Al-Kindy Teaching Hospital Research Articles

The Efficacy of Bedside Chest Ultrasound in the Detection of Traumatic Pneumothorax

Background Chest X-rays have long been used to diagnose pneumothorax. In trauma patients, chest ultrasonography combined with chest CT may be a safer, faster, and more accurate approach. This could lead to better and quicker management of traumatic pneumothorax, as well as enhanced patient safety and clinical results. Aim The purpose of this study was to assess the efficacy and utility of bedside US chest in identifying traumatic pneumothorax and also its capacity to estimate the extent of the lesion in comparison to the gold standard modality chest computed tomography. Methods This was an observational cross-sectional study of 160 patients with traumatic pneumothorax. This sample was collected from all chest trauma patients admitted to Al-Kindy Teaching Hospital in Baghdad-Iraq between November 2021 and September 2022. Such patients were to have a bedside chest US and chest CT scan performed by a skilled radiologist to detect lung point signs and lung sliding, which would be used to determine the patient's pneumothorax status. Results According to the study's findings, about 77.5% of the patients evaluated were men. Furthermore, 40.6% of patients experienced blunt trauma. Chest ultrasound revealed positive pneumothorax in 50 cases (31.2%), while positive pneumothorax was confirmed by computed tomography in 53 cases (33.1%) with no significance in the detection of pneumothorax between the two imaging modalities p-value(0.719). Comparably, there was no significant difference in estimating the size of a pneumothorax between the two modalities (p-value = 0.547). Chest ultrasound diagnostic accuracy showed a sensitivity of approximately 92.45%, specificity of 99.07%, and diagnostic accuracy of 96.88%. Conclusion Our findings indicated that chest ultrasound might be a valuable rapid diagnostic tool for traumatic pneumothorax in the emergency department in addition to diagnosis. It eliminates the need to transport patients for a CT chest scan.

The predictive role of Interleukin 6 and Procalcitonin associated with bacterial infection causing sepsis in patients with severe burn

Background. Sepsis is a major contributor to both death and illness on a worldwide scale. Bacteremia characterized by the presence of gram-negative, gram-positive, or mixed growth bacteria has been shown to be associated with a significantly increased risk of septic shock and a bad prognosis. Biomarkers are used to aid in the diagnosis of sepsis and to differentiate between bacterial causes, namely Gram-negative, Gram-positive, and mix growth bacteria. Objectives. This study aimed to evaluate the role of PCT and IL-6 in predicting bacterial infection in burn patients with sepsis due to gram-negative, gram positive and mixed growth bacteria. Methods. Forty-four patients with age (1.5–75 years), and nineteen healthy controls with the same age range, were involved in this study during their attendance to Specialized Burns Hospital in the Medical City, Al-Kindi Teaching Hospital in Baghdad, and Al-Nasiriyah General Hospital in Thi-Qar province. The study was conducted from 1st December 2023 to 1st April 2024 and approved by ethical committees of Institute of Genetic Engineering and Biotechnology for Postgraduate Studies/ Baghdad University. Blood samples and data were collected to evaluate the level of PCT and IL-6 associated with bacterial infection for burn patients by enzyme linked immunosorbent assay (ELISA). Results. 25 (50%) showed growth for Gram-negative, 13 (26%) for Gram-positive and 12 (24%) for mix growth bacteria. Results appeared a significant increase at (P≤0.01) in each of PCT and IL-6 in burn patients to control group according to gender. Patients exhibiting a combination of bacterial growth have notably elevated levels of procalcitonin (PCT). Levels of PCT were significantly elevated in burn patients with mixed growth sepsis compared to patients with Gram-negative and Gram-positive sepsis. However, there were no significant differences in IL-6 levels between burn patients with mix growth sepsis and patients with gram-negative and gram-positive sepsis (P> 0.05). Measuring PCT levels may assist in selecting the appropriate empirical antibiotic treatment. Conclusions. The PCT biomarker demonstrated superior performance in distinguishing between microbial sepsis caused by various kinds of pathogens. This finding has great promise for its use in clinical practice, particularly in burn units.

