Background: Tumor markers have a key role in guiding breast cancer management protocols and predicting prognosis. Objective: The aim of the study is to explore the role of Ki-67 expression in breast cancer and correlate it to well-known indicators of invasiveness such as age, tumor size, grade, hormonal receptors, and lymph nodes involvement. Materials and Methods: This retrospective study was conducted on (214) patients who were newly diagnosed with breast cancer and referred to Azadi Teaching Hospital/Duhok-Iraq, from November 1^st, 2016, to October 31^st, 2017. Data regarding patient's demographics, tumor size, histological type and grade, nuclear grade, and lymph node involvement were obtained from medical records. Patients underwent either mastectomy with axillary lymph node dissection or breast conservation surgery. Collected specimens were sent for histopathological examination and immunohistochemistry assessments of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2 (HER2), and Ki67 expressions. Results: Our study showed that histological grade, nuclear grade, mitotic index, and HER2 status were positively correlated to Ki67 index (P < 0.05). Furthermore, ER and PR status showed a negative correlation to Ki67 index (P < 0.05). Age, tumor size, and the number of lymph nodes involved displayed no significant correlation to Ki67 level (P = 0.080, 0.738, and 0.888), respectively. Conclusion: Results of this study confirmed that Ki67 index are significantly correlated with tumor grade, ER, PR, and HER2 status. However, Ki67 expression association with other clinic-pathological parameters such as age, tumor size, or lymph node involvement is not recognized and requires further studies.

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Background: Interest in Rosemary has increased due to the importance of being wide antimicrobial, anti-inflammatory, and antioxidant. Objective: This study aimed to evaluate the biological affectivities of essential oils (EOs) of rosemary against three types of bacteria. Materials and Methods: Chemical analyses were conducted using gas chromatography technique on the volatile oils of rosemary, which were extracted by Clevenger. Results: The major contents of these oils were camphor (22.35%), camphene (1.85%), β-pinene (3.75%), sabinene (10.25%), limonene (7.64%), linalool (11.58%), and myrcene (2.14%). The biological affectivities of these oils were examined on three types of bacteria: Bacillus cereus, Escherichia coli, and Pseudomonas. The results proved that the EOs of rosemary were influential against bacteria and gave minimum inhibitory concentration (MIC). The MIC values were 37 μg/ml for E. coli, 69 μg/ml for Pseudomonas, and 20 μg/ml for B. cereus. Results found that Pseudomonas was less sensitive for these oils. Conclusion: The EOs of Rosemary can be used in the pharmaceutical industry for the production of new synthetic agents in the treatment of bacterial disease caused by these three types of bacteria.

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Background: Febrile seizure (FS) is a benign convulsive disorder in under 5-year-old children, but at the same time, it is an alarming event in the lives of both child and parents. Lack of parent's knowledge about the nature of FS and how they should deal with it can lead to poor management. Objectives: To assess the knowledge and practice of parents regarding FS in their children and to assess the association of knowledge and practice of parents with certain socio-demographic characteristics. Materials and Methods: A cross-sectional study was performed on 100 parents of children with FS attending emergency department in Babylon Teaching Hospital for Pediatrics and Gynecology and AL-Noor Hospital for Pediatrics during a period of 5 months (from March 1 to August 1, 2018). A questionnaire was administered to parents which included items regarding family characteristics, characteristics of FS, their knowledge, and their first-aid practices with FS. Results: Regarding maternal age and paternal age, they ranged between 15–43 and 20–50 years, respectively. More than half of them live in urban areas, and concerning educational level of mothers, 70% were either illiterate or had a primary level of education. Majority of FS children were presented with first attack who represent a percentage of about 69%. About half of the respondents have good level of knowledge. Fifty-two percent of them considered that FS is equivalent to epilepsy, 69% stated that it is a life-threatening event, and 80% knew that it occurs during febrile occasions. Only 25% of parents took their children to doctor during attack of fit without first aids. Conclusions: Parents' knowledge regarding FS was significantly associated with higher maternal education, urban residence, and mother age. A higher level of practices was shown to have a significant association with increasing in the number of episodes experienced by parents and advancing in maternal age.

