Vol 14, No 1 Special (2010)

Background and objectives: Urinary tract infections carry a high risk of recurrence and antibiotic resistance due to biofilm formation. This study aims to identify the common bacterial pathogen responsible for UTI in Erbil setting and identify their pathogenic characteristics and sensitivity to commonly used antibiotics, using the minimal inhibitory concentration (MIC) method.

Methods: 96-flat wells microtiter plate was used for detection of the degree of biofilm formation of E. coli strains isolated from patients with urinary tract infection. Standard breakpoint MIC have been compared with MIC results of antibiotics

Results: Only 5.6% of total samples showed UTI, the most common bacterial isolate was E. coli (43.2%). Around 26% of pyuric cases appeared to be of sterile type. The biofilm formation involved 9.4% strong adhesion. Around 50% of isolates showed beta hemolysis. The most sensitive antibiotics include nitrofurantine (81.3%), gatifluxacin (40.6%) and Ciprofloxacine (37.5%).

Conclusion: Most common pathogens in UTI are E.coli. There was no correlation between biofilm formation and the presence of any of the other virulence factor such as antibiotic resistants and hemolysis. The more effective antibiotics against E.coli in this setting are gatifluxacine, Ciprofloxacin and nitrfuratoin having most MIC fall close to their standard breakpoints.

Background and Objectives: The importance of precordial ST-segment depression in patients with early inferior ST-segment elevation myocardial infarction remain unclear. Many studies have reported that patients with precordial ST-segment depression appear to have large infarctions.

The objectives of this study was to evaluate the effect of precordial ST-segment depression in patients with early inferior ST-segment elevation myocardial infarction on the left ventricular systolic function and left ventricular regional wall abnormalities.

Patients & Methods: Fifty eight patients with first inferior ST-segments elevation myocardial infarction (37 male, 21 female), their ages ranged from 30-91year,mean age 60.59±11.21 who underwent thrombolysis in the Coronary Care Unit of Erbil Teaching Hospital for the period from August 2008 to August 2009 were included in this study. Two-dimensional echocardiography was performed in the first week of acute inferior myocardial infarction. Patients were classified according to the absence (group I, 30 ,51.72%) or presence (group II ,28 , 48.28%) of precordial ST- segment depression .

Results: Group-II patients had a higher significant incidence of left ventricular systolic dysfunction (8,28.57%) than group I (2,6.67%),P=0.027 ,despite thrombolytic therapy (alteplase). Group-II patients had higher significant incidence of left ventricular regional wall abnormalities ( 12,42.9%) than group-I (3,10%),P 0.00 ,despite thrombolytic therapy (alteplase).

Conclusions: Early two-dimensional echocardiography is recommended for patients with inferior ST-segment elevation myocardial infarction associated with precordial ST-segment depression for the earliest detection of regional wall abnormalities and left ventricular systolic dysfunction.

Background and objective: Stroke is a worldwide health problem. This study was carried out to find out the risk factors associated with stroke in Erbil city.

Methods: A hospital based case-control study was carried out in Erbil city from January, 1^st 2009 to June, 30^th 2009. The sample included (173 cases and 173 controls) cases admitted to Erbil teaching hospitals with first-ever stroke diagnosed by the consultant internist or neurologists and confirmed by brain CT-scan. Sex and age-matched (± 5 years) patients admitted to the same hospital, who do not have stroke, were taken as a control group.

Results: The mean ± SD ages of cases and controls were 62.2 ±13.4 and 61.54 ±13.16 years, respectively with a male: female ratio of 1.1:1. Nearly 70% were ischaemic and 30% were haemorrhagic. A slightly more than half (51.45%) of strokes occurred in the 7^th and 8^th decades of life. Multiple logistic regression analysis revealed statistically significant association between smoking (P<0.001), exercise (P<0.001), hypertension (P=0.001), family history of stroke (P=0.004), BMI (P=0.012) and PCV% (P<0.001) with stroke. However multiple logistic regressions of risk factors for ischaemic and haemorrhagic strokes separately revealed that diabetes was significantly associated with ischaemic stroke (P=0.025) while body mass index was significantly associated with haemorrhagic stroke (P=0.001).

Conclusion: Majority of stroke patients were of older age. The most frequent risk factor among stroke cases were lack of exercise, overweight and obesity and hypertension.

Background and Objective: The White Squill (Urginea maritima) has been used as a medicinal plant through centuries over the world, believed to have certain traditional actions. The Squill bulb was used by herbalists traditionally for the treatment of cardiac failure, chronic bronchitis, rodenticides and asthma. Novel cardiac glycosides recently have been isolated from squill known as bufodienolides. In this study in vivo and in vitro pharmacological properties of extract of white squill were evaluated.

Materials Methods: Eighteen local domestic rabbits (Oryctolagus cuniculus) were used for in vitro studies (effect of the plant extract on isolated pulmonary arteries and atrium) and in vivo studies (effect of the extract on renal function). While six male albino rats were used for studying the effects of the plant extract on blood pressure and heart rate.

Results: White squill extract induced a quite clear positive inotropic effect. The extract also produced significant increases in urine flow, total solute excretion, urinary Na⁺ excretion rate and significant reduction in urinary K⁺ excretion rate in rabbits. White squill extract produced a fall in blood pressure of the rat which was accompanied by a negative chronotropic effect.

