The Medical Journal of Tikrit University
This journal is dedicated to the Medical College of Tikrit University, providing a platform for researchers to publish their work. It allows scholars to share their findings, enabling others to benefit from reviewing and building upon published research.
Horseshoe kidney with retrocaval ureter: a case report
Horseshoe kidney and retrocaval ureter are uncommon congenital anomalies of the genitourinary system that are easily diagnosed by typical imaging features. Both anomalies presenting in one patient is a rare disease characterized by isthmus of horseshoe kidney between the abdominal aorta and inferior vena cava. The clinical diagnosis and treatment of horseshoe kidney with retrocaval ureter remain a challenge. Here, we reported a case of 10-year-old boy with the two anomalies who was preoperatively diagnosed by enhanced computed tomography scanning. The literatures on such combined anomalies are reviewed and the diagnostic evaluation and surgical management of this rare entity are discussed.
horseshoe kidney; retrocaval ureter; congenital anomaly
The Importance of Functional Echocardiography in Mechanically Ventilated Neonates
Useful echocardiography (ECHO) for the children is a focus on cardiovascular ultrasound that expecting to clinical assessment and the executives of the current neonatal hemodynamic changes. This planned subsequent examination focused on evaluation of the hemodynamic changes in precisely ventilated neonates, assurance of the connection between ventilation settings and (ECHO(. Fifty precisely ventilated neonates because of non-innate respiratory issues went through ECHO following 24 hours of mechanical ventilation. Thirty children forged ahead mechanical ventilation and were accessible to 48 hours ECHO follow up . A 24 hours (ECHO) assessment appeared, profoundly critical negative relationship between the privilege ventricular yield (RVO) and the pinnacle inspiratory pressing factor (PIP) and mean aviation route pressure (MAP) (P esteem < 0.01 ) and huge negative connection with positive end expiratory presses (PEEP) ( P esteem < 0.05). A huge negative connection between the left ventricular yield (LVO) and the MAP (P. esteem < 0.05 ). A 24 hours ECHO assessment showed 14 patients had huge patent ductus discovered (PDA). There was profoundly critical increment (P value< 0.01) in PDA measurement, left atria/aural/aortic proportion (LA/AO proportion), huge increment (P esteem < 0.05) in LVO.
Mechnical ventilation , PDA, ECHO, neonates
A Study of Body Mass Index in Relation to Menarche in Adolescent Females at Tikrit District
Background: Anthropometric indices have been known to be associated with age at menarche. Objective: this study an attempt to determine the relation between menarche & nutritional status in adolescent's student. regarding the effect of menstrual cycle, Subjects and methods: cross-sectional study was conducted during the period extended from first of October 2018 to the end of March 2019. Females of secondary school in Tikrit district were be chosen from urban & rural areas Official permission to carry out this study was obtained from educational directorate of Tikrit district & the head masters of each school before the study. In addition approval permission & consent were obtained from all study students by using a multistage-stratified random sampling technique which includes(536) female adolescent students from secondary school of Tikrit district, Results: There was a highly significant difference between pre & postmenarcheal adolescent student. A higher percentage of underweight (30.9%) & normal weight (60.3%) were in premenarcheal students while higher overweight (31.2%) & obesity (12.6%) in postmenarcheal students. Menarcheal age appear to be associated with the change of nutritional status of adolescent students as they increase or decrease according the number of years of menstrual cycles. Underweight was recorded in adolescents students who were menstruating for less than 6 years while not present in adolescent with more than 6 years menstrual time while normal weight, overweight & obesity were fluctuating in increase & decrease along the menstrual cycle. Conclusion: The menstrual cycle had a highly significant effect on the distribution of nutritional status.
Menarche, nutritional status, adolescent
Assessment of Hearing Impairment and Hypertension among workers exposed to occupational noise in Baiji power plants
Methods: This was a cross-sectional study. The study sample (population) consisted of 240 healthy male employees from Baiji electric power plants with a history of past and present exposure to noise. The study was conducted during the period from the 15 December of 2012`to the 15 February of 2013. There are four sections in the power plants. Turbine, Boiler, central control room and fuel . All workers who worked in the power stations for 5-7 years or more were included in the study. Data was gathered from the results of available portable audiometric test and the blood pressure was measured in supine position by using mercury sphygmomanometer Hearing impairment was defined as average hearing threshold for frequencies 0.5kHz, 1kHz ,2kHz and 3kHz equal or more than 25 dB(A) in both ears. Workers are classified according to exposure time in to two groups. The workers are working in turbine and boiler formed continuously exposed group(CEG).While the workers are working incentral control room and fuel formed intermittently exposed group(IEG). Results:The prevalence of hearing impairment in this study was 17.08% among all the exposed workers. The prevalence of hearing impairment was significantly more in(CEG 14.58%)as compared to (IEG 2.5%).The Prevalence of hypertension among continuous exposure group to noise was(12.5%) significantly higher than the intermittent exposed group to noise ( 2.08%) .There was a positive association between duration of exposure and prevalence of Hypertension. Both hearing impairment and hypertension showed in the current study increasing frequency in relation to the duration of exposure( employment). 26.6% of hearing impairment cases found among those exposed for less than 15 years while 72.7% among those exposed for 15 years and more .On the other hand, hypertensive were 28% and 45.6% respectively with period of duration of exposure. The results of the present study indicate that hypertension and hearing impairment are commoner in workers continuously exposed more than that in workers intermittent exposed group to high level of occupational noise. The prevalence of hearing impairment and hypertension distributed according to the age of workers, we found that the 12.95% of bilateral neurosensory in age below 40 years, while 30.04% of cases in age above 40 years.While the prevalence of hypertension, we found 10.47% of cases in age below 40 years and 30.6% in age above 40 years .The most common group affected by hearing impairment (permanent bilateral) were present in Turbine and boiler of power plants. The common age group affected is above 40 year old. The study shows that the longer exposure to noise either during the working day or through the period of employment increased the chance to developing hearing impairment and hypertension. The occupational hearing loss due to work related disease are common and constitute up to(14%) of all occupational hearing diseases. Conclusions: These findings provide corroborative evidence to further substantiate the notion that exposure to noise is associated with hearing impairment .They also support the proposition that long term occupational exposure to noise appears to be a risk factor for arterial hypertension.
