Iraqi Postgraduate Medical Journal

Over the recent decades, we have seen an explosion in scientific knowledge, and medical technology has made it difficult for individuals to keep up with the current advancement. This explosion has established the need for sub specialization.
Historically, the practice of medicine went through historical phases. In Mesopotamia, there were two types of doctors: Asu, the scientific doctor, and Asipu, the temple healer. Both were treating people, dentists, and veterinarians.(1) Egyptian medicine was as advanced with some specialization.

BACKGROUND:
Lymphocele is one of the common complications following renal transplantation, and usually present with persistent lymphatic drain in immediate post-transplant period or perigraft (between the kidney allograft and the urinary bladder) collection in post-transplant routine ultrasound (1). Lymphorrhea or lymphorragia is defined as a lymph leak from the surgical drains or from the abdominal wall through the surgical wound (2).
AIM OF STUDY:
To compare between lymphatic’s ligation and electrocauterization in reducing post kidney transplantation lymphocele.
PATIENTS AND METHODS:
design: Prospective comparative study. Setting: Kidney Transplant Center in Medical City. Study period: From the1st August 2017 till 1st August 2019. Sample size: 100 patients with end stage renal disease. Exclusion criteria (Death, graft loss within 4-6 weeks, lack of follow-up).
RESULTS:
In this study, we noticed that lymphocele formation was in 20% of patients who were managed by lymphatic electro cauterization which was significantly higher than that in patients who were managed by meticulous ligation of lymphatics (6%) (P= 0.037). Regarding the mean of duration until drain removal, was significantly higher in cautery group than that in ligation group (7.1 versus 5.8 days, P= 0.02). Intervention needed for symptomatic lymphocele was greater in patients managed by lymphatic electrocauterization which was statistically significant (P= 0.045).
CONCLUSION:
We found that a meticulous surgical technique with ligation of all lymphatics, was significant in reducing the incidence of lymphoceles following kidney transplantation in our recipients.

BACKGROUND:
Risk stratification for patients with acute pulmonary embolism (PE) is important to create applicable treatment and management. Computed tomography pulmonary angiography (CTPA) is the first-line imaging method for assessment of patients PE. The different parameters of this modality can be used as predictors for survival in those patients.
AIMS:
This study aimed to assess the value of some parameters of CTPA as predictors for short-term mortality in patients with acute PE.
PATIENTS AND METHODS:
This is a prospective study which included a total of 30 adult patients with acute PE diagnosed with CTPA. Patients’ demographic and clinical data were recorded. Patients were followed up for 30 days after first diagnosis, and the survival rate was recorded. The CTPA parameters including the diameter of pulmonary artery (PA), ascending aorta (AO), superior vena cava (SVC) and inferior cava (IVC), right ventricle/ left ventricle diameter ratio, PA/AO ratio, inferior vena cava reflux as well as bowing of interventricular septum and clot burden according to Qanadli score (QS) were analyzed and compared between survivals and non-survivals.
RESULTS:
The 30-day survival rate in the present study was 73.33%. None of included demographic factors was significantly associated with the survival rate, while only the presence of abnormal coagulation, as comorbidity, was significantly associated with reduced survival rate. Four CTPA parameters were found to be significantly decreasing the survival rate. These were RV/LV over 1.2 (OR=19.0, 95%CI= 2.54-141.93), followed by IVC reflux (OR= 10.56, 95%CI=1.61-69.12), PA/AO ratio over 1.0 (OR= 12.6, 95%CI= 1.07- 148.13), and QS over 18 (OR=6.33, 95%CI= 1.0 to 40.07).
CONCLUSION:
CTPA findings that may predict the short term mortality were RV/LV diameter ratio more than 1.2, the high grades of IVC reflux, PA/AO ratio over 1.0 and QS >18. However, most of these parameters are non-specific for PE.

