Iraqi Postgraduate Medical Journal

BACKGROUND:
Post-stroke motor sequelae can lead to an abnormal limb posture and decreased function that can ultimately increase the susceptibility of the peripheral nerves in that limb to compression, particularly within the early stages of stroke.
OBJECTIVE:
To study nerve conduction in paretic and non-paretic extremity in patients with the first ever-one stroke and to relate these parameters with MRC (Medical Research Council) scale.
METHODS:
Twenty-three patients aged 31-62 years and duration of illness of 3 and 6 months were studied. Thirteen had right hemiparesis and 10 with left hemiparesis. MRC scale was ≥3 in 17 and <2 in 6 patients.
RESULTS:
The median and peroneal distal motor latencies (DML) were prolonged and the peroneal compound muscle action potential (CMAP) amplitude was reduced in the paretic as compared to the non-paretic side. The combined sensory index and the lumbrical/interosseous muscles comparison methods revealed significant differences between the paretic as compared to the non-paretic side.
Median distal sensory latency (DSL), DML, motor conduction velocity (MCV), and peroneal CMAP amplitude of the paretic limb were significantly different between those with ≥3 and those with <2 MRC scale. In the non-paretic upper limbs, the DSL and DML were significantly prolonged in those with <2 MRC when compared to those with ≥3 MRC.
CONCLUSION:
Post-stroke entrapment neuropathy may develop, along with axonal neuropathy symptoms in patients with severe paresis. The more severely affected limbs, the more severe electrophysiologic changes.

BACKGROUND:
The need of micronutrients in nutrients and human fitness is unquestionable and zinc (Zn) is a vital hint detail whose significance has been particularly outstanding in getting older, and immune senescence. Its deficiency is common within the aged and ends in numerous age-associated continual ailments together with atherosclerosis, degenerative illnesses of the fearful gadget, immunosenescence, and cancer.
OBJECTIVE:
The goal of this study is to estimate the ability position of the zinc supplementation in older patients whose aged 65 years and more, as a way to repair the immune reaction and the primary consequences of zinc on immune senescence with relation to gender and fitness kingdom, also to proof the history of infection by coronavirus 2 (SARS-CoV-2) among the studied sample.
PATIENTS AND METHODS:
This study covered 415 patients aged of 60 -89 years of both genders in a cross sectional study from January –April 2021 at geriatric health facility in Baghdad Teaching Hospital / Medical City and was classified according to usage of zinc supplement in the previous 6 months. The results of investigation were then compared to their archived data. Analytic study with the aid of using SPSS had been executed to evaluate the frequency of zinc intake in aged. The p value < 0.05 was significant.
RESULTS:
Among males who constitute 63.4 % of studied patients, 49.8% were using zinc in comparison with 37.5 % among females. The percentage of zinc intake as medical treatment was 62.8 % and 37.2% as a prophylaxis.
CONCLUSION:
The Nutritional interventions, inclusive of the supplementation of nutrients and minerals, make a contribution to latent therapeutic plan for COVID-19, appearing additionally to alter glucose and lipid level in blood.

BACKGROUND:
It is predicted that changes in LV morphology in hypertensive patients will cause a reduction in compliance and an increase in myocardial stiffness. The E/E' to (LVEDD) ratio represents the pressure–volume relationship of the LV, which was used to quantify LV stiffness.
AIM OF THIS STUDY:
Assess myocardial stiffness in hypertensive patients by applying a combined conventional and (TDI) on the pressure volume relation [(E/E')/LVEDD].
METHODS:
The research included 81 hypertensive patients (48 females and 33 males) and 33 healthy individuals (23females&10males) as a control group . A complete TTE echocardiographic examination was performed on all patients, including (TDI) of the mitral annulus, measurement of (LV) septal and posterior wall thickness, LV mass, LVEDD, and transmitral Doppler peak early (E) and late (A) diastolic filling velocities. The septal and lateral sites of the mitral annulus were used to average TDI early diastolic myocardial velocities (E').
RESULTS:
In hypertensive group, mitral annular TDI early diastolic velocity E' was significantly lower than the control group's P <0.05. Hypertensive group also showed a significantly higher late diastolic velocity compared with control group p <0.05. The mean E' was significantly lower while the mean E/E' ratio was significantly higher and the LV stiffness index was insignificantlydifferent in hypertensives compared with control subjects. In the hypertensive group, the LV stiffness was insignificantly correlated with IVS thickness.
CONCLUSION:
In hypertensive patients, LV myocardial diastolic stiffness index [(E/E')/LVEDD] is not so increased and is not correlated well with the LV wall thickness and LV mass index.

