Journal of the Faculty of Medicine Baghdad

Background: Acute idiopathic thrombocytopenic purpura (ITP) is a self – limiting illness, usually occurring after an infectious disease, and it is due to decrease number of circulating platelets manifests as a bleeding tendency, easy bruising (purpura), or extravasations of blood from capillaries into skin and mucous membranes.
Objective: To study and analyze the natural history of idiopathic thrombocytopenic purpura and treatment used in children below 15years.
Patients and methods: A cross sectional descriptive study was carried on total of 72 patients their ages range between(1-15)years who were admitted to Children Welfare Teaching Hospital / Baghdad from 1st of July 2010 to30th of June 2011. Seventy two cases admitted during that period and diagnosed as acute immune thrombocytopenic purpura but bone marrow aspiration study was done in 57cases and those cases that were studied and were analyzed to all types of clinical presentation & management used.
Results: Age group were ranged from (1-15) years with peak in age group of (1-5) years 38(66.7%), male were 29 (50.9%) equal to female 28 (49.1%). Most cases were reported in spring 25(43.9%), with preceding viral illness was encountered in 37 (64.9%) patients. Most cases were presented with skin rash 54(94.7%) except three cases, the epistaxis was the second presentation 21(36.9%), and the least presentations were intracranial hemorrhage & menorrhagia 1(1.8%). Most of the cases were treated with steroid (91.1%).
Conclusions: Bone marrow exanimation is recommended in each case of the thrombocytopenia, and if decision of bone marrow exanimation is taken, it is essentially to do it prior to steroid therapy. Oral prednisolone is the readily available, inexpensive drug that can be taken orally in hospital and as outpatient. Methylprednisolone rapidly increases platelet counts so reduces period of hospitalization, but it is not always available and can be used as in patient treatment only.
Keywords: Acute immune thrombocytopenic purpura, children.

Background: Bone marrow aspiration (BMA) and biopsy is a procedure that is used to evaluate the cause of abnormal blood test results, to confirm a diagnosis or check the status of severe anemia of unknown cause, to evaluate abnormalities in the blood's ability to store iron and also to diagnose infection.
Objectives: To identify the main indications of bone marrow aspiration and the most common diagnoses encountered in children welfare teaching hospital.
Patients and methods: This was a prospective and retrospective descriptive study over 6- month period from 8th of February 2010 to 8th of August 2010 in children younger than 14 years. All bone marrow aspirate results were reviewed. The clinical data provided by clinicians were also noted. General Anesthesia was used in (439) patients, and local anesthesia was used in (321) patients. The procedure done under aseptic technique, aspiration sampling was generally performed before biopsy; the site of aspirate usually from the posterior iliac crest except for those less than 12 months where the tibia was the preferable site of aspiration
Results: There were a total of 757 performed bone marrow aspirations. The main indications for bone marrow examination were the following:256 (34%) for diagnosis and follow up of leukemia ,154 (20%) for evaluation of fever of unknown origin,95 (13%) for evaluation of hepatosplenomegaly, lymphadenopathy andor pallor, 54 (7%) for evaluation of solid tumors , 49 (6%) for evaluation of thrombocytopenia,48 (6%) for evaluation of pancytopenia,36 (5%) for evaluation of lymphoma, 29 (4%) for suspected storage or metabolic diseases, 21(3%) for evaluation of undiagnosed masses in the abdomen, mediastinum, neck and jaw;12 (1.6%) for evaluation of unexplained anemia,3 (0.4%) for others. The most common results reported were: 312 (65%) normal BMA, 71 (14.5%) acute leukemia, 17 (3%) marrow involvement by malignancy (solid tumors, Non –Hodgkin Lymphoma), 8 (2%) megaloblastic anemia, 8 (2%) erythropoietic hyperplasia, 8 (2%) proliferation of reactive histiocytes with activehemophagocytosis, 4 (1%) kala azar.
Conclusions: The most common indication for this procedure in this hospital was to confirm diagnosis and follow up of acute leukemia.There is high rate of negative bone marrow examination which is unnecessarily done due to lack of further diagnostic facilities, also a high rate of non- informative results which might reflect inadequate experience of doctors performing the procedure. No complications were reported.
Key words: Bone Marrow Aspirate, Children, Welfare Teaching Hospital, indications

