Vol 21, No 2 (2017)

Background and objective: Energy drinks have become increasingly prevalent among young adults and adolescents in recent years, particularly young students and athletes who see the consumption of energy drinks as an easy and quick way to boost academic and athletic performance. This study was conducted to determine the prevalence of consumption of energy drinks in a sample of adolescent and adults in Erbil city as well as perceived benefits and its health hazards.

Methods: A convenience sample of 600 individuals from different sectors and social groups of Erbil city was selected. Data was obtained through direct interview. The data was managed through SPSS program version 18, using appropriate statistical tests.

Results: The prevalence of energy drinks consumption among the study population was 42.7%, especially adolescents and young adults (those ≤ 25 years) and was more common among males than females (55.7% and 29.8%, respectively). The main reasons for its consumption were related to getting energy and improving the mood and performance (66.0% and 30.4%, respectively). 62.7% of participants think that it is harmful and could have adverse effects such as heartbeat irregularity and blood pressure swinging, addiction, and osteoporosis (46.2%, 33.7% and 13.2%, respectively). Televisions were the major source of advertisement (71.45). A significant statistical association had been found between the age, gender and educational status of the participants and consuming energy drinks (P = 0.001, 0.001 and 0.002, respectively).

Conclusion: Energy drinks consumption found to be highly prevalent in adolescents and young adults in Erbil city, which calls for review and regulating the sale of these drinks including adolescents' education, raising community’s awareness, banning selling it in public places and increasing taxes.

Background and objective: Anabolic androgenic steroids are synthetic compounds based on the structure of testosterone, and are used to treat various conditions such as reproductive system dysfunction. High doses of anabolic androgenic steroids and exercise influence the hypothalamic pituitary gonadal axis, which can, in turn, affect testicular apoptosis. This study aimed to investigate the influence of anabolic androgenic steroids on semen parameters in bodybuilders (heavy exercise) in Erbil city.

Methods: Semen specimens and serum were collected from 150 which divided into three groups; each consists of 50 men. The control group (A) didn't practice exercise so didn't receive nandrolone. The exercise group (B) who practice daily without taking nandrolone. The exercise and treated group (C) who practice exercise and had been using nandrolone (200 mg- wk^-1, intramuscularly) for at least three months. Smear prepared by methyline blue stain and assessment of semen volume, sperm morphology, sperm concentration ,motility were carried out .Serum levels of follicle-stimulating hormone, luteinizing hormone, and testosterone were also carried out.

Results: There was no difference in the semen volume within three groups. Sperm concentration and the percentage of sperm motility in the group C was significantly lower (P <0.001) than that in the other groups. A significantly increased percentage of sperm with the tapered head was found in the group C. Our results also demonstrated a significant decrease in testosterone and follicle-stimulating hormone in the group C compared to group A and B.

Conclusion: Users of anabolic-androgenic steroids have sperm with abnormal shape, especially tapered head, and low concentration of sperm with sluggish motility attributing to infertility.

Background and objective: The Helicobacter pylori infections role in etiology of peptic ulcer is well known, but its role in gastroesophageal reflux disease is one of the important issues which has to be confirmed. We tried to find out the effect of Helicobacter pylori infection on gastroesophageal reflux disease.

Methods: The current study was done on 100 patients with gastroesophageal reflux disease from January 1^st to June 30^th, 2014 in Rizgary Teaching Hospital, Erbil city. The diagnosis was made by history, clinical examination, and endoscopy. Helicobacter pylori infection was confirmed by gastric biopsy and histopathological examination. We tried to find out the effects of Helicobacter pylori infection in gastroesophageal reflux disease patients and its eradication on their symptoms. The data was analyzed with the statistical package for the social sciences (version 18).

Results: The mean age ± SD of participants was 37.13 ± 12.5 (17-75 years). The prevalence of Helicobacter pylori infection was 75%. The endoscopy showed that 50 out of 75 patients had erosive esophagitis and 25 out of 75 patients had normal appearance known as non-erosive esophagitis. The study showed no significance of its eradication on symptoms of gastroesophageal reflux disease.

Conclusion: The effect of Helicobacter pylori infection in gastroesophageal reflux disease patients was significant regarding endoscopic finding while inversely related to symptoms severity. The eradication of infection did not cause improvement in symptom severity i.e. triple therapy not advised in the course of treatment.

Background and objective: The Helicobacter pylori infections role in etiology of peptic ulcer is well known, but its role in gastroesophageal reflux disease is one of the important issues which has to be confirmed. We tried to find out the effect of Helicobacter pylori infection on gastroesophageal reflux disease.

