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   Table of Contents - Current issue
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July-September 2019
Volume 16 | Issue 3
Page Nos. 167-265

Online since Wednesday, September 25, 2019

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ORIGINAL ARTICLES  

Evaluation of Serum Vitamin D level in patients with inflammatory bowel disease in Duhok Governorate Highly accessed article p. 167
Azad Saleh Mohammed
DOI:10.4103/MJBL.MJBL_17_19  
Background: Vitamin D deficiency is a common problem in patients with inflammatory bowel diseases (IBDs). Objectives: The aim of the current study was to measure serum Vitamin D concentrations (25 (OH) D) in patients with IBD and examine its relation to the severity of disease. Materials and Methods: This was a prospective cross-sectional study of adult patients diagnosed with IBD including ulcerative colitis and Crohn's disease compared to sex-matched controls from an outpatient clinic in a public hospital in Iraq between February 2018 and May 2018. The Vitamin D deficiency levels were assessed as below 20 ng/ml as deficient, between 20 and 30 ng/ml as insufficient, and >30 ng/ml as sufficient level. Results: Serum Vitamin D levels were measured in 145 patients including 68 patients (median age: 30.5 ± 17.25) and 77 healthy controls (median age: 52.00 ± 12.25) ranged 18–63 years. Further, the median length of disease progression was 3.0 years. Serum Vitamin D levels were significantly lower in patients (IBD or separately) compared to healthy controls. However, such significant difference was not found between patients with respect to Vitamin D and disease severity. In addition, it was confirmed that disease severity is related to Vitamin D deficiency in IBD patients. Conclusions: The current study revealed that the patients with IBD have a significantly lower level of Vitamin D compared to healthy control group. In addition, the Vitamin D deficiency is related to disease severity.
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Maternal and fetal risk factors associated with hypospadias in a sample of Iraqi boys Highly accessed article p. 174
Saif H Al-Tamimi, Firas S Al-Quraishi, Aseel A Naji
DOI:10.4103/MJBL.MJBL_16_19  
Background: Hypospadias is one of the most common congenital anomalies among boys. The exact causes of this anomaly are not clearly defined yet. However, many of the risk factors have been identified in different ethnic groups. Objective: The objectives of this study are to evaluate the maternal- and fetal-related risk factors for hypospadias in a sample of Iraqi patients. Materials and Methods: This case–control study included 42 boys with hypospadias cases and other 42 age-matched boys free from any genital anomalies as a control group. Maternal data, including age, parity, body mass index, hypertension, diabetes mellitus (DM), the use of assisted reproduction techniques (ART), level of education, consanguinity, and residence; and infant-related factors. Logistic regression analysis was used to predict the risk of each variable through the calculation of odds ratio (OR) and its corresponding 95% of confidence interval (CI). Results: Three maternal factors were found to be associated significantly with increased risk of hypospadias. These were maternal age >33 years (OR = 3.08, 95% CI = 1.02–9.26, P = 0.045), consanguineous marriage (OR = 3.0, 95% CI = 1.02–8.8, P = 0.045), and rural residence (OR = 2.64, 95% CI = 1.04–6.73, P = 0.041). Hypertension, DM, and using ART were more frequent among mothers of cases than controls; however, the differences were not significant. For fetal-related factors, infants with low-birth weight (LBW) were more frequent among cases than controls (40.48% vs. 19.05%), with a statistically significant difference (OR = 2.89, 95% CI = 1.08–7.75, P =0.035). Of note, twins were more frequent among cases than controls; however, this difference was not statistically significant (P = 0.074). Conclusions: These results highly suggest the critical role of advanced maternal age, consanguinity, rural residence, and infant LBW, as predisposing factors for the occurrence of hypospadias among Iraqi boys.