Postoperative incidence of iatrogenic gallbladder perforation during laparoscopic cholecystectomy in Sulaimaniyah Teaching Hospital
Background and objective: Iatrogenic perforation of the gallbladder has been reported in 28% of those patients who undergo laparoscopic cholecystectomy. It has been pointed out that gallbladder perforation can result in formation of gallstones and spillage of bile. The present study was carried out in order to investigate the postoperative incidence of iatrogenic gallbladder perforation during laparoscopic cholecystectomy in Sulaimani Teaching Hospital. Patients and methods: The present investigation was a single center, retrospective observational study that was carried out in Sulaimani Teaching Hospital in 2018-2019. The study sample included 99 patients who had undergone elective cholecystectomy. Required data on the possible risk factors and early outcomes and the patients’ demographics including age, BMI, and gender were collected. The collected data were analyzed through the Statistical Package for the Social Sciences (version 22.0.( Results: The results revealed that 80% of the patients were females. Also, 42.4% had no chronic diseases, while diabetes mellitus (DM), DM along with hypertension (HT), and HT were found to be the most prevalent chronic diseases among them with 18.2%, 16.2%, and 10.1% of prevalence, respectively. Only 17.2% of the patients had abdominal operation before, and acute cholecystitis and chronic cholecystitis were seen respectivelyin 13% and 17% of them. The most common causes of gallbladder perforation (GP) were found to be electrocautery (16.2%) and grasper (7.1%). Moreover, 33.3% of the patients were overweight (BMI between 25 and 29.9), 45.5% were obese (BMI between 30 and 34.9), and 20.2% had BMI of over 35. Most of the patients aged 30 to 49 (62.6%). A majority of the patients (94.9%) were found to have gallstones. Conclusion: Iatrogenic gallbladder perforation is prevalent among patients who undergo laparoscopic cholecystectomy. However, laparoscopic cholecystectomy is still a better choice and associated with fewer complications compared to open cholecystectomy. Required measures need to be adopted for patients with perforated gallbladder in order to minimize spillage and remove as much spilled gallbladder content as possible.
iatrogenic gallbladder perforation, laparoscopic cholecystectomy, gallstone, spillage of bile
Adrenal myelolipoma in a patient presented with hypertension- A Case Report
Adrenal myelolipoma is a rare benign tumour composed of mature adipose tissue and hematopoietic tissue. Very few cases have been reported. Most of these patients are asymptomatic. I present a rare case of Adrenal Myelolipoma where the patient presented with hypertension and a clinical suspicion of Pheochromocytoma, which turned out to be an Adrenal myelolipoma. Adrenal myelolipoma is a rare entity, not encountered frequently and can occur as an incidental finding. Awareness regarding this entity is very much essential to exclude surgical exploration or extensive surgery.
adrenal gland, myelolipoma, hypertension.
Prevalence of Metabolic Syndrome in a Sample of Iraqi Patients with Ankylosing Spondylitis treated with Anti TNF-a Therapy
Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease, which mainly affects the axial joints, including the spine, sacroiliac joints, and entheses. The aim of the study was to detect the prevalence of metabolic syndrome (MetS) in Iraqi patients with AS, in comparison to healthy controls and to assess their relationships with demographic and clinical characteristics. A cross-sectional study was conducted at the rheumatology unit of Baghdad Teaching Hospital in Medical City from October 2019 to March 2020.The study included a total of 100 patients diagnosed with AS, according to the modified New York diagnostic criteria, and 100 age and sex matched controls. Demographic data, disease activity scores, comorbidities, current medications were reported. Waist circumference, blood pressure, fasting blood sugar, triglyceride and high-density lipoprotein cholesterol were measured and MetS was diagnosed according to the NCEP ATPIII criteria. The prevalence of MetS in AS patients was (51%) which is higher than that of the controls (46%), but the difference was insignificant (p=0.4). The mean HDL-c, FBS, systolic and diastolic blood pressure were significantly lower in AS patients compared to controls (p=0.03; p=0.005; p=0.05; p=0.01, respectively). AS patients with MetS had significantly higher incidence of low HDL-c (P=0.03), and lower incidence of high FBS (P=0.01) and TG (P=0.04) than controls with MetS. The mean age and body mass index in patients with AS and MetS were significantly higher compared to patients with AS without MetS (p=0.005; p=0.001). Multivariate regression analysis showed that age of the patients was the only significant predictor for the risk of MetS (odds ratio [OR] =1.6, conﬁdence interval [95% CI] = 1.2 - 1.8, P=0.03). It was concluded that, the prevalence of metabolic syndrome in AS patients was higher than in the general population but statistically insignificant. Low HDL-c is the most important component of MetS in AS. AS patients with MetS were older in age and had higher BMI than AS without MetS.
Metabolic Syndrome; Ankylosing Spondylitis; Anti TNF-a
Background: Alkaline phosphatase (ALP) is important enzyme in diagnosis many diseases like osteomalacia. It presents in defect isoenzyme including bone, liver, and placental ALP. Aims of this study: Assess the efficacy of the bone ALP enzyme and intact parathyroid hormone (iPTH) to detect the possible presence of osteomalacia in pregnant women due to the vitamin D deficiency. Objective: Evaluate the nutritional state of pregnant women that will affect the good health of her bone and preparing her for lactation stage. Methods: Blood samples were collected from 87 normal fasting pregnant women then subdivided them into three subgroups according to their period of gestation. ALP and its isoenzyme were determined calorimetrically after separation of them by thermal stability method, and the level of parathyroid hormone was measured for 36 of them from different subgroups by the ELISA technique. Statistical test used as t-test (student test) and leaner regression . Results: There was a difference in the activity rates of the heat labile enzyme (HLAP), which is mostly related to the bones when compared between groups, and showed that there is a positive relationship between the activity of this enzyme with the activity of the placental isoenzyme and with the gestational age. PTH showed an increasing in its level and a direct proportion with placental isoenzyme. Conclusion and recommendation: Increased bone (ALP) isoenzyme, and elevated PTH could be a marker of osteomalacia in pregnancy, accordingly, we recommend a measurement of parathyroid hormone and placental, bone ALP in pregnant women to ensure the health of the placenta and bone.
