Vol 22, No 1 (2018)

Background and objective: Principles of surgical treatment of flexor tendon injuries include early primary repair with a strong core stitch combined with an epitendinous suture. This study aimed to evaluate the outcomes of primary flexor tendon repair according to the mechanism, zone of injury and number of core sutures.

Methods: This study was conducted in Erbil from May 2013 till March 2015. Injured flexor tendons were repaired for 121 patients. The patients were followed up for six months. We used the Strickland scoring system to evaluate the results.

Results: Sharp tools represented the main cause of trauma 68.6%, excellent results were found in 51.8% of cases with a sharp injury. The worst results were obtained in zone II with 44.7% fair to a poor result. Excellent results found in 43.4% with four strand core sutures while 24.4% in two strand core sutures (P ˂0.01).

Conclusion: Four strand core sutures have the better result with a low rate of tendon rupture than two strand core sutures. Sharp injuries had better results than crush injuries. The zone with worst results was zone II.

Background and objective: The ovary has a biological age that does not always correspond to the chronological age; this may be of great importance for the evaluation of women reproductive outcome. This study aimed to determine the effect of maternal age on the pregnancy rate, and the ovarian reserve markers (antimullerian hormone, follicular stimulating hormone, and antral follicular count).

Methods: A cross-sectional study was conducted in the in vitro fertilization center at the Maternity Teaching Hospital located in Erbil city, from January 1, 2015, to January 31, 2016. A convenience sample of 300 infertile women of different age groups was included in the study. Transvaginal ultrasound was conducted to determine antral follicular count, and blood test was done for determination of serum antimullerian hormone and follicular stimulating hormone. The study sample was divided into four age groups. Chi square test, ANOVA test, Pearson correlation, and logistic regression were used to determine the associations.

Results: The biochemical pregnancy rate of the study population was 37% and the clinical pregnancy rate was 32%. The most common type of infertility among the studied sample was primary infertility (74%). Results showed a strong inverse significant correlation between antimullerian hormone and antral follicular count with age, but there was no statistically significant association between maternal age and serum follicular stimulating hormone.

Conclusion: Maternal age is a significant factor that can affect ovarian reserve and causes ovarian aging. The pregnancy rate decreases with advanced maternal age.

Background and objective: Tip plasty is one of the most common feats encountered by the Aesthetic Rhinoplasty Surgeon. Tip rotation, with or without tip deprojection, is one of the challenging problems that face the surgeon, with many overwhelming techniques to correct rotation and projection of the nasal tip, including, but not limited to overlapping of the lateral crural cartilages. This study aimed to assess the efficacy and reliability of the technique of the lateral crural overlay of the lower lateral cartilages in enhancing nasal tip rotation and decreasing nasal tip projection.

Methods: This prospective study included 64 patients, who underwent primary, and secondary, open Rhinoplasty, with nasal droopy tip and nasal tip true overprojection problems. They have been treated in Sulaimaniyah Hospital for Burn and Plastic Surgery, and from Private Hospitals in Sulaimaniyah city. The age range was 18-34 years. Forty nine patients were female, the rest of the patients were male. They have been treated, primarily, for the tip drooping and to a lesser extent for nasal tip overprojection, by the senior author, with Lateral Crural Cartilages Overlay. The study conducted from April 2012 to January 2016. The patients, postoperatively, were followed up for up to one year. Goode ratio and Nasofacial angle deducted from real time photographs have been used to evaluate the amount of rotation and deprojection of the nasal tip.

Results: Overlapping of the Lateral Crura of the Lower Lateral Cartilages, is a safe and reasonable technic in achieving nasal tip rotation, with or without, projection reduction, of the droopy nose. The operative time and dissection are very encouraging. Complications associated with this technic are very negligible, with high patient satisfaction rates. Only five rhinoplasty patient has been revised for the sake of tip rotation/projection, in this series of cases. No Major complications happened in the collumellar skin incision or the nasal rim infracartilagenous incisions, nor in the undermined nasal vestibular skin separated from the undersurface of the Lower Lateral Cartilages.

