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   Table of Contents - Current issue
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July-December 2021
Volume 20 | Issue 2
Page Nos. 27-84

Online since Wednesday, December 15, 2021

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REVIEW ARTICLE  

Ketamine for treatment-resistant depression p. 27
Raad Saady Madhloom
DOI:10.4103/mj.mj_15_21  
Major depressive disorder (MDD) is of influence on about 350 million individuals worldwide, which is causing disability consecution and damaging consequences to the affected community and individuals. Treatments as antidepressant are affecting the system of monoamine where symptoms of depressive were relived in about 50% of cases. Such ratio turns into obviously low in depressed persons who failed already to cure following 2 or additional antidepressant drugs at sufficient duration and doses regarding it a treatment-resistant depression (TRD). There is an obvious requisite for quick action and influenced treatments. Ketamine (KMN) is considered an anesthetic old drug that has a promising quick action as an antidepressant in TRD patients with MDD, concentrating on clinical issues, i.e. administration route, dose, and action duration. Other indication proposes that KMN might be influenced in stress disorder as posttraumatic and ideation as acute suicidal.
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ORIGINAL ARTICLES Top

The value of combination of dynamic contrast-enhanced magnetic resonance imaging and diffusion-weighted imaging in the evaluation of breast masses p. 32
Narmein Abdsattar Mahmmud, Sahar Basim Ahmed, Ansam Moyaser Othman
DOI:10.4103/mj.mj_8_21  
Aim of the study: The aim was to characterize benign and malignant breast lesions on the basis of their magnetic resonance imaging (MRI) morphology and dynamic contrast enhancement in combination with the diffusion-weighted imaging (DWI) and their apparent diffusion coefficient (ADC) values at 1.5 T MRI, along with histopathological correlation. Patients and Methods: In this prospective study, 56 patients with suspicious breast mass who underwent 1.5 T MRI and proved by histopathology were included. Morphology was studied depending on the MRI signal intensity and dynamic contrast-enhanced imaging plus kinetic curve of enhancement of breast lesions. DWI and ADC values were calculated at b values of 0, 600, and 850 s/mm. The ADC value and histopathology correlation were analyzed. Results: Out of the 56 lesions, 27 lesions were histologically malignant (48.2%) and 29 were histologically benign (51.8%), with age range between 25 and 75 years, with a mean of 54.1 years, and with a standard deviation of ±12.69 years. The MRI results found a sensitivity (SN) of 85.2%, a specificity (SP) of 72.4%, a positive predictive value (PPV) of 74.2%, a negative predictive value (NPV) of 84%, and an accuracy of 78.6%. The DWI findings were as follows: 100% SN, 82.8% SP, 84.4% PPV, 100% NPV, and 85.3% accuracy. The combined MRI interpretation and DWI and ADC findings were as follows: 100% SN, 92.1% SP, 71.1% PPV, 100% NPV, and 86.4% accuracy. All malignant lesions showed restriction at DWI, while only 17.2% of the benign lesions are restricted at DWI. The mean of ADC value was higher in benign cases as compared to the malignant lesions (0.815 vs. 1.287 × 10−3) with statistically significant difference (P = 0.001). Conclusions: The combination of contrast-enhanced breast MRI with DWI and ADC value increases the diagnostic accuracy and SP in the characterization of benign and malignant breast lesions.
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Effects of omega-3 and vitamin c on methotrexate-induced liver injury p. 39
Dohah Saad Mohammed, Ali Ismail A. Al-Gareeb
DOI:10.4103/MJ.MJ_6_21  
Context: Methotrexate (MTX)-induced liver injury is a serious side effect characterized by the increased level of hepatic biomarkers and resulted in acute liver failure. Omega 3 and Vitamin C act as antioxidant that participate in the fighting of free radicals generation during the inflammatory process. Aims: To evaluate the effect of omega 3 and Vitamin C on hepatotoxicity induced by MTX. Settings and Design: 42 (Swiss albino mice) used and divided into six groups (7 mice each): First: Maintained with normal saline, second: Received a single dose injection of MTX (20 mg/kg, intraperitoneally), third: Pretreated with omega 3 100 mg/kg, fourth: Pretreated with omega 3 200 mg/kg, fifth: Pretreated with Vitamin C 100 mg/kg, sixth: Pretreated with Vitamin C 200 mg/kg, then these group injected with MTX on day 10. Subjects and Methods: MTX as 50 mg injection. Omega 3 as capsule 1000 mg. Vitamin C as powder 1000 mg. Assessment of liver enzymes (alanine aminotransferase [ALT], aspartate aminotransferase [AST], and alkaline phosphatase [ALP]) made using automated computering device (Flexor–EL80) provider by Vitalab (South Africa). Assessment of oxidative stress markers (malondialdehyde [MDA], superoxide dismutase [SOD], reduced glutathione [GSH]) and lactate dehydrogenase (LDH) made by using competitive ELISA kits using (ELISA microplate Humareader). Results: This study showed a significant increase in the liver enzymes (ALT, AST, ALP, and LDH) as well oxidative stress markers (MDA, SOD, and GSH) with severe changes in the histopathological findings (severe inflammatory cell necrosis) among group injected with MTX as compared with control group and illustrated improvement in serum level of ALT, ALP, LDH, MDA, SOD and reduced GSH; besides improved histopathological findings (mild and moderate changes) for a group of mice pretreated with omega 3 and Vitamin C. Conclusions: This study concluded that pretreatment with omega 3 (which was strong antioxidant supplement) and Vitamin C (which was dose-dependent manner with beneficial antioxidant action) exert more hepatoprotective effect against oxidative tissue damage induced by MTX.
