Thi-Qar Medical Journal

To detect the variants represents three mutations in Glucose-6-phosphate dehydrogenase
(G6PD) gene of hemolytic anemic patients in Sulaimani governorate, tests revealed normal
PCV, Hb, and G6PD activity ranges in the 10 subjects control sample, while patient's PCV
ranged 10-44%, Hb 3.2-13.8 g/dl, and G6PD activity 0.35-8.7 Iu/gHb (2.9-74.3%). According
to the G6PD activity, the severity of the anemia among the 40 patients was distributed as
6(15%) mild 25(62.5) moderate and 9(22.5) severe with no healthy. The Mediterranean variant
among patients, as detected by PCR amplification of 545bp exons 6 & 7 and digestion by
MboII endonuclease, prevalent 33(82.5%), The Chatham variant, as detected by amplification
of 253bp exon 9 and digestion by BstXI, prevalent 2(5%), and Cosenza variant, as detected by
amplification of 665bp exons 11-13 and digestion by Bsu36I (Eco81I) endonuclease, prevalent
4(10%), while 4(10%) did not revealed any of the three variants regarding that 3(7.5%) of the
patients showed both Mediterranean and Cosenza. Out of 7 Mediterranean variant's females, 1
was homozygous. The 10 control subjects did not reveal any of the three variants.

Background: The term "gestational diabetes mellitus" (GDM) refers to any degree of
glucose intolerance that manifests itself or is first noticed during pregnancy. is a severe
obstetric complication that affects between 5 and 10 percent of pregnancies globally; and is
characterized by an insufficient response to insulin (Hyperglycemia). to make up for
pregnancy's insulin-resistant condition. Gram-negative, spiral-shaped, microaerophilic H.
pylori bacteria.Having dimensions of 0.5 to 1 pm in width and 2 to 4 pm in length. The body
contains 2 to 6 flagella, and the flagella's motility grants and permits quick movement in
viscous solutions, like the mucus layer of the gastric epithelial cell.
Objective: The purpose of this study was to determine the relationship between
[Helicobacter pylori (H. pylori) with Gestational diabetes mellitus (GDM)].
Materials and Method: HP-IgG and HP-IgM levels were evaluated in 89 pregnancy
womens: 60 with Gestational Diabetes Mellitus (GDM) disease and 29 with healthy
pregnancy. The study participants and the healthy controls varied in ages from 23 to 47 year.
The enzyme-linked immunosorbent assay (ELISA) method measured HP-IgG and HP-IgM
levels in the blood.
Results: The serum HP-IgG was greater in GDM patients than in controls (p 0.01) and HP
IgM (p 0.05). the current study discovered a Positive association between HP-IgG and HP
IgM with GDM.
Conclusion: H. pylori infections are very common in GDM. The women with GDM,
infections with H. pylori are rise the risks of GDM. The H. pylori selection and
extermination therapy before pregnancy help in avoiding GDM

Background: Hyperlipidemia is common in public, the link between trace elements and
Hyperlipidemia is not clearly studied. For humans, copper, zinc and selenium are essential
trace elements in nutrients and required in very small quantities for various biological
functions. During disease, trace elements used for diagnosis, it is essential to distinguish
whether the balance is altered in free or bound elements.
Objective: For the assessment of copper, zinc, selenium and body mass index level and
to examine the correlation between parameters and study the probable relation of them
with diagnosis of hyperlipidemia in Babylon province.
Materials and Methods: Cu, Zn and Se were estimated in one hundred subjects; 50
patients with hyperlipidemia and 50 healthy subjects were participated in this study.
Patients and control groups with an age ranged between (19-75) years. The level of Zn and
Cu and Se were assessed in serum by Flameless Atomic absorption spectrophotometer
method.
Results:
Serum levels of selenium and zinc displayed a significant decrease, while serum copper
significantly elevated (p < 0.001) in hyperlipidemia patients. On the other hand, selenium
and zinc correlated significantly with body mass index.
Conclusion:
Among hyperlipidemia patients in Babylon province, the variability in some trace
elements indicate the significant relationship with hyperlipidemia.

Background: Diabetes Mellitus is the commonest endocrine disease and metformin is the
commonest oral anti diabetic agent prescribed. B12 deficiency is one of the side effects of
metformin due to the effect on calcium-dependent membrane action in the terminal ileum leading
to malabsorption of vitamin B12.
Aim of study: for determination of the prevalence and association of Vitamin B12 deficiency in
patients with type 2 diabetes mellitus managed with metformin.
Methods:
This case control study took place in the department of medicine, Alhussein teaching hospital in
Nassiriyah city in Iraq .We selected 43 patients with type 2 diabetes mellitus on metformin for at
least 12 months and 42 patients were taken as control. Patients with vitamin B12 levels of less than
297 pg/mL or methyl malonic acid (MMA) more than 47 ng/mL were considered B12 deficient.
Results:
serum B12 level was low in 17 out of 43 patients (39.5%) among cases, and 8 out of 42 patients
(19%) among controls . Mean age was 50 (±12.86) years in the control and 52 (±12.12) years in
the case group. Control group composed of 23 males and 19 females, while case group composed
of 17 males and 26 females. Duration of DM was 5.1 (±4.5) years for control and 6.1 (±3.75) years
for cases. HbA1c % was 8.44 (±2) for control and 8.25 (±1.65) for case . Vitamin B12 level was
349 (±99) pg/ml for control and 343 (±124) pg/ml for cases. B12 deficiency correlated
significantly with the duration and dose of metformin with (P.value=0.001and 0.002) respectively.
Conclusion: we found that there was a high prevalence of vitamin B12 deficiency among patients
managed on metformin with significant effect of duration and dose of metformin use on B12
levels. This should be considered in patients treated with metformin.

Background: Primary health care (PHC) issue is trying to promote the best possible health and
well-being for all individuals, regardless of their background, by focusing on the community's
needs for sustainable and affordable healthcare.
Objective:
The primary goal of this study is to assess the key elements of primary healthcare services
regarding knowledge and attitude of PHC staff in the PHC services centers located in the
Kurdistan Region of Iraq.
Methods:
It is a mass cross-sectional observational study including PHC services in the Kurdistan region,
Iraq. Sampling is done using multistage sampling that includes simple random sampling,
stratified random sampling, and systematic random sampling design. The required PHC (primary
health care) data were collected in Sulaimani, Halabja, Erbil, and Duhok governorates. The
method of data collection involves visiting all primary healthcare centers and obtaining prior
permission from the health directorate in each governorate. Face-to-face interviews with medical
personnel will be conducted, and a standardized checklist will be used to evaluate health service
indicators.
Results:
Out of a total of 222 primary healthcare centers in the Kurdistan region, we chose to focus on 68
main primary healthcare centers for this study. In the 68 primary health care invited 311 health
staff to participate in the survey. Questionnaires related to their socio-demographic and
characteristics of PHCs health staff, as well as their knowledge and attitudes about health
services, and self-efficacy. Descriptive analyses and regression models were performed.
Conclusion:
Monitoring a child's growth is a crucial measure for promoting their survival. To improve the
effectiveness of current primary healthcare centers, prioritizing laboratory services, and
improving the staff's attitudes and practices are essential.

Chemotherapy and Radiotherapy usually impairs the function of the salivary glands; the
disruption is both temporary and reversible.To indicate the effect of chemotherapy and
radiotherapy treatments on the electrolyte and pH of saliva. Fifty saliva samples from
cancer patients were collected with 50 controls. The saliva sample was collected with
closed lips within the oral cavity, and then it was expelled into a falcon tube and was
centrifugation (5 min at 2500 rpm), we took 250 microliters from the supernatant
(clarified saliva), and after that analyzed by (Electrolytes Analyzer machine). The pH of
saliva was more acidic in cancer patients in comparison to control individuals (P-value
0.001), and the mean chloride level in cancer patients was recorded (52.05mmo/L), but in
ordinary people, the mean showed (46.20mmo/L). In conclusion, cancer treatments are
affected by the increase of Chloride levels and decrease of Potassium and pH levels
compared with healthy people's saliva.