Conclusion: Overlapping, or overlaying, of the lateral crura of the lower lateral cartilages, is a reasonable technique to enhance tip rotation, and reduction of the tip projection, by medial crural steal and telescoping of the incised lower lateral cartilages, with good aesthetic and functional outcomes, with reasonable complication rates, very low revision rate, and high patient satisfaction rates.

Background and objective: Tonsillectomy is the surgical procedure of removing the tonsils. Various methods of tonsillectomy have been practiced aimed at decreasing or eliminating intraoperative and postoperative morbidity. This study was conducted to determine the different outcomes of tonsillectomy surgery in both coblation and dissection techniques.

Methods: A prospective control study was conducted with a total sample size of 66 patients. Each patient underwent tonsillectomy by using ArthroCare Coblator on the right side and dissection method on the left side. Children between the age of 3-12 years old were selected with indications of recurrent tonsillitis and/or kissing tonsil causing snoring and/or sleep apnea. Children with peritonsillar abscess, malignancy, bleeding disorder were excluded. Operative time and blood loss, postoperative pain, bleeding and healing process were compared between two methods. Operations performed by the same surgeon.

Results: The intraoperative time was significantly shorter (P <0.001) and intraoperative blood loss was significantly lesser (P <00.01) in coblation as compared to dissection tonsillectomy, while there were no significant differences in the postoperative pain scores on 1^st, 2^nd, 7^th and 14^th postoperative days. There was a significant healing process in tonsillar fossa in favor of coblation rather than dissection. No primary or secondary postoperative bleeding was reported.

Conclusion: Coblation tonsillectomy is a safe procedure with significantly less intraoperative time and less blood loss and better surgical wound healing with similar postoperative pain in comparison with dissection tonsillectomy.

Background and Objective: Oxidative stress and inflammation are cooperative events involved in essential hypertension development. This study aimed to evaluate the association of N-terminal pro-Brain natriuretic peptide, matrix-metalloprotinase-9 and 8-oxo2-deoxyguanosine with the essential hypertension, detect the effect of other confounding factors like the stage of the disease and gender, and estimate the correlation between the selected parameters.

Methods: This case-control study was performed at College of Pharmacy, Hawler Medical University on 50 hypertensive patients of both genders with essential hypertension as well as 45 matched age–gender adults were also enrolled in this study as a control group. The selected parameters were analyzed using ELISA technique.

Results: There was a significant elevation in the serum levels of N-terminal pro-Brain natriuretic peptide, matrix-metalloprotinase-9 and 8-oxo2-deoxyguanosine in patients with essential hypertension as compared with the controls. The mean serum levels N-terminal pro-Brain natriuretic peptide, matrix-metalloprotinase-9 and 8-oxo2-deoxyguanosine were increased significantly according to the stage progression of the disease P ˂0.001. No gender effects could be found.

Conclusion: Data suggested an association between circulating biomarkers (NT-proBNP, MMP -9, 8-oxo-2-dG) with the development of essential hypertension, there was a significant elevations in the serum selected parameters level in patients as compared with the control group.

Background and Objective: This study aimed to assess the immunohistochemical expression of stromal CD10 in invasive breast carcinoma and determine its relationship with some clinicopathological parameters.

Methods: A cross-sectional study was conducted on 91 female breast cancer cases collected from the archive of pathology department in Rizgary Teaching Hospital and some private labs during the period from January 2012 to August 2015. CD10 expression was detected by immunohistochemistry using labeled polymer and enhanced polymer systems (Dako EnVision™ Flex) Dakoprotocol. The scoring was based on the intensity and percentage of the stained stromal cells. Then CD10 immunoexpression was correlated with the age of patients, tumor size, histopathological types, tumor grade, lymphovascular invasion, lymph node status, and tumor stage.

Results: Stromal CD10 expression was observed in 70.4% of the cases. A statistically significant positive correlation was seen between stromal CD10 and the tumor subtype (P = 0.02), tumor grade (P = 0.025), lymphovascular invasion (P = 0.002), and lymph node status (P = 0.047), however, no statistically significant association was identified between stromal CD10 expression and age, tumor size and tumor stage.

