Al-Kindy College Medical Journal

Background:The referral system constitutes a key element of health system. Effective referral system between different levels of health care delivery represents a cornerstone in addressing patients’ health needs.

Objectives:To assess the referral system Baghdad/ Al-Rusafa Health Directorate by evaluation the referral pattern and identify the quality of the referral letters and feedback reports.

Type of the study: This cross-sectional study .

Methodology : It was conducted in5PHCC in from 1st July 2015 - 31st December 2015 at Bagdad/Al-Rusafa health directorate. The study population (sampled population) included all referrals in six months. Data were entered and analyzed by using the statistical package for social science (SPSS) software version 17 for windows .

Results: The referral rate was 2.85% .The variables of the referral letter (such as age, gender of the referred patient)were present, while the indication for referral(3.3%), result of investigation done in PHCC (4.67%), initial diagnosis (5.86%), however, the name of physician and signature were not mentioned or specified in 70% of the referral letters. The rate of feedback reports received by PHCCs was 19% of total number of referrals to the hospitals. The referral rate was (2.8%) from total number of patients seen in PHCCs.However, the quality of referral letters and feedback reports was poor in 69.5% and 78.5% respectively.

Conclusion: In this study there was a low referral percentage and low feedback report in five PHCCs of Baghdad/ Al-Rusafa health directorate compared to international literature.The quality of referral letters and feedback reports is poor and contained inadequate information and lacking important and relevant items in majority of referral needs to be improved

Key words: Referral ,Feedback report , primary health care centers(PHCCs)



Background:The referral system constitutes a key element of health system. Effective referral system between different levels of health care delivery represents a cornerstone in addressing patients’ health needs.

Objectives:To assess the referral system Baghdad/ Al-Rusafa Health Directorate by evaluation the referral pattern and identify the quality of the referral letters and feedback reports.

Type of the study: This cross-sectional study .

Methodology : It was conducted in5PHCC in from 1st July 2015 - 31st December 2015 at Bagdad/Al-Rusafa health directorate. The study population (sampled population) included all referrals in six months. Data were entered and analyzed by using the statistical package for social science (SPSS) software version 17 for windows .

Results: The referral rate was 2.85% .The variables of the referral letter (such as age, gender of the referred patient)were present, while the indication for referral(3.3%), result of investigation done in PHCC (4.67%), initial diagnosis (5.86%), however, the name of physician and signature were not mentioned or specified in 70% of the referral letters. The rate of feedback reports received by PHCCs was 19% of total number of referrals to the hospitals. The referral rate was (2.8%) from total number of patients seen in PHCCs.However, the quality of referral letters and feedback reports was poor in 69.5% and 78.5% respectively.

Conclusion: In this study there was a low referral percentage and low feedback report in five PHCCs of Baghdad/ Al-Rusafa health directorate compared to international literature.The quality of referral letters and feedback reports is poor and contained inadequate information and lacking important and relevant items in majority of referral needs to be improved

Background: Joint hypermobility was first mentioned by Hippocrates as an isolated feature, when he described the Celts' Incapacity to Pull a Bowstring or Throw a Dart, Due to The Slackness of Their Limbs

Objective: to determine the prevalence of mitral valve prolapse(MVP)in patients with benign hypermobility syndrome (BJHS).

Type of the study: Cross –sectional study.

Methods: Ninety patients with BJHS were included in this study. Full cardiological assessment was done for all of them, which include clinical examination, electrocardiography and echocardiography. Cardiac assessment was done for another sixty age and sex matched (normal mobile) Individuals served as a control group. Statistical analysis was done by using T test or chi square as indicated.

Results: Among 90 patients with BJHS, MVP was reported in 26 patients (28.9%) compared to four individuals (6.7%)of the control group on modern echocardiography studies (P=0.013).

Conclusions: the prevalence of MVP was significantly higher among patients with BJHS compared to normal mobile individuals.

Background: The stethoscope is a tool that doctors use daily in the examination of patients and it can take part in the transmission of health care-associated infections. In a single day it may come in direct contact with multiple patients and the intra hospital environment may be contaminated by various type of bacteria and possibly transmit to others.

Objective:- The study was to know the attitude and knowledge about the stethoscope hygiene behavior among physicians and to determine the types of bacterial agents that can contaminate stethoscopes.

Type of the study: The study was a cross-sectional study

Methods:- It was conducted from 1st of July to end of October 2014 at AL-Emmamain Alkadhomain Medical City in which a convenient sample of 150 physicians were included. A semi constructed questionnaire was used to collect demographic data and hygiene practice among participants. Specimen was collected using moisten sterile cotton swab and then cultured following standard microbiological techniques.

The results:- showed a total of 121 (80.6%) of the stethoscopes had bacterial contamination only 29(19.40%) had negative cultures. There is statistically significant association between stethoscope contamination and frequency of cleaning it. Of the studied group only 26 subjects (17.3%) received education regarding stethoscope cleaning.

Conclusion:-There was evidence that bacteria can transfer from the skin of the patient to the stethoscope and from the stethoscope to the skin and there was poor education and assessing cleaning practices of stethoscopes.

Background:The effects of contraception on Trichomonas vaginalis have important implications for women who suffer from infections associated with disruptions in the vaginal ecology, such as bacterial vaginitis and urinary tract infections.

