Vol 18, No 2 (2014)

Background and objective: Gonorrhea is a sexually transmitted disease caused by Neisseria gonorrhoeae. The bacteria can be passed from one person to another through vaginal, oral, or anal sex. It can also be passed from mother to her baby during birth. The symptoms in adult male include a burning sensation when they urinate and a yellowish-white discharge may ooze out of the urethra. Gonorrhea can spread to epididymis causing pain and swelling in the testicular area. This can create scar tissue that can lead to infertility. The aim of this study was to determine the prevalence of gonorrhea in adult male in Erbil Governorate and the susceptibility of isolated Neisseria to antibiotics.

Methods: Urethral discharge obtained from adult male aged between 19-49 years were examined for the presence of Neisseria gonorrhoeae using direct smear gram staining and cultural technique. The susceptibility of isolated bacteria to antibiotics was tested using disc diffusion method.

Results: This study showed that the incidence of gonorrhea among 312 adult male with urethritis in Erbil city was (8.97%) while (91.03%) of patients examined had nongonococcal urethritis. The higher percentage of infection with Neisseria gonorrhoeae (14%) occurred among age group (19-29) years and the lower (3.48%) in the age group (39-49) years. Among the 210 unmarried patients, 26 (12.38%) had gonorrhea and 184 (87.62%) had nongonococcal urethrits. All Neisseria gonorrhoeae were sensitive to ceftriaxone, spectinomycin and azithromycin. The isolates showed low sensitivity (21.42%) to penicillin.

Conclusion: It seems that gonorrhea is common among symptomatic adult male. The emergence of resistance to some antibiotics is worrying. Appropriate prevention strategies should be of highest priority of the policy makers.

Acroangiodermatitis (synonym pseudo-Kaposi's sarcoma) is an unusual, benign condition which clinically presents as erythematous, violaceous, brown, or purple-colored patches, plaques or nodules, mostly on the extensor surfaces of lower extremities. Acroangiodermatitis is often associated with different disorders including chronic venous insufficiency, arteriovenous malformations like Klippel-Trenauny syndrome, iatrogenic arteriovenous shunts like fistula in patients under hemolysis (lesions are developing distally to arteriovenous shunts), and in paralysed limbs. It has also been reported above amputation stump of the limbs (especially in those with poorly fitting suction-type devices). It resembles aggressive conditions like Kaposi's sarcoma and requires histopathological examination for its diagnosis. We report a case of a 47-years old man with lesions of acroangiodermatitis in both lower legs and feet, secondary to chronic venous insufficiency. Histopathology showed dilated capillaries in the dermis with extravasated red blood cells, hemosiderin deposits and granulation tissue formation. In conclusion we would like to emphasize the importance of histopathology and immunohistochemistry in distinguishing this benign condition from similar looking malignant conditions especially Kaposi’s sarcoma.

Background and objective: Initial proper management of open fracture makes a paramount difference to the outcome. The current survey was carried out to evaluate the local practice of the management of open long bone fractures.

Methods: A questionnaire was distributed on 17 doctors who were involved in the management of 42 open fractures in the previous year. Timing to debridement, type of anesthesia, antibiotic administration, number of normal saline liters used for washout, photo taken and other issues were studied.  

Results: After analyzing the data collected, it turned out that wound management takes place within nine hours, antibiotics given immediately upon admission, and photo of the wound taken in most but not all of the patients. Some of the wound management was performed under local anesthetics (11%), but the majority was done under general anesthesia. A variety of implants were used, mainly external fixation. The infection rate was 23%.

Conclusion: Auditing the practice of open fracture is crucial to improve outcome. The use of Gustiloof classification should be followed to predict outcome and decide on the amount of saline used, the latter was underrated in the current study. Local anesthesia is not adequate for proper wound debridement where the two ends of the bone should be delivered in the wound for washout. Antibiotics for more than 3-5 days will result in the development of resistance, which should be avoided.

Background and objective: Care for children with disabilities is often neglected and ignored. It tend not to be taken outside the home because of embarrassment and potential teasing and ridicule from others. Home care is the best way to provide daily care and management for children with chronic disabilities. This study was designed to assess the practices of mothers of children affected by cerebral palsy regarding home care management in Erbil city/Iraqi Kurdistan region.

Methods: A cross-sectional study was carried out during the period from July 1, to September 1, 2012. A convenience sample was taken, involving 100 mothers whom weekly or monthly attended Helena Center for Handicapped Children for physiotherapy and medical managements.

