Medical Journal of Babylon

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ORIGINAL ARTICLES
	Prevalence and risk factors of osteoporosis in kidney transplant recipients: Dual-Energy x-ray absorptiometry scan study	p. 267
	Esra Omar Hameed, Hussein Yousif Sinjari DOI:10.4103/MJBL.MJBL_91_18   Background: Osteoporosis is one of the major bone diseases that affect kidney transplant (KT) recipients; it causes significant long-term morbidity and increases the risk of fractures. The aim of this study was to investigate the prevalence and risk factors of osteoporosis in KT recipients. Materials and Methods: A cross-sectional study enrolled 70 KT recipients followed in the Nephrology Unit at Hawler Teaching Hospital, Erbil, Iraq, over a period of 6 months from December 15, 2017, to June 14, 2018. All patients were subjected to comprehensive history, clinical examination, relevant investigations, and measurement of bone mineral density (BMD) in the hip and lumbar spines using dual-energy X-ray absorptiometry. A T-score of –1 to + 1 standard deviation (SD) indicates normal BMD whereas a T-score of −1 to −2.5 SD was considered as osteopenia and T-score of <−2.5 SD was regarded as osteoporosis. Results: Osteoporosis was seen in 52.9% of the studied patients; statistically significant positive associations were detected between osteoporosis and low body mass index (BMI), diabetes mellitus (DM), second KT, pretransplant steroid treatment, and Vitamin D deficiency (P < 0.05), whereas no significant relationship was observed with age, gender, smoking, hypertension, and serum levels of calcium, phosphate, and parathyroid hormone. Conclusion: Osteoporosis is common among KT recipients. Low BMI, Vitamin D deficiency, DM, pretransplant steroid therapy, and second KT are the contributing factors. BMD measurement at pre- and post-transplant period is warranted for early recognition and management of this condition.
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	Ki-67 expression as an indicator of invasiveness in patients with breast cancer	p. 271
	Ahmed Salah Mahdi, Hayder Hussein Ibrahim, Ayad Ahmad Mohammed DOI:10.4103/MJBL.MJBL_54_18   Background: Tumor markers have a key role in guiding breast cancer management protocols and predicting prognosis. Objective: The aim of the study is to explore the role of Ki-67 expression in breast cancer and correlate it to well-known indicators of invasiveness such as age, tumor size, grade, hormonal receptors, and lymph nodes involvement. Materials and Methods: This retrospective study was conducted on (214) patients who were newly diagnosed with breast cancer and referred to Azadi Teaching Hospital/Duhok-Iraq, from November 1st, 2016, to October 31st, 2017. Data regarding patient's demographics, tumor size, histological type and grade, nuclear grade, and lymph node involvement were obtained from medical records. Patients underwent either mastectomy with axillary lymph node dissection or breast conservation surgery. Collected specimens were sent for histopathological examination and immunohistochemistry assessments of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2 (HER2), and Ki67 expressions. Results: Our study showed that histological grade, nuclear grade, mitotic index, and HER2 status were positively correlated to Ki67 index (P < 0.05). Furthermore, ER and PR status showed a negative correlation to Ki67 index (P < 0.05). Age, tumor size, and the number of lymph nodes involved displayed no significant correlation to Ki67 level (P = 0.080, 0.738, and 0.888), respectively. Conclusion: Results of this study confirmed that Ki67 index are significantly correlated with tumor grade, ER, PR, and HER2 status. However, Ki67 expression association with other clinic-pathological parameters such as age, tumor size, or lymph node involvement is not recognized and requires further studies.
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	Assessment of hemodialysis efficacy in patients with end-stage renal failure in the erbil hemodialysis center	p. 276
	Hazhar Saadullah Saeed, Hussein Yousif Sinjari DOI:10.4103/MJBL.MJBL_62_18   Background: Adequate and effective hemodialysis (HD) improves health-related quality of life and reduces morbidity and mortality in patients with end-stage renal disease (ESRD). The efficacy of dialysis procedure applied on patients diagnosed with ESRD was evaluated in the current investigation. Materials and Methods: In the present pre- and post-test cohort study, out of 375 patients, 120 patients (46 males and 74 females) on thrice-weekly chronic HD program were followed up over 6 months for evaluation of dialysis efficacy and possible outcomes. The efficacy of HD was measured through the Kt/V method and urea reduction ratio (URR). Results:The current study showed that the studied population (thrice-weekly HD patients) represents a minority of patients, i.e., 35.2% (132 of 375), and all other receiving insufficient HD treatment usually on twice weekly around 3 h for each session (64.8%). The study showed that the dialysis adequacy of the patients reached an adequate level by Kt/v and URR, 73.3% and 68.3%, respectively; the dialysis adequacy was increased with an increase in blood flow rate (P = 0.042), dialysis session time (P = 0.005), and dialysis sessions (P = 0.008). Patients with lower body mass index and without comorbidities were more likely to have adequate dialysis (P = 0.004 and P = 0.02, respectively). Conclusions: HD treatment is suboptimal in Erbil Dialysis Center. Intensive follow-up and application of corrective measures may improve dialysis efficacy. Energetic efforts are required to examine and correct the reasons behind the dialysis inadequacy.
