Annals of the College of Medicine Mosul

Background: Chronic lymphocytic leukemia is common adulthood leukemia with low incidence in Kurdistan region of Iraq. Staging of chronic lymphocytic leukemia is essential in treatment planning and the pattern of response is variable.
Aim of study: To evaluate the Rai staging distribution of patients with chronic lymphocytic leukemia in Kurdistan region/Iraq and its correlation with the treatment outcome.
Patients & Methods: A retrospective cross sectional review study conducted in three Hemato/oncology centers in Kurdistan for duration of eleven years through the period from 1st of January, 2010 to 31st of December, 2020 on convenient sample of 170chronic lymphocytic leukemia patients. Diagnosis of chronic lymphocytic leukemia was done according to the International Workshop on Chronic Lymphocytic Leukemia. The Rai staging was done by the clinical hematologist in Hemato/oncology center according to clinical evaluation and laboratory investigations. The pattern of the treatment response was determined according to the International Workshop on Chronic Lymphocytic Leukemia (iwCLL)
Results: The Rai staging of our patients was 0 in 15.3% of them, stage I in 12.4%, stage II 30%, stage III 13.5% and stage IV 28.8%. The treatment response of studied sample was complete response (43.5%), partial response (17.6%), stable (14.1%), no response (21.8%) and progressive (2.9%).A highly significant association was observed between no response to treatment and advanced Rai staging and also a highly significant association was observed between death outcome of patients and advanced Rai staging.
Conclusions: The treatment response of patients with chronic lymphocytic leukemia is directly related to Rai staging as patients with advanced Rai staging had lower treatment response rate.

Background: Hydatid cyst still has worldwide distribution with many cases discovered yearly in endemic areas. It has a predilection to involve the liver and the lung. Capitonnage has been practiced long time to avoid postoperative complications mainly air leak in addition to empyema formation. It may be still controversy concerning the efficiency of capitonnage especially for complicated hydatid cyst which led us to evaluate.
Aim of the study: To assess the efficacy of capitonnage surgery in minimizing the postoperative complications and hospital stay in complicated and non complicated pulmonary hydatid cysts.
Patients and Methods: A prospective study has been done at the department of thoracic surgery in Al-Jumhory teaching hospital at right side of Mosul, Department of pediatric surgery in Al-Khansaa teaching hospital and in Al-Rabee private hospital at left side of Mosul / Iraq between February 2017 and December 2019. Totally 118 patients with hydatid cyst of lung, including all ages and on different types of complicated and non-complicated cysts were included for this study. Co-morbid diseases like acute myocardial ischemia and uncontrolled diabetes mellitus were excluded from our study. Patients were evaluated in responce to the gender, age, clinical presentation, cyst condition (size, site and where ruptured or not) and postoperative hospital stay. Enucleation of the HC and capitonnage were carried out for all patients. The patient followed for three months at monthly interval, then each year with the mean follow up of 22 months.
Results: One hundred eighteen patients with median age of 32 years were operated using capitonnage method. In this study 49 (41.5%) of the patients found to have intact cyst and the remaining 69 (58.5%) had ruptured cyst. We recorded the early postoperative complications which include air leak in 10 cases, Atelectasis 8, pneumothorax 3, wound infection 3 and Hemoptysis in 2 cases.
Conclusion: Capitonnage can decrease the incidence of air leak and shorten hospital stay in complicated and non-complicated lung hydatid cysts.

Background: There is an idea that the level of medical college graduates is less than the expected. The improvement of medical training level for the undergraduates in medical schools need a re-evaluation and improvement for creation of new training programs including a better surgical training.
Objective: Is to evaluate the clinical surgical training of undergraduates at College of Medicine , University of Mosul .
Participants and methods: The study carried out at College of Medicine , University of Mosul during the year 2019. The study depends on questionnaire directed to 46 final year students who recently finished their clinical surgical training, 53 resident doctors graduated from the same college working among surgical wards, and 50 surgical department teachers and expert surgeons interested in medical education. The questionnaire asked about : does the student gain sufficient knowledge and clinical surgical skills during training, does the training provide safe doctor in work, does the training provide proper communication skills and ability to work properly in teams, and does the graduate able to gain the confidence of patients and other health workers. The participants score freely their answer in grade extend from 1-10, and asked to add any other notes up on surgical training of students including deleting or adding or any other suggestion.
Results: Knowledge gaining mean score by medical students, resident doctors, and expert surgeons was 6.9 ±1.45 , 6.68 ± 1.82 & 6.68 ± 1.95 respectively, while mean score for providing safe doctor to community was 6.04 ± 1.39 , 6.52 ± 1.40 & 6.17 ± 1.17 respectively. On the other hand the mean score gaining regarding communication skills and ability to work in teams was 6.30 ± 1.44 , 6.37 ± 1.41 & 6.59 ± 1.13 respectively, while gaining the confidence of patients and other health workers mean score was 6.47 ± 1.18 , 6.74± 1.45 and 6.66 ± 0.99 respectively. In all , there was no significant differences. The clinical surgical skills gaining mean score by medical students , resident doctors and expert surgeons was 6.26± 1.61 , 4.92 ± 1.70 , and 5.8 ± 1.84 respectively. Which reflect the presence of a significant differences between resident doctors in comparison to students and expert surgeons.
Conclusion: There is lower mean score in gaining clinical surgical skills of graduates and there is a need for more clinical training, improvement, development of clinical training, and a re-evaluation of clinical training to improve the quality of medical teaching to get competent graduates.

