Showing papers in "Zanco Journal of Medical Sciences in 2015"
TL;DR: The microbiology of urinary tract infection, antibiotics susceptibility pattern prevalence and their relation with age, gender and circumcision among infants and young children in Erbil city were clarified.
Abstract: Background and objectives: A urinary tract infection is defined by the presence of an organism in the urinary tract that is usually sterile. The age and gender are important factors influencing prevalence of urinary tract infections. The aim of this study was to clarify the microbiology of urinary tract infection, antibiotics susceptibility pattern prevalence and their relation with age, gender and circumcision among infants and young children in Erbil city.
Methods: Urine samples were collected from 300 children with sign and symptoms of urinary tract infection at Rapareen Pediatric Hospital in Erbil city. The specimens were cultured on appropriate media and the isolated organisms identified with a significant growth 105 CFU/ml. The susceptibility of bacteria causing urinary tract infection to different antimicrobial agents was investigated.
Results: The study showed that 43.3% of children had urinary tract infection (53.2% females, 30.2% males). The highest percentage of infection occurred at age group 6-10 years with female's predominance. The percentage of urinary tract infections in uncircumcised boys was 76.9%. The most common organism isolated was Escherichia coli (33.8%). The isolated bacteria were highly sensitive to Ciprofloxacin, Amikacin and Nitrofurantoin.
Conclusion: Early and appropriate diagnosis of urinary tract infection in infants and young children is important as it is marker for urinary tract problems. Escherichia coli was the most common organism causing urinary tract infection in children. The most of urinary isolates had high level of resistance to commonly used antibiotics.
26 citations
TL;DR: The investigation revealed that the traditional healers were not professionally authorized and 32 plants belonging to 23 families were used to treat various diseases in traditional medicine in Erbil-Kurdistan region.
Abstract: Background and objective: Herbal medicine is a traditional or folk medicine practice based on the use of plants’ seeds, berries, roots, leaves, barks, flowers and plant extracts for medicinal purposes. This survey highlights the traditional phytotherapy practices by traditional healers of Erbil-Kurdistan region in the treatment of various disorders.
Methods: An ethnobotanical survey was undertaken to collect information from traditional healers on the use of medicinal plants in Erbil-Kurdistan region. The indigenous knowledge of local traditional healers and the native plants used for medicinal purposes were collected through questionnaire and personal interviews.
Results: The investigation revealed that the traditional healers were not professionally authorized and 32 plants belonging to 23 families were used to treat various diseases in traditional medicine. The plants reported have been identified and presented in a table with the vernacular names, useful parts, dosage preparations and medicinal uses.
Conclusion: Many recorded species of plants are used in Erbil- Kurdistan region in traditional medicine but lack phyto-therapeutic evidence. Most indigenous plants remain to be studied which may yield many exciting data for further investigation.
16 citations
TL;DR: Qualitative analysis of ethanolic extract of Rosmarinusofficinalis shows presence of phytochemical compounds like condensed tannin, quinon, flavonoid, terpenoid and phenols, which is considered as the most efficient method of extraction from quantitative measures.
Abstract: Background and objective: The first step in the process of drug obtaining from natural origin was standardized extraction procedure. The aim of the study was to compare extracts of Rosemarinusofficinalis obtained by different methods of extraction from mass and phytochemical points.
Methods: Comparison was done through measuring the mass of yield of Rosmarinusofficinalis extracts using different methods of extraction. Qualitative analysiswas done through preliminary phytochemical screening tests for the presence of secondary natural groups of extracts of rosemary plant obtained by different methods of extraction.
Results: The highest yield mass (7.666%) was obtained from the microwave assisted extraction method belong to the modern methods of extraction group. In qualitative analysis, there was no difference in the presence of the secondary natural product groups with different methods of extraction belonging to the two classes conventional and modern. New group of natural products were detected in the ethanolic plant extract are condensed tannin and quinone.
Conclusion: Microwave assisted extraction is considered as the most efficient method of extraction from quantitative measures. Qualitative analysis of ethanolic extract of Rosmarinusofficinalis shows presence of phytochemical compounds like condensed tannin, quinon, flavonoid, terpenoid and phenols.
15 citations
TL;DR: Rheum ribes root was found to reduce significantly blood glucose levels in type 2 diabetes mellitus patients and phytochemical study for the correlation of antidiabetic activity with the active constituents in the plant was validated.
Abstract: Background and objective: Rheum ribes (polygonaceae) roots are used traditionally to treat diabetes, hypertension, obesity, ulcer, diarrhea, anthelmintic and expectorant. The purpose of this study was to investigate clinically the antidiabetic activity of Rheum ribes in type 2 diabetes mellitus patients and phytochemical study for the correlation of antidiabetic activity with the active constituents in the plant.
Methods: The antidiabetic activity of Rheumribes given alone and in combination with standard oral hypoglycemic agents was investigated in type 2 diabetes mellitus. The study was conducted on 120 patientswith type 2 diabetes mellitus for a period of 12 weeks. Preliminary phytochemical screening was carried out followed by high performance liquid chromatography analysis for the identification of flavonoid constituents in the root of Rheumribes.
Results: Rheumribes root showed significant blood glucose reduction (P <0.01) on 12th weeks of the observation period with 39.63% percent blood glucose reduction. The combination treatment of Rheumribes root and glibenclamide showed a significant difference (P <0.05) with the treatment group of glibenclamide and metforminwith maximum percent of reduction in blood glucose level of 48.91%.The results of preliminary phytochemical screening showed the presence of alkaloids, tannins, flavonoids, anthraquinones, and quinones. Quercetin was identified by high performance liquid chromatography. The proposed high performance liquid chromatography method was validated for linearity, accuracy, precision and limit of quantitation.
