Al-Kindy College Medical Journal

Insulin resistance is a fundamental feature of obesity, diabetes, and cardiovascular diseases and contributes to many of the metabolic syndrome's abnormalities. It is defined as a subnormal reaction to normal insulin concentrations or a situation in which greater than normal insulin concentrations are necessary for normal response.

Apart from graduating five-star doctors, a particular medical college has the mission to motivate and offer researchers the opportunity to publish high-quality researches on various health problems and disseminate updated medical knowledge to a wide range of local and international readers. This could be accomplished by establishing a medical journal and releasing issues regularly

Background: Both bladder cancer and schistosomiasis are endemic in Egypt. The former has a unique epidemiological pattern, which has been linked to bladder infestation by Schistosoma. The last decades have witnessed a great reduction in the infection rate of schistosomiasis and a decline in the incidence and changes in the patterns of bladder cancer. Whether these changes are linked to each other or a co-incidence is a subject of investigations.

Method: Literature on epidemiological data of bladder cancer and Schistosoma in Egypt was searched for in Medline, Scopus, PubMed, and Google Scholar. Furthermore, a hand search for literature and reports released by the Egyptian government and involved agencies was performed.

Results: Studies describe an overall reduction in Schistosoma infection rate from 80% in 1920s to 1.2% in 2006. Studies on bladder cancer epidemiology, on the other hand, agree on a decline in incidence and changes in the pattern, but differ in figures describing the magnitude of these changes. Many studies tried to ling the changes in Schistosoma and bladder cancer patterns. The evidence for this link, however, seems to be insufficient for a cause-and-effect relationship.

Conclusion: The relationship between the reduction in schistosomiasis infection rate and the changes in bladder-cancer epidemiological pattern in Egypt cannot be overlooked, but needs to be proved by more reliable evidence like prospective studies that include local health facilities and tertiary cancer centers.

Objective: explore the possible cause-and-effect relationship between the changes in Schistosoma infection rates and incidence and patterns of bladder cancer in Egypt.

Parasitic diseases can affect infection with COVID-19 obviously, as protective agents, or by reducing severity of this viral infection. This current review mentions the common symptoms between human parasites and symptoms of COVID-19, and explains the mechanism actions of parasites, which may prevent or reduce severity of this viral infection. Pre-existing parasitic infections provide prohibition against pathogenicity of COVID-19, by altering the balance of gut microbiota that can vary the immune response to this virus infection.

Background: Chronic renal failure (CRF) is a clinical syndrome that occurs when there is gradual decline in renal operation overtime.

Objective: This study aims to investigate the prevalence of depression among medical students at university of Baghdad, college of medicine in Iraq and the association between some variables and depression.

Aim: This study aimed to identify the impact of tobacco use in the etiology of chronic renal failure among Sudanese patients in Omdurman Military Hospital and Omdurman Kidney Dialysis Center

Materials and methods: This descriptive community-based study was conducted in Khartoum State. A random sample of 100 cases with chronic renal failure and 100 control subjects were selected. Demographic, socioeconomic characteristics, prevalence of tobacco use among the respondents and incidence of acute and chronic illnesses associated with renal failure were statically tested to find its correlation to renal failure

Results: Findings showed that there was no significant statistical association between educational level and occupational status, to chronic renal failure (P-value > 0.05). Use of tobacco including cigarettes, snuff and water pipe, indicated significant association (P-value ≤ 0.05).

Conclusion: From the above findings the followings could be concluded that educational level showed significant statistical correlation to chronic renal failure. Use of tobacco (smoking, snuff and water pipe) is one of the most important remediable renal risk factors.

Further studies focusing on controlled information on the success of a modem smoking cessation strategy in renal patients is highly recommended.

Background: There are so many evidences that there was antimicrobial resistance, and there were many strains that emerged which were difficult to treat. We are living in a situation that the dissemination of multiple drug resistant bacteria can lead us to the situation, in which no treatment could be offered for bacterial infection in future.

Aim of study: Assessment of nurses’ knowledge, attitude, and practices on antibiotic use and resistance in Fatima Al Zahra hospital in Baghdad.

