Journal of the Faculty of Medicine Baghdad

Background: Heterocyclic compounds and its derivatives have biological activities and used as analgesic, anti-helminthic, antituberculer, antifungal, antiviral, anticancer and inhibitor of some enzymes. Oxazepine (benzodiazepine) derivative used in relief of psychoneuroses characterized by anxiety and tension. Alkaline phosphatase (ALP) hydrolyzes phosphate monoesters, while Lactate dehydrogenase (LDH) catalyses oxidation of L-lactate to pyruvate utilizing NAD+ Objective: The study was carried out to know of the impact of 1,3-oxazepine derivative on the ALP and LDH enzyme activity on human serum in vitro. Methods: The study included the effect of synthesized 1,3-oxazepine divertive [(Z)-3-(5-mercapto-1-3,4-Thiadizol-2-yl)-2-(4-nitrophenyl)-2,3-dihydro-1,3-oxzepine-4,7-dione] on the activity of enzymes ALP and LDH for (34) healthy Iraqi females serum in vitro. The activity of both enzymes was measured spectrophotometrically. Different concentrations of 1,3-oxazepine derivative were used and the inhibition percentage was calculated. Results: The results of this study revealed that effect of 1,3-oxazepine derivative was inhibitor for ALP and LDH activity and the high inhibition percentage was 87.56% for ALP. The high inhibition percentage was 50% for LDH when 1,3-oxazepine derivative was used. Conclusions: 1,3-oxazepine derivative affected as inhibitor on ALP and LDH enzyme activity in human serum in vitro. This can be used in drug industry in the future.

Background: Heterocyclic compounds and its derivatives have biological activities and used as analgesic, anti-helminthic, antituberculer, antifungal, antiviral, anticancer and inhibitor of some enzymes. Oxazepine (benzodiazepine) derivative used in relief of psychoneuroses characterized by anxiety and tension. Alkaline phosphatase (ALP) hydrolyzes phosphate monoesters, while Lactate dehydrogenase (LDH) catalyses oxidation of L-lactate to pyruvate utilizing NAD+Objective: The study was carried out to know of the impact of 1,3-oxazepine derivative on the ALP and LDH enzyme activity on human serum in vitro.Methods: The study included the effect of synthesized 1,3-oxazepine divertive [(Z)-3-(5-mercapto-1-3,4-Thiadizol-2-yl)-2-(4-nitrophenyl)-2,3-dihydro-1,3-oxzepine-4,7-dione] on the activity of enzymes ALP and LDH for (34) healthy Iraqi females serum in vitro. The activity of both enzymes was measured spectrophotometrically. Different concentrations of 1,3-oxazepine derivative were used and the inhibition percentage was calculated.Results: The results of this study revealed that effect of 1,3-oxazepine derivative was inhibitor for ALP and LDH activity and the high inhibition percentage was 87.56% for ALP. The high inhibition percentage was 50% for LDH when 1,3-oxazepine derivative was used.Conclusions: 1,3-oxazepine derivative affected as inhibitor on ALP and LDH enzyme activity in human serum in vitro. This can be used in drug industry in the future.

Background: All though the most common etiology of lumbar radiculopathy is herniated disc or spinal stenosis, however there are several intraspinal or extra spinal pathogenic processes that may cause lumbar radiculopathy.Objective: To assess how often, and review the pathologies that cause non discogenic lumbar radiculopathy.Patients and Methods: A prospective study was conducted on 600 patients who had lumbar radiculopathy. During one year period we examined 600 patients in outpatient clinic with presumed diagnosis of lumbar disc herniation.Through history and comprehensive physical and neurological examination were performed for all patients. Diagnostic test were done including laboratory, electrophysiological and radiological assessments. in this study Patients with non discogenic lumbar radiculopathy, were refereed patients to other specialist to deal with cases.Results: There were 104 patients (17%) with non discogenic lumbar radiculopathy out of 600 patients presented with lumbar radiculopathy. There were peripheral neuropathy in 28.8%, peripheral vascular diseases in 19.25%, osteoarthritis or osteonecrosis of hip joint in 19.25%, extra spinal tumors in 14.5% of patients ,osteodiscitis in 11.5%, entrapment neuropathy in 6.5% of the patients.Conclusions:The most common causes of lumbar radiculopathy are herniated disc but there are 17% with non discogenic lumbar radiculopathy with broad list of pathologies.

