The Medical Journal of Tikrit University

Aim:
To investigate the incidence, and time of onset of Herpes simplex viral epithelial keratitis (HSVEK) following pars plana vitrectomy (PPV).
Patients and methods: This is a prospective study of all patients undergoing pars plana vitrectomy by one vitreo- retinal surgeon from January 2014 till January 2019.
Results:
865 cases underwent of pars plana vitrectomy, and 8 (0.93%) cases of HSVEK occurred during the first 4 weeks postoperatively. These cases were detected one day (n = 1), one week (n = 6), and one month after surgery (n = 1). Conclusions: HSVEK is a possible complication after PPV surgeries. Most cases occurred in the first postoperative week.

Gastrointestinal hemorrhage during infancy and childhood is common and accounts for up to 20% of referrals to pediatric gastroenterologists. Most causes are self-limited and benign, 75% to 85% of gastrointestinal tract bleeding (GITB) arrest spontaneously.
This is a descriptive single center retrospective study done on 200 patients less than19 years old whom attend the gastrointestinal center / Rzgari hospital in Hawler from the first of January 2015 till first of December 2017; 110 (55%) were females and 90 (45%) were males. 137 patients were adolescence (68.5%), 47 patients were school age (23.5%), 9 patients were preschool age (4.5%) and 7 patients were in toddler age group (3.5%) . it was found that 89 (44.5%) patients had upper GIT bleeding, 111(55.5%) patients had lower GIT bleeding. Esophagogastroduodenoscopy (EGD) results of 34(38.20 %) patients with upper GIT bleeding were normal while 17(19.10 %) had duodenal ulcer, 11(12.36 %) had gastric ulcer , and 6(6.74 %) had antral gastropathy. lower GIT bleeding found in 111(55.5%) patients; from these, finding of colonoscopy in 41patients (36.94 %) were normal, 16(14.41 %) were have internal pile, 15(13.51 %) were have colonic polyp, 11(9.90%) for solitary rectal ulcer and 10 (9.00%) ulcerative colitis, and 7(6.31%) patients were have Crohns disease.

This work was designed to evaluate and compare histologically between various types of nerve grafts; autograft, collagen tubes (natural polymers), and a cellular epineurial nerves sheaths (biological canduits), included a cellular rabbits nerve graft and a cellular rat nerve graft.
Forty local breaded rabbits were used and divided into four groups, and then subdivided into two subgroups (a total of 8 subgroups). Each subgroup contained five rabbits. Two times were used for animal scarifying and that were 45 days and 3 months post operation. All animals were undergone surgical operation on the sight thigh and sciatic nerve was sectioned at the mid thigh region. Segments of 8-10mm were sectioned and the gap was replaced with previous graft types. All rabbits were kept survive to the end of experiments. Comparison was made between the right (experimental) and left (control) sides. Samples were taken from proximal, middle, and distal stumps to evaluate the regeneration process.
All tissue samples were examined under light microscope. The histological results clarify an increase in amounts of fibrous tissues whether intrafascicular or extrafascicular. Also, there was an increase in epineurium thickness in the distal segments for both periods. A significant diameters decrease of nerve fibers of all experimental groups of both periods was observed compared to the control. A significant reduction in myelin thickness in the proximal and distal stamps was also obvious.

Congenital valvular pulmonary stenosis accounts for 5–10% of all congenital heart disease. Balloon pulmonary valvuloplasty is a safe and effective method in reduction of moderate to severe valvular pulmonary stenosis. This retrospective study done in Hawler surgical specialty cardiac center on pediatric patients who had pulmonary valve stenosis (with echocardiographic peak gradient ≥50mmHg) and treated by balloon pulmonary valvuloplasty.
A total of 178 cases were involved, 93(52.25%) patient was male and 85 (47.75%) patients was female. 160 patient (89.89 %) were treated with single balloon method 18 patient (10.11 %) were managed by double balloon method technique. Follow up period of these patients range from 1 year to 10 years (mean of 5.5 year). In 153 patients (85.96%) pressure across pulmonary valve were below 36 mm Hg, while in 21 (11.80%) pressure gradient across pulmonary valve were (36-50 mm Hg). Four (2.24%) patients had pressure gradient across pulmonary valve more than 50 mm Hg. Forty patients (22.47%) developed mild pulmonary valve regurgitation, while 20 patient (11.24%) developed significant pulmonary valve regurgitation.
Balloon pulmonary valvuloplasty provides long-term relief of pulmonary valvular obstruction in the majority of pediatric patients. The long-term results are favorable.

