Journal of the Faculty of Medicine Baghdad

Background: CHOP regimen was the standard treatment for patients with diffuse large and mixed cells Non-Hodgkin's lymphoma (NHL) even in comparison with second and third generation regimen. Recently Rituximab –CHOP is considered the standard treatment for aggressive B-cell NHL while CHOP (alone) is so for aggressive T-cell NHL, yet more than one study investigates another regimen which is VACOP-B and some showed its superiority over CHOP. Prior to the introduction of Rituximab, we used VACOP-B in the treatment of high &intermediate grade NHL in adult Iraqi patients as an alternative to CHOP.

Patients and Methods:We performed a prospective analysis of 20 adult patients who, between April 2000 and October2005, received VACOP-B chemotherapy for high and intermediate grade NHL. The weekly regimen consisted of: doxorubicin50 mg/m2 i.v. weeks 1,3,5,7,9,11; cyclophosphamide350 mg/m2 i.v. weeks 1, 5, 9; etoposide 100mg/m2iv, weeks 3,7,11; vincristine1.4 mg/m2 i.v. (2 mg max.) weeks 2, 4, 6, 8, 10;bleomycin 10 mg/m2 i.v.(max. 15 mg) weeks 2,4, 6,8, 10; methotrexate12.5 mg intratheical was given in selected patients.; prednisolone 60mg p.o.daily for 2 weeks, reduced to 60 mg every other day for 10weeks.The patients treated were aged 25-50 years, 8(40%) had high grade (Working Formulation )NHL; 12 (60%) had intermediate grade NHL;seventeen patients(85%) had Stage III/IV disease; and 3 (15%) had stage II,bone marrow involvement seen in 3(15%)patients .patients distribution regarding age adjusted international prognostic index(aaIPI)was 8(40%)with aaIPI 0,1and 12(60%)with 2,3. Follow-up time from completion of VACOP-B chemotherapy ranged from 6 months to 40 months (median 22).
Results: VACOP-B induced a complete response (CR) and partial response (PR) in 70% and 15% respectively, whilst one patient had no response to treatment and died due to progression of the disease, 2 patients died due to treatment related toxicity. The three year disease free survival (DFS) was 78%, where 4 patients relapsed, one of them in the central nervous system. This study showed 3-year overall survival (OS) 100% for those with a IPI 0-1and 48% for those with aa IPI 2-3. Tolerance to treatment was measured by WHO toxicity scores. The hemoglobin (Hb) toxicity median score for all patients was grade 1 (Hb 9.5-10.9 g/dl), and the white cell count (WCC), toxicity score was grade 2(WCC 2.0-2.9 x 109/1). No platelet toxicity was observed. Ten per cent of patients suffered grade 3 severity infections requiring antibiotics and there was two treatment related death.
Conclusions: VACOP-B chemotherapy is an effective regimen for high and intermediate grade NHL, with an encouraging result in patients with aaIPI 0, 1. although chemotherapy was given weekly, the tolerance to treatment was acceptable. Studies comparing VACOP-B vs. CHOP chemotherapy to decide the exact role of the first in treating high grade &intermediate grade NHL, in the absence of Rituximab, are still needed.

Background: Community acquired pneumonia is the most frequent infection-related cause of death. Illness severity might usefully guide a number of management decisions and predict mortality. Confusion, blood urea ,respiratory rate ,blood pressure and age 65 years or older (CURB-65) based largely on clinical assessment.
Objective: To evaluate the efficacy of CURB-65 score in assessment severity of community-acquired pneumonia and to predict mortality.
Patients and Methods: Fifty patients were enrolled in this prospective study between 1st. of March 2007 and 31st. of January 2008, recruited at Baghdad Teaching Hospital diagnosed as community acquired pneumonia depending on having lower respiratory tract infection symptoms , signs and new infiltrate on the chest radiograph.CURB-65 scoring system was applied and the patients were divided into three groups low risk[CURB-65= (0-1)], intermediate risk [CURB-65= (2)], and high risk [CURB-65= (3-5)] groups . The low risk group was managed at home with oral antibiotics, the intermediate and high risk groups were managed at hospital with intravenous antibiotics. The 30-day mortalities were established.
Results: There were 27(54%) females and 23 (46%) males at a median age of 68 year range from(15-90) year Thirty three patients (66%) had their age 65or older, 26 patients (52%) had B.U>7mmol/l, 11patients (22%) had R.R> 30/minute, 3 patients (6%) had systolic B.P<90 mm Hg, 11patients(22%) had diastolic B.P<60 mm Hg and 14 patients (28%) had confusion. Twenty patients (40%) were in the low risk group (CURB-65=0-1), 12 patients (24%) were in the intermediate risk group (CURB-65=2) and 18 patients (36%) were in the high risk group (CURB-65=3-5). The 30 day mortalities were (0%) in the low risk group, (16.5%) in the intermediate risk group and (30%) in the high risk.
The overall mortality was 8 (16%) patients.
Conclusion: CURB-65 effectively stratified patients regarding the site of medical care, type . route of administration of treatment and predicted mortality.

