Journal of the Faculty of Medicine Baghdad 2020-10-28T00:35:34+00:00 prof. Tharwat I. Sulaiman Open Journal Systems <h3>Journal of the Faculty of Medicine – University of Baghdad</h3> <h3>A peer-reviewed journal published Quarterly by the college of medicine –Baghdad University</h3> <h3>ISSN:&nbsp; &nbsp;0041-9419</h3> <h3>EISSN: 2410-8057</h3> <h3>The Journal interested in the publication of clinical and basic medical research.</h3> <h3>The first issue of this Journal was published under the name of (Journal of the Royal Iraqi Medical College) in April /1936, approved by the council of the College as a general journal dealing with the news of the college and few scientific articles to encourage the teaching staff for research publication. The journal was published randomly and ceased during World War II due to financial difficulties.</h3> <h3>In 1946 Prof. Dr. Hashim Al Witri, the college dean, assigned republication of the journal and urged the teaching staff to participate and publish their research in the journal. Despite his effort, the journal remained irregular in publication. In 1959&nbsp; Prof. Dr. Faisal Al-Sabih became the Editor in Chief of the journal when he returned from the United Kingdom and appointed on the teaching staff, restructured the journal and changed its name to (The Journal of the Faculty of Medicine) and used a new scientific system for publication of articles.</h3> <h3>The first issue of the new series started in June 1959. The journal continued to be published on a regular basis since then without interruption in (four issues during the year). The journal became registered the international number (ISSN) in 2000 and entered in many important international indexes.</h3> <h3>After 2003 the journal continued despite the difficulties involved in every aspect of the country and by the beginning of 2004, the journal progressed through a series of changes to reach a level that can be recognized internationally.</h3> <h3>After 2010 the journal became published electronically of the same edited issues.</h3> Clinical evaluation of selected Pharmacological Treatments used for Coronavirus (COVID-19) pandemic 2020-10-28T00:35:33+00:00 hasan mohammed altemimy <p><strong>Background:</strong> Coronavirus is an enveloped RNA virus, from the genus Betacoronavirus, that is distributed in birds, humans, and other mammals. WHO has named the novel coronavirus disease as COVID-19.</p> <p><strong>Objective</strong>: We have conducted this review to focus on the studies that assessed the treatment efficacy and safety of Coronavirus (COVID-19) to describe its relation with the clinical outcomes of patients.</p> <p><strong>Method:</strong> PubMed, was searched for studies on the clinical evaluation of selected currently used treatments for COVID-19. we included six studies about therapeutic activity of chloroquine/hydroxychloroquine, two case series about oseltamivir and three studies about lopinavir/ritonavir</p> <p><strong>Results:</strong> some of studies have been demonstrated and approved for a wider use hydroxychloroquine for COVID-19, others concluded that there was insufficient evidence to offer any recommendation on the routine use of these drug in patients admitted to the intensive care unit (ICU). Other treatments have insufficient evidence to recommend the use (lopinavir-Ritonavir or oseltamivir) for COVID-19 outside of research studies.</p> <p><strong>Conclusion:</strong> In order to determine their efficacy and safety for COVID-19, more adequately powered randomized clinical trials are required. Ideally, these studies should be double-blinded and conducted in a range of settings.</p> <p>&nbsp;<strong>Keywords: </strong>Covid-19, hydroxychloroquine, Azithromycin, Oseltamivir, lopinavir-Ritonavir</p> 2020-06-16T00:00:00+00:00 ##submission.copyrightStatement## Spectrum of Chest Computed Tomography findings of Novel Coronavirus disease 2019 in Medical City in Baghdad, a case series 2020-10-28T00:35:33+00:00 Atheer Adnan Salam Joori Zaid Hammoodi Haider Ghayad Ali Ibrahim <p>Background: Native chest Computed Tomography (CT) is a quick, non-invasive and practical investigation &amp; plays an important role in evaluation of Coronavirus Disease 2019.</p> <p>Objective: to describe the chest CT findings in patients with confirmed coronavirus disease 2019 (COVID-19) in sample from Baghdad population.</p> <p>Patients &amp; methods: Study sample consisted of 55 patients with laboratory confirmed COVID-19 from 1<sup>st</sup> March through 15<sup>th</sup> April 2020. Native chest CT was performed in radiology departments in Medical City Teaching Complex (MCTH). The chest CT images were reviewed &amp; analyzed.</p> <p>Results: The most frequent CT findings were ground-glass opacities (47.3%) &amp; mixed ground glass &amp; consolidation (43.6%). Most lesions were multiple (67.2%), peripheral (56.3%) &amp; bilateral (81.8%). Least common findings were pleural effusion (7.2%) &amp; mediastinal lymphadenopathy (1.8%).</p> <p>Conclusion: The commonest chest CT findings of COVID-19 in Baghdad population were multiple, bilateral, peripheral ground glass opacity &amp; consolidation.</p> <p>&nbsp;</p> 2020-06-16T13:10:40+00:00 ##submission.copyrightStatement## Epidemiology of the domestic and repatriation (Covid-19) Infection in Al Najaf province , Iraq 2020-10-28T00:35:32+00:00 Ahmed H. Al- Shareef Al-Shaibani <p><strong>ABSTRACT</strong></p> <p><strong>Background:</strong> Al-Najaf province , Iraq , has experienced an outbreak of coronavirus disease 2019 (Covid-19). Epidemiological and clinical characteristics of (Covid-19) infection have been reported but a detailed clinical course and risk factors for mortality including medical comorbidities and severity of illness at time of presentation , have not been well described.</p> <p><strong>Methods:</strong> From February 24 to April 7, 2020, a case series study done on 123 PCR-confirmed cases of (Covid-19) admitted to Al-Hakeem Hospital And Quarantine Center (AHQC), in Al-Najaf Province, Iraq. Demographics, clinical and laboratory data &nbsp;gathered from a local database at (AHQC). SPSS(statistical package for social sciences) used for statistical analysis. Frequency, percentage, mean and standard deviation used as descriptive statistics. Chi square or Yates corrected chi square used as needed.(P value≤0.05) regarded significant.</p> <p><strong>Results:</strong> In total of 123 Patients, most infections occur &nbsp;inside Iraq 96(78%) .The cohort included 67 (54.5%) females and 56 (45.5%) males, mean age was 32.58±18.56 years. most infections were mild or asymptomatic (72.3%). The most common symptoms was fever (74.8% ) , followed by cough (66.7%), headache (59.3%), and dyspnoea (28.5%). Most &nbsp;patients 108(87.8%) recovered and four patients (3.3%) died. There is a significant association between medical comorbidities , severity of illness and &nbsp;patients outcome (P value <strong>&nbsp;</strong>&lt;0.001).</p> <p><strong>Conclusions:</strong> The potential risk factors of medical comorbidities and severity of illness could help clinicians to identify patients with poor prognosis at an early stage and provides the rationale for a treatment strategy of infected patients and optimal antiviral interventions in the future.</p> 2020-06-16T13:31:59+00:00 ##submission.copyrightStatement## Soft tissue sarcomas: Evaluation by immunohistochemistry 2020-10-28T00:35:32+00:00 Ibtisam Hussein Al Obaidi <p>Soft tissue sarcomas represent a histologically heterogenous group of malignant tumors arising from the soft tissue compartments, i.e smooth muscles, skeletal muscles, adipose tissue, blood vessels, connective tissue mesenchyme, neural tissue and other tumors of uncertain histogenesis(1). Soft tissue sarcomas are relatively rare tumors, represent less than 1% of adult malignancies based on data report from American Cancer Society (2). The crude incidence rate in Iraq for soft tissue sarcomas was 219/ 100,000 population during 2014 with male: female ratio of 1.3:1, and highest peak age between 30-34 years (3). The histological subtype and microscopic criteria are two parameters that influence the tumor grade which is the best predictor for aggressiveness. ( 2)</p> <p><strong>Objectives</strong>:</p> <p>A retrospective evaluation of soft tissue sarcomas, using immunohistochemical study of Myosin, Desmin, Smooth muscle Actin (SMA) and Vimentin, aiming to re-evaluate the primary diagnosis and whether IHC assessment in soft tissue sarcoma is mandatory to reach a final interpretation.