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   Table of Contents - Current issue
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January 2019
Volume 18 | Issue 1
Page Nos. 1-58

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ORIGINAL ARTICLES  

Trend of cholera in Iraq in the time of unrest p. 1
Ashraf M. A Hussain, Riyadh K Lafta
DOI:10.4103/MJ.MJ_40_18  
Background: Countries that are facing war disasters are prone to develop outbreak emergencies especially when this is associated with massive displacement of populations or refugees to overcrowded settings, and when the provision of safe water supply and sanitation is a challenge. Objective: To portray the trend of cholera in Iraq for the last 18 years. Methods: Records of cholera cases registered for the last 18 years were reviewed from the Department of Health Statistics of the Iraqi Ministry of Health and categorized according to the 18 Iraqi governorates; the total of each governorate was computed for the whole studied years and then summed to get the total for Iraq. Data were categorized by gender and age. Rates of occurrence were plotted against time (for the period from 2000 to 2017) to define the trend of the disease. Results: The trend of cholera in Iraq showed four peaks, in 2003, 2007, 2012, and 2015, females showed slightly more cases than males, with a higher incidence among adult age group, and more in the southern provinces. Conclusion: The epidemics of cholera in Iraq are getting progressively more frequent, with higher number of cases forming a real burden on the health system and a serious threat to the community. Efficient preventive health plans are needed to overcome this growing problem that may compromise the life of people.
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Trends of under-five mortality in Nineveh (2004–2013): A time series analysis p. 5
Najlaa Ibrahim Mahmood Al-Sammak, Humam Ghanim Ibrahim
DOI:10.4103/MJ.MJ_33_18  
Context: Under-five mortality rate (U5MR) is the number of deaths since birth up to 5 years of age in a specific year divided by the number of live birth (LB) of the same year × 1000. It is a key indicator of child well-being including health and nutrition status, coverage of child survival interventions, and more broadly of social and economic development. Aim: The aim is to study U5MR and their cause trends in Nineveh Governorate for 10 years (2004–2013). Methodology: Design of the Study: This was a biometric (descriptive) study design. Sample of the Study: Under-five deaths plus LBs for the years 2004–2013 were taken. Research Settings: This study was carried out in Nineveh Governorate/Northwest of Iraq. Data Sources: The data were taken from vital registration system and death certificates. Outcome Measures: Various rates and proportions in addition to Chi-squared test for trend. Results: <5 MR varied from 17.83 in 2004 to 20.28/1000 LB in 2013 being worst in 2007 (26.28/1000LB) most of these deaths were among males. The main causes were respiratory distress syndrome, sepsis, congenital anomalies, infections, pneumonia, and accidents. Conclusions: About 20 children died every year for each of 1000 LBs before reaching their 5th birthday.
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Evaluation of the gastrointestinal clinical, endoscopic, and histological findings in patients with bile reflux diseases: A cross-sectional study p. 10
Sabeha Al-Bayati, Ahmed Sahir Alnajjar
DOI:10.4103/MJ.MJ_5_19  
Background: Bile reflux occurs when the bile flows upward from the duodenum to the stomach and esophagus. It occurs when the pyloric sphincter is damaged or fails to work correctly; bile can enter the stomach and then be transported into the esophagus as in gastric reflux. Objective: This study aims to evaluate clinical findings and the endoscopic and histological changes caused by bile reflux disease on gastric mucosa. Patients and Methods: This is a cross-sectional study carried out at Gastrointestinal Endoscopy Unit in Al-Yarmouk Teaching Hospital in Baghdad during the period from January 2016 to October 2016, upper endoscopy done to 50 patients in the Gastrointestinal Tract Center of Al-Yarmouk Teaching Hospital, in whom there is endoscopic evidence of bile reflux disease and biopsies from gastric mucosa were taken and send for histopathology and Helicobacter pylori examination. Results: Bile reflux was noted in 19 males (38%) and 31 females (62%). Bile reflux disease was more in age below 50 years (29 patients), more in the female, while after the age of 65 years, the male/female ratio was 1.5/1. The most common symptoms were epigastric pain. The most common endoscopic findings were gastric erythema. The major risk factors were cholecystectomy (8%). Pylori were present in about 24% of the patients. Conclusion: Bile reflux disease was more common in young female and cholecystectomy was common risk factor.