Screening of Papanicolaou Smear Outcome in Tikrit’s Women
Background: The cancer of cervix is second most common cancer among women. worldwide. It is have pre malignancy phase , dysplasia (intraepithelial neoplasia ) there for its preventable disease . Cervical cytology by Papanicolaou smear is an effective means of screening for cervical premalignant and malignant disease . Aim of the study :to screen the outcome of Pap Smear in Tikrit’s women. Patients and Methods: Cross section study carried out from January in2017 through December in 2018 on a sample of 95women attending departments of obstetrics and gynecology in Salah Alden general hospital in Tikrit . All studied women were referred for Pap smears. Results: normal Pap smears were seen in (35 women with negative result and 60 woman with positive result) .only54women with positive result do anther Pap smear after 6 month and 6 woman do total abdominal hysterectomy .after do anther smear 9 of them become negative and 45 diagnosis ca. cervix . Conclusion: Premalignant and malignant lesions of cervix are not uncommon in referred women especially in menopausal women and those using hormonal contraception. Lesions can be detected early by Pap smear. There is discrepancy, and delay in reporting of Pap smear result, negatively reflected on screening program.
Evaluation of Serum Osteopontin and Growth Differential Factor-15 in Patients with Heart Failure
Background: Heart failure (H.F) is a condition in which the heart cannot supply the body's tissues with enough amount of blood. Certain conditions such as narrowing arteries in heart (coronary heart disease) or hypertension gradually make heart weak or stiff to fill and pump efficiently. Osteopontin (OPN) is a glycoprotein expressed in many types of cells including bone, immune, endothelial cells, and others. OPN has an important role in mineralization and bone resorption. Growth differential factor-15 (GDF-15) is a member of transforming growth factor β (TGFβ) cytokine superfamily, GDF-15 is highly expressed in cardiomyocyte, adipocyte, macrophage, and other cells. Aim: to evaluate levels of OPN and GDF-15 in patients with heart failure Patients and methods: This study was achieved from August 2020 to October 2020, it was conducted on 22 patients with CVD who attended to cardio care unit (CCU) in Al-Ramadi teaching hospital in period from August to October 2020. The results were compared with 30 healthy control subjects. About four milliliters of venous blood were collecting in gel tube from patients and controls to estimate OPN and GDF-15 by ELISA method. Furthermore, fasting blood sugar (FBS) and total cholesterol (CHO) were measured for patients and control groups. Results: the level of OPN was significantly high in H.F patients (51.18± 23.57 ng/ml) compared to control group (1.07±0.41 ng/ml) furthermore FBS and CHO mean concentrations were significantly high in H.F. patients (195.46±89.16 mg/dl), (153.38±45.14 mg/dl) respectively, compared with control group (FBS 97.08±13.84 mg/dl), (CHO 112.18±10.64 mg/dl). Conclusion: the study’s results showed that a significant increase in level of OPN and GDF-15 as a biomarker for heart failure patients and there was a correlation between both OPN and GDF-15 with blood glucose concentration, also hyperlipidemia was present in H.F. patients.
Incidence of Thyroid Neoplasm in Postthyroidectomy Patient in Sala-Adeen Governate
Background: Thyroid tumor is relatively rare tumor but it represent the most frequent form of the endocrine gland .Thyroid neoplasm either benign or malignant. Benign is follicular adenoma. Thyroid cancer is one of the cancers that becoming a leading cause of death in many countries of the world. Objectives: The study aims to determine the frequency of thyroid neoplasm in post thyroidectomy patients and to determine the most common type of thyroid carcinoma and its percentage in Sala Adeen. Materials and methods: This retrospective cross-sectional study was carried out in TTH by referring to all records of patients data of one year(January 2012- January 2013).All patients who underwent different types of thyroid surgeries during this period were included in the study. All data including age, gender, relevant investigations like Ultrasonography, fine needle aspiration cytology, and final histopathology report were recorded on a standard form. Results :( 272) patients were operated for different thyroid lesions. Twenty one (7.7%) were malignant (17 females and 4 males)and 91 were benign. Mean age for males was 41.35 ± 15.52 years compared to 36.59 ± 13.28 years for females. Papillary carcinoma constituted 17(80%), while follicular carcinoma formed only 9.5 % of malignant case. Medullary thyroid carcinoma ranked third with only 4.7%.while anaplastic thyroid carcinoma was 4.7% of the cases .SNG was 127 patients, 11 case were malignant and MNG were112 case 9 cases were malignant. Papillary carcinoma was the commonest type which was observed in MNG in our study (80%). Conclusions: The results of this study are consistent with many international studies. The prevalence of thyroid cancer is not high when we compared with other region in the world, and the most common types of thyroid carcinoma were papillary thyroid carcinoma. The present study concludes also the thyroid carcinoma is more common in middle age females. Also the results indicate that the risk of malignancy in multi-nodular goiter is not as low as it was thought before and that it is quite significant.
