European Journal of Medical and Health Research
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Retained Stabbing Weapon in Thoraco-Abdominal Penetrating Trauma: A Case Report
No full textThe frequency of penetrating stab wounds has increased due to rising criminality, availability of weapons, conflicts, and drug consumption worldwide, although varying from country to country. Their mortality is related both to the severity of hemorrhagic injuries and to the septic risk of a hollow organ perforation. Management must be multidisciplinary, involving anesthesiologists, radiologists, and surgeons. Universally accepted clinical indications for exploratory laparotomy in penetrating abdominal trauma include a retained penetrating object, which must be kept in place until surgical removal. Computed tomography scan is the reference examination if the patient is stable, with a sensitivity of 80% for lesion assessment. The prognosis of abdominal stab wounds depends on the rapidity and effectiveness of management, particularly the detection and treatment of potentially fatal visceral injuries
Strengthening Vaccine Cold Chain Management to Enhance Quality, Safety, and Efficiency in PHCs
No full textBackground: Effective vaccine cold chain management is essential for maintaining vaccine potency and preventing wastage. Baseline data at PSMMC’s multi-site primary care network showed systemic failures, including a 90% transport temperature compliance rate and frequent temperature excursions.
Local Problem: The system lacked validated cold chain equipment, standardized workflows, and continuous temperature monitoring. Inefficient routing through the pharmacy and overcrowded storage led to chronic delays and instability in temperature control. Methods: A multidisciplinary team implemented a Lean 5S intervention, guided by RCA tools including a Fishbone Diagram and Pareto Chart. Interventions included validated containers, LogTag digital monitoring, district-based delivery scheduling, visual SOPs, and competency-based staff training. Results: Transport temperature compliance improved from 90% to 100%, delivery delays dropped from 60% to 0%, and staff competency increased from 20% to 100%. Vaccine wastage decreased by 47%, from 0.15% to 0.08%, with corresponding cost savings. Conclusions: The Lean 5S initiative strengthened cold chain reliability, improved operational efficiency, and aligned PSMMC practices with WHO and MOH standards. The intervention created a sustainable, high-reliability system for vaccine safety
Assessment of Drug Causality in Severe Cutaneous Adverse Reactions: A Comparison Between the Bégaud Method and the Naranjo Algorithm
No full textBackground: Severe cutaneous adverse reactions are rare but potentially life-threatening. Identifying the causative drug is crucial for managing and preventing recurrence. Two commonly used causality assessment methods are the Bégaud and the Naranjo algorithm, each with distinct approaches and limitations. The objective of our study is to compare these methods in assessing drug causality in severe cutaneous adverse reactions and to evaluate their concordance and practical applicability. Material and methods: We conducted a retrospective analysis of 116 cases reported to the Casablanca pharmacovigilance center between 2019 and 2023. Drugs implicated were assessed using both the Bégaud and Naranjo methods, and their scores were harmonized into four categories: doubtful, possible, probable, and highly probable. Statistical analysis was performed using Jamovi software. Results: A total of 442 drug observations were analyzed. Antibiotics were the most frequently involved drug class (34.5%). The Bégaud and Naranjo methods yielded identical causality classifications in only 37% of cases, with no statistical concordance (Kappa = 0.062). The Naranjo algorithm tended to implicate more drugs per case (median = 2.00) compared to the Bégaud method (median = 1.00; p < 0.001). Conclusion: The Bégaud and Naranjo methods demonstrated poor agreement in assessing the causality of severe cutaneous adverse reactions. The Naranjo algorithm offers simplicity and rapid application, making it suitable for emergency settings with limited drug exposure. The Bégaud method provides a more detailed analysis, better suited for complex and polymedicated cases. Both methods have complementary roles, and an integrated approach may improve diagnostic accuracy in pharmacovigilance
Knowledge, Attitudes, and Practices of Primary Health Care Physicians Regarding Deprescribing in Older Adults
