Vol 15, No 1 (2011)

Background and objectives: The aim of this study was to measure the rate of a typical cases of pityriasis rosea among dermatological visit and to outline the various clinical presentations of a typical pityriasis rosea disease.

Methods: This descriptive study was conducted for a period extended from October 2007 through June 2008. 88 patients who diagnosed to have pityriasis rosea were enrolled in this study. The diagnosis was based on history and clinical examination; questionnaire was designed to provide relative data and all patients’ data were recorded at time of diagnosis. Investigations in certain cases were done to aid in the diagnosis.

Results: A typical pityriasis rosea was found in 38.5% patients. Absence of herald patch in 17% of patients, papular rosea in 8%, inverse pityriasis rosea in 6.8%, localized pityriasis rosea in 4.5%, unilateral/inverse in 1.1% and urticarial in 1.1% of patients

Conclusion: A typical pityriasis rosea is not uncommon and different forms of a typical pityriasis rosea exist. Investigations are sometimes needed to confirm the diagnosis.

Background and objectives: Thyrotoxicosis is a common and serious world-wide health problem, it’s one of the common problems in Erbil governorate.

Methods: Clinical analysis done for 675 patients proved to have thyrotoxicosis by thyroid function tests.

Results: Hyperthyroidism in females were 4 times more common than in males, the mean age was around 44 years, graves disease being the most common cause, followed by multinodular goiter, Iodine-induced thyrotoxicosis , single nodule goiter, T3-Thyrotoxicosis, then finally auto-immune lymphocytic thyroditis. Weight loss was the most common feature, followed by other well known features of autonomic hyperactivity, tremor was the most common sign reported while periodic paralysis was the least common sign.

Conclusion: Graves disease is the commonest cause of thyrotoxicosis. Iodinization of salt program resulted in transient increase and later on decrease of thyrotoxicosis in the region.

Background and objectives: Hyperlipidaemia is raised serum levels of one or more of total cholesterol, low-density lipoprotein and triglycerides. Many drugs have been used for the treatment of this disorder. This work compares the effects of atorvastatin with or without ezetimibe on lipid profile, atherogenic index and serum alanine aminotransferase.

Methods: This study covers 90 subjects, 60 untreated hyperlipidemic patients, and 30 healthy subjects. Patients were divided into 2 groups, the first group included 30 patients treated with atorvastatin 20 mg/day alone, the second group included 30 patients treated with a combination of 2 drugs (atorvastatin 10 mg plus ezetimibe 10 mg) taken daily at night. Serum lipid profile, atherogenic index and serum alanine amniotransferase were measured after 12 hours fasting for the patients in 3 intervals: before, and after 8 weeks and 16 weeks of treatment.

Results: After therapy for both groups of patients, as compared to the levels before treatment, has shown that serum total cholesterol, triglycerides, low density lipoprotein cholesterol and very low density lipoprotein cholesterol were significantly reduced while high density lipoprotein cholesterol was significantly increased. Serum alanine aminotransferase increased by both groups of treatment with no significant difference between the two modes of treatment which has the same findings in comparison to the control group.

Conclusion: Combination of atorvastatin 10 mg and ezetimibe 10 mg daily, is more effective than atorvastatin 20 mg taken alone.

Background and objectives: Left ventricular systolic dysfunction complicating acute myocardial infarction are responsible for significant morbidity and mortality. This study to assess the effect of thrombolytic therapy on the left ventricular systolic function during the first week and a year after ST- elevation myocardial infarction.

Methods: In a study of 56 patients with first ST-Segment elevation myocardial infarction (42 men and 14 women; age range, 42-89 years (mean, 61 ± 10), who had been admitted to the Coronary Care Unit at Hawler Teaching Hospital from May 2008 to May 2009. study done to assess the left ventricular systolic function during the first week and first year after ST-elevation myocardial infarction.

Twenty one patients received tissue plasminogen activator (Alteplase) 12 hour after the onset of symptoms labeled as group-I, the remaining patients (35), had no chance to receive thrombolytic therapy labeled as group II.

Results: In group I the mean ejection fraction improved significantly from 51.6±9.4 during the first week to 55.14±11, P=0.034, at first year after acute myocardial infarction, while in group II there was no significant difference of mean ejection fraction during the first week (45.97±12.2) and first year of acute myocardial infarction (46.1±13.2),P=0.5.

Conclusions: Thrombolytic therapy has a beneficial effect on left ventricular systolic function detected by echocardiography at the end of the first year of ST-elevation myocardial infarction

Background and objectives: We have evaluated and compared the efficacy of Botox® in the treatment of bladder over activity in Idiopathic detrusor over activity (IDO) and Neuropathic detrusor over activity (NDO) in a tertiary centre. We hypothesised that the outcome of this less invasive treatment would be more promising in patients with IDO than those with NDO.

Methods: A total of 229 patients were reviewed with overactive bladder proven by urodynamic studies over the last 2 years. Of these, 174 patients received Botox® injection. 132 (75%) patients had IDO and 42 (25%) patients had NDO. 200 IU of Botox® was injected per patient in the IDO group and 300 IU in the neurogenic group.