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Background: Vitamin D, a fat-soluble vitamin that now is recognized as a prohormone that recently has an important role in the reproductive health. Vitamin D deficiency (VDD) had high prevalence worldwide and was estimated to affect about 50% of the population worldwide. Hypovitaminosis D related to several health problems in women such as infertility, polycystic ovarian syndrome endometriosis, and pregnancy-related complications such as preeclampsia and caesarian section. Objective: The aim of the study is to evaluate the serum level of Vitamin D in sample of Al-Hilla women at reproductive age. Materials and Methods: The total number included in the study was 500 patients. They were companions of patients visiting specialist gynecologic and obstetric private clinics in Hilla City from first of October 2017 to end of March 2018 the patients were grouped into three groups according to their age: Group 1: Patients aged (15–30) years. Group 2: Patients aged 31–40 years. Group 3: Patients aged more than 40 years and premenopausal. The data were collected which were then analyzed statistically and registered. Results: Whole sample mean serum Vitamin D level 15.85 ± 7.69 and the percentage of deficiency over all the sample was 76%. Regarding the result in each group, Group 1 include 350 patients, mean age (23.8 ± 3.96), and mean serum Vitamin D level (16.16 ± 7.69), t-test was statistically significant P < 0.05. Group 2 include 119 patients, mean age (35.2 ± 2.9), and mean serum Vitamin D level (15.14 ± 7.42), t-test was statistically significant P < 0.05. Group 3 include 31 patients, mean age (42.81 ± 1.45), and mean serum Vitamin D level (14.82 ± 7.77), t-test was statistically significant P < 0.05. Conclusion: Results of our study revealed a widespread, severe VDD in women at reproductive age with aproportion of deficiency in the whole sample of 76% and proportion of insufficiency 18% while only 7% had sufficient Vitamin D Serum level.

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Background: Urinary tract infections (UTIs) are the most common infections among pregnant women. It can be lead to poor maternal and perinatal outcomes. Objective: The objective of the study is to determine the prevalence rate of symptomatic UTIs and asymptomatic bacteriuria of pregnant women in the Babylon Governorate and to determine its association with sociodemographic, obstetrical, and other factors. Materials and Methods: Cross-sectional study between March 2018 and June 2018 involves examining 300 pregnant women at primary health centers; Maternity and Pediatrics Hospital of Hilla city, with and without symptoms of UTI were employed for this study. Midstream urine samples were taken, and general urine examination was performed. Results: The results of this study revealed that the overall prevalence of UTI among pregnant was 64.6% which include (symptomatic bacteriuria 8.0%, asymptomatic bacteriuria 6.3%, and UTI 50.3%). The higher rate of UTI was found in lower age, multiparous women, and during the second trimester. Factors such as socioeconomic status, history of UTI, dysuria, and positive laboratory results were found to be significantly associated with UTI. Conclusion: UTI is still the common health problem in pregnant women especially during their second trimester. Urinalyses are essential for all pregnant women during the antenatal period. The screening will be assisted to early detection and treatment of asymptomatic bacteriuria which prevent complication for mother and baby.

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Objective: This study aimed to recognize the harm of shisha smoking compared to cigarettes smoking by measuring serum lipid profile in males in AL-Nasiriya city and association lipid profile change with increase of smoking per day. Materials and Methods: This study was conducted between June to December (2015) in Nasiriya city in Iraq ,all samples were randomly selected. Spectrophotometer was used for biochemical analysis for each group of lipid profile. The subjects were divided into three groups, cigarette smokers (n = 35), shisha smokers (n = 20) and non-smokers groups (n = 20). Age ranged between (30 – 60) years and mean of duration smoking was (13.4±1.3) years. Results: Results showed that the increased levels of total cholesterol (TC), triglyceride (TG), very low density lipoprotein (VLDL) and low density lipoprotein (LDL) were significant in all groups of smokers as compared to non-smokers. Conclusion: The study concludes that the danger of shisha impact on human health may be similar or even worse than cigarette smoking.

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Background: Glycemic control is important to reduce the risk of micro - vascular problems among patients with diabetes mellitus. Sleep limitation leads to increase Hemoglobin A1C (HbA1c) levels; though, slight is known regarding the metabolic impacts of usual sleep limitation. The current study was a hospital-based cross-sectional study which performed to evaluate the association between habitual sleep quality with glycemic control and HbA1c fluctuations among contributors in the medical merjan city among Type 2 diabetics. Objectives: The purpose of current study is to assess sleep quality among Type 2 diabetic patients and to consider the influence of sleep value on glycemic control among those patients in Al-Hilla City. Methods: Our study was “descriptive cross sectional study” to assess the sleep quality using Pittsburgh Sleep Quality Index by filling out the questionnaire formats which designed for usage of the study. This study include a “convenient sample” of 150 Type 2 diabetic patients who visit the specialist day clinic in diabetic center of merjan medical hospital between the 25^th of February to the end of June, 2018. Verbal approval was attained from each Type 2 diabetic patient, data collection was done through the interviewing of contributors by use of structural questionnaire. Results: The mean age of diabetic patients was (53.20 ± 13.53), Male represents (42.7%) and female represents (57.3%). Poor sleep quality represent (35.3%). There was a significant increase in level of HbA1c and random blood sugar among patients with Type 2 diabetics with poor sleep quality and significant decrease of cholesterol and triglycerides levels with increase duration of diabetes mellitus. Conclusions: Poor sleep was common among diabetic patients. There is close association between sleep quality and glycemic control, as well as short sleepers have an increased occurrence of diabetes.

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Background: Red bull has been known as a healthy drink within many populations. The chemical composition of energy drinks can produce multiple adverse effects, including serious behavioral effects. Objective: To study the effect of energy drinks (Red Bull) on brain, liver, kidney, and heart in rabbits. Methods: thirty males albino rabbits were used, animals divided into 3 groups (A, B, and C), each group contain 10 rabbits. Group A treated with high dose of red bull (10 cc), Group B treated with low dose (5 cc), and Group C is control group. Results: The results showed that control group had no any pathological changes while both Groups A and B showed many pathological changes, Group A showed renal vascular congestion, hemorrhage of interstitial tissue, focal atrophy, and degeneration of lining epithelium of proximal and distal convoluted tubules, while Group B showed renal vascular congestion, glomerular capillary congestion, hemorrhage of interstitial tissue with swelling of lining epithelium of proximal and distal convoluted tubules that appeared as pale cytoplasm with star-shaped lumen, and swelling of glomeruli; this reveals that there is dose–response relationship between treated groups with low and high dose of red bull. Conclusion: Energy drinks have dose–response relationship with adverse effect; it has become apparent that the consumption of these energy drinks will seriously harm the body.

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Background and Objective: Tuberculosis (TB) is an endemic disease in Iraq. Many methods are available to diagnose pulmonary and extrapulmonary TB (EPTB). The most traditional test is the sputum smear for acid-fast bacilli (AFB). However, it is well known for its low sensitivity and specificity. On the other hand, culturing AFB although considered the gold standard for detecting Mycobacterium tuberculosis (MTB), yet it takes long time to confirm or exclude the presence of TB. The WHO has recommended the use of a gene-based molecular technique called GeneXpert (GX) MTB/rifampicin (RIF) for rapid and accurate detection of MTB in pulmonary and extrapulmonary (EPTB) sites. GX is a quick, fully automated system that can be easily used with minimal training. The objective of this study was to evaluate the accuracy of the GX test for diagnosing MTB in pulmonary and extrapulmonary sites in Kurdistan/Iraq that is considered as an endemic area for TB, as well as testing the ability of this technique to identify the resistant strains of these bacilli to first-line anti-TB treatment. Methodology: A total of 925 (504 males and 421 females) patients attended the TB center in Erbil/Iraq from August 2015 to August 2017. These patients were clinically diagnosed or suspected to have TB. Two sputum samples were collected from each patient and subjected to AFB smear staining. The other portions of the sputum were examined by GX assay, and a number of cases were grown on the Lowenstein–Jensen media. For extrapulmonary fluid samples, the same tests were done. Results: Seven hundred and forty-three were pulmonary samples, and the remaining 182 cases were extrapulmonary specimens (cerebrospinal fluid, peritoneal aspirate, pleural fluid, urine, and blood). Of these, 575 had their AFB smears done which was positive for in 184 (32%) and negative in 391 (68%) cases. On the other hand, real-time polymerase chain reaction using GX technology was positive in 228 (39.65%) while negative in 347 (60.34%) cases. The sensitivity and specificity of the GeneX versus AFB smear considering culture as a gold standard were 94.9% and 80.1%, respectively. In addition, GX technique revealed that about 20 (14.3%) of positive MTB cases were resistant to RIF therapy. Conclusion: The current study displayed the real significance of using GX test in diagnosing MTB in pulmonary and extrapulmonary specimens to save time and to avoid unnecessary anti-TB treatment.

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Background: Visual impairment in children is a severe worldwide public problem. It can be detrimental to child's ability to learn. In Iraq, the size of this problem among primary school children is not well defined. Objectives: to determine the prevalence of visual impairment among primary school children in Kufa city, Al Najaf Governorate and to identify some factors associated with decreased visual acuity in the sample. Subjects and Methods: A cross sectional study was performed during the period of 1st of March to the 15th of April, 2017; the studied sample was 630 primary school children aged 6 to 15 years of both genders from fourteen governmental schools, both students and schools were randomly selected. Data were collected by using questionnaire designed especially for this study. Measurement of each pupil's vision was done by using standard Snellen E chart. Those with visual acuity(VA<6/6) was regarded as visually impaired. The Statistical Package for Social Science, SPSS, (version 20) program was used for data entry and analysis. Results: From the total participants, there were 533(84.6%) students with normal VA(VA=6/6), 97(15.4%) students with decreased VA(VA<6/6). It was found that majority 81/97 (84.5%) of children with decreased VA were under the age of 10 years with a high significant statistical difference (X2=28.028, P = 0.0001). Statistical analysis showed a significant association of decreased vision with female gender (X2=4.429, P = 0.0353), rural residency (X2=6.446, P = 0.01), low socioeconomic status (X2=7.128, P = 0.028), and positive family history of wearing spectacles(X2=7.414, P = 0.006), the highest rate of decreased visual acuity was shown in the students of second grade( 24.7%), however, the grade was not statistically significant (X2=7.128, P = 0.265). The overall prevalence of low vision (VA≤6/18) in the studied sample was 5.4% (34/630), statistically, there is a significant correlation between poor vision and female gender (P = 0.031), however, there is no significant association of poor vision with residency (P = 0.373), socioeconomic status (P = 0.431), and family history of using spectacles (P = 0.146). Conclusions: The prevalence of decreased visual acuity among primary school children in Kufa city was 15.4%., reduced vision is significantly higher in younger age group(≤10 years old), female gender, rural residency, lower socioeconomic status, and in those of positive family history of wearing spectacles. Female gender is significantly associated with low vision.