Conclusions: The positive inotropic effect results mostly likely from blocking Na⁺/ K⁺- ATPase by glycoside constituent of the extract. The diuretic and natriuretic effects of the plant extract look like effects of potassium sparing diuretics. The hypotensive effect could be attributed to its diuretic property. The mechanism of bradycardia might be due to increased vagal tone, a reflex mechanism through baroreceptors.

Very occasionally, vesical stones developed because of foreign bodies in the bladder. Various types of foreign bodies can be found in the urinary bladder. We report a case of vesical stone following intravesical migration of IUCD in a 46 year-old female multiparous patient. The ultrasonographic examination of the pelvis and plain X ray confirmed the diagnosis. She had 10 years history of an IUCD insertion.   She became pregnant 3.5 years after the insertion. The case was managed surgicaly. The literature is reviewed about this rare cause of vesical stone.

Background and objectives: Urinary acidification induces strong antibacterial effect against different bacterial types involved in urinary tract infections. The aim of this study is to assess in vitro determination of the minimal inhibitory concentration of nitrite alone and acidified nitrite using addition of ascorbic acid in infected urine with different pH of the bacterial media.

Methods: E.coli bacteria have been isolated from the urine of patients with urinary tract infection. Identification of E. coli was achieved using biochemical tests. Determination of bacteriostatic activity of acidified sodium nitrite was carried out using 96- wells microtiter plate. Acidification effect against UTI bacteria was assessed using sequential steps; feeding bacteria with NaNo3, then transferring them to acidified urine after incubation using ascorbic acid.

Results: Ascorbic acid (40 mM) alone and sodium nitrite (200 mM) alone are considered to be a weak antibacterial agents on uropathgenic E. coli, while mixing 10 mM ascorbic acid with 625 μM sodium nitrite at pH 5 became a strong antibacterial agent against 14 isolates out of 32. Bacterial death can occur by sequential steps, first feeding bacteria with sodium nitrate and after incubation, transferring to the acidified urine at pH 5 and pH4.6 causing bacterial death.

Conclusion: Strong antibacterial agent can be formed in acidified urine containing nitrite. This antibacterial agent is strongly pH and nitrite dependent and is increased by addition of ascorbic acid. The antibacterial strength is a nitrite-dose dependent in mildly acidified urine.

Background: Dyspepsia is a relatively common clinical condition encountered by primary care physicians, lately H.pylori has been related to duodenal and gastric ulcers, and to a lesser extent, gastric malignancy. Screening for H.pylori can now be done by noninvasive techniques.

Aims: Evaluating frequency of H.pylori infection in dyspeptic patients in relation to age, gender, patient symptoms and endoscopic findings.

Patients and Methods: This prospective and descriptive study was conducted in Kurdistan Center for Gastrology and Hepatology (KCGH) on 86 dyspeptic patients, all the patients underwent Oesophageogastroduodenoscopy to find the cause of dyspepsia, a blood sample collected for determination of serum IgG for H.pylori.

Results: H.pylori account for 54(62.7%) of 86 dyspeptic patient. The incidence of the infection was higher in female patients (p=0.03), there was statistically significant difference between female and male (p=0.02). H.pylori infection is common in age groups 21-40 and 41-60 (26.7% and 23.2%) respectively, there was no relation between patient symptoms and H.pylori infection (p>0.05) except vomiting, loss of appetite and weight loss (p<0.05) also there was no association between endoscopic findings and H.pylori infection (p>0.05) except for gastric and duodenal erosion (p<0.0001).

Conclusion: H.pylori infection is frequent among dyspeptic patients, the infection is more common between ages 21-60 years and H.pylori infection has no relation to symptoms and endoscopic findings.

Background and Objectives: Haemodialysis patients have an increased risk of exposure to hepatitis C virus (HCV) infection. A high prevalence of HCV infection in hemodialysis (HD) patients has been reported. The study was carried out to determine the prevalence of HCV infection among HD patients and its association with certain socio-demographic variables and risk factors in Sulaimani governorate.

Material and Methods: A total of 101 patients on hemodialysis in sulaimani dialysis unit were studied from 1st October to 31st of December 2009. All study subjects were screened for anti- HCV antibody by third generation ELISA and confirmed by RIBA 111. Soci-demographic data and Factors that might be implicated in HCV transmission were collected.

Results: The overall prevalence of HCV was 26.7%. A significant association of anti- HCV with dialysis duration, history of blood transfusion, number of transfused blood units was found.

Conclusions: HCV is common among Sulaimani hemodialysis patients, and significantly associated with length of dialysis and number of transfused blood units. The use of separate machines for those who are anti-HCV positive should be emphasized.

Background and Objectives: Repaglinide is a nonsulfonylurea insulin secretagogue which has a fast onset and short duration of action that is used for prandial glucose regulation in type 2 diabetic patients, alone or in combination with other antidiabetic agents. The present study aimed to compare the effects of various doses of repaglinide in controlling blood glucose levels, especially postprandial blood glucose, as a monotherapy and in combination with metformin.