Results: The results revealed that less than half of the mothers were between 24-30 years old, half of them were illiterate, most of them were living with low socioeconomic status, and more than half were living in urban areas. The highest percentage of cerebral palsy children were in toddler developmental stage, the majority complained of spastic type. The present study found that there was significant association between mothers’ age and dental/oral care. There was also significant association between socio-economic status with both of dental/oral care and child safety. There were highly significant association between ages of cerebral palsy children with maintained oral care and hygiene, nutrition, hydration care and constipation. There was significant association between types of cerebral palsy and communication.

Conclusion: The finding of the study refers that the mothers having cerebral palsy child, complained of inadequate skills concerning home care management, and the study recommends a comprehensive health education program for mothers having cerebral palsy child.

Background and objective: Family planning allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. Insufficient knowledge, attitudes, and practices about the family planning and, more important, methods for family planning lead to increased number of unwanted pregnancies. The study aims at finding out the knowledge, attitudes and practices regarding family planning among two groups of women residing in two different areas (urban and rural) in Erbil city, Iraqi Kurdistan region.

Methods: A cross-sectional survey was carried out during the period from November 1, 2009 and August 31, 2010. A convenience sample of 700 married women was taken from two different areas of Erbil.

Results: A considerable proportion of women were unfamiliar with the term family planning, while high level of knowledge was found regarding types of contraceptives, ideal period between consecutive pregnancies, and the ideal age of pregnancy and labor. Most of the women had a positive attitude toward family planning, and knew at least one benefit of family planning to mothers and/or children. The study revealed limited effect of health education channels on the knowledge of women about family planning. The intra-uterine device and the withdrawal methods were the most popular family planning methods used among the study sample. Majority of families in both groups are currently using family planning.

Conclusion: A considerable proportion of women were unfamiliar with the term family planning. Most of the women had a positive attitude toward family planning. Appropriate approaches to be used to convince the policy makers about the importance of family planning.

Background and objective: Disseminated intravascular coagulation significantly contributes to the bleeding and thrombotic complications in patients with haematologic malignancies. This study was conducted to find out the incidence of disseminated intravascular coagulopathy in haematological malignancies before introduction of chemotherapy.

Methods: A prospective case series study was performed at Nanakaly Hospital for Blood Diseases from April 30, 2011 to April 1, 2012. Seventy patients with different haematological malignancies were enrolled; they were assessed with clinical importance of global haemostatic laboratory tests.

Results: Eighteen percent of studied patients had overt disseminated intravascular coagulopathy. The haemostatic measures were higher in overt disseminated intravascular coagulopathy cases than those with no evidence of disseminated intravascular coagulopathy cases (P < 0.001); and the highest incidence of disseminated intravascular coagulopathy cases was in acute promyelocytic leukemia's patients (77%, P = 039). Most of disseminated intravascular coagulopathy cases were clinically manifested with anemia, bleeding and rarely with thrombosis (100%, 69% and 7%, respectively).

Conclusion: Disseminated intravascular coagulopathy is not uncommon in haematological malignancies before starting chemotherapy. Global haemostatic tests are helpful for diagnosis of disseminated intravascular coagulopathy side by side with clinical manifestations and medical history.

Background and objective: Gingivitis is the presence of clinical signs of inflammation in gingiva and is associated with teeth showing no attachment loss. Human saliva contains informative components that can be used as diagnostic markers for human diseases. This study is directed to evaluate salivary phosphatase enzymes levels in diagnosis and follow up the treatment of gingivitis.

Methods: Saliva samples were collected from 100 healthy persons, and 50 patients before treatment (scaling and polishing) and 20 days after the treatment. Their age ranged between 20-30 years. Alkaline phosphatase and acid phosphatase activities, some kinetics and thermodynamic parameters were measured.

Results: Salivary alkaline phosphatase and acid phosphatase activities elevated in gingivitis, while their levels returned to the control values after treatment. The Michaelis constant (Km) values for salivary alkaline phosphatase and acid phosphatase decreased in gingivitis, while the maximum velocity (Vmax) values increased. These values returned back to normal values after treatment. The changes in the thermodynamic parameters (∆H*, ∆G* and ∆S*) values of transition state for salivary alkaline phosphatase were non-significant, while their changes were significant for salivary acid phosphatase, except for ∆G* value.

Conclusion: Salivary alkaline phosphatase and acid phosphatase levels can be relevant for diagnosis and the follow-up of gingivitis treatment.  

Background and objective: Loading an implant right after placement has been attempted and has gained popularity among clinicians. The aim of this study was to evaluate the clinical and radiographical outcomes of immediate loading of single dental implant placed in healed and in fresh extraction sockets.