Background: All though the most common etiology of lumbar radiculopathy is herniated disc or spinal stenosis, however there are several intraspinal or extra spinal pathogenic processes that may cause lumbar radiculopathy. Objective: To assess how often, and review the pathologies that cause non discogenic lumbar radiculopathy. Patients and Methods: A prospective study was conducted on 600 patients who had lumbar radiculopathy. During one year period we examined 600 patients in outpatient clinic with presumed diagnosis of lumbar disc herniation.Through history and comprehensive physical and neurological examination were performed for all patients. Diagnostic test were done including laboratory, electrophysiological and radiological assessments. in this study Patients with non discogenic lumbar radiculopathy, were refereed patients to other specialist to deal with cases. Results: There were 104 patients (17%) with non discogenic lumbar radiculopathy out of 600 patients presented with lumbar radiculopathy. There were peripheral neuropathy in 28.8%, peripheral vascular diseases in 19.25%, osteoarthritis or osteonecrosis of hip joint in 19.25%, extra spinal tumors in 14.5% of patients ,osteodiscitis in 11.5%, entrapment neuropathy in 6.5% of the patients. Conclusions:The most common causes of lumbar radiculopathy are herniated disc but there are 17% with non discogenic lumbar radiculopathy with broad list of pathologies.

Background: A tattoo is a foreign material implanted into the dermis by needle or some other trauma that results in a visible mark in the skin .either decorative or cosmetic tattoos or may be traumatic tattoos resulting from car accident or iatrogenic tattoos placed in radiation ports. There are many ways for tattoo removal one of them is laser treatment by Q-Switched (1064 nm and 532 nm) Nd: YAG Laser. Objectives: The purpose of this study is to evaluate the efficacy and safety of Q-Switched Nd: YAG (1064 &532 nm) Laser in treatment of tattoos. Patient and Method: Nineteen lesions of tattoo in different body sites in nine patients collected in private plastic surgery clinic in Baghdad from 1st of September 2010 till end of February 2011 treated by QSwitched Nd: YAG Laser with energy density 8.5 J/cm2 and multiple sessions of treatment up to five with to 6weeks interval. Results: The response of tattoo to laser treatment was variable from patient to patient and from session to session of same tattoo. In general the results were encouraging in majority of lesions except in 5 lesions in which ink has been used for tattooing introduced so deep by manual pricking with needle. Conclusion: switch Nd-YAG laser is a safe and effective option for tattoo removal لمقدمة: الوشم عبارة عن مادة غريبة تدخل في أدمة الجلد بواسطة وغز أبرة او أي شدة خارجية اخرى فتنتج علامة في الجلد، وتستخدم لغرض الديكور او الجمالية واحيانا تكون ناتجة عن حادثة طريق واحيانا أخرى نقوم بعمل الوشم لأسباب علاجية مثل تحديد الأماكن المحتاجة الى تسليط علاج أشعاعي. هنالك طرق عدة لأزالة الوشم و واحدة من هذه الطرق هو ازالة الوشم باستخدام كيو سوج (1064نانو متر، 532 نانو متر) اندي ياك ليزر. اهداف الدراسة:- هو تقييم فعالية كيو سوج (1064نانو متر، 532 نانو متر) اندي ياك ليزر في ازالة الوشم ومدى سلامته. ألأساليب :- تسع عشرة حالة وشم في اماكن متعددة لجسم تسعة ذكور تمت معالجتها بكيو سوج (1064نانو متر، 532 نانو متر) اندي ياك ليزر بطاقة 8,5 جول لكل سنتمتر مربع عدة جلسات قد تصل الى خمسة جلسات وبين جلسة واخرى على الاقل ثلاثة اسابيع وقد تصل الى ستة. النتائج:- كانت النتائج متباينة من شخص الى شخص ومن وشم الى وشم لنفس الشخص ومن جلسة واخرى لنفس الوشم , بصورة عامة كانت النتائج مشجعة بأستثناء خمسة حالات كان الوشم فيها قد عمل بواسطة وغز يدوي مع الحبر الملون. الأستنتاج:- ان كيو سوج (1064نانو متر، 532 نانو متر) اندي ياك ليزر فعال وخيار أمين لازالة الوش

