Vol 17, No 1 (2013)

Background and objective: Leukemia is a significant public health and life-threatening problem for pediatric cancer patients. Adolescents leukemic may face long periods of treatment; may describe the irritability, fatigue, bone pain, mouth ulcer, alopecia, and loss of appetite. The aim of the study was to assess the common physical problems among leukemic adolescent patients undergoing chemotherapy, and identify the association between their socio-demographic characteristics with physical problem.

Methods: A descriptive study was carried out in Nanakali Hospital for Blood Diseases / Erbil city from the period of /1st Nov. /2010 to/ 1st of Feb. /2011/. Eighty adolescent who are receiving chemotherapy in face to face interview, were selected regarding the study.

Results: The study shows that there were highly significant associations between socio-demographic characteristics with some of physical problems such as pain, fatigue, loss of appetite, and oral ulcer (mucositis).

Conclusion: The study shows that there were significant association between adolescent patient and some physical problems. The study recommends giving more support and attention by medical and nursing staff manage to reduce their physical problems.

Background and objective: Tonsillectomy is defined as the surgical excision of the palatine tonsils. This single blind prospective study of (200) patients underwent tonsillectomy in Al- Rizgary Teaching Hospital-Erbil- Iraq from February 2006 through June 2006.The main aim of this study is to evaluate the effect of post-tonsillectomy amoxicillin in preventing infection and secondary haemorrhage.

Methods: Our patient’s ages ranged from 2.5 years-55 years and were randomly divided postoperatively into two equal groups. The first group received amoxicillin antibiotic with analgesic paracetamol up to one week postoperatively. The second group received only paracetamol for one week. All tonsillectomy surgeries were done by cold knife dissection method.

Results: In the first group no one developed complications neither postoperative infection nor secondary hemorrhage , whereas in the second group who received only paracetamol, 4 patients (4%) had features of infections post operatively with another 2 patients (2%) developed secondary hemorrhage controlled conservatively.

Conclusion: The above results showed no significant effect of post-tonsillectomy antibiotic to prevent infection or delayed bleeding.

Background and objective: Cervical cancer is the second most common female cancer in the world. It is the commonest cause of female cancer deaths in South-East Asia and Africa and accounts for 15% of all female cancers in developing countries. the aims of this study was to determine the frequency of abnormal cervical cytology among women underwent Pap smear and assess for the presence of risk factors related to abnormal Pap smear results.

Methods: A hospital-based cross sectional study, using a questionnaire and involved 2,146 women at the Maternity Teaching Hospital in Erbil city from January to December 2009. All Pap smears cytological examinations were conducted using Bethesda classification system.

Results: Histological reports were found to be normal in 88.4% of women; meanwhile, 248 (11.6%) women had abnormal cytological findings with a mean age of 36.84 years, significantly older than those with normal results (p <0.05). The duration of marriage was also found to be significantly longer among those with abnormal Pap smear (18.34 years versus 15.72 years, (p < 0.05).

Conclusion: This study was able to indicate that during reproductive life, the older ages of women and longer duration of marriage were associated with an increased risk of abnormal Pap smear results.

Background and objective: Alopecia areata, is an organ-specific autoimmune disease with genetic predisposition and an environmental trigger, characterized by discrete, well - demarcated area of non scaring terminal hair loss. It affects sex, children and young adults. This study aims at assessing different aspects of alopecia areata and its clinical characteristics.

Methods: A descriptive study conducted during October 2006 and April 2007 on 100 patients with alopecia areata using a structured questionnaire, at the outpatient clinic of Dermatology and Venereology at Rizgary Teaching Hospital.

Results: Male-to-female ratio was 2.3:1, 42% of cases had a single patchy lesion while 52% had multiple patchy lesions, 5% had Alopecia Universalis and one case had Alopecia Totalis. The scalp was involved in 82% while mustache area in only 7% of the cases. Itching and burning were positive in 8%, exclamation marks in 23% and nail involvement in 22% of cases. Ophiasis found in 13% while past history of atopy was positive only in 11% of the cases. Family history was positive in 20% of all cases while past personal history in 31% of the cases. The age of first attack in most of cases was during the first three decades of life.

Conclusion: There is a significant relationship between the age of first attack and negative prognostic signs. Scalp with multiple patchy lesions was the common type of alopecia areata among our patients.

