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   Table of Contents - Current issue
Coverpage
October-December 2020
Volume 17 | Issue 4
Page Nos. 311-372

Online since Monday, December 14, 2020

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REVIEW ARTICLES  

Cartilage oligomeric matrix protein: A biomarker for diagnostic and monitoring osteoarthritis p. 311
Zahraa M. A A. Hamodat
DOI:10.4103/MJBL.MJBL_52_20  
Osteoarthritis (OA) is a painful, chronic, and widespread disease. Early treatment for disease is very important to prevent the progression of the disease. Currently, X-ray and clinical history are still the most dependable ways to diagnose OA and estimate the severity of disease. However, the joint damage by OA disease begins before it is diagnosed by radiographic changes. Hence, further practices for early diagnosis are required. Biomarkers and particles that are released into fluids during the disease have received many research interests for early diagnosis of OA. Therefore, in order for the biomarker to be beneficial in diagnosing of OA preradiography, it must have a strong and direct association with the disease. Hence, a good approach to detect and follow-up this disease is cartilage oligomeric matrix protein (COMP). COMP is one of the important biomarkers, which is closely related to the breakdown of the articular cartilage and the loss of function. Many studies have suggested that the COMP level is an indicator of the diagnosis and severity of the disease. In this review article, we highlighted the importance's role of COMP in OA.
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Dynamics of transmission of severe acute respiratory syndrome coronavirus 2 and its control measures p. 318
Indranil Chakrabarti, Nilanjana Ghosh
DOI:10.4103/MJBL.MJBL_58_20  
Coronavirus disease 2019 (COVID-19) caused by the β coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a zoonotic disease that has spread beyond the site of outbreak in Wuhan, China, to become a pandemic of magnanimous proportions. As the whole world is reeling under the burden of its morbidity and mortality, researchers are busy tracing its origin, deciphering its transmission dynamics, devising new, rapid, inexpensive, accurate diagnostic modalities, testing potent vaccines, and exploring effective therapeutic measures. Although till date much is unknown about the novel virus, the present review attempts to provide an insight to the transmission dynamics of SARS CoV2 and cover the various control measures that has been adopted to control its transmission.
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Clostridium Difficile-associated diarrhea: A mini-review p. 323
Inas Ahmed Saeed, Jawad R Al-Zaidi
DOI:10.4103/MJBL.MJBL_65_20  
The most common cause of antibiotic-associated diarrhea in hospitals and other health-care facilities is Clostridium difficile which is also cause of significant concern because of the increasing morbidity and mortality rates as well as increased health-care costs. The infection by this bacterium was ranging from mild, self-limiting diarrhea to serious diarrhea, pseudomembranous colitis, and life-threatening fulminant colitis which may lead to death. Infection by C. difficile develops after ingestion spores of this toxigenic strain by the patients through personal contact or environment. Pathogenicity depending on the production of two types of enterotoxins by bacteria: Tcd A and Tcd B toxins responsible for fluid secretion, inflammation, and tissue necrosis, so identification of this bacterium is depending on the presence of an important virulence factor (enterotoxin) in the stool by using tissue culture cytotoxicity assay, or by enzyme immunoassay for C. difficile glutamate dehydrogenase antigen, and sometimes by endoscopy to verify pseudomembranous colitis. The infection can be effectively treated by metronidazole and vancomycin before that, fluids, and electrolytes replacement must be supplied.
