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   Table of Contents - Current issue
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October-December 2019
Volume 16 | Issue 4
Page Nos. 267-370

Online since Monday, December 23, 2019

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ORIGINAL ARTICLES  

Video-assisted anal fistula treatment in the management of fistula-in-ano: A 3-year experience Highly accessed article p. 267
Hussein Oudah Al-Jasmawi, Alaa Bakir Raheem Al-Mhanaa, Mohammed Salih Al-Janabi
DOI:10.4103/MJBL.MJBL_79_19  
Background: Fistula-in-ano and especially the high and complicated type is still one of the difficult surgical problems to solve. The new promising technique, video-assisted anal fistula treatment (VAAFT) was done first by Professor P. Meinero in 2006. Objective: The objective of the study was to describe the technique and the encouraging result of VAAFT. Materials and Methods: Using Karl Storz Company fistuloscope, 200 patients with anal fistulas were treated in Babylon Private Hospital in Al Hilla (Center of Babylon Governorate). This was done in two phases: diagnostic phase including visualization of fistula tract and identification of internal opening, followed by the operative phase by cauterization, curettage of the tract, irrigation using 1% mannitol solution, and closure of the internal opening using no. 1 Vicryl (polyglactin). Results: From the 200 patients with anal fistulas, 40 patients (20%) had undergone classical fistula surgery. No major complications were recorded. Early and late postoperative pain and discomfort were mild. The cases followed up at 6 weeks and 3 months postoperatively. Primary healing rate was 70% at 12 weeks and 74% at 3-month follow-up. The overall healing rate percent after 1 year was 80%. Conclusion: VAAFT is a safe, sphincter-saving, painless procedure and can be done as a day case with promising preliminary results, and we can repeat the treatment till cure is achieved.
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The association of subclinical Vitamin D deficiency with severe acute lower respiratory infection in children under 5 years in Duhok p. 271
Akrem Mohammad Atrushi
DOI:10.4103/MJBL.MJBL_112_18  
Background: Vitamin D consumption can reduce susceptibility to respiratory tract infections in children. Objective: The aim of study was to measure the association of serum 25-hydroxyvitamin D3 with severe acute lower respiratory infections, controlling for demographic and other potential risk factors. Materials and Methods: A case–control study conducted from June 2017 to June 2018. Cases were <5 years of age in-patients with severe acute lower respiratory tract infections (LRTIs). Controls were healthy children <5 years old visiting the hospital. The child's demographic and other characteristics were studied. All participants had serum Vitamin D been measured. The cutoff of <10 nmol/l was considered deficiency, 10–30 nmol/l insufficiency, and >30 nmol/l normal. Results: The study included 50 cases and 50 controls. The mean serum Vitamin D level in the whole sample was 40 ± 6.7 ng/L (cases were 32.8 ± 27.38 ng/L and controls were 48.23 ± 59.1). The mean erythrocyte sedimentation rate of cases was 19.88 ± 12.8, the mean C-reactive protein 11.22 ± 8.03, the mean white blood cell 13.96 ± 5.13, and granulocyte 45.9%. The rate of Vitamin D deficiency was 14% whereas Vitamin D insufficiency is 48%. Weight-for-age was significantly related to vitamin level. Age of the patient, age of starting solid intake, sun exposure, and educational status of parents were significantly related to severe acute LRTIs. Conclusions: No significant association was found between severe acute respiratory tract infections and serum Vitamin D in the current study.
