Journal of Emergency Medicine, Trauma and Acute Care - 1 - The 3rd Annual International Conference on Information and Sciences, February 2024

Background: Workplace violence represents a severe problem facing health systems in almost all countries globally. Communication failure is thought to be the major issue that initiates violence.

Objective: This study aimed to test the effectiveness of a short training course for junior doctors on how to deal with patients’ aggressive attitudes in a trial to de-escalate violence against them.

Materials and Methods: This interventional randomized trial was conducted in a sample of hospitals in Baghdad and Karbala governorates, Iraq, from August 2021 through July 2022. A pre-training survey was conducted to collect data from a sample of junior doctors (1079) to explore their exposure to violent attacks. The one-arm randomized trial measured the difference in exposure of 190 doctors to violent attacks during a comparable period, six months before and six months after the training.

Results: Three-quarters (74.8%) of the sample reported exposure to lifetime violence. The prevalence of exposure to violence in the six months before the intervention was 66.8%, while six months after the training, it dropped to 53.2%, with a statistically significant difference.

Conclusion: A two-day training proved effective in reducing violent incidents. This result indicates the necessity of starting a nationwide, wide-scale, regular, periodic training program for junior doctors to de-escalate violence. The findings of this study represent a message to policymakers to make more efforts to lessen violence against healthcare workers.

Background: Strabismus is the loss of ocular alignment, which can lead to amblyopia, defective binocularity, and defective depth perception.

Objectives: To assess the results of strabismus surgery among patients older and younger than six years and study the influencing and predictive factors.

Methods: Surgical treatment for 202 patients clinically diagnosed with horizontal strabismus aged 4-45 years was carried out in Fallujah Teaching Hospital between September 2021 and October 2022. Surgical outcome was assessed at the end of 6 months post-operatively. Chi-square and Mann-Whitney Univariate tests were performed to evaluate the statistical relationship between pre-operative factors and surgical outcomes.

Results: Overall, the success rate of horizontal strabismus surgery was 68.3% (138 patients), and the rate of success among the esotropia group (55.1%) was better than the exotropia group (44.9%). Among age groups, a higher recorded success rate was for ages above 6 (71.7%). The success rate was higher in males than females (54.3% and 45.7%, respectively). Chi-square and univariate analysis showed a significant association between gender (p < 0.068), refractive error (p < 0.033), and surgical outcome.

Conclusion: Surgical correction of strabismus improved overall ocular deviation and binocular function. Esotropia patients benefited the most compared to exotropia patients.

Background: Caffeine consumption is considered a global issue, and the prevalence of caffeine consumption has dramatically increased among young adults.

Objectives: To assess the frequency of caffeine consumption, its sources, attitudes, and adverse effects among medical students in Fallujah and Anbar Universities in the west of Iraq.

Methods: A cross-sectional study was conducted, and a convenience sample was used to choose medical students from Anbar and Fallujah universities in the Anbar district in June 2022. The questionnaire consisted of questions about social characteristics such as age, gender, academic study level, and caffeine consumption-related questions.

Results: Out of the total (415), female students comprised 63.1% of the participants. The findings revealed that 34% of the participants consumed a caffeinated beverage once a day, 40% drank two to three times a day, 15.4% consumed caffeine once a week, and 57.6% had at least one cup each time. There was no statistically significant association between the adverse effects of caffeine and gender and the frequency of caffeine intake.

Conclusion: The findings of the current study reveal that caffeine consumption is common among medical students in the Anbar district.

Bone infection with Echinococcus granulosus represents 1–2.5% of hydatid diseases. The vertebrae are a common site of musculoskeletal hydatidosis; other bony hydatid diseases are rare. The primary diagnosis of bone hydatidosis is complex and requires a high index of suspicion with clinical features and immunological and radiologic investigation. Bone F.N.A. is avoided as there is a risk of spreading and anaphylaxis. This paper discusses the bony hydatidosis of the scapula and proximal humerus, extending outside the bone and destroying it.

Background: Refractive error (RE) represents a common cause of treatable visual impairment, and studying its epidemiology has been a research interest worldwide.

Objectives: To investigate the refractive status of Iraqi patients visiting the eye clinic at Fallujah Teaching Hospital and report the results compared to local and global records.

