Kirkuk Journal of Medical Sciences

Background: Jaudice is observed in first week of life in most neonates, it is usually benign but untreated severe indirect hyperbilirubinemia is potentially toxic to nervous system of neonates. Aim of study: Asses effect of some factors on modality of therapy in neonatal jaundice (phototherapy, exchange transfusion). Prematurity & Low birth weight is discussed in some detail. Methods: This cross sectional study was carried out at neonatal intensive care unit {NICU} of pediatric general hospital Kirkuk from first of March 2018 to first of September 2018 on 307 neonates admitted to hospital,154 of them had jaundice, these neonates were divided to those who had received phototherapy & those who had exchange transfusion, then divided to: term & preterm, normal weight & low birth weight, male & female, then the modality of therapy in each of these groups was analyzed & studied. Results: It was found that 307 neonates were admitted to NICU, 154 neonates (50.1%) of total admission to neonatal intensive care unit were due to jaundice, 115 neonate (74.6%) received phototherapy, 39 neonate (25.4%) had exchange transfusion. 100 neonates were male (64.9%) & 54(35.1%) were female. Phototherapy is used more frequently in preterm 28(77.7%) & 23(85.2%) LBW neonates than exchange transfusion, which was used in 8(22.3%) preterm & 4(14.8%) LBW. When the association between gestational age and type of therapy is statistically analyzed there was no significant association. No significant association between gender of baby and type of therapy was found. There was no significant association between weight of neonate & type of therapy. Conclusion: Fifty per cent of admissions to NICU were due to jaundice. Exchange transfusion is still used in relatively height percentage in NICU at Pediatric General Hospital Kirkuk because of late presentation of neonates with jaundice to medical team. Lack of awareness about the toxic effects of high bilirubin on the developing brain among families in our society. In addition old, over used phototherapy equipment in hospital, reduce the effectiveness of phototherapy.

Background: An increase in progesterone and estrogenlevels or increase of the blood volume during pregnancy causes various ENT manifestations. These pathologies usually disappear after birth and cause no harm to the patient but some time might be risky to the life of mother. Aims: To assess the prevalence of major ear nose and throat manifestations. Patient and Methods: 112 pregnant women presented to private otolaryngology clinic referred from obstetrician after complete examination managed accordingly. Results: Of 112 pregnant women presented with ear nose and throat symptoms majority were at the age group 20-35 years age (85.7%) and most cases presented at second trimester (53.6%) and (83.1%) were multigravida. Nasal symptoms (44%) were the most common problems discovered on examination. And the least symptoms were throat symptoms (21.4%). Conclusions: Most conditions presented during pregnancy are selflimiting.

Background: Aphthous ulcer or recurrent aphthous stomatitis is one of the most common mucosal disorders of the mouth. The exact etiology of aphthous ulcer is uncertain, but precipitated factors include stress, trauma, food sensitivity, and genetic predisposition. Stress and anxiety have a role in the onset and recurrence of aphthous ulcers. Aim of study: This study aims at clarifying the association between stress and aphthous ulcer and the influence of other triggering factors. Study design: observational cross-sectional study which was conducted on medical students of Medical College of Tikrit University (n/566), Patient age range from (19-24) years. The data were collected using questionnaires involved perceived stress scale (PSS) by Cohen. Results: In this study the frequency (31%) (176/566) of students has aphthous ulcer, (62%) (110/176) of them were female, and (37%) (66/176) of them were male. Perceived stress scale was high among the medical students, in the male (10%) (7/66) were under mild stress and (56%) (37/66) were under moderate stress and (33%) (22/66) were under severe stress. While in female (6%) (7/110) were under mild stress and (79%) (87/110) were under moderate stress and (14%) (16/110) were under severe stress. Conclusion: The prevalence of aphthous ulcer was high among medical students. With a highly significant association with stress.

Background: Laparoscopic gastric plication (LGP) is emerging as a safe and effective bariatric procedure. A comparative study between the efficacy and complications of LGP with modified enteric bypass and LGP with loop bipartition, which are still an investigational bariatric procedure. The objective of this study to compare safety and efficacy of LGP with enteric bypass and LGP with loop bipartition in the treatment of morbid obesity in a one-year follow-up study. Methods: A prospective study between February 2016 to December 2017, conducted on 80 morbid obese patients who were candidates for laparoscopic gastric plication, with either loop bipartition or modified enteric bypass surgery were randomly assigned to receive either LGP modified enteric bypass (n = 40) or LGP with loop bipartition (n = 40). Early and late complications, body mass index (BMI), excess weight loss, and obesityrelated co-morbidities were determined at the 1-year follow-up. Results: Operative time and mean length of hospitalization were shorter in the LGP with modified enteric bypass group than LGP with loop bipartition; (110 minutes versus 120 minutes, P<.001, and 2 days versus 3 days; P<.001, respectively). The mean percentage of excess weight loss (%EWL) at 12 months follow-up was (79.5%) in the LGB with modified enteric bypass group and (74.1%) in the LGP group (P = 0.03). Improvement was observed in all co-morbidities in both groups. Conclusion: Both LGP and LGB are effective weight loss procedures. LGP enteric bypass proved to be a simpler and less costly procedure compared with LGP with loop bipartition with a lower risk of stomal ulcer during one year follow up.