Background: The safety and effectiveness of vaccines that have been used against COVID
19 are important for controlling the SARS-CoV-2 pandemic. Unlike classical vaccines, the
Pfizer BioNTech vaccine contains the genetic information required to synthesize the SARS
CoV-2 spike protein, usually found on the viral surface. This vaccine is used in Iraq to
prevent the virus spread.
Aim of the study: This study aims to analyze the association between individual
backgrounds and side effects after receiving the first and second doses of the Pfizer
BioNTech vaccine.
Participants and Methods: A prospective cohort study was conducted between April
25th, 2021, and September 28th, 2021, among 110 health staff in Sulaimani city. The SPSS
version
22 was used for data entry and analysis.
The incidence of side effects was significantly higher females, in individuals older than 35
years, participants with a previous history of SARS-CoV-2 infection, and administrative
personnel. Concerning local side effects after the first dose, itching, and after the second
dose, pain, and tightness in the injected limb were significantly higher in individuals in the
age group >35 years (P<0.05). Regarding systemic side effects, after the first dose, myalgia
and insomnia were significantly higher in the age group >35 years, and arthralgia was
significantly higher in unhealthy participants (P<0.05). After the second dose, diarrhea was
significantly higher in females, and arthralgia was significantly higher in the age group >35
years (P<0.05).
Conclusion:
The Pfizer vaccine causes several temporary side effects, the occurrence of side effects is
more frequent in females, people greater than 35 years of age, individuals with a prior history
of SARS-CoV-2 infection, and administrative staff.

Background:
complications
Anemia during pregnancy is commonly associated with poor pregnancy outcomes and can result
in
that
Aim of the Study:
threaten
the
life
of
both
mother
and
fetus.
This study aimed to find the incidence of low birth weight and the association of anemia in
different trimesters of Pregnancy with the Mean birth weight of newborn
Methods:
In a prospective cohort study, a total of 224 Pregnant women followed from three primary health
care centers in Sulaimani city Kurdistan Region, Iraq till the birth of full term. Data were
analyzed using the statistical package for the Social Sciences version 26.0. A P-value ≤ 0.05 is
considered a significant value.
Result:
low birth weight incidence was 5.8%. The rate of anemia was different in each trimester. The
rate increased throughout the pregnancy from 32 %, 34.9 and 35.7% in the first, second, and
third trimesters respectively. The mean Birth weight ± Standard deviation of the newborn in this
study was 3043.53±389.7. However, the MBW of newborns from mothers with persistent
anemia was significantly lower (2693.4 ± 289). Relative Risk (95%Confidence interval) of low
birth among anemic to non-anemic mothers was in the first trimester 2.5 (1.793-3.702). And 3.2
(2.652-3.974) and 3.1 (2.584-3.838) in the second and third trimesters respectively.
Conclusion: An association was found between Anemia in each trimester of pregnancy and
the gender of the newborn with Mean birth weight. But for the mode of delivery, there is no
association.

Background: Water contamination can be one of the main sources of diseases, especially in
health centers and hospitals. In this regard, it is highly significant to investigate in the health
workers' knowledge, attitude, and practice (KAP) related to infection control. The present study
was aimed at examining the KAP of water pollution and infection control and their correlation
among the health workers in hospitals in Sulaimani city, Kurdistan-Iraq.
Materials and Methods:
A descriptive cross-sectional study was carried out on 400 medical personnel and health workers in
12 hospitals in Sulaimani, Kurdistan-Iraq from June 2022 to April 2023. Required data were
collected using a structured questionnaire which was completed through interviewing the
participants. The collected data were analyzed using Statistics Package for Social Sciences (SPSS
24.0).
Results:
The results indicated that the participants aged 30 to over 40 years, with a mean of 37.2. A larger
number of them (59.8%) were Females, and 55% of them held a technical diploma. Knowledge,
attitude, and practice of water contamination were found to be fair in 42.5%, 46.25%, and 41.25%
of the participants, respectively. It was also concluded that their knowledge was significantly
correlated with their level of education (p-value=0.000). A significant correlation was seen between
their attitude and their age and level of education (p-value=0.000). Their practice had a significant
correlation with their age (p-value=0.000) and level of education (p-value=0.013). The results of
both Chi-square test and Spearman rank correlation indicated that their knowledge had significant
correlations with their attitude and practice (p-value=0.000).
Conclusion:
Email: utjmed@utq.edu.iq
Health workers' attitude toward and practice of water contamination and infection control can be
enhanced by promoting their relevant knowledge by providing them with training programs.

Introduction of Hepatocellular carcinoma (HCC)
It is the most common type of primary liver cancer in adults and Is currently the most
common cause of death in people with cirrhosis.[1] HCC Is the third leading cause of
cancer-related deaths worldwide. Hepatocellular carcinoma (HCC) is a major health
problem worldwide, due to its high incidence (approximately 600000 new cases in 2000),
and high rates of mortality [1]. The identification that chronic liver disease is the process
relevant risk factor for this tumour, has made surveillance campaigns aimed at early
detection of HCC possible and surveillance is now universally recognised to be the
practical approach for improving treatment of HCC patients . The few cases (less than 5%)
of HCC that do not develop on the background of chronic liver disease present late and
usually have poor chances of cure.

Type 1diabetes (T1D) occurs due to immune system dysregulation and invading pancreatic
beta (β)-cells by auto-reactive immune T cells, which leads to decreases of β-cells activity and
viability in addition to prolonged therapy with exogenous insulin. The primary aim of this study
was to delve into and explore the roles of adiponectin (ADP) and islet antigen-2 autoantibody
(IA-2A) as potential predictors and/or diagnostic biomarkers for T1D and to determine the
effects of them on pancreatic β-cells dysfunction. A case-control investigation was conducted
between the months of August and December 2022, which included three study groups; the T1D
group which included 35 newly diagnosed T1D patients, first degree relatives (FDRs) group
which included a total of 35 FDRs of T1D patients and healthy control (HC) group with a total of
20 healthy individuals. Serum levels of connecting (C) peptide, ADP, and IA-2A were measured
for all study participants using an enzyme-linked immune sorbent assay (ELISA). The results
showed significantly lower levels of C. peptide and ADP among T1D and FDRs subjects in
comparison to HC group, whereas the IA-2A level was significantly higher in T1D and FDRs
subjects than in HC subjects. The level IA-2A revealed a significant positive association with the
levels of C. peptide and ADP within T1D and FDRs groups, whereas there exists a positive
correlation between ADP levels and C. peptide levels across all research groups. The
combination between lower C. peptide and ADP levels and higher IA-2A levels is the most
robust and cost-effective predictive and diagnostic biomarker for T1D. The positive relationship
between ADP and C. peptide indicated a possible utility of higher ADP levels as a marker of low
β-cells stress and/or death, whereas the positive relationship between ADP and IA-2A indicated
the vital anti-inflammatory role of ADP. High IA-2A level at the time of T1D diagnosis does not
predict the degree of pancreatic β-cells stress and/or death.

Background
A VSD is defined as an opening or hole in the inter vevtricular septum of the heart.
Isolated VSDs occur in approximately 2 of every 1000 live births and constitute over 20 percent of all congenital heart defect (1)
The diagnosis and surgical treatment of children with a large VSD is frequently delayed in many countries throughout the world (2).
Closure of a large ventricular septal defect (VSD) in children with elevated pulmonary artery pressure is associated with significant morbidity and mortality.(3) Pulmonary hypertensive episodes continue to be a major cause of postoperative morbidity and mortality. We designed a fenestrated flap valve double VSD patch in an effort to decrease the morbidity and mortality associated with the closure of a large VSD with elevated pulmonary arterial pressure.(4)

Methods
Twenty three patients (mean age, 6 years) with a large VSD and elevated pulmonary vascular resistance ,14 patients were male and 9 patients were female , underwent double patch VSD closure using moderately hypothermic cardiopulmonary bypass and cardioplegic arrest. The routine VSD patch was fenestrated (half of calculated aortic size) and on the left ventricular side of the patch, a second, smaller patch was attached to the fenestration along its superior margin before closure of the VSD(5) . fig (1&2) .

