Volume 12, Issue 1, Spring 2016, Page 1-203


Efficacy of modified midurethral minisling in stress urinary incontinence patients in Al-Diwaniya teaching hospital

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 1-5

Aim: to evaluate the efficacy of using modified midurethral minisling in women with SUI in Al-Diwaniya teaching hospital.
Patients and methods: 22 women underwent minisling were diagnosed as pure SUI.
Results: mean parity was 4.1, mean duration of symptoms was 28.8 months, mean length of operation was 65 minutes, mean length of hospital stay was 8 hours, mean cost was 195.000 ID, postoperatively ; one case with urine retention, no bladder injury , no vaginal or urethral erosion, no De novo urgency. Three failed cases(recurrent) assessed subjectively(history and examination) and objectively (Urodynamic testing).
Conclusion: efficacy of modified midurethral minisling is comparable to TVT-TOT with lower cost.
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Pathological Study of Cutaneous Leishmaniasis in Al-Diwaniya province

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 6-15

In the present study, 42 patients were observed, as cutaneous leishmaniasis, from 1 September 2012 until the end of August 2013. They divided to 25 (595. %) males and 17 (40.5%) females, and the diagnosis was depend on clinical examination, pathological lesions and parasitic isolation. Lesions were classified depending on number, so the patients who have multiple lesions were (64.3%), while (35.7%) have single lesion, the number of lesions per patient ranged from one to 12 lesions. Most of the lesions were located on face (40.5%), but some lesions were on the face & hand (21.4%), while few were found in hand and back (2.4%). Histopathologicaly, the cutaneous lesions were observed; keratinized layer and epidermal cells were necrosed or not present over the ulcer, Skin biopsies were taken, fixed with formalin, sectioned, and stained with hematoxyline and eosin stain (H & E stain). Microscopic examination, showed accumulation of amastigote, inflammatory cells such as neutrophils and lymphocytes with macrophages engulf amastigotes. Eleven samples of aspirated blood were collected by fine needle, for making direct Giemsa-stained smears before the cultivation, 72.7% of the cases were positive to the presence of leishmania tropica. There are three culture media were used in this study, biphasic medium, NNN medium, and lock’s solution; 63.4% of cases were positive in NNN medium, and 72.7 % were positive in both of biphasic media and Lock’s solution. Luck’s solution.

Gene Expression of Biofilm Regulatory Protein A (Brp A) in Streptococcus mutans Isolated from Oral Cavity

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 16-24

A total of 100 oral swabs were collected from patients suffering from dental caries and priodontal infections, ranging from 15-65 years old of both genders whom admitted to the Al-Diwaniyah Teaching Special Center of Dentistry within the period from December 2012 to March 2013, in order to quantify the gene expression of biofim regulatory protein (Brp A) in Streptococcus mutans (S. mutans) isolates by using the Real Time polymerase chain reaction. The gene expression of biofilm regulatory protein A(Brp A) was quantified in comparison with housekeeping gene 16s rRNA as a reference gene of biofilm S.mutans by using reverse transcriptase polymerase chain reaction (RT-PCR).The results revealed that the expression (absolute) of BrpA gene is decreased in the test treatment (S.mutans with 1% glucose+ 50% curcumine) in comparison with control (S.mutans grown in 1% glucose only).
In conclusion, the present study established the role of Brp A gene in biofilm formation and recommended to possibility of using the curcumine as adddative material in composition of toothpaste due to their inhibitory and reduction effect on biofilm S.mutans isolates.
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Identification of 5S rRNA gene of Enterobius vermicularis

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 25-29

Background: The present study was carried out from October 2012 to the end of September 2013.
The study included a collection of two hundred -twenty four stool sample from deferent ages, Ages were vary from one to sixty years old for detection Enterobius vermicularis .Stool samples were used direct wet mount ,concentration method and stained with iodine (( the eggs ,larvae and adult )) had been noticed by microscop , 10x ,40x and oil immersion lens (100x). The results showed that 146 (65%) out of 224 were microscopically positive. The stool samples were store in -20°C until use.
In molecular study of this parasite PCR technique was conducted, to detect one gene 5sRNA by using specific primers for Enterobius vermicularis, the results showed that 126(56.3%) samples out of 224 were positive.
In comparison between microscopic and PCR methods the results showed that 146 (65%), 126(56.3%) out of 224 were positive respectively,with important of PCR technique in diagnosis occult enterobiasis 30(23%).
Materials and methods: stool samples were used in this study to detect the presence one specific 5SrRNA gene . 224 randomly stool sample were determined by the polymerase chain reaction method. Results: The 5SrRNA gene may be facilities in diagnosis occult and non- occult Enterobiasis .Conclusion: Polymerase Chain Reaction technique was useful for identification of Enetrobius Vermicularis and occult cases.This study aimed to role of Polymerase chain reaction(PCR) technique used to prove the DNA of Enerobius vermicularis.
30(23%) .

Cultivation of Entamoeba species in Lock’s -egg medium and differentiation of E.moshkoviskii ,E.dispar and Ehistolytica by using single round polymerase chain reaction .

