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   Table of Contents - Current issue
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October-December 2022
Volume 19 | Issue 4
Page Nos. 507-751

Online since Monday, January 9, 2023

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REVIEW ARTICLES  

Impact of COVID-19 on maternal and child health services Highly accessed article p. 507
Shatrughan Pareek, Hardeep Kaur
DOI:10.4103/MJBL.MJBL_61_22  
Coronavirus disease (COVID-19) outbreaks caused a significant mortality and morbidity at a global level. Maternal and child health (MCH) services are one of the most affected services during the pandemic. Maternal health is an essential component of high-quality maternal care, according to the WHO framework for the quality care for pregnant women and newborns. The aim of this study was to provide a review of COVID-19 impact on MCH services. The Web of Science, Scopus, Google Scholar, and PubMed databases were systematically searched. Articles reporting MCH services, COVID-19, and coronavirus were included for assessment. The initial search resulted in 106 records. After the primary screening of titles, abstracts, and full texts and removing duplicates, 11 articles were selected and included in this review study. The findings revealed that the range of projected maternal mortality and child mortality was 1.3%–38.6% and 9.8%–44.7%, respectively. Additionally, the review highlighted that there is a huge impact of COVID-19 on the utilization of reproductive, maternal, and newborn health services. Moreover, the study also reported huge increases in maternal mental health issues, such as clinically relevant anxiety and depression. There is a need to identify the factors and the prompt management of maternal health services during COVID-19. Hence, clinicians should maintain reproductive and maternal care and MCH during any pandemic.
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Single-fiber electromyography in patients with diabetic neuropathy Highly accessed article p. 511
Zahid Mohammad Kadhim, Ihsan Abood Ajeena, Moahmmed Jaber Al-Maamory
DOI:10.4103/MJBL.MJBL_76_22  
Diabetic peripheral neuropathy (DPN) is the most common microvascular complication of diabetes mellitus. Clinically, it affects the most distal extremities, first resulting in a stock and glove pattern of sensory loss. It affects both small fibers (myelinated and unmyelinated) and large myelinated nerve fibers. However, the earliest manifestations might be due to small fiber dysfunction. The diagnosis of DPN relies largely on typical history and physical examination and supported by the conventional nerve conduction study (NCS) and electromyography (EMG). However, a large number of cases might be missed from diagnosis due to small fiber involvement that manifests before large fibers. This necessitates the use of other diagnostic strategies such as single-fiber EMG, which is helpful in deciphering small fiber dysfunction and DPN earlier than NCS.
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Role of PAD enzymes on histone citrullination in cancer p. 514
Noor Mohammed Abdulrahman, Shatha Hussein Ali
DOI:10.4103/MJBL.MJBL_148_22  
Citrullination process is a natural pathway which happened at the time of cell dying, but during removal of these products, PAD enzymes may release causing stimuli to the immune system. This can start a consequence of processes and enhancement of cancer disease. In this review, we will focus on this marker and significance of its application for early detection of cancer and for follow-up disease, and the latest approved medications act on this line.
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ORIGINAL ARTICLES Top

Clinical and epidemiological study of measles cases in central teaching hospital of pediatrics in Babylon Province p. 518
Ali Khalid Mohammed, Ahmed Raheem Nasir, Muhanned Muhdy Joda Alsweedy
DOI:10.4103/MJBL.MJBL_49_22  
Background: It is an acute highly contagious disease occurs frequently in young children. It consists of three stages: An incubation stage of approximately 10–12 days. Prodromal stage with an enanthem (Koplik’s spots) on the buccal and pharyngeal mucosa, low grade fever, conjunctivitis, coryza, and sometimes-increasing cough. A final stage of a maculopopular rash erupting over the neck and face, body, arms, and legs associated with high fever. Objectives: The aim of this study was to determine the epidemiology, clinical features, complications, effectiveness of vaccine and treatment on cases of measles. Materials and Methods: Prospective case study of measles cases who are less than 13 years of age admitted to central teaching hospital of pediatrics during the period between 1/4/2015-1/10/2015 Diagnosis of measles was done by the classical history of the prodromal, fever, and cough, conjunctivitis, followed by the appearance of the classical rash after few days of the prodromal stage with the presence of the path gnomonic Kopliks spots in some patients. Chest X-rays (CXR) was done to all patients with suspicion of pneumonia. In addition to CBC and blood film. GSE was done to all patients with gastroenteritis, in addition to CBC. blood film and stool culture. Results: Two hundred seventy-seven patients were studied The male patients were (158, 57.03%) patients and the females were (119, 42.97%) patients, most of them (203, 73.28%) were not vaccinated (74, 26.72%) patients received the first dose of the vaccine at age of 9 months (21, 7.58%) patients received the first dose at 9 months with the second dose (MMR) at age of 15 months and only three patients (1.08%) received first, second, and third dose (MMR) at age of 4 years. The commonest clinical features were rash, fever, cough, conjunctivitis with coryza. Pneumonia was the commonest complication followed by gastroenteritis. There are only two cases of death: one due to severe pneumonia and the other due to septicemia and its complications. Conclusion: Measles is still a major health problem even in vaccinated children and the severity of illness is the same in both vaccinated and non-vaccinated children, with the peak age of incidence is during the second half of first year of life.
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The effect of serum albumin level on the frailty score in elderly patients attending primary health care centres in Babel Highly accessed article p. 522
Ali Mousa Essa Al_Badri, Hayder F Al-Bayati, Ammar Waheeb Obeid
DOI:10.4103/MJBL.MJBL_77_22  
Background: Frailty can be described as a clinical state of practical reserve decline related to ageing. Slowness, fragile, fatigue, and low performance are incorporated and affect the fulfilment of effective tasks negatively. Both under and overweight could lead to a frailty dilemma. It is well known that serum albumin is the most considerable serum protein and is used as an indication of nutritional status. Many studies revealed that hypoalbuminemia was related to higher frailty scores. The universal prevalence of frailty among the elderly population varies between 4% and 59.1%Objective: Assessment of the effect of serum albumin on frailty score among patients who are attending primary health care centres. Materials and Methods: A cross-sectional study was conducted in a primary health care centre in Babil governorate/Iraq. A convenient sample of 71 old patients attending the primary health care centre. Selected patients of either sex were included and any old patients 60 yrs. old and above (male or female) were included, whereas, anyone below 60 yrs. old were excluded. The Socio-demographic characteristics of the patients (name, age, gender, residence, marital status, occupation, and level of education), and anthropometric measurements (weight, height, body mass index) were analyzed in this study. Frailty score was measured by using (rockwood_cfs) for each patient. P_value of ≤0.05 was considered significant. Results: Sociodemographic characteristics showed that frailty score was higher among the age group between 60 to 69 years with a mean age of 67.10 ± 6.75 yrs (P = 0.000). Male gender, urban residence, married, housewife group and primary education showed the highest proportion among the study group patients. Overweight and obesity comprised 33.8% and 50.7% respectively. Our study demonstrated that weight was significantly associated with frailty score (P = 0.031). physical activity was not statistically significant in association with the frailty score. Serum albumin levels of the study group patients was a statistically significant association with frailty scores, where the highest proportion of high frailty scores was among those with low serum albumin levels (P = 0.047).
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Awareness and attitude on use of nanotechnology among dental and medical professionals in Iraq p. 528
Azad M R Almuthaffer
DOI:10.4103/MJBL.MJBL_94_22  
Objective: Several products such as technological devices, pharmaceutical products, have been developed with nanotechnology applications, in medicine fields. This study aimed to assess dental and medical staff perceptions of nanotechnology in Iraq. Materials and Methods: This study was based on an online questionnaires distributed to (736) dental and medical staff in Iraq from different region and different place of work, and the method of selecting the sample was stratified random sampling. The study period was two months (June and July 2020). Result: the largest percentage was for the dental staff 76.5% did hear about nanotechnology, and about 23.5% did not, while among medical staff 54.9% answer yes, and about 45.1% answer they did not hear about nanomedicine. Regarding the uses or applications of nanomedicinee, largest percentage of the responses was may be 64.7% for the dental staff and 67.1% for medical staff. Conclusion: There is an inadequate knowledge of the dental and medical staff about nanotechnology and its applications the in Iraq in field of dentistry and medicine, and it is not effectively used in the dentistry and medical field.