Thyroid carcinoma (TC), Multi-Nodular Goitre (MNG), Follicular Thyroid Carcinoma (FTC) , Papillary Thyroid Carcinoma (PTC), Anaplastic Thyroid Carcinoma (ATC)
Breast cancer prognosis with relation to the human epidermal growth factor receptor-2 & hormonal status among women Mosul city – 2018
Background: Breast cancer is the leading cause of death of women around the world. Rates differ by around fivefold across the globe, but they are rising in areas where the disease was previously uncommon. Aim of the study: the aim was to discover whether the molecular classification of breast cancer offers more knowledge about survival relative to traditional histopathological prognostic factors. Methodology: In this study, the prognostic influence of ER, PR, and HER2 expression was analyzed independently in breast cancer patients using an immunohistochemical study (n = 297) at Mosul Oncology Hospital in 2018 on women diagnosed with primary breast cancer, and, in combination, survival analysis was performed using age-adjusted Kaplan-Meier and Cox relative risk models. Patient, Breast Cancer Stage. Result: The results showed that patients (n=297) with different ER, PR, and HER2 expressions had different clinical outcomes with different treatment responses. Breast cancer's molecular classification was based on the pattern of expression of ER, PR, and HER2. The breast cancer subtype ER + / PR + / HER2 + was found in 36.3% of cases, ER + / PR + / HER2- observed in 23.9% of cases, ER - / PR- / HER2 + was observed in 23.5% of cases, and finally, a triple-negative subtype was found in 16.16% of cases.ER+/PR+/HER2- tumor patients have a positive prognosis, while triple-negative adenoma patients have the worst prognosis. We also suggest that this molecular classification be used to select the best treatment form in all breast cancer patients.
Estrogen receptor, human epidermal growth factor receptor-2 , ER, HER2, Breast cancer, Mosul
Omitting ligation of the hernia sac during herniotomy and orchiopexy in children
Background Inguinal hernia is one of the commonest conditions in pediatric surgical practice requiring surgical intervention. Herniotomy after high ligation of the peritoneal hernial sac is the standard procedure performed to prevent recurrence. The conventional and accepted technique of orchiopexy recommends that ligation of the hernial sac is mandatory for prevention of postoperative development of hernia. Objectives of the study This study was planned to study the effects of non-ligation of the sac on the results of herniotomy in the pediatric age group. Patient and method This is a prospective study of 140 patients under the age of 6 years undergoing surgeries for indirect inguinal hernias (90 patients, all males) and orchiopexy surgeries (50 patients) over a period of two years (October 2008-october 2010) in Baquba teaching hospital. The age range of the patients was 4 months up to 6 years. The hernia sac wasn’t ligated but it is merely amputated and left to be retracted out of the sight. All patients were followed for 2-2.5 year Results For patients operated on for undescended testicle, no single patient developed inguinal hernia. For the patients operated on for indirect inguinal hernia 2 patients (2.22%) developed recurrence of their hernia. Conclusion We conclude that ligation of hernia sac is not necessary in achieving surgeries for indirect inguinal hernias and during inguinal orchiopexy. Cancelling ligation of the sac will save time and gives extra length for the cord in orchiopexy surgeries.
Hernia sac, Non ligation of hernia sac, management of hernia sac.
Factors Affecting Fragmentation and Clearance of stones after shock wave lithotripsy
Background: The applying of ESWL is widely extended from kidney stone to the most of urinary tract stones. Objective: the aim of the current study is to find the correlation between the location and the stone size with the efficiency of ESWL. Materials and Methods: Data were collected from patients in ESWL unit in urology department in Al-Karkh general hospital for three years, starting December 2017 until December 2020. The number of patient was (174) patient divided into two groups, first group (G1) with average stone size 12 mm while it was 14 mm for the second group (G2). The shocks used of the frequency of 90 shock/minute start up at 9 KV with escalated does increase to 18 KV till fragmentation of stone or till reach of average 3000 shocks for real stone on upper ureteric stone per session up to 3 session. Results: the collected data found that the best fragmentation was in the lower stone location (G2) 95.45% followed by the upper location 93.33%, and middle one 85.71%, the same sequence is for G1, 90.00%, 76.47% and 66.66% respectively same finding sequence with the clearance. Conclusions: ESWL affected with stone size, and location, the larger stone size the better fragmentation and clearance.
ESWL, fragmentation, clearance, Al-Karkh
Prevalence of Hypertension among workers exposed to occupational noise in Baiji power plants with Hearing Impairment
Background: Noise induced hearing loss, a permanent bilateral hearing impairment due to long term exposure to high levels of noise, represents one of the most common occupational hazards. This cross sectional study was undertaken to evaluate the auditory effects of noise and to further examine the hypothesis that a link between noise exposure and hypertension exists. Objectives: The objectives of the present study were to study the (i)prevalence of hypertension and hearing impairment in electric power plants workers, (ii) association between hypertension and hearing impairment, (iii) association between hypertension and hearing impairment, with duration of exposure, and (iv) correlation between levels of sound and noise induced health problems viz. hypertension and hearing impairment in a cross sectional study involving Workers working in Baiji electric power plants. Methods: This was a cross-sectional study. The study sample (population) consisted of 240 healthy male employees from Baiji electric power plants with a history of past and present exposure to noise. The study was conducted during the period from the 15 December of 2012`to the 15 February of 2013. There are four sections in the power plants. Turbine, Boiler, central control room and fuel . All workers who worked in the power stations for 5-7 years or more were included in the study.Data was gathered from the results of available portable audiometric test and the blood pressure was measured in supine position by using mercury sphygmomanometer. Hearing impairment was defined as average hearing threshold for frequencies 0.5kHz, 1kHz ,2kHz and 3kHz equal or more than 25 dB(A) in both ears. Workers are classified according to expoeure time in to two groups. The workers are working in turbine and boiler formed continuously exposed group(CEG).While the workers are working in central control room and fuel formed intermittently exposed group(IEG). Results:The prevalence of hearing impairment in this study was 17.08% among all the exposed workers .The prevalence of hearing impairment was significantly more in(CEG 14.58%)as compared to (IEG 2.5%).The Prevalence of hypertension among continuous exposure group to noise was(12.5%) significantly higher than the intermittent exposed group to noise ( 2.08%) .There was a positive association between duration of exposure and prevalence of Hypertension .Both hearing impairment and hypertension showed in the current study increasing frequency in relation to the duration of exposure( employment). The results of the present study indicate that hypertension and hearing impairment are commoner in workers continuously exposed more than that in workers intermittent exposed group to high level of occupational noise. The prevalence of hearing impairment and hypertension distributed according to the age of workers, we found that the 12.95% of bilateral neurosensory in age below 40 years, while 30.04% of cases in age above 40 years. While the prevalence of hypertension, we found 10.47% of cases in age below 40 years and 30.6% in age above 40 years . Conclusions: These findings provide corroborative evidence to further substantiate the notion that exposure to noise is associated with hearing impairment .They also support the proposition that long term occupational exposure to noise appears to be a risk factor for arterial hypertension.
