Thesises

The Predictive Effect of Neutrophils-toLymphocytes Ratio (NLR) in Acute Ischemic Stroke

By: Sara Salim Shahooth

Abstract:

Background: Ischemic stroke is the second most common cause of mortality and the third most common cause of disability worldwide. Objectives: – Predict the role of Neutrophil /lymphocyte count in short term outcome in patient with ischemic stroke. -Assess the association of neutrophil/lymphocyte value and the severity of acute ischemic stroke as a dependent risk factor. ·

Patient and method : a prospective cohort study carried out at two specialized neurological hospitals in Baghdad/Iraq .A sample of 200 acute ischemic stroke patients of more than 24h after stroke and less than 2 weeks. Outcome were measured in terms of: survival , death, and disability.

• Results: The study included 200 patients with stroke, The mean age of the dead subjects was significantly higher than that of surviving patients (75.12±9.2 years ,63.99±10.9 years) respectively, p

Clinical Characteristics and Outcomes of Pregnant Women Confirmed with SARS-COV2 Who Admitted to the Hospitals in Baghdad during 2020

Noor Ali Hussain

Abstract

 Background: During COVID-19 pandemic, pregnant women are considered as one of the vulnerable groups. Routine but essential services are the most affected during emergencies, therefore practitioners must pay closer attention to women and newborn to minimize the impact of the pandemic on these vulnerable populations.

 Aim of the study: To describe clinical characteristics and outcomes of pregnant women admitted to hospitals with SARS-CoV-2 in center of Baghdad during 2020. Patients and Methods: a cross sectional retrospective study was conducted in six maternity hospitals in center of Baghdad during a period of ten months, of 170 pregnant ladies attended for labor or management of health problems related to pregnancy and proved to have PCR positive for COVID-19, The data was collected from medical records and patient’s medical sheets of the admitted ladies, phone calls and questionnaire. Chi- square test was used to find out the significance of association between related categorical variables, P value < 0.05 was considered as discrimination point for significance.

 Results: the mean age of the included women was 29.59±6.78 year, 50.6 % of patients aged less than 30 years with 41.2%, of patients had primary education level ,78.2% of patients were housewives, 94.7% of pregnant women were with single fetus, , 84.7% of pregnant women delivered by caesarian section, ,58.2% of pregnant women suffered from symptoms were fever as the most common presents symptoms , 43.5% of neonates of mothers confirmed with COVID 19 positive had a negative test results of COVID 19

Conclusion: The majority of the pregnant ladies were symptomatic; hypertension was the most common co-morbidities in the included pregnant ladies. There was a significant association between age and presence of symptoms of COVID -19 infection in which patients who aged less than thirty years old presented with symptoms especially fever and dyspnea more than patients aged thirty years old or more.

Association between stroke and obesity and other risk factors among a sample of patients in Baghdad 2021

Saba Abdali Dawood

Abstract:

Background: Stroke is a major health burden and considered as part of a composite cardiovascular outcome with coronary heart disease, and many studies reported that metabolic obesity elevate cardiovascular and stroke risk. Obesity increased risk for ischemic stroke and it was found that overweight patients with stroke are higher than the number of patients with stroke and normal body mass index. Objectives: To estimate the rate of obesity among stroke patients and to associate the overweight and obesity as independent risk factor for stroke.

 Patients and methods: A cross sectional study was conducted in Doctor Saad Al-Witry forNeurosciences hospital in Baghdad and Imam Al_Sadiq hospital in Hilla, from 1st of November 2020 to 30th April 2021. Two groups of population were collected; the first group includes 100 patients with stroke. The mean age of all studied cases was 60.78±6.7 years. Males were 53 patients and females were 47 patients. The second group was 100 healthy controls from the medical staff and patient relatives without history of stroke. Their mean age was 59.83±5.87. Males were 63 and females were 37.

The questionnaire contain demographic data of the patient (age, gender, type of job, type of lifestyle), medical history ( family history of obesity, Diabetus mellitus, hypertension), and blood Investigation (blood level cholesterol).

