Thi-Qar Medical Journal

Background and Objectives: Open preservation rhinoplasty is a surgical technique that aims to
enhance both the aesthetic and functional aspects of the nose. Preservation of the upper lateral
cartilages plays a crucial role in maintaining the structural integrity and function of the internal nasal
valve. This study aimed to evaluate the impact of preserving the upper lateral cartilages on internal
nasal valve function in open preservation rhinoplasty procedures, specifically focusing on the internal
nasal valve .
Methods: A non-randomized clinical trial between April 2022 and January 2023 was conducted in the
Sulaimani region of Kurdistan, Iraq, involving 36 adult patients undergoing OPR. Data collection
included preoperative and postoperative assessments using the NOSE questionnaire, along with
physical examinations at 9 days, 3 months, and 6 months post-surgery, and photographs 3 months post
operative.
Results: The results showed significant improvements in functional outcomes, including nasal
stuffiness or congestion, nasal obstruction, breathing problems through the nose, sleeping problems,
and breathing problems during exercise. These improvements were statistically significant (p=0.001).
Based on the Rhinoplasty Outcome Evaluation (ROE), significant differences were observed in nasal
shape, nasal breathing, friends' and acquaintances' approval of the surgery, unrestricted social activities,
the aesthetic and structural appearance of the nose, and the reasons for seeking nasal shape alteration
or rhinoplasty.
Conclusion: Preservation of ULCs in OPR procedures positively impacts internal nasal valve function,
as demonstrated by improved postoperative outcomes. This technique maintains nasal structure
integrity and INV function, leading to favorable functional and aesthetic results.

Background : Tamoxifen, a selective estrogen receptor modulator is commonly used to treat
hormone receptor positive breast cancer. Prolonged tamoxifen treatment in breast cancer have been
reported to increase the incidence of functional ovarian cysts.
Aim : To study the frequency and characteristics of ovarian cysts in patients with hormone
receptor positive breast cancer taking tamoxifen.
Methods : A cross sectional study that included 183 patients with hormone receptor positive
breast cancer receiving tamoxifen for at least 6 months. Patients were examined by transvaginal
ultrasound to look for ovarian cysts which are defined as sonolucencies in the ovary with a diameter
of ＞30 mm
Results : The study shows that 22.4% (29/129) of patients taking tamoxifen have ovarian cysts.
Cysts size ranged from 30 – 66 mm., 62% of patients have single cyst, and, 69% have unilateral
cysts. All cysts are asymptomatic and have benign features on ultrasound. The cysts were most
commonly seen in young, premenopausal patients, and, in those who maintained menstruation
during treatment (p < 0.05).
Conclusions : Tamoxifen treatment for breast cancer is associated with increased incidence of
ovarian cysts which are mostly benign functional cysts and seen mostly in young premenopausal
women.

Background: Foreign Body Aspiration (FBA) poses a substantial worldwide health issue, with the
highest incidence observed among young children, Detecting and managing FBA promptly are crucial
to prevent potential complication.
Objectives: To evaluate the significance of preoperative clinical and radiological assessment in
diagnosing FBA in comparison with results of rigid bronchoscopy(RB).
Patients and Methods: A cross-sectional study was carried out in Nineveh province, Iraq, spanning
a period of 10 months from April 2018 to February 2019. The study focused on patients of pediatric
age group who were admitted with suspicion of FBA to Al-Khansaa Teaching Hospital in Nineveh
province. The cases who were included are under the age of 14 and had confirmed FBA through rigid
bronchoscopy (RB).
Results: Out of forty-four patient, 25 (56.8 %) were males, the average patients age was 4.8 years
with a standard deviation of 3.4 years. More than half of cases (54.5%) presented within the first 24
hours after onset of suspected FBA. The most common clinical presentation is the witnessed FBA
(93%) (41/44), followed by symptoms like chocking (34%), cough (23%), shortness of breath (11%)
and cyanosis (11%). Diminished air entry was the most frequently observed findings in clinical exam
(48%), followed by rhonchi in (36%) of cases. The primary CR findings were consolidation in 25%
and normal CR in another 25%. Radiopaque FB was successfully identified in CR of seven cases
(15.9%) only. Thus, the estimated sensitivity of CR in detecting FB by using RB as gold standard test
was 15.9%. Significantly, normal CR were more frequently observed in cases of early presentation.
Among the identified FBs, 63.6% were found to be of organic type, while 36.4% were of non-organic
type. The sunflower seeds found to represent most frequently encountered FB (34 %). Regarding site
of dislodgement of FB, 40.9% of FB were found in the right main bronchus (RMB) and 36.4% were
found in he left main bronchus (LMB).
Conclusion: A chest radiograph serves as a valuable asset for pediatric FBA diagnosis. However, its
value is optimized when combined with the clinical context to enhance accuracy. Notably, the
occurrence of false-negative chest X-rays is significantly linked to early presentations.

Background & Objectives: The use of alum in the water purification process increases
the residual aluminum content in water and potentially has adverse effects on people's health,
and considering the water source of Halabja city and the efficiency of the Halabja water
treatment plant in purifying or filtering aluminum concentration, this study aims to the study
of aluminum concentration in the drinking water treatment plant of Halabja, Iraq.
Method: In order to assessment of water, 3 sites were chosen for sample collection in the
study including raw water directly from Sirwan River, treated water from treatment plant and
tap water from households during the period from July to December 2023. Water samples were
collected in pre-cleaned, sterilized glass bottles of 500 ml capacity and transported to the
Atmosphere Company for Environmental and Laboratory Services in ice-cooled containers.
Analysis was done for chemical parameters including Aluminum (Al), pH, temperature (CO)
total dissolved solids (TDS), turbidity, and total Alkalinity.
Result: The amount of aluminum in Raw, Treated and Tap water was higher than the health
and healthy water standards. Although the amount of aluminum residuals in the treated water
was very low in the last analysis of sample, and despite being low, it was not in accordance
with international standards. Other physicochemical variables, pH, Turbidity, Temperature,
Alkalinity and T.D.S, although they were associated with fluctuations and increases in the
examined samples, but their values were in the optimal and standard range.
Conclusion: The use of alum in the purification process and the effect of other factors, the
concentration of aluminum remaining in the investigated waters is high and it is not safe and
sanitary water according to the standards, and this issue can have harmful effects on the
consumers of these waters.

The oral microbiomes, specifically, have a significant impact on an individual's
health. The oral cavity contains over 500 bacterial species from multiple phyla, which can exist
as either commensals or pathogens. Streptococcus mutans is recognized as a significant pathogen
in the development of dental caries through biofilm formation. The objective of this review is to
provide a comprehensive understanding of the role that S. mutans in the development of dental
caries.

The research endeavour involved the collection of a total of 100 samples from diverse
clinical origins. Specifically, 70 urine samples were obtained from patients, while 20 samples were
derived from wounds. Additionally, 10 samples were acquired through ear swabs from patients enrolled
in private clinics, Imam Sadiq Hospital, and Al-Hilla Hospitals. The data collection period spanned from
November 2023 to December 2024.
Out of the hundred samples that were analyzed, it was observed that a significant majority, specifically
eighty samples (80%), exhibited positive bacterial cultures. Conversely, a smaller proportion of the
samples, precisely twenty samples (20%), did not exhibit any growth of bacteria. The findings of this
study indicate the potential existence of microorganisms, including viruses, fungi, and other anaerobic
agents, which could pose challenges in terms of culturing or may be attributed to variations in the sizes
and compositions of the samples. Utilizing the Vitek 2 methodology, selective media, and biochemical
assays, it was observed that out of the eighty-nine samples analyzed, a subset of twenty samples
exhibited positive outcomes, suggesting Proteus mirabilis presence. The detection of luxS, rsmA, and
mrpA genes in Proteus mirabilis was accomplished using the polymerase chain reaction (PCR)
technique.

