Al-Kindy College Medical Journal

Online ISSN: 1810-9543
Publications
Article
Objective : Sciatic nerve block (popliteal approach) and femoral N block is a new technique other than general anesthesia in below knee surgery because it provides adequate muscle relaxation, with good intraoperative and post-operative analgesia. Nefopam is non opioid, non-respiratory depressant and non-sedative was mixed with local anesthetics drug to study the effects. This study was done to compare the onset and duration of sensory and onset time and duration of action of motor block following administration of either bupivacaine alone with administration of bupivacaine and Nefopam in patients undergoing below knee lower limb surgeries under ultrasound guided regional anesthesia.Methods: 100 patients with American society of anesthesiologists (ASA) 2 / 3/4 patients between 25 and 85 years who underwent elective and emergency lower limb surgeries randomly allocated into two group, each group has 50 patients by a sealed envelope technique to receive 20 ml of 0.5% Bupivacaine with 2 ml of normal saline in Group BS and 20 ml of 0.5% Bupivacaine with 2ml (20mg) of Nefopam in the second group (Group BN). The onset time, duration time of both sensory and motor blocking were seen and compared between the two groups.Results : The onset time of both sensory and motor blockade was shorter in Group BN (bupivacaine with nefopam) when compared to Group BS (bupivacaine and normal saline) (p<0.0001). The duration of both sensory and motor blockade was longer in Group BN when compared to Group BS (p<0.0001). There were no significant hemodynamic changes (PR, BP,SPO2) in both groups. Also there is no any side effect or any complication.Conclusion Nefopam when mixed with Bupivacaine in Sciatic nerve block and femoral nerve block in below knee surgeries shortens the onset time and prolongs the duration of action of both sensory and motor blockade without any systemic side effects and give excellent intra and postoperative analgesia.
 
Article
Background: Background: Helicobacter pylori is an important gastrointestinal bacteria related to the development of superficial atrophic gastritis, peptic ulcer and gastric cancer. Human leukocyte antigens (HLA) may play an important roles in host immune responses to H pylori antigens. Aim of the study: to investigate the association between HLA-DRB1 genotypes and superficial gastritis with H. pylori infection in an Iraqi patients. Patients and methods: Sixty patients with superficial gastritis and 100 individuals with apparently normal results after endoscopic examination were recruited from Al-Kindy Teaching Hospital - Gastrocolonoscope Unit between January 2014 and July 2016. All study patients and controls group underwent upper gastrointestinal endoscopic examinations. They were analyzed for CagA antibodies Immunoglobulin G (IgG) for H. pylori and HLA Class II genotyping (HLA-DRB1). Results: Patients with superficial gastritis with H pylori. The infection showed significant expression (P=0.0001) DRB1*03:01 genotypes and DRB1*15:01 (P= 0.004) as compared to control group. Conclusions: Genetic factor may play a role in gastritis. HLA-DRB1*03 and HLA-DRB1*15 may increased the susceptibility to superficial gastritis in H pylori infected patients.
 
Article
Background: Radioactive iodine-131 therapy is highly effective in treating patients with hyperthyroidism. An ablative dose is preferred by a number of endocrinologists, and, a fixed dose protocol seems to be better than a calculated dose in real practice. Objective: To check for hypothyroidism in hyperthyroid patients one year after RAI therapy, comparing between the results of high ablative versus usual dosages of RAI-131. Methods: This study included 174 hyperthyroid patients, 101 males and 73 females, divided into 2 groups, the first consisted of 162 patients given a usual fixed dose of RAI while the second consisted of 12 patients given a high fixed ablative dose of RAI. The study lasted about 2 years from August 2000 till July 2002 in the Specialized Centre for Endocrinology & Diabetes, Baghdad. Results: Out of 162 patients in the first group, 11 patients (6.8%), developed hypothyroidism compared to 4 patients out of 12 (33.3% ) in the second group ( p < 0.05). Conclusion: A high ablative dose RAI has a better outcome regarding hypothyroidism than a usual dose, although, endocrinologists have different opinions regarding this issue.
 
Scheme of COVID-19 management in children and adolescents Scheme of COVID-19 management in children and adolescents
Article
Sufficient high-quality data are unavailable to describe the management approach and guideline of COVID-19 disease in pediatric and adolescent population which may be due to mild presentation in most of cases and less severe complications than older ages. World Health Organization was concerned with the establishment of an approved guideline to manage the increasing number of COVID-19 patients worldwide aiming to prevent or lessen COVID-19 global burden. The clinical features have a wide spectrum starting from uncomplicated mild illness, mild-moderate pneumonia, severe pneumonia, acute respiratory distress syndrome, sepsis, septic shock, and multisystem inflammatory syndrome in children. Many important definitions were developed to identify the COVID-19 case status including confirmed, suspected, and probable case. Many laboratory tests may be beneficially done but reverse transcriptase – polymerase chain reaction (RT-PCR) for SARS-CoV-2 RNA is diagnostic. Patient isolation and adequate intake of fluid and calories, antipyretics (preferably paracetamol), antibiotics (in secondary bacterial infections), and bed rest are the mainstay of approved supportive treatment. While oxygen supplementation may be added in moderate to severe cases; anticoagulation prophylaxis (enoxaparin) is strongly advised in children with certain situations where hypercoagulability state is identified, and therapy should be evaluated based on risk factors. New approaches, drugs, and therapies are currently under research to manage COVID-19 pediatric and adolescent patients including antivirals (lopinavir/ritonavir, and favipiravir), remdesivir, tocilizumab, dexamethasone, convalescent plasma, and specific treatment of multisystem inflammatory syndrome in children (immunoglobulin, steroids, tocilizumab, anakinra, and aspirin). The practical approach was summarized in a flow chart scheme to assist health care professionals to manage COVID-19 in children and adolescents within a rapid look though details are given in the text.
 
Article
Parasitic diseases can affect infection with COVID-19 obviously, as protective agents, or by reducing severity of this viral infection. This current review mentions the common symptoms between human parasites and symptoms of COVID-19, and explains the mechanism actions of parasites, which may prevent or reduce severity of this viral infection. Pre-existing parasitic infections provide prohibition against pathogenicity of COVID-19, by altering the balance of gut microbiota that can vary the immune response to this virus infection.
 
Article
Coronavirus: (COVID-19) is a recently discovered viral disease caused by a new strain of coronavirus. The majority of patients with corona-virus infections will have a mild-moderate respiratory disease that recovers without special care. Most often, the elderly, and others with chronic medical conditions such as asthma, coronary disease, respiratory illness, and malignancy are seriously ill. COVID-19 is spread mostly by salivary droplets or nasal secretions when an infected person coughs or sneezes. COVID-19 causes severe acute respiratory illness (SARS-COV-2). The first incidence was recorded in Wuhan, China, in 2019. Since then it spreads leading to a pandemic. The typical incubation time for COVID-19 infection is 2-14 days (normally 5). The common features include fever, cough, tiredness, difficulty in breathing, loss of smell or taste. Occasionally, signs are absent. COVID-19 complications include renal failure, syndrome of cytokine release, pneumonia, respiratory failure, lung fibrosis.
 
Article
The world is currently challenging the serious effects of the pandemic of the Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). Data on pediatric COVID are rare and scattered in the literature. In this article, we presented the updated knowledge on the pediatric COVID-19 from different aspects. We hope it will increase the awareness of the pediatricians and health care professionals on this pandemic.
 