Methods: Patients with type 2 diabetes mellitus, which were poorly controlled with diet modification or metformin alone, were enrolled in this prospective study. The total number of the patients was 97, females (55) and males (42), at a mean age of 53 ± 8.1 years (range 31 − 69), 43 on Repaglinide monotherapy and 54 on repaglinide and metformin combination. Preprandial, postprandial blood glucose and glycated hemoglobin were recorded to determine repaglinide effect.

Results: the results showed that patients receiving repaglinide alone achieved glycemic control by 0.5 mg or 1 mg repaglinide before each main meal, while those receiving repaglinide in combination with metformin received higher doses (1mg, 2mg, and 4mg) of repaglinide before each main meal. Still, glycemic control was not achieved in some patients.

Conclusions: small doses of repaglinide (0.5−1.0 mg before main meals) was enough in type 2 diabetic patients with suboptimal control on diet alone to reach optimal glycemic control; but further dose titration up to (4 mg before main meals) is required in individuals who were previously on metformin with longer diabetes duration and advanced diabetic stages.

Background and Objectives: there is no screening program in our area, no reliable data on incidence, associated risk factors and effects of early management of DDH, and after 30 years of entering ultrasound in the management of DDH, still plain radiographs are in use. to observe effectiveness of early diagnosis and treatment of DDH using clinical screening and ultrasound-based management system. cross-sectional observational study

Methods: 1521 neonates in their first week of age attended the birth office for vaccination from 1st June to 31st July 2009, Ortolani and Barlow method used for clinical screening followed by filling a questionnaire to evaluate risk factor association. Ultrasound used for classification of hips (using Graf's method) followed by treatment in the first three months of age using Pavlik harness splint as a treatment method.

Results: 65.8 per 1000 live birth have DDH, twice common in female, 50% bilateral,ultrasound in the first week shows values of (0, 109, 20, and 3) and at 3 months (124, 5, 3, and 0) values for Graf(I,IIa,IIc&D,III&IV) respectively. Treatment rate with Pavlik harness splint were 17.5% with success rate of 82.5% without open reductions of the hip, finally to have 97.8% normal hips (Graf I) at the end of this study with treatment.

Conclusions: In DDH, early diagnosis and treatment through clinical screening and ultrasound-based management is effective

Background and Objectives: The instructions of the manufacturer showed that metronidazole infusion solution (5mg/mL) is incompatible with few drugs. This study aimed to determine the physical and chemical compatibilities of metronidazole infusion with commonly used intravenously administered physiological solutions.

Methods: Metronidazole injection in a commercially available concentration of 5mg/mL was mixed with 0.9% sodium chloride, 5% glucose saline or Ringer's solution in the infused bottle or during simulated Y-site injection. metronidazole was examined physically by visual inspection and chemically by ultraviolet-visible spectrophotometer analysis. Adsorption of metronidazole to intravenous administration sets without inline filters was also studied. Furthermore, the compatibility of metronidazole with some drugs related to beta-lactams was studied. Physical incompatibility was determined by visual inspection against a blackand- white background, and chemical incompatibility was measured by a stability-indicating UV-visible spectrophotometer assay for metronidazole.

Results: The absorbance magnitude (O.D.) recorded by UV-visible spectrophotometer showed differences in respect to the infused solutions as well as to the admixed physiological solutions. Moreover, metronidazole is incompatible with Co-amoxicillin and clavulanic acid, and cefepime. .

Conclusions: It is concluded that metronidazole infusion should be separately infused, not admixed with physiological solutions and avoided its combination with beta lactams.

Background and objectives: Numerous prospective randomized studies demonstrate the effectiveness of simple preoperative anxiety intervention in improving surgery outcomes as measured by decreased anxiety, decreased pain and reduced need for pain medications. The objective of study is to find out the effect of simple preoperative anxiety intervention on postoperative pain.

Patients and Methods: A sample of 300 patients who were admitted in general surgery units of two teaching hospitals ( Rezgari& Hawler) in Erbil city from 5^th April 2009 to the 10^th November 2009 were allocated randomly into two groups; 150 patients received preoperative anxiety intervention before surgery (which includes giving information about surgery, anesthesia and post operative management of pain) and another 150 patients as a control group received no intervention. The assessment tool included a special questionnaire about socio-demographic information and the anxiety level was measured before surgery by state-trait anxiety inventory scale of Spilberger which includes 20 items while measurement of pain score was obtained during 48 hours after surgery by visual analog scale (VAS) which is composed of a (10 cm) horizontal line.

Results: The patients in intervention group showed low pain scores; the Mean score and standard deviation of VAS scale for intervention group was (4.47±0.692) while for control group the Mean score and standard deviation was (6.55±1.121).

Conclusions: based on the results of the study the investigators conclude that giving information to patient before surgery can reduce the preoperative anxiety level which leads to decrease postoperative pain level.

Background and objectives: Hypertension is common chronic disease, its prevalence increases with age, the goal of treating hypertension is to control blood pressure below the target level (140/90 mm Hg). Poor or non compliance is one of the biggest and modifiable obstacles in controlling high blood pressure.

Method: Descriptive study was conducted on a 418 hypertensive patients at Ali Kamal consultation clinics in Suliamania city, from 3^rd May 2008 to 2^nd July 2008. During interview questionnaires were used to evaluate patient's compliance. SPSS version 13 was used for analysis.

