INVESTIGATION OF THYROIDS DYSFUNCTION AMONG INFERTILE WOMEN IN NASIRIYAH CITY

Objective: Epidemiological studies revealed that 10-15 % of couples in the world experience infertility. Thyroid dysfunction (hyperthyroidism and hypothyroidism) possessed adverse effect on reproductive health and resulted in, interference with ovulation, reduced rates of conception, increased early pregnancy loss, and adverse effects on pregnancy and neonatal outcomes. The current study aims to explore the thyroid dysfunction among infertile women in Nasiriyah city-Iraq. Methods: The study was conducted on 60 infertile women (age group 17–45 y) who visited infertility departments in Al-Hussein hospital, Al-Haboubi hospital and Bent AL Huda hospital, in Nasiriyah city, from October 2019 to March 2020. Thirty normal females (age matched) were taken as controls. TSH, T3, T4, LH, FSH, prolactin, progesterone and estradiol levels were determine by using VIDAS® Assay. Results: The prevalence of hyperthyroidism among infertile women was 13.33% and hypothyroidism was 10.00%. Both hyper and hypothyroidism induced adverse changes in the serum levels of LH, FSH, prolactin and gonadal hormones. Conclusion: Thyroid dysfunction was associated with a risk of not getting pregnancy. Women were advised to achieve euthyroidism before planning a pregnancy

In vitro antioksidacijska, citotoksična i antidijabetička aktivnost hidrolizata proteina iz Reevesove barske kornjače (Chinemys reevesii)

Research background. Cardiovascular diseases and diabetes are the biggest causes of death globally. Bioactive peptides derived from many food proteins using enzymatic proteolysis and food processing have a positive impact on the prevention of these diseases. The bioactivity of Chinese pond turtle muscle proteins and their enzymatic hydrolysates has not received much attention, thus this study aims to investigate their antioxidant, antidiabetic and cytotoxic activities. Experimental approach. Chinese pond turtle muscles were hydrolysed using four proteolytic enzymes (Alcalase, Flavourzyme, trypsin and bromelain) and the degrees of hydrolysis were measured. High-performance liquid chromatography (HPLC) was conducted to explore the amino acid profiles and molecular mass distribution of the hydrolysates. The antioxidant activities were evaluated using various in vitro tests, including 1,1-diphenyl-2-picrylhydrazyl (DPPH) and 2,2’-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS), hydroxyl radical scavenging activity, reducing capacity, chelating Fe2+ and lipid peroxide inhibition activity. Antidiabetic activity was evaluated using α-amylase inhibition and α-glucosidase inhibition assays. Besides, cytotoxic effect of hydrolysates on human colon cancer (HT-29) cells was assessed. Results and conclusions. The amino acid composition of the hydrolysates revealed higher mass fractions of glutamic, aspartic, lysine, hydroxyproline and hydrophobic amino acids. Significantly highest inhibition of lipid peroxidation was achieved when hydrolysate obtained with Alcalase was used. Protein hydrolysate produced with Flavourzyme had the highest radical scavenging activity measured by DPPH (68.32%), ABTS (74.12%) and FRAP (A700 nm=0.300) assays, α-glucosidase (61.80%) inhibition and cytotoxic effect (82.26%) on HT-29 cell line at 550 µg/mL. Hydrolysates obtained with trypsin and bromelain had significantly highest (p<0.05) hydroxyl radical scavenging (92.70%) and Fe2+ metal chelating (63.29%) activities, respectively. The highest α-amylase (76.89%) inhibition was recorded when using hydrolysates obtained with bromelain and Flavourzyme. Novelty and scientific contribution. Enzymatic hydrolysates of Chinese pond turtle muscle protein had high antioxidant, cytotoxic and antidiabetic activities. The findings of this study indicated that the bioactive hydrolysates or peptides from Chinese pond turtle muscle protein can be potential ingredients in pharmaceuticals and functional food formulations.Pozadina istraživanja. Kardiovaskularne bolesti i dijabetes najčešći su uzroci smrti na svijetu. Bioaktivni peptidi dobiveni proteolizom i preradom hrane imaju pozitivan učinak na prevenciju tih bolesti. Biološka aktivnost proteina iz mišića Reevesove barske kornjače i njihovih hidrolizata nije dovoljno istražena, stoga je svrha ovoga rada bila ispitati njihovu antioksidacijsku, antidijabetičku i citotoksičnu aktivnost. Eksperimentalni pristup. Mišići Reevesove barske kornjače hidrolizirani su pomoću proteolitičkih enzima (Alcalase, Flavourzyme, tripsin i bromelain), te su mjereni stupnjevi hidrolize proteina. Aminokiselinski sastav i distribucija molekularne mase hidrolizata ispitani su pomoću visokodjelotvorne tekućinske kromatografije. Antioksidacijska aktivnost određena je različitim testovima in vitro, uključujući sposobnost uklanjanja 1,1-difenil-2-pikrilhidrazila (DPPH), 2,2’-azino-bis(3-etilbenzotiazolin-6-sumporne kiseline) (ABTS) i hidroksil radikala, keliranja Fe2+ i inhibicije lipidne peroksidacije. Antidijabetička aktivnost ispitana je testovima inhibicije α-amilaze i α-glukozidaze. Osim toga, analiziran je citotoksični učinak hidrolizata na stanice tumora debelog crijeva (HT-29). Rezultati i zaključci. Analizom aminokiselinskog sastava hidrolizata pronađeni su veći maseni udjeli glutaminske i asparaginske kiseline, lizina, hidroksiprolina te hidrofobnih aminokiselina od onih u nehidroliziranim proteinima. Hidrolizat proteina dobiven pomoću proteolitičkog enzima Alcalase bitno je inhibirao peroksidaciju lipida. Pri koncentraciji od 550 µg/mL, hidrolizat proteina dobiven pomoću enzima Flavourzyme imao je najveću sposobnost uklanjanja slobodnih radikala mjerenu pomoću DPPH (68,32 %), ABTS (74,12 %) i FRAP (A700 nm=0,300) metoda, inhibicije α-glukozidaze (61,80 %) te najveći citotoksični učinak na stanične linije HT-29 (82.26 %). Hidrolizat proteina dobiven pomoću tripsina imao je znatnu (p<0,05) aktivnost uklanjanja hidroksilnih radikala (92,70 %), a onaj dobiven pomoću bromelaina najveću aktivnost keliranja Fe2+ (63,29 %). Najveća inhibicija α-amilaze postignuta je pomoću hidrolizata proteina dobivenih djelovanjem bromelaina i enzima Flavourzyme. Novina i znanstveni doprinos. Hidrolizati proteina mišića Reevesove barske kornjače dobiveni enzimskom hidrolizom imali su veliku antioksidacijsku, citotoksičnu i antidijabetičku aktivnost. Rezultati istraživanja pokazuju da se ti hidrolizati ili peptidi zbog svojih bioaktivnih svojstava mogu upotrijebiti kao sastojak u farmaceutskim i funkcionalnim prehrambenim proizvodima

