Vol 14, No 3 (2010)

Background and objective: α-amylase is an enzyme that degrades starch into maltose and glucose by hydrolyzing α-1,4-glucan bonds.It is known that the enzyme is found to be elevated in patients suffering from diabetes mellitus.A potent extracts of locally distributed wild plant,the Gundelia was found to inhibit elevated activity of α-amylase with dose responses.

Methods: Samples of 50 diabetes mellitus type-I has been investigated for urinary α-amylase activity.An inhibitory dose of Gundelia extract were used for the inhibition of the elevated enzyme activity.The data obtained were compared with that of healthy controlled samples﴾30﴿.The adopted protocol was a colorimetric determination﴾Anonymous,1980﴿ .

Results: α-amylase activity was found to be elevated﴾281.70±10.03 IU/24hr) in patient’s serum compared with that of controlled samples﴾43.38±3.33 IU/24hr﴿.The activity of the enzyme was found to be inhibited﴾160.11±250.4 IU/hr﴿ in patients serum using dose response of 15mg/ml of Gundelia extract. The study were comprehensive to determined the physical parameters of the enzyme activity and a values of Vmax and Km were obtained.

Conclusion: It was known that Gundelia is used in prevention and treatment of liver diseases. The plant has a role in the body as an antioxidant factor.It has a hypolipemic effect, therefore, a use of such plant extract could have a hypoglycemic activities on patients with DM-I.

Background and objective: It has been recognized for more than 40 years that patients experience different levels of anxiety when faced with impending surgery. The degree to which each patient manifests anxiety is related to many factors; this study aims to assess the level of anxiety among patients undergoing major general surgery and to identify the effect of gender on preoperative anxiety.

Methods: A sample of 300 patients who were admitted from 5^th April 2009 to the 10^th November 2009; in general surgery units of teaching hospitals ( Rezgari & Hawler ) in Erbil city were interviewed to assess their level of anxiety before surgery. The instrument used for this purpose was a questionnaire that included socio-demographic information and the State-Trait Anxiety Inventory (STAI) of Spilberger.

Results: Most of the patients showed moderate to severe anxiety level; (moderate=50% and severe=38.3%) others showed mild anxiety level (11.7%). A statistically significant relationship was seen between preoperative anxiety and gender; female patients showed high levels of anxiety (severe anxiety=46.9%) while male patients showed less severe anxiety level (severe anxiety=28.6%).

Conclusion: According to the results of the study patients undergoing major general surgery need to be assessed regarding level of anxiety before surgery. This anxiety should be reduced through appropriate interventions, especially in women who have been found to experience high levels of anxiety.

Background and objective: The presence of a perforated tympanic membrane with intermittent discharge and hearing loss of conductive type are the indication for myringoplasty. The purpose of this study was to determine risk factors in candidates for myringoplasty and to evaluate the post operative myringoplasty success rate results in our local region in Erbil/Kurdistan, Iraq. The second objective is to appraise and assess the effect of close observation and post operative treatment and follow up on this result, to increase the success rate.

Methods: A prospective study, randomly taken 68 patients with unilateral perforated tympanic membrane, who are candidates for myringoplasty; patients of different age groups ranging [16 -55] years old, of different gender 30 males and 38 females., having dry unilateral perforated tympanic membrane of more than 3 months, underwent myringoplasty [underlay] between may 2006 and April 2009 at Rizgary teaching Hospital. Measurement of the post operative results and outcome were depend on the take rate and the hearing level at the last follow up visit in different time postoperatively and with dry clean non infected operated ear.

Results: Small, dry posterior perforation, with postauricular approach in well pneumatized mastoid and in well educated non-smoker patient with close observation post-operatively using BIPP has better success rate. The success rate increased from 72% in the 1^st postoperative visit to 88% in the last postoperative visit.

Conclusion:-To increase the success rate, its necessary to determine the factors that affect the success rate preoperatively, also close observation with meticulous toilet of the operated ear post-operatively using BIPP is necessary to increase the success rate.

Background and objective: Acne is a common skin disease of adolescence. It is caused by inflammation of the pilosebaceous units, characterized by comedones, papules, pustules, inflamed nodules and it may result in scarring. This study was performed to define the different aspects of acne in patients attending the department of dermatology and venereology in Rizgary Teaching Hospital.

Methods: This study is a descriptive case- series hospital- based study, conducted on 200 patients with acne attending the department of dermatology and venereology in Rizgary Teaching Hospital in Erbil.

Results: The number of female patients with acne was 145 and male patients were 55. Acne of moderate severity was the commonest type, it was found in 57% and 64% of the patients had mixed types of lesions. Seborrhea was present in 84% of patients. Hirsutism was present in 44% of female patients and pre-menstrual flare-up was found in 73% of females. A significant relation was found between gender and degree of severity of acne. Also a significant relation was found between seborrhea and the acne severity.

