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   Table of Contents - Current issue
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July-December 2022
Volume 21 | Issue 2
Page Nos. 93-202

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REVIEW ARTICLES  

Feedback in medical education: Identification of barriers and potential strategies to overcome them Highly accessed article p. 93
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mj.mj_10_22  
A number of learning competencies have to be attained by the medical students during their training period, as very limited time is available for them. This calls for the need to help medical students in their journey to become competent by facilitating the process of acquisition of knowledge and skills. The purpose of the current review was to explore the importance of feedback in medical education, identify the potential barriers to its effective delivery, and identify the strategies to overcome them. An extensive search of all materials related to the topic was carried out on the PubMed search engine, and a total of 17 articles were selected based on their suitability with the current review objectives. Keywords used in the search include feedback and medical education in the title alone only. Feedback in medical education is one of the most essential strategies to enhance learning. The findings of some of the studies have shown that feedback is not always beneficial and that students feel that feedback is not that much important as medical educators believe about it. In conclusion, acknowledging the significance and scope of feedback in medical education, the need of the hour is to include the same in every stage of the teaching–learning process. However, the effectiveness of feedback is significantly influenced by a wide range of teacher-, student-, and environment-related factors, and there is a definite need to take appropriate measures to address the challenges posed by these factors.
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Anti-N-Methyl-D-Aspartate receptor encephalitis in pediatrics: A review of clinical manifestations, treatment, and prognosis p. 96
Sawsan Ali Hussein, Basma Adel Ibrahim, Wasnaa Hadi Abdullah
DOI:10.4103/mj.mj_6_22  
Anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDAR) is a severe autoimmune disease caused by the development of immunoglobulin G antibodies against the NMDAR's GluN1 subunit in the cerebrospinal fluid. It is characterized by a wide range of clinical features including psychological manifestations, dyskinesia, and epileptic seizures. Intravenous methylprednisolone, intravenous immunoglobulin, and plasma exchange are the first-line treatments. Early diagnosis, treatment, monitoring, and follow-up of the disease are crucial as it results in favorable prognosis. In the pediatric age group, relapse is possible.
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Cardiovascular health in turner syndrome: Manifestations, endocrine, and metabolic risk factors with a look at clinical practice p. 100
Wasnaa Hadi Abdullah, Abdulameer Jasim Jawad al-Gburi, Saba Ryadh Younis Al-Obaidi
DOI:10.4103/mj.mj_13_22  
Turner syndrome (TS) is the most frequent female chromosomal abnormality, with a higher overall mortality rate than the general population; cardiovascular events are a significant risk factor. Cardiovascular manifestations in TS include congenital heart diseases, in addition to acquired heart diseases such as acute aortic dissection, stroke, myocardial infarction, and hypertension. Growth hormone-insulin growth factor 1 axis abnormality, estrogen hormone deficiency, liability for diabetes mellitus, and dyslipidemia all are endocrine risk factors affecting cardiovascular health in TS. Heart anatomical defects should be closely monitored for progression and associated complications throughout the patient's lifetime by a skilled cardiologist.
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Management of acute invasive fungal sinusitis p. 104
Santosh Kumar Swain
DOI:10.4103/mj.mj_42_22  
Acute invasive fungal sinusitis (AIFS) is an uncommon and usually life-threatening clinical condition. Mortality in AIFS is very high. The colonization of the fungi at the sinonasal tract does not indicate the infection. The status of the immune condition of the patient plays an integral part in different manifestations of AIFS. AISF is an aggressive type of fungal infection and often leads to a fatal situation, particularly in patients who are immunocompromised. Diagnostic nasal endoscopy, as well as a computed tomography scan, is warranted in these patients. Magnetic resonance imaging improves diagnostic accuracy and assesses the spread of the disease into orbit and the brain. Histopathological and microbiological examinations confirm the diagnosis. To save lives, early diagnosis and treatment are essential. Therefore, clinicians need to have a high level of suspicion for this illness. Management of AIFS requires a multidisciplinary approach with significant predictors of survival being surgical debridement and antifungal treatment. Patients require urgent hospitalizations with intravenous antifungal therapy and surgical debridement. As soon as AIFS is identified, antifungal medication should begin. Higher survival rates are achieved with complete endoscopic resection of the disease than with incomplete resection. Liposomal amphotericin B has a more favorable outcome and fewer side effects than amphotericin B. The mainstays of AIFS management continue to be early surgical debridement and antifungal treatment. This review article discusses the epidemiology, etiopathogenesis, clinical features, investigations, and current treatment options of AIFS.
