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The effects of ferrous sulfate as an iron supplement on ejection fraction in patients with iron deficiency anemia associated with decompensated heart failure
Mohammed Qasim Yahya Mal-Allah Al-Atrakji
January-June 2018, 17(1):22-28
Background: Acute decompensated heart failure (HF) is a clinical syndrome that results when abnormalities in the structure and function of the myocardium impair cardiac output or decrease filling of the ventricles. Anemia is a common comorbidity in patients with chronic HF (CHF), is associated with increased disease severity, and may contribute to a worse the outcome. Aim of the Study: To study the relationship between iron level and left ventricular function (LVF) in patients having acute decompensated HF and the effects of iron supplement on this function. Patients and Methods: This cross-sectional study was conducted in the medical wards of Baghdad Teaching Hospital at different times during the period between October 1, 2016, and May 1, 2017. It included 60 patients diagnosed with CHF (9 patients with HF with preserved ejection fraction [EF] and 51 patients with HF with reduced EF) and admitted to the medical wards due to acute decompensation. For all patients, history, cardiological examination, New York Heart Association classification, electrocardiogram, and chest X-ray were done. Body mass index was measured. Standard echocardiography was performed. Hematological parameters were measured including hemoglobin (Hb), mean corpuscular volume, mean corpuscular Hb (MCH), MCH concentration, blood film, serum iron, erythrocyte count, total iron-binding capacity, and transferrin saturation. Results: Serum iron was significantly lower in patients with impaired EF with median serum iron 41 versus 94 mcg/dL in preserved EF (72.5% vs. 0%). Transferrin saturation was statistically and significantly lower in patients with EF <50% (39.2% of the patients with impaired EF had low transferrin saturation [P < 0.001] compared to 0% in patients with preserved EF). EF had inverse significant correlation with total binding capacity of iron (r = −0.585, P < 0.001). Iron supplements as ferrous sulfate have a highly significant effect (P < 0.001) on improving the LVF and EF, iron level and transferrin saturation in patients with decompensated HF with low EF. Conclusions: Most HF patients with low EF in this study had reduced iron level and transferrin saturation comparing to those with preserved EF. Iron supplement in a patient with low EF preserved the EF in them. Anemia still is founded in patients of HF with acceptable EF in the presence of normal iron status, and this is explained by other causes rather than iron deficiency.
  1,195 199 -
Immune checkpoint inhibitors and health-related quality of life: A systematic review of the current literature
Mohamed H Elshahidi
January-June 2018, 17(1):1-13
Background: Over the past years, some immune checkpoint inhibitors (ICPIs) have been approved for clinical use in several malignancies. Examining the effects of ICPIs on the patients' health-related quality of life (HRQoL) may help clinicians in their decision-making process. Aim: The aim of this review is to summarize the current evidence about the effects of ICPIs on the patients' HRQoL. Methods: PubMed, Embase (via OvidSP), Web of Science, Scopus, and EBSCOhost were searched from their dates of inception to January 2018. Studies reporting the effects of ICPIs on the HRQoL using a valid questionnaire are included in the review. A narrative summary of the included studies was presented. Results: Sixteen studies met the specific inclusion criteria, which are as follows: seven about melanoma, three about renal cell carcinoma (RCC), one about metastatic Merkel-cell carcinoma (mMCC), two about squamous cell carcinoma of the head and neck, two about non-small-cell lung cancer (NSCLC), and one about colorectal cancer (CRC). In melanoma, more improvements in the global health status (GHS) were observed with pembrolizumab, ipilimumab 3 mg/kg, and pembrolizumab every 2 weeks than with ipilimumab, ipilimumab 10 mg/kg, and pembrolizumab every 3 weeks, respectively. However, no clinically significant differences were found when adding gp100 vaccine, using different doses of pembrolizumab or combining ICPIs. In RCC, the EQ-5D utility index and the time to deterioration were improved in the nivolumab groups than in everolimus groups. In squamous cell carcinoma of the head and neck, the GHS remained stable or improved with nivolumab. However, there was no significant difference in the time to deterioration between nivolumab and investigator's choice. In mMCC, a slight gain in the GHS was observed with avelumab. In NSCLC, improvements were observed in the symptoms scales and some of the functioning scales with pembrolizumab than chemotherapy. However, no difference was observed between them on emotional functioning. In CRC, some clinically meaningful improvements were observed in nivolumab plus ipilimumab. Conclusion: Due to the complexities in the longitudinal analysis of HRQoL data and some other concerns in the included studies designs, these results should be interpreted carefully. PROSPERO registration number: CRD42018089311
  1,032 155 -
Knowledge and health-seeking practices of mothers attending primary health-care centers in Baghdad Al-Karkh sector about danger signs in newborns
Hiba Naji Abdulrida, Reem Jameel Hassan, Mary Mohammed Sabri
January-June 2018, 17(1):29-35