Introduction: Psoriasis is a chronic, common, immune-mediated inflammatory disease that affects the skin, joints and nails. Nail involvement is very common in the course of psoriasis; Psoriasis can involve any element of the nail apparatus-nail bed or matrix, or both. Resulting a disturbance in the nail morphology (pitting, leukonychia, onycholysis, subungual hyperkeratosis, oil spot) and nail dystrophy, the psoriatic nails lose their natural preventing barrier and therefore are more predisposed to fungal infections. Onychomycosis is fungal infection of nails caused by yeasts, dermatophyte and nondermatophytemoulds. Psoriatic patients with nail changes more liable to invasion by fungal elements than psoriatic patients without nail changes. Objective: To assess the frequency of onychomycosis in psoriatic patients nails due to the presence of predisposing nail changes to fungal elements infection. Materials and Methods: The nail specimens were prepared by scrubbing and clippings from the 30 psoriatic patients with nail changes and another 30 without nail changes. The nail specimens were taken from each patient undergoes 2 laboratory examinations: direct Result: Totally, we studied 60 psoriatic patients (30 men and 30 women). The mean age was 24.5±13.7years. The most common clinical form of psoriasis was psoriasis vulgaris (85%) and (15%) Arthropathic psoriasis. The percentage of positive mycology in psoriatic patients with nail changes 21(70%) is higher than; the group of psoriatic patients without nails changes 10(33.3%). The fungal agents, which isolated in this study, were Yeast like fungi (candida spp.) and Non Dermatophyte Moulds (NDM). Conclusion: This study revealed statistically significant relation between nail psoriasis and mycological results were the P-value= 0.037.

Background: Patient satisfaction can be defined as the extent of an individual's experience compared with his or her expectations. Patient satisfaction is a subjective and complex concept, involving physical, emotional, mental, social, and cultural factors. It is The Aim: Of this study is to audit the patient expectation and satisfaction regarding the quality of care offered by doctors, nurse, post operative care, pain relief, and hospital facilities. Patient and Method: This is prospective randomized study, while conducted in Emergency unit of main medical hospital surgical inpatient ward, about satisfaction and acceptance for patients with acute abdomen in emergency unit from time of admission to the time of discharge from hospital. This study includes 60 patients suffering from acute abdomn including [acute appendicitis, perforated appendix, intestinal obstruction, acute cholycystitis]. Results: A total of sixty patients are participated in the study. Age ranged from (8-65) years, mean age of (25.48%), 38 cases were male (55%) and 27 of cases were female (45%) and male to female ratio is (2:1). Conclusions: Acute appendicitis was the most common cause of acute abdomen encountered in this study. Majority of cases in this study dissatisfied from nurse care and pain relief and satisfied from doctors, post operative care and hospital facilities.

Background: Sacrococcygeal Pilonidal sinus (SPNS) isa common problem has a variable presentation and many surgical techniques for treatment. Still, there is controversy about the best method of surgery, because of notable rates of recurrence. Objective: The aim is to clarify the better, cost-effective and less painful method for treating patients having SPNS. Methods: This is a retrospective study of 119 patients with SPNS, treated by two different surgical methods: group A (69 patients) treated with open surgery and group B (50 patients) treated by primary midline closure. The patients followed for 2 years. Comparison between the two groups was done, for post-operative complications and recurrence. The data were analyzed using of Statistical Package for Social Science (SPSS) version 21. Chi square used to determine association between variables. P value < 0.05 is regarded statistically significant. Results: From 119 patients: Group A (69 cases) underwent open surgery and group B (50 cases) had primary closure. Postoperative infection was (5.9%), bleeding (2.5%), scar fissuring (5.9%) and chronic pain (3.4%). Recurrence found in 6 patients (5%); 2(2.9%) in Group A and 4(8%) in Group B. Conclusions: The open method needs multiple dressings which are coasty and painful, longer healing time and may be complicated by scar fissuring, but of lower recurrent and infection. The closed method is preferablefor patient's comfort, and it is costeffectiveness.

