Al-Qadisiyah Medical Journal

To date, tuberculosis (TB) is still a disease of big concern to humanity because it leads to losses in various life aspects such as people lives and economics. Because the long time and hard efforts needed to diagnose the disease, we have conducted this study to better detect the disease in patients in Al-Diwaniyah province, Iraq. Moreover, we have also launched this research to identify rifampicin-sensitive and -resistant patients. To fulfill our aims, we have recruited GeneXpert system for performing the XpertMTB/RIF test that identifies specific DNAsequences of Mycobacterium tuberculosis(MTB) and rifampicin-resistant patients. For this, 179 patients who visited The Chest and Respiratory Clinic Diseases, Diwaniyah, Iraq, were referred to submit sputum specimens to the GeneXpert. After the test had been run, 157 (87.7%) samples were negative, and 22 (12.3%) were positive to the bacterium. Out of 22 patients, 17 (77%) patients were sensitive, and 5 (23%) patients were resistant to the rifampicin. Our resultsindicate that the disease is still affecting the life of people in the province but has low percentage of rifampicin resistance in those patients. This keeps encouraging the continuous use of this drug against this bacterium. Moreover, the results attract the health facilities to use GeneXpert as reliable tool to diagnose MTBand whether it is resistant or sensitive to rifampicin.

This study was intended to explore if infected burns of patients of Al-Diwaniyah City, Iraq, haveKlebsiellaaerogenes as one of the pathogenic bacteria that infect burns or wounds. For such case, traditional, Polymerase chain reaction (PCR), and DNA gyrase subunit B gene (gyrB)-partial sequencing tooling to confirm diagnosis. Primary testing of the sample using blood and MacConkey agars and certain biochemical tests alarmed that the bacterium was present in this specimen. The PCR results confirmed the occurrence of the infection by this bacterial agent. The gyrBgene-partial sequencing followed by drawing a phylogenic tree placed the bacterium in a separate cluster from other Enterobacteriaceae family members. The current study indicates that this bacterium is present in the infected burns or injuries in Al-Diwaniyahcity.Our results have been reviewed the current trends in molecular phylogenetic analysis, A computational phylogenetic study and data was approach and registered Klebsiellaaerogenes with accession number (MG560868.1).

Background:Pediatric asthma is a syndrome of lung dysfunction with an imbalance between the forces that maintain airway patency and those forces that operate to narrow or close the pediatric airway. Zinc has been supposed to have anti-oxidant, anti- apoptotic, anti-inflammatory and anti-allergic effects in the organism . Zinc deficiency is suspected to play a role in the pathogenesis, control, and severity of allergic, skin and airway diseases.
Objectives: To evaluate the relationship between zinc serum level and bronchial asthma( its duration and severity).
Patients and methods: A prospective case –control study was conducted at the central Child teaching hospital in Baghdad in a period extended for six months from 15th March to 15th September , 2016. 47 children from ages 2 to 12 years (mean age 5.6year ) of both gender who were known cases of asthma were enrolled in the study, matched in age and gender with the control group of 47 healthy children without history of chronic disease. The zinc concentrations in serum were measured in both cases and controls.
Results:A total of 94 children were included, 47 patients who were asthmatic (22 males& 25 females). Mean age of children with asthma and control group children was 5.6 year . Body mass index percentile was higher in asthmatic patients (p 0.001). The study shows that asthmatic children significantly more likely to have family history of asthma compared to control group (p<0.001). in this study the meanconcentrations of zinc are lower in asthmatic children(67.4µg/dl) incomparison tocontrols(86.1µg/dl). And a significant correlation between serum zinc level with each of asthma severity and use of steroids and bronchodilator , (p < 0.001) for each.There was no significant association between age , gender, Body mass index(BMI) family history and duration of asthma with the low serum zinc level . (p 0.923, 0.478, 0.343 and 0.138 respectively).
Conclusion:Serum zinc level is lower in patients with bronchial asthma regardless their age and gender, and serum zinc level has significant relation to the severity of asthma and the use of steroid.

