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   Table of Contents - Current issue
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January-March 2020
Volume 17 | Issue 1
Page Nos. 1-116

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ORIGINAL ARTICLES  

Effect of hypothyroidism on lipid profile in women at Misan City/Iraq Highly accessed article p. 1
Eman Kamil Aati, Zainab Abdul Jabbar Ridha Al-Ali
DOI:10.4103/MJBL.MJBL_86_19  
Background: Hypothyroidism is a common endocrine disorder resulting from insufficient production of thyroid hormones, which have significant effects on the synthesis, mobilization, and metabolism of lipids. Objective: The present study aimed to measure some hormonal and biochemical parameters in women suffering from hypothyroidism in Misan province. Materials and Methods: This study included 88 women aged 20–35 years. 5–7 ml of blood was drawn, and serum was obtained. Thyroid and lipid profile tests were performed on all women. Results: The values of thyroid-stimulating hormone increased statistically significantly (P < 0.05) in the C (hypothyroidism women) and D (hypothyroidism and infertility women) groups, whereas triiodothyronine and thyroxin results decreased statistically significantly (P < 0.05) in the C (hypothyroidism women) and D (hypothyroidism and infertility women) groups. Triglycerides and very low-density lipoprotein (LDL)-cholesterol increased statistically significantly (P < 0.05) in the B (infertility women) and C (hypothyroidism women) groups compared to A (healthy women) and D (hypothyroidism and infertility women) groups, whereas LDL cholesterol (LDL-C increased statistically significantly (P < 0.05) in C (hypothyroidism women) and D (hypothyroidism and infertility women) groups compared with A (healthy women) and B (infertility women) groups. There were no statistically significant differences (P < 0.05) in total cholesterol and high-density lipoprotein-cholesterol among the study groups. Conclusions: Hypothyroidism causes increasing level of LDL. Indeed, it is a common cause of secondary dyslipidemia.
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Prevalence of the most frequent risk factors in Iraqi patients with acute myocardial infarction p. 6
Shwan Othman Amen, Soza Tharwat Baban, Salah Hassan Yousif, Ahmed Himdad Hawez, Zana Tharwat Baban, Dlovan Mustafa Fateh Jalal
DOI:10.4103/MJBL.MJBL_66_19  
Background: Coronary artery disease (CAD) and its major manifestation of acute myocardial infarction (AMI) are the most common causes of mortality and disability worldwide. Objectives: The major aim of this study was to assess the prevalence of the most frequent risk factors for AMI in Iraqi patients, including hypertension, hyperlipidemia, diabetes mellitus, smoking, family history, insufficient physical activity, obesity, and abnormal coronary artery characteristics. Materials and Methods: In this study, 74 patients presented with AMI (51 males and 23 female) were enrolled. Laboratory investigations were carried out using enzymatic immunoassay technique. Results: The mean age was 55.5 ± 12.47 years, with an age range of 20–90 years. The incidence of AMI in male patients was significantly higher than that in female patients. Major findings showed that 85.1% of AMI patients were insufficiently physically active and 74.3% were hypertensive. High level of low-density lipoprotein was seen in 50% of patients, high triglycerides in 41.9%, low high-density lipoprotein in 39.2%, and high total cholesterol in 34%. Nearly 39.2% were smokers, 35.1% were obese, and 29.7% were diabetic. Interestingly, 51.4% of the AMI patients had a positive family history of CAD. The left anterior descending artery was the most common vessel involved during AMI. Conclusions: The findings of this study conclude that AMI occurs in older age and in male gender among Iraqi population, and ST-elevation MI is the main presentation. Hypertension, hyperlipidemia, and smoking are the major risk factors. This study shed light on the primary prevention and control of these cardiovascular risk factors for CAD through healthy lifestyle, increased physical activity, and healthy dietary choices, which can reduce the prevalence of CAD.
