Journal of the Faculty of Medicine Baghdad

Background: Coronary artery bypass graft is routinely performed on an arrested heart using cardiopulmonary bypass with aortic cross clamping and Cardioplegia. Off-pump coronary artery bypass graft (OPCABG) is being increasingly used in selected cases as an attempt to decrease morbidity and mortality.
Objective: The main objective of this study is to clarify those patients who are indicated for OPCABG despite it is surgically demanding technique and to evaluate the mortality and morbidity associated with such procedures.
Patients and methods: It is a retrospective study of 28 patients with coronary artery disease, in need for coronary artery bypass graft admitted and surgically treated at the Iraqi Centre for Heart Diseases during 2 years period using OPCABG.
Results : most of the patients were male (82%), and most of them (42%) were within age group of 61-70 years, the main indication of off-pump coronary artery bypass graft was left ventricular dysfunction and the least indication was cerebrovascular accident and renal impairment.
Conclusion: Off-pump coronary artery bypass graft is useful in context of morbidity and mortality when indicated for patients with special criteria, those patients might get harm if we put them on bypass.
Key words: Coronary artery bypass grafting, off-pump Coronary artery bypass grafting, left ventricular dysfunction.

Background: Unintended durotomy is an infrequent but well-recognized Complication during degenerative lumbar spine surgery. The current literatures report a wide variation in incidence of durotomy during degenerative lumbar spine surgery.
Objective: To assess the incidence, treatment, clinical consequence, complications of unintended durotomy during degenerative lumbar spine surgery, and the results of 2-24 months clinical follow-up.
Patients and Methods: A prospective study was conducted on 264 patients who underwent degenerative lumbar spine surgery performed in Al-Sheikh Zayed Hospital and private nursing home hospital- medical city in Baghdad from January 2011 to June 2012. Patients managed by spine fixation were excluded from this study.
Results: The incidence of unintended durotomy during spine surgery was 8.33% (22 of 264 cases). The incidence varies according to the type of surgery being performed (6.66% in primary discectomy, 12.5% in decompressive laminectomy and 21.73% in revision surgery). Unintended durotomy was more common in revision surgery compared with primary surgery (21.73% vs 7.05%; p < .001), and it was significantly more common among elderly patients (17.39% in patients > 60 years old; p = .006). Most of the durotomies were managed by primary repair. A mean follow-up of 6 months showed good long-term clinical results.
Conclusions: All unintended durotomies must be repaired primarily. Durotomies that were immediately recognized and treated did not lead to any significant sequelae at a mean follow-up of 6 months.
Key Words: degenerative lumbar spine surgery, unintended durotomy, CSF leak.

Background: Lymphoblastic lymphomas (LBL) are neoplasms of precursor T cells and B cells, or lymphoblasts. The term lymphoblastic lymphoma has been used to describe predominantly lymph node–based disease; however, clinical distinction between LBL and acute lymphoblastic leukemia (ALL) has been arbitrary and has varied among different studies and institutions
Objectives: To determine the frequency of LBL among all Non-Hodgkin’s lymphoma (NHL) patients in children and to study the clinical and pathological features of LBL and assess the treatment outcome.
Methods: A retrospective study included 28 children with newly diagnosed LBL (based on morphology) below the age of 14 years over 8 years period from January 1st, 2000 to December 31st, 2007 All the patients except one were treated by modified Medical Research Council UK National Randomized Trial For Children and young Adult with Acute Lymphoblastic Leukemia (MRC UKALL) regimen, one patient was misdiagnosed as B-cell NHL and treated with United Kingdom Children’s Cancer Study Group (UKCCSG) Non-Hodgkin’s Lymphoma protocol.
Results: LBL forms 28/376 (7.1%) among NHL diagnosed in Children Welfare Teaching Hospital (CWTH) in the same period. The median age was 8.95 years (range 2 to 13.25 years) with male to female ratio of 3.7:1. Lymphadenopathy was present in 22 (78 .6%) of patients. The median duration of onset of symptoms was 7.25 months (range 1 week to 18 months). In response to treatment, 20 (71.4%) patients achieved complete remission (CR), 1 (3.6%) died during induction and 7 (25%) patients were non-responder (4 died and 3 abandoned). Of the 20 patients who achieved complete remission (CR); thirteen (46.4%) remained in continuous complete remission with a median follow up of 32.3 months, 3 (10.7%) patients died while in CR in an average of 16.6 weeks, 2 (7.1%) patients abandoned treatment and 2 (7.1%) patients relapsed.
Conclusion: The study showed a low frequency of LBL in comparison with other studies which might be due to inadequate diagnostic facilities which differentiate LBL from other types of NHL, low survival rate might be due to advanced stages at presentation in addition to abandonment of treatment in some patients.
Key words: Lymphoblastic lymphoma, children, outcome.

