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   Table of Contents - Current issue
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January-June 2022
Volume 21 | Issue 1
Page Nos. 1-91

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REVIEW ARTICLES  

Definition of developmental dysplasia of the hip: Literature review Highly accessed article p. 1
Jagar Omar Doski
DOI:10.4103/mj.mj_3_21  
Existing definitions of developmental dysplasia of the hip (DDH) lack uniformity. This study reviewed the main articles discussing DDH definition to make a uniform, feasible, and clinically relevant definition. Electronic databases with some orthopedic books were used to search for the relevant articles. The articles included were 26 (13 from journals and 13 from books). They were published in the last three decades, in the English language, and related to the human species. The retrieved descriptive data used to define DDH were summarized and sorted according to the concepts they contained (they were 12 concepts). Most of them gave more than one set of data to define DDH. From the summary of these data, it can be concluded that DDH can be defined as a developmental spectrum of abnormal formation and alignment of hip joint components that present in healthy infants.
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Microbiome of the head-and-neck region p. 8
Santosh Kumar Swain, Pragnya Paramita Jena
DOI:10.4103/mj.mj_30_21  
The microbiome includes microbes that are both helpful and potentially harmful to the human body. The majority of the microbiome are symbiotic and few are pathogenic. The collaboration of microbial colonizers is thought to help in and regulate bodily function. The rapid development of sequencing techniques and analytical methods is increasing the ability to understand the human microbiome. The importance of the human microbiome in the detection and prevention of the disease has been well established in different anatomical parts; however, there is limited literature or research on the microbiome of the head-and-neck region. Proper understanding of the microbiome in the head-and-neck area can help to differentiate the disease-prone patients from normal persons and is helping to guide the treatment regimens and usage of antibiotics. This can help to control resistance and limit the adverse effects of antibiotic overuse. Understanding by clinicians about dysbiosis can help to treat and even protect from common clinical entities such as tonsillitis and rhinosinusitis. Novel genetic sequencing (16S/next-gen sequencing) is helpful for the accurate identification of bacterial taxa in samples collected from the head-and-neck region and a better understanding of the composition of the otolaryngologic microbiome. In this review article, we discuss details of the head-and-neck microbiome distinguished by all relevant subsites.
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ORIGINAL ARTICLES Top

Effect Biofilm Formation in Pseudomonas aeruginosa Resistance To Antibiotic p. 13
Hanan Hameed Shatti, Wisam M Al-Saeed, Mohammed I Nader
DOI:10.4103/MJ.MJ_11_21  
Objective: Due Pseudomonas aeruginosa is the most common type of bacteria that causes hospital-acquired infections because it has multiple resistance mechanisms to antibiotics such as biofilm formation. It is important to understand to investigate biofilm production in multidrug resistant clinical isolates of P. aeruginosa from different sites of infection. Materials and Methods: This work was done on 114 patients were collected from different specimens From hospitals Baghdad. The collected samples were cultured on different media (blood agar, MacConkey agar, nutrient agar, and Cetrimide agar) for isolation of P. aeruginosa bacteria as well as isolates from all patient were tested for antimicrobial susceptibility using disk diffusion method ,in vitro formation of biofilm in microtiter plates containing Muller –Hinton broth. Results: Forty specimens (35.1%) were observed to have bacterial growth (positive samples) for P. aeruginos, the results of P. aeruginosa isolates were tested for antibiotic susceptibility showed that among forty positive results, the most isolates were potentially resistant to different antibiotics presented that the isolates resistant to piperacillin (34, 85%), gentamicin (26, 65%), tobramycin (30, 82.5%), amikacin (27, 67.5%), cefepime (25, 62.5%), meropenem (31, 77.5%), carbenicillin (31, 77.5%), ceftriaxone (30, 75%), ciprofloxacin (27, 67.5%), imipenem (22, 55%), ceftazidime 26 (65%), and norfloxacin 24 (60%). The results showed the ability of P. aeruginosa isolates to produce biofilm were 40 (100%) has the ability to produce biofilm, these were the result divided in to strong 19 (47.5%), moderate 12 (30%), and weak 9 (22.5%). Conclusion: There were 40 isolates biofilm producers in divers levels of biofilm strength.
