Iraqi National journal of Medicine

Background: Cancer is a global health problem and the main cause of mortality. Most cancer-associated cases of mortality are the consequences of lack of effective treatment and biomarkers for early diagnosis. New hopes for the improvement of the early diagnosis and treatment of cancer synchronize with the emergence of microRNAs (miRNAs). MicroRNAs are small, noncoding, single-stranded RNAs, the length of which is approximately 18–25 nucleotides and which bind to 3’ untranslated region (3’UTR) of the target messenger RNAs (mRNAs), leading to mRNA degradation or translational inhibition; thereby regulating gene expression post-transcriptionally.


Aim: Using microRNAs as promising and potential biomarkers for diagnosis and therapeutic targets.


Methods: The microRNA expression changes in peripheral blood and can be assayed using non-invasive, low-cost, precise, and rapid tools.


Results: It is noteworthy that miRNAs participate in multiple cancer-related biological processes, including proliferation, apoptosis, angiogenesis, drug resistance, invasion, and metastasis. Interestingly, the identified cancer-associated miRNAs, including over-expressed oncogenic miRNAs (oncomiRs) or underexpressed tumor-suppressive miRNAs, are diverse and specific for different tissues and cancer types.


Conclusion: The genetic testing of microRNAs opens up the exciting possibility of early diagnosis and treatment before the onset of metastasis.

Background:


Semen analysis measures ejaculate volume, pH, sperm count, motility, forward progression, and morphology. Although semen analysis is not a test for infertility, it is considered the most important laboratory test in the evaluation of male fertility. There are many factors affecting the seminal fluid parameters and testicular varicocele is one of them. Varicoceles are the most commonly seen and correctable male infertility factor. Varicocelectomy is a common operation performed for infertile males with clinical varicocele. The aim of study:


to evaluate the seminal fluid parameters changes after testicular varicocelectomy.
Patients and Method: A prospective cohort study was done at the Al Sader Medical City in Najaf during the period from (March-October 2019). The study include 30 males with age between 18 and 32 years old who had a clinical varicocele. Seminal fluid analysis was done one before surgery and another one three months after surgery and compare between the two tests to evaluate the changes in the parameters was done, which include seminal fluid liquefaction, volume, color, PH, sperm concentration, motility and morphology.
Results:


There were 30 patients enrolled in this study with a mean age of 23.8 ± 3.36. Seminal fluid concentration was 19.1 ± 7.2 million/ml and it was significantly increased postoperatively by almost 84% than preoperative concentration to reach 35.1 ± 11.3 (P ≤ 0.001). The changes in progressive motile sperms’ percent improved after varicocelectomy but not reach the statistical significance (P≥0.935). The mean ± SD percent of normal morphology sperms percent preoperatively was 46.9 ± 22.9 %, and after operation, it elevated to 50.9 ± 18.6 (p value≥ 0.336 ).The patients is divided in to two subgroups (normospermic and oligospermic subgroup).
Conclusion:


There is a significant improvement in sperm concentration. While there is significant improvement in sperm concentration in oligospermic subgroup, so the infertile patient who has oligospermia with varicocele will get better outcome after varicocelectomy.

Background: Dysphonia is altered voice quality, pitch, loudness, or vocal effort that impairs people’s quality of life. It is a very common complaint affecting nearly one-third of a population at some point in their life and could be caused by infection, tumor, trauma, vocal cord paralysis, etc.


Indirect mirror or endoscopic laryngoscopy is used to assess the laryngeal condition in dysphonic patients seeking mainly for the cause, but frequently the findings were normal or unremarkable.


Videolaryngoscopy (VLS) is very useful in dysphonic patients who have an otherwise normal indirect or flexible laryngoscopic examination. In addition to providing information regarding vocal fold vibrations, the image obtained through VLS can be magnified to make a more detailed assessment of the vocal cord anatomy than is possible with rigid of flexible laryngoscopy.





Objective of study: To assess the videolaryngostroboscopic findings in dysphonic patients with normal fiber-optic laryngoscopy.