Conclusion: Stromal CD10 is expressed in the majority of cases of invasive breast carcinoma and concerning the positive correlations between stromal CD10 expression and tumor grade, lymphovascular invasion, and lymph node status suggest a strong effect of stromal CD10 expression on aggressive behavior of breast carcinoma.

Background and objective: Myopiais a common refractive error in the estimation of corneal barrier and well-beingof endothelial function, the central corneal thickness is important to manage corneal diseases. This study aimed to explore the relationship between central corneal thickness, axial length and myopia among a sample of patients in Erbil.

Methods: This cross-sectional study was conducted from June 2015 to February 2016. Forty six emmetropes as a control group and 46 myopes were studied. Axial length was measured with A-scan ultrasound biometry and central corneal thickness with corneal topography. Central corneal thickness was correlated with myopia and axial length using the Pearson’s correlation coefficient.

Results: This study included 92 patients. The mean age of myopes was 31.87 years and 33 years for emmetropes. Myopia ranged from –0.5 to –11 diopters. The mean central corneal thickness was 541.80 micrometers for myopes and 548.93 micrometersfor emmetropes. The mean axial length was 25.77 millimetersfor myopes and 24.37 millimetersfor emmetropes.The Pearson’s correlation coefficient (r) of the central corneal thickness and myopia was -0.0245 (P =0.872), while that of the central corneal thickness and axial length in myopes was 0.035 (P = 0.566) and of the central corneal thickness and axial length in emmetropes was 0.26 (P = 0.091).

Conclusion: There was no correlation between central corneal thickness, axial length and myopia.

Background and objective: The presence of a cleft palate introduces feeding difficulties, problems in speech development, and the possibility of impaired facial growth. Intravelar veloplasty aids to gain functional repair of the palate. This study aimed to evaluate the effect of intravelar veloplasty on the function of velum in primarily repaired palates.

Methods: A review study was done in Rizgary Teaching Hospital, Erbil. Clinical and nasopharyngeal endoscopic examination was done for patients who underwent primary palatal repair with intravelar veloplasty between 2009 to 2014. The study assessed the velopharyngeal port for adequacy of closure, hypernasality of speech, and oronasal fistula rate.

Results: This study included 47 patients. The mean age of patients ± SD was 3.4±4 years (range 1- 20 years) at time of repair. Major improvement in intelligibility and production of pharyngeal sounds and velopharyngeal closure was noticed when using intravelar veloplasty in palatal repair. There was a significant association between defect type and degree of velopharyngeal port closure (P = 0.009), i.e., inadequate velopharyngeal closure was more common in the complete cleft palate.

Conclusion: This study showed that intravelar veloplasty helps to improve the velopharyngeal closure and oropharyngeal sounds production. The poor velopharyngeal closure is more likely related to wide, complete cleft palate.

Background and objective: Plantar warts are hard, grainy growths that usually appear on the heels or balls of feet. Plantar warts are caused by the human papillomavirus, usually self-limiting, but treatment is generally recommended to lessen symptoms, decrease duration, and reduce transmission. The study aimed to evaluate the clinical effectiveness of topical 40% salicylic acid in comparison to cryotherapy in the treatment of plantar wart.  

Methods: This study was conducted from March 2015 to January 2016 on 70 patients   with plantar wart who attended the consultation clinic of dermatology department in Rizgary teaching hospital. Patients were randomly allocated to two groups: cryotherapy treatment with liquid nitrogen every two or three weeks and self-application of salicylic acid daily.

Results: Sixty patients aged 12 to 60 years were included in the analysis at 13 weeks. Cure rates were 66.7% in the cryotherapy group and 80% in the salicylic acid group. A significant association was found between the duration of wart before treatment and cure rates (P <0.001).

Conclusion: No difference in effectiveness between cryotherapy and topical salicylic acid 40% in the treatment of plantar warts was found.