 Results: Among stroke patients, 41.1% of patients with heavy activity job and 61.4% of patients with light activity job. For that of control, 58.9% with heavy activity job and 38.6% with mild activity. There was significant association between heavy activity job and not getting stroke, p=0.004, OR=0.439, III 95%CI=0.248-0.777. There was a significant increase in risk of getting stroke if the patient is overweight or obese in comparison with normal weight (reference weight status), [OR= 3.327, 95%CI= 1.565-7.047 and OR= 4.791, 95%CI= 2.186-7.047] respectively. A significant association was founded between increasing waist-hip ratio and getting stroke, p value=0.008, OR= 2.148, 95%CI= 1.054-1.886. There was significant association between hypertension and getting stroke, p value=0.008, OR= 2.148, 95%CI= 1.054- 1.886. 40.2% of non-diabetic persons, and 69.1% of diabetic patients with had stroke. There was significant association between diabetes mellitus and getting stroke, p value=0.001, OR= 3.336, 95%CI= 1.793-6.208. 47.1% of obese patients had hypercholesterolemia which significantly higher than that found among overweight or normal weight patients, p value=0.049. 50% of increased Waist hip ratio patients had diabetes which significantly higher than that found among not increased WHR patients, p value=0.007.

Conclusions: A statistically direct and graded association between increased body weight and incidence of ischemic stroke. Hypertension is the leading factor of stroke. Stroke incidence not affected by age, gender, family history of obesity, and heavy work. High total serum cholesterol is mostly associated with ischemic stroke. Diabetes mellitus associated with more risk for stroke. A significant association was founded between high WHR and diabetus, and between obesity and hypercholesterolemia.

Awareness of thalassemia intermedia caregivers about iron overload in Baghdad

Sama Samir Said

Abstract:

 Background: Thalassemia is a hereditary haemoglobinopathy , requiring blood transfusion through life cause financial and emotional burden on the family and society. This study aimed to assess level of awareness in the caregivers of thalassemia patients to ameliorate their experience in caring their child. Method: A cross sectional descriptive study with convenience sample was conducted in AL-Karama and Ibn AL- Balady thalassemia centers in Baghdad from 15th of November 2020-1 st of June 2021 in which 220 caregivers of thalassemia intermedia patients were interviewed to assess their level of awareness, regarding blood transfusion, iron overload and its treatment.

Result: About 52% of the caregivers had good awareness, 46% had fair awareness and 2% had poor awareness level. 11.8%(26) thinks blood transfusion must be given from time to time, 28.4%(62) thinks iron overload means increase level of iron in the body, while Liver cirrhosis and heart failure were the most important complications of iron overload if not treated as 88%(194) of caregivers declare, chelating agent was one of the treatments of iron overload for 97.3%(214), Oral or subcutaneous chelating agents were mentioned by 99.1%(218) as types of treatment, 98.2%(216) know that Serum Ferritin and type of thalassemia were the most important indicators for patients to take chelating agents, About 87.3% (192)thinks that it should be a doctor decision to prescribe a chelating agent, Burning sensation in site of injection and Gastrointestinal Tract upset were side effects of chelating agents according to the opinion of 67.3%(148),moreover 84.5%(186) consulted a doctor before stopping treatment when side effect appears ,half (50%) of studied sample stated that they were going to change treatment from one type to another if liver enzymes elevated, 77.3%(170)were aware that the treatment is lifelong.

Conclusion: The mean age of children at diagnosis was about 5 years, half of them were males. Majority of the caregivers in the studied sample had good & fair awareness concerning thalassemia intermedia. The best knowledge answers were about regularity of receiving blood and treatment, complications of iron overload, rule of doctor decision, changing the type of treatment and indication of chelating agents. The poor knowledge answers were mainly about iron overload, factor contributed in delay complications, Good awareness level was significantly associated with educational level and age of child at time of diagnosis

Factors Influencing the Severity and Outcome of Patient’s with SARS-COV-2 Infection Admitted to Alkindy Teaching Hospital

Diana Aziz Hussein

Abstract:

 Background: A new human coronavirus, severe acute respiratory syndrome coronavirus 2, was recognized in Wuhan, China, in December 2019. Later on the virus has completed its way through the world to affect more than 180 countries. Severe acute respiratory syndrome coronavirus 2 has infected individuals in different age groups, different ethnicities, and both genders whereas spreading through societies at a distressing rate. Given the nature of this virus, there is considerable data still to be learned; however, we distinguish that the clinical exhibitions begin from flue like disease to more severe diseases such as pneumonia, bronchitis, severe acute respiratory distress syndrome, organs failure, and even death.

