Karbala journal of medicine https://journals.uokerbala.edu.iq/index.php/kj <p><strong>K</strong>arbala Journal of Medicine (<strong>ISSN:</strong> 1990-5483 (Print)) published every six months by Karbala Medical College. The journal welcomes original articles, case reports and letters to editor in all fields relevant to medicine. Review articles are usually by invitation only. However, review articles of high standards will be considered. English languages must be used.</p> University of Kerbala - College of Medicine en-US Karbala journal of medicine 1990-5483 Shortly, Many Patients May Not Find Doctors To Treat In Iraq! https://journals.uokerbala.edu.iq/index.php/kj/article/view/870 <p>The current general situation of Iraqi doctors' satisfaction, as an associated factor with brain drain problem, has been started to be studied academically. Serious findings have been registered due to serious challenges face the doctors. These seem to have resulted in frustration and made half of them think of emigration outside Iraq; more seriously one third may take this step shortly. This may lead to real shortage in the health services supplied, in addition to the shortage in the infrastructure, training process, updating equipment and other requirements. Unless effective and efficient measures are taken soon, the country may end with a new crisis, which adds a more burden on the suffering health institution.</p> Alaa Abed Dhurgham Abdulwahid Basim Abdul-Hassan Copyright (c) 2022 Karbala journal of medicine 2022-06-15 2022-06-15 14 2 2494 2495 Application of Nano-particulate drug delivery systems to deliver therapeutic agents into cancer cells https://journals.uokerbala.edu.iq/index.php/kj/article/view/886 <p><strong>&nbsp;</strong></p> <p><em>Cancer</em> is a disorder in which a group of cells grows uncontrollably, disregarding the cell division's physiological rules. Since its discovery (although the word cancer was not used)3000 BC, extraordinary research aims to uncover novel treatment approaches for combating cancer. Currently, over 60% of all ongoing clinical trials worldwide focus on cancer. The selection of treatment depends on the type of cancer, site, and stage of progression. Surgery, radiation-based surgical knives, chemotherapy, and radiotherapy are traditional treatment approaches that are mostly used. Side effects associated with conventional therapy highlight the need for novel cancer treatment.&nbsp;</p> <p>Nanotechnology has been widely investigated and utilized for cancer therapy, as nanoparticles play a key role in medication delivery. Nanoparticle-based drug delivery provides several advantages over traditional drug delivery, including better stability and biocompatibility, increased permeability and retention effect, and precision targeting. It has also been proven to tackle the resistance to anticancer drugs by targeting the underlying mechanism such as overexpression of drug efflux transporters, defective apoptotic pathways, and a hypoxic environment, leading to enhance multidrug resistance reversal. Moreover, nanoparticles' role in immunotherapy is undergoing investigation due to their essential role in cancer treatment. This review highlights the role of nanoparticles for drug delivery in chemotherapy, targeted therapy, and the targeting mechanism of nanoparticle-based drug delivery.</p> Narjes Alfuraiji Weam Kadhim Rana Hameed Qasim Chyad Abdulzahra Copyright (c) 2022 Karbala journal of medicine 2022-06-15 2022-06-15 14 2 2496 2512 Hyperstimulation Syndrome of the Ovary: A review on clinical feature, pathophysiology, risk factors, and prevention. https://journals.uokerbala.edu.iq/index.php/kj/article/view/884 <p>Hyperstimulation syndrome of the ovary is a dangerous complication of ovulation induction during infertility treatment by gonadotropins stimulation and human chorionic gonadotropin injection. Increased capillary permeability, causing fluid leakage from the intravascular compartment, with the accumulation of fluid in the third-space and consequent intravascular dehydration, is the main change in the pathophysiology of Hyperstimulation syndrome of the ovary. Vascular endothelial growth factor (VEGF) is the main mediator in the development of Hyperstimulation syndrome of the ovary. The recent application of new modalities: GnRH antagonist protocol, GnRH agonist (GnRHa) triggering of ovulation and embryo/oocyte vitrification, facilitates the elimination of Hyperstimulation syndrome of the ovary associated with controlled control ovarian hyperstimulation(COH) for IVF program. In this manuscript, we reviewed the pathophysiology, clinical features, predisposing factors, and both primary and secondary arrangement for preventing Hyperstimulation syndrome of the ovary as there is no single measure to prevent OHSS totally. Therefore, categorizing the women based on their risk potentiality seems to be beneficial to direct the line of management as early as possible to avoid the emergence of Hyperstimulation syndrome of the ovary.</p> Rihab Abbas Ali Maher Abbood Mukheef Hind Hadi Majeed Copyright (c) 2022 Karbala journal of medicine 2022-06-15 2022-06-15 14 2 2513 2520 Risk Factors for Anthracycline Associated Cardiotoxicity in Iraqi Breast Cancer Patients https://journals.uokerbala.edu.iq/index.php/kj/article/view/856 <p>Back ground: Anthracyclines are one of the most effective agents for the treatment of breast cancer; when used in combination regimens they improve both disease-free and overall survival in patients with breast cancer.