Al-Kindy College Medical Journal

Background: Multi- drug resistant (MDR) Staphylococcus aureus infections have become a major public health concern in both hospital and community settings.Objective: to investigate the antibacterial activity of T. Foenum- groecum essential oil against skin infection with S. aureus and to study probable synergistic activity in combination with Clindamycin.Type of the study: Cross-sectional study.

Methods: Antibacterial activity of T. Foenum- groecum essential oil extract (1.2gm/100 µl) was investigated in multi- drug resistance (MDR) Staphylococcus aureus specimen isolated from patients with skin infection in Baghdad. T. Foenum- groecum use externally for cellulites and skin inflammation due to the presence of diosgenin .fast liquid chromatography was used to separate these components. Results: Antibiotics combinations revealed that T. Foenum- groecum essential oil with Clindamycin against MDR isolates of S. aureus showed a synergistic effect when used as 1/4 MIC for each antimicrobial. In vivo study was executed to determine antibacterial activity of these compounds by induction of skin infection with Staphylococcus aureus in mice and the treatment begun after 4hrs later and continue to seven days then skin biopsy was taken and sent for histopathological examination.

Conclusions: According to the results of this study, we can conclude that T. Foenum- groecum essential oil has remarkable antistaphylococcal activity. Combination of T. Foenum-groecum essential oil with Clindamycin was more effective than Clindamycin alone in treatment of skin infection with Staphylococcus aureus.

Background: The association between oral microbial infection and systemic disease is not a new concept. A major confounding issue is that oral infections often are only one of the many important factors that can influence systemic diseases .Objective: This study was conducted to evaluate the periodontal health status of patients with acquired coronary heart disease. Type of the study: Cross-sectional study.Methods: The study group consisted of 200 patients with an age range (35-70) years, having coronary heart disease .This study group were compared to a control group of non-coronary heart disease (200 individuals ) matching with age and gender. The oral parameters were examined including the periodontal conditions, assessment of periodontal loss of attachment as well as the missing teeth according to the World Health Organization criteria (1997)(1) were followed for diagnosis and recording of oral health status.Results: Results of the present study show that the total sample had a highly significantly periodontitis and periodontal loss of attachment with advancing age (P<0.01), while no statistically significant differences were found between males and females with periodontal condition and periodontal loss of attachment among the study group (P>0.05), while there was significant differences among their corresponding controls (P<0.05). High percentage of missing teeth was recorded among the study and control group. Highly statistically significant differences were seen between study and control groups in all the degree of severity related with periodontal conditions (P<0.001).Conclusion: The data showed that 50.5%, 35% of the control group were with periodontal disease and loss of attachment respectively compared with study group 68%, 58.5% . The present study indicate that periodontal disease more common among patients with CHD than among controls matched for age and gender. Thus the possibility that chronic oral infection or similar factor may he positively associated with CHD at least in form patients susceptible to CHD.Although causality cannot be inferred from the present data, the observed association between chronic oral infections and CHD for susceptible patients in the present study can not be excluded

Background: Diabetes mellitus is a metabolic disorder affecting people worldwide, which require constant monitoring of their glucose levels. Commonly employed procedures include collection of blood or urine samples causing discomfort to the patients. Necessity arises to find alternative non invasive technique is required to monitor glucose levels. Saliva is one of most abundant secretions in the human body and its collection is easy, noninvasive and painless technique. Objective: The aim of this study was to determine the efficacy of saliva as a diagnostic tool by study the correlation between blood and salivary glucose levels and glycosylated hemoglobin (HbA1c%) in diabetes and non diabetes, and the comparison of salivary glucose level and blood HbA1c% with serum glucose level in healthy and diabetic subjects. Type of study: cross- sectional study.Method: Saliva and blood samples were collected from 40 patients visited the Baghdad hospital in Iraq who were previously diagnosed with non-insulin-dependent (type 2) diabetes mellitus and 10 healthy as control (male and female) in age group of 30-65 years. The samples were examined to determine blood and salivary glucose level by the glucose oxidase- peroxidase method and blood HbA1c% by the ion exchange resin method. Results: Our results showed significantly higher salivary and serum glucose level in diabetes compared to control and significantly positive correlation between salivary and serum glucose in diabetes, control, and both groups together; the blood HbA1c% in diabetes was significantly higher compared to control and found a positive correlation between blood HbA1c% and salivary and serum glucose level in diabetes and control. Conclusion: salivary glucose appears to be an indicator of serum glucose concentration in diabetes.

