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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Anti-N-methyl-D-aspartate receptors (NMDARs) encephalitis is a rare neurological autoimmune encephalitis. Its symptoms may mimic psychosis as this disease is a neurological disorder in psychiatry costume. Disparity in clinical symptoms and nonsupportive laboratory investigations except the cerebrospinal fluid (CSF) analysis delays the diagnosis. We are presented with a case of 29-year-old female with psychiatric symptoms such as suspiciousness, decreased sleep, and boastfulness. Within a few days, the patient developed neurological symptoms such as seizures and disorientation, while the patient was on an antipsychotic along with benzodiazepines. Her symptoms worsened with autonomic instability, and the patient entered into catatonic phase of the illness. We reached a positive diagnosis of anti-NMDAR encephalitis through CSF analysis. The patient recovered completely with the help of immunotherapy and intensive cognitive rehabilitation. This case emphasizes the need of a multidisciplinary approach in the management, early detection, and adequate treatment of this challenging illness for better results for patients.

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Background: E-cadherin is a cell adhesion molecule, its downregulation is associated with poorly differentiated tumors in many organs, and its loss is associated with adverse behavior of many tumors. Objectives: This study aims to find a correlation between E-cadherin status, the Grade Group, and the modified Gleason score in core biopsies obtained from prostatic carcinoma. Materials and Methods: This study is a retrospective and prospective cross-sectional study that was conducted on (50) paraffin blocks obtained from core biopsies of prostatic carcinoma. E-cadherin status was correlated with the Grade Group and the modified Gleason score. The E-cadherin staining pattern was also examined for its correlation with perineural invasion. Chi-square was used to determine the correlation between E-cadherin staining pattern on the one hand and the modified Gleason score, Grade Group, and perineural invasion on the other hand and P < 0.5% was considered as significant. Results: Only six patients (12%) fall in Grade Group 1 and according to the modified Gleason score, most patients had high scores. Regarding E-cadherin expression, 24 cases (48%) had aberrant E-cadherin expression, while the rest 26 cases (52%) had a complete strong membranous expression. Statistically, there was a significant correlation between aberrant E-cadherin expression and increasing grade according to the modified Gleason score and Grade Group with P values of 0.032% and 0.022%, respectively. In 24 patients (48%), perineural invasion was detected half of them had aberrant E-cadherin expression which was statistically notsignificant when both the parameters (perineural invasion and aberrant E-cadherin expression) are tested against the modified Gleason score and the Grade Group (P = 0.71%). Conclusion: Aberrant E-cadherin expression is associated with increasing modified Gleason score and Grade Group but has no significant correlation with perineural invasion.

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Background: Abdominal trauma, both penetrating and blunt, is a major public health concern worldwide. Trauma, especially abdominal trauma is increasing due to urbanization and industrialization including road traffic accidents. To decrease morbidity and mortality rate from intra-abdominal organ injury as a result of blunt abdominal trauma (BAT), physicians have to have a high suspicious of organ injury in any case presented with BAT because any delay in the diagnosis conversely affects the prognosis of the patient. Objective: The aim of this study was to determine the number of patients who had surgical operative intervention because of BAT, to investigate the mortality rate among patients with abdominal trauma, and to determine the hospital outcome of BAT. Materials and Methods: This was an observational retrospective study of 60 cases during 1-year duration (2016–2017) at Rozhalat Emergency Hospital, Erbil, Kurdistan region of Iraq. Results: 48 cases were( male 80%), 12 were( female 20%), with a male to female ratio of 4:1, and the mean age was 24,80. Majority of cases (36/60) were managed conservatively, while 24 cases had surgery. The overall majority of cases (50/60) had a good outcome discharged home safely but 10 cases died. The most common intra-abdominal organ injury was the spleen. Conclusions: Most cases were managed conservatively, with overall mortality rate of 16.7%, all the mortality (10/60) was among the operated cases (24/60) cases.

