Vol 16, No 2 (2012)

Background and objectives: Acute mitral regurgitation is one of the mechanical complications of acute myocardial infarction. The aim of the study was to detect the incidence of ischemic mitral regurgitation and its effect on in-hospital complications in early phase of acute myocardial infarction.

Method: The study sample consisted of 100 patients with first attack of acute myocardial infarction admitted to Coronary Care Unit in Erbil Teaching Hospital from October 2009 to May 2010.The patients categorized into: group-I which represent those without mitral regurgitation; group-II represent those with mitral regurgitation and the latter categorized patients with mild mitral regurgitation (group-IIA) and those with moderate-severe mitral regurgitation (group-IIB).

Results: The incidence of acute mitral regurgitation among patients with acute myocardial infarction was 33%. Fourteen patient (42.42%) had mild and 19 (57.58%) had moderate-severe mitral regurgitation. Group-II patients were older (mean age: 65.4±10.76 years) than group-I (mean age 56±11), p value=0.01. Left ventricular systolic dysfunction among group-IIA, 9 patients (64.28%) and group-IIB, 16 patients (84.21%) were higher than group-I, 12 patients (17.91%), p=<0.001.

Conclusion: Acute mitral regurgitation is common in early phase of acute myocardial infarction and it is strongly associated with left ventricular systolic dysfunction.

Background and objectives: Lowering the blood cholesterol and low density lipoprotein levels may reduce the risk of coronary heart disease. This study was designed to evaluate the effect of lipid-lowering therapy by simvastatin 20 mg versus atorvastatin 20mg on patients suffering from hyperlipidemia.

Method: This study is 16-weeks duration included 75 patients with hyperlipidemia. Patients were assigned randomly to receive either simvastatin 20 mg/day group (1), or atorvastatin 20 mg/day group (2). After 12 hours fasting, lipid profile, atherogenic index and alanine aminotransferase were assessed for the patients at baseline, 8-weeks and at the end of 16-weeks of treatment.

Results: After therapy for both groups of patients, as compared to the levels at the baseline, the serum total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C) and very low density lipoprotein cholesterol (VLDL-C) were significantly reduced while high density lipoprotein cholesterol (HDL-C) was significantly increased. Serum alanine aminotransferase (ALT) increased by both groups of treatment with no significant differences between the two modes of treatment.

Conclusion: After treatment with simvastatin 20 mg and atorvastatin 20 mg, there were a reduction in total cholesterol, triglyceride, LDL-C, and VLDL-C, and an increase in HDL-C in both groups. Comparing the two types of treatment, atorvastatin 20 mg was more effective in lowering triglyceride and VLDL-C than simvastatin 20 mg while Simvastatin led to greater reduction in LDL-C. Both modes of treatment were well tolerated by the patients.

Background and objectives: It is often felt that developing countries need to improve their quality of healthcare provision. The aim of this study was to identify the satisfaction of patients about different aspects of hospital health care services, and to build a solid database for future health care planning, guiding of health policy, and monitoring health care quality.

Method: A cross-sectional study was carried out in Erbil teaching hospitals from November, 15th 2010 to January, 15th 2011. A convenience sample of 720 patients was obtained. Data were obtained by a direct interview using an anonymous questionnaire designed by the researcher. A measurement scale (Likert scale) for satisfaction was used.

Results: The mean ± SD age was 43.98 ±13.48 years with a male: female ratio of 0.61:1. The overall satisfaction rate was 73.2%, and the rate in Erbil, Rizgary and Maternity teaching hospitals were 63.8%, 75% and 80.8%, respectively (P<0.001). Binary logistic regression analysis revealed that there was significant association between age (OR= 1.068), years of formal education (OR= 0.742) with the overall satisfaction, and female patients were significantly more satisfied than males (OR=2.342).

Conclusion: The satisfaction rate increased with age and there is inverse association between the satisfaction rate and educational level of patients.

Background and objectives: measuring the distance between the lowest point of the maxillary sinus floor and maxillary alveolar bone crest seen in the digital panoramic images and the effect of alveolar bone resorption to evaluate the clinical benefit of using software measurement program to measure the height of the alveolar bone in the region of maxillary sinus.

Method: Digital panoramic images were analyzed using the software computer programs that existed in the system to measure the distance from the lowest point of the maxillary sinus floor and maxillary alveolar bone crest. Images were divided into four groups (1st group dentulous cases, 2nd group single dental extraction, 3rd group multiple dental extraction, 4th group edentulous cases) and each group consist of 50 panoramic images.

Results: The mean distance of sinus floor to bone crest in fourth group cases was approximately half of the distance in first group due to extraction of teeth and there was highly significant difference (P<0.001) between first group, third group and fourth group images, and there was significant difference (P<0.005)between first group and second group images.