Background :
The majority of patients that have been underwent abdominoplasty show lasting weight loss after one year. This long term weight loss may be related to many factors, but the most obvious cause is the increase in satiety feelings full after eating. Many questions remain controversial about the permanent weight reduction.

Methods :
A retrospective study included those patients underwent abdominoplasty and we attempted to determine the most factor associated with weight loss. This study started between April 1999 to June 2010, it includes 40 patients underwent abdominoplasty at general and private hospitals. From the original 40 patients, 18 could not be contact for the follow up interview and thus were excluded from the results of the study. Other 2 patients were also excluded from the analysis because of their pregnancy in the postoperative years. Of the remaining 20 patients (4 males and 16 females), from them 2 patients had previously underwent bariatric surgery but those were included in our results. Those 20 patients ranged in age from 25 to 55 years.

Results:
All patients in this study that undergoing abdominoplasty had weight loss beyond that of their resected pannus, with minimum body mass index reach (18 + 2 weeks) after surgery. The weight loss is due to the increase in satiety by 75% (number = 15). A preoperative basal metabolic index greater than 24.5 K/m² can be used to predict the long term weight loss with sensitivity and specificity 95% and 85% respectively.


Conclusion:
Obese patients performed abdominoplasty with basal metabolic index greater than 24.5 Kg/m², appear to be more liable to lose weight after one year from the time of the operation. This is due to the increased satiety seen in many our patients is related to the changes in the neuroendocrine system. The removal of fat cells from the abdomen may leads to reduce the level of the hormones affecting appetite, which are secreted by fatty tissues. Sustained weight loss was also related more likely to greater amount of excess abdominal tissue removed.

Background:"Tuberculosis (TB) is one of the oldest diseases known to affect humans, it caused by bacteria belonging to Mycobacterium Tuberculosis (M.TB) complex". M.TB iscommonly transmitted from a TB infected person to other person by "droplet nuclei which are aerosolized by coughing, sneezing or speaking. Health care workers (HCWs) are exposed to a variety of infections, including TB, as they perform their job responsibilities". "The standard test for detecting latent TB infection (LTBI) is tuberculin skin test (TST) (Mantoux test) using purified protein derivatives (PPD) of M.TB."
Objectives:The aim is to study the rate of TB transmission from patients with active disease to the HCWs, and also studying the relation of deferent variables to the transmission risk including (Gender, Vaccination, and Duration of contact or work duration).
Methods: Cross sectional descriptive study done in Al Diwaneya teaching hospital (medical department) between September and December 2017.122 HCWs were included in this study their age ranging between 24-40 years mean 32year,100 (82%) were male and 22 (18%) female.
"0.1 ml (5) tuberculin units had been injected intradermally to the volar surface of forearm to be seen within 48-72hours".The test was considered positive if ( >=10mm induration) developed .
Results: The study shows the rate of tuberculin reactivity among HCWs 24.6% (30/122) a significant relationship between duration of work in hospital and tuberculin reactivity among HCWs. Word nursing staff
>10years work duration shows the higher rate (43.8%) followed by emergency nursing staff (30.8%) and then senior house officer (S.H.O) (20.8%), service workers shows (15%) while all joiner house officers included in the study shows (0%) with <2years work duration.
Conclusion:HCWs have high rate of LTBI. Their positivety correlated With the duration of their jobs. this should draw attention for better isolation for patients with TB to minimize the risk of transmission to the HCWs.

Abstract:
Background: Bacterial infections associated with multidrug resistance have been implicated in high mortality and morbidity reported among cancer patients.
Objective:To detect the causes of β-lactamase resistance inEscherichia coli and Klebsiella spp. isolated from colon
Methods: Twenty -eight stool samples from colon cancer patientssamples ,in addition to that, 25 samples were collected from control group (healthpersons). Samples were labeled and transported to the laboratory in portable containerthenstreaked on MacConkey agar and incubated at 37˚C for 24 hours under aerobic condition. The antimicrobial susceptibility testing was done by the agar discs diffusion method. Results: out of 28 samples from colon cancer patients, the results showed that 26 (92.8 %) of stool were positive for culture. The study revealed thatKlebsiellasp.and E. coli were the most common isolated species. The results showed that the vast majority of isolates were found to be resistant to ß-lactam antibiotics (ampicillin and amoxicillin) .
Conclusion and Recommendation:All of the tested E. coli andKlebsiellaeisolates are multidrug resistant; therefore, such organisms represent a serious therapeutic challenge in cancer patients.

