About Journal

Al-Anbar Medical Journal (AMJ) is an international peer-reviewed journal published biannually by the College of Medicine, University of Anbar. The Journal provides a suitable media of communication for biomedical researchers all over the world. The Journal welcomes original articles, review articles, case reports, images in clinical practice, and short communications in all fields relevant to medicine. The Journal is open access for both researchers and readers.
Read More ...

Journal Information

Publisher: University of Anbar

Email:  amj@uoanbar.edu.iq

Editor-in-chief: Prof. Dr. Raid M. Al-Ani

Managing Editor: Assist. Prof. Dr. Aamr Fakree AL-Ubaide

Print ISSN: 2706-6207

Online ISSN: 2664-3154

Reward Systems and Ultra-processed Foods.

Nour Shakir Rezaieg

Al- Anbar Medical Journal, 2022, Volume 18, Issue 2, Pages 53-55
DOI: 10.33091/amj.2022.176303

Indeed, the prehistoric period was associated with chronic malnutrition, which was a fundamental rule of human history. Because of this, natural selection favored genetic patterns that could survive in these harsh conditions by storing fat. This is because the main function of body fat is to store food reserves for the body [1]. Feeding behavior could be an interaction of a physiologic need for food with the reward system that powerfully encourages excessive eating in some people. Neuroadaptations in the reward system happens when people eat too many tasty foods. This disconnects eating behavior from caloric needs and leads to uncontrollable overeating [2]. Over time, body fat became a major issue. However, the negative effects of being overweight were not recognized in medical literature until as late as the 18th century. Then, technological advancement and economic prosperity resulted in the comfortable availability and simple cost of high-calorie foods, which are palatable to a large segment of the population [3].
     Many factors that were formed as a result of this technological development have become major contributors to the increase in the obesity epidemic, including the increased use of sugar substitutes, the addition of preservatives to foods, sugar-sweetened beverages, changing eating patterns, as well as the promotion of sedentary lifestyles [4].
     Excess calories taken in comparison to calories burned from any source result in the accumulation of these calories as body fat. Obesity may be characterized in many ways: For starters, it is a condition in which excess body fat interferes with normal activity and health. Second, the weight is more than 20% greater than the ideal height and body size. Third, a body mass index (BMI) is over 30. [5].  

Ventilator-associated Pneumonia: A Narrative Review

Hayder A. Alkayssi

Al- Anbar Medical Journal, 2022, Volume 18, Issue 2, Pages 56-60
DOI: 10.33091/amj.2022.176306

The difficulty of early diagnosis, the proper anti-microbial chosen, and the relatively high morbidity and mortality; make us collect the related subjects to deal with the most critical complication (ventilator-associated pneumonia) showing the major points needed for every intensivist. Ventilator-associated pneumonia is considered the most common respiratory complication (infection) in intensive care unit patients. Ventilator-associated pneumonia can be defined as a hospital-acquired infection of the lung parenchyma that occurs after 2 days of mechanical ventilation. Its incidence is about 9-25% in intubated patients for more than 2 days. We could classify ventilator-associated pneumonia as early and late; the first one happened within four days of receiving mechanical ventilation, otherwise, the late onset occurred after day four. Some patients with hospital stays before intensive care unit admission and intubation are considered to have late ventilator-associated pneumonia regardless of the period of mechanical ventilation because those patients might have had pathogens previously (nosocomial). Severe ill patients, prolonged mechanical ventilation, and failed extubation trials (recurrent intubation) lead to the development of ventilator-associated pneumonia rapidly and aggressively. Furthermore,ventilator-associated pneumonia is attributed to prolonged hospitality as well as high morbidity and mortality. We aimed in this narrative review to discuss ventilator-associated pneumonia regarding the etiology, causative agents, risk factors, strategies for early diagnosis, accurate treatment, and optimal prevention protocols.

Effect of Perineural Dextrose Injection on Myofascial Pain Syndrome

Sinan Ismail Khalil

Al- Anbar Medical Journal, 2022, Volume 18, Issue 2, Pages 61-65
DOI: 10.33091/amj.2022.176307