Background:
With a 5%–10% global incidence rate, polycystic ovarian syndrome (PCOS) is one of the
most prevalent endocrinal illnesses affecting premenopausal women. Understanding the
pathophysiology of the condition and how to treat it by inhibiting or controlling
associated pathways may need research into the inflammatory processes and mediators
that contribute to the onset and progression of PCOS.
Aim of study:
The current study aims to determine the relationship between serum levels of resistin and
adiponectin and metabolic alterations in PCO patients.
Methods:
Fasting blood samples were collected from 100 PCO married infertile women
(23.30±4.66 years) attending Bint AL-Hoda and Al-Shatra hospitals in Thi- Qar province - Iraq, in addition to 50 healthy age matched (23.84±4.80 years) control.
According to BMI and fasting serum glucose level, the patients of PCO were classified
into four groups: normal weight nondiabetic patients, normal weight diabetic patients,
overweight non-diabetic patients and
overweight diabetic patients compared with
healthy control.
Results:
Adiponectin considerably decreased in all PCO subgroups compared to healthy controls,
but resistin significantly rose in all PCO patients. However, its level was more
substantially (P˂0.05) elevated in overweight diabetics. All PCOS patients had
significantly higher levels of triglycerides, total cholesterol, LDL, and VLDL as
compared to healthy controls. While HDL was not significantly changed in all subgroups
of PCO patients except it significantly declined in overweight diabetic PCO patients.
Conclusion:
PCOS patients had dramatically changed adiponectin, or resistin levels compared to
healthy women. PCOS patients showed low adiponectin levels and high serum resistin
levels, indicating that the pathophysiology of PCOS may be influenced by serum
adiponectin levels. However, in PCOS patients, resistin levels had a separate relationship
with insulin resistance and BMI.

Intestinal protozoan parasites Giardia lamblia and E.histolytical/dispar are quite common and
they seriously affect public health in the underdeveloped nations. With the use of the Ministry of
Health's surveillance database, which has been made available, the research's objectives were to
ascertain the prevalence regarding G. lamblia and E.histolytical/dispar quantifying its gender,
age, and region-related prevalence in a population drawn from 11 provinces in Iraq between
January 2021 and December 2021. The prevalence was noticeably greater than that of G. lamblia
and E.histolytical/dispar. The prevalence of both was observed to differ depending on the age
group (21–30), sex (greater in males), and regions (higher in Middle region). The present
investigation yielded reduced incidence rates when compared with comparable research carried
out in Iraq. This might potentially be attributed to factors such as seasonal diversity, sample
size, enhanced personal hygiene, and availability of public health services.

Background: Human Cytomegalovirus (HCMV), as a member of the herpesvirus family, is a
highly prevalent virus that infects a significant majority of individuals worldwide at some point in
their lifetime. HCMV induces a cascade of inflammatory reactions that can result in cellular
damage and play a role in the initiation and advancement of diverse inflammatory conditions.
Inflammation is a significant determinant for diabetes (diabetes mellitus) and plays a crucial role
in the onset and development of various complications associated with diabetes.
Methods: This study included the collection of serum samples for the detection of Human
cytomegalovirus antibodies in 200 patients with diabetes type 2. Also included was a control
group consisting of 100 individuals of different ages who did not have diabetes. The period of
collecting sample was from August 2023 to October 2023. All these serum samples are detected
for Human cytomegalovirus antibodies by the enzyme-linked immunosorbent assay method.
Conclusions: According to the results of this study, there was a significant difference in term of
anti-human cytomegalovirus IgG antibody between diabetic type 2 patients and control and also
there was a high significant difference in term of anti-human cytomegalovirus IgM antibody
between those patients and control group. It was also found that there are no significant
differences in the detection of anti-human cytomegalovirus IgM antibody among patients in terms
of sex, age, residency and family history.

Background: Cutaneous warts represent prevalent skin lesions resulting from infection with
human papillomavirus (HPV) (Sterling et al., 2014). HPV, a diverse group of viruses capable
of infecting both skin and mucous membranes, can give rise to various conditions, prominently
including the development of warts. With over 100 distinct HPV types identified, the
association between specific strains and the manifestation of distinct wart types is well
established (Bernard et al., 2010).
Cutaneous warts are skin infection characterized by skin growths that high and rough. appear
in numerous regions of the body, most commonly on the hands, feet, and faces (Shallal et al.,
2023). warts caused by Human papillomavirus (HPV). According to previous studies there
are possible link between serum vitamin D insufficiency with developing of cutaneous warts
(Mahmoud & Ayyash, 2021). investigation of vitamin D aim in verifying the existence of a
relationship between vitamin D and the occurrence of cutaneous warts.
Aim: The aim of this study is to Investigate the serum levels of vitamin D in patients related
to the presence of cutaneous warts caused by human papillomavirus and in compared to healthy
individuals.
Methods: Between October 2023 and December 2023, this research involved gathering
serum samples from 103 individuals diagnosed with cutaneous warts. Additionally, a control
group comprising 50 individuals of various ages without warts was included. The
determination of serum vitamin D levels was conducted using the electrochemiluminescence
(ECL) method.

Background: Supraventricular tachycardia is a common disturbance in the cardiac rhythm that
originates above the cardiac ventricles, and include various forms like atrial fibrillation, atrial
flutter, and others, as well as the paroxysmal form which is called paroxysmal supraventricular
tachycardia that denotes a subset of supraventricular tachycardia that present in form of rapid
regular tachycardia with a sudden onset and offset like atrioventricular nodal reentrant tachycardia,
atrioventricular reentrant tachycardia, and atrial tachycardia. Management involves either non
pharmacological measures (vagal maneuvers) or pharmacological treatment. The Valsalva
maneuver is considered a simple non-invasive measure for induction of increased vagal tone, with
certain modifications are performed in order to increase venous return of relaxation phase.
Aim of the Study: To compare between the efficacy of modified Valsalva maneuver versus
standard Valsalva maneuver in the termination of paroxysmal supraventricular tachycardia.
Methodology: This study is a randomized controlled trial conducted in the coronary care unit of
Al-Hussein medical city – Kerbela during the period from January 2019 to January 2020, and
included 103 patients presented with paroxysmal supraventricular tachycardia, who were subjected
to either modified Valsalva maneuver or standard Valsalva maneuver, with documentation of the
response.
Those who did not respond to non-pharmacological measures were treated with pharmacological
treatment.
Results: Mean age of participants was (49.60 ± 11.88) years, females comprised 61.17% of them.
Patients treated with modified Valsalva maneuver had significantly higher positive response
compared to patients treated with standard Valsalva maneuver, with a P-value of 0.003 and odds
ratio of 4.7 (CI 95%).
Response was significantly higher among males (P-value = 0.001) and significantly lower among
long standing diabetic patients (P-value = 0.009).
All patients who had no response to non-pharmacological measures were treated successfully with
pharmacological therapy.
Conclusions: modified Valsalva maneuver was significantly more effective than standard
Valsalva maneuver in termination of paroxysmal supraventricular tachycardia. Males were better
responder than females. Long standing diabetic patients had poor response.

