Journal of the Faculty of Medicine Baghdad

Background: Laparoscopic sleeve gastrectomy (LSG)is derived from the biliopancreatic diversion with duodenal switch operation(BPD-DS). Specific and potentially severe complications of LSG are bleeding from the staple line and staple line leakage (SLL). A staple line leak may result in severe morbidity with potential sepsis and multi- organ failure.
Objectives: To review our experience with the definitive surgical management of staple line leak Post sleeve gastrectomy and its outcomes.
Patients and methods: retrospective review of patients who underwent definitive surgical treatment of staple line leak post sleeve gastrectomy from May 2014 till June 2016 at Saint Raphael center of morbid obesity, Primary surgery was laparoscopic sleeve gastrectomy in all patients. Staple line leak was diagnosed at the gastroesophageal junction in all patients.
Results: Six female patients were treated with definitive surgical management, mean body mass index was 42.7±4.0(range from 35.3-51.2 kg/m2 ), all patient had no associated co-morbidities related to obesity, the mean age of the patients was 36(range from 29-43 years), The leak was at the Gastroesophageal junction in all patients.All patients were fully recovered after definitive surgical treatment of leak, no signs of persist leak during the follow up period, with no mortality
Conclusions: Definitive surgical repair with conversion to Roux-en-Y gastric bypass, is safe and very effective and should be done when the general condition of the patient is optimized whenever possible.

Background: One of the most significant advances in the treatment of intra-abdominal collections during the past 2 decades has been the introduction of image-guided therapy with percutaneous catheter drainage. The development of improved imaging modalities, together with broad-spectrum antibiotics and soft drainage catheters, has changed the treatment of collections that previously required an urgent operation. Disease processes that have traditionally been treated with open surgical drainage and debridement can now be resolved with percutaneous catheter drainage and antibiotics. In selected cases, this will allow for better preparation of the patient for a later elective and definitive operation.
Objective: Highlight the outcome, safety and effectiveness of percutaneous drainage procedure of abdominal collections performed under imaging guide.
Patients and Methods: Forty one patients were referred from surgical wards and emergency department after diagnosing abdominal collections. Then each case discussed with radiologist to determine the route and type of catheter and imaging modality for guidance (ultrasound and/or computerized tomography). The size and site of the collections were estimated along with the most suitable approach and angle of catheter insertion. A safe drainage route was identified avoiding solid organs and bowel.
Results: Percutaneous drainage of 41 abdominal collections under imaging control was carried out in 41 patients during a one year period. No complications resulted from the procedure itself. Percutaneous drainage was sufficient to drain the collections in 35 cases (no further surgery is needed). Of those who require surgery (5 patients), the procedure considered to be as a temporary measure. One case was diagnosed as sero-mucinous tumor of bowel.
Conclusion: Percutaneous drainage of abdominal collections is a safe, effective and minimally invasive alternative approach to formal surgical drainage.The advantages include: the drainage can be done under local anesthesia, diagnosis and treatment can be achieved simultaneously in radiological department.
Key words; Percutaneous drainage, Imaging guide, Collection.

Background: The surgical treatment of pilonidal sinus varies from wide excision and laying the wound open or excision with primary closure or excision with the use of skin graft in some special cases.
Objectives: The objectives of this study is to determine the efficacy of treating non complicated pilonidal sinus disease with minimal excision and primary closure technique, complications and recurrence rate.
Patients and methods: This is a prospective study conducted in shahid ahmed ismaiel hospital in rania – As sulaimania IRAQ during the period from December 2013 to January 2016 and was carried on one hundred (100) consecutive patients with non complicated non recurrent pilonidal sinus patients who were treated with minimal excision and primary closure technique. The data were analyzed focusing mainly on complications mainly infection, gapping, wound disruption, recurrence rate and patient’s compliance to antibiotics use and local wound care.The results obtained were compared with other similar studies.
Result: One hundred patients with non complicated pilonidal sinus were treated with minimal excision and primary closure technique.Fifteen patients developed superficial wound infection, seventeen patients developed simple superficial wound gapping .Three patients developed deep wound infection with disruption. Four patients developed recurrence and they were treated with re-excision and skin graft placement. Minimal follow up was six months, Operations were done under general or spinal anesthesia .operative time ranged between 12 to 22 minutes (mean time 17 minutes).
Conclusion: Minimal excision and primary closure technique for the treatment of pilonidal sinus disease is associated with short hospital stay, shorter off work time, less cost, low complications rate and low chance of recurrence.
Key words: Pilonidal sinus, minimal excision, primary closure, recurrence rate.

