Journal of the Faculty of Medicine Baghdad

Background: The gold standard in assessing asthma control is the Global Initiative for Asthma (GINA) criteria. And because of the difficulties of access to pulmonary functions tests, The ACT has the added advantage that it does not require lung function assessment.
Objectives: The aim of this study is to assess asthma control through ACT score and GINA guideline, and to determine if the ACT can be as useful as the GINA-guidelines criteria in assessing asthma control in Iraq.
Patient and method: Cross sectional study with comparing ACT vs. GINA guideline in control of asthma level. This study was conducted at Respiratory consultation unit of the Iraqi National center of early detection of Cancer, Baghdad-Iraq, The study was conducted during the period from 1stNovember 2012 to 1stJuly 2013. A total of 71 adult asthmatic patients who were attended to the respiratory consultant unit were asked to participate and were enrolled in this study regardless their age or gender. Their asthma diagnosed and proved clinically by a combination of history, clinical finding In addition objective measurements using spirometry(FEV1) measured by the reversibility test which is defined as(an increment of>12% or 200 ml of FEV1 after 20 minutes of administration of inhaled short acting B2-agonist)
Result: There were 71 patients enrolled in this study, of them 66 (92.96%) had an ACT score of ≤ 19 ((26)(39.4%) are male),(40)(60.6%) are female ,and 5 patients (7.04%) had an ACT score of > 19 (only(1)(20.0%) is male and and(4)(80.0%) are female. It had been found the number of male is( 27)and(26)(39.4%)out of them had an ACT<19and only(1)(20.0%) had ACT>19 and number of female is(44),(40)(60.6%)out of them had ACT<19 and(4)(80.0%)had ACT>19. No significant differences had been found in between those patients with ≤19 ACT score vs. those with > 19, regarding the age and gender, in both comparison P>0.05 it had been found that good agreement present between ACT and GINA, 92.9%.ACT agreed the GINA in (37 patients with uncontrolled asthma, 24 patients with partially controlled and 5 patients with controlled).
Conclusion: ACT can serve as an alternative diagnostic tool in assessing asthma control even without an aid of a spirometer or a peak flow meter. An ACT score of more than 19 can classify patient as controlled asthmatic while an ACT score < 19 can classify the patient as uncontrolled and partially controlled asthmatics.
Keyword: (ACT): Asthma Control Test.(GINA) Global initiative for asthma

Background: Seasonal variation and gender preponderance have not been adequately studied in Guillain-Barre syndrome (GBS).
Objective: This study aims to evaluate the seasonal variation and sex preponderance in children with Guillian Barré Syndrome.
Patients and methods: A cross sectional study was carried out by reviewing wards' registry of all cases with Guillian Barré Syndrome admitted to Children Welfare Teaching Hospital during a 10-year period (1999 - 2008). Age, sex, seasonal distribution, residence and outcome were analysed.
Results: Guillian Barré Syndrome was diagnosed in 217 (126 boys, 91 girls) patients and the annual hospital rate of admission was 22.9 /100000 children. There was increase annual incidence from 1999 till 2008 with a drop in 2006, boys: girls ratio was 1.4:1 and boys were older than girls. Clustering of cases was found during January, March, May and November over the 10-year period, 37% of cases occurred during winter and 52.5% of patients were from Baghdad.
Conclusion: Guillian Barré Syndrome is more common in boys. Boys were older than girls. Clustering of cases was found during winter season.
Key words: Guillian Barré Syndrome; Iraqi children; seasonal clustering

