Annals of the College of Medicine Mosul

Background: Lung cancer is the second most frequently occurring cancer in the world. The global mortality-to-incidence ratio in 2020 was 0.81. Brain metastases (BM) are the most common type of intracranial malignancies. Among the non-small cell lung cancer (NSCLC), adenocarcinomas metastasize to the brain more frequently than squamous cell carcinomas. The incidence of brain metastases appears to be increasing, which may reflect improvements in diagnostic imaging and survival associated with more effective systemic therapies. The study aims to examine the survival after diagnosing BM and the prognostic factors that may affect it.
Methods: A chart review identified 59 patients with BM from histologically proven NSCLC over three years, from December 1, 2013 to November 30, 2016. Follow-up was updated from the case records and by phone contact. Patient-related variables were age, sex, histology of NSCLC, extracranial metastases, number of brain lesions, Karnofsky Performance Status, and survival from the time of the diagnosis of brain metastases. Whole Brain Radiotherapy of 20 Gray/five fractions over one week was used for all patients.
Results: The median survival after the diagnosis of BM was 6.5 months. Factors that affected survival were age, Karnofsky Performance Status, number of brain lesions, and extracranial metastases. There was no statistically significant survival correlation with sex and histological type of NSCLC.
Conclusions: Survival outcome was poor in NSCLC with BM patients. Age less than 60 years, Karnofsky Performance Status over 70, single brain lesion, and absent extracranial metastases were relatively favorable prognostic factors.

Background: Patients with diabetes mellitus often have dyslipidemia and accelerated atherosclerosis; therefore, effective management of dyslipidemia can lower death and morbidity rates while improving the quality of life for these patients. When used by diabetic patients, lipid-lowering medications like statins can have a number of adverse side effects that worsen the quality of life in addition to providing less-than-ideal results.
Aim of the study: This study aims to investigate how metformin medication affects the blood lipid levels of individuals with type 2 diabetes.
Methods: Forty-five type 2 diabetes patients, ranging in age from thirty to less than sixty, were involved in this study. For two months, patients received 500 mg of metformin orally (Glucomet, Furat Pharmaceutical Industries, Iraq). The total cholesterol, triglyceride, and HDL levels were measured using the Abbott, USA Cholesterol, Triglyceride, and HDL kits. The methods followed the guidelines supplied by the supplier.
Results:The study compared the average levels of serum lipids before and after treatment. The results indicated that there were no significant changes in mean serum cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) (p > 0.05). However, there was a significant decrease in very low-density lipoprotein (VLDL) (p < 0.001) and triglyceride levels (p < 0.001), which decreased from 220.69 ± 87.61 mg/dl to 165.21 ± 66.50 mg/dl.
Conclusion: Metformin medicine efficiently and safely reduces blood triglyceride levels in persons with type 2 diabetes mellitus. However, a more extended treatment duration may be necessary to obtain results similar to those for LDL and total cholesterol levels.

Background: Mental health is an integral part of health; in every society, there is persistent prejudice and societal rejection of those who have mental illness. Out of all the health issues, the general population has an inadequate knowledge of mental disorders.
Subject and Method: A Cross-sectional study was adapted to assess the public's knowledge and attitude toward mental illnesses. Data was collected from 800 participants who agreed to participate after visiting different health institutions in Mosul City during the data collection period. The data was collected over four months, from the 1st of November 2023 to the 1st of March 2024. Data was collected via a modified standardized questionnaire through a direct face-to-face interview with each participant. SPSS Version 26 software program was used for data analysis.
Results: Of 800 participants, with a mean age of 35.92, females form 55.1% of the study population, 83.4% of participants were from urban regions, 63.9% were unemployed, 53.6% were married, and 37% had a university education. The proportion of participants with overall accepted knowledge scores was 52%. Age, occupation, education, and marital state had a significant association with knowledge level. The overall positive attitude toward mental illness was 76.5%, and there were no significant differences in positive attitudes between different sociodemographic strata.
Conclusions: About half of the study population had poor or inadequate knowledge about mental illnesses. The knowledge level is associated with some sociodemographic features of participants. On the other hand, the study population had a relatively unfavorable attitude about mental illnesses with no significant association with the study populations' sociodemographic features.
It is advised that health education about mental health problems be enhanced by using community campaigns and local media.