BACKGROUND:
Umbilical cord around fetal neck (nuchal cord) is quite common finding, it is often assumed that it might cause cord compression and thus low fetal weight, oligohydramnios and intrapartum complication.
OBJECTIVE:
To determine effect of the nuchal cord on amniotic fluid index (AFI) and fetal weight.
MATERIALS AND METHODS:
Two hundred full term pregnant women were enrolled in this study. By using color Doppler ultrasound to detect the presence of nuchal cord, trans abdominal altrasound to detect AFI and fetal weight were estimated according hadlock equation, half of them were with nuchal cord (study group) and the remaining were without nuchal cord (control group).
RESULTS:
Descriptive statistics of studied groups revealed no statistically significant difference in mean maternal age, gestational age and obstetrical history between study group and control group. Loose nuchal cord was the dominant type reported in 90% of the patients and 71.6% having only single loop, while multiple loops were seen in 28.4% of study group.
A significant association was found between reduced AFI level and presence of cord around fetal neck and the mean estimated fetal weight was significantly lower in nuchal cord group 3068.9 ± 489.6 g compared to non-nuchal cord group 3208.5±331.5g, p < 0.05.
CONCLUSION:
Cord around fetal neck is associated with higher incidence of low fetal weight, low AFI which in turn increase risk for adverse perinatal outcome such as fetal distress that needs an urgent cesarean section.

BACKGROUND:
Cerebral venous thrombosis (CVT) is a condition where a thrombotic event involves cerebral venous sinuses of varied temporal evolution. It causes stroke with incidence of ≈1.3 per 100000 especially in young female. Many - risk factors had attributed in its etiology assuming, anemia, as one of these factor, - based on case reports and case series.
AIM OF STUDY:
Toassess the impact of anaemia on cerebral venous thrombosis (CVT) in comparison with arterial stroke
PATIENTS AND METHODS:
A case control prospective study performed at Al-Imamain Al-Kadhimain Medical City throughout the period from December-2017 to December-2019. It included 42 randomly selected cerebral venous thrombosis (CVT) patients who compared with another 60 patients with arterial stroke as control patient group -Both groups were offered complete blood count (CBC) within 48 hours as part of routine investigation. Those discovered to have anemia were categorized according to severity using WHO definition in both groups as well as their mean corpuscular volume (MCV). Statistical analyses performed to define the relationship between anemia, microcytosis and CVT diagnosis. Kaplan-Meier curve used to assess the survival of patients with CVT during the early outcome period of 14 days.
RESULTS:
Mean patients Hb was 11.05±3.11mg/dl versus 13.62±3.73 mg/dl in control group (p value < 0.001) with lower MCV (74.88±12.85 fl versus86.43±9.02 fl) (p value < 0.001). Severe anemia and severe microcytosis were associated significantly with CVT (OR= 13.5, 95% CI= 2.47-73.71, p= 0.001), (OR=2.87, 95%CI=2.17-3.8, p<0.001) respectively independently but not as such in combination with other confirmed other risk factors like age and gender. It is observed that mean duration of death was 8.5 days in CVT patients with anamia ( p value 0.227 ). All dead cases had severe anemia.
CONCLUSION:
There is inverse association between severity of anemia, microcytosis with CVT incidence, which may be considered as separate risk factors. The presence of anemia in CVT patient may result in - poor outcome and increasing early mortality rate.

