Journal of the Faculty of Medicine Baghdad

Background: quality of life of cancer survivors is adversely impacted by bowel toxicity; result from pelvic radiation therapy. In the UK, 12000 patients are treated with radiation therapy for pelvic cancer, mostly with curative intent; this carries a considerable risk for normal surrounding tissues side effects.
Objective: the aim of this study was to determine the frequency, types and grade of acute gastrointestinal toxicity in radical pelvic radiation therapy in our patients so that a comparison could be made with the Western countries.
Patients and Methods: a prospective analytic study was carried out in Radiotherapy department / Oncology teaching hospital / Medical city complex, from the 2nd of January to the 30th of April 2016. A total of 53 patients with histologically confirmed uterine, cervical, rectal, urinary bladder or prostatic cancer, treated by radical radiation therapy, were enrolled in the study. Patients were assessed for the frequency, types and grade of acute gastrointestinal toxicities according to grading criteria of CTC (Common Toxicities Criteria), at the start, during and at the end of the treatment. The data was analyzed by the Statistical Package for Social Sciences (SPSS 20).
Result: out of 53 patients, 60.37% (32) were female and 39.62% (21) were male. Endometrial cancers represent 30.18% of the cases, cervical cancers were 24.52%, and rectal cancers 11.32%, urinary bladder cancers 24.52% and prostatic cancers were 9.43% of the total cases. Diarrhea was present in 50.9% of the patients; nausea and vomiting were present in 22.6% for each. The majority had grade 1 toxicities and only 2 patients developed grade 3 diarrhea (4.7%).
Conclusion: The type and incidence of acute gastrointestinal toxicities in pelvic radiation therapy were mostly related to; Radiation dose, a combined used of chemotherapy with radiation therapy and surgery.

Background: Chromogranin A is a useful tumor marker for neuroendocrine tumors (NETs) diagnosis & follow-up, Octreotide (somatostatin-long acting repeatable (SAS-LAR)) is an established treatment for NETs. Studies regarding the relation between response to SAS-LAR & the change in Chromogranin A (CgA) plasma level are still lacking.
Objectives: To determine the association between the using of Octreotide (SAS-LAR) and CgA level on time sequence & clinical status.
Patients & methods: a prospective observational study included 38 neuroendocrine patients in The Oncology Teaching Hospital/medical city complex/Baghdad, started at September 2013 till May 2016; assessing their circulating chromogranin A (CgA) plasma levels on multiple occasions(0,2 and 4 months) by ELISA technique and its correlation with response to somatostatin analogues (SAS-LAR) in those patients.
Results: the study recruited 38 neuroendocrine patients. 21 (55%) of them were males, 23 (60%) patients were older than 50 years old & 17 (44%) had metastasis to different sites. Somatostatin analogues (octreotide 30mg) was administered to 20 out of 38 (52.6%) studied patients. Serial CgA tests were performed in (17 out of 20) patients used SAS-LAR, with a change in mean value from (225.3 U/L) pre-using the agent to (17.5 U/L) two months after its use & to (8.7 U/L) four months after its use (p=0.009, p=0.002 respectively) while the change in mean of CgA level was from (205.9 U/L) to (200.9 U/L) in 10 patients who did not use Octreotide (p=0.2).Also results showed that no statistically significant difference in mean value of CgA pre & two months after using Octreotide with regard to grade of the tumor.
Conclusions: Plasma CgA is a reliable marker for NETs (regarding diagnosis, prognosis and response to treatment including somatostatin analogues).All patients with NETs should undergo a baseline plasma CgA level at diagnosis. Serial assessment of circulating CgA could be done for NET patients when there is baseline elevation of CgA level in circulation

