Medical Journal of Babylon

Background: Vitamin D deficiency is a common problem in patients with inflammatory bowel diseases (IBDs). Objectives: The aim of the
current study was to measure serum Vitamin D concentrations ( 25 (OH) D) in patients with IBD and examine its relation to the severity of
disease. Materials and Methods: This was a prospective cross‑sectional study of adult patients diagnosed with IBD including ulcerative
colitis and Crohn’s disease compared to sex‑matched controls from an outpatient clinic in a public hospital in Iraq between February 2018
and May 2018. The Vitamin D deficiency levels were assessed as below 20 ng/ml as deficient, between 20 and 30 ng/ml as insufficient,
and >30 ng/ml as sufficient level. Results: Serum Vitamin D levels were measured in 145 patients including 68 patients (median age:
30.5 ± 17.25) and 77 healthy controls (median age: 52.00 ± 12.25) ranged 18–63 years. Further, the median length of disease progression
was 3.0 years. Serum Vitamin D levels were significantly lower in patients (IBD or separately) compared to healthy controls. However,
such significant difference was not found between patients with respect to Vitamin D and disease severity. In addition, it was confirmed
that disease severity is related to Vitamin D deficiency in IBD patients. Conclusions: The current study revealed that the patients with
IBD have a significantly lower level of Vitamin D compared to healthy control group. In addition, the Vitamin D deficiency is related to
disease severity.

Background: Hypospadias is one of the most common congenital anomalies among boys. The exact causes of this anomaly are not clearly
defined yet. However, many of the risk factors have been identified in different ethnic groups. Objective: The objectives of this study are to
evaluate the maternal‑ and fetal‑related risk factors for hypospadias in a sample of Iraqi patients. Materials and Methods: This case–control
study included 42 boys with hypospadias cases and other 42 age‑matched boys free from any genital anomalies as a control group. Maternal
data, including age, parity, body mass index, hypertension, diabetes mellitus (DM), the use of assisted reproduction techniques (ART), level
of education, consanguinity, and residence; and infant‑related factors. Logistic regression analysis was used to predict the risk of each variable
through the calculation of odds ratio (OR) and its corresponding 95% of confidence interval (CI). Results: Three maternal factors were found to
be associated significantly with increased risk of hypospadias. These were maternal age >33 years (OR = 3.08, 95% CI = 1.02–9.26, P = 0.045),
consanguineous marriage (OR = 3.0, 95% CI = 1.02–8.8, P = 0.045), and rural residence (OR = 2.64, 95% CI = 1.04–6.73, P = 0.041).
Hypertension, DM, and using ART were more frequent among mothers of cases than controls; however, the differences were not significant.
For fetal‑related factors, infants with low‑birth weight (LBW) were more frequent among cases than controls (40.48% vs. 19.05%), with a
statistically significant difference (OR = 2.89, 95% CI = 1.08–7.75, P =0.035). Of note, twins were more frequent among cases than controls;
however, this difference was not statistically significant (P = 0.074). Conclusions: These results highly suggest the critical role of advanced
maternal age, consanguinity, rural residence, and infant LBW, as predisposing factors for the occurrence of hypospadias among Iraqi boys.