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	Epidemiological and clinical characteristics of patients with inflammatory bowel disease in Erbil City	p. 281
	Jaafar Tahir Hassan, Abdullah Saeed Delmany DOI:10.4103/MJBL.MJBL_65_18   Background: Inflammatory bowel disease (IBD) is comprised of two major disorders: ulcerative colitis (UC) and Crohn's disease (CD). There is an evident gap in the epidemiological and clinical features of the patients with IBD in this region. To know the epidemiological and clinical characteristics of patients with IBD at Erbil city, this study had been conducted. Materials and Methods: A cross-sectional study extended from October 2017 to May 2018; during this period, 64 patients diagnosed with IBD were included in this study. Details about the epidemiological and clinical characteristics of patients with IBD had been reviewed. Results: From 64 cases of IBD, 65.6% was UC and 34.4% was CD, the disease was more prevalent at young age group (20–29 years) in both UC (33.3%) and CD (36.4%), respectively. Patients were comparable in all of the general characteristics except for smoking (P < 0.05). Patients with UC significantly presented with abdominal pain (P < 0.010), bloody diarrhea (P < 0.0001), rectal bleeding (P < 0.0001), and anemia (P < 0.045), while the CD patients were more presented with diarrhea (P < 0.0001), vomiting (P < 0.003), and oral ulcer (P < 0.044). Patients with UC were using more oral contraceptive pills (P > 0.05). Up to 54.8% of patients with UC had active state of the disease, while the majority of CD patients (81.8%) were in remission. Conclusions: UC was more common than CD; IBD was more common in men. Patients with UC and CD were comparable in the majority of epidemiological and clinical features. The drug history has a significant association with UC and CD, and CD was more prevalent among smokers.
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	Prevalence of hypothyroidism in type 2 diabetic female Kurdish subjects	p. 286
	Sarheed Jabar Muhammed, Dashti Habbas Albustani DOI:10.4103/MJBL.MJBL_99_18   Background: The incidence of thyroid disorders is more prevalent in type 1 diabetes compared to type 2 diabetes, due to associated autoimmune disorders. Physiological and biochemical interconnection between type 1 diabetes mellitus and autoimmune thyroid disease is now stimulating subject of study. Objectives: The objective was to assess the prevalence of thyroid dysfunction among type 2 diabetic Kurdish females and to explore the correlation between metabolic syndrome components and autoimmune thyroid abnormality. Materials and Methods: The study included 60 type 2 diabetic Kurdish females and 30 sex- and age-matched controls. All patients in the study were exposed to anthropometric characteristics, including HbA1c, lipid profile, serum uric acid, thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine, anti-thyroid peroxidase (TPO), and anti-thyroglobulin (anti-Tg). Results: Primary hypothyroidism was found in 24 (40%) diabetic patients (5.67 ± 3.35 μIU/mL) versus three (10%) controls (1.76 ± 1.19 μIU/mL) (P < 0.001). Anti-TPO was found in 66.7% (367.21 ± 234.53) of diabetic patients versus 10% (31.78 ± 32.14) of controls (P > 0.001). Anti-Tg was found in 60% (499.98 ± 358.14) of diabetic patients versus 0 (53.27 ± 36.23) controls (P > 0.001). A significant positive relationship was estimated between both TPO antibodies and Tg antibodies and TSH (P = 0.05 and P = 0.001, respectively) in diabetic patients. Conclusion: Autoimmune thyroid disorder is more prevalent in Kurdish women with type 2 diabetes than nondiabetic women, and thus points to a role of autoimmunity in the pathogenesis of type 2 diabetes.
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	Studying levels of homocysteine in diagnosed cases of polycystic ovary syndrome	p. 291
	Rojeen Rasheed Suleiman, Dhia Mustafa Sulaiman DOI:10.4103/MJBL.MJBL_94_18   Background: Polycystic ovary syndrome (PCOS) is an endocrine disorder characterized by an ovulatory infertility, menstrual dysfunction, and hirsutism. The pathophysiology behind PCOS is complex. Comorbidities associated with PCOS are hypertension, diabetes, dyslipidemia, and cardiovascular events. Objective: The aim of this study was to estimate the level of homocysteine in women with PCOS. Materials and Methods: In the current case–control study, 50 female patients diagnosed with PCOS and 40 apparently healthy controls were recruited. The diagnosis of PCOS was established according to Rotterdam criteria. The serum homocysteine level was measured using Cobas 6000 and compared between two study groups. Results: Results found that high percentage of patients in the case group had abnormal level of homocysteine (74.0%) compared to control with normal level of homocysteine. Mean homocysteine level was significantly higher in patients with PCOS (17 μmol/L) compared to its level in control patients (9 μmol/L), P < 0.0001. Results also revealed that the mean levels of homocysteine between the body mass index categories and marital status showed no significant difference in cases and controls, P > 0.05. Conclusions: The present investigation suggests that higher level of serum homocysteine could be used as a biomarker for PCOS.