Background and Objective: Autism is a persistent neurodevelopmental condition. This study aimed to investigate carious and periodontal problems among a sample of children with autism in Erbil, Iraq.

Methods: A total of 44 autistic children aged 1-14 years (30 males and 14 females) attending Erbil, Iraq Autism Centers were enrolled in the study. The control group consisted of 44 non-autistic children chosen from different schools which represent different geographical locations in Erbil city in the period between September, 1^st 2014 to January, 1^st 2015 to have matched age, sex and socioeconomic status. Each patient received an assessment of caries prevalence. Other conditions assessed were oral hygiene and gingival health status. The t-test of significance was used to compare groups.

Results: Data analyzed for the present study comprised observations from a group of children (cases = 44) diagnosed with autism matched with healthy children (controls = 44). The autistic children had lower decayed, missing or filled teeth than unaffected children with nonsignificant differences. The mean decayed-missing-filled teeth in primary teeth (dmft) of the autistic group was 11.57 ± 11.41 while that of the controls was 15.36 ± 12.81. The mean Decayed-Missing-Filled teeth in permanent teeth (DMFT) of the autistic group was 2.36 ± 3.86 and 2.89 ± 3.78 in the controls. With advancing age, the value of decayed, missing and filled teeth increased. Almost all of the autistic children had fair oral hygiene (1.291 ± 0.89) and had gingivitis.

Conclusion: Autistic children displayed lower dmft, DMFT scores compared to control group, fair oral hygiene level, and had gingivitis than did the unaffected control children. Hence, non-autistic children need further consideration.

Background and objective: Stroke is an increasing problem in developing countries and is the principal cause of disability and dependency in the western world. This study aimed to find out the one- and six-month case fatality, dependency and recurrence rates of stroke in Erbil teaching hospitals.  

Methods: This hospital-based prospective study included 293 stroke patients hospitalized in Erbil teaching hospitals from January 1^st, 2015 through December 31^st, 2015. Stroke was diagnosed by a consultant internist or neurologist and confirmed by brain CT-scan and/or MRI. Patients were followed-up for six months, then one- and six-month outcomes were measured including case-fatality, dependency and recurrences rates.

Results: The one and six month case fatality rates were 28.3% and 37.5%, respectively. The rates in females (33.3%, 42.6%, respectively) were higher than that in males (23.7%, 32.9%, respectively), but there was no significant association between case-fatality rate and gender. A total of 74.3% and 45.4% of patients at one- and six-month were functionally dependent. The majority (88.9%) of diabetic patients were functionally dependent. Also, the one and six month recurrence rates of stroke patients were 15.7% and 23.2%, respectively. For both one and six month post stroke more recurrence occurred from ischemic (16.2%, 14.3%, respectively) than from hemorrhagic (24.5%, 19.5%, respectively) strokes, but there was no significant association between the recurrence and stroke subtype (P = 0.691, P = 0.367, respectively).

Conclusion: The reported outcomes are relatively comparable to that reported in other developing countries, although it is still more than the rates of developed countries. Outcome measures can help to give information and develop guidelines for clinical practice and research.

Background and objective: Rhus coriaria, a well-known spice grown in the Kurdistan region of Iraq, commonly known in the Middle East Region by (Sumac), is reported to enclose many medical benefits. This study assessed the effects of topical application of Rhus coriaria extract on the rate of wound closure, the Hydroxyproline (HXP) and Nitric Oxide (NO) levels were measured using the healed skin tissue homogenate the elemental composition of the plant was screened.

Methods: Adult male Sprague Dawley rats were topically treated with 0.2 mL of the vehicle (gum accacia), Intrasite gel (positive control), 100 and 200 mg/kg of Rhus coriaria extract.

Results: Wounds dressed with the extract and Intrasite gel healed significantly earlier than those with the vehicle. The high content of HXP and NO proves that the effect of Rhus coriaria extract on an excision wound model was significantly higher than that of the vehicle itself. The highest mineral contents were in Potassium, Calcium, Phosphorus, Magnesium and the extract was rich in energy content.

