Journal of the Faculty of Medicine Baghdad

Background: Hypertrophic cardiomyopathy (HCM) is a common genetic cardiovascular disease. Its morphologically divided into asymmetrical septal hypertrophy, symmetrical concentric hypertrophy and apical hypertrophy,and physiologically divided into obstructive HCM and non obstructive HCM according to the left ventricular outflow tract (LVOT) gradient at rest or with provocation. Several factors that increase risk of sudden cardiac death (SCD), the more risk factors a patient has, the greater the chance that the patient is exposed to sudden death and sufficient to warrant consideration for interventional therapy.
Objective: The aims of the study are to evaluate the clinical presentations, risk stratification and family screening of patients with HCM.
Patients and methods: This cross sectional study was performed in Ibn-Albitar hospital for cardiac surgery. We studied the prevalence of certain variables among seventy three patients with HCM from “June 2010 to April 2012\" including the clinical triggers ,electrocardiographic (ECG) changes, ventricular and supraventricular arrhythmia by holter monitoring, morphological and physiological types of HCM by echocardiography, family screening and finally we assessed the risk factors for SCD and candidacy for interventional procedures.
Results: A total of seventy three patients, males to females ratio were 1.5:1 with a mean age of 34±26 (years). HCM was higher in patients younger than 45 years of age, 43(58.9%). Eighty seven percent were symptomatic and (12.3%) were asymptomatic diagnosed by family screening of first degree relatives with HCM. Family history of HCM was identified in (38.3%).Three quarter of patients had asymmetrical septal hypertrophy and (6.8%) had pure apical HCM. Abnormal ECG was found in(87.6%) mainly in the form of left ventricular hypertrophy( LVH )while 9 patients(12.3%) had normal ECG. Nonsustained ventricular tachycardia(NSVT) was found in(30.1%). Echocardiographically, systolic anterior motion(SAM) of the anterior mitral leaflet was seen in about half of patients and three patients (7.6%) had SAM without LVOT obstruction. About half of patients (49.4%) had resting and provocable LVOT obstruction and about half of obstructive type (47.2%) had LVOT gradient ≥50mmhg and are candidate for surgical or percutaneous intervention.
Conclusions: Most of our patients were symptomatic and significant number of patients had family history of HCM. Asymmetrical septal hypertrophy was the commonest morphological type of HCM. Relatively equal prevalence of obstructive and nonobstructive HCM and significant number of patients with the obstructive type had LVOT gradient ≥ 50mmhg who are candidate for surgical or trascatheter interventions.
Key word: clinical, hypertrophic, cardiomyopathy

Background: Achalasia is an uncommon but not a rare a malady. In Iraq, we lack true statistics about this condition.

Objective: is to review the experience with trans-thoracic modified Heller operation for achalasia cardia in a major thoracic surgical centre in Iraq over a 4-year period.

Study design: a combined retrospective and prospective study.

Setting: Department of Thoracic Surgery in Baghdad Medical City/Baghdad/Iraq.

Methods: This study is both retrospective (20 cases) and prospective (20 cases); the information is collected from either patients, case sheets or obtained directly from patients, interviews. In both situations, relevant demographic and clinical information is obtained. The patients then are subjected to a standard diagnostic workup followed by preparation of patients for surgery. A trans-thoracic modified Heller's operation: esophagocardiomyotomy) is done following a standard technique. No anti-reflux procedure is added. Follow up is done to evaluate results of surgery.Patients: 40 patients (26 males and 14 females) with achalasia cardia who were admitted to the Department of Thoracic Surgery in Baghdad Medical City over a period of 4 years (2008 to 2012).

Results: 26 males (65%) and 14 females (35%) with a mean age of 26.6 year. Patients aged 20 -40 years constituted the majority (47.5%). The commonest presenting symptom was dysphagia reported in 39 patients (75%). Cucumber dilated esophagus (rat tail sign) was the commonest appearance on contrast study found in 84% of studied patients. Ten patients (7 females and 3 males) had dilation therapy initially which failed to improve their symptoms thus scheduled for surgery. The remaining 30 patients were offered surgical treatment from the start; thus ultimately, operation was done to all 40 patients. Good to excellent results after surgery were obtained in 35 patients (87.5%).

