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False Beliefs About Diabetes Mellitus in the Kurdistan Region of Iraq: A Population-Based Study
Full text linkBackground. Diabetes mellitus (DM) is a chronic, non-transmissible health condition distinguished by high blood glucose levels caused by faulty insulin secretion and impaired insulin activity. People play an essential role in preventing and managing their illnesses. Thus, the misconceptions may negatively influence the prevention and management of DM.
The aim of this study was to gauge the extent of knowledge among the general population concerning DM, to determine the prevalence of misconceptions about DM in the community, and to find the factors influencing them.
Methods. A population-based study was conducted in Duhok Province, the Kurdistan Region of Iraq. A total of 2,305 adults were enrolled in the study. The study data were collected by face-to-face interview. The survey questionnaire comprised two sections: the first section included basic demographic characteristics of participants, while the second section consisted of ten questions to identify common misconceptions about DM among participants.
Results. Among the participants, there were 1,406 (61.0%) females. Participants’ age ranged from 18 to 90 years (the mean age: 54 ± 13.69 years). The most common misconceptions positively responded to were “Will I become addicted to insulin if I start taking it?”, followed by“ Does DM occur because of increased sugar intake?”. Male gender was associated with higher level of misconceptions. In addition, the misconceptions were more prevalent among diabetics as they might seek treatment from non-professionals. There was a significant association between education status and the prevalence of misconceptions. Healthcare workers were found to have a better knowledge about DM compared to the general population. Surprisingly, certain myths were prevalent even among healthcare workers.
Conclusions. Certain myths and misconceptions have been pervasive in our society. Actions must be taken to dispel these misconceptions as they lead to an avoidable burden of disease. Therefore, people’s knowledge of DM needs to be enhanced through educational programs, social media, television, newspapers and campaigns
Anatomical Features of the Parameters of the thigh Circumference of Students of Bukovyna
Full text linkIntroduction. According to the point of view of many scientists, the continuous growth of achievements in sports, high competition in the international sports arena require a constant search for effective methodical, organizational and management solutions in the long-term training of athletes. So, we can conclude that the main content of all stages of sports selection is the prediction of the athlete's sports talent. Taking into account that the anthropometric parameters of athletes have been studied and are being studied to this day as well, but there are almost no works devoted to the study of the anatomical features of the femoral area of athletes of team sports.
Aim. To find out the anatomical features of the thigh circumference of football students of Bukovyna, followed by modeling for sports selection.
Materials and methods. A study was conducted on 86 student-football players of Bukovyna (the initial study was conducted during September-October 2021, and a repeat study of these same students in September-October 2022). The main group consisted of 46 (53.5%) football players and the control group - 40 (46.5%) students aged 16 to 18 years. All students were subjected to an anthropometric study, according to the method of P.P. Shaparenka (thigh circumference in the upper third, in the middle third and in the lower third, body weight, height). Welch's test was used to distribute the established parameters in both groups by gender. A paired t-test (paired-samples t-test) was performed to compare the respondents' indicators during the first measurement and the second one a year later. Statistical analysis of the obtained data was carried out using the licensed program RStudio.
Results. The comparisment of the thigh circumference parameters of football students of the main group between boys and girls in the initial study, found a difference between the indicators, since in all measurements the indicators of the boys are higher than those of the girls (±3.02 cm), especially when the circumference of the thigh in the lower third on the right is ±5.04 cm. The comparisment of the thigh circumference of the main group on the right and on the left, has established that in boys and girls the circumference in the upper third on the right is bigger by ±4.02 cm than on the left; the circumference thighs in the middle third on the left in girls and boys are bigger by ±10.01 cm; the circumference in the lower third in boys is bigger on the right by ±7.05 cm, in girls by ±5.04 cm. the comparison of thigh circumference in dynamics after a year, in football students reveals an obvious difference with the increase in thigh parameters: in the upper third of the right in boys and girls by ±1.5 cm, in the left in boys and girls by ±4.02 cm; in the middle third by ±4.5 cm in both genders on the right and by ±4.02 cm on the left; in the lower third by ±1.5 cm on the right in boys and by ±3.02 cm in girls, on the left by ±4.02 cm in both genders. By comparing the circumference between the right and left thighs in the main group, there is a difference, because in the upper the right third of girls and boys is ±1.5 cm more than the left; in the middle third from the left, boys have more by ±9.03 cm, girls by ±8.5 cm; in the lower third on the right, boys have more by ±4.5 cm, girls have more by ±4.02 cm.