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Background: Toxoplasmosis is considered as one of the most prevalent human parasitic infections that can be transmitted from mother to the fetus. The onset of toxoplasmosis during pregnancy has clinical complications, including spontaneous abortion, preterm labor, stillbirth, and fetal abnormalities. Objective: The aim of this study was to investigate the seroprevalence of toxoplasmosis infection in aborted women. Materials and Methods: Seventy-five sera samples were collected from the women admitted in the obstetrics and gynecology ward with abortion. The blood samples were processed appropriately and tested for Toxoplasma gondii IgM and IgG using enzyme-linked immunosorbent assay (ELISA) technique, in addition to latex agglutination test (LAT) as a screening test. Results: Seropositivity of aborted women to T. gondii was 42.6% when used LAT while 4% and 22.6% when detection of T. gondii IgM and IgG respecyively ELISA.the highest percentage of infection was found to be 18.6% in the age group of 21–25 years, in patients inhibited in rural area. Also seropositive in women with double frequent of abortion. Conclusion: ELISA test was the best method to investigate toxoplasmosis in aborted women, especially with recurrent spontaneous abortion.

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Background: Osteoporosis is one of the major bone diseases that affect kidney transplant (KT) recipients; it causes significant long-term morbidity and increases the risk of fractures. The aim of this study was to investigate the prevalence and risk factors of osteoporosis in KT recipients. Materials and Methods: A cross-sectional study enrolled 70 KT recipients followed in the Nephrology Unit at Hawler Teaching Hospital, Erbil, Iraq, over a period of 6 months from December 15, 2017, to June 14, 2018. All patients were subjected to comprehensive history, clinical examination, relevant investigations, and measurement of bone mineral density (BMD) in the hip and lumbar spines using dual-energy X-ray absorptiometry. A T-score of –1 to + 1 standard deviation (SD) indicates normal BMD whereas a T-score of −1 to −2.5 SD was considered as osteopenia and T-score of <−2.5 SD was regarded as osteoporosis. Results: Osteoporosis was seen in 52.9% of the studied patients; statistically significant positive associations were detected between osteoporosis and low body mass index (BMI), diabetes mellitus (DM), second KT, pretransplant steroid treatment, and Vitamin D deficiency (P < 0.05), whereas no significant relationship was observed with age, gender, smoking, hypertension, and serum levels of calcium, phosphate, and parathyroid hormone. Conclusion: Osteoporosis is common among KT recipients. Low BMI, Vitamin D deficiency, DM, pretransplant steroid therapy, and second KT are the contributing factors. BMD measurement at pre- and post-transplant period is warranted for early recognition and management of this condition.

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Background: Hemorrhoidectomy by LigaSure electrosurgical unit seems to be very effective treatment and results in better surgical outcomes when compared with the conventional excisional hemorrhoidectomy. Objective: The aim of this study was to compare the feasibility and the surgical outcomes of LigaSure hemorrhoidectomy with that of conventional diathermy excisional hemorrhoidectomy. Materials and Methods: Patients characteristics were comparable in both groups. Ninety six patients with symptomatic mainly grade III and IV piles were randomized for either conventional excisional hemorrhoidectomy (48 patients) or to LigaSure hemorrhoidectomy (48 patients) for the period from April 2014 to July 2016. The surgical outcomes of both procedures including the operative time, intra-operative blood loss, postoperative pain, analgesic requirements, early and late postoperative complications, wound healing, recovery time and return to work, recurrence and patient satisfaction were recorded, compared and evaluated. Results: The mean operative time and amount of intra-operative blood loss were significantly lower in LigaSure hemorrhoidectomy group. Postoperative pain and need for parentral analgesia were comparable in the first 24 -48 hours postoperatively, but they were significantly lower in LigaSure group after the second postoperative day. Faster wound healing and early return to work were obviously noted among patient subjected to LigaSure hemorrhoidectomy. Early postoperative complications were lower in LigaSure group while late complications were comparable in both groups. Lastly, LigaSure group showed high satisfaction rate compared to conventional hexcisional hemorrhoidectomy group. Conclusion: LigaSure hemorrhoidectomy is superior and more advantageous in term of operative time, blood loss, post-operative complications, faster wound healing and return to work. It is simple, feasible and easy to learn.