Background: Despite significantly increased input from multidisciplinary teams during antenatal period, pregnancy outcome from women with type 1, type 2 and gestational diabetes mellitus (DM) remain substantially worse than that of general obstetric population. In Iraq, the true magnitude of infant of diabetic mother (IDM) is not well known as health system has been badly eroded over the period of gulf wars and sanctions.
Objectives: to through a light on IDM in the maternity ward and neonatal care unit (NCU) of Baghdad Teaching Hospital, Medical city complex, Baghdad.
Patients & Methods: A total of 120 IDM admitted to the maternity ward and (NCU) of Baghdad Teaching Hospital, Medical city complex, Baghdad, Iraq, were included in this descriptive study during the period 1st Jan. 2006 to 1st Jan. 2009. A questionnaire was filled for each neonate, which included maternal and neonatal information. Results were presented in frequencies. Multiple logistic regression was done to identify factors associated with death of IDM.
Results: Gestational diabetes was the common type (60.8%), cesarean section was a common mode of delivery (81.7%) and (84.2%) of mothers got antenatal care visits. Regarding the neonates, prematurity was observed in (26.7%), macrosomia in (26.7%), hypoglycemia in (56.8%), hyperbilirubinaemia in (26.1%),congenital anomalies in (12.5%) and Sepsis in (11.4%) of the neonates. Mode of delivery and prematurity significantly affect the death of neonates (p = 0.036 and 0.0008), while parity, type of DM, and birth weight were not significantly affecting the outcome of IDM.
Conclusions: High rates of hypoglycemia , Hyperbilirubinemia, prematurity, congenital anomalies and macrosomia were reported. The mode of delivery and prematurity significantly affect the death of IDM. Better perinatal care of mothers and their IDM with tighter preconceptual glycemic control is likely to reduce the prevalence of reported complications and death and improve the outcome for IDM.

Background; determining what radiologic studies to obtain following the diagnosis of a urinary tract infection(uti) is an area of medicine that is still not agreed upon, nor is there a gold standard.
Objective; to study the radiological abnormalities in paediatric patients with urinary tract infections.
Patients and methods; this prospective study was done from the first of june 2008 to the first of may 2009 include 104 pediatric patients who were referred to children welfare hospital ,(pediatric nephrological out patient clinic) with signs and symptoms of urinary tract infections, all of them had culture positive urine examination , ultrasonograhy was done for all patients, voiding cystouretherography was done for patients with recurrent attacks of urinary tracts infections (58 patients),and intravenous urography was done for patients with urinary tract abnormalities on ultrasonography (41patients).
Results; the results of the present study showed that about 63( 59.4%)of infants and children with (culture positive) urinary tract infections had positive ultrasonic findings ,the most frequent ultrasonic findings was pelvicalyceal and ureteral dilatation whichwas observed in 32.6%. Thirty four(32.6% )of patients had positive findings on voiding cystography ,( grade 5&4 reflux found in 22.4%). The intravenous urography study was beneficial in diagnosis of pelviureteric junction obstruction in 12.2% and visualized the obstructive effect of renal and ureteric stones in 24.4%.
Conclusion; the positive radiological findings supported the idea that the patients with recurent urinary tract infections need imaging work up.

Background: Neonatal infections are afrequent and important causes of neonatal morbidity and mortality especially in the developing countries.
Objective: The aim of the study is to determine the clinical picture, risk factors associated with neonatal sepsis and to estimate short term outcome from neonatal sepsis and its relation to birth weight, gestational age, onset of sepsis and type of bacteria.
Patients and Methods: A prospective study was conducted on 80 neonates presented with sepsis who had been admitted to intensive care unit in Children Welfare Teaching hospitals in Baghdad over six months period between (15th of January 2008 to 15th of June 2008).A thorough history and physical examination were carried out, and samples of blood were taken for blood culture and sensitivity.
Results: Eighty neonates were studied, sepsis was confirmed by clinical and laboratory measures. Fifty five (68.7%) neonates were males and 25(31.2%) were females. Fifty four (67.5%) were preterm and 26 (32.5%) were full term. Fifty nine (73.25%) neonates were still alive during period of hospitalization and discharged home, while 21 (26.25%) neonates died. Early onset sepsis was detected in 26 (32.5%) neonates while late onset sepsis was detected in 54 (67.5%) neonates, However, the death rate was higher in early onset sepsis (57.7%) compared to late onset sepsis (18.5%). The death rate was higher in neonates with maternal history of prolonged rupture of membrane >18 hours (54.8%), also it was increased when there was fever or infection during pregnancy.
Conclusions: The study showed that the most common neonatal risk factors that increase the incidence of mortality were early neonatal sepsis, home delivery, prolonged rupture of membrane more than 18 hours and maternal fever or infection, and the most common features were lethargy, absence or weak moro reflex and reluctant to feed, The most common bacteria isolated from blood cultures was E. coli.