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The role of the pro-inflammatory cytokine interferon-gamma in type 2 diabetes and its correlation with atherosclerosis p. 18
Marwa Naeem Jasim Al-Tamimi, Refif Sabih Al-Shawk, Isam Noori Salman Al-Karawi
DOI:10.4103/mj.mj_13_21  
Background: Immunity plays a major role in the development of atherosclerosis in type 2 diabetes mellitus (T2DM). Pro-inflammatory cytokines, such as interferon gamma (IFN-γ), play an important role in atherosclerosis-related inflammation. Aims: This study aims to determine whether IFN-γ level and AIP in patients with T2DM are associated with atherosclerosis development and the effect of IFN-γ concentration level in disease progression. Materials and Methods: This study involved 60 Iraqi T2DM patients (30 with dyslipidemia and 30 without dyslipidemia) with an age range of 35–70 years. For the purpose of comparison, 22 healthy participants comparable for T2DM were included in the study. Results: this study shows a significant increase in IFN-γ level in the patient groups as compared to the control group (P < 0.009). There was a gradualincrease of AIP in the three studied groups with a significant difference (P < 0.001). Conclusion: The level of IFN-γ and the AIPmay reflect the progression atherosclerosis which may give an alarming sign in studying group patients.
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Molecular technology for the detection of Pyoviridine gene in Pseudomonas aeruginosa isolated from burn cases p. 23
Eman Nassir Hussan AL-Jesmany, Oruba Khalid Abbas, Basima QASIM Hasan AlSaadi
DOI:10.4103/mj.mj_14_21  
Objectives: Using molecular technology for the purpose of confirmation of the diagnosis of Pseudomonas aeruginosa which depends on the detection of proteins like Pyoverdine gene of P. aeruginosa as diagnostic test. Materials and Methods: This work was done on 110 patients who had sustained burn injury from hospitals Baghdad, Al-Yarmouk and the Medical City Teaching Hospital during the period from October 2020 to the end of March 2021. The collected samples were cultured on different media (blood agar, MacConkey agar, nutrient agar, and Cetrimide agar) for isolation of P. aeruginosa bacteria as well as automated biochemical tests such as Api20E and VITEK 2 systems. The results showed that 76 (69%) samples had bacterial growth of P. aeruginosa. Antibiotic susceptibility testing was evaluated using the VITEK 2 compact. The Pseudomonas was detected using species-specific gene 16SrRNA gene using polymerase chain reaction (PCR) method and also detected by (PCR) using newly designed primers with a molecular size (389 bp) for pyoviridine gene. Results: This work showed that the predominant growth of burn wound infections was P. aeruginosa 76 samples (69%). Antibiotic susceptibility testing results showed the same sensitivity pattern of P. aeruginosa isolates to ceftriaxone and cephalothin (67.1%), gentamicin, piperacillin, ceftazidime, cefepime, and cefotaxime (65.7%). Resistance to imipenem, tobramycin, ticarcillin, and meropenem were (57.8%), (51.3%), (56.5%) and (55.2%) respectively, and had the highest sensitivity to amikacin (34.2%). Moreover, the highest resistance was to ciprofloxacin (69.7), and norfloxacin (71%). The results of using the 16SrRNA gene for the detection Pseudomonas give positive results (100%). Pseudomonas spp was detected by (PCR) for pyoviridine gene, revealed that 50% isolates give positive results. PCR product pyoviridine of the isolates (3) with the highest resistance to fluoroquinolones (ciprofloxacin and norfloxacin) was sent to nitrogen-based sequencing, and the sequencing results revealed the mutation presence. Conclusion: This study shows the current resistant pattern of P. aeruginosa against different classes of antibiotics and the involvement of several virulence genes in resistance mechanisms by using PCR which ultimately helps to select appropriate antibiotics useful for the treatment of many burned complicated by P. aeruginosa.
