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   Table of Contents - Current issue
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January-March 2022
Volume 19 | Issue 1
Page Nos. 1-110

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REVIEW ARTICLES  

The interrelationship between diabetes mellitus and COVID-19 Highly accessed article p. 1
Thekra Abdulaali Abed, Zainab Adil Ghani Chabuck
DOI:10.4103/MJBL.MJBL_11_22  
The pandemic of coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has involved more than 100 million individuals, including more than 2 million deaths. Diabetes represents one of the most prevalent chronic conditions worldwide and significantly increases the risk of hospitalization and death in patients with COVID-19. In this review, we discuss the prevalence, the pathophysiological mechanisms, and the outcomes of COVID-19 infection in people with diabetes. We propose a rationale for using drugs prescribed in patients with diabetes and some pragmatic clinical recommendations to deal with COVID-19 in this kind of patient.
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Ocular disorders and stem cell therapy: A review Highly accessed article p. 5
Thekra Abdulaali Abed, Basim A Abd
DOI:10.4103/MJBL.MJBL_12_22  
Sustenance of visual function is the ultimate focus of ophthalmologists. Failure of complete recovery of visual function and complications that follow conventional treatments have shifted search to a new form of therapy using stem cells. Stem cell progenitors play a major role in replenishing degenerated cells despite being present in low quantity and quiescence in our body. Unlike other tissues and cells, regeneration of new optic cells responsible for visual function is rarely observed. Understanding the transcription factors and genes responsible for optic cells development will assist scientists in formulating a strategy to activate and direct stem cells renewal and differentiation. We review the processes of human eye development and address the strategies that have been exploited in an effort to regain visual function in the preclinical and clinical state. The update of clinical findings of patients receiving stem cell treatment is also presented.
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ORIGINAL ARTICLES Top

Epidemiological and clinical characteristics of burn injuries among hospitalized patients in Babylon Province p. 9
Elaf M Obaid, Hasan A Baiee
DOI:10.4103/MJBL.MJBL_70_20  
Background: Burns form the fourth most common cause of injury after road traffic injuries, falls, and interpersonal conflicts and are usually correlated with devastating physical, mental, social, and financial harms, particularly in low and middle-income countries like Iraq. Objectives: To investigate the epidemiological and clinical characteristics of burn injury patients, to measure the mortality rate (case fatality rate) for burns, and to explain the main determinants of deaths among hospitalized burn injury patients. Patients and Methods: This was an observational descriptive cross-sectional study conducted on all acute burn injury cases who were admitted to the biggest teaching hospital in Babylon Province, Iraq. Data were collected from patients themselves or their companions and from patients’ hospital records using a pretested questionnaire designed for collecting the requested information that included demographic data, burn characteristics, burn determinants, and burn outcomes. Results: A sample of 120 patients with burn injuries were investigated. The mean age ± standard deviation was 18.9 ± 17.9 years. The mean age of burn death victims was 24.5 ± 17.66 years. The young age group (15–24 years) represented the highest proportion. Male to female ratio was 1:1.4. Most of the patients had low educational and income levels. The case fatality rate was 26.6% (32/120). The majority of cases were from rural areas; 67% of suicidal burn deaths had more than 50% of total body surface area. Intentional burn death victims had significantly severe burns (third-degree burn and high body surface area) as compared to accidental burn death victims. There was a statistically significant difference as regards the mode of burns between the intentional and accidental burn deaths; all intentional death victims were burnt with flame. Conclusions: The case fatality rate of burn injuries was high, females outnumbered males, the majority of the victims had low educational and income levels, and suicidal burn deaths were significantly associated with severe burn as compared to the accidental ones.