Article
The pandemic of coronavirus disease 2019 (COVID-19), first reported in China, in December 2019 and since then the digestive tract involvement of COVID-19 has been progressively described. In this review, I summed recent studies, which have addressed the pathophysiology of COVID-19-induced gastrointestinal symptoms, their prevalence, and bowel pathological and radiological findings of infected patients. The effects of gut microbiota on SARS-CoV-2 and the challenges of nutritional therapy of the infected patients are depicted. Moreover, I provide a concise summary of the recommendations on the management of inflammatory bowel disease, colorectal cancer, and performing endoscopy in the COVID era. Finally, the COVID pancreatic relation was explored. Conclusions: digestive symptoms in COVID-19 patients can be the only manifestation and they may be correlated with worse clinical outcomes. The likelihood of fecal-oral transmission of COVID-19 has significant consequences and requires further research. A clear link may exist between the gut microbiome and COVID-19 progression and it may have a therapeutic and prognostic value. No evidence for an increased frequency of covid-19 cases in IBD and stopping immunosuppressive medications is not advised. Triage and risk assessment of patients with suspected or confirmed COVID-19 before endoscopy is essential; deferral of elective endoscopies should be considered.
 
Article
Background: Corona virus disease 2019 (COVID-19) is a communicable disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified in December 2019 in Wuhan, China, and has since spread globally, leading to an ongoing pandemic. Aim of study: to review the clinical, lab investigation and imaging techniques, in pediatric age group affected COVID-19 to help medical experts better understand and supply timely diagnosis and treatment. Subjects and methods: this study is a retrospective descriptive clinical study. The medical records of patients were analyzed. Information’s recorded include demographic data, exposure history, symptoms, signs, laboratory findings, chest x- ray, and chest computed tomographic (CT) scans. Data were obtained with data collection forms from paper medical records. Results: there were 76 COVID-19 pediatric patients, 46.1% of those patients were within the age group 6 -10 years. The female to male ratio was 1:1, and 92.1% of them were living within the urbane area. About 60.5% of patients were pupils. Seventy-one (93.4%) patients of them had no comorbidity. Twenty (26.3%) patients were asymptomatic. Regarding the duration of hospital stay, 39(51.31) patients had
 
Article
There is limited data and evidence about the effects of COVID-19 on Maternal health, especially when new information is emerging daily, through pregnancy, child birth and post natal period, women are vulnerable to have the infection, this article, aimed to show the suitable measures that should be applied for women at reproductive age who are suspected /confirmed with COVID -19 infection, During pregnancy it is advisable to continue the antenatal care schedule, although reducing face to face visit is recommended (unless the pregnant condition required that ),and prioritize ANC at health facilities for high-risk pregnancy and during second half of pregnancy with adequate infection prevention control measures. Regarding child birth, positive COVID-19 result without other indications is not an indication to expedite birth, decision for mode of birth not influenced by positive COVID-19 result, it is recommended to support normal labour and if elective caesarean has been planned, epidural anesthesia is highly recommended than general anesthesia. For women with suspected or confirmed COVID-19, Betamimetics: should be avoided as they may exacerbate maternal hypotension, tachycardia and pulmonary edema. Maternal mental wellbeing should be screened in postnatal period because infected women with COVID -19 are more prone to develop an anxiety than general population because of the demands of the disease like isolation, bereavement, financial difficulties, insecurity and inability to access support systems which are considered as added risk factors to develop mental illnesses
 
Article
Background: the coronavirus leads to upper respiratory tract-associated manifestations like nasal congestion, sore throat, and smell disorder Objectives: To reveal the impact of COVID-19 pandemic on otolaryngology symptoms using our daily medical practice. Subject and Methods: A cross-sectional study that was carried on in the isolation wards at Al-Kindy and Al-Nu’man Teaching Hospitals during three months from the 1st of Jun. till the end of Aug. 2020. It included 1270 patients who were diagnosed with COVID-19 infection seen in the ENT consultation clinic and admitted to the isolation wards. Results: Otolaryngological manifestations were shown as 15.7% complained of sore throat, the headache was presented in 11%. Non-otolaryngological manifestations were more common than otolaryngological manifestations as fever presented in 63% of cases and cough in 56.1%. Conclusion: Otolaryngological symptoms are not uncommon but less than fever or cough. Otolaryngological manifestation with a history of contact with COVID-19 patients should be considered in the diagnosis.
 
Article
Background: The study was designed for the assessment of the knowledge of medical students regarding pandemics. In the current designed study, the level of awareness was checked and the majority of students were found aware of SARS-CoV and SARS-Cov2 (Covid-19). Objective: To assess the awareness of SARS-CoV and SARS-Cov2 (Covid-19) among medical students of Pakistan. Subjects and Methods: A cross-sectional survey was carried out in different universities of Pakistan from May to August 2020. A self-constructed questionnaire by Pursuing the clinical and community administration of COVID-19 given by the National Health Commission of the People's Republic of China was used among the 831 students who are enrolled in different medical universities of Pakistan and SPSS version 23 was used to analyze the data. Results: The majority (n=440, 52.9%) were male, (n=525, 63.2%) having age between 18 to 23years and (n=682, 82.1%) were unmarried. In educational status (n=501, 60.3%) were undergraduate and (n=214, 25.8%) were students of MBBS. After checking the residential status (n=343, 41.3%) were the permanent residents of Balochistan province. During the assessment of awareness towards Covid-19 results showed that (n=801, 96.4%) were aware regarding Covid-19. Conclusion: This study finalized that the students enrolled in different medical universities of Pakistan were aware of the Covid-19. The observed awareness can be due to qualitative education especially in the domain of disease prevention, which has been provided by the educational institutions of Pakistan in collaboration with the Ministry of Health. Keywords: Awareness, Covid-19, Medical students, Pakistan.
 
Article
This study aims to identify maternal death cases caused by Coronavirus infection 2019 pneumonia, including disease progression, fetal consequences, and the fatality cause. Patients and methodology: A retrospective case collection of Iraqi pregnant women in their second and third trimesters diagnosed with COVID-19 pneumonia and died due to it. The four cases were all of a young age, had a brief complaint period, and had no comorbidities. Fever, dyspnea, and fatigue were the most common symptoms. Hypoxia was present in all cases and was the cause of mortality in three cases, with thromboembolism being a potential cause in the fourth. Prelabour membrane breakup, fetal growth restriction, and fetal death are all examples of adverse fetal effects. Conclusion: COVID-19 pneumonia induces substantial fetal and maternal mortality rates through pregnancy, which should be considered when treating these cases.
 
Article
Background: Animal bite is one of the public health problems all over the world, especially in poor countries. Animal bites have an impact on human health due to rabies disease, which is a viral transmitted disease from animal to human with a high mortality rate.Objective: To determine the epidemiological characteristics of animal bite cases by person, time, and place.Method: Descriptive cross sectional study was done by reviewing cases caused by animal bites., Data including the demographic characteristics of age, gender, occupation, site of bite, and attending health institutions searching treatment were all included.Results: There were 11600 animal bite cases. Most of bites caused by stray dogs 11577(99.8%), and the males were more affected than females. The mostly affected site of bite was lower limbs. Babylon and Naniva provinces registered the highest rate of animal bite victims.Conclusion: The study is determining the epidemiological characteristics of animal bite cases by person, time, place and giving an accurate view about the epidemiological importance of the problem in Iraq.
 
