Al-Kindy College Medical Journal

Background: The normal decline in systolic blood pressure during recovery phase of treadmill exercise dose not occur in most patients with coronary artery disease, in others recovery values systolic blood pressure may even exceed the peak exercise value. Objectives: Treadmill exercise test parameters indicating the presence and extent of coronary artery disease have traditionally included such as exercise duration, blood pressure and ST-segment response to exercise. The three –minute systolic blood pressure ratio is another important indicator of presence and significance of coronary artery disease is useful and obtainable measure that can be applied in all patients who are undergoing stress testing for evaluation of suspected ischemic heart disease and this increase the sensitivity of exercise test . Type of the study: A prospective study. Methods: Between April 2011 and April 2012 ,all patients underwent treadmill exercise test , echocardiography coronary angiography in Ibn Ab-bitar Hospital Cardiac Surgery. Clinical and procedural data for patients undergoing treadmill and coronary angiography were prospectively collected and entered into database specially designed for the present study.To calculate mean systolic blood pressure ratio for each , Measurement of blood pressure in the 3rd minute of recovery time and divided by peak systolic blood pressure during exercise test ,after excluding patients . Coronary angiography was done for all patients who under went treadmill exercise test and multiple views were taken accordingly to clarify the lesion and critical lesion defined as >50% stenosis in LMS and >70% stenosis in LAD,LCX and RCA. Results: We studied 100 patients In the period from April 2011 to April 2012, 78(78%) male and 22 (22%) a female with a mean age 55.49±7.60 who undergone treadmill exercise testing and coronary angiography to assess the chest pain, 32 patient had normal blood pressure 68 had hypertension and 24 patients had normal coronary angiography and 76 patients had abnormal coronary angiography. SBP/3 minute recovery blood pressure ratio was significantly higher in patient with coronary artery disease than patient without coronary artery disease (mean ±SD O.92±0.09 VS 0.81 SBP/3 minute recovery blood pressure ratio was significantly related with the severity of coronary artery disease its higher in three vessels than one vessel disease 0.95±0.10 vs0. 91 ±0.01 p-value 0.0001. Conclusions: post exercise blood pressure response in patients with coronary artery diseaseis higher than patients with normal coronary artery .post exercise blood pressure is related to the severity of coronary artery disease

Background: Dorsal plication on each side of the penis at the 2 and 10-o’clock positions had been a mainstay for correction of ventral penile curvature. However, because only the 12-o’clock position proved to be a nerve-free zone, dorsal plication at the 12-o’clock position can be advocated.

Objectives: To evaluate tunica albuginea plication with and without neurovascular bundle mobilization in patients with ventral penile curvature. Type of the study: A prospective study.

Methods: A 34 patients with a mean age of (4.8 ± 0.54) years, Who still have ventral penile curvature all ≤ 30º after degloving of penis with or without other orthoplasty technique, randomized into two groups, in group (A) 17 patients subjected to midline dorsal penile plication at 12-o'clock, whereas in group (B) 17 patients subjected to plication of tunica albuginea at 2 and 10-o’clock positions after neurovascular bundle mobilization.

Results: 94.1% of group (A) and 88.2% of group (B) Patients have satisfactory appearance of the penis. No complications were reported in both groups

Conclusions: The incision and plication of tunica albuginea with neurovascular bundle mobilization is long and more invasive procedure than Midline dorsal penile plication with no significant differences in outcome.

Background: H1N1 influenza pandemic or swine flu was an influenza pandemic first described in Iraq in October 2009 .The virus appeared to be anew strain of H1N1 causes wide range of morbidity and mortality among different genders and age groups as part of worldwide pandemics.Seasonal flu is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and lungs. It can cause mild to severe illness, and at times can lead to death. The best way to prevent the flu is by getting a flu vaccine each year.

Objectives: Is to determine the morbidity and mortality in different age groups in patients with H1N1 influenza versus those patients with seasonal influenza who were admitted at the same time to AL-kindy teaching hospital during pandemic 2009. Type of the study: A retrospective observational study.

Methods: A total number of 210 cases with influenza symptoms and signs were included in this study which was conducted at AL-kindy teaching hospital , Baghdad, Iraq at inpatient medical wards over a period from October to December 2009. All cases were tested by real time PCR for H1N1 influenza virus by taking nasal and throat swab in addition to monitoring symptoms and signs of influenza and chest radiographs.

