Al-Kindy College Medical Journal

Background:Measurement of hemoglobin A1c (A1C) is a renowned tactic for gauging long-term glycemic control, and exemplifies an outstanding influence to the quality of care in diabetic patients.The concept of targets is open to criticism; they may be unattainable, or limit what could be attained, and in addition they may be economically difficult to attain. However, without some form of targeted control of an asymptomatic condition it becomes difficult to promote care at allObjectives: The present article aims to address the most recent evidence-based global guidelines of A1C targets intended for glycemic control in Type 2 Diabetes Mellitus (T2D).Key messages:Rationale for Treatment Targets of A1C includesevidence for microvascular and macrovascular protectionand changes in quality of life. More or less stringent A1C goals may be appropriate for individual patients, andgoals should be individualized based on:duration of diabetes, age/life expectancy, comorbid conditions, CVD or advanced microvascular complications,hypoglycemia unawareness, and individual patient considerations

Background: The first and second choice for vascular access in patients with end stage renal disease (ESRD) is radio cephalic and brachio cephalic arteriovenous fistula (AVF).In patients with failed previous AVF e or poorly visualized or impalpable cephalic veins, the basilic vein can be mobilized and superficialized to create an AVF with the brachial artery.Objective: The aim of this study is to report our experience at the Vascular Surgery Department/ Surgical Specialty Hospital in brachio-basilic (BB) vascular access for hemodialysis.Methods: From January 2006 to December 2009, 31 patients with ESRD whose cephalic veins were thrombosed or impalpable or had previous unsuccessful vascular access procedures were referred to the Vascular Surgery Department/Surgical Specialty Hospital for creation of vascular access. Brachio - basilic mobilization AVF was offered to them. There were 20 females and 11 males. Their ages ranged from 12 to 70 years with a mean of 40. following a careful clinical assessment of the patients, particularly their upper limb superficial veins, Doppler study of both subclavian veins was done to all patients; those with a vein stenosis exceeding 40% were excluded from the study. All patients had mobilization of basilic vein under general anesthesia via a hooky racket incision on medial aspect of upper arm extending from the axilla to the antecubital fossa. The vein is tunneled subcutaneously and anastomosed end to side to brachial artery. The postoperative condition was monitored looking for any complication. The follow up period lasted for 6 months.Results: nineteen patients (61.3%) had left-sided operations. All fistulae except one functioned well primarily (a success rate of 96.8%). One patient had primary thrombosis of the fistula while another patient developed an aneurysm of the AVF 4 months after the operation. The remainder had a smooth non-complicated postoperative course. All fistulae matured and were ready for cannulation in 6 weeks and remained functioning during the 6 months of follow up.Conclusion:: Brachio-basilic AV fistula with anterior basilica vein mobilization is an acceptable option for dialysis with good success rate and fewer complications

Background: Patients with type 2 diabetes have an increased prevalence of lipid abnormalities, contributing to their high risk of cardiovascular diseases (CVD).Glycated hemoglobin (HbA1c) is a routinely used marker for long-term glycemic control. In accordance with its function as an indicator for the mean blood glucose level, HbA1c predicts the risk for the development of diabetic complications in diabetic patients[2].Apart from classical risk factors like dyslipidemia, HbA1c has now been regarded as an independent risk factor for (CVD) in subjects with or without diabetes.Objective The aim of this study was to find out association between glycaemic control (HbA1c as a marker) and serum lipid profile in type 2 diabetic patients.Methods This study was conducted in specialized center for Endocrinology and Diabetes (SCED) on 320 type 2 diabetic patient , from May 2009 TO November 2010The variables such as age, sex, family history, physical examination, fasting blood glucose, renal function test, thyroid function test, lipids profile panel test , HbA1c and body mass index (BMI) were analyzed .Dyslipidemia was defined according to the National Cholesterol Education Programme (NCEP) Adult Treatment Panel (ATP) III guidelines. Diabetes was defined according to American diabetes association criteriaWe excluded from this study other causes of dyslipidemia other than DM like uremia,over weight, hypothyroidism and others causes.We selected diabetic patient with ldeal body weight and normal renal function.Results In our study 114 (81%) females out of 132 and 147 (83%) males out of 178 were found tobe dyslipidemic.HbA1c demonstrated positive and significant correlations with total cholesterol(TC), low density lipoprotein cholesterol (LDL-C), high density lipoproteincholesterol (HDL-C) and LDL-C ratio, non-HDL-C and TC/HDL-C ratio.Patients with HbA1c value > 7.0% had significantly higher value of TC,Triglycerid (TG), LDL-C, LDL-C/HDL-C ratio, non-HDL-C and TC/HDL-C ratio ascompared to the patients with HbA1c ≤ 7.0%. However, there was no significantdifference in value of HDL-C between two groups.Conclusion :HbA1c can be used as a potential biomarker for predicting dyslipidemia in type 2diabetic patients in addition to glycemic control.

