Al-Kindy College Medical Journal

Background: Acute urinary tract infection is a common bacterial infection causing illness in infants and children. At age of seven, 8% of girls and 2% of boys will have at least one episode. Although drinking water and using home remedies are known to help to flush away bacteria and keeps them from sticking to the bladder wall, researches to test the efficacy and safety of hydrochlorothiazide's diuretic effect as adjuvant to the antibiotics in pediatric age groups are lacking, and so this research was to address this subject.

Objectives: To assess the effectiveness and the safety of hydrochlorothiazide as adjuvant therapy to the antibiotics in treating acute urinary tract infection in pediatric age group.

Type of the study: Case-control prospective study.

Methods: The study was done including eight hundred sixty five patients ((In_ & Out_ patients)): The patients included were aged from few hours (neonates) to 16 years old, Those who attended three pediatric hospitals- department of nephrology of:The Central Child Teaching Hospital,Al- Elwyia Pediatric Hospital andIbn Al-Baladi Hospital

Results: 215 patients in group 1 ((97.3%)) presented with cystitis and 6 patients ((2.7%)) with pyelonephritis, And In group 2, 243 ((96.4%)) with cystitis and 9 patients ((3.6%)) with pyelonephritis.The urine cultures were negative in ((76.4, 80.1, 85.9,95.0 percentages of patients)) after ((10 days, 1 month, 3 months and 6 months respectively)) in group1 vs. ((60.3, 68.60,75.8,85.3 )) after the same periods in group 2 ((p-value=0.04 at 10 days, 0.03 at 1month, 0.04 at 3 month and 0.02 at 6month)).

Conclusions: This research had concluded that 5 days of treatment with antibiotics and hydrochlorothiazide were effective and safe to treat children with urinary tract infection. Hydrochlorothiazide (as a diuretic and hypocalciuric agent) adjuvant to the antibiotics in pediatrics was safe and effective to: Decrease duration of treatment and hospitalization days, Improve clinical responses to antibiotics and Decrease risk of complications of UTI.

Background: A recent discoveries used for reconstruction in maxillofacial surgery is the composite bone graft materials. The availability of collagen I matrix make our choice to use this material in surgery .It is biomaterials that its structure could be modified by simple techniques. Studies to find a new materials use for bone reconstruction is to overcome the disadvantages of autogenous bone and the synthetic resorbable bone substitutes.

Objectives: This study was done to evaluate the effect of biphasic calcium phosphate collagen composite (ccpc) on healing of bone defects after oral surgical procedures.

Type of the study: A cross sectional study.

Method: It involved 60 patients, 35 male and 25 female, age (15-40) yearsand experimental animals study involved sixty rabbits.The study was done in Department of Maxillofacial surgery in Al anbarCollege of Dentistry (2015-2016).These patients were received tooth extraction, and other minor surgical procedures .Clinical and radiographical examination and patients consents are done before surgery. The surgery was done under local anesthesia.The resulting bone cavities are filled with composite bone graft material composed from combination of lyophilized hydrolysed collagen sponge (Hemospon),Brasil and Osteon II bone graft material,Korea .The area is closed with 3/0 block silk suture .Antibiotic cover (Ampicillin 500mg ×4) for 1 week was prescribed. The patients were followed up by careful clinical examination with radiograph 15-30 days after surgery. .Sixty New Zeleandi White rabbit were used in our study for histopathologicalexamination.Intraperitoneal injection of ketamine 10 mg with XYL-M2 solution 20 mg xylazine base used to anesthetize the animals. (5mm diameter) bone defects were made using straight surgical hand piece and bur in anterior mandibular region and filled with each material. The study design involve the following groups: group 1( involve 15 rabbit; the defect was made and filled with blood clot only (control group),group 2( involve 15 rabbit, the defect was made and filled with collagen sponge only),group 3(Involve 15 rabbit, the defect was made and filled with Osteon II bone graft only),group4( involve 15 rabbit, the defect was made and filled with Osteon II bone graft +collagen (Composite bone graft).The flap were closed 3/0 black silk suture. The rabbits were killed after 30 days. 10 cmexcisional biopsy specimen was taken from the paramandibular area and placed in 10%formalin then send histopathologicalexamination.