Background and objective: Facial soft-tissue injuries are the most common injuries presenting to surgical causality reception. The present study aimed to provide a preliminary data base about the distribution, type, pattern and etiology of facial soft tissue injuries. Methods: In a prospective clinical study all patients with facial injury were enrolled in this study, over a ten months period (from 1st October 2010- 1st July 2011), who attended Surgical Casualty Reception in Rojh-halat Emergency Hospital. A questionnaire was used to collect patients’ database and relevant information. The wound configuration was divided as laceration, abrasion and contusion as well as the site of facial soft tissue injuries were recorded using the modified MCFONTZL system. Results: A total of 168 patients with facial soft tissue injuries were received and managed at Surgical Casualty Reception in Rojh-halat Emergency Hospital. The age of the patients were ranged from 1-80 years old. Most of the patients were within the age range of 1-10. Male patients constitute 62.5% of the cases. The most common etiology of facial soft tissue injury was falls. Regarding type of the injury, laceration was the most common type. The lips and chin region were mostly involved. Conclusion: Fall is the most common cause of facial injury. Lower third of the face is mostly involved. road traffic legislations have a role in decreasing road traffic accidents.

Background and objective: The goal of this study was to determine the association of complete left bundle branch block (LBBB), site , severity & risk factors of coronary artery disease (CAD). Complete Left bundle branch block increases the risk of cardiac mortality, and prognosis is primarily determined by the underlying CAD. Because the presence of complete LBBB makes the noninvasive identification of CAD less informative, patients with complete LBBB often are referred for coronary angiography to assess the presence and severity of CAD. Methods: A total of 150 consecutive patients with complete LBBB admitted to the coronary care unit were enrolled from the age of 27 to 81 years with the mean age of 59.32 ± 10.5. Male 84 (56%), Female (44%). History, basal investigations echocardiography and virology screen were performed. Coronary angiography has been done for all patients for different reasons of presentation. Results: Critical CAD 70 (46.7%), Left ventricular systolic dysfunction (LVSD) 50 (33.3%). Hypertension found in 83 (55.3%), diabetes mellitus (DM) in 44 (30%), DM& left ventricular systolic dysfunction(LVSD) were more associated with critical CAD. Conclusion: In our study complete LBBB was more common among hypertensive patients. In DM patients was associated with severe CAD. With Left anterior descending artery being the most common artery involved.

Background and objective: Consuming of opium is a new phenomenon that could be significantly observed in some regions of Iraqi Kurdistan region, especially in districts near to Iran borders. Long term consumption of opioids affects body homeostasis. This study is designed to determine the effects of opium on reproductive histological and hormonal parameters in addition to the study of qualitative sperm abnormalities in experimental rats. Methods: The rats of the experiment were divided into three groups: Control group and the two experimental groups which were treated with two different concentrations of opium (25 and 50 mg/kg/day) for 7 days. After the decided period, the rats were dissected. Serum testosterone and sperm quality was determined and histological sections were prepared from the testis. Results: Testosterone significantly reduced in opium treated rats in both low and high doses. The histological sections of testis showed testicular degeneration in the seminiferous tubules, while higher dose showed loss of normal architecture of seminiferous tubules, in addition to present of giant cell in lumen of tubules. Several types of sperm abnormalities were observed, but the head-neck connection abnormality was the dominant. Conclusion: This finding suggests that opium addiction can cause significant decrease in the male sexual hormone secretion and it also leads to the alteration in the sperms and testis structure. This may lead to sexual suppression and infertility which needs further investigations.

Background and objective: Nausea and vomiting are among the most common distressing complications encountered by patients postoperatively. The aim of this study is to evaluate the prophylactic effect of small dose of dexamethasone (5 mg) on postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy (LC). Methods: A prospective double blind placebo controlled study of 160 patients who underwent elective LC at Rizgary Teaching and Hawler Private Hospitals in Erbil, Kurdistan in a period between Jan 2009 and Dec 2009. Preoperatively the patients were allocated randomly to one of the four groups (n = 40 each). 1. The dexamethasone group received dexamethasone 5mg. 2. The metoclopramide group received metoclopramide 10mg. 3. The tropisetron group received tropisetron 2mg. 4. The placebo group received normal saline 2ml. Results: Both the dexamethasone and tropisetron groups were significantly different from the placebo group in the incidence of nausea and vomiting. The differences between the dexamethasone and tropisetron groups were not significant (P = 0.799). Conclusion: : prophylactic IV dexamethasone 5 mg significantly reduces the incidence of PONV in patients undergoing LC.