Background: Colorectal carcinoma (CRC) is a common malignancy in Iraq and carries a high mortality rate. It has been shown that CRCs
express high level of beta‑human chorionic gonadotropin (β‑HCG) as detected by immunohistochemistry. Objectives: The aim of this
study was to assess the expression of β‑HCG in CRC and to study the association between β‑HCG expression and pathological prognostic
parameters. Materials and Methods: This study was carried out on 35 colonic specimens consisting of 30 CRC selected from files of
Pathologic Laboratory of Al‑Kadhymia Teaching Hospital and Teaching Laboratories of the Medical City, Baghdad. Paraffin blocks were
cut sections stained with H and E stain and sections for streptavidin‑biotin immunohistochemical staining using monoclonal antibody against
β‑HCG. Immunohistochemical sections were examined for positive or negative staining and positivity assessed as: occasional, focal, and
diffuse tumors. Results: Of the 30 CRCs, 60% were male and 40% were female. The most common site of large bowel malignancy was the
rectum 13 (43.3%). Most of the tumors were moderately‑differentiated adenocarcinoma (83.3%). More than half of the cases were Stage
T3, followed by Stage T2, then Stage T4, 3 cases (10%), and no case in Stage T1. Lymph node metastases were found in 19 cases (63.3%).
Twelve cases (40%) of CRC show immunoreactivity to β‑HCG. β‑HCG expression was more frequent in the left side of the large bowel and
more common in poorly‑differentiated adenocarcinoma (80%). β‑HCG was more positive in Stage T4, and there was significant association
with lymph node metastasis. Conclusion: Expression of β‑HCG in CRC is not an infrequent phenomenon, and no stain was demonstrated
in benign and normal colonic specimens, while β‑HCG expression associated with poor differentiation, greater local invasion, and regional
lymph node metastasis.

Background and Objective: This study was done to investigate and compare the hematological parameters related to hemoglobin (Hb),
total white blood cell (WBC) count, and platelet parameters in a case–control study of patients with diabetes with those of nondiabetic
healthy persons, potentially predisposing patients with diabetes to complications. Materials and Methods: A case–control study consisted
of 50 children with type I diabetes have been diagnosed since 5 years attending Laila Qasim Diabetic Center compared with another 50
nondiabetic healthy children attending Pediatric Clinic at Raparin Pediatric Hospital from October 2018 to March 2019. Investigations were
done as follows: (a) both patients and controls including Hb (g/dl), total WBC count (109/L), platelet count (109/L), mean platelet volume
(MPV) (fl), platelet distribution width (PDW) (fl), platelet‑large cell ratio (P‑LCR) (%), and (b) patients only HbA1C (%) to know their
control state. Results: WBC, MPV, PDW, and P‑LCR were significantly higher among children with diabetes in comparison with the control
group (WBC 9.34 ± 1.56 109/L vs. 8.14 ± 1.88 109/L, P = 0.001; MPV 9.60 ± 1.13 fL vs. 8.07 ± 0.87 fL, P = 0.001; PDW 11.91 ± 1.18 fL
vs. 10.03 ± 1.1 fL, P = 0.001; and P‑LCR 19.34% ± 4.85% vs. 12.09% ± 4.37%, P = 0.001); Hb was significantly lower among children
with diabetes in comparison with the control group (Hb 12.61 ± 0.75 g/dl vs. 12.89 ± 0.64 g/dl, P = 0.04); No significant difference was
detected between the two groups regarding platelet count. Conclusion: The study revealed that hematological parameters changed as a result
of diabetes mellitus, especially Hb was decreased among patients with diabetes and WBC, MPV, PDW, and P‑LCR were highly elevated in
type I as compared with nondiabetic participants.

Background: Toxoplasmosis is considered as one of the most prevalent human parasitic infections that can be transmitted from mother to
the fetus. The onset of toxoplasmosis during pregnancy has clinical complications, including spontaneous abortion, preterm labor, stillbirth,
and fetal abnormalities. Objective: The aim of this study was to investigate the seroprevalence of toxoplasmosis infection in aborted women.
Materials and Methods: Seventy‑five sera samples were collected from the women admitted in the obstetrics and gynecology ward with
abortion. The blood samples were processed appropriately and tested for Toxoplasma gondii IgM and IgG using enzyme‑linked immunosorbent
assay (ELISA) technique, in addition to latex agglutination test (LAT) as a screening test. Results: Seropositivity of aborted women to T.
gondii was 42.6% when used LAT while 4% and 22.6% when detection of T. gondii IgM and IgG respecyively ELISA.the highest percentage
of infection was found to be 18.6% in the age group of 21–25 years, in patients inhibited in rural area. Also seropositive in women with double
frequent of abortion. Conclusion: ELISA test was the best method to investigate toxoplasmosis in aborted women, especially with recurrent
spontaneous abortion

