Al-Qadisiyah Medical Journal

Background: The second-leading source of neoplasm-related death and a primary factor in gastrointestinal Cancer, colorectal
Cancer (CCR) affects both genders globally. Poor eating behaviors, tobacco, an intestinal inflammatory disorder, swellings,
inherited characteristics, and the elderly all increase the threat of acquiring this malignancy. The illness is more hostile in patients
detected at earlier ages, although 90% of patients with colorectal tumors are older than 50, with a median oldness of 64 years.
American Cancer Association estimates that it caused more than 49,700 fatalities in 2015.
Objectives: The current study aims to study the correlation of CEA, with ALT, AST, ALP, TSP, TSB, Neutrophils, lymphocytes, and
NLR parameters in patients with colorectal carcinoma.
Methods: The serum CEA of all subjects was measured by the ELISA technique (Enzyme enzyme-linked fluorescent Assay), ALT,
AST, ALP, TSP, as well as TSB were measured by colorimetric methods, and neutrophils, lymphocytes as well and NLR were
measured by an Electrical Impedance Cell Counting methods ( CBC, automated machine ).
Results: The {mean ± SD} of Ages and Genders among Patients with healthy groups were not significant. The neutrophil count
was significantly higher in the patient subjects compared to healthy subjects. In addition, the lymphocyte count was significantly
lower in the patient subjects compared to healthy subjects. Moreover, the neutrophil to lymphocyte ratio (NLR) was significantly
higher in the patient subjects in comparison with the control subjects. Mean serum CEA was significantly higher in the patient
subjects in comparison with the control subjects.
Conclusion: The study results of the correlation between serum CEA, hematological materials, and other parameters in colorectal
carcinoma patients show a significant positive correlation of CEA, with ALT, AST, ALP, TSP, neutrophils, lymphocytes, as well as NLR
and weak significance with serum TSB.

Background: Enterococcus faecalis is a gram-positive, facultatively anaerobic, catalase-negative, oxidase-negative, non-sporeforming
bacteria belonging to the genus Enterococcus frequently lives in the intestines of healthy people. It typically appears in
pairs or chains of various lengths and its Microorganisms with mesophilic characteristics grow for ten – fifty four ∘ C and optimal
temp comprised between 30 ∘ C and 35∘ C. They are also able to grow in a huge range of pH from 4.4 and 9.6 and in hyper salty
media with 6.5% NaCl.
Objective: This study aims to molecularly detect some genes that are responsible for virulence factors (agg and hyl) by PCR
technique.
Materials and Methods: 130 clinical specimens were acquired from patients who were admitted to the Maternity and Pediatric
Teaching Hospital in Al-Diwaniyah City during the period from November 2022 to March 2023. Each specimen was tested for
culture on multiple types of media (Blood agar, MacConkey, Bile Esculin agar, and Chromogenic ager) followed by biochemical
testing (Catalase test and Oxidase test). After cultivation, the samples were identified by using the VITEK-2 compact system. The
isolates were investigated genotypically for harboring virulence factors genes that include agg and hyl by molecular methods PCR.
Results: The VITEK-2 compact system revealed that only 12 isolates were identified as Enterococcus faecalis. The results showed
the percentages of genes were (75%) and (41.6%) for agg and hyl respectively.
Conclusion: It has been found that the existence of several virulent factor genes in E. faecalis, such as egg and hyl, boosts this
pathogen’s pathogenicity, and amongst E. faecalis isolates, the agg gene exhibited a greater proportion, confirming the critical
need to develop control the infection associated with the development and increase pathogenicity of this pathogen.

Background: corticosteroids are synthetic derivatives that differ in their metabolic and electrolyte-regulating activities. These
agents are employed at physiological doses for replacement therapy when endogenous products are impaired. Long-term use is
associated with certain toxicities. Increased use of topical and systemic steroids for the treatment of many skin problems leads to
an increase in their side effects and misuse. Steroid components have been synthesized with adequate anti-inflammatory effects
and minimal adverse effects. The newest topical corticosteroids are used for the treatment of different dermatoses and allergies.
New topical corticosteroids are evaluated to compare the risk/benefit ratio.
Objectives: The present study aims to find the prevalence of acne form rash due to misuse of topical and systemic corticosteroids
among patients aged 15-50 years in AL-Diwaniyah Teaching Hospital in Iraq.
Subjects and methods: This cross-sectional study and hospital-based based involved 112 patients who answered a questionnaire
which consisted of 23 questions about patients and drugs. This study started on March 8th and ended on June 8th, 2023 during
this period data was collected from the outpatients in the dermatological unit in Al-Diwaniyah Teaching Hospital.
Results: The side effects of steroid use among the study participants are shown in Table 1. Acne and redness were reported in 54
(48.2%) of the cases. Hyper-pigmentation was reported in 24 (21.4 %) cases. Pruritus and dryness were reported in 21 (18.8 %) of
them. Rosacea was reported in 4 (3.6 %) cases. Hirsutism was reported in 3 (2.7 %) samples. Photosensitivity was reported in 2
(1.8 %), infection in 2 (1.8%), and allergy reported in 2 (1.8%) of them. The mean age of all the enrolled subjects was 29.39 ±9.93
years and the mean age of subjects with acne was significantly lower than the subjects with other symptoms, 23.13 ±6.45 years
versus 35.22 ±9.03 years, respectively (p < 0.001).
Conclusion: The study revealed that steroids induce acne is a common problem. Cosmetic concerns, over the counter availability
of topical corticosteroids, media advertisement of facial creams in Iraq, and the lack of knowledge about side effects and doses
of steroids led to the misuse of drugs.

