Medical Journal of Babylon

Background: Platelet‑rich plasma (PRP) has been employed widely in dental and oral surgery. However, there is considerable debate about
its effect on wound healing and inflammatory response. Materials and Methods: PubMed, Google Scholar, Scopus data base, and manual
search were performed to find out articles on the use of PRP in dental and oral surgery using keywords such as PRP , oral surgery, dental
surgery, lower wisdom teeth, periodontal pocket, dental implant, tooth socket preservation, dry socket, cystic lesion, and ridge augmentation.
These articles discussed the use of PRP (after surgical removal of wisdom teeth, treatment of periodontal pocket, ridge preservation, implant
stability, prevention of dry socket, treatment of bony defect after cystic removal, and ridge augmentation). Results: Twenty‑seven articles
were found on the usage of PRP in dental and oral surgery. Six articles on the use of PRP after surgical removal of lower wisdom teeth,
five articles in the treatment of periodontal pocket and implant stability, four article in ridge preservation, three articles in prevention of dry
socket and two articles on the use of PRP after cystic removal and ridge augomentation. Conclusion: PRP enhanced bone regeneration and
soft‑tissue healing aftery lower wisdom tooth surgery. It decreased the depth of periodontal pocket, maintained implant stability, preserved
ridge height and prevented dry socket. However, PRP had no effect on pain, swelling, and bleeding. There is no justification for the impact
of PRP on bone augmentation and healing of bony defect after cystic removal of the jaws. More studies should be carried out to support the
usage of PRP in oral and dental surgery.

In the field of medical education, surveys remain one of the most common methods for the planned and conducted educational research.
However, the validity of the obtained results depends on the adequate representation of the study population and the number of participants
who have responded to the survey. An extensive search of all materials related to the topic was carried out in the PubMed search engine and a
total of seven articles were selected based on the suitability with the current review objectives. Owing to the ongoing coronavirus disease‑2019
pandemic, a sudden rise in the incidence of online educational surveys has been observed. There is an immense need to improve the response
rates to the online surveys and thereby get representative results. In conclusion, online surveys are exceedingly being used in the field of
medical education research by different stakeholders. It is the responsibility of the researcher to ensure that they follow simple steps to reduce
both unit nonresponse and item nonresponse and thereby ensure more representation to the study findings.

Background: Primary sinonasal non‑Hodgkin’s lymphomas (NHLs) are uncommon malignancies. The lack of specific clinical presentations
often causes delayed visit to the clinician and so diagnosis is done in late with advanced stage. Objective: The objective of the study was to study
the primary sinonasal NHL with respect to clinical presentations, management, and outcome. Materials and Methods: This is a retrospective
study conducted in a tertiary care teaching hospital from March 2010 to April 2020. The clinical data of the patients of primary sinonasal NHL
were evaluated with respect to the age, sex, clinical presentations, staging, diagnosis, treatment, and outcome. Results: The mean age of the
participants was 62.45 years with male‑to‑female ratio of 1.5:1. All the cases of sinonasal NHL involved with paranasal sinuses and nasal cavity.
Nasal obstruction was the most common symptom. All were diagnosed with large B‑cell lymphoma and treated with combined chemotherapy and
radiation. Five patients were died during follow‑up period. Conclusion: Primary sinonasal NHLs are extremely uncommon clinical entity. The
diagnosis is based on the histological examination with immunohistochemical study. Early diagnosis and prompt treatment with chemo‑regimen
and radiotherapy are essential to achieve an optimum outcome. Early diagnosis and treatment improves the treatment outcome.