Background: The obstruction of the nasal is known as the most distinct disturbing complain of nasal disease and nasal sinus. The nasal obstruction could either be found unilateral (in one nasal cavity), bilateral (in both cavities), intermittent, progressive or persistent. The rhino-scopy (anterior and posterior) provides limited information when compared to nasal endoscopy. In certain cases, the structure which lies under the sight line and the posterior rhino-scopy is not possible. Furthermore, the early diagnosis of many unpleasant lesions will be very difficult unless using nasal endoscopy.
Objectives: This study was designed to identify the real & precise causes of nasal obstruction in adults & properly evaluate the condition of nasal cavity ,post nasal space and nasal mucosa by direct vision through nasal endoscopy. and evaluate the value of naso endoscopy in diagnosis of the cause of nasal obstruction.
Methods: This study was conducted to analyze noses related to 75 patients with nasal obstruction who underwent clinical and endoscopic nasal examination for the period from May 2014 to April 2015 in Mosul namely; Al-jumhoori Teaching hospital.
Results: This case series study included 75 patients complaining from nasal obstruction The study include 43 male patients (57.3%), and 32 female patients (42.6%) with a M:F ratio of (1.3:1). The patients’ ages ranged between 15-70 years of age whose mean age was 42.5 years. endoscopic findings for adults patients with nasal obstruction in our study were: congested nasal mucosa 40 (53.3%) patients, septal deviation 26 (34.6%) patients, inferior turbinate hypertrophy 18 (24.0%) patients, pale swollen mucosa with watery nasal secretion 14 (18.6%) patients, bilateral nasal polyposis 10 (13.3%), post nasal drip 10 (13.3%), crustation 8 (10.6%), mucopurulent discharge from middle meatus & congested mucosa 7 patients (9.3%), adenoid hypertrophy 5 patients (6.6%), no abnormal findings 4 patients (5.3%), bluish tinged mucosa with watery nasal secretion 3 patients (4.0%).
Conclusion: Nasal endoscopy includes evaluating the passages of the nasal cavity and the nasal sinus, and post nasal space using a magnified high-quality view and serves as an objective diagnostic tool in the evaluating of nasal mucosa, sinonasal anatomy, nasal cavity, and post nasal space pathology.
In this study, nasal endoscopy is recommended in cases where patients complain of obstruction in the nasal specifically when anterior and posterior rhino-scopic examinations do not succeed in diagnosing causes of nasal obstruction

Backgroud: COVID-19 or the disease caused by the SARS – Cov2 – (sever acute respiratory syndrome caused by coronavirus 2 ). Coronavirus has caused a pandemic that has affected patients in more than 188 countries and territories around the world.
Prodigious restrictions and safety measures have been adopted by the governments to control the spread of wildfire coronavirus disease 2019 (COVID-19) pandemic. However, the effective implementation of these measures depends upon the knowledge, attitudes, and practices (KAP) of the people.
Materials and Methods: A cross-sectional survey was designed for the present study. The study was conducted from May 2020 to Septembet 2020 in Mosul city and include adults who are not working in the medical field and visit family medicine centers or hospitals for any reasons except having a disease
Results: this study revealed that about (190) 95% of the participant knows that the disease can be spread by droplet of patient and (136) 68 % of them believe that surfaces touched by patient could be one of the measures to transmit the disease and (156) 78% of them said that the disease may transmited from asymptomatic patient.
Regarding the knowledge of the participant about measures used to prevent spread of Covid 19 this research demonstrates that (198) 99% and (190) 95% of them convinced that proper hand wash and maintain appropriate distance between himself and other person specially with symptoms is an effective measure to prevent transmission of the disease . On the other hand , this study check the attitude of the participants toward Covid 19 which found that 76% and 72% of them have a good attitude toward covid 19 which was washing hands regularly and put facemask while only 59% believe that curfew during pandemic state are useful and 58% found that the preventive measures advised by health personnel were useful and 63% still considered that this disease designed as a biological weapon.
Conclusions: According to this study about 65% of the participant have good knowledge , 63.4 % of them have good attitude a toward Covid 19 which is very important to limit it\'s transmission through the population .