Conclusion: Rheum ribes root was found to reduce significantly blood glucose levels in type 2 diabetes mellitus patients.Quercetin was identified by high performance liquid chromatography as an important flavonoid constituent.
15 citations
TL;DR: Age group 22-28 years, male gender, nursing experience from1-8 years and nursing experience in coronary care unit from 1-5 years were significantly associated with provision of high quality of nursing care, which shows that the majority of nurses provided fair levels of quality of Nursing care.
Abstract: Background and objective: Acute myocardial infarction is the death of myocardial tissue as a result of prolonged lack of blood and oxygen. The aim of this study was to assess the quality of nursing care for patients with acute myocardial infarction in the coronary units in Erbil city hospitals.
Methods: This descriptive study was conducted on a non probability, purposive sample of 70 nurses selected from coronary care units of four hospitals (Hawler Teaching Hospital, Rizgari Teaching Hospital, Cardiac Centre and Rojhalat Emergency Hospital) in Erbil City. A questionnaire containing two parts was used for data collection. Part I of the questionnaire included demographic characteristics and part II contained three observational checklists: immediate nursing care for patients with acute myocardial infarction, nursing care for patients during coronary care units and teaching the patient and family before discharge. The number of items of the assessment sheet was 78.
Results: The mean age of the participants was 30 years. Majority of the samples were male, graduated from nursing institute, having 1-8 years of nursing experience, having 1-5 years experience in coronary care units and have not participated in previous trainings. The highest percentage (75.7%) of nurses provided fair levels of quality of nursing care. Age group 22-28 years, male gender, nursing experience from1-8 years and nursing experience in coronary care unit from 1-5 years were significantly associated with provision of high quality of nursing care. Highly significant factors associated with provision of high quality of nursing care included the higher levels of education, and participation in training regarding nursing care in coronary care unit.
Conclusion: Concerning the levels of quality of nursing care, the study shows that the majority of nurses provided fair levels of quality of nursing care
11 citations
TL;DR: More than half of diabetic patients were in the moderate level of disability, which can result in the high prevalence of long term complications, and the standardized questionnaire developed by World Health Organization for disability assessment.
Abstract: Background and objectives: The disabling effects of diabetes mellitus are multi-factorial, which can result in the high prevalence of long term complications. The aim of this study was to assess disability levels of diabetic patients.
Methods: A quantitative design descriptive study was conducted in Leila Qasim Center in Erbil City in the Kurdistan Region of Iraq from February 2012 to February 2013. A non-probability purposive sample of 400 diabetic patients for more than 5 years was selected. A questionnaire was designed and divided into three parts: sociodemographic data, clinical data, and the standardized questionnaire developed by World Health Organization for disability assessment.
Results: The highest percentage (57%) of diabetic patients had a moderate level of disability, while 23% had a mild level of disability. Severe level of disability was present in 20% of sample. No one had not disability or extreme level of disability.
Conclusion: More than half of diabetic patients were in the moderate level of disability.
8 citations
TL;DR: Assessment of the association of maternal C-reactive protein in second trimester with risk of occurrence of preterm delivery later on found no significant association was found.
Abstract: Background and objective: Estimation of C-reactive protein is a simple method and could be helpful in detecting cases at risk for pre-term delivery. In this study we examined the association of maternal C-reactive protein in second trimester with risk of occurrence of preterm delivery later on.
Methods: A prospective case-cohort study was conducted between June 2011 and July 2012 at Maternity Teaching Hospital Iraq- Erbil. The sample size was 205 women at gestational age of 20+0 weeks to 26+6 weeks and after exclusion of all risk factors for preterm delivery. High-sensitivity C-reactive protein assays were performed on serum samples.
Results: Median concentration of C-reactive protein was 4.7 mg/liter. No significant association was found between high level of C-reactive protein and occurrence of preterm delivery (P = 0.78).
Conclusion: Measurement of C-reactive protein in second trimester cannot be used as an indicator for pre-term delivery.
6 citations
TL;DR: Thyme and Rosemary essential oils were ideal natural compounds against drug resistant Candida albicans strains and achieved their antifungal activities even at very low concentrations.
Abstract: Background and objective: Candida albicans is an oral commensal flora that causes opportunistic local and systemic infections in immunocompromied individuals. Fluconazole is frequently used for treating patients with active infections or preventing recurrent infections. The emergence of resistant strains encouraged scientists to search for compounds that have antifungal property and can overcome the usual microbial resistant mechanisms to antimicrobial agents. Essential oils from natural plants have received great interest due to the antimicrobial property of their multiple constituents. The aim of this study was to investigate the antifungal activity of Rosemary and Thyme essential oils against fluconazole resistant oral Candida albicans isolates.
Methods: Essential oil from areal parts of Rosemarium officinalis and Thymus vulgaris were obtained by hydrodistillation. Disk diffusion and microbroth dilution methods were followed to test the sensitivity of eight fluconazole resistant oral Candida albicans isolates and one ATCC strain to the extracted Essential oils. Minimum inhibitory concentration and minimum fungicidal concentration were used to evaluate the antifungal potential of the tested essential oils.
Results: The results of disk diffusion method using concentrated Essential oils showed marked inhibition of growth around the prepared discs from both Essential oils. However, the recoded diameters was higher in Thyme Essential oil (Mean ± SD: 42.4 ± 6.5) when compared with Rosemary essential oil (Mean ± SD: 11.8 ± 2.8). Serial two fold dilutions of the tested essential oils showed that both essential oils attain their antifungal activities even at very low concentrations. The highest MIC and MFC of Rosemary EO were 3.125% and 6.25%, respectively. Thyme essential oil showed very low MIC and MFC (<1.56%).
