Volume 2, Issue 3, 2024
Editorial
Environmental Pollution: A Growing Cancer Risk in Developing Countries
Abdullah Khalid Omer
Unchecked environmental pollution has emerged as a formidable adversary in developing countries, posing a significant risk to public health and well-being. As these nations experience rapid industrialization and urbanization, the consequences of this unchecked pollution are becoming increasingly evident. Among the myriad health risks associated with environmental degradation, the potential link to cancer is particularly alarming and demands urgent attention [1].
Environmental pollution in developing countries is multifaceted, encompassing air, water, and soil contamination. Industrial emissions, vehicular exhaust, improper waste disposal, and the extensive use of agricultural chemicals collectively contribute to the toxic cocktail that permeates these environments. Pollution represents a silent but pervasive threat for populations already struggling with limited access to healthcare and preventive measures [1,2].
Recent studies have drawn correlations between environmental pollution and cancer incidence. Airborne pollutants, such as benzene and formaldehyde, have been linked to lung cancer. Contaminated water sources, often laden with heavy metals like arsenic, mercury, and lead, have been associated with cancers of the bladder, liver, and skin. Soil pollution, exacerbated by the use of pesticides and industrial waste, also plays a significant role in increasing cancer risks [3].
The impact of environmental pollution on cancer rates is particularly pronounced in developing countries for several reasons. Firstly, regulatory frameworks in these nations are often weak or poorly enforced. Industries eager to capitalize on economic opportunities may flout environmental regulations, leading to unchecked pollution. Secondly, public awareness about the dangers of pollution is generally low, and the resources available for mitigation and adaptation are limited. In rural areas, where agricultural activities predominate, pesticides and fertilizers are rampant, often without proper guidance or protective measures. In urban settings, dense populations and traffic congestion exacerbate air pollution levels. The lack of efficient waste management systems results in the open burning of waste, releasing carcinogenic substances into the air [1,2].
Addressing the cancer risk of environmental pollution in developing countries requires a multifaceted approach. Governments must bolster ecological regulations and ensure strict enforcement. This may include setting stringent emission standards, monitoring industrial activities, and penalizing violations. Additionally, education campaigns are crucial to inform the public about the risks associated with pollution and the steps they can take to protect themselves. Communities should be empowered with knowledge and resources to advocate for cleaner environments [4].
Furthermore, developing countries should be encouraged and supported to adopt clean and sustainable technologies. International cooperation and financial assistance can play a significant role in facilitating this transition. Strengthening healthcare infrastructure is essential to improve cancer detection, diagnosis, and treatment. Early intervention may significantly enhance survival rates and quality of life. Investing in research to better understand the link between pollution and cancer is vital. Reliable data can inform policy decisions and help track progress over time [4].
While the primary burden falls on the governments and citizens of developing countries, the international community also has a role to play. Many of the pollutants afflicted by these nations originate from the activities of multinational corporations or the global demand for certain goods. There is a moral imperative for developed countries and international organizations to assist in the fight against environmental pollution and its health repercussions.
In conclusion, environmental pollution is not merely an economic or ecological issue; it is a profound public health crisis with cancer at its forefront. As developing countries continue their journey toward growth and development, ensuring a balance between progress and environmental stewardship is crucial. Failure to address this balance will not only undermine health outcomes but also threaten the sustainable future of these nations. The time to act is now, with concerted efforts from local, national, and global stakeholders to mitigate the risks and safeguard the well-being of current and future generations.
Original Articles
A Minimally Invasive Approach for Managing Umbilical Hernia and Rectus Abdominis Diastasis: A Single-Center Case Series
Hiwa O. Baba, Rebaz O. Mohammed, Saman S. Muhialdeen, Hawkar A. Nasralla, Abdulwahid M. Salih,...
Introduction
Umbilical hernias (UHs) and rectus abdominis diastasis (RAD) are distinct abdominal conditions that, though separate, frequently overlap in the context of surgical management. The debate over the most effective repair techniques continues, despite the proposal of numerous methods and guidelines. In this study, we reported a novel surgical technique involving a minimal incision for managing both UHs and RAD.
