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   Table of Contents - Current issue
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July-September 2021
Volume 18 | Issue 3
Page Nos. 151-276

Online since Wednesday, September 29, 2021

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REVIEW ARTICLES  

Causes and treatment of complete denture staining: A review Highly accessed article p. 151
Zainab Mahmood Al-Jammali, Hanan Ali Al Murshidy, Anas Moez Al-Yasiry
DOI:10.4103/MJBL.MJBL_53_20  
Complete dentures are constructed for elderly patients commonly and are specific for patients who are young but have deformed teeth congenitally. Loss of teeth may occur due to trauma, dental diseases, or pathology. The denture hygiene can be improved by polishing of denture’s tissue surface, but this polishing should not affect the prosthesis retentions. If the dentures are not washed regularly, they will have a tendency to accumulate plaque and stains. In this review article, we explan about causes of staining of complete denture and some of methods that are used to clean the denture. The purpose of this article was to review various methods and the materials used for cleaning dentures for geriatric denture wearers.
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Review on therapeutic trials for coronavirus disease-19 Highly accessed article p. 155
Ayam M Salih, Khalida K Abbas Al-Kelaby, Jawad R Al-Zaidi
DOI:10.4103/MJBL.MJBL_103_20  
Our world was gripped by the coronavirus disease-19 (COVID-19) pandemic during the first months of the year 2020. It has been characterized as a new coronavirus (i.e., severe acute respiratory syndrome-CoV-2, which is an acute severe respiratory syndrome coronavirus, and later, it has been referred to as the coronavirus disease-19 or COVID-19. Whereas this disease has been originated in Wuhan city in the Chinese province of Hubei, it was capable of rapidly spreading all over the world, which has resulted in a human disaster as well as massive economic damages. By the middle of June 2020, there were more than 8 million COVID-19 cases all over the world, with more than 436,000 death cases. The aim of this review study was to investigate the most effective therapeutic trials for COVID-19.
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Strengthening the component of teaching and assessing attitude in the medical curriculum p. 160
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/MJBL.MJBL_29_21  
In any field, learning among learners happens in all three domains, namely, knowledge, skill, and attitudes. In contrast to knowledge and skill domains, “attitude domain” is difficult to teach and even more difficult to assess. The purpose of the current review was to explore the different ways in which attitude domain can be taught and assessed during the medical education training. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of six studies were selected based on the suitability with the current review objectives and analyzed. As learning should happen in attitude domain as well, it is a must that we should orient the students about the same and accordingly formulate learning objectives and employ appropriate learning and assessment tools. Even though it is a challenging task, nevertheless, training can be given to medical students with regard to the development of positive attitudes. In conclusion, the presence of positive attitude is an indispensable component to improve learning and patient care. However, considering that the training and assessment of attitudes are often undermined, there has to be a conscious attempt from the medical educators to improve the existing scenario and eventually improve the patient outcomes in the long run.
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Gestational diabetes mellitus: A Narrative Review p. 163
Alaa Ibrahim Ali, Wassan Nori
DOI:10.4103/MJBL.MJBL_1_21  
Diabetes mellitus (DM) is a chronic disease that needs medical support and continuing patient education to avoid acute complications and decrease the long-term complications. The prevalence of diabetes is high in many areas, especially Asian. There are many risk factors for developing gestational diabetes, such as advanced gestational age, obesity, family history of DM, and previous delivery of large weight baby. There is higher perinatal morbidity and mortality in untreated cases, but this can be reduced with proper antepartum surveillance and adequate insulin treatment. This article consisted of an acceptable definition, pathogenesis, screening, risk factors, management of diabetes during pregnancy, maternal and fetal complication, and prevention.
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The positive role of antioxidants on body immunity: An overview p. 169
Rawaa Hadi Shareef, Zahraa Fathi Sharba, Evan Noori Hameed
DOI:10.4103/MJBL.MJBL_18_21  
The immune system is a complicated system; it is consisted from network of specialized organs, tissues, cells, proteins, and chemicals which it has the function to protect the host from various types of pathogens such as bacteria, virus, fungi, and parasite in addition to cancer cells. Antioxidants are defined as agents that can prevent the damage that is caused by free radicals through scavenging of them. They decrease the damage by neutralizing to the free radicals before they attack any of the cells and can prevent lipids, enzymes, proteins, carbohydrates, and DNA damage.