Comparative Outcomes of Elastic Stable Intramedullary Nailing vs. Plate Fixation in Pediatric Femoral Shaft Fractures. A Prospective Study.

Pediatric femoral fractures are common in emergency rooms, with treatment options varying by age. This study compares elastic stable intramedullary nailing (ESIN) and plate fixation for diaphyseal femoral fractures in children aged 5-10. Conducted at Al-Kindi Teaching Hospital, Baghdad, from December 2017 to December 2019, this prospective study included 32 children with closed transverse diaphyseal femoral fractures. Patients were divided into two groups: 16 treated with ESIN (Group 1) and 16 with plate fixation (Group 2). Criteria excluded comminuted, open, or pathological fractures. Group 1 had a mean age of 7.1 years and weight of 23.7 kg; Group 2 had a mean age of 7.8 years and weight of 30.9 kg. ESIN resulted in shorter operative times (58.4 minutes), earlier weight-bearing, and quicker fracture union (8.8 weeks) compared to plate fixation (76.3 minutes, 11.9 weeks). Blood loss was significantly less in Group 1 (32.8 ml) versus Group 2 (205.0 ml). No significant differences in wound healing or leg length discrepancies were observed. 1. Our study indicates a preference for Elastic Stable Intramedullary Nailing (ESIN) over plate fixation for pediatric femoral shaft fractures in children aged 5-10 years. 2. ESIN is associated with shorter operative times and faster commencement of weight-bearing, critical in pediatric recovery. 3. While ESIN is generally preferable, plate fixation may be better suited in certain clinical scenarios, emphasizing the importance of personalized treatment. 4. Based on our findings, ESIN is recommended for treating transverse diaphyseal femur fractures in the specified pediatric age group. 5. Recommends further studies, including randomized controlled trials, for a more comprehensive understanding of these treatments' long-term outcomes.

Association of adiponectin with thyroid dysfunction in diabetes mellitus type II

The two most prevalent endocrine-related conditions seen in clinical practice are thyroid diseases (TD) and diabetes mellitus (DM). Diabetes mellitus and thyroid dysfunction are strongly related conditions. Numerous research investigations have reported that individuals with diabetes mellitus are more likely to have thyroid issues, and vice versa. Compared to individuals without diabetes, Type 2 Diabetes Mellitus (T2DM) patients have higher rates of both hypothyroidism and hyperthyroidism. Thyroid hormones are circulating hormones that impact various organs and tissues, have a vital role in the metabolism of proteins, fats, and carbohydrates, and can exacerbate glycemic control in individuals with Type II Diabetes Mellitus (T2DM). At the Specialized Center for Endocrinology and Diabetes – Al-Kindi Teaching Hospital in Baghdad, a case-control research was carried out. The samples were gathered between January 1, 2021, and April 1, 2021. The current study had one hundred twenty (120) volunteers, all of whom fasted for eight to twelve hours before to the test: · Thirty (30) patients suffered from diabetic mellitus type II seventeen (17) females and thirteen (13) males. · Thirty (30) were control with, sixteen (16) females and fourteen (14) males. · Thirty (30) patients had thyroid dysfunction eighteen (18) females and twelve (12) males. · Thirty (30) patients had thyroid dysfunction and diabetes mellitus type II, sixteen (16) females and fourteen (14) males. Variables such as gender, age, Body Mass Index (BMI), thyroid hormones ,Fasting Blood Sugar (FBS), Glycated Hemoglobin (HbA1c), lipid profile (TG, CHOL, LDL-C, HDL-C, VLDL-C), Adiponectin (ADP)were measured and documented from participants included in this study. According to the results of hormones, there were substantial variations in all of the hormone levels. Thyroid Stimulating Hermon (TSH) was the highest level in Thyroid Dysfunction with Diabetes Mellitus type II: Hypothyroidism patients(0.46 ± 6.26) µIU/mL. T3 hormone was (187.84 ± 6.12) ng/dL, the highest resultin Thyroid Dysfunction with Diabetes Mellitus type Ⅱ: Hyperthyroidism patients. T4 was highest hormonal level in Thyroid Dysfunction with Diabetes Mellitus type II: Hyperthyroidism patients which was (14.02 ± 0.56) ng/dL. Fasting blood sugar (serum) measured a highly significant differences and highest level in patients who suffered from thyroid Dysfunction with Diabetes Mellitus type II: Hypothyroidism with (190.50 ± 12.72) mg/dL. Glycated hemoglobin (HbA1c) measured high significant differences with (11.13 ± 0.55) mmoL/L in patients of diabetes type II. Cholesterol, Triglyceride, LDL-C and VLDL-C high significant differences and highest levels were among patients with Thyroid Dysfunction with Diabetes Mellitus type II: Hypothyroidism with (209.45 ±12.29, 268.18 ±31.57, 114.24 ±13.74 and 55.98 ±5.63) mg/dL respectively, while HDL-C was significantly higher in control group. The Adiponectin had high significant differences among Thyroid Dysfunction: Hyperthyroidism patients with (17.98 ±1.43) ng/mL. In conclusion this data backs up the theory that inducing or suppressing adiponectin in individuals with thyroid dysfunction can help them in losing weight. Hypothyroid individuals with DM Type II and lipid abnormalities in their blood. This data is attributed to the idea that inducing or suppressing adiponectin in individuals with thyroid dysfunction might be a promising new treatment strategy. Adiponectin has been shown that’s involved in numerous physiological and pathological processes, including as inflammation and tissue remodeling. They may be crucial in the formation of adipose tissue and insulin resistance, and they have been linked to a number of inflammatory illnesses.

