Journal of the Faculty of Medicine Baghdad <h3>Journal of the Faculty of Medicine – University of Baghdad</h3> <h3>A peer-reviewed journal published Quarterly by the college of medicine –Baghdad University</h3> <h3>ISSN:&nbsp; &nbsp;0041-9419</h3> <h3>E-ISSN: 2410-8057</h3> <h3>The Journal interested in the publication of clinical and basic medical research.</h3> <h3>The first issue of this Journal was published under the name of (Journal of the Royal Iraqi Medical College) in April /1936, approved by the council of the College as a general journal dealing with the news of the college and few scientific articles to encourage the teaching staff for research publication. The journal was published randomly and ceased during World War II due to financial difficulties.</h3> <h3>In 1946 Prof. Dr. Hashim Al Witri, the college dean, assigned republication of the journal and urged the teaching staff to participate and publish their research in the journal. Despite his effort, the journal remained irregular in publication. In 1959&nbsp; Prof. Dr. Faisal Al-Sabih became the Editor in Chief of the journal when he returned from the United Kingdom and appointed on the teaching staff, restructured the journal and changed its name to (The Journal of the Faculty of Medicine) and used a new scientific system for publication of articles.</h3> <h3>The first issue of the new series started in June 1959. The journal continued to be published on a regular basis since then without interruption in (four issues during the year). The journal became registered the international number (ISSN) in 2000 and entered in many important international indexes.</h3> <h3>After 2003 the journal continued despite the difficulties involved in every aspect of the country and by the beginning of 2004, the journal progressed through a series of changes to reach a level that can be recognized internationally.</h3> <h3>After 2010 the journal became published electronically of the same edited issues.</h3> en-US <p>&nbsp;For all articles published in Journal of the Faculty of Medicine Baghdad, copyright is retained by the authors. Articles are licensed under an open access<a href="">&nbsp;Creative Commons CC BY NC 4.0 license</a>,&nbsp;meaning that anyone may download and read the paper for free. In addition, the article may be reused and quoted provided that the original published version is cited. These conditions allow for maximum use and exposure of the work, while ensuring that the authors receive proper rights.</p> <p>&nbsp;</p> (prof. Ali K. Al-Shalchy) (assistant Lecturer Sara Mohammed Abdullah) Tue, 11 May 2021 08:21:36 +0000 OJS 60 The efficacy of synchronized direct current shock in reverting long standing persistent atrial fibrillation in to sinus rhythm. What help to achieve high success rate? <p><strong>Background:</strong> Atrial fibrillation is the most frequent cardiac arrhythmia encountered in general medicine and cardiology practice. Synchronized direct current shock is a known safe and effective procedure to revert long standing persistent atrial fibrillation into sinus rhythm.</p> <p><strong>Patients and Methods</strong>: Patients with long-standing atrial fibrillation who were seen at the author’s private clinic and Al-Hassani Heart Center in Sulaimanya from April 2018 to December 2020 were chosen for rhythm control subjected to synchronized direct current cardioversion under heavy sedation applying a modified anterolateral paddles position with 200J and 300J successively according to the reversion dose required.</p> <p><strong>Objectives</strong>: The Objective of current study was to assess the efficacy of synchronized direct current shock in reverting long-standing persistent atrial fibrillation into sinus rhythm and recognizing factors that help in achieving high success rate.</p> <p><strong>Results</strong>: In this case series study 61 patients were included thirty-one males 30 females The success rate was 89%. Even patients with atrial fibrillation duration more than 2 years showed a success rate of 84%. The recurrence rate of atrial fibrillation was 30% within a follow up period of one month to 2 years. The modified paddles position has helped in achieving high reversion rate where success increased from 62% to 85% and failure rate decreased from 38% to 15%. The shock dose needed for reversion ranged from 200J to 300 J.