Background: The population worldwide have faced a growing epidemic of AO, the
prevalence of overweight and obesity is increasing in both developed and developing countries.
Abdominal obesity is a major risk factor for many chronic diseases including diabetes,
hypertension and ischemic heart diseases ,so it is considered a major Public health problem.
Objectives: This study was carried out to explore the effect types of delivery on the waist
circumference among women in Nasiriya maternity hospitals.
Materials and methods: A hospital based cross sectional study was carried out in two teaching
hospitals (Al Haboobi teaching hospital and Bent Al Huda teaching hospital) in Nasiriya
Maternity hospitals from first of November 2023 to second of February 2024. All non-pregnant
women who were suffering from any medical problem , and attended the obstetric outpatients in
these two hospitals were included in this study. Based on assumed prevalence of caesarean
section among women in a previous study in Al Nasiriya city(20%), so the needed sample size to
calculate such prevalence rate with precision of 5%, confidence level of 95%, and added extra
sample of 10%, is almost equal to 500 Women. data were collected by using a specialized
questionnaire which was designed for the purpose of the study. Abdominal obesity was
considered when patients waist circumference measurement more than 88 cm.
Results: This study showed that prevalence rate of Abdominal obesity among non-pregnant
women was 64.4%. This rate was significantly affected by mode of delivery (Abdominal obesity
was more among women who had history of caesarean section in comparison with women who
had history of normal vaginal delivery) (p=0.0001).
Conclusion: two-third of non-pregnant women with Abdominal obesity in Nasiriya maternity
hospitals . It is recommended to re-enforce pre natal health care of non-pregnant women
through the antenatal care services at primary health care level and state the complication after
caesarean section control weight before pregnancy.
According to the results obtained from this study and the current situation regarding the care of
women in reproductive age in Iraq and specifically in Al- Nasiriya city, the most important and
practical recommendation is to activate the maternal health care at PHCC or at least in every
hospital with a nutritional clinic with well-trained doctors and other heath staff .

Background: This study aimed to evaluate the effectiveness of the Rubella vaccine in children
who have received the MMR vaccine.
Material and Methods: The study design is a case - control study. This study was performed
in Thi-Qar Province, Iraq, from Sep-2023 to Jan-2024. 176 children were included (117 cases and
59 controls), aged less than thirteen years. The ELISA technique was used to detect anti-Rubella
Virus IgG.
Results: The seroprevalence of Rubella Virus IgG in the case group was positive in 110 (94.0%)
of 117 children. While within the control group, 29 (49.2%) of 59 children were positive, there
was a significant difference in IgG titer between both groups (p-value <0.001), but according to
sex, there were no significant differences between males and females in both groups (p- value =
0.957 and p- value = 0.711, respectively). The results found a positive correlation with INF-γ (r =
0.921, p- value < 0.001), but no correlation with IL-6 (r = 0.018, p- value = 0.849).
Conclusions: Our study concludes that the Rubella vaccine is potent for children who have been
vaccinated, with effectiveness reaching 94%, which is a very good percentage for controlling
disease. We recommend increasing vaccine coverage in Thi-Qar province.

Background: Ischemic heart disease (IHD) is one of the leading causes of death and disability
worldwide. It is an imbalance between oxygen demand and supply. The disease is caused by
decline of blood supply to the heart muscle as a result of coronary occlusion.
Objectives: This study was designed to determine the possible new biomarkers in diagnosis of
stable angina to facilitate faster therapeutic programs and also to study the cytokines roles in
pathophysiology of stable angina.
Methods: The current case-control research was performed on 86 stable angina patients, and 86
healthy subjects in Nasiriyah Heart Center. Serum Trop I, MYO, CK-MB, H-FABP, PCT, Lp
PLA2 and CRP hs, were assayed by immunoassay. Lipid profile and blood sugar and detected
by photometric assays. Serum IL-9, TNF-α and IL-1β were determined by ELISA and IL-6 by
immunoassay.
Results: The study revealed that serum troponin I level was insignificantly changed in stable
angina. However, compared with control, significant increase in the level of myoglobin, CK
MB, hsCRP, Lp-PLA2, PCT and H-FABP, were recorded in the stable angina patients. The
patients also showed significant increase in the serum levels of total cholesterol, triglycerides,
VLDL and LDL, while HDL was significantly decreased. Significantly elevation of serum levels
of TNF-α, IL-9, IL-6 and IL1β were also noted in the patients in comparison with healthy
control. According to these investigations, there were many variations in the levels of these
biomarkers when the patients of stable angina divided according to their weight, blood pressure
and glycemic state.
Conclusion: According to the results we conclude that, in addition to cTnI, CK-MB and MYO
several other markers such as Lp-PLA2, hs-CRP, PCT and H-FABP are sensitive, and can
utilized as indicators in diagnosis of stable angina.

Background: growth of microorganisms on heart valves inner lining eventually cause what is called infective
endocarditis. The pathological core lesion of infective endocarditis is termed a vegetation, which is composed
of colonies of microorganisms, inflammatory cells, fibrin and platelets.
Aims: to clarify the clinical background,
microbiological entity and in hospital course of patients with
infective endocarditis in Ibn-AL Betar cardiac Centre.
Methods: all patients with infective endocarditis admitted to Ibn-AL Betar cardiac center between June 2018
and January 2020 were studied. Echocardiography and lab tests done for all patients. Pregnant women and
pediatrics less than 14 years old were excluded from the study.
Results: our studied group was 30 patients, 30% female and 70% male with a median age of 34 years.
Infective endocarditis affecting native valves in 20 patients (66.6%), prosthetic valves in 5 patients (16.6%),
associating congenital heart disease in 4 patients (16.6%) and device related in one patient (3.3%). most
common valve to be infected was the aortic valve. Blood culture was positive in 8 patients
(26.6%).Staphylococcus aureus were the prevalent microorganism (16.6%).In hospital complications included:
heart failure in 22 patients (73.3%), septic shock in 5 patients (16.6%), acute renal failure in 4 patients
(13.3%), paravalvular abscess in 2 patients (6.6%), systemic embolization in 2 patients (6.6%) and septic
pulmonary embolization in 2 patients (6.6%). Surgery is indicated in 14 patients (46.6%); of them 5 patients
(16.6%) undergoing early surgical intervention. In hospital mortality was (16.6%).
Conclusion :Infective endocarditis is a hazardous disease. It comprises an increase in-hospital complications
with an enhanced mortality rate (16.6%). Staphylococcus aureus are the prevalent microorganism. Fever and
dyspnea are commonest presentations while peripheral stigmata of endocarditis were rarely observed in our
study.

BK polyomavirus, sometimes known as BKV infection, is a common and typically non
pathogenic virus that affects 80–90% of adults globally. BK virus (BKV) infection has become a
significant side effect of immunosuppression. Chemokines are 8–12 kDa tiny chemotactic cytokines that
form the chemokine fold by sharing four cysteines. A pro-inflammatory cytokine CXCL10 encourages
immune cells to migrate and become activated at the sites of infection. The main objective of this
research was to assess the expression levels of CXCL10 mRNA in urine and plasma in patient with renal
failure detected as bk virus DNA positive by real-time as contrasted with controls who are healthy.
Both the polyomavirus BK
infected renal failure patient and the healthy control group were the subjects of this
cross-sectional study. Using an in-house comparative real-time PCR, the mRNA levels of CXCL10 were
assessed
in the patient and control samples under study. The group of positive BKvirus DNA 16 cases were 8
males with mean age ±SD (41.0 ±15.58) and female 55.36 ± 18.65 vs. Control group 20 cases ,10 male
mean age ±SD (38.1±10.6) and 10 female (47.8±10.6). The mRNA expression levels of CXCL10 in
polyomavirus BK infected with renal failure patient increased compared with healthy controls. The 2
ΔΔCT gene fold level of CXCL102-ΔΔCTof polyomavirus BK infected with renal failure patient with
median 7.87 ranged (3.39 to 15.9) and 2-ΔΔCT of control with median 1.2 ranged (0.05 to 11.72). The p
= 0.00 statistically significant. the mean rank 27.5 for patient and 11.3 for control. This upregulation
was significant in polyomavirus BK infected vs. controls. These findings suggest that polyomavirus BK
can cause renal problems by inducing inflammatory indicators such as chemokine. Further completed
investigations with longer follow-up are required to confirm that individuals with polyomavirus BK
infection who have renal failure also have increased expression and production of CXCL10, a pro
inflammatory chemokine.

