Mustansiriya Medical Journal

Hypoxia-inducible factors (HIFs) are transcriptional factors that have a vital role in regulating a diversity of cell activities in response to cellular and tissue hypoxia. To date, there are three types of HIFs (HIF-1, HIF-2, and HIF-3), all share a common structure and function, and their activations are associated with many pathological conditions, including congenital anomalies, chronic inflammation, infections, and cancer. Furthermore, stimulation and/or inhibition of HIFs can be regarded as an innovative way to prevent and treat various conditions. This review aimed to clarify the knowledge about the function of HIFs in cellular homeostasis. Moreover, it tries to summarize the functions of HIF signaling in human health and diseases and the benefits of different drugs that target HIF signaling.

The thyroid gland is the largest and one of the most important endocrine glands in the body. It plays an important role in maintaining body metabolism and it can be affected by various disorders, for instance, hyperthyroidism, hypothyroidism, goiter, inflammations, and tumors. Therefore, comprehensive knowledge of thyroid gland basics (embryogenesis, histology, gross anatomy and physiology) is regarded as vital to every physician for the identification and management of these different conditions, for surgeons for the outcomes of thyroid surgery, for pathologists during their work in histopathological examination as well as forensic pathologists for identification of potential thyroid-related deaths and accidental autopsy findings.

The applications of artificial intelligence (AI) have swiftly forayed into medical education. This study aimed to decipher the role of AI in teaching pathology to medical students, enlisting its potential benefits which include improved diagnostic accuracy, personalized learning experiences, and effective feedback mechanisms. It also brings into the light challenges and ethical considerations associated with incorporating AI in pathology education. This article provides a comprehensive idea about the current as well as prospects of AI in pathology in the long run.

Since the first incidence of coronavirus disease 2019 (COVID-19) was identified in 2019, the illness has rapidly spread, increasing the number of cases, hospital admissions, and fatalities associated with COVID-19. The epidemic is putting an unprecedented amount of stress on the health-care system, including programs that perform both allogeneic and autologous hematopoietic stem cell transplantation (HSCT) and cellular treatment employing T cells. The risk of a severe COVID-19 infection in HSCT patients is widely acknowledged, and the COVID-19 vaccine is strongly advised. This mini-review provides a succinct overview of recent advances in COVID-19 and bone marrow transplantation.

Background:
More and more preschool children in Iraq and elsewhere are becoming overweight or obese. Many countries are now reporting a similar trend among preschool children. However, little information is available on the prevalence of overweight and obesity among preschool children in Iraq. In addition, available data are based on reported rather than measured height, weight, and body mass index (BMI).
Aims:
The aim of the study was to determine the prevalence of obesity/overweight among preschool children in private and governmental kindergartens (KGs) at Hilla 2020.

Settings and Design:
This study was a cross-sectional study.
Materials and Methods:
In order to determine the prevalence of obesity in preschool children 2-5 year old children who are attending kindergartens are selected as a sample in a cross sectional manner, the researcher measured the height and weight and calculated the BMI for each child to compare it with the WHO growth charts. The study was conducted for a period extended from January 2020 to December 2020. The total participants were 2148 parents and their 2–5-year-old children selected from all KGs available. The data were collected using an adapted questionnaire and were analyzed electronically.
Statistical Analysis:
Analysis of data was carried out using the available statistical package of SPSS-27 (Statistical Package for the Social Sciences, version 27). Data were presented in simple measures of frequency, percentage, mean, standard deviation, and range (minimum–maximum values). The significance of difference of different percentages (qualitative data) was tested using the Pearson Chi-square test. Statistical significance was considered whenever P ≤ 0.05.
Results:
The prevalence of overweight and obesity in preschool KG children was 14.8% and 5.9%, respectively; the main factors that affect childhood obesity are family income and the presence of obesity in other family members.
Conclusions:
There is a high prevalence of obesity/overweight among 2–5-year-old children with a significant difference regarding obesity/overweight prevalence between governmental and private KGs.

Background:
Otitis media with effusion is a collection of fluid inside the middle ear cleft, treatment of this condition include medical and surgical methods. This research goal is to focus and specify the clinical features of OME and the association between the new staging and the postoperative findings after surgery of insertion of ventilation tubes (VTs).

Objectives:
The objective of the study was to assess postoperative sequelae after VT insertion in children.

Patients and Methods:
Thirty two children with OME with surgical insertion of short term ventilation tubes were included in this study and followed up for one year.

