Mustansiriya Medical Journal

Background:
Peripheral neuropathy is one of the microvascular complications that affects patients with diabetes mellitus and involves both sensory and motor nerves. The development and the progress of diabetic peripheral neuropathy (DPN) were ascribed to the inflammatory activity of the immune cells in the nerves. Calprotectin (CLP) is a heterodimer protein found in the membranes of monocytes and other inflammatory cells and the cytosol of neutrophils and released from them up to activation.

Aim of Study:
Evaluation of serum CLP level as a potential inflammatory biomarker for the occurrence of DPN in type 2 diabetic patients.

Patients and Methods:
one hundred and twenty-six patients diagnosed with type 2 diabetes mellitus were randomly selected from those who attended the National Diabetic Center between December 2022 and July 2023. Michigan Neuropathy Screening Instrument (MNSI) and nerve conduction study (NCS) were used for grouping the patients. Enzyme-linked immunosorbent assay technique has been used to measure serum CLP levels.

Results:
Serum levels of CLP showed no significant differences among patients with and those without diabetic peripheral neuropathy according to their NCS findings and the total scores for each and for both in combination according to the subgroups (P > 0.05).

Conclusions and Recommendations:
The serum level of CLP in type 2 diabetic patients was not affected by the occurrence of diabetic peripheral neuropathy. Further studies are required on newly diagnosed patients and a larger sample size.

Background: Dermatophytosis (tinea) is a worldwide prevalent superficial fungal infection limited to the epidermis, mucosa, hair, and nails.
Iraq, like many other countries around the world, is facing the emergence of chronic, resistant, and relapsing tinea infections. Aims: The aim
of this study is to evaluate the efficacy, safety, and relapse rate of a combination of itraconazole and griseofulvin versus itraconazole alone
in the treatment of chronic tinea infections. Patients and Methods: The research was conducted over 14 months. Patients were divided
equally into two groups, each with 55 patients. Group I received a combination of itraconazole and griseofulvin, whereas Group II was on
itraconazole alone for 8 weeks. For the assessment of the relapse rate, follow‑up was for another 2 months. Results: The mean age (±standard
deviation) of the total was 31.27 ± 12.08 years. Males were 71 (64.5%) and females were 39 (35.5%). There was no significant difference in
their residency. Family history was positive in the majority of patients, 90 (81.8%). After 2 weeks of treatment, a marked cure was achieved
by 34 (61.8%) patients in Group I and 21 (38.2%) in Group II. After 8 weeks, the complete cure was 51 (92.8%) in Group I and 38 (69%) in
Group II (P ˂ 0.00). The marked cure was 4 (7.2%) in Group I, whereas 17 (31%) in Group II. The relapse rate after 16 weeks was 7 (12.7%)
in Group I and 34 (61.8%) in Group II (P ˂ 0.00). Conclusions: We concluded that therapeutic regimens of itraconazole and griseofulvin
were effective, safe, and well tolerated, with a low relapse rate.