Background :Intrauterine foetal death is defined by World Health Organization (WHO) as ‘death prior to complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy; the death is indicated by the fact that after such separation the fetus does not breath or show any other evidence of life.
Objective: The aim of the study is to assess obstetric outcome in the subsequent pregnancy in comparison with that following live birth in first pregnancy.
Patients and methods: A cross sectional, observational study carried out in department of Obstetrics and Gynaecology of Baghdad Teaching Hospital. during the period from March 2008 to April 2009 The studied group include 53 women in their second pregnancy whom first pregnancy were ended by vaginal delivery of a dead foetus and 489 women delivered a live birth in first pregnancy (labelled as control group).
Results: Women in the studied group (n=53) were at increased risk of miscarriage (p=0.005), preeclampsia (p=0.004), low birth weight (p=0.0001), induction of labour (p=0.0004), emergency CS (P=0.003), Elective CS (p=0.027), stillbirths (p=0.0006) as compared with the control group.
Conclusion: While the majority of women with previous stillbirth have alive birth in the subsequent pregnancy, they are a high –risk group with an increased incidence of adverse maternal and neonatal outcomes. .

Background:The breast cancer is the most common non-skin malignancy in women and prognostic factors are important in predicting disease free survival and overall survival.
Objective: To detect prognostic factors of breast cancer patients and study the correlation between these prognostic factors.
Patients and methods: this is a retrospective study which included87 patients with breast cancer receiving chemotherapy in Baghdad teaching hospital/ oncology department in the year 2010. Prognostic factors were registered including: age, histopathological subtype, degree of differentiation, lymph node involvement, ER and PR, Her 2/neu and lymphovascular invasion.
Results: Regarding breast cancer; 55(63.2%) of patients were early breast cancer as compared to32(36.8%)patients with locally advanced breast cancer.Regarding lymph node involvement 31(36.9%) of patients had N0,28(33.3%) had N1, 23(27.4%) had N2 and 2(2.4%) were with N3. Regarding degree of differentiation the most common type was moderately differentiated with 58(66.7%) followed by poorly differentiated with 23 (26.4%) and at last well differentiated tumors with 6(6.9%) patients. Infiltrative ductal carcinoma was the most common subtype other histopathological subtypes as infiltrative lobular carcinoma (13.8%) and medullary carcinoma (2.3%). Intraductal carcinoma were present in 23 cases (25.8%).ER was negative in 33% and PR was negative in 37.5% while the remaining cases shows positivity with different percentage scores.Cross tabulation between different prognostic factors ( tumor size, lymph node, degree of differentiation, lymphovascular invasion) were done and results were statistically not significant, regarding ER and PR showed strong significant correlation( p < 0.0005).between the two markers also significant correlation was found between lymphovascular invasion and lymph nodes involvement.
Conclusion: breast cancer is the most common solid malignancy treated in Baghdad teaching hospital. Early stage breast cancer were more common than advanced breast cancer, ER and PR(good prognostic factors) were statistically correlated to each other so were lymphovascular invasion with lymph nodes involvement(bad prognostic factors).

Background: Cognitive dysfunctions in epileptic patients may develop due to the neurophysiologic changes related to seizures or antiepileptic drugs.
Objectives: The aim of this longitudinal study was to evaluate the cognitive dysfunction in epileptic patients under antiepileptic drug therapy by the aid of event related potentials.
Patients & Method: P300 latencies were obtained from Fz, Cz and Pz electrodes positions from both epileptic patients (n = 224) and age and sex matched control group (n = 91). Epileptic patients were classified either having partial epilepsy, generalized epilepsy or both partial and generalized epilepsy (combined epilepsy). EEG and p300 test repeated for each patient every three months for one year. The effect of epilepsy type and duration, treatment types (monotherapy/ polytherapy), daily dosages and EEG abnormalities on P300 latencies were studied.
Results: P300 latencies were longer in the epileptics when compared to controls (P < 0.05). Besides, our results pointed out that P300 latencies were longer in patients with generalized and combined epilepsy as compared to those with partial epilepsy (P < 0.05).
Conclusion: We believe that P300 latencies may have an important role in the evaluation of cognitive dysfunction in epileptic patients treated with antiepileptic drugs.

