Volume 44, Issue 1, Winter and Spring 2022, Page 1-102


The Serum Level of Proinflammatory TNF-alpha Cytokine in Cyanotic and Acyanotic Congenital Heart Diseases in Mosul City

Asmaa Sheetawi; Firas Al-Tae; Ahmed Abdullah Ahmed; Mohammed Essmat Ahmed

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 1-9
DOI: 10.33899/mmed.2022.133834.1146

Background:Tumor necrosis factor – alpha (TNF-α)  has been proposed to play an important role  in the etiopathology of congenital heart diseases (CHD) worldwide. However, no previous  study about the role of TNF-α in the pathogenesis of CHDs in Mosul city / Iraq has been reported .
Objectives:1) To evaluate the serum levels of TNF-α cytokine in cyanotic and a cyanotic congenital heart diseases (CHDs and to compare the results with control healthy children in Mosul city 2) To find any association between the level of this pro-inflammatory marker  and other  demographic parameters such as age and gender  3) To test the diagnostic validity of this cytokine for the diagnosis of CHD at different cut-off values.
Patients, materials and methods:A case-control study was conducted in the Department of Microbiology / College of Medicine / University of Mosul over two years and 3 months from April 2019 to July 2021. Twenty nine (29) child with a cyanotic congenital heart diseases and seventeen  (17) child with cyanotic heart diseases were included. Another Thirty one (31) healthy child were also included as a controls. . All patients were collected from Al-Khansa teaching hospital in Mosul city. The serum TNF-α concentration was measured in all participants by using ELISA.
Results: Mean age of children with acyanotic heart diseases (2.7 ± 2.9 years) did not significantly differ from that of cyanotics (2.1 ± 1.9) or healthy controls (3.1 ± 1.7) ,  (P>0.05). The average TNF-α level in acyanotic heart diseases was 321.18 ± 325.71 ng/l compared to 120.63 ± 84.33 ng/l in cyanotics and 119.01 ± 139.71 in healthy controls. TNF- α was significantly elevated in acyanotic heart diseases in comparison to healthy children (P = 0.003). No significant difference was noted between acyaotics and cyanotic heart diseases in regards to TNF- α concentrations (P = 0.07). No age or gender effects were noted on TNF-α concentration in both acyanotic and cyanotic heart diseases (P>0.05). At the best cut-off  value of 124 ng/l  TNF-α had a specificity of  90.32% , sensitivity of 48.28% and accuracy rate of 39% as indicated by AUC-ROC curve .
Conclusion: The current study showed  higher TNF- α in acyanotic (but not in cyanotic)  heart diseases compared to healthy controls. TNF-α had poor diagnostic utility to discriminate between CHD and healthy individuals and  therefore not recommended as valuable biological marker for the diagnosis of CHD.

Assessment of neuropathological findings and medical treatment of Parkinson disease: A review of literature

Rand Abdulateef Abdullah

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 10-13
DOI: 10.33899/mmed.2022.133096.1138

ABSTRACT
Background: Parkinson disease is a long-lasting and progressive motor disorder which is identified by three critical motor symptoms which are bradykinesia, rigidity and tremor. 
Aim of the study: To assess the histopathological changes in the brain of Parkinson disease’s patients and the regimes used for treatment.
Conclusion: Several histopathological changes in the neurons in brain of patients with Parkinson disease are α-synucleinopathies, lewy bodies, damage of synaptic neurons, and hyperactivation of microglial cell. Many regimes were used in the treatment of Parkinson disease particularly to alleviate motor symptoms. The golden goal is they should focus on preserving the synaptic neurons before they get damaged. 