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	Anti-müllerian hormone level in patients with polycystic ovary syndrome	p. 295
	Salar Mohammed Saadullah, Dhia Mustafa Sulaiman DOI:10.4103/MJBL.MJBL_98_18   Background: Polycystic ovary syndrome (PCOS) is one of the common causes of chronic anovulation and hyperandrogenism in women between the age of 13 and 45 years old. PCOS is characterized by an increased number of follicles at all growing stages particularly in the preantral and small antral follicles, those who primarily produce Anti-Müllerian hormone (AMH). Objective: The aim of the study is to measure the AMH levels in serum of the women with PCOS. Materials and Methods: The study included 90 women (50 cases with PCOS and 40 control cases healthy women). PCOS patients were diagnosed according to the Rotterdam definition; serum AMH was measured using the ultrasensitive AMH enzyme-linked immunosorbent assay. Results: Mean serum of AMH in PCOS patients was 11.52 ng/ml and for the control group was 3.36 ng/ml and was statistically significant with the P < 0.0001. Conclusions: AMH is elevated in PCOS patients, which can be used in the future as a marker for the diagnosis of PCOS.
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	Sutureless focus harmonic thyroidectomy versus conventional clamping and knot-tying technique	p. 300
	Ibrahim Falih Noori, Mansour Amin Mohammad DOI:10.4103/MJBL.MJBL_45_18   Background: Thyroidectomy is the most frequent procedure in endocrine surgery. Since thyroid is the highly vascular organ, therefore, prompt and meticulous hemostasis is extremely important. Although conventional thyroidectomy is used frequently with acceptable outcomes, it is time-consuming and resulted in significant intraoperative blood loss with possible risk of injury to parathyroid glands and laryngeal nerves. The advent of ultrasonically activated focus harmonic device in thyroid surgery was encouraging for improving safety, effectiveness, and reduction of operative time. Aim of this Study: The purpose of this study was to analyze the effectiveness and surgical outcomes of using ultrasonic harmonic scalpel for thyroid surgery compared to conventional techniques (clamping and suture ligation (knots tying) and electrocautery. Patients and Methods:This is a prospective, randomized study in which 64 patients with various types of goiters presented for thyroidectomy. The patients were divided into two comparable groups. Group A (32 patients) included patients who had focus harmonic thyroidectomy and Group B (32 patients) included patients who received conventional thyroidectomy. Results: Focus harmonic thyroidectomy showed significant reduction in operative time, intraoperative blood loss, volume of postoperative fluid drainage, and postoperative pain scores compared with conventional thyroidectomy. There were no significant differences in the incidence of postoperative hypocalcemia and laryngeal nerve injury between both the groups. The total cost of focus harmonic thyroidectomy and hospital stay were also less compared with conventional techniques. Conclusions: Focus harmonic thyroidectomy was a safe, effective, faster, and beneficial alternative to conventional technique since it reduces the time of surgery, blood loss, postoperative drainage, and pain with comparable postoperative complications.
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	Prevalence of iron deficiency in patients with heart failure	p. 306
	Dersim Muslih Hussein DOI:10.4103/MJBL.MJBL_100_18   Background: Heart failure (HF) is a common health issue with the prevalence between 1% and 2% in public; in addition, it is a major risk factor for mortality, morbidity, and low quality of life. The prevalence of iron deficiency (ID) in patients with chronic HF (CHF) was examined in the present study. Materials and Methods: In the present cross-sectional, iron parameters of patients hospitalized for CHF decompensation were prospectively assessed within the 72 h following admission to hospital. ID was established as serum ferritin <100 μg/ml (absolute ID) and serum ferritin between 100 and 299 μg/ml with transferrin saturation <20% (functional ID) in accordance with the European Society of Cardiology HF Guidelines 2012. Results: The present study showed that the prevalence of absolute and functional iron deficiencies in patients with CHF was 44.9% and 18.8%, respectively, and 36.2% did not have the ID. The study did not find a significant difference in ID between male and female patients and between the patients with and without comorbidities. Conclusions: The present study suggests that ID is very common in patients admitted for CHF.