Methods: In a prospective, comparative, clinical study, 40 patients underwent single dental implant procedure in the maxillary esthetic zone. Twenty implants were placed into fresh extraction sockets (Group A), and the other 20 implants were placed into healed extraction sockets (Group B). Placement of the permanent crown was done within two weeks after implant placement.

Results: From a total of 40 implants only two failed to survive giving a cumulative survival rate of 95%. Both failures occurred in fresh extraction sockets resulting in a survival rate of 90%, while no implant failed in healed sites achieving 100% survival rate. The difference in marginal bone loss between two groups was statistically significant.

Conclusion: The immediate loading of single dental implant in maxillary esthetic zone is a viable clinical concept and lead to favorable treatment outcomes.

Background and objective: The temporomandibular disorders present with a variety of signs and symptoms which include pain in the joint and its surrounding, jaw sounds, limited jaw opening, jaw deviation and headache. The aim of this study was to compare the results and efficacy of arthrocentesis with those of conservative treatments for temporomandibular joint disorders.

Methods: In a clinical comparative prospective study, 45 patient of both sexes were enrolled in this study according to inclusion criteria’s. The arthrocentesis group consisted of 22 patients (31 joints). The conservative treatment group consisted of 23 patients (34 joints). For both groups, pretreatment and four months post treatment parameters (visual analogue scale for pain, maximum mouth opening and joint sounds score) were recorded.

Results: The results revealed that highly statistically significant difference between all pretreatment and forth months post treatment parameter means for both groups (P < 0.001). Both arthrocentesis and conservative treatments were effective. There was a highly statistical significant difference between the four months post treatment parameter means for both groups (P < 0.001). Arthrocentesis was superior to conservative treatments. The overall success rate was 87.1% for arthrocentesis and 55.9% for conservative treatments.

Conclusion: Both conservative treatment and arthrocentesis are effective in the treatment of temporomandibular joint dysfunctions. However, arthrocentesis seems to be superior.

Background and objective: Non-Hodgkin lymphoma is a cancer of the lymphatic system. Types of non-Hodgkin lymphoma vary significantly in their severity from indolent to very aggressive. The aim of this study was to investigate the incidence, immunohistochemical expression, clinical and histopathological prognostic factors of patients with non-Hodgkin lymphoma. Methods: A total of 59 patients with non-Hodgkin lymphoma cases were reviewed and investigated at Razgary Teaching Hospital in Erbil city during the period from January, 2011 to January, 2013. Data of patients were tabulated and distributed according to their age, sex, site, immunohistochemical expression and WHO classification. Results: Age of non-Hodgkin lymphoma patients ranged from 2 to 88 years with a mean of 45 year. Around 49% of the patients were of age group over 50 years and 54.2% of patients were male. Immunohistochemical investigation indicated that 71.2% of non-Hodgkin lymphomas were of B cell type, the highest percentage (33.3%) of them was of diffuse large cell type. While the T cell type was found in 20.3%, the highest percentage (33.3%) of them was of Anaplastic lymphoma. CD20 and CD3 showed more consistent and strong expression for B and T cells non-Hodgkin lymphoma, respectively. Results showed high BCL2 expression. Nodal non-Hodgkin lymphoma account for 50.8% of the total cases. Conclusion: Most non-Hodgkin lymphomas were of B cell type and highest percentage is of diffuse large cell type. CD20 and CD3 were more reliable as an indicator of B and T cell lineage, respectively. Most non-Hodgkin lymphomas were of intermediate-high grade. Nodal site represent highest rate for primary non-Hodgkin lymphoma.

Background and objective: Nurses play a key role in providing care at the end of life; death is inevitable that affect every human being. Nurses are present at both the beginning and the end of life and play a key role in caring for dying patients. The aim of this study was to assess the attitudes of critical care nurses toward care of the dying as well as assessing the relationship between demographical components and attitudes toward care of the dying.

Methods: A cross-sectional study was carried out in the cardiac center of Erbil city, Iraqi Kurdistan region, during the period from 2^nd February to 4^thof March, 2013. A convenience method of sampling was used to collect 40 nurses working in that center. The mean age(±SD) of nurses were 27.87 (±2.92, range=35-24). Each nurse was asked to complete the Frommelt Attitudes toward Care of the Dying Scale (FATCOD) and demographics questionnaire designed and copyrighted by Katherine Frommlet in 1988.

Results: The study indicated that there was positive attitude among study samples. Results showed that no significant relationship between attitudes score with gender, nurse education, and duration of service, while there was significant association between high attitudes score with older ages (P = 0.003).

Conclusion: The nurse's attitudes toward dealing with dying cases were positive in the majority of related items, and there were no associations between gender, duration of experience, and level of education and their attitude, while it was found a significant association between ages and attitudes towards care of the dying.