Iraqi Postgraduate Medical Journal

Cancer, the leading cause of death worldwide, is emerging as a major public health challenge of this era (1). Currently there are over 50 million people living with cancer all over the world with an estimated 10 million dying annually from the disease; nearly 70% are from developing countries (2). Cancer incidence and mortality rates will continue to rise owing to demographic changes associated with population growth and aging (3); the highest are likely to be registered in low- and middle-income communities for reasons attributed to lifestyle modification, urbanization, exposure to carcinogens and limited resources for diagnosis and treatment (4). The financial, physical and emotional strains on cancer patients and their families yield a considerable economic impact specifically when the disparities in access to care within the weak health systems lead to advanced stages at cancer presentations, prolonged disability and premature deaths (5). According to the latest global cancer statistics (1,2), breast cancer is the most prevalent malignancy worldwide (11.7%), surpassing lung cancer (11.4%) and followed by colorectal (10%), prostate (7.3%) and stomach cancers (5.6%). On the other hand, lung cancer is the leading cause of cancer mortality (18%), followed by colorectal (9.4%), liver (8.3%) stomach (7.7%) and breast cancers (6.9%).

BACKGROUND:
Preeclampsia is associated with ischemia and increased oxidative stress in the placenta. Ischemia-modified albumin has been widely accepted as a serological biomarker in preeclampsia.
OBJECTIVE:
To evaluate the relationship between maternal serum and cord blood ischemia modified albumin levels with preeclampsia severity and neonatal outcome.
PATIENTS AND METHODS:
This study includes 90 pregnant women who were divided into three groups: Group 1 includes 30 pregnant women with severe preeclampsia. Group 2 includes 30 pregnant women with mild preeclampsia. Group 3 includes 30 normotensive pregnant women with uncomplicated pregnancy considered as control group. The three groups were matched for age and gestational age. Maternal blood sample and neonatal cord blood were collected from all groups and level of ischemia Modified Albumin concentration was measured by kit uses enzyme – linked immune sorbent assay.
RESULTS:
The mean of maternal serum and cord blood Ischemia modified albumin of group A and Group B were significantly higher than that of group C (P- value =0.001), The study shows significant inverse correlation with neonatal birth weight and level of ischemia modified albumin within the study groups.
CONCLUSION:
Maternal serum and cord blood Ischemia Modified Albumin levels were significantly higher in severe preeclampsia than in mild and uncomplicated normotensive pregnant women, also their levels were inversely correlated with neonatal birth weight.

BACKGROUND:
COVID-19 disease represented pandemic severe respiratory syndrome affecting hundreds of millions all over the world. The computerized tomography (CT) with polymerase chain reaction tests represented the common diagnostic methods.
OBJECTIVE:
To compare COVID-19 severity scores between CT scan Total Severity Score (TSS) and British Society of Thoracic Imaging (BSTI) scores in addition to compare the CT scan severity score of COVID-19 with different clinical data.
PATIENTS AND METHODS:
A descriptive observational cross sectional study was carried out inX-ray Institute/ Medical Complex/ Baghdad/ Iraqbetween 1st of June, and 31st of November, 2020 on a sample of 100 patients with COVID-19. The data was collected from the patients or their relatives. Severity of COVID-19 disease was classified according to TSSand according to BSTIscore.
RESULTS:
There was a highly significant association between severe BSTICT score and moderate CT scan TSS (p<0.001). Severity was significantly increased among patients with severe BSTI CT score of COVID-19 patients (p<0.001). The characteristics related to increased CT severity score of COVID-19 infection are elderly age, male gender, cough, fever, dyspnea, past medical history, delayed CT, and hypoxia.
CONCLUSION:
CT scan is helpful for diagnosis and severity categorization of COVID-19 infection and the CTBSTI score of COVID-19 severity is directly related to CTTSS.

