Vol 14, No 2 (2010)

Background and objective: Skin diseases constitute serious public health problems throught the world, especially in children. The aim of the study was to determine the preva-lence of skin diseases in primary school children in Erbil city, and its relation to various socio-demographic factors.

Methods: A total of 6915 pupils aged 6-15 years were randomly selected from 32 primary schools using multistage random sampling technique. Data regarding general socio-demographic variables were collected from each student in a specially designed question-naire. Children were clinically examined and the dermatological findings were recorded.

Results: The overall prevalence of skin diseases was 40.6%, Infectious dermatoses have the highest prevalence rate (15.27%), followed by eczematous skin diseases (13.13%). The overall prevalence of skin diseases and infectious dermatoses were significantly higher among females, younger age groups and those of low socio-economic status, while eczematous skin diseases were significantly higher among males.

Conclusions: Skin conditions are common among school children, which may reflect pre-vailing low socio-economic conditions. Relevant health education programs and preventive measures should be implemented.

Background and objective: The association of the atypical antipsychotics with hypergly-cemia, elevated lipids, and weight gain was recognized soon after the introduction of clozapine and has become of increased concern as the use and uses of atypical antipsy-chotics have been expanded. The aim of the present study was to investigate the preva-lence of diabetes, dyslipidaemia, lipid peroxidation and hyperprolactinemia in Olanzepine treated patients in comparison with patients treated with haloperidol.

Methods: Fifty patients were selected randomly from psychiatric inpatient clinic in Erbil city in Iraqi Kurdistan Region between November 2007 and June 2008. All patients were diagnosed as schizophrenia, and none of them were in acute severe state. Thirty Schizophrenic patients received Haloperidol orally as typical antipsychotic and 20 patients received Olanazapine orally as atypical antipsychotic for a minimum of one month. Fasting blood samples for the assessment of serum malondialdehyde (MDA), lipid profile, fasting blood glucose (FBG) and prolactin levels were obtained after one month of the drug prescribing time. From those fifty patients, 16 patients were selected to follow them prospectively over a mean period of time of 112 days for olanzapine and 75 days for haloperidol. The prospective study includes FBG, lipid profile, BMI and serum MDA.

Results: The prevalence of hyperprolactinaemia and lipid peroxidation was higher in Haloperidol treated patients. Whereas, the prevalence of diabetes and dyslipidaemia were higher in Olanazapine treated patients, The mean level of BMI of the Olanazapine group was significantly higher than BMI of the Haloperidol group. There was 6.66 % prevalence of DM in Olanazapine treated patients, but there was no prevalence of DM in Haloperidol treated patients. There was no incidence of diabetes mellitus in the prospective study for both Haloperidol and Olanazapine treated patients.

Conclusion: No absolute evidence indicates that the atypical antipsychotic Olanazapine is the cause of diabetes, since the glucose levels of all patients were within normal range and there was no incidence of diabetes in the prospective study in spite of their higher weight and body mass index.

Background and objective: Prostate cancer is now the commonest cancer in men and the second commonest cause of cancer death after lung cancer. The introduction of pros-tate specific antigen (PSA) testing has revolutionized the early detection, management and follow-up of patients with prostate cancer and it is considered to be one of the best bio-chemical markers currently available in the field of oncology. This prospective study was aimed to Evaluate the diagnostic performance characteristics of prostate specific antigen (PSA) by comparing serum PSA value with histopathological finding of prostate biopsy , Determine the relation between PSA and various prostatic diseases, and To explain the effect of age on PSA testing.

Methods: To fulfill these objectives, 92 specimens of prostate biopsy from patients with history of prostatism who underwent prostate surgery (prostatectomy, TURP and true cut biopsy of prostate) with samples of serum for tPSA analysis taken preoperatively during a period of 10 months. In addition to 33 samples of serum taken from apparently healthy indi-viduals for tPSA analysis.

