Vol 15, No 3 (2011)

Background and objectives: A prospective study performed in Ibn-Albitar hospital a tertiary center to assess the effect of ischemic heart disease on heart rate variability.

Methods: Thirty nine consecutive patients all with history of chronic stable angina &with positive treadmill test underwent 24 hours holter test to assess heart rate variability. Compared it with 25 age & sex matched control volunteer group.

Results: Thirty one (79.48%) male of patients group& 20 (80%) male of control group . heart rate variability expressed as (SDNN) standard deviation of normal to normal interval, (RMSSD) square root of the mean squared differences of successive normal to normal intervals& (pNN50) the proportion derived by dividing (NN50) the number of interval differences of successive normal to normal intervals greater than 50 milliseconds (ms.) by the total number of normal to normal intervals all were significantly lower in patients group.

Conclusion: This study showed that heart rate variability significantly lower in patients with chronic stable angina.

Background and objectives: The majority of individuals in a population do not     develop tuberculosis, due either to lack of exposure or due to individual characteristics that limit development of the disease after exposure. Evidences suggested that there is an association between lifestyle variables and tuberculosis. The main objective of this study was to study the association between lifestyle characteristics and pulmonary tuberculosis.

Methods: A case-control study was carried out in Erbil city during the period May 10, to December 28, 2009. A convenient sample of 150 cases of TB attending the Consultation Clinic for Chest and Respiratory Diseases was included in the study. A sex and age matched, 150 patients were included in the study as a control group. The control group was taken from patient of the Medical Wards of both Rizgary and Hawler Teaching Hospitals who were free from chest infections and lung cancer. Cases and controls were interviewed using a questionnaire designed by the       researchers.

Results: Around one quarter (24%) of the cases were smokers compared with 14.7 % among the controls. Significant difference of nutritional status between both groups was detected. Controls eat more food and of better quality than cases. No significant association between alcohol drinking, practicing of sports/ exercise and TB was detected.

Conclusion: TB was found to be associated with low nutritional status and smoking.

Background and objectives: Epilepsy is a common neurological disorder and in spite of that, its prevalence was not studied in Hawler city before. The objective of this study is to know the prevalence of epilepsy in Hawler city.

Methods: A house hold survey was carried out in Hawler city, Iraq 4623 persons selected as clustered random   sample of the city population during period of April 2007 to June 2008.

Results: Out of the 4623 persons studied, only 45 patients (23 female and 22 male) were found to be epileptic, with a life time prevalence of 9.7/1000 population. The commonest age group affected was childhood age (1^st and 2^nd decade). This study showed that partial epilepsy was more common than generalized epilepsy. There is no marked difference between genders in the disease pattern (51.1% were females, 48.9% were males).

Conclusion: Epilepsy is a common disorder in Hawler city. There was no significant difference between genders in the disease pattern. In our locality children were more affected with epilepsy than other age groups.

Background and objectives: Several infection are associated with abortion among them toxoplasmosis and cytomegalovirus infection. Toxoplasma gondii causes congenital toxoplasmosis along with HCMV a highly teratogenic virus that interfere emberyogenesis. Both infections are almost asymptomatic thus, diagnosis depends primarily on serological tests namely ELISA to detect antibodies in serum of pregnant women.

Methods: A semi-quantitative Elisa technique is applied for detection of anti-toxoplasma IgG and anti-CMV IgM in sera of 348 pregnant women tested in Rezan Private Lab who have previously experienced abortion.

Results: The seropositivity rates are 29.05% for Toxoplasma-IgG and 45.25% for CMV-IgM. The increasing age is associated with increasing times of abortion (p ≤ 0.0001). Cases with co-infection are more likely to have multiple abortions. The number of abortions is statistically not highly associated with socioeconomic status of pregnant women (p ≥ 0. 1364).

Conclusion: Through this study a plain connection can be figured out between chance of multiple times of abortion and infections caused by CMV and Toxoplasma gondii. Similarly, this association is verified more with increasing age while the socioeconomic status of cases is not indicative for the possibility of multiple miscarriages. All these results are rationally expected and in agreement with most other studies.

Background and objectives: Acute lower respiratory tract infections (ALRI) are the leading cause of morbidity and mortality among children in developing countries. Pulse oxymetry is a simple technique to determine the oxygen saturation. However, the detection of hypoxemia by use of pulse oxymetry is not available in most situations in developing countries; in addition, the availability of supplementary oxygen is inadequate. It is therefore, important to identify hypoxemia accurately in children by using of clinical signs. The objective of this study was to find out the clinical signs and symptoms that predict hypoxemia in acute lower respiratory tract infection.