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Association of pregnancy loss with breast cancer in Babil Governorate’s women p. 15
Shurooq Faisal Lefta, Asmaa Kadhim
DOI:10.4103/MJBL.MJBL_87_20  
Background: The most common type of cancer among females is breast cancer. Throughout 2016, 897 women died from that disease which is recorded as the first cause of cancer-related mortality among Iraqi females after bronchogenic cancer (Annual Statistical Report 2016); it has been proposed that an interrupted pregnancy might increase a woman’s risk of breast cancer since breast cells could proliferate without the later protective effect of differentiation. Previous cross-sectional studies revealed a considerable lack of knowledge regarding the risk factors. Objective: The objective of this study is to investigate the possible significant association between female breast cancer and pregnancy loss in Babil governorate’s women. Materials and Methods: This was a case–control study which was conducted at oncology unit in Merjan Teaching Hospital and Babylon Teaching Hospital for maternity and children. A sample of 50 patients with established breast cancer and 100 healthy women without breast cancer as the control study group. Data were collected by interviewing both groups using a questionnaire about sociodemographic characteristics, reproductive factors, and medical history of other disease. Data were analyzed using the SPSS software version 25, and P ≤ 0.05 was considered statistically significant. Results: The most common type of breast cancer is invasive ductal carcinoma (48%) followed by ductal carcinoma in situ (34%) and then invasive lobular carcinoma (18%). Most of our patient diagnosed at Stage II and III (80%) with a mean age at the diagnosis 50.36 ± 5.84. Among all study variables, only early menopausal age is a risk factor for breast cancer in our patients; P < 0.001. There was no significant association between breast cancer and other reproductive factors, demographic characters, and chronic diseases. Conclusion: In Babil governorate’s women, this study shows no statistically significant difference in pregnancy loss between breast cancer patients and healthy control group. The most common breast cancer is invasive ductal carcinoma, and most of the patients present at Stage II and III. Among the study variable, only early age of menopause is a risk factor for breast cancer.
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Effect of coronavirus disease 2019 (COVID-19) pandemic on catheterization laboratory activity in Azadi Heart Center, Duhok, Iraq p. 21
Neshwan Albarwari, Mousa H Ahmed, Kamal A M Maerozy, Jamal B Mohammad
DOI:10.4103/MJBL.MJBL_52_21  
Background: Coronavirus disease 2019 (COVID-19) has a remarkable impact on healthcare systems globally, and it has challenged patients, healthcare personnel, healthcare systems, and the general population under serious threats. Aim: The aim was to determine the effect of the COVID-19 pandemic on catheterization laboratory activity in Azadi Heart Center, Duhok, Iraq. Materials and Methods: All data of consecutive patients visiting Azadi Heart Center for Cardiac Intervention (coronary angiography, congenital intervention, and cardiac device implantation) in two calendar years period (2019 and 2020) were collected, compared, and studied to explore the effect of the pandemic on catheterization laboratories activity during the peak of the pandemic in our region. Results: A significant decrease in all cardiac procedures and interventions was detected except for emergency percutaneous coronary intervention, and the total number of procedures performed between January 1 and December 31, 2020 reduced by one-third as compared with the same period in 2019. Conclusion: During the peak of disease, the COVID-19 pandemic had reduced all catheterization laboratories activity by one-third except for emergency percutaneous coronary intervention.
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Impact of ciprofloxacin and coenzyme Q10 on spermatogenesis in mice p. 26
Reshna Kamal Albarzanji, Shatha Saeed Zakar, Nidhal Abdulkader Mohammed Ali
DOI:10.4103/MJBL.MJBL_55_21  
Background: Ciprofloxacin is commonly used to treat many bacterial infections. There are controversial reports regarding abnormalities in sperm parameters in laboratory animal and human studies after ciprofloxacin administration. Coenzyme Q10 is a fat-soluble vitamin-like substance that is concentrated in sperm mitochondria, where it acts as an antioxidant and an energy promoter. Various studies found that coenzyme Q10 can improve sperm parameters, whereas other studies showed no significant improvement in sperm parameters. This study aimed at investigating the effect of ciprofloxacin and coenzyme Q10 on spermatogenesis and sperm morphology in male mice. Materials and Methods: Twenty eight-week-old male albino mice were randomly divided into four equal groups: control group, group 1 that received ciprofloxacin (102.78 mg/kg), group 2 that was given coenzyme Q10 (20.56 mg/kg), and group 3 that was given both ciprofloxacin and coenzyme Q10. The drugs were given twice daily for 35 days. On day 36, the mice were sacrificed; sperm were harvested, analyzed for sperm morphology, and stained for detection of sperm abnormalities. Testes were taken to evaluate spermatogenesis histopathologically. Data were statistically analyzed, and a P value of ≤ 0.05 was considered significant. Results: Sperm morphology showed no significant alteration in the groups treated with ciprofloxacin, coenzyme Q10, and a combination of ciprofloxacin and coenzyme Q10 compared with the control. However, histopathological lesions showed a mild decrease in spermatogenesis that was accompanied by mild vein congestion in the testicular tissue sections of mice treated with ciprofloxacin only. Conclusion: Ciprofloxacin had no significant negative impact on sperm morphology; however, it induced mild histopathological alterations in testicular tissue that was ameliorated by the coadministration of coenzyme Q10. This effect should be taken into consideration during ciprofloxacin therapy in males.
