Journal of the Faculty of Medicine Baghdad

Aim: is to report a case of trans-oral pin, penetrating base of skull and upper cervical region, which is rarely reported in the literatures and to compare it with other studies reporting similar case.
Patients Methods: the details, the presentation, both clinical and radiological finding, and surgical approach of such a case are presented.
Results: the diagnosis was verified with plain x-rays and C.T. scan with bone study. Surgery was conducted under G.A., the patient was recovered well without neurological deficit.
Conclusion: meticulous and close pre-operative care with safe operator and careful fellow up is mandatory. Surgery only offers the best chance of care.
Keywords: cervical injury, craniocervical trauma, pin trauma, trans-oral trauma.

Back ground: Ischemic VSD or ventricular septal rupture (VSR) is a rare but lethal complication of myocardial infarction (MI). Multi-system coronary disease is present in more than 50% of these patients. The event occurs 2-8 days after an infarction and often precipitates cardiogenic shock. The differential diagnosis of postinfarction cardiogenic shock should exclude free ventricular wall rupture and rupture of the papillary muscles. To avoid the high morbidity and mortality associated with the disorder, patients should undergo emergent surgery. Concomitant coronary artery bypass may be required.
Objective: This study stressed on a very serious complication of a common pathology (myocardial infarction), despite it's lethal complication but still it is treatable and still surgery is the only salvageable option.
Patients & methods: Retrospective study of 7 consecutive cases with ischemic VSR encountered from (1st Jan. 2008-30 of September 2011). All of the cases were carefully assessed & fully investigated preoperatively (by echocardiography study, catheterization ...etc) & for all of them emergency open heart surgery was done with heart lung machine to close a post infract VSD using synthetic patch and ventriculotomy closed with reinforced Teflon felts , all of them(except the last case which died immediately post operatively) stayed for 2-3 days in the CICU under follow up .
Results: Seven patients have been operated upon, 4 males (57%) and 3 female (43%), and their ages ranged between 50-63 years (75% in the 6th decade). Three of them (43%) were diabetic only but all of them were hypertensive. All of them were haemodynamically unstable so operation carried on emergently within 12-18 days post infarction (one operation done within 27 hours of infarction) and in none of them the clinical status helped to postpone them until more than 3 weeks post infarct. Five Out of the seven patients survived the operation, one died immediately post operatively &another one died 7 days post operatively due to renal failure (due to pre operative impaired renal function). Operative & early post operative mortality is (28%).
Conclusion: We need to be more aware about this fatal complication of acute MI taking in consideration its late presentation (2-8) days.
We have to work hardly to improve early revascularization to decrease the incidence of VSR. Improvement in surgical technique using double patch and glue improve mortality & morbidity rates. More cases need to have a better understanding & management of these cases.
Keywords: VSD, Ischemic , surgical repair
specialist cardiothoracic surgeon, Medical city, Iraqi Center for Heart Diseases

Background: Ultrasound guided fine needle aspiration (FNA) is a quick nonmorbid method of staging disease in the axilla,Color doppler ultrasound is used to differentiate benign lymph node from node that bears metastasis.
Objective: To evaluate the utility of ultrasound guided (FNA) of the axillary L.N depending on the size of the primary tumor and the appearance of the lymph node by ultrasound , and to document the difference in color Doppler flow features between benign and malignant lymph node in women with primary breast cancer.
Patients and methods: The total number of the patient in the study is (60). Data were collected about tumor size, lymph node appearance and color-power Doppler sonography compared to the result of ultrasound- guided FNA . Lymph node were classified as: Benign: if the cortex was even and measure < 3mm. Indeterminate : if the cortex was even but measure ≥ 3mm, or with focal cortical thickening but cortical thickness <3mm. Suspicious: if cortex focally thickened ≥ 3mm, or the fatty hilum was absent. Color-power Doppler evaluation was based on the morphologic pattern of vascularity ( central, peripheral and mixed).
Results: of these (60) patients , ultrasound guided FNA was done to (42) lymph node .The sensitivity and specificity of ultrasound guided FNA to detect metastasis to axillary lymph node in correlation to the size of tumor was 50% in tumor (≤1cm), and 86% in tumor between (1 - 2cm), and 93% in tumor >2cm.The sensitivity and specificity of ultrasound guided FNA to detect metastasis to axillary lymph node was 67% for indeterminate lymph node, and 95% for suspicious lymph node. The sensitivity and specificity of ultrasound guided FNA to detect metastasis to axillary node in correlation to color Doppler flow was 100% for mixed vascularity and 100% for peripheral vascularity.
Conclusion: There is a strong significant correlation relationship between the presence of peripheral blood flow in addition to the morphological changes which include focal cortical thickening >3mm and loss of hilum ,and the size of the primary tumor with presence of malignancy in LN in patient with primary breast cancer.
Keywords: color doppler , lymph node , ultrasound guided FNA