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Strategies for challenging development in antimicrobial resistance p. 172
Rasha A F Jasim
DOI:10.4103/MJBL.MJBL_35_21  
Antimicrobial resistance is a growing problem and a threat to public health. It occurs due to germs developing the ability to drub the antimicrobial agents designed to kill them. The danger comes from the quickly spreading of antimicrobial resistance around the world; therefore, it is recognized as a global public health issue by many international health organizations. Consequently, the reduction of this issue requires major and alternative solutions at the same time. Major solutions involve the ideal use of antimicrobial agents, conduction of antimicrobial and drugs surveillance programs, increased awareness for all categories of society, cleanliness and disinfection, restriction of the use of antibiotics in veterinary medicine and agriculture, and investigation or development of new antimicrobial agents. Whereas, an alternative solution occurs via developing new approaches, and return to the use of ancient drug. Hence, this review comes as an effort to make aware all the categories of society about the possible solutions of this problem.
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ORIGINAL ARTICLES Top

Eustachian tube dysfunctions due to mask among quarantined healthcare professionals during COVID-19 pandemic: A cross-sectional study from Nuh, Haryana (India) p. 178
Abhishek Singh, Harsh Nandini, Rohit Kumar Phulsunga, Vikas Gupta, Sulabha M Naik, Pawan Kumar Goel
DOI:10.4103/MJBL.MJBL_63_20  
Background: Hand hygiene and personal protective equipment (PPE) are the key factors to prevent COVID-19 disease among healthcare workers. The documented side effects of continuous use of mask or PPE are dermatitis, but its effects on eustachian tube seems to be neglected. Objectives: So, we conducted this study by keeping our main objective as to investigate the eustachian tube dysfunctions (ETDs) due to continuous use of mask among healthcare professionals (HCPs) in district Nuh, Haryana. Materials and Methods: This cross-sectional study was conducted among 217 eligible HCPs. The sample size was calculated as 97 considering unknown prevalence of ETDs among HCPs (50%), so all HCPs were included in the study. We developed a structured questionnaire in which responses were close-ended and it attempted to capture the responses of the study participants and an association between variables was considered significant if the P-value was <0.05. Results: Out of the 217 subjects, only 207 subjects provided their written consent after understanding the study objectives and 206 were included in the analysis as one subject has pre-existing ear disease. The daily hours of mask usage among 52.4% of participants was between 4 and 8 h; 2.6% of doctors experienced severe pain and pressure in the ear. The Eustachian Tube Dysfunction Patient Questionnaire-7 (ETDQ-7) score was significantly higher among females and mask usage of four or more hours (P < 0.05). Conclusion: The present study revealed that 42.3% of the participants had ETDs. The results will facilitate hospital-level administration to provide practical recommendations to medical workers such as head-supported mask instead of ear-supported masks and use of ear protectors.
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Smell and taste disturbances among COVID-19 patients: Our experiences p. 186
Santosh Kumar Swain, Smarita Lenka
DOI:10.4103/MJBL.MJBL_64_20  
Background: Coronavirus disease 2019 (COVID-19) infection is caused by a novel coronal virus called severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The common symptoms of the COVID-19 patients include cough, fever, dyspnea, and myalgia. However, the disturbances of the smell and taste are the important clinical presentations of the COVID-19 patients. Objectives: The objective of this study is to assess the olfactory dysfunction among COVID-19 patients. Materials and Methods: This is a retrospective study, which included COVID-19 patients between March 2020 and August 2020. There were 192 COVID-19 patients evaluated to find out loss of smell and taste. The diagnosis was done from nasopharyngeal swab with laboratory confirmed reverse transcription polymerase chain reaction positive for COVID-19. All the participating patients were undergoing proper otorhinolaryngological examinations, including anterior rhinoscopy, cold spatula tests, and diagnostic nasal endoscopy for proper evaluation of the nose, nasopharynx, and paranasal sinuses. Results: There were 112 patients (58.33%) olfactory dysfunction and 86 patients had taste disturbances out of the 192 COVID-19 patients. The mean age of the 112 patients was 52.42 years. Out of the 112 patients, 74 (66.07%) were male and 38 (33.92%) were female. Out of the 112 patients, 32 were presented with pneumonia during their hospitalization. Olfactory dysfunction began 5.4 (4–12) days. The mean duration of the anosmia was 9.2 (4–22) days and 96% of the cases recovered within 26 days. Conclusion: Smell and taste disturbances are the important clinical markers for SARS-CoV-2 infection. Testing the smell and taste in this COVID-19 pandemic may be helpful for the early identification of the COVID-19 patients and initiate early treatment or quarantine.