Methods
Following the de-identification of data, the necessary information was retrospectively collected from the clinical profiles of patients managed through our technique. The records included patient demographics, smoking, body mass index (BMI), family and patient history of hernias, parity, clinical symptoms, comorbidities, operation time, hospital admission, treatment outcomes, and follow-up. All the included cases had small-sized UHs (≤ 2 cm) and RAD.
Results
The patients' ages ranged from 23 to 44 years (34.3 ±5.65), with a mean BMI of 26.8±2.74 kg/m². All patients were multiparous women, with the majority having experienced three pregnancies. Clinical symptoms included pain and swelling in all cases. The surgical procedure duration varied from 30 to 45 minutes, with a mean of 33±4.9 minutes, and no complications were encountered intra or postoperatively. All the cases were discharged home the same day of the operation. There were no instances of hernia recurrence after a mean of 6.4 months of follow-up.
Conclusion
The technique discussed in this study may play a crucial role in effectively managing patients with UHs ≤ 2 cm and/or RAD, offering satisfactory outcomes with no complications and minimal operating times.
Role of ChatGPT and Gemini in the Urology Field: A Case-Based Study
Rawa Bapir, Ahmed Mohammed Abdalqadir, Kamran Hassan Bhatti, Nadeem Sohail, Bryar Othman...
Introduction
The healthcare sector is witnessing a transformation with the advent of artificial intelligence (AI), exemplified by ChatGPT and Gemini AI. These AI systems emulate human conversation and provide accurate medical responses. This study explores their integration into medical decision-making in the urology field.
Methods
The study presented a collection of 20 medical case scenarios, carefully crafted and revised by a team of authors in the field of urology. Each case was presented to ChatGPT and Gemini in September of 2023, and their responses were recorded and analyzed.
Results
Both AI tools displayed varying accuracy in diagnoses and management recommendations. ChatGPT failed in identifying congenital penile curvature, while Gemini succeeded. Conversely, ChatGPT excelled in recommending a management plan for renal artery aneurysms. Gemini outperformed in explaining iodinated contrast material toxicity. Both struggled with a bladder prolapse prevention question.
Conclusion
AI integration in urology is promising but has limitations. AI provides valuable insights but cannot replace human expertise. Research is vital to improve AI's role in urology. Clinicians should view AI suggestions as supplements to their judgment, fostering collaborative healthcare decisions.
Changing Face of Antimicrobial Resistance: A Cross-Sectional Study
Rawezh Salih, Berun A. Abdalla, Ayman M. Mustafa, Khanda A. Anwar, Abdullah Dler Ahmad, Wafa A....
Introduction
Infections of sterile body fluids are significant contributors to mortality and morbidity. Accurate species-level identification and understanding of the antimicrobial resistance profiles are crucial for selecting appropriate antimicrobials for empirical and targeted therapy. This study aims to examine the distribution of various bacterial species and their evolved antimicrobial resistance profiles isolated from different body fluids.
Methods
This retrospective study evaluated 301 body fluid samples collected at a tertiary hospital between January 2023 and December 2023. Samples were gram-stained and cultured on an appropriate media. Bacterial identification and susceptibility testing were performed using the BD Phoenix™ system, with disk diffusion method used for antibiotics not available in the system.
Results
Microbial growth was detected in 151 cases (50.2%), with a comparable prevalence among males and females (53.0% vs. 46.7%). The mean age was 49.81± 24.1 years. Growth rates were slightly higher in hospital-acquired infections (55.7%) than in community-acquired infections (49.2%). Cerebrospinal fluid showed the highest growth rate at 34.3%. Among the isolates, Streptococcus species were the most common (14.6%), while Escherichia coli was the predominant Gram-negative bacterium (13.2%). Sensitivity was highest with tigecycline (100%) and meropenem (92%), whereas resistance was most notable against ampicillin-sulbactam (100%) and azithromycin (95.2%). Multidrug resistance was identified in 106 isolates (70.2%).