Conclusion: Thyme and Rosemary essential oils were ideal natural compounds against drug resistant Candida albicans strains.
5 citations
TL;DR: The prevalence of multi-drug resistance to the antibiotics among extended spectrum beta lactamase producing E. coli isolates was established and Imipenems are recommended for the treatment of serious infections caused by these organisms.
Abstract: Background and objective: Bacterial resistant to broad spectrum β-lactams, which is mediated by the extended spectrum beta lactamase enzyme, has emerged recently as increasing problem. Extended spectrum beta lactamase producing strains can also displaying multi-drug resistance. Thus, increased number of infections due to these strains is a public health issue associated with high morbidity, mortality, high health-care costs and prolonged hospitalization. Therefore, this study aimed to evaluate multi-drug resistance among extended spectrum beta lactamase producing E. coli causing urinary tract infections.
Methods: A total of 400 mid-stream urine specimens were collected from patients with urinary tract infection. Disk diffusion agar method on Muller-Hinton agar plates was carried out. Double Disc Synergy Test was used for detection of extended spectrum beta lactamase producer. All the isolates that were screened out for extended spectrum beta lactamase production were also subjected to confirmation by using the Phenotypic Confirmatory Combination Disc Diffusion Test.
Results: The urinary tract infection cases were mainly due to Gram negative bacteria (87%). E. coli was isolated from 195 (48%) specimens. Sixty isolates of E. coli (31%) were found to be extended spectrum beta lactamase producers. The resistance to antibiotics tested was significantly higher (P <0.001) among extended spectrum beta lactamase producing isolates.
Conclusion: The prevalence of multi-drug resistance to the antibiotics among extended spectrum beta lactamase producing E. coli isolates was established. Imipenems are recommended for the treatment of serious infections caused by these organisms.
5 citations
TL;DR: Tissue expansion, if carefully planned and conducted, is one of the treatments of choice for post-burn reconstruction of the head and neck, allowing an expanded flap suitable for versatile coverage.
Abstract: Background and objective: Tissue expanders are useful adjuvant in reconstruction after burn. The technique provides tissue of similar texture and color to the defect to be covered and has the added advantage of minimal donor site morbidity. The study aimed to assess the outcome and complications of using tissue expansion for head and neck postburn reconstruction.
Methods: Thirty patients with head and neck burn scar, treated with thirty eight tissue expanders, were included in this prospective study at the Plastic Surgery Department in Rizgari Teaching Hospital in Erbil from April 2009 to November 2012, with the mean age of 14 years. Statistical package for social sciences (SPSS version 18) was used for data entry and analysis.
Results: The commonest use of tissue expander was for treating postburn scar alopecia (18 patients, 60%), followed by postburn cheek scar (six patients 20%). The scar size ranged from 4x10cm to 16x24cm. Complete burn scar excision was possible in 80% of cases with single or multiple sessions of expansion. Early exposure of the expander followed by infection occurred in three cases (10%), which led to interruption of the expansion and expander removal. Satisfactory results were achieved after reconstruction in 90% of cases.
Conclusion: Tissue expansion, if carefully planned and conducted, is one of the treatments of choice for post-burn reconstruction of the head and neck, allowing an expanded flap suitable for versatile coverage.
4 citations
TL;DR: This study investigated the detection rate of Porphyromonas gingivalis in chronic periodontitis patients versus healthy subjects using PCR assay, and its association with increased pocket depth and clinical attachment loss.
Abstract: Background and objective: Chronic periodontitis is the destruction of the tooth supporting structures as a result of a complex interaction between bacteria colonizing the gingival crevice and host’s immune responses. Porphyromonas gingivalis is one of the main periodontopathogens with multiple virulence factors. The aim of this study was to investigate the detection rate of Porphyromonas gingivalis in chronic periodontitis patients versus healthy subjects using PCR assay, and its association with increased pocket depth and clinical attachment loss.
Methods: Seventy subjects (35 patients with chronic periodontitis and 35 healthy subjects) meeting the inclusion criteria of this study were selected. All the subjects were clinically assessed for probing pocket depth and clinical attachment loss then subgingival microbial samples were collected using sterile paper points and analyzed for the presence of Porphyromonas gingivalis using polymerase chain reaction assay.
Results: A significant difference in Porphyromonas gingivalis detection rate between chronic periodontitis and healthy groups was recorded. Porphyromonas gingivalis was significantly associated with deep pockets. The detection rate increased with the increase in the severity of the disease, although, this correlation was not statistically significant.
Conclusion: A positive association was observed between Porphyromonas gingivalis and increased pocket depth. The recovery rate was higher in severe cases.
TL;DR: This study suggested that high percentage of the students had positive attitude toward community medicine course, and some recommendations have been made for improving the quality of the course.
Abstract: Background and objective: Community medicine is an important discipline for medical students who are going to be future doctors and deal with different health problems. Community Medicine is taught in 3rd, 4th and 6th year of study at Hawler College of Medicine. The aim of the study was to explore students' perception about this subject because it plays an important role in determining educational outcome.
Methods: This study was carried out in Hawler College of Medicine, Erbil city, Iraqi Kurdistan Region in the academic year 2013-2014. It was based on a self-administered questionnaire survey of 4th year students. The questionnaire consisted of closed and open ended questions related to the attitude of students toward community medicine course, views on the positive and negative aspects and recommendations to improve the course. The quantitative data were analysed through using the statistical package for the social sciences (version 19), while qualitative data analysis comprised thematic analysis of open-ended questions using common coding techniques.
