Vol 21, No 3 (2017)

Background and objective: There is no universal agreement on how one should harvest, process, or inject fat. The objectives of this study were to evaluate our integrated fat grafting technique, reporting our long term result in 189 patients who underwent autologous fat graft for facial rejuvenation.

Methods: The lower abdomen or thigh was chosen as the donor site for fat graft harvesting under low pressure with 10 cc syringe, processed with low speed centrifugation, and then injected into the face using blunt tip 1 mm cannula in multiple points, using multiple passes, into multiple tissue planes. A total of 189 patients were injected with the above technique for facial rejuvenation. The results were evaluated clinically and photographically and followed for up to five years. Data were analyzed using the statistical package for the social sciences.  

Results: Fat absorption leading to volume loss was the commonest minor complication reported in 51 cases (27%). No major complications were reported in this series. About 70% of the patients in this series were highly satisfied after first fat grafting. The main cause of dissatisfaction was the volume loss due to fat absorption which necessitated secondary fat grafting.

Conclusion: Our fat grafting technique emphasizes maintaining the viability of transferred fat grafts during their harvest, purification and placement with a good long-term result.

Background and objective: Acetal resin or polyoxymethylene is a flexible thermoplastic radiolucent denture base material. This study aimed to evaluate the addition of barium sulfate BaSO₄ nanoparticles on the mechanical and physical properties of acetal resin. 

Methods: Forty two specimens were prepared from both non-modified and modified acetal resin. The tested specimens were obtained by melt extrusion into the mold equipment followed by injection molding. The radio-opacity of non-modified and modified evaluated, and then some mechanical and physical properties tested.

Results: The results of radio-opacity test showed that the radiographic density of BaSO₄ 3% Acetal resin specimens was at the same level of 2mm thickness of the aluminum stepwedge. Non-significant decrease noted in surface roughness, creep in all strain regions, and compressive strength and modulus of elasticity.

Conclusion: It has been concluded that the addition of 3% BaSO₄ nanoparticles produced an acceptable radio-opaque Acetal resin denture base material. Although the addition caused some changes in properties, the modified Acetal resin remained as a flexible thermoplastic material.

Background and objective: Little is known about the status of redox balance and hypertensive nondiabetic and diabetic nonhypertensive metabolic syndrome patients and its relation to metabolic syndrome components in both pathological conditions. This study aimed to assess the association of redox balance with components of metabolic syndrome in "diabetic and hypertensive, metabolic syndrome" patients to find out which pathology can give a powerful evidence for a possible association with oxidative stress.

Methods: The total oxidative capacity, total antioxidant capacity, lipid profile and fasting serum glucose were measured in serum of 35 healthy subjects, 33 hypertensive nondiabetic and 21 diabetic nonhypertensive, metabolic syndrome patients. The body mass index and waist circumference were also measured. All groups were age and gender matched.

Results: In stratified groups, the highly significant total oxidative capacity, total antioxidant capacity and oxidative stress index were shown in diabetic and hypertensive groups respectively compared with healthy control group, with no significant effect for diabetes on total oxidative capacity and oxidative stress index compared to hypertension condition.

Conclusion: Although the presence of significant higher total oxidative capacity in both study pathologies compared to healthy control, however among metabolic syndrome patients neither hypertension nor diabetes mellitus achieved more dominant to total oxidative capacity. 

Background and objective: Involvement of lymph nodes is an important prognostic factor in most cancers, including colorectal cancer in which lymph node status is the strongest pathologic predictor of patient outcome. This study aimed to find any relationship between lymph node metastasis and associated clinicopathologic variables in colorectal carcinoma.

Methods: In this retrospective study, 136 cases of colorectal cancer were reviewed from Rizgary Teaching Hospital and some private labs in Erbil, Kurdistan region, Iraq during the period between August 2010 and December 2015. All cases were surgically treated with total colectomy or hemi colectomy.

