Iraqi Postgraduate Medical Journal

BACKGROUND:
Anterior cruciate ligament (ACL) injury is common among active individuals, and mostly
associated with other complex injuries in the knee. ACL reconstruction is vital for normal knee
function. The treatment of ACL injuries of knee depend on many factors including Age of the
patients, degree of laxity, level of activities and associated injuries .
OBJECTIVE:
To assess outcome after conservative management of ACL tear. Moreover, determine the patients
who need reconstruction, and the best time to perform surgery.
PATIENTS AND METHODS:
Prospective study of 72 patients who had unilateral ACL tear, 61 males and 11females (age 18-
40Y). 56 patients started management with rehabilitation program without reconstructive surgery,
12of them have underwent surgery after that because of unsatisfied outcome. ACLR performed for
28 patients 7 of them were female, complete ACL tear was observed in 21patients. Hamstring graft
by one-incision technique were used: same protocol of rehabilitation was followed postoperatively.
This study has been achieved in Al Shaheed Ghazi Al Hariri Hospital.
RESULT:
Average follow up period of 18 months, 78.5% of patient with rehabilitation (no ACLR) had good
functional result. While all patients with ACLR have been satisfied where 85% of them return to
their activity at level of I and II sport and 97% of quadriceps girth gaining compared to the sound
side also observed at the end of follow up period.
CONCLUSION:
Not all ACL tear need surgical reconstruction. It is indicated for high-risk life style and repeated
attacks of giving way. There is no differences between early and late reconstruction.

BACKGROUND:
Fractures of the distal third of the tibia are the major cause of morbidity in patients with lower
extremity injuries. Most fractures are sustained in young adults during high velocity injuries.
PATIENTS AND METHODS:
Forty patients with closed fractures of distal third of the tibia were treated in Al-Yarmouk Teaching
hospital between May 2012 and April 2014. 20 patients had been treated with open reduction and
internal fixation by heavy-duty plate and screws and were matched to 20 patients treated with closed
reduction and intramedullary nailing fixation, with regard to gender, age, and the AO classification of
the fracture.
RESULTS:
There were no significant differences in regard to: time of surgical procedures, non-union, hardware
failure or deep infections between plate fixation and intramedullary nailing. Open reduction and plate
fixation was associated with higher risk of: delayed union, osteopenia, ankle joint stiffness and
algodystrophy. Closed reduction with intramedullary nailing was associated with higher rates of
rotational malalignment and knee joint pain/stiffness. The limb length difference was of no clinical
significance in all patients.
CONCLUSION:
Intramedullary nailing is the preferred method for treating closed distal tibial fractures but open
reduction and plate fixation may provide superior results in terms of optimal alignment.

BACKGROUND:
Arthroscopic knee surgeries are performed in very large numbers worldwide, and in spite of
relatively low complication rate, but the total number is significant. Some of these complications
are due to tourniquet use and can be serious.
OBJECTIVE:
Is to asses if automated pump (with or without) dilute epinephrine saline irrigation can replace
the tourniquet use in soft tissue arthroscopic knee surgeries.
PATIENTS AND METHODS:
36 patients (9 females 25 % and 27 males 75 %) were included in this prospective experimental
nonrandomized study, and were necessitated soft tissue arthroscopic knee surgeries. Patients
were divided into two groups, in group A (patients) tourniquet and automated pump were used.
In group B (18 patients) automated pump with or without epinephrine irrigation fluid were used.
For both groups, visibility, time of surgery, amount of irrigation fluid used, pressure of pump,
postoperative pain and hemoglobin level before and after surgery were assessed and compared.
RESULTS:
There was no significant statistical difference( p value more than 0.05) in regard to visibility,
time of surgery, amount of irrigation fluid used, pressure of pump and postoperative pain
between the two groups. There was no significant statistical difference between hemoglobin
levels before and after surgery in both groups.
CONCLUSION:
Automated pump (with or without) dilute epinephrine saline irrigation can replace the tourniquet
in soft tissue arthroscopic knee surgeries.