Background: The lack of studies regarding the neuroendocrine tumors (NET) is related to the rarity of these tumors .Long acting Octreotide is an established treatment for NETs by both providing symptomatic relief & inhibiting tumor growth. However, studies regarding incidence of NETs & their response to long acting Octreotide are still insufficient.
Objectives: To study the clinico-pathologic characteristics of Iraqi patients with NET & their response to long acting Octreotide.
Patients & methods: This is a cross-sectional observational study that was conducted in Oncology teaching hospital using patients’ follow-up records. Data recruitment included all NET patients diagnosed after October 2013.
Results: During the study period (2 years) ,38 patients were recorded in Iraq/oncology teaching hospital NET Registry. Patients ` data (age, gender, site of the tumor, metastatic status as well as type of therapy applied) were collected. Twenty one (55.3 %)of the patients were males, M:F=1.2:1 , while 23 patients (60.5%) were over the age of 50 years .The gastroenteropancreatic (GEP) tract being the most common primary site followed by pelvis We found metastatic disease at presentation in 17 (44.7% ) of patients and the Liver was the most common metastatic site found in (15.8%, 6 patients). Seventeen (44.7%) patients presented with Grade 3 . Most common therapy applied in our patients included systemic chemotherapy, surgery, long acting Sandostatin & radiotherapy for palliation only according to both NCCN & ESMO guidelines. The median time of remission following Somatostatin analogue (SSA) administration was 3 months compared to 7 months in patients received other modalities of treatment (p=0.003).
Conclusion: Octreotide LAR provides symptomatic response & contributes to disease stabilization & tumor regression in both functional & non functional NETs.

Background: Obesity (body mass index >30) is increasing worldwide with an estimated 1.7 billion people currently affected by the disease, Gallstone represent the third most common disease observed among obese patients. Moreover about 30% of the patients who are candidates for bariatric surgery either have undergone a prior cholecystectomy or are found to present gallstones at time of surgery, On the other hand, newly formed gallstones may be diagnosed in 27% to 43% of patients who have undergone bariatric surgery within a very short period of time.
Objective: To determine the prevalence of gallstone disease requiring cholecystectomy after laparoscopic sleeve gastrectomy and roux en Y gastric bypass during a one year follow up and to determine the need for prophylactic cholecystectomy in these patients.
Patients and methods: prospective study among patients with morbid obesity treated with laparoscopic sleeve gastrectomy and Roux- en- Y Gastric Bypass between 1st of February 2013 till 31st of July 2015 at Saint Raphael hospital and Al-Hayat private hospital, patients with negative abdominal ultrasound preoperatively, patient with at least one year follow up after surgery were included in this study, The patients were divided into two groups for comparison. Group A patients who had laparoscopic sleeve gastrectomy, and group B included the patients who underwent laparoscopic Roux en Y gastric bypass. The primary outcome measure was the formation of symptomatic gallstones or sludge with or without complications.
Results: 284 patients in group A(sleeve) and 45 patients in group B(Bypass) were included in the analysis, the mean age of was 34.5 years for group A, and 191(67.3%) of the patients were women, whereas it was 41.5 years for group B and 33 (73.3%) of the patients were women, Symptomatic cholelithiasis subsequently requiring cholecystectomy occurred in 29 (10.2%) of 284 laparoscopic sleeve gastrectomy patients, and 5(11.1%) of 45 Roux en Y gastric bypass patients , symptomatic gallstone developed in a median of 7 months in group A, while the median time to developed symptomatic gallstone in group B was 8 months. No significant difference in symptomatic gallstone disease was found between the patients who underwent laparoscopic gastric bypass and those who had sleeve gastrectomy
Conclusions: Cholelithiasis was common in our patients before weight reduction surgery. The rate for symptomatic gallstones after surgery was not so high.. Routine prophylactic cholecystectomy should not be recommended for these patients.