Objective: To find the association of the common types of contraceptions with the Trichomonasvaginalis infection in women admitted to the Al-BatoolTeaching Hospital for Maternity and Children in Baqubah city.

Type of study: Cross-sectional study

Methods: This study consist of 75 women with contraception use and71 apparently healthy non contraception user women admitted to outpatient in Al-Batool Teaching Hospital for Maternity and Children in Baqubah City, Diyala. Iraq during the period from 1st January 2016 till 31th December 2016. After full history and clinical examination, high vaginal swab took from posterior fornix of vagina and general urine examination, all samples were examined by wet mount preparation under the microscope for the presence of Trichomonas vaginalis and gram-stained smears for the presence of Candida albicans, then all results were recorded.

Results:. Minimum age was 18 year and maximum was 47 year, infection rate of Trichomonas vaginalis was 41(45.66%) among contraception user and 6(8.45%) among contraception non- user while Candida albicans was 18(24%) and 1(1.40%) respectively, the highest frequency of infection 23 cases was diagnosed in the age group (29-39 year) among contraception user while 4 cases in age group (18-28) contraception non-user. On the other hand there was no significant correlation between age, parity, duration of marriage and infection and using of contraception. Marginal significant correlation between the type of contraception and infection with Trichomonas vaginalis. While no significant correlation between types of contraception, infection and duration of contraception use.

Conclusion: Infection with Trichomonas vaginalis significantly correlated to use of intrauterine contraceptive device and combined oral contraceptive pills, so great attention should be paid to those women for diagnosis and treatment.

Background: Pervasive Developmental Disorder (PDD) is a term refers to the overarching group of conditions to which autism spectrum disorder (ASD) belongs .

Objective: This study was designed to determine the existing behavior of children with autism in dental sitting, the behavior improvements in recall dental visits and evaluate the improvement in oral hygiene with using specific visual pedagogy chart.

Type of the study: Cross-sectional study.

Methods: Forty children of both genders, ages ranged from 4 – 6 years having primary teeth only were selected whose medical history included a diagnosis of autism. The behavior of the children in dental sitting were assessed according to the Frankel scale. The dmft index in the first visit was measured, with codes and criteria established by the WHO(1997).Behavior management method used was one or more of the followings: (physical restraint, "Tell-Show-Feel and Do" technique, verbal and non – verbal communication, reinforcement, parent present / absent).

Results: The samples represent by 22 males and 18 females autistic children with no statically significant difference (p> 0.05).The dmft index of autistic children in the first visit. The dmft (mean ± SD) for males was (7.818 ± 0.98) while for females was (6.922 ± 1.09).The frequency of children showed treatment acceptance without difficulty was increase in the recall visits.

Conclusions: The dental professional should be flexible to modify the treatment approach according to the individual patient needs.

Background: The use of minerals in treatment of different diseases is as old as man himself. zinc is the most famous trace mineral related to male sexual function. Oligoasthenozoospermic subfertile patients were treated with zinc sulphate for three months.

Objectives: Aim of the research is to investigate the role of Zinc and if it affects the abnormalities of some semen parameters and to study the possible role of pharmaceutical preperations of zinc in amelioration of male subfertility as well as to assess the ability of Zinc to induce changes in the serum and semen zinc levels in addition to the levels of reproductive hormones (FSH and Testosterone).

Type of the study: The study is a single group pretest-posttest experimental prospective comparative self-control; clinical trial research.

Methods: The patients were tested before and after the treatment for semen analysis via Computerized Assisted Semen Analysis (CASA) dynamic analysis report I and II as well as for FSH and Testosterone hormonal levels, serum and semen zinc levels .

Results: Zinc administration induced a significant increase(p≤0.001) in FSH, Testosterone, serum and semen zinc level as well as in the total and progressive sperm motility percentages .

Conclusions: Zinc administration induced significant changes (p≤0.001) towards improvement in the total and progressive sperm motility percentages in oligoasthenozoospermic patients by CASA dynamic analysis report I and II.

Background:Amino acid disorders are a major group of inborn error metabolism (IEM) with variable clinical presentation; its diagnosis constitutes a real challenge in a community with high consanguinity rate and no systematic newborn screening.

Objectives: to provide data about amino acid disorders detected in high-risk Iraqi children by using quantitative amino acid fluorescent high performance liquid chromatography (HPLC) analysis.

Type of the study: Cross-sectional study.

Methods: a descriptive cross sectional study from 1st February to 1st December 2014, at Neurological ward and clinic of the Children Welfare teaching Hospital, in Baghdad - Iraq. Plasma specimens of 500 patients, with clinical suspicion of inborn error of metabolism (IEM) because of unexplained neurological deficits, unexplained developmental delay, recurrent coma and/or Neuro-degeneration, hair changes and/or lethargy, poor feeding, vomiting and selected cases of autistic spectrum syndrome or with positive screening, were analyzed for amino acids by high performance liquid chromatography (HPLC). The amino acid disorders were confirmed in fifty patients were; clinical data of patients were reported and analyzed statistically.