BACKGROUND:
Pseudotumor cerebri (PTC) is an entity of uncertain cause recognized by increased intracranial pressure. The diagnosis rely on clinical symptoms, absence of structural, hydrocephalus, , vascular or intracranial mass lesion on imaging, increased cerebrospinal fluid pressure measured by lumbar puncture, and normal CSF composition. MRI (magnetic resonance image) and MRV (magnetic resonance venography) findings have been reported to be associated with Pseudotumor cerebri.
OBJECTIVE:
To assess the validity of individual magnetic resonance imaging (cross-sectional and venographic) signs associated with PTC and determine whether the gathering of cross sectional magnetic resonance image and magnetic resonance venography findings enhances the PTC diagnostic certainty.
PATIENTS AND METHODS:
It is a case-control study that 30 patients were included with PTC and 41 healthy persons. All participants (patients and controls) were subjected to brain MRI and MRV. MRI evaluated the presence or absence of the reported findings. Studies of MRV were evaluated the stenosis of transverse venous sinuses.
RESULTS:
Showed that partially empty sella had the best sensitivity (90%) with a specificity of 80.5%. Posterior displacement of stalk: had a sensitivity and specificity of 76.67% and 65.85%, respectively. Peri-optic nerve (PON) sheath distention revealed a sensitivity and specificity of 76.67% and 92.68%, respectively, making it one of the best MRI signs. These MRI signs when combined with MRV, the sensitivity and specificity of all signs increased largely.
CONCLUSION:
Three MRI signs; partially empty sella, posterior displacement of stalk, and PON sheath distention strongly suggest the diagnosis of PTC. Using MRV in combination with MRI findings greatly enhances the diagnostic value of all individual MRI findings in the detection of PTC.

BACKGROUND:
The coronavirus disease (COVID-19) pandemic has resulted in an unexpected high number of hospitalizations for pneumonia with multiorgan illness. It may be asymptomatic or may cause a wide range of symptoms. COVID-19 may cause inflammation in the larynx, trachea, bronchi, beside the lungs. In the diagnosis of COVID-19 patients, computed tomography (CT) with polymerase chain reaction tests has been reported to have a high sensitivity.
OBJECTIVE:
The study aimed to investigate the value of extended chest CT scan to the neck in adult COVID-19 patients.
PATIENTS AND METHODS:
This was a cross-sectional study including 120 patients who were admitted and treated at Al-Imamian Al-Kadhimiyain Medical City, Baghdad, Iraq, during the period from 1st April to 1st December 2021 due to signs and symptoms indicating for COVID-19 infection. Data was collected from patients or their relatives through direct interview and fulfilling prepared questionnaire. According to total severity score, the severity of COVID-19 disease in the chest was graded, also complete neck assessment was done especially lymph nodes (LNs), trachea and vocal cords by extended chest CT to the neck.
RESULTS:
There were two extended chest CT features differed significantly in COVID-19 patients from non-COVID-19 patients: higher number of thickened vocal cords and presence of cervical pathological lymph nodes (level II) in COVID 19 patients in compare to non-COVID -19 patients, also in comparison to mild and moderate cases, severe patients have three distinct characteristics. The mean internal tracheal diameter in severe cases was lower than either moderate or mild cases, the frequency of pathologic lymph nodes (level II) in severe was higher and all pathological cervical lymph nodes in severe cases were in right side and in comparison to mild or moderate cases there was a highly significant differences.
CONCLUSION:
The most important findings in extended chest CT scan to the neck in adult COVID-19 patients are frequent vocal cord thickening and pathological lymph nodes of level II. These findings mostly associated with severe COVID-19 cases in addition to unilateral involvement of neck lymph nodes.

