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  Most popular articles (Since January 16, 2018)

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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.
  2,369 298 -
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.
  2,215 327 3
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
  1,901 254 1
Evaluation of the gastrointestinal clinical, endoscopic, and histological findings in patients with bile reflux diseases: A cross-sectional study
Sabeha Al-Bayati, Ahmed Sahir Alnajjar
January 2019, 18(1):10-15
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.
  1,654 201 -
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.
  1,693 97 -
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.
  1,547 204 -
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.
  1,540 164 -
Trend of cholera in Iraq in the time of unrest
Ashraf M. A Hussain, Riyadh K Lafta
January 2019, 18(1):1-4
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.
  1,403 235 -
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.
  1,386 203 1
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.
  1,416 172 -
Determination of carbohydrate antigen 19-9 level in Sera of Iraqi patients with type 2 diabetes mellitus
Russul Riedh Al-Hamaoy, Hassan H Al-Saeed, Mahmood Shakir Khudhair
January 2019, 18(1):20-23
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.
  1,353 162 -
Thyroid dysfunction in patients with uncontrolled type 2 diabetes mellitus
Haidar Fadhil Al-Rubaye
January 2019, 18(1):16-19
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.
  1,313 174 -
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.
  1,289 163 -
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.
  1,243 183 -
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.
  1,250 146 -
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.
  1,232 157 -
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.
  1,203 145 -
Trends of under-five mortality in Nineveh (2004–2013): A time series analysis
Najlaa Ibrahim Mahmood Al-Sammak, Humam Ghanim Ibrahim
January 2019, 18(1):5-9
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.
  1,184 153 -
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.
  1,147 133 -
Employing qualitative research in medical education research
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
July-December 2018, 17(2):104-105
  1,057 155 -
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.
  1,066 143 -
The significance of (platelet/white blood cell) counts ratio in screening for high risk for preeclampsia and its related complications
Wisam Akram, Duha Muaeed
January 2019, 18(1):36-42
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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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.
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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.
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The association of serum copper with ceruloplasmin and zinc with folic acid levels in recurrent pregnancy loss in Iraqi Women
Olaa Riad Kadim, Shatha M. J. Al-Khateeb, Esraa H Humadi
January 2019, 18(1):43-46
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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