Bacground: Tetralogy of Fallot (TOF) is a commn congenıtal heart disease and it may be associated with aortic root dilation (ARD ) before or even years after the surgical repair. To the best knowledge this is the first study in Iraq dealing with this issue.
Objectives : To dtermine the frequency of aortic root dilatation among sample of children with Fallot teralogy in Mosul-İraq and to asses its associated risk factors.
Patients and methods : A total of 110 children ,54 with TOF compared to 56 normal chıldren by echocardiography for determining the frequency of aortic root dilatation among both groups. Among TOF children different factors like age and sex, size of the ventricular sptal defect (VSD) ,degree of overrıdıng of aorta over the interventricular septum, severity of the right ventricular outflow tract (RVOT) obstruction , positive family history of TOF affecting other family member , the presence of previous paliative surgery like Blalock-Taussig shunt and the use of Beta receptors blocking drugs were evaluated for its possible association with the problem.
Results: Fifty four children with TOF (male :female=0.45) , mean age 67.55 ± 51.8 months and mean body surface area (BSA) 0.71± 0.47 m2 were compared to fifty six normal chıldren (male :female=0.46) , mean age 47.64 ± 39.59 months and mean BSA 0.60 ± 0.24 m2. The frequency of ARD among children with unoperated TOF was high (69 %) in the studied sample and goes with what was already known (15%-87%). Male sex , increasing patient age and severe (RVOT) obstruction with pulmonary hypoplasia were positivelly correlated with the increased risk of the development of ARD while the other factors did not show significant association.
Conclusion: Aortic root dilatation should be considered seriously in children with TOF and when ever possible surgical correction should be performed after infancy.

Background: Vascular complications have been recognized as an important factor in morbidity after diagnostic and percutaneous coronary interventions.
Objectives: This study sought to evaluate vascular complications after diagnostic coronary angiography and percutaneous coronary intervention (PCI) from the common femoral artery.
Patients and methods: This prospective cohort study was carried out over a year period, from February 2008 till January 2009, at the Iraqi Center for the Heart Disease and Ibn Al-Bitar Hospital for Cardiac Surgery. A total number of 2400 patients underwent 3600 procedures, diagnostic coronary angiography (2196) and PCI(1404) via their common femoral arteries were included in this study.
Result: A total 407(11.3%) patients developed different vascular complications (retroperitoneal hematoma, loss of distal pulse, arterial perforation each of them 0.03%, bruises 8.9%, pseudoaneurysm 0.69%, AV fistula 0.03%, hematoma ≥10cm 0.3% and <10cm 1.2%). We identified multiple factors associated with increased frequency of vascular complications like age, gender and past medical history. We have more frequent minor complications and more attendance to treat our complications surgically.
Conclusions: This study has shown that the vascular complications continue to occur post PCI and diagnostic coronary angiography.

Abstract:
Background: Acute abdominal pain classically refers to pain within the abdomen that has been present for less than 7 days from the time of presentation. The use of CT scan in the evaluation of acute abdominal pain has increased to a large extent due to high accuracy of CT in the diagnosis of specific diseases like appendicitis and diverticulitis, especially with the use of multidetector CT scanners. It has been shown that the use of intravenous contrast media increases the diagnostic accuracy of CT scan examination, with a positive predictive value of 95% in the cases of acute appendicitis. The accuracy of CT scan imaging in patients with acute abdominal pain was not affected by the lack of entral contrast material.
Objectives: To evaluate the real usefulness of multi-detector CT( MDCT) in non-traumatic acute abdomen, to determine the cause of acute abdomen in those with uncertain pathological diagnosis.
Patients and methods: This prospective study had been conducted at Al-Sader medical city from the first of January to the first of September 2015. Our study includes all patients presented to the emergency department with non-traumatic acute abdominal conditions with uncertain underlying cause inspite of detailed history and physical examination with negative or non-conclusive U/S, plain abdominal XR finding and the surgeon failed to identify the exact underlying pathology. This study included (80) patients, (44 male and 36 female) . Non-enhanced CT scan was done first for all patients which was sufficient to reach the diagnosis in (22) patients, contrast material were not used because blood urea was elevated in (6) patients . In (8) patients, CT angiography protocol was performed for patients with suspected mesenteric vessels pathology. In the remaining (44) patients, intravenous contrast was given manually via a wide bore cannula ( gauge 18) and post contrast scan done in the portal phase (delay time 45-50 second).
Results: In this study, which was performed on (80) patients with undiagnosed nontraumatic acute abdominal conditions. We found that acute pancreatitis (20 patients)(25%) was the most common cause of undiagnosed acute abdominal pain, followed by intestinal obstruction (12 patients)(15%).While acute cholecystitis (8 patients)(10%) , portal or mesenteric vein thrombosis (8 patients ) (10%) , perforated viscus ,(6 patients)(7.5%), mesenteric arterial thrombosis (4 patients) (5%) ,left gastric artery aneurysm (2patient))(2.5%) , acute appendicitis(2 patient ) (2.5%)diverticulitis (2patient) (2.5%) and ectopic pregnancy (2patient) (2.5%). In (14 patients) (17.5%), no specific pathology could be detected.
Conclusion: The role of multi-detector CT (MDCT) has an important role in the management undiagnosed acute abdominal conditions in the emergency department. Acute pancreatitis is one of the main cause of undiagnosed acute abdominal conditions.
Keywords: The role of multi-detector CT (MDCT), non-traumatic acute abdominal conditions