Abstract:
Background:Hospitalized infections are major problem affecting millions of peoples each year . Klebsiellainfections are caused mainly by Klebsiellapneumoniae, the medically most important species of an important nosocomial pathogen, most frequently causing various clinical manifestation Objective:To identify the role of Klebsiellapneumoniae isolatesfrom different clinical cases in hospital –acquired infections .
Methods:During the period from March to September, 2018, a total of 110 clinical specimens were collected from patients with different nosocomial infections who were referred to Al-Diwaniya Teaching Hospital .Bacterial isolates were identified to the level of species using the traditional morphological and biochemical diagnostic tests. Multiplex PCR assay was performed to detection and genotyping Klebsiellapneumoniae based on capsular antigen (K) gene.
Results: Out of 110 of different specimens of patients with nosocomial infections, only 39 (35.4%)Klebsiellapneumoniae isolates were recovered. However, 47 specimens of sputum revealed 18 (16.36%) positive result; 37 urine specimens given 15 (13.36%) were positive for Klebsiellapneumoniae and 26 specimens of Burns and wounds gave 6 (5.45%) of K. pneumoniae, specimens. This study revealed that there was a predominance of K57, K1 and K2 serotypes in sputum, urine, burn and wound that isolated from patients with nosocomial infections.
Conclusion and Recommendation:The present study proved that K57 serotype was important virulence factor in the pathogenesis of K. pneumoniae in addition to predominant serotypes (K1 and K2) when compared with local serological studies.

Summary
Type 1 Diabetes millets it has a direct impact on cognitive functions. For prevent this problem, needs a good glycemic control, which can do by self-measurement blood glucose or need assistant from parents or teachers.
The child’s school performance will be best if the blood sugar remains in the acceptable range. Left untreated both high and low blood sugar levels can affect the child’s ability to concentrate on schoolwork and participate in school activities.
The cross section study was conducted on 100 diabetic patients aged between 8-18 years from Aldiwaniyah diabetic center, in Aldiwanyia city, from period of 1st March to 1st June, to estimated the effect of glycemic control on school performance, after selected patients, made an interviewed with them &/ parents, asked about demographical information (age, sex, level of education, residence, occupation & education of parents) disease variables (onset, duration, complication hypoglycemia or hyperglycemia, hospitalization, episodes of admission, insulin treatment times doses, blood sugar level, self measure &injection, regular visit to clinic), bad glycemic controls consider by level of HbA1c above 7% or had hyperglycemia for more than 3 times or hypoglycemia more than 2 times in last six months. School characters (failure, absences, skipping, exercise, activity) Poor school performance consider if she/he had absence from school more than 3 days, had school failure, skipping.
The bad school performance was observed in 73%, those with bad glycemic control represented (61%), in (83.7%) of bad glycemic control had poor school performance, in (79.6) patients with longer disease duration had poor school performance, on other hand (83.6%) of Patients with more frequent admission to hospital due to Diabetics complication had poor school performance.
In conclusion bad glycemic control, frequency of admission and disease duration were negatively effect on school performance, level of education patients his mother and self measurement of blood sugar were a determinants of glycemic control.
Recommendation was concentrated on ways of glycemic control by frequent self measurement, education of patients and relatives on nature of Diabetes and enhance compliance and motivation of patients. Frequent supervising by health care provider to schools of patients for reassurance and support of children and teachers.

Background: Neonatal mortality refers to death of a new born within the first 28 days of life. A child’s risk of death in the first four weeks of life is nearly 15 times greater than any other time before his or her first birthday.
Methods: A cross sectional study was conducted to review records of neonatal deaths that took place in all neonatal care units in AL- Daiwynia province during the year 2013. Data collection form was designed to collect the demographic data, data concerning pregnancy and delivery and any complication during pregnancy, delivery and perperium, mode of delivery, place of delivery and causes of neonatal death. Result: respiratory distress syndrome was the highest among causes of neonatal deaths (55.2%), followed by birth asphyxia (16.5%), sepsis (15%), neonatal jaundice and its complications (7.1%), pneumonia (2.5%), cold injury (1.8%) and diarrhea (0.8). Preterm delivery was noticed in (55%) of the deceased neonates, 37.5% of them were with normal birth weight, 32% with low birth weight, 17.5% with very low birth weight and 13% were with extremely low birth weight.Conclusion: Themost common causes of neonatal deaths wererespiratory distress syndrome, birth asphyxia and sepsis. Prevention of prematurity and low birth weight as major cause for respiratory distress syndrome will lead to a decrease in neonatal mortality and morbidity.

Hepatitis B virus (HBV) is one of the most prevalent pathogens in the world and infection with this virus is a serious threat for public health. The pathogenesis of HBV depends on the critical interplay between viral and host factors.
Test 88 samples for the detection of serological markers using ELISA and PCR technique for positive HBsAg. Regarding population group (HBsAg) positive, the seroprevalence rate of HBsAg, anti-HBs, anti-HBcIgM, HBc Total HBeAg , anti-HBe and HBV DNA were 25%, 5%, 12%, 10%, 9%, 17% and 22% respectively. In this study, hepatitis was diagnosed with the following tests HBsAg, anti-HBs, anti-HBcIgM, anti-HBc total using the ELISA device. HBV DNA was also tested using PCR. To determine the stage of the disease, the HBeAg, anti-HBe and ALT test was added and the stages of the disease were Chronic HBV, Acute HBV, Incubation period, Recovery stage, Window stage, false positive and carrier stage 36.36%, 25%, 17.07%, 15.90%, 2.27%, 2.27 % and 1.13% respectively.

Abstract
Introduction
Patient satisfaction is an important and commonly used indicator for measuring the quality in medical care, Patient satisfaction affects clinical outcomes, patient retention, and medical malpractice claims,it affects the timely, efficient, and patient-centered delivery of quality medical care.
Objective
The aim of the research is to identify the level of satisfaction of patients with chronic diseases aboutsection of pharmacy, and the extent of availability of chronic disease medicationsat Alemamain Al- khadymain medical city, which is the research community.
Method
In this study, the study population was from patients with chronic diseases and those who are the inpatients and outpatients in Alemamain Alkhadimain medical city, and their number is(76576), who received treatment and had clear ideas about the level of medical services provided to them from the period of 1/11/2010 until 1/11/ 2011 , also included a group of pharmacists working in the pharmacy section and its units in the medical city and their number(46), who are responsible for the availability of chronic disease medicines for those patients.
a random sample of 40 patients and 12 pharmacists was selected at the medical city and the forms completed through their interview,the collected data analyzed statisticallyby using the statistical package (SPSS(, to evaluate the level of satisfaction in the areas and aspects of the interview, as well as the testof the scientific hypotheses to determine the extent to which the personal characteristics of the patient affect his or her satisfaction on the hospital as a whole and his satisfactionon the availability of chronic diseases medications .
RESULTS
One of the most important results from this research is that the level of general satisfaction of patients with chronic diseasesin the medical city were not acceptablewith(52.5%), while satisfaction on the availability of chronic disease medications show up (51%), and there was increase in general satisfaction for patients with chronic diseases on the medical city with the availability of medicines for chronic diseases, alsothere were many difficulties encountered in managing the hospitalin the development of strategies and medical policies for the provision of these medications in appropriate quantity and quality.

