Karbala City Research Articles

Estimating the Prevalence of Primary Hypothyroidism in Karbala City, and Modulation of Clinical Manifestations Among Patients Receiving Levothyroxine; A Single Center Study

Background: Hypothyroidism has a wide range of clinical manifestations and general symptoms, including but not limited to obesity, tiredness, poor concentration, depression, widespread muscle soreness, menstruation abnormalities, and constipation. The administration of a daily dosage of levothyroxine is sufficient for the successful management of hypothyroidism, as it facilitates the restoration of serum thyroid stimulating hormone (TSH) levels to their normal range. Several factors can influence the absorption of levothyroxine in the human body, including age, weight, the presence of other medical problems, and dietary intake. The aim of this study was to assess the prevalence of primary hypothyroidism and alteration in clinical presentation associated with replacement therapy. Methods: This was a cross-sectional, observational study conducted over at Al Hassan Metabolism, Endocrine, and Diabetes Center (HMEDC) in Karbala city. The study team created a questionnaire, and data was collected from face-to-face patient interviews, which included various sociodemographic variables, TSH and ferritin levels, drug interactions, as well as signs and symptoms exhibited both prior to and following treatment. Additionally, the patient treatment regimen and the specific doses of levothyroxine administered are also recorded. Results: the total number of cases visited Al Hassan Metabolism, Endocrine, and Diabetes Center (HMEDC) during the study period was (10800). The prevalence of thyroid diseases was 300 (2.8%). The rate of primary hypothyroidism out of the total number of hypothyroid cases was 85.1%. (61%) of the patients had normal levels of TSH whereas (42%) of the patients were found to be undertreatment. A total of (84%) of the patients exhibited normal levels of ferritin. The patients exhibited a reduction in their signs and symptoms following the administration of therapy. Conclusion: treatment with levothyroxine improved sluggish speech, constipation, lack of appetite, cold sensitivity, weight gain, and weariness. There is no observed correlation between the dosage of levothyroxine and the manifestation of signs and symptoms.

Flow Cytometry Analysis of CD4⁺ and CD8⁺ T Lymphocytes in COVID- 19 Patients

The clinical presentation of COVID-19 varies greatly from case to another, with host characteristics playing a pivotal role. The immune system is a pivotal function in establishing the course of SARS-COV-2 infection. Severe instances of COVID-19 and the resulting death are caused less by the virus itself than by the destructive unrestrained immune response. Among the host determinants for poor disease prognosis is probably genetic vulnerability to dysregulated immune response. The objective of this work is to examine some of the host genetic variables that are being studied in relation to the severity of COVID-19. The complex relationship between autoimmunity and the pathophysiology of COVID-19 was examined. Patients with COVID-19 were recruited from AL-Dewaniyah Teaching Hospital and AL-Hussain Teaching Hospital in Karbala city. All patients had been diagnosed with the virus using real-time polymerase chain reaction. A total of 70 blood samples (35 from the mild group, 35 from the severe group, and 35 from the controlled group) were obtained in EDTA tubes. Orderly to investigate the correlation between the progression of disease and variations in specific regions of host immunoassays had been used by flow cytometry. The results of the flow cytometry were reported as the average percentage of positive cells for CD4 and CD8 immunological markers. Cases with COVID-19 had a substantially lower mean CD4 concentration than the healthy patients. Furthermore, the mean concentration of CD8 was significantly lower in cases with COVID-19 than in healthy. In addition, there is significant (P 0.001) decline in both CD4 and CD8 mean levels between patients with severe and mild COVID-19.

Assessment of Iraqi dental practitioners' and undergraduate students' knowledge regarding dentin hypersensitivity management: A cross-sectional study

Objective: The characteristic of dentin hypersensitivity is brief, intense pain that results from exposed dentin in reaction to a variety of stimuli, including mechanical, thermal, osmotic, or chemical factors. This study aimed to evaluate the level of knowledge among undergraduate students and practicing dentists in Karbala City, Iraq, concerning the mechanisms, etiology, and treatment of dentin hypersensitivity (DH). Methods: 102 surveys were distributed via Google Forms to general practitioners and fourth- and fifth-year dental students at the Kerbala College of Dentistry in Iraq. The data were inputted into Microsoft Excel and analyzed using SPSS 22.0 for Windows as frequency distribution tables and figures. Results: Despite the differences in comprehension and expertise between students and dentists, a comparative analysis of their responses to various questions revealed several similarities. According to the survey, 28.8% of students reported that 10% of patients suffered from DH, while 32% of dentists reported the same. Additionally, 72% of dentists and 71.2% of students stated that DH is a severe problem for patients. Both dentists, 30%, and 26.9% of students, indicated that DH lasted for less than 2 weeks. According to dentists and students, females are more affected by DH (74%; n=37) and (71%; n=37), respectively. Conclusion: Students and dentists showed a similar level of knowledge on DH.