Methods: A hospital-based cross-sectional study analyzed the saved patients’ records from the Fallujah eye clinic. The prevalence of myopia, hyperopia, and astigmatism was estimated and analyzed according to gender and age groups in children, adolescents, and adult patients.

Results: In children and adolescents under the age of 18 years, the prevalence of emmetropia, myopia, hyperopia, and astigmatism was 34.95%, 19.7%, 20.9%, and 24.6%, respectively. In adult subjects, 29.6% were emmetropic, 16.9% were myopic, 20.7% were hyperopic, and 32.8% were astigmatic. A significant association between RE and age was detected (P = 0.001) but not with gender (P = 0.061).

Conclusion: This study found a high prevalence of RE among all age groups, with astigmatism being the most prevalent RE, followed by hyperopia and myopia.

Background: Preterm birth has a significant impact on neonatal health and the healthcare system as it increases neonatal morbidities and mortality rates. Interleukin-6 is one of the pro-inflammatory cytokines that can trigger the production of chemokines and uterine activation proteins, consequently causing uterine contraction and subsequent cervical change. Hypoxia-inducible factor-1α plays a pivotal role in the hypoxic adaptive response of tissues. It has been suggested that hypoxia has a vital role in the initiating and/or strengthening of uterine contractions, proposing that hypoxia-inducible factor-1α could be involved in this process.

Aim: Investigate whether serum concentrations of interleukin-6 and hypoxia-inducible factor-1α would differ between women with threatened preterm labor who deliver prematurely and those who continue their pregnancy till term.

Patients and Methods: The case-control study was extended over 12 months, including women in their 28^th to 35^th weeks of gestation and with a single viable fetus. The women were divided into three groups: women with threatened preterm labor who delivered prematurely (27 women), women with threatened preterm labor who continued their pregnancy till term (23 women), and women with matching gestational age and uncomplicated pregnancies (the controls = 40 women). The serum levels of interleukin-6 and hypoxia-inducible factor-1α were measured by Enzyme-linked immunosorbent assay.

Results: The mean values of interleukin-6 and hypoxia-inducible factor-1α were significantly different between the study groups (p-value <0.001 by one-way ANOVA), where women with threatened preterm labor who delivered prematurely had higher serum values of interleukin-6 and hypoxia-inducible factor-1α (124.5 and 102.4, respectively) than the women with threatened preterm labor who continued their pregnancy till term (71.0 and 55.2, respectively), and than the women in the control group (55.3 and 50.0, respectively). There was a significant negative statistical correlation between the values of interleukin-6 and hypoxia-inducible factor-1α and the timing of delivery (R = -0.786 and -0.644, respectively, p-value < 0.001).

Conclusions: Both interleukin-6 and hypoxia-inducible factor-1α serum concentrations can help differentiate pregnant women who are genuinely in preterm labor from those who have preterm contractions but are not at risk of imminent delivery.

Background: Placental adhesion disorder, or placenta accreta, is caused by a decidua basalis shortage that leads to the chorionic villi penetrating the myometrium. Different types of placental adhesion disorders are classified according to the degree of uterine adhesion. Cesarean Hysterectomy is indicated in cases of morbid adherence of the placenta in various age groups during childbearing age.

Objectives: Evaluation of the influence of placental adhesion on hysterectomy at the time of cesarean in near-missed pregnant women and assessment of factors that increase its incidence among Iraqi women.

Methods: This research encompassed a case-control study involving 64 pregnant women, with the participants selected from Al-Yarmouk Teaching Hospital. The pregnant patients were divided into two groups. The first group consisted of thirty-two pregnant women with emergency cesarean hysterectomy due to placental adhesion. The second group was made up of thirty-two pregnant women with elective cesarean hysterectomy due to placental adhesion.

Results: In the present study, it has been found that there are no significant differences in the age of patients who undergo elective cesarean hysterectomy as compared to emergency cesarean hysterectomy (p > 0.05). Also, according to the gestational age, most elective surgery patients are full-term pregnancies; meanwhile, the emergency cases are mostly preterm. Elective patient parity was higher than emergency cases at three parity 13 vs 9. The patients with emergency cesarean hysterectomy showed that the presence of two or more scars in the uterus was accreta in about 72% of patients. Meanwhile, the elective patients with placental adherence showed a higher frequency of two or more scars, the same as observed in emergency cases. Still, there were more emergency cases than elective cases.