</p> <p><strong>Material and Patients: </strong></p> <p>A total of 50 cases soft tissue sarcomas were reviewed retrospectively from case archives of histopathology department/ Central Public Health Laboratory, for the period (2011-2018). The data for these cases were collected including the age, gender, site of the tumor and the preliminary biopsy report findings. Hematoxylin&amp; Eosin (H&amp;E) stain and IHC staining of unstained sections from formalin-fixed, paraffin-embedded tissue were performed using SMA, Vimentin, Desmin and Myosin.</p> <p><strong>Methods</strong>: Age and gender distribution of the 50 cases was correlated. The IHC staining performed on 5 microns paraffin sections, applying peroxidase-Antiperoxidase technique and both positive and negative control slides were included for Smooth muscle actin (SMA), clone 1A4, Desmin (clone D33), Myosin (clone 2F12.A9) and Vimentin (Clone V9). The monoclonal antibodies used were from DAKO manufacturer as ready to use monoclonal antibodies while freeze-dried antibodies used for myosin with 1:20 dilution. Negative and positive control slides were used simultaneously. The staining intensity was assessed based on the percentage of positive cells expression of the four IHC monoclonal antibodies. Negative staining reported when no stain seen. Positive (+) means up to 30% of tumor cells with antigen expression. Positive (++) interpretation given when 31-60% of tumor cells show staining reaction, while Positive (+++) interpretation reported when over 60% of tumor cells showing staining reaction.</p> <p><strong>Results:</strong></p> <p>The staining interpretation of the four monoclonal antibodies were confirmatory for the original diagnosis in 40% of cases, while 60% of the final diagnoses were against the original interpretation. SMA was positive in 38/50 cases (76%). Desmin was positive in 8/50 cases (20%) Vimentin was positive in 42/50 of cases (84%), Myosin was positive in 30/50 of cases (71.4%).</p> <p>The current study focus on histological re-evaluation of different types of soft tissue sarcomas (including RMS-with its subtypes), MFH-storiform, pleomorphic and myxoid subtypes), fibrosarcoma, leiomyosarcoma, alveolar soft part sarcoma and synovial sarcoma depending on immunohistochemical study. The original diagnosis have been changed after the immunohistochemistry stain from fibrosarcoma to rhabdomyosarcoma and leiomyosarcoma , Malignant fibrous histiocytoma to rhabdomyosarcoma, alveolar rhabdomyosarcoma to Malignant fibrous histiocytoma, soft tissue sarcoma to rhabdomyosarcoma , pleomorphic MFH to pleomorphic rhabdomyosarcoma. Embryonal and alveolar rhabdomyosarcoma were confirmed by IHC as so. Leiomyosarcoma was confirmed as the same in one case. Embryonal Rhabdomyosarcoma changed to leiomyosarcoma by IHC positivity for desmin. Six cases of MFH were confirmed as malignant fibrous histiocytoma after IHC. Two cases of synovial sarcoma were re-evaluated as rhabdomyosarcoma. Vimentin revealed 100% positivity in 10 cases and regarded as a sensitive marker for mesenchymal tissue but it is not specific for certain types of sarcomas. The presence of desmin diffusely throughout a tumor is an indication of myoid differentiation and the presence of either SMA or desmin focally should not necessarily be equated with myoid lineage but rather with myofibroblastic lineage, which go in the same direction with Hirofumi N. et al. (1998).