Conclusions: Model for predicting thigh circumference in the upper third (right): Cpr=β1 + β2 + 0.493w – 0.135h, left: Cpl=β1 + β2 + 0.465w; in the middle (right): Cmr=β1 + β2 + 0.460w – 0.183h, on the left: Cml=β1 + β2 + 0.449w; in the lower third (right): Cdr=β1 + β2 + 0.418w, on the left: Cdl=β1 + β2 + 0.387w.Резюме: На думку багатьох науковців, безперервне зростання спортивних досягнень в спорті, висока конкуренція на міжнародній спортивній арені вимагають невпинного пошуку ефективних методичних, організаційних і управлінських рішень в багаторічній підготовці спортсменів. Звідси можна зробити висновок, що основним змістом всіх етапів спортивного відбору є прогнозування спортивної обдарованості спортсмена. Беручи до уваги, що антропометричні параметри спортсменів вивчались та вивчаються до теперішнього часу також, але робіт присвячених вивченню саме анатомічним особливостям стегнової ділянки спортсменів командних видів спорту майже не має.
Мета дослідження: з’ясувати анатомічні особливості окружності стегна студентів-футболістів Буковини, з наступним моделюванням для спортивного відбору.
Матеріали та методи: Проведено дослідження на 86-ти студентах-футболістах Буковини (первинне дослідження було здійснено впродовж вересня-жовтня 2021 року, а повторне дослідження цих самих студентів у вересні-жовтні 2022 року). Основну групу склали студенти-футболісти – 46 (53,5 %) та контрольну – 40 (46,5 %) студентів, віком від 16 до 18 років. Усім студентам було проведено антропометричне дослідження, за методикою П.П. Шапаренка (окружність стегна в верхній третині, в середній третині та в нижній третині, масу тіла, зріст). Для розподілу встановлених параметрів в обох групах за гендером використовували тест Уелча. Для порівняння показників респондентів під час першого вимірювання та повторного через рік було проведено парний t-тест (t-тест парних вибірок). Статистичний аналіз отриманих даних проведено за допомогою ліцензованої програми RStudio.
Результати дослідження та їх обговорення: Отже, при порівняння параметрів окружності стегна студентів-футболістів основної групи між юнаками та дівчатами при первинному дослідженні є різниця між показниками, оскільки по всіх вимірах у юнаків показники вищі, ніж у дівчат (±3,02 см), особливо при окружності стегна в нижній третині справа ±5,04 см. За порівнянням параметрів окружності стегна досліджуваних основної групи справа та зліва, встановлено, що у юнаків та дівчат справа в верхній третині окружність більша на ±4,02 см, ніж зліва, окружність стегна в середній третині зліва у дівчат та юнаків більша на ±10,01 см, окружність в нижній третині у юнаків більша справа на ±7,05 см, у дівчат на ±5,04 см. Порівняння окружності стегна в динаміці через рік, у студентів-футболістів виявляє очевидну різницю зі збільшенням параметрів стегна: в верхній третині справа у юнаків та дівчат на ±1,5 см, зліва у юнаків та дівчат на ±4,02 см; в середній третині на ±4,5 см у обох гендерів справа та на ±4,02 см зліва; в нижній третині на ±1,5 см справа у юнаків та на ±3,02 см у дівчат, зліва у обох гендерів на ±4,02 см. За порівнянням окружності між правим та лівим стегном в основній групі є різниця, оскільки в верхній третині справа у дівчат і юнаків більше на ±1,5 см, ніж зліва; в середній третині зліва у юнаків більше на ±9,03 см, у дівчат на ±8,5 см; в нижній третині справа у юнаків більше на ±4,5 см, у дівчат на ±4,02 см.
Висновки: Модель для прогнозування окружності стегна в верхній третині (справа): Cpr=β1 + β2 + 0,493w – 0,135h, зліва: Cpl=β1 + β2 + 0,465w; в середині (справа): Cmr=β1 + β2 + 0,460w – 0,183h, зліва: Cml=β1 + β2 + 0,449w; в нижній третині (справа): Cdr=β1 + β2 + 0,418w, зліва: Cdl=β1 + β2 + 0,387w
Impact of Analytics Applying Artificial Intelligence and Machine Learning on Enhancing Intensive Care Unit: A Narrative Review
Full text linkIntroduction. The intensive care unit (ICU) plays a pivotal role in providing specialized care to patients with severe illnesses or injuries. As a critical aspect of healthcare, ICU admissions demand immediate attention and skilled care from healthcare professionals. However, the intricacies involved in this process necessitate analytical solutions to ensure effective management and optimal patient outcomes.
