Background: Chilblains, also called pernio or perniosis, are localized, tender, inflammatory, erythematous, often itchy lesions, which may blistered or ulcerated, caused by continued exposure to cold above the freezing point. More commonly seen in children, women and persons with low body mass index, with a genetic predisposition. Many prophylactic measures are used, and therapeutic remedies for the treatment of developed chilblains, like nifedipine, diltiazem, nicotinic acid derivatives, tamoxifen and minoxidil topically. Objectives: The aim of the present study was to evaluate the effectiveness of sildenafil in the treatment of chilblains in female patients. Patients and methods: Sixty five female patients with chilblain were seen in a private clinic in Kalar city, Al-Sulaimania Province, Iraq, for the period from the first of October 2014 to the thirty of September 2016, their ages ranged from 10-25 years (mean 16±8). The disease was diagnosed clinically and the patients were evaluated for different data, and identification of bacteria which complicate some patients with ulcerative lesions and all patients treated by sildenafil tablet (50mg, once daily after meal), for 7-10 days and assisted clinically (subjectively) for resolution of the disease. Results: Sixty patients (92.3%) out of (65) studied patients shows complete clearance of the disease clinically within 7-10 days of sildenafil treatment (50mg, tablet, once daily orally after meal). Five patients (7.7%) shows partial improvement of the disease with persistence of the signs and symptoms. Staphylococcus aureus was isolated from 20(30.76%) patients. Ten patients (15.4%) developed flushing and hotness of the face with nasal stiffness and 5 patients (7.7%) developing gastric upset. Conclusion: It was concluded that sildenafil was an effective therapy for the treatment of chilblain in female patients, although it was associated with some side effects.

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Background: Enterobacteriaceae is the most frequent Gram-negative pathogens that are accountable for many serious infectious diseases. The emergence and widespread carbapenem-resistant Enterobacteriaceae have increased dramatically and have become a burden on public health with increasing challenge in treatment with classical antibiotics. Objectives: The goal of this research was to detect of OXA-48 carbapenemaseproducing Enterobacteriaceae clinical isolates using a new in vitro phenotypes technique “OXA-48 K-SeT assay”. Methods: A total of 40 Enterobacteriaceae strains was involved in this investigation. Antibiotics susceptibility rates were carried out by modifying Kirby-Bauer's disk diffusion technique. Biochemical tests were performed using the API 20 E kit. Identification of OXA-48 carbapenemase was tested by OXA-48 K-SeT assay and modified Calgary biofilm method were used for detection of biofilm formation. Results: The majority of Enterobacteriaceae isolates were obtained from urine samples 23 (57.5%) followed by sputum and wound exudate samples 6 (15%), 5 (12.5%) respectively. The prevalence of infection with E. coli and K. pneumoniae was significant among age groups of 40 -59 years old (P <0.001), and patients with age below twenty or over sixty years old showed lower susceptibility to infection with Enterobacteriaceae. The strains of k. pneumoniae obtained from urine samples exhibited a strong propensity to develop biofilms and it showed an excellent biofilm propensity score, whereas E. coli strains showed a lower propensity to form biofilm. In addition, K. Pneumonia was displaying a predisposition to resistant to OXA-48 carbapenemase with 7 (17.5%) positive for OXA-48 K-SeT, while only 4 (10%) E. coli exhibit positive results for OXA-48 K-SeT. The most OXA-48-positive and OXA-48-negative of Enterobacteriaceae isolates showed markedly resistance to beta-lactamase inhibitor combination (amoxicillin-clavulanate and piperacillin-tazobactam) with different resistance rates were noted against cephalosporin groups (ceftazidime, cefotaxime, cefepime, and cefoxitin) and less resistance to monobactam groups (aztreonam) were observed, while no resistance was observed against colistin. The higher levels of antibiotic resistance correlated dramatically with increase biofilm-producing of Enterobacteriaceae, regardless of types of antibiotics (β-lactam and non- β-lactam antibiotics). Conclusion: The findings of this study show that the OXA-48 K-SeT assay were exact phenotypic method and significant test for direct detection of OXA-48-producing Enterobacteriaceae. This study found clearly correlating of biofilm formation and increased level of antibiotic resistance in Enterobacteriaceae isolates. The quick recognition and confirmation of carbapenemases resistance in these bacteria is important for proper choice of antibiotics and avoidance multidrug-resistant pathogens.