Background and objective: Infertility remains a global health challenge with devastating psycho-social consequences in many communities and an underlying long-term risk for separation of the couple, also remains a major clinical and social problem. Infertility is defined as inability of a couple to conceive naturally after one year of intercourse. An understanding of the medical causes of infertility is crucial in order to reduce incidences of infertility and for improving the clinical management of infertility. The aim of the study was to determine the causes of infertility in couples. Methods: A retrospective study was done in IVF Unit at Maternity Teaching Hospital in Erbil. Data of infertile couples were collected from already prepared patient’s files. Results: The frequency of primary and secondary infertility among women was 62.97% and 37.03%, respectively. Among 370 couples, 35.68% had female factor, 29.46% had both male and female factors, and 19.73% had male factor, while 15.14% of the couples had unexplained infertility. Conclusion: Primary infertility was common health problem in couples, also the causes of infertility in women is noticed more than men.

Background and objective: This study aims to determine the role of breast ultrasound in assessing patients with localized or diffuse pain in the breast. Methods: This cross-sectional study involved 170 women with the mean age of 31 years presenting with breast pain who were referred to the Radiology Department of the Maternity and Rizgari Teaching Hospitals from October 2008 to September 2009. The breasts of each woman were examined by ultrasound scan with special attention was focused on the milk ducts. The presence and the width of the ducts were documented. Each woman was asked for pain intensity and breast pain intensity evaluated as mild, moderate and severe. Results: The ultrasonic assessment of the affected breast classified the participants into 4 categories; normal (29.9%), tubular (18.6%), ductasia (18.6%) and mass (32.8%). Among the 58 participants having mass in the breast, 48.3% had cystic mass and 51.7% had solid mass. The ultrasonic features of the mass showed that 86.2% of cases were benign and 13.8% were intermediate. The histopathological assessment of the masses shown that 46.4% were fibrocystic changes, 20.7% were fibroadenoma, 24.1% were benign cysts, 3.4% were malignancies and 5.2% were breast infections. Conclusion: The study results show that duct ectasia is a major factor in determining the severity of mastalgia with no significance difference between cyclical and non-cyclical mastalgia.

Background and objective: Fatigue, is a common presenting symptom in primary care which negatively impacts work performance, family life, and social relationships. The aim of this study is to determine the causes of fatigue and to explore the relationship between fatigue and physical, mental, social and demographic factors among patients with special reference to gender. Methods: A cross sectional study was carried out at the Brayati Family Medicine Center in Erbil city from 1st of July to the 31st of October 2011. We studied 320 patients of both genders attending the center for various reason complaining from fatigue. Formal consent was obtained. Demographic data in addition to two questionnaires were completed, Lowa fatigue scale and Hospital Anxiety and Depression Scale. Results: 86 males (26.88%) and 234 females (73.12%). The age of the subjects varied from 16-74 years .The mean age was 29.2 years, 39.69% were in the age range 30-44 years. 58.12% were illiterate or read and write only; 65.63% were married and 57.19% reported their economic level as medium. 38.44% were fatigued according to lowa fatigue scale. Higher level was detected among older age group, singles, and low economic and minimum educational status (51.16%, 45.31%, 41.80%, 41.18 and 42.57% respectively). Depression was significantly associated with fatigue, 70% of patients who were depressed complained from fatigue. Findings indicated that, in addition to increasing anxiety among the study sample, higher levels of fatigue were detected in 61.36% of them. Conclusion: Fatigue as a symptom is very common both in community and health care settings but remains medically unexplained. The most important confounders in our studied population were depression and anxiety.