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ORIGINAL ARTICLES Top

Frequency and prognostic significance of hypercalcemia in patients with multiple myeloma p. 327
Kanar J Karim, Abid M Hassan, Hisham A Getta, Najmaddin S. H. Khoshnaw, Sana D Jalal, Akram M Mohammed, Kawa M Hasan, Dana A Abdullah, Ameer I A. Badi, Ahmed K Yassin, Banaz M Safar, Basil K Abdulla, Rawand P Shamoon, Truska A Amin, Zeki A Mohamed, Ali I Mohammed, Diveen J Hussein, Nawsherwan S Mohammed, Rezhin N Rajab, Firiad Hiwaizi
DOI:10.4103/MJBL.MJBL_54_20  
Background: Multiple myeloma (MM) is defined as a clonal B-cell malignancy of the bone marrow. Hypercalcemia is associated with cancers in general and in MM specifically becomes more obvious with frequent adverse outcomes. Objectives: The objective is to determine the frequency of hypercalcemia in MM patients and survival rate after 3 years of diagnosis with the assessment of relationship between MM prognosis and hypercalcemia. Materials and Methods: Retrospective data were reviewed from the Hematology and Cancer Centers of Kurdistan Region of Iraq (KRI, Erbil, Sulaymaniyah, and Duhok) from January 2012 to December 2017 on a sample of 130 patients with MM. The diagnosis of MM and hypercalcemia was done according to the International Myeloma Working Group definition of MM and serum calcium of ≥11 mg/dl. Results: The prevalence of hypercalcemia among MM patients after calcium correction was 17.7%. Serum creatinine level is significantly higher among MM patients with hypercalcemia. There was a significant association between high death rates and MM patients with hypercalcemia. The mean survival of MM patients was 4.5 years and 72% of the MM patients had 3-year survival, which decreased to <41% for 6-year survival. The survival of MM patients with hypercalcemia was significantly shorter than survival of patients without hypercalcemia. Conclusions: The frequency of hypercalcemia among MM patients in KRI is within the international acceptable range and is regarded as a poor prognostic factor that is associated with higher mortality and shorter survival.
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Celiac disease: Biochemical and histopathological considerations of local patients p. 332
Razan Yassin Abdullah, Rana Adil Hanoon
DOI:10.4103/MJBL.MJBL_62_20  
Background: Celiac disease (CD) is a chronic small intestinal condition caused by immune-mediated pathology, which is due to the prolonged deficiency of gluten in genetically susceptible people and induced by the ingestion of a complex protein, gluten, found in cereals such as barley, wheat, and rye. Objectives: This study aimed to identify the frequency of individuals affected by CD in Duhok city and the impact of certain environmental factors on the disease occurrence. Materials and Methods: The current study was conducted in the Duhok central public health laboratory in Duhok/Kurdistan region/Iraq. This study involved 500 intestinal biopsy samples from which 34 biopsies diagnosed as having CD characteristics by histopathological examination performed by specialists in Duhok central public health laboratory. This finding was also supported by serological testing results using the tissue transglutaminase assay (tTG-IgA). Results: The results revealed that female CD patients exceeded male CD patients and represented by 24 (70.6%) and 10 (29.4%), respectively. Furthermore, a total of 18 (52.9%) individuals affected by CD were born in summer and spring months, while 16 (47.1%) subjects were born in fall and winter months. Our work also showed that subjects who had clinical presentation indicating and/or referring to risk factors for developing CD and tested positive for anti-TTG antibodies had a greater probability of manifesting duodenal damage and an ultimate diagnosis of the disease. The result of this study showed that the percentage of breastfed patients was 22 (64.7%) and cow milk-fed patients were 4 (11.8%), five (14.7%) patients were breastfed for = 6 months, and 3 (8.8%) patients were fed both. Conclusion: Histopathological and serological assays have powerful diagnostic potential, and one can potentiate the results of others. Environmental risk factors can determine the rate and intensity of the condition.
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Upper gastrointestinal endoscopic findings in children at rapareen teaching hospital in Erbil, Iraq p. 337
Dlair Abdulkhaleq Chalabi
DOI:10.4103/MJBL.MJBL_61_20  
Background: Gastrointestinal disorders are a frequent health problem in children and information on digestive disease in children is lacking in most developing countries. The development of flexible esophagogastroduodenoscopy (EGD) with small diameter and the practice of the pediatricians have made gastroscopy feasible at all ages and promote more precise diagnosis and plan for therapy. Objectives: It has been carried out to demonstrate indications and findings of endoscopy in children. Materials and Methods: An observational study involved all patients who underwent upper gastrointestinal endoscopy at Rapareen Teaching Hospital for pediatrics during the period from April 1, 2019 to March 1, 2020. Results: During the study period, 84 patients underwent EGD. The mean age of patients was 6.99 ± 3.84 years ranging from below 1 year up to 14 years, majority of patients were above 5 years of age, and males constitute 65.5% of the study sample. Higher the age (whether mean or above 5 years) the more prone to have abnormal findings and upper gastrointestinal bleeding was the most common indication, while gastritis was the most frequent finding (34, 29.5%). Conclusion: Upper GIT endoscopy is an important tool in digestive disease diagnosis and most children referred had abnormal findings aid decision making and further management. Upper GIT bleeding was frequently reported and higher proportion of patients were male predominantly above 5 years of age.