Background: Retrograde Cardioplegia is a widespread method for myocardial protection in coronary bypass surgery and to abroad range of open heart surgical procedures in addition to antigrade Cardioplegia,
Objectives: Is to evaluate the use of retrograde cardioplegia and its advantages in coronary bypass surgery at Ibn Al-Nafees Teaching Hospital, Department of Cardiac Surgery,
Patients and methods: This is a retrospective study that was conducted at Ibn Al-Nafees Teaching Hospital from the first of January to the first of October 2015, fifty patients with coronary artery dieses were admitted to the hospital and coronary artery bypass graft (CABG) surgery was done under cardiopulmonary bypass using retrograde cardioplegic canula through the coronary sinus from the right atrium in addition to antigrade cardioplegia from aortic root for myocardial protection during surgery on arrested heart using cold crystalloid cardioplegia
Results: The fifty patients who were studied were operated upon, the age of patients was ranged from 37-79 year with a mean age 0f 60 year and male to female ratio was 3:1. 25 patients (50%)had left main coronary artery lesion ,all underwent bypass surgery on cardiopulmonary bypass machine using retrograde cardioplegia in addition to antegrade. in 45 patient (90%) the heart picked up (beating) spontaneously without using D.C shock while in five patient (10%) internal D.C shock was required for beating the heart from the state of ventricular fibrillation .In all patients , coming off from heart lung machine was easy with a small dose of inotropics agents. Intra aortic balloon pump was used in one patient. Only one early death observed in this study due to post operative renal failure.
Conclusion: Retrograde cardioplegia is a safe , widespread, and effective
method for myocardial protection in addition to antegrade cardioplegia and this achieved longer time of protection during cardiac arrest . This method is very useful in patients with left main coronary artery disease
Key words: retrograde cardioplegia, cardiac surgery, myocardial protection

Background: Pulmonary masses represent a great challenge for diagnosis. Fine Needle Aspiration Cytology (FNAC) is one of the diagnostic methods which was used since long time.
Objectives: To concern on Fine Needle Aspiration Cytology of pulmonary masses regarding benefits, precautions and patient's preparation to avoid suspected complications.
Patients and Methods: A prospective study is carried out from December 2008 to July 2015 on 45 patients presented with pulmonary masses to the Department of the thoracic and vascular surgery at Al-Yarmook teaching hospital and from the private sector. A Fine Needle Aspiration Cytology was done for them under local anesthesia as an outpatient procedure.
Results: 40 patients (88.9%) got accurate results of diagnosis as different types of malignancies. Five patients (11.1%) got inconclusive results. No mortality reported. Complications like Pneumothorax was occurred in three patients (6.7 %), Haemoptysis in 14 patients (31%) and mild chest pain in 13 patients (29%).
Conclusion: FNAC is relatively safe and valuable method to diagnose pulmonary mass lesions and to categorize them for better subsequent management either surgical or by chemotherapy but the patients must be prepared well and the doctor who intend to do FNAC either being trained to deal with possible complications or backed up with a thoracic unit.
Keywords: Pulmonary masses, Fine Needle Aspiration Cytology, Accurate diagnosis, Pneumothorax.

Background: although breast cancer in young women is less common and often overlooked, it is still considered a major health concern.
Objectives: to evaluate the demographic, clinical, radiological and histopathological characteristics of breast cancer among a sample of Iraqi women diagnosed under the age of 40 years.
Patients and methods: a retrospective study enrolled 73 females below the age of 40 years with a history of breast cancer. All data was extracted from an established information system database designed by the Principal Investigator of the Iraqi National Breast Cancer Research Project under supervision of the International Agency for Research on Cancer (IARC) over a 4-years period from 2011 to 2014.
Results: seventy three women under the age of 40 years with breast cancer were included in the study out of 625 diagnosed cases at different ages (11.68%). The age at presentation ranged from 25 to 39 years, the peak age frequency (63%) was recorded in the period between 35-39 years (n=46). Family history of breast cancer was noticed in approximately 31.5% of cases (n=23). Early menarche (less than 12 years old) was detected in 78.1% (n=57) of cases. On examination, 90.4% (n=66) of patients had painless palpable breast lump. By Sonography, the lesions were spiculated margins in 52% (n=38) of patients and echogenic halo around the mass was detected in 57.5% (n=42) of cases. Stage-II disease was recognized in 54.8% (n=40) of sample of the study and majority of the tumor (98.6%) were ductal in origin. According to Scarf-Bloom-Richardson method, 60.3% (n=44) of the tumors were moderately differentiated (i.e. grade- II). Eight patients (10.9%) were presented with triple receptor-negative breast cancer and recurrence of tumor was encountered in 17.8% (n=13) of cases.
Conclusions: The current study suggest that breast cancer among young Iraqi women under 40 years had high incidence rate but might be less aggressive than what is reported in western countries despite of high recurrence rate.
Key words: breast, cancer, young age, Iraq.