Background: Hyperalgesia and allodynia are abnormal sensory signs which are usually seen along neuropathic pain (NP) in patients on
paclitaxel (PT) chemotherapy. Pomegranate seed oil (PSO) has been used in the traditional medicine for the different kinds of pain. Nucleo‑CMP
Forte® (NCF) is a nucleotide‑based drug and L‑carnitine (LC) is a member of natural compounds have been shown effective in diverse peripheral
neuroglial disorders. The aim of this study is to compare the anti‑hyperalgesia and anti‑allodynia activity of PSO, NCF, and LC in PT‑induced
neuropathy. Materials and Methods: Thirty adult male mice were divided equally into five groups of six mice in each group as follows:
Control (C), PT, PSO (PTpso), NCF (PTn), and LC (PTc) groups. NP was induced by the administration of PT (6 mg/kg, i. p., once weekly)
to the mice in all groups except C group. PSO, NCF, and LC were administered orally once daily to mice with PT‑induced neuropathy in their
corresponding groups. Different behavior parameters were used to test the anti‑hyperalgesic and anti‑allodynic effect of PSO, NCF, and LC
on days 0, 7, 14, 21, and 28 of PT administration. Results: PSO, NCF, and LC significantly attenuated NP induced by PT from day 14 up to
28 days using the different behavioral tests for thermal hyperalgesia and allodynia. Conclusion: PSO, NCF, and LC have significant potential
anti‑nociceptive and analgesic activity against PT‑induced NP and PSO was the most efficacious than NCF and LC.

Background: Lung cancer (LC) is one of the well‑known fatal malignant neoplasms worldwide. Objective: The objective of this study
was to determine the potential relationship between ABO and Rhesus blood groups with LC. Materials and Methods: A retrospective
case series study was done on 500 patients diagnosed with LC using hospital case reports of both Nanakali Hospital and Rizgary
Teaching Hospital and 182,408 healthy blood donors in Erbil city of Iraqi Kurdistan Region. Results: Blood groups of 500 LC
patients were as follows: blood group A, 156 (31.2%); blood group B, 111 (22.2%); blood group O, 196 (39.2%); and blood group AB,
37 (7.4%), whereas blood groups of healthy donors were as follows: blood group A, 56,546 (31%); blood group B, 43,413 (23.8%);
blood group O, 68,221 (37.4%); and blood group AB, 14,228 (7.8%). The difference was statistically not significant by Pearson’s
Chi‑square (P = 0.909). Rh of patients was as follows: Rh negative in 42 patients (8.4%) and Rh positive in 458 patients (91.6%),
whereas Rh of healthy donors was as follows: Rh negative in 18,241 patients (10%) and Rh positive in 164,167 patients (90%). The
difference was statistically not significant by Pearson’s Chi‑square (P = 0.381). Conclusion: According to the results of the study, we
found that there was no statistically significant relationship between ABO‑Rhesus blood groups’ LC susceptibility in general and also
between different histopathological types.

Background: Many studies agree that routine histology is less sensitive and less specific than special stains and immunohistochemistry (IHC)
with false‑positive and false‑negative rates. Objectives: The aim was to evaluate the accuracy of four general histopathologists in documenting
Helicobacter pylori (Hp) bacteria in gastric biopsies (stained with H and E) by using IHC and modified Giemsa stain (MG), also to assess
the specificity of MG and whether it can replace IHC. Materials and Methods: Twenty seven reported gastric biopsies were collected from
each of four pathologists (9 reported as negative for Hp, 9 reported as scant Hp, and 9 as abundant Hp). The pathologists selected were known
to have different thresholds for Hp. The biopsies were stained with MG and IHC and they were read by two pathologists. Results: The four
pathologists showed different thresholds for labeling luminal gastric pits’ structures as Hp. Overall, there were 5/36 false‑negative cases (13.9%)
and 26/72 false‑positive cases (36%), most of them in the category reported as scant Hp detected. The results of MG were concordant with that
of IHC in 107/108 cases. Conclusion: The overall accuracy rate of Hp detection on routine histology was 71%; false positivity was much more
common than false negativity, especially when only scant Hp reported to be present. MG is a reliable stain and if done properly, it can replace
the more costly IHC. When Hp identification is crucial from the clinical management of view, special stains and/or IHC should be requested

