Journal of the Faculty of Medicine Baghdad

Background: A significant proportion of patients with ischemic heart disease have been associated with peripheral arterial disease, yet it is still underestimated by our health system as many of patients are asymptomatic and this condition remains under diagnosed and therefore undertreated.
Objective: To study prevalence of peripheral arterial disease of the lower limbs in patient with acute coronary syndrome and its association with certain risk factors.
Method: A cross sectional descriptive study was conducted in the coronary care unit at Al-Yarmouk Teaching Hospital from the 1st of January 2016 to the 1st of November 2016 where hundred and fifty (150) patients enrolled to the coronary care unit with approved acute coronary syndrome, had been evaluated for peripheral arterial disease by assessing Demographic, risk factors and clinical features of the patients, including age groups, gender, hypertension, diabetes mellitus, smoking, dyslipidemia, family history. Of coronary artery disease, previous history of cerebrovascular accident, body mass index, leg pain, measurement of ankle brachial index using hand held continuous wave Doppler device.
Results: in 150 acute coronary syndrome patients were included male were (70.7%) , peripheral arterial disease was found in 31.2% through measuring ankle brachial index, 51% of those patients were asymptomatic and 29.8% with atypical leg pain and 12.8% with intermittent leg pain and 6.4% had pain at rest. And ankle brachial index in the 150 patients with acute coronary syndrome were 68.8% normal (ankle brachial index =1.4-0.91) and 21.3% (ankle brachial index =0.9-0.71) and 7.3 %( ankle brachial index =0.69-0.41) and 2.6% (ankle brachial index ≤0.40).
Factors independently related to peripheral arterial disease were old age (>60 years) which constitutes 51% and p value was 0.013, and smoking which constitutes 46.8% and P value was 0.04, and dyslipidemia which constitutes 74% and P value was 0.03, and finally previous history of cerebrovascular accident which constitutes 21.2% and P value was 0.0018.
Conclusion: The prevalence of peripheral arterial disease in patients presenting with acute coronary syndrome is considerable and significant, the majority of patients were asymptomatic, it is associated with increased cardiovascular risk. Factors like aging, hypertension, diabetes mellitus, smoking, previous history of cerebrovascular accident, and dyslipidemia were strong predictors of peripheral arterial disease

Background: Eventration of the diaphragm is an abnormal elevation of the diaphragm. Publishing on
eventration of diaphragm in Iraq is scarce.
Objective: This study was carried out to report on the Iraqi experience on eventration of diaphragm.
Methods: This study is a review of case records of 18 patients with eventration diaphragm treated in Ibn
Al-Nafees Teaching Hospital during the period of March 2012 to December 2017.
Results: The age of patients ranged between 5 months to 70 years, with a male to female ratio of 2:1.
Dyspnea was the dominating presenting symptoms followed by cough. The left hemidiaphragm was the
most affected site (83.3%). The cause of eventration of the diaphragm was idiopathic in 72.2% of patients.
Chest X ray showed the elevation of the affected hemidiaphragm while CT scan demonstrated the thinnedout raised hemidiaphragm. The most common complications were atelectasis, and recurrent chest
infection. Hospital stay ranged between 4-14 days.
Conclusion: Eventration of the diaphragm is not uncommon in Iraq. Presentation, management, and
complication are similar to those reported globally.

Background: Germ cell tumors are a rare heterogeneous group of cancers with high cure rates in the
pediatric age group.
Objectives: To study the clinical and pathological features in a group of patients with germ cell tumors
and to evaluate their outcomes.
Patients and methods: A record review was undertaken on a group of patients with germ cell tumor
who were admitted to the Children Welfare Teaching Hospital in Baghdad during the years 2009 - 2015.
Information on gender, age, clinical signs, pathological findings, treatment and overall survival rate were
reviewed.
Results: The patients had a mean age of 4.2 years (ranging from 1 month - 14 years). There were 45 girls
and 16 boys. Abdominal pain was the most common presentation in 17 patients followed by a lower back
mass in 16 patients. Primary sites included extra gonadal (sacrococcygeal 18, pelvis 5, vagina 4, gluteal
3, intra-cardiac, and one each for the mediastinum, orbit and rectum), and gonadal (18 ovarian and 9
testicular). After a mean period of follow-up of 42 months, the overall survival at 1 year was 59%.
Conclusion: The prognosis of children with germ cell tumors is favorable, regardless the site and
histopathology.

Background: Scabies is a skin invasion by the Sarcoptes scabiei mite that is transmitted through close
personal contact. Places such as hospitals, prisons and childcare centers are more vulnerable to outbreaks.
Both males and females may have scabies at any age. It is most prevalent in tropical climate countries, among
poor people who live in rural areas, among displaced populations and among low socio-economic groups due
to crowded living conditions.
Objectives: To explore the prevalence of scabies in Al- Daseem area and identify factors associated with an
increased risk of scabies among residents.
Methodology: A cross-sectional study was conducted to address the 2019 scabies outbreak in Al- Daseem
area which is a poor low social class area located in Al-Rusafa side in Baghdad. Basic data was obtained from
records of CDC of the public health department in Al-Rusafa health directorate and from Ali Al-Wardy School
for all cases recorded during 2019, and analyzed using SPSS-23. Data analysis was done on two data sources:
The first was all students of Ali Al Wardi School, and the second was residents in this area from whom 20%
of the total number of residents were selected by simple random sampling method. Data collected include
age, sex, and having a family member with scabies.
Results: The total number of students was 2032, of whom 216 (10.6%) were infected with scabies, 131 males
and 85 females. Fifth grade students had the highest prevalence while grade four students had the lowest.
Information on the 11363 residents showed that 746 (6.6%) had scabies with a significant association with
age group, male gender and having another family member infected with scabies.
Conclusion: The prevalence of scabies in Al-Daseem region was (6.6%), with the associated factors being
male gender, age group, and having another family member infected with scabies

Background: Colorectal cancer is a serious disease that can lead to death, especially when the tumor is
diagnosed late. The cells of the colon or rectum lining sustain changes until those cells develop outside
the body control. Cancer screening helps in the early detection and treatment, and preventsspreadof the
disease.
Objective: To determine the extent of colorectal cancer based on the patient's age and to study, based on
age, the most common symptoms, clinical findings, the most common tumor site, as well as the types of
surgical intervention.
Patients and methods: In the period between January 2012 to March 2013, 35 patients with colorectal
cancer were admitted to Al-Yarmouk hospital for surgical treatment after final confirmation of the
diagnosis using various screening tests including colonoscopy, sigmoidoscopy and fecal occult blood test.
Results: Of the 35 patients included in this study 25 (71.4%) were above the age of 40 years (12 males
and13 females), and the remaining 10 (5 males and5 females) were 22-40 years. Anemia was the most
common clinical finding among younger and older patients (90% and 88% respectively). Weakness and
lethargy were indicated as the most common symptom among older patients (88%). Surgical treatmentfor
younger patients involved differentsites, 30% each of lefthemicolectomy, right hemicolectomy and
anterior resection, while among the older patients 56% had left hemicolectomy.
Conclusions: Colorectal cancer is most common among older people, yet it also occurs in younger people
as well. The apparent symptoms were nearly the same in younger and older patients. Weakness and
lethargy were the most common symptom in younger and older patients. Most of the patients over 40
years of age underwent left hemisectomy.

As one year elapsed since COVID-19 outbreak, venous and arterial thromboses are increasingly reported
in different vascular territories. Once accessed by the virus, the endothelial cells, abundant in angiotensin
converting enzyme-2 (ACE-2) protein, will be activated by the inflammatory process leading to
coagulopathy and vascular lesions. Herein, we describe a case of extensive thrombosis of the infra-renal
inferior vena cava and iliac femoral vein in a man of 62 and a case of acute superficial femoral artery
thrombosis in a lady of 55. Both were COVID-19 confirmed cases with severe pneumonia, high D-Dimer
levels and risk factors for severe disease or death. Despite presentation 1-2 weeks after the onset of
thromboses, they were successfully managed by catheter directed thrombolysis (CDT) using tissue
plasminogen activator (tPA). Owing to the increased morbidity and mortality of vascular thrombosis,
there is a need to identify COVID-19 patients who need prophylaxis and prescribe them the right
prophylactic drug (s). The excellent outcome of CDT in these two patients, from Sulaymaniyah/Iraq,
supports the use of this treatment modality as a valid, safe and effective option for acute arterial and
venous thromboses

In Iraq, child’s health had deteriorated over four
turbulent decades starting from the huge and rapid
degradation of the country infrastructure by the Iraq
–Iran war (1980-1988), the Gulf War in 1991, and the
economic sanction. (1) (2) This unique situation
forced the United Nations to issue Security Council
resolution 986 on 14th April 1995 and then
Memorandum of Understanding (MOU) to facilitate
the implementation and execution the Oil For Food
Program (OFFP). (3) Later, an evaluation of the
MOU was carried out through the Multiple Indicators
Clusters Surveys (MICS) by establishing a baseline
data in 1996, and monitoring the changes in 2000,
2006, 2010, and 2018. (4) The Comprehensive Food
Security and Vulnerability Analysis (CFSVA) survey
was carried out too to assure the reported data of
MICS. (5) Publishing on this problem is scarce;
therefore, it was the imputes to carry out this study.
This work was done to study the effects of
geopolitical factors on childhood nutritional status. A
review of the MICS reports 1996-2018 (4) and the
CFSVA report was done