The Medical Journal of Tikrit University

Background: The procedure Tubularized incised plate (TIP) urethroplasty using avascularized dartos fascia as neourethral coverage from the prepuce (foreskin) of uncircumcised patients is the standard procedure, however, in spite of the constant fact that circumcision is contraindicated in babies with hypospadias, still we see unlucky babies already circumcised before repair.
Aim of the current study: To assess the result of TIP urethroplasty in circumcised hypospadias patients and to determine how much prior circumcision will complicate or adversely affect the repair of the hypospadias.
Patients and methods: The data collection extends from March 2010 to December 2016, 40 boys with circumcised hypospadias aged between 11 months to 15 years were primarily repaired using TIP technique. Glanular, coronal, subcoronal, distal penile and midshaft were all incorporated in this study, all proximal and redo cases were excluded.
Results: In our study, fistula that needs surgical correction later on developed in four cases (10%). Two patients (5%) developed meatal stenosis get better to meatal dilatation.
Conclusion: Circumcision before hypospadias repair has a minimal adverse effect on the result of tabularized incised plate procedure in children with distal and mid shaft hypospadias.

Background: Rheumatoid arthritis (RA) is a progressive inflammatory disease, which could result in significant morbidity and mortality. Early and aggressive intervention with a new and effective biological treatment can alter the course of the disease, lengthen life, and improve function. Besides the rheumatoid factor (RF), another group of auto antibody has recently been detected in serum of patients with RA; the anti-cyclic citrullinated peptide antibodies (ACPA) which considered as a predictive of erosive disease with bad prognosis, in addition there are a number of prognostic variables that predict a poor outcome have been identified. Many studies found variable results regarding serum copper (S.Cu) levels in RA patients.
Objective: To assess the relationship between serum copper and some prognostic variables in rheumatoid arthritis.
Methodology: This study was a cross sectional study implemented in the Rzgary general teaching hospital in Erbil governorate-Kurdistan region/Iraq through the period of 12 months from 1st of November 2019, to 1st of November 2020. Study sample included fifty patients with RA. The diagnosis of RA was done according to 2010-American College of Rheumatology-European League against Rheumatism criteria. The S.Cu of patients was assessed in regard to variables of RA in the studied patients.
Results: There were a significant association between previous history of Cu wearing and high S.Cu level of RA patients (p=0.01), longer RA disease duration and high serum Cooper level (p<0.001), In addition, the positive ACPA, rheumatoid nodule and morning stiffness of patients were significantly related to high S.Cu level (p<0.001, p=0.001, p<0.001, respectively. There were a highly significant association between presence of bone erosions in x-ray of hand and high S.Cu level (p<0.001), anemia (p<0.001), high ESR level (p<0.001). While no significant differences were observed between S.Cu level regarding age (p=0.4), gender (p=0.1) and RF (p=0.75).
Conclusions: The serum copper level in rheumatoid arthritis patients was significantly related with many variables which considered as a predictor for disease prognosis. Encouraging physicians to adopt the serum copper level in assessment and monitoring of patients with rheumatoid arthritis.