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Assessment of knowledge about hypertension among hypertensive patients in Babylon Province p. 31
Helen Ali Mahdi, Ameer Kadhim Al-Humairi
DOI:10.4103/MJBL.MJBL_73_21  
Background: Hypertension is one of the most common health problems in the world and it is considered as the most common risk factor for different heart diseases such as coronary heart disease, stroke, renal disease, and peripheral vascular disease. Knowledge plays an important role in controlling hypertension among patients with hypertension and in preventing the long-term complications of hypertension. Objectives: To assess the knowledge among patients with hypertension in Al-Hilla city. Methods: This study was a “descriptive cross-sectional study” involving about 303 patients with hypertension older than 18 years who came to health-care centers and hospitals; the patients were assessed by a designed questionnaire through the interview method. The data were collected from April to July 2021. Results: The mean age of patients with hypertensive was 54.89 ± 10.42; females represented 51.2%, whereas males represented 48.8%. Good knowledge about hypertension was 36.0%, average knowledge about hypertension was 42.9%, and poor knowledge about hypertension was 21.1%. There is a relationship between the age and duration of hypertension with knowledge, and there is a significant association between the study variables (age, sex, marital status, educational level, residence, employment status, socioeconomic level, duration of hypertension, family history of hypertension, measurement of hypertension) in our study and knowledge. Conclusion: This study in Babylon Province shows that the highest proportion of patients with hypertension have average knowledge about hypertension (42.9%); there is a significant association between age, duration, and study variables (age, sex, marital status, educational level, residence, employment status, socioeconomic level, duration of hypertension, family history of hypertension, measurement of hypertension) with knowledge.
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Trends and characteristics of childhood cancer in Al-Najaf Governorate, 2012–2020 p. 37
Nadya Abdul-Aziz Najem, Ashraf Hussein
DOI:10.4103/MJBL.MJBL_78_21  
Objective of the Study: • To estimate the trends of occurrence of childhood cancer in Al-Najaf governorate for the period between 2012 and 2020• To study the characteristics of children newly diagnosed with childhood cancer in 2021Materials and Methods: Study Design: The study was a biometric descriptive study that involves the treatment and processing of already available data depending on the data of childhood cancer already registered for the years 2012 to 2020.• Data here include the total number of registered childhood cancer cases each year and dividing them into various types, with estimating the most common five cancers each year.• Data also include the age of the patients (divided into three age groups [1–5, 6–10, and 11–15 years] and the gender of the patients. Results: The total number of children with cancer who were newly diagnosed and registered during the years 2012–2020 was 802 (male=449, female=353, male: female ratio=1.2:1). The majority of cases were those of children aged younger than five years (327), than the other two groups (5–10 years and 10+ years).Brain / CNS cancer was the most common type of childhood cancer (170 cases), followed by lymphoma (150 cases: HL 110 cases and NHL 40 cases), and then leukemia (137 cases: ALL 117 and AML 20 cases); the greatest number of cases was observed in the center of Al-Najaf than others (Kufa, Manathera). Conclusion: The trend of childhood cancer in our study seems to be higher in children aged younger than five years in comparison with their older colleagues, with a high variation in the number of cases of childhood cancer between one year and another, which is suspected to emerge from imported cases from outside Al-Najaf; that became near platue after exclusion of these cases. Brain / CNS cancer was the most common type of childhood cancer in our study in Al-Najaf, with a great number of cases in the Center of Al-Najaf governorate.