BACKGROUND:
Urothelial carcinoma and prostatic adenocarcinoma are the most common tumors of genitourinary system. Both can demonstrate a broad histology or present as undifferentiated carcinoma that made the distinction of which is the primary source very difficult. In indeterminate tumor morphology, the immunohistochemical markers will assist the pathologists to avoid misinterpretation.
AIM OF THE STUDY:
To assess immunohistochemical expression of GATA3 in urothelial and prostatic adenocarcinoma with correlation to different clinicopathological parameters.
MATERIALS AND METHODS:
This retrospective study was done on formalin-fixed paraffin embedded tissue blocks from 20 urothelial CA and 20 prostatic adenocarcinoma cases. GATA3 was used and semi-quantitatively scored.
RESULTS:
90% of urothelial CA cases were GATA3 positive with 75% strong expression. While 85% of prostatic CA cases were GATA3 negative, there was no significant correlation between GATA3 expression and clinicopathological parameters except for gender in urothelial CA.
CONCLUSION:
GATA3 has a potential role to confirm the urothelial origin of the tumor in comparison to prostatic carcinoma. There was no significant correlation between GATA3 expression in urothelial carcinoma and prostatic carcinoma cases and clinicopathological parameters except for gender in the first.




GATA3, urothelial carcinoma, prostatic adenocarcinoma

BACKGROUND:
Patients with idiopathic nephrotic syndrome are usually steroid sensitive, however about 50% of relapsed children who experienced frequent relapses, develop steroid-dependency and become vulnerable for complications of long-term use of steroid.
OBJECTIVE:
Early detection of risk factors in patients with a nephrotic syndrome that could make them more liable to have steroid dependency after initial response to treatment with steroid.
PATIENTS AND METHOD:
A hospital-based retrospective cross-sectional study of patients aged 1-16 years; Followed up for at least 6 months at the outpatient clinic of the pediatric nephrology unit in central child teaching hospital .The study group was divided into two groups, group A included 68 patients with infrequent relapses nephrotic syndrome and group B included 32 patients with steroid-dependent nephrotic syndrome. Data was collected from medical record of patients visiting our hospital from 1st. of January 2015 to 31st. of December 2017.
RESULTS:
A sample of 100 patients participated in the current study; it shows that the male gender represents 51%, whereas the dependents patients on steroid occurred in 32% versus 68% infrequently relapse patients. It also shows the history of atopy (17%), microscopic hematuria (24%), hypoalbuminemia (79%), hypercholesterolemia (57%) and positive history of upper respiratory tract infection in 33%. It reveals that there was statistically significant (P0.015) association of steroid response with gender with a higher proportion of dependent patient in males than females. Also there was statistically significant association between steroid dependency and microscopic hematuria (P0.030) and between steroid dependency and history of upper respiratory tract infection (P0.043).While there were neither significant relationship with history of atopy nor with serum albumin level. There was a highly statistically significant (0.004) association with days of remission, higher proportion in more than 20 days, and highly statistically significant association of steroid dependency with hypercholesterolemia (0.001). Also there were significanthigher mean of days of remission in the dependent patient(P0.044), statistically significant higher mean of serum cholesterol (0.0005)and statistically significant higher mean of systolic and diastolic blood pressure(0.001 and 0.017 respectively). Finally there was a highly statistically significant difference in means according to the numbers of relapse with higher mean in dependent patients (0.002).
CONCLUSION:
Prolong duration of first remission, hypertension, male gender, increasing number of relapse, microscopic Hematuria and history of infection of the upper respiratory tract have a high predictive value to be steroid dependent in children with nephrotic syndrome.