Background: Breast masses are the most common surgical problems among females; that is why their management requires an efficient and accurate evaluation using the least invasive and most accurate methods with a minimal patient’s discomfort.
Objectives: To determine the reliability and application of sonographic BIRADS lexicon in comparison with Fine needle aspiration cytology and Core needle biopsy results in order to differentiate benign from malignant breast masses. Also to determine the accuracy of FNAC and CNB in diagnosis of breast masses, including the sensitivity, specificity, positive and negative predictive values of both techniques in Erbil city and to compare the results of this study with those of others.
Materials and Methods: This is a crosssectional study that was conducted on 132 female patients with breast masses who attended the breast cancer unit in Erbil at Rizgari Teaching Hospital, Maternity Teaching Hospital and some private clinics in a period spanning from 15 th July 2012 to 15 th February 2013. After being detected sonographically, sonographic guided fine needle aspiration cytology (FNAC) and core needle biopsy (CNB) of breast masses were performed. Masses were classified according to the sonographic BIRADS lexicon, FNAC and CNB. Pathological results were compared with sonographic features.
Results:
Hypoechoic breast mass with axillary lymph nodes had shown highest presentation on BIRADS classification (30 samples of FNAC) in which most of them (70%) were malignant C5, while on CNB irregular hypoechoic mass had the highest presentation 29 samples were (79.3%) malignant B5. BIRADS, FNAC comparison had a high sensitivity of (97.5%) and negative predictive value of (92.8%). However, this study revealed a lower FNAC specificity (62.2%) and positive predictive value (73.6%). In the same line, CNB sensitivity and negative predictive value were high 95.5% and 92.6% respectively while the specificity and positive predictive value were low (59.5% and 71.7%).
Conclusions: The BIRADS classification revealed that the highest frequencies of breast masses were among U5 (highly suspicious of malignancy) and U4 (suspicious of malignancy). Ultrasonic morphologic grading revealed that less than 30% of irregular outline masses of breast masses with axillary lymph nodes were benign masses and the reverse is true for those with well-defined masses or parenchymal changes.

Introduction: Third molars, also known as wisdom teeth, is the most distal (posterior) of the three molars found in each quadrant of the human dentition. Tooth impaction is a pathological condition in which a tooth is unable or unwilling to erupt into its normal functioning position. Dental treatment can help with this issue.
Aim of study: The current study aims to describe the histology of wisdom teeth in the adult patients in Kirkuk city.
Materials and methods: Fifty patients with impacted wisdom teeth in lower jaw, with age ranging from (17–25) years were taken from dental specialized centers and from private clinics in Kirkuk city during the period from September 2021 to March 2022. An informed permission was obtained from the Kirkuk health directorate to perform this study.
All the patients with impaction and full dentition without missing teeth are included in age range , and above the age 25 years were excluded from this study. The patients with trauma, cysts and tumor are also excluded.
After taking a panoramic tomograph for patients, evaluation of the impacted wisdom teeth begin for all the cases which were 50 cases, firstly determine the number of wisdom teeth impacted in the lower arch either in left or right. The 27 of patients (54 %) was female while the male was 23 patients (46%). In all 50 samples there were 22% of cases which is 11 patient have one wisdom tooth impacted.
The 78% of cases which are 39 patients of the samples with two teeth impaction.
This study targets the patients who are between the ages (17-25) with impacted lower wisdom teeth living in the Kirkuk city, Iraq. The mean age, when diagnosed, was 21.84 years old. In this study, clinical data were collected from the specialized dental center in kirkuk , which has a policy of using DPT for all new patients with impacted 3M.
Anatomy of Dental Structure
A layer of enamel of varying thickness covers the crown of the tooth. It is almost entirely composed of apatite crystals with a calcium phosphate filling. Calcium phosphate is also primarily responsible for dentine hardness. The enamel layer crystals are all elongated and arranged with their ends toward the enamel's surface. Enamel is replaced around the root of the tooth by cementum (the cement), another bonelike material that holds the tooth firmly in the jaw socket. However, there is a layer of tissue called the periodontal membrane that exists between the bone of the jaw and the cementum layer and is in contact with the tissues of the gums and the pulp cavity. Incisor and canine teeth have a single root, premolars have two roots, and molars have three roots.

Background: Menarche is the 1st menstrual cycle experienced by the females. Several factors have been shown to significantly influence age at menarche , such as genetic parameters , socioeconomic conditions , general health and life style, nutritional status, physical activity. The mean of menarche age was from 12- 13 years in Europe .
Subject and methods: cross- section study which was conducted in different regions of Iraq from the north to the south . Wth selecting the women ages from 17 to 25years. The sample size was 646 girls . All data was collected through online google forms questionnaire. Data analysis was doing by manual statistical method. The study was conducted during the period from 1 st November 2020- 30 th march 2021. The questionnaire was well structured and including information regarding certain factors associated with menarche age.
Results : The current study was about assessment of certain factors that influence the age at menarche among Iraqi girls. The most frequent age of menarche was among those with age group 12- 14 years (72.2%)followed by the age group less than 12 years (16.7%) and the lowest frequency was among those with age group more than 14 years ( 11.1% ) .Most of the girls with age at menarche was with same of their mother age at menarche(78%.5) Conclusion : The most frequent age of menarche among Iraqi female was 13 years and most of girls age at menarche was similar of their mothers. It was documented that there was an effects of genetic factors in addition to body weight on occurrence of menarche.