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Recombinant human chorionic gonadotropin versus purified human chorionic gonadotropin trigger for In vitro Fertilization intracytoplasmic sperm injection cycle p. 111
Zeena Helmi, Zainab Mussaid
DOI:10.4103/mj.mj_11_22  
The recombinant human luteinizing hormone or human chorionic gonadotropin (hCG) has substantially taken over the product which was formulated from the urine of pregnant women. In addition to this, a number of randomized controlled trials have been conducted comparing the significance of recombinant hCG (rHCG) with urinary hCG in assisted reproduction. Nevertheless, the present study has collected secondary information based on the nature of the chosen research area. The acquired data and information have been analyzed using content analysis technique to review the methodology and findings of the selected research articles. With the use of rHCG as well as purified hCG, the serum level was equivalent at day 5 among women underwent intracytoplasmic sperm injection (ICSI) but this level abnormally increased among those injected with rHCG thus, minimizing the rate of pregnancy. It has been concluded that purified hCG trigger plays a more efficient role in inducing oocyte maturation and increasing the rate of pregnancy among women undergoing in vitro fertilization ICSI cycle in comparison to rHCG trigger.
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C-reactive protein in elderly and pregnant COVID-19 cases: A new role for an old marker p. 114
Eham Amer Ali, Dina Akeel Salman, Wassan Nori
DOI:10.4103/mj.mj_54_22  
The clinical characteristics and prognosis of high-risk groups, including elderly and pregnant women, may vary according to the overall susceptibility of novel coronavirus. For that, numerous researchers worldwide have concentrated their efforts on finding a trustworthy biomarker that can determine the severity, prognosis, and survival of those affected. C-reactive protein (CRP), an inflammatory biomarker that showed higher levels in coronavirus 2019 (COVID-19) cases, underlay inflammation degree and was used to gauge the severity of COVID-19. In this review, we discuss whether CRP might have other uses in COVID-19 cases besides predicting the severity and the clinical outcomes among vulnerable risk groups. Doctors must analyze CRP levels along with the period of illness to identify those liable for rapid progress and be able to categorize case severity to guide the clinical decision to improve prognosis.
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ORIGINAL ARTICLES Top

The impact of COVID-19 pandemic on routine childhood immunization in Baghdad/Al-Karkh p. 119
Nadia Adil Khesro, Mary Mohammed Sabri, Roaa Muayed Sami
DOI:10.4103/mj.mj_33_21  
Background: The coronavirus disease 2019 (COVID-19) pandemic is extensively impacting national and international public health. Routine childhood immunization is projected for being adversely affected by COVID-19 mitigation measures. Consequently, vaccine preventable disease outbreak might be a big problem to encounter in the near future. Objectives: The aim of the study is to evaluate the prevalence of vaccination delay and explore the barriers leading to that and parents' attitude toward the importance of vaccination timelines. Materials and Methods: A cross-sectional study was carried out during the period between of May 1st and of August 1st, 2021. A sample of 400 parents attending vaccination unit with their under 2-year-old children were selected from health-care centers from Al-Karkh directorate. Results: The study shows that 266 (66.5%) of the parents were mothers, 134 (33.5%) were fathers, 288 (72%) of them were aged 30 y ears or less, 210 (52.5%) of them were college graduate or higher educational level, 302 (75.5%) of them did not have a health worker in their family, 292 (73%) of them had <3 children. This study revealed that 274 (68.5%) of the parents reported a delay in their children's vaccination timeliness, 198 (49.5%) of which was significant delay of more than 1 month and 76 (19%) was a delay of 2–4 weeks only. 126 (31.5%) reported an on-time vaccination. This study also showed a highly significant association between vaccination delay and history of COVID-19 infection in the family. This study demonstrated that curfew and difficulty in transportation 154 (38.5%) and fear of getting COVID-19 infection 142 (35.5%) were the most encountered barriers for vaccination delay. This study also showed that 51% of the parents had good level of attitude toward the importance of vaccination timeliness for their children. In addition, it showed a significant association between the level of attitude with the age and educational level of the parents and with having a health worker in the family. Conclusion: We conclude that 68.5% of sample had vaccination delay since the COVID-19 pandemic has started and good level of attitude toward the importance of vaccination timeliness. This indicates the need for strict recommendation about the importance of routine immunization schedule and need to commit to it even during pandemic situations.
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Mucoceles of paranasal sinuses: Our experiences at a tertiary care teaching hospital of Eastern India p. 124
Santosh Kumar Swain, Swaha Panda
DOI:10.4103/mj.mj_12_22  
Background: Mucoceles of paranasal sinuses are benign expansile mucus-filled cystic lesions due to chronic blockage of the sinus ostia. Due to their expansile growth, may affect nearby vital structures and lead to complications and morbidity. Objective: This study aims to evaluate the details of the clinical profile and management of paranasal sinus mucocele. Materials and Methods: This is a retrospective descriptive study of 54 patients with paranasal sinuses mucoceles that were managed with surgical interventions. Results: The age range of the study participants was between 12 years to 54 years. The mean age of the study patients was 28.61 years. Out of 54 patients, 34 (62.96%) were males and 20 (37.03%) females with a male-to-female ratio of 1.7:1. The frontal sinus (35.18%) was the most common sinus involved with mucocele followed by frontoethmoidal sinus (24.07%), ethmoid sinus, maxillary sinus (14.81%), and sphenoid sinus (9.25%). In this study, the headache was the most common symptom. Conclusion: Paranasal sinus mucocele has diverse clinical presentations. Allergic rhinitis, sinusitis, and radiation to the head-and-neck region are important predisposing factors for causing paranasal sinus mucocele. Orbital symptoms are indicators for prompt surgical intervention. Endoscopic sinus surgery is an effective and safe treatment option for paranasal sinus mucocele.
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Benign paroxysmal positional vertigo in pregnancy: Our experiences at a tertiary care teaching hospital of Eastern India p. 129
Santosh Kumar Swain, SA Vivek
DOI:10.4103/mj.mj_16_22  
Background: Benign paroxysmal positional vertigo (BPPV) is a common clinical condition characterized by sudden, brief paroxysmal attacks of rotation vertigo occurred by changing the head position. BPPV is the most common peripheral vestibular pathology and is found frequently in females. There are very limited data on the association between BPPV and pregnancy. Objective: The objective of this study was to study the BPPV during pregnancy along with details of clinical manifestations and management. Patients and Methods: This is a cross-sectional study where pregnant women with BPPV were enrolled. The study was conducted between April 2020 and May 2022. Detailed neurological examinations were done at the vertigo clinic. Results: There were seven cases of BPPV associated with pregnancy in this study. The most common symptom was rotatory vertigo. All were diagnosed with the Dix–Hallpike test. All underwent Epley maneuver and symptoms resolved. Out of seven cases, two showed low 25-hydroxyvitamin D levels. Conclusion: Vertigo is a morbid symptom during pregnancy that affects both pregnant women and fetal status. To improve the quality of life during gestation, clinicians should consider this BPPV as an important clinical entity in their differential diagnosis of vertigo.
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A study on BK polyomavirus among kidney transplant recipients and nontransplants p. 134
Ghufran Hammoodi Abed, Wisam Mahdi Al-Saeed, Asmaa Baqer Salem, Ahmed Sattar Abood
DOI:10.4103/mj.mj_34_22  
Background: BK polyomavirus (BKV) induces allograft malfunction in renal transplant recipients (RTRs) and it could cause loss of the allograft, however, this virus does not cause any harm among healthy subjects. Aims: This study was conducted to determine and compare the frequency of BK viremia between RTR and healthy subjects, and to find out its risks and its relation to their renal function. Settings and Design: This was a case–control study. Subjects and Methods: A total of 206 blood samples were collected from (106) RTRs within the first 2 years posttransplantation from the center of kidney diseases and transplantation, and (100) nonrenal transplant samples (healthy blood donors from the Iraqi Blood Donation Center in the Medical City of Baghdad. The large tumor antigen region of BKV was amplified by a real-time polymerase chain reaction. Statistical Analysis Used: Frequencies, percentages, Chi-square-test, odds ratio (OR), and confidence interval were used for statistical analysis by SPSS v. 28 (IBM ,USA). Results: BKV was positive in 23 (21.7%) of RTR patients and 8 (8.0%) of control, which is statistically significant P = 0.005. RTR patients under tacrolimus (TAC) were at a higher risk, to had BKV viremia (P = 0.05). However, there was no significant difference neither in relative risk (OR = 0.904) nor the distributions (P = 0.839) regarding serum creatinine levels. Conclusions: A significantly higher BK viremia among RTR and increasing risk of reactivation with TAC immunosuppression should warn the nephrologists about the risk of this immunosuppression regimen on the renal allograft.