Background: A confirmed case of influenza A (H1N1) virus infection is defined as a person with an influenza-like illness with laboratory confirmed influenza A (H1N1) virus infection by real-time RT-PCR or viral culture.
Objectives: To identify demographic and clinical predictors, and outcome of proved cases of H1N1 influenza epidemic in children.
Patients and methods: This study was conducted in Children Welfare Teaching Hospital/ Medical City/ Baghdad on 67 hospitalized patients aged 1 month to 18 years with signs and symptoms suggestive of influenza during the period of outbreak of pandemic influenza A (H1N1) from 1st of October 2009 to 1st of January 2010. Demographic aspect, clinical coarse, laboratory investigations, treatment and outcome were reported. For each patient 2 nasal, 2 throat swabs and single blood sample were collected, and sent to Central Health Laboratory. All suspected patients received Oseltamivir for 5 days. The data were analyzed statistically by Chi-square (χ2) test and Fisher's Exact Test.
Results: The median age for the studied patients was 7.7 years with a range of 1 month -18 years. 39 patients out of 67 (58.2%) were PCR positive. 34 out of 39 (87.1%) were <6-18 year old while 5 out of 39 (12.9%) were >3-6 years old. No case was reported in age group 1 month-3 years. Twenty eight patients out of 67 (41.8%) were PCR negative. 17/28 (60.7%) were <6-18 years old. 5 out of 28 (17.9%) were >3-6 years old. 6 out of 28 (21.4%) were 1 month -3 years old. Female: male ratio in PCR positive patients was 1.05:1 while it was 1.54:1 in PCR negative patients. Most of the children came from urban area in both PCR positive and negative results. Cough and fever had a higher frequency in both PCR positive and negative patients while headache was more in epidemic influenza. All PCR positive and 26 out of 28 (92.8%) of PCR negative patients improved while 2 out of 28 (7.2%) of PCR negative patients died.
Conclusions: Children at school age were more prone to acquire epidemic influenza. Both genders were equally affected. Frequency was more in urban area .Cough and fever was the most frequent presentation. Headache was a more common presentation in H1N1 influenza than in seasonal influenza.
Key words: Influenza, Epidemic, Children, Baghdad

Background: Primary myelofibrosis is characterized by clonal expansion of hematopoietic stem cell with a non-reactive clonal proliferation of fibroblasts and bone marrow fibrosis, which occurs at an extramedullary hematopoiesis. The clinical features of Primary myelofibrosis include anemia, marked splenomegaly and constitutional symptoms. Ineffective erythropoiesis and extra-medullary hematopoiesis are the main causes of anemia and organomegaly, respectively
Objectives : the aim of this study was to evaluate the clinical features, diagnostic tools and the treatment outcome of patients with primary myelofibrosis.
Patients and methods: this is a prospective study conducted at the national center of hematology in Baghdad during the period between October 2009 and October 2013. It includes 30 adult patients diagnosed with primary myelofibrosis. Diagnosis was based primarily on bone marrow aspirate and biopsy. The patients were followed up and assessed monthly with complete blood picture and liver function test and renal function test with serum lactate dehydrogenase level.
Results: thirty patients were included in this study. There were 16 male and 14 female, the median age was 58 year with range (26-75) years. The most frequent presentation was in the group older than 60 years. Twenty four (80 %) patients had symptoms at diagnosis. The most frequent presentation were the fatigue, left upper quadrant swelling, night sweats, weight loss and fever. The main clinical features were huge splenomegaly which is found in 29 (97%) of patients, while the main finding in blood count at presentation were anemia followed by leukocytosis with leukoerythroblastic blood picture in 22 (73 %) of cases. The level of LDH was high in about 23 (77 %). The bone marrow biopsy showed fibrosis stage 2 in 24 (80 %). Patients who died were in the highest risk groups. The median survival was approximately 28 months.
Conclusion: Primary myelofibrosis is part of myeloproliferative neoplasia; it usually runs chronic course. Till now none of the therapeutic modalities approved for treatment of primary myelofibrosis proved to be superior to others, yet the 5 year survival of this disease considered good.
Keywords: anemia, outcome, primary myelofibrosis

