Iraqi National journal of Medicine

Background: Burn injury is one of the leading causes of morbidity and mortality worldwide. Burn related hospital acquired infections is one of the major problems in the management of these injuries.


Aim of the study: To elaborate on the early laboratory and microbial culture changes in adult burn inpatients, and to make use of subtle changes in the laboratory investigations, to predict and detect infections in burn victims, in its early phases.


Patients and Methods: A Clinical observational study included a random sample of one hundred adult burn inpatients from Sulaymaniyah Burn Hospital, admitted from April 2019 to January 2021, retrospectively and prospectively followed up during the course of the study.


Results: thirty one (31%) patients were male and 69% were female, all patients were adults and aged ≥18 years. 51 % of them had mix II-III degree burns, while 38% second and 11% third degree burns. Hematocrit decreased, total WBC count increased while platelet in most of the patients was normal. Blood urea was increased, Serum creatinine levels were normal in most of the patient in first three weeks of their admission. Eleven patients (11%) died. Whereas 36% of the patients who died had Total Body Surface Area burn of more than 60%, while 72% of them had II and III degree burns. Also 90% of the patients had infections, majority of the isolate results were Gram-negative bacteria (66.8%), and (33.2%) were Gram-positive. Pseudomonas aeruginosa (32.5%) was the most common gram negative. The Staphylococcus aureus (33.2%) was the gram positive organism recovered. While 66.6% of patients had fever during the first week, 55.5% of patients had fever in second week. Most of the patients, who had fever, were infected with S.aureus and Pseudomonas aeruginosa throughout the second week post burn.


Conclusion and recommendations; Many laboratories and microbial parameter changes occur in the early phases of post burning, of which Leukocytosis can be a good predictor for infection in burns, especially when it happens in the second week and beyond. Yet it cannot distinguish gram negative from gram positive bacterial infections. To detect any change in the back ground laboratory parameters, as soon as they happen, infections in burns can be detected or suspected

Background: Pseudo-Pendred syndrome (PPS) is a genetic disorder inherited as an autosomal recessive disorder. PPS is characterized by the presence of hypothyroid goiter combined with mild to moderate form of SNHL, not presentable at birth, with no obvious inner ear malformation. This is the major difference from Pendred syndrome in which the SNHL is congenital, severe to profound in nature, and associated with inner ear malformation, mostly enlarged vestibular aqueduct. The main etiology of PPS is thought to be formation of autoantibodies against the thyroid tissue and the cochlea.


Case report: Our reported case is a 12-year-old girl who presented goiter, hypothyroidism, and hearing loss. Examination and hormonal and radiological investigations confirmed the hypothyroid goiter. The result of the thyroid antibody test was positive (TPO test = 174 IU\\mL). Audiological assessment and the CT scan of the temporal bone confirmed mild SNHL with no inner ear malformations. The patient received treatment in the form of thyroid supplement and hearing aid. On a side note, there are no other affected siblings in her family.


Conclusion: The Pseudo-Pendred syndrome is a congenital condition characterized by the presence of hypothyroid goiter with mild SNHL and normal inner ear structures. Despite the fact that no genetic analysis had been done to confirm the diagnosis of PPS, all the clinical, hormonal, immunological, audiological, and radiological assessments indicate PPS in our case. Furthermore, the main cause of the goiter and hearing loss is thought to be of autoimmune etiology.

Background: The association of diabetes mellitus, nighttime blood pressure dipping and nonarteritic ischemic optic neuropathy is inconclusive. There has been no study to test this association among Arab Patients.


Objectives: This study aims to test the association between diabetes mellitus, nighttime blood pressure dipping and nonarteritic ischemic optic neuropathy among cohort of patients from Basrah, Southern Iraq.


Methods: This was a cross-sectional study on patients with nonarteritic ischemic optic neuropathy conducted at the ophthalmology clinic at Faiha Teaching Hospital in 2018. Patients with nonarteritic ischemic optic neuropathy were screened for diabetes mellitus. Ambulatory blood pressure monitor was attached to some of the participants for 24 hours. Nighttime blood pressure dipping was classified into 4 categories: normal, blunted, severe and reverse.


