Pudendal nerve versus Lower Limb nerves electrophysiological abnormalities in diabetics with erectile dysfunction in Baghdad

Background: Erectile dysfunction (ED) is the persistent inability to perform and maintain penile erection strong enough for fulfilling sexual interaction. It is caused by autonomic neuropathy, vasculogenic causes, endocrine deficit, drug-induced, psychosocial problems, or a combination of these causes. Objective: This study aims to compare pudendal neuropathy against limb neuropathy in diabetics complaining of erectile dysfunction through electrophysiological studies. Methodology: Eighty-four diabetic males were enrolled in this analytic cross-sectional study presented with erectile dysfunction. All participants were assessed by electrophysiological studies using Bulbocavernosus Induced Reflex to assess the competence of the pudendal nerve. Other nerve studies were used to assess lower limb nerve competence. The study was conducted in Ghazi Al-Hariri Surgical teaching hospital in Baghdad for the period from October 2021 to June 2022. Results: Nerve assessments revealed earlier involvement of the peripheral lower limb nerves in comparison with pudendal nerve. Conclusion: Electrophysiological assessment is a practical test which can be used in identifying neurologic deficit among diabetic patients with erectile dysfunction.

Role of Visual Evoked Potentials in Multiple Sclerosis

Background: Multiple sclerosis (MS) is a chronic, demyelinating disease of the central nervous system (CNS) affecting young adults and is considered as the leading cause of non traumatic neurological disability of young adults affecting nearly 2 million people worldwide. The pathogenesis of MS is at best incompletely understood. There are several proposed mechanisms that may be important in the production of MS plaques: autoimmunity, environment and heredity. Deviation of immune responses in a genetically susceptible patient plays a central role in its pathogenesis. Electrophysiological, spinal tap and Radiological tools are important laboratory investigations and have added so much to the clinical diagnosis and for the classification of MS. It was found that visual function and conduction has been changed in patients with multiple sclerosis. Objectives: The aims of the study is to estimate and evaluate the visual evoked potential (VEP) parameters in patients with MS and its relation to their disability degree (using the expanded disability status scale score "EDSS") and visual presentation of them in comparison with healthy individuals. Patients and Methods: 112 patients with multiple sclerosis and 50 subjects without any neurological or psychiatric diseases as control group were recruited in this study. The cases were collected from Baghdad teaching hospital, MS center, Baghdad, Iraq at the period from May 2012 to April 2013, and studied at the unit of electrophysiology in Al-Shaheed Ghazi Al-Hareri Hospital in the Medical city. All patients and control groups were tested for VEP. Results: The present study showed a significant increase in the P100 latency and inter-ocular (IO) latency difference and non statistical significant decrease in the IO amplitude difference in patients group than the control group. Also among patients group there was positive linear correlation between the severity of the disease measured by EDSS score and P100 latency while negative linear correlation with the amplitude. Conclusion: There was a higher percent of patients with defective VEP parameters and so their visual pathway even if it was asymptomatic, in addition to their relation with patients` disability than the control group, making it easy to quantify and predict MS disability objectively. Keywords: Multiple sclerosis, Expanded Disability Status Scale, VEP

AH jump as predictor for successful Ablation of atrioventricular nodal reentrant tachycardia (AVNRT)

Background: Atrioventricular nodal reentrant tachycardia (AVNRT) is the commonest regular supraventricular tachyarrhythmia. Ablation in the area of slow pathway (SP) has been successfully implemented in every day clinical electrophysiological practice for more than 20 years. Although the procedure is generally regarded as effective and safe, data on long-term effects and predictors of success or failure are incomplete. Objectives: This study was designated to prove that AH interval is an electrophysiological parameter which serves as a predictor for successful AVNRT ablation. Methods: While performing an electrophysiological study using a programmed atrial stimulation, thirty nine (39) patients (25 female and 14 males) with a mean age 51 ± 16.7 years with AVNRT were assessed and underwent AVNRT radiofrequency ablation using diagnostic and ablation catheters inserted via the right femoral veins. This study was performed during the period from February, 2013 to march, 2014 at the unit of Electrophysiogy in Leipzig heart center. Results: Acute successful AVNRT ablation was achieved in 39 (100%) patients, including 23 (59%) with slow pathway (SP) ablation and 16 (41%) with SP modification. Patients with SP modification were younger male, had faster AVNRT cycle length, and had more frequent isoproterenol usage before ablation. During six months follow-up period, all patients experienced no AVNRT recurrences. . Conclusions: AH jump served as predictor for successful Ablation of atrioventricular nodal reentrant tachycardia with a better outcome