Background: Cystatin C is recently considered to be a good predictor of cardiovascular morbidity and mortality in patients with coronary artery disease (CAD)Objectives: Correlation between cystatin and ischemic heart disease.Methods :One hundred forty patients (140) with ischemic heart disease admitted to thin study at Baghdad teaching hospital from the period June. 2011 to Jan. 2012. Those patients was categorized into three groups.Group (A): patients with ischemic heart failure.Group (B): Patients with myocardial infarction.Group (C) patients with unstable angina.All these groups were in comparison to fifty (50) healthy controls. Fasting serum citation (C) were measured in all patients and control in addition to all other routine investigations.Results: All results of serum cystatin C in all three groups of patients were higher in comparison to control group (P. value < 0.05) while it was not significantly different between the three groups (P. value 0.05)Conclusion: Cytstatin C can be used as prognostic biomarker in patients with ischemic heart and its complicated.

Background: Speckle tracking echocardiography (STE)-derived mitral annular displacement (MAD) utilizes the speckle tracking technique to measure strain vectors, which provides accurate estimates of left ventricular ejection fraction (LVEF).Objectives: To validate the accuracy of mitral annular displacement (MAD), assessed by Speckle Tracking Echocardiography (STE), as a surrogate for determination of left ventricular systolic function in comparison to 2-Dimensions Simpson method in patients with different heart diseases.Methods : This cross-sectional study included patients who referred to outpatient department of Ibn Albitar Center for Cardiac Surgery, Baghdad, Iraq, between October 2012 and April 2013. STE continuously tracked annular motion throughout the cardiac cycle in the apical 4- and 2-chamber views. LVEF for each patient was measured by both Simpson method and STE-derived MAD.Results: This study included 100 patients, of them (35%) had ischemic heart disease (IHD), (10%) had dilated cardiomyopathy (DCM), (10%) had valvular heart disease (VHD), (25%) had normal echocardiography, and (20%) had hypertensive heart disease (HHD).There was significant correlation between EF % (derived by MAD) and EF % (derived by Simpson method) in patients with different heart diseases. This correlation was good in normal subjects (r=0.673), and those with IHD(r=0.896), DCM (r=0.724) and VHD (r=0.935), while in HHD it was moderately correlated (r=0.455). There was slight under-estimation of LVEF derived by MAD (a mean value of difference 0.846 %; p =0.022). In subgroup analysis, this difference was seen only in patients with HHD (a mean value of difference 3.145 %; p <0.001), while it was absent in other subgroups.Conclusion: STE-derived MAD provides easy, fast, and accurate assessments of global longitudinal systolic function. LVEF derived by MAD was correlated well with LVEF derived by Simpson method in patients with different heart diseases