BACKGROUND:
Patients with idiopathic nephrotic syndrome are usually steroid sensitive, however about 50% of relapsed children who experienced frequent relapses, develop steroid-dependency and become vulnerable for complications of long-term use of steroid.
OBJECTIVE:
Early detection of risk factors in patients with a nephrotic syndrome that could make them more liable to have steroid dependency after initial response to treatment with steroid.
PATIENTS AND METHOD:
A hospital-based retrospective cross-sectional study of patients aged 1-16 years; Followed up for at least 6 months at the outpatient clinic of the pediatric nephrology unit in central child teaching hospital .The study group was divided into two groups, group A included 68 patients with infrequent relapses nephrotic syndrome and group B included 32 patients with steroid-dependent nephrotic syndrome. Data was collected from medical record of patients visiting our hospital from 1st. of January 2015 to 31st. of December 2017.
RESULTS:
A sample of 100 patients participated in the current study; it shows that the male gender represents 51%, whereas the dependents patients on steroid occurred in 32% versus 68% infrequently relapse patients. It also shows the history of atopy (17%), microscopic hematuria (24%), hypoalbuminemia (79%), hypercholesterolemia (57%) and positive history of upper respiratory tract infection in 33%. It reveals that there was statistically significant (P0.015) association of steroid response with gender with a higher proportion of dependent patient in males than females. Also there was statistically significant association between steroid dependency and microscopic hematuria (P0.030) and between steroid dependency and history of upper respiratory tract infection (P0.043).While there were neither significant relationship with history of atopy nor with serum albumin level. There was a highly statistically significant (0.004) association with days of remission, higher proportion in more than 20 days, and highly statistically significant association of steroid dependency with hypercholesterolemia (0.001). Also there were significanthigher mean of days of remission in the dependent patient(P0.044), statistically significant higher mean of serum cholesterol (0.0005)and statistically significant higher mean of systolic and diastolic blood pressure(0.001 and 0.017 respectively). Finally there was a highly statistically significant difference in means according to the numbers of relapse with higher mean in dependent patients (0.002).
CONCLUSION:
Prolong duration of first remission, hypertension, male gender, increasing number of relapse, microscopic Hematuria and history of infection of the upper respiratory tract have a high predictive value to be steroid dependent in children with nephrotic syndrome.
KEYWORDS:Nephrotic syndrome, Steroid dependency, Predictive risk factors

BACKGROUND:
Vascular compression of the trigeminal nerve at its entrance into the pons is the common etiological factor in trigeminal neuralgia. Jannetta developed an operation to move the offending vessel(s) away from the nerve. This procedure is referred to as microvascular decompression because it involves an operating microscope and microsurgical technique. The area is exposed through a lateral posterior fossa craniectomy (retromastoid craniectomy), and after the vessel or vessels are separated from the nerve, a material such as a synthetic sponge or Teflon felt is inserted to maintain the separation.
AIM OF THE STUDY:
Searching for efficacy and complications of microvascular decompression surgery in treatment of trigeminal neuralgia.
METHODS:
The study included retrospective study on twenty-four patients with trigeminal neuralgia over a period from January 2016 to September 2018 at Neuroscience Hospital, Baghdad, Iraq. Preoperative evaluation with magnetic resonance imaging was applied to all patients. Pain was evaluated preoperatively and postoperatively using the Barrow Neurological Institute scale, visual analog scale and BPI-Facial scoring systems. Microscope-assisted microvascular decompression was performed using retrosigmoid craniotomy approach. The postoperative follow-up period was 6 months.
RESULTS:
Initial assessment to MVD patients reveals significant pain complaining with unknown etiology of TGN and normal brain MRI. They are mainly presented with significant right sided predominance and significant female gender predominance MVD patients shows significant improvement in 6 months follow-up compared with the preoperative.
CONCLUSION:
MVD can be offered as a line of surgical treatment for patients with TN. They are very effective method for patients with TN with immediate, better pain relief of TN.

BACKGROUND:
Urethral stricture remains a great challenge. We reported dorsal onlay BMG urethroplasty for repair of anterior urethral stricture.
AIM OF THE STUDY:
is to analyze short term outcome of Dorsal Onlay Buccal mucosal graft Urethroplasty, in regarding the result and complication rate in surgical specialties hospital /Medical City.
PATIENTS AND METHODS:
From January 2017 to June 2019, a total of 20 cases were enrolled in this study with anterior urethral strictures managed by dorsal onlay BMG Urethroplasty.
Patients with lichen sclerosus, previous failed urethroplasty and posterior urethral stenosis were excluded; those patients were followed up at 3 weeks, 3 months and at 6 months with history, physical examination, uroflowmetry, PVRV and retrograde urethrogram. Successful outcome was defined as normal voiding pattern with no need for surgical intervention after catheter removal.
RESULTS:
Mean patients age was 41 years. Mean stricture length was 3.5cm. Two patients developed stricture recurrence, during follow-up and required further intervention and was considered as failure. One patient developed wound infection which resolved after regular dressing. Success rate was 90%.
CONCLUSION:
Dorsal BMG urethroplasty is a reliable and satisfactory procedure to manage long bulbar urethral strictures with a lower complication rate.