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Significance of cystatin C for early diagnosis of contrast-induced nephropathy in Iraqi patients undergoing coronary angiography p. 191
Zahraa Malik Abood, Manal Kamal Rasheed, Haider Hamza Omran
DOI:10.4103/MJBL.MJBL_88_20  
Background: Contrast-induced nephropathy (CIN) has been traditionally defined as an increase in serum creatinine (sCr) after contrast media (CM) exposure. It is generally a transient and reversible form of acute renal failure. Objectives: The objective was to compare changes in serum creatinine and serum cystatin C (sCys C) in patients undergoing CM administration during coronary angiography (CAG) and/or intervention, and whether these changes are a reliable index for early identification of CIN. Materials and Methods: In this prospective study, 50 patients were included, 9 of them were omitted, and remaining 41 patients undergoing CAG and/or intervention. sCr, serum urea, sCys C, and estimated glomerular filtration rate (eGFR) were evaluated at baseline as well as 24 h after exposure to CM. Results: Forty one patients, six of them develop CIN (CIN group) and the remainder 35 not develop CIN (non-CIN group). Clinical parameters showed no significant association between CIN group and non-CIN group except in diabetes mellitus. As comparing patients before and after catheterization, the CIN group showed increase in sCr and serum urea, while remain nearly the same for sCys C, and obvious decrease for eGFR1 and eGFR2, in addition there is significant association for sCr, eGFR1, and eGFR2. In the non-CIN group, only the serum urea showed significant difference. Conclusion: The concentration change of sCr is significantly superior to cystatin C as an early biomarker in the CIN detection. An absolute increase of the concentration of sCr is highly sensitive and specific for the CIN in comparing to cystatin C.
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Bacteriological profile and antibiotics used for septic patients in Karbala, Iraq p. 195
Rana Majeed Hameed, Jabbar F M Alafloogee, Ghalib K Ma’an
DOI:10.4103/MJBL.MJBL_93_20  
Background: Sepsis is an issue of globular health care, characterized by complete inflammation of the body in response to microbial infection, which results in organ malfunction. This becomes a chronic patient complication. Therefore, sepsis may be a diverse and combined disease with varying etiology, severity, and treatment plan. Objectives: The purpose of this study was to demonstrate the existence of exposure and the resistance of microorganisms to the range of antibiotics in subjects of the local community. Results: Among 11 species of bacteria isolated from a variety of specimens, Escherichia coli (22.1%) and Staphylococcus aureus (20.3%) were the most common organism found over the subjects had been collected. The most sensitive antibiotics for Gram-negative E. coli were colistin 97%, imipenem 89%, meropenem 88%, and amikacin 79%, while the highest resistant rate was benzylpenicillin 93%, and oxacillin 86%. Methicillin-resistant S. aureus (MRSA) prevalence was 90%, vancomycin-resistant S. aureus (VRSA) 31%. Conclusion: Because of the high incidence of VRSA and MRSA, clinicians should become more vigilant in using vancomycin and another important antibiotic. Moreover, maintain this useful drug to be used for a prolonged time with good efficacy.
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Analysis of injury impact among Peshmerga forces during ISIS war in Duhok, Kurdistan Region, Iraq p. 200
Othman Sami Yousif, Haval Faris Mohammed, Dilshad D Alsheikh
DOI:10.4103/MJBL.MJBL_96_20  
Background: War with ISIS (Daesh) is plaguing the Middle East region since 2014. It had a major regional and global impact on the lives of many. Peshmerga forces are the most active and effective ground force against ISIS. The major western forces and the international communities including the United Nations back up these forces. Although the war started 4 years, till now, little is known about the injuries these forces suffer from the explosive materials on the battlefield, and even less is known about the first aid and paramedic activities on the frontlines. Material and Methods: Reports estimate that 8,610 peshmerga were injured and 1,466 have died since the war with ISIS started. In this study, we randomly sampled the Medical records of 100 peshmerga injuries during the 3 years ISIS war(2014 o 2017) from Duhok Emergency Hospital. Objectives: This study aims to provide the descriptive analyses for the injuries suffered by Peshmerga forces in Duhok region, near Mosul, ISIS’s largest captured city in Iraq where the heart of the Battlefield was located. Results: This study also provides the information about the management lines and the outcome of these injuries. The main focus of this study is on blast and explosion injuries. It sheds the light on the line of the medical management on the battlefield and also highlights the availability of medical staff/equipment both at the frontlines and also at Duhok Emergency hospital which took care of the injured Peshmerga forces near Mosul. Conclusion: This study assessed the medical services and the outcome performance of wounded Peshmerga from blast injuries during the ISIS war.
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Serum ghrelin level in type 2 diabetes mellitus postmenopausal women in relation to body mass index p. 204
Amal Abdulhussein Matrood, Hedef Dhafir AL-Yassin, Kifah Hamdan Alani
DOI:10.4103/MJBL.MJBL_4_21  
Background: People living with type 2 diabetes mellitus (DM) are more vulnerable to various forms of both short- and long-term complications, which often lead to their premature death. Objectives: The aim of this study was to evaluate the effects of serum level of ghrelin in diabetic postmenopausal, nondiabetic obese menopausal, and control healthy women. Materials and Methods: This case–control study included 90 participants (30 diabetic postmenopausal women, 30 nondiabetic obese menopausal women with body mass index (BMI) equal or >30, and 30 control healthy participants). Full history for referred individuals was taken and height and body weight were measured. BMI <18.5 was considered underweight, between 18.5 and 24.9 was a normal, between 25 and 29.9 was overweight, and more than 30 was obese. Results: Age ranged between 45 and 80 years old. Serum ghrelin had highly significant difference in obese comparison to both diabetes and control groups, and there is a significant difference between obese and diabetes with higher concentration in obese than diabetic group. Mean fasting blood glucose (FBG) showed a highly significant difference between obese, diabetes, and control groups with higher concentration in both obese and diabetes participants, and specifically, there is a significant difference between diabetes and obese groups with higher concentration in diabetic than obese group. BMI showed a significant difference and higher level in obese in comparison to other two groups. The serum ghrelin had a moderate significant correlation with FBG in obese but insignificant correlation with both diabetes and control groups. FBG shows no significant correlation with BMI in all three groups. Conclusion: There is an inverse relationship between fasting glucose and ghrelin level in type 2 diabetic patients and positive correlation in obesity. The study also shows that hyperglycemia due to disturbance in glucose metabolism may result in suppression of ghrelin level in type 2 DM.
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Outcomes of cerebral venous thrombosis in Al-Yarmook teaching hospital p. 208
Adil Khudhair Mizeel, Nameer Mohammed Taher
DOI:10.4103/MJBL.MJBL_12_21  
Background: Cerebral venous thrombosis (CVT) is a disease with multiple causes and has a low incidence rate. Seizure is one of the most common complications of CVT. The rate at which seizure occurs following CVT and the risk factors associated with that occurrence is a debated issue. Objectives: The aim of this study was to evaluate the incidence of seizure and its associated and risk factors for patients with CVT. Subjects and Methods: This was an observational study that included a total of 30 adult patients with CVT. Data, including age, sex, clinical manifestations such as fever, headache, vomiting, altered consciousness, and focal neurologic signs, such as sensory disturbances, were collected. Imaging findings that included hemorrhagic lesion, infarction, and thrombus site were also reported. Patients were followed up for 6 months from the initial diagnosis to recognize the development of seizures. Results: Within 6 months of follow-up, 13 (43.3%) patients developed generalized seizures, which was the most common type of CVT. The superior sagittal sinus (SSS) occlusion was recognized in 84.62% of patients with seizures and 48.06.5% in patients without seizures. Similarly, the right lateral sinus was occluded in 84.62% of patients with seizures as compared with 41.18% among those without seizures. Contraceptive use was reported in 61.54%of patients with seizures versus 17.65% in those without seizures with a significant difference. Conclusion: The involvement of SSS and lateral right sinus occlusion and use of contraceptives could be warning signs and a risk factor for the development of seizures in patients with CVT.
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Pattern of substance use in the elderly: A hospital based, cross sectional study in a tertiary setting of North India p. 213
Aarti Karahda, Priti Singh, Rajiv Gupta, Shobhit Kumar Prasad
DOI:10.4103/MJBL.MJBL_13_21  
Background: There are many unique features related to substance abuse in the elderly, which is an underestimated problem in society. Objectives: A cross-sectional exploratory study was conducted in a North Indian tertiary care setting to assess the pattern of substance use in the elderly. Materials and Methods: Fifty cases were included in the study via purposive sampling; a Drug Abuse Monitoring System pro forma and a semistructured pro forma designed to gather information on sociodemographic and substance use characteristics were used. Descriptive statistics were applied. Continuous variables were summarized as means and standard deviations and categorical variables as counts and percentages. Results: The mean age of the samples was 64.12 ± 4.54 years. Alcohol use was noted in 66% of the cases, tobacco use in 76%, opioid use in 16%, cannabinoid use in 4%, and sedative/hypnotic use in 4%. Majority of the cases were married, studied up to high school, self-employed, and living in joint family. Majority of the cases had initiation of substance use in young age due to peer pressure, and the reason for change in pattern were in majority mainly family issues and tolerance. Majority of the cases were brought by family members for treatment seeking. Conclusions: The issue of substance abuse in elderly population is underestimated, and studies are scarce in finding the exact prevalence in the society.
