Annals of the College of Medicine Mosul

Background: liver metastases are a common site for metastatic disease, little is known about how frequently different malignancies manifest as liver metastases.
Aim: To identify the most prevalent primary tumors and assess the effects of therapy and primary tumor detection on patient survival.
Patients and Methods: This prospective study comprised 42 patients initially presenting with hepatic metastases of unknown primary origin at Mosul Oncology Hospital between 2018 and 2021. A thorough clinical and diagnostic evaluation was done to know the primary tumors, and the patient's ultimate diagnosis and survival were prospectively analyzed
Results: Gastrointestinal tumors were found to be the most frequent primary tumors that metastasize to the liver followed by lung and breast cancer, patients with primary breast cancer had better survival compared with other primary that metastasize to the liver.
Conclusion: The most common primary tumors that metastasize to the liver are gastrointestinal tumors, followed by lung and breast cancer. Because the prognosis of hepatic metastasis varies depending on the primary tumor, it is highly advised to undergo a thorough clinical, radiological, and pathological examination to identify the primary tumors. This will allow more tumor-specific treatment to be administered.

Background: Hodgkin Lymphoma (HL) constitutes 10% of lymphomas and 1% of cancers in industrialized nations, classified into classical Hodgkin Lymphoma (cHL) and nodular lymphocyte-predominant Hodgkin’s lymphoma (NLPHL). The four cHL subtypes include nodular sclerosis, mixed cellularity, lymphocyte-rich, and lymphocyte-depleted. Etiologically, HL stems from B-cell clonal transformation, influenced by genetic predisposition and viruses like Epstein-Barr virus (EBV) and Human immunodeficiency virus (HIV). HL cells exhibit programmed death ligand 1 (PD-L1) overexpression, enabling immune evasion through interaction with PD-1 on T cells. The PD-1-PD-L1 axis is a promising therapeutic target, with ongoing scrutiny of PD-L1 identification by immunohistochemistry (IHC) in HL as a potential marker for immunotherapy efficacy.
Aim: To detect the frequency, and association between EBV & PDL-1 expression in Hodgkin lymphoma cases.To investigate the association between the expression of PD-L1 & EBV in Hodgkin lymphoma and some clinic-pathological parameters like age of patients & subtype.
Material and Methods: This is both a retrospective and prospective case series study which was conducted on 40 cases of Hodgkin Lymphoma, that were collected from private laboratories in the North of Iraq extending from November 2022 through September 2023. Reviewing of diagnosis & classification was done according to WHO of HL. PD-L1 & EBV status were evaluated immunohistochemically using intensity and percentage guided scoring for PD-L1 & cytoplasmic staining for EBV.
Results: In this study of 40 Hodgkin Lymphoma cases, the M: F was 3:2 & and nodular sclerosis subtype form the majority of cases (67.5%). PD-L1 expression occurred in (67.5%) of cases and (35%) in the tumor micro-environment. No significant associations were found with age, gender and subtype. EBV LMP-1 expression was found in (30%), with more frequency in males (83%), and associated with mixed cellularity HL subtype. PD-L1 intensity showed significant association with its cutoff in HRS cells and tumor microenvironment but not with EBV status, gender and HL subtype. PD-L1 and EBV LMP-1 expressions did not show a significant association.
Conclusion: In Hodgkin Lymphoma (HL), immunohistochemical expression of programmed death ligand 1 (PD-L1) is found in 67.5% of HL cases and 35% of the tumor micro-environment. However, there is no significant association between PD-L1 expression and the presence of EBV latent membrane protein-1 (LMP-1). Only 29.6% of patients with positive PD-L1 expression also show positive EBV LMP-1. Additionally, no significant associations were identified between PD-L1 expression and HL subtype, age, and gender. The expression of PD-L1 in the tumor micro-environment does not show a statistically significant difference when compared with HL subtypes. On the other hand, EBV LMP-1 immunohistochemical expression is significantly associated with male gender (83.3%) and certain histological subtypes but reveals no statistically significant difference concerning the age of the patients.