BACKGROUND:
Common warts are common diseases encountered in daily dermatologic practice. They are caused by human papilloma virus which has about 200 genotypes. Although spontaneous resolution can occur in 65-78% after two years but disfigurement and social embarrassment necessitate treatment.
Hydrogen peroxide has damaging effects on nucleic acids, proteins and lipids. It is currently used for debridement of wounds and has healing promotion and antimicrobial effects. It was recently approved for the treatment of seborrheic keratosis.
OBJECTIVE:
To evaluate topical 50% hydrogen peroxide use in the treatment of common warts regarding the safety and efficacy.
PATIENTS AND METHODS:
This interventional study was carried out during the period from April 2019 to July 2020 at Dermatology Center / Baghdad Medical city. Thirty patients were enrolled in this study; 9 of them were defaulted for unknown reasons and 21 patients completed the study.
Each patient was fully assessed to determine the clinical type, sites, size and number of warts. All patients did not receive any treatment for warts in the last month before enrollment in the study. A layer of 50% hydrogen peroxide solution was applied to each wart and allowed to dry for 2 minutes and the application was repeated 2 to 3 times till the appearance of white frost or bubbling or the patient feels stinging sensation. If the warts had thick hyperkeratotic surfaces, a simple paring with scalpel was done. The solution was applied once weekly for 3 weeks. A total number of 57 lesions were treated.
RESULTS:
Twenty-one patients completed the study. The total number of lesions was 57. Regarding lesions response to treatment; 51(89.5%) lesions were cured, 6 (10.5%) lesions showed partial response and no lesion was recorded to show no response. Regarding the number of weeks needed to achieve cure; 18 (31.6%) lesions achieved cure in the first week, 22(38.5%) patients in the second week and 8(14%) in the third week. On follow up one month later, a further 3 (5%) lesions were also cured. Regarding relapse, 2 lesions (3.5%) were seen as relapse during the follow up visit, one month after stopping the treatment. Regarding the side effects for treatment; the following were noted; 16 (76.2%) patients had pruritus, 16(76.2%) patients had erythema, 12(57.1%) had stinging, and 9(42.9%) patients had pain.
CONCLUSION:
Hydrogen peroxide 50% solution is an effective topical therapy for common warts. It is non-costly, available, does not need local anesthesia with temporary and tolerable side effects.

BACKGROUND:
Functional dyspepsia is one of the most common gastrointestinal symptoms and attributed to various causes including Helicobacter pylori infection.
AIM OF THE STUDY:
To correlate Helicobacter pylori infection to functional dyspepsia and to identify the possible risk factors for this infection.
PATIENTS AND METHODS:
Fifty patients who were referred to the endoscopy unit for dyspepsia symptoms, secondary gastric causes of dyspepsia were excluded during endoscopy, gastric biopsies were taken for histopathological study and for bedside urease test for detection of Helicobacter pylori infection.
RESULTS:
62% of non-ulcer dyspeptic patients were infected with Helicobacter pylori, 74.2% of the patients were above 30 years old, female gender patients were more than male patients ( 61.3% versus 38.7%).Using two standard methods of diagnosis of Helicobacter pylori infection, 31 patients had positive histopathology and urease test, 9 of them were positive for helicobacter pylori infection with single method (6 by histopathology and 3 by urease).Histopathology test has sensitivity 88% and specificity 76% in respect to rapid urease test for detection of Helicobacter pylori infection.
CONCLUSION:
The incidence of helicobacter pylori infection in patients with functional dyspepsia doesn’t differ from what reported in general population in our locality which may argue the role of helicobacter pylori infection in non-ulcer dyspepsia. Female gender and age >30 years were the common risk factors for the infection. Smoking and alcohol consumption were not associated with increased risk of infection.