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 30-35

The genus Entamoeba contains many species, three of which are identical (Entamoeba histolytica, Entamoeba dispar and Entamoeba moshkovskii ) reside in the human intestinal lumen. Entamoeba histolytica is the causative agent of amebiasis and mortality worldwide in humans. Although recent studies highlight the recovery of E. dispar andE. moshkovskii from patients with gastrointestinal symptoms. The cultivation of three identical Entamoeba species was done successfully in Lock’s-egg medium , a high number of trophozoite were found in culture .these three identical Entamoeba species did not differentiation by using microscope .but the devolution of scientific they could differentiation by using PCR technique when extraction the DNA in stool samples by using specific bands and primers . .

Detection of major virulence factor of Entamoeba histolytica by using PCR technique

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 36-45

Aim of the study: This study was undertaken to detect the major virulence factors of the intestinal parasite E.histolytica by using PCR technique, and to study the prevalence of this parasite in Al-Diwanyia Governorate.
Patients and method: Stool samples were collected from one hundred eighty- six patients suffering from acute diarrhea, 146 of them had bloody diarrhea. Their ages vary from one to seventy six years old at the period between (December 2011 and June 2012). Microscopic examination with wet mount and concentration method as general stool examination (GSE) were done to all samples, ELISA assay and PCR were done to all samples.
Result: the results showed that 126 samples out of 186 were microscopically positive for E.histolytica. To detect the antigens of E.histolytica from stool, ELISA assay was done for all samples, 89 samples out of 186 were positive. To detect the major virulence factors (V.F.) (lectin, cysteine proteinase, and amoebapore) of E.histolytica, PCR technique was conducted, by using specific primers for E.histolytica, the results showed that 62 samples out of 186 were positive, out of these positive samples, there were 55 samples positive for lectin, 58 samples were positive for amoebapore, and all samples (62) were positive for cysteine proteinase.
Conclusion: the study show that PCR technique and ELISA assay are much specific and sensitive more than microscopic examination for detecting E.histolytica and distinct from non pathogen species.
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Estimation of tear film break up time in normal peoples of Diwaniya,Iraq

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 46-50

Objective: to estimate tear film break- up time , a test of tear film stability in normal Iraqi population.
Material and method: 286 normal subjects ( 146 male and 140 female ) age from 12 to 78 years were participated in this study, tear break -up time is estimated using impregnated fluorescein strip wetted with normal saline and the measurement is done in one room with stable temperature and door closed , three readings for each subject and the mean is taken .
Results: The mean TBUT in this study was 15.3 second with SD 4.7 ( range from 6-28s), the study show TBUT to be decreased with age, The study show significant difference in result between male and female.
Conclusion : The tear break -up time (TBUT)values in this study are comparable to those reported for Asian population but much less than those for western population; there is significant difference between gender and the results tend to decrease with age.
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Immunoflourecent Staining Detect the Prognostic significance of M2 macrophage.

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 51-59

Tumor cells use multiple mechanisms to invade extracellular matrix and metastasize to distant organs. The interaction between the tumor cells and stromal cells in the tumor microenvironment plays an important role in tumor growth and metastasis. Tumor associated macrophage (TAM) are prominent stromal cells in this interaction. They secret a variety of growth factors, cytokines, chemokines, and enzymes that regulate tumor growth, angiogenesis, invasion, and metastasis. Macrophages show two polarization states in response to different micro-environmental signals. M1macrophages are pro-inflammatory and function as bactericidal and antigen-presenting cells. M2 macrophages have an immunosuppressive phenotype.
Thus the aim of current study is to find out whether there is prognostic value for M2 macrophage that infiltrating colorectal tumor tissue through linking its expression level with tumor histopathological variables by using immunoflourecent technique. Further more to find if there an association for M2 macrophage with tumor cell proliferation by using Ki67 as a proliferation marker.
Current study found that the Mean Ki67 score was significantly higher in patients than in control group, (P<0.001), moreover the common macrophage mean CD68+ macrophages, and M2 macrophage (CD163+) count was significantly higher in patients than in control group (P<0.001, P<0.001), respectively. I addition present study demonstrated that the M2 macrophage (CD163+) count showed significant correlation with tumor grade (P<0.001), LN involvement (P<0.001), stage (P<0.001), and Ki67% (P<0.001). However, when the ratio of CD68/CD163was considered, the following results were obtained: there was no significant correlation between CD68/CD163 ratio and both of tumor stage and LN involvement (P>0.219, P>0.468 respectively). While there was significant correlation between CD68/CD163 ratio and tumor grade (p<0.03).
From above results one can conclude that high expression of CD163 macrophages is associated with poor prognosis and from other hand could be targeted by immune therapy to lower the progression of colorectal cancer.
الخلايا السرطانية تستخدم آليات متعددة لغزو المكونات الخارج الخلية وتنتشر إلى أعضاء بعيدة. التفاعل بين الخلايا السرطانية خلايا النسيج الاخرى في بيئه الورم تلعب دورا هاما في نمو الورم والانتشار. الخلايا البلعميه المرتبطه بالاورام (TAM) هي خلايا انسجة بارزة في هذا التفاعل. حيث انها تنتج مجموعة متنوعة من عوامل النمو، السيتوكينات ، والإنزيمات التي تنظم نمو الورم،وتكوين اوعية الدموية جديده، والغزو، والانتشار. تظهر الخلايا البلعميه نوعين من الاستقطاب في استجابة للإشارات الدقيقة المختلفه لبيئه الورم. الخلايا البلعميه نوع ,M1 هي التي تلعب دور المحفرللمناعه و للالتهابات واباده الجراثيم, كما وتعمل كخلايا عارضة للمستضد. بينما النوع الاخر للخلايا البلعميه M2 لديها النمط الظاهري المثبطة للمناعة.
وبالتالي فإن الهدف من الدراسة الحالية هو لمعرفة ما إذا كان هناك اهميه للخلايا البلعميه نوع M2 المخترقه او المنتشره في نسيج الورم القولوني المستقيمي في التأثير على او تحديد مأل الورم من خلال ربط مستوى التعبير الموضعي لهذه الخلايا مع المتغيرات المتغيرات النسيجيه المرضيه باستخدام تقنية الوميض المناعي. كذالك من خلال قياس نمو الخلايا السرطانيه باستخدام معلم النمو .Ki67
اوجدت الدراسة الحاليه مستوى التعبير للـ Ki67 كانت أعلى بكثير في المرضى من الذين من المجموعة الضابطة، (P<0.001)، وعلاوة على ذلك كان معدل اخلايا البلعميه العامه (CD68) ، والخلايا البلعميه المثبطه للمناعه M2(CD163) هوه أعلى بكثير في المرضى من المجموعة الضابطة (0.001p، 0.468 p>على التوالي). في حين كان هناك ارتباط كبير بين CD68 / نسبة CD163 ودرجة تمايز الورم (0.03p Keywords

