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   Table of Contents - Current issue
April-June 2022
Volume 19 | Issue 2
Page Nos. 111-309

Online since Thursday, June 30, 2022

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How obesity affects female fertility Highly accessed article p. 111
Rabab Zahir Al-yasiry, Mufeda Ali Jwad, Muhjah Falah Hasan, Haythem Ali Alsayigh
Obesity and excessive weight affect not only overall health but also reproductive health. Many obese women are infertile, and multiple research have demonstrated the link between obesity and infertility. In addition to anovulation and menstrual abnormalities, obesity has been linked to reduced conception rate, as well as a reduced responsiveness to fertility treatment. It also raises the risk of miscarriage and increases the likelihood of neonatal and maternal complications. Treatment of obesity, particularly abdominal obesity treatment, is linked to improved reproductive function thus treating obesity must be the first priority in infertile obese women before considering drugs of ovulation induction or procedures of assisted reproduction.
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A review of airborne contaminated microorganisms associated with human diseases p. 115
Hazim H Hussain, Nagham T Ibraheem, Niran Kadhim F Al-Rubaey, Mohammed Malih Radhi, Nada Khazal Kadhim Hindi, Rusull Hamza Kh AL-Jubori
Biological contaminants refer to environmental contamination and food source with living microorganisms such as bacteria, molds, viruses, and fungi, in addition to mites, house dust, and pollen. Temperature, relative humidity, movement of air, and sources of nutrients have influenced the presence and spread of biological contaminants. Numerous living microorganisms can grow independently on each other, such as bacteria and fungi. Viruses (a small obligate parasite) depend on other living organisms for their development and for performing vital functions. Indoor air can contaminate with biological contaminants by a different status, including living, dead, or debris of the dead microorganisms which were transported through ventilation systems, when the microorganism components dissolve in water. They become aerosolized when the contaminants are physically disturbed, like in renovation or construction, and when the contaminants discharge harmful gases into the indoor environment. Most studies conducted in recent years agree that air pollution rates are increasing, bringing more risks to human health, as pollution is related to the risk of heart and lung disease and its effect on children, especially infants and newborns. Also, environmental pollution may have become the most dangerous disaster faced by humans, because it means environment retrogradation in which humans lives as a result of an imbalance within the compatibility of the constituent elements and loses its ability to carry out its natural role in self-removal of contaminants by the natural factors noticeable within air, land, and water. In some cases, many common infections can spread through airborne contaminated microorganisms such as Mycobacterium tuberculosis, measles virus (MV), influenza virus, Morbillivirus, chickenpox virus, norovirus, enterovirus, less commonly coronavirus, adenovirus, and respiratory syncytial virus (RSV). When an infected person coughs, talks, sneezes, has throat secretions, and releases nasal into the air, the airborne infection can spread. Bacteria or viruses spread out noticeably in the air or ground and transport to other persons or surfaces. This review provides the conception of biological contaminants and their properties, nature of the indoor environment, and adverse health effects associated with biological contaminants.
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Hypothyroidism in paediatric patients with Prader-Willi syndrome; regular monitoring is recommended Highly accessed article p. 123
Hussain Alsaffar, Wasnaa Hadi Abdullah, Sawsan Ali Hussein
Prader-Willi syndrome (PWS) is a genetic disorder described by multifaceted clinical features with implications on the endocrine system, metabolism, and behavior. Some symptoms of PWS syndrome can be confused with the relative clinical aspects of hypothyroidism, such as lethargy, muscular hypotonia, and poor sucking ability. In this review, we would like to enlighten the importance of checking thyroid function in PWS patients at birth, at least annually, in those on growth hormone (GH) treatment, in any child of PWS with growth failure, and in those in whom there is an insufficient response to GH therapy, to ensure that any aberrant thyroid function is not overlooked and adequately treated.
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Factors contribute to elevated blood pressure values in children with type 1 diabetes mellitus: A review p. 126
Nabeeha Najatee Akram, Wasnaa Hadi Abdullah, Basma Adel Ibrahim
Hypertension is common in children with type 1 diabetes mellitus. Although the exact prevalence of hypertension in pediatric patients with diabetes mellitus is unknown, many studies show rates ranging from 6% to 16%. Several studies looked at the variables that impact blood pressure levels in type 1 diabetes. However, articles in pediatric age group are limited. Upon reviewing the recently published articles, the factors which found to have a significant relationship with blood pressure readings in children with type 1 diabetes mellitus are as follows: patient age, gender, body composition, total fat percentage, body mass index, diabetes duration, glycated hemoglobin levels, and diabetic nephropathy.
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Iatrogenic aortic dissection: A review Highly accessed article p. 129
Abdulameer Jasim Jawad Al-Gburi
Acute aortic dissection (Stanford Type A) is a life-threatening medical emergency associated with a high rate of early mortality (57 percent) without surgical intervention. During coronary catheterization, it occurs at a rate of 0.02 percent to 0.06 percent. There are no clear guidelines regarding the optimal management of this fatal condition. The critical importance of preventing dissection propagation by stenting the dissection’s entrance in the coronary artery had been emphasized in prior review articles. Iatrogenic aortic dissections that do not involve the coronary arteries can be managed conservatively and closely followed-up with repeated imaging.
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Visual evoked potential findings and correlation between visual evoked potential and clinical severity in children with autism spectrum disorder p. 133
Farqad Bader Hamdan, Hula Raoof Shareef, Hamida Salim Jasim
Background: Autism spectrum disorder (ASD) is a heterogeneous behavioral disorder that is characterized by qualitative deficits in social communication and interaction and restricted, repetitive behavioral patterns, activities, and interests. For an optimum outcome in children with autism, early intervention (preferably before three years of age) is essential. Hence, there is a critical need to improve the awareness of ASD to enable earlier detection and intervention. The present study aims at achieving the following: (1) Investigating neural transmission within the visual system using visual evoked potentials (VEPs) as an index of the myelination process of the visual pathway. (2) Correlating the changes in the VEPs with the clinical severity of autism. (3) Investigating the possible gender differences in VEPs in autistic children. Materials and Methods: The study was conducted on 60 preschool children (11 females and 49 males) who were recruited from the autism center and the pediatric neurology ward and who met the DSM-V criteria for autism in the Pediatric Hospital for the period from 12 December 2019 to 1 June 2021. Their mean age was 4.5±1.17 years. Another 50 (40 males and 10 females) age- and gender-matched normally developed children served as the control group. Both groups were subjected to a detailed history, as well as complete physical and neurological examinations. The VEPs were assessed for all of them. The autistic children were excluded from the study if they had any motor, visual impairment, inborn errors of metabolism, epilepsy, other chronic medical or neurological disorders, or if they were taking medications during the period of study. Results: The P100 wave latency of the VEPs was significantly prolonged in both eyes of autistic children as compared with that of the control group. The N75-P100 amplitude was significantly lower in the left but not the right eye of patients when compared with those of normally developed children. Neither the P100 wave latency nor the N75-P100 amplitude of both eyes was associated with the gender or severity of illness. Conclusion: There are distinct changes in VEPs in autistic children, especially the abnormal prolongation of conduction time, suggesting that autistic children may have brainstem and visual pathway dysfunction. Gender and disease severity score have no impact on VEPs.