BACKGROUND:
A spreader flap, or autospreader flap, is a flap used for dorsal reconstruction in primary rhinoplasty
after cartilage dorsum excision. In a primary rhinoplasty that requires a humpectomy, the dorsal
aspect of the upper lateral cartilages is commonly discarded. Many of these patients need spreader
grafts to reconstruct the middle third of the nose. However, it is possible to reconstruct the upper
lateral cartilages into “spreader flaps” that act much like spreader grafts.
OBJECTIVE:
To evaluate the efficacy of autospreader flap for midvault reconstruction after humpectomy in
primary rhinoplasty.
PATIENTS AND METHOD:
This prospective study was done on 124 patients in Erbil, from February 2010 to Jan. 2014. All
patients who underwent primary rhinoplasty and requiring humpectomy are included in this study.
A tunnel is created on the underside of the upper lateral cartilage, which is released from the
cartilaginous septum and also from its attachment to the nasal bone. It is then rolled on itself to
make a spreader flap, which is secured with sutures. Scoring along the dorsal edge of the upper
lateral cartilage may be necessary in thick cartilage. The flap is then secured to the dorsal edge of
the reduced dorsal septum. Data were entered and analyzed using the statistical package for social
sciences SPSS version (18).
RESULTS:
In 124 patients who underwent an open approach rhinoplasty (44 patients were male and 80
patients were female), the autospreader flap almost always reconstructed the middle third of the
nose. It was easy to execute in the open approach. At surgery, seven patients needed spreader grafts
because the flaps were too narrow. Postoperatively, twelve patients exhibited inadequate nasal
width.
CONCLUSION:
Autospreader flap is a suitable technique for restoration of midvault after humpectomy in primary
rhinoplasty. The application of autospreader flap allows the surgeon to reconstruct the internal
valve and design an aesthetically pleasing dorsal nasal line.

BACKGROUND:
In recent years, flexible laryngoscope is a major contribution to endoscopic technique and is a
standard method in diagnosis of many laryngeal and pharyngeal diseases.
OBJECTIVE:
To show the accuracy of flexible fiberoptic endoscope in the diagnosis of laryngeal and pharyngeal
disorders in comparison with direct laryngoscopy
PATIENT AND METHOD:
A prospective study conducted at otolaryngology department, Surgical Specialties Hospital,
Medical City, Baghdad between Feb.2008 and Feb. 2009 with fifty patients were included in the
study. All patients with laryngeal or pharyngeal symptoms were examined by flexible fiberoptic
endoscope and direct laryngoscope under general anesthesia.
RESULTS:
Male to female ratio was 1.8:1; dysphonia was the main chief complains in 66% followed by
dysphagia in 16%. The commonest finding of flexible fiberoptic endoscope was laryngeal mass in
58% patients followed by impaired or immobile vocal cords in 18%. The accuracy of flexible
fiberoptic endoscope in diagnosis of pharyngolaryngeal disease was 76% while of the direct
laryngoscope accuracy was 92%.
CONCLUSION:
Flexible fiberoptic endoscope is vital instrument in outpatient clinic especially when indirect
laryngoscope is unsatisfactory, but don’t supplant direct laryngoscopy specially when biopsy is
indicated.

BACKGROUND:
since the introduction of ESWL in treatment of renal stones, it remained the first option for most
renal and ureteric stones, with a success rate ranging from 60% to 90%. Multiple variables can affect
treatment outcome, including those related to the machine, dose administered, and factors related to
the patient; the exact role of most of these factors is still under study.
OBJECTIVE:
We investigated the effect of shock wave frequency on treatment outcomes in terms of success and
complication rates.
PATIENTS AND METHOD:
139 patients with radio-opaque renal stones, presented to the Urology consultancy clinic during the
period June 2010 through January 2012 and decided to undergo ESWL treatment were randomized
into three groups, the first group (46 patients) received shock waves at a frequency of 120 waves per
minute, the second (47 patients) at 90 w/m, and the third group (46 patients) at 60 w/m. Patients were
followed for treatment outcome and appearance of complications at 1 week, 3 weeks, and 6 weeks.
Stone free status or insignificant asymptomatic residual gravels of 5mm or less are considered as
success. Durations of hematuria and analgesic requirement were the main complications looked for
during follow up, while subcapsular and retroperitoneal hematomas were looked.
RESULTS:
All patients received 3500-4000 shock waves per session at 17-18 KV energy. Success rate was
significantly higher in the second and third groups, while the durations of hematuria and analgesic
requirement were significantly shorter in groups 2 and 3. There was no significant difference between
groups 2 and 3 in all outcome and complication parameters; however, the duration of treatment was
significantly longer in groups 2 and 3.
CONCLUSION:
ESWL efficacy in fragmenting renal stones is significantly improved by decreasing frequency from
the standard 120 sw/min to slower rates (90 and 60 sw/min), with significantly decreased analgesic
requirement and hematuria durations. There were no significant differences between the 60 and 90
sw/min frequencies. Taking in account the longer treatment duration for the 60 sw/min frequency; the
90 sw/min frequency would be optimal in terms of stone disintegration, complications, and duration
of treatment.