BACKGROUND:
Hirschsprung’s disease (HD) is a functional intestinal obstruction due to an abnormality of the enteric nervous system, most of affected patients with HD are presented during the neonatal period, but the diagnosis is still non-specific and leading to missing some patients.
THE AIM OF THE STUDY:
Is to construct a simple clinical predictor scoring system to assist early diagnosis, allow early treatment of HD and to avoid doing rectal biopsy as much as possible.
METHODS:
A prospective cohort study was done in Children Welfare Teaching Hospital from the first of January 2016 to the end of December 2017; the study included 52 patients who were admitted to the pediatric surgery department at neonatal period with suspicion of HD. Clinical variables which include (low birth weight, prematurity, family history of HD, male gender, passage of meconium over 48 hours, passage of meconium in first stimulation, feeding intolerance, vomiting, abdominal distention, constipation, diarrhea, dependence on anal stimulation or enemas and important radiological findings) were taken for diagnosis of HD. Rectal biopsy (full thickness) or segment biopsy were done for the included patients to divide them into negative and positive (HD) groups.
According to the statistical results, a new clinical scoring system was constructed and only the variables with significant correlation with the dependent variable (histopathology) were selected.
RESULTS:
Male to female ratio among HD patients was (3.7:1). The transitional zone by contrast enema; dependence on anal stimulation and constipation show accuracy of: 92%; 90%; and 90% respectively; while passage of meconium over 48 hours, male gender and diarrhea show accuracy of: 73%; 69%; and 60% respectively. The probability of the variables in the scoring system were measured by the area under (ROC) curve on which constipation, transitional zone by contrast enema and dependence on anal stimulation achieved 2 scores for each, while delayed passage of meconium; diarrhea and male gender achieved 1 score for each. The developed scoring system designed as 9 points, at the cut-off point (4), the score achieves sensitivity; specificity and accuracy of: 93.9%; 100%; and 96% respectively.
CONCLUSION AND RECOMMENDATION:
A developed clinical scoring system is simple and easily applied, and it is useful tool in the early diagnosis and treatment of HD by allowing a single stage pull through operation in small infants. Rectal biopsy is spared for those patients with ≤ 4 scores who are still suffering in the follow up period.

BACKGROUND:
Diabetes is one of the major public health problems all over the world. The world health organization said that about 224 million persons in the world have diabetes mellitus (1). There is a globally agreed target to halt the rise in diabetes and obesity by 2025. Most of this increment will occur in the developing countries and this will be due to population growth, ageing, and sedentary life styles. Many patients with type 2 diabetes are taking a combined regimen of drugs. The lifestyle changes and the drugs to manage type 2 diabetes and the associated issues can only be effective by the attachment to the prescribed regimen. Effective treatment of diabetic patients requires good cooperation between doctors and patients. Compliance is one of the fundamental problems in this cooperation. (2)
AIMS OF THE STUDY:
To assess the compliance of type two diabetic patients with the medications, the diet, and the appointments to the diabetic clinics
To evaluate the Factors involved with it.
METHODS:
A cross- sectional study was carried out in 300 convenient samples of diabetic type 2 patients of both sexes and their age between 35-80 years attending Al-Imamein al-Kadhimein medical city and Alyarmook teaching hospital diabetic centers through the direct interview using a specially designed questionnaire.
RESULT:
Out of the whole sample (300) patients, two thirds (65%) of them were females. The average age of the studied sample was 55.1 (± 9.5) years, and ranged from 35 to 80 years. Good compliance of patients with medications was seen in (48.7%),while (49.7%) of the whole sample had good compliance to diet regimen that had been given to them by their doctors. only (49.3%) of the diabetic patients in our study had good compliance with appointments at the diabetic clinics. Fasting blood level was 243 ± 73.3 mg/dl in those with poor compliance to medication while those with good compliance readings of fasting blood sugar were 177.2 ± 67.5 mg/dl. Males were significantly associated (p= 0.004) with good compliance for medication, as 112 (42.6%) of females reported good compliance in comparison to (60%) of males. Poor compliance was prevalent among 67 (64.4%) of the rural cases in comparison to 87 (44.4%) of the urban cases. The study showed a significant poor compliance in the illiterate as compared to the higher education groups.
CONCLUSION:
Compliance of type 2 diabetic patients to the treatment was relatively low in Baghdad city. Extremely significant protection against the poor compliance was seen among the diet followers and to those satisfied by the consultations and doctors advices.

