باسم عبدالله محمدحسن المظفر

Introduction Human Echinococcosis is a zoonotic disease (a disease that is transmitted to humans from animals) that is caused by parasites, namely tapeworms of the genus Echinococcus. The diagnosis of hydatid disease is based on clinical assessment, serology, ultrasonography (USG). Hydatid cysts may be found in almost any part of the body but are most often found in the liver (60 %) and lungs (30 %) [1]. Breast involvement is rare accounting for only 0.27 % of the localization [2]. We report a case of 19 years old female who presented as a case of breast lump, which was later confirmed to be a case of hydatid cyst of the breast. H ydatid disease is rare in this part of the country, and hydatid disease of the breast is even rare. Key wards: hydatid cyst, triple assessment and ultra-sound scan

Wuchereria bancrofti is a human parasitic worm (Filariworm) that is the major cause of lymphatic filariasis. It is one of the three parasitic worms, together with BrugiaMalayi and B. Timori, that infect the lymphatic system to cause lymphatic filariasis. These filarial worms are spread by a variety of mosquito vector species. The usual form presentation of the disease is as hydrocele, acute or chronic lymphatic obstruction or subclinical microfilaremia. Finding of Wuchereria bancrofti in a cytological smear from upper arm abscess is a rare presentation. We discuss here a case of 19- years old female with recurrent abscesses and small ulcers in the arm and forearm. FNAC smears Cytology revealed sheathed microfilaria without any nucleus in the tail end confirming the species as Wuchereria bancrofti. The case is highlighted the rare presentation of WB and the role FNAC smear cytology in diagnosing filariasis.

Abstract:Pancreatic adenocarcinoma has high prevalence and mortality. Disease is more common in individuals over 70 and rarely occurs before the age of 40.Contributory factors for pancreatic cancer include advance age, male gender, more common in African American than African in their native Africa, smoking, obesity, family history, chronic pancreatitis, diabetes mellitus, red and processed meat, and strong evidence with heavy drinking. Pancreatic Adenocarcinoma (exocrine type cancer) are more common than neuroendocrine type cancer. In the early stages there are no symptoms of the disease. Pain in the upper stomach, jaundice, unexplained weight loss, tumor may compress neighboring organs, and 50% ofpatients with pancreatic adenocarcinoma also have diabetes. Diagnosis by medical imaging. Treatment with surgery, radiotherapy, chemotherapy and palliative care. Prevention, not smoking, limiting the intake of red and processed meat, healthy weight, and consumption of fruits and vegetables. Early detection and treatment have better outcome. Keywords: Adenocarcinoma, non-endocrine cancer, Management, Prognosis,

Abstract:Diabetes mellitus (DM), a chronic metabolic disorder with no known cure. In 2016,422 million people have diabetes worldwide with high mortality.DM is classified into four broad categories:type1,type 2,gestational diabetes and “other specific types”.DM is more variable disease than once thought and people may have combinations of forms. Clinical manifestation includes frequent urination.Increasedthirst, and increased hunger. Diabetic effects can range from feeling of unease,sweating, trembling, and increased appetite in mild cases to more serious issues such as confusion, changes in behavior,aggressiveness, seizure, unconsciousness, and rarely permanent brain damage or death in severe cases. Diabetes doubles the risk of cardiovascular disease (CVD), with high mortality. World Health Organization criteria, people with fasting glucose levels from 6.1 to 6.9 mmol/L(110-125mg/dl) are considered to have impaired fasting glucose. Glycatedhemoglobin (HbAIc) is better than fasting glucose determination. Management concentrates on keeping blood glucose levels as close to normal, without causing low blood glucose. Metformin is the first line treatment for type 2 diabetes, with added agents that decrease absorption of sugar, and make the body more sensitive to insulin. Prevention includes a normal body weight, physical activity, healthy diet, and limiting sugary beverages. Keywords:Diabetes mellitus,Management,Complication,Prevention

Abstract:Spinal cord injury (SCI) is an ancient disease, described by Hippocrates and traction techniques were recommended to straighten the spine. Motor vehicle accidents, falls, attempted suicide, gunshot wounds, military conflicts and support injuries are most common cause of SCIs. Most hospitalized SCI patients have nosocomial infection. SCI Patients may suffer from stress, malnutrition, renal failure; receive medications that impair immune responses. Frequent insertion of urologic, vascular, orthopedic, respiratory, gastrointestinal, and neurosurgical devices predispose to various prosthesis-related infections. Diagnostic challenges include inability to recognize the signs and symptoms of cord damage, and delay in diagnosing spinal epidural abscess. Treatment of infection e.g., two opposing factors resulting from changes in body composition in following SCI can alter the disposition of systematically administered antibiotics, such as vancomycin and aminoglycosides. Frequently diagnosed infections in SCI patients are urinary tract infection (UTI), pneumonia, pressure sores, osteomyelitis, infection due to multi-resistant organisms, and intra-abdominal infection. SCI patients are at high risk for Fournier gangrene that affects the perineal and genital regions and usually results from polymicrobial infection.Common pathogens are Staphylococcus aureus, including methicillin resistant Staphylococcus aureus(MRSA),Streptococci, vancomycin resistant Enterococcus(VRE)gram-negative bacilli including ESBL producing Klebsiella pneumoniae and Escherichia coli. Earlydiagnosis, gram negative coverage when initiating empirical antibiotic therapy has lower mortality and better outcomes. Keywords:Spinal cord injury, Urinary tract infection,Pressuresores,Diagnostic challenges.