Article
Background: Neonatal period is a very vulnerable period of life due to many problems, In spite of advances in perinatal and neonatal care still, the mortality rate of neonate high especially in developing country The World Health Organization estimates that globally four million neonatal deaths per year, Developing countries account for around 99% of the neonatal mortality in the world, In Iraq. Neonatal mortality rate about 19 per 1000 live births which represent 56% of child death below 5 years age in 2012. The hospital in the study represents the larger pediatric hospital in Iraq. It contains 400 children's beds and 24 neonatal incubators. Aims of the study: are to determine the institutional new-born case fatality rate and the cause of death in the neonatal care unit. Method; The study is cross-section study of the population sample of neonatal care unit of central teaching hospital of pediatric in Baghdad Al-krakh health directorate Result: Study appear total neonate admission during 2015 was 1977 neonates mortality rate 9% Four main causes of death were Respiratory related condition, Bacterial sepsis, Disorder related to short gestational and low birth weight not relayed to elsewhere classification and congenital malformation 37.5%, 33.3%, 7.1% and 7.1% respectively while the main primary cause of morbidity were Neonatal jaundice, Respiratory related condition, Bacterial sepsis and 37.5%, 35.2%. 14.1% respectively Conclusions: The majority of morbidity and mortality can prevent by appropriate intervention
 
Article
Background: Routine supplementation of vitamin D to infants is justifiable since vitamin D deficiency, and its consequences are highly prevalent not only in developing countries but worldwide. Maintaining a normal level of vitamin D is crucial in order to have a normal skeletal, as well as, extra-skeletal health. Knowledge of mothers regarding importance of vitamin D supplementation affect the health of their babies in a positive manner if accompanied by appropriate practice. Objective: To determine the level of knowledge, attitude and practice of Iraqi mothers of under or equal 12 months old infants in Baghdad, AL-Rusafa, regarding vitamin D supplementation for their infants. Type of the study: A cross-sectional study. Methods: A descriptive cross sectional, questionnaire-based study conducted at six primary health care centers in Baghdad AL-Rusafa. 400 mothers of under or equal 12 months old infants attending primary health care centers (PHCC)for routine vaccination and follow up of their infants were included in the study from the 10th of February 2016 till the 10th of June 2016. Results: A total of 400 mothers enrolled in the study, with a mean age of 27.11years ±6.65572, Only (45%) (n=180) of them had given their infants vitamin D drops, with a mean score of vitamin D supplementation practice of 1.26±1.51265 from 4 which was significantly correlated with their knowledge score which was 3.6100±2.14987 from 9 and their attitude score which was 3.6275±1.89644 from 6. Conclusion: The study revealed poor knowledge, fair attitude and poor practice among mothers regarding vitamin D supple­ment for their infants.
 
Article
Background:-Osteoarthritis (OA) is the most common form of arthritis and the leading source of physical disability in elderly people. The Prevalence of OA is increasing and will continue to do so as the population gets older. The OA is predominantly managed in primary care centers by primary health care physicians and much can be done to alleviate symptoms from osteoarthritis by combinations of therapeutic options including pharmacological and non-pharmacological treatments. Objectives of study :- To assess the knowledge, attitude and practice of Iraqi PHCC physicians in Baghdad, AL-Rusafa, regarding the management of osteoarthritis patient, and it's association with sociodemographic data. Methods:- A descriptive cross sectional study with some analytic elements has been conducted from the 1st of January to 1st of June 2017, in primary health care centers of six sectors selected randomly from Al Rusafa health directorate; in Baghdad. The data was collected by self-administered questionnaire regarding demographic characteristics, knowledge, attitude, and practices of physicians regarding management of osteoarthritis. Data analysis was done by (frequency, percentage), Chi square test (Fisher exact test). P value less than 0.05 was considered significant . Results: The total study sample was 204 enrolled physicians, their age ranged from (25-58) years, The correct answers regarding etiology, diagnosis, imaging findings etc. ranged from 64.2-83.3% which reflect good knowledge of physicians regarding OA disease as well as that highly qualified physician showed good knowledge, about half of enrolled physicians showed good attitude and their practices regarding osteoarthritis and its management are good in general. Conclusion; -The knowledge, attitude and practice regarding osteoarthritis managent among primary health care physicians are good in general.
 
Article
Background: Diabetes is defined by the World Health Organization as a metabolic disorder characterized by chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both. Families are co-regulating systems in which the stresses and strains of one family member affect the well-being of another member of the family. Caregivers of children with chronic illness report experiencing more parental stress than parents of healthy children. Objective: A descriptive cross-sectional study had been conducted in four centers of endocrine diseases in Baghdad city and data was collected by using self-administered questionnaire regarding quality of life adapted from World Health Organization. The study was conducted on six hundred participants. Data analysis was done by using frequency, percentage and mean and analytical statistics using Chi Square test. P value less than 0.05 was considered statistically significant. Results: The study showed that social domain had the highest mean score of (51.1) and that environmental domain had the lowest mean score of (38.9). The physical domain’s mean score was (40.2), while mean score of psychological domain was (46.2). The study reported that mothers of children with type 1 diabetes mellitus were more affected than fathers in physical, psychological and environmental domains. There was no difference between mothers and fathers in social domain of quality of life. Conclusion: It was concluded from the study that parents of diabetic children had generally poor quality of life that merits further investigations.
 
Article
Background: Patient satisfaction is of increasing importance and widely recognized as an important indicator of quality of the medical care. There was no homogeneous definition of patient satisfaction, since satisfaction concerns different aspects of care or settings, as well as care given by various professions. Objective: The objective of this study is to assess the patients’ level of satisfaction with diabetes care and to identify the underlying factors influencing it. Methods: This cross-sectional study had been conducted in the Specialized Center for Diabetes and Endocrinology in Baghdad Al- Rusafa 2018. Where150 type two diabetic patients attending their follow-up were requested to fill the questionnaire. The questionnaire identified patients, doctors, and practice related factors. For statistical analysis of the data, SPSS Version 24 was used, and the Chi-square statistical test was applied, A p-value less than 0.05 was considered statistically significant. Results: The study showed that the overall level of satisfaction was 79.3%. There was a statistically significant association between age group, gender, profession, educational level and marital status where P value 0.001 for all variables. Conclusion: It was concluded from the study that patients’ satisfaction was high. Majority of the diabetic patients were satisfied with health services, the level of satisfaction increases with age, female gender, and married patients, but it decreases with a high level of education and profession. High level of dissatisfaction seen on treatment services
 
Article
Background: Vitamin D deficiency/ insufficiency is common in different age groups in both genders especially among pregnant women and neonates where it is associated with several adverse outcomes including preeclampsia and preterm delivery. Objectives: To assess the extent of vitamin D deficiency/ insufficiency among mothers and their neonates and some factors related to it and identify some adverse outcomes of the deficiency/ insufficiency on neonates (preterm birth and low birth weight). Subject and Methods: A cross-sectional study was conducted on 88 Iraqi pregnant women and neonates admitted to “Al-Elwiya teaching hospital for maternity” in Baghdad- Al-Rusafah from 1st of June 2019 to 31st of August 2019. Data about maternal age, mode of delivery, sex, weight, and gestational age were obtained. Vitamin D levels of mothers and their neonates were measured by Enzyme-Linked Immunosorbent Assay (ELISA). Results: In a total of 88 mothers and neonates, 96.6% of mothers had Vitamin D deficiency/ insufficiency compared to (86.4%) of neonates. There was a statistically significant difference between maternal and neonatal vitamin D levels. Neonatal Vitamin D levels were positively correlated with maternal vitamin D levels. Neonatal weight was positively correlated with maternal Vitamin D levels. The mean maternal and neonatal vitamin D levels were (12.16 ng/ml ± 7.06) and (20.25 ng/ml ± 10.97) respectively. Conclusions: Vitamin D deficiency/ insufficiency was prevalent among mothers and neonates; with a higher prevalence among mothers. Maternal Vitamin D levels and neonatal weights were associated with neonatal Vitamin D levels.
 