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Prevalence of leukocytes in type 2 diabetic patients in Erbil City p. 19
Muhsin H Ubeid
DOI:10.4103/MJBL.MJBL_1_20  
Background: Diabetes mellitus (DM) has become a global health concern affecting children, youth, and adults. Type 2 DM (T2DM) is considered an inflammatory disease as inflammation can trigger the insulin signaling, assumingly by promoting beta cell death. Objectives: This comparative study has been conducted on white blood cells in diabetic patients to examine the relationship between inflammation and blood glucose levels. Methods: Blood samples from both males and females were obtained randomly and measured at Rizgary Teaching Hospital and Media Laboratory in Erbil City during October 2015 till March 2016. Blood glucose levels and different types of leukocytes were measured in T2DM patients and compared with nondiabetic patients. Results: The results showed an increment in the percentage of monocytes and neutrophils in diabetic females and a decrement in the percentage of lymphocytes as compared to controls, in contrast to diabetic males where an increment in the percentage of monocytes and lymphocytes was found. Conclusions: It has been proven by this study that leucocyte count is elevated in diabetic patients, in reference to the hyperactivated immune system in such people. However, the results revealed that the inflammatory system showed a significant difference between diabetic and nondiabetic people, reflecting on the importance of such system in the response of a body to the lack of control over blood glucose.
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Effects of bardoxolone on nuclear factor-erythroid 2-related factor 2 signaling pathway in HCT-116 human colonic cancer cell line: In vitro study p. 25
Naiel Abbass K Al-Khafaji, Sameer H Al-Rikabi, Talib H Kammona, Hamid N Obied
DOI:10.4103/MJBL.MJBL_90_19  
Background: Bardoxolone inhibited proliferation and induced apoptosis in vitro in wide types of human cancer cells. It has also been shown to inhibit the growth of tumor in the mice model. Several studies demonstrated that bardoxolone may modulate multiple molecular targets that have a fundamental role in both the development and progression of cancer. Objectives: The aim of this study is to assess the effects of Bardoxolone (CDDO-Me) in the treatment of colonic carcinoma by induction of the nuclear factor erythroid 2-related factor 2 signaling pathway (Nrf2) with regression of tumor markers as compared to other chemotherapeutic agents like 5-fuorouracil. Materials and Methods: Treatment groups are classified into four groups (control, chemotherapy group, bardoxolone, and combination treatment groups). Results: The results revealed that there were significant effects of bardoxolone treatment on cytoplasmic Nrf2 level (P < 0.05) as compared to control group (cancer cells without treatment). Conclusion: Bardoxolone has significant anticancer effects (P < 0.05) in low micrograms concentrations on human colonic cancer cells as compared to control groups.
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Diagnostic feasibility of total leukocyte count, neutrophil percentage, and C-reactive protein in suspicious cases of acute appendicitis p. 30
Ibrahim Falih Noori Alsubaiee, Azza Sajid Jabbar Al-Kinany
DOI:10.4103/MJBL.MJBL_27_19  
Background: Acute appendicitis is quite common in general surgical practice. The classical history of central abdominal pain with anorexia migrating to the right lower abdomen is present in <50% of cases. The diagnosis of equivocal cases still represents clinical dilemma and diagnostic challenge. Objectives: The main purpose of this study was to evaluate the feasibility of triple blood tests for total leukocyte counts, percentage of neutrophils, and C-reactive protein (CRP) as inflammatory markers to diagnose cases with a suspicion of acute appendicitis. Methods: A total of 132 patients (78 males and 54 females) were diagnosed clinically by blood investigations as cases of acute appendicitis for whom appendectomy had been performed. Results: The results showed that the overall diagnostic accuracy rate was 91.7% after the final histopathological confirmation of acute appendicitis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy rate of CRP were high than those of total leukocyte count and neutrophil percentage; the difference, however, was not significant. The sensitivity, specificity, PPV, NPV, and accuracy rate of combined results of the three tests were significantly high than those of any test alone, which could be good adjuncts that help in the diagnosis of equivocal cases of acute appendicitis. More importantly, we found that when the results of the three tests were within the normal reference ranges, acute appendicitis is quite remote and very unlikely. Conclusion: It can be concluded from this study that the combined positive results of the three blood tests could be good predictors of acute appendicitis with high sensitivity, specificity, and accuracy rate. Moreover, when the results of these tests are normal, the likelihood of acute appendicitis reaches to zero.
