Karbala Journal of Medicine

The current general situation of Iraqi doctors' satisfaction, as an associated factor with brain
drain problem, has been started to be studied academically. Serious findings have been
registered due to serious challenges that face doctors. These seem to have resulted in frustration
and have made half of the doctors to think to immigrate outside Iraq; more seriously one third
may take this step shortly. This may lead to real shortage in the health service providers. Such
a situation in addition to the existing defect in the health system infrastructure and lack of
training opportunities may end with new crisis in this country and add more burden on the
suffering health institutions unless effective and efficient measures are taken soon.
Keywords: Brain drain, medical doctors, Satisfaction, Iraq

Cancer is a disorder where a group of cells grows uncontrollably, ignoring the physiological
rules of cells division. Since its discovery (although the word cancer was not used)3000 BC,
extraordinary research aims to uncover novel therapeutic strategies for combating it. Currently,
over 60% of clinical trials over the globe focus on cancer. The type of cancer, site, and stage
of progression are among the factors determining the treatment selection. Traditional treatment
approaches include chemotherapy, surgery, radiation, and radiation-based surgical knives. Side
effects associated with traditional therapy highlights the need for novel cancer treatment.
Nanotechnology is widely investigated and utilized to treat cancer, where nanoparticles have
had a vital role in delivering anticancer medication. Nanoparticle-based drug delivery provides
several advantages over conventional drug delivery, including enhanced biocompatibility, sta
bility, permeability, and retention effect, as well as precision targeting. It has also been proven
to tackle the resistance to anticancer drugs by targeting the underlying mechanism (drug efflux
transporters overexpression, imperfect apoptotic pathways, and a hypoxic environment), en
hancing multidrug resistance reversal. Moreover, nanoparticles' role in immunotherapy is un
dergoing investigation due to their essential role in treating cancer. The current article high
lights the role of NP in delivering a chemotherapeutic medication, targeted treatment, and the
mechanisms of targeting.

Ovarian hyperstimulation syndrome is a dangerous complication of ovulation induction during
infertility treatment by gonadotropins stimulation and human chorionic gonadotropin injection.
Increased capillary permeability, causing fluid leakage from the intravascular compartment,
with the accumulation of fluid in the third-space and consequent intravascular dehydration, is
the main change in the pathophysiology of ovarian hyperstimulation syndrome. Vascular en
dothelial growth factor is the main mediator in the development of ovarian hyperstimulation
syndrome. The recent application of new modalities: Gonadotropin-releasing hormone antag
onist protocol, Gonadotropin-releasing hormone agonist triggering of ovulation and em
bryo/oocyte vitrification, facilitates the elimination of ovarian hyperstimulation syndrome as
sociated with controlled control ovarian hyperstimulation for IVF program. In this manuscript,
we reviewed the pathophysiology, clinical features, predisposing factors, and both primary and
secondary arrangement for preventing ovarian hyperstimulation syndrome as there is no single
measure to prevent OHSS totally. Therefore, categorizing the women based on their risk po
tentiality seems to be beneficial to direct the line of management as early as possible to avoid
the emergence of ovarian hyperstimulation syndrome.

Background: Anthracyclines are among the most successful medicines for treating breast can
cer; when taken in combination regimens, they enhance both disease-free and overall survival
in breast cancer patients. Unfortunately, they are the representative agents causing cardiotoxi
city, particularly Left ventricular dysfunction.
Aim of the study: To assess the incidence and risk factors for anthracycline-induced cardio
toxicity for early detection and prevention among breast cancer patients.
Methods: Eighty-six patients with breast cancer were given Adriamycin (60 mg/ m2) with
cyclophosphamide (600 mg/m2), with different cycles number and frequencies. They were
prospectively monitored clinically, and by echo study to detect any cardiotoxicity, several pa
tients and drug-related risk factors were analyzed to identify their influence on Anthracycline
Induced Cardiotoxicity.
Results: After anthracycline chemotherapy, 21 patients (24.4%) developed diastolic dysfunc
tion, and 7 patients (8.1%) developed reduction in the left ventricular ejection fraction more
than 10%, out of these 7 patients, 4 developed symptomatic cardio toxicity. Older age (> 60
years), Hypertension, diabetes, and abnormal renal function were all associated with a higher
risk for developing anthracycline cardiotoxicity.
Conclusions: Cardiotoxicity is common among breast cancer patients treated with anthracy
cline-based chemotherapy, which can even occur in a dose less than 240mg/m2. Age older than
60, Hypertension, diabetes mellites, and abnormal renal function showed significant associa
tion with Anthracycline Induced Cardiotoxicity