Background: Type 1 diabetes mellitus is one of the most common chronic endocrine disorders of childhood, growth impairment is one of its long−term consequences
Objective: To study the anthropometric indices among children with type 1diabetes.
Patients and Methods: All children with type 1diabetes attending Diabetic Clinic at Children Welfare Teaching Hospital-Baghdad, during 1/1 – 31/5/2013were included in this cross sectional study. Demographic data, disease information, and type of presentation were obtained directly through patient's interviews. The weight in kilogram and height in centimeter were measured for each child and their anthropometric indices were classified according to World Health Organization indicators, 1997.
Results: A total of 253 children with type 1diabetes were studied, 51.8% were females, 47.9% developed the disease at 5-9 years of age, and 52.6% presented with classical signs and symptoms. Stunting /sever stunting was 15% with male predominance, higher among older age group (10-20 y), wasting/ sever wasting was 19.4% with male predominance, higher among older age group (10-20 y), over weight/ obese was 3.6% with females predominant and higher among younger age group.
Conclusion: Wasting/ sever wasting and stunting /sever stunting were the highest growth problems among diabetic children with male predominance and higher among older age group at diagnosis.
Key words: type 1 diabetes, children, growth.

Background: Kala-azar is an important parasitic disease that affects children of all age groups with fatal outcome if left without treatment.
Objectives: Children admitted with Kala-azar were studied for evaluation of Indirect Immunoflorescent Antibody Test and Bone Marrow examination validity.
Patients and methods: A cross-sectional study was conducted on 60 children with Kala-azar admitted to Children Welfare Teaching Hospital - Medical City - Baghdad, for the period from the 1st of January 2011 to the 1st of February 2012. Information was obtained for each child including age, sex, residence, signs and symptoms, laboratory investigations and diagnosis was established by serology and/or bone marrow examination. Treatment and outcome were also noted.
Results: The majority (94%) of studied children were less than 5 years age group. Males were more than females with a ratio of 1.63:1. Sixty percent of patients were from Diyala governorate and 23% from Baghdad. The main clinical features were prolonged fever and hepatosplenomegaly (100%). Bone marrow examination was positive in 45% of suspected Kala-azar cases. IFAT was positive in 47(78%). IFAT sensitivity was 70% and specificity 15%. All cases were treated with Pentostam (sodium stibogluconate). No resistance to Pentostam treatment was detected. The case mortality rate was 2%.
Conclusion: The highest sensitivity in laboratory diagnosis among studied children was that obtained with a combination of bone marrow aspirate direct examination and IFAT. Conventional methods for diagnosis of visceral
Leishmaniasis are still indispensable.
Keywords: Validity, kala-azar, diagnosis, Baghdad

Background: Anorectal malformations (ARMs) represent a complex group of congenital anomalies resulting from abnormal development of the hindgut, allantois and Mullerian duct, leading to incomplete or partial urorectal septal malformations .
Objectives: The objective of this study is the accurate demonstration of the anatomy of the level of rectal atresia and any associated recto-urinary fistula by using APDC for optimal surgical management using APDC .
Patients and methods: This is a prospective study including sixty-five male patients with high ARMs who were admitted to the department of pediatric surgery in Children Welfare Teaching Hospital in Medical City Complex - Baghdad - Iraq ; during the period from April 2009 to November 2011 ; they were subjected to divided descending colostomy in the postnatal period ;Augmented-Pressure Distal Colostogram (APDC) was performed at a later age for demonstration of the level of rectal atresia and the presence of the recto-urinary fistulas which then were confirmed at operation.
Results: Rectourinary fistulas were demonstrated in 52 patients (80%) by APDC technique and were confirmed at operation in each case. In the remaining 13 patients (20%), this technique failed to demonstrate a fistula, in 8 of them no fistula was identified during operation or thereafter , while in the remaining 5 patients fistulas were detected during operation .
Conclusion: The APDC readily demonstrated the level of the rectal atresia and the associated recto-urinary fistulas in the majority of the patients , providing a road map for definitive surgical repair of ARMs.
Keywords: augmented pressure distal colostogram (APDC), ano rectal malformations(ARMs).