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Background: The detection of the estrogen receptor (ER) and progesterone receptor (PgR) in women with breast cancer (BC) is considered a crucial step for prognostic evaluation and treatment choice in clinical practice. Objectives: This study aimed to evaluate the expression of the hormonal receptors (ER and PgR), their distribution, and their association with clinicopathologic prognostic parameters in a sample of Iraqi women with BC. Materials and Methods: The paraffin-embedded blocks from a total of 80 women diagnosed with primary invasive breast carcinomas with BC were examined by immunohistochemistry to assess the expression of ER and PgR status. Demographic and clinical data were collected from each patient in the preformed questionnaire. The association of steroid receptor expression with clinicopathologic parameters was assessed using binary logistic regression. Results: Among 80 BC women involved in the study, 54 (67.5%) and 39 (48.75%) had high expression of ER and PgR, respectively. High ER expression was significantly associated with older age (odds ratio [OR] = 4.8, 95% confidence interval [CI] = 1.16-19.81, P = 0.03), postmenopausal status (OR = 3.6, 95% CI = 1.25–10.33, P = 0.015), smaller tumor (OR = 0.27, 95% CI = 0.09–0.75, P = 0.01), and with noninvolvement of lymph node (OR = 0.11, 95% CI = 0.02–0.51, P = 0.005). High PgR expression, on the other hand, was significantly associated with older age (OR = 4.44, 95% CI = 1.02–19.39) and postmenopausal status (OR = 3.13, 95% CI = 1.24–7.88, P = 0.016). Concomitant overexpression of both receptors was significantly associated with postmenopausal status and noninvolvement of lymph nodes. Conclusion: High expression of ER and PgR seems to be a good prognostic indicator because it was associated with less aggressive tumors.

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Background: Fracture tibia is one of the most common fractures in the pediatric age group. It accounts about 15% of cases. In majority of cases, close reduction and plaster application is the mainstay of treatment. Objectives: The objective was to assess the outcome of flexible nails in the treatment of tibial diaphysis fractures in children and to evaluate the results regarding the union rate and complications including limb length discrepancy, angular deformities, and pain. Materials and Methods: This prospective descriptive case–control study which included 30 children with 30 unilateral tibial diaphysis fractures in which the physis were open, all were closed, and open (type 1 and type 2) fractures, and with displaced transverse, short oblique, and spiral fractures, in which the trial of close reduction was failed. All patients are admitted and operated at West Erbil Emergency Hospital. Alignment of fractures, any infection, delayed union, nonunion, limb length discrepancy, motion of knee joint, time of complete union, and skin irritation were assessed with minimum follow-up period of 6 months. Results: In the current study, the complete union was achieved in 9–11 weeks in 20 (66.7%) patients, while in 6 (20%) patients, achieved in 12 weeks, and in 4 (13.3) patients, achieved in 13–16 weeks that were regarded as a delayed union. In 6 (20%) patients, there were nail protrusion and skin irritation, no shortening more than 0.5 cm was recorded, shortening <0.5 cm recorded in 12 (40%) patients, and no lengthening was recorded. In 3 (10%) patients, the angulations in coronal and sagittal views were 5°–10°. There was no case of nonunion. Conclusion: Elastic nails are an effective way for the treatment of the pediatric tibial diaphysis fractures. It is a simple and easy method but with radiation risk, although elastic nails have complications, all are avoidable and minor that will be managed with minimal intervention.

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Background: Anticoagulations remain an essential step to minimize the mortality and morbidity associated with thromboembolic phenomena in atrial fibrillation (AF). Nevertheless, the adherence to OAC stands for (Oral Anticoagulant) throughout the paper is not universal among the different populations. In Iraq, there are no data about adherence to (OAC) in patients with AF. Objectives: This study aimed to assess the adherence to oral anticoagulants (OAC) based on the American College of Cardiology/American Heart Association performance measures in eligible patients with a CHA₂DS₂-VASc ≥2 in patients with AF in Duhok, Iraq. Materials and Methods: A total of 132 patients who were diagnosed with AF were consecutively reviewed during 2018–2019 in Azadi Teaching Hospital, Duhok, Kurdistan Region, Iraq. For eligibility of taking an OAC, the VAS score derived from CHA₂DS₂-VASc for all patients was calculated. Results: The mean age of the patients was 65.29 (standard deviation [SD]: 17.18 years). The average duration of AF was (2.0) years. The mean of VAS score was 2.97 (SD: 1.75, ranged between 0 and 8.0). 78.0% of all patients were eligible for OAC at admission. Only 15.9% of the patients were on OAC. In the logistic regression analysis, none of the patient's characteristics predict significantly the nonadherence to OAC. Conclusion: The present study showed that a high percentage of AF patients were eligible for OAC. However, only a small percentage of them were receiving OAC at admission in our area.