Background: - Recurrent breast cancer is cancer that comes back following initial treatment. Risk factors of recurrence are lymph node involvement, larger tumor size, positive or close tumor margins, and lack of radiation treatment following lumpectomy, younger age and inflammatory breast cancer.
Objective: Asses the rate of recurrence for early breast cancer in Iraqi female patients, in relation to certain risk factors.
Patients and methods: _ A prospective study was conducted on 100 consecutive female patients, with stage I and stage II breast cancer treated by mastectomy and axillary dissection by the same team. Patients were assessed postoperatively every three months and recurrences were detected by physical examination and ultrasound of the bed of mastectomy and axilla. Statistical correlation using univariant analysis between recurrence rate and certain associated variables was done.
Results: - Recurrence rate was found to be 13%. It was more common among both young (20-29) years &the (40 – 49 ) years age groups which was 16.7%. Most of recurrences (61.6%) occurred (within 12_19 months) after surgical treatment. Statistically significant associations were found between recurrence and the latency period between first complaint and surgical management, the grade of the tumor, the size of primary tumor, and the number of lymph nodes involved. There was no statistically significant association between the type of adjuvant therapy and the incidence of local recurrence.
Conclusions: the rate of recurrence after modified radical mastectomy is relatively high in our study. The same known risk factors related to the stage, grade and delay of treatment were detected, and close follow up especially at the first 20 months after surgery is recommended.
Keywords: breast cancer, recurrence, risk factors, adjuvant therapy

Background: Pulmonary tuberculosis is a chronic infectious disease which affects nutritional status of the patients. The presence of poor nutritional status in pulmonary tuberculosis patients has been one of the most important determining factor in recommending adjuvant nutrient therapy to prevent oxidative stress and further complication.
Objective: This study was designed to assess the nutritional status and body mass index of pulmonary tuberculosis patients.
Patients and methods: During the period 1st of June 2010 to 30th of May 2011, a prospective study was done on 60 patients with active pulmonary tuberculosis and 60 controls.
Levels of total protein (TP), albumin (ALB.), triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDLC), low density lipoprotein cholesterol (LDLC), and body mass index (BMI) were measured.
Results: The mean levels of TP (59.5 ± 0.8g/dl), ALB (23.4 ± 1.8g/dl), TC (138.7 ± 4.9mg/dl), HDLC (32.2 ± 4.0mg/dl), LDLC (86.5 ± 1.3mg/dl) and TG (62.4 ± 1.3mg/dl) were significantly lower while the level of globulin (36.2 ± 1.2g/dl) was significantly higher in pulmonary tuberculosis patients when compared with controls (TP=81.2 ± 4.5g/dl; ALB= 50.0 ± 4.0g/dl; TC = 213.5 ± 26.8mg/dl; HDLC = 57.4 ± 8.5mg/dl; LDLC = 161.1 ± 28.3mg/dl; TG= 148.5 ± 37.1mg/dl; globulin = 31.4 ± 1.7g/dl respectively). (P <0.05)
The body mass index (16.9 ± 1.1kg/m2) was significantly lower when compared with controls (BMI= 23.5 ± 2.1kg/m2). (P <0.05)20
Conclusion: There is a significant degree of nutritional depletion and weight loss in PTB patients than in general population. BMI is considered to be a useful technique for assessment of nutritional state of PTB.
The nutritional derangement could call for prompt nutritional intervention in the management of pulmonary tuberculosis patients.
Keyword: BMI :BODY MASS INDEX. PTB: PULMONARY TUBERCULOSIS.