Results: A total of 136 cases of colorectal cancer were included in this study; 53% presented with one or more lymph node metastasis, 47% were between 40 and 60 years of age and 68% were male. There was no statistically significant relationship between lymph node status and any of the studied clinicopathologic variables. 

Conclusion: In colorectal adenocarcinoma, there was no statistically significant correlation between lymph node involvement and any of the studied clinicopathologic variables including tumor size, anatomic location, differentiation and histologic type, depth of invasion or patient gender and age.

Background and objective: Gingival recession is the apical migration of the gingival margin from its normal position on the crown of the tooth to the root apically beyond the cemento-enamel junction which can cause major functional and esthetical problems. It has been clinically related to higher incidence of root caries, attachment loss, hypersensitivity and esthetic related problems. The goal of this study was to evaluate the effective of a modification of surgical procedure to laterally repositioned flap for coverage of isolated recession.

Methods: A total of 25 patients with miller class II gingival recession attended the Department of Periodontology in the College of Dentistry, Hawler Medical University for treatment of their problem. Their gingival recession about 2 to 5mm in the lower anterior teeth with shallow vestibule. After full preparation of patient which include scaling and polishing and root planning the laterally displaced revised flap technique were done. Patients were followed up in 2 week and 3 month interval to see the changes after treatment during this period. These parameter were taken pocket depth, clinical attachment loss and gingival recession which can be measured by the distance from CEJ to the base of pocket.

Result: In the recipient side, the mean gingival recession was about 3.2 mm at base line, after 2 weeks the mean gingival recession became 0.6mm and after 3 months it became 0.38mm. In the donor side, the mean gingival recession was 0 mm at base line. After 2 weeks the mean gingival recession became 1.05mm and after 3 months it became 0.5mm.

Conclusion: It can be concluded that laterally displaced revised flap technique in localized recession defects can be used to restore the esthetic and functional properties of labial gingiva of teeth by repairing gingival defect.

Background and objective: Cerebrovascular diseases are attacks of sudden neurological deficits (motor, sensory or cerebellar). There are a lot of risk factors for stroke like age, diabetes, hypertension, smoking, hyperlipidemia, cardiac diseases and others. This study aimed to show if there is increasing rate of cerebrovascular events during Ramadan in   relation to fasting in our city during the summer season.

Methods: This case-control study was carried out in Rizgary Teaching Hospital, Erbil- Iraq from 1^st of August to 30^th of August 2011. Patients were included in this study if they were middle aged and elderly patients having clinical and radiological features of stroke, another group of in-patients was selected as a control group. Chi square test and logistic regression analyses were used to show the association between stroke and fasting.

Results: A sample of 60 patients and 60 control cases were included in this study. Fasting was significant risk factor for stroke in our studied sample, 66.7% of the cases were fasting compared with 40% of the control group (P = 0.03). Hyperlipidemia and history of ischemic heart disease found also to be associated with stroke (P = 0.017 and 0.011, respectively). Logistic regression analysis showed that only fasting and hypercholesterolemia were independent risks factors in causing stroke in our studied sample.

Conclusion: In Erbil, where the summer is too hot and the daytime (fasting hours) is long, fasting during Ramadan was found to be an independent risk factor for stroke, and specifically ischemic stroke.

Background and objective: Extraction of an impacted mandibular third lower molar tooth is one of the common surgical procedures that may lead to the damage of inferior alveolar nerve due to roots proximity to the mandibular canal. This study aimed to know the relative relationship and proximity of the mandibular third molar roots to the inferior alveolar canal in relation to gender, age, depth of impaction, relation with ramus, and type of angulation of the impacted tooth in Kurdistan population.

Methods: A sample of 366 digital panoramic radiographs of patients with impacted mandibular third molar was studied. Panoramic radiographic signs images were evaluated for the presence of root contact with the superior border of the mandibular canal, darkening of the roots apex, deflected roots, narrow root, superimposition of the canal, interruption of the white line, diversion of the inferior alveolar canal, and narrowing of the inferior alveolar canal. The depths of impaction, relation with ramus, and type of angulation were also studied.