Results:
In 22 patients, the fluid aspirated surgically after myringotomy was serous, whereas 10 patients were mucinous; for the patients, 53.12% had recurrence, whereas 46.88% showed no recurrence of OME. Only 6.25% of cases included in this study developed myringosclerosis; no otorrhea was reported during the period of the presence of VT in the tympanic membrane, no persistent tympanic membrane perforation after VT auto-extrusion.

Conclusion:
Even though VT have shown to be very useful in solving conductive hearing loss, its efficacy is a matter of debate in preventing long-term poor effects of the tympanic membrane and delayed onset of hearing loss. Even though ventilation tubes have shown to be very useful in solving the problem of conductive hearing loss.

Background:
Dengue fever and scrub typhus are endemic diseases in India. The aim was to study and compare clinical, biochemical, and hematological parameters between the dengue and dengue-scrub study groups.

Materials and Methods:
A retrospective hospital-based, cross-sectional study conducted at a tertiary care rural center. Various clinical, biochemical, and hematological parameters of dengue patients with random selection as the control group were compared with the dengue-scrub coinfection group (46 cases) as cases. The statistical significance was determined using an independent t-test. P < 0.05 was considered statistically significant. The t-test and the Mann–Whitney U-test were used.

Results:
Among the 86 cases (2.05%), scrub and dengue contributed 46 cases, followed by 27 cases of COVID-19 and dengue, four cases of malaria and scrub, three cases of malaria and dengue, and a single case of dengue with typhoid and leptospirosis with dengue. Serum albumin (P = 0.003, moderate effect size), serum globulin (P = 0.001, large effect size), alkaline phosphatase (P = 0.001, moderate effect size), and serum urea (P = 0.012, moderate effect size) levels were significantly different between only dengue and dengue-scrub group. In addition, the difference in hemoglobin levels, red blood cell count, white blood cell count, platelet count, cell variables, and ratios of those with dengue and scrub versus those with only dengue was significant (P < 0.05) with moderate-to-large effect size.

Conclusion:
Certain biochemical and hematological parameters such as albumin, globulin, alkaline phosphatase, platelet count, neutrophil-to-lymphocyte ratio, and platelet lymphocyte ratio can be used to support the diagnosis of coinfection (dengue-scrub).

Background:
There is no surrogate biological marker for detecting stroke. Because of this, mean platelet volume (MPV) and RDW may be used to predict the occurrence of stroke.

Aim:
This study aims to see if there is a link between platelet volume and acute ischemic stroke, as well as between red cell distribution width and acute ischemic stroke.

Setting and Design:
This was a cross-sectional study from February 2021 to January 2023.

Materials and Methods:
The present cross-sectional study was conducted to assess the role of mean platelet volume and red cell distribution width in acute ischemic stroke.

Statistical Analysis:
For the analysis, SPSS version 20 was utilized.

Results:
A total of 300 patients were included in this study. The small vessel infarct (9.05 ± 1.24 fL) had less MPV than the large vessel infarct (9.10 ± 1.10 fL), but there was no statistically significant difference between the two (P = 0.74). The average red blood cell width was lower in minor stroke infarcts (15.06% ±2.01%) than in large stroke infarcts (15.5% ±7.26%), but no statistically significant difference was found in the study. Fifty-three (17.67%) patients had a deadly outcome, and 247 (82.33%) had been cured when a final diagnosis was made.

Conclusions:
Stroke is the world’s leading cause of mortality, caused by cerebral vascular blockage or hemorrhage. However, there is no biological substitute marker for stroke diagnosis. RDW and MPV are potential biomarkers for this function and can forecast the incidence of stroke.

Background:
Diabetes is the leading cause of death and disability among cardiovascular disease patients. By 2025, India will have people with diabetes to one in every five diabetics worldwide.

Aim:
The study examines the relationship between glycosylated hemoglobin (HbA1c) levels and left ventricular diastolic dysfunction (LVDD) in type 2 diabetes patients.

Settings and Design:
This was a cross-sectional observational study.

Materials and Methods:
Over 2 years, 345 subjects with type 2 diabetes mellitus who gave informed consent and met the inclusion criteria were studied. The HbA1c test was performed using ion-exchange high-performance liquid chromatography. Electrocardiogram and two-dimensional echocardiography were used to evaluate cardiac dysfunctions. The relationship between potential variables and outcomes was determined using logistic regression.

Statistical Analysis:
All statistical analyses were carried out using STATA version 13 (College Station, TX: Stata Corp LP).

Results:
Mean HbA1c levels were found to be higher in patients with LVDD (10.40% ± 4.25%) compared to normal LVDD (7.51% ±3.18%) (P = 0.004) in the current study. The predicted left ventricular (LV) function with an area under the receiver operating characteristic curve of 0.883.