Conclusion
High antibiotic resistance and multidrug-resistant strains underscore the need for rigorous antibiotic stewardship and improved infection control to address untreatable infections.
Global Framework for Scientific Event: A 32-Country & 118-Expert Collaborative Effort
Fahmi H. Kakamad, Fattah H. Fattah, Abdulwahid M. Salih, Berun A. Abdalla, Shvan H. Mohammed,...
Introduction
Despite numerous efforts to define and categorize scientific events, a consensus remains elusive, complicating the understanding and classification of such events. The current study aims to establish clear, consensus-based definitions for various types of scientific events by examining their definitions and purposes from the perspectives of scholars across different countries.
Methods
The current study used a descriptive survey design to gather responses from scholars across 32 countries about their perceptions of scientific events. The sample size was determined using G*power, requiring 80 participants; 118 were recruited. Data was collected via a Google Forms survey with a 9-point Likert scale. Invitations were emailed. The Content Validity Index (CVI) was used to assess item relevance, with all items achieving a CVI above 0.78. Data analysis involved descriptive statistics, and ethical considerations regarding voluntary participation and confidentiality were observed.
Results
This study validated the definitions of ten event types, each achieving a CVI above 0.78. The scientific events were categorized into conferences, symposiums, workshops, courses, summits, panels, meetings, fast-track reviews, annual reviews, and seminars. Course and panel garnered the highest level of consensus with a CVI of 0.983. Fast-track review also demonstrated a strong agreement among participants, with 82.2% expressing their concurrence with the provided definition.
Conclusion
The study establishes consensus-based definitions for scientific events, enhancing standardization in the academic community and underscoring the importance of precise categorization.
Evolving Pattern of Human Cystic Echinococcosis: A Cross-Sectional Study
Ayman M. Mustafa, Yousif M. Mahmood, Fakher Abdullah, Suhaib H. Kakamad, Hemn H. Kaka Ali, Azad...
Introduction
Cystic echinococcosis (CE) poses a considerable public health challenge in many countries. Due to the absence of comprehensive CE surveillance and management guidelines and varying demographic and geographical factors across countries, examining the disease's epidemiology and clinical manifestations within specific regions is essential. The current study aims to investigate CE trends, clinical features, and patient complaints in an endemic area of Iraq.
Methods
This retrospective cross-sectional study was conducted at Smart Health Tower in Sulaymaniyah, Iraq, from May 2020 to May 2024. It involved patients diagnosed and treated for CE. Data was collected using detailed case forms covering patient demographics, cyst location, presentation, medical and surgical history, and recurrence.
Results
The study involved 605 CE patients with nearly equal gender distribution and a mean age of 40.1 ± 18.6 years. Most patients, 217(35.9%), were aged 31-50 and lived in urban areas 505(83.5%). The majority, 382(63.1%), were asymptomatic, with liver cysts being the most common 361(59.7%). Single cysts were more prevalent in 513(84.8%) cases, with surgery performed in 222(36.7%) of cases, and recurrence was rare 8(1.3%).
Conclusion
This study highlights a significant burden of CE in urban areas, where asymptomatic cases often lead to delayed diagnosis. The high prevalence of liver and lung cysts underscores the necessity for targeted public health strategies and enhanced control measures for free-roaming dogs.
Review Articles
Hydatid Cyst of The Breast: A Systematic Review
Rezheen J. Rashid, Khandan A. Anwar, Ayoob A. Mohammed, Soran H. Tahir, Ali H. Hasan, Snur...
Introduction
Due to its rarity, there is limited information regarding breast hydatid disease, mostly derived from case reports. This study aims to review the clinical presentation and management of the disease systematically.
Methods
The PubMed/Medline and Google Scholar were searched with the following keywords: (Breast OR Breasts OR "mammary gland" AND hydatid OR hydatidosis OR echinococcus OR echinococcal OR echinococcosis OR "E. granulosus"). Only English-language studies published in legitimate journals were included. Additional inclusion criteria involved a confirmed diagnosis of breast hydatid cyst, details on presentation, cyst characteristics, and management.