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Background: Seasonal influenza is an acute, highly infectious viral infection. Immunization of the children can protect not only the children but also the community from seasonal influenza. Parents' knowledge and attitudes can play an important role in the immunization coverage. Objectives: To assess parents' knowledge and attitudes toward childhood seasonal influenza vaccination for children aged below 5 years in Hilla governorate and to determine the relationship between them and socioeconomic status. Materials and Methods: A cross-sectional study was done on 288 parents who visited a six randomly selected primary health care centers in Hilla city and who had children aged between (6 and 59) months. Data were collected from May 1, 2018, to August 4, 2018, by interviewing parents using a questionnaire form after taking their consent, including a full assessment of parents' attitude and knowledge toward seasonal childhood influenza vaccination. Results: The results showed that 92.7% (n = 260) of the participants had moderate and good knowledge about seasonal childhood influenza vaccination with significant association with mother's education, age, and family income and 88.9% (n = 256) of them had a positive attitude toward the vaccine which was significantly associated with the family residence, the coverage rate of the seasonal childhood influenza vaccine was 30.6%. Conclusions: The majority of participants had good and moderate knowledge and a positive attitude toward seasonal childhood influenza vaccination. Higher knowledge level was reported in mothers of younger age. A very low percentage of illiterate mothers had good knowledge. The majority of parents with good knowledge had low family income.

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Background: Coronavirus disease-2019 (COVID-19) pandemic has led to a radical transformation of economic, social, and health-care networks. COVID-19 pandemic has reported a substantial drop in the number of patients presenting to cardiology Emergency Departments with acute coronary syndromes/acute myocardial infarction (ACS/AMI) and a drop in number of cardiac procedures. Objective: The objective was to describe how lockdown and COVID-19 pandemic has affected the evolution of AMI and hospital admissions due to ACS. We aimed to assess the impacts of COVID-19 on cardiology services and procedures performed on a daily basis before and during the pandemic. Materials and Methods: This single-centered retrospective study included all the consecutive patients with ACS/AMI including ST-segment elevation myocardial infarction (STEMI) and non-STEMI admitted to ER of Surgical Specialty Hospital-Cardiac Center/Erbil-Iraq, from the start of the lockdown (March 15, to April 15, 2020). The same analysis was conducted among patients presenting with ACS/AMI at the same identical time period before Lockdown (March 15, to April 15, 2019). Results: A total number of 40 patients admitted at SSH/Cardiac Center-Erbil with ACS/AMI during the study period, and showed a 37.5% drop in the number of patients with Myocardial Infarction comparing with the corresponding time window before the COVID-19 pandemic. Conclusion: These preliminary results strongly demonstrate a decrease in the number of admissions for ACS/AMI during the lockdown period (March 15, to April 15, 2020) due to multiple reasons.

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Background: Primary sinonasal non-Hodgkin's lymphomas (NHLs) are uncommon malignancies. The lack of specific clinical presentations often causes delayed visit to the clinician and so diagnosis is done in late with advanced stage. Objective: The objective of the study was to study the primary sinonasal NHL with respect to clinical presentations, management, and outcome. Materials and Methods: This is a retrospective study conducted in a tertiary care teaching hospital from March 2010 to April 2020. The clinical data of the patients of primary sinonasal NHL were evaluated with respect to the age, sex, clinical presentations, staging, diagnosis, treatment, and outcome. Results: The mean age of the participants was 62.45 years with male-to-female ratio of 1.5:1. All the cases of sinonasal NHL involved with paranasal sinuses and nasal cavity. Nasal obstruction was the most common symptom. All were diagnosed with large B-cell lymphoma and treated with combined chemotherapy and radiation. Five patients were died during follow-up period. Conclusion: Primary sinonasal NHLs are extremely uncommon clinical entity. The diagnosis is based on the histological examination with immunohistochemical study. Early diagnosis and prompt treatment with chemo-regimen and radiotherapy are essential to achieve an optimum outcome. Early diagnosis and treatment improves the treatment outcome.