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Assessment of knowledge and attitudes among pregnant women’s towards folic acid intake during pregnancy in a sample of women attending primary health care centers in Babylon province p. 142
Zahraa A Sadiq, Hanan K Hussein
Background: Folic acid (vitamin B9) is one of the important vitamins required for embryonic growth and development, as well as preventing the occurrence of congenital malformations, which are a major health concern in developing countries and around the world because they have a direct impact on the affected babies, their families, and the community. Objectives: To assess the knowledge and attitudes of pregnant women toward folic acid intake throughout pregnancy in a sample of women in Babylon Governorate and to assess the association of knowledge, attitude of folic acid with certain sociodemographic and obstetric characteristics. Methods: A cross-sectional interview-based study targeting a convenient sample of 265 pregnant women who attended antenatal care unit of five PHCCs in Babylon Governorate/Iraq during a period of three months (from April 1 to July 1, 2021). The respondents were interviewed with a pretested questionnaire, that includes data related to sociodemographic and obstetric history, seven questions related to pregnants’ knowledge, and five questions related to pregnant attitudes toward the importance of folic acid intake during pregnancy. Data were analyzed by SPSS, version 26. Results: 265 pregnant women were enrolled in this study. The result found that the mean (±standard deviation) age was 26.5 (±5.7) years where 58.1% (154) of women were in the age group of 20–29 years and two-third of participants were a resident in urban areas. In addition, 54.5% (144) of women had college and postgraduate education, housewives consisted 51% (134) of the sample, and 45 were employed; only 26 (9.8%) pregnant women were not hearing about folic acid intake during pregnancy. The major source of hearing was doctors. 44.8% (107) of participants had fair level of knowledge; knowledge score was significantly associated with age, residency, and occupation of pregnant women (P ≤ 0.05); knowledge score had no significant association with educational level, parity, history of abortion and stillbirth, or having children with congenital anomalies. 75 (31.4%) mothers had negative attitude toward using folic acid during pregnancy. Pregnant attitude toward folic acid supplements had no association with sociodemographic and obstetrical history. There was a positive moderate linear correlation between the mother’s knowledge and attitude (r = 0.36, P < 0.001). Conclusions: The study found that pregnant women had a fair and good knowledge about using folic acid during pregnancy. In addition, most pregnant women have a positive attitude.
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Patients characteristic, indications, and complications of permanent pacemaker implantation: A prospective single-center study p. 152
Mousa Haji Ahmed
Background: Permanent pacemaker implantation is a relatively safe procedure that significantly improves morbidity and mortality among patients with bradyarrhythmias. This study was conducted to determine the patients’ characteristics, indications, and complications of pacemaker implantation. Materials and Methods: This was a single-center, prospective study conducted in Azadi Heart Center, Duhok, Iraq between March 2013 and March 2020. All patients who had indications for permanent pacemaker implantation according to the current guidelines (AHA/ACC) were included and followed up for at least 1 year. Results: The study included 396 patients (242 males [61%] and 154 females [39%]) with a mean age of 65 ± 16 years. The most common presenting symptom was dizziness (63%). Atrioventricular block was the most common indication for pacing in 249 cases (63%), followed by sick sinus syndrome (SSS) in 138 patients (34.8%). The most common mode of pacing was DDD in 234 patients (59%). Among all patients undergoing permanent pacemaker implantation, 17 patients (4.25%) developed early and late complications. The most common early complication was pocket hematoma seen in four patients (1%), followed by pneumothorax in three patients (0.75%). Among late complications, painful shoulder was the most common affecting four patients (1%). Conclusions: Pacemaker implantation is a relatively safe procedure with a low complication rate. Elderly males were the most common group receiving permanent pacemaker. Dual-chamber (DDD) pacing mode was the most commonly used mode.
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Changes in coagulation status in patients with β-thalassemia in Iraq: A case-control study p. 157
Hussein Abdalzehra Wadaha, Hassan Dede Meshay, Mohammed Haseeb Khamees
Background: The pathogenesis β-thalassemia is characterized by anemia resulting from reduced β-globin synthesis with low hemoglobin A (HbA) production and higher production of hemoglobin A2 (HbA2) and fetal hemoglobin (HbF). However, thromboembolic events have been recently identified in patients with β-thalassemia due to hypercoagulable state. Objectives: The aim of this study was to evaluate the levels of some coagulation markers in Iraqi patients with β-thalassemia major and β-thalassemia intermedia. Materials and Methods: The study included three groups. The first group included patients with β-thalassemia major (n = 39), the second group included patients with β-thalassemia intermedia (n = 11), and third group included 20 apparently healthy control subjects. Each of prothrombin time (PT), activated partial thromboplastin time (APTT), antithrombin III (ATIII), and thrombin-antithrombin III (TAT) complex were measured according to the standard protocols. Results: Both PT and APTT in β-thalassemia major and β-thalassemia intermedia were higher than that of the control group with a highly significant difference (P = 0.002), whereas no significant differences were observed between patients with β-thalassemia major and β-thalassemia intermedia. Mean ATIII level was highest in the control group followed by β-thalassemia intermedia and then by β-thalassemia major groups (P < 0.001), whereas mean TAT complex was highest in thalassemia major group followed by β-thalassemia intermedia and then by control groups (P < 0.001). Conclusions: Prolonged PT and APTT in patients with β-thalassemia together with the reduction in the level of anticoagulant factor (ATII) suggest a role for liver impairment; however, the significantly higher TAT complex is suggestive of ongoing activation of coagulation cascade in patients with β-thalassemia.