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Plasma sclerostin level in multiple myeloma: Correlations with disease features and international staging system p. 534
Noor Hasan Baiee, Haithem Ahmed Al-Rubaie
DOI:10.4103/MJBL.MJBL_99_22  
Background: Multiple myeloma (MM) is a heterogenous plasma cell malignancy with various complications. Sclerostin is a Wingless-type (Wnt) inhibitor specifically expressed by osteocytes; it acts as a negative regulator of bone formation. Objectives: To assess plasma sclerostin level in MM patients and find its correlations with clinical and laboratory data, including osteolytic bone disease and international staging system (ISS). Materials and Methods: This cross-sectional study included 80 individuals: 40 newly diagnosed MM patients and 40 healthy adults. Patients were divided according to the presence of bone disease and ISS stage and were investigated for complete blood count, blood film and bone marrow (BM). Plasma levels of β2-microglobulin and sclerostin were measured using competitive and sandwich enzyme immunoassay techniques, respectively. Results: Sclerostin level was significantly increased in MM patients than control group (P < 0.001) and was significantly higher in those with osteolytic bone disease and/or pathological fractures than those without bone lytic lesions (P < 0.001). Patients with ISS stage III showed significantly higher sclerostin level than stages I and II (P = 0.003). High sclerostin levels were positively correlated with blood urea, serum creatinine, uric acid, and β2-microglobulin (P-values 0.034, <0.001, <0.018 and <0.001, respectively) and negatively with glomerular filtration rate (P = 0.001). No significant correlation was found with age, gender, hematological and other biochemical parameters. Conclusions: In newly diagnosed MM patients, the plasma sclerostin was significantly correlated with renal impairment. High levels of plasma sclerostin were also found in advanced disease stage and with the presence of significant bone disease.
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Prevalence of text neck syndrome in children and adolescents using smartphones in Erbil city p. 540
Areen Nimat Aziz, Lana Adil Bakir
DOI:10.4103/MJBL.MJBL_110_22  
Background: Neck and shoulder pain is a common health issue among children and teenagers in developing countries. Objective: This study aimed to identify the prevalence of text neck syndrome and its associated factors in children and adolescents. Materials and Methods: In this cross-sectional study, children and adolescents who attended primary health centers (PHCs) along with their parents were included. Four main PHCs in Erbil city in Iraqi Kurdistan in 2022 were selected for this study. Results: The prevalence of text neck pain was 69.0% among children. The level of neck disability score was 17.15 out of 21 among children. Adolescents (96.05%) those who used smartphones >3 h (83.56%), those studying secondary level (94.24%), and those with psychological, social, and physical functions and children who slept less, played fewer sports, used more computers, watched more TV, and played the game more than 3 h were more likely to have text neck syndrome. The study showed that children who spent more time on smartphones, watching TV, playing games, and those with physical and social functions had a high level of neck disability. Conclusion: This study found a high prevalence of text neck syndrome among schoolchildren in this region. The high prevalence of text neck syndrome was associated with more using smartphones and watching TV and a high prevalence of physical, psychological, and social issues.
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Sociodemographic characteristics and fate of hospitalized burned patients in Al-Hilla city p. 547
Hiba Khaleel Hasan, Ameer Kadhim Al-Humairi
DOI:10.4103/MJBL.MJBL_112_22  
Background: A burn is defined as a damage to the tissues due to high temperatures or heat, cold, electrical, chemical, friction, or irradiation. In developing countries such as Iraq, burn injuries are widespread, particularly in low-income and rural regions. Burns are considered the fourth most prevalent type of injuries worldwide. Objectives: The aim of this study is to assess the sociodemographic characteristics of hospitalized burned patients, as well as patients’ fate and related risk factors. Materials and Methods: This was a cross-sectional study. The data were collected by interviewing patients who admitted in the burns ward center of Al-Imam Al-Sadiq Teaching Hospital or their companions, for a 3-month period from February 1, 2022 to May 1, 2022. Statistical analysis was done by SPSS version 27. Results: We collected data from 73 burned patients, which showed that most of them were males 53.4%, the mean age ± standard deviation was 18.76 ± 16.81 years, 65.8% living in rural areas, most patients had scald burn 43.9%, with second degree of burns and total body surface area (TBSA) <50%. About the outcome, 38.3% died. We found a significant (P-value >0.05) association between the fate of burned patients and the age, gender, place of burn, degree of burns, TBSA involved, and the presence of inhalational injury. Conclusion: The majority of the burned patients were male children, with scald burns, second-degree burns, and TBSA more than 50%. The mean age was 18.67 ± 16.81 years. The mortality rate was 38.3% and increased with age, female gender, flame burn, TBSA more than 50%, and with inhalation injuries.
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Assessment the risk factors of congenital heart disease among children below 5 years age in Babylon province p. 554
Noor Ibraheem Mohammed, Mohanad Khudhair Shukur Al-ghanimi
DOI:10.4103/MJBL.MJBL_113_22  
Background: Congenital heart diseases (CHDs) account for 25% of all congenital malformations. CHDs are an important cause of morbidity and mortality in children. Prevention of CHDs can be achieved by preventing exposure to modifiable risk factors that affect the cardiac development during pregnancy. Objectives: To assess the sociodemographic and medical risk factors of congenital heart diseases among children below five years in Babylon city, Iraq. Materials and Methods: A retrospective case control study conducted from 1st of February to 1st of May, 2022, at Shaheed Al-Mehrab center, Babylon Maternity/Pediatric Hospital and Al-Imam Al-Sadik General Teaching Hospital, consisted of 100 participants classified to 50 CHDs cases and 50 controls by Echocardiogram, the mother/caregiver of each child was interviewed using a pre-tested questionnaire. Results: The age of the participants ranged from one day to 4.5 years, with a mean age (10.4 ± 13.2) months. (52%) of CHDs cases were females, (68%) of them were below one year age and (54%) of them reside in urban area, 28% of CHDs was VSD and 42% of the cases present with chest infection. BMI percentile was significantly lower in cases of CHDs (P = 0.008) and there was a significant relationship between CHDs and family history of CHDs (P = 0.013). Conclusion: Majority of the cases were females, below one year age and reside in urban area, presented with VSD and chest infection. BMI percentile was lower in cases of CHDs and there was a significant relationship between CHDs and family history of CHDs.
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Clinical characteristics and spectrum of cyanotic congenital heart diseases diagnosed in pediatric age group p. 560
Dana Majeed Azeez, Mudhafar Abdurrahman Habeeb
DOI:10.4103/MJBL.MJBL_115_22  
Background: It is necessary as early as possible to diagnose and treat cyanotic congenital heart defects (CCHDs) because survival of them is highly related to the time of diagnosis. But not all serious congenital heart diseases (CHDs) clinically appear with cyanosis during the first few days of life. There are several types of CCHD, some of them are more common like tetralogy of fallot (TOF), transposition of great arteries (TGA), and tricuspid atresia. Aim: This study was conducted to determine various types of cyanotic CHDs and clinical presentations of cyanotic CHDs and different procedures were done for them in children at Erbil. Materials and Methods: This was prospective, cross-sectional study, carried out in Pediatric Cardiac Department of Hawler Surgical Specialty Hospital-Cardiac Centre. All patients aged 0-18 years were included in the study. Results: During the study period, 124 cases were diagnosed with cyanotic CHDs. The common CHD type was TOF (46.8%), followed by D-TGA (12.1%), DORV (10.5%), tricuspid atresia (9.7%), and single ventricle (8.9%). Interventional management was done in 44.4% of studied children with CCHDs, total surgical repair was main procedure (14.5%). The common symptoms of cyanotic CHDs were commonly murmur (90.3%), shortness of breath (85.5%), cyanosis (76.6%), and fatigue (76.5%). Conclusion: TOF was the most common CCHD noted in our study. Ebstein anomaly, truncus arteriosus, and PPH were the least prevalence CCHD. Heart murmur was the most common presenting sign while shortness of breath and central cyanosis were the most common presenting symptoms.