Article
In their cross-sectional study, Al-Rubaye et al studied the extent of vitamin D (VD) deficiency/ insufficiency, factors affecting its degree, and the adverse outcomes of the altered VD status among a group of mothers and their neonates from Baghdad, Iraq. They found that 96.6% of the mothers had VD deficiency/ insufficiency compared to 86.4% in their neonates. Maternal VD levels and neonatal weights were significantly correlated with neonatal VD levels. We believe that the study results need to be revised. This is based two points listed in this letter to editor
 
Article
Background: Abdominal symptoms are possibly the most frequent of all symptoms encountered in surgical practice. Pain is the most common of all abdominal symptoms. Causes of acute abdominal pain include both medical and surgical. Most symptoms arise from intra-abdominal organs or systems while some may originate extra abdominally and are then referred to the abdomen. Medical causes of abdominal pain are encountered more frequently. Objective: To study the causes of acute abdominal pain in patients attending emergency department in Al- Imamain Al- Kadhimain Medical City. Type of the study: A prospective cross sectional study Methods: The patients attending Emergency Department in Al- Imamain Al- Kadhimain Medical City over the period from April-2014 to April 2016. There was a one day call duty per week managed by the same surgical team (total one hundred days study). Onlypatients above 12 years old with acute non-traumatic abdominal pain were included in this study. Results: The total number was 1217 patients over hundred days study. Their age ranges from 12-83 years; average age was 36.18 ±17 year. There was slight female predominance, 638 (52.42%) female patients and 579 (47.58%) male patients. The most common cause of abdominal pain was acute appendicitis 252 (20.70%), followed by ureteric colic 251 (20.62%), and acute cholecystitis249 (20.46%). Conservative management was done for 836 (68.69%) patients, while operative management done for 379 (31.14%) patients. Postoperative mortality was 8 (2.11%) patients.Medical causes of acute abdominal pain were found in 48 (5.74%) patients. Conclusion: Not all the patients attending surgical emergency department needs operations. Causes of acute abdominal pain include both medical and surgical diseases, some of the medical diseases are very serious like acute viral hepatitis, myocardial infarction , and diabetic ketoacidosis; and should not submit those patients to unnecessary operations with serious and may be fatal postoperative complications. General urine examination is a must in all patients with acute abdominal pain. Electrocardiography (ECG) may be needed in old patients.
 
Article
Background: Immediate postpartum contraceptive and post abortion contraception methods are effective safe methods and are becoming a standard practice in many countries, yet it is not widely used in Iraq. Aims: this study: is designed to assess the attitude and willingness of women to immediate contraception after giving birth or abortion and their satisfaction to previous use. Methods and Material: Four hundred thirty-four women were surveyed in the labor word immediately after giving birth/ abortion. Their knowledge, attitude and contraception use were assessed according to the response they reported to a given questionnaire. Results: women were not sure about the ideal time to begin using birth control post- partum.122 out of 434 (28%) have not heard about the immediate use of contraception before, only 97/434 (22.3%) reported a previous use of immediate contraception after previous birth / abortion. The satisfaction of the women to previous immediate contraception use was reported by 61/97 (77%) versus 7/97 (7%) who were not satisfied. High educated females with unstable income and women having more than five children depicted significantly higher willingness to immediate postpartum/ abortion contraception use (P=0.026, P<0.001, P=0.001) respectively. Similarly, a significant association was observed between positive attitude and pregnancy complications, including diabetes, bleeding and hypertension (P=0.001) and craving (P=0.003). Conclusions: Iraqi women showed high willingness to immediate post-partum/abortion contraception use; nonetheless small proportion have actually used it. Poor knowledge of various contraceptive types, best time of use with less side effect are the main obstacles for family planning.
 
Article
Background: Breast cancer is the first one among Iraqi females. Most of them present later for diagnosis. Early detection center in tertiary hospital practice uses FNAB for early diagnosis. Publications on accuracy of this detection are scarce. Objective: To test the accuracy of FNAB in breast lump diagnosis. Methods: Diagnostic test accuracy study, on 204 women with breast lump, attending the oncology department in 2017. Results: Fine-needle aspiration biopsy diagnosis of histologically malignant cases were, malignant in 89 (87.3%), suspicious of malignancy in 5 (4.9%), and benign in 4 (3.9%). Complete sensitivity was 87.3%, and specificity was 100%, with 12.7% false negative results and no false positive cases. The accuracy was 94%.
 
Article
Background: Acetabular retroversion has been proposed to contribute to the development of pain and osteoarthritis of the hip. Conventional anteroposterir (AP) pelvic radiographs may represent a reliable, easily available diagnostic modality. Objective: To obtained a reproducible technique allowing the anterior and posterior acetabular rims to be visible for assessment Method: This is a cross-sectional study conducted from December 2015 to March 2017 targeting patients with hip pain in orthopedic clinic of Al-Kindy teaching hospital. The study sample consisted of 100 patients with hip pain who were investigated with Antroposterior pelvic plain x-ray, which was done for all patients, looking for cross-over sign, the patients with positive cross-over sign radiographs were sent for CT scan to ensure retroversion of acetabulum. Results: Presence of a cross over sign was documented in 9 patients (9%). From these 9 patient only 8 were proved by CT scan to have retroverted acetabulum. Then the prevalence was 8%. Conclusion: The cross-over sign is a reliable indicator for diagnosis of acetabular retroversion and the presence of a cross-over sign in a plain film should heighten awareness of the advisability of proceeding to full assessment .
 
Article
Apart from graduating five-star doctors, a particular medical college has the mission to motivate and offer researchers the opportunity to publish high-quality researches on various health problems and disseminate updated medical knowledge to a wide range of local and international readers. This could be accomplished by establishing a medical journal and releasing issues regularly
 
Article
Background : Acne vulgaris is acommon skin disease, affecting more than 85% ofadolescents and often continuing into adulthood.People between 11 and 30 years of age and up to5% of older adults. For most patients acne remainsa nuisance with occasional flares of unsightlycomedones, pustules and nodules. For other lessfortunate persons, the sever inflammatory responseto Propionibacterium acnes (P.acnes) results inpermanentMethods: Disfiguring scars. (1, 2) Stigmata of severacne cane lead to social ostracism, withdrawalfrom society and severe psychologicdepression (1-4).Result Pathogenesis of acne Traditionally, acnehas been thought of as a multifactorial disease ofthe folliculosebaceous unit, involving excesssebum production, abnormal follicularhyperkeratinization, overgrowth ofPropionibacterium acnes, and inflammation (Fig2). Recent laboratory and clinical investigationsinto the roles of the innate immune system andextracellular matrix remodeling proteins have shedadditional light on this pathogenetic process (5-7).Role of androgens: Activity of type 1 5areductaseenzyme was shown to predominate inhuman sebaceous glands and epidermis. Thisenzyme is responsible for the conversion oftestosterone to the more potent androgen,dihydrotestosterone (DHT). DHT in turn is thoughtto mediate androgen dependent skin diseases suchas acne, hirsutism and androgenetic alopecia (13)The enzyme 5a-reductase type 1 has been studiedin those with and without acne and it has beenhypothesized that those with acne might have moreactive 5a-reductase type 1 .(2)Conclusion : The prominent role of hormones inthe pathophysiology of acne has long beenrecognized and corroborated by clinical andexperimental observations and therapeuticexperience (14). Although acne is not considered aprimary endocrine disorder, androgens, such asdihydrotestosterone, dehydroepiandrosteronesulfate, and testosterone, and growth hormone andinsulin-like growth factors, have all beenimplicated in the pathogenesis of acne (15).Corresponding address to :Dr. Yasir Mansour Mohamed Al-AniIslam Mohammad Nabil El Helou
 
