The Medical Journal of Tikrit University

Background: The most prominent benign tumor of the female breast is fibroadenoma. It is particularly prevalent among young women around the world.
Objective(s): Identification of the most common risk factors for fibroadenoma among Iraqi women in the city of Mosul, which contributes to early classify women who are at high risk of developing breast cancer after being diagnosed with fibroadenoma. Method: The biometry study design was adopted from Jan 2020 to Dec 2020 from Al-Jamhoori and Al-Kansa hospitals in the city of Mosul where have been included 102 patients in this study. Cases were identified from biopsies examined at the two hospitals'' pathology departments and were included in the study only if the diagnosis was reconfirmed by the study pathologist.
Results: Fibroadenoma was diagnosed at an average age of 32.6 years. Fibroadenoma (FA) was shown to increase the risk of participant characteristics considered to increase the risk of breast cancer with family history and higher education. Participants with established FA protective features (older age at menarche, more children) were shown to have a lower risk of fibroadenoma. Conclusion:
We demonstrated that biopsy-confirmed fibroadenomas can be detected early. Biopsy confirmation of a fibroadenoma may be more prevalent more likely in older women, thus, caution is needed if the findings are to be applied to fibroadenomas diagnosed at a younger age.

Background: Osteoporosis is a disease of bones that leads to an increased risk of fracture. It is characterized by bone thinning and decreased bone density, it occurs mainly in women and elderly people.
Aim: This study was carried out to assess the most common risk factors of osteoporosis in Mosul city.
Material & Methods:
To achieve the aim of the present study a case-control design was adopted. Data collection was carried out during the period from the first of June to the first of December 2013. The study subjects were 166 persons from both sexes and different age groups; 108 healthy person(control group) and 58 osteoporotic cases diagnosed by DEXA. A special questionnaire form was prepared for collecting data from both cases and controls.
Results:
The present study showed a significant association between age, sedentary life, and early menopause with osteoporosis. Also some drugs (contraceptive pills, thyroxin, steroids, proton pump inhibitors, cytotoxics, B. blockers and & metformin and some diseases (DM,CVD,RA), these drugs and diseases exhibited high odd ratios but without significant association.
Conclusion:
The present study concluded that there is a significant association of age, sedentary life, and early menopause with osteoporosis, in addition to some drugs and diseases.

Background: In most of the cases of neonatal sepsis the diagnosis is delayed until late stages of the diseases & end often in complications & death. The late diagnosis is due to the fact that the early signs are neither specific nor sensitive. The problem of delayed diagnosis and treatment is more prevalent & much longer in rural areas which are away from health care facilities. Recently, reliable & early diagnosis of neonatal sepsis has become a challenging topic in the medical discussion. The gold standard test for neonatal sepsis is the blood culture. However, blood culture is restricted by the drawback of false negative results & time-consuming investigation. C-reactive protein (CRP), a pentraxin protein, plays an essential job in inflammatory and/or infectious stimuli, thus being considered as an acute- phase protein in neonatal sepsis. Because the early diagnostic value of CRP is still a matter of debate when used for the diagnosis of neonatal sepsis. The aim of this study is to evaluate the diagnostic value of CRP in early diagnosis of neonatal sepsis in rural area. Patients & Methods: A cross sectional outpatient based research was carried out on 100 neonates suspected to have early sepsis examined in the private clinic in some rural areas in Al-Alam district. These rural areas in Iraq are away from health care services & the people suffer from poverty, so that the families can’t admit their sick children to hospital. Usually they want to treat their children at home on their own responsibility. This study is a necessity method for treating special conditions in exceptional circumstances that prevent them from following the approved medical rules, such as in-hospital treatment and using cheap, simple and rapid investigation. The period of the study was one year from 1 May
st
2020 to 1st May 2021. The patient’s inclusion criteria were neonates of age less than 28
days of life with manifestations of sepsis. The patient’s exclusion criteria were neonates
with previous treatment with antibiotics, congenital anomalies or any other diseases other
than sepsis. A questionnaire was developed and contained the clinical information about the
patients. Detailed history was taken from each family which includes age, sex, maturity,
residence, weight, risk factors and clinical presentations of neonatal sepsis. Investigations
C-reactive protein was done for all neonates. These neonates received antibiotic therapy of
combination (Gentamicin 5mg/kg plus ampicillin 200 mg/kg) or (3 generation
rd
cephalosporin 100mg/kg plus Ampicillin 200 mg/kg) based on the clinical examination and CRP result. Follow up carried out by clinical examination and serial CRP which done after 1 week.