Background: Coronavirus disease 2019 (COVID-19) is a sever acute respiratory disease. COVID-19 continues to have medical, economic, education and social consequences worldwide. Iraq used the following vaccines; Pfizer, AstraZeneca, Sinopharm and Moderna. The adverse effects of these vaccines and other unfounded rumors regarding the safety of these vaccines among our population, has affected the vaccination take up substantially in Duhok governorate.
Methods: This study was conducted using an online-based questionnaires distributed among the students at university of Duhok (UOD). A total of 1601 participants in this study,919 were vaccinated students and 682 were non-vaccinated students. In order to gain specific information from both vaccinated and non-vaccinated students, two different forms were developed. In general, vaccinated students’ questionnaires involved 20 questions and consisted of four main parts while, the questionaries’ for non-vaccinated students involved 17 questions and consisted of three main parts.
Results: Vaccinated UOD students showed a significant difference (p ≥0.01) in their knowledge’s and acceptance to COVID-19 vaccines, compared to non-vaccinated students. AstraZeneca it seems to be far less safe than other vaccines, with highest side effective ratio (94.6%) followed by Pfizer (78.5%) compared to Sinopharm vaccines (52%). The most common symptoms post vaccination were pain in injection (37.8%), muscle pain (34.9%) and fever (34.2%), after first dose.
Conclusion: Vaccinated students significantly shows better knowledge and acceptance than others. AstraZeneca was the most fear one and Sinopharm was the safest one. The most common symptoms post vaccination were pain in injection, muscle pain and fever

Background: FMS-like tyrosine kinase-3 internal tandem duplication mutation (FLT3-ITD) ranked as the most ubiquitous sub-group of the FLT3 genetic aberration and was identified in about 20 to 30 percent of the entire acute myeloid leukemia (AML) cases. The patients harboring FLT3-ITD gene mutation carry dismal prognostic parameters.
Objective: This study is intended to investigate the distribution of clinical and laboratory characteristics in patients with AML, determine the incidence of FLT3-ITD mutations in adult newly diagnosed patients with AML, and compare the baseline characteristics between the FLT3-ITD mutated and FLT3 non-mutated cases.
Methods: In this study, fifty adult patients with newly diagnosed AML were prospectively studied. Every participant was investigated for peripheral blood film, bone marrow aspirate film, flow cytometry study, and complete blood count. To discover FLT3-ITD mutations, next-generation sequencing technique was used.
Results: Out of 50 AML patients, FLT3-ITD mutation was detected in 8 (16%) of the patients. The mean age of the FLT3-ITD mutation patients was lower than that of the non-mutant individuals. FLT3-ITD mutation is more likely to occur among females. Most FLT3-ITD mutations were found in the FAB classification M5 subtype (37.5%), followed by the M1 subtype (25%).
Conclusion: The frequency of the FLT3-ITD mutation in patients with AML was 16%. Fever was the most presenting symptom, and splenomegaly was the most presenting sign in patients with AML. FAB M5 was the most frequent subtype in FLT3-ITD mutation. There was non-significant rise in the white blood cell count and peripheral blood blast percentage in FLT3-ITD mutant patients compared with those without mutation

Breast tumor ranks as the most prevalent cancer between female globally, spinning both developed and developing nations. In 2018, Breast cancer came in second place among the most common cancers, while came in the fifth place among the most common causes of cancer death. Chemotherapy, the primary method in cancer treatment, utilizing specific medications to manage the spread of cancer cells. However, these drugs have been known to exhibit adverse effects on non-cancerous cells. Consequently, there is a pressing need to create new anticancer medications that selectively target cancer cells. In this context, natural products from plants are anticipated to yield potential candidates for the development of targeted anticancer drugs. Therefore, this study targeted to appraise the anti-proliferative effect of Gall Oak (Quercus infectoria Oliv.) as an alternative medicine on human breast MCF-7 cancer cell line. Oak galls were extracted using three solvents (80% Ethanol, Ethyl Acetate and Petroleum Ether 40° - 60°), which differ in polarity, using SER 148 Solvent Extractor. Colorimetric detection was conducted to determine the phytochemical constituents of the extracts. The cytotoxic action of the extracts using Crystal Violet stain on MCF-7 cell line was evaluated. Eight concentrations of each extract were prepared (0.78, 1.56, 3.125, 6.25, 12.5, 25, 50 and 100 µg/ml). With three replicates for each concentration, optical density (OD) of cell growth was read by a Multi-detection plate reader at a transmitting wavelength of 492 nm. The results of the study indicate that the best inhibitory activity of the oak galls petroleum ether extract on MCF-7 cell line was found at 25 µg/ml concentration after 48 hours of treatment.