Results: Out of 210 cases, 90 (42.85%) cases were positive for H1N1 influenza and 120 (57.14%) cases had negative test are considered having seasonal influenza. Of the positive cases(64.44%) were males and (35.55%) were females. Of negative cases(seasonal flu)male gender were (61.66%) , while female gender were (38.33%). 57.77% of positive cases developed flue like illness compared with 54.16% of negative while 25.55% of positive developed pneumonia compared with 22.5% of negative.5.55% of positive cases developed ARDS compared with 5% only in negative cases.11.11% had different presentation in positive cases (bronchitis ,gastroenteritis) while 18.33%of negative. Mortality in positive cases are 14.4% compared with only 10% in negative cases.

Conclusions: Influenza A/H1N1had same symptoms and signs of epidemic seasonal influenza but run aggressive and short course of morbidity in 3-5 days with high percentage of complication and high mortality compared with seasonal epidemic influenza with rare affection above 65 years old, both groups had same incidence of complication with pneumonia and ARDS

Background: Most adult smokers start smoking regularly some time before 18 years of age. Cigarette smoking is a major ‘preventable’ cause of morbidity and mortality worldwide. It is well-known that smoking has hazardous effect on many systems like pulmonary and cardiovascular system.

Objectives: Study the prevalence of smoking among school pupils according to the mode of smoking, age, school grade, school environment and possible health risk associated with smoking. Type of the study: A cross-sectional study.

Methods: Study was conducted between 1st of March 2014 to 30th of May 2014 at Al-Doura/Al- Kurkh/Baghdad by using convenient sample, including all pupils from 6 schools. The schools were 2 secondary schools, 3 intermediate schools and 1 professional secondary school from second Al-Kurkh education directorate. A total of 1258 boy pupils were studied. An anonymous self-completion questionnaire was used. The questionnaire included 15 questions (3 open questions and 12 close questions) about sociodemographic information, smoking information, and possible health disorders associated with smoking. Results: The present study had shown that the prevalence of smoking habits both (12.1% cigarette and 2.3% shisha) increased with age, class grade, and broader school environment. Both cigarette and shisha smoking produce various health disorders among schools' pupils. The results indicate that dry cough more frequent among shisha smoking pupils which was statistically highly significant (P < 0.001).

Conclusions: Age, school grade of pupils and broader school environment play the major rule in the increasing prevalence of smoking among pupils, both cigarette and shisha smoking had hazardous effect on pupils' health.

Background: Penetrating Neck Injuries (PNI) management represents a challenge to most surgeons in civilian trauma, in weighing selective versus mandatory exploration of all cases in different circumstances. Data are encouraging surgeons to adopt the former approach.Objectives: The study aims to assess the selective approach in our war and terror time events in Al-Yarmouk teaching hospital.Type of the study:A retrospective study. Methods: Data of patients presented to the Thoracic and Vascular ward in Al-Yarmouk teaching hospital with PNI were assessed retrospectively, from March 2013 to March 2015, and analyzed for epidemiology, mechanism of trauma, management methods, associated organ injuries, complications and mortality. Results: Among 83 patients (76 males and 7 females) who presented with PNI, the mean age was 28.5±15 years with a peak incidence in third decade. Shell injury (52.2%) was the most common mechanism and zone II was the most frequently injured (49.4%). Therapeutic exploration of neck in 82% of the cases, a decision of surgical exploration (87%) patients. Vascular injuries were the most identified neck structures (39.5%). Chest injuries (35%) were the most common associated injuries identified in patients who had additional anatomic region injury (41%) beside PNI. Complication rate of 18% and infection (26.6%) were most common and mortality rate was 8%. Conclusions: Still the selective approach is preferable in management of PNI in our war and terror time circumstances and limited resources of country.

