The Medical Journal of Tikrit University

Background: a common undesirable outcome of pregnancy is abortion, mainly in the first trimester, and cause complication both physical and psychological.
Aim: To assess the associated factors with abortion in Mosul city. Patients and Method:A case-control study done at Mosul teaching hospitals for Obstetrics and Gyneacology (Al-Batool teaching hospital and Al-Khnsaa teaching hospital) . The study took 6 months period from 1st of February 2016 to 30th of July 2016.
A total of 300 pregnant women were collected -150 cases (documented to be pregnant by pregnancy test or by ultrasound) and 150 controls.
Results: A significant association has been found for the age of women <15 years and ≥ 40 years with abortion with p. value 0.01 & 0.05 respectivly.
A highly significant association was found in nullipara women (P=0.001) . History of more than two abortion and a short inter-pregnancy interval (less than 6 months) all show a significant association with abortion (P. value of 0.002, 0.001 & 0.000 respectively .
Hypertension, Diabetes and history of fever are all found having a significant relation with abortion with p. value of 0.025, 0.05 and 0.002 respectively.
A highly significant relation has been found between history of congenital abnormalities and abortion (p=0.000) also cervical incompetence and fibroid show a significant association with abortion with p. value of 0.004 and 0.002 respectively.
Absent Antenatal care show highly significant association with abortion(p.value0.000).Consanguinity appeared to have a significant association with abortion with P. value of 0.001.
Conclusions: consangeous marriage have risk of abortion and congenital abnormalities. Pregnancy at both extreme of age (less than 15 years and 40 years and more) has a more chance of abortion.

Background: IUI procedure is widely applied around the world. The aim of IUI is to put a prepared small volume of active motile sperm high in the uterine cavity, on the period of ovulation. In many centers IUI is usually applied in combination with ovulation induction or Controlled ovarian hyperstimulation (COH). however, the successful rate of getting pregnancy with IUI remains unchanged.
Aim of study: To clarify the prognostic factors effect in cases of unexplained infertility offered intrauterine insemination with controlled ovarian stimulation.
Patients and methods: This is a prospective cohort study has been conducted in Salahadeen General hospital (Iraq/Tikrit City) from December 2017 to August 2018. A 45 couples of unexplained infertility were included, a maximum of 3 cycles of IUI were done with clomiphene citrate, HMG. Ovulation trigger was given when the largest follicle diameter around 18 mm. and IUI was planned within 36hrs. later
Results: A50 cycles of IUI were entered into the study among 45 couples. From these cycles, conceptions resulted, giving an overall total pregnancy rate per cycle of 12%. Cycles per couple were ranged from one to three. The mean age of the male patients was (37year) and (33year) for the female patients. The mean of duration of infertility was (9.5year) in couples who got pregnancy while was (5.04year) in those who got no pregnancy. The pregnancy rate was higher in the age group of (25-29 yrs) and (more than 35ys). The pregnancy rate was higher in cycle with one follicle.
Conclusion: In this study different factors had been studied like couple`s age, duration of infertility, number and size of follicles, number of treatment cycles, semen parameters and duration of stimulation were used to predict the success rate but all were not significant. There was significant difference in the pregnancy rate in cases of primary (12.5%) and secondary infertility (11.5%) group (p value=0.042). The overall pregnancy rate per cycle in our study was 12%.

Diarrheal disease is common among children worldwide, especially developing countries, and common causes of mortality in children under the age of five. One hundred and fifty stool samples were collected from children with diarrhea below five years from the beginning of August 2016 until the end of December 2016.The prevalence of diarrhea was different among males and females: 47.11% of males were collected, while 52.88% of bacterial females. The study revealed that 104 isolates were identified from patients with diarrhea. These bacteria were isolated and diagnosed based on phenotype and biochemical tests.The most isolated bacteria were Serr a tia odor ifera (17.30%), followed by E.coli (14.42%) ,Sa lmonella (9.61%) , K.pneumonia e (5.76%) and S.sa prophyticus (5.76%), the results of the sensitivity test for 13 antibiotics were shown using the disc method and there was a different the levels of resistance to different antimicrobial agents.

