Journal of the Faculty of Medicine Baghdad

Background: The morbidity and mortality of congenital diaphragmatic hernia is related to the severity of lung hypoplasia ,pulmonary hypertension and associated anomalies.
Patients and methods: fifty nine consecutive patients with surgically proved diaphragmatic hernia (excluding hiatal hernia) were included in this prospective study. All patients were seen at Al-Kadhymia hospital for children and Al-Mustansyria hospital, in the period from January 2003 to December 2009.Plain chest x-ray was done for all the patients understudy,but barium study was arranged for only nine patients.
Results: There were fifty nine child with congenital diaphragmatic hernia ,Bochdalek hernia forms 81.4% of all congenital diaphragmatic hernia, the peak incidence at presentation was in the neonatal period (80,2%) of patients. The chest roentgenographic appearance was diagnostic in 87.5% of the patients with Bochdalek while Morgagni hernia in 62.5% of patients was diagnostic. Morgagni hernia constitutes 13.6% of the congenital variety, commonly to the right side (87.5% of patients ).The incidence of presentation beyond the neonatal period was 50% of cases . Absence of hemidiaphragm was found in 5% of the congenital variety , the chest x-ray was diagnostic in all patients.
Conclusion: The chest roentgenograph (frontal view) is a very helpful diagnostic tool for the diaphragmatic hernia with a high diagnostic accuracy (73.7%).

Background: Cholecystectomy in cirrhotic patients is commonly followed by high morbidity and mortality, the incidence of hepatic cirrhosis has increased since last decade as well as the occurrence of complication such as liver failure, portal hypertension, and biliary disorders.Patients and methods: laparoscopic Cholecystectomy was performed in 24 cirrhotic patients (18 child A and 6 child B) in an effort to obtain lower complications and mortality rates. The mean age of the group was 51.8 years, ten of the 24 patients were men and 14 female.Results: intraoperative complications such as bleeding, dense adhesion and long operative time were recorded.Conclusion: laparoscopic Cholecystectomy was safe and will tolerated by selected cirrhotic patients (child A and B) with clear indication for surgery.

Background:Assessment of fracture healing is a common problem in orthopedic practice and research. Computerized Tomography (CT) isa reliable tool for quantification of the fracture repair process in experimental animals. Histomorphometric evaluation providesa clear quantitative evidence of the bone healing process. The evaluation by micro-architectures in healing bone showed variable correlation between CT and histomorphometry.
Material and methods: open ulnar osteotomy induced in twentyyoung male rabbits under general anesthesia without internal fixation, and divided into five groups. Agroup of animals were sacrificed at end of 2nd week, 3rd week, 4th week, 5th week, and 6th week. The right ulna isolatedand the bone specimens taken for radiological examination, CT scan densimetry and histomorphometricevaluation carried out for the callus at the site of osteotomy for all animals in both group.
Results: The mean of histomorphometric evaluation of callus at the site of ulnar osteotomy at the end of second week were 2.9, and increased with duration to reach 9.3 at end of sixth week. The mean of CT densimetry of callus in site ulnar osteotomy at the end of second week were 96.2, and increased with duration to reach 723.3 at end of sixth week. The correlation coefficient between histomorphometric evaluations of callus in site ulnar osteotomy and value of CT densimetry measurements was 0.958, which considered very highly significant,(the Pvalue < 0.0001).Conclusion: The present study demonstrate that, there is strong correlation between CT scan bone densimetry of callus in site of osteotomy and the results of histomorphometric evaluation of callus. The CT scan bone densimetry of callus can be used to assess the bone healing in experimental and clinical studies, as it is noninvasive technique.

Background: Acute myocardial infarction (AMI) is an irreversible myocardial injury and necrosis caused by serious and long term ischemia. Fibrinogen is considered as
one of the probable risk factors of myocardial infarction.
Patients and methods: 1.8-mL venous blood specimen from 40 patients with MI and 50 control subjects was obtained and put it into tubes containing 0.2 mol/L trisodium citrate. Plasma fibrinogen level was determined by the method of Clauss (Diagnostic Stago, France). Results The mean age of patients was (45.2 ± 6) years in patients with premature myocardial infarction and (45.06±5) years in the control group (p =0.07). There were no statistically significant relationships between the two groups in history of premature myocardial infarction in their first-degree relatives (p =0.05), cigarette smoking (p =0.06), diabetes (p =0.08), or hypertension (p =0.071). The mean plasma fibrinogen in patients (495 ±10.2mg/dL) was elevated markedly compared with the control group (465±8.4 mg/dl) ( p =0.01) . Hyperfibrinogenemia (>450 mg/dL) was detected in 87.5% of patients and 52.0% of controls. Conclusion: This study introduced fibrinogen as a risk factor for premature coronary artery disease in Iraqi men