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Knowledge, attitude, and practice of junior doctors about thalassemia in Babylon province p. 162
Ola Musadaq Baqer, Ameer Kadhim Al-Humairi
Background: Thalassemia is a chronic condition that is caused by hereditary defects in hemoglobin production. Thalassemia is classified into two major categories, named α- and β-thalassemia, according to the hemoglobin gene defect. Premarital screening in the family members, followed by prenatal diagnosis is the most effective strategy for control of thalassemia. The most important thing is the determination of the traits or carriers of thalassemia. In our country, doctors acquired knowledge about thalassemia when they were students in medical college and after graduation, they worked in different hospitals. Some of them had worked in the thalassemia unit whereas others had not. Objectives: To assess the knowledge, attitude, and practice of junior doctors about thalassemia in Babylon province. Methodology: A cross-sectional study was conducted on 200 junior doctors (resident doctors and permanent doctors) who had different years of experience and places of work in Babylon province. The knowledge, attitude, and practice were assessed according to scoring by a group of researchers. Results: A cross-sectional study of 200 junior doctors (resident and permanent doctors), whose age ranged from 24 to 34 years with a mean age of (27.5 ±2.27) years. Most of the junior doctors were females: 145 (72.5%) worked in the emergency department 107 (53.5%). There were 92 (46%) junior doctors who possessed adequate knowledge about thalassemia. There were a significant association between knowledge and age, position/job, and smoking: P = 0.01, 0.02, and 0.04, respectively. The doctors had a positive attitude and good practice about thalassemia, 65 (32.5%) and 84 (42%) respectively. Regarding attitude, there is a significant association between it and position/job, P = 0.02 and in practice there is a significant association between it and gender, which is more in females (P = 0.02). Conclusion: The doctors had adequate knowledge, positive attitude, and good practice about thalassemia: 92 (46%), 65 (32.5%), and 84 (42%), respectively.
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Medical and social analysis of preschool children under the age of six years at secondary and tertiary care after home accidents in Hilla City p. 169
Aya Kadium Nsaif, Sijal Fadhil Farhood Al-Joborae
Background: Accidents mainly occur at home, children are the most vulnerable to in any household. Objectives: The goals of this study were to identify the commonest causes of home accidents that necessitate secondary and tertiary care admission. And to find out social variables related to home accidents. Patients and Methods: It is a descriptive hospital-based cross-sectional study which was carried out on a convenient sample of 200 preschool children who were cared for Emergency Department in Babylon Maternity and Pediatrics Hospital and Imam Sadik General Teaching Hospital whose mothers accepted to participate in this study. It was conducted over a period of four months from April 1 to August 1, 2021. Data were collected through interviewing the participants who were asked to give their verbal consent to a structural questionnaire containing information about sociodemographic factors, child, and family variables. The information was analyzed using SPSS version 24. Result: The rate of home accidents (falls and blows by forceful sticks) among children under the age of six years were 55.50% and 24.50%, respectively. From the different investigated factors, Paternal educational level showed significant relation to home accidents, and other variables (maternal educational level, number of family members, and home size) were found to be risk factors for home injuries. Conclusion: Falls were the commonest cause of unintentional injuries; in children, home accidents are still the major problem and jeopardize the lives of children. Home accidents among children under the age of six years are increasing and this issue requires more attention and effort.
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Intracapsular total thyroidectomy experience and outcome for benign thyroid diseases p. 176
Mohammad Abbas Safi, Sajid Hameed Alhelfy
Background: The total intracapsular thyroidectomy is a new procedure that removes all the thyroid tissue for benign thyroid diseases and two third of thyroid capsule with better intraoperative and post-operative consequences and less operative time than the capsular dissection and no recurrence rate of goiter or Graves’ disease that was detected during the follow up period. Objectives: To evaluate the outcome of total intracapsular thyroidectomy of benign thyroid diseases in term of safety and efficacy. Patients and Methods: This is a prospective descriptive study carried out in department of general surgery including a total of 80 patients with benign thyroid disease who underwent intracapsular total thyroidectomy. Patients were followed up for 6 months to 3 years with a median of 41.4 months for postoperative complications. Results: The mean age of the patients was 42.72 ± 8.12 years. The majority of patients were females (87.5%). The study showed that 97.5 % of the patient had no intraoperative complications. Postoperatively, only 4 patients (5%) developed complications. The mean operative time and blood loss was 71.78 ± 9.32 min and 82.8 ± 32.5 ml, respectively. Conclusion: The total intracapsular thyroidectomy is new procedure and more sophisticated than other operation types to treat benign thyroid disease. However, it is safe and efficient.
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Influence of oral bisphosphonate on dental implant: A review p. 180
Ahmed Salah Al-Noaman
Background: Bisphosphonates (BPs) are medications employed widely in the management of metabolic bone diseases. Dental implants are new therapy for replacement of missing teeth depend on the osseointegration process. There is a considerable debate on the effect of oral BPs on the osseointegration process and subsequently on the success rate of dental implant and development of BRNOJ. Objectives: The aim of this study was to revise literatures on the effect of oral (BPs) on the success rate of dental implants and the development of BPs-related osteonecrosis of the jaws. Materials and Methods: PubMed, google scholar, Scopus database, and manual search were performed to find out articles on the effect of oral BPs on dental implant outcome and development of BRNOJ. Results: twelve articles were found six retrospective studies, one prospective studies, two case control studies and one case series discussing the effect of oral BPs on success rate of dental implant and development of BRNOJ. Conclusion: the majority of patients were osteoporotic females and treated with oral BPs. Oral BPs have little, if any, influence on success rate of dental implant and there is no conclusive evidence on BRNOJ-related oral BPs in implanted patients. Patients on BPs and received implant therapy should be cautioned on developing BRNOJ and followed-up for long time period.