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Patterns and determinants of double burden malnutrition at household level in Babylon p. 43
Zahraa Salih Shalal, Ashraf Mohammed Ali
DOI:10.4103/MJBL.MJBL_81_21  
Background: The double burden of malnutrition (DBM) is a complex problem involving the coexistence of under- and overnutrition within the same individual, household, or population. Our study focused on double burden malnutrition at the household level, which happens when a mother is overweight or anemic, and a child is underweight in the same household. We characterized it as a household with an overweight or obese mother (OBM) and at least one child younger than the age of five who is malnourished. This double burden is assumed to have arisen as a result of low- and middle-income nations’ nutritional transition, as well as due to rapid changes in food production, eating patterns, and physical activity. Despite the fact that being underweight has long been regarded a major issue, overweight and obesity have been identified as a growing problem. Objective: The primary goal of this study was to evaluate the DBM at the household level in Babylon governorate, as well as the significant factors that influence it. Materials and Methods: The study was carried in Iraq in 205 families in Babylon province at level of houses. The houses were chosen randomly. Selection geographical area and systemic random of sampling we choose the fifth house in each area, if there were no children or children with chronic diseases, we would pass it to the next fifth house. The study was conducted in urban and rural areas. In Al-Hilla Center choose (al mohandessein, al akrammeen, and al gamiaa) and in area rural of hilla included (Hamza Al-Dali Village, Karragol, and village fzaa) in north of Babylon choose Al-Musayyib District (almuealimin and AL-Sajjad District) rural to Al-Musayyib we choose (Al-Jilawiyeh Village and Hor Hussein) and Babylon hospital for women and children. Results: In this study, all families were included. Overweight or obesity was seen in 5.37% of mothers and stunted children, and in 3.41% of OBM and underweight children. In all families, there was an 8.78% prevalence of any concomitant DBM. Higher maternal age, households with more than two members, and a lower food diversity score were all found to have statistically significant positive relationships. Conclusions: Despite the small sample size, the prevalence of DBM is considered significant and alarming and may be higher in larger survey studies. In Babylon, higher maternal age and the presence of more than one kid younger than the age of 5 years were linked to greater odds of household DBM, and both played important roles in pushing the DBM trend upward.
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Assessment of parents’ awareness about urinary tract infections in children of Babylon Province p. 50
Ola H Al-Zubaidi, Abdul R Al-Salman
DOI:10.4103/MJBL.MJBL_82_21  
Background: Urinary tract infection (UTI) is one of the commonest infectious diseases in children. Early recognition and prompt treatment are vital aspects in its management to prevent complications. The major challenges for parents, clinicians, and health workers are related to the wide variation of disease presentation. So the parents must be fully informed about UTI in children. Objective: To assess parents’ awareness about UTI in their children and determine the main factors that may affect the degree of parents’ awareness. With the enhancement of parents’ awareness via correction of any wrong answers, resolving any question or confusion. Materials and Methods: This is a cross-sectional study conducted from March 2021 until the end of June 2021 and included 300 parents of children aged 2–12 years, presented with symptoms suggestive of UTI visiting teaching hospitals, primary health care centers, and urological and pediatric private clinics in Babylon province. Parents were interviewed for about 10–15 minutes by using a predesigned questionnaire. Results: Mean age was 32.20 ± 8.81 years. Females comprised the majority of study participants (77.67%), whereas males comprised the remaining (22.33%). All of the fathers were married, as were 95.71% of mothers. Most fathers had university or higher education (55.22%), whereas most mothers had below-university education (57.08%). Most of the parents had medium income (85% of fathers and 83% of mothers). About two-third of them reside in urban areas (68% of fathers and 64% of mothers). Two children account for higher rank of children number (28%). Fever was the most frequent presenting symptom (65%). Overall parents’ awareness score was medium in 50% of participants and high in 49%. Similarly, symptoms, diagnosis, and treatment scores were nearly equal between high (46.67%, 44.33%, and 44.67% respectively) and medium (45.67%, 45.67%, and 45.67% respectively), while prevention score was high in 52%, complication score was medium in 59%. Symptoms and diagnosis scores were significantly higher in residents of rural areas. Treatment and prevention scores were significantly higher in those with higher education. Complication score was significantly higher in those with higher children number, male, illiterate, and rural residents. Conclusions: Parents in Babylon province have an acceptable level of awareness about UTI in their children, with highly educated parents having more degree of awareness about UTI treatment and prevention than those with a lower level of education. Parents from rural areas have more information about UTI symptoms, diagnosis, and complications than those from urban areas, with important role of experience on the parents' awareness about UTI complications.