Background: Breast cancer is the most frequent cancerous tumor and major cause of death from cancer between women all over the world.
Objectives: is to assess if ultrasound features of breast cancer can predict its histopathological grade and HER2 status of breast cancer for patients had their diagnosis in Oncology Teaching Hospital in Medical city complex from September 2014 to November 2015
Patients and Methods: This is retrospective study of 102 patients whom histopathologically proved breast cancer had reviewed their ultrasound findings and correlate them with histopathological grade and HER2 status
Results: well circumscribed lesions, poorly defined and spiculated lesions are more likely to be of intermediate to high grade histopathology with negative HRE2 status while malignant LNs states are more likely to be from moderate to high grade with positive HER2.
Conclusion: Breast ultrasound is a good tool in prediction of histopathology and HER2 status by assessment breast lesion morphology, outline and margin
Keywords: breast ultrasound, histopathological grade, HER2 status.

Back ground: The incidence of malignancy in multi-nodular goiter is thought to be low as compared with solitary thyroid nodule.
Objectives: Identifying incidence of malignancy in multi-nodular goiter.
Patients and Methods: This is a prospective study at Al-kindy teaching hospital from January 2013 to September 2015. 160 patient with multi-nodular goiter were included in the study (132females,28 males) their ages ranged between 17-75 years with a mean age of 35.88 years. Each of the patients had special form of detailed information including history and physical examination ,results of investigations; all the patients had near total thyroidectomy. All the specimens were fixed in formalin and sent for histo-pathological evaluation.
Results: Females affected by multi-nodular goiter more than males (132 females&28 males) with a ratio of 4.7/1 female to male ; 36.25 % of them were in the 4th decade of life ; the most common presenting symptom was mass in the neck (51.8 %) ; nodules affect both lobes +- isthmus in 85.6% of the patients ; FNAC(fine needle aspiration cytology) in suspected nodules show atypical cells in 18% of the patients ; the pathological cause of multi-nodular goiter was thyroid tumor in 30 patient(18.7%) , (16 patient) by adenoma( 53.3%) and (14 patient) by malignancy (46.7%) ; the most common malignant tumor was papillary carcinoma in 85.7% followed by follicular carcinoma in 14.3%.
Conclusion: The incidence of malignancy is quite high 8.7% in multi-nodular goiter patient which makes near total thyroidectomy as preferable procedure in the treatment of the disease.
Key words: multinodular goiter, thyroid malignancy,papillary carcinoma.

Background :Articular cartilage lesions in the knee joint are frequently seen,its treatment represents a challenge for orthopedic surgeons especially in young age patients and if left untreated,then they can progress to advanced osteoarthritis that may affect the functional status of the patients.Many treatment modalities had developed for these lesions, in the current study arthroscopic micro fracture plus intra articular whole bone marrow(WBM) injection was used as modality of treating these lesions.
Objectives: to assess the effectiveness of arthroscopic micro fracture plus WBM intra articular injection as a treatment modality for knee articular cartilage lesions.
Patients and Methods : a prospective experimental study was performed on 30 patients (14 females,16 males ) with a mean age of 38.6 years who had chondral lesions in their knee joint that failed to respond to conservative treatment.Arthroscopic micro fracture plus WBM intra articular injection was done to them.The functional assessment of the patients and their knee pain were evaluated by modified Cincinnati knee rating score (CKRS) and Visual Analogue Scale (VAS) respectively, both preoperatively and six months postoperatively. These results were compared.
Results: there was statistically significant improvement in a modified CKRS and VAS six months after surgery. 26 patients out of 30 patients
(86.7 %) were improved.The improvement was statistically significant for those patients ≤ 40 years of age and also for those above 40 yeas of age, but it was more pronounced in those patients ≤ 40 years.
Conclusion : Arthroscopic micro fracture plus intra articular WBM injection is an effective treatment modality for small,well defined,full thickness chondral lesions in the knee joint especially for those ≤ 40 years old on short term follow up. A long term follow up is needed.
Key words :Arthrospoic + micro fracture + bone marrow injection + chondral knee lesions.