Musculoskeletal biopsy (Bone and soft tissue lesions) referred by orthopedic unit in Al-Diwaniyiah teaching hospital

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 60-64

Objectives. To study the frequency and type of bone and soft tissue lesions referred by orthopedic unit in Al-Deewaniyiah teaching Hospital.
Patients materials and methods. The surgical pathology reports of 86 patients presented with bony and soft tissue lesions were studied. Those records belong to the period extending from January 2014 through December 2014. Histopathologic features were reviewed and classification was made.
Results. Lesions referred by orthopedic unit represented about 5% out of all surgical biopsies received by the surgical pathology unit of Al-Deewaniyah teaching hospital. Bony lesions represented 25.5% of lesions while soft tissue lesions represented 74.5% of lesions. There was apparent association between type of lesion and age of the patients. There was no significant association between type of lesion and gender of patients.
Conclusion. Bony and soft tissue lesions represent a minor fraction of surgical specimens examined by surgical pathology unit and most of these lesions are benign
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Evaluation of the applicability and usefulness of Myocardial Performance Index in predicting the development of heart failure in comparison with other cardiac indices.

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 65-72

Back ground: The myocardial performance (MPI) is a combined index of systolic and diastolic dysfunction and has been shown to be a predictor of cardiovascular outcome in heart diseases.
Aim : Evaluate the role of MPI in assessment of heart failure in comparison with other echocardiographic parameters. Methods : By M-mode echocardiography, measurement of ejection fraction (EF) and stroke volume (SV) had been done, then measurement of left ventricular mass (LVM ) by measurement of left ventricular internal dimension in diastole (LVIDd) and systole (LVIDs), posterior wall thickness in diastole (PWTd), and interventricular septal thickness in diastole (IVSd). Left ventricular mass (LVM) was calculated from the measurements of the left ventricle (LV) using the equation: LVM (g) = 0.81 [1.04 (interventricular septal thickness + posterior wall thickness + LV end-diastolic internal dimension)3 – (LV end-diastolic internal dimension)3] + 0.6. Left ventricular mass index calculated by dividing LVM on body surface area. Measurement of MPI by the apical five-chamber view with Doppler study . the sum of the isovolumic relaxation time (IVRT) and isovolumic contraction time (IVCT) divided by the left ventricular ejection time (LVET) obtained from the left ventricular inflow and outflow. Results: The percentage of abnormal MPI in this study is about 82% (normal value is 0.39±0.05) in comparison to EF and SV which are 39% and 54.2% respectively. MPI showed weak but negative correlation with EF and SV ( r = -0.163, -0.044) respectively, and positive correlation with LVM and LVMI (r = 0.416 , 0.413) respectively. EF showed negative correlation with LVET, IVCT and IVRT( r = -0.03 , -0.028 , -0.25 ) respectively . Conclusion : Use of MPI for assessing cardiac performance has a potential clinical advantage over the use of other classical echocardiographic indices.
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Arteriovenous Fistula In End Stage Renal Disease With Modified Technique

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 73-76

Background brachiocephalic fistula is a best choice for long term hemodialysis as a vascular access comparing with central venous catheter & arterio venous graft .
Aim: aim of this study is to increase successful rate of brachiocephalic fistula.
Methods: In this study patients divided as controlled group (75 patients) which operated on with classical technique & studded group (225 patients) which operated on with modified technique I e (cut a patch from arterial wall, ligation of distal & deep tributaries , us of heparin , avoid hypotension &keep upper limb extended & supinated.
Results: Overall successful e rate was 90,4% which represent as 84% in controlled group & 92,5% in studded group .
Although DM represent 61% of patients & hypertension represent 56,5% of patients the failure rate was more in patients with HT (72%) & (55,1) in patients with DM.
Conclusion: Modified technique for arteriovenous fistula should be used in all patients with DM,HT & CTD to increase successful rate .

