External marketing is a vital marketing communications strategy for establishing relationships with customers, providing information about the company's commitment, and explaining how the service will be provided. Lavalette Hospital, as a health service institution, recorded fluctuations in the number of outpatient visits between 2019 and 2024. This research aims to analyze the relationship between the application of external marketing and patient interest in repeat visits at the hospital. Using a cross-sectional approach, this research collects data observationally to identify correlations between existing variables. The results of the analysis show that there is a positive relationship with a correlation coefficient of 0.460, which indicates that the more effective the external marketing strategy, the higher the patient's interest in making repeat visits. With a p-value of 0.000 (p < 0.05), the alternative hypothesis is accepted, confirming that external marketing has a significant influence on the patient's decision to return to visit. This finding is in line with previous studies which show that the marketing mix has a significant impact on outpatient loyalty. These results emphasize the importance of implementing appropriate marketing strategies to increase patient satisfaction and interest in repeat visits at Lavalette Hospital.

Background: Breast cancer is the most common cancer worldwide. Mortality have reached a plateau and appear to be dropping this decline has been attributed to several factors, such as early detection through the use of screening mammography and appropriate use of systemic adjuvant therapy. Aims: To assess the value of type breast screening in women more than 40y age group and to assess the value of BIRAD system application in breast screening. Patients and methods: The study was performed during the period covered fourteen months from October 2012 to December 2013 in the Oncology teaching hospital in Baghdad Medical Teaching Complex. The study include 350 females with an age more than 40 years, Mammograms were performed for them and categorized using the Breast Imaging-Reporting and Data System (BI-RADS). Correlations between imaging findings, risk factors and pathological findings were analyzed. Result: Present study show that there was no cancer diagnosed in women categorized as BIRAD I, II and III. However among 8 women with BIRAD IV and V 75% had malignant disease and 25% had benign lesions. Correlation was found between known risk factor (age, menopause, early menarche less than 12years and BMI) and cancer diagnosis. Conclusions: Breast screen is very effective and important in discover breast cancer in asymptomatic women by using the mammogram which is an effective tool in detecting breast cancer in breast screening. BIRAD system minimized both over-utilization and under-utilization of follow-up tests/procedures.

Poroid hidradenoma (PH) is a rare benign neoplasm of eccrine origin, typically located within the dermis. It most commonly affects individuals in the sixth and seventh decades of life, though it can present at any age. The head, neck, and trunk are typical locations. This case report details a 26-year-old male with a large PH on the right hip, an atypical location. The lesion began as a small, painful nodule and progressively grew over 18 months. Initial treatment, suspected to be for an abscess, was unsuccessful. A dermatological evaluation revealed a 7 x 8 cm exophytic, ulcerated mass, and biopsy confirmed the diagnosis of PH. Histopathological analysis showed solid and cystic components, with poroid cells identified. Immunohistochemistry was positive for markers such as CEA, CK-7, and p63, which are consistent with this tumor type. Following the confirmed diagnosis, complete surgical excision was performed, and the patient remains asymptomatic with no signs of recurrence. Poroid hidradenoma is characterized by both poroid and cuticular cells, and although it is generally benign, malignant transformation has been reported in less than 1% of cases. Therefore, complete excision is recommended to reduce the risk of recurrence and malignancy. This case highlights the importance of early diagnosis and appropriate management of PH, including long-term follow-up to ensure the absence of recurrence.

Cutaneous lichenoid drug eruption (LDE) is a rare but increasingly common adverse drug reaction (ADR), often challenging to diagnose due to its clinical and histological resemblance to lichen planus (LP). We report the case of a 57-year-old man with a lichenoid eruption likely secondary to systemic antibiotics. He presented a widespread pruritic dermatosis, characterized by dark brown, lichenified plaques, particularly in the axillary folds. A punch biopsy revealed lamellar hyperkeratosis, mild acanthosis, vacuolization, and a moderate infiltrate of lymphocytes, histiocytes, and eosinophils in the superficial dermis, compatible with LDE. LDE is typically triggered by various medications, and its pathogenesis involves T-cell-mediated autoimmune damage to altered basal keratinocytes. Treatment involves discontinuing the offending drug, though recovery may take weeks to months. Corticosteroids, both topical and systemic, may be required in severe cases or when drug cessation is not feasible. This case emphasizes the importance of recognizing LDE, particularly in patients on multiple medications, to ensure prompt diagnosis and management.

Refractory hypoglycemia in non-diabetic patients is a rare condition characterized by low blood glucose levels (< 70 mg/dL) that do not respond to the conventional treatment. It can be caused by serious underlying issues such as liver failure, adrenal insufficiency, insulin-secreting tumors, or sepsis. This form of hypoglycemia requires rapid interventions to avoid severe neurological complications. Management involves addressing the underlying cause and providing supportive measures such as glucose infusion or pharmacological agents like glucocorticoids or diazoxide. A multidisciplinary approach and early identification are key to improving the prognosis of affected patients.

Necrobiosis lipoidica (NL) is a rare granulomatous skin disorder commonly associated with diabetes but may also occur in non-diabetic individuals. We present the case of a 52-year-old non-diabetic woman with NL, highlighting the rarity of its presentation and the importance of considering alternative etiologies such as autoimmune disorders and thyroid abnormalities. Clinically, NL manifests as erythematous papules merging into plaques with central atrophy, predominantly affecting the lower limbs. Diagnosis is confirmed through dermoscopy and histopathology, revealing characteristic features such as granulomatous inflammation and necrobiotic collagen. Therapeutically, there are no standardized guidelines for NL management due to its low prevalence. Topical glucocorticoids are commonly used but carry risks of skin atrophy and other adverse effects. Calcineurin inhibitors, such as tacrolimus, offer a safer alternative, especially in atrophic lesions. Biological therapies, including TNF-α inhibitors and Janus kinase inhibitors, have shown promise in severe cases. Despite various treatment options, strict glycemic control does not appear to prevent NL development or progression, and spontaneous resolution occurs in about 19% of diabetic cases after an average of 12 years. This case emphasizes the importance of a comprehensive evaluation in NL diagnosis and highlights the potential of alternative therapies for refractory cases.

The ANCA-Associated Vasculitis is a group of rare diseases that affect blood vessels and are related to the presence of specific antibodies called antineutrophil cytoplasmic antibodies (ANCA). While respiratory and kidney involvement are the most common in ANCA-associated vasculitis and thus are part of the classification criteria, it is important to remember that vasculitis are diseases with the potential to cause multi-organ damage. We present this case to emphasize that a sequential approach is necessary for decision-making regarding treatment to prevent complications and improve quality of life, especially when they are refractory to first-line treatment.