The Medical Journal of Tikrit University

Background Worldwide, malnutrition is common and is responsible directly or indirectly for about a third of all deaths of children under 5 years of age. Restrictive diets may be iatrogenic as a result of exclusion diets or parental food fads, or may be due to parasitic infection like Giardia lamblia which is a zoonotic parasitic disease caused by the flagellate protozoan Giardia lamblia (also sometimes called Giardia intestinalis and Giardia duodenalis). This study aims to evaluate the occurrence of infection by Giardia lamblia among the malnourished children under five years. Patients & Methods: A descriptive cross sectional study was done on children attending the pediatric department, and nutrition department in General Pediatrics Hospital in Kirkuk from 15th of March to the last of August 2015. The study included 101 children, their age from (2 months -5 years). Each child included in the study was assessed by a prepared questionnaire. Screening done by measuring weight for age, height for age, then diagnostic test done by depending on weight for height to confirm diagnosis or exclude malnutrition. Each malnourished case was sent for general stool examination.
The Results: The males were 56.4 % while female were 43.6% most of the cases were of 2-12 month for both females (47.4%) and males (54.5%) respectively.. Other findings for this study showed that all the cases were wasted (100%) followed by abdominal distention (60.4%) and finally most of the study cases were below 3rd percentile 73.3%.Regarding the general stool examination , the laboratory examination showed that positive test for Giardia lamblia were 12 cases, (11.9%) most of the study cases had normal Middle Arm Circumference (88.1%) and most pateints with Giardia lamblia had weight for age less than 3rd percentile (83.3%) and most Giardia lamblia positive patients had height for age less than 3rd percentile while negative Giardia lamblia infection had normal height for age (100%). Finally the present study concluded that Giardia lamblia is still prevalent among malnourished cases.

Background Acute coronary syndrome (ACS) refers to any group of clinical symptoms compatible with acute myocardial ischemia including unstable angina, Non-ST-segment elevation myocardial infarction & ST-segment elevation myocardial infarction. Heart - type fatty acid binding protein ( H-FABP ) also known as mammary-derived growth inhibitor is a protein that in humans is encoded by the FABP3 gene, The diagnostic potential of the biomarker H-FABP for heart injury. The aim was to To evaluate serum levels of FABP in patients with Acute Coronary Syndrome subgroups and investigate its role in differentiation among them.
Patients & Methods: The present study was conducted at the Department of Biochemistry, College of Medicine/ University of Baghdad during the period from December 2017 until August 2018. Thirty three patients with ACS were included as 11 with unstable angina (UA), 11 with non ST elevation myocardial infarction (NSTEMI), & 11 ST elevation myocardial infarction (STEMI) patients. Also this study included 18 non-ischemic chest pain subjects who served as pathological control. Blood samples were obtained for measurements of FABP and hs-cTn by ELISA method.
The Results: The mean (±SD) value of FABP was significantly increased in NSTEMI (3.80‎ ±‎ 1.45ng/ml, p< 0.001) and UA (3.62‎ ±‎ 0.42 ng/ml, p < 0.001) compared to that of STEMI (1.88‎ ±‎ 1.60 ng/ml). Also, the mean value of serum H- FABP levels of pathological controls (3.17‎ ±‎ 0.73 ng/ml) was significantly higher than that of STEMI group (p < 0.001). Regarding hs-cTn, it did not differ significantly among the groups of UA (2.82‎ ±‎ 0.69), NSTMI (4.08‎ ±‎ 2.35), and STMI (4.53‎±‎2.06(
Conclusion:
FABP showed significant elevation in UA and NSTMI and may be used as a biochemical marker in assessment of these two conditions and to differentiate them from STEMI. It used in ACS differentiation is superior of that of Tn.