Patient & Method: A cross-sectional study, Fifty patients were included in the study; They had complained of dysphonia, and the fiber-optic laryngoscopic examination was normal. Videostroboscopy were obtained for all patients to assess vocal fold vibration and seek any abnormal findings.


Results: A total of 50 patients were enrolled in this study. Regarding the stroboscopic findings, 42% of the patients were normal, 15 (30%) had early soft singer’s nodules, 6 patients (12%) had intracordal lesions, 4 patients (8%)had vocal cord polypoidal changes, 2 patients (4%) had presbylaryngis, and the other 2 patients (4%) had sulcus vocalis.


Conclusion: VLS is beneficial in detecting vocal cord lesions in patients with normal fiber-optic laryngoscopy. A high proportion (more than half) of dysphonic patients with normal fiber-optic laryngoscopy had abnormal findings.

Background: Cancer angiogenesis demonstrates an important role in the progression and pathogenesis of blood malignant disorders including acute lymphoblastic leukemia (ALL). Vascular endothelial growth factor (VEGF)-A is one of the most effective elements of endothelial cell growth; it promotes vascular permeability of endothelial cells and provides the new vasculature with oxygen and nutrients. Higher VEGF-A levels in childhood acute lymphoblastic leukemia (ALL) is associated with poorer patient outcomes.


Aim of the study: to assess the level of VEGF-A in plasma of children with ALL.


Subject and method: Forty children with ALL and 40 healthy children as control were enrolled in this study conducted at the Oncology Unit in Basrah Children’s Hospital from Oct 2019 to March 2020. Plasma VEGF-A level was evaluated using ELISA assay.


Results: The plasma level of VEGF-A is higher in ALL children than those in the control (p < 0.001). Moreover, the plasma VEGF-A level in the high-risk group (HRG) is higher than that in the standard risk group (SRG).


Conclusion: The significantly higher level of plasma VEGF-A in ALL children compared to the healthy ones may demonstrate the role of VEGF-A in stimulating angiogenesis in pediatric ALL.

Introduction: Hyperbilirubinemia – a condition of elevated serum bilirubin above the reference range, is common in hospitalized patients. The reasons for the increase in the bilirubin level can be pre-hepatic, hepatic, and post-hepatic. Sepsis is one of the most important causes of hyperbilirubinemia in critically ill patients.


Case report: We present a 30-year-old woman with no past medical and drug history who was admitted to the intensive care unit (ICU) due to multiple trauma and fractures due to a fall from height. During the ICU stay, the patient developed jaundice with a high increase in the bilirubin level. A diagnosis of sepsis-associated cholestasis was considered after ruling out other possible pathologies. The hyperbilirubinemia improved with the early management of sepsis concomitant supportive medical therapy.


Conclusion: Early recognition and treatment of sepsis as a cause of cholestasis should be considered in ICU patients. Drugs targeting mitochondrial function would provide rapid hepatic recovery reducing complications and mortality.

Antisocial behavior is a broad term that encompasses many facets of destructive behavior, most of which bring harm to another person or involve the violation of rights of others. Main antisocial behavior victims are young individuals, women and children. Numerous factors interact together for the development of aggression and antisocial behavior; these factors are social, environmental, physiological, neurological, and genetic. Consequently, this paper addresses the principal etiologic factors that participate in the development of antisocial behaviors for children, adolescents, and adult individuals.

Background: The current situation of the health system in Iraq, under the difficult conditions the country has been experiencing, generates great pressures on doctors because they are in the field of confrontation between the growing needs of patients day after day and the dilapidated capabilities and government neglect of the health sector with the absence of security and stability and weak law enforcement.The imposition of state authority has led to an increase in violence in the country in general and against doctors in particular. Moreover, there are other pressures that doctors are subjected to, such as security, economic, professional, social, and psychological pressures, which have led to the emigration of a considerable number of doctors or the exposure of some of them to physical liquidation.