Background: Obesity, a global public health concern, has been repeatedly linked to the development of different cancers in epidemiologic and basic research studies, Prostate cancer is the most frequently encountered solid tissue cancer in men. Gleason score of the prostate cancer is one of the most important parameter, which provides the most important data about biological behavior of the cancer and affect on the selection of the treatment and its outcomes. Therefore, accuracy of Gleason score, based on histopathological analysis of the biopsy material, has a critical importance
Patients and Methods: A cross-sectional study with retrospective analytical elements, among prostate cancer patients who were diagnosed based on histopathology of prostate gland ,then classified accorrding to G.S (gleasson score) and body mass index.
Aim of this study: To evaluate the association between high body mass index and Gleason grade of prostate cancer.
Results: The results of this study showed that patients with high body mass index Significantly associated with high grade of prostate cancer, as ( 46.4% and 62.2% of overweight and obese patients respectively had high Gleason score above 7 while 12.5% of overweight and 8.1% of obese patients had low Gleason score and the p Value was (0.002).
Conclusion: This study found that high body mass index associated with increase high grade of prostate cancer.

Objective: to assess the dermoscopic characteristics of alopecia areata and their correlations with clinical variants, nail changes, and severity of the disease.
Patients and methods: This is a case-series study, which was carried out on 209 patients with alopecia areata in the Department of Dermatology from January 2020 to January 2021 at Ibn-Sina Teaching Hospital, Mosul, Iraq. After the patient\'s acceptance to participate in this study, a detailed history was taken. A clinical and dermatological examination was done included hair pulling test, and disease severity was graded according to the severity of alopecia tool (SALT) scoring. Each patch of alopecia areata was examined and assessed using a SKIARY Smartphone Dermatoscope©, photos ‎were taken and evaluated by three dermatologist experts in dermatoscopy separately ‎and their notes were recorded, evaluated, and tabulated‎. Spearman`s rank-order correlation test was used for data analysis.
Results: Two hundred and nine patients with alopecia areata had participated in this research. The male to female ratio was 1.5:1. The mean age of presentation was of 21 ± 10.64 years. 45% of the patients had Grade S2 severity. Yellow dots were the most common dermatoscopic finding followed by black dots, while perifollicular scales were the least common. Yellow dots, broken hairs, exclamation mark hairs, and nails changes were correlated with the severe form of the disease (P <0.05).
Conclusion: Alopecia areata has many dermatoscopic manifestations which are helpful in the clinical diagnosis and prognosis of the disease. Yellow dots, black dots, exclamation marks hair, broken hairs, and nail changes are related to the severe form of the disease.

Background: Hydatid disease is a zoonosis induced by Echinococcus tapeworms. Humans are infected by ingestion of Echinococcus eggs by eating contaminated food.
Objective: To Investigate the epidemiology of hydatid cyst first and final diagnosis in patients find out its clinical profile.
Method: The current study is a Case-series retrospective study for the patients attending Al-jamhoory Teaching Hospital between January 1, 2019, and July 1, 2021. The information was gathered from medical records. The data were analyzed using the frequency index, relative frequency and SPSS (Statistical Package for the Social Sciences).
Results: One-hundred eleven patients underwent during the study period. Sixty-three percent of them were males. unemployment state was 81.98%. The commonest ages of infection were 41-50 years as constitute 38.73%. About Fifty-nine percent of the patients were affected in the liver and about four percent of the patients were injured in the lungs. Villagers made up 57.65% of the patients. We found a total of (65.76%) patients had cats or dogs at home. The diagnosis of hydatid infection by Ultrasound of abdomen, Chest X-ray, and CT of the chest were (47.74%), (42.34%) and (9.9%) respectively. About Ninety percent of patients eat at restaurants on a regular basis. About Twenty-eight percent of patients have a hydatid cyst in their family.
Conclusion: The study indicate that diagnostic instruments are fundamental in diagnosis of hydatid as its diagnosis through clinical or preclinical are uncertain. Further education program is recommended to decrease its occurrence in Mosul city.

