Vol 18, No 1 (2014)

Background and objective: Cigarette smoke is a leading preventable cause of many diseases and death, because it contains a complex mixture of chemical compounds. Few studies about the relation between cigarette smoking and glycoconjugate were found in literature, while no study was observed regarding passive smokers. Thus this relation is obscure till now. Therefore this work was designed to study the effect of cigarette smoking on serum glycoconjugates levels. Methods: One hundred twenty one completely healthy males from different areas of Duhok governorate were included in this study. Their age was ranged between 20 and 50 years. They were classified according to the number and duration of cigarette smoking into: heavy smokers (31), moderate smokers (26), passive smokers (30) and non-smokers (control). Fasting blood was withdrawn from all groups and used for determination of serum fucose and its related parameters. Results: The results showed that there was a significant decrease in serum total protein in heavy smoker groups when compared to non-smokers. The levels of serum total fucose and protein bound fucose significantly increased in smoker groups, while the results indicated that there was a significant increase in serum lipid associated fucose levels in heavy and passive smoker groups comparing to non-smoker group. A significant decrease in serum protein bound hexoses was observed in both heavy and moderate smokers. The result also showed that serum total calcium concentration, Ca/TP and Mg/TP ratios significantly decreased in all smoker groups.Regarding to serum Manganese (Mn) and Mn/TP ratio, their values increased significantly in case of passive smokers only. Conclusion: The results revealed that cigarette smoking had significant effects on glycoconjugates status (expressed in serum fucose and its related parameters).

Background and objective: Dental units, extra oral devices and mini-implants are the main types of anchorage that are used in orthodontic treatment. The aim of this study was to compare between mini-implants and dental unites as anchorage. Methods: This study used seven dogs wearing orthodontic appliances in the right and left sides of the maxilla for 40 days to retract the 3rd incisors toward the canines. On right side, canine was used as dental anchorage to retract the 3rd incisor by nickel-titanium closed coil spring along a straight arch wire. On the left side, mini-implant between the roots of canine and 1st premolar was used as skeletal anchorage. Different clinical measurements were done on the stone casts and photographs of maxillary dental arch for each dog before and after tooth retraction to assess the effectiveness of each anchorage type on the same animal. Results: Clinical measurements revealed a highly significant difference between dental and mini-implant sides. The mini-implant side showed less loss of anchorage than dental side, while the extrusion was higher in retracted tooth of mini-implant side than in dental side Conclusion: This study showed that the mini-implants provide more stable anchorage units than the teeth but cause more extrusion in the moving tooth.

Background and objective: Surgical treatment of condylar diseases involves some problems concerning the choice of the surgical approach to the condylar neck that provides adequate exposure of the area with the least trauma to the facial nerve and parotid tissue. In this paper, personal experience with the surgical treatment of some mandibular condylar neck problems by the preauricular, submandibular and the retromandibular- transmasseteric approaches is reported. Methods: Over the last 5 years, 52 condylar neck surgeries were carried out on 41 patients to treat 18 cases of condylar neck fractures, 19 cases of plate and bone graft fixation after resection of mandibular tumours and 4 cases of chronic pain and dysfunction of the TMJ. During follow-up, functions of the mandible and facial nerve branches were monitored as does the presence or absence of sialocele or parotid fistula. The appearance of the scar post- surgically and the quality of the access achieved by each type of the approaches to the condylar neck were also appraised. Results: The incidence of apparent postoperative scar appeared most after the preauricular approach to the condylar neck and least after the submandibular approach. Difficulties in management of condylar neck fractures are found more with the preauricular and least with the retromandibular-transmasseteric approaches. Weaknesses in the branches of the facial nerve are noticed in 50% of the preauricular approaches, 6.89% of the retromandibular-transmasseteric approaches, and 47.36% of the submandibular approaches. In all of the patients, this problem lasted for 3-6 weeks to resolve spontaneously thereafter. All the patients in this work suffered limitation of jaw opening in the early postsurgical period. This problem was a transient one and due to pain and muscle spasm. However, persistent limitation of jaw opening is reported in 13.79% of the retromandibular-transmasseteric approaches and 47.36% of the submandibular approaches to the mandibular condyle. Conclusion: Experience has shown that the retromandibular-transmasseteric approach to the condylar neck allows for good anatomical repositioning of the fractured condyle and direct access for precise positioning and fixation of the plate or bone graft to achieve satisfactory mandibular function with the least chance of trauma to the facial nerve and parotid tissues.