Subjects and Methods: A cross-sectional study. The study was carried on from 1st of February to 31st of March 2021. A questionnaire was constructed by the research team based on literature review and was adapted to assess the nurses’ knowledge, attitude, and practices on antibiotic use and resistance in Fatima Al Zahra hospital. The adopted questions were mainly based on previous studies carried out in Lebanon, and Ethiopia. It was piloted among 10 nurses. The questionnaire was further revised by the research team. The final questionnaire contained 26 questions on the following: Demographics characteristics (5 questions), Knowledge of antibiotics (7 questions), Attitude towards antibiotic use (7 questions); and practice with regards to antibiotic use (7 questions). Analysis plan: IBM SPSS (Statistical Package for the Social Sciences) Statistics version 21 Multilingual and Microsoft Excel 2010 were used to analyze the data. The frequencies were stated first then Chi-Square test and Fisher’s exact test were used to investigate the association. The p-value less than 0.05 were considered significant.

Results: One hundred and eight nurses participated in this study, of whom 101 (93.5%) were female, 31(28.7%) of participants at the age group of (18-27) years, 33(30.6%) were at the age group of (28-37) years, with mean age 26± 0.54 SD. Regarding the highest qualification, 41(38%) graduated from the high school of nursing, 35(32.4%) graduated from the midwife school. About 46(42.6%) of the participants were working in pediatric words, and 23(21.3%) were working in gynecology and obstetrics (Gyn & Obs) words. There was gap in the knowledge especially in nurses who had lowest qualification: 44(40%), of them believe that using antibiotic in cold can speed recovery and 41 (38%) believe that antibiotic can cure viral infections, and 42(38.9%), of them consider that newer and more costly antibiotics affect better.

Conclusion: There was a gap in nurse’s knowledge, and practice, towards the antibiotic use and antibiotic resistance, the Current work place was the most effective factor in this gap.

Background: Background: Diabetes mellitus is a life-threatening disease. Global prevalence of diabetes mellitus is increasing rapidly providing a worrying indication and major threat to global health unless interventions are created through community awareness and knowledge regarding different aspect of DM.

Aims: To assess the level of awareness regarding diabetes risk factors, prevention and management among community members in Baqubah city and to identify any association between awareness level and some variables.

Methods: Across sectional study was carried out from the 1st of January - 30th of November 2019 in all primary health care centers (six centers) in center of Baqubah city. A convenient sample of 400 participants who attended the health centers during the study period and eligible to inclusion criteria were included. Data were collected vie direct interview with a structural questionnaire that include personal data, questions regarding knowledge, regard diabetes definition, prevention, risk factor, management and control.

Results: Good diabetes awareness were reported among 50% of studied. A significant statistical association were found between good awareness and age of 20-30years, more than secondary school education, high family income and positive family history of diabetes with the following (52, 34, 35 & 68) % respectively.

Conclusion: Good diabetes awareness was dominant and was significantly associated with middle age group, higher education and positive family history of diabetes. an educational health programs that tackles area of weakness about awareness of diabetes mellitus need to be implemented on the governmental level.

Background: Diabetes mellitus is a major health issue that is one of the leading causes of cardiovascular disease. Recent studies have found a link between uncontrolled diabetes and cardiovascular disease, with dyslipidaemia predicting glycated-hemoglobin (HbA1c), which could be a major contributor to type 2 diabetes complications and etiology.

Objectives: The objective of present study was estimate lipid profiles among control and uncontrolled type 2 diabetic patients.

Subjects and Methods: Analytical case control based study, One hundred twenty participate were included in study, 70 patients with DM as case group refer to Abuagala Center and difference follow up diabetic center and 50 non diabetic subjects taken as control group males and females their age between 20 to 80 years. Fasting blood glucose (FBG), blood HbA1c, and serum lipid parameters were measured by CobseC311 from Roche instrument. Data was analyzed using SPSS version 22, which expressed as (mean±SD) with p.value.

Result:Among120 participant the levels of fasting blood glucose,blood HbA1c,and Triglyceridewereincreased significantly in T2DM (161.7±72.5mg/dl), (8.88±3.9 %), (121±61.9 mg/dl)when compare with control group(91.28±13.9), (5.7±0.50), (80±11.7) with P.value (0.000),while total Cholesterol, High Density Lipoprotein, and Low Density Lipoprotein were not significant different in T2DM when compared with control group. There was weak positive correlation between HbA1c with FBG, CHOL, LDL, and HDL (r = 0.207, P =0.089, r = 0.186, P =0.124, r = 0.167, P =0.168, r = 0.308, P =0.01) respectively, while TG hadweak negative correlation (r =- 0.146, P =0.228).

Conclusion: The results indicated to considerable increase in the lipid profile levels in type two diabetic patients when compared with healthy controls group which may lead to increase in coronary risk factors.