BACKGROUND:
World Health Organization (WHO) termed coronavirus disease 2019 COVID-2019, then declared it as a pandemic. It was documented that survivors of COVID-19 were at risk of developing anxiety, depression, and insomnia. This study was carried out to report on prevalence of psychiatric symptoms and identifying some determinants.
PATIENTS AND METHODS:
A total of 120 patients with COVID-19 were included in this study. Their age was 22 to 91 years giving male to female ratio of 1.6:1. They were selected conveniently (they were hospitalized in Al-Shafa center). The hospital anxiety and depression scale was used.
RESULTS:
Out of the total, 66% and 52.9% were showing anxiety and depression, respectively. Elderly COVID-19 patients were significantly prone for anxiety and depression (p = 0.0001 for both). No significant difference in anxiety and depression between males and females (p=0.8 and 0.7, respectively). Number of children was not significantly affect anxiety and depression (p=0.6 and 0.1, respectively). Marital status was without any impact on anxiety and depression (p=0.3 and 0.4, respectively). Education level had no impact on anxiety and depression (p=0.6 and 0.2, respectively). History of mental illness was not affecting anxiety (p=0.3) and significantly affect depression (p=0.0008).
CONCLUSION:
High rates of anxiety and depression were noticed. Elderly patients more significantly prone to anxiety and depression. Sex, size of family, and education level were not affecting anxiety and depression. History of mental illness significantly affects depression.

BACKGROUND:
The assessment of the level of some biochemical parameters (liver function test, renal function test, serum ferritin and plasma D-dimer) revealed that the Covid-19 infection affected the level of them. The study aimed to demonstrate the biochemical changes of liver and renal functions tests, serum ferritin and plasma D-dimer in Iraqi patients with Covid-19 disease.
PATIENTS AND METHODS:
A retrospective cross sectional study conducted in Isolation centers for Covid-19 patients in Baghdad and AL-Najaf AL-Ashraf Governorate from July 2020 to February 2021. Forty five males and 76 females were included in this study. The exclusion criteria were patients below eighteen years old age, pregnant women, and subjects with hematological diseases, cardiovascular disease, liver diseases and renal diseases. All parameters measured by automated method by Beckman coulter Au480 chemistry analyzer.
RESULTS:
Covid-19 infection was more in females than males and it is more in post middle age (41-50 years old). In the current study, most of the biochemical parameters (AST, ALT, urea, serum ferritin, AST/ALT ratio<1 and plasma D-dimer) increased through the period of Covid-19 infection of them AST, ALT, urea and AST/ALT ratio <1 were more increased in females. The age was significantly negative and positive correlated with the activity of AST and urea concentration respectively. The gender was significantly positive correlated with AST/ALT ratio. There was no correlation between plasma D-dimer and serum ferritin with other biochemical parameters except for AST activity which was significantly positive correlated with serum ferritin.
CONCLUSION:
Most of the biochemical parameters (AST, ALT, urea, plasma D-dimer and serum ferritin) were affected by Covid-19 infection which indicated organs damage. The age and gender were affected the activity and level of some biochemical parameters (AST and Urea were significantly negative and positive correlated with age respectively and AST/ALT ratio was significantly positive correlated with gender).

Background: Anorectal malformations (ARMs) include a wide spectrum of diseases affecting male and female neonates and involve the rectum, anal canal, and genitourinary tract.

Objective: To know the actual incidence of anorectal malformations in Mosul city, upgrade clinical knowledge about ARMs between health workers and midwives who look after newborn babies, and assess the related mortality in the limited resources zone.

Method: A closed cohort study was conducted on patients with ARMs admitted to the pediatric surgery centre between January 2018 and January 2019. Patients included in this study are those with ARMs in the neonatal period, those admitted for pull-through or closure colostomy. We excluded from this study any Patients born before 2018 or those not operated.

Results: sixty-two patients were included in this study with a Male: female ratio of 1.3:1. The estimated incidence was 4 per 5000 live birth. Twenty-eight (45.2%) patients presented after 48 hours of birth (Delayed diagnosis), with a median age at diagnosis of two days. Twenty-five (40.3%) from a total of 60 operated patients had associated congenital anomalies. Forty-three (69.3%) patients had colostomy (mainly transverse colostomy), with some cases have completed their three-stage procedure. Mortality was recorded in 5 (8%) cases ( four males and one female, with major congenital anomalies).

Conclusion: ARMs represent one of the stressful GIT anomalies to pediatric surgeons. The overall outcome is greatly influenced by age at diagnosis, surgical experience, and associated anomalies. The major subtypes that need three stages surgeries require great efforts and more hospital resources. We recommend the need for widespread teaching programs for midwives and health workers to diagnose and refer ARMs cases to the tertiary centres as soon as possible to minimize complications and hopping lessen the mortality rate.