(4)</p> <p><strong>Conclusions</strong>: The co-expression of SMA and Desmin helped in the diagnosis of leiomyosarcoma (LMS). Myosin expression was helpful in the diagnosis of rhabdomyosarcoma (RMS) and alveolar soft part sarcoma (ASPS). Smooth muscle actin (SMA) and vimentin were not specific for the diagnosis of malignant fibrous histiocytoma (MFH). High grade spindle cell sarcoma express SMA only without myosin or desmin can be categorized as pleomorphic myogenic sarcoma. By applying immunohistochemical markers, 60% of soft tissue sarcomas were different from the preliminary diagnosis while 40% of cases were supportive of the original H&amp;E diagnosis.</p> 2020-06-16T13:44:57+00:00 ##submission.copyrightStatement## The Prevalence of Physical Disability in Elderly SAMPLE in Primary Health Care Centers (PHCs) in AL-Resafa Sector /Baghdad/2018 2020-10-28T00:35:31+00:00 Rana A. Hassan Lamyaa Ali Hasan <p><strong>Background</strong></p> <p>The proportion of older population throughout the world is continuously increasing, and becomes a challenge worldwide, since it may lead to an increasing number of disabled populations, and to a rise of the national health burden, and so there is greater need to look into their physical disability aspects, which is otherwise neglected.</p> <p><strong>Objectives</strong></p> <p>To estimate the prevalence of Activity of Daily Living dependency(ADL) in primary health care centers(PHCs)&nbsp; in AL Resafa health sector in Baghdad, and to find association between dependency and some sociodemographic factors.</p> <p><strong>Method</strong></p> <p>A Descriptive cross- sectional study was carried out in all PHCs in AL Resafa health sector in Baghdad and 250 elderly were interviewed using pretested questionnaire which covered some Sociodemographic factors and Barthal index scale( a 10 item instrument measuring functional independence in personal Activities of Daily Living).</p> <p><strong>Results</strong></p> <p>250 participants all of them are aged 60 year and older, those aged 60 to 69 years were 47.6%, minority aged 80 years and older , elderly female were slightly more than male (51.6%,48.4% ), Most of participants 97.6% were living in company with their families, 82.0% were not currently employed, 48% overweight , According to Barthal index scale score: 78.0% were independent while ADL with assistance observed in 15.2% and those of ADL with severity 6.8%. There was a significant association between increase in age, Female gender, low education and obesity with decrease in ADL.</p> <p><strong>Conclusion</strong></p> <p>Preserving functional capacity of elderly is a great challenge to public health, subjects categorization on the basis of &nbsp;Barthel index to correlates functional disability will be of value for a better quality of life.</p> 2020-06-16T13:56:04+00:00 ##submission.copyrightStatement## Assessment of knowledge, behavior and attitude toward using antibiotics among non-medical students of University of Fallujah- Iraq. 2020-10-28T00:35:34+00:00 Ameel Al Shawi <p><strong>Background</strong>: Antibiotics are medicines used to&nbsp; treat bacterial infections, Antibiotic resistance occurs when bacteria change in response to the use of these medicines. The world urgently needs to change the way that it prescribes and uses antibiotics.</p> <p>Objective: To assess the knowledge, attitude, behavior toward antibiotic among&nbsp; non- medical students&nbsp; in University of Fallujah.</p> <p><strong>Method</strong>: A cross sectional study was done during the period from January to March 2019.&nbsp; Self-administered questionnaire was used that &nbsp;comprised 25 questions divided into four parts. The first part including demographic questions. Second part designed to assess the knowledge of respondents&nbsp;&nbsp; . Third part for assessment of attitude of respondents,&nbsp; . While Fourth to evaluate the behavior toward using antibiotics. The study subjects was non-medical students of University of Fallujah.</p> <p><strong>Results:</strong>Females represent 54.8 % of the sample ,&nbsp; ages of subjects was between 19 year to 24 year. About two thirds 64.1 % believed that antibiotics work on most coughs and colds. 