Background: Hypertension is the most common cardiovascular disease; its prevalence increases with advancing age. The risk of cardiovascular disease in adults is lowest with systolic BP 120 mm Hg and diastolic BP 80 mm Hg and increases progressively with higher systolic and diastolic blood pressures. Acupuncture (from the Latin word acus, "needle", and pungere, meaning "prick") is a technique in which the practitioner inserts fine needles into specific points on the patient's body. Accupuncture could be used as a nonpharmacological way of controlling high readings of blood pressure among cases with essential hypertension. This study aimed to investigate the effects of acupuncture on essential hypertension.
Patients and Methods: 51 hypertensive patients of both genders and 30 normotensive control subjects were involved in the study during the period from 1 December 2010 to 28 Feb 2011. Each subject recieved needling technique at certain acupoints of the body meridians according to Chinese medicine theory for 10 sessions, each session was thirty minutes and the responses were followed up for three months from the last session. Points selected are known as followed in Chinese medicine as ( du 20 , liver 3 and large intestine 11).
Results : Patient group which consists of (51) individuals{ (37) males and (14) females}, from those 51, there were 39 with response i.e they became normotensive and this represent (76.47%) while the rest were still hypertensive (23.52%) but they showed significant change in all parameters after treatment
Conclusion: From this study we conclude that acupuncture decreases blood pressure in hypertensive patients and had no hypotensive effect on normal subjects involved in this study.
Keywords: hypertension, acupuncture.

Background: In developing countries, neonatal death account for 99% of neonatal deaths in the world. In Iraq, the neonatal death rates are still unknown.
Objectives: To assess the death rate and the major causes of neonatal death in the neonatal care unit (NCU) in Baghdad Teaching Hospital-Medical City/ Baghdad.
Patients &Methods: A descriptive study of 564 neonatal deaths in the neonatal care unit (NCU) from 1st of January 2007 to 31st of December 2009 in Baghdad Teaching Hospital-Medical City/ Baghdad was carried out, and the causes of death as registered in the neonatal medical records and death certificates were studied.
Results: Neonatal death rate relative to admission was (18.5%). The Neonatal death rates were lower in 2007(15%) than 2008(20%) and 2009(19.2%), of 564 total neonatal deaths, males were 329 (58.3%), 235 (41.7%) were females with male to female ratio was 1.4:1. Eighty percent of neonatal deaths were preterm deliveries and (79%) were low birth weight (< 2.5 kg). Major causes of death were: Respiratory problems (62.8%), followed by congenital anomalies (17%), neonatal infections (11.2%) and birth asphyxia (9%).
Conclusions: The Neonatal death rate was lower in 2007 than 2008 and 2009. There was a high male to female ratio, and high percent of preterm deliveries and LBW. The main causes of death were respiratory problems, congenital anomalies and neonatal infections.
Keywords: Neonatal Deaths, Neonatal Care Unit, Neonatal mortality.

Background: Childhood diarrhea remains one of the leading causes of preventable mortality and disease burden throughout the developing world. It generated by several pathologic states, most commonly infections. Although the human large intestine ordinarily harbors a huge microbial population, most bacteria, protozoan, and viral agents of diarrhea are not members of this normal gut flora, but are aquired through contaminated food or water.
Objective: This study was conducted to investigate the main microbial causative agent of diarrhea in children below five years of age, and to evaluate the relationship between the incidence of diarrhea with sex and age group of the patients.
Patients and Methods: Total of two hundred twenty three stool samples were collected from children under five years of age suffering from diarrhea, who visit Children Welfare Teaching Hospital at Medical City Complex, Baghdad city during the period from July to the end of September 2010. General stool examination (GSE) was done for all the samples to identify the parasitic and fungal agents, and immunological detection were done to identify the viral causative agent of diarrhea, and the pathogenic strains of bacteria. Also biochemical tests for specimen cultured on specific culture media were done to identify the bacterial causative agents, after ensuring that the patients don’t take antibiotics at the time preceding sample collection.
Results: Pathogenic bacteria came first with higher number of microbial isolates. High number of bacterial isolates was related to Enteropathogenic Escherichia coli (EPEC). Entamoeba histolytica appears as the most frequent parasitic causative agent. Increased rate of infection were falls on the first and second age groups, and also high rate of infection were recorded in males than in females.
Conclusion: pathogenic bacteria appear as the most predominant causative agent of infectious diarrhea in males under two years of age.
Key words: Childhood diarrhea, Infectious diarrhea in children, Acute gastroenteritis in children