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Preoperative predilection of conversion to open in laparoscopic cholecystectomy p. 341
Alaa Bakir Raheem, Hussein Oudah Al-Jasmawi, Ameer Kadhim Al-Humairi
DOI:10.4103/MJBL.MJBL_42_20  
Background: With the new era of laparoscopic surgery within the last three decades, laparoscopic cholecystectomy emerges as the golden standard treatment for gallbladder disease and cholitiasis; laparoscopic treatment not always seems to be successfully completed laparoscopically. Making attempts for completing the procedure it is laparoscopically is challenging some times and conversion occurs. This study is to discuss the conversion main causes try to detect patients at risk factors for conversion in laparoscopic cholecystectomy. Objectives: The aim of the study was to predict which patients are having greatest risk factors for possible conversion to open procedure instead of being completed laparoscopically. Materials and Methods: This is a cross-sectional study performed retrospectively from October 2007 to January 2019 to detect the patients at risk factors for conversion in patients who started laparoscopically and conver to open approach occurred started by started via. All the procedures were performed by the same operator team surgeon. Surgery was done at AL-Hilla General Teaching Hospital, AL-Sadeque General Teaching Hospital, and in many private hospitals in Babylon Governance. A routine preoperative history, clinical examinations, and US, EX, and laboratory investigations were done for all patients, while abdominal Computerized Axial Tomography (CAT) scan, endoscopic retrograde cholangiopancreatography, and magnetic resonance cholangiopancreatography were done for selected patients if indicated. Many patients have different associated comorbid diseases. There are no selection criteria as all patients have no contraindications for laparoscopic surgery. Results: This study included 344 patients; 62 males (18.0%) and 282 females (82.0%). There are different age groups: the mean age is 42.38 (11–85) years for different gallbladder diseases including calculus cholecystitis, acalculus cholecystitis, microlithiasis, cholecystitis causing biliary pancreatitis, and empyema of gallbladder. Data were analyzed retrospectively as the results of surgical procedures outcome which show that only 11 patients (3.2%) whom underwent conversion from a total of 344 patients of the study. Conclusion: There are several factors associated with increased risk of conversion, but this study showed that there is no association with age, diabetes mellitus, and abnormal anatomical variations as risk factor for conversion.
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Evaluation of risk factor in Iraqi patients with angiographically documented peripheral vascular disease and the effect of specific risk factor on specific site or vessel p. 347
Basim Mohammed Madloom, Haider Hamza Umran
DOI:10.4103/MJBL.MJBL_85_19  
Introduction: The prevalence of lower extremity peripheral arterial disease (PAD) varies across populations, based on the groups studied and the detection methods used. Patients with PAD have significantly increased functional impairment and elevated rates of functional decline relative to those without PAD. Objective: This study was designed to determine the prevalence of risk factor in Iraqi patients with angiographically documented peripheral vascular disease (PVD) and effect of specific risk factor on specific vessel or area. Materials and Methods: In this case–control study from January 2010 to June 2011, 111 consecutive patients who attend care at the Iraqi center of heart disease with angiographically confirmed PVD were studied. They had clinical assessment including special documentation of risk factors. Luminal arterial narrowing of 50% or more is considered as a significant vascular lesion. Results: One hundred and eleven patients were included in this study, of whom 81 (73%) were male and 30 (27%) were female, with a mean age of 58.6 years. Of those patients, fifty-one had done coronary angiography. All the patients have significant PAD. Aging, gender, smoking, hypertension, diabetes mellitus, hyperlipidemia, and renal impairment are significantly associated risk factors for PAD. No statistically significant relation was found between specific risk factor and specific vessel involved. Conclusion: PVD prevalence increases with an increased number of risk factors. PVD prevalence increases with increased age. PVD was more prevalent in males. There was no relation between specific risk factors and specific anatomical area or vessel
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Assessment of renal involvement in an Iraqi cohort of rheumatoid arthritis p. 353