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Background: Hyperalgesia and allodynia are abnormal sensory signs which are usually seen along neuropathic pain (NP) in patients on paclitaxel (PT) chemotherapy. Pomegranate seed oil (PSO) has been used in the traditional medicine for the different kinds of pain. Nucleo-CMP Forte^® (NCF) is a nucleotide-based drug and L-carnitine (LC) is a member of natural compounds have been shown effective in diverse peripheral neuroglial disorders. The aim of this study is to compare the anti-hyperalgesia and anti-allodynia activity of PSO, NCF, and LC in PT-induced neuropathy. Materials and Methods: Thirty adult male mice were divided equally into five groups of six mice in each group as follows: Control (C), PT, PSO (PTpso), NCF (PTn), and LC (PTc) groups. NP was induced by the administration of PT (6 mg/kg, i. p., once weekly) to the mice in all groups except C group. PSO, NCF, and LC were administered orally once daily to mice with PT-induced neuropathy in their corresponding groups. Different behavior parameters were used to test the anti-hyperalgesic and anti-allodynic effect of PSO, NCF, and LC on days 0, 7, 14, 21, and 28 of PT administration. Results: PSO, NCF, and LC significantly attenuated NP induced by PT from day 14 up to 28 days using the different behavioral tests for thermal hyperalgesia and allodynia. Conclusion: PSO, NCF, and LC have significant potential anti-nociceptive and analgesic activity against PT-induced NP and PSO was the most efficacious than NCF and LC.

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Background: Lung cancer (LC) is one of the well-known fatal malignant neoplasms worldwide. Objective: The objective of this study was to determine the potential relationship between ABO and Rhesus blood groups with LC. Materials and Methods: A retrospective case series study was done on 500 patients diagnosed with LC using hospital case reports of both Nanakali Hospital and Rizgary Teaching Hospital and 182,408 healthy blood donors in Erbil city of Iraqi Kurdistan Region. Results: Blood groups of 500 LC patients were as follows: blood group A, 156 (31.2%); blood group B, 111 (22.2%); blood group O, 196 (39.2%); and blood group AB, 37 (7.4%), whereas blood groups of healthy donors were as follows: blood group A, 56,546 (31%); blood group B, 43,413 (23.8%); blood group O, 68,221 (37.4%); and blood group AB, 14,228 (7.8%). The difference was statistically not significant by Pearson's Chi-square (P = 0.909). Rh of patients was as follows: Rh negative in 42 patients (8.4%) and Rh positive in 458 patients (91.6%), whereas Rh of healthy donors was as follows: Rh negative in 18,241 patients (10%) and Rh positive in 164,167 patients (90%). The difference was statistically not significant by Pearson's Chi-square (P = 0.381). Conclusion: According to the results of the study, we found that there was no statistically significant relationship between ABO-Rhesus blood groups' LC susceptibility in general and also between different histopathological types.

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Background: Many studies agree that routine histology is less sensitive and less specific than special stains and immunohistochemistry (IHC) with false-positive and false-negative rates. Objectives: The aim was to evaluate the accuracy of four general histopathologists in documenting Helicobacter pylori (Hp) bacteria in gastric biopsies (stained with H and E) by using IHC and modified Giemsa stain (MG), also to assess the specificity of MG and whether it can replace IHC. Materials and Methods: Twenty seven reported gastric biopsies were collected from each of four pathologists (9 reported as negative for Hp, 9 reported as scant Hp, and 9 as abundant Hp). The pathologists selected were known to have different thresholds for Hp. The biopsies were stained with MG and IHC and they were read by two pathologists. Results: The four pathologists showed different thresholds for labeling luminal gastric pits' structures as Hp. Overall, there were 5/36 false-negative cases (13.9%) and 26/72 false-positive cases (36%), most of them in the category reported as scant Hp detected. The results of MG were concordant with that of IHC in 107/108 cases. Conclusion: The overall accuracy rate of Hp detection on routine histology was 71%; false positivity was much more common than false negativity, especially when only scant Hp reported to be present. MG is a reliable stain and if done properly, it can replace the more costly IHC. When Hp identification is crucial from the clinical management of view, special stains and/or IHC should be requested.