Background and objective: Nurses have major role in prevention and management of hepatitis B. Aim of the study was to find out the effect of an educational program on nurse' knowledge and practices concerning hepatitis B virus. Methods: A quasi-experimental study was conducted in emergency hospitals, Erbil city, Iraq from 15th of January to 15th of June 2012 involving 50 nurses. Assessment of the knowledge and practices of nurses was carried out by using a questionnaire developed by the researchers. An educational program was designed, constructed and oriented in order to improve the nurses' knowledge and practices towards hepatitis B virus. Post-test was carried out after the educational program using the same (pre program) questionnaire. Results: The mean (±SD) score of pre test knowledge was 6.96±1.6, while the mean (±SD) score of post test knowledge was 8.4±1.5 (P<0.001). The educational program has significant effects on nurses' knowledge about main function of liver (P<0.001), complications of renal failure (P=0.002), and avoiding sharing needles and syringes (P=0.013). The post test means (±SD) scores for practices (47±2.46) were significantly higher than the pre-test mean score (43.7±5.16). The educational program had effects on advising practice of hand washing before and after using gloves (P=0.01), using solution for hand washing (P=0.003), risk of contamination with patients' bloods and fluids (P=0.04), removing of gown and washing hands (P=0.012). Conclusion: The educational program played a significant role in some items which could raise the level of knowledge and practices toward prevention of hepatitis B virus.

Background and objective: Radiation is used in some aspects of medicine, researches and in industries. These radiation applications are useful to society. However radiation can also have detrimental effects. It was important to establish rules and resolutions governing these uses to balance the positive against the negative effects. Dose limits have been established for groups who use radiation in their work as well as for population at large. The rules used in most countries have been worked out by the International Commission on Radiological Protection (ICRP). The aim of this study was to evaluate the radiation protective measures in different diagnostic radiological departments in Erbil hospitals. Methods: Data on the number of diagnostic procedures using x-ray examinations in five hospitals were collected. The palm RAD 907 Nuclear Radiation Meter and Contamination Monitor CoMo 170 were used to measure radiation leakage. Questionnaire was also used to elicit information from the most senior personnel of the hospital. Results: The finding showed that the facilities for safety were grossly inadequate and the dose rates of 16.4μSv/hr and 20μSv/hr were recorded at places for paramedics and technician room respectively. Dose rate in front of window of the monitor room was 113μSv/hr and in the reception was 20μSv/hr indicating higher health risk to the paramedic, visitors and personnel at the hospital. Conclusion: Radiation protection facilities in the radiological departments of Erbil hospitals are in general poor including both public & private sectors indicating high health risk to the paramedics, visitors and personnel at the hospitals

Background and objective: A transient ischemic attack is a brief episode of neurological dysfunction resulting from focal cerebral ischemia not associated with permanent cerebral infarction. Transient ischemic attack carries a substantial short-term risk of stroke, hospitalization for cardiovascular events, and death. We aimed to evaluate prognosis of transient ischemic attack within three months follow up period, and identifying the predicting factors. Methods: Thirty patients with transient ischemic attack were evaluated and followed up for 3 months to identify their prognosis. ABCD2 score was used for risk stratification in index and follow up transient ischemic attack patients. Results: Within three months of follow up, 10% of patients developed transient ischemic attack and stroke each. There was an association between increasing age and increasing risk of index transient ischemic attack. Hypertension was the highest risk factors for index transient ischemic attack. Conclusion: Despite standard preventive medications, some patients will still have events later on.

Background and objective: Malondialdehyde is the end product of lipid peroxidation by oxidative stress (free radicals). Superoxide dismutase is one of the important antioxidant enzymes that catalyze conversion of superoxide to hydrogen peroxide. The aim of present study is to measure the serum Malondialdehyde concentration and Superoxide dismutase activity in occupational workers. Methods: A prospective study was carried out from October 2011 to May 2012 in collaboration between clinical biochemistry department at the College of Medicine-Hawler Medical University and chemistry department at the faculty of science and health at Koya University. Total of thirty non-office occupational workers were targeted, who exposed to air and industrial material pollutions, all individuals were healthy and non-alcoholics. Results: The mean value of each of the serum Malondialdehyde concentration and serum Superoxide dismutase activity were significantly higher in occupational workers than that of non-occupational workers. Conclusion: Based on findings of the present study it can be concluded that occupational works elevates the release of Superoxide dismutase enzyme, and also increases lipid peroxidation by reactive oxygen species which in turn causes elevation of Malondialdehyde

