University of AnbarAl- Anbar Medical Journal2706-620715120190601Pulse Pressure Index as a Discriminator of Predicting the Cardiovascular Events in Hypertensive Patients Treated with Drugs Acting on Angiotensinogen-Angiotensin Pathway1517087910.33091/amj.2019.170879ENMarwan S. Al-NimeCollege of Medicine, Al-Mustansiriya University, Baghdad, IraqIsmail I. HusseinCollege of Medicine, Al-Mustansiriya University, Baghdad, IraqYagub S. SalehDepartment of pharmacology, College of Medicine, University of Anbar, Ramadi, Anbar, IraqJournal Article20170905<strong>Background</strong><em>:</em> Pulse pressure index as a function of pulse pressure divided by systolic blood pressure served is a useful predictor of cardiovascular events<strong>.</strong><br /> <strong>Objectives</strong>: Our aim was to assess the pulse pressure index as a discriminating variable of predicting cardiovascular events in untreated or hypertensive patients and treated with one member of angiotensin converting enzyme inhibitors or angiotensin receptor blockers by using the scores of Framingham study.<br /> <strong>Materials and methods:</strong> This observational cross-sectional study, including 140 patients who grouped into; Group I (n = 30): untreated hypertensive patients; Group II (n = 60): patients treated with angiotensin receptor blockers; and Group III (n = 50): patients treated with angiotensin converting enzyme inhibitors. Anthropometric measurements, lipid profile, and blood pressure were determined. The probability of ten-year of cardiovascular events was calculated according to the Framingham study scores using The University of Edinburgh Cardiovascular Risk Calculator (http://cvrisk.mvm.ed.ac.uk/calculator/calc.asp).<br /> <strong>Results: </strong>There is a non-significant difference between Groups and within Groups of age, smoking habit, and the values of the cardio metabolic risk factors. Pulse pressure index as an independent risk factor found to be a significant discriminator of 10-year prediction of cardiovascular events by using the receiving operating characteristic curves.<br /> <strong>Conclusion: </strong>The pulse pressure index is a useful discriminator of predicting cardiovascular events, and it will improve the Framingham prediction risk among hypertensive patients. https://amj.uoanbar.edu.iq/article_170879_ede6ed32f405035bcdd2127a19b882d9.pdfUniversity of AnbarAl- Anbar Medical Journal2706-620715120190601Odontogenic Infections: Etiology and Management6917088210.33091/amj.2019.170882ENAhmed Jassam Al-NaqeebDepartment of Oral and Maxillofacial Surgery, College of Dentistry, University of Anbar, Ramadi, Anbar, IraqHala Jassam Mohammed Al-NaqeeDepartment of Human Anatomy, College of Medicine, University of Anbar, Ramadi, Anbar, IraqJournal Article20170402<strong>Background: </strong>odontogenic infection is a common problem facing the dentist and maxillofacial surgeon in their daily practice.<br /> <strong>Objectives: </strong>To determine the involved fascial spaces, the pathogenic bacteria and their antibiotic sensitivity in order to guide clinicians in proper management of odontogenic infections.<br /> <strong>Materials</strong> <strong>and Methods: </strong>Pus samples were obtained from patients with odontogenic infections by needle aspiration or sterile swab at the time of abscess drainage. The samples were cultured aerobically and anaerobically conditions, followed by identification of bacteria using different biochemical tests and sensitivity test by disk diffusion method.<br /> <strong>Results</strong>: This study included (20) patients, (11) patients were male and (9) female. The submandibular space was the most commonly involved. A mixed facultative anaerobic and strict anaerobic growth was observed in the cultures. <em>Viridans streptococci </em>was the predominant bacteria (42.42%), while the least isolated bacteria was <em>Fusobacterium</em> spp (9.1%). The isolated bacteria were highly susceptible to azithromycin (87.87%) and least susceptible to amoxicillin (39.39%).<br /> <strong>Conclusion</strong>: Incision and drainage of involved fascial space with the removal of causative tooth and the use of appropriate antibiotic remain the ideal treatment option for odontogenic infection.https://amj.uoanbar.edu.iq/article_170882_464bb321196eb760fedd9ea3270f4140.pdfUniversity of AnbarAl- Anbar Medical Journal2706-620715120190601Study of Awareness and Practice of Folic Acid Intake among Iraqi Women101517088410.33091/amj.2019.170884ENBadeaa T. YahyaaDepartment of Community Medicine, College of Medicine, University of Anbar, Ramadi, Anbar, IraqJournal Article20170905<strong>Background:</strong> Folic acid supplementation before and during pregnancy reduces the risks of neural tube defects. WHO recommended that folic acid supplement of 400 µg should be taken daily by all women, from the moment they begin trying to conceive until 12 weeks of gestation.<br /> <strong>Objectives:</strong> To study the knowledge, attitude and practice (KAP) of women at childbearing age regarding folic acid intake.<br /> <strong>Materials and methods:</strong> A descriptive cross sectional study was conducted at the second<br /> Al-Adhamyia primary heath care center/ Baghdad from the 1st of January to end of February 2017. One hundred seventy married women at age 15-49 years were enrolled in the study. They were selected by non-probability convenient sampling technique. Data was analyzed using SPSS version 22.<br /> <strong>Results:</strong> Mean age of the study sample was 30.3 ± 8 years. The illiterate and the highly educated were 7 (4.1%) and 70 (41.1%) respectively. Their awareness regarding the folic acid need was 79%. About 61.2% knew its importance in pregnancy, while only 47.1% knew its benefit in pre pregnancy. The practice of folic acid in previous pregnancy was 76.5%, mainly started during the first month. More than half (57.7%) used it daily. Results also show that there is a significant association between knowledge (heard of folic acid and awareness of its importance) of women and age, education and parity.<br /> <br /> <strong>Conclusion</strong>: Knowledge regarding folic acid and its importance among women was fairly good. The practice was also satisfactory. However, more strategies are needed to increase the awareness about the preconception use of folic acid in our communityhttps://amj.uoanbar.edu.iq/article_170884_6bdb338c7e6066e23523bbabea50cf6c.pdfUniversity of AnbarAl- Anbar Medical Journal2706-620715120190601Efficacy, Safety and Predictors of Response to Rituximab in Treatment of Iraqi Patients with Active Rheumatoid Arthritis162117088610.33091/amj.2019.170886ENSarah Tareq AbdulazeezSami SalmanRheumatology Department, College of Medicine, University of Baghdad, Baghdad, IraqFaiq I. GoriaRheumatology Department, College of Medicine, University of Baghdad, Baghdad, IraqJournal Article20180112<strong>Background: </strong>Rituximab (RTX) is an anti-CD20 chimeric monoclonal antibody which effectively depletes B cells and is used for treating rheumatoid arthritis (RA)<strong>.</strong><br /> <strong>Objectives: </strong>To assess the efficacy and safety of RTX and to evaluate the predictors of response to RTX in the treatment of Iraqi patients with active RA.<br /> <strong>Materials and Methods:</strong> An open-labeled single group study that was conducted over 13 months in 65 patients with RA diagnosed according to a 1987 American College of Rheumatology (ACR) criteria. All patients were given 4 doses RTX by intravenous infusion over 6 months 1gm/dose. Each patient was followed at each visit of disease activity, including the Clinical Disease Activity Index (CDAI) and functional class (F Class). Also, we assess 9 different patients' characteristics (age, gender, disease duration, the presence of RF, presence of ACPA, smoking status, previous use of TNF-blocker, the use of methotrexate and BMI) as predictors to RTX.<br /> <strong>Results: </strong>Data analysis showed significant improvement in CDAI (P value=0. 005) and functional disability (P-value =0. 001), and ESR (P-value =0. 005) with RTX use over 6 months. The analysis also showed that smoking has a negative correlation with response to treatment (p-value = 0.005). A better response was seen in RF-positive group. The other variables had no effects on the response to treatment. The patients who switched from TNF-blocker were (29), and the patients who started on RTX were 36 (either due to positive Purified Protein Derivative of a tuberculin test (PPD) or unavailability of TNF-blocker), results showed same RTX efficacy in both groups.<br /> <strong>Conclusion: </strong>RTX is effective both clinically on F Class and on ESR. It is more effective in patients who are not smokers, in those who are seropositive for RF. RTX is relatively safe with few side effects, tolerable by most patients. The most common side effect is a transfusion reaction in the form of a sore throat.https://amj.uoanbar.edu.iq/article_170886_06a9f734f2b014839bf3a1c5321f2cb4.pdfUniversity of AnbarAl- Anbar Medical Journal2706-620715120190601Oral Exostosis222217088810.33091/amj.2019.170888ENOmar M. BargasDepartment of Surgery (Otolaryngology and Head and Neck Surgery),
College of Medicine, University of Anbar, Ramadi, Anbar, IraqJournal Article20190428A 62-year-old heavy smoker woman presented to the outpatient otorhinolaryngology clinic with a two week history of dysphagia. On routine examination, an incidental finding of a 2.5 cm hard mass that seems to be liberated in the midline of the hard palate. The mass is painless and it was noticed for a long time duration, but it doesn’t appear to be increasing in size or has a troublesome effect therefore it was neglected. Oral exostosis or torus palatinus is a benign bony outgrowths with a prevalence of around 27 out of 1000 adults, more common in female and in Asian people. The pathogenesis is thought to be genetically inherited. Torus palatinus usually requires no treatment, but surgical excision is required if it is symptomatic or affects the denture in edentulous individual.https://amj.uoanbar.edu.iq/article_170888_ea73198899075041d640f2918f1bbdc2.pdfUniversity of AnbarAl- Anbar Medical Journal2706-620715120190601Subungual Glomus Tumor of the Index Finger232317088910.33091/amj.2019.170889ENMohammed J. AlfeehanDepartment of Surgery (Plastic Surgery), College of Medicine, University of Anbar, Ramadi, Anbar, IraqJournal Article20190520 A 42-years- old male presented to the plastic outpatient clinic with severe agonizing pain in the fingernail of the right index finger of one-year duration. The pain was aggravated by movement, touch and cold weather, disturbing his sleep and work performance, and not responding to analgesia. On examination, there was only pinpoint tenderness in the lanula of the right index fingerwith no obvious abnormalities in the phalanx or nail. T2 weighted MRI revealed round, bright lesion subungually in area of lanula about 4 mm in diameter (Panel A) which goes with the diagnosis of the glomus tumor. An excisional biopsy was performed (Panel B). The histopathological study confirmed the diagnosis (Panel C). Glomus tumor is a painful benign tumor of the glomus body (digit thermoregulatory shunt) which accounts for 1- 4.5 % of tumors in the hand. The tumor characterized by 3 classical features (severe paroxysmal pain, sensitivity to cold, and localized tenderness), most of the affected subjects are suffering from at least two of them. Usually there are no abnormalities in the nail and finger or toe, females are more affected than males. The tumor is treated by surgical excision, but there is a 20% local recurrence rate and metachronous tumors. At follow-up during a one year, the patient reported no pain with some irregularity of the nail.https://amj.uoanbar.edu.iq/article_170889_b2ef64a0ed8db66e04924d8c6bf7d9bc.pdf