Wound infection is infection at any level from 1-30days of the operation or up to one year after operation if included the embedding of foreign body, reasonable use of antibiotic is one of the key factor to stop wound infection .The administration of prophylactic antibiotic with recommended regimens, such as in developed countries has not been applied in AL-Batool hospital
.This hospital still used other types of antibiotics, in addition for several reasons, antibiotics were continued postoperatively to reduce the risk of delayed infections. Therefore, this study was done to analyze the effectiveness of prophylactic antibiotics as recommended in cesarean sections , This is a prospective cohort study carried out at Al- Batool hospital in Mosul city, 150 cases of elective cesarean sections recruited in this study during the period from 1st December 2019 to the 1st June 2020 ,they divided to three groups according to route of antibiotic administration .The ratio of wound infections in group 1&2 was (5%) and 20% in group (3) patients who don’t received pre –operative prophylactic antibiotics
. No significant differences in wound infection founded between group1&group2,whereas high rate of wound infection occurred in group3 p-value (0.014 ),in this study single prophylactic doses of antibiotics give as much protection as multiple doses in preventing post elective cesarean section wound infections . Obesity prior to pregnancy showed a statistically significant value as a cause of wound infection P-value (0.001). Analysis of the results demonstrated two types of pathogens were identified Staphylococcus species (85%) and proteus (15%).

Background: Noise induced hearing loss, a permanent bilateral hearing impairment due to long term exposure to high levels of noise, represents one of the most common occupational hazards. This cross sectional study was undertaken to evaluate the auditory effects of noise and to further examine the hypothesis that a link between noise exposure and hypertension exists.
Objectives: The objectives of the present study were to study the (i)prevalence of hypertension and hearing impairment in electric power plants workers, (ii) association between hypertension and hearing impairment, (iii) association between hypertension and hearing impairment, with duration of exposure, and (iv) correlation between levels of sound and noise induced health problems viz. hypertension and hearing impairment in a cross sectional study involving Workers working in Baiji electric power plants. Methods: This was a cross-sectional study. The study sample (population) consisted of 240 healthy male employees from Baiji electric power plants with a history of past and present exposure to noise. The study was conducted during the period from the 15 December of 2012`to the 15 February of 2013. There are four sections in the power plants. Turbine, Boiler, central control room and fuel . All workers who worked in the power stations for 5-7 years or more were included in the study.Data was gathered from the results of available portable audiometric test and the blood pressure was measured in supine position by using mercury sphygmomanometer.
Hearing impairment was defined as average hearing threshold for frequencies 0.5kHz, 1kHz ,2kHz and 3kHz equal or more than 25 dB(A) in both ears. Workers are classified according to expoeure time in to two groups. The workers are working in turbine and boiler formed continuously exposed group(CEG).While the workers are working in central control room and fuel formed intermittently exposed group(IEG).
Results:The prevalence of hearing impairment in this study was 17.08% among all the exposed workers .The prevalence of hearing impairment was significantly more in(CEG 14.58%)as compared to (IEG 2.5%).The Prevalence of hypertension among continuous exposure group to noise was(12.5%) significantly higher than the intermittent exposed group to noise ( 2.08%) .There was a positive association between duration of exposure and prevalence of Hypertension .Both hearing impairment and hypertension showed in the current study increasing frequency in relation to the duration of exposure( employment). The results of the present study indicate that hypertension and hearing impairment are commoner in workers continuously exposed more than that in workers intermittent exposed group to high level of occupational noise. The prevalence of hearing impairment and hypertension distributed according to the age of workers, we found that the 12.95% of bilateral neurosensory in age below 40 years, while 30.04% of cases in age above 40 years. While the prevalence of hypertension, we found 10.47% of cases in age below 40 years and 30.6% in age above 40 years .
Conclusions: These findings provide corroborative evidence to further substantiate the notion that exposure to noise is associated with hearing impairment .They also support the proposition that long term occupational exposure to noise appears to be a risk factor for arterial hypertension.

