Caregivers’ Satisfaction toward Under-Five Health Care Services Provided at Primary Health Care Centers in Al Karkh, Baghdad, 2020

Background: Satisfied caregivers are more likely to return for further care and to recommend the primary health care center services to others. Satisfied caregivers usually are compliant with the medical provider advice and the recommended treatment plan. Compliance will eventually lead to better health outcomes. Method: A cross-sectional study with an analytic element was conducted during the period from the beginning of July to the end of September 2020. A convenient sample was collected from six primary health care centers in Al-Karkh side of Baghdad city where caregivers who attend those centers with their children for under-five health care services were interviewed using a structured questionnaire.Objective: To measure the caregivers’ satisfaction toward under-five health care services at primary health care centers in Baghdad Al-Karkh and their association with certain socio-demographic characteristics. Results: A total of 500 caregivers were interviewed during the study period, the overall satisfaction was (64%). Caregivers were satisfied with primary health care centers cleanliness (77.8%), while they were highly dissatisfied with the communication with the nurses (78.8%), with the waiting time for a routine visit (74.6%), with nurses’ antiseptic methods (59.2%), and with the availability and adequacy of their children’s vaccines (65.4%). Conclusions: The level of satisfaction of caregivers with under-five health care services provided at primary health care centers was relatively low. The study revealed that the less educated and older caregivers showed a significant higher level of satisfaction.

Possible relationships of selected food items to osteoporosis among a group of Iraqi women

Background: Osteoporosis is a global health problem which is estimated to affect more than 200 million people worldwide, especially postmenopausal women. It is characterized by decreased bone mineral density leading to fragility and increased risk of fractures. Objective: This study was conducted to explore the consumption of inappropriate foods related to osteoporosis among a group of Iraqi women. JFac Med Baghdad 2021; Vol.63, No. 4 Received: Sep., 2021 Accepted: Nov., 2021 Published: Jan., 2021 Patients and methods: A cross sectional study of 140 females aged ≥ 40 years attending polyclinics in Al-Dora sector in Baghdad city from 18th January to 24th April 2021. The bone mineral density was measured by portable quantitative calcaneal ultrasound machine (osteosystem) and the bone was assessed for osteoporosis by T-score. Food frequency questionnaire was used for collecting data related to food consumption. Results: Out of the total sample, 74 (52.9%) were found to be osteoporotic. There was a significant association with high salt and coffee consumption with the occurrence of osteoporosis (77.3% and 83.3%, respectively, p = 0.001), compared to those who did not consume caffeinated drinks. Participants with daily consumption of caffeinated drinks had a highly significant association with osteoporosis (21.8% vs 100%, p = 0.001). Conclusion: Excessive consumption of salty foods and caffeinated beverages appears to exert a negative effect on bone mineral density and the occurrence of osteoporosis among the studied group of Iraqi women.

Pneumomediastinum following a dental procedure

Background: Subcutaneous emphysema is a common presentation to the emergency department. The presence of emphysema in the head and neck region due to dental procedure is not common, and the presence of pneumomediastinum is exceedingly rare. Case Report: A young lady, presented to the emergency department with chest pain, found to have pneumomediastinum following a dental procedure including a wisdom tooth extraction. Conclusion: Complications following dental procedures are not uncommon, hence there should be a high index of suspicion for the emergency physicians for such patients, especially those where air turbine dental tools have been used.

proportion and risk factors of fatal outcomes among severely and critically ill COVID-19 patients: A hospital experience, Baghdad, Iraq 2021

Background: Severe forms of Coronavirus disease 2019 (COVID‐19) were found among 6 - 10% of all COVID-19 patients. Acute respiratory distress syndrome ARDS is non-cardiogenic pulmonary edema manifested by the rapid development of shortness of breath, tachypnea, and hypoxemia. Patients’ outcomes after critical care for COVID-19 have not been adequately documented in this low-resource environment, despite advocacy for prevention and response measures in low- and middle-income countries. Objectives: To highlight the rate of severe illness among COVID-19 patients and its associated factors in Al-Imam Ali Hospital, Baghdad-Iraq 2021. Patients and Methods: A descriptive cross-sectional study on cases with severe and critical COVID-19 illness (with ARDS) admitted to the isolation ward in Al-Imam Ali Hospital from 23 March to 23 May, 2021. All COVID-19 patients admitted in a severe or critical state were included. A data collection form was filled by the researcher. The P value of < 0.05 was used to determine statistical significance. Ethical Approval was obtained. Results: A total of 504 severely ill COVID-19 patients were included in this study. There were 71 (14.1%) patients below 45 years of age. Males formed 40.9% of patients while that of females was 59.1%. Fever was the presenting symptom in 381 (75.6%) patients, 197 (39.1%) patients had anosmia, and 192 (38.1%) had ageusia. There were 358 (71.0%) survivors while 146 (29.0%) died. Patients aged 65 years or more had more possible risk for death than those below 65 years (OR=1.14, 95% CI =0.6-2.2). Female gender appeared to be protective compared to male gender (OR=0.52, 95% CI =0.35-0.77). Ex-smokers had a higher risk than non-smoker and current smokers (OR for ex-smoker=4.38, 95% CI 2.6-7.5), and (OR for current smoker=1.7, 95% CI 0.98-3). Renal disease was found to be a risk factor leading to death (OR=2.9; 95% CI=1.73-5.1). Diabetes Mellitus, respiratory diseases, and solid cancer showed a high risk for death, [OR=2.3, 95% CI=1.4-4; OR=1.7; 95% CI=1.1-2.9, OR=8, 95% CI=3.3-19 respectively]. Patients with three comorbidities had a higher mortality risk, OR=1.6, 95% CI=1.3-2. Conclusion: This study concluded that mortality of severely and critically ill COVID-19 patients was 29%, and males and older patients were risk factors for death. In addition to; ex-smoker, alcoholic, and patients with baseline comorbidities appeared to be risk factors for mortality. Finally; laboratory tests and Pao2/Fio2 ratio can be used to predict the outcome.