Results: Clinically, the treated area show good healing with absence of infection .Radiographs during follow up period show radiopacity indicating new bone formation .The results of experimental animals (Rabbits) indicategrowth new bone . In group 1 and group2, the center of the defects was depressed by surrounding tissues Eung et al, While, in group 3&group 4, the graft materials maintained the space and the center of the defect did not depress. Statistical analysis indicates that during 4 th week ,the highest healing % is (100%) in group 3 &group4 in compared to control group (50%)..A significant difference in healing % was found among the treated groups.

Conclusion:The result indicates that biphasic calcium phosphate collagen composite can be efficiently utilized clinically

Background: Neonatal septicemia is a major health problem in developing countries furthermore data on bacteriological profile in early onst sepses (EOS) and late neonatal sepsis (LOS) are lacking in context of continuous change in bacteriological profile and increasing resistant strains. Objectives: The study done to determine the pattern of organisms implicated in neonatal septicemia in a neonatal care unit and to measure the degree of bacterial resistance to some antibiotics.

Type of the study : cross –sectional study.

Methods: Confirmed cases of neonatal septicemia admitted at Al-Alwyia pediatric teaching hospital for the period from January 2011- January 2012 were included which constitute 107 case. Blood samples were obtained, incubated and Subculture was done on blood agar and MacConkey Agar routinely after 48 hours and 7 days and in between if visible turbidity appeared. Bacterial isolates and antibiotic sensitivity were identified by standard conventional methods.

Results EOS constituted 29.9%(32 case) of confirmed neonatal sepsis , while LOS constituted 70.1% (75case) .Eescehrichia coli (E. coli) constitutes 37% of EOS followed by Klebsella pneumonia and Staphylocoocus species (which constitute 12.5% for each of them ) were the most common microorganisms, while for LOS: E.coli constituted 38.7 % of LOS followed by Staphylocoocus species 17.3% and Klebsella pneumonia 10.7%. Gram negative (G negative) bacteria predominated over gram positive (G positive) bacteria in both EOS (81.2%) and LOS (74.7%) . Staphylocoocus species predominates G positive sepsis in both EOS and LOS. Group B streptococci are not identified in the study sample. Microorganisms tested shows highly resistant to amoxicillin or ampicillin and to gentamycin.For amoxicillin or ampicillin higher resistant (100%) were encourted with pseudomonas, proteus and Enterobacter. For cefotaxime high rate of resistance encountered with klebsella (71.4%) compared to 40% resistant in pseudomonas. Amikacin also shows varied degree of resistant for E. coli(22% ) and klebsella (41%) , pseudomonas(10%) ,and Enterobacter (16.7%) .for Staphylococcus aureus, proteus and citrobacter no resistance was encountered to amikacin and the sensitivity was 100% in tested isolates .

Conclusions: G negative bacteria is more common in EOS and LOS with predominant of E. coli in two categories .Resistant strains to commonly used antibiotics is a common finding. Guidelines in treatment of neonatal sepsis should be frequently reviewed taking in consideration antimicrobial resistance . Due to magnitude of problem, preventive measures for EOS and LOS should be considered.

Background: Characterization of the ovarian masses preoperatively is important to inform the surgeon about the possible management strategies. MRI may be of great help in identifying malignant lesion before surgery. Diffusion Weighted Imaging (DWI) is a sensitive method for changes in proton of water mobility caused by pathological alteration of tissue cellularity, cellular membrane integrity, extracellular space perfusion, and fluid viscosity.

Objective: to study the diagnostic accuracy of DWI in differentiation between benign and malignant ovarian masses.

Type of the study:Cross-sectional study.

Methods: this study included 53with complex ovarian mass or masses ,Diffusion Weighted Imaging was obtained to all these patient with correlation to the histopathological results; the Signal Intensity (SI) of the solid and cystic part of the lesions was evaluated on T2 and Diffusion Weighted Imaging ,with Apparent Diffusion Coefficient (ADC) values were also obtained .

Results: 22 masses out of the total 53 were malignant and 31 were benign .On DWI the high SI intensity observed more frequently in the malignant lesions than the benign lesions (p value 0.0293) .There was significant difference between the mean ADC value of the malignant and benign ovarian lesions, with the mean ADC value for the benign lesions solid component =1.05 x10 -3, and the mean ADC value for the malignant lesions solid component =0.91 x10-3. The ROC study reveals that 0.926 x 10 -3 may be the optimal cutoff value with sensitivity 54.8 %, specificity 59.1%, NPV 48.15 %, PPV 63.39% , Accuracy 56.6%. With exclusion of the teratoma and endometriomas from statistical analysis the ROC reveals that 0.99 x10 -3 may be the optimal cut off value with sensitivity 76.9 % , specificity 77.3% , PPV 66.67% , NPP 85% and accuracy 77.14% Conclusions: Combined with conventional pelvic MRI, DWI is a helpful tool in differentiation between benign and malignant ovarian masses, with high signal intensity on DWI more frequently observed in the malignant than benign ovarian lesions.

Background: Depression in elderly aged (60 year and above )is a widespread mental health problem . The current primary healthcare systeminadequately recognize and treat elderly patients with depression..

Objectives:To determine the prevalence of depression among elderly patientsin Mosul city, its correlation with some sociodemographic variablesand to assess severity of depression in relation to past history of depression.

Type of the study: This is a cross-sectional study.

Methods: This study assess the prevalence of depression in a randomly selected sample 150 elderly patients aged 60 years and above (89 female & 61 male) who attended the geriatric clinic in Ibn Sina Teaching Hospital /Mosul City between the 1st/March /2014 to the 10th /June 2014.A short form of Geriatric Depression Scale (GDS) the Arabic version was used to assess depressionand a semi-structured interview were applied after screening the patients for cognitive impairment using the Mini Mental State Examination (MMSE) to exclude those who scored less than 23 on this scale .

Results:The study showed that the Prevalence of depression was 65.3% , statistically significant difference was not found with any variable used. Strong positive relation was found in severely depressed patients with the past history of depression, multiple physical complaint was found in the depressed sample.

Conclousin:As the prevalence of depression among elderly patients was high , National programs should be developed in community & health services focusing on early detection and treatment of depression among the elderly population.

Background: Ultrasound provides a powerful tool for assessing early pregnancy and detecting pregnancy failure at first trimester and promoting rapid effective management. Several criteria have been established to predict the pregnancy outcome particularly in symptomatic women .

Aim: To evaluate asymptomatic women at the first trimester of pregnancy , to assess the efficacy of certain ratios as mid sac diameter (MSD) / yolk sac ratio & crown rump length (CRL)/mid sac diameter (as indicator of early first trimester oligohydramnios) in predicting poor 1st trimester outcome

Type of the study: A cross-sectional study.

Patients & Methods: A sixty three asymptomatic women were enrolled in this prospective study . Transvaginal sonography was performed for confirmation of pregnancy viability & exclusion of multiple pregnancies 6-8 weeks of gestation & follow up ultrasound repeated at the beginning of second trimester to confirm the continuation of pregnancy and viability of fetus. Several parameters assessed and tested against each others as embryonic heart rate , the size and morphologic criteria of gestational sac , yolk sac and the crown rump length

Results: The women were classified into two groups: group A are those with successful outcome at the first trimester and group B are those with poor outcome of the 1st trimester . Decrease embryonic heart rate below 100 beat per minute and low mid sac diameter/ yolk sac size ratio of < 1.9 , were found to be significant predictors of poor outcome however mid sac diameter/crown rump length ratio was not found to have a similar significance

Conclusion: In addition to the classical parameters assessed by trans-vaginal ultrasound, other important parameters need to be routinely applied as the embryonic heart rate that predict poor outcome when less than 100 bpm . In addition to the ratio of mid sac diameter to the yolk sac diameter which , if less than 1.9 , may point to abnormal first trimester fate.

Background: Ultrasound provides a powerful tool for assessing early pregnancy and detecting pregnancy failure at first trimester and promoting rapid effective management. Several criteria have been established to predict the pregnancy outcome particularly in symptomatic women .

Aim: To evaluate asymptomatic women at the first trimester of pregnancy , to assess the efficacy of certain ratios as mid sac diameter (MSD) / yolk sac ratio & crown rump length (CRL)/mid sac diameter (as indicator of early first trimester oligohydramnios) in predicting poor 1st trimester outcome

Type of the study: A cross-sectional study.

Patients & Methods: A sixty three asymptomatic women were enrolled in this prospective study . Transvaginal sonography was performed for confirmation of pregnancy viability & exclusion of multiple pregnancies 6-8 weeks of gestation & follow up ultrasound repeated at the beginning of second trimester to confirm the continuation of pregnancy and viability of fetus. Several parameters assessed and tested against each others as embryonic heart rate , the size and morphologic criteria of gestational sac , yolk sac and the crown rump length

Results: The women were classified into two groups: group A are those with successful outcome at the first trimester and group B are those with poor outcome of the 1st trimester . Decrease embryonic heart rate below 100 beat per minute and low mid sac diameter/ yolk sac size ratio of < 1.9 , were found to be significant predictors of poor outcome however mid sac diameter/crown rump length ratio was not found to have a similar significance

Conclusion: In addition to the classical parameters assessed by trans-vaginal ultrasound, other important parameters need to be routinely applied as the embryonic heart rate that predict poor outcome when less than 100 bpm . In addition to the ratio of mid sac diameter to the yolk sac diameter which , if less than 1.9 , may point to abnormal first trimester fate.

Background: Aortic valve stenosis results from minor to severe degrees of aortic valve maldevelopment. This stenosis causes mild to severe obstruction of the left ventricular outflow .

Objectives : to study the immediate and intermediate results of percutaneous balloon aortic valvuloplasty in patients with congenital valvular aortic stenosis .

Type of the study: A prospective study.

Methods: The study was done on thirty five patients with congenital valvular aortic stenosis who had percutaneous balloon aortic valvuloplasty in Ibn Al- Bitar Center for Cardiac Surgery from May 2009 to February 2011.

Results: Twenty seven patients were male (77.2%) and 8 patients were female (22.8%), male to female ratio 3.5/ 1, . The aortic valve was bicuspid in 18 patients (51.4%) while 17 patients ( 48.6%) had tricuspid aortic valve. Balloon aortic valvuloplasty was successful in 30 patients (85.7%),. Maximum peak instantaneous Doppler pressure gradient across the aortic valve 24 hours postprocedural echocardiography showed reduction which is statistically significant. New aortic regurgitation had occurred in 15 patients ( 42.8%), it was mild in 9 patients ( 25.6%), moderate in 5 patients ( 14.3%) and severe in 1 patient( 2.9%) which is statistically significant. The follow up of 12.57 ± 3.88 ( 3- 22) months after intervention was done for all patients using echocardiography Doppler study, reveal the maximum peak instantaneous Doppler pressure gradient across the aortic valve was raised which is statistically significant. The aortic regurgitation was present in 18 patients (51.4%) , it was mild in 9 patients (25.7%) , moderate in 6 patients (17.1%) and severe in 3 patients ( 8.6%). No mortality had been reported during the procedure or on follow up.

Background: The diagnosis of prostatic pathology may be of challenging , as some difficult and suspected, atypical cases may lack basal cell layer by routine H&E sections . Antibodies against 34BE12(HMW-CK) and p63 aid the diagnosis of such cases , to distinguish benign from malignant prostatic lesions.

Objective: to identify basal cells in atypical prostatic lesions ,and distinguish benign from malignant prostatic lesions.

Type of the study: A retro-spective study.

Methods: 115cases of paraffin embedded prostatic tissue blocks ,diagnosed as : 76 cases were benign prostatic hyperplasia( BPH) , 9 cases were high grade –prostatic intraepithelial neoplasia (HG-PIN) , and 30 cases were prostatic carcinoma(PCa) .Sections from each blocks were prepared for immunostaining with 34BE12 and p63.

Results : basal cells were detected in cases of BPH , and HG-PIN , and absent in all cases of prostatic carcinoma ,using basal cell markers . Negative benign glands(>2) were found in 71.6% and 38.2% for BPH and 57.1% and 55.6% for HG-PIN immunostained with high molecular weight cytokeratin (34BE12) and p63 , respectively, and significantly reduced to 9.0% and 11.1% for BPH and HG-PIN, respectively with combined using of both markers .Conclusion : Combination of both basal cell markers (34BE12 , p63) improving basal cell detection in atypical ,suspected prostatic lesions and distinguish benign from malignant lesions.

Background: the activity of acute lymphoblastic leukemia had been observed to correlate with levels of serum lipoproteins

Objective: to evaluate the correlation of serum levels of different types of lipoproteins with activity of the disease in patients with acute lymphoblastic leukemia.

Type of the study: A prospective study.

Methods: A study included patients diagnosed as acute lymphoblastic leukemia, their serum levels of lipoproteins at time of diagnosis, and on relapse were obtained for comparison.

Results: there is significant inverse correlation of activity of acute lymphoblastic leukemia with serum total cholesterol, serum low density cholesterol levels, and serum high density lipoprotein level, but not with serum triglycerides level.

Conclusion:. The level of lipid profile is inversely correlated with activity of acute leukemia, and lipid profile assessment is recommended in evaluation of patients with acute leukemia .