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Prevalence of Vitamin D deficiency and its correlate with overweight and obesity in community-dwelling old adults p. 36
Ismael Hasan Jawad, Hasan Alwan Baiee
DOI:10.4103/MJBL.MJBL_98_19  
Background: Vitamin D has different biological actions in the body. Vitamin D has the pleiotropic effects in multiple organ systems, and Vitamin D deficiency (VDD) was suggested to be associated with overweight and obesity according to previous reports. Several interventional studies have examined the effect of Vitamin D supplementation on overweight and obesity. Objectives: the aim of this study is to identify the prevalence of VDD and its correlate with overweight and obesity in community-dwelling old adults. Materials and Methods: This was a cross-sectional study that included convenient consecutive sample of elderly people who attended the office of retired employees and the elders' home in Hilla City-Babylon Province–Iraq. The period of the study started from the first of January to September 2019, and a pretested semi-structured questionnaire was used to interview the participants after obtaining their verbal consent. The sample included (300) old adults of both genders; the serum level of Vitamin D was assessed by chemoimmunoassay method. The weight was measured in kilograms by using weight measuring balanced scale for all individuals, and height was measured (in centimeters) by using a fixed board in standing position without shoes, the head in the horizontal plane. The body mass index was calculated according to weight in kg/height in m2. Results: The study included 300 participants; most of the study sample had either insufficiency or deficiency of Vitamin D level. Obese and overweight elders in this study had significant low serum Vitamin D level (both deficiency and insufficiency of vitamin) as compared to the nonobese group; this difference was statistically significant P < 0.05. Conclusion: There was a significant inverse relationship between Vitamin D level and excess body weight in Iraqi old adults.
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Profile of high-risk pregnancy attending primary healthcare centers in Babylon governorate in 2019 p. 41
Esraa Rabee Jaafar, Hadeel Fadhil Farhood
DOI:10.4103/MJBL.MJBL_54_19  
Background: Access to healthcare and prevention of maternal and neonatal mortality are of major components of social justice. Pregnancy could be a distinctive and natural physiological method among females, however will be deteriorated following background or sudden disorders of mother or fetus. Pregnancy is classified as high risk when mother, fetus, or neonate is more susceptible to disability, disorders, or death. High-risk pregnant mothers are women with history of chronic diseases (hypertension, thyroid disease cardiovascular disorders, and diabetes mellitus), history of abortion during previous pregnancies, multiparity, those aged <18 or more than 35 years, intervals <3 years pregnancies, delivery by cesarean section (CS), and gravidity more than four. Objectives: (1) Identify the prevalence of high-risk pregnancy (HRP) attending primary health care centers in Babylon province. (2) Assess the risk factors associated with HRP. Patients and Methods: An exploratory descriptive cross-sectional study to be conducted at about 10 primary healthcare centers include a convenient sample of 290 pregnant women who visit the antenatal care unit in Babylon governorate from February to May 2019. There are two tools used for data collection: Tool I: Morrison and Olsen high risk scoring inventory tool, it is simple, valid form for antenatal risk scoring which categorize patient as low, (0–2) high (3–6) or extreme high (7 or more) on the basis of past obstetric history, medical and surgical history and current pregnancy. Tool II: An interview questionnaire sheet designed by researches for data collection by which the pregnant are to be interviewed for about 10 min after giving their verbal consent. Results: The mean age of pregnant women is 25.53 ± 5.72; 54.1% from urban area and the majority not employee, i.e., 92.4% and their education level was primary, i.e., 37.6%, 40.7% had + ve husband consanguinity, and 86.2% had regular menstrual cycle. The risk factor affecting current pregnancy was mainly: anemia (18.6%) and hypertension (6.9%), and 6.2% sensitized due to RH negative. The factors affecting past pregnancy included the following: multipara (8.3%), previous miscarriage (12.1%), and previous CS (16.2%). Only 3.1% had previous surgery in the genital tract, 3.2% had gestational diabetes, and 1.7% had chronic hypertension. Conclusion: The results demonstrated the need for health surveillance and education, counseling and guiding women at risk. Early diagnosis, prompt treatment, and prevention should be taken as soon as possible by regular antenatal care to prevent complication.