Background:
More than two million mortalities of children worldwide are delayed through effective immunization yearly. This study was conducted to
1
identify the reasons and factors affecting the immunization defaulting. Subjects and method:
A cross sectional study was conducted in all the primary health care districts in Saladdin province between July – November 2019, caretakers of (359) children were interviewed, and data collected via self- administered questionnaire to their parents.
Results:
There were (274) defaulters and (85) non-defaulters with the defaulters having higher mean age for mothers and fathers than non-defaulters. The statistically significant factors associated with immunization defaulters were the maternal education, residency, distance to PHCC, socioeconomic status, ANC state and family size. The most common reasons for defaulting were busy parents forgetting the date of vaccination, child or caregiver illness, long distance to nearest PHCC and no sufficient parents' knowledge about schedule.
Conclusion:
Children born to older parents, illiterate mothers, living in rural distant areas or living in big or poorer families with poor ANC appear to have higher defaulting rates.

Tuberculosis (TB) is a communicable disease resulting from infection with Mycobacterium tuberculosis .Tuberculosis remain a leading cause of mortality in the world , nearly one third of the global population is infected with Mycobacterium tuberculosis , which is at risk of developing the disease . Iraq is considered to be a middle burden country with tuberculosis The current study was done on (125) patients suffered from symptoms of pulmonary TB, the information collected from center records in order to comparison between the results of GeneXpert test and results of direct sputum smear (AFB) for year 2018-2019.
The males were 63 (50.4%) patient with mean age of them was 40.97± 14.2 years , while the females represented 62 (49.6%) patient with mean age of them was 44.4 ± 17.1 years without significant difference between them . The early morning sputum samples for Ziehl-Neelsen stain were obtained from all patients. Which revealed positive in 7 (11.11%) male patients and 4 (6.45) of female patients.
Genexpert test for sputum samples was performed in 125 patients which was positive in 23(18.4%) patients as 14(22.22%) males and 9 (14.15%) females.
The two tests was positive in 11(8.8%) of patients.
The results of GeneXpert test and direct sputum smear statistically was not significant.

Background: This study was done to detect the level of IgE in asthmatic children.
Aim: The aim of this study is to evaluate the relation between asthma in children and IgE level in children.
Study Design: Case-control study.
Patient study: This study was performed in Mosul city from January 2019 to June 2019. The total number of children in this study was 200 (152 patients and 48 control) were recruited from the emergency department, outpatients clinics of Ibn al-Atheer teaching hospital for children, pediatric private clinic and from primary schools of children in Mosul city. The sample size was 152 patients with asthma (109 males and 43 females) whose age between 1-15 years. Methods: 5 ml of blood were collected by vein puncture using disposable syringe from each patients and control enrolled in this study for determination of IgE levels using enzyme linked immune-sorbent assay (ELISA technique). Result: IgE levels was significantly elevated in asthmatic children and even in some control cases.
Conclusion: There was a strong association between Asthmatic children and elevated IgE levels in most of patients and some control cases.

Background:-Obesity has become a leading health concern; this condition is a chronic, multifactorial complex in which a child's weight ≥ 20% of the ideal weight for a given height.
Aim of the study:- Is to find out the liability of obese children to the diabetes mellitus.
Objectives of the study:- To measure the serum levels of C- peptide, Cortisol, and some biochemical parameters in children with obesity and comparing them with lean or normal weight children in some primary schools in Kirkuk city.
Methods:- This study was carried on 152 children divided into two groups :-
1. Obese children (n 100 from both gender). 2. Lean or normal weight children (n 52 from both gender). For all of them studied serum C-peptide, Cortisol, Biochemical parameters (serum Leptin, Adiponectin, Malondialdehyde,
Results: This study showed that mean BMI, serum c-peptide , leptin, malondialdehyde, were significantly (P<0.05) higher in obese group than in lean or normal weight group, and serum adiponectin, was significantly lower in obese group than in normal weight group. Conclusion:-This present study identified high prevalence of obesity among primary school children, increased BMI in obese children, increased circulating levels of leptin as a biological marker for obesity, increased circulating c- peptide level as a marker of insulinoma, increased oxidative stress in obese children, and finally decreased adiponectin level in obese children.