Background: Urinary tract infections (UTIs) and their complications such as Bladder cancer (Bl. C.) are a health growing problem worldwide. Objective: To shed light on this subject, present study was done to investigate relationship between recurrent urinary tract infection (RUTI) due to Escherichia coli (E. coli) and Bl. C.Type of study: Cross-sectional study. Methods: This study included 130 patients with RUTI, 50 patients with Bl. C. and 50 control of both sexes (aged 7-85 years) attending Al-Zahra Teaching Hospital in Al-Kut/Wassit governorate and Al-Harery Teaching Hospital of specialized surgeries/Baghdad. The patients were divided into two groups: the first group (n=130) included those who were suffering from recurrent UTI without bladder cancer and diagnosed clinically as having recurrent UTI. The second group(n=50) included those who had bladder cancer. One hundred and thirty morning midstream urine specimens were collected from recurrent urinary tract infection patients and 50 from healthy persons as a control and also 50 biopsy specimens collected from recurrent UTI with bladder cancer(after surgical operation to these patients) during beginning of October 2012 to end of March 2013. Results: Intracellular bacterial communities (ICBC) (namely Escherichia coli) was isolated from (68/130) 53% from patients with RUTI while (12/50) 24% isolated from patients with Bladder cancer In this study, other molecular technique called Repetitive extragenic palindromic (REP) were used for drawing the genetic map of bacteria to know the points of similarity and differences between isolated bacteria. A difference between bacteria in each group were found, but when comparing the genetic map of UPEC isolated from patients with Bl. C. with those isolated from patients with recurrent UTI high difference between them were seen. Conclusion: Detecting the intracellular bacterial communities (namely E. coli) in patients with recurrent UTI, with or without bladder cancer. Detecting similarity and difference in genetic map of UPEC isolated from RUTI and Bl. C. by Repetitive extragenic palindromic DNA (REP) technique, in which found high similarity between UPEC isolated from each group but difference from UPEC isolated from other group

Background: The post-operative acute abdominal complication is one of the most difficult clinical problems facing the surgeon, and it represents a unique challenge for him not only because of the difficulty in making a precise diagnosis but also in the decision for further management . Objective: discuss the post-operative acute abdominal complications requiring re-interventionType of the study: Cross sectional study. Methods : Patients with early post-operative Acute Abdominal complications ( within 30 days from the initial operation ) who required re-intervention were studied prospectively Results :The study included 82 patients 47 of them were females, their age ranging 7-87,Different types of the initial operation were reported,51 % of them were emergency operations. Exploration for Trauma was the most frequent initial operation 28%,followed by Biliary Surgery in 25.6% The most common cause for postoperative acute abdominal complications was intraabdominal infections and /or collections in 68.4% of patients Mortality was 10%, 50% of them were in the intraabdominal infection group 24.3% of patients required more than one re intervention Conclusion : Acute abdominal complications in the early post-operative period presents a problem of special concern not only because of the difficulty in the detection of acute post-operative complications within the abdomen but also in making precise decision to separate those complications from a new condition unrelated to the operation

Background: Acute myocardial infarction (AMI) is one of the most common diagnoses in hospitalized patients. Increased plasma hemostatic markers were noted in acute myocardial infarction, indicating that the blood coagulation system is highly activated in those patients. Aims of the study: To study the level of intrinsic coagulation factors including (FVIII:C, FIX:C ,FXI:C ,FXII:C ) in patients with acute myocardial infarction. Type of the study: Cross –sectional study. Methods: Thirty patients (their age range is 48-68 years) were included in this study (9 female, 21 male) who were just admitted to the coronary care unit in AL-Yarmouk Teaching Hospital and diagnosed as having acute myocardial infarction patients, blood samples were taken from those patients . Twenty healthy subjects (6 female, 14 male) age and sex matched with the patients were included as a control group. The following investigations were done for both groups: 1.Packed cell volume(PCV%) .by microhaematocrit method. 2.FVIII:C assay. [ by parallel line bioassay of coagulationfactors]. 3.FIX:C assay. 4.FXI:C assay. 5.FXII:C assay. Results Mean FVIII:C (162.63%±17.22)was significantly (P value< 0.05)higher in patients with acute myocardial infarction than control group(94.70%±9.34).1-Mean FIX:C (151.20%±14.20) was significantly (P value <0.05) higher in acute myocardial infarction group than control group(94.10±8.51). 2-Mean FXI:C (146.30%±7.87) was significantly (P value <0.05) higher in acute myocardial infarction group than control group (102.00%±7.91). 3-Mean FXII:C(71.03±11.46) was significantly (P value <0.05) lower in acute myocardial infarction group than control group (119.00%±8.52). 4-There is inverse relationship between FXI:C and FXII:C in acute myocardial infarction group(P value -0.736). Conclusions Patients with acute myocardial infarction had significantly higher levels of FVIII:C,FIX:C,FXI:C than controls. FXII:C level was significantly lower in patients with acute myocardial infarction than control group. There is an inverse relationship between FXI:C and F XII:C in patients with acute myocardial infarction.