No full textBackground: Polypharmacy is highly prevalent among older adults and is associated with increased risks of adverse drug reactions, drug–drug interactions, and functional decline. Deprescribing has emerged as an important patient-safety strategy in primary care; however, its implementation largely depends on physicians’ knowledge, attitudes, and practices. Objective: To assess the knowledge, attitudes, and practices (KAP) of primary health care (PHC) physicians regarding deprescribing in older adults and to examine demographic factors associated with these domains. Methods: A cross-sectional survey was conducted among 200 PHC physicians working in Baghdad, Iraq. Data were collected using a structured, pretested electronic questionnaire covering knowledge, attitudes, practices, and perceived barriers and enablers related to deprescribing. Responses were scored and categorized into poor/fair and good levels. Results: More than half of participants demonstrated good knowledge of deprescribing (59.0%), while a higher proportion showed good attitudes (77.5%) and good practice (58.0%). Insufficient guidelines (40.5%) and lack of time (31.0%) were the most commonly reported barriers, whereas availability of better guidelines was the main enabler (75.0%). Gender was significantly associated with knowledge (p = 0.03), while practice was significantly associated with gender (p = 0.021) and years of experience (p = 0.002). Physicians with more than 10 years of experience were more likely to demonstrate good deprescribing practice. Conclusion: PHC physicians showed generally positive attitudes and acceptable knowledge toward deprescribing, but important gaps in practice remain. Targeted training, clearer guidelines, and practical decision-support tools are needed to strengthen deprescribing implementation and enhance medication safety in older adults
Environmental Chemical Skin Carcinogenesis Concerning the Development of Melanoma and Keratinocyte Cancer: From Nitrosocontamination / Endogenous Nitrosation in Pharmaceuticals to Photocarcinogenicity in Humans
No full textNitrosamines have been recognized since the 1930s as carcinogens, and as photolabile compounds capable of undergoing photodegradation, regardless of their carcinogenic potential. While larger studies are gradually being conducted and officially acknowledged, single case reports often provide highly valuable clinical insights, reflecting real-world clinicopathological correlations. Drugs such as those taken by the patient presented (like ramipril/amlodipine, moxonidine, febuxostat, esomeprazole) share several important characteristics: All five have been discussed in the literature in the context of potential 1) nitrosamine contamination or 2) formation from secondary/tertiary amines under specific (acidic) conditions. For each of them, literature data from recent decades suggest the possibility of systemic distribution with accumulation in peripheral tissues, including the skin. It should be noted that the FDA’s Daily acceptable intake (AI) limits for nitrosamines are largely derived from mutagenicity and carcinogenicity data, including bacterial assays such as the Ames test (using Salmonella typhimurium and/or Escherichia coli strains). However, while these assays are well established for detecting mutagenic potential, they cannot replicate the complexity of the so called dynamic human skin related carcinogenesis. In particular, they may not adequately account for mechanisms such as Nitroso phototoxicity/ Nitroso photocarcinogenicity, were photochemical reactions in peripheral tissues - such as the skin - could occur independently of, or prior to, hepatic metabolic activation of the drugs mentioned. Consequently, localized ultraviolet-driven chemical reactions and/or independent tissue-specific oxidative or nitrosative stress pathways may not be sufficiently reflected in standard bacterial-based risk models. Already published national and international data, suggest a pathogenetic association between polymedication
intake and the increased skin cancer risk, particularly in chronically treated, polymorbid patients.In clinical practice, these considerations raise the possibility that photocarcinogenicity - and more specifically, Nitroso Photocarcinogenicity - may be influenced by the combined effects of polymedication, especially in the presence of potential nitrosamine contamination/ endogenous formation (even without contamination).These processes also depend on individual pharmacokinetic and pharmacodynamic profiles of each drug, as well as on individual variability in metabolism, enzyme activity, and tissue distribution. Nitroso mediated Photocarcinogenesis may additionally be influenced by nutritional Nitrosogenesis: nitrosamines may be introduced into the body through medication without any availability of external Nitrosamine contamination. If the drugs posses secondary or tertiary amino group, there is a possibility to undergo on that way the so called endogenous Nitrosation/ Nitrosamine formation in the presence of nitrites rich food intake in acidic environment (in the stomach) - leading to the in vivo formation of N-nitrosamines. Polymedication (ramipiril/amlodipine, moxonidine, febuxostat, esomeprazole) and the subsequent development of cutaneous melanoma and BCC skin tumors located in close proximity, can once again be explained within the conceptual framework of the so called exogenous Nitrosocontamination and the endogenous drug related Nitrosogenesis leading subsequently to the drug related Nitroso- Photocarcinogenesis
The Significance of Tranexamic Acid after Percutaneous Nephrolithotomy: A Single-Center Study