Gas Turbine Performance Enhancement and Evaluation for Power Generation in the City of Karbala, Iraq

Gas Turbine Performance Enhancement and Evaluation for Power Generation in the City of Karbala, Iraq

Influence of perceived leadership styles on burnout among nurses

The study examines the relationship between nurses' job burnout and leadership styles in Karbala city teaching hospitals. The research was conducted in Iraq, in the city of Karbala, and included 324 nurses to explore how leadership styles and demographic factors affect job burnout. The results reveal a relationship between leadership style and reduced burnout among nurses, suggesting that effective leadership can positively impact nurses' well-being. Most of the participants were young people, and females constituted a large proportion of the sample. This study emphasizes the importance of leadership in alleviating nurse burnout and improving overall job satisfaction.

Applying SWOT Analysis to Manage Maintenance of Municipal Water Projects in Karbala City

Applying SWOT Analysis to Manage Maintenance of Municipal Water Projects in Karbala City

Microfacies and Sedimentary Environments of Nfayil Formation (Middle Miocene) in Karbala Using Stable Isotope

A surface section of the Nfayil Formation (Middle Miocene) was studied approximately 80 km from the holy city of Karbala. The study area includes the Malutiyat area's Nyfail Formation (Middle Miocene age). The Nfayil Formation contains marls interbedded with limestones, as well as marly limestone. Fieldwork and petrographic analysis are being conducted on Miocene sediments from the Karbala region. Details obtained from textural and faunal properties aided in the designation of microfacies zones, which led to environmental subdivisions as a ramp. The carbonate lithic arenite sandstone has a significant amount of carbonate fragments. Microfacies characteristics of the whole successions showed skeletal and non-skeletal grains. The oysters, an index fossil of the Nfayil Formation are found in the lower part of the Nfayil Formation. The stable isotopes 18O/16O and 13C/12C in carbonates are analyzed to define the depositional characters and the basin paleo depth. The studied samples have negative δ18O isotope values (average -11.79 %). The carbon isotope composition is of positive values (average 2.16‰), The Z values, higher than 120, reflect the marine sediments of the formation. Four facies were identified, (Lime mudstone Microfacies, Sandy Lime mudstone Microfacies, Peloidal Bioclastic Packstone-Wackestone Microfacies, Bioclastic Wackestone Microfacies) and based on them, the formation environment was determined (restricted marine, and shallow open marine environments).

Comparison of General Anesthesia and Spinal Anesthesia on Hemodynamic Stability in Patients Undergoing Hernia Repair

Introduction. The issue of choosing the optimal anesthesia that is least dangerous to the patient’s life is still the main concern of the workers in the anesthesia and intensive care department, including techniques, medications, plans, and instructions followed in order to choose the best anesthesia. It can also be said that spinal anesthesia is the best and most standard anesthesia for those who repair hernia.The aim of the study — learn about obtaining and verifying hemodynamic stability in patients undergoing hernia repair under anesthesia.Materials and methods. An accurate and recent study of patients attending Al-Hussein Medical City and Al-Hassan Hospital in the city of Karbala. We included 100 patients who underwent a herniotomy, were divided into two groups on the types of general and spinal anesthesia. Fifty patients received general anesthesia and 50 patients received spinal anesthesia. Data related to the patient’s age, weight, change in blood pressure and pulse rate were analyzed. The study analyzed patients aged 20–90, dividing them into two groups: general anesthesia (GA) and spinal anesthesia (SA), for careful follow-up before, during, and after operations.Results. We show that it is also more stable in SA which is about 56 % in comparison to GA which is about 40 % but increased blood pressure is more in GA which was 32 % and 24 % in SA, but decreased blood pressure is also more in GA which was 28 % and in SA was 20 %. In this study, as shown, there is more stability in heart rate, which is 56 % in SA but in GA it is 32 % and the increase in heart rate was 34 % in SA but was 60 % in GA. The decreased heart rate was 10 % in SA and about 8 % in GA and the effect of SA is more stable.Conclusions. We found spinal anesthesia was more than general anesthesia in stability of blood pressure and heart rate and minimum or normal.