Background: Emergency contraception (EC) is a general term used to describe drugs and devices that are utilized to prevent pregnancy following unprotected intercourse or in the event of contraceptive failure. This postcoital birth-control option is available by means of hormonal pills or copper-bearing intrauterine device.Objectives: The objectives of the study were to assess the women's knowledge regarding EC, to compare the knowledge of school teachers with other women in the community, as well as assessing the pre-post test knowledge of teachers.Type of the study: A cross sectional and quasi- experimental study.Methods: It was carried out in Duhok during the period from 20th of November 2014 to 6th of January 2015. A Simple and systematic methods of sampling was used to collect 600 married women in their reproductive age group (15-49 years old ), 300 visitors from Primary health Care Centers, and 300 from school teachers.Results: showed that (77%) of study sample were used a natural (withdrawal) contraceptive way, while (3%) heard about emergency contraceptive, (13.2%) of them had unintended pregnancy and (1.2%) had an experience of induced abortion. From those who heard about emergency contraception (2.7%) considered the hormonal pills were the methods of emergency contraceptive and the friends were the source of information in (1.5%). In addition, there is a highly significant difference between the teacher's knowledge in pre and post-test .Conclusions: Our community knowledge toward EC is low, and there is a good benefit after doing the education program about the information regarding emergency contraception

Background: Mothers are considered as the key role in effect on child's dental behavior. So it is important to involve her in oral health promotion program to prevent early childhood dental caries from occurring in early age. Objectives: To identify the knowledge, practice and attitude of mothers about the oral health of their children. And to measure the change in oral hygiene of children aged (4-7) years old after one month of interventional program on their mothers. Type of study: Non-randomized interventional.Methods: Non-randomized interventional study for one month in Al Shaab area in Baghdad to 65 mothers who have children aged (4-7) years .A modified administrated questionnaire is given to assess mothers’ knowledge, practice and attitude about their children’s oral hygiene. Loe and Silness index is used to measure the oral hygiene of their children through measure highly associated with oral hygiene of the children.Results: The study found the mothers level of education is not associated with their child's oral health behavior about brushing times and thumb sucking habit but it is highly associated with fluoride supplement for their children also mothers level of education and their attitude about fearing from dental treatment are not associated but are associated with their attitude about child's tooth pain.Conclusion: Improvement in oral hygiene of children after one month from receiving their mothers a short term oral hygiene program.

Background: Scientific education aims to be inclusive and to improve students learning achievements, through appropriate teaching and learning. Problem Based Learning (PBL) system, a student centered method, started in the second half of the previous century and is expanding progressively, organizes learning around problems and students learn about a subject through the experience of solving these problems.Objectives:To assess the opinions of undergraduate medical students regarding learning outcomes of PBL in small group teaching and to explore their views about the role of tutors and methods of evaluation. Type of the study: A cross-sectional study.Methods: This study was conducted in Kerbala Medical Colleges among second year students. A self-administered questionnaire was prepared to evaluate the newly applied teaching system. The study analysis included simple descriptive analysis and determining association through t-test, chi square test and regression analysis and using structural equation models to determine simultaneous association between different students’ demographic characteristics and potential predictors using SPSS-20 and Amos software at a significance level of < 0.05.Results:A total of 131 undergraduate medical students participated in the study with a response rate of 94%. The majority (93%) have indicated that PBL strategy contributed effectively to their knowledge development with a similar majority (92%) considering PBL successful new teaching method. About 86% reported that would choose PBL rather than conventional method and also 86% would advise PBL for others. Similarly, high majority indicated that various PBL activities are essential. Regarding the tutors’ role in PBL, the majority (92%) indicated that this role was positive and fundamental. According to two thirds (68%) of participants PBL application in Kerbala Medical college was very good application while a higher majority described various PBL sessions as successful and positive and fundamental role of tutors was stressed by most students.Conclusions: This study highlighted the benefits of soliciting student impressions of effective small group teaching. The students’ emphasized group atmosphere and facilitation skills of tutor in learning.Key words: Problem Based Learning, Medical Education, Small Group Teaching, Team Based Learning, Kerbala Medical College

