Vol 14, No 1 (2010)

Background and objective: Laparoscopic cholecystectomy is the gold stander surgery for gallbladder diseases, especially symptomatic gall stone disease. to identify the factors that causes the conversion of planed laparoscopic cholecystectomy to an open procedure. Identifying these predictive factors will predict the conversion rate and eventually will help the surgeon, the patient and the hospital in planning the surgery.

Methods: Retrospective study. Between October 2003 and December 2004 hundred and fifty patients with symptomatic gallstone underwent laparoscopic cholecystectomy in Department of Surgery, Sulaimaniyah Teaching Hospital

Results: ages of the patients were between 11-70 years with a mean of 40, female to male were 5/1, and in 47% the symptoms were present for more than two years. Conversion incidence was 8.7.

Conclusion: The predictive factors for conversion in our study accordingly were duration of the symptoms, abnormal intra-abdominal findings, concurrent illnesses, and intra-operative complications.

Background and objective: Anemia is still one of the most common problems in the world even in developed countries, but its evaluation is still underestimated especially in developing countries like our, so it needs further planning, screening and management. This study was done in 12 primary health care centers PHCC in Erbil city – Kurdistan re-gion/Iraq during period fro 1st Feb - 31st Jul 2008. The main objectives were to determine the hemoglobin value in our children , to estimate the prevalence of anemia and correlating it with feeding pattern .

Methods: This prospective study was conducted in 500 apparently healthy children col-lected randomly, visiting the vaccination centers routinely during 5 months period. Feeding. pattern were studied in relation to hemoglobin (Hb) level only.

Results: From total 500 children conducted in this study, the mean Hb. of them was 10.4 g/dl. Those with normal Hb were 196 (39.2%), while 304 (60.4%) of them were anemic. Those with mild anemia were 145 (29.0%) and 159 (31.8%) of them had moderate anemia. The sex had no effect on Hb level. The anemia was lesser in children below one year Children on breast feeding had lower percent of anemia (51.9%),those on exclusive breast feeding only 6 (33.4%) while those on adult milk (74.9%) of them were anemic.

Conclusion: There was a high prevalence of anemia among the investigated children and less common in children with breast feedin. .

Background and objective: Quality of antenatal care services and client satisfaction are interrelated concepts. Measuring quality of care conceptualized in such a broad manner represents a true challenge Studies have revealed positive correlations between patient satisfaction and health care utilization. The present study aimed to determine the level of satisfaction for pregnant women in Erbil society for provision of services and health care utilization .

Methods: Cross sectional study was carried out on 300 pregnant women attending (MCH) maternal &child health unit of three primary health care center (PHC) in Erbil city ( nazdar bamerni, mala-afandi, azadi) from 1^st of march 2008 to the 5^th of September 2008. The variables included were socio-economic state, age ,occupation ,address, educational state, religion ,satisfaction with overall care provider, drug provision, tetanus vaccine , waiting time ,and health education regarding family planning and breast feeding programs .

Results: about two third of the sample at age group 21-30 year, majority of women 76% was housewives, 43.3% with primary school education, most of them 77.7% from moderate socioeconomic status,89.7% satisfied with care services available, 91.4% were satisfied with adequate medicine supply,88.7% satisfied with tetanus vaccine supply , 84% of the sample satisfied with waiting time in less than one hour, while access of session in female health education talking about important family planning and birth spacing method were19.4%, and information of benefit breast feeding 42.3%.

Conclusion: The study revealed that majority of women satisfy with health care services but Erbil need to improve in the program of health education regarding family Planning and benefits of breast feeding.

Background and objective: Measles is an infectious viral disease which is highly communicable and a notifiable disease, it is encountered as a cause of morbidity and mortality. The objective of this study was to find out the most encountered acute complications of measles and relation of these complications to the age of children and vaccination status.

Methods: This is a prospective study done in Raparin pediatric teaching hospital, Erbil city, in the period of December 2008 to May 2009. Sixty eight cases of measles admitted with variable complications were studied. History was taken, complete examination and follow up in the hospital for variable complications was done.

Results: The mean age was 23.28 ±18.91 months, 42 cases (61.8%) of the admitted children were two years or less. Male children were 35(51.5%) cases and female 33 (48.5%) cases. Most of affected cases were unvaccinated for measles 58 cases (85.3%), history of contact in the family was observed in 33 cases (48.5 %) while10 cases (14.7%) has contact history in the pediatric hospital and 25 cases (36.8%) didn’t show any clear contact history. The most common complications were diarrhea 45 cases (66.2%), pneumonia and vomiting 36 cases (52.9%) for each and febrile convulsions 5 cases (7.4%) and encephalitis 2 cases (2.9%).

