mjl@ lmstnSry@ lTby@最新文献

{"title":"Evaluation of maternal serum sestrin2 levels in preeclampsia and their relationship with the Disease severity","authors":"Raghad Fadhil, Lilyan W. Sersam","doi":"10.4103/mj.mj_33_20","DOIUrl":"https://doi.org/10.4103/mj.mj_33_20","url":null,"abstract":"Background: Preeclampsia (PE) is considered one of the major causes of both maternal and fetal mortality and morbidity. Advances have been made on understanding the pathophysiology of this pregnancy-specific disorder. Sestrin2 (SESN2) is a metabolic regulator protein, whose expression is induced in response to exposure to different adverse effects such as hypoxia, DNA damage, or oxidative stress, thus acting as cytoprotective. Objective: The objective of the study was to investigate the levels of maternal serum SESN2 in preeclamptic and uncomplicated pregnancies and their association with the disease severity. Patients and Methods: This was a case–control study conducted at the Department of Obstetrics and Gynecology at Al-Yarmouk Teaching Hospital in Iraq – Baghdad city from the first of March till the end of November 2019. The study included a total of 92 pregnant women, 27 with a healthy pregnancy, 33 with nonsevere PE, and another 32 having severe PE. From all participants, blood samples were collected for the evaluation of serum SESN2 levels using enzyme-linked immunosorbent assay. Results: The mean readings of SESN2 for normal pregnancies were 5.22 ± 1.71 ng/ml which was significantly lower than that for the nonsevere PE group (8.41 ± 1.42 ng/ml), while SESN2 levels were the highest among those with severe PE (16.92 ± 5.15 ng/ml). A negative correlation was found between each of GA at delivery, birth interval, and birth weight and the SESN2 level (P = 0.001); while mean arterial pressure positively correlated with SESN2 levels (P = 0.001), the cutoff value for the diagnosis of severe PE was 9.95 ng/ml (sensitivity of 93.8% and specificity of 98.8%). Conclusion: Maternal serum SESN2 levels are significantly higher in pregnancies complicated by severe PE than nonsevere PE and control groups. It could be a useful biomarker that can help in diagnosing severe PE.","PeriodicalId":33069,"journal":{"name":"mjl@ lmstnSry@ lTby@","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46208322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of florid diabetic retinopathy","authors":"Faiz I. Shakarchi, Ahmed F. Shakarchi, shadha a al-Bayati","doi":"10.4103/mj.mj_28_20","DOIUrl":"https://doi.org/10.4103/mj.mj_28_20","url":null,"abstract":"Background: Florid diabetic retinopathy (FDR) is a severe form of proliferative diabetic retinopathy associated with high risk of blindness. Aim: The aim of this study is to evaluate the efficacy and safety of prompt intravitreal injection of bevacizumab followed by complete pan-retinal photocoagulation (PRP) for treating eyes with FDR. Setting and Design: Prospective, interventional case series. Patients and Methods: Patients with FDR were treated initially with intravitreal injections of bevacizumab 1.25 mg. One week after the injection, patients were sent for wide field fluorescein angiography (WFA), and PRP was performed in two sessions, 2 weeks apart. Patients were examined every 2–4 weeks to determine the status of new vessels (NVs). Additional laser burns were applied in cases with recurrence of NVs. Statistical Analysis: Numbers and percentages were calculated and reported. Results: Eleven patients (18 eyes) with FDR were included. All included patients had poorly controlled diabetes mellitus with mean glycated hemoglobin of 10.6%. One week after the injection, all eyes showed clinical regression of NVs. WFA showed extensive areas of peripheral retinal capillary nonperfusion. Eight weeks after the injection, three eyes (16.7%) showed recurrent increase in NVs, and additional laser therapy was performed for these eyes with special attention to ablating the areas of peripheral capillary non-perfusion. After 16 weeks from the primary treatment, 15 eyes (83.3%) had complete neovascular regression on clinical and angiographic assessment. Pars planavitrectomy was required for three eyes (16.7%) with tractional retinal detachment (2 eyes) or macular epi-retinal membranes (one eye). Conclusions: According to this study, most cases with FDR stabilized after prompt bevacizumab injection followed by complete PRP with special attention for ablating the peripheral capillary nonperfusion areas, guided by WFA images.","PeriodicalId":33069,"journal":{"name":"mjl@ lmstnSry@ lTby@","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42147665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of left ventricular longitudinal function in hypertensive patients without left ventricular hypertrophy by mitral annular plane systolic excursion","authors":"S. Khider, Ghalib Al-Shareefi","doi":"10.4103/mj.mj_35_20","DOIUrl":"https://doi.org/10.4103/mj.mj_35_20","url":null,"abstract":"Background: Hypertension is an important risk factor for many cardiovascular diseases worldwide. Assessment