BACKGROUND:
The obstructive effect of the posterior urethral valve (PUV) can manifest along a spectrum of
severity, ranging from disease incompatible with postnatal life to conditions that have such minimal
impact that they may not manifest until later in life.
OBJECTIVE::
To compare the outcome of patients with PUV underwent both techniques of PUV incision and
primary urinary diversion (with a delayed PUV incision).
PATIENTS AND METHODS:
A prospective and retrospective study of twenty-eight children with posterior urethral valve was
conducted. Details of age, presenting symptoms, serum creatinine, ultrasound and Voiding
cystographic (VCUG) findings, the presence or absence of vesicoureteric reflux and the type of
surgical interventions done were recorded. On the follow-up between 1- 2 year period, the patients
were assessed by progression of the clinical state, biochemical analysis and ultrasound of the
abdomen. Outcomes of surgery and further surgical intervention also assessed in addition to the
assessment of the bladder function for older children.
RESULT:
The primary treatment of the PUV was with incision of the PUV in 13 cases (46.4%) while the
primary treatment with urinary diversion and delayed incision of the PUV was performed in 15 cases
(53.3%). A posterior urethral valve incision was cured in 46% of patients, while the primary
diversion and the delayed incision operation was cured in 26.6%; Most of the patients (60.7%) still
needed further urological intervention. There was no statistical significance between the results of
both surgical procedures. Renal impairment and poor bladder function were more common with
diversion operation.
CONCLUSION:
There is no convincing evidence to support any procedure as a way of improving long-term renal
function or long-term bladder function. Therefore, urinary diversion is to be considered in selected
cases with clear goals and endpoints in mind as it has an important place in the management of boys
with PUV.

BACKGROUND:
During the course of laparoscopic cholecystectomy .the gallbladder specimen and the spilled stones
are retieved by the formal endobag , which is not available in Iraq , or directly through the umbilical
or the epigastric port .Direct retrieval of the gallbladder specimen and the spilled stones may cause
contamination of the port site .
OBJECTIVE :
To evaluate the safety,cost effectiveness and incidence rates of intraperitoneal and port site
infections when using a sterile male condom as an endobag for retrieval of gallbladder specimen and
spilled gallstones .
METHODS :
This is a prospective study performed in AL-Karama Teaching Hospital, Medical College / Wasit
University, Iraq .A total of 306 patients, with symptomatic cholelithiasis underwent Laparoscopic
Cholecystectomy (LC), were included in this study performed during the period from April 2011 to
June 2014. A sterile male condom was inserted through 10 mm epigastric port. The gallbladder
specimen / spilled gallstones of every patient were retrieved inside a sterile male condom. Patients
less than 15 years old and those with liver cirrhosis, gallbladder carcinoma and obstructive jaundice,
were excluded. The follow-up period ranged from 2 to 42 months.
RESULTS:
Dissected gallbladders / spilled gallstones of the 306 patients; 279 (91.2%) were females and
27(8.8%) were males with a mean age of 39±12.5 SD (range 16-75) years, were safely retrieved
through 10 mm epigastric port inside male condoms.
Incidental perforation of gallbladders ,during their dissection from the hepatic bed, was
observed11(3.6 %) patients. Perforation of the condom during retrieval of the gallbladder
specimens/spilled stones occurred in 12(3.8%) patients.
This study had no intraperitoneal nor port site infections. No mortality occurred during the follow-up
period.
CONCLUSION:
Use of a sterile male condom as endobag for retrieval of gallbladder specimen and spilled stones is
simple, inexpensive and safe technique. It also reduces the intraperitoneal and port site septic
complications .

BACK GROUND:
The epidemic of obesity is a major health problem in the developed world with a great influence
on morbidity and mortality.
OBJECTIVE:
To evaluate serum ghrelin levels achieved through LSG and on insulin resistance and the serial
changes of insulin concentration in obese patients following gastric sleeve.
SUBJECTS AND METHODS:
Twenty four patients underwent LSG with 25 controls were selected. Body mass index (BMI),
waist circumference (WC), lipid profile, fasting blood sugar (FBS), glycated hemoglobin
(HbA1c), fasting insulin, QUICKI and ghrelin hormone concentrations were measured for
controls and patients prior LSG, then one month and three months post-surgery.
RESULTS:
A significant decline was noticed in BMI, WC, TC, TG, LDL-cholesterol, fasting insulin, and
ghrelin, with significant increase in QUICKI in patients undergone LSG with significant
differences in all studied parameters between patients and controls. A negative correlation was
noticed between ghrelin and BMI in patients before sleeve gastrectomy.
CONCLUSION:
Ghrelin is a hormone closely linked with obesity taking into account the marked loss in appetite
in the period after laparoscopic sleeve gastrectomy.