Background and objective: Posterior vitreous detachment is a common problem which may induce several potentially serious events. The aim of the study was to determine the prevalence of posterior vitreous detachment in Erbil and its distribution among different age groups also to determine its correlation to age, gender, smoking, blurring of vision, floater, flashes of light, diabetes mellitus and hypertension. Methods: A cross-sectional study carried out on 150 persons (300 eyes) with mean age of 40 years attending Rizgary Teaching Hospital (Erbil, Iraq) who were referred for ultrasound examination for any indication other than eye problem. The patients were examined by ocular ultrasound unit equipped with a 7.5–10 MHz real-time linear high-frequency probe with the contact method. Results: The prevalence of posterior vitreous detachment was 19.3%, with an extremely statistical significant association between posterior vitreous detachment and increasing age, diabetes, hypertension, blurred vision and floater, but no association with smoking, gender and flash of light. Conclusion: Posterior vitreous detachment is a common disease its prevalence increases with advancing age with a strong association to blurred vision, floaters, diabetes mellitus and hypertension but no association with gender, smoking or ultrasound detected vitreous opacities.

Background and objective: Staphylococcus aureus (S. aureus) is responsible for a wide range of diseases and increased number of the strains that acquired resistance to antibiotics. The emergence of Vancomycin resistance of S. aureus has been a significant impact on human health. The distribution of Vancomycin minimum inhibitory concentrations (MIC) and minimum bactericidal concentrations (MBC) in S. aureus isolates, and compared antibiotic susceptibility to non-glycopeptideantibiotics in different Vancomycin MIC value groupswere assessed in this study. Methods: S. aureuswere isolated by standard method and subjected to MIC tested by broth microdilution method for Vancomycin and eight non-glycopeptideantibiotics, alsoVancomycin MBCs were determined. Results: Approximately 56% of S. aureus with a 0.5 µg/ml Vancomycin MIC were accounted, whereas 1.77% of S. aureushadan 8 µg/ml Vancomycin MIC. In other hand, most S. aureus had 1 and 2 µg/ml Vancomycin MBC. Conclusion: About half of the S. aureus isolates had 0.5 µg/ml of Vancomycin MIC. Relationship between Vancomycin MIC and resistance to non-glycopeptideantibiotics were observed, with increased Vancomycin MIC, the resistance to others antibiotics also elevated, and vice versa.

Background and objective: Successful management of diabetes requires high degree of patient participation; this can be achieved by providing diabetic person with the knowledge and skills to perform self care on a day-to-day basis. This study aimed to assess the knowledge and practices of diabetic patients about diabetes in Erbil city. Methods: A cross-sectional study was carried out during the period of April 2011 to April 2012 at Shahid Layla Qasm health center for diabetic care in Erbil city. The study involved a convenience sample of 400 diabetic patients aged ≥ 18 years old, both male and female. A specially designed questionnaire was used for data collection, which included socio-demographic characteristic of patients and other questions related to knowledge and practice about diabetes. SPSS was used for data entry and analysis. Results: Out of 400 study subjects, 18 (4.5%) had good knowledge score, 209 (52.3%) had acceptable knowledge score, and 137 (43.3%) had poor knowledge score about the diabetes. A statistically significant association was found between knowledge levels and age of patients (P=0.02). This study also showed that, only 51 (12.8%) of patients had good practices, while 213 (53.3%) of them had acceptable practices and 136 (33.9%) had bad practices. A statistically significant association was found between practice levels with occupation (non manual skilled or semiskilled); (P value <0.001) and educational level (institute and more); (P value <0.001). Conclusion: The rate of knowledge and practice was significantly associated with participants’ occupation and educational level. Those with low and acceptable knowledge had better practice than those who had good knowledge about diabetes.

