Iraqi Postgraduate Medical Journal

BACK GROUND:
Measurement of protein excretion in a 24-hour urine collection has been the long-standing goldstandard but time consuming test for the quantitative evaluation of proteinuria induced by
preeclampsia. An alternative method is the measurement of protein- creatinine ratio in a spot urine
sample, which provides a more convenient and rapid method to assess protein excretion.
OBJECTIVE:
To assess the correlation between the spot urine protein- creatinine ratio and 24-hour urine protein
excretion in women with preeclampsia and to use the urine protein- creatinine ratio as alternative to
time-consuming 24-hour urine protein collection.
Study design: A cross sectional study.
Setting: Department of Obstetrics and Gynecology at Al-Yarmouk Teaching Hospital for a period
of one year from Jan. 2013 to Jan. 2014
PATIENTSAND METHODS:
Eighty three singleton pregnant women suffering from pre-eclampsia with gestational age between
28 to 39 weeks were selected to participate in the study. They were divided into two groups:
61pregnant women with mild to moderate pre-eclampsia and 22 with severe pre-eclampsia.These
women were prospectively studied for proteinuria. Urine protein- creatinine ratio was determined
in a spot mid-stream urine sample, and the amount of protein excretion was measured in 24-hour
urine collected on the subsequent day. The correlation between the two tests was assessed.
RESULTS :
Diagnostic value of protein/creatinine ratio was expressed in terms of specificity and
sensitivity.There was significant correlation between protein/ creatinine ratio in a single void urine
with 24 hr. urine collection for protein as the P value was (0.0001), The ROC curve analysis
showed an area under the curve of (0.879), indicating that the urine protein: creatinine ratio can
detect severe proteinuria at a cutoff point of 4.2 with a sensitivity of (81.8%) and specificity of
(85.2%).
CONCLUSION:
There is a significant correlation between the spot urine protein/ creatinine ratio and 24-hour urine
protein excretion in women with preeclampsia.

BACKGROUND:
Threatened miscarriage is a distressing condition to both pregnant woman and gynecologist. It is
important to predict the outcome of threatened miscarriage through maternal history, biochemical
tests, and fetal ultrasound for patient counseling and to avoid delay in management.
Study design
A prospective multiple logistic regression analysis study.
OBJECTIVE:
To assess the power of factors which are maternal history (age, vaginal bleeding, parity and
hypertension), biochemical tests (β-hCG & serum progesterone level) and fetal ultrasound (crown
rump length& fetal heart rate) for predicting the outcome of pregnancy (fetal demise & ongoing
pregnancy) complicated by threatened miscarriage between 7-11 wks and to determine the time
interval from onset of symptoms to fetal demise development.
PATIENTS AND METHODS:
The study was carried out on 80 pregnant women at their 7-11 weeks of gestation suffering from
vaginal bleeding attending Al-Elwiya Maternity Teaching hospital. They were subjected to
ultrasound to confirm fetal viability, assay of serum progesterone and β-hCG levels and pain with
bleeding scores. All these were repeated on weekly basis for four weeks follow up to monitor the
pregnancy and identify the period to fetal demise (if happened). The data is gathered on
questionnaire paper and then subjected to statistical study.
RESULTS:
The β-hCG (human chorionic gonadotrophin hormone) level was found to be the main predictor
for pregnancy outcome (miscarriage/fetal demise & ongoing pregnancy) and highly statistically
significant (P value<0.0012), followed by bleeding (p <0.002) and maternal age (p<0.01)
respectively, while other variables (serum progesterone, fetal ultrasound, parity) showed no
statistically significant effect (P value=0.47, 0.63, 1.146 respectively) on the risk of
miscarriage/fetal demise. Serum progesterone level was highly significant in predicting ongoing
pregnancy (P value=0.001)
CONCLUSION:
Measuring of beta hCG levels is found to be a good predictor for the outcome of the first trimester
threatened miscarriage whether ends in to fetal demise or continuing pregnancy, while other factors
like ultrasound, serum progesterone levels and parity are useful in assessing an ongoing pregnancy
but have no power in predicting possibility of fetal demise. Also measuring the interval from the
onset of bleeding to fetal demise development can be useful to avoid delaying pregnancy
management.

BACKGROUND:
Most women with polycystic ovary syndrome PCOS don’t even know that they have it ,and do
not get a diagnosis until they begin trying to get pregnant.
OBJECTIVE:
To identify the prevalence of the polycystic ovary syndrome (PCOS) among infertile women
attending the Institute of Embryo Research and Infertility Treatment in AL-Kadhymia\Baghdad,
and to identify some of the common characteristics of infertile women with PCOS and others
without PCOS .
METHODOLOGY:
A cross sectional study was conducted for about four months,during which a review of records
of all the women attending the Institute during the year 2010 (six hundred women) .
RESULTS:
Results showed that the most common factors of infertility in infertile women is the PCOS,
PCOS had a higher frequency among women aged 20-29 years, Slightly higher frequency of
diabetes mellitus and hypertension among them than other group. higher frequency of acne &
hirsutism among the PCOS cases than other causes group, and a higher frequency of increased
prolactin level& LH level in the PCOS cases.
CONCLUSION:
PCOS infertility comprises more than one fourth of causes of infertility and is associated mainly
with primary infertility & among younger age group(20-29years) .

BACKGROUND:
There is increasing evidence that high-risk human papilloma virus (HPV) is involved in cancers other
than cervical cancer. A number of reports have identified HPV DNA in breast tissue and breast
cancer specimens, suggesting that the virus could play a role in the pathogenesis of this tumor.
OBJECTIVE:
The aim was directed towards the use of In situ molecular methods to localize the virus in breast
tissue. In addition, this study investigated the prevalence of high-risk HPV infections in Iraqi women
with and without ductal carcinoma (DC) of the breast.
PATIENTS AND METHODS:
29 cases of ductal carcinoma and 44 controls obtained from adjacent area to benign breast. Formalin
fixed, paraffin embedded specimens were used by In situ hybridization technique for detection of
HPV16 subtype. Data analysis was performed by SPSS 20 software using descriptive statistics and
Chi-square tests.
RESULTS:
The HPV16 were identified in 69% and 27.3% of the ductal carcinoma and control breast tissue
specimens respectively. Statistically, the difference between the normal and ductal carcinoma cases
were highly significant (P=0.001).
CONCLUSION:
HPV16 In situ hybridization revealed statistically significant increase in DC (69%) as compared to
controls (27.3%) and most of them were localized in the nuclei in integrative form. HPV16 were
detected in skin and mammary tissue in both DC an control cases. This may indicates a role of
HPV16 in the pathogenesis of DC.

BACKGROUND:
Dacryocystorhinostomy (dcr) is the standard trcatmert for nasolacrimal duct Obstruction .based on
opening the lacrimal sac, which is connected to the nose, by removing the bone and the mucosa
between these two structures at the level of the middle meatus.
OBJECTIVE:
To highlight the procedure of endonasal endoscopic dacryocystorhinostomy.
PATIENTS AND METHODS:
This was a prospective study conducted at Ghazy Al- hariri teaching hospital for surgical
specialties during the period from 22nd of February 2011to the 4th of March 2013. A total of 22
patients were referred from the ophthalmologist for endoscopic dacryocystorhinostomy after had
been diagnosed as distal obstruction of nasolacrimal duct or sac. Data were collected and all
patients were investigated with general pre-operative investigation in addition to CT scanning to
exclude any associated abnormalities or neoplasm and rigid nasal endoscopy were performed for
all patients. Intranasal decongestant and steroids along with oral antibiotic were given preoperatively in 14 patients. Endoscopic dacryocystorhinostomy was performed; the patients were
followed up for 6 months and evaluated regularly for any complication.
RESULTS:
The mean age of the patients was (32.9 ± 12.7) years with range of (12– 69) years. About 59% of
the patients aged 21-40 years. Females were predominant with a female to male ratio of 3.4:1. All
patients had mucopurulant conjunctival discharge. The median duration of presentation was 5-6
months. The DCR performed eleven in right side and eleven in left side, and 4 associated operation
were conducted for management of associated abnormalities. Eight complications developed
during different time of follow up and only one patient needed re insertion giving a success rate of
95.5%.
CONCLUSION:
The endoscopic endonasal DCR is a safe procedure for the treatment of nasolacrimal duct
obstruction and with high success rate and less serious complications.

BACKGROUND:
Keratoconus is a progressive non inflammatory bilateral (usually asymmetric) ectatic corneal
disease characterized by paraxial stromal thinning ,weakening that lead to corneal surface
distortion ,vision loss primarily from irregular astigmatism and myopia and secondly from corneal
scar.
OBJECTIVE:
To evaluate visual and refractive outcomes after intracorneal continuous ring (ICCR) implantation
combined with intrapocket corneal collagen cross linking in patient with keratoconus.
Setting: Eye Specialty Private Hospital, Baghdad, Iraq.
METHODS:
This study assessed the results of implantation of Myoring ICCR combined with CXL in 40 eyes
with KC. Outcome measures include UDVA,CDVA(spectacle correction),refraction, complications
and side effects. Postoperative follow- up was up to 1 year.
RESULTS:
The study evaluated 40 eyes of 34 patients with a mean age of 25.75 years. Preoperatively, the
pachymetry at thinnest location range from (367_555ϻm) and the mean keratometry (K) readings
50.51± 3.94D. Post operatively ,there was statistically significant improvement in the
UDVA,CDVA,K reading ,manifest spherical and cylindrical refractive errors ,and spherical
equivalent (p<.05).The mean UDVA improved by 13 lines ,CDVA improved by 3.5 lines and the
mean K reading decreased by 7.14 D .No serious intraoperative complications occurred .Side
effects includes glare and night vision problems.
CONCLUSION:
Treatment of KC with simultaneous ICCR implantation and intrapocket collagen cross linking
significantly improved visual and refractive outcomes .the UDVA and CDVA continuously
improved during the 1st year postoperatively.

BACKGROUND:
Vertebro-basilar dolichoectasia (VBD) is an uncommon vasculopathy of unclear origin affecting the
arterial wall of vertebral artery (VA) and basilar artery (BA). A variety of clinical syndromes and
neuroimaging features have been associated with VBD.
OBJECTIVE:
This cross sectional study is conducted to shed a light on the neuroimaging signs of VBD and explore
the association between the clinical presentation and imaging parameters of VBD in patients
clinically suspected to have VBD with neuroimaging diagnosis.
MATERIAL AND METHODS:
This randomized cross sectional study was performed in Middle Euphrates Neuroscience Centre in
Annajaf city between April 2012 to December 2012,A 34 patients with neuroimaging diagnosis of
VBD (18 patients by MRI and 16 patients by MDCT) were included, VBD were assessed by studying
the basilar artery width (BAW), bending length (BL) and level of basilar artery bifurcation according
to Dan Deng et al criteria. The findings were correlated with patient clinical presentation.
RESULTS:
Thirty four patients, (24 males & 10 females) with age range between 25-81 years and mean of 57.9
year were included in this study. Among all presenting symptoms, only headache showed statistically
significant association (p value <0.05) with the width of the basilar artery. There was higher
prevalence of single cranial nerve involvement (SCNI) in patients with more tortuous basilar artery
(55.5% of those with BL more or equal to 10 mm versus 16% of those less than 10 mm) with
statistically significant association (p value <0.05), suprasellar extension was seen in 26.4% of cases
and showed significant association with headache and visual symptoms.
CONCLUSION:
\VBD is an important clinical entity and could be associated with or responsible for many serious
clinical presentations, special attention is needed for VBD diagnosis and it's parameter during
evaluation of brain imaging especially in patients with un-explained or vague presentation.