Background: Neonatal jaundice (NJ) is a common problem worldwide and frequent in Iraq . Several reports were published on prevalence, distribution, causes and treatment of NJ.This clinical trial was carried out to demonstrate the effect of combinations of Castrol oil, riboflavin and magnesium in mechanical elimination of bilirubin after enhancing hepatic excretion by phototherapy.Patients & methods: This clinical trial included a total of 61 significantly jaundiced neonates who were admitted to the special care baby unit of Children Welfare Teaching Hospital, medical city complex, Baghdad, Iraq, during the period June 1st to Dec.31st 2007. Phototherapy was applied alone in 30 neonates (group 1) and phototherapy with Bilinorm in 31 neonates (group 2),(Bilinorm oral gel constituted of riboflavin sodium phosphate, magnesium oxide and castor oil). Student’s t test was used to examine the differences in variables between the two groups.
Results: There were no significant differences between the two groups in body weight, age of onset of jaundice, age on admission, and TSB on admission (p =0.9,0.4, 0.4, 0.4, respectively). A significant difference in total decrease in TSB was noticed between group II (7.2 ± 2.4) and group I (5.9 ± 1.8)(p = 0.02). Days of hospitalization were significantly lower in group II (2.4 ± 0.8 days) than in group I (3.3 ± 1.5 days) (p = 0.009), and hours of phototherapy were significantly lower in group II (47.4 ± 19.7 hours) than in group I (66.8 ± 27.4 hours) (p= 0.002).
Conclusions: There was a statistically significant difference regarding total decrease in TSB, days of hospitalization and hours of phototherapy when both Bilinorm and phototherapy were used than when phototherapy was used alone. So mechanical elimination of bilirubin from intestinal lumen may enhance the effect of phototherapy.

Background: Sildenafil is a drug that is used to treat erectile dysfunctions, it acts by inhibiting CGMP specific phosphodiesterase type 5, an enzyme that regulates blood flow in the penis.The most common adverse effects of sildenafil are headache, dyspepsia, nasal congestion and impaired vision which includesphotophobia and blurred vision. Many dermatological side effects are present like flushing, urticaria, sweating and many others.
Patients and Methods: Fifty six males were included in this study, with ages between 37 – 60 years and a mean age of50.1 ± 7.1years. The study was conducted from November 2004 till May 2009 in the Department of Dermatology of Al-KadhymiaTeaching Hospital in Baghdad; all patients experienced dermatological side effects every time they use the drug. Full history and full examination including dermatological examination were done for all patients.
Results:The commonest dermatological side effect was flushing of the face which was seen in 44 (78.6%) patients followed by hyperhydrosis which was seen in 14 (25%) patients then urticaria which was seen in 12 (21.4%) patients.It is seemed that side effects were more with 100mg dose than with 50mg dose (78 side effect against 22 one) and this result was statistically significant Conclusion: Dermatological side effects of sildenafil are fairly common and dermatologist must be aware of these side effects especially when he searches for the cause of angioedema, urticaria, pruritis as well as erythroderma

Background: Hormones have very important role in spermatogenesis and production capacity of testis. Disturbances in their vlevels can be very crucial in dysfunction of testis which results in men infertility. This study carried out to evaluate the hormonal disturbances in men infertility and its correlation with semen parameters and types of infertility.
Patients and Methods: Blood and semen samples were collected from 91 infertile men and 20 healthy and fertile control who attended Al-Kadymiah hospital and some private clinics in Baghdad from January to December 2009.Semen and serum samples were analysed for semen parameter and FSH, LH, Testosterone and prolactin levels.
Results: Fifty one (56%) of infertile men were found with azoospermia, 22(24%) were with mildoligospermia and 18(20%) were with severoligospermia.Semen analysis of infertile men showed very low quality parameters with a non homogenized hormonal results.Elevation of FSH and LH with low level of testosterone were detected in azoospermic and Severoligospermic groups, while elevation of FSH with hyperprolactinaemia were detected in mildoligospermia.
Conclusion: FSH and LH elevated levels were found to have a major role in azoospermia and severoligospermia, while prolactine and FSH elevations were correlated with mildoligospermia. Also these hormonal disturbances were found to associate with the quality of the semen where the low semen quality parameters detected in those with FSH, LH elevation and low level of testosterone. We concluded that hormonal disturbances can be considered as a reliable indicator to distinguish between non obstructive (over levels of FSH, LH and decrease level of testosterone) and obstructive (over levels of FSH,prolactin) types of infertility which is very important in therapy.
Keywords: FSH, LH, Testosterone, Prolactine, Azoospermia, Oligospermia