Background: Haemoglobinopathy is a large heterogeneous group of genetic abnormalities of haemoglobin. It is one of the most common inherited diseases worldwide.
Aim of this study: This study aimed to find the frequency of different types of Haemoglobinopathies in premarital couples in Nineveh province.
Subjects and Methods: In this cross-sectional study, the subjects were couples who go to the primary health care centers in Nineveh governorate for routine premarital investigations and the data were collected from the main premarital screening centers in Nineveh governorate.
Results: In this study, 1127 cases were included. 613 (54.4 %) were male, their ages range between (13-80 years), and 514 (45.6 %) were female, their ages range between (10-52 years). 47 cases were diagnosed as βeta-thalassaemia carriers with an overall frequency of 4.2 %. Ten cases had haemoglobin S (HbS) by the High Performance Liquid Chromatography (HPLC) (sickle cell trait in 9 cases and sickle β-thalassaemia in only one case); the overall frequency of sickle cell carrier state is 0.89 %. Eight cases with an overall frequency of 0.71 % were diagnosed as having other types of Haemoglobinopathies (haemoglobin D, haemoglobin E, haemoglobin H). Eighty one cases were diagnosed as having iron deficiency with an overall frequency of 7.2 %. By using the Hardy –Weinberg equation; we found the expected number of children born with homozygous βeta-thalassaemia would be (0.3/1000 from those born) and homozygous sickle cell disease would be (0.01/1000 from those born).
Conclusions: β-thalassaemia trait represented the most frequent Haemoglobinopathy in the region, Iron deficiency was significantly higher in females than in males, HPLC is a good technique for routine use and the expected number of children born with homozygous β-thalassaemia, sickle cell and others (HbD, HbE, HbH) were (0.3/1000, 0.01/1000 and 0.0085/1000 from those born) respectively.

Objective: To 1) assess IL-6 levels in the serum of patients with rheumatoid arthritis (RA). 2) study IL-6 promoter -174 G>C “single nucleotide polymorphism (SNP)” as an imminent factor for the disease development. 3) find any relation between the level of serum IL-6 cytokine and other parameters such as age, gender, clinical severity of diseases and “disease activity scores (DAS28)”.
Materials & methods: This research was carried out through a case – control approach at “Ibn – Senna Teaching Hospital” in Mosul city between November 2020 and July 2021. It included 61 RA patients diagnosed according to “ACR / EULAR 2010 criteria” and 50 healthy individuals. IL-6 serum levels were ascertained by ELISA and genotyping of IL-6 promoter was accomplished by “sequence-specific primer-polymerase chain reaction (SSP-PCR)”.
Results: Mean IL-6 level in RA (69.42 ng /l ± 62.99) was elevated in comparison to healthy people (14.66 ng /l ± 23.58), P < 0.001. No age or gender effects on IL-6 concentration were noted. The ideal cut-off of IL-6 for discrimination of RA with best discriminative utility compared to healthy controls was 22.80 ng/l. At this value the IL-6 sensitivity was 91.8%, specificity 82.0% and accuracy rate 73.80%. G/G genotype was the most pervasive genotype in both RA patients and controls (70.5% in RA and 64% in healthy controls). However, it did not seem to be a risk factor for RA development compared to G/C or C/C genotypes “(OR = 1.3438, 95% CI=0.605-2.984,P=0.469)”. The mean IL-6 level in patients with GG genotype was (73.70 ng / l ± 71.09) compared to (58.37 ng /l ± 37.86) in patients with GC genotype. There was no significant difference in the IL-6 level between patients with GG and patients with GC genotypes (P = 0.2375). Although higher IL-6 mean concentration was reported in severe RA, however, no significant difference was found between patients with mild, moderate and severe RA respectively. No correlation of serum levels of IL-6 with genetic promoter polymorphism, clinical severity of diseases or DAS 28 score were reported.
Conclusion: The concentration of serum IL-6 was elevated in RA in regard to healthy controls which confirmed its pivotal role in RA pathogenesis. Our data did not support the role of IL-6 promoter -174 G> C polymorphism as a risk factor for RA, nor seem to play a major role in the increase of IL-6 level among our patients with RA.