BACKGROUND:
Celiac disease is one of the commonest autoimmune, systemic diseases, occurs at any age in genetically predisposed individuals. It occurs in female more than male. H .pylori chronic gastritis occurs in association with celiac disease, the relations are poorly understood, many studies showed that H.pylori chronic gastritis trigger autoimmune response in celiac disease, other suggest that H.pylori reduces immune response.
OBJECTIVE:
To evaluate the association of Helicobacter pylori chronic gastritis with celiac disease in terms of clinical presentation, histological features (including Marsh grading of celiac disease and Sydney system classification of chronic gastritis), celiac serology and endoscopic findings.
MATERIAL AND METHOD:
A cross-sectional retrospective study conducted in the Department of Pathology/ Collage of Medicine /Al-Nahrain University for a period from January 2020 to March 2021. A study included analysis of 164 cases of celiac disease as control group and 164 cases had celiac with H.Pylori associated gastritis as a case group collected sample of Iraqi patients from January 2017 to December 2019.
RESULTS:
In this study, 374 cases were included; out of this numbers, 210 cases (56.1%) had associated H. Pylori chronic gastritis, whereas 164 cases (43%) were endoscopically negative for changes of H.pylori chronic gastritis (as mentioned by gastrointestinal specialist), this relation was statistically significant (P value < 0.05). In case group (Celiac disease and H. Pylori gastritis), the mean age was 34.6±15.3 years; the age range was 9 -85 years. In control group (Celiac disease only), the mean age was 30.8±13.9 years; the range was 3.5 - 83 years. The commonest symptom was epigastric pain which was significantly higher in 66 patients (40.7%) in cases versus 38 patients (23.3%) in control group (p value < 0.05). The endoscopic findings were significantly different between case and control groups (p value < 0.05), normal finding was found in 5 patients (3.1%) of the cases in comparison to 81patients (49.4%) of the control .Pangastropathy was significantly higher in case group (112 patients, 69.1%) than control group (6 patients, 3.7%). Classification of duodenal histopathological changes of cases groups according to Marsh Oberhuber classification (1999) showed that Marsh 3b was more in both case and control groups. In (marsh 3a), 11patients (42.3%) had mild atrophy, 3patients (20.00%) had moderate atrophy. In (marsh 3b), 12 patients (46.20%) had mild atrophy, 12 patients (80%) had moderate atrophy, 1patient (100.00%) had severe atrophy. In (marsh 3c) 3 patients (11.50%) had mild atrophy; this relation was statistically significant (P value=0.02). In (marsh 3a), 14 patients (20.9%) had gastric atrophy. In (marsh3b), 25 patients (26%) had gastric atrophy. In (marsh 3c), 3patients had gastric atrophy, this relation was statistically significant (P value <0.05).
CONCLUSION:
There is statistically significant association between H.pylori chronic gastritis and celiac disease (p value=0.017). No significant difference in classification of celiac disease according to March Oberhuber (1999) between case and control groups; however, Marsh3b was in 79(48.2%) of control group and in 93(56.7%) of case group. There was a significant association between presence and grade of atrophy of gastric mucosa in chronic gastritis in and Marsh grading of celiac disease in case group.

BACKGROUND:
Carcinoma of the endometrium is the most common gynecologic malignancy in developed countries. Estrogen and progesterone receptors are present in most cases of endometrial adenocarcinoma of endometrioid type, with low-grade tumors being almost invariably positive.
OBJECTIVE:
Evaluation of estrogen and progesterone receptors expression in endometrial carcinoma and their correlation with age, grade and stage of tumor.
MATERIALS AND METHODS:
This is a retrospective study using data collected form archived materials from Teaching Laboratories of Baghdad Medical City ,the period of the study (from February 2020 to December 2020) including formalin fixed, paraffin embedded tissue blocks. Three sections of 5µm thickness were taken from each block, the first was stained with (H&E) for histological revision, the second section was stained for ER and the third section was stained for PR to determine the signal specificity.
RESULTS:
Twenty five cases of endometrial adenocarcinoma were studied. In this study, the peak incidence of endometrial carcinoma was found to be in the range of (61-70) years old. Most cases showed grade I (40%) and grade II (44%). Seventy two percent were positive for estrogen receptor and (60%) of all tumors reacted positively for progesterone receptor. Co-expression of both estrogen receptor and progesterone receptor were noted in (52%) of cases.
CONCLUSION:
Majority of cases with endometrial carcinoma were found to be of grade I and grade II (low grade) and confined to the uterus (stage I & II) at time of diagnosis and most of them express ER and PR and half of the cases express both.

BACKGROUND:
Colostomy in patient with ARM has complications. There are some risk factors have impact on complications development.
OBJECTIVE:
Predict risk factors for development of stoma complications in ARM patients.
METHODS:
A prospective study conducted on neonates and infants with ARM who underwent colostomy at the department of pediatric surgery - central Child Teaching Hospital/Baghdad-Iraq from January/2019 till January/2021, searching for stoma complications and evaluating the effect of several variables on stoma morbidity.
RESULTS:
A total (64) patients, the most common associated anomaly was cardiac one. The mean operative time was 69.8 minutes. The mean stoma duration was (9.7) months. The postoperative stoma care was good in (59.4%) and poor in (40.6%) cases.
54.7% of patients had complications. The most common were skin excoriation. Mortality was reported in two cases (3.1%).
CONCLUSION:
Colostomy Creation carries a lot of complications. Variables of sex, associated anomaly, operative time, stoma care, and stoma duration were determinant of morbidity while age, weight, type and level of stoma have no significant associations. Loop type has shorter operative time but higher incidence of UTI than divided one. Prolapse of stoma was not related to stoma type.