Conclusion: Children who were infected and developed complications were less than two years of age , most of them were not vaccinated and they were from rural areas.

Background and objective: Rotavirus is the most important cause of severe diarrhea in children worldwide. We have investigated that certain cytokines especially interleukin- 8 (IL-8) as a chemokine, may play an important role in the pathogenesis of and the protection against rotavirus disease in children. The purpose of this study was to reveal the association between IL-8 and child diarrhea with rotavirus.

Methods: Stool samples were collected from 150 children under 5 years of age who developed diarrhea and 45 from non-diarrheic children of equivalent age. All samples were detected for rotavirus and serum IL-8 level. The study was undertaken from May to December of 2006. Enzyme linked immunosorbant assay (ELISA) was applied for detection rotavirus and IL-8.

Results: Among the children, female patients with breast feeding were less infected with rotavirus compared to males with artificial and mixed feeding. The IL-8 concentration was highly significantly between the study groups (P< 0.01). Regarding the gender, serum IL-8 level was significantly higher in males than females (P<0.05). However, no significance prevalence in IL-8 level was recorded between gender in healthy control group (P >0.05).

Conclusion: Rotavirus infection induces the expression of chemokines as IL-8. These data support the hypothesis that chemokine secretion may play a role in the initiation and modulation of the immune response to rotavirus infection.

Background and objective: Weight gain as a side effect of the second generation antipsychotics have been increasingly noted during therapy; however no studies addressed such a valid clinical concern in Iraq till now. The objective of this study was to determine the weight changes among patients treated with either Olanzap-ine or Risperidone.

Methods: A retrospective study was performed by reviewing the charts of 80 patients who have been treated with Olanzapine monotherapy (60 patients) or Risperidone monotherapy (20 patients) through the period of April 2008 to April 2009, compar-ing the baseline weight in kilograms with after one month of therapy weight.

Results: Among the 60 patients treated with Olanzapine, 42 (70%) gained weight, 70.37% of males and 69.69% of females treated with Olanzapine gained weight. Among the 20 patients treated with Risperidone, 12 (60%) gained weight, 50% of males and 75% of females treated with Risperidone gained weight. Those treated with Olanzapine, gained 3.96 kg after 30 days of treatment, while the amount of gain was 2.25 kg among those treated with Risperidone after the same period. Olanzapine-treated group gained about 6.21% of their baseline weight which was significantly higher than that of Risperidone-treated group who gained about 2.89% of their baseline weight (P value of 0.03). Females gained more amount of weight than males in both group.

Conclusion: Both second generation antipsychotics, Olanzapine and Risperidone, are associated with weight gain. However, Olanzapine appears to have a greater potential in inducing weight gain. Both genders affected nearly equally, though females were victims of more amount of weight gain.

Background and objective: Generalized anxiety disorder is a common psychiatric disorder; it may act as a risk factor for psychoactive substance abuse and dependency development. The objectives are to assess the degree of abuse and dependency in generalized anxiety disorder patients, and the effect of treating the disorder on substances abuse and dependency. 

Methods: 120 patients with generalized anxiety disorder, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), were studied from January 2007 to June 2008 for the presence of psychoactive substance abuse and dependency according to DSM-IV.  All cases were managed for six months by the tricyclic antidepressant imipramine (35-75mg/day), with counseling to decrease anxiety by reassurance and anxiety management including relaxation training, in addition to supporting and encouraging the patients with abuse to stop the used psychoactive substances by a tapering schedule over weeks.

Results: Substance abuse were presents in 32.5% of patients (tobacco 17.5%, benzodiazepines 13.3%, and alcohol 1.7%), this rate decreased to 13.3% (tobacco 11.7%, benzodiazepines 0.8%, and alcohol 0.8%) six months after starting treatment. The decrease in benzodiazepines abuse and dependency was greater than that in tobacco or alcohol.

Conclusion: Generalized anxiety disorder appears to encourage abuse on psychoactive substances. Treating the disorder decreases abuse and using imipramine appears to have a good therapeutic effect on generalized anxiety disorder with low risk for abuse.

Background and objective: Geographic Information System (GIS) is a system for solving complex planning and management problems. GIS provides an excellent means of visualizing and spatial analyzing health data. The aim of this study was to highlight the valuable uses of GIS in planning of health services in Erbil city.