Background: A tattoo is a foreign material implanted into the dermis by needle or some other trauma thatresults in a visible mark in the skin .either decorative or cosmetic tattoos or may be traumatic tattoosresulting from car accident or iatrogenic tattoos placed in radiation ports. There are many ways for tattooremoval one of them is laser treatment by Q-Switched (1064 nm and 532 nm) Nd: YAG Laser.Objectives: The purpose of this study is to evaluate the efficacy and safety of Q-Switched Nd: YAG (1064 &532 nm) Laser in treatment of tattoos.Patient and Method: Nineteen lesions of tattoo in different body sites in nine patients collected in privateplastic surgery clinic in Baghdad from 1st of September 2010 till end of February 2011 treated by QSwitchedNd: YAG Laser with energy density 8.5 J/cm2 and multiple sessions of treatment up to five with to 6weeks interval.Results: The response of tattoo to laser treatment was variable from patient to patient and from session tosession of same tattoo. In general the results were encouraging in majority of lesions except in 5 lesions inwhich ink has been used for tattooing introduced so deep by manual pricking with needle.Conclusion: switch Nd-YAG laser is a safe and effective option for tattoo removal لمقدمة: الوشم عبارة عن مادة غريبة تدخل في أدمة الجلد بواسطة وغز أبرة او أي شدة خارجية اخرى فتنتج علامة في الجلد، وتستخدم لغرض الديكور او الجمالية واحيانا تكون ناتجة عن حادثة طريق واحيانا أخرى نقوم بعمل الوشم لأسباب علاجية مثل تحديد الأماكن المحتاجة الى تسليط علاج أشعاعي. هنالك طرق عدة لأزالة الوشم و واحدة من هذه الطرق هو ازالة الوشم باستخدام كيو سوج (1064نانو متر، 532 نانو متر) اندي ياك ليزر. اهداف الدراسة:- هو تقييم فعالية كيو سوج (1064نانو متر، 532 نانو متر) اندي ياك ليزر في ازالة الوشم ومدى سلامته. ألأساليب :- تسع عشرة حالة وشم في اماكن متعددة لجسم تسعة ذكور تمت معالجتها بكيو سوج (1064نانو متر، 532 نانو متر) اندي ياك ليزر بطاقة 8,5 جول لكل سنتمتر مربع عدة جلسات قد تصل الى خمسة جلسات وبين جلسة واخرى على الاقل ثلاثة اسابيع وقد تصل الى ستة. النتائج:- كانت النتائج متباينة من شخص الى شخص ومن وشم الى وشم لنفس الشخص ومن جلسة واخرى لنفس الوشم , بصورة عامة كانت النتائج مشجعة بأستثناء خمسة حالات كان الوشم فيها قد عمل بواسطة وغز يدوي مع الحبر الملون. الأستنتاج:- ان كيو سوج (1064نانو متر، 532 نانو متر) اندي ياك ليزر فعال وخيار أمين لازالة الوش

Background: Multiple myeloma is characterized by clonal expansion and accumulation of abnormal plasma cells in the bone marrow compartment. This study was conducted to determine the frequency and hematological presentation of multiple myeloma in Nanakaly Hospital in Erbil city.patients and Methods: This descriptive retrospective study was carried out at Nanakaly Hospital over a period of six years from January 2007 to August 2012. A total of 109 patients who were diagnosed with multiple myeloma all were included to analyze the clinical and laboratory profiles. All patients were selected based on preset diagnostic criteria by the WHO.Results: The study showed a male: female ratio of 1:1.1, the mean age of male patients was 57.8 years and for females were 57.9. Backache was the most frequent presentation (41.28%) of the patient then bone pain (33.94%), followed by pallor (10.1%) and bone mass (9.2%). The hematological findings showed anemia in 72% patients. Forty five percent of the bone marrow nucleated cells were plasma cells.Conclusions: Males are affected equally to females by multiple myeloma. Majority of patients present with backache, bone pain and anemia.