Background: Nosocomial respiratory infections in the intensive care is one of the challenging issues, competing with other major causes of morbidity and mortality, that’s why it needs to be studied thoroughly.
Objectives: To assess the prevalence of colonization of respiratory tract by Gram-negative rods (GNRs) for critically ill patients in Baghdad teaching hospital, and to determine antimicrobial resistance of the isolated strains.
Patients and Methods: A cross sectional study conducted on critically patients at the ICU/Baghdad teaching hospital during the period from December 2012-june 2013. thirty four adult patients on mechanical ventilator with endontracheal intubation or trachestomy, were enrolled in this study, tracheal specimen were collected from all patients, and were cultured on various bacteriological media(blood agar, chocolate agar, macConky agar,saboroied agar) then incubated for various time. Drug resistance was examined with various antimicrobial drugs according to diagnostic microbiology guidelines.
Results: thirty four adult patient(mean age 45years), 32 patients yielded positive microbial growth on culture , infection rate= 94%, with gram negative infection show the highest rate of infection = 90% ,mainly acenitobacter baumanni about 44%,E.coli 35%, P.aeroginosa23%, K.pneumoniea20%, S.aureus11%, and monilia comprising 32% of infection. Many patients showed mixed infection pattern (more than one bacterial type). A.baumanni showed the highest resistance pattern (87%) was resistant to all types of antimicrobials and the sensitive one is only for one or two antibiotics.
Conclusion: inappropriate and incorrect administration of antimicrobial agents in empiric therapies and lack of appropriate infection control strategies are leading cause for opportunistic infection
Key words: ICU, gram negative bacteria, antibiotic resistance.

Background: Chronic obstructive pulmonary disease (COPD) is a preventable disease with some significant extra pulmonary effects that may contribute to the severity in individual patients.. The systemic manifestations of COPD include a number of endocrine disorders , such as those involving the pituitary, the thyroid , the gonads, the adrenals and the pancreas. The mechanisms by which COPD alters endocrine function are incompletely understood but likely involve hypoxemia , hypercapnia , systemic inflammation and glucocorticoid administration.
Objective: To evaluate the relationship between pulmonary function tests and thyroid gland function in patient with chronic obstructive pulmonary disease (COPD).
Subjects and Methods: Cross sectional study was done in Baghdad teaching hospital from April 2012 to October 2012 in respiratory outpatient. Thirty eight patients were included in the study (36 male and 2 females) who had stable COPD , thyroid function tests and FEV1% were done to all of them. Patients were classified into four groups according to GOLD criteria: mild COPD ( > 80) FEV1% , moderate (80 – 50)%, severe ( 50 – 30)% and very severe < 30%.
Results: one patient has decreased level of TSH , one patient has decreased T3 hormone and one patient has increased free T3 hormone level, all other patient had normal thyroid hormones levels. The results of study showed no significant changes in thyroid hormones concentrations with COPD and its severity.
Conclusion: We found no significant changes in thyroid hormones in patients with COPD, and any changes that occur in TFT in these patients are may be due to other causes than COPD.
Keyword: COPD, : Chronic Obstructive Pulmonary Disease. TSH:Thyroid function test

Background: the most common cause of obstructive jaundice is CBD stones, and these can produce significant morbidity and mortality. The management of the obstructive jaundice due to CBD stones is in evolution; several methods of investigations and treatment have been introduced, and each one has its own advantages and disadvantages.
Objective: to study and evaluate the management of obstructive jaundice due to CBD stones in Baghdad teaching hospital.
Patients and methods: a prospective study of 111 patients with clinical, laboratory, and imaging features suggestive of obstructive jaundice due to CBD stones who were managed in Baghdad teaching hospital over the period from January 2011 to November 2011; other 14 patients with obstructive jaundice due to other causes were excluded. . All patients were symptomatic and had abnormal liver function tests. Transabdominal US was done for all of them, MRCP for 26 patients, and EUS for 9 patients. Four patients had primary stones, 95 patients had secondary stones, 9 patients had retained stones and 3 patients had Mirizzi syndrome.Those patients were subjected to ERCP both to prove the diagnosis and extract the CBD stones. Only three patients sent directly for surgical treatment because they were diagnosed as Mirizzi syndrome. Surgical treatment also was offered for those patients in whom endoscopic management failed.
Results: from the 125 patients presented with obstructive jaundice included in this study 14 patients were found to have a periampullary lesions, and they were excluded from the study, so the total number of the patients was 111; 46 males and 65 females Endoscopic management was done for 108 patients with success rate of 90%. Surgical treatment was required in 13 patients, 10 of them following failure of ERCP and the other 3 patients were those with Mirizzi syndrome. The most common complication of ERCP was acute pancreatitis and the most common cause of failure to extract the stones was the size of stone (more than 15mm)
Conclusions: Endoscopic sphincterotomy and stone extraction followed by laparoscopic
cholecystectomy is still considered the orthodox treatment of CBD stones. Large and multiple CBD stones are the most common causes of failure of endoscopic extraction and indication for surgical treatment. There was higher incidence of retained CBD stones in our study than what was reported in western countries, because there is no intraoperative screening to avoid missing CBD stones in our hospital.
Key wards: CBD stones, endoscopic management, surgical intervention