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Thyroid dysfunction in patients with uncontrolled type 2 diabetes mellitus p. 16
Haidar Fadhil Al-Rubaye
DOI:10.4103/MJ.MJ_4_18  
Background: Diabetes mellitus, particularly type 2, and thyroid dysfunction are the most common endocrine disorders. In addition, thyroid dysfunction is associated with poor glycemic control, and there is increased incidence of thyroid dysfunction in type 2 diabetics. Objectives: This study had been designed to find the frequency of thyroid dysfunction in patients with uncontrolled type 2 diabetes mellitus, the frequency of different types of thyroid dysfunction in this group of patients, the effect of having thyroid dysfunction on the glycemic control, and the glycemic control in patients with well-treated thyroid dysfunction. Patients and Methods: This study is a cross-sectional study which included 500 patients with type 2 diabetes mellitus who had been randomly selected from the patients attending the National Center for Diabetes/Al-Mustansiriya University and the outpatient clinic of Al-Yarmouk Teaching Hospital during the period between August 1, 2016, and July 31, 2017. All of the patients underwent a full history and physical examination, in addition, all of them were sent for random plasma glucose, glycated hemoglobin, and “thyroid-stimulating hormone.” Results: This study showed that 364 patients (72.8% of the sample) had poor glycemic control. Thyroid dysfunction was diagnosed in 67 patients (18.4% of those with poor glycemic control), 43.28% of them were known to have thyroid dysfunction, and the rest of them were discovered to have thyroid dysfunction during the study. Hypothyroidism, including both subclinical and primary types, was diagnosed in 26 patients. Statistical analysis showed that significant association between poor glycemic control and thyroid dysfunction calculated Chi-square was 10.67 and P = 0.001086. Conclusions: This study showed that thyroid disorders are not uncommon in patients with uncontrolled type 2 diabetes mellitus. Hypothyroidism is the most common type of thyroid dysfunction and having thyroid dysfunction whether in the form of hypo or hyperfunction is associated with poor glycemic control and controlling thyroid state result in better glycemic control.
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Determination of carbohydrate antigen 19-9 level in Sera of Iraqi patients with type 2 diabetes mellitus p. 20
Russul Riedh Al-Hamaoy, Hassan H Al-Saeed, Mahmood Shakir Khudhair
DOI:10.4103/MJ.MJ_10_18  
Background: Diabetes mellitus is a major medical problem worldwide that can be qualified as the last stage of chronic pancreatitis; on the other hand, chronic pancreatitis is considered as a risk factor for pancreatic cancer. Therefore, the evaluation of carbohydrate antigen 19-9 (CA 19-9) level in patients with diabetes mellitus makes it imperative to find normal range for CA 19-9 level for this patient to eliminate the additional interventional approaches. Objectives: The objectives of this study were to define the normal range (cutoff value) of CA 19-9 in type 2 diabetic patients using enzyme-linked immunosorbent assays. Materials and Methods: This study included 80 patients diagnosed as type 2 diabetes mellitus (T2DM) with mean age (46.5625 ± 1.1054 years) who were divided into two groups. In Group I, 40 patients with T2DM have a mean duration of (6.6 ± 0.9421 years) and take medication. Group II consisted of 40 patients who were newly diagnosed with type 2 diabetic and do not take medication. Totally, 40 healthy individuals with mean age (44.7 ± 1.4539) were classified as the control group. Results: The mean ± standard error (SE) serum level of CA 19-9 in patients with T2DM in Groups I and II was 30.22933 ± 3.2434 U/ml and 32.58443 ± 2.7997 U/ml, respectively, which was significantly higher than the mean ± SE serum level in control group (6.4328 ± 1.3087 U/ml). When using a serum CA 19-9 concentration of 49.5 U/ml as a cutoff value to differentiate between T2DM and pancreatic cancer, sensitivity was 88.8% and specificity 77.5%. Conclusion: Define the normal range (cutoff value) of CA 19-9 in type 2 diabetic patients is useful in discriminating pancreatic cancer patients from type 2 diabetic patients.