Aim. The aim of this review was to highlight the enhancement of the ICUs through the application of analytics, artificial intelligence, and machine learning.
Methods. The review approach was carried out through databases such as MEDLINE, Embase, Web of Science, Scopus, Taylor & Francis, Sage, ProQuest, Science Direct, CINAHL, and Google Scholar. These databases were chosen due to their potential to offer pertinent and comprehensive coverage of the topic while reducing the likelihood of overlooking certain publications. The studies for this review involved the period from 2016 to 2023.
Results. Artificial intelligence and machine learning have been instrumental in benchmarking and identifying effective practices to enhance ICU care. These advanced technologies have demonstrated significant improvements in various aspects.
Conclusions. Artificial intelligence, machine learning, and data analysis techniques significantly improved critical care, patient outcomes, and healthcare delivery
The Relationship Between Anxiety Symptoms, Anxiety Sensitivity, and Emotional Schemas in Patients Admitted to Psychiatry Outpatient Clinic
Full text linkIntroduction. Anxiety disorders are among the most common mental disorders being an important cause of disability as they impair the functionality of affected individuals.
Our study aimed to evaluate the effects of anxiety sensitivity, which is one of the cognitive structures involved in the etiology and perpetuation of psychopathologies, and emotional schemas, which evaluate how people handle their emotions, on anxiety symptoms.
Methods. One hundred participants who were admitted to the outpatient psychiatry clinic, agreed to participate in the study, and met the inclusion criteria were included in the study. The Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-I), Leahy Emotional Schema Scale Turkish Version (LESS-T), and Anxiety Sensitivity Index (ASI-3) were administered to the participants.
Results. A correlation analysis revealed a significant relationship between the BAI score and BDI-I score, ASI-3 total score, and LESS-T Uncontrollability, Weakness, Comprehensibility, Acceptance of Emotions, Rumination, Denial of Emotions, Validation subscale scores (p < 0.05). A logistic regression analysis that examined the risk factors predicting anxiety symptoms in individuals found that increasing BDI-I and ASI-3 total scores had an increasing effect on the development of anxiety, and an increase in the LESS-T Denial of Emotions subscore had a decreasing effect.
Conclusions. Determining anxiety sensitivity and emotional schemas in patients with anxiety symptoms may be a guide in identifying and treating the risk factors for the development of anxiety disorders
Impact of Oral Habits and Buccal Frenulum on Gingival Microcirculation in Children: Findings and Clinical Significance
Full text linkBackground. Oral mucosal abnormalities such as abnormal lip frenulum, buccal frenulum, ankyloglossia are commonly observed in a routine dental practice. The close anatomical and functional relationship between the gingiva and the alveolar bone determines the significance of abnormal mucosal structures in the development of malocclusions and periodontal diseases. Oral habits are more prevalent in childhood; however, they can persist into adolescence and adulthood, potentially leading to dentofacial impairments and malocclusions. Therefore, there is a growing interest in understanding oral mucosal blood flow in the presence of oral habits and abnormal mucosal structures, as their combined effects may have a synergistic influence on the development of maxillomandibular anomalies.
Aim. This study was aimed to investigate age-depended parameters of gingival microcirculation in children with buccal frenulum, oral habits, and maxillomandibular anomalies.
Methods. This cross-sectional study involved 45 apparently healthy children and 180 children with oral habits, buccal frenulum, and maxillomandibular anomalies, divided into 3 age groups (ages 9 to 12, 12 to 15, and 15 to 17 years). Oral mucosal blood flow was assessed using a rheograph DX (Kharkiv, Ukraine) by measuring qualitative characteristics and quantitative parameters such as the vascular tone index (VTI), venous outflow index (VOI), peripheral resistance index (PRI), extensive blood flow index (EBFI), and rheographic index (RI). Statistical analysis included Spearman’s correlation, a Kruskal-Wallis H test, and a Dunn’s post-hoc test.