Background A newborn skin may exhibit a variety of changes during the first four weeks of life. Most of these changes are benign and self limited but others require further work up for infections etiologies or underlying systemic disorders .
The aim of current study is to assess the frequency of neonates with various skin lesions attended to pediatrics unit, dermatologic unit, neonatal care unit, or those delivered in labor room and those admitted to pediatric ward in Salahaldeen General Hospital.
Patients and method : The observational case control study involved study of 260 live newborns (160 males and 100 females) performed during the period between the first of July, 2017 to the 15th of September, 2017. Results : The frequency of various skin lesions were (50%) for Mongolian spots, (31.1%) for milia, (6.25%) for erythema toxicum neonatorum,and (6.25%) for omphalitis.There was statistically significant relationship between skin lesions and mood of delivery, maternal health status including diabetes mellitus, pregnancy induced hypertention, urinary tract infection as risk factors, and the age of newborn babies.
Conclusion : It is concluded that most of skin lesions were physiologic about (90.66) and about (9.3%) _ were pathologic lesions. Most common skin lesions in this study were Mongolian spots, in which form about (50%).

Background Erythropoietin is the growth hormone of erythropoiesis that produced mainly in the liver during fetal life and in the kidney during infancy. It’s low level considered being the main cause of anemia in prematurity. The aim was to measure serum erythropoietin concentrations in premature babies and correlate it to different hematological parameters. Patients & Methods: This was a cross-sectional study conducted for four months starting from 1st December 2018 to 1st March 2019, included 25 premature neonates admitted in neonatal care unit of Rapareen pediatric hospital & maternity hospital, Erbil, Iraq. All premature neonates whose gestational age was between 28 -34 weeks were included in the study regardless of their birth weight. Hemoglobin, hematocrit, reticulocyte count and serum erythropoietin levels were measured in premature babies at first and at the end of the fourth week.
The Results: Serum erythropoietin measured in total 25 premature babies, in which serum erythropoietin in 52% of them was within the normal range (2-20 mIU/ml) while in 48% were below this range. serum erythropoietin concentration positively correlated to gestational age (r=0.47) in contrast it was negatively correlated to the Hb (r=0.51) and PCV(r=0.34). Conclusion: The results of this study suggest that about half of premature neonates had low serum EPO level while other half had normal serum EPO level in the 1st week of life, also we identified a strong negative correlation between serum EPO and Hb in the 1st month of life, therefore, there was a statistically significant difference between serum EPO in 1st week and 1st month.

Background: One of the commonest emergencies in surgical practice (pediatric and general surgery) is acute appendicitis which is associated with acute phase reaction. Diagnosis of acute appendicitis is still a challenging issue for surgeons because lifetime risk of acute appendicitis is high (in some series reach 8%), rate of negative exploration is also high (in some series reach 35%) and complications of acute appendicitis (mainly perforation of appendix) are still high, especially in developing countries (in some series reach 62%). Several modalities have been used for diagnosis of acute appendicitis which include scoring systems (e.g. Alvarado scoring system), imaging techniques (ultrasound and computerized tomography), and laboratory investigations (white blood cell count, neutrophil percentage, C-reactive protein and some other serological markers) in order to improve diagnosis, reduce negative exploration rate and reduce complications rate. The aim of study is to evaluate efficacy of (CRP, WBC count and neutrophil percentage) in diagnosis of acute appendicitis. Patients and methods: The study was conducted at the beginning of January to the end of August 2018. Thirty male patients, whose age between 10-40 years and admitted to emergency department of Kirkuk general hospital and diagnosed clinically as acute appendicitis by same surgeon, were studied. In emergency department, white blood cell count (WBC) and neutrophil percentage (NP) are estimated by same automated analyzer in same laboratory (as part of complete blood count estimation). C- reactive protein (CRP) was estimated qualitatively by latex agglutination technique in same laboratory. Appendicectomy was done by same surgeon and decision was done regarding whether appendix was inflamed or not macroscopically (by same surgeon) and microscopically (by histopathological examination by same histopathologist). Chai-squared test was used to compare between means of variables. Results: There were significant relations between onset of symptoms and results of CRP results, onset of symptoms and end diagnosis, and WBC count and end diagnosis. All other relations were non-significant. Conclusions: Diagnosis of acute appendicitis remains a challenging issue in clinical practice. Frequent clinical examination remains the best method for accurate diagnosis of acute appendicitis. Laboratory investigations can be used as an adjuvant in diagnosis of acute appendicitis..