Methods: The current study was done on 100 patients with gastroesophageal reflux disease from January 1^st to June 30^th, 2014 in Rizgary Teaching Hospital, Erbil city. The diagnosis was made by history, clinical examination, and endoscopy. Helicobacter pylori infection was confirmed by gastric biopsy and histopathological examination. We tried to find out the effects of Helicobacter pylori infection in gastroesophageal reflux disease patients and its eradication on their symptoms. The data was analyzed with the statistical package for the social sciences (version 18).

Results: The mean age ± SD of participants was 37.13 ± 12.5 (17-75 years). The prevalence of Helicobacter pylori infection was 75%. The endoscopy showed that 50 out of 75 patients had erosive esophagitis and 25 out of 75 patients had normal appearance known as non-erosive esophagitis. The study showed no significance of its eradication on symptoms of gastroesophageal reflux disease.

Conclusion: The effect of Helicobacter pylori infection in gastroesophageal reflux disease patients was significant regarding endoscopic finding while inversely related to symptoms severity. The eradication of infection did not cause improvement in symptom severity i.e. triple therapy not advised in the course of treatment.

Background and objective: Rheumatoid arthritis is a systemic inflammatory disease. Ocular manifestations involved with rheumatoid arthritis are keratoconjunctivitis sicca, episcleritis, scleritis, anterior and posterior uveitis, dry eyes and ulcerative keratitis. This study aimed to detect the prevalence of ocular manifestations in rheumatoid arthritis patients, find out the relation between the effects of disease modifying anti-rheumatic drugs, biological agents and ocular complications in rheumatoid arthritis patients and explore role of anti-cyclic citrullinated peptide antibodies.

Methods: This is a cross-sectional clinical study of 60 rheumatoid arthritis patients who have attended Rizgary Teaching Hospital in Erbil. A data information about symptoms of ocular manifestations and history of ocular complications before starting disease modifying anti-rheumatic drugs and/or biological agents were taken. Musculoskeletal examination, serum Anti-CCP antibodies test were done. Ocular examination by ophthalmologist was done.

Results: This study was conducted from April to November 2015 and involved 60 patients; 55 females and five males with a mean± SD age of 46 ± 11.46 years. Thirty nine (65%) patients had ocular manifestations of rheumatoid arthritis. The most frequent manifestation was dry eyes 30 (50.0%). There was no relation between severity of the rheumatoid arthritis disease and ocular manifestation (P = 0.529). There was a relationship between the Anti-CCP antibodies titer and presence of ocular manifestations in rheumatoid arthritis patients (P = 0.006). There were no curable effects of the disease modifying anti-rheumatic drugs, biological agents on ocular manifestations in rheumatoid arthritis patients (P = 0.787).

Conclusion: Dry eye was the most common ocular manifestation, anti-CCP antibodies are a sensitive marker for ocular manifestations. Disease modifying anti-rheumatic drugs and biological therapies provide no significant efficacy in treatment or prevent the occurrence of ocular manifestations in rheumatoid arthritis patients.

Background and objective: Snodgrass first described the tubularized, incised plate (TIP) urethroplasty for distal hypospadias repair in 1994. This study aimed to find out whether there is any difference in the fistula rate with single versus double layer tubularization, and the use of ventral versus dorsal dartos layer.

Methods: Between May 2009 and July 2014, tubularized incised plate urethroplasty was performed for correction of hypospadias in Erbil for 112 patients with age ranging from 1-32 years. Five patients were excluded from the study because of lack of adequate follow up. Data were analyzed using the statistical package for the social sciences.

Results: Urethral fistula occurred in seven cases (6.5%).The use of an additional reinforcing second layer for the tubularization had a significant effect on decreasing the fistula formation (P = 0.05). The fistula rate was slightly lower with dorsal dartos flap (5.4%) than ventral dartos flap (7.8%).

Conclusion: The urethral plate, when dissected, should be thick enough to allow for tubularizationin two layers. Both dorsal and ventral dartos flaps are effective in preventing urethral fistula.

Background and objective: Orthodontic space opening is a common treatment for congenitally missing teeth. Dental implants are often used to replace the missing tooth to establish ideal esthetics without restoring the adjacent teeth. This study aimed to investigate the outcome of implants placed in orthodontically created bone. 

Methods: Fifty dental implants were used for rehabilitation of lost tooth/teeth in 30 patients after space creation using orthodontic treatment. Patients with congenital and traumatic missing tooth/teeth, who lost the space for accommodation of normal size crown, and patients with spacing were enrolled in the study. NiTi open coil spring was used for space creation. The patients were followed up clinically and radiographically (OPG).  