Conclusions: though good and excellent results followed Heller’s operation for achalasia cardia versus multiple forceful dilatations, laparoscopic Heller oesophageal myotomy reverses the symptoms of achalasia with minimal morbidity. It is recommended to learn and practice this minimal invasive procedure rather than to continue doing an old operation

Background: Ureteral stone can cause obstructive uropathy and subsequent deterioration of renal function. There are four treatment options for ureteral calculi: lithotripsy, ureteroscopy, laparoscopic ureterolithotomy, and open stone surgery. Holmium YAG laser is an excellent intracorporial lithotripter for all kinds of stones. Accordingly, there is steady increase in number of ureteroscopic laser lithotripsy operations in the managmant of Ureteral stone.

Objectives: this study was designed to demonstrate the effect of ureteric stone location on the success rate of ureteroscopic Holmium laser lithotripsy in the management of ureteric stones.

Patients and Methods: Ninety middle-aged patients of either sex (35.9 ± 10.8 years) with ureteric stone (9.5 ± 3 mm) were treated with semiregid ureteroscopy using Holmuim: YAG laser as an intracorporial lithotripter. In 32 patients (35%) the stone were located in the lower ureter, 22 patients (24%) in middle ureter and in 36 patients (40%) in the upper ureter. Then all the patients were followed up on day 1 and 4 weeks for clearance of stone by plain abdominal radiography and abdominal ultrasonography.

Results: the stone free rates 4 weeks after the treatment were 66% for upper, 75 % for middle and 87.5% for lower ureteric stones. In 12 patients (13%)cannot be possible to reach the stone, six patients (6.6 %) had proximal stone migration and treated later on by extracorporeal lithotripsy after double-J stent placement. Ureteral perforation occurred in 7 patients (7.7%), all managed by double-J stent placement except 1patient needed an open surgical treatment..

Conclusion: YAG laser lithotripsy is efficacious modality of treatment for ureteric stones especially in lower ureter and it is a safe and technically feasible and in early experience, it is preferred to start with more distal stones.

Background: The optimal timing of surgery for Wilms' tumor has been debated for many years. It appears dubious whether surgical ease or per operative complications consistently improved after preoperative chemotherapy.

Materials and Methods: This is a cross section study ,the sample collected from January 2009 to November 2012 .Thirty four patients were selected after informed consent . Patients aged between 10 months and 5 years who were newly diagnosed with Wilms' tumors. including (17) patients with unilateral wilms tumors received immediate nephrectomy without preoperative chemotherapy according to the National Wilms' Tumor Study Group protocol and (16) patients with unilateral Wilms' tumors and one patient with bilateral wilms tumor received delayed nephrectomy or partial nephrectomy following preoperative chemotherapy according to the International Society of Pediatric Oncology( SIOP) WILMS TUMOR 2001/UK Final Version /January 2002 protocol.Objective : To compare the use of immediate nephrectomy versus delayed nephrectomy or partial nephrectomy following neo adjuvant chemotherapy for treatment of non metastatic Wilms' tumor, in terms of surgical morbidity and per operative complications .

Results: there is significant change in the maximal tumor size (more than 50% reduction in the maximal tumor diameter) was observed in 52.9% of patients receiving pre operative chemotherapy. There is reduction in the complication rate in that patient receiving pre operative chemotherapy. These observed specifically for decreasing residual tumor and tumor spillage episodes. Bilateral partial nephrectomy after neo adjuvant chemotherapy was done for one patient (5.6%) with bilateral wilms tumor. We found significant decrease in the complication rate mainly for those patients with high risk score receiving pre operative chemotherapy rather than those with low risk score.

Conclusion: We would favor tumor resection when it is possible as early in therapy as is practical and safe, when there is concern about the safety of primary tumor resection the pre operative chemotherapy can be safely initiated.

Background: long term survivorship in total knee arthroplasty is significantly dependant on prosthesis alignment, several studies have correlated poor outcome with malalignment of the components. The debate on the optimal system for femoral alignment is now largely resolved, but there is still controversy about whether intramedullary or extramedullary systems are better for the tibial side.

Objecives : is to determine whether intramedullary or extramedullary tibial alignment guide is better for accurate sagital tibial prosthesis alignment in total knee replacement arthroplasty.