The clinical pregnancy rate in In Vitro Fertilization and intracytoplasmic
sperm injection (ICSI) remains low in spite of many evolutions in assisted
reproduction. The ovulatory infertility is the main causes of female infertility
related to oocyte problems. Maternal age, oocyte competence with its follicular
fluid affect oocyte quality and pregnancy rate. So many studies were done for
the follicular fluid and its content to study the effect of its environment and
their relation to pregnancy success. The aim of the study is found a relation
between vitamin D blood level and the oocyte maturation, embryo grade and
pregnancy rate in In Vitro Fer tilization/Intracytoplasmic injection cycles
Materials and Methods
A prospective observational study which was connected at the High
Institute of Infertility Diagnosis and Assisted Reproductive Technologies.
Infertile women (75) who admitted to in vitro fertilization programs in the
institute for the In Vitro Fertilization/Intracytoplasmic injection. Controlled
ovarian stimulation was done to each patient and at the day of ova pick up,
follicular fluid aspiration was done and Vitamin D analysis by Eliza was done.
Level of Vitamin D was assessed to each patient.
Results:
Follicular fluid matching to successfully mature good quality oocyte to
achieve pregnancy. In this study the common causes of infertility are: ovarian 13(21%), unexplained 12(19.4%), PCOS 10(16.1%), male factor 10(16.1%), tubal factor 10(16.1%), and mixed 7(11.3%). Serum level of vitamin D was divided into three groups: Group (1) or normal group ( ≥30 ng/ml), group (2)
or insufficient group (21-29.9 ng/ml) and group (3) or deficient group ( ≤ 20.9 ng/ml) is found among 28 (43.5%),15(25.8%) 19(30.6%), of patients respectively. According to the serum level of vitamin D in three groups, the
mean number of oocyte MII or embryo grades number was not significantly
different .Positive chemical pregnancy is not significantly more among those
with sufficient group (1) as compared with deficient group (3) . The vitamin
D in follicular fluid level demonstrated a not significant positive correlation
between its level and retrieved MI ,MII oocyte number. The results demonstrate a non-significant positive correlation between follicular fluid
vitamin D level and grade (I) embryo. There is no significant difference
between pregnancy rate and follicular fluid of vitamin D.
Conclusion:
There is a non-significant correlation between oocyte maturity, embryo grade and chemical pregnancy rate with both serum and follicular vitamin D level.

Background: COVID-19 is a new coronavirus that has the potential to be deadly. The World Health Organization (WHO) has declared the COVID-19 outbreak to be an international public health emergency. According to new evidence, comorbid diabetes in COVID-19 patients is linked to disease progression and even death. Aim of study is to evaluate the role of serum osteopontin, CRP and D-Dimer activity in the severity of covid19 and possibility of using these biomarker as predictors for mortality of covid19 in diabetic patients.
Patients and methods: This is a cross sectional, hospital based study. This study was carried out from 1st December 2021 to 30th January 2022 and included 60 Patients admitted to COVID19 isolation centers in Alshefa-14 and Kirkuk general hospital (30 COVID-19 without D.M and 30 COVID-19 with D.M) and 30 control samples. All data were collected through a face-to-face interview by a questionnaire.
Results: The current study showed a significant increase in all the measured parameters in patients with positive COVID-19 when compared to control group with no apparent clinical diseases. D-dimer increased in patients by a mean of (3215 ng/l, SD ± 50) when compared to control group (218 ng/L SD ± 27.3) with (p-value <0.05). And when this level is compared between the patient groups (severe non-diabetic, sever diabetic and mild), it’s noted that its level mostly increased in the severe non-diabetic (3912 ng/l, SD ± 49.99) and sever diabetic (1602 ng/l, SD ± 1602) patient group when it is compared to the control and mild group with (P value < 0.05). CRP increased in the severe non-diabetic (111 mg/dl, SD ± 18.30) and sever diabetic (162 mg/dl, SD ± 23.0) patient groups more than both mild (15 mg/dl, SD ± 16.6) patient groups and control group (5 mg/dl, SD ± 1.22) with (p-value <0.05). Osteopontin concentration is increased in the patients sever diabetic (29.31ng/ml, SD ± 1.64) and sever non-diabetic group (21.27 ng/ml, SD ± 1.96) when it’s compared with control group (11.59 ng/ml, SD ± 3.21) with (p-value <0.05). And its level is the highest in Sever patient group when compared with the both mild (diabetic and non-diabetic) patient groups (9.79 ng/ml, SD ± 3.0) and control group (10.1 ng/ml, SD ± 3.21) with (p-value <0.05). Because higher levels of D-dimer, CRP and Osteopontin were linked to a worse prognosis and outcome, these measures can be used as predictors for illness progression or follow-up after therapy.

