Mustansiriya Medical Journal

Objective: The objective of our study is to compare ultrasound and electrostimulator guidance for the injection of diluted botulinum neurotoxin
Type A. Materials and Methods: Eighty‑six children were injected under a pacemaker and 94 under ultrasound. The injection involved the
muscles of the lower limbs in 180 children aged between 2 and 15 years. Assessment was by the Modified Ashworth Scale, lower‑limb range
of motion, and Gross Motor Function Classification System (GMFCS) for function, as well as procedural pain. Results: The analysis does not
find any difference between the two techniques concerning spasticity, functional evolution according to the GMFCS, and articular amplitudes,
with the exception of the popliteal angle of the right knee with an estimated P = 0.01 for the group injected under ultrasound. Interventional
pain between the two groups found a significant difference (P = 0.04) in favor of ultrasound identification. Conclusion: The stimulator had the
same results as ultrasound on the orthopedic level of spasticity as well as on gross motor function. Nevertheless, ultrasound tracking remains
more comfortable and less painful than stimulator tracking.

Background: ACOVID-19, caused by the novel coronavirus SARS‑CoV‑2, presents with varying severity, from mild symptoms to severe
disease, including ARDS and multi-organ failure. Identifying early biochemical markers to predict the severity of COVID-19 is crucial
for improving patient outcomes. Aims and Objectives: The study aimed to identify distinct patient groups with COVID‑19 and healthy
controls using cluster analysis of multiple biomarkers. Specifically, it sought to determine if early detected levels of ferritin, D‑dimer, and
C‑reactive protein (CRP) are associated with the severity of COVID‑19. Materials and Methods: Biochemical profiles of sixty patients with
SARS‑CoV‑2 RNA‑positive testing and thirty healthy controls were collected and analyzed. Two-dimensional automated hierarchy clustering
was performed on all biomarkers. The study focused on alterations in the biochemistry markers ferritin, D‑dimer, and CRP. Additionally,
levels of inflammatory cytokines, particularly interleukin-6 and tumor necrosis factor-alpha, were measured. Results: Ferritin, D‑dimer,
and CRP levels were significantly higher in COVID‑19 patients compared to the control group. Early detected levels of these biomarkers
were associated with a higher incidence of severe COVID‑19. Elevated levels of inflammatory cytokines, especially interleukin‑6 and tumor
necrosis factor‑alpha, were also observed in COVID‑19 patients, indicating the presence of a cytokine storm, which is a major cause of organ
dysfunction and mortality in severe cases. Conclusion: Our findings suggest that elevated levels of ferritin, D‑dimer, and CRP are indicative
of severe COVID‑19. Early detection of these biomarkers can help predict the severity of the infection and guide clinical management. The
study also underscores the significant role of inflammatory cytokines in the pathogenesis of COVID‑19, contributing to the understanding of
the cytokine storm that leads to severe disease outcomes.

Background: Violence toward health‑care workers is a global health problem, usually associated with decreased job satisfaction, and poor patient care outcomes, with serious consequences for the patients. Its extent is difficult to measure due to under‑reporting. Objective: The objective of this study was to explore the opinion of some influential community members about violence against health workers with respect to its types, reasons, mechanisms in place, and suggestions to de‑escalate it. Methods: A qualitative in‑depth study was conducted with 10 key informants (including people working in judicial premises, police and military services, teachers, municipality members, and religious leaders). The discussion was conducted through a direct face‑to‑face interview, using a semi‑structured interview guide that included open‑ended questions. Results: Almost all the interviewees agreed that the main reasons for violence were the general security instability in the whole country, the poor quality of health services, weakness of laws and regulations for the punishment of the perpetrators, irresponsible behaviors of some doctors, in addition to the unexplained negative role of media toward doctors. Conclusion: workplace violence is a common, frequently happening practice in most health‑care facilities in Iraq, probably attributed to the long‑suffering of wars and conflicts. Shortage of staff and equipment is the base for this malpractice.

Background: Chondrosarcomas (CSs) are the second‑most common primary malignant tumor of the bone and are a malignant tumor of cartilaginous origin. Aim: The aim of the study was to analyze the accuracy of fine‑needle aspiration cytology (FNAC) in diagnosing CS and its correlation with histologic diagnosis and evaluate the survival outcome and prognostic factors in CS. Setting and Design: Retrospective study conducted from January 2013 to December 2019. Materials and Methods: Data regarding clinical findings, FNAC diagnosis, histopathological, radiological findings, and patient status were retrieved. Statistical Analysis: Kaplan–Meier curve and Log Rank (Montel Cox) analysis were used for statistical analysis. Results: Twenty‑six cases of CS were selected. The accuracy of diagnosing CS on FNAC was 61.53%, and the accuracy in interpreting it as a malignant lesion was 92.30. Overall survival outcome in CS patients was 92.23% at 1 year, 73.23% at 3 years, and 61.32% at 5 years. Survival outcomes significantly altered depending on the histological variants, metastases status, and histological grading, which showed Chi‑square values of 31.77 (P ≤ 0.001), 8.43 (P = 0.011), and 6.33 (P = 0.043), respectively. The median survival time of CS was 2214.98 days, with a standard error of 362.83. Patient age, gender, tumor size, and skeletal versus extraskeletal CS had little impact on CS survival (Chi‑square value = 0.464 (P = 0.496 NS), 0.570 (P = 0.450 NS), 2.83 (P = 0.242 NS), 0.125 (P = 0.724 NS), respectively. Conclusion: FNAC is a beneficial, reliable tool for screening and diagnosing CS. Prognostic factors such as histological variants, histological Grade 1 and 2, and no metastases status are associated with good survival. Patient age, tumor size, and extraskeletal location are not associated with prognosis and survival.

Background: The problem of using psychotropic substances and addiction has become one of the major problems in the world. Despite the
significant increase in treatment programs of addiction, many studies indicate that the rate of relapse globally is very high, especially when
treatment is limited to the medical side only. Aims: The study aims to determine the percentage of influence of psychological, societal, social,
economic, and other factors that lead to relapse when recovering from addiction. Methods: This study conducted in two main hospitals for the
treatment of substance use disorders in Baghdad (Ibn Rushud Teaching Hospital for Psychiatry and Al‑Ataa Center for Addiction Treatment)
through the period from January 10, 2023, to June 10, 2023. All (300 inpatient) who are suffering from relapse to addiction after recovery
were included in the study. The scale was prepared for the psychological, social, therapeutic, environmental, and economic factors, which
was used by a group of senior doctors working in the field of treatment of addiction and rehabilitation centers, who unanimously agreed
with their expertise on these factors. Results: This study revealed that the most important factor for relapse is the availability of addictive
substances (91%); other factors include psychological, social pressures that the addict is exposed to in his social environment, in addition to
the loss of social support (76%). The pressure of friends or peers with a rate of (78%) and the weakness of family control (44%) in addition
to the influence of other factors that were examined in this study. Conclusion: There are many factors affecting the return of those recovering
from addiction to addiction again, and the most prominent of these factors is the abundance or ease of access to psychoactive substances in
addition to other factors, which include (psychological, social, societal, and economic factors).Society must realize that the responsibility for
preventing addiction should not be borne by the medical treatment alone, because it is a problem that must be dealt with collectively by all
parties to enable recovered patients from addiction to build their lives with confidence

Background: This study evaluates the potential of ChatGPT, an artificial intelligence (AI) language model, to assist health‑care professionals in
selecting appropriate medications for the management of herpes zoster. Agroup of experts specializing in dermatology and infectious diseases
assess the recommendations provided by ChatGPT for ten hypothetical clinical scenarios involving herpes zoster. Aims and Objectives: The
main objective is to determine the extent to which ChatGPT can contribute to informed decision‑making when it comes to repurposing drugs
for the treatment of this condition. Materials and Methods: The accuracy and relevance of ChatGPT’s suggestions are evaluated by comparing
them to current medical research and literature. Results: The findings indicate that ChatGPT consistently offers valuable recommendations
for potential drug repurposing in the management of herpes zoster, aligning with scientific evidence and published literature. While there
may be limitations in terms of therapeutic options and the inability to customize treatment plans, health‑care professionals find ChatGPT’s
guidance beneficial in identifying potential repurposed drugs. However, it is important to address these limitations, such as the need for more
clinical data and the ability to customize treatment plans. Further research is necessary to enhance ChatGPT’s effectiveness in managing herpes
zoster. Conclusion: Future studies should focus on refining the model’s capabilities, incorporating comprehensive clinical data, and enabling
customization of treatment plans to make ChatGPT a valuable resource for health‑care professionals dealing with herpes zoster.

Background: The association between the activity of autonomic nervous systems (ANS) and pulse wave velocity (PWV) was commonly deduced after adjusting for confounding factors. The relationship between the ANS and PWV was either maintained, but attenuated, or no longer statistically connected after controlling for confounding variables. Research in young healthy individuals showed that the ANS does not control aortic stiffness (indexed by PWV) in a pressure‑independent manner. Therefore, the role of the ANS in controlling PWV is debatable. Objectives: The objective of this study was to examine the possibility that ANS directly affects PWV independent of blood pressure (BP) and heart rate (HR). Subjects and Methods: Thirty‑four healthy male volunteers (19 years old) were recruited. Stable brachial systolic BP (SBP)/diastolic BP (DBP) and HR were measured in semi‑supine position after a 15‑min rest. During the last 5 min, fingertip digital pulse wave (DPW) and lead II electrocardiogram (ECG) signals were recorded. The pulse transit time, and consequently PWV, was calculated by measuring the duration between the ECG R wave climax and a reference point on the DPW in the same cardiac cycle. The ANS activity was assessed by calculating the HR variability (HRV) indices obtained from the ECG record of 5‑min R‑R intervals (RRIs). Results: HRV indices low‑frequency (LF)/high‑frequency (HF) (LF band power measured in the 0.04–0.15 Hz)/the HF band power measured in the 0.15–0.4 Hz band) and SD2/SD1 ratios (SD1 and SD2 represent the dispersion along the minor and major axis of the fitted ellipse of the Poincaré plot) (sympathovagal balance) were significantly and positively correlated with PWV. In addition, the standard deviation of RRI, or normal‑to‑normal “NN” (SDNN) interval, after excluding ectopic beats, the square root of the mean squared differences of successive NN intervals (RMSSD) were significantly and negatively correlated with the PWV. No correlation was obtained between PWV and HR, SBP, or DBP. Conclusion: Peripheral PWV during rest or inactivity is affected directly by the sympathovagal balance independent of BP.

Background: Despite the promising of introduction of tyrosine kinase inhibitors (TKIs), chronic myeloid leukemia (CML) remains a significant cause of annual mortality. Red blood cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) are parameters derived from a complete blood count (CBC) commonly used to diagnose anemia, autoimmune diseases, and inflammation. These parameters have been reported to have a strong association with various diseases, including hematologic malignancies. Objectives: The study aims to identify whether RDW, NLR, and PLR can act as predictors of survival in newly diagnosed and treated CML patients. Materials and Methods: The study involved 60 Iraqi patients (37 males, 23 females, aged 17–69 years) with CML at chronic phase, who were referred to the National Center of Hematology/Mustansiriyah University, Baghdad, from February 2022 to December 2022. Twenty were newly diagnosed (T0), and 40 were under TKI treatment (T+), with 20 on imatinib and 20 on nilotinib. Additionally, a control group of 20 age‑ and gender‑matched healthy subjects was included. CBC assessed red blood cell (RBC) indices across all groups. Results: There was no significant difference in the age of CML patients at the onset of disease between males (34.5 ± 11.7 years) and females (34 ± 11.9 years). Likewise, there was no significant difference in the treatment of CML patients with imatinib or nilotinib between males (48% and 52%) and females (53.3% and 47.7%), respectively. Most RBC indices for patients and controls were within normal ranges without significant differences. However, RDW% in T0 was markedly elevated (20.4%), with about 80% showing anisocytosis, surpassing both T+ and controls, and exceeding the upper limit of normal. The total and differential white blood cell (WBC) counts were significantly higher in T0 compared to T+, exceeding their normal ranges. Additionally, the NLR was significantly higher in T0 (8.13) compared with T+ and controls (1.80 and 1.87, respectively). Platelet count, mean platelet volume, and platelet distribution width (PDW%) differed significantly among the three groups but remained within the normal range. However, PLR in T0 (31 ± 24) was significantly lower than those in T+ and controls (130 ± 43 and 102 ± 27, respectively). Conclusion: It can be concluded that the monitoring of some parameters in peripheral blood in CBC test (as a simple and inexpensive test) such as RDW%, NLR%, and PLR% during the therapy course of CML patients may act as predictive markers to evaluate the prognosis of disease in CML patients and the degree of response to certain TKI treatment.

Background: Acromegaly is a rare endocrine disorder; it has an incidence of 4 per million annually and a prevalence of 40 per million. It is
due to growth hormone‑secreting pituitary adenoma. The objective of our study is to evaluate the levels of brain natriuretic peptide (BNP)
in patients with acromegaly with and without obstructive sleep apnea (OSA). Materials and Methods: One hundred five registered patients
with acromegaly in the National Diabetes Center‑Mustansiriyah University were enrolled in the study. Out of 105 patients with acromegaly,
81 have OSA while the remaining 24 have no OSA. OSA affects 81.8% of males and 72% of females. All recruited patients have given oral
consent to participate in the study which was conducted during the period from January to October 2023. Results: Males with OSA had a
mean age of 52 years while those without OSA had a mean age of 46 years. Epworth Sleepiness Scale is higher among those with OSA. BNP
is found to be higher in females with OSA (905.54 pg/ml) while in males with OSA, it drops down to 878.76 pg/ml. In no OSA group, the BNP
level was 355.33 ± 30.1 pg/ml while in those with OSA, it jumped to 890.66 ± 205.63 pg/ml. Conclusions: The results showed that BNP was
elevated in patients with acromegaly and OSA versus those without OSA, OSA is more common in males particularly when they get older.