Patients and methods: Of 65 patients recruited, only 48 patients (55 knees) were met the inclusion criteria of this study (32 female and 16 male) with an average age of 62.2 years ranging from 57 to 70 years who had attended the outpatient clinic in medical city-orthopedic and trauma consultation unit and private work, during the period from October 2010 till March 2012. All patients were diagnosed to have severe osteoarthritis of their knees and we performed total knee replacement arthroplasty for them. Patients were divided into two groups, group A, were 22 patients (25 knees) in which we used intramedullary alignment guide for the preparation of proximal tibia, and group B, were 26 patients (30 knees) in which we used extramedullary alignment guide for the preparation of the proximal tibia. Three months postoperatively, a standing long leg proper lateral plain X-ray (digital software) was taken and the sagital tibial slope was measured for each case.

Results: Accurate alignment of sagital posterior slope of tibial prosthesis was found in 80% (20 out of 25 knees) in group A, and in 43.3% (13 out of 30 knees) in group B.By using Student t test, the P value was less than 0.001 which was very significant.

Conclusion: we concluded that the intramedullary tibial alignment guide is statistically more accurate than extramedullary tibial alignment guide, in the sagital positioning of the tibial component.

Background: Phenylketonuria (PKU) is one of the most important metabolic causes for mental retardation in children, in which early diagnosis would successfully prevent mental retardation, yet, there are some other serious metabolic diseases that share the same mode of presentation and some of the phenotypic manifestations also.
Methods: During the period from August 2009 to August 2011, 63 cases were referred to the Children Welfare Teaching Hospital (CWTH) with clinical features of PKU, all were enrolled in this study, few blood drops on a special filter paper were taken from each patient and sent to a specialized metabolic laboratory in Saint Joseph University \Beirut, using tandem mass spectrophotometry (MS/MS). The results were received through internet after being analyzed and interpreted.Aim: This study aimed to assess the prevalence of PKU and other inborn errors of metabolism among sick children, presenting with clinical features suggestive of PKU, what are the diseases that share same clinical presentation of PKU, and make a proper early diagnosis and management when possible.

Results: out of the 63 cases, only 28(44.4%) came positive with different diseases, only 7(11.1%) were cases of PKU. The results also showed some other Inborn Errors of Metaboilsm(IEM): homocystinuria(HCY)or methionine adenosyltransferase(MAT) 7(11.1%),Methylmalonic academia (MMA)4(6.3%), maple serum urine disease (MSUD) in 3 cases(4.7%).The consanguinity was positive in 41 cases (65%). Positive family history was documented in 23(36.5%).All PKU cases had the background of consanguineous marriages (100%).

Conclusions: PKU is one of the most important metabolic cause for mental retardation in our study, but some other serious metabolic defects like homocystinuria(HCY) or MAT, organic acidemias, maple syrup urine disease(MSUD) also causes mental retardation and share some of the phenotypic manifestations of PKU. Many families had positive history of affected siblings,especially those with consanguineous marriages.

Background: Magnetic resonance imaging (MRI) is the modality of choice for investigation of disorders of the spine. The use of spinal MRI imaging has increased over the last few years, with improvement in hardware such as magnets, coils as well as imaging techniques. Which should lead to accurate reporting of these examinations includes identifying the incidental abnormalities even if they are not related to the spine.

Objective: The objective is to evaluate the incidence, types and associated variables of

Patients and methods: A retrospective study of 507 patients was reviewed for MRI spine at Baghdad teaching hospital and x- ray institute who underwent imaging between January 2011 and fifteenth of august 2012.unsuspected Extraspinal findings (incidental findings) by MRI spine and with correlation to the sex, age group, types of these findings and the benefit of their early detection.

Results: From the 507 patients, incidental finding were detected in 83 patients (16.37 %) some of them have more than one incidental finding, this result showed significant association with age above 60 years, (p≤0.05)

Conclusion: A systematic approach to the MRI of the spine should include assessment of tissues and organs outside the region of clinical interest to detect and report any incidental abnormality which could have significant impact on patient’s management.

Background: The population composition in all countries is changing very rapidly, with the result that there will now be Increasing numbers of elderly in all communities and in all countries of the world .Age-related changes in body habits, and disease and medication-related interactions can affect the nutritional requirements of elderly persons. This can further compounded by difficulties that older persons experience in accessing grocery stores and in cooking healthy food Many older persons relay on the convenience of buying processed foods or ordering fast food that can contribute to both obesity and deficiencies in essential nutritional requirements . The diagnosis of nutritional deficiency states in elderly people is made more difficult by the usual symptoms and signs being masked by diseases.