Investigation the Relationship Between Myonectin Levels and Both Lipid Profiles and Liver Function Tests in Diabetic Nephropathy Patients

Myonectin, or CTRP12, is a relatively recent adipokine—a protein released by adipose tissue that has gained interest in the context of metabolic health, including its possible implications in diabetic complications. Volunteers were divided into three groups, healthy subjects as controls (group A), they don't suffer from any disease, patients with T2D without nephropathy (group B) and T2D with nephropathy (group C), the age ranges between (35-70) years and the average duration disease of T2D (5-25) years, attending to the AL-Kindi teaching hospital, Baghdad Iraq. There was a highly significant increase P ≤ 0.01 of FBS, Insulin level, HOMA-IR, HbA1c, TC, TG, HDL and TSB among different groups (T2D with nephropathy, T2D without nephropathy, and control), a highly significant increase P ≤ 0.01 of myonectin levels among different groups. There was no significant difference present in AST U/L, and ALP U/L. A statistically significant increase in ALT U/L when compared with the control group. Conclusion: Levels of serum myonectin were significantly higher in patients with (T2D without nephropathy) as compared with ( T2D with nephropathy) and the control group.

Relationship between PSA and Serum Zinc in BPH-Afflicted Iraqi Men

Background: Benign prostatic hyperplasia (BPH) is a common benign tumor of the prostate that becomes more common as men age. The enlarged prostate may compress the urinary tube (urethra), which runs through the middle of the prostate, preventing urine from flowing from the bladder to the outside. Complete obstruction can develop if BPH is severe enough. BPH usually appears after the age of 40 and progresses slowly. Aim of the Study: Studying the connections between serum zinc and PSA in Iraqi BPH patients is the aim of this investigation. Patients and Methods: The case-control study lasted three months, from mid-November to the end of February, at Al-Kindi Teaching Hospital and Ghazy Al-Hariri Hospital in Baghdad Governorate, Iraq. It entailed gathering 90 blood samples, which were separated into two groups. The first group (A) consisted of 60 patients with benign prostatic hyperplasia ranging in age from 45 to 80 years, while the second group (B) consisted of 30 apparently be healthy males aged 45 to 80 years. All participants in this study provided diagnose permission. Patients diagnosed with benign prostate hyperplasia had an international prostate symptom score of 18 or higher; the patient's prostate volumes (PV) were equal to or more than 25 milliliters. Radiologists with competence in the department used transabdominal ultrasound equipment manufactured in Germany by Siemens to figure out how big the prostate gland is. Both groups had their serum zinc and PSA levels measured by ELISA (Enzyme-Linked Immunosorbent Assay) assays The calculation of BMI was be calculated with the help of given standard formula. BMI = [(Weight in Kilograms / (Height in Meters x Height in Meters)]. Results: The study that the mean prostate size was elevated significantly in the BPH group (54.0 ± 8.4 cc ) as compared with