Article
Background: Acne vulgaris is one of the top three most commonly encountered dermatological problems worldwide in both primary and secondary care. Human keratinocytes express functional TLR2 heterodimers. An increased expression of TLR2 was detected in the epidermis of inflammatory acne lesions, as observed in normal skin; the expression level increased with the degree of differentiation of the keratinocytes. TLR2 expression is upregulated in inflammatory acne lesions and induced by C. acnes. The current study conducted to assess the oral isotretinion treatment effect on the acne vulgaris patients by evaluated the Toll Like Receptor 2 as a major immune system marker in Acne vulgaris immune response. Methods: 50 patients with acne vulgaris seen in outpatient clinic of dermatology centre(Al-Baidhaa out clinic center) in Baghdad during the period 1/9/2017 to 1/8/2018. The diagnosis of patients were done by the specialist dermatologist only sever and moderate acne cases were chosen. Fifty serum samples were collected before oral isotretinion therapy, only forty-five serum samples were collected after 8 weeks of oral isotretinion therapy. All patients have received 0.5mg-1mg/kg/day of oral isotretinoin. The mean ages was 22 years(range, 16-36 years). A total of 50 patients, 36(72%) of patients were females and 14(28%) were males. Furthermore 43(86%) of cases have heredity history. Also control serum samples were collected from people without acne and they chose with the same mean ages. The serum samples were stored at -70°C for up to six months. ELISA test for quantitative determination of TLR2 human was done. Statistical analysis was done using T-test. Results: Highly significant statistical difference were noticed (p<0.001) when we compare study group after therapy with control group, also highly significant statistical difference was noticed (p<0.01) when we compare study group before therapy with control group. Conclusion: Significant decrease of TLR-2 level was noticed in study group after isotretinoin therapy in comparison with same group before therapy and also with the control group. Pronouncedly the effects of oral isotretinion suggest a path towards importance of this therapy as an anti-acne agent
 
Article
Background: Known as suxamethonium or succinylcholine, is a medication used to cause short-term paralysis as part of general anesthesia. The duration of operation is one of the important factors accounting to the success of the operation. Simple safe available drug can change the plan of anesthesia. Objective: The purpose of this study was to assess adding Lidocaine three minutes intravenously before induction of general anesthesia on the duration of optimum prolongation the action of Suxamethonium . With other group with regular method. Type of the study: a cross-sectional study Methods: A 100 candidate to compare the effect of Lidocaine for unpremeditated patients ,American society of anesthesia( ASA) physical status II .patients were scheduled for caesarian section surgery were randomly assigned to two groups: Group I patients received 1.5 mg/kg Lidocaine 3 minutes before induction of general anesthesia, Group 2 patients received just the anesthetic agents. For assessment of prolongation of action the researcher Deepened on the clinical signs of recovery from Suxamethonium which are: spontaneous breathing, ability to swallow when we open the patient's lower jaw ( observing movement of the tongue ).between the two group Both groups received general anesthesia. Results: The of prolongation of Suxamethonium in elective cases in Group I was a about 7 - 15 minutes, while in Group II the time of Suxamethonium was about 3 - 5 minutes Conclusions : The study concluded that there was a significant difference between the two groups from the side of suxamethonium time in group one( lidocaine group)as there was prolongation of time more than group two .
 
Article
Background: The emergence and spread of multidrug-resistant Gram-negative bacilliin burn wound infections related to biofilm formation, which lend to challenge in treatment with conventional antibiotics andprompting to search for novel antimicrobial agents to control the infections.Silver nanoparticles (AgNPs) have wide spectrum biological properties with different mechanisms of action and less toxicity towards human cells. Objective:The goal of this study was to evaluated the anti-bacterial and anti-biofilm activities of AgNPs alone and in combination with aminoglycoside (Amikacin) and β-lactam (Ampicillin) antibiotics against multidrug resistant Gram-negative bacilli (Pseudomonas aeruginosa, Escherichia coli, klebsiellapneumoniae) isolated from burn wound infections. Type of the study: Cross –sectional study. Methods: 70 clinical isolates of GNBtested for susceptibility tests by disk diffusion method against 10 antibiotics. The minimum inhibitory concentrations (MICs) of AgNPs and antibiotics were carried out according to the standard broth microdilution method, while synergistic interactions were evaluated by time kill-kinetic assays. Calgary method was applied for anti-biofilm activity. Results:Pseudomonas aeruginosa represented the majority of GNBisolated from burn wound infections 34 (48.5 %)followed by Klebsiella pneumonia 21 (30 %) and Escherichia coli 15 (21.5 %). Silver nanoparticles showed remarkable antibacterial activity against GNB that isolated from burn wound infections with the MICs between 25- 75 µg/ml. Aztreonam, amikacin and cefepime were the most effective antimicrobial drugagainst GNB isolates.Synergistic bactericidal effects were observed in two-drug combinations of AgNPswith broad-spectrum aminoglycoside (Amikacin) and β-lactam (Ampicillin) antibiotics against multidrug resistant GNB. In addition,AgNPsalone or in combination with ampicillin inhibited biofilm activity about 60 % – 75 % ofGNB,while combination of AgNPs withamikacin exhibited a powerful anti-biofilm activity and inhibition biofilm formation by 75% to 80%. Conclusion: The results confirmed a synergistic bactericidal effects and significant enhancing of anti-biofilm activity of AgNPs in combination with antibiotics (amikacin and ampicillin) against multidrug resistant GNB isolated from burn wound infections. These data suggest that AgNPs could beapplied as nanodrug for treatment of burn wound infections
 
Socio Demographic Profile
Relation between Perception and Reality
Article
Background: Obesity tends to appear in modern societies and constitutes a significant public health problem with an increased risk of cardiovascular diseases. Objective: This study aims to determine the agreement between actual and perceived body image in the general population. Methods: A descriptive cross-sectional study design was conducted with a sample size of 300. The data were collected from eight major populated areas of Northern district of Karachi Sindh with a period of six months (10th January 2020 to 21st June 2020). The Figure rating questionnaire scale (FRS) was applied to collect the demographic data and perception about body weight. Body mass index (BMI) used for assessing the actual body weight status. Cohen's Kappa statistics were performed. Results: Out of 300 participants, n=143 were males, and n=157 were females. In reality, according to BMI, 6 % were underweight, 47 % were average, 28 % were overweight, and 19 % were obese. According to perception, 8% of participants were underweight, 39 % were average, about 45% were overweight, and 8 % were obese. The mean score of real BMI was 25. 51±5.62 and figure rating score was 4.81±1.75. r value showed a strong positive relationship between both variables with a a P-value of <0.001. Cohen's Kappa score was 0.362. The rate of agreement between actual and perceived body weight status in the general population was 53.88%, and the disagreement rate was 46.12% Conclusion: There was a weak agreement in the perception and realities of the self-image of people have the wrong impression about their body image.
 