Background: success of our therapy. One can feel the triumph of medicine against cancer through the directed therapy that is now available for CML, making patients die with rather than from n this study we evaluate chronologically the hematological response of our CML patients in Patient and Methods: Every patient seen and treated with Glivec was subjected to a critical evaluation in Kirkuk Hematology-Oncology Center. The standard dose for all patients is 400 mg orally daily. Following the pattern of response through CBC results available over the first 28 days of therapy were recorded first; for the rest of the first three months of treatment, weekly CBC was determined. Spleen size, Hb level and platelet count were also recorded. It is aimed to establish a platform for knowing how future patients with CML in our locality respond to Glivec treatment. Results: The mean age of our patients was 44 years. Out of the 67 patients of CML, 35 were male and 32 were female. The first line treatment of all these CML patients was Glivec. We witnessed complete hematological response in (92.5%) of CML patients during the first three month after start treatment. Glivec has normalized the WBC count in the majority of our patients. Early neutropenia and thrombocytopenia necessitating manipulation of the standard Glivec daily dose of 400 mg. Conclusion: Glivec is the target therapy in the management of the chronic myeloid leukemia with Philadelphia-positive chromosome and cause Complete hematological response that arise during the first three month after started treatment which lead to normalized WBC count and its differentiation in the blood smear with significant clinical improvement especially the size of spleen which become impalpable in (88%) of CML patients.

Background: Fine-needle aspiration and cytology is the cornerstone of preoperative evaluation of thyroid nodules, but Fine-needle aspiration and cytology diagnostic performance has varied across different studies. Several published guidelines provide recommendations for selecting nodules for cytology based on US appearance and nodule size. Some US parameters have been associated with increased risk of malignancy; however no characteristic seems sufficiently reliable in isolation to diagnose malignancy. The incidental thyroid nodule is one of the most common incidental findings on imaging studies that include the neck. An incidental thyroid nodule is defined as a nodule not previously detected or suspected clinically, but identified by an imaging study (ultrasound, CT or MRI). Patients and Methods: A prospective study of 75 patients were collected from Jan. 2016 till march 2017 from hospital medical data included clinical, Ultrasound, Fine needle aspiration and cytology and histopathology report. For prospective FNA collection, patients were enrolled in an institutional review board-approved protocol and informed consent was obtained. Results: Of the 75 patients (62 female, 13 male) A considerable proportion (41.3%) of patients were suspected to be malignant the cytological study showed that (30.7%) of the patients had colloid goiter, (13.3%) had follicular cells, and (10.7%) had papillary cells. Regarding histological diagnosis, (53.3%) found to have colloid goiter. FNA had a relatively high sensitivity (81.8%) and specificity (77.5%) around one third (32.3%) of those suspected to have malignancy found to really have cancer, incident cancer were found Conclusion: By using the Thyroid Imaging Reporting and Data System guidelines, one can see a significant reduction in the number of thyroid nodules recommended for biopsy. False positive and false-negative results continue to present a challenge in the evaluation of thyroid nodules. Molecular testing studies are needed to more accurately refine FNA diagnosis in the cytologically indeterminate group where the majority of cases prove to be benign and surgery could be avoided.

Background: Diaphyseal forearm fracture are common injuries among children, its treated either conservatively or surgically, closed reduction cast immobilization remain the current gold standards for treating these injures, but angular & rotational malunion result in functional disability in older children. Intramedullary nailing of forearm fracture is an alternative method especially in case of failed closed reduction and cast immobilization. The aim of our study is to value the outcome of using flexible elastic nail in pediatric diaphyseal forearm fractures. Methods: This study is a prospective study was conducted in Erbil city from January 2016 to January 2017 on forty-nine pediatric patients with diaphyseal forearm fractures treated surgically with titanium elastic nailing system (TENS), thirty-three boys & sixteen girls, twenty-one fractures on right side and twenty-eight on left side, age range between 5-15 years with mean age of 9 3.1three patients had polytraumatic injury , the fracture had been classified according to descriptive classification, Average follow up was11± 2months for 43 children. Result: In 43 of 49 patients, the operative procedure was done as primary treatment, completed within the first 24 hours after injury. In six of the patients, secondary displacement occurred after attempted conservative therapy, and in those cases the procedure was performed after 8 ± 3 days. Operating time averaged 42 ± 15 min. The average time that radiographs showed bridging callus on the antero-posterior and lateral views was 13 weeks for both radius and ulna, Ten of the 49 patients were given aboveelbow splints postoperatively, Implant removal was performed after an average of 6.3 ± 1.7 months, the radiological results are documented regarding angulation and displacement. The functional results are documented, there were no observed cases of refracture, 6 months after hardware removal all patients pain free with no limitation of movement and activities, 37 patients were rated as excellent outcome, three with good out come and three with poor out comes. Conclusion: Flexible elastic nail is an effective and minimally invasive method of diaphyseal forearm fractures with excellent results in terms of bony union and functional out comes with minimal complications and without jeopardizing the integrity of the physes.