Summary
This is a retrospective study of 45 patients with Thoracic Outlet Compression Syndrome who
were treated surgically in the department of Thoracic & Cardiovascular Surgery at the "Medical
City Teaching Centre – Specialized Surgeries Hospital" , from January 1st, 1997 to December 31st
,2006.
They are studied according to their age , sex , causative factors , clinical features , side of
affection and compliance , diagnostic measures , theraputic planing , surgical approaches , and
surgical outcomes.
We compare our results with four different studies ; one from the same centre in Iraq done in
1993 , and the other three studies taken from centres in the United States of America , Turkey,
and India & done in 1998 , 2003 , & 2004 respectively.
Our study agreed with the other studies that TOCS is more common in female than male , more
common in the 3rd & 4th decades of life , more on the right than the left side , mostly caused by
cervical rib , and more with neurological manifestations.
There are four different approaches for the surgical treatment of TOCS ; posterior approach ,
anterior approach , transaxillary approach , and double route approach. In our study 98% of the
surgical treatment was performed through the posterior approach , we compare the advantages
and disadvantages of this approach with the other approaches in the four different studies
mentioned. The Thoracic Outlet Compression Syndrome (TOCS) is a group of common
conditions caused by compression of the nerves & vessels supplying the upper limb. Symptoms
vary from mild to limb threatening , it might be missed or ignored by many physicians as they
mimic common conditions such as tension headache or fatigue syndromes. Clinical diagnosis,
appropriate investigations and surgery, especially if reserved for carefully selected patients, yield
satisfying and sometimes dramatic results 1 .

is a surgical specialty. It can be used to improve how someone looks and to reconstruct facial and body
tissue defects. These issues may be caused by illness, injury (trauma), or birth disorders.
Plastic surgery restores and improves function, as well as appearance. It can include surgery on any
part of the anatomy except the central nervous system (brain and spinal cord)
Justice is a concept involving fairness, equality, and equitable treatment.1Cosmetic surgery is usually
considered to be elective in nature and thus not covered by third-party payers. Patients normally pay
for cosmetic procedures out-of-pocket. One could argue that cosmetic surgery is not available to all,
based on personal finances, and therefore does not meet this ethical requirement. On the other hand,
one can argue that since patients are responsible for the cost of their own care, then cosmetic surgery
does not affect the overall availability of health care resources. When using this argument cosmetic
surgery passes this ethical test.
Background
The word “plastic” in plastic surgery, is a Greek word meaning “to form”. Plastic surgery is divided into two
sections, reconstructive surgery and cosmetic surgery.2The initial idea of the genesis of plastic surgery is
returned to repair the deep wounds of the Neanderthals due to the rock, cool guns, and spears back and bite
animals.2 Historical records remained in countries like Egypt, India, Greece, Rome, in relation to wound
healing; and the use of other body tissues to reconstruct the nose and lip, repair the cleft lip and tumors, correct
congenital anomalies, etc. All point to the initial steps in the era of plastic surgery.2Plastic surgery in the
nineteenth century progressed and at this time for first time, the skin graft was performed in Milan.2Plastic
surgery, including reconstructive and cosmetic surgery, writings on clay in Mesopotamia in ancient Persia
showed the wound healing and congenital anomaly repair to be born in that period.2
Plastic surgeries were developed between the two world wars. Advertisements in magazines and newspapers in
this area lead to the spread of these practices and had a key role in most people’s concerns wished to change
their physical appearance. Females are more likely to apply for cosmetic surgery, as they wish to be more
attractive at their jobs and to have a higher social status, to seem younger, and due to psychological, social and
personality factors.1 Social and community factors play important roles as these factors are related to cultural
norms changes, globalization and the expansion of the Western culture receiving through the media and travels.
In today’s consumer- oriented societies, attention to body image has become very popular, and the
media has important role.3
Prevalence
The American Society for Aesthetic Plastic Surgery reported an increase of 446% in cosmetic
procedures since 1997 and an overall increase of 8% in 2007, with a 17% increase in men undertaking
cosmetic surgery (8). This increase is similar in the United Kingdom. The British Association of
Plastic Surgeons recorded a 35% increase in procedures performed by its members from 2004 to 2005
(9). With the increased prevalence, accessibility and evolution of cosmetic surgery in Western society,
it is becoming increasingly relevant to explore the various internal and external factors that motivate
people to undergo cosmetic surgery.
Advertising and public deception is the ethical problem of plastic surgery. Media forge some surgeons
by intensive advertisings of body image, claiming a lie, exaggerating individual capability using
photoshop images in the offices, that all provide ethical problems in the field of plastic surgery.At
present, aesthetic surgery has become increasingly popular around the world and this medical
profession has become a profitable business as “cosmetic surgery industry”.2 Plastic surgery corrects
the defects and pays less attention to the culture and beauty in relation to physical appearance and
attention to characteristics such as gender, age, and race.In this field, health services are offered
commercially.

Background:
The ABO and Rh system have a great association to different kind of malignancy as mentioned
in the literature. The data about prevalence of blood group with thyroid malignancies were
limited in the literature; we aimed to record the relationship of different ABO and Rh blood
groups with different malignant thyroid tumors.
Methodology:
the demographics, ABO blood group, Rh factor, histopathological type of malignant thyroid
tumors were recorded for each patient with malignant thyroid tumor (MTT); then we evaluated
the association between different blood group types with different histopathological pattern.
Results:
Papillary thyroid carcinoma (PTC) was the most common MTT [n=46, (92%)], while all other
types were uncommon, they were follicular thyroid carcinoma [(n=1) 2%], medullary thyroid
carcinoma [(n=1) 2%], Hurthle cell carcinoma [(n=1) 2%] and anaplastic thyroid carcinoma
[(n=1) 2%]., the blood group A with Rh positive was the most frequent [n= 17, (34%)], , the
O+ve was [n=15 (30%)], B+ve [n=10 (20%)], while AB-ve [n=3 (6%)] while a small number
was Rhesus negative. The A+ve blood group was the commonest blood group in PTC patients
(34.8%), followed by O+ve (30.4%).
Conclusion:
Blood group A+ve is the most frequently reported among cases of papillary thyroid carcinoma,
which is the most common MTT.

Abstract:
Background: Immediate implant placement (IIP) has been increasingly popular in the recent
years, particularly in the anterior region for esthetic reasons. The effect of IIP may overweight
delay implant placement (DIP) in term of implant stability, success rate, clinical outcome, and
radiological measures.
Methodology:
In this review, 484 randomized controlled trials and controlled clinical trials study have been
reviewed for their title and abstracts. The review used PRISMA design for developing methods,
and has searched both database of MEDLINE (PubMed) and The Cochrane Library. Twenty
eight papers and 1639 patients were been involved for the study analysis. Primary outcome
variables were survival rate, failure rate and success rate, and secondary outcomes were clinical
and radiological evaluation and aesthetic score in both IIP and DIP.
Results:
Implant success rate were slightly higher in DIP, and implant fail and complications have rated
higher in IIP compared to DIP. Probing depth (PD) is mostly similar in both protocols. Numerus
studies in this review have demonstrated the significant healthier soft tissue such as keratinized
mucosa (KM) width, peri-implant mucosal thickness (PMT) at implantation, loss of Midfacial
Mucosa Level (MML) in the IIP procedure. High significant aesthetic score was observed in IIP
protocol. Pink esthetic score (PET) score in both protocols were highly varies and controversial
in nine studies. Six studies concluded the significant high mean of marginal bone loss (MBL) in
DIP and five studies confirmed the significant high MBL in IIP. Conclusion: IIP has slightly
higher in implant failure and clinical outcome in term of KM width, PMT at implantation, loss of
MML in the IIP procedure. IIP was associated with better aesthetic score. More studies require to
conclude the radiological evaluations in both protocols.

Introduction:-
Perforation of the Esophagus
Causes :-
1-Iatrogenic Esophageal perforation following instrumentation either by the rigid esophagoscope or by
bougienage. Is the most common cause of perforation.
2-Traumatic perforation due to foreign bodies ingestion or blunt and penetrating trauma
3-Spontaneous rupture ( Boerhaave‘ s syndrome ) due to the strain of emesis with or without
predisposing disease .


The sites of the normal anatomical constriction, are the most common sites of perforation .
The consequence of the perforation is the contamination of the peri- esophageal space with the
digestive fluids, food and bacteria which can lead to extensive suppuration and sepsis.

Even perforation of the cervical esophagus can extend into the mediastinum along the facial
planes and results in chemical and infectious mediastinitis, which is lethal unless treated early.
Note:- Any patient presents with new symptoms after instrumentation should be considered to have
perforation until proved otherwise.

