Iraqi National journal of Medicine

Bacillus Calmette-Guérin (BCG), is a live attenuated strain of Mycobacterium bovis, and is the essential constituent of the vaccine against tuberculosis (TB) and adjuvant treatment for bladder cancer. This vaccine has a potential pathogenic action; bacilli can cause recorded complications that can be located locally near the site of inoculation and at a distance through blood dissemination root. The BCG-related disease can represent a side effect of anti-TB vaccination in patients with acquired or congenital immunodeficiency or a complication of the therapeutic oncologic schedule in patients with malignancy. Here in we report three cases of BCG-related disease which visited our national tuberculosis Iraqi center in 2022, two of those with locally developed TB and the third presented with disseminated miliary TB.

Background: Cisplatin is a chemotherapeutic agent that is used extensively for the treatment of a broad spectrum of tumors. However, progressive irreversible side effects of Cisplatin, including ototoxicity, have been reported. Methods: A cohort study was implemented from 1 April to 30 August 2015 to study the association between Cisplatin chemotherapy and sensory-neural hearing loss as the major and most important sign of ototoxicity. The cohort group included cancer patients treated with Cisplatin, while patients on Carboplatin were the control group. Cisplatin and Carboplatin belong to alkylating platinum chemotherapy drugs, which are used to treat various malignant solid tumors. Data collection was done through a questionnaire, including information related to sociodemographic characteristics and current and past medical history. Hearing loss was assessed using pure tone audiometry at the time of starting chemotherapy and one month later. Results: The total number of patients was 50, with male to female ratio 1:1 and a mean age of 49.7±14.7 (range 18–80 years): 27 patients were on Cisplatin with a mean age of 50.3±13.5 and 23 patients were on Carboplatin chemotherapy with a mean age of 51.9±15.1 with no significant difference in age (P=0.695). A highly significant association between Cisplatin use and sensory-neural hearing loss (RR, 5.13; P <0.001) was noted. No significant association was found between hearing loss and sociodemographic characteristics or other clinical conditions. Conclusions: Ototoxicity represents a significant clinical sequel of Cisplatin chemotherapy in patients with cancer. A future study using a larger sample size aiming at the evaluation and prevention of Cisplatin induced ototoxicity is recommended.

Background: Hoarseness is a common symptom in otolaryngology practice, and it’s the earliest manifestation of a large variety of conditions directly or indirectly affecting the larynx, ranging from benign to most malignant. Aim: This study was undertaken to find out a clinical profile, the incidence of common predisposing and etiological factors of hoarseness. Methods: Two hundred cases of hoarseness for 18 months were studied. All cases were analyzed for detailed history and examination with visualization of the larynx through rigid video laryngoscopy or flexible nasopharyngolaryngoscopy and in some cases, direct laryngoscopy and biopsy were taken for histopathological study. The final results were analyzed by simple manual analysis with frequency and percentage using Microsoft Excel Software 2007. Results: A total of 200 patients were included in the study. Among them, patients in the age groups of 31–40 years and 41–50 years were the main sufferers of hoarseness. Similarly, among 200 patients 124 (62%) were males whereas 76 (38%) were females, with the male to female ratio of 1.6:1. Vocal cord nodules were the most commonly encountered etiology with a frequency of 17.5 % whereas tuberculous laryngitis was the least commonly encountered etiology with a frequency of 0.5%. Conclusions: There was an etiological variation in hoarseness ranging from simple laryngitis to the most life-threatening malignancies. It is important not to ignore the hoarseness and precise history, examination and investigations should be done to diagnose the early underlying pathological changes for prevention and accurate management.