Background: Obesity has become one of the most important public heath problems all over the world.An epidemic of obesity is affecting children and adolescents across the developed and developing countries in recent years. As the prevalence of obesity increased, so did the prevalence of co morbidities like metabolic and endocrine diseases.Objectives: To overview obesity clinical features and the prevalence of associated co morbidities in children and adolescents attended the obesity researches and therapy center in Alkindy medical collage.Type of study: This is a cohort observational studyMethods : Obese child and adolescents aged 4-15year attended the obesity research and therapy unit in AL Kindy medical collage from the 1st of September to the 31st of October 2015, Results: Children and adolescents are equally susceptible to obesity but Girls are twice susceptible to have obesity than boys 34:16 (68%: 32%). The study shows that all patients have BMI>95th and 84% of them have BMI >99th percentile. Only 26% of patients have height more than 95th percentile. More than 2/3 of patients have snoring and other sleep disorders, most of them are adolescent boys. 22% are hypertensive mainly adolescents.42% have hyperglycemia,40% hypercholestremia, and 70% have high triglyceride level with no gender or age group association. Increased appetite (88%), family history of obesity(82%) and sedentary life style (76%) are the most common causes of children and adolescents obesity. Conclusion: Novel approaches in the prevention and treatment of childhood and adolescent obesity are urgently required particularly to family behavior pattern. Key words: Obesity, childhood, adolescent.

Background: The skin functions as a barrier to the external environment, damage to this barrier following a burn disrupts the innate immune system and increases susceptibility to bacterial infection. Objective: This study was carried out to determine the bacterial isolates and study their antimicrobial susceptibility in burned wound infections at one burn's hospital in Baghdad.Type of study:Cross-sectional study.Methods: The bacteria were identified at species level by using Analytic Profile Index (API) system and The antimicrobial susceptibility test was performed according to Kirby-Bauer (disk diffusion) technique.Results: Over a period of one year (from October 2014 to October 2015). Out of 848 patients with different degrees of burns, 186 (19.81%) positive bacterial isolates. Out of 186 bacterial isolates, the isolation rate of Gram positive was 14(7.53%) and Gram negative isolates was 172(92.47%). From those 172 Gram negative bacteria the most frequently isolated bacteria was Pseudomonas aeruginosa 60(32.26%) isolates followed by Acinetobacter baumannii 40(21.51) and all Gram positive bacteria were Staphylococcus aureus 14(7.53). The most effective antibiotic on Staphylococcus aureus isolates was Vancomycin (sensitivity rate was 11(92.86%)), while the highest resistance was to Penicillin and the rate of resistance was 14(100%) followed by Ampicillin 12(85.71%). The most effective antibiotic on Gram-Negative isolates was Imipenem (sensitivity rate was 165(95.93%)) followed by Amikacin (sensitivity rate was 146(84.88%)). On the other hand the Gram negative bacteria in this study were mostly resistant to Ampicillin 164(95.35%) and Amoxicillin-Clavulanic acid 157(91.28). Acinetobacter baumannii and Klebsiella pneumoniae isolates were the mostly resistant isolates than other gram negative bacteria under this study.Conclusion: Pseudomonas aeruginosa was the most frequently isolated bacteria among gram negative bacteria and the most effective antibiotics on Gram-Negative and Staphylococcus aureus isolates were Imipenem and Vancomycin, respectively.

Background: Skull secondary tumors are malignant bone tumors which are increasing in incidence.Objective: The objectives of this study were to present clinical features , asses the outcome of patients with secondary skull tumors ,characterize the MRI features, locations, and extent of secondary skull tumors to determine the frequency of the symptomatic disease.Type of the study: This is a prospective study.Methods: This is a prospective study from February 2000 to February 2008. The patients were selected from five neurosurgical centers and one oncology hospital in Baghdad/Iraq. The inclusion criteria were MRI study of the head(either as an initial radiological study or following head CT scan when secondary brain tumor is suspected , visible or palpabable skull mass is noted ) that revealed either calvarial or skull base metastases were included in this study.Results: During the period of the study 175 patients were included according the inclusion criteria. Primary sites were breast cancer (54.85%), lung cancer (14.28%), prostate cancer (6.28%), malignant lymphoma (5.14%), and others (19.42%). The mean time from primary diagnosis to skull metastasis diagnosis was 71 months for cases of breast cancer, 26 months for prostate cancer, 9 months for lung cancer, and 4 months for malignant lymphoma. Calvarial circumscribed intraosseous metastases were found most frequently (25.7%). The patients were mainly asymptomatic. However, some patients suffered from local pain or cranial nerve palsies that harmed their quality of life. Treatment, mainly for symptomatic cases, was by local or whole-skull irradiation.Conclusion: Secondary skull tumors are not rare, and most are calvarial circumscribed intraosseous tumors. MRI contribute to understanding their type, location, and multiplicity, and their relationship to the brain, cranial nerves, and dural sinuses. Radiation therapy improved the quality of life (QOL) of patients with neurological symptoms.