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Background: This study was performed to determine whether transvaginal cervical length (TVCL), amniotic fluid index (AFI), or a combination of both can predict delivery latency within 7 days in women presenting with preterm premature rupture of membranes (PPROMs). Materials and Methods: This was a prospective observational study of TVCL measurements in eighty singleton pregnancies with PPROM between 24–34 weeks. Transvaginal ultrasonography was performed to measure the CL and AFI. Delivery latency was defined as the period from the initial TVCL after PPROM to delivery of the baby, with our primary outcome being delivery within 7 days of TVCL. Sensitivity, specificity, and predictive values were used to test whether the presence of a short TVCL, AFI, or a combination of both affected the risk of delivery within 7 days. Results: The study showed that the validity of CL alone in predicting labor when the cutoff value = 2 cm, the sensitivity = 52.6%, specificity = 69%, positive predictive value (PPV) = 60.6%, negative predictive value (NPV) = 61.7%, and accuracy = 61.25%. The validity of AFI alone when the cutoff value = 5 cm, the sensitivity = 71.1%, specificity = 50%, PPV = 56.3%, NPV = 65.6%, and accuracy = 60%. With a combination of CL and AFI in predicting time of labor after PPROM, the following results were found: sensitivity = 50%, specificity = 92.8%, PPV = 86.4%, NPV = 67.2%, and accuracy = 72.5%. In women with PPROM, we found the ratio of gestational age (GA) ≤30 weeks who labored within 7 days as 44.7% and those labored more than 7 days as 55.3%. Conclusion: Our study showed that there was an increase in PPV when combining AFI and CL in the prediction of time of labor, so women with AFI ≤5 and CL ≤2 had 86.4% risk of delivery within 7 days after PROM. Furthermore, we found that there was no significant association between GA and parity with the prediction time of labor.

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Background: The incidence of thyroid disorders is more prevalent in type 1 diabetes compared to type 2 diabetes, due to associated autoimmune disorders. Physiological and biochemical interconnection between type 1 diabetes mellitus and autoimmune thyroid disease is now stimulating subject of study. Objectives: The objective was to assess the prevalence of thyroid dysfunction among type 2 diabetic Kurdish females and to explore the correlation between metabolic syndrome components and autoimmune thyroid abnormality. Materials and Methods: The study included 60 type 2 diabetic Kurdish females and 30 sex- and age-matched controls. All patients in the study were exposed to anthropometric characteristics, including HbA1c, lipid profile, serum uric acid, thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine, anti-thyroid peroxidase (TPO), and anti-thyroglobulin (anti-Tg). Results: Primary hypothyroidism was found in 24 (40%) diabetic patients (5.67 ± 3.35 μIU/mL) versus three (10%) controls (1.76 ± 1.19 μIU/mL) (P < 0.001). Anti-TPO was found in 66.7% (367.21 ± 234.53) of diabetic patients versus 10% (31.78 ± 32.14) of controls (P > 0.001). Anti-Tg was found in 60% (499.98 ± 358.14) of diabetic patients versus 0 (53.27 ± 36.23) controls (P > 0.001). A significant positive relationship was estimated between both TPO antibodies and Tg antibodies and TSH (P = 0.05 and P = 0.001, respectively) in diabetic patients. Conclusion: Autoimmune thyroid disorder is more prevalent in Kurdish women with type 2 diabetes than nondiabetic women, and thus points to a role of autoimmunity in the pathogenesis of type 2 diabetes.

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Background: Adequate and effective hemodialysis (HD) improves health-related quality of life and reduces morbidity and mortality in patients with end-stage renal disease (ESRD). The efficacy of dialysis procedure applied on patients diagnosed with ESRD was evaluated in the current investigation. Materials and Methods: In the present pre- and post-test cohort study, out of 375 patients, 120 patients (46 males and 74 females) on thrice-weekly chronic HD program were followed up over 6 months for evaluation of dialysis efficacy and possible outcomes. The efficacy of HD was measured through the Kt/V method and urea reduction ratio (URR). Results: The current study showed that the studied population (thrice-weekly HD patients) represents a minority of patients, i.e., 35.2% (132 of 375), and all other receiving insufficient HD treatment usually on twice weekly around 3 h for each session (64.8%). The study showed that the dialysis adequacy of the patients reached an adequate level by Kt/v and URR, 73.3% and 68.3%, respectively; the dialysis adequacy was increased with an increase in blood flow rate (P = 0.042), dialysis session time (P = 0.005), and dialysis sessions (P = 0.008). Patients with lower body mass index and without comorbidities were more likely to have adequate dialysis (P = 0.004 and P = 0.02, respectively). Conclusions: HD treatment is suboptimal in Erbil Dialysis Center. Intensive follow-up and application of corrective measures may improve dialysis efficacy. Energetic efforts are required to examine and correct the reasons behind the dialysis inadequacy.