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Expression of beta-human chorionic gonadotropin as a prognostic factor in colorectal carcinoma p. 179
Hameed Naeem Mosa, Esraa Abdulaal Aldujaily, Ali Jabir Duabil, Liwaa Hussein Alkelabi, Azhar Naji Alnajim, Faiza Aftan Al-Rawi
DOI:10.4103/MJBL.MJBL_38_19  
Background: Colorectal carcinoma (CRC) is a common malignancy in Iraq and carries a high mortality rate. It has been shown that CRCs express high level of beta-human chorionic gonadotropin (β-HCG) as detected by immunohistochemistry. Objectives: The aim of this study was to assess the expression of β-HCG in CRC and to study the association between β-HCG expression and pathological prognostic parameters. Materials and Methods: This study was carried out on 35 colonic specimens consisting of 30 CRC selected from files of Pathologic Laboratory of Al-Kadhymia Teaching Hospital and Teaching Laboratories of the Medical City, Baghdad. Paraffin blocks were cut sections stained with H and E stain and sections for streptavidin-biotin immunohistochemical staining using monoclonal antibody against β-HCG. Immunohistochemical sections were examined for positive or negative staining and positivity assessed as: occasional, focal, and diffuse tumors. Results: Of the 30 CRCs, 60% were male and 40% were female. The most common site of large bowel malignancy was the rectum 13 (43.3%). Most of the tumors were moderately-differentiated adenocarcinoma (83.3%). More than half of the cases were Stage T3, followed by Stage T2, then Stage T4, 3 cases (10%), and no case in Stage T1. Lymph node metastases were found in 19 cases (63.3%). Twelve cases (40%) of CRC show immunoreactivity to β-HCG. β-HCG expression was more frequent in the left side of the large bowel and more common in poorly-differentiated adenocarcinoma (80%). β-HCG was more positive in Stage T4, and there was significant association with lymph node metastasis. Conclusion: Expression of β-HCG in CRC is not an infrequent phenomenon, and no stain was demonstrated in benign and normal colonic specimens, while β-HCG expression associated with poor differentiation, greater local invasion, and regional lymph node metastasis.
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Hematological parameters in children with type-1 diabetes p. 184
Kamal Hussein Khudhur, Mouroge Hashem Al-Ani
DOI:10.4103/MJBL.MJBL_24_19  
Background and Objective: This study was done to investigate and compare the hematological parameters related to hemoglobin (Hb), total white blood cell (WBC) count, and platelet parameters in a case–control study of patients with diabetes with those of nondiabetic healthy persons, potentially predisposing patients with diabetes to complications. Materials and Methods: A case–control study consisted of 50 children with type I diabetes have been diagnosed since 5 years attending Laila Qasim Diabetic Center compared with another 50 nondiabetic healthy children attending Pediatric Clinic at Raparin Pediatric Hospital from October 2018 to March 2019. Investigations were done as follows: (a) both patients and controls including Hb (g/dl), total WBC count (109/L), platelet count (109/L), mean platelet volume (MPV) (fl), platelet distribution width (PDW) (fl), platelet-large cell ratio (P-LCR) (%), and (b) patients only HbA1C (%) to know their control state. Results: WBC, MPV, PDW, and P-LCR were significantly higher among children with diabetes in comparison with the control group (WBC 9.34 ± 1.56 109/L vs. 8.14 ± 1.88 109/L, P = 0.001; MPV 9.60 ± 1.13 fL vs. 8.07 ± 0.87 fL, P = 0.001; PDW 11.91 ± 1.18 fL vs. 10.03 ± 1.1 fL, P = 0.001; and P-LCR 19.34% ± 4.85% vs. 12.09% ± 4.37%, P = 0.001); Hb was significantly lower among children with diabetes in comparison with the control group (Hb 12.61 ± 0.75 g/dl vs. 12.89 ± 0.64 g/dl, P = 0.04); No significant difference was detected between the two groups regarding platelet count. Conclusion: The study revealed that hematological parameters changed as a result of diabetes mellitus, especially Hb was decreased among patients with diabetes and WBC, MPV, PDW, and P-LCR were highly elevated in type I as compared with nondiabetic participants.
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Seroprevalence of toxoplasmosis in aborted women in Babylon Province, Iraq p. 188
Lawhedh Jasim Mohammed, Mohammed Salih Al-Janabi
DOI:10.4103/MJBL.MJBL_26_19  
Background: Toxoplasmosis is considered as one of the most prevalent human parasitic infections that can be transmitted from mother to the fetus. The onset of toxoplasmosis during pregnancy has clinical complications, including spontaneous abortion, preterm labor, stillbirth, and fetal abnormalities. Objective: The aim of this study was to investigate the seroprevalence of toxoplasmosis infection in aborted women. Materials and Methods: Seventy-five sera samples were collected from the women admitted in the obstetrics and gynecology ward with abortion. The blood samples were processed appropriately and tested for Toxoplasma gondii IgM and IgG using enzyme-linked immunosorbent assay (ELISA) technique, in addition to latex agglutination test (LAT) as a screening test. Results: Seropositivity of aborted women to T. gondii was 42.6% when used LAT while 4% and 22.6% when detection of T. gondii IgM and IgG respecyively ELISA.the highest percentage of infection was found to be 18.6% in the age group of 21–25 years, in patients inhibited in rural area. Also seropositive in women with double frequent of abortion. Conclusion: ELISA test was the best method to investigate toxoplasmosis in aborted women, especially with recurrent spontaneous abortion.