Background and Objectives: Injection drug usage is a major public health issue. The study is aimed to find the clinical profile and
trends of injection drug usage in young people who attended de‑addiction services at a tertiary care center in North India. Methods: This
retrospective record review analyzed data from consecutive young‑aged people attending de‑addiction services at a tertiary care hospital in
North India between 2015 and 2019. The sociodemographic data and clinical and injection‑related characteristics were discerned from the
data. Results: Out of 135 patients included in the analysis, 132 (97.8%) were male. There was a 13‑fold rise in treatment seeking over the past
5 years (2015: 7 vs. 2019: 98). One hundred and thirty‑two (97.8%) were male. High Risk behavior was present such as sharing of needles
in 31 (22.9%), paraphernalia sharing in 24 (17.8%), 6 (4.4%) reported ever-having symptoms of sexually transmitted infection, 13 (9.6%)
had sex with sex worker, 9 (6.7%) reported ever-having HIV screening, 6 (4.4%) reported having HIV positive status. Thirty‑two (23.7%)
reported having previous treatment for drug abuse and 13 (9.6%) reported previously being hospitalized for drug abuse. Heroin usage has
been present in 96 (71.1%) followed by pentazocine usage in 19 (14.1%). Conclusion: Our findings revealed that treatment‑seeking young
age population (the WHO defined age group 15–24 years) from the defined geographical location has been showing an increasing trend in
injecting drug user usage along with greater injection and sexual risk behaviors associated with it. This can be used to design the public health
strategy to educate regarding avoiding injection drug‑related practices.

Background: Mothers play an important role in controlling family eating habits as well as the type of food consumed. Obesity is one of the
causing factors for many diseases. Objectives: This study was designed to determine whether a woman’s level of education is associated with
the family’s daily dietary intake and mother weight status or not. Materials and Methods: A web survey study designed through Google Forms
was sent online to the entire Iraqi population from August 26 to September 20, 2020. The survey was distributed through institutional and
private social networks (University E‑mail, Facebook, Instagram, Viber, and WhatsApp). This method was entirely effective for the research
hypothesis. A face‑to‑face interview was also conducted with illiterate women in public hospitals and medical centers. Results: The study
result by 376 participating women showed a significant relationship between the level of education and body mass index (BMI) (P = 0.001).
No significant relationship was shown between the level of daily dietary intake and BMI. The results also showed a significant association
between education and family level of dietary intake (P = 0.003). The study showed a better daily dietary intake with those who do not have
a high education level. Conclusions: The study concluded that healthy dietary choices and daily food intake are not related to education level
but the mother’s nutritional knowledge level.

Background: E‑cadherin is a cell adhesion molecule, its downregulation is associated with poorly differentiated tumors in many organs,
and its loss is associated with adverse behavior of many tumors. Objectives: This study aims to find a correlation between E‑cadherin
status, the Grade Group, and the modified Gleason score in core biopsies obtained from prostatic carcinoma. Materials and Methods: This
study is a retrospective and prospective cross‑sectional study that was conducted on (50) paraffin blocks obtained from core biopsies of
prostatic carcinoma. E‑cadherin status was correlated with the Grade Group and the modified Gleason score. The E‑cadherin staining
pattern was also examined for its correlation with perineural invasion. Chi‑square was used to determine the correlation between E‑cadherin
staining pattern on the one hand and the modified Gleason score, Grade Group, and perineural invasion on the other hand and P < 0.5%
was considered as significant. Results: Only six patients (12%) fall in Grade Group 1 and according to the modified Gleason score, most
patients had high scores. Regarding E‑cadherin expression, 24 cases (48%) had aberrant E‑cadherin expression, while the rest 26 cases (52%)
had a complete strong membranous expression. Statistically, there was a significant correlation between aberrant E‑cadherin expression
and increasing grade according to the modified Gleason score and Grade Group with P values of 0.032% and 0.022%, respectively. In
24 patients (48%), perineural invasion was detected half of them had aberrant E‑cadherin expression which was statistically notsignificant
when both the parameters (perineural invasion and aberrant E‑cadherin expression) are tested against the modified Gleason score and the
Grade Group (P = 0.71%). Conclusion: Aberrant E‑cadherin expression is associated with increasing modified Gleason score and Grade
Group but has no significant correlation with perineural invasion.

Background: Abdominal trauma, both penetrating and blunt, is a major public health concern worldwide. Trauma, especially abdominal
trauma is increasing due to urbanization and industrialization including road traffic accidents. To decrease morbidity and mortality rate from
intra‑abdominal organ injury as a result of blunt abdominal trauma (BAT), physicians have to have a high suspicious of organ injury in any case
presented with BAT because any delay in the diagnosis conversely affects the prognosis of the patient. Objective: The aim of this study was
to determine the number of patients who had surgical operative intervention because of BAT, to investigate the mortality rate among patients
with abdominal trauma, and to determine the hospital outcome of BAT. Materials and Methods: This was an observational retrospective
study of 60 cases during 1‑year duration (2016–2017) at Rozhalat Emergency Hospital, Erbil, Kurdistan region of Iraq. Results: 48 cases
were( male 80%), 12 were( female 20%), with a male to female ratio of 4:1, and the mean age was 24,80. Majority of cases (36/60) were
managed conservatively, while 24 cases had surgery. The overall majority of cases (50/60) had a good outcome discharged home safely but
10 cases died. The most common intra‑abdominal organ injury was the spleen. Conclusions: Most cases were managed conservatively, with
overall mortality rate of 16.7%, all the mortality (10/60) was among the operated cases (24/60) cases.

