Al-Kindy College Medical Journal

Traumatic Brain Injury (TBI) is still considered a worldwide leading cause of mortality and morbidity. Within the last decades, different modalities were used to assess severity and outcome including Glasgow Coma Scale (GCS), imaging modalities, and even genetic polymorphism, however, determining the prognosis of TBI victims is still challenging requiring the emerging of more accurate and more applicable tools to surrogate other old modalities

Purpose: to review in detail various aspects of odontogenic keratocyst, emphasizing recent nomenclature, clinical, histopathological, recurrence, and management of odontogenic keratocyst.

Methods: To achieve the objective of this review, a manual search was done in hard copy books of oral and maxillofacial pathology, and an electronic search was done in the google website, oral and maxillofacial pathology E-books, virtual database sites, such as PubMed, Research Gate, Academia, and Google scholar using the descriptors: odontogenic cyst, kerato odontogenic tumor, odontogenic keratocyst, and jaws cystic lesion. The eligibility criteria for selecting articles were: to be in the English language, studies published in journals, or indexed in these databases until 2021. Exclusion criteria were: articles in any languages other than English, studies presented in duplicate between the bases, whose theme did not contemplate the objective proposed in this review, or those not available in the digital environment. Data collection occurred from October to December 2020, followed by a thorough evaluation of the studies found, including an exploratory, selective, analytical, and interpretative reading.

Summary and conclusions: the odontogenic keratocyst is noteworthy because of its unusual growth pattern, the tendency to recur, and association with an inherited syndrome. The renaming of odontogenic keratocysts as keratocystic odontogenic tumors has been one of the most debatable changes in the terminology of odontogenic lesions in recent years. Early diagnose of this lesion is important to perform the more conservative treatment. A wait-and-see policy, with yearly follow-up for the first five years and every two years after that, is strongly advocated.

The pandemic of coronavirus disease 2019 (COVID-19), first reported in China, in December 2019 and since then the digestive tract involvement of COVID-19 has been progressively described. In this review, I summed recent studies, which have addressed the pathophysiology of COVID-19-induced gastrointestinal symptoms, their prevalence, and bowel pathological and radiological findings of infected patients. The effects of gut microbiota on SARS-CoV-2 and the challenges of nutritional therapy of the infected patients are depicted. Moreover, I provide a concise summary of the recommendations on the management of inflammatory bowel disease, colorectal cancer, and performing endoscopy in the COVID era. Finally, the COVID pancreatic relation was explored. Conclusions: digestive symptoms in COVID-19 patients can be the only manifestation and they may be correlated with worse clinical outcomes. The likelihood of fecal-oral transmission of COVID-19 has significant consequences and requires further research. A clear link may exist between the gut microbiome and COVID-19 progression and it may have a therapeutic and prognostic value. No evidence for an increased frequency of covid-19 cases in IBD and stopping immunosuppressive medications is not advised. Triage and risk assessment of patients with suspected or confirmed COVID-19 before endoscopy is essential; deferral of elective endoscopies should be considered.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is still a severe threaft for human health currently, and the researches about it is a focus topic worldwide.

Aim of the study: In this study, we will collect some laboratory results of the patients with coronavirus disease (COVID-19) to assess the function of liver, heart, kidney and even pancreas.

Subjects and Methods: Laboratory results of the patients with COVID-19 are collected. The biochemical indices are classified and used to assess the according function of liver, heart, kidney; meantime, and blood glucose is also observed and taken as an index to roughly evaluate pancreas.

Results: There were some indices exhibited abnormal. For patient 1, the ratio of albumin and globulin slightly was lower than the down-limit of reference range. For patient 2, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), creatine kinase (CK), creatinine kinase-MB isoenzyme (CK-MB), lactate dehydrogenase (LDH), alpha-hydroxybutyric dehydrogenase (HBDH), and beta-2 microglobulin (β2-MG) were respectively higher than the according upper limit of the reference range, while prealbumin (PA) was lower than the down limit. For patient 3, GGT, CK, PA were high than normal range. For patient 4, CK, LDH, HBDH were higher than the upper range.

Conclusion: Infection of SARS-Cov-2 could cause liver and heart injury, and it is suggested that clinicians and researchers should pay more attention on the prevention, treatment and causative mechanism of such an injury.

Background: The presence of cancer has a profound psychological impact on the quality of life of patients and their families, on family and social relationships, and on role functioning.

Aim of the study: Assess the impact of childhood cancer on patients and their families.

Subjects and methods: A Prospective questionnaire-based study, for 151 patients, had malignancy identified by tumor registry of Children Welfare Teaching Hospital. The information was taken from the parent(s) in the presence of the patient who sometimes answered some questions during the interview.

Result: There was an interview with 151 families of children with cancer in the outpatient clinic. Sixty-two (41%) patients have leukemia while 89 (59%) have solid tumors. Boys were more than girls. Regarding patients, the mean age at the time of the interview was 10.2 years, while the mean age at diagnosis was 7.1 years. The majority of the parents accepted the diagnosis (89.4%), the rest of the parents (10.6%) were skeptical and tried to re-evaluate the condition elsewhere. More than one-half of the parents started to have quick temper (54%) after diagnosis. Most of them had sleep difficulties (83.2%) after diagnosis. Neglection of other siblings in the family was reported in more than one-half of the interviewed families (52.1%). Most of the parents lost their emotional control (69.2%) with the surrounding people after knowing the diagnosis. After an initial period of treatment, there was a decrease in the social activity of the families in 42% of cases. There was a high concern of the parents about the patient’s future marriage (69%), conception (62%), and career (52%).

Conclusions: The establishment of a multidisciplinary cancer care team including social workers, teachers, psychologists, and others to support the child and family is seems to be mandatory during the whole period of treatment and thereafter.

Background: Corona virus disease 2019 (COVID-19) is a communicable disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified in December 2019 in Wuhan, China, and has since spread globally, leading to an ongoing pandemic.

Aim of study: to review the clinical, lab investigation and imaging techniques, in pediatric age group affected COVID-19 to help medical experts better understand and supply timely diagnosis and treatment.

Subjects and methods: this study is a retrospective descriptive clinical study. The medical records of patients were analyzed. Information’s recorded include demographic data, exposure history, symptoms, signs, laboratory findings, chest x- ray, and chest computed tomographic (CT) scans. Data were obtained with data collection forms from paper medical records.

Results: there were 76 COVID-19 pediatric patients, 46.1% of those patients were within the age group 6 -10 years. The female to male ratio was 1:1, and 92.1% of them were living within the urbane area. About 60.5% of patients were pupils. Seventy-one (93.4%) patients of them had no comorbidity. Twenty (26.3%) patients were asymptomatic. Regarding the duration of hospital stay, 39(51.31) patients had <7 days. All of the patients were nonsmokers. All patients had recovered and discharged from hospital after 2 negative real technique-polymerase chain reaction (RT-PCR) tests, no death was reported. Only 16(21.1%) patients had severe symptoms.

Conclusions: the most common symptoms were fever, Cough, Loss of appetite, Shortness of breath & Fatigue. There was a statistically significant association between white blood cells counts, neutrophil number, Chest X-Ray results, with case severity and a statistically significant association between form of treatment in patients who received Oxygen, Oseltamivir, Azithromycin, Paracetamol, Dexamethasone, and case severity.

Objective: to assess the predictive value of Doppler imaging of the uterine artery in the identification of early intrauterine abnormal pregnancy as compared to a normal intrauterine pregnancy.

Subjects and methods: one hundred and twenty pregnant ladies, at their 6-12 weeks of gestation, with a singleton pregnancy were included in this population-based case-control study. Thirty women with a missed miscarriage, 30 with hydatidiform mole, 30 with a blighted ovum, and 30 as a control group, without risk factors, underwent Doppler interrogation of the uterine arteries. Resistive index (RI), pulsatility index (PI), and the systolic/diastolic ratio (S/D) were measured for both sides. The t-test, or ANOVA test when appropriate, was used to analyze the relationship between the variables.

Results: there was a significant reduction of RI mean, PI mean, and S/D ratio among women with different types of abnormal pregnancy compared with the control group. RI and PI mean levels were significantly lower in women with hydatidiform mole and significantly higher in women with missed miscarriage. Lower left S/D mean level was significantly associated with hydatidiform mole and upper left S/D level was associated significantly with control women. For prediction of missed miscarriage; right and left uterine artery RI shows a sensitivity of 80%, 73.3%, a specificity of 68%, 71.1%, and the highest AUC was 0.78 for both.For prediction of molar pregnancy, right and left uterine artery RI showed a sensitivity of 63% for both, a specificity of 54.4%, 60%, and the highest AUC was 0.58, 0.61 respectively.

Conclusions: Uterine artery Doppler ultrasonography at 6-12 weeks of gestation is predictive for early pregnancy complications such as missed abortion, hydatidiform mole, and blighted ovum.

Background: The main objective was to compare the outcome of single layer interrupted extra-mucosal sutures with that of double layer suturing in the closure of colostomies.

Subjects and Methods: Sixty-seven patients with closure colostomy were assigned in a prospective randomized fashion into either single layer extra-mucosal anastomosis (Group A) or double layer anastomosis (Group B). Primary outcome measures included mean time taken for anastomosis, immediate postoperative complications, and mean duration of hospital stay. Secondary outcome measures assessed the postoperative return of bowel function, and the overall mean cost. Chi-square test and student t-test did the statistical analysis..

Results: Thirty-two patients were allocated to group A and 35 patients to group B. The mean time taken for anastomosis was significantly shorter in group A (23.25 ± 1.20 min in group A vs. 36.71 ± 1.93 min in group B; P<0.001). A significant shorter duration of hospital stay was seen in group A (7.00 ± 1.778 days in group A vs. 9.74 ± 1.990 days in group B; P<0.001). The detection of bowel sound was substantially quicker in group A as compared to group B (4.56 ± 0.50 days in group A vs. 6.46±0.50 days in group B; P<0.001). There was no significant discrepancy between the two groups regarding anastomotic leak rates (P= 0.543). The mean cost of double layer intestinal anastomosis method was significantly higher than that of single layer anastomosis (P<0.001).

Conclusions: The use of single layer extra-mucosal anastomosis of the intestine has the advantage of taking less time, less morbidity and cost-effective to perform with the same rate of anastomotic leak in the closure of colostomy.

Background: Most primary Health Care Centers (PHCCs) in Iraq have a referral system records; however, this mechanism does not function well because of the lack of other requirements for an efficient referral system.

Objective: To assess the practice & opinion of doctors in PHCs toward the referral system, and to determine the doctors in PHC's commitment to referral system instructions and guidelines.

Subjects and methods: A cross-sectional study with analytic elements was conducted in nine health directorates in Iraq, from the 1st October 2018 – 30th June 2019.One PHC was selected randomly form each sector in every governorate, A questionnaire was used to collect the required information. SPSS version 24 analysis was used for the statistical analysis.

Results: sixty-three doctors were working in PHCs had participated in the current study, the mean age (40.03 ±10.24), 58.7%were female, 46% were general practitioner, 30.2% of the participated doctors had 300 and less patient/month; 31.7% of doctors had ≤10 Patients referred/month, emergencies was the main cause for referral (46.03%), and 37(58.37%) of doctors announced that the referred-form not retrained to the PHC, and ever retrained-forms had no feedback 29(46%), 28(44%)of the participated doctors agreed that the current referral-system was effective and seven of them strongly agreed, 59(93.7%) believe in the importance of hospital-feedback, with a significant relationship between their attitude about the effective-current-referral system & Refer cases Percentage, while no significant-relation with their Patients examined/month. Loaded crowded and hospital doctors shortage as possible causes and suggest to referral-system activation especially the hospital -part".

Conclusions: there was inadequate knowledge of referral-policies and lack of coordination or/and clear feedback-expectations and PHCs-hospitals collaboration and lack of referral-system integrated within an electronic-health-record.

Background: Diabetes is defined by the World Health Organization as a metabolic disorder characterized by chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both. Families are co-regulating systems in which the stresses and strains of one family member affect the well-being of another member of the family. Caregivers of children with chronic illness report experiencing more parental stress than parents of healthy children.

Objective: A descriptive cross-sectional study had been conducted in four centers of endocrine diseases in Baghdad city and data was collected by using self-administered questionnaire regarding quality of life adapted from World Health Organization. The study was conducted on six hundred participants. Data analysis was done by using frequency, percentage and mean and analytical statistics using Chi Square test. P value less than 0.05 was considered statistically significant.

Results: The study showed that social domain had the highest mean score of (51.1) and that environmental domain had the lowest mean score of (38.9). The physical domain’s mean score was (40.2), while mean score of psychological domain was (46.2). The study reported that mothers of children with type 1 diabetes mellitus were more affected than fathers in physical, psychological and environmental domains. There was no difference between mothers and fathers in social domain of quality of life.

Conclusion: It was concluded from the study that parents of diabetic children had generally poor quality of life that merits further investigations.

Background: Body image is one of the most important psychological factors that affects adolescents’ personality and behavior. Body image can be defined as the person’s perceptions, thoughts, and feelings about his or her body.

Objectives: to identify the prevalence of body image concerns among secondary school students and its relation to different factors.

Subjects and methods: A cross-sectional study conducted in which 796 secondary school students participated and body shape concerns was investigated using the body shape questionnaire (BSQ-34).

Results: The prevalence of moderate/marked concern was (21.6%). Moderate/ marked body shape concern was significantly associated with unemployed fathers and mothers, low level of maternal education, lower socioeconomic status, concern with body weight or problematic eating, increased BMI, increased anxiety and depression.

Conclusions: The high prevalence of moderate/marked dissatisfaction with body shape and its possible relation to subsequent hazards such as eating disorders, depression, and anxiety should be of concern.

Background: Non-atherosclerotic spontaneous coronary artery dissection (SCAD) is defined as a non-traumatic and non-iatrogenic separation of the coronary arterial wall. SCAD is a highly uncommon cause of myocardial infarction (0.1 to 0.4 %).

Case presentation: 40-year-old African American woman, G1T1P0A0L2, with a past medical history of tobacco abuse and obesity who had uncomplicated cesarean section delivery for healthy twins two weeks prior presented with substernal, sudden onset chest pain. The pain radiated to left arm and back, pressure-like, and is associated with nausea, vomiting, and dyspnea.

On examination she was within normal limits except for a well-healed C-section wound. An electrocardiogram showed normal sinus rhythm with Nonspecific ST Abnormality. The first set of troponins less than 0.03, the second set shows troponins 0.18 and D-dimer 2340. The chest x-ray was unremarkable. An echocardiogram showed only mild to moderate mitral valve regurgitation. CT angiography of the chest showed no evidence of pulmonary embolism. She was started on a heparin drip and catheterization the next day showed no atherosclerotic coronary artery disease, but SCAD of inferior diagonal first branch noted. No intervention was done, heparin was stopped. The patient was started on aspirin, statin, Clopidogrel, Metoprolol, and Lisinopril per cardiology recommendation.

Conclusions: As an internist and primary care provider, we should keep Non-atherosclerotic SCAD in mind when a young female patient presents with acute chest pain. More studies are needed to find out the optimal management.

Current recommended conservative medical management includes long-term aspirin, beta blocker, and one year of clopidogrel, with the addition of a statin in patients with dyslipidemia.