Background: Coronary artery spasm occurs spontaneously leading to the syndrome of variant angina. It occurs in about 15 % of patients undergoing coronary angiography.
Objectives: This study sought to estimate the rate of coronary artery spasm that occurs during coronary angiography and percutaneous coronary intervention with their risk factors in patients admitted to the Iraqi center for heart disease.
Methods: This is a cross sectional observational study, We prospectively collected the data of patients over six months period (from August 2014 till February 2015 ) who developed coronary artery spasm during cardiac catheterization (diagnostic and therapeutic).
Results: Out of 1274 patients, 106 patients developed coronary artery spasm(8.3%). 71.6% of patients were adult aged 50-69 years.74.5% patients were males (P.V 0.0001).
Smoking was a strong risk factor for the coronary artery spasm (P.V<0.0005).
Engagement of catheter in the coronary artery ostia during angiography was the most common cause of spasm (P.V0.0001).
Spasm was induced by stents (31.1%), by guide wire (16%), by balloon (3.7%) while spontaneous spasm occurred in 6.6% only.
The frequency of spasm in apparently disease - free vessels was more in the right system (65.4%) compared to the left system (34.6%). In diseased vessels the frequency is comparable in both systems.
Conclusions: This study has shown that the CAS is frequent during diagnostic cardiac catheterization and percutaneous coronary intervention procedures.

Abstract:
Background: Breast cancer is the most frequently diagnosed cancer in women worldwide and organized national mammographic screening has been adopted as gold standard for breast cancer early detection in most developed countries in the world.
Objectives: to evaluate and emphasize the performance of the initiative opportunistic breast cancer screening program in Iraq and to determine the incident malignancy rate of breast cancer among asymptomatic self-referring women aged 40 years or older via digital mammography by mean of the breast imaging reporting and data system (BI-RADS©).
Patients and methods: this retrospective study included a total of 809 asymptomatic self-referring women over age 40 years, mostly consisted of employees of the different Iraqi ministries who attended the national center of early detection of cancer in Medical City Complex at Baghdad for screening purpose during the period from September 2012- October 2013 by using digital mammography. Ultrasound examination performed as complementary study in particular cases and all cases are graded according BIRADS lexicon. BIRADS category 4 and 5 were followed by cytopathological analysis.
Results: 809 asymptomatic self-referring women were included in this initiative screening program for early detection of breast cancer at the main breast care referral center in Baghdad. The mean age at presentation was 49 years (range 40–76 years). The current study found that overall incident malignancy rate among total sample of the study was 1.11% whilst individual malignancy rate per BI-RADS category was 11.1% for BI-RADS 4 lesions and 80% for BI-RADS 5 lesions.
Conclusion: introduction of individual opportunistic screening program of breast cancer has led to a significant increase in early detection rate of breast cancer and enhance the health awareness for breast cancer screening among asymptomatic women.
Keywords: Breast cancer, opportunistic screening, mammography, BIRADS.