of left ventricular (LV) systolic function has a major diagnostic and prognostic importance in patients with hypertension. The use of mitral annular plane systolic excursion in the assessment of LV systolic dysfunction is helpful especially in cases of poor imaging quality, “since good imaging quality is needed for the modern echocardiographic techniques. Objectives: Detection of early subclinical LV longitudinal systolic dysfunction in hypertensive patients without LV hypertrophy (LVH) with preserved ejection fraction by mitral annular plane systolic excursion. Patients and Methods: A comparative case-control study which took place at Al-Yarmouk Teaching Hospital in Baghdad/Iraq from October 2018 to October 2019. The study population consisted of 60 patients without LVH and 60 healthy subjects considered as controls. Echocardiographic parameters for left ventricular systolic assessments were done for all subjects. Results: Mean peak annular systolic velocity was significantly lower in hypertensive patients without LVH compared to controls (P = 0.034). There was no significant difference between hypertensive patients without LVH and controls regarding mitral annular plane systolic excursion (P = 0.4). There was positive linear correlation between mitral annular plane systolic excursion and peak annular systolic velocity for hypertensive patients without LVH (r = 0.535, P = 0.015). Conclusion: Although there was a significant linear correlation between mitral annular plane systolic excursion and peak systolic velocity and both are considered as a surrogate for LV longitudinal systolic function, mitral annular plane systolic excursion cannot be used for assessment of LV longitudinal systolic function in patients with hypertension without LVH.","PeriodicalId":33069,"journal":{"name":"mjl@ lmstnSry@ lTby@","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49608021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Male circumcision using bone cutter with thermal cautery","authors":"Salih Hammoodi Al-Ani","doi":"10.4103/mj.mj_29_20","DOIUrl":"https://doi.org/10.4103/mj.mj_29_20","url":null,"abstract":"Background: Bone cutter is a widely used procedure to cut the prepuce during circumcision. Aim of the study: The aim of the study was to assess the safety of circumcision of male using bone cutter with thermal cautery, including the operative time and healing time and the effect of dressing on rate of infection and bleeding. Materials and Methods: Over 20 years period from 1996 till 2015, six thousands of males were circumcised under local anesthesia (in form local infiltration of 1% plain lidocaine 5 min before circumcision and xylocaine spray after the procedure) using a bone cutter with thermal cautery, the first assistant is to fix the upper limbs, while the main assistant is to fix the knees in a fully extended position by the left hand, while the right hand used to elevate the two mosquitoes, then by using thermal cautery to cut the foreskin above the jaw of bone cutter and by using S-ring in certain situation to fix the bone cutter tightly. Results: Six thousands males were included in this study. The mean operative time was 1-2 minutes, healing time was 5-7 days, 387 cases (6.45%) developed early & late complications, 180 (3%) bleeding, 195 (3.25%) developed infection, 3 (0.05%) with mild glans injury need dressing only for 24-48 hours only 9 (0.15%) need re-circumcision later on in the same procedure. Conclusions: Bone cutter with thermal cautery circumcision is feasible with a relatively lower complications rate, shorter operative time, and short healing time.","PeriodicalId":33069,"journal":{"name":"mjl@ lmstnSry@ lTby@","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41993978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The portrayal of microbes in respiratory medicine","authors":"M. Rao, V. Chennamchetty, D. Mathai, M. Verma, T. Leon, Pamphil Igman, S. Bhat, M. Nizami, S. Agarwal, L. Billa, A. Khan","doi":"10.4103/mj.mj_24_20","DOIUrl":"https://doi.org/10.4103/mj.mj_24_20","url":null,"abstract":"Respiratory diseases caused by a number of infectious agents including Streptococcal pneumonia, streptococcal pyogenes, Klebsiella pneumonia H. influenzae, Legionella pneumophilia, Mycoplasma pneumonia, Coxiella Bunetii, chlamydia pisittaci. These microbes enter into the lungs and cause primary cases of pneumonia. The whole respiratory epithelium down to the internal bronchioles is ciliated. The cilia and the thin film of mucus covering them have the critical function of trapping foreign particles, including bacteria, and propelling them toward the pharynx. They contribute to the prevention of respiratory infection as they do the macrophages utilizing their secretory, phagocytic, and bactericidal activity. Despite the wonderful defense, the bacterium escapes and settles in the lungs to produce diseases. Pneumonia is the term used to describe inflammation of the lung. Pneumococcal pneumonia is characterized by homologous consolidation of one or more lobes or segments. Pneumococcal