No full textObjectives: The study aims to assess the impact of tranexamic acid (TXA) administration on several outcomes in cases undertaking percutaneous nephrolithotomy (PCNL), with an emphasis on evaluating operative surgical times, postoperative complications, in-hospitalization rates, and hematocrit/hemoglobin decline. Methods: A randomized controlled clinical trial was conducted from January 2021 until July 2023 at the Al-Hilla Teaching Hospital. A total of forty patients who underwent PCNL were involved, and divided into two groups at random. After surgery, TXA was administered to the first group (TXA Group, n = 20), while the second group (NTXA Group, n = 20) did not receive any medication. Clinical and demographic data on the patients were documented, and the two groups' performance was compared in terms of severalvariables, including hospitalization, operative time, hemoglobin and hematocrit drop, and postoperative complications. Results: TXA Group observed significantly less postoperative hemoglobin compared to NTXA Group (p = 0.01; 12.9 ±1.3 vis. 10.8 ±1.4 g/dl). The postoperative hematocrit dropped significantly in TXA Group (p = 0.001); (39.1 ±3.9%) compared to the NTXA Group (34.9 ±3.7%). The average operative time was shorter in the TXA Group significantly (p = 0.024); 63.3 ± 10.8 min against 73.5 ± 16.3 min in the NTXA Group. Patients in TXA Group hospital stay was substantially shorter compared to NTXA Group, (154.0 ±10.7 vis. 160.6 ±11.7 hours, p = 10.021). Although postoperative moderate hematuria was present in all patients in both groups, NTXA Group experienced four cases (20%) of heavy hematuria, and TXA Group only had one case (5%) of severe hematuria (p = 0.047). Blood transfusion was necessary for four patients (20%) in the NTXA Group and one case (5%), a statistically significant difference (p = 0.047). The results suggest that the TXA administration in PCNL trials not only leads to better outcomes given less hemorrhage and post-operative complications but also improves rehabilitation by enabling shorter hospitalization and reducing the rates of postoperative sequels. Conclusions: As this single-center study shows, TXA administration during PCNL procedures expedites recovery and rehabilitation by reducing operative duration, the duration of in-hospital stays, postoperative hematocrit/hemoglobin declines, and the need for blood transfusions, with minimal adverse effects
Apical Debris Extrusion of Two Heat Treated Rotary NiTi Instruments; AF F-One Files and Orodeka Plex-V Files in Severe Curved Simulated Canals. A Comparative In Vitro Study
No full textObjective: the extrusion of apical debris is considered as the prime reasons of endodontic flare up. The aim of this paper was to calculate the weight of this debris after preparation of curved resin canals using two different endodontic rotary systems: Fanta AF F-One and Orodeka Plex-V files. Materials and methods: twenty curved simulated resin canals were divided into two sets (n=10) rendering to the files applied for canal instrumentation. All samples were prepared with apical file of 25/04. The debris was to be collected in pre-weighed vials then incubated at 37°C for two weeks. Then the vials were re weighing and the quantity of debris of each canal was collected from subtracting the amount of pre-weight from post-weight of the vial. t-test was utilized to compare the mean weight of the extrusion to assess the significant difference between the examined groups. Level of significance was 0.05. Results: there was no significant difference between the tested groups in term of apically extruded debris (P=0.724). Plex-V system showed more percent of extrusion than AF F-One system. Conclusions: the two tested systems extruded debris without significant difference. List of Abbreviations: Nickle-titanium (NiTi), Apical Extruded Debris (AED), Root canal treatment (RCT), Working length (WL), rotation per minute (rpm), Newton (N), Statistical Package for Social Sciences (SPSS), Probability value (P). Significant (Sig), That is to say (i.e.,)
Community Awareness of Preventive Health Measures and Lifestyle-Related Diseases: A Cross-Sectional Study at Al-Diwaniyiah Teaching Hospital, Iraq
No full textIntroduction: Non-communicable diseases (NCDs) related to lifestyle, such as type 2 diabetes mellitus, hypertension, cardiovascular disease, and obesity are the most common causes of premature mortality and morbidity in Iraq. Increasing awareness within communities about preventative health behaviours are essential to reduce the burden of these diseases. Evidence about community awareness levels in the Al-Diwaniya Governorate is limited. Aim: To determine the awareness levels of community members of preventative health behaviours and preventable lifestyle diseases among those attending the outpatient clinics at Al-Diwaniya Educational Hospital and the sociodemographic factors associated with low levels of awareness. Methods: This cross-sectional descriptive study was conducted at Al- Diwaniyiah Teaching Hospital outpatient clinics between January to June 2025. Using convenience sampling, 420 adults participated in the study. The validated self-administered structured survey collected sociodemographic data and information about 1) common preventable lifestyle diseases, 2) modifiable risk factors for common preventable lifestyle diseases, and 3) knowledge of preventative health behaviours. Descriptive statistics and the Chi-square statistic were conducted using SPSS version 26. Results: The average participant age was 38.4 ± 12.7 years. Overall, there was adequate awareness of preventable lifestyle diseases for 41.9% of