Background: As photochemical reaction that can stiffen the cornea, CXL is the only promising method of preventing progression of keratectasia such as KC and secondary ectasia following refractive surgery. The aim of CXL is to stabilize the underlying condition with a small chance of visual improvement. Objective: To show the sequences of changes in visual acuity and topographic outcomes during 1 year post CXL for patients with progressive Keratoconus.Type of the study: Cross sectional studyMethods: CXL procedure was done for 45 eyes with progressive KC. The following parameters had been monitored pre operatively, 1, 3, 6 and 12 months postoperatively: K apex, K2, corneal thickness at thinnest location, anterior and posterior elevation points, BCVA and UCVA. Placido –Scheimpflug topography (Sirius) device had been used to monitor the corneal parameters of the study. One –way ANOVA and Paired sample T test was used for statistical analysis.The study done in Lasik specialty center /Baghdad/IraqResults: At 1 year, an averages flattening of (2.11 D) diopter in K2 and (1.88 D) diopter in K apex were found. Mean BCVA improved by 1 line from (0.18) Log MAR to (0.13) Log MAR and mean UCVA improved by 3.5 lines from (0.89) to (0.64) log MAR. The corneal thickness at thinnest location was 5.71 Mm less than the baseline. All the above mentioned parameters showed a trend of worsening between the baseline and 1 month, and improvement thereafter. We found no statistically significant changes in the anterior elevation points while the posterior elevation point changed (increased) significantly.Conclusions: Corneal collagen cross-linking seems to be effective in decreasing progression of KC , with improvements in optical measures in many patients. Post operative parameters discussed within this review followed a seemingly reproducible trend in there natural course over 12 months .Generally, the trend that observed was immediate worsening between baseline and 1 month resolution at approximately 3 months, and improvement thereafter.

Background:Nocturnal Enuresis is a common problem affecting 20% of five years old children and up to 2% of adolescent and young adult. Although it is a self limiting benign condition, it has social and psychological impact on the child and his family. Many pathophysiological theories had been suggested, but none is confirmed. Hypercalciuria has been suggested to be associated with higher incidence of nocturnal enuresis. Objectives:The aim of our study to test the value of Ca/Cr ratio, on random urine sample, in diagnosing hypercalciuria in enuretic children. Type of study: Cross sectional study.Methods:Forty four enuretic children were enrolled in this study and forty five children without nocturnal enuresis were taken as control group. Results:The prevalence of abnormal Ca/Cr ratio was higher among enuretic children when compared with control group; the result was statistically significant (P. value0.002). Among the enuretic children, higher Ca/ Cr ratio was statisticallyassociated with urinary symptoms, abnormal general urine examination, and positive family history. Nosuch association was found with the gender or frequency of bed wetting per week. Conclusions:the results of this study suggest that hypercalciuria has a significant association with NE, rendering routine screening of hypercalciuria by Ca/Cr ratio on a random urine sample, is reasonable. Furthermore, a large scale studies are needed to confirm the role of low calcium diet, and other measures in treatment of idiopathic hypercalciuria, in the management of enuretic children with abnormal Ca/Cr ratio

Background: Adenoiditis is a common cause of otitis media with effusion (OME) in children & perhaps OME is one of the most common diseases leads to hearing impairment in children with subsequent impairment of speech development & learning difficulties , however, treatment remains controversial. Objectives: To evaluate if there is a significant advantage of tympanostomy tube insertion in association with adenoidectomy over adenoidectomy in association with myringotomy alone in treatment of children with OMEType of the study: This is a prospective study. Patients & methods: The study consisted from 63 children diagnosed as cases of bilateral OME & variable degrees of adenoid hypertrophy. The patients were divided randomly into two groups, group A (32) were subjected to adenoidectomy & myringotomy with tympanostomy tube insertion & group B (31) were subjected to adenoidectomy & myringotomy alone. Pure tone hearing threshold was measured preoperatively & at the 3rd month and 6th month postoperatively. Statistical analysis is done to compare the means of pure tone hearing threshold between group A & B. Results: The mean pure tone hearing threshold preoperatively in group A was 28.3 dB, while it was 27.9 dB in group B. Three and six months postoperatively the means in group A were 13.2 dB and 6.8 dB respectively , while the means were 19.4 dB and 13.6 dB respectively in group B. Statistical analysis showed statistically significant difference between the means of pure tone hearing thresholds in both groups during the whole follow up period (P value less than 0.05). Conclusion: There is statistically significant advantage of tympanostomy tube insertion in association with adenoidectomy compared to adenoidectomy with myringotomy alone in treatment of OME in term of hearing level