Background: Hand osteoarthritis (HOA) is a common joint disorder leading to considerable pain and with substantial impact on hand function. Carotid intima-media thickness (CIMT) is a measurable index of the presence of atherosclerosis. Increased CIMT is associated with increased cardiovascular mortality and morbidity, so early diagnosis and management may improve quality of life.
Objective: To assess the relationship between carotid intima-media thickness (CIMT) and hand osteoarthritis (HOA), and to evaluate the predictors of this relationship.
Patients and Methods: One hundred Iraqi HOA patients and 100 healthy controls were included in this study. Full history was taken and complete clinical examination was done for all patients. Disease characteristics [age, sex, duration, body mass index (BMI), waist circumference, family history of HOA, smoking history, lipid lowering agent use] were also documented. Laboratory analysis included complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and lipid profile. Individuals in both groups were assessed for CIMT by B-mode ultrasonography. X-rays of both hands was taken for patients and was graded according Kellgrenand Lawrence scale.
Results: Fifty five (55%) Iraqi HOA patients have increased CIMT compared with 38 % of controls (p=0.02). There was no statistical significant association between increased CIMT and HOA radiographical grading (p=0.72). The lipid profile was the only predictor of increased CIMT in patients with HOA [p=0.02, OR (95% CI) = 3.24 (1.20-8.75)]
Conclusions: There is increased frequency of increased CIMT (55%) in Iraqi patients with HOA. Abnormal lipid profile is the only significant predictor of increased CIMT.

Background: Nurses experience increasing demands in the workplace and have limited support in their occupation to help them lowering the level of stress, and one of the observable severities of stress among nurses in intensive care units are the social Stressors. So the study was aimed to assess the social stressors and the severity of stress among nurses in cardiac surgical intensive care units.
Objectives: The study aimed to assess the level and sources of social job stress related to the social relationship experienced by nurses, who were working in intensive care units and to find out the relationship between social stressors and some variables such as age, gender, educational level, marital status, Years of experience in cardiac intensive care units.
Patients and Methods: A descriptive-analytic Study was conducted on cardiac surgical intensive care units nurses in Baghdad hospitals. The sample of the study were selected purposively and consisted of 60 nurses who were working in cardiac surgical intensive care units in Baghdad city (Ibn Al- Bitar Hospital for Cardiac Surgery, Ibn Al-Nafis Hospital for Cardiovascular Diseases, and the Iraqi Center for Heart Diseases) in the period of 1st February 2006 to the 6th April 2006. Data was collected through the use of the constructed questionnaire and the process of the self- administrative report for each nurse as a mean of data collection methods.A Questionnaire was designed to consist two parts; the first part concerned with the demographic characteristics of the sample and the second part concerned with the social environmental stressors, and it contain 14 items describing the social stressors. Data was analyzed through the application of the descriptive statistical analysis (frequency, percentage, mean, standard division, and mean of score) and inferential statistic (chi-Squire test).
Results: The results of the study revealed that the most of sample were female (53 %), their age ranged between (30-39) years, of university graduates, single, with (6-10) experience in cardiac surgical intensive care units. Also the results revealed that nurses in cardiac surgical intensive care units suffer from severe level of stress related to the social environmental stressor RS. (67.69 %).
Conclusions: Nurses who were working in intensive care units suffered from sever job stress related to the workplace stressors, and there is a significant relationship between social job stress and nurses age. Therefore there was a need for an effective stress management to assist such nurses to deal with job stress.

Background: Breast cancer is the malignant tumor that forms from the uncontrolled growth of abnormal breast cells. It usually affects tissues involved in milk production (Ductal and lobular tissues). It is the most common malignancy in women and it remains one of the greatest health threats facing women around the world as we enter the 21st century.
Objectives: To estimate the role of IL-10 in the progression of invasive ductal carcinoma.
Patients and Method: Seventy three metastatic invasive ductal carcinoma Iraqi women were admitted to Nuclear Medicine Hospital in Baghdad and 15 samples of apparently healthy women were involved as a control. The blood samples (2 mL) were drown from all studied cases in order to be used for measuring their serum level of IL-10 by using Enzyme-linked Immune Sorbent Assay technique.
Result: The results have shown that the high significant relation was that of elevated IL-10 levels, which increased in 98.6% of patients.
Conclusion: The result indicates that the highl significant elevation of serum IL-10 concentration are strongly asso¬ciated with metastatic invasive ductal carcinoma, this may be helpful in adding further vision in the diagnosis of women with this type of cancer.