Post-operative leak from GI anastomoses is common and serious condition that carry a high mortality and morbidity and to it is serous septic complication and fluid and electrolyte disturbance . Also it cause severe fecal feeding problem with malnutrition and its complication, leading to sever complication.
.Aim of study:
Is to estimate the incidence of leak ( fecal fistula ) from the site of gastro-intestinal anastomoses using different technique of bowel anastomoses ( single layer vs. double layer bowel anastomoses). Material & Methods :
100 patients [ 60♂ (60%)] & [ 40♀ (40%) ] are included in this study, which is conducted in SGH during the period between Jan. 2017- Dec. 2020
.Informed Written consent was taken from all patients prior to enrolling into the study. Only the patients who have small bowel and colonic anastomoses are taken in this study to estimate the incidence of leak after bowel anastomoses using either single layer or double layer anastomoses
.The patients are divided into 2 groups:-
Group A : 50 patients with single layer anastomoses .
Group B : 50 patients with double layer anastomoses.
Results : The overall incidence of fecal fistula in this study was 10% (10 patients from the 100 patients in this study ). Regarding patients with leak from the anastomoses, 7 patients (70%) had double layer & 3 patients (30%)had single layer anastomoses. The incidence of leak is more in female (60 % ) than in male (40 % )and more in large bowel anastomoses(70 % ) than small bowel anastomoses (30 %) . The overall morbidity is 30% from the post-op. leak .
Conclusion: Bowel leak from the site of bowel anastomoses is common and carry high mortality and morbidity . Single layer meticulous bowel anastomoses carry lowest rate of leak and complication including narrowing of the bowel lumen prolongation of time of operative .

Objectives: To evaluate the surgical outcomes in term of clinical improvement and complications.
Type of study: Prospective study in Mosul teaching hospital department of neurosurgery from 1-6-2017 to 1-1-2019.
Patients and methods: include 160 patients treated by open surgical release. Inclusion criteria: patient with clinical features of Carpal Tunnel Syndrome (CTS) , pre-operative Electromyography (EMG) evidence of CTS , failure of medical treatment and open surgical decompression was the adopted operation .Follow up period for 6 months, visual analogue pain scale, relieve of parasthesia and improvement of motor activity of hand had adopted as Satisfactory result .
Results: There were 142 female, 18 male, mean age 41.6 years.
103 patient were right sided, 47 left sided and 10 patient were bilateral. EMG results were 118 severe, 35 moderate while 7 were mild.
All patients had satisfactory results except 10 patients post-operativly . Conclusions: The open surgical treatment is safe, effective and produces excellent results in the surgical treatment of carpal tunnel syndrome .

Back ground : Coronavirus disease 2019 (COVID-19) was first identified in China leading to out break of respiratory illness . there are many vaccination used for prevention of the disease. Many side effects appeared with taking theses vaccine as pain, redness, swelling at site of injection and systemic effects (e.g, fever , fatigue, headache, muscle or joint pain, with rare serious adverse events.
Patients and methods: The current study was descriptive one ,it was conducted among persons vaccinated with Covid-19 vaccines from the period 14th November 2021 -18th march 2022 in Tikrit city . The sample was taken from people attending Tikrit teaching hospital out patient clinics and those previously taken the vaccines. The information was obtained according to a designed questionnaire which included all information regarding certain demographic characteristics and common adverse effects as a result of COVID-19 vaccination according to vaccine type.
Results : The most frequent adverse effects was among subjects given AstraZeneca vaccine , followed among those given Pfizer vaccine and the last among those given Sinopharm vaccine. The more frequent cases with adverse effect with AstraZeneca and Pfizer vaccine was among age group (35 -45 years )(63%,70.2% respectively) while those among those given Sinopharm was among age group less than 35 years (38.2%).The commonest adverse effect of COVID-19 vaccination was pain/tenderness at site of injection (76.3%) followed by fever/chills (70.6%) and muscle weakness/tiredness (66.6%) .
Conclusion: The most frequent adverse effects of COVID-19 vaccination was pain/tenderness at site of injection and the highest frequency of adverse effects were among those given AstraZeneca vaccine.