Results
Most cases were reported in India (32.6%) and Turkey (25.6%). The mean age of the patients was 40.88 ± 15.7 years, and all 43 patients were female. Most (69.8%) were asymptomatic, while 25.6% reported pain and 2.3% reported dry skin. Surgery with albendazole was the treatment of choice in 51.2% of the cases, followed by surgery alone in 39.5%. Most cases (65.1%) recovered without complications, whereas one did not and was under follow-up. The recovery status was not mentioned in 14 cases (32.6%).
Conclusion
Breast hydatid cyst is an extremely rare finding that can be asymptomatic in most instances. Surgery combined with albendazole may be the most successful treatment approach.
Cushing's Syndrome and Topical Corticosteroids in Pediatrics: A Systematic Review
Berun A. Abdalla, Honar O. Kareem, Bilal A. Mohammed, Karzan M. Hasan, Soran M. Ahmed, Khdir...
Introduction
Despite the increasing number of pediatric cases of iatrogenic Cushing's syndrome (CS) due to topical corticosteroids, systematic reviews are lacking to provide comprehensive insights into the disease. This study aims to provide a systematic overview of the disease.
Methods
Relevant literature was identified using Google Scholar and PubMed. The search strategy was restricted to studies on human published in English. The inclusion criteria encompassed confirmed pediatric cases of iatrogenic CS induced by topical corticosteroids.
Results
The mean age of the cases was 38.8 months, with a female gender predominance (57.1%). Abnormalities in growth patterns were observed in approximately 75% of the cases. The most common clinical presentation was a "moon face" appearance (74.6%), followed by weight gain (55.5%). Clobetasol propionate was the most frequently used topical steroid (54%), followed by betamethasone types (35%). The mean duration of steroid use was 25.4 weeks. The primary indications for steroid use were dermatitis (47.6%), psoriasis (17.5%), and scabies (15.9%). Laboratory tests for adrenocorticotropic hormone and cortisol levels revealed low levels in 73% and 78% of cases, respectively. All cases had their initial steroid discontinued. Oral hydrocortisone was the primary replacement therapy (39.7%), followed by sulfur cream (12.7%). Fifty-one cases (81%) recovered from the disease. Partial recovery was observed in 2 cases (3.2%), while four cases (6.3%) did not survive.
Conclusion
A specialist should supervise topical corticosteroid administration, and parents need to be fully informed about the proper usage and potential side effects to avoid iatrogenic CS and other complications.
Gastric Mucormycosis: A Systematic Review with Metadata
Ayman M. Mustafa, Yousif M. Mahmood, Ali H. Hasan, Hoshmand R. Asaad, Dana T. Gharib, Karokh F....
Introduction
Gastric mucormycosis is a highly lethal condition with nonspecific signs that have become increasingly underrecognized in the last decade. The current study aims to systematically review gastric mucormycosis, highlighting its presenting symptoms, risk factors, various management approaches, and their outcomes.
Methods
Scopus, PubMed, Web of Science, and Google Scholar were systematically searched for papers on gastric mucormycosis published up to June 1, 2024. The current study included papers documenting cases of gastric mucormycosis across all ages and genders, detailing diagnostic modalities and management approaches.
Results
A total of 106 studies were selected, including 115 patients, of whom 80 (69.4%) were male. The average age of the patients was 47.91 ± 17.01 years. The main presenting symptom was abdominal pain in 58 (50.4%) patients, followed by vomiting, fever, and melaena in 28 (24.3%), 25 (21.7%), and 18 (15.6%) patients, respectively. No identifiable risk factor was present in 33 (28.7%) patients. However, a history of organ transplantation, diabetes mellitus, or hematologic malignancy was reported in 26 (22.6%), 25 (21.7%), and 10 (8.7%) patients, respectively. The conservative management approach exhibited the highest survival rate among the various strategies, with 39 (66.1%) patients surviving, which was statistically significant (P-value <0.001).