The prevalence of antibiotic resistance continues to rise rapidly, necessitating the development of innovative approaches to combat diseases caused by drug-resistant bacteria. One of these approaches is pharmaceutical nanotechnology, which has the potential to generate novel therapeutic compounds for biomedical applications. Of these substances, silver nanoparticles (AgNPs) exhibit promising antibacterial and anti-biofilm properties. Two hundred and thirty different clinical samples (urine, sputum, diabetic foot pus, pleural fluid, tracheostomy tube, cerebrospinal fluid, folly's catheter, ear swab, and blood) were collected looking for K.pneumonaie, which are multiple drug-resistant (MDR). Twenty-three K.pneumonaie clinical isolates were identified by conventional bacteriological media and confirmed by the VITEK-2GN system. Then, the biofilm-forming activity was assessed using qualitative methods such as Congo Red agar and quantitative methods such as microtiter plate assay that involved crystal violet staining. Conventional PCR detected fimH and mrkD biofilm gene frequency among biofilm-producing K.pneumonaie. The chemically synthesized AgNPs were used, and their Minimal Inhibitory Concentration (MIC) and Minimal Biofilm Inhibition Concentration (MIBC) were determined. Biofilm genes, namely fimH and mrkD gene, had been detected before and after treatment with silver nanoparticles in the clinical isolates. The findings indicated that all isolates resisted the tested antibiotics and could build biofilms to various degrees (19 had strong biofilm capability,3 were moderate biofilm producers, and only 1 had weak biofilm production capability). The susceptibility of all isolates to AgNPs was demonstrated by their antibacterial activity, with MIC and MIBC values being 50000 μg/ml or 25000 μg/ml according to the isolates. In addition, applying AgNPs resulted in a substantial decrease in biofilm formation, with 8 out of 23 isolates converting to non-biofilm producers. Biofilm genes fimH and mrkD were present in 100% and 78.26%, respectively, and not affected by silver nanoparticle treatment. There was a synergistic effect between silver nanoparticles and imipenem in compacting MDR K.pneumonaie.

Background: Tympanic membrane perforation is a relatively common finding that is caused by various factors, including trauma and infection. Conductive hearing loss of varying degrees can be caused by a perforated eardrum.
Objective: The aim of this study was to evaluate the effect of size and site of tympanic membrane perforation on hearing.
Methods: This is a case-control study involving patients with tympanic membrane perforation at the ENT Department—Al-Jumhori Teaching Hospital, Mosul, Iraq, from September 1st, 2010, to September 1st, 2011. All the data were collected and compared with normal control persons with no tympanic membrane perforation.
Results: The study included 78 patients with tympanic membrane perforation. Fifty-eight patients (74.3%) have unilateral perforation, while the other twenty patients (25.7%) have bilateral perforation. A total of 98 ears with tympanic membrane perforation were included in this study compared with 100 control persons with no perforation. The mean age of patients was 35.3 years, while the control average age was 42.59 years. Hearing level in patients with perforated tympanic membrane was as that, in 16 patients, the hearing level was 0-20 dB (16.3%), 60 patients hearing level 21-40 dB (61.22%), 20 patients hearing level 41-60 dB (20.4%) and two patients hearing level more than 60 dB (2.04%). In comparison, in the control group, 89 patients the hearing level was 0-20 dB (89%), seven patients had a hearing level of 21-40 dB (7%), three patients had a hearing level of 41-60 dB (3%) and one patient's hearing level more than 60 dB (1%). Moreover, posteroinferior perforation was the most common site of perforations.
Conclusion: Our results revealed that the larger the perforation, the greater the hearing impairment. Moreover, posterior perforations of the tympanic membrane were the most common types. They significantly caused more hearing loss, possibly even greater than those due to larger perforations located elsewhere.