Results: Significant relation of the proximity of the mandibular third molar roots to the inferior alveolar canal with the gender (P = 0.001) and age (P <0.001) were seen. A significant relation of the proximity of the mandibular third molar roots to the inferior alveolar canal with the depth of impaction (P <0.001), relation with the ramus (P =0.004), and angulation of impaction were also seen (P <0.001).

Conclusion: Significant relation of the proximity of the mandibular third molar roots to the inferior alveolar canal with gender, age, depth of impaction, relation with the ramus, and angulation of impaction were seen.

Background and objective: There is evidence that the procalcitonin levels are usually correlated with the high sensitivity C-reactive protein levels in inflammatory conditions. Therefore, this study aimed to assess the simultaneous changes of the procalcitonin and hs-CRP levels in the diabetic foot syndrome complicated type 1 and 2 diabetes.

Method: This observational study was carried in the Center of Diabetes Mellitus in Erbil, Iraq from 1^st January to the 30^th September 2015. A total number of 170 participants were enrolled in this study. They grouped into Group I (healthy subjects, n=30), Group II (type 1 diabetes with diabetic foot syndrome, n=70) and Group III (type 2 diabetes with diabetic foot syndrome, n=70). The anthropometric measurements, blood pressure, fasting serum glucose and lipid profile, and the inflammatory markers included high sensitivity C-reactive protein and procalcitonin were determined.

Results: Group III patients had a significant longer duration and score of diabetic foot syndrome, higher anthropometric measurements, higher blood pressure and fasting lipid profile levels compared with Group II. Serum procalcitonin and high sensitivity C-reactive protein levels were significantly higher in diabetic patients compared with Group I subjects. The serum levels of procalcitonin and high sensitivity C-reactive protein of Group III patients (1.11±0.47 ng/ml; 12.48±2.57 mg/L) were significantly higher than corresponding values of Group II patients (0.334±0.094 ng/ml; 5.73±0.89 mg/L). A non-significant correlation between procalcitonin with high sensitivity C-reactive protein in Group II and III was observed.

Conclusion: We conclude that the simultaneous measurements of high sensitivity C-reactive protein and procalcitonin as inflammatory biomarkers are not necessary because the correlation was not significant.

Background and objective: Entrance skin dose is the value of the radiation absorbed dose by the skin where the X-ray beam enters the patients. Assessment of entrance skin doses, specifically for pediatric radiology, is very crucial as the children are dividing cells rapidly and are more sensitive to radiation than adults. Their cells can be easily damaged by excessive radiation dose. This study is considered as an attempt to evaluate the effects of diagnostic X-ray on pediatric patients throughout measuring the entrance skin doses and hematological parameters for pediatric patients. Ways of protecting themselves from X-ray hazards is also included.

Methods: A case-control study was used to collecting the data for 70 pediatric patients from October 2015 to August 2016 at Radiology Departments of five governmental hospitals throughout Hawler city the capital of Kurdistan Region- Iraq. Pediatric patients aged between (1 day - 6 years) they were divided into case and control group by which 40 of them had got diagnostic X-ray examination as (case group) and 30 of them had not had past history of taking X-rays as (control group). Entrance skin dose was measured indirectly via parameters such as a focus on skin distance, tube voltage (KV) and tube current (mAs) in an arithmetical equation.

Results: High level of entrance skin doses were received by pediatric patients in this study. Also, it was found that diagnostic X-ray has effects on pediatrics white blood cells and platelets with the significant difference between case and control group and p-values (< 0.001 and 0.006) respectively.

Conclusion: Entrance skin doses levels received by pediatric patients in this study was higher than other studies level and then pediatric patients will be at risk if they are exposed to unnecessary exposure to ionizing radiation. It is important to focus on improving pediatric radiography for reducing the hazards of X-ray radiation on pediatric patients.

