Medical Journal of Babylon

Background and Objectives: The healthcare industry is fast accepting the benefits of Internet of Medical Things (IoMTs) and
incorporating the services in day-to-day activity. The objective of this review was to comprehensively review the IoMTs, briefly revisit
the functioning architecture, classify, list the challenges and possible solutions, and suggest the future trends among IoMTs usage and
implementation. Materials and Methods: During April 2021, an extensive search for articles for Internet of Medical Things (IoMTs),
medical devices, Internet of Things (IoTs) with biosensors either in title or in keywords was done using PubMed, ScienceDirect,
Google Scholar, and Web of Science databases. Studies were categorized into two types: those evaluating the clinical outcomes of
IoMTs and those evaluating the technological basis of IoMTs. Results: IoMT architecture was reviewed under four headings: sensors,
IoT gateway/framework, machine learning, and reporting tools. IoMT classification based on place of usage (body centric IoMTs,
hospital IoMTs with point of care kiosks, and ubiquitous IoMTs), based on the system-wise application (cardiovascular, renal,
pulmonary, endocrine, medication) and based on outcomes (fitness-alone IoMTs, clinical grading and monitoring IoMTs, and remote
patient monitoring IoMTs) is proposed. Conclusion: IoMTs can be classified based on the place of usage into body centric, hospitalbased,
and ubiquitous systems. Classification based on the body systems and sensors aids in first-hand information about the existing
IoMTs. Challenges for effective implementation of IoMTs are interoperability, data privacy, security, regulatory, and infrastructural
costs. The future is promising for IoMTs with robust technological improvement and effective implementation.

Applicability of stem cells in cell-based therapy and regenerative medicine provided hope for untreatable diseases; subsequently, stem
cells bioengineering has become a promising scientific research topic. Different types of stem cells possess different characteristics;
certain types are superior to others according to their advantages. Cell bias toward asymmetric division is the first step regarding
tissue regeneration and homeostasis, and this event is stimulated by chemical and mechanical cues arising from the surrounding
microenvironment. Inappropriate asymmetric cell division (ACD) consequently results in organ disrupt morphogenesis. Intracellular
events including polar distribution of regulatory proteins and fate determinants are of significant importance to prepare cells toward
asymmetric division. The assembly of polarity proteins on opposite sides of the cell would induce downstream signaling pathway, and
this forms a fundamental mechanism to establish cell asymmetric division. This review addresses the current understanding regarding
stem cells biology, niche-raised cues, and polarity of regularity proteins and fate determinants of ACD.

The aim of this work was to review several studies investigating the effects of genetic polymorphisms on warfarin dosing in regional
and Iraqi studies and to report any consistent pattern of relevant findings. Despite the growing use of the recently introduced direct
oral anticoagulants, warfarin is still the mainstay agent for oral anticoagulation because of its cost-effectiveness. However, a difficulty
to establish a stable warfarin dose is frequently encountered. In addition to the warfarin narrow window of efficacy and safety, the main
contributor to the challenging dosing is the wide range of variability in warfarin pharmacokinetics and pharmacodynamics among
different patients as well as within the single patient context. A link between nonappropriateness of warfarin doses and dramatically
increased risk of thromboembolic and hemorrhagic events has been well documented. Several single nucleotide polymorphisms
(SNPs) in the genes implicated in warfarin pharmacokinetic and pharmacodynamic processes have been highlighted as possible
contributors to warfarin dosing instability. Vitamin K epoxide reductase complex 1 gene SNPs have consistently been found to be
the predominant genetic factor contributing the dosing variations. The SNP rs9923231 was significantly associated with the greatest
predicting capability of warfarin dosage. However, a range of about 30%–50% of the variances in warfarin dosing was explained by
the combined contribution effect of several genetic and nongenetic (clinical) factors in the regional and Iraqi studies.

Variances in the patients’ outcomes have been a well-documented challenge in anticoagulant therapy. A clinical encounter with a
thromboembolic or a hemorrhagic event, due to subtherapeutic or adverse effects of an anticoagulant, is often managed by switching
the anticoagulant agent into another, which is more specific and direct-acting. This management approach is usually associated with
a financial burden. Additionally, the certainty of achieving better efficacy and safety profile is still questionable. Genetic variants
affecting the protein sites that are involved in the anticoagulant pharmacokinetic and pharmacodynamics interactions have been
suggested to contribute to the variability in the response to anticoagulant therapy. The current work reviewed the studies investigating
the response variability associated with the anticoagulant therapy (heparins, rivaroxaban, apixaban, and dabigatran) and the potential
pharmacogenes contributing to such response variability. Several genetic polymorphisms were reported as potential contributors
to variances in response to anticoagulant therapy and were associated with adverse events. A link has been proposed for heparin
resistance with single nucleotide polymorphisms (SNPs) of the anti-thrombin-encoding gene (SERPINC1) as well as heparin-induced
thrombocytopenia with human leukocyte antigen (HLA) variant allele (HLA-DRB3*01:01). Several investigations also remarked
variations in the serum drug level of direct oral anticoagulants (DOACs) that are associated with SNPs in the proteins contributing to
the pharmacokinetics of the anticoagulant agent. Several studies discerned significant associations between SNPs in the ABCB1 gene
and elevations in the serum levels of rivaroxaban, apixaban, and dabigatran. Moreover, carriers of the variant genotype of the SNP
(rs776746) in the cytochrome P450 3A5 enzyme-encoding gene (CYP3A5) had significantly higher drug levels when compared with
the non-carriers. In contrast, some SNPs were reported to impart a protective phenotype to the carrier. The SNP (rs2244613) in the
carboxylesterase-encoding gene (CES1) has been significantly associated with a decline in dabigatran trough levels and a lower risk
of hemorrhage. Further investigations are essential to elucidate the extent of pharmacogenetics-based alterations in the drug levels as
well as the subsequent clinical outcomes of anticoagulant therapy.

Nutritional biochemistry examines the health benefits gained from eating healthy food. It specifically focusses on nutrient chemical
components and how they function metabolically, physiologically, and biochemically. The biochemical study gives information about
food metabolism and hormones and enzymes participating in this process and describes the process of food intake and how energy is
obtained and the way the energy is spent. It is study of nutrition as a science. Nutritional biochemical therapy refers to specific nutritional
procedures including assessment and interventions in the treatment of an illness, injury, or disease condition. Studying the biochemistry
of food and its metabolism gives us knowledge about effectors of metabolism in positive direction as it is the source of energy, which is
the foundation of life. Its negative effect as metabolite can give rise to diabetes mellitus, cardiovascular disease, and cancer.