Background:
The applying of ESWL is widely extended from kidney stone to the most of urinary tract stones.
Objective:
the aim of the current study is to find the correlation between the location and the stone size with the efficiency of ESWL. Materials and Methods:
Data were collected from patients in ESWL unit in urology department in Al-Karkh general hospital for three years, starting December 2017 until December 2020. The number of patient was (174) patient divided into two groups, first group (G1) with average stone size 12 mm while it was 14 mm for the second group (G2). The shocks used of the frequency of 90 shock/minute start up at 9 KV with escalated does increase to 18 KV till fragmentation of stone or till reach of average 3000 shocks for real stone on upper ureteric stone per session up to 3 session.
Results:
the collected data found that the best fragmentation was in the lower stone location (G2) 95.45% followed by the upper location 93.33%, and middle one 85.71%, the same sequence is for G1, 90.00%, 76.47% and 66.66% respectively same finding sequence with the clearance.
Conclusions: ESWL affected with stone size, and location, the larger stone size the better fragmentation and clearance.

Background
Inguinal hernia is one of the commonest conditions in pediatric surgical practice requiring surgical intervention. Herniotomy after high ligation of the peritoneal hernial sac is the standard procedure performed to prevent recurrence. The conventional and accepted technique of orchiopexy recommends that ligation of the hernial sac is mandatory for prevention of postoperative development of hernia.
Objectives of the study
This study was planned to study the effects of non-ligation of the sac on the results of herniotomy in the pediatric age group.
Patient and method
This is a prospective study of 140 patients under the age of 6 years undergoing surgeries for indirect inguinal hernias (90 patients, all males) and orchiopexy surgeries (50 patients) over a period of two years (October 2008-october 2010) in Baquba teaching hospital. The age range of the patients was 4 months up to 6 years.
The hernia sac wasn’t ligated but it is merely amputated and left to be retracted out of the sight. All patients were followed for 2-2.5 year Results
For patients operated on for undescended testicle, no single patient developed inguinal hernia.
For the patients operated on for indirect inguinal hernia 2 patients (2.22%) developed recurrence of their hernia.
Conclusion
We conclude that ligation of hernia sac is not necessary in achieving surgeries for indirect inguinal hernias and during inguinal orchiopexy. Cancelling ligation of the sac will save time and gives extra length for the cord in orchiopexy surgeries.

Background: Breast cancer is the leading cause of death of women around the world. Rates differ by around fivefold across the globe, but they are rising in areas where the disease was previously uncommon. Aim of the study: the aim was to discover whether the molecular classification of breast cancer offers more knowledge about survival relative to traditional histopathological prognostic factors. Methodology:
In this study, the prognostic influence of ER, PR, and HER2 expression was analyzed independently in breast cancer patients using an immunohistochemical study (n = 297) at Mosul Oncology Hospital in 2018 on women diagnosed with primary breast cancer, and, in combination, survival analysis was performed using age-adjusted Kaplan-Meier and Cox relative risk models. Patient, Breast Cancer Stage.
Result: The results showed that patients (n=297) with different ER, PR, and HER2 expressions had different clinical outcomes with different treatment responses. Breast cancer's molecular classification was based on the pattern of expression of ER, PR, and HER2. The breast cancer subtype ER + / PR + / HER2 + was found in 36.3% of cases, ER + / PR + / HER2- observed in 23.9% of cases, ER - / PR- / HER2 + was observed in 23.5% of cases, and finally, a triple-negative subtype was found in 16.16% of cases.ER+/PR+/HER2- tumor patients have a positive prognosis, while triple-negative adenoma patients have the worst prognosis. We also suggest that this molecular classification be used to select the best treatment form in all breast cancer patients.

Background: Thyroid tumor is relatively rare tumor but it represent the most frequent form of the endocrine gland .Thyroid neoplasm either benign or malignant. Benign is follicular adenoma. Thyroid cancer is one of the cancers that becoming a leading cause of death in many countries of the world. Objectives: The study aims to determine the frequency of thyroid neoplasm in post thyroidectomy patients and to determine the most common type of thyroid carcinoma and its percentage in Sala Adeen.
Materials and methods: This retrospective cross-sectional study was carried out in TTH by referring to all records of patients data of one year(January 2012- January 2013).All patients who underwent different types of thyroid surgeries during this period were included in the study. All data including age, gender, relevant investigations like Ultrasonography, fine needle aspiration cytology, and final histopathology report were recorded on a standard form.
Results :( 272) patients were operated for different thyroid lesions. Twenty one (7.7%) were malignant (17 females and 4 males)and 91 were benign. Mean age for males was 41.35 ± 15.52 years compared to 36.59 ± 13.28 years for females. Papillary carcinoma constituted 17(80%), while follicular carcinoma formed only 9.5 % of malignant case. Medullary thyroid carcinoma ranked third with only 4.7%.while anaplastic thyroid carcinoma was 4.7% of the cases
.SNG was 127 patients, 11 case were malignant and MNG were112 case 9 cases were malignant. Papillary carcinoma was the commonest type which was observed in MNG in our study (80%).
Conclusions: The results of this study are consistent with many international studies. The prevalence of thyroid cancer is not high when we compared with other region in the world, and the most common types of thyroid carcinoma were papillary thyroid carcinoma. The present study concludes also the thyroid carcinoma is more common in middle age females. Also the results indicate that the risk of malignancy in multi-nodular goiter is not as low as it was thought before and that it is quite significant.