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Echocardiographic assessment of left ventricle diastolic dysfunction using transmitral doppler acceleration rate of mitral inflow E-Wave p. 139
Adel Abdul-Wahab Alsalman, Hasan Ali Farhan, Marwa Qasim
DOI:10.4103/mj.mj_37_22  
Background: Diastolic dysfunction (DD) has a high prevalence in the community. Although it often remains asymptomatic, it can be a significant cause of morbidity and mortality. The assessment of the left ventricular diastolic function (DF) should be an integral part of a routine examination, particularly in patients presenting with dyspnea or heart failure. Patients and Methods: A cross-sectional study started from June 2018 to February 2019. The study was conducted in four medical institutions in Baghdad. Mitral inflow for the assessment of left ventricular DF depending on guideline 2016 was performed. Results: Left ventricular ejection fraction (EF) was higher in a group with normal DF than in the group with DD (P = 0.0001). Mean E/A ratio was higher among patients 2.15 ± 0.48 than in the control Group 1.30 ± 0.50 the difference between them was significant (P = 0.0001). Mean acceleration time (AT) was longer in individual with normal DF (88.23 ± 13.85) than that of patients with LVDD (72.89 ± 8.88), while the acceleration rate in LVDD group (1364.38 ± 277.31) was higher than that in normal LVDF (859.12 ± 275.95). There was a significant difference (P = 0.0001) between the two groups. Conclusion: AT and rate were significantly correlated with DD in normal EF group, but both of them have no relation to the grading of DD.
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The impact of media supplement on the viability, proliferation, and differentiation potential of bone marrow-derived mesenchymal stem cells p. 145
Nibras Hatim Khamees
DOI:10.4103/mj.mj_49_22  
Background: Bone marrow-derived mesenchymal stem cells (bmMSCs) are one of the most promising therapeutic methods in modern medicine. These cells are grown in tissue culture media, commonly supplemented with fetal bovine serum (FBS), but such supplement carries a number of drawbacks, such as immunological reaction and composition variation. Another supplement known as insulin-transferrin-selenium could act as serum replacement and help enhance the experimental results and therapeutic value of MSCs. Objective: The objective was to investigate the effect of tissue culture supplement in regard to bone marrow MSCs viability, proliferation, and differentiation potential. Materials and Methods: Human bmMSCs were grown in tissue culture plates at seeding density of 5 × 103 cells/cm2. The cells were divided into two groups, 10% FBS supplement or insulin-transferrin-sodium (ITS) supplement. The viability of the cells was assessed with live/dead cells kit (ethidium homodimer-1 and calcein). Cell proliferation was assessed with MTS assay, while multilineage differentiation potential was assessed with human MSC functional identification kit. Results: Our results showed that the viability of MSCs was comparable between FBS and ITS supplement groups at 24 h and 48 h intervals. Both groups showed similar proliferation capacity after 48 h and 72 h of incubation with no significant statistical difference. The cells from both groups were able to differentiate into osteoblasts, adipocytes, and chondrocytes. Conclusion: Insulin-transferrin-selenium supplement could be used as an alternative to FBS in laboratory experiments and clinical applications (such as cell therapy) to avoid the drawbacks of FBS and enhance the outcome of these applications.