At all ages (from birth to adulthood) large number of people may affect with acne, the disease with chronic inflammation of the
pilosebaceous follicle. Although acne is a benign dermatological change, it has a massive effect and stays for a long time, with a
defect in growth, self-confidence, and emotional stress. The interruption in observing the medical help aggravates the physical and
psychological injuries; thus, it is related to elucidate the disease and to find the suitable treatment for it. In the skin, testosterone (T)
and dihydrotestosterone (DHT) are synthesized and bind to the androgen receptor. Several revisions about acne sustenance the role
of androgen hormones. There are two principles used for the treatment of acne rendering to the American Academy of Dermatology
(ADD).

Background: Pancreaticoduodenectomy provides the only opportunity to cure resectable and borderline pancreatic ductal
adenocarcinoma. This is linked to a high rate of morbidity and mortality, especially when combined with hepatic artery anomalies.
The goal of this study was to analyse the spectrum and impact of hepatic artery anomalies on intraoperative and postoperative
variables, and oncologic outcomes in patients undergoing pancreaticoduodenectomy. Materials and Methods: All patients with
resectable periampullary or pancreatic head tumours who underwent pancreaticoduodenectmy (PD) were included. Patients were
divided into two groups using computer-generated random numbers; Group A included patients who had pancreaticoduodenectmy
(PD) with normal hepatic artery anatomy and Group B included patients with aberrant hepatic artery anatomy. The data was collected
and analysed using SPSS 22. Results: Among the 238 patients who met the inclusion criteria, 177(74.36%) participants were included
in Group A (Normal hepatic artery anatomy) and 61 (25.36%) in Group B (Aberrant hepatic artery anatomy). The mean age of
patients in Group A was 51.3 ± 8.63 years while it was 50.6 ± 8.09 years in Group B. The difference in gender, BMI, pre-operative
haemoglobin, bilirubin and albumin between two groups was statistically insignificant (P value >0.05). The difference in mean
operative time of Group A 230.9(168–390) minutes and Group B 319.6(200–620) minutes was statistically significant (p-value <0.001).
The mean blood loss in Group A (511.5 120.18 ml) was significantly lower than in Group B (623.6 127.06 ml) (P ≤ 0.001). There were
no significant differences between the two groups in terms of post-operative pancreatic fistula, delayed gastric emptying, wound
infection, atelectasis, hospital stay, peri-operative mortality, positive resection margins, and mean lymph node yield. Conclusion:
Patients with hepatic artery anomalies who undergo pancreaticoduodenectomy have significantly more operative blood loss. This
could be due to the procedure’s complexity and lengthy operative time. There were no differences between the two groups in terms of
postoperative morbidity, oncological outcome, or mortality.

Background: Osteoarthritis (OA) is a leading cause of disability and doubles the number of visits to primary care practitioners for those
with the condition in comparison to those without. OA affects the knee more often than any other joint, Platelet-rich plasma (PRP)
is a concentrate of autologous blood growth factors which has been shown to provide some symptomatic relief in early osteoarthritis
(OA) of the knee. Objective: the aim of this prospective study is to demonstrate the effectiveness of prp injection in patients with OA
of the knee. Materials and Methods: 60 patients with 74 knees affected by variable grades of OA were enrolled in our study in Alwasity
teaching hospital from January 2018 to December 2019 with follow up till December 2021. 49 patients with 62 knees were females
and 11 patients with 12 knees were males, all patients received three injections of prp at weekly intervals and were followed up every
three months for two years. Results: After one year of follow up 11 knees with KL-G I had decrease in VAS score to 0–2 (73.3%),19
knees with KL-G II had decrease of VAS score to 1–3 (70.3%),10 knees with KL-G III had decrease of VAS score to 4–5 (40%), All 7
knees with KL-G IV didn’t have any response during treatment or at the end of 1st year. All patients had scores similar to that before
starting treatment at the end of 2nd year. Conclusion: The present state of knowledge holds promise for PRP of certain specifications
for pain management in early OA knee. PRP has consistently been shown by various clinical studies to be useful in OA of the knee.
Nevertheless, a lot of grey areas remain in our understanding of PRP and OA, and many more focused clinical and in vitro studies are
required. PRP seems to be an evolving future trend.

Background: Rheumatoid arthritis is a chronic disease associated with inflammation and progressive damage of joints. It is
present in the Middle East and North Africa where the epidemiology of RA remains poorly understood with a dearth of data
of the prevalence and activity of disease among Arab countries. The prevalence of RA in Babylon, Iraq in 1975 was 1.02, but
during the past decade it was noticed that the prevalence and clinical data varied greatly depending on the area of the study.
Objectives: We tried to estimate the incidence of RA in Babylon Province, Iraq during 2014–2019. Materials and Methods: It
was a cross-sectional study to detect new cases of the disease in Marjan Teaching Hospital from 2014 to 2019. All patients
were diagnosed according to the American College of Rheumatology criteria of 1987 and the revised one of 2010. Results:
The total number of new RA cases during this period was 1814 patients. Females were 1577, and male patients were 237. The
incidence was 1.1 in 2014 and then reached 1.7 in 2019 with an accumulative risk of 10.0. The average duration of the disease was
2.1 years, and the average age was 43 years. Conclusion: This study was done to follow the previous study performed in the same
hospital between 2001 and 2011. The incidence was not significantly increased during the period of this study when compared
with other studies. This study lacks the rate of severity and response to treatment, which indicate that another study is needed.
It is done to see the incidence of disease and the effect of social and environmental factors that followed war conflicts in the
area of Iraq.