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	Prevalence of metabolic syndrome in angiographically confirmed coronary artery disease	p. 310
	Alan Mobarek Mahmood, Mousa Haji Ahmed, Jamal Bashir Mohammad DOI:10.4103/MJBL.MJBL_101_18   Background: Coronary artery disease (CAD) is one of the most common causes of death in the developed world with the high prevalence of cardiac risk factors and associated morbidity. These risk factors were mostly contributed in the metabolic syndrome. Objective: The study aimed to determine the prevalence of metabolic syndrome among patients with angiographically documented CAD and its relation with the severity of CAD. Materials and Methods: In the current cross-sectional study, a total of 320 patients aged 18 years and older of both genders and diagnosed with CAD by medical and clinical examinations and angiography findings were included in the study. Patients with normal angiographic or nonsignificant coronary stenosis and those with acute coronary syndrome were excluded from the study. Results: The prevalence of metabolic syndrome in patients diagnosed with CADs was 68.4% in this study. The numbers and severity of coronary arteries involved were importantly increased through increasing the numbers of the components of the metabolic syndrome that the patient have it. The majority of the patients with right coronary artery (67.6%), circumflex artery (63.2%), left anterior descending (66.7%), and multivessel (69.8%) had metabolic syndrome with no significant difference (P = 0.913). Moreover, the most of the patients with one vessel (66.4%), two vessels (68.2%), three vessels (72.2%), and four vessels (66.7%) were metabolic syndrome (P = 0.846). Between the individual components, diabetes mellitus (DM) was the most significant risk factor accounts for the number and severity of the CAD in all CAD patients. Conclusions: The prevalence of metabolic syndrome is high among patients with angiographically documented CAD. Patients having metabolic syndrome have more severe and more complex CAD.
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	Relation of visfatin and polycystic ovarian syndrome in women	p. 316
	Zryan Sirwan Omer, Mutaz Sabah Ahmied, Nabila Kamil Yaqoub DOI:10.4103/MJBL.MJBL_63_18   Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies in women of the reproductive age group. Objective: The study aimed to assess the relation of serum visfatin level in women with polycystic ovarian syndrome. Materials and Methods: A cross-sectional study was carried out in Kirkuk city from January 10, 2018, to June 15, 2018. The number of polycystic ovary syndrome (PCOS) women under study was 60 women whose ages were between 15 and 45 years old. These patients admitted to obstetrics and gynecology unit at Azadi teaching hospital. The control group who were matched to the patients studied included 30 individuals. Results: The study showed that there is the significant difference between PCOS women and the control group concerning visfatin level and the highest mean of visfatin was occurred in PCOS women (13.60 ± 7.98 vs. 7.73 ± 1.22). There was significant relation between body mass index and visfatin level among PCOS women in this study. The highest rate of PCOS women had irregular menstrual cycle. The study showed that most PCOS women included in the study had hirsutism. The high rate of acne recorded among PCOS women. Conclusion: It was concluded that there was a highly significant relation of visfatin with PCOS.
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	Impact of elevated red cell distribution width on patients with acute myocardial infarction	p. 320
	Sami R Al-Katib, Mohammed S Abdul-Zahra, Basim A Abd DOI:10.4103/MJBL.MJBL_102_18   Background: Red cell distribution width (RDW) is an important parameter that has a critical impact on the severity of coronary artery disease, especially on that of acute myocardial infarction (AMI). Objective: This study was aimed to determine the effect of elevated RDW on the outcome of AMI. Materials and Methods: This is a retrospective, case–control study conducted on two groups of participants; the first group (cases) comprised 87 patients suffering from AMI, while the second one (controls) comprised an equal number of patients having stable angina. Matching of controls to patients was done according to age (within 5 years) and gender. The study extended from the beginning of October 2017 to the end of March 2018. Participants in both groups were collected from Al-Sadr Teaching Hospital and Merjan Medical City at Iraqi Najaf and Babylon Governorates, respectively. RDW values were determined by the use of hematological auto-analyzer. Results: Statistically significant differences found between the study groups regarding RDW (P = 0.0001, odds ratio [OR] = 9.481, 95% confidence interval [CI] = 5.127–17.535) and cardiac troponin I (cTnI) (P = 0.0001, OR = 1.325, 95% CI = 1.109–1.584). Strong positive correlation was found between RDW and cTnI (r = 0.272, P = 0.0001). Other measured parameters which are age, gender, history of hypertension, diabetes and smoking, body mass index, hemoglobin (Hb), packed cell volume, mean cell volume, and mean cell Hb concentration all showed no significant differences between the study groups regarding them. Conclusion: RDW owns substantial diagnostic and prognostic value that can aid in the management of AMI patients.