Background: Breast cancer is one of the common malignancies among women worldwide. Human papillomavirus (HPV) infections have been linked to many human cancers in addition to cervical cancer and one of them is breast cancer.Objective: To investigate the presence of human papilloma virus type 6 and type 11in breast cancer tissue specimens by in situ hybridization technique.Patients and Methods: Thirty four formalin-fixed, paraffin embedded tissue blocks from breast cancer patients were obtained from the archives of the pathology laboratory of Al-Yarmouk Teaching Hospital from January 2011 to July 2012. In addition formalin-fixed, paraffin embedded blocks tissue for twenty fibroadenoma of breast were collected and used as control group. In situ hybridization technique was used for the molecular detection of HPV type 6 and HPV type 11.Results: There were 82.4 % of breast cancer tissues positive for HPV type 6 and 88.2 % were positive for HPV type 11.Conclusion: The presence of human papillomavirus DNA in most breast carcinoma samples merits further investigation and confirmation by second assay in order to establish the exact role of this virus in the pathogenesis of breast cancer.

Background: Preeclampsia is most common medical disordersduring pregnancy, and the rate of hypertension ranges from 5 – 8 % f or all types of pregnancy. There was a significant difference between cancer antigen -125, plasma fibrinogen and C- reactive protein to the severity of preeclampsia.Objective: To determine the level ofserum CA-125 level, C-reactive protein and plasma fibrinogen in preeclampsia and their association with the severity of disease and progression of mild preeclampsia to severe type.Patients and method: A prospective case-control studywhich was carried out in the department of gynecology and obstetric at Baghdad teaching hospital from 1st ofJanuary 2015 to 1st of July 2015.One hundred forty pregnant women were included; they were selected and divided into three groups:Group A: Thirty five (35) pregnant women with mild preeclampsia.Group B: Thirty five(35) pregnant women with severe preeclampsia.Both group A and B are selected according to the clinical signs, symptoms and investigations and admitted to obstetrics ward for evaluation.Group C: seventy (70) pregnant women with uncomplicated singleton pregnancies as control group .Blood samples were taken for measurement of serum cancer antigen -125, C- reactive protein and plasma fibrinogen for all groupsResults: The mean level of Cancer antigen- 125in control , mild and severe preeclampsia groups was ( 14.4±4.11) , (33.60± 4.52) and ( 37.35± 4.85) respectively which was a significant difference between control ,mild groups ( p value < 0.0001) and between control and severe preeclampsia groups ( p value < 0.0001), the mean level of C-reactive protein in mild and severe preeclampsia was( 15.62± 2.6)and ( 29.3± 7.02) which was significant higher in comparison to control group which was ( 8.17 ± 1.56 ) the P value was < 0.0001 . theplasma fibrinogen levels in mild and sever preeclampsia was (470.37±51.1) and (563.14±48.28) which were markedly higher than that of control group (342. 97±56.6) in third trimester pregnant women.Conclusion:Serum Cancer antigen -125, Serum C - reactive protein and Serum plasma fibrinogen were significantly higher in preeclampsia groups in comparison to the control group and these increments was directly correlated with the severity of preeclampsia .

