Abstract: Digital pathology is a technology for representing whole stained tissue sections from glass slides and viewing them by a pathologist on a computer. We aim to find out the role of digital pathology in the assessment of “PD-L1 in HER2-neu-positive breast cancer” and the effect of storage time on PD-L1 expression. This is a case series study that evaluates “PD-L1 protein immunohistochemical expression” using monoclonal mouse Anti-PD-L1 (Dako), clone 22C3 on “50 formalin-fixed paraffin-embedded tissues (core biopsy)” in Iraq over 7 months and scored using a combined positive score. “PANNORAMIC® Flash DESK DX slide scanner (3DHISTECH digital pathology firm)” was used to scan the slides. The PD-L1 stained slides were stored for 7 months, then a reassessment of the 50 slides was done using a light microscope in the same methods and compare the results with digital images. The results of reassessment of the 50 glass slides after 7 months under a light microscope found that there is slight fainting in the staining and slight changes in the combined positive score in 11 cases. Digital pathology contributes to documenting the PD-L1 assessment score, the storage time of PD-L1 immunohistochemical slides will cause fainting of the staining.

Abstract: Сorona-virus disease “СOVID-19” is a greatly contagious disease that affect  the public healthiness. It affects the respiratory and many other organs. This study reviews the pathological finding obtained from biopsies and autopsies of "Сovid- 19" infected patients. Different articles and researchers which had been published till July 2022 had been reviewed. Overall, 60 articles were identified as full articles and included in this study. Diffuse alveolar destruction, vascular damage with thrombosis, inflammatory changes in tissues were the chief pathological findings in this review. These differences in the pathological features among patients indicate various mechanisms of organs injuries caused by the virus which may affect  the prognosis and the treatment protocol. 

Abstract: Background: It is suggested that polymorphisms in the Vitamin D receptors gene (rs1544410 BsmI) may affect blood pressure in Iraqi patients with essential hypertension (EH). Essential hypertension accounts for 95% of all cases of hypertension. EH seems to be considerably affected by genetic factors and environmental factors. Aim: To understand how vitamin D receptor gene polymorphism (VDR rs1544410 BsmI) affects blood pressure in Iraqi patients with essential hypertension in Al Diwaniya province. Materials and Methods: This is a single-center observational cross-sectional descriptive study of 90 patients with essential hypertension.  PCR-TETRA ARM technique was used, and blood samples were genotyped and examined for the polymorphisms BsmI (rs15444410) genes. Results: The most frequent allele was C (95,53%) while the most frequent genotype was TC (57, 63%). There was no statistical difference between the actual and expected frequency distribution, according to Hardy-Weinberg equilibrium. The effect of VDR polymorphism rs1544410 on blood pressure indicates (the mean systolic blood pressure in homozygous TT, heterozygous TC, and homozygous CC carrier patients was 147, 151, and 147 respectively p=0.4. On the other hand, mean diastolic blood pressure in homozygous TT, heterozygous TC, and homozygous CC carrier patients was 87, 90, and 88 respectively p=0.3) there was no statistically significant effect on systolic and diastolic blood pressure. Conclusion: Our study revealed that Vit D receptor gene polymorphism rs1544410 was not related to Vit D level, there was no statistically significant effect of rs1544410 on systolic and diastolic blood pressure.

Abstract: Background: Dysphagia is an alarm gastrointestinal symptom that may be a manifestation of serious underlying condition, which necessitate proper and timely medical intervention.  Objectives: To disclose the underlying conditions in patients presenting with dysphagia through endoscopic examination and assess associated alarm features. Patients and Methods: This is a retrospective cross sectional study that was carried out in Al-Salam General Teaching Hospital in Mosul (Iraq) from January 2018 to January 2020. A total of145 patients (females 85, males 60) presenting with dysphagia were subjected to upper gastrointestinal endoscopic examination. Demographic characteristics, clinical features and detailed endoscopic findings were collected and analyzed. Results: Mean age of patients was 48.4 (SD ± 17.5) years, age range 18-89 years, females constituted (85/145, 58.6%) and males (60/145, 41.4%). Endoscopic findings were esophagitis/ulcer associated with gastroesophageal reflux disease (GERD) (24.1%), neoplasms (15.2%), achalasia (6.9%), candida esophagitis (3.4%), drug-induced esophageal lesions (3.4%), hiatus hernia (2.8%), esophageal strictures (2.1%), and Schatzki ring (1.4%). Normal endoscopic findings were detected in 40.7% of patients.  Main symptoms associated with dysphagia were chest pain and heartburn (20.7%). Age groups > 50 years were affected in 85% of patients having malignancy, while weight loss and anemia affected 80% and 40% of such patients respectively. Conclusion: Endoscopy detected significant esophageal lesions in about two thirds of patients presenting with dysphagia. Age above 50 years, weight loss and anemia, are predictive of malignancy, and endoscopy has a diagnostic role in this setting.