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Identification and sequencing of ISAba2 of Acinetobacter baumannii isolated from baghdad hospitals p. 29
Salah Sabah Muhsin, Wasan Abdul-Elah Bakir, Majeed Arsheed Sabbah
DOI:10.4103/mj.mj_17_21  
Background: The ability of multidrug-resistant Acinetobacter baumannii to survive in any situation including the acquisition of many different kinds of virulence factors and antibiotic resistance genes is the primary source of worry in hospital settings. Despite their low hydrolysis capability, oxacillinase (OXA) types are often associated with genetic factors such as insertion sequences (ISs) in order to enhance carbapenemase production and mobilization. As a result, assessing the frequency of IS genes in A. baumannii is extremely essential in many hospitals and medical institutions. Aims: The goal of this work is to find the IS ISAba2, which may have a role in antibiotic resistance in extensively drug-resistant (XDR) A. baumannii. Methods: The polymerase chain reaction (PCR) was used to confirm the presence of A. baumannii by identifying the blaOXA-51 gene. According to the current Clinical and Laboratory Standards Institute recommendations (2020), antimicrobials are determined using the Kirby–Bauer disc diffusion technique on Mueller-Hinton agar. The molecular research of ISAba2 includes PCR and Sanger sequencing of the PCR results. Results: Among 38 A. baumannii isolates, 23 (61%) and 25 (66%) were resistant to meropenem and imipenem, respectively. The blaOXA-51 gene was detected in all 21 XDR strains tested; furthermore, ISAba2 was found in all 21 XDR-analyzed A. baumannii isolates. Conclusions: ISAba2 has a high predominance between extreme drug-resistant A. baumannii. The identification of these parameters can assist in the control of infection and decrease of the microorganism's prevalence rate.
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The role of retinol-binding protein 4 in women infected with Toxoplasma gondii p. 37
Rajaa Abd Ali, Azhar Hatif Al-Kuraishi, Fatin Shallal Farhan
DOI:10.4103/mj.mj_20_21  
Background: Ocular toxoplasmosis mainly affected people in the second to fifth decades, as a result of acute or reactivate congenital or postnatally acquired infection. Retinol binding protein 4 (RBP4) is a protein transporter for retinol (Vitamin A) from the liver to peripheral tissue. Because of its function in vision RBP4 has become a target for ophthalmology research. Objectives: Identification of the role of RBP4 parameter in women infected with acute toxoplasmosis. Methodology: One hundred and fifteen blood samples were collected from aborted women, who were suspected of having toxoplasmosis for the period October 2020 to March 2021; in addition, 25 samples were collected from apparently healthy women to use as a healthy control group. All sera were investigated for the presence of anti-Toxoplasma IgM, IgA and IgG antibodies, all IgG-positive samples (50 samples) were neglected. IgM and IgA-positive samples (40 serum samples) out of 115 samples were used as toxoplasmosis case group (acute toxoplasmosis), while the negative IgM, IgA, and IgG aborted women samples were used as aborted nontoxoplasmic control group (25 serum samples). The samples from healthy women that gave negative results for the three antibodies were used as the healthy control group. Results: The RBP4 serum level was reflected a significant decrease 1.84 ± 0.44 ng/ml in aborted toxoplasmic cases when compared with aborted nontoxoplasmic and healthy control groups; 2.85 ± 0.60, 3.90 ± 0.62 ng/ml, respectively. Conclusion: There was a highly significant decrease in RBP4 serum levels in acute toxoplasmosis-infected women. This decreasing may be one of the indirect effects of Toxoplasma gondii infection on their hosts. Furthermore, this level can be used as aid test for the detection for toxoplasmosis.