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In vitro assessment of antimicrobial susceptibility patterns in positive blood cultures of 22 neonates with neonatal sepsis in a children's hospital in Baghdad p. 45
Saad Badai Nashtar, Razzaq Kaream Abdullah, Waad Edan Louis Al-Rubaye
DOI:10.4103/mj.mj_7_21  
Introduction: neonatal sepsis (NS) is a serious disease in neonatology responsible for the higher percentage of neonatal deaths. It is a microbial disease caused by various types of bacterial and nonbacterial pathogens. Objectives: The objective is to determine the causative bacterial pathogens of NS for the specified period and their susceptibility toward the available antimicrobial drugs. Patients and Methods: Blood cultures of 67 neonates with clinical picture of NS were assessed for antimicrobial sensitivity. Results: Forty three cultures (64.2%) were negative, 4 cultures (5.9%) revealed Candida spp. and 20 (29.9%) cultures were positive. Gram-negative bacteria Klebsiella was the predominant pathogen causing NS (45.45%) followed be Gram-positive Staphylococcus aureus (18.2%). Vancomycin, ciprofloxacin, and amikacin were the most effective antimicrobials against Gram-positive isolates while imipenem was the most effective against Gram-negative bacteria. Discussion: klebsiella was the predominant microbe in NS in many studies, other pathogens were variable between countries. Vancomycin and imipenem approved their excellent effects reported in many others studies while penicillin approved high bacterial resistance recorded previously. Conclusion: Gram-negative bacteria were predominant and more resistant to the tested antimicrobials. Imipenem, vancomycin, ciprofloxacin were the best effective according to the isolated microbes.
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Evaluation of the hepatoprotective effect of different doses of curcumin and vitamin c in methotrexate-induced hepatotoxicity in mice p. 49
Dhekra Hasan Khudair, Ali I Al-Gareeb
DOI:10.4103/mj.mj_5_21  
Background: Methotrexate, the antineoplastic and immunosuppressive drug, is used in the treatment of different types of cancers and the management of chronic inflammatory diseases. Hepatotoxicity is one of its major side effects. Objectives: The present study assesses the hepatoprotective effect of different doses of curcumin and Vitamin C in methotrexate-induced hepatotoxicity. Materials and Methods: The prospective experimental study was conducted at the College of Medicine, Mustansiriyah University, Baghdad, Iraq, and in the animal's house of the Iraqi Center for Cancer Research, Baghdad-Iraq, from November 2020 to June 2021, and comprised Swiss albino female mice aged 3–4 months and weighing 30–40 g each. The mice were divided into 6 groups, the first group was considered as control which received only distilled water, the second group was considered as methotrexate group, third and fourth groups orally supplemented with 10 mg/kg and 20 mg/kg curcumin, respectively, fifth and sixth groups orally supplemented with 100 mg/kg and 200 mg/kg Vitamin C, respectively, The experiment continued for 10 days, and on the 10th day all groups, except the control one, received 20 mg/kg methotrexate intraperitoneally to induce hepatotoxicity. Parameters measured were serum alanine aminotransferase (ALT), aspartate aminotransferase, alkaline phosphatase (ALP), and lactate dehydrogenase (LDH), and liver tissue malondialdehyde (MDA), superoxide dismutase, and glutathione. SPSS 16 was used for data analysis. Results: The results show significant hepatoprotection produced by curcumin reflected by a decrease in LDH and MDA. Vitamin C also produced a significant hepatoprotection demonstrated by a decrease in ALT, ALP, LDH, and MDA. Conclusion: Curcumin and Vitamin C were found to provide hepatoprotection against methotrexate-induced hepatotoxicity through the modulation of oxidative stress biomarkers in a dose-dependent manner.