Background: Infection with Hepatitis C virus (HCV) is a major cause of chronic liver disease, WHO estimated that about 170 million people are infected with Hepatitic C virus, Silymarin (Legalon) have been recently shown to be effective in treatment of Hepatitic C virus infection.
Objectives: The effectiveness of Legalon (Silymarin) on viral load in patients with Hepatitic C virus infection.
Patients and methods: A prospective case – control study included 400 patients with Hepatitis C virus infection. 200 patients (group A) were treated with (peg-interferon, ribavirin, silymarin) the other 200 patients (group B) were treated with (peg-interferon, ribavirin) . only G1 & G4 genotypes were included , viral load were assessed initially and after 3 months in patients with positive viral load.
Results: Viral load follow in group A, Hepatitis C Viral load was reported in 150 cases giving a response rate of 75% while in the 200 cases of group B the response was reported in 110 giving an overall response rate 55% , this indicate that cases in group A had a significant higher response rate than those in group B.
Conclusion: Patients taking Silymarin (420 mg/day) for 3 months showed a decrease in viral load, effectiveness of silymarin was more in Genotype 1 than in the Genotype 4, the response was better in low viral load patients ( less than 600000 IU/ml).
Keywords: Hepatitis C, Treatment, Silymarin effects on treatment.

Background: Postpartum hemorrhage is an important cause of maternal morbidity and mortality. Considerable difference of opinion exist regarding the optimal approach to the management of the 3rd stage of labour, practice varies between countries &between units.
Objectives: To evaluate the effectiveness of intra umbilical vein injection of oxytocin and umbilical cord driange in shortening the duration of third stage of labour.
Patient and Methods: In this randomized controlled study, 100 women were enrolled in this study they divided into three groups. (Group 1 ,N =30 )received 20 units of oxytocin diluted in 20 ml 0.9% saline solution injected in the umbilical vein after clamping.(Group 2, N = 34) placental cord drainage.(Group 3, N= 36) with no intervention. The primary outcome was mean duration of third stage of labor.
Results: The third stage of labor was significantly shorter in group 1 and 2 as compared to group 3. Groups 1 shorten the duration of third stage of labor by 3 min. and group 2 shorten the duration of third stage of labor by 4.27 min.There were no reports of need for manual removal of placenta or retained placenta.
Conclusion: The use of intraumbilical injection of oxytocin and placental cord drainage in the third stage of labor significantly reduced the duration of the third stage.
Key word: intraumbilical cord oxytocin, umbilical cord drainage, third stage of labour.

Background: Since 1985 the World Health Organization (WHO) had stated: “There is no justification for any region to have Caesarian Sections (CS) rates higher than 10-15%”. Since then, CSs have become increasingly common in both developed and developing countries. The rate of CS has been reported to be as high as 24.5% and 25.8% among Iraqi women in the years 2009 and 2010 respectively.
Objectives: The study was designed to provide data on the level of existing knowledge, attitudes and preference of modes of delivery, which can be used as a platform to raise knowledge among pregnant women and their partners and thereby empowering women to make informed choices.
Patients and Methods: This cross-sectional study was undertaken in an antenatal care clinic in Baghdad Teaching Hospital, Medical City, and Baghdad from 1st Feb. -31st May 2016. All 300 pregnant attending antenatal clinic were interviewed with a structured questionnaire that solicited information on their knowledge, attitudes and preference towards modes of delivery.
Results: Mean age of pregnant women was 28.3 ± 9.8SD years and84.7% were not employed. More than half of them (54.3%) had married at younger age (<20 years). Educational levels were 43.3% primary, 18% secondary and 20.4% university levels. Knowledge of majority of pregnant mothers (82.6%) about modes of delivery were obtained from relatives. Half of pregnant women had good knowledge about modes of delivery, 51.3% of them had negative attitude toward CS, and 62% had positive attitude towards CS delivery in current pregnancy.
Conclusion: Study results emphasize the need for educating families, especially pregnant women and their partners about the pros and cons of different modes of giving birth to their babies.
Keywords: pregnant women .Knowledge, Attitude, Mode of delivery, Baghdad.