Background: Lung cancer is the leading cause of cancer deaths and its incidence is rising. The determination of histopathology and stage of primary lung carcinoma is crucial to develop appropriate treatment approach that affects morbidity and mortality. Fiber optic bronchoscope techniques for early detection of lung cancer are a promising tool as they might allow visualizing changes of early lung cancer and also permitting sampling for histological confirmation.
Objective: This study was intended to compare the fiber optic bronchoscopy findings and their anatomical locations with the histopathology types in patients with lung cancer.
Patient and Methods: A cross section study was conducted during the period from 1st February 2012 to the 31th of July 2013, 49 patients with clinical and radiological findings suggesting primary lung cancer and diagnose later by bronchoscope samples as cases of primary lung cancer chosen for analysis of their bronchoscope findings, at Baghdad teaching hospital / respiratory clinic.
Results: Patients with squamous carcinoma (31%) had (67%) visible mass and (13%) presented invisibly as external compression. Patients with adenocarcinoma (41%) had (40%) visible mass and (35%) presented invisibly as external compression while normal bronchoscope was seen in (30%) of those patients so that adenocarcinoma mostly invisible. Patients with small cell carcinoma (28%) had (50%) visible mass and (21%) presented invisibly as external compression.The location of finding in (27%) of the patients with squam
ous carcinoma was in the right main bronchus and (20%) in right upper lobe bronchus while the carina affected in (47%). Patients with adenocarcinoma have vocal cord affected in (25%) and left upper lobe bronchus lesion in (25%).
Conclusion: There was no relationship between the fiber optic bronchoscope findings and their anatomical locations with the histological types of lung.
Keyword: FOB:Fibro-Optic Bronchoscopic, BCA-Bronchogenic carcinoma.

Background: One of the strongest risk factors for breast cancer is high breast density, relatively little fat in the breast and more connective and glandular tissue.
Objectives: this study aims to measure risk of increase breast density in correlation of CA breast & compare our results with results in other population, to compare the performance of ultrasonography and mammography in measuring breast density according to BIRDS system
Materials &methods: The study included 45 females .Measuring risk of increase breast density in correlation of CA breast & comparing the performance of ultrasonography and mammography in measuring breast density according to BIRADS system.
Results : there is strong influence of breast density as a risk factor of breast CA, according to mammography, it had been significantly found that mammographic density was the more prevalent among CA patients it found in According to mammography, also use of RI as significant and important way for estimation of density as use of 0.6 as a cutoff point, as 91% of dense breast had RI more than 0.6.
Conclusions : increase breast density is associated with possible increase risk of CA breast and use of ultrasound, mammogram and RI play a role in estimating breast density.
Keywords: Breast Density, Mammography, Doppler Ultrasound, Resistive Index.