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S100A4 and S100A6 proteins expression promote migration of Bladder cancer cells in Zebrafish p. 192
Hanaa Al-Mahmoodi, Ibtihal Alshamarti, Qais Ibraheem Al-Ismaeel, Ahmed Mohamed Salih, Hishyar Azo Najeeb, Rusul Mohammed Al-Rubaay
DOI:10.4103/MJBL.MJBL_34_19  
Background: Bladder cancer (BC) is one of the major causes of cancer-related mortality in the world. S100 family of small Ca-binding proteins has been implicated in the progression of different cancer types, including BC. Objective: The goal of this study is to develop a more rigorous understanding of the role of S100 proteins in BC progression and also to what extent S100s have the ability to increase the metastatic potential for BC. Methods: A selected panel of bladder cell lines (J82, T24, HT1376, and RT112) was transplanted into zebrafish embryos to investigate their migration behavior and metastatic potential. Characterizing the expression pattern of S100 proteins including (S100A4 and S100A6) in different BC cells was performed using quantitative polymerase chain reaction and Western blot. Assess the effect of S100 proteins on bladder cell migration in vivo was carried out using a zebrafish xenotransplant model. S100 proteins expression was modulated by small-interfering RNA approach. Results: High expression of mRNA and proteins levels of S100A4 and A6 were detected in T24 and J82 cell lines, which displayed the highest migration rate in zebrafish embryos. In addition, our data showed that the average migration rate of T24 cells transfected against S100A4, S100A6, and S100A4 and A6 were 17.3%, 10%, and 17.3%, respectively, which was lower than from siControl 41.9%. Likewise, the same effect of protein silencing on cell migration was observed in J82 cell lines. S100A4, S100A6, and S100A4 and A6 knockdown reduced the migration rate of J82 cells to 14.6%, 17%, and 14% compared to the control 37.8%. Furthermore, overexpressed S100A4 expression in RT112 cells significantly increased in migration ability by 29%, compared to control cells 7.3%. Conclusion: S100A4 and S100A6 play a role in BC cells invasion and migration. Silencing of these proteins affected dissemination of BC cells in zebrafish embryos highlighting their role in tumor progression.
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A comparative study of diagnostic nasal endoscopy and computed tomography in chronic rhinosinusitis p. 199
Rawand Kamaran Hussein, Said Mustafa Said Jaf
DOI:10.4103/MJBL.MJBL_20_19  
Background: Chronic rhinosinusitis (CRS) is a common condition in medical practice. It is defined as inflammation of the mucosa of nose and paranasal sinuses, the fluids within these cavities, and/or the underlying bone that has been present with or without treatment for at least 12 weeks' duration. Objective: This study aimed to determine the correlation of nasal endoscopy examination and computed tomography (CT) in the early diagnosis of CRS. Materials and Methods: The study was carried out in outpatient Department of Otorhinolaryngology, in Rizgary Teaching Hospital in Erbil. A total of 60 patients with clinical evidence of sinonasal diseases were evaluated with nasal endoscopy and computed tomographic evaluation. Patients with previous variation of paranasal sinus anatomy due to facial trauma and former sinus surgery were rejected. Patients with history of having malignant neoplasms or congenital malformations were also excluded from the study. Results: Sixty patients with chronic rhinosinusitis participated in the study. Their mean age + standard deviation was 38.18 + 10.19 years, ranging from 20 to 63 years. The median was 37.5 years. The largest proportion (41.7%) of the sample aged 30–39 years old, and only 16.7% aged ≥50 years. The main symptoms of the patients were nasal obstruction (80%), ear pressure (80%), and nasal discharge (78.3%). No significant difference was detected between the two tests regarding their findings. Conclusion: Nasal endoscopy have sensitivity and specificity almost as good as CT scanning, and being an outpatient procedure, it may reduce unnecessary diagnostic scanning procedures.