Background: Tuberculosis (TB) remains one of the commonest infectious diseases in India, where control is difficult due to the
emergence of multi-drug-resistant TB (MDR-TB). The rifampicin resistance (RR) is an important surrogate marker of MDR-TB.
Aims and Objectives: The aim of this article is to determine the prevalence of RR-TB among all symptomatic presumptive TB patients
by cartridge-based nucleic acid amplification test (CBNAAT) in our institution. Materials and Methods: A retrospective crosssectional
study was conducted from January 2018 to December 2020 in the Directly Observed Treatment (DOT) center of a tertiary
care hospital. All presumptive cases of pulmonary TB patients coming to the DOT center were subjected to CBNAAT by GeneXpert
Mycobacterium tuberculosis rifampicin (MTB/RIF) (Cepheid). Data were collected from a data-extraction sheet from registration
books and analyzed using SPSS version 20. Fisher’s exact test was applied to examine the association between categorical variables
and P-value less than 0.05 was considered significant. Results: A total of 6171 presumptive TB patients were included in the study. The
overall prevalence of TB was 1590 (25.77%) in all age groups. The prevalence of RR-TB among all confirmed TB cases was 10.75%
(171/1590) with the majority being males (130 cases). The prevalence of RR cases among new and previously treated was 3.1% and
36.34%, respectively, which were statistically significant (P < 0.05). Conclusion: We found that RR-TB is still much prevalent in our
area, and it was significantly higher in previously treated cases. The CBNAAT is a good molecular assay method for rapid detection
of TB and also for the detection of RR-TB.

Background: Assessment of micronutrients in pregnant women particularly ZINC and whether its concentration is different between
term and preterm birth is important to optimize the normal pregnancy and to reduce the incidence of pregnancy complications,
especialy preterm labour and pre labour rupture of membrane. Objectives: Assessment of correlation between maternal serum ZINC
level and the prelabour rupture of membrane in both preterm and term pregnant women. Study Design: Case control study. Materials
and Methods: A case control study performed in Al-Imamain Al- Kadhumain Medical City/Obstetrics and Gynecology department
from 1st of February to 1st of November 2019,Including 400 pregnant women their gestational age ranged between (24 to 42) divided
in to 4 group: group A, group B, group C, group D which all undergo serum Zinc level measurement. Result: The mean ± SD of
serum ZINC in group A which include the preterm prom,which is less than the control group (B) preterm intact membranes which,
and the mean ± SD of serum zinc of group (C) which include the term prelabour rupture of membranes which is less than group (D)
which is the control group of group (C) term intact membranes. This study shows significant relationship between ZINC deficiency
and prelabour rupture of membrane in both term and preterm pregnant women at a P value< 0.001 and <0.001 respectively, also
this study show inverse relationship between serum zinc and increasing parity, maternal age, vaginal infection, and BMI. Conclusion:
Pregnant women with prelabour rupture of membranes wether term or preterm tend to have lower Zinc level. Increasing maternal age,
increasing parity,high BMI,vaginal infection are associated with low Zinc.

Background: Febrile seizure is the most common convulsive disorder in childhood. The role of iron in the metabolism of
neurotransmitters and carrying oxygen to the brain suggests the possibility of a relationship between iron-deficiency anemia and
febrile seizures. Objectives: The aim of study is to study the role of iron-deficiency anemia as a risk factor for febrile seizures. Materials
and Methods: This is a hospital-based case–control study performed in 30 children with febrile seizures (case) and 80 febrile children
without seizures (control) who were aged between 6 and 60 months. The groups were matched in terms of age, gender, and the use
of supplemental iron. Laboratory tests consisted of complete blood count, serum iron, plasma ferritin were done for each patient.
Results: Thirty-four percent of the cases with febrile seizure had iron-deficiency anemia compared with 20% of children with febrile
illness without seizure and 12% of healthy children. The odds ratio for iron-deficiency anemia in the patients with febrile seizure was
3.059 (95% confidence interval (CI) = 0.969–9.657) compared with the febrile children without convulsion and 5.608 (95% CI = 1.834–
17.146) compared with the healthy group. Conclusion: Based on the result of this study, iron deficiency could be an important risk
factor for the development of febrile convulsion. This encourages the evaluation of iron status in children with febrile seizure.

Background: Being a systemic infection, coronavirus disease 2019 (COVID-19) affects hematologic system, along with cardiovascular,
pulmonary, gastrointestinal, and neurological systems, resulting in altered hematological parameters. These altered hematological
findings are thought to have a role in early risk stratification and prognostication of COVID-19 patients. However, the data on
hematological abnormalities associated with the disease among Eastern Indian COVID-19 patients, particularly the Bengalis, are
limited. Aim: The aim is to study the association, if any, between various hematological parameters and disease severity of COVID-19.
Materials and Methods: The study was a cross-sectional study involving 145 laboratory-confirmed cases of SARS-CoV-2 infection. Based
on the disease severity, the patients were divided into three groups: mild, moderate, and severe. Various hematological parameters were
analyzed. Results: Of the 145 patients, 82.8%, 9.6%, and 7.5% of the cases were in the mild, moderate, and severe groups, respectively.
The mean age was 48 years. The result of our study showed that the age of the patients is directly proportional to the severity of the
illness. About 62.1% of the patients were male, whereas the rest (37.9%) were female. Our study showed an independent association of
Covid severity with male gender. Although mean total leukocyte count (TLC), absolute count of neutrophil, lymphocyte, eosinophil,
neutrophil–lymphocyte ratio (NLR), neutrophil–monocyte ratio (NMR), lymphocyte–monocyte ratio, platelet–lymphocyte ratio, and
systemic inflammatory index among mild, moderate, and severe COVID-19 cases were statistically significant (P < 0.05), basophil,
monocyte, and platelet count were statistically insignificant among the three groups. Nearly all of the hematological parameters
could be used as potential diagnostic biomarkers for subsequent analysis because their area under the curve was higher than 0.50.
Conclusion: Severity of COVID-19 is associated with older age, male sex, higher TLC, neutrophilia, lymphopenia, eosinopenia, high
NLR, and high NMR. As complete blood count is an inexpensive routine blood investigation, it can be very useful in a resource-poor
healthcare facility, which is unable to provide high-end investigations.