BACKGROUND:
In pregnancy, Gestational Diabetes Mellitus is considered as intolerance to carbohydrate which discovered in pregnancy. It is a glucose metabolism abnormality associated with long and short-term morbidities that could affecting both of the offspring and mother such as shoulder dystocia, preeclampsia or hypertension.
OBJECTIVE:
To evaluate the level of serum adropin in pregnant ladies with Gestational Diabetes Mellitus (GDM) in comparison with that of normal euglycemic pregnant patient.
METHODS:
At National Diabetes Center and AL-Yarmouk teaching hospital, a case-control study was done for the period from January 2020 to October 2020. Forty pregnant ladies with Gestational Diabetes Mellitus (cases) and fifty healthy pregnant ladies (controls) were involved. Lipid concentration and serum adropin were evaluated between 24th-28th weeks of pregnancy for the two groups. The results were compared between them using independent sample t-test.
RESULTS:
Serum adropin was significantly correlated with maternal age, and fasting blood sugar and 2-hour blood glucose measurement after subjecting them to 75-gram Oral Glucose Tolerance Test (p-value: 0.004, 0.001, 0.001) respectively but, serum adropin was significantly negatively associated with Gestational Diabetes Mellitus (AUC: 0.927, PV=0.001, 95%CI: 0.860-0.964) the cutoff point of 38.05 with sensitivity of72.5% and specifity of 98% was considered as the most accurate point of adropin concentration for diagnosis of Gestational Diabetes Mellitus.
CONCLUSION:
Low level of serum adropin is independent diagnostic factor for Gestational Diabetes Mellitus.

BACKGROUND:
Colorectal cancer is the fourth most frequently diagnosed cancer after lung, breast and prostate cancer, and the second leading cause of cancer death after lung cancer globally. Sometimes, distant metastases can cause the initial clinical symptoms. Synchronous metastatic colon cancer define as initially presented metastatic disease.
OBJECTIVE:
To evaluate the clinical presentations of patients with synchronous metastatic colon cancer, the outcome of current chemotherapy protocols used and their toxicity in our center for those patients , and to correlate the different clinical and pathological parameters in patients with this disease .
PATIENTS AND METHODS:
This is a hospital based prospective study would hold in Oncology Teaching Hospital Medical City during the period from 1 July 2019 – 1 July 2020. 50 patients would be recruited, all have evaluated by histopathological and radiological parameters, all diagnosed as metastatic colon cancer who are treated with chemotherapy and biological agents. All involved cases would be re-assessed after at least 4 cycles of treatment by physical examination, Lab investigations and Survival curve then demonstrate to shows the relation between the outcome and prognostic factors.
RESULTS:
In this study a total of 50 patients were involved ; All of them were diagnosed and treated for synchronous metastatic colonic cancer. the median age of diagnosis was 55.30 years, males in this study were higher than females (56% versus 44%); of enrolled patients 74% were with negative family history.Our study shows that the left side of involvement was the predominant (54%), and the highest proportion of patients in both groups were with single metastasatic site (52%); and the liver was the most common single site of metastasis in (40.0%) of patients In both groups, the most frequent clinical features were altering bowel habit and abdominal pain which reported in (60.0%) the highest proportion of patients in our study were treated with both chemotherapy and target therapy, (78.0%) all of them were receive XELOX {xeloda tablet and oxaliplatin} as chemotherapy and Avastin as target one ; in both groups the commonest grade of differentiation is the grade two (82%); while adenocarcinoma was the commonest histopathological type (92%). The primary tumor was resected in (62%) of patients all due to intestinal obstruction. Reassessment of all patients in both groups was done by Lab investigation and radiological assessment, the median progression free survival was 24.7 months.
CONCLUSION:
In our study, the progression with statistical significance was seen among patients with right sided tumor, patients with multiple sites of metastases, those who treated by Chemotherapy only without target therapies, and in patients who had mucinous adenocarcinoma .

