Prevention and treatment of Osteoporosis, An application of the Institute of Medicine (IOM) continuum of care model

Abstract Background: Osteoporosis results from disordered bone remodeling characterized by an imbalance between bone formation and bone resorption carried out by Osteoclasts leading to an increased occurrence of osteoporotic fracture. The absolute and relative rises in the elderly population and increasing unhealthy habits of children and adolescents are causing increases in the incidence of osteoporosis and fragility fractures. The objective of this review is to assess the risk factors and prevention of osteoporosis on all prevention levels; primary, secondary, and tertiary. The main non-modifiable risk factors are gender and genetic factors while the modifiable risk factors include physical activity, calcium intake, vitamin D, and dietary intake. Primary prevention of osteoporosis can be started from an early age by optimizing factors that improve bone mass and quality leading to a better BMD. Secondary prevention can be applied through a screening program for early detection which could be implemented generally or only for high-risk patients, while tertiary prevention is aimed at treatment and rehabilitation.  The outcome of a successful prevention program is based on improving the bone mineral density of the population and detecting osteoporosis early and treating it medically to prevent fragility fracture.

Measuring Students’ Awareness Of Using Antibiotics In Treating Respiratory Tract Infections In Universities Of Baghdad, 2020-2021.

Background: The emergence and spread of pathogenic bacteria that are resistant to antibiotics have become a major public health concern. The incorrect prescription, inappropriate consumption, and excess use of antimicrobial drugs, specifically antibiotics, are possibly the main factors contributing to the widespread antibiotic-resistant bacteria.This study aims to assess the prevalence of students who use antibiotics without consulting doctors in Baghdad Universities, check which antibiotic is more frequently being used as over-the-counter (OTC), and determine the regularity of antibiotics intake. Subjects and Method:  This cross-sectional study was conducted between 2020/October and 2021/January in Baghdad (Iraq) in which 150 students from many universities completed an online questionnaire that included student’s name , gender , age , university & college, stage, smoking status, and clinical information about the disease and the antibiotics regarding the type, duration, and improvement. Statistical calculations were conducted using SPSS Statistics and Microsoft Office Excel. Results: High rates of antibiotics without a prescription were identified in our study: 62.7%. The drug most often used for self-medication was amoxicillin (60.6%). Antibiotic use, duration of treatment and outcome did not show an association with any of the cross-tabulated variables (p > 0.05). On the other hand, antibiotic type showed a significant association with gender (p=0.015) and smoking status (p=0.023) but no significant association with other variables (p > 0.05). 32.5% ofamoxicillin and azithromycin users took the antibiotics regularly in the full course. Regularity of amoxicillin or azithromycin intake did not show a significant association with either gender or stage. Conclusion: Self-medicated antibiotics are a very common practice among students in our study, especially medical ones. Amoxicillin is the most widely used antibiotic. Many students who participated in our study don’t have any idea about the full course of using antibiotics. Keywords: Antibiotics, awareness, Respiratory Tract Infection, Students of Baghdad Universities

Assessment of Satisfaction with Primary Health Care Services: an Account of Clients’ Perception in Baghdad.

Background: Primary health care (PHC) is the “front door” of the health system. This perception highlights the importance of the wide perspective required to analyze the quality of care that’s provided by primary health care centers. Aim:   To assess satisfaction with the quality of care provided by the medical consultation units in PHC centers from the perspective of the clients in question Methods: Cross-sectional primary health care center-based study was conducted from the 1st to the 23rd of February 2022 in Baghdad, Iraq. Six peripheral PHC centers were randomly selected from both Al-Karkh & Al-Rasafa. Clients’ satisfaction with care was assessed according to the revised model of quality which includes: safety, effectiveness, waiting time, and patient/kin-centeredness besides other criteria. All of these details, including the socio-demographic characteristics, were collected by a structured-interview questionnaire. Results: Out of (415) clients who were enrolled in this study, two-thirds (65%) expressed general satisfaction regarding the overall healthcare services. When the quality of care was dissected into a more specific nature, the overall satisfaction had dropped and the lowest level of satisfaction was in timeliness, safety, and patient/kin-centeredness (18.5%, 38%, and 40%, respectively), while the highest was in equity, kindness with compassion & holistic care (68%, 63%, and 57%, respectively). Other criteria remained on the borderline, with almost (50%) satisfaction for each. Conclusion: The clients’ overall satisfaction was above the average which reflects an acceptable quality of care. Nevertheless, the overall satisfaction per se might be misleading in the assessment of quality and not necessarily correlate to the reality and that’s why every aspect of care must be evaluated separately, and not just the tip of the iceberg

Quality of life among gastric cancer patients in one center in Baghdad, Iraq in 2021.

Background: In Iraq, gastric cancer is the ninth most frequent cancer. health-related quality of life (HRQOL) encompasses a person's physical, mental, emotional, and psychological well-being, as well as their social and functional status. These aspects are crucial in assessing the long-term health consequences of stomach cancer. The purpose of this study is to summarize the quality of life among gastric cancer patients and how it affects their daily activity. Methods:A descriptive cross-sectional study was done in an oncology teaching hospital in Baghdad Iraq in 2021. 30 patients with gastric cancer diagnosed using endoscopic biopsy were recruited. Participants were asked to answer questions in a structured interview. The questionnaire included questions about the quality of life including symptoms, treatment, and activities of daily living. Results:Half of the sample were males. 46.66% were in their sixth decade or older. 33% had poor quality of life during the recent 3 months and 80% had worse quality of life than before. 50% had worse economic status than before. 30% had a lack of energy almost every day and 80% had a low mood at least once a day. Diabetes is the most frequent co-morbidity. Conclusion: The majority of patients had a good or acceptable lifestyle, but worse than before with half having worse economic status than before. Most participants have bad moods and lack of energy, and the majority have limited social activities. Keywords: quality, life, gastric cancer, Iraq.