The effect of Valsalva maneuver on diastolic filling indices in patients with essential hypertension.

Background: Left ventricular hypertrophy and diastolic dysfunction are considered to be an important risk factor for cardiovascular morbidity and mortality in asymptomatic hypertensive patients. At the bedside, left ventricular geometric remodeling and diastolic dysfunction in hypertension can not be diagnosed without echocardiography which is a useful adjunct to the medical history, physical examination, ECG, and chest radiography. Hence, it provides an opportunity for good management and prognosis of what appears to be preclinical hypertensive complication.  Subjects and Methods: 127 subjects with essential hypertension of either sex attending echo unit were subjected to medical history, clinical examination, physical measurements, ECG, M-mode and Doppler echocardiography. They were classified as 46 treated hypertensives where they were on regular antihypertensive medication, and 81 untreated hypertensive patients. In addition, they were sex and age matched to 39 healthy subjects who served as control group.  Results: The results of this study revealed that hypertensive patients especially those with stage II hypertension were prone to develop left ventricular hypertrophy (LVH) of concentric geometric pattern and diastolic dysfunction. However, small percentage of those patients found to have diastolic dysfunction despite they were without LVH. In addition, Doppler echocardiography clarify that hypertensives with abnormal transmitral inflow profile; of left ventricular impaired relaxation pattern suffered left ventricular systolic dysfunction. Moreover, in this study there was no evidence of  pseudonormal transmitral inflow filling pattern which is excluded after Valsalva maneuver. Conclusion: There is a strong association between left ventricular hypertrophy and diastolic dysfunction which was more common in patients with stage II hypertension. However, left ventricular diastolic dysfunction is usually follows left ventricular hypertrophy, but it still may proceed especially in those patients with left ventricular hypertrophy (LVH) of concentric geometric pattern. In addition, left ventricle diastolic dysfunction is not necessary coincide with the development of systolic dysfunction, namely normal ejection fraction and fractional shortening

Influence of Diabetes Mellitus on myocardial repolarization by measurement of QT variability Index

Background: Various abnormalities in myocardial repolarization assessed by QT variability index (QTVI) in diabetics are associated with high risk to ventricular arrhythmia. The increase in cardiovascular morbidity and mortality appears to relate to the synergism of hyperglycemia with dyslipidemia, hypertension and obesity in addition to disturbed myocardial repolarization. Objectives: The aim of the present study was to estimate and evaluate an index of myocardial repolarization instability (QTVI) in patients with DM on insulin or oral hypoglycemic drugs in comparison with healthy individuals. Patients and Methods: The study was conducted on fifty six (56), middle-aged patients with DM of either sex in addition to age-matched healthy subjects (32) served as control, during the period between December 2009 to January 2011 in Al-Kadhimya Hospital. 21 patients were on insulin therapy and 35 were on oral hypoglycemic drugs (OHD). Holter monitoring for 30 minutes was performed for each subject, and QTVI was calculated as the logarithm of the ratio between the variances of the normalized QT and RR intervals. Results: QTVI was significantly increased in patients with DM as compared with the control healthy subjects (−0.82± 0.56, −1.54± 0.27 respectively; P<0.01). However, QTVI did not differ significantly among patients on insulin or OHD treatment. Conclusion: the present study concludes an elevated QTVI in patients with DM when compared with that of control