Background: Diffuse large B cell lymphoma (DLBCL) is an aggressive Non-Hodgkin lymphoma subtype.It is the most prevalant and responsible for thirty to forty percent of cases across various geographical locations with variable clinical presentations and underlying genetic diversity. B cell lymphoma 6 (BCL6 ) is a Proto-oncogenic transcriptional factor which is highly expressed in many lymphomas including diffuse large B-cell lymphoma.
Objectives: To assess BCL6 immunohistochemical expression in lymphomas of diffuse large B cell and its association with some clinical parameters (age, gender & presentation).
Material and Methods: During a period of ten months extending from November (2022) through August (2023), 61 diffuse large B cell lymphoma cases were included in this retro and prospective case series study, obtained from histopathological departments of governmental and private laboratories. Immunohistochemistry investigation using BCL6 was performed, and data of the positive BCL6 expression were evaluated.
Results: Out of 61 cases of lymphoma of diffuse large B cell, the mean age was 55 years, and the median was 61 years, with male predominance (55.7 %) vs (44.3 %) females. The nodal presentation is more frequent than extra nodal site (72.1% vs 27.9 %).41% of DLBCL cases was BCL6 positive (of which 56% were associated with age <60 years and 76% was nodal) with significant association between BCL6 expression and female gender (p value= 0.39).
Conclusion: BCL6 expression in diffuse large B cell lymphoma patients is more frequent in females and younger age (less than 60 years old).

Background: One of the revolutionary applications in the last few years is the social media which enhanced easy communication between people from different localities. Social media enters the daily lives of people and becomes an essential technology. According to the latest statistics, social media users are approximating 4.74 billion worldwide with average use of 2.5 hours per person.
Aim: This study focused the light on the potential effects of social media on the social life of people, the psyche of individuals, and the academic performance of students.
Methods: A cross-sectional study was carried out on 512 participants of both sexes and of different socio-demographic backgrounds in Nineveh Governorate over a period of 6 months. For the academic aspect, the questionnaires were allocated to 486 students from the total participants. The questionnaires were designed to cover as much as possible the potential effects of social media on the social, psychological, and academic aspects of life.
Results: The use of social platforms made three quarters of the participants experienced some sorts of psychological problems such as anxiety and depression, 38% were negatively affected by bad comments, in addition to lonliness feeling, all of them showed significant association (P < 0.001). Howerver, the social media did not affect the social life of the participants and their communications. Inversely, most users confirmed that social platforms enhanced their academic performance despite the effects of wasting time and reduced focussing on their study.
Conclusions: Social media have variable effects on individuals’ life. They have negative effects on the psychological status, neutral on the social life, and positive on the educational level. Knowledge of these effects is crucial to avoid the harmful effects and achieve the greatest benefit from using these platforms

Background: COVID-19 is a widespread infection all over the world which could be affected by different biological, physiological and pathological parameters.
Aim: The study is conducted to investigate the relationship between COVID-19 infection and, the expression of the TAS2R38 gene and other physiological parameters (blood groups, age and gender).
Methods: A total of 105 persons participated in this study. They were subdivided into groups according to COVID-19 infection, age and gender. Phenylthiocarbamide (PTC) test paper was used to detect the distribution of the TAS2R38 gene allele in the whole participants (PAV/PAV homozygote, AVI/PAV heterozygote, AVI/AVI non-taster). Standard serological tests were used to determine the ABO and Rh blood groups.
Results: Up to 71% of homozygotes, 72% of heterozygotes and 68% of non-tasters of the participants tested positive for COVID-19. Both men and women had approximately the same percentage of having been infected with COVID-19. The percentage of having COVID-19 was reported to be significantly higher for middle-aged subjects in comparison with young subjects. Apart from a significant negative correlation with Rh blood grouping, no correlation was found between PTC test results, and having COVID-19 infection and the studied physiological variables.
Conclusion: The study indicates that there is no significant correlation between TAS2R38 polymorphism and the physiological variables age, gender and ABO blood grouping. The study shows the absence of a crucial role of the gene in susceptibility to COVID-19 infection.