Bzhar Abdullah Abubaker, Hussein Yousif Sinjari
DOI:10.4103/MJBL.MJBL_29_20  
Background: Rheumatoid arthritis (RA) is an autoimmune chronic systemic inflammatory disease involves synovial joints but may involve extra-articular organ as well. Objectives: to determine the prevalence of indicators of renal involvement in patients with RA with implications of impact of related drugs on the kidney. Materials and Methods: This cross-sectional study was conducted from May 1, 2019, to November 1, 2019, in the Outpatient Rheumatology Clinic of Hawler teaching hospital, Erbil, Iraq. One hundred and seventy-six patients with seropositive RA were enrolled, other 13 were dropped because of missing data. Participant's characteristics and data regarding drug history were collected. Body mass index (BMI), erythrocyte sedimentation rate (ESR), and serum creatinine were measured; renal function was assessed from the estimated glomerular filtration rate (eGFR) using the modification of diet in renal disease formula. Urine examined for proteinuria, microscopic hematuria, and noninfectious leucocyturia. When eGFR <60 ml/min/1.73 m2 regarded as renal impairment, impact of RA medications non-steroidal anti-inflammatory drug, disease-modifying anti-rheumatic drugs, and biological agents on renal function and urine sediments were studied. Results: Out of a total 176 RA patients, 56.8% were females, their mean age 50.4 (±10.4) years, BMI 28.7 (±3.6) kg/m2, with disease duration 8.3(±4.5) years. Renal impairment was detected in 20 (11.4%) participants. Proteinuria, hematuria, and uninfectious leucocyturia were observed in 10.2%, 23.9%, and 25%, respectively. Renal dysfunction was significantly associated with old ages, BMI ≥30, long duration of disease and proteinuria (P = 0.004, 0.002, 0.014, and 0.009, respectively). Renal impairment was not significantly associated with sex, smoking status, ESR level, RA medications, hematuria, and uninfectious leucocyturia (P > 0.5). Conclusions: Renal disorder is common in RA patients. Regular monitoring of renal involvement by using eGFR and urinary dipstick is crucial, especially in the elderly obese RA patients with a long duration of the disease and proteinuria. Early identification of renal disease can facilitate the early intervention and achieve the better management of RA patients.
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High prevalence of vitamin D deficiency in patients with acute myocardial infarction: An Iraqi single-center study Highly accessed article p. 358
Shwan Othman Amen, Soza Tharwat Baban, Salah Hassan Yousif, Zana Tharwat Baban, Ahmed Himdad Hawez, Dlovan Mustafa Fateh Jalal
DOI:10.4103/MJBL.MJBL_67_19  
Background: Coronary artery disease (CAD) is the leading cause of morbidity and mortality worldwide despite current advances in primary preventive and state-of-the art interventional strategies for effective CAD treatment. The major manifestation of CAD is the acute myocardial infarction (AMI). Vitamin D deficiency is associated with an increased risk of coronary atherosclerosis and AMI. Objectives: The major aim of this study was to determine the association of Vitamin D deficiency with AMI in Iraqi patients living in this region. Materials and Methods: Vitamin D level status was determined in 148 patients presented with AMI and 148 of healthy controls. Measurement of serum 25-hydroxyvitamin D (25(OH) D) levels was performed using enzymatic immunoassay method. Normal serum 25(OH) D level is = 30 ng/ml, while patients with level of 20–30 ng/ml was classified as insufficient, and those with level 10–20 ng/ml as deficient. The severe Vitamin D deficiency in patients was defined when serum 25(OH) D level was = 10 ng/ml. Results: The mean of 25(OH) D level was significantly lower in patients with AMI (8.73 ng/ml) as compared to healthy controls (13.60 ng/ml). Notably, the prevalence of severe deficiency of 25(OH) D level (<10 ng/ml) was higher in patients with AMI (67.6%) as compared to that in healthy controls (51.4%). This difference was statistically significant. Similar trend was observed for the prevalence of deficient Vitamin D level (≥10–<20 ng/ml) in cases (28.4%) as compared to control group (24.3%). Moreover, 4.1% of AMI patients showed insufficient 25(OH) D level in comparison to 13.5% in healthy individuals of control group. Interestingly there were no AMI patients with sufficient 25(OH) D level (30–100 ng/ml) while 10.8% of healthy individuals in the control group showed sufficient 25(OH) D level. Conclusions: This study concludes that Vitamin D deficiency is a highly prevalent condition in patients with AMI among Iraqi population and it is an emerging new risk factor associated with AMI.
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Breast cancer in 2020: Does receptor status still drive the cancer as before – An Indian study p. 363
Rahul Sud, S Viswanath, Salil Gupta, Pradeep Jaiswal, Harshit Khurana
DOI:10.4103/MJBL.MJBL_68_20  
Background: Incidence of breast cancer has increased globally over the past several decades with the greatest increase in the Asian countries. The hormone status perhaps plays the most vital part in disease discordance and impacts the clinical behavior of the disease. This study attempts to study the receptor status in carcinoma breast in the Indian Population and study any change in its correlation with the clinical profile, tumor characteristics, and metastatic profile. Methods: This was a prospective observational study done on all patients with breast cancer treated at Command Hospital Airforce, Bangalore, between January 2017 and December 2019. Two hundred and eight female patients with breast carcinoma were included in the study. Results: Estrogen (ER) and progesterone receptors (PR) are found positive in only 20%–45% of Indian patients. ER-positive rates are lower in Indian patients than those in Western countries. Triple-negative breast cancer (TNBC) metastasizes especially to the liver and lung; however, Her 2nu-positive tumors present as Stage III rarely metastasize. Hormone-positive tumor showed a bimodal peak pattern, while TNBC is seen uniformly in all age groups now. BIRADS 5 was seen exclusively in triple-positive disease. Grade I tumors are exclusively seen in hormone-positive tumors, but 25% of these tumors present with distant metastasis and 90% with node-positive disease. Conclusion: Breast cancer patients of Indian origin tend to be younger; tumors are often large when rst diagnosed, and of a high grade as compared to Western countries. The hormone receptor status still determines and drives the disease; however, there is a major paradigm shift in the disease behavior now as compared to the earlier data. The biology of the disease and the clinicoepidemiological profile of breast cancer in relation to the receptor status is an ever-evolving event and periodic evaluation of their correlation is the need of the hour. This will improve the further understanding of the disease, help in therapeutics, and improve outcomes in such patients
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SHORT COMMUNICATION Top

Coronavirus disease 2019 pandemic: Improving the outbreak readiness and response in camp settings p. 369
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/MJBL.MJBL_46_20  
The coronavirus disease-2019 (COVID-19) pandemic has accounted for the jeopardizing the health care delivery system and exposure of the lack of preparedness and emergency response plan. If this is the status of the general population, it is difficult to imagine the outcome of the outbreak for population groups who are living in camps or similar settings due to an ongoing humanitarian emergency. Acknowledging the specific and unique needs of the vulnerable population groups living in camp settings, guidelines have been formulated to improve the readiness and response action to the potential outbreak of the disease. This is the need of the hour as it will aid in reducing the probability of transmission of infection, early identification & provision of appropriate treatment to the infected people, strengthen the risk communication mechanism to provide trustworthy information, and will also guide in implementing a multi-sectoral response to the viral infection. In conclusion, in the fight against COVID-19 outbreak, it is the responsibility of the health stakeholders to ensure that the outbreak readiness and response strategies should be extended to the vulnerable population groups who are living in camp settings due to an ongoing humanitarian emergency.
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Ensuring delivery of malaria control services in coronavirus disease-2019-affected areas in the american region p. 371
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/MJBL.MJBL_31_20  
The coronavirus disease-2019 (COVID-19) pandemic has affected the delivery of all the national health programs, including the efforts that have been taken for the prevention, control, and elimination of malaria. There are no doubts that the sudden upsurge in the number of COVID-19 cases has made the health authorities to focus their resources and time toward the effective containment of the infection. Thus, the need of the hour is to guide the health authorities toward the interventions, which need to be implemented to accomplish malaria elimination and at the same time safeguard the well-being of healthcare professionals. This can be accomplished by adapting the detection of malaria cases, simplifying malaria surveillance, and ensuring management of logistics. In conclusion, in the battle against COVID-19 infection, the routine services for malaria containment have been affected significantly. Thus, we have to take an evidence-based decision toward the continuation of the malaria services in the region, based on the transmission pattern of the disease.
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