Results: Out of 50 implants, the success rate was 78% (39 implants). Eleven implants (22%) failed to get osseointegration. Mean age of the patients was 26.33. Female patients constituted 63.33%, and male patients 36.67%. A new one replaced all the failed implants. Most of the failures were in the mandible.  

Conclusion: Orthodontic treatment can be used as a type of osteodistraction method for provision of an acceptable amount of bone for dental implants. The quality of the gained bone can be improved by offering sufficient time for healing.  

Background and objective: The prevalence of obesity is rising across the world and it is regarded as a major health concern which is thought to be associated with a number of chronic illnesses including rheumatoid arthritis. This study aimed to find out the prevalence of obesity in patients with rheumatoid arthritis and to apprehend the association of obesity with disease activity and latex positivity.

Methods: One hundred twenty patients with rheumatoid arthritis who were regularly visiting Rizgary Teaching Hospital in Erbil were included in a cross-sectional study using specially designed mixed questionnaire. Body mass index and waist circumferences were measured, and their association with disease activity score 28 (DAS28) and clinical disease activity index (CDAI) were estimated. Furthermore, we evaluated their association with positive latex test.

Results: There was increased frequency of obesity in rheumatoid arthritis patients, and there was a positive association between body mass index and waist circumference with disease activity measured by DAS28 and CDAI (P <0.001). There was no significant association between obesity and latex positivity which has been assessed separately for males and females (P = 0.898 and 0.086, respectively).

Conclusion: Obesity is frequently found in rheumatoid arthritis patients. It is associated with higher disease activity, but not with the latex positivity in these patients.

Background and objective: Rheumatoid arthritis (RA) is an autoimmune disease of unknown etiology. Vitamin D3 plays an important role in bone metabolism and may also have immunomodulatory effects. This study was designed to estimate the prevalence of vitamin D₃ deficiency in patients with rheumatoid arthritis as compared to healthy controls and to analyze the association between vitamin D3 with disease activity.

Methods: This case-control study included 50 consecutive rheumatoid arthritis patients, who fulfilled EULAR-ACR-2010 and ACR 1987 criteria for Rheumatoid Arthritis, and 50 age matched controls. Their mean age and standard deviation (SD) was 46.42±10.86 years. They were not on vitamin D3 supplements. They were selected from the Rheumatology and Medical Rehabilitation Department of Rizgary Teaching Hospital in Erbil City. The activity of disease was assessed by disease activity score and clinical disease activity index parameters. The vitamin D3 was measured for all patients and controls.

Results: A total of 100 participants were enrolled in the study. The vast majority of them were female, and 70% of cases had deficient vitamin D₃ levels, while 46% of control group suffered from vitamin D3 deficiency (P <0.05). There was a non-significant statistical relationship between vitamin D₃ levels and duration of disease, disease activity score and clinical disease activity index.

Conclusion: Level of vitamin D3 was low among cases compared to controls and it was statistically significant. Vitamin D3 was not correlated with the disease activity.

Background and objective: Osteoarthritis is the most common joint disease and a leading cause of disability. Increased circulating levels of C-reactive protein have been associated with prevalent knee osteoarthritis. This study aimed to assess the association between C- reactive protein positivity in patients with knee osteoarthritis in Erbil

Methods: Data from100 participants in this case-control study were enrolled from May 1^st to December 1^st, 2015 in Rizgary Teaching Hospital in Erbil city. Data were divided into two groups. The cases included 50 patients (17 male and 33 female) with a mean age of 58.9 ±3.8 years and diagnosed with primary knee osteoarthritis of one or both knee joints. Controls included 50 persons (17 male and 33 female) with a mean age of 58.1 ±3.9 years without knee osteoarthritis and matched for age, sex, and body mass index. C-reactive protein qualitatively measured. Patients were radiologically assessed by Kellgren and Lawrence grading scale (grade 0-4).

Results: C-reactive protein was positive in 41 out of 50 (82%) of knee osteoarthritis patients compared to 3 out of 50 (6%) of healthy controls (P = 0.001). C- reactive protein positivity among knee osteoarthritis patients were significantly associated with body mass index, positive family history of knee osteoarthritis, duration of diseases, and Kellgren and Lawrence grade (P <0.05). No significant association was found with sex, site of knee joint involvement, and knee pain severity (P >0.05).

Conclusion: C-reactive protein positivity was significantly associated with knee osteoarthritis compared to healthy controls. Furthermore, body mass index, positive family history of knee osteoarthritis, early osteoarthritis, and Kellgren and Lawrence grade II, were significantly associated with positive C-reactive protein in knee osteoarthritis.