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Assessment of the alteration of blood indices in patients with type 2 diabetic mellitus: A cross-sectional study p. 24
Mohammad Hasan Ali, Abeer J Hassan
DOI:10.4103/MJ.MJ_1_19  
Background: The prevalence of diabetes mellitus has a major impact on national and global health. Diabetes, a noncommunicable disease, was considered one of the top ten causes of death. Diabetic patients with chronic hyperglycemia have increased risk of macrovascular and microvascular complications in the long term. Diabetes is associated with an increased risk for morbidity from anemia which leads to dysfunction and structural change in all formed elements. Objective: This study focused on the alteration of blood parameters in diabetic patients compared with healthy controls. Materials and Methods: This is a comparative study including 230 patients treated at a specialized center for endocrinology and diabetes from December 2017 to January 2018. Of the total 230 diabetic patients enrolled in this study, 46 were male and 184 were female, their age range was 20–70 years, and they were compared with 100 healthy individuals that served as control group. A questionnaire was administered as data collection form. Body mass index was estimated. Fasting blood glucose, HbA1c, and formed element indices were laboratory investigated and analyzed by using autohematology analyzer (Huroba ABX). Data were statistically analyzed using SPSS software version 17. Results: The results of the current study revealed that there were statistically significant differences in blood parameters such as red blood cell (RBC) and white blood cell (WBC) count, mean cell volume (MCV) level, and red cell distribution width (RDW) level (P ≤ 0.05), whereas no significant differences were recorded in RBC (hemoglobin, hematocrit, mean cell hemoglobin [MHC], and MCH concentration) and platelet (platelet count, MPV, and PDW) parameters (P ≥ 0.05) when compared with the control group. Conclusions: The present study concluded that blood parameters such as RBCs, MCV, RDW, and WBCs are significantly higher among diabetic patients.
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Malondialdehyde level in the patients subjected to open heart surgery in association with lipid profile p. 30
Muntaha Abdulmaged Arif, Mutaz Sabah Ahmeid, Salih A Allaw
DOI:10.4103/MJ.MJ_34_18  
Background: Reactive oxygen species are usually produced by the living cell and have different functions in its normal activity and considered as one of the factors that involved in heart disease. Malondialdehyde (MDA) considered as one of the most indictors of oxidative stress and damage produced as a result of lipid peroxidation. Objectives: The main objective is to evaluate serum oxidative stress by measuring the changes in the level of MDA as a marker of oxidative stress and demonstrate the correlation of MDA with lipid profile in patients subjected to open-heart surgery. Methods: A case–control study was carried out in the Department of Chemistry and Biochemistry, College of medicine, Tikrit University, Tikrit, Iraq. The study was carried out for 50 patients subjected to open-heart surgery recruited from the Medical City/Iraqi Center for Heart Disease and Ibn Al-Bitar Cardiac Surgery Center, Department of Cardiac Surgery, Baghdad, Iraq between October 1, 2017 and March 1, 2018. The levels of MDA and lipid profile were measured in the serum of 50 patients, in three different interval preoperative, early postoperative, and late postoperative and compared with 30 age- and gender-matched controls. Results: The results revealed a statistically significant difference in the serum MDA level between patient during preoperative, early postoperative, and late postoperative stage against control group and significant differences in their MDA levels among all patients' stages. Furthermore, there was a significant positive correlation between serum MDA level and total cholesterol in the early postoperative stage. Conclusions: There was an increase in the level of MDA in the early postoperative stage as an indicator of reperfusion damage that occurs immediately after open-heart surgery which then decreases dramatically with decrease in total cholesterol, triglyceride, low-density lipoprotein-cholesterol (LDL-C), and very-LDL-C.