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Hepatoprotective effects of alpha-lipoic acid, Vitamin C alone, or in combination on methotrexate-induced liver injury p. 41
Raghad Raheem Abd Hasan, Ali Ismail Algareeb
DOI:10.4103/mj.mj_23_21  
Background: Different mechanisms have been attributed to methotrexate (MTX)-induced liver injury, one of which is related to MTX generation of free radicals and inducing the disturbance of oxidative stress biomarker. Alpha-lipoic acid (ALA) is a strong antioxidant dietary supplement and has an anti-inflammatory effect. Vitamin C is an antioxidant and might produce an anti-inflammatory action through its antioxidant effect. The Aim of the Current Study: To evaluate the effect of ALA and Vitamin C single or concurrent use of them on MTX-induced liver injury. Materials and Methods: Thirty-five adult male albino mice were divided into five groups: Group 1 were administered distilled water and sodium bicarbonate orally by oral gavage for 10 days and injected normal saline intraperitoneally (ip) in the 10th day, Group 2 were injected MTX ip on the 10th day only, Group 3 were administered 100 mg/kg Vitamin C orally for 10 days and injected MTX ip on the 10th day, Group 4 were administered ALA 60 mg/kg orally for 10 days and injected MTX ip on the 10th day, Group 5 were administered both ALA and Vitamin C orally and injected MTX ip on the 10th day. After 2 days of the last treatment, the animal was anesthesized and the blood was withdrawn to be used for biochemical assessment of liver functions and liver tissue was dissected out to be used for oxidative stress biomarker determination and histopathological study. Results: MTX group showed an increase in serum level of alanine aminotransferase, alkaline phosphatase, and lactate dehydrogenase, an increase liver tissue malondialdehyde (MDA), and a reduction of tissue glutathione and superoxide dismutase (SOD), while the treatment groups showed an improvement of liver enzyme elevation and decreased lipid peroxidation MDA and increased SOD. Conclusion: Pretreatment by using ALA alone or vitamin alone provides comparable improvement of liver histology and liver injury while combined regimen did not provide more significant improvement of liver injury than using each one alone.
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Hepatoprotective effects of pomegranate against methotrexate-induced acute liver injury: An experimental study p. 48
Ali Ismail Al-Gareeb, Ghaith Faris Mohammed
DOI:10.4103/mj.mj_24_21  
Background: Methotrexate (MTX) is a synthetic antimetabolite with a wide range of clinical applications, but its liver toxicity induced mainly through oxidative stress represents a primary concern on its clinical use. Pomegranate fruit contains many polyphenolic compounds that possess potent antioxidant effects and, therefore, have a possible hepatoprotective effect. Objectives: This study seeks to address the hepatoprotective effects of pomegranate against MTX-induced liver injury. Materials and Methods: Twenty-eight healthy female albino mice were grouped into four groups; control and MTX groups received oral 0.5 ml distilled water, while; the PG150 group received 150mg/kg oral pomegranate, and the PG300 group received 300mg/kg oral pomegranate. The oral course continues for 10 days, and on the last day, all groups were injected with 20 mg/kg MTX intraperitoneally, except the control group injected with normal saline. 48-hours later, samples were collected and prepared for biochemical and histopathological evaluation. Results: After biochemical analysis, MTX causes an elevation in serum Alanine aminotransferase, Lactate dehydrogenase, and liver tissue malondialdehyde, indicating hepatic injury, while pomegranate pre-treatment will hold down this elevation significantly and dose-dependently, causing amelioration of the toxic effect of MTX; the histopathological findings support this finding. Also, MTX causes consumption of liver tissue content of superoxide dismutase (SOD) and Glutathione (GSH), while pomegranate pre-treatment boosts the SOD and GSH hepatic tissue level. Conclusion: Pomegranate has a dose-dependent amelioration effect on the toxic effect of MTX on the liver.
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Pediatric rhabdomyosarcoma in child's central teaching hospital: An eight-year experience p. 53
Doaa Auday Hatam, Allawi Noor Hussein Al-Janabi, Shaimaa Saad Abdul-Zahra AL-Harris
DOI:10.4103/mj.mj_25_21  
Background: Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in the first two decades of life. There is, however, a paucity of reports on the pattern of its occurrence in Iraq. Aim: To determine the demographic characteristics, clinical presentation, and survival among children with RMS treated at Child's Central Teaching Hospital (CCTH). Patients and Methods: A retrospective study was on 48 patients of histologically proven. RMS, in previously untreated children aged <15 years old at the CCTH in Baghdad, during the period from January 2009 to December, 2017. Results: Forty-eight patients with confirmed RMS were included. The mean age (standard deviation) was 4.9 (3.5) years. Thirty-four patients (70.8%) were <6 years, male 22 patients (46.8%), female 26 patients (54.2%), male:female ratio of approximately 1:1.2. Histopathology was embryonal in 38 case (79.1%). Incisional biopsy was done in 21 patients (43.8%), while excisional biopsy in 18 (37.5%) patients. The head and neck was the most common site of involvement at presentation, (nonorbital) 16 (33.3%) of cases. The estimated 4-year event-free survival (EFS) was 26.3% ± 7%. Twenty-one (43.8%) patients abandoned treatment. Among the cases who completed their treatment in the center, eight cases (16.7%) relapsed. In univariate analysis using log-rank test, nodal involvement was found to significantly influence the EFS at 4 years (P = 0.01). The estimated 4-year overall survival was 41.4% ± 9%. Nodal involvement significantly reduces overall survival at 4 years (P = 0.006). Conclusions: Clinical features and epidemiology of RMS in Iraqi children treated at CCTH somewhat resembles those of other countries. However, the EFS at 4 years and overall survival at 4-years are lower than that reported elsewhere.