BACKGROUND:
Dyslipidemia is common in Patients with chronic renal failure undergoing intermittent haemodialysis
and is considered a risk factor of cardiovascular disease in these patients.
OBJECTIVE:
To highlight the lipid profile abnormalities in children with end stage renal disease undergoing
maintenance hemodialysis and know whether the hemodialysis duration and frequency of sessions
per week has any impact on lipid profile in these patients.
PATIENTS AND METHOD:
A case-control study which was collected in the dialysis unit of (Al Karama Teaching Hospital,
Child's Central Teaching Hospital , Al Kadhumia Teaching Hospital and Ibn Al Balady Hospital) for
six months started on 1st June 2013 till the 1st of December 2013. Blood samples were obtained from
40 patients with end stage renal disease undergoing maintenance haemodialysis (2-3 sessions per
week) and 40 matched healthy controls and analyzed for serum total cholesterol, low density
lipoproteins, high density lipoprotein and serum triglyceride.
RESULTS:
A statistically significant decrease was found in serum high density lipoprotein level (Mean=
46.40mg/dl ,p < 0.025) in Hemodialysis patients when compared with healthy controls. A significant
increase in serum triglyceride content of patients (p < 0.000) was also observed. It was found that
improvements in lipid profile results were achieved with the use of more frequent (more than
2sessions of haemodialysis per week). There is no any impact of the duration being on HD on the
lipid profile in the study.
CONCLUSION:
This study found that normal lipid profile is better maintained in patients undergoing adequate
haemodialysis, and the frequency of haemodialysis sessions can affect the atherogenic states of the
lipid profile which is probably the responsible for high incidence of atherosclerotic heart diseases
among these patients.

BACKGROUND :
Congenital heart disease (CHD) define as abnormalities of heart structure that originate before
birth, they are responsible for more deaths in the first year of life than any other birth defects.
OBJECTIVE:
To determine the prevalence of the identifiable CHDs and to identify risk factors that may
predispose for its occurrence .
METHODS:
This is a case series hospital based study carried out in IB- IN- Al-Atheer teaching hospital of
pediatric in Mosul city. during the period from April 2013 to April 2014 . 460 cases with CHD
were compared with an equal number of controls selected from the general population and
individually matched for age, sex, and family practitioner Information was obtained by
Questionnaire sheets ,medical examination and investigations.
RESULT:
Out of 75320 attendants, 680 cases were referred to echocardiography unit where 460 cases of
CHD were detected, the prevalence was (6.1/1000 patients). Atrial septal defect (42. %),
ventricular septal defect was detected (30%) and Patent ductus arteriosus (9.3%) are the most
common CHD detected. More than half of cases of CHD (86%) are detected at infancy with
female- male ratio of 1.4:1 An association was found between family history, consanguinity
and occurrence of CHD. Also an association was found between maternal risk factors such as
mothers disease ,drug intake, obesity, smooking during pregnancy.
CONCLUSION:
CHD is a public health problem among infants and young children and there are many risk
factors showed a significant effect on its occurrence such as positive family history,
consanguinity and material risk factors during pregnancy So proper and timely counseling,
regular antenatal care. folate supplementation especially during the most sensitive period of
embryogenesis is essential to avoid congenital heart malformation