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Management of epidural hematoma in the pediatric age group p. 276
Mohammed Jaber Al-Mamoori
DOI:10.4103/MJBL.MJBL_47_19  
Background: Epidural hematoma (EDH) is a traumatic accumulation of blood between the inner table of the skull and the stripped-off dural membrane, which has been stripped from the overlying bone both by the direct trauma and by the hydrostatic force of blood. Pediatric EDH presented with both age-specific and/or atypical manifestations when compared with EDH in adults. Objectives: The aim of this study is to determine the management protocol of choice for pediatric EDH patients that can lead to an early diagnosis, effective treatment, and a good outcome for both operative and nonoperative groups of patients. Surgical management for EDH is the decision of choice for most cases, but still, there is a role for conservative management in selected cases. Materials and Methods: In this prospective study, 210 cases of pediatric EDH under the age of 18 years were studied during a 10-year period in the Neurosurgical Department of Hilla Teaching Hospital in Babylon, Iraq, from 2008 to 2018. This study considered the following parameters: characteristics of patients, clinical manifestations, mechanism of head injury with age-specific distribution, radiological findings, associated pathologies, management, source of bleeding in operated cases, correlated pathologies in dead patients, and outcome. Categorical variables are presented in the form of frequencies and percentages. Results: The age group >6-12 years have the highest incidence 33%. Males constituted 75% of the victims whereas females 25%. Accidental fall had the highest incidence of 47.1%. The classic clinical course of lucid interval was present in only 7% of cases. Supratentorial EDHs comprised 91% whereas infratentorial EDHs (posterior fossa) only 9%. Skull fracture was present in 92.2% of cases. Surgical evacuation was done in 110 cases whereas 100 cases were managed conservatively. Middle meningeal artery or vein was identified as a source of bleeding in 50% of the operated cases. Glasgow outcome scale was applied to assess the outcome and to compare the outcome in both operative and conservative groups. The overall mortality was 6.7%. Conclusion: EDH is a life-threatening entity in the pediatric age group, so that special attention and a high index of suspicion are required. Clinical and neuroimaging assessments by computed tomography scan have a fundamental role for optimal therapeutic decision. Both surgical and conservative management should have excellent outcome if they accomplished on solid basis. Conservative management should be achieved in specialized neurosurgical centers that can assure rapid conversion to surgical intervention in case of neurological deterioration. In borderline cases, surgical evacuation of EDH may spent less hospital stay time with better cost–benefit ratio than conservative management. Judicious surgical intervention can result in excellent long-term outcome.
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The effect of intra-abdominal carbon dioxide pressure on blood pressure in laparoscopic surgeries p. 286
Nzar Nuri Rasheed Sherwani, Tayeb Sabir Kareem
DOI:10.4103/MJBL.MJBL_59_19  
Backgrounds: The high intra-abdominal carbon dioxide (CO2) gas pressure of the pneumoperitoneum may result in physiological changes. Objectives: This study aimed to examine the impact of high CO2 pressure on intraoperative blood pressures (BPs) in patients undergoing laparoscopy surgeries. Materials and Methods: In this quasi-experimental clinical trial, 36 patients diagnosed with different intra-abdominal diseases were undergone laparoscopic surgeries under a standard of CO2 pressure (≥13 mmHg). In another group, 39 patients who were matched in age and gender were undergone laparoscopic surgeries under low CO2 pressure (≤12 mmHg). Results: The patients in both high and low CO2 pressure groups were comparable in age (37.65 vs. 42.37 years; P = 0.114), gender (P = 0.212), and operation time (36.18 vs. 34.64 min), respectively. The patients underwent high CO2 pressure had significantly lower levels of diastolic BP after anesthesia (72.28 vs. 77.89; P = 0.020), lowest systolic BP (SBP) (94.69 vs. 102.26; P = 0.006), and lowest diastolic BP (DBP) (59.00 vs. 68.36; P < 0.001) in contrast with higher level of postoperative diastolic BP in high CO2 group (111.23 vs. 78.11; P < 0.001). SBP and DBP and heart rate were decreased significantly from preoperative to postanesthesia and postoperative surgery in groups. Conclusion: The present study showed that BP parameters were deceased following laparoscopy surgeries (higher pneumoperitonial CO2 pressure has lower BP in comparison to lower pneumoperitonial CO2 pressure). Low CO2 pressure is recommended during laparoscopic surgeries as much as possible, especially in patients with comorbidities such as heart diseases, old ages, and for operations that take longer time.