Noise induced hearing loss; Occupational exposure; Hypertension
Comparative study to assess the effect of different antibiotics administration and other factors on post cesarean wound infection
Wound infection is infection at any level from 1-30days of the operation or up to one year after operation if included the embedding of foreign body, reasonable use of antibiotic is one of the key factor to stop wound infection .The administration of prophylactic antibiotic with recommended regimens, such as in developed countries has not been applied in AL-Batool hospital .This hospital still used other types of antibiotics, in addition for several reasons, antibiotics were continued postoperatively to reduce the risk of delayed infections. Therefore, this study was done to analyze the effectiveness of prophylactic antibiotics as recommended in cesarean sections , This is a prospective cohort study carried out at Al- Batool hospital in Mosul city, 150 cases of elective cesarean sections recruited in this study during the period from 1st December 2019 to the 1st June 2020 ,they divided to three groups according to route of antibiotic administration .The ratio of wound infections in group 1&2 was (5%) and 20% in group (3) patients who don’t received pre –operative prophylactic antibiotics . No significant differences in wound infection founded between group1&group2,whereas high rate of wound infection occurred in group3 p-value (0.014 ),in this study single prophylactic doses of antibiotics give as much protection as multiple doses in preventing post elective cesarean section wound infections . Obesity prior to pregnancy showed a statistically significant value as a cause of wound infection P-value (0.001). Analysis of the results demonstrated two types of pathogens were identified Staphylococcus species (85%) and proteus (15%).
Prophylactic antibiotics, Al-Batool hospital, surgical site infection, Mosul city.
Long-term results of balloon pulmonary valvuloplasty in pediatric age group in surgical specialty teaching hospital/cardiac center/Hawler
Congenital valvular pulmonary stenosis accounts for 5–10% of all congenital heart disease. Balloon pulmonary valvuloplasty is a safe and effective method in reduction of moderate to severe valvular pulmonary stenosis. This retrospective study done in Hawler surgical specialty cardiac center on pediatric patients who had pulmonary valve stenosis (with echocardiographic peak gradient ≥50mmHg) and treated by balloon pulmonary valvuloplasty. A total of 178 cases were involved, 93(52.25%) patient was male and 85 (47.75%) patients was female. 160 patient (89.89 %) were treated with single balloon method 18 patient (10.11 %) were managed by double balloon method technique. Follow up period of these patients range from 1 year to 10 years (mean of 5.5 year). In 153 patients (85.96%) pressure across pulmonary valve were below 36 mm Hg, while in 21 (11.80%) pressure gradient across pulmonary valve were (36-50 mm Hg). Four (2.24%) patients had pressure gradient across pulmonary valve more than 50 mm Hg. Forty patients (22.47%) developed mild pulmonary valve regurgitation, while 20 patient (11.24%) developed significant pulmonary valve regurgitation. Balloon pulmonary valvuloplasty provides long-term relief of pulmonary valvular obstruction in the majority of pediatric patients. The long-term results are favorable.
congenital heart disease, pulmonary stenosis, valvuloplasty
Descriptive Histology of Different Types of Nerve Grafts in Rabbits
This work was designed to evaluate and compare histologically between various types of nerve grafts; autograft, collagen tubes (natural polymers), and a cellular epineurial nerves sheaths (biological canduits), included a cellular rabbits nerve graft and a cellular rat nerve graft. Forty local breaded rabbits were used and divided into four groups, and then subdivided into two subgroups (a total of 8 subgroups). Each subgroup contained five rabbits. Two times were used for animal scarifying and that were 45 days and 3 months post operation. All animals were undergone surgical operation on the sight thigh and sciatic nerve was sectioned at the mid thigh region. Segments of 8-10mm were sectioned and the gap was replaced with previous graft types. All rabbits were kept survive to the end of experiments. Comparison was made between the right (experimental) and left (control) sides. Samples were taken from proximal, middle, and distal stumps to evaluate the regeneration process. All tissue samples were examined under light microscope. The histological results clarify an increase in amounts of fibrous tissues whether intrafascicular or extrafascicular. Also, there was an increase in epineurium thickness in the distal segments for both periods. A significant diameters decrease of nerve fibers of all experimental groups of both periods was observed compared to the control. A significant reduction in myelin thickness in the proximal and distal stamps was also obvious.
Gastrointestinal bleeding in pediatric age group
Gastrointestinal hemorrhage during infancy and childhood is common and accounts for up to 20% of referrals to pediatric gastroenterologists. Most causes are self-limited and benign, 75% to 85% of gastrointestinal tract bleeding (GITB) arrest spontaneously. This is a descriptive single center retrospective study done on 200 patients less than19 years old whom attend the gastrointestinal center / Rzgari hospital in Hawler from the first of January 2015 till first of December 2017; 110 (55%) were females and 90 (45%) were males. 137 patients were adolescence (68.5%), 47 patients were school age (23.5%), 9 patients were preschool age (4.5%) and 7 patients were in toddler age group (3.5%) . it was found that 89 (44.5%) patients had upper GIT bleeding, 111(55.5%) patients had lower GIT bleeding. Esophagogastroduodenoscopy (EGD) results of 34(38.20 %) patients with upper GIT bleeding were normal while 17(19.10 %) had duodenal ulcer, 11(12.36 %) had gastric ulcer , and 6(6.74 %) had antral gastropathy. lower GIT bleeding found in 111(55.5%) patients; from these, finding of colonoscopy in 41patients (36.94 %) were normal, 16(14.41 %) were have internal pile, 15(13.51 %) were have colonic polyp, 11(9.90%) for solitary rectal ulcer and 10 (9.00%) ulcerative colitis, and 7(6.31%) patients were have Crohns disease.
upper gastrointestinal bleeding, lower gastrointestinal bleeding, hematemesis, Malena, hematochezia.