Conclusion: The current study concluded that Rhus coriaria showed high potential in wound healing activity.

Background and objective: Wound dressing is one of the major nursing responsibilities. Aseptic technique is mandatory to minimize complications. Effective wound dressing promotes wound healing and leads to early discharge and saving costs. This study aimed to assess wound dressing practices among nurses in Erbil emergency hospitals and determine the relationship between the practices and the sociodemographic characteristics.

Methods: A descriptive study was conducted at three Emergency Hospitals in Erbil city. This study was carried out from November 17^th, 2014 to November 17^th, 2015 on a non-probability purposive sample of 64 nurses who worked at emergency reception department of three emergency hospitals. The questionnaire was constructed for data collection which consisted of two parts; part I of the questionnaire included demographical characteristics of nurses and part II contained an observational checklist that consists of 24 items of nurses' wound dressing practice. Data were collected through the direct observant approach and analyzed through the application of descriptive analysis measures (frequencies and percentages) and inferential statistical analysis (chi-square and Fisher's exact test).

Results: Majority (65.6%) of nurses’ wound dressing practices were at the medium level of practice and minority (34.4%) were at high level. The highest steps practiced was with irrigation and dressing items (1.61), and lowest with the discard wound dressing supplies items (0.79). There was no significant association between the wound dressing practice and nurses’ chararacteristics of age, gender, educational level, years of experience and training participation (P = 0.51, 0.609, 0.54, 0.21 and 0.78, respectively).

Conclusion: The overall nurses’ wound dressing practice was suboptimal and not impressive and the worse practice with items related to wound dressing infection control practice.

Background and objective: Postprandial lipemia is a risk marker for the presence or progression of cardiovascular disease. Identifying factors affecting lipoprotein metabolism in postprandial state is of interest in order to find ways for prevention of atherosclerosis and cardiovascular diseases. This study aimed to assess obesity measurements and to find out the relationship between them and postprandial lipemia and to determine postprandial lipemia in obese subjects and to compare it with fasting lipemia taking in consideration the levels of Apolipoprotein B.

Methods: A cross-sectional study was designed to examine the association between obesity and postprandial lipemia. One hundred seventy one subjects of both genders with different body mass index participated in the study. Anthropometric measurements and blood pressure were recorded for them. Lipid profile was measured twice: after 12 hours fasting, two hours postprandially.

Results: There were significant differences between different groups of patients regarding with studied parameters. Men had a higher postprandial response than did women. There were significant differences between fasting and postprandial levels of lipid profile, except for the measurement of apolipoprotein B. Therefore, the level of plasma apolipoprotein B was not affected by meal intake. The postprandial lipemia was significantly related to the measurements of obesity.

Conclusion: Apolipoprotein B can replace low-density-lipoprotein-cholesterol in lipid profile assessments. By designing equations, by doing the postprandial triglyceride test, the level of fasting plasma triglyceride and level of plasma Apolipoprotein B can be estimated.

Background and objective: Nearly all colleges, universities and homes today are regularly using video display terminals, such as computer, iPad, mobile, and TV. Very little research has been carried out on Kurdish users to reveal the effect of video display terminals on the eye and vision. This study aimed to evaluate the prevalence of computer vision syndrome among computer users.    

Methods: A hospital based cross-sectional study was conducted in the Ophthalmology Department of Rizgary and Erbil teaching hospitals in Erbil city. Those used computers in the months preceding the date of this study were included in the study.

Results: Among 173 participants aged between 8 to 48 years (mean age of 23.28±6.6 years), the prevalence of computer vision syndrome found to be 89.65%. The most disturbing symptom was eye irritation (79.8%), followed by blurred vision(75.7%). Participants who were using visual display terminals for more than six hours per day were at higher risk of developing nearly all symptoms of computer vision syndrome. Significant correlation was found between time-consuming on computer and symptoms such as headache (P <0.001), redness (P <0.001), eye irritation (P <0.001), blurred vision (P <0.001) and neck pain (P <0.001).