Background: Obesity is a growing health concern worldwide, and Iraqis are no exception to this trend. Medical students have
a critical role in promoting healthy lifestyle habits and preventing chronic diseases, including obesity. Therefore, understanding
their attitude and practices regarding obesity is crucial in developing effective interventions to tackle this issue.
Aim of the study: To evaluate attitudes, and practices regarding obesity and its complications among medical students at the
University of Al-Qadisiyah.
Participants and method: A cross-sectional study had been conducted from March to July 2023, and included 136 participants.
Descriptive statistics were used to summarize the demographic information and the responses to the questionnaire. Inferential
statistics were used to determine the association between the variables and the level of attitude, and practice among medical
students regarding obesity.
Results: The study included 36 (26.5%) of students at the clinical stage and 100 (73.5%) of students at preclinical stage. Females
accounted for approximately two times the proportion of males in the study. Most of the students in the study were between
the ages of 20 - 22 years and (80.9%) of them were from urban areas and (68.4%) of the students were of normal weight. The
students were categorized based on the results of 100 point scores into 32 (23.5%) with low attitude, 96 (70.6%) with moderate
attitude, and 8 (5.9 %) with good attitude. There was no significant difference in mean attitude score based on gender, age, years
of study, and residence. There was no significant difference in mean attitude score based on body mass index (BMI). The students
were categorized based on the results of 100 point scores into 81(59.6%) with low practice, 53(39.0%) with moderate practice,
and good with good practice. There was no significant difference in mean practice score concerning gender, age, years of study,
and residence. There was no significant difference in mean practice score concerning BMI.
Conclusion: Medical students have a moderate attitude toward obesity, but it is worth mentioning that there was a relatively high
rate of they ashamed of their bodies if they were fat. Practice toward obesity and its complications was relatively low and medical
students should be encouraged healthy lifestyles.

Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine condition in women of reproductive age,
increasing the risk of infertility. It affects an estimated 12-21% of women of reproductive age and involves clinical signs such as
oligo or anovulation, hirsutism, acne, and polycystic ovaries on ultrasound. Many women with PCOS (between 38% and 88%)
are overweight or obese. Even modest weight loss of 5% body weight has been shown to result in significant improvements
in both symptoms of hyperandrogenism and ovulatory function in women with PCOS. The majority of women with PCOS also
experience metabolic dysfunction, which is commonly referred to as Metabolic Syndrome (Mets). Metabolic Syndrome is a
condition that is characterized by a combination of different physiological and metabolic abnormalities. These abnormalities
include hyperinsulinemia, hyperglycemia, hypertension, and dyslipidemia.
Aim of the study: The present study aims to evaluate the confounding effect of a high body mass index which is associated with
PCOS among patients in AL-Diwaniyah city in Iraq.
Subjects and Method: The study was planned to be a case-control study to assess the prevalence of polycystic ovarian syndrome
in relation to BMI in cases in AL-Diwaniyah city in Iraq. At the end of the study, 120 women were separated into two groups. The
first group consisted of 60 women with PCOS illness, while the second group consisted of 60 normal women who had not been
diagnosed with PCOS. Each group was further subdivided into two groups where group[A] was overweight, and group[B] was
normal weight.
Results: There was a significant difference in mean BMI (p 0.001), with the PCOS overweight-obese group having the highest
mean BMI, followed by the control overweight-obese group, then the control normal weight group, and lastly came the PCOS
normal weight group. Furthermore, there was a significant difference in mean waist circumference (p 0.001), with the PCOS
overweight-obese group having the highest mean waist circumference, followed by the control overweight-obese group, the
control normal weight group, and finally the PCOS normal weight group. There was no statistically significant difference in marital
status between the research groups (p = 0.082). Furthermore, there was a significant difference in the frequency of difficulties in
lowering waist circumference (p 0.001). The highest frequency was seen in the control overweight-obese group, followed by the
PCOS overweight-obese group, the control normal weight group, and lastly the PCOS normal weight group.
Conclusion: According to the current study findings, overweight and obese women tend to have a greater prevalence of PCOS
than normal-weight individuals. It is crucial to indicate that PCOS can develop in women of normal weight.