Background: The frequency of Skin problems in children under 5years years old
attending AL-Hussein teaching Hospital in AL Nassiriah City are generally not well
established.
Objective: to estimate the Frequency rate of skin diseases in children under 5years old in
AL Nasirirah City.
Patients and Methods: A cross-sectional study was carried out on402 patients of both
sexes with different skin diseases aged from birth to 5 years.
Result: the majority of the patients were Preschool children 306(76.12%). Infection was
the preponderant dermatoses278 (69.2% ). Among them, viral was the most
common134( 48.2%). Eczematous dermatoses were the second most common type76 (
18.9%) then papulosquemous disorders11 (2.71%), followed by pigmentary disorders 7(
1.74%). Both hair disorders & genodermatoses constituted 5(1.24%) of cases and
urticaria4(0.99%), finally a miscellaneous group of skin disorders were recorded 16(
3.98%).
Conclusion: infections and infestations were a major skin problems in children under 5
years old.

Background: Coronavirus disease 2019 (COVID-19) is a new viral disease that affected multiple
organs in the body.
Aims: to investigate the role of neutrophil count to albumin ratio (NAR) and serum level of C-reactive
protein (CRP) in predicting mortality in patients with COVID-19.
Patients and Methods: This was a prospective study including 100 patients with SARS-CoV-2.
Patients demographics (age and gender) were collected through direct interview. Laboratory
parameters (total white blood cell count, absolute neutrophil count, hemoglobin concentration, serum
albumin, CRP titer, CT scan findings were gathered from patient’s records. The neutrophil albumin
ratio (NAR) was calculated by dividing the absolute neutrophil count by serum albumin concentration.
Patients were followed-up for one month.
Results: Mortality rate was 53%. The mean age of the survivors and non- survivors was 44.72±16.71
years and 51.04±12.87 years, respectively with a significant difference. 83.02% of non-survivors had
sever lung lesion compared with only 31.91% of survivors who had such lesions. The median NAR
and CRP in non-survival patients was 450 and 175 mg/L, respectively compared with 246.5 and 140
mg/L, respectively in survivors with highly significant differences. The sensitivity and specificity of
CRP in predicting mortality were 59% and 60%, respectively, at a cut-off value of 55.5 mg/L, while
the sensitivity and specificity of NAR were 80% for both, at a cut-off value of 358.85.
Conclusions: Inflammatory markers including CRP, are significantly associated with high mortality
rate. The neutrophil albumin ratio showed a significant association with mortality with a sensitivity and
specificity of 80% for both, at a cut-off value of NAR = 358.85.

The study included the collection of (100) samples were collected from different
skin sites(Acne, impetigo, cellulitis, folliculitis). Clinical samples were collected from patients
who were admitted and visit in Al- Imam Al-Sadiq Hospital and Maternity and Children's
Hospital in Al-Hilla city, at the period from October (2023) to January (2024). Twenty isolates
were showed positive and identified as Staphylococcus aureus by using selective media,
biochemical tests and Vitek 2 system. and it was found that, out of the total 100 samples,
89(89%) samples showed positive bacterial culture. No growth was seen in other 11(11%)
samples, which indicate the presence of microorganisms that may be cultured with difficulty
such as virus, fungi and other anaerobic agents or may be due to difference in the size and nature
of the samples. Among (89) positive culturing selective media, 89/100 positive cultures ,were
divided into 48/89 (53.93%) Gram-negative bacteria, and 41/89 (46.07%) Gram-positive bacteria
based on Gram stain and culture medium. Among Gram positive bacteria 20/41 (48.78%),
isolates of Staphylococcus aureus were obtained. icaA, and fnbA were detected by PCR
amplification, fnbA was found in 70% of the isolates while icaA 60%. and 191 bp 689 were
considered positive for the presence of fnbA ,and icaA respectively.

Background:
Dental caries is an infectious disease-causing tooth demineralization and cavities. Dental caries in
children is caused by the combination of three major factors carbohydrates, the presence of caries bacteria on dental
plaque, and the rapid impact of hard tooth surfaces. The mouth contains a large number of bacteria, including a few
species that cause dental caries called cariogenic bacteria. Gram positive bacteria are the main contributors to caries in
the teeth
Methods
:
A study was conducted in Thi-Qar province between August and December 2023 AD, involving 100
swabs and dental plaque samples from (70 patients and 30 controls) aged 3-11 years. The samples were processed and
cultivated in a specific culture medium.
Conclusions:
The current investigation demonstrated a high rate of Gram-positive bacteria isolated from dental
cavities in children aged 3 to 11 years. Gram stain, biochemical tests, and VITEK 2 compact results showed that gram
positive bacteria accounted for 81% (180 isolates) and gram-negative bacteria for 19% (42 isolates). There were 109
isolates with typical Streptococcus colony morphologies.

The purpose of the recent study was to profile of biofilm formation gene (fnbA) in S.
aureus which isolated from burn patients, and to detect the antibacterial activity and MICs of
silver nanoparticles against pathogenic S. aureus isolated from burn wounds. One hundred and
sixty samples from burn patients were collected from August to October 2023 in a burn center in
the Thi-Qar province of Iraq. The S. aureus was only identified in (35; 21.90%) isolates.
Microscopical examination, morphological characterization, diverse biochemical testes, were
used to recognize S. aureus isolates. The PCR technique results recorded that 42.8% of S. aureus
isolates had the fnbA gene. The Ag NPs had antibacterial activity against completely S. aureus
isolates.

The samples were collected from soft deep caries lesion, from patients who were
visited to Medical Educational Clinics of the College of Dentistry / University of Al-Kufa,
during a period of five months from November 2022 to end of March 2023, provided the study's
100 participants with soft deep caries lesion specimens. The samples were grown in a number of
different media. After that, they spent 18-24 hours in a (37oC) incubator. Colony morphology,
microscopy, and biochemical testing were first used by scientists to identify Streptococcus
mutans. Only 20% of the isolates were confirmed to be St. mutans from the 100 positive clinical
samples, the automated Vitek 2 system deployed GP-ID cards including 64 biochemical assays
to guarantee the isolates were indeed St. mutans. The approach promptly and accurately
identified 20 distinct bacterial isolates with probabilities ranging from 94% to 99.7%. In the
present study, it was used ELISA to distinguish between St. mutans isolates that produced
biofilms and those that did not, by using the median values of optical density (OD) at 570 nm (>
0.240, 0.120, and 0.120), bacterial biofilms cause chronic diseases that are difficult to treat.
Twenty distinct isolates were tested for their ability to form biofilm, 9(45%) were found to be
strong biofilm producers, while 11(55%) were rated as moderate biofilm producers.

Background: Premature rupture of the membranes (PROM) is the term used to describe membrane
rupture that occurs before labor begins. Membrane rupture that occurs before 37 weeks of gestation
and before childbirth is referred to as preterm PROM (PPROM). Acute phase reactant ferritin rises in
response to inflammation. The purpose of this study was to look at the usefulness of serum ferritin as
a PPROM marker. This study aimed to investigate the usefulness of serum ferritin as a marker for
PPROM.
Methods: A cross-sectional study was carried out in the department of obstetrics & gynecology of
Al-Elwyia Teaching Hospital for 9 months. This study included 180 pregnant women, they were
divided into three groups: the PPROM group included 60 women presented with PPROM, the
Spontaneous labor group included 60 women presented with spontaneous preterm labor, and the
control group included 60 healthy pregnant women. A structured questionnaire was designed, and it
included age, parity, gravidity, gestational age, obstetrical history, and gynecological and past medical
histories. Venous blood samples of 5 ml were collected in plain tubes from each patient to measure
serum ferritin. ANOVA test with LSD post-hoc test was used to compare the significant difference
between the three groups. Analysis of receiver operating characteristic curves was utilized to forecast
serum ferritin's diagnostic ability in PPROM. Statistical significance was considered whenever the P
value was less than 0.05.
Results: Ferritin levels were significantly different between the three groups. Post hoc multiple
comparisons showed that the PPROM group had significantly higher ferritin levels when compared
with the spontaneous preterm group and the controls, while there was no significant difference in serum
ferritin levels between the spontaneous preterm group and the control group. The optimal cut-off
ferritin level for predicting PPROM was 37.41 ng/ml with sensitivity and specificity of 80.8% and
91.6% respectively, and accuracy of 84.4%.
Conclusions: This study concluded that ferritin levels were significantly raised in the PPROM group
compared with the other two groups. The use of ferritin as a predictor for PPROM is recommended as
it does not require additional instruments when a ferritin kit is available, and the results of the test can
be taken rapidly.