Background: Among the frequent daily challenges in the practice of gynecology are abnormal uterine bleeding (AUB) beside the distinction of fundamental endometrial lesions that stand behind it .Ki67 is among the excellent markers as the higher proliferation rate is one of the features of cancer cells.
Aim: This study aims to clarify the expression of Ki67 in the endometrium of women suffering from abnormal uterine bleeding in Nineveh Province and to correlate its expression with the histological picture.
Subjects, Materials, and Methods: This is a case series study that was enrolled analysis of data (retrospectively and prospectively) of 51 females who were presented with history of abnormal uterine bleeding and they were underwent an elective D&C and or hysterectomy after admission in several Hospitals, in Nineveh Province, Northern Iraq from 1st January, 2020 to 30th December, 2020. The selected paraffin blocks (n-=51) were cut into 3-4 micrometers thick sections and mounted on poly-L-lysine glass slides for immunohistochemical staining with using of positive and negative control sections at Unit of Immunohistochemistry in Vin Hospital -Duhok-North of Iraq. Staining was performe using the optimized protocol recommended by the International Ki67 in Breast Cancer Working Group together with Dako Autostainer according to manufacturer instructions.
Results: This work revealed that 23(45%) out of 51 cases were aged >50 years. The highest mean of percentage of Ki67expression was in sections of proliferative endometrium. In fact, sections of 3/7 of cases which were exhibited a percentage of Ki67 expression from 76% to 100% aged >50 years, while sections of 3/7 of cases of menopause women showed percentage of Ki67 expression from 26% to 75 %. Further, 12 cases out of 17 showed an intensity of staining score of 2 were aged ˂50 years, while 3 out of 5 cases (which revealed an intensity of 3 ) were aged < 50 years. Five cases out of 17 which showed an intensity of staining score of 2 were aged >50 years, while 2 out of 5 cases which exhibited an intensity score of 3 were aged > 50 years. The current study showed that 11/16 cases of benign conditions presented with percentage of Ki67 expression of less than 25%,while 14/15 cases of endometrial hyperplasia presented with Ki67 expression of <25%. In contrary, 8 cases out of 20 of cases of endometrial adenocarcinoma showed Ki67 expression of >25%. Further, the intensity of Ki67 immunostaining of more than 2 was shown in 4 cases of endometrial adenocarcinoma. Regarding cases of endometrial hyperplasia, the current work revealed that 7 cases (46%) out of 15 cases were aged more than 50 years. About 4 cases (26%) of them are of atypical type with no significant differences between the percentage and intensity of Ki67 expression in cases of endometrial hyperplasia. In fact, 15 cases (75%) of endometrial adenocarcinoma were aged more than 50 years. Four (20%) of them were of grade 3, while six cases (30%) of them were of grade 2. According to the grade of endometrial adenocarcinoma, sections of 2 out of 5 cases of grade one (well differentiation) endometrial adenocarcinoma showed the percentage of Ki67 expression of more than 15%, while 5 out of 10 cases of grade 2 (Moderately differentiation) endometrial adenocarcinoma showed the percentage of Ki67 expression of more than 15%. Finally, 3 out of 5 cases of grade 3 (poorly differentiation) endometrial adenocarcinoma showed the percentage of Ki67 expression of more than 15%. About 5 cases out of 16 with Ki67 expression of more than 25%.Finally, 8 cases out of 20 cases of endometrial adenocarcinoma showed the Ki67 expression of more than 25%.
Conclusion: Analysis of immunohistochemical expression of Ki67 in sections of women presented with AUB revealed that there is a relation with the age of patients. A significant association between expression of the Ki67 and poor tumor characteristics was conclude. Significant differences was shown between the expression of the Ki67 in sections of proliferative phase and those of endometrial hyperplasia ,while significant differences was found between the expression of the Ki67 in sections of endometrial hyperplasia and those of endometrial carcinoma. Using of Ki67 as diagnostic and prognostic tool in endometrial carcinoma may be conclude.

Background: Metabolic processes directly affect the bone skeleton in the human body; especially during pregnancy in females. A bone profile obtained from a blood test can reveal the changes on it.
Objectives: The present study aims to estimate the changes that occur in some bone components during pregnancy and whether these changes are physiological or pathological.
Patients and methods: Blood samples were collected from 126 females who attend to Al-Hadbaa primary health care center and Al-Khansaa Hospital in Mosul city during the period from January to April 2008. These females classified into two main groups; Group-1 consists of 87 normal pregnant females which are subdivided to 3 subgroups according to their gestational age. Group-2 consists of 39 non-pregnant healthy females (control group). The biochemical parameters measured were: serum calcium, serum albumin, serum inorganic phosphorus (iP), serum alkaline phosphatase (ALP), and corrected serum calcium, and the measured data for these parameters were analyzed using different statistical methods.
Results: The total serum calcium, inorganic phosphorus and serum albumin decreased in pregnant female compared to the control group, while alkaline phosphatase activity was elevated in pregnant females compared to the non-pregnant females.
Conclusion: The increasing in ALP during pregnancy is accompanied by decreasing serum calcium in the 2nd trimester and decreasing in iP in the 3rd trimester that could be a pathological changes related to the bone.

