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   Table of Contents - Current issue
Coverpage
January-June 2020
Volume 19 | Issue 1
Page Nos. 1-39

Online since Thursday, August 20, 2020

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ORIGINAL ARTICLES  

Spectrum of chest computerized tomographic findings in novel coronavirus disease-19 p. 1
Suhail Rafiq, Musaib Ahmad Dar, Inayat Elahi, Irshad Mohi Ud Din
DOI:10.4103/MJ.MJ_13_20  
Background: Coronavirus disease-19 (COVID-19) is a zoonotic viral disease caused by nonsegmented, enveloped, positive-sense, single-strand ribonucleic acid coronavirus. Recent outbreak started in Wuhan, China, where a new type of coronavirus was isolated from respiratory samples such as bronchoalveolar lavage and sputum of patients developing respiratory symptoms. The World Health Organization declared COVID-19 a pandemic on January 20, 2020. On April 6, 1,288,080 were infected with this virus with 70,567 deaths. Computerized tomography (CT) is the investigation of choice for diagnosing, managing, and accessing temporal changes in COVID-19. Objective: The objective of this study is to describe the chest CT findings in documented nCovid-19-positive patients. Methodology: This was a retrospective observational study done in Government Medical College, Chest Disease Hospital from February 20 to April 25, 2020. Forty-eight patients with COVID-19 reverse transcriptase-polymerase chain reaction-positive test were scanned on 64 slice Somatom CT scanner and findings analyzed. All patients with previously underlying chest disease were excluded. Results: The various chest findings in the nCovid-19-positive patients include ground glassing, (81.25%), consolidation (56.25%), nodules (43.75%), halo sign (31.25%), crazy paving pattern (50%), air bronchogram (12.5%), air bubble sign (6.25%), vascular enlargement (25%), reversed halo sign or atoll sign (18.75%), bronchial wall thickening (6.25%), and mosaic attenuation (6.25%). None of the patients had pleural effusion. Conclusion: Characteristic CT findings of COVID-19 can help radiologists in the early diagnosis of symptomatic patients in whom testing is awaited. Bilateral peripheral ground-glass opacities with consolidation in dependent parts of the lung along with the absence of pleural effusion were the most common abnormality.
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Transatrial/transpulmonary approach versus transventricular approach in classical tetralogy of fallot repair p. 6
Hammood Naser Mohsin, Firas Sadeq Abdul Kareem
DOI:10.4103/MJ.MJ_9_19  
Background: Right ventricular dysfunction is an important cause of morbidity and mortality following total correction of tetralogy of Fallot (TOF). Transatrial/transpulmonary approach avoids ventriculotomy (as opposed to the transventricular approach) which gives maximum protection of the right ventricle structure and function. Objectives: The main objective is to review the results of transatrial/transpulmonary approach and compare it with that of the transventricular approach. Patients and Methods: Forty patients underwent repair of classical TOF were retrospectively studied from January 1, 2015 to January 1, 2018 at Ibn Al-Nafees Teaching Hospital for cardiothoracic surgery in Baghdad, Iraq. We divided the patients into two groups: group A (transventricular approach group) – 22 patients, and Group B (transatrial/transpulmonary approach group) – 18 patients. In this study, we did comparison between these two groups. Results: There were eight operative deaths; the overall mortality was 20%, six patients in Group A (27.27%) versus two patients in Group B (11.11%). Severe right ventricular systolic dysfunction after repair was found in 14 patients (35%), 11 patients in Group A (50%) versus 3 patients in Group B (16.66%). Tachyarrhythmias were seen in 18 patients after repair (45%); 13 patients in Group A (59.09%) versus 5 patients in Group B (27.7%). Conclusion: Transatrial/transpulmonary approach procedure in the TOF surgery is more safe and associated with lower morbidity and mortality than the transventricular approach.
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The eosinophilic and neutrophilic counts in sputum of asthmatic Iraqi patients and its correlation with asthma control p. 11
Haider Noori Dawood, Jamal Baha Alwan, Sudad Ahmed Khalaf
DOI:10.4103/MJ.MJ_3_20  
Background: Asthma control is very critical guide for therapy according to the current asthma guidelines. The asthma control test (ACT) was successfully used to assess the control level. However, variation in clinical features which composite the items of the test does not always associate with the extent of the structural changes in pulmonary airways. Thus, there is a necessity for the surrogate marker to assess the control level. Eosinophilic and neutrophilic cells have an important role in the pathological process of asthma. Aims: The aim of this study is to assess the sputum eosinophil and neutrophils as a discriminative marker between different levels of asthma control. Patients and Methods: This cross-sectional study included 88 asthmatic patients. Only 50 patients produced sputum. Demographic data, ACT parameters took from patients. Spirometer test has been done. Sputum study includes processing of sputum, counting of sputum total white cell were done. Results: According to sputum cells count and differentiation, 64% eosinophils, 10% neutrophils, 6% mixed and 20% was paucigranulocytic (non). Eosinophilic phenotype patients were poorly control with a statistically significant difference. While neutrophilic phenotype was nonstatistically significant difference. Conclusions: The most common type of asthma phenotyping is eosinophil which in turn correlated with poor asthma control while other types like neutrophil are not correlated.
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Chemotherapy-induced neutropenia after initial and subsequent chemotherapy cycle of non-hodgkin lymphoma p. 16
Entisar Hadi Al-Shammary, Dhuhaa Jassim Mohammed
DOI:10.4103/MJ.MJ_4_20  