Results. The study revealed a significantly higher VTI in all patient groups, increasing with age and reaching +80.54% in the oldest age group compared to the respective control group. This elevation was accompanied by a moderate correlation enhancing the PRI (+4.61% in 9-12-year-old group to +33.42% in 15-17-year-old group). Furthermore, the VOI exhibited a noteworthy and age-dependent increase; however, there was a notable reduction in the RI (-41.10% to -59.70%) and EBFI values (-35.54% and -37.70% versus -23.97% in the youngest age group).
Conclusions. This study demonstrated a relationship between oral habits, buccal frenulum, and age-dependent disturbance of gingival microcirculation in children. The findings suggest that chronic traumatization due to oral habits and abnormal mucosal structures lead to increased vasoconstriction and impaired vessel elasticity. Early intervention and management of such category of patients are crucial for preserving optimal gingival microcirculation
The Impact of SARS-CoV-2 Pandemic on Medical Students: Knowledge, Attitudes, and Practices towards E-Learning: An Online Cross-Sectional Study in the Kurdistan Region, Iraq
Full text linkBackground. After COVID-19 emergence, medical education witnessed a shift from face-to-face education to digital education, which inevitably affected medical students. Globally, due to the closure of schools and universities, medical education was shifted to electronic learning (E-learning).
This paper aimed to assess the effects of the COVID-19 pandemic on medical education and determine medical students’ knowledge, attitude, and practices towards E-learning in the Kurdistan Region of Iraq.
Materials and Methods. An online cross-sectional study was conducted among 500 undergraduate students of seven medical colleges in the Kurdistan Region, Iraq, in November 2021, to assess their state during the COVID-19 pandemic and how this affected their education.
Results. There were 50.6% of males and 49.4% of females. The mean age was 20.6 (± 1.5 SD) years. Approximately 17% of participants mentioned having financial issues, while 19.2% of students experienced health-related problems. As many as 67% of participants reported that the Internet quality was good or very good, whereas 46.8% of students disagreed that E-learning was a possible substitute for traditional learning. About two-thirds of participants agreed or were neutral that downloadable content was better than live content; however, only 19.2% of students agreed that E-learning could be used in the clinical aspect. A total of 52.2% of participants disagreed that E-testing could replace traditional learning methods. Surprisingly, 86.4% of students stated that they regularly used the Internet in their study.
Conclusions. E-learning was the main adjustment made in the educational system, including medical education. The study concluded with insights into how different circumstances could have different consequences on the efficacy of medical education. E-learning showed effective results in continuing learning until the educational system switched to a blended system. Training programs for medical education personnel are vital in effective E-learning opportunities
Nisin: Prerequisites and Prospects for Application in the Medical Field
Full text linkNisin is a typical representative of class I bacteriocins belonging to subtype A1 lantibiotics. This lantibiotic is produced by gram-positive bacteria of the genera Lactococcus, Streptococcus, Staphylococcus, and Blautia. Currently, at least twelve natural variants of nisin are known. They differ in some physicochemical properties and biological activity. Nisin is generally recognized as safe (GRAS) and has been used as a food additive for seven decades. The current review presents the data from scientific reports over the past decade supporting the value of this lantibiotic as a therapeutic agent. Most research works demonstrate a high inhibitory potential of nisin against antibiotic-resistant bacteria when using alone and in combination with antibiotics. A number of studies prove the ability of nisin to modulate the composition of oral and intestinal microbiomes, to inhibit the growth of both bacteria causing infectious processes and bacterial pathogens associated with cancer. Nisin has been shown to have its own antitumor potential and to be able to enhance the therapeutic effect of chemotherapeutic drugs. There is convincing evidence of its immunomodulatory and anti-inflammatory activity. The reasons limiting its widespread application in clinical practice can be successfully eliminated via modern bioengineering technologies that improve the functional characteristics and stability of nisin in various physiological conditions
Associations of Dietary Fructose and Sucrose Intake with HbA1c and Anthropometric Measurements in Patients with Type 2 Diabetes Mellitus
Full text linkAim. This study aimed to evaluate the associations of daily dietary intake of fructose and sucrose with HbA1c levels and anthropometric measurements in patients with Type 2 diabetes mellitus.
Methods. A total of 64 individuals were included in the study. Demographic characteristics, eating habits, frequency of fructose and sucrose source consumption, and dietary intakes were assessed through questioning. Anthropometric measurements, including body weight, height circumference (HtC), waist circumference (WC), hip circumference (HC), neck circumference (NC), wrist circumference (WrC), and mid-upper arm circumference (MUAC), were evaluated. The HbA1c level was categorized into two groups: good glycemic control (HbA1c≤ 7%) and poor (HbA1c> 7%) glycemic control.