Background: The most frequent type of arthritis is osteoarthritis. Degenerative joint disease is often known as "wear and tear"
.arthritis. It most commonly affects the hands, hips, and knees Objective(s): The objective of this study is to Assessment the
association between Cigarette smoking and osteoarthritis Patients and Method :In this research, a case-control study design was used in Ibn-Sena , Al-Salam Teaching Hospital and Mosul General Hospital in Mosul, Iraq, from June 1, 2021 to September 30, 2021. A total of 100 patient with knee osteoarthritis were included as cases in this study, with another 100 patient who did
.not have knee osteoarthritis serving as controls Results: The findings of the study suggest that gender has an impact on osteoarthritis. According to the findings, osteoarthritis strikes older women more frequently than it does in men.
.Osteoarthritis is no associated with smoking Conclusion: The lack of a link between smoking and the risk of osteoarthritis of the knee, may be due to the nature of the sample, the majority of which are women who may not smoke, which is in
.agreement with the literature Recommendations: More research is needed on the metabolic consequences of smoking on knee osteoarthritis with a bigger sample size so that gender-based disparities in smoking habits and Knee Osteoarthritis incidence may be assessed.

Malnutrition usually occurs when the person is not receiving the enough nutrients, this may result from an inadequate or unbalanced food, gastrointestinal troubles and absorption difficulties ,or other medical situations. Earlier concepts that the heart is spared in malnutrition have been shown to be incorrect. Inadequate intake of protein and energy results in proportional loss of skeletal and myocardial muscle. As myocardial mass decreases, so does the ability to generate cardiac output. while cardiac function is impaired, the reduction is appropriate and proportional to the decrease in body surface area, which is an indicator of overall metabolic demand and cardiac function is impacted pathologically in the malnourished child and decreases disproportionally to body surface area. Malnourished children suffer several alterations in body composition, with loss of heart and skeletal muscle mass, complicated by electrolyte abnormalities and mineral or vitamin deficiencies that could produce cardiac abnormalities, including hypotension, cardiac arrhythmias, cardiomyopathy, cardiac failure and even sudden death.
The total number are 100 cases,50 cases were malnourished and 50 cases were considered as control cases, Show most of study cases resident in rural 31 (62%), 19 (38%)urban, while in control 50, 35 (70%) urban and 15 (30%) rural. Regarding the time of introducing solid diet in study cases 50, most of them 31 (62%) take solid food in age 7-12months, 6 (12%) before 6 months, and 13 (26%) without solid food. But in control cases 50, most of them 41 (80%) take food below 6 months, and only 6 (12%) without solid diet. Distribution of cases according to the stroke volume in regard to the control cases. There is significant decrease in the stroke volume in the malnutrition cases 14 (28%) as compared to the control cases (0%).decrease in ejection fraction in case study 14 (28%) in compared to control group, while 35 (70%) of study cases have normal ejection fraction in compared to control 49 (89%).w decrease in left ventricular volume in case study 14 (28%) in compared to control group while 35 (70%) of study cases have normal left ventricular volume in compared to control 49 (89%).decrease in ejection fraction in severe type in about12(80%) and in 2(9.1%) of moderate type of malnourished children from the total number 50. decrease in stroke volume in severe type of malnutrition in about12(80%). cardiac thickness decrease in severe type in about 10(66.7%) of severe type of malnourished children.

