Al- Anbar Medical Journal

No abstract

The difficulty of early diagnosis, the proper anti-microbial chosen, and the relatively high morbidity and mortality; make us collect the related subjects to deal with the most critical complication (ventilator-associated pneumonia) showing the major points needed for every intensivist. Ventilator-associated pneumonia is considered the most common respiratory complication (infection) in intensive care unit patients. Ventilator-associated pneumonia can be defined as a hospital-acquired infection of the lung parenchyma that occurs after 2 days of mechanical ventilation. Its incidence is about 9-25% in intubated patients for more than 2 days. We could classify ventilator-associated pneumonia as early and late; the first one happened within four days of receiving mechanical ventilation, otherwise, the late onset occurred after day four. Some patients with hospital stays before intensive care unit admission and intubation are considered to have late ventilator-associated pneumonia regardless of the period of mechanical ventilation because those patients might have had pathogens previously (nosocomial). Severe ill patients, prolonged mechanical ventilation, and failed extubation trials (recurrent intubation) lead to the development of ventilator-associated pneumonia rapidly and aggressively. Furthermore, ventilator-associated pneumonia is attributed to prolonged hospitality as well as high morbidity and mortality. We aimed in this narrative review to discuss ventilator-associated pneumonia regarding the etiology, causative agents, risk factors, strategies for early diagnosis, accurate treatment, and optimal prevention protocols.

Background: Myofascial pain syndrome (MFPS) is defined as the motor, sensory, and autonomic signs resulting from trigger points (TrPs).
Objectives: To assess the effectiveness of the perineural injection in patients with MFPS.
Materials and methods: The study was conducted at AL Ramadi Teaching Hospital, Department of Rheumatology, Ramadi City, Iraq. The study period was from June 2019 to January 2021. A retrospective review of 100 patients with prospectively collected clinical and radiologic data was performed to evaluate the effectiveness of perineural injection on MFPS. A 3 ml of 5% dextrose solution was managed sub-cutaneous straight at the labeled chronic constrictive injury and tender spots rounding the knee. The VAS and WOMAC were calculated for each participant at the time of the presentation and 1, 3, and 6 months following treatment.
Results: The mean age of the patients was 60.93 ± 6.17 years (25-70 years). Three-quarters (75/100) of the cases were female. Seventy subjects were from the age group ≥ 40 years, while the remaining 30 cases were from the age group < 40 years. Fifty-five cases were with right-sided involvement. Successful results were achieved in 90% of the participants. There were no statistically significant differences between the effective and not effective groups regarding the age, gender, and the involved side (P-value > 0.05). There was a reduction in the mean VAS (8.47 ± 0.77) of pain and WOMAC (78.99 ± 5.69) score at the time of presentation to 1.87 ± 1.32 for the VAS and 17.84 ± 4.66 WOMAC at 6-months post-injection period. No complications were reported in all patients apart from mild pain at the injection site
Conclusion: Perineural dextrose injection was successful in 90% of the patients with MFPS. This modality results in a sharp reduction of both VAS and WOMAC scores from the time of the presentation to 6-months post-treatment. We recommend using this modality because it is easy, effective, and safe.

Background: Functional and camouflage orthodontic treatments in cl II malocclusions are different treatment methods that usually used in orthodontic practice. A comparison of treatment success between those treatment groups shows which treatment method is better to choose.
Objectives: This study aimed to compare functional and camouflage orthodontic treatments in patients with class II malocclusion.
Materials and methods: The sample size was from individuals who they completed treatments between February 2017 and July 2020 at the Department of Orthodontics, Faculty of Dentistry in Suleyman Demirel University, Turkey. The subjects were from 2 genders and a total number of 146 cases with an average age of 11-22 years. Peer Assessment Rating (PAR) index was used to evaluate the success of the treatment using plaster models taken from these cases before and after the treatment.
Results: In our study, orthodontic treatment results were evaluated by the PAR index in three groups as very successful, successful, and unsuccessful according to the scores of success rate (PAR%). The majority of treatments were found to be successful (67.81%), approximately a quarter of cases were very successful (26.71%), and low rate of failure (5.48%).
Conclusion: Although there were positive occlusal changes in functional and camouflage orthodontic treatment groups, patients in the functional orthodontic treatment group showed more improvement in the PAR change rate. Therefore, we recommend starting with treatment at an early age to get more benefit from the growth of patients.