Abstract
Background:Unovulation is an important cause of female infertility whether primary or secondary. Prostaglandins play an important role in normal physiology of ovulation. Non-steroidal anti-inflammatory drugs (NSAIDs) are often prescribed for treatment of a variety of medical conditions in the field of obstetrics and gynecology. Sufficient controversy about the role of NSAIDs on ovulation exists.
Aim of the study:to evaluate rate of ovulation in two groups one was healthy fertile women receiving NSAIDs and the other group include healthy fertile women receiving placebo treatment.
Patients and methods:The present case control study included two groups of healthy fertile women. The first groups included 30 women who were given the NSAIDdiclofenac sodium (olfen, Novartis) as 100 mg daily oral dose for 2 months duration and the other group included 30 women who were given placebo treatment for the same 2 months period. In the cycle following the completion of the intended period the following investigations were performed: serum progesterone level at day 10 and day 20 of menstrual cycle and ultrasound examination for identification of ovarian follicle size ate day 10 of the cycle and then at day 20 to confirm or exclude ovulation. The study extended from November 2017 to January 2018 and was carried out at Al-Diwaniyah maternity and child teaching hospital at Al-Diwaniyah province, Iraq.
Results:
Conclusion:TheNSAID diclofenac sodium interferes significantly with ovulation in women during their reproductive life and should be use with caution in women seeking pregnancy.

Abstract
Background:
Aim of the study: To assess the value of single serum progesterone in diagnosis of viable, ectopic and failing pregnancy.
Patients and methods: This cross sectional study was done in Al Basra general hospital and Al Basra maternity and child hospital from June 2013 through January 2014. The study included 64 patient, all have 1st trimester vaginal bleeding and/or abdominal pain. From each patient a 5 cc blood sample was obtained for assessment of progesterone and β-HCG, and then patients were sent to ultrasound examination.
Result:Mean age of women enrolled in the present study was 31.21± 4.23 years and it ranged from 20 to 35 years.Mean gestational age was 8.30 ±2.15 and it ranged from 6 to 12 weeks. Ultrasound examination revealed that 36 patients (56.3%) had viable pregnancy, 18 patients (28.1 %) had failing pregnancy and 10 patients (15.6%) had ectopic pregnancy. Mean serum progesterone in women with viable, failed and ectopic pregnancies was 20.01 ± 1.7 ng/ml, 9.09 ± 8.2 ng/ml and 19.7± 16.3 ng/ml.The sensitivity and specify of single serum progesterone measurement in diagnosis of pregnancy failure in this study were 72.2% and 66.6%, respectively while those of serum β-HCG were 95.4% and 98.1%.
Conclusion: Single serum progesterone is not of significant value in predicting pregnancy outcome.

The study was intended to evaluate the role of ultrasound as diagnostic technique in the diagnosis of breast diseases, comparing it to the conventional and widely used technique i.e mammography,FNAC and histopathology.
THE breast diseases were divided according to their clinical and ultrasound criteria into simple cyst(10), galactocele(3), fibro adenoma (64), carcinoma (36), duct ectasia (6), abscess (3), mammary dysplasia (25) , and undetermined cases (3).
All those patients were subjected for pathological confirmation by needle aspiration cytology in (80) and/or excisional biopsy in 110 patients.Twelve patients refuse FNAC (18%). The age of the patients ranged from 15-80 years with a mean of 40 years .One hundred and fourteen(76), patients had benign lesions and 36 cases of them (24%) had malignant lesions. For cystic lesions like simple cyst, abscesses , and cystic changes of mammary dysplasia , the study shows 100% sensitivity , specificity and accuracy. For FNAC , the sensitivity , specificity, and accuracy were 91% 92% respectively. For carcinoma of the breast , thee sensitivity , specificity and accuracy were 86.7% , 91%. And 90% respectively ,which is less because of some overlap of the ultrasonic criteria of benign and malignant lesions.The sensitivity ,specificity and accuracy of ultrasound is high, especially in benign lesions . therefore ultrasound is an accurate , safe , and non-invasive technique for diagnosis of breast diseases in addition to be without danger of radiation, especially for young patients less than 35 years of age.

Abstract
Intestinal anastomosis is one of the most commonly performed procedure it is required to re-establish gastrointestinal continuity after surgical resection , traumatic disruption or bypass procedure.
Since the second half of the 20th century , mechanical suture (stapler) has been in use and became a popular method in bowel anastomosis.
Our study involved the comparing of the postoperative outcome between hand sewn anastomosis(HS) and stapled anastomosis(SA) for patients with trauma cases in emergency and elective cases .mainly in the view of duration of operation , postoperative hospitalization time , fistula formation rate , morbidity and mortality .
There were no significant differences between SA group and HS group in operative indication or other parameters.
In both emergency and elective intestinal surgery comparable results can be achieved using mechanical and manual anastomosis with the same outcome and no significant differences found only in the duration of the operation.

AbstractINTRODUCTIONNeonatal seizures are the most frequent and distinctive manifestations of neurological disturbances during the neonatal period. This retrospective study aimed to determine the incidence rate, causes and risk factors for neonatal seizures in Al-Diwanyah Province during one calendar year from the 1st of January, 2016 to 31st December, 2016
METHODS.Data were extracted from the records at Maternity and children Teaching Hospital in Al-Diwaniyah. All neonates who had developed clinically recognized seizures before 28 days of life were enrolled in the study. These data included gestational age (full or pre-term infant), maternal diseases and drug intake during the last trimester, family history of seizures, number of parities, consanguinity, mode of delivery (normal vaginal delivery or caesarian section) age and gender of neonate, body weight at birth (normal or low body weight), and age at which seizure has developed (early onset or delayed onset). Biochemical tests were blood sugar and serum calcium.

RESULTS
Out of 3167 recorded birth in the hospital, 113 neonates have developed seizure with overall incidence rate of 3.57%. Four main causes of seizures were recognized which were: asphyxia (34.5%), hypoglycemia (23%), hypocalcemia (14.16%) and intraventricular hemorrhage (7.08%). However, in 21.42% of cases, the cause(s) was/were undiagnosed.
DISCUSSION
Three risk factors (gender, family history of seizures and number of parities) were found to have no significant association with any of these causes of seizures. The other risk factors associated with these causes in different modes. Each of early onset of seizure, mother’s disease during pregnancy, caesarian section delivery and full term infant were significantly associated with hypoglycemia. Hypocalcemia, on the other hand, was significantly associated with delayed onset of seizures and preterm infants with low body weight, while there was very significant association between asphyxia and normal vaginal delivery. Although less frequent than other causes of seizure, intraventricular hemorrhage was found to be significantly associated with three risk factors (delayed onset of seizures, normal vaginal delivery and preterm infants). Finally, a positive significant association was found between consanguinity and undiagnosed causes of seizures
CONCLUSION.
These results pointed out the importance of asphyxia and hypoglycemia as the main causes of neonatal seizures. The most important risk factors associated with these causes are normal vaginal delivery, mother’s disease during pregnancy, and low body weight at birth.

Abstract
Background:Malnutrition is one of most serious world health problems and is the major cause of illness and death throughout the world. It is associated with about half of all child death. It affects physical growth, morbidity, mortality, cognitive development, reproduction, and physical work capacity, and it consequently impact on human performance, health and survival. Thus, when attempting to reduce child mortality, monitoring and reducing the prevalence of malnutrition in vulnerable population is essential. Malnutrition is an outcome of various factors resulting from unfavorable socioeconomic circumstances.
Objective: To determine the prevalence of undernutrition (wasting, stunting and underweight) and associated maternal risk factors of children under 5years in Babylon.
Methods: Across-sectional study design was used to study a group of 400 children, aged 2- 60 months. The sample was convenient, the data collected from four health centers during the period from 25th of February to 10th of May 2013. Assessment of maternal risk factors for child malnutrition was accomplished through a structured questionnaire used to interview child’s mother. The anthropometric measurements were assessed according to standard techniques used to calculate z-score for height for age (stunting), weight for height (wasting) and weight for age (underweight). As reference curve, the World Health Organization Child Growth Standard was used
Results: The prevalence of malnutrition of children under five years in Babylon was 19.25% found as 15% for stunting, 3%for wasting and 4.75% for underweight. The majority 52% were males, 48% were females. Malnutrition was higher among children aged 13-24months (35%) and higher among family who had three or more children less than 5 years (16%). Also the study revealed that malnutrition was higher among mothers who had primary education (62%). Higher prevalence (66%) was present among children who live in rural area. In this study, the prevalence of acute malnutrition (wasting) was higher among infant aged 2-12 months (84%) and higher prevalence of wasting (50%) among those children who had history of illness (acute or chronic).
Conclusion: There was high prevalence of malnutrition in Babylon and there are several risk factors associated with malnutrition. Prominent risk factors include low educated mothers, child age, child birth order, high numbers of children under five years and living in rural area.