Background: High-risk neonate defines as one who requires more than the standard monitoring and care offered to a healthy term newborn infant; therefore, early detection of neonatal illness is an important step toward improving newborn survival. Objectives: The objective of this study is to assess the knowledge and health-seeking practices of mothers attending primary health-care centers about WHO recognized danger signs in newborns. Subjects and Methods: A cross-sectional study was carried out in primary health-care centers selected conveniently in Baghdad-Alkarkh district. Participants were 275 mothers of child-bearing age group selected conveniently; the data were collected during the period from March 1 to June 30, 2017. A general questionnaire used for the data collection. Results: About 81% of mothers in study sample listed three or more of the who recognized danger signs. About 71.7% of mothers tend to seek advice or treatment for the illness outside the home. The proportion of good knowledge and health-seeking practices was higher in (Educated, employee, mothers who had a history of antenatal care attendance with higher number of visits). There was no relationship between number of children and family support with seeking care outside the home. Mothers who had good knowledge of danger signs of their babies tend to seek care from health facilities more frequently 75%, and this relation was statistically significant, 61.2% of mothers who perceive illness in newborns delayed seeking advice or treatment outside the home, 66% not taking newborn to the health facilities because they expect self-resolution of the illness. There is good knowledge and perception of mothers toward some danger signs such as fever, poor feeding, and jaundice while fair toward others such as cold body, chest indrawing, and signs of local infections. Conclusion: There are good knowledge and perception of mothers about the WHO recognized danger signs in newborns; however, there is a gap between mothers' knowledge and their health-seeking behavior for sick newborn and explored their deep perceptions, constraints, and various treatments.
  768 129 -
A new horizon into the central effect of quercetin on human vigilance in normal healthy volunteers
Ali Kadhim Al-Buhadilly
January-June 2018, 17(1):14-18
Background: Quercetin is one of the dietary flavonoids found in citrus fruits and leafy vegetables as well as seeds and green tea. Its name comes from Quercetum and belongs to flavonol class which is not synthesized in the human body. Many studies revealed a significant effect of quercetin in advancing psychomotor/cognitive performances and reversing the neurotoxin-induced neuronal damage. Therefore, the present study aimed to illustrate the central effect of quercetin on human vigilance and in normal healthy volunteers. Subjects and Methods: A total of fifty healthy volunteers with a mean age of 23 years were enrolled in this experimental study; they were divided into two groups: Group I: twenty healthy volunteers treated with placebo (500 mg/day starch capsule) for 2 weeks and Group II: thirty healthy volunteers treated with quercetin 500 mg/day for 2 weeks. Each volunteer in each group was subjected to vigilance-psychomotor testing by Leeds psychomotor performance tester which measures Psychomotor-vigilance test (PVT) and Cortical arousal activity (CAA). Results: Quercetin produced a more significant effect on total reaction time, recognition reaction time, movement reaction time, fusion index, % fusion (P < 0.01), and flicker percentage (P < 0.05) compared to control, but quercetin produced an insignificant effect on CFFd, critical flicker-fusion frequency, and flicker index. Conclusion: Quercetin improves psychomotor performance and CAA in normal healthy volunteers.
  681 91 -
Assessment of the factors reducing operative and postoperative lateral orbitotomy complications
Hayder Alhemiary, Dhuha Almayoof
January-June 2018, 17(1):19-21
Background: Lateral orbitotomy is a well-known approach for lesions of the lateral, superior, and inferior part of the orbit, especially for extraconal lesions. A surgical technique which includes avoiding temporalis muscle aggressive retraction and cutting but meticulous retraction is used instead accompanied with experience of the surgeon about the anatomy of the orbit and avoiding extensive bleeding with the subsequent high infection predisposition; all these factors contribute to the low percentage of complications. Materials and Methods: Ten cases were operated upon during the period from 2012 to 2016 in medical city, neurosurgical department. In this regard, contrast-enhanced computed tomography scans gives useful information for operative strategy. All patients were approached using lateral orbitotomy procedure utilizing microsurgical technique taking in consideration meticulous retraction of the temporalis muscle, the site of the lesion, and its relation to the important orbital structure. Objective: The objective of this study is to assess of factors that minimize operative and postoperative lateral orbitotomy complications. Results: Ten cases operated with consideration to factors reducing complications of those six patients were female, with age range between 35 and 57 (mean 43 years). In four patients, the lesion was cavernous hemangioma, one patient optic nerve glioma, two patients lacrimal gland pleomorphic adenoma, and three patients exophthalmus due to Grave's disease (thyroid eye disease). With meticulous care during muscle retraction without cutting, it had no significant risk of bleeding intra operatively, one patient had early postoperative infection, and another case had unacceptable scar. Conclusion: The success of surgery can be improved, operative and postoperative complications can be reduced, and cosmetic problems become acceptable if a meticulous care is taken during temporalis muscle retraction and using microsurgical technique. Operation done by an expert surgeon familial with the anatomy of the orbit, avoiding extensive bleeding that need drainage system which predispose to high infection rate, will reduce operative and postoperative complications. In addition good operative field matching with the size and the type of the lesion play a role in minimizing the complications.
  555 75 -
Evaluation of awareness about pharmacovigilance and adverse drug reaction monitoring among medical professionals attending Central Leprosy Institute
Pugazhenthan Thangaraju, Sajitha Venkatesan, T Tamilselvan, Elavarasan Sivashanmugam, MK Showkath Ali
July-December 2018, 17(2):63-68
Background: The introduction of pharmacovigilance (PV) program helps in very early detection of adverse drug reactions (ADRs) and identification of risk factors and various measures to be taken once it happened. This study was aimed at investigating the knowledge and attitude of doctors in a research institute about ADR reporting and suggesting possible ways of improving ADR reporting. Materials and Methods: This study was a cross-sectional, questionnaire-based survey conducted at a tertiary care leprosy hospital which is a research institute. The respondents were doctors and students visiting this institute. The study instrument was a self-developed, prevalidated, semi-structured questionnaire of 25 questions. Results: A total of 55 questionnaires were considered for analysis, giving a response rate of 100%. In all, 87.93% of the respondents were aware about pharmacovigilance, 68.96% were aware of ADR reporting system in India, 91.37% opined that only serious ADR with any medicine should be reported, and 4.3% believed that ADR should be reported only for newly marketed agents. Although 88.79% of the respondents observed an ADR, only 31.03% reported it; 60% were aware about the complete step to be taken after ADR. The general attitude of the respondents about ADR reporting was as follows: ADR reporting should be mandatory (60.34%), voluntary (29.31%), and need base (10.34%) and the preferred mode to report should be phone (34.48%), dropbox (22.41%), E-mail (25.86%), and personal visit (8.6%). Nearly 77.58% of the respondents needed a complete feedback after the ADR reporting. Almost 51.72% of the respondents opted increasing awareness about PV through training/projects/continuing medical education, as the factor encouraging for ADR reporting, and 51.72% opted lack of knowledge about the process of reporting, as the factor discouraging ADR reporting. Conclusion: From the study, it was found that most of the doctors and students were unaware of the ADR reporting forms and their availability which should be sorted out in the institutional setting for better results.
  422 97 -
Maternal–placental growth factor and the identification of fetuses with placental intrauterine growth restriction
Henan Dh Skheel Al Jebory, Asmaa Zubaid Alazzawy
January-June 2018, 17(1):36-41
Objective: This study was designed to discriminate between fetal growth restriction that is placentally mediated and constitutionally small fetuses depending on the measurement of placental growth factor (PlGF) in the maternal circulation. Study Design: This was a prospective case–control study. Settings: This study was conducted at the Department of Gynecology and Obstetrics at Al-Yarmouk Teaching Hospital. Patients and Methods: The study included 100 cases (11 placental intrauterine growth restriction [IUGR] and 89 constitutionally small) with singleton pregnancies. Serum PlGF was measured by ELISA technique. Concentration less than the 5th percentile for normal pregnancy was considered a positive PlGF test. Results: A positive PlGF test was found in 10 out of the 11 placental growth restriction cases and in 4 out of the 89 constitutionally small fetuses. PlGF can differentiate between IUGR due to placental dysfunction from constitutionally small fetuses with 90.1% sensitivity and 95.5% specificity. Conclusion: PlGF may serve as a promising tool to identify placental IUGR antenatally.
  465 48 -
A profile on health-care services for old in Baghdad
Esraa Tariq, Riyadh Lafta
January-June 2018, 17(1):52-56
Background: The world is aging with people living longer and fewer children being born; the number of old people is increasing, and thus the aging of populations demands a comprehensive public health response. Objective: The objective of this study was to shed light on the health-care services for old people in age-friendly primary health-care centers (PHCCs) in Baghdad city in respect with its availability, accessibility, and utilization. Methods: This is a descriptive cross-sectional study that was conducted in 22 age-friendly PHCCs in Baghdad. The evaluation was based on the WHO age-friendly PHCCs toolkit. The checklist comprises a list of questions related to clinical services. Results: Wheelchairs were present in 100% of the centers, 85.7% of centers in Al-Karkh and 62.5% of centers in Al-Russafa have clear emergency exits, and all the centers have essential equipment and investigations. Free services for the elderly were not present in any of the centers; the referral system was weak with no feedback. Computerized health information system was present in only quarter of the centers. Conclusion: All the age-friendly PHCCs lack a special unit for the elderly. Most of the centers do not have a suitable source of drinking water. There are some criteria that comply with the WHO instructions, but there are other essential services that should be available to improve the health services and utilization of these services.
  447 45 -
Intralesional streptomycin: New, safe, and effective therapeutic option for cutaneous leishmaniasis
Wisam Majeed Kattoof
January-June 2018, 17(1):42-46
Background: Leishmaniasis encompasses a spectrum of chronic infections in humans in which organisms are found within phagolysosomes of mononuclear phagocytes. Cutaneous leishmaniasis is divided into Old World and New World cutaneous leishmaniasis caused by Leishmania tropica. Aminoglycosides as it antibacterial, were also tried as a new therapeutic option for parasitic infestation. Proliferation rate and protein synthesis in the promastigote stage of the parasite are inhibited by aminoglycoside such as streptomycin. Aim: The aim of this study is to estimate the effectiveness of intralesional streptomycin as a new antileishmanial agent. Settings and Design: This was a therapeutic trial with controls. Materials and Methods: Sixty three lesions (57.8%) from a total of 109 lesions were treated with intralesional injection of streptomycin after dilution with distilled water (20%) and 46 lesions (42.2%) were used as a control. Statistical Analysis: Statistical Analysis System program and Chi-square test were used. Results: In Group A, clinical cure was achieved in 40 lesions (83.3%). Moderate response was noticed in 8 lesions (16.7%). In Group B, none of the remaining 39 control lesions shows moderate, marked or total clearance degree of response. Only 3 lesions (7.7%) showed a slight degree of response and 1 lesion (2.7%) with mild degree. Conclusion: Intralesional streptomycin solution 20% can be considered as a new effective therapeutic option for cutaneous leishmaniasis.
  450 40 -
Single-nucleotide polymorphism of interleukin-27 gene: A risk factor of recurrent pregnancy loss in Iraqi women
Esraa H Humadi, Layla H Hamad, Hasan F Al Azzawie, Samera H Hamad
January-June 2018, 17(1):47-51
Background: Studies have been done to investigate the association between a single-nucleotide polymorphism (SNP) of interleukin-27 (IL-27) gene and the recurrent pregnancy loss (RPL). However, different results have been found in different spots of the world. Therefore, more studies are needed to understand the variation in these results. This is the first study that shows the implication of the SNP of IL-27 gene in RPL. Objective: This study aims to investigate the association between RPL and SNP of gene (−964 A > G) in Iraqi women. Materials and Methods: From September 2013 to September 2014; 100 women, as a control group, and 100 women (with three or more consecutive pregnancy loss), as a study group, were recruited to investigate the association between the IL-27(−964 A > G) SNP and the PRL. The IL-27(−964 A > G) SNP was determined using polymerase chain reaction-restriction fragment length polymorphism technique. Genotype and allele frequencies were compared using Fisher test between the two groups. P < 0.05 is considered to be statistically significant. Results: The age and body mass index were both not significantly different between the two groups. The frequencies of genotypes of this polymorphism in the RPL group were AG (60%), AA (31%), and GG (9%), while these frequencies were AG (21%), AA (68%), and GG (11%) in the control group. The genotype frequencies of the −964 A > G polymorphism was significantly different between the study and the control groups (P = 0.007). The allele frequencies of this polymorphism were A (35%), G (65%) in the RPL group versus A (61%), G (39%) in the control group. The frequencies of A and G alleles in the both groups were not significantly different. Conclusion: IL-27 (−964 A > G) polymorphism is a risk factor for RPL in a sample of Iraqi women. However, this is different from what has been found in some studies which might implicate other factors in the RPL.