Results: The result of this study suggested that high percentage of the students had positive attitude toward the course. Sixty-six respondents (55.4%) mentioned that there are positive aspects in the course like research project (33.3.1%), having respectful and friendly teachers (31.8%) and participation of students in discussions in the classroom. Sixty-six respondents (55.4%) mentioned that there are negative aspects in the course like short duration of the course (27.2%) and some topics were repeated from other years. Fifty-seven respondents (47.8 %) have recommended a number of priorities for improving the quality of the course like: increasing practical sessions with more student participation (36.8%); decreasing theoretical lectures (22.8%) and the time for the research should be isolated without lectures (19.2%).
Conclusion: Community medicine course is well perceived by the students with some negative aspects. Some recommendations have been made for improving the quality of the course.
TL;DR: Assessment of the role of research in health policy making in Iraqi Kurdistan context and identify the main barriers and facilitators for enhancing such role found poor networking among researchers, policy-makers, practitioners and representatives from civil society has its negative impact on evidence-based policymaking.
Abstract: Background and objective: Evidence from research is underutilized in policy and practice in the majority of developing countries including Iraq. This aim of this study was to assess the role of research in health policy making in Iraqi Kurdistan context and identify the main barriers and facilitators for enhancing such role.
Methods: This cross-sectional survey was carried out between November 2013 and March 2014 in the three governorates of the Iraqi Kurdistan Region, Erbil, Duhok and Sulaimaniyah. The study participants included 10 key health informants and three health advisors. Two types of combined questionnaires for health policy makers and health advisors were used for data collection.
Results: Conferences and seminars were the main sources of scientific evidences identified by health policymakers (80%), followed by consultants (70%). Different jargons/discourse was the main obstacle in consulting researchers (90%), followed by lack of tradition in collaborating (70%). Collection of specialists/advisors, followed by professional associations, scientific committees and international organizations/UN agencies were the main groups identified by health advisors to build bridges between the scientific community and policymakers.
Conclusion: Policymakers very rarely consult researchers directly in their decision making. There is poor networking among researchers, policy-makers, practitioners and representatives from civil society which has its negative impact on evidence-based policymaking. There is obviously a lack of any sort of program of funded research that can inform policymaking.
TL;DR: The prevalence of stillbirth in the Maternity Teaching Hospital in Erbil is high in comparison to the rate in other countries, and could be due to high level of deliveries per day and lack of good follow up of patients during labour.
Abstract: * Kirkuk Health Directorate , Kirkuk, Iraq. ** Department of gynecology, college of medicine, Hawler Medical University, Erbil, Iraq. Introduction The World Health Organization (WHO) and the international classification of diseases (ICD) defined stillbirth as the death of a fetus that has reached a birth weight of 500g, or if birth weight is unavailable, a gestational age of 22 weeks or crownto-heel length of 25 cm. Stillbirth is classified as fresh stillbirth when the baby born with an intact skin suggesting that the death occur during labour (less than 12 hours before delivery), and macerated stillbirth, when there is signs of degeneration (peeling of skin, red serous effusions in the chest and abdomen due to hemoglobin staining) suggesting the death occur more than 12–24 hours before labour. About 3.2 million stillbirths occur worldwide every year, 98% of these in the developing world, 5/1000 total deliveries in the developed world, 25-32/ 1000 total deliveries in the developing world. Death of an infant in utero or at birth has always been a devastating experience for the mother and of concern in clinical practice. It is important to recognize that the loss of a fetus during pregnancy is a cause of major protracted psychological morbidity for some women and their families. Stillbirths are both common and devastating, and in developed countries, about one third has been shown to be of unknown or unexplained origin. There are several factors associated with fetal loss. Some of these have a clear causal link such as an abruption or a cord event, while others may contribute indirectly to fetal loss such as obesity. Some losses may be associated Background and objective: Death of an infant in utero or at birth has always been a devastating experience for the mother and of concern in clinical practice. The aim of this study was to determine the prevalence, probable risk factors and association of stillbirth with different maternal variables in Erbil Maternity Teaching Hospital. Methods: A cross-sectional design was used to determine the prevalence of stillbirth and a case control design was used to determine the probable risk factors and demographic characteristics of women with stillbirth in Maternity Teaching Hospital in Erbil city, Kurdistan region, Iraq, from April 1, to December 31, 2011.Three hundred seventy nine women having stillbirth were regarded as cases while 758 women delivering alive newborns were regarded as control group. Results: The prevalence of stillbirth during the period of the study was 20.4 per1000 total births. Macerated stillbirth was about four times higher than the fresh stillbirth. There were statistically significant differences between the cases and controls in relation to: maternal age (≥ 35 years), level of education, history of antenatal care visits, parity, medical diseases of the mother, congenital anomalies of the newborn, and history of previous stillbirth. In 65.4% of cases the probable cause of death was unexplained. Conclusion: The prevalence of stillbirth in the Maternity Teaching Hospital in Erbil is high in comparison to the rate in other countries. This could be due to high level of deliveries per day and lack of good follow up of patients during labour.
TL;DR: The seroprevalence of T. gondii infection in schizophrenic patients in Erbil is investigated and compared with that obtained from control individuals inErbil correlated with inflammatory marker C-reactive protein.
Abstract: Background and Objectives: Schizophrenia is a complex chronic neuropsychiatric disease of the central nervous system, believed to have multiple etiologies. Toxoplasma gondii has emerged as an interesting candidate as a possible cause of some cases of schizophrenia. As there is scarce information about the seroprevalence of T. gondii infection in psychiatric patients in Erbil; we investigated the seroprevalence of T.gondii in schizophrenic patients and compared with that obtained from control individuals in Erbil correlated with inflammatory marker C-reactive protein.