Background: Worldwide the incidence of penetrating abdominal injuries, including warfare injuries, is increasing and in most cases exploratory laparotomy is warranted. A single laparotomy may not be sufficient and a relaparotomy sometimes may be needed to deal with these patients.
Aim of the study: This study was done to evaluate the causes of relaparotomy following warfare penetrating abdominal injuries and to determine the relationship between the cause of the relaparotomy and the outcome.
Patients and methods: A retrospective study conducted on 252 patients undergoing laparotomy for penetrating abdominal injuries at Baghdad teaching hospital or was admitted to the hospital for continued care, in the period from August 2014 to August 2015. Out of these 252, relaparotomy was needed in 42 patients within 60 days of the primary surgery.
Results: Among 252 patients, in whom emergency exploratory laparotomy for warfare penetrating trauma were done, 42 patients required relaparotomy (16.17%), 40 patients (95.23%) were military male and 2 patients (4.77%) were civilians as one male and one female. The causes for a second laparotomy found to be broadly divided into three main groups: A – Completion of damage control surgery (DCS) in 19 / 42 patients (45.24%)
B – Missed injuries in 8 / 42 patients (19.05%)
C – Postoperative complications in 15 / 42patients (35.71%)
The mortality rate was 4.36% after the first laparotomy and 21.42% after the second laparotomy.
Conclusions: Completion of damage control surgery and dealing with postoperative complications are the most common causes of relaparotomy. Relaparotomy is associated with a higher mortality rate, particularly among those with a leak from anastomosis or missed bowel injuries.

Background: Genus Ca ndida is the major yeast infecting humans. Ca ndida albica ns (C. albica ns) have a role in the most opportunistic yeast infections in candidiasis, yet remains as the most common between genus species. About (50-90) % of human candidiasis occurs due to such yeast. Objectives: This research aims to detect, isolate and identify C. a lbica ns, also examining the C. albica ns susceptibility to some antifungal agents. Methods: A total of 200 dermal and oral children’s samples have been collected, their age was not more than 2 years., the diagnosis was made via conducting a confirmative and routine process through direct microscopic examination. Then, they have been cultured on Sabouraud Dextrose Agar (SDA) as well as microscopic examination related to colonies and sub- cultured on the CHROM agar which has been a selective media used for identifying the species of ca ndida. C. albica ns were identified via the use of a germ tube test.
Results: From those 200, a total of 91 have been diagnosed as Ca ndida spp. infections. In terms of GIT, C. non a lbica ns was maximum (20%) and C. a lbica ns for diaper rash was (20%). In a total of 60 isolates Ca ndida spp., the results of anti-fungal susceptibility were equivalent for nystatin and amphotericin B. where, 56,7% of isolates were sensitive, while 41,7% and 1,7% of the isolates are resistant and intermediate, respectively. whereas for ketoconazole, 13,3% of isolates were sensitive, also 85,0% and 1,7% were resistant and intermediate to ketoconazole, respectively, lastly, 23,3%, 25,0% and 51,7% of isolates were intermediate, sensitive and resistant to polymyxin, respectively.
Conclusions: An increase in fungal infections and resistance to antifungal medications due to the increased usage of some immunosuppressive medications and extreme chemotherapy.

