Journal of the Faculty of Medicine Baghdad

Background: the novel coronavirus (2019-ncov), formally known as severe acute respiratory syndrome coronavirus 2 (sars-cov-2), the etiological cause of the (corona virus disease 2019) covid-19, appeared in wuhan, hubei province, china. On 11 march 2020, the world health organization (who) declared this disease as a pandemic. As new information on the clinical characteristics, treatment options, and outcomes for covid-19 emerges approximately every hour, physicians should keep themselves up-to-date on this topic.
Objective: to study the demographic features, clinical signs and symptoms and certain vital and laboratory findings of covid-19 hospitalized cases; and to identify the used medication, complications, length of stay at the hospital and disease outcomes of confirmed covid-19 cases.
Patients and methods: a descriptive cross-sectional study with analytic elements was conducted at ibn-al khateeb hospital, baghdad on covid-19 patients admitted to the hospital from 1st of march to 4th of may 2020. All inpatients of all age groups, diagnosed as covid-19 and had a definite outcome (recovered and discharge or death) during the period of the study were included.
Results: the mean age ± sd for the patients included in the study was = 37.9±18.85 years, with 51.2% being males. The outcome was statistically significantly associated with age, marital status, hypertension, disease severity at admission and length of stay at hospital.
Conclusion: this study found that age was associated with disease outcome. Care, attention and monitoring should be taken into consideration for hypertensive patients. Patients’ initial signs and symptoms of dyspnea, weakness and sore throat were significantly associated with disease outcome

Background: Thyroid nodules are very common in clinical practice. Although most of thyroid nodules are benign, it is crucial to checkout which nodules are more likely to be malignant. Ultrasound is a major diagnostic tool for screening and evaluating thyroid diseases because it is safe, non-invasive, non-radioactive and effective.
Objective: The aim is to identify the role of ultrasound in assessing thyroid nodules and to review various ultrasound criteria predicting malignancy.
Patients and methods: A case series study conducted during the period from January 2015 to February 2016 at the First Surgical Unit, Department of Surgery, Baghdad Teaching Hospital by a team of surgeons. One hundred eighty Patients who underwent surgical intervention for nodular thyroid disease were included in the study. The ultrasound features of these patients were analyzed with respect to the number of nodules (solitary or multiple), size, echogenicity, consistency, the presence of calcification, border definition, vascular pattern and whether there was lymphadenopathy and / or local invasion to adjacent structures. The final diagnosis was confirmed by histopathological examination after surgery. The ultrasound features of thyroid nodules were studied for their correlation with benign and malignant lesions.
Results: Among 180 patients with nodular thyroid disease, thyroid malignancy was found in 22 (12.2%) patients. Ultrasound features of thyroid nodules included significant echogenicity, consistency, calcification, border definition, vascular pattern and the presence of local invasion. Ultrasound features suggesting malignant nodules are solid and hypoechoic nodules, ill-defined borders, nodules with local invasion to adjacent structures, the presence of microcalcification and nodules that show increased vascularity on doppler study.
Conclusion: Ultrasound is useful in evaluating nodular thyroid disease and is valuable for identifying many malignant and potentially malignant nodules. Despite that, no single ultrasound feature is reliable in making the diagnosis of thyroid malignancy, combining ultrasound suggestive criteria could aid in predicting malignant nature of a given nodule.

Background: Long QT syndrome is an important cause of arrhythmic death, and it is characterized by electrocardiographic changes and a prolonged QT interval. Patients may present with sudden cardiac death, recurrent syncope, and palpitation.
Objective: Clinical orientation for the Long QT syndrome and minimizing its misdiagnosis to achieve high diagnostic index.
Patients and Methods: Patients presenting with ventricular arrhythmias, syncope, dizzy spells, and prolonged, non-drug-induced QT interval from 2004 uptil 2019 at Al Nasirya Heart Center , Al Sulaimanya Heart Hospital, and Al Nahrain Teaching Hospital were enrolled in this study. All aptients studied clinically and followed up. Management included beta blocker drug therapy and ICD implantation.
Results: Forty-two patients were included within 15 years, comprising 22 pediatric and 20 adult patients (26 males, 16 females). Ventricular fibrillation reported in 18 patients and ventricular tachycardia in five patients. Thirty-eight patients received beta blockers, and 85% showed marked reduction in ventricular arrhythmia events. Implantable cardioverter-defibrillator (ICD) was implanted in 34 patients.The diagnosis of Long QT syndrome was missed in 85% of cases during the provisional medical contacts .
Conclusion: In this case series study patients with LQTS presented with syncope, recurrent dizzy spells or palpitation. The diagnosis requires high index of diagnostic suspicion.This case study is intended to orient physicians to diagnosis this fatal problem.

Background: Low birth weight (LBW) is the main leading cause of infant death. It is contributing to a variety of short and long term poor health outcomes. Determination of risk factors associated with LBW is important to select a suitable action to prevent or reduce this outcome. Studies on LBW and maternal risk factors in the Kurdistan region of Iraq are scarce.
Objectives: This study aimed to determine risk factors associated with Low birth weight in Sulaimania city, Kurdistan region of Iraq.
Cases and Methods: This study was carried out in the Maternity Hospital in Sulaimania from first of July, 2019 to first of February, 2020. Participants were 300 randomly selected mothers who gave a live birth. The questionnaire form, which contains information about factors associated with low birth weight (infant’s weight at birth lower than 2.5 kg) were filled by collectors. Infants were weighed immediately after delivery, and the weight was recorded in addition to sex of the infants, gestational age (weeks), age of the mother, job of the mothers, mother’s educational levels, antenatal care attendance, gravidity, residency, exercise and history of chronic diseases of mothers were recorded.
Results: The results of the present study indicate that LBW was reported in 44.7% of the participants. For the LBW group, 48.5% were males and 51.5% were females. The highest percentage of LBW was among those born preterm 75.4% and the lowest was among full term 24.6%. Many factors such as an employed mother (85.8%), no exercise during pregnancy (88.1%), residency in urban (61.9%), mothers with chronic diseases (86.6%) and low level of education (illiterate and primary) (67.9%) were found as the significant risk factors of LBW. However, other factors such as prenatal care visits, age of mothers and gravidity were not found to be associated with LBW.
Conclusion: The current study concludes that multiple risk factors may be associated with LBW in Sِulaimania city, Kurdistan region of Iraq. Gestational age (preterm delivery), working mothers, no regular exercise, urban residence, low level of education and mother’s diseases such as hypertension, respiratory conditions, chronic infections and diabetes mellitus were considered as the risk factors associated with LBW.

Background: Lumbar puncture is a procedure that is frequently performed in the pediatric practice.
Objective: To review some (patient, provider and technique- related) characteristics of lumbar puncture performed at the Children Welfare Teaching Hospital, Baghdad / Iraq.
Methods: A descriptive cross-sectional study was conducted in the period from April to September, 2017. A self-prepared questionnaire was used to collect the data. It included 32 items, which were divided into three sections: Residents doctors' information (3 items), patient's information (2 items) and procedure’s information (27 items).
Results: The total number of performed procedures was 103, of which 51 (49.5%) were performed in the oncology ward. About half (50, 48.6%) of the patients were preschool-aged. Lumbar puncture was indicated for diagnostic purposes in 52(50.5%) cases. Nearly two thirds (67, 65.9%) of the procedures was performed by senior residents (3rd/4th Board residents). A written consent was obtained in only one case, the couch sheet were not renewed in 92 (93.9%) cases, a drape were not used in 92 (93.9%) cases, sitting upright position was assumed in 90 (91.8%) cases, gloves were worn by the doctor in all cases, anesthesia was used in 47 (48%) cases, antiseptics were used in 97 (99%) cases ,one holder was noted in 93 (94.8%) cases ,SpinocanQuincke and 22 Gage needle type was used in 98 (100%) cases, one entry attempt per procedure was reported in 79 (80.6%) cases and no documentation in the patients’ notes was reported in any of the procedures.
Conclusion: Lumbar puncture load was found in the oncology ward both for the patients and the residents. Safety was considered but was suboptimal in all wards

Background: Tuberculosis (TB) is a major public health issue and a main cause of global morbidity and mortality. TB is the world's ninth leading cause of death despite the numerous treatment strategies for managing the disease.
Objective: To assess the traditional method (direct smear examination and culture) against real-time PCR as pulmonary and extrapulmonary tuberculosis laboratory diagnostic techniques.
Cases and methods: Samples were collected from (612) TB cases, (409) of whom were pulmonary tuberculosis (PTB) and (203) were extrapolmonary tuberculosis (EPTB). The cases were seeking care at the Specialized Chest and Respiratory Disease Center/ National Reference Laboratory for Tuberculosis (NRL) in Baghdad, during the period 1st of May -1st of October 2019. Direct smear examination, Lowenstein-Jensen culture and Real Time PCR were used to diagnose TB.
Results: Out of 612 samples received, 82(13.4%) were positive by smear microscopy, while 90(14.7%) were able to grow on Lowenstein-Jensen (LJ) media. Ninety DNA extracts from the samples which were positive on LJ media and 25 control specimens, were diagnosed with molecular analysis by using real time PCR to determine the species of Mycobacterium tuberculosis complex. The results revealed that the 71 samples (78.9%) were M. tuberculosis, three specimens (3.3%) were combined M. bovis and M. tuberculosis, and one M. tuberculosis, M. bovis, and M. bovis BCG, while15 (16.7%) were negative and subsequently excluded from study.
Conclusion: The comparison between molecular diagnostic methods by using Real time PCR with conventional diagnostic methods, provides a new promising technique and is potentially a practical and rapid alternative to the slower traditional pulmonary and EPTB diagnostic culture. The results show M. bovis overall contribution on human TB in comparison to M. tuberculosis is minor among PTB and EPTB cases in the sample studied.