Overexpression of p53 gene has an important role in induction and progression of breast carcinoma

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 77-85

Breast cancer is the most common cancer in women, accounting for 23% of all female cancers around the globe. breast cancer molecular disease occurs due to the alteration in the genes that control cell growth and proliferation , such as HRE2/neu, c-MYC, K-RAS, RB, P53,PTEN,BRCA1 and BRCA2. The p53 tumor suppressor gene is located on chromosome 17p13, consists of 11 exons and encodes a53-kDa nuclear phosphoprotein, that has a very important function in many cellular processes, such as cell-cycle control, DNA repair , apoptosis and gene transcription. p53 is the most common mutated gene in human cancers , including breast. The aim of this study was to study the correlation between the overexpression of p53 and clinicopathological parameters in breast cancer patient. The current study included 85 sample of Paraffin-embedded breast cancer tissues, which were analyzed for p53 overexpression by immunohistochemistry. We also studies correlation between p53 overexpression and clinicopathological parameters.
The results have clarified that 64.7% (55 out of 85) of cases of breast cancer had high expression of P53 immunostaining in their histological sections ,while 35.3% of cases were negative for p53 expression. The p53 expression was significantly correlated high grade and stage as well as age group less than 50 years ,and there was no significant correlation between p53 expression and gender of patient, lymph node status, tumor size, tumor site and histological types.
Conclusion: These results demonstrated the overexpression of p53 in more than half of breast cancer cases and that overexpression of p53 was well correlated with grade and stage as well as young age group less than 50 years breast cancer patients.
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Intussusceptions Analysis of 57 cases of intussusceptions at Alkarama Teaching Hospital Wassit-Al-kut

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 86-92

This is a prospective study of 57 cases of intussusception who were admitted to the Alkarama Teaching Hospital inAl-kut from the 1st of October 2011 to the 1st of March 2014.
Age ranging was from one month to three years and the mean age was (6 months); the commonest age group affected was those between (6-12) months , the male: female ratio was (1.7:1) , the disease was more prevalent in spring time .
The cardinal symptoms were abdominal pain in 55 patients (96.5%), followed by the passage of red currant jelly stool in 50 patients (87.7%) and vomiting was present in 45 patients (78.9%).
The most common sign was abdominal mass in 31 patients (54.4%) .
Most of the patients 35 (61.4%) presented in the (24-48) hours from onset of symptoms.
In diagnosis we depended mostly on the clinical picture of the disease supported by plain abdominal x-ray , ultrasonography as Barium enema was not feasible.
Surgical management was the only option for alatients. Simple manual reduction of the bowel with appendectomy was the procedure in 44 (77.2%) of patients and in 7 patients (12.3%) resection was done due to gangrenous bowel with primary anastamosis which was not possible in one of them (1.8%) and ended with ileostomy
Six patients (10.5%) had secondary intussusception and in 4 of them , Meckel`s diverticulum was the lead point and the other 2 cases the polyps were the cause and all were treated by resection and primary anastamosis. Postoperative complications were recorded in 21 patients (36.8%) and mortality rate was recorded in one patient (1.8%).
(1.8%).

Impact of Women’s Body Mass Index (BMI) on the Outcomes of Intra-Cytoplasmic Sperms Injection (ICSI)

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 93-99

Obesity is one of major health problems across the world that negatively impact many body systems and organs including reproductive system. The objective of this study was to examine the effect of body-mass index (BMI) on the outcomes of intra-cytoplasmic sperms injection (ICSI). Eighty five women entering an ICSI program in the fertility center of Al-Sadr medical city / Al-Najaf Al-Ashraf, from January till April 2015, were enrolled in this study and divided according to BMI to normal weight group [(BMI 18.5-24.9 kg/m2) (n=22)], overweight group [(BMI 25-29.9 kg/m2) (n=43)] and obese group [(BMI≥30 kg/m2) (n=20)]. The patients underwent standard controlled ovarian hyperstimulation protocols and ICSI procedures. The outcome measures in the form of embryological outcomes and most importantly pregnancy rates were studied. The results revealed a significantly negative impact of high BMI in obese women group on total oocytes number retrieved (p value 0.021), mature oocytes number [oocytes in meiosis II (M II)] (p value 0.003), good quality oocytes number (p value 0.005), grade I embryos number (p value 0.040) and clinical pregnancy rate (p value 0.001). On behalf of these results, it is worthy to encourage women with high BMI to lower their body weight before entering an ICSI program..

Assessment of Knowledge, Attitude and Practice in a sample of Iraqi type 2 diabetic patients

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 100-106

Background: knowledge; attitude and practice backgrounds affect much the outcome of diabetes. Non-compliance imposes a considerable health care and financial burden on the health system.