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Medication adherence in hypertensive diabetic patients p. 569
Hasan Alwan Baiee, Mustafa Bahaa Makai
DOI:10.4103/MJBL.MJBL_129_22  
Background: Diabetes-related hypertension increases mortality risk by 7.2 times in the underdeveloped countries such as Iraq, with a greater risk of death. In developing countries, patients’ adherence to chronic illness treatments such as hypertension and diabetes is low. Nonadherence is linked to higher rates of hospitalization and poor health outcomes. Objectives: The aim of this study to determine the prevalence of medication adherence among the hypertensive diabetic patients and to identify factors that associated with poor or nonadherence to medications. Materials and Methods: This is a hospital-based descriptive cross-sectional study. The study included a sample of 385 hypertensive diabetic patients of both gender, their ages above 18 years. The study was carried out from February 2022 to the end of May 2022 at the consultation clinics at Imam Al-Sadiq and Marjan Teaching Hospitals, Babylon, Iraq. Following verbal consent, the participants were interviewed using a prepared structured validated and reliable questionnaire will be use that includes demographic characteristics using the Morisky 8 Item Medication Adherence Scale (MMAS-8) was used to assess medication adherence. Results: This study showed that more than half of the patients (51.2%) had low adherence, whereas 22.9% had medium adherence. Those with high adherence constituted 26.0%. There were statistically significant associations between good adherence and high level of education, younger age, and nonsmoking. Patients with good adherence to medications have better blood pressure and blood sugar control. Conclusion: The level of medication adherence among diabetic hypertensive patients in Babylon province is low.
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Assessment of impact of regional analgesia on labor and neonates in Hilla City p. 575
Safa Abd Al Hassan Kadhim, Milal Muhammed Al Jeborry
DOI:10.4103/MJBL.MJBL_135_22  
Background: Epidural is the most effective form of pain relief in labor with around 30% of laboring women in the UK and 60% in the USA receiving epidural analgesia. Objectives: To assess effect of regional analgesia on labor pain, duration, outcome of delivery and neonates. Materials and Methods: Case control study included 400 pregnant woman 200 of them delivered by painless labour and other 200 whose delivered without analgesia who attended to the babylon maternity and pediatric hospital,Al sadiq hospital and private hospitals in al hilla city which included private Teiba, Al Fayhaa hospitals from first of february 2022 to June 2022. Results: The duration of first stage of labor was significantly prolonged at control mothers 26%(52) in compare to 10%(20) of mothers with epidural anesthesia had prolonged labor. While second stage shown no significant association with epidural anesthesia (P = 0.47). Fetal heart rate abnormalities shown no significant association with epidural analgesia (P = 0.96). While back pain and headache was significantly higher in mothers with epidural analgesia (P < 0.001). Conclusions: EA was not associated with a higher instrumental delivery rate and higher rate of c/s, EA not cause significant maternal or neonatal complications in primi- and multiparas. Importantly, EA associated with short first stage of labor and not higher rate effect on duration of second stage of labour.
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Knowledge of mothers regarding management of fever in their children under five years of age in Al-Hilla City p. 581
Raghad Abdulwahab Mohsen Altahhan, Sura Falah Abdulhadi Aljubbawi
DOI:10.4103/MJBL.MJBL_140_22  
Background: Improper fever definitions will lead to excessive treatment with its adverse consequences, or missed fever, or delayed diagnosis of dangerous illness. Mothers’ care for a feverish child can sometimes be inappropriate and harmful. Objective: To assess knowledge of mothers regarding definition and management of fever in their children under five years of age and to identify the association between mothers’ knowledge and mothers’ socio demographic factors. Materials and Methods: A cross-sectional study was conducted among 302 mothers of alive children aged bellow five years. The mothers were interviewed (face-to-face) after giving their verbal consent to participate in this study by using a systematic questionnaire, which included mothers’ socio-demographic characteristics and questions related to fever management. It was carried out at Babylon Teaching Hospital for Maternity and Children, Al Imam Al Sadiq Teaching Hospital, and Al Noor Hospital For Children in Al-Hilla City, Iraq, from February 1 to June 15, 2022. Results: The mean age of mothers was (27.07 ± 6.33) years, 16.56% of mothers were higher education graduates, 86.75% were housewives. 0.66% of mothers had insufficient knowledge regarding fever management, 65.23% had moderate knowledge, and 34.11% had high knowledge. The mothers’ knowledge was in significant association with the mothers’ educational level, mothers’ occupation, using internet, and in significant negative correlation with number of alive children that the mothers had. Conclusion: About two-thirds of the mothers had moderate knowledge regarding fever management, about one-third had high knowledge, and less than one percent of mothers had insufficient knowledge.
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Incidence of acute kidney injury in hospitalized COVID-19 patients p. 589
Yasamine Abdul Hussein Abdul Waheed, Haider Mehdi Mueen Al-Shireefy
DOI:10.4103/MJBL.MJBL_143_22  
Background: Acute kidney injury (AKI) is common among patients hospitalized with COVID-19 and associated with worse prognosis. Objective: We aim to assess the incidence of AKI in hospitalized COVID-19 patients. Materials and Methods: This is a retrospective cross-sectional study conducted at Merjan Teaching Hospital from May 1 to October 1, 2021. It involved a review of data of 174 hospitalized polymerase chain reaction–confirmed COVID-19 patients from hospital health records. Results: In our hospitalized COVID-19 patients, AKI was found in 14 patients forming 8.05% of the total hospitalized patients. The age of participants with AKI was 62.64 ± 19.08 years; male patients formed the larger proportion (53.45%). More than one-third of the patients (36.21%) had a history of hypertension, and more than one-fifth of the patients had a history of diabetes mellitus (22.99%). History of ischemic heart disease was present in 4.60%, heart failure in 0.57%, asthma in 3.45%, chronic obstructive pulmonary disease in 1.15%, cerebrovascular accidents in 1.75%, and lung fibrosis in 1.15%. Patients with AKI had a significantly higher level of blood urea (22.44 ± 11.74); the level of serum creatinine was also significantly higher among patients with AKI (267.57 ± 87.27); significant relationship was observed between the outcome of the patient and the incidence of AKI. Conclusions: The current study showed a higher risk of mortality and morbidity in COVID-19 patients with AKI. Identifying high-risk groups and earlier diagnosis of AKI in COVID-19 patients can improve results in patients and decrease mortality.
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Mycological profile of acute invasive fungal rhinosinusitis during COVID-19 pandemic at a tertiary care hospital p. 595
Jyoti Chauhan, Narinder Kaur, Harit Kumar, Rosy Bala, Shubham Chauhan
DOI:10.4103/MJBL.MJBL_193_22  
Introduction: During the coronavirus disease-19 (COVID-19) pandemic, a surge in acute invasive fungal rhinosinusitis (AIFRS) cases with high mortality was reported in India. Objective: The objective was to study the spectrum of fungus associated with AIFRS during the pandemic of COVID-19. Materials and Methods: A total of 51 patients who were clinically diagnosed as cases of acute invasive rhinosinusitis in the department of ear, nose and throat (ENT) were included in the study. The clinical data along with demographic details were noted, and fungal identification was done using a conventional method. Results: Out of 51 patients, 66.6% were males and 33.4% females. Predominantly affected age group was 41–50 years. Out of 51 patients, 92.15% (47/51) had suffered from COVID-19 and 7.8% (4/51) did not have COVID-19 infection previously. Thirty-seven patients out of 51 (72.54%) were diabetics. Out of 51 samples collected from patients, 94.11% (48/51) were fungal culture-positive and only 5.8% (3/51) were culture-negative. A total of 52 fungi were isolated from the 48 culture-positive samples. Mucormycetes were predominantly isolated from the samples followed by Aspergillus species and Candida species. Among mucormycetes, Rhizopus species was the predominantly isolated. Conclusion: Patients with COVID-19, especially those at high risk, need to undergo an ENT examination once they recover because an early identification of AIFRS and a strong clinical suspicion of the disease are crucial for a successful course of treatment and to improve patient prognosis.
