Journal of the Faculty of Medicine Baghdad

Summary:
Background: Relapse is defined as recurrent tuberculosis at any time after completion of treatment and apparent cure Recurrence of tuberculosis may occur as a result of relapsed infection due to the same Mycobacterium tuberculosis strain, or due to exogenous reinfection with a new strain.
Objective: To study the factors associated with relapse of pulmonary tuberculosis.
Methods:. Across sectional study had been done in the chest and respiratory diseases teaching specialized center in Baghdad during the period from the 1st of January 2010 to the 30th of July 2011. A total of 58 patients with relapsed pulmonary tuberculosis were included in this study. For each patient.the fallowing variables were collected age, gender, marital status, regularity of treatment, diabetes mellitus, smoking, alcohol intake and prisonment have been studied.
Results: Mean age for all relapsed cases was 47.4years.A 53patients(91.4%) of relapse cases were married. There was only 30 patients(51.7%)of relapse cases regular on treatment. It was 15 patients (25.9%) contribute to about one forth (25.9%) of relapsed cases was diabetic. There was 28 patients (48.3%)of relapsed cases was smokers. A17 patients (29.3)% of them was prisons.Finaly 13 patients(22.4%) of relapsed cases had history of alcoholic intake.
Conclusions: Recurrence of tuberculosis was more common in male, married, diabetic, prisoners, and history of alcohol patients and patients presenting at least one of the risk factor can benefit from the implementation of a post-treatment surveillance system for early detection of recurrence.
Keywords: PTB : Pulmonary Tuberculosis.

Summary:
Background: Venous thromboembolic disease (VTED) is a well known complication that occur following total knee arthroplasty (T.K.A). One of the (VTED) forms is asymptomatic deep venous thrombosis with an incidence has been estimated to be up to  20% in patients undergone primary T.K.A , despite routine treatment with heparin postoperatively.
Objectives : is to assess the prevalence of post-operative asymptomatic D.V.T among patients receiving two different thromboprophylactic drugs after T.K.A.
Patients and methods: 68 patients who had T.K.A were randomly divided for the purpose of post-operative thromboprophylaxis into two groups , group [ A ] (control group) consisted of 35 patients received heparin, and group [B] of 33 patients received low molecular weight heparin (L.M.W.H) (enoxaparin) subcutaneously. Both groups were given the drug for two weeks post-operatively, then aspirin untill the 6th week after surgery. Bilateral Duplex U/S performed preoperatively and postoperatively at 5-7 days. The third ultrasonography was performed on the third week after surgery on all patients. the evaluation of the result expressed as primary efficacy outcome which was the composite of D.V.T (either symptomatic or detected by Ultrasonography if the patient was asymptomatic). Non-fatal pulmonary embolism or death from any cause at 42 days after surgery, were also evaluated with a confidence interval (C.I.)
Results: The overall incidence of asymptomatic D.V.T was 2.94% (2 in 68 patients). Those two patient were in heparin group; (group [A]) which represent 11.4% that is highly significant, while no cases (0%) reported among enoxaparin group; Group [B].
Conclusion: Enoxaparin significantly lowered the prevalence of deep vein thrombosis (D.V.T.) after T.K.A.
Key words: D.V.T, enoxaparin, heparin T.K.A

Summary:
Background: revascularization therapy for patients with left main (LM) and/or three vessel coronary disease is a matter of argument for long a time whether bypercutaneous coronary angiography orcoronary artery bypass grafting. SYNTAX trial was designed to assess the optimal revascularization strategy between percutaneous coronary intervention and coronary artery bypass grafting, for patients with left main stem coronary artery disease and/or 3-vessel coronary disease.
Objectives : To estimate the complexity of coronary artery disease in patients referred to a tertiary Iraqi cardiac center and its effect on mode of revascularization.
Patients and Method: Ninety nine patients who were referred to Iraqi center for heart disease from July to December 2010 withthe diagnosis of CAD were included. Full history, clinical examination, biochemical tests ( blood sugar ,total cholesterol , blood urea and serum creatinine) were checked, electrocardiographic and echocardiographic characteristics were analyzed .All patients underwent diagnostic angiography andSYNTAX score calculator was applied and the SYNTAX score was recorded.Patients were divided into two groups : group A , thosewho were planned for PCI and group B who were planned for CABG .
Results: Mean age of the patients was 57.6±10.6, ranging 19-80 year, male were more than female (75.8% vs. 24.6%). Risk factors prevalencewas DM (42.6%), high blood pressure (52.8 %), smoking (42.4%), hypercholesterolemia (43.4%) and prior MI (32.3%).
Mean age of group A was 54.22±11.27 while group B was 62.37±7.47 (P value 0.0001) . There was no significant difference in risk factors prevalence between group A and B ( DM 36.2% vs.51.2% p=0.31), hypertension(53.4% vs.53.3% p=0.98), smoking (41.3% vs.43.9% p=0.8), hypercholestoemia (31% vs. 60.9%),ejection fraction<50% ( 20.6% vs. 24.3% ) (p=0.66). All patient with left main steam disease 13 (31.7%) passed to CABG group.
Mean total SYNTAX score for all patients was 16.7±6.5. Mean SYNTAX score were (10.24±6, 26.01±7.7) for group A and B respectively (P value 0.00001).
Conclusion: Patients with lower SYNTAX score were managed by PCI. Iraqi patients treated with PCI have lower syntax score than that in SYNTAX study, while those who were treated by CABG, were comparable to that in SYNTAX study.
Key words: CAD, SYNTAX score, revascularization