Fourth Derivative and Compensated Area under the Curve Spectrophotometric Methods Used for Analysis Meloxicam in the Local Market Tablet

Two Rapid, direct, ecological friendly and economical spectrophotometric methods were used for estimation of meloxicam in the market Tablet dosage form. The First method is based on the use the fourth order derivative spectrum (D4) and the second method is depend-ed on the ratio of the area under the curve for the two peaks in the drug (Compensated area under the curve). The linear calibration graphs of the two methods were measured in the con-centration range (5-35)mg/l and the average of recoveries for local market Tablet (AWA)® were 99.8% for D4 method and 100.2% for CAUC method which indicating a good accuracy and precision for these methods. In this study, the results obtained by these suggested meth-ods have been successfully statistically compared by t-test and Mann-Whitney test showed a good agreement

Bladder Adenocarcinoma: A Case Report

Background: Bladder adenocarcinoma (AC) is a rare histological variant and research on the best ways to treat it is scant. Clinical Case: We present the case of a 70-year-old woman who has had hematuria for the past month with no history of serious illness. She visited a urologist, who performed a cystoscopy on her as a result. A urinary bladder adenocarcinoma was discovered in a biopsy. Complete investigations revealed no metastasis. The patient was considered for a partial cystectomy, according to the results of the MRI. She underwent the surgery, which was followed by concurrent chemo-radiotherapy. She underwent multiple reevaluations, and her case was stable after about a year of follow-up. Conclusions:&nbsp;With the best surgical outcomes, the choice to perform a partial cystectomy was appropriate given the tumor\u27s location. However, a lengthy follow-up is required

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Global injury morbidity and mortality from 1990 to 2017 : results from the Global Burden of Disease Study 2017

Correction:Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.Peer reviewe

Estimating global injuries morbidity and mortality : methods and data used in the Global Burden of Disease 2017 study

Background While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.Peer reviewe

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe