بهاء عبد الرزاق محمد علي المذحجي

Abstract Objective We aim to provide a comprehensive description of the epidemiology, management, and outcome of vascular trauma in Najaf, with a report of unusual case presentation and surgical technique in management. Methods We did a retrospective observational study of patients who presented after vascular trauma and were managed by a single surgeon between 1st January 2017 and 1st August 2020. Most of the cases operated on in the Al-Sadir Medical City, the tertiary center in the city that receives patients from the whole middle Iraq region. Vascular injury complicating hemodialysis access in patients with renal failure were excluded from the study. Small vessel injury (below the knee and below elbow), and we excluded patients with primary amputation from the series. Results Over 43 months, 60 cases of vascular trauma were encountered. At the time of presentation, patients' mean age was 31.2 ± 12.6 (range, 10-60). There were 55 males (91.6%) and five female (8.3%), and the male to female ratio was 11. We had 14 (23.3%) cases of blunt trauma and 46 (76.6%) cases of penetrating trauma. The femoral artery was the most commonly affected vessel in 19 patients (31.6%), followed by the brachial artery in 14 patients (23.3%). The most common type of vascular injury was complete cut 40%, and the most common surgical intervention was reverse interposition venous graft 46.6%. We had 21 cases (35%) with associated venous injury, mostly managed by lateral repair. The amputation rate in our series was 6.6%, and the mortality rate is also 6.6%. We reported spontaneous brachial artery rupture in 16 years old male with undiagnosed connective tissue disease after ordinary movement. The cheese-like artery was ligated without consequences. We also reported aortic bifurcation thermal injury during laparoscopy and free wall rupture in 46 years old female who was successfully managed by unusual aortic bifurcation reconstruction technique without prosthetic use material despite the loss of a large amount of native tissue. Our series had 47 years old male with acute extensive aortic dissection treated by the stent and complicated by occlusion of celiac, superior mesenteric, and right renal arteries. We did a retrograde graft from the right common iliac artery to the superior mesenteric then right renal arteries, but unfortunately, the patient died in the ICU two months later. Conclusion Vascular injury is an increasing problem in Najaf because of city expansion, increased violence, and advancement in medical interventions that lead to more iatrogenic vascular injury. Early diagnosis and management is of paramount importance to achieve a satisfactory outcome

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Abstract Introduction: Smoking causes 90% of cases of lung cancer in men and 70-80% of cases in women. Individuals without smoking history have other risk factors e.g. genetic, infectious, air pollution, cooking and heating fumes or radiation. In those patients the most common histology is adenocarcinoma. Complex coronary intervention is associated with significantly higher dose of radiation exposure than diagnostic procedure. Objective: We aim in this study to show the relationship between X-ray exposure in complex coronary intervention and increase incidence of bronchogenic carcinoma. Methods: A case control observational study. We recruited 60 cases of bronchogenic carcinoma presented to our facility from March 2012 to march 2019. Some had history of radiation exposure due to complex coronary intervention, compared with randomly selected 60 healthy relatives matched for age, sex and smoking index. Associations between radiation exposure and lung cancer risk were estimated by use of odds ratios. Reported P values are two-sided. Results: 15 patients with bronchogenic carcinoma had history of radiation exposure due to complex coronary intervention while only 5 patients of controls had been exposed to this form of radiation. Odd ratio = 3.67, p-value = 0.0257 Conclusion: Complex coronary intervention is associated with significant radiation exposure and increase incidence of bronchogenic carcinoma

This study aimed to show the incidence, presentation, management, and outcome of acute limb ischemia (ALI) in patients diagnosed with COVID-19 pneumonia, and prove the association between them. A multi-centre retrospective cohort study in the middle and south of Iraq, comparing 400 patients admitted to the isolation hospitals for COVID-19 pneumonia with a matched control group at period from 1st June 2020 to 1st August 2020. A total of 21/400 cases of ALI in COVID-19 pneumonia and only 4/400 cases in the non-COVID-19 group. Relative Risk (Risk Ratio= 5.25, 95%CI=1.818-15.157, P = 0.001). There were 291 (72.7%) males and 109 (27.2%) females. The average time from diagnosis of COVID-19 to the onset of ALI was (9.4±6.4 days). The mean ischemic time was (22.05 ±18.8 hours) in the COVID-19 group, while it was (11.75±8.7 hours) in the non-COVID-19 group. The mean D-dimer level for the patient with COVID-19 pneumonia without ALI is (1705±1256 μg/L), while it is (3730±2373 μg/L) for the patient with COVID-19 pneumonia. The embolectomy done in 14 patients (66.6%) of the COVID-19 pneumonia group, and it was successful in 10 patients (71.4%). In comparison, it was done in 3 patients (75%) of the control group and was successful in 2 (66.6%). Amputation was done in 4 patients (19%) of the COVID-19 pneumonia group, while only one patient (25%) in the control group had amputation. The association between COVID-19 pneumonia and ALI incidence; the D-dimer level is also associated with ALI in COVID-19 pneumonia cases. The anticoagulants, antiplatelet, vasodilators, and embolectomy had a management success rate.

COVID-19 is the infectious disease caused by the most recently discovered coronavirus. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. COVID-19 is now a pandemic affecting many countries globally, such a situation has not existed since the flu pandemic in 1918. In this book we aimed togive guidance on the full range of significant health issues associated with this threatening disease which is often severe and fatal with no proven treatment and vaccines to day of published this book. The book comprises seven chapters, the first chapter provides a general introduction on the history of the COVID-19. Subsequent three chapters cover the basic aspects of virology including the epidemiology, molecular changes of SARS-CoV-2 genome, and immunological aspects regarding COVID-19. The five chapters that follow diagnosis ofCOVID-19, while six and seven chapters exploring developments and recent researches in the field treatment and vaccine of COVID-19. This book is the product of a collaboration effort. We wish to express our appreciation to all the contributing authors. We are especially grateful to members of the revising team, Prof. Lawrence Nofer, Prof. Christopher Schultz and Prof. Justin Sambol for providing support, feedback, and guidance during the process. Gratitude is extended to many of our colleagues for their advice and helpful discussions. Finally, we believe a clear head is crucial in times of over information, with dozens of scientific papers published every day regarding COVID-19, news about hundreds of studies being planned or already on the way and social media blending hard data with rumors and fake news.

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