Al-Kindy College Medical Journal

The knowledge of transferring body organs or tissues appears in the ancient mythology of Roman, Greek, Indian, Chinese, and Egyptian civilizations. The stories of organ transplants performed by GODs and health care’s using organs from cadaveric and after that transplantation change from lore to medical training

There is a global shortage of health care providers needed to address all levels of primary and specialty care. The recent COVID-19 pandemic also highlights the importance and added value of health professionals with specialty training in infectious diseases. In the United States, advanced practice providers (APPs) are being engaged to meet the expanding demand for generalist and specialist patient care. The history and development of advanced practice registered nurses (APRNs) and physician assistants (PAs), are discussed as collaborative healthcare providers to promote better understanding of the ways they can be incorporated into a healthcare system. An example of how APPs are utilized to provide both inpatient and outpatient care of persons with infectious diseases is illustrated at our midwestern United States regional medical center. Especially relevant for regions of the world where both nurses and physicians are in short supply, this paper identifies ways that healthcare leaders can support, develop and strategically utilize APPs to provide critically necessary functions and achieve excellent outcomes. Challenges to future healthcare administration are articulated and compared with World Health Organization roadmap objectives for nursing that can be expanded to better utilize all APPS as valuable healthcare professionals.

Background: The risk of antibiotics resistance (AR) increases due to excessive of antibiotics either by health care provider or by the patients.

Objective: The assessment of the self-medication Practice of over the counter drugs and other prescription drugs and its associated risk factor.

Subjects and Methods: Study design: A descriptive study was conducted from “20th December 2019 to 08th January 2021”. A pre validated and structured questionnaire in English and Urdu language was created to avoid language barrier including personal detail, reasons and source and knowledge about over the counter drugs and Antibiotics. Sample of the study was randomly selected. Data was analyzed by software SPSS version 22.

Results: Out of n=3388 respondents, the prevalence of self -medication practice of OTC drugs and antibiotics as self – medication practice in all of the respondents is 88% and 85.9% respectively. Knowledge of the respondents about the use of the antibiotics as well as side effects of antibiotics was 40.7% and 15.3% respectively. Headache, fever, cough and stomach problem were the minor ailments for which majority of OTC drugs and antibiotics used respectively. The commonly used OTC drugs and OPDEA were Paracetamol and Omeprazole. The commonly used antibiotics were Metronidazole, Amoxicillin and Clavulanic acid and Ciprofloxacin.

Conclusion: Government should make policies to train pharmacist in the community for antibiotics stewardship and standard treatment guidelines through educational workshops. Our future study will be on how to minimize antimicrobial resistance in the developing countries
Conclusion: Government should make policies to train pharmacist in the community for antibiotics stewardship and standard treatment guidelines through educational workshops. Our future study will be on how to minimize antimicrobial resistance in the developing countries.

Background: L. sativum, are traditionally used for the treatment of various diseases and thought to have medicinal value. Isolates from many part of the world is now multidrug resistant. Therefore, there is an urgent need to look for and test an alternative herbal drug.

Objective: The present study aimed to evaluate the antibacterial activity of L. Sativum seed extract against multi drug resistant (MDR) and sensitive Pseudomonas aeruginosa clinical isolates.

Subjects and Methods: An ethanolic and aqueous stock extracts were prepared from L. sativum seed plant then serial dilutions were prepared and the obtained concentrations (50, 25, 12.5 and 6.2 mg/ml) were tested against 30 multidrug-resistant and 35 sensitive clinical isolates of Pseudomonas aeruginosa using wells diffusion method.

Results: It was found that L. sativum seed extracts had antimicrobial activity against MDR and sensitive isolates at different concentrations of 100, 50 and 25 according to the mean ± SD (standard deviation) of the maximum zones of inhibition. The total number of isolates that were sensitive to both extracts were 49/130 (37%) which represented 17/60 (28.3%) MDR and 32/70 (45.7%) sensitive isolates. The aqueous extract exhibited more inhibitory effect than ethanolic extract 43 (66%) vs. 6 (9%) against the examined isolates (n=65).