  418 41 -
Evaluation of the effects of TAK-242 and GIT-27 on methotrexate-induced liver injury
Bassim I Mohammad, Bassim S Ahmed, Alaa Fadhel Hassan
July-December 2018, 17(2):85-92
Background: Methotrexate (MTX)-induced liver injury is a common problem that is described as increased level of hepatic biomarkers that is seen in 14%–25% of patients with inflammatory bowel disease and 49% of patients with rheumatoid arthritis or as idiosyncratic induced liver injury that is seen in 1% of patients with inflammatory bowel disease, or as fibrosis and cirrhosis in 17% of rheumatoid arthritis patients and 25% of psoriatic patients. This profile may rarely progress to acute liver failure. Aim: The aim is to study the effect of TAK-242 and GIT-27 on MTX-induced liver injury. Materials and Methods: Thirty-five Albino-Wistar rats were divided into five groups: the first group was maintained on distilled water, the second group was administered intraperitoneal (I.P.) dimethyl sulfoxide followed by oral MTX, the third group was administered oral MTX, the fourth group was administered I.P. TAK-242 followed by oral MTX, and the fifth group was administered I.P. GIT-27 followed by oral MTX. Results: The significant increase in markers of hepatic function, inflammatory and oxidative stress markers, as well as severe liver histopathologic change “steatosis” induced by methotrexate were alleviated in the animals pretreated with the drugs TAK-242 and GIT-27. With significant improvement in serum level of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, bilirubin, interleukin-6, tumor necrosis factor-α, malondialdehyde and reduced glutathione; beside an improved histopathologic profile of moderate steatosis. Conclusion: This study suggests that both TAK-242 and GIT-27 protect against liver injury induced by MTX depending on their antagonism of the inflammatory Toll-like receptors 4 and 2/6.
  366 83 -
Neurotrophic and neurotoxic effects of retinoic acid on human neural stem cell culture
Abdal-Jabbar F Al-Rubai
July-December 2018, 17(2):69-74
Background: Retinoic acid (RA) is one of the most critical molecules in the organic development of human being; it has been implicated in controlling of hundreds of genes which control several processes in human development. Furthermore, RA has negative insult on pregnancy outcome since it has teratogenic potential when used in high doses. Materials and Methods: Human neural stem cells are used in this study to test the effect RA in different doses on cell viability, cellular protein amount, neurite length, neurosphere sizes, reactive oxygen species (ROS) production, and migration distance. Results and Conclusions: Our results show that RA at low doses (2, 5 μM) preserve cell stemness and increase the sizes of neurospheres significantly, but at high doses, it appears that RA has a neurotoxic effect on these stem cells through significant increase in ROS which has negative effects on neurite length and cellular migration.
  379 62 -
Assessment of endothelial function among patients with type 2 diabetes mellitus
Saadealdeen Majeed Hassoon, AS Kalid Mahdi Al Bermani
January-June 2018, 17(1):57-61
Background: Endothelial dysfunction is an initial key step in the pathogenesis of atherosclerosis. Many tests developed to measure endothelial function, most of which are either invasive or semi-invasive. The unique nature of brachial artery reactivity test of being a noninvasive, quantitative, and repeatable procedure is gaining increasing interest as an index in assessing endothelial cell function. Aim of Study: The aim is to study the assessment of endothelial function among a group of patients with type 2 diabetes mellitus (DM), using brachial artery reactivity test. Patients and Methods: In a case control study enrolling 35 patients with type 2 DM matched against a similar number of nondiabetic participants of related genders and age groups to trace the brachial artery diameter both at rest and in response to reactive hyperemia using a commercially available U/S machine equipped with a high-resolution linear probe (7.5 MHz) following an already defined U/S protocol. Results: The diabetic participants revealed a statistically significant attenuation in brachial artery dilatation in response reactive hyperemia when compared with nondiabetic group (mean ± standard deviation) (4.63 ± 0.4 mm vs. 5.61 ± 0.47 mm). Comparing the two groups, a statistically significant impairment of the brachial artery dilatation is traced in relation to the atherosclerotic risk factors both in isolation and in clusters. Moreover, strict glycemic control (HbA1c ≤6%) significantly altered the response to vasodilatation (0.74 ± 0.17 mm vs. 0.43 ± 0.14 mm, P = 0.0001). Age, gender difference, and duration of diabetes did not significantly alter the results. Conclusions: Endothelial dysfunction is not uncommon among patients with type 2 DM. Brachial artery reactivity test is a well-accepted, noninvasive, repeatable, and a quantitatively reproducible index to trace endothelial function.