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Background: A wide variety of tumors and pseudotumors can involve the orbit. Although the incidence of orbital tumors is relatively low, the diagnosis and the treatment strategy for such tumors are of great concern to neurosurgeons and ophthalmologists. Objectives: The main aim of this study is to determine the distribution of patient age, sex, pathology, origin, and location of orbital tumors for optimum management because the delay in the diagnosis and treatment is the most preventable cause of morbidity and mortality. Materials and Methods: In this study, 95 cases of orbital tumors are studied prospectively during 10 years' period in the Hilla Teaching Hospital in Babylon-Iraq from 2008 to 2018. The parameters dealt with in this study included; the distribution of patient age and sex, clinical manifestations, investigations, pathology, origin of tumors and tumor location in the orbit, management, surgical procedures, and mortality in 95 patients (aged from 6 months to 75 years, the mean age is 29.8). Results: In this study, the highest age group incidence of orbital tumors is in the first decade of life which constitutes (24.2%), the second peak is in the fourth decade of life which constitutes (17.9%). 42 (44.2%) of the patients are males and 53 (55.8%) of the patients are females. Among the 95 cases, 76 (80%) are primary orbital tumors, 15 (15.8%) are secondary orbital tumors (tumors that originating from contiguous regions), and 4 (4.2%) are metastatic orbital tumors. Orbital tumors location; 83 (87.4%) are extraconal and 12 (12.6%) are intraconal. The two most common orbital tumors are dermoid cyst (27.4%) and pseudotumor (16.8%). Overall mortality is seven patients (7.4%). Conclusion: Orbital tumors are a relatively rare and challenging group of tumors. The age of onset, state of vision, tumor location in the orbit and other radiological findings provide the most important information for the diagnosis of orbital tumor prior biopsy or surgical resection and to make decision about other further treatment modality. For any patient complain from visual loss, proptosis, and impaired ocular motility, it is better to undergo magnetic resonance imaging and computed tomography-scan imaging to detect or exclude intraorbital or intracranial diseases.

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Background: Coronary artery disease (CAD) is one of the most common causes of death in the developed world with the high prevalence of cardiac risk factors and associated morbidity. These risk factors were mostly contributed in the metabolic syndrome. Objective: The study aimed to determine the prevalence of metabolic syndrome among patients with angiographically documented CAD and its relation with the severity of CAD. Materials and Methods: In the current cross-sectional study, a total of 320 patients aged 18 years and older of both genders and diagnosed with CAD by medical and clinical examinations and angiography findings were included in the study. Patients with normal angiographic or nonsignificant coronary stenosis and those with acute coronary syndrome were excluded from the study. Results: The prevalence of metabolic syndrome in patients diagnosed with CADs was 68.4% in this study. The numbers and severity of coronary arteries involved were importantly increased through increasing the numbers of the components of the metabolic syndrome that the patient have it. The majority of the patients with right coronary artery (67.6%), circumflex artery (63.2%), left anterior descending (66.7%), and multivessel (69.8%) had metabolic syndrome with no significant difference (P = 0.913). Moreover, the most of the patients with one vessel (66.4%), two vessels (68.2%), three vessels (72.2%), and four vessels (66.7%) were metabolic syndrome (P = 0.846). Between the individual components, diabetes mellitus (DM) was the most significant risk factor accounts for the number and severity of the CAD in all CAD patients. Conclusions: The prevalence of metabolic syndrome is high among patients with angiographically documented CAD. Patients having metabolic syndrome have more severe and more complex CAD.

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Background: In Nigeria, prostate cancer is the most commonly diagnosed cancer among men. Nigeria men are ignorant of the risk factors for the disease despite rising prevalence, despite the country's movement toward a demographically aging population. For a measurable change in behaviors, it is important to assess existing knowledge to inform policy and programmatic decisions. Objective: This study was undertaken to determine the predictors of knowledge and practice of prostate cancer screening among commercial motorcyclists in Ilesa town of Nigeria. Materials and Methods: A descriptive cross-sectional study was carried out among 400 eligible commercial motorcycle riders selected using the multistage sampling method. Research instrument used were semi-structured pretested interviewer-administered questionnaire. Data were analyzed using the SPSS software version 17.0. Results: Mean age of respondents was 39.5 ± 2.4 years. Fifty-seven percent and 27.6% were aware of prostate cancer and prostate cancer screening, respectively, with the mass media being the source of information. Fifty-seven percent had poor mean knowledge while 63.0% had good mean attitude toward prostate cancer screening. Although only 3%have gone for prostate cancer screening before, about 95% were willing to go for prostate cancer screening test. Age, marital status, and education status were all significantly associated with good knowledge and practice of prostate cancer screening (P < 0.05). Predictors of good knowledge and practice of prostate cancer screening were being educated, age <45 years, being married and being in polygamous setting. Conclusion: Moderate awareness and knowledge, good attitude, and poor practice of prostate cancer screening were found among studied respondents. This calls for stakeholders in cancer care to create more awareness, organize sensitization programs, and implement community-based programs that would increase access to screening for prostate cancer.