Background: Bladder cancer (BC) is one of the major causes of cancer‑related mortality in the world. S100 family of small Ca‑binding
proteins has been implicated in the progression of different cancer types, including BC. Objective: The goal of this study is to develop a more
rigorous understanding of the role of S100 proteins in BC progression and also to what extent S100s have the ability to increase the metastatic
potential for BC. Methods: A selected panel of bladder cell lines (J82, T24, HT1376, and RT112) was transplanted into zebrafish embryos
to investigate their migration behavior and metastatic potential. Characterizing the expression pattern of S100 proteins including (S100A4
and S100A6) in different BC cells was performed using quantitative polymerase chain reaction and Western blot. Assess the effect of S100
proteins on bladder cell migration in vivo was carried out using a zebrafish xenotransplant model. S100 proteins expression was modulated by
small‑interfering RNA approach. Results: High expression of mRNA and proteins levels of S100A4 and A6 were detected in T24 and J82 cell
lines, which displayed the highest migration rate in zebrafish embryos. In addition, our data showed that the average migration rate of T24 cells
transfected against S100A4, S100A6, and S100A4 and A6 were 17.3%, 10%, and 17.3%, respectively, which was lower than from siControl
41.9%. Likewise, the same effect of protein silencing on cell migration was observed in J82 cell lines. S100A4, S100A6, and S100A4 and
A6 knockdown reduced the migration rate of J82 cells to 14.6%, 17%, and 14% compared to the control 37.8%. Furthermore, overexpressed
S100A4 expression in RT112 cells significantly increased in migration ability by 29%, compared to control cells 7.3%. Conclusion: S100A4
and S100A6 play a role in BC cells invasion and migration. Silencing of these proteins affected dissemination of BC cells in zebrafish embryos
highlighting their role in tumor progression.

Background: Chronic rhinosinusitis (CRS) is a common condition in medical practice. It is defined as inflammation of the mucosa of nose
and paranasal sinuses, the fluids within these cavities, and/or the underlying bone that has been present with or without treatment for at least
12 weeks’ duration. Objective: This study aimed to determine the correlation of nasal endoscopy examination and computed tomography (CT)
in the early diagnosis of CRS. Materials and Methods: The study was carried out in outpatient Department of Otorhinolaryngology, in Rizgary
Teaching Hospital in Erbil. A total of 60 patients with clinical evidence of sinonasal diseases were evaluated with nasal endoscopy and computed
tomographic evaluation. Patients with previous variation of paranasal sinus anatomy due to facial trauma and former sinus surgery were
rejected. Patients with history of having malignant neoplasms or congenital malformations were also excluded from the study. Results: Sixty
patients with chronic rhinosinusitis participated in the study. Their mean age + standard deviation was 38.18 + 10.19 years, ranging from 20
to 63 years. The median was 37.5 years. The largest proportion (41.7%) of the sample aged 30–39 years old, and only 16.7% aged ≥50 years.
The main symptoms of the patients were nasal obstruction (80%), ear pressure (80%), and nasal discharge (78.3%). No significant difference
was detected between the two tests regarding their findings. Conclusion: Nasal endoscopy have sensitivity and specificity almost as good as
CT scanning, and being an outpatient procedure, it may reduce unnecessary diagnostic scanning procedures.