  401 35 -
Fetal parameters and early evidence of fetal macrosomia in prepregnancy diabetic women
Hala A. G. AL Rawi, Ban Hadi, Najlaa Hanon
July-December 2018, 17(2):75-79
Background: Diabetes in pregnancy with macrosomia is an important risk factor for neonatal morbidity and mortality. Prediction of macrosomia is significantly improved by adding ultrasound to clinical findings. Objective: For earlier detection of macrosomia in prepregnancy diabetic mothers using fetal growth profile including biparietal diameter, femoral length, and also abdominal circumference (AC). Patients and Methods: A historical prospective cohort study was performed at National Endocrine and Diabetic Center in addition to the Obstetrics and Gynecology Department at Al-Yarmouk Hospital for 2 years, from September 2014 to 2016. A hundred and sixty pregnant women were enrolled in this study, 80 of them with a history of prepregnancy diabetes mellitus were taken as a patient group and the other 80 pregnant women with a compatible gestational age and without a history of diabetes mellitus were taken as a comparison group. Abdominal ultrasound was done for patients in both groups at 20, 28, and 36 weeks of gestation and then birth weight was measured for each. Results were compared between two groups. Results: The incident of macrosomia was 30% in patient group and 10% in comparison group. Regarding early prediction of macrosomia by ultrasound using biparietal diameter, femoral length, and AC, the results of the current study revealed that those macrosomic babies have higher femoral length, AC but not biparietal diameter in comparison with babies of average weight using ultrasound performed at 20-week gestation and repeated at 28 and 36 weeks. Conclusion: In diabetic mother, fetal macrosomia can be predicted by ultrasound during pregnancy as early as 20-week gestation.
  347 56 -
Serum irisin levels in normotensive and preeclamptic pregnancies
Fatin Shallal Farhan, Sura Basil Findakly, Lilyan W Sersam
July-December 2018, 17(2):80-84
Background: Early prediction of preeclampsia represents a big dilemma for obstetricians, but the discovery of a novel biomarker highlights the way for its prediction during the early stage of the pregnancy. Objective: The objective of this study was to evaluate serum irisin levels in preeclamptic and healthy pregnant women in the third trimester of pregnancy. Materials and Methods: This study was a prospective case–control study conducted at Al-Yarmouk Teaching Hospital during the period from October 1, 2017, to May 1, 2018. Totally 80 pregnant women were enrolled in the study; 40 of them were preeclamptic patients and the other 40 were healthy pregnant women assigned as a control group. Serum irisin levels were measured to all participants by enzyme-linked immunosorbent assay method. The results were compared for both groups. Results: Serum irisin was lower in preeclamptic patients compared to controls (280.7 vs. 311.3 μg/L, respectively), but the difference was not statistically significant as the P value was 0.189. Conclusion: Irisin might be involved as a biomarker for pregnancy-associated problems such as preeclampsia.
  293 56 -
A working classification proposed for indices based on dental specialties in dental research
Thorakkal Shamim
July-December 2018, 17(2):100-103
In dentistry, indices are values that are assigned to quantify the incidence, prevalence, and severity of disease. This paper calls attention to a working classification proposed for indices based on its relationship with nine dental specialties with literature search of indices used in dental research in the PubMed database.
  276 30 -
Impact of maternal body mass index on umbilical artery indices and neonatal outcome
Fadia J Alizzi, Ban Ahmad
July-December 2018, 17(2):93-97
Objectives: This study was designed to clarify the relationship between maternal body mass index (BMI) and umbilical artery (U.A) indices and to evaluate the effect of maternal BMI on the neonatal outcome. Study Design: This was a prospective cohort study. Patients and Methods: This study included 121 pregnant women with uncomplicated, singleton pregnancy between 18 and 35 years, at 32 weeks of gestation, seen in Al-Yarmouk Teaching Hospital antenatal care. Women were divided according to the BMI into underweight (BMI <18.5), normal weight (BMI 18.5–24.9), overweight (BMI 25.0–29.9), and obese women (BMI ≥30). U.A velocity was recorded by Doppler ultrasound, and the women were followed till the time of delivery, mode of delivery, 5 min Apgar score, and birth weight were also recorded. Results: Obese women had significantly higher pulsatility index, resistance index, and systolic-diastolic ratio compared to overweight and normal weight groups (P < 0.001), cesarean section (C/S) rate was significantly higher (P < 0.001), and 5 min Apgar score was significantly lower (P < 0.001). Conclusion: The current study showed the negative impact of increasing BMI on fetoplacental circulation and increased risk of C/S. Neonates of obese mothers had low 5 min Apgar score.
  241 24 -
Employing qualitative research in medical education research
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
July-December 2018, 17(2):104-105
  205 30 -
Facial schwannoma: Case report
Sedat Aydin, Mehmet Gökhan Demir, Kayhan Basak, Tolga Çakıl
July-December 2018, 17(2):98-99
Facial nerve schwannoma is a rare benign tumor of the temporal bone. It might cause hearing loss, facial nerve paresis, or paralyzes. We present a 46-year-old male patient who diagnosed facial nerve schwannoma on the tympanic segment. We have operated the patient through transmastoid approach successfully. On the follow-up, the patient's facial paralyzes are not recovered so upper eyelid implant and canthopexy methods applied.