Background: Histopathological diagnosis of a specimen requires good histoprocessing. It ultimately depends on sample preparation
and staining, which is time consuming by routine tissue processing technique. The objective of the present study was to compare the
reliability of kitchen microwave for tissue processing and staining with the standard conventional processing and staining in different
tissue samples. Materials and Methods: The study sample included 204 specimens from different parts of the body. Three set of tissues
were processed and three set of slides from each sample were stained by routine as well as microwave method and the quality of
microscopic features was compared. Results: No significant difference was found in nuclear and cellular characters in case of staining
by both methods. While, in case of processing, mean scoring for nuclear characters for routinely processed and microwave-stained
(RM) slides was 6.95 ± 0.09 (confidence interval [CI] 6.83–0.09), for microwave-processed and microwave-stained (MM) slides, it was
6.82 ± 0.07 (CI 6.74–6.90) by observer 1 (P = 0.068). The mean score of cellular character of RM slides was 7.85 ± 0.06 (CI 7.76) and
for MM slides, it was 7.65 ± 0.17 (CI 7.47–7.88) by observer 2 (P = 0.076). The microwave method was better for both processing
(P = 0.001) and staining (P = 0.003) in case of small biopsies (P = 0.057). The microwave method was as good as routine method for
processing of aorta and staining of breast and kidney tissues (P = 0.23, 0.32, and 0.38, respectively). The time taken by the microwave
method is considerably less for both processing and staining. Conclusion: The microwave method requires less time when compared
with the routine method, thus reducing the overall turnaround time which ultimately helps in rapid same-day diagnosis and patient
management. Microwave can be preferred method for smaller biopsies when compared with large biopsies. Lack of automation
and requirement of more manpower remain the major disadvantages for use of microwave method in large turnover histopathology
laboratories.

Background: Diabetes mellitus is a chronic condition characterized by hyperglycemia that can lead to serious complications. It results
from a defect in insulin secretion, insulin resistance, or both. Type 2 diabetes mellitus (T2DM) is the most common type of diabetes
and mainly affects adults. It is associated with insulin resistance and low-grade chronic inflammation in the adipose tissue, muscles, and
liver. Measurement of hemoglobin A1c (HbA1c) is one of the most widely used tests to monitor diabetes. The aim of this study was
to shed light on the effect of glycemic control of type 2 diabetes on procalcitonin (PT) levels in order to prevent future complications.
Materials and Methods: This case-control study included 68 patients with type 2 diabetes mellitus. At Biochemistry Department,
College of Medicine, and University of Baghdad and at Al-Sadiq Teaching Hospital in Al-Hilla City, during the period from July 2020
to October 2020. Hemoglobin A1C (HbA1c) was estimated by using an affinity chromatography assay. These patients were divided
according to HbA1c level into bad control group (HbA1c > = 7%) which included 36 patients, and good control group (HbA1c
<7%) which included 32 patients. Another group of 32 nondiabetic apparently healthy subjects (HbA1c <5.7%) served as control
group. Patients with type 1 diabetes mellitus (T1DM), gestational diabetes, insulin-treated type 2 diabetes, history of recent infection,
diabetic foot, ischemic heart disease, cerebrovascular disease, or recent trauma or surgery were excluded. PCT of each participant was
estimated using an enzyme-linked immunosorbent assay (ELISA). Results: The mean PCT values of bad control group, good control
group, and control groups were 871.3776, 834.5005, and 208.5313 pg/mL, respectively. The study showed that there was no significant
difference in mean PCT between good control and bad control groups (P > 0.05). In addition, there was no significant correlation
between PCT and HbA1c among diabetic patients (r = 0.072, P > 0.05). However, there is a significant differences in mean of PCT
values between diabetic patients and control group (P < 0.05). Conclusion: There was no effect of glycemic control on PCT level in
patients with T2DM. However, the level of PCT was increased in comparison with non-diabetic healthy subjects.

Background: Rheumatoid arthritis (RA) is a systemic autoimmune disease with protean manifestations. It is characterized by symmetric
polyarticular inflammation, which can lead to progressive joint damage. As a result, RA is associated with substantial functional disability,
morbidity, and accelerated mortality, which pose an enormous and growing societal burden. Polypharmacy is a major public health
concern, which is growing worldwide. Polypharmacy is associated with adverse outcomes including mortality, falls, adverse drug reactions,
increased length of stay in hospital and readmission to hospital soon after discharge. Objectives: The aim of this study was to quantify
polypharmacy in a group of patients with RA, its relationship with patients’ characteristics and to assess the risk of potential undesirable
interactions between medications used for managing RA and those used for chronic and non-chronic diseases. Materials and Methods:
A cross-sectional study was conducted at Baghdad Teaching Hospital, Rheumatology Unit during the period from December 2019 to
December 2020. A total of 188 adult patients, previously diagnosed with RA according to the 2010 American College of Rheumatology/
European League against Rheumatism rheumatoid arthritis classification criteria, were included in the study. Data were collected using a
pre-constructed data collection sheet. Questionnaires included demographic and clinical data of the patients. In this study, polypharmacy
was defined as the association of five or more medications, regardless of the duration. Drug interactions were identified by use of the
Medscape’s drug interaction checker® database. Results: Among 188 RA patients in this study, polypharmacy was found in 71.8% of
the patients and there were 331 potential drug–drug interactions (1.77 ± 2.52 DDIs/patient). Most of the potential drug–drug interactions
were related to the use of methotrexate, with nonsteroidal anti-inflammatory drugs being the major representative of these drug–drug
interactions with methotrexate. Conclusion: High prevalence of polypharmacy was found in RA patients. Positive correlation between
polypharmacy and patient’s age, disease activity and the presence of other comorbid conditions. Polypharmacy was associated with
increased incidence of potential drug–drug interactions in RA patients. Methotrexate was involved in most drug–drug interactions.

Background: Hyperglycemia often occurs in pregnant women with a significant increase in the global prevalence of diabetes. This
phenomenon provides a large amount of research data for studying the relationship between pregnancy and blood glucose. Irisin
is a myokine first identified for its ability to induce the browning of white adipose tissue, to increase energy expenditure, and to
protect against insulin resistance and obesity. Objectives: The aim is to assess the relationship between serum levels of irisin and
gestational diabetes mellitus (GDM). Materials and Methods: A case–control study was conducted at the Department of Obstetrics
and Gynecology at Al-Imamian Al-Kadhemain Medical City, from the first of January 2020 to the end of October 2020. Pregnant
women at the second trimester (n = 100) were divided into two groups: women with GDM previously diagnosed as case group (n = 50)
and healthy pregnant women as control group (n = 50). Results: Mean serum level of irisin for the case group was 707.5 ± 167.2 ng/
mL, and 892 ± 123.8 ng/mL for the control group, with a highly significant decrease in the case group than that in the control group
(P < 0.001). The validity test of the serum irisin level at cutoff value of 702 shows that sensitivity was 94%, specificity was 90%,
negative predicted value was 94%, positive predicted value was 90%, and the accuracy of the test was 92%. Conclusion: Serum levels
of irisin were significantly lower in patients with GDM.