Background: Enteral nutrition is a widely used, standard-of-care technique for nutrition support in critically ill and trauma patients.
Objective: to determine the role of feeding jejunostomy as a safe way for enteral nutrition in patients who meet the criteria for its use.
Method: prospective, comparative study done in the 3rd. surgical unit at Baghdad Teaching Hospital from 1st.of January 2003 till 1st. of April 2009, of 230 patients who fit the criteria for feeding jejunostomy insertion. The patients were divided into 2 groups (those with feeding jejunostomy 122 patients (53%) and without feeding jejunostomy 108 patients (47%)). We follow up these patients using the particular parameters.
Results: feeding jejunostomy was performed in 122 patients (53%), 68% of feeding jejunostomy was performed in urgent procedures, pancreaticoduodenal injuries was the most common indication. The BMI was noticed to be either increased in 48 patients (39.34%) or stabilized in 70 patients (57.37%) with feeding jejunostomy, while the lymphocytes count was either increased in 64 patients (52.45%) or remain within normal range in 56 patients (45.9%) with feeding jejunostomy, while serum protein level showed no decrease in any patients with feeding jejunostomy. Diarrhea was the most common complication observed in 14 patients (11.5%) with feeding jejunostomy.
Conclusion: Feeding jejunostomy is an effective and safe way of delivering nutrition postoperatively. It leads to increase or stabilize BMI, lymphocytes count and serum protein level, although it produced GI complications which are generally mild and resolve quickly with non-invasive treatment.
Keywords: Feeding jejunostomy, enteral nutrition, feeding jejunostomy complications, BMI

Background: Breast Lump Is The Second Most Common Presenting Symptom, After Breast Pain, To The Breast Clinic. Tru-Cut Needle Biopsy Provides Enough Tissue For Histopathological Diagnosis And Is Considered A Reliable Method For Establishing Preoperative Tissue Diagnosis.
Objectives: To Compare The Results Of Fine Needle Aspiration Cytology (FNAC), Tru-Cut Needle Biopsy With Excisional Biopsy In Detecting Breast Cancer In Palpable Breast Masses.
Patients and Methods: This Is A Prospective Study Done In Baghdad Teaching Hospital Breast Clinic From January 2009 To October 2010.It Is Conducted On 120 Females Who Presented With Palpable Breast Masses. After Detailed History And Physical Examination The Patients Were Sent For Ultrasound Examination And/Or Mammography And Then Both FNAC And Tru-Cut Needle Biopsy Were Performed In An Outpatient Setting Followed By Excisional Biopsy.
Results: This Study Shows That Tru-Cut Needle Biopsy Is Superior To FNAC In Confirming Breast Cancer In Palpable Breast Masses With Suspicion Of Malignancy And It Can Give Definitive Histopathological Diagnosis Of The Lesion With Low Cost And Low Complication Rate.
Conclusion: Tru-Cut Needle Biopsy Is Superior To Fine Needle Aspiration Cytology In The Detection Of Breast Cancer In Palpable Breast Masses With Low Cost And Low Complication Rate.
Key Words: Tru-Cut Needle Biopsy, Breast Mass.