Results: Eighty one of 118 (68.7%) known patients with IDO reported being dry after receiving the Botox® compared to 20/39 (51.3%) patients with NDO. Whereas, 88/118 (68.7%) patients with IDO reported significant satisfaction compared to 25/39 (64.1%) patients with NDO.

Conclusion: Botox® is an effective, minimally invasive treatment for drug refractory IDO + NDO. In comparison, patient reported satisfaction and dryness with the procedure was statistically the same. However, the IDO group responded slightly better to treatment. The average mean effect was the same in both groups.

Background and objectives: Diabetes mellitus is a common and demanding health problem that has a great effect on everyday life of patients. This study was done to determine sociodemographic and clinical characteristics that affect the quality of life (QOL) of diabetic patients.

Methods: A total of 300 patients with diabetes mellitus in Erbil city were included in this study. The World Health Organization Quality of Life (WHOQOL-100) questionnaire was applied for assessment of 6 domains of QOL using multiple regression analysis.

Results: Type of work and body weight were the most significant factors shown to affect diabetic patients QOL domains. Type of work was significantly affecting physical (P=0.006), psychological (0.004), level of independence (P<0.001) environmental (P=0.007) and spiritual (P=0.009) QOL domains. Duration of diabetes was significantly affecting physical (P=0.002), psychological (P=0.037) and level of independence (P<0.001) domains. Body weight was significantly affecting physical (P=0.039), psychological (P=0.012), level of independence (P=0.036), social relationships (P=0.022) and spiritual (P=0.030) QOL domains.

Conclusion: QOL had a variable significant association with certain socio-demographic and clinical characteristics of diabetics. There should be an emphasis on improving QOL of diabetics and consequently achieving better metabolic control.

Background and objectives: The aim was to study the distribution of traumatic dental injuries in the permanent anterior teeth among 7-12 years old children treated in the Department of Pediatric Dentistry/ College of Dentistry at Hawler Medical University, Erbil, Iraq.

Methods: In this retrospective clinical study the case records of 1868 patients were reviewed and only patients with traumatic dental injuries were included. Type of tooth injury was classified according to modified Ellis and Davey¹² crown fracture. Data on age, gender, number of injured teeth and type of injury were also collected from the dental records for the period 2007-2009.

Results: Records of 1868 examined children showed that the prevalence of traumatic dental injury was 4.5% (84). Of those 84 patients, 60.7 %( 51) were boys and 39.3 %     ( 33) were girls with male/female ratio 1.55: 1. The highest frequency of tooth injuries occurred among 9-10 years old children. Single tooth injury was found in 84.5% of the cases, while 15.5% had two teeth injury. Traumatic injuries affecting teeth in the upper jaw were more frequent. The most frequent injuries were class II crown fracture (47.4%), followed by class III (40.2%), class IV (11.4%) and class I (1%) respectively.

Conclusion: The prevalence of dental trauma is relatively low. More attention should be paid to preventive measures, which includes wearing mouthguards, especially in the early stages of psychophysical growth of male population.

Backgrounds and objectives: The ectoparasite Polyplax spinulosa (Class: Isecta; Sub-Order: Anoplura; Familiy: Polyplacidae) was found to act as a biological vector of some pathogenic virus, bacteria and protozoa. The main objective of the present study was to identify the P. spinulosa parasitizing laboratory rats in two different animal houses (Science College-Salahaddin University and Medicine College-Hawler Medical University) and the effect of washing with different detergent agents on the mean intensity and numbers of the Polyplax spinulosa.

Methods: In a study from the beginning of February to July 2010, thirty (30) adult Albino rats (15 rats from each Science and Medicine Colleges) randomly were collected from two selected animal houses of two universities in Erbil City. The fur was gently examined and scraped off using a fine brush; hair particles and ectoparasites that dropped off were transferred to a petridish, and examined using magnifying lenses and dissecting microscope before and after washing with two different agents. The ectoparasites collected in small vials were fixed in 70% ethanol.

Results: The overall prevalence with the P. spinulosa was 80%, the higher rate of infestation (100%) and mean intensity (13.33) was among rats of Science College, while the lower rate (60%) and mean intensity (4) was among rats of Medicine College. The present study showed that Cis-Cypermethrin has greater role than Cyprimidine in declining the rate of infestation with this ectoparasite.

Conclusion: The overall prevalence with the P. Spinulosa was 80%, The higher rate of infestation was among rats of Science College. Cis-Cypermethrin has a role in declining the rate of infestation with this ectoparasite.

Background and objectives: Data indicated that procyanidins extracted from grape seeds has uric acid-lowering effects in mice, however the hypouricaemic effect of procyanidins was accompanied with changes in enzymatic activities of xanthine dehydrogenase and xanthine oxidase. This study was designed to investigate the effect of procyanidins extracted from Crataegus monogyna on serum uric acid, adenosine deaminase (ADA), 5-nucleotidase, xanthine oxidase, and renal function on normal and potassium oxonate induced hyperuricemic rats.