Association between HbA1c and dyslipidemia among sample of Iraqi Patients with Type2 DM

Background: Diabetic Mellitus is considered as a public health concern. More than 8 percent of the United States has diabetes. Diabetes is a serious risk factor for Atherosclerotic cardiovascular disease (ASCVD) and an important cause of mortality. ASCVD is the commonest cause of death in the Western world. Diabetes was defined as a high risk condition for ASCVD. In adults with diabetes with ASCVD or multiple ASCVD risk factors it is important to prescribe high intensity statin to reduce LDL at least to 50%. Objective: To investigate association between dyslipidemia and HbA1c and to detect benefit of using some statins in decreases the risk of CVD. Material and method: A prospective randomized single dose study was carried out at a private clinic in Wasit governorate-Iraq; included patients with type 2 diabetes. Clinical biochemical lab assessment and re assessment was carried out before and after 3 months of receiving Rosuvastatin 20 mg/ day. A questionnaire paper was used, including sociodemographic and clinical features (age, gender, measuring weight, height, and waist circumference; biochemical markers [total cholesterol, HDL, LDL, TG and HbA1c]). Results: A total of 256 type 2 DM patients were included; receiving 20 mg of rosuvastatin as a single dose for 3 consecutive months. 83 (32.4%) of them were males and 173 (67.6%) were females. Mean age of male (52.0710.486) and that of female (53.1110.410). the mean difference of (BMI, WC, HbA1c, LDL, TG, and cholesterol) among all studied sample after treatment was significantly lower than mean difference that measured before treatment, except that for HDL; where it was significantly higher after treatment, P <0.001. Mean differences of HbA1c and total cholesterol were reduced significantly after treatment among males, females, age <45 yrs., and age 45 yrs., P<0.01; without significant differences in between groups, P>0.05. Conclusions: HbA1c value associated with level of lipid profile in diabetic patients. All age groups and both gender have had benefit of rosuvastatin treatment in reduction of lipid cholesterol as well as HbA1c. Rosuvastatin can be used by type 2 diabetics’ regardless age and gender. HbA1c can be used as a predictor of dyslipidemia in type 2 diabetes.

Missed foreign body inhalation for 15-years

Background: Foreign body inhalation is a life threating event in children and it is common in our country ,which is a daily practice of Thoracic .It can lead to morbidity even mortality in the hands of untrained or not well- trained doctors. Aim: Is to report a case of missed foreign body inhaled 15-years back, which is uncommonly reported in the literatures and to compare it with other studies reporting similar cases. Methods: The details, presentation, clinical findings, radiological appearance and the successful removal by a rigid bronchoscope under general anesthesia will be presented. Results: The successful removal of this long standing impacted foreign body (plastic whistle) using the rigid bronchoscope and the eventful outcome of patient’s clinical symptoms is elucidated. Conclusion: Refractory respiratory symptoms of long duration without improvement justify the need for diagnostic bronchoscopy which will offers the best chance of cure in missed foreign body inhalation.

Web Query Behaviour Concerning HEV (Blue) Light in Ophthalmology

Background: High-energy visible (HEV) possesses high-frequency in the violet-blue band of the visible light spectrum. Blue light has relevance to ophthalmology via photochemically-induced retinal injury. Objectives: To explore the spatial-temporal mapping of online search behavior concerning HEV light. Materials and Methods: We retrieved raw data of web search volume, via Microsoft Google Trends, using five search topics; "Biological effects of HEV light", "Vision impairment", "Macular degeneration", "Retinal tear", and "Retinal detachment", for the period 2004-2020. Results: Web users, mainly from Far-East Asia and Australasia, were most interested in seeking online information concerning "Macular degeneration" and "Vision impairment" search topics, moderately interested in "Biological effects of HEV light" and "Retinal detachment", and least interested in "Retinal tear". Internet users from the Middle East and Arab world contributed minimally to the holistic map. Web queries increased at both chronological ends, 2004-2006 and 2018-2020; however, these trends were respondent to specific search topics. For instance, the search volume for the "Biological effects of HEV light" increased significantly in 2018-2020. Predictive modeling was most accurate for "Biological effects of HEV light". The strongest correlation was for "Vision impairment" versus "Macular degeneration". ANOVA, linear modeling, and machine learning unanimously agreed on predictors' significant effect (search topics and time) on the web search volume. Conclusion: Web queries' mapping provided indirect evidence on the causality between HEV light and retinal damage. Future research mandates rigor observational and experimental studies.