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Estimation and isolation of ceruloplasmin and some biochemical indicators in diabetes mellitus type II patients compared to healthy controls in Kirkuk Province, Iraq p. 49
Karam Yahya Noah, Farah Khalaf Hmood, Israa Ghassan Zainal
DOI:10.4103/MJBL.MJBL_76_19  
Background: The pathogenesis of diabetes mellitus (DM) was affected by oxidative stress. Many inflammatory markers having antioxidant property, among them ceruloplasmin (CP), which is the appropriate candidate to recognize the general insulin resistance in patients suffering from DM- Type II. Objectives: This study aimed to estimate some biochemical parameters (that considered markers of oxidative stress) in patients with DM type II (DM-II) compared to healthy controls and study the correlation between them. Materials and Methods: This study included 75 samples of blood serum divided into (50) samples (26 males and 24 females) as patients with DM-II. The control group included 25 healthy controls (15 males and 10 females). Ceruloplasmin (CP) was isolated from human serum using 60% ammonium sulfate precipitation, then estimated the activity and specific activity of enzyme. The isolated enzyme was characterized by 10% polyacrylamide gel electrophoresis. Some biochemical indicators were also estimated. These included random blood sugar (RBS), total protein, thiol, free amino, and carbonyl. Results: The electrophoresis results for both protein and glycoprotein stain indicated that the bands of CP in patients group have more intensity than the bands of healthy controls. There were nonsignificant increase in total protein, thiol/protein, carbonyl and carbonyl/protein levels, nonsignificant decrease in the free amino and free amino/protein levels, and significant increase in the RBS and thiol levels in patients group compared to healthy controls. The correlation results indicated that there were significant positive correlation between CP and RBS with r = 0.306. Conclusion: The findings may support an association between oxidation proteins and DM-II. The stronger response observed in serum CP and thiol from patients with the change in the concentration of proteins which suggest that these oxidative proteins markers contents may be useful in evaluating the progression of DM-II and in elucidating the mechanisms of disease pathogenesis.
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Association of catechol-O-methyltransferase gene polymorphism with benign prostatic hyperplasia in Babylon Province p. 54
Nibras Yahya Hussein, Mufeed J Ewadh, Abdul Razzaq Al-Salman
DOI:10.4103/MJBL.MJBL_83_19  
Background: Benign prostatic hyperplasia (BPH) is a common nonmalignant disorder in elderly men. Objectives: The objective of the present study was planned to evaluate the frequency and association of catechol-O-methyltransferase (COMT) gene G↔A (Val 158 Met) single-nucleotide polymorphism (SNP) with BPH in Babylon Province. Materials and Methods: To accomplish this purpose, 146 patients with BPH and 102 apparently healthy controls were subjected to the study. DNA was extracted from whole blood for all samples. Genotyping of COMT gene G↔A (Val 158 Met) SNP was carried out by allele-specific oligonucleotides-polymerase chain reaction. Results: Results indicated that the homozygous genotype (Met158Met) (AA) of COMT gene G↔A (Val 158 Met) SNP was found to be significantly increase the risk of BPH by three folds with respect to those of the wild genotype (Val158Val) (GG) of COMT gene G↔A (Val 158 Met) SNP. The heterozygous genotype (Val158Met) (GA) of COMT gene G↔A (Val 158 Met) SNP was found to be none significantly increase the risk of BPH with respect to those of the wild genotype (Val158Val) (GG) of COMT gene G↔A (Val 158 Met) SNP. The minor allele frequencies (A) of COMT gene G↔A (Val 158 Met) SNP were significantly higher in BPH patients when compared with that of the control group. Conclusions: The COMT gene G↔A (Val 158 Met) SNP is involved in the pathogenesis of BPH.
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Perinatal and neonatal mortality, risk factors, and causes in Babylon teaching hospital for maternity and children during 2018 p. 58
Nadia Kadhim Nayyef, Jawad Kadhim Al-Bairmani, Ayser Mohammed Al-Hillali
DOI:10.4103/MJBL.MJBL_93_19  
Background: The perinatal mortality rate (PMR) is referred to fetal death from the 20th weeks of gestation until 7 days after birth expressed as number of death per 1000 live birth. The risk for mortality in fetuses and neonates is very high around the time of birth. Objectives: To evaluate the neonatal and PMRs according to sex distribution, causes, and risk factors. Methods: 200 neonatal deaths (NDs) in our hospital were reviewed to assign obstetric and neonatal information, final causes and the circumstances of death. Results: the age of patients enrolled in the study range between 24 weeks. Gestational age (GA) – 28 days, mean ± standard deviation (SD) – 2.64 ± 3.38 days. PMR = 43.6/1000 birth, neonatal mortality rate = 44.4/1000 live birth. Their mothers age mean ± SD – 27.68 ± 6.52 years. Regarding gender, M: F = 2.2:1. Perinatal mortality, 189 neonate (94, 5%) 88 male preterm baby (44%), 52 female preterm neonate (26%), term ND in the 1st week, 40 male (20%) and 9 female (4.5%). Death after 1st week from 8 to 28 days about 11. Regarding GA divided into 4 categories <28 week gestation account 11, 28–33. 6/7 weeks 93 ND (58 male, 35 female), 42 ND at 34–36.6 week (28 male, 14 female), term baby 54.44 male and 10 female. Regarding causes of death: prematurity include 99 (49.5% – 64 male and 35 female), neonate include 37 (18.5% – 30 male, 7 female), antepartum death include 17 (8.5%, 9 male, 8 female), sepsis include 15 (7.5% 10 male, 5 female), intrapartum complication include 14 (7%, 11 male, 3 female), 8 ND with pneumonia (4%, 7 male and 1 female), 3 ND with meningitis (1.5% male 2, female 1), other causes 7. Conclusions: Both NMR and PMR are higher than world health organization standard rates in Babylon Teaching hospital for maternity and children.
