used to activate and modulate the immune system of the host in order to control the cyst growth and development.Materials and Methods: Protoscolices were isolated from human hydatid cysts and treated with four purified concentrations (25, 50, 75, 100μm/ml) of 1-HP plus hydatid cyst fluid as a positive control group for 4, 24, 48 and 72 hrs period of exposure. Then After 72 hours, the protoscolices which were treated with different concentration of 1-HP were inoculated intraperitonially of male white balb / c mice to see the infectivity of the protoscolices in vivo. Results: The results showed that the higher purified concentration 75,100 mole/ml of this pigment had a highly significant toxic effect on the viability of protoscolies, especially after 72 hrs.This toxicity of the pigment decreases the number of the protoscolices to develop and grow in vivo.Conclusion: It has been found that 1-hydroxyphenazine is a dose dependant toxic pigment causing attenuation of the protoscolices viability in vitro which decreases the number of protoscolices to develop and grow in vivo.

Background: Cherry extract has a wide range of biological activity. In the present investigation, two oral doses 0.04&0.08 mg/kg/day of cherry stick (ethanol extract) in albino male mice resulted in a significant decrease in concentration of serum total cholesterol concentration, triglyceride and total protein, albumin and globulin.
Objective: we investigated the impact of biological activities of cherry stick extract on serum cholesterol, triglyceride, total protein, albumin and globulin in white albino male mice.
Design: This study include three groups of white albino male mice. The first group (G1) was a control group comprised of 5 animals. The second group (G2) consisted of 5 animals treated with 1ml of cherry stick extract at concentration of 0.04 mg/kg/day for two weeks after treatment, while the third group (G3) consists of 5 animals treated with 1ml of cherry stick extract at concentration of 0.08 mg/kg/day for two weeks with treated animals.
Results: there was a statistically significant reducing effect on serum total cholesterol, triglyceride, total protein and albumin P<0.001 at 0.04 mg/kg/day and 0.08 mg/kg/day for all biochemical parameters. Globulin was markedly decreased P< 0.01 in comparison with control but no significant change in ratio of albumin to globulin.Conclusion: Extract of cherry stick exerts at low dose a remarkable effect on serum cholesterol, triglyceride and total protein.

Background: It is well known that the low level laser irradiation has act on immune system cells in a number of ways, one of them includes increasing phagocytic activity of irradiated cells. This study was established to shed light on the possible effect of laser irradiation on phagocytic activity of polymorphoneutrophils. Subjects and methods: Fresh blood samples were obtained from twenty healthy volunteers for phagocytosis assay. The polymorphoneutrophils were isolated from blood and examined their phagocytic capacity befor and after exposure to laser irradiation.
Results: The present study revealed a significant increase in the mean percentage of phagocytosis after exposure to diode laser of wave length (632) nm (red), which was further increased by increasing the time of exposure. Conclusion: The current study suggests that low level of laser can increase the phagocytic activity of polymorphoneutrophils, and this increase propotional to increaseing the time of exposure.

Background: Fenugreek seeds are used as food ingredient in traditional medicines; also aspirin is an incredible chemical with many useful benefits in the medical field. The objective was to study the effect of aspirin and fenugreek on testes of mice.
Method: 20 white male mice weighing (18-23gm) were divided into four groups 5 each. Group 1, represented control, group 2, mice treated with fenugreek seed (100mg/KgB.W), group 3 mice treated with aspirin (10mg/Kg B.W), group 4 mice treated with aspirin and fenugreek seed for 21 days. Body weight and testes weights were recorded. Histopathological examination of testes was carried out. Results: a significant decrease (P<0.05) in body weight of mice treated with aspirin when compared to the other groups. A significant decrease (P<0.001) in testicular weight of mice treated with aspirin as compared to control and other groups was noted. Structural changes in testes have shown that: aspirin administration caused a decrease in seminiferous tubules diameter associated with increase in connective tissue between them and basement membrane thickness of seminiferous tubules. While fenugreek seed reverse these changes.Conclusion: fenugreek seeds exhibited antioxidant property that could ameliorate the alternations induced in mice treated with aspirin. Further studies are needed to be done on mammals to support our findings.