Delivering bad news which is usually refers to convey any information that seriously and negatively affects the patients
and or their families’ views to the present or future life, regards as one of the most difficult tasks that face physicians during their
professional life regardless to their qualification.
Aims of the study: To evaluate physicians’ awareness of delivering bad news to their patients and their behavior in relation to
breaking bad news in Al-diwaniya province. Method: Across sectional study conducted among physicians from different hospitals
and primary health centers in Al-diwaniya City, from both sex, male and female. The study involved doctors from different
specialties and qualifications. The study sample was 200. Results: 200 doctors agreed to participate in the study, 55.50% of
them were females and 44.50% males. The study showed that 68% of the participants didn’t receive any structured education
or training for breaking bad news. Also, the study revealed that 81.50% of the doctors in this study preferred to talk to patient’s
family rather than patients in delivering bad news. Majority of the participants (91.50%) though that more attention should be
paid for education and training of doctors during studying and residency period, while 74.50% of them felt that they are in need
for more training and education. Conclusion: 68% of the study sample didn’t receive training and education for breaking bad
news and 91,50 % agreed more attention for training and education should be given.

Introduction:
Visual symptoms are important and critical clinical manifestations of pituitary apoplexy. Visual loss needs more rapid and critical
for achieving a better outcome.
Aim of study:
Based on early pituitary apoplexy decompression, the present study evaluates the visual results of the surgical operation for
pituitary apoplexy.
Patients and methods :
The study had been conducted between January 2019 and January 2022. Patients with radiological and clinical findings that
indicated pituitary apoplexy were included in the study and they were divided into two groups. Group A included those who
presented early and underwent early surgical intervention(35 patients and two were excluded from the study lost in follow-up)
and Group B included those who presented late (34 patients one lost during follow-up) and were scheduled for surgery (early
<72 hrs., late>72 hrs. . ).
Results :
Pituitary apoplexy affects 66 patients, with a mean age of 35.66 years and a range of 16 to 68 years out of whom 34 (51.51%)
were men and 32 (48.48%) were women.
Visual problems were a common symptom among all the individuals where Bi-temporal hemianopia was the most prevalent
visual complaint in 44 patients (66.66%), followed by mono-ocular hemianopia in 13 patients (19.69%), both eye blindness
in 4 patients (6.06%), right blindness in 4 patients (6.06%), and left blindness in 1 patient. P value < 0.05 which is statically
significant that early presentation with early surgical intervention had a better response than late presentation with late surgical
intervention.
Conclusions :
Early surgical decompression of the pituitary fossa for apoplexy yielded better results in terms of the resolution of visual issues.

background
Damage to the heart and blood vessels, as well as to other organs and premature death, have all been related to hypertension, a
multifactorial, progressive cardiovascular disease. The aldosterone-renin ratio (ARR) is a useful screening measure for secondary
hypertension, which can be caused by primary aldosteronism. Angiotensin II receptor blockers (ARBs) are the most often
utilized medications that influence the renin-angiotensin system. These drugs prevent the physiological effects of angiotensin II
by binding to angiotensin type 1 receptor AT1R. Blood pressure can be lowered by inhibiting AT1R, as this results in decreased
production of vasopressin and aldosterone with subsequent relaxation of blood vessels.
Objective :To determine the association between aldosterone renin ratio and response to valsartan in iraqi patients with
essential hypertension.
Method: This is an observational cross sectional descriptive single center study for 90 hypertensive patients of Iraqi nationality
who taking valsartan tablet 160 mg/oraly once daily for at least two week.
Result:There is no significant relationship between aldosterone renin ratio and response to valsartan( p>0.05).
Conclusion: There is no association between aldosteron /renin ratio and response to valsartan .

Background: The global pandemic has posed significant challenges for medical students, resulting in increased rates of
depression, anxiety, and stress. The pandemic has also resulted in substantial disruptions to academic endeavors, clinical
training, and prospective career opportunities. Many students have faced increased academic demands as they strive to adapt
to virtual learning methods while also dealing with the uncertainty surrounding future clinical placements.
Objective: To assess the prevalence of perceived stress associated with the outbreak of Coronavirus disease 2019 (COVID-19)
among medical students and to investigate potential correlating factors to higher prevalence.
Subjects and methods: The study constitutes a cross-sectional analysis which was constructed retrospectively through
surveying 350 students who are currently at the 4th, 5th, and 6th stages of medical college. The online questionnaire contained
a number of questions that were categorized into three sections including prevalence of stress, influence of socio demographic
characteristics, and reflections of stress-related to the pandemic on student social life.
Results: The study found that 223(63.71%) students suffered from stress related to the pandemic. Stress was uniformly
distributed among students according to age and sex, as non-significant association was discovered. However, being at an
advanced stage of medical education imposed a significant association with high rates of stress (P=0.007). Similar observation
was also seen among students who are their parents achieved higher education (P<0.001) and those who are living in urban
areas of cities (P=0.009). Similarly, students who showed higher prevalence of stress were also more likely to present worse
reflections on student personal and social life, (P<0.001).
Conclusion: The study revealed that the COVID-19 pandemic has resulted in significant levels of stress among medical
students that were evidently higher with every higher stage of medical education. The pandemic has also impacted students’
social lives and compromised both psychological wellbeing and medical education. It is anticipated that the effects of COVID-19
on the study of medicine and the welfare of students will be substantial and enduring, highlighting the need for a
comprehensive preparedness strategy