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The effect of laparoscopic cholecystectomy on lipid profile p. 151
Ali Rodan Shuwelif, Haider Salim Mihson, Ayad Khani Maikhan
DOI:10.4103/mj.mj_45_22  
Background: Gallstone disease (GSD) is one of the most common surgical gastrointestinal diseases. Cholesterol is one of the constituents of gallstones. Hyperlipidemia and GSD are often linked to cholesterol in pathophysiology, and cholecystectomy is associated with hepatobiliary circulation affecting fat absorption. The aim of the study is to assess the lipid profile (LP) changes after laparoscopic cholecystectomy (LC). Methods: Prospective cohort study that included 200 patients with documented GSD and baseline measurement of LP, followed by LC for half of them, and two follow-up measurements of LP after 2 weeks and 1 month. Comparison of the LP between the two groups to estimate the difference that occur due to LC, after that, comparison of the two follow-up measurements with baseline to estimate the effect of these changes with time. Results: Total serum cholesterol (TC) and triglyceride level (TG) were significantly lower from control 1 month after surgery; on pairwise analysis, TG level was lower than baseline on both 2-week and 1-month follow-up measurements. High-density lipoprotein (HDL) was higher than the control after 1 month, on pairwise analysis at 2 weeks, no difference from baseline was found, and a significant difference was found after 1 month. Both low-density lipoprotein (LDL) and very LDL (VLDL) were not different from the control. Conclusion: LC is associated with a reduction of the serum level of both TC and TG and an increase serum level of HDL after 1 month of follow-up.
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The role of neutrophil to lymphocyte and platelet to lymphocyte ratios in diagnosing thyroid nodule p. 155
Haider Salim Mihson, Ayad Khani Maikhan, Ali Rodan Shuwelif
DOI:10.4103/mj.mj_46_22  
Background: Thyroid nodule is a common clinical finding and may be associated with a 5%–7% risk for malignancy. Methods for the detection of malignancy had their own drawbacks, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) may give a promising result to solve this dilemma. The Aim of the Study: This study aims to evaluate NLR and PLR as predictors of malignancy in solitary thyroid nodules. Also, to estimate their effect on tumor size, lymph node metastasis, and extrathyroidal extension. Patient and Methods: Prospective cohort study conducted at Major Teaching Hospital over a period of 1 year. Patients with solitary thyroid nodules were included in the study and according to histopathological results divided into two groups (A: Malignant and B: Benign), blood samples were drawn from participants, and measurement of lymphocyte, neutrophil, platelet, NLR, and PLR was done. Results: Both NLR and PLR were higher in cases of malignancy with a cutoff point for NLR >2.9 associated with 84.8% sensitivity (SN) and 71.4% specificity (SP), while PLR >140.15 associated with 87.9% SN and 71.4% SP. High NLR is further associated with larger tumor size. Conclusion: Both NLR and PLR are good predictors of malignancy of thyroid nodules. NLR of more than 2.9 is associated with larger-size tumors.
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The benefit of middle turbinate stabilization during functional endoscopic sinus surgery, A comparative study p. 160
Ali Abed Mohammed
DOI:10.4103/mj.mj_5_22  
Background: The laterlization of middle turbinate and adhesion to the lateral nasal wall is a common coplication of fuctional endoscopic sinus surgery (FEESS) result in failure of initial procedure and obstruction of osteomeatal complex. Current procedure for middle turbinate medialization, include creation of controlled synaechia between middle turbinate and nasal septum (bolgerization) and fixation of middle turbinate to nasal septum by suturing using absorbale vicryl suture (conchopexy).Objective: Is to compare between FESS with middle turbinate fixation to the septum by conchopexy or bolgerization technique to prevent laterlization of middle turbinate and thier impact on postoperative symptoms and signs and conventional FESS without fixation of the middle turbinate to the septum. Patients and Methods: The current stydy include 80 patients, they were divided into 3 groups, Group 1, include 30 patients underwent conventional FESS with medialization of middle turbinate only, using middle meatal pack, lest for 2 days. Group2, included 25 patients underwent FESS with Bolgerization method. Group3, included 25 patients underwent FESS with conchopexy by suturing the middle turbinate to the septum. Preoperative, postoperative, symptoms and endoscopy findings were compare among all the 3 groups. Result: Significant improvement is achieved in all groups and this improvement was founds to be significant stastically for nasa obstruction,nasal discharge, olfactory function, (P > 0.001)and for facial pain (P = 0.009). Bolgerization technique had better result in improving olfactory disturbance as compared to other methods. The pstoerative endoscopic findings improvement score was stastically significant for all groups with (P = 0.002) for the 1st group and (P = 0.001) fore the 2nd and 3rd groups. Regarding synaechia and laterlization of middle turbinate , in group 3 one of the patient had laterlization and synaechia between the middle turbinate and the lateral nasal wall (4%), 4 patients in group 2 (16%), and 10 patients in group 1 (33.3%). Conclusion: Conchopexy and Bolgerization are effective method to stabilize middle turbinate and preventing middle turbinate laterlization and synaechia following FESS with highly significant improvement of postoperative symptoms and endoscopic findings.