Article
Background: Acute appendicitis is the most common surgical abdominal emergency with a life time prevalence of 1 to 7 individuals. Because the clinical diagnosis of acute appendicitis remains a challenge to surgeons, so different aids were introduced like different scoring systems, computer aided programs, ultrasonography, computerized tomography, Magnetic resonance imaging, Gastrointestinal tract contrast studies and laparoscopy to improve the diagnostic accuracy. Objective: To evaluate ultrasound in the diagnosis of acute appendicitis in those patients clinically diagnosed with histopathology as gold standard. Methods: A cross sectional study carried in Al-kindy Teaching Hospital through one year duration from 1st of may2015 to1st of May 2016. All included patients were subjected to ultrasonographic examination to assess the vermiform appendix with a graded compression technique. The Ultrasonography findings were recorded as positive and negative for acute appendicitis. All the appendices removed from the study patients were sent for histopathological study. Statistical analysis done using (SPSS) version 21, Chi-sequare test used for categorical variables and t-test was used to compare between two means. Level of significance (P value) set at ≤ 0.05. Results: A total of 215 patients with suspected appendicitis, males 112 (52.09%) and females 103(47.9%) were included in present study. The validity results of ultrasound in comparison with histopathology findings were as following; accuracy 86.5%, sensitivity 86.5%, specificity 86.6%, positive predictive value 99.8% and negative predictive value 32.5%. Conclusion: The ultrasonography has a good accuracy, sensitivity and specificity in diagnosing acute appendicitis.
 
Article
Background: Tear of MCL of the knee is a frequent problem among knee ligaments injuries.Injuries to the MCL are usually caused by contact on the outside of the knee and are accompanied by sharp pain on the inside of the knee. Contrary to most other knee ligaments the medial collateral ligament (MCL) has an excellent ability to heal, being fairly large and well vascularised structure. The vast majority of isolated medial ligament injuries heal without significant long-term problems Objectives: is to compare between the early clinical examination, and assessment under general anesthesia (GA), and to find out the best methods to assess the MCL tear especially in suspected cases. Type of the study:Cross- sectional study. Methods: Fifty patients are collected from casualty & outpatient units from November/2014 to October/2016 with MCL injury in AL-Kindy teaching hospital.We decided to evaluate them under general anesthesia by valgus stress test at 30 degrees & 0 degrees to estimate the integrity of MCL, in addition to anterior &posterior Drawer test to evaluate anterior &posterior cruciate ligaments Results: : From the 50 patients we select, there were 21 patients seen in the examination to have MCL tear.1 of them were Grade I ( 4.8% ),14 of them were Grade II (66.7% ),&6 of them were Grade III (28.5%)Associated injuries with ACL injury were 5 patients, with PCL injury were 1 patient and with medial capsular injury were 2 patients. Follow up of case range from (2-10) weeks with an average of 6 weeks combined with physiotherapy programs. Conclusions: Diagnosis of MCL tear by valgus stress test under GA is the best method for the assessment of MCL tear in suspected cases.
 
Article
Background: Studies show that diabetic patients have a higher incidence of ischemic stroke than non-diabetic patients. In the Framingham study the incidence of thrombotic stroke was 25 times higher in diabetic men and 36 times higher in diabetic women than in those without diabetes Objectives: aim of this study to analyze topography in diabetic patients. Type of study: Cross sectional study. Methods: 48 patients with acute stroke were classified into 4 groups: euglycemic, stress hyperglycemia, newly diagnosed diabetics, and known diabetics. Results:no significant differences were found in the type, site or size of stoke between the 4 groups, higher levels of blood sugars and hemoglobin HbA1cwere significantly higher with chronic white matter ischemia in stroke patients. Conclusions: hyperglycemia, diabetics and chronic glycemic disturbance may play role in the pathophysiology of white matter ischemia.
 
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Babesiosis is a tick-borne disease caused by Babesia microti. We present a case of false positive HIV in the setting of confirmed babesiosis infection. An understanding that patients with babesiosis can have a false positive HIV test result is important in management decisions.
 
Article
Background: the activity of acute lymphoblastic leukemia had been observed to correlate with levels of serum lipoproteins Objective: to evaluate the correlation of serum levels of different types of lipoproteins with activity of the disease in patients with acute lymphoblastic leukemia. Type of the study: A prospective study. Methods: A study included patients diagnosed as acute lymphoblastic leukemia, their serum levels of lipoproteins at time of diagnosis, and on relapse were obtained for comparison. Results: there is significant inverse correlation of activity of acute lymphoblastic leukemia with serum total cholesterol, serum low density cholesterol levels, and serum high density lipoprotein level, but not with serum triglycerides level. Conclusion:. The level of lipid profile is inversely correlated with activity of acute leukemia, and lipid profile assessment is recommended in evaluation of patients with acute leukemia .
 
Article
Background: Central serous chorioretinopathy (CSCR) is an idiopathic condition aggravated by exogenous or endogenous glucocorticoids. Vascular deregulation in the choroid is a new hypothesis regarding central serous chorioretinopathy occurrence. The inhibition of choroidal mineralocorticoid receptors has a great role in shortening the duration of CSCR by inhibiting choroidal vasodilatation and leak. Objective: To assess the effect of oral spironolactone on subretinal fluid, central macular thickness and visual acuity in patients with acute CSCR compared to observation. Subjects and Methods: a hospital based, randomized clinical trial carried out at outpatient clinic in Ibn-Alhaitham Teaching Eye Hospital/ Baghdad, enrolling 60 patients with acute unilateral CSCR, allocated randomly (every other patient) to either receiving spironolactone 25 mg orally, twice daily for 2 months (30 patients) or observation only (30 patients). The follow-up included visual acuity measurement, central macular thickness and subretinal fluid height examinations by ocular coherence tomography (OCT) at one- and two-months post enrollment for all patients. Results: Complete absorption of subretinal fluid was observed in 21(70%) of the eyes in the treatment group and in 6(20%) in the control group at two-months. Visual acuity and mean macular thickness improved significantly in both groups at the one- and two- months, mean changes was larger in treatment group compared to control group at the two-month-follow up endpoint. Conclusion: Oral spironolactone imparted greater improvement in central macular thickness and faster resolution of sub retinal fluid in patients with acute central serous chorioretinopathy versus observation.
 
Article
Thyroid hemiagenesis (THA) is a rare congenital anomaly in which one lobe of thyroid gland fails to develop during embryological stage. Agenesis may be unilateral, total or isthmic. Left thyroid lobe is more commonly involved than right lobe in hemiagenesis. Agenesis of the isthmus was seen in 50% of cases. Left sided hemiagenesis is more common than right sided hemiagenesis with a Left to right ratio of 4:1. Clinically patients can be euthyroid, hypothyroid or hyperthyroid. Often it is diagnosed as an incidental finding during ultrasonography (USG) study of neck, which can easily diagnose this condition. Actual incidence of THA is unknown; most cases are diagnosed in patients admitted for thyroid scan or thyroid surgery because of suspicion of other thyroid abnormalities. This explains high frequency of association of hemiagenesis with other thyroid abnormalities such as multinodular goiter, adenoma, hyperthyroidism, hypothyroidism, chronic thyroiditis, and carcinoma. Khaladkar, et al. emphasized that surgeon when planning a thyroidectomy must be aware of rare anatomical variations because such anomalies are not noticed in the differential diagnosis, investigations and treatment. We report a rare case of 46 years old female patient who presented with nontoxic nodular goiter and intraoperatively we found a right sided multinodular goiter including the isthmus with complete absence of the left thyroid lobe with ipsilateral inferior parathyroid adenoma which is according to the available studies is the sixth case recorded worldwide till now.
 
Article
The pleomorphic adenoma is a benign salivary gland tumor, presenting usually in the parotid gland. This case report describes an unusual case of 29 years old female with a single, nodular swelling evident in the upper lip which was diagnosed as pleomorphic adenoma of the minor salivary glands in the upper lip .The lesion measured 1.0 x 1.0 cm in size for 2 years duration cause depression of labial cortical bone apical to lateral and canine teeth. It is characterized by slow growth. Complete excision was performed and the histopathological analysis supported by immunohistochemistry showed pleomorphic adenoma .It did not recur 18 months after operation.
 