Method: This case control study included 93 schizophrenic patients seeking medical advice at Hawler Psychiatric Hospital and private clinics with 93 non psychiatric control were screened for the presence of anti-toxoplasma IgG, IgM (by ELISA test) and C-reactive protein using qualitative methods. A questionnaire was used to collect socio-demographic and behavioral data among the respondents.
Results: In chronic cases anti-Toxoplasma gondii IgG antibodies were seropositive in 30/93 (32.3%) of the schizophrenic patients and 4/93(4.3%) of control (P
TL;DR: Assessment of the post episiotomy care instructions provided by midwives in Erbil, Dohuk and Suleimanya found that midwives do not properly instruct the mothers who have episiotome regarding care during postpartum period.
Abstract: Background and objective: One of the main responsibilities of midwives is the provision of post episiotomy care instructions for women who have episiotomy before discharge from the hospital after delivery. This study aimed to assess the post episiotomy care instructions provided by midwives and compare the instructions of midwives of the three main cities of Kurdistan region.
Methods: This cross-sectional study was conducted between July 1st, 2013 and July 10th, 2014 in the three governorates of Kurdistan Region of Iraq (Erbil, Dohuk and Suleimanya). All the midwives (n=53) working in the delivery room of the three maternity teaching hospitals were included in the study. A questionnaire was designed for the purpose of the study. Data were collected through interview with midwives. ANOVA and Chi-square test were used for data analysis.
Results: The midwives in Erbil didn’t provide post episiotomy care instructions at all. Most of midwives of Duhok and Sulemanyia didn't provide proper instructions to mothers who have episiotomy, and there was highly significant difference between their instructions regarding some topics.
Conclusion: Midwives do not properly instruct the mothers who have episiotomy regarding care during postpartum period. The practice of midwives was different in the three cities of Kurdistan region. Hospital policy and the job descriptions of midwives regarding post episiotomy instruction should be reevaluated.
TL;DR: This study established the value of renal sonography in the pregnant women, though not a common condition, as Renal collecting system dilatation was the main finding.
Abstract: Background and Objectives: Renal disease can affect the outcome of pregnancy. The renal system undergoes significant physiological and anatomical changes during pregnancy. Ultrasound is the commonest imaging modality used in the evaluation of the abdominal organs in pregnancy. The purpose of this study was to sonographically evaluate the kidneys in normal pregnancy.
Methods: A prospective descriptive study in which real time B-mode renal ultrasound was performed on 500 pregnant women attending for a routine obstetric ultrasound scan. Questions about the age, parity and presence of loin pain were asked. Obstetrical ultrasound examination was initially performed followed by examination of maternal kidneys.
Results: Renal collecting system dilatation was the main abnormal finding; it was present in 18.2% of cases, (15.2% right side and 3% left side). Bilateral hydronephrosis was seen in (2.6%) of cases. Rate of hydronephrosis was more in primiparous women. Other findings were renal stones (2.8% right and 1.8% left sides, respectively), ureteric stone (0.2%) and acute pyelonephritis (1%).
Conclusions: This study established the value of renal sonography in the pregnant women, though not a common condition. Renal collecting system dilatation was the main finding. A significant proportion of patients with asymptomatic renal calculi were detected incidentally.
TL;DR: A substantial number of women in Basrah showed postpartum depression, and several obstetric and psychosocial variables were significantly associated with postnatal depression.
Abstract: Background and objective: Post partum depression is considered an important public health concern worldwide with its negative impact on mothers and children. The aim of this study was to determine the prevalence and risk factors of post partum depression among women in Basrah.
Methods: Data were collected by interviewing women 8-12 weeks post partum using a questionnaire including information on socio-demographic and prenatal, natal and postnatal medical history. Postpartum depression was assessed using an Edinburgh Postnatal Depression Scale.
Results: A total of 302 women were included in the study. The prevalence of postnatal depressive symptoms was 31.5%. The results showed no significant relationships between depression symptoms and education, occupation, monthly income and parity, while several obstetric and psychosocial variables were significantly associated with postnatal depression. On multiple regression analysis, history of depressive symptoms, anaemia during pregnancy, exposure to violence and relationship with mother or daughter in law remained significant factors (P <0.001)
Conclusion: A substantial number of women in Basrah showed postpartum depression. Further research is required to affirm these determinations.
TL;DR: The use of cone beam computed tomography for examination of tempromandibular joint space in patients with myofacial pain dysfunction syndrome give a good diagnostic criteria for affected side.
Abstract: Background and objective: Joint space assessment and condylar relation in the glenoid fossa is considered as integral component of the clinical assessment of the patient with tempromandibular joint disorder. Any variant from normal tempromandibular joint may affect the diagnosis and management of the case. Methods: Thirty patients with unilateral myofacial pain dysfunction syndrome were included in this study (14 male and 16 female). Joint space analysis was performed by cone beam computed tomography for all patients. Analysis of data for joint spaces (anterior, middle, posterior, medial and lateral) was performed by using t-test. Results: The joint spaces and condyle positions in anterior, superior and posterior regions showed less joint space and statistically significant difference (P <0.05) from same joint space of normal side. No statistically significant differences were found in space value between middle and lateral condylar space of the diseased side and normal side of the patient. The joint spaces in normal sides were between 2 to 3.2 mm. Age and gender variations showed no statistical differences. Conclusion: The use of cone beam computed tomography for examination of tempromandibular joint space in patients with myofacial pain dysfunction syndrome give a good diagnostic criteria for affected side.
TL;DR: Flushing of the tubes with water-soluble contrast media during hysterosalpingography increases subsequent pregnancy rates in infertile patients.
