European Journal of Medical and Health Research
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Effect of Anti-Tumor Necrosis Factors Therapy on Hematological Parameters in Patients with Ankylosing Spondylitis in Merjan Teaching Hospital
No full textBackground: Ankylosing spondylitis (AS) is a chronic immune-mediated inflammatory disease frequently associated with hematological abnormalities such as anemia, thrombocytosis, and altered indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). Anti-TNF therapy has revolutionized the treatment of AS, yet, the impact of anti-TNF therapy on hematological parameters in Iraqi patients remains underexplored. Objectives: to evaluate the effect of anti-TNF therapy on hematological parameters and disease activity in patients with AS at Merjan Teaching Hospital as well as documenting adherence, adverse events, and potential confounders. Methods: A prospective observational cohort study was conducted between January 2024 and July 2025, enrolling 85 biologic-naïve AS patients fulfilling modified New York or ASAS criteria. Patients received infliximab, adalimumab, or etanercept according to clinical judgment. Baseline and follow-up assessments included complete blood count (CBC), derived indices (NLR, PLR, SII), Erythrocyte Sedimentation Rate, c-reactive protein, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The statistical analyses were completed using paired t-tests, repeated measures ANOVA, correlation analysis and multivariate regression with adjustment for covariates. Results: The cohort comprised predominantly males (87%) with a mean age of 40.9 years. Baseline disease activity was high (mean BASDAI 6.26 ± 1.39; CRP 45.27 ± 44.61 mg/L; ESR 49.84 ± 15.28 mm/h). Anti-TNF therapy significantly reduced BASDAI, ASDAS, CRP, and ESR over 12 weeks. Hematological improvements included increased hemoglobin, reduced platelet counts, and normalization of NLR and PLR. Adherence exceeded 80%, with minor adverse events reported; no severe hematological toxicities occurred. Conclusions: Anti-TNF therapy in Iraqi AS patients effectively improved disease activity and corrected hematological abnormalities. Indices such as NLR and PLR may serve as reliable biomarkers of treatment response, underscoring the dual clinical and hematological benefits of biologic therapy in AS management
Volar Locked Plate Versus Ligamentotaxis in Fixation of AO Type C Distal Radius Fracture Regarding Functional Outcomes: A Comparative Prospective Study
No full textBackground: Type C intra-articular distal radius fractures are complex, and the relative benefits of volar locked plate fixation versus external fixation based on ligament taxis remain debated. Aim of the study: This study compared functional outcomes of these two surgical procedures. Patients and methods: In a prospective comparative cohort study at a single tertiary center, 45 adults with AO Type C distal radius fractures were treated with external fixation based on ligamentotaxis (n = 24) or volar locked plate fixation (n = 21). Patients were followed up at 2 weeks, 6 weeks, and 3 months. Functional outcome was recorded at 3 months’ post-op and it included pain on a visual analogue scale, wrist and forearm range of motion, grip strength, Disabilities of the Arm, Shoulder and Hand questionnaire score, complications, and time to return to work. Results: At 3 months’ post-op, Volar locked plate fixation yielded lower pain scores (mean 2.4 vs 3.5; p < 0.001), higher grip strength (81.4% vs 75.2%; p = 0.024), and earlier return to work (8.1 vs 10.0 weeks; p = 0.005) than external fixation. Wrist extension and forearm supination were significantly greater (p = 0.011 and p = 0.006, respectively) in the Volar locked plate treated group. Disabilities of the Arm, Shoulder and Hand scores were lower after volar locked plate fixation but not significantly different (p = 0.2), and complication rates were low and similar in both groups. Conclusion: Volar locked plate fixation provided better functional outcomes and earlier return to work than external fixation based on ligament taxis
Acute Intestinal Occlusion Due to an Internal Hernia in a Postoperative Patient Carrier of Down Syndrome