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Seroepidemiology of human parvovirus B19 among pregnant women in Erbil, Iraq p. 64
Nabaz Ahga, Kawthar Alharmni, Zakarea Alkhayat
DOI:10.4103/MJBL.MJBL_81_19  
Background: Human parvovirus B19 (HPV B19) is a member of the family Parvoviridae. It can be transmitted congenitally from an infected mother to the embryo. The virus has been implicated in hydrops fetalis, spontaneous abortion, aplastic crisis, and acute symmetric polyarthropathy. Objective: The present study was carried out to determine the seroprevalence of HPV B19 immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies among apparently healthy pregnant women and to define the risk factors associated with. Materials and Methods: Blood samples were collected from consenting pregnant women who were attending Erbil Maternity hospitals from the period between January 2018 and June 2019. The sera were obtained from samples were analyzed for IgG and IgM antibodies of HPV B19 using (EUROIMMUN AG, Luebeck Germany) ELISA Classic Parvovirus B19 IgG/IgM kits. Structured questionnaire was used to obtain data on sociodemography and risk factors. Results: A total of 349 pregnant women were enrolled in this study and were screened for both IgM and IgG antibodies. Overall, 139 (39.8%) were positive for parvovirus B19 IgG and 32 (9.2%) had IgM antibody. Demographics including age group, occupation, number of children, and trimester of pregnancy. The differences of distribution of the Parvovorus IgG in relation to the above-mentioned demography were as follows: age >35 years: highly significant (P ≤ 0.01), second trimester: nonsignificant, homemakers: highly significant (P ≤ 0.01), ≥5 children highly significant (P ≥ 0.01). The differences of distribution of the Parvovorus IgM in relation to the above-mentioned demography were as follows: age <20 years: significant (P ≤ 0.05), second trimester: nonsignificant, homemakers: highly significant (P ≤ 0.01), ≥5 children: significant (P ≥ 0.05). Conclusions: HPV B19 is prevalent in Erbil, Iraq. More than half (51%) of the women were IgG negative, so they are susceptible to the HPV B19 infection. Hence, there is a need for routine screening for B19 IgM antibodies for all women of childbearing age and subsequent clinical management of positive cases.
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Health-related quality of life of chronic obstructive pulmonary disease patients p. 69
Ali Ayad Tareq
DOI:10.4103/MJBL.MJBL_78_19  
Background: Chronic obstructive pulmonary disease (COPD) is a common health problem, characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities. COPD is usually caused by significant exposure to noxious particles or gases. Objective: The objective was to assess the impact of COPD on health-related quality of life (HRQOL) of COPD patients. Materials and Methods: In this cross-sectional descriptive study, sixty stable COPD patients without significant comorbidity, not in acute severe exacerbation, who were assessed for HRQOL were interviewed at the Chest Consultant Clinic of Baghdad Teaching Hospital by using 14 questions of Centers for Disease Control and Prevention HRQOL Questionnaire between May 2017 and February 2018. Results: Of the sixty participants (80% male and 20% female), all of them were cigarettes smokers (current 57%, ex– smoker 43%)” mean ± standard deviation (SD) of age 57.4 ± 10.9 years, mean ± SD of their tobacco smoking pack years 61.0 ± 28.7. About 62% of them said that their general health is poor with COPD and 95% of them said they were limited in any way in their activities from the disease. Eighty-five percent of them said that they didn't get enough rest or sleep in the last 30 days due to their illness. Seventy-five percent 75% of them said that shortness of breath due to COPD made it hard to do usual activities in the last month. They needed help for personal care and help for routine needs in life as their answers to questionnaire questions revealed. Statically significant results (P < 0.05) also revealed that the higher COPD severity stage, the lower HRQOL. Conclusions: HRQOL of COPD patients is considerably impacted by this disease and the impaction differs according to the severity stage of COPD, the higher the severity of COPD, the lower the quality of life. As the goal of therapy in COPD is to improve symptoms and quality of life, so assessment of HRQOL is mandatory in all COPD patients and it is important part of disease management and follow-up. It is necessary to increase public awareness about tobacco smoking harms because of their direct effect on developing and severity of COPD.