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The modified alvarado score versus alvarado score in the diagnosis of acute appendicitis p. 203
Suzan Safar Sulo, Hisham Ahmad Al-Atrakchi
DOI:10.4103/MJBL.MJBL_48_19  
Background: Appendicitis is the most common surgical emergency presented daily to emergency surgical department. The Modified Alvarado Scoring System (MASS) is easier and applicable in the diagnosis of acute appendicitis using extra signs instead of neutrophilic left shift. Objective: The aim of this study is to compare and evaluate the diagnostic accuracy of MASS versus the Alvarado scoring system. This study was carried out in Duhok Emergency Teaching Hospital, Iraq, over the period of 12 months, from October 2017 to October 2018. Materials and Methods: A cross-sectional study including 200 patients, diagnosed with acute appendicitis by the senior surgeon on call and underwent conventional open appendicectomy. MASS were applied to all patients preoperatively by author and results of both scores compared to operative and histopathological findings of excised appendix to analyze the efficacy of both scores in the diagnosis of acute appendicitis. Results: Of 200 patients who underwent operation those with Alvarado score of 9–10 had sensitivity of 88% and specificity of 100%. Those with a score of 7–8 had sensitivity of 63% and specificity of 68%. For MASS patients with score of 9–10 had sensitivity of 96% and specificity of 100%, and those with a score of 7–8 had sensitivity of 77% and specificity of 86%. The higher the score, the sensitivity and specificity increased. Positive predictive value and accuracy of neutrophilic left shift of Alvarado were 95% and 65%, positive predictive value and accuracy of extra signs of modified Alvarado score were 97% and 84% respectively. Conclusion: Both Alvarado and MASS are fast, simple, and repeatable systems in the diagnosis of acute appendicitis. This study reveals that accuracy of MASS is higher than Alvarado score, and the rate of negative appendicectomy can be reduced using this system.
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Echocardiography assessment of the left ventricular systolic function and regional wall motion abnormalities pre- and post-coronary artery bypass grafting surgery p. 207
Vazheen Abdul Hameed Ismael, Mousa Haji Ahmed, Maher Mohamad Amin Taher
DOI:10.4103/MJBL.MJBL_51_19  
Background and Objective: Coronary artery disease is a significant global health problem and is a leading cause of disability and death. In this study, the effect of coronary artery bypass graft (CABG) surgery on left ventricular (LV) systolic functions and regional wall motion abnormalities in the 1st week and 3rd month after surgery was evaluated through echocardiographic techniques. Patients and Methods: Fifty patients who underwent elective isolated CABG at Azadi Heart Center were included and studied prospectively from November 2018 to May 2019. Transthoracic two-dimensional echocardiography was used to assess the LV-systolic function (LV ejection fraction [LVEF]) and wall motion score index (WMSI) and abnormalities. Results: Almost all patients had chest pain preoperatively, and 32% and 38% of them were in Canadian Cardiovascular Society (CCS) Class III and IV, respectively. Ninety percent had multivessel disease, and the left anterior descending was the most common vessel affected (86%), complete revascularization was done in all patients using 3–6 grafts, and left internal mammary artery was used in 48 patients (96%). There was no significant improvement in LVEF in the early postoperative period (P = 0.28). On the contrary, there was a highly significant improvement of LVEF lately postoperatively, which was improved from (49.62%–56.92%) at (P ≤ 0.001). As well, there was a substantial improvement of WMSI at lately postoperative (P = 0.026) that changed from (1.204 to 1.12). Conclusions: The present study suggests that CABG has a positive effect on LV systolic functions and regional wall motion abnormalities 3-month post-operatively as confirmed through echocardiographic techniques.