Background: Background: Helicobacter pylori is an important gastrointestinal bacteria related to the development of superficial atrophic gastritis, peptic ulcer and gastric cancer. Human leukocyte antigens (HLA) may play an important roles in host immune responses to H pylori antigens.

Aim of the study: to investigate the association between HLA-DRB1 genotypes and superficial gastritis with H. pylori infection in an Iraqi patients.

Patients and methods: Sixty patients with superficial gastritis and 100 individuals with apparently normal results after endoscopic examination were recruited from Al-Kindy Teaching Hospital - Gastrocolonoscope Unit between January 2014 and July 2016. All study patients and controls group underwent upper gastrointestinal endoscopic examinations. They were analyzed for CagA antibodies Immunoglobulin G (IgG) for H. pylori and HLA Class II genotyping (HLA-DRB1).

Results: Patients with superficial gastritis with H pylori. The infection showed significant expression (P=0.0001) DRB1*03:01 genotypes and DRB1*15:01 (P= 0.004) as compared to control group.

Conclusions: Genetic factor may play a role in gastritis. HLA-DRB1*03 and HLA-DRB1*15 may increased the susceptibility to superficial gastritis in H pylori infected patients.

Background: Obesity is an increasing health problem in developed countries and has grown into a major global epidemic. Recent studies suggested colonization of the stomach by Hpylori might affect gastric expression of appetite- and satiety-related hormone and patients cured of H pylori infection gained weight. Obesity and Helicobacter pylori (H. pylori) are important because of the problems they lead and their frequency of occurrence.

Objectives: To find out the prevalence of H. pylori infection in obese.

Type of the study:A cross-sectional study

Methods: A total of 32 obese female admitted to the study. Body mass indices (BMI) of all subjects were calculated H. pylori positivity were studied.

Results: The age range of the obese was (20-59) and the BMI (was 25-55 kg/m²). 26 obese (81.25%) were H pylori positive, and all obese above 45 were H pylori positive.

Conclusions: Obesity and h pylori are closely associated and the prevalence of h pylori increased with obesity. We consider that H. pylori infection can be a risk factor for obesity and almost all obese patients above 45 years were sero positive. However, further studies evaluating more subjects are required. And we need to do national survey about h pylori prevalence in our community

Background: Anaemia is a major public health concern and is one of the most prevalent health issue in women within reproductive age group.

Objective: to assess maternal knowledge related to anaemia during pregnancy.

Type of the study: A cross –sectional study.

Method: The study including 200 mothers who attended selected primary health care centres, Baghdad during November and December 2015, they completed a previously prepared questionnaire coveringsocio-demographic characteristics and knowledge regarding anaemia in 4 main domains. The responses were analysed by using frequency, percentage and percent score for each statement and overall percent score for each domain and mean overallpercent score for all the four domains.

Results: the main source of information of the participated mothers was health personal (59.5%).The overall percent score for the main domains was good 71% for aetiology of disease, excellent 91% for signs and symptoms of anaemia, good 75% for complications of anaemia and very good 75% regarding ways of prevention and treatment.

Conclusion: Satisfactory knowledge level of mothers regarding anaemia during pregnancy.

Background: Studies show that diabetic patients have a higher incidence of ischemic stroke than non-diabetic patients. In the Framingham study the incidence of thrombotic stroke was 25 times higher in diabetic men and 36 times higher in diabetic women than in those without diabetes

Objectives: aim of this study to analyze topography in diabetic patients.

Type of study: Cross sectional study.

Methods: 48 patients with acute stroke were classified into 4 groups: euglycemic, stress hyperglycemia, newly diagnosed diabetics, and known diabetics.

Results:no significant differences were found in the type, site or size of stoke between the 4 groups, higher levels of blood sugars and hemoglobin HbA1cwere significantly higher with chronic white matter ischemia in stroke patients.

Conclusions: hyperglycemia, diabetics and chronic glycemic disturbance may play role in the pathophysiology of white matter ischemia.

Background: Abdominal symptoms are possibly the most frequent of all symptoms encountered in surgical practice. Pain is the most common of all abdominal symptoms. Causes of acute abdominal pain include both medical and surgical. Most symptoms arise from intra-abdominal organs or systems while some may originate extra abdominally and are then referred to the abdomen. Medical causes of abdominal pain are encountered more frequently.

Objective: To study the causes of acute abdominal pain in patients attending emergency department in Al- Imamain Al- Kadhimain Medical City.

Type of the study: A prospective cross sectional study

Methods: The patients attending Emergency Department in Al- Imamain Al- Kadhimain Medical City over the period from April-2014 to April 2016. There was a one day call duty per week managed by the same surgical team (total one hundred days study). Onlypatients above 12 years old with acute non-traumatic abdominal pain were included in this study.

Results: The total number was 1217 patients over hundred days study. Their age ranges from 12-83 years; average age was 36.18 ±17 year. There was slight female predominance, 638 (52.42%) female patients and 579 (47.58%) male patients. The most common cause of abdominal pain was acute appendicitis 252 (20.70%), followed by ureteric colic 251 (20.62%), and acute cholecystitis249 (20.46%). Conservative management was done for 836 (68.69%) patients, while operative management done for 379 (31.14%) patients. Postoperative mortality was 8 (2.11%) patients.Medical causes of acute abdominal pain were found in 48 (5.74%) patients.

Conclusion: Not all the patients attending surgical emergency department needs operations. Causes of acute abdominal pain include both medical and surgical diseases, some of the medical diseases are very serious like acute viral hepatitis, myocardial infarction , and diabetic ketoacidosis; and should not submit those patients to unnecessary operations with serious and may be fatal postoperative complications. General urine examination is a must in all patients with acute abdominal pain. Electrocardiography (ECG) may be needed in old patients.

Background: Congenital club foot is a complex deformity of foot .It is a collection of different abnormalities, with different etiologies. Consequently, Severity varies with difficulties in evaluating treatment strategies with outcome results. The treatment of congenital club foot remains controversial. Usually, the orthopedist\'s goal is to obtain anatomically and functionally normal feet in all patients. Objective: To asses short term follow up result of conservatively treated club feet in relation to the age of initial casting by Ponseti technique.

Methods :A cross sectional observational study with some comparative content done in Al-kindy teaching hospital .A total of 36 patients (44 clubfeet) were treated by Ponseti method during the period of October 2014 to April 2017and were studied prospectively (mean follow up period 6 months, minimum follow-up period of 3 months) . Twenty six patients were male, thus male to female ratio is 2.6 : 1. It involved only patients less than two months. The patients were divided in to two groups: Group (A) included patients less than 4 weeks, while Group (B) between 4-8 weeks of age at the initiation of the treatment. gender, bilateralism, severity of the initial clubfoot deformity measured by Pirani Severity Score System, total numbers of Ponseti casts before the tenotomy, details of tenotomy, compliance with brace were examined. Passive range of movements and look of club foot are evaluated with mean six months follow-up.

Results: We followed the functional Pirani Severity Scoring System and got good to excellent results in 32 patients 88.9 % (37 clubfeet – 84.1%) at mean 6 months of follow up. Ten patients 27.8 % (12 clubfeet – 27.3%) had relapse at varying age; out of which 6 patients 60% (8clubfeet 66.7%) were corrected by Ponseti casting method, while 4 patients 40% (4 clubfeet 33.3%) were resistant to Ponseti method. Poor compliance with the Denis Browne splint and poor cast technique was thought to be the main cause of failure in these patients.

Conclusion: Good understanding the main pathology of club foot, and the ideal method of conservative treatment for correction of the deformities systematically before starting the treatment. In all types of club foot, we start conservative treatment, either as a definite treatment or to make surgical treatment easier for the surgeon and the patient. So Starting the treatment from the first day of life give excellent results and it will be decreased with delay.

Background: Known as suxamethonium or succinylcholine, is a medication used to cause short-term paralysis as part of general anesthesia. The duration of operation is one of the important factors accounting to the success of the operation. Simple safe available drug can change the plan of anesthesia.

Objective: The purpose of this study was to assess adding Lidocaine three minutes intravenously before induction of general anesthesia on the duration of optimum prolongation the action of Suxamethonium . With other group with regular method.

Type of the study: a cross-sectional study

Methods: A 100 candidate to compare the effect of Lidocaine for unpremeditated patients ,American society of anesthesia( ASA) physical status II .patients were scheduled for caesarian section surgery were randomly assigned to two groups: Group I patients received 1.5 mg/kg Lidocaine 3 minutes before induction of general anesthesia, Group 2 patients received just the anesthetic agents. For assessment of prolongation of action the researcher Deepened on the clinical signs of recovery from Suxamethonium which are: spontaneous breathing, ability to swallow when we open the patient's lower jaw ( observing movement of the tongue ).between the two group Both groups received general anesthesia.