the control group (19.66 ± 2.88 cc (P:0.01). There is a significant increase in the PSA concentration of benign prostatic hyperplasia patients, (3.14 ± 0.95 ng/ml), as compare with control subjects, (0.84 ± 0.10 ng/ml) (P:0.01). There is significant reduction in the serum zinc concentration of benign prostatic hyperplasia patients, (70.4 ± 9.63 ng/ml), as compare with control subjects, (99.3 ± 10.5; p≤0.01). The higher percentage of benign prostatic hyperplasia in patients above 66 years, and the lowest is in age group 45-55 years. Conclusion: Benign prostatic hyperplasia patients of all ages had considerably higher serum PSA than age-matched healthy controls. Benign prostatic hyperplasia patients of all ages had considerably lower serum zinc than age-matched healthy controls. Prostate size and PSA are greater in benign prostatic hyperplasia patients of all BMIs. Benign prostatic hyperplasia patients had significantly lower serum zinc than healthy controls of the same BMI.

Evaluation of serum levels of Proinflammatory Cytokines IL-8, IL-17, and IL-22 in Helicobacter pylori infection and their association with the degree of gastritis histopathology in a sample of Iraqi patients

Gastritis can be defined as histological inflammation of the gastric mucosa. It can be classified according to the time course of the disease as acute or chronic, histological findings, anatomic location, and pathological mechanisms. The objective of this study was to evaluation of serum levels of the proinflammatory cytokines IL-8, IL-17 and IL-22 in Helicobacter pylori infection and their association with the degree of gastritis histopathology in a sample of Iraqi patients. The case-control prospective study consists of 60 patients who attended the Gastrointestinal Tract Center at Al-Kindy Teaching Hospital during the period from December 2019 to April 2020. In addition, the control group included 60 apparently healthy individuals. Biopsies from the gastric antrum and/or body mucosa were used to assess the severity of chronic inflammation, neutrophil infiltration, atrophy, intestinal metaplasia. Serum samples were obtained to determine H. pylori infection, circulating interleukin (IL)-8, IL-17, and IL-22. Results showed that the Patients’ ages with gastritis ranged from 18-75 years. The body mass index revealed that 33.33% of the patients were obese and 35% of them were overweight. Most of the patients with active chronic gastritis and superficial chronic gastritis had positive titers for anti-H. pylori IgG antibody (167.89 ± 3.18 IU/ml) and (150.74± 1.45 IU/ml) respectively, which was significantly different from the control group (4.36 ± 0.29 IU/ml) (P=0.0001). Histopathological analysis showed that all subjects experienced chronic inflammation, while neutrophil infiltration was found 36.66% and there was significant association between serum levels of IL-8, IL-17, and IL-22 with a degree of chronic inflammation and neutrophils infiltration. In conclusion, the most common cause of gastritis was H. pylori with histopathological lesions, showing neutrophils infiltration and chronic gastric mucosal inflammation associated with increased levels of IL-8, IL-17, and IL-22 in serum.