BACKGROUND:
Occasionally, coronary arteries without significant stenosis are observed during invasive treatment of
acute coronary syndrome (ACS).
OBJECTIVE:
The aim was to study the frequency and to determine the most predictive factors of Troponin positive
ACS without significant Stenosis on angiography.
METHODS:
The study involved one hundred twenty four patients admitted with Troponin positive ACS who
underwent cardiac catheterization during hospitalization. The primary end-point was the estimation of
coronary arteries without significant stenosis, and the secondary end-point was analysis of the most
predisposing factors. In evaluating the primary end-point, the patients were divided into two groups
according to the presence of ST elevation myocardial infarction (STEMI) or not. Also the patient who
has no significant coronary artery Stenosis (< 50%) was subdivided to two groups:
a- Myocardial Infarction with No critical lesion in Coronary angiogram (MINC)
b-Normal coronary angiogram
RESULTS:
Overall, 20 patients (61%) had coronary arteries without significant lesions, from which 8 patients
(6.4%) had MINC and 12 patients (9.6%) had normal coronary angiogram. The predictors were: female
sex (P=0.008), age <45 years (P=0.001), and the absence of: diabetes (P=＜ 0.001), hypertension
(P=0.005) and absence of ST-segment elevation (P=0.001). Furthermore absence of regional wall
motion abnormality (RWMA) is considered as another predictors for non-significant coronary artery
lesion (P=0.008). Also the angiographic analysis of all lesions revealed that single vessels CAD are the
commonest finding in Group I patients (P= 0.02). We further analyzed a suspicious angiographic
lesions by using QCA {18 lesions (14.5%)} and FFR {6 lesions (4.8%)} technique.
CONCLUSION:
Overall, patients with Troponin positive ACS had non- significant coronary artery Stenosis on
angiography, and female sex, age <45 years and the absence of diabetes, hypertension, ST- segment
elevation or RWMA were all associated with coronary angiography showing no significant stenosis.

BACKGROUND :
Coronary artery bypass grafting (CABG) can be divided according to it's timing into:elective, urgent,
emergency and salvage.The purpose of urgent CABG is to reperfuse the coronary artery blood flow
rapidly, improves areas of myocardial ischemia, repair ventricular dysfunction and prevent the spread
of the infarction area. Urgent CABG has a higher morbidity and mortality than elective CABG.
OBJECTIVE:
The purpose of this study was to identify preoperative and peroperative risk factors associated with this
morbidity and mortality, evaluate clinical outcomes and recommend the possible solutions.
MATERIALS AND METHODS:
This is a retrospective study that reviewed the hospital records of 50 patients who underwent urgent
CABG at the Iraqi Center for Heart Diseases for three years (2008-2010). The main daignostic tools
were coronary angiography and echocardiography. All underwent conventinal CABG on cardiopulmonary bypass with cardioplegic arrest. Variables that may be related to operative risk were
analaysed.
RESULTS :
Forty-three patients underwent isolated CABG, while six patients underwent postinfarction ventricular
septal defect repair and one patient underwent mitral valve replacement in addition to CABG,
Postoperative mortality was 20%.
CONCLUSION:
The most common cause of mortality was Low Cardiac Output Syndrome followed by Acute Renal
Failure.Preoperative risk factors for perioperative mortality were age more than 65 years, preoperative
cardiogenic shock and low ejection fraction below 40.

BACKGROUND:
Multiple sclerosis is an autoimmune inflammatory demyelinating disorder of the central nervous
system. Multiple sclerosis is now universally found to be more prevalent in women than men
OBJECTIVE:
The aim of the study is to clarify the role of gender in early onset multiple sclerosis
PATIENTS AND METHODS:
This retrospective study was conducted in the multiple sclerosis clinic archive system in the
Medical City Hospital in Baghdad, Iraq. Data collection was carried out between March 2008
and March 2009. The patients diagnosed to have relapse remitting multiple sclerosis according to
the revised McDonald’s diagnostic criteria for multiple sclerosis, and onset of disease must be
before the eighteenth birthday. For each patient, the following information was gathered: age,
gender, date of onset, and date of second attack, presenting symptom, and extended disability
status scale and the date, and type and location of MRI lesions. A p-value <0.05 was considered
the cutoff point to determine significant findings.
RESULTS:
Forty-eight of the patients where females (62.3%) and 29 patients where males (37.7%), with a
female: male ratio 1.6:1.
No significant difference was found regarding distribution of gender in each age group, and no
significant difference was found when age at onset was compared between males and females,
although in male patients a shift to children and a shift at adolescence in female were observed
The comparison of different radiological sites between males and females shows a significant
difference with more males having infratentorial lesions compared with females (P=0.033).
No significant difference was found between the two genders regarding, age at onset the
presenting symptom, mode of onset and no significant difference was found when interval
between the first and second attack was compared between males and females.
CONCLUSION:
Female preponderance was highest for subjects with disease onset at adolescents. No significant
difference was found when age at onset was compared between males and females, although in
male patients, a shift to children and a shift at adolescence in female were observed. A
significant difference in the time, between first and second attack between males and females. A
significant difference in the MRI findings was the finding that males had a higher incidence of
infratentorial lesion than females.