Background: a number of studies have shown that application of topical calcineurin inhibitors is effective for a broad spectrum of inflammatory skin disorders.
Objective: to compare the efficacy and safety of 1% of pimecrolimus cream versus 0.05% of clobetasol cream and 0.005% of calcipotriol cream in psoriatic patients.
Patients and methods: adults on stable plaque psoriasis were randomized to three treatment groups (pimecrolimus, clobetasol, and calcipotriol group). The criteria of inclusion involve affected BSA of ≤10%, with a local psoriasis severity index (LPSI) score of ≥5. The main assessment of clinical efficacy was the percent changes in LPSI. The quantitative determination of cytokine levels (IL -6, s IL-2R, TNF-α), skin biopsies, and creams safety were also evaluated.
Results: the median percent changes in LPSI for pimecrolimus, clobetasol and calcipotriol groups were 51%, 56% and 59%, respectively (p>0.05). Pimecrolimus cream decreased cytokines levels and improved pathological features of psoriatic lesion. Mild skin burning was the most frequent adverse event reported by pimecrolimus (40%; p<0.05) versus 8% in clobetasol and 12% in the calcipotriol gr. Conclusion: pimecrolimus cream demonstrated efficacy comparable with that of clobetasol and calcipotriol for the treatment of mild to moderate plaque psoriasis.
Key words: psoriasis; pimecrolimus; clobetasol; calcipotriol; efficacy; safety.

Background: Autism spectrum disorder (ASD) is a general term for a group of complex disorders of brain development; these disorders have no single known cause, they are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors.
Objective: The aim of the study was to evaluate different biochemical parameters in some autistic Iraqi children, and to compare the results with healthy children who matched with age, looking for any alteration in the studied parameters in order to understand the biochemistry of this disorder.
Patients and Methods: Forty one consecutive autistic children admitted to (Al Safa center for autism and Iben-AL Rshid Psychiatry Teaching Hospital) were included in the current study with mean age of (6.62y±3).
Results: Results obtained in the present study were higher significantly high levels (p≤0.05) of serum uric acid, serum total bilirubin, and thyroid stimulating hormone (TSH). While non-significant differences (p≥0.05) in the levels of fasting blood glucose, total cholesterol, serum totals protein, serum albumin, and total thyroxine T4, triiodothyronine T3. The results also indicated three cases of autistic children who have positive test for serum Anti- tissue-transglutaminase IgA & IgG antibody by using ELISA technique.
Conclusion: The present study highlights the relationship between some chemical parameters and ASD. Further study must carry out with large number of cases to investigate this relationship more deeply in these patients.
Keywords: Autistic Spectrum Disorder, glucose, cholesterol, uric acid, bilirubin, hypothyroidism,
celiac disease.

Background: Prevention against nosocomial infection is an important issue of health care field and considered a challenge of patients’ since it reflects its effect on their quality of life. This due to that it will lead in most cases to prolonged hospitalization and also more cost.
Objective: To determine the prevalence of different types of nosocomial infection and to demonstrate the association of different risk factors (hospital environment, workers, visitors) with nosocomial infection.
Patients: this study was carried out in eleven months at Ba’quba general Hospital; Iraq. A total of 81 clinical specimens (urine, pus from abscess , burn swab, nasal swab, ear swab and wound swab) taken from surgical patients,102 specimens from hospital workers,50 specimens from patient visitors,335 specimens from hospital environment and 64 specimens from 18 newly admitted patient were studied.
Methods: all microorganisms which were isolated from patients, workers, visitors control group and environment were identify using standard bacteriological and mycological methods.
Results: the present findings demonstrates that the percentage of nosocomial infection (N.I) types found to be highest with urinary tract infections 21 (40%), followed by surgical site infections 19 (35.8%) and respiratory tract infection 12 (23%).
Conclusion: most of the isolated microorganisms were resistant to antibiotics and most of them have ability to produce β-lactamase enzyme.
Keywords: Nosocomial infection. Hospital acquired infection,