Conclusion: There are elevations in the incidences of placental adhesion, reflecting the increase in cesarean hysterectomy surgeries and near-miss cases.

Background: Nephrocalcinosis (NC) is a serious condition among neonates that needs proper management. The study aimed to detect the prevalence of nephrocalcinosis among preterm babies in Fallujah city, west of Iraq, and measure its association with a variety of risk factors.

Methods: Thirty preterm cases were recruited from September to December of 2019. A pediatric radiologist performed an ultrasound on babies in the sample to detect nephrocalcinosis.

Results: There were 30 neonate babies; 7 (23%) cases had nephrocalcinosis. The mean gestation weight was 1.6±0.4 Kg. About 6% of the neonates did not need an oxygen supply, 10% required steroids, 33% needed theophylline, 20% received vancomycin, 3% received diuretics, and 70% received gentamycin. There was a statistically non-significant association between gender and using oxygen, theophylline, steroids, vancomycin, and diuretics with the occurrence of nephrocalcinosis.

Conclusion: Nephrocalcinosis among premature babies is a common disease and should be considered for screening. Treatment is mandatory to prevent its dangerous consequences.

Background: Gestational diabetes is a condition that occurs during the latter stages of pregnancy and is marked by notable resistance to insulin due to the release of hormones by the placenta. Zinc alpha 2-glycoprotein (ZAG) is an intriguing protein due to its ability to perform numerous essential functions in the human body. Prior research has linked ZAG to lipid metabolism.

Objectives: This study was designed to evaluate the ZAG level in GDM pregnant women undergoing different therapeutic modalities. Furthermore, the study examines the correlation between ZAG and lipid parameters.

Method: The study included a sample of 76 pregnant women aged 18 to 40 years. A total of 22 pregnant women without any health issues (Group 1), 30 pregnant women recently diagnosed with GDM (Group 2), and 24 pregnant women with GDM who were receiving various treatments (Group 3) were included in the study. All participants were in their second or third trimester of pregnancy, and their demographic information and lipid measurements were assessed.

Results: There was no statistically significant difference in ZAG levels among study groups (P ≥ 0.05); hence, GDM pregnant women in Group 2 showed the highest level. In GDM pregnant women who received treatment, there was a significant difference in ZAG levels among subgroups (p<0.01). The metformin group had the lowest level of ZAG. The high-density lipoprotein and triglyceride levels were significantly higher in GDM-pregnant women in Groups 2 and 3 (p<0.05). Only in Group 3, ZAG levels and other lipid parameters (total cholesterol, high-density lipoprotein, low-density lipoprotein, triglyceride, and very low-density lipoprotein) were highly statistically significantly correlated with each other (p<0.01), except for triglyceride levels, where there was no correlation between them (p≥0.05).

Conclusion: The current findings revealed that ZAG levels are altered in GDM pregnant women and are beneficial indicators for metabolic status during treatment. ZAG levels correlate well with the lipid profile in GDM pregnant women who received treatment.

This study examined how Er,Cr:YSGG laser surface conditioning affected the adhesion of lithium disilicate ceramic to the dentin tooth structure. Forty samples were divided into four groups (n=10). The first group was untreated, whereas the second was etched with hydrofluoric acid. The third group was treated for 2 minutes with a 7 W, 25 Hz Er,Cr:YSGG laser. The fourth group received the same Er,Cr:YSGG laser treatment at 5 W. The untreated group had the lowest shear bond scores. Laser-irradiated Group 3 at 7 W had a higher maximum shear bond strength than the hydrofluoric acid-etched group. The laser-irradiated groups also had a more uniform, non-invasive surface roughness pattern. The samples were tested by atomic force microscopy, scanning electron microscopy, and a universal shear bond testing machine. Surface treatment with the Er,Cr:YSSG laser at 7 W improves lithium disilicate ceramic adhesion to dentin. The laser outperforms hydrofluoric acid as the gold standard.