Background: Cytokines are crucial in the mechanisms underlying inflammation and articular degeneration accompanying the autoimmune disease rheumatoid arthritis. Interleukine-17 and interleukine-23 were shown to have a key function in the chronic immune process and the consequent tissue destruction in the joints of rheumatoid patients.
Aims: The study goal was to quantify interleukins-17A and IL-23 concentrations in a group of newly diagnosed rheumatoid patients and to evaluate if there is a linkage between these cytokines and the activity parameters of this illness.
Subjects and Methods: A study involving 250 individuals, 125 rheumatoid patients, and 125 controls was performed. The ELISA technique utilized Blood samples to estimate interleukines-17A and -23.
Results: Rheumatoid cases had higher IL-17A (median= 49.7 pg/ml) and IL-23 (mean= 21.1 ng/L) concentration, P < 0.05, than controls. IL-17A was shown to be positively correlated with DAS-28 (P<0.01), С-reactive protein (r= 0.036, P < 0.01), and ESR value (r = 0.021, P < 0.05). The AUC for IL-17A= 0.742, and IL-23=0.804 with P < 0.05).
Conclusion: Both interleukine17-A and IL-23 possess value in the pathogenesis of rheumatoid arthritis, and it is possible to use them as biomarkers for disease diagnosis and to predict the prognosis of the disease.

Background: Coronary artery disease is an extremely common heart ailment affecting millions of individuals around the globe and is one amongst the most common causes of morbidity and mortality. Several biomarkers are currently used for the diagnosis and management of cardiovascular diseases. Among them, N-terminal Pro-Brain Natriuretic Peptide (NT-ProBNP), is a true cardiac hormone exerting pleiotropic systemic effects.
Aim of the study: To identify the role of plasma NT-ProBNP and atherogenic index (TG/HDL-C) in the prediction of the number of occluded coronary arteries and distinguish between them (single versus multiple vessels).
Subjects and methods: This study was carried out at Mosul Center for Cardiology and Cardiac Surgery. It involved 90 patients (age ≥ 20 years) classified into three groups based on the findings of coronary angiography, each group consisted of 30 patients. Group I: included patients with no coronary artery occlusion and served as the control group, group II: CAD patients with single vessel occlusion, and group III: involved patients with CAD having multi-vessels occlusion (2 vessels or more).
Plasma NT-proBNP, total cholesterol (TC), triglyceride (TG), low density lipoprotein-cholesterol (LDL-C), and high density lipoprotein- cholesterol (HDL-C) were measured for all patients and atherogenic index of plasma (AIP) was calculated ( as TG/HDL-C).
Results: The study revealed that the mean (±SD) value of plasma NT-proBNP was significantly higher in group III compared with group I and group II (P < 0.0001). In addition, the mean value of plasma NT Pro-BNP of group II was significantly increased in comparison with group I (p < 0.001). The mean values of AIP of group III and group II were significantly higher when compared to group I (p< 0.001 and 0.023 respectively), but with non-significant differences between group II and group III.
Receiver operator characteristic (ROC) curve analysis showed that the optimal cutoff point for plasma NT-proBNP was 72.50 pg/ml for diagnosing CAD with the sensitivity of (81.7%) and the specificity of (80%) and that for AIP was 0.55 with the sensitivity of (70%) and the specificity of (70%) as well.
Conclusion: Plasma levels of NT-ProBNP and /or atherogenic index of plasma can significantly predict the severity of coronary artery disease and differentiate between single and multi-vessels occlusion.