Background: Factor V Leiden is considered the most common inherited risk factor for venous thrombosis in Caucasian populations, including those in the Eastern Mediterranean region. While several studies have addressed Factor V Leiden prevalence in patients with venous thrombosis in the Eastern Mediterranean countries, none have been reported from Iraq.
Objective: To study the prevalence of Factor V Leiden in an unselected group of Iraqi patients with Deep Venous thrombosis.
Materials and Methods: A total of 50 unselected patients with deep venous thrombosis referred to the Medical City Teaching Hospital in Baghdad, Iraq, as well as 40 age and sex matched controls, were enrolled. The evaluation included in addition to detailed history, Factor V Leiden by polymerase Chain reaction and reverse hybridization.
Results: Factor V Leiden mutation was documented in 8 patients (16%), compared to 1 control (2.5%) (Odds Ratio 7.4; p= 0.0397). The mutation was more frequent among younger patients, those with family history of thrombosis and those with recurrent thrombosis, but only the latter was of significance.
Conclusions: The study suggests that Factor V Leiden is frequently encountered in Iraqi patients with Deep venous thrombosis from Baghdad, but less so than in some surrounding Eastern Mediterranean countries. Although further larger studies maybe warranted, the current study favors screening for Factor V Leiden in the workup of newly diagnosed venous thrombosis cases in this city.

Background: It is still difficult to give a final diagnosis in chronic myeloproliferative disorders (CMPDs) because of the overlap of the common pathological and clinical features of these disorders like bone marrow fibrosis which is considered important because it affects the normal function of the bone marrow. The collagen fibers are of different types, but in the bone marrow, the two main types are: collagen I, which is the most abundant type and collagen III (reticular) which is often associated with type I.
Objectives:To study bone marrow fibrosis (BMF) in samples of bone marrow biopsies (BMB) of chronic myeloid leukemia (CML) and other chronic myeloproliferative disorders using histochemical stains to establish the grade of fibrosis and enabling a correct differentiation between chronic myeloid leukemia, essential thrombocythemia (ET), polycythemia rubra vera (PRV), and idiopathic marrow fibrosis (IMF) as subtypes of myeloproliferative disorders.
Patients and methods: This retrospective study included collection of previously preserved formalin fixed- paraffin embedded bone marrow trephine biopsies of patients with chronic myeloproliferative disorders from January 2003 through December 2008 .The relevant clinical data of patients were retrieved from the stored case sheets. Applied histochemical stains (Reticulin stain, Van Gieson stain, and trichrome stain) with Haematoxylin and Eosin (H&E) stain on sections from these specimens. These stains were used to detect the presence and the degree of pathological marrow fibrosis by the most recent grading system, the European Consensus 2005(EC2005) originally described by Thiele at 2003. Using Trichrome stain for collagen type I and reticulin stain for reticulin fibers (collagen type III) and by using a special marrow fibrosis grading system as a routine work with H&E is valuable in determining the degree of marrow fibrosis on bone marrow biopsy examination and simplifies the diagnosis.
Results: Sixty eight percent of chronic myeloproliferative disorders patients had no marrow fibrosis when diagnosed by H&E, while only 30% of chronic myeloproliferative disorders patients had no marrow fibrosis when the diagnosis was made by special stains and marrow fibrosis grading system. There is rare marrow fibrosis in essential thrombocythemia, polycythemia rubra vera, but present in chronic myeloid leukemia and almost always in marrow fibrosis. Some patients really have myelofibrosis of different grades and the histological findings by using histochemical stains are crucial to distinguish between myeloproliferative diseases
Conclusion: Patients with chronic myeloid leukemia and other chronic myeloproliferative disorders had marrow fibrosis of different grades, which is confirmed by using histochemical stains for different collagen fibers and special grading system for marrow fibrosis (EC2005) that has to be applied. It can be used routinely to avoid misdiagnosis of the primary disease or its conversion and transition to another chronic myeloproliferative disorders type, in which the clinical and laboratory features overlap, but the prognosis and therapeutic implications are significantly different.

Background: Human colorectal carcinogenesis is a complex, multistep and multigenetic process. Matrix metalloproteinase-2 and cyclooxygenase-2 are key enzyme in degradation of extracellular material, are over expressed in several epithelia like colorectal adenocarcinoma.
Objectives: This study was designed to detect the expression of matrix metalloproteinase-2 and cyclooxygenase-2 in patients with colorectal carcinoma and their correlation with age, gender, tumor grade and presence or absence of muscle invasion.
Materials and methods: Immunohistochemical staining of MMP-2 and COX-2 was determined in 40 tissue samples from colorectal patients, from teaching laboratories in Baghdad medical city. In addition twelve apparently normal colorectal autopsies were used as a control group.
Results: The expression of matrix metalloproteinase-2 was detected in 30 of 40 colorectal cancer cases (75%) while cyclooxygenase-2 was detected in 31 0f 40 colorectal cancer cases (77.5%). All normal colorectal specimens showed negative results. The incidence of both of them was higher for grade II than those in earlier grade.
Conclusion: Cancer cells to have a more aggressive behavior may show an up regulation of tumor cell derived matrix metalloproteinase-2 and cyclooxygenase-2.