Background: Neural tube defects NTDs constitute a major health burden (0.5-2/1000 pregnancies worldwide), and remain a preventable cause of neonatal and infant death. Vitamin D is fat soluble, primarily involved in the metabolism of calcium, phosphorus and regulates bone minerilization. Objective of This Study: To assess the relation between low serum Vitamin D level in pregnancies complicated by NTDs in comparison with normal pregnancies. Patients and Methods: A case- control study, carried out in Salaheddin General Hospital from February 2017 to the September 2017. This study involved 30 pregnant women whose pregnancies were complicated by NTDs and 30 women with normal pregnancies with assessment of vitamin D in each group. Results: Low serum vitamin D level was found in 26 women (86.7%) had severe vitamin D deficiency and 4(13.3%) had moderate Vitamin D deficiency of the cases and 6 (20%) of the controls had moderate vitamin D deficiency. With a statistical significant at a p- value = <0.05. Serum Ca level was found to be a low in (100%) of those with NTDs pregnancies cases group, while it was low in (7%) of control group. There was a significant relationship between the presence of NTDs and low serum Ca at a p- value = <0.05. Conclusions: In this study there is an association between NTDs and low serum vitamin D levels, adding to the evidence about the importance of nutritional and maternal health factors in the etiology of this disease. Vitamin D supplementation can be advised for the further decrease in the recurrence and occurrence of NTDs.

Background and objectives: Lower respiratory tract infection (LRTI) is one of the major causes of morbidity and mortality in young children and elderly. The most important lower respiratory infection is pneumonia, the fourth leading cause of death. Most cases of bronchitis are of viral etiology. Most common lower respiratory infections are acute bronchitis, chronic bronchitis, and pneumonia; the common causative agents are Streptococcus pneumoniae, Haemophilu influenzae, Enterococcus spp, Klebsiella pneumonia. Aims of the study was to find the common bacterial causes of lower respiratory tract other than acid fast bacilli in Erbil city and to determine if there is any relation between the causative agents with gender of the patients, also to determine the antibacterial susceptibility profile of the bacteria that isolated from patients with lower respiratory tract infection. Method: 250 sputum samples collected from patients suffering from lower respiratory tract infection attending the Microbiology Laboratory of Rezgary Hospital, Raparin Hospital and Par Hospital within period of 6 months (from August 2016 to February 2017). A questionnaire form sheet prepared for each patient who includes the following information: Patient name, age, gender, residence, symptoms, Drug history, past medical history and antimicrobial susceptibility done for each pathogen either by vitek or disk susceptibility tests. Result: From 250 patients only 142 patients showed positive growth, 100 (70.4%) were males and 42(29.6%) were females. Lower respiratory tract infection was mostly seen in age group of (41-50) years. The age range in this study varied between six months and 97 years with mean age (47±25.23) years. All together 10 different species of bacteria were identified, majority of which were gram negative (89.42%). The gram-negative bacteria were: Klebsiella pneumonia (30.29%), Acinetobacrebaumanaii (28.9%), Pseudomonas aeruginosa (11.9%), Escherchia coli (8.45%), Pseudomonas oryzihabitans (4.94%), Serratia marcescens (2.82%) and Proteus mirabilis (2.12%) isolated from sputum samples. The gram-positive bacteria were: Staphylococcus aureus (7.04%), Streptococcuspneumonia (2.12%) and Streptococcus oralis (1.42%) isolated from sputum samples. On performing antimicrobial susceptibility testing, in gram-positive bacteria, they were resistant to Amoxicillin and Penicillin while most of them were sensitive to Tetracycline. While in gram negative bacteria, they were resistant to Amoxicillin and Ampicillin and most of them were sensitive to Amikacin. Conclusion: Most of the isolated bacteria were gram negative which was (89.44%) while (10.56%) were gram positive. The prevalence of lower respiratory tract infection caused by bacterial infection is higher in males than females. Most of the gram positive and gram negative were resistant to most of the common antibiotics that used by the patients. Varieties of pathogens are responsible for lower respiratory tract infection and antimicrobial resistance has become significant public health problem.

ackground: Hypertension is a major health abnormality affecting around (20%) of the adult populations in more country. Mortality from vascular events like stroke and ischemic heart disease double with increases in the systolic blood pressure or increases in diastolic blood pressure. Diagnosis of hypertension and control of blood pressure are highly important for decreasing the risk of cardiac attacks and vascular events like strokes. We studied the prevalence, awareness, and control of hypertension in attendance of medical consultation room in Azadi Teaching Hospital in the period from 2013-2015. Objective: To determine: (1). Prevalence, awareness and control of hypertension in adult population attended Azadi Teaching Hospital in Kirkuk. (2). The proportions of treated patients, controlled, and uncontrolled HTN. Patient and methods: Across-sectional point prevalence study. A total of 2351 unselected medical consultation clinic attendance; Blood pressure information on 2351 individuals (in 2013- Prevalence of hypertension based on clinical diagnosis, self- diagnosis, and (BP) measurements. Results: A total of (41%) of all patients were diagnosed as having hypertension (BP nine percent of hypertensive patients were on antihypertensive medications, (21%) of which awareness, treatment, and control rates of hypertention have increased significantly .01). Conclusions: Prevalence of HTN is high in Kirkuk population. The proportions of attendance who received medications remained low, and BP control was bad among HTN patients. These findings indicate that increase in improvement of management and controlling of HTN among our population seriously needed.