Flaxseed has the highest concentration of lignan, which is one of the major phytoestrogen groups. Lignan has non-hormonal effects in addition to its estrogenic and anti-estrogenic properties. The improvement of the symptoms of premenstrual syndrome are one of the indications of this plant, therefore this study aimed to determine the effects of using flaxseed throughout the menopausal period on women’s menopausal symptoms and quality of life.
Patients and Methods:
double blind clinical trial done in Salahadeen general hospital/ gynecology outpatient clinic 1 January to 15 July 2021, including convenient sample of 60 menopause women divided into 3 groups: Intervention group receive 5 g of flaxseed daily (20 patient) group A. HRT group receive 2 mg of estradiol hemihydrate + 1 mg of norethindrone acetate (20 patient) group B. And Control group who did not receive any medical or complementary treatment (20 patients) group C. All 3 groups followed for 3 months.
Results:
Flaxseed had significant effect in decreasing the total MRS with mean (-4.5) score after treatment in comparison to (-6) of hormonal therapy and (4.5) in control group, its effect is lower than the hormonal therapy but had good effect. In the post treatment there were significant higher mean total physical SF-36 score among group A (44.98 ± 7.58), and B (40.7 ± 6.46) than group C (30.8 ± 3.92).
Conclusions:
flaxseed had significant positive effect in reducing the postmenopausal symptoms and had good effect in improving the quality of life among menopause women

The aim of this case series study was to show the presentation of cerebral palsy with underlying family history among peoples in Salaheldin area. This study was carried out among 50 Childs with cerebral insult pre- and peri-natal or post- delivery. It includes 35 males and 15 females whose age range between 8 months to 15 years with mean age 10± 5 years attending rehabilitation hospital in Tikrit. All were reviewed with history, examination and investigations. The result showed significant relation of cerebral palsy with close siblings marriages between father and mother in a 64% while 36% with no close siblings between father and mother. This study revealed 38% of cases are preterm delivered and 60% with full term delivery while 2% with premature delivery (34 weeks).

Background: Hepatitis B virus (HBV) is the most prevalent of the hepatitis viruses that cause chronic liver infections in humans, and it is a major public health concern worldwide. It is transmitted through blood, unprotected sex, shared or re-used needles, and from an infected mother to her newborn baby during pregnancy or delivery. Objective(s): Examine the quality of life related to health among patients with chronic viral hepatitis B, as well as to define the relationship between the quality of life associated with health and the demographic characteristics of patients.
Methodology: A descriptive quantitative analysis was performed between January 2020 and December 2020 in Al- Jamhoori teaching hospital in the city of Mosul, anon likelihood (purpose sample) of (69) persons with chronic viral hepatitis B who were follow-up clients in Al- Jamhoori Teaching Hospital. Data were collected using a semi- constructed questionnaire consisting of three parts of the demographic data form, the elements of the medical information, and the major quality of life domains comprising six main domains: physical, psychological, freedom level, social, environmental and spiritual. A panel of experts in various specialties determined the validity of the content. Usage of the test-retest system in the pilot study determined the reliability of the instrument. Data is objectively described and evaluated using the procedures of descriptive and inferential statistical analysis.
Results: The study found that chronic viral hepatitis B occurs more frequently in individuals in urban-suburban areas were (87.18%) than in rural areas (12.82%). Chronic viral hepatitis B is more prevalent in males (81.54%) than in females (38.46%). chronic viral hepatitis B is more prevalent in married (21.85%) than in unmarried, chronic viral hepatitis B is more prevalent in housewife women were (33.33%) than another woman, chronic viral hepatitis B is more prevalent in low-level education (25.64%) than others. The incidence also increases with the increase in the number of hospital visits (89.74%). The low living situation also shows an increase in hepatitis B infection (64.10%).
Conclusion: The study concluded that chronic viral hepatitis B occurs more frequently in individuals in urban-suburban areas than in rural areas. Chronic viral hepatitis B is more prevalent in males than in females, chronic viral hepatitis B is more prevalent in married than in unmarried, chronic viral hepatitis B is more prevalent in housewife women than other women, chronic viral hepatitis B is more prevalent in low-level education than others. The incidence also increases with the increase in the number of hospital visits. The low living situation also shows an increase in hepatitis B infection.