Background: Vesicular system is a good approach to improve hydrophilic drug permeability using phospholipids as Nanocarriers to increase lipophilicity and reduce vesicle size. L-ascorbic acid is a water soluble vitamin with antioxidant activity with poor skin permeability. Aim: The purpose of this work is to prepare LAA-containing ethosomes formulations utilizing a modified thin film hydration approach. Methods: eight formulas were prepared using different types of phospholipids (egg yolk lecithin and soya lecithin), different volumes of ethanol (2 and 3mL), and tween 80 as a surfactant. The prepared formulas (F1, F2, F3, F4, F5, F6, F7 and F8) were characterized to detect the best one regarding the physical appearance, pH, average vesicle size, polydispersity index (PDI) and entrapment efficiency. Scanning electron microscope (SEM) and transmission electron microscope (TEM) were used to evaluate the morphological properties Results: The best prepared ethosomal formula was F3 which contains (1.5g) LAA, (0.1 g) egg yolk lecithin, (2 mL) ethanol, 0.025 mL tween 80 and (q.s.10mL) of distilled water. Its average vesicle size value (176nm), PDI = 0.243, high entrapment efficiency (89.8%) and good physical stability. The morphological properties showing spherical, smooth, and devoid of drug crystalline structures. The drug-excipient compatibility is confirmed using (FTIR, DSC and PXRD) analyses. Additionally, the Ex-vivo drug permeation investigation demonstrated that the prepared formula of LAA had flux and permeability coefficients that were two times higher than the control. Conclusions: The average vesicle size and PDI are affected by, the volume of ethanol, type of lecithin and presence of solubilizing agent.

Background: Obesity is one of the most serious public health challenges of the 21st century and represents a serious health problem for low- and middle-income countries, particularly in urban settings. Its prevalence has increased at an alarming rate. Globally, more than 340 million children and adolescents aged 5–19 years are overweight or obese, and approximately two-third of them live in developing countries. Aim: The present study was implemented to assess the prevalence rates of overweight and obesity among adolescents in intermediate schools in Basrah, Iraq. Methods: A cross-sectional study was conducted during the second semester (between January 15 and May 30, 2013) among children attending public and private secondary schools in Basra city to determine the relationship between certain variables and the prevalence of overweight and obesity. Results: According to the study findings, the overall prevalence rates of overweight and obesity among adolescents aged 13–15 years in intermediate schools were 20.6% and 22.6%, respectively. Conclusions: A combination of decreased physical activity, sedentary behaviors (watching TV, playing video games, and using the internet), ingestion of unhealthy foods, and consumption of soft drinks may be responsible for the observed increased prevalence of overweight and obesity among adolescent students in Basra city.

Background: The placenta is a life-supporting organ for the growing fetus. Several studies have highlighted the relationship between placental weight and neonatal birth weight; however, the role of glycosylated hemoglobin (HbA1c) has not been addressed. Aim: The study aimed to determine the relationship between the placental weight, neonatal birth weight, and HbA1c at term pregnancy in a Sudanese hospital. Methods: This was a cross-sectional hospital-based study conducted at Al Ban-Jaded Hospital between November and December 2022. Data, including the gestational age at delivery (in weeks), parity, mode of delivery, fetal birth weight, placental weight, fetal gender, and presence or absence of maternal medical diseases, was obtained from 60 singleton term deliveries who met the inclusion criteria for the study. The tested data was analyzed using SPSS version 25, and t-test was used to compare the statistical significance (P value ≤ 0.05 was considered statistically significant). Results: The mean age was 27.02 ± 6.8 years. The mean HbA1C was 5.98% ± 0.39% (5.2%–6.9%). Glycated hemoglobin was elevated (≥5.7%) in the majority (46, 76.7%) of pregnancies. The mean placental weight was 290 ± 106 g (100 g–700 g), while the mean birth weight was 3.00 kg ± 0.36 kg (2.3 kg–3.8 kg), and the placental/birth weight ratio was 9.6%. There was a significant positive correlation between neonatal weight and placental weight (r=0.514, P value=0.000). Also, neonatal weight and placental weight had a significant positive correlation with HbA1C (r=0.657, P value=0.000). Placental weight and neonatal birth weight significantly increased with the gestational age of neonates (P value <0.05), with a slight drop noted in term gestation. Conclusions: There is a positive correlation between placental weight and birth weight of the neonate in pregnancies with high maternal HbA1C, and placental weight and birth weight were higher than in pregnancies with normal maternal HbA1C.