Energy management enhancement of a smart home supplied by renewable energy system

Solar energy is a reliable and eco-friendly solution for power outages in Karbala, Iraq. This study presents a smart grid technology model for energy management in electrical systems, optimizing power schemes and economic benefits through a unique spatial distribution approach in Iraq, with the primary objective of ensuring consistent base loads for smart homes while achieving other economic goals. The algorithm’s effectiveness was tested in three different scenarios. The energy was supplied by the national grid and battery bank-powered base loads. Meteorological data, including temperature and solar radiation, was gathered from a station in Karbala city for testing and evaluation. The study found that energy consumption decreased by 85% in April, with solar energy accounting for 37% of the total consumption. Smart homes saved 48% of energy, reducing reliance on the grid to 15%, as well as the reduction of energy consumption reached up to 47% and 60% in January and July, respectively, with solar energy estimated at 14% and 26% in those months.

Three-Dimensional Determination (Morphometric Study) of Arch Perimeter and Palatal Depth in an Iraqi Sample Aged 17–25 Years with Sickle Cell Anemia: A Cross-Sectional Study

Sickle cell anemia (SCA) is a hereditary disorder caused by the substitution of valine for glutamic acid in position six of globin's beta chain. Segmental arch dimensions, arch perimeter, and palatal depth comparison between SCA and control using the three-dimensional (3D) technique was the aim of this study. This cross-sectional investigation was carried out in Karbala City. The sample consisted of 200 casts (100 SCA and 100 control). Each group consisted of 50 casts upper, and 50 casts lower (25 males and 25 females). The arch perimeter was calculated using two segmented arch lengths bilaterally. Palatal depth was measured from the mesiolingual cusp tip of the upper first permanent molar to the corresponding palatal vault. The difference between the control and SCA groups was calculated using the independent t-test. Except for lower left incisal to canine distance (LLI-C), where p = 0.01 there was no significant difference in segmental arch measurements and perimeter between males in SCA and males in control. There was no significant difference in segmental arch measurements and perimeter between females in SCA and females in control. There was no significant difference in palatal depth between the control and SCA (male and female). SCA did not affect the segmental, arch perimeter, and palatal depth measurements.

A retrospective survey on follow-up of splenectomy patients due to β-thalassemia and Sickle cell Anemia in Karbala, Iraq during 2010-2023

Background: Hemoglobinopathy is considered a common monogenetic genetic disorder worldwide. Splenectomy is considered a therapeutic strategy in patients with hemoglobinopathy. The aim of current study was to provide a survey on the splenectomy and 5 years follow-up in different clinical forms of β-thalassemia (intermedia, Major) and Sickle cell Anemia (SCA) patients who referred to Hereditary Blood Disease Center in the Karbala Teaching Hospital for Children in Karbala, Iraq. Materials and Methods: In this retrospective study we tried to evaluate 126 hemoglobinopathy and thalassemia patients from Karbala City, Iraq. All cases of splenectomy due to hemoglobinopathy and thalassemia during 2010-2023 who referred to the Hereditary Blood Disease Center in the Karbala Teaching Hospital for Children in Karbala, Iraq were included. Patient data was collected at three-time points. The first was after the splenectomy, the second during 1-5 years, and the third step after 5 years. Clinical and laboratory data were retrieved from the patient’s file. Results: The mean age of splenectomy of included patients was 14.1±7.5 years. From 126 cases, 103 (81.74%) were β-Thalassemia, 13 (10.32%) were SCA, and 10 (7.94%) were Sickle cell beta-thalassemia. The mean age in SCA was significantly less than two other groups (mean age in β-Thalassemia, SCA and Sickle cell beta thalassemia were 18.2±8.7, 24.2±12.7 and 25.2±9.5, respectively) (p=0.008). Platelet and WBC count represents a significant increase during 1-5 years after splenectomy in comparison with 1 year after splenectomy (for Platelet and WBC p=0.03 and 0.001, respectively). Conclusion: splenectomy is considered the last therapeutic option in hemoglobinopathy patients. All Hemoglobinopathy patients represented significant improvement after splenectomy. Because there was no suitable treatment in the past, splenectomy was considered a therapeutic solution. It should be said that periodic follow-up of splenectomy patients in hemoglobinopathy plays an important role in improving the management of these diseases.