Background: Transradial compared to classic transfemoral coronary intervention has been shown to have similar efficacy rates, while being more cost-effective and most importantly safer due to fewer access site complications. Furthermore, patient comfort is increased and outpatient treatment may be feasible..Objectives: To start trans-radial intervention program and the initial learning curve for fellows and the catheterization –laboratory nursing staff. To test how could it be applicable and comfortable for our patientsMethods: This prospective study was performed in Ibn-Albitar hospital for cardiac surgery over a period of 6 months from the 1st of August 2012 till the 1st of February 2013. Every patient referred for percutenuos coronary intervention whether on scheduled or on an emergency basis was considered initially for trans-radial approach for intervention unless they are excluded. Allen test was required ensuring adequate ullnar collateral supply. Sledinger technique was used for radial artery puncture and a special radial sheath was introduced. Intervention was performed through the same catheter and equipments that are used for femoral approach.. medication given according to center protocol, the relevant data collected and patients immediately ambulated unless they receive sedation.Results: A total of 126 patients were referred for intervention during the study period, 20 cases were excluded for various reasons , 6caese were crossed over to femoral approach and the other 100 cases the procedure completed transradially. The mean age of the patients was 57 ± 8 years. Of these 72% were males ,with different risk factors . Most cases presented with chronic stable angiana (87%). Access site was right radial artery in 87% of patients while left radial approach used in 13% of patients. In 72% of cases single guiding catheter was used, in 21% of cases 2 guiding catheter were used and more than 2 types of guiding catheter were used in 7% of cases. In most session of intervention single artery was treated (78%) , 2 vessel intervention in 21%, 3 vessel in one case..Lesions treated were different types 26%,36%,38% A,B and C respectively. The success in obtaining radial access was 97.7% ,while angiographic procedural success rate was 96%. Mean total procedure time was ( 43+/-23min ), mean fluoroscopy time (13+/-8 min )and the average amount of contrast used was (178+/-80ml). with no major complication apart from 3% small heamatom and 6% radial loss. Around 80% of patients preferred TRI approach.Conclusion: Radial artery approach for percutenuos coronary interventions has high procedural success rate and associated with low risk of access site complications and no significant increase of procedural and fluoroscopy time. It is comfortable approach for most patients especially female and obese. Early ambulation with no risk of bleeding and reduction of the duration of hospital stay are in favor of TRI approach.

Background: ;Hepatitis C virus (HCV) is a major cause of chronic liver disease. Approximately 85% of patients acutely infected with HCV progress to chronic liver disease with persistence of HCV-RNA for more than 6 months Among patients with chronic HCV infection , 15-20% progress to end-stage liver disease main transmission methods of the virus is by : blood and blood products ; sharing needles and acupuncture .Objective: To evaluate Iraqi patients infected with chronic HCV, including their treatment, and factors that affect their response to treatment .Methods :This study was performed at Gastroenterology and Hepatology hospital in Baghdad from January 2011 to March 2012.The study enrolled 90 patients with HCV Antibody positive (Ab +ve) , every patient subjected to thorough history taking and clinical examination, and complete investigations , some of the patients subjected to liver biopsy which is analyzed by Ishak classification , the data analyzed by chi square and P value <0.05 considered statistically significant..All these patients were treated with peg interferon alpha2a given once weekly and ribavirin given in two doses daily and follow up the patients during treatment regimen.Results: Ninety patients were enrolled, 66(73.3%) patients were male,24(26.7%) patients were female, patient age range from 18-63,mean age 41.4 year .The predominant genotype is genotype 1:45 (50%) patients , genotype 4:33(36.7%) patients .Only 27(30%)patients have viral load more than 600,000Uml while 63(70%) Patients have viral load less than 600,000Uml .34(37.7%) patients showed End treatment virological response.39 (42.2%) patients had been subjected to liver biopsy including those genotype 1 and4.There was a significant association between viral load and liver enzymes .Conclusion: There is a relatively low complete response to the treatment regimen for hepatitis C . Most of our patient with hepatitis C are discovered accidently, Most of them are male , young or middle age , asymptomatic or have minimal symptom , have low viral load .The commonest genotype is 1(50%) followed by genotype 4(36.7%) .Early virologic response were seen in most of the patients while end treatment response were seen in only 37.78% .

