Print ISSN: 2706-6207

Online ISSN: 2664-3154

Volume 18, Issue 1

Volume 18, Issue 1, Winter and Spring 2022, Page 1-52

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.

Modes of Transmission of Brucellosis in Anbar Governorate, Iraq

Hani Y. Danhash; Rafi Khaleel Al_Ani; Maher S. Khaleel

Al- Anbar Medical Journal, 2022, Volume 18, Issue 1, Pages 5-9
DOI: 10.33091/amj.2022.174523

Background: Brucellosis is a common and endemic disease in the Anbar governorate. Besides,
the Brucella microorganism has different ways of transmission.
Objectives: The study aimed to determine the ways of transmission of Brucella organisms to
human beings in the Al-Anbar governorate.
Materials and methods: A retrospective study was carried out on patients visiting the two main
Ramadi Teaching Hospitals in Ramadi city, Iraq for the diagnosis and treatment of Brucellosis.
Patients with blood-culture-positive brucellae were enrolled in the study. The study included
the period between February 2002 and March 2005. Data were collected and recorded regarding
age, gender, and residence. The possible ways of acquiring the disease were recorded too. These
included ingestion of possibly contaminated foods, butchering of animals, meat cutting, keeping
animals in homes or nearby their livings, cleaning animal places, caring for, milking of them, aiding
in their delivery and if they wear gloves, blowing in the mouth of delivered fetuses, their work, and
possible laboratory worker exposure.
Results: A total of 312 patients with brucellosis were enrolled in the study. The disease appears
to be more common in rural areas (P-value
<0.001). More cases were females in all age groups,
and it was more common in the age group 31-40 years. The main mode of transmission is direct
or indirect contact with infected domestic animals (P-value
<0.001). Lab workers and ingestion
of raw milk and unsafe milk products were the least recorded expected risk for infection. Three
risky behaviors for acquiring brucellosis were also recognized in this study: milking animals, aiding
domestic animals in delivery, and blowing in the mouth of delivered fetuses to promote breathing
of the newly delivered animals.
Conclusion: Direct or indirect animal contact was the main way of Brucella transmission in the
Al-Anbar governorate

Effect of Preoperative Alpha-Blocker in Ureteroscopy for Ureteral Stones: A Case-Control Study

Asaad I Othman; Nabeel M Al-Hamamy

Al- Anbar Medical Journal, 2022, Volume 18, Issue 1, Pages 10-14
DOI: 10.33091/amj.2021.174524

Background: Urothethiasis is the most common urinary tract disease with a global prevalence
rate of 2-20%. Alfa-blocker has a relaxation effect on the smooth muscles of the ureter making the
removal of ureteric stone easier during the ureteroscopic procedure.
Objectives: To evaluate the effect of preoperative -adrenoreceptor antagonists therapy (tamsulosin) in the treatment of ureteral stone using a ureteroscope regarding operative time, access to
the ureter, and the complication rate.
Materials and methods: A prospective case-control study was conducted at Al-Jamhory
Teaching Hospital, Mosul, Iraq. During the period from June 2019 to August 2020. Subjectts with
ureteral stones (7-15 mm) scheduled for ureteroscopic intervention were enrolled in the study. The
patients were classified into two groups, the first group was received a pre-operative alpha-blocker
(tamsulosin 0.4 mg capsule per day for 7 days), and the second group (Control) did not receive
further medication. The operative time, uretric access, and intra- and postoperative complications
were registered for both groups.
Results: There was a matching between the two groups regarding the age, gender, and side, size,
and location of the ureteric stones. There was a statistically significant difference between the two
groups regarding the operative time (23.2
± 4.569 minute in the treated group vs. 25.48 ± 4.904
minute in the control group) (P-value = 0.009). Besides, the ureteroscopic operation was easier
(P-value = 0.031) in treated group (n = 51 easy case, 85%) than the control group (n=41, 68.33%
easy case). The intraoperative and postoperative complications were mucosal injury, perforation,
bleeding, pain, hematuria, and fever. The total number of complicated cases was 14 (23.33%) in
the treated group and 25 (41.66%) in the control group, and there was a significant difference
between the two groups (P-value = 0.032).
Conclusion: The study revealed that the preoperative alpha-blocker tamsulosin was improved the
outcome of ureteroscopy (shorter operative time, easier access to the ureter, and low complication

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
Materials 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

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.
Objectives: 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
> 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.