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Effectiveness of an educational program on nurses’ knowledge regarding neonatal sepsis: A quasi-experimental study p. 185
Dilshad Abdullah Mohamed, Akram Mohamed Alatroshi
Background and Objectives: Neonatal sepsis is the main health problem that is accountable for about 30–50% of the overall neonatal mortality in the developing nations. Nurses can provide a straight care and have the ability to impact on neonate’s outcomes, so that teaching nurses about sepsis is measured essential to improve neonates’ care, safety, and outcomes. The present study intends to increase the nursing knowledge regarding neonatal sepsis in Heevi Pediatric and Maternity Hospitals ICU departments. Materials and Methods: A quasi-experimental study was conducted in the Heevi Pediatric and Maternity Hospitals from October 15, 2020 to January 20, 2021. The study included two groups: the control group (27 nurses) from Heevi Pediatric Hospital and the interventional group (25 nurses) from Maternity Hospital. The data were collected through the use of a questionnaire prepared in English and translated into Arabic and Kurdish. Its first part was concerned with demographic characteristics of the nurses, and the second part assessed their knowledge before and after implementation of the educational program regarding neonates with sepsis using a scoring system. The statistical calculations were performed by Statistical Package for Social Sciences, Version 25 (SPSS 25; IBM Corp.; USA). The ethical approval of the current intervention was obtained from the research Ethics Committee of Directorate of Health. Results: The pre-assessment of the outcomes showed that the control and experimental groups were comparable in knowledge score (P = 0.0931), whereas the post-assessment of the outcomes has showed a highly significant improvement in the experimental knowledge score in comparison to the control group (P ≤ 0.0001). The control and experimental groups were comparable in knowledge (awareness), and this comparability is highly significant in the interventional group (P < 0.0001), but in the control group, there is also a noticeable progress as P = 0.0014. The nurses were comparable in the different educational groups regarding nurses’ educational levels and their awareness of neonatal sepsis (P = 0.9737). The nurses were comparable in the experimental group with their age (P = 0.3410), experience in working in neonatal intensive care units (P = 0.3744), and the training courses the nurses shared (P = 0.49546). In the control group unit, the maximum score of nurses’ knowledge was 20 and the minimum score was 9. Whereas in the interventional group, the maximum score was 17 and the minimum score was 11. After application of the program to the interventional group, the score was as follows: in the control group, the maximum and minimum scores were 21 and 11, whereas in the interventional group, the scores were 24 and 19, respectively. Conclusion: The educational program was effective in increasing the nurses’ knowledge regarding neonatal sepsis care.
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Comparison of prevalence of psychological morbidities, associated factors, and coping styles between pre/para-clinical and clinical undergraduate medical students: A rural institution-based cross-sectional study in a northern state of india p. 191
Sunny Garg, Sonika Lamba, Manoj Rawal, Sanjeet Singh, Lalit Kumar, Kirti Bansal
Background: Psychological morbidities are high among undergraduate medical students. They experience the transition between pre/para-clinical and clinical training as a stressful period, and cope differently. Research from India in this regard is lacking. Aims: The aim of this study was to assess and compare the prevalence of psychological morbidities, associated factors, and coping styles between pre/para-clinical and clinical undergraduate medical students. Materials and Methods: This institution-based cross-sectional observational design study was conducted among pre/para-clinical and clinical group of undergraduate medical students (a total of 382) by using a questionnaire in the period between April and June 2021. Stratified random sampling technique was used to select the study participants. The survey included standard self-administered questionnaires like general health questionnaire-28 (GHQ-28) and Lin-Chen’s coping inventory to assess psychological morbidities and coping styles, respectively. Associated factors for psychological morbidities, and coping styles between two groups were compared using chi-square test, independent t test, and binary logistic regression analysis. Results: Of the 382 responders, psychological morbidities (GHQ-28 score >23) were found in 61% of participants. Both groups reported a high level, a slightly higher preponderance in clinical (61.5%) than pre/para-clinical students (60.6%), and with nonsignificant difference of psychological morbidities. Compared to pre/para-clinical group, clinical group was found to have more substance consumption behavior (P < 0.001), dissatisfaction with academic performance (P < 0.001), sought psychiatric consultation (P < 0.05), and currently on psychiatric treatment (P < 0.05). Overall, coping was found to be average and good among the participants. Active problem coping behavior was more significantly used by pre/para-clinical group, whereas passive problem coping and passive emotional coping behavior were positively significantly correlated with psychological morbidities in the clinical group. Conclusions: This study established a significant correlation between psychological morbidities and passive coping styles in the clinical group. These students need interventions to encourage the use of more active coping styles during the training to provide advances in future career. A strong correlation with dissatisfied academic performance may be a call for an efficient and more student-friendly curriculum.
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Histopathological assessment of colonoscopic biopsies in patients with bleeding per rectum p. 203
Mustafa Bani Khassaf, Ban Jumaah Qasim
Background: Lower gastrointestinal (GI) bleeding is usually defined as bleeding from the GI tract distal to the ligament of Treitz, and it is usually suspected when patients present with hematochezia, or maroon stools per rectum. It has various causes, which often require colonoscopic biopsy for their conclusive diagnosis. Aim of Study: To determine the histopathological changes of colonoscopic/sigmoidoscopic biopsies in patients presenting with bleeding per rectum according to the age, gender, clinical symptoms, and endoscope findings. Materials and Methods: In retrospective and prospective studies, 58 cases of colonic tissue paraffin blocks from patients with BPR were collected from Teaching Laboratories of Al-Imamain Al-Kadhumain (AS) Medical City. From each block, sections of 5 um thickness were taken and stained with the routine HandE stain. Result: The mean age of the cases with BPR was (44.5 ± 15.7) years, with an M:F ratio of 2.2:1. The most common diagnosis was nonspecific colitis 13(22.4%) cases followed by 7 (12%) cases diagnosed as ulcerative colitis. There is a significant difference in the distribution of final diagnosis according to the patient’s gender and age with a p value of (0.03) and (<0.001), respectively. There is a significant difference in the relationship between final diagnosis and colonoscopic findings (P = 0.004). Conclusion: In this study, the most common etiology of BPR was nonspecific colitis, ulcerative colitis, hyperplastic polyp, and internal hemorrhoid. There is a significant correlation between final diagnosis and colonoscopic findings.
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Evaluation of immunohistochemical expression of topoisomerase II alpha protein in patients with breast cancer and its correlation with different prognostic factors p. 210
Mohammed Saeed Sharif Fadhil Al-Alawchi, Haider Abdul Ridha Alkafaji
Background: There are indications to support the knowledge about the prognosis of breast cancer. One of these markers is regarded as a prognostic factor and related to the proliferation rate. Topoisomerase IIα (TOP2A), encoded by the TOP2A gene, is a molecular target for anthracycline therapy. Aims: The aim of this article is to establish any association of the status of topoisomerase IIa immunohistochemistry with different prognostic clinicopathological and molecular parameters in breast cancer. Settings and Design: A cross-sectional retrospective study was carried out in the Department of Pathology and Forensic Medicine, Faculty of Medicine, Babylon University, during the period from January 2020 through December 2020. Materials and Methods: Fifty cases with invasive breast carcinoma have been obtained from surgical modified radical mastectomy specimens from the Laboratory of Histopathology in Al-Kafeel Specialized Hospital, Karbala for the last 3 years (2017–2019). Different clinicopathological variables were estimated. The expression of TOP2A was stained by using the PathnSitu PolyExcel Detection System of Immunostaining. Statistical Analysis Used: Immunostaining with TOP2A expression used a cut-off value of 10%. The results were considered statistically significant if the P-value was ≤ 0.05. Results: Fifty cases of TOP2A overexpression were classified as follows: 28 cases (56%) had 3+ expression, 4 cases (8%) with 2+ expression, and 4 cases (8%) with 1+ expression, whereas 14 cases had no expression of TOP2A (28%). TOP2A overexpression was shown to be associated with a higher grade (P = 0.023) and molecular subtypes (P = 0.057), but not with other clinicopathological parameters (age of patients, type of histology, number of lymph nodes involved, tumor size). Conclusion: According to these results, TOP2A plays a major role in the aggressive nature of tumors. This may support the suggestion to be used as a prognosis marker.