Results: out of 500 patients visiting the neurological outpatient and ward, clinical and neurological finding were recorded as well as the family history and/or other symptoms suggestive of aminoacidopathy, Sixty patients were confirmed their diagnosis as amino acid disorders, ten patients were excluded because they lost the follow up or there is no solid base for a causal relationship between detected abnormal amino acids and neurological disorders, therefore only 50 patients were



enrolled in the study. Patients with Phenylketonuria were the most frequent 24 (48%), homocystinuria 14 (28%), maple syrup urine disease 9 (18%) & other amino acid disorder, (Citrullinemia, non-ketotic hyperglycinemia & Tyrosinemia) 1for each disorder (2%). Considerable delay in diagnosis was noticed which lead to variable neurological abnormalities in most patients and the psychomotor delay was the main clinical presentation at time of diagnosis 34 (68%).

Conclusion: in the absence of newborn screening, the majority of Aminoacidopathies cases was still diagnosed clinically, but delayed. The importance of clinical awareness and accurate biochemical analysis were the key tools for diagnosis and the necessity for a comprehensive national newborn screening program.

Background: Hip fractures are common, morbid, and costly health events that threaten independence and function of older patients . Early functional recovery is extremely important for elderly patients with femoral intertrochanteric fractures to shorten their hospital stay, omit the necessity of the further nursing and care services, and reduce associated medical expenditures . Assessment of (ADL) is an important predictor of outcomes Of orthopedic surgery in very early postoperative period at two weeks and a month postoperatively using Japanese orthopedic score get a quick recovery of ADL & return the patient to his or her premorbid level function reducing the morbidity and mortality.

Objectives: We evaluate in our study the Return of ADL function in 27 cases of elderly with intertrochanteric hip fractures treated with closed reduction and surgical fixation with proximal femoral nail anti rotation in very early postoperative period at two weeks and a month postoperatively.

Type of the study : Prospective observational stud

Methods: Prospective observational study of 27 consecutively patients with an intertrochanteric fracture Stable and unstable fractures treated between December 2015 and Augest 2016 were enrolled in study.

Results: Regain in a walking ability and daily living activities which indicate a fast recovery in early days and weeks after surgery in contrary the regular fellow up a month up to 3 month revealed a slower recovery from that achieved in early weeks

Conclusions: Use of proximal femoral nailing in intertrochanteric elderly osteoporostic fracture has a significant impact on early functional recovery

Background: Migraine is common in systemic lupus erythematosus.It is a significant source of patient disability.

Objective: To determine the rate of migraine in patients with systemic lupus erythematosus, to assess migraine type, severity, and the association between migraine and patient’s characteristics.

Type of the study: Cross-sectional study.

Methods: 100 subjected were recruited and divided into two groups; fifty patients with the diagnosis of systemic lupus erythematosus were recruited from the Rheumatologic department of medicine,and another 50 normal subjects, then complete medical and drugs history were taken from them.

Results: Fifty patients completed the questionnaire. Thirty percent of systemic lupus erythematosus patients and 12% of normal subjects had migraine. Of the patients with migraine 80%, 13.3% and 6.7% met criteria for migraine without aura, migraine with aura and retinal migraine respectively. The moderately severe migraine was commonly observed (53.3%). There were significant associations between migraine and systemic lupus erythematosus patients who have Raynaud’s phenomenon, and cardiolipin antibodies.There were no statistically significant associations between migraine, systemic lupus erythematosus duration and patient’s age,sex, and anti-dsDNA.

Conclusions:A high rate of migraine in patients with systemic lupus erythematosus.Migraine associated with Raynaud’s phenomenon, and cardiolipin antibodies.

Background: Significant numbers of patients with spinal tuberculosis (TB), especially in developing countries, still present late after disease onset with severe neurological deficits.

Objective:This study was conducted to assess the outcome of surgery in patients with tuberculosis of the spine with motor deficits.

Type of the study: Retrospective study.

Methods: We retrospectively analyzed data obtained in all the patients with severe motor deficits due to spinal TB admitted to and surgically treated in four hospitals in Baghdad/Iraq during the period from January 2012 to January 2014. History, examination, imaging, histological, postoperative, and follow-up data were retrospectively culled from hospitals records and then analyzed. Data obtained in 48 patients with 6-24 months of follow up (mean follow-up period 12.8 months) were analyzed. The disease in 34 patients was characterized by Frankel Grade A/B and in 14 patients by Frankel Grade C at admission.

Results: Thirty (88%) of the 34 patients with Frankel Grade A/B status and 13 (92.8%) of the 14 patients with Frankel Grade C status at admission experienced improvement to Frankel Grade D/E (walking with or without support) at the last follow-up examination after surgery. The degree of improvement exhibited by patients with a Frankel Grade A/B spinal cord injury was comparable to that shown by patients with Frankel Grade C status. Even patients with flaccid paraplegia, gross sensory deficit, prolonged weakness, spinal cord signal changes demonstrated on magnetic resonance imaging, and bladder involvement have experienced dramatic improvement in motor function since surgery. A significant number of the patients have shown remarkable improvement in other symptoms such as pain (91.6%), spasticity (88%), and bladder symptoms (88%).