Background: Multiple sclerosis is a devastating central nervous system autoimmune disorder that is characterized by a series of inflammations, demyelinations, and neurodegenerations that affect the brain and spinal cord. The epigenetic studies specially micro Ribonucleic acid expression represent an important field of researches that probably uncover the obscurities behind the multiple sclerosis pathogenesis.Objectives: to study the expression of micro Ribonucleic acids (20a, 146a, 155, and 145) in multiple sclerosis patients by the use of real time polymerase chain reaction.Patients and Methods: A case-control study was performed using real time polymerase chain reaction technique to measure the relative expression of micro Ribonucleic acids (20a, 146a, 155, and 145) in peripheral blood leukocytes of 25 newly diagnosed untreated multiple sclerosis patients and comparing them with that of 25 clinically apparent healthy controls .Results: Studying of micro Ribonucleic acids expression in multiple sclerosis patients revealed a significant down-regulation in micro Ribonucleic acid-20a while up- regulation of micro Ribonucleic acid-155 expression in multiple sclerosis patients in comparison to controls. Micro Ribonucleic acids -146a and 145 were not associated with significant changes in its expression in multiple sclerosis patients in comparison to controls.Conclusion: multiple sclerosis is associated with significant changes in micro Ribonucleic acids expression including micro Ribonucleic acid-20a, and micro Ribonucleic acid-155 but not micro Ribonucleic acid 146a and-145 that can be measured by real time polymerase chain reaction technique.

Background: Osteoporosis is a bone condition that makes bones thininer and more fragile because of reduced bone density and it puts people at risk of fractures, especially of the hip, spinal vertebrae and wrist.Objective: This study will highlighted the role of IL-17 in postmenopausal osteoporosis.Patients and methods: This study applied on 84 includes subjects (42 postmenopausal osteoporosis patient and 42 of healthy control group), conducted from December 2014 to March 2015 to measure the IL-17 serum level by using ELISA kit.Results: In osteoporotic postmenopausal women the mean of serum IL-17 was (0.49pg/ml) and it is significantly higher than that of healthy group (0.09pg/ml).Conclusion: Serum IL-17 was significantly elevated in osteoporotic postmenopausal women when compared to healthy postmenopausal women.

Background: The most widely used vaccination against SARS-associated coronavirus (SARS-CoV-2) is the Pfizer vaccine, which provides protection against this virus. However, its ability to safeguard the oral cavity is unclear, and neither are the exact immunological biomarker levels it activates. Aim of the study: To investigate the possibility that Pfizer vaccination protects the oral cavity against Covid-19. Patients and Methods: The study group consisted of a total of 70 subjects (30 as the control group They were followed up before being vaccinated as non-vaccinated (maybe previously infected or non-infected or recovered) and 40 participants followed up three weeks after the first dose and one week after the second vaccination. All saliva samples were collected from the individuals in the current study at the medical city hospital in Baghdad from September 2021 to July 2022. The salivary biomarkers sIgA and IL-17 were detected by enzyme-linked immunosorbent assay (ELISA) kits. Result: Secretory IgA levels showed a highly significant difference (p0.05) in the followed-up group after the first vaccination compared to the non-vaccinated group (controls), however, a non-significant difference in its level was found in the followed-up group after the first vaccination compared to after the second vaccination. In contrast to healthy controls, non-vaccinated participants had greater salivary IL-17 levels. Followed-up participants’ IL-17 levels did not change significantly after the first and second vaccines (P>0.05). Conclusion: The Pfizer vaccine had a minor impact on sIgA because mRNA vaccines protect systemically more than salivary. Nevertheless, the Pfizer vaccine raises IL-17 levels after the first and second doses without triggering cytokine syndrome.

Background: Osteoporosis is a bone condition that makes bones thininer and more fragile because of reduced bone density and it puts people at risk of fractures, especially of the hip, spinal vertebrae and wrist. Objective: This study will highlighted the role of IL-17 in postmenopausal osteoporosis. Patients and methods: This study applied on 84 includes subjects (42 postmenopausal osteoporosis patient and 42 of healthy control group), conducted from December 2014 to March 2015 to measure the IL-17 serum level by using ELISA kit. Results: In osteoporotic postmenopausal women the mean of serum IL-17 was (0.49pg/ml) and it is significantly higher than that of healthy group (0.09pg/ml). Conclusion: Serum IL-17 was significantly elevated in osteoporotic postmenopausal women when compared to healthy postmenopausal women.

Background: Necrotizing fascitis is a progressive, rapidly spreading inflammatory infection located in the deep fascia, with secondary neerosis of the subcutaneous tissues polymicrobial infection is the most common finding in necrotizing fascitis rather than a single caustive organism.