Introduction: Meningitis is known as a disease that Infect the central nervous system (CNS), it is mainly caused by bacteria, mycobacteria, fungi, viruses and parasites that cause disease and death, bacterial infections constitute the highest percentage of the other species, with (56.6%) and viruses (30.2%). Aim: The present study aimed to isolate bacteria cause meningitis and identify these bacteria. Materials and Methods: A total 248 clinical samples of cerebrospinal fluid (CSF) from meningitis patients were collected, for the period of July to October 2018. From the Child Protection Teaching Hospital in the Medical City Complex in Baghdad. All clinical samples were collected and cultured on blood agar, chocholate agar and MacConkey agar or 24 hours. All isolates were identificated depending on macroscopic, microscopic and biochemical tests (Oxidase, Catalase, Gelatinase, Haemolysin, growth coagulase for Staphylococcus spp.) and (Voges-Proskauer, Methyl red, Indol, Citrate, Urase, Kliglar, Catalase, Oxidase, for Gram negative bacteria) and definite with Vitek-2 compact. Results: The results of the study showed growth of 42 samples, 7/16(44%) S. epidermidis, 3/16(19%) S. hominis, 3/16(19%) S.haemolyticus, 2/16(12%) S.aureus, 1/16(6%) S.warneri. Whereas the Gram negative bacteria include, 1(2%) isolate of Pseudomonas putida, Escherichia coli, Klebsiella pneumonia, and 2(4%) isolates Burkholderia cepacia and Acinetobacter baumannii, and 19(45%) isolates were others (Enterococcus faecium, streptococcus thoraltensis, Kocuria kristinae, Leclerciaade carboxylata, Rothiadent ocariosa, Globicatella sulfidifaciens, Pantoea spp., Pantoeaag glomerans). Conclusion: Various species of bacteria appeared but Gram positive Staphylococcus spp. was more predominant.

Background: The prevalence of birth defects increased abruptly in recent years especially in Iraq. The etiology may be related to either genetic or environmental factors. Material & Method: In this cross sectional study that is conducted in Azadi Teaching Hospital in Kirkuk city in Sonographic unit & delivery room. A total of 1814 prenatal fetuses and postnatal newborns with their mothers were involved in this study. All the fetuses or newborns were examined for search of different fetal structural defects. The aim of the study: Was to identify the prevalence of fetal structural defects among pregnant women who attending Azadi Teaching Hospital. Results: Neurological defects were the most frequent detected anomaly (58.8%) followed by skeletal defects (15.4%), (10.3%) for hydropsfetalis, (7.7%) for urinary system defects, (7.7%) for cystic hygroma and only (5.1%) for facial defects. The anomaly detection rate by trans-abdominal ultrasound was (1.9%) during 2nd and 3rd trimesters, and postnatal diagnosis by physical examination was (2.5%). Conclusion: The following factors were found to involve in the etiology of fetal structural defects; family history of congenital anomalies, maternal age, multigravidas mothers, taking tonics and supplements during pregnancy, smoking, living in rural areas finally socioeconomic status.

Background: Laparoscopic cholecystectomy has now replaced open cholecystectomy for the treatment of gallbladder diseases. However, laparoscopic cholecystectomy may cause various complications an important one of them is biliary injury. Laparoscopic cholecystectomy has been practiced for close to 25 years. The rate of common duct injury remains somewhere between 0.4 to 0.7 percent and is approximately the same around the world. Recent papers have stressed in which ways laparoscopic common duct injury can be avoided but none of the methods mentioned is foolproof. In addition, this complication can occur to even the most experienced laparoscopic surgeon. This injury to be emphasized by the surgical community as an inherent risk of the operation, and patients should be fully informed of this potential complication. Aim: Of this study is to assess the outcome of laparoscopic cholecystectomy (LC) by determining the incidence of biliary leak and avoid it. Settings: Surgical wards of Azadi Teaching Hospital Kirkuk between 2013- 2015. Patients and Method: This is a prospective study of 204 patients. We evaluated the data according to outcome measures, such as bile duct injury, morbidity, mortality. Result: During this period, 204 patients underwent LC, of whom two patients (1%) have minor bile duct injuries. Conclusion: Biliary tract injury is a major complication of LC. Anatomical anomalies, local pathology, and poor surgical techniques are the main responsible factors.