Objectives: To identify the common risk factors that affects the outcome of Covid-19 disease and study the association of comorbidities with patient’s outcome Patients and methods: cross sectional study was carried out in Alkindy teaching hospital, where medical files of 300 patients with covid-19 were selected randomly from the files of admitted patients to Al-Kindey teaching Hospital during the period from 1 st Dec.2020-1 st Apri.2021.Age, gender, smoking status, co-morbid illness were reviewed and recorded. Spss version 23 was used for data entry and analysis. Results; The results showed that the mean age of patients was 50.6±14.5 SD, 58.9% was male and 41.1% was female, 54.3% had co-morbid illness. 37.1% with hypertension, 27% with diabetes, 2.7% with chronic obstructive pulmonary disease, 1.3% with cardiac disease, 3% with renal failure, 3.3% VII had cancer and 3% with immunocompromised disease. The older age group (>40 years), male patients, non-smoker, patients who had hypertension, cardiac disease, renal failure were more likely to have either moderate or severe clinical presentation. The older age group (≥40 years), patients with hypertension, cardiac and renal disease patients had poor outcome (death) more than others.

 Conclusion: Comorbidities are present in around half of inpatients with COVID-19 that included in this study, and these comorbidities predispose to sever clinical presentation and poorer clinical outcomes

Compliance of geriatric patients to treatment with hypertension and diabetes mellitus in Baghdad 2021

Ghassan Basim Hamad

Abstract

Background: Geriatrics is medical term of the elderly people starts from the age of 65 years old People and above ,hypertension and diabetes mellitus are two major diseases in elderly group and patient compliance to their medication in essential to control over disease symptoms and reduce complications their morbidity’s which they lying within first 10 cause of death in Iraq.

Aim of study: Evaluate compliance of geriatric to treatment of diabetes mellitus and hypertension and determined factors which can prevent complication and improve life in this slice of community. Study Objectives: To measure the level of compliance to treatment in geriatric patients with hypertension and diabetes and link the outcome with sociodemographic variables.

Patients and method: A cross sectional study in four popular medical clinics in Baghdad were selected to visit Patients 65 years and older with hypertension and /or diabetes mellitus, asked to fill questionnaire to assess their adherence to their medication, 200 patients with hypertensin and /or diabetes mellitus were selected in 6 months duration to measure their compliance with their medication, statistical analysis done using IBM- SPSS v24 statistical program were P value ≤ 0.05 used as cut off value to find association between socio-demographic variables and patients compliance.

Result: Study found that 22.5% percent of patients had good compliance ,39.5% fair and 38% poor compliance level. Age group 65-70 years were more compliance than older age, patient with university level were associated with better compliance.

Conclusions: Patients with a less number of drugs have better adherence, higher education level is required to maintain good adherence level, patients with hypertension only have better adherence than patients with diabetes, patients Suffering from diabetes mellitus who shift to insulin have better compliance level than who did not shift from oral hypoglycemic medication. Recommendation: Awareness sessions in popular medical clinics to geriatric

Obesity and Other Risk Factors among Patients with Endometrial Hyperplasia and Endometrial Carcinoma in Baghdad

Atyaf Mahmood Ibrahim

ABSTRACT BACKGROUND: Obesity is more strongly associated with the development of endometrial cancer than any other cancer type, by pathophysiological action of despite adipose tissue that consider as a source of hormones like estradiol estrogen, which is a known endometrial growth factor, stimulating endometrial glands and stroma proliferation resulting in endometrial hyperplasia and its sequence.

 Aims of study: 1.Evalute the relationship between obesity and endometrial hyperplasia or endometrial carcinoma in studied sample in Baghdad. 2.Evaluate the relationship of variables that suspect as risk factors for endometrial hyperplasia and endometrial carcinoma. PATIENTS AND METHODS : This cross-sectional study conducted in Baghdad, Nov 2020 to June 2021, (170) patients were enrolled in this study suffered from endometrial hyperplasia and Endometrial carcinoma confirmed by endometrial biopsy, valid questionnaire was used, which contains three parts: part one sociodemographic characteristics, part two contains questionnaire related to signs and symptoms that patients suffering from on, part three contain histopathological result and ultrasound examination, height and weight measurements used for calculating Body Mass Index for each participants, Standard World Health Organization criteria were used to categorize Body Mass Index (normal 18.5–24.9 kg/m2 , overweight 25–29.9 kg/m2 , obese ≥30 kg/m2 ) Endometrial biopsy was taken from each patients by diagnostic dilatation and curettage under general Anesthesia in the hospital, data were analyzed by using International Business Machines-Statistical Package for the Social Sciences (SPSS) version 24; qi square test was used to find out significance of association between the variables , P value ≤ 0.05 regarded as cut off point.