Background: Preeclampsia is most common medical disordersduring pregnancy, and the rate of hypertension ranges from 5 – 8 % f or all types of pregnancy. There was a significant difference between cancer antigen -125, plasma fibrinogen and C- reactive protein to the severity of preeclampsia.
Objective: To determine the level ofserum CA-125 level, C-reactive protein and plasma fibrinogen in preeclampsia and their association with the severity of disease and progression of mild preeclampsia to severe type.
Patients and method: A prospective case-control studywhich was carried out in the department of gynecology and obstetric at Baghdad teaching hospital from 1st ofJanuary 2015 to 1st of July 2015.One hundred forty pregnant women were included; they were selected and divided into three groups:
Group A: Thirty five (35) pregnant women with mild preeclampsia.
Group B: Thirty five(35) pregnant women with severe preeclampsia.
Both group A and B are selected according to the clinical signs, symptoms and investigations and admitted to obstetrics ward for evaluation.
Group C: seventy (70) pregnant women with uncomplicated singleton pregnancies as control group .
Blood samples were taken for measurement of serum cancer antigen -125, C- reactive protein and plasma fibrinogen for all groups
Results: The mean level of Cancer antigen- 125in control , mild and severe preeclampsia groups was ( 14.4±4.11) , (33.60± 4.52) and ( 37.35± 4.85) respectively which was a significant difference between control ,mild groups ( p value < 0.0001) and between control and severe preeclampsia groups ( p value < 0.0001), the mean level of C-reactive protein in mild and severe preeclampsia was( 15.62± 2.6)and ( 29.3± 7.02) which was significant higher in comparison to control group which was ( 8.17 ± 1.56 ) the P value was < 0.0001 . theplasma fibrinogen levels in mild and sever preeclampsia was (470.37±51.1) and (563.14±48.28) which were markedly higher than that of control group (342. 97±56.6) in third trimester pregnant women.
Conclusion:Serum Cancer antigen -125, Serum C - reactive protein and Serum plasma fibrinogen were significantly higher in preeclampsia groups in comparison to the control group and these increments was directly correlated with the severity of preeclampsia .
Key Words:preeclampsia, plasma fibrinogen, CA 125, C – reactive protein.

Background: preeclampsia is characterized by endothelial dysfunction with vasoconstriction due to cell adhesion molecules or mediators released by defective placentation. Soluble platelet selectin, one of the cell adhesion molecules, is elevated in many inflammatory conditions including preeclampsia.
Objective: To investigate if soluble platelet-selectin levels can be used as a marker for adverse outcomes in pregnancy complicated with sever preeclampsia
Patients and methods:This study involved 115 pregnant women in their third trimester of pregnancy; divided into Group A: involves 25 pregnant women with preeclampsia complicated by intrauterine growth restriction.Group B: involves 35 pregnant women with preeclampsia without intrauterine growth restriction.Control group: involve 55 pregnant women with normal blood pressure and normal fetal growth .The data were conducted from patients by special questionnaire, this involve name, age, parity, examination included vital signs, abdominal, obstetrical examination and investigations including :Liver function test, Renal function test, Complete blood picture and maternal serum levels of soluble platelet selectin was measured by enzyme-linked immunosorbent assay ,albumin in urine and serial obstetrical ultrasound scan to confirm the diagnosis of intrauterine growth retardation and Doppler study to determine fetuses at risk .
Results: this study revealed a significantly higher concentration of soluble platelet selectin levels in serumofpreeclamptic women with and without intrauterine growth retardation versus normotensive and normal fetal growth. The maternal serum levels of sP-selectin in preeclampsia without intrauterine growth restriction were significantly higher than preeclampsia complicated by intrauterine growth restriction .Sensitivity was 91.7% and specificity 100% at cut off value 6.975 ng/ml of maternal soluble platelet _selectin for prediction of adverse pregnancy outcome .
Conclusion: soluble platelet -selectin levels have a positive significant correlation with the severity of preeclampsia, so it can beconsidered as a marker for its severity and can be used as a predictor for adverse outcomes as itsnegatively correlated with these complications
Keywords:soluble platelet-selectin ,preeclampsia with & without intrauterine growth retardation versus normotensive pregnancy .

Background: The annual incidence of stroke in children after the newborn period is approximately 2.3 per 100000. Half are ischemic, and half are non-traumaticintracerebral and subarchnoidal hemorrhages.
Objectives: To study the etiologic factors, clinical presentation andoutcome of stroke among children admitted to children welfare teaching hospital/Baghdad.
Patient and methods: A prospective study was carried out in Children Welfare Teaching Hospital;Children age ranged between 1 month -13 years and was admitted to pediatric neurology ward between 1st of November 2013 and 1st of November 2014. After carful clinical history, physical and neurological examinations, the diagnosis of brain stroke was confirmed in all patients by computerized tomography (CT) and/or magnetic resonance imaging (MRI). Patients included in this study were those diagnosed as having ischemic stroke, hemorrhagic stroke.
Results: The total number of cases were 61, 36 were male (59%). The age at onset ranged from 1-156 months. Ischemic stroke constituted 39 patients (63.9%). The most common etiologic factors for the ischemic stroke were protein C deficiency (9, 23.1%). The most common etiologic factor for hemorrhage was bleeding disorders in about 50% of patients. The most common presenting features were hemiplegia, seizure, alteration of consciousness; Cranial nerves palsy is mostly present in the ischemic stroke (14,35.9%) and only in one patient (4.5%) of hemorrhagic stroke.
Conclusions: Ischemic stroke is more common than hemorrhagic stroke in pediatric age group. The significant risk factors for ischemic stroke are protein C deficiency, Congenital heart disease(CHD) and positive family history, while vitamin K deficiency, prolong Partial thromboplastin time (PTT) and trauma are significant for hemorrhagic stroke. The most common clinical features of both types of stroke are hemiparesis, siezure and alteration of consciousness.
Keywords:Ischemic stroke, Hemorrhagic stroke, Children Welfare Teaching Hospital.

Background: neonatal period is the most vulnerable and high risk time in the life because of the highest mortality incidence in human life during this period. Neonatal mortality rate is defined as the number of deaths twenty seven completed days of live per 1000 live births.
Objectives: To determine the neonatal mortality rate (NMR) in Al-Ramadi province, the center of Al-Anbar Governorate, Western Iraq, from 2003-2013 with rate comparison of the two different stages of that period.
Methods: Data were collected from the births and deaths certificate center in Al- Ramadi province, Western Iraq, included; age, sex, address ,date of birth and cause of death. Data collected in two different periods, the first period from 2003- 2007 and the second period from 2008- 2013. The neonatal mortality rates (NMRs) were analyzed and compared with other studies.
Results: The neonatal mortality rate (NMR) of the first period was 34.5/1000 and neonatal mortality rates NMR of the second period was 24.3/1000. During the 11 studied years the higher rate of neonatal mortality was in 2006 (36.8/1000) and lower rate in 2012 (21.3/1000). Approximately two-third of neonatal deaths occurred during the early neonatal period and one third in the late neonatal period. Males had higher neonatal rate (NMR) than females, and rural residence higher than urban.
Conclusions: Al-Ramadi province had high neonatal mortality rate comparing with national Iraqi neonatal mortality rate (NMR) ,due to deterioration of socioeconomic and security conditions. There was significant association between NMR and residency and significant association between NMR and gender.
Key words: Neonatal mortality, early neonatal mortality rate, late neonatal mortality late.