BACKGROUND:
Stroke is a clinical diagnosis that refers to sudden onset focal neurological deficit of presumed vascular origin. MR perfusion (MRP) provide a rapid, quantitative, and easily interpretable visual assessment of the penumbra.
OBJECTIVE:
To study the value of MR perfusion in acute ischemic stroke within 1st 24hr.
PATIENTS AND METHODS:
Diffusion weighted images (DWI) and perfusion weighted images(PWI) were obtained in 30 ischemic stroke patients within 24 hours after symptoms onset. Perfusion diffusion mismatch (PDM) was analyzed by automated software that aligned apparent diffusion coefficient (ADC) defect with mean transient time (MTT) or time to maximum (Tmax) map.
RESULTS:
Type I (PWI>DWI) in (7) patients (23%), type II (PWI=DWI) is the main pattern described in (20) patients (67%). Average rCBF ratio was significantly reduced in the ischemic core (0.28±0.14) as compared to the normal brain tissue (0.51±0.14). Average rCBV ratio was significantly decreased in the ischemic core (0.35±0.15) as compared with the normal brain (0.90±0.88). MTT value was significantly higher in the infarct core (7.6 sec±0.92) than in the normal brain tissue (4.3sec±0.32).
There was significant reduction in average rCBF ratio in the penumbra (0.54±0.14) in comparison with normal brain tissue (0.66±0.14). A non-significant reduction in average rCBV ratio within penumbra (0.84± 0.29) in relation to normal brain tissue (0.98±0.25). MTT value in the penumbra was significantly higher (4.6sec±0.45) than in the normal brain tissue (4.07sec±0.18).
CONCLUSION:
Type II PDM pattern was the dominant pattern in patient with acute ischemic stroke in the 1st 24 hours. Salvageable penumbra in type I PDM described in (78%) of patients. rCBF in penumbra was higher than ischemic core and lower than normal brain and was the most useful parameter in defining ischemic penumbra and for follow up of patients with acute ischemic stroke.

BACKGROUND:
Cancer of unknown primary origin is an obscure group of diagnoses in which the primary anatomical site of tumor origin is not specified.
OBJECTIVE: This study aimed to determine the trend of cancer of unknown primary origin in Iraq in the period from 2005 to 2019 at the national and governorate level and its pathological characteristics.
METHODS:
The data was compiled from the cancer registry of Iraq for the period 2005-2019 and from Al Amal Cancer Hospital for the period 2010-2019. Data included information on gender, age, geographical distribution, site of metastasis, and histology types.
RESULTS:
A total of 9,593 cases of CUP were registered in the cancer registry for the period 2005-2019. The total number of registered patients in Al Amal Cancer Hospital between 2010- 2019 was 1,698. The incidence of cancer of unknown primary origin demonstrated a convergence during 2005-2019 with an average of 1.88/100,000. There was a slight increase in incidence through 2006 (2.6/100,000) and 2007 (2.4/100,000) for both sexes. The majority of reported cases were in the age group 56-65 (31.5%) and males constituted 53.9% of all the cases. The commonest metastatic sites were lymph nodes (18%) and the liver (16%). Adenocarcinoma constituted 55.9% of cases.
CONCLUSION:
Iraq is considered a country with a low incidence of cancer of unknown primary origin. The diagnosis and treatment of cancer of unknown primary origin are challenging due to its late presentation, difficulty in diagnosis and the treatment choices offered are limited and non-selective.

BACKGROUND:
Generally, nipple discharge represents a benign etiology. In the case where the discharge is unilateral, uniductal, spontaneous, persistent, serous or bloody, and in the case where it occurs in conjunction with a mass, the risk of malignancy is increased. Ductal ectasia and papilloma are the most common causes of pathological nipple discharges. Malignancy is a possibility, most often ductal carcinoma in situ.
OBJECTIVE:
To determine the value regarding dynamic contrast improved magnetic resonance imaging (MRI) in diagnosing suspicious nipple discharge.
METHOD AND PATIENTS:
Dynamic contrast MRI was used to assess 35 patients who have pathological nipple discharges. The features of MRI have been studied and associated to the histo-pathology.
RESULTS:
Histopathology indicated 11 high-risk, 17 benign, and 7 malignant lesions. The presence of non-mass and mass enhancements, as well as T2 weighted MRI images, had statistical significance in distinguishing malignant from benign causes of the pathological nipple discharges (Pvalue=0.004 and0.008) (0.018,0.008,0.004).
94.1% specificity and 94.4% sensitivity in distinguishing benign from malignant pathological nipple discharge causes, and 94.3% accuracy in diagnosing breast lesions, with positive predictive value of 94.4% as well as a negative predictive value of 94.1%.
CONCLUSION:
MRI is a powerful technique for determining the cause of pathological nipple discharge.