The aim of this study is to explain the effect of fasting and dietary habits in Ramadan on lipid profile and some liver enzymes
.The study had been carried from April, 2022 to May 2022 on 20 healthy male individuals.
Background & Aims: The fasting state in Ramadan has numerous health benefits. Nevertheless, its beneficial role on the lipid profile liver function was evaluated by limited studies and different findings were recorded. So, this study aimed to define the effect of fasting state in Ramadan on lipid profile and some liver enzyme levels in healthy individuals.
Materials & Methods: Twenty healthy adult men without history of liver diseases and current usage of any medication affecting the liver were involved in the present survey. Liver function tests were measured before and after Ramadan.
The biochemical parameters including liver enzymes Aspartate aminotransferase (AST) and Alanine Aminotransferase (ALT) were evaluated before and after Ramadan by the standard enzymatic method.
Results: A decrease was observed in mean level of cholesterol , Low dencity lipoprotein (LDL) cholestrol, Very low dencity lipoprotein (VLDL) and Triglyciride(TG).An increase in the mean level of healthy type High dencity lipoprotein (HDL) cholesterol. The values of ALP and AST decreased at the end of the study in the post-Ramadan group versus pre-Ramadan
Conclusion: The fasting state in Ramadan improve the lipid profile levels and liver function in healthy adults.

Background : Urinary tract infection is a common infection causing illness in children. It is either presented with specific symptoms or may asymptomatic especially in younger infant. It is most common cause of febrile disease in children .Affecting about 2% of boys and 80% of girls by the age of 11 years. UTI is important infection usually occurs due to bacteria although viruses and fungi and parasites can also cause infection.
Aim : The aim of this study early diagnosis of UTI by use strip method.
Patients and method: Across sectional hospital based study done on patients who attended the outpatient clinic of pediatric General hospital in Kirkuk city selected randomly ,during the period from 1 st of July to 30 th of August 2017
.The population included in this study was children aged 2 month to 12 years old ,total number about 250 cases, only selected the patient with positive stripe test for pus ,which represented about 170 patients ( 95 girls and 75 boys), were send t for urine culture .The patients included in this study ,were those patients who had signs and symptoms of UTI .Each patient included in the study were assessed by appropriate questionnaire which include name ,age ,sex, ….etc
.Each patient included in the study were assessed for presence of UTI using strip method .Urine sample taken from patients by clean catch and by urine collection bag in children younger than 2 years, after learning the mother to wash genital area with water and soap if available before applying the urine bag .Patient > 2year ,urine were taken by midstream urine sample after cleaning the area as above .Urine putted in tube and sent immediately to the lab fir culture after take the results of strip method . The strip screen for presence of 8 different items in addition to pus, cell, nitrate ,PH, protein ,glucose, ketone ,bilirubin , erythrocyte, and Hb. The number of pus cell in strip were represented in different colors according to number of pus cell. The patient were diagnosed as UTI by strip method in the presence of 1+ or more pus by comparing the matching color .
Results: The total number of cases included in the study were 250 cases , 170 (68%) of cases were positive by strip for UTI , 52 (30%) of cases were positive by culture of urine. 155 (62%) of cases were female . 215 (86%) of cases live in urban area .135 (54%)of cases were poor .166 (66%) of patient have illiterate mother ,55 (22%) primary school,29 (11.6%) secondary school, (0%) collage .
Conclusion :The study concluded that The strip method is not specific to diagnosis UTI and still the culture method is the sole method to diagnosis of UTI.