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Comparing certain echocardiographic measurements with catheterization in children with pulmonary hypertension due to left-to-right cardiac shunt p. 79
Haider Sahib Humady Tuky, Mohanad Kudhair Shukur Alghanimi, Ban Abbas Semender
DOI:10.4103/MJBL.MJBL_53_19  
Background: Children with left-to-right cardiac shunt are at increasing risk of developing pulmonary hypertension and it's degree will guides the line of management of those patients. However, cardiac catheterization is the standard way to investigate PHT, and echocardiography shows an increasing role in diagnosis. Objectives: To check the consistency of noninvasive echocardiographic parameters with that is measured by conventional cardiac catheterization in assessing children with pulmonary hypertension due to congenital heart disease (PHT-CHD). Materials and Methods: This prospective cross-sectional study included 60 children with PHT-CHD we assessed six echocardiographic parameters; pulmonary vascular resistance (PVR), mean pulmonary artery pressure (MPAP), pulmonary capillary wedge pressure (PCWP), pulmonary to systemic flow (QP/QS), acceleration time of right ventricular outflow tract, and shunt gradients. Then these data were compared with same catheterization parameters. Results: There insignificant difference among PVR, MPAP, PCWP, and QP/QS measured by catheterization and the same parameters measured by echocardiography with P > 0.05. The total sensitivity of echocardiographic measurements was 94.23%, specificity 91.45%, positive predictive value 90.71%, and negative predictive value 87.35%. Conclusion: Echocardiographic measurements show respectable similarity to catheterization results in patients with PHT-CHD.
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Willingness of people living with human immunodeficiency virus/acquired immunodeficiency syndrome to pay for treatment and preventive services in human immunodeficiency virus care centers in Osogbo, Osun State p. 84
Wasiu Olalekan Adebimpe, Nurat Dasola Badru, Oluwatosin Adediran Adeoye, Joy Osifo
DOI:10.4103/MJBL.MJBL_29_19  
Background: The global financial meltdown has led to donor countries and agencies cutting down on human immunodeficiency virus (HIV) funding and support to developing countries such as Nigeria, leading to a dire need to circumvent acute funds shortage. Objectives: To assess the willingness to pay (WTP) for HIV treatment and preventive services among people living with HIV (PLHIV)/acquired immunodeficiency syndrome in Osogbo, Southwestern Nigeria. Materials and Methods: This was a descriptive cross-sectional study among 300 PLHIV attending HIV treatment and care centers selected using the multistage sampling method. Research instruments used were semi-structured interviewer-administered pretested questionnaire. Data were analyzed using the Statistical Package for the Social Sciences software version 23.0. Results: The mean age of respondents was 36.9 ± 11.6 years, with 57.0% of the respondents having good knowledge of the sources of funding of HIV services. Only 153 (51.0%) were willing to pay for HIV treatment and care services, of which 123 (80.3%) were only willing to pay voluntarily and 10 (6.5%) willing to pay only if pushed. On binary logistic regression, predictors of WTP for HIV services include age above 40 years and being in a polygamous marriage. Conclusion: Only about half of PLHIV showing WTP underscore the need for stakeholders in HIV care to enlighten clients on the challenges facing HIV funding toward encouraging them to pay for some if not all services received.