The Quality of Life in Patients with Chronic Urticaria

sayf Zuhair yousif; Pers Yousif Yaaqub

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 14-21
DOI: 10.33899/mmed.2022.133449.1142

Background: Chronic skin urticaria (CU) is a type of skin illness that is characterized by pruritus, angioedema, or wheals for longer than six weeks. It has a major impact on patients quality of life.
Study aim: To identify the impact of chronic skin urticaria on the patients quality of life.
Study setting: Erbil Dermatology Teaching Center.
Study sample: One hundred and three patients, above 16 years of both sexes who were having chronic urticaria were included in the study sample.
Study design: A case series research was used in this study.
Study period: The study was conducted from the first of March 2021 to the end of January 2022.   
Data collection: All patients were interviewed by the researcher using a specially designed questionnaire sheet and the needed information was filled by the researcher. These information include age, gender, education, occupations, residence, marital status, and skin types in addition to the DLQI questionnaire which was downloaded from Cardiff University website. There are 10 questions or items in the DLQI questionnaire, which are further subdivided into six subdomains of life.
Result: The score mean of DLQI was (9.3±4.37); 24 (23.3%) CU patients have a low effect, 39 (37.9%) with moderate effect and 40 (38.8%) patients have high effects. The mean DLQI score was higher among self employed patients and lower among retired patients and higher among CU patients were visiting more than two doctors and among patients who receiving treatment.
Conclusion: Chronic skin urticaria has commonly moderate effect on the patients’ quality of life and affected by occupation, severity of disease, and treatment.
Recommendations: This study recommended that the physician should adopt an integral plan in management of CU taking in consideration mental and social wellbeing of patients. Additionally, more national researches on the QoL of CU patients must be maintained.

Knowledge, Attitude and Practice of Nursing Staff toward Working at Emergency Unit

Rawaa Y Al-Rawee; Mohammed Faris Abdulghani; Ashraf Abdul-Rzzaq Mohammed AlSalih; Emad Hussain Mohammed; Bashar Abdul-Ghani Tawfeeq

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 22-28
DOI: 10.33899/mmed.2021.131807.1118

Highlights : Emergency department need essentisl careful assessment as it deal with acute, urgent health situations so should have high skilled well trained staff.
Aims : Study involves assessing the emergency nurse's knowledge, attitude, and practice regarding the practical obstacles that impede nurses from working in the Emergency Departement and taking necessary measures to resolve them.
Material and Method : The current study was a cross-sectional study conducted upon (400) nurses.  Questionnaire form to assess nurses' knowledge, attitude, and practice in Mosul's teaching hospitals / Iraq related to working in the Emergency Departement. The acceptability score was established at 61.2 mark / 85%; less than this limit was considered unsatisfied as degree 85% (61.2 marks) was considered as acceptable. The data were surveyed applying the (SPSS version 25) descriptive and inferential statistics.
Result : The study showed that there were statistically significant differences in the level of knowledge. The mean ± S.D of the knowledge was (33.15 ± 11) .  The mean of practice was (23±9). The majority of nurses was in the accepted level 196 (49%) and statistically highly significant P-value was 0.01. Attitude answering questions show high agreement on questions (Number of the good training staff is essential in the emergency department? , and Handwashing is necessary before preparation and administration? ) with answers  percentage are [ 96.25% and 93.75% respectively].  The difference between nurses was highly significant  p-value was 0.001.
Conclusion : This study concluded that the awareness or knowledge of nurses is satisfactory with  the level of attitude and practice with respect to Emergency Department

Detection of the analgesic effect of ceftriaxone in chicks

Inaam Kadhim Othman; Muna HI Alzubadaidy

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 29-36
DOI: 10.33899/mmed.2022.133399.1141

Objective: To evaluate the analgesic effect of ceftriaxone when administered alone or in combination with paracetamol and diclofenac sodium in boiler chicks. 
Methods: This study was conducted in Department of Physiology, Biochemistry and Pharmacology, College of Veterinary Medicine  ,University of Mosul , Mosul, Iraq, from November 2021 to February 2022. It was determined using formaldehyde test and the median analgesic effective dose (ED50) for ceftriaxone, paracetamol and diclofenac sodium depending on the method of Dixon. An isobolographic ratio of 0.5:0.5 of the ED50 for each drug at the analgesic level was calculated.
Results: The administration of ceftriaxone at doses of (523, 1064 and 1330mg/kg) intramuscularly was led to a significant (p value=0.02) and clear analgesic effect through the disappearance of the right foot lift caused by the injection of formaldehyde, in aadition to significant decrease (p value=0.01) in foot thickness at dose of 1330 mg/kg . Analgesic ED50 of ceftriaxone , paracetamol and diclofenac sodium by Dixon method were 42.6 ,32.6 and 6.26 mg /kg respectively. The intramuscular administrations of drugs in a ratio of 0.5:0.5 result in a significant decrease (p value<0.001) in ED50 values ​ to 6.77, 5.34 and 0.99 mg/kg respectively. The application of the isobolographic analysis revealed the type of interaction between ceftriaxone/paracetamol, ceftriaxone /diclofenac sodium, and the interaction was synergistic when they were given at the ratio 0.5:0.5.
Conclusion: The results showed that ceftriaxone exerts its analgesic effect in chicks by reducing the mechanical hyperalgesia resulting from formaldehyde injection in the planter of the right foot and potentiated the analgesic effects of paracetamol and diclofenac sodium through the synergistic interaction.
 