BACKGROUND :
Post-operative adhesions form a main lifelong surgical issue, Adhesive intestinal obstruction
remains the main complications of adhesions.multiple Risk factors play an important role in the
initiation of the disease and its Management.
OBJECTIVE:
To identify the risk factors that increases the incidence of Adhesive intestinal obstruction and the
complication of surgical intervention.
PATIENTS AND METHODS :
One hundred and eight patients with adhesive Intestinal obstruction (out of two hundreds and ten
patients with acute intestinal Obstruction) were admitted to the surgical wards of Al-Yarmouk
Teaching Hospital, studied prospectively for the period between the 1st of January 2013 and the
30th of April 2014 . Data obtained regarding different parameters like Age ,sex, number and types
of previous operations,management of those patient Whether conservative or operative.
RESULTS:
Adhesive intestinal obstructions are (51.43%) of the total cases with Acute intestinal obstruction.
The highest incidence was among age group between 30-39Year, (32.4%). Explorative
laparotomy are the main risk factors for postoperative adhesions with an incidence of 29.6%. The
recurrence rate after surgery For adhesive intestinal obstruction is 13.8%.
CONCLUSION:
Since the recurrence rate after surgical Intervention in adhesive intestinal obstruction is relatively
low, the role for conservative measures may be limited to a short period of time.

BACKGROUND:
During the last decade focused assessment with sonography for trauma increasingly has become
the initial diagnostic modality of choice in trauma patients.
OBJECTIVE:
This study was carried to evaluate the sensitivity, specificity and accuracy of FAST when done by
residents in the emergency surgical department, & its effect in determining the type of
management.
PATIENTS AND METHOD:
210 patients with blunt abdominal trauma were assessed with FAST within 30 minutes from
admission to the emergency room. FAST results were considered positive if it detected intra
peritoneal fluid , negative if it did not detect intra peritoneal fluid , and indeterminate (equivocal) if
the results were not conclusive.
In cases with negative Fast results and no other injuries were detected the patients were kept in the
emergency department for 24 hours for observation and discharged later on.
Those with indeterminate initial FAST or who deteriorated clinically after negative initial FAST
were subjected to repeated FAST and / or emergency abdominal and pelvic computed tomography
(C.T scan) or explorative laparotomy according to their clinical condition.
Patients with positive ultrasonography results underwent emergency abdominal or pelvic C.T, or
surgery according to their clinical picture.
RESULTS:
From the 210 patients included in the study we found that 177 patients (84.2) % had negative
FAST results, 22 patients (10.4)% had positive FAST results , 2 patients (0.95)% had false positive
results , 8 patients (3.8)% had false negative FAST results and 11 patients (5.2)% had equivocal
FAST results.
After exclusion of equivocal cases , FAST had sensitivity of (71.4)% specificity of (98.8)% ,
accuracy of (89.1)%, positive predictive value of (90.9)% and negative predictive value of(95.4)%.
CONCLUSION:
FAST is useful adjunct to the initial evaluation of blunt trauma patients with reliable accuracy &
high negative predictive value.
FAST had a great effect in determining the type of treatment especially in case of mass causality.
And using FAST by general surgeons helps in the determination of the type of treatment for
patients with blunt trauma.

BACKGROUND :
Tracheal resection and primary re anastomosis for tracheal stenosis or tracheal tumor is not
uncommon operation .
OBJECTIVE:
To assess the aetiology of stenosis of cervical trachea and their surgical reconstruction .
PATIENT AND METHODS:
This is a retrospective study of forty patients with cervical tracheal stenosis ,who were treated at
Ibn Al Nafees Hospital during six years period from January -2006 to October -2012 .It illustrates
the diagnostic methods and the surgical techniques of reconstruction .
RESULTS:
Most of the patients ,were male (80%) and only (20%) were female .The most common etiological
factor was post intubation stenosis (70%),less common cause was traumatic stenosis and the least
was neoplastic stenosis . Progressive dyspnea was the most common presenting clinical feature
.The mean length of resection was three rings .Seven patients developed complications , and dealt
with successfully with one mortality .
CONCLUSION:
Bronchoscopy and radiography remain the main diagnostic tool for evaluating it .Resection and
end to end anastamosis is the best method of treatment In special cases .Some cases can be treated
by endoscopy and laser therapy .