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Antimicrobial activity of some nanoparticles synthesized by laser ablation technique against some bacteria isolated from oral cavity p. 601
Huda Abbas Mohammed, Nebras Mohammed Sahi, Rafea T Ahmed, Abeer fauzi Al-Rubaye
DOI:10.4103/MJBL.MJBL_147_22  
Background: Tooth decay is an infectious disease that affects many people around the world and results in tooth pain due to dental cavities, which leads to tooth loss. Nanomaterials were used in the manufacture of fillings to reduce the activity of bacteria that cause tooth decay. Objectives: The current study aims to determine the efficiency of the antimicrobial activity of some nanoparticles (Go + Ag + poly, Zn + poly, Zn + poly, Ag + Zn + poly) manufactured by laser ablation technique to determine their ability to disrupt the biofilm formation produced by microorganisms and thus prevent tooth decay. Materials and Methods: Samples were collected from people who suffer from gingivitis and tooth decay and identification of bacteria by VITEK 2 Densi screening device. Nanoparticles were manufactured by laser ablation technique at the wavelength 1064 nm and then measuring the ability of bacterial isolates to form biofilm before and after the addition of nanoparticles using an enzyme-linked immunosorbent assay (ELISA) device at wavelength 490 nm. Results: The results showed the efficiency of the nanocomposite (Ag + poly) in inhibiting the growth of bacteria, followed by (Go + Ag + poly), (Zn + poly), while (Ag + Zn + poly) did not show any effect in inhibiting the growth of Sphingomonas paucimobilis, Streptococcus pneumonia, Serratia plymuthica, Staphylococcus hyicus on the culture media. It was noticed that the average value for formation biofilms that was represented through optical density at 490 nm were noticeably higher before adding nanomaterials than the mean value of biofilm formation amount after adding nanomaterials at P ≤ 0.05 which is considered as a differential sign. Conclusion: Laser ablation technology was used to manufacturing nanoparticles for using as an inhibitor of bacterial species which isolated from patients with dental caries, where it was found that most of the nanoparticles manufactured by this technique have a role for inhibiting of Sphingomonas paucimobilisSerratia plymuthica, Staphylococcus hyicus that were isolated from people with dental caries. The nanoparticle (Ag + poly) showed a remarkable efficiency in inhibiting the growth of S. paucimobilis, S. pneumonia, and S. hyicus except S. plymuthica was not affected by this nanoparticle, while the nanoparticle (Ag + Zn + poly) did not show any effect in inhibiting the growth of S. paucimobilis, S. pneumonia, S. plymuthica, and S. hyicus on the culture media. Mostly, laser-ablated nanoparticles showed antimicrobial action in vitro. Accordingly, there is a need for additional research to describe in detail the mechanism of the toxicity of these nanoparticles.
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Oral health–related quality of life among dental implant patients in relation to temporomandibular joint function p. 609
Rihab Abdul Hussein Ali, Saif Mohammed Radeef, Nawres Bahaa Mohammed, Ban Sahib Diab
DOI:10.4103/MJBL.MJBL_155_22  
Background: The placement of dental implants may enhance the oral health–related quality of life, which may influence temporomandibular joint function. Aim: The purpose of this study was to compare dental implant patients with partially and fully dentate patients in terms of oral health–related quality of life related to temporomandibular joint function. Materials and Methods: Ninety dental implant patients aged 50–60 years were included in the study, with 90 patients from other two groups who were matched in age and gender. For evaluation of oral health–related quality of life, Arabic version of Geriatric Oral Health Assessment Index was utilized. In order to define the occurrence and severity of temporomandibular joint disorders among patients, Helkimo Clinical Dysfunction Index was used. To analyze the data, SPSS 22 (Chicago, IL, USA) was employed. Results: Data revealed that the mean values of oral health–related quality of life and its three domains were higher among the fully dentate group than the other groups with a statistically significant difference. A similar picture was observed regarding the temporomandibular joint function. The mean values of oral health–related quality of life were decreasing significantly with increasing severity of temporomandibular disorders among the partially edentulous group. The same figure found concerning the three domains; however, the significant decreasing was found for physical domain only. Conclusion: After receiving oral implant therapy, the quality of life in relation to dental health had increased. The temporomandibular problems have an adverse effect on the dental health.
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Sociodemographic characteristics, smoking, and family history of patients with inflammatory bowel disease, northern part of Iraq p. 615
Blnd Ibrahim Mohammed, Bushra Karem Amin
DOI:10.4103/MJBL.MJBL_162_22  
Background: Inflammatory bowel disease (IBD) is a long chronic condition of the gastrointestinal tract that includes Crohn’s disease and ulcerative colitis. The incidence rate of IBD increases globally. The exact pathogenesis of IBD is not known and has yet to be discovered. Materials and Methods: This study was conducted in Kurdistan region of Iraq (Erbil, Duhok, Sulaimaniyah, and Halabja) from July 2021 to July 2022. Sociodemographic variables (gender, age, education level, employment status, marital status, and residency) plus smoking habits and family history were collected by a questionnaire and reviewed in 83 patients with IBD and 170 matched controls, followed by statistical comparison in both studied groups. A combination of clinical, radiographic, histological, and endoscopic assessment from medical records was used for the diagnosis of IBD. Results: Of all IBD patients, 56.6% (47) were male and 43.4% (36) were female. Statistically no significant differences were identified, among patients and controls, for gender, age, marital status, level of education, and employment, whereas significant differences were identified for residency, smoking, and family history, and P value was 0.019, 0.016, and 0.001, respectively. Conclusions: Smoking and family history were determined as a risk factor for the development of IBD and the odds ratios (95% confidence interval) were 1.916 (1.126–3.260) and 3.260 (1.596–6.658), respectively.
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Direct lateral approach for total hip arthroplasty and its complications in a group of patients p. 620
Mohammed Ab-Kudher Ab-Al-Sada, Salah Mahdi Khaledi, Tarik Ziad Tarik Al-Dahan
DOI:10.4103/MJBL.MJBL_163_22  
Background: Total hip arthroplasty (THA) aims to treat pain and to restore the joint motion and stability. The surgical approaches to perform it are different, and all approaches have disadvantages or complications. The direct lateral approach (DLA) advantages include the decrement of the dislocation possibility. Objectives: The objective of the study was to determine the Harris hip score (HHS) and frequency of complications by gender among a group of patients who underwent THA through DLA, and the mean age of those patients with and without complications. Materials and Methods: This is a cross-sectional study conducted from June 2014 to January 2021 and included 80 patients in Saint Raphael Hospital in Baghdad undergoing primary THA by DLA. We excluded patients with revision THA. Age, gender, follow-up period, complications, and HHS were recorded and entered into computer software Microsoft Excel version 2019. Mean ± standard deviation was used to express continuous variables, whereas frequency and percentage were used to express categorical variables. t-test and Chi-square test were used as appropriate. Results: There were a total of 80 patients (29 males/51 females). Mean HHS was 96.7 ± 1.5; mean HHS and frequency of complications did not differ significantly by gender. The percent of dislocation, fracture, and infection among patients was 3.8%, 5%, and 3.8%, respectively. The mean age did not differ significantly among patients with and without complications. Conclusions: Gender had no role in the complications related to DLA, and age had no role in the complications.