Abstract: Background and objectives: A possible therapeutic effect of diagnostic tubal patency testing has been debated in the literature for more than half a century. The aim of this study was to evaluate the effect of flushing the fallopian tubes with water-soluble contrast medium during hysterosalpingography on subsequent pregnancy rates and to find out diagnostic findings of hysterosalpingography in infertile patients.
Methods: A prospective study was conducted on 220 women. hysterosalpingography using water-soluble contrast media was done in a private clinic as part of their infertility work up from January 2012 to July 2012 in Erbil city, Kurdistan region, Iraq. The pregnancy rate was determined within six months from the procedure using water soluble contrast media and it was correlated with different hysterosalpingography findings.
Results: The mean age (+SD) of the study population was 30.59 (+5) years. The clinical pregnancy rate was 23.2%. A statistically significant difference was found between the rate of pregnancy and hysterosalpingography results in which 27.2% of patients with normal hysterosalpingography and 6.8% of patients with abnormal hysterosalpingography got pregnant during six-month follow-up period after the procedure (P = 0.004).
Conclusions: Flushing of the tubes with water-soluble contrast media during hysterosalpingography increases subsequent pregnancy rates in infertile patients.
TL;DR: Women’s education and occupation, socioeconomic status, number of children, tetanus toxoid vaccine, far distance to ANC service, and high educational level are significantly associated with percentage of receiving antenatal care.
Abstract: Background and objective: Antenatal care is the care of the woman during pregnancy. The aim of this study was to determine the factors affecting the utilization of antenatal care among reproductive age group women (15-49 years) in Erbil city.
Methods: A cross-sectional study was conducted between April 1st, 2012 till April 1st, 2013 in Erbil city at the Birth and Death Certification Registration Center and the Maternity Teaching Hospital. Data from a sample of 500 women among reproductive age group (15-49 years) was collected by using a questionnaire through direct interview. Statistical package for the social sciences (version 18) was used for data entry and analysis.
Results: Antenatal care service utilization in the study area was 82.4%. From those who attended antenatal care service, 45.8% started antenatal care visit during the first trimester of pregnancy and 41% had less than four visits. Utilization of antenatal care services was significantly associated with high educational level, professional job, having least number of children, highly tetanus toxoid vaccine receivers and near distance to antenatal care services.
Conclusion: Nearly 49.5% of antenatal care user women did not receive adequate number of visits as recommended by the World Health Organization. Women’s education and occupation, socioeconomic status, number of children, tetanus toxoid vaccine, far distance to ANC service are significantly associated with percentage of receiving antenatal care.
TL;DR: Miscarriage was significantly high among women with gestational age 13 weeks and the estimated volume of the hematoma did not correlate with the outcome of the pregnancy, perhaps it is the presence or absence of a hematomas as a marker of the integrity of placentation and not its size.
Abstract: Background and objective: Subchorionic hemorrhage is the most common sonographic abnormalities and the most common cause of first trimester miscarriage and mainly associated with vaginal bleeding. The present study was conducted with an aim to find out the effect of subchorionic hemorrhage in first and second trimester of pregnancy outcome.
Methods: A case cohort prospective study was designed to investigate 100 patients having a subchorionic hematoma in the presence of singleton live embryo or fetus. The study assessed the association of the volume size of subchorionic hematoma, maternal age and gestational age at time of the diagnosis with adverse pregnancy outcomes.
Results: The incidence of miscarriage and preterm delivery was 35% and 21% respectively. The mean (±SD) age of those who aborted was 29.97 ± 7.0 years, slightly higher than the mean age of those who ended with preterm delivery (27.7 ± 5.87 years) and those continued with their pregnancies to viability (28.3 ± 6.2 years). There was a statistically significant association between previous histories of preterm delivery and pregnancy outcome (P =0.015). Miscarriage was significantly high among women with gestational age 13 weeks (P <0.001). The estimated volume of the hematoma did not correlate with the outcome of the pregnancy, perhaps it is the presence or absence of a hematoma as a marker of the integrity of placentation and not its size.
Conclusion: Subchorionic hematoma in first and second trimester of pregnancy associated with adverse pregnancy outcome (spontaneous miscarriage and preterm delivery.
TL;DR: Postoperative jaw opening exercises are crucial for lasting success and failure of patient compliance is the cause of reankylosis.
Abstract: Background and objective: True ankylosis of the temporomandibular joint may be defined as joint surfaces fusion. It can affect the function adversely and when occurs during childhood, it can adversely affect mandibular growth. The treatment is usually surgical, but, unfortunately, poses a significant challenge because of the high recurrence rate. The objective of this paper is to evaluate the outcome of following a definitive protocol in the treatment of temporomandibular joint ankylosis. Methods: Seventy-seven patients, 36 unilateral and 41 bilateral ankylosis (118 ankylosed joints) were diagnosed clinically and radiologically as having true ankylosis of the temporomandibular joint during the period between 2001 and 2013. Resection of the ankylosed bone or horizontal ramus osteoctomy of the affected side with interpositional autogenic or alloplastic material, with possible ipsilateral and/or contralateral coronoidectomy to achieve the definitive interincisal opening of not less than 35mm. Results: The postoperative measurement of interincisal opening of ≥35mm with lateral and protrusive movement was the criteria for success of surgery. Reankylosis occurred in 7 unilateral and 12 bilateral cases. Conclusion: Postoperative jaw opening exercises are crucial for lasting success and failure of patient compliance is the cause of reankylosis.
TL;DR: Although many extrinsic and intrinsic factors influence formation of kidney stones and bone resorption, this study suggests that drinking of Barbican beverage may be helpful to prevent bone Resorption and also to reduce risk of stone formation.