Background: Vitamin D can enhance semen quality and stimulate ovaries. Earlier research has linked fertility problems to a vitamin D insufficiency. However, because the field of study is very young, further research is required to establish the link between vitamin D and fertility.
Managing the levels of calcium and phosphorus in the blood and maintaining the health of the bones both depend on vitamin D. The main advantages of vitamin D are:- Increasing oral health, Supporting the immune system, Strengthening bones and muscles , Potentially lowering the incidence of cancer, managing hypertension, preventing diabetes, and promoting a healthy pregnancy.
Methods: matched the concept of "vitamin D" with a number of other concepts: " syndrome of polycystic ovary (PCOS) ʺ, "ovarian reserve," "endometriosis," and "in vitro fertilization."
Results: There were conflicting findings on a state of vitamin D in polycystic ovary syndrome, in vitro fertilization and endometriosis. Anti-Müllerian hormone (AMH) levels in infertile females have not been found to significantly correlate with vitamin D concentrations in certain studies, however vitamin D deficiency may be related to a decreased ovarian reserve in females above the age of 40.
Conclusion: Both fertile and infertile females frequently suffer from vitamin D deficiencies. This deficit is linked to a number of unfavorable results in various infertility-related disorders. Vitamin D influences endometrial thickness, in spite of that there is many contradictory research on the link between vitamin D state and AMH , endometriosis and PCOS.

Background: Malnutrition and metabolic acidosis are frequently observed in patients receiving regular hemodialysis. Both conditions, malnutrition and metabolic acidosis are linked to an increased mortality rate in chronic hemodialysis patients.
Objectives: To clarify the role of hemodialysis and metabolic acidosis on malnutrition in patients receiving maintenance hemodialysis.
Patients and Methods: This is a cross-sectional study, includes 64 patients on regular hemodialysis and had metabolic acidosis. Subjective Global Assessment was used to evaluate patients’ nutritional conditions and urea reduction ratio to assess hemodialysis adequacy. According to urea reduction rate , patients were allocated into two groups: group (A) includes patients with adequate dialysis and group (B) includes those with inadequate dialysis, then group (A) further subdivided into two groups according to their nutritional status, group (A1) with well-nourishment and group (A2) malnourishment. Comparing group (A) vs (B) and group (A1) vs (A2) in order to determine the relationship of metabolic acidosis and hemodialysis adequacy to malnutrition.
Results: Malnutrition was common in those patients as 32 patients (50%) had malnutrition, while just 2 patients (5.56%) with adequate hemodialysis (group A2) had malnutrition , 20 patients ( 71.43%) of those with inadequate hemodialysis (group B) had malnutrition.
Conclusions: Inadequate hemodialysis rather than metabolic acidosis contribute sto malnutrition in chronic hemodialysis patients.

Background: The structural variations in the umbilical cord linked to advanced pregnancy may have an impact on the fetus's viability.
Aim of the study: The goal of this project is to revise the consequences of geriatric pregnancy on the structural tissue of the umbilical cord.
Materials and Methods: From January 2022 to May 2022, samples were drawn at random from the obstetrics and gynaecology unit at Al-Khansaa Teaching Hospital in Mosul. Pregnant women aged 15 to 50 years were divided into two groups: those over 35 and those under 35 pregnant. Both groups underwent a comprehensive histological examination, morphological analysis, and histopathological umbilical artery research. These biopsies were prepared for light microscopy. The data was also subjected to statistical analysis.
Results: Histomorphology of this study revealed no significant relationship between the pregnant woman's age and the length and diameterin addition there was a reduction in Wharton’s jelly with advanced age compared to young age. Also, the current study revealed significant variations in the width of the tunica intima and tunica media layers and the wall-lumen ratio of umbilical vessels related to different ages. Microscopic measurements of geriatric pregnancy showed a decline in Wharton jelly fibers and the formation of a devoid cavity resembling a comb of honey. The endothelium of birth cord vessels corroded, causing their muscle cell to separate. The amount of collagen fibre concentration in the wall of the cord vessels decreased and there was degradation.
Conclusion: Women over 35 are regarded as pregnant women at risk due to changes in the gross anatomical parameters and microscopic morphology of their cords, which are reflected in the well-being of their offspring.