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Detection of EhCRT gene expression in Entamoeba histolytica-Infected children and its correlation with interleukin 25 and tumor necrosis factor alpha p. 164
Noor Mohammed Khalaf, Hatham Ebraheem Khalil, Ahmed Sattar Abood
DOI:10.4103/mj.mj_21_22  
Objectives: Entamoeba histolytica is a human enteric protozoan, which is the causative agent of amebiasis. The host activates a series of immunological responses to protect against the parasite after contact with the ameba and further invasion of the gut epithelium layer. As a result, the ameba has developed a variety of evasion mechanisms to hold out the immune response and continue to survive and cause disease. The calreticulin (EhCRT) is one of the immunogenic molecules of E. histolytica that induces an immune response in the human host. Increase in the expression of the EhCRT gene could provide control mechanism that allows the parasite to adapt and survive in host tissues. Aim of the Study: This study was designed to detect the EhCRT gene of E. histolytica by real-time polymerase chain reaction (PCR) in stool samples of children with amebiasis and its roles in host–parasite relationship via measuring the concentration of tumor necrosis factor alpha (TNFα) and interleukin 25 (IL25) by enzyme-linked immunoassay (ELISA) technique in their serum. Materials and Methods: A total of 86 diarrheal fecal samples were collected from children in age <1 year to 13 years suspected to be infected with E. histolytica during the period from December 30, 2020, to September 1, 2021. Microscopically positive samples were the subject to conventional PCR and real-time PCR for the detection of E. histolytica HM1:IMSS strain using (Psp) gene sequences and detection of calreticulin (EhCRT) expression. Blood was withdrawn from each child included in the study for ELISA test to measure the level of IL25 and TNFα. Results: Fecal samples for microscopic examination revealed that 71 (82.6%) children had amebic colitis, E. histolytica gene was detected in 44 samples (71%) using conventional PCR, and the immunogene EhCRT was expressed in 36 stool samples using real-time PCR. The results of the recent study showed highly significant elevation in the level of TNFα and IL25 in the amebic group (Eh+ve PCR). The majority of amebic children were in the age group of 1–4 years, had mucoid, acute, and with primary episodes of diarrhea. Conclusion: E. histolytica is a protozoan parasite highly prevalent among diarrheal children and is responsible for gastrointestinal amebiasis in the human host. The PCR is a useful tool in the diagnosis of E. histolytica infection. It is clear that the expression of the calreticulin gene (EhCRT) concedes with the duration of diarrhea a virulence factor that plays a role in host pathogenic pathways. The findings of this study showed that the level of TNFα in the serum of children infected with amebic colitis (Eh gene + ve) is significantly increased during the course of infection and the cytokine IL25 exhibits a significant drops in the same children.
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Assessment of soluble natural killer group 2d ligand (MHC Class I A and UL16 Binding Protein 1) in Iraqi patients with acute myeloid leukemia p. 171
Baan Abdulatif Mtashar, Zainab Fadhel Ashoor, Zeyad Ahmed Shabeeb, Bassam Francis Matti
DOI:10.4103/mj.mj_29_22  
Background: Acute myeloid leukemia (AML) is “a heterogeneous disease,” defined by a wide range of genetic alterations and molecular mutations that have an effect on clinical outcomes and could be used to develop new drugs. In AML, the immune system is tricked and actively suppressed by leukemia itself and by mechanisms that leukemia picked up through further mutations under suppression of selection. Myeloblasts in Acute myeloid leukemia can evasion the naturak killer cell killing by many ways , one of the these way ,the myelocblast cells shed NKG2D soluble ligand (MIC A/B and or ULPB 1-6 ) in blood and bound to NKG2D activation receptor which lead to inhibit activation of NK cells. The Aim of Study: The aim of this study assessment of Soluble ligand (MICA and ULPB-1) in patients with AML. Patients and Methods: Thirty patients newly diagnosed as AML were enrolled in this study, 24 patients out of 30 were follow up after 14 days of tratment. after 30 days of treatment we get result of therapy. twenty healthy looking persons were considered as control subjects. We used ELISA technique to detection the level of soluble legand ( MICA and ULPB-1). Results: The study showed that in order level of sMICA, there were significant differences in AML patients at diagnosis and after 14 days of treatment in comparison to control subjects while there were no significant differences in the level of sULPB1 between AML patients at diagnosis and after 14 days of treatment in comparison to control subjects. Conclusion: This study showed that there was an elevated level of sMICA in AML patients at diagnosis and 14 days to treatment while there was no elevated level of sULPB1 in comparison to the control group.
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Impact of various hematological and biochemical parameters in severe and nonsevere COVID-19 patients: A retrospective single-center study p. 178
Aurobinda Banerjee, Jayashree Banerjee, Mohua Mazumdar, Jyoti Prakash Phukan
DOI:10.4103/mj.mj_52_22  
Background: COVID-19 infection has been declared a pandemic in 2020 and since then it has been affecting the vast population of the world till today. Alteration of various hematological and biochemical parameters has been documented in various literatures. Aim: The aim of our study is to find out the prognostic role of hematological and biochemical parameters in severe and nonsevere COVID-19 patients. Materials and Methods: It was a retrospective record-based study conducted in a district-level COVID hospital of West Bengal, India. The COVID-confirmed patients admitted to the hospital during the second wave of COVID were included and data from records, including laboratory investigations were collected from the hospital registry. The severity of COVID was categorized based on the national guidelines. Independent samples t-test was applied to find out any relation of hematological and biochemical parameters abnormality in relation to disease severity. P < 0.05 was considered statistically significant. Results: A total of 94 COVID-confirmed cases were included in our study. Males constitute the majority of cases (51 males vs. 43 females). Seventeen cases were categorized as severe COVID (18.09%), whereas others were nonsevere COVID. Among hematological parameters, total leukocyte count (TLC), neutrophil and lymphocyte percentage, and neutrophil-to-lymphocyte ratio (NLR) were significantly altered among the severe compared to the nonsevere group (P < 0.05). While C-reactive protein (CRP), D-dimer, and serum ferritin levels also showed significant alteration among severe COVID patients (P < 0.05). Conclusion: Our study showed that severe COVID patients were significantly associated with neutrophilia, raised NLR, CRP, D-dimer, and serum ferritin levels.
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Tinnitus in COVID-19 patients: Our experiences at an eastern Indian tertiary care teaching hospital p. 184
Santosh Kumar Swain, Somadatta Das
DOI:10.4103/mj.mj_3_22  
Background: Tinnitus is a common otologic symptom found in the outpatient department of otolaryngology. Patients with COVID-19 infection have complained of tinnitus. However, in the present COVID-19 epidemic, it has received little attention. Objective: The goal of this study was to see how common tinnitus was among COVID-19 patients in a tertiary care teaching hospital. Materials and Methods: This is a prospective study that looked at 28 COVID-19 participants who had tinnitus. COVID-19 infection was confirmed in all of them using a nasopharyngeal swab reverse transcription–polymerase chain reaction (RT-PCR). The detailed history-taking clinical examination of the ear was done for the assessment of tinnitus and its outcome was analyzed. Results: There were 28 COVID-19 patients presented with tinnitus out of 212 patients infected with severe acute respiratory syndrome coronavirus-2. There were 16 (57.14%) men and 12 (42.85%) women out of 28 COVID-19 patients with tinnitus, with a male-to-female ratio of 1.33:1. Seven (25%) of the 28 patients had hearing loss, whereas 4 (14.28%) had balance issues. Out of 28 patients, 5 (17.85%) had symptoms of migraine. Conclusion: This study shows that COVID-19 patients may be affected by subjective otoneurological symptoms like tinnitus. Tinnitus is more common in male COVID-19 patients than in female. The associated symptoms of hearing impairment and balance issues should be anticipated along with tinnitus. More research is needed to figure out the specific pathophysiological process that causes this subjective ringing sensation in COVID-19 patients.