Background: Appendicitis is the most common surgical emergency presented daily to emergency surgical department. The Modified
Alvarado Scoring System (MASS) is easier and applicable in the diagnosis of acute appendicitis using extra signs instead of neutrophilic
left shift. Objective: The aim of this study is to compare and evaluate the diagnostic accuracy of MASS versus the Alvarado scoring system.
This study was carried out in Duhok Emergency Teaching Hospital, Iraq, over the period of 12 months, from October 2017 to October 2018.
Materials and Methods: A cross‑sectional study including 200 patients, diagnosed with acute appendicitis by the senior surgeon on call
and underwent conventional open appendicectomy. MASS were applied to all patients preoperatively by author and results of both scores
compared to operative and histopathological findings of excised appendix to analyze the efficacy of both scores in the diagnosis of acute
appendicitis. Results: Of 200 patients who underwent operation those with Alvarado score of 9–10 had sensitivity of 88% and specificity of
100%. Those with a score of 7–8 had sensitivity of 63% and specificity of 68%. For MASS patients with score of 9–10 had sensitivity of 96%
and specificity of 100%, and those with a score of 7–8 had sensitivity of 77% and specificity of 86%. The higher the score, the sensitivity
and specificity increased. Positive predictive value and accuracy of neutrophilic left shift of Alvarado were 95% and 65%, positive predictive
value and accuracy of extra signs of modified Alvarado score were 97% and 84% respectively. Conclusion: Both Alvarado and MASS are
fast, simple, and repeatable systems in the diagnosis of acute appendicitis. This study reveals that accuracy of MASS is higher than Alvarado
score, and the rate of negative appendicectomy can be reduced using this system.

Background and Objective: Coronary artery disease is a significant global health problem and is a leading cause of disability and death.
In this study, the effect of coronary artery bypass graft (CABG) surgery on left ventricular (LV) systolic functions and regional wall motion
abnormalities in the 1st week and 3rd month after surgery was evaluated through echocardiographic techniques. Patients and Methods: Fifty
patients who underwent elective isolated CABG at Azadi Heart Center were included and studied prospectively from November 2018 to
May 2019. Transthoracic two‑dimensional echocardiography was used to assess the LV‑systolic function (LV ejection fraction [LVEF]) and
wall motion score index (WMSI) and abnormalities. Results: Almost all patients had chest pain preoperatively, and 32% and 38% of them
were in Canadian Cardiovascular Society (CCS) Class III and IV, respectively. Ninety percent had multivessel disease, and the left anterior
descending was the most common vessel affected (86%), complete revascularization was done in all patients using 3–6 grafts, and left internal
mammary artery was used in 48 patients (96%). There was no significant improvement in LVEF in the early postoperative period (P = 0.28).
On the contrary, there was a highly significant improvement of LVEF lately postoperatively, which was improved from (49.62%–56.92%)
at (P ≤ 0.001). As well, there was a substantial improvement of WMSI at lately postoperative (P = 0.026) that changed from (1.204 to 1.12).
Conclusions: The present study suggests that CABG has a positive effect on LV systolic functions and regional wall motion abnormalities
3‑month post‑operatively as confirmed through echocardiographic techniques.

Background and Objective: In this study, the role of intracranial ultrasonography was evaluated in detecting intracranial abnormalities
in premature neonates; furthermore, some maternal risk factors were evaluated for increasing incidence of intracranial abnormalities.
Materials and Methods: A prospective cross‑sectional study was done on 60 preterm neonates admitted in the neonatal care unit in
both Raparin pediatric teaching hospital and maternity teaching hospital over a 5‑month period. Neurosonogram was carried out for
all within 1 week of life, and then, a second brain ultrasound (US) scan performed for them after 1 week if the first one was abnormal
and the third scan for those who were abnormal at the second visit. Results: Incidence of intracranial abnormalities by ultrasonography
in preterm neonates is 13.3% in the present study. There were 50% male and 50% female neonates. Ten percent of the study sample
had evidence of intraventricular bleeding, and 3.3% had ventricular dilatation. There is a significant association between maternal
risk factors and incidence of intracranial abnormalities (P = 0.01), and furthermore, there is a significant association between weight
and gestational age (P = 0.001). There is no significant association between US finding with each of weight, gestational age, gender,
and mode of delivery. Conclusion: Neurosonogram is the best initial method of investigation for preterm babies in the evaluation of
intracranial abnormalities even if clinically silent. Maternal risk factors should be taken into consideration in increasing incidence of
intracranial abnormalities. It is best to perform neurosonogram studies on all preterm babies within the 1st week of birth. It is widely
available, cheap, and repeatable.

