Iraqi National journal of Medicine

Background: In exploring novel avenues to assess cardiac health, this study investigates the potential of retinal vascular signs (RVS) as an effective tool for predicting coronary artery disease (CAD) in elderly hypertensive patients who present with angina pectoris. Considering the rising prevalence of cardiac disorders, there is an increasing interest in using noninvasive imaging modalities for early cardiovascular disease detection. This study conducts a comprehensive analysis to establish a direct correlation between retinal microvascular alterations and the development of heart disease in hypertensive patients. Methods: A total of 70 elderly hypertensive patients with acute angina underwent coronary angiograms and were divided into two groups (case and control). Each patient underwent ultrasound of the carotid artery and pulsed Doppler flow of the ophthalmic artery (OA). The severity of coronary artery stenosis was determined using the Gensini score (GS). Significant CAD was defined as the confirmed obstruction of more than 75% of one’s main coronary arteries. Results: The mean systolic velocity/mean diastolic velocity (MSV/MDV), pulsatile index, and resistance index in the Doppler flow of the OA were found to have significant and independent correlations with carotid intima-media thickness (c-IMT). Additionally, MSV/MDV was found to have a significant and independent correlation with the GS, and retinopathy was significantly associated with coronary artery disease (p = 0.05). Conclusions: Changes in retinal blood vessels caused by hypertension are confirmed as excellent predictors of coronary artery disease and a useful screening tool for the same, particularly in primary healthcare centers.

Background: The study was conducted to assess hearing improvement and graft uptake rate in patients with an anteriorly extended tympanic membrane perforation who underwent endoscopic cartilage tympanoplasty. Aim: The study aims to assess the efficacy of endoscopic cartilage tympanoplasty in repairing an anteriorly extended tympanic membrane perforation. Methods: A total of 135 patients aged between 10 and 63 years with an anteriorly extended tympanic membrane perforation were included in this study. Patients with an active middle ear disease and ossicular abnormality were excluded. Pure-tone audiometry was performed preoperatively at 500, 1000, 2000, and 4000 Hz, and the air-bone gap (ABG) for each frequency was determined. The patients underwent endoscopic cartilage tympanoplasty utilizing the tragal cartilage with its perichondrium after separation. Graft uptake rate and hearing gain by ABG reduction were assessed 3 months after the procedure. Data analysis was carried out with SPSS version 22. Results: We studied 71 females and 64 males. Preoperative ABG at 500, 1000, 2000, and 4000 Hz were 25 ± 4, 23.5 ± 4, 23.6 ± 4, and 23.9 ± 3, respectively. Postoperative hearing gains for the above frequencies were 16.4 ± 3, 16.1 ± 4, 14.7 ± 4, and 15.6 ± 4, respectively. Graft uptake rate was 91.8% with complete closure of perforation and only 8.2% with residual tiny perforation that looked like a slit. Conclusion: Endoscopic cartilage tympanoplasty is an effective method for the improvement of hearing and the repair of challenging anteriorly extended tympanic membrane perforation.

Background: The preferred method of treatment for severe osteoarthritis of the knee is total knee arthroplasty (TKA). TKA has been linked to a significant increase in inflammatory markers such as erythrocyte sedimentation rate (ESR)—a test that measures how quickly red blood cells settle to the bottom of a test tube—and C-reactive protein (CRP)—a protein made by the liver that increases when there’s inflammation in the body. Aim: Assessment of the typical time trend and physiological kinetics of CRP and ESR during the early postoperative period over 4 weeks Methods: The study was conducted in the Basrah arthroplasty center, from June 2022 to October 2023. The study sample consisted of patients undergoing TKA operations with no history of inflammation, infection, uncontrolled chronic disease, or any autoimmune disease. We enrolled 34 uncomplicated cases. ESR and CRP were measured over time. Results: The highest mean CRP values (123.2 ± 101.0) mg/L were in the first week and then started to decrease; the ESR highest reading was in the second week (66.4 ± 31.2) mm/h and then declined. The difference was significant from the baseline reading for both markers. Conclusion: In the initial postoperative period, CRP remains a better acute phase reactant than ESR and has a more expected pattern.

Background: Reconstruction of the head and neck has made significant progress with the advent of microsurgery. The radial artery free flap is a workhorse flap in head and neck reconstruction due to its high-quality tissue that conforms to the complex and vital structures in this region. Aim: This study aims to assess the versatility and pliability of the radial artery free flap in the reconstruction of head and neck defects. Methods: A retrospective study was conducted over a six-year period (2017 to 2022) in Erbil, the capital of the Kurdistan region in Iraq, at Maryamana and PAR private hospitals. Twelve patients were included in the study, all of whom presented with large soft tissue losses and defects exposing vital structures in the head and neck The Allen test was performed bilaterally to assure perfusion. The operations were carried out under general anesthesia, and patients stayed in the hospital for seven days post-operation. Antiplatelet (aspirin) and anticoagulant (heparin) were administered. The patients were followed up for six months to several years after the operation. Results: Twelve patients were included in the study. The mean age (SD) was 49.2 (16.7%) years, with an age range of 22-78 years. The largest proportion (41.7%) of the sample were aged 40-49 years, and two thirds (66.7%) of the patients were female. The lip was affected in five patients out of eight (41.7%), and the tongue was affected in three patients (25%). Cancer was the cause of the defects in seven patients (58.3%), trauma in four patients (33.3%), and hemi-facial microsomia in one patient (8.3%). The success rate was 91.7%, with failure occurring in only one patient (8.3%). Conclusion: The radial artery free flap is versatile in the reconstruction of complex structures within the head and neck due to its high-quality fasciocutaneous properties, such as being thin, pliable, and having a long pedicle. This makes it particularly effective for lip and tongue reconstruction.