Results: A total of 74 patients with nonarteritic ischemic optic neuropathy were included. Females constituted 64.9 % of the cases. Forty patients (53.3%) were found to have diabetes mellitus. While 41 participants (55.5 %) were hypertensive. Nocturnal dipping of blood pressure was measured in 38 patients. Only 6 (15.7%) of them had severe dipping.


Conclusions: There may be an association between diabetes mellitus but not nighttime blood pressure dipping with nonarteritic ischemic optic neuropathy.

Adherence to medication is the range to which an individual corresponds with the prescribed medication dosing regimen. Medication non-adherence among patients with schizophrenia is extremely common issue, broadly ranging from 4% to 72%. Medication non-adherence among schizophrenic patients has serious consequences for individuals as well as the health system such as relapse of symptoms, re-hospitalization, aggression, suicide, cognitive deterioration, loss of job and arrest, victimization, and overall unfavorable outcome. Factors determining adherence are divided into medication-related as side effects, patient-related as lack of insight, illness-related as persecutory delusions, sociocultural-related such as stigma, and clinician-related factors like poor therapeutic alliance. Improving adherence is best achieved by exploring the reasons for non-adherence with appropriate management plans to deal with them. Adherence can be improved by providing basic strategies that must routinely accompany every prescription, and specific interventions like psycho-social ones, antipsychotic long acting injections, reminders, service interven­tions, and may be even financial incentives.

Background: Hyponatremia is a commonly occurring electrolyte disturbance among hospitalized patients, and many studies suggest that individual serum sodium levels may have a prognostic role in assessing probability of mortality.


Aim of the study: Determination of hyponatremia prevalence in patients admitted to the Oncology Teaching Hospital.


Method: A six-month cross-sectional study of hyponatremia prevalence was conducted in the Oncology ward in Medical City. The patients (105) who were admitted for more than three days with different types of malignancies and causes of admission were investigated for serum sodium, blood urea, random blood sugar, and urinary sodium (single measurement). These results were compared to the sodium levels of control of non-cancer individuals (135) selected using the same exclusion criteria.


Results: The prevalence of hyponatremia in the admitted patients was 43.7%, whereas it was 0.73% in the control group.


Conclusion: The prevalence of hyponatremia in Oncology Teaching Hospital, Medical City ward, was higher than that reported in previous studies (conducted in international cancer centers); hypoosmolar hyponatremia prevalence is almost similar to that stated in previous studies.

Background One of the most devastating complication that follows cleft palate surgery is oro- nasal fistula. It can lead to many problems like fluid and food regurgitation, poor oral hygiene and retropharyngeal incompetence. The repair of palatal fistula had long presented a remarkable challenge to the plastic surgeon. Repair of these fistulae required the use of more than the usual two-layered closure procedures; demanding the introduction of a ‘Third layer’ of tissue to enhance smooth healing, and thereby reduce the chance of closure failure which predispose to fistulization. In this study we used an autogenous graft of ‘’ dermis and fat (dermis-fat) graft ‘’ to serve as the third protective, supportive and enhancive layer.


Aim of the study: To evaluate the use of dermis-fat graft as autogenous tissue to achieve three layers closure of the palatal fistula.


PATIENT AND METHOD The study included 22 patients ( 13 males, 9 females ), ranging in the ages between 2 to 40 years (13 males versus 9 females). The fistula size varies from 4 mm to 25 mm in diameter. Timing of fistula repair ranged between 6 months up to more than 4 years, Fistula assessment was done focusing on size, site, number and shape. Then assessment of surrounding tissue viability and pliability


Results, operated upon, having 30 oro-nasal, We used minimal thickness of the graft ( 4-6 mm ) in 23 fistulae, and 7-8 mm thick graft in 7 ones. 24 cases was having full healing while in 2 fistulae partial wound dehiscence occurred. In another 2 fistulae there was obliteration of the buccal sulcus. While partial graft exposure in 2 other fistulae. We experienced no hematoma, or infection or airway obstruction.


conclusion Using of interpositional dermis-fat graft had shown to have promising result in closure of oro-nasal fistula that followed cleft palate surgery. It provided durable, stable, and flexible coverage with minimal donor site morbidity. It can be used for fistula of less than 1.5 cm of various locations.

Background: Lymphocele development is a well-established complication following kidney transplant. Some devices, such as electrothermal bipolar sealing devices, have been found to reduce lymphatic drain following kidney transplantation.