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Serum visfatin level in sickle/β thalassemia in correlation with frequency of vaso occlusion crises: A comparative study p. 58
Mohammed Ali Al-Jabory, Najiha Ahmed Ameen
DOI:10.4103/MJBL.MJBL_83_21  
Background: Hemoglobinopathies are the most common heritable disorders of erythrocytes, with sickle cell diseases (SCDs) and thalassemia being the most common. SCDs are characterized by the presence of sickle hemoglobin within red blood cell (RBC) as a result of point mutation (β6glu→val). SCDs include sickle cell anemia, hemoglobin C disease (HbSC), and sickle/β thalassemia. The latter is caused by coinheritance of two different mutations in β globin gene, one from each parent: one for sickle hemoglobin and the other for β thalassemia. Vaso occlusion is a key feature of this disease that occurs due to a series of interactions leading to painful crisis. Visfatin is a pro-inflammatory adipocytokine that contributes to vaso occlusive crises (VOC) through its role in the inflammatory process. Visfatin can directly promote endothelial dysfunction and stimulates vascular smooth muscle cells proliferation. Objectives: The primary aim of this study was to assess serum visfatin level in sickle/β thalassemia patients and evaluate the possible association between serum visfatin level in sickle/β thalassemia patients and the frequency of VOC, serum ferritin level, complete blood count (CBC) and high-performance liquid chromatography (HPLC) parameters. The secondary aim of this study was to compare the findings in two centers (Al-Karama Teaching Hospital, in Baghdad and Babylon Teaching Hospital for Maternity and Children, in Babylon). Materials and Methods: This was a cross-sectional study conducted from December 2018 until the end of August 2019 and included 77 individuals. Among them, 57 were sickle/β thalassemia patients (Group I): 28 from Al-Karama Teaching Hospital (Group IA) and 29 from Babylon Teaching Hospital for Maternity and Children (Group IB). The remaining 20 individuals act as a healthy control group (Group II). Clinical data were gathered, with collection of 5 mL of peripheral blood in order to examine CBC, C-reactive protein (CRP), serum ferritin, and serum visfatin. Results: Mean age was (13.14 ± 5.40) years. Males formed (59.74%), whereas females formed the remaining (40.26%). The mean number of annual frequency of VOC events was (3.05 ± 0.95) with no significant difference between the two subgroups. White blood cells count was significantly higher among cases compared to controls (P = 0.004). Hemoglobin was significantly lower among cases compared to controls (P < 0.001). Also, hemoglobin was significantly higher in cases of group IA compared to group IB with P = 0.022. Similarly, hemoglobin A2 (HbA2) was significantly higher in cases of group IA compared to group IB with P = 0.013. Serum ferritin was markedly higher among cases compared to controls with P < 0.001. Serum visfatin was significantly higher among cases compared to controls with P < 0.001. No significant difference was observed between the two subgroups regarding serum ferritin and visfatin.There was positive correlation between visfatin and annual frequency of VOC (r = 0.821, P < 0.001), moderate negative correlation between visfatin and HbA (r = –0.46, P < 0.001), moderate positive correlation between visfatin and HbS (r = 0.54 and P < 0.001), and strong positive correlation between visfatin and ferritin among cases group (r = 0.60 and P < 0.001) but not in control group. Conclusions: Serum visfatin level is significantly higher among patients with sickle/β thalassemia compared to healthy individuals with positive correlation exists between visfatin level and the annual frequency of VOC, ferritin level, and HbS; negative correlation with HbA, among those patients with sickle/β thalassemia. Hemoglobin level and HbA2 percentage significantly higher among Al-Karama hospital patients compared with those in Babylon hospital.
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Serum Lipids Deregulation in Neonatal Sepsis p. 66
Azhar H Alsaqee
DOI:10.4103/MJBL.MJBL_90_21  
Neonatal sepsis (sepsis neonatorum) refers to bacterial infection of blood, which occurs in neonates within the first 28 days. It can be caused by Escherichia coli, Listeria, and some strains of Streptococcus, mostly Group B Streptococcus. This study was on 40 cases with neonatal sepsis, in which they all adjusted to the Tollner characterization of sepsis in 1988. Furthermore, clearly 40 healthy neonates coordinated in age and sex were picked as a control group. Klebsiella pneumonia was the prevalent refined microbe in this investigation, concluding the predominance of fecal over the of the presence of new safe strains. Lipid profile is upset among cases with neonatal sepsis contrasted with controls.