  206 26 -
Addressing the global public health concern of childhood cancers
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
July-December 2018, 17(2):106-107
  171 23 -
The effectiveness of vaginal lisuride in the treatment of hyperprolactinemia
Hind Abdul khaliq Nassir
June 2015, 14(1):14-17
Background: hyperprolactinemia is a disorder which may be represented clinically by one or more of the following: galactorrhea, infertility, oligmenorrhea, amenorrhea, luteal phase defect and hirsutisim, lisuride drug was recently used vaginaly in the treatment of hyperprolactinemia to decrease the side effects by it's use orally. Patients & Methods: An interventional study conducted over a period of one year from October 2011 to October 2012, in Al-Yarmok Teaching Hospital, 50 patients presented with one or more of the following symptoms, abnormal menstrual cycle (amenorrhea, oligmenorrhea), infertility (unovulatory), galactorrhea. All the 50 patients with elevated prolactin level were received lisuride (dopergin) 0.2 mg vaginally at bed time and continued for 12 weeks, serum prolactin was measured at 8,12 weeks with monitoring of ovulation by serial U/S. Results: The study include fifty patients with mean age was 27.2 years ± SD7.01, and there mean weight was 62.1kg ± SD9.08 All 50 patients had elevated serum prolactin level with mean 66.1ng/ml ± SD 15.5, at the end of the treatment the range of serum prolactin level between 6-17ng/ml ± SD2.9, which was significantly lower than pre treatment level P =0.0001 At the end of the treatment 86% achieved regular cycle, Ovulation occur in significant number of patients p value < 0.01, (37.5%) of them get pregnancy. less side effect compared to oral lisurid. Conclusion: Vaginal lisurid is an effective drug used for the treatment of hyperprolactinemia to avoid the discontinuation of the drug because of it's side effect, when given orally.
[ABSTRACT]   Full text not available  [PDF]
  59 10 -
Study of risk factors for neonatal thrombocytopenia in preterm infants
Basil M Hanoudi
June 2015, 14(1):64-69
Background: Thrombocytopenia is a common hematological problem in neonatal care units. Neonatal thrombocytopenia has been defined as platelet count less than 150x109 /L, regardless of gestational age. Objectives: To determine the frequency and assess the severity of neonatal thrombocytopenia in preterms, and the maternal and neonatal conditions as risk factors. Patients and methods: A cross sectional study was carried out in the neonatal care unit of Child Central Teaching Hospital/ Baghdad, over a period of six months (30th of June to 31st of December 2013). Study group included only preterms who had thrombocytopenia. Data of neonates was collected by direct interviewing of the mothers or other family members, clinical assessment and examination and relevant investigations were done. Results: The frequency of preterm neonatal thrombocytopenia was 95 (13.04%), out of 728 neonates admitted to neonatal care unit. Male to female ratio was 1.37:1, male gender was significantly associated with prematurity and mild to moderate severity thrombocytopenia (P 0.016, P 0.019). Prematurity was significantly associated with late onset neonatal thrombocytopenia (P 0.035). Late-onset thrombocytopenia, and 32- <37 wk gestational age group were significantly associated with mild to moderate severity thrombocytopenia group (P 0.008, and 0.004 respectively). Sepsis was a frequently associated risk factor in thrombocytopenic preterms, and found in 70 (73.68%) cases of preterm thrombocytopenia (with only 8 cases were culture positive and 62 cases were clinical based diagnosis). Also birth asphyxia, respiratory distress syndrome, and Rh incompatibility were significantly associated with thrombocytopenic prematures (P 0.026, 0.001, 0.008 and 0.036 respectively). Birth asphyxia, respiratory distress syndrome, sepsis and Rh incompatibility were significantly associated with moderate to severe thrombocytopenia (P 0.001, 0.001, 0.003 and 0.011 respectively). There was no significant difference between the presence of maternal disease and gestational age to the severity of neonatal thrombocytopenia (P 0.458, 0.698 respectively). Conclusions: Preterm thrombocytopenia is relatively common in neonatal care units. Sepsis, respiratory distress syndrome and birth asphyxia were significant neonatal risk factors of thrombocytopenia at lower gestational age preterms. Most episodes were late onset with mild or moderate severity.