Background: Cytomegalovirus (CMV) virus is a recognized important cause of congenital CMV infection which carries a significant risk for symptomatic disease and developmental defects in newborns. Its prevalence varies from place to other and time to time. This study is conducted to estimate its prevalence in Baghdad among infants suspected of having a congenital infection and to study the associated findings.

Subjects and Methods: The study was carried out in Al-Alwyia pediatrics teaching hospital. Data were collected, and blood samples were taken for infants suspected to have intrauterine infections over a period of one year, from 1 October 2019 to 1 October 2020. Immunoglobulin M (IgM) tests for CMV were conducted for all collected samples. CMV- immunoglobulin G (IgG) was a further analysis if negative results were obtained for CMV-IgM testing. Samples were tested by Eliza method.

Results: The overall positivity for CMV-specific antibodies among suspected infants was 16.7% for IgM and 66 % for IgG. Males constitute 55% of CMV-IgM positive results. These results are statistically significant concerning age groups. 1-3-month age group was the largest (40 % of IgM positive infants) with a p-value of 0.000. This indicates delayed presentation of CMV-affected infants. With the same p-value, 74% of infants less than one month of age were IgG positive reflecting the maternal prevalence of CMV- IgG in an equivalent percentage.

Convulsion followed by delayed milestones was the most common presenting symptoms in congenital CMV infection with statistically significant associations.

Conclusions: The study indicates that infection with CMV constitutes a significant portion of suspected infants. The study recommends special attention to take steps concerning early management.

Background: Many countries recommend the use of long-acting reversible contraceptive intrauterine device immediately after cesarean delivery. The cesarean delivery rate in Iraqi public hospitals is 32.2% and may reach 85.8% in private hospitals. Immediate post-partum intrauterine device insertion at cesarean is rarely done in Iraq.

Objectives: To assess the safety and practicality of immediate post-partum intrauterine device insertion during cesarean delivery for family planning and pregnancy spacing in Iraqi women.

Subjects and Methods: A single arm clinical trial included 150 eligible women who attended Al-‎Elwiyah Maternity Teaching Hospital or Al Hayat Rahibat Hospital for term delivery. A copper intrauterine device was placed in the uterine cavity immediately after delivery of the placenta during cesarean delivery. The intrauterine device was fixed in place at the fundus using an absorbable suture. Patients were followed up at six weeks, then annually for three years.

Results: Expulsion of the intrauterine device was not reported by any of the participants. The most-reported complaints in the first twelve months of intrauterine device placement were abdominal pain, abnormal vaginal discharge, and ‎heavy menstrual blood loss, however, none were statically significant (P= 0.256). After the first year, there was a significant reduction in the ‎frequency of complaints (P= 0.002). Only 7.33% (95% CI: 6.92–7.75%) of the patient requested intrauterine device removal within the three years. The main reason was to plan a new pregnancy followed by recurrent infection associated with uncontrolled diabetes ‎mellitus. Diabetes was ‎a significant predictor for immediate post-partum intrauterine device removal, P= 0.049.

Conclusion: The intrauterine device placement during cesarean delivery with suture fixation is a safe procedure with a zero-expulsion rate and is an effective reversible long-term contraceptive method.

Background: COVID-19 pandemic has influenced all life aspects; Dental staff, like other healthcare providers, may be exposed to COVID-19 as part of their work and its psychological impacts on healthcare workers should not be ignored

Objectives: To assess the anxiety, and fear from COVID-19 pandemic in dentists working in specialist dental centers: sample the Al-Resafa health directorate, and its relation between the anxiety, and COVID-19 fear with some of their demographic variables

Subjects and Methods: A cross-sectional study was conducted on 2nd Jan. to 14th Feb. 2021, by an electronic version of questionnaire through Google-form; the questionnaire was formed based on Mental-Health-American-Organization (MHAO) for anxiety test & the English-Version of the Fear of COVID-19 Scale. Analysis of data by using SPSS, Frequencies, percentages chi-square test had calculated; P-value considered significant if it's ≤0.05.

Results: The response rate was 90.43%, most of them aged less than 30 years old, female 356(60.8%), married status 295(50.3%), Rotator 297(50.7%). The study revealed that moderate anxiety 115(19.6%), moderate and mild fear of COVID-19 in 275(46.9%), severe in 120(20.5%) of them. there is a significant relation between gender &anxiety, marital status & No. of children with COVID-19 Fear.

Conclusion: One-fifth of dentists had moderate anxiety, and half of them had a mild fear of COVID-19 & one-fifth had a severe fear of COVID-19.