Background: Astrocytic tumors are the most common primary tumors of the central nervous system. Several grading systems are used to grade astrocytomas. The most widely used system is the World Health Organization (WHO) classification (1979, 1993, 2000, and 2007) that grades astrocytomas (I-IV) based on cytological atypia, mitotic activity, vascular proliferation, and necrosis: pilocytic astrocytoma (grade I), diffuse astrocytoma (grade II), anaplastic astrocytoma (grade III), and glioblastoma (grade IV).
Objectives: The aim of this study is to evaluate p53 over expression , Ki-67 expression in astrocytomas and Correlate these two markers with histologic grade of astrocytomas.
Methods: Formalin fixed, paraffin-embedded blocks from 40 patients with brain astrocytoma included in this retrospective study. LSAB (Labeled Strept-Avidin, Biotin) method was employed for immunohistochemical detection of Ki – 67 and P53.
Results: P53 was detected in (25%) of the cases and was significantly positively correlated with grade IV. Ki-67 labeling index was (>5%) in (50%) of the cases. Both biomarkers were positively correlated with each other, and the grade of astrocytoma; however, Ki67 is a better marker for differentiating (diagnostic marker) between the grades of astrocytoma than p53.
Conclusion: P53 overexpression and ki-67 expression plays an important role in pathogenesis of astrocytoma evolution, as they positively associated with higher tumor grade.
Key words: Ki – 67, P53, Astrocytoma.

Background: Understanding the risk factors associated with injuries at workplace is an essential element to design and implement preventive measures for such injuries which are a significant source of disability, death and socioeconomic losses worldwide.
Objectives : describe cases of occupational injuries with respect to person- place- time model.
Materials and methods: Cross-sectional study done from October 2013 to October 2014 carried on 467 records of occupational injuries kept in the National Center for Occupational Safety and Health for the years 2011-2013.
Results: Ahigher proportion of reported occupational accidents occurred in young male workers, during day time and among primary school graduates.The leading cause of fatality/permanent disability was electrical shock. Work-related road accidents had the highest fatality/permanent disability rate.Missing data in the field:age, duration of service, length of sick leave constituted 22.5%, 43% and 69.4% respectively.
Conclusion: Work accidents could be prevented through the application and the use of safety techniques and equipments.Improving the quality and the completeness of data on occupational injuries is an important step to promote the performance of occupational health services.
Keywords: injured workers; occupational injuries; Iraq.

Background: Several factors render multiple myeloma (MM) an interesting subject for study by researchers. These include marked progress in understanding the molecular biology of normal and neoplastic plasma cells and recent advances in molecular genetics techniques. Among molecular markers, p-53 cancer suppressor gene have been widely studied.
Aim: is to correlate p-53 protein expression in multiple myeloma, as examined by immunohistochemical method, with some pathological and clinical parameters (Clinical stage and cytological grade).
Patients and methods: This is a retrospective study; whereby archival paraffin-embedded BM tissue blocks along with the clinical and hematological records of fifty patients (29 males and 21 females), with multiple myeloma and twenty controls were obtained from the Department of Hematology of the Medical City Teaching Laboratories in the period from April 2012 to April 2014. P-53 was studied by immunohistochemical staining.
Results: There was a significant positive linear correlation between increasing scores of p-53 and advancing clinical stages of disease. There was a significant positive linear correlation between increasing scores of p-53 and decreasing maturity of plasma cells.
Conclusions: Multiple myeloma patients with advanced clinical stages and immature plasma cell morphology had high p-53 scores. Since the above-mentioned factors are known independent prognostic factors, p-53 expression can readily be adopted to identify myeloma patients with an adverse prognosis.
Key words: Multiple myeloma; P-53; IHC.