Methods: Thirty female albino rats were divided into three groups. The first group included 18 rats pretreated with the uricase inhibitor potassium oxonate (250 mg/kg, i.p.), served as an animal model for hyperuricemia. The rat models were divided into three subgroups, each subgroup having six rats. The first subgroup served as a normal control. Subgroup 2 received a single daily dose (100 mg/kg p.o) of procyanidins for 7 days. The third subgroup received daily dose (50 mg/kg p.o) of allopurinol for 7 days as positive control. The second group included six rats received only water as a vehicle. The serum uric acid, xanthine oxidase, adenosine deaminase (ADA) and 5-nucleotidase levels were measured and compared to those in normal untreated control group. The Third group included six normal rats received a single dose of Procyanidins (50 mg/kg body weight; i.v.) to study the renal effects of procyanidins..

Results: A single daily dose (100 mg/kg PO) of procyanidins for 7 days significantly reduced serum levels of uric acid, ADA and 5’-nucleotidase, without detectable effects on the level of xanthine oxidase in hyperuricemic rats. Intravenous infusion of a single dose of procyanidins (50 mg/kg i.v) produced marked increases in urinary Na⁺ excretion (4.8 folds) and urine flow (2.6 folds) accompanied by insignificant change of potassium excretion in the rats.

Conclusion: The reduction in serum uric acid most probably is due to inhibiting enzymes, ADA and 5-nucleotidase. The antihyperuricemic and diuretic effects of procyanidins recommended it as a good drug for the treatment of gout and renal uric acid calculi.

Backgrounds and objectives: Myocardial infarction (MI) usually occurs when coronary blood flow decreases abruptly after a thrombotic occlusion of a coronary artery previously affected by atherosclerosis. Sialic acid (SA) is attached to non reducing residues of the carbohydrate chains of glycoproteins and glycolipids. An elevation in seru TSA, LBSA and PBSA concentrations has been observed in a number of pathological conditions .The aim of the study was to determine the serum TSA and its LBSA and PBSA in patients with acute myocardial infarction (AMI).

Methods: Serum TSA, LBSA and PBSA concentrations were evaluated by UV/VIS spectrophotometry in (100) apparently healthy individuals and (100) newly diagnosed AMI patients.

Results: The mean levels of serum TSA, LBSA and PBSA in AMI patients were significantly higher (P< 0.5) than those of apparently healthy individuals.

Conclusion: The results indicate that the serum values of TSA, LBSA and PBSA appeared to be of a value in diagnosis of AMI.

Background and objectives: This study was designed to evaluate the clinical status of implants placed immediately in lifted maxillary sinus using Resorbable Tissue Replacement (R.T.R.) cone bone substitutes.

Methods: Twenty implants were placed in twenty patients in the period between Jan. 2006 and Sept. 2010. Lateral approach, open window method for sinus lift with placement of Resorbable Tissue Replacement Cone bone substitutes were carried out. A 4-6 mm of the bone level was required in the alveolar ridge for primary stability, with sufficient inter-arch space for the prosthesis. All implants were placed in upper molar region simultaneously with sinus lift procedure in conjunction with Tissue Replacement Cone bone substitutes. The implant survival was defined when the prosthesis had been delivered and followed for two years without infection, pain, and mobility after loading.

Results: Twenty patients, 13 males and 7 females, with an average age of 41 years old were participated in this study. A total of twenty implants were followed up for two years. Eighteen patients with eighteen implants (90.0%) showed no signs of sinusitis or other complications and the peri-implant health judged to be good with a peri-implant sulcus depth of 2-3mm. Two implants (10%) showed mobility before loading.

Conclusion: A good survival rate was observed in implants placed immediately in lifted maxillary sinus using Resorbable Tissue Replacement (R.T.R.) cone bone substitutes.

Background and objectives: This study was designed mainly to determine fasting serum insulin level and other parameters related to obesity, since Type II diabetes mellitus is the most prevalent problem associated with obesity. In Kurdish region, no previous studies about insulin essay in overweight and obese individuals have been executed. Measuring insulin level in overweight and obese individuals can give information about the body's sensitivity to insulin.

Methods: Fasting blood samples were derived from (60) overweight individuals (30 males + 30 females) and from (30) normal weight individuals and were analyzed for insulin level by using an immuno assay method (ELISA method) whereas fasting blood glucose, Triglyceride(TG), Total Cholesterol(TC). High Density Lipoprotein(HDL), were estimated spectrophotometrically.

Results: From total (60) overweight individuals 76.6% have insulin resistance. From this percent about 52% of those individuals were with family history of diabetes and 24% were with family history of obesity.

Conclusion: Three relatively simple metabolic markers can identify overweight and obese individuals who are sufficiently insulin resistant to be at increased risk for various adverse outcomes are (TG level, ratio of TG to HDL, and insulin level).