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Comparative study between effect of niclosamide and vitamin c on methotrexate-induced liver injury in mice p. 55
Zainab Saad Zeki, Ali I Al-Gareeb
DOI:10.4103/mj.mj_4_21  
Background: Niclosamide is an old drug used before in the treatment of tapeworms, its main mechanism of action is through the amelioration of mitochondrial-free radical generation. It has been thought that free radical generation has an important role in methotrexate-induced liver injury. Vitamin C, an antioxidant agent, has an essential role in the methotrexate-induced oxidative stress (OS) pathways in mice hepatocytes. Aim: The aim of the study was to evaluate the effect of pretreatment with Vitamin C in different doses and niclosamide in different doses on liver injury, when we induced liver injury with methotrexate. Materials and Methods: Forty-two albino mice were divided equally into six groups, the first group was considered as “the control group,” which received a normal saline solution, the second group was considered as “Methotrexate group,” third and fourth groups were orally pretreated with “niclosamide at a dose (70 mg/kg/day) and (140 mg/kg/day)” respectively, fifth and sixth groups were orally pretreated with “Vitamin C at a dose (100 mg/kg/day) and (200 mg/kg/day),” respectively, all groups, except the control group, were injected with “Methotrexate (20 mg/kg)” intraperitoneally on the 10th day, to induced hepatotoxicity and assessed the effect of the pretreatment with these medications on OS biomarker and histopathological alteration that induced by methotrexate-induced hepatotoxicity. Results: It was found that pretreatment with niclosamide 70 mg/kg/day and 140 mg/kg/day and Vitamin C 100 mg/kg/day and 200 mg/kg/day, in mice injected with methotrexate, led to a decrease in “liver function tests, OS parameters, as well as improvement in liver tissue.” There was an improvement in “serum alanine aminotransferase, alkaline phosphatase, malondialdehyde” in addition to an improvement in “histological appearance,” but it was noted that pretreatment with niclosamide gives a better improvement in “liver function, OS, and liver tissue.” Conclusion: Niclosamide is better than Vitamin C in protecting the hepatocytes against methotrexate-induced liver injury, also niclosamide and Vitamin C have a dose-dependent protecting effect against methotrexate-induced liver injury.
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Evaluation of some biomarkers in diagnosis of bacterial bloodstream infection in children p. 62
Rana Mohammed Abood, Zainab Fadhel Ashoor, Yasir Ibrahim Al Saadi
DOI:10.4103/MJ.MJ_10_21  
Background: Bloodstream infection (BSI) is a life-threatening condition caused by the presence of microorganisms, generally caused by a range of bacteria in the blood. Objectives: The aim of this study was to evaluate the possible role of procalcitonin (PCT) and C-reactive protein (CRP) as biomarkers of pediatric BSI. Methodology: The study was conducted on 150 blood samples collected from the patient who admitted to Children Welfare Teaching Hospital, Medical City, Baghdad. During the period from November 2020 to March 2021, ninety blood samples from them were positive culture and 60 blood samples were negative culture (control group). The isolates were identified depending on the morphological, microscopic examination, and biochemical tests. Moreover, serum was obtained from all participants for the determination of the screening level of human PCT measured by enzyme-linked immunosorbent assay and CRP by slide agglutination test. Results: The results in this study revealed that the mean levels of serum PCT and CRP in Gram-negative group and Gram-positive group were significantly difference from the control group. Conclusions: The adoption of these biomarkers as routine diagnostic tests for sepsis may help in the early diagnosis of pediatric sepsis.
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The role of insulin level on the biofilm-forming capacity in diabetes-related urinary tract infection p. 66
Wasan Ghanim Abed, Refif Sabih Al-Shawk, Kifah Ahmed Jassim
DOI:10.4103/mj.mj_12_21  
Background: Type 2 diabetes mellitus (T2DM) is more prone to get infections and the most common infection is urinary tract infection (UTI), most of the causative agents are related to biofilms, biofilm-forming capacity affected by host factors such as glucose and others. Aims: The objective of this research was to see how insulin affects the biofilm-forming capacity that most common pathogens associated with diabetic patients in different isolates. Materials and Methods: The objective was investigated by comparing the amounts of serum insulin in UTI patients to those without UTI whether the patients with T2DM or nondiabetic. The study was conducted on 40 T2DM patients divided into 20 patients with UTI and 20 without UTI, and 40 nondiabetic control subjects 20 with UTI and 20 patients without UTI. Serum insulin levels were detected by using enzyme-linked immunosorbent assay kit. Results: The mean concentration of serum insulin was a highly significant increase in T2DM in comparison to the nondiabetic control group. Pseudomonas auroginosa was the strongest biofilm producer isolate. Conclusion: In conclusion, insulin's direct effect was elevated the capability of biofilm formation. This contributes to a better knowledge of the causes of frequent bacterial infections in diabetics.