Objectives: To assess the dietary and food intake in a sample of elderly subjects.

Patients and methods: A random sample of 184 elderly persons were included in the study 58.2% males and 41.7% females selected randomly from a list of public health centers in urban areas of Baghdad city , it was carried out during the period between the first of March and the end of August 2005.

Results: Highest proportion of the studied males and females aged 65-74years, the total number of males and females in this age group constitute (65.8%) of the studied sample. The highest frequency of elderly subjects with inadequate dietary intake was observed in vitamin B12 (59.2%) .The frequency of inadequate dietary intake was higher among elderly females than that in males for energy 28.6%, iron 18.2%,vitamin C 54.5%, vitamin B1262.3%, while it was higher among elderly males for protein 13.1%. It was found that high proportion of the studied sample had mean food daily intake less than the recommended mean values for milk 98.4% , vegetables 97.3% , fruits 96.7% , fish and sea food 95.1% . Furthermore 70.7%, of the studied elderly subjects had mean food daily intake less than the recommended mean values of meat/poultry, legumes 59.3% , egg and products 57.6% respectively , while 88% of them had high recommended mean food daily intake of cereals. The mean ± SD of BMI of elderly subjects of present study was 27.6 ± 4.8 .

Conclusion: The mean food daily intake of milk , meat/poultry/fish ,vegetables and fruits are deficient in a high proportion of the studied elderly subjects .Acceptable percentage of the studied sample had high mean food daily intake of cereals .The frequency of inadequate dietary intake was higher for energy , iron ,vitamin c, vitamin b12 in the study sample .

Background: In Iraq, adolescents confront challenges, external and internal factors and their life circumstances are exacerbated by threats to their physical and mental health.

Objective: To throw a light on training for life skills which in turn leads to promotion of adolescents physical and mental health.

Methods: A total of 120 adolescents participated in the study (50 of them were trained for life skills and the others act as control group) for the period April 2010 to Sept. 2011. Their age was 19 ± 2.4 years with male to female ratio of 1.4:1. The program consisted of several subjects concern with physical and mental health. Positive outcomes were determined. Scores of training variables presented in mean ± SD. Student's t test was used to examine the difference in variables between trained and untrained adolescents.

Results: Scores of positive outcomes (good personal hygiene, getting enough sleep, healthy weight, got exercise, social competence (adolescent shows respect, tries to resolve conflicts and concern about self-esteem), condemnation of abuse, harassment, bullying and rape, aware about sexual transmitted diseases (STDs) including acquired immunodeficiency syndrome (AIDS), intimate relationship, awareness to teen pregnancy or abortion and family planning, concern with family life (arranged marriages) and study skills (motivation, goal setting, time management, positive study attitude and empowering concentration) were significantly higher in trained than in untrained adolescents (p= 0.023, 0.025, 0.001, 0.04, 0.025, 0.001 and 0.001, respectively).

Conclusion: Life skills could be applied for promotion in mental health as well as physical health.

Background: Asthma is an increasing worldwide health problem. The prevalence of asthma is higher in some ethnic minorities and lower in other ethnic groups. Environmental exposures, and psychosocial factors, have been suggested to be main mediators for asthma. Ethnicity related to racial background can influence the differences in asthma through the disease susceptible alleles.

Objective: To evaluates environmental and cultural risk factors for asthma among different ethnic groups.

Methods: Random sample of 337 Iraqi selected from 5,490 Iraqi residents’ in the Greater Detroit area. Validated questionnaire was used. Chi-square, t-test and logistic regression were used.

Results: Results showed a significant difference in the prevalence of asthma among Chaldeans (0.7%) and Arabs (8.7%). However environmental and psychosocial exposures and socioeconomic status were not significantly associated with asthma in Arabs, nor Chaldeans.

Conclusion: Even though Arabs and Chaldeans are from the same geographical region, and therefore share similar environmental background history, the asthma prevalence was about 9 times higher in Arabs as compared to Chaldeans. Ethnic background was the only significant risk factor associated with asthma. Genetic differences could explain the high susceptibility to asthma in Arab compared to Chaldean. .