Conclusion: It was concluded that the objective assessment of alveolar bone height and its 2-dimensional relation to maxillary teeth was greatly helpful by applying the software program.

Background and objectives: The objective of this study was to explore the optimal combination of agents with their doses used along with cisplatin for the protection of nephrototoxicity.

Method: This experiment was carried out on patients suffering from different types of solid tumors divided into two groups: control group receiving cisplatin in a dose of 90 mg/ m² and the studied group receiving cisplatin in a dose of 90 mg/m² with bismuth subcitrate (200mg/day) and vitamin E (400mg/day).Blood urea and serum creatinine were tested for the assessments of renal function.

Results: control patients showed a sustain and significant elevation in blood urea and serum creatinine level in comparison with baseline along the entire period of the study, P<0.05. Meanwhile, the effect of cisplatin was shown to be significantly decreased in patients received bismuth-vitamin E therapy (P<0.05) along the entire period of the study.

Conclusion: Bismuth and vitamin E in combination play a beneficial role for preventing cisplatin nephrototoxity. The potentiated actions for preventing cisplatin nephrototoxicity could be achieved via combined use of these agents.

Background and objectives: Many chemicals have been used in the skin peeling for melasma such as Jessner’s solution, trichloracetic acid, glycolic acid, lactic acid and salicylic acid which is beta-hydroxy acid used topically in different dermatoses. This study was done to investigate the efficacy and safety of superficial chemical peel with salicylic acid in treatment of melasma in comparison to Jessner’s solution peel.

Method: forty-eight cases with melasma , were divided into group-A and group-B. Treatment is performed by using superficial chemical peel with salicylic acid solution (30%) once every 2 weeks in group –A while Jessner’s solution peel used in group -B

Results: Most of the patients in both groups showed significant improvement in their melasma with the use of treatment and adequate sun protection as assessed by clinical appearance and MASI scores (Melasma Area and Severity Index) ,the results was better in group-A

Conclusion: Superficial chemical peel with salicylic acid for melasma is an easy, cheap and effective treatment in comparison to Jessner’s solution peel. Results were much better in epidermal type with few side effects.

Background and objectives: Cryptococcosis is subacute or chronic respiratory disease caused by yeast like fungus called Cryptococcus neoformans. The disease may metastasize to CNS and other parts of the body. The objective of the study is to find the prevalence of this disease in a sample of patients in Erbil.

Method: One hundred and twenty eight patients with chronic respiratory tract infection were included in this study. Early morning sputum sample was collected from each patient and subjected to both direct examination and culture

Results: The study showed 24 positive cases of Cryptococcosis, from the total 128 patients examined; 16 of them (66.6%) gave positive culture for Cryptococcus neoformans while 8 (33.3%) gave positive culture for opportunistic species of Cryptococcus. The latter were immunocompromised   individuals.

Conclusion: It is concluded that looking for Cryptococcus, is quite significant in patients with chronic respiratory diseases.

Background and objectives: Nonunion following diaphyseal tibial fractures is still a challenging problem facing orthopaedic practice , different approaches used to tackle this problem , the aim of this study was to evaluate the outcome of treatment by non cannulated intramedullary nailing as regards union and complications

Method: Eighteen patients with non-united diaphyseal tibial fractures their age ranged between 19 –60 years (mean of 33.5 years) were studied and treated by non cannulated intramedullary nailing between 2005 to 2010. Initially all these patients underwent multiple surgeries including wound excisions , revision of fixation and bone grafting All underwent fixation by non cannulated intramedullary nailing , in 14 patients , the site of the non-union wasexplored to correct alignment by osteotomy, while closed intramedullary nailing were performed in the remaining 4 patients

Results: In seventeen cases (94.4%) union was achieved between 5 – 9 months with an average of 7.5 months , complications included refracture and failure of fixation in 1 patient (5.6%) and superficial wound infection occurred in 3 cases (16.6%)Patients with nonunited diaphyseal fractures were followed post-operatively for 1–6 year (average 4 years), eventually healing was successful with full weight bearing without support and pain , fracture line was not visible on radiographs

Conclusion: Non-cannulated intra-medullary nailing appears to be very helpful procedure to promote union in these cases with relatively less significant complications.

Background and objectives: Surgical treatment has been a traditional way of treatment of incomplete abortion. Expectant management and medical treatment can reduce costs and complications generated by surgery. Current study was designed to determine the success rate of treatment of incomplete abortion by mesoprostol thus avoiding surgical intervention. Moreover, factors which can impair efficacy of the treatment were investigated.