Background: Iodine is an essential element in the formation of thyroid hormones, the body may encounter situations in which high iodine load
occur in the body like doing the contrast studies using the iodine‑containing contrast media. In most people, this iodine load is well‑tolerable;
however, in some others, this may result in derangements in the thyroid function, from which hyperthyroidism is the most common.
Objective: The objective of the study is to determine the subclinical changes in the thyroid functions in a cohort of patients with coronary
artery disease (CAD) undergoing coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). Materials and Methods: In
this pilot study, a total of 101 patients with CAD undergoing CAG and/or PCI were recruited during the year 2018. All cases had normal
thyroid function tests including (thyroid‑stimulating hormone [TSH], free T4, and free T3) preprocedural. Six weeks after CAG/PCI serum
TSH, free T4 and T3 were assessed again. Results: No significant differences were observed in levels of TSH, free T4, and free T3 between
preprocedures (CAG/PCI) and after 6 weeks with P values (0.645, 0.135, and 0.807), respectively. In addition, no difference was found between
the subgroup of CAG versus PCI. Conclusion: In euthyroid patients undergoing CAG/PCI minimal changes could occur in thyroid function.
However, these changes are of limited significance in the short term.

Background: Autoimmune bullous skin disorders are rare but potentially fatal disorders of the skin and mucous membranes. These diseases
may require long‑term treatment with systemic corticosteroids and other immunosuppressive drugs, which can lead to serious adverse events.
Rituximab has proved to be effective form of therapy for pemphigus and pemphigoid. Objective: The aim of this study was to evaluate the
effectiveness of a full coarse treatment with rituximab for cases of pemphigus and pemphigoid. Materials and Methods: A case series study
involved ten cases of pemphigus and pemphigoid consulted the Dermatology Department of Merjan Teaching Hospital, Babylon, and treated
with a full course of rituximab. Results: A complete remission (CR) has been achieved in the vast majority of cases, whereas the side effects
were trivial and rare. Conclusions: Rituximab has proved to be effective form of therapy for pemphigus. A CR has been achieved in the vast
majority of cases, whereas the side effects were trivial and rare.

Background: Physiologic alterations during pregnancy worsen the anemia severity, and they are associated with an increased risk of fetal
growth restriction, low birth weight, and preterm birth. Objective: The aim of the present study was to determine pregnancy outcomes in
women with minor β‑thalassemia. Materials and Methods: A total of fifty women who attended the consultation clinic of Azadi Teaching
Hospital for antenatal care visit were screened consecutively and included in the present cross‑sectional study in Duhok, Iraqi Kurdistan.
The patients were followed up until delivery for pregnancy outcomes from May 20, 2018 to February 10, 2019. Results: About 14.0% of the
patients had a history of baby death. The most prevalent clinical features were anemia (18.0%) and a history of preeclampsia (16.0%). Most
of the patients had undergone a trial of normal vaginal delivery (80.0%), and 14.3% of their newborns were admitted to the neonatal intensive
care unit (NICU). Only one of newborns died at 5 min following delivery due to a low Apgar score. The study showed that neonates who were
admitted to the NICU had lower Apgar scores after 1 and 5 min compared to nonadmitted group (5.71 and 6.71 vs. 7.24 and 9.29, respectively).
The mothers of the neonates who were admitted to the NICU had a higher prevalence of previous dead baby (42.9%; P = 0.031), previous
history of preeclampsia (57.1%; P = 0.005), and more likely to undergone cesarean section (C/S) (71.4%; P = 0.001). Conclusions: The present
investigation suggests that the β‑thalassemia newborn admitted to the NICU had a higher prevalence of clinical issues compared to those not
admitted to the NICU.