Conclusions: A significant proportion of patients with spinal TB and severe motor deficits experience remarkable improvement after surgical decompression and hence should undergo surgery even though they may be suffering from paraplegia of considerable duration

Background: Diabetes mellitus is a common health problem of the world. Iron may be a part of the cause of the disease and its Complications

Objectives: This study was designed to determine the relationship between the levels of iron indices and diabetes mellitus type 2. Type 2

Type of the study: Cross –sectional study.

Methods: diabetes mellitus is clinical condition characterized by hyperglycemia due to the absolute or relative deficiency of insulin. It is also followed by pathological abnormalities like impaired insulin secretion, peripheral insulin resistance, and excessive hepatic glucose production. Although type 2 diabetes mellitus is a multiple etiological disease, emerging scientific evidences show there is somewhat related to the disease with iron metabolism

Results: The study includes thirteen (15 female and 15 male) patient with Diabetes mellitus and (15 male and 15 female ) as the control. In the present study, significantly increased (p < 0.05) At ferretin , iron, transferitin, transferin saturated and significant decrease (p < 0.05) EIBS, TIBC .

Conclusions: These results suggest that the role negative of increase iron in development Diabetes mellitus by a number of mechanisms.

Background: Although radiological diagnostic studies (RDS) are an important and acceptable part of medical practice, it is not without hazards. It is associated with increased risk of cancer. Unfortunately the typical and safe dose of each radiological examination is not known. Most of our knowledge of cancer risk comes from studies of survivors of those exposed to whole body radiation from atomic bomb in Hiroshima & Nagasaki, jobs associated with radiation exposure, Chernobyl survivors & patients treated with radiation therapy for cancer and other diseases.

Objectives To estimate radiation dose received by patients from diagnostic radiological examinations and lifetime attributable risk of cancer (LTARC).

Type of the study: A prospective study.

Methods A prospective study was conducted in Al-Kindi Teaching Hospital (KTH) during the period from 1st June to 31st august 2016. The study was performed on 910 adult patients. There were 595 males (65.38%) and 315 females (34.62%); mean age was 41.5 years (range 20-63).Different RDS were considered including chest-x ray (CXR), skull x-ray(SXR), x-ray of limbs and pelvis (LPXR) for orthopedic causes , computed tomography scan (CTS) and mammography (MG) .

Results CXR was performed for 260 (28.57%) patients which delivers 0.12 mSv. SXR was done for 160 (17.58%) patients which delivers 0.3 mSv. LPXR was performed for 220 (24.175%) which delivers 0.3-0.6 mSv. MG exposes 150 (16.48%) to 3 mSv. While CTS ,which delivers 6.2-16 mSv according to anatomic area being scanned, was done for 120(13.19%) patients.

Conclusion There is great abuse for using RDS from both patients and doctors, without realizing their danger and association with cancer development. It was proved that RDS expos patients to different kinds of tissues injury including cancer.

Background: Currently there are four general approaches to correct refractive errors: refractive corneal surgery, crystalline lens surgery and implantation of an intraocular lens in anterior or posterior chamber.

Objective: To evaluate the predictability, safety and stability of toric phakic implantable collamer lens implantation to correct moderate to high myopic astigmatism. in Eye Specialty Private Hospital, Baghdad, Iraq.

Type of the Study: a prospective non randomize intervention study.

Methods: 60 eyes of 40 patients underwent implantation of a toric implantable collamer lens (V4c design).Mean spherical refraction was ₋11.32 diopter (D) ±3.17 (SD) with range from ₋6.00 to ₋18.00D and the mean cylinder was -2.61(D) ±1.16 with range from ₋1.00 to ₋5.50D .The outcome measures that evaluated during a 12 months follow-up period include UDVA, refractive outcomes, CDVA, vault and adverse events.

Results: At 12 months postoperatively the mean Snellen decimal UDVA was 0.77±0.23 and mean CDVA was 0.80±0.21, with an efficacy index 1.16. Twenty nine eyes (48.33%) showed gain in CDVA with safety index





1.21.The treatment was highly predictable for spherical equivalent and astigmatic component .The mean SE dropped from (₋12.63D ±3.11) to ( ₋0.11 D±0.20) with 58 eyes within ±0.50 D and 60 eyes with ± 1.00D of target correction . For achieved cylinder 60 eyes (100%) had ≤0.50D and 51 eyes (85%) had ≤0.25D with strong positive linear correlation between achieved and expected cylinder(r=0.94)

Conclusions: The results of the present study support safety, efficacy, predictability of toric implantable collamer lens implantation to treat moderate to high myopic astigmatism

Background: The vaginal microbial ecosystem stability preclude many other organisms but sometimes the vaginal micro biota is disturbed and this cause change in the normal

balance causing symptoms of vulvuvaginitis like abnormal or increased vaginal discharge, redness and itching.

Objective: To prove C. albicans presence in their vagina clinically and laboratory by culture of vaginal swab on two media.

Type of the study: This study is a case control study

Methods: This study is a case control study in which 100 clinically patient women admitted to maternity hospital in kalar city and khanaqin hospital during the period from 1st August– 30th of October 2016 who were examined to prove C. albicans presence in their vagina clinically and laboratory by culture of vaginal swab on two media, the first media was used for primary isolation which was Sabouraud´s dextrose agar media and the second was to differentiate Candida spp. according to their color .

Results: Results of this study presented that the highest invasion of the vagina of Candida spp was accounted for C. albicans (39.6%)from the (53) positive cultures , while other species were as follows: C. glabrata (26.4%), C. tropicalis (20.8%) ,C. krusi(13.2 %).

Conclusions: this study presented that the highest invasion of the vagina of Candida spp was accounted for C. albicans

Background: In the present study used device jet plasma needle with atmospheric pressure which generates non thermal plasma jet to measure treatment potent with plasma against pathogenic bacteria founded in UTI was inactivated with plasma at 10 sec,

Objective:. This work included the application of the plasma produced from the system in the field of bacterial sterilization , where sample of Gram- negative bacteria (Escherichia coli) were exposed to intervals (1-10)second . Midstream Urine samples swabs were obtained from patients with urinary tract infections.

Type of the study: Cross -sectional study.

Methods: The work were used in this study obtained from studying 100 urine samples, the age of patients ranged between 10 years to 60 years. They were 60 females and 40 males. These samples were cultured on culture media to isolate bacterial colonies .After that, bacteria were identified by means of highly specific investigations Escherichia coli, plasma needle treatment is applied on bacteria through sterilization, and adhesion.

Results : It was found that the percentage of the killing of Gram-negative bacteria (E.coli) was 100% at (10) second, also decreasing bacterial adhesion on epithelial cells, where numbers adhesion bacterial with uroepithelial cells decrease after treatment with plasma needle .

Conclusion : From this work, it has been observed that applied voltage ,distance between plasma needle and treatment model as well as time treatment effect on inactivation bacteria and sterilization ,also it effect on decreasing bacterial adhesion on epithelial cells, where numbers adhesion bacterial with uroepithelial cells decrease after treatment with plasma needle .

Background: Nicotine is the foremost chemical constituent responsible for addiction in tobacco products, in the non-ionized condition can be easily absorbed via epithelial tissue of the lung, the mouth, the nose and across the skin

Objective:The study examines the harmful effect of the nicotine which is an important component of cigarette in vitro.

Type of the study: Cross-sectional study.

Methods: Examines the harmful effect of the nicotine which is an important component of cigarette in vitro by using two types of lung cancer cell lines (H460 TP53+/+, H441 TP53-/-).

Results: The results showed the total count of H460( TP53+/+) cancer lung cell lines was (5.2 ×106 cells /ml) , the number (4.9 ×106 cells /ml) of them were alive and (3.6×105 cells /ml) of them were dead, with percentage of viability (93.15%), while the total count of H441( TP53-/-) lung cancer cells was (5.1 ×106 cells /ml), the number (4.1 ×106 cells /ml) of them were alive, and the number (9.9×105 cells /ml) of them were dead with percentage of viability (80.55%). And it revealed that the nicotine inhibited viability of H460 lung cancer cell lines in all concentrations (1, 10, 500 and 1000 μ M) and the cells were completely abolished by treatment with (1000 μ M) when the viability reached to minimum percentage (3.43%), while nicotine induced proliferation in H441 lung cancer cell lines even in lowest concentration (1 μ M), whereas the viability reached to maximum percentage (41.04%) at concentration (1000 μ M). Also it noticed that the treatment with nicotine at concentrations (1,10, 500 and 1000 μ M ) for 24 and 48 hr induced the apoptosis but not necrosis in H460 lung cancer cell lines, especially at the highest concentrations (1000 μ M) for 48hr when the percentage of apoptosis reached to the maximum value (55.5%), however it was induced proliferation in H441 lung cancer cell lines with highest proliferation at concentration (1000 μ M), when the percentage apoptosis value reached to the minimum percentage (1.5%) when compared to un treated cells (control).

Conclusions: the cells lack to TP53(H441 TP53-/-) will proliferate when exposed to nicotine and some of these cells will suffer from necrosis as a replacement of apoptosis.

Background: Alternative natural therapy by plants extracts had opened wide door for the use of natural products as an alternative therapy instead of many antibiotics and drugs , which had many harmful side effects.Also, an increased interest has been centered on the industrial wastes, especially plant raw materials which contain phenols (e.g. Pomegranate peel and Bay leaves) which is a sources of natural antioxidants ,which are on the contrary of synthetic antioxidants that had restrict use due to their health risks , carcinogenesis and toxicity .

Objectives :This study was done to find out the etiology and sensitivity pattern of uropathogenic bacteria isolated from patients with urinary tract infection , in order to select the bacterial isolates that had multidrug resistance .

Type of the study: Cross-sectional study.

Methods: preparation of Hot water extract , Cold water extract , Methanol extract and Ethanol extract of both Pomegranate peels and Bay leaves and test there antibacterial activity against these uropathogenic bacteria which are multidrug resistant .

Results :All extracts from pomegranate fruit peels exhibited inhibitory activity against all tested bacteria . Hot , Cold water extract and Ethanol extract of pomegranate peels recorded the highest inhibition zones compared with the Methanol extract. On the other hand, there were no



antibacterial activity of any extract of Bay leaves on any of tested bacteria. The medicinal plants antibacterial activity was well documented and those plants are new potential alternative antibacterial agent especially against multi resistant bacteria which had been the center of focus globally.