Background: Assessment is a vital step in management, which aims at improving planning and
implementation of processes, activities, campaigns, and programs. This was the motive behind
conducting this study to evaluate the health system response in Basra Province, south of Iraq.
Method: This evaluative study included the selection of evaluation sites to obtain the relevant
background information about the resources involved, policy and legislation documents, and the
existing structure and process of COVID-19 crisis-management. The sample targeted included
medical and stakeholder non-medical staff.
Results: A gap was determined in following-up the principles of scientific handling of epidemics
including documentation, the absence of specialized staff in health-crises management was
documented, shortage in planning and preparing protocols and guidelines for epidemic
management was found.

Background: Branched stones called staghorn calculi make up most of the pelvicalyceal
system. For staghorn calculi, percutaneous nephrolithotomy (PCNL) is currently the
recommended first-line treatment option. Optimal renal access is critical to PCNL success.
Objective: to compare between lower and upper calyceal PCNL approaches for treating
staghorn calculus at the renal pelvis and/or lower calyx.
Methods: PCNL was performed on 40 patients with complex renal stones in our center.
Twenty had a lower calyceal puncture, and 20 had upper calyceal access. The two methods are
compared in terms of the overall duration of the procedure, the requirement for a second
puncture, the success rate (residual stone presence), intraoperative blood transfusion rates,
postoperative complication rates, and hospital stay.
Results: The mean operative time in lower access was 64.5±23.73 min which was longer than
that of upper group (50.5±18.88 min) with a significant. Compared to none in the upper calyceal
approach, five patients (20%) in the lower approach require a secondary puncture. Two patients
(10%) in the upper access experienced pneumothorax versus one patient (2%) in the lower access
experienced angioembolization. There is no difference in the duration of hospital stays between
the two methods.
Conclusion: The upper calyceal approach, with minimizes lung complications and requires a
short surgical time, is a feasible option for pelvic and/or lower calyceal renal calculi.

Introduction: The anterior ethmoidal artery (AEA) is an important anatomical structure during
endoscopic sinus surgery (ESS) due to the risk of injury. Preoperative identification of landmarks
correlating with AEA location could help reduce complications. This study aims to determine
anatomical variations affecting the AEA course concerning the skull base.
Methods: A retrospective review was conducted of 50 patients who underwent ESS.
Preoperative coronal CT scans were analysed for supraorbital ethmoid cells (SOEC), suprasellar
cells (SBC), and Keros classification of olfactory fossa depth. Radiological AEA location relative
to the skull base was recorded. Intraoperative videos were reviewed to correlate findings with
radiology.
Results: SOEC were present on 24 right and 28 left sides. SBC were present in 39 right and 33
left sides. The most common Keros types were right type 1 (31) and left type 1 (27).
Radiologically, AEA was within the skull base on 32 right and 27 left sides. Intraoperative
correlation showed a higher incidence of AEA below the skull base with SOEC/SBC presence and
more profound Keros types. The relationship between anatomical variations and AEA location
was statistically significant (p<0.05).
Conclusion: This study demonstrates that anatomical variations, including SOEC, SBC, and
Keros classification, influence the course of the AEA relative to the skull base. Preoperative
identification using these landmarks on CT may help surgeons localise and protect the AEA during
ESS, thus reducing the risks of injury. More extensive prospective studies are needed to validate
these findings.

The rapid increase in the prevalence of cardiovascular diseases and low vitamin D levels are both
considered important public health issues. low level of vitamin D can promote endothelial dysfunction
and the development of atherosclerosis. also Vitamin D receptors are also expressed in the
cardiomyocytes of the left ventricle. One of the important mechanisms by which vitamin D affects
cardiovascular health is its effect on adipose tissue. Vitamin D can modulate the inflammatory response
of immune cells and adipocytes inside adipose tissue. Given the importance of vitamin D levels and
their relationship to adipose tissue in people with cardiovascular disease, understanding the mechanisms
of action of vitamin D in adipocytes may have a significant impact on maintaining cardiovascular health.
In the present review, we focus on mechanisms through which vitamin D may influence adipose tissue
associated with cardiovascular disease. In addition to checking whether vitamin D supplementation can
be a treatment option to improve adipose tissue function and thus prevent cardiovascular disease.

Background: Hashimoto's thyroiditis (HT), an autoimmune disease of the thyroid gland that is the leading
cause of hypothyroidism in developed countries, HT may develop at any stage of life, especially between the
ages of 30 and 50 years, and affects both male and female. However, it is usually found in female within a
female-to-male ratio of 10:1. The risk of HT is higher in areas where there is adequate iodine intake, especially
among individuals with genetic predispositions. The prevalence of HT is approximately 2 percent across all age
groups, with an annual incidence of 0.3 to 1.5 cases per 1,000 individuals. HT causes permanent hypothyroidism,
such that the thyroid gland becomes unable to produce hormones, which requires therapeutic replacement. The
TH etiology is multifactorial, incorporating both genetic and environmental factors. Currently, there are no cures
and a limited understanding of the disease mechanisms. However, emerging evidence suggests that viral
infections may serve as potential triggers for HT. The Epstein-Barr virus (EBV) is a double-stranded DNA virus
that demonstrates a distinctive tropism towards B lymphocytes and epithelial tissue. Many studies have linked
the EBV infection to the onset or development of autoimmune diseases, since EBV possesses the ability to
modulate and evade the immune system. A hypothesis suggests that genetically vulnerable B lymphocytes during
the EBV lytic infection infiltrate the thyroid, producing autoantibodies and activating autoreactive T cells. These
autoantibodies then contribute to the autoimmune response that ultimately leads to HT.
Objective: The current study aims to explore the affiliation between HT and EBV infection by comparing the
positive proportions of anti-Epstein-Barr virus viral capsid antigen antibodies (Anti-EBV-VCA) between
patients newly diagnosed by the specialist physician as HT patients and healthy individuals.
Methods: Sixty serum samples from newly diagnosed by the specialist physician as HT patients, 51 females
and 9 males, and sixty healthy controls, 48 females and 12 males, were obtained and tested by the indirect
Chemiluminescence Immunoassay (CLIA) for both Anti-EBV-VCA IgG and Anti-EBV-VCA IgM.
Results: The results did not show any significant difference in the Anti-EBV-VCA IgG positive proportions
between the patients and the healthy groups (P. value= 1), while a significant difference was noticed in the
positive proportions of Anti-EBV-VCA IgM (P. value< 0.001).
Conclusion: Increased positive proportions of VCA-IgM for EBV in the patients with HT compared to the
healthy controls suggest that active EBV infection may have a role in the HT onset or progression.