Background: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disorder globally. The prevalence is 25% worldwide, distributed widely in different populations and regions. The highest rates are reported for the Middle East (32%). Due to modern lifestyles and diet, there has been a persistent increase in the number of NAFLD patients. This increase occurred at the same time where there were also increases in the number of people considered being obese all over the world. By analyzing fatty liver risk factors, studies found that body mass index, one of the most classical epidemiological indexes assessing obesity, was associated with the risk of fatty liver.

Objectives: To assess age, sex, and body mass index (BMI) as risk factors in NAFLD.

Subjects and Methods: It is a case-control cross-sectional study from September 2020 till June 2021 which included all obese patients consulted the obesity research and therapy unit during the period of the study. Age and sex were recorded, body mass indices were calculated for all patients and categorized into normal with BMI < 25kg/m2, overweight with BMI 25-30 kg/m2, and obese with BMI > 30 kg/m2, ultrasonography was done to them to diagnose fatty liver changes which were categorized into three grades; mild, moderate and severe

Results: 192 patients were enrolled in the study with an age range from 18-55 years with a mean of 38.09, males were 48 and females were 144. Sever NAFLD is present in 2.8% of obese females and 5.5% of obese male with 0% in normal and overweight individuals.

Conclusion: NAFLD was more prevalent with increasing BMI and age in all sexes.

Background: Central serous chorioretinopathy (CSCR) is an idiopathic condition aggravated by exogenous or endogenous glucocorticoids. Vascular deregulation in the choroid is a new hypothesis regarding central serous chorioretinopathy occurrence. The inhibition of choroidal mineralocorticoid receptors has a great role in shortening the duration of CSCR by inhibiting choroidal vasodilatation and leak.

Objective: To assess the effect of oral spironolactone on subretinal fluid, central macular thickness and visual acuity in patients with acute CSCR compared to observation.

Subjects and Methods: a hospital based, randomized clinical trial carried out at outpatient clinic in Ibn-Alhaitham Teaching Eye Hospital/ Baghdad, enrolling 60 patients with acute unilateral CSCR, allocated randomly (every other patient) to either receiving spironolactone 25 mg orally, twice daily for 2 months (30 patients) or observation only (30 patients). The follow-up included visual acuity measurement, central macular thickness and subretinal fluid height examinations by ocular coherence tomography (OCT) at one- and two-months post enrollment for all patients.

Results: Complete absorption of subretinal fluid was observed in 21(70%) of the eyes in the treatment group and in 6(20%) in the control group at two-months. Visual acuity and mean macular thickness improved significantly in both groups at the one- and two- months, mean changes was larger in treatment group compared to control group at the two-month-follow up endpoint.

Conclusion: Oral spironolactone imparted greater improvement in central macular thickness and faster resolution of sub retinal fluid in patients with acute central serous chorioretinopathy versus observation.

Background: human paillomavirus infections (genital warts) are the most frequent sexually transmitted viral infections. a wide range of treatment options is available with different efficacy.

Objective: To evaluate the efficacy of podophyllin, trichloracetic acid (TCA) in the treatment of genital warts and side effects of them.

Subjects and methods: a total of sixty patients with genital warts were randomly selected, 30 in each group, in the Department of Dermatology, medical city for a Duration of 11 months from January 2009 to December 2009 treated with 35 % podophyllin in the tincture of benzoin or 50% TCA) .Forty-eight patients were followed up for three months.

Results: warts cleared in 63% and 70% of the patients after treatment with podophyllin and TCA respectively within 3 months. Soreness happened in 6 patients with podophyllin and in 9 patients with TCA. small ulcers happened in 1 patient by podophyllin and 2 patients with TCA. pain was in 5 patients treated by podophyllin and in 6 patients treated by TCA. erythema was noticed in 10 patients treated by podophyllin and in 11 patients treated by TCA.

Conclusion: there was a higher clearance rate with TCA and earlier response. The occurrence of adverse reactions is little more with TCA

Background: Axillary lymph node (ALN) enlargement with diffuse cortical thickening and conserved echogenic hilum may represent a diagnostic and therapeutic challenge. Sonographic strain elastography may help the characterization of borderline ALN.

Aim: To evaluate the strain elastography of borderline ALN and to calculate a cutoff value of strain ratio (SR) that can identify suspicious ALN with the highest sensitivity and specificity to reduce unnecessary invasive procedures.