BACKGROUND:Gastrointestinal bleeding (GIB) in infants and children is one of the more alarming conditions encountered in pediatrics. It is nonetheless an anxiety-provoking complaint. Most etiologies are self-limited and benign.
AIM OF STUDY:To review the causes of upper gastrointestinal bleeding and its clinical presentations in children and evaluate the role of endoscopy for diagnostic and therapeutic purposes.
PATIENTS AND METHOD:Fifty eight patients from 4 days old up to the age of 18 years who referred with upper gastrointestinal bleeding to the Gastro intestinal&Hepatology unit in the Children Welfare Teaching Hospital/ Medical City/Baghdad, in the period from 1st of April 2010 to 1st of November 2010.
RESULTS: there were 58 patients (34 males and 24 females) with male to female ratio (1.4:1), 58.5% presented with hematemesis, 5.2% had melena and 31.1% had both, 5.2% of patients presented with hematochezia . The most common causes of upper GI bleeding among all patients were esophageal varices (39%), gastric erosions (19.6%), duodenal ulcer (7.4%), gastric ulcer (9.7%), (4.9%) for Mallory Weiss syndrome and also (4.9%) for oesophagitis. The causes of bleeding could not be ascertained in (30%) of cases. (15.3%) of patients, there was a history of consumption of medications predisposing them to upper GI bleeding. Fifteen patients (25.8 %) had comorbid disease. There were three deaths (5.1%) in this study.
CONCLUSION: oesophagealvarices were the common cause of upper GI bleeding. Most patients presented with hematemesis. In children with upper GI bleeding, upper GI endoscopy provides an accurate diagnostic tool and also provides therapeutic intervention when needed
Keywords: UGIB upper gastrointestinal bleeding,CWTH children welfare teaching hospital

Background: Type 1 diabetes mellitus (T1DM) can be considered as an inflammatory disease of the pancreatic islets in which a process of programmed cell death (apoptosis) is elicited in the β-cells by interaction of activated T-cells and proinflammatory cytokines in the immune infiltrate. Interleukin-6 (IL-6) is a pleiotropic cytokine with a key impact on both immunoregulation and nonimmune events in many cell types .
Objective: to assess the level of serum IL-6 as an inflammatory marker in type 1 diabetic children, with correlation to FBG and HbA1c.
Subjects and methods: 45 type 1 diabetic child (20 males and 25 females), mean age 10.9± 3.4 years who attended the National Diabetic Center, Al-Mustansiria university were included in this study. 45 apparently healthy controls matched for age and sex were participated in this study .Fasting venous blood samples were collected from all the subjects. The serum was used for analyzing HbA1c, Fasting Blood Glucose (FBG) and IL-6, HbA1c was estimated by high performance liquid chromatography ,Serum glucose level was determined enzymatically and serum IL-6 was measured by enzyme linked immune sorbent assay.Analysis of data was performed using the statistically package for social science (SPSS) version 17.0.
Results: Mean serum IL-6 level in type 1 diabetic children were significantly higher compared to the healthy controls (30.9 Pg/ml ±10.85versus 10.57 Pg/ml±1.98 (P˂0.0001), and positive strong correlation was found between serum IL-6 and FBS, HbA1C ,BMI.
Conclusion: There is a low-level of chronic inflammatory state in type 1 diabetic children reflected by the level of serum IL-6, that may play a key role in the early stages of atherogenesis and the development of microvascular complications.
Keywords: type 1 diabetic children, interleukin-6, inflammation