&nbsp;Unfortunately, they are the representative agents causing cardiotoxicity, particularly Left ventricular dysfunction.</p> <p>Aim of study: to assess the incidence and risk factors for anthracycline induced cardiotoxicity for its early detection and prevention among breast cancer patients.</p> <p>Methods: Eighty-six breast cancer patients were assigned to receive doxorubicin (60 mg/m<sup>2</sup>) plus cyclophosphamide (600 mg/m<sup>2</sup>), with different cycles number and frequency. they were prospectively monitored clinically and by echo study to detect any cardiotoxicity,&nbsp;several patient and drug related risk factors were analyzed to identify their influence on <a name="_Hlk46357286"></a>Anthracycline Induced Cardiotoxicity.</p> <p>Results:&nbsp;After anthracycline chemotherapy, 21 patients (24.4%) developed diastolic dysfunction, and 7 patients (8.1%) developed reduction in the left ventricular ejection fraction more than 10%, out of these 7 patients, 4 developed symptomatic cardiotoxicity.&nbsp;Older age (&gt; 60 years), hypertension, diabetes and abnormal renal function were all associated with higher risk for developing anthracycline cardiotoxicity.</p> <p>Conclusions: Cardiotoxicity is common among breast cancer patients treated with anthracycline based chemotherapy which can even occur in a dose less than 240mg/m<sup>2</sup>.&nbsp;Age older than 60, Hypertension, diabetes mellites, and abnormal renal function showed significant association with Anthracycline Induced Cardiotoxicity.</p> <p>Key words : breast cancer , anthracycline , cardiotoxicity.</p> Zaid Khudair Azher Sebieh Al-Zubaidy Copyright (c) 2022 Karbala journal of medicine 2022-06-15 2022-06-15 14 2 The psychological depression response of Iraqi subfertile wives :a descriptive study https://journals.uokerbala.edu.iq/index.php/kj/article/view/874 <p>Worldwide about 15% in the childbearing years have subfertility problems. [1]&nbsp; &nbsp;Many studies demonstrated that men and women have abnormal emotional responses, such as stress, anxiety and depression. Around 5% of couples living in the developed countries experience primary subfertility (inability to have any children or secondary subfertility. [1]&nbsp; &nbsp;Experts say that only half of all subfertility cases had a physical origin, the rest were unexplained. But researcher notice that most cases of subfertility attributed to physiological cause in the man or woman. About one-third from those physiological problems is identified in the woman, one-third in the man, and about one-tenth of the time in both. Half of the women and 15% of the men said that infertility was the most upsetting experience of their lives. [2]&nbsp; In Iraq and because of the social regulations and ideas about the female and male thinking the females was under huge psychological pressure towered the pregnancy. In our community less research to examine both men’s and women's reactions to subfertility, men's tend to report experiencing less distress than women. When the problem is diagnosed in their wives, men do not report being as distressed as the women do. Treat infertility by more advanced assisted reproductive technology such as in vitro fertilization (IVF) studies suggest that they may also add to the stress, anxiety, and grief that patients are already experiencing from infertility&nbsp;itself.</p> <p>Aim: The purpose of this study was to evaluate the prevalence of psychological stress (depression) experienced by subfertile wives</p> <p>Material and methods: DESIGN: Cross-sectional prospective study held in between March 2018 until March 2020&nbsp;&nbsp;&nbsp;</p> <p>SETTING: Face-to-face and online interviews were conducted in study participants</p> <p>PARTICIPANTS:498 subfertile women were interviewed all suffering from primary or secondary infertility only 433 of them were accept to participating in our study and answered the questionnaire they are from subfertility units in maternity hospitals in Kerbala, Najaf and Babylon and in privet clinics and on social media</p> <p>METHODS: A structured questionnaire were used and filled by direct interviewed and/or by social media chatting&nbsp;</p> <p>MAIN OUTCOME MEASURES: The correlation between depression score and subfertility</p> <p>RESULTS: The prevalence of depression was very high among infertile women in Kerbala, Najaf and Babylon/Iraq, where 93.5% were depressed</p> <p>&nbsp;</p> mousa mohsin Copyright (c) 2022 Karbala journal of medicine 2022-06-15 2022-06-15 14 2 2528 2533 Knowledge and attitude of mothers towards neonatal jaundice in KarbalaaTeaching Hospital for Children https://journals.uokerbala.edu.iq/index.php/kj/article/view/864 <p>Background:<br>Neonatal jaundice is one of the most common disorder in neonates globally. It's believed that delays in detection and improper treatment of neonatal jaundice can be responsible for neonatal morbidity and mortality. Knowledge and health seeking behavior of mothers play an important role in the course of this health condition.