Salivary Biophysical Properties in Relation to Dental Caries Severity Among Type 1 Diabetic Children

Diabetes Mellitus is a multifactorial metabolic disorder characterized by elevated blood glucose levels or hyperglycemia. Diabetes Mellitus may cause many oral problems as a result of both micro- and macrovascular complications. We aimed to assess the probable relationship between the severity of dental caries and the biophysical properties of saliva (flow rate, PH, and viscosity). Materials and Methods: A cross-sectional comparative study was conducted in Karbala City, in which a sample of 45 children with type 1 diabetes aged between 10-12 years was compared with a group of 45 non-diabetic children matched in age and gender. Dental caries severity and experience were recorded and diagnosed using Manji et al.'s criteria and the decayed, missing, and filling index (DMFS/dmfs). Unstimulated salivary specimens were collected to evaluate flow rate, pH, and viscosity. Pearson (r) correlation coefficient test and one-way ANOVA test were employed for data analysis using SPSS-22. Results: Salivary levels of viscosity and flow rate were not statistically significant (P > 0.05) predicators regarding the dental caries experience and severity among type1 diabetic children (controlled and uncontrolled) while pH level of saliva was a statistically significant predictor regarding dental caries experience (DS/ DMFT) among uncontrolled diabetic children. Conclusion: Compared to non-diabetic children, type 1 diabetic children exhibited pronounced changes in salivary biophysical properties but unpronounced changes in caries status.

Geogrid reinforcement for improving bearing capacity and stability of square foundations

Abstract Shallow foundations are often the most economical option for building support, as they distribute structural weight to soil layers, require minimal earthwork, and do not necessitate specialized machinery. The most common type of soil in the city of Karbala is sandy soil. It is granular and loose by nature which has a relatively low bearing capacity. According to previous studies, the soil weakness is one of the problems with shallow foundation construction. Thus, the aim of this study is to improve the properties of the soil using geogrid reinforcement. Three critical parameters are examined, including depth, size, and number of geogrid layers in the soil reinforcement process to increase bearing capacity and decrease soil settling. The effect of geogrid depth (u) was studied by considering four depth ratios (u/B = 0.5, 1.0, 1.5, and 2.0) in order to determine the ideal depth of the geogrid layer, where (B) refers to the width of the footings. The results indicated that a decrease in depth ratio significantly increased the bearing capacity of footings built on reinforced soil layers compared to those built on natural soil, and the settlement reduction ratio (SRR) also increased. The size of the geogrid layer (i.e., width of the geogrid layer (b) was evaluated by evaluating four size ratios (b/B = 1.5, 3.0, 4.5, and 6.0). With an increasing size ratio of the geogrid layer, the bearing capacity ratio (BRC) was significantly improved. Additionally, the study examined the optimal number of geogrid layers, focusing on single and multiple layers with N = 1, 2, 3, and 4. The results showed a higher BRC for footings on reinforced soil layers, as well as a significant rise in SRR with an increase in the number of geogrid layers. Finally, it was concluded that the optimal depth ratio was u/B = 0.5, the size ratio was b/B = 4.5, and reinforced with three geogrid layers, which provided the highest bearing capacity and SRR. The experimental test results were verified by comparing them with those calculated using theoretically developed models. The variation between the experimental and theoretical results is reasonable, confirming that the experimental testing results exhibit a high degree of accuracy.