Background:
Lung cancer is responsible for the most cancer deaths in both men and women throughout the world. Deaths from lung cancer (160,440 in 2004, according to the National
Cancer Institute) exceed thenumber of deaths from four other major cancers combined(breast, colon, pancreatic and prostate).

Objective:
To assess the behavior and the approaches oflung cancer in a sample of Iraqi patients.

Methods:
This descriptive retrospective study was performed using the records of 450 patients proved to have lung cancer that had attending the chest department in ALdiwanyah teaching hospital for the period from January,1st,2003 December,31st,2018.

Results:
The results of this study revealed that 70% of the patients were male, with a mean age of 63 years. The majority of the patients (96%) were smokers, the numberof cases increases with the increase in the duration of smoking or the amount of daily cigarette smoking. ,that can be calculatedinto tow groups(more than 20 pack-yearwere 80% while less than20 pack-year were 16%).


Conclusions:
Lung cancer is an important and serious public health problem with an increasing in incidence and prevalence in Iraq; cough is the most common clinical finding, found in 60% of patients, followed by chest pain (22%); cigarette smoking is responsible for the at least 95% of its etiology. Sequamous cell carcinoma is the most common type of primary lung cancer in Iraq (44%) with prominence in male gender; adenocarcinoma is the second common type(30%). Key words: Lung cancer, Bronchogenic carcinoma,Tumor

Background: Fiber-Opticbronchoscopy is a diagnosticand
therapeutictool for the managementof therespiratory diseaseswithhigh safety profile
Aimof study: To analysethefindings of the fiberoptic bronchoscopies of theincluded patientsinourstudy..
Patientsand Methods:
A retrospectivestudywas doneto findoutthedemographic
profiles,bronchoscopicindication,findings, diagnosis and complicationsof the patientswho underwent bronchoscopiesexaminations intherespiratory unitatAldiwanyahteachinghospital in2014and 2015.
Results:
Amongstthe 102patients,commonestindicationof bronchoscopy wasradiological opacityfoundin81.2% of patients,followedbyunexplained cough 10% of patients.Mostcommon clinical presentations of the patientswas Cough(81.4%),followedbydyspnea (34.3%).

Outof 102patients,61patients (59.8%)were males, 44patients
were currentsmokers.
A 41patients (40.2%) werefemales, 21patients were currentsmokers.Thepatient's agerangefrom 15to 75years,the mean ageof males were58.8±10.6andfor femaleswere 52±15.4.Themostcommonfinding onbronchoscopy wasabnormal mucosa foundinabout55.9% of patients.Malignancywas seenin46.1% cases,whileTuberculosisseenin9.8%.
Thesequamouscell carcinomawas the most histological type (44.7%)of patient diagnosedwithcancer.
Inthe102patientthe bronchoscopydone withneither deathnor serious complications occurrencelikespneumothoraxor cardiac arrest.
Themostcommoncomplicationwasmildnasalbleedingduring procedure in(24.51%).
Conclusion:
Fiberopticbronchoscopy isa useful diagnostictestfor differentlung pathologieswithhighsafety profileregardingsevercomplications.