Complete agenesis of the right hemi-diaphragm in an adult: case report and literature review.

Congenital agenesis of the hemi-diaphragm (AHD) in adults is rare and exceedingly so on the right side. Since its first recognition in 1959, no more than 9 cases have been published in the English literature by the year 2016. “Partial diaphragm agenesis” is actually large congenital diaphragmatic hernia (CDH) rather than true AHD. Respiratory compromise is the likely presentation, however, patients may survive for years without symptoms. Despite a straightforward clinical and radiographic diagnosis of AHD, the best method of repair is controversial. Herein, we present a case of complete right-sided AHD in a man of 54 diagnosed on surgical exploration 16 years earlier. Despite trans-thoracic mesh repair, the patient experienced just a modest improvement of his shortness of breath (SOB). Though the liver persisted high in the chest as shown by serial CT scans of the chest, polypropylene mesh was effective in preventing further visceral herniation. Adult patients with right-sided AHD always deserve operative intervention to avoid the potential complications.

A Review on Medical Child Abuse and Child Protection

Background Medical child abuse describes a child receiving unnecessary, harmful, or potentially harmful medical care at the caretaker's instigation. Objectives To focus on medical child abuse as an entity and emphasize its epidemiology, clinical presentations, prevention, and management. Results In the UK, the annual incidence of medical child abuse in children below one year increased to 3:100,000, while its prevalence in Arabs, including Iraq, is ambiguous due to lack of evidence and improper clinician's awareness. The mean age at diagnosis is 14 months to 2.7 years. Female caregivers are the most common offenders. Clinically, medical child abuse could fit into three stages; falsification of illness story, falsification of illness story and physical signs' fabrication, or induction of illness in children. A successful diagnosis mandates a comprehensive review of medical records to identify discrepancies between caregivers' stories versus clinical findings or investigations. Management requires recognizing abuse, halting it, securing the child's safety, maintaining the family's integrity when possible, and aborting unnecessary lateral referrals within the healthcare system. Conclusion Reported cases of medical child abuse are increasing steadily, while less severe ones go unrecognized. No diagnostic tool can help other than the physician's high index of suspicion. The management follows the same principles applied for other forms of child abuse, while good medical practice ensures its prevention.

Vitamin D level and telogen hair loss: A Case control study

Background: Hair loss is a common skin condition. Hair is not a vital organ but losing it has a worse effect on the psychological state of the patient and may interrupt his daily social activities. Telogen effluvium founded to be the commonest noninflammatory cause to diffuse hair loss. Since nutritional disturbances are one of the triggering factors for it. It might be useful in the management of TE Due to the limited number of studies& little information is available on this subject possible role of vitamin D or its deficiency should be studied further. Aim of the study: to determine the association between Telogen effluvium and vitamin D level. Materials and methods: This is a case-control study performed in a period between December 2018 until June 2020; in Baghdad dermatology center at medical city. One hundred women who were seeking treatment for diffuse hair shedding and who hadn’t received treatment or supplements yet and One hundred fifty control subjects are chosen from patients who were referred to the dermatology clinic for the treatment of nevi and who are not pregnant or lactating, had no systemic or local scalp diseases are included in the study. Full History, physical examination performed for all cases including looking for cutaneous diseases, supplements & drug intake. Serum Vitamin D3 is measured using (Ichroma (TM), Boditech Med Inc., Korea). Result: A total of 250 females were included in this study, 100 of them got telogen effluvium & 150 were patients who attend dermatology clinic seeking treatments for nevi or skin tag (control group) .The mean age of cases was (22.59 ±4.837 year) that wasn’t significantly different from mean age of control group (23.647±6.022 years) (p-value =0.127). The mean level of Vitamin D was significantly lower than that of control group (11.16±4.49) Vs (18.98±10.65), P value <0.001. Vitamin D mean level in acute phase was significantly higher than that of chronic phase pts. (11.68±4.77 & 9.93 ±3.55 respectively), p value=0.04. Mean vit. D among symptomatic patients. (9.7 ± 3.5) was significantly lower than that among asymptomatic pts. (13±4.19) (p=0.001).No significant association were noticed between job & residence of the patients of both groups, (P-value =0.283 & 0.069 respectively (. Conclusion: Age mean difference was not significant among cases and controls. Deficiency in vitamin D may assume a possible leading cause of telogen effluvium among women with hair loss. Cases were significantly associated with low level of Vitamin D3 than controls.Low level of vitamin D was dominant among housewives, urban women, and among symptomatic patients with acute duration.