Background: the difference in expression of type IV collagen in borderline tumors and ovarian carcinomas has been studied, but the association with adhesion molecules like CD44 have not gain enough interest. Objectives: The purpose of this study is to assess the expression of CD44v6 and type IV collagen status in borderline tumors and invasive ovarian carcinomas and the correlation between them to define the role of these molecules in tumor invasion and metastasis. Type of the study: A cross sectional study Methods: The study included a total of (101) formalin-fixed paraffin-embedded ovarian tissue blocks; of which (19) cases were borderline tumors and (82) cases were overt ovarian carcinomas. Sections from each block were immunohistochemically stained for CD44v6 and type IV collagen. Results: CD44v6 was significantly correlated with FIGO stage of borderline tumors (p=0.001) and ovarian carcinoma (<0.001) and with histological grade of ovarian carcinomas (p=0.004). There was significantly higher expression of type IV collagen in borderline tumors compared to invasive carcinoma(p<0.001) this significance was also seen in correlation to age, stage and grade of the invasive carcinoma, no significant differences in other clinicopathological features were found. There was negative correlation between CD44 v6 & type IV collagen which was statistically significance (P<0.05) in carcinoma but not in borderline tumors. Conclusions: Our data suggest that observed inverse correlation of type IV collagen expression with CD44v6 positivity in surface epithelial tumors indicates that these molecules may cooperate in the invasion and progression of ovarian carcinomas.

Background: Data on the impact of neonatal and total pediatric admissions volume on neonatal mortality are sparse. Objectives: This study is done to estimate the neonatal mortality in relation to neonatal admissions and to total hospital admissions in Al-Alwyia Pediatric Teaching Hospital through years 2005-2012 Type of the study: A retrospective study.Methods: statistical records of all cases admitted to APTH were studied during 2005-2012.Results: Neonatal mortality decreased to the nadir at last year of study period (2012) and reached 6.1% of neonatal admissions compared to 2005 level which was 9.7 %. Mortality rate among premature and low birth weight (LBW) infants decreased also. The study also reveals that neonatal mortality constitute significant a contribution to childhood mortality (61.4 %) and morbidity (28.3%) throughout the study years. With a highly significant p value parallel to increasing number of neonatal admissions (case over load) , there is a trend of neonatal mortality rate to be decreased Case fatality rate also decreased among overall children to 3.5% in 2005 and to 3.3% in 2013 in spite of 2.4 times increase in neonatal admission during the study period.This neonatal overload is more than overall pediatric over load, because the total hospital admissions are increased just 1.2 times.Conclusions: The neonatal admissions case overload is high and increasing and constitutes a significant proportion of total childhood mortality. Neonatal mortality including premature and (LBW) infants is decreasing .Further actions are needed to meet global goals.

Background: Avascular necrosis (AVN) is defined as cellular death of bone components due to interruption of the blood supply; the bone structures then collapse, resulting in bone destruction, pain, and loss of joint function. AVN is associated with numerous conditions and usually involves the epiphysis of long bones, such as the femoral head. In clinical practice, AVN is most commonly encountered in the hip. Early diagnosis and appropriate intervention can delay the need for joint replacement. However, most patients present late in the disease course. Without treatment, the process is almost always progressive, leading to joint destruction within 5 years.Treatment of a vascular necrosis depends mainly on early diagnosis which mainly based on clinical findings, x-ray finding & MRI.A variety of non vascularized bone grafting techniques have been proposed with varying degrees of success as treatment alternatives for osteonecrosis of the femoral head. The success of these procedures may be enhanced using ancillary growth and differentiation factors. Objectives: To treat non traumatic hip osteonecrosis by non vascularized bone graft versus core decompression. Type of the study: A retrospective study. Methods: We retrospectively reviewed 72 patients (88 hips) with osteonecrosis of the femoral head between May 2009, and March 2014,divided into two groups . Group A include 34 patients (44 hips) with osteonecrosis of the femoral head who had non vascularized bone grafting procedures done for them . Minimum follow-up was 12 months. We compared the outcomes in this cohort to similar hip number (44 hips) in 40 patients treated with core decompression only (group B). We used Phemister technique to make a window at the posterior aspect of greater trochanter to remove necrotic bone and packed the excavated area with autogenous cancellous bone graft taken from ipsilateral iliac crest or leave it without bone graft (decompression only). Results: We report the result of treatment for femoral head avascular necrosis depending on Ficat classification stage I, II, & III. The minimum follow up was 12 months (12m-36m). The success percentage of hips in our cohort of patients with non vascularized bone grafting group A are 86% (38 of 44 hips), which is higher than group B 63% (28 of 44 hips) with core decompression alone. Conclusions: These procedures core decompression and autogenous cancellous bone graft may defer joint arthroplasty in selected patients & it is more effective than core decompression alone in treating early stages of femoral head osteonecrosis.