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The significance of (platelet/white blood cell) counts ratio in screening for high risk for preeclampsia and its related complications p. 36
Wisam Akram, Duha Muaeed
DOI:10.4103/MJ.MJ_35_18  
Background: We have taken a standpoint that the scope of the platelet count or its variance is significantly higher in pregnancy; 50,000-6,00, 000 compared to the white blood cells(WBC) 9,000-11,000. Hence, their ratio may be a useful marker in predicting preeclampsia. Aim of the Study: The aim of this study was to verify that placental weight (PW ratio) or platelet/WBC count might be a useful screening ratio for preeclampsia and its related complications. Patients and Methods: We have taken a total of 104 primigravida patients, each one is corresponding to the gestational ages (GA) 20–34 weeks, and seven patients per each week for initial PW ratio assessment. In addition, all women were told to come again at 34 weeks of gestation for reassessment of PW ratio (platelet/WBC) count, and a meticulous ultrasound examination for intrauterine growth restriction (IUGR) as well as biophysical profile. Results: At the end of the study, we subdivided the 104 initial sample into three subgroups; normal women (n = 76); women with preeclampsia but no IUGR (n = 16); and women with preeclampsia and IUGR (n = 12). There was a statistically significant difference between the three groups with regard to systolic, diastolic, and PW ratio. In addition, the PW ratio was significantly different among the three subgroups using the analysis of variance test. Nonlinear polynomial of the third degree between PW ratio and GA has shown a significant correlation between PW ratio and GA. The correlation between them was statistically significant, yet the distribution of PW was normal in distribution P = 0.16. In addition, since all screening test should be subject to Weibull distribution, we challenged the PW ratio against this distribution and was found to be positive P = 0.3 by using the Kolmogorov–Smirnov test. At last, logistic regression was constructed to evaluate the correlation between PW ratio and the number of infants with IUGR, and a highly positive correlation was found P = 0.0001. Moreover, PW was significant with all the items of the biophysical profile which includes body posture, gross body movement, respiratory fetal movement, oligohydramnios, and NST. At last, we have constructed easily used chart and reference tables for PW ratio between 20 and 34 weeks; hence, they can be used in clinical practice to verify this ratio among women with preeclampsia. Conclusion: A simple easily to calculate ratio has been constructed which has been shown in this paper to be significantly correlated to preeclampsia and IUGR, and from this ratio, easy reference table and figure have been constructed. Yet, by no mean, we call that this ratio or table is used as a substitute for clinical methods to screen or to diagnose preeclampsia until its significance is evaluated by further trials. However, it may be of value as an adjuvant test to other standard tests used for preeclampsia screening or monitoring.
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The association of serum copper with ceruloplasmin and zinc with folic acid levels in recurrent pregnancy loss in Iraqi Women p. 43
Olaa Riad Kadim, Shatha M. J. Al-Khateeb, Esraa H Humadi
DOI:10.4103/MJ.MJ_41_18  
Background and Objectives: Recurrent pregnancy loss (RPL) is the most common adverse pregnancy outcome. Micronutrients include minerals and vitamins are essential for normal function, growth, and development. Minerals have important effects on the health of the mother and the fetus. Micronutrient deficiency during pregnancy can lead to obstetric complications and even fetal death. Materials and Methods: A total of 90 pregnant women included in this study were between 7 and 20 weeks of gestation, their age was 18–40 years, and they were divided into three main groups. Patients: Group 1, pregnant women diagnosed with missed miscarriage no = 30; Controls: Group 2, ongoing pregnancy no = 30; and Group 3, nonpregnant women no = 30. Serum copper (Cu) and zinc (Zn) were determined using flame atomic absorption spectrometry. While the serum ceruloplasmin (CP) was measured by immunoturbidimetric assay and folic acid (FA) by enzyme-linked immune sorbent assay. Results: Serum Cu and CP were significantly higher in the women with RPL compared with healthy groups. Moreover, the levels of Zn were significantly lower in in women with RPL compared with healthy control groups, and the result of serum FA was showed that there no significant variation in patients with RPL compared with control groups. Conclusions: The study showed that the alteration in the trace elements could participate with the RPL.