Background and objective: Developmentally missing teeth include hypodontia, oligodontia, and anodontia. In the case of absence of one or more teeth or supernumerary one, the need for treatment is very great. Aesthetic concerns, periodontal diseases and malocclusion are some of the complications following hypodontia. This study aimed to find out the prevalence and distribution of hypodontia in Erbil orthodontic patients in relation to the side, jaw, tooth types and gender.

Methods: Orthopantomograms of 600 patients (10-34 years old), seeking orthodontic treatment from different orthodontic clinics in Erbil city between 2014 and 2015 were evaluated. A tooth diagnosed as congenitally missing when cannot be identified or discerned radiographically on the basis of calcification and there is no evidence of extraction.

Results: The prevalence of hypodontia was 6.66%. Maxillary lateral incisors were most frequently missing (42.68%), followed by mandibular second premolars (19.51%). Hypodontia was more frequently found in females with no statistically significant difference. 62.5% of hypodontia located in maxilla while 27.5% located in the mandible and only 10% was in both arches in the same patient.

Conclusion: The pattern and prevalence of hypodontia are different among races and ethnic groups. The prevalence of hypodontia in Erbil orthodontic patients was 6.6%. Upper lateral incisor was the most frequently missing teeth. Tooth agenesis in the upper arch was more prevalent than in the lower arch.

Background and objective: Bone loss regarded as a major health concern which is thought to be associated with a number of chronic illnesses including rheumatoid arthritis. This study was designed to determine the frequency of low bone mass as well as the influence of disease duration on bone mass in the patients with rheumatoid arthritis.

Methods: Sixty patients with rheumatoid arthritis who were visiting Rizgary Teaching Hospital in Erbil from April 2015 to March 2016were included in a cross-sectional study. Bone mineral density was measured using dual energy X-ray absorptiometry.

Results: There was increased frequency of bone loss in patients with rheumatoid arthritis. There was a positive association between bone mineral density of the spine and femoral neck with disease activity measured by disease activity score and disease activity index (P <0.05). There was a significant association between bone mineral density and disease duration. 

Conclusion: Significant proportions of patients with rheumatoid arthritis have osteoporosis at the femoral neck and lumber spine, and disease duration longer than five years is associated with a significant increase in bone loss.

Background and objective: Primary brain lymphoma is an extranodal aggressive intracranial neoplasm of lymphocytic origin originating and confined to the brain parenchyma and meninges. It is rare in immune competent patients, but its incidence is increasing. This retrospective study was conducted to record the MRI features of primary brain lymphoma at the time of diagnosis in immunocompetent patients.

Methods: Of the 450 patients diagnosed with the brain tumor during a period of five years from 2008 to 2013, the clinical features and MRI findings of 16 cases of pathologically proven to be non-Hodgkin’s lymphoma were studied. All the patients were tested negative for HIV and there was no history of immune suppression drugs or any other chronic illness. All the patients were examined with MRI observing the tumor location, multifocality, signal intensity in different sequences, enhancement patterns, peritumoral edema, the presence of hemorrhage and calcification.

Results: Of the 16 patients, including the monofocal and multifocal cases, 30 lesions exhibited. The mean age at diagnosis was 53 years. Nine patients (56.25%) found to have a multifocal disease. In more than 75% of lesions, MRI was hypo to iso signal on T1 and T2. Mild to moderate perilesional edema, strong contrast enhancement and restricted diffusion were seen in all cases. The hemorrhagic tumor was noticed in four lesions (13.3%). No calcification and no leptomeningeal lesions were noted. The MRI images in post steroid therapy were studied within one month of treatment. Tumour regression was noticed in 21/30 (70%), stable in 3/30 (10%) and progressing in 6/30 (20%). 

Conclusion: MRI is a reliable imaging technique in the management of patients with primary brain lymphoma. Early accurate diagnosis is crucial to avoid the unnecessary operation and shift patients from extensive surgery to chemoradiotherapy.

Background and objective: The characteristics of diabetic foot disease are well documented in Erbil city; henceforth it would be appropriate to evaluate the problem of diabetic hand syndrome in this environment and to assess the frequency and the most important clinical and biochemical risk factors for the development of these complications.

Methods: This is an observational case-control study done over a period of one year. A total of 100 consecutive patients with type 2 diabetes mellitus were enrolled and described as cases. One hundred age- and sex-matched nondiabetic individuals were taken in the control group; all were examined and then underwent the appropriate investigations.