Background Mortality rate is one of the important means of assessment to any health system, and according to studies of causes of death, there is a high proportion of deaths happened due to causes that can be prevented. Since there is no previous study about mortality rates in Salahaldin province, the current study is considered to be a guide for any future studies.
Materials and Methods: A cross-sectional study was carried out in Salahaldin province to all death happened during 2018. The number of deaths included in the study was 3274. The analysis tool used (ANAcod v.2) was a special tool developed by WHO. The number of population considered was (1,595,235) according to Salahaldin Statistics Directorate. Results: The study showed that mortality rate in different groups, crude death rate, life expectancy and male/female ratio were resemble that of high economic communities, and disease burden showed that most deaths happened due to non-communicable diseases, with a clear role for injuries and accidents in middle age males .
Conclusion: the most common causes of death are related to non- communicable diseases especially in old ages. Preventive measures shows effective role in making mortality rate due to infectious diseases lower than other causes especially among children. Weak medical documentation of causes of death .

Background According to world health organization estimation over 800000 people die by suicide every single year which corresponds to a rate of 11.5 per 100000 of population worldwide and gives a number of a one suicide death every 40 minutes. according to a study by the “Intentional injuries in the Eastern Mediterranean Region 1990 -2015 that is done in 22 countries of the middle east including Iraq, the study states that there is 100 percent increase in the suicide rates in the 25 years study in the region compared to not more than 19 percent increase in Europe which led them to call it the lost generation study. The objectives of this study are:To establish the pattern of suicide attempts in Kurdistan \ Iraq, to classify the most common methods used to commit the suicide and to establish the best methods to be used to identify the actual suicide from the fake one that planned to be as suicide but are criminal in their nature (homicide.)
Method This research was made by collecting the data regarding the suicidal cases and homicidal cases in the years 2015, 2016 and 2017 for Erbil, Sulaymaniyah and Duhok.
Results The total number of the studied files was 248 file of suicidal cases that occurred in Erbil during the years 2015-2017 in which I obtained the data about each victim individually, while the total cases including Duhok, Sulaimanya, Halabcha, Soran, Karmean, and Rapereen are exactly 564 cases (plus the 248 from Erbil) in which we couldn’t obtain the individuals exact data.
The highest rate of suicide in male individuals were using the firearms, while in females was the self-burn, male individuals (464) were more than the females (348) in all the governorates, the most common age of suicide inside Erbil is the age between 20-29 (87cases.)
Conclusion
The prevalence of suicide in Erbil were 3.96 (per 100000) in the years from 2015- 2016, while in Kurdistan as all was harder to find (less data about Kurdistan population) and it was 3.83 (per 100000) in the same years

Background The rotator cuff tendons are key to the healthy function of the shoulder. Rotator cuff tear is a painful injury involving the supraspinatus, Infraspinatus, teres minor, and subscapularis . Diagnosis is usually made through detailed history, physical examination, and often, imaging studies. Patients and method From February 2006 to November 2007.Thirty two patients with shoulder pain were subjected to a prospective comparative study in Al-Yarmouk Teaching Hospital and of these 33 patients , 8 patients were found to have full thickness tear(FTT)and 25 patients were found to have partial thickness tear(PTT) clinically and these patients underwent ultrasonograpic(U/S)examination.
Result The result of the clinical examination were compared to the result of ultrasonography (U/S) examination.The clinical examination shows that P.T.T. more common, and occurs in younger age groups than F.T.T. Also rotator cuff tears more common in the dominant side and more common in male than female. Sensitivity of U/S in detection of F.T.T. was {87.5%}. Sensitivity of U/S in detection of P.T.T. was {56%}
Conclusions F.T.T. is diagnosed mainly clinically and ultrasonography is useful in the diagnosis with sensitivity of {87.5%}.P.T.T. is diagnosed mainly clinically and ultrasonography is not so useful in the diagnosis with sensitivity of {56%}.