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	Smoking and its correlates among secondary school students in Al-Hilla City 2018	p. 326
	Roaa Khalid Al-Murshedi, Hasan A Baiee DOI:10.4103/MJBL.MJBL_66_18   Background: Although the prevalence of smoking has been decreasing in the developed countries in recent years, the less developed countries, such as Iraq, are facing an impact from smoking prevalence rise. Objective:The study objective was to assess the prevalence of smoking and its correlates among secondary school students. Materials and Methods: A descriptive cross-sectional epidemiological study was conducted on the secondary school students 4th, 5th, and 6th for males and females who were indiscriminately selected from 15 secondary schools located in Al-Hilla city\Babylon Province\Iraq during the period from March 7 to April 30, 2018. A questionnaire adapted from global school-based student health survey (2013) was used to collect data. Results: Of 860 students, only 810 responded and completed the questionnaire (response rate 94.2%). The overall prevalence of smoking was 32.0%, and the majority of smokers were male. The dominant type of tobacco smoking in this study appeared to be a hookah in about two-thirds (one-third exclusive hookah smoking and one-third mixed hookah and cigarette smoking), and multiple reasons have been found to impulse the student to smoking and that the friend was the first tobacco source. A significant association has been found between tobacco smoking and gender, age, grade, income, marital status, having alive parents, abuse, early age work, school performance, having a family member with medical diseases, family relationship, and sleeping difficulties (P < 0.05). Conclusion: The high prevalence of smoking was revealed among secondary school students, especially hookah tobacco smoking, and some factors appear to play a pivotal role in smoking initiation. Hence, preventive measures need to be applied.
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	Orbital tumors: A prospective study of 95 cases	p. 334
	Mohammed Jaber Al-Mamoori DOI:10.4103/MJBL.MJBL_69_18   Background: A wide variety of tumors and pseudotumors can involve the orbit. Although the incidence of orbital tumors is relatively low, the diagnosis and the treatment strategy for such tumors are of great concern to neurosurgeons and ophthalmologists. Objectives: The main aim of this study is to determine the distribution of patient age, sex, pathology, origin, and location of orbital tumors for optimum management because the delay in the diagnosis and treatment is the most preventable cause of morbidity and mortality. Materials and Methods:In this study, 95 cases of orbital tumors are studied prospectively during 10 years' period in the Hilla Teaching Hospital in Babylon-Iraq from 2008 to 2018. The parameters dealt with in this study included; the distribution of patient age and sex, clinical manifestations, investigations, pathology, origin of tumors and tumor location in the orbit, management, surgical procedures, and mortality in 95 patients (aged from 6 months to 75 years, the mean age is 29.8). Results: In this study, the highest age group incidence of orbital tumors is in the first decade of life which constitutes (24.2%), the second peak is in the fourth decade of life which constitutes (17.9%). 42 (44.2%) of the patients are males and 53 (55.8%) of the patients are females. Among the 95 cases, 76 (80%) are primary orbital tumors, 15 (15.8%) are secondary orbital tumors (tumors that originating from contiguous regions), and 4 (4.2%) are metastatic orbital tumors. Orbital tumors location; 83 (87.4%) are extraconal and 12 (12.6%) are intraconal. The two most common orbital tumors are dermoid cyst (27.4%) and pseudotumor (16.8%). Overall mortality is seven patients (7.4%). Conclusion: Orbital tumors are a relatively rare and challenging group of tumors. The age of onset, state of vision, tumor location in the orbit and other radiological findings provide the most important information for the diagnosis of orbital tumor prior biopsy or surgical resection and to make decision about other further treatment modality. For any patient complain from visual loss, proptosis, and impaired ocular motility, it is better to undergo magnetic resonance imaging and computed tomography-scan imaging to detect or exclude intraorbital or intracranial diseases.
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	Sociodemographic and medical factors of preterm delivery according to the clinical subtypes of prematurity	p. 341
	Sijal Fadhil Farhood Al-Joborae, Farah Wajid Alwan DOI:10.4103/MJBL.MJBL_87_18   Background: Preterm delivery is defined as childbirth occurring at <37 completed weeks. Preterm birth remains one of the most important problems in pregnancy, as it is still a major health problem worldwide, which results in 75% of neonatal mortality. Often, the cause of preterm delivery is unknown; however, several etiological risk factors have been identified. Objective: The objective of this study was to examine sociodemographic and medical risk factors of preterm delivery in relation to clinical subtypes as follows: extremely preterm (<28 weeks), very preterm (28 up to 32 weeks), and moderate-to-late preterm (32 up to 37 weeks). Materials and Methods: It is a descriptive hospital-based cross-sectional study which was carried out on a convenient sample of 200 preterm babies who were cared for in the neonatal care units in Babylon Maternity and Pediatrics Hospital, Hilla General Teaching Hospital whose mothers accepted to participate in this study. This study was conducted over 5 months from March 1, 2018 to August 1, 2018. Results: Thirty-nine percent of respondent mothers had a history of abortion and (18.0%) had a history of recurrent preterm birth. Spontaneous preterm delivery (premature rupture of membrane) was the mode of delivery in (53.5%) of mothers and (49.5%) of respondents were multigravida. As high as (43.5%) of respondent mothers had current medical illnesses, hypertension representing (33.33%) of these illnesses. Forty percent of mothers had irregular ANC and (15.5%) did not have any antenatal care at all. Conclusion: Several significant risk associations between preterm birth according to clinical subtypes of prematurity and the following risk factors were identified as follows: maternal age, gravidity, birth order, BMI, educational level, mode of delivery, history of abortion, contraceptive use before pregnancy, and genetic defects.