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Remdesivir effects on COVID-19 infection in adult patients p. 625
Zena Hasan Sahib, Ahmed Hasan R Al-Zurfi, Ali Talib M Al-Masoodi, Ali Baay, Entisar Al-Muhktar
DOI:10.4103/MJBL.MJBL_168_22  
Introduction: Coronavirus disease 2019 (COVID-19) is a serious pandemic affecting the global world since 2019 with heavy impacts on the social, economy, and normal daily life; one of the promising antiviral treatment used frequently all over the world is the remdesivir. Aim: The aim was to study the effect of 3–5 days remdesivir treatment course, regarding its starting time on clinical status and the fate of patients with COVID-19, with monitoring of the side effects. Materials and Methods: A prospective observational study involved 90 patients with COVID-19 who received remdesivir 5 days course; all were hospitalized, diagnosed by computerised tomography (CT) chest and polymerase chain reaction (PCR) at Merjan Teaching Hospital from August 2020 to October 2020. Those 90 patients’ age ranged from 25 to 88 years. Sixty-two patients received convalescent plasma with remdesivir against 13 patients who not received it. Tocilizumab was added for 18 patients, whereas 57 were not treated with it. Clinical state (SpO2, subjective dyspnea, respiratory rate (RR), fever, and the type of O2 supplements) of the patients was assessed three times. Regarding the time of starting remdesivir treatment during the course of disease, patients were assessed in three groups: patients received remdesivir within <10 days, patients received it between 10 and 15 days, and patients received it >15 days. Mean of the duration of patients discharge was recorded. Results: It showed an extremely significant difference (P < 0.001) between the discharged and both referred to respiratory care unit (RCU) and death patients. There were significant differences (P < 0.05) in the clinical state (SpO2, subjective dyspnea, RR, fever, and the type of O2 supplements) of the patients in all three times of assessments with significant correlation (P < 0.01) between means of the clinical state (SpO2 and subjective dyspnea score) and the fate (discharge, admission to RCU, and death) of patient who received it. There were no significant differences (P > 0.05) between means of time of starting therapy and the fate of patients. At the same time, no significant differences (P > 0.05) were seen in the mean of liver function test. There were no significant differences (P > 0.05) between the fate of patients who received convalescent plasma with remdesivir, but a significant disadvantage (P < 0.001) was seen in the fate of patient who received tocilizumab. Conclusion: We can conclude that remdesivir improves the clinical state of patients with COVID-19 regardless of the time of its starting during the course of disease.
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Mother’s perception toward childhood diarrhea: A cross-sectional study p. 635
Abbas Abid Khazaal, Miami Kadhim Yousif, Hasnah Abdelzahra Mousa
DOI:10.4103/MJBL.MJBL_170_22  
Background: Diarrheal disease is considered as the second most common cause of death among under-5 children globally. Objective: The aim of this article is to determine mothers’ knowledge and practices regarding diarrhea causes and principles of management. Materials and Methods: A cross-sectional study was conducted on 200 mothers of under-5 children who attended the pediatric outpatient department for diarrhea. The correlation between mothers’ age and level of education with their knowledge regarding signs of dehydration and their awareness of the use of oral rehydration solution (ORS) and management of diarrhea was done. The χ2 test was used, and a P-value of 0.05 was considered significant. Results: Nearly half (45%) of the mothers believed intestinal infection caused that diarrhea, whereas (37.5%) blamed the teething process. Mothers rated the severity of diarrhea as increased frequency (70%), change in consistency (62.5%), foul smell stool (13.5%), and change in stool color (7%). The study showed that 45% of the mothers did not know any sign of dehydration and indicated poor mothers’ adherence to ORS use (4%), despite their awareness of ORS (66.5%). The study showed a significant correlation between mothers’ education and initial management of diarrhea at home (P <0.05), but not with their awareness of ORS or their knowledge about signs of dehydration. There was no significant relation between mothers’ age and their awareness of ORS, their knowledge regarding the signs of dehydration, and their initial action to manage diarrhea at home. Conclusion: Most respondents lack satisfactory knowledge of diarrheal diseases. Therefore, mothers need health education to create a better attitude toward the prevention and management of diarrheal diseases.
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The relationship between brain computed tomography scan findings and prognosis in patients with missile-penetrating head injuries p. 640
Husam Ghazi Al-Anbari, Nuha M Salih Al-Zaubai, Ahmed Hashim Matloob, Ali A Hadi
DOI:10.4103/MJBL.MJBL_184_22  
Background: Missile-penetrating head injury is a challenging problem for treating physicians. In Iraq and during 2003–2007, there was a civil war, which led to multiple causalities after suicide bombings or other clashes with coalition forces. A brain computed tomography (BCT) scan is considered as an initial diagnostic test to evaluate the next management plan. The authors tried to find the relationship between BCT scan findings and patients’ outcomes. Objective: This study aimed to explore the relationship between BCT scan findings of patients with missile-penetrating head injury and their prognosis. Materials and Methods: This was a cohort retrospective clinical study performed in Karbala, Iraq in the period from January 2005 till January 2006. Seventy patients with missile-penetrating head injuries were admitted and evaluated in Al-Hussain General Hospital (affiliated with the University of Al-Ameed). All patients had BCT scans and their outcome was evaluated using a modified Glasgow Outcome Scale. Results: In this study, the mortality rate is 15.71%. BCT scan findings are correlated with patients’ outcomes, which revealed the injury of one lobe carries the best outcome, whereas those with more than two lobes or posterior fossa injury carry the worse prognosis. Moreover, intraventricular hemorrhage (IVH) showed the highest mortality rate, whereas tract hematoma alone seems to carry a good prognosis with the least mortality. Conclusion: BCT scan is essential in both diagnosis and prognosis of patients with missile-penetrating head injury. IVH and posterior fossa injury lead to the highest mortality rate.
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Evaluating the effect of lemongrass essential oil addition on some properties of heat cure acrylic soft-lining material p. 646
Huda Jaafar Naser, Faiza M Abdul-Ameer
DOI:10.4103/MJBL.MJBL_188_22  
Background: Denture liners’ viscoelasticity absorbs shocks and relieves tissue pressure. Soft liners must be replaced every 6–12 months because oral conditions destroy elastomers. By adding chemicals to soft liners, researchers have created a new class of flexible, oral-friendly materials. This lowers denture and mucosa pressure. Objectives: The aim of the study is to discover if the best two concentrations of lemongrass essential oil (LGEO) added to heat-cured soft denture liner improves the material’s hardness, the strength of the peel bond, and surface roughness. Materials and Methods: In a pilot study, 2.5 vol.% and 5 vol.% LGEO improved the heat-cured soft-liner material’s Shore A hardness and surface roughness. The main study categorized 90 specimens into three groups (Shore A hardness, peel bond strength, and surface roughness). Each of the groups has three subgroups (control, 2.5 vol.% of LGEO additive, and 5 vol.% of LGEO additive). One-way analysis of variance, Dunnett’s T3 post hoc, Tukey’s honestly significant difference, and Fisher’s exact test were used for data analysis, which was significant at P < 0.05. Results: After adding 2.5 vol.% and 5 vol.% of LGEO additives (experimental subgroups), Shore hardness, peel bond strength, and surface roughness of the two experimental subgroups decreased significantly from the control subgroup at P < 0.05, except for 2.5 vol.% of the LGEO additive subgroup, which did not differ significantly at P > 0.05. When failure mode was assessed, all subgroups varied substantially. The 2.5 vol.% of LGEO addition specimens showed adhesive and cohesive failure with some mixed type, whereas 5 vol.% showed predominantly cohesive failure. Conclusions: LGEO enhances the hardness and surface roughness of the soft-lining material, making it more resilient and smoother. This leads to a greater cushioning effect and reduced damage to the oral tissues while decreasing the liner’s peel bond strength to an acceptable level. 5 vol.% is the best percentage that improves liner properties.