Conclusions:
LVDD is a common finding in people with type 2 diabetes. LVDD causes various cardiac complications, including LV hypertrophy, which is concerning. The current findings suggest that HbA1c is a reliable predictor of LVDD that can be used for screening in resource-limited areas where echocardiography is unavailable. In addition, regular HbA1c screening and blood sugar control can help prevent cardiovascular complications caused by LVDD in type 2 diabetic patients.

Background:
Hemophilia is an inherited bleeding disorder that could cause many complications one of them is hemarthrosis. Neutrophils are the predominant immune cells that infiltrate joints after hemorrhage. Tissue injury is often accompanied by the productions of neutrophil extracellular traps (NETs), which are DNA constructs containing attached granular enzymes.

Aims of Study:
Measuring the circulating NETs, neutrophil elastase (NE), and myeloperoxidase (MPO) in the plasma of hemophilia A patients with hemarthrosis, for an understanding of hemarthrosis’ underlying pathology.

Subjects and Methods:
Fifty persons were recruited in this study, during a period of 8 months from November 2022 to June 2023: 25 patients were diagnosed as hemophilia A with hemarthrosis and another 25 individuals served as a control group who were unrelated, apparently healthy, and were age and sex matched. Plasma NE and MPO were measured by ELIZA technique.

Results:
The plasma MPO and NE levels were significantly higher in hemophilia A patients than controls: 12.714 ± 19.439 and 1535.34 ± 2059.87 ng/mL, respectively, at (P < 0.05) compared to control group 3.672 ± 3.623 and 235.26 ± 274.61 ng/mL.

Conclusions and Recommendations:
Patients with hemarthrosis had a considerably higher level of NETs in their plasma than healthy individuals. These findings may indicate the function of NETs in the pathology of hemophilia A with hemarthrosis, and the identification of high NETs might serve as a biomarker, as well as a possible prognostic and therapeutic target for such individuals.

Background:
Community acquired pneumonia (CAP) is an important subject in pulmonary medicine and chest imaging plays a major role in the diagnosis and chest x ray (CXR) historically are the image of choice in the workup. Aims and objectives: to provide the role of chest X-ray (CXR) in diagnosis of pneumonia.

Materials and Methods:
This study which involves 185 cases of high clinical probability of CAP investigated by CXR and several patterns of infiltrates has been detected mainly lobar pneumonia followed by interstitial infiltrates then lobular and bronchopneumonic pattern. Chest x ray is not only a tool for diagnosis but also can be utilized in the follow up for resolution or development of complications.

Results:
CXR is a good modality for pneumonia diagnosis in which lobar pattern of infiltrate was the most common type 82 patient (44.3%), followed by interstitial pattern which was 57 patients (30.8%), then bronchopneumonia pattern 21 patient (11.3%) and lobular pattern 20 patient (10.8%).

Conclusions and Recommendations:
Chest x ray plays a major role in diagnosis of pneumonia, it can provide information about any structural pulmonary diseases , exclude alternative diagnoses and even giving an idea about the possible underlying pathogen and hence the antibiotic that preferred to be use; so we recommend to use CXR as an initial modality of choice in cases of suspected pneumonia

Patients with COVID-19 may develop venous and arterial thrombosis due to severe inflammation, cytokine storm, and diffuse intravascular coagulation, increasing mortality and morbidity. The aim was to report the clinical profile and outcome of patients diagnosed with peripheral gangrene associated with COVID-19. In this case series, we discussed the clinical presentation, laboratory parameters, and outcome in a series of three patients with peripheral gangrene associated with COVID-19 and also compared those findings. Three patients (two males and one female, age range: 50–72 years, and mean: 61.6 years) were admitted with the diagnosis of COVID-19-associated peripheral gangrene. Three patients had clinical and laboratory evidence of disseminated intravascular coagulation. Marked thrombocytopenia was noted in two patients. Despite vigorous therapy, two patients succumbed to their illness within 9–21 days of intensive care admission. D-dimer level and procalcitonin increased in all cases, while those who succumbed to death showed a marked variation in the D-dimer level from day 1 to the day of death. Prothrombin time (PT) was markedly increased in all three cases, while activated partial thromboplastin time showed little change. Amputation was done in two patients, out of which one succumbed to death. Peripheral gangrene cases in the background of COVID-19 portend a fatal outcome and need strict monitoring of the D-dimer, procalcitonin, and PT level, and a marked variation in these values could be alarming and used as a marker for predicting survival in cases of COVID-19 with peripheral gangrene and also highlighted the limited role of amputation in reducing mortality.