Background: Expectoration of blood that originated in the lungs or bronchial tubes is a frightening symptom for patients and often is a manifestation of significant and possibly dangerous underlying disease. Tuberculosis was and still one of the common causes followed by bronchiactasis , bronchitis, and lung cancer. Objectives: The aim of this study is to find the frequency of causes of respiratory tract bleeding in 100 patients attending alkindy teaching hospital.Type of the study: : Prospective descriptive observational study Methods of a group of patients consist of one hundred consecutive adult patients, with Lower respiratory tract bleeding are studied. History, physical examination, and a group of selected investigations performed, including complete blood examination and blood film, PT, PTT, sputum direct gram and AFB stain, cytology ,chest radiography, CT scan, and bronchoscopy when indicated.Results: pulmonary tuberculosis, acute bronchitis, lung carcinoma, and bronchectiasis are the major causes of hemoptysis in our study with 27%, 23%, 23%, 20% respectively. Of the included patients 63% were males, specially age 41-60, while 37% were females. The primary malignancy is more common than secondary cancer, and that squamous cell carcinoma, and adenocarcioma, are the most common.Conclusions: Tuberculosis is the main cause of lower respiratory tract bleeding, followed by lung carcinoma bronchitis, and bronchiactesis. Most of the patients are males and in middle age , sever bleeding is not common and squamous cell carcinoma is commonest cause regarding malignancies followed by adeno carcinoma

Background: Multiple sclerosis is a chronic autoimmune inflammatory demyelinating disease of the central nervous system of unknown etiology. Different techniques and magnetic resonance image sequences are widely used and compared to each other to improve the detection of multiple sclerosis lesions in the spinal cord. Objective: To evaluate the ability of MRI short tau inversion recovery sequences in improvementof multiple sclerosis spinal cord lesion detection when compared to T2 weighted image sequences. Type of the study: A retrospective study. Methods: this study conducted from 15thAugust 2013 to 30thJune 2014 at Baghdad teaching hospital. 22 clinically definite MS patients with clinical features suggestive of spinal cord involvement, patients were imaged with sagittal short tau inversion recovery sequences and sagittal T2 weighted. Results: The mean age of the patients was 32.5 ± 6.7years; female to male ratio was 2.7:1. The total number of spinal cord MS lesions was 44 of them 86.4% in the cervical spine, 68.2%of the lesions had less than one vertebra extension,79.6% of the lesions did not show changes in the spinal cord morphology. There was a significant upgrading in the lesions conspicuity at short tau inversion recovery sequence comparing to T2 weighted image, P<0.001. A significant difference had been found in artifact grading between both sequences; P<0.001. Conclusions: short tau inversion recovery magnetic resonance image sequences improve detection of MS spinal cord plaques compared with T2 weighted image and itincreasesthe conspicuity of the visualized T2weighted image lesions, but also it accentuates theartifacts more than T2weighted image.

Background: Fractures of patella constitute 1% of all fractures. Various techniques have been described for internal fixation of patella fractures. Superiority of one technique over the other has long been debated. Objective: We reviewed a series of seventy patients with transverse or comminuted fractures of patella treated with cerclage and tension band wiring technique to assess if it had any advantages over k. wires and tension band wiring technique. Type of the study: Retrospective study. Methods; Seventy patients with displaced patella fracture, with a mean age of 47 years (range 13-75) were divided into two groups :group A 36 patients were treated with cerclage and tension bands technique ,and group B 34 patients were fixed by 2 K. wires and tension bands technique. Clinical outcome was assessed using the system of Bostman score. Range of motion and evidence of radiological union were assessed at regular follow-ups. Results; All patients in group A gained Excellent result and good result, while only one patient gained poor result in group B . One patient (2.8%) developed superficial infection in group A and three patients( 8.8% ) developed superficial infection in group B. All fractures had united at the end of 10 weeks. Twenty two patients (31.4%) underwent a second surgery for wire removal; 5 cases in group A ( 13.9 % ) two of them due to implant related complications and 15 ( 44.1%) patients for group B mainly due to pain and interference with daily activity. Malunion or non-union was not noted in any of the cases. . Conclusion; The advantages of the cerclage and tension bands technique for fixation of displaced patella fracture are early mobilization, elimination of k-wire related complications, and ease of use in comminuted fracture pattern as well and a lower reoperation rates as compared to other method of fixation by 2 K. wires and tension bands technique. We strongly recommend its use in cases of displaced comminuted transverse fractures of patella .