pneumonia occurs at all ages but most frequently in early and middle adult life. Pneumonia is characterized with the rise in body temperature 39-40oC, remain associated with painful cough initially dry, but later patient develops production of tenacious sputum, which is often rusty and occasionally bloodstained. Staphylococcal pneumonia is caused due to Streptococcus aureus, which may occur either as a primary respiratory infection or as a blood-borne infection from a staphylococcal lesion elsewhere in the body. Klebsiella pneumonia is caused due to K. pneumoniae, a rare disease with high mortality. There is usually massive consolidation and excavation of one or more lobes, with the upper lobes being most often involved and with large amounts of purulent sputum, sometimes characteristic red currant jelly sputum. Legionella pneumonia is caused by Gram-negative bacillus L. pneumophila, which is usually transmitted in water droplets from infected cisterns used to provide water for showers, particularly in warm climates. It is often a serious and occasionally a fatal illness. C. psittaci causes psittacosis (ornithosis), a systemic illness contracted from infected birds. Pneumonia associated with it may be extensive, with severe toxemia. M. pneumoniae is a pleomorphic bacterium; symptoms of mycoplasma pneumonia are mild compared to other cases of pneumonia (walking pneumonia). On the other hand, liver function test derangements and dyselectrolytemia are more common. It is susceptible to tetracyclines though a few strains are sensitive only to erythromycin.","PeriodicalId":33069,"journal":{"name":"mjl@ lmstnSry@ lTby@","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42165356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spectrum of chest computerized tomographic findings in novel coronavirus disease-19","authors":"Suhail Rafiq, M. Dar, I. Elahi, I. Din","doi":"10.4103/mj.mj_13_20","DOIUrl":"https://doi.org/10.4103/mj.mj_13_20","url":null,"abstract":"Background: Coronavirus disease-19 (COVID-19) is a zoonotic viral disease caused by nonsegmented, enveloped, positive-sense, single-strand ribonucleic acid coronavirus. Recent outbreak started in Wuhan, China, where a new type of coronavirus was isolated from respiratory samples such as bronchoalveolar lavage and sputum of patients developing respiratory symptoms. The World Health Organization declared COVID-19 a pandemic on January 20, 2020. On April 6, 1,288,080 were infected with this virus with 70,567 deaths. Computerized tomography (CT) is the investigation of choice for diagnosing, managing, and accessing temporal changes in COVID-19. Objective: The objective of this study is to describe the chest CT findings in documented nCovid-19-positive patients. Methodology: This was a retrospective observational study done in Government Medical College, Chest Disease Hospital from February 20 to April 25, 2020. Forty-eight patients with COVID-19 reverse transcriptase-polymerase chain reaction-positive test were scanned on 64 slice Somatom CT scanner and findings analyzed. All patients with previously underlying chest disease were excluded. Results: The various chest findings in the nCovid-19-positive patients include ground glassing, (81.25%), consolidation (56.25%), nodules (43.75%), halo sign (31.25%), crazy paving pattern (50%), air bronchogram (12.5%), air bubble sign (6.25%), vascular enlargement (25%), reversed halo sign or atoll sign (18.75%), bronchial wall thickening (6.25%), and mosaic attenuation (6.25%). None of the patients had pleural effusion. Conclusion: Characteristic CT findings of COVID-19 can help radiologists in the early diagnosis of symptomatic patients in whom testing is awaited. Bilateral peripheral ground-glass opacities with consolidation in dependent parts of the lung along with the absence of pleural effusion were the most common abnormality.","PeriodicalId":33069,"journal":{"name":"mjl@ lmstnSry@ lTby@","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41508460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonaneurysmal cerebrovascular conditions associated with intracranial arterial fenestrations","authors":"S. Alsaadi, Samer S. Hoz, S. Al-Obaidi, Bahaa S. Abdalnaby, Ammar M Al-Smaysim","doi":"10.4103/mj.mj_6_20","DOIUrl":"https://doi.org/10.4103/mj.mj_6_20","url":null,"abstract":"Background: Cerebral arteries have been identified with multiple anatomical variations, including a concomitant fenestration with aneurysms, but no association is proven. Aim: to investigate non aneurysmal disorders associated with intracranial arterial fenestration. Methods: A thorough and detailed analysis of the available literature from 1970 to 2020 in PubMed were contemplated to identify and address all the disorders associated with arterial fenestration with exclusion of intracranial aneurysms. Results: While segmental vulnerability may induce invisible anatomical histological and hemodynamic changes, cadaveric studies showed that the frequency of fenestration is up to 40% higher than the clinical reports, and