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Seroprevalence of hepatitis B and C viruses among diabetes mellitus patients in Duhok province p. 219
Yasen Rashad Abdulkareem, Sabri Khalaf Shaikho
DOI:10.4103/MJBL.MJBL_16_21  
Background and Objective: Patients with diabetes mellitus are at high risk of developing hepatitis B virus (HBV) and hepatitis C virus (HCV) infections owing to frequent hospitalization and blood investigations. The aim of this study was to determine the prevalence of HBV and HCV infections among diabetes mellitus (DM) patients in Duhok. Materials and Methods: In this cross-sectional study, a total of 200 patients with DM type 1 and 2 were included. Patients’ serum samples were obtained to study HBsAg, and anti-HCV assays were done by the enzyme immunoassay method. Patients diagnosed to be positive for HBsAg and anti-HCV were referred to the infectious diseases unit for further evaluation. Results: The mean age of patients was 53.33 ± 11.25 years (mean±SD). More than two-thirds of them (70.0%) were females. The crude prevalence rates of HBV and HCV in patients with T2DM were 1.5% and 1.0%, respectively. The diabetes-specific seroprevalence of infection with HBV and HCV was 1.5% and 1.0%, respectively. The study did not show that baseline and clinical characteristics are related to developing viral hepatitis infection in diabetic patients. Conclusion: The study showed a very low seroprevalence of HBsAg and anti-HCV infection in type 2 diabetic patients with no relationship with clinical information.
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Medical aspect of endoscopic endonasal transsphenoidal hypophysectomy in skull base center of Basra p. 224
Mustafa H Alali, Firas T Obaid, Ahmed M Al Abbasi
DOI:10.4103/MJBL.MJBL_21_21  
Background: Endoscopic endonasal transsphenoidal (EETS) approach is a minimally invasive technique that has gained increased acceptability for the removal of sellar and para-sellar tumors. Objectives: To evaluate the EETH in the skull base center of Basra and compare our EETH procedures with others done in different centers. Patients and Methods: A prospective observational study was carried out in Basra skull base center at Al-Sader Teaching Hospital between August 2017 and July 2019, and it included 50 patients (29 female and 21 male) with a female to male ratio of 1.38:1. We included all patients with a pituitary tumor fit for surgery, and there were no exclusion criteria. The standard technique involved a unilateral, endoscopic, and endonasal approach to the sella turcica via an anterior sphenoidotomy, with enlargement of the natural sphenoid ostium using powered instrumentation and 0° and 30° rigid endoscopes for visualization. This was performed as a joint procedure by a consultant otolaryngologist and a consultant neurosurgeon. Results: The most common presenting symptom for pituitary tumor was headache, which is present in 80% (40 patients) of patients, followed by visual disturbance in 56% (28 patients). The MRI study of the brain and sellar region shows that 46 patients (90%) were diagnosed as having pituitary adenomas. Eighty-four patients present had a tumor larger than 1cm in size. Sixty eight percent (34 patients) had an abnormal hormonal study before the operation, whereas 32% (16 patients) had a normal hormonal analysis. Histopathological examination of the tumors showed pituitary adenoma in 90% (45 patients), followed by craniopharyngiomas in 6% (three patients) and 2% (one patient) was Rathke’s cyst and 2% (one patient) was pituitary carcinoma. Postoperative follow-up result indicated headache improvement in 82% (34 patients), improvement in menstrual disturbance in 67% (13 patients), and vision improvement in 46% (13 patients). Seventy-four percent showed hormonal normalization after EETH, which is statistically significant (P < 0.05). Conclusion: This study show that endoscopic, endonasal, transsphenoidal hypophysectomy is a minimally invasive, effective, and safe procedure to remove pituitary tumors.
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The prognostic value of serum uric acid in ST-segment elevation myocardial infarction p. 230
Sulaiman Yaseen Mohammed, Mohammed Tahir Rasool
DOI:10.4103/MJBL.MJBL_23_21  
Background and Objective: Acute myocardial infarction is the leading cause of mortality and morbidity across the world. Acute myocardial infarction with ST-segment elevation has been considered a common cardiac emergency and has considerable morbidity and mortality. The role of uric acid (UA) in the mortality rate of ST-segment elevation myocardial infarction (STEMI) was examined in the present study. Materials and Methods: In this prospective study, 107 patients diagnosed with STEMI aged 18 years and older in the coronary care unit at Azadi Teaching Hospital, Duhok, Iraq from April 20, 2017 to December 20, 2017 were followed up for 1 month to determine the 30-day mortality in relation to serum UA level. Results: The mean age of patients was 55.27±13.59 years. The inferior type of STEMI was the most prevalent one among the patients (45.1%). Serum UA was not significantly different in both the groups (P > 0.05). Conclusion: The study did not show UA as a risk factor for mortality in patients with STEMI.