Background: Acute appendicitis is the most common abdominal surgical emergency. The diagnosis of this condition is still essentially clinical and there is difficulty in the clinical diagnosis, especially among elderly, children and patients with a typical presentation, so early and accurate diagnosis of acute appendicitis is important to avoid its complications.Objectives: To evaluate the degree of accuracy of Alvarado scoring system in the diagnosis of acute appendicitis.Method: Two hundred patients were admitted to the Alkindy Teaching Hospital from January 2011 to april 2014- presented with symptoms and signs suggestive of acute appendicitis. After examination and investigations all patients were given a score according to Alvarado scoring 10 (8 variables) and they were classified accordingly to 6 groups of scores (score 5, score 6, score 7, score 8, score 9 and score 10). All the patients underwent appendectomy and the appendix specimens were sent for histopathological examination and the patients were divided into two groups:1-patients 7 score (164 patients)2-patients <7 score (36 patients)-We calculate the percentage of appendix proved to be inflamed by histopathology in each group of these 6 scoring groups.Results: The patients ages range from (7-64 years).One hundred six patients were male, 94 patients were female with male: female ratio of 1.24:1.Out of 200 patients, 168 patients had inflamed appendix proved by histopathological study, including 93 male and 75 female, while 32 patients have a normal appendix (13 male, 19 female).The Alvarado sensitivity found to be 83%, specificity is 59%, diagnostic accuracy of 85%, positive predictive value of 92% and negative predictive value of 59%.The diagnostic accuracy of the Alvarado score was found to be increased with the increase in the Alvarado score as it was 81% with Alvarado score 7 it was 100% in Alvarado score 10.Conclusion : Alvarado scoring system is a useful tool in diagnosis of acute appendicitis because it is simple, with high diagnostic accuracy rate and this accuracy increase proportionally to the increase in the degree of the score.Alvarado scoring system is a useful tool in diagnosis of acute appendicitis because it is simple, with high diagnostic accuracy rate and this accuracy increase proportionally to the increase in the degree of the score

Background: Carpal tunnel syndrome is the most common entrapment neuropathy in humans today. For patients in whom conservative treatment fails, surgical decompression is indicated. Various surgical techniques are becoming increasingly popular. Due to the rapid postoperative recovery shown after endoscopic operations, proximal palmar mini-incision for carpal tunnel release is a comparative alternative.Methods: Ninety four patients [113 hands] with a carpal tunnel syndrome underwent carpal tunnel release through a 1-cm longitudinal incision made just over the distal flexor crease. The self- administered Boston Questionnaire was used to assess the severity of patients’ symptoms and their functional status, both before and after the surgical intervention and at their final follow-up. Patients were also asked, during the final follow-up, about the pain level of their scar tissue and functional outcome.Results: There was a significant decrease in the Boston Carpal Tunnel Questionnaire scores for the symptom severity scale and the functional status of patients in thisgroup, post- operatively at one month and at final follow – up. The mean operative time was significantly shorter than open or endoscopic CTR. After 1 month, only 4 hands[3.5%] stated they had scar tissue pain, no recurrence, short period return to work &cost effective.Conclusions: proximal mini-incision is as effective as ECTR. Furthermore, it is also a safe and simple procedure with shorter operative time& reduced surgical cost. The absence of relapse and good clinical results make this technique suitable