Background: The human CD19 (Cluster Differentiation) antigen is a 95 kd transmembrane glycoprotein belonging to the immunoglobulin superfamily. CD19 gene located on the short arm of chromosome 16p11.2 (P: petit). CD19 is a member of the Ig immunoglobulin superfamily expressed on the surface of B lymphocytes, and may play a pivotal role in B-cell differentiation and activation. Research suggests that mutations in a gene CD19 leads to a lack of expression of CD19 membrane and result in an antibody deficiency syndrome.
Objective: The aim of this work is to study the mutations in Exon 2 CD19gene in leukemia patients in Baghdad/Iraq.
Patients and Methods: This cross sectional study was performed in the National Center of Hematological Diseases/Al Mustanisyria University. Blood samples were collected from 50 leukemia patients including (25 acute lymphocyte leukemia ALL and 25 chronic lymphocyte leukemia CLL) and 50 samples of apparently healthy individuals. DNA was isolated and the CD19 gene was amplified by using specific primers for exon2 of this gene. The nucleotide sequences of CD19 gene was according to Macro gene company, USA. Analysis was done using BLAST program which is available online at (http:// www.ncbi.nlm.nih.gov) and BioEdit program.
Results: The DNA sequencing results of flank sense of CD19 gene from healthy individual was found to be compatible 100% with wild type of Homo sapiens from the Gene Bank, while 99% compatibility was found for that gene of all ALL and CLL patients with wild type of gene. The difference was attributed to insertion of 1900 C nucleotide in position +48 of exon 2 of CD19 gene resulted in the replacement of a serine (TCC) residue into isoluseine (ATC), and deletion 1904 C in position + 49 of exon 2. This mutation resulted in change of codon from GCA to GCC but there was no changes in the amino acid (Alanine to Alanine). The second mutation (Deletion nucleotide) amended the first mutation effect (Insertion nucleotide) and did not lead to a change of all the amino acid sequence (framshift). The results showed that the incidence of insertion and deletion mutation at position +48 and +49 in exon 2 of CD19 gene and leukemia was highly significant (X2 = 15.75, P<0.01).
Conclusion: This study suggests that the ploymrphism in exon 2 of the CD19 gene is strongly associated with leukemia patient of Baghdad population.
Keywords: Framshift mutation, acute lymphocyte leukemia ALL, chronic lymphocyte leukemia CLL, CD Cluster Differentiation.

Background: JAK2V617F mutation is the most prevalent molecular abnormality in myeloproliferative neoplasms (MPNs) and has become a valuable marker for diagnosis of MPNs. Almost all patients with polycythemia vera (PV) have this acquired mutation. However, it has also been found in many other hematological diseases, and some studies even detected the presence of JAK2V617F in normal blood samples.
Objectives: To discuss the actual need to defer blood donors with high hematocrit.
Patients and methods: This prospective case control study was started on 16th of December 2012 and completed on 8th of July 2013, and enrolled 94 male blood donors who attended the National Blood Transfusion Center (NBTC) in Baghdad, Iraq. Their age range was between 21 and 62 years, and their hematocrit was ≥ 0.48 l/l. A control group of 20 patients known to have JAK2V617F positive PV were also included. The following investigations were done for both the study and the control groups: complete blood count, serum erythropoietin, and real time PCR for JAK2V617F detection.
Results: The present study found that 21.3% (20/ 94) of healthy blood donors were positive for JAK2V617F mutation. The mutant ratio was higher in the PV control than positive JAK2V617F donors (p=0.001). Out of 20 donors who have positive JAK2V617F mutation, 90% were smokers, and 22.8% (18/79) of all smokers were positive for JAK2V617F, while 13.3% (2/15) of non-smokers showed positivity for the mutation, the difference between various types of smoking and the level of JAK2V617F mutation among study groups was statistically insignificant with a p-value of 0.356. There is a frequent association of pruritis with JAK2 positivity as the percentage of pruritis in JAK2V617F positive blood donors was 40%. There was significant statistical difference between donors with positive JAK2V617F mutation and the PV control group for the hematocrit, total WBC count, absolute neutrophil count, and platelet count with p-values of (0.002), (0.001), (0.001), and (0.001) respectively.
Conclusion: The frequency of JAK2V617F mutation was much higher than that anticipated for blood donors. The blood donated from individuals with upper normal hematocrit does not necessarily denote to complete safety of blood as being devoid of JAK2V617F mutation.
Keywords: Blood donors, polycythemia vera, real time PCR, JAK2V617F