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Study the profile of some antioxidant markers in diabetic mellitus and non-diabetic patients with cardiovascular disease p. 653
Israa Ghassan Zainal
DOI:10.4103/MJBL.MJBL_190_22  
Background: Cardiovascular diseases (CVDs) claim the lives of millions worldwide. Objective: Evaluate the levels of some antioxidant biomarkers in sera of patients with CVDs with and without diabetes mellitus type 2. Materials and Methods: Includes 100 samples in 68 patients (40 with CVDs and 28 CVDs with diabetic), and 32 healthy subjects. Results: Serum (Albumin, thiol, thiol/T.protein, amine, free amine/ T.protein, carbonyl, carbonyl/ T.protein, and Ischemia modified albumin (IMA)) showed a stronger response, a significant rise in carbonyl and carbonyl/TP, and a significant reduction in thiol and thiol/TP in the patients with CVDs with T2D compared to CVDs may be a good factor to differentiate them or predict more serious complications. Conclusions: Oxidation markers may be useful in monitoring CVDs with and without diabetes.
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Association between placental localization and fetal gender detection early in pregnancy p. 659
Hadeel AbdulSattar Qasim, Ruaa Abduljabbar Hamid
DOI:10.4103/MJBL.MJBL_196_22  
Background: Ultrasound (US) is a highly feasible way to assess fetal health as well as detect the gender to satisfy parents’ curiosity and it is important in several hereditary and chromosomal diseases. Objectives: The aim of this study was to determine the gender of the fetus during the first trimester by detecting the chorionic villi (placental) location by US and finding its relation with fetal gender. Materials and Methods: The study was conducted on 67 women in April 2019–April 2020 on outpatient private clinic, ultrasound machine used DC N3 Pro, transabdominal approach by 5 MHz probe 3C5A measuring transverse and sagittal views of the gestational sac and localizing chorionic villi, another scan was done in the second trimester to identify the fetal gender by visualizing the genitalia. Results: Of 67 pregnant women examined, 40 had male fetuses and 27 had female fetuses. Approximately 50% of males had right-sided placenta. And 50% of them had left sided placenta, 11 out of 27 examined females fetus had right sided placenta, 16/27 female had left sided chorionic villi, Chi square analysis done, P-value was 0.456. Conclusion: The site of chorionic villi has an insignificant correlation with fetal gender difference.
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A clinicoepidemiological study of cerebral palsy among children attending Medical Rehabilitation and Rheumatology Center p. 664
Raed Farooq Khaleel, Rana Moayad Abdul-Aziz, Samah Sabar Katea
DOI:10.4103/MJBL.MJBL_205_22  
Background: Cerebral palsy (CP) is an umbrella term used to accurately describe a group of permanent movement and posture disorders that cause activity limitations and are caused by nonprogressive disturbances in the developing fetal or infant’s brain. Objective: This study aimed to evaluate the risk factors, comorbidities, and associated clinical problems with CP. Materials and Methods: A cross-sectional study was conducted among children with CP who attended the Medical Rehabilitation and Rheumatology Center for the first time. A random sample of 76 children aged ≤1 to 5 years who were clinically diagnosed with CP was enrolled in this study. The data were collected between January 2021 and December 2021. Sociodemographics, etiology, risk factors associated with the neonatal period, factors related to obstetric histories, and CP classification were typically gathered from a questionnaire designed for this purpose. Results: The majority of participants were males, 63.2%, compared with females; 47.3% of infants were born at a low birth weight <2500 g. Two-thirds of children, 64.5%, were diagnosed with CP before 1 year. Neonatal jaundice was present in 56.6% of newborns. Hypoxic-ischemic encephalopathy, 47.4%, is the most significant perinatal risk factor for CP. First-degree consanguineous marriage was observed in 35.5% of the studied sample. The mothers of 70, 92.2%, children with CP were multiparous. Most of the patients, 72.4%, had spastic CP, and quadriplegia was primarily reported in 51.3% of them. Conclusions: CP cannot be prevented in most cases, but the risk factors can be reduced. Early diagnosis gives the multidisciplinary team the opportunity for early intervention and rehabilitation.
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Relationship between vitamin D3 level and body mass index in postmenopausal breast cancer patients p. 671
Barrak F Al Obeidy, Alya A Al Zobair, Nazar M T Jawher, Fang Zheng
DOI:10.4103/MJBL.MJBL_207_22  
Background: Many studies have shown a relation between vitamin D3 deficiency and breast cancer, others estimated an inverse correlation between vitamin D3 and obesity. Objectives: This study aimed to verify the relation between vitamin D3 level and obesity in postmenopausal breast cancer patients. Materials and Methods: This is a cross-sectional study included seventy-six postmenopausal patients with breast cancers who were diagnosed in the period from January 2020 to February 2022 who were divided into two groups: patients with body mass index (BMI) ≥ 30 and those patients with BMI <30. Vitamin D3 level was estimated and compared between the two groups. We studied the correlation between vitamin D3 level with the age of the patients and the parity. Results: the mean age of the included patients was 61 ± 7.7 years and the mean BMI was 32.3 ± 4.3g/m2. The mean value of vitamin D3 was 15. 0 ± 5. 4 for the patients with BMI ≥ 30 while it was 18.2 ± 4.3 for those patients with BMI <30 and there was a significant difference between the two groups with P = 0.007. Furthermore, patients’ vitamin D3 levels showed significant inverse correlations with their age (P = 0.008) and BMI (P = 0.001). Conclusion: There is consistent evidence that deficiency of vitamin D3 is associated with obesity in breast cancer postmenopausal patient; also, vitamin D3 level has a negative correlation with the age and parity of the patients.
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The Antibacterial Effect of Green Tea on Enterococcus faecalis, Iraq p. 676
Ehsan Mansoor Kadhim, Bushra Karem Amin, Bassam Karem Amin
DOI:10.4103/MJBL.MJBL_208_22  
Background: For centuries, people have employed plants as a source of therapeutic substances. Herbal remedies are used as analgesics, antibacterial, and anti-inflammatory medicines in dentistry. The present study aimed to show the antimicrobial activity of green tea, against faecalis strains (ATCC 29212) in vitro, with various concentration of different extracted solvents. Materials and Methods: In this study, different solvents were used for the extraction active substances from dried green tea, followed by determining the antimicrobial actions of green tea against faecalis strains (ATCC 29212) in vitro. Green tea’s antibacterial properties were present in every component when tested on Enterococcus faecalis. The least amount of hexane extract, however, significantly reduced the growth of the aforementioned bacteria. Conclusions: According to the findings of this study, green tea extract is a suitable replacement for sodium hypochlorite and other endodontics irrigation solutions. To identify the ideal concentration, more research is necessary.