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The relationship between −330 interleukin-2 gene polymorphism and its plasma levels in patients with alopecia areata p. 292
Sarah Isam Al-Rubaye, Abdulsamie Hassan Alta'ee, Zena Saeed Al-Fadhily
DOI:10.4103/MJBL.MJBL_46_19  
Background: Alopecia areata (AA) is an autoimmune, dermatological, chronic, inflammatory disease that attacks hair follicles and causes hair loss. Hair loss usually occurs on the scalp, but it can also affect the beard, eyebrows, and other areas of the body. Interleukin-2 (IL-2) is a cytokine that contributes to the regulation of the immune system and is classified as a proinflammatory factor. IL-2 is an autocrine secretary element produced from activated T-cells, exhibiting growth factor characteristics. Objective: The objective of this study was to investigate the effect of the −330 IL-2 gene polymorphism (rs2069762) on plasma IL-2 levels in Iraqi patients with AA. Materials and Methods: In this study, 100 patients with AA and 100 ethnicity-, age-, and sex-matched healthy controls were selected. Blood samples of all individuals were collected in EDTA tubes. The restriction fragment length polymorphism–polymerase chain reaction method was applied to determine various alleles and genotypes in these individuals. Plasma concentration of IL-2 was measured in all the samples using human IL-2 kit. Results: The frequency of −330 G/T IL-2 genotype was higher in patients with AA compared to normal individuals. Accordingly, the plasma levels of IL-2 were significantly higher (P < 0.0090) in patients when compared to the control group. Conclusion: In case of patients with AA, the −330 G/T IL-2 genotype is associated with higher plasma levels of IL-2.
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GeneXpert MTB/RIF assay – A major milestone for diagnosing Mycobacterium tuberculosis and rifampicin-resistant cases in pulmonary and extrapulmonary specimens p. 296
Shatha Thanoon Ahmed
DOI:10.4103/MJBL.MJBL_62_19  
Background and Objective: Tuberculosis (TB) is an endemic disease in Iraq. Many methods are available to diagnose pulmonary and extrapulmonary TB (EPTB). The most traditional test is the sputum smear for acid-fast bacilli (AFB). However, it is well known for its low sensitivity and specificity. On the other hand, culturing AFB although considered the gold standard for detecting Mycobacterium tuberculosis (MTB), yet it takes long time to confirm or exclude the presence of TB. The WHO has recommended the use of a gene-based molecular technique called GeneXpert (GX) MTB/rifampicin (RIF) for rapid and accurate detection of MTB in pulmonary and extrapulmonary (EPTB) sites. GX is a quick, fully automated system that can be easily used with minimal training. The objective of this study was to evaluate the accuracy of the GX test for diagnosing MTB in pulmonary and extrapulmonary sites in Kurdistan/Iraq that is considered as an endemic area for TB, as well as testing the ability of this technique to identify the resistant strains of these bacilli to first-line anti-TB treatment. Methodology: A total of 925 (504 males and 421 females) patients attended the TB center in Erbil/Iraq from August 2015 to August 2017. These patients were clinically diagnosed or suspected to have TB. Two sputum samples were collected from each patient and subjected to AFB smear staining. The other portions of the sputum were examined by GX assay, and a number of cases were grown on the Lowenstein–Jensen media. For extrapulmonary fluid samples, the same tests were done. Results: Seven hundred and forty-three were pulmonary samples, and the remaining 182 cases were extrapulmonary specimens (cerebrospinal fluid, peritoneal aspirate, pleural fluid, urine, and blood). Of these, 575 had their AFB smears done which was positive for in 184 (32%) and negative in 391 (68%) cases. On the other hand, real-time polymerase chain reaction using GX technology was positive in 228 (39.65%) while negative in 347 (60.34%) cases. The sensitivity and specificity of the GeneX versus AFB smear considering culture as a gold standard were 94.9% and 80.1%, respectively. In addition, GX technique revealed that about 20 (14.3%) of positive MTB cases were resistant to RIF therapy. Conclusion: The current study displayed the real significance of using GX test in diagnosing MTB in pulmonary and extrapulmonary specimens to save time and to avoid unnecessary anti-TB treatment.