Conclusion
Conservative management demonstrates higher survival rates than combined surgical and conservative approaches. However, this finding could be attributed to a more extensive disease in those requiring surgery. Therefore, an individualized assessment of each patient should be made on a case-by-case basis.
Revisiting Pulmonary Sporotrichosis: A Comprehensive Systematic Review of an Overlooked Fungal Infection
Fahmi H. Kakamad, Harem K. Ahmed, Hadi Mohammed Abdullah, Bnar J. Hama Amin, Fattah H. Fattah,...
Introduction
Pulmonary sporotrichosis (PST) is a rare and neglected but severe disease. Its optimal management remains challenging, as recommendations are primarily derived from case reports. This study summarizes PST patients' presentation, diagnosis, management, and outcome.
Methods
Studies were identified through a search on Google Scholar and PubMed. The collected data included study characteristics, demographic data, risk factors, comorbidities, clinical status, presentations, imaging findings, diagnostic methods, disease focality, fungal species, treatment methods, complications, ICU admission status, and outcomes.
Results
Most of the studies were conducted in the USA (71.7%). In total, 34.7% of the cases were smokers, 30.7% had occupational exposure to dust and soil, 5.3% had contact with pets or roses or wooden materials, and 2.7% had environmental exposure. Overall, 32% of the patients were alcoholic, 29.3% had bacterial infections, 24% had respiratory or pulmonary diseases, and 17.3% were found to have HIV. The most frequently reported symptom was coughing (61.3%). The most common imaging finding was cavitary lesions (53.3%). The most commonly utilized diagnostic approach was sputum culture (69.3%). A combined conservative regimen was the treatment of choice in 26 patients (34.7%). The survival rate was 69.3%, with a recurrence rate of 5.8%.
Conclusion
The coexistence of multiple risk factors may trigger the disease. Its low incidence in endemic areas suggests the potential for missed or misdiagnosed cases. Treatment approaches include a combined conservative regimen or in combination with surgery. The survival rate is high, but the mortality rate should not be overlooked.
Case Reports
A Unique Positioning of Saphenofemoral Junction: A Case Report and Literature Review
Fahmi H. Kakamad, Rezheen J. Rashid, Shvan H. Mohammed, Nasren Sharef Sabr, Ali H. Hasan, Ayoob...
Introduction
The saphenofemoral junction (SFJ) serves as a proximal link joining the superficial and deep veins in the lower limbs. Its anatomical position is typically 2.5 cm inferior and 4 cm lateral to the pubic tubercle. This study reports an exceptional case wherein the SFJ was found in the lower thigh.
Case presentation
A 24-year-old male presented with left leg pain and swelling for five years duration. Clinically, the left lower limb showed noticeable varicose veins. The duplex ultrasound showed several enlarged varicose veins, primarily around the knee. However, the SFJ was observed roughly 15 cm below the pubic tubercle, with a reflux lasting more than four seconds. The patient declined all therapy modalities, and regrettably, he was lost to further follow-up.
Literature review
No prior reports were found in the literature describing such an abnormal positioning of the SFJ approximately 15 cm below the pubic tubercle.
Conclusion
In conclusion, while the lower limb veins have various anatomical variations, locating the SFJ in the mid-third of the thigh is rare and has not been documented in the literature.
Retraction
Retraction Note: Complications of Abdominal Wall Hernia Repair Using Mesh: A Single Cohort Study
Chathik H. Werasuriya, Lykorgos K. Alexakis, Hsan Bairu, Ahidul Hilal
The Original Article was published on 10 February 2023
The article mentioned above, which was published online on 10th of October, 2023, in Barw Medical Journal (Complications of Abdominal Wall Hernia Repair Using Mesh: A Single Cohort Study), has been retracted as a result of an agreement between the journal's Editor in Chief, Professor Kawkab Shishani, and Barw Publisher. The publisher learned from a third party that several articles had similar formats and structures. Also, there was a conflict between the authors; not all authors approved the last version of the manuscript. These all lead to the decision to retract it. The authors did not respond to the notification of retraction.