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Prevalence of dysmenorrhea and its impact on daily activities among women in Babylon city p. 680
Shaimaa Alaa Hassan, Ban Amer Moussa
DOI:10.4103/MJBL.MJBL_87_21  
Background: Dysmenorrhea is an essentially menstruation-connected problem among menstruating women worldwide and it negatively affects the quality of life. It evaluates by means of prevalence determination. These factors are not scientifically evaluated yet. Statistical studies about prevalence of dysmenorrhea, symptoms, and relieving treatments are too scant in Iraq. Objectives: The main objective of this study was to identify the prevalence of dysmenorrhea among menstruating women in Babylon city, Iraq, to estimate the impact of dysmenorrhea on women’s lifestyle, and to examine the coping mechanisms based on the women’s experience to reduce dysmenorrhea’s density. Materials and Methods: A cross-sectional study was carried out to select a random sample of 270 women in Babylon city. The mean age of the participants was 30.02 ± 8.29 years. Several questionnaires were designed to collect the data including sociodemographic characteristics, menstrual characteristics, habits and emotional factors, and relieving factors. Data were analyzed byusing the Statistical Package for the Social Sciences (SPSS) software program, version 26.0 with P < 0.05 being considered statistically significant. All ethical procedures were taken into account. Results: The prevalence of dysmenorrhea was 85.9% (n = 232) after considering that it defines as abdominal pain. The finding shows that dysmenorrhea was significantly associated with duration of menstruation (P = 0.05), dizziness (P = 0.046), nausea and vomiting (P = 0.015), and fatigue (P = 0.008), skipping breakfast (0.012), and mood change (0.006). Regarding the relieving factors, the significance was reported with mostly ignoring the pain (0.001), practicing self-medication (0.022), and using home remedies to reduce the pain (0.001). However, the association with effects on daily life (P = 0.150) was reported to be insignificant. Conclusions: The proportion of dysmenorrhea among Babylonian women is very high and attracts attention. Skipping breakfast, ignoring the pain, never caring for a medical consult, and lacking of regular physical exercise were specified as the most active predictors of dysmenorrhea. Increasing awareness among women regarding dysmenorrhea, associated symptoms, risk factors, and relieving mechanisms were highly recommended.
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Gene expression and plasma level of CuZn and Mn superoxide dismutase in Iraqi women with polycystic ovary syndrome p. 691
Aghras Sabah Nawar, Zeena H O Alwan, Qaiser I Sheikh
DOI:10.4103/MJBL.MJBL_221_22  
Background: Polycystic ovarian syndrome (PCOS) is an endocrinopathy disorder that affects women worldwide and is linked to an etiological factor as well as pathophysiology. Objective: The purpose of this study was to determine the association between superoxide dismutase 1 (SOD1) and superoxide dismutase 2 (SOD2) gene expressions and SOD enzyme activity in PCOS patients. In this study, 75 women were diagnosed with PCOS by Rotterdam criteria, and control healthy women with normal menstrual cycles and no signs of hyperandrogenism were included. Patients were separated into two subgroups according to their administration of metformin drug. Materials and Methods: CuZn SOD and MnSOD enzymes activity was determined based on the ability of the enzyme to inhibit the autoxidation of pyrogallol, and total oxidant status (TOS) was examined in the plasma using Erel method. mRNA level of SOD1 and SOD2 was evaluated in the blood sample via qPCR. Results: SOD enzyme activity was significantly higher in the patients’ group than in the controls (P < 0.0001), along with a significant increase in SOD2 gene expression (P < 0.01). In patients treated with metformin, gene expression of SOD2 was significantly increased (P ≤ 0.05) comparing with patients without treatment, with increased enzyme activity (not significant). However, the SOD1 activity was significantly decreased (P < 0.01) with increased SOD1 expression in patients treated with metformin. In addition, TOS was increased in the patients’ group than in the controls and decreased in patients treated with metformin than in untreated patients with metformin. Conclusion: The results revealed a significant association between PCOS and a higher level of enzyme activity and expression. Treatment with metformin drug was related to a higher level of activity and expression of SOD2, while lowering the expression of SOD1, which suggests that oxidative stress might be involved in the development of this syndrome.
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Assessment of sympathetic activity of adrenal medullae in patients with kidney stone treated by extracorporeal shock wave lithotripsy (ESWL) p. 697
Rusul Abdul Kadhim Mohammed, Samir Sawadi Hammoud, Wadhah A Almarzooq
DOI:10.4103/MJBL.MJBL_227_22  
Background: Extracorporeal shock wave lithotripsy (ESWL) is the most widely used method for treating kidney and upper ureteric stones smaller than 2 cm due to its effectiveness, safety, non-invasive, and an outpatient procedure. Objective: The present study aims to assess the effect of ESWL on the sympathetic activity of adrenal medullae in patients with renal stone. Materials and Methods: A cross-sectional study was conducted at the ESWL Unit, AL-Hilla Teaching Hospital, Babil Province, Iraq on 50 patients from October 1, 2021 to April 30, 2022. Before and right after an ESWL session, patients underwent a history, physical examination and laboratory tests to measure their levels of serum catecholamines (CAs). Results: The results of this study revealed that there is a significant increase of serum epinephrine and norepinephrine levels (P-value <0.001) after ESWL session. There is a significant (P <0.1) increase in epinephrine and norepinephrine levels in patients treated for upper pole renal stones when compared with mid and lower pole renal stones after having an ESWL session. Changing the lithotripter’s parameters (energy, frequency, and number of shock waves) did not significantly (P > 0.05) correlate with the level of both norepinephrine and epinephrine in the serum after the ESWL session. Conclusion: The study found that patients with renal stones treated with ESWL had elevated serum CA levels after the session. The CA level correlates with the site of stone (the stone comes near to the adrenal medullae as there was an increase in the CA level), whereas it was unaffected by the lithotripter’s parameters.
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Assessment of electroencephalographic changes and clinical characteristics among patients with substance-related disorder p. 703
Zainab Walaa Sahib Mubarek, Farah Nabil Abbas, Azher Nema Mohammed Al-Agam
DOI:10.4103/MJBL.MJBL_228_22  
Background: Substance abuse is defined as the hazardous use of psychoactive substances such as alcohol and illegal narcotics. It is a significant global public health concern. Chronic relapsing diseases, defined by compulsive use of drugs despite negative health effects, were substantial contributors to the illness burden in the USA and all over the world. Objective: The objectives were as follows: (a) to determine the presence of electroencephalographic (EEG) changes and their types among patients with substance-related disorders and (b) to evaluate the sociodemographic and clinical characteristics of patients with substance-related disorder. Materials and Methods: It was a cross-sectional study conducted from September 1, 2021 to August 1, 2022. It was performed on 112 patients (104 males and 8 females) in the Neurophysiology Department of Al Imam Al Sadiq Teaching Hospital in Al-Hilla Governorate. The patients were diagnosed by psychiatrists, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. All patients were assessed by history, physical examination, and EEG test. Results: The study showed that the frequency of EEG changes was 57.1%, whereas those without any changes was 42.9%. Those with score 2 or moderate severity were 53.6%. Severe abnormalities were found in 3.5% of the patients. There was a significant association between the EEG change and the type of substance taken, with a P-value of 0.008. The study showed the association between the EEG change and duration of substance taken, with a P-value of 0.0001, which was significant. There was a significant association between the type of substance taken and age (P = 0.002). The association between the type of substance taken and gender, residence, and occupation was non-significant. Conclusion: The study concluded that the EEG changes were of high prevalence in patients with substance-related disorder. The most common abnormality was score 2 (moderate severity). The most common substance with an abnormal EEG change was amphetamine.
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Accuracy of C-reactive protein and procalcitonin in differentiating between complicated and non-complicated acute appendicitis patients in Babylon province p. 709
Raad Gazy Al Sehlany, Moaed E Al-Gazally, Mohend A N Alshalah
DOI:10.4103/MJBL.MJBL_230_22  
Background: Clinical care may be influenced by the ability to predict whether a patient has complicated appendicitis at the time of presentation. However, it is unclear whether prehospital or in-hospital factors are associated with complicated appendicitis. We also want to know if C-reactive protein (CRP) and procalcitonin (PCT) can be used as supporting factors for Alvarado Score associated with complex appendicitis. Objectives: The aim of this study is to know the possibility of adding CRP and PCT to support the diagnostic protocol for differentiating between complicated acute appendicitis and noncomplicated acute appendicitis by knowing the sensitivity and specificity of each of them, as well as knowing which is more acceptable to add to the diagnostic protocol. Materials and Methods: A cross-sectional study was carried out in the Emergency Unit at AL-Hilla Teaching Hospital in Babylon province, Hilla city, between October 2021 and January 2022. There were a total of 90 patients; CRP and PCT were measured for patients by enzyme-linked immunosorbent assay method, in addition to knowing their Alvarado score. SPSS software was used to conduct the statistical analysis. Results: At the time of surgery, 34 (40%) of the 90 patients had complicated appendicitis, whereas 54 (60%) without complication. The age and gender of the groups did not show any significant difference. The Alvarado score, CRP, and PCT levels all showed a significant difference (P < 0.05). The correlation between Alvarado score and biochemical parameters (CRP and PCT) show a significant positive correlation. Conclusions: CRP and PCT support Alvarado score to differentiate between complicated acute appendicitis and noncomplicated acute appendicitis, and this is evident from the significantly higher concentrations of both in patients with complicated acute appendicitis than in patients with noncomplicated acute appendicitis.