BACKGROUND:
Breast cancer is the most common malignancy in women in the United States and is second only to lung cancer as a cause of cancer death. Worldwide, breast cancer is the most frequently diagnosed cancer and the chief cause of cancer death among females.
The National Comprehensive Cancer Network Guidelines recommend taxanes for the treatment of early-stage and metastatic breast cancer. Peripheral neuropathy is a common non-hematological side effect of taxanes, which may result in chemotherapy delays, reductions, discontinuations and poor quality of life. Taxane-induce peripheral nerve damage can lead motor and sensory symptoms. Initial detection of peripheral neuropathy simplifies complete regression since an acute taxane induce peripheral neuropathy is both reversible and mild to moderate in severity.
Till now, there are no accepted preventive procedures or expectable parameters for chemotherapy induced peripheral neuropathy including taxanes, however duloxetine 60mg was official in large randomized phase 3 trials for treatment of chemotherapy induce peripheral neuropathy.
PATIENTS AND METHOD:
Single institution retrospective study started between November 2019 to December 2020, was conducted in Babil Oncology Center/Babil/Iraq which included 60 randomly selected patients with breast cancer, receiving chemotherapy including Taxane group and had undergone nerve conduction study. A collected multiple demographic parameters were compared by dividing the patients into two groups; patients who developed taxane induce peripheral neuropathy and patients who were not developed, these parameters were: patient age, body mass index , hormonal receptor status, human epidermal growth receptor 2 status, metastatic setting and duration and period of last cycle of taxane received. The clinical information, histological and immunohistochemistry laboratory results for each patient obtained from the Oncology Patients Archive Unit, then the statistical process was carried out on the collected information.
RESULTS:
Of 60 patients included in this study, 15 patients (25 %) developed taxane related peripheral neuropathy, of whom 13 (86.7%) developed mixed sensorimotor peripheral neuropathy and two (13.3%) patients developed sensory neuropathy. While the severity ranged from mild (one patient), mild to moderate (10 patients), moderate (4 patients) and there was neither sever nor life threatening peripheral neuropathy. The mean age of patients was 51.38 years and mean body mass index of patients was 26.24 Kg/m2. Peripheral neuropathy had statically significant association with age, body mass index and human epidermal growth receptor 2. Peripheral neuropathy was somewhat more in metastatic setting but statically insignificant.
CONCLUSION:
About one fourth of patients developed peripheral neuropathy after receiving taxane chemotherapy. Elderly, obese patients and patients who have human epidermal growth receptor 2 positive tumors are predictors for taxane induce peripheral neuropathy.

BACKGROUND:
Left ventricular hypertrophy is a significant risk factor for cardiovascular complications such as ischemic heart disease, heart failure, sudden death, atrial fibrillation, and stroke. A proper non-expensive tool is required for detection of this pathology. Different electrocardiographic (ECG) criteria were investigated; however, the results were conflicting regarding the accuracy of these criteria.
OBJECTIVE:
To assess the accuracy of three electrocardiographic criteria in diagnosis of left ventricular hypertrophy in adult patients with hypertension using echocardiography as a reference test.
PATIENTS AND METHODS:
This is a hospital-based cross sectional observational study which included 340 adult patients with a history of hypertension (240 patients with left ventricular hypertrophy and 100 patients without depending on Echocardiographic results). Three electrocardiographic criteria including Sokolow Lyon Voltage, Cornell voltage, and Cornell voltage duration were evaluated for their sensitivity and specificity in detection of left ventricular hypertrophy in those patients.
RESULTS:
Each of older ages (over 50 years) (OR= (OR=6.25, 95%CI=3.75-10.39, p<0.001), male gender (OR=0.58, 95% CI= 0.36-0.93, p= 0.018) and type 2 diabetes mellitus (OR=8.14, 95%CI= 4.04-16.41, p<0.001) were significantly associated with development of left ventricular hypertrophy in patients with hypertension. The sensitivity and specificity of Sokolow Lyon Voltage, Cornell voltage, and Cornell voltage duration were 17.5% and 96%; 13.33% and 97%; and 10% and 98%, respectively.
CONCLUSION:
Older ages, male gender, and type 2 diabetes mellitus can increase the risk of left ventricular hypertrophy in hypertensive patients. All the studied criteria have low sensitivity and high specificity in recognition of the left ventricular hypertrophy in patients with hypertension, with no advantage of definite criterion over the others.