Backgrownd : Pneumonia is a significant causes of respiratory morbidity and mortality in children especially in developing countries worldwide is the leading causes of death in children younger than 5 year. Sever pneumonia characterized by high fever and difficulty breathing and can be fatal it is critical there fore to assess the severity of condition during initial bedside assessment in emergency department by using pediatric respiratory severity score. The PRESS score which depend on respiratory rate ,wheezing ,accessory muscle use ,spo2 and difficulty feeding.
Aim: This study done to evaluate the role of The Pediatric respiratory severity score ( PRESS) as screening test for assessment of severity of pneumonia. Patient and method: Convenient sample hospital based selective study done on patient attending emergency department at Salah Aldeen General Hospital who complain from shortness of breathing during the period from May 2017 to
13November 2017 .The study included 52 children there age from 0-60 month .Each patient included in the study were assessed by prepared questionnaire from parents include (name ,age ,sex, residence ,type of feeding screening done by general examination including respiratory rate and sings of dyspnia that include tachypnea , use of accessory muscle, wheeze ,and chest indrawing . Each patient examined for chest examination looking for crepitation and ronchi ,each patient where assessed by Acute Respiratory infection World health Organization program ( ARI) . Each patient also assessed by pediatric respiratory severity score (PRESS) that include respiratory rate wheezing , accessory muscle use , feeding difficulties ,and SPO2 level above 95%.And each patient assessed by community acquired pneumonia (CAP) score. The diagnosis of pneumonia when done by CXR with x-ray report from experience radiologist .
Results: The total number of cases 52 case32 (62%) male and 20 (38% )female. Most of study cases from urban 31 (60%) and age 3-12 month age was23 (44%) most of cases had tachypnea 35(67%) and with bottle feeding 28(54%). Most of cases had history of upper respiratory tract infection 42(81%) and 30(58%) of cases not taken vaccination. According to community acquired pneumonia ( CAP) severity score. Most of cases with mild to moderate CAP 29 (56%) and according to acute respiratory infection (ARI) program found most of cases with very severe illness 28(54%) and according to pediatric respiratory severity score PRESS where found most of cases with sever pneumonia 26 (50%) according to radiological finding most of cases where multifocal pneumonia 24 (46%).
Conclusion: The PRESS was sensitive as ARI score but the specoificity was similar to CAP score . So it is recommended that the use of PRESS score for assessment of pneumonis in children 0-6 months age.

Background: Peptic ulcer disease (PUD) is a common gastrointestinal problem with significant morbidity and mortality despite introduction of effective therapy. Some aspects of this disease carry regional and ethnic variations.
The aim of the present study is to demonstrate demographic and endoscopic characteristics of gastroduodenal ulcers in Mosul, and display their frequencies and bleeding complications.
Patients & methods : This is a retrospective, cross-sectional study of 326 patients diagnosed endoscopically with peptic ulcers in Al-Salam General Hospital in Mosul during a period from January 2018 to December 2020. Details of patients records regarding demographic, clinical, and endoscopic findings were collected and analyzed. Results: Total number of patients was 326. Duodenal ulcer (DU) comprised 286 patients (205 males, 81 females), and gastric ulcer (GU) 40 (18 males, 22 females). Mean age of DU patients was 34.1 ± 13.9 years, and GU 54.9±15.3 years. Male:female ratio was (223/103, 2.2:1). DU:GU ratio was (286:40, 7.2:1). The main site of DU was the duodenal bulb (283/286, 99%) and for GU the antrum and lesser curve (28/40, 70%). Around 90% of ulcers were single. Bleeding was a presenting symptom in 20% of patients, and in 32.3% were associated with the use of mainly non-steroidal anti-inflammatory drugs (NSAIDs). Conclusions: In Mosul city DU affects a relatively younger ages compared to GU. DU was more predominant in males. DU:GU ratio was wide. Ulcers were mainly single and located in the duodenal bulb and antrum of the stomach. Bleeding was a common presentation of PUD. NSAIDs contributed largely to bleeding complications.