Background: Post-traumatic stress disorder is defined as the combination of three clusters of symptoms which are re- experiencing, avoidance and hyperarousal, persisting for at least one month, in survivors of a traumatic event, and it differs from other mental disorders.
Aim: This study performed to assess the presence and frequency of post- traumatic stress disorders among Tikrit University students after mass displacement in June 2014.
Patients and Methods: The current study is cross-sectional study done from 1st of November 2017- 1st of March 2018 as 300 students involved in the study who exposed to trauma after Salahaldeen mass displacement in June 2014 were surveyed. Students chosen as cluster (nine colleges) sample then simple random sampling. Data collected from Tikrit Universities-Iraq. The demographic information, type of exposure, common complains, family history, coping mechanisms and other associated psychological disorders have been described. The study depends in diagnosis on Dia gnostic a nd Sta tistical Ma nua l of Menta l Disorder s fifth edition (DSM- 5) cr iter ia.
Results: From a total 300 students (who exposed to trauma) there were (52.7%) students had post-traumatic stress disorders, (51.3%) of those were females. Frequent type of exposure to traumatic events affecting post- traumatic stress disorders outcome was relative or close friend death (46.2%) in males while 44.1% females. Most frequent coping mechanism of post-traumatic stress disorders was reading Koran or praying (32.6%) of cases. Most frequent psychological disorders associated with post- traumatic stress disorders was phobic disorders 27% among male gender, while anxiety most frequent among females were 20.4%.
Conclusion: The study showed the frequency of Post-traumatic stress disorder symptoms were high, especially in those who experienced multiple traumatic events and most frequent in female gender, Most traumatic event that the Post-traumatic stress disorder cases were exposed to it were death of relative or close friends
Recommendations:
Patients had post-traumatic stress disorder need regular supervision by mental health care professional to provide them with knowledge and treatment.

Background: An anal fissure is defined as an ulcer in the anoderm usually in the posterior midline, less frequently in the anterior midline, and rarely in the lateral position of the anal canal.
Objective: The objective of this study was to compare the efficacy of outcome of lateral internal sphincterotomy with topical 2% Diltiazem gel in the treatment of chronic fissure in ano.
Methodology: 100 patients were randomly selected from the admitted patients with chronic fissure in ano. where this study was done from August 2018 to August 2019. were randomly divided into Group 1 (Diltiazem gel) and Group 2 (internal sphincterotomy) with 50 patients in each Group. The data obtained was analysed using SPSS software version 20.0.
Results: Dominant part of the fissure were back in area with sentinel pile present in 46 of cases. Cases were followed up at week by week intervals for 6 sequential weeks and every other week for consequent 3 months. 2 cases from Group 1developed fistula in ano and required medical procedure. 25 of patients in Group 1 and 50 of patients in Group 2 had completely healed fissures at the end of 4 weeks. 48 of patients in Group 1 who were totally healed with Diltiazem gel application and 49 of patients in Group 2 were free from pain toward the part of the arrangement. Three patients in Group 1, whose fissure did not recuperate following a month and a half of Diltiazem application and stayed symptomatic, in this manner experienced inner sphincterotomy and fissures healed in about a month after medical procedure. The mean length of healing was relatively longer in Group 1(5.04 weeks) than Group 2 (3.6 weeks). Confusion was accounted for in 1 case in Group1 which was return in signs and indications which required sebsequent medical procedure.
Conclusion:
Hence Subcutaneous fissurectomy with topical 2% Diltiazem gel is a better surgical option for chronic fissure in ano than conventional Lateral internal sphincterotomy.

Background and Objective: Renal failure is a disorder with a feature of high urea and creatinine level with the outcome of anunexpected decrease in kidney function resulting in a significant decline in glomerular filtration rate. Apart from the major clinicalimportance of ABO blood group on blood transfusion and organ transplantation, there seem to be strong associations betweenblood group types and some diseases as a result of the carbohydrates compound found on the surface of the red blood cellmembrane. This study aims to determine the effect of ABO blood group on renal disease patients. Materials and Methods: This case study was conducted on 150 patients with renal failure attending Dialysis unit in Tikrit Hospital from April-June, 2022. Ethical approval and patient consent statements were taken from everyone and the study was performed in the Medical Laboratory department of the hospital. Total 3 mL of patient blood was put into plain bottles. Serum was used to the determine ABO blood group was done with red cell samples by tube agglutination method. The data obtained were analyzed by SPSS software version 22.
Results: Generally, the study revealed a strong association of ABO blood group on renal failure (p<0.001). However, Group O antigen was statistically discovered to cause the severity of renal failure (p<0.05). Conclusion: The results showed that blood group O individuals are more susceptible and suffer severely in renal disease than other blood group individuals.