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Serum follistatin and its role in intracytoplasmic sperm injection outcomes p. 302
Baydaa Lateef Hameed, Mutaz Sabah Ahmeid
DOI:10.4103/MJBL.MJBL_55_19  
Background: progress in assisted reproductive technology (ART) has enabled the clinicians to treat many types of infertility. Objectives: The ultimate goal of all these procedures is to get a viable intrauterine pregnancy as a step to get a healthy baby. Intracytoplasmic sperm injection (ICSI) refers to the technique of assisted reproduction, including injecting a single sperm into the center (cytoplasm) of the egg. Materials and Methods: A prospective study included 45 women who were enrolled in ART programs in infertility center for in-vitro fertilization (IVF) in International Center/Kirkuk, Iraq. All women were subjected to the basic fertility workup at the infertility center which consists of history taking, physical examination, ovulation detection, evaluation of tubal patency, and uterine cavity. The average age of the included women ranged between 20 years and 42 years of age. All women were enrolled in short protocol type of IVF/ICSI cycle, and they had normal menstrual cycles. Serum samples were stored for estimation of follistatin level by ELISA technique and for estimation of luteinizing hormone, follicle-stimulating hormone, estrogen, and progesterone by VIDAS technique. Results: The present study showed that 31.1% of women underwent ICSI technique became pregnant and 68.9% were nonpregnant. The highest mean of age were recorded among pregnant women compared with nonpregnant women (32.21 ± 6.68 vs. 31.80 ± 5.38 years) although the result was nonsignificant (P > 0.05). The highest mean of body mass index were recorded among nonpregnant women compared with pregnant women (23.92 ± 1.55 vs. 25.36 ± 1.99 kg/m2); the result was significant. The study showed highest mean level of serum follistatin present in nonpregnant compared with pregnant women (0.75 ± 0.32 vs. 0.62 ± 0.24 ng/ml) although the result was nonsignificant (P > 0.05). Conclusions: There was no relation of serum follistatin with pregnancy after ICSI.
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Frequency of cesarean sections in female physicians and medical students in Babylon governorate p. 307
Safa Hadi Yassir, Bushra J Al-Rubaey
DOI:10.4103/MJBL.MJBL_69_19  
Background: Cesarean sections (CSs) defined as delivery of the fetus through abdominal incision. In certain condition, it is a life-saving surgical procedure for both mother and her fetus. Objectives: The aim of this study was to evaluate the frequency and causes of CSs in female Physicians and medical student in Babylon Governorate. Materials and Methods: It was a cross-sectional study conducted in Babylon. The duration of the study was over a period of 5 months, included a convenient sample of 345 female physicians and medical students delivered by CSs who worked at central and peripheral hospital mentioned who agreed to participate in this study, data were collected using a predesigned questionnaire by which female physicians and medical student were interviewed. Results: The mean age of female physicians whom delivered by CSs is (30.32 ± 4.38) years. More of them are para one CS (65.8%), no period of subfertility (92.5%), no history of miscarriage (78.6%), and delivered after 37 weeks of gestation (89.6%). Threatened miscarriage represented (47.3%) fallowed by anemia (14.2%) and preeclampsia (8.8%). The main indication of CSs was patient's wishes which represented (43.2%) of CS, (77.2%) of them had CS without any medical reason only afraid from the pain of normal vaginal delivery, (9.4%) had a history of primary subfertility, (6%) had bad obstetric history, (4.7%) had a history of pregnancy complications such as threatened miscarriage, gestational hypertension, and gestational diabetes mellitus. Conclusions: CSs rate in female physicians and medical student in Babylon Governorate were much higher than the optimal range recommended by the World Health Organization. In spite of their knowledge about the complications of CSs, more of them preferred CSs with no medical reason because of afraid from vaginal delivery pain.
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Assessment of immune susceptibility to rubella among pregnant women in Hilla City p. 312
Hanaa Yas Khadair, Suhaila F. M. H. Al-Shaikh
DOI:10.4103/MJBL.MJBL_90_18  
Background: Rubella (German measles) is a viral infection, which is contagious disease and self-limiting. Nonimmune adult women may be infected during pregnancy; the 1st-trimester rubella infection is very dangerous and may lead to miscarriage or severe fetal malformation (congenital rubella syndrome). That is why basic epidemiological data concerning rubella (immunity and seropositivity) is necessary for health planners and health-care providers in preventive medicine. Objective: The main objective of the study was to assess the immune susceptibility to rubella among pregnant women by checking serum immunoglobulin (Rubella IgG) using enzyme-linked immunosorbent assay (ELISA) test. Materials and Methods: The study protocol was approved by the Ethical Committee of Babylon University, College of Medicine. A cross-sectional study was to investigate the seroprevalence of rubella infection and associated possible risk factors among pregnant women. A total of 100 pregnant women in their first trimester of pregnancy were enrolled from four different primary health-care centers in Al-Hilla city. Filling a prepared structured questionnaire followed by ELISA test to detect IgG against rubella in the blood samples was collected. Results: A total of 100 pregnant women with a mean age of 24.78 ± 5.74 years who are in their first trimester of pregnancy, the study shows that 58 (58%) of the pregnant women have negative IgG against rubella (none immune), whereas the remaining 42 (42%) have positive IgG (either by previous infection with rubella or through vaccination). Living in rural area was highly significant among the seronegative pregnant women, 32 out of 58 seronegative women (55.2%), 41 (97%) of the seropositive group had regular vaccination program, whereas 36 (62%) of the seronegative group had irregular or unknown vaccination history, and 18 (31%) have no vaccination at all with a P < 0.001. The primary level of education was dominant among all the studied women with a P = 0.017. Conclusion: A high percentage of women of reproductive age group, mainly those living in the rural area are considered (at risk) population which necessitates an action by the health services provider.