Results: Of the total 100 diabetic patients, 63% had macrovascular complications and 60% had one or more hand disorders. Limited joint mobility (47% vs. 18%, respectively; P = 0.0001) and Dupuytren’s contracture (16% vs. 2%, respectively; P = 0.001) were significantly higher in type 2 diabetes mellitus patients than in the controls, but not trigger finger. These hand soft-tissue changes correlated significantly with poor glycemic control.

Conclusion: This study shows a high prevalence of hand disorders in diabetic patients with the limited joint mobility being the most common hand disorder. The hand soft tissue changes are under recognized in diabetic patients, occurring in 60% of the cases. We recommend that physicians should consider examining the periarticular region of the joints in the hands in each diabetic patient.

Background and objective: This study aimed to measure the prevalence of dyslipidemia in patients with rheumatoid arthritis compared with healthy control people and find out the correlation between dyslipidemia and disease activity.

Methods: A prospective case-control was done. A total of 100 female patients with rheumatoid arthritis were included in the study. This study was conducted at the Rheumatology Out-patient Clinic in Rizgary Teaching Hospital, Erbil City over seven months from April 2013 to October 2013. Patients who fulfilling the 1987 revised American College of Rheumatology and 2010 American College of Rheumatology/European League against rheumatism classification criteria for rheumatoid arthritis and 100 healthy female age-matched controls with the mean age for both groups being 45. Fasting lipid profiles of cases and controls were estimated after an overnight fasting of 12 hours. Association     between lipid profile and disease activity using disease activity score DAS 28, inflammatory markers (CRP and ESR) was also determined. 

Results: Rheumatoid arthritis patients showed a higher prevalence of associated dyslipidemia (47%) in comparison to control (5%), P = 0.004. There was a significant reduction in serum high density lipoproteins (P = 0.04), with significant elevation of serum total cholesterol, triglyceride, low density lipoprotein and very low density lipoprotein (P = 0.001, 0.004, 0.04 and 0.05, respectively) in comparison to controls. There was a significant relation between disease activity score 28 and serum high density lipoproteins (P <0.001) and there was a significant relation between ESR and triglyceride (P = 0.05).

Conclusion: is frequent among the patients with rheumatoid arthritis and highly associated with active rheumatoid arthritis. Serum high density lipoproteins significantly reduced while other parameters of lipid profiles significantly increased in comparisons to control. 

Background and objective: Perianal fistulae commonly occur in middle-aged men. It is important to determine the presence of fistula tracks, its grading and presence of abscess or inflammation. This study aimed to assess the role of MRI in diagnosis and classification of perianal fistula.

Methods: This study included 20 patients with perianal sepsis that were referred to the MRI section of Radiology Department in Rizgary Teaching Hospital between August 2015 and April 2016. All patients underwent MRI examination.

Results: The mean ± SD age of the 20 patients was 38.5 ± 10.4 years (range 22-55 years), of which 16 patients (80%) were males and four patients (20%) were females. Eighteen patients had a single external opening and two patients had two external opening. All the simple non-branching fistulas were successfully identified by axial and coronal planes of contrast enhanced T1Weighted image fast spin echo, of which five cases had simple intersphincter (G1) fistula and two had simple transphincter (G3), seven cases had intersphincter fistula either secondary tract or horse shoe and abscess (G2), five cases had complex transsphincter (G4). Two cases of complex G4 type had inflammation and edema in ischiorectal and ischioanal fossa and the internal openings were clearer in STIR T2axia.

Conclusion: MRI non-invasively offers important information about perianal fistula that can reduce surgical complications and postoperative recurrence of the disease. Every patient with suspicious perianal sepsis should undergo MRI examination to prevent complications and morbidity.

Background and objective: Dry pressure curing device is one of the devices used in curing of acrylic resin denture bases. This study aimed to evaluate some properties of acrylic resins, cured by three different techniques.

Methods: Two hundred and fifty two specimens were prepared from two brands of heat curing acrylic resin (Paladent20 and Major). The specimens were cured by three techniques (dry heat pressure curing, conventional curing and microwave irradiation). For each curing technique, seven specimens were prepared and some mechanical and physical properties were tested.

Results: Less residual monomer showed in the dry heat pressure curing of Paladent 20 acrylic resin. The conventional curing of Major acrylic resin has shown the least porosity. The highest bending strength and less water sorption showed by microwave irradiation of Major acrylic resin specimens.

Conclusion: Some properties of the specimens cured by the dry heat pressure curing device were better than other curing techniques. The microwave irradiation has some good properties when compared with other techniques. The Paladent 20 brand of acrylic resin showed better properties than the Major acrylic resin.