Conclusion: This study showed that acne of moderate severity was the commonest type. Females made the majority of our acne patients. Multiple exacerbating factors were found to be contributing.

Background and objective: Previous reports have shown that moderate-intensity regular exercise reduces blood pressure, also has beneficial effects on other biochemical parameters. The aim of this study was to determine the effects of regular exercise on blood pressure and lipid profile in overweight or obese women.

Methods: Thirty five apparently healthy women participated in this study. Their age ranged from 22-46 years, most of them were overweight and obese. The exercise group met a Treadmill training program 2 km in half hour in J&K and Raeky fitness centers in Erbil city. The training group exercised at least three times per week. Blood pressure, heart rate, serum glucose and lipid profiles were monitored throughout 4 weeks of regular exercise.

Results: Regular exercise produced significant reductions in both blood pressure and heart rate (Systolic BP decreased from 123.57±3.76 to 113.93±3.52 mmHg, Diastolic BP decreased from 81.07±9.8 to 73.57±2.59mmHg). Highly significant reductions in total cholesterol and low density lipoprotein were observed, whereas no significant changes were detected in serum glucose, triglycerides and High density lipoprotein levels.

Conclusion: These data suggest that 4 weeks of regular exercise training in normal persons can result in significant reduction in blood pressure accompanied by favorable changes in lipid profile.

Background and objective: Iron deficiency is the most prevalent and common micronutrient deficiency in the developing world today. The aim is to determine the iron status among 1-5 years old children admitted to emergency department for different reasons and to determine the risk factors associated with iron deficiency in these children.

Methods: a cross sectional study was carried out on a total of 106 children aged 1-5 years attended the emergency department of Raparin teaching hospital for children in Erbil from 16^th of May to 16^th of August 2007 were invited to participate in the study, parent were interviewed for potential risk factors of iron deficiency, blood were taken for analysis of hemoglobin, serum iron, total iron binding capacity and transferrin saturation after a verbal consent. Iron deficiency was defined as serum iron <50 microgram/dl and/or transferrin saturation (TS)<16%.

Results: iron deficiency was noted in 51.9% and 48.1% according to serum iron and transferrin saturation respectively. Male have more risk to have lower TS<16% as compared with female ( OR 0.400, 95% CI 0.182-0.879). Age and tea ingestion were significant independent predictor of iron deficiency, family income associated significantly with low serum iron while pica, frequency of meat ingestion, number of sibling and weight percentile have non significant relation with neither low serum iron nor low transferrin saturation

Conclusion: iron deficiency is important health problem in this population of children, prevalence of iron deficiency found in 1-2 year age group in this study was alarming, this suggest the need for greater efforts of prevention.

Background and objective: to many dental disciplines, especially oral and maxillofacial surgeons to perform dental treatments and oral surgical procedures comfortably. This study was conducted to estimate the degree of mouth opening and its correlation to sex, age, height and weight.

Methods: The maximum mean mouth opening of 1262 Kurdish adult was measured using a calibrated ruler, in addition to body height and weight. Student-t test was used to assess the statistical difference between males and females and Pearson correlation coefficient to assess the correlation between mouth opening and both body height and weight.

Results: The mean value of mouth opening was 50.56 mm for males and 48.46 mm for females. The greatest mean mouth opening was noted in the age group of 16-24 and decreased gradually with advanced age. A significant positive correlation was noted between mouth opening and both body height and weight.

Conclusions: Mouth opening was higher in males than females in all age groups and decreased gradually with advancing age. It was positively correlated with body height and weight.

Background and objective: Serum calcium and iron were used as a biochemical markers for investigation of the neoplastic diseases ,since there is a growing concern about the possible links between these minerals and tumors of various organs and tissues ,the objectives of this study were to determine the changes in the serum levels of Ca & Fe ions in patients with benign prostatic hyperplasia and bladder cancer and to identify the role of these markers in diagnosis and prognosis of these patients .

Methods: This study was done in Baghdad at Al-Kadhemia Teaching Hospital between 10/9/2002 and 1/9/2003 .Serum samples were obtained for measurement of calcium and iron.,which were determined by flame atomic absorption spectrophotometer .

Results: Hypercalcemia affects up to 30% of patients with bladder and prostate cancers. In addition there were a decrease in the iron serum level as a result of tumor growth .

Conclusion: Hypercalcemia, is one of the most common metabolic disorders accompanying neoplasia.The cancers most often associated with hypercalcemia, in addition there were a reduction in serum level of iron this biochemical marker may be associated with the pathogenesis of cancer.

Background and objective: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most frequently isolated pathogens in both community and hospitals, and associated with high morbidity and mortality rates with rapid development of resistance. The methicillin-resistance occurs due to the presence of PBP2a of the bacterial cell wall, which has low affinity for β-lactam antibiotics. MRSA are often multi-resistant to both β-lactams and non-β-lactams antibiotics. The study was documented the occurrence of community and hospital acquired MRSA infections.