Background: Filamentous fungi such as Penicillium chrysogenum is widely used as hosts for
the industrial products such as proteins and secondary metabolites.
Aim of study:
Determine which two fermentation media used in this study is the best for the production of crude
antimicrobials from Penicillium chrysogenum. A strain of Penicillum chrysogenum
UNIJAG.PL.242was isolated from water sample (0.5 ml) of the Hammar marsh area in Thi-Qar
Province, south of Iraq. The isolation was carried out using potato dextrose agar (PDA) at 25°C for
5 days and sub-culture was conducted on Malt extract agar (MEA) and Czapez dox agar (CDA)
besides PDA at the same conditions of the isolation. P. chrysogenum was identified depending on
the morphological and molecular characteristics in which ß-tubulin genes within the fungal
genome were detected and then sequenced. This fungus was preliminarily tested against
Staphylococcus aureas, Streptococcus pyogens, Bacillus cerues, Escherichia coli and
Psuedomonus aeroginosa by which P. chrysogenum inhibited growth of Staphylococcus aureas.
The fungus fermented using penicillin production medium (PPM) and corn steep liquor medium
(CSLM) and the crude extracts of the fungal filtrate were harvested and tested against these
bacteria that the extract of PPM inhibited S.aureus, S.pyogenes, B.cerues. And E.coli but
P.aeroginosa was resistant to this extract. Relatedly, the extract of CSLM did not produce
inhibitory values against B.cerues and P.aeroginosa which the remaining tested bacteria were
affected. Both crude extracts were analyzed using HPLC which showed the numbers of peaks
which some of them were similar to peak of pure penicillin G which was tested a control in this
Conclusion:
process.
The present study concluded this fungus produced antimicrobial compounds and PPM is better
fermentation medium than CSLM.

A Pt(II) complex including quercetin, naringinin, and apigenin was made in the
current study, and its structural characteristics were determined utilizing spectrum
techniques. The Pt(II) complexes have been investigated for their ability to combat
microorganisms and breast cancer. According to the findings of the investigation into
the complex's antibacterial action, Staphylococcus aureus, Escherichia coli, Candida
alblicans, and Aspergillus niger were all considerably impacted. Using the 2,2
Diphenyl-1-picrylhydrazylradical scavenging activity assay (DPPH), it was examined
whether the Pt(II) complexes have antioxidant qualities and may be useful in the
treatment of disorders caused by free radicals. These novel complexes may be
exploited for these therapeutic purposes, according to this study's findings.

Background: Patient satisfaction is the emotional response to the perceived performance
or outcome of a healthcare service, which can result in a positive or negative evaluation
based on expectations. The study aimed to evaluate patient satisfaction with healthcare
providers and health services in the public hospital.
Methods and patients:
A cross-sectional study was conducted from November 2019 to February 2021 to assess
the satisfaction of 311 hospitalized patients with healthcare providers and hospital services
in Sulaimani City’s general hospitals. The study included patients who aged 14 years and
older and had been hospitalized for at least two days. Accompanied patients were excluded.
Data was collected using a researcher-administered questionnaire through face-to-face
interviews, utilizing standardized 4-point Likert scales.
Results:
Demographic data were analyzed using frequency analysis. The participants' mean age was
37.9 years. The median domain scores for hospital services, nursing care, and doctor care
were 80 (IQR 72.5-85), 45 (IQR 45-52.5), and 50 (IQR 42.5-57.5), respectively. A Chi
square test analyzed the relationship between categorical independent variables. 61.1% of
participants were extremely satisfied with hospital services, while 38.9% were highly
dissatisfied. Nursing care received lower satisfaction (37.7%) compared to doctor care
(62.3%). Uneducated participants showed a significant association with satisfaction with
doctor care (coefficient=0.88, P<0.01), residence, and hospital services (coefficient=0.68,
P<0.05). Overall, a higher percentage of participants (61.1%) reported satisfaction with
hospital and doctor care, while nurse care received only 40.8% satisfaction.
Conclusion, the proportion of patients who reported satisfaction with their doctor's
treatment and care, as well as with hospital services and facilities, was higher than that of
patients satisfied with nurse-led healthcare.

Toxoplasma gondii is one of the most successful microorganisms on Earth due to its high
compatibility with a wide range of host species, including mammals, Diabetes mellitus is a
worldwide condition, however it is more prevalent in the industrialized nations. According to the
International Diabetes Federation's most recent estimates for 2019, there are currently an estimated
537 million adults living with diabetes worldwide.in Iraq more than 13.9% of adult live with
diabetes . The main objective of the current study is to verify the presence of immunosera in
diabetic patients against Toxoplasma gondii infection and its relationship with role programmed
death (PD-1) and programmed death ligand ( PD-L1 ) in patients .One hundred twenty (120)
serum sample take from diabetic patients match with 60 control group were obtained and tested
using widely available enzyme immunoassay kits for anti-Toxolasma IgG. The total infection with
toxoplasmosis among patients with DM was 42(35%). Sandwich ELISA technology were used to
explain the level PD-1and PD-L1 and the result were found a high level of pd-1 and pd-l1 in
patient compared with control .

Background: Upper extremity vascular injuries had high incidence in current surgical practice due
to increased incidence of terrorist action.
Aim of study: Is to highlight the Medical City experience as major referral center and to assess
morbidity and mortality of injured patient, also analyzes the causes of injuries, presentations,
surgical approaches, outcome and complications of vascular trauma of the upper limbs, in spite of
limited hospital resources.
Methods: From October 2014 to November 2015 (56) cases were collected from Ghazi Al-Harreri
Martyr Hospital, Thoracic and Vascular Department, Medical City, Baghdad. All patients
underwent full physical examination, resuscitation and evaluation were performed according to
Advanced Trauma Life Support (ATLS) guidelines.
Result:
Fifty six patients with upper limb vascular injury were prospectively followed, of them 51 males
(91%) and 5 females about (9%) with age range from (7-46) with a mean age of 22 years. The
mechanism of trauma was mostly penetrating (bullet, shells and stabbing injury) in 50 patients
(89%), blunt trauma was in 6 patients (11%).
Conclusion:
Upper extremity vascular injuries carry better prognosis and lower complication. Early referral of
injuried patients affects the outcome of these patients especially when associated with other
injuries.

Background: Breastmilk is vital in attaining newborn health and optimum growth and
development. Early initiation of breastfeeding which is affected by way of delivery has great
importance for both mothers and newborns. The main aim of this study is to assess breastfeeding
barriers and difficulties among mothers undergo cesareans section.
Methodology: A cross sectional, descriptive study was conducted among a convenience
sample of 100 mothers having 6-24-month age children which were born through cesarean
section in Rania city. The data were collected using a questionnaire format with face to face
interviewing technique from 15th to 27th December 2021. Validity and reliability of the data
collection tool was attained (r.=0.73) and data were analyzed using SPSS.
Results:
More than half of mothers were at the age of 24-35 years old. The highest percentage of mothers
42% were at the highest level of education and the majority of them 82% were house wife. Most
of the mothers 79% were at barely sufficient monthly income. About half of the cesarean
deliveries 47% were emergency. Only 36% of the mother’s initiate feeding within first hour and
54% of them practiced exclusive breastfeeding for the first day following delivery. Highest
percentage of mothers mentioned pain as a main difficulty for breastfeeding within the first day
of life, while insufficient milk was the main difficulty following that period. There were no
significant association between breastfeeding history, difficulties of breastfeeding and
indications of cesarean section.
Conclusion:
Cesarean delivery adversely affected timely initiation of breast feeding and continuing for the
age of six months. Different indications of cesarean delivery had no significant association with
the history of breastfeeding and its difficulties.