ACKGROUND:
Alopecia areata is an inflammatory, non-scaring type of hair loss. Microneedling is a new therapeutic procedure used in dermatology. It facilitates the absorption of topical therapies across the epidermis.
AIM OF STUDY:
Evaluating the efficacy of Microneedling combined with clobetasol propionate 0.05% cream versus clobetasol propionate 0.05% cream alone in treatment of alopecia areata.
PATIENTS AND METHODS:
This study was carried out on 20 patients and the total number of patches was 99. In the same patient, at least 2 patches were selected to be treated as group A or B; so, the 99 patches were divided in to two groups.
Group A: Microneedling combined with clobetasol propionate 0.05% cream: 51 patches (from 20 patients) were treated using a dermapen devise. The cream was applied before and after microneedling and a total of four sessions were done at 2 weeks interval, then patients were seen after 2 weeks from the last session for follow up. Group B: clobetasol propionate 0.05% cream alone: 48 patches (from the same 20 patients) were treated, the cream was applied twice daily with gentle massage for 3-5 minutes for 8 weeks duration. Patients were seen at 2 weeks interval.
RESULTS:
At 8th week visit: the response to treatment in group A was seen in 58.8% of the patches and 63.3% of them showed complete coarse hair regrowth while in group B, the response to treatment was seen in 58.3% of the patches and 32.1% of them showed complete coarse hair regrowth. When two groups were compared regarding complete hair regrowth there was statistically significant difference.
CONCLUSION:
Combination of Microneedling with clobetasol propionate 0.05% cream is a promising, safe and easy to perform technique in the treatment of alopecia areata

BACKGROUND:
Dental phobia is a serious condition with a multifactorial etiology. To overcome the negative impact of dental phobia and avoidance of dental treatment on oral health the prevalence of dental phobia, socio-demographic and clinical factors were investigated in this study.
AIM OF THE STUDY:
To assess the prevalence of dental phobia among adult patients consulting dental clinics in Primary Health Centers. To study the socio-demographic and the clinical characteristics factors associated with dental phobia.
METHODOLOGY:
It is a descriptive, cross-sectional study that was conducted on 211 patients consulting dental clinics in five different Primary Health Centers (PHCs) belong to Al Karkh district.
RESULTS:
The study showed that (7.6%) of patients had dental phobia. Dental phobia was more prevalent in females. The age group recorded the highest level of dental phobia was 20 -29 years old. Regarding the categories of MDAS fear from anesthetic injection was the most influential item. There was positive association between dental phobia and emergency dental visits. There was positive association between dental phobia and being unable to delay dental treatments due to painful or trouble complains. There was positive association between dental phobia and fear from blood, injection and injury. Also dental phobia was higher among patients who experienced discomfort from smelling sterilizers, seeing needles or white coats of medical staff, or hearing sounds of drilling.
CONCLUSION:
7.6% of the patient had dental phobia. Fear from injection of local anesthesia was the main influential item in MDAS. Dental phobia was common in females and in younger age group.

BACKGROUND:
The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was introduced to standardize terminology used in reporting thyroid cytology. The Bethesda system used six categories for thyroid cytology reporting. Each diagnostic category is linked to a certain risk of malignancy and recommended clinical management.
AIMS:
To evaluate FNAC in thyroid nodules based on the Bethesda system for thyroid cytopathology.
SETTINGS AND DESIGN:
A cross-sectional study.
METHODS AND MATERIAL:
Study conducted in Al-Imammain Al-Kadhimian (AS) Medical City in period from 1st Jan 2019 – 1st August 2019. We performed FNAC either directly or under U/S guide, and all slides were examined by one cytopathologist and residents of histo- cytopathology.
RESULTS:
There were 357 patients who enrolled in this study. Their mean age was 44.25 ± 13.49 years. Female patients represent 88.8% of total patients with male to female ratio is 1:6. The non-diagnostic sample (Bethesda I) was found in 66 (18.5%) patients, the benign thyroid lesion (Bethesda II) was found in 217 (60.8%), atypia of undetermined significance (Bethesda III) was found in 34 (9.5%), follicular neoplasm or suspicious for follicular neoplasm (Bethesda IV) was found in 38 (10.6%), and suspicious for malignancy (Bethesda V) was found in 2 (0.6%), while no case was diagnosed with malignancy (Bethesda VI). The higher value of TSH is associated with lower Bethesda score; also, the higher value of T4 is associated with lower Bethesda score too. There were 16 (4.5%), 74 (20.7%), 10 (2.8%), and 11 (3.1%) of patients that presented with nodular surface of thyroid gland that were diagnosed with I, II, III, and IV Bethesda system respectively.
CONCLUSION:
Bethesda system gave us a uniform terminology in reporting thyroid cytopathology. The most frequent category was category II. Thyroid nodules presented in older age group compared to other studies. Most of thyroid nodules are benign rather than malignant.

