Mustansiriya Medical Journal

Background: Coronavirus disease‑19 (COVID‑19) is a zoonotic viral disease caused by nonsegmented, enveloped, positive‑sense, single‑strand
ribonucleic acid coronavirus. Recent outbreak started in Wuhan, China, where a new type of coronavirus was isolated from respiratory samples
such as bronchoalveolar lavage and sputum of patients developing respiratory symptoms. The World Health Organization declared COVID‑19
a pandemic on January 20, 2020. On April 6, 1,288,080 were infected with this virus with 70,567 deaths. Computerized tomography (CT) is
the investigation of choice for diagnosing, managing, and accessing temporal changes in COVID‑19. Objective: The objective of this study
is to describe the chest CT findings in documented nCovid‑19‑positive patients. Methodology: This was a retrospective observational study
done in Government Medical College, Chest Disease Hospital from February 20 to April 25, 2020. Forty‑eight patients with COVID‑19 reverse
transcriptase‑polymerase chain reaction‑positive test were scanned on 64 slice Somatom CT scanner and findings analyzed. All patients with
previously underlying chest disease were excluded. Results: The various chest findings in the nCovid‑19‑positive patients include ground
glassing, (81.25%), consolidation (56.25%), nodules (43.75%), halo sign (31.25%), crazy paving pattern (50%), air bronchogram (12.5%), air
bubble sign (6.25%), vascular enlargement (25%), reversed halo sign or atoll sign (18.75%), bronchial wall thickening (6.25%), and mosaic
attenuation (6.25%). None of the patients had pleural effusion. Conclusion: Characteristic CT findings of COVID‑19 can help radiologists
in the early diagnosis of symptomatic patients in whom testing is awaited. Bilateral peripheral ground‑glass opacities with consolidation in
dependent parts of the lung along with the absence of pleural effusion were the most common abnormality.

Background: Right ventricular dysfunction is an important cause of morbidity and mortality following total correction of tetralogy of
Fallot (TOF). Transatrial/transpulmonary approach avoids ventriculotomy (as opposed to the transventricular approach) which gives maximum
protection of the right ventricle structure and function. Objectives: The main objective is to review the results of transatrial/transpulmonary
approach and compare it with that of the transventricular approach. Patients and Methods: Forty patients underwent repair of classical TOF
were retrospectively studied from January 1, 2015 to January 1, 2018 at Ibn Al‑Nafees Teaching Hospital for cardiothoracic surgery in Baghdad,
Iraq. We divided the patients into two groups: group A (transventricular approach group) – 22 patients, and Group B (transatrial/transpulmonary
approach group) – 18 patients. In this study, we did comparison between these two groups. Results: There were eight operative deaths; the overall
mortality was 20%, six patients in Group A (27.27%) versus two patients in Group B (11.11%). Severe right ventricular systolic dysfunction
after repair was found in 14 patients (35%), 11 patients in Group A (50%) versus 3 patients in Group B (16.66%). Tachyarrhythmias were seen in
18 patients after repair (45%); 13 patients in Group A (59.09%) versus 5 patients in Group B (27.7%). Conclusion: Transatrial/transpulmonary
approach procedure in the TOF surgery is more safe and associated with lower morbidity and mortality than the transventricular approach.

Background: Asthma control is very critical guide for therapy according to the current asthma guidelines. The asthma control test (ACT)
was successfully used to assess the control level. However, variation in clinical features which composite the items of the test does not
always associate with the extent of the structural changes in pulmonary airways. Thus, there is a necessity for the surrogate marker to
assess the control level. Eosinophilic and neutrophilic cells have an important role in the pathological process of asthma. Aims: The aim
of this study is to assess the sputum eosinophil and neutrophils as a discriminative marker between different levels of asthma control.
Patients and Methods: This cross‑sectional study included 88 asthmatic patients. Only 50 patients produced sputum. Demographic data,
ACT parameters took from patients. Spirometer test has been done. Sputum study includes processing of sputum, counting of sputum total
white cell were done. Results: According to sputum cells count and differentiation, 64% eosinophils, 10% neutrophils, 6% mixed and 20%
was paucigranulocytic (non). Eosinophilic phenotype patients were poorly control with a statistically significant difference. While neutrophilic
phenotype was nonstatistically significant difference. Conclusions: The most common type of asthma phenotyping is eosinophil which in
turn correlated with poor asthma control while other types like neutrophil are not correlated.

Background: Cytotoxic drugs often suppress the bone marrow’s ability to produce white blood cells which lead to the induction of
neutropenia and the risk of febrile neutropenia. Chemotherapy‑induced neutropenia (CIN) is major dose‑limiting toxicity of systemic
chemotherapy and it is associated with significant morbidity and mortality. Objective: Evaluating frequency and severity of CIN after
initial and subsequent chemotherapy cycles among non‑Hodgkin lymphoma (NHL) children undergoing similar chemotherapy regimens.
Patients and Methods: A prospective study performed in the Oncology Department of Child Central Teaching Hospital/Baghdad, between
August 1, 2012, and January 31, 2014, which included (59) patients <15 years, with newly diagnosed NHL who received similar chemotherapy
regimens of NHL. All patients were evaluated for the incidence of neutropenia after the initial or subsequent course of chemotherapy to
compare between CIN after first and subsequent chemotherapy cycles of similar regimens, that is,: COPADM1 versus COPADM2 and
COPADM3, “COPADM” regimen includes the following drugs (C: Cyclophosphamide, O: Oncovine, P: Prednisone, AD: Adriamycine, and
M: Methotrexate), each chemotherapy cycle was received every 21‑day interval. Results: Of a total 59 patients with NHL,55.9% of them were
male and 44.1% were female, who received initial (COPADM1) and subsequent (COPADM 2 and COPADM 3) chemotherapy cycles of NHL,
there is a significant increment in the risk of CIN after initial cycle “COPADM1” in comparison to other subsequent cycles of COPADM2
and COPADM3, “P = 0.01.” The patient characteristics (age group and gender) had no significant effect on the risk of CIN, there is a higher
percent of severe neutropenia and hospitalization with parenteral antibiotic use after the first COPADM cycle in comparison with subsequent
cycles but statistically not significant (P = 0.6 and 0.1, respectively). Conclusion: Frequency of CIN after the first chemotherapy cycle had
significantly higher than subsequent cycles, with lesser extent to neutropenic severity and neutropenia‑related hospitalization.

Background: Primary hypothyroidism can be defined as an increase in serum thyroid‑stimulating hormone (TSH) level, and the concentration
of free T3, free T4, T3, and T4 is low. Hypothyroidism is a prevalent disease mostly affecting middle‑aged women. One of the most important
determinants of glucose homeostasis is thyroid hormones. Hypothyroid patients have a higher prevalence of insulin resistance and tendency to
Type 2 diabetes mellitus than the normal individual. Objective: To investigate the correlation between TSH and hemoglobin A1c (HbA1C) in
patients with primary hypothyroidism; so, to study the effects of hypothyroidism on glucose metabolism. Subjects and Methods: Ninety‑five
Iraqi primary hypothyroidism patients and 40 healthy persons taken as control were selected from Specialized Centre for Endocrinology and
Diabetes during the period from June 2017 to January 2018. The patients were diagnosed previously as cases of primary hypothyroidism, and
they were on treatment and still on treatment. All patients were sent to investigate TSH, T4, T3, and HbA1c. The patients were subdivided
into three main groups: first is uncontrolled nondiabetic primary hypothyroid group (36 patients), second is controlled nondiabetic primary
hypothyroid group (43) and third is the diabetic primary hypothyroid group (16 patients). Results: A significant difference (P < 0.05) between
HbA1C% in both controlled and uncontrolled hypothyroid groups against the control group, but there is no significant difference (P = 0.08)
between the controlled and uncontrolled hypothyroid groups. The TSH relation with HbA1c was found to be significantly positive in the
uncontrolled hypothyroid and diabetic, hypothyroid groups (r = 0.401 and 0.58, respectively). Conclusions: Significant increment was found
in the level of HbA1c in hypothyroid patients, whether it is controlled or uncontrolled and a positive relationship was observed between TSH
and HbA1c% in the uncontrolled and diabetic hypothyroid groups. Diabetes augments the effects of hypothyroidism on HbA1c.

Background: Cerebral arteries have been identified with multiple anatomical variations, including a concomitant fenestration with
aneurysms, but no association is proven. Aim: to investigate non aneurysmal disorders associated with intracranial arterial fenestration.
Methods: A thorough and detailed analysis of the available literature from 1970 to 2020 in PubMed were contemplated to identify and
address all the disorders associated with arterial fenestration with exclusion of intracranial aneurysms. Results: While segmental vulnerability
may induce invisible anatomical histological and hemodynamic changes, cadaveric studies showed that the frequency of fenestration is
up to 40% higher than the clinical reports, and the cadaveric reports also showed a higher occurrence of such fenestrations as compared
to radiological studies. The vertebrobasilar system, the most common site of fenestration. Fused vertebrae and other vascular defects of
up to 7% are previously associated with the vertebral artery fenestration. Conclusion: intracranial fenestration is a critical anatomical
variant. Thus, A comprehensive angiographical examination can enhance overall prognosis in presurgical planning in association with
other vascular abnormalities.

Objective: The study was aimed to identify the risk factors for obstetrical brachial plexus palsy (OBPP). Patients and Methods: A retrospective
case–control study was designed. A comparison was performed between cases of brachial plexus paralysis (n = 32), with controls without
brachial plexus paralysis (n = 30) randomly selected from physical rehabilitation medicine examination. Statistical analysis was performed
using the SPSS Package. Results: Independent risk factors for brachial plexus paralysis were macrosomia (birth weight 4000 g; odds
ratio [OR] = 12.353; 95% confidence interval [CI] 2.510–60.802, P < 10−3), labor dystocia and instrumental vaginal delivery (forceps delivery
and vacuum extraction; OR = 8.8; 95% CI 2.743–28.234, P < 10−3), and prolonged pregnancy (OR = 1.28; 95% CI 1.066–1.538, P = 0.011);
however, vaginal breech delivery (breech presentation or extraction; OR = 3.231; 95% CI 0.598–17.456, P = 0.258), parity (OR = 2.545; 95%
CI 0.677–9.565, P = 0.206), shoulder dystocia (OR = 1.957; 95% CI 0.571–6.702, P = 0.367), and after cesarean section (OR = 1.103; 95% CI
0.987–1.234, P = 0.238) do not represent any risk factor. Conclusions: In our population (n = 62), macrosomia, labor dystocia, instrumental
vaginal delivery, and prolonged pregnancy were the significant risk factors for neonatal brachial plexus paralysis, while shoulder dystocia,
breech deliveries, parity, and cesarean section were not. Despite our small sample, we found three significant risk factors associated with OBPP.

The most serious dural sinus accident following traumatic brain injury is superior sagittal sinus (SSS) injury. It is usually resulted from
depressed skull fracture extends to the midline. We present a traumatic superior sagittal sinus injury triggered by the metal ceiling fan blade
with its surgical management. Injuries of the SSS have an increased mortality rate in head injured patients. Metallic ceiling‐fan head injury
differs from the classic traumatic brain injury concerning the presentation, radiology, management, and outcomes.

The much-awaited dream of many educationalists across India has finally turned into reality and we have shifted to the competency-based
curriculum for the undergraduates from the 2019 academic year. With close to 4 months into this transition and implementation, we have
realized a wide range of strengths-weaknesses-opportunities-challenges (SWOC) and it is the need of the hour to learn from the same and plan
our curriculum in such a manner that the execution of the same can be significantly improved in the coming years. Even though, challenges are
there, but it is important to understand and have a belief that all this has been done to improve the health care services offered to the general
population. In conclusion, the competency-based curriculum for undergraduate students has to be looked upon as an opportunity to produce
competent and globally acceptable doctors and thus it is high time that all the stakeholders accept this as a challenge and work in a concerted
manner to accomplish the intended goals.