Background: For various reasons, inguinal hernia repair under local anaesthesia is not well accepted to both patients and surgeons. The patients fear from pain and surgeons need full relaxation and co-operation to do successful hernia repairMethods: purpose of this study is to evaluate the effectiveness of local anaesthesia in inguinal hernia repair.prospective study was made from January 2011-0ctober 2013 , on a total of 50 patients with inguinal hernia operated on under local anaesthesia. Patients were selected primarily on the basis of their willingness to accept the procedure after the technique was described to them.Results: In this study 50 patient and 58 herniorrhaphies done for them during a period of about 34months were evaluated .A questionnaire was sent to each patient postoperatively to aid in evaluating the subjective reactionto the local anaesthesia. all patients were males ,age range between 31-83 year, median age 51 .types of inguinal hernia were sliding 1case ,pantaloon 5cases ,indirect 28cases ,direct 24 cases ,Rt. Side 27cases, Lt. side 15 cases ,bilateral hernia 8 cases .we give local anesthesia by 2 methodsConclusions: Local anesthesia is without question the safest available technique of anesthesia.Local anesthesia is an extension of the surgical procedure (indeed, often an integral part of that procedure), and as such its administration should be the concern of the surgeon

Background: The disc prolapse is a common condition especially in young adults. Different levels are affected in the lumber region; the L4/L5 disc is more susceptible to longitudinal load and is the most common site of lumbar disc prolapse. The L5/S1 disc is protected from torsion load by strong ilio-lumbar ligaments but it is more susceptible to axial compressive forces. Many factors affect the result and outcome of surgery in these levels.Objective: The aim of this study is to correlate operative data, short-term results, complications, and prognostic factors (age, gender, mobility, hospital stay, and level of pain) for one-level lumber discectomybetween different levels (L4–L5 vs. L5–S1).Methods In this prospective study, 32 patientsin Al-Yarmouk teaching hospital undergoing survey form March 2008-December 2012.Six patients were excluded from this study because they were diabetics and multilevel disc degeneration .Fifteen (57.6%) patients undergoL5-S1 discectomy and 11 (42.4%) patients undergoL4-5 discectomy. Questionnaires for leg and back pain intensity (Visual Analogue Scale ;VAS), duration of leg pain, and disability (Oswestry Disability Index; ODI), were obtained preoperatively, 3 months, 6 months, 1-year- and 2 year follow-up.Analyses were utilized to evaluate the relationship between surgical outcomes and variable (gender, age, lumber segment, pre-operative ODI, and pre-operative VAS).Results: Mean operative time was[73.44 ± 26.25] min, mean hospital stay was [3-7] days, and mean mobilitywas [2.55 ± 0.93] days. At 2-year follow up, patients revealed a statistical significant improvement inVAS pain (P < 0.05), and ODI lumbar function (P < 0.05).The complications rate were 20.3 %.Our study elaborates good results for one-segmental L5-S1overL4-L5 discectomy. Discectomy of the L4–L5 disc wasassociated with an increased risk of complication (P < 0.05). The comparison revealed that operative time was influenced by age (P = 0.034); hospital stay was influenced by level (P = 0.036) and pre-op VAS (P = 0.006); while complications were influenced by level (P = 0.001) and pre-op ODI (P = 0.049Conclusion: The study revealed significant results for L5-S1 discectomy over L4-L5 discectomy in the late follow up period; the complications rate were higher in L4-L5 level discectomy