Background: Rheumatoid arthritis (RA) disease activity plays a central role in causing disability both directly and via indirect effects mediated through joint damage. Evaluation of RA disease activity is therefore important to predict the outcome and effectiveness of therapeutic interventions during follow-up. Clinical disease activity index (CDAI) is new simple tool for measurement of disease activity.
Objectives: To assess validity and reliability of CDAI in comparison to disease activity score-28 joints (DAS28) in Iraqi patients with active RA.
Patients and Methods: Sixty nine Iraqi RA patients were included in this study. All patients were fulfilling the ACR classification criteria and active. Full history was taken and complete clinical examination was done for all patients. Patients’ age, sex, duration of the disease, number of tender joints, number of swollen joints, patient’s and physician’s (evaluator) global assessment by visual analogue scale (VAS) (0–10 cm) were recorded. Laboratory analysis included erythrocyte sedimentation rate (ESR). CDAI and DAS28 were measured to assess disease activity.
Results: Of 69 patients included in this study, there were 58 women and 11 men. Mean age of the patients was 45.65±12.26 years and mean duration of disease was 7.75±7.85 years. Mean DAS28 and CDAI were 5.86±1.24 and 30.07±14.07respectively.There was direct significant correlation between CDAI and DAS28 (r= 0.879, P< 0.001). Also we found good agreement between CDAI and DAS28 (Kappa = 0.795, P < 0.001). CDAI had sensitivity 90%, specificity 92%, Likelihood ratio (LR) 45.67, Area under the curve (AUC) 0.983 [95% confidence interval (CI) 0.933-1.000] (P value < 0.001).
Conclusions: CDAI is a valid and reliable measure for assessment of Iraqi patients with active RA in comparison to DAS28.
Key words: Clinical disease activity index, disease activity score 28 joints, rheumatoid arthritis activity

Background: Carpal tunnel syndrome (CTS) is one of common peripheral nerve disorder which involves an entrapment neuropathy of the median nerve at the wrist which occurs either due to primary idiopathic cause or secondary to systemic causes. The diagnosis of CTS is clinical and supported by neurophysiological analysis. Surgical intervention is the main treatment modality.
Objective: The aim of the present study is to evaluate the effectiveness of low level laser therapy (LLLT) to treat mild – moderate CTS cases.
Pateients and methods: The study involves 60 symptomatic patients complaining of CTS were divided into two groups. Group A was subjected to real LLLT by Gallium – Arsenide (Ga-As) laser (904 nm), whereas group B was subjected to sham laser. Thirty asymptomatic normal individuals as group C were subjected to real LLLT in the same protocol as that applied to CTS cases. The individuals were evaluated clinically and by nerve conduction studies (NCSs) at early time as baseline reading and immediately after the treatment and later on after two weeks from stopping the treatment sessions.
Results: LLLT showed significant pain reduction (70.9%) and improved latency and amplitude studies for sensory (16.7% and 29%, respectively) and motor (18% and 26%, respectively) median nerve fibers in patients group who were exposed to real laser therapy in comparison to sham group but normal individuals showed significant increment in motor amplitude (12%) after completing therapy sessions. Conduction velocity and minimal F wave latency studies did not show significant changes in all study groups.
Conclusion: LLLT is proved to be an effective, easy, handy, relatively safe, and noninvasive treatment modality for idiopathic CTS of mild – moderate severity. Broadening the spectrum of wavelengths and changing the power density and energy doses and enrolment of cases which has already been treated surgically still a hopeful view of using LLLT in CTS treatment for further investigations.
Keywords: Carpal Tunnnel Syndrome, Low Level Laser Therapy, Nerve Conduction Study, Visual Analogue Scale, Boston questionnaire.

Background: The nail organ has an important functional and aesthetic importance. Nail Growth Rate (NGR) has attracted the attention of many investigators not only due to the importance of the nail apparatus but also as a tool to reflect health.
Objective: To study the effects of smoking and age on nail growth.
Patients and methods:The study was conducted at the Department of Physiology and the Department of Dermatology, College of Medicine, University of Baghdad during the period from January 2011 to May 2011.
Nail growth measurement was performed by etching a T – mark on the nail plate of the right and the left thumbs with a wide bore needle. The vertical distance between the point of meeting of the T and the proximal nail fold was measured using (vernier). A second measurement was performed one month later. The difference between the 2 readings was divided by the number of days between the readings to give the NGR.
Results:The NGR was measured in a total of 106 subjects. The subjects were divided into 3 groups:
Group1 (Smoker male subjects): 23 subjects were included in this group. Their ages ranged between 20 and 59 years with a mean of 35.87 +11.72 years. Group 2 (Non-smoker male subjects): 34 subjects were included. Their ages ranged between 13 and 52 years with a mean of 31.76 + 10.16 years.Group 3 (Non-smoker female subjects): 49 subjects were included. Their ages ranged between 8 and 58 years with a mean of 27.49 +11.66 years. NGR measurement in:
Group 1:The mean growth rate in the right thumb was 95.4 + 28.8 microns/day, and for the left thumb was 96 + 34 microns/day.
Group 2:The NGR was 105.6 + 34.35, and 103.4 + 34.24 microns /day, for the right thumb and the left thumb respectively. .
Group 3: The NGR was 100 .5 + 33.52 microns/day for the right thumb and 101.6 + 31.77 microns /day for the left thumb.
Conclusion: Age was inversely correlated with nail growth in right and left thumbs in all groups. The duration of smoking and number of cigarettes was inversely related to nail growth, but it did not reach statistical significance.
Keywords: Nail growth rate, smoking, age

