Issue 1

The Utility of Platelets Indices and Other Blood Parameters in Gynecological Diseases

Wassan Nori; Alaa Ibrahim Ali; Roaa Mokram Hamed

Al- Anbar Medical Journal, 2021, Volume 17, Issue 1, Pages 3-8

Platelets are circulating cells known for their contribution to hemostasis, coagulation, protectingthe blood vessels integrity, and wound healing. In the last decade, increasing evidence has linkedplatelets to activities beyond that. Platelets have been implicated in many physiological andpathological conditions involving immunity, inflammation, and even malignant tumors. Their rolehas been evaluated both as prognostic and diagnostic markers. Interestingly, platelets communicatewith each other through a range of cytokines and interleukins secreted by their intracellular granulesonce activated or triggered. The understanding of this sophisticated mechanism of secretion andthe genetic guidance of granule biosynthesis remained unclear. Complete blood count and itsparameters are informative and affordable diagnostic tests as they highlighted platelet counts,plateletcrit, platelet indices; mean platelet volume, and platelet distribution width. Recently,increasing evidence suggests that implementing these parameters is a useful biomarker in the field ofgynecology. Their role in obstetrics has been discussed in many studies, especially in hypertensivediseases, diabetes, abnormal fetal growth pattern, and early pregnancy loss. This review outlinesthe role of platelets and their indices in Gynecological disease

Impact of the COVID-19 Pandemic on Cancer Care in Iraq: Exploratory Research

Ahmed K. Ahmed .; Mohammad Omar Farouq Alkaiya .; Hoda Jrad .; Abdul Rahman Jazieh .; Layth Mula-Hussain .

Al- Anbar Medical Journal, 2021, Volume 17, Issue 1, Pages 9-15

Background: The COVID-19 pandemic has a tangible impact on the health care systems globallyand is represented by interruption of the usual services in many health facilities and exposingvulnerable patients to significant risks.Objectives: We aimed to evaluate this pandemic’s impact on Iraq’s cancer care.Materials and methods: We conducted an exploratory study using a validated web-basedquestionnaire of 51 items. The questionnaire collected information on the capacity and servicesoffered at the Iraqi cancer centers, the magnitude of care disruption, reasons for the disruption,challenges faced, patient harm estimation, and the interventions implemented during the pandemic.Results: 18 cancer centers from 11 Iraqi governorates took part between 21st April and 8th May2020. These centers were serving around 18,867 new patients per year. Most of them (72.2%)were facing challenges in delivering their care during the pandemic. Although 44.4% of the centersreduced their services as part of a pre-emptive strategy, other reported reasons included lack ofpersonal protective equipment (22.2%), an overwhelmed system (11.1%), and a restricted approachto medications (11.1%). Missing at least one therapy cycle by > 10% of the patients was reportedin 38.9% of the centers. Participants have reported that their patients were exposed to potentialharm from interruption of cancer-specific care (44.4%) and non-cancer-related care (33.3%).Conclusion: The negative impact of the COVID-19 pandemic on cancer care in Iraq is evident.Additional research to estimate such an effect at the patients’ level and the required measures tocounteract this problem is vital.

The Significance of Blood Eosinophilia in Atopic Dermatitis

Naeem N. Alhayan .; Jaafar S. Alkubaisi .

Al- Anbar Medical Journal, 2021, Volume 17, Issue 1, Pages 16-19

Background: Atopic dermatitis (AD) is chronic relapsing, pruritic, inflammatory skin disease. Itusually accompanies other atopic problems like asthma and allergic rhinitis. Eosinophil plays a rolein patients with AD.Objectives: To assess blood eosinophils in patients with AD and to evaluate the factors that areaffecting the blood eosinophilia.Materials and methods: This prospective study was conducted at Hit General Hospital in theperiod from October 2018-October 2019. The age, gender, and personal or family history of asthmaor allergic rhinitis of the patients with AD were recorded. The severity of the disease was assessedby the SCORAD score. The total number of eosinophil was measured for each subject. The datawere analyzed using SPSS version 22.Results: Out of 70 patients with AD, 38 (54.3%) were females, and 32 (45.7%) males. The age ofthe patients ranged from 8 months to 30 years (mean 7.59±7.40). The highest age group affectedwas 2-12 years 40 (57.1%). The SCORAD score ranged from 6-80 (mean 24.19±17.59). Themajority of our patients with mild course 50 (71.1%). The majority of the cases were without ahistory of asthma (n=53,75.7%), and around 50% without allergic rhinitis. The range of eosinophilcount was 42-3360 (mean 636.44±491.37). The majority of the subjects (n=53,75.7%) with mildeosinophilia (500-1500/ mm3). The age, gender, and patients with a history of allergic rhinitis orasthma had no significant effect on the number of eosinophils (P-Value >0.05). While, there wasa high statistically significant difference between the eosinophils count, and the severity of AD(P-Value=0.000).Conclusion: From these findings we concluded that blood eosinophilia is a relatively commonlaboratory finding of AD. Blood eosinophilia was influenced by the severity of AD.