participants. Awareness levels of preventable lifestyle diseases were significantly more prevalent in participants with university education (68.4%) compared to those with only primary education (18.2%; p < 0.001). The variables of sex (i.e., female), residence (i.e., urban), and income level (i.e., higher income) were independently associated with better awareness of preventable lifestyle diseases. Inadequate knowledge of specific preventative health behaviours were found across all levels of education (e.g., dietary modifications, exercise, smoking cessation, and routine screening). Conclusion: There is inadequate community awareness of preventative health behaviours and preventable lifestyle diseases among those attending Al-Diwaniya Educational Hospital. Targeted community health education programs are urgently required to improve awareness of preventative health behaviours and preventable lifestyle diseases, specifically for those with lower levels of education, living in rural locations, or have lower monthly income to attempt to reduce the growing burden of NCDs in Iraq
Impact of Cesarean Delivery Patterns and Scar Thickness on Subsequent Pregnancy Outcomes: A Community-Based Study in Southern Iraq
No full textBackground: The integrity of the lower uterine segment scar following cesarean section (CS) is a critical determinant of safety in subsequent pregnancies. Sonographic measurement of the uterine scar niche and residual myometrial thickness provides a non-invasive means of stratifying risk for uterine rupture, scar dehiscence, and adverse perinatal outcomes. Despite a nationally elevated CS rate in Iraq, data from local populations remain scarce. Objective: To evaluate the relationship between lower uterine segment (LUS) scar thickness measured by transabdominal ultrasonography at 36–38 weeks of gestation and subsequent obstetric outcomes in women with a previous cesarean section attending Babylon Educational Hospital for Gynecology and Pediatrics, Iraq. Methods: A prospective cohort study was conducted between January 2023 and December 2024. A total of 215 pregnant women with one or more prior CS were enrolled and classified by LUS thickness: Group I (thin scar, <2.5 mm), Group II (adequate scar, 2.5–3.5 mm), and Group III (thick scar, >3.5 mm). Maternal and neonatal outcomes including mode of delivery, intraoperative uterine rupture or dehiscence, blood transfusion, neonatal Apgar scores, NICU admission, and birth weight were recorded and analyzed. Results: Of the 215 participants, 67 (31.2%) had a thin scar, 89 (41.4%) an adequate scar, and 59 (27.4%) a thick scar. Complete uterine rupture occurred exclusively in Group I (7.5%), and scar dehiscence was significantly more frequent in Group I (20.9%) compared with Groups II (2.2%) and III (0%) (p<0.001). Emergency CS, blood transfusion, and neonatal NICU admission were all significantly higher in Group I. Logistic regression identified LUS thickness as an independent predictor of uterine dehiscence (OR 0.34 per mm increase; 95% CI 0.18–0.63; p=0.001). Conclusion: Lower uterine segment scar thickness measured at 36–38 weeks of gestation is a reliable sonographic predictor of uterine scar complications and adverse perinatal outcomes in Iraqi women. Routine third-trimester LUS assessment should be incorporated into antenatal care protocols for women with previous cesarean delivery
Evaluation of Pneumatization Pattern of Sphenoid Sinus on Computed Tomography Scan in an Urban Nigerian Population
No full textBackground: The pneumatization pattern of the sphenoid sinus (SS) is highly variable. A good understanding of sphenoid sinus pneumatization is critical for skull base surgeries and functional endoscopic sinus surgery (FESS) in order to avoid serious complications. Purpose: The purpose of this study is to present the pneumatization pattern of the sphenoid sinus in adult participants in our environment. Methods: This is a retrospective study conducted at a privately owned Radiodiagnostics Center after obtaining institutional ethical approval. Brain Computed Tomography images of 200 patients aged ≥18 years were studied for the variant pneumatization patterns of the sphenoid sinus. The data obtained were analyzed using the statistical package for social science, IBM SPSS (version 25.0 by incorporation, Chicago - Illinois, USA 2017). The continuous variables will be expressed as means (x) and standard deviation (SD). P-value was considered significant at <0.05. P-value was considered significant at <0.05. Results: The majority of the participants were males 118 (59%) with a mean age of 48.3 ±18.1 years while the female patients were 82(41%) with a mean age of 47.4 ±17.6 years. The commonest pneumatization pattern is the post sellar type 93(46.5%), followed by the sellar type 53(26.5%) then the presellar type 49(24.5%) and the least common is the conchal type 2(2.5%). None of the pneumatization patterns showed a significant age and gender difference. Sphenoid sinus agenesis was not documented. Conclusion: The postsellar and conchal type of sphenoid sinus pneumatization was found to the commonest and the least common in our environment. None of the pneumatization patterns showed a significant age and gender difference. Sphenoid sinus agenesis was not documented.