Background:
WHO reported that about 15 million neonates are born preterm, with about million deaths occurring during infancy PTB infants who survive frequently suffer from chronic pulmonary diseases and learning deficits, causing heavy burdens for society and family. This study aimed at finding the relation between preterm labour and maternal (25(OH) D blood level.
Subject and Methods
A prospective cohort study, conducted in obstetric department in Salah Al-Deen general hospital from 31 Jan to the 11 July 2021.
st
st
A convenient sample of 154 pregnant women in the 2nd trimester were taken and followed up for assessment of pregnancy outcome. Inclusion criteria include all pregnant women aged 18-45 years, and planned delivery at Salah Al-Deen general Hospital. Data collection done through: standardized questionnaire. Blood samples were collected from the mothers on 13-24 week and ≥32 week and followed to report the prevalence of preterm delivery. Results:
Deficient vitamin D3 found among 40 (27%) of the total pregnant women, insufficient level found among 110 (73%) of the women while none of the pregnant women had sufficient vitamin D3 at 32 week of gestation. Vitamin D3 deficiency found among 3 (12%) of the preterm labour and 2(1.2%) of the full term labour group, while insufficient vitamin D3 found among 21 (84%) of the preterm labour and 108 (83.7 %) full-term labour in a statistically significant relation. The correlation of the vitamin D3 level at 13- 24 week of gestation and gestational age show significant linear (r= 0.426). The correlation of the vitamin D3 level at 24 - 32 week of gestation and gestational age show significant linear (r= 0.449). Conclusions:
Vitamin D3 deficiency found significantly among women of the preterm labour than the full term labour group.

Objective: This study was conducted to investigate the prevalence of knee osteoarthritis in Iraqi patients with type 2 diabetes mellitus in comparison to non-diabetic controls.
Patient and methods: A case control study was conducted on 50 patients; known cases of type 2 diabetes mellitus, whose ages range between 40 - 70 years old were randomly enrolled in the study. Another group consists of 50 patients non diabetics, matched for age with the patients’ group, and was kept as control. Only diabetic group was subjected to measurement of fasting blood sugar and HbA1c was done for patients’ group to evaluate glycemic control. X-ray of the weight bearing bilateral knee joints were obtained from antero-posterior aspect. The Kellgren and Lawrence system was used to classify the severity of osteoarthritis using five grades. Quality of life and disease impact was assessed by using Western Ontario and McMaster Universities Osteoarthritis Index.
Results : The current study revealed that 25% of Iraqi diabetic type 2 patients had osteoarthritis and grade 1 of Kellgren Lawrence System was equal in both groups (34%) while grade 2 and 3 were higher in diabetic group (40%, 10%) respectively and (22%, 4%) in control group. Conclusion
● Patients with type 2 diabetes mellitus had a higher prevalence of osteoarthritis
Compared with non-diabetic controls although statistically was not significant.
● Type 2 DM can be considered as a predictor for the development of OA
of the knee independent of age and other known risks for OA.

Allergic rhinitis frequently occurred ,Many types of inflammatory cells and mediators are involved in this disorder. Of particular note is that the pro-inflammatory mediators (e.g. cysteinyl leukotriens, cytokines, and histamine) are involved in nasal and bronchial inflammation, in patients with rhinitis.
Aim
The aim of the study was to define the immunological profile of allergic rhinitis cases in regards to : Eosinophil count , total IgE levels , specific IgE levels , serum immunoglobulin’s levels , serum complement component( C3,C4 )levels , interleukin 4 and interleukin 10 levels. Materials and methods:
This is a cross sectional study which was carried out on 100 patients with allergic rhinitis) at the Asthma and Allergy Institute in Baghdad, from February 2007 to July 2007, and fifty participants as a control group. Spirometry was performed with the goal of recording as precise as possible of spirometry measures forced expiratory volume in one second (FEV1) and forced vital capacity (FVC).
Samples of blood were drawn for serological study from all the participants.
Results and Discussion:
The age distribution of Allergic rhinitis showed the majority of cases occurred between the age of 5 and 35 years, but
The gender distribution showed female predominance in allergic rhinitis.
The mean total serum IgE level in AR was significant higher than its level in the control group (P<0.01).The mean serum concentration of IgG, IgM and C3 complement component were higher in rhinitis patients.