Background: The number of coronavirus infection cases has increased rapidly since early reports in the December 2019 in China. But data on the clinical features of infected peoples is variable from one country to the other. Objective: Studying clinical features of patients with a positive RT PCR COVID – 19, in a group of Iraqi patients. Results: The study included 200 patients with 133 (66.5%) males and 67 (33.5%) females, and age range of 14- 89 years, with mean age 46.4 years. A history of contact with a COVID -19 positive case was found in 80 patients (40%), Ischemic Heart Disease in 11 patients (5.5%), hypertension 34 (17%), diabetes mellitus 36 patients (18%). The most frequently seen age group was between 21-39 years (76 patients - 38%). The most frequently seen symptoms were fever 76.5% and generalized weakness 73%. A statistically significant association was found between age and dyspnea (p = 0.014) and also diarrhea (p = 0.035), as well as between gender and rhinorrhea (p = 0.08) and nausea and/ or vomiting (p = 0.005). Patients and Methods: This is a record review study of 200 patients with a confirmed COVID - 19, conducted in Al Imamain Al Kadhimain Medical City from 1 May to 30 August 2020, the diagnosis of patients during this period. Data about demographic and the clinical characteristics have been recorded.

Background: Al-Najaf province , Iraq , has experienced an outbreak of coronavirus disease 2019 (Covid-19). Epidemiological and clinical characteristics of (Covid-19) infection have been reported but a detailed clinical course and risk factors for mortality including medical comorbidities and severity of illness at time of presentation , have not been well described. Methods: From February 24 to April 7, 2020, a case series study done on 123 PCR-confirmed cases of (Covid-19) admitted to Al-Hakeem Hospital And Quarantine Center (AHQC), in Al-Najaf Province, Iraq. Demographics, clinical and laboratory data gathered from a local database at (AHQC). SPSS(statistical package for social sciences) used for statistical analysis. Frequency, percentage, mean and standard deviation used as descriptive statistics. Chi square or Yates corrected chi square used as needed.(P value≤0.05) regarded significant. Results: In total of 123 Patients, most infections occur inside Iraq 96(78%) .The cohort included 67 (54.5%) females and 56 (45.5%) males, mean age was 32.58±18.56 years. most infections were mild or asymptomatic (72.3%). The most common symptoms was fever (74.8% ) , followed by cough (66.7%), headache (59.3%), and dyspnoea (28.5%). Most patients 108(87.8%) recovered and four patients (3.3%) died. There is a significant association between medical comorbidities , severity of illness and patients outcome (P value <0.001). Conclusions: The potential risk factors of medical comorbidities and severity of illness could help clinicians to identify patients with poor prognosis at an early stage and provides the rationale for a treatment strategy of infected patients and optimal antiviral interventions in the future.

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is caused coronavirus disease2019 (COVID-19) affecting people worldwide. The angiotensin converting enzyme2 (ACE2) represents areceptor of SARS-CoV-2 on the infected host cell. Apelin or its receptor agonists suppress the production ofangiotensin-converting enzyme (ACE) and angiotensin II (Ang-II) and is characterized by a protective effectagainst SARS-CoV-2.Objective: The study aims to assess the serum level of Elabela biomarker as an early detector for AcuteKidney Injury (AKI) in patients with COVID-19.Cases and Methods: This is a case-control study which included 45 hospitalized adult patients in multiplecenters (public hospitals) receiving COVID-19 cases in Baghdad. These cases had a positive real-time orreverse transcription polymerase chain reaction (RT-PCR) of nasal/oropharyngeal swabs. Excluded from thestudy were those with a negative PCR and comorbidities and 43 apparently healthy adult subjects as controls.The age range of the cases and controls was (20 to 60) yearsResult: There are no a statistically significant differences between the two groups in terms of age and genderdistribution. Statistically significant differences were found in terms of eGFR, S. Creatinine, D. dimer,NEU×103/µL, LYM×103/µL and ELA biomarker. Significant negative correlations were found betweenElabela with D. dimer and NEU×103/µL, and between eGFR with S. creatinine, D. Dimer, and NUT×103/µL.Conclusion: The Elabela biomarker can be used for the early detection of acute kidney injury in COVID-19patients.