Results: The of prolongation of Suxamethonium in elective cases in Group I was a about 7 - 15 minutes, while in Group II the time of Suxamethonium was about 3 - 5 minutes Conclusions : The study concluded that there was a significant difference between the two groups from the side of suxamethonium time in group one( lidocaine group)as there was prolongation of time more than group two .

Background: Blastocystis spp. distributes world widely and the genus Blastocystis include many subtypes that are isolated from human intestinal tract. It is considered the most common parasite detected in human being.

Objectives: To evaluate the incidence of Blastocystis spp. among leukemic children, to find out its association with the presence of symptoms (diarrhea and abdominal pain), and to assess the efficacy of different staining methods in detection of Blastocystis spp.

Type of the study: cross-sectional study.

Method: 103 children were enrolled in this study, 53 leukemic patients and 50 healthy controls. The study was performed during the period between January and June 2014, in Oncology department of Ibn Al-Atheer teaching hospital in Mosul city. Three consecutive samples were taken from each child and a thorough history was taken from them. The samples then treated with 3 stains, iodine, iron hematoxylin, and trichrome.The data was analyzed using minitab version 17, Fischer’s exact test, Two-proportions test, and Correlation test. The results were considered statistically significant with P-value <0.05.

Results: Blastocystis spp. was detected in 18.87% of leukemic children and in 10% of healthy group. All specimens were stained by iodine, iron hematoxylin, and trichrome stains. Infection rates among patients were (9.4%, 11.3%, and 18.87% respectively) while among healthy children they were (4%, 6%, and 10% respectively). However, these differences were statistically nonsignificant. A higher infection rate was detected in the preschool children (33.3%) than school age group (6.9%). Furthermore, there was a significant association between Blastocystisspp. infection and intestinal symptoms (abdominal pain and diarrhea).

Conclusion: Our study reveals a higher rate of infection with Blastocystis spp. among leukemic children than normal controls and a significant association was seen between incidence ofBlastocystisspp. infection and symptomatic children. Those results draw attention for the significance of Blastocystis spp. infection in immunosuppressed patients and lighten the way for further studies on its pathogenicity and diagnostic methods.

Background: The anterior knee pain is an important chief complaint of the patients with knee osteoarthritis due to patellofemoral pathology. The pain receptors denervation can be achieved by circumferential denervation of the patellar area by a process of electrocautery.

Objectives: The aim of current study is to assess the pain after total knee arthroplasty (TKA) by patelloplastywith and without circumferential denervation via electrocautery at a minimum follow up with 1 year separately for each patient.

Type of the study:Cross- sectional study.

Methods: Thirty five patients,with mean age of about (62.8) years, were enrolled in this prospective, hospital based study that was held at Al-Yarmouk Teaching Hospital in Baghdad from October 2012 to November 2016. These patients were divided into 2 groups, first group was composed of 19 patients who have TKA with patellar circumferential denervation by electrocautery with patelloplasty by removing peripheral osteophytes of patella , the second group of 16 patients were undergone TKA without denervation, but only patelloplasty. The second group was considered as the control group. Visual analogue scale (VAS) was used to evaluate pain pre and post operatively. The patient’s functional ability was assessed by knee society score (KSS) also before and after TKA for both groups and pain killer was given according to patients need.



Results: All of the patients were followed for 12 months period. No drugs were used other than occasional use of pain killers in first month after operation for all patients in group one of study. On VAS scale, significant statistical difference in pre and post-operative scales were noticed between both groups of study. The Knee Society Scale (KSS) was showing a non- significant statistical significance between both study groups before and after TKA. ConclusionA: nterior knee pain can be reduced through the use of patelloplasty with circumferential denervation of patella byelectrocautery, compared with non- denervated procedure. Good clinical outcome was also present.

Background: Routine supplementation of vitamin D to infants is justifiable since vitamin D deficiency, and its consequences are highly prevalent not only in developing countries but worldwide. Maintaining a normal level of vitamin D is crucial in order to have a normal skeletal, as well as, extra-skeletal health. Knowledge of mothers regarding importance of vitamin D supplementation affect the health of their babies in a positive manner if accompanied by appropriate practice.

Objective: To determine the level of knowledge, attitude and practice of Iraqi mothers of under or equal 12 months old infants in Baghdad, AL-Rusafa, regarding vitamin D supplementation for their infants.

Type of the study: A cross-sectional study.

Methods: A descriptive cross sectional, questionnaire-based study conducted at six primary health care centers in Baghdad AL-Rusafa. 400 mothers of under or equal 12 months old infants attending primary health care centers (PHCC)for routine vaccination and follow up of their infants were included in the study from the 10th of February 2016 till the 10th of June 2016.

Results: A total of 400 mothers enrolled in the study, with a mean age of 27.11years ±6.65572, Only (45%) (n=180) of them had given their infants vitamin D drops, with a mean score of vitamin D supplementation practice of 1.26±1.51265 from 4 which was significantly correlated with their knowledge score which was 3.6100±2.14987 from 9 and their attitude score which was 3.6275±1.89644 from 6.

Conclusion: The study revealed poor knowledge, fair attitude and poor practice among mothers regarding vitamin D supple­ment for their infants.

Background: Antibiotics are among the most commonly used medicine, in both community and hospital setting, all over the world especially in countries where no strict guideline to regulate their use. In Iraq, only a few studies conducted to describe the antibiotic prescription pattern in general hospitalsand even less in pediatric hospital.

Objective: To describe the patterns for antibiotics used in Elwia pediatric teaching hospital in Baghdad, Iraq

Type of the study: Descriptive cross sectional study.

.Methodology: The study was conducted at AL-Elwia Pediatric Teaching Hospitalduring the year 2016. A random sample from all the prescriptions sheets, of patients consulting outpatient clinic or admitted to different departments were studied for different parameters in different departments of the hospital.

Results:A total number of 9440 prescriptions, were collected and analyzed.The age group 1-5 years was the most common group consulting the hospital followed by those below 6 months of age. About 51% of all patients were males. The study revealedthat 87.56% of all patients consulting the hospital were received antibiotics. The highest rate of antibiotic used was in inpatient department (99.9%) followed by NNCU (92.11%). Amoxicillin was the most preferred antibiotics by pediatrician in outpatient, inpatient and ER department.

Conclusion: The results of this study indicate that there is, in general, overuse of antibiotics in all hospital departments when compared with other developing countries.

Background: While two-thirds of breast cancers express hormone receptors for either estrogen (ER) and/or progesterone (PR) , genetically altered PI3K pathway was found in more than 70% of ER-positive breast cancers.An aberrant activity of cyclin-dependent kinase 1 (CDK1) in a wide variety of human cancers has selectively constituted an attractive pharmacological targets in MYC-dependent human breast cancer cells.

Aim of the study: Role of p110-beta as well as and CDK 1 in the pathogenesis of subset of breast cancers and contribution in their carcinogenesis.

Type of the study: is a retrospective study

Methods: This retrospective research enrolled 70 paraffin embedded breast tissue blocks which were retrieved from archives of the period 2011 till 2017 at major hospitals and private histopathological laboratories as well as Forensic Medicine Institute in Baghdad. They comprised 30 breast cancers, 25 benign breast tumors and 15 apparently normal breast autopsies. Two 4 mm - thick sections were specified on positively charged slides for monoclonal primary p110 as well as and CDK 2 antibodies using immune-enzymatic antigen detection system for immunohistochemistry (IHC) techniques.

Results: Seventeen out of 30 (56.7%) of the total breast cancer cases in this study showed positive immunohistochemistry reaction(IHC) for detection of P110- beta gene expression in these tissues. In the benign group, 6 out of 25 cases (24%) revealed positive IHC signals. None of control group presented positive signals. The differences begroup tween the percentages of P110-beta in breast cancers and each of control group and benign breast tumors group are statistically very highly significant (P value = < 0.0001). The expression of CDK1 was detected in 53.3% (16 out of 30) of breast cancers tissues and in 44% (11 out of 25) benign breast tumors, whereas none of control group of tissues showed CDK1- expression.

Conclusions: The present data indicate that p110-beta as well as and CDK 1 could have a role in the pathogenesis of subset of breast cancers and contribution in their carcinogenesis.

Hydatid disease is a zoonotic infection caused by Echinococcus species. The cystic form of this infection mostly involves liver and lung. Hydatid disease of the parotid gland even in endemic regions is a very rare entity that may be easily overlooked in daily practice. Herein, I present a case report of a 60-year-old Iraqi female patient who presented with a progressively painless mass in her right parotid. It was diagnosed radiologically as a hydatid cyst and was excised successfully. Histopathologic examination of the resected specimen confirmed the hydatid cyst. This case emphasizes the importance of considering hydatidosis in the differential diagnosis of any parotid mass, especially in endemic countries.