Background: Coronary heart disease (CHD) is primarily caused by atherosclerotic lesions within the intima of coronary arteries and acute
coronary syndrome (ACS) is the main acute clinical manifestation of CHD. The ACS is manifested in one of three subtypes and it is the
leading cause of mortality worldwide. The three subtypes of ACS include: acute myocardial infarction (MI) with the electrocardiogram (ECG)
presenting ST‑segment elevation (STEMI), MI with no ST‑segment elevation on ECG (NSTEMI), and the third subtype is unstable angina (UA).
The early diagnosis of is important in decreasing morbidity and mortality in ACS patients. Objective: To investigate the role of serum level
of cardiac myosin‑binding protein‑C (cMyC), compared with high‑sensitivity cardiac troponin‑I (hsCTn‑I) in the early diagnosis of ACS and
differentiation of its subtypes. Materials and Methods: One hundred and twenty patients (72 males and 48 females), aged ≥30 years selected
from those who were admitted to emergency department (ED) of Al‑Yarmouk teaching hospital and diagnosed with ACS by cardiologists. The
duration between the onset of chest pain and admission to ED should not exceed 3 h in any cohort. Apparenty healthy subjects as controls group
for the study were recruited from those who had no current illness, particularly CHD, no other systemic disease and each had a normal ECG.
For each study subject, cMybp‑C and hsCT‑I serum levels on admission were measured using the enzyme‑linked immunosorbent assay kits.
For each ACS patient, serum level of hsCTn‑I level was measured 3 h after admission. Results: The comparison of cMybp‑C levels among
study groups revealed an overall significant difference and on paired comparison of study groups, the cMybp‑C mean level was significantly
higher in each ACS subgroup than in controls group (P < 0.001), except in UA subgroup versus controls group. The cMybp‑C levels showed
a significant positive correlation with hsCT‑I levels on admission in STEMI and NSTEMI subgroups but not in UA subgroup. The cMybp‑C
levels also showed a significant positive correlation with hscT‑I levels 3 h after admission in STEMI and NSTEMI subgroups but not in UA
subgroup. On receiver operating characteristic curve analysis, the cMybp‑C level had a better diagnostic accuracy than hscTn‑I on admission
in differentiation of patients with “STEMI or NSTEMI” from those with UA or from controls. Conclusion: Serum cMybp‑C mean level is
significantly higher in ACS patients with STEMI and NSTEMI than in controls and the increase was more significant than hsCTn‑I mean level
on admission, so it could help the early diagnosis of ACS patients. The serum levels of cMybp‑C also had a better diagnostic accuracy than
hsCTn‑I on admission in differentiation of ACS patients with STEMI or NSTEMI from those with UA or from controls.

Background: As a continuation of earlier laboratory research and its findings, we are studying the effects of biostimulation and alteration
on human blood plasma to improve blood circulation in blood vessels, treat some infections, and treat various diseases, including blood
protein‑related ones. Methods: Blood samples were collected through venipuncture into tubes containing, ethylenediaminetetraacidic as
an anticoagulant from healthy adult donors, and plasma was separated from blood components. Blood plasma samples were irradiated for
varying periods (5, 10, 15, and20) min. Before and after irradiation, total protein and albumin concentrations were calculated using 375 nm
and 650 nm lasers. Using a spectrophotometer, the concentration of total protein and albumin was determined for each sample. Results: At
the (375 and 650) nm laser wavelength and exposure durations of (5, 10, 15, and 20) min, it was observed that the total protein concentration
had significant differences between pre‑ and postirradiation probate value (P = 0.05, P = 0.05, P = 0.05, and P = 0.05, respectively). It was
observed that the total protein and albumin concentrations had significant differences between pre‑ and postirradiation. In addition, the results
demonstrate that the concentration of total protein and albumin decreases more significantly at a laser wavelength of 650 nm compared to a laser
wavelength of 375 nm at times of (5 and 10) min. Conclusions: Our results clearly indicate that low-level lasers with different wavelengths
of ( 375 , 630) nm both affect the concentration of total protein and albumin in human blood plasma, which can contribute to the treatment of
many pathological conditions in the future.

Background: The piriform aperture (PA) is a midface structure that forms the anterior skeletal boundary of the nose. It is highly variant due to its physiological adaptations to the climate. Its variations are useful in forensic identification and reconstructive surgeries of the face. This study aimed at determining the PA’s dimensions and their accuracy in sex determination. Materials and Methods: The PA’s dimensions were retrospectively examined using 336 (199 males and 137 females) adult cranial computed tomography images in the database of the radiology unit of a university teaching hospital in Delta State, Nigeria, following institutional authorization. The aperture’s index was calculated as a ratio of height to width. The data were analyzed using Statistical Package for the Social Sciences Version 23. The sexual dimorphism in the parameters was assessed using an independent t‑test. Association among the continuous variables was analyzed by Pearson’s correlation test. P = 0.05 was considered statistically significant. The percentage accuracy for correct sex prediction was assessed using the discriminant function analysis. Results: A significant relationship between dimensions with sex was observed (P < 0.05). The width of the aperture was the best sex‑discriminating parameter (70.2%). The overall accuracy for sex discrimination using the aperture’s dimensions was 75.0%. Conclusion: This study provides the standard ranges for the PA’s width and height, valuable for surgical planning. These dimensions were sexually dimorphic and demonstrated an acceptable overall accuracy of correct sex allocation (75%). Consequently, this aperture may be utilized as a supplementary tool in conjunction with other methods for sex determination within studied population.