Background and objective: As the etiology of mastalgia is poorly understood this study applied ultrasonography to mastalgia patients with the aim of analyzing the significance of milk duct dilatation in patients with mastalgia. Methods: This cross-sectional study involved 170 women with the mean age of 31 years presenting with breast pain who were referred to the Radiology Department of the Maternity and Rizgari Teaching Hospitals from October 2008 to September 2009. The breasts of each woman were examined by ultrasound scan with special attention was focused on the milk ducts. The presence and the width of the ducts were documented. Each woman was asked for pain intensity and breast pain intensity evaluated as mild, moderate and severe. Results: The mean±SD diameter of duct was 3.99±1.37 mm. The mean diameter of the duct was higher among the younger age group of <25 years than older age groups (4.28 vs 3.95 and 3.87), among married than singles (3.99 vs 3.90) and among those having cyclic pain compared to those having non-cyclic pain (4.0 vs 3.95). However, these differences were not statistically significant. The mean diameter of the duct was significantly higher among those having bilateral pain than those having unilateral pain (4.47 for bilateral vs 4.02 for left side and 3.61 for right side) and among those having severe pain compared to those having moderate or mild pain (4.91 vs 3.40 and 3.28). Conclusion: The study results show that duct ectasia is a major factor in determining the severity of mastalgia with no significance difference between cyclical and non-cyclical mastalgia.

Background and objective: Inflammation is a physiological response to injury and infection. However, chronic inflammation causes tissue damage and is a feature of most chronic diseases. Despite significant progress in developing therapies to target chronic inflammation over the years, almost all current therapies have serious side effects. The current investigation is to identify naturally-existing anti-inflammatory therapies with fewer side effects. Methods: The anti-inflammatory effects and mechanisms of action of extracts and fractions obtained using vacuum liquid chromatography (VLC) from ginger (Zingiber officinale) on the production of nitric oxide (NO) and prostaglandin E2 (PGE2) were investigated. NO and PGE2 production were induced by stimulating the mouse RAW264.7 monocyte/macrophage cell line with lipopolysaccharide (LPS). Levels of NO and PGE2 were determined using the Griess method and enzyme linked sorbent assay (ELISA), respectively. Results: Extracts of two Zingiber officinale species obtained with chloroform showed potent inhibitory effects on NO and PGE2 production. The extracts had a higher potency than N(G)-nitro-L-arginine methyl ester (L-NAME), a known specific inducible nitric oxide synthase (iNOS) inhibitor and were comparable in their effects on PGE2 with Indomethacin, a specific PGE2 inhibitor. Further, we identified a fraction (F6) that had most potent inhibitory effects. Conclusion: The study shows that extract of Zingiber officinale have strong inhibitory effects on key pro-inflammatory mediators involved in chronic inflammation. Both the extracts and F6 had better inhibitory effects than established pharmaceutical inhibitors of NO and PGE2.

Background and objective: Thalassaemia is a heredity blood diseases characterised by decreased synthesis of one of the two types of polypeptide chains (β or α) which form the normal adult human hemoglobin molecule (HbA, α2‚β2), resulting in decreased filling of the red cells with haemoglobin, and cause anaemia. The study aimed to improve mothers’ knowledge and practices of Thalassaemic children who are using Desferal therapy. Methods: A quasi-experimental study was carried out at Hawler Thalassemia Center in Erbil City from the 1st of March to the end of May 2010. One hundred mothers were selected and divided into two groups, 50 mothers exposed to the educational programme (study group) and a second group of (50) mothers were served as control. Pre and post test of subject of interest were done during the two occasions. Results: The results revealed that mothers’ knowledge and practices in the study group were improved. There is no significant association between mothers’ knowledge and practices with socio-demographic characteristics at pre-test which became significant at post-test . Conclusion: Yet, most of the mothers in the study group have gained benefit from implementation of this educational programme.

Background and objective: Urinary tract infection (UTI) is a condition in which the urinary tract is infected with a pathogen causing inflammation. One of the predisposing factors for UTIs is diabetes mellitus (DM), spillage of glucose into the urine provide a good culture medium for bacteria. The objectives of this study were to evaluate the distribution of UTIs among diabetic patients of both genders with studying the effect of some relative factors, and identifying types of the causal microorganisms. Methods: Diabetic patients (type1 and 2), from both genders were included in this study. All patients were interviewed. Uncontaminated urine samples were collected for microscopic and macroscopic analysis. Isolations and identifications of bacteria were done by standard methods. Results: Out of 150 diabetic patients, 53 (35.33%) have UTI. Gender, middle age and high level of proteinuria were risk factors, while type and duration of DM with its type of treatment, body mass index (BMI), and hypertension were non significant. The isolated types of pathogens were Escherichia coli (45.3%), Klebsiella pneumoniae (15.1%), Staphylococcus saprophyticus (15.1%), Citrobacter diversus (11.3%), Candida albicans (7.5%) and Staphylococcus aureus (5.7%). Conclusion: This study revealed that diabetic females were most susceptible to get UTIs than diabetic males. In both genders the most reliable age for UTI were between 31-40 years. The results showed that the level of proteinuria was higher in patients suffering from UTIs associated with DM, which considered as a risk factor. Certain types of microorganisms were isolated; the most common types were Escherichia coli, Klebsiella pneumoniae and Staphylococcus saprophyticus.