Arterial stiffness index as a marker for the occurrence of atherosclerotic cardiovascular disease

Background: Arterial functional changes reflected by vascular stiffness might occur at early stages of cardiovascular disease before the morphological alterations reflected by increasing the intima media thickness and it is widely used as a very sensitive indicator of functional vascular damage. Objectives: This study is aimed to correlate ultrasound detected vascular functional changes with the severity and extent of coronary artery disease. Patients and methods: Sonographic scans were performed on 100 Patients (61males, 39 females) with an age range of (40-65years) for measuring carotid and brachial arteries end diastolic and end systolic diameters to calculate vascular stiffness index . Coronary CT angiography has been used to visualize the atherosclerotic plaque to define the degree of luminal stenosis by creation of high-quality images which are obtained by the multislice CT spiral scanners. Results: A positive statistical correlation was observed between the stiffness index of both carotid and brachial arteries in single coronary lesion (SCL), multiple coronary lesion (MCL) and control groups in addition to the significant positive correlation between both arteries stiffness index with the percentage of coronary artery stenosis in SCL group. Significant difference between the arterial stiffness index among the study groups is only noticed for carotid artery between the control and MCL groups (p<0.05). Conclusion: Conduit arterial stiffness index is a good indicator of the severity and extent of coronary artery disease

Assessment of endothelial dysfunction by flow mediated dilatation in patients with Coronary Artery Disease

Background: Endothelial dysfunction is thought to be a key event in the development of atherosclerosis. It is a systemic process that simultaneously affects different vascular territories including coronary arteries. It is recommended that noninvasive approaches assessing endothelial function in peripheral vessels like flow mediated dilatation are indirectly representative of coronary vascular function. Objectives: This study is aimed to assess endothelial dysfunction by using flow mediated dilatation in patients with coronary artery disease Patients and methods: 82 patients of either sex with an age range of 40-65years are involved in this study. Each patient was subjected to two tests; first test was the flow mediated dilatation percentage (FMD%) measurement to assess endothelial functional integrity and second one was coronary computerized tomography angiography for measuring the percentage of coronary artery stenosis. Results: the results of this study revealed that FMD% is inversely correlated with the percentage of coronary artery stenosis (p value <0.01). FMD% in patients having a single coronary vessel atheromatous stenosis (9.9±3.5) % was significantly lower than that of control subjects (15.3±7) %, p<0.0001. Conclusion: this study concludes that FMD% of brachial artery could be used as a marker for systemic endothelial functional integrity including that of coronary arteries

Impact of metformin on the clinical and metabolic parameters of women with polycystic ovary syndrome: a systematic review and meta-analysis of randomised controlled trials

Context: Polycystic ovary syndrome (PCOS) is one of the commonest endocrine disorders affecting women of reproductive age, and metformin is a widely used medication in managing this condition. Aim: To review the available literature comprehensively on the therapeutic impact of metformin on the clinical and metabolic parameters of women with PCOS. Data source: We searched PubMed, MEDLINE, Scopus, Embase, Cochrane Library and the Web of Science and selected sources for grey literature from their inception to April 2020. An updated search in PubMed was performed in June 2022. Data synthesis: Two reviewers selected eligible studies and extracted data, and the review is reported following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: In 24 eligible randomised controlled trials (RCTs) involving 564 participants who received metformin therapy, metformin was associated with significant reduction in body weight by 3.13 kg (95% CI: −5.33, −0.93), body mass index (BMI) by 0.82 kg/m² (95% CI: −1.22, −0.41), fasting blood glucose [standardised mean difference (SMD): −0.23; 95% CI: −0.40, −0.06], low-density lipoprotein cholesterol (LDL-C) (SMD: −0.41; 95% CI: −0.85, 0.03), total testosterone (SMD: −0.33; 95% CI: −0.49, −0.17), androstenedione (SMD: −0.45; 95% CI: −0.70, −0.20), 17-hydroxyprogesterone (17-OHP) (SMD: −0.58; 95% CI: −1.16, 0.00) and increase the likelihood of clinical pregnancy rate [odds ratio (OR): 3.00; 95% CI: 1.95, 4.59] compared with placebo. Conclusion: In women with PCOS, metformin use has shown a positive impact in reducing body weight, BMI, total testosterone, androstenedione, 17-OHP, LDL-C, fasting blood glucose and increasing the likelihood of pregnancy in women with PCOS