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To identify the risk factors associated with development of anterior abdominal wall hernia p. 219
Mohnish Kumar, Manu Shankar, Richa Joshi, Shobhit Kumar Prasad
Background: Numerous risk factors for the development of hernia have been identified, including abnormal collagen fiber organization and increased intra-abdominal pressure. Objectives: The purpose of this study is to investigate if one or both of these factors (arrangement of collagen fibers and increased intra-abdominal pressure) contribute to the formation of hernias. Materials and Methods: Adolescents and adults with anterior abdominal wall hernia were admitted to the hospital and underwent surgery after completing a standard preoperative evaluation protocol that included a detailed medical history, physical examination, and laboratory tests. Prior to anesthesia induction in the operation room, intra-abdominal pressure was measured using a Foley’s catheter attached to a pressure transducer. According to their condition, the patients underwent routine surgery, either laparoscopic or open. Excision of the sac and submission to the histo-pathological examination for collagen analysis using two different stains, Masson’s trichrome and Gomori’s reticulin. Categorical variables were quantified using numbers and percentages (percent), whereas continuous variables were quantified using the mean, standard deviation, and median. The chi-square test was used to ascertain correlations between qualitative variables. P < 0.05 was considered statistically significant. Results: We considered a total of 200 patients, 50 of whom served as controls. Elevated intra-abdominal pressure has been identified as a risk factor for ventral wall hernia. Collagen fibers in patients with hernias were found to be disorganized at the microscopic level. Obesity and elevated intra-abdominal pressure were found to be statistically significant predictors of collagen disorder and the development of hernias. Hernias are more likely to occur as people age. Although chronic cough has been linked to metabolic disorders such as diabetes, hypertension, and kidney disease, we found no statistically significant link. Conclusions: Intra-abdominal pressure elevation, disordered collagen fiber arrangement, obesity and increasing age are risk factors associated with hernia development.
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Bone marrow examination: A useful aid in early diagnosis of PUO in children p. 227
Arijit Majumdar, Soumali Biswas, Angshuman Jana
Background: Pyrexia of unknown origin (PUO) is a common diagnostic dilemma that needs a number of diagnostic modalities to arrive at a diagnosis. Bone marrow examination is one of the common tests implicated in the diagnosis in combination with others. Authors, in this study, have attempted to explore the role of bone marrow morphological study in determining the various causes of PUO in children. Materials and Methods: A retrospective study was conducted at Dr. B. C. Roy PGIPS, Kolkata, West Bengal over the period of 2 years. Bone marrow aspiration was performed and evaluated morphologically in 100 patients. Marrow trephine biopsy was also performed in some cases, undiagnosed in aspiration smears, to reach at a conclusion. Results: Besides reactive hyperplasia (25%), other frequent outcomes were acute lymphoblastic leukemia in 15 (15%), marked hemophagocytosis in 15 (15%), and visceral leishmaniasis in 5 (5%) patients. Conclusion: Early diagnosis of PUO can be aided by the morphologic examination of bone marrow. Bone marrow biopsy is a complementary and in some respects, better diagnostic tool than aspiration in patients with PUO. This study will help to know the current spectrum of diseases causing PUO in children in this region.
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Tubularized preputial free graft one-stage repair for proximal hypospadias p. 232
Bassam Khalid Al-Hajjar
Background: One of the most frequent urogenital malformations in newborn boys is hypospadias. After undescended testis, in boys, it is the second most popular congenital abnormality. There are different one-stage surgical procedures used to repair proximal hypospadias, each has its own advantages and outcome. One of them is tubularized preputial free graft, which is first tried by the urologist team of Horton and Devine who used full thickness preputial grafts tubularized in a single-stage operation. Aim: The aim of this article is to assess the outcome of a one-stage tubularized preputial free graft. Materials and Methods: The present case series study provides a prospective analysis of 88 proximal hypospadiac boys operated on primarily over more than 5.5 years (from March 2014 to September 2019) using preputial skin as a tubularized free graft in one stage. Ethical approval for this review was obtained. Results: The present study includes 88 boys with hypospadias with mean age 20.6 months (ranging from 5 months to 7.5 years). The proximal hypospadias represents 33 (37.5%), penoscrotal 51 (58.0%), and scrotal 4 (4.5%) boys. Thirty-three boys out of 88 are under 12 years, 29 are between 12 and 24 years, and 26 above 24 years. The postoperative complications reported are fistula which occurs in 9 (10.3%), glans dehiscence in 3 (3.4%), meatal stenosis in 3 (3.4%), and diverticulum in 2 (2.3%), and numbers of complications with respect to age groups were six complications under 12 years, two complications between 12 and 24 years, and nine complications above 24 years. Conclusion: One-stage correction using a tubularized preputial free graft is an appropriate choice for repairing proximal hypospadias with chordee when compared with other widely used procedures for proximal cases.
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Anxiety and depression among caregivers of the children with thalassemia, attending at Thalassemia Control Unit of a Rural Tertiary Care Medical College, Darjeeling, West Bengal p. 238
Kallol Bhandari, Eashin Gazi, Bidhan Chandra Mandal, Tushar Kanti Saha
Background of Study: Caregivers of the children with thalassemia often experienced a life with varied degree of anxiety and depression due the chronic illness like of their children. Mothers as the main caregivers for most of the thalassemic children suffers with different forms of psychological problems. Objectives: The aim of this study was to assess the levels of anxiety and depression of the caregivers of children with Thalassemia and also to find out sociodemographic factors associated with their anxiety and depression. Materials and Methods: Descriptive cross-sectional study conducted in Thalassemia Control Unit (TCU) of North Bengal Medical College (NBMC) from December 2018 to April 2019. Complete enumeration method was used to include 136 caregivers of children (≤12 years) with thalassemia. Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) was used to assess the levels of anxiety and depression. Collected data were entered into MS-Excel and analyzed by using SPSS software program, version 22.0. Results: Mean age of caregivers was 34.3 (SD ± 1.4 years). Most of caregivers were female (89%) and had educational qualification up to primary school (45.6%). Majority (70.6%) of the caregivers were the mothers of the children. Most of the study participants (54.4%) had moderate depression followed by 30.1% with mild mood disturbances. Majority (69.9%) of the study participants had mild anxiety and 30.1% moderate anxiety. The median (IQR) of BDI score was 21(23–18) and median (IQR) of BAI score was 20(22–18). Conclusions: Early counseling, psychotherapy, appropriate treatment should be prioritized. Social support, community involvement with their full participation should be emphasized.
