Specialized stroke units are known to provide best care for stroke patients. However in their absence, patients are often shifted to regular intensive care units that are already overburdened. We carried out a retrospective study to identify ischemic stroke patients who can be safely cared outside the intensive care unit (ICU) using National Institute of Health Stroke Scale (NIHSS) score as predictor of serious morbidity and mortality. We analyzed 50 ischemic stroke patients with complete records of NIHSS score and well-documented complications, if any, while being nursed in our ICU. The results show that patients having NIHSS score between 0-4 rarely have any complications other than very trivial ones’. These patients can be cared in high dependency units or stroke wards with dedicated trained nursing staff. Furthermore we noted that the patients at maximum risk of serious morbidity and mortality have NIHSS score greater than 15. These patients frequently need ventilatory/ hemodynamic support or management of cerebral edema and elevated ICP and hence justify ICU support.

The presence of a foreign body in the middle ear is a rare clinical situation. They represent 1% of otologic disorders and less than 0.4% of all consultations in emergency services [1, 2]. This accident is a real emergency which sometimes threatens the vital prognosis. It poses two problems concerning its location and its extraction. We report the clinical case of a patient followed for chronic otitis media who accidentally introduced a metallic foreign body into his right middle ear.

Program Evaluation is the systematic gathering of information for purposes of making decisions. After the development and establishment of e learning program, Pak Red Crescent Medical & Dental College (PRCM&DC) were made with the help of the Medical Education Department a program evaluation questionnaire based on all frequently asked questions send to all students by e evaluation form. All the students who have The Students who have internet facility and attend the classes regularly are included. Student’s response rate is 34.88%. Reliability coefficient of the questionnaire is 0.822. Majority of the students found the clear objectives of the subject and interactive teaching decrease the anxity. Students were satisfied with learning material which is provided by the facilitators like lesson plans, course notes, handouts books and important notes are very helpful. Many students agreed that they were encouraged to asked questions and give answers during lectures, and most of them were satisfied with the delivery and pace of lecture. Majority of the students were satisfied with the present teaching through e learning method. They were well understood the teaching and learning material and also were appreciate the organization of the thought material.

Kikuchi-Fujimoto's disease or necrotizing histiocytic lymphadenitis is a rare benign disease, revealed by the presence of cervical lymphadenopathy in an inflammatory context. Reporting the case of a young patient whose diagnosis was only possible by the pathological study of the surgical specimen.

Background: Cardiac functioning and assessment in patients with established CAD can be done through performing Echocardiography and calculating the Ejection Fraction, which is an important and vital tool in clinical practice and related to prognosis. Left Ventricular Ejection Fraction (LVEF) can predict future clinical outcome and assist in risk stratification. Objective: The aim of this research was to evaluate the relationship between lower EF with clinical and biochemical markers, and to determine the predictors of left ventricular EF in patients with established CAD whose younger than 35 years’ age. Patients and Methods: This study was enrolled in Surgical Specialty Hospital- Cardiac Center / Erbil-Iraq among 100 consecutive patients (77 males and 23 females) between November 2016 to December 2017 of those whose age was ≤ 35 years old. Results: The mean age was 31.6 ± 2.91 years with an Age range of 24-35 years. 22.9% of those with Anterior Wall Myocardial Infarction (AWMI) and 22.7% of those with Inferior Wall Myocardial Infarction (IWMI) had left ventricular Ejection fraction (LVEF) of less than 44% (P = 0.0001). 33.3% of Patients with STEMI on presentation, later had LVEF of ≤ 44% (P = 0.0001). Lower LVEF (≤44%) was observed more in male gender and smoker patients with established CAD (P <0.05). 29% of those with 10-fold S. Troponin level elevation on presentation, had LVEF ≤44% and 45.2% of them had LVEF of between 45%-54% (P =0.001). 37.5% of those with Very High LDL levels had EF ≤44% (P = 0.02). After performing Coronary Angiography, 68.8% of those with poor functioning of heart (LVEF ≤ 44%) had LAD lesion. (P < 0.05). Conclusion: We concluded that there was evidence of a strong relationship (Inversely Proportional) between Poor EF with high LDL and Markedly Elevated Serum Troponin of more than 10 folds, young Patients with AWMI and IWMI had Poor functioning of the heart. (LVEF of ≤44).