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Role of intracranial ultrasonography in the evaluation of premature babies p. 215
Balen Karim Salih, Abbas Abdulkadir Rabaty
DOI:10.4103/MJBL.MJBL_21_19  
Background and Objective: In this study, the role of intracranial ultrasonography was evaluated in detecting intracranial abnormalities in premature neonates; furthermore, some maternal risk factors were evaluated for increasing incidence of intracranial abnormalities. Materials and Methods: A prospective cross-sectional study was done on 60 preterm neonates admitted in the neonatal care unit in both Raparin pediatric teaching hospital and maternity teaching hospital over a 5-month period. Neurosonogram was carried out for all within 1 week of life, and then, a second brain ultrasound (US) scan performed for them after 1 week if the first one was abnormal and the third scan for those who were abnormal at the second visit. Results: Incidence of intracranial abnormalities by ultrasonography in preterm neonates is 13.3% in the present study. There were 50% male and 50% female neonates. Ten percent of the study sample had evidence of intraventricular bleeding, and 3.3% had ventricular dilatation. There is a significant association between maternal risk factors and incidence of intracranial abnormalities (P = 0.01), and furthermore, there is a significant association between weight and gestational age (P = 0.001). There is no significant association between US finding with each of weight, gestational age, gender, and mode of delivery. Conclusion: Neurosonogram is the best initial method of investigation for preterm babies in the evaluation of intracranial abnormalities even if clinically silent. Maternal risk factors should be taken into consideration in increasing incidence of intracranial abnormalities. It is best to perform neurosonogram studies on all preterm babies within the 1st week of birth. It is widely available, cheap, and repeatable.
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Silent thyroid function abnormalities in patients undergoing coronary angiography p. 220
Ameen Mossa Mohammad, Joma Aziz Joma, Bayar Ahmed Qasim, Ahmed Hassan Yousif
DOI:10.4103/MJBL.MJBL_49_19  
Background: Iodine is an essential element in the formation of thyroid hormones, the body may encounter situations in which high iodine load occur in the body like doing the contrast studies using the iodine-containing contrast media. In most people, this iodine load is well-tolerable; however, in some others, this may result in derangements in the thyroid function, from which hyperthyroidism is the most common. Objective: The objective of the study is to determine the subclinical changes in the thyroid functions in a cohort of patients with coronary artery disease (CAD) undergoing coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). Materials and Methods: In this pilot study, a total of 101 patients with CAD undergoing CAG and/or PCI were recruited during the year 2018. All cases had normal thyroid function tests including (thyroid-stimulating hormone [TSH], free T4, and free T3) preprocedural. Six weeks after CAG/PCI serum TSH, free T4 and T3 were assessed again. Results: No significant differences were observed in levels of TSH, free T4, and free T3 between preprocedures (CAG/PCI) and after 6 weeks with P values (0.645, 0.135, and 0.807), respectively. In addition, no difference was found between the subgroup of CAG versus PCI. Conclusion: In euthyroid patients undergoing CAG/PCI minimal changes could occur in thyroid function. However, these changes are of limited significance in the short term.
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Rituximab for the treatment of pemphigus and pemphigoid: A case series of ten patients p. 224
Safaa S Alwaash, Khalid H Al-Shibly
DOI:10.4103/MJBL.MJBL_25_19  
Background: Autoimmune bullous skin disorders are rare but potentially fatal disorders of the skin and mucous membranes. These diseases may require long-term treatment with systemic corticosteroids and other immunosuppressive drugs, which can lead to serious adverse events. Rituximab has proved to be effective form of therapy for pemphigus and pemphigoid. Objective: The aim of this study was to evaluate the effectiveness of a full coarse treatment with rituximab for cases of pemphigus and pemphigoid. Materials and Methods: A case series study involved ten cases of pemphigus and pemphigoid consulted the Dermatology Department of Merjan Teaching Hospital, Babylon, and treated with a full course of rituximab. Results: A complete remission (CR) has been achieved in the vast majority of cases, whereas the side effects were trivial and rare. Conclusions: Rituximab has proved to be effective form of therapy for pemphigus. A CR has been achieved in the vast majority of cases, whereas the side effects were trivial and rare.
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The pregnancy outcome in patients with minor β-thalassemia p. 229
Evar Mohammed Saeed Ismael, Maida Yousif Shamdeen
DOI:10.4103/MJBL.MJBL_35_19  
Background: Physiologic alterations during pregnancy worsen the anemia severity, and they are associated with an increased risk of fetal growth restriction, low birth weight, and preterm birth. Objective: The aim of the present study was to determine pregnancy outcomes in women with minor β-thalassemia. Materials and Methods: A total of fifty women who attended the consultation clinic of Azadi Teaching Hospital for antenatal care visit were screened consecutively and included in the present cross-sectional study in Duhok, Iraqi Kurdistan. The patients were followed up until delivery for pregnancy outcomes from May 20, 2018 to February 10, 2019. Results: About 14.0% of the patients had a history of baby death. The most prevalent clinical features were anemia (18.0%) and a history of preeclampsia (16.0%). Most of the patients had undergone a trial of normal vaginal delivery (80.0%), and 14.3% of their newborns were admitted to the neonatal intensive care unit (NICU). Only one of newborns died at 5 min following delivery due to a low Apgar score. The study showed that neonates who were admitted to the NICU had lower Apgar scores after 1 and 5 min compared to nonadmitted group (5.71 and 6.71 vs. 7.24 and 9.29, respectively). The mothers of the neonates who were admitted to the NICU had a higher prevalence of previous dead baby (42.9%; P = 0.031), previous history of preeclampsia (57.1%; P = 0.005), and more likely to undergone cesarean section (C/S) (71.4%; P = 0.001). Conclusions: The present investigation suggests that the β-thalassemia newborn admitted to the NICU had a higher prevalence of clinical issues compared to those not admitted to the NICU.