Background: Diabetic nephropathy is a common complication of diabetes mellitus type2. The neutrophil gelatinase Associated lippocallin (NGAL) is an ubiquitous protein consist of 178 amino acid. NGAL can be identified in plasma and urine starting 2- 4 hours after a kidney injury resulting changes in glomerular filtration and tubular reabsorption and with increased secretion in tubular epithelial cells.
Objective: This study aimed to evaluate the role of serum Neutrophil Gelatinse Associated Lipocallin (NGAL) in early detection nephropathy.
Method : This study was conducted in Medical City, Baghdad Teaching Hospital during the period from December 2015to June 2016.The study included (90) subjects with age range between (30 – 56)years, divided in to three groups , 30 healthy control,30 type 2 diabetic mellitus patients with normal albuminuria and 30 type2 diabetic mellitus patients with micro albuminuria .Body mass index (BMI) was determined, serum NGAL, Fasting serum glucose (FBS),serum creatinine ,serum urea ,andglycated hemoglobin (HbA1c%) were measured for each individual in addition to the concentration of albumin in urine and Glomerular Filtration Rate (eGFR) was calculated.
Results:The results of the present study showed that the levels of NGAL, FBS, HbA1c, urea creatinin, were significantly higher in micro albuminuria than normal albuminuria and healthy control. In diabetic patients with micro albuminuria, Serum NGAL shows significant positive correlation with FBS, HbA1c% and urine albumin. Serum NGAL shows significant positive correlation with duration of diabetes but significant negative correlation with GFR.
Conclusion:Serum NGAL increased markedly with the reduction of GFR.Serum NGAL is may be considered predictive marker for early detection of diabetic nephropathy in type2 diabetes mellitus.
Keywords:diabetic mellitus,diabetic nephropathy,micro albuminuria, serum NGAL, HbA1c.

Background: Guillain-Barre syndrome (GBS) is the most common cause of acute motor paralysis in children where most of electrophysiological findings reveal demyelinating neuropathy. However, an axonal form of Guillain-Barre syndrome had been reported too.
Objectives: Assess the role of neurophysiological study (EMG and NCS) in the diagnosis of Guillain-Barre syndrome subtypes in children and estimate the frequency of subtypes whether demyelinating or axonal form of Guillain-Barre syndrome.
Subjects and methods: Two study groups of either sex was involved, thirty (30) Guillain-Barre patients with different ages and thirty(30) normal healthy subjects matched for age and gender served as control group. Each subject submitted to sensory and motor nerve conduction study (NCS) and electromyography (EMG) of both upper and lower limbs.
Results:The results of this study revealed that 24 (80%), 5 (16.7%), 1 (3.3%) had Acute inflammatory demyelinating polyneuropathy, Acute motor axonal neuropathy and Acute motor sensory axonal neuropathy respectively. The most affected age group was (3-6) years, and the majority of patients had a preceding infection in the past 3 months. Furthermore, 29 patients out of 30 had lost deep tendon reflexes and the H-reflex was absent in 22 (73.3%), however, the F-wave was absent in lower limbs more than upper limbs (46.6%) and (26.6%) respectively. The distal motor latency was abnormal in 121 (82.3%) nerves out of 147 total examined nerves.
Conclusion:Acute inflammatory demyelinating polyneuropathy (AIDP) is the most frequent subtype of GBS, the change in sensory and motor NCS parameters was higher in lower limbs than upper limbs. Proximal segments are more vulnerable to demyelination rather than intermediate or distal nerve segments.
Keywords: GBS (guillain – barre syndrome), NCS (nerve conduction study), AIDP (acute inflammatory demyelinating polyneuropathy), AMAN (acute motor axonal neuropathy), AMSAN (acute motor sensory axonal neuropathy).