Abstract: Background: Pre-eclampsia (PE) is a multi-factorial and multi-systemic disorder precise to gestation; it is classically diagnosed by the hypertension associated with proteinuria and /or target organ damage during pregnancy subsequent to 20th week of conception, in woman who is formerly had normotensive blood pressure. Aim of the study: To compare the levels of troponin I between pre-eclamptic and normotensive pregnant women. Patients and Methods: A prospective case-control study was done to achieve the study’s aim and carried out in the Obstetrics and Gynecology department at Alkhansaa maternity and childhood teaching hospital, Mosul, Iraq. The data collection period extends from 20th of December 2020 to the 1st of June 2021.One hundred pregnant women were invited to participate in the study. The diagnosis of PE was made by NICE guideline criteria. Results: The mean GA, gravida, para, and abortion are lower in severe PE.BMI is lower in mild than severe PE and controls. Troponin I levels shows no difference between PE groups concerning the symptoms. No correlation found in Troponin I level between PE groups with proteinuria. Conclusions: Mean Troponin I levels was higher among PE group than normal.

Abstract: Objective: the current work aims to find out whether glutathione has a protective role against hepatic and renal tissue toxicity induced by the use of azathioprine.Methods: A total of twenty-eight Wistar rats were assigned to 4 equal groups, the control group (I) was given distilled water. Azathioprine in a dose of 5mg/kg body weight was administered to group II. Group III received azathioprine 5mg/kg body weight with glutathione 100 mg/ kg body weight, the last group (IV) received glutathione alone 100 mg/ kg body weight. The treated groups were given the treatment by oral plastic gavage daily for 6 weeks. The liver and kidney of the animals were dissected and prepared for histological examination.Results: The obtained results indicated that in group II Liver sections showed steatohepatitis with marked Ballooning degeneration of the hepatocytes, Coagulative necrosis, focal inflammatory cells infiltration in the Portal triads with hyperplasia and hypertrophy of Kupffer cells. Renal sections of group II revealed vacuolar degeneration in the epithelial lining cells of renal tubules with focal lymphocytic inflammatory cells aggregation in renal parenchyma. dilatation of the Bowman's space with formation of renal cysts and necrosis of some glomeruli. In group III the histology of rats’ liver and kidney sections showed improvement of the histological lesions. In liver section, some necrotic hepatocytes with central veins congestion and slight inflammatory cells infiltration. The renal tissue slides revealed tubular necrotic epithelium with marked inflammatory cells infiltration.Conclusion: The current study concluded that azathioprine in a dose of 5mg/kg for 6 weeks can produce hepatic and renal cellular damage. Glutathione in a dose of 100mg/kg for 6 weeks can reduce this tissue damage.

Abstract: Background: Rotavirus infection is the most significant cause of severe dehydrating diarrhea, responsible for 5–10 million fatalities annually despite vaccinations. Acute rotavirus is the leading cause of vitamin A insufficiency by many mechanisms.  Aims: To study the acute prognostic clinical effect of the addition of vitamin A on treating preschool-age patients with confirmed infection with acute rotavirus diarrhea. Materials and methods: A randomized, double-blind study of 55 children from 6 to 72 months aged in Al-Hussein hospital for children with positive acute rotavirus infection from October 2022 to May 2023 in Al-Diwaniya city in Iraq, was classified into two groups with a vitamin A dose of 100000 IU for those age less than 12 months and 200000 IU for those older given in the first day of involvement, while the other group received a placebo.   Results: Vitamin A significantly decreased stool consistency and frequency to significant levels and reduced the diarrheal severity of acute rotavirus and the period of hospitalization from 7.18 days to 5 days only. Conclusion: Vitamin A intake in acute rotavirus infections significantly reduces the severity of diarrhea and hospitalization.

