Introduction: The healthcare workers are at high risk of developing stress-related problems during outbreaks. This study aimed to explore the perceived stress and its relation to the duration of dealing with COVID-19 patients in medical doctors.Methods: The doctors who work in different medical settings in Iraqi Kurdistan during coronavirus outbreak were invited into this cross-sectional study. The doctors were invited from one pediatric, one emergency, one special corona, and one maternity and gynecology hospital. The “Perceived Stress Scale -10 (PSS)” measured the perceived degree of a doctor who experienced stress. The information was collected through a web-based technique to avoid the disease spread.Results: Doctors’ mean duration of dealing with suspected/confirmed cases of COVID-19 was 1.2 (Range: 0-16 days). The mean stress score was 18.81 out of 40. Most of the doctors had a moderate level of stress (69.4%), followed by a low (21.1%) and a high level of stress (9.6%). The general physicians and medical lab specialties had higher stress scores; 21.56 and 19.88, respectively. The high level of stress was among general physicians and community and family medicine doctors; 20.0% and 25.0%, respectively. Whether or not doctors dealt with suspected/confirmed cases of COVID-19, did not have a significant difference over the perceived stress score; 19.02 vs. 18.87; P=0.786). The mean score of stress was raised with increasing duration of dealing with suspected/confirmed cases of COVID-19; r=0.202; P=0.004 and decreased with increasing age (r=-0.141; P=0.045), and clinical experience (r=-0.139, P=0.048).Conclusion: This study showed that medical doctors are at a moderate level of perceived stress during the COVID-19 outbreak in Iraqi Kurdistan.

Introduction The thyroid gland has a very important role in hematopoiesis, blood disorders are frequently seen in patients with thyroid disorders. Thyroid hormones have direct effect on blood parameters by stimulating erythrocytes precursors and indirectly by enhancing erythropoietin production. Patients and methods This is a case-control study which included 300 subjects who were grouped to 3 equal groups as a control, hypothyroidism, and hyperthyroidism groups. Patients with inherited or acquired red cell abnormalities, those receiving treatment for thyroid disorder or anemia, patient with chronic diseases, aged <12 years, pregnant ladies and patients unwilling to participate in the study were excluded. Results The mean age of patients is 40.72 years, and females constituted 60.7% of cases. The analyses showed a significant difference the RBC, HB, MCV, MCHC, RDW, and WBC (P values 0.000, 0.000, 0.001, 0.012.0.002, and 0.027) respectively, while platelets showed no significant correlation (P value 0.08). The univariate analyses showed that RBC, the HB, and the WBC were the most severely affected parameters (Sig. 0.000, 0.000, and 0.005) respectively. Conclusion The study concluded that females are more affected by thyroid disorders than males and the peak age is at the forties, thyroid dysfunction affect all blood parameters except platelets.The follow up of patients with thyroid disorders should include the complete blood count and patients diagnosed with anemia should be evaluated for thyroid disorders before iron therapy. Cases of anemia that resist treatment should be investigated for the possibility of thyroid dysfunction.

Background Vitamin D deficiency is prevalent in most parts of the world. Its insufficiency or deficiency is implicated in bone diseases, some cancers, infectious diseases, heart disease, autoimmune and metabolic diseases including type 2 diabetes mellitus. Results The mean age of patients was 49.94 ± 9.36, while the mean age the controls was 48.95 ± 10.56. Females constituted 56.1% and males 43.9% in the cases group, while for the control group females were 54.8% and males were 43.9%. Low vitamin D levels were detected in 110 (71%) of cases and 63 (40.6%) of controls. There was a significant difference in vitamin D levels among cases and controls (p < 0.001), vitamin D level was lower among females compared to males, p < 0.001 and those living in urban areas compared to rural areas, p < 0.001, BMI and dyslipidemia had a significant effect on vitamin D levels among diabetics, p values 0.002 and < 0.001 respectively. The serum 25(OH)-D level was significantly lower in patients with poor glycemic control compared to those with good glycemic control and in patients with a diabetes duration greater than 5 years, p values < 0.001 and 0.002 respectively. No significant correlation was detected with age and smoking, p values 0.181 and 0.260 respectively. Conclusion There is a high prevalence of hypo-vitaminosis D among patients with type-2 diabetes, particularly among patients with poor glycemic control and in those with longer diabetes durations. Vitamin-D deficiency is more prevalence in females, and those living in urban areas, those with obesity and patients with dyslipidemia.

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IntroductionGall bladder anomalies varies from variations in the size, site, duct systems, and shape. Abnormal location comprises the commonest one.The presence of an ectopic gall bladder is estimated to occur in around 0.1–0.7% of individuals, it can be truly ectopic locating under the left lobe of the liver or just to the left of falciform ligament.Gall stones are common disorder that may mandate cholecystectomy especially in symptomatic patients, surgery can be done laparoscopically safely in cases of abnormal anatomical position, but such cases may be at higher rate of complications especially if associated with other biliary tract anomalies.MethodsSix cases of symptomatic gall stones who underwent laparoscopic cholecystectomy included in this case series. During insertion of the telescope through the umbilical port, we found midline gallbladder under the falciform ligament instead being under right lobe of the liver. We did modification of the port sites by placing epigastric port in the left hypochonrdium.ResultsIn all the six cases the surgery had been done successfully laparoscopically without conversion to open technique. Follow up of the patients done for 2 months with no post-operative sequelae.ConclusionLaparoscopic cholecystectomy for midline gall bladder is technically difficult. Modifying the port sites make the surgery easier. MRCP preoperatively, intraoperative cholangiography, or fluorescent cholangiography may be needed if there is any concern about biliary anomalies or for real time detection of biliary injuries.