Summary:
Background: There is an epidemic of several non communicable diseases and metabolic abnormalities in humans including hypertension, obesity, hyperlipidemia, low high density lipoprotein cholesterol, microalbuminurea, and insulin resistance. These diseases and metabolic abnormalities have been collectively classified as metabolic syndrome and are closely associated with type 2 diabetes and other health problems including death.
objectives: To investigate the prevalence of metabolic syndrome among type 2 diabetic patients in Baghdad teaching hospital,the frequency, and distribution of risk factors according to gender groups in our studied patients with metabolic syndrome in order to have an idea of the commonest possibly treated and prevented risk factors to decrease morbidity and mortality of metabolic syndrome.
Patients and methods: A cross sectional study was done during the period 1st March 2011 till the 1st of March 2012, a sample of 220 patients with diabetes mellitus who accepted to take part in this study was recruited. All patients were subjected to clinical examination and laboratory tests according to the updated ATP111 criteria, in which we measured blood pressure,waist circumference, fasting blood sugar, fasting high density lipoprotein level and fasting triglyceride level, these data were analyzed by Statistical package for social science version 18.
Results: There were 220 patients with mean age of (54.52± 9.5), male to female ratio 1.4, metabolic syndrome was present in 41.8% (92) and 58.2% (128) had no metabolic syndrome . The frequency of positive risk factors in association with metabolic syndrome were, for the waist circumference 114 patients (51.8%), high triglyceride level 65 patients (25.5%), low high density lipoprotein level 10 patients (4.5%), hypertension ≥ 130/85 mmHg 117 patients(53.15%) and fasting blood sugar 220 patients (100%).
Conclusions: The study showed that metabolic syndrome prevalence still an important factor for the morbidity and mortality of Iraqi patient in spite of its low prevalence compared to other similar studies.
Key Words: metabolic syndrome,type 2 diabetes mellitus.

Summary:
Background: The World Health Organization has declared that obesity is a disease of pandemic significance. The number of performed bariatric procedures has rapidly and considerably increased over the past decade. The most frequently performed and best studied procedures are laparoscopic gastric banding (LAGB), laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB).
Objectve: To provide a critical appraisal of the most important scientific evidence comparing the short term outcomes of these three weight-reduction procedures (laparoscopic gastric banding (LAGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic Roux-en-Y bypass (LRYGB)) using retrospectively collected data for patients with morbid obesity in Iraq.
Patients and Methods: Between August 2010 and November 2012, three types of bariatric operations (LAGB, LSG, LRYGB) were performed in a hospital in Baghdad for patients with morbid obesity by the same team. A total of 32 patients underwent LAGB operation (21 women and 11 men) with a mean age of years = 33.77 (range 16 to 52 years), and of the 29 patients underwent LSG operation (22 women and 7 men) with a mean age of years = 33.86 (range 20 to 52 years) and of the 9 patients underwent LRYGB (7 women and 2 men) with a mean age of years= 35.11 (range 25 to 45 years). Thereafter patients were followed up monthly for the first 3 months postoperatively.
Results: Using statistical Package for the Social Sciences Software (SPSS) version 15,we found the mean weight loss 1 month after surgery was 10.97kg (range 5-25 kg) for LAGB, 12.34 kg (range 6-21 kg) for LSG and 12.33 kg (range 10-20kg) for LRYGB. Mean weight loss 3 months after surgery was 18.81kg (range 7-38 kg) for LAGB, 22.48kg (range 10-59 kg) for LSG and 24.33kg (range 16-40kg) for LRYGB.
Conclusion: The results from our study showed that all the studied procedures had a significant weight reduction rate in the first three months post operatively and that LRYGB is superior to the LAGB and LSG in weight reduction, although, all procedures are associated with marked weight loss. The age of the patients did not influence the decrease in BMI or affect the type of the procedure in weight reduction for the studied group. The results of this study do not diverge from those previously reported in the literature regarding the complications and the resolution or at least
improvement of medical co-morbidities after these three procedures had been proved in this study.
Keyword: laproscopy . Barialric, Surgery, Iraq.