Background: Diabetic nephropathy (DN) represents the most common cause of end stage renal disease (ESRD) worldwide. Diabetic nephropathy occurs as a result of an interaction between hemodynamic and metabolic factors, however recent evidence shows an increase growing support for the notion that inflammation plays a key role in the pathogenesis of diabetic nephropathy.
Objectives: To speculate the role of IL-18 and TNF-α proinflammatory cytokines in the initiation and development of diabetic nephropathy in T1DM and T2DM.
Materials and methods: Eighty seven T1DM and T2DM patients with or without DN were enrolled. IL-18 and TNF-α cytokines were measured by solid phase immunosorbent assays.
Materials and methods: Eighty seven T1DM and T2DM patients with or without DN were enrolled. IL-18 and TNF-α cytokines were measured by solid phase immunosorbent assays.
Results: IL-18 had increased significantly in patients with DN compared to those without DN in T1DM and T2DM patients whereas TNF-α had exhibited a significant elevation among patients with DN compared to those without DN in T2DM but not T1DM.
Conclusion: IL-18 is suggested to play a crucial role in the initiation, development, and progression of DN in T1DM and T2DM patients whereas TNF-α is playing a similar role but only in T1DM patients with DN.
Key words: Diabetic nephropathy, interleukin-18, tumor necrotic factor-alpha.

Background: Thyroid transcription factor-1 (TTF-1) isa protein that is well known to be expressed immunohistochemically in normal and neoplastic thyroid and pulmonary tissues. However; increasing studies have showed its expression in normal tissues and tumors of other organs including endometrium. These facts are important to be considered in the use of this marker in the differential diagnosis of carcinoma of unknown origin and make it important to use it as a part of a panel of immunohistochemical stains. In this setting Cytokeratin 7 and 20(CK-7&CK-20) are important since they have different coordinate expression profile in different organs and tumors.
Obejectives: This study is designed to assess expression of TTF-1, CK-7 and CK-20 in neoplastic and non-neoplastic endometrium.
Patients and Methods: Thirty six cases have been studied including 23 case of endometrial carcinoma and 13 cases of non-neoplastic endometrium including cases of irregular secretory endometrium, simple hyperplasia, complex hyperplasia, complex atypical hyperplasia, and atrophic endometrium.The study performed in the Baghdad medical city from May 2013 to December 2013
Results: Two cases out of 23 cases of endometrial carcinoma (8.7%) showed expression of TTF-1 and none of the non-neoplastic endometrial cases showed any expression. Twenty one (91.3%) of 23 cases of endometrial carcinoma and all non-neoplastic endometrial cases showed expression for cytokeratin 7 with different scores.Neither neoplastic nor non-neoplastic endometrium showed expression for cytokeratin 20.
Conclusion:We concluded that although TTF-1 regarded as a marker for thyroid and pulmonary tissues (and tumors); other tumors "including cases of endometrial carcinomas can showed TTF-1 expression. CK7+ve/CK20-ve profile of endometrial carcinoma is important to consider in assessment of carcinoma of unknown origin especially if combined with TTF-1.
Keywords: TTF-1 CK-7 CK-20 Neoplastic non-neoplastic endometrium.

Background: Diabetes Mellitus is a complex chronic disease, requiring continuous medical care with multi factorial risk reduction strategies beyond glycemic control. Approximately 30% of patients with types 1 and type 2 diabetes had depression. In addition to the high risk of complications and poor glycemic control, individuals with both diabetes and depression have a 2-3 times greater risk of early mortality than do non-depressed people with diabetes. Early detection of this comorbidity is worthy, especially with simple and relatively valid scales.
Objectives: To identify the prevalence and potential risk factors of depression among diabetic patients in Babel province, 2013-2014
Patient and Method: A cross-sectional study conducted in Marjan Hospital, diabetes Center, Babel, October, 1st, 2013 to April, 1st, 2014. The study included all patients with Type1 & 2 diabetes excluding pregnant women and those with advanced complications. Data on socio-demographic variables, diabetes characteristics and presence of comorbid diseases and complications was compiled. Self Reporting Questioner (SRQ-20) to identify mental illnesses; DSM-IV criteria for depression and Hamilton-17 Scale, for assessment of severity of depression were used.
Results: A total of 466 patients were approached; 91.2% responded. About 90% were of type 2 DM; 37% had depression; 78% had mild and only 4% had severe and very severe depression. Presence of depression was significantly associated with age (P=0.000), marital status (0.036), type of treatment (P=0.001), presence of Ischemic Heart Diseases (P=0.000); retinopathy (0.012), and neuropathy (0.000).
Conclusions: More than one third of diabetic patients had depression. Age, type of treatment, and presence of other comorbid conditions or complications were significant risk factors.
Key words: Diabetes, Depression, Risk Factors, Prevalence, Iraq