Results: In studied sample (30.4%) were males and (69.6%) were females, the mean age±SD (58±10). Compliance to antihypertensive treatments was (58%), Fair compliance (30%), and poor compliance (12%). Significant association (P<0.05) were found between good compliance and older age, Unemployed 353(84.4%), longer duration of hypertension 221(52.9%), doing follow up in private clinics 37(69.8%), Depending on both Governmental and private pharmacy to get medications 206(52.4%), knowledge of patient and home blood pressure checking 90(73.2%). While gender, illiterate 263(62.9), medium economic state 294 (70.3), positive family history of hypertension 250(59.8), No previous hospital admission 261(62.4) and number of prescribed drugs do not affect compliance (P>0.05).

Conclusions: Younger age, poor hypertension awareness and employment adversely affect compliance to antihypertensive medication. Regular blood pressure checking increases compliance, while numbers of drugs and gender not affect compliance rate.

Background and Objective: Studying the relation of LDH level to presentation, stage and histological subtype of lymphoma and to evaluate its prognostic significance.

Patients and Methods: Hospital records of 13 Hodgkin's and 37 non-Hodgkin's lymphoma patients were reviewed. Patients were followed up; their serum LDH levels were measured after completing therapy. A group of 25 apparently healthy persons matched for age and gender served as controls and their serum LDH levels were measured.

Results: Serum LDH activity was significantly higher in lymphoma patients compared to control group (P <0.001); although none of the Hodgkin's lymphoma patients had serum LDH level above the normal range. Serum LDH activity was not of value in relation to grade and histological subtype of lymphoma, and ESR; but significantly associated with stage of the disease. There was no significant difference in the mean enzyme level among patients who responded and those who not responded to chemotherapy.

Conclusions: Serum LDH level was of no clinical or prognostic significance in Hodgkin's lymphoma. The stage of the disease rather than serum LDH value was the main prognostic marker in non-Hodgkin's lymphoma.

Background and objective: Stroke is the third most common cause of death. The objective of this study was to find out the case fatality rate of first-ever stroke in Erbil city.    

Methods: This cross-sectional study included 228 first-ever stroke patients hospitalized to teaching hospitals in Erbil city from January, 1^st 2009 to August, 31^st 2009. Stroke was diagnosed by the consultant internist or neurologist and confirmed by brain CT-scan. Patients were followed-up and one month case-fatality rate was calculated.

Results: The one month case-fatality rate was 23.7% with a higher proportion of deaths occurred in females (26.4%) than in males (21.2%) (P= 0.358). The case-fatality increased with age (P = 0.019); around 75% of deaths occurred in the 7^th and 8^th decades of life and more than 95% occurred among those 60 years and more. More deaths occurred from haemorrhagic (31.3%) than ischaemic (20.7%) strokes (P= 0.093). The mean ± SD ages of dead and alive were 68.56 ±11.52 and 61.32 ±12.91 years, respectively (P<0.001). Multiple logistic regression revealed significant association of stroke outcome with age (P= 0.037) and atrial fibrillation (P<0.001).

Conclusion: The one month case-fatality rate was relatively comparable to that reported in other developing countries.

Background and Objectives: Hand deformity is a typical feature of the RA. Therefore it is crucial to find out the prevalence of hand deformity in RA and to identify factors associated with its presence.

Methods: A group of 100 patients with RA fulfilling the 1987 revised ACR criteria, were attending routine out patient clinics and physiotherapy unit in Rizgary Teaching hospital in Erbil, between 1^st Oct. 2008 to 31^st June 2009, are included, Patients who had congenital anomaly, history of trauma, patients below 16 years and other rheumatologic disease had been excluded.

Results: Hand deformity was recorded in (57%) of cases .The frequency of deformities was as follow; ulnar deviation of the MCP joints (41%), palmer subluxation of the MCP joint (38%), Z deformity(13%), boutonniere deformity (27%) , swan neck deformity (35%), radial deviation of the wrist (24%) and subluxation of the wrist joint (16%). Female to male ratio was 5:1, 55% 0f patients were between 40-59 years of age. X-ray of both hand shows 60% of patients had bone erosion, RF was positive in 73% of patients, CRP was positive in 75%. Family history was positive in 30%. There was a significant correlation between development of deformities and disease duration, No. of joints involved, RF(Rheumatoid Factor) ,CRP(C-reactive protein) and ESR(Erythrocyte sedimentation rate), other factors that had been studied but had no significant correlation with development of deformities which were age, gender, occupation, residence, type of treatment.

Conclusions: Rheumatoid arthritis is a chronic rheumatologic disease that affects the hand and causes deformities, which mainly depend on the duration of disease, so early treatment and suppression of inflammation is necessary to delay or arrest the development of deformities.

Background and Objectives: Penile fracture has been reported with sexual intercourse, masturbation, rolling over or falling on to the erect penis.

Patients and Methods: between August 2005 to August 2009 we prospectively prepare 21 patients with diagnosis of ’fractured’ penis. Recording details age, time of attendance, cause, symptoms, signs, site of rupture, operative findings, and final outcome.

Results: A total of 21 patients were identified. The mean age was 29 years (range, 22-49 years). The interval between time of injury and presentation ranged from 50 minutes to 8 days. Ten (48%) cases were attributed to sexual intercourse, 6 (28%) to penile manipulation, 2 (10%) to rolling over the erect penis during sleep, and 3(14%) falling on to the erect penis. Nineteen patients underwent surgery; all had primary suturing of the tunica tear, while two also required primary urethral repair. At follow-up, 3 patients had erectile dysfunction, 3 had mild penile deformity and one had a mild urethral stricture.

Conclusions: early surgical repair ensure a successful outcome with minimal complications. The public should be educated about that condition to seek medical attention immediately, as delay may result in permanent complication that could be avoided.

Background and Objective: Multiple sclerosis is an autoimmune demyelinating disorder of the nervous systems that is commonly manifested by visual system involvement and that my initially present with ophthalmologic symptoms .Manifestations of MS in the eye include both the afferent and efferent visual pathways. Optic neuritis, the most common neurophthalmological manifestation of MS, may be the initial clinical disease manifestation. Our aim is to assess the proportion of neurophthalmological manifestations in MS patients, with frequency of ocular dysfunction as presenting symptoms.

Patients and Methods: (120) patients with clinically definitive MS criteria, whom attended to center of MS during the period from November2006 and July2007 were included in this study. The study depends on clinical examination (V.A, V.F, color test, papillary reflex, fundoscopy) and patient report.

Results: 120 MS patient had a mean age 29.6 year, 60% were female, 40% were male. Arabic were 55% and Kurdish were 45% of patient. The common type of MS was RRMS in 79.17%,followed by PPMS 14.16% and SPMS in 6.67% of patient. Optic neuritis was found in 16.7% as initial presentation & Diplopia occurs in 1.6% only. RRMS was the commonest type associated with optic neuritis 83.95%. Optic neuritis represented the commonest symptoms of neurophthalmological manifestations, which recorded in 67.5% followed by INO in 7.5%, while 6.67% didn't have any neurophthalmological manifestations. Unilateral ON was observed in 92.59%, abnormal VA 85.19%, central and cecocentral scotoma 70.37%, ocular or periorbital pain was found in 86.42% and optic disk swelling was recorded in 25.93% of MS patients.

Conclusions: More than 93% of Iraqi MS patients had at least more than one type of neurophthalmological manifestations. Neurophthalmological finding was common as presenting symptoms or during the course of MS and optic neuritis represented the commonest manifestation of MS with high relationship with relapsing remitting MS.

Background and Objective: Febrile seizure is the most common convulsive disorder in childhood. Intense parental anxiety and fear from recurrence is observed. The aim is to determine the risk factors for febrile seizure in children.

Methods: this observational study undertaken from 1^st February to the end of June 2008. One hundred ten children between 6months-6years of age admitted with attack of febrile seizure were recruited. Demographic data including age, sex, type & duration of febrile seizure, family history of febrile seizure and epilepsy, interval between fever onset and   occurrence of seizure were recorded.

Results: Out of 110 patients 54 cases were male (49.1%) & 56 were female (50.9%), male to female ratio among those with recurrent febrile seizures was 1.4:1.The peak age group for febrile seizure was 13-24 months (49.1%) & the mean age was 22.1 months. Complex febrile seizure was observed in 40patients (38.2%). Positive family history of febrile seizure was noted in 48 patients (43.6%) and family history of epilepsy in 10 patients (9.1%) was positive. It was found that 52.7% of cases were having respiratory tract infection, 39.1% having gastroenteritis & in 2% no focus of infection were found.

Conclusions: It can be concluded from the present study that first attack of febrile seizure in younger age (≤12months), complex febrile seizure & Positive family history of febrile seizure in children ≤12months were risk factors for recurrent febrile seizures.

Background and Objectives: Both gastric and duodenal ulcers associated with were a major threat over the past two centuries, with a high morbidity, mortality. H. Pylori discovery switched the notion from an acid-driven disease to an infectious disease, with reconciliation of previously suggested pathogenesis.This study was undertaken in order to investigate the causes of dyspepsia in patients undergoing endoscopy examination and to measure the anti H. pylori antibodies level in serum of these patients then to find any correlation between the titer of these specific antibodies and the severity of their dyspeptic symptoms.

Methods: The study was conducted in microbiology lab. at Azadi teaching hospital. 90 patients suffering from symptoms of gastric upset were included in this study. Their age range from 10 to 66 year old, 46 female and 44 male. Endoscopy was done for each patient and the result of examination was reported and gastric juice aspirate taken from stomach by endoscopy was sent for direct examination for Giardia lamblia, monilia, pus cells, and RBC. 5 ml of whole blood was taken from each patient and serum collected after centrifugation and kept at -20*c to be used for detection of specific H.pylori IgM by ELISA and total serum IgA by single radial diffusion test.

