Objective: To evaluate the role of ultrasound in the diagnosis of thyroiditis and to evaluate its sonographic features. Methods: Thirty-nine cases included in this study, age ranged between16-65years with a mean of 39.4 years. The majority (95%) of the cases were female. Examinations were done in an outpatient clinic using real-time Sonography with the high-frequency linear probe, Following variables; gland size, its echogenicity, texture, vascularity and pattern of involvement by the disease process were recorded, then accordingly, a provisional diagnosis of thyroiditis made and reported. After that, US-guided Fine Needle Aspiration Cytology (FNA) done for the patients according to physical referral and order, while the procedure explained to the patient's and written consent. Then the final results were compared while FNA was considered as a gold standard diagnostic test. Results: Thirty-seven cases (95%) proved to be thyroiditis with ultrasound diagnostic sensitivity of 95%. Most commonly diagnosed type of thyroiditis was chronic (69.2%). Regardless type of thyroiditis, most common sonographic features were decreased in echogenicity and heterogenic texture, they were reported among all studied cases (100%). Majority of cases (Nearly 67%) had large thyroid size and most of the patients (nearly 77%) had diffuse thyroid involvement. Regarding vascularity, decreased vascularity was most common finding (43%), while among cases of increased vascularity, majority of cases (77%) were chronic thyroiditis. Conclusions: Ultrasound is a sensitive tool and can play an important role in the diagnosis of thyroiditis, while it's available, noninvasive and cost-effective imaging modality. The decrease in echo and heterogeneity in texture are the two most common US features in the diagnosis of thyroiditis.

Background:Readmission after hospitalization is a preventable experience which can impose huge costs on the patients and the health care systems. Studies have reported that readmission of patients within 30 days following discharge is quite common and associated with some clinical and nonclinical factors. Mental and behavioral health issues, alco holrelated disorders, pregnancy, diabetes, schizophrenia, and mood disorders have been reported as the commonest conditions that can cause readmission. Research has also stated that patient readmission can show low quality of health care services. Objective: To assess the incidence of patients who had been readmitted to emergency room in Sulaimani Emergency Hospital during three consecutive months. Patients and Methods:The present prospective study which was carried out on 126 readmitted patients who were selected from 3264 patients who had referred to Sulaimani Accident & Emergency Hospital in Kurdistan Region of Iraq from (1st. Jun 2018) to (31st.Aug. 2018). A researcher-designed checklist was used to collect the required data. The collected data were analyzed through descriptive statistics using Statistical Package for Social Sciences version 22.0, and the results were presented as frequencies and percentages in tables. Results: The results of the present study revealed that the hospital readmission rate was lower among the patients older than 50 years. Also, female patients accounted for a larger population of readmitted patients than the males. There was no significant association found between gender and readmission. Epigastric and abdominal pains were the most frequent symptoms and presentations observed at readmission. In addition, associated medical diseases and surgical procedures were found to have outstanding effect on readmission. The most common detected disorders among the readmitted patients were suspected acute appendicitis and acute pancreatitis. In addition the type of medical intervention was found to have a remarkable effect on the rate of readmission. A significant relationship was observed between the observed clinical presentations and the readmitted patients' age, occupation, and marital status. Also, the readmitted patients' past surgical history and their age, gender, occupation, and marital status were significantly correlated. Conclusion: Hospital readmission was found to be common among patients who had associated medical diseases, surgical procedures, suspected acute appendicitis, and acute pancreatitis; therefore, such patients need to be provided with more careful care and proper

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Background: Reginald Fitz described appendicitis in 1886.1From then the term appendicitis has been used. Acute appendicitis is the Commonest cause of abdominal surgical intervention with a prevalence of nearly 1 in 7 people[2].It is related to occasional mortality and high morbidity. Regarding conservative management an initial non-operative management for acute appendicitis was tried in the 1950s but was not accepted at that time[16] .Conservative management of acute appendicitis is safe and associated with reduced rate of operation ,complication and reduced costs of treatment[17-18]. Treatment include bowel rest, intravenous antibiotic with3rd generation Cephalosporine and Metronidazole .Datas show successful result in 90% of patients in whom appendicitis was confirmed by CT however 1/4 of patients may require surgical intervention within one year [19]. Objective: To assess the role of conservative management of acute appendicitis in patients with Modified Moderate Alvarado Score of (4-7). Patients and Methods: This is a prospective study conducted in Sulaymanya Teaching Hospital from December 2017 to December 2018 .A total number of 100 cases of acute appendicitis who were admitted in the emergency department with Modified Moderate Alvarado score (4-7)had been included. All the cases of the study were collected and all these patients received treatment and they divided into two groups according to the response and failure of treatment. Group A consist of (59%) patients in whom conservative treatment had been succeeded group B included (41%) patients in whom conservative treatment had been failed. The two groups were comparable according to age, gender and comorbidity. Inclusion crieteria include patients with Alvarado score (4-7). Exclusion crieteria include patients with high and low Alvarado Score , Appendicular Abscess, Appendicular mass, Fecolith, pregnant ladies, ectopic pregnancy and ovarian cyst. Results: Finally a total 100 patient were included in this study the success rate of conservative treatment of Acute Appendicitis was 59 % the failure rate was 41 %. Conclusion: in this study the result indicate that Conservative management of acute appendicitis of Modified Moderate Alvarado Score (4-7) is safeand reduces the rate of non-indicated surgery and reduces the rate of morbidity related to operation from those selected patients, and in this study the result also indicates that conservative management is successful in cases with Modified Moderate Alvarado score(4-7).

The patient record is an essential patient data were the nursing documentation part is fundamental. .Competent nursing care is based on correct and complete records, and keeping record is an essential skill that needs to be developed by each and every health staff. The present study was conducted in order to assess the documentation on current medical patient's records in the Accident and Emergency Hospital/Sulaimani city. A quantitative descriptive design. Research was accomplished, based on retrospective data made available by the Accident and Emergency Hospital. Non-probability (purposive sample) of 201 patient files were selected from 1,194 patient files during 6 months between Jun to December 2016.The present study showed that the face sheet was completely recorded about %95 which means satisfactory, other items which were recorded by physician such as chief complaint and history of present illness, radiology, laboratory, medication intervention report, consent forms, physical examination, and consultant report were unsatisfactorily recorded. Last items which were recorded by the nurse who working in Accident and Emergency Hospital medication and administration record and a graphic sheet of vital signs were unsatisfactorily recorded. Deficiency in documentation system and most of the provided medical and nursing care remains undocumented given numerous deficiencies in the documentation system. It is recommended the components of the nursing record tool can be utilized once a paperless system is implemented as planned in the hospital.