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Background: The concept of minimal access surgery was introduced to achieve several objectives; among which was to minimize post-operative pain by bringing access trauma to the lowest possible level without compromising the clarity of the operative field. Objectives: To study the effect of using local intraperitoneal application of xylocaine, in 2 different concentrations applied directly as near as possible to the intra-abdominal operative field in laparoscopic cholecystectomy, on post-operative pain control. Patients and methods: 110 patients with symptomatic gall stone disease were treated with laparoscopic cholecystectomy. These were divided into 3 groups, the first group, of 40 patients, was operated upon using the classical steps of that surgery and the final step was always to wash the field with normal saline followed by sucking extra fluid before terminating the surgery. In the second group (36 patients) a step was added; and that is the application of local Xylocaine (3 ml of 2% solution-without adrenaline-diluted with 7 ml of normal saline to a total of 10 ml- i.e. 0.6% solution) sprayed as near as possible to gall bladder bed (after excising the gall bladder) and kept in. In the third group (34 patients), 5 ml of the 2% Xylocaine were diluted up to 10 ml (ending with a 1% solution) sprayed in the same way. These 3 groups were followed postoperatively regarding the level of pain and magnitude of post-operative pain control and the amount of post-operative analgesia needed for each of them. Results: The first group of patients who did not receive intraperitoneal xylocaine, expressed higher levels of post-operative pain, and needed higher (or more frequent) doses of post-operative analgesia, than the 2nd and the 3rd groups who did receive intra-peritoneal xylocaine sprays. This was expressed as better post-operative pain control in these patients. There was no significant difference in pain control between the 2nd and the 3rd group patients. Using this simple technique will add no more than a minute or two to the time of the operation at its end. Pain control will be significantly aided if subcutaneous Xylocaine was also used in addition at the port site wounds. Conclusions: Using local intraperitoneal xylocaine sprayed at the gall bladder bed in laparoscopic cholecystectomy (as the end step after excising the gall bladder) gives a better post-operative pain control and decreases the need for higher or more frequent doses of post-operative analgesia.

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Background: At any time during pregnancy, intrauterine infection is an important risk factor for neonatal sepsis and is a frequent cause of mortality and morbidity in newborn infants Objectives: to evaluate maternal plasma procalcitonin levels in the pregnant women complicated with preterm prelabor rupture of membrane and prelabor rupture of membrane at term and compare it with healthy pregnant women at preterm and term and determine the role of procalcitonin in the diagnosis of subclinical chorioamnionitis in PPROM cases Study design: A prospective case-control study Patients and Methods: One hundred women 18_40 years old with singleton pregnancies were seen in Al-Yarmuk teaching hospital between September 2015 to August 2016. Women were divided into 4 groups according to weeks of gestation and membrane status (intact or ruptures). Group 1 included 30 women with gestational age between 28-36 weeks and membrane rupture without uterine contraction. Group 2 included 25 women with rupture membrane at term (37-41weeks) without uterine contraction. Group 3 included 20 healthy women at preterm (28 - 36 weeks) with intact membrane. Group 4 included 25 healthy women at term (37-41weeks) not in labor with intact membrane; the last two groups represented the control groups. In all groups, we measured maternal plasma procalcitonin level, white blood cells(WBC), C reactive protein (CRP), send placenta for histopathology and check birth weight of the baby and sign of neonatal infection. Results: the mean PCT level in the women of group one (the PPROM group) was higher (0.171 ±0.078) ng/ml than PROM and control groups with a p-value of <0,001. In addition, it was more significant in the detection of histological chorioamnionitis in PPROM patients than neonatal infection, as the cut off value was 0.08, with high sensitivity 96%, specificity 82%, positive predictive value (PPV) 84.2% and negative predictive value (NPV) 95.3%. Conclusions: Maternal plasma PCT level was significantly higher in PPROM than in term PROM and controls groups. PCT was more significant in predicting histological chorioamnionitis than neonatal sepsis. PCT was superior to CRP and WBC count in detecting subclinical intraamniotic infection by its ability to detect histological chorioamnionitis and neonatal sepsis.