Results: Abnormal endoscopy findings were found in 36 out of 90 patients Giardia lamblia was not found in any case. The results of ELISA test for specific IgM against Helicobacter pylori showed that 10 cases were positive which indicate acute Helicobacter pylori infections ( 7 female, 3 male ) their age range from 10 to 60 years. Seven of them have abnormal endoscopy finding range from gastritis to gastric ulcer. The other 3 patients  have negative endoscopy finding. The concentration of total serum IgA was measured by single radial diffusion. 17 patients had high level of total serum IgA, 8 of them with abnormal endoscopy finding and the other 9 with normal endoscopy finding. All ten patients with positive specific anti H .pylori IgM have normal level of total serum IgA.

Conclusions: This study found anti H.pylori specific IgM confirmative for diagnosis of acute infection even in the absence of positive endoscopy finding. The measurement of total serum IgA is not helpful for diagnosis of acute or chronic infection and to be replaced by specific anti H. pylori IgA in serum.

Background and Objectives: To identify the Immunohistochemical expression of glial fibrillary acidic protein (GFAP) in different types of brain tumors, and to correlate the results with patient's age and sex, and with tumor type, site and grade.

Patients and Methods: During the two year period, from July 2007 to June 2009, 52 cases of neuroepithelial tumors were collected from Rizgari Teaching Hospital, and private labs in Hawler city. Typing and grading of tumors were done according to the World Health Organization (WHO) classification system. Immunohistochemical staining was done for GFAP using polyclonal antibodies and chromogen visualizing system. A semi quantitative histochemical score was applied to the GFAP staining.

Results: Of the 52 collected cases, 36 were astrocytoma, 6 medulloblastoma, 5 oligodendroglioma, 3 ependymoma, 1 oligoastrocytoma, and 1 ganglioglioma. GFAP was expressed in 86.5% of neuroepithelial tumors. Higher positivity was found in gliomas than in other neuroepithelial tumors (p < 0.001). A significant correlation between GFAP expression with the patient's age and site of the tumor was found. It was inversely correlated with the grade of glioma.

Conclusions: GFAP expression is helpful in identification of glial from non-glial neuroepithelial tumors. It is of a great use to highlight the tumor grade particularly if the scoring system is applied.

Background and Objective: Hydatid diseaseais is one of the most important zoonosis in the world. Because of economical and hygienic importance of the disease and no currently available drugs totally effective against it, researches in preventive methods in endemic areas are considerable. This study was undertaken to investigate the effectiveness of native protoscoleces glutathione S transferase as vaccine candidate against hydatid disease in mice.

Methods: Glutathione S transferase was partially purified from protoscoleces on sephadex G 150 column. Four groups of Balb/c mice (each of 20 animals) were immunized subcutaneously with 25µg, 50µg, 75µg and 100µg of the enzyme and three groups of mice were utilized as positive, negative and adjuvant controls.

Results: the study showed considerable protection (75%) and reduction (98.2%) in mice immunized with 75 µg of the enzyme. No significant differences were observed in total   leukocyte number and in functions of the liver and kidney in all immunized groups as   compared to control negative group. However, lymphocyte transformation response was highly significantly (P< 0.001) increased.

Conclusions: it can be concluded from the results, immunization of mice with 75µg of native protoscoleces glutathione S transferase conferred considerable protection against hydatid infection in mice.

Background and Objectives: To analyze the role of immunohistochemistry in characterization of malignant round cell tumors

Patients and Methods: Immunohistochemical staining (IHC) with (monoclonal or polyclonal) antibodies was performed on 127 cancer cases reported as malignant round cell tumors over a 12 month period from July 2008 through August 2009. Setting: Department of histopathology, Duhok Central Labs

Results: Malignant round cell tumors were more frequently located in the respiratory tract 30 (23.6%) followed by gastrointestinal tract 25 (19.7%), lymph node 19 (14.9%), and bone/soft tissue 19 (14.9%). Among these, 75 (82.7%) cases were primary and 22 (17.3%) metastatic. Application of immunohistochemistry resulted in characterization of 112 (88.2%) cases. Non-Hodgkin lymphoma 21 (16.5%) was at the top of the diagnosed list followed by adenocarcinoma 20 (15.7%), sarcoma 17 (13.4%), and small undifferentiated carcinoma 15 (11.8%).

Conclusions: Immunohistochemistry is a very helpful tool for characterization of malignant round cell tumors.

Background and Objective: Bond strength of the adhesive sealers to both human dentin and gutta-percha is critical property for success of the root canal sealing. This in vitro study aimed to measure the shear bond strength (SBS) of three different adhesive sealers (glass-ionomer based sealers (Ketac-Endo) and (Diaket) and epoxy resin-based sealer (AH 26) to both the gutta-percha and human dentin.

Methods: Part I: The dentin substrate was obtained from single rooted human teeth. The dentin specimens were treated either with EDTA 15% or phosphoric acid 37% to achieve the removal of smear layer. Three adhesive sealers (glass-ionomer based sealers (Ketac-Endo) and (Diaket) and epoxy resin-based sealer (AH 26) were placed on the   dentin surfaces both with and without the use of the bonding agent. Bond strength was tested using a single plane shear test assembly. Part II: Discs of gutta-percha with a diameter of 8 mm and thickness of 4mm were made by softening of the gutta-percha cones and fixed with plaster in rings. Four millimeter long sections of polyethylene tube filled with freshly mixed sealer were placed on the gutta-percha and tested using a single plane shear test assembly.