the cadaveric reports also showed a higher occurrence of such fenestrations as compared to radiological studies. The vertebrobasilar system, the most common site of fenestration. Fused vertebrae and other vascular defects of up to 7% are previously associated with the vertebral artery fenestration. Conclusion: intracranial fenestration is a critical anatomical variant. Thus, A comprehensive angiographical examination can enhance overall prognosis in presurgical planning in association with other vascular abnormalities.","PeriodicalId":33069,"journal":{"name":"mjl@ lmstnSry@ lTby@","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49376639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical control over superior sagittal sinus injury due to metallic ceiling fan-blade injury","authors":"S. Alsaadi, S. Mohammed, Zahraa M. Kareem, Mustafa E. Almurayati, Samer S. Hoz","doi":"10.4103/mj.mj_7_20","DOIUrl":"https://doi.org/10.4103/mj.mj_7_20","url":null,"abstract":"The most serious dural sinus accident following traumatic brain injury is superior sagittal sinus (SSS) injury. It is usually resulted from depressed skull fracture extends to the midline. We present a traumatic superior sagittal sinus injury triggered by the metal ceiling fan blade with its surgical management. Injuries of the SSS have an increased mortality rate in head injured patients. Metallic ceiling-fan head injury differs from the classic traumatic brain injury concerning the presentation, radiology, management, and outcomes.","PeriodicalId":33069,"journal":{"name":"mjl@ lmstnSry@ lTby@","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48282020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Competency-based medical education for undergraduates in India: Strengths, weaknesses, opportunities, challenges analysis and the way forward","authors":"S. Shrivastava, P. Shrivastava","doi":"10.4103/mj.mj_1_20","DOIUrl":"https://doi.org/10.4103/mj.mj_1_20","url":null,"abstract":"The much-awaited dream of many educationalists across India has finally turned into reality and we have shifted to the competency-based curriculum for the undergraduates from the 2019 academic year. With close to 4 months into this transition and implementation, we have realized a wide range of strengths-weaknesses-opportunities-challenges (SWOC) and it is the need of the hour to learn from the same and plan our curriculum in such a manner that the execution of the same can be significantly improved in the coming years. Even though, challenges are there, but it is important to understand and have a belief that all this has been done to improve the health care services offered to the general population. In conclusion, the competency-based curriculum for undergraduate students has to be looked upon as an opportunity to produce competent and globally acceptable doctors and thus it is high time that all the stakeholders accept this as a challenge and work in a concerted manner to accomplish the intended goals.","PeriodicalId":33069,"journal":{"name":"mjl@ lmstnSry@ lTby@","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48095876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The eosinophilic and neutrophilic counts in sputum of asthmatic Iraqi patients and its correlation with asthma control","authors":"H. Dawood, Jamal Alwan, S. Khalaf","doi":"10.4103/mj.mj_3_20","DOIUrl":"https://doi.org/10.4103/mj.mj_3_20","url":null,"abstract":"Background: Asthma control is very critical guide for therapy according to the current asthma guidelines. The asthma control test (ACT) was successfully used to assess the control level. However, variation in clinical features which composite the items of the test does not always associate with the extent of the structural changes in pulmonary airways. Thus, there is a necessity for the surrogate marker to assess the control level. Eosinophilic and neutrophilic cells have an important role in the pathological process of asthma. Aims: The aim of this study is to assess the sputum eosinophil and neutrophils as a discriminative marker between different levels of asthma control. Patients and Methods: This cross-sectional study included 88 asthmatic patients. Only 50 patients produced sputum. Demographic data, ACT parameters took from patients. Spirometer test has been done. Sputum study includes processing of sputum, counting of sputum total white cell were done. Results: According to sputum cells count and differentiation, 64% eosinophils, 10% neutrophils, 6% mixed and 20% was paucigranulocytic (non). Eosinophilic phenotype patients were poorly control with a statistically significant difference. While neutrophilic phenotype was nonstatistically significant difference. Conclusions: The most common type of asthma phenotyping is eosinophil which in turn correlated with poor asthma control while other types like neutrophil are not correlated.","PeriodicalId":33069,"journal":{"name":"mjl@ lmstnSry@ lTby@","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45990630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}