Background: The population composition in all countries is changing very rapidly, with the result that there will now be Increasing numbers of elderly in all communities and in all countries of the world .Age-related changes in body habits, and disease and medication-related interactions can affect the nutritional requirements of elderly persons. This can further compounded by difficulties that older persons experience in accessing grocery stores and in cooking healthy food Many older persons relay on the convenience of buying processed foods or ordering fast food that can contribute to both obesity and deficiencies in essential nutritional requirements . The diagnosis of nutritional deficiency states in elderly people is made more difficult by the usual symptoms and signs being masked by diseases.

Objectives: To assess the dietary and food intake in a sample of elderly subjects.

Patients and methods: A random sample of 184 elderly persons were included in the study 58.2% males and 41.7% females selected randomly from a list of public health centers in urban areas of Baghdad city , it was carried out during the period between the first of March and the end of August 2005.

Results: Highest proportion of the studied males and females aged 65-74years, the total number of males and females in this age group constitute (65.8%) of the studied sample. The highest frequency of elderly subjects with inadequate dietary intake was observed in vitamin B12 (59.2%) .The frequency of inadequate dietary intake was higher among elderly females than that in males for energy 28.6%, iron 18.2%,vitamin C 54.5%, vitamin B1262.3%, while it was higher among elderly males for protein 13.1%. It was found that high proportion of the studied sample had mean food daily intake less than the recommended mean values for milk 98.4% , vegetables 97.3% , fruits 96.7% , fish and sea food 95.1% . Furthermore 70.7%, of the studied elderly subjects had mean food daily intake less than the recommended mean values of meat/poultry, legumes 59.3% , egg and products 57.6% respectively , while 88% of them had high recommended mean food daily intake of cereals. The mean ± SD of BMI of elderly subjects of present study was 27.6 ± 4.8 .

Conclusion: The mean food daily intake of milk , meat/poultry/fish ,vegetables and fruits are deficient in a high proportion of the studied elderly subjects .Acceptable percentage of the studied sample had high mean food daily intake of cereals .The frequency of inadequate dietary intake was higher for energy , iron ,vitamin c, vitamin b12 in the study sample .

Background: Chronic Myeloid Leukemia (CML) occurs due to malignant transformation of a pluripotent stem cell. Progression is insidious from chronic to aggressive accelerated or blastic phases. Studies revealed a significant role of the tumor suppressor gene P53 in disease progression.

Objectives: To evaluate the immunohistochemical expression of mutant P53 protein in CML at different clinical phases.

J Fac Med Baghdad

2013; Vol.55, No .3

Received Nov .2012

Accepted July.2013


Subjects, materials and methods: This case - control study was conducted over 8 months period from January to August in 2010 on 60 preserved bone marrow trephine biopsies of patients with CML (30 in chronic phase, 15 in accelerated phase and 15 in blastic phase) collected from the Department of Histopathology, Teaching laboratories, Medical City directorate, Baghdad. Mutant P53 was evaluated by immunohistochemistry technique of Dakopatts Corporation and scored in the department of pathology / college of medicine / University of Baghdad.

Results: This study was done on 60 CML patients whose age mean was 41.6 ± 16.8 years and range from 14 to 81 years with male to female ratio of 1.06:1. Positive mutant P53 expression was detected in 10 out of 30 cases (33.3%) in chronic phase while it was positive in 8 out of 15 cases (53.3%) in the accelerated phase and positive in 13 out of 15 cases (86.7 %) in the blastic phase with p value of 0.003.

Conclusions: There was a significant difference in the immunohistochemical expression of mutant P53 in the bone marrow biopsies of CML patients among different phases and its expression was more in advance phases of the disease. Moreover the mutant P53 expression show a significant correlation with the blast percentage in the accelerated and blastic phases of CML.

Background: Chronic Myeloid Leukemia (CML) occurs due to malignant transformation of a pluripotent stem cell. Progression is insidious from chronic to aggressive accelerated or blastic phases. Studies revealed a significant role of the tumor suppressor gene P53 in disease progression.

Objectives: To evaluate the immunohistochemical expression of mutant P53 protein in CML at different clinical phases.