Background: Fractures of the hip in children are rare , although it have been associated with a very high rate of serious complications including avascular necrosis (up to 47%) and coxa vara (up to 32%). The Objective: Our objectives is to present a rare type of injuries presented to our hospital . and to discuss the type of treatment we did , and the outcome after 2 year fallow up , with discussion of other treatment options .
Material and methods : Over a period of 2 years from January – 2008 to December- 2009 we have treated displaced fractures by early anatomical reduction, internal fixation and immobilization in a spica cast to try to reduce these complications.
The Result : We have reviewed 6 patients who had a displaced non- pathological fracture of the hip when under 16 years of age. Their mean age at the time of the injury was eight years (4 to 11). They returned for examination and radiography at a mean follow-up of 2.1 year. Each patient had been treated by early (24 hours) closed or open reduction with internal fixation and all of them had immobilization in a spica cast.

Background: Colorectal cancer is the third most common form of cancer and the second leading cause of death among cancers in the Western World. Adenocarcinoma represents 98% of colorectal cancer. In Iraq, It is the 7th most common malignant tumor according to the commonest ten cancers by site in 2005. the 7th commonest in male , while the 4th commonest in female
Materials and Methods: This cross-sectional study was done in Kirkuk city from the beginning of March 2017 to the end of April 2018. The study include 50 patient (27 male and 23 female) with different degree of CRC (from new diagnosis to metastasis), their age were 27-77 years, these patients were attended to Kirkuk oncology center evaluating the role of interleukin-6 in progression and prognosis of colorectal carcinoma. This study also included 40 healthy blood donors as control group. Five ml blood was collected from each patient and control enrolled in the study for determination of serum IL-6 level.
Results: The study found that highest rate (56%) of CRC patient of admitted to Kirkuk oncology center were above 50 years old and 20% were below 30 years, Table 1. The study showed that 60% of CRC patient were in the first grade of the cancer (without metastasis), 30% in the grade 2 and only 20% were in the grade 3 of progression of the cancer, Table 1. In this study, IL- 6 was significantly elevated in CRC patient comparing with healthy control (P<0.05), Table 3 show mean and standard deviation of IL- 6 which recorded 33.79±6.22 pg/ml on CRC patients versus 6.6±0.91 pg/ml in the control group. Interleukin- 6 showed significant elevated level (P<0.05) in CRC patients who in the grade 3 (i.e: who with advanced stage of metastasis) (37.19±7.12 pg/ml), followed by CRC patients in grade 2 (28.24±5.59 pg/ml) and the lowest mean of IL- 6 was found in CRC patients who didn’t suffer from metastasis (20.27±3.21 pg/ml.)
It was concluded that the there was a significant relation of interleukin elevation with promote colorectal cancer.

Background: Upper respiratory tract co-infection including (nose, mouth, pharynx and throat) originated from colonization bacteria , viruses and fungi epithelial layer lining the upper respiratory tract.
The aim: To determine the pathogens ( bacteria and virus) common in the upper respiratory co-infection.
Materials & Method: the study covered children aged ( 5months to 12years) which has upper respiratory tract co-infection detection the pathogens causing infections through a series of diagnostic tests. .
Using characteristics , microscope examination and biochemical test for diagnosis of different types of bacteria after doing sensitivity test for this bacteria used group of antibiotcs. The Human parainfluenza virus (HPIV) was diagnosed using indirect enzyme linked immunosorbent assay by two kits including ( IgM parainfluenza type 1,2,3 kit and IgG parainfluenza type 1,2,3 kit .)
Result: A total of 150 patients of children, found 119 of children was infected with different types of bacteria including gram negative bacteria wich formed percentage 8% and included ( E.coli, Pseudomonas areuginosa, Klebsella pneumoniae, Citrobacter freundii ) and gram positive bacteria formed percentage 71.3% and included Staphylococcus aureus, Staphylococcus
epidermidis,Streptococcus pyogenes, Streptococcus pneumoniae, Viridans
streptococci, Group B streptococci, Group C streptococci, Group G streptococci , Group D streptococci, Group F streptococci . These types of bacteria were resistant with different percentage for beta-lactem antibiotics which included cefepime, amoxacillin clvulanic acid, ampicillin, penicillin G, tetracyclin, ceftazidime, Gentiamcin, ceftriaxone) , as for antibiotics (vancomycin, erythromycin, clindamycin, chloramphenicol ) some isolated bacterial species were sensitive to these antibiotics . Out of a total of sick children, 59% of them were infected with HPIV, 33% of them had IgM anti human parainfluenza virus and 26% had IgG anti human parainfluenza virus . Among the patients of children found, 41% ones had co-infection with bacteria and virus.
Conclusion All bacterial species ( gram positive and gram negative) were
resistant to beta lactem antibiotics with varying percentage depending on the bacteria species -Participation of bacterial species ( S.pyogenes, Staph.aureuse and S.pneumoniae ) with Human parainfluenza virus to cause Co-infection to each other in the respiratory system.