Background: Thalassemia is a common genetic disorder on a global scale. Individuals with transfusion dependent beta-thalassemia experience a range of physical, psychological, and social disorders that ultimately result in a diminished quality of life.
Aim of study: To assess Health related quality of life in adult patients with transfusion dependent beta-thalassemia and to correlate it with various clinical parameters.
Methods: This study is designed as a case-control study involving 80 adult individuals transfusion dependent beta-thalassemia at Ibn Al-Atheer Hospital in Mosul city, along with 80 individuals who are considered healthy controls. To assess the Health-Related Quality of Life score, the researchers utilized the RAND Short Form 36 Questionnaire.
Results: In this study 32 men and 48 women were included. The mean age was 23.8 years ±5.9. After reviewing the patients' quality of life, it was observed that the mean score for physical function was 79.7±15.7%, role of limitations due to physical health problem was 66.9±30.9%, role of limitation due to emotional problem was 73.3±43.3%, energy fatigue was 65.5±29.4%, social function was 77.27±18.6%, pain was 72.2±18.6%, general health was 54.1±22.4%, emotional wellbeing was 58.2±26.8% and overall mean was 67.9±17.8% were significantly lower than healthy controls. The role of limitation due to emotional problem and emotional wellbeing were significantly lower in male compared to female patients with p-value of (0.004, 0.02) respectively.
Conclusion: In this study the Health Related Quality of Life in adults with transfusion dependent beta-thalassemia was reduced in all domains of short form 36 scores.

Background: The relationship between diabetes and acid related mucosal damage has been studied in many previous researches. There is no obvious idea about how much the diabetes disease can affect acidic mucosal secretions and the relation with gastric mucosal damage. Many theories about effect of diabetes disease itself or anti diabetic drugs on the gastric acid secretions and mucosa.
The aim of study: To evaluate the effect of DM on secretion of gastric acid in the stomach and the effect of DM on mucosal damage in the stomach.
Design: The study of Case-Control was adapted.
Methodology: The study of Case-Control was conducted from January 2018 till May 2018 in endoscopic unit in AL-_Salam Teaching Hospital ,database surveyed 90 patients, 43 diabetic and 47 non-diabetic patients who complain from upper GI symptoms (Gastro-esophageal reflux disease (GERD), epigastric pain, dyspepsia, upper GI bleeding) undergoing Oesophageo-Gastro-Duodenoscopy (OGD) and measurement of gastric PH by using PH kit. A multitude of acid-related afflictions have been identified, encompassing a wide range of expressions such as acid reflux, ulcers, strictures, inflammations, bile reflux, bleeding sites, and erosions.
Results: Intriguingly, despite experiencing upper GI symptoms, there were no discernible disparities in mucosal damage between the two groups. However, upon closer examination, it becomes evident that diabetic patients are at a comparable risk of acid-related damage as non-diabetic patients. Astonishingly, this risk persists even after accounting for factors such as acid reflux, gender, and age.
Conclusion: A remarkable finding emerged from our study - the risk of acid-linked mucosal damage showed no significant variation, even after accounting for potential confounding factors. Surprisingly, our data challenges the notion of a lower threshold for conducting endoscopy in diabetic patients. This discovery urges us to reevaluate our assumptions and delve deeper into the intricate relationship between acid levels and mucosal damage in this specific population.

Background: Clinically varicocele (VCL) is defined as tortious dilation of the pampiniform venous plexus. Anatomically it includes the area between the testis and the final venous drainage which comprises pampiniform plexus, inguinal, and testicular veins. An important complication of advanced VCL is male infertility in 15-20% of cases. VCL is a correctible cause of male infertility. Pathophysiological consequences of VCL on the testes are variable from one person to another in deteriorating quantity, motility, and morphology of sperms.
Aim: In this study, VCL complication consequences on sperm motility had been studied and concentrated as one of the most important fertilizing factors, in order to set a correct reversing time for the VCL effects on the testes.
Material and methods: This clinical study was carried out in 3 years, from march 2016 to April of 2019, In which (86) male varicocele-related infertility cases were collected in whom (54) primary and (32) secondary infertility cases.
Seminal fluid analyses were performed intervalley every three months pre and postoperatively.
Hormonal assays included serum (FSH, LH, Testosterone, Prolactin, and TSH).
The VCL patients were grouped according to VCL dependent infertility duration into three groups:
1st group or early (less than one year). 2nd group or middle stage (less than two but more than one year). 3rd group or late stage (more than two years). All had been managed by operations (laparoscopic or open inguinal) and ± supplementary antioxidant medicines. Follow-up then continued for 18 months after treatment.
Results: overall response of conceiving was 39.5%, in Group 1, while 56% of the response was recorded in Group 2, and 31.42% in Group 3.
Subclinical group got 50% of the recovery. In the laparoscopic class, 20% bilateral varicocele was observed during the operation. In 8 (9.4%) patients of G2 and G3, subnormal testosterone levels were observed to reverse after the operation.
Conclusion: The presence of varicocele is directly associated with congestion and a back-pressure effect on the testes, and the longer duration of varicocele with the majority of spermatic veins is associated with epididymal destructive changes moreover to testicular tissues. Consequently, more irreversible bad spermatic parameters were observed due to more aggressive testicular and epididymal endothelial damage.