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Interferon-gamma: Has acromegaly and diabetes an impact on such marker? p. 59
Sabreen Hamodi Hamza, Zainab Fadhel Ashoor, Abbas Mahdi Rahmah
DOI:10.4103/mj.mj_26_21  
Background: Acromegaly is a rare endocrine disease, its incidence is 4-6 per million per years while its prevalence is 40-60 per million. The distinctive facial characteristics are prognathism prominent forehead, and large hands and feet. This happens after the fusion of growth plates; separating acromegaly from gigantism that occurs before growth plates are closed. Interferon-gamma was checked in (80) acromegalic patients (50% are diabetics and 50% are non-diabetics) while (40) persons were regareded as healthy control group being non-diabetic, non-acromegalic. Aim of the study: To find out impact lnterferon-gamma in diabetic acromegalic versus non-diabetic acromegalic patients.Methods: Eighty acromegalic subjects were enrolled in across sectional study by measuring the level of lnterferon-gamma in the sera of diabetics and non-diabetics as 39 are diabetics while the remaining 41 patients are non-diabetic. Result: lnterferon-gammais high among diabetic acromegalic patients when compared with non-diabetic acromegalic subjects. Conclusion: Interferon gamma is high in acromegalic diabetic patients, nondiabetic acromegalic patients, and controls (100%, 97.6%, and 97.5%, respectively). Interferon gamma is elevated in patients with acromegaly only in the age group of 30–39 years, but in those with diabetes, the elevation is noticed later within the age group of 40–49 years as if concomitant diabetes delays its elevation.
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Cosmetic and functional outcomes of single-stage feminizing genitoplasty in children with congenital adrenal hyperplasia p. 64
Moamin Junaid Salim, Ali Farooq Al-Mayoof, Ali Egab Joda, Osama Ismael Almushhadany
DOI:10.4103/mj.mj_32_21  
Introduction: Evaluating the cosmetic and functional outcomes in girls with congenital adrenal hyperplasia (CAH) is essential to criticize the effectiveness of single-stage feminizing genitoplasty (SSFG). Objective: The aim of this study is to evaluate the outcomes of SSFG in terms of cosmetic and functional results for girls with CAH. Materials and Methods: A prospective study involves the performance of SSFG for patients with CAH in two pediatric surgery centers for a period of 9 years. The surgical procedure was either total or partial urogenital mobilization. The cosmetic and anatomical outcomes were evaluated according to Creighton criteria as good, satisfactory, and poor. The patients were followed up for 4–9 years. Results: The study included 55 girls with CAH, the mean age at operation was 4.1 ± 1.2 years. Most of cases are prader Stage II (42%). Total urogenital mobilization was performed in 74.5% of patients. Vaginal stenosis was the most common complication (11%). Urinary incontenance registered in 3 cases. The cosmetic and functional outcome was good in (65.5%), satisfactory (21.8%), and poor in (12.7%). Conclusion: Early SSFG is effective in providing good cosmetic and functional outcome in patients with CAH.