Background: Bcaterial vaginosis is an important gynecological problem, during reproductive age group with high relapse rate ,it is associated with high vaginal PH, vaginal vitamin C recently tried to decreased vaginal PH and treat bacterial vaginosis.
Patients & Methods: One hundred and one women with Bacterial vaginosis their age range from 18-40 years enrolled in this study, the Diagnosis is confirmed by at least 3out of 4 of (Amsel criteria) which include a thin homogenous vaginal discharge, vaginal PH of ≥4.7, a characteristic ''amine odour'' release when alkali (lo% KOH) is added to a specimen of vaginal fluid, and at least 20% of epithelial cells having the appearance of clue cell in a wet mount of vaginal fluid or on gram stain . All women were randomly assigned to receive either 250mg vitamin C vaginal table at bed time for 6days (51patients) or oral metronidazole 500mg twice daily for 7days (50 patients) the patients were evaluated at two follow up visit 1st after treatment completed and 2nd one week later. Therapeutic success was defined as the presence of less than 3 Amsel criteria.
Results: Regarding the infection with bacterial vaginosis no significant difference between two groups, (15.9%) of patients still infected with bacterial vaginosis at 1st follow up visit in (vagi-C) treated group. Compare to 26.7% of metronidazole group P=0.5, this confirmed at 2nd follow up visit P=0.1. Regarding vaginal PH there is significant reduction of vaginal PH in both groups at end of treatment P=0.0032 in Vagi-C, and P=0.0001 in metronidazole treated group.
Conclusion: Vitamin C vaginal table 250mg has effective as oral metronidazole for treatment of bacterial vaginosis.
Key Words: vaginal vitamin C, bacterial vaginosis.

Background: genital herpes simplex virus infection in pregnancy poses a major risk to the fetus and it has been associated with bad obstetric out come causing preterm labor, intrauterine growth retardation and spontaneous abortion. This study was conducted to determine if premature rupture of membranes before 37 weeks of gestational age are observed with subclinical shedding of herpes simplex virus (HSV).Patients and methods: Cervical swabs were taken from 75 women with a history of preterm premature rupture of membranes before 37 weeks of gestation, and 20 women with normal obstetrical history for the presence of HSV antigen using Enzyme linked Immuno Sorbent Assay (ELISA) method.
Results: HSV antigen was detected in 37 swabs(49.3%) which revealed a significant association with preterm premature rupture membranes(PPROM) compared to control group(P<0.05).The majority of HSV infected women were asymptomatic 34(91.9%), and 23(56.1%) of the cases was associated with history of recurrent PPROM, compared to those women with history of single PPROM.Conclusion: The risk of maternal transmission of HSV to the fetus or newborn is a major health concern and the high rates of undiagnosed or asymptomatic HSV infections complicate the issue of prevention. With advent of serologic test that can reliably detect the virus in asymptomatic patient. Maternal HSV screening now is mandatory.

Background: The problem of excessive alcohol consumption is a major cause of public health concern in most countries of the world today. Royal Colleges of Physicians and Psychiatrists recommended that every inpatient should be screened with a questionnaire for alcohol related problems. Therefore, this work was carried out to report on alcoholism in the emergency unit in two general hospitals in Baghdad, Iraq.
Methods: The study was carried out in Al-Sader general hospital (Al-Sader city, Baghdad) and Baghdad teaching hospital (Baghdad) for the period 1st July 2008 to 1st May 2009. Data collection was two days per week. Version of 25 items Michigan Alcoholism Screening Test (MAST) and semi-structured schedule based on Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for alcohol dependence were used. Males aged 16 – 70 years attended emergency units were included in the study.
Results: There were 11% had alcoholism. Alcoholism was significantly associated with age > 40 years, married, low educated and employed (p= 0.02, 0.002, 0.03, respectively). Alcohol dependence was significantly associated with younger age (< 40 years), single, low educated, early onset of drinking (< 30 years) and positive family history of alcoholism (p=0.006, 0.004, 0.004, 0.004, 0.005, respectively). Sensitivity and positivity of MAST were 86.7% and 60.7%, respectively.Conclusion:

Background: Breast cancer is the most common malignant tumor in women worldwide. In Iraq, there is a tendency for this disease to be diagnosed in younger ages, at advanced stages with a prevalence of more aggressive tumor behavior.Patients and Methods: The study included a total of 216 women with breast lumps and proven breast cancer who visited the Main Referral Training Center for Early Detection of Breast Tumors in the Medical City Teaching Hospital in Baghdad (85 patients) and the Specialized Clinics belonging to the major hospitals of Hilla (62 patients) and Karbala (69 patients) complaining of apparent breast lumps.
Results: 31% of patients was in the age category (40-49 years), 38.4% of patients whose highest education within the primary school level, 36.4% of patients had history of lactation, 52.3% of total had started menstruation at the age (10-12 years), 85% of patients had negative history of oral contraceptive pills consumption, Ki-67 tumor marker was demonstrated in 62.5% of total with highest frequency of expression was displayed in Baghdad and in relation with grade II.
Conclusion: Significant differences among the three Iraqi governorates were noted with respect to patient’s age, educational status, history of breast feeding, age at menarche and history of oral contraceptive pills consumption. Higher Ki-67 nuclear expressions were demonstrated among patients from Baghdad. There was a direct significant relationship between Ki-67 nuclear expression and the nuclear staining intensity with tumor grades.

Background:Prognostic histological evaluation of many cancers have recently concentrated on angiogenesis.
Materials &Methods: A total of twenty formaline-fixed, paraffin embedded blocks of renal cell carcinoma were included in this study. Sections weresubjected for immunohistochemical staining of CD34. The median of the MVD of all cases of RCC were obtained to divide the cases into high- and low-MVD score groups and were correlated with the tumor stage and grade. Results: there was a significant correlation of the high MVD score with tumor stage (P=0.02).

Background: Sildenafil, a selective phosphodiesterase -5 (PDE-5) inhibitor increases cyclic guanosine monophosphate (cGMP) and amplifies many biological actions of nitric oxide (NO) which is an important mediator of gastric mucosal defense ; was evaluated in this study using different doses for its cytoprotective effect on gastric mucosal damage induced by indomethacin . We also evaluated the effect of this drug on NO production, Prostaglandin E2 (PGE2) synthesis, Myeloperoxidase (MPO) activity, and Interlukin-4 (IL-4) expression.
Methods: The study was performed between April and July 2008 in the Department of Pharmacology / College of Medicine /Baghdad University .It was conducted on 80 adult male albino rats, divided into 8 groups, the first served as a control received the vehicle, the second received indomethacin orally of 60mg/kg .The third and fourth groups were pretreated 30 minutes prior indomethacin with oral sildenafil 10 and 20mg/kg respectively. The other groups were pretreated 30 minutes prior to sildenafil (10and20mg/kg) with intraperitoneal NG-L-Arginine Methyl Ester (L-NAME) 20mg/kg with or without L-Arginine. The rats were then sacrificed after 4 hours and their stomachs were isolated and submitted to macroscopical assessment and for the measurement of the gastric PGE2, MPO, and IL-4.
Results: Sildenafil (10 and 20 mg/kg) pretreatment resulted in a significant (p<0.01) decrease in the gastric damage score. The MPO activity was significantly (p<0.01) decreased, while the level of IL-4 was significantly (p<0.01) increased. On the other hand PGE2 level was not changed. L-NAME given 30 min before 10 and 20 mg/kg sildenafil, significantly (p<0.01) abolished the protective effects of sildenafil and also reversed the effects of sildenafil on MPO activity and IL-4 levels. On the other hand addition of L-Arginine resulted in the restoration of the protective effects of sildenafil which was also reflected on the gastric damage score, MPO activity and IL-4 levels. Conclusions: The results demonstrate that the injurious effect of indomethacin can be reduced or ameliorated by sildenafil pretreatment, and that the protective effect of sildenafil against indomethacin was through an NO dependent pathway.

Background: End stage renal disease in patients with diabetes mellitus has been called a medical catastrophe of worldwide dimensions .It was recognized that anemia is a complication of diabetes, particularly in patients with diabetic kidney diseases. The purpose of the present study is to determine whether erythropoietin, adiponectin, and leptin levels correlate with anemia in uremic diabetic patients (under hemodialysis).
Patients and Methods: The studied groups were comprised of (30) diabetic patients(9 patients with type1 and 21 type2 diabetes) with renal failure (group2) who had been under hemodialysis compared with (30) healthy controls (group1). Blood film was obtained in addition to blood tests include fasting serum glucose (FSG), glycosylated hemoglobin (A1c), insulin, urea, creatinine, uric acid, estimated glomerular filtration rate (eGFR), serum erythropoietin (EPO), Adiponectin (ADPN),and leptin.Results: It was found that uremic diabetic patients in group2(G2) had higher FSG, A1c, insulin and higher levels of urea, creatinine, uric acid and lower levels of eGFR when compared to healthy controls (P <0.05). Anemia was confirmed in the diabetic patients by Hemoglobin (Hb) and hematocrit (Hct) that were lower than healthy control (group1) (G1) (P<0.05).EPO, ADPN levels were increased in uremic diabetic patients as compared to control subjects (P <0.05). While, leptin levels were higher in type2 diabetes when compared to type1 diabetes and control subjects (group1) (P <0.05). There were positive significant correlations between (FSG and A1c), (Hb and Hct), (EPO and leptin), (EPO and Hct), (ADPN and urea). In addition there were significant negative correlations between (FSG and EPO), (A1c and leptin), (ADPN and leptin).Creatinine was negatively associated with Hb and Hct. ADPN was negatively associated with Hb in uremic diabetics.Conclusions: Anemia is a common accompaniment to diabetes, particularly in those with renal failure or under hemodialysis .Adipocytokines like leptin and adiponectin may involved with anemia in these patients. Leptin in the present study was positively associated with EPO levels (the hormone that stimulates red blood cells production in the bone marrow). ADPN was negatively associated with Hb. These elevated levels of ADPN may antagonize EPO and leptin to increase the hemopoiesis rate and Hb levels in uremic diabetic patients in addition to other factors involved with diabetes.

