Vol 19, No 2 (2015)

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.

Background and objective: There are many modifiable risk factors that are closely associated with coronary artery disease. The aim of this study was to assess the association between some coronary risk factors and the angiographically documented coronary artery disease.

Methods: This descriptive cross-sectional study was based on review of hospital records of 310 consecutive patients who underwent coronary angiography in Erbil Cardiac Center. A questionnaire was used to record patient’s demographic profile, coronary risk factors and the severity of stenosis in percentage.

Results: Of the 310 patients, 69.4% had evidence of coronary artery disease on coronary angiography. Male gender, age, diabetes, and smoking habit were strongly associated with angiographically documented coronary artery disease, while the association of hypertension and family history were not statistically significant. Only male gender was strongly associated with severity of coronary artery disease.

Conclusion: The angiographic extent of coronary artery disease was found to have the strongest positive correlation with male gender and the weakest with hypertension. The most important predictive factors for coronary artery disease positivity were age, diabetes and smoking status. Hypertension and family history of premature coronary artery disease did not prove to be either a significant predictor of coronary artery disease at coronary angiography or an important determinant of coronary artery disease severity.

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 12^th 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.  

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.

Background and objective: The aim of this study was to provide a general description of a new experience of introducing teaching in clinical skills laboratory to the final year students of Hawler College of Medicine and to assess the students’ perspectives of one year training experience in the newly established clinical skills laboratory.   

Methods: This study was based on a self-administered questionnaire survey of 79 final year medical students. The questionnaire included 31 statements related to the physical environment of the clinical skills laboratory, duration of clinical skills practice, quality of clinical skills teaching and usefulness of clinical skills laboratory. Each statement was rated on a five-point Likert scale.  

Results: Most students were satisfied with the location of the clinical skills laboratory (62.8%) and appropriateness of educational atmosphere of the laboratory (59%). Less than half of the students were satisfied with adequacy and appropriate use of educational equipments. Students had concerns about the short duration of clinical skills practice and unavailability of structured and well explained guidelines (36.7%). Majority of students indicated that they prefer to take sessions in the skills laboratory and practice before dealing with real patients (78.1%) and have earlier integration of teaching in clinical skills laboratory in the medical study curriculum (71.8%).  

Conclusion: This short and new experience of training in clinical skills laboratory was positively recognized in general. The study identified shortcomings in a number of aspects that need to be addressed to improve the experience.  

Background and objective: The posture during sitting has an impact on the incidence of back pain. In this study, an observation of the sitting posture among the medical students during examination period was studied.

Methods: Seventy seven students (F:M, 47:30) with a mean age of 23 years were involved. The type of the seat, height, weight of student, incidence of back pain, sports activities, gender and hand dominancy, in addition to the different types of posture were studied.

Results: Three types of posture were identified; straight, curved with contact to the back of the seat and curved without contact to the back of the seat. Neck side tilt was also observed. It was noticed that, short statured students sit straighter; however neck tilt was commoner in the left handed students. The majority of students adopt unhealthy sitting posture.

Conclusion: Attention has to be paid to the types of the seats made available to students. Seats with adjustable height and a design where there is a curve in the seat accommodating the pelvis would be helpful. Special seats for the left handed should be available. Education and sports activities should be highlighted.   

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 1^st, 2012 till April 1^st, 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.

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.  

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.

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 1^st, 2013 and July 10^th, 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.

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

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.

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.

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 <12 weeks, while term pregnancy 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.