Background: Background : Patients with non-rheumatic atrial fibrillation have high risk of thromboembolism especially ischemic stroke usually arising from left atrial appendage .Transoesophageal echocardiography provides useful information for risk stratification in these patients as it detects thrombus in the left atrial or left atrial appendage. Objective : This study was conducted at Al-Kadhimiya Teaching Hospital to assess the prevalence of left atrial chamber thrombi in patients with chronic non-rheumatic atrial fibrillation using transoesophageal echocardiography and its clinical significance as well as to verify the superiority of transoesophageal over transthoracic echocardiography in the detection of these abnormalities. Type of the study: Cross sectional study.Patients and Methods : Forty (40) consecutive patients (11 female and 29 male), at a mean age of 46 ± 9 years (range 28–60) with chronic non-rheumatic Atrial fibrillation were enrolled to this prospective study between March 2006 and December 2006. Tansthoracic and transesophageal two dimensional , M- mode , Doppler, and color- flow echocardiography were obtained with a kretz diagnostic ultrasound system. Results : The prevalence of Left atrium thrombus was 12.5%, 5 patients from the total number which was 40 patients. All of them seen bytransoesophagealechocardiography and non are detected byTansthoracic echocardiography . All the left atrial thrombi were confined to the left atrial appendage (100%). Left atrial spontaneous echo contrast was detected in 10 patients 25% by transoesophageal echocardiography, but was not observed in patient bytransthoracic echocardiography. All the 5 thrombi were found in left atria were significantly associated with spontaneous echo contrast 100% (P-value <0.001), reduced left ventricle ejection fraction (p-value <0.05) , large left atrium diameter ( p-value <0.05) and low LAAV <20 cm/s (p-value <0.001) compared to those without thrombus . Conclusions : The study showed that the prevalence of left atrial thrombus and appendage is not uncommon in patients with non-rheumatic atrial fibrillation and is exclusively seen in patients with left atrial SEC. Low Left ventricle ejection fraction , large Left atrium diameter , and low Left atrial appendages velocity are significantly associated with subsequent thrombus formation , and is more sensitive in the detection of these abnormalities compared with transthoracic echocardiography

Background: Autism is a complex developmental disability that typically appears during the first three years of life. Autism affects the normal development of the brain in the areas of social interaction and communication skills.Objectives: To identify risk factors for Autism among a sample of autistic children in Baghdad city. Type of the study: this is a case – control, study. Methods: This study was conducted during the period of data collection extended from first of November 2010 until the first of April 2011,The total number of children involved was 100children with diagnosis of autism. Handred children who are free from autism were taken as the control sample. Results: there was a significant association between paternal age and the risk for autism, fathers older than 40 years had 11 times increased risk of having an offspring with autism, (p=0.043).Psychologicalproblems, showed a statistically increased risk of autism associated with maternal history of (maternal unhappy emotional state), the odds ratio of this risk factor was seven (p=0.01). Post term (14% in cases vs. 2% in controls) (P=0.005, OR 8.80) and neonatal jaundice (30% in cases and 11% in controls) (P=0.001, OR 3.71) were significantly associated with autism.Bottle-feeding showed the highest significant associations with risk of autism (p=0.004, OR=2.84).Conclusion:Autism has many associated risk factorslikepaternalage (fathers older than 40 years),psychological problems (maternal unhappy emotional state),post term,neonataljaundiceandbottle-feeding

Background: Folic acid (vitamin B9) is one of the important vitamins that are necessary for growth and development of the embryo and preventing the occurrence of congenital malformations which are one of the important health problems in the developing countries and the world as it has a direct effect on the affected babies, their families and the community. It affects an estimated 3% of newborns worldwide.Periconceptional supplementation with folic acid (before conception and during the first 12 weeks of pregnancy) was found to decrease many important types of these anomalies. Objectives: The aim of this study is to assess knowledge, attitude and practice of periconceptional use of folic acid in pregnant women who are attending antenatal care unit in three Primary Health Care Centers in Baghdad / AL-Russafa side. Type of the study: Descriptive cross-sectional study Patients and Methods: The study used a convenient sample technique for pregnant women who are attending antenatal care unit in three primary health care centers in Baghdad/ALـRussafa at the period from January to April 2014. The sample size was 200. Non-pregnant women were excluded. Results: a large proportion (86%) of pregnant women who had been interviewed knew about folic acid. 61% of them gained the information about it from doctors and 44.5% know its importance in protection from congenital anomalies. Although there was a good practice regarding folic acid supplementation during the current pregnancy; only 10% of them had used it in the proper time (at least one month before pregnancy to the end of the first trimester). It has been found that the largest rate of its use was in the second month (28%), Still 22% of them realize that it must be taken before pregnancy. Conclusion: From 200 pregnant women interviewed in the current study, the majority knew about folic acid but nearly only half of them states its importance in protection from congenital anomalies. Most of the women usedfolic acid in the current pregnancy on a daily bases and take it as pure folic acid. Although some of the pregnant women were aware about the proper time of taking folic acid, only few took it before pregnancy. Doctors were the main source of information.