Background: The detection of the estrogen receptor (ER) and progesterone receptor (PgR) in women with breast cancer (BC) is considered a
crucial step for prognostic evaluation and treatment choice in clinical practice. Objectives: This study aimed to evaluate the expression of the
hormonal receptors (ER and PgR), their distribution, and their association with clinicopathologic prognostic parameters in a sample of Iraqi
women with BC. Materials and Methods: The paraffin‑embedded blocks from a total of 80 women diagnosed with primary invasive breast
carcinomas with BC were examined by immunohistochemistry to assess the expression of ER and PgR status. Demographic and clinical data
were collected from each patient in the preformed questionnaire. The association of steroid receptor expression with clinicopathologic parameters
was assessed using binary logistic regression. Results: Among 80 BC women involved in the study, 54 (67.5%) and 39 (48.75%) had high
expression of ER and PgR, respectively. High ER expression was significantly associated with older age (odds ratio [OR] = 4.8, 95% confidence
interval [CI] = 1.16–19.81, P = 0.03), postmenopausal status (OR = 3.6, 95% CI = 1.25–10.33, P = 0.015), smaller tumor (OR = 0.27, 95%
CI = 0.09–0.75, P = 0.01), and with noninvolvement of lymph node (OR = 0.11, 95% CI = 0.02–0.51, P = 0.005). High PgR expression, on the other
hand, was significantly associated with older age (OR = 4.44, 95% CI = 1.02–19.39) and postmenopausal status (OR = 3.13, 95% CI = 1.24–7.88,
P = 0.016). Concomitant overexpression of both receptors was significantly associated with postmenopausal status and noninvolvement of lymph
nodes. Conclusion: High expression of ER and PgR seems to be a good prognostic indicator because it was associated with less aggressive tumors

Background: Fracture tibia is one of the most common fractures in the pediatric age group. It accounts about 15% of cases. In majority of
cases, close reduction and plaster application is the mainstay of treatment. Objectives: The objective was to assess the outcome of flexible nails
in the treatment of tibial diaphysis fractures in children and to evaluate the results regarding the union rate and complications including limb
length discrepancy, angular deformities, and pain. Materials and Methods: This prospective descriptive case–control study which included
30 children with 30 unilateral tibial diaphysis fractures in which the physis were open, all were closed, and open (type 1 and type 2) fractures,
and with displaced transverse, short oblique, and spiral fractures, in which the trial of close reduction was failed. All patients are admitted
and operated at West Erbil Emergency Hospital. Alignment of fractures, any infection, delayed union, nonunion, limb length discrepancy,
motion of knee joint, time of complete union, and skin irritation were assessed with minimum follow‑up period of 6 months. Results: In the
current study, the complete union was achieved in 9–11 weeks in 20 (66.7%) patients, while in 6 (20%) patients, achieved in 12 weeks, and
in 4 (13.3) patients, achieved in 13–16 weeks that were regarded as a delayed union. In 6 (20%) patients, there were nail protrusion and skin
irritation, no shortening more than 0.5 cm was recorded, shortening <0.5 cm recorded in 12 (40%) patients, and no lengthening was recorded.
In 3 (10%) patients, the angulations in coronal and sagittal views were 5°–10°. There was no case of nonunion. Conclusion: Elastic nails are
an effective way for the treatment of the pediatric tibial diaphysis fractures. It is a simple and easy method but with radiation risk, although
elastic nails have complications, all are avoidable and minor that will be managed with minimal intervention.