Article
Background: Acute urinary tract infection is a common bacterial infection causing illness in infants and children. At age of seven, 8% of girls and 2% of boys will have at least one episode. Although drinking water and using home remedies are known to help to flush away bacteria and keeps them from sticking to the bladder wall, researches to test the efficacy and safety of hydrochlorothiazide's diuretic effect as adjuvant to the antibiotics in pediatric age groups are lacking, and so this research was to address this subject. Objectives: To assess the effectiveness and the safety of hydrochlorothiazide as adjuvant therapy to the antibiotics in treating acute urinary tract infection in pediatric age group. Type of the study: Case-control prospective study. Methods: The study was done including eight hundred sixty five patients ((In_ & Out_ patients)): The patients included were aged from few hours (neonates) to 16 years old, Those who attended three pediatric hospitals- department of nephrology of:The Central Child Teaching Hospital,Al- Elwyia Pediatric Hospital andIbn Al-Baladi Hospital Results: 215 patients in group 1 ((97.3%)) presented with cystitis and 6 patients ((2.7%)) with pyelonephritis, And In group 2, 243 ((96.4%)) with cystitis and 9 patients ((3.6%)) with pyelonephritis.The urine cultures were negative in ((76.4, 80.1, 85.9,95.0 percentages of patients)) after ((10 days, 1 month, 3 months and 6 months respectively)) in group1 vs. ((60.3, 68.60,75.8,85.3 )) after the same periods in group 2 ((p-value=0.04 at 10 days, 0.03 at 1month, 0.04 at 3 month and 0.02 at 6month)). Conclusions: This research had concluded that 5 days of treatment with antibiotics and hydrochlorothiazide were effective and safe to treat children with urinary tract infection. Hydrochlorothiazide (as a diuretic and hypocalciuric agent) adjuvant to the antibiotics in pediatrics was safe and effective to: Decrease duration of treatment and hospitalization days, Improve clinical responses to antibiotics and Decrease risk of complications of UTI.
 
Article
Background; Neonatal period is a very vulnerable period of life due to many problems, In spite of advances in perinatal and neonatal care still, the mortality rate of neonate high especially in developing country The World Health Organization estimates that globally four million neonatal deaths per year, Developing countries account for around 99% of the neonatal mortality in the world, In Iraq. Neonatal mortality rate about 19 per 1000 live births which represent 56% of child death below 5 years age in 2012. .Objectives The aims of the study were to determine the institutional new-born case fatality rate and the cause of admission and death in the neonatal care unit.Method; Across-section study was carried out of the Neonatal Care Unit of Central Teaching Hospital of Pediatric in Baghdad Al-krakh Health DirectorateResult; During 2015, 1977 neonates were admitted, Mortality rate was 9%, Four main causes of death were identified; Respiratory related condition, Bacterial sepsis, premature neonate (Disorder related to short gestational and low birth weight not relayed to elsewhere classification) and congenital malformation 37.5%, 33.3%, 7.1% and 7.1% respectively , The main causes of morbidity were Neonatal jaundice, Respiratory related condition, Bacterial sepsis 37.5%, 35.2%. 14.1% respectively Conclusions: The majority of neonatal morbidity and mortality can be prevented by appropriate interventions
 
Article
The aim of this study is to evaluate the association between IBD and oral symptom and mucosal lesions in patients with Crohn’s disease and ulcerative colitis Methods: This is a cross-sectional study that has been done in (Kurdistan center for Gastroenterology and hepatology) of Teaching Hospital in Sulaymaniyah-Iraq, which included 101 patients previously diagnosed with Inflammatory Bowel Disease who were interviewed regarding manifestations of inflammatory bowel disease especially oral manifestations. Required data were collected through a specially designed questionnaire, Results: The patients’ mean age was 45.74±12.58 years. Patients with ulcerative colitis and Crohn’s disease were not significantly different in terms of age, sex, smoking, and drinking alcohol (p>0.05), and it was seen that age groups 41-50 and 51-60, males, smokers, and drinkers were more affected by these two diseases. They were not significantly different in terms of chief complaint, drug history, oral hygiene, and disease duration (p>0.05). Most of the patients (78 out of 101) had fair or poor oral hygiene. The two groups of the patients were not significantly different in terms of oral manifestations and symptoms (p>0.05). The most common oral manifestations were found to be respectively angular cheilitis, aphthous ulcer, and diffuse lip swelling in both diseases. The most common symptoms were respectively dry mouth and halitosis. Conclusion: This study revealed that dentists and oral and maxillofacial Medicine could involve in a diagnosis of IBD, by at least in the referral process, because patients in clinical setting may give a history of orofacial complaints giving a hint on possible systemic background of IBD
 
Article
Background:. Children with spina bifida occulta require early surgery to prevent neurological deficits. The treatment of patients with a congenitally tethered cord who present in adulthood remains controversial. Objective: The aim of this study is to describe the outcome obtained in 61 adult patients with congenital TCS and no prior surgical treatment who underwent surgical untethering. Methods: This prospective study was conducted on 61 adult patients who underwent surgical untethering for spina bifida occulta at four neurosurgical centers in Baghdad / Iraq between March 2000 and January 2018. Patients who had undergone prior myelomeningocele repair or tethered cord release surgery were excluded. The most common intraoperative findings were lipomyelomeningocele (41%) and a tight terminal filum (36%). The follow-up duration ranged from 10.8 to 149.5 months (mean 20.9 months). Of the 34 patients with back pain, status improved in 65%, worsened in 3%, remained unchanged in 18%, and improved and later recurred in 15%. Lower-extremity pain improved in 16 patients (53%), remained unchanged in 23%, improved and then recurred in 17%, and worsened in 7%. Lower-extremity weakness improved in 47%, remained unchanged in 47%, and improved and then recurred in 5%. Finally, of the 17 patients with lower-extremity sensory changes, status improved in 35%, remained unchanged in 35%, and the information on five patients was unavailable. Surgical complications included three wound infections, one cerebrospinal fluid leak, and two pseudomeningoceles requiring surgical revision. One patient developed acute respiratory distress syndrome and sepsis postoperatively and died several days later. Conclusions: Adult-age presentation of a congenital tethered cord is unusual. Despite a slight increase in postoperative neurological injury in adults, surgery has relatively low risk and offers good potential for neurological improvement or stabilization. As in children, we recommend early surgery in adults with this disorder. The decision to undertake surgery, however, should be modulated by other factors such as a patient’s general medical condition and risk posed by anesthesia.
 
Article
Background: The vaginal microbial ecosystem stability preclude many other organisms but sometimes the vaginal micro biota is disturbed and this cause change in the normal balance causing symptoms of vulvuvaginitis like abnormal or increased vaginal discharge, redness and itching. Objective: To prove C. albicans presence in their vagina clinically and laboratory by culture of vaginal swab on two media. Type of the study: This study is a case control study Methods: This study is a case control study in which 100 clinically patient women admitted to maternity hospital in kalar city and khanaqin hospital during the period from 1st August– 30th of October 2016 who were examined to prove C. albicans presence in their vagina clinically and laboratory by culture of vaginal swab on two media, the first media was used for primary isolation which was Sabouraud´s dextrose agar media and the second was to differentiate Candida spp. according to their color . Results: Results of this study presented that the highest invasion of the vagina of Candida spp was accounted for C. albicans (39.6%)from the (53) positive cultures , while other species were as follows: C. glabrata (26.4%), C. tropicalis (20.8%) ,C. krusi(13.2 %). Conclusions: this study presented that the highest invasion of the vagina of Candida spp was accounted for C. albicans
 
Article
Alopecia (Baldness) is a very usual trouble in current time. It accompanied by intensive weaking of the scalps hair and follows a specific pattern. Hereditary predisposition plays a very important role in alopecia in spite of not completely understood. Alopecia can be typed to various categories according to etiology, may be due to hereditary factors, autoimmune disease and drugs or chemicals. There are many options of strategies of treatment according to the type and causes of alopecia. Chemical or synthetic medications apply for management of hair loss are accompanied with the wide range of undesirable effects. Naturally occurring drugs also play important role in alopecia management with minimal side effects.
 