Background: Pulmonary tuberculosis is epidemic disease it is a one cause of death worldwide it caused by bacteria (Mycobacterium tuberculosis) that mostly infect the lungs. Tuberculosis is curable and preventable disease. Transmission of TB is through the air, when person with pulmonary tuberculosis spit, cough, or sneeze, the microorganisms spread in the air. Few germs can cause infection with tuberculosis. About 1/3 of the population has latent tuberculosis, latent means there is an infection with tuberculosis bacteria but a person still not ill and cannot transmit the disease. Main objective (aim): The study aimed to evaluate the knowledge of secondary school students about pulmonary tuberculosis. Subject and Methods: This is a cross-sectional study, done on the secondary school students in Tikrit city at the period of time from first of January to rst of April 2016. Cluster sampling chosen then students selected randomly from each cluster. Sample size was 98 students was collected by questionnaire, then summarized and presented in simple tables and figures. Result: The study found (57.14%) of students were having some information about pulmonary tuberculosis. By education, we were trying to improve their information about the disease and learn the others "who didn't have any information about the disease" By comparison the results were yield by questionnaire, the students respond very well to the awareness seminar. Conclusions: Students don't have enough information about the disease relation to its epidemiological spread in Iraq. Health education of the students improves their information. Recommendations: perform a program of health education in schools, universities, for patients and for the general population about tuberculosis.

Background and Objective: Liver plays an important role in regulating glucose levels in the body. The liver enzyme gamma-glutamyl transferase (GGT), is a common marker of liver function and has also been associated with insulin resistance, which can be a precursor to gestational diabetes and type 2 diabetes. The aim of this study was to evaluate serum GGT in gestational diabetics. Materials and Methods: The cross sectional study was conducted between department of biochemistry and gynecology during Junes to November, 2016 in Erbil city. Blood specimens were collected in the diabetic center in Maternally Teaching Hospital after diagnostic by gynecologist. A total 50 cases were considered as Group I (GDM) and 50 were Group II controls (normal healthy pregnant women). Patient group also subdivided into three subgroups; subgroup 1 GDM first time, subgroup 2 GDM second time and subgroup 3 regard as diabetic patient type2. Results: There were statistically significant differences at the level (p value <0.001) elevations in serum GGT in GDM compared with control group, also uric acid, and calcium were increased in GDM. Conclusions: Our finding showed that increase serum GGT level is an independent risk factor for GDM and identified as high risk factor for GDM.

Background: Emerging antibiotic resistance and Extended-Spectrum Beta-Lactamase (ESBL) producing Escherichia coli causing different nosocomial infections are rapidly increasing at alarming levels and it poses a major health burden in the 21st century globally. Objective: The aim of this study is to determine the distribution of blaTEM gene ESBLproducing E. coli from clinical specimens in different hospitals in Erbil city. Methods: A total of 200 samples were collected from (sputum, urine, wound) from patients attended public hospitals in Erbil city. The isolation and identification of Escherichia coliand antimicrobial susceptibilitywere performed by using Vitek 2 compact -lactamase production in E.coli was confirmed by using both Double disk diffusion and Standard disk diffusion techniques. Moreover, PCR technique was used for genotypic detection of an ESBL gene blaTEMaccording to the standard protocol. Results: Out of 200 samples 60(30%) of E. coli isolates and the highest rate of E. coli isolates were obtained from the urine samples (20%) and the lowest number was isolated from sputum specimens (2.5%). The ESBL-producing Escherichia coli isolates were detected using double disk synergy test (76.7%) in comparison to standard disk diffusion test (80%). Genotypic screening results confirmed that all ESBL-producing E. coli isolates (66.7%) were carried blaTEM gene (700 bp) in clinical specimens (50% urine, 13.33% wound and 3.33% sputum). All ESBL-positive E. coli isolates showed high rates of susceptibility to Carbapenems antibiotic group including Imipenem (83.3%), Meropenem (81.7%), and Ertapenem (80.0%). Conclusions: -lactamase gene in ESBL-producing E. coli observed in this study for the first time is considered as alarming because there is a limited treatment options remained for infections. Attempts to reduce the dissemination of multi-drug resistant E. coli through compliance with strict hospital infection control and prevention standards are imperative. Findings of this study may help clinicians selecting appropriate antimicrobial therapy in patients with different infections caused by ESBLproducing E. coli.