The aim of the study: The purpose of the study is to compare the usage of conventional lymphatic ligation with the electrothermal bipolar sealing device and its influence on the formation of lymphoceles after kidney transplantation surgery.


Patients and methods: A cohort retrospective and prospective study was conducted from May 2015 to November 2020 at the Basrah renal transplantation center in Al-Sader Teaching Hospital, Basrah. One hundred and thirty anonymized patients with end-stage renal diseases were involved in the present study. They were categorized into two groups: group 1 (conventional ligation group) with 70 patients and group 2 (electrothermal bipolar sealing device group) with 60 patients. The groups were compared and matched for possible risk factors. Patients were followed up for six weeks with full laboratory investigation (complet blood count, renal function tests, and liver function tests) and medical and surgical assessments. Statistical package of social siences version 25 was used for the statistical analysis of the data. Confidence intervals of 95% were applied as the dependent interval in statistics, and p-values < 0.05 were considered significant.


Results: The mean age of the patients was parallel for both conventional ligation and electrothermal bipolar sealing device groups (34.69 ± 10.28 vs. 33.68 ± 10.35). The operative time (155.57 ± 17.9 vs. 140.33 ± 17.07), lymphocele development (12 (17.1%) vs. 4 (6.7%)), lymphatic drainage volume (974.57 ± 178.39 vs. 493.83 ± 163.65), and the days of drainage (8.28 ± 3.3 vs. 4.6 ± 1.4) showed statistically significant differences between the conventional ligation technique and the electrothermal bipolar sealing device technique (p < 0.05).


Conclusion: The cautery of bipolar vessels is advantageous when compared to conventional ligation in kidney transplant lymphatic dissection, reducing the risk of lymphocele occurrence, in addition to its feasibility, safety, and easy performance

Background: Periampullary cancers have poor prognosis, mainly due to late diagnosis. Although pancreaticoduodenectomy is considered the only possible curative option for these cancers, it is associated with high morbidity and mortality.


Aim: To identify the risk factors associated with postoperative morbidity and mortality.


Patients and Methods: Data were prospectively collected from the 44 patients who underwent pancreaticoduodenectomy for periampullary cancers in Al-Sader Teaching Hospital, Basrah, Iraq, from June 2017 to June 2020. These variables were reviewed according to developing postoperative morbidity and mortality. The statistical analysis was done using SPSS version 23 and the chi-squared or Fisher’s exact (FE) test. Any level of significance below 0.05 was considered statistically significant.


Results: Increased age and the presence of preoperative co-morbidities are independent predictors of developing postoperative morbidity and mortality. The most common postoperative complications leading to mortality are pulmonary embolisms and pancreatic leaks.


Conclusion: Improvement in the management of comorbidities and perioperative care are essential in decreasing postoperative morbidity and mortality.

Background: Patients undergoing endoscopic sinus surgery may develop complications because of the sinuses’ proximity to the orbit and skull base. Endoscopic sinus surgery is done for patients with chronic rhinosinusitis with polyps (CRSwNP), chronic rhinosinusitis without polyps (CRSsNP) not responding to the medical treatment, and antrochoanal polyps.


Objectives: The present study aims to evaluate the complications of functional endoscopic sinus surgery (FESS) in Mosul city.


Methods: A case series study of 70 patients of different age groups who underwent functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis with polyps (CRSwNP), chronic rhinosinusitis without polyps (CRSsNP), and antrochoanal polyps at Al-Jamhoory Teaching Hospital, Mosul, Iraq, for the period from October 2011 to August 2012.


Results: The age of patients ranged from 11 to 65 years, with a mean of 33.1 years.


Thirty-four patients (48.57%) were male, and 36 patients were female (51.43%). Minor complications were observed in 25.71% of our patients. No major complications occurred.


Conclusion: Although functional endoscopic sinus surgery (FESS) is an effective and minimally invasive technique, intraoperative and postoperative complications can still arise. Fortunately, complications are mostly minor, but patients should be informed about these complications. We recommend further studies on complications of endoscopic sinus surgery with more patients and a longer follow-up period.

Background : COVID-19 pandemic affected the world for the last 20 months (January 2020-August 2021. It was troublesome, devestating in terms of cases, deaths and socioeconomic consequences and unpredictable in behaviour.