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Assessment of the left ventricular performance in hypertensive patients with normal coronary angiography and ejection fraction: Insight by two-dimensional speckle tracking echocardiography p. 68
Safaa Hasan Fadhil, Hachim Rasan Elaebi, Shakir Khudhair Abbas
DOI:10.4103/mj.mj_36_21  
Aim: To evaluate the validity of the longitudinal speckle tracking echocardiography (STE) in the detection of early changes in the performance of the left ventricle for hypertensive patients with normal ejection fraction (EF) and coronary angiography. Patients and Methods: A case-control study enrolled 50 patients and a randomly collected control group of 30, who consulted Ibn-Albitar Cardiac Center from November 2016 to the first September 2017. The patients had hypertension while the control did not. Both had normal coronary angiography, assessed by conventional echocardiography, two-dimensional STE, and anthropometric measures. Results: The mean age for the patients or cases was 52.48 ± 4.292 years, and their mean body mass index (BMI) was 30.10 ± 1.854 kg/m2. They had been diagnosed with hypertension for a mean duration of 8.14 ± 3.326 years. All were on treatment; the mean left ventricular (LV) mass was 108.96 ± 19.469 (g/m2) while the mean global longitudinal strain (GLS) was −16.720 ± 3.191. There was an approximately equal number of males and females among the cases: 24 (48.0%) and 26 (52.0%), respectively. Twenty-seven (54.0%) had LV hypertrophy (LVH), and only 4 (8.0%) cases had diastolic dysfunction with GLS −12. The mean age of the controls was 55 ± 4.792 years, and their BMI was 30.77 ± 2.063 kg/m2. They had a mean LV mass of 92.50 ± 10.058 (g/m2) and their GLS was slightly lower (more negative) than the cases, at −17.517 ± 2.222. Thirteen controls were males (43.3%) while 17 (56.7%) were females. Only 2 (6.7%) had diastolic dysfunction with GLS −14. GLS was significantly higher (less negative) in the cases with LVH compared to the controls: 15.278% compared to −17.517% respectively, with a mean difference of −2.238%. There was no statistically significant difference between controls and cases without LVH. Conclusions: The use of STE is beneficial in the detection of subtle changes in the LV of hypertensive patients with normal coronary angiography and normal EF.
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Molecular detection of agglutinin-like sequence 1 gene in Candida albicans that is isolated from diabetic foot patients p. 72
Mohammad Hassan Mohammad Tariq, Uroba Khalid Abbas
DOI:10.4103/mj.mj_37_21  
Objectives: Candida albicans is a microbe living within the natural human flora and is found in the upper respiratory tract, mouth, intestines, and vagina. C. albicans is able to cause infections that range from superficial infections of the skin to life-threatening systemic infections. Aim of Study: Detection of virulence gene agglutinin-like sequence (ALS) 1 by using molecular technology from clinical samples (C. albicans) that is isolated from ulcers of diabetic foot patients. Materials and Methods: This work was done on 235 patients who had diabetic foot patients admitted to the Specialized Center for Endocrinology and Diabetes (Baghdad Health Department/Rusafa) for the treatment of diabetic foot ulcers during November 2020 till March 2021. The collected samples of diabetic foot ulcers were cultured on different media (Sabouraud's dextrose agar with chloramphenicol for selective isolation and culturing of yeasts and HiCrome Candida Medium) for isolation of C. albicans fungus as well as automated biochemical test VITEK 2 system. The ALS1 virulence gene was detected by polymerase chain reaction using newly designed primers with a molecular size (419 bp). Results: Out of 235 Diabetic Foot Ulcer (DFU) cases, C. albicans were isolated in 20 (8.5%) patients (12 males and 8 females) of diabetic foot ulcers. In this study, the incidence of C. albicans infection at age [50–59 years] group was [40%], and increased at age group [60–69 years] to [55%], which represents the highest incidence of infection, then decreased in the age group [79–79 years] to [5%]). Seventy-five percent of the isolates were ALS1 gene positive. Conclusions: Diabetic people are more susceptible to infections due to their hyperglycemic environment and reduced immunity. The use of HiCrome Candida Identification Media with VITEK 2 system can help reduce the unnecessary steps of microorganism identification process. C. albicans infection is more common in males the females regarding diabetic foot ulceration. Majority of diabetic foot ulcers occur in older adults. ALS gene might be associated with diabetic foot ulceration.
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The need of modifying current teaching in pathology practical classes – A study from second professional MBBS student's perspective in North India p. 78
Vandna Yadav, Rimjhim Shrimal, Vinod Kumar, Abhay Vilas Deshmukh
DOI:10.4103/mj.mj_41_21  
Background: The main goals of teaching in second professional MBBS Pathology practical classes is to provide a framework for the description of the disease and to provide students with knowledge of the functional and structural changes in order that disease pathogenesis is well understood. Aims: It was a cross sectional descriptive study which aimed to find out the importance of teaching in pathology practical classes in the MBBS curriculum as well as to assess the student's perception regarding subject understanding. Materials and Methods: Two hundred and sixteen students of 2nd MBBS who had already completed 1st year and were about to appear in university examination in the year 2020 were included. An extensive questionnaire was prepared regarding 2nd-year pathology teaching. The feedback from students was obtained and analyzed. Results: About 67.5% of students found pathology practical classes more interesting than theory classes. 88% of students were confident to interpret CBC reports. Almost half (50%) did not visit the histopathology section while; only 12% and 38% of students were confident to collect blood and urine samples of the patient. About 83% and 93% of students found gross specimen and clinical charts useful in teaching. 63.88% of students suggested to increase the number of practical hours in pathology. Conclusion: Our study has emphasized the importance of teaching in pathology practical classes as important for better understanding in clinical subjects. As the competency-based curriculum is being starting from 2019 batch and onward, this elaborative study, especially in the practical aspects in the subject Pathology can act as a baseline to get access to the effectiveness of the new curriculum in the coming years.
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CASE REPORT Top

An unusual Cause of Persistent Frontal Headache in a 9-Year-Old Boy p. 84
Santosh Kumar Swain
DOI:10.4103/mj.mj_40_21  
Headache is a common clinical experience of the patients and is found in all age groups. Intranasal mucosal contact with the absence of inflammation in the nasal cavity and paranasal sinuses may cause a secondary headache which is called a rhinogenic contact point headache (RCPH). RCPH is currently a topic of interest among clinicians and is accepted as a cause of headaches by the International Headache Society Classification. The diagnostic nasal endoscopy showed an S-shaped deviated nasal septum with intranasal mucosal contact in both nostrils. The headache of the child was disappeared after performing septoplasty and excision of the bilateral mucosal contact points. These anatomical variations in the nasal cavity in the pediatric age with bifrontal headache is a very rare clinical entity. Hence, clinicians and pediatricians should keep in mind RCPH during the evaluation of headaches in a pediatric patient. In this case report, a 9-year-old boy presented with a persistent bifrontal headache due to mucosal contact points in the nasal cavity.
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SHORT COMMUNICATION Top

Coronavirus disease-19 pandemic and telework: Banking upon the collaboration between workers and employers p. 87
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mj.mj_8_22  
The emergence of coronavirus disease-2019 (COVID-19) pandemic has brought about a significant change in the dynamics of health and the work profile. Telework refers to the practice of working remotely with the help of different information and communication technology applications and thereby continuing the work. Although telework definitely minimized the probability to acquire the COVID-19 infection, gradually evidence emerged suggesting problems resulting because of defective design of the workplace and long duration of working hours. It is an undeniable fact that the ongoing pandemic frankly resulted in an overnight change in the work pattern of all employees. To conclude, considering the trends of the COVID-19 pandemic, telework is expected to be there, even in the postpandemic period. This calls for the need to enhance collaboration between workers and employees to enable a reduction in the incidence of physical and mental illnesses and promotion of safe and healthy behavior.
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Role of debriefing and feedback in facilitating learning through simulation-based medical education p. 90
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mj.mj_38_20  
Clinical skills training has been acknowledged as one of the crucial domains of medical students' training and plays an important role in aiding them to become competent health-care personnel. The inclusion of simulation in medical curriculum has emerged as the approach to provide opportunities to undergraduate students to practice, learn, and assess skills in controlled settings and that too without harming the patients. Although mere participation in a simulation exercise might result in learning, the given feedback ascertains the attainment of the learning objectives. The conduction of the debriefing session after the simulation exercise is one of the most common ways to deliver feedback and it simultaneously gives the teacher an opportunity to understand the knowledge, skills, and attitude of the student, which contributed to the performance of the student in the simulation exercise. In conclusion, the components of feedback and debriefing are critical to ensure effective learning in simulation-based medical education. Thus, it is essential to plan for a feedback session and also train the teachers in the skills of administering feedback and debriefing and all the medical institutions implementing simulation-based education should strengthen the feedback element.
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