Background: Cytogenetic studies have been used to assess carcinogenic or mutagenic exposures and effects early in occupational, biological and environmental settings. Bacterial infection has not traditionally been considered asa major causes of cancer. Bacteria have been linked to cancer by two mechanisms: induction of chronic inflammation and production of carcinogenic bacterial metabolites.
Objective: Because of new concepts in relating infection with certain malignancies the present study is performed. Therefore this study was conducted to determine the effects of bacterial products associated with biopsies of bladder tumor on human lymphocytes tissue cultures in vitro. Moreover, if there is any relation between these products for induction chromosomal aberration (CA) and formations of micronucleus (MN).
Subjects and Methods: Chromosomal aberration and micronucleus assay were studied on six identified bacterial isolates of bladder tumor biopsies included 2 isolates of Escherichia coli , 2 isolates of Pseudomonas aeruginosa and 2 isolates of Klebsiella pneumoniae. The bacterial products activity for induction (CA) and (MN) were assayed according to the procedure mentioned in the text.
Results: The results showed that each bacterial species have significant effects for induction different types of structural chromosomal aberration (CA) and formation of (MN).
Conclusion: K. pneumoniae yielded high significant related predisposing factor in inducing different cytogenetic analysis followed by P. aeruginosa and E. coli .

Background: Helicobacter pylori represents the major etiologic agent of gastritis, gastric and duodenal ulcer disease and can cause gastric cancer. Diagnostic testing for Helicobacter pylori can be divided into invasive and non-invasive techniques based upon the need for endoscopy. Serological test is one of the non – invasive tests although measuring these antibodies is not reliable method of diagnosis but may be used in certain condition.
Objectives: To evaluate serum IgG antibodies against Helicobacter pylori by ELISA technique.
Patients and Methods: The current study consisted of 115 patients (74 males, 41 females) attending The Gastrointestinal tract Center and Gastroscopy department in Baghdad Medical City and was subjected to gastroscopy, during the period from November 2004 to May 2005. Those how were examined for serum IgG against Helicobacter pylori by ELISA technique were compared with 10 apparently healthy individuals representing the control group.
Results: By using the serological method (ELISA) 85 patients out of the 115 showed positive results (73.91%), however 7 out of the 10 individuals representing the control group were serologically positive (70%).
Conclusion: Positive IgG antibody test for Helicobacter pylori indicates a marker for infection rather than an indicator for active infection.

Background: Heat shock proteins have a general role in the response of the arterial wall to stress and may serve as a mediator/inducer of atherosclerosis in particular circumstances when HSPs specifically bind to the Toll-like receptor 4/CD14 complex, initiating an innate immune response, including the production of pro-inflammatory cytokines, this also followed by cytokine amplification through transmigration of macrophages and neutrophils.
Objective: To investigate the percentage of expression of HSP60 by peripheral blood lymphocyte (PBL) in atherosclerotic coronary heart disease (CHD) patients using immunocytochemistry technique.
Method: A total of fifty patient (40 males and 10 females), ranged from the mean age (59.12±8.54) years with a range from 42-80 years and fifteen, age and sex matched, apparently healthy individuals, taken as a healthy control group, were enrolled in the current study and the patients group were further classified into acute cases (n=11 patients) ״7 males and 4 females״ and chronic cases (n=39 patients) ״33 males and 6 females״. Three ml of blood sample had been taken from each subject, and immediately transferred to sterile heparinised vacutainer tubes for lymphocyte separation. Immunocytochemistry was used to detect HSP60 by using monoclonal antibody to HSP60 protein.
Result: Results revealed a statistically significant elevation levels between patients and control groups (P=0.000), the expression of HSP60 was elevated in all patients with no significant difference between acute and chronic cases (P>0.001).
Conclusions: HSP60 plays an important role in induction and development of atherosclerosis by stimulating different mechanisms which are the triggers for the process of atherosclerosis development. It is found in higher levels in both acute and chronic cases of atherosclerotic CHD in comparison with control cases.