BACKGROUND:
Ovarian serous neoplasms are the most common type of epithelial ovarian tumors, classified as Low-Grade Serous Neoplasia (inclusive of benign serous cyst adenoma, borderline serous tumors, low grade serous carcinoma) and High-Grade Serous Carcinoma. P16 is a cyclin-dependent kinase-IV inhibitor that mediates its action through inhibitory effect on the cell cycle, Ki-67 determine the proliferating cells of the tumor, is strictly connected with cellular cycle.
OBJECTIVE:
The aim of the present study is to diagnostic evaluate of p16 and ki67 protein expression in of ovarian serous tumors in Iraqi patients.
MATERIAL AND METHODS:
52 cases of ovarian serous tumors specimens were studied. Using p16 (Mouse monoclonal p16 antibody, Cytoplasm and Nuclear expression) and ki67 (monoclonal mouse antihuman Ki-67/MIB-1 antibody, Nuclear expression).
RESULTS:
There is a significant correlation of p16 and ki67 expression in ovarian serous tumors. P16 Immune reactive score cases with score 3 of high grade serous carcinoma 69.2%, low grade serous carcinoma 7.7%, borderline serous 15.4%, and no any case of ovarian serous cyst adenoma. Ki67 labeling index expression in all cases of ovarian serous cyst adenoma, 76.92% borderline tumors, 92.96% low grade serous tumors with low labeling index. While 100% high grade serous carcinoma, 23.07% borderline tumors, 7.7% low grade serous carcinoma with high ki67 labeling index.
CONCLUSION:
Significant correlation of p16 expression in ovarian serous tumors, with strong diffuse expression in high grade serous carcinoma. P16 can be used as a diagnostic marker. Ki67 has been reported to be of a diagnostic value in differentiation of low grade serous carcinoma from high grade serous carcinoma.

BACKGROUND:
Fifty percent of blindness worldwide is attributed to cataract, and cataract surgery is the most common surgery performed by ophthalmologist.
OBJECTIVE:
The objective of this study was to investigate the changes in anterior segment parameters and its correlation to IOP changes after phacoemulsification.
PATIENTS AND METHODS:
It’s a prospective cohort study that was done at Ibn Al-Haitham Teaching Eye Hospital for patients planned to have phacoemulsification, for 55 patients during 8 months, from the 1st.July.2018 to 28th.Feb.2019. The data included full preoperative and postoperative assessment, key parameters were: axial length measurement, intraocular lens, anterior chamber depth, anterior chamber volume, and anterior chamber angle for the four quadrants.
RESULTS:
There were statistically significant differences in preoperative compared to postoperative values of intraocular pressure (decreased by 4.55 mmHg), anterior chamber depth (increased by 0.74 mm), volume (increased by 32.75 µl), and mean angle (increased by11.78 degree) maximum inferiorly (12.31 degree) and minimum superiorly (8.29 degree). There was no statistically significant correlation between intraocular pressure changes with anterior chamber depth, volume, or angles, but there was a statistically significant correlation with preoperative intraocular pressure (correlation coefficient 0.513).
CONCLUSION:
A decrease in intraocular pressure does not correlate with anterior chamber depth, volume, and angle, so IOP seems not related to anatomical changes directly but to facility of drainage change after the surgery or uveoscleral outflow increase. The decrease in intraocular pressure was significantly higher in patients with higher preoperative values of intraocular pressure.