Conclusions: Pomegranate have antibacterial activity against multidrug resistant pathogenic bacteria isolated from UTI patients , So it emerged as alternative therapy for humans leading to reduction the cost and the risk of using antibiotics .

Background: First six to twelve months after initial urinary tract infection, most infections are caused by Escherichiacoli, although in the first year of life Klebsiella pneumoniae, Pseudomonas, Enterobacter spp andEnterococcus spp, are more frequent than later in life, and there is a higher risk of urosepsis compared with adulthood

Objectives: To determine the prevalence of bacterial isolates from Urinary Tract Infections of children at a children hospital in Baghdad and their antimicrobial susceptibility patterns.

Type of the study: Cross-sectional study.

Methods: During six months of study (1 June to 31 December, 2016), 117urine specimens were collected from a children hospital in Baghdad.

Results: Out 38 isolates of Gram positive and Gram negative bacteria were obtained from urine specimens in a percentage of 5(13.2%) and 33(86.8%),respectively. The lowest incidence was among the 11-15 years old age group (11.9%) whereas the highest incidence was among the 1-5 years old age group (43.6%)(P≤0.05).Also out of 38positive cultures, the incidence was higher in females 31(81.6%)than that of males 7(18.4%).

Out of 38 positive cultures, the isolation rate was 5(13.2%) for Gram positive isolates and 33(86.8%)for Gram negative isolates. The most frequently isolated bacteria was Escherichia coli19(50%)(P-value ≤ 0.05), while the only isolated Gram positive was Staphylococcus aureus5(42.86%) isolates.The most effective antibiotics for Staphylococcus aureus isolates were Vancomycin and Amikacinfor (100%) and for Gram negative isolates wasimipenem (100%). Ampicillin showed the highest resistance rate for both Gram positive and Gram negative isolates(100%) and Pesudomonas aeruginsa isolates showed the highest resistant rates to most antibiotics under study.

Conclusions: The most frequently isolated bacteria was E. coli from all urine cultures and the most effective antibiotics for Staphylococcus aureus isolates were Vancomycin and Amikacinfor

Background: Drug resistant epilepsy is defined as failure of adequate trials of two tolerated, appropriately chosen and used antiepileptic drug schedules to achieve sustained seizure freedom. Up to 30% of patients referred to clinics with a diagnosis of pharmaco-resistant epilepsy may have been misdiagnosed, and many can be helped by optimizing their treatment.Pseudoresistance, in which seizures persist because the underlying disorder has not been adequately or appropriately treated, must be ruled out or corrected before drug treatment can be considered to have failed.

Objectives: The objectives of this study were to determine the causes of drug failure in patients with epilepsy and to differentiate between drug resistant epilepsy and pseudoresistant epilepsy.

Type of the study: This is a retrospective study.

Method: It is conducted in Baghdad governorate at the epilepsy clinic in the neurosciences hospital during the period from the 1st of February through July 2013. Two hundred patients with refractory epilepsy were involved. These patients attended the epilepsy clinic during 2011 and 2012. The data was collected from the files of the patients including age, gender, weight, history of presenting illness, type of seizure, drugs used, duration of disease, EEG and imaging findings, compliance and follow up.

Results: Drug resistance epilepsy constituted a prevalence of 24% (128) as the total number of patients with epilepsy attending the hospital during the same period was 527.The mean age of patients with refractory epilepsy was 25 years. Male were 56.5% (113/200) and urban residents were 70.5% (141/200). The study revealed that 64% (128/200) of refractory epilepsy was attributed to drug resistance; while the remaining proportion was pseudoresistance 36% (72/200). The main cause of pseudoresistance was poor compliance 36.1% (26/72).The most common type of seizure in the sampled patients was generalized tonic clonic seizures in 51.5% (103/200).Compliance was found to be statistically associated with abnormal EEG finding, past medical history (hypertension, cardiac diseases, encephalitis, diabetes mellitus and any significant history) and quality of follow up. The follow-up was found to be statistically associated with the family history, past medical history( encephalitis and hypertension) and compliance of patient.

Conclusion:A considerable number of patientsdiagnosed as cases of drug resistant epilepsy had another explanation causing drug failure.The study recommends the application of consensus definition for drug resistant epilepsy and periodic evaluation of patients with drug resistant epilepsy to exclude pseudoresistance.

Background: Multiple sclerosis is a chronic heterogeneous demyelinating axonal and inflammatory disease involving the Central Nervous System [CNS] white matter with a possibility of gray matter involvement in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This damage disrupts the ability of parts of the nervous system to communicate, resulting in a wide range of signs and symptoms. Cerebral venous insufficiency theory was raised as a possible etiology for the disease at 2008 by Zamboni an Italian cardiothoracic surgeon. This theory was defeated by Multiple Sclerosis[ MS] researchers and scientists who thought that the disease is an autoimmune rather than vascular.

Objective: To assess the findings of Magnetic Resonance Venography [MRV] in a group of patients with MS and to compare these results with a healthy control group Magnetic Resonance Venography[ MRV] findings.

Type of the study: A case – control cross sectional study.