J Fac Med Baghdad

2013; Vol.55, No .3

Received Nov .2012

Accepted July.2013


Subjects, materials and methods: This case - control study was conducted over 8 months period from January to August in 2010 on 60 preserved bone marrow trephine biopsies of patients with CML (30 in chronic phase, 15 in accelerated phase and 15 in blastic phase) collected from the Department of Histopathology, Teaching laboratories, Medical City directorate, Baghdad. Mutant P53 was evaluated by immunohistochemistry technique of Dakopatts Corporation and scored in the department of pathology / college of medicine / University of Baghdad.

Results: This study was done on 60 CML patients whose age mean was 41.6 ± 16.8 years and range from 14 to 81 years with male to female ratio of 1.06:1. Positive mutant P53 expression was detected in 10 out of 30 cases (33.3%) in chronic phase while it was positive in 8 out of 15 cases (53.3%) in the accelerated phase and positive in 13 out of 15 cases (86.7 %) in the blastic phase with p value of 0.003.

Conclusions: There was a significant difference in the immunohistochemical expression of mutant P53 in the bone marrow biopsies of CML patients among different phases and its expression was more in advance phases of the disease. Moreover the mutant P53 expression show a significant correlation with the blast percentage in the accelerated and blastic phases of CML.

Background: Extended-spectrum β-lactamases (ESBLs), including cefotaximases (CTX-M), mediate resistance to extended spectrum cephalosporins and significantly compromise the treatment tools for Shigellosis.

Objective: To determine the ESBLs production by Shigella spp. and its role in the resistance to third generation cephalosporins and to determine the occurrence of plasmid- borne blaCTX genes in ESBLS Shigella isolates by Multiplex PCR.

Methods: Susceptibility of 59 clinical Shigella isolates was tested by disk diffusion method to six antimicrobial agents. Presence of ESBLs was established by the combination disk method. Minimum inhibitory concentration of β-lactams was determined by agar dilution method for resistant isolates, and then ESBL producers were subjected to plasmid extraction and PCR experiments.

Results: Overall isolates had high rate of resistance to Ampicillin (84.7%), Tetracycline (84.7%), Co-trimoxazole(72.9%) and Cefotaxime(69.5%). Moderate to Ceftriaxone (52.5%) and low rate of resistance to Ceftazidime(30.5%). The MIC value of resistant isolates of S. sonnei and S. flexneri for CTX and CRO ranged from (64-512 μg/ml) for both, and (32-256 μg/ml) for CAZ, whereas S. dysenteriae exhibit only high level resistance MIC (256 μg/ml) for CTX, low level resistance (64 μg/ml) for CRO and complete susceptibility to CAZ. 31 of 41 (75.6 %) of Shigella spp. were β-lactamase producers, of these (82.6%) were S. flexneri, (68.8%) S. sonnei, and one S. dysenteriae isolate. The results of PCR amplification of bla CTX gene groups showed that blaCTX-M genes were identified in (74.19%) ESBLs isolates distributed as 14(45.16%) S.flexneri isolates, 9(29.03%) S. sonnei, while no gene was detected in ESBLs S. dysenteriae isolate. The prevalence of bla CTX-M I, bla CTX-M II (TOHO 1) and blaCTX-M III, were ( 54.8%, 16.1% and 3.2% ) respectively. Non of the isolates carried more than one type.

Conclusion: The occurrence of plasmid- borne blaCTX genes in ESBLS Shigella isolates are increasing in Iraq with co-resistance to some other classes of antibiotics

Background: Tuberculosis (TB) is still a major global public health problem worldwide. The global prevalence of Mycobacterium (M tuberculosis) infection has been estimated in 32% of the world population with more than 8 million new cases diagnosed each year.

Materials and Methods: A total of 192 M tuberculosis complex isolates were collected from patients with positive sputum smear who had been treated previously with the four main anti- tuberculosis drugs for more than two months. The isolates were identified by their colonial morphology, pigmentation, shapes on Ziehl-Neelsen smears, growth on Löwenstein-Jenson medium and biochemical tests as niacin and nitrate tests. A proportional method was used for the in vitro drug susceptibility testing.Objective: To estimate drug resistance among previously treated tuberculosis patients, focusing on multi-drug resistant strains at two time intervals (2002 and 2009) in Yemen.