Abstract: Aims : to assess and compare lipid profile indices (serum total cholesterol TC, triglycerides TG, low density lipoprotein cholesterol LDL-c, high density lipoprotein cholesterol HDL-c, and atherogenic index AI) in epileptic patients receiving valproate and topiramate monotherapy for at least six months, taking dosage and length of treatment into account, in comparison to healthy controls. Methods: This study, which took place between the first of December 2012 and the 30th of April 2013, used a retrospective, cross-sectional, case series design.    The study involved 78 epileptic patients who had been separated into two groups.37 epileptic patients in group one were receiving TPM alone, while 41 epileptic patients were receiving VPA monotherapy. 40 healthy people of equal age and sex were used as controls in this investigation. Both patients and controls had fasting blood samples drawn for the assessment of serum lipid parameters. Results : We observed statistically significant lower serum TC levels  at a dose level of 200 mg TPM with a significant lower levels of TC,TG and HDL-c levels among patients receiving VPA at dose  greater than 400mg /day . There were no statistically significant differences in the lipid profiles of the two groups of epileptic patients. Conclusions : In epileptic patients the use of TPM at a dose of 200mg /day was associated with significant decrease in TC  with no changes in other lipid profile parameters while the use of VPA at a dose greater than 400 mg /day was associated with a significant decrease in TC, TG and HDL-c.

Abstract: Background: As one of the most important congenital anomalies, undescended testis, or cryptorchidism contributes to infertility and as well as a risk factor for testicular carcinoma. However, it is unclear if cryptorchidism by its own a cause of testicular cancer. Objectives: To evaluate the anatomical, morphological anomalies and histopathological changes of undescended testis in patients at various ages presenting to Al-Salam Teaching Hospital. Materials and methods: A prospective cohort study was done in Mosul city teaching hospitals. Data of 40 patients with undescended testis after surgical exploration of the inguinal region were analyzed. Intra-operative gross appearance was examined and morphological changes were reported. A biopsy was taken from the undescended testis, preserved in Bouin’s solution and sent for histopathological examination. Results: The location of the testis among the 40 male patients was variable, the most common site was in the intracanalicular position (50%). Twenty two patients (55%) had normal sized testes, while in the rest: the testes were smaller or atrophied. Germ cell count was markedly diminished in 65% of the cases. One patient (2.5%)  was diagnosed with intratubular germ cell neoplasia. Conclusion: Patients with undescended testes in Mosul present late for medical care which raises the probability of infertility and malignant transformation.

Abstract: Background: Basal cell carcinoma (BCC) recurrence is extremely infrequently documented after complete surgical excision. There are well-studied risk factors for this undesirable consequence like localized erythema, induration, or ulceration at the site of surgical excision of the initial lesion of BCCs. Material and Methods: According to the histopathology report, all patients whose primary BCCs were removed with free surgical margins between January 2018 and December 2021 were included in the current study. The patient's age, sex, sun exposure, tumor site, size, clinical diagnosis, histopathological variant of primary lesion, least free margin distance of the original lesion and recurrence time were all noted in the medical records that were obtained. Result: Sixty patients including 30 males and 30 females, among them, 56.7% lived in rural areas, compared to 43.3% who came from urban. Furthermore, 45% of patients were housewives and the majority of patients were illiterate (70%). 20% of patients had hypertension, diabetes mellitus and ischemic heart disease. 15% had hypertension, diabetes mellitus, 10% only had hypertension, 31.7% had no disease and 25% of participants experienced bleeding, 36.7% had ulcers and only 6.7% experienced itching. Regarding previous therapy for BCC before surgical excision, 15% of patients received 5FU and peeling solution for each of them. Only 8.3% of patients used cryotherapy, 10% of patients used cautery, 5% of patients received CO2 laser, only one patient (1.7%) had BCC previously treated before surgical excision and recurred. Conclusion: All recurrent BCCs were surgically removed with margins less than 4 mm. The preferred surgical treatment for basal cell carcinoma is with sparing margins more than 4 mm which may be individualized to the patients in order to lower recurrence rates