Background: Genetic factors play an important role in susceptibility to Guillain Barre' syndrome. Human leukocyte antigen (HLA) as part of immune system has a role in the disease process.Aim of the study: to assess the relationship between HLA-A alleles with Guillain Barre' syndrome (GBS) compared with a healthy control group using PCR-SSOP method.Type of the study: Cross-sectional study.Patients and methods:Patient's group consisted of 30 Iraqi Arab Muslims patients with Guillain Barre' syndrome that consulted the Neurological department in Neurosciences Hospital between January-2013 to January- 2014 were genotyped for HLA-A alleles. A control group consisted of 30 healthy volunteers among the staff of AL-Kindi College of Medicine that did not have any neurological disorders.Results: Present study found a decreased frequency of HLA-A:0101 allele (p=0.001) in GBS patients compared to healthy controls.Conclusions: current results suggest that GBS is negatively associated with HLA-A:0101 allele.

Background: Appendectomy is still one of the most commonly performed emergency surgical procedures worldwide.Avoiding delays in the diagnosis in these patients may play a role in reducing observed morbidity.Aim of study:To analyze the clinico-pathological profile and outcomes of patients undergoing emergency appendectomies to determine risk factors influencingcomplicaions.Type of the study: A prospective analytic studyPatients and Methods: The study involves 108 patients underwent emergency appendectomies at Al-kindy teaching hospital from April 2014 to March 2015. Appendicitis was categorized into two groups perforated andnonperforatedappendicities. A comparison between them was made in regard to Gender, Age, clinical presentation, investigations(White blood cells count), patient’s delay, hospital delay, anatomical location of the appendix, presenceof fecolith.Results: Five factors were predicted that influence appendicealrupture,the patient’s pre-hospital time delay was the most important risk factor for perforation. The male are slightly more affected than female in a percentage of (60male) 55.55% and (48female) 44.44%.The most common appendix anatomical location for complicated appendicitis was pelvic 16 out of 32 (50%).The presence of fecolith in the lumen of appendix was considered significant risk factor for perforation 23/32 (71.875%). In the perforated group 28patients out of 32had high White blood cells count(87.5%) compared to patients in the non-perforated group36 (47.39%).Conclusions:Young age group, male gender, pelvic anatomical location of the appendix ,presence of faecolith in the lumen of the appendix and prehospital time delay were found to be the most important risk factors

Background: Cartilage forms most of the temporary skeleton of the embryo and provides a model in which most bones developObjective: Using laser therapy to enhance autologous cartilage grafts expansibility and to analyze whether this "enhancement" results in reduced rates of cartilage resorption and greater preservation of normal architectural features compared with "unenhanced" grafts. Type of the study: Cross sectional study.Methods: 24 New Zealand rabbits were divided into two groups (control and treated with 904nm, 10mW diode laser). Auricular cartilage segments measuring 1 cm2 were harvested from both ears of each rabbit, and were implanted in to the subcutaneous region of the left flank. 3 rabbits from each group were anaesthetized at 3, 6, 9 and 12 weeks post operation, implanted cartilages were then peeled. Gross and microscopic examinations were performed to assess size, structural integrity, and architectural features, with comparisons performed between each of the conditions. The results were assessed using T – test. Results: Grafts of control group were softer, more pliable when compared with grafts treated with laser irradiation. The rate of healing, and the quality of the cartilage is more enhanced in the treated group. The mean areas of the harvested cartilage grafts treated with laser therapy were 1.17 cm2 , 1.34 cm2, 1,64 cm2 and 1.76 cm2 respectively, while the corresponding value for the untreated specimens was 0.95 cm2, 0,99 cm2, 1.05 cm2 and 1.08 cm2. The percentage of decrease in size was 14% for the untreated specimens and 0% for the specimens treated with laser therapy for all cases. Conclusions: Our findings demonstrated significant improvements in graft quality using laser therapy. These findings may justify changes in how cartilage grafts are prepared and delivered for facial augmentation procedures to reduce graft resorption and maintain the structural integrity of the cartilage.