Background: Colonoscopy is the most trusted diagnostic tool in the screening and diagnosis of colorectal cancer and other colorectal diseases. Aim: This study intends to present the results of colonoscopic procedures carried out in Center for Digestive and Liver Disease and Surgery in Basrah Methods: Retrospective evaluation of 698 consecutive subjects who underwent screening or diagnostic colonoscopy at Basra Center for Liver Disease and Digestive System between 2014 and February 2020 was conducted. The primary outcome measure was the rate of adenoma detection, calculated alternately as the total number of detected neoplastic lesions divided by the number of subjects screened and as the proportion of subjects with at least one neoplastic lesion. The demographic information, presentation, and colonoscopic findings have been reported as frequencies and percentages. Results: The study involved 400 (57.3%) male and 298 (42.7%) female subjects, with ages ranging from 1 to 90 years and a mean±SD of 42.3±18.6 years. Cecum access rate was 86.8% (606/698), and 48 (6.9%) out of the 698 participants had malignancy. The adenoma detection rate was 12.3% (87 out of 698 patients). Conclusion: In our study, the success rate, which is determined by the rate of cecum access, was relatively lower than the approved standard due to causes related to the patients. Even so, it is higher than that reported in previous studies. The adenoma detection rate was low, which is likely due to the small sample size as the center is in its early inception.

Background: Rheumatoid arthritis (RA) comprises an inflammation-based condition with a clinical phenotype that is mainly reliant on the occurrence of rheumatoid factor and anti-citrullinated protein antibodies. Literature indicates that seronegativity might be accompanied by higher severity of clinical symptoms, while higher disease activity, based on the recent classification criteria should also be associated with seronegativity. Aim: This investigation targets the identification of more efficient immune markers of RA seropositivity as well as examining the possibility that the latter is associated with lower severity. Methods: Serum samples from 128 RA patients, 106 seropositive and 22 seronegative, were analyzed using ELISA to determine the levels of four biomarkers: Wnt-1-induced secreted protein-1 CCN4, vascular cell adhesion molecule-1 (VCAM-1), matrix melloprotenase-3 (MMP-3), and granulocyte-macrophage colony-stimulating factor (GM-CSF). Additional clinical parameters were also investigated through a special questionnaire form that also covered demographic data. As a measure of RA activity, the parameter of joint disease activity score 28 (DAS28) was adopted. Results: Patients with seronegativity demonstrated higher RA activity, i.e., DAS28ESR score, in comparison with seropositive ones. Their sera also contained higher levels of the four tested immune markers in comparison with both seropositive patients and healthy controls. Das-28 ESR levels exhibited significant direct proportional correlations to CCN4, VCAM1, MMP3, GM-CSF, and Das-28CRP values. Conclusions: The tested four immune markers are considered biomarkers with high reliability and effectiveness to discriminate between seronegative and seropositive patients, as well as for the monitoring and prediction of RA activity and joint and bone damage in seronegative patients.

Background: Glomerular diseases are the leading causes of end-stage renal disease globally. Recognizing the glomerular disease pattern in a specific geographical area is crucial for understanding the region\'s pathobiology as well as the incidence and progression of the disorder. Aim: To determine the overall spectrum of glomerular diseases based on renal biopsy and compare the results with studies from other countries. Methods: This study was conducted at the Nephrology and Renal Transplant Center, Medical City, Baghdad, Iraq from January 2016 to December 2017. The cohort comprised 849 patients aged 3–65 years who were referred to the center for management. Parameters recorded for each patient included name, age, gender, and clinical and laboratory findings. All biopsy specimens were reported by the same pathologist using light and immunofluorescence microscopy. Two pieces from the left kidney were obtained using a gunshot needle (16 or 18 gauge) and placed in 2 mL formalin for histopathologic examination. Results: The mean age was 24.67 ± 15.902 years, with females comprising 53% of the sample. FSGS was the most predominant condition observed in 229 (27.1%) patients, followed by MCD in 215 (25.5%), LN in 189 (22.5%), and MN in 118 (14%) patients. MCD, MN, and IgA glomerulonephritis were more common in males than females, while LN, vasculitis, FSGS, and MPGN were more prevalent in females. Conclusions: The histopathological study of renal biopsies reflects a spectrum of glomerular diseases that show both similarities and differences compared to other countries.