Summary:
Background: Pneumonia is a common form of lower respiratory tract infection (LRTI) in children under five years of age and it is the leading cause of morbidity and mortality in this age group. Early management is important in decreasing its complications and mortality.
Methods: A cross sectional study of 100 patients, their ages ranged from 2 months to 5 years. They were admitted to Children Welfare Teaching Hospital Medical City–Baghdad in a period from 7th of November 2010 to 5th of May 2011, suffering from Lower Respiratory Tract Infections (fever, cough and tachypnea) and classified into two groups according to chest radiograph (CXR) findings, those with a patch (pneumonia) and others with normal or hyper inflated CXR. The possibility of various demographic and clinical symptoms and signs to predict the presence or absence of the patch were evaluated.
Results: From a total of 100 patients enrolled in this study, 42%had a patch and 58% had normal or hyperinflated CXR. Older age, male gender, longer duration of hospitalization, high level of paternal education and family history of same disease are significantly associated with the presence of patch. Signs and symptoms like deterioration in the level of consciousness, lung crepitation and decrease in air entry and convulsion are significantly associated with the presence of the patch.
Conclusion: Pneumonia is frequent in children with LRTI. Presence of convulsions, deterioration in the level of consciousness, lung crepitation and decrease in air entry in a child with LRTI may raise the suspicion of having pneumonia. Factors like older age, male gender, and high level of paternal education were associated with increase the susceptibility to have pneumonia in children with LRTI.
Key word: children; predictors; pneumonia.

Summary:
Background: Big birth weight is one of the important factors affecting the perinatal morbidity & mortality. It may result in an irreversible squeal because of birth trauma & fetal asphyxia.
Objectives: to compare the short term outcomes of macrosomic infants born to diabetic and non-diabetic mothers.
Patients & Methods: This is a prospective study of 50 singleton macrosomic newborns weighting 4000 g & more aged 1-3 days admitted in the neonatal care unit of Children Welfare Teaching Hospital & Baghdad Teaching Hospital during a 6 months period from 1st of March to 1st of September 2010. The maternal & neonatal records were reviewed & infant morbidities including hypoglycemia, respiratory distress, feeding intolerance, birth injury & associated anomalies were discussed. All the infants were followed until they were discharged from the hospital.
Results: Infants of diabetic mothers (52%) were more likely to develop neonatal morbidity compared to infants of non diabetic mothers (48%), these include hypoglycemia (76.9% vs. 8.3%), Respiratory distress (61.5% vs. 37.5%), and birth injury (7.7% vs. 4.2%) & nearly equal incidence of feeding intolerance (11.5% vs. 12.5%). Associated anomalies especially congenital heart disease (10%) found in infant of diabetic mothers only.
Conclusions: Most of birth weight variation remains unexplained & most non-IDM macrosomic infants do not have identifiable risk factors. Macrosomia is generally associated with neonatal morbidity & neonatal injury. The potential dangers of birth injury in vaginal delivery have increased the rates of cesarean section to (68%). Infants of diabetic mothers have a higher rate of neonatal morbidity overall including hypoglycemia, respiratory distress, birth injury & congenital heart disease.
Keywords: Outcome, Infants, Macrosomic neonates, Diabetic mothers, non-Diabetics mothers