61.3 % of the participants stated&nbsp; “I will take antibiotic without prescription by doctor”, while 55.6 % of respondents prefer taking antibiotics with tea, only 39.1 % said that took antibiotics with water.</p> <p><strong>Conclusion:</strong>poor knowledge among the students towards antibiotic usage. Health education programs might be needed among universitystudents&nbsp;to improve the general knowledgeand attitudes towards antibiotic</p> 2020-06-16T00:00:00+00:00 ##submission.copyrightStatement## Rupture of renal artery aneurysm during cesarean section: a case report 2020-10-28T00:35:33+00:00 Rawaa Dawood Aljanabi Jawad K. Al-Diwan <p class="s4">&nbsp;</p> <p class="s4"><span class="s2"><span class="bumpedFont15">Introduction:</span></span></p> <p class="s4"><span class="s2"><span class="bumpedFont15">Renal artery aneurysm (RAA) occur</span></span><span class="s2"><span class="bumpedFont15">s</span></span><span class="s2"><span class="bumpedFont15"> to focal dilatation of artery secondary to weakness of the arterial intima and media. RAA is a rare clinical entity with an incidence of 0.01 – 1%.</span></span><span class="s8"><span class="bumpedFont15">1</span></span></p> <p class="s9"><span class="s2"><span class="bumpedFont15">Rupture RAA during pregnancy is extremely rare event. The obstetric and urologic literatures are deficient in this regard. Diagnosis of rupture RAA during pregnancy is very difficult i.e. no pathognomonic presentation. When rupture occurs during pregnancy the clinical presentation is confused with those more common conditions e.g. placenta abruption or rupture uterus. </span></span></p> <p class="s4"><span class="s2"><span class="bumpedFont15">Most of the cases are discovered incidentally, even it is only diagnosed after autopsy.</span></span></p> <p class="s4"><span class="s2"><span class="bumpedFont15">Case presentation:</span></span></p> <p class="s4"><span class="s2"><span class="bumpedFont15">A fifth </span></span><span class="s2"><span class="bumpedFont15">cesarean section was done for 30 years </span></span><span class="s2"><span class="bumpedFont15">old</span></span><span class="s2"><span class="bumpedFont15">women presented with placenta previa. </span></span><span class="s2"><span class="bumpedFont15">She was </span></span><span class="s2"><span class="bumpedFont15">gravida 6</span></span> <span class="s2"><span class="bumpedFont15">para </span></span><span class="s2"><span class="bumpedFont15">5. </span></span><span class="s2"><span class="bumpedFont15">Cesarean section was an elective one. </span></span><span class="s2"><span class="bumpedFont15">She gave a </span></span><span class="s2"><span class="bumpedFont15">live </span></span><span class="s2"><span class="bumpedFont15">birth</span></span> <span class="s2"><span class="bumpedFont15">male </span></span><span class="s2"><span class="bumpedFont15">weighing 2.4 kg. &nbsp;</span></span><span class="s2"><span class="bumpedFont15">Hysterectomy was carried out </span></span><span class="s2"><span class="bumpedFont15">after </span></span><span class="s2"><span class="bumpedFont15">sever bleeding during operation. </span></span><span class="s2"><span class="bumpedFont15">Ten units of blood were given in addition to other management steps. Urologists </span></span><span class="s2"><span class="bumpedFont15">and general surgeon </span></span><span class="s2"><span class="bumpedFont15">were consulted.</span></span><span class="s2"><span class="bumpedFont15"> The patient was dead.</span></span> <span class="s2"><span class="bumpedFont15">Exploration was done and </span></span><span class="s2"><span class="bumpedFont15">revealed a rupture of left renal artery aneurysm. &nbsp;</span></span></p> <p class="s4"><span class="s2"><span class="bumpedFont15">Di</span></span><span class="s2"><span class="bumpedFont15">s</span></span><span class="s2"><span class="bumpedFont15">cussion:</span></span></p> <p class="s4"><span class="s2"><span class="bumpedFont15">It was the 5</span></span><span class="s8"><span class="bumpedFont15">th</span></span><span class="s2"><span class="bumpedFont15"> cesarean section for women. Literature documented that previous history of cesarean sections is the primary risk factor for developing placenta previa.