Evaluation of Antimicrobial Activity of Plants Extract Against Bacterial Pathogens Isolated from Urinary Tract Infection among Males Patients

Mais E Ahmed .; Makarim Q. Al-lam; d Dina M Abd Ali .

Al- Anbar Medical Journal, 2021, Volume 17, Issue 1, Pages 20-24

Background: Urinary tract infection (UTI) is a considerable problem affecting the health of peopleeach year. It is caused by various Gram-positive (G+ve) and Gram-negative (G-ve) pathogens. Itis an important illness in the world affecting all age groups across their life span.Objectives: To identify the most common aerobic bacteria that cause UTIs and their antibioticsusceptibility and antimicrobial activity of plant extracts of the males’ patients.Materials and methods: The study involved 35 midstream urine samples from the male students(University of Baghdad, Baghdad, Iraq) with suspicious symptoms of UTI, during the period fromJanuary-March 2018. Each urine sample was cultured first on Mannitol Salt Agar and MacConkeyagar plates to differentiate between G+ve and -ve bacteria. The isolated bacteria were subjectedto certain antibiotics and 100% plant extract oils.Results: Out of 35 urine samples, there were 62 isolates. There were 34 (54.8%) G-ve and28 (45.2%) G+ve pathogens. Staph. epidermidis (n=17, 27.4%) was the most common isolatedpathogen, while P. aeruginosa (n=5, 8.1%) was the least isolated organism. Vancomycin wasthe most sensitive antibiotic for the Staph. epidermidis (52.9%) and Staph. epidermidis (45.5%).While oregano oil was more sensitive to Staph. epidermidis and Staph. aureus in 64.7% and 63.6%respectively. Imipenem was the most effective antibiotic for the three common G-ve isolates E. coli,K. Pneumoniae, and Enterobacter spp in 83.3%, 90%, and 85.7% respectively. Oregano oil was themost susceptible plant extract for E. coli (91.7%).Conclusion: Plants oils are potentially a good source of antimicrobial agents. Besides, the plantextract oils are cheaper than antibiotics. Therefore, they could be used in UTI medicine.

Prevalence of Attention Deficit Hyperactivity Disorder among Primary School Children in Tikrit City, Iraq

Rafi Khaleel Al-Ani .; Mahmood M. Al-Sumiadai .; Abdalkadir I Abdulla .; Ashoor R. Sarhat .

Al- Anbar Medical Journal, 2021, Volume 17, Issue 1, Pages 25-29

Background: Attention-deficit/hyperactivity disorder (ADHD) is the most widely recognizedneurobehavioral problem of children, which can interfere with the social and academic level.Objectives: To detect the prevalence of ADHD among primary school students in Tikrit city,Iraq, and to find the effect of the disease on school performance.Materials and methods: A cross-sectional study was done among students in 6 primary schoolsfor boys and girls during the studying year 2012-2013. The criteria of diagnosis were done accordingto the American Psychiatric Association. Students who fulfill the criteria were included andthe following parameters were studied including age, gender, family history, mother education,socioeconomic status of the family, and school performance.Results: The prevalence rate of ADHD in this study was 8.67%. Boys were mostly affected (65%).Most of them were under 9 years old (49%). Inattention subtype was mostly found in this study(38%) followed by combined (34%) and then hyperactive (28%). Positive family history was foundin (43%) of cases. The education level of their mothers was intermediate or secondary school level(37%). The majority of the cases were from the middle socioeconomic status (53%). Poor schoolperformance was seen in 69% of the cases.Conclusion: ADHD is a big problem among students of primary schools in Tikrit city with asignificant effect on the academic state

The Outcome of Sacrococcygeal Teratoma: A Multicenter Study in Iraq

Saad S Yousif .; Arkan H Ahmad .