Introduction: Sinonasal inverted papilloma is a non-cancerous growth of epithelial cells commonly found in
the nasal cavity and paranasal sinuses. It predominantly affects adults in their 50s, with a higher occurrence in
males. This condition has a notable recurrence rate and carries a risk of malignant transformation ranging from
5% to 15%.
Objective: This study aims to assess the effectiveness of endoscopic medial maxillectomy as a surgical
intervention for sinonasal IP, focusing on patient outcomes and recurrence rates.
Methods: In a retrospective descriptive cohort study conducted between January 2021 and February 2023 at
Sulaimany Teaching Hospital-Otolaryngology, Head and Neck Surgery Center and Middle East ENT Center at
Zhian Private Hospital, 11 patients were enrolled. Of these participants, 72.7% (8 cases) were male and 27.3%
(3 cases) were female, with a mean age of 45.45 years (range= 23-56). The patients underwent endoscopic
resection for sinonasal inverted papilloma and were assessed using endoscopy, sinonasal outcomes test (SNOT)
22, radiological imaging, and histopathological examination.
Results: The study included 11 patients who underwent endoscopic resection for sinonasal inverted papilloma.
The examination of these patients revealed a higher prevalence of T2 stage (6 cases) and T3 stage (4 cases)
during the initial diagnosis. Furthermore, one occurrence of recurring disease and one instance of malignant
transformation were documented.
Conclusion: The results underscore the efficacy of modern endoscopic surgical techniques in efficiently treating
inverted papillomas, leading to improved patient outcomes, decreased recurrence rates, and enhanced overall
quality of life following the operation. These advances have successfully eradicated most inverted papillomas
endoscopically, resulting in good quality of life and low recurrence rates.

Background: The physician-patient relationship has long been linked with a special ethos of confidentiality.
It is one of the most important aspect in any medical specialty, it promises patients' trust in the health system.
Healthcare workers in general, and doctors in particular, must to be knowledgeable about patients' rights.
Aim of study: To examine practicing physicians’ knowledge and attitudes related to different aspects of
patient confidentiality and data sharing.
Subjects and Methods: This was a cross-sectional study with analytic component conducted in two teaching
hospitals and six Primary Health Care Centers in Baghdad during a period of 10 months from 1st of February
to 1st of December 2023. It included 253 physicians. Data collected by a questionnaire with three parts:
Socio-demographic characteristics, knowledge about data sharing and confidentiality, and attitudes towards
patient confidentiality and data sharing).
Results: In this study, 52.5% of participants had fair knowledge towards patient confidentiality and 19%
were with poor knowledge. Rates of good knowledge were significantly higher in female physicians,
physicians who had board certificate, and those who received training on medical ethics. Regarding
physicians’ attitude towards patient confidentiality, 79.9% were found to have a positive attitude 20.1% had
negative attitude. Having board degree, having contact with > 40 patients per day, and taking training on
medical ethics were significant factors associated with positive attitude of physicians towards patient
confidentiality.
Conclusion: The majority of participants showed fair level of knowledge and positive attitude towards
patient confidentiality. The most important modifiable factors that may increase the level of knowledge and
attitude were getting higher level of education (board certificate) and taking training on medical ethics.

Background:
Heart failure (HF) is defined as any structural and/or functional impairment of cardiac blood ejection raised from a
structural or functional cardiac disorders that impair the ability of the ventricle to fill with or eject blood, leads to a
complex clinical syndrome with typical symptoms and clinical signs1,2. HF influences 23-26 million patients
globally.4,5 The major causes of HF include ischemic heart disease (IHD) ,myocardial infarction (MI), hypertension,
and valvular heart disease (VHD). The association of an angiotensin II receptor antagonist and a neprilysin inhibitor
is a new actor in HF management.18
Patients and Methods:
This is an observational analytical Cohort study which has been performed in the Teaching Cardiac Center in Thi
Qar Governorate in Nasiriyah city in Iraq. All participants are patients who either recently diagnosed as heart failure
(6 months to 1 year) or diagnosed since (1 to 3 years). Key criteria for the study has been involved socio
demographic characteristics as age (years) (40-60 or more than 60), Body Mass Index(BMI), educational level of
patients, occupation, history of tobacco smoking or alcohol intake, the history of co-morbidities as Atrial
fibrillation (AF), Diabetes Mellitus (DM) (types I and II), Dyslipidemia, Chronic kidney disease(CKD) and Chronic
obstructive pulmonary disease(COPD).
Results:
The number of both genders is equal in my study. After 6 weeks follow up period from starting to take ARNI,
(27.02%) of them improved regarding EF. About (72.98%) of them had initial increament in ejection fraction by
about (4 -8%). Good prognosis regarding signs and symptoms of heart failure were remarkable.
Conclusion: -
Chronic symptomatic patients with HFrEF ( NYHA class II or III ) who tolerate an ACEI or ARB can be
switched safely to sacubitril/valsartan (ARNI), to further reduce morbidity and mortality. -
The main barrier that prevents cardiologists in Thi Qar to prescribe ARNI is the cost of the drug because
most of the Iraqi patients are unable to buy this expensive medication.
Recommendations:
1-All patients with HFrEF (NYHA class II - III) should receive ARNI.
2-This medication should be provided in all Iraqi hospitals and Cardiac centers because this drug is very expensive
and patients may not be able to buy it.
3-Explaining the concept of the medication related burden and further studies are recommended to include
adherence assessment of patients toward treatment.

Background
It is usual for many people to suffer from bacterial infections, a common health issue in everyday
life. Various illnesses, like strep throat or E. coli food poisoning, come about due to the invasion
of bacteria into the human body.
Objectives
This research aims to comprehensively evaluate the potential benefits of using ginger as an
antibiotic to treat bacterial infections. While antibiotics have revolutionized medicine, their
overprescription and misuse have led to increased drug resistance in bacteria.
Literature Review
Benefits and uses of ginger as an antibiotic in treating bacterial infections
Ginger (Zingiber officinale) has long been traditionally used as a herbal medicine to treat various
diseases, and studies have increasingly demonstrated its antibacterial properties against both
Gram-positive and Gram-negative bacteria, indicating its potential as an antibiotic [1, 2, 3].
Methodology
whereby a literature review is done alongside an experimental analysis in the lab. The proposed
study is entitled Literature Presentation: A detailed literature survey will be performed using
popular biomedical databases such as PubMed, Science Direct, and Google Scholar.
Results
A literature review revealed several key findings regarding ginger's antibacterial properties and
effectiveness. Several laboratory studies have demonstrated that various chemical compounds in
ginger, such as gingerol, shogaol, and bardol, possess potent antimicrobial activity against
diverse bacterial strains.
Conclusion
Based on previous studies, it can be said that ginger possesses antibacterial properties and can be
used as an adjuvant treatment for bacterial infections. Compounds in ginger appear to be able to
directly inhibit a range of harmful bacterial strains in the laboratory, including antibiotic-resistant
forms.

Background: Throughout development, the embryo and fetus are surrounded by a clear, yellow
fluid called amniotic fluid (AF), which serves a variety of functions Meconium-stained amniotic fluid
occurs in 8-10% of all deliveries. It has been associated at times with suboptimal neonatal outcomes,
although this is controversial. Amniotic fluid may be quickly and non-invasively assessed using
ultrasound (U/S). It provides a secure real-time alternative with similar therapeutic results. This study
aimed to identify the role of U/S in detecting echogenic amniotic fluid and its association with
pregnancy outcomes.
Methods: A case-control study was carried out in the obstetrics & gynecology departments at Al
Elwyia (Baghdad) and Bunt Al-Huda (Dhi Qar) Teaching Hospitals. A total of 174 pregnant women
who presented with singleton viable pregnancies and decreased fetal movement were recruited and
they were classified into two groups according to echogenicity of AF by U/S. The first group included
87 women with positive echogenic AF (Case group) and the second group included 87 women with
negative echogenic AF (Control group). A structured questionnaire was designed, and it included
maternal characteristics and pregnancy outcomes. U\S was done by two specialists in the department
of radiology. Data analysis was done by using version 26 of the Statistical Packages for Social
Sciences. Pearson Chi-square test (α2-test) was used to examine the significance of the difference
between different percentages. A level of P- P-value < 0.05 was considered significant.
Results: Echogenic AF on U/S predicted a much higher proportion of meconium (60.9%) and
bloody-stained amniotic fluid (9.2%) compared to controls where only 14.9% had meconium and non
had bloody stained AF, A positive test result had sensitivity and specificity in predicting meconium of
80.3% and 68.5% respectively. In positive echogenic AF and compared with controls, the rate of
preeclampsia, cesarean section, neonatal admission to the intensive care unit, and neonatal death were
significantly higher, while the mean Apgar score at 5 minutes was significantly lower.
Conclusions: This study concluded that the confidence of U/S was 37.9% in pregnant women with
meconium-stained AF, with sensitivity and specificity of 80.3%, and 68.5% respectively. A positive
test of echogenic AF on U/S was highly significant in the prediction of neonatal admission to the ICU
because of meconium aspiration syndrome. Training obstetrician residents to be experienced in
evaluating the echogenicity of amniotic fluid in obstetrical units & labor rooms is recommended.