Neurogenic bladder is the name given to a number of urinary conditions in people who lack
bladder control due to a brain, spinal cord or nerve problem. This nerve damage can be the result
of diseases such as multiple sclerosis (MS), Parkinson's disease or diabetes. It can also be caused
by infection of the brain or spinal cord, heavy metal poisoning, stroke, spinal cord injury, or
major pelvic surgery. People who are born with problems of the spinal cord, such as spina bifida,
may also have this type of bladder problem. Causes of neurogenic shock is usually a spinal cord
injury. When the nerves in the spinal cord are damaged, they stop sending messages to the nerves
that control other functions in the body. If nerve signals to the muscles in the blood vessels are
shut down, the vessels stop working properly. Neurogenic bladder affects people with stroke and
Parkinson's disease and many other types of nervous system conditions. Conditions that damage
nerves like advanced diabetes can also cause neurogenic bladder.
Methods:
Study design : Descriptive , Cross -sectional study, Study patterns : Retrospective study
Place & Time of study : The study took place in Thi Qar governorate , study begun at 2nd of
April 2023 and ended at 6th of May 2023
Study Population : The population of Thi Qar about 2 million , The study included the
students and staff from Thi Qar University, children younger than 18 and elderly above 80 were
excluded.
Analysis :
Qualitative data had been analyzed by using SPSS (statistical package for social science) , were
Reliability , frequency , percentage and chi square had been calculated
Results:
A 55 patients suffer from neurogenic bladder, were recruited in this study that focus on different
aspects of assessment, that include their socio-demography clinical character that scored according
to Binned score

Summary
A teenage mother is more likely to drop out of high school, affect employment and social
class, increased risk for preterm delivery and low birth weight, less likely to receive prenatal
care. Advanced maternal age associated with increased risks of birth defects, low birth
weight, increase rate of caesarean section, gestational diabetes, preeclampsia.
The objective of the study is to identify obstetric and perinatal outcomes among teeagers and
old pregnant women (older than 35 years) in a sample of maternity hospitals in Baghdad,
2016.
A comparative cross-sectional study, carried out in three hospitals during the period of 15th
of March 2016-15th of June 2016.
A convenient sample of pregnant women admitted for delivery were included. The pregnant
women were divided into three groups: group A represents 120 pregnant women aged below
20 years(teenage pregnant), group B represents 120 pregnant women aged 20-34 years (low
risk pregnancy) and group C represents 92 pregnant women aged 35+ years ( advanced age
pregnant).In a comparison between group A and B; group A had higher proportion of
participants that visited clinics for 1st time in the 1st trimester (62.5%) emergency type of
Cesarean section (62.9%), fetal distress, contracted pelvis and obstructed labor than group B.
In a comparison between group C and B; group C had higher proportion of participants who
had one or two visits, Hypertensive disorders of pregnancy, medical disorders fetal distress
than group B. No association found between antepartum hemorrhage, postpartum
hemorrhage, premature delivery, still birth and neonatal care admission anemia, and maternal
age.
In conclusion adolescent mothers tend to visit antenatal care (both public and private) more
than and at early stage of pregnancy. Women aged 35 year or more had delayed antenatal
care and less numbers of visits and a higher proportion of complications during pregnancy
like hypertension disorder of pregnancy, medical disorders and caesarean section.

Background; Thyroid and parathyroid dysfunction in hemodialysis patients is a critical medical
concern that arises due to the intricate relationship between kidney function and these endocrine
glands. Hemodialysis, a life-saving procedure for individuals with kidney failure, often disrupts
the delicate balance of hormones in the body. Thyroid dysfunction, characterized by alterations in
thyroid hormone levels, is common and can lead to fatigue, weight changes, and mood swings. On
the other hand, parathyroid dysfunction involves imbalances in calcium and phosphorus
metabolism, resulting in bone and cardiovascular complications. Monitoring and managing thyroid
and parathyroid health in hemodialysis patients is crucial to improving their overall well-being and
quality of life.
Methodology:
Case-control the study was conducted on 75 patients undergoing hemodialysis and 75 age-matched
healthy controls. Thyroid function tests and serum electrolytes were measured for each group.
Results;
Our results show a significant difference between patients and the control group in each oxidative
stress marker and serum electrolyte level.
Conclusions:
From the results, we could conclude that thyroid and parathyroid dysfunction play a role in
hemodialysis and can affect the management of end-stage renal failure patients.

Herbal medicine is an effective treatment for many diseases that are intractable to traditional
medicine. Salvadora persica L. is an extensively utilized plant by many Arab populations
worldwide due to its varied medical benefits. The study looks at plant roots' antimicrobial and
free radical scavenging properties of flavonoid, glycoside, and alkaloid extracts. The activity of
the extracts was evaluated for Escherichia coli, Staphylococcus aureus, Pseudomonas
aeruginosa, and Candida albicans. Based on the findings, the three extracts recorded no activity
towards the selected microorganisms except the flavonoid extract which showed an efficacy
close to that of amoxicillin against Staphylococcus aureus and Escherichia coli growth with
inhibition zones 14mm and 15mm respectively. Inhibiting lipid peroxidation was more
successfully accomplished by flavonoid extract which recorded 50% compared to standard
compound BHT (60%), the glycoside and alkaloid extracts exhibited noticeable activity as
antioxidant with 27% and 18.4 % inhibition.

Introduction : Lung cancer is the most common cancer in males and the leading cause of cancer mortality.
In females, it is also one of the top three females cancers in terms of incidence and mortality. With the
changes in smoking prevalence and habits in many countries , the epidemiological and pathological features
of lung cancer have changed significantly in the last three decades.
Aim of the study :
To study the epidemiological and pathological characteristics of lung cancer in Thi-Qar, a major province
in the south of Iraq.
Patients and Methods :
Retrospective cross sectional study of 287 patients with a pathologically confirmed diagnosis of primary
carcinoma of the lung who attend Al-Nasiriyah oncology center during the period from January 2013 to
December 2018.
Results :
The total number of registered patients was 287. Males constitute 71 % (n = 205), and, females 29 % (n =
82) with a Male to Female ratio of 2.5:1. Mean age of the patients in the study was 66 years (SD = 12.9) ,
Range (36 – 95 years). About 75% of the patients are between 50 – 80 years of age, with 12% of patients
below 50 years of age. Up to 57% of the patients in the study are current smokers, 28% ex-smokers, while
15% are never smokers. Females constitute half of never smoker patients with lung cancers, while, males
make up two thirds of lung cancer patients with history of smoking (current or past). Non small cell lung
cancer constitute 80% of cases while small cell lung cancer 20% of cases. Squamous cell carcinoma was
the most common histological type in both sexes (40%) and the predominant type in males, while,
adenocarcinoma was more common in females. Squamous cell carcinoma and small cell lung cancer were
strongly associated with smoking, while, adenocarcinoma occur at higher frequency in never smokers. Half
of the patients diagnosed at an advanced stage of the disease, while, 28% diagnosed with loco-regional
disease, and, only 22% of the patients diagnosed with localized disease

Background Embolectomy can be consider a simple procedure that can be performs under
local anesthesia which have a great influence on the outcome of patients and their limbs
,especially when it performs within the golden hours of ischemia.
Aim of Study This study was designed to discuss the effectiveness of embolectomy procedure
in the management of acute vascular occlusion in our center and compare the outcomes with
other regional and national studies.
Patients And Methods A retrospective study was carried out from October 2014 to October
2017 at AL Sadder teaching hospital in Al Basrah city. Traumatic vascular occlusions were
excluded from this study. The collected data was reviewed retrospectively including age, sex,
associated, comorbidities, time before initial symptoms and outcome after embolectomy.
Results Ninety seven patients were admitted to the vascular ward with signs and symptoms of
ALI. The mean age was 56 years, 51.5% female and 48.5% male. All of them underwent
emergency embolectomy. The cause of vascular occlusion was embolism in 72 patients and
thrombosis in 12 patients. The limb salvage rate was 88.65%, Eleven patients ended with limb
amputation. Complication occurred in 31 patients in the form of: ten patients hematoma, nine
patients SSR, five patients re embolectomy, four patients fasciotomy, two patients foot drop
and one patient AKI. Thirteen patients died with hospital mortality rate of 13.4%. There was
a significant correlation between the time from the initial symptoms to the surgical
intervention and limb amputation rate (P value = 0.0009).
Conclusions Embolectomy is an important procedure in the management of patients with
ALI with a high limb salvage rate up to 88%. Time interval between the initial symptoms of
vascular occlusion and surgical intervention is an important predictor to the limb’s outcome
after embolectomy; the earlier the treatment the better the results.

Background: The intricate relationship between Vitamin D levels and glycemic control in
individuals with varying HbA1c levels has been a topic of significant research interest due to its
potential implications for diabetes management. This study aimed to explore the association
between Vitamin D classifications and HbA1c levels across different glycemic states and genders.
Methodology:
Using ANOVA analysis, we examined HbA1c levels across four Vitamin D classification groups
(Vit D 1, Vit D 2, Vit D 3, Vit D 4). Pairwise comparisons were conducted, and glycemic situations
(normoglycemic, prediabetic, and diabetic) were analyzed across these Vitamin D groups. Simple
linear regression analysis was employed to assess the correlation between Vitamin D and HbA1c
levels. Gender-based differences were also explored within each Vitamin D and HbA1c
classification.
Results:
The ANOVA analysis revealed significant differences in HbA1c levels across Vitamin D groups (p
< 0.05). Pairwise comparisons indicated substantial variations between several groups. While a
weak correlation was found between Vitamin D and HbA1c levels (R Square = 0.044), subsequent
gender-specific analysis showed no significant differences within each Vitamin D and HbA1c
classification
.