To treat tendon injuries, platelet-rich plasma (PRP) is widely utilized in orthopedic surgery and sports medicine. Tendinopathy, a condition of the tendons, can be treated using PRP. The purpose of this study is to examine the applicability of the combination of three different cell types and PRP on tenocyte-conditioned medium (CM) to investigate the potential effect on promoting tendon healing. Tenocytes, bone marrow mesenchymal stem cells and dermal fibroblasts were cultured in a three-dimensional PRP hydrogel with or without CM, and the proliferation and migration of the cells were observed. Through reverse transcription quantitative polymerase chain reaction and enzyme-linked immunosorbent assay, the CM derived from tendon was applied to mesenchymal stem cells, tendons, and skin fibroblasts, respectively, to determine its effect on matrix formation phenotype and inflammatory protein secretion. Tendon cell CM combined with PRP stimulated tendon formation of mesenchymal stem cells and skin fibroblasts and reduced the secretion of inflammatory proteins. In conclusion modifying the target tissue with PRP before cell implantation can optimize the effect of cell therapy. Skin fibroblasts and bone marrow mesenchymal stem cells combined with PRP can be used to regenerate tendons.

There are many incidents that lead to oxidative stress resulting from reactive oxygen species. Many plants including fruits, vegetables and fungi are recognized as sources of natural antioxidants that can protect against oxidative stress such as mushrooms like, Ganoderma lucidum including many compounds can protect against oxidative stress. In this study we aimed to investigate the antioxidant effects of Ganoderma lucidum (Red Reishi Mushroom) on liver histologically by light microscopy, measurement of some biochemical parameters (cholesterol, tricholesterol , HDL,VLDL, LDL and glutathione). We use 20 male rats weighing around 200-250g , which were divided into 4 groups. The first group as a control group 1 didn't receive any medication and gained free access to food and water. The second group received hydrogen peroxide H2O2. The third group received vitamin C + H2O2. The fourth group received Ganoderma lucidum + H2O2 for 30 days. After experiment, we analyze the results (histopathological sections of liver and detection of biochemical parameters such as cholesterol, tricholesterol ,HDL,VLDL.LDL and glutathione) to reveal the effects of Ganoderma lucidum and antioxidant compared with the other groups with duration of exposure.

Background: Urological injuries are an important matter of a gynecologist especially during hysterectomy and Caesarean section. These complications, although rare, can lead to morbidity and mortality and also can create worry and psychosocial concerns for couples. The most common site liable for injury are bladder and distal ureter .
Objective:The objective of this study is to find out the frequency and kind of urological injuries in obstetric and gynecological procedures.
Patients and method: This Prospective case series study ,performed at Al- Batool maternity teaching hospital, Mosul, Iraq during the period from January 2013 to July 2014 , The study include 21 patients who underwent obstetric and gynecologic surgeries that complicated with Iatrogenic Bladder & Ureter Injury (IBI&IUI).All patient accessed with focus history and examination , Intraoperative and postoperative bladder and ureter injury was recorded and studied.
Results: The results of the study showed that out of 11,861 obstetric& gynecological (OBG) procedures 21(0.18%) patients have urological injuries. The patients ages ranged between 23–55 years [mean ±STD (36.47±7.69 years)] and patients parity 0–12[mean ±STD (4.33±2.56)].
Of the 21 patients who have injury ,17 patients (80.95%) due to obstetrical procedures & 4 patients (19.05%) due to gynecological procedures
.13(61.9%)cases were emergency VS 8(38.1%) cases were elective . Among the obstetric procedure 16 (94.11 %) had previous caesarean sections with 11(64.70 %) had more than one scar. Pelvic adhesion of severe type was found in 13 (61.9%) patients. Morbidly adherents placenta in the form of accreta , percreta occurred in 5 patients (29.4%)
The frequency of urological injury (17 case) among all obstetric operastion (11344 case) was 0.15% while the frequency of urological injury(4 cases) among all gynecological operation (517 case )was 0.77% . 50% of bladder injury are of grade 3.
Conclusion and recommendations : Iatrogenic ureteric and bladder injuries from obstetric and gynecologic surgeries though uncommon but are liable to occur. Bladder injury occurred more commonly than ureteral injury ,Possible injury to the urinary tract should be discussed with all patients undergoing a surgical intervention, as it is a recognized complication.