Background: Anticoagulations remain an essential step to minimize the mortality and morbidity associated with thromboembolic phenomena in
atrial fibrillation (AF). Nevertheless, the adherence to OAC stands for (Oral Anticoagulant) throughout the paper is not universal among the different
populations. In Iraq, there are no data about adherence to (OAC) in patients with AF. Objectives: This study aimed to assess the adherence to oral
anticoagulants (OAC) based on the American College of Cardiology/American Heart Association performance measures in eligible patients with
a CHA2DS2‑VASc ≥2 in patients with AF in Duhok, Iraq. Materials and Methods: A total of 132 patients who were diagnosed with AF were
consecutively reviewed during 2018–2019 in Azadi Teaching Hospital, Duhok, Kurdistan Region, Iraq. For eligibility of taking an OAC, the VAS
score derived from CHA2DS2‑VASc for all patients was calculated. Results: The mean age of the patients was 65.29 (standard deviation [SD]:
17.18 years). The average duration of AF was (2.0) years. The mean of VAS score was 2.97 (SD: 1.75, ranged between 0 and 8.0). 78.0% of all
patients were eligible for OAC at admission. Only 15.9% of the patients were on OAC. In the logistic regression analysis, none of the patient’s
characteristics predict significantly the nonadherence to OAC. Conclusion: The present study showed that a high percentage of AF patients were
eligible for OAC. However, only a small percentage of them were receiving OAC at admission in our area.

Background: Seasonal influenza is an acute, highly infectious viral infection. Immunization of the children can protect not only the children
but also the community from seasonal influenza. Parents’ knowledge and attitudes can play an important role in the immunization coverage.
Objectives: To assess parents’ knowledge and attitudes toward childhood seasonal influenza vaccination for children aged below 5 years
in Hilla governorate and to determine the relationship between them and socioeconomic status. Materials and Methods: A cross‑sectional
study was done on 288 parents who visited a six randomly selected primary health care centers in Hilla city and who had children aged
between (6 and 59) months. Data were collected from May 1, 2018, to August 4, 2018, by interviewing parents using a questionnaire form
after taking their consent, including a full assessment of parents’ attitude and knowledge toward seasonal childhood influenza vaccination.
Results: The results showed that 92.7% (n = 260) of the participants had moderate and good knowledge about seasonal childhood influenza
vaccination with significant association with mother’s education, age, and family income and 88.9% (n = 256) of them had a positive attitude
toward the vaccine which was significantly associated with the family residence, the coverage rate of the seasonal childhood influenza vaccine
was 30.6%. Conclusions: The majority of participants had good and moderate knowledge and a positive attitude toward seasonal childhood
influenza vaccination. Higher knowledge level was reported in mothers of younger age. A very low percentage of illiterate mothers had good
knowledge. The majority of parents with good knowledge had low family income.

Background: Patients with type 2 diabetes (T2D) are at increased risk of urinary tract infection (UTI). Objective: The aim was to study
clinical, etiological profile, complications, and follow‑up of symptomatic UTI in T2D patients and the effect on glycemic control and renal
parameters. Materials and Methods: This was a hospital‑based prospective study done on admitted 200 T2D symptomatic UTI patients.
Various clinical, biochemical parameters and urine examination and culture were monitored. All patients were followed for 6 months with
respect to the number of UTIs, glycemic control, and renal parameters. Results: UTI was common in females (81%) compared to males (19%).
Lower UTI (cystitis) was present in 55.5% and pyelonephritis 44.5%, emphysematous pyelonephritis in 9.5%, and bacteremia in 58.1% of
UTI patients. Bacteriuria was present in 69%. Escherichia coli (55%) was the most common organism isolated from urine culture. Severe
hyperglycemia was present in 83.5%, diabetic ketoacidosis in 8%, hyperglycemic hyperosmolar state in 13%, shock in 14.5%, and multiorgan
dysfunction syndrome in 10.5% of UTI patients. UTI in females was significantly associated with postmenopausal state, longer duration of
diabetes, retinopathy, nephropathy, poor glycemic control, acute kidney injury, cystopathy, and upper UTI. The prevalence of recurrent UTI
was 39.6%. Recurrent UTI patients had significantly higher glycosylated hemoglobin at follow‑up than at baseline, but renal parameters did
not improve despite intensive treatment. Conclusion: Symptomatic UTI in T2D patients is common in postmenopausal females with longer
duration of diabetes, poor glycemic control, cystopathy, and chronic diabetic complications. Recurrent UTI patients have poor glycemic control
on follow‑up while renal parameters do not improve.