Summary:
Background: Respiratory distress remains a major problem post adaptation and one of the most common reasons for admission of neonates to Intensive Care.
Objectives: To study the causes and short term outcomes of respiratory distress in full term neonates and its correlation to mode of delivery.
Patients and Methods: A cross sectional study was carried out on 100 full termoutborn neonates with respiratory distress admitted to Neonatal care unit of Children Welfare Teaching Hospital, Medical City, Baghdad from 1st of April to 31st of August 2011.
Results: Hundred full term neonateswerestudied, 66% were boys and 81% born by cesarean section (elective cesarean sectionin 62%). In both sexes, Transient TachypneaofNewbornand pneumothorax ranked the 1st and 2nd among other causes.Among boys, early onset sepsis/pneumonia ranked 3rd, whereas late pneumonia and hyaline membrane disease among girls.The proportion ofTransient TachypneaofNewborn was higher in those who were delivered by cesarean section(86.66%).There was no significant correlation between the mode of delivery and respiratory distress in congenital heartdisease, birth asphyxia, meconium aspiration andtracheoesophagel fistula.The case fatality was 100% in birth asphyxia, 16.66% in sepsis/pneumonia, 9.09% in hyaline membrane disease and 5.88%in pneumothorax.
Conclusions:Transient tachypnea was the commonest cause of hospitalizations among term neonates with respiratory distress. Elective cesarean sectionwas correlated with neonatal respiratory distress.
Key Words: Respiratory Distress, Full Term Outborn neonates

Summary
Background: Rotavirus infection is the most commoncause of watery viral diarrhea in children younger than 5 years of age; it is a major cause of childhood morbidity and mortality.
Objective:The aim of the study is todetermine the clinical picture, age distribution of patients with rotavirus infection and their maternal educational background.
Patients &methods: A total of 202 patients suffering from diarrhea were included in this study, over 6 months period( from 1stof March 2011to 30th of August 2011),in Children Welfare Teaching hospital. History and physical examinationwere carried out, anthropometrics measures were done and plotted on Centers for Disease Control& World Health Organization charts to determine the nutritional status.Stool was collected for General stoolexamination, stool PH, stool culture and stool for rotavirus antigen.
Results: The study showed that41 children out of202 were rotavirus positive (20.29%) , and (192) (94.69%) of diarrhea occur below 2 years of age mainly between 6-12 months old(138) (68,32%), most of the mothers of the patients were illiterate (78)(38.6%),all of the patients were dehydrated and with the other clinical features( diarrhea ,vomiting ,fever).Most of the cases of rotavirus infection occurred with mixed feed children23/41(57%).
Conclusions: Rotavirus infection is an important cause of diarrhea especially in the last 6 months of the first year of life.Poor maternal educationis risk factors in occurrence of diarrhea.
Keywords: watery diarrhea, rotavirus infection.

Summary:
Background: The use of nitrous oxide- oxygen alone for the maintenance of general anesthesia in obstetrics is associated with an unacceptable incidence of awareness. We have to add inhalational anesthetic drug. But still there is a complaint from the obstetricians regarding the triggering effect of Hallothane on uterine muscle relaxation Isoflurane is inhalational anesthetic drug and recently brought to Iraq.
Objectives : The aim of this study is to evaluate and compare the effect of halothane & isoflurane on uterine muscle contraction in caesarian section.
Patient and method: This is a prospective study done on 40 patients in Medical city hospital /Baghdad /Iraq. They were randomly allocated to either the isoflurane group or halothane group ,(each of 20 patients) . Caesarian sections under Standard general anesthesia were donefor all the patints. Time from the delivery of fetus to full uterine contraction was estimated. Also the surgeon graded uterine relaxation on a ten centimeter visual analog scale; the zero point indicated none & the 10 mark sever relaxation respectively.The need for supplementary doses of oxytocin were recorded.
Results: The surgeons' assessments of uterine relaxation indicated that it was significantly less with isoflurane (P- value less than 0.05 ) and only one patient in the isoflurane group required additional oxytocin as compared to one patent in halothane group. The time required for complete uterine contraction after delivery in patients given isoflurane revealed significant decrease than patients given halothane (P- value less than 0.05 ).
Conclusion: Isoflurane's effect is less than that of halothane on uterine muscle relaxation during caesarian section . This decreases the incidence of awareness during anesthesia.
Key words :isoflurane, halothane, ceasarean section