Conclusion: The present study demonstrates that more than three-fourths of the participants had one of the symptoms of computer vision syndrome while working on visual display terminals.

Background and objective: Ischemic stroke is classically characterized as a neurological deficit attributed to an acute focal injury of the central nervous system by a vascular cause, it occurs as a result of obstruction by a blood clot (thrombus) or plugs within a blood vessel supplying blood to the brain. In this study, we investigated the association of von Willebrand factor-antigen and serum lipids with ischemic stroke.

Methods: The following retrospective study was conducted on 138 participants; 88 patients with ischemic stroke and 50 healthy controls.

Results: In crude analyses, Plasma von Willebrand factor antigen, fasting serum Total cholesterol, Triglycerides and LDL-C were significantly higher in patients with ischemic stroke than in controls (P <0.001, P <0.001, P = 0.003, P <0.001, respectively), while the difference in the level of serum HDL-C between patients with ischemic stroke and control was significantly lower (P = 0.023).

Conclusion: These data suggest that von Willebrand factor, total cholesterol, triglycerides, LDL-C and HDL-C gives some contribution to stroke risk even in the elderly and that von Willebrand factor antigen and lipid profile assessment must be taken into account in estimating the individual risks of stroke.

Background and Objective: Fragmentary evidence suggests that trophoblast viral infection may play a role in placental dysfunction leading to complications like Preeclampsia. Among these, placental exposure to CMV induces an inflammatory response that precedes invasive trophoblast cell death. This study aimed to assess the frequency of anti-CMV IgG seropositivity and IL2 level in serum in patients with preeclampsia compared to normotensive control pregnant women.

Methods: A total of 90 women were enrolled, of which 60 had preeclampsia and 30 normotensive pregnant women as the control. A serum sample was collected from each subject and was investigated for anti-CMV IgG serostatus and IL-2 concentration using Enzyme-Linked Immunosorbent Assay (ELISA) based kits.

Results: In preeclamptic and normotensive pregnant women, 33.3% and 16.6% of the tested sera were seropositive for anti CMV IgG antibodies respectively (P = 0.136). Early onset preeclamptic women revealed a high frequency of anti-CMV seropositivity (80%) when compared with late onset Preeclampsia (20%). Cytokine assessment revealed a higher IL-2 level in preeclamptic women seropositive for anti-CMV IgG although statistically was not significant (P = 0.14), but in normotensive women, the IL-2 level was significantly higher in sera seropositive for anti-CMV IgG (P = 0.02).

Conclusion: This study delineates a high frequency of anti-CMV IgG antibodies particularly those with early onset preeclampsia; with no significant difference for the IL-2 level.

Background and objective: Transient hypoglycemia may affect the newborn in the first hour of life and is the most prevalent metabolic disorder. The maternal-fetal diffusion that keeps the fetal glucose level nearly two thirds of the maternal glucose concentration. This study aimed to identify the prevalence of hypoglycemia and detect certain demographic and maternal factors that may be associated with and their relation to neonatal blood glucose level.

Methods: A prospective cross-sectional study was conducted in Erbil Maternity Teaching Hospital in Erbil city during a period of 4 months, from February 1^st to May 31^st, 2013. A total of 400 newborns from the neonatal care unit and the delivery and waiting rooms were included in the study. All of them were less than 3 hours of age and didn’t receive oral feeding.

Results: Among 400 neonates, 65 were hypoglycemic confirmed by serum sample with a prevalence of 16.25% during the first 3 hours. Most of the screened neonates were male (male: female ratio 1,45: 1). A highly significant association was found between neonatal hypoglycemia with preterm babies and hypoglycemic mother. Grand multiparity, low birth weight and head circumference also may predispose to hypoglycemia while mean length of affected babies was lower than the normoglycemic group. The severity of hypoglycemia was significantly associated with gestational age, birth weight and maternal serum glucose status.

Conclusion: Hypoglycemia is present in relatively high frequency among newly born babies and certain factors like prematurity, low birth weight and maternal hypoglycemia can predict its occurrence and its severity.