Background: Myofascial pain syndrome (MFPS) is defined as the motor, sensory, and autonomic signs resulting from trigger points (TrPs).
Objectives: To assess the effectiveness of the perineural injection in patients with MFPS.
Materials and methods: The study was conducted at AL Ramadi Teaching Hospital, Department of Rheumatology, Ramadi City, Iraq. The study period was from June 2019 to January 2021. A retrospective review of 100 patients with prospectively collected clinical and radiologic data was performed to evaluate the effectiveness of perineural injection on MFPS. A 3 ml of 5% dextrose solution was managed sub-cutaneous straight at the labeled chronic constrictive injury and tender spots rounding the knee. The VAS and WOMAC were calculated for each participant at the time of the presentation and 1, 3, and 6 months following treatment.
Results: The mean age of the patients was 60.93 ± 6.17 years (25-70 years). Three-quarters (75/100) of the cases were female. Seventy subjects were from the age group ≥ 40 years, while the remaining 30 cases were from the age group < 40 years.  Fifty-five cases were with right-sided involvement. Successful results were achieved in 90% of the participants. There were no statistically significant differences between the effective and not effective groups regarding the age, gender, and the involved side (P-value > 0.05). There was a reduction in the mean VAS (8.47 ± 0.77) of pain and WOMAC (78.99 ± 5.69) score at the time of presentation to 1.87 ± 1.32 for the VAS and 17.84 ± 4.66 WOMAC at 6-months post-injection period. No complications were reported in all patients apart from mild pain at the injection site.    
Conclusion: Perineural dextrose injection was successful in 90% of the patients with MFPS. This modality results in a sharp reduction of both VAS and WOMAC scores from the time of the presentation to 6-months post-treatment. We recommend using this modality because it is easy, effective, and safe.  

A Comparison of Treatment Success between Functional and Camouflage Orthodontic Treatments in cl II Malocclusion

Luay Ali Zaidan; Nisreen M. Saleh

Al- Anbar Medical Journal, 2022, Volume 18, Issue 2, Pages 66-71
DOI: 10.33091/amj.2022.176308

Background: Functional and camouflage orthodontic treatments in cl II malocclusions are different treatment methods that usually used in orthodontic practice. A comparison of treatment success betweenthose treatment groups shows which treatment method is better to choose.
Objectives: This study aimed to compare functional and camouflage orthodontic treatments in patients with class II malocclusion.
Materials and methods: The sample size was from individuals who they completed treatments between February 2017 and July 2020 at the Department of Orthodontics, Faculty of Dentistry in Suleyman Demirel University, Turkey. The subjects were from 2 genders and a total number of 146 cases with an average age of 11-22 years. Peer Assessment Rating (PAR) index was used to evaluate the success of the treatment using plaster models taken from these cases before and after the treatment.
Results: In our study, orthodontic treatment results were evaluated by the PAR index in three groups as very successful, successful, and unsuccessful according to the scores of success rate (PAR%). The majority of treatments were found to be successful (67.81%), approximately a quarter of cases were very successful (26.71%), and low rate of failure (5.48%).
Conclusion: Although there were positive occlusal changes in functional and camouflage orthodontic treatment groups, patients in the functional orthodontic treatment group showed more improvement in the PAR change rate. Therefore, we recommend starting with treatment at an early age to get more benefit from the growth of patients. 

Prevalence of Helicobacter pylori Infection in Cigarette and Nargileh Smoking Males in Erbil City, Iraq

Chiman Hameed Saeed; Suhayla Hamad Shareef; Pshtiwan Dhahir Majeed

Al- Anbar Medical Journal, 2022, Volume 18, Issue 2, Pages 72-76
DOI: 10.33091/amj.2022.176309

Background: Smoking is the foremost public health problem affecting the world and it has a crucial implication in causing many common diseases due to Helicobacter pylori infection which is globally distributed. Smoking is considered a critical risk factor that accelerates infection with this bacterium.
Objectives: The study's goal was to find out how common Helicobacter pylori infections were among male cigarette and nargileh smokers.
Materials and Methods: A case-control study was performed between August and December 2021in Erbil Teaching Hospital in Erbil City, Kurdistan Region, Iraq.  Blood samples were collected and used for detection of anti-Helicobacter pylori IgG Abfor 80 males who were smokers and 80 who were non-smoker.
Results; The prevalence of Helicobacter pylori positivity was 64.9% in smokers and 45.5% in nonsmokers (P-Value = 0.03). The highest percentage (54.1%) was found in the young age group (25-34) years (P-Value = 0.05), and 89.2% of Helicobacter pylori-positive individuals exhibited stomach symptoms (P-Value = 0.01). Fifty percent of Helicobacter pylori-infected individuals were nargileh smokers.  
Conclusion: The prevalence of Helicobacter pylori showed significant value in nargileh smoking males. Therefore, smoking was a key factor in the seroprevalence of Helicobacter pylori and had a substantial impact on it.

Prevalence of Dyslipidemia and Hypertension in Iraqi Adolescents with Type 1 Diabetes Mellitus

Dawood S. Abdoun; Riyadh Adil Al-Rawi; Balsam Yahya Abulmajeed

Al- Anbar Medical Journal, 2022, Volume 18, Issue 2, Pages 77-81
DOI: 10.33091/amj.2022.176311

Background: Diabetes is one of the most common non-communicable diseases in the world. It is a chronic disease with multiple complications such as retinopathy, neuropathy, nephropathy, and cardiovascular disease.
Objectives: The study aimed to identify the prevalence of dyslipidemia and hypertension in type 1 diabetes mellitus (T1DM) in Iraqi adolescents.
Materials and Methods: A cross-sectional retrospective study was conducted on adolescent patients with T1DM for more than two years and aged 10-18 years old. For each participant, the age, gender, onset and duration of the DM, body mass index (BMI), blood pressure, and low-density lipoprotein (LDL) level in the blood were recorded
Results: Of 70 subjects, there were 42 (60%) girls. The duration of the DM was predominantly between 2-5 years (59%). Around half of the cases were diagnosed between 5 and 10 years. Girls had a significantly higher mean BMI than boys [21.5 kg/m2 for girls and 18.6 kg/m2 for boys (P-value 0.001)]. Seven (10%) patients were diagnosed with hypertension. LDL was high in 22 patients (31%) with the majority of them (15/22) having an LDL value of between 100-130 mg/dL. Most of the participants with a high LDL were girls (18/22) with a statistically significant gender difference (P-value = 0.018). There were significant correlations between high blood pressure and BMI (P-value = 0.004) and elevated LDL levels (P-value = 0.008). 
Conclusion: The study revealed that hypertension and dyslipidemia were seen in 10% and 31% of children with T1DM respectively. The elevated LDL and BMI were significantly higher in female patients than in males. Besides, there were significant associations between high blood pressure and BMI and elevated LDL levels. 

Giant Antrochoanal Polyp in a Six-years-old Boy: A Case Report and Literature Review

Raid M. Al-Ani

Al- Anbar Medical Journal, 2022, Volume 18, Issue 2, Pages 82-85
DOI: 10.33091/amj.2022.176312

Antrochoanal polyps are more prevalent in children than adults. Unilateral nasal obstruction and rhinorrhea are usually the features of unilateral antrochoanal polyps. Bilateral nasal obstruction can be a feature of antrochoanal polyp if it is large and obstruct both choanae. The giant antrochoanal polyp is rarely reported in the literature. We are reporting this scenario of giant left antrochoanal polyp in a 6-years-old boy who presented with bilateral nasal obstruction, nasal and postnasal mucopurulent discharge, hypo-nasal speech, mouth breathing, snoring, and obstructive sleep apnea syndrome. The physical examination revealed a mass seen in the oropharynx behind the uvula. Further examination by nasal endoscopy, computerized tomography, and histopathological evaluation of the excised polyp have confirmed the diagnosis of an antrochoanal polyp. Although this entity is not commonly seen in daily clinical practice, careful assessment is needed to not miss the diagnosis for early treatment to avoid unwanted complications. 

Atypical Presentation of Pelvic Abscess: A Case Report

Haitham Noaman; Ammar Fouad

Al- Anbar Medical Journal, 2022, Volume 18, Issue 2, Pages 86-89
DOI: 10.33091/amj.2022.176313

An abscess is a common disease worldwide and its diagnosis is usually straightforward. However, pelvic abscess is rarely seen in daily clinical practice. Besides, it is a challenge for the surgeon to diagnose abscesses in unusual location, including the pelvis. A 41-year-old housewife lady had a history of poorly controlled insulin-dependent diabetes mellitus with recurrent vaginitis, cervicitis, and recurrent urinary tract infection. She presented with bilateral hip joint pain and limitation in her movement, with diabetic ketoacidosis. She was admitted to the hospital for the treatment of diabetic ketoacidosis. A physical examination revealed a high-grade fever, unwell, and there is a pelvic mass. Laboratory tests showed leukocytosis and a low hemoglobin level. Ultrasonography and computerized tomography revealed a 5 × 5 pelvic mass, which was located anterior to the bladder, with a high suspicion of an abscess formation. The patient was admitted to the surgical ward and drainage of the abscess under general anesthesia with antibiotic cover was performed. The patient was discharged two weeks postoperatively with an improvement in all presenting features. Bilateral insidious hip joint pain with limitation of movement should orient the clinician to a pelvic abscess as one of the differential diagnoses of these symptoms.

Compound Odontoma Associated with Dentigerous Cyst

Tahrir N. Aldelaimi; Afrah A. A. Khalil

Al- Anbar Medical Journal, 2022, Volume 18, Issue 2, Pages 90-90
DOI: 10.33091/amj.2022.176315

A 17-year-old female presented to the Department of Oral and Maxillofacial Surgery complaining of hard expansion with pain sensation in the posterior part of the left mandible for two weeks ago. She  was healthy with an unremarkable medical history. Intra-oral examination revealed retained lower left deciduous molar (#75) with bony expansion on the left side of the mandible. Orthopantomograph (OPG) showed unerupted  third molars as well as compound odontoma associated with dentigerous cyst include the cement-enamel junction of impacted lower left second premolar leading to mechanical obstacle of eruption and in turn impaction (Panel A). Under local anesthesia, two sided flap was raised, surgical removal of impacted tooth with cyst enucleation, and curettage of the surrounding odontoma tissues (Panel B) with preservation of the inferior dental canal (Panel C). Odontomas are hamartomas that presented as complex or compound odontomas; their etiology still unknown. Compound odontoma was a malformation having more orderly arranged dental tissue pattern that was rarely associated with dentigerous cyst of impacted premolars. The early diagnosis and management of odontoma and cyst are important for both surgeon and patient to avoid the need for surgical intervention and the need for future Prosthodontic restoration of extracted teeth. At the end of six weeks, results showed complete healing and the patient retained her normal sensation with good aesthetic outcome.

Multiple Xanthoma Tuberosum

Hazim Ismael Ghazzay; Thamir A. kubaisi

Al- Anbar Medical Journal, 2022, Volume 18, Issue 2, Pages 91-91
DOI: 10.33091/amj.2022.176316

A 43-year-old unmarried healthy woman presented at the dermatology clinic with xanthelasma (Panel A) and asymptomatic multiple rounded, grouped, and yellow to orange colored nodules, located on the hands and feet for 16 years (Panels B and C). The lesions were 15 mm in size; and were indurated, coalesced, and gradually grown. The patient had no history of diabetes mellitus, hypertension, heart problems, or any history of thyroid disease. On the other hand, she had a family history of sudden death when her brother died at the age of 28 years after a cardiac attack. The vital signs were normal. Full blood counts were normal. Fasting blood glucose was 98 mg/dl (reference range 70 to 99 mg/dl), triglycerides 174 mg/dl (reference range < 150 mg/dl), serum total cholesterol 216 mg/dl (reference range < 200 mg/dl), low density lipoprotein 259 mg/dl (reference range < 116 mg/dl), and high density lipoprotein 29.5 mg/dl (reference range > 55 mg/dl for females). Serum uric acid, liver enzymes, and thyroid function tests were within normal limits. The patient had no evidence of ischemic heart disease or pancreatitis. Treatment started with Rosuvastatin at 40 mg/day. The diagnosis is multiple xanthoma tuberosum (MXT). It is characterized by deposition of lipid at the subcutaneous tissue, particularly on the elbows, knees, face, knuckles, and toe joints. Equal prevalence is reported in males and females. The biopsy is not performed owing to the missing of the patient. This case shed light on MXT associated with abnormal serum lipoprotein levels and a family history of sudden cardiac death. The affected subjects with MXT need long-life follow-up to catch its serious cardiovascular complications as early as possible and treated them promptly.

Occlusion of Two Coronary Arteries Simultaneously

Amjed Sheet

Al- Anbar Medical Journal, 2022, Volume 18, Issue 2, Pages 92-92
DOI: 10.33091/amj.2022.176317

A 60-year-old woman with a history of stroke and known hypertension presented to the emergency room after experiencing acute chest pain for an hour. Her blood pressure was 80/55 mmHg, and her pulse rate was 42 beats per minute. An electrocardiogram (ECG) showed first-degree cardiac block and inferior and anteroseptal leads with acute ST-elevation myocardial infarction (STEMI) (Panel A). The patient was promptly moved to the catheterization lab after receiving first care. Early distal left anterior descending (LAD) artery partial blockage with thrombus-containing lesion was found during diagnostic coronary angiography (Panel B). After a challenging engagement of the right coronary artery (RCA), it was discovered that there was a proximal complete blockage with a thrombus-containing lesion (Panel C). Unfortunately, the patient collapsed with severe bradycardia (34 beats per minute) and hypotension (systolic blood pressure = 60 mmHg), which did not react to quick intravenous fluid and atropine ampules. A temporary pacemaker was soon implanted. After the pacing was started, the patient developed ventricular fibrillation, which required cardiopulmonary resuscitation (CPR) and successive DC shocks before the pulse returned to sinus. The RCA was successfully stented quickly, followed by the stenting of the LAD lesion (Panel D and E). The patient rapidly returns to sinus rhythm with great coronary blood flow, and normal blood pressure is recorded after one hour of recovery. Two hours later, echocardiography demonstrated normal systolic function with no aberrant segmental motion. Occlusion of two coronary arteries is a critical disorder that requires immediate detection and treatment to avoid complications such as ventricular arrhythmias and cardiogenic shock. The patient was released with excellent outcomes.

Clear (Pale ) Cell Acanthoma

Abdullah Mancy

Al- Anbar Medical Journal, 2022, Volume 18, Issue 2, Pages 93-93
DOI: 10.33091/amj.2022.176318

A 36-year-old gentleman presented to the  Dermatology and Venereology outpatient clinic with a painless nodule of the volar aspect of the left forearm for six months (Panel A). On examination, there was a single, non-tender, smooth surface, and dome-shaped nodule. It was shiny with a reddish rim at its periphery. The nodule was excised completely as a treatment and for histopathological examination that shows it as a clear cell acanthoma (CCA) [panel B (H/E-4X) and C (H/E-10X)]. CCA is a rare benign cutaneous tumor of unknown cause. It is mostly presented as a painless, solitary, slowly growing, and pink-brown or red nodule that is seen mostly on the distal lower extremities of middle-aged and elderly patients. Multiple lesions and different morphologies such as polypoid, giant, atypical, pigmented, and cystic lesions can be seen. Other sites like the abdomen, areola, face, and scrotum can be affected. CCA has specific dermoscopic features in which the blood vessels are arranged in a string-like appearance, but the diagnosis is rarely done without biopsy. Histopathological examination reveals epidermal acanthosis with a psoriasiform pattern of pale keratinocytes and spongiosis in association with dilated blood vessels of the edematous dermal papillae. CCA is treated by surgery such as excision, CO2 laser, or cryosurgery. With a weekly regular follow-up of the patient for two months, the lesion was completely cured.

Types and Clinical Profile of Unilateral Sinonasal Masses

Ammar H. Khammas; Husam S. Hameed; Firas J. Alobaidy

Al- Anbar Medical Journal, 2022, Volume 18, Issue 1, Pages 1-4
DOI: 10.33091/amj.2022.174522

Background: Unilateral mass in the sinonasal region is a common problem facing the otolaryngologist in daily clinical practice. There are various benign and malignant conditions originating in this area with different clinical features depending on their nature and extent.
Objectives: To evaluate the types and clinical profile of unilateral sinonasal masses.
Materials and methods: This study includes 60 patients who attended the outpatient clinic at Alyarmook Teaching Hospital, Baghdad, Iraq, between January 2017 and April 2018. A thourough history from each patient was taken. Moreover, the clinical examination was done according to standard clinical practice. The imaging results of the nose and paranasal sinuses were documented. Then biopsy was taken from the mass at the operating room under local or general anesthesia if indicated. The specimen was sent for histopathological examination and the results were documented on the data collection sheet. The patients were divided into two groups: non-neoplastic and neoplastic according to the histopathological results.
Results: Out of 60 patients, there were 36 (60%) males. The age of our cases was ranged from 6 to 79 years with a mean age of 34.20 ± 18.126 years. Non-neoplastic causes were (n=38, 63.3%) more than the neoplastic group, and the majority of them were unilateral simple polyp (n=23, 38.3%). Inverted papilloma was the most common benign tumor (n=8, 13.3%), while, squamous cell carcinoma was the commonest malignant neoplasm (n=2, 3.3%). Non-neoplastic causes were more in both sexes. The most affected age group was 20-49 years (n=31, 51.7%). The non-neoplastic causes were mostly seen in the age group 20-49 years (n=22, 36.7%). There was no statistically significant difference between the age and gender and the causes of unilateral sinonasal lesions (P-value > 0.05). Nasal obstruction, nasal discharge, and hyposmia were more in non-neoplastic than neoplastic group. While epistaxis and facial pain were found to be higher in the neoplastic group.
Conclusion: Non-neoplastic masses outnumber neoplastic ones. Among non-neoplastic lesions, inflammatory polyps were the most common. Benign neoplasms outnumber the malignant neoplasms with inverted papilloma and squamous cell carcinoma were the most common respectively.

Hydatid Cyst Pleural and Pericardial Effusions as a Complication of Postoperative Hydatid Cyst Resection from the Liver: A Case Report

Haitham Noaman; Khalil Sarhan Khalaf

Al- Anbar Medical Journal, 2022, Volume 18, Issue 1, Pages 48-50
DOI: 10.33091/amj.2022.174531

Hydatid cyst is a zoonotic endemic disease in Iraq. It carries considerable complications either related to the disease itself or following its surgical removal. Pleural and pericardial effusion is a rare postoperative complication of hydatid cyst removal. A 65–year-old Iraqi female patient complained of right-sided chest heaviness and palpitation one month following surgical removal of 2 large hydatid cysts. There were no other associated symptoms. Physical examination revealed the possibility of pleural and pericardial effusions (poor air entry and stony dullness of the right posterior part of lower zone, difficulty to palpate the apex beat, increase heart dullness, and no pericardial rub). The diagnosis was confirmed by chest X-ray and echocardiogram. She received Albendazole tablet 400 mg twice daily for 6 weeks with a good response. The Early presumption of the disease in an endemic area with a good dose and appropriate course of Albendazole tablets treatment can give very good results. To our best knowledge, this is the first case in the world who presented with hydatid cyst pleural and pericardial effusions and responded completely to the Albendazole tablets.

Dermatological Manifestations of Patients with COVID 19: A Cross-sectional study

Iqbal G. Farhood; Ali T. AbdulHasan; Salam F. Lafta; Afraa Mamoori; Fatima Al-Hasani

Al- Anbar Medical Journal, 2022, Volume 18, Issue 1, Pages 43-47
DOI: 10.33091/amj.2022.174530

Background: A global pandemic “Coronavirus disease-19 (COVID-19)” caused by the “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2). It was isolated in December 2019 in Wuhan (China). Skin manifestations of COVID-19 disease are overlooked in the clinical approach to those suspected of this virus focusing on the pulmonary findings.
Objectives: This study aimed to describe the dermatological manifestations of COVID-19 in Iraqi patients.
Materials and Methods: A cross-sectional study was carried out at general hospitals, primary care centers, and private clinics in three Iraqi cities Baghdad, Babil, and Karbala. The study covered the period from October 2020 – to February 2021. Data regarding the demographic and clinical characteristics of each participant were registered. A thorough physical examination by a dermatologist was conducted for every subject. The data were entered and analyzed using SPSS version 25.
Results: One hundred COVID-19 patients with cutaneous manifestations were enrolled in this study. There were 59 females. Their ages ranged from 19-62 years. Most of the patients were from the age group ≤ 40 years (68). Just above half of the participants were non-healthcare workers. The highest blood group of the patients was A (45) and the least AB (11). Half of the subjects were presented within the first 7 days from the onset of the disease. Fifty-one cases were with mild disease form. In 54 patients, dermatological manifestations have appeared in the active stage of the disease. Hair loss was the commonest manifestation (30), all of them in the age group ≤ 40 years, and the majority of the cases (26) was affecting the female. While the least manifestation was acrocyanosis in 2 patients, both of them were male and from the age group > 40 years. There were highly statistically significant differences between the skin manifestations and the age and gender (P-value = 0.000).
Conclusion: Most of the patients were from the age group ≤ 40 years and female. Hair loss was the commonest skin abnormality due to COVID-19.  The majority of cutaneous manifestations were started in the active phase of the infection. The age and gender determined the type of dermatological manifestations.

COVID-19 Variants and Vaccine Benefits-Risks Balance

Abdulsalam Al-Ani .

Al- Anbar Medical Journal, 2021, Volume 17, Issue 2, Pages 46-48
DOI: 10.33091/amj.2021.171068

Since the emergence of coronavirus disease 2019 (COVID-19), the SARS-CoV-2 virus (the causative agent of the disease) has spread and imposed an enormous health burden worldwide. As of 27 July 2021, almost 200 million people were infected with more than 4 million deaths globally (according to WHO Coronavirus Dashboard, https://covid19.who.int/table). Although many treatment modalities have been used or still under trials all over the world, no specific treatment was found to cure or prevent the disease development. Therefore, immunization was regarded the best choice to prevent the development of the disease or at least reduce morbidity and mortality. Using the concept of herd immunity; that; with a threshold at 60 to 70% of the all population gaining immunity through previous exposure to the virus or by vaccinations; can control a very contagious disease. Owing to COVID-19 serious complications and millions of deaths worldwide with a great impact on the health care system, natural infection is an unsuitable option to reach population protection [1]. 

Robotic-Assisted Removal of Parapharyngeal Space Tumor via a Retro-auricular Approach: A Case Report

Kalpana Nagpa .; Suresh Singh Naruka .; Nishant Rana .; Sumaid Kaul .

Al- Anbar Medical Journal, 2021, Volume 17, Issue 1, Pages 37-40
DOI: 10.33091/amj.2021.171064

Parapharyngeal space (PPS) tumors are rare and excised most commonly via the transcervicalapproach. A female patient presented with a left side neck swelling of size 5cm x 4cm, progressivelyincreasing in size. Radiologically a well-defined soft tissue intensity mass lesion in left parapharyngeal space (PPS) was noted suggesting paraganglioma (Schwannoma). Resection of the tumorwith robotic assistance via the retro-auricular approach was planned and resected. The roboticassistance resection of PPS mass via retro-auricular tunnel has the advantages of lessening theextent of dissection and better instrument access eliminating blind dissection.

Value of Shear Wave Elastography in Discriminating Category IV Breast Lesions According to Breast Imaging-Reporting and Data System

Mohammed Abd Kadhim; Noor Yousif Abed

Al- Anbar Medical Journal, 2022, Volume 18, Issue 1, Pages 21-26
DOI: 10.33091/amj.2021.174526

Background: Breast cancer is the second cause of cancer death in women. Shear wave elastography (SWE) is an ultrasound (US) procedure that can improves the sensitivity and the specificity in the diagnosis of breast lesions.
Objective: To evaluate the value of SWE to discriminate benign from malignant Breast Imaging-Reporting and Data System (BI-RADS) IV breast lesions.
Materials and Methods: A cross sectional analytic study was done in the Radiology Department, Oncology Teaching Hospital, Baghdad Medical City, Baghdad, Iraq. The study period was one year (February 2020 to January 2021). The study included 42 female patients with suspicious breast lesions in the group BI-RAD 4 by mammography and US. Shear wave elastography was done for all patients. The final diagnosis of all breast lesions were done by fine needle aspiration cytology or true cut biopsy or excisional biopsy.
Results: The final histological diagnosis showed that 23 (54.8%) of study patients were with benign breast lesions. There was a statistically significant association between the quality of SWE and histopathological diagnosis as the proportion of malignant breast lesions was significantly higher among the patients with score 5 (homogenous dark blue) images (85.7%, P= 0.004). Subjectts with malignant lesions had a significantly higher mean of E-mean SWV than those with benign lesions (133.8 versus 75.47 kPa, P = 0.001). The best cut point of E-mean SWV was 83 kPa (E-mean SWV > 83 kPa is predictive for malignant lesion of breast) with 89.5% sensitivity, 60.9% specificity, and 73.8% accuracy.
Conclusion: SWE have a significant diagnostic value in differentiation of BI-RADS IV breast lesions into benign and malignant in both qualitative and quantitative patterns. The best cut off value in SWE is 83 KPa for E-mean.

Lactose Free-Milk for Young Children with Acute Diarrhea, Western of Iraq

Wisam Z. Al-Dulaimy .; Mohammed K. Al-Sabeea .; a, Muneam A. Ayyed .; Rafi Khaleel Al-Ani .

Al- Anbar Medical Journal, 2021, Volume 17, Issue 2, Pages 68-71
DOI: 10.33091/amj.2021.171073

Background: Secondary lactose intolerance occurs commonly from intestinal inflammation following infection recommending avoidance of milk contains lactose.
Objective: To identify the role of lactose-free milk (LFM) in the treatment of acute diarrhea in children ≤ 2 years in Al-Ramadi Maternity and Childhood Teaching Hospital in Ramadi city, Iraq.
Material and methods:  A single-blind randomized controlled trial study was done on babies ≤ two years old who presented with acute diarrhea. Two hundred cases were chosen randomly, 100 of them were received LFM added to the regime of management of diarrhea (group A), and the other 100 cases were received ordinary formula milk (OFM) (group B). Babies who were breastfeeding, those with chronic or bloody diarrhea, and those who received antibiotics were excluded from this study. Data about age, gender, the response ( stopping diarrhea), and its duration within 3 days were recorded.
Results: The response of stopping diarrhea after 3 days among group A was 89%, while group B was 67%. There was a highly statistically significant difference between the 2 groups (P-value = 0.001). Out of 44 babies in the age group 0-6 months in group A, there were 42 (95.4%) who respond to therapy, and it was the highest age group affected. There was a high statistically significant difference (P-value = 0.003) between the rate of response and the age group in group A. However, there was no significant difference (P-value > 0.05) between the gender and the response rate. Moreover, there was no significant difference (P-value >  0.05) between the rate of response and the age and gender of the babies in group B. There was a statistically significant difference (P-value<0.05) between group A and B concerning the mean duration of response (55.06 hours ± 11.304 in group A, and 63.58 hours ± 8.727 in group B).
Conclusion: There were a high response rate and rapid response among young children with acute diarrhea after giving LFM in comparison with OFM. 

The Effect of Sweet-tasting Foods Addiction on Appetite-related Hormones among Obese Adolescents

Nour Shakir Rezaieg

Al- Anbar Medical Journal, 2022, Volume 18, Issue 1, Pages 15-20
DOI: 10.33091/amj.2021.174525

Background: Food ingestion and energy spending are organized through a complicated neurological system that involves both hypothalamic centers and peripheral satiety regulation (gastrointestinal and pancreatic hormones).
Objectives: To assess the effects of sugar addiction on appetite-related hormones and metabolic hormones.
Material and Methods: The study was done in two main hospitals in Anbar governorate, Iraq from April 2020 to November 2020. Concentration of fasting blood glucose (FBG), insulin, hormone insulin resistance (HOMA-IR), leptin, ghrelin, lipid profile, TSH, T3, and T4 were measured in the 54 obese adolescents and were compared with 54 normal-weight adolescents.
Results: There was a significant increase in the concentrations of FBG, insulin, HOMA-IR, leptin, total cholesterol (TC), triacylglycerol (TAG), low-density lipoprotein cholesterol (LDL-C), and TSH in obese adolescents as compared to normal-weight adolescents (P-value < 0.05). While there was a significant (P < 0.05) decreased in the concentrations of ghrelin, high-density lipoprotein cholesterol (HDL-C), T3, and T4 in obese adolescents compared with normal-weight adolescents. The results also showed that there is a significant positive correlation between the concentration of leptin and each of BMI,  FBG, insulin, and HOMA-IR, while there was a significant negative association between leptin level with HDL-C and ghrelin.
Conclusion: Sweet-tasting meals are a major source of stimulation, which leads to overeating and thus leads to obesity. 

Rh Blood Group Positive Newborn of Rh Blood Group Negative Parents, Why, and How?

Yahya Ethawi; Mona Kahalf; Rola Al Zir

Al- Anbar Medical Journal, 2020, Volume 16, Issue 2, Pages 28-30

The proteins of Rhesus (Rh) antigens are transmembrane proteins. The main antigens are D, C,E, c, and e, which are encoded by two adjacent gene loci. The presence or absence of RhD allele ina person is typed either positive or negative, represents by a suffix (+/-) after the ABO type. Theantigenicity of Rh antigen is guarded by many factors, for example, the molecular weight of theantigen and the antigen being accessible to the antibody. Rh phenotypes can be identified by thepresence or absence of the Rh surface antigens. The Rh antigen protein represented by 2 allelesat the specific gene locus. Rh-negative positive person can be homologous have 2 RhD alleles orheterozygous having RhD and Rhd alleles. Therefore, Rh positive parents can have Rh-negativechildren if both are Rh heterozygous. At the same time, Rh negative parent can have Rh positivechildren if both parents genotypically are positive but phenotypically are negative. They will testnegative on antigenicity testing but on DNA testing they are actually RhD positive. Thus theywill give the allele to their baby. If the baby expressed the RhD antigen on the surface will bephenotypically and genotypically positive.

Types and Clinical Profile of Unilateral Sinonasal Masses

Ammar H. Khammas; Husam S. Hameed; Firas J. Alobaidy

Al- Anbar Medical Journal, 2022, Volume 18, Issue 1, Pages 1-4
DOI: 10.33091/amj.2022.174522

Background: Unilateral mass in the sinonasal region is a common problem facing the otolaryngologist in daily clinical practice. There are various benign and malignant conditions originating in this area with different clinical features depending on their nature and extent.
Objectives: To evaluate the types and clinical profile of unilateral sinonasal masses.
Materials and methods: This study includes 60 patients who attended the outpatient clinic at Alyarmook Teaching Hospital, Baghdad, Iraq, between January 2017 and April 2018. A thourough history from each patient was taken. Moreover, the clinical examination was done according to standard clinical practice. The imaging results of the nose and paranasal sinuses were documented. Then biopsy was taken from the mass at the operating room under local or general anesthesia if indicated. The specimen was sent for histopathological examination and the results were documented on the data collection sheet. The patients were divided into two groups: non-neoplastic and neoplastic according to the histopathological results.
Results: Out of 60 patients, there were 36 (60%) males. The age of our cases was ranged from 6 to 79 years with a mean age of 34.20 ± 18.126 years. Non-neoplastic causes were (n=38, 63.3%) more than the neoplastic group, and the majority of them were unilateral simple polyp (n=23, 38.3%). Inverted papilloma was the most common benign tumor (n=8, 13.3%), while, squamous cell carcinoma was the commonest malignant neoplasm (n=2, 3.3%). Non-neoplastic causes were more in both sexes. The most affected age group was 20-49 years (n=31, 51.7%). The non-neoplastic causes were mostly seen in the age group 20-49 years (n=22, 36.7%). There was no statistically significant difference between the age and gender and the causes of unilateral sinonasal lesions (P-value > 0.05). Nasal obstruction, nasal discharge, and hyposmia were more in non-neoplastic than neoplastic group. While epistaxis and facial pain were found to be higher in the neoplastic group.
Conclusion: Non-neoplastic masses outnumber neoplastic ones. Among non-neoplastic lesions, inflammatory polyps were the most common. Benign neoplasms outnumber the malignant neoplasms with inverted papilloma and squamous cell carcinoma were the most common respectively.

Keyword Cloud