Background: Vitamin D deficiency is common in women with polycystic ovary syndrome (PCOS). Vitamin D deficiency is a common health
condition in the reproductive period of women and may escalate the symptoms of PCOS in women. Objective: The aim of this study was to
investigate the association between serum Vitamin D levels in patients with PCOS compared to healthy controls. Materials and Methods: In the
present case–control study, a total of 70 women diagnosed with PCOS were considered cases, and their Vitamin D levels and some other
biochemical parameters were compared to 43 apparently healthy controls. The diagnosis of PCOS was established in line with the Rotterdam
Consensus on Diagnostic Criteria for PCOS, including oligo or anovulation, clinical and biochemical signs of hyperandrogenism, and
polycystic ovaries and exclusion of other etiologies (congenital adrenal hyperplasia, androgen‑secreting tumors, and Cushing’s syndrome).
Results: The study revealed that patients with PCOS were significantly younger compared to the healthy controls; 26.57 versus 33.51;
P < 0.001. Moreover, a higher percentage of patients had irregular menstruation (81.4%) and hirsutism (81.4%) compared to controls
(4.7% and 4.7%, P < 0.001, respectively). The study revealed that the patients had a significantly lower level of Vitamin D and serum prolactin
and higher levels thyroid‑stimulating hormone compared to healthy control; 5.49 versus 17.83 ng/ml; 11.94 versus 8.57 IU/L; and 2.50 versus
1.72 IU/L, respectively. Conclusion: The present study suggests that patients with PCOS were more likely to have irregular menstruation and
a lower level of Vitamin D compared to apparently healthy controls.

Background: Left bundle branch block (LBBB) indicates organic heart disease. It is responsible for a greater degree of asynchrony in the left
ventricular (LV) contraction as a result of alteration in LV depolarization sequence. This study aimed to compare the duration of QRS complex
in LBBB in relation to LV systolic function by two‑dimensional transthoracic echocardiography. Patients and Methods: In this cross‑sectional
study, 82 patients with LBBB were divided into two groups. Group I defined as QRS <160 ms and Group II defined as QRS ≥160 ms. Then,
the relationships between QRS duration and echocardiographic LV ejection fraction (EF) were derived. LV systolic dysfunction defined as
EF <40%. Results: Eighty‑two patients with (LBBB) had been included in the study, the duration of the QRS complex of 55 patients (67%)
was <160 ms (Group I), and it was ≥160 ms (Group II) in 27 patients (33%). More than half (55.6%) of Group II aged ≥70 years compared with
38.2% of Group I (P = 0.001). Group II had high incidence of LV systolic dysfunction (70.4%) compared with 20% in Group I, while 18.2%
of Group I had an EF of ≥60% compared with 3.7% in Group II (P < 0.001). Conclusion: The prolongation of QRS duration (≥160 ms) in
LBBB is a marker of significant LV systolic dysfunction.

Background: Rubella virus infection is associate with various pregnancy outcomes. Usually, such infection is more prevalent among
women with low positivity for protective immunoglobulin G (IgG). Several factors are known to influence the seroprevalence of this virus.
Objectives: This study aimed to investigate the seroprevalence of anti‑rubella IgG and immunoglobulin M (IgM) antibodies and associated
factors among pregnant women with and without a history of abortion. Materials and Methods: A total of 91 pregnant women (79 women with a
history of previous abortion and 12 women without such history) were enrolled in this cross‑sectional study. Sera were collected from each
woman, and the levels of rubella IgG and IgM were measured using enzyme‑linked immunosorbent assay. Demographic and reproductive
data for the women were also collected. Univariate logistic regression was used to find the association of factor with serostatus of the virus.
Results: The overall seropositivity for IgG and IgM was 95.6%, (95% confidence interval [CI] = 91.3–99.9) 9.89%, (95% CI = 9.68–10.1),
while six women (6.59%) were positive for both types of Igs. Two factors showed a significant association with rubella IgG seropositivity:
A history of previous abortion (odds ratio [OR] = 0.68, 95% CI = 0.45.0.99, P < 0.001). Moreover, urban residence (OR = 1.09, 95%
CI = 1.0–1.19, P = 0.048). On the other hand, younger age (≤28 years) (OR = 0.1, 95% CI = 0.01–0.82) and previous abortion (OR = 0.14,
95% CI = 0.03–0.61) were significantly associated with IgM positivity. Conclusions: Most women are protected from rubella virus infection
through possessing a high level of IgG; however, there is a considerable proportion with evidence of acute infection which indicate that the
virus is endemic in the study area.