Back ground: Chronic hepatitis C (HCV) is the most common chronic liver disease at present, and HCV infection is found with variable prevalence in dialysis populations in different parts of the world.
Objective: The aim of this study was to determine the concentration of sialic acid and immunoglobulins level in the sera of patients with chronic renal failure whom infected with Hepatitis C virus, and the effect of hemodialysis on them.
Patients&Methods: Regarding to this aim, total sialic acid levels (TSA) and immunoglobulins level were studied on the blood samples of 20 patients with chronic renal failure + Hepatitis C virus (positive group) and 20 patients with chronic renal failure (negative group) and 20 healthy volunteers. Serum TSA determinations were carried out by the resorcinol method.
Results: In (positive group), the mean of TSA concentration (after hemodialysis treatment) was 68 ± 2.9 mg/dl, and the mean of TSA concentration in (negative group) was 110.7 ±7.5 mg/dl, while the mean TSA level in healthy control group was 58.3 ± 1.7 mg/dl. Its has been that this increase may be due to the increased synthesis and catabolism of glycoproteins and glycolipids in chronic renal failure patients. Also, this study aimed to assess serum concentration of immunoglobulins: IgG, IgM and IgA. Serum IgG was increased in patients of (positive group) and (negative group) with respect to control healthy (6.1, 5.5, 5.4 respectively) (p<0.05).There was no significant difference between the third groups in serum IgM concentration (6.6, 6, 6.2 respectively).Also in serum IgA concentration (5.8, 6, 5.5 respectively).
Conclusion: We conclude that the TSA levels in the first groups both were found to be significantly elevated as compared to control levels (p<0.05), and Hepatitis C virus are linked to selective increase of serum IgG.
Key Words: Hepatitis C virus, Hemodialysis, Sialic acid, Immunoglobulins.

Background: He-Ne laser (632.8 nm) pre-irradiation may lead to modulate the damaging effects of ionizing radiation and decreasing in radiation damage on cells, by the induction of antioxidant defence mechanisms and accelerated the repair.
Objective: To study the protection properties of He-Ne laser (632.8 nm) pre-irradiation against UV light (253.7 nm) damage on human lymphocyte blood cells and its DNA.
Subject & Methods: 27 samples were processed only for lymphocyte blood cells separation, while a 45 samples for the extracted DNA from lymphocyte. The total of 72 samples were employed to evaluate the influence of He-Ne laser pre- irradiation against UV-light.
Results: The results showed that He-Ne laser (632.8 nm) pre-irradiation on human lymphocyte blood cells and its DNA leads to a decrease in the damage which caused by UV light (253.7 nm) irradiation.
Conclusion:The magnitude of protection depends on the He-Ne laser pre-exposure doses. A higher survival percentage of lymphocyte blood cells and its DNA occurred with low He-Ne laser dose.
Keywords:He-Ne laser (632.8 nm) irradiation, UV-light (253.7 nm) irradiation, lymphocyte blood cells and its DNA protection.