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Background: Intra uterine insemination is an assisted reproductive technique using husband or donor sperms, at the time of ovulation in natural or stimulated cycle, to be placed in the uterine cavity or in the cervical canal. It is a common procedure used for the treatment of infertility. Objectives: To identify factors that can predict successful outcome in intrauterine insemination and the socio-demographic characteristics of couples visiting intra uterine insemination department in Al–Yarmouk Infertility Center through five-year records review. Patients & Methods: A descriptive study (review of records) was conducted on all available records of infertile couples (259 couples), undergone intra uterine insemination treatment for their infertility problems in Al-Yarmouk Infertility Center, from 2007 through 2011. The necessary data were collected from only124 couples with complete information. Results: The overall pregnancy rate was 27.4% (34 cases) in whom 4.8% were delivered successfully; the miscarriage rate was 4%, and no ectopic pregnancy or multiple pregnancies were encountered. Four significant variables were identified for successful outcome: duration of infertility (<10 years 45.2 vs. 5.6%), type of infertility (secondary infertility 46.7 vs. 21.3%), number of trials (twice and more 68.1% vs. 15.7%), and progressive motility of sperm after preparation (couples with >50% normal progressive motility 37.3 vs. 18.5%). Conclusions: Intrauterine insemination provides better results in couples with secondary infertility, shorter duration of infertility, increasing number of trials, and in those with 50% normal sperm motility or more

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Background: Healthy nutrition is especially important during the first 6 months of life being the period of exceptionally accelerated growth and high nutrient requirements. The global nutrition target number 5 for 2025 by World Health Organization is to elevate the rate of exclusive breastfeeding in the 1^st six months up to 50 percent. Aim of study: to determine the exclusive breastfeeding rate and associated risk factors for the first six months of life in Misan, South East of Iraq. Subjects and Methods: A cross-sectional study with analytical elements. It was conducted in Al-Sader Teaching Hospital during the period from 1^st of September 2016 to 1^st of March 2017 among randomly selected 500 mothers having infants aged between 7-12months. Results: Exclusive breastfeeding rate was 45.6% and there was a significant association with some factors like residence, previous breastfeeding, maternal health status, education level, employment, the number of babies at delivery and birth order in which the P values were 0.009, 0.0008, 0.0005, 0.033, 0.038, 0.05 and 0.03 respectively. Conclusion: Exclusive breastfeeding rate in Misan was low and it was less than the target of World Health Organization.

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Background: Acute coronary syndromes in premenopausal women is uncommon and limited data is available regarding their risk factor profile and angiographic characteristics. Objectives: To determine the clinical and angiographic findings in premenopausal women presented with acute coronary syndromes. Patients and methods: Cross sectional study included 160 patients (68 premenopausal women and 92 age matched male controls) who were admitted in the coronary care unit of Ibn Al-Betar Center for Cardiac Disease and diagnosed as a cases of acute coronary syndromes between September, 2013 and June, 2014 . The clinical characteristics, angiographic findings for premenopausal women were compared to age matched males. Results: Hypertension was the commonest risk factor for coronary artery disease in both premenopausal women (54.4%) and age matched males (43.5%). The prevalence of smoking was significantly lower in premenopausal women compared with age matched males (8.8% vs 63.0%, p=0.0001). There was no clear risk factor for CAD in 32.4% of premenopausal women (32.4% vs 12.0%, p=0.0006). No significant difference was noted in the prevalence of hypertension (54.4% vs 43.5%, p=0.17), diabetes mellitus (33.8% vs 27.2%, p= 0.36) , dyslipidemia (27.9% vs 35.9%, p=0.29) and family history of CAD (26.5% vs 20.7%,p=0.23) between both groups . Typical chest pain was the presenting symptom in 57.4% of premenopausal women. There was more proximal left anterior descending artery involvement in the premenopausal group (25% vs 17.4%, p=0.02). The rate of angiographically normal coronaries was more in premenopausal women (16.2% vs 9.8%, p=0.045). Conclusion: acute coronary syndrome could be considered in premenopausal women who present with chest pain and careful consideration, examination and diagnosis are essential workup steps in order to not miss this condition.