Background: Gestational hypertension represents a transient period of elevated blood pressure with special effects on the maternal left ventricle that is different from the effects observed in chronic essential hypertension; it affects a previously normal heart and lasts for a maximum of nine months associated with volume and pressure overload on the maternal heart. Tei index (also called myocardial performance index) was found to be a dependent combined index evaluating the systolic and diastolic function of the left ventricle and represents a sensitive indicator for many types of heart diseases.
Objective: to evaluate the effects of gestational hypertension on the maternal myocardial function during the third trimester by measuring the Tie index using transthoracic echocardiography.
Method: This study was performed in Baghdad teaching hospital in the time period from November 2015 to August 2016. The study included a total of 150 women; 100 women had gestational hypertension, in the third trimester of a singleton pregnancy and with a mean age (29.83 ± 5.33 year), gestational hypertension was identified as elevated systolic or diastolic blood pressure over 140/90 mmHg that emerges after the 20th week of gestation with proteinuria level lower than 300 mg/dl. Another 50 normotensive pregnant women with singleton pregnancy and mean age (28 ± 3.18 year) were used as controls. Left ventricular mass index (LVMI) and relative wall thickness (RWT) were measured to find the type of hypertrophy in gestational hypertension. Ejection fraction (EF) was measured with 2D directed M mode echocardiography, and isovolumic relaxation time (IVRT), isovolumic contraction rime (ICT) and ejection time (ET) were measured for both groups using pulse wave Doppler echocardiography in order to calculate the myocardial performance index which is also called “Tei index” and equals the sum of IVRT and IVCT divided by the ET (Tei index = IVRT+IVCT/ET).
Results: Left ventricular mass index and relative wall thickness were significantly higher in gestational hypertensive women, 41% of gestational hypertensive women had normal geometry and 59% had abnormal geometry (34% eccentric hypertrophy, 19% concentric hypertrophy and 6% concentric remodeling). IVRT and IVCT were significantly higher in gestational hypertensive women with p value of 0.0001 and P = 0.003. ET showed a non-significant lower values (p= 0.34) in gestational hypertensive women. Tei index was significantly higher in Gestational hypertension (P=0.011).
Conclusion: Women with gestational hypertension had altered myocardial function characterized by the higher Tei index values associated with eccentric hypertrophy which can be explained by the fact that gestational hypertension poses higher afterload on the left ventricle instead the state of low peripheral resistance that is ysually expected during normotensive pregnancy.
Keywords: Echocardiography; Gestational hypertension; Myocardial performance.

Background: This study was conducted in pursuit of gaining an understand effects of the low level laser irradiation on whole blood is very essential way in revealing the mechanisms of the action of laser radiation on biological tissues.
Objective: The purpose of this study is to investigate the in vitroeffect of laser radiation on some hematological parameters and erythrocyte sedimentation rate.
Subject and Method: Blood samples were obtained from 30 healthy volunteers, each sample was divided into four new samples, one of them was considered as control while the other three were exposed to three different laser doses. Thewavelength of532nm was used for irradiation with 4mm diameter beam spot on blood samples, with power density of 796.17mW/cm2. The irradiation times were 1.8, 3.7and 6.2 secand so the different doses of irradiation 1.5,3 and 5 J/cm2, respectively.
Results: The erythrocyte sedimentation rate was measured after laser irradiation and compared with un-irradiated control sample. The results of this study showed thaterythrocyte sedimentation rate value increased significantly with a dose of 1.5J/cm² but not with the othertwo doses’ values in male persons but not in females. Moreover, the mean cell volume shows significant decrement post irradiation.
Conclusion: Laser irradiation induces physical changes in red blood cell membrane permeability and blood viscosity and consequently alters erythrocyte sedimentation rate.
Keywords: erythrocyte sedimentation rate, hematological parameters, low level laser.

Background: Diabetic nephropathy is a common complication of diabetes mellitus type2. The neutrophil gelatinase Associated lippocallin (NGAL) is an ubiquitous protein consist of 178 amino acid. NGAL can be identified in plasma and urine starting 2- 4 hours after a kidney injury resulting changes in glomerular filtration and tubular reabsorption and with increased secretion in tubular epithelial cells.
Objective: This study aimed to evaluate the role of serum Neutrophil Gelatinse Associated Lipocallin (NGAL) in early detection nephropathy.
Method : This study was conducted in Medical City, Baghdad Teaching Hospital during the period from December 2015to June 2016.The study included (90) subjects with age range between (30 – 56)years, divided in to three groups , 30 healthy control,30 type 2 diabetic mellitus patients with normal albuminuria and 30 type2 diabetic mellitus patients with micro albuminuria .Body mass index (BMI) was determined, serum NGAL, Fasting serum glucose (FBS),serum creatinine ,serum urea ,andglycated hemoglobin (HbA1c%) were measured for each individual in addition to the concentration of albumin in urine and Glomerular Filtration Rate (eGFR) was calculated.
Results:The results of the present study showed that the levels of NGAL, FBS, HbA1c, urea creatinin, were significantly higher in micro albuminuria than normal albuminuria and healthy control. In diabetic patients with micro albuminuria, Serum NGAL shows significant positive correlation with FBS, HbA1c% and urine albumin. Serum NGAL shows significant positive correlation with duration of diabetes but significant negative correlation with GFR.
Conclusion:Serum NGAL increased markedly with the reduction of GFR.Serum NGAL is may be considered predictive marker for early detection of diabetic nephropathy in type2 diabetes mellitus.
Keywords:diabetic mellitus,diabetic nephropathy,micro albuminuria, serum NGAL, HbA1c.