Results: From 92 cases 12 of them were malignant, 49 cases were BPH and 31 cases were BPH with prostatitis. Statistically there was significant relation between PSA values and histopathological findings of prostate biopsy and significant relation between age and PSA value of apparently healthy individuals. PSA sensitivity was (100%), specificity (46.25%), PPV (21.8%), and NPV (100 Sensitivity of PSA testing was better than specific-ity.

Conclusion: It is concluded that PSA evaluation is a sensitive marker for prostate can-cer but because of various other conditions that affect serum PSA concentration. Other methods of investigations such as DRE, TRUS and histological examination should be combined to confirm diagnosis.

Background and objective: Mutations of the P53 tumor suppressor gene and altera-tions in its protein expression often occur in a variety of human malignant tumors, including endometrial carcinoma, but the practical implications of this phenomenon are yet to be fully exploited. This study was designed to evaluate P53 protein expression in normal, hyper-plastic and malignant endometrium by immunohistochemical study and to correlate P53 expression in endometrial carcinoma with other clinic-pathological prognostic parameters (age, histologic type, tumor grade, cervical & myometrial invasion, and tumor stage).

Methods: The studied samples included 100 formalin fixed, paraffin embedded endo-metrial tissue specimens which were divided to the following diagnostic categories: - Pro-liferative endometrium (n=10); secretory endometrium (n=10); simple hyperplasia (n=10); complex hyperplasia without atypia (n=20); atypical complex hyperplasia (n=10) and endo-metrial carcinoma (n=40).

Results: None of the normal endometrium, simple hyperplasia and complex hyperplasia without atypia showed P53 immunostaining, while 20% of atypical complex hyperplasia and 32.5% of endometrial carcinoma showed immunoreactivity for P53. In endometrial car-cinoma, significant correlation was observed between P53 expression and age at diagno-sis, histological grade,FIGO stage, myometrial invasion & cervical invasion ; but not with the histological type .

Conclusion: The results indicated the validity & simplicity of the application of immuno-histochemistry in determining the status of P53 overexpresion which is strongly associated with endometrial carcinoma aggressiveness and high malignant potential.

Background and objective: CO2 insuflation constitutes the commonest means of creat-ing the pneumoperitoneum (PP), but it is attributed to many post-laparoscopic cholecyste-comy adverse effects including pain triggering. The aim of this trial was to evaluate the effi-cacy of low-pressure CO2 PP during laparoscopic cholecystectomy (LC) in reducing the incidence of postoperative pain.

Methods: A double-blind, randomized, clinical trial was conducted on 100 patients with symptomatic gall stones. Patients were randomized preoperatively into group A (n=50) who underwent LC with 8 mmHg CO2 PP throughout the procedure and those in group B (n=50) had LC with 12 mmHg CO2 PP. Abdominal and shoulder-tip pain were assessed with verbal rating scale (VRS) scoring at 4, 8, 12 and 24 hours postoperatively.

Results: The low-pressure PP did not increase the duration of surgery. There were neither significant peri-operative complications nor conversion to open procedure in either group. A statistical comparison of mean cumulative VRS scores for abdominal and shoulder-tip pain in both groups shows statistical significance at 4, 8, 12 and 24 hours after operation.

Conclusion: A CO2 PP at 8 mmHg reduces both the frequency and intensity of abdomi-nal and shoulder-tip pain following LC without increasing the rate of intra-operative compli-cations.

Background and objective: Family planning program is one of the successful maternal and child health programs. This study aimed to find out the percentage of usage of dif-ferent types of contraceptive methods among women attending family planning centers to know the most preferable method among them .

Methods: A Cross sectional study was carried out on 400 women attending family plan-ning unit (FPU) in Erbil city ( from 1st of July 2008 to the 30th of September 2008. The variables included were, age, occupation , address, educational state, religion, socio-economic state, different contraceptive methods; Combined oral pill (COCP), intrauterine contraceptive device( IUCD), Depo-Provera injection, condom, the reason for choosing such methods, the different complications with uses of these methods, the number of live children.