Background: Colorectal Adenocarcinoma contributes one of the most common malignancies and the second leading cause of death from cancer in the western world. Epidermal growth factor receptor (EGFR) belongs to a family (ErbB-tyrosine receptors), EGFR plays an important role in the pathogenesis of colorectal cancer.
Objectives : to evaluate the immunohistochemical expression of epidermal growth factor receptors (EGFR) in colorectal adenocarcinoma and to correlate this expression with different clinicopathological parameters.
Pateints and method: In this study clinicopathological parameters of twenty five colorectal adenocarcinoma cases diagnosed in private pathology laboratories in Baghdad /Iraq from November 2012 to September 2013 were respectively evaluated in terms of age, gender, pathological diagnosis including; tumor location, lymph node status. EGFR expression was investigated immunohistochemically.
Results: twenty five colorectal cancer patients were included in this study with median age 54.5, range from (28-81)years, 15 cases (60%) were female and 10 (40%) cases were male. Tumor size range from 3-10 cm with mean 6.5 cm, 10 (40%) cases were from rectum, 7 (28%) from the right side colon & 8 (32%) cases were from from left side colon. Twenty three (92%) cases were moderately differentiated, and two (8%) cases were poorly differentiated, five (20%) cases were T1, 10 (40%) cases were T2, 5 (20%) cases were each T3 & T4 respectively. 3 (12%) cases were N1, 7 (28%) cases were N2, and fifteen (60%) cases have no lymph node involvement. Three (12%) cases with distant metastasis. Eighteen (72%) cases of colorectal adenocarcinoma demonstrate EGFR reactivity in > 1% of the tumor cells. No significant statistical correlation was noticed between EGFR expression and each of age, gender, site of the tumor and grade of tumor (P value > 0.05). A significant statistical correlation was noted between EGFR expression and local tumor invasion (T) and lymph node involvement (p value <0.05).
Conclusion: Epidermal growth factor receptor plays an important role in colorectal adenocarcinoma oncogenesis. EGFR expression appears to have a value as a prognostic biomarker, since it's expression by the tumor cells is significantly correlated to lymph node involvement and tumor local invasion.
Keywords: Colorectal Adenocarcinoma, EGFR

Background: The combined pill includes a combination of an estrogen and a progestin. Users of these pills have an increased risk of developing thrombotic disorders compared to the non-users. Obesity is an independent risk factor for venous thromboembolism. Obesity with oral contraceptive use increases the risk of thrombosis furthermore.
Objectives: To assess the effects of these pills in obese and healthy non-obese women on factor VII activity and D-dimer level. Also to compare the thrombophilic effects of combined pills in women with control group of normal healthy non-users women.
Patients and Methods: This study was started on November 2014 and completed on March 2015, and included 50 females attended at Baghdad Teaching Hospital. They were using contraceptive pills (Microgynon® ED Fe) for at least 3 months. Females were divided into 2 equal groups; the non-obese group and the obese group. As well 25 non-obese age-matched non-pregnant females not on contraception or taking any hormonal therapy were recruited as a control. The hemostatic parameters done for them included the prothrombin time, activated partial thromboplastin time, factor VII, D-dimer level, and platelet count.
Results: There were significant reductions in prothrombin time in both the non-obese and obese groups compared to the control (P= 0.014 and 0.020, respectively). The correlations between the duration of pills use and clotting times both showed insignificant differences in the study groups. The factor VII activity in the non-obese and obese groups were significantly higher than that of the control (P= 0.041 and 0.001, respectively). There were also significant increase in D-dimer levels in the non-obese and obese groups compared to the control (P= 0.029 and 0.038, respectively). The platelet count was significantly increased only in the obese group compared to the control (P = 0.027).
Conclusion: The use of the combined oral contraceptive pills (Microgynon® ED Fe) is associated with significant increase in factor VII activity and the level of D-dimer that may lead to enhanced procoagulant activity. Therefore, females should be properly assessed and monitored before starting using the pills and while on them.
Keywords: Combined oral contraceptive pills, Obesity, Factor VII, D-dimer

Background: Aspergillosis is a large spectrum of diseases caused by members of the genus Aspergillus. Invasive aspergillosis is a severe infection that occurs in patients with prolonged neutropenia, following chemotherapy,transplantation,or immunosuppressive protocols .Galactomannan ( GM) is a molecule ,found in the cell wall of Aspergillus species and is released in the blood during growth .The detection of GM in the blood is used to diagnose the invasive Aspergillosis in humans using ELISA assay.
Objectives: To detect Galactomannan antigen in in the serum of immunocompramized patients suspected to have invasive aspergillosis.
Patients and methods: This study was conducted on 50 patients from the hematology&oncology department,of Baghdad teaching hospital and pediatric oncology wards ,from March 2013 to October 2013.The patients presented with fever that is not responding to antibiotics along with cough and sputum and abnormal chest X-ray findings suspicious of IA. 11 healthy Iraqi individuals served as a control group.
Results: ELISA test was positive in 39 of 50 (78%)while all of the control group individuals were negative(100%).The concentration of galactomannan antigen detected by ELISA was statistically significant when compared to control group( OD 0.658±0.033 vs 0.191±0.020 respectively) ( p<0.05).
Conclusion: The detection of galactomannan antigen is a very useful and rapid method for the diagnosis of invasive aspergillosis disease in immunocompromised patients.
Key words: Galactomannan antigen,invasive aspergillosis.