Background: Thyroid surgery is most common endocrine surgery in general surgical practice. Objectives: the aim of this work is to evaluate the feasibility, benefits and outcomes of open mini-incision thyroidectomy and compared the results with that of conventional thyroidectomy. The comparison between the two groups was in term of incision length, amount of blood loss, time of operation, postoperative pain, hospital stay and the cosmetic outcomes.Type of the study: this is a single-blinded randomized controlled studyMethods: This study compared the advantages and outcomes of 22 patients subjected to mini-incision thyroidectomy (Group A) with the equal numbers of patients subjected to conventional thyroidectomy (Group B).Results: the operative time was statistically longer in minithyroidectomy than with conventional thyroidectomy. Postoperative pain score in the operative day and 24 hours postoperatively showed a significant difference in favor of mini-incision thyroidectomy. The cosmetic outcome and patients satisfaction was significantly and far better in minithyroidectomy group. The results between both groups were comparable regarding the postoperative complications. The hospital stay was shorter in the mini-incision group than in conventional group but the difference was not significant.Conclusions: mini-incision thyroidectomy is simple, safe and practical procedure that achieves the same results and the rate complications to the conventional thyroidectomy with less post operative pain and better aesthetic results. It is easily converted to conventional technique when necessary without added risks .

Background: Guillain Barré syndrome is an acute inflammatory demyelinating disease of the peripheral nerves. Its synonyms are: acute inflammatory demyelinating polyradiculoneuropathy, idiopathic polyneuritis, acute infective polyneuropathy and post infections polyneuritis. Objectives: We attempt to study the clinical presentations and complications in patients with GBS who were admitted to children welfare Teaching Hospital and to compare the results with the other studies.Type of the study: A retrospective study.Methods: A study done on seventy patients with GBS who were admitted to children Welfare Teaching Hospital in Medical City-Baghdad from different parts of Iraq between January 2002-December 2006.Results: Forty (57.14%) of them were males and 30(42.86%) were females, a male to female ratio 1.33:1. There were more cases during winter months. Antecedent events were found in 44 patients (62.86%),26 patients (37.14%) had no history of antecedent events. It was found that 24 patients (34.3%) had only bilateral lower limbs weakness and 46 patients (65.7%) had both bilateral lower and upper limbs weakness. Sensory manifestations occurred in 35 patients (50%). Cranial nerves involvement was observed in 25 patients (35.7%). Autonomic nerves involvement was observed in 9 patients (12.9%). Respiratory muscles were involved in 20 patients (28.6%), 11 patients (15.7%) were admitted to the RCU and needed ventilator setting, 3 patients (4.28%) died in RCU. The results were compared with similar studies from other parts of the world.Conclusions: This study showed that there is no specific pattern of motor weakness involvement and all cases show symmetrical muscle weakness.Bulbar nerves (glossopharyngeal and vagus nerves) involvement is the commonest cranial nerve involvements.Autonomic nerves involvement and respiratory muscles involvement are the main cause of death in GBS. GBS patients should be admitted to the hospital and RCU with ventilator setting should be available along with well trained medical staff. Because the disease may run a prolonged course, we recommend close follow up of the patient to see the end result at that time.

Background: Obesity is a worldwide challenge and is closely
connected to many metabolic diseases. Two types of
adipose tissue, white adipose tissue (WAT) and brown
adipose tissue (BAT) have been identified. White fat cells
store chemical energy, brown adipocytes defend against
hypothermia, obesity and diabetes.
Objective: To localize and quantify brown adipocytes in
human subcutaneous (S) and visceral (V) adipose tissue by
histology and immunohistochemistry.
Type of the study: A cross –sectional study.
Methods: Adipose tissue was obtained from histopathology
specimens taken from ten patients, of different age, sex and
body mass index (BMI), undergoing surgery for different
pathologies. Immunohistochemistry for detection of UCP
(Uncoupling Protein) in S and V adipose tissue depots was
performed, and percentage of the positive pixels for UCP
color intensity was measured and statistical analysis
performed.data was expressed as mean ± standard
deviation (SD) and analyzed using student t-test to compare
values