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The relation between polycystic ovary syndrome and Vitamin D deficiency p. 234
Nohra Behnam Israel, Maida Yousif Shamdeen
DOI:10.4103/MJBL.MJBL_37_19  
Background: Vitamin D deficiency is common in women with polycystic ovary syndrome (PCOS). Vitamin D deficiency is a common health condition in the reproductive period of women and may escalate the symptoms of PCOS in women. Objective: The aim of this study was to investigate the association between serum Vitamin D levels in patients with PCOS compared to healthy controls. Materials and Methods: In the present case–control study, a total of 70 women diagnosed with PCOS were considered cases, and their Vitamin D levels and some other biochemical parameters were compared to 43 apparently healthy controls. The diagnosis of PCOS was established in line with the Rotterdam Consensus on Diagnostic Criteria for PCOS, including oligo or anovulation, clinical and biochemical signs of hyperandrogenism, and polycystic ovaries and exclusion of other etiologies (congenital adrenal hyperplasia, androgen-secreting tumors, and Cushing's syndrome). Results: The study revealed that patients with PCOS were significantly younger compared to the healthy controls; 26.57 versus 33.51; P < 0.001. Moreover, a higher percentage of patients had irregular menstruation (81.4%) and hirsutism (81.4%) compared to controls (4.7% and 4.7%, P < 0.001, respectively). The study revealed that the patients had a significantly lower level of Vitamin D and serum prolactin and higher levels thyroid-stimulating hormone compared to healthy control; 5.49 versus 17.83 ng/ml; 11.94 versus 8.57 IU/L; and 2.50 versus 1.72 IU/L, respectively. Conclusion: The present study suggests that patients with PCOS were more likely to have irregular menstruation and a lower level of Vitamin D compared to apparently healthy controls.
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The association of duration of QRS complex in left bundle branch block with left ventricular systolic function p. 238
Farznda Mustafa Salih Zebari, Abdulkareem Abdulwahab Al-Othman
DOI:10.4103/MJBL.MJBL_42_19  
Background: Left bundle branch block (LBBB) indicates organic heart disease. It is responsible for a greater degree of asynchrony in the left ventricular (LV) contraction as a result of alteration in LV depolarization sequence. This study aimed to compare the duration of QRS complex in LBBB in relation to LV systolic function by two-dimensional transthoracic echocardiography. Patients and Methods: In this cross-sectional study, 82 patients with LBBB were divided into two groups. Group I defined as QRS <160 ms and Group II defined as QRS ≥160 ms. Then, the relationships between QRS duration and echocardiographic LV ejection fraction (EF) were derived. LV systolic dysfunction defined as EF <40%. Results: Eighty-two patients with (LBBB) had been included in the study, the duration of the QRS complex of 55 patients (67%) was <160 ms (Group I), and it was ≥160 ms (Group II) in 27 patients (33%). More than half (55.6%) of Group II aged ≥70 years compared with 38.2% of Group I (P = 0.001). Group II had high incidence of LV systolic dysfunction (70.4%) compared with 20% in Group I, while 18.2% of Group I had an EF of ≥60% compared with 3.7% in Group II (P < 0.001). Conclusion: The prolongation of QRS duration (≥160 ms) in LBBB is a marker of significant LV systolic dysfunction.