Background: Multiple sclerosis (MS) is a chronic, demyelinating disease of the central nervous system (CNS) affecting young adults and is considered as the leading cause of non traumatic neurological disability of young adults affecting nearly 2 million people worldwide. The pathogenesis of MS is at best incompletely understood. There are several proposed mechanisms that may be important in the production of MS plaques: autoimmunity, environment and heredity. Deviation of immune responses in a genetically susceptible patient plays a central role in its pathogenesis. Electrophysiological, spinal tap and Radiological tools are important laboratory investigations and have added so much to the clinical diagnosis and for the classification of MS. It was found that visual function and conduction has been changed in patients with multiple sclerosis.
Objectives: The aims of the study is to estimate and evaluate the visual evoked potential (VEP) parameters in patients with MS and its relation to their disability degree (using the expanded disability status scale score "EDSS") and visual presentation of them in comparison with healthy individuals.
Patients and Methods: 112 patients with multiple sclerosis and 50 subjects without any neurological or psychiatric diseases as control group were recruited in this study. The cases were collected from Baghdad teaching hospital, MS center, Baghdad, Iraq at the period from May 2012 to April 2013, and studied at the unit of electrophysiology in Al-Shaheed Ghazi Al-Hareri Hospital in the Medical city. All patients and control groups were tested for VEP.
Results: The present study showed a significant increase in the P100 latency and inter-ocular (IO) latency difference and non statistical significant decrease in the IO amplitude difference in patients group than the control group. Also among patients group there was positive linear correlation between the severity of the disease measured by EDSS score and P100 latency while negative linear correlation with the amplitude.
Conclusion: There was a higher percent of patients with defective VEP parameters and so their visual pathway even if it was asymptomatic, in addition to their relation with patients` disability than the control group, making it easy to quantify and predict MS disability objectively.
Keywords: Multiple sclerosis, Expanded Disability Status Scale, VEP.

Background: Gastroesophageal reflux disease can lead to esophageal complications, including esophagitis, ulceration, stricture, hemorrhage, and Barrett's esophagus. However, the spectrum of problems associated with GERD has expanded to extra esophageal sites. Chronic cough and asthma are two clinical problems caused or triggered by GERD. Spirometric changes among GERD associated cough and asthma still a topic of ongoing research.
Objectives: This study was designated to evaluate the spirometric picture of GERD associated cough and asthma subjects in relation to different clinical aspects of the disease including body mass index (BMI), disease duration, presence or absence of symptoms as well as endoscopic findings.
Subjects and methods: Ninety adult subjects (90) of either sex with a mean age of 40.5±12 year are involved in this study. Fifty five (55) GERD associated cough and asthma subjects served as test group while the remaining (35) served as control group. Each subject underwent spirometry and gastric endoscopy in Pulmonary Function and Endoscopy Units respectively at Ibn-Sina Teaching Hospital /Mosul.
Results: Spirometric data of the control group were within the normal predicted range (80-120%) thus excluding the possibility of any asymptomatic obstructive airway disease. Whereas, the measured spirometric parameters (forced vital capacity (FVC), forced expiratory volume in 1 second ratio (FEV1%), peak expiratory flow (PEF), and forced mid expiratory flow(FMF) are significantly reduced in the test group with a clear restrictive pattern among the overweight subjects. In addition, neither the presence nor duration of symptoms affected the spirometric picture of the GERD associated cough and asthma subjects, unlike those with positive endoscopy findings who revealed significant obstructive pattern when compared to those with negative endoscopy findings.
Conclusions: GERD associated cough and asthma subjects with positive endoscopy findings showed obstructive pattern of spirometry irrelevant to the presence or absence of symptoms or duration of the disease.
Key words: Gastroesophageal Reflux Disease, chronic cough, asthma.