Background: this study include The thyroxin's act on nearly every cell in the body and show Hypothyroidism , Hyperthyroidism ,and Thyrotoxicosis in pregnant women in Tikrit city .
Aim To identify thyroid hormones changes pregnant women in city Tikrit for the screening period of November – January determine the value of thyroid hormone (T3, T4 and TSH ) , and evaluate the association between them.
Patients and Methods: the samples was conducted in Salah Addin Hospital from ,the patients was 40 case and the control samples was 20 sample . the same ages and for the period from 9\7to 11\7. All patients were (females) the range of is age from 20 to 45 years, and with Control Groups were 40 personal normal women ,They were collected from the medical staff and patients relatives who were free from signs and symptoms of thyroid disorder.
Result :Serum TSH, T3 and T4 were determined in hyperthyroidism, hypothyroidism and normal control (immunoassay). The mean concentration of serum TSH level in patient with hyperthyroidism sd0.05) decreased compared with non-pregnant
Conclusion: The differences between the measurements may be due to the different characteristics of the study subjects such as, in current study most women were using non-iodized salt. While, most of the studies were take only subjects in both groups that consuming iodized salt.

Background: The cause of iron deficiency anemia (IDA) refractory to iron therapy is suggested the Helicobacter pylori (H. pylori) infection.
The aim of this study was to evaluate the relation between H. pylori infection and IDA among children aged between 6-12 years old.
Patients and Methods: This was a case-control study conducted for six months starting from August 2018 until February 2019 included 50 children with IDA and 50 age and sex-matched non-anemic controls, attending the pediatric outpatient clinic at Rapareen pediatric Hospital, Erbil, Iraq. All of the participants were subjected to clinical evaluation and the following investigations: CBP, serum iron, serum ferritin, and stool for H. pylori.
Results The results indicate that there was a statistically significant association between IDA and H. pylori infection. 12% of IDA cases had positive H. pylori antigen in stool in contrary to only 2% of healthy (control) group. Chi-square test was done and P-vale was 0.04.
Conclusion The results of this study demonstrate an association between positive H. pylori infection and IDA in children between 6 and 12 years old. Moreover, the infection may increase the severity of anemia.

Background: Anemia is a common health problem influencing both developing and developed countries with major outcome for human health as well as social and economic development.
Aim : the present study aimed to identify the risk factors of anemia in child bearing women visiting family medicine centers in Mosul City.
Patients and Methods : The study was done at the family medicine centers in Mosul City , Nineveh Health Directorate. Using case- control study design for a period of three months extending from 1st March to 1st June 2017. One hundred sixty five women of childbearing age(15-49 years) and their hemoglobin was <12gm/dl was considered as cases, and 165 women of childbearing age(15-49years) and their hemoglobin level >12gm/dl was considered as controls .A special questionnaire formula has been prepared for collecting data from both cases and controls.
Results : the result of this study was significant association of drinking juices containing vitamin C in preventing anemia(p= 0.03). Clots with menstruation had high significant association ( p= 0.001). High parity had significant association (p= 0.02) with about 2 folds increase probability of anemia in cases than controls. There was strong association between history of hemorrhoid, history of previous anemia, and family history of anemia (p= 0.01),in contrast past medical history ,past surgical history, parasitic infestation, ingestion of drugs like NSAID ,and antacid had high odds ratio but without significant association.
Conclusions :The conclusion is that there is significant association of drinking juices containing vitamin C , clots with menstruation ,and high parity with anemia ,in addition to some medical diseases(hemorrhoid, history of previous anemia, and family history of anemia),with anemia.