Introduction: Gestational diabetes defined as carbohydrate intolerance of variable severity with onset or first recognition during the
present pregnancy. This definition applies whether or not insulin is used for treatment and undoubtedly includes some women with
previously unrecognized overt diabetes. Objectives: To assess the effect of Vit B12 deficiency, Homocystein and Lipid metabolism in
association with increased risk of Gestational Diabetes Mellitus. Materials and Methods: A prospective case control study. Sample
collection: pregnant women at the 2nd and 3rd trimester (n = 100) were divided into two groups: Women with GDM considered as case
group (n = 50) and healthy pregnant women as control group (n = 50) were enrolled in this study. Results: The mean level of serum B12
in case group were (169.3 ± 13.6) and (227.5 ± 29.9) of control group with highly significant decrease in case group than that in healthy
control group (P < 0.001). Significant correlation between Vit B12 and BMI, and significant association with moderate correlation
with Gestational age (P- values =0.042). Significant association with moderate correlation between Vit B12 and both insulin level and
HOMA-IR test in GDM group (P < 0.05) respectively. Highly significant association (P < 0.001) with good correlation (0.712) was
found between Homocysteine and B12. Significant correlation between Vit B12 and lipid profile (cholesterol, LDL, HDL, and TG)
and LDL, HDL, and TG were presented with moderate correlation. Homocysteine [umol/L] level in GDM group was (8.31 +/- 2.02)
and (7.33 +/- 3.54) for healthy group with significant difference (P < 0.001). Conclusion: Highly significant decrease of vit B12 in
patients with GDM than that in healthy group, while highly significant increase of Homocysteine and triglyceride in GDM patients
than in healthy group.

Background and Objectives: Pancytopenia is a combination of anemia (with a reduction of the red blood cell count), leukopenia, and
thrombocytopenia. Leukopenia is usually mainly due to a reduction in the neutrophil count although the number of other granulocytes,
monocytes, and lymphocytes are often also reduced. Pancytopenia is a manifestation of many serious and life-threatening diseases. This
study was undertaken to evaluate the clinicopathological features of pancytopenia and the role of bone marrow study for etiological
categorization. Settings and Design: This is a cross-sectional observational study conducted in a tertiary referral center of north east India, for
a period of 1 year (from August 2020 to July 2021). Materials and Methods: Proper history taking and clinical examination were done for all
patients attending with hemoglobin <10 mg/dL, total leukocyte count <3000 cells/cmm, and platelet count <1 lakh/cmm. The investigations
done were peripheral blood smear examination with Leishman stain, special staining, as well as specific biochemical and radiological
investigations as per requirement in cases; bone marrow aspiration (under all aseptic precaution); and bone marrow trephine biopsy (under
all aseptic precaution). The results are presented in tables and compared with similar studies. Results: A total of 42 cases of pancytopenia
were evaluated. The age group of 18–20 years was the most commonly affected. Male-to-female ratio was 1.33:1. All the patients presented
with generalized weakness and pallor, and a large portion also with abdominal discomfort, hepatomegaly, and splenomegaly. Anisocytosis
and macrocytosis were the most common peripheral blood smear findings. Vitamin B12 level was decreased in 75% of all the evaluated cases
(15 of 20 cases). Bone marrow was hypercellular in most of the cases (80.95%) followed by hypocellular marrow (14.29%). Megaloblastic
erythroid hyperplasia was the most common abnormality found in bone marrow. Megaloblastic anemia was the most common etiology
followed by hypoplastic/aplastic anemia. A significant portion (7.14%) also showed bone marrow involvement by myeloma. One case of
involvement by metastatic tumor was found. Conclusions: Most cases of pancytopenia were due to megaloblastic anemia and so easily
curable. The bone marrow study is essential to evaluate a case of pancytopenia to know the exact etiology for proper management.

Background: E-learning (electronic-learning) usually means the introduction of electronic media and other useful communicative
technologies in the undergraduate and postgraduate education. E-learning is a wide term including all forms of modern educational
technology in learning process and teaching, which is more appropriate for both distance and flexible learning. Objective: This study
aimed to determine the students’ knowledge regarding the suitability of e-learning application in the medical education. Materials and
Methods: A study was done on the students of the second and fifth medical stage at Tikrit Medical College during the period from
April 1, 2021, to the end of June 2021, and 520 medical students were included in the study (260 students from both stages). The data
were collected through a special questionnaire sheet that contains four main items about the e-learning, and the electronic distribution
of the form was conducted after receiving their verbal consent before participation in the study after full, detailed information about
the study was given. The statistical test, Chi-square test, was used to estimate the relation between the current variables, and P < 0.05
was regarded significant. Results: The current study shows that 53.1% of the studied students were female, 65.4% within the age group
23–24 years, and 85.3% living in the rural area. There is a statistically significant among 39.7% of male study students from the second
stage that the main difficulty is the disagreement of medical staff in comparison to 54.6% of students from the fifth stage that the
main difficulty is the financial problems. On the other hand, 37.2% of study students from the second stage disagree that e-learning
is affected by good trainer skills compared with 15.1% of study students from the fifth stage. Conclusion: For female students of
both stages, the main problem affecting e-learning is the current administrative instruction. The study recommended that e-learning
introduction into the graduate and undergraduate education will promote a direct shift toward future adult learning in all branches
and aspects of educational cycle.