Awareness of Gout and Hyperuricemia in a Sample of the Adult Population in Iraq

Shaimaa K. Jubair; Sami S. Shihab; Naqaa A. Mousa

Al- Anbar Medical Journal, 2022, Volume 18, Issue 1, Pages 27-32
DOI: 10.33091/amj.2022.174527

Background: Gout is the most common type of inflammatory arthritis in men and postmenopausal
women. The incidence and prevalence of hyperuricemia and gout were increased all over the world
even among developed countries.
Materials and methods: A cross-sectional study was conducted at the Rheumatology Unit of
Baghdad Teaching Hospital in Medical City, Baghdad, Iraq from October 2020 to April 2021. A
total of 247 subjects were included in the study. Data were collected using a pre-constructed data
collection sheet by face-to-face individual interviews. The sheet includes demographic characteristics, gout-related questions regarding the etiology, suspected predisposing agents, complications,
diagnostic methods, food-related, clinical manifestations among studied cases, and attitudes of the
gout patients among the study sample.
Results: Of 247 subjects, there were 67.2% (n = 166) males, 27.9 (n = 69) from the age group
40-49 years, 36.4% (n = 90) from Baghdad city, 25.5% (n = 63) university graduates, 19.9% with
good income, 70.5 (174) employed, 221 (89.5%) married, 85% (n = 210) non-smokers, and 8.9%
(n = 22) with family history of gout. Overall, 59 (23.9%) of the participants had a high level of
awareness whereas low awareness levels accounted for 41.3% (n = 102). The awareness level showed
a statistically significant association with education level, occupation, economic status, smoking
habit, family history of gout, and patients with gout (P-value
< 0.05).
Conclusion: There was a high proportion (41.3%) of the participants with a low level of awareness
about gout and hyperuricemia. The awareness level among the participants was related to the
education level, occupation, economic status, smoking habit, family history of gout, and patients
with gout.

Impact of COVID-19 Pandemic on Antenatal Healthcare in Al-Ramadi city, Iraq

Haifa G. Al-Ani

Al- Anbar Medical Journal, 2022, Volume 18, Issue 1, Pages 33-36
DOI: 10.33091/amj.2022.174528

Background:Antenatal care (ANC) is a form of preventive medicine, pregnancy-specific, and
general health advice effectively given in the antenatal period. ANC is conducted by healthcare
personnel on pregnant women at regular intervals to protect and improve maternal and neonatal
Objectives: The study aimed to know if the COVID-19 pandemic affects the coverage rate of
ANC visits of pregnant women.
Materials and methods: This is a retrospective cross-sectional study conducted at Al-Andalus
Primary Healthcare Center which is located in the center of Al-Ramadi city, Iraq. We reviewed the
records of all ANC first, second, and total visits of the months February, May, and October during
the years 2019, 2020, and 2021.
Results: The study showed the coverage rate of ANC visits was statistically significantly declined
with the restrictions imposed in response to the COVID-19 pandemic. At the end of 2021, there
are some elevation in the coverage rate of ANC visits. .
Conclusion: The study concluded that the lockdown period in the pandemic state due to
COVID-19 led to a significant decline in the coverage rate of ANC visits.

A Comparison of Patients’ Satisfaction after Functional and Camouflage Orthodontic Treatments in cl II Malocclusion

Luay Ali Zaidan; Nisreen M. Saleh

Al- Anbar Medical Journal, 2022, Volume 18, Issue 1, Pages 37-42
DOI: 10.33091/amj.2022.174529

Background: Functional and camouflage orthodontic treatments in cl II malocclusions are
different treatment methods that are usually used in orthodontic practice. A comparison of
patients’ satisfaction with these two treatment groups is an important tool for the evaluation of
treatment outcomes.
Objectives: We aimed to compare patients’ satisfaction with orthodontic treatment subjectively
(according to the opinion of patients) between functional and camouflage orthodontic treatments
in patients with class II malocclusion.
Materials and methods: The sample of the study was formed from individuals whose treatments
were finished between February 2017 and July 2020 at the Department of Orthodontics, Faculty
of Dentistry at Suleyman Demirel University, Turkey. A satisfaction questionnaire was used to
evaluate the satisfaction of the patients with the treatment process at the end of their treatment.
The subjects of the study were selected from 2 genders and a total of 146 cases of average age 11-22
years. The research material consists of a satisfaction questionnaire that was given at the time of
treatment end.
Results: The general satisfaction questionnaire score was found to be higher in the patients
who received functional orthodontic treatment (P-value = 0.011). In the subgroups, the total
questionnaire scores among the treatment subgroups were found to be quite similar.
Conclusion: In our study, the satisfaction level of the quality of life questionnaire was found
to be high, while in response to more specific questions on satisfaction, some departments of the
questionnaire found less satisfaction or dissatisfaction in patients.

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
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
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.

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 65year-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.