Beta-coronavirus, which caused Severe Acute Respiratory Coronavirus-2 Syndrome (SARS-CoV-2), a major respiratory outbreak in Wuhan, China in December 2019, is now prevalent in many countries around the world. Identifying PCR-based viruses is a well-known and relatively stable protocol. So diagnosis is very important for early identification of disease and to prevent further spread. In this study, we evaluated the power of a conventional RT-PCR to detect SARS-CoV-2 by two different genes. Material and Methods: We did comparative analysis for RNA dependent RNA Polymerase (Rdrp gene) and Spike (S gene by) RTPCR. We took Two hundered Seventy four (274) Nasopharangeal samples came from different hospitals of Najran zone and run samples in three runs in three different runs and we did comparative analysis of Rdrp gene using Ko gene kit and S gene using Altona kit. Results: Analysis was done Qualitatively. We compared Rdrp gene with S gene. We find Sensitivity-100 % and Specificity-96%.In Second run Sensitivity was 100%, Specificity was 98%. In third run Sensitivity and Specificity was 100%.So by comparative analysis of Rdrp and S gene showed that diagnosis by Rdrp gene is more sensitive and specific than S gene. Conclusion: Detection of Rdrp gene for SARS CoV2 is more sensitive and specific than Sgene.But diagnosis by Symptoms, Serology, Chest X-Ray and Chest CT Scan gives additional help.

Background: Smoking is a well-recognized risk factor of CAD, angiographic profile and traditional risk factors among smoker patients varies, along with their clinical presentation and outcome. Objective: This study has been conducted to focus on the angiographic profile of smoker patients presenting with CAD and to explore the prevalence of their additional of risk factors. Method: This study has been enrolled among 328 smoker patients with CAD presenting to ER of SSH-cardiac Center/ Erbil from Jan 2017 to March 2020. Results: The study population was composed of 320 males (97.6%) and 8 females (2.4%). The mean age was 39.07+12.3 years, with an age range of 20-75. The results showed that smoker patients with CAD had occlusive CAD (79.3%). The prevalence of most commonly occluded artery was LAD (43.8%) during CoA presenting with AWMI. The prevalence of risk factors was, Hypertension (37.8%), positive family history (40.2%), high levels of LDL (53.7%), Lowered levels of HDL (31.7%), elevated levels of TC (31.7%), elevated levels of TG (29.3%). It was noted that 29.3% were Diabetic, and according to the HbA1c levels, of 34.1% was diabetic, this clarifies that 4.8% of the smoker patients were undiagnosed DM (Newly diagnosed DM). Conclusion: Smoking is associated with the angiographic profile, traditional risk factors and their clinical outcomes. AWMI was mostly observed among smoker patients owing to LAD lesions.

Sars-Cov-2 could occur in active tuberculosis patients; with risk of aggravation, could also reveal tuberculosis or infect former tuberculosis patients.

Since the start of the coronavirus disease-19 (COVID-19) pandemic in late December 2019, in Wuhan, China, the severe acute respiratory syndrome coronavirus-2 (SARS CoV-2), the virus responsible for COVID-19 present with the classical presentation of respiratory as the name denote that may be fatal. However, there are reports of atypical manifestations in the majority of the patients. One of the atypical presentations is oral manifestations of SARS CoV-2 that may be due to the initial infection or reactivation of Herpes Simplex Virus-1 (HSV-1) or stress-related. Herein, we report a middle-aged man; who presents with vesicular lesions on the lip that were diagnosed clinically as herpes simplex labialis (cold sores), as confirmed by reverse transcription-polymerase chain reaction (rt-PCR) as SARS CoV-2 infected.

Introduction: Abnormalities in serum lipid and lipoprotein levels are recognized major modifiable cardiovascular disease and essential hypertension risk factors. The objective of this study was to examine the serum lipid patterns of newly diagnosed hypertensive patients attending a tertiary healthcare center. Material and Method: This is prospective and observational study conducted at Department of General Medicine, Shadan Institute of Medical Sciences over a period of 6 months. The serum lipid profiles of 75 hypertensive patients was studied and compared with those of healthy controls. The serum lipid profiles (TC, TGL.HDL, VLDL, LDL, TC/ HDL, LDL/ HDL ratios) were studied with respect to various clinical profiles like age, sex, type, incidence etc. Study group consisted of patients with hypertension as identified by history, clinical examination, and other relevant examinations. Results: In our study 36.2 ± 3.8 years was the mean average age of study group whereas for the control group it was 37.7± 3.9 years. In the age group 35-40 years occurrence of hypertension was seen in extreme as compare to other age group. In study groups total cholesterol, triglyceride, HDL Cholesterol and LDL Cholesterol were significantly higher as compared to control group (p<0.03). Among the hypertensive subjects most frequently occurring abnormality was elevated TC (70%), followed by elevated LDL (60%). Conclusion: This study showed that lipid abnormalities are highly prevalent among diagnosed hypertensives.