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The role of asprosin and ceramides in the development of growth hormone deficiency in children p. 714
Muntadher Mohammad Al-Jubawi, Seenaa B Mohammed, Rihab F Al-Abedi
DOI:10.4103/MJBL.MJBL_231_22  
Background: Growth hormone deficiency (GHD) is an endocrine condition, which is defined as a reduction in growth hormone (GH) synthesis; this study aims to evaluate the level of asprosin and ceramides in children (patients) with idiopathic isolated GHD. Materials and Methods: The present study was designed as a case–control study; 43 patients (24 males and 19 females) with idiopathic isolated GHD were involved in this study. Forty-five subjects (26 males and 19 females) who were apparently healthy control that enrolled in this study were matched with patients of the same sex and age. Results: The present study revealed a significant decrease (P < 0.05) in the levels of asprosin, ceramides, and glucose in patients with GHD when compared with its control group. Conclusions: Asprosin may be one of the underlying causes of GHD through its indirect role in releasing GH. GHD may decrease the level of ceramides by the effect of GH on lipid metabolism.
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Separation, purification, and phylogenetic characterization of detergent-compatible protease produced by Penicillium species p. 721
Omar Sadik Shalal
DOI:10.4103/MJBL.MJBL_232_22  
Background: Filamentous fungal forms are said to secrete multiple peptidases with portent detergent capabilities in addition to their usage in food, beverages, and pharmaceutical industries. Objective: The current study isolated and purified fungal isolates from clinical samples and studied their capability as caseinolytic and in removing blood stains from fabrics. Materials and Methods: The present work isolated nine isolates, which are protease-positive and out of them eight belong to Penicillium sp. From the IS2 region, amplification of the isolates concluded their match using Blastn as Penicillium citrinum in majority. Results: The enzyme extract (P18), which was found effective in removing blood stains with good caseinolytic activity, was found to belong to P. citrinum as from Blastn studies. In addition, these proteases extracted were highly compatible with commercially available detergents. P4 was found to remove blood stains from fabrics in less than 30 min (P<0.02) when compared with other extracts (P1 and P4). Conclusion: The ability to secrete protease in promising amounts along with its potential usage as detergent makes these enzymes useful in industries, especially for the laundry industry.
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Study of serum chitinase-3-like-1 protein (CHI3L1) and C-reactive protein (CRP) in patients suffering from chronic plaque psoriasis p. 729
Ahmed Hassan Al-Saba, Khawla Abdulhamza Shemran, Mohammed K Al-Hattab
DOI:10.4103/MJBL.MJBL_236_22  
Background: Psoriasis is a chronic inflammatory disease marked by the formation of well-defined raised erythematous plaques on the skin surface with silvery white scales. Chitinase-3-like-1 protein (CHI3L1) is thought to be important in physiological and pathological processes including angiogenesis, mitogenesis, and remodeling. C-reactive protein (CRP) has been suggested as an inflammatory biomarker in psoriasis and other disorders. Objectives: The aim of the current study is to determine the serum levels of CHI3L1 and CRP in psoriasis patients and to compare with healthy controls. In addition, the present study aims to investigate which is more sensitive and specific for diagnosing psoriasis. Materials and Methods: This is a case–control study. Sixty patients were involved in this study, divided into two groups (severe group that contains 30 patients and moderate group that contains 30 patients). Thirty individuals apparently healthy as control subjects were involved in the current study and all of them without any skin disease or other autoimmune diseases. Results: The current study revealed a significant increase in the serum CHI3L1 and CRP among psoriatic patients when compared with healthy controls. Conclusion: CHI3L1 and CRP increase with increased severity of psoriasis disease. CHI3L1 was a more sensitive and specific biomarker than CRP, according to the area under the curve in the receiver-operating characteristic curve test. Therefore, it is a good marker for the diagnosis of psoriasis patients.
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Effect of SARS-CoV-2 infection on HBV-infected patients: Reactivation p. 736
Laith A I K Al-Kaif, Mohammad Abd-Kadhum Al-Saadi, Alaa H Al-Charrakh
DOI:10.4103/MJBL.MJBL_248_22  
Background: Hepatic manifestations of COVID-19 are prevalent in individuals infected with viral hepatitis type B (HBV). Objectives: The current study aims to determine the extent of the HBV reactivation depending on the immune impact on patients infected with SARS-CoV-2. Materials and Methods: One hundred forty-one hospitalized cases were divided into patients infected with HBV with/without SARS-CoV-2 diagnosed by automatic fluorescent immunoassay system COVID-19 Ab (IgM/IgG). Next, HBV reactivation was assessed using hepatitis B surface antigen (HBsAg), HBcAb (IgM), HBeAg, and HBeAb ELISA test. Results: The results showed significant differences in HBV reactivation patients with SARS-CoV-2 at P < 0.05. Out of 141 HBV patients, 115 (1, 80, and 34) had positive COVID-19 in IgM, IgG, and IgM with IgG, respectively. The results of reactivation test showed 34.07% of patients have HBV reactivation. Conclusions: The HBV reactivation patients had been recorded in acute and chronic cases of HBV patients, where no severe cases were recorded compared with the advanced cases of the disease who received immunosuppressive therapy and biological treatment. Therefore, it is necessary to consider the special care of persons exposed to infection with SARS-CoV-2 to patients infected with viral hepatitis, in particular, advanced cases of the disease and their stages of treatment as it leads to liver dysfunction and life-threatening complications.
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Bridging the gap in the delivery of cancer care in low- and middle-income nations p. 747
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/MJBL.MJBL_73_22  
Cancer continues to be one of the global causes of concern, as each year the number of reported cases continues to rise. The available global trends of cancer are a clear indicator of the fact that people are deprived of cancer care and it is predominantly because of the inequality and inequity, which has become an undeniable aspect. Acknowledging the impact of cancer on the individual, family, and the community in terms of impairment in the quality of life and financial load, it is the responsibility of the policy makers to improve the delivery of cancer care. This calls for the need that international welfare agencies and funding partners should join their hands together with an aim to strengthen the prevention, care, and research and development domain of cancer care, especially in low-resource settings. To conclude, despite being a global cause of concern, the care offered to cancer care patients has not been uniform worldwide and a wide range of disparities have been observed. There arises the need to take concerted actions to ensure the delivery of comprehensive care to cancer patients with an intention to minimize their suffering and improve their prognosis.
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2022 monkeypox outbreak in non-endemic nations: Necessity to strengthen surveillance and prevention activities p. 750
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/MJBL.MJBL_84_22  
Monkeypox is a zoonotic viral infectious disease that has been predominantly reported in the central and west Africa. A recent outbreak of monkeypox has been reported in the month of May 2022 and since then the outbreak has been reported in 28 nations. As the infection has been reported in non-endemic nations, there is an indispensable need to strengthen the surveillance, preparedness, and outbreak response-related actions to monitor the spread of the infection. To conclude, the 2022 outbreak of monkeypox in non-endemic nations is an eye-opener for public health authorities to be vigilant, and strengthen prevention and control activities.
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