Background: The glycosylated hemoglobin (HbA1c) test is the most widely accepted laboratory test for assessment long term glycemic control. Patients understanding of (HbA1c) can lead to better glycemic control, which reduce the development and/or progression of diabetic complication.
Aim of study: To assess whether knowledge about (HbA1c) and its target goal is associated with better glycemic control among diabetic patients.
Patients and Method: Cross sectional descriptive study among diabetic patients attending Baba Gurgur Diabetic Center_K1 Hospital _NOC in Kirkuk city from October 2018 to January 2019.
The study included three hundred _fifty patients, (M: F 203:147), were invited to answer a validated questionnaire which assess their awareness and understanding of (HbA1c) and its target goal. Their last (HbA1c) were estimated in center laboratory.
Result: A total of three hundred- fifty (350) patients were recruited in the study, two hundred five (58.6%) were knowing of the term HbA1c coded as ( group A), one hundred five (51.2 %|) of group A, were knowing HbA1c and its goal coded as ( group C) ,remainder one hundred participants (48.8%) were knowing HbA1c ,not knowing goal coded as( group D).The group B included one hundred- forty five participants (41.4%) recognized as un ware of HbA1c. Mean HbA1c was significantly lower in group A compared to group B (7.814±2.077) vs (8.975±1.912), p value <0.000. Mean level of HbA1c in group C significantly lower than group D (7.510±2.140) VS (8.155±1.935), p value < 0.025.
There was a significant differences in mean HbA1c between group A and group B with education, regular monthly income, duration of diabetes, and treatment modality matched subjects. These factors associated with understanding of awareness of HbA1c in glycemic control. No significant association was noted between age, gender, marital state and good understanding of HbAc. In total of 350 participants were recruited in this study, one hundred-ninety four (55.5%) were worker in northern oil company. One hundred-thirty of worker (67.0%) were aware of HbA1c (group A), and sixty-four employer (32.9%), were un aware of HbA1c test.
Conclusion: Maintenance of good glycemic control was seen with increasing level of awareness about HbA1c test.

Background: The ear is the most frequent organ affected during an explosion. Recognition of possible damage to it’s auditory and vestibular components, and particularly the recovery time of the incurred damage, may help in planning the optimal treatment strategies for the otological manifestation of blast injury and preventing deleterious consequences.
Objective : to evaluate the otological manifestation of blast injury in relation to the distance of explosions, the site of the exposure, space of explosions and to the age of patients and to report the oto-vestibular initial symptoms and follow up .
Patients and Method : Forty two patients collected from AL amam Ali hospital in Baghdad and underwent complete physical, ENT examination ,balance study and pure tone audiomatry.
Result: Complaints deafness and aural fullness, blood stained discharge, and tinnitus resolved, whereas dizziness presists in some patients. By the end of three month follow up 25% of ear drum perforation (medium and small) had healed spontaneously. Hearing impairment was detected in 79 ears of the 84 ears. Recovery of hearing was complete in 9 ears and partial in 19 ears that followed up for one month. 6 patients were complained of vestibular balance abnormalities, 2 of them suffered from positional vertigo. Caloric test was not done because un-cooperation of patients and it was not valid all the time. Conclusion: exposure to high powered explosion may result in sever auditory and vestibular damage. Various symptom and signs may resolve within a period of time. The distance from explosion, the side of explosion, the space of explosion and the age of the patient have relation to the presentation of the patient and subsequent treatment.

Background:
About one of each ten couples is subfertile. Ovulation disorders underline about 30% of female subfertility. Ovarian follicles depletion and poor oocyte quality is known as diminishing ovarian reserve.
This study was conducted with the aim to determine the clinical and laboratory attributes of women with abnormal clomiphene citrate challenge test and diminished ovarian reserve.
Patients and methods: One hundred eight women of 22-50 years old were studied including those with primary, secondary infertility or recurrent pregnancy loss. All women were tested by Clomiphine Citrate Challenge (CCC) test after estimation of day 3 serum FSH, then the patients received 100 mg clomiphene citrate on day 5 to 9 and again serum FSH level was measured on day 10 of the cycle. Serum progesterone was also evaluated on cycle day 21 .
RESULTS: From a total of 108 women involved in the study, 72 women had normal CCC test and 36 abnormal CCC test. Out of 36 women, 11 had abnormal CCC test depending on day 10 of the cycle alone. Among women with abnormal CCC test, (91.6%) were over the age 35 years versus (41.7%) in the normal group. The discripancy in the onset of menarche was statistically insignificant. Finally the pregnancy rate was 25% in normal group compared to 5% for abnormal group.
CONCLUSIONS: This study revealed that women with certain clinical and laboratory attributes need to be evaluated for ovarian reserve including: Women older than 35 year, Menstrual cycle span under 26 days especially in patients older than 35 years, Unexplained infertility, endometriosis or previous ovarian surgery.