ABSTRACT
Background :
Enoscopic polypectomy in those patients with chronic rhinosinusitis and nasal polyps have many objects. These are :
Opening diseased sinus ostia to help restoration of mucociliary clearence ,removing the diseased tissue to alleviate symptoms of nasal blockage, help in delivery and distribution of topical nasal therapy to the diseased mucosa in the nose and paranasal sinuses, especially to the frontal and sphenoid sinuses and also to open the olfactory cleft area to improve the sense of smell.
Objectives : To discover the frequency of recurrence of sinonasal polyp post surgical removal by means of endoscopic polypectomy (EP) also the associated risk factors that predispose to that recurrence.
Design : prospective study.
Patient and method : Thirty two patients presented to the (E.N.T.) department in ALdiwaniyah general Hospital suffering from sign and symptom of nasal polyp resisting to medical polypectomy, with different ages and sex were studied from period of April 2018 to March 2019 ,and they were submitted for full history, clinical, endoscopic examination, radiological evaluation ,then the patients submit to of Endoscopic polypectomy, later on follow-up was done for period of 12 month that included: frequent endoscopic nasal examination.
Results : In this study we evaluate the frequency of the recurrence of nasal polypos post endoscopic polypectomy was 25%.

Conclusion: The overall recurrence rate was 25%, the highest frequency of recurrence was during the period of first six months post surgery and especially after the forth month.

Aim of the study :
To evaluate frequency of the recurrence of sinonasal polyp post endoscopic polypectomy (EP) . also the associated risk factors that predispose to that recurrence.

Abstract:
Background
Metatypical cell carcinoma (MTC) is a new entity of skin cancer. It represents an intermediate type between basal cell carcinoma (BCA) and squamous cell carcinomas (SCC). The behavior of the metatypical cell carcinoma lies between these two varieties of skin cancer. The differential diagnosis can not be made depending on morphological and clinical features, so histological examination is mandatory.
Methods
It is a retrospective study carried out on of 120 patients with metatypical skin cancer who were treated by surgery, radiotherapy and chemotherapy.
Results
It was found, that more males (62.5%) are affected with MTC than females (37.5%) with predilection for cervicofacial areas (71.7%), then the trunk (10%), the limb (9-6%), the scalp (3.7%) and other regions (5%) (Table 1). The disease recurred in 12 cases (10%) mainly in head and neck areas.
Conclusion
In this study, I have focused on the importance of differential diagnosis and specific treatment of MTC, even though more clinical studies and long-term follow up are needed before establishing specific guide lines.

Abstract
Background: Minimum elevation of serum creatinine,even within normal reference range are associated with worse outcome of the patients.
Objective: The application of the most recent definition of AKI proposed by the Acute Kidney Injury Network (AKIN),published in March 2012 to promote the earlier detection of HAAKI.
Patients&Method: Cross –sectional observational study conducted in the medical ward in Al-Diwanyia Teaching Hospital for a period 9 months from 1st of January to 30 of September 2013 . All adolescents & adults patients who fulfill the criteria of the study included. Data about demographics ,co-morbidities of patients & serial measurement of (S.Cr) were directly collected . The definition of AKI according to Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury -2012,based on AKIN criteria.

Result:
Out of 522 patients included in the study( the mean age of them 59 ± 23) ,HAAKI (stage1)were recorded in 79 (15.13%) patients , elderly patients aged ≥ 65 represent 50.63% of all cases of HAAKI(without significant gender variation). About 19 patients(24.05%) morbidities HAAKI due to intermingle co morbidities. The most 3 prevalent co morbidities were reported either independent or in association with other co morbidities in patients with HAAKI,1stone diabetes mellitus , 51 diabetic patients which represent 64.5% of total 79 patients with HAAKI & 37.22% of total diabetic patients studied . The 2nd was sepsis which reported in about 37 patients (46.83%).About 36 patients (45.56%) had HAAKI due to nephrotoxic drugs which represent the 3rd more frequent co morbidities.

Limitations: Single-medical ward study of limited period .Classification of the diseases according to conventional method.
Conclusions: Our results suggest that HAAKI is a common complication . Our efforts should be focused to prevent or minimize the risk factors of HAAKI (particularly in advanced age).