Background: Antibiotic over prescription is a worldwide problem. It represents a major factor
for the development of bacterial resistance and treatment failure. Treating those resistant
bacterial infections requires expensive and limited antibiotics.
Objectives: Measure the extent of antibiotic prescription in hospitals out-patient clinics and
primary health care centers.
Materials and Methods: An observational cross-sectional analytical study was carried out on
688 patients of both genders and different ages according to Dobson's formula, excluded patients
with TB. The study was done in almost all the out-patient clinics in Al-Nasiriya governmental
hospitals including (Al-Hussein Teaching Hospital, Bint Al-Huda Teaching Hospital and Al
Habboobi Teaching Hospital) along with fifteen randomly selected primary health care centers
from the 2nd of January, 2017 to the 1st of October, 2017. The prevalence of the problem (46%)
took from the research pilot study. Statistical Package for Social Sciences (SPSS) was used for
analysis, P value less than 0.05 was considered as significant.
Results: The results showed a high prescription rate of antibiotics (61%), cephalexin was the
most frequently prescribed antibiotic (18.9%), while nitrofurantoin, amikacin and doxycycline
were the least prescribed drugs with a prevalence of (0.2%) each.
Conclusion: A high prescription rate was an obvious result in this study. Giving the fact that
cephalexin was the most prescribed antibiotic.

Introduction
Venous malformation is the most common vascular malformation, and is low flow type. About
40% of cases present in the area of head and neck. They are divided into superficial and deep
types. Superficial type involves skin and present with significant functional and cosmetic
outcome. Deep type includes intramuscular malformation and may have delayed presentation
until subjected to infection and trauma (1-3).
Phlepoliths are defined as calcified thrombi and related to vascular malformations or
hemangiomas produced by stasis of peripheral blood flow and are secondarily mineralized and
enlarged (4). Phleboliths in head and neck region reported in both children and adults and
commonly in the cheek. (5,6)

Background:
Mitral valve repair and replacement depends on cardiopulmonary bypass and techniques of repair and replacement
are improving continuously and a lot of surgeons contributed to the development of this field.
Aim of study: -
To determine whether minimally invasive mitral valve surgery improves clinical outcomes compared with
conventional open mitral valve surgery in patients undergoing mitral valve replacement. -
To analyze the learning curve of the surgeon who has started performing minimally invasive mitral valve
surgery at our institution and to provide recommendations on the necessary experience to achieve and retain high
quality outcomes in this field.
Patients and Methods:
This is a prospective study of 26 patients who underwent mitral valve replacement in Al Najaf Center for Cardiac
Surgery and Trans Catheter Therapy from August 2015 to October 2016, 16 patients underwent isolated mitral valve
replacement through a minimally invasive approach and 10 patients underwent isolated mitral valve replacement
through a conventional sternotomy.
Statistical analysis was done by using SPSS (statistical package for social sciences) version 20. In which we use
frequencies, percentages and mean as descriptive statistics. T-test, paired t-test , and Yates corrected chi square had
been used according to type of variable. P value <0.05 regarded significant.
Result:
MICS was done in 16 patients (61.5%) while the remaining underwent conventional sternotomy.There was no
reopening for bleeding for all patient with MIMVS while in conventional sternotomy 2 patients (20%) had been
reopened for bleeding. In conventional sternotomy wound infection was seen in 2 patients (20%) while in MIMVS no
infection had been reported. There are no significant differences in postoperative echocardiographic finding between
MIMVS and conventional sternotomy approach.

Background
Coronary artery disease has increasing frequency worldwide and considered as important cause
of mortality, Off-pump coronary artery bypass grafting (OPCAB) has been shown to be a good way
for surgical revascularization.
Aim of study
The aim is to find any correlation between the demographic and clinical characteristic
of the patients from a side and the need for an assisted option while the patient having an
OPCAB and interpretation of any possible cause factor.
Patients and Methods
A retrospective study enrolled a 168 patients who underwent an OPCAB in Al-Najaf Cardiac
center in the period from the 1st of January 2015 till the 1st of December 2018. The Pre
operative demographic and clinical characteristics of the studied group were gathered to detect
possible cause factors for using any OPCAB assisted option like the conversion to
cardiopulmonary bypass machine, Intra-Aortic balloon pump (IABP) use or the epi-cardial
pacing. Descriptive statistics used to interpret the data, Chi-squared and Fisher’s exact tests used
to detect the significant correlation between the dependent and the independent variables beside
the bivariate correlation analysis.
Results
Smoking, arrhythmia, low left ventricular ejection fraction (EF) and left circulation dominancy
were significantly associated with higher conversion rate (Pvalue<0.005), in other hand the use of
IABP show significant association with lager body mass indices, renal impairment, arrhythmia, left
main stem involvement (LMS), low EF, multi-vessel disease and left coronary circulation dominancy,
while temporary pacing implantation show only correlation with age off more than 55 year. Rate of
conversion and the use of an assisted option correlated with more mortality and ICU stay time.
Conclusions
Higher conversion rate, use of IABP and pacing associated with older age, smokers, those with
low EF, multi-vessel disease and LMS involvement who required planned application of pre
operative IABP. Assisted options are predictors of mortality and associated with longer ICU stay
time.

Definitions:
Bronchoscopy- is an endoscopic procedure, which provides direct access to
the tracheo-bronchial tree and play an essential role in the diagnosis and
treatment of patients with chest problems.
Fiberoptic Bronchoscopes- are flexible bronchoscopes composed of
fiberoptic bundles which provide both illumination and visualization pathways.
A small channel with a diameter of 1 to 3 mm traverses the fiberoptic scope,
through which instruments can be passed. Several manufacturers produce
various models, and each model has particular advantages and limitations, and
they differ in outer diameter from less than 4mm to more than 6mm and also in
the arc of bending from 60 to 180 degrees, while the viewing angles vary from
66 to 100 degrees (1)
Ultrathin Fiberoptic Bronchoscopes- are also now available with an
outer diameter of 1.8 to 2.2 mm,it is usefull and safe in diagnosis of peripheral
pulmonary lesions.

Background: Both Migraine & nutritional disorders are common disorders with significant health &
socioeconomic impacts. We aimed to determine the relationship between BMI and migraine headache
severity, frequency, and disability.
Methods: We collected 100 females migraineurs attending the out patient clinic of a tertiary
neurology hospital. The patients were divided into four categories, based on BMI: underweight (<18.5),
normal weight (18.5 to 24.9), overweight (25 to 29.9), and obese (>30). The headache frequency,
severity, duration and disability using MIDAS score were assessed. Multivariate analyses were
conducted.
Results: On multivariate analysis, overweight patients represented 62.82% of longer headache (>24
hr) group while they represented only 22.73% among shorter headache (<24 hr) group (OR= 8.09,
95%CI=2.15-30.51, p=0.002). BMI have lost their association in multivariate analysis. Multi-parity of
2-3 and ≥4 were more common in severe headache cases than mild/moderate cases (OR=9.89, 95%CI=
1.4-69.67, p=0.021 and OR=11.37, 95%CI=1.36-95.1, p= 0.025 respectively). 70.73% of patients with
severe headache were overweight compared with 42.37% of patients with mild/moderate headache
(OR= 4.32, 95%CI=1.34-13.96, p=0.014). About 60% of patients with high MIDAS grade had ≥4 parity
compared with 17.86% of patients with low grade who had such parity (OR=7.78, 95%CI=1.27-47.61,
p=0.026). The frequency of overweight and obese patients among high grade group was 68.18% and
18.18%, respectively compared with 42.86% and 5.36%, respectively among low grade group with
significant differences (OR= 3.56, 95%CI=1.15-11.03, p= 0.027 and OR=7.22, 95%CI=1.1-47.14,
p=0.039, respectively).
Conclusion: BMI does have significant effects on migraine headache severity and the resulting
disability but its effects on headache frequency and duration was not supported.