In 2019, a wild coronavirus infection epidemic (COVID-19) has infected about 183 million people worldwide, resulting in roughly 3,972,000 fatalities. Various studies had reported there were no significant differences between pregnant and non- pregnant women infected with COVID-19 regarding clinical signs. Few studies, however, had focused on the newborns delivered by COVID-19 infected women. In the present survey research, a total of 49 pregnant women with COVID-19 sickness who had passed on in 2 doled-out broad clinical centers in Iraq, between the end of june of 2020 to mid of july 2021 were considered, along with 50 neonates carried by them (one of the women was carrying twins). Maternal fragment ascribes, movement course, appearances, and lab test records were obtained from crisis centers. The babies were administered into hospitals if they were found to have the relevant symptoms (5 cases), or legal guardians accepted a segregated clinical solution (23 cases), while 22 cases was symptome free but still followed by telephone if they had any complain. Any recordings of test results, radiography, and tomography files of the hospitalized babies that are the focus of this paper were separated from other records. 4 babies were tested for the presence of sever acute respiratory syndrome -CoV-2 antibodies.
Of the 49 pregnant women infected with COVID-19 (23 confirmed and 26 through clinical diagnosis), and their mean age was 39 years. 34 of the patients were found to have mild symptoms like fever (29), headache (9), shortness of breath (4), abdominal pain (2), increased salivation (1), while 15 displayed no symptoms. 11 of the patients had difficulties with their pregnancy, and 47 decided to deliver their babies through c-section procedure.
Of 50 newborns, 28 were transferred to neonatal care unit for treatment and care, while the remaining 22 who had no symptoms were administered to care services normally. 5 of the hospitalized babies were diagnosed with COVID-19 infection (2 confirmed and 3 suspected). Also, 12 of 13 normally service-administered babies displayed radiological findings indicating pneumonia (in X-rays and Computed tomography scans, 1 had intermittent cough, remaining displayed no relevant symptoms). SARS-CoV-2 antibodies and corresponding IgM and IgG levels were evaluated for four of the babies, and two out of these four were found to be positive. The limited number of tested babies prevented any statistical study regarding their social status variables.
As part of this study, 2 out of 50 babies delivered by COVID-19 infected mothers were found to display pneumonia related findings in their radiological surveys. These findings are indicative that intrauterine and/or intrapartum infection of the baby is a potential risk, which requires further testing and clinical preparations.

Background: Three-dimensional ultrasonography enhances the imaging capabilities of two-dimensional ultrasonography because of its additional capability to reconstruct the coronal view. It is particularly useful for visualizing the intrauterine contraceptive device position in relation to the endometrial cavity.
Aim: To estimate the role of three-dimensional ultrasonography ultrasound in the detection and evaluation of intrauterine contraceptive device malposition and other complications. To determine the commonest risk factors and presentations of the intrauterine contraceptive device malposition.
Patients and Method: A cross-sectional study was conducted in the Salahadeen General Hospital and a private ultrasound clinic during the period from the 1st of January to the 30th of June 2022. A convenient sample of 100 women who had an intrauterine contraceptive device. Results: The pain was presented in 24% of the participants, while 22% of them had bleeding. The conspicuity was significantly higher with three- dimensional ultrasonography ultrasound use than with two-dimensional ultrasonography use. About 33 (33%) of participants had intrauterine contraceptive device malposition by using three-dimensional ultrasonography ultrasound, and 11(33.3%) of them had normal positions on two-dimensional ultrasonography ultrasound
Conclusion: Three-dimensional ultrasonography was better than two- dimensional ultrasonography in the detection of intrauterine contraceptive device malposition in symptomatic and asymptomatic women.