Ischemic heart disease is a leading cause of death worldwide which may present as a stable ischemic heart disease . The diagnosis depend on history and clinical examination in addition to electrocardiography and echocardiography. In patients with normal electrocardiography and echocardiography and have low to intermediate risk of ischemic heart disease, we need another tools like exercise stress test which include duke treadmill score as a composite score to evaluate the patient with ischemic heart disease. SYNTAX score is an angiographic scoring system that is widely used to evaluate the severity and complexity of cardiovascular disease in catheterization laboratory.
The aim to look at the prevalence of ischemic heart disease and its culprit electrocardiography changes during or after exercise and calculate duke treadmill score. Then after prospectively looking at coronary angiographic findings and its syntax score. To assess if there any anatomical association between positive electrocardiographic changes, coronary angiography and duke treadmill score.
A cross sectional study, out of 280 patients who attended exercise treadmill test unit in Saladin General Hospital during the period from June 2017 to June 2019, one hundred patients of them had positive stress test. sixteen patients refused coronary angiography and complete analysis done for 84 patients.
In this study, two-third of patients with positive treadmill test were with significant lesions which more significant in gender, high BMI, and smoking and residual one third with the normal result or no significant lesion. In this study, there is no association between ST depression and culprit lesion in angiography except in complex coronary diseases which give an extensive ST depression in stress time.
In this study, there is a significant association between high-risk duke treadmill test and the extent of coronary artery disease (p < 0.0001) and a significant relation between duke treadmill score and syntax score (p 0.0001).

Aim of the study:
To evaluate the use of dermis-fat graft as autogenous tissue to achieve three layers closure of the palatal fistula.
One of the most devastating complication that follows cleft palate surgery is oro- nasal fistula. It can lead to many problems like fluid and food regurgitation, poor oral hygiene and retropharyngeal incompetence. The repair of palatal fistula had long presented a remarkable challenge to the plastic surgeon. Repair of these fistulae required the use of more than the usual two-layered closure procedures; demanding the introduction of a ‘Third layer’ of tissue to enhance smooth healing, and thereby reduce the chance of closure failure which predispose to fistulization. In this study we used an autogenous graft of ‘’ dermis and fat (dermis-fat) graft ‘’ to serve as the third protective, supportive and enhancive layer.

Over eleven months period from October 2003 until September 2004, (200) patients with surgically treated thyroid disease in Mosul city were collected. The patients were examined clinically , and the biopsies examined histologically.
There were 170 females and 30 males and the female to male ratio was 5.6:1 .The age ranged between 14 and 75 years, with a mean of 36.4 years. The peak age incidence was at 3 and 4 decades. Seventy percent of the patients
rd
the patients were urban and the rest were rural areas.
On clinical examination 57% had multinodular goiter ,11.5% had diffuse enlargement and 31.5% presented with single nodule. Among the single nodules, 66.6% were right sided, 31.7% left sided, and 1.5% had single nodule in the isthmus.
Ultrasound examination was performed on 50 patients and revealed 26% cystic ,66% solid , and 8% mixed echogenicity.
On histopathological examination there were 52% non toxic nodular goiter, 17.5% toxic nodular goiter, 11% thyroiditis, 8% adenoma, and 11.5% thyroid malignancy. Papillary carcinoma formed 78.2%, of all malignant lesions, follicular carcinoma formed 17.4%, and medullary carcinoma constitute 4.3% of malignant lesions.
FNAC was done for 84 patients; 69 of them were benign and 8 were malignant with 2 false positive and one false negative. The sensitivity, specificity, and accuracy was; 88.8% , 97.1% , 96.2% , respectively.