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Effect of the dietary protein intake on urea reduction rate in patients on maintenance hemodialysis in Merjan Teaching Hospital p. 244
Khalid H Al-Shibly, Jawad K Al-Diwan
Background: Chronic kidney disease (CKD) constitutes a major health problem worldwide. The mainstay of nutritional treatment in patients undergoing maintenance hemodialysis is the provision of an adequate amount of protein and energy. Objective: The present study aims to assess the correlation of protein consumption with dialysis adequacy in patients on hemodialysis. Materials and Methods: A cross-sectional study was conducted at the Dialysis Unit of Merjan Hospitals, Babil Governorate, Iraq on 64 hemodialysis patients from April to August 2021. The tools used for the data collection were anthropometry, medical information, and 24-h dietary recalls. A descriptive analysis was performed. Results: The food intake was evaluated and compared with the recommended intake. The patients’ average energy intake was 18.7 ± 7.2 kcal/kg/day, which represents 53.4% of the recommended daily energy intake for dialysis patients. About 75% of the consumed energy was provided by carbohydrates, 12.2% was provided by fats, and the rest 14.6 was provided by protein. The average dietary intake of protein was 0.71 ± 0.29 g/kg/day. Only 7.8% of the patients had met the Recommended Dietary Allowance (RDA) of protein intake. In the study sample, the measures of the delivered dose of hemodialysis therapy are directly correlated to the amount of consumed protein per kilogram body weight. But this correlation is only significant for patients who consume 1.2 g/kg body weight or less. Conclusion: The energy and protein intake were significantly low when compared with specific recommendations for individuals in hemodialysis; a dietician has an important role in providing nutritional education to the patients to improve the nutrient intake.
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Dietary pattern assessment and body composition analysis of adult patients with type 2 diabetes mellitus attending diabetes and endocrine center in Mirjan Teaching Hospital, Babil / 2021 p. 250
Hayder F Al-Bayati, Jawad K Al-Diwan
Background: Type 2 diabetes mellitus is an array of dysfunctions characterized by hyperglycemia resulting from a combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion; it accounts for 90–95% of all adults. Poor glycemic control is associated with complications of diabetes, and it could be avoided by good diabetic control, where different factors such as age, gender, obesity, exercise, and education have been reported to be associated with poor control in different settings. Objectives: This study showed the relation of some body compositions and intake of certain food items as assessed by a 24-h dietary recall and glycemic control among the study groups. Materials and Methods: A cross-sectional study has been conducted on 60 type 2 diabetes patients attending Diabetes and Endocrine Diseases Center in Mirjan Teaching Hospital in Babil, sociodemographic characteristics being studied, glycemic control of patients was studied according to their HbA1c. Glycemic control was studied among patients concerning some anthropometric measures; all these were measured with the aid of an InBody device, which was used in this study. Diet was investigated among the study group by using the 24-h dietary recall method to investigate the relationship between certain food being eaten and glycemic control. Glycemic control was studied among patients in relation to the glycemic index (GI) of foods eaten. Results: Sociodemographic characteristics showed that type 2 diabetes was higher among people in age group between 40 and 60 years with mean age 54.75 ± 10.2 years, male gender, urban residents, married people, housewives, and people with secondary and higher education. Regarding glycemic control rate, 75% patients had poor control and 25% had good control. Poor glycemic control was statistically significant with waist circumference (P = .010 for males and P = .003 for females), waist-to-hip ratio (P = .031 for males and P = .008 for females), and percentage of body fat (P = .002 for males only). There was a statistically significant association between starch and refined grain intake (P = .000) and added sugar and other sweetened beverages (P = .003), and glycemic control but no statistical association with vegetables, fruits, and milk and its products. Glycemic control was highly statistically significant with the intake of foods with a high GI (P = .000).
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Assessing the prevalence and socio-demographic determinants of the unsolved problem of perceived social stigma: A study among leprosy-affected persons in North Bengal, India p. 258
Alapan Bandyopadhyay, Sampriti Samanta, Abhijit Mukherjee, Sharmistha Bhattacherjee
Background: Leprosy has been affecting the human race since millennia, characterized by widespread, slow-healing lesions that lead to severe physical deformities. Along with its communicability, leprosy patients have therefore been subjected to widespread social stigma all over the world. Even though a largely effective national program has reduced the incidence of cases substantially in India, stigma has persisted. The present study aimed to assess the perceived stigma among leprosy patients living in rural areas and receiving care in a rural leprosy clinic of Northern West Bengal, India and to determine different factors associated with it. Materials and Methods: A cross-sectional study was conducted among 61 leprosy patients over the month of January 2021. The Explanatory Model Interview Catalog (EMIC) stigma scale was used to measure the perceived social stigma. Descriptive statistics and a multivariable linear regression analysis were used to present and explain the data. Results: Illiteracy and low socio-economic status were prevalent among the patients. The perceived stigma scores ranged from 4 to 35, with a mean of 23.36 ± 9.13. When adjusted for predictor variables such as age, sex, marriage, education, and socio-economic status, it was seen that perceived social stigma increased significantly (P-value=0.029) with increasing age. Female sex (P-value=0.022), illiteracy (P-value=0.017), and Grade 2 disability (P-value=0.009) were also significantly associated. Conclusion: The study observed that the overall perceived stigma levels among leprosy patients in this region were still high. This signals an enduring persistence of the problem. It is of urgent need to develop and implement stigma reduction strategies.