BACKGROUND:
It is an inflammatory disease of lungs with consolidation of one or more lobes caused mostly by
Streptocccus pneumoniae bacteria. It is a worldwide disease with high mortality among children
less than 5 years old.
OBJECTIVE:
To determine the proper empirical antibiotic treatment for lobar pneumonia in hospitalized
children and the correlation between the blood culture result and response to treatment.
METHODS:
A Cross sectional study was performed between January 2013 through December 2013 to 69
patient admitted to Central Teaching Hospital Of Pediatrics in Baghdad, aged more than two
months to ten years, all of them met the WHO case definition of pneumonia, data was collected
from the mothers for (age, sex, previous health and vaccination status). Blood sample was
collected for blood culture and sensitivity for all patients.
RESULTS:
The study showed that of 69 patients hospitalized with lobar pneumonia 69.5% were males, and
30.5% were females, 82.6% of patients were in an age group less than one year. The study found
that 69.6% of patients were not vaccinated and they were mostly less than 1 year. The response
to treatment range from 88.8%-94% and Blood culture was negative in 95.6% of samples.
Mortality rate was 4.3%
CONCLUSION:
Treatment with Ceftriaxone (3rd generation Cephalosporine) alone is effective as an empirical
treatment for lobar pneumonia in hospitalized patients, so no need for combination therapy of
Ceftriaxone and Vancomycin and the Blood culture was negative for Streptococcus pneumoniae
in all cases so the results of Blood Culture had no correlation with response to treatment.

BACKGROUND :
Aortic valve calcification in End Stage Renal Disease (ESRD) patients occurs ten to twenty years
earlier than general population. It is associated with myocardial, coronary arteries and conduction
system calcification and it is associated with rapid development of aortic valve stenosis.
OBJECTIVE:
To study the incidence of aortic valve calcification in hemodialysis patients and to look for risk
factors associated with this calcification.
PATIENTS AND METHODS:
Forty six patients with End Stage Renal Disease (ESRD) on regular haemodialysis in Baghdad
Teaching Hospital / Dialysis Unit and forty six patients with no renal disease as control group were
studied between February 2005 - January 2006. Duration of dialysis, blood flow rate during dialysis,
serum Calcium, serum Phosphorous and their products were included in this study. Echocardiography
was done for all patients.
RESULT :
The incidence of Aortic Valve Calcification (AVC) in ESRD patients on haemodiaysis was 30 % and
it was higher than that of general population ( p value 0.0085) . It occurs 10-15 year earlier than in
patients with no renal disease. End Stage Renal Disease patients with AVC were older than those with
non calcified valves. Only 7.4 % of those ESRD patients with AVC have hemodynamic AV stenosis
( p value 0.5 ). The mean duration of haemodialysis in ESRD patients with AVC was longer than that
of ESRD patients without AVC which was statistically significant. Also there was statistically
significant association between blood flow rate during haemodialysis and AVC. There was
statistically significant association between Calcium phosphate products and AVC in ESRD patients.
CONCLUSION:
There is ahigher incidence of aortic valve calcification in ESRD patients on haemodialysis . This
calcification occurs earlier than that in patients with no renal disease .The duration of haemodialysis is
a risk factors for AVC .

BACKGROUND:
Multiple sclerosis is an inflammatory demyelinating disease of the central nervous system affecting
nearly 2 million people worldwide. Multiple sclerosis typically begins in early adulthood and has a
variable prognosis.
OBJECTIVE:
To determine the factors that affects the prognosis in Iraqi patients with relapsing remitting
multiple sclerosis.
PATIENTS AND METHODS:
This study includes fifty patients with relapsing remitting MS and was conducted from March 2007
to July 2008 in Baghdad Teaching Hospital MS clinic. A study protocol sheet was done and filled
from the patient’s database in the MS clinic. The prognostic indicator of residual disability depends
on the Expanded Disability Status Scale (EDSS).
RESULTS:
The mean age for the study sample was 45.58 years, with 27 male and 23 female. High percentage
of patients presented as monosymptomatic (70%), most of the symptoms was spinal (48%). The
mean value for relapses was 2.3 with maximum number of 6. The study shows that there is no
significant effect of gender as a prognostic indicator on the residual disability of patient with
relapsing remitting MS. There is significant correlation between the age at CDMS and the EDSS in
the first visit (EDSS1).
CONCLUSION:
We concluded that the older age at onset, pyramidal and sphincteric involvement at the beginning
of the illness and more relapses in the first 2 years of the illness all are associated with poor
prognosis.