Visualizing sustainable rainwater harvesting: A case study of Karbala Province

Abstract The management of rainwater collection in a practical way is a fundamental need for the management of water resources in a manner that is sustainable. The goal of this research is to determine whether or not remote sensing technology is effective in providing data on precipitation for the purpose of locating rainwater collection tank locations in the province of Karbala. Rainfall patterns fluctuate considerably. Remote sensing may not capture variability enough to estimate the rainfall period and location. Sustainable rainfall harvesting requires accurate rainfall timing and distribution. This information is applied in the modeling of hydrological processes, the management of disasters, and environmental research. Following the completion of a geographical study, it has been established that the city of Karbala may be divided into two basic sections. Through the use of estimation, it is possible to more easily identify the region that is ideal for the location of rainwater-harvesting reservoirs and lakes. On the contrary, it is crucial to keep in mind that a location that was chosen based on average rainfall over a period of two years could not be suitable for other time periods. This is an idea that should be kept in mind several times. To put this into perspective, when choosing a location, it is vital to take into consideration the severity of the rainfall as well as the geographical location of the area. Particularly in locations such as Karbala, the implementation of data visualization systems into water management practices has the potential to improve both the efficiency and sustainability of water management methods. The findings of this study show the significance of implementing precise site selection techniques to enhance rainwater collection systems and encourage activities that are environmentally responsible for water management.

Association between Dietary Habits and Nutritional Status among Adolescent Girls

Background: Adolescents with good eating habits are more likely than those with bad eating habits to learn normally and do better academically. Dietary habits refer to the long-term dietary patterns that an individual forms and maintains in his daily life. Objectives: The study aims to assess influence of dietary habits of adolescent girls on nutritional status and identify if their association between pattern of dietary habits and nutritional status among adolescent girls. Method: A cross-sectional study was conducted with 400 students from middle and secondary schools in Karbala City, Iraq. Data were collected from December 2o, 2023 to February 4, 2024, Data collection was performed using self-report instrument and it is organized into three sections, include, dietary habits, nutritional status and sociodemographic data. Data were analyzed utilizing descriptive and inferential statistics. Result: That 61% of female adolescents have normal weight and 20.2% of female adolescents have underweight but 12% of them have overweight. Exhibits that female adolescent having moderate dietary habits as reported among 73% of them (M±SD= 11.96 ± 1.81. Conclusion: The eating habits of adolescent’s girls do not affect the nutritional status, and most of them have healthy eating habits, while about one fifth of them have unhealthy eating habits, and more than a third of them had an abnormal body mass. Which indicates the importance of involving them in healthy awareness programs about healthy nutrition and ways to maintain a normal level of body mass.

Pregnancy Self-Care Gaps Between First-Time and Experienced Mothers in Iraq

This study explores self-care behaviors among primigravida and multigravida women in Holy Karbala City, focusing on managing minor pregnancy discomforts. Amidst hormonal changes that alter the maternal body, understanding and implementing effective self-care is pivotal for pregnant women's health. This descriptive quantitative research utilized a non-probability sample of 350 women across three trimesters, analyzed using SPSS version 26. Results indicate that self-care behaviors were moderate overall and similarly moderate concerning minor discomforts. A significant correlation was found between the women's self-care behaviors and their educational level, occupation, family type, gravidity, number of abortions, parity, and length of marriage, with respective p-values of .001, .002, .004, .001, .002, .008, .050, and .011. The findings highlight the necessity of targeted educational strategies to enhance self-care practices among pregnant women, addressing demographic and reproductive characteristics that influence these behaviors. Highlights: Moderate Self-Care: Both primigravida and multigravida women displayed moderate self-care for pregnancy discomforts. Correlation with Demographics: Self-care behaviors correlate significantly with education, occupation, and family type. Need for Education: Findings suggest enhancing educational programs to improve self-care among pregnant women. Keywords: Pregnancy Self-Care, Primigravida, Multigravida, Discomfort Management

Feasibility of Photovoltaic-Powered Hydrogen Production for Off-Site Refueling Stations in Iraqi Cities: A Techno-Economic Analysis

The study explores the feasibility of using a photovoltaic (PV) energy system to produce hydrogen for off-site hydrogen refueling stations (HRS) in three Iraqi cities (Karbala, Maysan, and Nineveh), focusing on a comprehensive system model consisting of a 558 MWp off-grid photovoltaic system, a 157.5 MWp proton exchange membrane (PEM) electrolyzer, a converter, and a hydrogen storage tank. Utilizing HOMER Pro software for system simulation and MATLAB, with consedaring 28 years from 2022 to 2050 life span, incorporating hourly weather data for 2022 to optimize system performance. The outcomes identify that the Karbala city as the most cost-effective for green hydrogen production, highlighting the economic benefits of PV technology, which presents the most economical option with a levelized energy cost of $5,010/GWh. The project is projected to produce 10.61 million kg of hydrogen annually at a production cost of $2.75/kg, with an overall project cost estimated at $372.77 million. The results are of strategic significance for Iraq transportation sector, supporting the development of a robust green hydrogen infrastructure for HRS. This infrastructure is expected to promote sustainable transportation practices and reduce reliance on fossil fuels, contributing significantly to the energy transition in Iraq. This techno-economic analysis provides a foundational assessment for stakeholders considering investments in renewable hydrogen production and infrastructure development.