Background: Chronic gastritis (CG) is histopathological entity characterized by chronic inflammation of the stomach that mostly caused by Helicobacter pylori, development of inflammation in gastric mucosa result in release of pro- and anti- inflammatory cytokines .This study aimed to shed light on the role of cytokines (IFN-γ, IL-8, IL-4, IL-10, and GM-CSF) in the development and prognosis of CG among Iraqi patients.
Patients and methods: 100 Iraqi patients with CG (61 male and 39 female) with age range (10-79) year, were involved in this stady while attending Specialist Hospital of Disease of Liver and Gastrointestinal System at Baghdad Medical City from Nov. 2007 to Apr. 2008. Patients divided according to histological diagnosis into three groups : 66 with active CG, 21 with Superficial CG and 13 with Inactive CG . All Patients were investigated for infection with H. pylori by histological examination and for quantitative estimation of serum anti H. pylori (IgG) by Enzyme Linked Immunosorbent Assay (ELISA), and Amplified Sensitivity Immuno Assay (EASIA) technique to measure the level of cytokines (IFN-γ, IL-8, IL-4, IL-10, and GM-CSF) for both patients and healthy control groups.
Results: Incidence of H. pylori is (66٪) among all patients, highly significant increased (p<0.01) in serum level of anti H. pylori in patient groups: Active CG, Superficial CG and Inactive CG respectively and significant increased (p<0.01) trend of IFN-γ, IL-8, IL-4, IL-10, and GM-CSF in all patient groups as compared with healthy control.
Conclusions: High frequency of H. pylori in patient reflect the important role of H. pylori in etiopathogenesis of CG. Increased serum level of cytokines (IFN-γ, IL-8, IL-4, IL-10, and GM-CSF) propaply play crucial role in driving inflammatory process and promoting gastric mucosa destruction in CG, regulation of these cytokines is consider as an important therapeutic goal.
Key words: Chronic gastritis, IFN-γ, IL-8, IL-4, IL-10, GM-CSF.

Background: Green tea Camellia sinensis is non fermented tea. The tea is an infusion of flavorful leaves that has been consumed for centuries as a beverage and is valued for its medicinal properties. Over the last few decades green tea has been subjected to many scientific and medical studies to determine the extent of its long-purported health benefits, with some evidence suggesting regular green tea drinkers may have lower chances of heart disease and developing certain types of cancer. Green tea has also been claimed useful for weight loss management.
Methods: Three doses of the hot water extract were used (19.2, 38.4 and 57.6 mg/kg) to investigate micronucleus formation and phagocytic index. Mice were divided into two groups. Group one; control and group two; mice were administered with three doses of the green tea extract orally as a single dose (0.1 ml) per day for 7 days. Then the mice were sacrificed in day 8 for immunological and cytogenetic assessments.
Results: Results revealed that the first and third doses of green tea hot water extract were significantly effective in enhancing the values of phagocytic index and reducing micronucleus formation.
Conclusions: Hot water may be a good solvent to extract active component from Camellia sinensis especially catechin, polyphenols, polysaccharides, flavonoids and vitamins. The high dose of hot water extracts of Camellia sinensis showed an excellent enhancing effects on the function of immune system of mice, moreover, reduction in micronucleus formation was recorded at such dose.
Key words: Green tea, Cytogenetic, Immunological effect