Assessment of the Nurses Practices Toward Care the Child with Clubfoot at the Orthopedic Units at Baghdad City

Objective(s): To improve the nurses' practice who working in the orthopedic units towards care the child with clubfoot and to find the relationship between the nurses' practices and their demographic characteristics. Methodology: A descriptive study was conducted at three teaching hospitals (Al-Kindi Teaching Hospital, Al-Wasiti Teaching Hospital and the Child welfare Teaching Hospital for the period from 17th of February to 2th of March of 2023. A non-probability sample had (60) nurses who working at the orthopedic units (included outpatient clinics, orthopedic wards and braces units). The pilot study performed for the period from 5th to 15th of February to 2023 on 6 nurses to test the reliability and applicability of the study tool and to determine the time consuming for doing it. The study tool constructed based on previous literatures related to the current study which included a nurses' socio demographic characteristics in part one while the second part as observational checklists in four domains. The data analyze through the spss program version (26) to interpret and explain the results of the study. Results: The results of the study showed the most (75%) of the nurses' practices in all domains were at low level (M.S less than 0.33) In regarding their demographic characteristics; the most (70%) of them were females, (40%) of them were within the age group (30-40 years) and 57.4% of them had a diploma in nursing. Conclusions: The study concluded that the studied nurses had an adequate practice regarding care of a child with clubfoot at the orthopedic units. While there on statistically significant relationship between the socio-demographic characteristics of the nurses and their nurses' practice. Keywords: Effectiveness, Clinical pathway program, Clubfoot, Child, Nurses’ Practices, Orthopedic units.

Risk factors associated with the development of coronary artery disease in the middle age group

Background: Acute coronary syndrome includes Unstable Angina and evolving Myocardial Infarction which is usually divided into ST-segment elevation Myocardial Infarction (ST-SEMI) and non- ST-segment elevation (non- ST-SEMI) or new onset Left Bundle Branch Block. Aim of the study: To assess the association between traditional risk factors and the development of cardiovascular diseases. Methods: A cross-sectional study, was conducted during the period from the 1st of January 2022 to the 1st of May 2023 at Alrusafa Directorate of Health /AL Kindy Teaching Hospital and Ibn Al-Nafees Hospital Results: The smoker patients were 48.5%, whereas 44.5% were overweight, and 18.5% of them were obese. 57.0% had hypertension, 41% had diabetes mellitus, and 41.5% had hyperlipidemia. The patients with ST-SEMI are (65.5%), while 15.5% of them had non- ST-SEMI. No significant association was obtained between the sociodemographic history and the type of ACS. Conclusion: Hypertension was the commonest prevalent disease among the patients followed by diabetes mellitus. A family history of the acute coronary syndrome is significantly associated with the type of acute coronary syndrome.

Nipple Discharge as Presentation of Underlying Breast Disease at Alkindy Teaching Hospital, Interventional Study

Nipple Discharge as Presentation of Underlying Breast Disease at Alkindy Teaching Hospital, Interventional Study

Nipple Discharge as Presentation of Underlying Breast Disease at Alkindy Teaching Hospital, Interventional Study

Nipple Discharge as Presentation of Underlying Breast Disease at Alkindy Teaching Hospital, Interventional Study

The influence of socioeconomic status and general health on the fracture incidence

Background/Aim: There is an association between patient general health, socioeconomic status and fracture incidence. Aim of this study was to demonstrate the relation between the socioeconomic and health status and the occurrence of fractures in Al-Kindy Hospital residents. Methods: A prospective cross-sectional study was performed by using data collected from fractured patients in Al-Kindy Teaching Hospital / Baghdad Orthopaedics Outpatient Clinic, between 12 December 2021 and 8 March 2022. A hundred patients aged 20 to 75 years were included in this study. The data were collected using a researcher-administered questionnaire, which included items to assess patient's socioeconomic status (accommodations, occupation, income status, level of education, owing motor vehicle) and assessed patient's health status (height, weight, presence of chronic disease(s), smoking status, alcohol consumption, water source quality, sun exposure, nutrition status). Results: A 100 patients from Al-Kindy Teaching Hospital between the age 20-75 participated in the study. The incidence of fractures was higher in younger and more active males (68 %) than females (32 %). Highest percent appeared in lower group of socioeconomic status (58 %) and in lower group of health status (44 %). There was a significant relation between health status and body mass index (BMI). Obese and overweight patient were the more vulnerable to fractures. Conclusion: Fractures are more likely to happen to people with low socioeconomic status, low general health status and overweight people.