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The Association between Hyponatremia and Recurrent Febrile Convulsion p. 71
Hadeel Rashid Abdul Hameed, Susan Kareem Kamel Jabur
DOI:10.4103/MJBL.MJBL_91_21  
Background: Febrile seizures are a common pediatric problem, yet there is a great deal of disagreement about the appropriate diagnostic evaluation of a child with this disorder. Different predisposing factors have suggested enhancing the susceptibility to febrile seizure and its recurrence. Objective: To determine the effect of hyponatremia in recurrent febrile convulsions. Materials and Methods: A case-control study was carried out at Al-Zahraa teaching hospital in Al-Najaf city during the period between 1 January and the end of October 2021. One hundred fifty children in the age range between six months and six years old were studied. We classified the patients into three groups: Group (A) included 50 children who presented with fever without seizure; group (B) included 50 children who presented with simple febrile convulsion; and group (C) included 50 children who presented with recurrent febrile convulsions. Group A was considered as the control group. The serum level of sodium Na+ was estimated in these three groups by Na kits. Results: There was no significant difference between males and females, in all age groups. Also, it was shown that a family history of febrile convulsion represented 20%, 50%, and 50% in groups A, B, and C, respectively; a family history of recurrent febrile convulsion represented 4%, 4%, and 10%, in groups A, B, and C, respectively; and a family history of epilepsy represented 0%, 4%, and 0% in groups A, B, and C, respectively. A value of P in family history of febrile convulsion was 0.002, in family history of recurrent febrile convulsion was 0.345, and in family history of epilepsy was 0.132. Therefore, there was no significant difference in all parameters except a family history of febrile convulsion that was significant in all three groups. Also, the study will show no significant difference in age, white blood cell count, and random blood surge whereas there is a significant difference in temperature. A significant difference in serum sodium level was the lowest in group C. Regarding calcium level, there was a significant difference between groups A and B. Conclusion: There is a significant association between recurrent febrile convulsion and lower level of serum sodium, in which serum sodium concentration is lower in those patients with recurrent febrile convulsion.
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Thyroid Function Disorders in Patients with Chronic Kidney Disease p. 76
Hussein Yousif Sinjari, Jassim Muhammed Ibrahim
DOI:10.4103/MJBL.MJBL_93_21  
Background: Various thyroid functional test abnormalities are commonly observed in chronic kidney disease (CKD) due to alterations in thyroid hormone synthesis, metabolism, and regulation. Objectives: The study aims at investigating the prevalence of thyroid function disorders in patients with CKD and its association with the degree of renal failure. Methods: A cross-sectional study was performed on patients with CKD, at the Nephrology unit, Hawler Teaching Hospital, Erbil, Iraq from 1 July 2020 to 31 December 2020. Demographic features such as age, sex, and body mass index (BMI) were recorded; blood tests were done, including serum-free triiodothyronine (FT3), free thyroxin (FT4), thyrotropin (TSH), and creatinine. The CKD-EPI (epidemiological) equation was used to estimate glomerular filtration rate (eGFR).The participants were classified according to their thyroid function, age, BMI, and eGFR. The association of thyroid dysfunction with gender, age, BMI, and eGFR was studied. Results: A total of 104 patients with CKD enrolled in the current study: Half of them were on conservative treatment, and the other half were on a chronic hemodialysis (HD) program. Fifty four (51.9%) of them were male, mean age was 53.99 ± 14.59 years, mean BMI was 25.19 ± 3.14 kg/m2, and most of them (63.5%) were overweight. According to eGFR classification, most of the participants (70.2%) were at stage 5 CKD, 20.2% at stage 4, and 9.6% at stage 3. From the study population, it was observed that 34 out of 104 (32.7%) participants presented with thyroid function disorders. Among them, 22 (21.2%) patients presented with subclinical hypothyroidism, seven (6.7%) had overt hypothyroidism, three (2.9%) hyperthyroidism, and two (1.9%) subclinical hyperthyroidism. Hypothyroidism (clinical and subclinical) was positively associated with increasing age and advanced CKD. Conclusion: Thyroid function disorders are common among patients with CKD. Hypothyroidism, the most prevalent one, was positively associated with increasing age, low eGFR, and in patients on HD therapy.