Background: -lactamases (MBLs) are emerging worldwide as powerful resistance determinants in Gram negative bacteria Rapid dissemination and spread between different bacterial species by large gene transfer favor by globalization and travel represent a high risk of worldwide pandemic among Enterobacteriaceae Objective:This study design to screen for phenotypic detection of MBL and genes coding for metallo - lactamase(MBL) such as, blaVIM, blaIMP and bla NDM among infected burn wound patients in Sulaimani city /Iraq. Materials and Methods: Out of 230 burn wound samples, 201 wound swabs and 29 tissue biopsy were collected from hospitalized burn patients with second and third degrees burnfrom Burn and Plastic Surgery Hospital in Sulaimani city from the period of April to October 2011. According to direct gram stain , bacterial cultural , biochemical tests, analytic profile identification(API) system and vitek 2 Compact system , antimicrobial susceptibility Testing by using Kirby-Bauer disk diffusion method and vitek compact system, -lactamase by Double disk synergy test and Combined EDTA disk test and Modified Hodge test and -lactamase enzyme by using polymerase chain reaction. Results: Out of 230 burn wound samples177 samples gram negative bacteria were isolated; inflammatory cells showed significantly associated with positive bacterial culture. The most frequent bacteria isolated were Pseudomonas species 48(27.12%), in which Pseudomonas aeruginosa account for a higher percentage 46(25.98%) and one species (0.56%) of each P. stutzeri and P.florescence wasisolated followed by Acinetobacterspecies 44 (24.86%) in which Acinetobacterbaumanniiwas the commonest and accounts for a higher percentage 41 (23.16%) and one species(0.56%) of each of A. ursingi, A. hemolyticasandA.complexwere identified. On the other hand in the family of Enterobacteriaceae,the most common bacteria were Klebsiellapneumoniae44(24.86%), Enterobacter cloacae 18 (10.17%) and Escherichia species 11(6.21%). The susceptibility of bacterial isolates against 18 antibiotics from different classes of antibiotics was tested and it was found that most of the isolated species of non fermenter bacteria such as Acinetobacterand Pseudomonas species show multidrug resistant pattern and high resistance against most of the antibiotics commonly used. The most resistant antibiotics against non fermenter bacteria were Ticarcillin (81.82%) against Pseudomonas species and Ticarcillin, Tazobactam- Pipracillin and Cefoxitin (93.18%) against Acinetobacterspecies .The most resistant antibiotic against K. pneumonia andE.cloacaewere Cefoxitin(84.9%)and Amoxicillin Clavulanic acid (84.9%).The most resistant antibiotics against Escherichia specieswere Cefotaxime, Trimethoprim and Cefipime (90.91%) but the most effective antibiotic with a highsensitivity rate was Imipenem (90.91).Phenotypic tests were carried out for the detection of MBL enzyme for all studied isolates and it was found that Combined disk test was the most sensitive test giving the highest percentage (31.07%) followed by Double disk synergy test(28.8%), Modified Hodge test (20.9%) .Polymerase chain reaction assay was used for genotypic detection of MBL genes (blaIMP,blaVIM, ,blaNDM ) in all isolates and the results revealed that the gene blaIMPwas locatedin 33(18.64%),blaVIM,in19 (10.73%), 2(1.12%)forblaNDM Also these genes were detected in 25 stock cultures of Gram negative bacteria preserved in 25 °C since 2008 to 2010. blaIMP gene was detected in11(44%) , blaVIM in 12(48%) and 2(8%) for blaNDM, all these genes were detected in K. pneumonae,P. aeruginosa and A. baumanniiwith length amplified genes (230) bp for IMP and (390)bp for VIM and( 621)bp for NDM. Conclusions:These results indicate that most of the Meropenem resistant strains from infected burn wound strains in this study were producing MBL enzymes The presence of MBL genes among Meropenem sensitive strains indicates that there might be a hidden MBL gene among isolated strains which cannot be diagnosed by phenotypic tests leading to the dissemination of these genes in the hospital silently among patients even within normal health workers who act as carriers for MBL genes in future

Context: Infant mortality rate is the number of deaths under one year of age in a year divided by total number of live birth in the same year × 1000. It is a standard measure that is not affected by population age structure and therefore suitable to use for comparisons over time and across regions, in addition, it reflects the underlying well-being of communities and the social environment that cultivate health and access to healthpromoting resources. Aim: Determine the trend of infant mortality in Nineveh for 10 year period (2004-2013). Subjects and Methods: Study Design: Descriptive biometric study design. Study Settings: Nineveh Governorate/ North of Iraq. Study Sample: Infant deaths and live births from 2004 to 2013. Data Collection Tool: Death certificates, vital registration system. Outcome Measures: Infant mortality rate in general in addition to the proportions of their mortality by sex and causes with their trends by using various rates, proportions, and Chisquared test for trend. Results: The trend of infant mortality rate fluctuated significantly from 15.36 to 16.93/1000 live births between 2004 and 2013. Most of these deaths were due to respiratory distress syndrome, sepsis, congenital anomalies, infections, birth asphyxia, and pneumonia. Conclusions and Recommendations: Infant mortality was relatively low and most of its causes were preventable, thus; more efforts are still needed to control such causes and improve infants' survival.