Background: Although pain after laparoscopic cholecystectomy is less intense than after open Cholecystectomy, some patients still experience considerable discomfort, and use of local anaesthetics irrigation is controversial.
Objectives : to evaluate the effect of intraperitoneal and port site instillation of local anaesthetics on pain relief in the first 6 hours postoperatively.
Patient and Method: Forty patients underwent elective laparoscopic cholecystectomy were included in this study and sample was divided into two equal groups. Group A received 20 ml of 0.9% normal saline instilled in the gallbladder bed, while group B received 20 ml of 0.25% bupivacaine instilled in the same region and 10 ml of 0.5% bupivacaine in divided doses at the trocar sites. The evaluation of postoperative pain was done at fixed time interval according to the numerical rating scale,and the request time of analgesics, pain site and vital signs were recorded.
Results: Pain score showed significant difference only at 0h and 1h with p-value <0.05, otherwise there was no significant differences in the following hours. Request for analgesia showed no statistically significant differences.
Conclusions: Intraperitoneal irrigation of bupivacaine is not so effective in decreasing pain after laparoscopic cholecystectomy.
Keywords: Bupivacaine; cholecystectomy; laparoscopy; pain; intraperitoneal irrigation

Background: The events in pregnancy elicit one of the best examples of selective anatomical, physiological and biochemical adaptations, with profound changes in respiratory physiology. The changes in respiratory physiology are due to increased size of the fetus with advance gestation which constitutes a mechanical impediment to normal process of ventilation.
Patients and methods: This study started from the 1st of Nov. 2009 till the 30th of Oct. 2010. pregnant women aged (16-44 years) of different weight, height and different conception from 1st, 2nd, 3rd trimester and post term were included. Spirometry was performed in Baghdad teaching hospital( pulmonary function unit) .
Result: FEV1/FVC ratio was found to be higher in the studied group as compared to the control group. The decrease in forced expiratory volume in one second (FEV1) with pregnancy is not of such amplitude as the decrease in forced vital capacity (FVC), so that the FEV1/FVC ratio was seen to increase. Decrease in FEV1, forced expiratory flow rate (FEF 0.12-0.25, 0.25-0.75) and peak expiratory flow rate (PEFR).
Conclusions: This study informed that FEV1, FVC, (FEFR 0.12 -0.25, 0.25 -0.75) and peak expiratory flow rate values decreased during each stage of pregnancy.
Keyword: pregnancy, spirometry.

Background: Many parents of autistic child do well despite their child’s disability, they have the ability to withstand hardship and rebound from adversity, and becoming more strengthened, parents have managed to overcome the constant challenge by using their resilience to adapt well in the face of adversity.
Objectives: The study aimed to assesses the level of parents' resilience with autistic childandtofind out the relationship between parents' resilience and some child characteristics such as child gender, child age, child age at diagnosis, type and place of treatment; also to the parents characteristics such as parents' gender, age, mother age at child birth, educational level, marital status, occupation, income, number of children in the family, and number of autistic children in the family.
Patients and Methods: A Descriptive analytical study was carried out from May 25, 2009 to June 20, 2010 in order to determine parents' resilience in dealing with the impact of raising a child with autism. A purposive (non-probability) sample of (100) parents raising a child with autism who was attending the out patient psychiatric clinic at Child's Central Teaching Hospital in Baghdad City. Data was collected by filling the questionnaire .The questionnaire form consist from two parts; the first part is concerned with the demographic characteristics of the child and demographic characteristics of the parents; the second part consists of six domains of resilience and contains 34 items that describe the parents' resilience.
Results: Results of the study indicate that parents of autistic child experience moderate level of resilience level of resilience; also there were significant differences between parents' resilience and types and place of treatment, mothers' age at child's birth,level of education, and income.
Conclusions: The study concludes that parents have to face burden to provide necessary care for their child; despite the many difficulties associated with autism; they can maintain a solid familial life style.
Key words: Parents' Resilience, Autistic child

Background: type 1diabetes (T1DM) is a form of diabetes mellitus that results from autoimmune destruction of insulin-producing beta cells of the pancreas, leading to permanent insulin deficiency ,categorized as either being positive or negative for various auto antibodies related to pancreatic function .An anti glutamic acid decarboxylase autoantibody(Anti-GAD) is recognized as one of the major serological markers for type 1 diabetes mellitus.
Objectives: to determine the prevalence of the immunological marker (Anti-GAD) among a sample of type1diabetus mellitus patients and to identify some factors that might be associated with its seroposivity.
Method: A cross-sectional retrospective study was carried out during February to May, 2011 in specialized diabetic clinic of Children Welfare Teaching Hospital, Baghdad .The study sample included 120 type1diabetus patients for whom(Anti-GAD) had been determined, patients reports were studied and analyzed statistically.
Results: The demographic characteristics of this studied sample with higher percentage 57.5% of females, 46.7%in the age group 10-14 years, 12.5% had family history of other autoimmune diseases and the majority 69.2% had healthy Body Mass Index (BMI).while the clinical characteristics revealed higher percentage 47% with onset of the disease (5-9) years, 64.2% having a duration of disease (1-4)years ,86.7% presented with classical type of presentation and 52.5% had good control of diabetes . The prevalence of Anti-GAD in this studied sample was 66.7%. Seropositivity of Anti-GAD was significantly associated with delayed age of patients at diagnosis with mean age (7.5± 3.25) years, short duration of the diseases with mean (3.85±2.57) years, female gender (65%) compared to (35%) of male gender had positive Anti-GAD test, while seropositivity of Anti-GAD was not related to other study variables (age of patients, control of diabetes mellitus, BMI, and family history of other autoimmune disease).
Conclusions: High prevalence of Anti-GAD and its titer in this studied sample, seropositivity was related mainly to female gender, delayed age at diagnosis and short duration of diabetes.
Keywords: type1 diabetes mellitus, immunological marker (Anti-GAD)

