Al-Kindy College Medical Journal

Alopecia (Baldness) is very usual trouble in current time. It is accompanied by an intensive weakening of the scalp's hair and follows a specific pattern. Hereditary predisposition plays a very important role in alopecia despite not completely understood. Alopecia can be typed to various categories according to etiology, may be due to hereditary factors, autoimmune disease, and drugs or chemicals. There are many options of strategies of treatment according to the type and causes of alopecia. Chemical or synthetic medications apply for the management of hair loss are accompanied by a wide range of undesirable effects. Naturally occurring drugs also play important role in alopecia management with minimal side effects.

Background: Obesity tends to appear in modern societies and constitutes a significant public health problem with an increased risk of cardiovascular diseases.

Objective: This study aims to determine the agreement between actual and perceived body image in the general population.

Methods: A descriptive cross-sectional study design was conducted with a sample size of 300. The data were collected from eight major populated areas of Northern district of Karachi Sindh with a period of six months (10th January 2020 to 21st June 2020). The Figure rating questionnaire scale (FRS) was applied to collect the demographic data and perception about body weight. Body mass index (BMI) used for assessing the actual body weight status. Cohen's Kappa statistics were performed.

Results: Out of 300 participants, n=143 were males, and n=157 were females. In reality, according to BMI, 6 % were underweight, 47 % were average, 28 % were overweight, and 19 % were obese. According to perception, 8% of participants were underweight, 39 % were average, about 45% were overweight, and 8 % were obese. The mean score of real BMI was 25. 51±5.62 and figure rating score was 4.81±1.75. r value showed a strong positive relationship between both variables with a a P-value of <0.001. Cohen's Kappa score was 0.362. The rate of agreement between actual and perceived body weight status in the general population was 53.88%, and the disagreement rate was 46.12%

Conclusion: There was a weak agreement in the perception and realities of the self-image of people have the wrong impression about their body image.

Background: Immediate postpartum contraceptive and post abortion contraception methods are effective safe methods and are becoming a standard practice in many countries, yet it is not widely used in Iraq.

Aims: this study: is designed to assess the attitude and willingness of women to immediate contraception after giving birth or abortion and their satisfaction to previous use.

Methods and Material: Four hundred thirty-four women were surveyed in the labor word immediately after giving birth/ abortion. Their knowledge, attitude and contraception use were assessed according to the response they reported to a given questionnaire.

Results: women were not sure about the ideal time to begin using birth control post- partum.122 out of 434 (28%) have not heard about the immediate use of contraception before, only 97/434 (22.3%) reported a previous use of immediate contraception after previous birth / abortion. The satisfaction of the women to previous immediate contraception use was reported by 61/97 (77%) versus 7/97 (7%) who were not satisfied. High educated females with unstable income and women having more than five children depicted significantly higher willingness to immediate postpartum/ abortion contraception use (P=0.026, P<0.001, P=0.001) respectively. Similarly, a significant association was observed between positive attitude and pregnancy complications, including diabetes, bleeding and hypertension (P=0.001) and craving (P=0.003).

Conclusions: Iraqi women showed high willingness to immediate post-partum/abortion contraception use; nonetheless small proportion have actually used it. Poor knowledge of various contraceptive types, best time of use with less side effect are the main obstacles for family planning.

Background: percutaneous balloon dilation of corotation of aorta is a less invasive and alternative to surgical repair for patients with discrete coaction of aorta and although the used of balloon angioplasty in patients with recurrent postoperative coarctation gained a wide consensus, the use this technique for native coarctation is still controversial in children less one years.

Objective: to evaluate the immediate and late result of balloon dilation of native coarctation of aorta in infant and children.

Type of the study: A prospective study.

Subjects & Methods: The study was done on forty-five patients who were referred for cardiac catheterization and balloon angioplasty of native coarctation of the aorta at Ibn-AL-Bitar center for cardiac surgery between January 2015 to May 2016.Left heart catheterization was performed with evaluation of the morphology and pressure gradient across the stenotic segment of aorta. Follow up evaluations were done between 1 week and 18 months after discharge (mean 6 months) with transthoracic echocardiography.