Abstract The term “acute abdomen” denotes any sudden spontaneous non-traumatic disorder whom the chief manifestation is in the abdomen. There is frequently a progressive underlying intra-abdominal disorders, therefore the early diagnosis and treatment of such conditions are essential for a favorable outcome. Abdominal pain is a common presentation that requires almost immediate management. Diagnosis of acute abdomen before laparotomy is essential in reducing the morbidity, mortality and at the same time in preventing unnecessary operations, especially when the diagnostic facilities are limited and clinical awareness plays an important role in the diagnosis and management. To evaluate the diagnostic accuracy of the preoperative assessment with the operative diagnosis of adult male patients with non-traumatic acute abdominal conditions. This is a prospective study conducted at the ALSader medical city during the period from 1 st.of December 201 2 to 1 st. of December 201 4. The study included 65 patients with clinical manifestations suggestive of acute abdomen that require exploratory laparotomy, while any patients with trauma to the abdomen, previous laparotomy, acute abdomen of medical causes and those below 1 2 years old were excluded from the study. Acute abdomen was more common in the age group 20-39 years. This study revealed that acute appendicitis was the cause of acute abdomen in 52.3%. Other common causes of acute abdomen were perforated viscus / peritonitis 1 8.46% and intestinal obstruction 15.38%, . Leukocytosis has a sensitivity of 36.8% and a specificity of 66.6%. UA has a sensitivity of 50% and a specificity of 77.1 %. US has a sensitivity of 66% and a specificity of 75%. Erect chest X-ray has a sensitivity of 20% and a specificity of 92.5%. Supine/erect plain abdominal X-rays has a sensitivity of 63.6% and a specificity of 93.02%. This study showed that the overall diagnostic accuracy of preoperative assessment was 86.1 5%. The diagnostic accuracy of perforated viscus /peritonitis was 1 00 %, the diagnostic accuracy of intestinal obstruction was 83.33%, while the diagnostic accuracy of acute appendicitis was 82.92%. Key words: Acute abdomen, non-traumatic, laparotomy, pre-operative, operative, diagnosis.

To effectively study surgery, one needs an organised approach to a wide variety of surgical problems. During their medical studies, students have to learn inspection, considered to be one of the important skills but because of the shortage of cases and the rarity of some of them, all students do not get equal chances to see and learn from patients. Advances in photography however can provide students with high defiition photographs from which students are able to see the signs which they would otherwise miss. I have used my interest in photography to collect good original pictures of a variety of surgical cases to provide opportunities for students to study adequately illustrated common clinical conditions encountered in practice. These provide good practice for students to enhance their inspection skills. I hope that this book will be helpful in assisting medical students in their preparation for the clinical parts of fials in surgery and can add on to the surgical fild of knowledge of the intended readers.

ABSTRACT The present study reports the performance of fial year medical students from the Universit Malaysia Sabah (UMS) in the end of the senior surgical postig examinatin (SSP) with the aim to demonstrate the medical students graduatig from this newly established university are of good standing and of improving quality. A study on the outcome of the method of teaching conducted on this study was performed by measuring the students’ performance contiuously and at the end of their postig. The present data analyses demonstrate that there have been improvements in the medical students’ performance between the last two batches of students graduatig from UMS. However, the students appear to be weaker in their MCQs, demonstratig a decline in theoretial knowledge. The analyses also demonstrate that there is a poor positie correlatin between theoretial knowledge, clinical skills and/or contiuous assessments, demonstratig the importance of emphasis in these 3 areas amongst medical students. Further studies may be required to determine the reason for this poor correlatin since these may lead to bettr understanding on how to improve the overall performance of future medical student. CONCLUSION: The present study demonstrates that UMS medical student appears to contiue to improve in their SSP performance although there are concerns about the decline in theoretial knowledge. Keywords: Clinical assessment, performance-assessment, senior surgical postig, MCQ, MEQ, Essay, OSCE

ABSTRACT Primary parotid lymphoma is uncommon and rarely suspected. In most cases, the disease would have disseminated at the time of diagnosis. We describe a case of primary non-Hodgkin’s lymphoma of the parotid gland which progressed to the central nervous system. Clinical history is of limited value in identifying this condition. Diagnostic imaging studies (CT or MRI) may indicate whether or not the mass is salivary in origin but do not help to confirm the diagnosis. In this case, it was deemed that FNA alone is incapable of determining the precise histological subtype for lymphoma, whilst a tru-cut biopsy demonstrated a more sensitive method of determining the diagnosis. The lessons learned from this case would prove useful for other health care providers to make an early diagnosis and hopefully manage more effectively if similar conditions appear in their practice. Performing the appropriate measures can help to not only improve the prognosis but may even avert the prospect of unnecessary surgery. KEYWORDS: non-Hodgkin’s lymphomas, neck , parotid gland, salivary gland

Medical Education

General Surgery

Medical Professionalism

his study aimed to evaluate the hormonal receptor status in female breast cancer and assess the relationship with the patient's age and family history in Najaf, Iraq