Al- Anbar Medical Journal, 2021, Volume 17, Issue 1, Pages 30-34

Background: Sacrococcygeal teratoma (SCT) is one of the most common solid tumors in theneonate. They are more common in females and presented as sacral masses. They require an earlysurgical resection with regular follow-up.Objectives: To evaluate the SCTs regarding the perinatal variables, clinical characters, pathological features, management options, and outcome.Materials and methods: A prospective study of 37 patients with SCTs were admitted topediatric surgery departments in Ramadi (west of Iraq) and Mosul city (north of Iraq) during theperiod from December 2013 to December 2018. The detailed data of each patient were recordedand analyzed including history, physical examination, investigations, management, and follow-up.Results: There were 23 (62%) females and 14 (38%) males. The ages were ranged from 1 dayto 2 years. Fifty-one percent were diagnosed prenatally by ultrasound and 30% of them weredelivered by Caesarean section. Among the neonatal age group (28 patients),75% were born at fullterm, their median birth weight was 3100 g. Associated anomalies were 3%. Plain X-ray of thetumors was revealed calcification in 22%. The serum α-fetoprotein level was high at presentation.According to Altman classification, there were type I 54%, type II 40%, type III 3%, and type IV3%. Ninety-seven percent was presented as sacral mass and only 3% was presented with urinarytract obstruction. One (3%) was died a few hours after labor due to the rupture of the tumor.Surgical intervention was performed in 94% of patients. Macroscopically, 59% were mixed, 22%solid, and 19% cystic. Histologically, 92% had mature teratoma, 3% immature, and 6% malignantteratoma. Wound infection occurred in 10%, wound dehiscence in 3%, and poor cosmetic scar in8%. One (3%) patient had a recurrence.Conclusion: The proper management are important factors affecting the outcome in the perinatalperiod and early diagnosis with complete excision of the tumor. The size of the primary tumordoes not affect the recurrence and the outcome

Interesting Progression of COVID-19 Related Pneumonia

Maythem A. Al-Kaisy .

Al- Anbar Medical Journal, 2021, Volume 17, Issue 1, Pages 35-36

COVID-19 is a newly emerging viral disease, the pandemic had major repercussions on human life,economy, and travel. Although multiple management guidelines are proposed none of them provedto be efficacious. Most of the patients have a good prognosis according to multiple studies andfew will undergo management in intensive care settings. The disease mainly affects the respiratorysymptoms destroying lung tissues bilaterally but may also affect other organs like kidneys, liver,heart, and brain. Here we present a case of a young man who had COVID-19 pneumonia bilaterallybut mainly on the left lung. The patient needed mechanical ventilation with a long hospital stay.He was later discharged in a good condition to be admitted again after 1 week for flu-like symptomsand lung changes consistent with COVID-19 pneumonia in the right lung. The study demonstratesthe unpredictability of the progression of the viral illness that even patients deemed stable and fitfor discharge need more monitoring and further studies to manage the emerging complications thatmay arise in the rehabilitation period.

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

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.

Renal Cell Carcinoma with Polycythemia

Asaad I Othman .; Nabeel M Al-Hamamy .; Saud Al-Jumaly .

Al- Anbar Medical Journal, 2021, Volume 17, Issue 1, Pages 41-43

Renal cell carcinoma (RCC) is the most common renal tumor and participates in about 80-85%of primary renal tumors. It is usually diagnosed incidentally during the evaluation for othermedical problems; or it may be presented with gross hematuria, loin mass or pain. However, itinfrequently presents as a paraneoplastic syndrome (PNS) which includes, hypertension, hypercalcemia, and abnormal liver function. A 75-year-old gentleman presented with an incidentalleft renal mass following the evaluation of the left loin pain with headache and dizziness. Thepatient had a history of hypertension for 10 years on control medical therapy and no history ofsmoking or chronic obstructive airway disease. The complete blood picture was showed a markedelevation in hemoglobin 21.7 g/dl and hematocrit level 65%. Ultrasound was showed left renalmass and a computerized tomography scan was showed the enhancement in the left renal masspicture suggestive of RCC. After phlebotomy of 2 units of blood, the patient underwent radicalnephrectomy, then the histopathology was reported clear cell type RCC Fuhrman nuclear gradingsystem II. At 2 months following surgery, the patient’s hemoglobin level and hematocrit werereturned to normal. The pathogenesis of PNS may be due to an abnormal immune system responseto a cancerous cell. There is a wide range of the PNS concerning RCC including non-specificconstitutional features for example; cachexia, weight loss, and fever, and specific metabolic andbiochemical disorders (i.e. hypercalcemia, non-metastatic hepatic dysfunction, amyloidosis, etc.).PNS is often unrecognized but polycythemia should be considered important biomarkers in RCC,therefore, it can be used as a tumor marker in the diagnosis and follow-up of the patient after surgery.