Background: Cheese has an outstanding nutritional quality, but is also an efficient vehicle for transmission of diseases to humans and is an excellent medium for bacterial growth and an important source of bacterial infection. when consumed all without pasteurization Salmonella spp. are one of the most frequently reported causes of bacterial foodborne worldwide.
Objective: This study was carried out to study the microbiological contamination of processed cheese.
Material and Methods: A total of 13 samples of processed cheese were randomly collected from supermarkets in Baghdad, IRAQ. Elven grams of cheese were added to 99ml of sterile diluted peptone water in a flask and shaken well to make 10-¹ dilution .Further dilution were made. 0.1 ml was used to incubate culture media (selective) incubated at 37C°and 42C° for 24 hours. Colonies were counted. Bactrac 4300 was used to confirm diagnosis of Salmonella spp.
Result: Although none of tested samples contained Salmonella spp. Or Staphylococcus aureus or Escherichia coli either other bacteria using conventional method, one sample of them been contaminated by Salmonella spp. using Bactrac 4300 system.
Conclusion: It can be concluded that processed cheese contaminated by this pathogen in this area as well in other countries and might constitute a risk for contamination and Bactrac 4300 a new method used for confirmation.
Keyword: Processed cheese, Microbiological test, Salmonella

Background: Viral infection in pregnancy is known to cause many problems such as fetal malformation; growth restriction and even fetal death; the relationship between viral infection and abortions is not well understood. The infection during pregnancy can affect the fetus due to lack of mother's immunity.
Objective: To assess the frequency of human parvovirus B19-specific antibody type IgM and IgG among pregnant women with spontaneous abortion.
Patients and Methods: A semi-quantitative enzyme linked immunosorbent assay technique was applied for detection of anti-human parvovirus B19 IgM (Ridascreen-K6031-Germany) and IgG (Ridascreen -K6021- Germany) in sera of 90 pregnant women who have previously experienced abortion were collected from Al-Batool teaching hospital for maternity and children in Baquba-Diyala province, Iraq, during the period from October 2014 till May 2015. The age was ranged from 18-40 years. Statistical analysis was performed by using statistical package of social sciences, version-16, and P-value of < 0.05 as significant difference.
Results: Among study group the mean age was 26.57 years, with an age range 18-40 years. Seropositivity rate was 11.11% (10 cases) for an individual occurrence of human parvovirus B19 IgM alone and 13.33% (12 cases) for a similar individual rate of human parvovirus B19 IgG, while 6 cases (6.66%) had both types of antibodies. Multiple variables regarding occurrence of anti-human parvovirus B 19 specific IgM and IgG antibody simultaneously, was evaluated, and none the variables had significant difference.
Conclusion: The fact that 31.11% of studied participants had specific Parvovirus B19 antibody revealed a high occurrence of primary acute parvovirus infection and non-immune against parvovirus B19. Considering the potential role of this virus in abortion and fetal death, it emphasizes the importance of Parvovirus infection in pregnant women also this finding is comparable with that in the other countries.
Key word: Pregnant women, Abortion, Human parvovirus B19, ELISA.

Background: Humans skin, is the largest organ of the integumentary system, it has multiple layers of ectodermal tissue and guards the underlying muscles, bones, ligaments and internal organs. Pityriasis versicolor is the prototypical skin disease etiologically connected to Malassezia species. Malassezia furfur is the primary causative agent of pityriasis versicolor which causes either hyperpigmentation or hypopigmentation of the skin.
Objective: To identify of Malassezia furfur associated with pityriasis versicolor patients and healthy control by using molecular detection methods.
Material and Methods: Sixty patients suffering from pityriasis versicolor disease who attended Medical Imammaine Kadhmain City from beginning of 1st December 2013 to the 30th of April 2014. Clinical diagnoses were done by consultant dermatologist. Forty were males and twenty were females with a mean age of (28.63 ± 11.83) years old. Control group includes skin swabs collected from 120 healthy volunteers, with ages ranging from 1 to 70 years with a mean of (30.03 ± 14.58 years). Both groups were investigated for M. furfur using phenotypic and molecular characterization.
Results: According to the gender, pityriasis versicolor was more infection in males than females with (68.3%). Malassezia furfur had a high percentage with male of pityriasis versicolor patients and healthy volunteers (65.0% and 73.1%, respectively). According to the site of lesions, Malassezia furfur was most isolated from chest site with percentage (35.0%) while in healthy volunteers, Upper limbs and chest were most site lesions associated with M. furfur with a percentage (23.1%).
Conclusions: It was concluded that pityriasis versicolor was more common in male than female. Also the chest site was most the lesions associated with Malassezia furfur in pityriasis versicolor patients.
Key words: Malassezia furfur, Pityriasis versicolor.