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Clinical characteristics and outcomes of heart failure with preserved, mildly reduced, and reduced ejection fraction: A 6-month follow-up study p. 265
Goran Adnan Rahman, Abdulkareem Abdulwahab Al-Othman
Background and Objective: Heart failure is a major public health problem with 64.3 million people affected all over the world, and it is an important cause for hospital admission and mortality. The aim of this study is to assess the clinical characteristics, frequency of hospitalization, and outcomes of heart failure with preserved, mildly reduced, and reduced ejection fraction. Materials and Methods: This is a prospective study of 91 patients aged more than 18 years of both genders with clinical features of heart failure supported by transthoracic echocardiography, who had been admitted to the Coronary Care Unit of Hawler Teaching Hospital for the period from October 2019 to February 2021. Heart failure patients were classified into preserved, mildly reduced, and reduced ejection fraction according to the European Society of Cardiology guidelines 2021 for the diagnosis of heart failure. The hospital outcomes, echocardiographic variables, the frequency of hospitalization, and mortality over 6 months were compared. Results: Among the 91 patients, the majority were females 48 (52.7%), the male: female ratio is 1:1.1, and the majority had heart failure with preserved ejection fraction 68 (75%). Ischemic heart disease 27 (30%) accounts for the majority of heart failure with preserved ejection fraction. Hyperlipidemia 17 (18.9%), orthopnea 15 (16.7%), paroxysmal nocturnal dyspnea 15 (16.5%), cardiovascular hospitalization 13 (14.3%), and mortality 6 (6.6%) were higher in heart failure with reduced ejection fraction. Conclusion: The high frequency rate of ischemic heart disease was reported in heart failure with preserved ejection fraction. Cardiovascular hospitalization and mortality rate were higher among heart failure patients with reduced ejection fraction.
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Detection of Toxoplasma gondii oocysts in contaminated soils using polymerase chain reaction analysis in Duhok City Iraq p. 271
Arshad Mohammad Abdullah, Narmin Saeed Merza, Ahmed Saeed Merza
Background: The impact of the acquisition of Toxoplasmosis from the environment through ingestion of oocyst from the soil, food, or water contamination remains worrisome worldwide. Objective: This study aimed to apply the molecular method for the detection of the occurrence of Toxoplasma oocysts by polymerase chain reaction (PCR) from different soil samples in Duhok province, Kurdistan region of Iraq. Materials and Methods: In this study, the occurrence of soil contamination with Toxoplasma gondii oocysts was recorded in different Duhok City’s areas by collecting 144 soil samples from different places. Results: Only seven samples (4.86%) were identified as T. gondii oocysts using microscopical identification and confirmed at the molecular level via PCR analysis using a fragment of 122 bp as a target of B1 gene. No significant difference was observed among soil types; parks showed the highest percentage 2.77%, followed by playgrounds (1.38%), whereas rubbish dumps accounted for 0.96%. Conclusion: The current study showed, a low percentage of T. gondii oocysts are recorded in soil samples as compared with other studies worldwide, but there is still the risk of infection among people who ramble at these places remains, especially among children who play with soil at these places.
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Effect of isometric exercise on heart rate variability in prehypertensive young adults p. 275
Suresh K Kotwal, Garima Charak, Nadeema Rafiq, Sudhanshu Shekhar, Tauseef Nabi
Background and Objective: Heart rate variability (HRV) is a sensitive and specific non-invasive tool to evaluate the degree of heart rate variation under the balanced influence of sympathetic and parasympathetic components of the cardiac autonomic nervous system. The aim was to study the effect of isometric hand grip exercise on HRV in prehypertensive young adults and to find a correlation of HRV with body mass index (BMI). Materials and Methods: This observational study was done on 60 healthy young adults aged 18–30 years. All the subjects were divided into three groups of 20 each on the level of their BMI and systolic and diastolic blood pressures. Group I were subjects with BMI <25 and normotensive, group II with BMI <25 and prehypertensive, and group III with BMI >25 and prehypertensive. HRV analysis (Chart HRV module, ADInstruments Pty Ltd) was performed with the following parameters calculated: low-frequency power (LF), high-frequency power (HF), and LF/HF ratio. Results: LF/HF ratio was significantly increased (P<0.001) in prehypertensive subjects (groups II and III) when compared with the normotensive subjects (group I), which indicates a heightened sympathetic discharge in prehypertensives. A positive correlation between anthropometric parameters and cardiac autonomic activity parameters and increased sympathetic activity in obese subjects were noted. Conclusion: An increase in anthropometric indices is associated with a change in cardiac autonomic activity, especially toward sympathetic activity. Regular anthropometric assessment can prevent the development of cardiac abnormalities and the incidence of sudden cardiac death.
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Association between gestational hypertension and preeclampsia with spontaneous prelabor rupture of membrane p. 281
Amal Faraj Wenas, Helema Yasser Al-Massawi
Background: Hypertensive disorders of pregnancy constitute one of the leading causes of maternal and perinatal mortality worldwide. Prelabor (premature) rupture of membranes (PROM) occurs in 10% of all pregnancies, of which 7%–8% occur after 37–42 weeks. Aim of the Study: The aim of the study was to investigate the association between gestational hypertension and preeclampsia with the risk of spontaneous PROM. Materials and Methods: This is a case-control study; 150 pregnant women with gestational age ≥20 weeks were included in this study. Eligible women were divided into three equal groups: 50 pregnant women with preeclampsia, 50 pregnant women with gestational hypertension, and 50 normotensive pregnant women. In addition, the risk of spontaneous PROM was assessed among these groups. Results: This study shows that 52% was primigravida in the preeclampsia group, whereas 26% in the gestational hypertension group and 38% in the normotensive group; this was statistically significant. Regarding the gestational age, 88% were full term in the preeclampsia group, 94% in the gestational hypertension, and 94% in the normotensive; there was no significant difference among the three study groups. In the preeclampsia group, seven (14%) have PROM with no significant association, whereas in the gestational hypertension group, 19 (38%) have PROM, which was statistically significant. In the normotensive group, 18 (36%) have PROM, which is also significant. The risk of PROM between each study group was compared: there was significant difference between percentages when comparing the normotensive group with the preeclampsia group (more percentage of PROM among the normotensive) and highly significant difference when comparing the gestational hypertensive group with the preeclampsia group. Conclusion: In this study, we concluded that gestational hypertension is associated with the risk of PROM, and preeclampsia is not associated with the risk of PROM.