Objectives : To document comparative profile of the COVID -19 in Iraq and other Eastern Mediterranean Countries in terms of time trend and three epidemiological parameters ( incidence, case fatality and mortality rates).


Methods : A record-based prospective study. Data were checked daily throughout the study period from February 21, 2020 through February 23, 2021. The targeted numbers were recorded on an excel sheet or word table and updated daily over the specified period. The data covered the period from the onset of the pandemic in various countries. Data included the daily new cases of COVID-19 reported by various government agencies and Ministries of Health in the region supported by two private websites. The multiple sources used assured cross-matching of reported figures and a very high degree of consistency was achieved.


Results: The annual incidence rate, case fatality ratio and cause specific mortality rate in Iraq were 17,636.8 per million, 1.97% and 347.3 per million in that order. These three rates were very variable among various Eastern Mediterranean Countries.


Conclusion : Iraq and other Countries in the region were harshly struck by COVID-19. Extensive variation in the major epidemiological parameters were documented. The pandemic uncovered major defects in the health care systems and still awaiting a hope to contain this unpredictable event.

Background: Disturbance of skin integrity (wound) provides a suitable environment for the growth and multiplication of bacteria. The emerging occurrence and spread of multidrug-resistant microbial pathogens present a significant challenge in providing effective health care and is, therefore, a worldwide medical issue.


Aim: The current study reports on the occurrence of possible pathogens associated with wound infections at National Cancer Institute, Wad Madani, Sudan.


Methodology: This was a cross-sectional descriptive, hospital-based study including 100 patients with wounds suspected to be infected. Suspicion was dependent on the inability of wounds to heal properly. A structured questionnaire was given to the subjects to acquire demographic information (age, gender, marital status) and the history of antibiotics administration. Wound swabs were collected and processed according to standard procedure and isolated bacteria were tested for their antimicrobial susceptibilities through the disc diffusion technique according to the CLSI guidelines.


Results: Morphological identification revealed that the percentage of gram-positive cocci among the isolates was: S. Aureus (66%), and Streptococci (34%). On the other hand, gram-negative bacilli included the following: E coli (48.1%), Proteus vulgaris (19%), Proteus mirabilis (14%), Klebsiella species (9%), Pseudomonas species (5%) and other bacterial species (4%). Most bacterial isolates exhibited a high rate of resistance to cephalosporin generations (Cefixime (69%), Cefuroxime (49%), Cefotaxime (32%), Ceftriaxone (29%), Cefepime (20%)). The majority of bacterial isolates were sensitive to Meropenem (resistance rate 3%). The antibiogram results of the other antibiotics were as follows: Ciprofloxacin (18%), Gentamicin (16%).


Conclusion: S. Aureus was the most prevalent bacteria among the isolates with a percentage of 66%. The highest rate of resistance was observed among cephalosporin generations, mainly Cefixime and Cefuroxime with resistance rate of 69% and 49%, respectively.

Background: Few studies have attempted to evaluate the organizational impact of telemedicine and the associated process changes that affect the way that it is used and accepted.


Objective: To evaluate the degree of satisfaction of both the doctors who participated in electronic clinics and the patients who benefitted from it by inquiring about suggestions for optimization.


Method: An online survey was conducted in which both the patients and the doctors were blinded; the link for the inquiry was sent to them without any recognizable names attached by a personnel from outside the research group. Responses were gathered and analyzed, and relevant graphs and tables were constructed using Microsoft Excel.


Results: A total of 277 patient responses were analyzed. The most common platform for obtaining information about the electronic clinics was social media. It was observed that 77.7% of the respondents were satisfied with e-clinic, 85.5% found the service easy, 75.1% felt it was trustful, and 50.5% found the time available to be adequate. Among the respondents, 83.4% intend to resort to electronic counseling in the future. Most of the doctors who participated in e-clinics were pediatricians (25%), followed by otorhinolaryngiologists (22%). Most doctors enrolled in the service because they wanted to help the people (41.8%). WhatsApp (58.2%), Facebook (44.8%), and phone calls (40.3%) were the most common platforms for consultation. Among the doctors, 53.7% responded that the experience was successful, 43.3% recommended continuing the service throughout the course of the pandemic, and 53.7% recommended continuing even after the pandemic comes to an end.


Conclusions: Evaluation of the clinical service via the electronic survey revealed a spectrum of satisfactory responses from both the patients and the doctors who participated, and suggestions for technical optimizations and for the continuation of the service even beyond the pandemic were received.