Abstract: Background and objective: Malt beverage without alcohol (Barbican) is an energy beverage which is regularly consumed by Muslim countries and substantial quantities are exported to the Gulf States and Middle East countries. Barbican is used widely by people whom alcohol is forbidden either on medical grounds or on religious aspects. The aim of this study was to assess the effect of short-term drinking of Barbican on urinary excretion of calcium and uric acid in normal young males in Erbil city.
Methods: Thirty healthy male volunteer subjects of 21-23 years age consumed 330 ml of Barbican® beverage per day for two successive days after cross design. The urinary calcium and urinary uric acid were evaluated before and after consumption.
Results: There was no statistically significant increase in urinary uric acid before and after consumption of Barbican beverage (P = 0.071). Urinary calcium significantly decreased after consumption of Barbican drink (P = 0.037).
Conclusion: Although many extrinsic and intrinsic factors influence formation of kidney stones and bone resorption, this study suggests that drinking of Barbican beverage may be helpful to prevent bone resorption and also to reduce risk of stone formation.
TL;DR: The main cause of the maternal deaths was pre-eclampsia and its complications and most of those died were residents of rural areas and were illiterate women.
Abstract: * Maternity Teaching Hospital, Erbil, Iraq. ** Head and supervisor of gynecology department of kurdistan board for Medical Specialist. *** Department of gynecology, College of medicine, Hawler Medical University, Erbil, Iraq. Introduction Maternal mortality data reflect the health care status of any given country in general and the efficiency of health care to women in particular. Maternal mortality is defined by the World Health Organization (WHO) as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. Direct maternal deaths are those resulting from obstetric complications of the pregnant state (pregnancy, delivery and postpartum), interventions, omissions, incorrect treatment, or a chain of events resulting from any of the above. Deaths due to, for example, obstetric hemorrhage or hypertensive disorders in pregnancy, or those due to complications of anesthesia or cesarean section are classified as direct maternal deaths. Indirect maternal deaths are those resulting from previously existing diseases, or from diseases that develop during pregnancy and that are not due to direct obstetric causes but aggravated by physiological effects of pregnancy. For example, deaths due to aggravation of an existing cardiac or renal disease are considered indirect maternal deaths. Approximately 500,000 to 1 million women die each year worldwide because of pregnancy complications. The vast majority of these deaths occur in developing Background and objective: Maternal deaths are still leading problems in many developing countries, including Iraq. Iraq is, in fact, far away to reach the Millennium Development Goal declared to reduce the maternal mortality ratio by three quarters between 1990 and 2015. The aim of this study was to highlight the main causes of avoidable deaths that lead to maternal mortality among those admitted to Maternity Teaching Hospital in Erbil. Methods: This survey was carried out in the Maternity Teaching Hospital in Erbil city, Kurdistan region, Iraq. Variables included in this study were those related to patient’s age, number of parity and mode of delivery of the last baby. Data were collected from patient’s records. In addition, some clinical data were included related to causes leading to death and underlying condition of death. Results: Of the total 75000 live birth recorded in the hospital during the study period (2011-2013), 33 maternal deaths were recorded which gives an overall maternal mortality ratio of 44 per 100,000 live births. Pre-eclampsia and eclampsia were among the top causes of maternal deaths in this study (42.4%) followed by obstetrical bleeding and rapture uterus (30.3%). Conclusion: Maternal mortality rate in Maternity Teaching Hospital was 44/100,000 total live births. The main cause of the maternal deaths was pre-eclampsia and its complications. Most of those died were residents of rural areas and were illiterate women.
TL;DR: Breast cancer biomarkers have huge impacts on disease stage, and are greatly affected by age of women at time of diagnosis of breast cancer.
Abstract: Background and objective: Female breast cancer is the most commonly diagnosed cancer worldwide, affecting more than one million women annually. The objectives of this study were, firstly, to evaluate the effects of breast cancer biomarkers such as human epidermal growth factor receptor-2and hormone receptor status on the stage of breast cancer at the time of presentation, and secondly, to assess the role of “women’s age” on the level of biomarker expressions and on the advancement in breast cancer disease stage at the time of diagnosis in a sample of women diagnosed with breast cancer in Erbil City.
Methods: A retrospective analysis of medical records of women affected with breast cancer was performed from January 2013 to April 2014. Cancer staging was done based on the histopathological reports according to the American Joint Committee on Cancer TNM staging system. Patients were classified to either hormone receptor/human epidermal growth factor receptor-2 positive or negative based on immunohistochemistry or FISH analysis.
Results: The mean age (+SD) at diagnosis was 48.9 (+12.4) years. About a quarter of breast cancer cases were diagnosed in young women aged less than 40 years, who had a proportionally more hormone receptor negativity and human epidermal growth factor receptor-2 over-expression, and a significantly more advanced cancer stage at time of diagnosis compared to their older counterparts.
Conclusion: Breast cancer biomarkers have huge impacts on disease stage, and are greatly affected by age of women at time of diagnosis of breast cancer.
TL;DR: This study calculated the serum level of LDL indirectly, using different equations in type 2 diabetes patients in an attempt to focus on the variation of estimating level which reflected on the decision to prescribe lipid lowering agents.