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Background: The emergence of the antibiotic resistance in the treatment of UTIs is a serious health problem, especially in the developing countries where there is high level of ignorance, poverty, and bad hygienic practices, Objective: The aim of this study was to detect the types of bacteria and their antibiotic sensitivity in patients with diabetes mellitus with recurrent urinary tract infections and compare between types of bacteria in patients with the previous admission to hospital from those who are not. Materials and Methods: This cross-sectional study was conducted on eighty patients with diabetes mellitus and recurrent urinary tract infection, those patients who visited the Outpatient Unit in Diabetic and Endocrine Center in Merjan Medical City in Babylon Province. This study was carried out from March 1, 2016 to September 30, 2016. General urine examination was done to the patient with urinary tract infection. Urine samples were sent for culture and sensitivity against different types of antibiotics. Results: Results found that the mean age of the patients was (58.23 ± 14.38) and majority of them (63.7%) were female and (52.5%) of them came from rural area. The main bacteria causing urinary tract infection was Escherichia coli in more than 55% of cases, while the amikacin antibiotic regard as the best antibiotic in the treatment of urinary tract infection in this study with lowest resistance percentage (3.8%). Based on the history of previous admission to the hospital, there was 57.5% with a history of previous admission, and there was statistically significant difference in the types of bacteria between the two groups. Conclusion: There was significant difference in bacterial type between patients who previously had hospital admission and those who had not. E. coli was the main bacteria causing UTI in this study. Amikacin showed the best sensitive drug for bacteria that cause urinary tract infection.

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Background: Microbial contamination of operating theater (OT) and intensive care unit (ICU) is the most frequent cause of nosocomial infections in patients. Objectives: this study aims to evaluate the prevalence level and variety of microbial contamination in these high-risk areas in the surgical specialty hospital in Erbil city. Materials and Methods: Three sampling procedures were employed in this study, which includes swabbing, open plate, and both microbiological and biochemical investigation of water supply in these high-risk areas. Standard microbiological techniques were used for microbiological culture and identification of microbial pathogens. Results: 48.3% yielded positive microbial growth. The most common isolates were Gram-positive bacteria (83.1%), of which Staphylococcus aureus accounted for 78.6% of bacterial pathogens isolated, followed by Streptococci (33.3%) and Enterococci (28.6%). Whereas, lower rate of Gram-negative bacterial contamination (16.9%) was observed, including Escherichia coli (19%) and each of Pseudomonas aeruginosa and Proteus (4.8%). Air contamination with Aspergillus (19%) and Molds (14.3%) was observed, respectively. The highest rate of microbial contamination was observed in OT rooms (35.6%) where 50% of environmental hygiene practice was detected using infection control practice audit tool. In addition, 21.4% of positive cultures were identified in ICU rooms where only 9% of environmental hygiene was practiced. Conclusions: These findings emphasize the important role of infection control system to prevent the cross-transmission of nosocomial pathogens to cause contamination and infection in the critically ill patients.

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Background: Epidural hematoma (EDH) is a traumatic accumulation of blood between the inner table of the skull and the stripped-off dural membrane, which has been stripped from the overlying bone both by the direct trauma and by the hydrostatic force of blood. Pediatric EDH presented with both age-specific and/or atypical manifestations when compared with EDH in adults. Objectives: The aim of this study is to determine the management protocol of choice for pediatric EDH patients that can lead to an early diagnosis, effective treatment, and a good outcome for both operative and nonoperative groups of patients. Surgical management for EDH is the decision of choice for most cases, but still, there is a role for conservative management in selected cases. Materials and Methods: In this prospective study, 210 cases of pediatric EDH under the age of 18 years were studied during a 10-year period in the Neurosurgical Department of Hilla Teaching Hospital in Babylon, Iraq, from 2008 to 2018. This study considered the following parameters: characteristics of patients, clinical manifestations, mechanism of head injury with age-specific distribution, radiological findings, associated pathologies, management, source of bleeding in operated cases, correlated pathologies in dead patients, and outcome. Categorical variables are presented in the form of frequencies and percentages. Results: The age group >6-12 years have the highest incidence 33%. Males constituted 75% of the victims whereas females 25%. Accidental fall had the highest incidence of 47.1%. The classic clinical course of lucid interval was present in only 7% of cases. Supratentorial EDHs comprised 91% whereas infratentorial EDHs (posterior fossa) only 9%. Skull fracture was present in 92.2% of cases. Surgical evacuation was done in 110 cases whereas 100 cases were managed conservatively. Middle meningeal artery or vein was identified as a source of bleeding in 50% of the operated cases. Glasgow outcome scale was applied to assess the outcome and to compare the outcome in both operative and conservative groups. The overall mortality was 6.7%. Conclusion: EDH is a life-threatening entity in the pediatric age group, so that special attention and a high index of suspicion are required. Clinical and neuroimaging assessments by computed tomography scan have a fundamental role for optimal therapeutic decision. Both surgical and conservative management should have excellent outcome if they accomplished on solid basis. Conservative management should be achieved in specialized neurosurgical centers that can assure rapid conversion to surgical intervention in case of neurological deterioration. In borderline cases, surgical evacuation of EDH may spent less hospital stay time with better cost–benefit ratio than conservative management. Judicious surgical intervention can result in excellent long-term outcome.

