Al-Kindy College Medical Journal

It is well- known that the distinguished scholastic journal is a crucial cornerstone, which contributes to the scientific integrity of a particular academic institution. The establishment of the Al-Kindy College of Medicine (AKCM), University of Baghdad, in 1998 urged the need to issue Al-Kindy College Medical Journal (KCMJ).

Prostate cancer is the commonest male cancer and the second leading cause of cancer-related death in men. Over many decades, prostate cancer detection represented a continuous challenge to urologists. Although all urologists and pathologists agree that tissue diagnosis is essential especially before commencing active surgical or radiation treatment, the best way to obtain the biopsy was always the big hurdle. The heterogenicity of the tumor pathology is very well seen in its radiological appearance. Ultrasound has been proven to be of limited sensitivity and specificity in detecting prostate cancer. However, it was the only available targeting technique for years and was used to guide biopsy needle passed transrectally or transperineally. Magnetic Resonance Imaging (MRI) has revolutionized the process with the advent of its multiparametric imaging (mp MRI) where the prostate is evaluated by different MRI techniques and the likelihood of the detected lesion is scored using the new prostate imaging-reporting and data system (PIRADS) scoring. Despite the improved detection of clinically significant prostate cancer by mpMRI, the ideal way to target the area of suspicion detected by mpMRI is the next level of challenge. In this review article, we will discuss the recent methods of targeting and focus on the different platforms used to integrate the mpMRI static images with the real-time US scanning in what is called (US-MRI fusion techniques)

Since the COVID-19 pandemic alarm was made by the severe acute respiratory syndrome (SARS)-coronavirus (CoV) 2, several institutions and agencies have pursued to clarify the viral virulence and infectivity. The fast propagation of this virus leads to an unprecedented rise in the number of cases worldwide. COVID-19 virus is exceptionally contagious that spreads through droplets, respiratory secretions, and direct contact. The enveloped, single-stranded RNA virus has a specific envelop region called (S) region encoding (S protein) that specifically binds to the host cell receptor. Viral infection requires receptors\' participation on the host cell membrane\'s surface, a key- step for the viral invasion of susceptible cells.

Recently, the Italian alpha 1 antitrypsin Registry results showed a close geographic distribution of positive cases like the one recorded for SARS -CoV-2 infection. AAT deficient patients presented with the highest infection rates. They were giving attention to alpha 1 antitrypsin AAT\'s role in COVID-19 infection. Alpha 1 antitrypsin deficiency (AATD) is undoubtedly the most common genetic condition in adults. AATD is characterized by decreased serum levels or impaired AAT action, raising the risk of developing many diseases, particularly pulmonary emphysema cirrhosis of the liver. This review will discuss the main immunological properties that AAT has as a protective agent against the infection and possible therapeutic application.

Background: The study was designed for the assessment of the knowledge of medical students regarding pandemics. In the current designed study, the level of awareness was checked and the majority of students were found aware of SARS-CoV and SARS-Cov2 (Covid-19).

Objective: To assess the awareness of SARS-CoV and SARS-Cov2 (Covid-19) among medical students of Pakistan.

Subjects and Methods: A cross-sectional survey was carried out in different universities of Pakistan from May to August 2020. A self-constructed questionnaire by Pursuing the clinical and community administration of COVID-19 given by the National Health Commission of the People's Republic of China was used among the 831 students who are enrolled in different medical universities of Pakistan and SPSS version 23 was used to analyze the data.

Results: The majority (n=440, 52.9%) were male, (n=525, 63.2%) having age between 18 to 23years and (n=682, 82.1%) were unmarried. In educational status (n=501, 60.3%) were undergraduate and (n=214, 25.8%) were students of MBBS. After checking the residential status (n=343, 41.3%) were the permanent residents of Balochistan province. During the assessment of awareness towards Covid-19 results showed that (n=801, 96.4%) were aware regarding Covid-19.

Conclusion: This study finalized that the students enrolled in different medical universities of Pakistan were aware of the Covid-19. The observed awareness can be due to qualitative education especially in the domain of disease prevention, which has been provided by the educational institutions of Pakistan in collaboration with the Ministry of Health. Keywords: Awareness, Covid-19, Medical students, Pakistan.

Background: Mental health is integrated into PHC as a strategy of WHO to fill the gap in mental health treatment. Part of this strategy needs a level of task shifting so that mental health care is provided by different level of PHC workers and not only specialists such as psychiatrists and psychologists.

Objectives: To assess the knowledge and attitudes of family doctors regarding the provision of psychological health in PHCC and if there is an association between the certificates of these family doctors and their Knowledge and attitudes to psychological health.

Subjects and Methods: A cross-sectional descriptive study with analytic elements was conducted in 8 family health care centers in Baghdad city/Al-Karkh. Data was collected via questionnaire form which consists of three domains: Domain one includes sociodemographic data, domain two was about knowledge and consists of (7) questions and domain three consisted of (12) questions about the attitude of physicians regarding mental health. A convenient sample of (83) family health care physicians were included in the current study.

Results: The mean age of participants was 42 years (range: 27 – 53). The results revealed that 22.9% of participants were male, 77.1% were female. The percentage of mental illness seen by the physicians daily in the health care center was (15.7%). Physicians with higher degree certificates obtained higher knowledge scores in comparison to residents or practitioners as well as the females reported a significantly higher score of knowledge in comparison to males. Moreover, higher scores of positive attitudes were found.

Conclusion: Family Physicians with higher certificates have more knowledge and attitude than other certificates.

Background: Laparoscopic cholecystectomy (LC) has become the standard treatment for symptomatic cholelithiasis. Bile duct injury and accidental gallbladder perforation with spillage of bile and stone are common complications of LC. This study was carried out to assess the early complications of gallbladder perforation during LC, and identify the risk factor of that perforation.

Objectives: to evaluate the early complications which may occur after the perforation of the gallbladder during laparoscopic cholecystectomy and to determine the risk factors which are associated with the perforation of the gall bladder.

Subjects and methods: A prospective comparative study on 192 patients who underwent LC between August 2012 to January 2014 in Baghdad teaching hospital. Data were collected, Patients with and without gallbladder perforation were compared in terms of gender, age, anatomic difficulty, the experience of the surgeon, omental and other organ adhesions to the gall bladder.

Results: fifty-five patients had a perforation of GB during LC, 46 patients had GB perforated during dissection of gallbladder bed from hepatic fossa. The mean operative time and duration of postoperative hospitalization were longer in the perforated group, perforation occurs more frequently in acute cholecystitis compared to chronic cholecystitis. There were significant risk factors related to gallbladder perforation which include male gender, AC, adhesion around the gallbladder, and experience of the surgeon.

Conclusion: accidental gallbladder perforation leading to longer operative and hospital time which loss the advantage of LC. The male gender, AC, and experience of the surgeon had the main risk factors of the perforated gallbladder.

Background: the coronavirus leads to upper respiratory tract-associated manifestations like nasal congestion, sore throat, and smell disorder

Objectives: To reveal the impact of COVID-19 pandemic on otolaryngology symptoms using our daily medical practice.

Subject and Methods: A cross-sectional study that was carried on in the isolation wards at Al-Kindy and Al-Nu’man Teaching Hospitals during three months from the 1st of Jun. till the end of Aug. 2020. It included 1270 patients who were diagnosed with COVID-19 infection seen in the ENT consultation clinic and admitted to the isolation wards.

Results: Otolaryngological manifestations were shown as 15.7% complained of sore throat, the headache was presented in 11%. Non-otolaryngological manifestations were more common than otolaryngological manifestations as fever presented in 63% of cases and cough in 56.1%.

Conclusion: Otolaryngological symptoms are not uncommon but less than fever or cough. Otolaryngological manifestation with a history of contact with COVID-19 patients should be considered in the diagnosis.

Background: Vitamin D deficiency/ insufficiency is common in different age groups in both genders especially among pregnant women and neonates where it is associated with several adverse outcomes including preeclampsia and preterm delivery.

Objectives: To assess the extent of vitamin D deficiency/ insufficiency among mothers and their neonates and some factors related to it and identify some adverse outcomes of the deficiency/ insufficiency on neonates (preterm birth and low birth weight).

Subject and Methods: A cross-sectional study was conducted on 88 Iraqi pregnant women and neonates admitted to “Al-Elwiya teaching hospital for maternity” in Baghdad- Al-Rusafah from 1st of June 2019 to 31st of August 2019. Data about maternal age, mode of delivery, sex, weight, and gestational age were obtained. Vitamin D levels of mothers and their neonates were measured by Enzyme-Linked Immunosorbent Assay (ELISA).

Results: In a total of 88 mothers and neonates, 96.6% of mothers had Vitamin D deficiency/ insufficiency compared to (86.4%) of neonates. There was a statistically significant difference between maternal and neonatal vitamin D levels. Neonatal Vitamin D levels were positively correlated with maternal vitamin D levels. Neonatal weight was positively correlated with maternal Vitamin D levels. The mean maternal and neonatal vitamin D levels were (12.16 ng/ml ± 7.06) and (20.25 ng/ml ± 10.97) respectively.

Conclusions: Vitamin D deficiency/ insufficiency was prevalent among mothers and neonates; with a higher prevalence among mothers. Maternal Vitamin D levels and neonatal weights were associated with neonatal Vitamin D levels.

Background: The clinical examination is one of the best suitable methods for diagnosis of low backache. Backache is one disease that the signs, clinical examination finding, and the results on imaging modalities not always related. The straight leg raising (SLR) and slump tests, can be used for diagnosis of lumber disc herniation.

Objectives: To compare the result of the slump test and SLR test in the diagnosis of lumber disc herniation.

Subjects and Methods: A prospective comparative study conducts on 280 patients in Al-Kindy teaching and private clinics complaints of backache, aging between 18-70 years old with acute or recurrent backache, sciatica pain, or low back and sciatica pain for last 12 weeks, while patients with spinal surgery, sacroiliac joints pain, cervical dysfunction and hip and knee pathology, and chronic illness were excluded.

MRI of the lumbar region was done and clinically examine first by SLR test then Slump test on the next days by separated author. All the record collected patient’s data are interpreted with the MRI finding by the third doctor.

Results: The Slump test is significant than the SLR in the patients with disc herniation at L4-L5 and (L4-5 &L5S1) 93.1% versus 70%, while for L5S1 level no significant in both tests. Leg pain present in 74.1 %, low back and leg pain in 21.5%, and only 4.4% present with low back only.

Conclusion: The Slump test is more sensitive than the SLR test in diagnosis of lumber disc herniation.

Background: The appointment system is a common practice in primary health care clinics in developed countries. The patients and health care providers in the primary health care setting perceived the appointment system as an indicator of good quality service.

Objective: The aim of this study was to survey patients’ and health care providers’ attitudes towards the introduction of an appointment system and their satisfaction with the existing ‘walk-in’ system in the primary health care setting.

Subjects and Methods: A questionnaire survey was conducted included a convenient sample of 234 patients as well as 76 health care providers from two primary health care centers in Al-Karkh district, Baghdad governorate. The study used two separate questionnaires, for patients and staff.

Results: Approximately half of the patients (51.7%) and the majority of the health care providers (85.5%) agreed on the introduction of the appointment system. The employee’s patients, highly educated patients, and patients with chronic illness showed a significant agreement to this idea. Most participants, patients, and providers agreed that reduction of workload, provision of quality care to the patient, and improvement of patient-provider relationship are the most important advantages of the application of an appointment system. While the lack of flexibility of this system was the main perceived disadvantage.

Conclusion: Respondents showed great acceptance to the idea of introduction of the appointment system to be run concurrently with the existing walk-in system (mixed system) in the primary care setting in Iraq, and they preferred this system to be flexible and responsive to the needs and preferences of the patients as well as health care providers.