Abstract: Background and objective: Diabetes mellitus is a disorder that is often associated with cardiovascular diseases and underlying lipid abnormalities. The aim of this study was to calculate the serum level of LDL indirectly, using different equations in type 2 diabetes patients in an attempt to focus on the variation of estimating level which reflected on the decision to prescribe lipid lowering agents. Methods: A total of 70 patients with type 2 diabetes using oral hypoglycemic agents alone and/or once- or twice-daily insulin, their non-HDL atherogenic lipoprotein in reference to atherogenic index were conducted in Martyr Layla Qasm Center for Diabetes Mellitus in Erbil, Iraq, during the period from June, 2011 to January, 2013. Results: Age of type 2 diabetes patients ranged from 29 to 82 years with a mean age of 56.6 years with duration of disease ranged between 1.2-39 years. Results revealed that the mean fasting serum glucose and glycosylated hemoglobin were 181.9 mg/dl and 8.428%, respectively. The mean value of serum triglycerides was 171.5 mg/dl which is higher than the cut-off normal value of 150 mg/dl. Results showed significant correlation between atherogenic index and calculated atherogenic lipoprotein and significant correlation between atherogenic index and waist circumference as an indicator of central obesity. Conclusion: The mean body mass index value indicated that the patients were obese and the mean value of waist circumference did not reach the cut-off level of central obesity. The mean value of atherogenic index indicated that the patients were at increased risk of cardiovascular events. Estimation of LDL value from the direct measurement of lipid profile in type 2 diabetes with high serum triglyceride level is not a reliable method.
TL;DR: The serological test was superior to cytology for the diagnosis of Herpes simplex virus type 2 infection in women presented with cervicitis with no clinically apparent genital ulcer or blisters.
Abstract: Background and objective: Herpes simplex virus type 2 linked to the genital tract infection may produce significant acute or chronic cervicitis. Identification of the virus is important due to its association with genital tract disease and sexual transmission. The virus establishes lifelong latency with periodic reactivation. Therefore, it causes significant physical and psychological morbidity. The aim of this study was to assess and compare cytological examination with serological test in the diagnosis of genital herpes simplex virus type 2.
Methods: This study included 104 women. Pap smear was collected from 24 healthy women as a control group (group A), 40 patients with severe cervicitis on cytological examination (group B) and 40 patients with atypical cervicitis (group C). Blood sample was obtained from the patients and the control group and tested for Herpes simplex virus type 2 specific serology. The ages of the studied groups ranged from 21-53 years. They were referred to the Maternity Teaching Hospital and private laboratories in Erbil city, Kurdistan region, Iraq during the period from December 2011 to December 2012.
Results: Herpes simplex virus type 2 IgG antibodies were found in 10 sera from patients with nonspecific cervicitis (group-B) and only in three patients with atypical cervicitis (group-C). No positive serological test was identified in the control group. All Pap smear results showed features suggestive of cervicitis but without viral cytopathic herpetic changes.
Conclusion: The serological test was superior to cytology for the diagnosis of Herpes simplex virus type 2 infection in women presented with cervicitis with no clinically apparent genital ulcer or blisters.
TL;DR: Use of certain clinical data (like duration of manifestations) with the modified Alvarado score system supported by leukocytosis and positive ultrasound findings in children suspected to have acute appendicitis provides a high degree of diagnostic accuracy of complicated cases rather than simple acute appendix cases.
Abstract: Background and objectives: Appendicitis is the most common acute surgical emergency of childhood. Decision-making in patients with acute appendicitis poses a diagnostic challenge worldwide. Among the reported diagnostic criteria, modified Alvarado score system and ultrasound findings where used to support diagnosis and even exclude complicated cases. The aim of this study was to detect clinical and sonograghic features that distinguish children visited the emergency department with acute simple appendicitis and idntify factors related to complicated cases.
Methods: This cross-sectional study included 76 children with the provisional diagnosis of acute appendicitis according to clinical findings attending the Emergency Departement at Rapareen Teaching Hospital in Erbil between January and December 2012.
Results: Of 76 patients included in this study, 75 patients (99.7%) had appendicitis whether inflamed (63 patients, 82.9%) or complicated (13 patients, 15.8%) and only one patient had normal operative (non-inflamed appendix) findings. Delay of admission, high temperature at time of presentation, localized tenderness and MASS of ≥ 7 increased the risk of complicated appendicitis as do leukocytosis and positive ultrasound findings.
Conclusion: The study shows that use of certain clinical data (like duration of manifestations) with the modified Alvarado score system supported by leukocytosis and positive ultrasound findings in children suspected to have acute appendicitis provides a high degree of diagnostic accuracy of complicated cases rather than simple acute appendicitis
TL;DR: The prevalence of overweight and obesity among the study sample was low and there was no significant association with the eating habits and life-style practices, apart from those sleeping less than eight hours/nigh.
Abstract: Background and objective: The prevalence of obesity is increasing worldwide at an alarming rate in both developing and developed countries. The aim of this study was to assess the weight of a sample of school students and its association with their eating habits and life-style practices.
Methods: This cross-sectional study was conducted on 477 students selected from four intermediate and secondary schools in Kore sub-district in Erbil, Iraq. Data on the students’ eating and drinking habits, in addition to weight, height, smoking and other life style habits were collected through a self- administered questionnaire.
Results: The prevalence of overweight and obesity (categorized into one group) was more common among female students than male students (19.9% and 11.8%, respectively) with a significantly statistical difference (OR=0.536; 95% CI, 0.321-0.894, P= 0.017). Sleeping hours/night was also significantly associated with overweight and obesity, where sleeping less than 6 hours and between 6 and 8 hours was significantly associated with overweight and obesity (P = 0.004 and 0.001, respectively). There was no statistical association between overweight and obesity and all reported eating habits including breakfast, lunch, fried food, vegetables, salads and fruit juice intake, in addition to intake of crisps and cakes, energy providing drinks, soft drinks, and of milk and dairy products.
Conclusion: The prevalence of overweight and obesity among the study sample was low and there was no significant association with the eating habits and life-style practices, apart from those sleeping less than eight hours/nigh.