Background: Chronic lymphocytic leukemia (CLL) is a low-grade B-lineage lymphoid malignancy. Both Ki-67 which is a large nuclear protein associated with cell proliferation and Bcl-2 which is an anti-apoptotic protein which is associated with dysregulation of the intrinsic apoptotic pathway , were thoroughly investigated in many cancer patients particularly in hemopoietic malignancies .
Patients, materials and methods: This retrospective study was conducted from November 2009 to May 2010 , on fifty formaline fixed paraffin embedded blocks of CLL cases retrieved from Medical City Teaching Hospital ; their age range was 39-75 years along with twenty control cases with benign reactive marrow , The sections of bone marrow biopsies were processed routinely in Al-Kadimiya teaching hospital laboratory and stained with H&E and the expression of Bcl2 and Ki67 was evaluated by light microscope. Smears stained for Bcl2 were classified according to the scoring system used by Soini Y,et al. ,whereas those stained for ki67 were evaluated by estimation the percentage of positive stained nuclei in the smears as was adopted by Diop S,et al.
Results: Immunohistochemical staining of CLL cases revealed that 11/50 cases (22%) were positive for Ki67 showing diffuse or granular nuclear brown stain , whereas all control cases were negative for the marker . Those positive cases significantly correlate with modified Rai system , Hb concentration and platelet count ,but they did not significantly correlate with white blood cell count or lymphocyte % in the bone marrow and peripheral blood smears . Regarding Bcl 2 , 32/50 cases(64%) were positive for the marker showing diffuse cytoplasmic brown reaction ,however no significant correlation was found between Bcl2 score and modified Rai system or with any of the mentioned hematological parameters .Finally , there was no significant correlation between Ki67 and Bcl2 expression .
Conclusions: The proliferative marker Ki-67 expression closely related to the clinical stage of CLL patients , thus it could be considered as an informative and simple tool for assessing disease activity . On the other hand ,although Bcl2 expression was high in CLL patients but it did not related with the clinical stage of those patients . Finally . Ki67 and Bcl2 were independent markers and no correlation was found between them as they act on different pathways since ki67 is a proliferative and Bcl2 is an antiapoptotic marker.
Keywords : Bcl 2 , Ki 67 , CLL