Herpes simplex viral epithelial keratitis following pars plana vitrectomy
Aim: To investigate the incidence, and time of onset of Herpes simplex viral epithelial keratitis (HSVEK) following pars plana vitrectomy (PPV). Patients and methods: This is a prospective study of all patients undergoing pars plana vitrectomy by one vitreo- retinal surgeon from January 2014 till January 2019. Results: 865 cases underwent of pars plana vitrectomy, and 8 (0.93%) cases of HSVEK occurred during the first 4 weeks postoperatively. These cases were detected one day (n = 1), one week (n = 6), and one month after surgery (n = 1). Conclusions: HSVEK is a possible complication after PPV surgeries. Most cases occurred in the first postoperative week.
Single Session Ureteroscopic Laser Lithotripsy for Paediatric Ureteral Stones in Mosul: A Prospective Study 2020
Backgound: The incidence of pediatric urinary stones increased 4% per year during 1984-2008. Hematuria (Gross or microscopic) is seen in 30% to 55% of all pediatric urolithiasis. Nearly, 25-50% of pediatric ureteral stones need surgical intervention like ureteroscopy. Patients and Methods: In 2020, a prospective clinical study was done over a six months period (June to December) at the department of urology in Mosul Medical City. All children 14 years of age and below of both genders who presented with ureteric stones unpredictable for spontaneous passage were studied while cases with urologic comorbidities that necessitate open surgery were excluded. Abdomino-pelvic ultrasonography, plain abdominal radiography (KUB) and either intravenous urography (IVU) or computed tomography urogram (CTU) were done for all patients to identify stone characteristics (size, diameter, density and impaction) or ureteral state (dilatation or stricture). Results: seventeen cases of semirigid ureteroscopic Ho:YAG laser lithotripsy procedures were performed. Their average age was (5.64) years, male to female ratio was 12:5. Abdominal pain and fever were the commonest presenting symptoms (76.4%). The overall stone clearance following one session of ureteroscopic laser lithotripsy was 88.2% i.e. clearance was achieved in 15 out of 17 procedures (88.2%) whereas the remaining 2 out of 17 (11.8%); needed retreatment; one case required 2nd session ureteroscopy while the other had stone migration up to renal pelvis which was treated by stenting and later on by SWL. On comparing the stone free rates in relation to their sites in the ureter or to their diameters the P-values were not significant. The post-operative complications were faced in 4 cases only (23.5%), fever in 3 cases (17.6%), while retrograde stone migration was in 1 case (5.9%). Conclusion: Semi rigid ureteroscopic Ho:YAG laser lithotripsy is safe and effective in treating pediatric age group complaing from ureteral stones of different characteristics with a high clearance rate in single session procedures.
Pediatric stones, ureteral stone, ureteroscopy, laser lithotripsy.
Interleukin-1 and Tumor Necrosis Factor alpha in Systemic Lupus Erythematosus patients
Background: Systemic lupus erythematosus (SLE) is a long-lasting autoimmune disorder with an unclear cause that can impact almost every part of the body. In addition to heredity environmental effect, an imbalance between pro-inflammatory and anti-inflammatory cytokines plays a role in immune system dysfunction, initiates an inflammatory response, and leads to damage in tissues and organs. In SLE, inflammatory responses can be enhanced and/or sustained by the presence of cytokines that are produced in excess both systemically and in specific local tissues. Methodology: Numerous significant chemical substances have been regarded as a targets for diminishing acute or chronic infection in systemic lupus erythematosus (SLE). another research has shown that the abnormal synthesis of chemokines , especially the interleukin related to the family Interlukin-1 and Interleukin-10, drives immune response and affects immunomodulation , which are crucial in the development of such auto immune diseases. Among the cytokines in the IL-1 family, IL-1, IL-18, IL-33, IL-36, IL-37, and IL-38 have been extensively studied in relation to SLE. Furthermore, the IL-10 family cytokines, including IL-10, IL-20, are found to be immune reaction in auto immune disorder. Results: Cytotoxic substances released by activating of CD8+ T cells which leads to tissue damage. By activation of CD8 cells which produce many chemokines that effect vital tissues Additionally, B cells play a role in the pathogenic severity in final step represented in autoimmune disorder. Conclusions: Autoantibodies attach outside of cells, triggering the complement system to unleash their cell-killing effects and result in tissue harm. Conversely, autoantibodies targeting proteins inside cells serve as important biomarkers for autoimmune diseases.
Vitamin D Deficiency among Patients with Newly Diagnosed Tuberculosis
Background: Tuberculosis is a common public health problem in Kurdistan region and Iraq. Objective: To determine the prevalence of vitamin D deficiency among newly diagnosed individuals with tuberculosis. Methods: Present study was an observational cross-sectional carried out in Erbil Tuberculosis center at Erbil city-Kurdistan region/Iraq through the period of eight months from 1st of October, 2024 to 30th of April, 2025 on sample of sample of one hundred patients with newly diagnosed tuberculosis and sample of one hundred healthy individuals as controls. Results: The vitamin D deficiency was recorded in 74% of newly diagnosed tuberculosis cases. Our study showed a statistically significant relationship was observed between severe vitamin D level deficiency and TB cases (p<0.001). Risk factors related to vitamin D deficiency among newly diagnosed tuberculosis cases are increased age, illiteracy, unemployment, widow relationship, positive menopause for females, low family income, high crowding index, current smoking, shorter exposure duration to sunshine, no vitamin D supplement and rare frequency of food rich in vitamin D. Conclusion: The prevalence of vitamin D deficiency in newly diagnosed tuberculosis cases in Erbil city-Kurdistan region/Iraq is high. The vitamin D deficiency may play a significant role in development of tuberculosis.