&nbsp; There was no correlation between the needed dose for reversion and body weight where patients with body weight of 71-80kg, more than 80% reverted with 200J. Pre shock antiarrhythmic drugs did not facilitate the conversion, the reversion rate in patients with or without antiarrhythmic drugs were 85% and 82% successively. &nbsp;No per procedure complications were seen.&nbsp;</p> <p><strong>Conclusion:</strong> Electrical cardioversion of atrial fibrillation with modified paddles position is a safe, effective and smooth procedure with significantly high success rate and very low incidence of complications even with very long-standing atrial fibrillation.</p> AMAR Talib AL-HAMDI, Azad J. Ali ##submission.copyrightStatement## Tue, 11 May 2021 00:00:00 +0000 The clinical features of COVID - 19 in a group of Iraqi patients: A record review <p><strong>Background: </strong>The number of coronavirus infection cases has increased rapidly since early reports in the December 2019 in China. But data on the clinical features of infected peoples is variable from one country to the other.</p> <p><strong>Objective: </strong>Studying clinical features of patients with a positive RT PCR COVID – 19, in a group of Iraqi patients.</p> <p><strong>Results: </strong>The study included 200 patients with 133 (66.5%) males and 67 (33.5%) females, and age range of 14- 89 years, with mean age 46.4 years. A history of contact with a COVID -19 positive case was found in 80 patients (40%), Ischemic Heart Disease in 11 patients (5.5%), hypertension 34 (17%), diabetes mellitus 36 patients (18%). The most frequently seen age group was between 21-39 years (76 patients - 38%). The most frequently seen symptoms were fever 76.5% and generalized weakness 73%. A statistically significant association was found between age and dyspnea (p = 0.014) and also diarrhea (p = 0.035), as well as between gender and rhinorrhea (p = 0.08) and nausea and/ or vomiting (p = 0.005).</p> <p><strong>Patients and Methods:</strong> This is a record review study of 200 patients with a confirmed COVID - 19, conducted in Al Imamain Al Kadhimain Medical City from 1 May to 30 August 2020, the diagnosis of patients during this period. Data about demographic and the clinical characteristics have been recorded.</p> Haider Dawood, Ayad Hwayyiz, Ibrahim Ibrahim, Imad Abdul Rahman ##submission.copyrightStatement## Tue, 11 May 2021 00:00:00 +0000 The Missed symptoms of behjet’s disease <p>Abstract</p> <p>Objectives:&nbsp;Behçet's disease is a systemic chronic proinflammatory vascular disease .this study wants to describe more details of patients with Behçet’s disease in iraq.</p> <p>Methods: Any patient with suspected or diagnosed&nbsp; Behçet’s&nbsp; disease attending centre of dermatology/behjet unit , 2017-&nbsp; 2018.</p> <p>A total 47 patients ,Full history and examination were taken.</p> <p>Percentage of complains were calculated.</p> <p>Results: 37 were females and 10 were males , Age of patients ranged from (11-63) years.Pethargy test was negative in 13 patients , positive in 15 ,21 had negative family history and 9 had positive .</p> <p>They complain from Malaise , oral ulcer, genital ulcer, unexplained fever ,20 symptoms began from childhood ,decreased hearing,eye complain, dysphagia , dyspnea ,headache ,&nbsp; memory problems, depression , muscle contraction, peripheral paresthesia , joint complains, sleep disturbances and&nbsp; renal problems.</p> <p>Conclusion: &nbsp;describes new symptoms can help in diagnosis of behjet’s disease .</p> <p>&nbsp;</p> lama H. Altaha ##submission.copyrightStatement## Tue, 11 May 2021 00:00:00 +0000 Pathological Nipple discharge: a comparison between breast ultrasound and mammography <p>Background:Nipple discharge is a relatively common complaint of females in reproductive age and after menopause.</p> <p>Objectives: The aim of this stud was to compare the radiological findings of mammography and ultrasound in women with pathological nipple discharge of different pathology.</p> <p>&nbsp;Methods:&nbsp; mammography and ultrasound was done for a total of 50 patients attending the National center of Early detection of Breast cancer with pathological nipple discharge. Ultrasound guided FNA was performed for all cases, and histopathology was available for eleven case.