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Estimation of trace elements (selenium, iron) and their biological effect in serum levels of breast cancer patients p. 89
Saja Nasief Jasim, Abdul Majeed K Ahmed, Sayran Sattar Saleh
DOI:10.4103/MJBL.MJBL_94_19  
Background: Breast cancer (BC) is the most commonly occurring cancer that records a significant percentage of all cancers among women. The most common type of BC is ductal carcinoma. The trace elements, selenium (Se) and iron (Fe), have an important role in the metabolism of human body in which they have very vital biological effect on the enzymes involved in antioxidants and immune system. Materials and Methods: Venous blood samples were collected into plain vials from 50 patients and 50 controls, which were transported to the laboratory on ice and centrifuged at 3000 rpm for 15 min, and the serum was stored at −4°C until the day of mineral estimation, using SHIMADZU Atomic Absorption Spectroscopy AA7000 using Graphite Furnace Technique. Results: There was a significant (P < 0.05) decrease in the concentration of Se in serum samples of BC patients as on comparison with the healthy individuals. Level of difference of Fe remains insignificant (P > 0.05) in the serum of BC patients as compared with normal healthy controls. Conclusion: We found a significant association between trace elements (serum Se and Fe) with BC.
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Helicobacter pylori infection among children with recurrent abdominal pain p. 93
Media Khalid Abdullah, Kawes Omar Zangana
DOI:10.4103/MJBL.MJBL_92_19  
Background: Helicobacter pylori is one of the most common chronic bacterial infections worldwide and it is more prevalent in developing countries. Its association with recurrent abdominal pain (RAP) in children is still controversial. Objectives: The aim of this study was to determine the prevalence of H. pylori infection and evaluate its association with RAP and response to proper eradication therapy. Materials and Methods: A cross-sectional study involved 185 children aged <18 years who attended the outpatient department in Rapareen Teaching Hospital presented with a history of RAP. Only 150 children fulfilled the criteria to be included in the study and later they were divided into two groups according to the presence of H. pylori infection or not. Results: The prevalence of infection among healthy children was 11 (11%), whereas among 150 children with RAP included in the study, the prevalence of positive H. pylori was 36 (24%) and was statistically significant. Family history of H. pylori infection was significantly higher in 24 (16%) children among those who tested positive and treatment shown to have great impact on clinical and laboratory results in 17 (77.3%) and 13 (72.2%) children, respectively, during follow-up compared to those who did not receive therapy. Conclusions: The prevalence of H. pylori infection is significantly higher among children with RAP and children who have excellent response to proper eradication therapy proved by high rate of negative stool test for H. pylori after treatment.
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Effectiveness of removable walker cast in the healing of diabetic neuropathic foot ulcer p. 97
Yasir Azeez Mohammad, Amer Abbas Al-Asdy
DOI:10.4103/MJBL.MJBL_68_19  
Background: The elevation of the plantar loading has been implicated in the etiology of plantar foot ulceration in individuals with diabetes mellitus (DM) and peripheral neuropathy. Many strategies are used to reduce this load which are regarded as critical for ulceration healing and commonly called offloading. Objective: The objective was to evaluate the effectiveness of the use of a removable cast walker (RCW) in the healing of diabetic neuropathic planter foot ulcerations. Materials and Methods: Twenty-nine adult diabetic patients attending Al-Faiyha General Hospital, Basrah city in Iraq, participated in this cross-sectional (randomized selection) prospective study between August 2014 and September 2015. We relied on clinical features for survey a diabetic neuropathy of affected foot and we proved the diagnosis by nerve conduction study. Assessment of vascularity was done clinically and by Doppler ultrasound study. Surgical debridement was done, and the participants were instructed to wear a RCW on the 2nd day post operation. Follow-up was performed weekly, and the outcome was assessed by complete wound healing. Results: Twenty-nine patients were included in our study and follow-up program. The mean duration of the neuropathic nonischemic ulcers was 7.1 ± 4.3 months. The healing rate was 62.5%, and we found that the total percentage of healing of the ulcers with 1A and 2A classes was 69.0% with a mean duration of 8.45 ± 2.2 weeks. In addition, we observed that the percentage of patients with diabetic neuropathic foot ulceration with an obvious forefoot deformity was 56.5% of all forefoot ulcers, with a healing rate of 76.9%, whereas those without an obvious foot deformity was 43.5% with a healing rate of 80%. Conclusion: RCW is an effective method in the treatment of diabetic neuropathic nonischemic foot ulceration. The healing rate of the ulceration by using this method of offloading mainly depends on the site of planter foot ulcer.
