Mustansiriya Medical Journal

Singers are regarded as exceptional vocal performers. Vocal abnormalities in singers are not uncommon. Any disturbance in voice quality can negatively impact singers’ professional careers and business profits. Voice change, voice fatigue, and difficulty in singing higher pitches are major complaints of singers. Many singers experienced laryngopharyngeal reflux disease (LPRD), muscle tension dysphonia, and chronic laryngitis. LPRD is a clinical condition associated with laryngeal inflammation leading to the onset of voice disorders. Professionals like singers
are usually predisposed to the development of LPRD. The occurrence of LPRD in professionals like singers can have a profound impact on their professional lives. Vocal hygiene is considered an important part of vocal rehabilitation. In the case of professionals such as singers, it is imperative to provide awareness for proper vocal hygiene to prevent lifestyle changes such as abusive behaviors and other harmful habits that can result in functional vocal pathologies. To date, there are several controversies exist about diagnosis and treatment of LPRD. Proton pump inhibitors are prescribed to treat LPRD in combination with maintaining proper vocal hygiene. This review aims to discuss the current management of LPRD among singers.

Background: Stress occurs when environmental demands exceed an individual’s adaptive capacity, resulting in biological and psychological changes. Aim of the Study: The aim of this study was to evaluate the level of stress among doctors in the emergency department of medical city and to identify factors associated with stress. Subjects and Methods: Convenience sampling was implemented. Questionnaires were implemented to inquire about the data of 348 medical professionals. The research was conducted in the emergency departments of Baghdad’s Medical City complex from October 1, 2023, to July 31, 2024, during working hours, which were predicated on 2–3 days per week. Results: Out of 72.1% of the participants reported moderate stress levels, While 11.5% having low stress levels, and high perceived stress was noted in 16.4%. Risk factors for stress included sex, degree, and a specific designation. Males exhibited higher stress levels, which were statistically significant increase stress. Doctors with a board as a postgraduate degree and those with a specific designation demonstrated a significant association with high‑stress levels. Marital status and ethnicity showed no association with stress levels. No significant association was observed between medical history and the levels of stress. There was no significant association between stress levels, work experience, and place of residence. Conclusion: Nearly three‑quarters of the physicians reported moderate levels of stress.

Background: Magnetic resonance imaging (MRI) scans provide more detailed three‑dimensional anatomical and physiological information than other imaging modalities. This research aims to assess patients’ MRI safety awareness and evaluate related demographic characteristics. Patients and Methods: A descriptive, cross‑sectional study was conducted at the radiology department of Al‑Kindy Teaching Hospital in Baghdad, Iraq. A random 200 patients were scheduled to go through MRI examinations. All interviewed patients personally filled out a 15‑item questionnaire. Gender, age, marital status, education level, employment, and domicile are collected in the first six questions. The second half tests MRI knowledge with 9 questions. Results: The participant’s age ranged between 18 and 65 years. The majority of the participants provided were aware of the protocols for preparing for an MRI scan, the noise emitted by the machine, and the incompatibility of contrast material during an MRI procedure in pregnant women. There was a greater degree of awareness regarding the pre‑MRI preparation standards among individuals with higher education, independent contractors, and domestic consumers (P = 0.001). Knowledge of the rationale for assessing renal function before contrast media administration was significantly correlated with patients’ marital status and gender (P = 0.038 and 0.007, respectively). Urban residency and a patient’s understanding of the application of a contrast agent in specific MRI procedures were correlated significantly (P = 0.032). Conclusion: Iraqi patients’ understanding of MRI safety was restricted to preparation processes, machine noise, and contrast material incompatibility in pregnant women. Patients’ information was influenced by their sociodemographics.

Background: The most common and significant complications following surgical repair of esophageal atresia (EA) are related to esophageal anastomosis, and it greatly affects the overall outcomes. Although several factors have been implicated in the development of esophageal anastomotic complications, it is still unclear how we can predict these complications and the best way to prevent or at least decrease them. Objective: To identify and evaluate the risk factors for anastomotic complications after primary repair of EA. Patients and Methods: This was a prospective study of neonates having EA with primary surgical repair treated in a child central teaching hospital from June 2020 to December 2022. Analysis includes assessment of demographic data and clinical variables with recording the incidence of complications related to esophageal anastomosis. The enrolled patients were divided into two groups: those with an anastomotic complication (Group AC), including stricture, leak, and recurrent tracheoesophageal fistula (TEF) and those with no anastomotic complications (Group NAC). Then, we compared these two groups regarding the influence of these variables as suggested risk factors affecting the outcomes. Results: Of the total 63 patients diagnosed with TEF, 39 of them met the inclusion criteria. Twenty‑two patients (56.4%) had early anastomotic complications, 19 patients (48.7%) had anastomotic leaks, 11 patients (28.2) had anastomotic stenosis, and 1 patient (2.6%) developed a recurrent fistula. Multivariate logistic regression analysis among the complication group reveals that aggressive esophageal mobilization, intermediate gap, anastomosis under tension, type of sutures, and neck flexion have significant statistical value. Conclusions: There is no correlation between variables of sex, body weight, gestational age, time of repair, use of transanastomotic feeding tube, and type of approach with the development of anastomotic complications. Variables of aggressive esophageal dissection, anastomosis under tension, intermediate gap, the use of non‑absorbable sutures, and absent neck flexion postoperatively were identified as risk factors for early anastomotic complications.

Background: Osteoporosis (OS) poses significant risks to postmenopausal women, leading to debilitating fractures and reduced quality of
life. This bone disease, characterized by diminished bone mass and strength, is influenced by age, genetics, ethnicity, and hormonal changes,
profoundly impacting the susceptibility to fractures in older women. Aim of the Study: The aim of this study was to evaluate the effect of
certain demographic factors such as duration of menopause, premenopausal hysterectomy, Vitamin D deficiency, and other factors on bone mass
reduction and OS occurrence. Patients and Methods: This cross‑sectional study was conducted at Baghdad Teaching Hospital from January to
October 2023 and involved 150 postmenopausal women aged 45–65 years. To assess bone health, data were gathered through questionnaires,
physical examinations, and laboratory tests, including dual X‑ray absorptiometry (DEXA) s cans and Vitamin D levels. Results: Out of 150
postmenopausal women studied, 58% had OS, and 42% did not No Osteoporosis (NOS). Risk factors for OS included age, obesity, smoking,
lack of physical activity, and menopause duration over 5 years. Hysterectomy with oophorectomy significantly increased OS risk. Vitamin
D deficiency correlated strongly with OS. Low serum calcium and Vitamin D levels emerged as independent predictors of OS, with reduced
serum calcium linked to a 7.8‑fold increased risk. Conclusion: The study revealed a high prevalence of OS (58%) among postmenopausal
women. Key risk factors include aging, higher body mass index, smoking, inactivity, and prolonged menopause. OS risk is notably higher
posthysterectomy with oophorectomy. Vitamin D deficiency and low serum calcium are significant, independent predictors of OS.

Context: Early‑onset neonatal sepsis (EONS) is one of the leading causes of death in the neonatal period. Aims: To identify maternal and neonatal risk factors in the 1st day of life that predicts mortality in neonates with EONS. Patients and Methods: A case–control study included neonates with an EONS who were admitted to the neonatal intensive care unit in tertiary hospital in Baghdad‑Iraq from May 2023 to May 2024. All patients included in the study have had blood withdrawn for septic screening in the 1st day of life and subsequently carried the diagnosis of EONS by positive blood culture results. According to the fate of the patients, the study sample was divided into two groups: a case group
composed of newborns with early sepsis who died and a control group made up of newborns who survived hospital care. Neonatal and maternal factors with possible influence on the fate of neonates were analyzed and compared between both groups. Results: A total of 168 neonates were included in the study, 50 neonates died with reported death rate of (42.4%). The deceased neonates had a significantly earlier time of blood withdrawal for investigation than the survived neonate P = 0.008. The clinical presentation was significantly different between the two
groups, P = 0.005. Lower maternal hemoglobin showed a protective effect against neonatal mortality from EONS P = 0.031. Apgar scores on 1 and 5 min were both significantly lower in deceased neonates P = 0.011, <0.001, respectively, and on multivariate analysis score ≤3 was the only predictive factors for death. Conclusions: Mortality rates from EONS are an alarmingly high and closely related to maternal and neonatal factors. Apgar scores ≤3 at 1st and 5th min can serve as the early predictors of death in neonates with EONS.

Russell–Silver syndrome (RSS) is an uncommon but clinically important genetic disorder defined by specific dysmorphic features such as relative macrocephaly at birth, body asymmetry, intrauterine growth restriction, and postnatal growth failure. RSS is diagnosed clinically when ≥4/6 Netchine–Harbison Clinical Scoring System criteria are met. Maternal uniparental disomy of chromosome 7 and lack of methylation of chromosome 11p15 are the most common causes of RSS. To maximize growth and developmental results, early detection and diagnosis of
RSS are essential for starting appropriate therapies, such as growth hormone therapy. In this case report, we describe a 4 years and 3 months old girl from Iraq who presented with growth failure and distinct dysmorphic characteristics suggestive of RSS. We want to focus the light on the importance of clinical diagnosis for RSS (by history and physical examination) rather than depending solely on genetic testing, especially in countries where genetic diagnosis is restricted and of considerable cost.