Background: Heart failure (H.F) is a condition in which the heart cannot supply the body's tissues with enough amount of blood. Certain conditions such as narrowing arteries in heart (coronary heart disease) or hypertension gradually make heart weak or stiff to fill and pump efficiently. Osteopontin (OPN) is a glycoprotein expressed in many types of cells including bone, immune, endothelial cells, and others. OPN has an important role in mineralization and bone resorption. Growth differential factor-15 (GDF-15) is a member of transforming growth factor β (TGFβ) cytokine superfamily, GDF-15 is highly expressed in cardiomyocyte, adipocyte, macrophage, and other cells. Aim: to evaluate levels of OPN and GDF-15 in patients with heart failure
Patients and methods: This study was achieved from August 2020 to October 2020, it was conducted on 22 patients with CVD who attended to cardio care unit (CCU) in Al-Ramadi teaching hospital in period from August to October 2020. The results were compared with 30 healthy control subjects. About four milliliters of venous blood were collecting in gel tube from patients and controls to estimate OPN and GDF-15 by ELISA method. Furthermore, fasting blood sugar (FBS) and total cholesterol (CHO) were measured for patients and control groups. Results: the level of OPN was significantly high in H.F patients (51.18± 23.57 ng/ml) compared to control group (1.07±0.41 ng/ml) furthermore FBS and CHO mean concentrations were significantly high in H.F. patients (195.46±89.16 mg/dl), (153.38±45.14 mg/dl) respectively, compared with control group (FBS 97.08±13.84 mg/dl), (CHO 112.18±10.64 mg/dl).
Conclusion: the study’s results showed that a significant increase in level of OPN and GDF-15 as a biomarker for heart failure patients and there was a correlation between both OPN and GDF-15 with blood glucose concentration, also hyperlipidemia was present in H.F. patients.

Background: The cancer of cervix is second most common cancer among women.
worldwide. It is have pre malignancy phase , dysplasia (intraepithelial neoplasia ) there for its preventable disease . Cervical cytology by Papanicolaou smear is an effective
means of screening for cervical premalignant and malignant disease . Aim of the study :to screen the outcome of Pap Smear in Tikrit’s women.
Patients and Methods: Cross section study carried out from January in2017 through December in 2018 on a sample of 95women attending departments of obstetrics and gynecology in Salah Alden general hospital in Tikrit . All studied women were referred for Pap smears. Results: normal Pap smears were seen in (35 women with negative result and 60 woman with positive result) .only54women with positive result do anther Pap smear after 6 month and 6 woman do total abdominal hysterectomy .after do anther smear 9 of them become negative and 45 diagnosis ca. cervix .
Conclusion: Premalignant and malignant lesions of cervix are not uncommon in referred women especially in menopausal women and those using hormonal contraception. Lesions can be detected early by Pap smear. There is discrepancy, and delay in reporting of Pap smear result, negatively reflected on screening program.

Background:
Alkaline phosphatase (ALP) is important enzyme in diagnosis many diseases like osteomalacia. It presents in defect isoenzyme including bone, liver, and placental ALP.
Aims of this study:
Assess the efficacy of the bone ALP enzyme and intact parathyroid hormone (iPTH) to detect the possible presence of osteomalacia in pregnant women due to the vitamin D deficiency.
Objective:
Evaluate the nutritional state of pregnant women that will affect the good health of her bone and preparing her for lactation stage.
Methods:
Blood samples were collected from 87 normal fasting pregnant women then subdivided them into three subgroups according to their period of gestation. ALP and its isoenzyme were determined calorimetrically after separation of them by thermal stability method, and the level of parathyroid hormone was measured for 36 of them from different subgroups by the ELISA technique. Statistical test used as t-test (student test) and leaner regression .
Results:
There was a difference in the activity rates of the heat labile enzyme (HLAP), which is mostly related to the bones when compared between groups, and showed that there is a positive relationship between the activity of this enzyme with the activity of the placental isoenzyme and with the gestational age. PTH showed an increasing in its level and a direct proportion with placental isoenzyme.
Conclusion and recommendation:
Increased bone (ALP) isoenzyme, and elevated PTH could be a marker of osteomalacia in pregnancy, accordingly, we recommend a measurement of parathyroid hormone and placental, bone ALP in pregnant women to ensure the health of the placenta and bone.