Methods: A well matched case control study was performed on 120 children from 2 months to 5 years of age admitted with acute lower respiratory tract infections (ALRI) to the emergency department of Raparin Pediatric Teaching Hospital -Erbil, from 1^st January 2009 to 1^st April 2010.Clinical symptoms and signs were recorded .Hypoxemia was defined as oxygen saturation less than 95%. A portable oxymeter was used to measure oxygen saturation with an appropriately sized sensor on the finger or the toe. The reading was taken while the child was breathing room air. The clinical symptoms and signs to predict the presence of hypoxemia were evaluated.

Results: Sixty (50%) children were hypoxemic. The median O₂ saturation was 91.2%with a range of 72-93.8%. Physical signs including intercostal and subtotal retractions, supraclavicular recessions, grunting, nasal flaring, cyanosis, head nodding, were statistically associated with hypoxemia.

Conclusion: None of the clinical features either alone or in combinations has sufficient sensitively and specificity to predict hypoxemia in children with acute lower respiratory tract infections, therefore pulse oxymetry is desirable for identification of hypoxemia.

Background and objectives: Diabetes mellitus is a metabolic disorder, characterized by hyperglycemia. The oxidative stress in diabetes was greatly increased due to prolonged exposure to hyperglycemia and impairment of oxidant /antioxidant equilibrium. Proteins and lipids are among the prime target for oxidative stress. The objective of this study was to find out correlation between lipid peroxidation in terms of malondialdehyde (MDA) and   impairment of antioxidant in terms of vitamin C (Vit C) to severity and complication of type 2 diabetes mellitus.

Methods: We study a total of 163 subjects among them 109 patients were type 2 diabetic patients and remaining 54 subjects were healthy control subjects. Fasting blood samples were collected in Layla Qasm center for diabetes /Hawler city and analyzed for plasma vitamin C, serum MDA, serum lipid profile and serum glucose in the research lab of Clinical Biochemistry College of Medicine/ Hawler.

Results:  Plasma vitamin C levels were significantly decreased in diabetes mellitus (0.48 ± 0.026) mg/dl compared to non- diabetic patients (1.18 ± 0.057) mg/dl. Patients with type 2 diabetes showed a significant increase in serum MDA (1.52 ± 0.04) mmol/L in comparison to non- diabetic patients (0.73 ± 0.026) mml/L.

Conclusion: In this study group, there is significant correlation between lipid peroxide concentration and lipid fractions except vitamin C and HDL-cholesterol.

Background and objectives: determine the causes and types of complete denture fractures.

Methods: The study was performed in the Hawler medical university, college of Dentistry Department of Prosthodontics. The number of fractured complete denture collected was 290 from patients aged 35-80 years of both genders. The (causes of denture fracture, the type of fracture and the history of previous recurrent fractures) were recorded.

Results: : The main cause of denture fracture was poor fitting (40%), followed by poor occlusal relation (21%). Midline fracture was the commonest type of fracture (59%). From the study (51%) of the dentures had previously been repaired once or more. The ratio of lower to upper complete denture fractures was approximately 3:1; most of the fractured dentures (56%) were those of males.

Conclusion: The causes of the fracture were divided into material factors and clinical/ technical factors. Denture fractures can be reduced by following prosthodontic principles, analyzing proper fit, eliminating occlusal interferences and using high impact polymers or metal reinforced.

Background and objectives: Epidermoid cyst of the testis is a very rare benign lesion that accounts for about 1% of all testicular tumors.

Case report: 16-year old male with epidermoid cyst of the testis is described in which the diagnosis was unsuspected clinically and diagnosed histopathologically. The clinical, histogenesis, pathology and management are briefly reviewed.

Background and objectives: to study the diagnostic accuracy of Computed Tomography in evaluation of various etiologies of hemoptysis with normal chest radiographs.

Methods: Two hundred patients with hemoptysis and normal chest radiograph were evaluated with computed tomography from the period of December 2008 to October 2009. The patients were categorized according to the primary etiology and severity of hemoptysis.

Results: of the 200 patients with hemoptysis included in this study, 121 males and79 females.  Majority of patients had mild hemoptysis and pulmonary tuberculosis was the leading cause of hemoptysis( 73.3% .). CT showed diagnostic accuracy of 75%.