Background: Colorectal adenocarcinoma is the most common type of gastrointestinal cancer, with about 150,000 cases each year in the United States and about 56,730 deaths from colorectal cancer risk. In Iraq and according to the Iraqi cancer registry (ICR) reports, the incidence of colorectal carcinoma was 4.55% of whole body malignancy, & it is the seventh cause of death from cancer (ICR 2005). In males, it’s the 7th common cancer while in females it’s the 4th most common cancer. The estrogen and progesterone receptors belong to a super- family of nuclear hormone receptors. These receptor proteins function as transcription factors when they are bound to their respective ligands, these receptors shares a common structural and functional organization
Objectives: to evaluate the immunohistochemical expression of estrogen (ER) and progesterone (PR) in colorectal adenocarcinoma and to correlate this expression with different clinical and pathological parameters.
Material and method: Twenty five cases of colorectal adenocarcinoma diagnosed in private laboratories in Baghdad/Iraq from November 2011 to march 2013, were respectively evaluated in term of age, gender, pathological diagnosis, including the tumor site, size, lymph nodes status, grade and stage of tumor. Using infiltrative ductal carcinoma of the breast as control for both estrogen and progesterone receptors expression were investigated immunohistochemically, nuclear and cytoplasmic staining of tumor cells were accepted positive.
Results: Fourteen (56%) of the cases were male, 11 (44%) case were female, with age distribution ranging from (24-84) years, with a mean age of 56.5 year. Tumor size ranges between 2.5-10 cm, mean of 6.25 cm. Seven cases (28%) cases were from the caecum, 5(20%) from each rectum, sigmoid and left colon respectively and 3(12%) cases were from more than one segment of the colon. Histologically the tumor grade ranges from moderately differentiated in 23(92%) cases and poorly differentiated in 2(8%) cases. Regarding pathological staging (TNM system), 5(20%) cases were stage T2, 17 (68%) cases were stage T3 and 3(12%) cases were T4, lymph node involvement found in 10(40%) cases and distant metastasis were found in 2 (12%) cases. Estrogen receptors expression was positive in 2(8%) cases, while progesterone receptor was positive in 5(20%) cases; both ER positive cases were PR positive. Both ER positive cases were female; one of the PR positive cases was male. All of the ER and PR positive cases were moderately differentiated, one case of ER positive tumor showed nodal involvement while three cases of PR positive showed nodal involvement.
Conclusion: - Estrogen and progesterone receptors in colorectal adenocarcinoma had same activity. The level of ER and PR expression in tumor tissue could not predict malignant biological behavior of the colorectal adenocarcinoma. No significant statistical correlation was observed between ER, PR expression and any of the studied clincopathological parameters.
Keywords: Colorectal adenocarcinoma, ER, PR.

Back ground: Gastrointestinal Stromal Tumors (GISTs), although are rare, are the most common mesenchymal tumors of the digestive system. Vascular endothelial growth factor(VEGF) is associated with the malignant potential of several types of carcinomas.
Objectives: to evaluate the expression of VEGF in GIST and its correlation with different clinic- pathologic parameters and risk categories.
Patients, material, and methods: This is a retrospective study including thirty two randomly selected cases of GISTs collected from the pathology laboratory of the gastroenterology and hepatology teaching hospital and from private laboratories from the period January 2010 to December 2013. VEGF immunohistochemical marker was applied to the tumor tissue sections to evaluate its expression and to correlate it with other parameters.
Results: The mean age of the patient was 42.5 years with a female to male ratio of 1.3:1. The stomach was the most common site for the tumor. VEGF was expressed in 12(37.5%) cases. There was a significant statistical correlation between overexpression of VEGF and the patients' gender and the primary tumor site. There was no significant statistical correlation between VEGF overexpression and age of the patients, size of the tumor, mitotic index, and risk of malignant potential categories.
Conclusion: There is a significant statistical correlation between VEGF expression and both gender of the patients, and the primary site of GIST.
Key Word: GIST, VEGF.

Back ground:-Rheumatoid arthritis is one of the most common forms of inflammatory polyarthritis, with a prevalence of approximately 0.8% of adults worldwide, Rheumatoid arthritis patients may become disabled within few years if untreated that may lead to permanent disability. Different biomarkers have been assessed for the improved diagnosis of Rheumatoid arthritis, including a wide range of autoantibodies. However, only rheumatoid factor (RF) and anti-cyclic citrullinated peptide (ACCP) have gained wide acceptance.
Aim of the study to investigate the levels of ACCP, Leptin, and Lipoprotein (a) in females with RA to provide information on possible pathophysiologic mechanisms, and to give recommendations for determination of these parameters in diagnosis and follow up of Rheumatoid arthritis patients.
Patients and methods:- The study included Forty women with RA and Thirty apparently healthy women with matching age and weight as controls.The patients were selected at the outpatient clinic of Rheumatology & Rehabilitation in Medical City/ Baghdad Teaching Hospital during the period from (May2013 ) to (December2013 ).
Results:-The results showed that levels of ACCP antibodies in serum of patients with RA were significantly higher than in serum of healthy control. Also there were significant differences between mean of serum leptin level and Lp (a) in patients compared to the control group.
Conclusion:- Serum biomarkers like ACCP, Leptin, & Lipoprotein (a) assays are becoming increasingly available and may help in early diagnosis and assessment of complications in Rheumatoid arthritis patients.
Kew word:- ACCP, Leptin, lipoprotein, RA