Background: Acrylic resin dentures are susceptible to fracture; it is unresolved problem in prosthodontics. The repair procedure should be simple, strong, and accurate. This study evaluated the transverse and impact strength of autopolymerizing acrylic resin, the repair material was modified with kraft lignin as a new enforcement material and compared with the commercially available self cured acrylic resin.
Materials and Methods: The addition of kraft lignin to the acrylic resin were done in percentages of 0.25%, 0.5%, 0.75%, 1.0%, 1.25%, and 1.5% (wt%). Seventy specimens were made according to the ADA specification No 12 for transverse strength using three point bending test and Impact strength test was conducted following the procedure given by the ISO 179 with Charpy Type Impact testing instrument.
Results: Mean transverse strength of experimental specimens where increased only in 0.25wt% addition of lignin (61.3400 Mpa) then results tend to decrease, and no statistical differences found between the control and any one of the modified groups. The impact strength increased more than the control in the groups 0.25, 0.50, 0.75,and 1.0wt%,13.9700, 15.5900, 35.2100, 33.6900 Kj/m2 respectively, then has been decreased at 1.50wt% until reach value of the control (9.2525 Kj/m2).Highly significant difference was found at 0.5, 0.75 and 1.0wt% (p<0.05).
Conclusions: The autopolymerizing acrylic resin exhibited significantly higher impact strength as a result of addition the biopolymer lignin. The transverse strength of the modified specimens was decreased after increasing the weight percent addition of lignin.
Key words: Autopolymerizing acrylic resin, KL (kraft lignin), transverse strength, impact strength

Background:The diabetogenic agent alloxan is a selective necrosis of insulin producing cells .Alloxan accumulated rapidly in liver and pancreatic islets , this study was carried out to evaluate the antidiabetic effect of cinnamon oil on the destructive effect of alloxan in liver and intestine diabetic tissues .
Materials and methods:Thirty male rats were used and divided into threegroups: Group I =10 animal controls, Group II =10 treated with alloxan, Group III = 10 treated with alloxan + cinnamon oil .
Results:Liver and intestine tissues of diabetic groups revealed necrotic, degeneration of cells (histologically ) , increase in blood serum enzymes for acid and alkaline phosphatase , total protein ,cholesterol and triglycerides ( biochemically) , and increase in the activity of acid and alkaline phosphatase in liver and intestine tissues ( histochemically ). While diabetic group treated with cinnamon oil revealed decrease in all these parameters.
Conclusions: Oral administration of cinnamon oil produce significant hypoglycemic effect restores liver function and normalize the histological, histochemical and biochemical abnormalities caused by diabetes in alloxan induced diabetic rats, this may be due to antioxidant effect of this herb.
Keywords: liver, intestine, Diabetes mellitus, Cinnamon oil,Acid phosphatase, Alkaline phosphatase

Background and objectives: P53 gene mutation and deletion are among the important molecular markers linked to lung cancer. In most cases, the inactivating mutations affecting both p53 alleles are acquired in somatic cells. Less commonly, the mutations are inherited ones. The aim of the present study was to analyze the frequency of having a wild and/or a mutated p53 gene in lung cancer compared to benign lung lesions and to relate these findings to different morphological types and grades of lung cancer.
Patients, materials and methods: In this retrospective study, the histopathology blocks of 30 lung cancer cases covering the period from2002 to 2007were obtained from the archives of the histopathology section of the Special Surgeries Hospital Laboratories. Twenty cases of non-malignant lung diseases served as a control group. Sections made on charged slides were subjected to p53 mRNA in-situ hybridization and p53 protein immunohistochemical staining.
Results: Positive p53 in situ hybridization signal was detected in 29 cases of carcinoma. The highest percentage score was score- 3 being detected in 16(53.3%) cases. High intensity of hybridization signal was seen in 17(56.7%) cases. All control cases revealed positive hybridization signals (100%). Seven cases revealed score-3 and of these 5 revealed high intensity of hybridization. Immunohistochemical expression of p53 protein was seen in 21(70%) cases of carcinoma with score-3 being found in 11(36.7%) cases, 7cases revealed score-3 in situ hybridization signals as well. High intensity was found in 11(36.7%) cases, 10 of them showed high intensity of hybridization signal. Only two control cases (10%) revealed positive p53 expression. They showed score-2 and low intensity of expression. Significant statistical correlations were found between in situ hybridization signaling and immunohistochemical expression scores and intensities in carcinoma cases with p value < 0.05.
Conclusion: The relations of tumor grade to the score and intensity of ISH signaling and IHC expression were significant suggesting the importance of having higher scores and intensities of positive cells which is an indication of tumor progression and prognosis. Studying p53 gene integrity or expression of a mutated protein is important for predicting tumor prognosis and establishing a proper therapeutic approach.