Objective: To evaluate the analgesic effect of ceftriaxone when administered alone or in combination with paracetamol and diclofenac sodium in boiler chicks. 
Methods: This study was conducted in Department of Physiology, Biochemistry and Pharmacology, College of Veterinary Medicine  ,University of Mosul , Mosul, Iraq, from November 2021 to February 2022. It was determined using formaldehyde test and the median analgesic effective dose (ED50) for ceftriaxone, paracetamol and diclofenac sodium depending on the method of Dixon. An isobolographic ratio of 0.5:0.5 of the ED50 for each drug at the analgesic level was calculated.
Results: The administration of ceftriaxone at doses of (523, 1064 and 1330mg/kg) intramuscularly was led to a significant (p value=0.02) and clear analgesic effect through the disappearance of the right foot lift caused by the injection of formaldehyde, in aadition to significant decrease (p value=0.01) in foot thickness at dose of 1330 mg/kg . Analgesic ED50 of ceftriaxone , paracetamol and diclofenac sodium by Dixon method were 42.6 ,32.6 and 6.26 mg /kg respectively. The intramuscular administrations of drugs in a ratio of 0.5:0.5 result in a significant decrease (p value<0.001) in ED50 values ​ to 6.77, 5.34 and 0.99 mg/kg respectively. The application of the isobolographic analysis revealed the type of interaction between ceftriaxone/paracetamol, ceftriaxone /diclofenac sodium, and the interaction was synergistic when they were given at the ratio 0.5:0.5.
Conclusion: The results showed that ceftriaxone exerts its analgesic effect in chicks by reducing the mechanical hyperalgesia resulting from formaldehyde injection in the planter of the right foot and potentiated the analgesic effects of paracetamol and diclofenac sodium through the synergistic interaction.
 

Role of High Mobility Group Box-1 in Status Epilepticus, From Pathophysiology to Biomarker and Therapeutic Potential

Rana M. Raoof; Muna Al-Hamdany; Khalida I. Noel

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 37-41
DOI: 10.33899/mmed.2021.131944.1121

Status epilepticus (SE) is a neurological emergency that require prompt diagnostic and treatment measures due to its associated mortality and morbidity. The role of neuro-inflammation in status epilepticus has been studied extensively and many potential molecules have been proposed as a promising biomarkers and therapeutic targets for the condition. Inside the nucleus, HMGB1 is a DNA-binding protein with many housekeeping functions. Under certain conditions, HMGB1 will be translocated to the extracellular space promoting a strong pro-inflammatory reaction with activation of many downstream inflammatory pathways related to seizure onset and progression. In this review the potential role of HMGB1 in the pathogenesis of SE was highlighted stressing on the promising implications of this molecule as a therapeutic target for SE.

Bowel Injuries after Laparoscopic Ovarian Drilling: Observation of Three Cases with Review of Literatures

karam Kamal younis

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 42-47
DOI: 10.33899/mmed.2022.133534.1145