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The efficacy of direct trocar versus veress needle method as a primary access technique in laparoscopic cholecystectomy p. 47
Ali Adil Abdullah, Mustafa Usama Abdulmageed, Firas Majeed Katoof
DOI:10.4103/MJ.MJ_39_18  
Objective: The objective of this study was to compare the safety and efficacy of direct trocar method and veress needle as the primary entry technique to establish pneumoperitoneum. Study Design: This was a randomized controlled study. Patients and Methods: A randomized controlled study was done on 150 patients who complained from gallstones and attended to our surgical team, from the period of May 1, 2013 to May 31, 2017, the patient age range was 19–65 years with a mean age of 41 ± 0.9 years, after confirming the diagnosis of gallstones, informed consent was obtained from the patients. Those with previous abdominal surgery or serious comorbidities were excluded from the study. A total of 150 patients were divided randomly with 75 patients had the access into their abdomen by veress needle and the other 75 patients by direct trocar method. Variables comparing the safety and efficacy of the two methods were studied. Results: Direct trocar method was faster (2.3 ± 1.1 standard deviation [SD] min) than veress technique (5 ± 0.9 SD min), CO2leak occurs just in one case of trocar method while it does not occur in veress technique, extraperitoneal insufflations occur in four cases (5.3%) operated by veress method, and only in one case of direct trocar method, port site infection develops in two cases (2.6%) of direct trocar method and in single case of veress cannula. Only one case of port site hematoma occurs in direct trocar method. Conclusion: Direct trocar method is a safe, fast, and easily done technique for the establishment of primary entrance into the peritoneal cavity and hence pneumoperitoneum, there were no significant variations in minor complications and without major ones.
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CASE REPORTS Top

Metachronous cancer of the nasal cavity after totally cured larynx squamous cell carcinoma p. 51
Sedat Aydin, Mehmet Gökhan Demir, Burak Dikmen, Mustafa Paksoy, Tolga Çakil, Sedef Çoruk
DOI:10.4103/MJ.MJ_31_18  
Head-and-neck region tumors are mostly seen on the larynx. The risk factors of this region may increase the secondary tumors. Nasal squamous cell carcinoma (SCC) can be detected after larynx SCCs, a second primary tumor. Second primary tumors are difficult to manage. Total rhinectomy is the choice of treatment modality, but rehabilitation is necessary. We present a secondary nasal SCC treated with total rhinectomy. A 67-year-old patient, who was treated for larynx SCC by total laryngectomy 3 years ago, was admitted to the outpatient clinic with a complaint of nasal swelling and pain. The patient was diagnosed as nasal SCC. Total rhinectomy was performed, and silicon nasal prosthesis was applied after 3 months of surgery. Total rhinectomy can be rehabilitated via silicon nasal prosthesis. This was cost-effective, safe, less time-consuming, and functional. Using prosthesis has given us better chance to detect recurrences. We encourage surgeons to use prosthesis for rehabilitation.
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Intraosseous ganglion cyst of the distal tibia in a young male patient p. 54
Zuhdi Osama Elifranji, Jihad Moh'd SaidAl-Ajlouni, Dana M Aldaghlise, Mohammed M Ahmed, Yousef E Abuosba
DOI:10.4103/MJ.MJ_37_18  
The case of a 25-year-old man with a ganglion cyst of the medial aspect of the ankle has been presented. Biopsy was taken during the surgery and sent for histopathology, which showed cystic area lacking epithelial lining filled with mucoid material. The patient was treated with curettage of the medial malleolus.
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LETTERS TO EDITOR Top

Necessity to Address the Challenge of Climate Change and Its Consequences in Small Islands p. 57
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/MJ.MJ_38_18  
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Narrow-Band Imaging Pattern: A Promising Radiologic Aid in Potentially Malignant Lesions and Oral Cancer p. 58
Thorakkal Shamim
DOI:10.4103/MJ.MJ_3_19  
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