No full textInternal hernias are a common cause of bowel obstruction, which can present clinically in an acute or progressive manner. This diagnosis should be considered as a priority in patients with no prior surgical or inflammatory abdominal history. There are two types: the first variety involves intestinal loops herniating through a preexisting orifice, enclosed within a peritoneal hernia sac; the second involves loops protruding through an abnormal opening in the peritoneum, with imaging appearance similar to that of loop or adhesive band obstructions. In this article, we report the case of a 16- year-old female patient who presented a bowel obstruction without gas being expelled, along with vomiting and diffuse abdominal pain. There was no outward gastrointestinal hemorrhage. The overall condition evolved in a context of apyrexia and preserved general health. A CT scan revealed an appearance of a mechanical colonic obstruction caused by epiploic strangulation at the rectosigmoid junction and probable mesenteric volvulus on an incomplete common mesentery. The patient is known carrier of Down syndrome (trisomy 21), underwent surgery two times one at the age of 5 without any documents presented during her admission, the second one year after for incisional hernia
Portal Hypertensive Biliopathy Mimicking Cholangiocarcinoma: A Five-Case Report and Literature Review
No full textPortal hypertensive biliopathy (PHB) represents a rare but significant complication of portal hypertension, particularly associated with portal cavernomas. This condition manifests with structural and functional abnormalities of the biliary tree due to extrahepatic vein obstruction. Often asymptomatic for extended periods, PHB eventually presents with intermittent jaundice and cholestasis. Diagnostic challenges abound, as PHB can mimic sclerosing cholangitis or cholangiocarcinoma. Here, we present the first documented series of PHB in Morocco, accompanied by a comprehensive review of the literature. Our report underscores the diagnostic complexities and highlights the need for heightened clinical suspicion and tailored management strategies in this rare pathology
Modified Ying-Yang Flap for a Problematic Lesion in the Back Region
No full textThe Ying-Yang flap has been established as a safe and reliable option for the reconstruction of defects of varying sizes, providing effective tension distribution across multiple vectors while remaining less invasive than many conventional techniques. The evenly distributed tension promotes fast wound healing, preserves the anatomical integrity of surrounding tissues, and often results in a well-camouflaged final result. However, the technique can be further modified to achieve a more personalized reconstructive approach. In our case, a modified Ying-Yang was utilized for the reconstruction of a circular defect of the back following surgical excision of a problematic lesion. This modification offered several key advantages: 1) balanced tension distribution across multiple vectors, 2) preservation of native tissue architecture, 3) maintenance of vascular integrity to support flap viability, and 4) avoidance of complications commonly associated with skin grafts or more invasive reconstructive options - thereby providing a safer and functionally superior outcome
Derived Stature of Meitei Community by Measuring Tibia
No full textNorth Eastern (NE) region of India is inhabited by migrant people from surrounding countries. Basu's (2003) study of Tibetan people, reported lower limb length is shorter in hilly areas than in plain valley areas. In Manipur also two types of heterogenous people are seen. One of them has a shorter lower limb length while others have long lower limbs
The Impact of Junk Food Consumption on Mental Health among Healthcare Workers: A Narrative Review
No full textBackground: This narrative review explored the prevalence of junk food (JF) consumption and its detrimental effects on the health and mental well-being of healthcare workers (HCWs) as well as to assess the obstacles preventing the adoption of healthy eating habits in its workplace.