Background: The role of amniotic fluid is to provide a protective environment for fetus growth. The low volume of amniotic
fluid (oligohydramnios) has been reported to associate with perinatal and neonatal outcomes. Objectives: The aim of this study was to explore
the effect of oligohydramnios on fetal outcomes at intrapartum and early neonate, including fetal distress. Materials and Methods: In the present
investigation, the pregnant women who attended the labor ward of Duhok Maternity Hospital were consecutively screened for eligibility criteria.
The patients presented with oligohydramnios from 37 to 40 weeks of gestation to labor room were included in this study and were followed
up for neonatal outcomes. The diagnosis of oligohydramnios was established as an amniotic fluid index of 5 cm or less by the ultrasound
examination. Results: The mean age of the women with oligohydramnios was 26.10 ± 5.20 years ranged between 16 and 40. The mean age
of the gestational age was 38.54 ± 1.13 weeks ranging from 37 to 40. The previous history of a dead newborn was so low (mean: 0.02 ± 0.14).
Half of the patients delivered their pregnancies by cesarean section (C/S) (50.5%), and most of them had a good Apgar score value (98.8%).
The study showed that women who had a past medical history or delivered by C/S, their newborns were more likely to admit to neonatal
intensive care unit (NICU), 36.8% versus 12.1% (P = 0.017) and 78.9% versus 21.1% (P = 0.010), respectively. Conclusions: The present
study recommends that pregnant patients diagnosed with oligohydramnios are at a higher risk of C/S and NICU admission.

using high‑resolution ultrasound. Patients and Methods: A cross‑sectional prospective study between December 2017 and March 2018,
included 1200 asymptomatic adults participants (1000 women aged 15–70 years and 200 men aged 19–65 year). The prevalence of thyroid
incidentaloma, their distribution according to age and sex, nodule size, ultrasound characteristics, and risk stratification of malignancy
using Thyroid Imaging Reporting and Data System (TI‑RADS) grade were studied. Fine‑needle aspiration cytology (FNAC) examination
was done for some specific patients. Results: The prevalence of thyroid incidentaloma was 27.3%. Thyroid incidentaloma were more
prevalent in females and elderly people in both sexes mainly in 60–75‑year‑old peoples. Nodules were solitary in 244 (74.4%) and multiple
in 84 (25.6%) patients. The size of 186 nodules (45.1%) were <5 mm, 112 incidentaloma (27.2%) were 5–10 mm, and 114 (27.6%) were
more than 10 mm in size. Thyroid incidentaloma were cystic in 228 (55.3%), solid in 133 (32.3%), and complex in 51 (12.4%). Most solid
nodules were hyperechoic (84/133, 63.2%), 29 (21.8%) isoechoic, and 20 (15%) were hypoechoic. 92.9% (171/184 solid and mixed nodules)
were have well‑defined and regular borders and only 13 nodules (7.1%) have irregular and ill‑defined borders. Furthermore, 90.7% of solid
and mixed nodules have wider than taller diameters. Microcalcifications were seen in three and macrocalcifications in two solid nodules.
Of 412 incidentaloma, 258 were TI‑RAD 2 score, 136 TI‑RAD 3, and 18 nodules were classified TI‑RAD 4. TI‑RAD nodules 5 were not
detected. Suspicious incidentalomas of TI‑RAD 4 score were sent for FNAC examination. Papillary carcinoma detected in four nodules and
follicular tumor in eight nodules, three of them proved to be follicular carcinoma. The rate of malignancy in thyroid incidentaloma was 1.7%.
Conclusion: Thyroid incidentaloma is relatively common, and the majority are benign. Ultrasound characteristics and size of nodule could
be a reliable screening tool for malignant potential of the thyroid nodule.