Background and objective: Tibial diaphyseal fracture is of two types, closed fracture, in which the skin is intact and open fracture in which the skin is injured. An open fracture is a type of fracture in which a break in the skin and underlying soft tissues communicates with the fracture and its haematoma .i.e. the fracture and its haematoma communicates with external environment. Our aim is to evaluate the treatment outcome of this structured protocol in terms of soft tissue injury healing and effective fracture stabilization by POP and external fixation, and to detect if there is any difference in time needed for union in both methods. Methods: This is a comparative study done in Emergency hospital in Erbil – Kurdistan region, for management of open tibial diaphyseal fractures caused by gunshot injuries. The study included 50 patients of 18 to 65 years old. Patients were divided into two groups after debridment according to methods of treatment; group 1 was managed by POP, group 2 was managed by external fixation. The patients recruited and treated over 11 month period (August 2007 to June 2008). Results: The study included 50 patients; 44 males (88%) and six females (12%). Their ages ranged between 18 years and 65 years with the mean age of 27.46 years. Patients divided into three groups according to Gustilo classification: GI included 8 patients (16%), GII included 34 patients (68%) and GIII included 8 patients (2A, 6B) (16%). There was significant difference between immobilization of open tibial diaphyseal fractures by pop and external fixation (P=0.001). Conclusion: There will be delay union of the fractures when immobilized by external fixation. It is better to remove external fixature after 6 weeks and replace it by another method of immobilization of the fracture. Treatment of type III fracture is very difficult and needs long time, usually more than one year.

Background and objective: Anaemia is often an unrecognized complication of diabetes mellitus that has adverse effect on the progression of diabetes related complications. Contributors to its development include erythropoietin insufficiency and iron deficiency. The aim of this study was to assess the prevalence of iron deficiency anaemia and anaemia of chronic disease among diabetic patients. Methods: Over a period of six month from November 2010 to May 2011, 250 diabetic patients, attending Layla Qasim diabetic center were studied, their age ranged between 18-73 years. Venous blood samples were collected from each of them. A complete blood picture, iron study, HbA1c% and fasting blood glucose were performed. According to the duration of diabetes, patients were divided into three groups: group I patients (duration of diabetes < 5 years), group II (duration of diabetes between 5-9 years) and group III (duration of diabetes ≥10 years). Results: One hundred ten patients (44%) were found to have anaemia. The frequency of anaemia was more among group III (46.6%). Higher prevalence of anaemia was found among female patients (53.9%) than male patient (24.1%). Among anemic patients, 72 patients (65%) considered as having anaemia of chronic disease (ACD), 26 patients (24%) were iron deficiency anemia (IDA), 11 patients (10%) were thalassemia trait and one patient (1%) had autoimmune hemolytic anaemia. ACD was more frequent among group II (80%) and group III (70.4%), while IDA was more frequent among group I (12.6%). both ACD and IDA were more frequent among female patient than male patients (34.7% and 13.8% respectively). There was no significant correlation between HbA1c and Hb, serum iron parameters and S.ferritin. Conclusion: It was concluded that anaemia is common among diabetics and remains unrecognized by both physicians and patients; it is more common among female diabetics. The commonest type of anaemia among diabetic patients is ACD followed by IDA.

Background and objective: Yellow nail syndrome is a rare clinical syndrome. Given the low number of known cases (approx. 200 cases described) and unclear disease etiology, no accepted standards of treatment exist. Case report: A 65 years old man presented to Rizgary Teaching Hospital consultation department of internal medicine with shortness of breath, swelling of both upper and lower limbs and nail changes.

Background and objective: Hypoparathyroidism is an uncommon endocrine-deficiency disease characterized by low serum calcium levels, elevated serum phosphorus levels, and absent or inappropriately low levels of parathyroid hormone in the circulation. It is characterized by carpal and pedal muscle spasms, positive Chvostek's and Trousseau's signs. Diagnosis is done by typical clinical and laboratory findings. Current treatment options include oral calcium, vitamin D, and thiazide diuretics. We present a 21 years old girl exhibiting characteristic features of idiopathic hypoparathyroidism presented with nonunion fracture of right ulner bone.

Adeno cystic carcinoma of the larynx is very rare and concomitantly with the follicular thyroid carcinoma is not reported in the literature. This case was presented to our centre because of the stridor and small anterior neck mass. Evaluation of the case showed a subglottic mass with an enhanced right thyroid mass on the CT scan. The treatment was thyroidectomy followed by total laryngectomy and bilateral neck dissection. The histopathological study of the subglottic mass showed adeno cystic carcinoma and of the thyroid mass was follicular carcinoma. The adeno cystic carcinoma of the larynx is usually asymptomatic and it has the opportunity to invade deeply before the diagnosis. Proper evaluation of the head and neck is mandatory in any laryngeal lesion.