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	Human carbonic anhydrase: Purification and characterization study in thalassemia major patients compared to healthy subjects	p. 349
	Salwa Saleh Hussein, Israa Ghassan Zainal DOI:10.4103/MJBL.MJBL_81_18   Background: Carbonic anhydrase (CA) catalyzes the reversible reaction of converting carbon dioxide to bicarbonate. Objective: This study was aimed to isolate and purify human erythrocytes CA and study its physicochemical properties of the enzyme reaction for ß-thalassemia major patients. Materials and Methods:The blood samples included 61 samples of blood (31 males and 30 females) from ß-thalassemia patients visited Azadi Hospital/Kirkuk city. Healthy individuals as control group included 40 participants. The separated fractions were obtained using four steps: extraction by ethanol and chloroform, ammonium sulfate precipitation, dialysis, and gel filtration chromatography; finally, the CA was analyzed by polyacrylamide gel electrophoresis. Results:The CA activity showed significant (P ≤ 0.05) decrease, total protein showed nonsignificant (P ≥ 0.05) increase, and specific activity significantly (P ≤ 0.05) increased in patients group compared to healthy individuals. CA was partially purified with a factor of 22.5 and 18 by extraction with ethanol and chloroform and 1.5,1.4 for Fraction I and 1,2 for Fraction II using gel filtration chromatography. The optimum conditions for the CA reaction in patients group were enzyme concentration (6 μl), substrate concentration (6 Mm), pH = 7.4, and temperature 37°C. The electrophoresis study indicated that the bands of CA in patients group showed bands with less intensity than the bands in healthy individuals. Conclusion: The best method to purify CA from human erythrocytes with high recovery and fold of purification was ethanol–chloroform extraction.
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	Comparison of pica in breastfeeding versus artificial feeding in children 2 years of age or younger	p. 357
	Sijal Fadhil F. Al-Joborae, Zainab Amer Mousa Al-Malikey DOI:10.4103/MJBL.MJBL_84_18   Background: Pica is the daily compulsive eating of food or nonfood items not part of one's habitual diet or preferences, which is inappropriate to the developmental level. Pica is a distinctive but poorly understood accompaniment of iron deficiency or depletion in some children, although most pica items contain little or no iron. Objectives: The objective of the study is to assess and compare pica in breastfed versus artificially fed children aged 2 years or younger in Hilla city, Babylon Province, Iraq. Materials and Methods: This is a descriptive hospital based cross-sectional study which was carried out on a convenient sample of 150 children aged 2-year-old or younger who attended pediatric clinics in three hospitals in Babylon Province in the Center of Iraq who accepted to participate in this study. Results: The study found that the mean age (month) of children with childhood pica is 14.51 ± 4.13 with the mean birth weight (g) is 2812.83 ± 533.18, the gender gap in childhood pica is in favor of male children (69.3%). The study found that almost two-thirds of children with pica were breastfed (68.7%) while the other one-third was artificially fed. The majority of children suffering from pica consumed the material clay (43.3%). The mean of hemoglobin (Hb) (g/dl), total serum iron (μg/dl), and serum ferritin (ng/ml) and which is 8.44 ± 1.50, 7.68 ± 2.36, and 6.36 ± 1.54, respectively. Conclusion: Children with pica had low level of Hb, iron, and ferritin which mimics the hematological picture accompanying iron deficiency anemia. There is a significant mean difference between the type of feeding of children with pica and the birth weight, serum iron, Hb, and serum ferritin. Furthermore, there is a significant association between type of feedings and the following variables: gestational age, onset of pica, birth order, and spacing between births.
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	Maternal risk factors of perinatal mortality in Duhok	p. 363
	Iman Yousif Abdulmalek, Husna Abdulrazaq Yusif DOI:10.4103/MJBL.MJBL_88_18   Background: Perinatal mortality (PM) rate is an important index of community health condition. A high-risk pregnancy is one that threatens the health or the life of the mother and her fetus, during or after the pregnancy and birth. Objective: This study aimed to identify the etiological maternal risk factors and other causes that lead to PM, to calculate the PM rate (PMR) in maternity hospital in Duhok, and to compare it with the previous rates, and to find out the relationship between maternal socio-demographic and obstetrics variables with PMR. Materials and Methods: During the study, which was from January to December 2013, the total deliveries were 20281, and the perinatal deaths were 496 cases. Results: The PMR was (24.5%/1000 births), the number of early neonatal deaths were 268 (54%), and it is higher than stillbirths deaths (fresh and macerated). The most common causes and associated risk factors behind the fresh stillbirths (30.5%). Macerated stillbirths 77 (15.5%), were the main causes of death. The most causes of early neonatal deaths were birth asphyxia (36.6%) and prematurity (34.3%). It was found that most important maternal risk factors for PM are preeclampsia, and obstructed labor. The results of the study revealed a significant association between mother's level of education, occupation, residential area, antenatal care, gestational age, parity, and PM, but revealed a nonsignificant association between the mother's age and PM. Conclusions: There was a significant relation between maternal risk factors and PM, the early diagnosis of these risk factors decreased the PM. The PMR was 24.5/1000 total births in 2013, at a maternity hospital in Duhok, It was lower than that of 2004 and 2005. Most of the PM were in the groups of poor antenatal care and their residence from the rural area.