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Diastolic dysfunction in left ventricular hypertrophy in hypertensive patients with normal ejection fraction: A cross-sectional study in ibn al-bitar center for cardiac surgery p. 71
Shakir Khudhair Abbas, Safaa Hasan Fadhil, Hachim Rasan Elaebi
DOI:10.4103/mj.mj_29_21  
Background: Hypertension is the main cause of death and left ventricular (LV) diastolic dysfunction. LV hypertrophy (LVH) in the hypertensive patient has two types: eccentric and concentric which are classified according to the posterior wall thickness to LV end-diastolic dimensions. Aim of Study: The left ventricular diastolic function in age- and sex-matched patients with hypertension and and normal left ventricular ejection fraction was compared in the study. Patients and Methods: A total of 110 patients were enrolled in this study in Ibn Al-Bitar Cardiac Center from April 2013 to June 2014. History and examination were performed on each patient, then LV mass index (LVMI) was measured by echocardiography and patients were classified into two groups eccentric and concentric LVH. LV diastolic function was differentiated using echocardiography by measurements of left atrial volume index (LAVI), E wave, and A waves, the (E/A) ratio, transmitral deceleration time (DT), e' wave and the (E/e'). Results: LVMIs did not differ between the concentric and eccentric LVH groups. The diastolic function parameters such as LAVI, E/A ratio DT, and e' wave did not differ in both groups. Concentric LVH has E/e' significantly higher (mean ± standard deviation [SD] =12.82 ± 4.4) than those with eccentric LVH (mean ± SD = 10.37 ± 3.2). Conclusion: In patients with hypertension and LVH, concentric LVH group may be susceptible to worse diastolic dysfunction of LV than the eccentric LVH group with a similar LVMI, so we can predict the severity of diastolic dysfunction (higher E/e' ratio) by classifying LVH into concentric and eccentric.
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Comparison of serum interleukin-37 level in obese, nonobese type ii diabetic patients and healthy controls p. 76
Fadwa E Alhayali, Aysegül A Yücel, Zainab F Ashoor
DOI:10.4103/mj.mj_9_21  
Backgroud: Type 2 diabetes mellitus (DM2) is a metabolic disease resulting from the genetic and environmental factors and which causes insulin dysfunction on peripheral tissues, as well as in the pancreatic β-cell. Underlying pathologies such as overweight and obesity are the main factors for the development of T2DM. Interleukin-37 (IL-37) is an anti-inflammatory cytokine and also called as a “dual function.” Aim of study: This study has demonstrated was elevated in the obese T2DM patients and IL-37 protects from obesity-induced leading to development of T2DM. Fifty-eight patients who visited to the National Center for Diabetes Research and Treatment in the İraq/Baghdad with the age of <40–>60 years were employed in this study. Patient groups were 29 obese T2DM and 29 nonobese T2DM patients, and they when compared with 29 individuals as healthy control groups. In this study, serum IL-37 levels were determined by enzyme linked immunosorbent assay. Results: In obese T2DM patients, the mean serum level of IL-37 was elevated and significantly higher (mean ± standard deviation [SD], 5.594 ± 3.421 pg/ml; P < 0.0001) in comparison with nonobese T2DM patients (mean ± SD, 1.851 ± 0.417 pg/ml; P < 0.0001) and healthy control group (mean ± SD, 0.777 ± 0.099 pg/ml). Conclusions: In this study, obese T2DM patients had higher serum IL-37 levels but lower serum IL-37 levels in nonobese diabetic patients as compared to the healthy controls. This result led to the supposition that the rise in serum IL-37 level is related with obesity. Further, it suggests that IL-37 being an anti-inflammatory mediator might be responsible for some underline changes, which may develop the progress of T2DM.
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CASE REPORT Top

Midgut volvulus with giant jejunal diverticulum in an elderly patient: Case report with literature review p. 82
Hasanain Abdulameer Jasim
DOI:10.4103/mj.mj_44_20  
Midgut volvulus is a rare cause of acute intestinal obstruction in elderly patients. It can be classified into primary (without obvious cause) or secondary (secondary to other abnormality). Jejunal diverticula are an uncommon type of diverticulum of the small bowel. However, associated with a high rate of complications such as diverticulitis, perforation, or rarely volvulus. In this case report, we present a female elderly patient with a proximal small bowel volvulus around the axis of superior mesenteric vessels with the giant jejunal diverticulum at the tip of the volvulus.
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