Background: Adequate vitamin D concentration during pregnancy are necessary to maintain calcium homeostasis, bone maturation and mineralization. The aim of the study to show correlation between maternal and neonatal vitamin D level and its relations.
Subjects and Methods : A cross sectional study was done on mothers and their neonates on Maternity Teaching Hospital in Erbil-Iraq during the period from first of January to the 30th of July 2015.Data collected from all mothers about age, parity, mode of delivery, maternal diet, weight, gestational age, apgar score and vitamin D.
Results : The study show that most of mother age > 35 years, gravida 3 and more, Para 3 and more, normal BMI, wearing hejab, poor nutrition, no vitamin supplement during pregnancy and housewives are deficient maternal and neonatal vitamin D level and age < 35 years, gravida 1-2, parity 1-2, overweight BMI, not wearing hejab, traditional nutrition and employed are on safe range of maternal and neonatal vitamin D level.The results indicate that there was a statistically significant There were 25 cases of neonates on deficient range of vitamin D level, 22 cases (88%) of them are product of mothers with deficient range of vitamin D level, the p value < 0.001
Conclusion : It is concluded that there is parallel correlation between maternal and neonatal vitamin D level and the level of vitamin D in mother and neonate are important for health of both, and education the people about the factors that make the mother and neonate on safe range of vitamin D level.

Background: Headache disorders: are classified as primary and secondary, migraine is one of the most common primary headache. It affects 6% of American men & 18% of women.
The aim of this study is to determine the effects of some prophylactic drugs on migraine headache during and after treatment and distribution of the disease according to age and gender in Shirqat city.
Materials &Methods: a prospective study was performed in Shirqat general hospital - outpatient clinic in Shirqat city from September 2016- September 2019. The age of patients were ranging between (15-60 years) with mean age of patients was (31, 9) and there are 103 male and 224 female .Inclusion criteria in general included patients who had frequent or long lasting migraine headaches.
Results: In this study most patients were women, female-male ratio about 2,2:1, mean age 31.9. in our study used six prophylactic drugs and patients divided to groups, each group used one prophylactic drug. All prophylactic drugs show good effect on migraine headache during and even after treatment.
Conclusions:
Migraine headache one of the most common primary headache in Shirqat city, more in female and in young and middle ages.
And All prophylactic drugs showed good obvious effects and the best one was propranolol.

Background: The predominance of hypovitaminosis D is especially high in pregnant populaces. The creating baby is altogether needy upon the maternal pool of calcium and, thusly, there are developing worries about the ramifications of nutrient D insufficiency in pregnancy and past. Glucose is the principle vitality substrate for intrauterine growth. the aim of study to describe the relationship between maternal vitamin D status and risk of macrosomia
Material and methods : This short prospective study was conducted in Kirkuk city for the period from June to September 2019 on 100 pregnant women who delivered infant with macrosomia whose ages were between 20-45 years old who admitted to Kirkuk general hospital/Obstetric part.The biochemical assessment of vitamin D by ELISA. The study also included 40 healthy pregnant women as control group in the same age groups The study showed significant differences between cases and control regarding Intrapartum BMI, gestational weeks at birth, birth weight, gestational diabetes and nulliparous pregnancy.
Results : The study showed that 77% of pregnant women have vit D deficiency compared with 12.5% of healthy control (P :0.001). Mean 25- OHD Concentrations and Proportions Classified According to IOM Cut Points Within the Cohort in Early Pregnancy, at 28 Weeks of Gestation and in Cord Blood at Delivery. The study showed negative correlation of gestational age and birth weight with maternal vitamin D level.