Background: dyspepsia is a common complaint, affecting about 26-41% of the general population. Investigations fail to identify organic cause in 50%–60% of functional dyspepsia. Little informations are available about whether quick eating is one of the risk factors for functional dyspepsia (FD).
Objectives: To study the association between quick eating and FD.
Materials and methods: The study was performed on 132 resident doctors in the medical city/Baghdad, by introducing a questionnaire derived from the Rome III criteria for diagnosis of FD and its subtypes and calculating the average daily meal duration for each one. The subjects were all Arabian, Iraqi, white resident doctors sharing the same type and amount of food. We excluded those with history of alcoholism, chronic NSAID use, documented organic gastrointestinal lesion, or with alarm features of dyspepsia , chronic systemic disease or previous history of dyspepsia.
Results: The prevalence of uninvestigated dyspepsia (UD) was 37.88%, post-prandial distress syndrome (PPD): 16.67%, and epigastria pain syndrome (EPS):12.12%.Quick eating (independently on the BMI) was significantly associated with higher prevalence of FD and EPS, but not PPD. Higher BMI was associated with higher prevalence of FD and PPD (not EPS), smoking was associated with higher prevalence of FD and both subtypes, while age and gender had no effect on the prevalence of each.
Conclusion: prevalence of UD increases in quick eaters regardless the BMI, Smoking and higher BMI also increase the UD prevalence.
Key words: functional dyspepsia, uninvestigated dyspepsia, speed of eating, PPD, EPS.

Abstract:
Background: Social phobia is common among adolescents. It can have a negative impact on school achievement.
Objctives: to study prevalence of social phobia among secondary school students and its impact on school achievement.
Methods: A total of 500 secondary school students were included in the study. They were randomly chosen from 8 schools for boys and girls in Babil city. Social phobia inventory (SPIN) was used to assess the presence of social phobia, and success or failure in the past year was used as indicator for school achievement.
Results: Social phobia prevalence among students was 32.4%. It was more common among females and students from rural areas. Students with social phobia had failed more frequently than those without social phobia (38.4% vs. 30%).
Conclusion: Social phobia is common and has negative impact on school performance among secondary school students.
Key words: Social phobia, school performance, Babil, Iraq.

Abstract:
Background: In Iraq, breast cancer is the most common type of malignancy among the Iraqi population in general. It accounts for approximately one third of the registered female cancers according to the latest Iraqi Cancer Registry.
Objectives: This study was conducted to assess the sociodemographic characteristics of patients with breast cancer in Baghdad.
Methodology: This cross sectional study that was conducted in Baghdad City during a three months period from January to March 2016. It was conducted at Al-Amal National Hospital for Cancer Management. The questionnaire form gathered info about sociodemographic characteristics including: age, gender, educational attainment, marital status, living arrangement, finical status, and disease associated factors like disease duration and treatment modalities.
Results: A random sample of 250 female patients with breast cancer was analyzed. The mean age was 56 years. The high frequency of breast cancer was among women aged 50-59 years, which is consistent with what was reported in the literature as age is one of the risk factors for developing breast cancer. The highest proportion of study sample completed their secondary school and about one fifth had university education. Married females constituted a large proportion of the study sample. In addition, parous women were frequent in the study sample, which was also consistent with global prevalence data of breast cancer.
Conclusions: A high proportion of BC patients were married, multiparous, urban residence, and at least completed their secondary school.
Keywords: Sociodemographic characteristics, breast cancer, Iraqi patients.