Methods; This is a cross-sectional study, conducted in Erbil city during the period between (1/2/2009-1/5/2009). Data on number of health centers and hospitals, health manpower and health services of 2008 were collected & analyzed spatially and presented in appropriate maps, figures and tables. Health services data was linked to the population data for computing health indicators like doctor- population ratio and nurse -population ratio. Bed occupancy rate (BOR) and average patients stay for all hospitals of year 2008 is calculated and analyzed spatially.

Results: Total number of health centers(HCs) which provide all types of health services to the community were (15), (12) of them have one or more of these health services. There are (13) quarters without health centers. Most of physicians (80.6%) & assistant physicians (Medical assistants) (79%) are working in hospitals, while only (19.4%) of physicians & (21%) of medical assistant are working in HC. The highest number of doctor-population ratio was in (Shahid Najdee Haidar) HC (14588) while the lowest was in (Mala Afandi) HC (1635). Maximum bed occupancy rate was in (Hawler teaching) hospital (66.7%), while the minimum was in (Amal) Hospital (11%).

Conclusion: GIS is a promising tool for evaluating health facility distribution and planning of equitable distribution health services in Erbil city.

Background and objective: Obesity is an important and increasing public health problem, being a risk factor for overall mortality and major chronic disease. To determine relationship between different measures of body mass index and incidence of hip and knee osteoarthritis in male and female.

Methods: Comparison of prevalence of primary osteoarthritis of knee and hip. Between age and sex matched control from out patient clinic of Erbil and Rizgary teaching hospital over period of eleven months starting on Jan 2007.this constituted one hundred and eighty five subjects of normal body `mass index. And one hundred and sixty subjects with high body mass index. Subjects fulfilling our inclusion criteria under went clinical evaluation and radiology of their knee and hip joints, we assessed by chi-squared test, differences in frequency of osteoarthritis between those with normal body mass index and those with high body mass index and between male and female.

Results: Obesity was a stronger predictor of osteoarthritis of knee joint with no sex and age difference. In the prevalence of osteoarthritis of hip joint. No link between obesity and hip osteoarthritis was found in this study.

Conclusion: Obesity in 35-45 year old men and female will predispose to primary osteoarthritis of the knee.

Background and objective: The aim of this study was to assess radiographically the angulations and depth of impacted mandibular third molars.

Methods: In a retrospective study 163 impacted mandibular third molars of 100 patients were examined on orthopantomograms (OPT) in the College of Dentistry/ Hawler Medical University during 2008. From these orthopantomograms the angulations (mesioangular, distoangular, vertical, and horizontal) and the depth (types A, B, and C) of the impacted mandibular third molars were recorded. The frequencies of unilateral and bilateral impaction were also recorded.

Results: The average age of the patients was 26.5 + 5 ranging from 20-40 years with a median of 25 years. Fifty eight (58%) of the cases were female and 42 (42%) were male. The frequency of mesioangular, distoangular, vertical and horizontal impactions were 73 (44.8%), 37 (22.6%), 28 (17.2%), and 25(15.4%) successively. The depths of the impactions were 45 (27.6%) depth A, 74 (45.4%) depth B, and 44 (27%) depth C.The frequency of unilateral impaction was 26 (26%) and that of bilateral impaction was 74 (74%).

Conclusion: Impacted mandibular third molars are more common in female. Mesioangular impaction is more common followed by distoangular. Depth B most common and most of the patients have bilateral impaction.

Background and objective: Siwak, Miswak, or Arak (Salvadora persica ) belongs to Salvadoraceae and is considered as the most widely used twigs since early times by Babylonians some 7000 years ago, it was later used throughout the Greek and Roman empires, and has also been used by ancient Egyptians and Muslims. The aim of this study was to determine the antibacterial activities of different extracts of Siwak on the growth of different oral isolates of Streptococcus mutans, Staphylococcus aerus and Candida albicans.

Methods: Experiments were conducted in the laboratories of the College of Science, University of Salahaddin and College of Dentistry, Hawler Medical University for a period from Jun. 2008 to Feb. 2009, to determine the effects of different Siwak (Salvadora persica) extracts at concentrations of 500, 1000, 5000 and 10000 µg/ ml on the growth of different oral isolates of Streptococcus mutans, Staphylococcus aureus, and Candida albicans.

Results: The results showed that all Siwak extracts (especially Siwak aqueous extract) were effective against Streptococcus mutans. and Staphylococcus aureus. The strongest antibacterial activity was observed using the concentrations of 10000 µg/ ml. While Siwak extracts were ineffective against Candida albicans.

Conclusion: Siwak extracts had significant antibacterial effect against Streptococcus mutans. and Staphylococcus aureus, and ineffective against Candida albicans.