Back ground: Several devices with different physical bases have been developed for the clinical measurement of corneal thickness, they classified into 4 categories: Scheimpflug photography based, Slit –Scanning topography, optical coherence tomography (OCT) based and ultrasound (US) based.Objective:To evaluatethe precision of the new Scheimpflug –Placido disc corneal topography in measurement of corneal thickness and to compare the measured values with that obtained by US pachymetry.Methods: Setting of this study is Lasik center in Eye Specialty Private Hospital. Baghdad. Iraq.Eyes of healthy subjects were examined with the Sirius topography.3 consecutive measurements of central (CCT)and thinnest (TCT) corneal thicknesses were obtainedand the measurements repeated within 1 week. The within –subject standard deviation (Sw),test-retest repeatability ,coefficient of variation (CoV),and interclass correlation coefficient (ICC) were calculated to evaluate intra session repeatability and intersession reproducibility. For US pachymetry (Tomey-SP 100) only CCT was measured. Comparison ofthe measurements that obtained by the 2 devices done by paired t-test.Results: The topography provides high intrasession repeatability with test-retest and CoV close to 6μm and0.4%, respectively for both CCT and TCT. The inter session reproducibility also high with test-retest and CoV close to 8μm and 0.5%, respectively.ICC was higher than 0.97 for repeatability and reproducibility . Anarrow 95% limit of agreement was found between the pachymetry obtained by topography and US pachymetry measurements.Conclusions :The topography has been used showed high intrasession repeatability and intersession reproducibility of CCT and TCT measurements in healthy eyes .Absence of statistically significant differences suggest that the topography -TCT and the US pachymetry - CCT can be used interchangeably in subject with normal cornea.Financial Disclosure: No financial or proprietary interest in any material or method mentioned.

Background:No previous Iraqi study was done on the estimation of post mortem interval (PMI) from the medico-legal point of view; depending on the biochemical changes of vitreous humor.Objectives:To find out the relationship between some biochemical changes in vitreous humor and post mortem interval.To find out a new formula for estimation of PMI from some biochemical changes in vitreous humor.Method:The study was conducted on one hundred twenty two cases referred to the medico-legal institute in Sulaimani province during the period between 1st of February and 30th of July 2012.Complete classical autopsy was performed for each case and vitreous humor was collected at autopsy from the posterior chamber of the eye and the samples after collection were immediately transported for biochemical analysis.Only crystal clear vitreous humor was used for analysis.Results:With increasing postmortem interval; the vitreous humor potassium (K+) and calcium (Ca++) were increased. The changes of potassium and calcium were significantly correlated with the postmortem interval. The studied changes in chemical components of vitreous humor after death revealed that potassium had the best linear correlation with the postmortem interval within 40 hours after death and can be estimated by the following equation: (PMI=3.36[k+]-14.35)with standard deviation of±7.44hours.Conclusion:The study showed that vitreous potassium can precisely be used for estimating PMI and proposed a new formula for estimation of PMI which is PMI=3.36[K+]-14.35 that can be used for up to 40 hours with standard deviation of ±7.44hours.

Background:: Infertility is a very common condition affecting approximately 13-14% of couples in the reproductive age. In general population; about 85% of couples have achieved conception within a year. Intrauterine insemination is one of the procedure which have a role in the treatment of infertile couple.Objectives:is to confirm that the use of ovulation induction in the course of intrauterine insemination elevates the pregnancy success rate.Method:This study had been conducted between December 2013 till December 2014 in AL-Elwiyah maternity hospital and AL-Samaraii hospital / Baghdad.On history and clinical examination; the chosen couple had the following criteria; primary infertility for more than one year, no previous IUI trials, husbands with normal seminal fluid analysis, wives in reproductive age group; with regular cycles of 24 – 35 days, body mass index (18-26)kg/m2, normal body contour, no galactorrhea nor hirsutism, normal uterine cavity and patent fallopian tubes by hysterosalpingography. Total number of cases is 76; had been divided into two groups who underwent IUI schedule, 38 cases preceded by ovulation induction and the other 38 cases had spontaneous ovulation by showing a single dominant Graffian follicle size of 18 mm measured by daily vaginal ultrasound.Results:During the study period; the total number of married women participated in the study were 76; divided into two groups. The first group contains 38 women who had the inclusion criteria of our research, underwent IUI after follow up and confirmed spontaneous ovulation, the second group included 38 women who also had the same inclusion criteria and underwent IUI after effective ovulation induction. 5 cases became pregnant while 33 cases didn’t conceive, while in the second group with ovulation induction; 12 cases became pregnant while the remaining 26 cases failed to conceive;Theoverall pregnancy rate was highest(31%) in the group treated with ovulation induction and intrauterine insemination in comparison with the other group which revealed a pregnancy rat.e of only (13%).Conclusion:For fertile couple in which no recognized cause for her infertility ;as for history;clinical examination and investigation are concerned, then combination of ovulation induction with intrauterine inseminationis an effective means for achieivingpregnancyrate by 31%compared with only 13%pregnancy rate in naturally ovulation cycle.