Background and objective: The close proximity of lingual nerve in relation to the lingual cortical bone of the posterior mandibular third molar is clinically important because lingual nerve may be subjected to trauma during surgical removal of the impacted lower third molar. This prospective study aimed to evaluate the incidence of lingual nerve paresthesia following surgical removal of mandibular third molar in College of Dentistry, Hawler Medical University.

Methods: A total of 116 third molars surgery were carried out under local anesthesia for 116 patients for removal of lower mandibular teeth Using Terence Ward's incision made in all cases, and after that, the buccal flap was reflected, lingual tissues had been retracted during bone removal with a periosteal elevator. The sensory disturbance was evaluated on the 7th postoperative day by standard questioning the patients: “Do you have any unusual feeling in your tongue, lingual gingiva and mucosa of the floor of the mouth?"

Results: One patient experienced sensory disturbance, the lingual nerve paresthesia incidence was 0.9% as a transient sensory disturbance, while no patient of permanent sensory disturbance.

Conclusion: The incidence of injury to the lingual nerve can be minimized by careful clinical evaluation, surgeon’s experience, surgical approach and knowledge about anatomical landmarks during surgical removal of an impacted lower third molar tooth.

Background and objective: The detection and investigation of methicillin resistance staphylococci specifically S. aureus in clinical microbiology setting is very helpful both for informing the appropriate treatment of individual patients and also for the surveillance of these organisms. This study aimed at the rapid molecular detection of methicillin resistant staphylococci harbouring β-lactamase gene and determination of the efficiency of m-PCR through comparison with uniplex PCR.

Methods: Standard microbiological techniques were applied for the determination of the presence of methicillin resistant S. aureus in samples recovered from different body sites of patients who attended Al-Kadhumyhia Teaching and Baghdad Teaching Hospitals. The resulting methicillin resistant S. aureus (MRSA) isolates were subjected to uni and multiplex PCR amplifications for detecting the existence of mec A gene and β-lactamase (TEM) resistance gene.

Results: Half of the cases involved were found to be caused by MRSA. All the tested isolates showed positive amplification bands for the presence of mec A gene and only 48.8% of these harbored TEM gene. The obtained results revealed high sensitivity of universal bacterial and TEM primers expressed as 97.6% and 100% respectively, while the sensitivity of mec A primer was limited to 60%.

Conclusion: The phenotypic identification of MRSA revealed a higher incidence rate and that different molecular techniques can yield conflicting results and it can also be concluded that resistant due to beta- lactamase production can be a crucial factor added to the previously settled methicillin resistant due to mec A gene.

Background and objective: Unwanted and expired medications are accumulated at the homes and the community Pharmacies due to many reasons. Improper disposal and its hazardous impact on the environment is one of the major issues. This study aimed to identify the currently followed methods of disposing expired/unused medications at the homes and the community pharmacies and to report the response of the pharmacists regarding disposal of medications in Sulaimani city.

Methods: This study was carried out between July 2015 and February 2016. A total of 145 houses and 62 pharmacies were observed utilizing a self-administered questionnaire. All expired/unwanted drugs were quantitatively analyzed.

Results: The results revealed that 95.2% of respondents throw away their unwanted pharmaceuticals in the garbage. Around 41% of respondents showed their awareness of the potential harm to the environment by improper disposal of medication while 59.3% were unaware. Most participants (91%) believed that returning expired/unused medications to a community pharmacy is a proper way for disposal of them. Around 39% of the community pharmacies throw away the expired medications in the garbage, while 46.8% of them returned them to the suppliers. Additionally, 58.1% of the community pharmacists agreed to use their workplace as a collection point for collecting expired/unused medications.

Conclusion: High amount of expired/unused medications were kept in the households that necessitate establishing a procedure for disposal that ensures safety to human and environment. There was good interest in the collection of unused medications for proper disposal in the community pharmacies.

Background and objective: Suicide is a common problem worldwide; the suicidal ideation is a predictor of suicide. This study aimed to shed light on the demographic as well as clinical risk factors for suicidal ideation among depressed outpatients.