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Background: Menopause is the perpetual cessation of menstruation due to defeat of ovarian follicular activity. Menopause in women leads to various physiological changes in the body. Objective: To study the metabolic and hormonal changes in postmenopausal women. Patients and Methods: Forty five postmenopausal women were participated in the study and compared them with 45 premenopausal women who had a regular menstruation. They were attending the Medical City Hospital/Obstetrics and Gynecology Department during the period from July 2016 until the end of December 2016. Anthropometric and physiological parameters were taken. Biochemical and hormonal parameters were measured for all individuals. Results: In this study, there was a significant increase in serum apolipoprotein E levels, total cholesterol, triacylglycerol, low density lipoprotein cholesterol, urea, and thyroid stimulating hormone in postmenopausal group as compared to premenopausal group, (P ≤0.05). Serum total tri- and tetra-iodothyronine levels were decrease in postmenopausal group as compared to premenopausal group, but it was not significant. There was a significant increase in apolipoprotein E in postmenopausal women who had family history for dyslipidemia, (P =0.001). There was a significant positive correlation between apolipoprotein E and thyroid stimulating hormone. While there was a significant negative correlations among apolipoprotein E with high density lipoprotein cholesterol and estradiol, (P ≤ 0.01) Conclusions: The physiological basis and the complex interaction between thyroid hormones and apolipoprotein E and their relation with estradiol hormone among postmenopausal women trigger the lipids control mechanism.

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Background: Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that principally attacks synovial joints. Aims: To evaluate the status of serum fucose and protein bound fucose, anti-CCP, TNF-α and RF in serum of RA patients. Subjects and methods: The study has included 30 patients with early RA (with disease duration <1 year) (23 females+ 7 males) with age range (30-61) years and 30 patients with late RA (with disease duration >1 year) diagnosed according to the 2010 EULAR criteria (25 females, 5 males) with age range (30-60) and 28 healthy control individuals (22 females,6 males) with age range (30-55), who were age and sex matching with patients. Results: Levels of total serum fucose and protein bound fucose significantly decrease in RA patients than healthy control, while anti-CCP, TNF-α, RF, CRP and ESR significantly increase in RA patients than healthy control. Levels of total serum fucose, protein bound fucose & ACCP were not significant between three stages of activity in late & early RA patients. The level TNF-α & RF were significant only in very active cases in late RA, while not significantly in all cases of early RA. Positive correlation was found between ACCP & ESR in RA patients & early RA patients. Positive correlation found between TSF & PBF, negative correlation found between TNF-α & ESR in late RA patients. Positive correlation found between ACCP & ESR, CRP & ESR in early RA patients. Conclusions: This study illustrate that total serum fucose and protein bound fucose aid to diagnosis RA patient. Also Anti-CCP is a good & specific marker for diagnosis of RA,it is a good prognostic and as index test of severity.