BACKGROUND:
contralateral breast cancer (CBC) exists in two forms: synchronous and metachronous. Screening for CBC is important on initial cancer diagnosis because it allows for informed surgical decision making.
OBJECTIVE:
To assess the clinical, mammographic and sonographic features of CBC and to compare contralateral breast cancer features with those of index cancer.
METHODS:
A case series study conducted in Breast clinic, Oncology Teaching Hospital. The medical records of patients who visited the center during the period between 2018 and 2020 were reviewed. A total of 29 cases with bilateral breast cancer were collected. Twelve of them were with synchronous contralateral breast cancer and 17 have had metachronous breast cancer. Mammographic films and high-quality US images were reviewed to record lesion characteristics and BI-RADS category classification.
RESULTS:
Patients’ mean age at the time of index tumor diagnosis was 49.7 (±9.87) ranged between 22-70 with 34.49% were 45 years and younger. 51.7% of them reported positive family history of breast cancer. 62.1% of the CBC were non-palpable lesions diagnosed during follow up in contrast to index tumor which were palpable l in 86.2%, P<0.0001. In mammography, microlabulated margin was seen in 71.4% of CBC mass whereas speculated mass was the dominant shape of the index cancer (63%), P=0.037. By sonography, non-mass hypoechoic area constituted 41.4% of CBC compared to 6.9% of index cancer, P=0.005. Moreover, CBC lesions were significantly smaller than index tumors with mean diameter of 15.3 (±9.5) vs 27.95 (±11.9), P <0.0001. 51.7% of CBC were irregular with 24.1% had indistinct margin compared with 44.8% of index cancers which exhibited speculated margin, P=0.027.
CONCLUSION:
CBC has mammographic and sonographic feature different from index tumor. Careful contralateral whole breast examination of patients newly diagnosed with breast cancer is essential particularly in younger patient and those with family history.

BACKGROUND:
Anti-mullerian hormone level reflects the ovarian follicular reserve and considered as sensitive marker of ovarian aging. Although the ultimate pathogenesis of polycystic ovary syndrom remains obscure, the distinictive feature is a failure of follicular maturation resulting in anovulation and accumulation of pre-antral and small antral follicles which contribute significantly to the production of anti-mullerian hormone.
OBJECTIVE:
To evaluate the anti-mullerian hormone levels in polycystic ovary syndrome women and to explore its relation with body mass index.
STUDY DESIGN:
Cross section study.
Setting: Department of Gynecology and Obstetrics at Al-Elwiya Maternity Teaching Hospital.
MATERIALS AND METHODS:
One hunderd women suffering from polycystic ovary syndrom (18-37 years old) were included in the study and arranged in three groups according to their body mass index: first group, 30 of them, were having normal body weight (body mass index 18.5 to 24.9kg/m2) and second group, 59 participants with body mass index 25 to 29.9kg/m2 and third group, 11 women, their body mass index ≥ 30kg/m2. Blood sample was collected from them after taking a detailed history and assessment according to the questioner form and the results were compared among the groups.
RESULTS:
Increase in body mass index is found to be accompanied with decrease in anti-mullerian hormone levels (P <0.05), with mean anti-mullerian hormone level significantly decreases as body mass shifts up from normal to overweight to obesity (8.5, 6.4 & 4.4 ng/mL respectively) (P <0.05). Anti-mullerian hormone level did not significantly correlate with age of those women (P >0.05).
CONCLUSION:
An inverse correlation had been found between anti-mullerian hormone levels and body mass index in women with polycystic ovary syndrome.