Background: Cytotoxic drugs often suppress the bone marrow's ability to produce white blood cells which lead to the induction of neutropenia and the risk of febrile neutropenia. Chemotherapy-induced neutropenia (CIN) is major dose-limiting toxicity of systemic chemotherapy and it is associated with significant morbidity and mortality. Objective: Evaluating frequency and severity of CIN after initial and subsequent chemotherapy cycles among non-Hodgkin lymphoma (NHL) children undergoing similar chemotherapy regimens. Patients and Methods: A prospective study performed in the Oncology Department of Child Central Teaching Hospital/Baghdad, between August 1, 2012, and January 31, 2014, which included (59) patients <15 years, with newly diagnosed NHL who received similar chemotherapy regimens of NHL. All patients were evaluated for the incidence of neutropenia after the initial or subsequent course of chemotherapy to compare between CIN after first and subsequent chemotherapy cycles of similar regimens, that is,: COPADM1 versus COPADM2 and COPADM3, “COPADM” regimen includes the following drugs (C: Cyclophosphamide, O: Oncovine, P: Prednisone, AD: Adriamycine, and M: Methotrexate), each chemotherapy cycle was received every 21-day interval. Results: Of a total 59 patients with NHL,55.9% of them were male and 44.1% were female, who received initial (COPADM1) and subsequent (COPADM 2 and COPADM 3) chemotherapy cycles of NHL, there is a significant increment in the risk of CIN after initial cycle “COPADM1” in comparison to other subsequent cycles of COPADM2 and COPADM3, “P = 0.01.” The patient characteristics (age group and gender) had no significant effect on the risk of CIN, there is a higher percent of severe neutropenia and hospitalization with parenteral antibiotic use after the first COPADM cycle in comparison with subsequent cycles but statistically not significant (P = 0.6 and 0.1, respectively). Conclusion: Frequency of CIN after the first chemotherapy cycle had significantly higher than subsequent cycles, with lesser extent to neutropenic severity and neutropenia-related hospitalization.
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Glycemic status in patients with primary hypothyroidism and its relation to disease severity p. 20
Atheer Yass Ali, Khalid Ibrahim Allehibi, Nihad Abdullah Al-Juboori
DOI:10.4103/MJ.MJ_5_20  
Background: Primary hypothyroidism can be defined as an increase in serum thyroid-stimulating hormone (TSH) level, and the concentration of free T3, free T4, T3, and T4 is low. Hypothyroidism is a prevalent disease mostly affecting middle-aged women. One of the most important determinants of glucose homeostasis is thyroid hormones. Hypothyroid patients have a higher prevalence of insulin resistance and tendency to Type 2 diabetes mellitus than the normal individual. Objective: To investigate the correlation between TSH and hemoglobin A1c (HbA1C) in patients with primary hypothyroidism; so, to study the effects of hypothyroidism on glucose metabolism. Subjects and Methods: Ninety-five Iraqi primary hypothyroidism patients and 40 healthy persons taken as control were selected from Specialized Centre for Endocrinology and Diabetes during the period from June 2017 to January 2018. The patients were diagnosed previously as cases of primary hypothyroidism, and they were on treatment and still on treatment. All patients were sent to investigate TSH, T4, T3, and HbA1c. The patients were subdivided into three main groups: first is uncontrolled nondiabetic primary hypothyroid group (36 patients), second is controlled nondiabetic primary hypothyroid group (43) and third is the diabetic primary hypothyroid group (16 patients). Results: A significant difference (P < 0.05) between HbA1C% in both controlled and uncontrolled hypothyroid groups against the control group, but there is no significant difference (P = 0.08) between the controlled and uncontrolled hypothyroid groups. The TSH relation with HbA1c was found to be significantly positive in the uncontrolled hypothyroid and diabetic, hypothyroid groups (r = 0.401 and 0.58, respectively). Conclusions: Significant increment was found in the level of HbA1c in hypothyroid patients, whether it is controlled or uncontrolled and a positive relationship was observed between TSH and HbA1c% in the uncontrolled and diabetic hypothyroid groups. Diabetes augments the effects of hypothyroidism on HbA1c.
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Nonaneurysmal cerebrovascular conditions associated with intracranial arterial fenestrations p. 25
Salima B Alsaadi, Samer S Hoz, Saad Abdul Kareem Mohammed Al-Obaidi, Bahaa S Abdalnaby, Ammar M Al-Smaysim
DOI:10.4103/MJ.MJ_6_20  
Background: Cerebral arteries have been identified with multiple anatomical variations, including a concomitant fenestration with aneurysms, but no association is proven. Aim: to investigate non aneurysmal disorders associated with intracranial arterial fenestration. Methods: A thorough and detailed analysis of the available literature from 1970 to 2020 in PubMed were contemplated to identify and address all the disorders associated with arterial fenestration with exclusion of intracranial aneurysms. Results: While segmental vulnerability may induce invisible anatomical histological and hemodynamic changes, cadaveric studies showed that the frequency of fenestration is up to 40% higher than the clinical reports, and the cadaveric reports also showed a higher occurrence of such fenestrations as compared to radiological studies. The vertebrobasilar system, the most common site of fenestration. Fused vertebrae and other vascular defects of up to 7% are previously associated with the vertebral artery fenestration. Conclusion: intracranial fenestration is a critical anatomical variant. Thus, A comprehensive angiographical examination can enhance overall prognosis in presurgical planning in association with other vascular abnormalities.
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Risk factors for obstetrical brachial plexus palsy p. 30
Hanene Belabbassi, Amina Imouloudene, Houria Kaced
DOI:10.4103/MJ.MJ_2_20  
Objective: The study was aimed to identify the risk factors for obstetrical brachial plexus palsy (OBPP). Patients and Methods: A retrospective case–control study was designed. A comparison was performed between cases of brachial plexus paralysis (n = 32), with controls without brachial plexus paralysis (n = 30) randomly selected from physical rehabilitation medicine examination. Statistical analysis was performed using the SPSS Package. Results: Independent risk factors for brachial plexus paralysis were macrosomia (birth weight 4000 g; odds ratio [OR] = 12.353; 95% confidence interval [CI] 2.510–60.802, P < 10−3), labor dystocia and instrumental vaginal delivery (forceps delivery and vacuum extraction; OR = 8.8; 95% CI 2.743–28.234, P < 10−3), and prolonged pregnancy (OR = 1.28; 95% CI 1.066–1.538, P = 0.011); however, vaginal breech delivery (breech presentation or extraction; OR = 3.231; 95% CI 0.598–17.456, P = 0.258), parity (OR = 2.545; 95% CI 0.677–9.565, P = 0.206), shoulder dystocia (OR = 1.957; 95% CI 0.571–6.702, P = 0.367), and after cesarean section (OR = 1.103; 95% CI 0.987–1.234, P = 0.238) do not represent any risk factor. Conclusions: In our population (n = 62), macrosomia, labor dystocia, instrumental vaginal delivery, and prolonged pregnancy were the significant risk factors for neonatal brachial plexus paralysis, while shoulder dystocia, breech deliveries, parity, and cesarean section were not. Despite our small sample, we found three significant risk factors associated with OBPP.
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CASE REPORT Top

Surgical control over superior sagittal sinus injury due to metallic ceiling fan-blade injury p. 34
Salima B Alsaadi, Saad Abdul Kareem Mohammed, Zahraa M Kareem, Mustafa Almurayati, Samer S Hoz
DOI:10.4103/MJ.MJ_7_20  
The most serious dural sinus accident following traumatic brain injury is superior sagittal sinus (SSS) injury. It is usually resulted from depressed skull fracture extends to the midline. We present a traumatic superior sagittal sinus injury triggered by the metal ceiling fan blade with its surgical management. Injuries of the SSS have an increased mortality rate in head injured patients. Metallic ceiling-fan head injury differs from the classic traumatic brain injury concerning the presentation, radiology, management, and outcomes.
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SHORT COMMUNICATION Top

Competency-based medical education for undergraduates in India: Strengths, weaknesses, opportunities, challenges analysis and the way forward p. 37
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/MJ.MJ_1_20  
The much-awaited dream of many educationalists across India has finally turned into reality and we have shifted to the competency-based curriculum for the undergraduates from the 2019 academic year. With close to 4 months into this transition and implementation, we have realized a wide range of strengths-weaknesses-opportunities-challenges (SWOC) and it is the need of the hour to learn from the same and plan our curriculum in such a manner that the execution of the same can be significantly improved in the coming years. Even though, challenges are there, but it is important to understand and have a belief that all this has been done to improve the health care services offered to the general population. In conclusion, the competency-based curriculum for undergraduate students has to be looked upon as an opportunity to produce competent and globally acceptable doctors and thus it is high time that all the stakeholders accept this as a challenge and work in a concerted manner to accomplish the intended goals.
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