Conclusion: computed chest tomography plays an important role in assessing patients with hemoptysis.

Background and objectives: The metabolism of several trace elements has been reported to alter in bronchial asthma and these elements might have specific roles in the pathogenesis and progress of this disease. The aim of the present study was to investigate serum levels of Zinc, Copper, Calcium, Iron and Magnesium in asthmatic children

Patients and Methods: The comparative study includes 56 asthmatic patients and 44 healthy non asthmatic control subjects. The trace elements concentrations were measured by means of an atomic absorption spectrophotometer, results were calculated from the calibration curve obtained by statistical analysis of concentration Vs Absorbance data for elements using fitting of straight line by least square.

Results: Mean(±SD) zinc level was significantly (p<0.01) decreased in asthmatic children (70.6±8.3 μg /dL) compared with controls non asthmatic children (78.3± 9.2 μg /dL),calcium and iron serum concentrations were significantly(p<0.001) higher in asthmatic patient (10.98±2.53 mg/dL, (113.23 ± 45.47 μg/dl) respectively compared with controls (8.23±3.4mg/dL,83.25±29.43 μg /dL) respectively, on the other hand copper level was significantly (p<0.01) higher in asthmatic children (143±20.8μg/dl) in comparison to the control values (130±22.7 μg/dL). Magnesium concentration was significantly lower in comparison to the control values (p<0.01).

Conclusion: The results support that deficiency of Mg, Zn, Cu, Ca and Fe may play a role in the development of asthma

Background and objectives: .The purpose of this study was to evaluate the effect of smear layer removal on apical seal and the quantity of microleakage associated with lateral cold condensation and thermafil obturation.

Methods:  Forty extracted single–rooted human teeth were randomly divided into two experimental groups; in group A, 20 roots with smear layer free, 5.25 % sodium hypochlorite (NaOCl) and 17% Ethylenediamine tetraacetic acid (EDTA) were used as irrigants to remove the smear layer, while in group B, 20 roots with smear layer, normal saline was used as irrigant. All root canals were instrumented with the Pro-taper rotary system using a crown-down technique. Each group of instrumented roots were subdivided randomly into two obturation groups; in group 1, 10 roots were obturated by thermafil with plastic carrier, while in group 2, 10 roots  were obturated by cold lateral compaction technique. Zinc oxide euginol was used as the sealer. The root surfaces were then coated with nail polish except for the apex, then dye penetration study conducted and samples were examined under the stereomicroscope. Data had been collected from two independent examiners and statistically analyzed using student t-test.

Results: There was non significant difference between all the groups radiographically while stereomicroscopic analysis showed significant difference of smear layer free group when obturated by thermafil with other groups. 

Conclusion:  Smear layer free group gave the best results when used with lateral condensation technique (LCT) and smear layer group gave the best results when used with thermafil.

Background and objectives: Cervical smears can reduce both incidence and mortality rates from invasive cervical cancer. Despite its success, cervical cytology has important limitations. The aim of this study is to assess the validity of conventional Pap smear in diagnosis of cervical intraepithelial neoplasia in Erbil through comparison with colposcopy with or without cervical biopsy.

Methods: A hospital-based study was carried out in Erbil Maternity Hospital from the 1^st May to 31^st December 2008. The study sample included 336 women attending the breast disease center for routine breast examination. Cervical Pap smear followed by colposcopic examination was done for each woman on the same day. Cervical punch biopsy was taken for those with abnormal colposcopic findings. Colposcopy with or without biopsy was considered as a gold standard diagnosis of cervical intraepithelial neoplasia (CIN).

Results: Out of 336 women, 48 (14.3%) had abnormal cervical smear results, of which 43 (12.8%) of the total had low-grade cervical lesions and 5 (1.5%) of the total had high-grade cervical lesions. Colposcopy-directed biopsy revealed that 69 (20.5%) had abnormal findings of which 65 (19.3%) women had CIN I and 4 (1.2%) of the total had CIN II and III. The sensitivity and specificity of the cervical smear were 62.3% and 98.1%, respectively. The positive predictive value was 89.6% while the negative predictive value was 91%. The false negative percentage was 37.7%. The accuracy of the test was 90.8% and the degree of agreement between Pap smear and colposcopy with biopsy results was 90.2%.

Conclusion: The high accuracy of cervical smear in this study and high agreement rate between cervical cytology and colposcopy indicates that conventional Pap smear is an important dependable screening test in spite of its low validity in terms of its sensitivity.