Aim: the use of outpatient instrument (flexible bronchoscopy) to improve cancer diagnosis earlier
with no hospital stay giving much time to early diagnosis and early management and follow up of
bronchogenic cancer patients and to rule out which patient need further intervention or management.
Patients and Methods: A retrospective study of 160 patients where a flexible bronchoscopy is done
in suspected cases of malignant lung lesion in relation to history, examination, chest x-ray and refer
them to their age, sex , location and social status and habits including smoking, and sampling of
sputum, lymph nodes and pleural fluid cytopathological exam and comparing the results with the
transnasal or transoral fibroptic bronchoscopic procedures whether they were wash (brushing not
done), biopsies and postbronchoscopic sputum cytological exam using Olympus fibroptic
bronchoscopy.
Results: The patients arranged in two groups according to bronchscopic findings into visible and
invisible tumors and central tumors and peripheral tumors groups according to radiologic findings.
Best results in visible and central tumors, with the squamous cell carcinoma was the highest yield.

Cutaneous Leishmaniasis represents one of the widespread epidemic disease in Iraq
caused by the protozoan Leishmania parasite. However, There are clinical difficulties in
distinguish between this disease and other skin diseases can leave permanent skin scars.
This study aims to identify potential biomarkers for Cutaneous Leishmaniasis diagnosis
and prognosis and to know the progression of the disease and the distribution of
inflammation within the skin cells. In this review, 17 proteins have been selected using
literature searching such as pubmed and web of science to identify potential biomarkers
for Cutaneous Leishmaniasis diagnosis and prognosis and further studies needed to find
the role of these protein in the development of the disease.

Background: diabetes mellitus is a common disorder worldwide. Type 2 is the
commonest form of this disorder. Patients with DM type 2 have a higher
susceptibility to develop certain complications including diabetic peripheral
neuropathy which often leads to foot ulceration and consequently amputation. One
of the major contributers to the development of this complication is the oxidative
stress. Gamma glutamyl transferase (GGT) is an enzyme that increases in level
with increasing oxidative stress.
Aim of the Study: To determine the strength of association between serum GGT
and the presence of diabetic peripheral neuropathy, and to detect whether elevated
serum GGT can be used as an early marker for the development of diabetic
peripheral neuropathy.
Methodology: This study is a case-control study that included a total of 60
participants: 30 patients of type 2 DM with peripheral neuropathy (cases) and 30
patients of type 2 DM without peripheral neuropathy (controls). Data was collected
from Al-Sadr Medical City and Middle Euphrates Center for Neurological
Sciences (Al-Najaf – Iraq) during the period from November 2017 through January
2018.
Results: Statistical analysis of the data shown that there is a strong statistical
significance indicating significant relationship between elevated serum GGT levels
and the presence of peripheral neuropathy in study population (χ2 = 13.07 , d.f =
1 , P < 0.001).
Conclusion: Elevated level of serum GGT is associated with diabetic peripheral
neuropathy in patients with type 2 DM.

Background: Coronary artery ectasia (CAE) is an uncommon condition where a coronary artery becomes
abnormally dilated. The present study was conducted in order to figure out the prevalence, prediction, and
angiographic characteristics of coronary ectasia at the Sulaymaniyah Cardiac Center.
Materials and methods: The present cross-sectional study was conducted on 70 patients with coronary
ectasia in in Sulaymaniyah cardiac center, Kurdistan region, Iraq from January to July 2022. Required data
were gathered through the patients' medical files and coronary angiography reports. The collected data were
analyzed via Statistical Package for Social Sciences (SPSS, version 24.0).
Results: Most of the patients (74.3%) were males. Most of them (80%) aged over 46 years. Acute coronary
syndrome (ACS) and chronic coronary syndrome were found in 60% and 37.1% of the patients, respectively.
Moreover, hypertension was observed in most of the patients (80%). The results revealed diffusion of two
or more vessels (37.1%) and diffusion of only one vessel (31.4%) as the most frequent types of coronary
ectasia. Classification of coronary ectasia was found to be significantly correlated with hypertension (p
value=0.004) but not with the patients' age, gender, chronic coronary syndrome, smoking, or diabetes
mellitus (p-value>0.05).
Conclusion: The prevalence of coronary ectasia was found to be 3.3% among the studied population. Acute
coronary syndrome was the most common presentation associated with CAE. Right artery was the most
involved artery. Hypertension and smoking were found to be the most common risk factors for coronary
ectasia.

Pseudomonas aeruginosa is characterized by that it is associated with many morbidities and
deaths for people with immunodeficiency, as well as people who visit hospitals frequently and
patients with burns, especially severe ones, because the bacteria are Gram-negative, opportunistic,
and cause severe infections. The study included 45 samples that isolated the advanced aeruginosa
bacteria from moderately burned men and women, their ages ranged between 12 to 60 years. The
purpose of the study was to investigate the susceptibility of P. aeruginosa to resistance to some
antibiotics for the purpose of controlling the incidence of wound infection in patients with burns.
The phenotypic pattern of the bacteria under study shows that there is severe resistance to some
antibiotics, while the bacteria are unable to resist some other antibiotics.

Background: Ankylosing spondylitis (AS) is a persistent inflammatory rheumatic condition that
predominantly affects the axial skeleton, resulting in inflammatory back pain, stiffness, and reduced
mobility of the spine. The C-reactive protein/albumin ratio (CAR) has recently gained recognition as a new
inflammatory biomarker. This research aims to assess the correlation between disease activity and the C
reactive protein to serum albumin ratio among individuals diagnosed with ankylosing spondylitis.
Materials And Methods: The present cross-sectional study was conducted on 100 patients suffering
from ankylosing spondylitis in Sulaymaniyah Shahid Hemn teaching hospital from December 2022 to
August 2023. Required data were gathered from the patients' medical files and by assessing the disease
activity through ankylosing spondylitis disease activity score (ASDAS) and bath ankylosing spondylitis
disease activity index (BASDAI). Moreover, the patients were examined to collect data on their C-reactive
protein to albumin ratio, ESR, and HLA B27. The collected data were analyzed through Statistical Package
for Social Sciences (SPSS, version 24.0).
Results: The patients' age ranged from 20 to 60 years, and most of them (70%) were males. C-reactive
protein-to-serum albumin ratio was normal (≤1.6) in most of the patients (64%). BASDAI scores were low
and high in 38% and 37% of the patients, respectively. According to ASDAS scores, the disease activity
was found to be high in 45% of the patients, low in 24% of them, and very high in 18%. The results revealed
that peripheral arthritis, dactylitis, sacroiliitis, uveitis, inflammatory bowel disease, enthesitis, and HLAB27
were positive in 37%, 20%, 100%, 21%, 12%, 39%, and 62 of the patients, respectively. C-reactive protein
to-serum albumin ratio was found significantly associated with BASDAI score (p-value=0.008) and
ASDAS score (p-value=0.017), but not with HLAB27 or treatment (p-value>0.05).
Conclusion: C-reactive protein to serum albumin ratio is a reliable index for disease activity for patients
with ankylosing spondylitis.

Background: The neutrophil to lymphocyte ratio (NLR), which reflects the balance between neutrophils
and lymphocytes, and red cell distribution width (RDW), which measures the variation in red blood cell
size, have been used as biomarkers for assessing disease activity and treatment response in rheumatoid
arthritis (RA). These markers offer insights into inflammation and immune dysregulation in RA and could
aid in clinical decision-making and optimizing patient management. The present study was carried out to
assess the relationship between RDW and NLR with disease activity in RA.
Materials and methods: The present cross-sectional study was conducted on 105 patients with
rheumatoid arthritis in Rheumatology and Rehabilitation division in Sulaymaniyah, Kurdistan region-
Iraq from January 2023 to June 2023. The patients' medical files and relevant examinations were used to
collect required data. Statistical Package for Social Sciences (SPSS, version 24.0) was used to analyze the
collected data.
Results: The patients aged 53.38 years on average. The mean patient and evaluator global disease
activities were respectively 5.38 and 4.52. Moreover, the mean scores of RDW, neutrophil/lymphocyte
ratio, ESR, HG, and RBC were respectively 15.4672, 2.3603, 31.611, 12.773, and 4.8798. clinical Disease
activity had no significant relationship with the patients' age, BMI, disease duration, RDW,
neutrophil/lymphocyte ratio, WBC count, HG, or RBC (p-value>0.05). Also, no significant relationships
were found between DAS-28 (ESR) and the patients' age, sex, BMI, Sero, disease duration, PMH, RDW,
neutrophil/lymphocyte ratio, WBC count, HG, RBC, drug history, smoking history, or alcoholic history
(p-value>0.05).
Conclusion: Neutrophil to lymphocyte ratio (NLR) and red cell distribution width (RDW) cannot be
utilized as reliable biomarkers to assess disease activity in patients with rheumatoid arthritis; therefore,
further studies are required to understand rheumatoid arthritis progression.