Background: The glans size can be assessed to determine whether there's a link between urethroplasty issues and hypospadias complications. The urethral plate width is regarded as a fundamental factor in hypospadias repairs.
Aim: To evaluate the relation of age with glans size and urethral plate width and the effect of glans size and plate width on postoperative complications.
Patients and methods: A Prospective case series study on patients with distal hypospadias treated by TIP classified into Group A with glans size ≤12mm, Group B with glans size >12mm, and Group C with urethral plate width ≤8 mm, Group D with urethral plate width >8mm, all groups were evaluated for postoperative complications, the statistical analysis was performed by using IBM-SPSS 26.
Results: A total of 100 prepubertal boys, ranging in age (1-14 yr.). Glans size (≤12mm) 36 boys, while 64 boys had size (>12mm), and the relation of glans size of both groups were weakly correlated with age. On the other hand, urethral plate width was (≤8mm) in 90 boys, while in 10 boys with a width (>8mm), the relation between plate width and the age of patients was also weakly correlated. The presence and absence of complications among patients regarding age, glans size, and plate width show non-significant differences concerning these parameters.
Conclusion: In hypospadias surgery, a weak correlation exists between advancing age and the increase in penile glans size and urethral plate width. In addition, the postoperative complication was not correlated to glans size and urethral plate width measurements, so the best time for surgery could be arranged according to the penile biometers rather than the age.

Back ground: Left ventricular diastolic dysfunction (LVDD) is a common complication observed in patients with type 2 diabetes mellitus(T2DM) and is associated with increased cardiovascular morbidity and mortality.
MicroRNAs (miRNAs) have emerged as important regulators of gene expression and have been implicated in the pathogenesis of LVDD. This study aimed to investigate the role of gliclazide, an oral antidiabetic medication, on the expression of microRNA-150 (miR-150) in patients with T2DM and LVDD.
Objective: this study was to investigate the effects of the antidiabetic medication gliclazide on the expression of microRNA-150 (miR-150) in individuals with both left ventricular diastolic dystunction (LVDD) and type 2 diabetes mellitus (T2DM).
Method: A total of 62 patients with T2DM and LVDD were enrolled in this study and were randomly assigned to receive either gliclazide treatment or standard care for a period of 6 months . Blood samples were collected from all participants at baseline treatment period. The expression levels of miR-150 were measured using quantitative real-time polymerase chain reaction (qRT-PCR).
Result: the patients with T2DM and LVDD exhibited significantly increased expression of miR-150 compared to healthy controls. However, after 6 months of gliclazide treatment, there was a significant upregulation of miR-150 expression in the treatment group compared to the control group, These findings suggest that gliclazide treatment may have a beneficial effect on LVDD in patients with T2DM by modulating the expression of miR-150. MiR-150 has been implicated in the regulation of cardiac hypertrophy and fibrosis, which are key processes involved in the development of LVDD. Therefore, the upregulation of mir-150 by gliclazide may contribute to the amelioration of LVDD through the attenuation of cardiac remodeling.
Conclusion: The gliclazide treatment in patients with T2DM and LVDD was associated with a increase in miR-150 expression and improvements in diastolic function. These findings highlight the potential of miR-150 as a therapeutic target for the management of LVDD in patients with T2DM and suggest that gliclazide may have additional benefits beyond glycemic control in this patient population. Further research is warranted to elucidate the underlying mechanisms and clinical implications of miR-150 modulation in the context of LVDD and T2DM.