BACKGROUND:
Despite the predominance of tobacco smoking as its presumed etiology, lung cancer is also a
significant health problem in those with no history of smoking.
OBJECTIVE:
To assess the clinical and epidemiological characteristics of lung cancer in non smokers patients.
PATIENTS AND METHODS:
This was a retrograde across-sectional study conducted at Baghdad teaching hospital during the
period from 14th February 2012 to 8th January 2013. Including 100 patients with proved lung
cancer all were never smokers.Medical records of those patients were revised, data were collected
regarding sociodemographic characteristics of patients and medical history in addition to the
clinical characteristics. Data analyzed with SPSS software, and the results were presented in
tables and figures accordingly.
RESULTS:
In the current study 100 patients with different types of lung cancer were included, all were
never smoker.
Female gender was more common than males .In this study majority of the cases were aged 60
years and more.The prevalence of passive smoking among studied group was (39%),Urban
residence was the dominant, 74%.
On X-ray examination all the patients had positive findings; (99%) had unilateral findings and
only one with bilateral.Adenocarcinoma was the predominant type, (51%) of the cases, which is
much higher than the prevalence of other types. Adenocarcinoma was significantly predominant
among females than males (64.7%) vs. (35.3%) respectively, P= 0.003.
majority of the cases were of stage IV (78%) and stage III (22%), this reflected the late
presentation of the patients.Vast majority of dead cases (96.5%) were died within 2 years, and
only 3 patients were survived for three years while none of the cases were survived for more than
3 years.
CONCLUSION:
The prevalence of lung cancer in non smoker women was higher than in men. In this study the
prevalence of lung cancer seemed to be increased with the advancing age. Passive smoking was
an important risk factor for lung cancer in more than one third of studied group, and women were
more likely to be affected.

BACKGROUND:
Thalassemia is an inherited autosomal recessive blood disease caused by genetic defects result in
reduced rate of synthesis of one of the globin chains that make up hemoglobin. The combination of
transfusion and chelating therapy has dramatically extended the life expectancy of thalassemic
patients.
OBJECTIVE:
The objective of this study is to determine the factors associated with short stature in thalassemic
patients and main endocrine complications.
PATIENTS AND METHODS:
A case-control study was performed prospectively in Ibn-Al Balady hospital in (Al- Sader cityBaghdad- Rasafa) for the period extended from the 1st of January to 31st of May (2013). Data were
collected from 181 thalassemic patients, their ages were 10 to 20 years old being attended the
hospital for regular follow up and blood transfusion. The control in this research work was one of
the patients' relatives with the same age after thalassemia was ruled out in the control. Data
collected in this study included: age, sex, height and weight were assessed by the National Center
of Health statistics (NCHS) growth curves , history of splenectomy, times of blood transfusion ,
hepatitis infection, type of chelating agent. Serum ferritin, hormones level, fasting and random
blood sugar and serum calcium were estimated.
RESULT:
It was founded that 79% of the β-thalassemic patients had short stature (their height equal or less
than5rd percentile) with significant relation with high serum ferritin (P-value=0.006). Delayed
puberty was the commonest endocrine complication in thalassemic patients (83.9%).
CONCLUSION:
High serum ferritin is associated with growth retardation and many endocrine complications .
Aggressive iron-chelating therapy and regular measurement of hormones concentration are
necessary for thalassemic patients mainly during puberty to avoid growth retardation.

BACKGROUND:
The Philadelphia-negative classical chronic myeloproliferative neoplasms are characterized by
proliferation of one or more cell lines in the bone marrow and increased number of mature and
immature cells in the peripheral blood. These myeloproliferative neoplasms include; polycythemia
vera, essential thrombocythemia and idiopathic myelofibrosis, in which JAK2V617F is by far the
most prevalent mutation. Because of the rapid turnover of cells in these neoplasms, derangement in
the serum levels of vitamin B12 and folate is expected.
OBJECTIVE:
To assess the possible correlation of serum B12 and folate levels with JAK2V617F mutation in
patients with polycythemia vera, essential thrombocythemia and idiopathic myelofibrosis.
PATIENTS AND METHODS:
This case-control study was conducted from December 2012 to December 2013, and enrolled 54
patients, diagnosed as polycythemia vera (36), essential thrombocythemia (6) and idiopathic
myelofibrosis (12), attending Medical City, Baghdad Teaching Hospital. Twenty healthy
volunteers were included as a control group. JAK2V617F mutation status had been reviewed at time
of sampling. The following investigations were done: automated complete blood counts; serum
B12 and folate were measured using the electrochemiluminescence immunoassay.
RESULTS:
The mean levels of serum B12 and folate were much higher in myeloproliferative neoplasm
patients than control group (p-value of 0.028 and 0.004 respectively).
Serum B12 level showed significant difference between polycythemia vera patients with positive
JAK2V617F and negative mutation (p= 0.04), while no significant difference was found for serum
folate level (p= 0.630). Insignificant differences were also found for idiopathic myelofibrosis
patients (B12, p= 0.140; and serum folate, p= 0.098), and essential thrombocythemia patients (B12,
p= 0.133; and serum folate, p= 0.800).
Correlations of serum folate and B12 with hematocrit, white blood cell count, absolute neutrophil
count, platelet count, mean cell volume, and mean cell hemoglobin in myeloproliferative neoplasm
patients: significant correlations were only found in PV patients between B12 and total white blood
cell count, absolute neutrophil count and platelet count (p= 0.009, 0.012 and 0.002 respectively).
CONCLUSION:
There is derangement in the levels of serum B12 in patients with polycythemia vera in relation to
JAK2V617F mutation, thus we may propose that this mutation may have a possible impact on
polycythemia vera patients, in particular, reflected by higher levels of serum B12 through the
associated increase in absolute neutrophil count.