BACKGROUND:
Thyroid cancers are neoplasms originating from follicular thyroid cells thought to be related to a
number of environmental and genetic predisposing factors. Human Papilloma Virus (HPV) is one
among their associated infective agents.
OBJECTIVE:
To determine the frequency of human papilloma virus genotype-16 in infection in a group of iraqi
patients with papillary thyroidcell carcinoma
MATERIALS AND METHODS:
A total number of 64 patients with different thyroid lesions were collected during 2008-2013; 30
have thyroid cancers, 22 benign thyroid tumors while12 healthy thyroid tissues were used as
control group. In situ hybridization(ISH) was used to localize high risk HPV-genotype 16 in these
tissues.
RESULTS:
Among malignant thyroid tumors 53.3% patients had HPV-16 while 27.3% HPV-16 positivity was
detected in benign thyroid tumor group. None of healthy thyroid tissues revealed ISH reactions.
There was 38.5% female had HPV-16, while there was 28% male had HPV-16. No significant
statistical associations were noticed between the presence of HPV-16 and the age of those patients.
CONCLUSION:
Human papilloma virus genotype-16 could share a role in pathogenesis of this group of patients
with thyroid cancers.

BACKGROUND:
blood donation is a safe procedure and thousands of persons donate blood without any ill effect,
however, few donors show adverse donor reactions.
OBJECTIVE:
To assess the occurrence of adverse donor reactions in a sample of blood donors attending Iraqi
National Blood Bank in Baghdad
PATIENTS AND METHODS:
This is a cross sectional study, carried out in Iraqi National Blood Bank (INBB) between October
and December 2013. The donors included in the study randomly. Especial form was prepared for
each donor and the required information was recorded including the adverse reactions that were
observed during donation and later for 15 minutes.
RESULTS:
The study included 200 blood donors; their mean of age was 35 years with range of (19-66) years;
their mean of weight was 88 Kg with range of (62 -152) kg.
Twenty seven (13.5%) donors showed adverse reactions during the first 15 minutes post donation
and the most frequent reaction was hematoma at the venipuncture site with frequency of 4 % from
all donors and followed by pallor and sweating with frequency of 3.5 % for each reaction; nausea
and dizziness 3% for each, muscular twitching 1.5%, weakness and syncope 1% for each while the
least frequent reaction was convulsion with a frequency of 0.5%.
The results showed that donors taking breakfast and donors with previous donations showed
significantly less frequency of adverse reactions.
CONCLUSION:
Blood donation is a safe procedure and 13.5% of the studied donors showed adverse donor
reactions and the most frequent reactions were hematoma followed by pallor and sweating while
the least frequent reaction was convulsion and donors taking breakfast and donors with previous
donations showed significantly less frequency of adverse reactions