Background: Patients with type 2 diabetes may develop cardiovascular disease (CVD) without experiencing or recognizing the characteristic signs and symptoms. Diastolic dysfunction is present in 40% of individuals diagnosed with diabetes and is associated with inadequate glycemic management. The MALAT1 coding gene is situated on the short arm of human chromosome 11q13.1, and its transcript spans around 8 kilo bites. MALAT1 has substantial involvement in the pathophysiological process. It performs the roles of an innovative biomarker and target of therapy for the diagnosis, treatment, and prognosis of diabetes-related conditions. The expression of MALAT1 is much higher in the heart tissue of rats with diabetes mellitus (DM), and inhibiting MALAT1 improves cardiac function.
Objective: To clarify the role of sitagliptin in left ventricular diastolic dysfunction in T2DM and investigate its potential impact on epigenetic modulation (lnRNA MALAT1) and the inflammatory process.
Materials and Methods: This study is an observational cross-sectional descriptive study conducted at a single center. Sixty individuals with type 2 diabetes mellitus and left ventricular diastolic dysfunction in total were recruited from AL-Diwaniyah Teaching Hospital and the Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Al-Qadisiyah, Iraq, under the supervision of a specialist cardiologist. The Trizol reagent (Genaid, Korea) was used to extract the total RNA, and the concentration of RNA was subsequently determined. The primer amplification was carried out in accordance with the manufacturer's instructions for the AddScript RT-qPCR Syber master (AddBio, Korea).
Results: study results indicate a significant downregulation of MALAT1 in the sitagliptin-treated group (P<0.0001) compared to metformin treatment. This was analyzed by GraphPad Prizm software (version 8.4.3).
Conclusion and recommendation: The present study's findings indicate that the expression of MALAT1 is notably increased in the cardiac tissue of individuals with diabetes. Additionally, reducing the expression of MALAT1 is linked to an enhancement in the functioning of the left ventricle, partially due to a decrease in programmed cell death of heart muscle cells. Hence, suppressing MALAT1 could be a promising therapeutic approach for managing cardiac dysfunction associated with diabetes.

Background: Type 2 Diabetes Mellitus (T2DM) is one of the most prevalent metabolic diseases characterized by persistent hyperglycemia, and heart failure can be a common comorbidity and fatal complication of diabetes mellitus. An early sign of diabetic heart disease is left ventricular diastolic dysfunction, and microRNA dysregulation was one of the pathogenic mechanisms behind left ventricular diastolic dysfunction.
Aims: To investigate the potential effect of Empagliflozin on genetic modulation (Micro RNA150-5P).
Method: This is a single-center, cross-sectional, descriptive observational research. Specialist cardiologists recruited sixty individual T2D and left ventricular diastolic dysfunctions at AL-Diwaniyah Teaching Hospital, and the amount of RNA was quantified. The total RNA was extracted using Trizol reagent (Genaid, Korea), and the manufacturer's instructions to Add the RT-qPCR Syber master script were followed when performing the primer amplification. (Add Bio, Korea)
Result: Empagliflozin induces a considerable dawn regulation of miR-150-5p in left ventricular diastolic dysfunction, indicating that empagliflozin negatively affects microRNA 150-5p in diabetic patients with LVDD.
Conclusion: Empagliflozin causes a decrease in the expression of micro RNA in diabetic patients with left ventricular diastolic dysfunction, and this effect is statistically significant compared to metformin treatment.

Background: Adiponectin is a pivotal protein that controls metabolic homeostasis, exhibiting features that enhance insulin sensitivity and reduce inflammation. Adiponectin levels decline progressively during mid- and late pregnancy, following the rise in insulin resistance and the increase in gestational weight gain to support fetal growth and development.
Objectives: The study aims to evaluate the association of serum adiponectin levels with body mass index (BMI) and random blood sugar in healthy pregnant women during the second and third trimesters.
Materials and methods: A case-control study included 100 healthy pregnant women and 100 healthy non-pregnant women as controls; the BMI was calculated manually, random blood sugar was tested using a glucometer, and the enzyme-linked immunosorbent assay technique estimated the serum levels of adiponectin. An independent t-test and a Pearson correlation test were used to analyze the data. Significant results are defined as a p-value less than 0.05.
Results: The serum levels of adiponectin progressively declined from the second to the third trimesters compared with the control group; however, it was statistically non-significant (P-value = 0.901). Adiponectin levels were negatively correlated with BMI in the second and control groups and positively correlated with BMI in the second trimester (r = -0.005, r = -0.129, r = 0.096), respectively. No relationship was found between adiponectin levels and random blood sugar (RBS) in the second and third trimesters and control groups (r = 0.102, r = 0.042, r = 0.050), respectively. No statistically significant associations were observed among each group (P-value > 0.05).
Conclusions: The decline of serum adiponectin levels as pregnancy progresses, in parallel with the rise of BMI and random blood sugar, supports the physiological role of adiponectin in maintaining fetal growth and development.