Objective:
"A significant extradural hematoma (EDH) is generally treated by craniotomy and removal of the hematoma."This is a report of treatment following an EDH on computerized tomography (CT) in children without surgical intervention. The authors examined whether this way of management is a successful and safe therapeutic option.
Methods:
Retrospective study was carried out by collecting data from charts of patients with EDH treated without surgical intervention in Tikrit teaching hospital between June 2016 and February 2020. "Included were patients without focal neurological deficits, with a Glasgow Coma Scale (GCS) of 15 and an initial CT showing an EDH with a minimal thickness of 1 cm. Mild clinical symptoms of increased intracranial pressure such as headache, nausea or vomiting were managed symptomatically". "Follow-up included a standardized interview, a neurological examination and CT".
Results:
Thirteen children with EDH had success without surgical intervention. Only one 11-year-old male patient with a delayed diagnosed parietal EDH required surgical removal 24 h after admission and 4 days after the insult. Clinical follow-up showed patients without neurological deficits, a Glasgow Outcome Scale of 15 over one year. Follow-up CT showed complete resolution of the EDH within 2 to 3 months.
Conclusions:
Our study demonstrates that significant EDH can be managed conservatively in neurologically normal children. We recommend that such treatment be carried out in specialized centers under adequate neurological observation since urgent surgery in case of neurological deterioration may be carried out.

Objectives: The aim of this study was to investigate the difference in the serum malondialdehyde (MDA) between hydatid cyst patients and controls.
Design : case –control study .
Patients and methods: The study was conducted on patients with CE before the surgical treatment in two general teaching hospitals in Mosul city ( Al-Zahrawy hospital, Al-Salam hospital ) between June 2009 - September 2012. Eighty seven patients with positive Echinococcus granulosus IgG ELISA tests and 103 apparently healthy controls with negative E.granulosus IgG ELISA tests . total MDA activities of both patients and controls were determined by using thiobarbituric acid Test Assay method ( TBA assay method ).
Results : The mean age of patients was (32.1 ±11.45 ) years and (30.81 ±12.19 ) years for controls . The MDA levels of patients and controls was statistically significant (p<0.05). The difference between MDA levels of patients and control group was statistically significant both for females (p<0.05) and males (p<0.05 ) in the patient and control group, The MDA levels of liver and lung CE was statistically significant
(p<0.05). while no correlation was found between age and MDA levels no statistically significant (p>0.05) both in females and males.
Conclusions: In the present study found the plasma concentration of malondialdehyde (MDA) levels is higher in hydatid cyst patients than controls.

Background: Putting vascularized flaps over the neourethra is indicated in hypospadias surgery. This will lessen the complications rate, mostly the urethrcutaneous fistula, this is more indicated in secondary and complicated cases.
The study’s Aim: To assess our initial experience with tunica vaginalis flap (TVF) in proximal primary and secondary hypospadias.
Materials and methods: This study prospectively included secondary and primary proximal hypospadias which are corrected using tubularized incised plate (TIP). The age of the patient, type of hypospadias, complications of primary repair, complications of our repair and the follow up results were reported.
Results: Between December 2011 to December 2018, 33 children with primary proximal or failed cases were repaired using TIP with the use of (TVF) interposition. Seventeen cases were primary with peno-scrotal opening repaired by single stage (Group A).
Sixteen cases were secondary hypospadias (Group B), 5 of them had distal opening as their original pathology while the remaining 11 cases had peno-scrotal opening with complete dehiscence of the previous repair.

The follow-up time extended from 2 to 60 months, Group A (n=17); 4 cases (23%) developed Urethral fistula and 2 cases (12%) developed Meatal Stenosis. While in Group B (n=16);3 cases (19%) developed fistula and 3 cases (19%) developed Meatal Stenosis. Only one case 6% developed glandular dehiscence. . The scrotum was obviously normal in both groups.

Conclusion: TVF looks to be good interposition layer and good option in crippled and proximal hypospadias. It is a vascularized layer that could cover any urethroplasty length.