Background: Multifunctional cytokines play important and only partially defined roles in mammary tumor development and progression. Normal human mammary epithelial cells constitutively produce interleukin 6(IL-6) and a non-secreted form of tumor necrosis factor. Transformation of mammary epithelial cells by different oncogenesis is frequently associated with alterations of cytokine/ growth factor production and responsiveness.
Methods: We measured levels of 1L-6 in 84 females with breast cancer and examined their correlation with clinicopathological variables including stages of the disease and estrogen and progesterone receptor expression on tumor cell.
Results: Our results revealed significantly higher serum IL-6 in breast cancer patients (12.98 pg/ml) compared to a healthy group (2.05pg/ml) (P<0.05) and a direct association with different clinical stages. And we found that expression of this cytokine was inversely associated with estrogen and progesterone receptor cells.
Conclusion: Serum levels of IL-6 are highly elevated in breast cancer patients and correlate with tumor progression. Assay for serum levels IL-6 can be used as predictive non-invasive tests for tumor progression in breast cancer patients; also our data suggest that cytokine could be involved in the aggressiveness of ER-PR negative breast tumors. Expression of interleukin 6(IL-6) correlates with estrogen and progesterone receptor in breast cancer patients.
Keyword: Interleukin 6, breast cancer, estrogen-progesterone receptor

Background: Neonatal septicemia (NNS) is the most serious complication in Neonatal Intensive Care Units (NICU) that demand urgent diagnosis and accurate treatment.
Methods: Serum was obtained from 31 neonates aged 1 hour-28 days that were diagnosed clinically and bacteriologically to have neonatal septicemia.
Results: Mean serum levels of both IL-8 and IL-1 recorded a significant increase in neonatal septicemia cases.
Conclusion: Usage of IL-8, IL-1 as diagnostic marker for NNS reduces unnecessary antibiotic therapy and therefore unnecessary costs, pain, and possible side effects of antibiotic therapy and it may help to reduce development and spread of drug resistant bacteria.
Keywords: Neonatal septicemia (NNS), Interleukines (ILs).

Background: Uncontrolled tumor cell proliferation is a reality in tumor cells, and the progression from a normal cell into a transformed cell probably includes genetic events affecting checkpoints in the cell cycle machinery.
Materials and methods: This study investigated the immunoexpression of p16INK4a in the paraffin sections from 43-cancers of colorectal tissue (CRC),26-hyperplastic polyps and adenomas(CRHPA) and 35-normal tissues (CRN),using immunohistochemical assay. We correlated the expression patterns with tumor histopathological type, site of the tumor, distance metastasis according to the TNM system.
Results: In colorectal cancer (CRC) patients’ p16INK4a,immunoexpression was detected in 32/43, there was significant association for p16INK4a, which showed high reaction with monoclonal antibodies in the distal colon and rectal area with P value < 0.001. There was no significant correlation between tissue invasion stage and p16INK4a. There was no significant difference in the immunoexpression of p16INK4a in relation to the two groups of patients with the stage of the disease.
Conclusion: p16INK4a, expression have high level in CRHPA than in CRN tissue. Also, their expression in CRC is more than in CRN tissue. In addition, p16INK4a immunoexpression in CRC was significantly more than in CRHPA.
Keywords: colon cancer, p16INK4a, immunohistochemical assay, cell cycle checkpoints