Background: Type-2 diabetes mellitus (T2DM) is a significant contributor to cardiovascular risk, with diabetic individuals having double the mortality rate compared to those without diabetes. Among the various early subclinical cardiac problems in type 2 diabetes, left ventricular diastolic dysfunction (LVDD) is the most easily identifiable impairment. Nevertheless, only a limited number of biomarkers can accurately forecast this group's cardiovascular events. Levels of miR-150-5p are reduced in patients with type 2 diabetes mellitus (T2DM), regardless of whether they have cardiovascular disease. Our findings also demonstrate a decrease in miR-150-5p levels in these patients. Lower levels of miR-150-5p in the blood have been observed in nearly all forms of cardiovascular disease, and its potential to predict various clinical outcomes has been extensively studied in patients.
Objective: To assess the effect of glimepride (Glm) and Metformin on cardiac parameter miR-150-5p in patients with type 2 diabetes and diastolic dysfunction.
Patients and methods: In a cross-sectional study that included 60 patients with type 2 diabetes and diastolic dysfunction in an age range of 45 to 65, the patients were divided into two groups: group G1 (received standard treatment for T2DM with Metformin 1g×2 max daily dose ) and group G2 (received standard treatment for T2DM with Metformin + Glimepiride 4mg daily).
Results: Treatment with glimepride significantly increased miR-150-5p expression in patients with type 2 diabetes mellitus (T2DM) and left ventricular diastolic dysfunction (LVDD), according to this study. The rise was more pronounced in patients who were given Glimepiride and standard medical treatment.
Conclusions: Glimepiride plays an important role in improving cardiac biomarkers like miR-150-5p. Glimepiride use in diabetic patients with the addition of Metformin to usual diabetes type 2 treatment may benefit patients with cardiac complications.

Background: The menopausal state is normal physiology in the aging action, and it refers to the stop of reproduction with the end of cyclic ovarian activity. The lipid profile in many research studies was higher in postmenopausal women than in premenopausal women. In premenopausal women, the changes in circulating plasma levels of sex hormones each month are still present, and their potential impacts on Cholesterol, lipoproteins, and ischemic heart risk levels.
Objectives: The current study aims to assess the lipid profile in postmenopausal and premenopausal ladies with normal weights and compare the lipid levels in the follicular and luteal phases of the premenopausal one in Mosul City.
Methodology: The analytic study was carried out on 60 postmenopausal women aged between (49-65) years and (75) premenopausal women ranging from (20-44 ) years with regular menstrual cycles. The BMI were ( 23.43±1.04) and (24.80 ±0.01) for pre and postmenopausal groups respectively. Lipid profiles have been done for both groups; samples of the premenopausal women group were taken in the follicular phase between (4- 8) days of the menstrual cycle, and a second sample was taken by asking the women to come back in the luteal phase in 21 - 25 days. Only 68 women shared in the follow-up study.
Results: The current study shows a high serum cholesterol, triglyceride, LDL level Total Cholesterol/HDL ratio, and a low HDL cholesterol level in the postmenopausal group compared to women having a regular cycle (p<0.001). In the premenopausal group, significant differences in lipid profile during the cycle phases were not found (follicular and luteal ).
Conclusions:
1.Serum cholesterol, triglyceride, LDL, and total Cholesterol/HDL ratio were higher, and serum HDL cholesterol levels were lower in the postmenopausal group compared with ladies with a regular cycle and normal BMI in Mosul city.
2.The triglyceride and LDL were somewhat higher in the follicular phase when the hormone estrogen and progesterone levels were lower than those in the luteal phase, but statistically, they were insignificant.