Background: A Catheter-associated with candidiasis infection is the most common nosocomial infection and the objective of this work is to isolate and identify Candida species from catheterized patients by ordinary culture and PCR.Objective:To study the isolation and identification of Candida species from catheterized patients by culture media and polymerase chain reaction(PCR).Methods: One hundred and thirty five Candida species isolates were obtained from urine culture of catheterized specimens from male and female patients , During the period between October 2011 to April 2012 , attending AL-Ramadi general teaching Hospital. A quantitative urine culture for isolation and identification of Candida species was. The isolation of Candida species was done out on selective media with antibiotics is Sabouraud Dextrose Agar. The identification of Candida species was based upon a combination of morphological and biochemical criteria as germ tube test and API 20 candida. Molecular study of Candida species was done using polymerase chain reaction (PCR).Results: Out of the one hundred and thirty five catheterized urine examined .Candida spp. was isolated from in 92 samples. The isolated of Candida spp. were recorded 26(40.0%) C.albicans among female patients and 20(36.4 %) among male patients .positive candidiasis was detected among diabetic patients (28.6%) from female and (20.0%) from male .Also the candidiasis was detected among patients under antibiotic treatment was (20.3%) from female patients and (32.1%) from male patients.Polymerase chain reaction ( PCR) results showed that out of 27cultured specimens , (18) were positive for C. albicans (66.7%) , and out of 9 specimens ,(7) were positive for C.glabrata (77.8%) while out of 4specimens ,(2) were positive for C.parapsilosis (50.0%) .Statistical analysis using chi – square test was applied in this work.Conclusion: The three species of Candida. albicans , Candida .glabrata .& Candida .parapsilosis are important causes of UTI in patients under catheterization in Ramadi teaching hospital and they could be one of causes nosocomial infection .

Background: The association between diabetes and inflammatory dental diseases had been studied extensively for more than 50 years. A large evidence base suggests that diabetes is associated with an increased prevalence, extent and severity of gingivitis and periodontitis and loss of teeth. Many patients do not aware that they are diabetic.Objectives:The aim of the current study was to assess a fast, non-invasive, safe procedure to screen for diabetes and its severity in dental clinics and to assess the change in blood glucose level before and after tooth extraction during periodontalResults: there were no significant differences between the blood samples collected before tooth extraction from finger puncture method (FPB) and the gingival crevicular blood (GCB) P ˃ 0.05Also there were no significant differences between finger blood glucose levels (FBGL) before and after the tooth extraction (P ˃ 0.05).There weresignificant differences between the blood samples collected after tooth extraction from finger puncture method(FPB)and the socket blood (SB), P ˂0.05.There were highly significant differences between the gingival crevicular blood (GCB) before tooth extraction and the socket blood (SB)after tooth extraction P˂0.01.Conclusion: The data of this study has shown the followings the gingival crevicular blood could be an excellent source of blood for glucometric analysis. The blood obtained from the socket of the extracted tooth is undependable for glucometric analysis. There is no effect of tooth extraction procedure on the blood glucose level of the controlled diabetic patients