[ABSTRACT]   Full text not available  [PDF]
  55 9 -
Comparative effects of three iron chelation therapies on the quality of life of patients with homozygous transfusion-dependent beta-thalassemia
Jamal Q walii, Majid Naji Agha
December 2015, 14(2):33-37
Background: Beta-thalassemia is a genetically inherited disorder characterized by reduced synthesis of the beta chain hemoglobin. Treatment consists of blood transfusion and chelating therapy in a form of paranteral deferoxamine (DFO) and oral deferasirox (DFX). Aim of the study: To compare the quality of life, patient satisfactory adherence to the three different modalities of treatment. Objectives: To compare three groups of patients receiving different modalities of treatment and the effect on their daily activities. Patients and methods: A total of 270 patients (118)male and (152) female enrolled in the study, their age ranging from (10.5 year)-till (17 year), for the period from (May 2013—till May 2014), A special Questionnaire was arranged including three parts, First was on demographic data, the second part included Wallstons health locus of control scale and the third part included the patients satisfaction. Results: The ratio of male to female were (1—1.3).The most common drug used was (DFX) (55.5%).Life style scale regarding ability to perform daily activity showed (90.6%) of patients on (DFX). About patient adherence to treatment (45.3%) of (DFX) group of patients. Conclusion: It is concluded that optimal chelating therapy should be individualized for each patient to enhance their adherence and improve the quality of their life.
[ABSTRACT]   Full text not available  [PDF]
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Thoracic epidural anaesthesia for laparoscopic cholecystectomy in patient with type Iv spinal muscular dystrophy
Tariq Torkey Atta, Saad Muhammad Wajih, Zinah Majid Mnati
June 2015, 14(1):74-78
Spinal muscular atrophy (SMA) is a rare genetic neurodegenerative disease characterized by degeneration of spinal cord lower motor neurons, which results in atrophy of skeletal muscles, hypotonia and muscle weakness. Patients with type IV SMA often have onset of weakness at adulthood. Anesthetic management is often difficult in these patients as a result of muscle weakness and hypersensitivity to neuromuscular blocking agents also succinylcholine induced hyperkalemia, postoperative intensive care unit admission and long hospital stay. Laparoscopic surgery is normally performed under general anesthesia, but regional techniques have been found beneficial, usually in the management of patients with major medical problems. The goals for anesthetic management of these patients include satisfactory anesthesia during surgery, excellent postoperative analgesia with minimal compromise of respiratory function without exacerbation of neurologic signs and symptoms. We describe a 37-year-old male patient with type IV SMA scheduled for laparoscopic cholecystectomy. We decided to use an epidural technique to avoid muscle relaxants, tracheal intubation and to evaluate the efficacy and feasibility of thoracic epidural anesthesia for laparoscopic cholecystectomy, so that it can be used later as Anesthetic technique in patients when general anesthesia is not feasible. After operation, there was no exacerbation of neurologic signs and symptoms or development of respiratory complications neither a need for intensive care unit admission.
[ABSTRACT]   Full text not available  [PDF]
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Serum profile of cytokines in Iraqi inflammatory bowel disease patients
Hazima M Al-Abassi, Maha F Nazal, Ali H Ad'hiah, Khawala I Mushe'al, Istabraq H Mubarak, Ifitkhar A Alqaisy, Alyaa W Saadi, Samer S Kadhim
December 2015, 14(2):11-16
Background: Studies indicated that IBD-related tissue damage results from a dynamic interplay between immune and non-immune cells, in which cytokines are crucial mediators. Aim: To determine serum level of eight cytokines (IL-2, IL-4, IL-8, IL-10, IL-12, IL-17A, IP-10 and IFN-γ) in inflammatory bowel disease (IBD) Iraqi patients. Patients and Methods: The IBD patients (54 ulcerative colitis; UC and 25 Crohn's disease; CD) attended the Gastrointestinal Teaching Hospital in Baghdad for diagnosis and treatment during the period March-August 2012. Serum level of cytokines was determined by ELISA method. Results: Four cytokines showed significant variations between UC patients and controls. Levels of IL-8 (2.47 ± 0.35 vs. 0.48 ± 0.19 pg/ml), IL-12 (5.06 ± 0.47 vs. 1.58 ± 0.79 pg/ml) and IP-10 (6.96 ± 1.02 vs. 1.98 ± 0.76 pg/ml) were increased in patients, while level of IL-10 (2.72 ± 0.44 vs. 7.33 ± 2.32 pg/ml) was decreased. In CD patients, levels of IL-8 (3.26 ± 0.56 vs. 0.48 ± 0.19 pg/ml), IL-12 (4.71 ± 0.79 vs. 1.58 ± 0.79 pg/ml) and IP-10 (5.03 ± 1.50 vs. 1.98 ± 0.76 pg/ml) were also significantly increased in patients compared to controls. Comparing UC and CD patients revealed that IL-10 level was significantly decreased in UC patients (2.72 ± 0.44 vs. 5.79 ± 1.10 pg/ml), while IFN-γ was significantly increased (5.99 ± 0.49 vs. 3.78 ± 0.61 pg/ml). Conclusion: These findings highlight a pathogenic role of these cytokines in UC and CD patients.
[ABSTRACT]   Full text not available  [PDF]
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