Methods: A total of 100 depressed patients who visited the psychiatric outpatient department of Hawler Teaching Hospital from August 2015 to January 2016 were assessed for the suicidal ideation and risk factors of suicidal ideation by adopting standardized diagnostic and symptoms rating scales.

Results: Suicidal ideation was present in 64% of patients; significant predictors for suicidal ideations were previous suicide attempt, the severity of depression and hopelessness.

Conclusion: Suicidal ideation is highly prevalent among psychiatric outpatients with major depression. Those patients discovered to have risk factors are in great need of help to prevent future suicide.

Background and objective: As diabetes mellitus a common health problem, it is well known that it can lead to optic neuropathy that affects the optic nerve functions. It is important to monitor the effect of this metabolic disease on the optic nerve that can lead ultimately to decrease visual acuity that can be irreversible. This study aimed to find out the prevalence of diabetic optic nerve diseases and to evaluate the patient characteristics and fundus findings.

Methods: Screening examination was done for 2213 patients with type 2 diabetic patients presented to the diabetic center from October 2007 to September 2009. The examination includes visual acuity test using conventional E chart, slit lamp exam, followed by installing short acting Mydriatics (tropicamide 1%) eye drops for fundoscopy examination using +76.D or +90 D.

Results: Eighty eight patients (approximately 4%) had optic nerve problems; 50 females and 38 males. The mean age was 59 years. A total of 58 (116 eyes) patients were bilaterally affected, 42 patients with optic papillopathy, 8 patients with anterior ischemic optic neuropathy and profound loss of vision, 8 with glaucomatous cupping and pallor and 30 patients with end stage optic atrophy. A total of 63 (71.5%) patients had poor metabolic control.

Conclusions: Patients with type 2 diabetes mellitus have 4% prevalence of diabetic optic neuropathy.

Background and objective: Depressive symptoms are present in several psychiatric disorders, the ones most commonly seen in patients with cancer, especially more common in those who are at the end of life. This study aimed to assess the severity of depression and association between socio-demographic data with the severity of depression among Cancer Patients in Nanakaly Hospital, Erbil City.

Methods: A cross-sectional study was conducted on 100 cancer patients of both genders in Nanakaly Hospital, Erbil city, Iraq, from February 22^nd, 2016 to April 27^th, 2016. A questionnaire was designed for the study; it contained two parts. Part one consisted of socio-demographic characteristics such as age, gender, level of education, occupation, marital status, economic status, religion and residential area of the patients. Part two consisted of Beck depression rating inventory. Data were collected through interviews with patients. Frequency, percentages and Chi-square tests were used for interpretation of data.

Results: The mean age (±SD) was 49.54 (±16.66) years. Each of males and females represented 50% of the sample. Most of the participants were married (75%), illiterate (35%), Muslims (94%), housewives (38%), had somehow sufficient income (40%) and from rural areas (84%). Majority of the studied sample (79%) suffered from moderate depression level, while only (21%) of them suffered from severe depression. There was no significant association between the level of depression and the socio-demographic characteristics of the patients and the medical status as well.

Conclusion: The study concluded that most of the cancer patients have depression symptoms.

Background and objectives: Lymphoproliferative neoplasms are among the commonest human neoplasia. Immune dysregulation is frequently associated with many of these diseases, particularly those related to B-cell origin. This study aimed to find out the immunological status of newly diagnosed patients with lymphoproliferative disorders.

Methods: This study was carried out in Erbil province during the period from November 2010 to April 2011. Fifty two newly diagnosed patients (34 males and 18 females) with lymphoproliferative disorders referred to Nnakaly Hospital for blood disease and 20 healthy control subjects had been included in this study. Determination of immunoglobulin subclasses by radial immunodiffusion in addition serum protein electrophoresis has been performed for each sample for the detection of monoclonal bands.