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Chronic Total Occlusion Anatomy and Characteristics of Coronary Collaterals and Angiographic Features Predicting the Success of Chronic Total Occlusion Intervention p. 81
Shiekh Rayees, Aashaq Hussain Khandy, Tauseef Nabi, Sajaad Manzoor
DOI:10.4103/MJBL.MJBL_99_21  
Background and Objective: Angiographic assessment of chronic total occlusion (CTO) anatomy and collateral characteristics of coronary arteries are necessary for CTO intervention. Materials and Methods: This was a hospital-based observational study of 100 coronary angiograms (CAG) with CTOs. CTO anatomy and collateral characteristics of coronary arteries were studied for predicting anterograde and retrograde CTO intervention. Results: Right coronary artery (RCA) CTO was the most common (62%), followed by left anterior descending (LAD). More than two-thirds of RCA and LAD CTO lesions were >20 mm and half were in mid-segment. Left circumflex artery (LCX) and RCA lesions were more frequently calcified. LAD CTOs often had blunt stump; LCX CTOs frequently had bending >45°. The mean J-CTO score was lowest in RCA CTOs (2.0 ± 1.19). There were 10 different types of collaterals in RCA CTOs, 8 in LAD CTOs, and only 4 in LCX CTOs. The most common RCA CTOs collateral was LAD septal to the right posterior descending artery (RPDA) (69.4%) and in LAD CTOs, the most common was septal collaterals from the RPDA to LAD (40.9%). RCA CTOs had a higher percentage of septal collaterals, less tortuosity, and favorable entry and exit angle when compared with other two arteries. Conclusion: RCA CTOs were the most common. Angiographic features in CTO lesions vary among three major coronary arteries. The RCA CTOs had lesser mean J-CTO score, more number of septal collaterals, less tortuous collaterals, and favorable entry and exit angle. RCA CTOs were better accessible for anterograde and retrograde intervention.
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Mucocele of Appendix: A Rare Cause of Surgical Abdomen p. 89
Yaqoob Hassan, Ishfaq Ahmad Wani, Shiekh Imran Farooq
DOI:10.4103/MJBL.MJBL_102_21  
Background: Appendiceal mucocele is a rare surgical emergency caused by intraluminal accumulation of mucoid material due to obstruction. Proper diagnosis and adequate surgical management are paramount to prevent the complications. Objectives: The aim of this study is to report on our management of appendiceal mucocele and highlighting the importance of proper pre-operative workup to reach a definitive diagnosis as a possible means of avoiding the associated grave complications. Materials and Methods: The patients of mucocele of appendix encountered over the period of five years in our department were managed and reported. Results: We present a series of three cases of appendiceal mucocele and included two females and one male patient with a median age of 41.67 years. Clinical examination, biochemical parameters, and imaging studies showed features of acute appendicitis. A 65-year-old female patient, presented with signs and symptoms of acute appendicitis was admitted and on exploratory laparotomy, showed inflamed globular cystic mass of appendix 10 cm × 6 cm × 4 cm, with dilated base and subjected to right hemicolectomy. A 35-year-old male patient was operated for appendicitis and diagnosed with mucocele appendix of 6 cm × 1 cm × 1 cm. Another patient, 25-year-old female was subjected to diagnostic laparoscopy in view of recurrent pain in right iliac fossa. A diagnosis of mucocele of appendix was made and removed via endobag. Conclusion: Appendiceal mucocele with acute presentation remains a rare diagnosis. Proper pre-operative workup to reach a definitive diagnosis is imperative for adequate surgical management to prevent the associated post-operative grave complications. Pre-operative diagnosis helps in decision making for the selection of the appropriate surgical procedure and alarms the operating surgeon for meticulous surgical dissection, adequate removal of mesoappendix with utmost cautious to prevent the mucus spillage into the peritoneal cavity.