Objectives: To assess the knowledge, attitude and practice background of type 2 diabetes Iraqi patients toward their disease by using the Knowledge, Attitude and Practice (KAP) questionnaire.
Patients and methods: A cross sectional questionnaire based study enrolled 300 type 2 diabetes patients. It was held in National diabetic center/Al-Mustansiryiah University in Baghdad from January 2015 through April 2015. Patients knowledge, attitude and practice background were assessed using KAP (knowledge Attitude and Practice) questionnaires.
Results: Mean knowledge score was 6.48+2.66, attitude score was 5.28+2.07 and practice score was 4.62+1.49. males showed significantly higher KAP scores than females (P<0.001). Patients with higher significant education had the highest knowlegde score in comparison with those with secondary eduction; the difference was statistically highly significant (P<0.001). Patients living in urban areas showed significantly higher mean score than those living in rural areas (P<0.001). Patients who had jobs experienced a significantly higher knowledge score than those without job (P<0.001). Smoker patients had significantly higher KAP scores than non-smoker patients (P<0.001).

Conclusion: The study concluded that low/ moderate knowledge, attitude and practice of diabetes among the diabetic patients, which need more effort and role to be played by clinical pharmacist to fulfill this gap.
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The Prevalence of Thyroid Disorders in Patients with Melasma

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 107-111

Background: Melasma is an acquired hyper pigmentation disorder recognized by blotchy, light-to-dark brown color macules distributed symmetrically in the sun-exposed parts in the body especially the face due to multiple causing factors including hormonal imbalance.
Aim of study: To detect the pravelance of thyroid disorderes in iraqi patients with melasma and its effect on cardiovascular variables, and to detect the relationship between autoimmune thyroid disorders with melasma.
Materials and methods :The design of the study is a case control study which included 122 subjects (82 melasma patients and 40 control group) where eighty two consenting patients (8 male and 74 female) clinically diagnosed to have melasma and aged 15-45 years (32.05±8.51 years) were included in the study, and fourty healthy volunteer of controls group are included in the study aged 15-45 years (31.6±8.35 years). The males and females were classified into three age groups for each one, fifteen years interval was considered to be suitable for classifying subjects. Patients were investigated for levels of (T3,T4,TSH,TgAb,and TPO).
Results: Melasma were more common in females than males . Also thyroid autoimmunity were more common in females than males. There was no significant difference in (heart rate, blood pressure, mean blood pressure, pulse pressure, and double product) between patients of melasma and control groups. The melasma group value of TSH is significantly higher than that of control group and also the melasma group value of both TgAb, and TPO are significantly higher than that of control group .While no significant difference in T3 and T4.
Conclusion: There were considerable association between melasma and autoimmune thyroid disorders, mostly in females..

Interleukin-6 Level among Iraqi Patients with Chronic Lymphocytic Leukemia from Babil Province

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 112-123

Introduction: Interleukin-6 (IL-6) is a pro-inflammatory cytokine and an anti-inflammatory myokine. Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in adults. The exact role of IL-6 in CLL is still contraversial and needs alot of research.
Aim of the study: To measure serum level of interleukin-6 among Iraqi patients from Babil province with a newly diagnosed untreated chronic lymphocytic leukemia and to assess it's association with the stage of the disease and peripheral blood indices.
Materials and methods: This is a case-control study included 106 Iraqi patients with a newly diagnosed untreated chronic lymphocytic leukemia (CLL). They were from Babil province and attended the hospital during the period from 1st of November 2012 to 30th of October 2015, while the control group included 106 age and sex matched healthy individuals. CBC, blood film and serum IL-6 (Human IL-6 ELISA kit ) were done for both groups, and bone marrow exam was performed for the patients only.
Results: The age of the patients ranged from 44 to 82 years with mean age of 61.8 ±6.14 years. Male:Female ratio was 1.8:1 and 57.5% of them were asymptomatic. Serum IL-6 was undetected in 39.6% (42/106) of the control cases and in 13.2% (14/106) of the patients; all of them were in CLL stages 0 and 1. Mean serum IL-6 in the patient group was 12.6 ±5.1 pg/ml, while it was 6.2 ±2.3 pg/ml in the control group (P-value was 0.001). Higher levels were documented in stages 3 and 4 (P-value 0.0001).
Conclusion and recommendations: Elevated serum IL-6 was found among Iraqi patients with newly diagnosed untreated CLL, and higher levels were documented in advanced stage disease. Further studies are needed to assess exact role of IL-6 in CLL as it may have prognostic and/or therapeutic implications.
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Environmental Pollution and Risk of Congenital Anomalies in Al-Diwaniya Governorate