 RESUIT: Results of this cross-sectional study show that (170) cases were included, 151 (89%) patients suffered from endometrial hyperplasia and 19 (11%) patients suffered from endometrial carcinoma, 48% of studied cases suffered from obesity, 44% ,31% and 25% bleeding types were of menorrhagia, postmenopausalbleeding and polymenorrhea respectively.

CONCLUSION: Obesity was statistically significance with endometrial hyperplasia and endometrial carcinoma.

KNOWLEDGE ABOUT ANEMIA IN PREGNANCY AMONG FEMALES ATTENDING PRIMARY HEALTH CARE CENTERS IN BAGHDAD

Samia Ihsan Hassan

ABSTRACT

 Background: In pregnancy, several physiological changes occur that lead to decrease in the level of hemoglobin. Anemia in pregnancy constitutes a major public health problem in developing countries and high morbidity and mortality among mothers. Inadequate antenatal care along with poor knowledge of dietary needs of pregnant woman, and overall poor socio-economic conditions are all responsible for this rates of morbidity and mortality. As the education levels of the pregnant women and their husband will be improved, the prevalence and severity of anemia in the studied population of pregnant women will be decreased.

STUDY OBJECTIVES: To assess level of knowledge about anemia in pregnancy among adult females attending primary health care centers and to find out if there is any association between socio-demographic characteristics of adult females and knowledge about anemia in pregnancy in Al-Adhamiya Health District , 2021. Methods: A cross-sectional study with analytic component conducted in four primary health care centers in Al-Adhamiya Health District during a period of four months from 1 st of December 2020 to 1st of April 2021. It included 400 females aged between 18 – 45 years attending the selected PHCCs for any complain.The data had been collected through distribution of well-designed questionnaire including two parts: (Participants’ sociodemographic characteristics and knowledge parts). Results: In this study, of the 400 participants : (45.5%) were in the age group of (25 – 35 )years 81% were housewives, 86% were married and (70.9%) of them were multiparous the mean total knowledge score was 11.40 and only (24.5%) had good knowledge, (60%) had fair knowledge and(15.5%) had poor knowledge score,95% was concerning iron supplement based on doctor prescription. There were statistically significant associations 2 between knowledge score and age of females, marital status, educational level, occupation, and parity. Conclusion: The majority of studied females have fair and acceptable levels of knowledge about anemia in pregnancy. Younger age, being single, low educational level, unemployed, and low parity were associated with worst level of knowledge

Prevalence of Obesity among Diabetic Patients in Public Health Clinics in Al-A`Adhamiya District in Baghdad

Dr. Ahmed Saad Saed

Abstract Background : Obesity and type 2 diabetes are problems that the whole public should be worried about in today’s society. These two forms commonly coexist, with estimates indicating that 60–90% of type 2 diabetes patients are or have been obese. Obesity is often regarded as a significant risk factor for type 2 diabetes mellitus in the future.

 Objectives: the goal of this research was to find out how common overweight and obesity are among diabetic patients who visit popular medical clinics (AlAdhamiya sector), to find out the association between sociodemographic characteristics and diabetes patients’ weight status, as well as those associated with successful DM management.

 Methodology: A total of 383 type 2 diabetic participants were questioned for various demographic variables, diabetes-related information, and personal behaviors in this study. Anthropometric measures were taken, and the BMI was calculated. As a consequence, the collected data was evaluated.

Results: The results of this cross sectional study show that 800 diabetic patients were intervened but only 383 cases complete HBA1c test and were included in this study.The mean age of studied sample was 56.94 ±13.24 (range from 30 to 78 year) ,72 percent of the total patients were overweight or obese,Significant association was noticed between being unemployed and overweight, between having positive family history of DM and being obese,and between being not smoker and being obese.

Conclusion: No significant association between gender, education level, job, smoking status with good control of DM. Patients treated with oral hypoglycemic drugs, patients consumed vegetable in their diet, patients spend more time with sport, regular treatment patients, patients gave negative famil

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