BACKGROUND:
Diabetes is one of the major public health problems all over the world. The world health organization said that about 224 million persons in the world have diabetes mellitus (1). There is a globally agreed target to halt the rise in diabetes and obesity by 2025. Most of this increment will occur in the developing countries and this will be due to population growth, ageing, and sedentary life styles. Many patients with type 2 diabetes are taking a combined regimen of drugs. The lifestyle changes and the drugs to manage type 2 diabetes and the associated issues can only be effective by the attachment to the prescribed regimen. Effective treatment of diabetic patients requires good cooperation between doctors and patients. Compliance is one of the fundamental problems in this cooperation. (2)
AIMS OF THE STUDY:
To assess the compliance of type two diabetic patients with the medications, the diet, and the appointments to the diabetic clinics
To evaluate the Factors involved with it.
METHODS:
A cross- sectional study was carried out in 300 convenient samples of diabetic type 2 patients of both sexes and their age between 35-80 years attending Al-Imamein al-Kadhimein medical city and Alyarmook teaching hospital diabetic centers through the direct interview using a specially designed questionnaire.
RESULT:
Out of the whole sample (300) patients, two thirds (65%) of them were females. The average age of the studied sample was 55.1 (± 9.5) years, and ranged from 35 to 80 years. Good compliance of patients with medications was seen in (48.7%),while (49.7%) of the whole sample had good compliance to diet regimen that had been given to them by their doctors. only (49.3%) of the diabetic patients in our study had good compliance with appointments at the diabetic clinics. Fasting blood level was 243 ± 73.3 mg/dl in those with poor compliance to medication while those with good compliance readings of fasting blood sugar were 177.2 ± 67.5 mg/dl. Males were significantly associated (p= 0.004) with good compliance for medication, as 112 (42.6%) of females reported good compliance in comparison to (60%) of males. Poor compliance was prevalent among 67 (64.4%) of the rural cases in comparison to 87 (44.4%) of the urban cases. The study showed a significant poor compliance in the illiterate as compared to the higher education groups.
CONCLUSION:
Compliance of type 2 diabetic patients to the treatment was relatively low in Baghdad city. Extremely significant protection against the poor compliance was seen among the diet followers and to those satisfied by the consultations and doctors advices.

BACKGROUND:
Coronavirus disease 19 containment measures are reaching a new turn with the introduction of several new vaccines. It is obvious that new vaccine acceptance will play an important role in the control efforts and not only the vaccine effectiveness and safety which are the main objective of this study.
AIM OF THE STUDY:
To figure out the level of acceptance of COVID19 vaccines among health care workers in Al Risafa Directorate of Health.
PATIENTS AND METHODS:
This is an online cross-sectional self-filled survey conducted in a 10 days period with the enrollment of 2423 participants from the largest directorate of health in Iraq that is Al Risafa directorate of health, the sample included all job titles and has been conducted prior to the administration of COVID 19 vaccines in Iraq.
RESULTS:
The majority of participants were PHC based, dentists more than others, most of them are nonsmokers and 44% had history of previous infection. The highest percentage 57% rejected the idea of having the vaccine, due to safety concerns and lack of conviction while 76.8% of total participants preferred to postpone the vaccination. History of vaccination with influenza vaccine was associated with better acceptance rate.
CONCLUSION:
The acceptance level of all new COVID 19 vaccines is disappointedly low among health care workers which would affect disease transmission control plans. Participants with previous good attitude for having vaccines such as flu vaccine showed better acceptance rates. Safety concerns, myths about vaccines and lack of trust lead to (hard to vaccinate) vaccine coverage problem.