Newly diagnosed Tuberculosis, Vitamin D deficiency.
Dyslipidemia and Metabolic Risk Factors in Postmenopausal Iraqi Women with Chronic Heart Disease: A Case-Control Study
Background: The main reason postmenopausal women die is cardiovascular disease; dyslipidemia is a major contributing factor. This study evaluates postmenopausal women with chronic heart disease (CHD) to clarify how changes in lipid profile affect disease progression. Methods: Case-control research is conducted on ninety 50–60-year-old women from Kirkuk, Iraq. 30 age-matched healthy controls were matched against 60 postmenopausal women diagnosed with CHD. Serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very-low-density lipoprotein (VLDL) were determined using enzymatic spectrophotometry. Results: Postmenopausal CHD patients exhibited significantly elevated levels of total cholesterol (201.2 ± 40.08 mg/dL), TG (154.34 ± 44.90 mg/dL), LDL (129.62 ± 39.95 mg/dL), and VLDL (30.86 ± 8.98 mg/dL) compared to controls. HDL levels were significantly reduced (40.73 ± 9.28 mg/dL vs. 51.33 ± 6.26 mg/dL; p < 0.05). Conclusion: In postmenopausal women, dyslipidemia is significantly correlated with CHD, which underlines the importance of lipid monitoring and early treatment in this high-risk population.
Postmenopausal women, Chronic heart disease (CHD), Lipid profile, Dyslipidemia, total cholesterol (TC), High-density lipoprotein (HDL), Triglycerides (TG), Low-density lipoprotein (LDL), Very-low-density lipoprotein (VLDL)
Assessment of breast self-examination among women attending al Shirqat hospital regarding the knowledge ,attitudes and practices
Introduction: Breast cancer is prevalent malignancy affecting women globally, with Iraq facing a significant burnden. Breast self-examination is a vital, cost-effective method for early detection ,yet its practice remains low, particularly in developing countries, therefore; this study aimed to identify the knowledge, attitude, and practice of females attending the surgical unit in al Shirqat hospital-Salahdeen on breast self-examination. Methodology: A cross-sectional study was conducted from 1st October 2024 to 1st April 2025, involving 217 randomly selected female attending in the surgical outpatient clinic in al Shirqat hospital-Salahdeen governorate. Data was collected using a designed questionaire which composed of demographic characteristics of women Knowledge of women about breast self-examination were assessed by score system practice women about breast self-examination were assessed by score system .Use of health belief model (HBM) to collect data about women's perception to breast self-examination and data and analyzed using SPSS version. Results: The study revealed that the majority of participants (86%) had unsatisfactory knowledge of breast self-examination, and (68%) demonstrated a positive attitude towards breast self-examination. However (78%) exhibited poor breast self - examination practice. Significant association were found between ages, marital status, education level, family history of breast cancer and the levels of knowledge, attitude, and practice of breast self-examination. Conclusion: The study underscores the necessity of educational programs and health interventions to enhance knowledge and promote regular breast self- examination practice among women, which could lead to earlier detection of breast cancer and potentially improves outcomes.
Breast self-examination, knowledge, attitude, practice.
The association between vitamin D level, lipid profile, and selected pro-inflammatory markers
Background: Vitamin D has a well-known role in the regulation of calcium hemostasias and controlling bone metabolism. However, little is known about vitamin D status and its relation to inflammation. Recent studies suggest that vitamin D has an anti-inflammatory effect and causes down regulation of inflammation markers production, which favours less inflammation. Objective: This study investigates the relationship between low vitamin D status, lipid profile parameters, and inflammation markers. Methods: In this case-control observational study, 52 participants from two cities (Baghdad and Sulaymaniyah) in Iraq were enrolled. Individuals with normal and abnormal inflammatory process were included in the study. The study population was divided into two groups based on their highly sensitive C -reactive protein (Hs-CRP) level, the control group and the study group. Serum Hs-CRP and 25-hydroxy cholecalciferol [25(OH)D] levels were measured for all participants. The data were evaluated to compare differences in vitamin D status between the two groups. Results: The overall study population showed Hypovitaminosis D, with a mean 25(OH)D level of 22.6 +15.7 ng/mL. Significantly higher Hs-CRP, ESR, WBC and lower 25(OH)D levels were observed in the study group compared to those in the control group. A higher mean 25(OH)D level was found in the control group compared to the study group (25.1 ng/mL vs. 17.9 ng/mL, p=0.033). The mean values of serum cholesterol, triglycerides, high density lipoprotein– cholesterol (HDL-C), and low-density lipoprotein– cholesterol (LDL-C) were not significantly different across groups. Conclusions: This study demonstrates that there is an association between low vitamin D status and inflammation markers.
Determination Of Some Oxidative Stress Markers In Sheep Diagnosed With Anemia In Salah Al-Deen Governorate
Background: The purpose of this study was to determine the changes of oxidation stress markers in sheep suffering from nutritional deficiency anemia. Additionally, the blood picture of these sheep was examined and compared to that of non-anemic sheep, which served as a control group. Methods: Sheep aged 1-3 years who were clinically classified as anemic and non-anemic according to clinical symptoms were involved in the study. The study included 40 sheep divided to two groups, 30 animals as anemic group, and 10 animals as control group. The percentage of hemoglobin and the amount of red blood cells were also measured to validate this diagnosis. Superoxide dismutase, glutathione, and malondialdehyde were among the oxidation indicators. Results: The findings demonstrated that the levels of each of the three (Hb, RBC, and HCT) were significantly Lesser (p≤0.05) in the groups of animals identified as anemic, as verified by blood picture tests, when compared to healthy animals. The levels of super-oxide dismutase and glutathione in anemic animals were significantly Lesser (p≤0.05) than in the control group, but the levels of malondialdehyde in anemic animals were significantly upper (p≤0.05) than in the control group.