Background: Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. The understanding of the pathogenesis
of the disease is essential to improve the plan of management. Objective: The objective of this study is to identify the role of periostin as
inflammatory biomarker of asthma. Materials and Methods: A total of 200 participants were enrolled in the study, of which there are
100 controls and 100 asthmatic patients. Blood samples were obtained from the participants for periostin investigations by enzyme‑linked
immunosorbent assay assay. Results: Serum periostin concentrations were significantly (P < 0.001) higher in asthmatic patients (mean ± standard
deviation [SD]; 68.152±9.792) compared to control group (mean ± SD; 46.488 ± 4.237). Periostin correlated negatively with forced expiratory
volume (FEV) 1% and FEV1/forced vital capacity (FVC) in asthmatic patients. Conclusions: Serum periostin is increased in Iraqi asthmatic
patients compared to controls and periostin correlated negatively with FEV1% and FEV1/FVC in asthmatic patients. Asthma is the most
significant variable relates to high periostin serum concentration.

Background: Supraventricular tachycardia (SVT) is one of the common presentations in accident and emergency department.
Objective: The aim of the study was to measure out the number of the SVT patients that will respond to modified Valsalva maneuver (MVM).
Materials and Methods: A cross‑sectional study among done for 60 patients presented with SVT to Rozhalat Emergency Hospital in Erbil
between June 15, 2018, and January 15, 2019, a questionnaire form designed to collect data and use MVM properly as the first line of treatment
with care to keep the information private. Results: The study results revealed that majority of our sample are middle‑aged (40–65 years) and
female by 50% and 65%, respectively. Male gender patients were a better responder to modified Valsalva comparing to female gender 53.3%
and 46.7%, respectively (though it is statistically not significant). As early patient presented with onset of symptoms, is better responded to
modified Valsalva, those patients are divided into patients who come within 1st h (53.3%), within 1–3 h (46.7%), and after 3 h (0%). This was
statistically significant. In general, modified Valsalva technique was successful to invert 25% of patients to sinus rhythm nonpharmacologically,
and 8.33% of total patients that responded to modified Valsalva needed more than one trial. Conclusions: We can conclude from the study that
males are better responders to modified Valsalva than females, As long as patients come early to the emergency room, the better they respond
to modified Valsalva. We can also conclude that modified Valsalva was a very good technique for treating SVT patients.

Dear Editor,
Breastfeeding has been linked with both short‑term and long‑term
merits pertaining to the health, financial, and environmental
attributes of the children, women, and the community.[1] In fact,
it has been anticipated that more than 0.8 million under‑five
children lives can be saved by just ensuring that all children
in the age group of 0–23 months are exclusively breastfed.[2]
The available evidence depicts that the value of breastfeeding
is much acknowledged in the low‑ and middle‑income nations,
but the doubts still prevail in developed nations, as reflected
by shorter duration of breastfeeding.[2] Despite that <40% of
children <6 months of age are exclusively breastfed.[2]
It is worth noting that despite the numerous and well‑confirmed
merits, breastfeeding no longer continues to be a norm in most
of the communities.[2] Further, a wide range of factors (viz.
medical, sociocultural, psychological, discomfort, etc.,) have
been identified, which together have played a significant
role in not allowing women to initiate or even continue
breastfeeding.[3] It is a definite cause of concern, as most of
the women eventually turn to top feeding in the absence of
a proper and adequate support.[1] In addition, the commercial
angle of companies is also playing their part in reducing the
rates of breastfeeding across different populations.[2]