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The frequency of persistent symptoms after acute COVID-19 among Iraqi patients p. 235
Shwan O Amen, Banan Q Rasool, Salah H Yousif, Sara S Shakir, Bnar S Shekho
DOI:10.4103/MJBL.MJBL_25_21  
Background: Post–coronavirus disease 2019 (COVID-19) symptoms tend to persist in many survivors of COVID-19. Objectives: To find out the prevalence of persistent symptoms that continue to appear after the eradication of the COVID-19 infection among Iraqi survivors. We hypothesized that wearing a mask during the COVID-19 pandemic may lead to a lesser viral load in an individual who gets infected, thereby leading to milder symptoms and manifestations. Materials and Methods: Overall, 70 consecutive Iraqi patients diagnosed with COVID-19 during the period from early August to late September 2020 were enrolled in the study, and on a mean of 31 days after recovery, they were assessed for persistent symptoms after the acute COVID-19 infection. Results: The mean age ± SD was 40.5 ± 16.1 years old. On a mean of 31 days post-COVID-19 recovery, 91.4% of all the patients had at least one persistent symptom. The most common persistent symptoms recorded were fatigue (42.9%), dyspnea (32.8%), and chest pain (25.7%). There was a statistically significant difference (P = 0.002) among patients with hypertension, among whom 45.5% had persistent palpitation. Among patients with ischemic heart disease, 25% had constant chest pain, and 37.5% complained of palpitation post-recovery. Patients who had used masks before infection (85.4%) were managed at home, and they did not require hospitalization. Overall, 45.7% of those dyspneic during the infection period were still complaining of exertional dyspnea post-recovery (P = 0.041). Conclusion: A large proportion of the Iraqi patients with COVID-19 infection had persistent symptoms after recovery. The use of a mask before infection showed mild symptoms during the acute phase, and hospitalization or oxygen therapy was not indicated for them.
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Raised inflammatory markers as predictors of response to anti-tumor necrosis factor drugs (etanercept and infliximab) in a sample of Iraqi patients with ankylosing spondylitis p. 241
Saif Abdulkareem Raoof Al-Shaibani, Nizar Abdullatif Jassim, Anmar Abdulwahhab Khaleel Al-Bayati
DOI:10.4103/MJBL.MJBL_27_21  
Background: Ankylosing spondylitis (AS) is a chronic systemic inflammatory disorder mainly affecting the axial skeleton, although peripheral joints, entheses, and extra-articular tissues such as eyes, heart, and lungs may also be involved. Raised inflammatory markers in patients with AS at the start of anti-tumor necrosis factor (anti-TNF) therapy are associated with more clinical response. Objectives: The aim of this article is to assess the role of raised inflammatory markers in predicting response to anti-TNF drugs in patients with AS. Materials and Methods: The prospective cohort study enrolled a total of 71 patients with AS. Nineteen patients were excluded from the study due to discontinuation of anti-TNF therapy and 52 patients continued in the study and were followed for 3 months. Results: The mean age of the patients was 35.2±9.6 years, males constitute 84.6% of them and the median disease duration was 5 (3–10) years. Univariate analysis showed that the predictors of response to anti-TNF drugs were raised baseline C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Bath Ankylosing Spondylitis Disease Activity Index, and Bath Ankylosing Spondylitis Functional Index. Multivariate analysis showed that the only independent predictor for response to anti-TNF drugs was raised baseline CRP. The optimal cut point for CRP to predict response was >7.5 mg/L, whereas that for ESR was >32 mm/h. Conclusion: Raised inflammatory markers at baseline predict better response to anti-TNF drugs in AS patients. CRP had better prediction of response to anti-TNF drugs than ESR.
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Association between hepatitis C virus infections and Toll-Like Receptor 3 Gene polymorphism, Erbil city p. 245
Abdulrazzaq Bahaulddin Mohammed, Blnd Ibrahim Mohammed, Tariq Hammed Amin
DOI:10.4103/MJBL.MJBL_28_21  
Introduction: Globally, hepatitis C virus (HCV) has infected about 180 million people by 2019. The World Health Organization (WHO) reports that 71 million people worldwide are infected with chronic HCV. HCV is considered as a main public health problem globally, and recently it has been observed that the prevalence of this virus is declining but still populations with asymptomatic chronic HCV exists. The main objective of the present study was to determine the effects of TLR3 gene single nucleotide polymorphism (SNP) on the susceptibility of HCV infections in Erbil city of Iraq. Materials and Methods: For this purpose, samples were collected from many private hospitals, which included 50 samples from patients with HCV and 10 samples as controls from healthy people. The sample followed molecular techniques for determining toll-like receptor 3 (TLR3) SNP. Finally, the results were analyzed using Chromas-Pro software. Results: The results of the present study showed that both age and gender have a crucial role in HCV infection. About 66% of the HCV patients were males and 64% of patients were above 40 years. Conclusion: The results concluded that there was a significant relation between TLR 3 SNP (rs78726532 polymorphism) and the risk of HCV infection in population of Erbil city.
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Spectrophotometric determination of salbutamol by oxidative coupling reaction with 1-Naphthylamine-4-sulfonic acid in the presence of potassium per sulfate p. 249
Kameran S Hussein, Abdul Majeed K Ahmed, Fatimah Y Mohammed
DOI:10.4103/MJBL.MJBL_30_21  
Background: Oxidative coupling reactions are among the most important reactions that have wide applications in chemistry, and the oxidative coupling process involves the interaction of two or more organic substances in the presence of an oxidizing agent, where an oxidation process occurs for these substances forming intermediate compounds that interact with each other to form a colored product that can be determined by either spectrophotometric, polarographic, or various chromatographic methods and these reactions were used to quantify many different organic and inorganic compounds. In this article, the spectrophotometric determination of salbutamol was done by an oxidative coupling reaction with the reagent 1-Naphthylamine-4-sulfonic acid in the presence of potassium per sulfate. Objective: In this study, we developed a simple, rapid, sensitive, selective, and accurate UV-visible spectrophotometric method for analyzing salbutamol in pure drugs and pharmaceutical formulations. Materials and Methods: Based on oxidative reaction with 1-Naphthylamine-4-sulfonic acid at pH 11.24, form a yellow-orange colored product in alkaline medium has a maximum absorbance at 470 nm. The Beer’s law is followed in the concentration range 5–23 μg/mL. Results: The product was stable for 60 min, molar absorptivity was found to be 0.8054 × 104 L·mol−1·cm−1, and sandal index was 0.0296 μg·cm−2 with a relative error (RE) of 0 to −0.79, and a relative standard deviation (RSD) of 0.54%–1.84%. Detection limit (DL) was 0.227 μg/mL, quantitative limit (QL) was 0.756μg/mL, correlation coefficient was 0.9998, and recovery was 99.51%, respectively. Conclusion: The method was found to be accurate and precise, as indicated by recovery studies which is up to 100% and relative standard deviation is not more than 2 that is good result. The proposed method has been successfully applied in the determination of preparations containing salbutamol.
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Ceruloplasmin activity and ferritin in patients with chronic liver disease p. 257
Mohammed Hussein Habeeb, Mufeed Jalil Ewadh, Mazen Jaafer Mousa
DOI:10.4103/MJBL.MJBL_32_21  
Background: Ceruloplasmin (CP) is a copper-containing glycoprotein found in the globulin portion of human blood serum 2. CP, a glycoprotein secreted by hepatocytes, carries more than 90% of copper in the bloodstream of healthy people. CP is an effective antioxidant that prevents lipid peroxidation by removing oxygen. CP inhibits lipid peroxidation initiation. CP has function also known as an extracellular superoxide dismutase species (SOD) that neutralizes radicals of superoxide anions. Aims: The aim of this study is to understand the status of CP in chronic liver disease (CLD) patients, which could yield important information regarding the overall oxidative stress and iron storage. Out of the total 86 samples, 50 samples were patients who have been diagnosed with CLD, especially chronic hepatitis B virus (HBV) and hepatitis C virus (HCV), collected from the Center of Internal Medicine and Cardiology in Marjan Teaching Hospital in Hillah city, Babylon Province, Iraq and other samples were healthy controls. Materials and Methods: The CP oxidase activity test was processed by PPD buffer oxidation. Ferritin concentration was tested by enzyme-linked immunosorbent assay. Results: There were no significant differences in levels of ferritin between HBV and HCV patient groups, but there are slight increases in the mean of CP activity in the HCV patients. A positive significant correlation was observed between CP activity and ferritin. Conclusion: 1. CP activity increases in CLD patient and in HCV more than HBV. 2. CP activity is affected by viral load so it increases in positive viral load patients compared with negative viral load patients. 3. There was a positive correlation between CP activity and ferritin. 4. Serum ferritin is not affected by CLD.