Results: Of the 192 M tuberculosis complex tested isolates, 55 (28.7%) were resistant to one or more drug; 20 (10.4%) were resistant to one drug, 13 (6.8%) to two drugs, 13 (6.8%) to three drugs and 9 (4.7%) to four drugs. Regarding the resistance to an individual drug, out of 192 tested isolates, 36 (18.7%) were resistant to rifampicin, 34 (17.7%) to isoniazid, 33 (17.2%) to ethambutol and 18 (9.4%) to streptomycin and these results were without a statistical significance. The incidence of multidrug resistance against rifampicin and isoniazid with or without other drugs was 13.5% among the tested M tuberculosis complex strains and this result was also without a statistical significance.

Conclusion: The results of this study revealed nearly similar drug resistance patterns for the tested isolates in comparison with previous findings of 2002 and the emergence of more multi-drug resistance M tuberculosis complex strains after a time interval in Yemen.

ackground: Ghrelin, identified as an endogenous ligand for the growth hormone secretagogue receptor, functions as a somatotrophic and orexigenic signal from the stomach. The secretion of ghrelin increases under conditions of negative energy balance, such as starvation, cachexia, and anorexia nervosa, whereas its expression decreases under conditions of positive energy-balance such as feeding, hyperglycemia, and obesity. In addition to having a powerful effect on the secretion of growth hormone, ghrelin stimulates food intake and transduces signals to hypothalamic regulatory nuclei that control energy homeostasis. Thus, it is interesting to note that the stomach may play an important role in not only digestion but also as a pituitary growth hormone release and central feeding regulation.

Objective: The goal of this study was to test the hypothesis that circulating ghrelin suppresses insulin secretion in healthy children.

Subjects and methods: Enzyne-Linked immunosorbent assay method was used to assay Ghrelin and Insulin. By taking blood sample from 40 obese children, 11 overweight children and 29 normal weight healthy children their age (5-11) years.

Results: the mean concentration of Ghrelin was significantly lower in obese and overweight children than in controls ( P < 0.000 ) . The mean concentration of Insulin was significantly higher in obese and overweight children than in controls ( P < 0.007 ). Negative correlations was obtained between Ghrelin and BMI, also negative correlation between Ghrelin and Insulin was obtained.

Conclusions: This study showed that ghrelin reduces insulin secretion and glucose disappearance in healthy children. This findings raise the possibility that endogenous ghrelin has a role in physiologic insulin secretion, and that its antagonist may improve β-cell function.

Background: Family history of type 2 diabetes is a major risk factor for type 2 diabetes. Type 2 diabetes is characterized by progressive β-cell dysfunction; many investigators have used C peptide levels as a biomarker of β-cell function.

Objective: the current study was design to investigate the impact of family history on biochemical characteristics (c-peptide, HbA1c, lipid profile, insulin secretion, insulin sensitivity and insulin resistance.Subjects and methods: three hundreds patients (152 males 148 females) with type 2 DM were enrolled in this study; and two hundreds individual serves as a control groups (103 male 97 female). The following clinical characteristics were reported: age, sex, waist circumference WC, systolic blood pressure SBP, diastolic blood pressure DBP, family history, body mass index BMI, laboratory analyses included serum c-peptide, blood glycosylated hemoglobin (HbA1c) assay, lipid profile which included serum cholesterol, serum triglyceride(TG), serum low density lipoprotein cholesterol (LDL) and serum high density lipoprotein-cholesterol (HDL). Insulin secretion, sensitivity and resistance were calculated from fasting serum glucose (FSG) (mg/dl) and C-peptide (ng/ml) values by homeostasis model assessment (HOMA).The statistical analysis was done by SPSS (statistical packagefor social sciences- version 17).

Result: Statistically was observed that highly significant increase in serum C-peptide in patients compared to control group (3.85±1.02 vs 1.53±0.24 p<0.01).The patients with a family history of type 2 diabetes mellitus had longer diabetes duration, heavier weight, higher levels of TG, LDL-cholesterol, and lowered age, HDL-cholesterol than those without a family history . Also, the presence of a family history of diabetes was associated with lower levels of fasting plasma C-peptide (3.01± 1.78 vs 4.95±1.82, p<0.05). Serum C-peptide had a significant negative correlation with family history and duration of diabetes. Furthermore, C-peptide was inversely correlated with HbA1c, and insulin sensitivity (HOMA-S). On the other hand, C-peptide correlated positively with BMI, DBP, LDL-cholesterol, TG, insulin resistance HOMA-IR, and insulin secretion HOMA-B. As well as, C-peptide did not show significant correlation with age, FSG, and TC. When the multiple linear analysis was executed with C-peptide as dependent variable with other independent variable (BMI, duration, family history, HOMA-IR, HOMA-S, and HOMA-B) there were significant result with this variables. The person correlation analyses to identify the parameters that most closely related with diabetic duration according to family history of diabetes; which showed that diabetic duration had a significant negative correlation with C-peptide, and HOMA-B only in patients with family history of Type2 DM (-0.126, and -0.229) respectively.

