Al- Anbar Medical Journal

Background: Unilateral mass in the sinonasal region is a common problem facing the otolaryngologist in daily clinical practice. There are various benign and malignant conditions originating in this area with different clinical features depending on their nature and extent.
Objective: To evaluate the types and clinical profile of unilateral sinonasal masses.
Materials and methods: This study includes 60 patients who attended the outpatient clinic at Alyarmook Teaching Hospital, Baghdad, Iraq, between January 2017 and April 2018. A thourough history from each patient was taken. Moreover, the clinical examination was done according to standard clinical practice. The imaging results of the nose and paranasal sinuses were documented. Then biopsy was taken from the mass at the operating room under local or general anesthesia if indicated. The specimen was sent for histopathological examination and the results were documented on the data collection sheet. The patients were divided into two groups: non-neoplastic and neoplastic according to the histopathological results.
Results: Out of 60 patients, there were 36 (60%) males. The age of our cases was ranged from 6 to 79 years with a mean age of 34.20 ± 18.126 years. Non-neoplastic causes were (n=38, 63.3%) more than the neoplastic group, and the majority of them were unilateral simple polyp (n=23, 38.3%). Inverted papilloma was the most common benign tumor (n=8, 13.3%), while, squamous cell carcinoma was the commonest malignant neoplasm (n=2, 3.3%). Non-neoplastic causes were more in both sexes. The most affected age group was 20-49 years (n=31, 51.7%). The non-neoplastic causes were mostly seen in the age group 20-49 years (n=22, 36.7%). There was no statistically significant difference between the age and gender and the causes of unilateral sinonasal lesions (P-value >0.05). Nasal obstruction, nasal discharge, and hyposmia were more in non-neoplastic than neoplastic group. While epistaxis and facial pain were found to be higher in the neoplastic group.
Conclusion: Non-neoplastic masses outnumber neoplastic ones. Among non-neoplastic lesions, inflammatory polyps were the most common. Benign neoplasms outnumber the malignant neoplasms with inverted papilloma and squamous cell carcinoma were the most common respectively.

Background: Brucellosis is a common and endemic disease in the Anbar governorate. Besides, the Brucella microorganism has different ways of transmission.
Objective: The study aimed to determine the ways of transmission of Brucella organisms to human beings in the Al-Anbar governorate.
Materials and methods: A retrospective study was carried out on patients visiting the two main Ramadi Teaching Hospitals in Ramadi city, Iraq for the diagnosis and treatment of Brucellosis. Patients with blood-culture-positive brucellae were enrolled in the study. The study included the period between February 2002 and March 2005. Data were collected and recorded regarding age, gender, and residence. The possible ways of acquiring the disease were recorded too. These included ingestion of possibly contaminated foods, butchering of animals, meat cutting, keeping animals in homes or nearby their livings, cleaning animal places, caring for, milking of them, aiding in their delivery and if they wear gloves, blowing in the mouth of delivered fetuses, their work, and possible laboratory worker exposure.
Results: A total of 312 patients with brucellosis were enrolled in the study. The disease appears to be more common in rural areas (P-value<0.001). More cases were females in all age groups, and it was more common in the age group 31-40. The main mode of transmission is direct or indirect contact with infected domestic animals (P-value<0.001). Lab workers and ingestion of raw milk and unsafe milk products were the least recorded expected risk for infection. Three risky behaviors for acquiring brucellosis were also recognized in this study: milking animals, aiding domestic animals in delivery, and blowing in the mouth of delivered fetuses to promote breathing of the newly delivered animals.
Conclusion: Direct or indirect animal contact was the main way of Brucella transmission in the Al-Anbar governorate.

Background: Urothethiasis is the most common urinary tract disease with a global prevalence rate of 2-20%. Alfa-blocker has a relaxation effect on the smooth muscles of the ureter making the removal of ureteric stone easier during the ureteroscopic procedure.
Objectives: To evaluate the effect of preoperative α-adrenoreceptor antagonists therapy (tamsulosin) in the treatment of ureteral stone using a ureteroscope regarding operative time, access to the ureter, and the complication rate.
Materials and Methods: A prospective case-control study was conducted at Al-Jamhory Teaching Hospital, Mosul, Iraq. During the period from June 2019 to August 2020. Subjectts with ureteral stones (7-15 mm) scheduled for ureteroscopic intervention were enrolled in the study. The patients were classified into two groups, the first group was received a pre-operative alpha-blocker (tamsulosin 0.4 mg capsule per day for 7 days), and the second group (Control) did not receive further medication. The operative time, uretric access, and intra- and postoperative complications were registered for both groups.
Results: There was a matching between the two groups regarding the age, gender, and side, size, and location of the ureteric stones. There was a statistically significant difference between the two groups regarding the operative time (23.2 ± 4.569 minute in the treated group vs. 25.48 ± 4.904 minute in the control group) (P-value = 0.009). Besides, the ureteroscopic operation was easier (P-value = 0.031) in treated group (n = 51 easy case, 85%) than the control group (n=41, 68.33% easy case). The intraoperative and postoperative complications were mucosal injury, perforation, bleeding, pain, hematuria, and fever. The total number of complicated cases was 14 (23.33%) in the treated group and 25 (41.66%) in the control group, and there was a significant difference between the two groups (P-value = 0.032).
Conclusion: The study revealed that the preoperative alpha-blocker tamsulosin was improved the outcome of ureteroscopy (shorter operative time, easier access to the ureter, and low complication rate).

Background: Food ingestion and energy spending are organized through a complicated neurological system that involves both hypothalamic centers and peripheral satiety regulation (gastrointestinal and pancreatic hormones).
Objectives: To assess the effects of sugar addiction on appetite-related hormones and metabolic hormones.
Material and Methods: The study was done in two main hospitals in Anbar governorate, Iraq from April 2020 to November 2020. Concentration of fasting blood glucose (FBG), insulin, hormone insulin resistance (HOMA-IR), leptin, ghrelin, lipid profile, TSH, T3, and T4 were measured in the 54 obese adolescents and were compared with 54 normal-weight adolescents.
Results: There was a significant increase in the concentrations of FBG, insulin, HOMA-IR, leptin, total cholesterol (TC), triacylglycerol (TAG), low-density lipoprotein cholesterol (LDL-C), and TSH in obese adolescents as compared to normal-weight adolescents (P-value < 0.05). While there was a significant (P < 0.05) decreased in the concentrations of ghrelin, high-density lipoprotein cholesterol (HDL-C), T3, and T4 in obese adolescents compared with normal-weight adolescents. The results also showed that there is a significant positive correlation between the concentration of leptin and each of BMI, FBG, insulin, and HOMA-IR, while there was a significant negative association between leptin level with HDL-C and ghrelin.
Conclusion: Sweet-tasting meals are a major source of stimulation, which leads to overeating and thus leads to obesity.

Background: Breast cancer is the second cause of cancer death in women. Shear wave elastography (SWE) is an ultrasound (US) procedure that can improves the sensitivity and the specificity in the diagnosis of breast lesions.
Objective: To evaluate the value of SWE to discriminate benign from malignant Breast Imaging-Reporting and Data System (BI-RADS) IV breast lesions.
Materials and Methods: A cross sectional analytic study was done in the Radiology Department, Oncology Teaching Hospital, Baghdad Medical City, Baghdad, Iraq. The study period was one year (February 2020 to January 2021). The study included 42 female patients with suspicious breast lesions in the group BI-RAD 4 by mammography and US. Shear wave elastography was done for all patients. The final diagnosis of all breast lesions were done by fine needle aspiration cytology or true cut biopsy or excisional biopsy.
Results: The final histological diagnosis showed that 23 (54.8%) of study patients were with benign breast lesions. There was a statistically significant association between the quality of SWE and histopathological diagnosis as the proportion of malignant breast lesions was significantly higher among the patients with score 5 (homogenous dark blue) images (85.7%, P= 0.004). Subjectts with malignant lesions had a significantly higher mean of E-mean SWV than those with benign lesions (133.8 versus 75.47 kPa, P = 0.001). The best cut point of E-mean SWV was 83 kPa (E-mean SWV > 83 kPa is predictive for malignant lesion of breast) with 89.5% sensitivity, 60.9% specificity, and 73.8% accuracy.
Conclusion: SWE have a significant diagnostic value in differentiation of BI-RADS IV breast lesions into benign and malignant in both qualitative and quantitative patterns. The best cut off value in SWE is 83 KPa for E-mean.

Background: Gout is the most common type of inflammatory arthritis in men and postmenopausal women. The incidence and prevalence of hyperuricemia and gout were increased all over the world even among developed countries.
Materials and methods: A cross-sectional study was conducted at the Rheumatology Unit of Baghdad Teaching Hospital in Medical City, Baghdad, Iraq from October 2020 to April 2021. A total of 247 subjects were included in the study. Data were collected using a pre-constructed data collection sheet by face-to-face individual interviews. The sheet includes demographic characteristics, gout-related questions regarding the etiology, suspected predisposing agents, complications, diagnostic methods, food-related, clinical manifestations among studied cases, and attitudes of the gout patients among the study sample.
Results: Of 247 subjects, there were 67.2% (n = 166) males, 27.9 (n = 69) from the age group 40-49 years, 36.4% (n = 90) from Baghdad city, 25.5% (n = 63) university graduates, 19.9% with good income, 70.5 (174) employed, 221 (89.5%) married, 85% (n = 210) non-smokers, and 8.9% (n = 22) with family history of gout. Overall, 59 (23.9%) of the participants had a high level of awareness whereas low awareness levels accounted for 41.3% (n = 102). The awareness level showed a statistically significant association with education level, occupation, economic status, smoking habit, family history of gout, and patients with gout (P-value < 0.05).
Conclusion: There was a high proportion (41.3%) of the participants with a low level of awareness about gout and hyperuricemia. The awareness level among the participants was related to the education level, occupation, economic status, smoking habit, family history of gout, and patients with gout.

Background: Antenatal care (ANC) is a form of preventive medicine, pregnancy-specific, and general health advice effectively given in the antenatal period. ANC is conducted by healthcare personnel on pregnant women at regular intervals to protect and improve maternal and neonatal health.
Objectives: The study aimed to know if the COVID-19 pandemic affects the coverage rate of ANC visits of pregnant women.
Materials and methods: This is a retrospective cross-sectional study conducted at Al-Andalus Primary Healthcare Center which is located in the center of Al-Ramadi city, Iraq. We reviewed the records of all ANC first, second, and total visits of the months February, May, and October during the years 2019, 2020, and 2021.
Results: The study showed the coverage rate of ANC visits was statistically significantly declined with the restrictions imposed in response to the COVID-19 pandemic. At the end of 2021, there are some elevation in the coverage rate of ANC visits.
Conclusion: The study concluded that the lockdown period in the pandemic state due to COVID-19 led to a significant decline in the coverage rate of ANC visits.

Background: Functional and camouflage orthodontic treatments in cl II malocclusions are different treatment methods that are usually used in orthodontic practice. A comparison of patients' satisfaction with these two treatment groups is an important tool for the evaluation of treatment outcomes.
Objectives: We aimed to compare patients' satisfaction with orthodontic treatment subjectively (according to the opinion of patients) between functional and camouflage orthodontic treatments in patients with class II malocclusion.
Materials and methods: The sample of the study was formed from individuals whose treatments were finished between February 2017 and July 2020 at the Department of Orthodontics, Faculty of Dentistry at Suleyman Demirel University, Turkey. A satisfaction questionnaire was used to evaluate the satisfaction of the patients with the treatment process at the end of their treatment. The subjects of the study were selected from 2 genders and a total of 146 cases of average age 11-22 years. The research material consists of a satisfaction questionnaire that was given at the time of treatment end.
Results: The general satisfaction questionnaire score was found to be higher in the patients who received functional orthodontic treatment (P-value = 0.011). In the subgroups, the total questionnaire scores among the treatment subgroups were found to be quite similar.
Conclusion: In our study, the satisfaction level of the quality of life questionnaire was found to be high, while in response to more specific questions on satisfaction, some departments of the questionnaire found less satisfaction or dissatisfaction in patients.

Background: A Global pandemic “Coronavirus disease-19 (COVID-19)” caused by the “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2). It was isolated in December 2019 in Wuhan (China). Skin manifestations of COVID-19 disease are overlooked in the clinical approach to those suspected of this virus focusing on the pulmonary findings.
Objectives: This study aimed to describe the dermatological manifestations of COVID-19 in Iraqi patients.
Materials and Methods: A cross-sectional study was carried out at general hospitals, primary care centers, and private clinics in three Iraqi cities Baghdad, Babil, and Karbala. The study covered the period from October 2020 – to February 2021. Data regarding the demographic and clinical characteristics of each participant were registered. A thorough physical examination by a dermatologist was conducted for every subject. The data were entered and analyzed using SPSS version 25.
Results: One hundred COVID-19 patients with cutaneous manifestations were enrolled in this study. There were 59 females. Their ages ranged from 19-62 years. Most of the patients were from the age group ≤ 40 years (68). Just above half of the participants were non-healthcare workers. The highest blood group of the patients was A (45) and the least AB (11). Half of the subjects were presented within the first 7 days from the onset of the disease. Fifty-one cases were with mild disease form. In 54 patients, dermatological manifestations have appeared in the active stage of the disease. Hair loss was the commonest manifestation (30), all of them in the age group ≤ 40 years, and the majority of the cases (26) was affecting the female. While the least manifestation was acrocyanosis in 2 patients, both of them were male and from the age group > 40 years. There were highly statistically significant differences between the skin manifestations and the age and gender (P-value = 0.000).
Conclusion: Most of the patients were from the age group ≤ 40 years and female. Hair loss was the commonest skin abnormality due to COVID-19. The majority of cutaneous manifestations were started in the active phase of the infection. The age and gender determined the type of dermatological manifestations.

Hydatid cyst is a zoonotic endemic disease in Iraq. It carries considerable complications either related to the disease itself or following its surgical removal. Pleural and pericardial effusion is a rare postoperative complication of hydatid cyst removal. A 65–year-old Iraqi female patient complained of right-sided chest heaviness and palpitation one month following surgical removal of 2 large hydatid cysts. There were no other associated symptoms. Physical examination revealed the possibility of pleural and pericardial effusions (poor air entry and stony dullness of the right posterior part of lower zone, difficulty to palpate the apex beat, increase heart dullness, and no pericardial rub). The diagnosis was confirmed by chest X-ray and echocardiogram. She received Albendazole tablet 400 mg twice daily for 6 weeks with a good response. The Early presumption of the disease in an endemic area with a good dose and appropriate course of Albendazole tablets treatment can give very good results. To our best knowledge, this is the first case in the world who presented with hydatid cyst pleural and pericardial effusions and responded completely to the Albendazole tablets.