Comparative prospective study of knee pain in medial pararpatellar and transpatellar entry for interlocking nail fixation of tibia fracture

Objective: To compare two insertion techniques of intramedullary interlocking nails (medial parapatellar versus intrapatellar insertion) in patients with tibial fractures. Methodology: This study was performed at Al-Kindy Teaching Hospital from August 2020 until March 2022. All 32 patients with tibial fractures (29 males and 3 females) were included for tibial closed nail fixation and then followed up for 6 months. We categorized these patients into two groups; Group A (16 patients), those treated by medial parapatellar insertion of an interlocking nail, and Group B (16 patients) with transpatellar tibial nail insertion. All patients were treated by the same surgical team. Results: The range of movement in two weeks (from extension to flexion) was up to 30°. At the end of the follow-up period, all patients in Group A had functional flexion greater than 90°, whereas three patients in Group B had limited flexion that necessitated scheduled physical therapy. Regarding the functional outcome, in group A patients and in group B patients, the mean International Knee Documentation Committee score demonstrated a better outcome in patients with medial parapatellar insertion than those in group B. According to the visual analysis score, the transpatellar insertion demonstrated more discomfort than that in the paramedial insertion group, both clinically and statistically. Conclusion: Medial entry point in intra medullary tibial nailing had less anterior knee pain in post-operative follow up.

Thyroidectomy in elderly ; is it safe?

Background: The prevalence of thyroid nodules rise with age and different data available about the risks of thyroid surgery in old age people. In general, old age could be a predictor of perioperative mortality and morbidity. The aim of this study is to prove if there is increased risk accompanying thyroidectomy in elderly patients. Subjects and Methods: Prospective study of one surgeon of study sample undergoing thyroid surgery at Al-Kindy teaching hospital and Saint Raphael hospital .This study was including two groups; group (A) involved patients 65 years and older, group (B) involved patients below 65 years old who were subjected to thyroidectomy. Taking in consideration histopathology results, indications of surgery (compressive symptoms, suspicious or confirmed malignancy, toxic goiter and recurrent goiter) and complications (including rates of temporary and permanent hypocalcaemia, temporary and permanent RLN paralysis, postoperative hematoma, wound infection and seroma), in addition to the risk of perioperative mortality. Results: There were 574 patients below 65 years and 127 elderly patients (>=65 years) who underwent thyroidectomy between January 2015 and December of 2018. There were no deaths in either group; no one had bilateral RLN paralysis. Old age patients had a lower frequency of complications in comparison to the younger counterparts, including transient hypocalcaemia (3.1% vs 14.8%, respectively) and temporary RLN injury (0% vs 0.69%, respectively), in addition to permanent RLN injury (0% vs 0.34%, respectively). Conclusions: Thyroidectomy in elderly is safe as compared to younger patients regarding perioperative complications

Pattern changes of cutaneous dermatoses among Iraqi women preceding and during the COVID-19 pandemic.