<br>Patients and methods:<br>Descriptive Cross sectional study had been taken in Karbala Teaching Hospital for Children, data collection was done on a convenience sample of a total 164 mothers of neonate with jaundice. The data were collected through direct face to face interview with the mothers using special designed questionnaire. Statistical Package for Social Sciences program was used for statistical analysis. <br>Result: <br>The mean knowledge score was good. In which the study shows (51.2%) of mothers had good knowledge and (48.8%) had fair knowledge. Although knowledge of mothers about onset and duration, causes and treatment of jaundice was acceptable (fair), it was good about definition and symptoms, complications and way of diagnosis. Knowledge level had a significant association with mothers residency (urban mothers had more knowledge from rural mothers).<br>The mean attitude score was positive attitude. There was also a significant association between mother's attitudes towards NNJ. And older women, multiparty and good ANC were significantly and positively affected the attitude. <br>Conclusion:<br>In conclusion, the majority of mothers have a satisfactory level of knowledge and attitudes related to neonatal jaundice. However, cultural beliefs and traditional infant care practices still have an impact on mothers.</p> Mohamed Fadil Salam Sahib Obaid Moatasem Ghazi Hasoon Almhanna Copyright (c) 2022 Karbala journal of medicine 2022-06-15 2022-06-15 14 2 2534 2541 Incidence and Patterns of Abuse among Patients aged 60 years and older Attending the Consultation Clinics in Al-Imam Hussein Medical City in Karbala Governorate, 2020 https://journals.uokerbala.edu.iq/index.php/kj/article/view/869 <p><strong>Background: </strong>Elder abuse is defined by the World Health Organization in Europe as a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person. It is an important cause of morbidity and mortality in developing and developed countries.</p> <p><strong>Subjects and Methods: </strong>A cross-sectional study conducted included 402 patients attended the Consultation Department of Imam Hussein Medical City aged 60-year-old and over. A structured modified questionnaire was developed for the study and filled out by a doctor using face-to-face interviews.</p> <p><strong>Objective: </strong>To evaluate the proportion of elder abuse, identify its different patterns, and determine the risk factors related to the problem.</p> <p><strong>Results: </strong>Out of 402 total respondents, females constituted 52% (70.1%) were married, the proportion of all types of abuse/neglect was 82.1%, psychological abuse accounted for three-quarters of the study participants (74.1%), followed by physical abuse, financial abuse, and neglect (61.9%, 53.7%, and 45.8% respectively), while sexual abuse reported by only 4% participants. In general, the main three perpetrators of all types of abuse were spouses, followed by a son and daughter (41.8%, 38.1%, and 21.9%), respectively.</p> <p><strong>Conclusion: </strong>The proportion of elder abuse is high in Karbala, with psychological abuse being the most commonly reported pattern, the abuse induced by a family member in most of the cases, and two-thirds of the study participants did not report the abuse.</p> Zainab Badri Abdul-Abbas Baydaa Ibrahim Salman Ahmed J. Al-karaqully Copyright (c) 2022 Karbala journal of medicine 2022-06-15 2022-06-15 14 2 2542 2550 Correlation of the use of corticosteroid in patients with COVID-19 and serum level of D-dimer https://journals.uokerbala.edu.iq/index.php/kj/article/view/911 <p>Abstract: The Global pandemic, COVID-19, represents a vigorous challenge for medical institutions because of unpredictable complications and the rapidity of spread. One of critical complications that is associated with COVID-19 insult is cardiovascular coagulopathy which can be fatal. This life threatening sequele could be prdected by estimation of serum level of D-dimer. The latter is a well known diagnostic marker of COVID-19 infection. Besides, D dimer is a fibrin metabolite and is directly related to the overall coagulation process in the body. Corticosteroid is the main stay of treatment of moderate and severe cases of COVID-19 infection especially those with considerable hypoxia.&nbsp;</p> <p>Aim of the study: to evaluate wheather using corticosteroid minimizes the occurrence of coagulopathy, an effect marked by reduction of the level of D-dimer during the course of the disease .&nbsp;</p> <p>Method: A total of 152 male patients infected with COVID-19 were selected randomly. They were diagnosed by a specialist Physicians according to standard guidelines. Patients were non-diabetic and non-hypertensive, 72 of them received dexamethasone for 5 days from the start of treatment of COVID-19. Serum level of D- dimer was estimated after seven days of starting of treatment then statistical analysis was done.&nbsp;</p> <p>Results: Data of the current study revealed that there was a significant reduction in the serum level of D-dimer in patients who received dexamethasone treatment as compared to the other group who didn't receive dexamethasone.&nbsp;</p> <p>Conclusion: It was concluded that using dexamethasone significantly decreases the serum level of D-dimer and thus may minimize the possibility of coagulopathy that induced as a result of COVID-19 infection.</p> <ol> <li>Keyword: D-dimer, COVID-19, dexameth</li> <li>asone</li> </ol> Ali Mansoor Al Ameri Al Ameri Copyright (c) 2022 Karbala journal of medicine 2022-06-14 2022-06-14 14 2