Background: Cystoid Macular Edema (CME) in its various forms can be considered one of the leading causes of central vision loss in the developed world. It is not a disease itself, It represents a common pathologic sequel of the retina and occurs in a variety of pathological conditions such as, diabetic retinopathy, central or branch retinal vein occlusion(CRVO,BRVO), intraocular inflammation and following cataract extraction. Objective: This study was done to investigate the pattern of CME in patient attending Erbil Teaching Hospitals.Type of the study: Cross- sectional study.Methods and Materials: This is a hospital base cross- sectional study that included 61 patients (75 eyes) conducted at Erbil Teaching Hospitals for six months. All patients underwent a comprehensive assessment including medical and ophthalmic history, detailed ophthalmic examination and Optical Coherence Tomography (OCT) examination.Results: of the 61 patients 32 (52.5%) were females and 29 (47.5%) were males. The mean age was (56.4±10.8) years. Out of the 75 eyes included in the study, 41 eyes (54.66%) had diabetic retinopathy, 10 eyes (13.34%) had CME following cataract operation (Irvine-Gass syndrome), 8 eyes (10.67%) had BRVO, 6 eyes (8%) were had CRVO, 5 eyes (6.66%) had age related macular degeneration, 3 eyes (4%) with uveitis, and 2eyes (2.67%) had Retinitis Pigmentosa. The average macular thickness was (415.6± 107).Conclusions: Diabetic retinopathy is the most common predictive factor of CME, followed by cataract surgery. CME is more severe in diabetic retinopathy, CRVO and after cataract surgery.

Background: Educational environment is one of the most important determinants of an effective curriculum. Students' perceptions of their educational environment have a significant impact on their behavior and academic progress. Objective: 1. To identify students’ perception to the educational environment.2. To identify any gender or class level differences in the students’ perception.Type of the study: This is a descriptive cross-sectional studyMethodology: The study was carried out on convenient sample of 150 students of 2nd and 5th grade. This study was done in Al Kindy Medical College, Baghdad, Iraq and conducted during the period from the 1st of October 2013 till the end of March 2014, by using DREEM questionnaire a validated universal diagnostic inventory for assessing the quality of educational environment through direct interview. Inclusion criteria include any student from the 2nd and 5th class who agree to participate in the study. The data was entered into a Microsoft Excel spreadsheet and were analyzed using SPSS version 16. Student t test was done to find out the difference between the mean scores, P<0.05 was considered as statistically significant.Results: For all students (n= 150) the total DREEM score of a maximum possible of 200 was 110.18 , it was more positive than negative overall domain score, which means that the students had positive perception and more positive scores than negative. Total DREEM scores were significantly higher for females (M = 138.8; SD = 17.2) than males (M = 132.3; SD = 20.7), although all domains mean scores were higher for female than male, there was statistical significant difference regarding Students’ perception of learning, Students’ perception of atmosphere and Students’ social self-perception.Regarding the class level, 5th year students gave significantly higher total DREEM ratings (M = 139.1; SD = 17.4) than 2nd year students (M = 135; SD = 18.8). Second year students also gave significantly higher Students’ perception of learning (SPL) ratings than 5th year students and significantly higher Students’ perception of atmosphere ( SPA ) ratings higher than 5th year students. Conclusions: Students assessed the educational environment as more positive than negative;. The greatest difficulty was with ‘students’ perception of learning’.

ان التثقيف الصحي يعمل على الارتقاء بالمعارف والمعلومات وتغيير السلوكيات الصحية للمجتمع. لتقييم اثر التوعية والتثقيف الصحي للحصول على قاعدة معلومات لتقييم فعالية الرسائل الصحية الموجهة الى المجتمع والتزود بالبيانات اللازمة لمتابعة تحقيق اهداف البرامج الصحية والوقائية المتفق عليها دوليا" كأساس للعمل المستقبلي ولخلق مجتمعا واعياً مثقفاً مشاركاً فعالاً متبنياً سلوكيات صحية .تم اختيار عينة عشوائية منتظمة من قبل الجهاز المركزي للاحصاء / وزارة التخطيط فكانت العينة تمثل (210) مركز صحي في عموم العراق عدا اقليم كردستان وبواقع 100 استمارة لكل مركز صحي فكان حجم العينة (21000) استمارة استبيانية تشمل الذكور والاناث بنسبة (7:3) بعمر 16-49 على ان يكونوا متزوجين ولهم طفل واحد او اكثر تشمل الاستمارة الاستبيانية على: بيانات تعريفية للفرق الميدانية- البيانات التعريفية للمراجع والاستبانة االتي تضم (32) سؤال لذكور و (57) سؤال للاناث النتائج اوضحت ان نسبة المعارف الصحية التي يمتلكها المجتمع 54% ونسبة السلوكيات الصحية التي يطبقها 58%, اما الذين لا يمتلكون المعرفة والسلوك الصحي فنسبتهم 12%.ان التوعية المطبقة في المراكز الصحية لم تحقق الغاية المنشودة منها فيما يخص اهداف البرامج الصحية المطبقة في الوزارة .