Methods: it was conducted at Neurosciences Hospital MS clinic from Oct.2014 to Dec. 2015, recruiting sequentially 50 patients who attend the MS clinic; 19 male and 31 females, their age was ranged from 16 to 53 year old. Diagnosis of MS was based on fulfillment of McDonald 2010 criteria for MS diagnosis, detailed history , examination and Expanded Disability Status Scale( EDSS)[see Appendix1] were recorded according to structured questionnaire forum. Each patient was send for Magnetic Resonance Venography[ MRV] using 3 Tessla Phillips model Achieva, 2012. The results of MRV were interpreted by specialist radiologist. Statistical analyses were done using SPSS version 21 with P value less than 0.05 was considered significant.

Results: Fifty patients with Multiple Sclerosis were involved in the study female 31, male 19, their ages were ranged between 21 and 60 year old. Magnetic Resonance Venography [MRV] findings suggest of venous thrombosis were seen in [4 / 50] 8% of patients and [46 /50] 92% of the patients in this study have no findings of venous thrombosis. The comparison with the control group showed no significant statistical difference.

Conclusion: Magnetic Resonance Venography[MRV] finding is not statistically different between healthy people and Multiple Sclerosis patient

Background:Parkinson’disease(PD) is a neurodegenerative disorder of the central nervous system characterized by resting tremor, bradykinesia, cogwheel rigidity, and impairment of postural reflexes; the frequency of PD increases with aging.Clinically Parkinson\'s disease characterized by two groups of symptoms: motor and non-motor symptoms.Non-motor symptoms can be categorized as autonomic, cognitive/psychiatric (may include depression, dementia, anxiety, hallucinations), sensory and rapid eye movements (REM) sleep behavior disorder (RBD).

Objectives:The objectives of this study are to find out the frequency of the non-motor symptoms of idiopathic Parkinson disease in a group of patients in Baghdad hospitals.

Type of the study:A cross sectional study with analytic elements,

Methods: It was conducted in movement disorders clinic in neuroscience hospital, outpatient clinic at Baghdad teaching hospital and AL-Kadhumain teaching hospital during the period between the 1st. of December 2013 through July 2014. One hundred and two patients diagnosed as idiopathic Parkinson disease by a consultant neurologist..

Results:The study found that the mean age of patients with Idiopathic Parkinson disease was 60 years. Among them, two thirds of patients (68/102) were males, and 55 % (56/102) of patients were in advanced stage of the disease. The study also mentioned the percentage of non-motor symptoms of Idiopathic Parkinson disease and they ranged from the most frequent symptom[constipation(80%)] to the least frequent[bowel incontinence(16%)].Also the study shows the distribution of symptoms according to gender and the study found no significant difference between males and females. The study finds that there is no significant difference in symptoms development along the period of disease progression except for bowel incontinence [30.4 % (14/46) in early disease progression compared to 3.6 %( 2/56) in advanced disease] and sexual interest [34.8 %( 16/46) in early disease progression compared to3.6 (2/56) in advanced disease].

Conclusions:Non motor symptoms of Parkinson disease is so frequent and represent a major burden on patients\' quality of life and the study recommends a more concentration on them in the future

Background: Stroke is an acute neurologic injury and represents the 2nd leading cause of mortality worldwide, and also the most leading cause of acquired disability and morbidity in adults.

Objective: Effect and association between stroke and risk factors.

Type of the study: A retrospective study.

Methods: The study conducted on 312 patients in 2016, all data were collected from patients’ files from the emergency unit, which included basic demographic and disease characteristic, co morbid diseases, risk factors, final diagnosis.

Results: both previous stroke, ischemic heart disease was strong predictor of new stroke ,and hypertension was major risk factor that associated with new stroke (odd ratio= 13.034, 2.659and 5.684respectively), no significant correlation between sex and stroke in the collected sample despite that female had slightly higher rate of stroke than male, patients with age above 70 years carry the highest risk to present with stroke.

Conclusion: The rate of stroke in Iraqi patients still significantly associated with advance age, two major predictor of stroke are associated with stroke previous stroke and ischemic heart disease and hypertension was the major risk factor correlated with new onset stroke, and prevention programs must be implemented on them especially hypertension since it is modifiable risk factor

Background: Stroke is an acute neurologic injury and represents the 2nd leading cause of mortality worldwide, and also the most leading cause of acquired disability and morbidity in adults.

Objective: Effect and association between stroke and risk factors.

Type of the study: A retrospective study.

Methods: The study conducted on 312 patients in 2016, all data were collected from patients’ files from the emergency unit, which included basic demographic and disease characteristic, co morbid diseases, risk factors, final diagnosis.

Results: both previous stroke, ischemic heart disease was strong predictor of new stroke ,and hypertension was major risk factor that associated with new stroke (odd ratio= 13.034, 2.659and 5.684respectively), no significant correlation between sex and stroke in the collected sample despite that female had slightly higher rate of stroke than male, patients with age above 70 years carry the highest risk to present with stroke.

Conclusion: The rate of stroke in Iraqi patients still significantly associated with advance age, two major predictor of stroke are associated with stroke previous stroke and ischemic heart disease and hypertension was the major risk factor correlated with new onset stroke, and prevention programs must be implemented on them especially hypertension since it is modifiable risk factor

Background: Friedreich ataxia (FRDA) is the most common form of inherited ataxia, comprising one-half of all hereditary ataxias with a carrier rate between 1 in 60 to 1 in 90 and with a disease prevalence of 1 per 29,000. It can occur in two forms the classic form or in association with a vitamin E dependent ataxia. The precise role of Vitamin E in the nervous system is unknown; An Oxidative attack is suspected to play a role in Ataxia with Vitamin E deficiency, as well as in Friedreich ataxia. Vitamin E is the major free-radical-trapping antioxidant.