Abstract: Background: An instructive program related to nutrition is characterized as Any set of learning encounters planned to encourage intentional food possession and other nutrition-related behaviors conducive to health and well-being. Aim: The study aims to investigate the effects of structural program on mothers' knowledge regarding weaning.  Subjects and methods: The present study was carried out in Mosul City, four health care centers, 112 mothers who fulfilled the criteria. A structured Knowledge Questionnaire was filled for each one by ticking the correct answer. A pre special questionnaire was performed for knowledge take the correct answer then explain the educational program, mothers were intervented through five days sessions related to healthy weaning and basic nutritious food which were targeted directed to enhance knowledge of mothers about health food and hygein The questionnaire filled again after intervention as a post-test on the fifth day. Data was analysed to Frequencies and percentages were created for variables. The chi-square test, Fisher Exact test, and Z-test for two proportions.The ethical approval was gotten from the College of Medicine the College of Mosul and the Nineveh health directorate Ethical Committee. Results: For the socio-demographic characteristics  44.6% of participants were aged between 16-24 years and majority of participants were housewives and half of particpants reported getting weaning information from family. Most of the questions were statistically significant except for Essential qualities of weaning food and Wait until the infants are 3-6 months was not significant Conclusions: Education of the mothers with structural educational program was succeded in providing mother with good information regarding adequate nutrition in improving complementary feeding knowledge.  

Abstract: Background: Blood safety is a significant transfusion medicine problem around the world; The selection of blood donors is essential for the safety of donors and recipients as well as maintaining an adequate blood supply, and this can be accomplished by enforcing donor deferral guidelines and investigating potential Transfusion Transmitted Infections (TTI). The purpose of this study: was to examine the demographics of blood donors as well as the frequency and factors that contribute to donor deferral in the province of Duhok. Method: This cross-sectional study was carried out at the Duhok blood banking center from December 2021 to May 2022. The participants in this study were the blood donors who attended the center during the research period. SPSS 26 was used for data gathering and statistical analysis. Results: Most of the donors were in the age group 30-39 (39.2%). In terms of occupation, most subjects were unemployed (63.01%) followed by military persons (21.23%). Of all the potential blood donors were males 1148 (98.30%) and 20 (1.70%) were females. Deferral occurred in 1168 (17.81%) of attempts; 190 (91.35%) of all deferrals were temporary and 18 (8.65%) permanent. The three main causes of deferral were medication use (25.96%), a recent donation (21.63%), and anemia (10.57%). Conclusion: The pattern of donor deferrals described in this study was the same as those in other regional investigations. The reason for donation was mainly voluntary rather than replacement. The majority of contributors were men, so it's critical to support and motivates female donors in order to expand the total number of donors. In order for the deferred donors to participate in future blood donations, they must be actively satisfied.

Abstract: Objective: To understand the impact of a novel COVID-19 pandemic on parents’ general attitudes about children's vaccines. Materials and Methods: 625 parents of children under the age of six who visited the four primary healthcare centers between December 1, 2022, and March 30, 2023, participated in the study. A total of 17 questions were asked about children’s vaccination state and sociodemographic characteristics of participants and their children, Additional research on attitudes and conduct around routine childhood vaccinations during the COVID-19 pandemic. Results: 25.44% (n = 159) of the participants had children with delayed vaccination. Reasons for delaying vaccinations during the pandemic were discovered including 88.68% (n = 141) reasons related to COVID-19, where the participants stated 68.55 (n=109) “fear of COVID-19 infection,” 12.25% (n = 20) “one or more of the family member was infected by COVID-19 this lead to the entire family is in quarantine,” and 7.55% (n = 12) “curfew or transportation issues.” the most influencing variables for vaccination when parents visit a healthcare center were “children's routine vaccinations are essential and must be given. Further, they have been informed that the required precautions are being taken, and they are aware of how the COVID-19 infection is spread.." Conclusion: Parents should be told by healthcare workers that vaccination is essential and must be given on schedule at all times during a pandemic with continuous appointments for vaccination procedures during a pandemic.  