Background: Diabetic retinopathy is an important complication of diabetes mellitus. It is supposed that elevated sialic acid in diabetes mellitus plays an important role in diabetic retinopathy. This study investigated serum total sialic acid levels related to glycemic control, blood pressure, retinopathy, and serum lipid level in diabetic retinopathy patients.
Patients & Methods: Type 2 diabetic patients aged (56.47±10.68) years were recruited for the study. Fasting venous blood samples were collected from 132 diabetic subjects of whom 79 without retinopathy and 53 were diabetic with retinopathy. All the blood samples were processed for serum total sialic acid (TSA), fasting serum glucose (FSG), HbA1c, and lipid profile. Systolic and diastolic blood pressure was recorded by standard mercury sphygmomanometer.
Results: Serum (TSA), FSG, HbA1c, triglycerides (TG), and LDL-cholesterol were increased significantly (P<0.01 for TSA, FSG, HbA1c; P<0.05 for TG, and LDL) in patients with diabetic retinopathy (DR) compared to diabetics without retinopathy. Duration of diabetes and blood pressure were also significantly higher in DR patient compared to those without retinopathy. Correlation analysis showed a significant positive correlation between serum TSA and several risk factors of diabetic retinopathy: diabetic duration, FSG, HbA1c, systolic blood pressure SBP, diastolic blood pressure DBP, and LDL in diabetic patients with retinopathy.
Conclusion: It is concluded that elevated serum total sialic acid level is strongly associated with the presence of diabetic retinopathy, a microvascular complication of diabetes. Increasing concentration of sialic acid is clinically correlated with several risk factors of diabetic retinopathy including glycemic control (blood sugar and HbA1c), hypertension, and duration of diabetes, triglycerides, and LDL. These findings strengthen the hypothesis that the increase in serum sialic acid is early manifestation of diabetic retinal disease.
Keywords: Type 2 diabetes, sialic acid, diabetic retinopathy, risk factors

Background: Apoptosis is a physiological type of cell death; it is active, well-controlled genetic program of cell death that does not produce inflammatory process. It is involved in cell turnover in healthy adult tissues and it is responsible for focal elimination of unwanted cells during normal embryonic development, organ homeostasis, immune regulation and defense without causing stress to the neighboring cells.
Method: This study was carried on 30 Grave's disease female patients with a mean age of (29.8 ± 8.3) years. The study parameters were considered as: before and after treatment; patient becomes clinically and biochemically euthyroid after 4-6 weeks of starting treatment with antithyroid drug (carbimazole).From each patient 7 mL of blood were aspirated (2ml for detection of peripheral blood lymphocyte apoptosis 5ml for T3,T4andTSH).For each patient fine needle aspirate (FNA) from thyroid tissue to study the histopathological changes by Hematoxylene and eosin stain, and lymphocyte apoptosis by DNA binding dye Acridine orange.
Results: The percentage of peripheral blood lymphocytes apoptosis increased significantly after treatment (23.9 ± 5.06) than its percentage before treatment (11.1 ± 1.8) with P value < 0.00001, as detected by DNA-binding fluorescent stain (acridine orange). There was a significant increase of intrathyroidal lymphocytes apoptosis (21.7±4.2) and (34.7±5.6) before and after treatment respectively with a P value < 0.0001, detected by acredine orange and hematoxylin and eosin stains. T3, T4 and thyroid autoantibody levels decreased significantly, while TSH level increase significantly after treatment.
Conclusion: Grave's disease is associated with increased rate of apoptosis in both peripheral blood lymphocytes and intrathyroidal lymphocytes. After treatment with carbimazole there was significant Increase in peripheral blood lymphocytes and intrathyroidal lymphocytes apoptosis, this lead to significant decrease in the autoimmune reaction assessed by decrease in the anti thyroglobulin antibodies in serum.
Keywords: lymphocyte apoptosis, acredine orange, Grave's disease.

Background: pulmonary function can change with age for normal individual's .Spirometric measurement for the ratio of forced expiratory volume in one second (FEV1), the forced vital capacity and the ratio (FEV1/FVC) can reveal airway obstruction and the consequence change in pulmonary performance. These parameters can be different for different race /ethnic and gender.
Methods: Pulmonary function test were carried out on 29normal male and 37 normal female the test parameters were FEV1 and FVC from which the ratio of FEV1/FVC %was calculated in relation to age. Iraqi average for FEV1 and FVC and FEV1/FVC % has also been obtained
Results: results of these tests reveled that the ratio of FEV1/FVC % is almost the same for individual's ages between 20-60 and a significant depression in the value of the ratio FEV1/FVC % for ages > 60 years.
Conclusion: the effect may be linked with some changes in the airways in addition to the increased weakness in the muscles in the old age people.
Keyword: spirometry, FEV1, FVC, FEV1/FVC and non-smokers healthy subjects