Background: Preeclampsia (PE) is a hypertension condition that often manifests after 20 weeks of gestation. It is regarded as a leading cause of death among mothers and babies globally. Aim: To evaluate how serum kallistatin affects PE severity. Patients and Methods: A case–control study that included three groups of 95 third trimester pregnant women with viable fetuses was chosen. Group M (32 mild PE), Group S (31 severe PE), and Group C (32 control pregnant normotensives). Serum kallistatin, complete blood count, liver, and renal functions were compared between groups, at An Al‑Yarmouk Teaching Hospital Obstetrics and Gynecology. Results: The concentrations of serum kallistatin in severe PE were markedly lower than those in mild and normotensive pregnant women. (1.79, 3.24, and 4.55, P < 0.001). Kallistatin accurately predicted mild, severe, and normotensive PE. All healthy women’s parameters did not correlate with kallistatin. In PE, age, gestational age, and platelets correlated directly with kallistatin, but systolic and diastolic blood pressure, alanine transaminase, aspartate aminotransferase, and total serum bilirubin correlated inversely. Kallistatin had higher sensitivity than specificity and comparable negative to positive predictive values. Conclusions: Mother’s serum kallistatin is inversely related to PE severity and significantly lower in PE patients than normotensives. Kallistatin’s sensitivity and specificity for predicting PE in normotensive women were 93.7% and 68.8%, respectively, using a threshold value ≤3.92 ng/ml using a threshold value ≤2.136 ng/ml, 90.3%, and 93.8% predicted severe PE from mild PE, respectively.

Background: Preeclampsia (PE) is a major health problem that increases the risk of renal impairment during pregnancy. Studies have described the utility of Cystatin C as a better indicator of kidney function during pregnancy compared to urea, creatinine, or uric acid. Objective: The objective of the study was to evaluate cystatin C as a diagnostic tool for renal impairment in women with severe PE and compare it to standard renal function tests. Patients and Methods: A case–control study was conducted at Al Yarmouk Teaching Hospital, Bagdad. From March 1, 2022, to September 1, 2022, 94 3rd‑trimester pregnant women with newly diagnosed or a history of PE were included in the study and interviewed and subsequently divided into three groups. The GraphPad Prism Software was used for data analysis and graphical presentations in addition to SPSS version 28; 0.05 was selected as a cutoff point for statistical significance. Results: The mean of cystatin C for control 0.39 ± 0.15 was significantly lower than for severe PE 1.12 ± 0.53, P < 0.001. The mean cystatin C for mild PE 0.52 ± 0.13 was considerably lower than for severe PE 1.12 ± 0.53, P < 0.001. Conclusions: Patients with severe PE had higher serum cystatin C than patients with mild PE and healthy normotensive pregnant females. Serum cystatin C at a cutoff value of >0.61 had higher diagnostic accuracy than the other standard kidney tests (urea, creatinine, and uric acid), with a sensitivity and specificity of 90.32% and 93.75%, respectively.

One of the major global health issues that still exist is tuberculosis (TB); primary tubercular osteomyelitis of the rib is an extremely rare entity.
We present a case of isolated TB of the anterior fourth rib as the initial presentation, without any lung lesions. A high index of suspicion is
necessary for the diagnosis of tubercular rib osteomyelitis. Usually, there is no significant morbidity and full remission following surgical
removal of the affected rib in conjunction with the proper antitubercular therapy.

Pulmonary valve atresia (PVA) is a fatal pediatric cardiac condition and commonly associated with other anomalies such as double outlet right ventricle (DORV). There is a disagreement over the best surgical strategy for treating PVA in conjunction with DORV. Prematurely born neonates are considered high‑risk group for early pulmonary artery shunt surgery as the staged repair is found to be associated with higher interstage mortality, while the primary repair may lead to frequent postrepair reinterventions due to the presence of associated developmental anomalies. In this report, we present the successful results of using percutaneous transcatheterization in a high‑risk patient; a 6‑h premature neonate who had DORV, PVA with other anomalies including situs inversus, levocardia, D‑malposed great arteries without patent ductus arteriosus. This rapid interventional catheterization offered to the neonate has an immense advantage of lifesaving and the protection against the remolding effect on the right ventricle that usually develops when waiting for the palliative procedures or surgery to take place.