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Assessment of the serum level of melatonin and its correlation with insulin, insulin resistance, and glycated hemoglobin in Iraqi patients with polycystic ovarian syndrome p. 316
Ahmed Abduljabbar Hameed, Mutaz Sabah Ahmeid
DOI:10.4103/MJBL.MJBL_75_19  
Background: Polycystic ovarian syndrome (PCOS) is one of the most frequent gynecological endocrinopathy that occur in premenopausal females. The importance of melatonin (N-acetyl-5-methoxytryptamine) in human reproduction is still unidentified. A numerous study suggests that melatonin and reproductive hormones are closely related. Objectives: The study aimed to evaluate the role of melatonin in women with PCOS and its correlation with insulin, insulin resistance (IR), and glycated hemoglobin (HbA1c) in a patient with PCOS. Materials and Methods: A prospective cross-sectional study was designed taking 60 PCOS patients and 30 controls women from January to April 2019. These patients admitted to obstetrics and gynecology unit at Babylon teaching hospital. Five milliliter of blood sample was taken on day 2 of menstrual cycle from each subject enrolled in this study. Blood samples were collected for testing serum melatonin, insulin, IR, and HbA1c estimation. Results: The study showed that there is the significant difference between PCOS women and the control group concerning melatonin level. Results also showed higher means of HbA1c in PCOS women than control women, and positive correlation between HbA1c and melatonin. The study showed higher means of insulin was shown in PCOS women when compared with control group, and positive correlation between insulin and melatonin. Furthermore, this study showed higher means of IR was recorded in PCOS women when compared with control group, and positive correlation between IR and melatonin. Conclusions: Women with PCOS have significant increase of serum melatonin in PCOS women. And, there were significant increases in serum levels of HbA1c, insulin, and IR in women with PCOS compared to healthy women. In addition, positive correlation was found between melatonin with insulin, IR, and HbA1c. This study could open the way for therapeutic role of melatonin in the treatment of PCOS women.
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Assessment of proper technique of artificial feeding among infants in Al-Hilla City p. 321
Dalya Muayad Al Maroof, Mudher Hassan Noor
DOI:10.4103/MJBL.MJBL_63_19  
Background: Infant formula is considered an effective alternative to breast milk. Safe preparation of infant formula is a crucial goal by the World Health Organization for infants receiving some or all of their feeding using infant formula. Objectives: The objective is to find out the errors in the method of bottle-feeding which leads to feeding problems in infants in Al-Hilla city. Methods: This cross-sectional study was conducted on a convenient sample of 384 infants (who attended the general wards in Babylon Maternity and Pediatric Hospital, AL-Noor Hospital and some primary health-care centers). Results: The percentage of mothers who had followed all the recommended steps for feeding and sterilization of infant bottle was (16.90%). Conclusions: Very low percentage of mothers were found to follow all the proper steps of bottle-feeding.