Background: Chronic obstructive pulmonary disease, characterized by chronic airway inflammation and progressive airflow limitation,
and is considered as common, preventable and treatable disease. The defining standard values for diaphragm thickness and thickening
ratio using B-mode ultrasound may provide a simpler, safer means of evaluating diaphragmatic function in chronic obstructive
pulmonary disease patients. Objective: to assess the diaphragmatic structure and function using B-mode ultrasonography studying the
diaphragm muscle inspiratory and expiratory thickness and thickening fraction in patients with COPD compared to healthy controls,
and to study their sensitivity and specificity as well as their correlation with certain pathophysiologic parameters namely (peripheral
capillary oxygen saturation, body mass index and C-reactive protein) to establish possible relation with the pathophysiology of the
disease. Materials and Methods: The present study is a case control study was conducted in Al-Imamein Al-Kadhimein Medical City,
Baghdad, Iraq in the period extended from November 2019 to October 2021. Forty patients with the diagnosis of COPD underwent
B-mode ultrasound analysis. Three images were captured both at end expiration (Tmin) and at maximal inspiration (Tmax). The
thickening fraction was calculated as (Tmax-Tmin/Tmin), and each set of values was averaged. Findings were compared with a
database of 40 healthy control subjects. Results: Diaphragm thickness and thickening fraction were significantly higher in COPD
patients compared to control subjects with the mean of the Rt. inspiratory diaphragmatic thickness equals (3.23 ± 0.68mm versus
2.8 ± 0.55mm; respectively, p=0.006) compared to control, and (2.44 ± 0.71 versus 1.96 ± 0.6; respectively, p=0.004) for the mean
Rt. diaphragmatic thickening fraction, while the mean of the Lt. inspiratory diaphragmatic thickness was (3.22 ± 0.63mm versus
2.79 ± 0.51mm; respectively, p=0.003) compared to control, and (2.45 ± 0.63 versus 1.95 ± 0.54; respectively, p=0.003) for the mean
Lt. diaphragmatic thickening fraction, ROC analysis shows that the right and left diaphragmatic fractions had the highest sensitivity
and specificity parameter for COPD. No correlations were found between body mass index, SpO2 with diaphragmatic parameters.
Conclusion: the current study found diaphragmatic ultrasonographic characteristics in patients with COPD show significant increase
in inspiratory thickness and thickening fraction compared to control group, yet they were of low diagnostic accuracy.

Background: Hypertension is one of the most common health problems in the world and considered as the most common risk factor
for different heart diseases such as coronary heart disease, stroke, renal disease, and peripheral vascular diseases. Adherence to healthy
lifestyle and medications plays an important role in controlling hypertension among hypertensive patients and in preventing the
long-term complications of hypertension. Objectives: The study aimed to assess the adherence to healthy lifestyle and medications
in controlling hypertension among hypertensive patients in Al-Hilla city, Iraq. Materials and Methods: This study was a “descriptive
cross-sectional study” involving about 303 hypertensive patients who visited healthcare centers and hospitals above 18 years by a
designed questionnaire through the interview method. The data were collected from April to July 2021. Results: The mean age of
hypertensive patients was 54.89 ± 10.42 years, females represent 51.2%, males represent 48.8%, adherence of hypertensive patients
to healthy lifestyle was 65.3%, and adherence to medications was 55.4%. There was no significant association between adherence to
healthy lifestyle and medications and variables in our study (age, sex, marital status, educational level, residence, employment status,
socio-economic level, duration of hypertension, family history of hypertension, and measurement of hypertension). Conclusion: In
this study in Babylon Province, the highest proportions of hypertensive patients adhere to healthy lifestyle (65.3%) and medications
(55.4%), and there is no significant association between adherence to healthy lifestyle and medications and variables in our study (age,
sex, marital status, educational level, residence, employment status, socio-economic level, duration of hypertension, family history of
hypertension, and measurement of hypertension).

Background: Rifampicin-resistant pulmonary tuberculosis (RR-PTB) remains a global health burden. The spread of RR Mycobacterium
tuberculosis is a threat to treatment and control of tuberculosis. Objective: This study aimed to assess the rate of RR-PTB and
further determine the factors associated with it. Materials and Methods: This study was achieved in April and May 2022. Data were
collected, reviewed, and analyzed from archived records of patients who had been tested using Xpert MTB/RIF assay at the Chest
and Respiratory Disease Specialized Centre in Erbil City from January 1, 2015 to December 31, 2020. Results: A total of 1236 medical
records of patients who tested for drug resistance using GeneXpert were included in this retrospective data analysis study. Overall,
GeneXpert positive results were reported in 196 cases (15.9%) which denote confirmed cases of tuberculosis by the GeneXpert test
in the period 2015–2020. From the total confirmed patients, twenty-one cases (21,10.7%) were found to be RR-PTB. The highest
prevalence of RR-PTB according to gender, age range, category of patients, and prevalence of HIV status was as follows: male (11;
52.4%), 18–28 years (9; 42.9%), relapse (13; 61.9%), and HIV positivity (12; 57.1%), respectively. The differences in distribution of the
rifampicin resistance concerning the aforementioned demography were as follows: gender: nonsignificant, age range: not significant,
relapse: significant (P ≤ 0.05), HIV positivity: highly significant (P ≤ 0.01). Conclusion: This study reported the prevalence rate of
rifampicin-resistant M. tuberculosis was 10.7% among confirmed TB patients. HIV-positive and previous TB treatment history were
significantly associated with high RR-PTB. This result showed that GeneXpert assay is a convenient tool for the early diagnosis of
rifampicin-resistant M. tuberculosis.

Background: Extrapulmonary tuberculosis (EPTB) is still a major health problem in developing countries. Diagnosis of EPTB is
difficult due to paucity of acid-fast bacilli in clinical specimens. Objectives: To study the diagnostic role of cartridge-based nucleic
acid amplification test (CBNAAT) and rifampicin resistance in EPTB on fine-needle aspiration samples. Materials and Methods: It is
a prospective study comprising 79 patients of clinically suspected EPTB cases for 1 year duration. All patients underwent fine-needle
aspiration cytology (FNAC) with Ziehl–Neelsen (ZN) staining followed by CBNAAT for confirmation of tuberculosis (TB) and to
detect rifampicin resistance. Data have been collected and analyzed regarding sensitivity, specificity, positive predictive value, and
negative predictive value of FNAC in comparison with CBNAAT. Results: Out of 79 patients, 47 (59.49%) patients were male and
cervical lymph node was the most common site of aspiration (42, 52.16%). Granuloma with necrosis (38, 48.10%) followed by necrosis
only (14, 17.72%) were the common findings on FNAC. Out of 79 suspected EPTB patients, CBNAAT confirmed 62 patients as
having TB. Specificity of FNAC with ZN staining was 100.0%; however, sensitivity was low (43.55%) compared to CBNAAT. Only
three cases were detected as rifampicin resistant. Conclusion: Compared to FNAC, CBNAAT has very good sensitivity and specificity
in the diagnosis of EPTB. It has also as added advantage of detecting rifampicin resistance at the same time. CBNAAT should be used
for diagnosis of EPTB wherever the facility is available.