Background: Hepatitis G virus and GB virus C (GBV-C) RNA viruses that were independently identified in 1995, and were subsequently found to be two isolates of the same virus. Blood transfusion is the main risk factor for HGV transmission Immune-mediated mechanisms are believed to play an important pathogenic role in hepatitis G virus infection. Interleukin-1 (IL-1) plays an important role in the inflammatory process. implying that IL-1 may play a role in viral clearance and suggesting that IL-1 has direct antiviral activity, so that IL-1 induces novel antiviral pathways within a cell. Interleukin 10 ( IL-10 )is secreted by T helper-2 type cells (Th2) which may down regulate cell-mediated immune effecter mechanisms important in the host defense against intracellular pathogens.
Objectives : This prospective study aimed to estimate interleukins 1 and 10 levels in acute hepatitis (G) in Iraqi patients with leukemia
Methods: This cross sectional study was carried out at the national center of hematology , almustansiriya University and department of microbiology in Baghdad medical college in Baghdad, Iraq from January till August 2012. The study involved 33 patients (19 males & 14 females) diagnosed with hepatitis G infection as having a positive IgM antibodies by ELISA technique .Serum IL-1 and IL-10 levels were measured in 33 patients with hepatitis G virus infection and 40 leukemia patients without HGV infections as a control group by ELISA technique .
Results: Twenty three patients (70%) with hepatitis G infection had elevated serum IL-1 alpha levels (the normal detection level is below 5 pg/ml), the patient serum IL 1 alpha range 2-37 pg/ml, with a mean 27.813 and SD 32.765 ). There was also a high significant correlation between serum IL-1 alpha level and hepatitis G infection (p value= ± 0.004) when compared with the control group by the t –test Also serum IL-10 level was below the normal detection limit (5-20 pg/ml) in 20 (60%) patients .The 33 patients had serum IL-10 levels (range 0.6 - 9 pg/ml, with a mean 2.213 & SD± 4.745 ) . There was a significant correlation between serum IL-10 level & hepatitis G infection when compared with the control group (p<0.0386 by t- test),so the viral infection may suppress the T helper 2 cells by the gamma interferon . This elevation in IL1 alpha which is an inflammatory cytokine produced by antigen presenting cells , may suggest that IL-1 is an important interleukin to eradicate hepatitis G virus infection.
Conclusions: This study showed that serum Th2 cytokines are suppressed (IL10 ) while serum inflammatory cytokine (IL 1 alpha ) is elevated in a proportion of patients with hepatitis G virus infection. However, the elevated IL 1 alpha cytokine levels may represent a systemic response and not as a result of increased local production within the liver.
Keyword : Hepatitis G virus , interleukin 1, interleukin 10 .

Background: Staphylococcus aureus infections are growing problems worldwide with important implications in hospitals. The organism is normally present in the nasal vestibule of about 35% apparently healthy individuals and its carriage varies between different ethnic and age groups.
Objective:To study the antibiotic resistance of staphylococcus aureus isolated from nasal cavity of Health Care Personnel.
Patients and methods: A total of 180 samples were collected from the nose of the two groups (health care personnel, community control) at Baghdad Teaching Hospital. They were screened for nasal colonization with S.aureus during the period between April 2012 to September 2012, by using a sterile cotton swabs.
Results: Nasal swabs with Staphylococcus aureus which isolated from health care personnel was 40%, while in community control was 33.33%.
Conclusion: High prevalence rate of S. aureus nasal carriers was found among health care personnel of Baghdad Teaching Hospital. The highest rate was found in sub staff group. And among community control, high prevalence rate of S.aureus nasal carriers was found in the school students. All isolates of S. aureus were resistant to pencillin G, ampicillin, and erythromycin. Vancomycin was the most effective drugs against S.aureus, isolates and followed by rifampicin and fusidic acid.
Keywords: Staphylococcus aureus, Antibiotic resistance.

Background: Gastroenteritis is a common illness in pediatric age group; the causes could be bacterial, fungal or viral infection. Rotavirus is the most common cause of infectious diarrhea in children. Children between 3 months to 2 years old have the most severe symptoms. Rotavirus is extremely easy to catch and is transmitted mainly by the oral- fecal route. For diagnosis; the specimen of choice is the stool which has been collected during the first 3 to 5 days of illness. If collected 8 or more days after onset of symptoms the specimen will rarely contain the virus.
Objective: The objective of this study includes a survey for Rotavirus that cause diarrhea in children admitted to Children Welfare Teaching Hospital in Baghdad between 13th. of Juanuary-2010 to 14th.of October-2010 using a rapid test method for detection of Rota virus to children from one day to 6 years.
Materials and Methods: Latex agglutination test for the stool of 61 children suspected with Rotavirus infection was done in addition to general and bacteriological test of these stool samples at Children Welfare Teaching Hospital from January 2010 to October 2010
Results: There were 61 children from one day-6 years old, only 11(18.03%) had positive Rotavirus infection with high percentage in males (seven cases) and (four cases) in females and only one case detected with positive Rotavirus infection at the age of 42 month. No pathogenic bacteria or fungus were isolated.
Conclusion: The data indicate that male has highly incidence than female and children up to 78 months had diarrhea that not caused by Rotavirus.
Key words: Rotavirus, Latex agglutination, viral gastroenteritis