</p> <p>Results: ultrasound was able to provide clue of possible underlying cause for all pathological nipple discharge whereas mammography was negative in 54%. Ultrasound was more sensitive in diagnosing malignant breast lesions associated with pathological nipple discharge (85.7%) but less specific (88.3%) as compared with mammography which had (71.4%) sensitivity and (90.6%) specificity. Negative predictive value of ultrasound was 97.4% , mammography was 95.1% and of non-bloody nipple discharge was 94%.</p> <p>Conclusion: Ultrasound is essential to complete pathological nipple discharge workup, particularly when mammography is normal, to rule out the possibility of neoplastic changes and to provide clues for nonneoplastic etiology that may guide the management.</p> Dhuha M Alhadethy, Enam K Altameemi, Laith A Khalaf, Areege Mustafa Kamal ##submission.copyrightStatement## Tue, 11 May 2021 00:00:00 +0000 threatening a teacher <p><strong>Abstract</strong></p> <p><strong>Background:</strong> Threatening teachers increases teacher stress and impairs emotional well-being. There are many reasons for violence against teachers. There are communication errors and conceptual differences in applying the rules that emphasizes corporal punishment rather than persuasive punishment. Also, it is related to a parent complaint that expresses Parents' belief in the education their child received in school is getting weaker. In addition to the incompetence that teachers must implement, like personal, social and professional aspects that make students offend teachers. Threatening someone considered as physical aggression<sup>. </sup>Aggression is any behavior intended to harm another person that wishes to avoid such harm High rates of aggression were reported recently in Iraq, especially after wars.</p> <p>Some studies have shown that students, whose friends engage in negative activities such as dropping out of school and have lower academic performance, may engage in aggressive activities toward teachers and/or other students.</p> <p><strong>Objectives:</strong> To estimate the prevalence of students’ aggressive act towards teachers.</p> <p><strong>Methodology:</strong> A cross-sectional study was carried out in Al-Sadr city in Baghdad. A total of 720 adolescent secondary schools students from both genders were included in the study. They were selected by multistage random sampling. Their age was ranged from 13-21 years. Data was collected from 1<sup>st</sup> of February 2019 to 30 of April 2019 through a self-reported questionnaire (Aggression-Problem Behavior Frequency Scale).</p> <p><strong>Results:</strong> The mean age of participants was 16.2±2.04 years. Of all participants, 84.3% were assessed to be aggressive.</p> <p>There was a significant difference between aggressive act (threatening a teacher) and sex, school type, grade, history of absence from school and employed mother,(P=0.038, 0.009, 0.0001,p= 0.02 and p=0.018, respectively). 10% of male threatening a teacher.</p> <p>&nbsp;</p> <p><strong>Conclusion:</strong> A high prevalence of aggression among students was found. Threatening a teacher was dominant among male students, intermediate schools, 4<sup>th</sup> grade, students with history of absence from school, and not employed mother.</p> Tuka Younis Hassan ##submission.copyrightStatement## Tue, 11 May 2021 00:00:00 +0000 Domestic violence among pregnant women in Baghdad\Iraq 2018 <p><strong>Background: </strong>Domestic violence against women is a public health problem that affects more than one third of all women globally. It includes any physical, sexual or emotional abuse imposed upon women within family relationships. Several studies in Iraq demonstrated that domestic violence has been increasing over the past two decades.</p> <p><strong>Objective: </strong>Determine the prevalence of domestic violence against pregnant women and factors associated with it.</p> <p><strong>Patients and methods:</strong> A total of 345 pregnant women were included in a cross- sectional study conducted during the period from July - November 2018. They were selected through multistage random sampling from four Primary Health Care Centers in Baghdad. An Abuse Assessment Screen was used, with a known validity and reliability.