Background: The first five years of a child’s life is a golden period for their growth and development, fostering their future learning skills
and social and emotional abilities due to rapid gains in physical and cognitive growth and development. Objectives: The aim of this
study was to examine the knowledge of mothers about the growth and development of under 5-years children in western Rajasthan.
Materials and Methods: The present study was conducted with quantitative descriptive approach. The study was conducted at Prince
Bijay Singh Memorial (PBM) Hospital, Bikaner, Rajasthan. The population of the current study comprised of 150 mothers, having at
least an under-5 year’s child. The subjects were selected by Non-probability convenient sampling technique for this study. Self-structured
questionnaire on demographic profile and knowledge about growth and development were distributed among the mothers. Results:
The study revealed that half of the mothers were belongs to 26–35 years of age group. The majority of mothers (42%) were having
education up to primary level. In occupational status, the most of mothers (56.66%) were house wife. Furthermore, the majority of the
mothers (65.33%) had average level of knowledge followed by 28.67% of them had good level of knowledge while only 6% had poor
level of knowledge regarding growth and development of under-5 year children. Likewise there was a significant association between
the knowledge scores of the mothers and age (p-value- 0.031), educational status (p-value- 0.0001) and occupation (p-value- 0.0001).
Whereas, variables like as: family income, type of family and Number of children in family were not significantly associated the level of
knowledge. Conclusion: Findings of this research study suggested that most of the mothers having average level of knowledge towards
growth and development of under-5 year children. In addition, Knowledge of the mothers was partially associated with their selected
demographic variables. Furthermore, sound knowledge of mothers is vital for growth and development of under-5 year children.

Introduction: COVID-19, first detected in Wuhan, China in December 2019, fast spread across the globe, causing a pandemic affecting
many countries around the world. Objectives: The aim of this study was to assess the severity of clinical features and paranasal sinuses
computed tomography (CT)-scan findings in COVID-19 patients and find the relationship between smoking and severity of COVID-19
symptoms. Materials and Methods: A cross-sectional study was achieved on a cohort of 399 patients, who clinically suffer from COVID-
19 symptoms. The collected data for those patients included COVID-19 polymerase chain reaction (PCR) tests, presence of the IgG and
IgM antigens, and paranasal sinuses CT-scan images. Results: This was a cross-sectional study of 399 patients infected with COVID-19.
The mean age of the patients was 39 ± 11 years. Approximately 53.6% of them were males, whereas 46.4% were females. 55.6% of them
performed CT scan for sinuses. 28.6% of the patients were with severe clinical features. 51.1% of them were smoking. 77.4% of them
were of positive PCR, 57.9% positive IgG, and 86.7% positive IgM. 27.8% of patients were of the age group of 40–49 years. There was a
significant association between the severity of COVID infection and age group. There was a significant association between the severity of
COVID infection and sinus CT-scan findings. There was a significant association between the severity of COVID infection and positive
PCR. There was a significant association between the severity of COVID infection and positive IgM. There was a significant association
between smoking and sinus CT-scan findings. Conclusion: At the time of COVID infection, the severity of infection ranged from mild to
moderate. More severe infection with COVID-19 associated with significant finding in sinus CT scan in patients at age group 50–59 years,
and sinus also more severe COVID infection associate with positive CT scan finding that occur more in smocking patients.

Background: Osteoarthritis (OA) is by far the most common form of arthritis and is a major cause of pain and disability in older
people. Knee OA as a disabling disease affecting all aspects of patients’ life.
Health – related quality of life (HRQOL) is increasingly being acknowledged as a valid health indicator in many diseases especially
chronic processes. Objective: To assess the impact of Knee OA on HRQOL of Knee OA patients. Materials and Methods: A
cross sectional descriptive study assessed HRQOL of 100 knee OA patients without significant comorbidity, were interviewed at
Rheumatology consultant clinic of Baghdad Teaching Hospital by using 14 questions of CDC Health Related Quality of Life
Questionnaire between September, 2020 to March 2021. Results: From 100 participants (21% male, 79% female), 96% of them said
that knee pain made usual things hard to do with mean of 19 days according to the last 30 days before the interview. 89% of them
said that they were limited in any way in any activities because of knee OA. Conclusion: The overall results of this study reflect the
negative impact of Knee OA on HRQOL of the patients and, we found that the higher BMI (body mass index), age, disease duration
and bilateral involvement, the lower the quality of life.

Background: Developmental dysplasia of the hip (DDH) includes multiple abnormalities. Females are more susceptible for DDH. The
clinical examination is used for diagnosis, but its sensitivity is generally low. Ultrasound (US) examination identifies DDH in infants
younger than 6 months of age. Because of its accessibility and the lack of exposure to radiation, the clinical applications of US in the
diagnosis of DDH have expanded, making it the gold standard test for DDH. Objective: This study aimed to measure sensitivity and
specificity of limited hip abduction (LHA) as a screening test for the detection of DDH. Materials and Methods: A cross-sectional
study including 60 infants were brought to the Al-Wasity Teaching Hospital, Baghdad and Al-Rusafa Health Directorate, Ministry of
Health and Environment, Baghdad, Iraq, within the period from January 2020 to October 2020. They were referred by other physicians
and clinics or their parents suspected that they have abnormal hip. We excluded infants with associated congenital abnormality
such as arthrogryposis or spina bifida. The diagnosis was made by clinical and US examination. The clinical examination included
identification of LHA. Data regarding age and gender were recorded and were statistically analyzed. Frequencies and means were
used to express data, and the χ2 goodness of fit test and Student’s t-test were used as appropriate to detect significance of difference
between frequencies and means. Results: The sensitivity and specificity of unilateral and bilateral LHA were 51.35%, 95.18% and
27.03%, 63.86%, respectively. Conclusion: Unilateral LHA was more sensitive and specific than bilateral.