Background : Bowel injury remains a potential serious complication of gynecological laparoscopy. Electro thermal energy, especially in the form of monopolar diathermy, is used widely during Laparoscopic Ovarian Drilling (LOD) by diathermy for clomiphene-resistant polycystic ovary disease (PCOD). Occasionally there can be unrecognized transfer of energy in the operating area, resulting in electro thermal bowel  injury. If iatrogenic bowel injury  is not recognized  at the time it occurs, it can have devastating consequences.
Objectives : Through personal observations of 3 patients who underwent (LOD) for clomiphene-resistant (PCOD) followed by bowel perforation ,we highlighted their  ways of presentation , recognition ,  avoidance  and management  of such complication.
Setting : Surgical wards of Al-Jamhoori Teaching Hospital in Mosul City  
Patients and Methods : Through personal observation, we report a series of 3  infertile women   who underwent laparoscopic ovarian drilling for clomiphene resistant infertility  but were readmitted 2-3 days later with pinhole leaks from perforated bowel  .
Results : After (LOD ) ,two patients out of three were urgently explored via laparotomy and multiple  bowel perforations were found and  repaired. Consequently they improved .The third patient presented lately after rupture of  bowel and peritonitis. Although she underwent explorative laparotomy but her condition was potentially fatal and died from sepsis.
Conclusion : Gynecologists should be aware for the proper, safe and judicious use of diathermy during (LOD) to avoid complications with consultation and involvement of surgeons early following the procedure. High clinical suspicion is crucial for early diagnosis of bowel injuries. When diagnosis is delayed, then morbidity and mortality rises.
 

Childhood obesity: A review of literatures

Mazin Mahmoud Fawzi; Omar Farouq Fadel Alomari

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 48-53
DOI: 10.33899/mmed.2022.133478.1144

Obesity is a multifarious disorder involving developmental, behavioral, biological, environmental, and hereditary components; it is a major medical health issue. The greatest predominant cause of childhood obesity is a discrepancy in energy balance. The physicians have commonly depended on changes in food consumption with exercise since there is no single treatment choice for obesity treatment . The prevention of childhood obesity is considered as the enduring, cost-effective solution to the problem of obesity, effective methods for it still indescribable. In summary, this study will overview the implications, and treatment options available for childhood obesity.

Utility of different modalities in treatment of keloid scar

Hala N. Al Salman

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 54-60
DOI: 10.33899/mmed.2022.132869.1134

Background : Keloids constitute an abnormal benign fibro-proliferative wound healing response to any type of skin injury. it has high influence on Patient’s psychology and cosmetic view. It has high prevalence in African-American subjects. Until now there is no definitive treatment.
The aim of study : to assess the response in three different groups using three different modalities (intralesional steroid, cryotherapy, and both).
Patient and method : This was a randomized controlled clinical method with equivalent intervention assignment study, which was done on 16 patients (105 lesions), who attended Ibn Sina Teaching hospital, Mosul, Iraq, from January 2019 to January 2021.
Results : there were significant responses to the three modalities (p-value less than 0.05). and the response assessed for each patient according to Vancouver Score Scale (VSS), Patient and Observer Scar Assessment Scale (POSAS), and 2 diameters assess.
Conclusion: The results of this study showed that the combination of cryotherapy with intralesional steroids is more effective than steroid or cryotherapy alone in treating keloids.

Neonatal gastro-intestinal tract perforation in Mosul city

Bassam Khalid Alhajjar; Ibrahim Shukur Alhadidi; Ahmad Mahmud Al-Sharabi

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 61-69
DOI: 10.33899/mmed.2021.131611.1115