BACKGROUND:
Pseudomonas aeruginosa (P. aeruginosa) is the most frequently isolated bacteria in clinical
cases of ulcerative keratitis. P. aeruginosa produces several proteases and toxins, the best
characterized being exotoxin, elastase, alkaline protease and IV. These are all important factors
in the establishment of bacterial infection and the amount of damage caused by the infection to
the cornea.
OBJECTIVE:
The aim of the present study was to study the role of P. aeruginosa proteases ( elastase ( LasB)
, LasA, Alkaline protease, and protease IV ) in corneal ulceration by using Real - time PCR.
METHODS :
One hundred - twenty clinical samples (corneal scraping) were collected from patients suspected
with bacterial keratitis presenting to Ibn –Alhaytham Teaching Hospital from May 2013 until
November 2013. Methods for isolation and identifying P. aeruginosa based upon culture
coupled with biochemical tests and confirmed by new technique called Vitek 2 compact system.
The role of proteases enzymes ( elastase ( LasB), LasA, alkaline protease and protease IV ) of P.
aeruginosa in the corneal ulceration was studied by Real – time PCR.
RESULTS :
Real time aalysis demonstrated that three bacterial isolates of P. aeruginosa were possessed
elastase gene (11.5%), one bacterial isolate was harbored LasA gene (3.8%), twenty bacterial
isolates were possessed protease IV gene ( 76.9%) , and all bacterial isolates were possessed
alkaline protease gene (100%).
CONCLUSION:
The presence of the alkaline protease and protease IV genes in almost bacterial isolates of P.
aeruginosa improved the fact that these enzymes were not only tissue damaging but also very
important colonizer agents to cornea.

BACKGROUND:
Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease that commonly
affects the small joints of the hands and feet, and results in irreversible joint damage, deformity,
and functional impairment.
Hand function is an important domain of the health status of RA patients. Assessment of hand
function, therefore, is an essential part in the follow-up of RA patients and in gauging their
response to treatment.
Numerous measures were developed to evaluate the hand function. One widely accepted measure
includes simple clinical tests: Key grip, ball grasp, pen grasp, pinch grip and grip strength.
OBJECTIVE:
This study aims to determine the effect of hand deformities on hand function in a sample of
patients with RA.
PATIENTS AND METHODS:
A cross-sectional study was conducted on 116 randomly selected Iraqi patients fulfilling the 2010
ACR/EULAR criteria for Classification of RA. Patients with other conditions that can affect the
hand function were excluded.
Patients were evaluated for age, hand deformities and Disease Activity Index (DAS28). A novel
score was used to combine all hand deformities into one value.
Hand function was assessed by 3 subjective tests (key grip, pen grasp and ball grasp) and 2
objective tests (pinch strength and grip strength, measured by specialized dynamometers).
RESULTS:
Objective hand function tests (mean grip strength and mean pinch strength) had significant
moderate negative correlations with the score of hand deformities (p<0.001, r=-0.459 or better),
while the mean ranks of impairment of subjective hand function tests (key grip, pen grasp and ball
grasp) showed significant weak positive correlations with the score of hand deformities (p=0.002
or less, r=0.283 or more).
CONCLUSION:
The presence and degree of hand deformities are significantly associated with poor hand function
in patients with rheumatoid arthritis.