Background: The recent coronavirus (SARS-CoV-2) pandemic has created a serious public health concern worldwide. Shortly after the successful mapping of the genome sequence of SARS-CoV-2 and the declaration of the pandemic by the World Health Organization (WHO) in early 2020, scientists and pharmaceutical companies raced against time in efforts to develop vaccines. As of the 18th of February 2021, the WHO had approved at least seven different vaccines to be rolled out worldwide. However, despite the seriousness of the pandemic and its rapid spread, Iraqi society still refrains from taking vaccines against the disease. Although there is an increase in vaccination with the availability of coronavirus vaccines in Iraq, the rate remains below the level required to achieve herd immunity in Iraqi society soon.


Objectives: To assess the spread of COVID-19 vaccine related misinformation in the Iraqi community.


Methods: A cross-sectional study based on an internet survey that contained a 14-item questionnaire to assess public knowledge related to the COVID-19 vaccine.


Results: A total of 1066 participants completed the survey questionnaire. The study showed a high level of COVID-19 vaccine–related misinformation in the Iraqi community. Individuals who are unemployed with low education levels and living in rural areas, those who did not take the vaccine, and those who were unwilling to advise others to take the vaccine had significantly increased the level of COVID-19 vaccine–related misinformation. In addition, this study found that the most common sources of information among participants were websites and social media.


Conclusions: COVID-19 vaccine–related misinformation is widely spread. This aspect must be considered in any planned public measure that aims to control the pandemic.

Objective: To review and compare the efficacy of glutathione formulations as skin-whitening agents in adults participating in several clinical studies.


Methods: Using a MEDLINE search with the time frame specified up to March 2020 , seven clinical studies involving GSH use for lightening the skin were recognized and assessed for significance and validity.


Results: Four controlled clinical trials (GSH capsules: 60 healthy volunteers; 250 mg oral GSH capsules:60; 2% glutathione lotion: 30s healthy volunteers; GSH as wash:74 healthy volunteers) and a case series(GSH lozenges: 30 patients) showed a significant reduction in melanin index. A case series (GSH soap: 15 patients) revealed a skin-lightening effect based on photography. Only one placebo-controlled study on IV GSH (1200 mg) in 60 healthy volunteers demonstrated a poor effect of glutathione as a whitening agent.


Conclusion: The literature search revealed that glutathione is not useful enough as a skin-whitening agent, as it is only effective on some parts of the skin and did not present any long-lasting effect. Although the safety profile of topical and oral glutathione seemed to be good, long-term research studies employing better study design are required in order to evaluate the efficacy of this antioxidant.

Background


Infectious meningitis is an infection of the subarachnoid space causing inflammation of the leptomeninges. Early diagnosis is crucial to initiate appropriate therapy, avoid complications, and improve prognosis. Cerebrospinal fluid analysis is important in the diagnosis and is done by performing lumbar puncture with some limitations and complications. MRI plays a role in the diagnosis by depicting abnormal leptomeningeal enhancement.


Aim of the study


To evaluate the efficiency of contrast-enhanced fluid-attenuated inversion recovery compared with contrast-enhanced T1 spin echo in the diagnosis of infectious meningitis.


Patients and Methods


A prospective analytical study of diagnostic tests was conducted. Brain MRI was done using a 3-Tesla system. Gadolinium was used as contrast material. The final diagnosis of meningitis was made based on cerebrospinal fluid analysis. Validity parameters, predictive values, and diagnostic accuracy for both sequences were calculated and compared to each other. Quantitative and qualitative analysis was performed.


Results


Fifty-six patients were involved (31 males and 25 females) in this study, and they ranged from 15 to 68 years in age. Cerebrospinal fluid analysis was positive in 41 patients and negative in 15. Contrast enhanced–fluid attenuated inversion recovery has higher sensitivity, specificity, positive predictive value, negative predictive value, and accuracy compared with contrast enhanced–T1 spin echo. The mean net meningeal enhancement is significantly higher in contrast enhanced–fluid attenuated inversion recovery. Substantial interobserver agreement between the two sequences was observed.


Conclusion


Contrast enhanced–fluid attenuated inversion recovery is superior to contrast enhanced–T1 spin echo in the diagnosis of infectious meningitis.