Background: Iron overload in beta thalassemia patients may lead to the alteration of arterial structures together with hyperlipidemia and
other risk factors that may lead to the atherosclerotic changes and thickening of carotid arteries. Carotid ultrasound is easy, noninvasive,
and rapid test that can detect atherosclerotic changes by the assessment of carotid intima-media thickness, which is a structural marker of
atherosclerosis, and it correlates well with vascular risk factors and its relation with stroke and coronary artery disease. Aim: The aim was
to evaluate the role of carotid ultrasound in the assessment of atherosclerotic changes in iron-overloaded beta thalassemia major patients.
Patients and Methods: This is a case–control study done in Babylon Gynecology and Children Teaching Hospital from July 1 to December
31, 2018 on 60 patients with beta thalassemia major and 30 normal children as a control group. Their age ranges from 3 to 14 years old.
Carotid ultrasound examination was done on all patients and the control group. Results: In this study, carotid intima-media thickness
was significantly higher in patients than in controls (P < 0.001). Carotid intima-media thickness significantly increases in patients with
beta thalassemia major with increasing duration of blood transfusion (P < 0.001), with increasing serum ferritin (P = 0.004), and with
increasing serum cholesterol (P < 0.001). The study also showed no correlation between body mass index and blood pressure with carotid
intima-media thickness. Conclusion: Carotid ultrasound is useful in the assessment of carotid intima-media thickness, which is a marker
of atherosclerosis and has a strong positive correlation with markers of iron overload and hyperlipidemia.

Background: Hypertension is Common and is a third on the list of chronic pediatric diseases (after asthma and obesity), Obesity on the
Other hand is a growing problem worldwide and both are consider being major causes of morbidity and mortality in many countries,
and can lead to long-term health risks in children. Objective: is to examine the association between blood pressure and Obesity in
Baghdad primary school. Materials and Methods: cross sectional study, from January 1, 2016 to June 1, 2016. Clusters of 1044 children
aged 6–12 years from primary schools in Baghdad were surveyed, excluding those who have cardio vascular, renal and endocrine
diseases. Data on age, gender, height, weight, systolic and diastolic blood pressure were collected, body mass index has been measured.
Classification of children was based on age and sex-specific BMI percentile groups as normal weight, overweight,and obese. Result:
The overall prevalence of hypertension in the current study is 19.6%, (7.6%) prehypertension, (72.7%) normal, obesity prevalence is
19.1%,(15.4%) overweight and (61.6%) normal, after comparison between blood pressure values and age-sex-body mass percentile
groups, the result revealed that blood pressure values were higher in obese groups (9.6%) than those in normal weight groups(6.3%) for
both sex. Conclusion: Hypertension is not uncommon problem in 6–12 years old children and it is more prevalent in overweight and
obese children Blood pressure should be routine and frequent checking in children, especially obese children.

Background: Energy drinks (ED) consumption is an increasingly occurring phenomenon in our Iraqi society. ED marketing should
be limited or forbidden particularly among adolescents until independent research confirms their safety. Objectives: To estimate the
prevalence of energy drinks consumption among young people in Iraq in regard to: gender, sport habits, disease state, purpose of use,
addiction liability. Materials and Methods: A cross- sectional study was conducted for Iraqi young adult people from October/2021
to January/ 2022 using a questionnaire. This survey included (784) person aged 15 to 35 years old after obtaining approval from the
directors of each college and receiving oral approval from each participant. Data was collected through the questionnaire. Results: A
very high proportion of ED consumers are males, and are actually sport practitioners, with no chronic disease. Tiger is the ED No.1
in Iraq. Mainly consumed on monthly basis, mainly for energy provision and improved performance. The general people attitude
for these ED is to stay awake, and is therefore associated with sleep disturbance, however consumers do not think that it is difficult
to give up ED and do not consider themselves addicted to it, and are aware of most of its risks. Conclusions: Most consumers are
athletics with no chronic disease, almost monthly consumers ED for energy provision with Tiger being the most consumed ED, most
consumers with able to give up ED consumptions were aware of risks of ED with a steep rise was observed recently compared to
the past years.

The journey of medical training is long and comes with an immense amount of financial and emotional stress to both the medical student
and their family members. In order to avert all such untoward consequences and to minimize the financial load, it is essential that a right
candidate with apt intellectual capabilities and personality should preferably opt for the field of medicine. In continuation, a competent
medical undergraduate student not only requires a sound cognition base and good skills, but also requires a range of personal qualities.
Despite the role of the personal attributes in predicting the performance of a medical student, the assessment of personality has not been
given much importance. However, the available research findings on personality suggest that a systematic measurement of personality
can provide significant information about the decision to select students for the medical profession or for their right specialty as a part of
the postgraduation course. In conclusion, the personality of a medical student plays an important role in the academic performance and
the clinical outcomes. Thus, it becomes the need of the hour to provide adequate emphasis toward the timely assessment of personality
among medical students to improve academic outcome, career preference, and even upgradation of the quality of care offered to patients.

The process of transforming young students into competent medical graduates is a challenging one, wherein as teachers, we have to
adopt a combination of innovative and traditional teaching-learning approaches to meet the needs of different types of learners. In
the current era, the majority of teachers and medical students has access to the Internet and use smartphones. Instagram is a social
media application that provides a platform for users to share image-based or video-based information. The findings of studies have
revealed that the application has been utilized by teachers to share images dealing with infectious diseases and radio-diagnosis, and
this, in turn, inculcates clinical reasoning and critical thinking skills. To conclude, the utility and reach of social media applications,
including Instagram, are increasing among medical students each day. The need of the hour is to acknowledge the scope of the same
and use the same for the benefit of students either in the form of passing specific information or through a structured curriculum to
ensure attainment of the learning outcomes.

A carcinoma of the prostate gland is one of the commonest malignancies found in men contributing to significant morbidity and
mortality because of its varied presentation. Known to mainly disseminate through the local, lymphatic, and hematogenous route,
it can rarely metastasize to the supradiaphragmatic regions such as supraclavicular lymph node. We report one such rare case of
adenocarcinoma of the prostate gland with Virchow’s node as the only initial sign of presentation, which was diagnosed after a
detailed examination and advanced imaging modalities.

Moyamoya disease is a rare, progressive cerebrovascular disease marked by stenosis and occlusion of the distal internal carotid arteries
and branches of the circle of Willis, leading to creation of a collateral network of blood vessels at the base of the brain. It has been
found to be a significant cause of childhood stroke. We would like to present two cases of moyamoya angiopathy with a growth
hormone deficiency, in 13-year-old and 10-year-old brothers in Iraq. Hypothalamic-pituitary dysfunction may complicate Moyamoya
angiopathy, which is attributed to chronic cerebrovascular insufficiency. Therefore, it is worth checking and regularly monitoring for
this problem, especially in growing children and adolescents, to achieve normal growth and development.