Background: Circulatory diseases are one of the leading causes of death in the world which continue to rise despite preventive measures.
Objective: To determine gender, age and cause specific trends of mortality due to circulatory diseases between 2007 and 2011 in Erbil city.
Methods: A review of registered death records from disease of circulatory system was performed at the statistical unit in Directorate of Health in Erbil city. No special codes for the cause of death were available on death certificate. Statistical analysis was done using SPSS version 19
Results: Diseases of circulatory system was responsible for 25.5% of total deaths during the study period. Highest rates were recorded at 2011 with 74 deaths per100000 population. After 2009, circulatory mortality increased sharply to be the first cause of death till 2011, Stroke, Ischemic heart diseases (IHD), cardiac arrest and heart failure were the main cause of deaths. Most of deaths occur in age group of 65-74 years. Ischemic heart diseases was the main cause of death in male (31.5%) while stroke in female (34.5%) which were statistically significant
Conclusion: Circulatory mortality was the second leading cause of death in Erbil city till the year 2009 where it started to increase to be the first cause till 2011. Future preventive public health strategies for circulatory diseases prevention are mandatory.

Background: Thalassemia is a form of inherited autosomal recessive blood disorder characterized by abnormal formation of hemoglobin.
Objective: Determine frequencies & association of HLA class II alleles (DRB1& DQB1) in Iraqi β-thalassemia major patients.
Patients: seventy unrelated randomly selected β-thalassemia major patients, and one hundred unrelated randomly selected healthy individuals, composed the control group.
Methods: low resolution PCR-SSO (Sequence Specific Oligonucleotide) technique was used for HLA typing.
Results: HLA DQB1*5 give significance importance as an etiological risk factor for β-thalassemia major; HLA DQB1*3 give significance importance as a preventive risk factor for β-thalassemia major.
Conclusion: The positive association of HLA DQB1*5 and DQB1*3 with β-thalassemia major may have the possibility that these antigens, or the genes encoding them, are closely linked with other possible susceptibility genes.

Background: Multiple sclerosis is a devastating central nervous system autoimmune disorder that is characterized by a series of inflammations, demyelinations, and neurodegenerations that affect the brain and spinal cord. The epigenetic studies specially micro Ribonucleic acid expression represent an important field of researches that probably uncover the obscurities behind the multiple sclerosis pathogenesis.
Objectives: to study the expression of micro Ribonucleic acids (20a, 146a, 155, and 145) in multiple sclerosis patients by the use of real time polymerase chain reaction.
Patients and Methods: A case-control study was performed using real time polymerase chain reaction technique to measure the relative expression of micro Ribonucleic acids (20a, 146a, 155, and 145) in peripheral blood leukocytes of 25 newly diagnosed untreated multiple sclerosis patients and comparing them with that of 25 clinically apparent healthy controls .
Results: Studying of micro Ribonucleic acids expression in multiple sclerosis patients revealed a significant down-regulation in micro Ribonucleic acid-20a while up- regulation of micro Ribonucleic acid-155 expression in multiple sclerosis patients in comparison to controls. Micro Ribonucleic acids -146a and 145 were not associated with significant changes in its expression in multiple sclerosis patients in comparison to controls.
Conclusion: multiple sclerosis is associated with significant changes in micro Ribonucleic acids expression including micro Ribonucleic acid-20a, and micro Ribonucleic acid-155 but not micro Ribonucleic acid 146a and-145 that can be measured by real time polymerase chain reaction technique.

Background: Endometrial cancer is the most common gynecologic malignancy in the United States and the fourth most common cancer in women, comprising 6% of female cancers.
Objectives: The aim of this study is to investigate the antioxidant vitamins, Coenzyme Q10 and oxidative stress in patients with endometrial cancer.
Patients and methods: Fifty six endometrial cancer women patients with various clinical stages (stage 1A, stage1B, stage II, stage III, stage IV) mean aged 58.055 ± 10.561 years, and 30 healthy women volunteers mean aged 39.731 ± 13.504 years, were includes as control group.
Results: The results in this study revealed a highly significant decreased (P<0.01) in β- carotene, Vitamin E and significant increased (P<0.01) in (Uric acid and MDA). The results of ( Coenzyme Q10 and Vitamins (A, C) showed a significant decreased (P<0.05), in the sera levels of patients with endometrial cancer as compared to control group.
Conclusions: This study suggest that high levels of oxidative stress and low levels of antioxidant defense system may be associated with increased the risks of endometrial cancer.

