Al-Kindy College Medical Journal

The beginning of COVID-19 in Wuhan, China in late December 2019 and its worldwide transmission has led the World Health Organization to formally address the pandemic. The pandemic has imposed influential impacts on different environmental, economic, social, health, and living aspects. Publishing in scholastic journals was not immune from these impacts.

Artificial intelligence is a discipline of computer science that gives machines the intelligence resembles that of humans and empowers them to acquire knowledge, evaluate, and handle issues when exposed to information in different formats. AI is now useful as a powerful tool to help researchers collect, deal with, and analyze large sets of data in a fast and cost-effective way; additionally, a statistical collection and analysis of a vast amount of dataset of enormous numbers of published research articles will be with a high level of accuracy.

However, Artificial intelligence has many struggles, conflicts, and challenges that need to be discussed and clarified.

Since the appearance of COVID-19 disease as an epidemic and pandemic disease, many studies are performed to uncover the genetic nature of the newly discovered coronavirus with unique clinical features. The last three human coronavirus outbreaks, SARS-CoV, MERS-CoV and SARS-CoV-2 are caused by Beta-Coronaviruses. Horizontal genetic materials transfer was proven from one coronavirus to the other coronavirus of non-human origin like infectious bronchitis virus (IBV) of avian. Horizontal genetic materials transfer was also from non-corona viruses like astroviruses and equine rhinovirus (ERV-2) or from coronavirus-unrelated viruses, like influenza virus type C. However, SARS-CoV-2 is identical to SARS-CoV and MERS-CoV. Interestingly, Wuhan city-SARS-CoV-2 is very similar to two types of bats Coronavirus in RdRp nucleotide sequence to RdRp of SARS-CoV-2 suggesting possible transmission from bats. Moreover, many genomic mutations are found in SARS-CoV-2 genomes suggesting the mutations are developed and the virus is constantly changed. The newly discovered SARS-CoV-2 has a new open reading frame (ORF) that encodes for thirty-eight amino acid peptide chains and has no similar sequence in all reported NCBI data regarding respiratory viruses. The short peptide can serve as an identification target for SARS-CoV-2 detection.

Although severe epistaxis is uncommon, it is serious. The systematic endoscopic nasal examination is an essential step in identifying the bleeding point and aiding electrocauterization. Currently, the S-point, which is located in the superior part of the nasal septum behind the septal body and corresponding to the axilla of the middle concha, is identified in about 30% of cases with severe epistaxis. Cauterization of this point has an excellent rate of controlling the bleeding and preventing its recurrence. We aimed to highlight the significance of the S-point in the management of severe cases of epistaxis.

Background: Rheumatoid arthritis (RA) is a chronic and systemic autoimmune disease that is characterized by severe synovial inflammation, cartilage erosion, bone loss, and generalized vasculopathy. Although the immunologic mechanism of RA is still unclear, it is now thought to be a primarily Th17-driven disease. Along with other factors, IL-23 stimulates the expansion of Th17 cells from naive CD4+ T cells.

Objective: The objective of this study is to assess the circulating levels of interleukin (IL)-23 in rheumatoid arthritis (RA) and determine the correlation between plasma/serum IL-23 levels and disease activity. So, we performed a systematic review with meta-analysis comparing plasma/serum IL-23 levels between patients with RA and controls and examined correlation coefficients between circulating IL-23 levels and disease activity

Subjects and Methods: Using the following keywords: lenterleukin-23, IL-23, and rheumatoid arthritis, a comprehensive literature search was carried out in the following databases: PubMed, Scopus, Google Scholar, and Web of Science. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were followed, and the review was registered in the PROSPERO International prospective register of systematic reviews with registration number CRD42022345901. Results were reported as standardized mean differences (SMDs) with a 95% confidence interval. All statistical analysis was performed using StatsDirect statistical software version 3.0.0 (StatsDirect Ltd., Cheshire, UK). A sensitivity analysis was conducted using the leave-one-out approach to test the robustness of the results.

Results: The total sample size for the RA group included in our review was 408 cases, while the control group sample size was 244 cases. The serum IL-23 level in the RA group was significantly higher than the control group (pooled SMD = 3.5, 95% CI; 2.1: 4.8, P < 0.0001) as compared to the control group. There were 8 studies with a total sample size of 402 that reported the correlation between IL-23 and DAS28-based RA activity. According to our findings, a significantly positive correlation between IL-23 and DAS28-based RA activity was found, with a weighted mean correlation of 0.57 (95% CI; 0.4: 0.75, P < 0.0001).

Conclusion: Our meta-analysis has shown that IL-23 circulatory levels are higher in RA patients and that there is a significant positive correlation between IL-23 and disease activity. Our findings emphasize the role that IL-23 may have in RA. More studies may be required to fully comprehend the involvement of IL-23 in RA.

Background: Ultrasound guided core needle biopsy is becoming a gold standard in the work up of suspicious breast lesion. In Iraq, radiologists are not taking the lead in core needle biopsy performance.

Objectives: To evaluate the radiologist performance of core needle biopsy highlighting the precession and accuracy of the procedure, the concordance of ultrasound and histopathology, and identifying challenges facing the radiologist during the procedure.

Subjects and Methods: A prospective study involving a total of 50 patients with ultrasound (US) BIRADS IV or V. Ultrasound guided core needle biopsy was performed for each patient. Surgical pathology diagnosis was available for 40 patients. core needle biopsy results were correlated with Breast Imaging-Reporting and Data System (BI-RADS) categories and validity of the test was evaluated.

Results: Malignancy was confirmed by histopathology in 76% of the cores. Concordance between BI-RADS(US) and histopathology for benignity and malignancy was achieved in all cores. Borderline lesions constituted 10% of total cores taken. Surgical resection of these lesions upgraded 3/5 (60%): two atypical ductal hyperplasia and an intraductal papillary lesions diagnosed by core needle biopsy found to be invasive ductal carcinoma after surgical resection. Sensitivity of core needle biopsy in this study was 91.4% with 100% specificity. Positive and negative predictive values were 100% and 62.5% respectively. The underestimation rate in high-risk group was 3/5 (60%). No significant complication was reported.

Conclusion: Ultrasound guided core needle biopsy is a safe, efficient and relatively inexpensive method in diagnosing suspicious breast lesions. Radiologists can produce high sensitivity and specificity results. Radio pathological correlation is of paramount in achieving accurate results.

Background: Hypothyroidism is a decrease in the production of the thyroid hormones and leads to gland dysfunction. Ashwagandha extract was used as an ayurvedic treatment and supposed to be as antihypothyroidism agent.

Objectives: to investigate the impact of ashwagandha (Ash) extract on propylthiouracil (PTU)-induced hypothyroidism in rats.

Subjects and Methods: The rats were divided into three groups, control group, PTU (hypothyroid) group (6mg/kg/day by oral route), PTU (6mg/kg/day by oral route) +Ash (50mg/kg/day by oral route) treated group. All treatment continued for 30 days. At the end of experiment, measurement of serum T3, T4 and TSH was performed. Thyroid gland, right sided tibia and dentate gyrus region of hippocampus were examined using histological, histochemical and immunohistochemical studies. All measurements were statistically analyzed.

Results: Decrease in serum T3 and T4 and congestion of the blood capillaries, follicular distortion, and vacuolar degeneration of some follicular cells were exhibited in thyroid gland of hypothyroid group. Histological changes in growth plate cartilage in the form of decrease of matrix deposition and plate thickness were detected. Dentate gyrus showed distorted granule cell layer. Immunohistochemically, low expression of the GFAP was expressed in astrocytes. PTU+Ash treated group showed improvement of the previous changes.

Conclusion: Administration of ashwagandha with PTU displayed protective effect on the thyroid gland and its associated histological changes in growth plate cartilage and dentate gyrus. Higher doses of ashwagandha should be used for extrapolation if it may give better results than the used dose.

Background: Diabetic neuropathy can affect any peripheral nerve, including sensory neurons, motor neurons, and the autonomic nervous system. Therefore, diabetic neuropathy has the potential to affect essentially any organ and can affect parts of the nervous system like the optic nerve, spinal cord, and brain. In addition, chronic hyperglycemia affects Schwann cells, and more severe patterns of diabetic neuropathy in humans involve demyelization. Schwann cell destruction might cause a number of changes in the axon. study aims to evaluate serum myelin protein level as a predicting marker in the diagnosis of diabetic neuropathy and to prevent early neuropathy complications of type 2 diabetes.

Subjects and methods: To achieve the purpose of the objective, this study involved 120 individuals divided into three groups. The first group included 40 healthy individuals; the second group included 40 type 2 diabetic patients with a diabetes duration of more than 5 years; and the last group included 40 type 2 diabetic patients with a diabetes duration of less than or equal to 5 years. The enzyme-linked immunesorbent assay (ELISA) system is used to detect serum MOG and MPZ.

Results: both groups of type 2 diabetes patients had significant (p≤ 0.05) increases in serum myelin protein zero P0 (MPZ) and myelin oligodendrocyte glycoprotein (MOG).

Conclusion: According to the results, myelin protein can be used to diagnose patients with diabetic neuropathy at an early stage. But it did not rise to the level of a biomarker due to a lack of sensitivity

Background: Few updated retrospective histopathological-based studies in Iraq evaluate a comprehensive spectrum of oro-maxillofacial lesions. Also, there was a need for a systematic way of categorizing the diseases and reporting results in codes according to the WHO classification that helps occupational health professionals in the clinical-epidemiological approach.

Objectives: to establish an electronic archiving database according to the ICD-10 that encompasses oro-maxillofacial lesions in Sulaimani city for the last 12 years, then to study the prevalence trend and correlation with clinicopathological parameters.

Subjects and Methods: A descriptive-analytical study included the archived records from three major histopathological centers in Sulaimani (College of Dentistry, Shahid Saifaldeen, and Shorsh Hospitals), related to surgical biopsies of oro-maxillofacial lesions performed between 2008 and 2019 in Sulaimani. Data were tabulated in an excel sheet and analyzed.

Results: This study involved 2100 oro-maxillofacial lesions, male: female ratio was 1:1.2, and a mean age of 41.03±19.51 years old. The most frequently involved sites were; the lip (14.5%), followed by the gum and alveolar ridge (14.2%). 69.4% of cases were non-neoplastic lesions. The neoplastic lesions were significantly (P=.000) observed in old patients with a mean age of 46.1±21.09, mostly epithelial tumors (39.1%), followed by connective tissue tumors (19.5%). Malignant connective tissue tumors were more frequently seen than benign ones (52.5% versus 47.5%). The non-neoplastic lesions revealed predominate soft tissue lesions (45.2%), followed by salivary gland diseases (13.8%), with a mean age of 38.26±18.8. Squamous cell carcinoma was the most common epithelial tumor, while haemangioma was predominant among connective tissue tumors

Conclusions: ICD-10 classification of oro-maxillofacial lesions in Sulaimani city helps establish a standardized coding database system for clinicopathological distribution. However, the majority of recorded lesions were non-neoplastic especially diagnosed as soft tissue lesions. Still, neoplastic lesions with their minor distribution deserve great attention as they threaten patients’ lives.

Background: Self-medication is a practice or action taken by individuals for themselves in order to achieve and maintain health, as well as to avoid and protect against disease. The aim of this study is to evaluate the knowledge, attitudes, and practice of self-medication among medical students at Sudan International University.

Subjects & Methods: This was a prospective study that involved 288 out of 1000 students in the Faculty of Medicine at Sudan International University. Data were collected using a self-administered questionnaire from January to March 2022 to evaluate the self-medication knowledge, attitude, and practice among first, second, and third-year medical students.

Result: The age groups of this study were arranged as follows; 197(17-20 year), 72(21-23 year) and 19(>23 year). Regarding the sex of the study population, the female group was 215(74.7%) while the male group was 73(25.3%). The classification of the population according to their academic levels; as follows; first year 124 (43.1%), second year 52 (18.1%) and third year 112(38.9%). The prevalence of self-medication was found to be a common practice by the majority of the students, since 279 (96.9 %) of the study group practiced self-medication, in contrast to only 9 (3.1%), who did not deal with any self-medication. Also, the result showed that the most common drugs were; vitamins 183 (65.6%) and analgesics 176 (63.1%) followed by antibiotics 172 (61.6%). Regarding the illnesses described by the student as an indication of self-medication, they are as follows; headache is the most common (93.2%), followed by common cold and cough 211(75.6%). Concerning the source of information used by the studied population for self-medication, pharmacists were found to be the main source of information 122 (42.4%) followed by parents of the students 102 (35.4%). Furthermore, the results revealed that the main reason given for practicing self-medication by the study group was that the illness was not serious is (69.5%).

Conclusion: Self-medication was found to be widely practiced in 96.9% of cases, and the main reasons for self-medication were that the disease was not serious.

Background: Economic Globalization affects work condition by increasing work stress. Chronic work stress ended with burnout syndrome.

Objectives: To estimate the prevalence of burnout syndrome and the association of job title, and violence with it among physicians in Baghdad, and to assess the burnout syndrome at patient and work levels by structured interviews.

Subjects and Methods: A cross section study was conducted on Physicians in Baghdad. Sampling was a multistage, stratified sampling to control the confounders in the design phase. A mixed qualitative and quantitative approach (triangulation) was used. Quantitative method used self-administered questionnaires of Maslach Burn out Inventory. Qualitative approach used an open-ended question modified from Copenhagen Burnout Inventory by face-to-face interviews. An ordinal logistic regression used in the analysis phase to overcome confounders.

Results: The percentages of emotional exhaustion, depersonalization, and feeling of inefficacy were 72.5%, 31.9%, and 12.7% respectively. Total burnout syndrome was 56.4%. Being single and hospital workers were significantly associated with emotional exhaustion (p=0.006, 0.001 respectively) and total burnout syndrome (p=0.017, 0.016 in sequence). In addition to emotional exhaustion and burnout syndrome, singles suffered from depersonalization (p=0.010). Administrative responsibilities made physicians less liable for emotional exhaustion but more prone to feeling of inefficacy (p=0.038, 0.017 respectively). Less than 40-year age group had a relation with depersonalization, p=0.003, and total burnout syndrome p=0.013. Being male was significant with total burnout syndrome, p=0.008. All Violence types were associated significantly with burnout syndrome and its dimensions, p=0.001 (except feeling of inefficacy in which only threat was significant with it, p=0.054).

In qualitative part, the response rate was 80%. It was formulated from 3 themes. Highest percentages in these themes were gained by female and graded physicians.

Conclusion: Burnout affects over half of Baghdad’s doctor. Violence was significant to burnout syndrome but job title was not. In qualitative part female and graded physicians were most groups to be affected.

Background: Essential oils extracted from plants have been widely used in antimicrobial activity, particularly the Callistemon viminalis, with a high number of essential oils extracted.

Objectives: To identify the chemical composition of essential oil derived from Callistemon viminalis and evaluates its antimicrobial activity against selected bacterial and fungal strains.

Subjects and methods: During the study, the antimicrobial activity of different selected essential oils on some bacteria (Escherichia coli, Pseudomonas aeruginosa, Salmonella enteritidis, Staphylococcus aureus, and Streptococcus pneumonia) and fungus (Candida albicans) was evaluated. The MicroScan WalkAway automated device was used to confirm the identification of the bacteria microorganisms and the germ tube and microscopy detection confirmed the fungus identity of specific morphological features after growth on corn meal agar, used in this study.

Results: the GC-MS analysis reveal that the chemical composition of the essential oil was contained Eucalyptol (41.17%) area, Viridiflorol (8.43%) area, Alpha-Pinene (4.53%) area, Alpha-Terpineol (4.53%) area and others. The essential oil shows activity against Staphylococcus aureus with inhibition zone diameter of 10 mm, and for Streptococcus pneumoniae, with ihibition zone of 22 mm.

Conclusion: The highest antimicrobial activity was against S. aureus and S. pneumonia of Gram-positive bacteria. The study result show that resistance from Gram-negative bacteria and resistance from fungus C. albicans to the oil. These varying results of bacterial suseptabilty may be based on the construction of the bacterial cell wall between Gram-positive and Gram-negative bacteria. The essential oil components detected with higher percent area in GC-MS from C. viminalis are Eucalyptol, alpha-Pinene, Viridiflorol, beta-Eudesmol, and alpha-Tocopherol.

Background: coronavirus 19 is a beta-coronavirus, enveloped and roughly spherical with approximately 60 to 140 nm in diameter with positive-sense single-stranded RNA genome.

Objectives: Measurement of interleukin 6 (IL6) level in a group of patients with confirmed Covid19 infection and its correlation with many hematological and biochemical parameters , mainly lymphocyte , neutrophil count and their ratio , platelet count , serum ferritin , C reactive protein as well as D-dimer level

Subjects and Methods: This study was conducted on 60 PCR positive patients variably affected by COVID-19 , cases collected sequentially from June till November 2021 from Medical City hospital (Private Nursing hospital/ Intensive Care Unit (ICU)) with outpatient mild cases collection.

Results: IL-6 levels showed a significant difference between the mild-moderate groups (p 0.001) and the mild- severe groups (p 0.009) ; additionally, there was significant statistical correlation between IL-6 and the other parameters included in the study.

Conclusions: IL6 level was highly elevated in most of moderately and severely affected COVID 19 patients ,It's level correlates well with the most important hematological and inflammatory parameters that enable it to be used as a marker to assess the severity of the infection and for following up patients.

Background: Oral health is a mirror of general health. During pregnancy, oral health is affected by changes in saliva and oral hygiene measures which may lead to more dental caries.

Objective: Assess oral health status in relation to salivary antimicrobial peptides in pregnant women.

Subjects and Method: This cross sectional study was carried out in different primary health care centers in Rusafa sectors/ Baghdad city. The total sample included was 80 women (their age range from 21-30). The study group consisted of 40 pregnant women: half of them were in the first trimester and others were in third trimester, while the control group included 40 non-pregnant married females. Dental Plaque was recorded according to simplified oral hygiene index. Dental caries were diagnosed by using WHO (2013) criteria. Unstimulated salivary samples were collected. Chemical analysis of salivary samples was performed for the detection of human β-Defensin 2.

Results: The current study revealed that dental caries experiences (decayed surfaces(DS), missed surfaces (MS) and decayed, missing, filled surfaces(DMFS)) were higher among pregnant than non-pregnant females especially in the third trimester, add percentage with no significant differences, while filled surfaces (FS) were higher in the control group with also no significant difference. Regarding plaque index, results revealed that pregnant women had higher plaque index than non-pregnant women, with significant higher per-centage (53.3%) in the third trimester, P value = 0.027. The salivary human β-Defensin 2 was higher among the pregnant group in the third trimester with statistically no significant difference.

Conclusion: More plaque accumulation during pregnancy may explain the higher preva-lence of dental caries as the dental plaque considered to be the chief contributing factor in dental caries.

Background: Vitamin D improves innate immunity by enhancing the expression of antimicrobial peptides. The antimicrobial action of cathelicidin is widespread and effective against cariogenic bacteria. This research aimed to investigate the effect of vitamin D deficiency on the level of salivary cathelicidin concerning dental caries experience.

Subjects and Methods: A case-control study was carried out, and the sample was composed of 80 females; the study group involved 40 females with a serum vitamin D concentration of less than 10 ng/ml. In addition to the control group involving 40 females who matched the case in number and age but serum vitamin D concentration of 30 ng/mol or more, their age range was 20-30 years. WHO 2013 index was used for the assessment of dental caries experience, and collection of unstimulated saliva was done to measure salivary cathelicidin.

Results: Data from the current study showed that the mean values of the Decayed, Missing, and Filled Teeth index and its components (Decayed Teeth, Missing Teeth) were higher in the study group than those in the control one, with a significant difference for Decayed Teeth. Salivary cathelicidin was higher in the control group with a statistically significant difference.

Conclusion: It was confirmed that serum vitamin D status and salivary cathelicidin levels are related. Vitamin D deficient patients who had higher Decayed, Missing, and Filled Teeth index values expressed a lower level of salivary cathelicidin than the control group.

Background: Osteoporosis is denoted by low bone mass and microarchitectural breakdown of bone tissue, directing to increased fracture risk and bone fragility. Fractures may lead to a decreased quality of life and increased medical costs. Thus, osteoporosis is widely considered a significant health concern.

Objective. This study aimed to compare quantitative computed tomography (QCT) and dual-energy X-Ray absorptiometry (DXA) to detect osteoporosis in postmenopausal women.

Subjects and Methods. We measured spinal volumetric bone mineral density (BMD) with QCT and areal spinal and hip BMD with DXA in 164 postmenopausal women. We calculated the osteopenia and osteoporosis detection rate for the two methods. The difference between these rates for DXA versus QCT was analyzed using the chi-square test.

Results. The detection rate of osteoporosis was 57.9% for QCT and 50.6% for DXA (significant difference, p=0.002). At the same time, the detection rate of osteopenia was 36.6% for QCT and 31.7% for DXA (significant difference, p=0.002).

Conclusions. Quantitative CT bone densitometry is an excellent tool for the evaluation of BMD. It is more sensitive than DXA for detecting osteoporosis in postmenopausal women.

Background: It is well-known that silicon oil (SO) injection into the vitreous cavity after pars plana vitrectomy is usually associated with high intraocular pressure.

Objectives: To determine the influence of silicon oil (SO) removal on IOP level after pars plana vitrectomy for spontaneous rhegmatogenous retinal detachment (RRD)

Subjects and Methods: A prospective study was conducted at Ibn Al-Haitham eye teaching hospital, Baghdad- Iraq. Intraocular pressure (IOP) was measured pre and post SO removal in patients who have underwent retinal detachment surgery with SO injection of 1000 centistokes (cSt) viscosity. Baseline IOP was measured for all the patient before the SO removal. Follow-up was performed at 1, 4, and 8 weeks after SO removal. IOP was measured by Goldman applanation tonometer. Patients with IOP > 21 mm Hg at 8 weeks post-operatively with or without anti-glaucoma mediations were considered as persistent IOP elevation after SO removal.

Result: Sixty eyes of 60 patients were included. Twenty eyes had persistent IOP elevation after SO removal on first week postoperative. It decreased to 14 eyes on 4th week after SO removal and further decreased to 12 eyes on 8th week af-ter SO removal. The percentage of persistent IOP elevation following SO remov-al was about 20% on 8th week of SO removal.

Conclusion: Persistent IOP elevation sometimes happens after SO removal. Therefore, removing SO does not simply treat the elevated IOP happened during SO injection. Patients after SO removal should be followed up for IOP for several weeks and should be treated medically or surgically as required.

Background: Ankylosing spondylitis is a chronic inflammatory disease that mostly involves the spine and sacroiliac joints. It is associated with a decreased quality of life. Biological medicines such as infliximab and its biosimilar are the mainstay treatments for active ankylosing spondylitis.

Objective: The study objective was to conduct a pharmacoeconomic study comparing the cost-effectiveness of the reference infliximab with its biosimilar in ankylosing spondylitis patients visiting public hospitals.

Subjects and Method: This is a two-center pharmacoeconomic study performed at two large teaching governmental hospitals in Baghdad, Iraq, which supplied infliximab to outpatients with ankylosing spondylitis. The outcome data were obtained from patient’s medical records and face-to-face interviews with the patients from December 2021 through April 2022. The Independent T-Test was used to measure the differences in areas of utility, and quality of life, between the two infliximab groups.

Results: The study recruited 62 patients with ankylosing spondylitis who received infliximab (31 received Remicade, and 31 received Remsima) for at least 12 weeks at two public teaching hospitals. The mean age of the patients was 37.85 years and 83.9% were men. In general, both reference infliximab and its biosimilar were successful in increasing the quality of life. Their importation costs were different from 2019 to 2021. The incremental cost-effectiveness ratio of reference infliximab versus biosimilar was $ 40,909/quality-adjusted life year (QALY) according to 2019 pricing. In contrast, in 2021 reference infliximab (Remicade) was less expensive and yielded slightly better quality of life improvement than biosimilar (Remsima) making Remicade more cost-effective (dominant).

Conclusion: Remicade was slightly superior to Remsima in quality of life improvement. However, it was difficult to determine whether the reference or its biosimilar was more cost-effective in 2019 because the health officials did not specify a willingness to pay per quality-adjusted life year. Compared to Remsima, Remicade was more cost-effective in 2021 because it was less expensive and more effective in terms of quality of life improvement.

Background: The problem of difficult gallbladder is not clearly defined and associated with real missing of therapeutic approaches that decreased morbidity. Moreover, the difficult gallbladder was reported as a contributing risk factor for biliary injury due to raised difficulty in surgical dissection within Calot’s triangle. The aim of this study is to determine the surgical outcomes of the open fundus-first cholecystectomy in lowering the rate of lethal intraoperative risks.

Subjects and Methods: Our prospective study conducted during the period of January 2019 to December 2022 at Ibn Sina specialized hospital, Khartoum, Sudan, for two hundred and fifty-three patients underwent elective open fundus-first cholecystectomy for intraoperative difficulties.

Results: the majority of cases had long-standing cholelithiasis with intraoperative difficulties revealed by pre-operative TUS and MRCP which required open fundus-first cholecystectomy in 173 (68.4%) of patients, (P-value <0.05). The operative surgical time was 120 minutes in 103 patients (40.7%), (P-value <0.05). During open cholecystectomy, variable intraoperative difficulties were found in all patients, (P-value <0.05) and were divided into: (A) Contracted intra-hepatic gallbladder seen in 157 (62.1%) of cases; (B) Distorted anatomy within Calot's triangle seen in 135 (53.4%) of patients; and (C) Intraoperative bleeding from the liver bed was observed as bloody oozing form in 150 (59.3%) of cases. Our patients had minimal postoperative complications like mild wound infection in 8 (3.2%) of cases and mortality rate was zero.

Conclusions: There is a need for appropriate therapeutic and preventive strategies in healthcare systems for safe dealing with difficult cholecystectomy. Unclear anatomy due to severe inflammatory dense adhesions at Calot’s triangle and CBD stones needing difficult surgeries are the most important limiting factors for fundus-first laparoscopic cholecystectomy. Hence, we humbly recommend an open approach of fundus-first cholecystectomy as safe surgical option to reduce the incidence of bile duct injuries and intra-operative bleeding.

Background: The overproduction of thyroid hormones is known as hyperthyroidism. Increased susceptibility to caries and periodontal disease are two potential oral symptoms. The interleukin-6 (IL-6) was observed to significantly increased in the hyperthyroid group. According to multiple research, IL-6 dysregulation has been linked to a number of oral disorders, including periodontal diseases. The study aimed to evaluate periodontal health status in relation to IL6 among hyperthyroidism patients.

Subjects and Methods: The sample was composed of 90 female patients aged 25-45 years attending endocrine disorder center in al-Najaf Governorate/Iraq which include hyperthyroid group and healthy group, the hyperthyroid patients were diagnosed by specialist and under treatment with carbimazole. The clinical examination of periodontal health status assessment was performed according to WHO (2013) in addition to evaluation the Plaque and gingival condition. The Saliva was collected to evaluate IL-6 concentrations.

Results: The plaque index (PLI) in the study group was more than the control with a significant difference (P<0.05). The gingival index (GI) in the study was more than the control but with no significant difference (P>0.05). Both periodontal pocket depth (PPD) and clinical attachment loss (CAL) were higher in the study group than in the control group, with a significant difference. IL-6 was higher in the study group than in control with a significant difference. There was a positive non-significant correlation between PPD and CAL with IL-6 in hyperthyroid patients.

Background: Patients with decompensated cirrhosis are often given therapeutic and prophylactic drugs. Polypharmacy raises both the likelihood of prescription errors and the complications associated with drugs. Clinical pharmacists are excellent at recognizing, addressing, and preventing clinically significant drug-related problems.

Objectives: Identification types of pharmacist interventions to address drug-related problems in patients with decompensated cirrhosis and assess the acceptance/implementation of these recommendations. And identify patient factors associated with accepting pharmacist recommendations.

Subjects and Methods: Prospective, interventional, clinical study for 80 hospitalized decompensated cirrhosis patients was conducted at Baghdad Teaching Hospital and lasted for four months, from the first of December 2021 until the last of March 2022. The study involved two phases, the first one was observational to identify drug-related problems and classify them according to the Pharmaceutical Care Network Europe classification version 9.1, and the second phase was interventional to increase the awareness of patients and health care providers about those problems and to propose a proper solution for each one.

Results: The most frequent pharmacist intervention was proposed to the prescriber (54.7%), followed by speaking to the caregiver (37.7%). Acceptance and full implementation were highly observed in 71.1% of the intervention. There is a significant association between occurring ascites and bleeding in patients and accepting/implementing pharmacist recommendations

Conclusions: Patients with decompensated liver cirrhosis have a significant prevalence of drug-related problems. Clinical pharmacists are excellent at recognizing drug-related problems and reducing their incidence, and their interventions were well accepted.

Rudimentary non-communicating functional uterine horn with unicornuate uterus, originating from anomalous embryological development of one Mullerian duct, is prone to different complications either at the gynecological or obstetrical level such as chronic pelvic pain, hematometra, subfertility and decreased quality of life. This unique case report presents a 14-year-old female with a history of severe chronic pelvic pain. She was diagnosed with Familial Mediterranean Fever (FMF) and had an appendectomy for suspected appendicitis within the symptoms’ interval. Ultrasound showed a right 5*6 cm right complex cystic mass assuming ovarian in place. She underwent a suspected endometrioma cystectomy operation and was diagnosed with left unicornuate uterus with right functional non-communicating rudimentary horn. The patient was followed up and mentioned marked improvement of her previous pain attacks. Her family members observed marked improvement in her usual daily activities and quality of life. Occult non-communicating uterine horn are frequently misdiagnosed due to its rarity and unspecific symptoms. The diagnosis of Mullerian anomalies should be added to the differential diagnoses for women with infertility, chronic abdominal and pelvic pain, and dysmenorrhea to avoid the patients’ agony and to alleviate their quality of life.