Method: The sample size included 100 patients with first trimester incomplete abortion attending Maternity Teaching Hospital in Erbil city/ Kurdistan Region / North of Iraq between October, 1^st 2009 and March, 1^st 2010 being assigned to receive 400 µg mesoprostol orally. A week later the patients were specifically examined to verify that complete abortion had been occurred. A second dose was administered if complete abortion was not yet achieved, provided that the patient was hemo-dynamically stable and notably no substantial bleeding or infection been noticed.

Results: The success rate of the treatment was 62% and 93% after first and second dose respectively. The difference in response to the treatment was related to the difference in endometrial thickness and gestational age. No any serious complication was reported.

Conclusion: Mesoprostol administered orally is an effective method in treating first trimester incomplete abortion.

Background and objectives: Impacted lower third molar has been blamed for lower incisor crowding. The aim of this study was to measure the amount of pressure exerted by lower third molar.

Method: The study was conducted on 62 patients who underwent surgical removal of impacted lower third molars. The mean age of the subjects was 25.4 years with a range of 18-37 years. Interdental frictional strength was measured between posterior teeth, before and one week after lower third molar removal, using 0.05 mm stainless steel strip and   digital force gauge.

Results: No significant difference was noted in interdental frictional strength before and after lower third molar removal. The depth of impacted lower third molar and proximity of impacted tooth to the adjacent second molar has no significant influence on the interdental frictional strength.

Conclusion: Impacted lower third molar does not exert any significant force on the teeth and should not cause lower incisor crowding.

Background and objectives: This study aimed to investigate the correlation between the ligamentum flavum thickness and age, sex, body mass index and type of disc degeneration.

Method: 126 consecutive patients were examined prospectively. The sample included all the patients who had an MRI examination after they presented to Rizgary teaching hospital complaining of lower back and/or leg pain. The LF thickness was measured by using lumbo-sacral spine MRI.

Results: The mean thickness of LF was more at L4-L5 (right: 0.27mm, left 0.25mm), L5-S1 (right: 0.25 mm, left 0.25 mm) levels, and was thicker on the right side. LF was thicker in females than males with a statistically significant measurement at L2-L3, L3-L4 and L4-L5 levels. The mean thickness of LF was more at older age group than the younger age groups, and the results were statistically different at left side of L2-L3 and right side of L4-L5 level. Thickness of LF was more among those with higher BMI for all levels except for L5-S1. In most cases, LF was thicker in patients with advanced disc degeneration.

Conclusion: Thickening of the LF is associated to some extent with sex, age, BMI and disc degeneration. Thickening of the LF is potentially due to its buckling into the spinal canal secondary to disc degeneration more than to LF hypertrophy. Further research is needed to confirm these associations.

Background and objectives: Adenosine deaminase (ADA), is an enzyme that catalyzes hydrolytic deamination of either adenosine or deoxy adenosine to produce inosine and deoxy inosine respectively. The aim of the present study is to evaluate the serum ADA activity in acute lymphoid leukemia.

Method: A prospective study was carried out from January to June 2011 by the clinical biochemistry department in College of Medicine-Hawler Medical University on (30) patients with Acute lymphoid leukemia (group 1), and (30) healthy individuals, (group 2).

Results: The mean value of serum ADA activity was significantly lower in Acute lymphoid leukemia (group 1), than those of healthy individuals, (group 2) (p<0.01), and both ions   Na⁺ and K⁺ acted as an activators for Serum ADA activity.

Conclusion: Based on the findings, it can be concluded that in acute lymphoid leukemia the activity of Serum ADA was decreased due to decline in the immunity.

Gorlin-Goltz syndrome, also known as basal cell nevus syndrome, is an uncommon, autosomal dominant inherited disorder, which is characterized by numerous basal cell carcinoma, odontogenic keratocysts and musculoskeletal malformations. However, medical literature documents both common and lesser known manifestations involving the skin, central nervous system, craniofacial anomalies etc. A case of Gorlin –Goltz syndrome with no family history has been reported here, the patient have multiple odontogenic keratocysts, tiny pits involving the palms and soles, rib anomalies, numerous nevi and nodes predominantly present on his face, chest and back. Histopathological study confirms the presence of multiple keratocysts in the jaws and the absence of basal cell carcinoma of the skin. Immunohistochemical study showed negatively p53 staining result. Early diagnosis and treatment is important to prevent long term sequelae including malignancy and oromaxillofacial deformation and destruction.

Osseous metaplasia of the endometrium is an uncommon clinical and pathological disorder. It is a very rare cause of infertility and induced by abortion. Hysteroscopic examination revealed multiple bony specules and a resectoscopic excision of the bony specules was performed. Histopathological examination reveals bony trabeculae adjacent to the endometrial glands & stroma.

Case presentation: 34-year-old woman with osseous metaplasia of the endometrium is described, in which the diagnosis was suspected clinically and confirmed histopathologically. The clinical, pathogenesis and pathological features are briefly reviewed.