Aim: explore the advantages of using microneedling tenique for treating dermatological disorders.
Background: The microneedling process has been expanded in the last decade, since it is considered as a safe, effective, low-cost and accessible aesthetic technique. It is a process of mechanical induced skin reconstruction. Microneedling is a technique compose of fine needles, which create a fine superficial skin perforations that initiate factors such as fibroblast growth factor (GF), platelet-derived factor and transforming GF α and β, which stimulate fibroblasts enabling them to form and reorganize new elastin as well as collagen fibers via a process of fibronectin matrix formation resulting in new skin tissues remodeling.
There are many types of microneedling include: Roller microneedling device, it has a drum-like head with numbers of tiny needles; Electronic microneedling which is a pen-like instrument; Radio frequency microneedling device, which works as a microneedling pen plus bipolar radio frequency energy. Microneedling induces histological changes in the skin, such as mild epidermal hyperplasia, dermal deposition of extracellular glycosaminoglycans and fibrin, in addition to proliferation of keratinocytes and fibroblast, there are an increase in elastic material in mid and papillary dermis, marked thickening of skin dermis and improvement of collagen material.
Conclusion: microneedling is advised for treatment of various skin diseases like facial scars, stretch marks, dyschromial conditions, rejuvenate photoaged skin, alopecia, actinic keratoses and pigmentary disorders.

Background: Obesity has a variety of consequences on the physiology of the skin, including changes in the sebaceous glands and production of sebum, sweat glands, lymphatics, collagen structure and function, wound healing, microcirculation and macrocirculation, and subcutaneous fat. These consequences lead to various skin manifestations associated with obesity, such as acanthosis nigricans, achrocordons, keratosis pilaris, striae distensae, cellulite, and palmoplantar keratoderma-plantar hyperkeratosis and others.
Aim of the study: To study the cutaneous manifestations of obesity in adults.
Methods: A cross-sectional study was conducted in Al-Mosul Public Hospital and Al-Salam Teaching Hospitals in the Ninevah governorates .Inclusion criteria involved adults> or = 18 and BMI > or = 30 kg/m2. At the same time, exclusion criteria involved pregnant women and children.
Results: Skin tags were found in 56.1% of class I of obesity classifications ,70.0% of class II obesity, and 100.0% of class III of obesity classifications, the difference was statistically significant at (p=0.037). Cellulite was found in 58.5%, 85.0%, and 100.0%, respectively, with significant differences (p=0.012). Ulcers were found in 7.3%, 5.0%, and 33.3%, respectively, with a significant difference (p=0.042). Intertrigo was found in 43.9%, 25.0%, and 77.8%, respectively, with a significant difference (p=0.028). Excessive sweating was found in 21.9%, 25.0%, and 77.8% of the classes, respectively, with (p=0.003), and the Bonferroni correction was significant only between class I and III.
Conclusion: Obesity is linked to a wide range of dermatologic illnesses and is responsible for several pathological changes in the skin.

Background: The ability to generate a high-quality multiple-choice question (MCQ) is a very important skill for every medical educator. Analysis of these questions is an important post-test evaluation step that will give valuable feedback to the item (MCQ) constructor regarding how difficult and discriminative each item was. Moreover, the effectiveness of each alternative is also investigated and their efficiency is calculated.
Objectives: To evaluate the quality of MCQs used in Anatomy exam over a period of 2 years.
Materials and methods: A cross-sectional study was conducted to analyze 320 MCQs used in four anatomy tests. For each item, the difficulty index (DIF), discrimination index (DI) and distractor efficiency (DE) were calculated.
Results: The mean difficulty of the four tests ranges between 57.35-61.52. The majority of MCQs were either of average difficulty (39.7%) or moderately easy (35.3%). Seventy per cent of MCQs were highly discriminative with DI above 0.4. The efficiency of the distractors was 100% in 49.7% of questions. The four tests were highly reliable with KR-20 >0.9. A very strong negative and positive correlation was found between DIF and DE, DI and DE respectively.
Conclusion: The four anatomy tests showed high reliability and acceptable difficulty and discrimination reflecting competence in item writing. However, Conscious attention is always required while writing the distractors to eliminate any non-functioning ones thus Increasing the DE of the MCQ.