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	Impact of sleep quality on glycemic control in type 2 diabetes mellitus	p. 369
	Ameer Kadhim Al-Humairi, Nawar Kadhim Hassan DOI:10.4103/MJBL.MJBL_80_18   Background: Glycemic control is important to reduce the risk of micro - vascular problems among patients with diabetes mellitus. Sleep limitation leads to increase Hemoglobin A1C (HbA1c) levels; though, slight is known regarding the metabolic impacts of usual sleep limitation. The current study was a hospital-based cross-sectional study which performed to evaluate the association between habitual sleep quality with glycemic control and HbA1c fluctuations among contributors in the medical merjan city among Type 2 diabetics. Objectives: The purpose of current study is to assess sleep quality among Type 2 diabetic patients and to consider the influence of sleep value on glycemic control among those patients in Al-Hilla City. Methods: Our study was "descriptive cross sectional study" to assess the sleep quality using Pittsburgh Sleep Quality Index by filling out the questionnaire formats which designed for usage of the study. This study include a "convenient sample" of 150 Type 2 diabetic patients who visit the specialist day clinic in diabetic center of merjan medical hospital between the 25th of February to the end of June, 2018. Verbal approval was attained from each Type 2 diabetic patient, data collection was done through the interviewing of contributors by use of structural questionnaire. Results: The mean age of diabetic patients was (53.20 ± 13.53), Male represents (42.7%) and female represents (57.3%). Poor sleep quality represent (35.3%). There was a significant increase in level of HbA1c and random blood sugar among patients with Type 2 diabetics with poor sleep quality and significant decrease of cholesterol and triglycerides levels with increase duration of diabetes mellitus. Conclusions: Poor sleep was common among diabetic patients. There is close association between sleep quality and glycemic control, as well as short sleepers have an increased occurrence of diabetes.
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	Role of hepcidin in hearing loss	p. 376
	Sami R Al-Katib, Yasir L Hasson, Rawaa H Shareef DOI:10.4103/MJBL.MJBL_106_18   Background: Hearing loss is considered as a public health problem that affects the population at all ages. Hepcidin is an important protein with a crucial role in the homeostasis and metabolism of iron. Objective:The objective of this study was to evaluate the association between hepcidin and hearing loss and to find out the mechanisms that lead to this association. Materials and Methods: A total of 300 persons included in this study, 150 as a patients' group who are suffering from hearing loss and attended Al-Sadder Teaching Hospital in Al-Najaf Al-Ashraf City, Iraq, while the other 150 participants who are selected randomly as controls' group and are free from hearing loss.  The ages of all participants ranged between 18 and 70 years, and controls were matched with patients by gender and age (within 5 years). Many parameters are measured such as hepcidin, C-reactive protein (CRP), interleukin-6 (IL-6), advanced glycation end products (AGEs), and glutathione peroxidase-3 (GPX-3). Results: The results of this study revealed that sensorineural hearing loss was the most common type followed by mixed one.  Furthermore, it was shown that hepcidin and CRP were significantly higher in patients compared with controls, while there were no significant differences between patients and controls in the levels of IL-6, AGEs, and GPX-3.  The correlation analyses showed a significant positive correlation between hepcidin and CRP and hepcidin and IL-6. Conclusion: Hepcidin and CRP have a negative impact on hearing, increase significantly with hearing loss, and have role in the development of hearing loss.
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	Effect of smoking during pregnancy on birth weight, placental weight, and time of third stage of labor	p. 381
	Tariq A Al-Shemmeri DOI:10.4103/MJBL.MJBL_51_18   Background: Cigarette smoking of the mother during pregnancy is a well-known cause associated with adverse reproductive outcomes, including increase in the incidence of placenta previa, abruption-placentae, and double the risk of infant mortality from all causes. Objective: This study aims to demonstrate the effect of smoking, whether active or passive, on the newborn body weight, placental weight, and the time of the third stage of labor. Materials and Methods: This prospective study involves sixty patients, their ages range between 20 and 32 years, all of them underwent vaginal deliveries, and the lowest accepted packed cell volume (PCV) was 32%. The participants were classified into four groups: active smokers, passive smokers, mixed smokers, and the rest who are nonsmokers, representing the control group. The following data were collected from every: age, gravidity and parity, and number of cigarettes per day, and for each female, the newborn body weight, placental weight, the time of the third stage of labor, and PCV of the mother were estimated. Results: Among these sixty patients who involved in the study, 3% were active smokers, 31% were passive smokers, 27% were mixed smokers, and 39% were nonsmokers; the mean newborn body weight of nonsmokers (control group) was 3252 g; active smokers, 2430 g; passive smokers, 2819 g; and mixed smokers, 2407 g. The mean placental weight in nonsmokers was 527 g; active smokers, 640 g; passive smokers, 551 g; and mixed smokers, 599 g. The time of the third stage of labor in nonsmokers was 6.9 min; active smokers, 12 min; passive smokers, 5.8 min; and mixed smokers, 6.6 min. Conclusions: Cigarette smoking by pregnant women leads to a low birth weight and larger placenta and may interfere with the time of the third stage of labor.