Background: Various length questionnaires have been invented to assess the psychosocial impact of adult acne. However, there is still disagreement regarding the optimal number of items that ensure reliable response and clinical applicability.
Aim: to estimate the relationship and concordance between the clinical score and the different lengths of acne-specific QoL questionnaires (long 19-item Acne-QoL, mid-length 9-item AQOL, and short 5-item CADI).
Patients and Methods: This cross-sectional study includes 94 adult acne patients recruited from a teaching hospital. The patients will disclose their sociodemographic characteristics. The dermatologist used the Global Acne Grading (GAGS) to determine the severity of acne. Acne-specific self-administered quality of life questionnaire of three different lengths will be used to assess the psychosocial impact of illness.
Results: Adult acne predominantly affected women (71.3%), persisted from adolescence (69.1%), was mainly on the face (67.0%), and was mild (85.1%). The average adult acne QoL scores were (50.8±21.7) in long Acne-QoL, (6.2 ± 3.4) in mid-length AQOL, and (4.50±2.22) in short CADI. The correlation coefficient between various length acne-specific QoL questionnaires and clinical grade was (R=-0.36) in long Acne-Qol, (R=0.25) in short CADI, and (R = 0.19) in mid-length AQOL. Bland-Altman agreement between clinical grade and mid-length AQOL yields the least bias (0.0197), moderate bias (-0.165) in long Acne-QoL, and considerable bias (-0.213) in the short CADI.
Conclusions: Mild facial acne persists beyond age 25, is particularly common in adult females, and negatively impacts patients' psychosocial lives. The 9-item AQOL was the most consistent with clinical assessment results and was the most effective instrument for assessing the impact of acne

Objective: To assess the knowledge of occupational safety measures among laboratory health workers.
Materials and Methods: A cross-sectional study designed to achieve the aim of the present study. The questionnaire comprised two sections: section one covered sociodemographic parameters, and section two covered knowledge parameters.
Results: The study consisted of 400 participants over six months, starting on Nov 3, 2023, and ending on May 3, 2024, and about three-fifths of the participants (59.2%) were females, and around a half of them (51.0%) had a university education. Less than half (45.4%) have less than five years of experience. Nearly two-thirds (68.8%) received the hepatitis B viral vaccine. Overall, the percentage of knowledge assessment regarding occupational hazards ranged from (1.8%) who thought masks were one of the personal protective measures to (90.2%) of participants who believed that blood and body fluid were the most frequent causes of infection. Knowledge assessment regarding accident control measures ranged from (17.8%) who thought that the most common cause of needle stick injury is handling equipment before use, to (86.5%) who believed that immediately washing the eyes with water was the most essential way to reduce the risk of exposure to a chemical substance. Knowledge assessment regarding the availability of emergency safety measures ranged from (12.8%) of the participants who knew the eyewash unit in their lab to (94.8%) who thought that the equipment/ chemical had been appropriately kept after use.
Conclusions: Despite much academic concentration on this topic, lab staff still have some defects, and lab safety measures should be more frequent clinical training sessions due to their paramount importance.