Background: Nitric oxide ( NO) is a physiological mediator of many processes in the eye including regulation of aqueous humor dynamics. Compounds acting via NO dependent mechanisms may enhance aqueous humor outflow and reduce intraocular pressure (IOP) .
Objective: Sildenafil a cGMP specific phosphodiesterase 5inhibitor that potentiates NO production and increases cyclic GMP is tested in this study for its effects on intraocular pressure in an acute ocular hypertension model in rabbits.
Materials and methods: Newzealand albino rabbits of either sex weighing 2–2.5 Kg , were used in this study. Sildenafil was prepared in a vehicle of phosphate buffer and diluted to the required strength of 0.5%. Intraocular pressure (IOP ) was measured after 45 seconds of one drop of proparacaine topical anesthesia by using schiotz indentation tonometer. Basal IOP was obtained for both eyes using 12 rabbits .One drop of sildenafil (0.5%) was then topically instilled in the left eye while the right eye received the vehicle and served as a control. After 30 minutes of drug and vehicle administration the IOP was measured in both eyes and acute ocular hypertension was induced by the administration of 15ml/kg 5% glucose. The IOP was then recorded every 15 min for 180 minutes.
Results: Topical 0.5% sildenafil administration had no effect on the basal IOP levels. However sildenafil significantly (p < 0.05) attenuated the acute rise in IOP induced by 5% glucose infusion. The IOP levels returned to their basal values in shorter time with sildenafil compared to the control
Conclusion: Topical sildenafil pretreatment reduces IOP in acutely induced intraocular hypertension.

Background: antiemetics are commonly prescribed as prophylactic for nausea and vomiting when opiates analgesics are prescribed in the emergency department.
Objective: to assess the incidence of nausea and vomiting after tramadol analgesia, and the effect of prochlorperazine on this incidence.
Patients and methods: I.V tramadol was administered with prochlorperzine (group I) or pyridoxine (group II) to 44 patients with acute sever pain.
Results: the incidence of nausea and vomiting was not significant between patient groups; while the occurance of extrapyramidal side effects was only seen in the prochlorperazine group. The low incidence of nausea and vomiting after opiate analgesic and higher incidence of side effects with prochloperazine are consistent with controlled data in literature.
Conclusion: prophylactic prochlorperazine should not be used routinely in emergency department for patients receiving narcotic analgesia.

Background: Various abnormalities in myocardial repolarization assessed by QT variability index (QTVI) in diabetics are associated with high risk to ventricular arrhythmia. The increase in cardiovascular morbidity and mortality appears to relate to the synergism of hyperglycemia with dyslipidemia, hypertension and obesity in addition to disturbed myocardial repolarization.
Objectives: The aim of the present study was to estimate and evaluate an index of myocardial repolarization instability (QTVI) in patients with DM on insulin or oral hypoglycemic drugs in comparison with healthy individuals.
Patients and Methods: The study was conducted on fifty six (56), middle-aged patients with DM of either sex in addition to age-matched healthy subjects (32) served as control, during the period between December 2009 to January 2011 in Al-Kadhimya Hospital. 21 patients were on insulin therapy and 35 were on oral hypoglycemic drugs (OHD). Holter monitoring for 30 minutes was performed for each subject, and QTVI was calculated as the logarithm of the ratio between the variances of the normalized QT and RR intervals.
Results: QTVI was significantly increased in patients with DM as compared with the control healthy subjects (−0.82± 0.56, −1.54± 0.27 respectively; P<0.01). However, QTVI did not differ significantly among patients on insulin or OHD treatment.
Conclusion: the present study concludes an elevated QTVI in patients with DM when compared with that of control.

Background: There is considerable evidence which associate cardiovascular morbidity and mortality with obesity, however, a direct effect of uncomplicated obesity on cardiac function is not well established.
Objective: To evaluate the relationship between body mass index (BMI) and left ventricular structure and function.
Methods: This cross-sectional study was carried out on (146) apparently healthy adults from both sexes (85 male and 61 female) aged 20-59 years(36.49±9.92 ). Subjects were grouped according to BMI into1.normal weight group included 47 subjects (BMI=18.5-24.9Kg/m2);2. Overweight group included 43 subjects (BMI=25-29.5 Kg/m2) and 3. obese group included (56) subjects(BMI≥30). Echocardiographic indices of left ventricular structure and function were obtained. This study was performed between October 2009 till April 2010 at the Echocardiography Unit in Ibn Sina Teaching Hospital in Mosul.
Results: There was a significant increase in LVM(left ventricular mass), LVMI(left ventricular mass index), LVIDD(left ventricular internal dimension in diastole) and PWT(posterior wall thickness) among over weight and obese subjects (P< 0.001),however, both contractility indices [LVEF%(left ventricular ejection fraction percent) and LVFS %(left ventricular fractional shortening percent)] seemed unchanged significantly. The left ventricular diastolic function [E/A ratio(ratio of passive to active velocity inflow)] has significantly decreased among the obese group (P< 0.001). This observed decrease in E/A ratio with increasing BMI coincided with a statistically significant increase (P< 0.001) in LAD (left atrial dimensions).
Conclusions: Increased body weight is positively correlated with LVM but not with systolic dysfunction. All subjects with isolated obesity have subclinical left ventricular diastolic dysfunction; this correlates with BMI.