Background: Pancreatic carcinoma is one the most lethal malignancies and the Prognosis for patients with locally advanced or metastatic disease is poor. The 5-year survival rate is about 4%, which is the lowest of any cancer and median survival is 6 months. The high mortality rate is largely due to the typically advanced stage of the cancer at the time of diagnosis and treatment. Resection is the only current treatment resulting in cure for pancreatic carcinoma. However, due to the initiation and progression of this cancer without symptoms, only about 10% to 15% of patients present with localized disease amenable to potentially curative resection. Chemotherapy increases survival and up to date, the use of palliative chemotherapy is increasing due to the availability of more drugs and a wider range of indications. CA 19–9 is the marker most widely used clinically as elevated in approximately 75% of patients with pancreatic carcinoma with reported sensitivities ranging from 70% to 90% and specificities ranging from 68% to 91% with great support of CK marker in excluding or confirm diagnosis.
Objectives: Evaluation of CA19-9 and CK HMW markers expression in pancreatic and ampulla of vater carcinoma immunohistochemically & to correlate the immunohistochemical expression of CA19-9 and CK HMW markers with carcinoma location.
Material and method:- 36 samples of whipple operations and partial pancreatectomy whom already diagnosed as pancreatic carcinoma from 2009-2013 whom visit and admitted to GIT hospital in Baghdad medical city. A tissue sample block from mass that already processed and identified by dissection report from data base of histopathology Lab was collected for staining by immunohistochemical method with C19.9 and CK marker.
Results:-36 patients - 24 male and 12 females, Mean age (45+2.02) range (28-65) year with Male: Female ratio is (2:1) As differentiation of malignant cell in this study it was higher level with grade II (60%) For TNM classification the result was dominantly staging as T3. IHC staining of CK19-9:-in present study we have 75% of patient samples with positive result. .Present study show that 4 patient's samples of total 6 positive CK/IHC staining was pancreatic carcinoma while only 2 of total positive was ampulla carcinoma.
Conclusion:-CA19-9 is pancreatic tumor associated marker but cannot used for screening and association with clinical findings. Meanwhile CK tissue immunolabling mostly helpful in diagnosis of ampullary and pancreatic carcinoma and CK immunohistochemical staining can be used as exclusion aid in diagnosis of pancreaticcarcinoma.
Keywords: whipple', pancreatic carcinoma, ampullary carcinoma CA19-9, CK.

Background: Giardia lamblia and Cryptosporidium parvum are recognized as important health problem in different countries. Humans may infect by two parasites at different age groups. But more common in countries with poor sanitation and unsafe water. Cellular and humoral response is engaged by the host to fight against parasitic infection, cytokines are produced by CD4 of payer's patches or generated from the mucosa lymphoid tissue as result of long duration antigen stimulation via trophozoites or cyst stage or others.
Objectives: To evaluate the levels of IL-2, -4 and C- reactive protein in the sera of patients with Giardia lamblia and Cryptosporidium parvum.
Materials and methods: A total of 142 patients with diarrhea (56 males, 86 females) and compared with 60 healthy looking controls (10 male, 50 female). Attended to the central teaching hospital for pediatric in Baghdad city - Iraq, between 1st April 2012 till 1st August 2013. The diagnosis was established based on direct microscopic examination of stool and Cer Test Crypto-Giardia card, is a one-step colored chromatographic immunoassay. The patients serum had been tested for IL-2, -4 by used Enzyme linked Immunosorbent Assay (ELISA), while the concentration of C- reactive protein was determined by auto chemistry analyzer.
Results: The results of laboratory diagnosis revealed that 61 cases infected with Giardiasis, 31cases infected with Cryptosporidiosis and 50 cases infected with double infection. levels of IL-2, -4 and CRP in serum patients with Giardia lamblia and Cryptosporidium parvum was increase when comparing with the healthy looking controls, the statistical analysis shows no significant difference (p<0.05) between infected groups.
Conclusion: Giardia lamblia and Cryptosporidium parvum infections had significant effects on IL-2, -4 and CRP levels.
Keywords: Interleukins, C-reactive protein, giardiasis, cryptosporidiosis and inflammatory response.

Background: Human parvovirus B19 (B19V) is the only human pathogenic parvovirus, It is highly erythrotropic and preferentially replicates in erythroid progenitor cells (EPCs). Recently the effects of B19 infection have been well studied in children with acute lymphoblastic leukemia (ALL).
Objective: To detect parvovirus B19 among children with ALL.
Methods: A cross sectional study involved forty five patients with ALL (21 patients were newly diagnosed ALL and 24 children who underwent chemotherapy) who were attending department of oncology in Children's Welfare Teaching Hospital in Baghdad Medical City between December 2012 and April 2013, compared to forty five of apparently healthy children as a control group, age and sex were matched. A serological and molecular detection of parvovirus B19 were done using enzyme linked immunosorbant assay (ELISA) and Real-time PCR.
Results: B19-IgM, IgG and DNA were detected in study cases as (15.6%, 40% and 13.3%) compared to control group (4.4%, 13 % and 0%) respectively. B19-IgG and B19-IgM were detected in newly diagnosed cases in (41.7% and 19.05%) as well as in (38.1% and 12. 5%) of cases on chemotherapy respectively, all cases with B19-DNA signals were underwent chemotherapy (25%) with mean viral load of (36x104 copies/ml).
Conclusion: children who suffering from ALL are at increased risk of B19 infection. Notable percentage of persistent B19 infection was recorded among children with ALL who are receiving ongoing treatment.
Key words: parvovirus B19, acute lymphoblastic leukemia (ALL), real time PCR.

Background: Rheumatoid arthritis (RA) characterized by local and systemic effects of inflammation has a wide range of biochemical markers implicated directly or indirectly to its pathogenesis.
Objective: To evaluate interlukine 35 (IL-35) in Iraqi females with newly diagnosed
RA and to assess its contribution in the disease process.
Patients and method: Serum of (55 Females) of newly diagnosed RA and 23 healthy Females were used to estimate their interlukine levels.
Results: Females of RA showed a significant increase in the levels of interleukine 35(IL-35) and in the levels of High Sensitivity C-Reactive Protein (hs CRP). While there were no significant changes in the level of alkaline phosphatase (ALP) and calcium (Ca). The correlation between IL-35 and each of hs CRP, ALP and Ca (-ve) were non-significant (r = -0.066, -0.04271 and -0.103) respectively.
Conclusion : This is the first study to show the elevation of serum levels of IL-35 in Iraqi female patients with newly diagnosed RA which indicates that IL- 35 may be a good biomarker for early RA.
Key Words: Rheumatoid arthritis (RA), Interleukin 35 (IL-35), High sensitivity C- reactive protein (hs CRP), Calcium (Ca), alkaline phosphatase (ALP).

Background: In this study, a targeted drug delivery system has been developed based on nanoporous particles covered with cadmium sulfide and loaded with 5-flourouracil. The nanoparticles loaded drug exerts a cooperative antineoplastic activity.
Methods: Iron oxide nanoparticlers were synthesized and functionalized with cadmium and loaded with 5-flourouracil. Different techniques were used for characterization such as infrared (IR) and ultraviolet (UV) measurements. A cell culture test was done in order to investigate the effect of drug loaded on nanoparticles.
Results: The development of nanoparticles loaded anticancer agent for possible application in targeted treatment of cancer where the drug release is triggered by externally applied UV irradiation. In addition, the treatment of cancer cells with drug loaded magnetic material leads to a decrease in viability of the cells due to the activity of cadmium nanoparticles. Upon exposure to low power UV light (365 nm) the loaded 5-flourouracil is released which induces additional decrease in viability of Cervical carcinoma cells HeLa.
Conclusions: In summary, an anticancer drug delivery system based on nanoporous material loaded 5-fluorouracil has been developed. The cooperative anticancer effect of nanoparticles and loaded 5-flourouracil was observed.
Keywords: Nanoparticles, magnetism, 5-flourouracil, drug release.