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Serum zinc levels in iron deficiency anemia, non-iron deficiency anemia, and normal pregnant women and its correlation with iron status and hematological parameters p. 103
Suzan Omer Rasool, Burhan Abdullah Zaman, Deldar Morad Abdulah
DOI:10.4103/MJBL.MJBL_91_19  
Background: There is limited information on zinc deficiency in pregnant women. The present study aimed to assess the serum zinc (S. zinc) levels and its relation to iron deficiency anemia (IDA) in pregnant women. Patients and Methods: In this case–control study, S. zinc concentrations of 34 individuals diagnosed with IDA, 20 non-iron deficiency anemic pregnant women, and 32 non-anemic apparently healthy individuals were measured. Results: S. zinc was significantly lower in the IDA group (49.59 ng/dL) compared to the healthy controls (55.78; P = 0.018). The individuals in three groups were comparable in the number of persons with zinc deficiency. The study showed that S. zinc has a positive correlation with Hb (r = 0.281, P = 0.011). In addition, S. zinc had a positive correlation with hematocrit (HCT, r = 0.305, P = 0.005) and a negative correlation with serum iron (S. iron, r = 0.242, P = 0.029). Conclusions: This investigation showed that the patients with IDA have a significantly lower concentration of S. zinc and it was substantially positively correlated with Hb, red blood cell, and HCT and negatively with S. iron. Further studies are still needed to evaluate the benefits of zinc and iron supplementation in IDA patients.
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Microbial causes of urinary tract infection and its sensitivity to antibiotics at Heevi pediatric teaching hospital/Duhok City p. 109
Salah Abdulkareem Ibrahim, Delshad Abdallah Mohamed, Sherzad Khudeida Suleman
DOI:10.4103/MJBL.MJBL_64_19  
Background: Urinary tract infection (UTI) refers to the presence of microbial pathogens within the urinary tract, and it is usually classified by the site of infection as the bladder (cystitis), kidney (pyelonephritis), or urine (bacteriuria). Objectives: The objectives of this study were to determine the etiological bacterial pathogens of UTIs and to identify antibiotic sensitivity patterns of pathogens isolated among age groups of children. Materials and Methods: In this cross-sectional study, a random sample of the local registry of Heevi pediatric hospital of the patients who were diagnosed with UTI and were sent for antibiotic sensitivity between August 2018 and July 2019 was taken for analysis. Seven hundred and twenty-two patients were included in the present study whose ages ranged from birth to more than 10 years. Results: The study showed that 22.8% and 20.6% of the patients were in >3–5 and 7–10 years of age and majority were females (66.5%). The study revealed that 56.2% of the patients had different pathogens, and Escherichia coli was the most common pathogen in the diagnosed patients with UTI. The pathogens had different frequency in the urine samples. Most of the cultures were sensitive to gentamycin (23.4%), amikacin (27.6%), and norfloxacin (25.4%). The most resistant cultures were toward trimethoprim (31.2%), cephalothin (32.6%), and cefixime (21.6%). The study showed that E. coli was prevalent pathogen in all age groups. The study did show that common antibiotics were not statistically significantly different between male and female patients, including gentamycin (P = 0.145), amoxicillin (P = 0.304), and norfloxacin (P = 0.407). The common antibiotics were more prevalent in >3–5 years group, including gentamycin; amoxicillin; and norfloxacin. Conclusion: This study finding showed that E. coli isolates were the predominant pathogens and showed increasing sensitivity pattern to antimicrobial gentamycin, amikacin, and norfloxacin.
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Maternal and child survival in the context of sustainable development goals - Unfinished business p. 115
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/MJBL.MJBL_73_19  
The optimal wellbeing and health of mother and child has been regarded as one of the global public health priorities owing to their vulnerable nature in the different settings. However, the ground reality is quite alarming with more than 5.2 million deaths being reported in under-five year age-group. Even on the maternal front, the existing trends of maternal mortality and the progress which we have made, it is quite obvious that we will miss the global target by more than 1 million lives. The need of the hour is to accelerate the progress and this can happen only if the individual nation sets their own targets and formulate tailor-made strategies which will be successful in their own settings to accomplish a reduction in maternal and child deaths. In conclusion, a lot needs to be done to improve the maternal and child survival estimates and it will essentially require a collaborative approach from the concerned stakeholders and sectors.
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