Background: obesity is an important cause of adverse health problems, including male infertility. Testosterone is essential for spermatogenesis and permits the release of mature sperms. In the absence of testosterone stimulation, spermatogenesis does not proceed beyond the meiosis stage.
Aromatase expression is directly related to the degree of adiposity; it is dependent on cytokine stimulation and requires the presence of glucocorticoids, 17β-estradiol in the plasma of adult men is formed by aromatization convert testosterone and androstinedione to 17β-estradiol
Apoptosis is an important process in the context of germ cells since they undergo both mitosis and meiosis, and this process is affected by interleukin 6and 2 (IL6 and IL2).
Objectives: To assess the effect of body mass index on serum sex steroidal hormones, seminal antiapoptotic factor soluble fibroblast associated surface antigen (sFas) and inflammatory markers (IL6, IL-2), with conventional semen parameters in infertile men.
Patients and methods: One hundred and six male partners of infertile couples were involved in the study. Height and weight of them were measured to calculate the body mass index (BMI). Serum testosterone and estradiol 2.were measured for all.Semen sample was taken after 2-7 days of abstinence. Conventional semen analysis was done for each sample according to the protocol of (WHO) 2010, after incubation and liquefaction period (30-60 min). Semen plasma was collected for analysis of interleukins (2 and 6) and sFAS .by specific kits Patients with severe oligospermia (below million sperm/ml) were excluded from the study. The rest (77) subjects were divided into three groups according to BMI (WHO, 2010) as follows: Normal (BMI < 25 kg/m2) (n=24): Overweight (BMI ≥ 25 and < 30 kg/m2) (n=30): Obese (BMI > 30 kg/m2) (n=23).
Results: The results showed a significant decrease in Testosterone level and Testosterone/E2 ratio in overweigh and obese subjects as compared to normal. The results of conventional semen analysis showed significant difference in pH and no. of round cell between the two groups. There was positive correlation between IL2 with sFAS in the two groups, and negative correlation of IL2 with total progressive cell and motility in both overweigh and obese groups. There was positive correlation of IL6 with no. of round cells in both studied groups.
Conclusion: BMI affects Testosterone level and Testosterone/E2 ratio (they were significantly decreased in overweigh and obese patients). A positive correlation between IL2 and sFAS in obese patients as well as positive correlation of IL6 with round cells in obese patients indicate the role of apoptosis which is essential for normal fertility to remove abnormal and unwanted cells in ejaculate, in infertile overweight and obese patients.
Key words: Infertility, BMI, IL2, IL6,sFAS.

Background: Many anti-obesity medicines have been increased in recent years to solve the problem of obesity; among these medicines are Green Lean Body Capsules (GLBCs) which contain green plants and fruits extract.
Objective: This study was designed to evaluate the effects of daily oral consumption of GLBCs on level of serum lipids, renal function tests, and the histological structure of the kidney in albino rats.
Patients and Methods: Twenty adult albino male rats weighing 240-260 g were divided into 2 equal groups: control group and GLBCs-treated group. During the 4-weeks treatment, each rat in the GLBCs-treated group was orally administered with 20 mg/kg B.W. of GLBCs, while the control rats were orally administered with 0.1 ml D.W. Body weights were monitored at the beginning and at the end of the experimental period. Lipid profile [total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), very low-density lipoprotein cholesterol (VLDL-C) and low-density lipoprotein cholesterol (LDL-C)], renal function tests (blood urea and serum creatinine) ; in addition to the histological examination of the kidney were evaluated in all the rats.
Results: The results revealed that body weight gain was significantly (P<0.05) less in the GLBCs-treated rats than in the control rats. Results of the lipid profile showed that the levels of TC, TG, LDL-C and VLDL-C were significantly (P<0.05) lower while the level of HDL-C was significantly (P < 0.05) higher in the GLBCs-treated rats than that in the control rats. Regarding the renal function tests, the results revealed that blood urea and serum creatinine levels in the GLBCs-treated rats were significantly (P<0.05) lower than that in the control rats. However, microscopic examination of the kidney revealed that both the control and the GLBCs-treated groups presented similar type of histological manifestations.
Conclusion: The data presented in this study suggested that the compounds found in GLBCs may act synergistically to suppress body weight gain, decrease the level of serum lipids, and decrease the level of renal function tests without any histological abnormalities effect in the kidney.
Key words: Green lean body capsules, body weight, lipid profile, rats.