Back ground:-Rheumatoid arthritis (RA) is a systemic disease characterized by progressive, erosive and chronic poly arthritis, where cellular proliferation of the synoviocytes and neo-angiogenesis leads to formation of pannus which destroys the articular cartilage and the bone .
Objective :-to evaluate theOxidative Stress index( OSI )by measuring malondialdehide( MDA) and Total Antioxidant Capacity( TAC) in serum of RA patients in addition to uric acid and albumin and to investigate the alteration in these parameters compared to healthy individuals.
Patients and Methods :- twenty five patients with rheumatoid arithritis and twenty five apparently healthy subjects matched for age and weight have been included in this study,uricacid and Serum malondialdehyde were measured by enzymatic methods. serum total antioxidant capacity was measured according to Miller et al method.
Results :-The data obtained showed that the serum levels of Albumin, the total antioxidant capacity were significantly lower in patients with RA than in healthy controls.While the serum levels of MDA,uric acid were significantly higher in patients with RA than in healthy controls.
Conclusion:- there is acontribution of antioxidant to the pathogenesis of RA.
Key word:-Albumin,oxidative stress, total antioxidant capacity,MDA,uric acid

Back ground: Peripheral neuropathy is a common complication of diabetes mellitus. However, patients with diabetes are more vulnerable to develop chronic inflammatory demyelinating peripheral polyradiculoneuropathy (CIDP) which is an acquired immune mediated disorder.
Objectives: : Assess the role of electrophysiological study (NCS and EMG) in the diagnosis of CIDP in diabetic patients and Differentiate between diabetic CIDP and diabetic peripheral polyneuropathy(PNP).
Subjects and methods: Three groups of subjects of either sex involved in this study; fourty one (41) patients with diabetic CIDP, fourty six (46)patients with diabetic peripheral polyneuropathy and fourty one (41) control subjects. Sensory and motor nerve conduction study (NCS) and electromyography (EMG) of both upper and lower limbs were performed for each subjects. This study was conducted at the unit of neurophysiology in Neuroscience Hospital and Al- yarmouk Teaching Hospital, in a period from November /2012 to May /2013.
Results: Prolonged distal sensory latency distal (DSL), decreased sensory nerve action potential (SNAP) amplitude and slowing of sensory nerve conduction velocity (SNCV). Sensory NCS was significantly changed in both patients groups. While the presence of abnormal median-normal sural (AMNS) and abnormal radial – normal sural (ARNS) pattern of sensory involvement were detected only in diabetic CIDP patients. Concerning motor nerve conduction study, prolonged distal motor latency (DML), slowing of conduction velocity and prolonged mean F-wave latency were detected in both patients group, but these abnormalities were more in diabetic CIDP patients. Conduction block CB% and abnormal temporal dispersion TD% were observed only in diabetic patients with CIDP. Whereas needle EMG of diabetic CIDP revealed that there are mixed axonal and demyelinating neuropathy.
Conclusion: This study conclude that the abnormal sensory and motor NCS in the lower limbs were higher when compare with that of upper limbs. However, the changes in motor parameters are more in diabetic patients with CIDP than that of diabetic PNP. In addition, the proximal nerve segments are more vulnerable to be affected by demyelinating process rather than the other segments. Moreover, most of diabetic patients with CIDP have mixed axonal and demyelinating changes in respect to those who had only demyelinating neuropathy.
Keywords: CIDP (chronic inflammatory demyelinating peripheral polyradiculoneuropathy), DM (diabetes mellitus).

Background: Tuberculosis infection represents a global health problem and a great risk to Health Care Workers. Identifying individuals, particularly Health Care Workers with latent tuberculosis infection will support tuberculosis control through chemoprophylaxis and prevent cross-infection. The aim of this study was to assess the prevalence and some risk factors for latent tuberculosis infection among Health Care Workers in three tuberculosis health institutions in Baghdad.
Methods: A cross-sectional study was conducted in 2013 in Baghdad- Iraq on Health Care Workers working in the Specialized Respiratory & Chest Diseases Center (Tuberculosis institute), Ibn Zuhur Hospital for Chest Diseases and Al-Resafa Health District TB Clinic in Al-Sadr City. Information about age, gender and occupation was obtained. All subjects received a Mantoux tuberculin skin test. Induration of ≥10 mm was considered a positive test.
Results: A total of 212 Health Care Workers were enrolled, 71.7% of them were males; none had recently received BCG vaccine. Fifty nine (27.8%) had a positive tuberculin skin test. Physicians (38.2%) and nurses & paramedicals (31%) have the highest rates of positive result than other occupations. The highest rate of positive results was seen among Health Care Workers in Specialized Respiratory & Chest Diseases Center (55.1%). There was a significant association between positive TST response with the occupation (job title) and the working site. No significant association was seen with age or gender (P>0.05).
Conclusion: Around one third of Health Care Workers in these tuberculosis facilities had latent tuberculosis infection. Job and work place were significant determinants.
Keywords: Health Care Workers, Latent Tuberculosis, occupational health, Iraq