Background: Gray-scale sonography is generally
considered as a first-line diagnostic tool for patient with
suspected acute cholecystitis. It is suggested by gallstones,
Murphy's sign, thickening of the gallbladder wall and bile
sludging, but the specificity of these sonographic findings
are not as high as their sensitivity. Blood flow of the
gallbladder wall is increased in acute inflammation.
Objective: To evaluate the sensitivity and specificity of
power Doppler sonography and compared with conventional
color Doppler and gray-scale sonography in diagnosing
patients with acute cholecystitis.
Type of the study: This was a cross sectional study.
Patients and methods: The study was conducted through
the period from August 2014 to August 2015 on 80 patients
with acute right upper quadrant abdominal pain and
clinically suspected acute cholecystitis. Firstly, gray-scale
sonography of the abdomen was performed. Next, color
Doppler and power Doppler sonography of the gallblader
wall was done to detect mural flow. Quantifying intramural
vascularity was performed using Uggowitzer scoring
system. Grading of vascularity ++ and +++ were suggestive
of acute cholecystitis. Results of gray-scale and Doppler
sonography were compared with post cholecystectomy
histopathological results.

Background: Thrombasthenia is an inherited genetic disorder affecting platelets, which is characterized by spontaneous muco-cutaneous bleeding and abnormally prolonged bleeding in response to injury or trauma. Objectives: The aim of this study was to assess the diagnosis and treatment of thrombasthenia in Children Welfare Teaching Hospital. Type of the study: A cross-sectional study. Methods: This descriptive study was performed on 66 patients with thrombasthenia from the first of October 2013 till the first of July 2015.The diagnosis of the disease was done by a wide spectrum of characteristics including family history, clinical manifestations, laboratory tests.. Results: The common manifestations of the disease at time of diagnosis were epistaxis in 23 patients (34.8%) and gum bleeding in 22 patients (33.3%) .Mostly established at age 1-10years.Family history was positive in most patients.hepatitis C was rare in our patients after platelet transfutions. Conclusions: : It is a rare hemorrhagic disease in our center, mostly presented as minor bleeding involving mainly mucocutaneous regions which appears at an early childhood with positive family history in most cases

Background: Radial neck fractures in children account for 5 to 10% of all elbow fractures in children. They are extra-articular fractures of the radius proximal to the bicipital tuberosity. The physis is typically involved as a Salter-Harris I or II pattern. Alternatively, the fracture sometimes is extraphyseal, through the metaphysis. In children there is considerable potential for remodeling after these fractures. Up to 30° of radial head tilt and up to 3 mm of transverse displacement are acceptable. Many modalities of treatment are available regarding Surgical &Non-Surgical treatments. Objectives: To evaluate the functional outcome after surgical percutaneous joystick reduction therapy of severely angulated radial neck fracture in children. Type of the study: A prospective study. Methods: During the period between February/2012 and May/2015, we made a prospective study of (18) patients suffered from O′Brien type II&III radial neck fracture with severe angulation that require surgery seen at Al-Kindy Teaching Hospitals. However, we select a group of children who had more than 30° of Radial head angulation really cannot treated by conservative method. Angulated radial neck fractures in children reduced with a percutaneous Kirschner wire. We select of surgical procedure after failure of thumbing intraoperatively. The primary indication for surgery was changing type II&III to typeI which can go on in manage conservatively. Results: All the (18) patients treated with percutaneous pinning techniques were followed-up, clinically and radiographically evaluated pre-surgery, post-surgery and finally (6) months after surgery. The mean angulation of the fractures was 64° (30° - 90°) before reduction and 10°(0° - 22°) after reduction. Mean fracture displacement after reduction in all cases was less than 3 mm. Range of Motion (ROM) in flexion, extension, pronation and supination was the functional parameter in our study as graded by (the grading system of Steele). We obtained an outcome of excellent results in 15 patient (83%), good results in 3 patients (17%) and we have no fair or poor results. Conclusions Percutaneous Joystick Reduction Techniqueusing K-wire in children with radial neck fractures is a safe, short, easy procedure requires only good technical measures, minimally invasive in nature with minimal hospitalization time, has a minimal morbidity and complication rates, it is recommended surgical treatment that can achieve recovery of normal radial neck angulation, elbow motion and yielding excellent results.