Background: Hepatic ischemia-reperfusion (I/R) injury may occur in a variety of clinical set¬tings and this remains a significant problem. Oxygen free radi¬cals, produced on reperfusion have been shown to play a major role in hepatic I/R injury. Various therapeutic effects have been described for Zingiber officinale. Additionally, it has been presented that Zingiber officinale has protective effect against ischemia reperfusion injury to various organs. Therefore, it seems possible that the administration of Zingiber officinale might protect the liver against the ischemia reperfusion injury.
Objectives : To determine whether Zingiber officinale prevents hepatic ischemia-reperfusion injury to the liver.
Methods: Thirty-six rats were divided into three groups as control (Group 1), I/R group (Group 2), and Zingiber officinale treatment group (Group 3). All rats underwent hepatic ischemia for 60 min followed by 60 min period of reperfusion. Rats were internalely infused with only 0.9% saline solution in group 2. Rats in group 3 received alcoholic extract of Z. officinale (200 mg/kg) intraperitoneally, before isch¬emia and before reperfusion. Blood samples were harvested from the rats, and then the rats were sacrificed. Serum aspartate aminotransfera¬se (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) oxidative stress levels of reactive oxygen species (ROS) ,nitric oxide (NO) and lipid peroxida¬tion (LPO) levels were determined.
Results: The levels of liver enzymes and Oxidative stress in group 3 were significantly lower than those in the group 2.
Conclusion: Our results suggest that Zingiber officinale treatment protects the rat liver against hepatic ischemia-reperfusion.
Keywords : Zingiber, liver enzymes, oxidative stress ,ischemia.

Background: Malassezia spp. are lipophilic unipolar yeasts recognized as commensals of skin that may be pathogenic under certain conditions. Yeasts of the genus Malassezia are known to be members of the skin micro flora of human and other warm-blooded vertebrates. Psoriasis is a common cutaneous disease of unknown etiology, may be triggered by infections, including those due to fungi.
Objectives: Although the role of Malassezia spp. in the pathogenesis of psoriasis is still not fully understood, it is thought that these lipophilic yeasts might be a trigger factor in the exacerbation of psoriatic lesions. Malassezia is associated with the development of skin lesions in psoriasis because of the response of the scalp lesions in psoriasis to antifungal agents.
Materials and methods: Twenty three patients with psoriasis were included in this study, who attended Al-Kadhumyia teaching hospital / Dermatology department, from the 30th of October 2010 to the 1st of April 2011. Fifteen (15) were males and eight (8) were females, with the mean age of 44.61±14.65 years (ranging between 3months to 70 years old). The diagnosis was established by clinical examination done by consultant Dermatologist. The site of scraping were face, lower and upper limbs. Control included 14 apparently healthy individuals were randomly selected from entities, primary and secondary schools in Al-Aubaidi city (10 males and 4 females) with a mean age of 26.83±15.68 years (ranging between 1-70 years old). Both groups were investigated for Malassezia spp., cultivation and identification of Malassezia spp. included Sabouraudَs dextrose agar with and without olive oil.
Results: Malassezia globosa had a high percentage overall Malassezia spp. with psoriatic patients (17.04%). According to gender, males had higher infection rate than females among psoriatic patients. psoriatic patients with age group of (41-50) years had a high percentage among others (56.60%). Oily skinned patients revealed psoriasis disease.
Conclusions: From these findings it was suggested that M. globosa reported a high percentage overall Malassezia spp. with psoriatic patients.
Keywords: Malassezia spp, psoriasis.

Background: Pulmonary involvement in patients with Rheumatoid Arthritis (RA) is a serious extra articular manifestation.
Objective: The aim of the study is to detect pulmonary involvement, classify the type of involvement (whether obstructive, restrictive or mixed), and to find out whether pulmonary system was involved in the early stage of the disease and is asymptomatic and to determine the associated possible risk factors.
Patients and Methods: 82 patients with RA and 40 control subjects were included in this prospective study. They were submitted to medical history, physical measurements (height, weight and BMI) and spirometric evaluation for FVC, FEV1, FEV1%, PEFR and FMF (FEF25-75%).
Results: 42 patients with RA (51%) show abnormal spirometric results, mostly in the form of respiratory restriction in 33 patients (40%), obstructive results in 7 patients (9%); while mixed abnormality in 2 patients (2%). Various risk factors are correlated with reduced spirometric results.Asymptomatic patients with abnormal spirometry found in 9 (11%) and 6 patients (7%) had abnormal results within two years of their articular disease.
Conclusion: Pulmonary involvement is common in Iraqi patients with RA, mostly in the form of respiratory restriction. Pulmonary involvement is believed to be asymptomatic in some patients and
even occurs early in the disease process. Various risk factors are found to be correlated with the abnormal spirometry.
Keywords: RA(Rheumatoid Arthritis), Pulmonary Involvement.