Background: Worldwide about 15% in the childbearing years have infertility problems. Many
studies demonstrated that men and women have abnormal emotional responses, such as stress,
anxiety and depression. In our community less published researches examined both men’s and
women's reactions to subfertility. Some treatment options like Assisted Reproductive Technol
ogies (ART) such as Invitro fertilization (IVF) ad more stress, anxiety, and grief to the patients
whom already have these symptoms from delay of pregnancy.
Aim: this study was carried out to assess the prevalence of depression for infertile females in
Kerbala, Najaf and Babylon.
Methods: Face-to-face interviews were conducted with 498 infertile women all suffering from
primary or secondary infertility only 433 of them complete their participation in our study and
answered the questionnaire. We made specific form of questionnaire consists of demographic
and obstetrical information's mixing with some questions from validating questionnaire used
in Patient Health Questionnaires-nine (PHQ-9). The data were analyzed by application of spe
cific model of descriptive analysis includes; frequency, percentage, mean and inferential data
(standard deviation, Chi-square, t-test and Pearson correlation coefficient).
Results: The prevalence of depression was very high among infertile women in Kerbala, Najaf
and Babylon/Iraq, which is 93.5% were depressed from study sample. The mean score of de
pression among infertile patients was 12.26 ± 6.57 out of 36.
Conclusion the study concludes that the infertility has large impacts on woman in our commu
nity with different forms of psychological symptoms as especially depression that may affects
their activity and social performance.

Background: Neonatal jaundice (NNJ) is one of the most common disorder of
newborns worldwide. Delay in the detection of NNJ and improper treatment could
lead to neonatal morbidity and mortality. The mother’s knowledge and health
seeking behaviors play an important role in the fate of this hazard.
Objectives: To determine the level of knowledge and attitude of mothers in Karbala city
towards NNJ, and its correlates.
Subject and methods: A Cross-sectional study had been taken in Karbala Teaching Hospital
for Children. A convenient sample of a total 164 mothers of neonate with jaundice. The data
were collected through direct interview with the mothers, using a special designed
questionnaire. Statistical Package for Social Sciences program was used for statistical analysis .
Result :The mean knowledge score was good. Where (51.2%) of mothers had good knowledge
and (48.8%) had fair knowledge. Although knowledge of mothers about onset, duration, causes
and treatment of jaundice was acceptable (fair), it was good about definition and symptoms,
complications and way of diagnosis. Knowledge level had a significant association with urban
resident mothers (P=0.032). The mean attitude score was positive attitude (0.70 out of 1). A
significant association between positive mother's attitudes towards NNJ and being older mother
(P=0.034), multiparty (P=0.032) and good Antenatal care (P<0.001). Higher knowledge score
was significantly correlated with higher attitude score, (R=0.179, P = 0.022).
Conclusion: The overall knowledge of mothers is good, and the overall attitude is
good (positive attitude). However, cultural beliefs and traditional baby care still
have an impact on mothers.

Background: Elder abuse is defined by the World Health Organization in Europe as a single
or repeated act, or lack of appropriate action, occurring within any relationship where there is
an expectation of trust, which causes harm or distress to an older person. It is an important
cause of morbidity and mortality in developing and developed countries.
Subjects and Methods: A cross-sectional study conducted included 402 patients attended
the Consultation Department of Imam Hussein Medical City aged 60-year-old and over. A
structured modified questionnaire was developed for the study and filled out by a doctor us
ing face-to-face interviews.
Objective: To evaluate the proportion of elder abuse, identify its different patterns, and de
termine the risk factors related to the problem.
Results: Out of 402 total respondents, females constituted 52% (70.1%) were married, the
proportion of all types of abuse/neglect was 82.1%, psychological abuse accounted for three
quarters of the study participants (74.1%), followed by physical abuse, financial abuse, and
neglect (61.9%, 53.7%, and 45.8% respectively), while sexual abuse reported by only 4%
participants. In general, the main three perpetrators of all types of abuse were spouses, fol
lowed by a son and daughter (41.8%, 38.1%, and 21.9%), respectively.
Conclusion: The proportion of elder abuse is high in Karbala, with psychological abuse be
ing the most commonly reported pattern, the abuse induced by a family member in most of
the cases, and two-thirds of the study participants did not report the abuse.

Background: The Global pandemic, COVID-19, represents an emotional challenge for
medical institutions because of unpredictable complications and the rapidity of its spread. One
of the critical complications associated with COVID-19 insult is cardiovascular coagulopathy
which can be fatal. This life-threatening sequel could be predicted by estimating the serum
level of D-dimer. The latter is a well-known diagnostic marker of COVID-19 infection.
Besides, D dimer is a fibrin metabolite and is directly related to the overall coagulation process
in the body. Corticosteroid is the mainstay of treatment of moderate and severe cases of
COVID-19 infection, especially those with significant hypoxia.
Aim of the study: to evaluate whether using corticosteroids minimizes the occurrence of
coagulopathy, an effect marked by a reduction of the level of D-dimer during the course of the
disease.
Patients and Methods: A total of 152 male patients infected with COVID-19 were selected
randomly. A specialist Physician diagnosed them according to standard guidelines. Patients
were non-diabetic and non-hypertensive; 72 of them received dexamethasone for 5 days from
the start of treatment of COVID-19. Serum level of D- dimer was estimated after seven days
of starting treatment then statistical analysis was done.
Results: Data of the current study revealed a significant reduction in the serum level of D
dimer in patients who received dexamethasone treatment compared to the other group who did
not receive dexamethasone.
Conclusion: It was concluded that using dexamethasone significantly decreases the serum
level of D-dimer and thus may minimize the possibility of coagulopathy induced as a result of
COVID-19 infection.