Background: Gastro-intestinal perforation (GIP) of neonates considered as one of the foremost emergency problems faced by pediatric surgeons around the world. It represents important challenges with a high mortality of 15-70% has been reported. Despite enhancements in anesthesia, as well as, intensive care, mortality has remained high, especially in premature babies.
Patients and Methods: A retrospective series study including 50 patients diagnosed as GIT perforation were admitted to the neonatal pediatric surgery center in Al-Khansaa teaching hospital, allocated over the period extending from April 2017 to June 2019. Records were reviewed for the age, sex, gestational age, weight, duration of symptoms, associated anomalies, causes of GIT perforation, procedure done, mortality, amorbidity, and hospital stay period. Leak from intestinal anastomosis secondary to resection as surgical interference were  excluded from the study.
Results: The presentation age varied between 12 hours to 27 days with a median age of 3.5 days. The weight mean is 2.93 kg. The mean gestation age was 34 weeks, ranging from 30-42 weeks. The majority had the symptoms before 30 hours. Most of the sample is within the 1st week representing 86.0%. The males are representing 76.0% while the females are 24.0% with a ratio about of (3:1). About 56.0% of the perforations occur in the small bowel and only 4.0% in appendix. The large bowel represents 28.0% and the stomach 12.0%. The positive findings of abdominal X-Ray are found in 80.0% of patients. 40.0% of patients are died. The frequent site is the ileum, found in 8 patients (40.0%) of all deaths. Next are the Jejunum and colon, representing 20.0% for each. The stomach pathology found in 10.0%, as well as, the cecum 10.0%.
Conclusion: The commonest site of perforation is small bowel. History, clinical picture and erect abdominal X-ray are very important for the diagnosis. The risk factors raise the mortality rate include malnutrition, the appearance of complications, lack of certain drugs, delayed diagnosis, prematurity, and associated anomalies. The outcome is improved with early identification, diagnosis, and treatment.
AIM OF THE STUDY : To study the causes and outcome of neonatal GIT perforations in Mosul city and its drainage areas in the north of Iraq.

Knowledge, Attitude and Perception of Married Women Toward Family Planning in Shekhan City

Jinan Nori Hasan

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 70-75
DOI: 10.33899/mmed.2021.131885.1119

The current study represents a cross sectional study and included 350 married women with ages range between 15 to 45 years from Shekhan city to study their information, attitude and practice concerning contraceptive methods and family planning (FP). The current work revealed presence of high percentage of parity of participant married women (5 and more) which record 107(30.6%), and nearly 63 (18%) of participants were pregnant at study time. Majority of participants think that FP is useful and 162(46.3%) of the enrolled females employed one of FP methods at study time. The most common cause of non-using FP methods is one or both parents want more children. The most common methods used are male condom, IUCDs and contraceptive pills .
The level of awareness was not optimal in regards to FP and contraceptive methods. Modified educational and counselling interferences among child bearing age females messages concerning FP were focused on males mainly so more short courses and seminars in various populations are recommended .

Online Team-Based Learning for Teaching Antenatal Care during COVID- 19 Pandemic

Omaima Abdulrazzaq zubair; Humam Ghanim I. Zubeer; Samar A. Ahmed; Mohamad H Shehata; Mohamad A Hassanein

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 76-82
DOI: 10.33899/mmed.2021.131802.1117

Background : Covid 19 era bring learning to be more distant via internet. Many students' engagement methods applied in this context. The present study aims to enhance students' engagement in the learning process through application of online Team Based Learning in teaching antenatal care in fourth year medical students during COVID 19 period .
Methods : A pilot intervention study was used to test the online team based learning application for teaching antenatal care partition of Community medicine curriculum during COVID-19 period. Then, the   study was implemented on two sessions through two academic years for the large group fourth-year medical students of College of Medicine, University of Mosul, Iraq. Google classroom, Google form, Telegram and Zoom platform was the online platform that used for application of the study .
Results : A total of 389 students were voluntarily participated in the study from two different academic years. There was significant improvement in the students’ performance obtained from team readiness assurance test in compares to individual readiness assurance test at each session's application.  Students give high satisfaction for TBL as a better way of teaching comparing to traditional teaching methods .
Conclusion : Pear's study has positive impact on students' understanding and when used online make the teaching easier and enjoyable .

Impact of Conflict on Physical Activity among Teenagers in Mosul City

Mayyadah Y. Mahmmod; Jawad K. Al-Diwan

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 83-87
DOI: 10.33899/mmed.2022.131880.1120