Summary:-Background: The electrocardiographic QT interval has been extensively studied in diabetes mellitus. Recently, there has been increasing interest in the relationship between diabetes and QT abnormalities .The QT interval, which is easily obtained from a standard resting electrocardiogram( ECG), reflected the total duration of ventricular myocardial depolarization and repolarization. The heart rate corrected QT interval (QTc) by Bazett's formula on the electrocardiogram has been proposed as a risk factor for ventricular arrhythmias in diabetes mellitus. Dispersion of QT(QTd) is defined as the difference between maximum and minimum QT interval QT interval on 12 lead ECG, which reflected spatial ventricular repolarization in homogeneity ,has been report to increase in diabetic subjects compare with non diabetic subjects. Patients and Methods: Type 2 diabetic patients (n=80) and healthy subjects (n=25) were required to have 12-lead ECG suitable for QT analysis ,QT interval was measured in each lead to found(maximum, minimum, and mean ).QT interval vary according to the heart rate, it can be corrected using Bazett's formula to give QTc interval, and to found (maximum, minimum, and mean).Dispersion of QT interval(QTd) was calculate using the difference between the maximum and minimum QT interval duration as same as for dispersion of corrected QT interval(QTcd). Result: There were significant difference in QT interval indices between type 2 diabetic and healthy subjects (P<0.05) as well as the correct QT interval indices. ROC curve analysis of QT and QTc interval duration parameters demonstrated that no QT parameters performs better than maximum and minimum of QT and QTc, areas under ROC curve were(0.69 and 0.66 P<0.001)for maximum and mean QT respectively and (0.80 and 0.75 P<0.001) for maximum and mean QTc respectively. From this result we can say that QTc parameters better than QT parameters in context of patients and control differences. In multiple linear regression models, maximum, mean, and dispersion of QT interval were significantly affect by diabetes mellitus after adjustment for age, gender, body mass index (BMI), and heart rate. Whereas, only maximum and mean QTc were significantly affected by diabetes mellitus after adjustment for age, gender, and BMI. Prolongation of QT interval (QTc and QTd) also seen in a diabetic subjects which significant different as compare to the healthy subjects. Conclusion: The result of this study indicate that corrected QT interval (maximum and mean)in a routine ECG is a useful marker to identify the QT abnormalities differentiating diabetes type 2 from healthy subjects.

Background: there are different procedures for the diagnosis of females suspected with toxoplasmosis. However, time, cost, and accuracy of the test should meet patient’s needs.Material and methods: one hundred and eleven female with suspected toxoplasmosis were under go three different procedures for the diagnosis of Toxoplasma gondii infection. Latex agglutination test, rapid chromatographic (immunoblot) and ELISA test were done for all patients. The results were described as frequency and percentage of positivity; also, specificity and sensitivity of immunoblot were assessed according to the result of other tests.Results: The Latex test has shown 80% and 61.54% sensitivity and specificity respectively with IgG measured by ELISA while it has shown 100% sensitivity and specificity with IgM measured by ELISA. IgM immunoblot give a relatively higher sensitivity and specificity (95% and 98.89%) respectively than IgG immunoblot (88% and 89.29%) made with IgM and IgG ELISA respectively. Conclusion: Rapid chromatographic test considered as a good test for detection of IgG and IgM anti Toxoplasma gondii antibodies in both acute and chronic Toxoplasmosis.

Background: Fibromyalgia syndrome (FMS) is a very common cause of multiple regional musculoskeletal (MSK) pain and disability; it is characterized by chronic widespread for at least three months and tender points identified by the American Collage of Rheumatology (ACR).The cause of FMS is currently unknown. However, several hypotheses have been developed including genetic predisposition. This study aims to evaluate the contribution of serum lipid profile to the pathophysiology of FMS.
Patients & 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. Colorimetric method was used to determine serum lipid profile. Results were evaluated using descriptive and inferential statistics; data were expressed as (mean ± SEM). P value of <0.05 was accepted as significant.
Results: There were no significant differences among the three subject groups in serum lipid profile.Conclusion: .