Background: Smoking is the foremost public health problem affecting the world and it has a crucial implication in causing many common diseases due to Helicobacter pylori infection which is globally distributed. Smoking is considered a critical risk factor that accelerates infection with this bacterium.
Objectives: The study's goal was to find out how common Helicobacter pylori infections were among male cigarette and nargileh smokers.
Materials and Methods: A case-control study was performed between August and December 2021in Erbil Teaching Hospital in Erbil City, Kurdistan Region, Iraq. Blood samples were collected and used for detection of anti- Helicobacter pylori IgG Ab for 80 males who were smokers and 80 who were non-smoker.
Results; The prevalence of Helicobacter pylori positivity was 64.9% in smokers and 45.5% in nonsmokers (P-Value = 0.03). The highest percentage (54.1%) was found in the young age group (25-34) years (P-Value = 0.05), and 89.2% of Helicobacter pylori-positive individuals exhibited stomach symptoms (P-Value = 0.01). Fifty percent of Helicobacter pylori-infected individuals were nargileh smokers.
Conclusion: The prevalence of Helicobacter pylori showed significant value in nargileh smoking males. Therefore, smoking was a key factor in the seroprevalence of Helicobacter pylori and had a substantial impact on it.

Background: Diabetes is one of the most common non-communicable diseases in the world. It is a chronic disease with multiple complications such as retinopathy, neuropathy, nephropathy, and cardiovascular disease.
Objectives: The study aimed to identify the prevalence of dyslipidemia and hypertension in type 1 diabetes mellitus (T1DM) in Iraqi adolescents.
Materials and Methods: A cross-sectional retrospective study was conducted on adolescent patients with T1DM for more than two years and aged 10-18 years old. For each participant, the age, gender, onset and duration of the DM, body mass index (BMI), blood pressure, and low-density lipoprotein (LDL) level in the blood were recorded
Results: Of 70 subjects, there were 42 (60%) girls. The duration of the DM was predominantly between 2-5 years (59%). Around half of the cases were diagnosed between 5 and 10 years. Girls had a significantly higher mean BMI than boys [21.5 kg/m2 for girls and 18.6 kg/m2 for boys (P-value 0.001)]. Seven (10%) patients were diagnosed with hypertension. LDL was high in 22 patients (31%) with the majority of them (15/22) having an LDL value of between 100-130 mg/dL. Most of the participants with a high LDL were girls (18/22) with a statistically significant gender difference (P-value = 0.018). There were significant correlations between high blood pressure and BMI (P-value = 0.004) and elevated LDL levels (P-value = 0.008).
Conclusion: The study revealed that hypertension and dyslipidemia were seen in 10% and 31% of children with T1DM respectively. The elevated LDL and BMI were significantly higher in female patients than in males. Besides, there were significant associations between high blood pressure and BMI and elevated LDL levels.

Antrochoanal polyps are more prevalent in children than adults. Unilateral nasal obstruction and rhinorrhea are usually the features of unilateral antrochoanal polyps. Bilateral nasal obstruction can be a feature of antrochoanal polyp if it is large and obstruct both choanae. The giant antrochoanal polyp is rarely reported in the literature. We are reporting this scenario of giant left antrochoanal polyp in a 6-years-old boy who presented with bilateral nasal obstruction, nasal and postnasal mucopurulent discharge, hypo-nasal speech, mouth breathing, snoring, and obstructive sleep apnea syndrome. The physical examination revealed a mass seen in the oropharynx behind the uvula. Further examination by nasal endoscopy, computerized tomography, and histopathological evaluation of the excised polyp have confirmed the diagnosis of an antrochoanal polyp. Although this entity is not commonly seen in daily clinical practice, careful assessment is needed to not miss the diagnosis for early treatment to avoid unwanted complications.

An abscess is a common disease worldwide and its diagnosis is usually straightforward. However, pelvic abscess is rarely seen in daily clinical practice. Besides, it is a challenge for the surgeon to diagnose abscesses in unusual location, including the pelvis. A 41-year-old housewife lady had a history of poorly controlled insulin-dependent diabetes mellitus with recurrent vaginitis, cervicitis, and recurrent urinary tract infection. She presented with bilateral hip joint pain and limitation in her movement, with diabetic ketoacidosis. She was admitted to the hospital for the treatment of diabetic ketoacidosis. A physical examination revealed a high-grade fever, unwell, and there is a pelvic mass. Laboratory tests showed leukocytosis and a low hemoglobin level. Ultrasonography and computerized tomography revealed a 5 × 5 pelvic mass, which was located anterior to the bladder, with a high suspicion of an abscess formation. The patient was admitted to the surgical ward and drainage of the abscess under general anesthesia with antibiotic cover was performed. The patient was discharged two weeks postoperatively with an improvement in all presenting features. Bilateral insidious hip joint pain with limitation of movement should orient the clinician to a pelvic abscess as one of the differential diagnoses of these symptoms.