Results: The age of patients range from 1month to 4 years (median age at time of procedure was12.3month). Associated lesions in 11 patients (24.4%). Immediate results were reduction in gradient from 42.5± 17.3 to 10.3± 8.2 mm Hg in forty-two patients (93.3%). Late result during follow up period, 29 patients (69%) had maintain gradient less than 20mmHg. Complications were reported in 6 patients (13.3%). there was one procedure related death (2.2%).

Conclusions: Balloon angioplasty for treatment of native coarctation of the aorta is effective with sustained benefit on long-term follow-up in infants and children >6 months. Transverse arch hypoplasia and children <6 months old has major effect on late outcome of recurrent coarctation of aorta.

Background: Multifactor affect the pathogenesis of thrombosis in solid malignancy; however, a significant role is attributed to the cancer cells ability to interact with and activate the host hemostatic system. [1]

Hemostasis is highly correlated to tumor growth, angiogenesis and metastasis, modulation of these pathways reflects interesting and promising treatment options in the future. [1]

Most patients with cancer frequently suffer from chronic compensated DIC and have abnormal laboratory coagulation tests without clinical manifestations of thrombosis, which is a subclinical hypercoagulable state that can be detected by varying degrees of activation of blood clotting. The results of laboratory tests in these patients reflect continuous fibrin formation and lysis during the course of malignancy. [1]

Aim of study: To study the effect of solid malignant tumors on blood coagulation via measurements of plasma fibrinogen and D-dimer.

Subjects and methods: Thirty patients (9 males and 21 females) attending the oncology consultatory out-patient clinic at Baghdad Teaching Hospital/ Medical City were randomly selected and included in this study.

These patients were newly diagnosed as having malignant solid tumors depending on histopathological reports from private and governmental sectors.

All the laboratory tests were done at the hematology and biochemistry departments of Teaching Laboratories/ Medical City.

Results: Plasma fibrinogen level was significantly higher in patients group rather than control group (3.863 ±0.706) Vs (2.497±0.457 g/L} respectively, (P-value 0.001).The mean value of factor VIII activity was {181% ±58.4)and (99.3% ±11.1)for patient and control groups respectively, the P-Value was significant ( > 0.001 ).D-dimer was negative for all members of control group, for patients group ( 66.7 %) of them showed positive D-dimer and (33.3)were negative for D-dimer ,P-value was significant ( >0.001 ). Conclusions: There was increase in plasma fibrinogen level and positive D-dimer in cancer patients compared to the control group reflecting subclinical thrombophilia and higher risk of VTE in patients with solid tumors due to activation of prothrombotic and fibrinolytic pathways by malignant cells which is vital for the use of primary prophylaxis by anticoagulants.

Background: Neonatal hyperbilirubinemia is a common disease in neonates especially in early days of birth that requires a good and successful treatment for reducing the severity and its complications that can produce important and irreversible effects.

Objectives: To evaluate the effectiveness of conventional phototherapy, intensive phototherapy and exchange transfusion on outcomes of neonatal jaundice at Fatima Al-Zahra Hospital for maternity and child care in Baghdad.

Patients & Methods: A retrospective study was carried out using medical records of neonates with diagnosis of unconjugated jaundice, admitted in the septic neonatal care unit of Fatima Al-Zahra hospital over 6 months period between 1st May till 31st October 2018. The total serum bilirubin, fractionations and blood group were done in all cases. They treated with conventional phototherapy, intensive phototherapy and exchange transfusion according to the severity of jaundice.

Results: Total neonates admitted from 1st may to 31st October 2018 in septic neonatal care unit were 1254, among them 432 (35%) were diagnosed as unconjugated neonatal jaundice “indirect hyperbilirubinemia”. Male: Female ratio (1.4:1), males 256(59.3%), females 176(40.7%). Physiological jaundice was the most common cause 129(29.9%) cases. Prematurity in 104(24.1%) and ABO incompatibility 59(13.7%) while Rh incompatibility 14(3.2%), sepsis 8(1.9%) and unknown causes of jaundice were 118(27.3%) because lack of lab facilities. Conventional phototherapy was the most common kind of treatment in 237(55%) while intensive phototherapy used in 175(40.3%) cases with successful reduction in T.S.B level and the rate of improvement without need for exchange transfusion (92%) (161/175).Only 20(4.5%) cases were treated with exchange transfusion especially for ABO incompatibility 8 (42.1%) cases and Rh incompatibility 4 (21.1%) cases. Most of neonates 429 (99.3%) discharged with complete improvement and only 2 (0.5%) neonates suffered from kernicterus and one death (0.2%).

Conclusion: Conventional phototherapy is still the standard treatment of mild to moderate indirect hyperbilirubinemia. Use of intensive phototherapy in the treatment of unconjugated neonatal hyperbilirubinemia is effective in reducing T.S.B level, need for exchange transfusion and hospital staying.

Recommendations: provide aseptic neonatal care unit in the hospital with further number of intensive phototherapy devices as it is so effective in treating unconjugated neonatal jaundice and reduces need for exchange transfusion as it is proven in the study.

Background: Helicobacter pylorus is one of the most harmful human pathogens & carcinogen. Of the world's population, more than 50% has H. pylori in their upper gastrointestinal tracts. It has been linked to a variety of extra gastric disorders. In correlation to hepatobiliary diseases; recently, the bacterium has been implicated as a risk factor for various diseases ranging from chronic cholecystitis and primary biliary sclerosing cholangitis to gall bladder cancer and primary hepatic carcinomas. However, the association between Helicobacter pylori (H. pylori) and gallbladder diseases is still vague and is controversial.

Aim of study: To elucidate the association of H pylori and gallbladder diseases (calculus, acalculous, polyp), the feasibility of using rapid urease test in post-operative diagnosis, and many factors related bacterium.

Subjects & methods: This case series study was conducted in Al-Kindy Teaching hospital - surgical unit during a period extended for 2 years from September 2016 to September 2018, where patients suffered from signs and symptoms of gallbladder disease were interviewed using a predesigned questionnaire including age, gender, occupation, residency and whether the drinking water was safe (purified) or not. Physical examination was done including weight status, BMI was calculated (BMI=wt. (kg)/ height (M) [2]. Provisional diagnosis of gallbladder disease was confirmed by examination, necessary laboratory investigations (Hematology, Biochemistry, and radiology).

Cholecystectomy was done by using Laparoscopic cholecystectomy or open surgery.

The presence of H.pylori in the mucosa of excised gallbladder was studied by using:

1) Rapid urease kit (HNAN C., LTD)

2) Histopathology & chemical analysis of associated gallstone

Results: Seventy-eight patients undergoing cholecystectomy for symptomatic gallbladder disease, the gallbladder mucosa of 30 patients were tested positive for H. pylori with any one of the tests used in this study. The rapid urease test was sensitive 57.1% and specific 58.3 % of the cholecystectomies performed in our study. The mean age of studied patients was (34 ± 4 years). Females constitute 73.1% (57 out of the total 78 of patients). Of the studied cases; 26 patients (33.3%) were obese. Employee patients constitute 43 (55.1%) of patients, and 53 patients (67.9%) lived in urban areas. Purified water consumed by 61 (78.2%) of the studied population.

Gallstones were detected in 56 (71.8%) of studied cases, acalculus chronically inflamed gallbladder was found in 20 (25.64%), and 2 cases (2.56%). were found to have gallbladder polyp. pylori infection was diagnosed in 30 (38.5%) of total cases (of the 56 calculus confirmed cases 48.2% were H.pylori positive, and of the 22 acalculus cases 13.6% H.pylori positive).

Conclusion:

Significant association is found between chronic calculus cholecystitis and H.pylori infection. While no significant association was found in correlation with acalculus cholecystitis and other gallbladder pathology. In regard to feasibility of using urease kit test, it is found that this test is sensitive 57.1%, and specific 58.3%, as such it is less accurate than histopathology study. Significant correlation was found between age, gender, weight status, and non-purified water source with H.pylori infection..

Background: Nasal obstruction is common in otorhinolaryngology outpatient visitors. The diagnosis of such compliant is by history, clinical examination and diagnostic procedures. Nasal endoscopy and computerized tomography scan are common diagnostic investigations. Nasal obstruction is either anterior or posterior (nasal septal deviations, hypertrophied turbinate pathological cyst, polyps, mass etc), or postnasal obstruction (hypertrophied turbinate, adenoid hypertrophy, nasopharyngeal cyst or nasopharyngeal tumors).

Aim of study: Prospective study to compare endoscopic finding and computerized tomography of nose, paranasal sinuses and postnasal space as diagnostic methods for nasal obstruction and other nose, paranasal sinuses and post nasal space diseases.

Subjects and methods: 80 patients with nasal obstruction between the age of 12-60 years old.All patient were examined by nasal endoscopy (rigid or flexible) under local anaesthesia (10 % xylocaine spray and cotton wicks soaked with ephidren 0.5 % and xylocaine 2 % ) and nose, paranasal sinuses and post nasal space C.T. scan,weather without contrast or with it, bone window or soft tissue according to the lesion.

Results: Both nasal endoscopy and C.T. scan were an important tools for diagnosis of nasal diseases and complementary to each other.

Conclusion: Endoscopic examination of the nose gives a real view of nasal structures, postnasal space, any mass or polyps present.Computerized tomography is an accurate diagnostic method of the Nose, paranasal sinuses and post nasal spaces anatomical variations or pathologies.

Background: Shock is a common clinical state, we face chocked patients in causality, surgical and gynecological specialties like stab wounds, road traffic accidents, placenta preavia, placenta accrete, placenta pericreta, ectopic pregnancy, perforated viscus etc. All such patients undergo surgical exploration and majority of them are shifted to ICU to complete monitoring and support. High percent of them they develop acute kidney injury intra and postoperatively and carry high mortality rate because of not so good nursing care in ICU in Iraq.

Objective: to clarify that Furosemide can protect kidney function during shock and reduce ICU admission and mortality rate.

Method: 100 shocked patient were enrolled in this study which was done in medical city hospital, Al-Sadder General hospital and Alkindi teaching hospital in Iraq/Baghdad from January 2019 to June 2020. Patients were divided into 2 groups: group SN this include 50 patient who received 2 ml normal saline as placebo(control group)and second group SL which include 50 patient who received 2 ml (20 mg) furosemide (study group). This trial was double blind study, both the patient and the junior anesthesia doctor do not know about the study conducted. patients below age of 14 years were excluded from the study. 98 patients of those 100 patients were involved in multiple stab wound injury, multiple bullet injury and road traffic accident and only 2 patients were diagnosed as ectopic pregnancy.

Result: ICU admission and mortality rate was less in patients receiving furosemide compared to patients received placebo (2% and 14% versus 1%and 7%respectively).

Conclusion: furosemide reduces ICU admission and mortality rate in shocked patients.

Background: Prostatic adenocarcinoma is the most widely recognized malignancy in men and the second cause of cancer-related mortality encountered in male patients after lung cancer.

Aim of the study: To assess the diagnostic value of diffusion weighted imaging (DWI) and its quantitative measurement, apparent diffusion coefficient (ADC), in the identification and localization of prostatic cancer compared with T2 weighted image sequence (T2WI).

Type of the study: a prospective analytic study

Patients and methods: forty-one male patients with suspected prostatic cancer were examined by pelvic MRI at the MRI department of the Oncology Teaching Hospital/Medical City in Baghdad from September 2017 to September 2018. Thin sections axial T2 and DWI sequences were performed for each patient. Two patients were excluded from the study due to poor image quality (motion artefact). Regions with hypointense signal on T2WI and/or restricted lesion in DWI were determined. The ADC values were measured and the results were registered and sent for biopsy correlation. The sensitivity, specifity, accuracy and other parameters were calculated for T2WI and DWI.

Results: The sensitivity and specifity of T2WI in the detection of prostate cancer was about 76.6% and 77% respectively. These improved to 96% and 88.8% by performing the DWI and measuring the ADC value. The mean ADC value was greatly lower in prostatic cancer (about 650x 10-6 mm2 /s) than in normal prostate parenchyma (about 1250 x10-6 mm2 /s) with significant difference between them (p value about 0.04)

Conclusion: In practice, using diffusion weighted MRI sequence and its ADC quantitative measurement greatly increases tumor detection in patients suspicious to have prostatic cancer and should be routinely used when doing pelvic MRI for patients with high clinical suspicion.