Results: By using t-test, the results revealed that there was highly significant difference between epoxy resin-based sealer and the two other glass-ionomer based sealers at p< 0.01 with in favor of the AH26 sealer.

Conclusions: The bonding system & the dentin pretreatment increased the adhesive potential of the AH26 sealer which had higher shear bond strength than the two glass-ionomer based sealers

Background and Objectives: Carbohydrate antigen 19-9 (CA19-9) is one of the most representative tumor markers in colorectal carcinomas. Colorectal cancer is one of the leading causes of cancer-related mortality in the world. The objective of this study is to investigate the expression of CA 19-9 in colon tumors and its correlation with pathological prognostic factors (age, gender, tumor site and histological grade).

Methods: A total of 47 colonic tissues were selected from Razgary teaching hospital from the period January, 2007 to January, 2009 consisting of 20 colonic adenocarcinoma, five tubular adenoma,12 retention polyp, four ulcerative colitis and six normal colonic mucosa.

Results: CA19-9 expression found in 18 out of 20 colonic adenocarcinoma, 2 out of 5 tubular adenoma and one out six normal colonic tissues

Conclusions: It was concluded that high expression of CA19-9 is seen more frequently in colonic adenocarcinoma with higher grade tumor in comparison with benign tumor and normal tissue. There was also high CA19-9 expression in old age patient (>50 years) and in male gender.

Key words: Colon adenocarcinoma, CA19-9.

Background and Objectives: (a) To determine the effect of regular desferroxamine (DFO) therapy on De-Ritis ratio. (b) To determine the changes in some liver function test parameters between patient on regular DFO and those with irregular DFO therapy.(c)To determine the relation between serum iron and serum ferritin in both groups. (d) To determine the effects of age, sex and body mass index (BMI) on measured parameters in both groups.

Methods: This study was conducted at Thalassemia Center /Ibn-Al-atheer Pediatric-Hospital in Mosul from October 2007 to April 2008. Forty patients with β- Thalassemia were selected as follow: twenty patients with regular DFO therapy and other twenty with irregular DFO therapy.

Results: De-Ritis ratio serum Ferritin, Ferritin: total serum protein ratio and total serum protein shows no significant changes between both groups. Serum ALT, AST, ALP activities and serum iron shows significant increase in those with irregular DFO therapy (P< 0.01).

Conclusions:Irregular DFO therapy shows significant effects on serum iron and some other liver function test parameters that indicate chronic hepatocytes damage without changes in De-Ritis ratio which is used as indicator for acute hepatocytes damage.

Background and Objectives: Premenstrual syndrome which affects women during their reproductive life, causes a cluster of physical, psychological and behavioral symptoms, which prevent many women from functioning properly .The main objective of this study is to find out the prevalence of premenstrual syndrome among college of nursing students.

Methods: Cross sectional study was conducted, which included (112) students the data were collected through the use of questionnaire which included the following parts: background information, physical and psychological symptoms of premenstrual syndrome, during the 1^st week of October, 2009.

Results: Majority of study sample complained from more than one symptom of premenstrual syndrome. There was no significant statistical difference between symptoms of premenstrual syndrome and regularity of menstruation.

Conclusions: Majority of study sample had premenstrual syndrome symptoms and these symptoms affected their study and clinical training.

Background and Objectives: Emergency ambulance personnel (EAP) are vulnerable to posttraumatic stress disorder (PTSD). In Iraq, EAPs were exposed to life threatening situation during political violence conflict post 2003 Gulf war. This study was carried out to report on PTSD among EAP.

Methods: A total of 189 male EAPs (only one female in was in the emergency department) were selected randomly from the Deptartment of ambulance in Baghdad. A questionnaire form was filled for each EAP. The form included the symptoms of PTSD according to DSM- IV (intrusive, avoidance and hyperarousal symptoms). Demographic data and exposure to violence accident, type of accident and duration of damage were included, also.

Results: : The mean age of EAP was 38.5 ± 9.4 years. There was 122 (64.5%) had PTSD. Age, education, marital status and years in emergency ambulance department were significantly associated with PTSD.

Conclusions: High rate of PTSD among EAPs was reported. Measures to prevent PTSD and to give further support to EAP are needed. Further studies will clarify the situation of PTSD in Iraq.

Background and Objectives: Identification of LADA represents a major interest for many diabetologists, because its prevalence is relatively high and seems to be underestimated. Also, correct diagnosis of LADA patients allows an early and accurate therapeutic intervention.
Aim of the Study: The purpose of this study was the evaluation of the prevalence of latent autoimmune diabetes in adults (LADA) among group of clinically diagnosed type2 diabetic patients.

Methods: Seventy four type 2 diabetic patients were tested for the presence of autoantibodies ICA, GAD, IA-2. All patients were also characterized according to clinical symptoms preceeding the onset of the disease, age, BMI. ICA was measured by indirect immunofluorescence on cryostat sections of human pancreas of blood group O. GADab and IA-2ab were measured by ELISA assay.

Results: The presence of at least one autoantibody was revealed in 14/74 patients. That allowed us to recognize LADA in these cases. The coexistence of two antibodies was   observed in 3/14 patients. None of the patients had three examined autoantibodies. GADab were detected more frequently (12/14) than GADab and IA-2ab, which were found with the same frequency (2/14) (P < 0.004).