Objective: To detect the sensitivity of Doppler study of renal arterial resistivity index in patients with acute obstructive uropathy presented by hydronephrosis and hydroureter by taking CT-KUB study.
Methods: this is a comparative cross-sectional prospective analysis done between January 2020 and march 2021. The data were collected in Rizgary teaching hospital. The study included patients with flank pain referred to Radiology department and those with hydronephrosis included in the study. Same number of normal participants were examined by ultrasound for comparison. The ultrasound examination undertook between 2-6 hours after the onset of loin pain.
Results: the data was collected from 51 patients, age ranging from 18- 57 years, and equal number of participants of relatively the same age was collected, males constitute about 78.4% of total number of 51 patients, females constitute of about 19.6%.
Hydronephrosis has been found in all patients with loin pain; divided into three categories; mild (72.5%), moderate (27.5%), no sever hydronephrosis was recorded in the study.
The stone was confirmed by ultrasound in 20 patients constituted about 39.2%, the stone in 31 patients was confirmed by CT-KUB which constituted 60.8%.
Resistive index of affected kidney was 0.689, in contrast the resistive index of the contralateral normal kidney was 0.613.
Conclusion: Doppler ultrasound with measurement of RI is effective in the evaluation of distal ureteric obstruction, but it cannot replace the CT-KUB. Hence, this study concludes that the renal resistivity indices should not be interpreted in isolation.

Introduction: Renal transplantation is considered to be an appropriate choice of therapy for patients with end-stage renal failure. There is a continuous discussion on the safety, efficacy, and main advantages for selecting between the left and right renal transplant. In this regard, our aim is to evaluate the role of left and right renal transplantation on possible complications and outcomes in a case-control study.
Methods: The recipient patients who received the donated kidney from the right (n=28) and left side (n=24) were matched in age, gender, and BMI and included in this retrospective case-control study. The patients who were included in this study underwent donor nephrectomy between July 2018 and August 2020 in two hospitals in Erbil city.
Results: The patients who received the left or the right-sided kidney were similar in operative time, 122.32 vs. 118.92 (P=0.3207), warm ischemic time/min; 1.39 vs. 1.46 (P=0.6417), graft function (P=0.5030), and preoperatively HB, 8.97 vs. 8.42 gm/dL (P=0.0913), respectively. The patients had similar postoperative hospital stays (5.5 days; P=1.000). The study found that 35.71% and 20.83% of patients required intraoperative blood transfusion. The incidence rate of postoperative hematoma in patients who received left or right donor kidney was 3.58% and 4.17%, and the incidence rate of readmission was 7.14% and 8.33% and allograft rejection was 0.0%% and 4.17%, respectively. No other complications were observed in both groups after one year.
Conclusions: This study showed that the patients who received left and right-sided kidneys had similar outcome and complications.

Backgrounds and aim: A pilonidal sinus (PNS) is a common condition that affects men mostly especially young adults. The method of treatment of this surgical condition is controversial still. In this regard, we compared the outcomes of interest between excision and drainage of an abscess in PNS patients.
Methods: Patients who were diagnosed with PNS abscess and admitted for the treatment between 2019 and 2020 were treated either by excision (n=48) or drainage of abscess (n=30). The patients were followed up for the outcomes of the interest, including infection, pain, discharge, and wound size at the first, third, and sixth months of surgery.
Results: The patients who were treated by excision technique had significantly longer operative time compared to patients who were treated by drainage of abscess 9.65 vs. 5.50 min, P<0.0001. In addition, they had a longer postoperative hospitalization time, 4.19 vs. 3.43 hours, P=0.0002, and required longer time to back to normal activity, 4.69 vs. 4.20 days, P=0.0221, respectively. The patients in both groups had similar incidence rates of infection, pain, and discharge at the different periods and similar incidence rates of wound rate at the first month. The patients who were treated by drainage of abscess had significantly higher incidence rates of two and three cm wound size compared to those who were treated by excision. 75.00%, P=0.4287, whereas, the patients who were treated by drainage of abscess significantly developed postoperative fever, 16.67% vs. 0.00%, P=0.018.
Conclusions: The study showed that total excision of pilonidal sinus abscess develop better outcomes of the wound at third and sixth months of operation.