COVID-19 Vaccination Among Diverse Population Groups in the Northern Governorates of Iraq

Objectives: The present study was carried out to investigate COVID-19 vaccination coverage among populations of internally displaced persons (IDPs), refugees, and host communities in northern Iraq and the related underlying factors.Methods: Through a cross-sectional study conducted in five governorates in April–May 2022, 4,564 individuals were surveyed. Data were collected through an adapted questionnaire designed to gather data on participants.Results: 4,564 subjects were included (59.55% were 19–45 years old; 54.51% male). 50.48% of the participants (51.49% of host communities, 48.83% of IDPs, and 45.87% of refugees) had been vaccinated with at least one dose of COVID-19 vaccine. 40.84% of participants (42.28% of host communities, 35.75% of IDPs, and 36.14% of refugees) had been vaccinated by two doses, and 1.56% (1.65% of host communities, 0.93% of IDPs, and 1.46% of refugees) were vaccinated with three doses.Conclusion: Sociodemographic factors including age, gender, education, occupation, and nationality could affect vaccination coverage. Moreover, higher acceptance rate of vaccination is associated with belief in vaccine safety and effectiveness and trust in the ability of the vaccine to prevent complications

Neonatal sepsis and mortality in low-income and middle-income countries from a facility-based birth cohort: an international multisite prospective observational study

Background Neonatal sepsis is a primary cause of neonatal mortality and is an urgent global health concern, especially within low-income and middle-income countries (LMICs), where 99% of global neonatal mortality occurs. The aims of this study were to determine the incidence and associations with neonatal sepsis and all-cause mortality in facility-born neonates in LMICs. Methods The Burden of Antibiotic Resistance in Neonates from Developing Societies (BARNARDS) study recruited mothers and their neonates into a prospective observational cohort study across 12 clinical sites from Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa. Data for sepsis-associated factors in the four domains of health care, maternal, birth and neonatal, and living environment were collected for all mothers and neonates enrolled. Primary outcomes were clinically suspected sepsis, laboratory-confirmed sepsis, and all-cause mortality in neonates during the first 60 days of life. Incidence proportion of livebirths for clinically suspected sepsis and laboratory-confirmed sepsis and incidence rate per 1000 neonate-days for all-cause mortality were calculated. Modified Poisson regression was used to investigate factors associated with neonatal sepsis and parametric survival models for factors associated with all-cause mortality. Findings Between Nov 12, 2015 and Feb 1, 2018, 29 483 mothers and 30 557 neonates were enrolled. The incidence of clinically suspected sepsis was 166·0 (95% CI 97·69–234·24) per 1000 livebirths, laboratory-confirmed sepsis was 46·9 (19·04–74·79) per 1000 livebirths, and all-cause mortality was 0·83 (0·37–2·00) per 1000 neonate-days. Maternal hypertension, previous maternal hospitalisation within 12 months, average or higher monthly household income, ward size (>11 beds), ward type (neonatal), living in a rural environment, preterm birth, perinatal asphyxia, and multiple births were associated with an increased risk of clinically suspected sepsis, laboratory-confirmed sepsis, and all-cause mortality. The majority (881 [72·5%] of 1215) of laboratory-confirmed sepsis cases occurred within the first 3 days of life. Interpretation Findings from this study highlight the substantial proportion of neonates who develop neonatal sepsis, and the high mortality rates among neonates with sepsis in LMICs. More efficient and effective identification of neonatal sepsis is needed to target interventions to reduce its incidence and subsequent mortality in LMICs. Funding Bill & Melinda Gates Foundation