BACKGROUND:
Vitamin D has an important biologic activity including cellular proliferation, differentiation,
immune system modulation and muscle strengthening. Vitamin D is considered as essential
environmental factor in the etiology of T-cell mediated auto immune disease.
OBJECTIVE:
To estimate the level of vitamin D3 in a sample of healthy students in Baghdad College of
Medicine and correlation of the various variables to the levels of vitamin D3.
SUBJECTS AND METHODS:
A cross–sectional study was conducted on 90 healthy Iraqi Students in Baghdad College of
Medicine, from 1st March 2014 to 30th October 2014. Subjects had history of chronic illness,
smoking, alcohol consumption, pregnancy, post-menopause and chronic use of medication was
excluded from the study. Subjects were evaluated for age, gender, body mass index, dietary habit,
walking exercise and graduate level of students (undergraduate or postgraduate). Venous blood
samples were obtained from all subjects to estimate serum level of 25 hydroxy vitamin D3 using
enzyme –linked immunosorbent assay (ELISA).
RESULTS:
The frequency of female was more than males (63.3% versus 36.7%) with mean age of 32.24±9.59
years. Mean serum vitamin D3 level was 18.33± 8.8 ng/ml. There was significant higher level of
vitamin D3 in the undergraduate student than postgraduate (22.29 ng/ml versus 15.93 ng/ml) with p
value = 0.001. Subjects who consume vegetables rich diet had higher serum of vitamin D3 than
those who consume more meat and balanced diet (27.467, 16.975 ng/ml and 15.971 ng/ml) with p
value <0.001. Subjects who used to exercise and perform daily exercise > 30 minutes per day have
higher level of vitamin D3 than subjects who exercised ≤ 30 minutes, and subject without exercise
(29.27 ng/ml, 22.91 ng/ml and 16.34 ng/ml respectively) with p value < 0.00. Obese students have
vitamin D3 level higher than over weight and normal weight students (25.85, 20.12 and 16.17
ng/ml respectively) with p value < 0.00. Gender did not exhibit statistical difference (male 18.42
ng/ml and female 18.28 ng/ml).
CONCLUSION:
Most studied subjects had mild to moderate vitamin D inadequacy. Subjects who consume more
vegetable, perform brisk daily walking exercise, undergraduate and overweight have higher mean
level of vitamin D3 while the gender have no effect on mean level of vitamin D3.

BACKGROUND:
Tuberculosis is one of the oldest diseases known to affect humans, it caused by infection with
Mycobacterium Tuberculosis, which is part of a complex organisms including M.bovis ( reservior
Cattle ) and M.africanum ( reservior human ). Mycobacterium Tuberculosis is most commonly
transmitted from a patient with infectious pulmonary TB to other person by droplet nuclei which
are aerosolized by coughing, sneezing or speaking. Health care workers are exposed to a variety of
infections, including TB. the standard test for detecting Latent TB infection is tuberculin skin test
(Mantoux test) using purified protein derivatives of Mycobacterium Tuberculosis.
OBJECTIVE:
Is to estimate the rate of TB transmission from patients with active disease to the Health care
workers, and also to study the relation of different variables to the transmission risk including
(Gender, Vaccination, and Duration of contact or occupation duration).
SUBJECT AND METHODS:
Cross sectional descriptive study done in Ibn-Zuhur hospital and Ibn-alkhateeb hospital between
April and May 2013 .One hundred and two Health care workers were included in this study (50)
HCWs from Ibn-zuhur hospital and (52) Health care workers from Ibn-Alkhateeb hospital. 5 units
of PPD (0.1mL) had been injected intradermally to the volar surface of forearm to be seen within
48-72 hours. The test was considered positive if (>=10mm induration) developed.
RESULTS:
The study shows the rate of tuberculin reactivity among health care workers 25.5% (26/102) a
significant relationship between duration of work in hospital and tuberculin reactivity among
HCWs. (50) HCWs from Ibn-zuhur hospital their age ranging between 24-48 years mean 36 year,
34 (68%) were male and 16 (32%) female and (52) HCWs from Ibn-Alkhateeb hospital their age
ranging between 21-43 years mean 32 year, 42 (81%) were male and 10 (19%) female.in Ibn-zuhur
hospital 32%(16/50) Ward nursing staff (5-10) years' work duration shows the higher rate (38.5%)
followed by Laboratory staff ( 5-10) years (28.57%) and then doctors < 5 years' work (25%)
,service workers (2-5) years' work shows (22.22 %).While in Ibn-Alkhateeb hospital 19% (10/52)
ward nursing staff (5-10) years' work duration shows the higher rate 27% followed by Laboratory
staff (20%) and then service workers (2-5) years' work shows (12.5%) while doctors < 5 years
work duration shows (8.5%).
CONCLUSION:
Health care workers have high rate of latent TB infection. Their positivity correlated with the
duration of their jobs. Health care workers with negative tuberculin skin test should be immunized
with BCG vaccine.

BACKGROUND:
The use of computer and internet by people in all walks of life increase day by day, The internet
plays a crucial role in access to information resources especially for medical students.
OBJECTIVE:
The purpose of current study is to determine the pattern of internet use among Hawler medical
university students .
METHODS:
A cross sectional study started between 10/4-8/5/2014 involve 400 undergraduate students in four
colleges of Hawler medical university. A self-administered questionnaire was used to collect data and
analyzed using Microsoft Excel and open-info version 2.3 to find the association between variables at
p value ≤ 0.05 to be significant.
RESULTS :
Out of 400 students, 298(74.5%) use internet daily,252(63%) of users were females.192(48%) were
from first stage,372(93%) access internet at home ,235(58%) connecting to internet using either
smart phone or personal laptop,225(56%) of students fathers and 166(41.5%) of mothers educational
level were college degree. 313(78.3%) of students were from families with medium socioeconomic
status ,335(84%) preferred facebook sector of internet,145(36.%)thought that internet interfere
negatively with their study,213 (53%) want and 120(30%) want strongly to use internet in medical
education in future..The main barriers to internet use is time constraints 280(70%) while only
48(12%) report poor computer and internet skills .
CONCLUSION :
It was seen that there is under utilization of the potential of internet resources to augment learning.
Increase awareness is mandatory for correct manner of better utilization of internet resources in
medical education.

INTRODUCTION:
Renal vein thrombus is a blood clot develop in
the renal vein (1). It is uncommon condition with
variable clinical presentations (2). It is associated
with serious morbidity and, if left untreated,
significant mortality (3).
CASE REPORT:
Fourty years old female living in Al-Simawa
province presented to Urological Clinic in Najaf,
with severe left loin pain of a sudden onset, it
was colicky severe, agonizing pain localized to
loin, The pain is not radiated anywhere and not
associated with nausia or vomiting The patient
was treated as a case of ureteric colic without
response to any medication . She was
hypertensive and on oral contraceptive pill for 4
years. She had 4 children, the youngest one is 4
years old.Other systems review was not
significant.
On examination:
The patient was pale with bilateral non pitting leg
swelling,her hight was 157 cm and her weight
was 89kg and her BMI was 36, her blood
preseure 140/90mmHg , She was afebrile with
tender left flank .
Urinalysis showed pyuria about 10-12 pus cells
/HPF, and microscopic hematuria 12-15
RBC/HPF .
Ultrasound shows enlarged left kidney, uniform
in its exterior , increased echogencity, normal
PCS without dilatation, and no stranding or focal
lesion or perinephric collection. by Doppler
showed generalized oligemia of the left kidney,
and CT angiographic study U/S shows was
highly suggested .
Renal CT Angio showed enlarged the kideny
with poor delayed perfusion and normal left renal
artery The left renal vein length was 16mm,
contains large filling defect involving whole
length indicating left renal vein thrombosis, with
normal inferior evena cava.
The patient was admitted to the hospital as a case
of renal vein thrombosis (RVT), searching for
other etiology rather than contraceptive pill,
Antinuclear antibody, Antiphospholipid antibody,
and anticardiolipen antibody, all were negative.
bleeding profile including prothrombin, partial
thromboplastin time, bleeding time and INR all
were within normal ranges.
Contraceptive medication stopped immediately,
Capoten 50mg orally was given for blood
pressure control, analgesia in the form of
tramadol ampule 2 times daily and paracetamol
ampule 3 times daily for pain control, Glucose
Water 2 Liters daily and ceftriaon I gm vial 2
times intravenously to treat associated infection
which was manifested by pyuria, Enoxaparine
6000 I.U. subcutaneously 1x2 for 3 days and
warfaren 5mg orally was given. On 2nd day the
patient had frank painless total hematurea which
was disappeared on 3rd day, On 4th day loin pain
subsided.
Followup ultrasound and renal doppler showed
progressive daily improvement in renal
perfusion.
Fourth day, the resistive index was 0,78 on the
left kidney while on right kidney was 0,55. On
sixth day both kidneys were of symetrical renal
perfusion and left kidney with resistive index of
0,64 and the right kidney with resistive index of
0,62. She was discharged on 7th day with oral
coagulant warfaren 5mg and with
antihypertensive capoten 50 mg.
On day 10, U/S and doppler showed normal left
renal vein interm of caliber with normal flow
without thrombus or stenosis