BACKGROUND:
Telangiectasias are superficial cutaneous vessels of arteriolar, venule, or capillary origin.These lesions especially when on the face often cause cosmetic concern and patients often seek treatment due to these aesthetic imperfection.
OBJECTIVE:
To evaluate the effectiveness and side effects of monopolar Radiofrequency current in the treatment of facial telangiectasia.
METHODS:
This is an Interventional non-randomized clinical study ,It was conducted at private clinic ,Baghdad ,Iraq from June 2020 till December 2020 ,eighteen patients were included in the study, From each patient the nasal area and/ or the cheek area were included (total of 16 nasal areas and 7 cheek areas),the response to treatment were assessed according to visual scaling and patient satisfaction.
RESULTS:
One radiofrequency session was significantly associated with complete response in the nose telangiectasia (92.9%, P = 0.03), better response when compared to the check. No recurrence was significantly associated with Nose telangiectasia (86.7%, P= 0.014) better response when compared to the cheek. There was no significant association between patient satisfaction and number of sessions (P = 0.792) .
CONCLUSION:
RF technology to treat facial telangiectasia is easy to use cheap method with minimal postoperative side effect.

BACKGROUND:
Melasma is a common hyperpigmentation disorder. It is therapeutically challenging, with a high relapse rate.
OBJECTIVE:
To evaluate the efficacy of Kligman formula versus the same formula combined with mesotherapy for treating melasma.
PATIENTS AND METHODS:
This is an interventional controlled comparative study conducted at the Center of Dermatology and Venereology, Medical City, Baghdad, and a private clinic in Baghdad, during the period from May 2020 to June 2021. Twenty-four patients with melasma were divided into 2 groups. Group A consisting of 13 patients were treated with Kligman formula for two months. Group B consisting of 11 patients were treated with the same formula plus two weekly sessions of mesotherapy for a total of two months. Response to treatment was assessed using the Melasma Area and Severity Index (MASI) score at the baseline and at the end of the two months treatment period.
RESULTS:
The mean MASI score for group A before treatment was 10.7 + 2.6, and decreased to 4.6 + 1.4 after treatment. Regarding group B, the mean MASI score before treatment was 9.8 + 1.7 and decreased to 3.7 + 1.5 after treatment, with statistically significant reduction in MASI score (P value > 0.001) for both groups. There was no statistically significant difference in percent of change in MASI scores between the two study groups (P = 0.321).
CONCLUSION:
The use of Kligman formula is still effective in the treatment of melasma, and the addition of mesotherapy has not resulted in statistically significant improvement in MASI score in melasma patients.

BACKGROUND:
One of the most prevalent presentations in outpatient clinics is a breast lump. A palpable mass in a woman's breast could be benign or cancerous, and it needs to be evaluated very well. The triple evaluation approach, which combines clinical examination, radiological imaging, and fine needle aspiration cytology, was used to diagnose the nature of a breast mass. The gold standard for confirming a diagnosis is still an open biopsy.
OBJECTIVE:
To evaluate the role of the triple assessment (a combination of clinical examination, ultrasonic examination, and Fine needle aspiration cytology) in the diagnosis of breast lumps and its correlation with histopathological diagnosis.
MATERIALS AND METHODS:
A Cross-sectional study including 60 females patients was collected from Al-Karama Teaching hospital and private histopathology laboratory in Wasit Province to include cases referred from 1st January 2019- 1st April 2021. The results of fine needle aspiration cytology, clinical examination, and ultrasound were compared to those of histopathology to assess the diagnostic accuracy of them.
RESULTS:
This study included 60 women with breast lesions. The results of this study shows that 36 (60%) of cases were approved as having breast cancer and 24 cases (40%) were approved as benign breast lesions. Twenty five women (41.7%) were aged 40-49 years. There were 22(36.7%) women presented with regular mobile soft mass, 12(20%) women with irregular immobile hard mass. Forty six percent of all women (28 cases) were presented with breast lesion located at upper outer quadrant.
The validity of clinical diagnosis according to the gold standard histopathology in diagnosing breast masses found to be 68.3%, the sensitivity and specificity of clinical diagnosis for detecting breast masses according to the gold standard histopathology were52.8%, 91.7%respectively.
Validity of Ultrasound test according to the gold standard histopathology in diagnosing breast masses found to be 86.7%, 80.6% sensitivity, 95.8% specificity.
Validity of FNAC according to the gold standard histopathology found to be 93.3%.
91.7% sensitivity, 95.8% specificity, only 3 cases was false negative.
Validity of triple assessment according to the gold standard histopathology found to be 97.4%, 94.1% sensitivity, 100% specificity.
CONCLUSION:
The most accurate of the three components of the triple test (clinical assessment, ultrasonography examination, and fine needle aspiration cytology) is fine needle aspiration cytology. The triple modalities are more accurate when used together than when used separately.