</span></span><span class="s8"><span class="bumpedFont15">1</span></span> <span class="s2"><span class="bumpedFont15">Other risk factors are gestation with male fetuses and multiparity.</span></span><span class="s8"><span class="bumpedFont15">3</span></span><span class="s2"><span class="bumpedFont15"> The mentioned risk factors were characters of the reported case.</span></span><span class="s2"><span class="bumpedFont15"> It was stressed that multiple cesarean sections affect adversely the health of women.</span></span><span class="s8"><span class="bumpedFont15">2 </span></span><span class="s2"><span class="bumpedFont15">It was the 5</span></span><span class="s8"><span class="bumpedFont15">th</span></span><span class="s2"><span class="bumpedFont15">cesarean section. </span></span></p> <p class="s4"><span class="s2"><span class="bumpedFont15">RAA is an unusual diagnosis. Hemodynamic changes during pregnancy that is increased blood volume and cardiac output, raised intrabdominal pressure and hormonal alterations, affect the arterial wall and increased the risk of rupture RAA, more so in the 3</span></span><span class="s8"><span class="bumpedFont15">rd</span></span><span class="s2"><span class="bumpedFont15">trimester.</span></span><span class="s8"><span class="bumpedFont15">3</span></span> <span class="s2"><span class="bumpedFont15">The reported case was gravida 6 which might enhanced the formation and rupture of RAA.</span></span><span class="s2"><span class="bumpedFont15"> It was reported </span></span><span class="s2"><span class="bumpedFont15">that</span></span><span class="s2"><span class="bumpedFont15"> women with RAA and unusual number of women were multiparous.</span></span><span class="s8"><span class="bumpedFont15">4</span></span></p> <p class="s4"><span class="s2"><span class="bumpedFont15">Owing to the pregnancy state</span></span><span class="s2"><span class="bumpedFont15">,</span></span><span class="s2"><span class="bumpedFont15"> RAA was missed as </span></span>​<span class="s2"><span class="bumpedFont15">cesarean section was planned for delivery </span></span><span class="s2"><span class="bumpedFont15">of a</span></span><span class="s2"><span class="bumpedFont15">case of placenta previa. The final diagnosis made only after exploration. It is the same as mentioned in literature.</span></span><span class="s8"><span class="bumpedFont15">5</span></span></p> <p class="s4"><span class="s2"><span class="bumpedFont15">In this case, RAA was on the left side. Literature reported that RAA was often on the left side.</span></span><span class="s8"><span class="bumpedFont15">4</span></span><span class="s2"><span class="bumpedFont15"> Since 1970, published reports have not shown a left sided predominance of RAA.</span></span><span class="s8"><span class="bumpedFont15">6</span></span></p> <p class="s4"><span class="s2"><span class="bumpedFont15">There are no previous reports of diagnosis of the intact RAA during pregnancy. This report might be the first one in Iraqi literature of rupture of RAA during pregnancy. </span></span></p> <p class="s4"><span class="s2"><span class="bumpedFont15">Conclusion: The possibility of a ruptured RAA should be considered in pregnant women with evidence of retroperitoneal hemorrhage. Imaging facilities should be available in theater rooms to be used immediately.</span></span><span class="s2"><span class="bumpedFont15"> &nbsp;</span></span></p> <p class="s4"><span class="s2"><span class="bumpedFont15">References:</span></span></p> <div class="s10">1- <span class="s2"><span class="bumpedFont15">Oylele Y, Smulian JC. Placenta previa, placenta accrete and vasa previa. Obstet Gynecol 2006; 107: 927-941.