Background: We compared the pattern of cutaneous dermatoses among Iraqi females of all ages between 4 months preceding the coronavirus disease 2019 (COVID-19) pandemic, and the same months 1 year later within the COVID-19 pandemic. Methods: This was a cross-sectional study, that targeted all female patients attending an outpatient clinic for dermatology and venereology in Al-Kindy teaching hospital, Baghdad between October 2019 to the end of January 2020, and the same 4-month duration 1 year later (October 2020 to the end of January 2021) after the COVID-19 peak period had passed and there was no or partial curfew to exclude seasonal impact. Results: A total of 2657 female-patients of all ages were enrolled in this study with 1314 females during the 4 months pre COVID-19, and 1343 females during the pandemic. The mean age of patients presented before the pandemic was 27.2±16.6 years, while the mean age of patients during the pandemic was 28.1±15.6 years with no statistically significant difference in mean ages (P >0.05). Hair loss in general with telogen effluvium specifically increased significantly. Cutaneous contagious viral infections were reduced significantly and specifically of these molluscum contagiosum and condylomata accuminata. Other forms of infections including bacterial and parasitic were also reduced while dermatophytosis was increased but not to a significant level. Acne vulgaris, rosacea, lichen planus, urticaria, pityriasis rosea, seborrheic dermatitis, and vitiligo were increased, but psoriasis, alopecia areata, other types of dermatitis, and melasma were reduced but none to a significant level. Conclusions: The COVID-19 pandemic resulted in changes in the pattern of diseases presented to an out-patient clinic for dermatology and venereology. This could be either related to COVID-19 infection or stress associated with the pandemic, because of curfew, or wearing facemasks which maycause a decrease or increase in certain diseases.

Early Enteral Feeding Versus Delayed Enteral Nutrition: Effects On Morbidity After Intestinal Surgery; A Prospective Study

Routine practice after bowel anastomoses has been to keep patient nil per oral till the return of bowel sound with a belief that this will prevent postoperative nausea and vomiting and protect the anastomotic site where, however this trend had been changed to encourage enteral feeding as early as possible as various studies has shown early enteral feeding to be beneficial in terms of nutritional, immunological aspect and for faster postoperative recovery of patient.
 Objective; To study and compare the effects of early enteral feeding with those of conventional management in postoperative patients undergoing intestinal primary suturing or direct repair.
 Patients and methods ; A prospective interventional study conducted for 135 patients with an age range between 15 – 67 years old who admitted to the general surgery Department in AlKindy Teaching Hospital, Baghdad, Iraq for the period between 1st of March 2019 and 1st October 2021. The patients were randomly assigned to schedule with starting oral feeding on the first day after surgery, referred to as early feeding group and those with delayed oral feeding till first passage of flatus and bowel movement, referred to as regular feeding group and compared overall prevalence of postoperative complication, length of hospital stay and outcome of surgery in these two groups.
 Result; There was less post operative complication in early feeding group as compaired with regular feeding group patients. Twenty percent patients developed post operative vomiting in early feeding group and sixteen percent patients in regular feeding group. Post operative fever occurred in five percent patients in early feeding group while sixteen percent patients in regular feeding group sufferd from postoperative fever. Abdominal distension noted in five percent patients in early feeding group while sixteen percent patients in regular feeding group. The average length of hospital stay in patient belong to early feeding group was 2-5 day while patient in regular feeding group stayed in hospital for average 3-8 days. 
 Conclusion; There is more benefit from early oral feeding than delay oral feeding strategy in incidence of postoperative morbidity and period of hospital stay after intestinal surgery.

Procalcitonin as Predictor of Bowel Injury in Penetrating Abdominal Injury

Background: Diagnosis of bowel injury may be considered one of the difficulties in penetrating abdominal trauma. Aim of the Study: The aim of this study is to estimate the predictive ability of procalcitonin in diagnosing bowel injury in multiply injured patients. Patient and Methods: In a cross-sectional study at the Emergency Department of Al-Kindy teaching hospital over 1 year, patients were had penetrating abdominal trauma, and measurement of procalcitonin to all participants to estimate its predictive ability. Results: Procalcitonin was found to be a single independent predictor of bowel perforation with sensitivity of 90.3%, specificity of 80.6%, and cutoff point of 4.5 ng/ml. Conclusion: Procalcitonin level of more than 4.5 ng/ml in cases of penetrating abdominal injury may be considered an aiding predictor for bowel perforation, thus shifting the treatment toward surgical intervention.

Pattern changes of cutaneous dermatoses among Iraqi women preceding and during the COVID-19 pandemic

Background: We compared the pattern of cutaneous dermatoses among Iraqi females of all ages between 4 months preceding the coronavirus disease 2019 (COVID-19) pandemic, and the same months 1 year later within the COVID-19 pandemic. Methods: This was a cross-sectional study, that targeted all female patients attending an outpatient clinic for dermatology and venereology in Al-Kindy teaching hospital, Baghdad between October 2019 to the end of January 2020, and the same 4-month duration 1 year later (October 2020 to the end of January 2021) after the COVID-19 peak period had passed and there was no or partial curfew to exclude seasonal impact. Results: A total of 2657 female-patients of all ages were enrolled in this study with 1314 females during the 4 months pre COVID-19, and 1343 females during the pandemic. The mean age of patients presented before the pandemic was 27.2±16.6 years, while the mean age of patients during the pandemic was 28.1±15.6 years with no statistically significant difference in mean ages (P >0.05). Hair loss in general with telogen effluvium specifically increased significantly. Cutaneous contagious viral infections were reduced significantly and specifically of these molluscum contagiosum and condylomata accuminata. Other forms of infections including bacterial and parasitic were also reduced while dermatophytosis was increased but not to a significant level. Acne vulgaris, rosacea, lichen planus, urticaria, pityriasis rosea, seborrheic dermatitis, and vitiligo were increased, but psoriasis, alopecia areata, other types of dermatitis, and melasma were reduced but none to a significant level. Conclusions: The COVID-19 pandemic resulted in changes in the pattern of diseases presented to an out-patient clinic for dermatology and venereology. This could be either related to COVID-19 infection or stress associated with the pandemic, because of curfew, or wearing facemasks which maycause a decrease or increase in certain diseases.

Incidence of Needle Stick and Sharp Items Injuries Among Nurses At Al-Kindy Teaching Hospital

Background: This paper aimed to assess the rate of NSIs among the Iraq nursing staff at Kindy teaching hospital Methods: A descriptive study was conducted to collect information about the rate of acupuncture accidents among nurses at Al-Kindi Teaching Hospital. Results: (77%) of the sample were in the stage group of 20-30 years. while the majority of the sample (74%) was female. Regarding the educational level, the high percentage of high school with 52%, followed by the institute of nursing with a 22% about experience years the majority of sample 70% were 1-5 years in hospital. Among the nurses involved in the study, 72% were injured in acupuncture sharps while 64% did not participate in training courses about NSIs Conclusion: Nursing workers suffer a high rate of sharp injuries, which can increase the chances of a disease and its consequences. Emphases of researcher's mast increasing the nurses’ awareness and skills, holding workshops, finally, the importance of completing the hepatitis B vaccine course can be effective in reducing the incidence of infections and the risks of infectious diseases. Keywords: nurses, needle stick injuries, and sharp object.

Incidence of Erythema Multiforme among Patients with ORF Disease in Al-Kindy Teaching Hospital

Background: ORF virus has a worldwide distribution among sheep and goats. The hypersensitivity reaction, erythema multiforme (EM) is a known complication of ORF infection in humans; however, its occurrence is poorly understood and has not been extensively reviewed. Aims of the Study: To assess the incidence of EM among patients with ORF infection and to find the association of EM incidence to age, gender, and occupation of the patients. Method: A cross-sectional study of analytic design was conducted between 1st January 2018 and 31st December 2018 at Al-Kindy Teaching Hospital. Thirty cases of age ranging from 16 to 65 years who were clinically confirmed with ORF with and without EM eruption were included in this study. Data related to age, gender, occupation, complete clinical history, time of getting ORF infection and EM eruption was collected. Results: The finding of the current study showed that the mean age of studied sample was 36.1 ± 9.1, 19 (63.3%) participants were less than 40 years of age, 24 (80%) were female, 24 (80%) were housewives, and 9 (30%) ORF patients were presented with EM. 4 (44.4%) patients got EM infection in the first week of ORF infection and 3 (33.3%) in the 2nd week. No significant association (p ≥ 0.005 for all) was found between the status of EM and age category, gender and occupation of the patients. Conclusion: We could conclude that the incidence of EM was relatively high among patients who had ORF infection.