Objective: Theobjectives of the study is to asses vitamin E level in patients with Friedreichs ataxia phenotype in Iraqi patients.

Type of the study:Cross-sectional study.

Method: This study was conducted at the neuroscience hospital and Baghdad teaching hospital during the period from the 1st of November 2013 through November 2014. Forty patients with friedreich's ataxia attended in neuroscience hospital and Baghdad teaching hospital during this period; there was12 male, 20 female patients and their age range between (4-50) years.

Results: Regarding the level of vitamin E in patients in the present study, The study revealed that mean level of vitamin E for Friedreich ataxia patients was (10.92 μg/ml) ranging from (8-18 μg/ml),while in the control group the mean was (28.06μg/ml) ranging from (22-36μg/ml), the difference in mean level was found to be statistically significant (p=0.0001.) Thirty percents of (FRDA) patients was (8-9.9μg/ml), while half of patients (50%) were within (10-11.9 μg/ml),and low percentage (15 %)of patients were within (12-13.9 μg/ml ). The rest (5%) were had vitamin E level equal or more than 14 μg/ml. these finding revealed that majority of Friedreich ataxia patients were found with low level of vitamin E (32 patients(80%)), and low percentage with normal level (8 patients(20%.)) Patients with Friedreich ataxia were found to have a comparable level 10.47±1.79(8.4-13.5),11.48±2.61(9.4-18) and 10.66±1.26(9-12.5) for those with less than 10 years, 10-19 years , equal or more than 20 years of age respectively (p=0.382), while it was found to have a significantly decreasing level with advance in the age for the control group, 30.57±4.61(24.5-36), 27.46±3.16(23.7-33.5), 25.50±3.03 (22.9-29) for those less than 10 years, 10-19 years, 20 years or more respectively (p=0.006.) Vitamin E level in relation to Gender showed that Friedriech ataxia male patients had significantly higher vitamin E level compared to females [12.05±2.66 (9.0-18.0) compared to 10.17±1.07 (8.4-12.0)] (p=0.003), while relation to gender in the control group was not of significant value statistically [27.08±2.90 (22.9-30.0) for male compared to 29.04±4.97 (23.7-36) for females] , p=0.136.

Conclusion: In the light of the results of the present study, the following conclusions were made: The level of vitamin E in friedreichs ataxic phenotype patients was subnormal than normal range representing 80% of the sample selected for the test. The level of vitamin E in male patients of freidriechs ataxic phenotype patients was higher than female patients.

Background: A role for vitamin D deficiency in Parkinson disease (PD) has recently been suggested.

Objective:: To estimate the state of vitamin D in PD with an age-matched healthy control.

Type of the study: A case control study.

Method: The study randomly comparison of plasma 25-hydroxyvitamin D (25[OH] D) concentrations of collected samples in a clinical neurology department ward / Baghdad teaching hospital / Medical City and Parkinson disease movement disorder clinic. Participants were registered into the study from October 2015 to October 2016. We was study serum vitamin D level in 40 consecutive patients with Parkinson disease and 40 age-matched healthy controls after matching for age, sex, race, and geographic location. Occurrence of suboptimal vitamin D 25(OH) concentrations in Parkinson patients.

Results: Significantly, more patients with PD (62.5%) had deficient vitamin D than did controls (27.5%). The mean 25(OH) D concentration in PD was (18.09) significantly lower than in the control (24.89)..

Conclusions: This study demonstrates a significantly lower vitamin D level in PD than healthy controls. These data support a possible role of vitamin D deficiency in PD.

Background: Thyroid operation needs very meticulous haemostasis to have minimal morbidity and mortality.

Objectives: Assessment of harmonic knife in open thyroid surgery as anew haemostatic procedure .

Type of the study: Cross-sectional study.

Methods: This study had been conducted at Alkindy teaching hospital in Baghdad city from the 1st of May 2013 to the 1st of January 2017 on 229 goiterous patients who needs thyroidectomy(36 males,193 females),divided in 2 groups according to the haemostatic procedure used during their operations, Group A (15 males,85females)using the usual conventional surgery(pick, tie &cut), Group B (21males,108 females) using harmonic knife as haemostatic procedure and compare the results according to time of surgery, amount of discharge in the drain during the first 24 hours post operatively ,the incidence of recurrent nerve palsy and the remote post operative hypocalcaemia (3months post operation) .

Results: It shows that thyroid surgery (thyroidectomy) by using harmonic knife as haemostatic procedure is shorter in duration [mean67.22 minutes] with less blood loss in the

drain [mean 64.96cc] and less incidence of hypocalcaemia in remote post operative period [3.8%] in comparison to the results of the usual conventional thyroidectomy procedures (mean duration 82.02 minutes, mean blood loss in the drain 111.13cc & incidence of hypocalcaemia is 7%}.

Conclusions: Harmonic knife is very safe & beneficial haemostatic device in thyroid surgery.