Abstract: Background: Pneumonia is a common acute respiratory infection that affects the alveoli and airways; it is a significant health problem and is associated with morbidity and mortality in all age groups worldwide. Objective: The objective of this study is to evaluate the knowledge and practices of nurses at Qala Hospital in Kalar, Iraq, regarding the prevention and management of pneumonia in patients with COVID-19. Methods: A quantitative design descriptive cross-sectional study was used to evaluate was used to recruit a sample of 46 nurses in Qala Hospital in Kalar City, from April 2022. The study sample was chosen by convenience sampling technique. and The data for this study were collected using a researcher-designed questionnaire. The collected data were then analyzed using the Statistical Package for the Social Sciences (SPSS) version 22. Results: Most of the study nurses 60.9% fell within the age range of 23-27 years, female, single, diploma in nursing, and had Experience as a Nurse (1-2) years. The study findings revealed more than half sufficient knowledge regarding the Prevention of pneumonia. Nurses weren't particularly unaware of the management of pneumonia. Good knowledge about the prevention and management of pneumonia in a patient with COVID-19. Statistically, a significant association was found between nurses' marital status and level of education, while no significant relationships with age and gender. Conclusion: In this study, the majority of participants were female, young in age, and held a Nursing diploma. Around two-thirds of the participants had one to two years of experience working in a hospital setting. The findings suggest that nurses possess sufficient knowledge about the management of pneumonia. The main observation was that participants demonstrated good knowledge regarding the prevention and management of pneumonia in patients with COVID-19.

Abstract: Montelukast is an orally dosed drug (available as a film-coated tablet, chewable tablet, or oral granules an antagonist of the cysteinyl leukotriene receptor is frequently used to treat asthma symptoms in both adults and children.This study aims to conduct a review of articles on the use of Montelukast on the experimental level. Due of the significant adverse effects of montelukast and the high prevalence of asthma in children, there is a warning by FDA regarding the use of this drug to stop this agent  immediately if side effects occur. However, an intense and, at times, life-threatening withdrawal upon discontinuation of montelukast was reported including severe neuropsychiatric side effects including anxiety, depression, insomnia, suicidal thoughts and actions. Several studies with contradictory views were performed on the effect of Montelukast use on the animals.Montelukast has anti-inflammatory,antioxidant actions on several tissues. Further research on how montelukast works and its effects on which organ, particularly on children, is incredibly important, given the enormous popularity and global distribution of this drug. The present study analyzed the previous published case reports regarding montelukast induced adverse drug reactions. They included agitation, anxiety, depression, sleep disturbance, hallucinations, suicidal thinking and suicidality, tremor, dizziness, drowsiness, neuropathies and seizures. The immune system can be involved, in particular, cases of ChurgStrauss syndrome have been published. Furthermore, it can induce hypersensitivity reactions, including anaphylaxis and eosinophilic infiltration. In addition, hepatobiliary, pancreatic and uropoietic disorders have been observed. Some of these cases are characterized by severe prognosis (i.e. neurological deficit and fatal hepatotoxicity).

Abstract: Vitamin D is essential nutrients for health. Both pregnant women and children and are more prone to have vitamin D deficiency and can cause nutritional rickets and disorders in calcium homeostasis. Many researches have connected vitamin D deficiency to negative health outcomes, including those that go beyond bone health, in both children and pregnant women. Reports of high incidence of nutritional rickets continue to progress. With adequate vitamin D and calcium supplementation, nutritional rickets is a completely avoidable illness that may be eradicated in infants and children around the world. In order to execute workable prevention measures for vitamin D insufficiency and nutritional rickets, a comprehensive, multi-level approach is required. The history, danger signs, and debates around vitamin D insufficiency during pregnancy and children are highlighted in this overview

Abstract: Cannabis has been known for many centuries for its recreational and medical uses. The use of medical cannabis (MC) is on the rise with growing body of evidence about the benefits and safety of MC treatment. The use of MC represents a very interesting area for both patients and researchers for its potential therapeutic uses which include wide array of benign and malignant diseases across the board including both sexes and different age groups. Currently more than 40 countries have approved the use of Cannabis for medical purposes. This article will review the history, terminology, mechanism of action, metabolism, pharmacological forms, legality and adverse effects profile. It represents an essential source of knowledge for clinician and researchers interested in pursuing the therapeutic potentials of MC. Proper understanding of such introduction is pivotal for safe and effective use of this multipurpose medicine.