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Rubella virus seroprevalence and associated factors in pregnant women with and without previous spontaneous abortion p. 243
Raghad Adel Mohammed, Mohammed Talab Kokaz
DOI:10.4103/MJBL.MJBL_43_19  
Background: Rubella virus infection is associate with various pregnancy outcomes. Usually, such infection is more prevalent among women with low positivity for protective immunoglobulin G (IgG). Several factors are known to influence the seroprevalence of this virus. Objectives: This study aimed to investigate the seroprevalence of anti-rubella IgG and immunoglobulin M (IgM) antibodies and associated factors among pregnant women with and without a history of abortion. Materials and Methods: A total of 91 pregnant women (79 women with a history of previous abortion and 12 women without such history) were enrolled in this cross-sectional study. Sera were collected from each woman, and the levels of rubella IgG and IgM were measured using enzyme-linked immunosorbent assay. Demographic and reproductive data for the women were also collected. Univariate logistic regression was used to find the association of factor with serostatus of the virus. Results: The overall seropositivity for IgG and IgM was 95.6%, (95% confidence interval [CI] = 91.3–99.9) 9.89%, (95% CI = 9.68–10.1), while six women (6.59%) were positive for both types of Igs. Two factors showed a significant association with rubella IgG seropositivity: A history of previous abortion (odds ratio [OR] = 0.68, 95% CI = 0.45.0.99, P < 0.001). Moreover, urban residence (OR = 1.09, 95% CI = 1.0–1.19, P = 0.048). On the other hand, younger age (≤28 years) (OR = 0.1, 95% CI = 0.01–0.82) and previous abortion (OR = 0.14, 95% CI = 0.03–0.61) were significantly associated with IgM positivity. Conclusions: Most women are protected from rubella virus infection through possessing a high level of IgG; however, there is a considerable proportion with evidence of acute infection which indicate that the virus is endemic in the study area.
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Fetal and maternal outcomes in oligohydramnios pregnancy (37–40 weeks of gestation) at labor p. 248
Hividar Abdulqahar Majeed, Maida Yousif Shamdeen
DOI:10.4103/MJBL.MJBL_36_19  
Background: The role of amniotic fluid is to provide a protective environment for fetus growth. The low volume of amniotic fluid (oligohydramnios) has been reported to associate with perinatal and neonatal outcomes. Objectives: The aim of this study was to explore the effect of oligohydramnios on fetal outcomes at intrapartum and early neonate, including fetal distress. Materials and Methods: In the present investigation, the pregnant women who attended the labor ward of Duhok Maternity Hospital were consecutively screened for eligibility criteria. The patients presented with oligohydramnios from 37 to 40 weeks of gestation to labor room were included in this study and were followed up for neonatal outcomes. The diagnosis of oligohydramnios was established as an amniotic fluid index of 5 cm or less by the ultrasound examination. Results: The mean age of the women with oligohydramnios was 26.10 ± 5.20 years ranged between 16 and 40. The mean age of the gestational age was 38.54 ± 1.13 weeks ranging from 37 to 40. The previous history of a dead newborn was so low (mean: 0.02 ± 0.14). Half of the patients delivered their pregnancies by cesarean section (C/S) (50.5%), and most of them had a good Apgar score value (98.8%). The study showed that women who had a past medical history or delivered by C/S, their newborns were more likely to admit to neonatal intensive care unit (NICU), 36.8% versus 12.1% (P = 0.017) and 78.9% versus 21.1% (P = 0.010), respectively. Conclusions: The present study recommends that pregnant patients diagnosed with oligohydramnios are at a higher risk of C/S and NICU admission.
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Prevalence of thyroid incidentaloma detected by high-resolution ultrasound and their potential risk of malignancy in healthy individuals in Basrah Province p. 252
Hanan Hamza Al-Rikaby, Ibrahim Falih Noori Al-Subaiee
DOI:10.4103/MJBL.MJBL_31_19  
Background: This study conducted to define the prevalence and potential risk of malignancy of thyroid incidentaloma in a healthy population using high-resolution ultrasound. Patients and Methods: A cross-sectional prospective study between December 2017 and March 2018, included 1200 asymptomatic adults participants (1000 women aged 15–70 years and 200 men aged 19–65 year). The prevalence of thyroid incidentaloma, their distribution according to age and sex, nodule size, ultrasound characteristics, and risk stratification of malignancy using Thyroid Imaging Reporting and Data System (TI-RADS) grade were studied. Fine-needle aspiration cytology (FNAC) examination was done for some specific patients. Results: The prevalence of thyroid incidentaloma was 27.3%. Thyroid incidentaloma were more prevalent in females and elderly people in both sexes mainly in 60–75-year-old peoples. Nodules were solitary in 244 (74.4%) and multiple in 84 (25.6%) patients. The size of 186 nodules (45.1%) were <5 mm, 112 incidentaloma (27.2%) were 5–10 mm, and 114 (27.6%) were more than 10 mm in size. Thyroid incidentaloma were cystic in 228 (55.3%), solid in 133 (32.3%), and complex in 51 (12.4%). Most solid nodules were hyperechoic (84/133, 63.2%), 29 (21.8%) isoechoic, and 20 (15%) were hypoechoic. 92.9% (171/184 solid and mixed nodules) were have well-defined and regular borders and only 13 nodules (7.1%) have irregular and ill-defined borders. Furthermore, 90.7% of solid and mixed nodules have wider than taller diameters. Microcalcifications were seen in three and macrocalcifications in two solid nodules. Of 412 incidentaloma, 258 were TI-RAD 2 score, 136 TI-RAD 3, and 18 nodules were classified TI-RAD 4. TI-RAD nodules 5 were not detected. Suspicious incidentalomas of TI-RAD 4 score were sent for FNAC examination. Papillary carcinoma detected in four nodules and follicular tumor in eight nodules, three of them proved to be follicular carcinoma. The rate of malignancy in thyroid incidentaloma was 1.7%. Conclusion: Thyroid incidentaloma is relatively common, and the majority are benign. Ultrasound characteristics and size of nodule could be a reliable screening tool for malignant potential of the thyroid nodule.
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Role of periostin in Iraqi asthmatic patients p. 256
Ameera Jasim Al-Aaraji, Suhayr Aesa Al-Qaysi, Ali Salih Baay
DOI:10.4103/MJBL.MJBL_39_19  
Background: Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. The understanding of the pathogenesis of the disease is essential to improve the plan of management. Objective: The objective of this study is to identify the role of periostin as inflammatory biomarker of asthma. Materials and Methods: A total of 200 participants were enrolled in the study, of which there are 100 controls and 100 asthmatic patients. Blood samples were obtained from the participants for periostin investigations by enzyme-linked immunosorbent assay assay. Results: Serum periostin concentrations were significantly (P < 0.001) higher in asthmatic patients (mean ± standard deviation [SD]; 68.152±9.792) compared to control group (mean ± SD; 46.488 ± 4.237). Periostin correlated negatively with forced expiratory volume (FEV) 1% and FEV1/forced vital capacity (FVC) in asthmatic patients. Conclusions: Serum periostin is increased in Iraqi asthmatic patients compared to controls and periostin correlated negatively with FEV1% and FEV1/FVC in asthmatic patients. Asthma is the most significant variable relates to high periostin serum concentration.
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Response of supraventricular tachycardia patients to modified Valsalva Maneuver in Rozhalat emergency hospital/Erbil City – Kurdistan Region of Iraq p. 261
Dara Farhad Abdulqadir, Halgurd Fathullah Ahmed, Shakawan Muhamad Ismaeel
DOI:10.4103/MJBL.MJBL_56_19  
Background: Supraventricular tachycardia (SVT) is one of the common presentations in accident and emergency department. Objective: The aim of the study was to measure out the number of the SVT patients that will respond to modified Valsalva maneuver (MVM). Materials and Methods: A cross-sectional study among done for 60 patients presented with SVT to Rozhalat Emergency Hospital in Erbil between June 15, 2018, and January 15, 2019, a questionnaire form designed to collect data and use MVM properly as the first line of treatment with care to keep the information private. Results: The study results revealed that majority of our sample are middle-aged (40–65 years) and female by 50% and 65%, respectively. Male gender patients were a better responder to modified Valsalva comparing to female gender 53.3% and 46.7%, respectively (though it is statistically not significant). As early patient presented with onset of symptoms, is better responded to modified Valsalva, those patients are divided into patients who come within 1st h (53.3%), within 1–3 h (46.7%), and after 3 h (0%). This was statistically significant. In general, modified Valsalva technique was successful to invert 25% of patients to sinus rhythm nonpharmacologically, and 8.33% of total patients that responded to modified Valsalva needed more than one trial. Conclusions: We can conclude from the study that males are better responders to modified Valsalva than females, As long as patients come early to the emergency room, the better they respond to modified Valsalva. We can also conclude that modified Valsalva was a very good technique for treating SVT patients.
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LETTER TO EDITOR Top

Continuing efforts to target all stakeholders to enhance the prevalence of breastfeeding p. 265
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/MJBL.MJBL_41_19  
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