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Auditory event-related potential (P300) in patients with schizophrenia p. 261
Zahraa Tariq Hasson, Ali Fuad Al-Hashimi, Uday Khalid Al Qaisy
DOI:10.4103/MJBL.MJBL_34_21  
Background: Schizophrenia is a psychiatric disorder characterized by multiple symptoms such as positive symptoms, negative symptoms, and cognitive symptoms. Cognitive deficit can be detected with specific neurophysiological tests. Among these tests are the measurements of auditory P300 event-related potential which is a neurophysiological method that allows the examination of cognitive functioning of the human brain. Objective: The aim of this article is to assess cognitive deficits in chronic schizophrenia patients by studying the amplitude and latency of P300 potential and to compare findings with those from control subjects. Materials and Methods: The present study was a case–control study extended from January 2020 to May 2020. Forty subjects were enrolled in this study: 20 patients aged 20–50 years comprising 11 males and 9 females diagnosed with schizophrenia and 20 apparently healthy volunteers comprising 11 males and 9 females were analyzed. Results: The results of the current study revealed that a highly significant difference was found in the years of education between patients and controls (P-value <0.001) with no significant difference to be noticed regarding age or gender. When analyzing the P300 component with an unpaired t-test, the patient group showed delayed latency and smaller P300 amplitude than the control group (P<0.001). Conclusion: The present study concludes that P300 indices could be valuable biomarkers to assess changes in cognitive functioning of patients with schizophrenia.
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Students’ perspective regarding current pathology training in theory classes in MBBS course and insights to improve teaching–learning strategies: A study in Central India p. 266
Abhay Vilas Deshmukh, Vandna Yadav, Anupama Gupta, Nitin M Gangane
DOI:10.4103/MJBL.MJBL_36_21  
Background: As the subject pathology in second MBBS represents a transition phase between theoretical knowledge regarding etiopathogenesis of a disease and communication with patients in clinics, the main goal of a medical teacher is to provide a framework for the description of disease course and to understand the clinical signs/symptoms for management aspects as well. Objectives: The aim of this article is to find out students’ perception of importance of pathology subject in MBBS curriculum as well as to assess subject understanding, teaching methodology, and assessment criteria. Settings and Design: This is a cross-sectional descriptive e-platform-based feedback analysis. Materials and Methods: Ninety-eight students of 2nd MBBS (2018 batch) who were about to appear in university examination in the year 2020 were enrolled. The feedback from students was obtained. Results: About 75.8% of students were satisfied with number of lectures for the chapters taught during their tenure. About 91% (n = 81) opined that combination of two or more methods is better while teaching for better understanding; 73.6% (n = 67) felt that pathology lectures were interactive enough. About 80.2% (n = 73) opined that adequate diagrams, flow charts, tables, and clinical applications were included in the lectures, and 79.1% (n = 72) of the students opined that they could implement the knowledge gained in first year whereas 82.5% was same regarding implementation in clinical posting. About 71.34% (n = 65) suggested that weightage of internal examination marks should be increased and 50% passing cut off in university examination should be reduced. Conclusion: The study has emphasized the importance of pathology as a subject for understanding clinical subjects and underlines the need of a few changes in teaching-learning process and assessment criteria as per student’s perception. As NMC has implemented its competency-based curriculum from 2019 batch onwards, it requires a fundamental change of the roles and commitments of not only educators but also planners and policymakers.
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CASE REPORT Top

Angiokeratoma of the tongue: A case report and review literature p. 272
Ahmed Al Abbasi, Firas Tawfeeq, Mustafa Haseeb Alali, Safaa Sahib Naji Sultan
DOI:10.4103/MJBL.MJBL_19_21  
Angiokeratomas are vascular abnormalities that usually appear as multiple or solitary cutaneous plaques. Several clinical variants have been designated, with the same principal histopathological lesion. Mucosal affections, including the oral cavity, are infrequently found either as a component of the systemic variety, called angiokeratoma corporis diffusum, or are associated with cutaneous lesions in more locations. Isolated oral involvement seems to be rather infrequent. Here, we report a case of this rare entity affecting a 6-year-old boy in the dorsum of the tongue.
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LETTER TO EDITOR Top

Hypertension in Iraq Highly accessed article p. 275
Shwan Othman Amen, Banan Qasim Rasool, Hewa Mustafa Muhammad
DOI:10.4103/MJBL.MJBL_24_21  
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ERRATUM Top

Erratum p. 276

DOI:10.4103/1812-156X.327060  
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