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Comparison between somatosensory-evoked potential parameters in patients with nonspecific versus specific chronic low back pain p. 325
Jumana Sami Khudhair, Ali F Al Hashimi, Yasir M Hamandi
DOI:10.4103/MJBL.MJBL_65_19  
Background: Modern pain neuroscience has revolutionized our understanding about pain, including the role of central sensitization in amplifying pain experiences with increased neuronal response to central nervous system stimuli. During external upper and lower limb perturbation, it has been shown that Chronic low back pain (CLBP) was associated with longer reflex response latencies of trunk muscles. One theoretic but rarely examined possibility for longer reflex latencies is related to modulated somatosensory information processing. Objectives: The objective of the study was to compare the somatosensory-evoked potential (SSEP) parameters of the right median and left tibial nerves between patients with nonspecific and specific CLBP. Materials and Methods: The study includes 102 CLBP patients, clinically and radiologically confirmed and divided into two groups: 48 patients with nonspecific pathology and 54 patients with specific pathology. During this SSEP study the right median and left tibial nerves of all patients were examined. Recorded parameters include the latency and amplitudes. Results: The means of the latencies of all the SSEP waves of the right median and left tibial nerves were only significant in the peripheral SSEP waves in the upper and lower limbs (N9 and N10, respectively) and highly significant in cortical right median N20 SSEP wave. Regarding the central sensory conduction time values, both in the median and tibial SSEP study, The significant differences was noted only in the median nerve SSEP study. Regarding the means of the amplitudes of differently studied SSEP components of the right median and left tibial nerves, it was only significant in the peripheral SSEP (N9) wave of the right median nerve and in the subcortical and cortical (P37 and N45) waves in the tibial nerve SSEP study. Conclusions: Results showed a significantly higher SSEP amplitude and latency in nonspecific CLBP patients as compared to their counterpart CLBP patients. This could reflect a higher excitability of sensory cortex and sensory pathways in patients with nonspecific CLBP as compared to their counterpart patients.
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Electrolyte disturbance in asphyxiated neonates in maternity hospital in Erbil, Iraq p. 331
Barzan Abdullah Hasan, Morouge Hashem Al-Ani
DOI:10.4103/MJBL.MJBL_52_19  
Background: Perinatal asphyxia is the worldwide most common cause of neonatal morbidity and mortality. It accounts for about 25% of all neonatal deaths. Electrolyte disturbances are the most common problem of asphyxiated neonates. This study measures the serum sodium, potassium, and calcium levels in asphyxiated neonates. Objective: The objective is to study serum calcium, serum potassium, and serum sodium levels in asphyxiated newborns of different severity in the early neonatal period and compare with controls. Materials and Methods: The serum potassium, sodium, and calcium levels of asphyxiated neonates were measured in postnatal period. Neonates were included according to the Apgar score and clinical examination. The measured electrolyte values were compared with the normal neonates. Results: From 50 asphyxiated neonates, 17 had hyponatremia, 6 had hyperkalemia, and 4 had hypocalcemia. The serum sodium and potassium levels showed statistically significant (P < 0.00) with the different degree of asphyxia, but calcium levels were not statistically significant (P = 0.06). There was a negative linear correlation with sodium and calcium levels but with the serum potassium levels was positive. Conclusions: Hyponatremia was significant in all stages of birth asphyxia, hyperkalemia was significant with increased severity of birth asphyxia, and hypocalcemia was not significant.
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Influence of iron deficiency anemia on growth: A cross-sectional study p. 335
Zanyar Hewa Fareeq, Kawes Omar Zangana
DOI:10.4103/MJBL.MJBL_61_19  
Background: The most important risk factors for iron deficiency (ID) and ID anemia (IDA) are poor iron intake, low bioavailability of iron, chronic loss from the body, and some specific periods of life when the iron requirement is so much like growth during childhood and pregnancy. Objective: In this study, the effect of IDA on physical growth was investigated in children through finding out associations between different growth parameters and IDA. Materials and Methods: In this cross-sectional study, we measured growth parameters in fifty children with IDA before and for 6 months' postiron therapy in comparison with fifty age- and sex-matched normal controls. Annualized growth velocity and body mass index (BMI) were calculated from measured growth parameters. Red blood cell indices and serum ferritin were measured. After a 6 months' period (October 1, 2018–March 1, 2019) from starting treatment of the anemic group, growth parameters and the hematological assessment were measured again. Results: Mean age and standard deviation for cases were 19.1 ± 12.7 months while that of controls were 19.2 ± 12.4 months, and there was no significant difference regarding age distribution P > 0.05. Before the treatment, children with IDA were significantly shorter in comparison to age- and sex-matched controls. The BMI of anemic group increased significantly P < 0.05. Weight, length, and occipitofrontal circumference were also significantly increased after iron therapy P < 0.0001. After receiving therapy, serum ferritin was significantly correlated with growth velocity and BMI for the anemic group: (r = 0.853 P < 0.0001) and (r = 0.460 P < 0.001), respectively. After treatment, the anemic group had a growth velocity 5.2 ± 1.8 which was faster than that of nonanemic one 3.4 ± 1.8, P < 0.0001. Conclusion: This study documented a positive effect of IDA on physical growth in children, especially during the first 2 years of life during which growth is fast.