Subjects and Methods: A prospective study included 45 patients who attended the Breast clinic in Oncology Teaching Hospital with borderline axillary lymphadenopathy (intact hilum and diffusely thickened cortex more than 3mm) who had normal ipsilateral breast, suspicious ipsilateral breast lesion, or who had ipsilateral mastectomy. B-mode sonography and elastography were performed for all participants. Four-point elasticity score (ES), and SR were obtained for the targeted lymph node followed by ultrasound-guided fine need aspirate (FNA) biopsy..

Results: Malignant ALN constituted 20% of the cohort. B mode measurements were not able to differentiate between cytologically confirmed benign and malignant ALN in terms of axis ratio (mean ± standard deviation, 0.46 ± 0.08 vs 0.50 ± 0.12) and cortical thickness (4.88 ± 1.93 vs 6.27 ± 2.46). The mean SR of all samples was 2.66 ± 2.25. Metastatic ALN depicted significantly higher SR (P<0.0001), with 88.9% exhibiting ES score 3 and 4. None of the metastatic ALN had ES score 1. ROC curve was used to investigate the utility of SR as a diagnostic tool. The area under the curve (AUC) was 0.906 with a 95% CI of 0.814-0.997, P<0.001. SR cutoff of 2.1 was chosen with 100% sensitivity and 66.7% specificity.

Conclusion: High proportion of borderline ALNs are not malignant. Strain elasticity can improve the risk stratification of such cases and prevent unnecessary invasive procedures. We suggested an algorithm that could better tackle borderline ALN which will need further evaluation

Background: Diabetes mellitus is one of the commonest chronic disorders worldwide with a rapid rise in prevalence. In Iraq its prevalence is high especially in elderly age group. Patients with type 2 diabetes mellitus have higher vulnerability for complications, whether microvascular or macrovascular. Ocular complications are common in diabetes mellitus, and comprise diabetic retinopathy, diabetic papillopathy, cataract, glaucoma, dry eye disease and diabetic keratopathy. Diabetic keratopathy involves endothelial and epithelial tissues of the cornea, leading to persistent epithelial defect, corneal erosion, or corneal ulcers.

Aim of the Study: To compare the mean corneal endothelial cell count between patients with type 2 diabetes mellitus and non-diabetics.

Subjects and Methods: This is a case-control study conducted in Ibn Al Haitham Teaching Eye Hospital – Baghdad and included 249 participants, 125 cases with type 2 diabetes and 124 controls who had no diabetes. Endothelial cell count was measured for 1 eye of each participant using TOPCON® SP-3000P microscope. Patients who had diabetes for less than 5 years, and patients who had previous ocular surgery, injury or disorders were excluded.

Results: There was a significant difference in endothelial cell count between cases with type 2 diabetes mellitus and controls; P = 0.001. There was also a significant negative correlation between age and endothelial cell count, R = -0.20, P = 0.002. Similarly, there was a significant negative correlation between duration of diabetes mellitus and endothelial cell count, R = -0.44, P < 0.001.

Conclusions: Type 2 diabetes mellitus causes significant reduction in mean corneal endothelial cell count. There is also a negative correlation between corneal endothelial cell count and both age and duration of the disease.

Babesiosis is a tick-borne disease caused by Babesia microti. We present a case of false positive HIV in the setting of confirmed babesiosis infection. An understanding that patients with babesiosis can have a false positive HIV test result is important in management decisions.

Tuberculosis continues to be the leading cause of morbidity and mortality, with an estimated annual incidence of 10.4 million worldwide. It has been estimated that 10% of patients with extrapulmonary tuberculosis have musculoskeletal involvement, with the spine being the most common. Spinal tuberculosis (TB) accounts for 50% of cases of musculoskeletal tuberculosis.

Spinal tuberculosis is the result of infection with Mycobacterium tuberculosis. It is a secondary infection, the primary lesion of which is in the lungs, genitourinary system, or gastrointestinal tract and can be active or latent. Involvement of the vertebral segment is the result of hematogenous spread of infection along the arterial pathway or Batson's vein plexus, lymphatic spread, or direct invasion from adjacent internal organs.

Computed tomography (CT) is better suited for assessing the extent of the lesion when contrast is used to enhance granulomatous tissues and abscesses, but exposes the patient to high radiation. Magnetic resonance imaging (MRI) can detect changes that occur in the early stages of the disease. WHO has suggested that any extrapulmonary tuberculosis should require sputum examination and chest x-ray, as there is a high risk of pulmonary infection. Thus, computed tomography (CT) and magnetic resonance imaging (MRI) are the main modalities for detecting tuberculous spondylitis.