Background: Medical educators’ dissatisfaction may cause them to leave the practice of teaching, where it is often hard to replace those who have left. In addition, medical teaching staff dissatisfaction may indicate adverse quality for institution/ university organizations. Objectives: To assess teaching staff satisfaction with online learning during the COVID pandemic at Al-Nahrain University /College of Medicine, Baghdad/Iraq. Methodology: A cross-sectional study included a convenient sample of 50% of the teaching staff participating in the online academic year 2020-2021. The faculty satisfaction questionnaire was taken from the "Bolliger and Halupa" study, based on the validated Online Course Satisfaction Survey (OCSS) questionnaire that contains four major categories: Interaction, instructor planning, institutional support, and affordance. Results: The study included 85 medical college teachers from all departments. The total satisfaction level of participants in this study was 25.6%, which is considered low. The total satisfaction score given by the participants was (0.98), the highest score of (1) was given to the items of affordance questions, and the lowest was given for student–instructor interaction and course design and development (0.79, 0.89), respectively. Conclusion: The satisfaction of teaching staff with online learning during the COVID-19 pandemic was generally low, especially regarding student-instructor interaction and course design and development Received: Jan., 2023 Accepted: July 2023 Published: Oct. 2023

Background: Severe forms of Coronavirus disease 2019 (COVID‐19) were found among 6 - 10% of all COVID-19 patients. Acute respiratory distress syndrome ARDS is non-cardiogenic pulmonary edema manifested by the rapid development of shortness of breath, tachypnea, and hypoxemia. Patients’ outcomes after critical care for COVID-19 have not been adequately documented in this low-resource environment, despite advocacy for prevention and response measures in low- and middle-income countries. Objectives: To highlight the rate of severe illness among COVID-19 patients and its associated factors in Al-Imam Ali Hospital, Baghdad-Iraq 2021. Patients and Methods: A descriptive cross-sectional study on cases with severe and critical COVID-19 illness (with ARDS) admitted to the isolation ward in Al-Imam Ali Hospital from 23 March to 23 May, 2021. All COVID-19 patients admitted in a severe or critical state were included. A data collection form was filled by the researcher. The P value of < 0.05 was used to determine statistical significance. Ethical Approval was obtained. Results: A total of 504 severely ill COVID-19 patients were included in this study. There were 71 (14.1%) patients below 45 years of age. Males formed 40.9% of patients while that of females was 59.1%. Fever was the presenting symptom in 381 (75.6%) patients, 197 (39.1%) patients had anosmia, and 192 (38.1%) had ageusia. There were 358 (71.0%) survivors while 146 (29.0%) died. Patients aged 65 years or more had more possible risk for death than those below 65 years (OR=1.14, 95% CI =0.6-2.2). Female gender appeared to be protective compared to male gender (OR=0.52, 95% CI =0.35-0.77). Ex-smokers had a higher risk than non-smoker and current smokers (OR for ex-smoker=4.38, 95% CI 2.6-7.5), and (OR for current smoker=1.7, 95% CI 0.98-3). Renal disease was found to be a risk factor leading to death (OR=2.9; 95% CI=1.73-5.1). Diabetes Mellitus, respiratory diseases, and solid cancer showed a high risk for death, [OR=2.3, 95% CI=1.4-4; OR=1.7; 95% CI=1.1-2.9, OR=8, 95% CI=3.3-19 respectively]. Patients with three comorbidities had a higher mortality risk, OR=1.6, 95% CI=1.3-2. Conclusion: This study concluded that mortality of severely and critically ill COVID-19 patients was 29%, and males and older patients were risk factors for death. In addition to; ex-smoker, alcoholic, and patients with baseline comorbidities appeared to be risk factors for mortality. Finally; laboratory tests and Pao2/Fio2 ratio can be used to predict the outcome.