BACKGROUND:
Interleukin 6 (IL-6), a pro-inflammatory cytokine, plays a key role in the development of
rheumatoid arthritis (RA). Transforming growth factor-beta1 (TGF-β1) is an anti-inflammatory
cytokine which is considered to be an important (down) regulator of inflammation in RA.
OBJECTIVE:
To evaluate serum concentration of IL6 to TGF-β1 ratio in a sample of Iraqi patients with RA.
METHODS:
A case control single center study was conducted for 11 months. A total of 50 patients with RA
diagnosed according to the 1987 American College of Rheumatology (ACR) and 30 individuals
matched in age and sex as control group were included. Serum concentration of IL-6 to TGF-β1
ratio and serum IL-17 were determined in both RA groups using enzyme-linked immunosorbent
assay (ELISA). The cut off value was assessed by receiver operating characteristics (ROC) test and
correlation by spearman's Rholinear correlation coefficient.
RESULTS:
Frequency of females was more than males in patients and controls (88% and 76.7% respectively).
Ages of patients range between 20-70 years with a median 43.76 years while in controls, ages
range between 20-60 years with a median 37.67 years. Serum concentration of IL-6 toTGF-β1 ratio
was significantly more in patients than those in controls (p=0.018). Area under the curve (AUC) at
value 0.686 was statistically significant (p=0.018) and had intermediate accuracy. Serum IL-6 to
TGF- β1 ratio≥ 2.4pg/ml was the optimum cutoff value that can differentiate between RA and
healthy controls with accuracy 71.9%. There was a significant positive linear correlation between
IL-6 to TGF-β1 ratio and IL-17( r=0.56, p<0.001) and simple linear regression analysis showed
that for each 1unit increase in IL6 to TGF-B1 ration there was a significant increase of 0.7
pcg/ml in IL-17(R2=0.467, P < 0.001)
CONCLUSION:
Serum concentration of IL6 to TGF-β1 ratio was significantly higher in Iraqi sample of RA patients
compared to controls. This may help in early diagnosis of RA and suggest potentially an early
effective treatment.

BACKGROUND:
Uterine leiomyomas are important, common pathological conditions that impose a major healthcare
burden. Leptin, a product of the obese (Ob) gene, is produced predominantly in adipose tissue and
expressed in several tissues and organs and in myomas and the surrounding myometrium.
OBJECTIVE:
To assess serum leptin levels in women with and without uterine leiomyomas.
METHODS:
This prospective case- control study was carried out on ninety women in their reproductive age. They
were divided into two groups; the study group consisted of 45 women with uterine leiomyomas proved
by histopathology after operation, and a control group consisting of 45 healthy women without uterine
leiomyomas proved by ultrasound examination. Body mass index (BMI) was calculated in all women.
Blood samples were collected from all women in both groups in the proliferative phase of their
menstrual cycle. Hemoglobin, blood urea nitrogen, serum creatinine, fasting blood sugar and serum
leptin levels were examined. Serum leptin levels were determined by Radioimmunoassay and compared
in myomatic and normal women.
RESULTS:
The mean serum leptin levels were significantly lower (p=0.0001) in the myomatic women (7.57± 2.88
ng/mL) than in the normal women (9.56± 1.77 ng/mL). The mean ratios of serum leptin levels / body
mass index in the myomatic women (0.267± 0.09) were significantly lower (p=0.0001) than in the
normal women (0.34±0.05). In addition, a significant correlation was found between serum leptin levels
and body mass index in both the myomatic women (r=0.587, p=0.0001) and the normal women
(r=0.608, p=0.0001).
CONCLUSION:
In myomatic women compared to normal women, the lower serum leptin levels observed were
independent of body mass index with no significant up-regulation of leptin production in response to
increased adiposity.

BACKGROUND:
Coriandrum Sativum is a native of Mediterranean region and is grown in North Africa, central
Europe, and Asia as culinary herb and medicament. In addition to the other health-supporting
reputation, coriander has hypoglycemic, hypolipidemic, and aphrodisiac effects.
OBJECTIVE:
To study the effect of Coriandrum Sativum on process of spermatogenesis.
MATERIALS AND METHODS:
Coriandrum sativum was given daily to mature male rats in a dose of 50mg/ 100g body weight for 14
days. 10% formalin fixed paraffin-embedded tissue sections were performed for histological and
morphometrical studies.
RESULTS:
Histological study showed wider seminiferous tubules & increased spermatocytes population with an
increased sperm density in the lumen of the tubules. Morphometrically, the diameters & thickness of
the germinal epithelia of the seminiferous tubules were significantly increased in coriander treated
rats than that of the control group.
CONCLUSION:
Coriandrum sativum appeared to be stimulant to the process of spermatogenesis.