The Role of Anti-Thyroglobulin Antibodies in Predicting Thyroid Cancers in Patients Undergoing Thyroidectomy

Background: Preoperative prediction of thyroid malignancy can help in risk stratification and perioperative management. It has been debated that anti-thyroglobulin antibody (TgAb) are more frequently elevated in patients with thyroid cancer than in the general population. Aims: to evaluate the predictive value of TgAb in predicting thyroid cancer in patients undergoing thyroidectomy. Patients and Methods:   This is a prospective single-center study including 98 patients diagnosed with a thyroid nodule and scheduled to have a thyroidectomy. Demographic data and final histopathology reports were reported. Serum levels of TgAb were measured by ready kit using competitive radioimmunoassay. Accordingly, patients were divided into two groups: TgAb-positive and TgAb-negative groups. Results: Thyroid malignancy was reported in 18 patients (18.37%), while the other 80 patients (81.63%) were found to have benign tumors. Twenty-one patients (21.43%) were TgAb-positive and 77 (78.57%) were TgAb-negative. The frequency of positive TgAbs among patients with thyroid malignancy was 61.11% compared to 12.5% among patients with benign tumors (OR= 11.0, 95%CI= 3.46-34.96, P< 0.001). The sensitivity and specificity of TgAbs were 61.11% and 87.5% respectively. The positive and negative predictive value of TgAbs were 52.38% and 90.91%, respectively Using receiver operating characteristic curve was used to find out the cut off value of TgAb in predicting thyroid malignancy. The area under curve was 0.681, 95%CI= 0.565-0.797, p= 0.048. The sensitivity and specificity of the test at the TgAb cut off value= 114.6 U/ml was 0.35 and 0.77 respectively. Conclusions: Positive preoperative serum TgAb level was associated higher frequency of thyroid malignancy. The TgAb has poor sensitivity (61.11%) and good specificity 87.5%) in predicting thyroid malignancy in patients undergoing thyroidectomy.  Keywords: thyroid malignancy, anti-thyroglobulin antibodies, sensitivity and specificit

The Prevalence of Hepatitis B & C Among Hemodialysis Patients in Baghdad Medical City.: Hepatitis B & C

Background Hepatitis B and C are infectious diseases caused by the hepatitis B and C viruses respectively, that affects the liver. Hepatitis viruses are transmitted by blood-to-blood contact associated with dialysis, poorly sterilized medical equipment, needle-stick injuries, blood transfusion, and intravenous drug users.MethodsThis is a cross-sectional study conducted in the Hemodialysis Unit of Baghdad Teaching Hospital between the period of April andSeptember 2018. Ninety-eight patients were enrolled in this study after adopting informed consent. All patients were on regular hemodialysis as a renal replacement therapy with different durations. Full history was taken from themIncluding age, gender, occupation, marital status, past medical, and surgical histories. Blood test results were also recorded. All data were analyzed using SPSS20 with 95% confidence which means a p-value less than 0.05 to be statistically significance. ResultsThe percentage of Hemodialysis patients infected with Hepatitis C was (43%) while those infected with Hepatitis B was (3%). There is no statistically significant association between age and infection with Hepatitis B & C (P>0.05). The mean age of patients infected with Hepatitis B was (65.8±8.2), while for patients infected with Hepatitis C it was (45.3±14.7).ConclusionHepatitis C is more prevalent than Hepatitis B in the Hemodialysis Unit and the infection was not statistically associated with the age or gender of the patient

Cutaneous Warts Treatment Modalities: Cutaneous Warts

Abstract Warts are common problem in the communities and caused by many types of human papilloma virus. There are many modalities of treatment in which none was shown to be perfect and only few were based on high-level clinical trials. Treatment should be individualized in practice depending on many factors like immunity status, age, number, and sites of the warts, with generally being less costly and with no pain. Treatments can be traditional, destructive, virucidal, antimitotic and immunomodulatory. Salicylic acid being most widely used due to effectiveness and convenience with little side effects. Remission and recurrence can seem unpredictable for warts treatment

Analyzing Predisposing Risk Factors for Breast Cancer among Iraqi Women in Baghdad Teaching Hospital and National Center for Cancer Diseases in Baghdad in 2018.: Analyzing Predisposing Risk Factors for Breast Cancer among Iraqi Women

AbstractBackgroundBreast cancer is the most frequent malignancy in women worldwide. In Iraq, Breast cancer ranks the first among cancers diagnosed in women, the goal of this study is to bring the lights towards the importance of most common risk factors for breast cancer to reduce the incidence of breast cancer.MethodsA case control study involved breast cancer women who attended national center for cancer diseases hospital in Baghdad between first of June 2018, and first of September 2018, the cases were (60) and control were (90) all of them were interviewed using questionnaire that contains risk factors for breast cancer and all cases had their medical records available. SPSS version 23 was used. Each parameter is compared separately for statistically significant differences.ResultsThis study shows that the mean age of cases is 48.30 and the mean of controls is 34.42. The Body mass index, the martial status, radiation exposure and smoking of both cases and control were not statistically significant, the gravity, abortion and breast feeding also show no significant differences. The family history is highly significant between cases and controls, 24 cases shows from 60 had family member with the disease and most of them had sisters as the affected family member. Contraceptive intake also showed significant differences, there is 35 cases from 60 use contraceptive drug.ConclusionThe majority of women with breast cancer had been in the 5th decade, Family history and contraceptive pills intake are strong predictors for Breast cancer