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	Predictors of knowledge and practice of prostate cancer screening among commercial motorcyclists in Ilesa Town in Southwestern Nigeria	p. 385
	Wasiu Olalekan Adebimpe, Deborah Fashina DOI:10.4103/MJBL.MJBL_103_18   Background: In Nigeria, prostate cancer is the most commonly diagnosed cancer among men. Nigeria men are ignorant of the risk factors for the disease despite rising prevalence, despite the country's movement toward a demographically aging population. For a measurable change in behaviors, it is important to assess existing knowledge to inform policy and programmatic decisions. Objective: This study was undertaken to determine the predictors of knowledge and practice of prostate cancer screening among commercial motorcyclists in Ilesa town of Nigeria. Materials and Methods: A descriptive cross-sectional study was carried out among 400 eligible commercial motorcycle riders selected using the multistage sampling method. Research instrument used were semi-structured pretested interviewer-administered questionnaire. Data were analyzed using the SPSS software version 17.0. Results: Mean age of respondents was 39.5 ± 2.4 years. Fifty-seven percent and 27.6% were aware of prostate cancer and prostate cancer screening, respectively, with the mass media being the source of information. Fifty-seven percent had poor mean knowledge while 63.0% had good mean attitude toward prostate cancer screening. Although only 3%have gone for prostate cancer screening before, about 95% were willing to go for prostate cancer screening test. Age, marital status, and education status were all significantly associated with good knowledge and practice of prostate cancer screening (P < 0.05). Predictors of good knowledge and practice of prostate cancer screening were being educated, age <45 years, being married and being in polygamous setting. Conclusion: Moderate awareness and knowledge, good attitude, and poor practice of prostate cancer screening were found among studied respondents. This calls for stakeholders in cancer care to create more awareness, organize sensitization programs, and implement community-based programs that would increase access to screening for prostate cancer.
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	Radiological and clinicopathological findings in large case series study of lung cancer in Erbil City/Iraq	p. 391
	Zahir Salih Hussein, Kamaran Amen Karadakhy DOI:10.4103/MJBL.MJBL_86_18   Background: Lung cancer (LC) is the most common fatal malignant neoplasm worldwide, especially in developing countries. Objective: The objective of this study was to evaluate the correlation between radiological and clinicopathological findings of the LC. Materials and Methods: A retrospective study was performed on 446 patients in Erbil city/Iraq from January of 2014 to December of 2016. Results: The mean (± standard deviation) age at diagnosis was 65.21 (±10.9) for males versus 62.1 (±9.98) years for females. Most cases of squamous cell carcinoma and small-cell carcinoma were current or ex-smokers, whereas adenocarcinoma was common in passive and never smokers. The right lung was affected more than the left lung (P < 0.05). The most common histological subtypes in the right upper lobe were adenocarcinoma and small-cell carcinoma, whereas the left upper lobe was affected mostly by squamous cell carcinoma (P < 0.001). Adenocarcinoma commonly presented with peripheral mass, whereas hilar ± central mass was common in small-cell carcinoma and squamous cell carcinoma. Cavitation was seen mainly in squamous cell carcinoma (P < 0.001). Conclusions:LC is a disease of old age presenting at late stage. Smoking remains the major cause of LC. Despite increasing the frequency of adenocarcinoma still it is not more common than squamous cell carcinoma as seen in developed countries. Adenocarcinoma is predominant in never and passive smokers. The right lung is affected more than the left lung. Adenocarcinoma and small-cell carcinoma affect the right upper lobe, whereas squamous cell carcinoma affects the left upper lobe. Further studies are necessary to confirm or refute the side and lobe preference by LC.
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LETTERS TO EDITOR
	Need to take urgent actions to contain tuberculosis: United nations	p. 396
	Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava DOI:10.4103/MJBL.MJBL_107_18
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	Pre- and postadenotonsillectomy nocturnal enuresis in children with adenotonsillar hypertrophy	p. 398
	Abdulhusein Mizhir Al-Maamuri DOI:10.4103/MJBL.MJBL_57_18
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