ABSTRACT:
BACKGROUND:
Dacryocystorhinostomy: a surgical procedure to bypass the lacrimal sac and duct to create new path of tear into nose to treat epiphora (tearing due to reduced transport of tear or defective drainage of tear outflow caused by obstruction of nasolacrimal duct).
OBJECTIVE:
Our study’s aim was to compare the surgical outcomes between endoscopic DCR and endocanalicular diode laser DCR including pre operative circumstances, type of anesthesia, intraoperative duration and amounts of bleeding, post operative pain and complications, success rates after 9 months of follow up.
PATIENTS AND METHODS:
60 patients were operated; 30 of them as endoscopic DCR group A (28 of them in Al Shaheed Ghazi Al Hariri Teaching Hospital and other 2 in Al Mukhtar Hospital) and 30 as Endocanalicular diode laser DCR group B in Ibn Al-Haithem Teaching Hospital in period between June 2017 to June 2018. All patients were assessed by detailed history and examination included fluoresceine dye, probing, irrigation of Lacrimal system and nasal examination.
RESULTS:
60 patients, mean age was 36.43 ± 17.405 years(5-79 years), 16 males and 44 females, 31 left eyes and 29 right eyes ,the chronicity of symptoms ranged from 6 months to 14 years, CT scans were done for 24 patients (22 in group A and2 in group B). The mean duration of operation was 38.13± 9.51 minutes in group A, 32.63±11.02 in group B. The mean intraoperative bleeding was 68.93±29.49 ml in group A, 56.33±21.57 ml in group B. There is no significant difference in pain and complications in both groups. The success rate in group A was 96.67% while in group B was 63.33%. The results were comparable to other studies.
CONCLUSION:
Both our groups have the advantages of: absence of facial scar, short duration especially in Endocanalicular diode DCR, less bleeding and pain, lacrimal pump preservation with successful rate comparable to the external DCR especially in endoscopic DCR.

BACKGROUND:
Varicocele is a disease characterized by abnormally engorged veins of the pampiniform plexus. The prevalence of varicocele is approximately 15% in adult males. Multiple classification systems are available for grading varicoceles, all of them are non-ideal. Ultrasound elastography (USE) is a new imaging technology that examines tissue stiffness. Elasticity imaging by USE provides stiffness measurement as additional information to conventional US.
AIM OF THE STUDY:
Is to examine changes in testicular stiffness in varicocele in an attempt to assess the role of Shear wave elastography in testicular varicoceles and to provide additional diagnostic data to further improve and unify a grading system for varicoceles.
PATIENTS AND METHODS:
A cross sectional descriptive study undertaken on sixty-three patients which took place at Al-Yarmouk Teaching Hospital, Baghdad, Iraq, in the period between Jan. 10th to Nov. 11th, 2020. Standard scrotal ultrasonography followed by two-dimensional shear wave elastography were done for all patients. Sixty-three patients (126 testes) were divided to three groups; group (A): testes with a maximum venous diameter of less than 1.9mm representing non-varicose testes, group (B): those with a venous diameter between 2 and 3.4mm, and group (C): with venous diameter of equal or more than 3.5mm. Three stiffness measurements were taken by elastography in supine position with another three measurements in erect posture.
RESULTS:
Twenty-seven percent of subjects had normal testes, while 73% had varicoceles. 50% of varicoceles were bilateral, while 48% were left sided. Only one case (2%) had a right sided varicocele. There were no statistically significant differences between the mean volumes of the aforementioned groups. A weak negative correlation observed between the pampiniform venous plexus diameter and testicular stiffness, the mean testicular stiffness of group A was 2.85 ± 0.47 while groups B and C showed a mean stiffness of 2.80 ± 0.51 and 2.73 ± 0.44 kilo Pascals respectively. The differences were statistically insignificant between these groups. There was a highly significant difference between supine and erect testicular stiffnesses. Normal testes showed 19% increase in their mean stiffness in upright posture, as compared to varicose testes which demonstrated 13% increase.
CONCLUSION:
Shear wave elastography is a modern technology, however; its role in discriminating between grades of varicoceles is limited.