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Type of the study: case control Aim: to evaluate the severity of imminent preeclampsia in consanguinity versus non consanguinity groups Design and patients methods: a highly selective criteria have been chosen for the women to be participated in this study. The study group (N=30) were not only cousins rather their parents were also cousins and most came from the rural area. While the control Group (N=30) were women in whom no consanguinity neither with couple nor their parents were selected. All women were primigravida 20- 30 years in age. They were all taken from labor ward after 37 weeks of gestation, and for each at admission systolic, diastolic blood pressure, serum uric acid, blood urea, blood platelets count and serum fibrinogen and SGPT with SGOT were initially taken at admission. Since all the patients were in severe and imminent preeclampsia they were all pre prepared with MgSO₄ as anti convulsant and during preparation serial reading were also taken for all the above parameters at 3 and 6 hours later to measure the area under curve profile AUC. Mean blood pressure was taken instead of systolic and diastolic and calculated by the well documented formula Results: The ODD ratio for the primary determinant of preeclampsia severity namely blood pressure and proteinurea were higher in the consanguinity group versus control; 6.58 for systolic; 6.73 for diastolic and 4.07 for protein/creatinine ration in urine, respectively. Serum uric acid and blood urea was also higher for their ODD ratio in the consanguinity group; 5.2 and 5.21 respectively. More importantly the markers of imminent preeclampsia were also significantly higher in the consanguinity group with odd ratio 2.22and 2.61 for SGOT and SGPT respectively. Best subset regression was calculated for the best combination which correlates with mean blood pressure and serum SGPT with Blood urea combinations were having the lowest coefficient of Mallow (Cp); 32.23. From that independent variable a prediction table has been constructed to sort out all the patients with imminent preeclampsia who are most affected and near complications probably and expressed as column of intervals of blood urea with corresponding 1,2.5, 5, 10, 90, 95,97.5 and 99 centile of serum SGPT. The area under 10^th centile was shaded with green while above 90^th centile with red and in between shaded with yellow color. It is probable that patients who's reading in the red zone or upper yellow zone are at more risk for more serious complications of preeclampsia like adrenal hemorrhage and renal complications and better to expedite their delivery. Conclusion: this study has shown that preeclampsia among consanguinity group was much more severe than those in non consanguinity couples. Yet by no mean that respect reflects the true picture in society. A table has been constructed and we over stress here that under no circumstances this table can be used for evaluating, modifying or changing the routine protocol of preeclampsia management.

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Background: Inflammation is an important risk factor in disorders such as cardiovascular, metabolic syndrome, diabetes mellitus and insulin resistance and there is a controversy about the role of pro and anti-inflammatory factors in acromegaly and their relationships with each other. Evidence showed that IL-10 level is associated with insulin resistance. Objectives: To investigate the association of GH with IL-10, TNF-α and hs-CRP in patients with active acromegaly and the association of IR with IL-10, TNF-α and hs-CRP. Methods: The study was conducted on thirty Iraqi acromegalic patients (age 35-57 years) attending the endocrine clinic of National Diabetes Center of Mustansiriyah University and were diagnosed with active acromegaly. For the purpose of comparison, 28 apparently healthy control subjects age matched to the patients were included in this study. Serum was obtained from all subjects for the determination of the GH , hs-CRP,IL-10 and TNF-α levels which was measured by Enzyme Linked Immunosorbent Assay (ELISA) in both study groups. Results: The results in this study revealed that mean levels of serum TNF-α hs-CRP levels were significantly decreased in active acromegaly as compared with control group and this significantly correlated with GH, while IL-10 and IR were significantly increased in active acromegalic patients when compared with control group and IL-10 showed no significant correlation with GH, but significantly correlated with IR in patients group. Conclusion: There were significant negative correlations between TNF-α and hs-CRP levels with GH in patients with active acromegaly, while IL-10 is nonsignificantly correlated with GH. A positive correlation of both TNF-α and IL-10 was observed with IR in patients with acromegaly. TNF-α and IL-10 can play a role in IR in patients with acromegaly and might be involved in the inflammatory network of acromegalic patients.