Background: Diabetes mellitus (DM) causes damaging effects on the cardiac function; these effects can be observed on the diastolic performance of the heart reflected on the change in transmitral blood velocity, the cardiac wall and septum thickness.
Objectives: The present study was to assess the diastolic and systolic cardiac muscle performance for patients with type 2 diabetes mellitus compared with control individuals and to evaluate the index of myocardial performance.
Patients and Methods: The study involved 97 patients (35 male and 62 female of average age of 56.2 ±10.755) of type 2 diabetes mellitus (DM), they were investigated for their left ventricle performance and compared with 51 normal individuals "the control group" (20 male and 31 female of average age of 41.4 ± 13.196).
Measurements of isovolumetric contraction time IVCT, ejection time ET, ejection fraction EF%, isovolumetric relaxation time IVRT, the early and late peak velocities E and A of transmitral flow, left ventricle diameter in diastole and systole LVIDs, LVIDs, posterior wall thickness PWTd, and Interventricular septum thickness in diastole IVSTd were measured, and index of myocardial performance IMP was calculated.
Results: Results reveal differences in these parameters for patients group relative to controls, in IVRT, ET, E, A, E/A, EF%, IMP, LVIDs, PWTd and IVSTd all are strongly significant with p value <0.001and for FS% p value = 0.0029 except for IVCT the change was 9.342% with p value 0.188 and the change in LVIDd -3.586%, p value 0.052 were not significant.
Conclusion: Diabetes mellitus can cause a deleterious effect on the myocardium. The effect causes impairment in the cardiac diastolic performance and muscle contractility caused by the damage inflicted by hyperglycemia (high blood sugar). Also results show that IMP is increased in type 2 DM patients. This increase may be an early sign of diabetic cardiomyopathy in diabetic patients.
Key words: Diabetes mellitus, Echocardiography, Index of myocardial performance (IMP).

Background: Tumor markers are often requested as part of a diagnostic workup, and increased concentrations in serum may suggest malignancy of a particular organ. However, definitive diagnosis is based on histological evaluation of the involved tissue.
Objective: The aim of present study is to evaluated CEA and CA15-3 in order to clarify at least in part their possible use as an early diagnosis tools in sera of patients with stomach, colon and rectum cancers.
Patients and methods: The study was carried out on 61 subjects comprising of 16 patients with colon cancer group (G1), 10 patients with rectum cancer group (G2), 10 patients with stomach cancer group (G3) and 25 normal healthy control The patients were selected, during the period from (February 2010 to January 2011) with age range of (40-55) years. The patients were admitted to Al khadmiya Teaching Hospital, Iraq for treatment. Serum CA15-3 and CEA were measured by enzyme linked immunosorbent assay (ELISA).
Results: The serum value of CA15-3, was highly significant increase (p0.001) in G1 and G2 cancer groups compared to normal healthy subjects. while the serum value of CEA of G1 and G2 was a significant increase (p0.05)compared to control but CA15-3 and CEA in serum of G3 showed no significant difference(p>0.05) compared to control.
Conclusions: In this study CA15-3 and CEA could not be of valuable use as diagnostic markers in serum of stomach cancer while in colon and rectal cancers are of useful value.
Keywords: CA15-3, CEA, Tumor markers, Colorectal cancer, stomach cancer.

Background: Patients with chronic renal failure undergoing longterm hemodialysis (HD) are prone to atherosclerosis and at increased risk of developing cardiovascular diseases.
Objective: The objective of this study is to compare atherogenic index of plasma (AIP) in predicting the risk of cardiovascular disease (CVD) in patients with chronic renal failure (CRF) on regular hemodialysis, when associated with other chronic diseases.
Patients and methods: A total of forty male patients with CRF on hemodialysis, matched in, age, body mass index BMI, and duration of hemodialysis were enrolled. They were grouped as group 1 (G1) includes eleven subjects with CRF without (hypertension and / or diabetes) groups 2 (G2) fourteen CRF subjects with hypertension and group 3 (G3) fifteen CRF subjects with diabetes. As a control group, eighteen healthy male subjects were included with special exclusion criteria. The plasma total cholesterol TC, triglyceride TG, and high density lipoprotein-cholesterol HDL-C were estimated using spectrophotometry methods. While low density lipoprotein-cholesterol LDL-c, and AIP were calculated using special formulas. Statistical analysis was performed by the student t-test.
Results: The results of the study revealed significant increase in TC and TG, with significant decrease in HDL-c for all patient groups compared to control. No significant difference in LDL-c of G1 compared to control was found, while significant increase in LDL-c of G2 and G3 was found when compared to G1 or control. The AIP values were (0.42 ± 0.19 vs 0.43 ± 0.17; P>0.05) for G1 and G2 respectively, that showed no significant difference of atherogenic risk between these groups.
Conclusions: These results concluded that AIP seems to be superior to LDL-c in predicting the risk for CVD in CRF groups on hemodialysis and those at the highest risk when CRF coupled with diabetes.
Keywords: AIP: atherogenic index of plasma, CRF: chroic renal Failure, hemodialysis.