Methods: By searching websites for studies to be enrolled in this review in the period from 2014 to 2024, 81 studies were found on the PubMed website and 33 on other websites, for a total of 114 studies. 68 studies were prepared that did not fit our topic, leaving 46 studies that were classified as follows: 14 studies for HCWs, 8 nursing studies, 18 medical student studies and 6 studies in others. Results: This review emphasizes the prevalence of JFs consumption habits among different HCWs, trends of JFs consumption among both gender of HCWs, barriers to healthy eating habits at the workplace, possible associations among participant's demographics, job nature and JF consumption at work as well as the prevalence of overweight and obesity among HCWs and lastly, impact of JFs on mental health and work outcomes among HCWs were discussed. Conclusion: The evidence from this narrative review has provided enough information about effects of JF consumption on the health and mental well- being of HCWs. Future studies can assess how new strategies to encourage healthier eating among HCWs affect diet quality and more general measures of health and wellbein
Small Bowel Obstruction Caused by a Food Foreign Body: A Case Report
No full textSmall bowel obstruction caused by alimentary foreign bodies is rare, particularly in patients without prior abdominal surgery. Delayed diagnosis may lead to serious complications, including bowel ischemia. We report the case of a 47-year-old woman with no surgical history who presented with acute small bowel obstruction. Imaging revealed mechanical obstruction with a feces sign and no signs of ischemia. Surgical exploration identified a mobile intraluminal food foreign body located 1.20 m from the duodenojejunal flexure. A gentle milking maneuver allowed transanal expulsion of the foreign body, which was identified as a fig, without the need for bowel resection. Postoperative recovery was uneventful. Alimentary foreign body–induced small bowel obstruction is uncommon but should be considered in patients without prior surgery. Computed tomography is essential for diagnosis. When feasible, transanal extraction following intraoperative mobilization represents a safe and minimally invasive alternative to enterotomy, with excellent outcomes
Adult-Onset Tuberous Sclerosis Complex Presenting as Chronic Lumbar Pain: A Case Report of Symptomatic Renal Angiomyolipoma
No full textTuberous sclerosis complex (TSC) is a rare autosomal dominant neurocutaneous disorder characterized by hamartomas in multiple organs, including the brain, kidneys, liver, and lungs. Neurological manifestations, such as epilepsy, typically lead to diagnosis in childhood. This case report describes an atypical presentation in adulthood, with chronic lumbar pain asthe primary symptom prompting diagnosis of symptomatic renal angiomyolipoma, illustrating diagnostic challenges and management limitations in resource-limited settings. A 28- year-old woman with a history of childhood epilepsy and family history of epilepsy presented with persistent chronic lower back pain refractory to analgesics. She had no cutaneous stigmata or neurological deficits. Investigations revealed bilateral renal angiomyolipomas (AMLs), hepatic cysts, pulmonary cystic changes, and cerebral cortical tubers with subependymal nodules on MRI/CT. A large left renal AML of epithelioid variant prompted nephrectomy due to mass effect and suspected malignant transformation. Histopathology confirmed epithelioid AML. This case illustrates the phenotypic variability of TSC and the potential for delayed diagnosis when renal manifestations predominate in adulthood. It underscores the need for lifelong multisystem surveillance and timely use of mTOR inhibitors to avoid invasive procedures, particularly where access is limited
Efficacy and Tolerability of Vagus Nerve Stimulation Therapy (VNS) in Epileptic Patients at Baghdad Teaching Hospital
No full textBackground: Vagus nerve stimulation (VNS) is an established adjuvant therapy for patients with drug-resistant epilepsy (DRE) who are not candidates for resective epilepsy surgery. It has been increasingly used in both pediatric and adult populations to reduce seizure burden and improve quality of life. This study reviews the experience with VNS therapy for DRE at Baghdad Teaching Hospital. Patients and Methods: This uncontrolled retrospective study was conducted at the epilepsy clinic of Baghdad Teaching Hospital. Medical records of 71 patients with DRE who underwent VNS implantation between 2015 and January 2023 were reviewed. The cohort included 51 males and 20 females. Collected variables comprised age at implantation, sex, age at seizure onset, duration of follow-up, seizure type, seizure frequency before and after implantation, epilepsy etiology (lesional or non-lesional), VNS stimulation parameters at the last follow-up visit, and reported adverse effects. Data were analyzed descriptively to assess clinical outcomes and tolerability. Results: The age of epilepsy onset was <1 year in 27 patients (38.0%), 1–10 years in 34 patients (47.9%), and >10 years in 10 patients (14.1%). Seizure types included focal seizures in 13 patients (18.3%), generalized seizures in 10 (14.1%), focal to bilateral tonic-clonic seizures in 20 (28.2%), and multiple seizure types in 28 (39.4%). Overall, 56 patients (78.9%) showed a clinical response to VNS therapy, while 15 (21.1%) were non-responders. Adverse effects were reported in 30 patients (42.3%), with hoarseness of voice being the most common (32.4%), followed by shortness of breath (15.5%). Most side effects were mild and manageable. Conclusion: VNS is a safe, tolerable, and effective adjuvant treatment for patients with drug-resistant epilepsy who are not suitable candidates for surgical intervention. Seizure control tends to improve over time after implantation, and the majority of adverse effects are mild and well tolerated