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Background: Cesarean section is the most frequent surgical procedure in obstetrics. Surgical site infection is one of the most common postcesarean complications. Objective: Assessment of sensitivity of common bacterial pathogens in surgical site infection to some of the clinically used antimicrobials. Patients and methods: this study was conducted in Al-Elwiyah maternity hospital for the whole year 2016. Sixty in- and outpatients presented complaining of post cesarean surgical site infection signs and symptoms were subjected to wound swab for culture and sensitivity to identify the causative bacteria and evaluate their sensitivity to the commonly used antimicrobials. Results: thirty-four out of sixty cultures were contaminated. The main isolated bacterial pathogens were staphylococcus aureus (47%), E. coli (23.5%), pseudomonas aeruginosa (11.7%) and others. Antimicrobial sensitivity of Gram positive bacteria (Staphylococcus aureus) was high for vancomycin (100%), amikacin (93.8%) and tobramycin (87%). Gram negative microbes were susceptible for amikacin (100%), vancomycin (100%) and imipenem (100%). Conclusions: The major microbial species isolated from infected post-cesarean SSI were S. aureus, E. coli and P. aeruginosa. Their sensitivity to antimicrobials was variable; vancomycin and amikacin have shown the best effect against all isolated species.

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Background: Empyema Gallbladder is a sequel of severe acute cholecystitis. Previously, laparoscopic cholecystectomy was relatively contraindicated because of fatal complications. Objectives: To determine the safety of laparoscopic surgery in treatment of empyema gallbladder. Methods: A retrospective study conducted on 92 patients from Nov. 2007 to May 2017, with gallbladder empyema who underwent laparoscopic cholecystectomy at Al-Yarmouk teaching hospital in Baghdad, Iraq. The operation was done by using four ports. Results: A retrospective study of 92 case of empyema gallbladder, laparoscopic cholecystectomy was performed for 92 cases proved to have empyema gallbladder. A successful laparoscopic cholecystectomy done to 75 cases (81.52%) (Group I), a conversion to open cholecystectomy was done to17 (18.47%) (Group II) patients due to various reasons, the most common as a gangrenous wall of gallbladder 6 (6.5%) patients, bleeding from cystic artery 5 (5.4%) patients, severe obscured anatomy of Calot's triangle duo to adhesions 3 (3.2%) patients. Duodenal injury 2 (2.1%) patients and common bile duct injury 1 (1.08%) patient. Maximum operative time was 80 minutes for all cases. Postoperative complications occurred in 22(29.3%) patients of Group I, and 9(52.9%) patients of Group II. Group I (75 patients) in whom successively laparoscopic cholecystectomy (LC) was done, and Group II (17 patients) where conversion to open cholecystectomy. About 53(70.6%) of Group I patients discharged from hospital within 1-3days, and about 9 (52.9%) of Group II patients discharged from hospital within 7days. Conclusions: Gallbladder Empyema is a serious sequel of acute cholecystitis, where the laparoscopic cholecystectomy can be done to treat it safely.

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Aims: Is to find relationship between autism and absence of Glutathione-Stransferase (GSTs) genes GSTT1 and GSTM1, which are responsible for detoxification from the body. Methods: The present study includes the collection of (sixty) Iraqi children with a psychiatrist autism, the range of their age was 2-10 years. All blood samples were subjected to multiplex polymerase chain reaction (PCR) technique in laboratories of college of science (for Woman) Baghdad University for detection of the presence or absence of the gene encode for glutathione protein, and determination of the level of mercury and lead in blood samples. Results: The results of the study showed that the male: female ratio in autistic children is (5.7:1). The percentage of children who have (GSTM1-null) genotype was 55.9% higher than the children 44.0% with (GSTM1-positive) genotype while the frequency of (GSTT1-null) genotype (11.8%) was lower than that of (GSTT1-positive) genotype (88.1%) in the tested cohort. The numbers of parents who have a positive GSTM1 genotype are lower than other groups while the number of parents who have a positive GSTT1 is higher than in other groups. The present study reveals that the presence of high concentrations of mercury in the blood samples for all children with autism compared with their families and with the normal value. Conclusions: It is concluded from the present study that the deletion or absence of GSTM1 genotype in autistic children is higher than presence. This indicates that GSTM1- null genotype is related to the ASD but not as a risk factor for autism. The high frequency of GSTT1 positive genotype in autistic children and their parents is an indicator for a relationship between them. Further studies with large size of samples is needed to detect the activity of oxidative stress effect of enzymes encoded by alleles of GSTT1 genes.

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