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 124-129

Analytic study, conducted on 15 cases of congenital deformity of the newborn babies in the maternity and children's teaching hospital in Diwaniya for the period from the first of January until the end of December 2014 (6 males and 9 females) , were recorded cases include cardiac defects , urinary system anomalies , neural tube defects , cleft lip 'and Down syndrom.
The largest percentage is cardiac malformations and abnormalities of the urinary system,
the proportion of malformations among females were more than in males , for the place of residence was a al- Jumhoory locality in the top of the other 'as to the nature of the environment there were no any strange environmental phenomenon or different from other regions environment' except al- Jumhoory locality had seen very violent military conflicts.
Key words:
Environmental pollution, Congenital defects .
Background:
Although environmental pollution suggested to play a great role in occurrence of certain bad outcome , evidence of health consequences to populations is sparse.
Aim of the study:
To investigate whether there is an association between risk of congenital anomaly and level of environmental pollution in Diwaniya during the last years .
Methodology:
Case series for each age-sex defected born baby in the region for 15 disorders represented births from January 2014 –December 2014 , were calculated, based on the estimates of cases by cause, type of disorder , incidence, age of the mother, duration, and disability severity.
Estimates of the burden and prevalence of exposure in different localities of disorders attributable to malnutrition, poor water supply, poor sanitation, personal and domestic hygiene, , tobacco use by mother, occupation, hypertension, physical inactivity, and use of illicit drugs during pregnancy .
We asked also about history of feeding , rash appearance , x-ray exposure , history of previous baby with congenital anomaly , also asking about antenatal care during the whole period of gestation and also about the duration of residence of mothers .
Results :
From the total 15 congenital anomalies recorded during the whole year , 6 males and 9 females , non-chromosomal anomalies combined, raised risks were found for Tetralogy of Fallot 5 cases ( 33.3% ) , urinary system anomalies 4 cases ( 26.6% ) , while those with cleft lip 2 cases and those with neural tube anomalies 2 cases represents only 13.3% for each , also cases with chromosomal anomalies ( Down syndrome ) 2 cases represents only 13.3% from the total cases .
According to the locality , it was found that al- Jumhoory locality is the highest ( 5 ) cases i.e. 33.3% of the total , followed by al-wihda locality ( 4 ) cases which represents 26.6% of the anomalies recorded . Other localities { al- asry , al-oroba , al- askary , al-hakim , al- taqia and al- sanniah } registered only one case for each .
According to other variables , age of the mother , smoking , presence of associated diseases like hypertension or D M , level of education , we don’t find any significance .
Conclusions:
Although both environmental exposure and multiple genetic factors may plausibly explain some of the excess risks of birth defects observed, several alternative explanations, including exposure misclassification, ascertainment bias, and residual confounding cannot be excluded. Some of the effects observed, if real, might be therapeutic drugs , radioactive substance from weapons , cigarette smoking during pregnancy and maternal infection with rubella or cytomegalovirus .
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Some maternal and neonatal factors affecting early and late neonatal sepsis

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 130-136

Background:
Neonatal sepsis categorized as early and late onset. Early neonatal sepsis (ENS) in the first 7 days of life with 85% occurs in the first 24 hours of life. Late neonatal sepsis (LNS )occurs after the first week of life and is acquired from care giving environment.
Aims of study:
To explain the effect of some maternal and neonatal factors on early and late neonatal sepsis, like premature rupture of membranes, midwife interference and prematurity. With change in blood investigations, like effect of antibiotics on the results of blood cultures.
Methods:
We prepared a questionnaire about the name ,age in days, gender with perinatal and maternal history and take blood samples for CBC and differential, blood culture, CRP and ESR to explain the effect of neonatal sepsis on the blood investigation results and identify the specific pathogen causing neonatal sepsis by blood culture.
Results:
We found that the neonate is more susceptible to ENS in comparison to LNS. Also we found that the blood culture result highly affecting by antibiotics used before culture. The mortality rate is more in ENS in comparison to late type.
There was no significant difference in gender, maternal fever and antenatal care, between ENS and LNS groups. Prematurity was higher in ENS group compared to LNS group (44.7%, vs. 29%) respectively; and the difference was significant (p = 0.042). Mode of delivery showed no effect in ENS group (NVD = C/S = 50%); while it seems to be more effective in LNS group as (74.2% vs 25.8%) of patients are C/S, (p = 0.003).Only (13.2%) of ENS subjects were home delivery , while (25.8%) of LNS subjects were home delivery, (p = 0.048). Midwife interference was more effective in LNS subjects than ENS subjects, (35.5%, vs. 18.4%) respectively, (p = 0.019).Premature rupture of membrane was significantly more frequent in ENS subjects than LNS subjects (31.6% vs. 16.1%) respectively, (p = 0.028).Death was more frequent in ENS subjects than LNS subjects; (18.4%, vs. 3.2%) respectively .
Conclusion and Recommendation:
We found that the premature neonate more susceptible for neonatal sepsis than full term with premature rapture of membrane more frequently affecting ENS in comparison to late type. we found also that the C-reactive protien and platelets count had high sensitivity to the diagnosis of neonatal sepsis.We recommend antenatal care especially in the third trimester and use of antibiotic prophylaxis if there is a history of leaking liquor and avoid prematurity because premature neonates are more prone to early neonatal sepsis. Antibiotics should be avoided before blood culture aspiration to avoid false negative results.
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A study of the Retinal Nerve Fiber Layer Thickness Changes in Multiple Sclerosis Using Optical Coherence Tomography in Nassiriyha city

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 137-146

Optical coherence tomography (OCT) is a non-invasive relatively inexpensive technique that allows the quantitative cross sectional imaging of the RNFL. It has been used predominantly to investigate retinal axonal loss in glaucoma. The aim of the current study was to evaluate the retinal nerve fiber layer thickness as a structural biomarker for axonal loss in multiple sclerosis regardless the frank history of previous attack of optic neuritis. We evaluated the relationship between RNFL changes and the patients' age and duration of the disease. We also studied the correlation between the RNFL thickness and patients' clinical data as BCVA, history suggestive of optic neuritis as well as optic disc appearance by fundoscopy..

Effects of the prednisolone and hydrocortisone on the body weight of the pregnant rats and their embryo in the different stages of pregnancy.