Background: DVT is a very common problem with a very serious complications like pulmonary embolism (PE) which carries a high mortality,and many other chronic and annoying complications ( like chronic DVT, post-phlebitic syndrome, and chronic venous insufficiency) ,and it has many risk factors that affect its course, severity ,and response to treatment. Objectives: Most of those risk factors are modifiable, and a better understanding of the relationships between them can be beneficial for better assessment for liable pfatients , prevention of disease, and the effectiveness of our treatment modalities. Male to female ratio was nearly equal , so we didn’t discuss the gender among other risk factors. Type of the study:A cross- sectional study.Methods: Data taken from 114 patients with DVT were analyzed by association rules mining.Immobility was the most important risk factor. Results: Smoking add more risk to immobile, post operative patient. Age per se has no effect.100% of patients with long bone fracture, were immobile. Fever occurred in one third of post operative patients who develop DVT. Conclusions: Association rules mining allow better and faster analysis of more data with an interactive powerful system, which saves time and effort, and discovers the relations among many factors to one or more than one factors. So, we use this method for analysis in this study, and we get the above mentioned relations, which are important for the future management of DVT.

Background: Energy drinks are non alcoholic beverages which contain stimulant drugs chiefly caffeine and marketed as mental and physical stimulators. Consumption of energy drinks is popular practice among college students as they are exposed to academic stress. Caffeine which is the main constituent of energy drinks could become an addictive substance or cause intoxication. Objectives: This study aims to assess the prevalence of energy drinks consumption among medical students of alkindy college of Medicine.Type of the study: A cross sectional study.Methods: It was performed at alkindy medical college on March 2016. A total number of 600 students were contacted to participate in this study. A self administered questionnaire was used to collect the data. Spss version 18.0 was used for statistical analysis.Results: Out of 600 students, 501 (83.5%) participated in the study. The majority were females 304 (60.7%) and only 197 (39.3%) were males with a mean age of (20.43 ± 1.74). 120 (24%) of participants had consumed energy drinks at least once. Higher proportion of male students 77 (64%) consumed energy drinks compared to females 43 (36%). Regarding inspiration of first use of energy drinks, the highest percentage 9.8% was due to friends. Majority of consumers 85 (17.2%) used energy drinks irregularly. The main cause of energy drinks consumption was focusing for studying 7.2% (n=36). Conclusions: Energy drinks consumption is a common practice among medical students. Friends had a strong influence on usage of energy drinks. Students consumed energy drinks mainly for focusing for studying. Further studies are recommended to evaluate factors involved in consumption of these drinks among medical students and their understanding of the risks involved as well as possible interventions to promote safe consumption

Background: Asthma is a common chronic disease in children in which the body’s airways swell, preventing the lungs from filling with air, there are many different inflammatory cells involved in asthma which can synthesize and release cytokines which are recognized to be important in chronic inflammation and play a critical role in the inflammatory response. Objectives: to assess the local effect of ICS on oral tissue by measuring Interlukine-12 level and Candida albicans colony in saliva among12 year's old asthmatic children who were collected from AL- Zahra Center Advisory for Allergy and Asthma, and compares them with non-asthmatic children of the same age and gender.Type of the study: Cross –sectional study.Methods: The total sample composed of 60 children 30 asthmatic children who received medium dose of ICS/day for two years and thirty non-asthmatic children. The unstimulated saliva was collected under standard condition and then analyzed for assessment of IL-12 level and Candida albicans colony. Results: Among asthmatic and non- asthmatic children; the mean rank of salivary IL-12 was found to be higher among C. albicans carrier group than without C.albicans with statistically highly significant difference (P< 0.01). Concerning each gender the same findings were recorded. Concerning IL-12 + and IL-12-, results reported that the mean rank differences were found statistically non-significant difference (P>0.05). Concerning each gender the same results were reported. Concerning gender differences, data analysis showed that there were no statistically significant differences. The results illustrated that the mean rank of salivary IL-12 was found to be higher among asthmatic than non- asthmatic children with statistically significant difference (P=0.016). Concerning each gender, similar results were recorded as the difference was not significant (P>0.05). For C.albicans carrier asthmatic and non- asthmatic children and total asthmatic and non- asthmatic children, the relation between the IL-12 concentration and C.albicans quantities were strong highly significant in positive directionConclusions: The findings of the present study showed that the asthmatic disease and oral candida colonization play an important role in elevation of the IL-12 level in saliva.

Background: Joubert syndrome (JS) is a very rare autosomal recessive disorder characterized by agenesis of cerebellar vermis, abnormal eye movements, respiratory irregularities, and delayed generalized motor development. Retinal dystrophy and cystic kidneys may also be associated with this clinical syndrome. The importance of recognizing JS is related to the outcome and its potential complications. This syndrome is difficult to diagnose clinically because of its variable phenotype. Its neuroimaging hallmarks include the characteristic molar tooth sign and bat wing-shaped fourth ventricle