Background: Myocardial Infarction (MI) is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque. It has been suggested that the adipose tissue may play an important role in mediating this chronic inflammatory process. Inflammatory responses are involved in the initiation and progression of atherosclerotic plaques. Resistin is a cysteine-rich polypeptide that is expressed at relatively lower levels in human adipocytes but higher levels in macrophages. Insulin is an important hormone as it regulates the level of glucose, in the blood. This protein is formed in specialized cells of the pancreas called beta islet cells.
Subjects and Methods:The study included 50 patients with AMI and fourty healthy subjects as controls. levels of resistin, insulin and troponin were measured.
Results: The levels of resistin and insulin were significantly elevated with (p<0.001), there was a positive correlation between resistin with insulin and troponin in acute myocardial infarction.
Conclusions: There was a significant increase in the levels of resistin, in acute myocardial infarction patients and this increase may be related to inflammation. Elevated levels of resistin can lead to glucose intolerance in AMI patients.

Background: Sub-clinical hypothyroidism (SCTD) is most commonly an early stage of hypothyroidism. Although the condition may resolve or remain unchanged, within a few years in some patients, overt hypothyroidism may develop, with low free T4 levels as well as a raised thyroid stimulating hormone(TSH) level. In general thyroid dysfunction is a condition known to reduce the likelihood of pregnancy and to adversely affect pregnancy outcome. As screening for thyroid disease becomes more common, SCTD is being diagnosed more frequently in clinical practice. The aim of the study is to find out the effect of treating SCTD with thyroxin on the fertility status of the female patient.
Patients and methods: Forty three infertile patients attending the infertility clinic at Baghdad teaching hospital were compared to 32 control un explained infertility women. After exact history and examination, hormonal analysis (T3 and T4, TSH, Prolactin and Progesterone) and ultrasound were done for patients and control, then the patients were randomly divided into 2 groups one group was given thyroxine treatment, the other group was given parlodel, and after 3 months the hormonal analysis and ultrasound were repeated and compared to the previous results.
Results: Comparing the patient group to the control showed a significant increase in the TSH and prolactin level in patients group but the progesterone concentration was not significantly different between the groups. After giving thyroxine the group who received it showed significant reduction in prolactin and improvement in the dominant follicle size and progesterone level while the group who was given parlodel showed only significant reduction in prolactin with no significant increase in the other 2 parameters.
Conclusion: TSH in subclinical hypothyroidisim is correlated positively with age and with the prolactin concentration. Treatment with thyroxine induces a significant improvement in the fertility statues including the significant decrease in prolacttin concentration and increase in the dominant follicle size and increase in the progesterone level compared to those given parlodel only. This makes it obvious that treating patients with SCTD have a significant reflection on their fertility and ability for future pregnancy.

Pyometra is an uncommon gynecological condition resulted from occlusion of the cervix usually by a malignant condition. It has an incidence of 0.1%-0.5%. Untreated pyometra leads to rupture uterus and acute infective peritonitis presented as acute abdomen and needs urgent surgical intervention. Pyometra resulted from occlusion of the vagina is very rare. No cases have been described in the English literature to the best of our knowledge and in the PubMed. The purpose of reporting this case is to show that occlusion of the vagina could occur in postmenopausal women as a consequence of local infection and results in pyometra and also to show that pyometra can be presented in a different way apart from the classical presentation. The way to reach the diagnosis and how to manage the case has been also discussed thoroughly.

Background: Echocardiography is a very important diagnostic modality in the clinical practice of cardiology. Although it has been extensively used as a diagnostic tool. Echocardiography has recently emerged as a sensitive, non invasive technique for evaluating left ventricular mass(LVM) and detecting left ventricular hypertrophy. Objective: to determine the effect of sex, age, and anthropometric measurements on echocardiographic values for cardiac chambers, left ventricular mass index in adults Iraqi sample.
Methods: This was observational study based on a randomly selected sample from Baghdad city, 75 normal obese Iraqi subjects with no history of cardiovascular disease underwent transthoracic echocardiography.
The following M-mode echocardiographic parameters were measured such as ventricular diameters, interventricular septal thickness (IVSTD), posterior wall thickness in diastole (PWTD), left ventricular mass, left ventricular mass indexes values were expressed as mean and standard error.
Results: Echocardiographic values were slightly influenced by gender and age. The overall, cardiac measurements were higher in male gender. LV posterior wall thickness, mass indexes corrected for height2.7 and body surface area (BSA) were influenced by age. In multiple regression analysis age and BSA were a powerful predictors for non indexed LVM or for LVM to BSA , where as body mass index was the strongest predictor of LVM to height 2.7 ( LVM/h 2.7 ).
Conclusions: Left ventricular mass (LVM) in normal obese Iraqi adults is age and body surface area (BSA) dependent. Age and body mass index (BMI) were the best predictors of LVM/h 2.7 in normal obese Iraqi adults. Left ventricular mass is larger in men, corrected or not for anthropometric variables.