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 147-154

The aim of the study was to investigate the effects of prednisolone and hydrocortisone on the body weight of the pregnant rats and their embryos after treatment with the drugs during pregnancy.
Materials and Methods: Thirty six adult female pregnant rats were randomly divided into three groups: Grop-1: control group C. (n = 12) received Distilled water 1 ml /kg b.w./day/intramuscularly for 14 days. Group-2: first treatment T1. (n=12) treated with prednisolone 4mg/kg b.w/day/intramuscularly for 14 days . Group-3: second treatment T2.(n=12) treated with hydrocortisone 40mg/kg b.w/day/ intramuscularly for 14 days.The body weight of the pregnant rats and their embryo detected at the day 15th and 20th of the gestation (developmental stage of rat embryo=E). At the detected period for taking the body weight of the pregnant rats and six animals from each group were sacrificed and taken the body weight of embryo with and without placenta.
Results: the results showed that prednisolone decrease the body weight of the pregnant rats and its embryo more than hydrocortisone, and may cause absorption for percentage of embryo.
Conclusion: prednisolone and hydrocortisone causes low body weight in the pregnant rats and its embryo when used for 14 days intramuscularly.
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The Prevalence of Anticardiolipin Antibodies in women with Bad Obstetric History

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 155-160

Background: Bad obstetric history (BOH) implies previous unfavorable fetal outcome in terms of two or more consecutive spontaneous abortions, early neonatal deaths, stillbirths, intrauterine fetal deaths, intrauterine growth retardation and congenital anomalies. The immune factors associated with pregnancy loss are classified as autoimmune and alloimmune factors. The autoimmune factors include the synthesis of autoantibodies (anti-phospholipid antibodies, anti-nuclear antibodies, anti-thyroid antibodies). The main types of antiphospholipid antibodies are Lupus Anticoagulant (LA) and Anticardiolipin (aCL) antibodies (IgG & IgM).
Objective: To measure the level of anticardiolipin antibodies in the sera of women with bad obstetric history.
Patients & method: the study was conducted from October 2009 till June 2011 including 117 patients who attended private clinic & laboratory. Patients included in the sudy were those with history of two or more recurrent miscarriages, intrauterine fetal death & stillbirth. Fetal losses due to diabetes or congenital anomalies were excluded.
Serum levels of anticardiolipin IgM & IgG antibodies were measured using AESKULISA phospholipid-Screen-GM (Germany) which is a solid phase enzyme immunassay for the separate qualitative & quantitative detection of IgG and /or IgM antibodies in human sera.
Results: from the total of 117 patients with BOH fourteen (11.96%) had positive anticardiolipin antibodies in their sera. When comparing between the different groups of patient who were classified according to the type of fetal loss the highest number & percentage of positive anticardiolipin antibody were found in those with three & more recurrent miscarriages (4 cases, 57.14%). When comparing the IgM & IgG levels in different patients groups, the highest levels were found in those with three & more recurrent miscarriages.
Conclusion: Anticardiolipin antibodies can have a positive association in women with bad obstetric history especially those with three & more recurrent miscarrigages. The level of IgM & IgG is highest in this group however these antibodies should be looked for in other patients with BOH
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A comparison of conjunctival rotation flap and autoconjunctival graft techniques in pterygium surgery at aldiwaniah teaching hospital from 2007_2013

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 161-165

purpose: to compare the result of conjunictival flap and autograft in term of recurrence rate and complication in Pterygium surgery.
Methods: A total of sixty patients(twenty five male and thirty five female) operated for pterygium with conjunctival autografts(in 25 eyes) or conjuctival flap(in 35 eyes) technique at diwanyia teaching hospital and with 18 months follow-up were registered. Patients were called for voluntary examinations of their respective ocular surface status.
Result: Mean age was 42.5 years (range, 23–75), 58.33% of the patients were male, and 75% worked predominantly outdoors. Mean follow-up was 12 months (range, 3–18)
Recurrence rate was 8%in graft,8.6%in flap, however edema was less in flap and granuloma was nil in both.
Conclusions: After a long follow-up period for autograft and conjunctival flap pterygium surgery, there were no statistically significant differences in recurrence rates ,as well as flap is faster and easier technique with less postoperative edema.
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Laparoscopic treatment of ovarian dermoid cysts