Background: Inflammation and more specifically inflammatory cytokines are determinant in the development of microvascular diabetic complications, including neuropathy, retinopathy and nephropathy.
Objective: The aim of present study is to evaluate the relationships between high sensitive C-reactive protein, microalbuminuria and risk factors for cardiovascular disease.
Subjects and methods: the study involved (30) patients with type 1 diabetic mellitus compared to (30) healthy control. A fasting blood sample was drawn from all subjects after an overnight fasting to measure the biochemical parameters which including glycated hemoglobin, lipid profile, atherogenic index of plasma and high sensitive C-reactive protein concentration in blood of all subjects, also evaluating microalbuminuria, creatinine, urea level in urine of type 1 diabetic mellitus patients and healthy control.
Results: results revealed a significant increase in the level of glycated hemoglobin, total cholesterol, triglyceride, low density lipoprotein, high sensitive C-reactive protein, microalbuminuria, urea and atherogenic index of plasma. While a significant decrease in high density lipoprotein level in patients group compared with control group. Also, there were a highly significant positive correlation between high sensitive C-reactive protein and glycated hemoglobin, atherogenic index of plasma and microalbuminuria.
Conclusions: the results of this study suggests that high sensitive C-reactive protein can be use with microalbuminuria as a biochemical marker to predict the early stage of cardiovascular disease in children and adolescents with type 1 diabetic mellitus.
Key words: hs-CRP, microalbuminuria, type 1 diabetic mellitus, cardiovascular risk.

Background: Arterial functional changes reflected by vascular stiffness might occur at early stages of cardiovascular disease before the morphological alterations reflected by increasing the intima media thickness and it is widely used as a very sensitive indicator of functional vascular damage.
Objectives: This study is aimed to correlate ultrasound detected vascular functional changes with the severity and extent of coronary artery disease.
Patients and methods: Sonographic scans were performed on 100 Patients (61males, 39 females) with an age range of (40-65years) for measuring carotid and brachial arteries end diastolic and end systolic diameters to calculate vascular stiffness index . Coronary CT angiography has been used to visualize the atherosclerotic plaque to define the degree of luminal stenosis by creation of high-quality images which are obtained by the multislice CT spiral scanners.
Results: A positive statistical correlation was observed between the stiffness index of both carotid and brachial arteries in single coronary lesion (SCL), multiple coronary lesion (MCL) and control groups in addition to the significant positive correlation between both arteries stiffness index with the percentage of coronary artery stenosis in SCL group. Significant difference between the arterial stiffness index among the study groups is only noticed for carotid artery between the control and MCL groups (p<0.05).
Conclusion: Conduit arterial stiffness index is a good indicator of the severity and extent of coronary artery disease.
Keywords: arterial stiffness index, coronary artery disease.

Jervell and Lange-Nielsen syndrome (congenital LQTS and hearing loss) isa rare inherited disorder characterized by deafness present at birth (congenital) occurring in association with abnormalities affecting the electrical system of the heart , Iron-deficient anemia and elevated levels of gastrin are also frequent features of JLNS1. The severity of cardiac symptoms associated with Jervell and Lange-Nielsen syndrome varies from case to case. Some individuals may have no apparent symptoms (asymptomatic); others may develop abnormally increased heartbeats (tachyarrhythmias) resulting in episodes of syncope, cardiac arrest, and potentially sudden death. Physical activity, excitement or stress may trigger the onset of these symptoms. Jervell and Lange-Nielsen syndrome is usually detected during early childhood and is inherited as an autosomal recessive trait.2