Background: The COVID-19 pandemic demands effective biomarkers for assessing disease
severity. C-reactive protein (CRP), D-Dimer, and White Blood Cell counts (WBCs) have
emerged as potential indicators of COVID-19 severity and prognosis.

Materials and Methods: This study, conducted at Qalla Hospital, enrolled 112 confirmed
COVID-19 patients and 35 healthy controls. Comprehensive clinical and laboratory evaluations
included CRP, D-Dimer, and WBC measurements. Diagnosis of COVID-19 followed established
clinical criteria and confirmed through SARS-CoV-2 testing. Rigorous assessments were
conducted to ensure precise participant classification.

Results: Significantly elevated CRP (p-value=0.0001), D-Dimer (p-value=0.0001), and WBCs
were observed in COVID-19 patients compared to healthy controls. Elevated CRP levels
indicating inflammation, increased D-Dimer levels associated with coagulation abnormalities,
and raised WBCs within CRP level (0.943) indicative of an immune response were prevalent in
COVID-19 patients. Gender distribution was balanced, while comorbidities such as diabetes
mellitus (25%), hypertension (34.8%), kidney disease (6.2%), and multiple concurrent diseases
(34%) were prevalent in the COVID-19 cohort.

Discussion: The substantial differences in CRP, D-Dimer, and WBCs underscore their
potential as valuable biomarkers for diagnosing and monitoring COVID-19 severity. These
biomarkers could serve as critical tools in evaluating disease progression, predicting
complications, and guiding tailored therapeutic interventions. Conclusion: CRP, D-Dimer, and
WBCs exhibited marked disparities between healthy individuals and COVID-19 patients,
indicating their potential as diagnostic and prognostic indicators. Continued investigation into
these biomarkers' utility may refine risk stratification and treatment strategies, ultimately
improving patient outcomes in COVID-19 management. Understanding the clinical implications
of CRP, D-Dimer, and WBC levels could profoundly impact disease management and patient
care strategies.

Physiological and hormonal changes during pregnancy are common, but whether maternal
physiological and hormonal status could affect fetal gender remains unclear. To examine the links
between physiological and serum hormonal status with fetal sex in the first trimester. A cross-sectional
research involving 75 healthy young pregnant women (20-35 years) were selected after ultrasound
confirmation of gestational age at conception to 12 weeks of conception. Participants were divided into
2 groups: 38 carried a male fetus, and 37 carried a female fetus. The data acquired through hemodynamic
parameters, anthropometric measurements, and determinations of serum glucose, β-hCG, and
testosterone levels. Statistical analysis was performed by using SPSS (version 20). The average β-hCG
level of male fetuses was lower than that of female fetuses (18129±402 vs 27732±452 U/L, p<0.005).
Of note, maternal serum testosterone level was significantly different in those with male and female
fetuses (1.49±0.15 vs 2.61±0.14 nmol/L, p<0.05). No significant association was found between
maternal glucose concentration and fetal gender. Also, no statistically significant differences were found
for hemodynamic parameters (including diastolic pressure, systolic pressure, and mean arterial
pressure) and anthropometric measurements (mother's: height, weight, and body mass index)
when compared between two groups. It can be said that maternal serum β- hCG and total testosterone
levels are a good predictor of fetal sex in the first trimester.

Background: Vitamin D is thought to have immunomodulatory and anti-inflammatory properties, and a
lack of it has been related to several autoimmune illnesses, including rheumatoid arthritis (RA). The link
between serum Vitamin D levels and the severity of RA is of great interest.
Objectives: This study aimed to determine the relationship between vitamin D level and disease activity
score in rheumatoid arthritis.
Methods: In this cross-sectional study we enrolled 100 patients aged between 18 and 80 in the
rheumatology department at Shahid Doctor Hemn Teaching Hospital/Rheumatology and Rehabilitation
center in Sulaymaniyah, from January to July 2023. All of them were diagnosed with rheumatoid arthritis.
Cobas 6000 machine was used to estimate vitamin D levels. DAS28 (ESR) was used to evaluate the disease
activity score in all patients.
Results: There was no significant correlation between vitamin D and disease activity (p=0.271). Vitamin
D deficiency increased with age, especially 41-60 and 61-80 age groups (p=0.041). Higher disease activity
among those with lower economic status, lower among those with good economic status (p=0.018).
Smoking status correlated with disease activity, non-smokers generally moderate, others varying levels
(p=0.028).
Conclusion: There was no significant relation between vitamin D level and disease activity score in
rheumatoid arthritis.

Background. SARS-CoV-2 virus, a type of Coronaviridae virus that affects people, is the
cause of COVID-19.This viral disease like any other diseases, the infection linked to this
one might be brought on by a parasite, virus, bacteria, or other kind of microbe.
Methods. Examining the level of antibodies in the serum of patients of anti- E. histolytica
IgA, IgG and IgM antibodies and anti-CMV IgG and IgM antibodies are measured by
immunoassay of patient's sera by ELISA system and whole blood was withdrawn to check
for bacteremia.
Results. As a result, 60 blood samples from COVID-19 patients were taken, along with 30
samples from healthy individuals, for testing to find antibodies against E. histolytica and
Cytomegalovirus. The patients were clinically and radiographically proven to have the
COVID-19. To screen for bacteremia, the entire blood was tested.
Conclusions. The results show a significant difference in the titration of E. histolytica-
IgA antibody, IgG and IgM. COVID-19 patients with CMV-IgG antibody showed (100%) rate
of infection reporting a significant differences during the current study, while CMV-IgM
antibody showed (3.3%) rate of infection. Regarding bacteremia, all results of bacteria
detection in blood culture of Covid-19 patients were negative and there is no relationship
between the infection of COVID-19 and bacteremia.

Enterolithiasis is an uncommon pathological condition in which calculi or concretion formation
The mortality rate for 1 occurs in the intestines and has a prevalence ranging from 0.3 to 10%.
uncomplicated primary enterolithiasis is very low, but it rises to 3% in poorly conditioned
patients with significant obstruction and a late diagnosis. Primary enteroliths arise in areas of
intestinal stasis in the setting of diverticular disease, surgical enteroanastomosis, blind pouches ,
and intestinal stenosis or strictures seen in the infectious or inflammatory bowel diseases .
Secondary enteroliths include gallbladder and renal stones that may migrate into the
gastrointestinal tract as a result of fistula formation. Enteroliths can cause bowel obstruction ,
If haemorrhage, or perforation, but the vast majority are cleared asymptomatically.
Treatment . 2 ive therapeutic management fails, surgical exploration is indicated. nonoperat
relies on timely recognition of the disease and endoscopic or surgical intervention. With
advents in new technology, improved outcome is expected for patients with enterolithiasis 3 .
Presentation is often nonspecific, but typically includes “tumbling” abdominal pain, nausea ,
and vomiting related to the bowel obstruction, and may potentially lead to the gastrointestinal
bleeding and perforation. We present a case of primary enterolith in 7 year old boy resulting in
symptoms of partial small bowel obstruction and highlight the rarity of condition

Aim of study: to identify the structural and functional myocardial abnormalities in
patients with chronic liver disease of various origin , by two dimensional trans thoracic
Echo assessment
Patients and Methods:
This study is a cross sectional study conducted in AL-Hussain medical city in patients
attending the gastrointestinal and hepatological center and patients admitted to medical
ward in AL-ZAHRRA center of internal medicine from September 2019 , to February
2020 on sample of 34 chronic liver disease patients .The diagnosis was based on history ,
clinical
examination
,biochemical investigations , abdominal ultrasound,
Oesophagogastrodudenoscopy and in some patient histopathological findings ,those
patients sent to transthoracic echocardiography study.
Conclusions:
There is significant correlation between chronic liver disease and echocardiographic
changes and the most common finding is diastolic dysfunction.