Background: epistaxis is one of the ENT problem that’s common in general population, it can
happen in any age due to variable causes and risk factors ,sometimes doesn’t need treatment while
in severe cases need surgical and medical care
Objective: The aim of this study is to find prevalence and risk factors among the population in
college of medicine in Sulaymaniyah
Patients and Methods: a retrospective cross-sectional study at college of medicine in
Sulaymaniyah university, in which 329 cases enrolled among the cases (students, teacher,
employer) are involved
Result: The prevalence of epistaxis among population in college of medicine in Sulaymaniyah
was found to be 52.9, most of the cases was below 18 years, it usually happened in summer.
Conclusion: Most of cases happen below 18 years, the most common risk factors was nasal trauma
and it usually happens in summer, most of the cases that experienced epistaxis had positive family
history

Background and Objectives: Smoking is a known risk factor for various respiratory infections and
diseases. However, its impact on the severity and outcomes of COVID-19 remains a subject of
ongoing research. The objective is to evaluate if smoking is linked to mortality in COVID-19
patients.
Methods: A retrospective cohort study was conducted on the ICU admitted COVID-19 patients,
between May, 2020 and July, 2021. Admitted patients to the hospital with positive Severe acute
respiratory sendrom-2 were categorized based on smoking status. The main focus was on mortality
during hospitalization. Odds ratios (OR) and 95% confidence intervals (95%CI) were presented for
smoking status.
Results: Among 400 COVID-19 deaths (mean age was 61.2 ± 13.0 years), the majority was
between 60-60 years (35.3%, n=141), followed by older than 70 years (27.7%, n=111) then 50-59
years (17.7%, n=71), then 40-49 years (12.3%, n=49), only 7.0% (n=28) was < 40 years. The
majority was male (62.2%, n=249) rather than female (37.8%, n=151). Mean ICU stay was 9.3 ±
10.7 days. 59.5% have at least one comorbidity. The prevalence of active smoker =1.8% vs 5.3%;
former smoker= 28.7% vs 22.1%; and never smoker= 69.5% vs 72.5% regarding death and
discharged patients. AS has lower risk of mortality (OR= 0.36 (95%CI 0.13- 0.99; P =0.041) than
NS, The AS, as well as low risk of mortality (OR=0.29 (95%CI 0.11- 0.79; P = 0.0) than FS.
Indeed, the former smoker has higher risk mortality (OR was 1.25 (95%CI 0.88 - 1.78; P= 0.203)
than NS.
Conclusion: The older adults, males, comorbidity are at higher mortality risk by COVID-19
infection. Active smokers have lower in-ICU mortality than former smokers and never smokers,
While, the former smokers have higher risk of mortality than active smokers and never smokers.

Background: Overhanging dental restorations are defined as a horizontal mismatch in the smooth
and approximate surfaces of the restorations. A significant prevalence and degree of severity of
periodontal problems are associated with the presence of overhang margins restorations.
Aim: This study aimed to determine the prevalence of overhang margins in patients with class II
restorations.
Materials and Methods: An observational cross-sectional study was performed in 200 patients
attending Shorsh Teaching Dental Center in Sulaimani City of Iraq. Patients were examined using
sterilized patient examination kits and under the dental chair light. After the initial diagnosis of the
overhang, final confirmation was obtained with the radiographic studies. For data collection,
gender, age, time of restoration, type of material used, daily home care, and any history of gingival
bleeding or inflammation were obtained. Data was analyzed using SPSS software, version 21.
Results: The results of this study showed the prevalence of overhang in 296 (38.3%) examined
teeth, including 190 (44.2%) upper teeth, and 106 (30.9%) lower teeth, 202 (43.7%) molar teeth
and 94 (30.2%) premolar teeth, 241 (64.6%) composite teeth, and 55 (35.4%) amalgam teeth, 110
(37.1%) mesial teeth, and 186 (62.9%) distal overhang teeth, that 152 (51.4%) overhang teeth
occurred in men and 144 (48.6%) overhang teeth occurred in women.
Conclusion: The results of this study showed that the frequency of overhang was relatively high
in the examined teeth. The results of this study showed the highest frequency of overhang in
composite teeth. Overhang treatment and removal appear to be necessary to minimize periodontal
risks.

Background and objectives: Femoral overgrowth is not related to age, fracture level, or fracture
anatomical location. This study measures the amount of bone overgrowth in operative and non-operative
ways to manage femoral shaft fractures in children.
Methods: In this prospective cohort study, 50 participants with femoral shaft fractures were recruited at
Shar/Shorsh teaching hospitals from June 2022 to June 2023. We collected patients' socio-demographics
and clinical data (fracture side, site, and the mode of the treatment they received). The participants were
treated with various methods. Later, we assessed the mean shortening at the time of bone union and
overgrowth after one year of follow-up by x-ray and clinical exam.
Results: Most shaft fractures were at the dominant side (74%), mid-femur (64%), and (52%) had
undergone hip Spica. No-operatively managed cases comprised (52%). There was a significant
difference in the femoral shortening before and after one year using the X-ray parameter (p=0.000).
Moreover, a statistically significant difference (p=0.038) was seen in femoral overgrowth after one year
of follow-up by x-ray assessment only. Additionally, non-significant differences were noted between all
treatment types (hip Spica, plate and screw, elastic nail, and closed reduction + external fix) in femoral
shortening at the time of union/femoral overgrowth using both x-ray and clinical assessment following a
year.
Conclusion: No significant difference was noticeable in the amount of bone overgrowth between
operative and non-operative managements that caused no laming or restriction of daily activities.

Background: Every year some 12 million children in developing countries die before they reach
their fifth birthday. Seven in ten of these deaths are due to acute respiratory infections (mostly
pneumonia), diarrhea, measles, malaria, or malnutrition. The IMCI was developed in response to
many global under-five deaths in low- and middle-income countries in the 1990s. This study aimed
to assess the compliance of health workers to the guiding booklet of IMCI in the management of
cases.
Methods: A cross-sectional study was conducted in the four primary healthcare centers (PHCCs)
in Baghdad for 5 months. A total of 223 children aged between 2 months to 5 years who attended
the selected four PHCCs in their initial visit were recruited. A structured questionnaire was
designed for this study, including information about the recruited children and assessment criteria
of the IMCI guiding booklet for case management.
Results: The assessment of the 6 domains of IMCI guidelines were as follows: high/perfect scores
were detected in 86.6% for cough/difficulty breathing, 100% for diarrhea, 37.6% for fever, 100%
for ear problems, 78.5% for throat problems, while weak score was detected in 71.8% for anemia
and malnutrition. Out of the 223 children, 182 (81.6%) received treatment, antibiotics were
prescribed for 99 (44.4%) of them, and (88.9%) of these cases received antibiotics according to the
IMCI guidelines. In most of the cases (94.5%) treatment administration was explained to the
patient's relative and 59.9% were asked if they understood how to administer it.
Conclusions: Adherence of physicians to IMCI guidelines regarding cough/difficulty breathing,
diarrhea, ear problems, and throat problems was high, while it was low in terms of fever and
anemia/malnutrition. We recommend the installation of an internal audit system with clear criteria
to allow evaluation of PHCCs and their employees' performance at regular intervals.