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Comparative Evaluation of Cell Block Histopathology and Conventional Smear Cytology in FNAC of Clinically Suspected Cervical Lymph Node Malignancy p. 94
Chanchal Bhunia, Sankha Chatterjee, Dipankar Kundu, Sharmistha Bhattacherjee
DOI:10.4103/MJBL.MJBL_106_21  
Introduction: Cervical lymphadenopathy is a common clinical presentation in various departments of clinical practice. Fine needle aspiration cytology (FNAC) is usually the first choice to diagnose superficial cervical lymphadenopathy. However, FNAC sometimes does not yield information for precise diagnosis, and the risk of false-negative and indeterminate diagnosis is always present. In order to overcome these problems, cell block technique has been resorted to make the best use of the available material. Objective: The aim of this article is to evaluate whether there are any diagnostic advantages of cell block histopathology over conventional smear cytology by corroborating with excisional biopsy. Materials and Methods: A descriptive study with cross-sectional design was performed among 106 cases with clinical suspicion of malignancy. FNAC was performed without anesthesia, and the aspirated material was flushed on slides and then fixed immediately. The remaining materials were processed into cell blocks followed by HE staining. The data obtained were analyzed using SPSS (IBM Statistics, Version 20.0, SPSS, Chicago, IL, USA) statistical software. Ethical approval was obtained from the Institutional Ethics Committee, and informed consent was taken from all the participants before the procedure. Results: Out of the 106 cases, 101 (95.28%) cases were diagnosed as malignant lesions and 5 (4.72%) cases diagnosed as non-malignant lesions. The majority of the patients were in the 40–59 year age group and were males. The sensitivity of cytology to provide specific diagnosis in malignant lesions was 90.57%, whereas those of cell block histopathology and cell block histopathology with cytology were 94.34% and 98.11%, respectively. Conclusion: Cell block as an adjunct to FNAC can be a useful diagnostic technique in cervical lymphadenopathy. Compared with FNAC, it gives more accurate diagnostic architecture and apparent histopathological features.
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LETTER TO EDITOR Top

Impact of lymphopenia on COVID-19 infection severity p. 99
Ali Ayad Tareq, Naqaa Majeed Hameed, Tabarak Saleem Abdulshaheed
DOI:10.4103/MJBL.MJBL_86_21  
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SHORT COMMUNICATION Top

Coronavirus Disease-2019 Infection among Children p. 102
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/MJBL.MJBL_103_21  
The emergence of the coronavirus disease-2019 (COVID-19) pandemic has changed the dynamics of almost everything across the globe. The available evidence and the reported trends suggest that the COVID-19 infection among children and adolescents generally manifests in the form of less severe illness and has less incidence of mortality as compared with the adult population. Although it is an encouraging thing that COVID-19 manifests in children in mild forms, we cannot ignore the very fact that the symptoms of the disease might be ignored owing to their mild nature. Children do play a role in the transmission of COVID-19 infection to other individuals, as outbreaks of the infection were reported in schools or summer camps. In conclusion, children are quite susceptible to the COVID-19 infection and also have the potential to transmit the causative virus to others. Even though the precise risk to acquire or transmit the infection by children is quite variable due to a number of factors, including the levels of community transmission, there is an immense need to strictly adhere to the infection prevention and control measures to minimize the incidence of infection or complications among them.
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Scope of Professionalism Mini-evaluation Exercise Tool in Teaching and Assessing Professionalism among Medical Students p. 105
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/MJBL.MJBL_111_21  
Medical professionalism refers to a set of values or behaviors, which eventually establishes the trust that the general population has on healthcare professionals. It will not be wrong to document that conventional assessment tools were not able to assess the complex domains of professionalism. Workplace-based assessment tools have been identified as the solution to assess professionalism among medical students during the routine clinical practice and accordingly multiple such tools have been tried under heterogeneous settings. The Professionalism Mini-Evaluation Exercise tool is an effective method to assess inter-professional skills, doctor-patient relationship, reflective abilities, and time management. In conclusion, medical professionalism plays a defining role in shaping the careers of medical students. It is the need of the hour to employ the professionalism mini-evaluation exercise tool in the field of medical education as both a learning and an assessment tool to inculcate the different aspects of professionalism among students.
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CASE REPORT Top

Metronidazole-induced Cerebellar Neurotoxicity p. 107
Jyoti Aggarwal, Monica Gupta, Zainab Mehdi, Arushi Yadav, Nidhi Arora
DOI:10.4103/MJBL.MJBL_97_21  
Unintentional overuse of commonly prescribed medications can prove catastrophic. A 30-year-old man presented with difficulty in speaking and walking since 10 days. Examination revealed ataxic gait and bilateral cerebellar signs. During a recent admission for amoebic liver abscess, he was managed with the percutaneous aspiration of abscess and metronidazole which he continued for more than 2 weeks. During the current presentation, brain imaging showed confluent hypodensities in the bilateral dentate nucleus suggestive of metronidazole toxicity. Two weeks after discontinuation of the offending agent, the patient improved clinically with complete radiological resolution of lesions.
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