Oxidative markers, Anemia, Sheep, Blood picture.
Molecular Study of Respiratory Syncytial Virus Concomitant with COVID-19 Infection in Children under 5 Years
Background: Worldwide, an estimated 33 million children under the age of five years are projected to be infected with the respiratory syncytial virus (RSV), with 10% of those cases necessitating hospital admission and up to 199,000 deaths from the illness. Patients and Method: We tested 100 suspected patients for RSV infection, with the help of pediatrician . The study was conducted at the Ramadi Teaching Hospital for Maternity and Children /Al-Anbar. The period of study was from 1 December 2023 to 15 March 2024. Result: In this study, we examined 100 cases of respiratory infection, 58 cases were positive for RSV. Out of 58 cases with positive RSV, 32 were positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antigen, and from cases positive for SARS-CoV-2 antigen, 18 were confirmed positive for SARS-CoV-2 by polymerase chain reaction (PCR). The age of patients ranged from 1 month to under 5 years and 57% were males while 43% were females. Statistical analysis was performed on data from RSV-infected patients as well as age subgroup populations. Patients were classified into the following age groups:1 to 6 months N=36(36%), 6 to 12 months N=24(24%), 12 to 18months N=9 (9%), 18 to 24 months N=17(17%), and more than24 months N=14(14%). The serotype of RSV were N=15(25.8%) of serotype A and were N=43 (74.1%) of serotype B. Conclusion: RSV is the leading cause of sickness and death in newborns globally, especially in low- and middle-income nations. Palivizumab is crucial for preventing severe RSV LRTIs in high-risk newborns, but the excessively high cost prevents widespread use. During the Pandemic, primary preventative measures, such as hand hygiene and face masks, were more cost-effective in reducing RSV burden. In addition to the vaccination, non-pharmaceutical preventive hygiene measures should be implemented to reduce RSV spread globally, even after the coronavirus disease-19 (COVID-19) pandemic.
RSV , COVID-19 , SARS-CoV-2 , children, hygiene, RSV Serotype A, PCR , lower respiratory tract infection , epidemiology, influenza
Febrile Neutropenia In Pediatric Patients with Acute Leukemia During Induction Chemotherapy in Hiwa Hospital at Sulaimaniyah City, Kurdistan Region of Iraq
Background: Febrile neutropenia (FN) is common in pediatric oncology patients, and the majority of patients with FN do not have a microbiologically defined infection, but those who do are at risk for overwhelming complications, including severe infection and death. Objectives: To determine the risk factors and treatment outcomes of FN pediatric patients with acute leukaemia during induction of chemotherapy. Patients and methods: This cross-sectional, retrospective, observational, hospital-based study was conducted on 10 years of recorded data (January 01, 2015, to January 01, 2025) of pediatric acute leukaemia patients (n=115) who developed FN during induction of chemotherapy from the Pediatric Department at Hiwa Hematology/Oncology Hospital, Sulaimaniyah, Iraq. Results: The patients’ mean age was 8.02 ± 4.65 years with a mean body mass index (BMI) of 16.56 ± 4.46 kg/m². Most patients were aged 1.0 – 6.0 years (41.7%, n=48), males (56.5%, n=65), underweight (76.5%, n=88), had blood group A+ (43.5%, n=50), had ALL (58.3%, n=67), experienced immunosuppression (87%, n=100), had no fatigue or anxiety (59.1%, n=68), and had a body temperature of >38.5° C (58.3%, n=67). Also, majority of patients had profound neutropenia (62.6%, n=72), fever (46.1%, n=53), negative microbial cultures/identified infection (82.6%, n=95), had positive C-Reactive Protein (63.5%, n=73), received prophylactic antimicrobial (73.0%, n=84), had no abnormality on imaging (87.8%, n=101), not admitted to Intensive Care Unit (ICU) (84.3%, n=97), and were recovered (89.6%, n=103). Consequently, no significant differences were observed in age, gender, BMI, or culture-related findings (p ≥ 0.05). Conclusions: A chemotherapy-induced FN is a crucial life-threatening complication of the cytotoxic drugs used in the management of pediatric acute leukaemias.
Acute leukaemias, pediatric patients, chemotherapy induction, survival rate, febrile neutropenia
Assessment of Knowledge, Attitudes, and Prevalence of Different Types of Tobacco Products Smoking in Rania District, Sulaimani-Iraq
Background: Tobacco smoking remains one of the leading preventable causes of morbidity and mortality worldwide. While global and regional data are abundant, localized studies are essential for understanding the knowledge, attitudes, and prevalence (KAP) of tobacco use within specific communities. Methods: A community-based cross-sectional study was conducted between April and July 2025 in Rania District and its sub-districts (Chwarqwrna and Hajyawa). Using a multistage convenience sampling method, 820 individuals aged ≥12 years were recruited. Data were collected via a validated, bilingual (English/Kurdish) questionnaire adapted from the Global Youth Tobacco Survey (GYTS). Statistical analysis was performed with SPSS version 25, using descriptive statistics, Chi-square tests, and logistic regression to determine associations. A p-value <0.05 was considered significant. Results: The mean age of participants was 29.6 ± 12.5 years, with 83.2% males. Among respondents, 61% were active smokers, while 39% were non-smokers. Knowledge levels were fair in 66% of participants, with a significant association between knowledge and tobacco use (p=0.021). Neutral attitudes toward smoking predominated (84.1%) and were significantly associated with smoking behaviors (p<0.001). Peer influence and sociodemographic factors, including male gender and middle socioeconomic status, were strongly associated with smoking initiation and continuation. Conclusion: The study highlights a high prevalence of smoking in Rania District, compounded by moderate knowledge and neutral attitudes toward tobacco use. Targeted interventions addressing knowledge gaps, reshaping social norms, and strengthening local tobacco control measures are urgently required.
Tobacco smoking; Knowledge; Attitudes; Smoking prevalence; Rania District; Kurdistan Region