Background and objective: Viral Hepatitis Type B&C is serious public health challenge throughout the world.Hepatitis B and C viruses still remain to be the major causes of chronic hepatitis.It is estimated that around 350-400 million people in the world are chronic carriers of HBV, which represents approximately 7% of the total populationwhereas infection with HCV is found in approximately 3% of the world population, which represents 160 million people. Hepatitis B infection has a wide range of seroprevalence in the Mediterranean countries ranging from intermediate (=>2% ) to high prevalence ( =>7%). World Health Organization estimated a prevalence rate for HCV infection of about 4.6% in Eastern Mediterranean in 1999. During the eightieths years of the last century, Iraq was considered to be of intermediate endemicity with hepatitis B as reflected by 3% seroprevalence of HBsAg in normal population. Hepatitis C was found to be of low endemicity among blood donors 0.5%. There were no national wide epidemiological studies regarding the prevalence of hepatitis B&C accordingly we conduct this study to determine the prevalence of both types all over the Iraq. Methods: From the 1st of January 2005 to 31st of December 2006, a community based cross-sectional study was conducted all over Iraqi governorates. A total of 9610 persons, recruited by surveying a nationally representative random sample of households were analyzed. A stratified random sample proportional to size of each of the 18 Iraqi governorates, both urban and rural areas were included. Prevalence estimates were therefore weighted and age-adjusted. Five (5ml) of blood samples were taken from the study subjects, and tested for hepatitis B surface antigen, antibody to hepatitis B core antigen antibody to hepatitis B surface antigen and hepatitis C antibodies . Results: The national prevalence rate of HBs Ag was 1.6% and correlated positively with age. The prevalence rate of anti-HBs antibodies was 17%. The prevalence of anti-HBc was 9.7%. The prevalence of anti-HCV was low (0.4%). The prevalence rate of anti-HBs antibodies in <10 years children is only 32.2%, which raise the issue of incomplete coverage of hepatitis B vaccine during the years preceding the study years. Conclusion: The findings revealed that Iraq is of low prevalence with HBsAg.On the other hand,hepatitis C was found to be of very low prevalence. As a marker of exposure to hepatitis B, Anti HBcIgG was found to increase with age.

Adrenocortical carcinomas are highly malignant rare tumors that can occur in adults, adolescents or children, Whil they can affect both sexes the incidence is higher among girls. Hormone-secreting tumors and the associated classic endocrine syndromes (virilizing, feminizing, Cushing’s and Conn’s syndromes) represent the most common presentation in this age group. Both genetic and environmental factors have been implicated in its etiology. Diagnosis is done by imaging studies including Computerized tomography scan an/ord magnetic resonance imaging of abdomen in addition to ultra-sound examination, histological confirmation is done by excisional biopsy or in exceptional conditions by fine needle aspiration. Regarding functional state of the tumor hormonal study is needed. Treatment includes; complete radical surgical resection which might be curative in case of small tumors, in patients with incomplete resection or metastatic spread treatment options include mitotane and/or chemotherapy. radiation therapy is recommended in the treatment of bone, brain and other metastases, radiation therapy is also recommended in the treatment of symptomatic local recurrences. Regarding prognosis It has been reported that patients with untreated adrenocortical carcinoma have a median survival of 3 months only. In treated adrenocortical carcinoma, overall 5-year survival ranged between 23% and 60% in different series. We present a 17 years old girl, she presented with generalized acne, virilizing features, primary amenorrhea and hemoptysis, Investigations revealed adrenocortical carcinoma. In the light of this case, the literature about adrenocortical carcinoma was reviewed. Conclusion: Adrenal carcinoma can occur in our locality and the diagnostic keys are hormonal and imaging studies.