Results: Among 400 women who attended ( FPU) 269( 67.25%) of them were at age (21-34), most of them prefer the use IUCD, condom, CCP, and lastly injection in a rate of : (36.55%),( 29.25%), (27.25%) and 2.5% respectively,( 53.75%) of cases significantly have complications with contraceptive uses specially IUCD (71.95%) , the most common complication associated with different contraceptive use was infection, then abnormal vaginal bleeding in a rate (46.04%),and (29.76%) respectively.

Conclusion: The present study revealed that majority of women who attend Family plan-ning units prefer to use IUCD, then condom, COCP, and lastly depo-provera injection, Most of study sample were exposed to infection, which indicated the need to promote health education in FP center through meeting session with them regularly.

Background and objective: Dealing with the pyramidal lobe of the thyroid gland was not principally and cautiously under run in the surgery of the thyroid gland as the other two lat-eral lobes formerly. For this reason, the present work planned to study the anatomy and histopathology of the pyramidal lobe and to evaluate the degree their significance in surgi-cal fields.

Methods: The study included patients' preparation for operation, recording age, gender distributions, and measurement of pyramidal lobe moreover to view of directions. Blood supply and histopathology of the pyramidal lobe investigated during thyroid operations of 113 patients in Rizgary teaching hospital in Erbil.

Results: Goiter patient's sex distributions were as the following; 94 (83%) female and 19 (17%) male. PL frequency was 61/ 113 case (74%); 50 (82%) females and 11(18%) males. pyramidal lobe directions were 21 directed right, in 40 cases to left. Arterial supplies of 34 cases were from a branch of the superior thyroid artery, in 27 cases were from isthmus. Venous drainage was joining venous plexus of the thyroid isthmus. Age distribution; fe-males were commonly affected at (25 to 45y). Males were (28-62y). Pyramidal lobe mean length was (3.2+ 1.8cm) and the width (1.6+ 0.7cm). Histopathologically; pyramidal lobe involved by principal thyroid lobes pathologies in 43 (71%) of the patients.

Conclusion: This study alert us that the pyramidal lobe mustbe managed as a principal lobe during operations, because It may be a source of pitfall during the operation or it may be a future source of mucinous carcinoma of thyroid.

Background and objective: Melasma is an acquired and symmetric hyperpigmentation of the face. The aim of this study was to assess clinical varieties, aggravating factors of melasma, distribution among different age and sex groups and observed diseases.

Methods: This descriptive study was conducted on 210 patients with melasma attending the department of Dermatology and Venereology at Rizgary Teaching Hospital in Erbil city. Data were collected from November 2007 to the end of June 2008. All patients and both sexes were included in the study except for patients who received treatment during last two months of pres-entation. A questionnaire was prepared and full history and a thorough examination was done for each patient.

Results: The study showed that 83.33% of the patients were females with a mean age of 23.71 years. Main factors found to induce or exacerbate melasma were sunlight (71.9%) and emotional stress (65.7%). The most common morphological type was centrofacial (70.95%). Wood’s light examination showed epidermal type predominance.

Conclusion: Melasma is a disease of reproductive period. Sunlight and emotional stress are the most common aggravating factor. The most common morphological type of melasma seen was centrofacial. Epidermal type of pigment predominates in most patients with melasma.

Background and objective: Urinary tract infection (UTI) defines as a condition in which the urinary tract is infected with a pathogen causing inflammation. UTI affects all age groups, but women are more susceptible than men, it is the second most common form of infection. This study was designed to isolation and identification of common uropathogenic bacteria and determining the sensitivity of infectious urinary isolated strains to different antimicrobial agents.

Methods: This study included 350 patients (125 males and 225 females) with sign and symptoms of UTI, who were referred to the Teaching Hospital in Erbil and Sulaimania cit-ies, from March till May 2007. Also, 25 healthy individuals were included in the study as a control group. Api tests and several biochemical tests were used for identification different isolated bacteria from UT.