ABSTRACTBackground Subclinical hypothyroidism is mild thyroid hormone deficiency, defined by elevation of serum thyroid-stimulating hormone concentration despite a normal free T3, free T4 level, can be distinguished by clinical and circumstantial observations from other conditions that cause this constellation of laboratory findings. The aim is to find the prevalence, anthropologic, and metabolic changes associate subclinical hypothyroidism(SH) in adult patients presented to obesity research and therapy unit (ORTU Objective: To find the prevalence of subclinical hypothyroidism (SH) in adult obese patients presented to obesity research and therapy unit (ORTU) in AL-Kindy College of medicine and to describe the anthropologic and metabolic presentation of subclinical hypothyroidism in adults obese patients presented to ORTU. Method: A retrospective descriptive study of adult obese males and females patients attending ORTU during the period February 2013 to February 2014 aging 20-60 years. Patients grouped according to age and BMI. In addition to TSH, glucose, cholesterol, triglycerides and HDL are measured, results tabulated and analyzed. Results: This study revealed that (6.9%) had SH , 91 (86.7%) were females and 14 (13.3%) were males. TSH in patients with SH significantly rise with age (8.31 to 11.16 mu/l), in addition fasting glucose (104 to 116 mg/dl), total cholesterol and triglycerides also rise significantly. Increasing BMI associated with significant elevation of the mean level of TSH in patients with subclinical hypothyroidism (7.32 to 11.32 mu/l in BMI above 40). The same findings of the effect of increasing BMI on the mean level of fasting glucose (104 to 115), cholesterol and triglycerides. Conclusion: Prevalence of subclinical hypothyroidism in ORTU is about 6.9% with a significant association of increasing TSH with age and BMI. There were elevated fasting glucose, cholesterol, and triglycerides in SH patients that also increased significantly more with age and BMI.

Background: Because of wide use of Functional Endoscopic Sinus Surgery (FESS) technique in the recent years and basic role of coronal computed tomography (CT) scan in demonstrating the normal drainage route of para-nasal sinuses, identifying the major patterns of inflammatory sinonasal disease and accompanied anatomical variations is essential for appropriate preoperative surgical planning. In review of publisthed literature, there is no data on CT patterns of chronic inflammatory sinonasal disease and their accompained anatomical variations of nose and PNS in our local population.Objectives: was to determine the frequency of CT patterns and variations in patients with sinonasal symptoms.Methods: This was a cross sectional descriptive study conducted on 404 consecutive patients with clinical manifestations of chronic rhinosinusitis referred to radiology department of Alkindy teaching hospital. Coronal and if needed axial CT scan were taken from them. CT scans were reviewed and inflammatory patterns and accompanied anatomical variations were specified.Results: Five major recurring patterns of inflammation including infundibular 23.76%, ostiomeatal unit (OMU) 21.78%, sphenoethmidal recess (SER) 7.92%, sinonasal polyposis 19.80% and sporadic 20.79% were seen. Special pattern was noted in 3.96% while normal CT examination was noted in 9.90%. The total percentage was more than 100% due to simultaneous occurance of more than one pattern in the same case. In 73.2% of cases accompanied anatomical variation including septal deviation (34%), concha bullosa (26%), Agger nasi cell (13%), giant bulla ethmoidalis (12%), Haller cell (8%), pneumatization of uncinate process (5%), paradoxic middle turbinate (4%), and Onodi cell (2%) were seen.Conclusion: In this study, the concept of the major inflammatory patterns of sinonasal disease was introduced and their frequncies in our local poluplation were reported. By applying these patterns to the radiological report, more tailored and safe endoscopic sinus surgery could be possible

ABSTRACT Pulmonary alveolar microlithiasis is rare infiltrative pulmonary disease characterized by intra-alveoli deposition of microliths. We present a familial case of an adult female with complaint of progressive shortness of breath on exertion. Chest radiograph showed innumerable tiny dense nodules, diffusely involving both lungs mainly the lower zones. High-resolution CT scan illustrated widespread intra-alveolar microliths, diffuse ground-glass attenuation areas and septal thickening predominantly in the basal regions. Chest radiograph is all that is needed for the diagnosis of this case but CT scan was done to demonstrate the extent and severity of this disease