Background: Intracapsular femoral neck fracture (ICFNF) was and still is a challenge for orthopedic surgeons; and among few accepted methods of treatment, the most widely used is multiple cannulated lag screws (CLS); but still there are some controversies in the accepted time lapse for operation and age limit of the patients. Objective: treatment of choice for (ICFNF) in wide variety age groups, and after different times since the fracture happened. Patients and Methods: from (Dec. 2014-Sep. 2017) 23 patients with (ICFNF) were selected from those admitted to the orthopedic surgery department in Azadi Teaching Hospital Kirkuk. The time lapse before the surgery ranged from 1/2-6 days; the patient's ages ranged from 14-62years. All were treated by fixation with multiple (CLS) and minimal capsulotomy. The outcomes studied monthly both clinically and radiologically in duration from 8 to 20 months. Results: Fourteen cases (61%) were rated as excellent, six cases (26%) as good, two cases (9 %) as fair, and one case (4%) was rated as poor; according to the pain, limp and range orded in four cases (17%) in the form of superficial infection in one case, malunion in two and both in the other. Conclusion: This method can be used successfully in treating (ICFNF) in wide age groups and even after a delay of up to 6 days.

Objective: This study aimed to isolate bacteria from the eyelids of that non-cosmetic user group and eye cosmetic user group. Materials and Methods: The study samples were taken by swabs, and the bacterial isolates were identified by Vitek2 compact system, and the antibacterial activity of Kohl (Al-Ethmed) was performed by well diffusion technique. Results: The highest percentage of bacterial isolates was gram positive Staphylococcus. aureus (21.40%) followed by Coagulase negative Staphylococcus (CNS) (19.60%) and - hemolytic Streptococcus (16.10%), while the percentage of gram negative isolates represented by Echerichia coli, Klebsiella Spp. and Proteus Spp. was (3.60%) and the percentage of Pseudomonas aeruginosa was (1.80%). The percentage of most bacterial isolates increased within cosmetic user group. The geographical areas showed that there was some difference in percentage of the species between Erbil, Sulaymania and Kirkuk. According to the ages, -hemolytic Streptococcus were shown to be the common isolates among all age groups, while according to gender; the results revealed that S. aureus (21.20%), CNS (15.10%), Haemophilus (9%), E. coli and Proteus (6.60%) and p. aeruginosa (3%) were the predominant isolates in females. However, -hemolytics Streptococcus (18.10%), -hemolytic Streptococcus (22.70%) were of the highest percentage in males followed by Micrococcus luteus (13.60%), S.pyogenes (9%) and Klebseilla (4.50%). The results showed that S. aureus, -hemolytic Streptococcus and -hemolytic Streptococcus were resistant to (CT) with a percentage of (71.4%), (75%), (66.6%), (60%) and (84%) respectively, while E. coli, Klebseilla species, p. aeruginosa and Proteus showed (100%) resistance to cefuroxime (CX). It is worth mentioning from our study that Kohl (which Prophet Mohammed (Peace be upon him) used it and recommended to use) as cosmetics exhibited considerable antibacterial activities, when the different kohl concentrations were used inhibition of the growth of both -hemolytic Streptococcus and p. aeruginosa was achieved at all concentrations. However, CNS, Haemophilus and Klebseilla isolates were inhibited at (500), (2500) and (62.5) µg/ml.

Background Third stage of labour is defined as the time from delivery the baby to complete delivery of the placenta and its attached membranes Most common complications of the third stage of labour are postpartum hemorrhage (PPH). Active management of third stage of labour (AMTL) prevents PPH. Misoprostol is a prostaglandin E1 analogue has been suggested as an alternative of the routine prophylactic oxytocic agents in AMTL. Rectal route had been chosen because it avoids gastrointestinal side effects Objectives: To asses effectiveness of (400 mcg) rectally administered misoprostol tablet in the AMTL in comparison with standard oxytocin regimen Patients and Methods In prospective case-control study, 100 women were randomized, 50 patients received either 400mcg misoprostol tablets rectally (study medication) the other 50 received 10 IU oxytocin in 500 ml Ringer lactate solution IV. As a method of AMTL. Patient with risk factor for PPH had been excluded. A comparison between the two groups in their amount of blood loss, drop in hemoglobin level from admission to 24 hr. after delivery, duration of third stage of labour and any side effects appear done Results Maximum amount of blood loss in both groups of the study was 440 ml, so we had no case of PPH. There was no stastically significant difference in mean blood loss, mean difference in Hb level (gm/dl) on admission and 24 hours after delivery, and duration of third stage of labour found between study groups [p values= 0.138, 0.227, 0.08 respectively]. More shivering occurs in cases but the difference was not significant. Conclusions: Misoprostol in a dose of 400 mcg rectally shows promising results, it seems safe and effective drug that can be used in the management of third stage of labour.