Journal of the Faculty of Medicine Baghdad

Abstract
Background: Atrial fibrillation is the most frequent cardiac arrhythmia encountered in general medicine and cardiology practice. Synchronized direct current shock is a known safe and effective procedure to revert long standing persistent atrial fibrillation into sinus rhythm.

Patients and Methods: Patients with long-standing atrial fibrillation who were seen at the author’s private clinic and Al-Hassani Heart Center in Sulaimanya from April 2018 to December 2020 were chosen for rhythm control subjected to synchronized direct current cardioversion under heavy sedation applying a modified anterolateral paddles position with 200J and 300J successively according to the reversion dose required.

Objectives: The Objective of current study was to assess the efficacy of synchronized direct current shock in reverting long-standing persistent atrial fibrillation into sinus rhythm and recognizing factors that help in achieving high success rate.

Results: In this case series study 61 patients were included thirty-one males 30 females The success rate was 89%. Even patients with atrial fibrillation duration more than 2 years showed a success rate of 84%. The recurrence rate of atrial fibrillation was 30% within a follow up period of one month to 2 years. The modified paddles position has helped in achieving high reversion rate where success increased from 62% to 85% and failure rate decreased from 38% to 15%. The shock dose needed for reversion ranged from 200J to 300 J. There was no correlation between the needed dose for reversion and body weight where patients with body weight of 71-80kg, more than 80% reverted with 200J. Pre shock antiarrhythmic drugs did not facilitate the conversion, the reversion rate in patients with or without antiarrhythmic drugs were 85% and 82% successively. No per procedure complications were seen.
Conclusion: Electrical cardioversion of atrial fibrillation with modified paddles position is a safe, effective and smooth procedure with significantly high success rate and very low incidence of complications even with very long-standing atrial fibrillation.

background: The number of coronavirus infection cases has increased rapidly since early reports in the December 2019 in China. But data on the clinical features of infected peoples is variable from one country to the other.

Objective: Studying clinical features of patients with a positive RT PCR COVID – 19, in a group of Iraqi patients.

Results: The study included 200 patients with 133 (66.5%) males and 67 (33.5%) females, and age range of 14- 89 years, with mean age 46.4 years. A history of contact with a COVID -19 positive case was found in 80 patients (40%), Ischemic Heart Disease in 11 patients (5.5%), hypertension 34 (17%), diabetes mellitus 36 patients (18%). The most frequently seen age group was between 21-39 years (76 patients - 38%). The most frequently seen symptoms were fever 76.5% and generalized weakness 73%. A statistically significant association was found between age and dyspnea (p = 0.014) and also diarrhea (p = 0.035), as well as between gender and rhinorrhea (p = 0.08) and nausea and/ or vomiting (p = 0.005).

Patients and Methods: This is a record review study of 200 patients with a confirmed COVID - 19, conducted in Al Imamain Al Kadhimain Medical City from 1 May to 30 August 2020, the diagnosis of patients during this period. Data about demographic and the clinical characteristics have been recorded.

Background: Behçet's disease is a systemic chronic pro inflammatory vascular disease.
Objectives: To describe new criteria for the diagnosis of patients with Behçet’s disease in Iraq.
Patients and Methods: Any patient suspected or diagnosed with Behçet’s disease attending the Center of Dermatology/Behcet’s Unit was enrolled in this study during December 2017- June 2018.A full history was taken followed by a clinical examination.
Results: A total of 47 patients were assessed with full history and examination, 37were females and 10 were males. The age range of patients was 11-68 years. Pethargy test was negative in 13 patients, positive in 15and was not done in 19. Twenty-one patients had a negative family history, nine had a positive one and 17 were not sure. In 20 patients, symptoms started since childhood.
The patients complained of malaise, oral ulcers, genital ulcers, unexplained fever, decreased hearing, eye complaints, dysphagia, dyspnea, headache, memory problems, depression, muscle contraction, peripheral paresthesia, joint complains, sleep disturbances, and renal problems.
Conclusion: unexplained fever, headache, depression, malaise, sleep disturbances, memory defects, and muscle contractions are important missed criteria that may help in the early diagnosis of BD

Background: Nipple discharge is a relatively common complaint of females in reproductive age and
after menopause.
Objectives: The aim of this study was to compare the radiological findings of mammography and
ultrasound in women with pathological nipple discharge (PND) of different etiology.
Methods: Mammography and ultrasound were done for a total of 50 patients attending the breast clinic
in Oncology Teaching Hospital in Baghdad complaining from PND. Ultrasound guided fine needle
aspiration was performed for all cases, and histopathology was available for eleven cases.
Results: The mean age for the women included in the study was 45.3 ± 10.4 years. Ultrasound was
able to provide clues for a possible underlying cause for all PND whereas mammography was negative
in 54%. Ultrasound was more sensitive in diagnosing malignant breast lesions associated with PND
(85.7%) but less specific (88.3%) as compared with mammography which had (71.4%) sensitivity and
(90.6%) specificity. Negative predictive value of ultrasound and mammographywere 97.4% and 95.1%
respectively.
Conclusion: Ultrasound is essential to complete PND workup, particularly when mammography is
normal, to rule out the possibility of neoplastic changes and to provide clues for non-neoplastic etiology
that may guide the management.

Background: Threatening teachers increases their stress and impairs their emotional well-being. There
are many reasons for violence against teachers. Threatening someone is considered as physical
aggression. Aggression is any behavior intended to harm another person who wishes to avoid such harm
High rates of aggression were reported recently in Iraq, especially after wars.
Objectives: To estimate the prevalence of students’ aggressive act and associated factors towards
teachers in secondary schools in an under-privileged residential area in Baghdad.
Methodology: A cross-sectional study was carried out in Al-Sadr city in Baghdad. A total of 720
adolescent secondary schools students from both genders were included in the study. They were selected
by multistage random sampling. Their age ranged from 13-21 years. Data was collected from 1st of
February 2019 to 30th of April 2019 through a self-administrated questionnaire (Aggression-Problem
Behavior Frequency Scale).
Results: The mean age of participants was 16.2±2.04 years. Of all participants, 84.3% were assessed to
be aggressive. There was a significant difference between aggressive acts (threatening a teacher) and
gender, school type, grades, history of absence from school, unemployed mother, and living with one
parent (P=0.038, P=0.009, P<0.001,p= 0.02 and p=0.018,P<0.001, respectively). Among male students
10% reported that they threatened a teacher.
Conclusion: the prevalence of aggressive acts towards teachers in secondary schools in an underprivileged residential area in Baghdad was high. Threatening a teacher was dominant among male
students, secondary schools, grades, students with history of absence from school, unemployed mother,
and living with one parent.

Background: Domestic violence against women is a public health problem that affects more than one
third of all women globally. It includes any physical, sexual or emotional abuse imposed upon women
within family relationships. Several studies in Iraq demonstrated that domestic violence has been
increasing over the past two decades.
Objective: Determine the prevalence of domestic violence against pregnant women and factors
associated with it.
Patients and methods: A total of 345 pregnant women were included in a cross- sectional study
conducted during the period from July - November 2018. They were selected through multistage random
sampling from four Primary Health Care Centers in Baghdad. An Abuse Assessment Screen was used,
with a known validity and reliability.
Result: The overall prevalence of domestic violence was 37.1%. It was 9.0% during pregnancy. There
were significant associations between domestic violence during pregnancy and the duration of marriage,
husband’s age at marriage, husband’s consumption of alcohol and the number of children.
Conclusion: Pregnancy acts as a protective factor against domestic violence.

Background: Multiple Sclerosis is a chronic inflammatory autoimmune disease of the central nervous
system. Up to 10 % of Multiple Sclerosis patients have onset in paediatric age group. Although the clinical
profile of Multiple Sclerosis appears similar to that seen in adults, several features may differ and specific
issues arise in children.
Case report: Here, we report a 12-year-old girl who presented with a 3-year history of episodes of
seizures, facial nerve palsy and finally fatigue and cognitive impairment were noted and interfered with
her academic performance. Because of the presumed atypical clinical presentations, the diagnosis was
missed then dismissed despite neuro-imaging features and CSF immunological findings that were highly
suggestive of Multiple Sclerosis. Later on, evolution of the disease by neuro-imaging helped confirm the
diagnosis and direct toward the delayed therapy.
Conclusion: Age–related variations in presentations of Multiple Sclerosis need to be considered.
Maintaining a high index of suspicion speeds up diagnosis and use of appropriate treatment and thus
minimizing associated morbidities.

Background: Pulmonary sequestration is a lung tissue (out of function), that received its blood supply from
anomalous artery and not continuous with the tracheobronchial tree.
Objectives: To report a personal experience in dealing with five patients with pulmonary sequestration, due
to anomalous arterial supply from the descending Thoracic Aorta ,ways of diagnosis and proper surgical
management.
Patients and Methods: Five patients with pulmonary sequestration, admitted, investigated and surgically
managed at the department of Thoracic and Vascular surgery, in the surgical sub specialties hospital of the
Medical City Teaching Complex during ten years period (2010-2019).
Results: Four of our patients were male, the remaining one was a female, all managed successfully by
Operative ligation of the anomalous blood supply and resection of the involved segment or lobe.
Conclusion: Resection of the involved segment or lobe after ligation of the anomalous artery offers the best
chance of cure.

Background: The assessments of performance in any health system is challenging goal. The objective of current article was to review the top healthcare systems then compare them with Iraqi health system.
Methods: The top 12 commercial Health Systems in 2020 ranked by a survey of more than 20,000 international citizens from 73 countries on 65 diverse metrics. These metrics vary from simple to critical health system performance criteria.
Results: Up to January 2020, the review showed that Canada has the top Health System. Most other top countries were Europeans. There were some strong and weak points in each health system. Iraqi health system struggles with several obstacles that need rehabilitation.
Conclusion: Iraqi health system needs some improvements. The Netherlands Health system model improves the Iraqi health system.