Results: The bacterial cultivations revealed positive results for 119 (34%) urine speci-mens, 56 (47.05 %) in males and 63 (52.94 %) in females compared to control group (0%). The highest percentage of infection was observed in females in age group (20-39) years (44.44%). The highest rate of uropathogenic isolates was E. coli 53 (41.08%) fol-lowed by S. aureus, Proteus sp., Klebsiella sp., Enterobacter sp., and Pseudomonas sp. 23(17.82%), 23(17.82%), 11(8.52), 10(7.75) and 9(6.97) respectively. The uropathogenic bacterial isolates showed different susceptibility to antimicrobial agents, ciprofloxacine was the most efficient to inhibit UTI.

Conclusion: Incidence of UTIs in females is more than in males with a higher rate in the 20-39 years age group. E. coli was the commonest pathogenic bacteria isolated from uri-nary tract.

Background and objective: Patients with chronic renal failure and diabetic nephropathy reveals biochemical changes .This study aim to investigate the differences of some impor-tant biochemical changes in these two groups of patients in comparison with normal con-trols.

Methods: (80) patients were selected with different Renal disease complications. A control group of (30) healthy,18 males and 12 females were included in this study. Patients were divided into two groups the first group with chronic renal failure, include (40) patients,(25) male and (15) female ; the second group with diabetic –nephropathy , include ( 40) pa-tients,(25) male, and (15) female. Determination of the biochemical compound level as creatinine ,urea ,uric acid ,total protein (T.P) , albumin ,total cholesterol (TC), triglyceride(TG), low density lipo-protein (LDH-c) ,high density lipoprotein (HDL-c) , and LDL-c/HDL-c ratio.

Results: Patients with chronic renal failure showed increasing levels of (creatinine, urea, -uric acid ) in their serum, and lower levels of (total protein, albumin). Mild increase in lev-els of (TC, LDL-c), while great increased level of triglyceride were recorded, also a great decline in the level of HDL-c was found, which indicate a high risk factor and moderate in-crease in (LDL-c/HDL-c) ratio .Patients with diabetic nephropathy showed slight increase in the levels of (creatinine, urea, uric acid ), however still lower than that in chronic renal fail-ure group. Also they showed decreased levels of (total protein, albumin) ,but still lower than in chronic renal failure and Increased level of ( TC,TG, LDL-C, LDL-c/HDL-c) which were greater than the increase in chronic renal failure .Also decrease in the level of HDL-c, but still less than that in chronic renal failure.

Conclusion: Patients with chronic renal failure or with diabetic nephropathy showed sig-nificant increase in the levels of creatinine, urea, and uric acid; and decreased levels of al-bumin and total protein. Both group of patients showed variation in their cholesterol, LDL-c, triglyceride, and LDL/HDL-c ratio.

Background and objective: Metabolic syndrome is a potent risk factor for cardiovascu-lar diseases (CVDs), has not been adequately explored in Erbil individuals and its relation to leptin hormone. The present study aim to evaluate such a relationship between serum leptin and metabolic syndrome in Erbil individuals.

Methods: Samples collection were carried out in Razgary teaching hospital, 45 cases with metabolic syndrome and 30 healthy control subjects, anthropometric variables measure-ments (blood pressure, body weight, body height, body mass index) and biochemical tests: fasting, serum glucose, serum triglycerides, high-density lipoprotein cholesterol and serum leptin were obtained from the study samples.

Results: Serum leptin levels were significantly higher in females in comparison to the males in metabolic syndromes group (with median 53.6 Vs 23.8 ng/dl with P value < 0.05) with also present statistical significant difference in leptin between metabolic syndrome group and control group in both males and females. No important association between se-rum leptin and each of selected criteria of metabolic syndrome. The observed case-control difference in serum leptin is mainly attributed to gender and body mass index (BMI) differ-ences and not a function of metabolic syndrome itself.

Conclusion: Among subjects with metabolic syndrome, only age , gender and body mass index were important in determining the magnitude of serum leptin among cases groups.