Investigation of Interleukine-1 Beta in Urinary Tract Infection Patients

Objective: The study aims to investigate interleukin -1 beta (IL-1 ) in patients with urinary tract infections in the holy governorate of Karbala. Methods: This study was conducted during the period from October 2023 to February 2024 at Imam Hussein Hospital in the holy city of Karbala and the laboratories of the College of Applied Medical Sciences/University of Kerbala. The current study included collecting urine samples (for use in general urine examination) and blood (using blood directly to measure the complete blood count CBC and serum to measure interleukin -1 beta (IL-1 ) from 70 patients with urinary tract infection (35 patients with positive bacterial growth and 35 patients with negative bacterial growth) in addition to 70 healthy people. The following general criteria were also investigated: age, sex, height, and weight. Results: Eight bacterial species were obtained. From the findings of the study is the increase in concentration of IL-1 in patients with urinary tract infections compared to the control group. The presence of a negative correlation between LBP and IL-1 . Conclusions: Increase the concentration of IL-1 in patients with urinary tract infections. There is a negative correlation in patients with bacterial growth between LBP and IL-1 .

Evaluation of Lead Ion in the Wastewater of the Lifting and Treatment Stations Using ICP-MS and CPE Methods

To pre-concentrate trace amounts of lead before determining it by UV-vis spectrophotometer, a new method for micelle-mediated phase separation has been created. The process depends on the extraction of lead from iodine media using Triton X-114 in the cloud point extraction method without the need for any chelating agents, where the optimal conditions for the method were achieved, which temperature 50 °C, pH 4, and 30 mmol L−1 concentration of KI, 0.3 mL of 2% (v/v) Triton X-114, and time of 10 min in the water bath. Linearity was followed between 1 and 16 µg/mL of lead concentration. The method's lead detection limit is 0.1 µg/mL and %RSD 3.633. Additionally, the interference impact of certain cations was evaluated. The proposed technique was successfully applied to determine the lead ion in the wastewater in ten different stations in the center and district of Al-Hur in Karbala City. The lead ion of the wastewater of the stations under study was also determined directly using inductively coupled plasma-mass spectrometry (ICP-MS) technology comparing its results with the new method and performing the statistical analysis of both methods. The p-value was less than 0.05, showing significant differences between both methods.

Correlation Study Between Shortness of Breath, Fever, Severe Cough, and Hypoxemia in Corona Patients

Our current research includes a study of the correlation between some of the most important symptoms associated with infection with the corona virus, and hypoxia in the blood, especially after its attachment to the wall of the epithelial lining of the pulmonary alveoli sacs directly, and the completion of the incubation cycle in the lungs as well. And it is known that infection with the corona virus leads to poor performance and function of the lungs in the required manner before infection, due to the exposure of the wall of the pulmonary alveoli to inflammation through a significant increase in its thickness. The number of patients indicated for each month, and the total number for the year, which is about (8999) patients , through which we can determine whether there is a significant difference between them or not, in addition to that we can show through the percentage of each type of symptoms that appear on corona patients (fever, sever coughing, shortness of breath: 75 %, 68 %, 34 %) respectively, the relationship between them and oxygen level in the blood. Objective: Observing the most important symptoms that lead to hypoxia in the blood, and controlling them, which leads to a gradual improvement in the patient's condition, and this study gives a qualitative clarification in the possibility of controlling the infection. Methods: Collecting statistical data from a group of specialized medical clinics in Karbala Governorate and documenting them for a full year according to the months of the year for the period from 7/2021 to 7/2022. Results: Samples collected from a group of outpatient medical clinics from different regions of the city of Karbala, for the period from July 2021 to July 2022, corresponding to the data of World Health Organization (WHO). The study of the correlation between the symptoms represented by fever, shortness of breath, severe cough, and hypoxemia is done on the third stage in particular. Conclusion: We conclude from our current study that there are no significant differences between the number of patients and the three stages type that recorded through this periodic time, even if there is a difference in age and gender