Conclusion: the current study suggested that subjects with a family history of diabetes mellitus are predisposed to develop this disease earlier. Although, serum C-peptide increased significantly in diabetics group compared with controls, and C-peptide decreased in patients with family history of diabetes. In addition, the results showed that family history of type2 diabetic patients is thought to have a deep impact on duration of the disease, lipid profile, insulin resistance, insulin sensitivity, and this may lead to higher prevalence of diabetic complication compared to patients without family history. These results support the necessity of earlier screening for diabetes in family members of T2DM patients and prevention the complications of the disease.

Background: Ulcerative colitis has been reported to be associated with autonomic dysfunction, mainly of vagal involvement.

Objectives: To Determine whether there is a parasympathetic dysfunction in ulcerative colitis patients in remission state or not.
Results: For all of the three tests, patients group gave significantly lower results (P˂ 0.05) which was the least level of significance. Materials and methods: Three standardized tests of parasympathetic function, based on heart rate variation in response to certain stimuli (heart rate response to Valsalva maneuver, to deep breathing and to standing from supine position) were used on 54 ulcerative colitis patients in remission, and 41 healthy volunteers as a control group.

Conclusion: Ulcerative colitis is associated with vagal dysfunction which could be a hidden cause for the underlying inflammatory status because of the recently established anti-inflammatory role of vagus nerve.

Background: Traumatic brain injury (TBI) is a serious public health problem. Even injuries classified as mild which is the most common, can result in persistent neurobehavioural impairment. Diffuse axonal injury is a common finding after TBI, and is presumed to contribute to outcomes, but may not always be apparent using standard neuroimaging. All severities of TBI can result in a degree of axonal damage, while irreversible myelin damage was only apparent for moderate to severe TBI.

Objectives: To evaluate the effects of moderate closed head injury on visual evoked response (VER) and to assess the changes in VER 6 months later as follow up indices.

Subjects and methods: This prospective study was conducted in the Department of Neurophysiology /Hospital of Neurosurgery/Baghdad from November 2010 to February 2012, using Esoata Italian machine. Ninety three patients with moderate closed head injury (49 female and 44 male), with an age range from (5 -51) years, with a mean age of (26±11.95) years, were chosen according to Glasgow coma scale (9-12 score) undergo VER and only 86patients will follow up by VER and both were compared to control group of 55 healthy subjects.

Results: P100 wave latency of visual evoked response (VER) was found to be significantly prolonged (P100= 145.41±9.67 msec.), in patients with moderate head injury at an early measurement after injury as compared to that of the healthy (P100= 97.66±4.58 msec.), whereas, the amplitude of P100 at an early measurements is reduced significantly (2.71± 0.77 µv) when compared to healthy subjects (7.32± 1.62 µv). By 6 months post injury the latency of P100was significantly prolonged (P100=137.19±8.45msec.) when compared to that of control group, while it is significantly reduced when compared to the patients with head injury at an early measurements. However, at 6months post injury the P100 amplitude was significantly increased (amplitude =3.26±0.62μv) when compared to the patients with head injury at an early measurement whereas, significantly reduced when compared to the control group.

Conclusion: this study revealed that head injury had serious effect on the brain functions reflected by changes in VER which needs long period of time to return to normal levels.

Abstract
We describe here a case of a 70 yr old man with long-standing rheumatoid arthritis who presented with low grade fever, fatigue, loss of appetite and weight, bluish discoloration of the fingers and patches of gangrenous skin on the fingers. There was intense pain in the fingers which prevented him from sleep. Along with these symptoms he developed loss of sensation in the dorsum of left foot, then left foot drop. We give below full account of the case and review of the causes of vasculitis. We want to emphasize on the importance of identifying vasculitis as one of the complications of rheumatoid arthritis and intensive treatment of this complication, as it is a life-threatening complication.