Results. The mean daily fructose and sucrose intakes were 10.57 ± 8.28 g (2.38 ± 1.96%), and 29.21 ± 24.78 g (6.29 ± 5.35%), respectively. All the anthropometric measurements assessed were lower in the group with good glycemic control; however, only in case of BMI, MUAC, NC, and WrC, these differences were significant. Patients with good glycemic control were found to consume more fruit. Anthropometric measurements were not related to daily fructose intake, but positively associated with sucrose intake and HbA1c levels. Specifically, HbA1c levels were negatively associated with fiber intake and positively associated with sucrose intake. Moreover, HbA1c levels were positively affected by NC and consumption of non-alcoholic carbonated drinks, and negatively affected by WC and consumption of sugar-containing instant coffee.
Conclusions. The mean daily fructose intake among diabetics was found to be moderate and sucrose intake was consistent with the recommended range. The level of HbA1c was shown to be associated with all the anthropometric parameters assessed, and it was found that sugar-sweetened beverages could affect the level of HbA1c. However, further studies with larger sample sizes are needed to investigate these relationships more comprehensively.
 
A Case of Delayed Immune Checkpoint Inhibitor Hepatitis in a Patient with Malignant Melanoma
Full text linkImmune checkpoint inhibitors are an increasingly utilized class of medications in oncology. Significant adverse effects have been reported, including hepatitis which mostly occurs early after initiating treatment. We present a case of a 78-year-old male with past medical history of recurrent sinusoidal mucosal malignant melanoma on pembrolizumab for three years that presented with painless jaundice of 72-hour duration. Laboratory evaluation demonstrated alkaline phosphatase at 1780 IU/L, aspartate aminotransferase at 2290 IU/L, alanine aminotransferase at 1224 IU/L, and bilirubin of 10.0 mg/dL with direct bilirubin of 7.4 mg/dL. The patient underwent interventional radiology transjugular liver biopsy demonstrating features of drug-induced liver injury secondary to pembrolizumab therapy. He was started on steroid therapy and completed six-week course with resolution in liver enzymes. This is a unique case in which pembrolizumab-induced hepatitis occurred three years after initiation of treatment. Due to the increased use of immune checkpoint inhibitors for oncologic treatment, it is important for clinicians to recognize their immune-related adverse effects and varying timing in which these toxicities may occur
КЛІНІЧНЕ СПОСТЕРЕЖЕННЯ ГОСТРОЇ КИШКОВОЇ НЕПРОХІДНОСТІ ВИКЛИКАНОЇ ГІГАНТСЬКОЮ ГРАНУЛЬОЗОКЛІТИННОЮ ПУХЛИНОЮ ЯЄЧНИКА
Full text linkOvarian granulosa cell tumours (OGCT) are non-epithelial neoplasms of the ovaries and belong to the group of granulosa-stromal tumours. The most likely source of these tumours’ development is granulosis of the primordial follicles of the ovary as a result of hormonal imbalance.
The aim of the study is to represent a clinical observation of acute intestinal obstruction caused by a giant ovarian granulosa cell macrofollicular tumour.
A woman, aged 52 years, medical history № 2579, was admitted to the surgical department of Communal Non-Profit Enterprise (CNPE) City Clinical Hospital (CCH) № 1 in Ivano-Frankivsk as an urgent patient with complaints of nausea, vomiting, delayed passage of flatus and defecation, general malaise, abdominal distention. During the laboratory and instrumental examination, a giant tumour of the abdominal cavity was revealed; it has led to the compression of internal organs and the development of small- and large-intestinal obstruction. The operation was performed: middle-median laparoscopy, removal of a giant cyst of the right ovary. Complete hysterectomy with appendages, drainage of the abdominal cavity were also performed.
During the operation, a giant tumour with dimensions of 65x70x50 cm, of dense but elastic consistency, pale-pink in color, with multiple chambers of different diameters filled with cloudy, yellow liquid was revealed. The removed uterus with appendages and a large omentum were also given for pathological examination. Pathohistological examination results included: 15824-8- granulosa-cell ovarian tumour; 15815-7- uterus - plethora; 15818-20-ovary - white bodies, fallopian tube - chronic salpingitis; 15812-4- omentum - focal hemorrhages. The postoperative period was uneventful, the patient was referred to a gynecologist-oncologist for consultation and treatment