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease, which mainly affects the axial joints, including the spine, sacroiliac joints, and entheses. The aim of the study was to detect the prevalence of metabolic syndrome (MetS) in Iraqi patients with AS, in comparison to healthy controls and to assess their relationships with demographic and clinical characteristics. A cross-sectional study was conducted at the rheumatology unit of Baghdad Teaching Hospital in Medical City from October 2019 to March 2020.The study included a total of 100 patients diagnosed with AS, according to the modified New York diagnostic criteria, and 100 age and sex matched controls. Demographic data, disease activity scores, comorbidities, current medications were reported. Waist circumference, blood pressure, fasting blood sugar, triglyceride and high-density lipoprotein cholesterol were measured and MetS was diagnosed according to the NCEP ATPIII criteria. The prevalence of MetS in AS patients was (51%) which is higher than that of the controls (46%), but the difference was insignificant (p=0.4). The mean HDL-c, FBS, systolic and diastolic blood pressure were significantly lower in AS patients compared to controls (p=0.03; p=0.005; p=0.05; p=0.01, respectively). AS patients with MetS had significantly higher incidence of low HDL-c (P=0.03), and lower incidence of high FBS (P=0.01) and TG (P=0.04) than controls with MetS. The mean age and body mass index in patients with AS and MetS were significantly higher compared to patients with AS without MetS (p=0.005; p=0.001). Multivariate regression analysis showed that age of the patients was the only significant predictor for the risk of MetS (odds ratio [OR] =1.6, confidence interval [95% CI] = 1.2 - 1.8, P=0.03). It was concluded that, the prevalence of metabolic syndrome in AS patients was higher than in the general population but statistically insignificant. Low HDL-c is the most important component of MetS in AS. AS patients with MetS were older in age and had higher BMI than AS without MetS.

Adrenal myelolipoma is a rare benign tumour composed of mature adipose tissue and hematopoietic tissue. Very few cases have been reported. Most of these patients are asymptomatic. I present a rare case of Adrenal Myelolipoma where the patient presented with hypertension and a clinical suspicion of Pheochromocytoma, which turned out to be an Adrenal myelolipoma. Adrenal myelolipoma is a rare entity, not encountered frequently and can occur as an incidental finding. Awareness regarding this entity is very much essential to exclude surgical exploration or extensive surgery.

Background and objective: Iatrogenic perforation of the gallbladder has been reported in 28% of those patients who undergo laparoscopic cholecystectomy. It has been pointed out that gallbladder perforation can result in formation of gallstones and spillage of bile. The present study was carried out in order to investigate the postoperative incidence of iatrogenic gallbladder perforation during laparoscopic cholecystectomy in Sulaimani Teaching Hospital. Patients and methods: The present investigation was a single center, retrospective observational study that was carried out in Sulaimani Teaching Hospital in 2018-2019. The study sample included 99 patients who had undergone elective cholecystectomy. Required data on the possible risk factors and early outcomes and the patients’ demographics including age, BMI, and gender were collected. The collected data were analyzed through the Statistical Package for the Social Sciences (version 22.0.(
Results: The results revealed that 80% of the patients were females. Also, 42.4% had no chronic diseases, while diabetes mellitus (DM), DM along with hypertension (HT), and HT were found to be the most prevalent chronic diseases among them with 18.2%, 16.2%, and 10.1% of prevalence, respectively. Only 17.2% of the patients had abdominal operation before, and acute cholecystitis and chronic cholecystitis were seen respectivelyin 13% and 17% of them. The most common causes of gallbladder perforation (GP) were found to be electrocautery (16.2%) and grasper (7.1%). Moreover, 33.3% of the patients were overweight (BMI between 25 and 29.9), 45.5% were obese (BMI between 30 and 34.9), and 20.2% had BMI of over 35. Most of the patients aged 30 to 49 (62.6%). A majority of the patients (94.9%) were found to have gallstones.
Conclusion: Iatrogenic gallbladder perforation is prevalent among patients who undergo laparoscopic cholecystectomy. However, laparoscopic cholecystectomy is still a better choice and associated with fewer complications compared to open cholecystectomy. Required measures need to be adopted for patients with perforated gallbladder in order to minimize spillage and remove as much spilled gallbladder content as possible.

Methods: This was a cross-sectional study. The study sample (population) consisted of 240 healthy male employees from Baiji electric power plants with a history of past and present exposure to noise. The study was conducted during the period from the 15 December of 2012`to the 15 February of 2013. There are four sections in the power plants. Turbine, Boiler, central control room and fuel . All workers who worked in the power stations for 5-7 years or more were included in the study. Data was gathered from the results of available portable audiometric test and the blood pressure was measured in supine position by using mercury sphygmomanometer
Hearing impairment was defined as average hearing threshold for frequencies 0.5kHz, 1kHz ,2kHz and 3kHz equal or more than 25 dB(A) in both ears. Workers are classified according to exposure time in to two groups. The workers are working in turbine and boiler formed continuously exposed group(CEG).While the workers are working incentral control room and fuel formed intermittently exposed group(IEG).
Results:The prevalence of hearing impairment in this study was 17.08% among all the exposed workers. The prevalence of hearing impairment was significantly more in(CEG 14.58%)as compared to (IEG 2.5%).The Prevalence of hypertension among continuous exposure group to noise was(12.5%) significantly higher than the intermittent exposed group to noise ( 2.08%) .There was a positive association between duration of exposure and prevalence of Hypertension. Both hearing impairment and hypertension showed in the current study increasing frequency in relation to the duration of exposure( employment). 26.6% of hearing impairment cases found among those exposed for less than 15 years while 72.7% among those exposed for 15 years and more .On the other hand, hypertensive were 28% and 45.6% respectively with period of duration of exposure. The results of the present study indicate that hypertension and hearing impairment are commoner in workers continuously exposed more than that in workers intermittent exposed group to high level of occupational noise. The prevalence of hearing impairment and hypertension distributed according to the age of workers, we found that the 12.95% of bilateral neurosensory in age below 40 years, while 30.04% of cases in age above 40 years.While the prevalence of hypertension, we found 10.47% of cases in age below 40 years and 30.6% in age above 40 years .The most common group affected by hearing impairment (permanent bilateral) were present in Turbine and boiler of power plants. The common age group affected is above 40 year old.
The study shows that the longer exposure to noise either during the working day or through the period of employment increased the chance to developing hearing impairment and hypertension. The occupational hearing loss due to work related disease are common and constitute up to(14%) of all occupational hearing diseases.
Conclusions: These findings provide corroborative evidence to further substantiate the notion that exposure to noise is associated with hearing impairment .They also support the proposition that long term occupational exposure to noise appears to be a risk factor for arterial hypertension.

Background:
Anthropometric indices have been known to be associated with age at menarche.
Objective:
this study an attempt to determine the relation between menarche & nutritional status in adolescent\'s student. regarding the effect of menstrual cycle,
Subjects and methods:
cross-sectional study was conducted during the period extended from first of October 2018 to the end of March 2019. Females of secondary school in Tikrit district were be chosen from urban & rural areas Official permission to carry out this study was obtained from educational directorate of Tikrit district & the head masters of each school before the study. In addition approval permission & consent were obtained from all study students by using a multistage-stratified random sampling technique which includes(536) female adolescent students from secondary school of Tikrit district,
Results:
There was a highly significant difference between pre & postmenarcheal adolescent student. A higher percentage of underweight (30.9%) & normal weight (60.3%) were in premenarcheal students while higher overweight (31.2%) & obesity (12.6%) in postmenarcheal students. Menarcheal age appear to be associated with the change of nutritional status of adolescent students as they increase or decrease according the number of years of menstrual cycles. Underweight was recorded in adolescents students who were menstruating for less than 6 years while not present in adolescent with more than 6 years menstrual time while normal weight, overweight & obesity were fluctuating in increase & decrease along the menstrual cycle.
Conclusion:
The menstrual cycle had a highly significant effect on the distribution of nutritional status.

Horseshoe kidney and retrocaval ureter are uncommon congenital anomalies of the genitourinary system that are easily diagnosed by typical imaging features. Both anomalies presenting in one patient is a rare disease characterized by isthmus of horseshoe kidney between the abdominal aorta and inferior vena cava. The clinical diagnosis and treatment of horseshoe kidney with retrocaval ureter remain a challenge. Here, we reported a case of 10-year-old boy with the two anomalies who was preoperatively diagnosed by enhanced computed tomography scanning. The literatures on such combined anomalies are reviewed and the diagnostic evaluation and surgical management of this rare entity are discussed.