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Antiviral treatment of chronic hepatitis C infection among children and adolescents with beta-thalassemia major p. 340
Dlair Abdulkhaleq Chalabi, Sawsan Al-Azzawi
DOI:10.4103/MJBL.MJBL_40_19  
Background: Hepatitis C virus (HCV) was encountered as one of the most common infections transmitted through blood transfusion to thalassemic patients. After the discovery of new generations of antiviral drugs labeled direct-acting antiviral (DAA) drug since 2014, promising results were reported compared to older regimen of Peginterferon with or without ribavirin (RBV). Objective: The main objective of the study is to assess the hepatitis C viral status of multitransfused beta-thalassemia major patients and the sustained viral response rate to different modalities of therapy. Materials and Methods: A cross-sectional analytical study was conducted in Erbil Thalassemia Center. A sample of all children and adolescent (18 years or younger) patients of beta-thalassemia major with HCV antibody positive were reviewed according to the available medical records in the center. They were divided into two groups ( first who received interferon ([IFN] ± RBV and second who received sofosbuvir (SOF) and daclatasvir [DCV]) for the aim of the study. Results: Among registered 695 patients with thalassemia major screened for HCV antibody, 659 children and adolescents were included and 186 were tested seropositive (28.22%), and they had been submitted to polymerase chain reaction analysis with HCV-RNA identified in 110 (59.13% of initially ELISA test positive). IFN-dependent therapy was given to 87 patients, while sofosbuvir and DCV for remaining 21 patients, sustained viral response was 100% among those received latter therapy with no reported relapse compared to former regimen of 44.3% sustained response and 6.33% relapse rate. Conclusion: DAA drug has a promising therapeutic result replacing the old therapy of IFN-RBV among thalassemic patients with 100% response rate in the study group.
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Metformin versus insulin in the management of gestational diabetes mellitus p. 346
Ola Amer Mahmood
DOI:10.4103/MJBL.MJBL_11_19  
Background: Gestational diabetes mellitus (GDM) is one of the most common medical conditions complicating pregnancy and its prevalence increasing nowadays due to the increasing obesity in our society. The whole story is due to insulin resistance which is best managed by metformin rather than insulin. Objective: The main objective of the study is to compare the efficacy of metformin in controlling hyperglycemia in GDM or their effect on the pregnancy outcome versus insulin therapy. Materials and Methods: This study was carried out at the Obstetrics and Gynecology Department of Al-Zahraa Teaching Hospital in Al-Najaf from February 2015 to November 2015, as 100 pregnant ladies from (20 to 32) weeks of gestational age were already diagnosed to have GDM or we diagnosed them by formal 75 g oral glucose tolerance test. Results: Metformin was better in controlling blood sugar (111 mg/dl versus 145 mg/dl in insulin). Neonatal complication and cesarean section rates were higher in insulin limb. Conclusion: Metformin was better in controlling blood sugar in GDM than insulin, with better neonatal outcome.
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Assessment of knowledge and practical skills among integrated management of neonatal and childhood illness program healthcare personnel in primary healthcare centers p. 351
Shaymaa Sabah Hussein, Hadeel Fadhil Farhood
DOI:10.4103/MJBL.MJBL_50_19  
Background: Integrated management of neonate and childhood illness (IMNCI) guidelines are a simplified system of diagnosis and treatment design for the use by the health workers with limited training. The IMNCI aims to reduce death and illness and to promote growth and development among children under 5 years of age and target acute causes of childhood death. Objectives: To study the knowledge and performance of doctors and healthcare workers about IMNCI program and assess the adherence of doctors and healthcare workers to IMNCI guidelines for managing childhood disease. Materials and Methods: The study is a cross-sectional study conducted in primary healthcare centers in Babylon Governorate from February to May 2019 on 130 healthcare personnel using a predesignated semi-structured questionnaire including sociodemographic characteristics and knowledge and practice domains about IMNCI. Results: The mean age of participants was 37.8 ± 10 years and the age category of ≥40 years was the most prevalent (40.8%). While 31.5% aged 20–29 years of age, 27.7% aged 30–39 years of age. The female gender was more dominant among the study sample as 112 (90.8%) of them were females compared to 18 (9.2%) males. Regarding occupation of the study sample, 28.5% of them were family medicine specialists, 27.7% paramedical staff, 23.8% graduate doctors, and 20% were general practitioners. 62% had serving more than 1–10 years while <7.7% had serving <1 year. 76.2% had training in IMNCI while 23.8% without IMNCI training. 56% of total study sample had fair knowledge level, 37% had poor knowledge level, while 7% only had good knowledge. More than 28% had fair practice while 72% had poor practice. Conclusion: This study showed that the majority of healthcare personnel had fair knowledge about IMNCI while practical skills were poor.