BACKGROUND:
Malnutrition is a major problem in children with cancer, Nutritional assessment is an essential component of the history and physical examination. Malnutrition is an unspecific term used to define an inappropriate nutritional condition that is characterized either by a deficiency or an excess of energy, protein, and other nutrients.
AIM OF THE STUDY:
To evaluate the nutritional status of patients newly diagnosed with malignancy, and to show the correlation between malnutrition and different age, type of malignancy, duration of presentation.
PATIENTS AND METHODS:
Prospective study carried out on 150 patients between 2-15 years newly diagnosed with malignancy admitted to Child’s Central Teaching Hospital for the period from 1st of April 2020 to 31st of January 2021, exclusion criteria was age less than 2years and patients who receive chemotherapy, nutritional status included weight for age, height for age, triceps skin fold thickness, mid upper arm circumference, Body Mass Index were calculated.
RESULTS:
150 patients &300 control, patients distributed as leukemia were 83 patients (55.3%), lymphoma were 30 patients (20%) and solid tumors were 37 patients (24.7%) , Regarding age and sex distribution, patient aged 2- 15 years mean male to female ratio is 1.25:1 , percentage of malnutrition is weight for age shows 63(42%), triceps skin fold thickness 40(26.6%), mid upper arm circumference 66(44%), Body Mass Index 66(44%) which is statistically significant for malnutrition between case and control except height for age which was not significant.
CONCLUSION:
In this study, there is a high prevalence of malnutrition among cancer patients at time of diagnosis.

BACKGROUND:
Acute myocardial infarction (AMI) is a cardiovascular emergency that needs immediate diagnosis and treatment. Myeloperoxidase (MPO) an enzyme generated by active leukocytes, has been connected to atherosclerosis in a mechanistic way and earlier research has suggested that MPO could be employed as a diagnostic and analytical marker for AMI patients. Many cardiovascular disease ( CVD) events have been linked to oxidized-LDL (Ox-LDL) &Glutathione (GSH) .
OBJECTIVE:
Studies a new, rapidly rising, or cost-effective biomarker for the detection of AMI.
PATIENTS AND METHODS:
Eighty (80) patients & (40) control offered with chest pain presented to the Coronary Care Unit looking for medical help about their newly developed symptoms. Serum levels were measured by enzyme-linked immunosorbent assay (ELISA).
RESULT:
The result of this current study showed that a highly significant association between the serum concentration of MPO and the three groups study (p<0.001). In this present study, a higher significant difference is noted in the level of serum oxLDL in the STEMI group (p < 0.001) and (0.005) in the NSTEMI group. the higher significant difference is noted in the level of serum GSH in NSTEMI & STEMI compared with control (p < 0.001) and between the patents groups (p= 0.019)
CONCLUSION :
Myeloperoxidase(MPO) & GSH serum level is highly associated with AMI and can be used as a biomarker of early diagnosis, progression, and grading of AMI Increased serum concentrations of oxLDL are analytical of future AMI

BACKGROUND:
Psychobehavioral is an all encompassing term for psychological and behavioral factors that are major determinants of the widely accepted biopsychobehavioral or multidimensional concept of diseases such as cancer.
AIM OF STUDY:
To identify psychobehavioral issues affecting patients with a diagnosis of a spinal column or cord tumor.
PATIENTS AND METHODS:
Using the keywords “cancer communication,” “psychobehavioral care,” and “spine cancer patient,” a review of literature was performed on Medline, and PsycInfo, a database of the psychology and psychiatry literature in the United States. The relevant articles were reviewed; in addition, relevant references from selected articles were searched. The Spine Oncology Study Group (SOSG), an international group of spine oncology specialists, identified key questions to be addressed in the course of the systematic review of the literature. The key questions were answered using literature review and expert opinion.
Research questions:

Who are the allied health care professionals necessary for the comprehensive care of the spine tumor patient?
Does compassionate communication (in giving life altering information) affect outcome? What tools can be used in communication with the spine tumor patient?

RESULTS:
Systematic review yielded 120 articles addressing communication in cancer patients. Those articles specifically addressed the 2 questions of interest in the spine tumor patient population. The literature search identified quality evidence; 2 randomized controlled studies were identified. Although neither specifically pertained to the spine tumor patient population, these articles were reviewed and graded as low-quality evidence.
CONCLUSION:
A multidisciplinary group of allied health care professionals is a necessary prerequisite for the effective psychobehavioral care of the spine tumor patient. Compassionate communication, in the form of group sessions, telephone support groups, or internet based groups, can alleviate the psychobehavioral discomfort experienced by spine tumor patients.