</span></span></div> <div class="s10">2- <span class="s2"><span class="bumpedFont15">Seidman DS, Pazi I, Nadu A, Dollberd S, Stevenson DK, Gele R et al. Are multiple cesarean sections safe? Eur J Obstet Gynecol Reported Biol 1994; 57: 7-12</span></span></div> <div class="s10">3- <span class="s2"><span class="bumpedFont15">Porcaro AB, Migliorini F, Pianon R, Antoniothi SZ, Furlan F, De Biase V et al. Intraparenchymal renal artery aneurysms. Case report with review and update of literature. Int Urol Nephrol 2004; 36: 409-416.</span></span></div> <div class="s10">4- <span class="s2"><span class="bumpedFont15">Soliman KB, Shawky A, Abbas MM. Ammory M, Shoaban A. Rupture renal artery aneurysm during pregnancy. A clinical dilemma. BMU Urol 2006; 6: 22</span></span></div> <div class="s10">5- <span class="s2"><span class="bumpedFont15">Henke PK, Cardnean D, Welling III TH, Upchurch GR, Wakefield TH, Jacob L et al. Renal artery aneurysm: a 35-year clinical experience with 252 aneurysm</span></span><span class="s2"><span class="bumpedFont15">s</span></span><span class="s2"><span class="bumpedFont15"> in 168 patients. Annal of Surgery</span></span><span class="s2"><span class="bumpedFont15"> 2001; 214: 454-463.</span></span></div> <div class="s10">6- <span class="s2"><span class="bumpedFont15">Yang JC, Hye RJ. Ruptured renal artery aneurysm during the pregnancy. Ann Vasc Surg 1996; 10: 370-372.</span></span></div> <p class="s4">&nbsp;</p> <p><a>2</a></p> <p class="s11">&nbsp;</p> 2020-06-16T00:00:00+00:00 ##submission.copyrightStatement## A Novel Unusual Manifestation of CH-Alpha as Acute Metabolic Disturbances: Case Report and Big Data Analytics 2020-10-28T00:35:31+00:00 Ahmed Al-Imam Fai'q Isho Gorial, Professor Dr. Ali Kamil Al-Shalchy, Dean of College of Medicine <p><strong>Background:</strong> The pharmaceutical “marketplace” is booming with a plethora of over-the-counter products known as supplements, including regulated and unregulated chemicals that can be purchased from pharmacies, the black market, or via the internet, including the infamous deep web and the darknet. Some supplements can boost specific physiological functions, including physical endurance, sexual performance, and musculoskeletal-articular rejuvenation.</p> <p><strong>Case Report:</strong> We are reporting a case of acute metabolic disturbances that materialized following the ingestion of CH-alpha. An otherwise healthy 35 years old male from Iraq, manifested with bilateral periorbital and dependent leg edema. Biochemical profiling revealed hypoproteinemia [6.5 g/dl], hypogammaglobulinemia [1.58 g/dl], hypercholesterolemia [218 mg/dl], and a borderline serum creatinine [1.2 mg/dl]. Following CH-Alpha's withdrawal, the patient’s condition resolved spontaneously. Although the reported case is anecdotal, we implemented the Bradford Hill’s criteria to analyze its credibility and the implied level-of-evidence in connection with causality. We also carried out collateral analytics of big data, using Google Trends, to infer data on the spatiotemporal variations of the interest of the public in CH-Alpha and related products.</p> <p><strong>Conclusion:</strong> Future externally-valid studies, including controlled trials and metanalytic studies, can satisfy the full Hill’s criteria on the potential causality for the observed acute dysmetabolism in humans.</p> 2020-06-16T16:28:36+00:00 ##submission.copyrightStatement## Illiterate Mother is a determinant of aggression 2020-10-28T00:35:31+00:00 Tuka Younis Hassan <p>Most young children provoke negative reactions from parentral interference. These reactions worsen child's behavior. Starting a harmful pattern leading to emergence of an aggressive behavior. A cross sectional study was carried out in Al-Sadr city, Baghdad.&nbsp; The target population was represented by all students attending governmental secondary schools, who are resident in Al-Sadr city aged between 13 and 21 year. The data collected by self-reported questionnaire (Aggression—Problem Behavior Frequency Scale)<sup>. </sup>A total of 720 students contributed in this study. Out of the total, there were 257 (35.7%) students raised by illiterate mothers. Out of those, there were 241 (93.8%) students reported aggressive behavior. &nbsp;</p> 2020-06-16T15:25:37+00:00 ##submission.copyrightStatement##