Aim: This study was conducted to determine the challenges, risks, and concerns perceived by Iraqi medical doctors, and to explore any possibility of associations to some socio-demographic and professional characteristics of the doctors.


Method: A questionnaire form was structured after reviewing several international forms relevant to exploring the participants' opinions and measuring satisfaction. The form was validated by experts and the approved version was uploaded to the Internet and sent to candidate Iraqi medical doctors through Google Forms. A link to the questionnaire survey was sent to them via doctors' WhatsApp groups. Convenience sample was used to collect data from May 30 to June 17, 2020.


Results: A total of 606 medical doctors from most of the Iraqi provinces sent their responses to the questionnaire. More than 92% of them held serious concerns,such as a tribal threat. Other challenges included being infected with a serious infection, more than 3 quarters had been exposed to violence, more than half of them have been involved in problems with the administrative and/or judicial authorities, more than 35% consider the government department where they work as the party who protects them. More importantly, about 92.7% of the respondents answered that they do not feel safe/secure. The social enhancers seen by most of the respondents were having a law to protect them, owning a house or a piece of land, and/or having an Association that defends them.


Conclusions: The Iraqi medical doctors face considerable physical, economical, psychological, emotional, and social challenges that affect their professional performance and their life. If the same situation remained as such it may lead to the loss of one third of the Iraqi doctors. Especially, after COVID-19 pandemic, many countries are welcoming doctors from abroad, including Iraq. If this is added to the shortage in the doctor-population proportion in Iraq, it means there will be a jeopardizing shortage.





Recommendations: Several recommendations have been put to reduce pressure on the Iraqi medical doctors aiming at improving performance, effectiveness, and efficiency.

Background: Hemorrhoidal disease is a common morbidity seen by general surgery clinics. Transanal Doppler guided (DG) hemorrhoidal artery ligation (HAL) with rectoanal repair (RAR) has been invented as a new treatment option. HAL-RAR was associated with mild to moderate postoperative complications in the literatures; and considered easy, safe, mostly painless procedure with very good results in treating hemorrhoids.


Objective: This study was conducted to evaluate the outcome of using DG-HAL-RAR procedure through documenting postoperative complications during a median follow-up period of 18 months.


Method: The study included 151 women presented with hemorrhoids in Basra, operated upon using the DG-HAL-RAR and complications assessed.


Results: The patients’ mean age was 40–99 years. Most of the hemorrhoids were internal plus external (86.1%), of third degree (68.2%) and non-recurrent (90.1%). The surgical management needed an average of 6 ligations and 3 mucopexies. During the follow up periods, the most frequent complication was early bleeding, while the least was hemorrhoids recurrence.


Discussion: During the follow up period, the postoperative complications were early bleeding, early pain, urine retention, late bleeding, anal stenosis, and hemorrhoids recurrence, the incidence of which were similar or close to the incidence of documented by other studies, except for early bleeding which was much higher than in our study. Some complications, reported by other studies,were not reported in this study.


Conclusions: DG-HAL-RAR procedure can be used effectively and safely in second or third degree hemorrhoids.

COVID19 emerged as one of the biggest global public health crises in recent history. Many pharmaceutical companies have raced against time to develop a vaccine, so that the pandemic can be brought under control. The aim of the current study was to assess the acceptance of the COVID19 vaccine among the general population in Iraq. A cross-sectional study was conducted among 1069 respondents from different states of Iraq using questionnaires administered online. Though a total of 77.6% of the respondents agreed to take the COVID19 vaccine when available, a majority (64.3%) said they would wait for some time before taking the vaccine. Around two-thirds agreed to pay a price for the vaccine and the majority (48.6%) preferred the Oxford (AstraZeneca) vaccine. There was a significant association between age, working status, educational level, having family members infected with COVID19 and taking flu vaccine before with acceptance of Covid19 vaccine with P value (<0.001, <0.001, <0.001,0.05, <0.001) respectively. Overall, there is high acceptance willingness among the general population to pay for COVID19 vaccine, once it is available. More education and promotion are needed to assure the public that the vaccine is effective and safe