Conclusion: The study concluded that the L. sativum extracts had an antibacterial activity against the susceptible and MDR isolates which may enable it to be used an alternative treatment for medicinal purposes.

Background: This study aimed to evaluate the outcome of long-term results of dacryocystorhinostomy (DCR) techniques in specialized eye care center in Iraq.

Subjects and Method: This is a prospective study of 650 patients from July 2014 to July 2019 with nasolacrimal duct obstruction in Ibn Al Haitham Eye Teaching Hospital. A preoperative questionnaire was done, then one month, three months, six months and one year postoperatively. The success of surgery defined as follow; Absence of epiphora completely, Resolve of dacryocele or mucocele or any new attack of daryocystitis, Appearance of fluorescein dye from nose in fluorescein disappearance test, Successful irrigation of nasolacrimal duct which is proofed endoscopically. The three types of surgery (External, Endoscopic and Transcanalicular Laser DCR) were discussed to the patient then preferred one is chosen. The results and complication were recorded.

Results: A total of 650 patients were included in this study, all were operated by same surgeon. The mean age of patients for external, endoscopic and Transcanalicular laser DCR (T-DCR) were 57, 44 and 51 years old respectively. The female patients were more than the male patients in all types of DCR surgeries and they represent 73.84% of total patients of external DCR (ext-DCR), 78.28% in endoscopic DCR (endo-DCR) and 55.15% in TCL-DCR. A satisfied patient to outcome according to surgery type was 91.20% with ext-DCR, 88.70% with endo-DCR and 51% with TCL-DCR.
Conclusion: The most satisfied techniques to patients with higher success rate are the ext-DCR and endo-DCR while the TCL-DCR is still evolving with limit indications and lower success rate.

Background: Selenium-73 with half- life of 7.15 hour emits β+ in nature and has six stable isotopes which are ( 74Se,76Se,77Se,78Se,80Se and 82Se ). Selenium-73 has many applications in technology and radioselenium compounds of metallic have found various applications in medicine.

Objective: To make a comparison between different reactions that produced cross sections of Se-73 radioisotopes.

Subjects and methods: The feasibility of the production of Selenium -73 via various nuclear reactions was investigated. Excitation functions of 73Se production by the reactions of 75As (p,3n), 169Tm( d,x), 74Se, natSe, natBr (p,x) , 75As (d,4n), natGe (3He,x), 70Ge (α, n), and 72Ge (α, 3n) and neutron capture were calculated using the available data in the international libraries in accordance with SRIM code . Theoretical calculations of the thick target integral yields were deduced using the calculated cross sections by using Matlab program

Results: When proton induced reaction on 75As, 74Se, natSe and natBr to obtain 73Se, the reaction 75As(p,3n) with range of energy (22.5 to 45.5 MeV) and the maximum cross section is 315 mb at 36.5 MeV gives maximum yield (2*106 GBq/C).while for the reaction 75As (d,4n) 73Se with range of energy (25 to 56 MeV) , and maximum cross sections is 30 mb at 43MeV gives (0.085*106 GBq/C).

The three reactions natGe (3He,x) , 70Ge (α,n) and 72Ge (α,3n) show that the best reaction to obtain 73Se is 72Ge (α,3n) within the range of energy (27 to 46 MeV) and maximum cross sections 494 mb at 42MeV give the maximum yield (0.03*106 GBq/C).

Conclusion: the use of proton as projectile is best compared with other particles in order to get maximum isotopes production yield of 73Se.

Background: Although mammography is a powerful screening tool in detection of early breast cancer, it is imperfect, particularly for women with dense breast, which have a higher risk to develop cancer and decrease the sensitivity of mammogram, Automated breast ultrasound is a recently introduced ultrasonography technique, developed with the purpose to standardize breast ultrasonography and overcome some limitations of handheld ultrasound, this study aims to evaluate the diagnostic efficacy of Automated breast ultrasound and compare it with handheld ultrasound in the detection and characterization of breast lesions in women with dense breasts.

Objectives: To evaluate the diagnostic efficacy of Automated breast ultrasound and compare it with hand held ultrasound in detection and characterization of breast lesions in women with dense breast.

Subjects and Methods: A prospective observational study conducted at Oncology Teaching Hospital during the period of ten months from 1st of February till 1st of December 2020. Included 62 women with dense breasts on diagnostic mammograms. All women underwent technician performed automated breast ultrasound and radiologist performed handheld ultrasound for both breasts. All suspicious lesions with selected probably benign lesions underwent biopsy, handheld ultrasound detected 48 masses (67.6%), 15 of them (21.1%) were cystic, automated breast ultrasound detected 54 masses (76.1%); 20 of them (28.2%) were cystic. The sensitivity of handheld ultrasound was=87.5%, Specificity=58.8%, the sensitivity of automated breast ultrasound was=93.8%, Specificity=70.6%.

Conclusion: Automated breast ultrasound is an effective modality to detect occult breast lesion in women with dense breasts, automated breast ultrasound and handheld ultrasound have a reliable agreement in detection and characterization of breast lesions with higher accuracy of automated breast ultrasound in the evaluation of malignant lesions.

Objective: to assess the awareness and knowledge of our medical students regarding dose levels of imaging procedures and radiation safety issues, and to conclude how the curriculum of clinical radiology in the college medical program impacts such knowledge.

Subjects and methods: this is a cross-sectional study conducted among 150 medical students in Alkindy College of Medicine between January 2021 to July 2021, regardless of their age or gender. The study included six grades according to the year 2020-2021. A questionnaire consisting of 12 multiple-choice questions was conducted via an online survey using Google Forms. The questions were divided into two parts (awareness concerning issues of radiation protection, and information about dose levels of frequent radiological investigations).

Results: Regarding their radiology knowledge, about one-third of all participants rated as average. Students who had not established training in radiology chose the inappropriate choice more often than individuals who had received training. Also, students without instruction/ teaching in diagnostic clinical radiology were more likely to connect MRI and ultrasound with an increased cancer possibility compared with those students receiving radiology teaching. About the desired educational method, 32% wanted a tutorial or workshops, 29% wanted a learning module, 25% chose a case study and 14% chose a lecture.

Conclusion: With increasing years in medical school, the student’s alertness demonstrates better performance regarding the radiation exposures in imaging diagnosis. The greater part of medical students has inadequate knowledge about different aspects of radiation sources, hazard, and their safety. We think that adding more theoretical and practical programs to the educational radiology curriculum will advance awareness of radiation safety and increase knowledge among medical students regarding the doses of radiological examinations.

Background: Clubfoot, or talipes equinovarus, is a congenital deformity that consist of; supination and adduction of the forefoot and midfoot; equinus of hindfoot and varus. It was found that more than 100,000 babies are born each year with congenital clubfoot

Objectives: The purpose of this study was to investigate the complications of ponseti method for treatment of children with idiopathic club foot.

Subjects and Methods: 50 children with 74 clubfeet were managed by Ponseti method from May 2019 to July 2020 in Al-Wasity teaching hospital with primary correction of the deformity followed sometimes by elongation of Achilles tendon then the patients were followed up till June 2021 and the complications were calculated.

Results: complications were 10.8% incomplete correction (mostly equinus) and it was corrected by surgery, 6.7% ulcer on the medial surface of head of 1st metatarsal , 9.4% cast falling and 18.9% relapse.

Conclusions: Ponseti technique is a safe and effective method for correction of clubfoot and decreases the need for corrective surgery with minimal complications that can be easily managed.

Background: During the pandemic, Corona virus forced many people, especially students, to spend more time than before on the computer and smartphone to study and communicate. The poor posture of the body may have worse effect on its body parts , most of which is the cervical spine (forward head posture).

Objective: To assess the incidence of neck pain and the associated factors among undergraduate medical students related to position during E learning

Subjects and Methods: Cross-sectional study was conducted among medical students in three Iraqi universities during 2021. The sample size was 152. Online questionnaire by Google forms sampling method were used to collect the data which was analysed using SPSS 25.

Results: The percentage of students who suffered cervical pain was (80.3%) of the 152 who participated in this study and the majority of those who suffered pain were complained from increase pain during the pandemic (72.1%). This study also showed the students recumbent on the floor 67 (44.1%) more than those who use the table and chair 62 (40.8%) during E-learning. The percentage of students who use the phone for more than 4 hours were (73.7%).

Conclusion: there is a relationship between poor posture and cervical pain during E-learning in the pandemic. Most of students were suffering from neck pain with greatest percentage were in those who student in recumbent on the floor and when using chair and table.

Background: Repeated blood transfusion is the main therapeutic option for transfusion-dependent anaemias with consequent iron overload and organ damage .Therefore iron chelating agents are important protective measures for these patients. The aim of this study was to investigate the efficiency and safety of Desferroxamine in paediatrics population subjected to iron overload as a consequence of repeated transfusion in a group of Sudanese children

Subjects & Methods: This was a descriptive cross-sectional hospital based study. Conducted in two main paediatric reference hospitals in, Sudan. Within the period between November 2017 and April 2018 (6 months duration). The two centres were JaafarI bn- Oaf hospital and Albulk hospital. The study population included all patients of transfusion dependent anaemia who received desferrioxamine within the study period. Hundred patients were enrolled in the study. The study variables were demographic data, number of blood transfusions , serum ferritin pre and post blood transfusion and treatment of desferrioxamin

Results: Sixty percent (60%) of the studied cases were males and 40% were females ,46% were thalassemic, 46% were sicklers, 5% aplastic anemia and 3% with red cell aplasia .The mean serum ferritin level before starting desferoxamine was 2.14 and after dessferoxamine was 2.48, P –value was highly significant. The most common side effect encountered was skin rash (36%)

Conclusion: This study revealed some features of safety and efficiency of desferoxamine therapy in Sudanese paediatrics population affected by transfusion-dependent anemia. More studies are needed to describe this important health problem

Background: The prevalence of both obesity & diabetes are increasing all over the world & more in women. They have a negative impact not only on morbidity & mortality but also on quality of life.

Objectives: To assess the HRQoL with a specific comparison between obese & normal weight among women with Type 2 Diabetes Mellitus.

Subjects and Methods: A cross sectional study was conducted among 618 diabetic women aged 18 to 45 years. Data collection was done by interview & SF36 questionnaire. A comparison for Physical Component Summary & Mental Component Summary scores were done on the base of their Body Mass Index.

Results: There was a significant difference score between obese & normal patients in PCS (p=0.001) & in MCS (p=0.009). The normal weight patients had significantly higher PCS mean (±SD), in strata of ; age (≤35,>35)=78.43(±8.80), 65.02(±17.9) /socioeconomic status (poor, fair) =69.96(±20.72), 67.50(±15.71) /marital status (single, married, divorced or widowed)=72.50(±14.81), 67.68(±17.44), 71.09(±16.79) /number of children (≤ 2 / >2 ) =68.66(±12.91), 69.64(±20.82) /smoking (smoker , nonsmoker) =72.50(±8.55), 68.44(±17.34) / duration of DM (5-10 year, >10 year) =67.68(±16.46), 70.27(±17.18)/complications of DM (one complication , > one complications) =71.12(±15.56), 77.91(±8.98)/treatment type (OHM, injection, both) =64.86(±18.87), 73.67(±14.49), 60.00 (±10.31)& regularity of visit (poor,fair,good) =66.25(±9.78), 60.31(±19.73), 72.63(±14.00). Also the same thing in MCS mean (±SD), in strata of; (SES) (poor) =72.11(±18.82), number of children (>2) =69.20(±19.66), smoking (smoker) =82.25(±11.50), duration of DM (>10 year) =67.55(±16.3), complications of DM (> one complications) =65.81(±10.17), & regularity of visit (poor) =59.86(±18.46).

Conclusions: Obese patients have a lower score as compared with normal weight patients in PCS & MCS.

Background: Parvovirus B19 is a human pathogenic virus associated with a wide range of clinical conditions. During pregnancy congenital infection with parvovirus B19 can be associated with poor outcome, including miscarriage, fetal anemia and non-immune hydrops.

Objective: The study aimed to determine the prevalenceof Parvovirus B19 DNA in pregnant women attending the Military hospital in Khartoum, demonstrating the association between the virus and poor pregnancy outcomes.

Subjects and methods: This study was a cross sectional study, testing pregnant Sudanese women whole blood samples (n= 97) for the presence of Parvovirus B19 DNA using nested PCR technique.

Result: Two samples were found positive for Parvovirus B19 DNA out of the total number of samples screened.

Conclusions: The prevalence of Parvovirus B19 DNA among pregnant women attending the Military hospital was 2.1%.

Background: Drawing blood to measure total serum bilirubin is painful & time consuming. Transcutaneous bilirubinometer working by multiwavelength spectral reflectance from the skin surface on forehead or upper sternum is a quick & painless technique.

Objectives: to compare the effectiveness of transcutaneous (over the upper sternum and forehead) and serum bilirubin measurement of neonate with jaundice.

Subjects and Methods: This is a cross sectional prospective study. It enrolled 175 jaundiced neonates & excluded those exposed to phototherapy. It was conducted at Child Central Teaching Hospital in Baghdad, Iraq from the 1st of August to the 30th of October 2018. Transcutaneous bilirubin measurement on forehead and upper sternum was done by JM 103 Minolta Air shields bilirubinometer. Total serum bilirubin was measured by APEL BR 501 BILIRUBIN METER. Data entered & analyzed using SPSS 20 computer software. Means, frequencies, cutoff values, sensitivity & specificity were calculated.

Results: The mean age, gestational age & birth weight were (6.3±4.3 days), (36.9±2.1 weeks) and (2.7±0.6 Kg) respectively. Mean total serum bilirubin, transcutaneous chest & forehead bilirubin levels were 12.6±4.2 mg/dl, 11.8±3.8 mg/dl & 11.2±3.9 mg/dl respectively. Mean total serum bilirubin was significantly higher than transcutaneous chest and forehead bilirubin. Cutoff values of transcutaneous chest & forehead bilirubin levels were [(9 mg/dl) with sensitivity (95.4%) & specificity (86.4%)] and [(8.2 mg/dl) with sensitivity (94.7%) & specificity (86.4%)] respectively.

Conclusions: Transcutaneous bilirubin measurements on chest and forehead have an acceptable validity in predicting hyperbilirubinemia with less accuracy on forehead.

The prevalence of gastrointestinal symptoms of COVID-19 is variable with different types of presentations. Some of them many present with manifestations mimicking surgical emergencies. Yet, the pathophysiology of acute abdomen in the context of COVID-19 remains unclear. We present a case of a previously healthy child who presented with acute appendicitis with multisystemic inflammatory syndrome. We also highlight the necessity of considering the gastrointestinal symptoms of COVID-19 infection in pediatric patients in order to avoid misdiagnosis and further complications.

Ureteric obstruction is rarely noted in cases of gastric cancer. Its involvement by distant metastasis from gastric adenocarcinoma without direct invasion is an exceptionally unusual occurrence. This is the story of a 58-year-old man who arrived at the emergency department with acute flank pain and fever. He was initially diagnosed with obstructive pyelonephritis after the discovery of a new onset, complete ureteric obstruction on the left side. Subsequent investigations and follow-up revealed the presence of gastric adenocarcinoma with possible ureteric metastasis bilaterally, flank pain and hydronephrosis were the first and only presentations of gastric cancer. The rarity of the condition and the unusual presentation encouraged us to report the case.

The emergence of COVID-19 has resulted in an unprecedented escalation in different aspects of human activities, including medical education. Students and educators across academic institutions have confronted various challenges in following the guidelines of protection against the disease on one hand and accomplishing learning curricula on the other hand. In this short view, we presented our experience in implementing e-learning to the undergraduate nursing students during the present COVID-19 pandemic emphasizing the learning content, barriers, and feedback of students and educators. We hope that this view will trigger the preparedness of nursing faculties in Iraq to deal with this new modality of learning and improve it should the COVID-19 pandemic keep on or a new pandemic emerges.