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Assessing risk factors and causative organisms of acute diarrhea in children under 5 years in AL-Hindiya, Karbala, Iraq p. 357
Haider Sahib Humady Tuky, Ban Abbas Semender
DOI:10.4103/MJBL.MJBL_58_19  
Background: Acute diarrhea is a leading source of illness and death all over the world, especially in developing countries and the most affected are children below 5 years age. Objectives: To throw a light on the risk factors, presentations, and causative organisms of acute diarrhea, to find a way to protect our children. Materials and Methods: This prospective cross-sectional study was conducted on 250 children under 5 years of age; they attended AL-Hindiya general Hospital, in the period between November 2018 and end of June 2019. Full history was taken from each patient focused on risk factors, presentation, and possible complications; then, patients were subjected to clinical examination, stool analysis, and stool culture, and some of them were sent for abdominal ultrasound. Results: The most vulnerable age group for acute diarrhea was 2–12 months. Male to female ratio is 1.17. Crowded family and poor income were the most frequently risk factors to develop acute diarrhea. Bottle feeding was used in 111 patients (44.4%); improper sewage and trash disposal, poor hand washing practice, incomplete vaccination, prior use of antibiotics, and underweight all are considerable risk factors. The peak for acute diarrhea occurs during summer (63.6%). Those patients most commonly presented as watery bowel motion less than or equal to five times per day, well-hydrated, vomiting, fever, associated with upper respiratory tract infection. There is no growth of organism in stool sample of 126 patients (50.4%), while Entamoeba histolytica isolated from 34 samples (13.6%). Conclusion: Children under 5 years in A-Hindiya city still at considerable risk of acute diarrhea. The risk is more in rural, young, low educated, unemployed, and poor parents with crowded families. It is vital to encourage breastfeeding, immunization, improve personal hygiene, water supply, and sanitation to reduce the risks of acute diarrhea. The most frequent isolated organism from stool samples is E. histolytica followed by Rota virus.
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SHORT COMMUNICATION Top

Role of leadership in ensuring road safety in low- and middle-income nations: World Health Organization p. 362
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/MJBL.MJBL_30_19  
The global consensus is that road traffic deaths and injuries are an unacceptable and alarming outcome for the sake of mobility. Even though, road safety has been recognized as a public health concern and efforts have been taken to improve the same, the reality is that the number of road traffic deaths is still increasing. Acknowledging the magnitude of the problem and its preventable nature, it is the need of the hour to have a more effective leadership, both from the government and the private sector in ensuring road safety. In order to improve the leadership in road safety, the World Health Organization has come up with a holistic policy on road safety and management of vehicles. In conclusion, the presence of a strong leadership is the crucial element which has to be addressed in the low and middle income nations and it is high time that all the concerned stakeholders work in a coordinated manner to deal with the preventable problem of road traffic injuries.
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LETTERS TO EDITOR Top

Maternal obesity and risk of fetal congenital abnormality p. 364
Ola Amer Mahmood
DOI:10.4103/MJBL.MJBL_12_19  
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Influence of oral contraceptive pills on periodontal disease p. 367
Lawhedh Jasim Mohammed
DOI:10.4103/MJBL.MJBL_80_19  
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Prevalence of breast cancer women in Babylon Province, Iraq p. 369
Nadir A Sanad Al-Jenabi, Ali Abaid Kadhem, Hamid Fadhel Abbas
DOI:10.4103/MJBL.MJBL_70_19  
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