Background: Coronavirus disease‑2019 (COVID‑19) pandemic has led to a radical transformation of economic, social, and health‑care
networks. COVID‑19 pandemic has reported a substantial drop in the number of patients presenting to cardiology Emergency Departments with
acute coronary syndromes/acute myocardial infarction (ACS/AMI) and a drop in number of cardiac procedures. Objective: The objective
was to describe how lockdown and COVID‑19 pandemic has affected the evolution of AMI and hospital admissions due to ACS. We aimed
to assess the impacts of COVID‑19 on cardiology services and procedures performed on a daily basis before and during the pandemic.
Materials and Methods: This single‑centered retrospective study included all the consecutive patients with ACS/AMI including ST‑segment
elevation myocardial infarction (STEMI) and non‑STEMI admitted to ER of Surgical Specialty Hospital‑Cardiac Center/Erbil‑Iraq, from
the start of the lockdown (March 15, to April 15, 2020). The same analysis was conducted among patients presenting with ACS/AMI at the
same identical time period before Lockdown (March 15, to April 15, 2019). Results: A total number of 40 patients admitted at SSH/Cardiac
Center‑Erbil with ACS/AMI during the study period, and showed a 37.5% drop in the number of patients with Myocardial Infarction comparing
with the corresponding time window before the COVID‑19 pandemic. Conclusion: These preliminary results strongly demonstrate a decrease
in the number of admissions for ACS/AMI during the lockdown period (March 15, to April 15, 2020) due to multiple reasons.

Anti‑N‑methyl‑D‑aspartate receptors (NMDARs) encephalitis is a rare neurological autoimmune encephalitis. Its symptoms may mimic psychosis
as this disease is a neurological disorder in psychiatry costume. Disparity in clinical symptoms and nonsupportive laboratory investigations except
the cerebrospinal fluid (CSF) analysis delays the diagnosis. We are presented with a case of 29‑year‑old female with psychiatric symptoms such
as suspiciousness, decreased sleep, and boastfulness. Within a few days, the patient developed neurological symptoms such as seizures and
disorientation, while the patient was on an antipsychotic along with benzodiazepines. Her symptoms worsened with autonomic instability,
and the patient entered into catatonic phase of the illness. We reached a positive diagnosis of anti‑NMDAR encephalitis through CSF analysis.
The patient recovered completely with the help of immunotherapy and intensive cognitive rehabilitation. This case emphasizes the need of a
multidisciplinary approach in the management, early detection, and adequate treatment of this challenging illness for better results for patients.

Dear Editor,
Asthma is a common global chronic inflammatory disease
of the airways that is characterized by episodes of cough,
wheezing, and shortness of breath with increasing prevalence
in the past years.
In the United States, asthma is the most common reason to
seek medical treatment. It is responsible about 15 million
annual outpatient visits to physician and for 2 million annual
in patients hospital treatment with estimated yearly 55 billion
$ cost.[1]
Triggers that worsen asthma control, such as allergens or
occupational agents, smoking should be avoided.
Patients with asthma need to understand how to use their
medications and the difference between reliever and controller
therapies. Education may improve compliance, particularly
with inhaled corticosteroids

Dear Editor,
We read with great interest the article by Jaiman et al.,[1] in
which the authors presented a modified supracondylar chevron
osteotomy for correction of genu valgum deformity. The technique
illustrated by them has essentially been described in the literature
by Aglietti et al.[2] and Gupta et al.[3] and termed it as supracondylar
wedge‑less “V‑” shaped osteotomy. We would like to congratulate
the authors for conducting this wonderful study.[1] However, we
would like to make the following observations for the benefit
of the readership of this journal so that the technique may be
employed successfully in constrained resource environment:
1. The peripheral setups may have various constraints in the
form of limited availability of intraoperative C‑arm image
intensifier, sophisticated implants such as anatomically
contoured distal medial femoral locking plate, and long
metallic goniometers. The authors should have elaborated
more on the correct placement of the apex of “V” in the
scenario of nonavailability of intraoperative fluoroscopy.
In this situation, the operating surgeon should rely on the
various surgical landmarks like the presence of a leash of
medial epiphyseal vessels which consistently cross the
operative field transversely[3,4] and the apex of “V” should
be kept just proximal to these vessels
2. The authors have used an anatomically