Al-Kindy College Medical Journal

The first known use of the term conspiracy theory dated back to the nineteenth century. It is defined as a theory that explains an event or set of circumstances as the result of a secret plot by usually powerful conspirators. It is commonly used, but by no means limited to, extreme political groups. Since the emergence of COVID-19 as a global pandemic in December 2019, the conspiracy theory was present at all stages of the pandemic.

Background: Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), presents an extra challenge in the management of patients with cancer, given the increase in morbidity and mortality in having both conditions. Cancer patients are well known to have a high risk of VTE; particularly; those who have had major surgery, chemotherapy and/or hormonal therapy. These groups of patients need to understand the risk factors and the prophylactic measures to prevent developing VTE. This review aims to provide an overview of the literature on cancer patients’ understanding of VTE and their experiences of cancer-associated thrombosis (CAT).

Method: A scoping review was carried map the literature and explore the types of evidence available. A structured electronic search was conducted in Embase, Scopus and Medline in June 2020. All titles and abstracts from the search were evaluated independently by two reviewers and disagreements were resolved by a third arbitrator. Eligible papers were qualitative studies and reviews of adult patients' experience of cancer-associated thrombosis.

Results: Ten articles met the inclusion criteria, nine primary qualitative studies and one systematic review that explored cancer patients’ experiences of living with CAT. Participants had various cancer types. Most had advanced disease and were receiving palliative care. Four major themes emerged from the data: Lack of meaningful information on CAT, cancer patients unaware of signs and symptoms of VTE, limited awareness of CAT amongst HCPs and acceptability of anticoagulant.

Conclusion: All the studies explored patients’ experience of VTE in the cancer context, and all included studies showed that participants had limited information about VTE, VTE risk and VTEs’ signs and symptoms. However, no qualitative studies explored patients' understanding of VTE in prophylactic settings in high-risk cancer patients.

Cystic conditions of the jaw cause bony destruction and may cause resorption or displacement of adjacent teeth. Odontogenic cysts have developmental or inflammatory origins. To describe in detail the inflammatory odontogenic cysts, 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, PubMed, Research Gate, Academia, and Google scholar using the keywords "odontogenic cysts," "classification of the odontogenic cysts," "radicular cyst," "periapical cyst," "lateral inflammatory cyst," "residual cyst," "paradental cyst," "collateral inflammatory cyst," "treatment of inflammatory odontogenic cysts," and matching each odontogenic inflammatory cyst subtype with these words "gross description," "pathogenesis," "microscopical," clinical," "radiographical" appearance. Articles published till February 2021 were included in this review. In conclusion, an accurate diagnosis of an inflammatory odontogenic cyst requires information relative to its clinical, radiographical, macro- and microscopical findings. In many instances, two cysts that are classified differently may exhibit similar histopathological features. In such cases, clinical and radiographic findings are necessary to make a precise diagnosis.

Melatonin, a hormone synthesized mainly by the pineal gland, has been found in extra-pineal organs as well. It’s known as an organizer of circadian rhythms and more recently as an anti-oxidant. In addition to its role in maintaining immunity, pathophysiology of cardiovascular and neurological diseases, and as an anti-cancer agent, evidence has demonstrated that melatonin exerts a positive impact on male and female fertility primarily through oxygen scavenging effects. In In Vitro Fertilization (IVF) programs, supplementation of melatonin may be associated with better outcomes in terms of sperm quality, oocyte quality, embryo quality and pregnancy rates. This review summarizes various actions of melatonin on the body focusing on male and female fecundity.

Coronavirus: (COVID-19) is a recently discovered viral disease caused by a new strain of coronavirus.

The majority of patients with corona-virus infections will have a mild-moderate respiratory disease that recovers without special care. Most often, the elderly, and others with chronic medical conditions such as asthma, coronary disease, respiratory illness, and malignancy are seriously ill.

COVID-19 is spread mostly by salivary droplets or nasal secretions when an infected person coughs or sneezes.

COVID-19 causes severe acute respiratory illness (SARS-COV-2). The first incidence was recorded in Wuhan, China, in 2019. Since then it spreads leading to a pandemic.

The typical incubation time for COVID-19 infection is 2-14 days (normally 5). The common features include fever, cough, tiredness, difficulty in breathing, loss of smell or taste. Occasionally, signs are absent. COVID-19 complications include renal failure, syndrome of cytokine release, pneumonia, respiratory failure, lung fibrosis

Background: Client satisfaction with the immunization service is used to evaluate the quality of the admitted service and at the same time it affects the goodness of the health care outcome.

Objectives: This study assessed the satisfaction with immunization services offered to children and factors affecting this satisfaction.

Methods: Exit interviews for clients were conducted in Baghdad, Al-Karkh in a representative sample of primary health care centers to assess clients’ satisfaction with immunization services. Clients are companions of children encountered at study settings.

Results: Among the 253 respondent clients, 183 (72.3%) reflected satisfaction with the immunization services administered to their children at primary health care centers and 70 (27.7%) were dissatisfied. This satisfaction was significantly associated with younger age of clients (P < 0.05), clients who are mothers of the accompanied children (P < 0.05), and waiting no more than 30 minutes at the health facility to obtain immunization (P < 0.05). The major cause of dissatisfaction was the long waiting time before receiving the service.

Conclusion: Although the majority of clients are satisfied with immunization services; it is important to shorten the time consumed for vaccinating children at PHCCs in a way that gains more satisfied clients.

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: Physicians with higher certificates had more knowledge and attitude than other certificates; therefore, raising the awareness among family physicians about mental health services through making workshops, symposiums, more training courses is recommended.

Background: Infections are common in the children attending daycare centers how act as predisposes to it. Hygienic interventions have a fundamental role in infection control and disease prevention in child care settings.

Objective: - To evaluate the knowledge, attitude, and practice of nurseries workers in infection prevention and control among the children.

Subjects and Methods: A cross-sectional study using the researcher-developed questionnaire validated by two experts and piloted and 100 nurseries-workers had participated in it.

Result: the mean age of participants was 37.5 years±12.1, (37%) aged 18-30 yrs, 58% married, and 57% with higher education, 54% of nurseries the participant take care of 11-20 children. 67 (67%) had correct knowledge about infection control, (91%) had the corrected practice, but unfortunately, 47 (47%) had low-attitude. Education level has significantly associated with the knowledge, attitude, and practice of the child care workers.

Conclusion: the majority of the nurseries workers had good knowledge and correct practice and less about their attitude in infection prevention.

Background: Depression, a state of low mood and aversion to activity, can affect people's thoughts, behavior, tendencies, feelings, and sense of well-being. It can either be short-term or long-term, depending on the severity of the person's condition. Risk factors include personal or family history of depression, major life changes, trauma, stress, certain physical illnesses, and medications.

Objective: This study investigates the prevalence of depression among medical students at the University of Baghdad, college of medicine in Iraq, and the association between some variables and depression.

Subjects and Methods: A cross-sectional study design with a convenience sampling method was conducted. A sample of 323 medical students attending the University of Baghdad, college of medicine, were included in this study between July 2019 and September 2019, regardless of their age or gender. The study included five grades according to the year 2019-2020. An online survey was conducted using Google Forms which included two sections. Section 1 included questions about participants' demographics. The second section included the PHQ-9 (Patient Health Questionnaire-9) score.

Results: A total of 323 students of different demographics participated in this study. The number of males was 108 (33.4%), and the number of females was 215 (66.6%). The frequency of participants who got mild depression was the highest, i.e., 127 (39.3%), whereas 85 (26.3%) were non-depressed. Therefore, this study sample had a high prevalence of depression. On the other hand, the frequency of mild-moderate depression was 57.9%.

Conclusion: The prevalence of depression among medical students at the University of Baghdad was high. Gender, having friends, having a medical condition or disease, having family issues, whether it's easy to communicate with others, encountering an event that affected them, and having a family member who suffers from a psychological condition are associated with depression among students. In contrast, age, marital status, college year, seeking help in the past, and having a part-time job have no association with depression

Background

Respiratory tract aspergillosis is a pulmonary disease cause by aspergillus species which are opportunistic fungi that mainly infect immuno-compromised patients .

Objective(s)

The present study aimed to detect the frequency of pulmonary aspergillosis among clinically suspected and under follow up tuberculosis patients conducted at Tropical Diseases Teaching Hospital, Omdurman, Khartoum State , Sudan during the period from December 2019 to November 2020.

Materials and Methods

One hundred and fifty sputum samples were collected from suspected cases of pulmonary tuberculosis and under follow up tuberculosis patients. All specimens were examined using 20% KOH and cultured on two sets of Sabouraudʹs Dextrose agar slope media with chloramphenicol.

Results

Asperigillus species were isolated from 9/150 (6%) patients. They represented 5(3.3%) A.fumigatus, 3 (2%) A. niger and 1 (0.6%) A. Flavus. It was found that all Aspergillus isolates were revealed from Non acid fast bacilli (Non AFB) patients 9/137(6.6%) with the most common frequency among asymptomatic patients 3/35(8.6%) , patients who were under tuberculosis treatment (8.5%), those who were under Rifampicin (RIF) and Isonizide (INH) treatment (10%) and with duration of less than three month. Also the higher percentage (13%) was represented among the age group range from 61-80 year and slightly among males 6/97 (6.2 %) than females 3/53 (5.7%). There was statistically non-significant association between the frequency of aspergillosis and the studied variables in this study.

Conclusion

The frequency of pulmonary aspergillosis among patients with anti-tuberculosis treatment reflects the need for routine screening and diagnosis of those patients since the use of anti- tuberculosis treatment can promote the growth and reproduction of fungi.

This study aims to identify maternal death cases caused by Coronavirus infection 2019 pneumonia, including disease progression, fetal consequences, and the fatality cause.

Patients and methodology: A retrospective case collection of Iraqi pregnant women in their second and third trimesters diagnosed with COVID-19 pneumonia and died due to it.

The four cases were all of a young age, had a brief complaint period, and had no comorbidities. Fever, dyspnea, and fatigue were the most common symptoms. Hypoxia was present in all cases and was the cause of mortality in three cases, with thromboembolism being a potential cause in the fourth. Prelabour membrane breakup, fetal growth restriction, and fetal death are all examples of adverse fetal effects.

Conclusion: COVID-19 pneumonia induces substantial fetal and maternal mortality rates through pregnancy, which should be considered when treating these cases.

Pressure ulcer (now called Pressure injury) happens when the bony prominence like the sacrum exposes to pressure for a long period and also can cause soft tissue injury. In order to prevent and cure pressure-induced wounds, continuous and attentive repositioning is necessary. Wound management begins with the identification and aggressive management of the modifiable factors, such as positioning, incontinence, spasticity, diet, devices, and medical comorbidity, which contribute to pressure injury formation. Initial interventions include washing, cleaning, and maintaining the surfaces of the wound. In certain cases, it may be sufficient to debride the non-viable or contaminated tissue; however, operational care in more severe cases or to encourage patient satisfaction may be necessary. Our patient is a 50-year-old overweighted man, nonsmoker, and confined to a wheelchair presented with a 20*20*8 stages 4 ulcers in the sacral area after multiple failed bedside debridement. When we use the fasciocutaneous we should consider the depth of the wound and fill dead space. Here we the local situation in Palestine as those patients are usually neglected and their management is restricted to bedside debridement, with no experience in flap reconstruction operations which would dramatically improve patients’ lives. We believe that further awareness is demanded for such procedures.

In their cross-sectional study, Al-Rubaye et al studied the extent of vitamin D (VD) deficiency/ insufficiency, factors affecting its degree, and the adverse outcomes of the altered VD status among a group of mothers and their neonates from Baghdad, Iraq. They found that 96.6% of the mothers had VD deficiency/ insufficiency compared to 86.4% in their neonates. Maternal VD levels and neonatal weights were significantly correlated with neonatal VD levels. We believe that the study results need to be revised. This is based two points listed in this letter to editor