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Background and Objectives: Injection drug usage is a major public health issue. The study is aimed to find the clinical profile and trends of injection drug usage in young people who attended de-addiction services at a tertiary care center in North India. Methods: This retrospective record review analyzed data from consecutive young-aged people attending de-addiction services at a tertiary care hospital in North India between 2015 and 2019. The sociodemographic data and clinical and injection-related characteristics were discerned from the data. Results: Out of 135 patients included in the analysis, 132 (97.8%) were male. There was a 13-fold rise in treatment seeking over the past 5 years (2015: 7 vs. 2019: 98). One hundred and thirty-two (97.8%) were male. High Risk behavior was present such as sharing of needles in 31 (22.9%), paraphernalia sharing in 24 (17.8%), 6 (4.4%) reported ever-having symptoms of sexually transmitted infection, 13 (9.6%) had sex with sex worker, 9 (6.7%) reported ever-having HIV screening, 6 (4.4%) reported having HIV positive status. Thirty-two (23.7%) reported having previous treatment for drug abuse and 13 (9.6%) reported previously being hospitalized for drug abuse. Heroin usage has been present in 96 (71.1%) followed by pentazocine usage in 19 (14.1%). Conclusion: Our findings revealed that treatment-seeking young age population (the WHO defined age group 15–24 years) from the defined geographical location has been showing an increasing trend in injecting drug user usage along with greater injection and sexual risk behaviors associated with it. This can be used to design the public health strategy to educate regarding avoiding injection drug-related practices.

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Background: Platelet-rich plasma (PRP) has been employed widely in dental and oral surgery. However, there is considerable debate about its effect on wound healing and inflammatory response. Materials and Methods: PubMed, Google Scholar, Scopus data base, and manual search were performed to find out articles on the use of PRP in dental and oral surgery using keywords such as PRP , oral surgery, dental surgery, lower wisdom teeth, periodontal pocket, dental implant, tooth socket preservation, dry socket, cystic lesion, and ridge augmentation. These articles discussed the use of PRP (after surgical removal of wisdom teeth, treatment of periodontal pocket, ridge preservation, implant stability, prevention of dry socket, treatment of bony defect after cystic removal, and ridge augmentation). Results: Twenty-seven articles were found on the usage of PRP in dental and oral surgery. Six articles on the use of PRP after surgical removal of lower wisdom teeth, five articles in the treatment of periodontal pocket and implant stability, four article in ridge preservation, three articles in prevention of dry socket and two articles on the use of PRP after cystic removal and ridge augomentation. Conclusion: PRP enhanced bone regeneration and soft-tissue healing aftery lower wisdom tooth surgery. It decreased the depth of periodontal pocket, maintained implant stability, preserved ridge height and prevented dry socket. However, PRP had no effect on pain, swelling, and bleeding. There is no justification for the impact of PRP on bone augmentation and healing of bony defect after cystic removal of the jaws. More studies should be carried out to support the usage of PRP in oral and dental surgery.

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In the field of medical education, surveys remain one of the most common methods for the planned and conducted educational research. However, the validity of the obtained results depends on the adequate representation of the study population and the number of participants who have responded to the survey. An extensive search of all materials related to the topic was carried out in the PubMed search engine and a total of seven articles were selected based on the suitability with the current review objectives. Owing to the ongoing coronavirus disease-2019 pandemic, a sudden rise in the incidence of online educational surveys has been observed. There is an immense need to improve the response rates to the online surveys and thereby get representative results. In conclusion, online surveys are exceedingly being used in the field of medical education research by different stakeholders. It is the responsibility of the researcher to ensure that they follow simple steps to reduce both unit nonresponse and item nonresponse and thereby ensure more representation to the study findings.

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