Background: Profound alterations of respiratory function physiology accompany pregnancy; these conditions contribute to many of the disorders of the lung during pregnancy. The adaptive changes during the gravid period are designed to support maternal and fetal well-being during the special stresses of fetal growth and parturition Peak.
Objective: This study aimed to know the effect of pregnancy on peak expiratory flow rate in comparison with non-pregnant Iraqi women.
Method: This study was conducted on 255 healthy female at their reproductive ages , made up of 60 pregnant female in 1st trimester , 65 in 2nd trimester , 60 in 3rd trimester and 70 non pregnant as control group.
Results: There were a significant negative relation between PEFR % and gestational age. The PEFR % decrease progressively with advancing gestational age in comparison with control group (p< 0.001).
Conclusion: These results suggest that the effect of pregnancy on the respiratory function of healthy women is influenced by gestational age.

Background: Canned fish is consumed regularly in all countries. The levels of heavy metals which are present in the environment could constitute a hazard to food security and public health. These can be accumulated in aquatic animals such as fish.
Objective: In this study, selected heavy metals: Copper (Cu), Nickle (Ni), Chromium (Cr) and Iron (Fe) were evaluated in commercial canned fish products (Sardines) that are commonly consumed in Iraq. The canned fish (Sardine) which studied were Yacout Sardine (Morocco), Marina Sardine (Tunisia), Silver Sardine (Morocco) and Salsa Sardine (China).
Methods: Prospective study was done in Baghdad from January to June 2016 . 40 samples of four different foreign brands (10 samples for each brand were obtained): Yacout Sardine (Morocco), Marina Sardine(Tunisa), Silver Sardine (Morocco) and Salsa Sardine (China) of canned fish (90 g cans) were analyzed for their content of Cu, Ni, Cr and Fe. Atomic absorption spectroscopy technique was used for determination of metals under study.
Results: Mean levels of Cu in four types of canned sardine were 0.7±0.03 μg/g in Yacout canned sardine, 0.9±0.0303 μg/g in Marina canned sardine, 2.1±0.367 μg/g in silver canned sardine and 1.0±0.41 μg/g in Salsa canned sardine, while mean levels of Ni in four samples were 0.14±0.043 μg/g, 0.12±0.035 μg/g ,0.12±0.055 μg/g and 0.14±0.0285 μg/g .Also mean levels of Cr in same four samples were 0.1±0.0332 μg/g, 0.08±0.02 μg/g, 0.1±0.0245 μg/g, 0.11±0.0274 μg/g. and mean levels of Fe in four samples were 21±1.685 μg/g , 25±1.1 μg/g , 20±1.886 μg/g and 30±0.831 μg/g respectively
Conclusion: analytical data obtained from this study shows that the metal concentrations for the types of canned sardines except Fe were generally within the Environmental Protection Agency in United States of America (U.S.EPA), Food and Agriculture Organization (FAO),World Health Organization(WHO) and Food and Drug Administration in United States of America (U.S.FDA) recommended limits for canned fish and do not cause any risk for the local consumers, but contamination of Fe in majority of canned sardines samples may cause risk for the consumers.

In this case report we discuss essential issue to be considered with regard to the clinical genetic testing in the epilepsies. The identification of genes that influence risk for the epilepsies has extremely important implications for both research and clinical practice. In a research context, information obtained may lead to the development of new treatments targeted to specific mechanisms, or even to ways of preventing epileptogenesis. In clinical practice, the use of genetic information can either clarify the diagnosis in people already known or suspected to have epilepsy (diagnostic testing), or to predict onset of epilepsy in people at risk of developing epilepsy because of a family history (predictive testing). This 8-year old girl presented because of rapid regression in the cognitive function and had disturbed consciousness which started few weeks before admission. History of delayed milestones, epilepsy, subtle facial dysmorphology, ataxic gait and happy demeanor collectively raised suspicion of genetic/metabolic disorder. Genetic study discovered a deletion involving the maternally derived chromosome 15q11 region and this deletion is associated with Angelman Syndrome.