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Background: Patients with type 2 diabetes (T2D) are at increased risk of urinary tract infection (UTI). Objective: The aim was to study clinical, etiological profile, complications, and follow-up of symptomatic UTI in T2D patients and the effect on glycemic control and renal parameters. Materials and Methods: This was a hospital-based prospective study done on admitted 200 T2D symptomatic UTI patients. Various clinical, biochemical parameters and urine examination and culture were monitored. All patients were followed for 6 months with respect to the number of UTIs, glycemic control, and renal parameters. Results: UTI was common in females (81%) compared to males (19%). Lower UTI (cystitis) was present in 55.5% and pyelonephritis 44.5%, emphysematous pyelonephritis in 9.5%, and bacteremia in 58.1% of UTI patients. Bacteriuria was present in 69%. Escherichia coli (55%) was the most common organism isolated from urine culture. Severe hyperglycemia was present in 83.5%, diabetic ketoacidosis in 8%, hyperglycemic hyperosmolar state in 13%, shock in 14.5%, and multiorgan dysfunction syndrome in 10.5% of UTI patients. UTI in females was significantly associated with postmenopausal state, longer duration of diabetes, retinopathy, nephropathy, poor glycemic control, acute kidney injury, cystopathy, and upper UTI. The prevalence of recurrent UTI was 39.6%. Recurrent UTI patients had significantly higher glycosylated hemoglobin at follow-up than at baseline, but renal parameters did not improve despite intensive treatment. Conclusion: Symptomatic UTI in T2D patients is common in postmenopausal females with longer duration of diabetes, poor glycemic control, cystopathy, and chronic diabetic complications. Recurrent UTI patients have poor glycemic control on follow-up while renal parameters do not improve.

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Background: Mothers play an important role in controlling family eating habits as well as the type of food consumed. Obesity is one of the causing factors for many diseases. Objectives: This study was designed to determine whether a woman's level of education is associated with the family's daily dietary intake and mother weight status or not. Materials and Methods: A web survey study designed through Google Forms was sent online to the entire Iraqi population from August 26 to September 20, 2020. The survey was distributed through institutional and private social networks (University E-mail, Facebook, Instagram, Viber, and WhatsApp). This method was entirely effective for the research hypothesis. A face-to-face interview was also conducted with illiterate women in public hospitals and medical centers. Results: The study result by 376 participating women showed a significant relationship between the level of education and body mass index (BMI) (P = 0.001). No significant relationship was shown between the level of daily dietary intake and BMI. The results also showed a significant association between education and family level of dietary intake (P = 0.003). The study showed a better daily dietary intake with those who do not have a high education level. Conclusions: The study concluded that healthy dietary choices and daily food intake are not related to education level but the mother's nutritional knowledge level.

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Background: Thalassemia is one of the most common inherited diseases; it is an inherited impairment of hemoglobin production, in which there is partial or complete failure of the synthesis of globin chain. Hepatitis B and hepatitis C had emerged as a major cause of end-stage liver disease. Both the viruses are transfusion-transmitted disease. Objective: The objective of the study is to assess the prevalence of hepatitis B and C viruses in thalassemic patients and its relation with type of thalassemia, blood transfusion, and spleen status. Material and Methods: A cross-sectional study was conducted on 100 multitransfused thalassemic patients for 2 months from November 1, 2016, to January 1, 2017. Test for HBsAg., HBcAb. IgG and IgM for screening of hepatitis B virus (HBV). HBcAb. by VIDAS method and confirmation by reverse transcription polymerase chain reaction for hepatitis C virus (HCV) was done. There is no family history of HBV and HCV infection nor vaccination history of the studied population. Results: Twelve (12%) patients had a positive HBcAb, while 3 (3%) had HBsAg positivity, higher percentage of HCV-infected patients (91%) received regular every 1-month blood transfusion, 50% of hepatitis C patients had splenomegaly, and 20.7% had splenectomy. Conclusion: Good and sensitive screening tests and stringent donor selection processes are required for the better control of this transfusion-transmitted infection among thalassemic patients.

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