Background: Autoimmune thyroiditis is one of autoimmune thyroid diseases. The cause of Hashimoto’s thyroiditis is not clearly identified; however, both genetic and environmental are suggested to play a role in pathogenesis of the disease. Helicobacter pylori (H pylori) is one of the possible causative agents.
Objectives: The aim of this study is to look for the association of H. pylori infection with Hashimoto’s thyroiditis.
Patients and Methods: a case-control study involved patients with Hashimoto’s thyroiditis (n=100) and control group (hyperthyroidism n=50, healthy persons n=50), the study groups were subjected to serological investigation of anti- H. pyloriIgG antibodies, anti-thyroid peroxidase antibody, and anti-thyroglobulin antibody(anti-TG Ab) using ELISA technique; besides, demographic data were collected from study groups.
Results: Eighty two percent of Hashimoto’s thyroiditis patients were females; 57% of Hashimoto’s thyroiditis patients were positive for anti- H. pyloriIgG antibodies while the positive result was detected in only 22% of control group and the results were statistically significant (p <0.05). The strength and direction of the relationship between the concentrations of anti-HP IgGAbs and anti-TPO antibodies in Hashimoto’s thyroiditis group revealed positive correlation (r = 0.6241).
Conclusion: the infection with H. pylori is one of the possible predisposing factors to etiology Hashimoto’s thyroiditis. The association between H. pylori infection and other genetic and environmental factors that are related to Hashimoto’s thyroiditis should be studied in depth.
Key word: Hashimoto’s thyroiditis, H. pylori, Anti-TPO.

Background: Toxic-shock syndrome (TSS) is an acute onset; multiorgan disease caused mainly by Toxic-shock syndrome toxin-1 (TSST-1) producing Staphylococcus aureus strains.Testing for TSST-1 or anti-TSST-1 antibodies in the clinical setting may help to predict and prevent the appearance of TSS caused by nosocomial S. aureus infection.
Objectives: Detection of TSST-1 in the sera of children patients arranged to undergo surgical operations, and its relevance with certain demographic factors.
Patients and methods: This cross-sectional study was conducted in the Baquba General Teaching Hospital- Diyala province for the period from August 2015 to April 2016. Eighty eight patients from those undergoing surgical operations were enrolled. The age range was 1-14 years. Thirty one (35.2%) were males and fifty seven (64.8%) were females. Human privacy was respected by taking patient’s consensus. Venous blood samples were collected aseptically; the sera were separated and kept frozen till use. Serum samples were investigated for the presence of TSST-1 using ELISA technique. Statistical analyses were done using SPSS version 18. P value less than 0.05 was considered significant.
Results: The results showed that the overall detection rate of TSST-1 among children undergoing surgeries was 44.3%. It was insignificantly higher among younger age group, females, and ruralizes. According to the type of surgery, the detection rate was higher among those patients with fractures (10.2%), followed by patients with burns (9.1%), but it failed to reach the levels of statistical significant.
Conclusion: About one half of children patients undergoing surgical operations are infected with TSST-1 producing S. aureus.
Keywords: Toxic-shock syndrome, Toxic-shock syndrome toxin-1, S. aureus.

Background: Infective keratitis is the most common cause of blindness and preventable ocular morbidity worldwide. There are many published series of infective keratitis from both temperate and tropical parts of the world, and management strategies are well established1.
Objective: The current study was aimed to detect the specific bacteria and predisposing factors that predisposed for the bacterial keratitis.
Material and methods: Retrospective study of the hospital records of 40 patients who were diagnosed as bacterial keratitis and treated at the Ophthalmology in-patient department of at Ibn Al- haithum Teaching Hospital from May 2015 to December 2015.Patients who don’t have corneal scraping, or culture and sensitivity findings discarded from this study. Predisposing factors, clinical and microbiological data were reviewed. Corneal scrapings were obtained by physicians then were subjected for bacterial culture and biochemical tests.
Results: Pseudomonas aeruginosa was the most common bacteria isolated at higher percentage 19(47.5%) cases whereas Klebsiella pneumoniae isolated at lower percentage 2(5%). The most common risk factors was foreign body in 10 (25%) followed by contact lenses in 8 (20%) patients.
Conclusion: Gram negative bacteria were the most frequent bacterial organisms especially Pseudomonas aeruginosa isolated from corneal scraping and corneal ulcer was found to be occurring principally by foreign body followed by contact lens wearing.
Keywords: Bacterial keratitis, bacterial pathogens of keratitis, risk factors and keratitis.