Background:Probiotics are defined as living microbial food supplements that beneficially affect the host by improving its intestinal balance. In recent years there is a great interest for viable microorganisms that promote or support a beneficial balance of microbial population of gastrointestinal tract. Probiotics may be consumed in different forms, comprising foods, mainly in fermented state and pharmaceutical products, mainly as capsules or in microencapsulated forms.
Methods:Twelve albino mice were divided into four groups designated as 1, 2, 3 and 4. Each group consists of 3mice, and subject to the followings treatments: Group 1: This group was used as a control. Group 2: This group was dosed with 0.1ml. of 0.5 × 105 cfu/ml of Lactobacillus plantarumculture. Group 3: This group was dosed with 0.1ml. of 0.5 × 105 cfu/ml Salmonella typhimurium culture. Group 4: this group was dosed with 0.1ml of 109cfu/ml Lactobacillus plantarum culture, and infected with 0.1ml of 0.5 × 105cfu/ml culture of Salmonella typhimurium, then histological sections were made from intestine and examined to evaluate protective effect of Lactobacillus plantarum.
Results:Histopathological study exhibited that intestinal sections of mice infected with Salmonella typhimurium showeda necrosis, degenerative changes and inflammatory cells infiltration as compared with normal sections taken from uninfected mice, while treating with Lactobacillus plantarum prevented the histopathological effect of Salmonella typhimurium on mice intestine.Conclusion: Probiotic L. plantarumhad a protective effect on intestine sections of mice infected with Salmonella typhimurium.

Background: - Aspergillus fumigatus is a ubiquitous and opportunistic fungal pathogen causing sever invasive aspergillosis, an important source of morbidity and mortality in immunocompromised hosts (human and animals) .The present study was conducted to obtain more clarification about the toxicity and histopathological effects of this pathogen in albino mice .Material and Methods :- fourteen male mice( 6-10) weeks old ,( 20 – 28) gm weight , divided into two groups , test group ( n= 8) , intranasally infected with 25µl (710 conidia / ml normal saline ) of A. fumigatus for 7 successive days , compared with uninfected group ( n=6) . the weight of all animals were measured at the beginning and at the end of the experiment , in addition to histological study for lung , liver and kidney were performed , with estimation of enzyme activity of GOT ( Glutomic Oxaloacetic Transaminase),GPT (Glutamic Pyruvic Transaminase) , ALP (Alkaline Phosphatase ) and Creatinine Kinase in homogenized liver and kidney tissues were studied by colorimetric method .
Results :- increased ( p< 0.05) in body weight , and organs weight ( lung , liver , kidney ) in infected mice with different histological changes were found in organs tissues of infected mice especially in lung and liver , these changes were supported by variation in enzyme activities of GOT, GPT, ALP and Creatinin kinase in homogenized organs tissues
Conclusion: - normal host can suffer from systematic diseases after inhalation of infective forms of A. Fumigatus (conidia), and further work is needed to study the active components, which are responsible for pathogenesis of this opportunistic fungi.

Rupture of the trachea or main bronchus can occurs during severechest trauma and this event has been reported since more than acentury. This is a report of a 19 year old male patient sustained car accident leading to loss of consciousness due to multiple trauma ,involving specially the head and the chest that he needs assisted ventilation in an intensive care unit and later a tracheostomy .The patient regain his consciousness gradually , and a late diagnosis of traumatic rupture of the left main bronchus , which was approved by bonchoscopy and CT chest .Surgical repair of the ruptured left main bronchus was accomplished sixty days from the admission with the lung fully expanded on a post operative chest X-ray . The patient referred later to the ENT Department , thereafter a successful weaning from the tracheostomy was performed .The patient discharged well , but he was in need for regular bronchoscopic dilatation for a tracheal stricture as a complication of tracheostomy .The patient is still well during the follow up period .The report will includes a review of the literatures about thisrelatively uncommon post traumatic condition.

A case of systemic lupus erythematosus like induced by carbamazepine therapy in a 27 year old female patient with left sided trigeminal neuralgia had been recorded, 9 years from starting carbamazepine therapy. The patient condition improved clinically 3 days after withdrawal of carbamazepine , the titer of antinuclear antibodies dropped from 1/640 to 1/80 after 3 weeks, and disappear completely after 6 months follow up.

Background: Although studies regarding the role of religious beliefs in psychological well being are relatively recent, the importance of people’s religiousness and spirituality for their health status has been widely acclaimed based on hundreds of published studies.
Patients and Methods: The Arabic Modified version of WHOQOL-SRPB (World health organization quality of life-spirituality, religiosity and personal belief) questionnaire was self administered to a systematic random sample of 100 fifth year medical students.
Results: Around a quarter (21-28%) of subjects perceived religiousness as very to extremely important. This percentage raised to 38% for spirituality and further to 61% for personal believes. The mean score for the “death and dying” facet was the lowest of all facets. The rate of students being satisfied on the overall SRPB measure was high ranging between 85 to 90%.
Conclusion: It was concluded that the students sample showed high rate of satisfaction by their QOL-SRPB instrument. It is realized that these religious and spiritual beliefs contributed to a good response to quality of life as it was similar to another sample in a nearby stable country (Jordan).Key Words: