Volume 15, Issue 1, Winter and Spring 2019, Page 1-23

Pulse Pressure Index as a Discriminator of Predicting the Cardiovascular Events in Hypertensive Patients Treated with Drugs Acting on Angiotensinogen-Angiotensin Pathway

Marwan S. Al-Nime; Ismail I. Hussein; Yagub S. Saleh

Al- Anbar Medical Journal, 2019, Volume 15, Issue 1, Pages 1-5

Background: Pulse pressure index as a function of pulse pressure divided by systolic blood pressure served a useful predictor of cardiovascular events. Objectives: Our aim was to assess the pulse pressure index as a discriminating variable of predicting cardiovascular events in untreated hypertensive patients and treated with one member of angiotensin converting enzyme inhibitors or angiotensin receptor blockers by using the scores of Framingham study. Materials and methods: 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). Results: 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. Conclusion: The pulse pressure index is a useful discriminator of predicting cardiovascular events, and it will improve the Framingham prediction risk among hypertensive patients

Odontogenic Infections: Etiology and Management

Ahmed Jassam Al-Naqeeb; Hala Jassam Mohammed Al-Naqee

Al- Anbar Medical Journal, 2019, Volume 15, Issue 1, Pages 6-9

Background: Odontogenic infection is a common problem facing the dentist and maxillofacial surgeon in their daily practice. Objectives: To determine the involved fascial spaces, the pathogenic bacteria and their antibiotic sensitivity in order to guide clinicians in proper management of odontogenic infections. Materials and methods: 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. Results: 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. Viridans streptococci was the predominant bacteria (42.42%), while the least isolated bacteria was Fusobacterium spp (9.1%). The isolated bacteria were highly susceptible to azithromycin (87.87%) and least susceptible to amoxicillin (39.39%). Conclusion: 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.

Study of Awareness and Practice of Folic Acid Intake among Iraqi Women

Badeaa T. Yahyaa

Al- Anbar Medical Journal, 2019, Volume 15, Issue 1, Pages 10-15

Background: 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. Objectives: To study the knowledge, attitude and practice (KAP) of women at childbearing age regarding folic acid intake. Materials and methods: A descriptive cross sectional study was conducted at the second 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. Results: 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. Conclusion: 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 community.

Efficacy, Safety and Predictors of Response to Rituximab in Treatment of Iraqi Patients with Active Rheumatoid Arthritis

Sarah Tareq Abdulazeez; Sami Salman; Faiq I. Goria

Al- Anbar Medical Journal, 2019, Volume 15, Issue 1, Pages 16-21

Background: Rituximab (RTX) is an anti-CD20 chimeric monoclonal antibody which effectively depletes B cells and is used for treating rheumatoid arthritis (RA). Objectives: 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. Materials and methods: 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. Results: 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. Conclusion: RTX is effective both clinically (CDAI and F Class) and laboratory (ESR). It is more effective in patients who are not smokers, and 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.