Polycystic ovarian syndrome (PCOS) is typical disease characterized through irregular
menstruation as well as the biochemical or clinical signs of an overabundance of testosterone . A
person may experience PCOS symptoms at any age. These include early puberty in infancy, hirsutism
and irregular menstruation in adolescence, infertility and glucose intolerance in middle age and later
in life (heart disease and diabetes mellitus). Although a pelvic ultrasound examination is helpful,
polycystic ovaries are a typical condition in females with PCOS, so ultrasound evidence is required
regarding the diagnosis. It is advisable to test for hyperlipidemia and glucose intolerance, particularly
in obese women, as PCOS is frequently associated with diabetes mellitus. The addition of insulin
sensitizing medications, such as metformin, may be helpful in situations like anovulatory infertility.
Lifestyle modifications as advised for diabetes are essential for treatment. While clomiphene citrate
with or without metformin, ovarian drilling, gonadotrophin-induced ovulation induction, and diet and
exercise can all help most women manage their infertility, in vitro fertilization should be avoided. .
The DhiQar governorate served as the study's site. It was collected from Bint Al-Huda Maternity
Hospital comprising 100 blood samples drawn from 30 Healthy lady, and 70 blood samples drawn
from women who had pco and were between the ages of 18 and 42 The hormonal analysis for FSH,
LH , Progesterone and Prolactin by using auto analyzer device maglumi . A device was also used
packed cell volume haematocrite to measure Blood ratio.

Background: Direct resin composites are often selected for anterior restorations due to their
numerous advantages over indirect techniques. These benefits include the ability to be applied to
tooth surfaces with minimal to no preparation, ease of repair, and excellent aesthetic properties.
Additionally, they require less time in the dental chair and are more cost-effective. This study aims
to characterize and compare the translucencies of two different anterior resin composite materials,
Shufo resin composite (Tokyo, Japan) and Micerium resin composite (Italy), with natural dental
tissues.
Method: Radiographic imaging was utilized to record the enamel and dentin thicknesses of
extracted upper central incisor teeth. Ten specimens were fabricated for each group. Colorimetric
measurements were conducted on dry samples using a spectrophotometer (Rayplicker spectro
diameter Micro Office device), with color space coordinates recorded.
Results: Comparative analyses of the CIE Lab color space coordinates, precisely the L*
(lightness) values, were conducted for the incisal, gingival, and middle third positions. The results
indicate a statistically significant difference (p-value < 0.05) between the natural tooth and
Micerium and Shufo in the incisal and middle third positions. Additionally, translucency
parameters, including lightness, hue, and chroma values, were calculated using a formula derived
from the Commission Internationale de l'Eclairage (CIE) color space coordinates.
Conclusion: The CIE Lab colorimetric values obtained for natural enamel and dentin tissues
were superior to those of all the resin composites evaluated. Furthermore, the samples' desiccation
augmented the CIE Lab values for both natural enamel and dentin, indicating a significant
influence of the hydration state on these tissues' color properties.

Objective: To determine the incidence and outcome of molar pregnancy in Basra maternity and
child hospital.
Methods: 55 cases of molar pregnancy had been diagnosed by clinical history, physical
examination and investigations especially ultrasound scan. Those patients were managed as
primary measure by dilatation and curettage once or twice depend on the case and then followed
by serial βHCG measurement.
Those with persistent rise HCG despite treatment or with persistent bleeding classified as persistent
gestational trophoblastic disease and referred to chemotherapy.
Results: current study shows that the incidence of molar pregnancy in our hospital about 5.2%
mainly recorded among those with age of 30-39 years, multiparus patients and those with low
socioeconomic class.
Vaginal bleeding was the most common presenting symptom among attendants, less commonly
hyperemesis gravidarum and large for date uterus.
Molar pregnancy was seen more commonly in those with previous history of molar pregnancy
(19.10%) and those with history of previous abortion (21.2%).
81.8% of cases shows complete remission after they had their first and/ or second evacuation, only
9.1% of cases they had persistent gestational trophoblastic disease for which they were shifted for
chemotherapy.
Conclusion: In conclusion early ultrasound examination which remain the main pool in the
diagnosis of molar pregnancy is mandatory for those patients with history of early pregnancy
bleeding, hyperemesis gravidarum and large for date uterus.
Because 9.1% of cases remain as persistent gestational trophoblastic disease despite their first and
/
or second evacuation so serial measurement of βHCG is mandatory for all cases so that early
detection and management of persistent gestational trophoblastic disease will be most beneficious
for those patient.

Background: Escherichia coli (E. coli) is a major cause of diarrheal diseases, with rising
antibiotic resistance complicating treatment. This study aims to isolate and identify
E. coli
from clinical diarrhea samples and to profile the tetB antibiotic resistance gene using PCR,
while also exploring genetic polymorphisms within this resistance determinant.
Methods: Seventy fresh fecal samples were collected from patients with diarrhea at Al-Hussein
Teaching Hospital, Thi-Qar province, Iraq, from February to July 2020. After culture-based
identification and verification through the API-20 system, 60 samples (85.71%) were confirmed
as
E. coli . Analysis by age showed a higher prevalence (40%) in children aged 1-5 years,
with lower prevalence (15%) in individuals aged 16-20 years.
Results: PCR analysis demonstrated the presence of the tetB gene in 100% of the E. coli
isolates. Sequence analysis revealed various mutations within the
tetB
gene, and
phylogenetic trees based on tetB sequences were constructed. These trees accurately placed
the E. coli isolates within bacterial taxonomy, offering insights into the relationships between
genetic mutations and phylogenetic positioning.
Conclusions: This study underscores the utility of
classification of
E. coli
tetB
amplicons for phylogenetic
isolates. Such methods effectively differentiate antibiotic-resistant
strains in clinical samples, contributing to an understanding of their evolutionary traits and
potential impacts on public health.

Overview
The presentation of unrepaired VSDs is largely dependent on the presence of hemodynamically significant
shunt. The murmur of VSD is typically pan-systolic best heard in the left lower sternal border; it is harsh
and loud in small defects but softer and less intense in large ones. (TTE) is the most valuable tool for
diagnosis due to its high sensitivity. Approximately 85% to 90% of small isolated VSDs close spontaneously
during the first year of life. Surgical repair reduces the risk for endocarditis, might improve PAH, and
overall, it increases survival.
Aim of the study: Is to evaluate the result of surgical closure of VSD in Ibn Al-Nafees teaching hospital.
Patients and methods: This is a retrospective study for surgically managed patients with ventricular septal
defect in single center done in cardiac center, Ibn Al-Nafees teaching hospital during the period from
January 2020 till December 2021. The documents of 50 patients were studied in our center during 2 years
only. Patients who met the criteria of the study were included. The other patients were excluded from the
study mainly those who had more complex cardiac anomalies, including tetralogy of Fallot, atrioventricular
septal defect and coarctation of aorta.
Result: The youngest patient was 3 year while the oldest one was 28 years. The mean age group was 15
years. The lowest body weight was 13 kg while the highest was 80 kg. Only 15 patients had cardiac
catheterization and most of them had other associated anomalies like ASD , aortic incompetence, subaortic
ridge , PS , etc.
86% of patients have had pulmonary hypertension from mild to moderate to severe degree while those with
PS protect the pulmonary circulation from pulmonary hypertension. The material of patch used was Dacron
patch for all cases. The shortest cross clamp time was 19 minutes while the longest was 125 minutes. The
shortest cardiopulmonary bypass time was 44 minutes while the longest time was 185 minutes. In our study
aortic valve prolapse and regurgitation was the most common associated anomalies present in 20% of the
patients. In our study 2 patients died.
Conclusion: Still we have adult congenital heart diseases like VSD or other congenital heart diseases which
become very rare in developed countries. Mortality rate of 4%. Although it is high than the standard which
is 0-1% in advanced cardiac centers.