Conclusions: Among patients with diagnosed type2 diabetes there is a group with autoimmune diabetes, called LADA. Phenotype similarity between diabetes type 2 and LADA makes the proper diagnosis impossible without more specific tests. The diagnosis of LADA is based on the presence of autoantibodies.

Background and Objectives: Estimation of different iron body status markers, ceruloplasmin and oxidative stress in pre- and postmenopausal women at Baghdad city.

Methods: This study was performed at the Chemistry and Biochemistry Department,   College of medicine, Al-Nahrain University, Baghdad, Iraq from January 2009 to October 2009. The study consisted of 42 healthy women categorized into two groups premenopausal women (n= 22) aged 29.71±8.92 years and postmenopausal women (n=20) aged 53.33±4.61 years. Iron, total iron binding capacity (TIBC) were measured colorimetrically, ferritin levels were measured by enzyme linked immunosorbent assay (ELISA), ceruloplasmin level was estimated by radial immunodiffusion technique whereas malondialdehyde was quantified colorimetrically

Results: Non-significant increase (P>0.05) in iron, ferritin levels, transferrin saturation   percents in sera of postmenopausal women and non- significant increase (P>0.05) in total iron binding capacity (TIBC), transferrin, iron stores in sera of premenopausal women. Malondialdehyde increased non- significantly (P=0.44) in premenopausal women whereas ceruloplasmin increased significantly (P=0.000) in postmenopausal women group. On the other hand ferritin was correlated positively and significantly with body mass index (BMI) (r= 0.696; P < 0.05) and with ceruloplasmin levels (r=0.725; P<0.05) in pre- and postmenopausal women.

Conclusions: Hormonal changes which usually associated with menopause may be the cause of increased oxidative stress and consequent rise in ceruloplasmin levels as an   antioxidant response

Background and Objective: Rubella infections acquired postnatally are usually mild, but maternal infection during pregnancy is associated with considerable risk of intrauterine fetal infection with multi-system damage.Detection of anti-rubella IgM specific antibodies among pregnant and childbearing women in Baquba city and to explore the effects of   certain demographic factors.

Methods: The present study was conducted in Baquba-Diyala province during the period from April/2007 to September/2008. Ninety pregnant women were chosen from those   attending the primary health care centers in Baquba. They include 30(33.3%) pregnant women who had previous abortions with a mean age 27.2 ± 5.3 years, and 60(66.7%) pregnant women without previous abortion with mean age 23.7± 5.1 years. Additionally, 94 non-pregnant childbearing women were enrolled as a control group. Of those, 37(39.4%) had previous abortions with mean age 33.5 ± 7.8 years, and 57 (60.6%) without abortion, the mean age was 30.7±7.8 years. Certain demographic factors were collected by personal interview. Anti-rubella IgM specific antibody was detected by enzyme-linked immunosorbant assay (ELISA). Data were statistically analyzed using SPSS computer   assisted processing. P value of < 0.05 was considered significant.

Results: The results revealed that 3(5%) of pregnant women without previous abortion and 8(26.7%) of pregnant women who had previous abortions were seropositive for anti-rubella IgM antibody. The difference between the two groups was statistically significant (p= 0.003).Whereas, the IgM seropositivity was insignificantly higher in childbearing women without previous abortion compared to childbearing women who had previous abortions (24.6% vs 16.2%), (p=0.33). Furthermore, the IgM seropositivity among childbearing women without previous abortion was significantly higher compared to pregnant women without previous abortion (24.6% vs 5%), (p=0.003).The presence of life births, time of gestation, and the levels of education significantly affect the seropositivity rate of IgM.

Conclusions: Prenatal screening for anti-rubella IgM antibody is an important tool to identify active infection and to provide obstetric management to avoid the risk of congenital rubella syndrome.

Background and Objectives: Unexplained infertility occurs in many couples of childbearing age, immune mechanisms have been postulated in this disorder for the last few decades. Circulating antibodies against spermatozoa present in serum and seminal plasma have been especially implicated. This autoimmunity against spermatozoa has been investigated in males, while the isoimmunity (in the females) has got low attention.

Methods: Fifty women with unexplained infertility and twenty fertile women were involved in this case-control study. ELISA system was prepared and used to detect antisperm antibody (ASA) in cervical mucus (CM) and serum specimens of both groups of women. CM was collected at mid-cycle period and dissolved mechanically (not by bromeline).

Results: Thirty percent of infertile women have IgG-ASA in their serum and 20% have IgA-ASA in the CM, while 22% of fertile women have IgG-ASA in their serum and no fertile women have any titer of IgA-ASA in their CM specimens. Only CM-IgA-ASA of infertile women showed significant statistical correlation with cellular property of CM, which was scored according to Insler score.

Conclusions: It is concluded that ELISA test is sensitive and specific test for detection of serum and secreted ASA. Also, secretory IgA-ASA are more indicative and have potential role in immunological infertility as iso-immunity than IgG-ASA. Therefore, it is strongly recommended that immunological infertility should be considered as an important cause of infertility and to be having a special interest by clinicians.