Background: The resistance to antimicrobial factors is an increasingly global problem worldwide, especially among nosocomial bacteria. Staphylococci have become one of the common causes of nosocomialinfections. Multi drug-resistant staphylococci pose a growing problem for human health.
ObjectiveThis study was carried out to evaluate the association between the antibiotic susceptibility patterns and the msrA Erythromycin-Resistant gene in staphylococci isolates obtained from various clinical samples of patients.
Methods: A total of 25 staphylococci clinical isolates were collected from the central Health Lab. DNA from each sample was extracted and The gene implicated in resistance to erythromycin (msrA) was amplified using PCR method.
Results:The PCR of msr A gene showed positive 16 out of 25 for isolated staphylococci (gave 163 sized amplicons), whichresults may be considered as an important criterion to treating Staphylococcal infections.
Conclusion: The PCR is a useful and practical device for the routine diagnosis of macrolide resistance staphylococci use to be microbiology laboratory work flow .the detection of resistance genes by PCR was more reliable, accurate and specific than other methods of detection.
Key words : PCR,msrA, staphylococci, erythromycin

Background:- Colonic cancer is a very common disease world-wide being fourth most common cancer characterized by abnormal proliferation of the inner wall of colon at beginning then taking full colon wall thickness then to surrounding lymph nodes and tissues and finally metastasis.
Objective:- To evaluate the efficacy of serum CA19-9 and CCSA-4 levels in the screening and prognosis of colonic cancer and their validity for this.
Patients and methods:-This study was applied on 35 patients with colonic cancer, 35 patients with benign polyps and 16 negative controls. All individuals were subjected to blood sampling for measuring their serum CA19-9 and CCSA-4 using ELISA technique.
Results:-Our study shows that colonic cancer patients presented at ages between 53-82 years of age (mean 68.5). Serum levels of CCSA-4 were significantly elevated in those patients with advancing stages (C&D) compared with stages (A&B) and lower levels found in patients undergone surgical removal of tumor or received chemotherapy.Also a positive relation found between CCSA-4 with alcohol intake and smoking. Less significant levels and relations found with CA19-9.
Conclusion:-Serum CCSA-4 is sensitive and specific indicator for diagnosis, prognosis and screening of colonic cancer.
Keywords:-Colonic cancer, tumor marker, CA19-9, CCSA-4.

Background: Multiple Sclerosis disease is a demyelination process which interferes with the neuronal signal transmission, thus leading to different cognitive and physical dysfunctions like optic neuritis, motor, sensory and coordination problems. Recently many researches have been directed toward studying the relation between some genes and multiple sclerosis. Among the important genes to be studied in multiple sclerosis is the forkhead box P3 gene expression.
Objectives: The aims of the present work were to study the expression of forkhead box P3 gene by real time polymerase chain reaction, and to perform chromosomal analysis on the multiple sclerosis patients peripheral blood lymphocytes.
Patients and methods: A case-control study was performed using real time polymerase chain reaction technique to measure the relative expression of forkhead box P3 gene in peripheral blood leukocytes of 25 newly diagnosed untreated multiple sclerosis patients and comparing them with that of 25 apparently healthy controls, in addition to performing chromosomal analysis on multiple sclerosis patients peripheral blood lymphocytes.
Results: Significant down-regulation in forkhead box P3 gene was detected in multiple sclerosis patients in comparison to controls. Chromosomal analysis that was performed for multiple sclerosis patients revealed normal results.
Conclusion: Multiple sclerosis is associated with significant change in forkhead box P3 gene expression that can be measured by real time polymerase chain reaction technique. Furthermore, multiple sclerosis is not associated with gross chromosomal abnormalities.
Key words: Multiple sclerosis, Foxp3 gene, real time PCR, chromosomal abnormality.