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Massive pleural effusion suggesting a malignant effusion: A case series study p. 189
Marwan Majeed Ibrahim
DOI:10.4103/mj.mj_44_22  
Background: Massive pleural effusion is one of the way of presentations of malignant effusion, it is unlikely to be seen in other causes of effusions, thorough workup and follow up is necessary, in this case series most of the cases was confirmed to be of malignant etiology. Objectives: The main objective from this study is to detect the cause behind massive pleural effusion and for early detection of a malignant etiology. Methods: Case series study involving 11 inpatient cases of massive effusion that had been evaluated sequentially with pleural fluid cytology then if negative pleural biopsy with either medical pleuroscopy or video assisted thoracoscopy (VATS). Results: Six of eleven cases were discovered to have malignant effusion, two cases were tuberculous pleuritis (TB pleuritis), one case were complicated parapneumonic effusion; the other 2 cases there were no specific diagnoses. Conclusions: Most of the cases of massive pleural effusion were discovered to be malignant effusion.
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Procalcitonin as predictor of bowel injury in penetrating abdominal injury p. 192
Ayad Khani Maikhan, Ali Rodan Shuwelif, Haider Salim Mihson
DOI:10.4103/mj.mj_47_22  
Background: Diagnosis of bowel injury may be considered one of the difficulties in penetrating abdominal trauma. Aim of the Study: The aim of this study is to estimate the predictive ability of procalcitonin in diagnosing bowel injury in multiply injured patients. Patient and Methods: In a cross-sectional study at the Emergency Department of Al-Kindy teaching hospital over 1 year, patients were had penetrating abdominal trauma, and measurement of procalcitonin to all participants to estimate its predictive ability. Results: Procalcitonin was found to be a single independent predictor of bowel perforation with sensitivity of 90.3%, specificity of 80.6%, and cutoff point of 4.5 ng/ml. Conclusion: Procalcitonin level of more than 4.5 ng/ml in cases of penetrating abdominal injury may be considered an aiding predictor for bowel perforation, thus shifting the treatment toward surgical intervention.
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CASE REPORTS Top

Siblings with dyschromatosis universalis hereditaria a rare case report p. 196
Pallavi Kumari, Sonia P Jain, Pratiksha Moreshwar Sonkusale, Abhay Vilas Deshmukh
DOI:10.4103/mj.mj_9_22  
Dyschromatoses are a group of genodermatosis characterized by the presence of both hyperpigmented and hypopigmented macules of variable shapes and sizes. Here, we report siblings presented with asymptomatic progressive mottled pigmentation of reticulate pattern over the trunk and limbs since 6 years of their age without any systemic or other cutaneous illness. They were born to nonconsanguineous parents following an uneventful pregnancy. Their paternal grandfather had a similar appearance. Histological examination was consistent with dyschromatosis universalis hereditaria (DUH). Based on the clinical and histological findings, a diagnosis of DUH was made. We report this case of rare genodermatosis in siblings affected by the same disease.
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Post-COVID-19 candidiasis of the tongue in an 18-year old male p. 199
Santosh Kumar Swain, Pragnya Paramita Jena
DOI:10.4103/mj.mj_56_22  
Fungal infection in the oral cavity is considered a marker of immunosuppression in certain chronic conditions such as cancer patients on immunosuppression medications and human immunodeficiency virus infections. Currently, coronavirus disease-2019 (COVID-19) pandemic is causing immunocompromised conditions of patients and inviting superadded infections such as local Candida infections such as oral candidiasis and invasive fungal infections. The role of opportunistic fungal infections in the morbidity and mortality of COVID-19 infections remains less established. Overuse of antibiotics for the treatment of COVID-19 infections is also thought to hamper normal flora in the oral cavity which is also an important risk factor for aggravating opportunistic fungal infection in the body. Here, an 18-year-old immunocompetent male presented with a white patch on the dorsal surface of the tongue, which developed 1 week after relieved from COVID-19 infection. The microbiological test of the whitish patch over the tongue confirmed candidiasis.
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LETTER TO EDITOR Top

Evaluation of Some Biomarkers in Diagnosis of Bacterial Bloodstream Infection in Children p. 202
Mahmood Dhahir Al-Mendalawi, Mohammed Jalal Al-Khalidi
DOI:10.4103/mj.mj_42_21  
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