Article
Background:Amino acid disorders are a major group of inborn error metabolism (IEM) with variable clinical presentation; its diagnosis constitutes a real challenge in a community with high consanguinity rate and no systematic newborn screening. Objectives: to provide data about amino acid disorders detected in high-risk Iraqi children by using quantitative amino acid fluorescent high performance liquid chromatography (HPLC) analysis. Type of the study: Cross-sectional study. Methods: a descriptive cross sectional study from 1st February to 1st December 2014, at Neurological ward and clinic of the Children Welfare teaching Hospital, in Baghdad - Iraq. Plasma specimens of 500 patients, with clinical suspicion of inborn error of metabolism (IEM) because of unexplained neurological deficits, unexplained developmental delay, recurrent coma and/or Neuro-degeneration, hair changes and/or lethargy, poor feeding, vomiting and selected cases of autistic spectrum syndrome or with positive screening, were analyzed for amino acids by high performance liquid chromatography (HPLC). The amino acid disorders were confirmed in fifty patients were; clinical data of patients were reported and analyzed statistically. Results: out of 500 patients visiting the neurological outpatient and ward, clinical and neurological finding were recorded as well as the family history and/or other symptoms suggestive of aminoacidopathy, Sixty patients were confirmed their diagnosis as amino acid disorders, ten patients were excluded because they lost the follow up or there is no solid base for a causal relationship between detected abnormal amino acids and neurological disorders, therefore only 50 patients were enrolled in the study. Patients with Phenylketonuria were the most frequent 24 (48%), homocystinuria 14 (28%), maple syrup urine disease 9 (18%) & other amino acid disorder, (Citrullinemia, non-ketotic hyperglycinemia & Tyrosinemia) 1for each disorder (2%). Considerable delay in diagnosis was noticed which lead to variable neurological abnormalities in most patients and the psychomotor delay was the main clinical presentation at time of diagnosis 34 (68%). Conclusion: in the absence of newborn screening, the majority of Aminoacidopathies cases was still diagnosed clinically, but delayed. The importance of clinical awareness and accurate biochemical analysis were the key tools for diagnosis and the necessity for a comprehensive national newborn screening program.
 
Article
Background: Penetrating neck injuries are common problem in our country due to increasing violence, terrorist bombing and military operations.These injuries are potentially life threating and need great attention and proper management.Objective: The aim of this study is to focus on the importance of anatomical zonal classification of the neck in the management of penetrating injuries of the visceral compartment of the Neck.Methods :70 patients with various injuries who were managed at causality unit and Otolaryngology department in Al-Kindy Teaching Hospital during aperiod from January 1st 2015 to October 31st 2015.The study carried on those patient depending on proper clinical examination and their urgent management.Results : Both civilian and military patients were admitted to the hospital, 34 patients (47.2%) in their 20s age group, while only 2 (2.8%) in 60s.High percentage of penetrating neck injuries in zone , 48 patient (68.6%) and lowest in zone , 6 patients (8.5%).40 patients (57.1%) presented with tracheal and laryngeal injuries and 12 patients (17.5%) were with pharyngeal injuries, 4 patients (5.7) were with recurrent laryngeal nerve injury and 13 patients (18.5%) presented with vascular injuries.Radiological examination done for 53 patients (75%) and we found foreign bodies in 30 patients (56.6%), tracheal deviation in 4 patients (7.5%) and emphysema in 19 patients (35.8%).Tracheostomy done in 51 patients (72.8%) neck, exploration in 20 patients (28.5%) and a 9 patients (12.8%) treated conservatively.Conclusion: Zonal classification of penetrating neck injuries was helpful in the management. Our study explains demographics and location of the injuries. Young men involved in violence and bombing was at high risk.Zone with involvement of trachea, larynx and pharynx were most common areas of injuries.RecommendationsAnatomical zone classification should be used as a guideline in management of penetrating neck injuries. (Trauma lifesaving guideline).Tracheostory should be practiced by every doctor in casualty unit. Team of surgeons and anaesthiologist should be always ready for any intervention with patient present to the casualty unite with a penetrating neck injury. Emergency medicine medical practice must be presents in every casualty unit to deal with insults.Aim of the study1.To recognize penetrating injuries of the neck according to the anatomic neck zones.2.Identify the outcome of their treatment
 
Article
Background: Anaemia is a major public health concern and is one of the most prevalent health issue in women within reproductive age group. Objective: to assess maternal knowledge related to anaemia during pregnancy. Type of the study: A cross –sectional study. Method: The study including 200 mothers who attended selected primary health care centres, Baghdad during November and December 2015, they completed a previously prepared questionnaire coveringsocio-demographic characteristics and knowledge regarding anaemia in 4 main domains. The responses were analysed by using frequency, percentage and percent score for each statement and overall percent score for each domain and mean overallpercent score for all the four domains. Results: the main source of information of the participated mothers was health personal (59.5%).The overall percent score for the main domains was good 71% for aetiology of disease, excellent 91% for signs and symptoms of anaemia, good 75% for complications of anaemia and very good 75% regarding ways of prevention and treatment. Conclusion: Satisfactory knowledge level of mothers regarding anaemia during pregnancy.
 
Article
Background: Imaging has a critical role in the diagnosis and evaluation of cardiac diseases, beginning with chest radiography and fluoro-scopy and progressing to coronary angio-graphy, echocardiography, nuclear medicine and recently multidetector computed tomo-graphy (MDCT) as well as magnetic resonance (MR) imaging Objective: To highlight the role of Multi-detector CT in the evaluation of coronary artery disease and its importance of being noninvasive diagnostic technique. Methods: A cross sectional study for 20 patients. Patients were asked to fast 6 hours prior to the examination and the patients with heart rates above 65 beats per minute were given cardio-selective beta-blocker and for heart rate above 75 (up to 85) beat/min, the best systole phase was used for reconstructing our images Results: for Evaluation of native coronary arteries, the CTCA showed significant lesions (occlusion or >60 % stenosis) in the native arteries of 13 patients and insignificant lesions in 7 patients. Evaluation of CABG (8 arterial grafts); for (LIMA) graft, 83% were patented, and 17% were narrowed and 100 % of (radial graft) were patent. For Venous Grafts the study included 10 venous grafts; 70 % were patent, 20% were narrowed and 10 % were totally occluded. Conclusion: The multi-slice CTCA is now a clinically reliable noninvasive tool that allows the evaluation of the native coronary arteries, the bypass grafts, coronary stents.
 
Top-cited authors
Akram Jaffar
  • Dalhousie University
Samar Sarsam
  • University of Baghdad
Hayder Al-Momen
  • University of Baghdad
Omar F. Abdul-Rasheed
  • Al-Nahrain University
Ali Fuad Al-Hashimi
  • Al-Nahrain University