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Pulmonary tuberculosis: Impact of clinical and radiological presentations on mortality p. 288
Zahir Salih Hussein
Background: Tuberculosis (TB) is an infectious disease, currently the top cause of infectious death from a single pathogen worldwide. Objective: The objective of this study was to determine the impact of clinical and radiological presentations of pulmonary TB on mortality. Materials and Methods: This retrospective case series study was performed on 215 patients (120 females and 95 males) using the recorded files of patients who were registered as pulmonary TB at the Chest and Respiratory Disease Center in Erbil, Iraq. Recorded files were studied from January 2018 to December 2019. Results: The mean age ± SD of the patients was 44.03 ± 21.57 years (ranged from 1 to 91 years), and female to male ratio was of 1.16:1. The right lung [97 (45.1%)] and upper zones [148 (68.8%)] were involved more frequently than other zones. Infiltration [120 (56%)] was the most common lung lesion. Clinical symptoms such as hemoptysis, weight loss, night sweat, shortness of breath, and chest pain were associated with a statistically significant increase in mortality. The right upper zones were affected more than other zones, and its involvement was statically significant. The involvement of both lungs had significant higher mortality [9 (25.7%)] than a single lung involvement [right lung: 2 (2.1%) versus left lung: 3 (3.9%)]; P value was <0.0001. The lower lung zone involvement has higher mortality [7 (19.4%)], and the type of lung lesion such as miliary distribution and cavitation has higher mortality, 2 (100%) and 3 (14.3%), respectively; P value was <0.016. Conclusion: Poor predictors of the outcome of pulmonary TB include clinical (hemoptysis, weight loss, night sweat, shortness of breath, and chest pain) and radiological (both lung involvement, upper zones especially the right upper zone, miliary distribution, and cavitation) presentations.
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Diabetic nephropathy in children with type 1 diabetes mellitus with vitamin D deficiency and dyslipidemia as associated risk factors p. 294
Wasnaa Hadi Abdullah, Ausama Jamal Kadhum, Ghazwan Abdulsalam Baghdadi
Background: Diabetic nephropathy (DN) is one of the most common and significant chronic complications associated with diabetes mellitus (DM). Vitamin D (VD) deficiency is linked to poor control of diabetes and its complications including the microvascular one such as DN. Dyslipidemia is believed to play a role in DN progression. Objective: The aim of this article is to estimate the prevalence of DN in children and adolescents with type 1 DM and its association with VD deficiency and dyslipidemia as risk factors. Materials and Methods: We conducted a cross-sectional study over a period of 6 months on 45 patients (children and adolescents) who attended the Pediatric Endocrinology Clinic of the National Diabetic Center/Al-Mustansiriyah University in Baghdad city, Iraq. The age of study participants ranged from 10 to 17 years, with the duration of type 1 DM of 5 years or more. Data including age, gender, duration of diabetes, daily insulin dose per kilogram body weight, growth measurements, and blood pressure (BP) were reported. A venous blood sample was collected for glycated hemoglobin (HbA1c), lipid profile, VD level, whereas a urine sample was collected for albumin-to-creatinine ratio. Two of the three specimens were obtained within a 3–6-month period due to variability in urinary albumin excretion. Results: The majority of diabetic children (71.1%) had DN. There were no significant differences in age, gender, duration of diabetes, body mass index (BMI), and BP between patients with diabetes and nephropathy and those with only diabetes. Both insulin dose and the HbA1c levels were significantly greater in diabetic patients with nephropathy (P-value 0.018 and 0.04, respectively) compared with diabetic patients without nephropathy. Insufficient and deficient VD levels were significantly higher among diabetic patients with nephropathy, whereas the sufficient level was higher among diabetic patients without nephropathy (P = 0.020). Diabetic patients with nephropathy had significantly higher levels of triglyceride, low-density lipoprotein (LDL), very LDL but lower high-density lipoprotein levels than diabetic patients without nephropathy (P-values 0.004, 0.047, 0.024, and 0.030 respectively). Conclusion: DN was not significantly associated with age, gender, disease duration, BMI, and BP of patients. Patients with DN need higher doses of insulin therapy and had higher HbA1c levels. VD deficiency is linked to a higher risk of DN. Patients with nephropathy had more significant dyslipidemia than patients without nephropathy.
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Pathophysiological mechanism of seizure in cerebral venous sinus thrombosis p. 299
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
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Understanding the significance of high stakes and low stakes assessments in medical undergraduate training p. 301
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
Assessment is a crucial part of the medical curriculum and is present throughout the duration of undergraduate training. Assessments should be planned in such a way that something should always be at stake (means the consequence of the assessment). Conducting assessments without keeping anything at stake makes the students adopt a casual approach toward examination, while using the results of the assessment for promotion to the next professional year accounts for an immense amount of stress and anxiety. To conclude, both high stakes and low stakes assessments have pros and cons, and the ideal approach will be to employ them as a continuum and use a mix of them. This will significantly aid in improving the learning outcomes of the students and in the attainment of the desired competencies.
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Strengthening the delivery of feedback in medical institutions by establishing feedback culture p. 304
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
The training imparted to medical students is quite vast and complex, and a lot is expected from them at the end of the overall training. Considering that each student differs from another, it is important to understand that a number of approaches should be adopted to ensure that they continue to learn. Feedback is an integral component of the medical education delivery process and it aids the students as well as teachers in performing better while discharging their roles. Even though the feedback carries immense significance in the teaching–learning or assessment process, it is not being widely practiced in different settings. In order to ensure successful implementation of a feedback culture, we have to pay attention to three interdependent aspects, namely the teacher, the student, and the environment. To conclude, feedback is an essential tool to facilitate learning among medical students. However, this will essentially require us to establish a culture of giving feedback to students in the medical institution and capitalize on each of the learning opportunities for the benefit of students and teachers.
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Hypersensitivity reactions to liposomal amphotericin in a bone marrow transplant patient p. 307
Alaa Hussein Alsajri, Shadan Waleed Al-Hishma, Mazin Abbas Shubber
Introduction: Hodgkin’s lymphoma is one of the treatable types of blood cancer. Autologous bone marrow transplantation is used as one way to treat this disease. Neutropenic fevers are treated with antibiotics and antifungals, including amphotericin B. Adverse effects and hypersensitivity to liposomal amphotericin, Ambisome, are very uncommon compared with conventional amphotericin. Case Report: In this case, we noticed hypersensitivity reactions to the Ambisome, represented by an increase in body temperature, a drop in blood pressure, and hypo-oxygenemia, in addition to an increase in the heart rate. Case Management: The patient was treated with injections of hydrocortisone, chlorpheniramine, and normal saline, in addition to giving oxygen; he was improved. Conclusion: In spite of the few cases that have recorded hypersensitivity reactions to the Ambisome, it is necessary to conduct an allergy test and to monitor the patient well when giving the Ambisome, especially in the first dose.
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