Background: Since declaring coronavirus disease 19 as a pandemic by the World Health Organization, a great concern was directed toward pregnant women and their fetuses. Despite the substantial impact of COVID-19 disease on pregnancy, there is a scarcity of national researches discussing this important issue. Objectives: To study the relationship between peripheral blood abnormalities and COVID-19 in pregnant women. Patients and methods: A case control study was conducted in the labour wards of Baghdad Teaching Hospital in the Medical complex / Baghdad /Iraq during the period from 1st of February till 31st of July, 2021. Fifty pregnant women diagnosed with COVID-19 disease were compared to 50 healthy pregnant women as controls. The pregnant women enrolled in the study were tested by COVID-19-Reverse transcription RT-PCR test upon admission to hospital. The confirmation of COVID-19 diagnosis was done according to the Iraqi guidelines approved by the Iraqi Ministry of Health. Results: Dyspnea was a significant clinical presentation of pregnant women with COVID-19 disease. Those women had abnormal white blood cell count, lymphocytopenia, high neutrophil to lymphocyte ratio, high platelets to lymphocyte ratio and mild to moderate anemia which were significant when compared to controls. The maternal and neonatal morbidity and mortality rates were higher among pregnant women with COVID-19 disease. Abnormalities in peripheral blood system parameters like lymphocyte count, neutrophils count, platelets count and hemoglobin level were predictors of maternal morbidity and mortality. Conclusions: The clinical presentations and hematological abnormalities are useful in the diagnosis of COVID-19 disease in pregnant women and may be used as predictors of maternal and neonatal morbidity and mortality.

Background: Coronavirus is an enveloped RNA virus, from the genus Betacoronavirus, that is distributed in birds, humans, and other mammals. WHO has named the novel coronavirus disease as COVID-19. Objective: We have conducted this review to focus on the studies that assessed the treatment efficacy and safety of Coronavirus (COVID-19) to describe its relation with the clinical outcomes of patients. Method: PubMed, was searched for studies on the clinical evaluation of selected currently used treatments for COVID-19. we included six studies about therapeutic activity of chloroquine/hydroxychloroquine, two case series about oseltamivir and three studies about lopinavir/ritonavir Results: some of studies have been demonstrated and approved for a wider use hydroxychloroquine for COVID-19, others concluded that there was insufficient evidence to offer any recommendation on the routine use of these drug in patients admitted to the intensive care unit (ICU). Other treatments have insufficient evidence to recommend the use (lopinavir-Ritonavir or oseltamivir) for COVID-19 outside of research studies. Conclusion: In order to determine their efficacy and safety for COVID-19, more adequately powered randomized clinical trials are required. Ideally, these studies should be double-blinded and conducted in a range of settings. Keywords: Covid-19, hydroxychloroquine, Azithromycin, Oseltamivir, lopinavir-Ritonavir

Background: The radiological scoring of severity and progression of lung abnormalities is of great value for clinicians to define the clinical management of COVID-19 patients. Objectives: The purpose of this study is to implement the Brixia scoring tool to assess the pattern of lung involvement in patients with COVID-19 to help predict the severity of their clinical outcome, where the clinical outcome correlates to outpatient, inpatient and/or ICU admission. Patients and Methods: We conducted a case series study at the Sheikh Khalifa Medical City Ajman (SKMCA), United Arab Emirates from 14 March to 30 October 2020. Patients’ medical records were reviewed and followed up from the time of diagnosis until discharge and/or death. The patients were included based on the following criteria: Confirmed COVID-19 infection via RT-PCR assay, symptoms of COVID-19 within one week prior to presenting at the hospital and an initial Chest X-ray at hospital presentation. Two independent and experienced radiologists implemented the Brixia scoring tool for the assessment of pulmonary involvement detected on CXR of patients with COVID-19. Results: We reported cut-off values of the CXR score to be 7 for ICU admission (sensitivity=84.1%) and a cut-off score of 9 to predict the outcome of death (sensitivity=70.4%); where both values were statistically significant with p-value <0.001. Age and co-morbid conditions potentiate the CXR score. Conclusion: Patients with a Brixia score higher than the cut-off value would require ICU admission. In addition to the Brixia scoring tool, age and pre-existing co-morbid diseases are important predictors of the clinical outcome. CXR can serve as a valuable factor for risk stratification for clinical outcome in patients with COVID-19 pneumonia