Background: Brain abscess by definition is a crucial pus collection inside the brain, resulted from the infection by a variety of bacteria, fungi, and parasite. It can be single or multiple. The size, position, and number of lesions, as well as the organism\\'s pathogenicity, host reactions, and the severity of cerebral edema, all influence the presentation.
Objective: To assess how well a brain abscess was managed and to evaluate the patients with favorable and unfavorable Glasgow outcome scale (GOS).
Patients and methods: From January 2014 to January 2021, the study was achieved and conducted in the Neurosurgical Department of Ibn-Sina Teaching Hospital on Mosul\\'s left coast. The neurosurgery unit managed a case series investigation of 70 patients who had a brain abscess. Age, sex, duration of illness, initial neurosurgical status, and abscess features are among the clinical data.
A comparison was performed between patient with Favorable Glasgow outcome scale (GOS), moderate disability or those with good recovery and those with Unfavorable GOS, death or persist vegetate status outcome at discharge.
Results: The study involved 48 male and 22 female patients (male / female ratios 2.2:1). The series consist of 52 patients who experienced favorable outcome and 18 resulted from an unfavorable outcome. The mean of age for those patients was 20 years. The difference between males and females regarding favorable and unfavorable outcomes is insignificant. P-value was significant in cyanotic congenital heart diseases as cause of brain abscess were particularly prevalent among the children (adult VS children = 1:9). The most common site for single abscesses was the frontal lobe (25 patients), and majority of patients treated with burr hole drainage, which had the best results.
Conclusion: Although there were technological improvement of imaging and antibiotics treatment, the mortality of brain abscesses is still relatively high, especially among those with decreased level of consciousness on admission.

Background: Folate is essential for metabolism and development. So, folate metabolism abnormalities are common in infants with some congenital defects. An infant born to mothers with normal folate status has more resistant to congenital heart diseases (CHDs). Evidence on risk factors for developmental defects resulting from drug use before conception and during pregnancy is still very limited. The relationship between folic acid for mothers before and throughout pregnancy and the incidence of fetal malformations and diseases have been recognized.
Aims: This article is a rapid review for assessment of the folic acid supplementation as a preventive measure of CHDs during fetal development, and what is already recognized about a policy of this subject, by using systematic review methods to search some of the existing researches.
Materials: publications related to determining and quantifying the use of folate by pregnant mothers to decrease the risk of congenital heart diseases were reviewed. Many studies have confirmed the reduction of congenital heart diseases by folic acid supplementation prior to pregnancy.
Conclusion: the protective effect of folic acid against congenital heart abnormalities has been established. Though, the dose and time of supplementation are not known; more researches are needed to explain the mechanisms.

Case report : To the best of our knowledge this could be the first report of a successfully performed laparoscopic surgery for female patient having had multiple liver hydatid cysts ( 7 in number) in both lobes of liver.
Background: Laparoscopic hydatid surgery ( LHS) was almost gaining acceptance all over the world. But still there are contraindications to this approach of particular are those with multiple cysts ( &gt;3 cysts)1.On reviewing the literature most of the reports of LHS were for patients with solitary hydatid cyst and exceptionally for a maximum of three cysts. Herein an initial effort to expand the application of LHS in managing multiple hydatid cysts of liver (&gt;3) with all the advantages of laparoscopic approach; less pain, good cosmetic results, rapid recovery and less complications.

Propolis is a glue-like substance which produced by honey bees, it is related to honey. It is also called bee glue as they use it to reconstruct their hives and for the hives maintenance. They make propolis by mixing many substances like bee wax, saliva, exudate collected from trees, sap flows and other sources.
Many studies have made concerning importance of propolis and it is wide medical benefits as it is role in improving immunity, reducing elevated blood pressure, curing many allergic conditions and dermatological diseases.
The aim of this review is to enumerate some of its chemical constitutions and it is role in treating some medical conditions.