Results: Serum IgM and IgA level were decreased in all groups of patients with different lymphoproliferative disorders compared to control group. Serum IgG level showed insignificant reduction in acute lymphocytic leukemia and chronic lymphocytic leukemia patients, but it was increased in non Hodgkin lymphoma, Hodgkin lymphoma and multiple myeloma patients. Paraproteinemia had been seen in all patients with multiple myeloma while only 10% of chronic lymphocytic leukemia and non Hodgkin lymphoma showed paraproteinemia. No M-band had been noticed in acute lymphocytic leukemia and Hodgkin lymphoma.

Conclusion: There were some conflicting data regarding serum immunoglobulin levels in newly diagnosed patients with lymphoproliferative disorders in Erbil, Iraq.

Background and objective: Miscarriage represents a common problem that occurs in the first trimester of pregnancy. There is no general agreement on the value of submitting tissues from uterine evacuation in cases of miscarriage for histopathological examination. This study aimed to evaluate the role of histopathological examination in cases of first-trimester miscarriage.

Methods: This is a descriptive study was carried out over a period of 14 months, from January 2015 to March 2016, at Erbil Maternity Hospital. A total of 375 biopsies from patients admitted to maternity hospital with the diagnosis of the first trimester miscarriage and cases of spontaneous miscarriage were included in this study. The clinical data including age, parity, gestational age, clinical diagnosis, the method of evacuation, and other relevant information were collected and submitted for histopathological examination.

Results: Incomplete miscarriage was the commonest type of miscarriage and constituted 65.3% of the studied group and surgical evacuation was the most common method of termination. The histopathology reports confirmed the pregnancy in all patients and revealed retained product of normal pregnancy in 315 (86.6%) cases, partial mole in 15 (4%) patients, complete hydatidiform mole in one (0.2%) case, decidual reaction in 21 (5.6%) cases and no product of conception in 13 (3.4%) cases.

Conclusion: Histopathological examination of the products of conception is an important method in detecting undiagnosed molar pregnancy that needs special follow-up and further management.

Background and objective: Nursing caries is a complex and severe form of tooth decay that affects a child’s teeth and leads to severe pain, teeth loss, and psychological problems. This type of decay is caused by primary factors (host, cariogenic bacteria, fermentable carbohydrate and the time) and other secondary factors. Besides, the dental caries influence by the role of saliva as a defense system. These defense systems include clearance, buffering, antimicrobial agents, and calcium and phosphate delivery for remineralization. This study aimed to find out the relationship between calcium, inorganic phosphorus and alkaline phosphatase of unstimulated saliva in children with nursing caries.

Methods: The sample included 374 children aged 4-6 years; 324 were the study group (with nursing caries) while 50 were control group (caries-free). The case sheet and questionnaire included the child's feeding habits and oral hygiene. A 1.5-2 ml of saliva was collected from the selected children using spitting technique. The method included dental examination for the recording of the dmft and dmfs indices, and saliva analysis to determine the level of salivary calcium, phosphorus and alkaline phosphatase in control and study groups. 

Results: The study group children demonstrated a statistically highly significant (P ≤0.01) higher saliva calcium (5.229 ± 0.963 mg/dl) and alkaline phosphatase concentrations (6.321 ± 1.792 KAU/dl) than the control group (4.968± 0.757mg/dl, 5.384 ± 2.119 KAU/dl), respectively. The same group demonstrated a statistically highly significant (P ≤0.01) lower inorganic phosphorus concentration (10.991 ± 1.376 mg/dl) than the control group (11.961 ± 1.484 mg/dl). The study group showed a lower percentage of breastfeeding (28.4%) in comparison to the control group (42.0%). Concerning mix-feeding, the study group showed the higher percentage (45.4%) in comparison to the control group (32.0%). The bottle-fed found to be equal in both groups, there was a statistically non-significant difference between the study and control group.

Conclusion: Salivary calcium and alkaline phosphatase level have a major role in causing nursing caries in children. On the other hand, salivary inorganic phosphorus level showed a negative correlation with caries activity (dmfs). The type of infant feeding has no effect on the children with nursing caries.