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 166-176

Objectives:
Dermoid cyst which is also known as benign or mature cystic teratoma is a common disease and accounts about 21.8% of all ovarian tumors.They areone of the most common tumors in women during the reproductive yearsand they are not uncommon during pregnancy. They are mostly benign in nature but surgery is needed to relief of symptoms and to prevent complications.
In the recent years, the laparoscopic approach have greatly replaced most of the gynaecological operation and specially in benign ovarian diseases as it improved significantly the outcome of these lesions.
Aim of the study: reviewing the laparoscopic management of ovarian dermoid cysts and assessing the intra-operative complications, and early postoperative follow-up.
Material and MethodA prospective study of 43 patient who underwent laparoscopic management of ovarian dermoid cysts.
The patients are presented either with acute symptoms like pain , vaginal bleeding or chronic symptoms like abdominal pain or menstrual irregularities. This suspicion is documented by pelvic ultrasound . then the patients are qualified for laparoscopic management under general anasthesia.
Results:
A total of 43 women with ovarian dermoid cyst were included and treated laparoscopically . the main age is 31.31 years.Mean cyst diameter size that was measured by ultrasound was 7.24. they are bilateral in 28 % of cases. Patient age and size of cyst did not differ between those with left and right lesions.
Cystectomy with enuculation of the cyst was the most commonly applied procedure , while total adnexectomy and partial oophorectomy was the least frequent.The whole gonad was removed in one postmenopausal patients.
The mean duration of the operation was 53.48 minutes (± 20.61; range 35-120 ).The total number of days in the hospital excluding the period of preoperative examination (generally 1 day) was 2.54 days.All the extracted material was submitted for a final histopathological examination.
Intra-operatively;a minimal spillage occurred in 18 casesand rupture of retrieval bag occurred in 2 cases but none developed post-operative chemical peritonitis.In two cases we discover bleeding from the left ileac fossa 5 mm port .Port site infections were noted in six patient.No case of postoperative peritonitis was recorded. There was one case of post-operative paralytic ileus.
Discussion:
Laparoscopic removal of ovariandermoid cysts has increased in the last few years. But this need aproper early qualification, based on medical history, gynaecological and sonographic examination to assure the benignity of these lesions although malignant transformation of these benign lesion is rare and it is a contra-indication to the laparoscopic treatment.
Dermoid cysts occur not often during pregnancy, but caused their complications ( high risk of torsion and rupture ) demand immediate surgical intervention
Laparoscopic treatment consist of total cyst excision with preservation of the remaining ovarian tissue but partial oophorectomy or total oophorectomy can be indicated if there is suspected area specially in post-menopausal women .
Laparoscopic treatment of ovarian dermoid cyst may be complicated with port site haemorrhage , intra –peritoneal spillage of the cyst content and post-operative paralytic ileus . these are mostly minimal and can be managed conservatively.
Conclusion:
We concludes that the minimal access surgical treatment through the laparoscopic ovariandermoid cystectomy is a safe and beneficial method in selected patients. It offers the advantages of shorter hospital stay, and better cosmetic result in comparison to classical surgery.

Incidence Rate of Musculoskeletal Congenital Anomalies of Neonates in Muthanna Province From 1/1/2008 to 1/1/2009

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 177-192

The aim of this study is to know the incidence rate of musculoskeletal congenital anomalies in Muthanna province at the period of 1/1/2008 to 1/1/2009 . The study compromised ( 218 ) live birth neonates ( 1 day – 1 year ) of musculoskeletal congenital anomalies at Hussein Teaching and obstetric and pediatric teaching hospitals . The overall incidence of various types of musculoskeletal congenital anomalies was ( 0.7 %) ( 7 per 1000) , and this is high incidence in comparison with the other countries .The fertility rate was ( 47 % ) and this is a good rate .The study showed high incidence of musculoskeletal congenital anomalies in Samawa city than Rumaitha and Khidher cities . The study revealed ( 35 ) cases due to chicken pox and German Rubella , ( 28 ) cases due to toxoplasmosis , ( 25 ) cases due to diabetes mellitus , ( 2 ) cases associated with the epilepsy and ( 2 ) cases due to thyroid diseases . The mothers were interviewed regarding the age , family history , consanguinity , parity , maturity of fetus , history of maternal disease , history of exposure to ionizing radiation or chemical agent and use of folic acid . The neonate was examined and sent for some investigations ( e.g. radiograph , ultrasound , computerized tomographic scan and some lab. Investigations ) . .

Detection of Serotype Gene of Klebsiella Pneumoniae Isolated from Different Clinical Cases of Hospitalized Infections in Al-Diwaniya city

Al-Qadisiah Medical Journal, 2016, Volume 12, Issue 1, Pages 193-203

This study aimed to identify serotype of Klebsiella Pneumonia isolated from different clinical cases of hospitalized infections( urinary tract infection, respiratory infection, burns & wounds) by using polymerase chain reaction(PCR).A total of 110 clinical specimens from in-patients with nosocomial infections(including 47 respiratory infection,37 UTI , burns & wound infections 26) in Al-Diwaniya Teaching Hospital during the period from December 2012 –March 2013 were collected. K. Pneumonia isolated from 35.4% of the specimens distributed as 18.18% sputum specimens,10.90% urine specimens & 6.36% burns & wounds specimens.
K1,K2,K5,K20,K54 & K57 serotypes of K. Pneumonia were successfully detected in multiplex PCR.The results revealed that 28 specimens(25.4%) were type able including 7 positive K1(Amplicon size 1046bp) serotype isolates ( 4 from sputum,2 from urine & 1 from burn), 6 positive of K2(Amplicon size1121) serotype isolates (3 from urine,2 from sputum & 1 from wound),3 positive for K5(Amplicon size 999bp) serotype isolates( 2 from sputum & 1 from urine),2 positive for K20(Amplicon size 1116bp) serotype isolates from urine 2 positive of K54(Amplicon size 881bp) serotype isolates were one from sputum & the other from urine& finally 8 positive of K57(Amplicon size 1182bp) serotype isolates(4 from sputum,2 from urine & 2 from burns & wounds).
However, among 11 (10%) specimens, K. Pneumonia were non type able.
This study revealed that there were predominance of K1,K2 & K57 serotype isolates in sputum, urine burns & wounds of patients with nosocomial infections
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