</p> <p><strong>Result: </strong>The overall prevalence of domestic violence was 37.1%. It was 9.0% during pregnancy. There were significant associations between domestic violence during pregnancy and the duration of marriage, husband’s age at marriage, husband’s consumption of alcohol and &nbsp;the number of children.</p> <p><strong>Conclusion: </strong>Pregnancy acts as a protective factor against domestic violence</p> Hiba Raad Saeed, Besmah Mohamad Ali, Jawad k. AL-Diwan ##submission.copyrightStatement## Tue, 11 May 2021 00:00:00 +0000 Paediatric multiple sclerosis: a case report of missed and dismissed diagnosis <p>Multiple Sclerosis (MS) is a chronic inflammatory autoimmune disease of the central nervous system (CNS). Up to 10 % of MS patients have onset in paediatric age group. Although the clinical profile of MS appears similar to that seen in adults, several features may differ and specific issues arise in children. Here, we reported a 12-year old girl who presented with 3-year history of episodes of seizures and facial nerve palsy and finally fatigue and cognitive impairment were noted and interfered with her academic performance. Because of the presumed atypical clinical presentations, the diagnosis was missed then dismissed despite neuroimaging features and CSF immunological findings that were highly suggestive of MS. Later, evolution of the disease by neuroimaging helped confirming the diagnosis and directed toward the delayed therapy.</p> nebal wael saadi, Qusay Abed Fahad ##submission.copyrightStatement## Tue, 11 May 2021 00:00:00 +0000 Pulmonary Sequestration Second case series from Iraq <p><strong><u>Background:</u></strong></p> <p>Pulmonary sequestration is a lung tissue (out of function), that received its blood supply from anomalous artery and not continuous with the tracheobronchial tree.</p> <p><strong><u>Aim:</u></strong></p> <p>To report a personal experience in dealing with five patients with pulmonary sequestration, due to anomalous arterial supply from the descending Thoracic Aorta ,ways of diagnosis and proper surgical management.</p> <p><strong><u>Patients and Methods:</u></strong></p> <p>Five patients with pulmonary sequestration, admitted, investigated and surgically managed at the department of Thoracic and Vascular surgery, in the surgical sub specialties hospital of the Medical City Teaching Complex during ten years period (2010-2019).</p> <p><strong><u>Results </u></strong><strong>:</strong></p> <p>Four of our patients were male, the remaining one was a female, all managed successfully by</p> <p>Operative ligation of the anomalous blood supply and resection of the involved segment or lobe.</p> <p><strong><u>Conclusion:</u></strong></p> <p>Resection of the involved segment or lobe after ligation of the anomalous artery offers the best chance of cure.</p> waleed M. hussen ##submission.copyrightStatement## Tue, 11 May 2021 00:00:00 +0000 A Reviewing the Top Health Systems with Comparison to Iraqi Health System <p><strong>Background: The assessments of performance in any health system is a</strong></p> <p><strong>challenging goal. </strong></p> <p><strong>Objectives: This article reviews the top healthcare systems then compares</strong></p> <p><strong>them to Iraqi health system. </strong></p> <p><strong>Patients and methods: The top 12 commercial Health Systems in 2020</strong></p> <p><strong>ranked by a </strong><strong>survey of more than 20,000 international citizens from 73</strong></p> <p><strong>countries on 65 diverse metrics. These metrics vary from simple to critical</strong></p> <p><strong>health system performance criteria. </strong></p> <p><strong>Results: </strong><strong>Up to January 2020, the review shows that Canada has the top Health System. Most other top countries are Europeans. </strong><strong>There are some strong and weak points in each health system. Iraqi health system struggles with several obstacles that need a rehabilitation. </strong></p> <p><strong>Conclusions: </strong><strong>Iraqi health system needs some improvements. </strong><strong>The</strong></p> <p><strong>Netherlands Health system model improves the Iraqi health system.</strong></p> Hazim A Alhiti ##submission.copyrightStatement## Tue, 11 May 2021 00:00:00 +0000