Methods: The clinical specimens were collected from patients at three teaching hospitals in Erbil city. All Staphylococcus aureus were identified as MRSA by detection of PBP2a.

Results: Out of 377 Staphylococcus aureus isolated, 30.24% were MRSA. The wound was the most common infection site for both community and hospital acquired MRSA. Statistically the patients with hospital acquired MRSA were older than the community acquired MRSA.

Conclusion: MRSA is one of the most common causes of serious infection in community and hospital settings. The most common site infected by MRSA is the surgical wound infection.

Background and objective: This prospective study was to evaluate the probable risk factors for perforation of duodenal ulcer, highlighting any prevalent one in the occurrence of perforation in Sulaemania city. The study was designed to be performed on patients with perforated duodenal ulcer attending the emergency department in Sulaemania teaching hospital over the period of this study.

Methods: This study was conducted between 1^st of March 2009 till the 1^st of October 2009 involving 50 patients with perforated duodenal ulcer attended the emergency department in Sulaemania teaching hospital. A number of probable risk factors for the patients were studied.

Results: Out of 50 patients, 41(82%) were males, 9(18%) were females and the male to female ratio was (4.5:1), about 32% of the patients were more than 60 years old. Patients described themselves as having a nervous personality were 31(62%) and the number of patients lived in city center were 28(56%). Smoker patients were 36(72%) and 33 patients (66%) had a history of NSAIDs ingestion.

Conclusion: Smoking, NSAIDs ingestion, sex, age and stress played a major role as risk factors in the occurrence in duodenal ulcer perforation. There is a seasonal variation in incidence of perforation including high incidence during spring and autumn.

Background and objective: Infertility is common in our community . Infertility has become nowadays not only a medical, but a social problem as well .Fallopian tube problem is among one of the common causes of infertility. Hysterosalpingography and laparoscopy are used as a screening test for diagnosis of tubal patency . Hysterosalpingography is an out patient X-ray procedure, has for many years been an invaluable procedure for the assessment of tubal pathology and intra-uterine pathology. Laparoscopy is an invasive procedure used since 1944 by Raoul Palmer,of Paris for gynecological examination.  We aimed in this paper to explore the role of hystrosalpingography in the evaluation of tubal patency in the diagnosis of the cause of female infertility in our society and to reduce the need for laparoscopy .

Methods: One hundred fifty seven infertile women with fallopian tubes problem out of one thousand three hundred fifty patients who underwent HSG had given consent to undergo Laparoscopy in Sulaimaniea Maternity Teaching Hospital and in Hatwan Private Hospital during 2^nd may. 2007 to 3^rd may. 2008. For infertility not less than 2 years duration.

Results: 1350 infertile patients with age range (20 – 39) years underwent HSG, 157 patients show pathology of the fallopian tubes. Diagnostic laparoscopy was performed for them after the HSG procedure to confirm the abnormalities diagnosed by HSG. ,The results showed non insignificant difference P value, the HSG gave 92,4% sensitivity and 100% specificity, while laparoscopy showed 100% sensitivity and 100% specificity.

Conclusion: We conclude the feasibility of using HSG as a diagnostic method for investigating tubal patency in subfertile women when compared to the use of diagnostic laparoscopy.

Background and objective: Induction of labor is deemed successful when it initiates uterine contractions, progressively dilates and effaces the cervix, and leading to the normal vaginal birth of the baby with no maternal or fetal complications . Because the success of induction is related to cervical ripening, artificial cervical ripening before labor induction is used when the cervix is unfavorable to reduce the associated risk of cesarean delivery. The objective is to test the efficacy and safety of Isosorbide mononitrate for cervical ripening before the induction of labor at term, from.

Methods: A randomized clinical trial was conducted in maternity hospital in Sulaimani, from the 1st of January 2008 to the 1st of July 2008. Forty six pregnant women with gestational age of (37- 42) weeks, singleton, viable, low risk pregnancy and cephalic presentation with Bishop score of less than 6 were selected for induction of labor for various causes. Forty eight hours before induction, 40 mg IMN (2 tablets of 20 mg) were inserted vaginally up to 3 doses 16 hours apart.

Results: It was found that the mean ± SD Bishop score before IMN administration was (1.95 ± 1.5), while after IMN was (6.65± 3.06) P-value = 0.0001. Sixteen cases (35.6%) went to active labor. The mean ± SD time of admission in labor room was (5.06 ± 3.8) hours.43 cases (93.5%) needed oxytocin for their inductions & eighteen cases (39.1%) were delivered by C/S. There was no significant change in FHR before and after IMN and all women delivered active babies with normal Apgar score. The main side effect was headache which was experienced by 31cases (63.4%).

Conclusion: IMN is an effective and safe agent for cervical ripening which can be used as an outpatient basis.