Background: Cardiovascular diseases (CVDs) are the leading cause of death worldwide. While lifestyle changes contribute to their prevalence, regional differences exist. Arrhythmias and acute coronary syndromes (ACS) pose significant burdens on healthcare systems, necessitating specialized care and interventions. Thus, the adherence to the international guidelines plays an important role in patients' management and improving the outcomes. Aim of the study is assessing doctors' adherence to guidelines for patients’ management in the cardiac care unit in Mosul City.
Methods: A case series study was conducted in three main hospitals (Ibn Sina, Al-Salam, and AL-Mosul General Hospitals) that contain CCU in Mosul City. The participants were chosen by using a nonprobability judgmental sampling strategy. This approach ensured the inclusion of all participants who met the study criteria resulting in a total of 53 doctors working in the CCU of the mentioned hospitals. Face-to-face interviews were conducted during working hours with no exclusion criteria. Between December 2023 and February 2024, data were gathered using a questionnaire form that was developed based on international guidelines and approved by a pilot study. The study utilized statistical analysis with SPSS, using descriptive statistics and the Fisher exact /Chi-square test to measure the associations between variables at a significance level of p ≤ 0.05.
Results: In the CCU, respecting patients' autonomy by physicians revealed a significant difference between different degrees of specialty being better among sub-seniors (94.7%) and lowest (50%) for senior doctors. Resident doctors revealed high response in initiating high-quality CPR (70.8%) and educating about self-care and arrhythmia medications (83.3%), while senior doctors fall behind in providing privacy and considering early invasive strategies for ACS (only 50% for each).
Conclusion: This study revealed a good commitment of physicians toward many aspects of patients' management in the CCU and defects in others. These findings underscore the necessity for standardized guidelines and on-going professional development to ensure high-quality and consistent care for cardiac patients.

Background and Objectives: Eye exposure to UVB radiation can lead to photokeratitis. Antioxidant agents, such as Vitamin E, enhance corneal healing.
Aim of this work Study: the influence of a narrow band of UVB light on the eyes of rats and evaluate the preventive role of vitamin E on the eye following UVB radiation.
Methods: Twenty male Wistar albino rats were included in this work. They haphazardly distributed into four equal groups (n=5), group A, a negative control group, group B (exposed to different intensities of a single daily dose of UVB radiation extending from 240 mJ UVB/cm2 up to 960 MJ/1 week, group C: treated as group B with the oral ingestion of vitamin E, group D: ingested oral dosages of vitamin E for one week.
The rats were them sacrificed, and the eyes were removed and fixed in 10% buffered formalin for 24 hours to be followed by histological processing and tissue staining with hematoxylin and eosin stain as well as TUNEL stain to be ready for histopathological examination.
Results: The eyes of group B rats corneal damage in the form of irregular hypertrophy of the cornea, ulceration, stromal edema, hemorrhage, inflammatory cell infiltration, and increased apoptotic cells. All these changes were reduced following the use of vitamin E in group C, while groups A and D show normal histological pictures.
Conclusion: daily exposure of the eye to the progressive increasing intensity of UVB for one-week results in severe histological changes in the cornea that are alleviated by using a protective daily dose of vitamin E before exposate to radiation.

Background: Elastography is an imaging tool that works in conjunction with conventional B-mode ultrasound to provide additional information on the stiffness of the tissues and improve the diagnosis of breast cancer. It can also reduce the number of true cut biopsies for suspicious breast lesions.
Objective: This study aims to assess whether addingshear wave elastography (SWE) to B-mode US is a useful adjunct for better characterization of suspicious breast lesions and lowering the number of unnecessary breast biopsies.
Patients and method: This is considered a prospective study of seventy-three ladies complaining of suspicious breast lesions categorized as BIRAD III and more between December 2020 and January 2022.SWE was used to assess the breast lesions' elastography measures and compare them with histopathology results.
Results: SWE gives excellent discriminative ability with an area under the curve ( UAC ) of 0.862; the Sensitivity was 100%, and the specificity was 77.5%.
Conclusion: Shear wave elastography (SWE) is a noninvasive tool that can differentiate benign and malignant lesions. Most false positive results were granulomatous mastitis; lesions with thick inspissated secretions also show high elastography values.

In today's world, mobile phones are ubiquitous in all regions and different contaminated settings. People view them as essential tools for social interaction and communication. Nevertheless, because they are not cleaned well and people do not always wash their hands after using them, they might harbor bacteria, viruses, and parasites that may lead to various infections.