BACKGROUND:
There are obvious effects of war trauma on students 'life performance causing long lasting impact when occur before adulthood. Early recognition and treatment are vital.
AIM:
To assess knowledge, attitude and practice of secondary school teachers’ toward psychological support to their student and the factors that affect them.
METHODS:
Cross sectional study conducted in Baghdad 2018 by using a structured questionnaire developed upon WHO guidelines and the International Federation of Red Cross and Red Crescent Societies guideline for psychological support. A total of 235 teachers completed the questionnaire.
RESULT:
Mean age of participants was 44.51±9.17 years, 75.7% were female, 70.2% college graduate, 72.8%married, 80.1% had 1-3children, and 30.2% had 26 and above years of experience. Only 8.5% of participants had training on psychological support. Good knowledge was found in 66.8% of participants. Accepted attitude toward positive- adaptive behavior was found in 80.0%, discovering students’ weak points in 70.2% of them. Indeed, 83.0 % of teachers had good practice about students’ psychological- support. The association between teachers’ knowledge, attitude and practice and their psychological- support-training were statistically not significant, while significant association was found between teachers’ knowledge about Supporter-teacher stress relive points with their psychological support providing, significant association was found between teachers’ attitude about discovering weak points with their psychological- support- providing.
CONCLUSION:
Most of the teachers had good knowledge but only nearly one-tenth of them had training on psychological support, also nearly one-third of participants said that Psychological Support guideline is available in their school.

BACKGROUND:
Gastric carcinoma is the fifth most common cancer worldwide. P53 is tumor suppressor gene, located on chromosome 17p13.1, involved in cell senescence and differentiation. In gastric cancer, P53 expression had shown to be associated with bad prognosis.
AIMS OF THE STUDY:
To determine P53 immunohistochemical expression in gastric adenocarcinoma and correlate it with clinic-pathological variables.
MATERIALS AND METHODS:
Forty formalin fixed, paraffin embedded tissue blocks (24 endoscopic biopsies & 16 gastrectomy cases) included in this retrospective study, collected from archived materials from Baghdad hospitals & laboratories (from January 2019 to December 2020).
Two sections of 5μm thickness were done, one stained with H&E and the other for P53 using mouse monoclonal antibody (clone BP-53-12).
RESULTS:
Immunohistochemical expression of P53 was expressed in 32 cases (80%) (24 cases intestinal type adenocarcinoma & 8 cases diffuse type adenocarcinoma). Five had score +1, eleven had score +2 and sixteen had score +3. Twelve lymph nodes positively expressed p53, eleven of them (91.7 %) involved by metastatasis.
CONCLUSION:
P53 significantly expressed in intestinal type adenocarcinoma and directly related with tumor differentiation, depth of invasion and lymph node metastasis but not with tumor location.

Pembrolizumab is an effective anticancer immunotherapy. It is generally well tolerated although immune-related adverse events can occur. Autoimmune thyroid dysfunction is the most common one among these events. Several evidences suggested that pembrolizumab can induce thyroid dysfunction after several treatment cycles. The aim of the study is to evaluate the incidence and risk factors of thyroid function abnormalities related to pembrolizumab therapy.
This is a multicenter prospective study including 100 patients with different cancers who initiated pembrolizumab treatment. Demographic data was collected in addition to the number of treatment cycles, history of thyroid surgery, thyroid disease, chemotherapy and steroid treatment. Baseline T3, T4 and TSH were measured and assessed periodically. Patients were distributed into 2 groups, those who maintained euthyroid state and the others who developed thyroid dysfunction. Assessment was analyzed looking for any relationship of this dysfunction with age, gender, dose, underlying diagnosis or previous disease or treatment lines.
Thyroid dysfunction was reported in 31 patients (31%). Female patients were the predominant affected group, (P <0.001). Intriguingly, 38.75% of patients with euthyroidism were ex/current smokers compared with 19.35% of patients with thyroid dysfunction (P <0.028). The median number of pembrolizumab cycles in patients with euthyroidism and with thyroid dysfunction was 5.0 and 6.5, respectively (P <0.028). Finally, the presence of thyroid disease was more frequent among patients with thyroid dysfunction than those with euthyroidism (P <0.005).
Conclusions: A considerable proportion of patients receiving pembrolizumab can develop thyroid dysfunction. Female gender, number of treatment cycles and history of thyroid disease may be risk factors for thyroid dysfunction in those patients.