Background : Physical inactivity regarded as one of the leading risk factors for global mortality through its effect on multiple chronic non-communicable diseases (NCD), which in turn responsible for disability adjusted life years lost DALY and premature death in addition to mental disorder and a substantial economic burden worldwide.
Aim of study : To estimate the prevalence of physical activity/ inactivity among teenagers in Mosul city/ Iraq in post conflict period (2017-2019).
Patients & Methods : Cross sectional study was conducted upon 600 teenagers aged (12-17) years of both sexes attending secondary schools of Mosul city. Data collected between October and December 2019, using special form of questionnaire (Physical Activity Questionnaire for Adolescent PAQ-A), the data was obtained directly by interview with the students themselves to confirm a detailed questionnaire form. Using (SPSS 25) statistical package for social science program to calculate the prevalence of physical inactivity among teenagers [The student was physically inactive when he spends less than 60 minute daily of moderate to vigorous physical activity and physically active when he spends 6o minute or more daily of moderate to vigorous physical activity]. The data was presented as frequencies and percentages. A statistical test; chi-square test was used to test for the presence or absence of significant association between dependent and independent variables. A p-value less than 0.05 were considered significant.
Results : A total of 600 teenagers had been included in the study, 472 (78%) were physically inactive.
Conclusion : The current study showed the prevalence of physical inactivity is high among teenagers, especially females.
Recommendations : the study recommends the following to minimize the spread of physical inactivity among teenagers in the city:
1. Creation of active environment as provide safe places, public green spaces and ensure time for students to be active at school.
2. Encouraging teenagers, especially females to adopt physical activity routine as a part of their healthy life style.
3. Enhance regular population surveillance system of physical activity across all ages.
 

Complications after Covid-19 vaccination

Sameer Ibrahim Hasan; Imad A Thanoon; Abdul-rahman I. A-J Thanoon; Omar SI. Hasan; Rwqaya S. Dawood

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 88-94
DOI: 10.33899/mmed.2022.134076.1151

Background : Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus.
Most people who fall sick with COVID-19 will experience mild to moderate symptoms and recover without special treatment. However, some will become seriously ill and require medical attention.
Objective : The aims of this study is to explore the different side effects associated with the three most common vaccines against Covid-19 in Nineveh, Iraq. Such study will aid healthcare workers and policy makers in the betterment of medical care for concerned patients, therefore, improving their quality of life.
Patients and methods: The study is a prospective case series study, included 498 participants, 48.1% of them were between the ages 18 to 30 years, 54.0% are married, Only these two characteristics were significantly different among vaccine users (p-value = .041 and .001, respectively).
Results: Frequency of Adverse Reactions Based on the Vaccine
For the first dose, the most common symptoms were body/joint pain, headache, fatigue and fever.
The frequency of these symptoms in addition to respiratory symptoms were significantly more frequent within the AstraZeneca vaccine (all p <.001).
While the Pfizer-BioNTech vaccine had significantly higher frequency of no experienced symptoms (p <.001).
For the second dose, the trends of the adverse effects did not change. However, the symptoms of joint/body pains, headache, fatigue, and fever were significantly more pronounced in the Pfizer-BioNTech vaccine (all p <.001).
Conclusions and recommendations: In conclusion, we noticed that post vaccine side effects are common with all vaccines but are more pronounced in new technology vaccines.
The application of a governmental surveillance system adverse effect severity is highly recommended.

Peroxisome Proliferator- Activated Receptors (PPARs): A Review on Effects on Glucose Metabolism, Energy Homeostasis and Cardiovascular System

Amjad Hazim Al-Naemi

Annals of the College of Medicine, Mosul, 2022, Volume 44, Issue 1, Pages 95-102
DOI: 10.33899/mmed.2022.133951.1148

Background:Molecular biology and human medical genetics have introduced several novel biomarkers giving control over vital body functions, of these are transcriptional factors known as peroxisome proliferator activated- receptors “PPARs”. The aim of this review is to shed light on available online information and published research works about these biomarkers. The current review will try to display those findings mainly related to energy homeostasis, glucose metabolism, insulin sensitivity and some cardiovascular interactions.
Methods:a literature review about peroxisome proliferator activated- receptors and their roles in controlling some vital body functions has been made and recorded. Search covered published investigations and research works over the last three decades as accessible.
Results: peroxisome proliferator activated- receptors have crucial roles in controlling a big deal of vital biological processes in humans.
Conclusions: Peroxisome proliferator-activated receptors are important transcriptional factors with clinical impacts. Literature shows a wide spectrum of effects and interactions through affecting many genes involved in processes of glucose homeostasis, energy balance, and peripheral insulin sensitization in addition to interfering with processes of inflammation, angiogenesis, blood pressure control and atherosclerosis.