Vol 14, No 3 Special (2010)

Background and Objectives: Blood donation is a process by which an individual voluntarilydonates blood for humanitarian reasons, for storage in blood bank. The aim of this study is evaluation of iron status of blood donors in Erbil city.

Methods: Over six months period ,489 healthy looking adult male attending Nanakaly hospital for blood disease in Erbil city north of Iraq, those divided into 1st time donors, multiple donors (2-4times/2year) and frequent donors(>4times/2year), blood samples for complete blood picture, serum iron parameters &serum ferritin level were performed.

Results: Ninety one donor(18.6%)were found to have laboratory evidence of iron deficiency, all were repeated donors, (20.5%) among multiple donors increased to (26.7%) among frequent donors. iron deficiency was positively related to the frequency of blood donations(p<0.001).the frequency of early stages of iron deficiency was higher among multiple donors (store depletion 47.9%, iron deficient erythropoiesis (IDE) 47.9% ompared to 37.2% store depletion &44.2% iron deficient erythropoiesis (IDE) among frequent donor iron deficiency anemia (IDA) was higher among frequent donors(18.6%V4.2%p=0.01).mean cell volume (MCV) was inversely related to frequency of donation, emoglobin and Hematocrit (HB& PCV) showed no association with serum ferritin or with frequency of donations, however serum iron& transferrin saturation were positively associated with  erum ferritin level.

Conclusion: iron deficiency is common among repeated donors and worsens with increasing frequency of donations ,iron supplementation may be needed.

Background and Objectives: Landek (Cradle) is a special equipment use for swaddling and calming newborn babies The effect of Landek on the developmental dysplasia of hip has been studied in this research in order to raise the social and cultural awareness about this issue.

Methods: 168 cases with developmental dysplasia of hip have been prospectively collected over three years in Duhok-Iraqi Kurdistan. The cases were divided in to two groups. The first group was advised not to use Landek and the other group were continued to use Landek. Both groups are followed up for six months. The grading of DDH was performed depending on the ultrasonic examination (Graf technique). The cases in both groups were diagnosed to have grade IIb.

Results: The first group has shown 90% improvement from grade IIb to grade I, 8% to grade IIa and 2% were not improved. The control group has shown deterioration to grade III in 50% of them and to grade IIc in 25%. The rest did not show changes in grade. For the acetabulum to grow properly, it requires a normally positioned femoral head. The popular use of Landek and other swaddling methods among eastern societies were considered to be post-natal risks for DDH because they put hip joint in both adduction and extention position. These two positions were found to be unfavorable for the normal development of hip joint.

Conclusions: Landek found to have adverse effect and facilitates the developmental dysplasia of the hip in patents with poorly developed hip joint. Therefore, a broad campaign is necessary against the use of Landek for newborn babies.

Background and Objectives: The positive pelvicalyceal changes observed by ultrasound in suspected acute appendicitis cases confuse the mind in taking a decision for surgical interferences or medical management. This study aims to analyze the effect of pelvicalyceal system dilatation on the diagnosis of acute appendicitis and the associated factors of mild pelvicalyceal system dilatation in acute appendicitis.

Methods: The study assessed 326 suspected acute appendicitis in addition to 260 cases of functional dyspepsia as a control group. Ultrasound of the abdomen was a principal imaging study in the research with the emphasis on pelvicalyceal dilatation, combined in some cases with KUB, CT and Doppler-Ultrasonography.

Results: Out of 326 cases of acute appendicitis, ultrasound revealed that 34% had RPCSD and 7% had bilateral BPCSD. The pelvicalyceal dilatations were observed in 54.5% of the acute recurrent cases or chronic appendicitis and suppurative appendicitis were 30%. The recorded length of appendix ranged from 3.8 to 18 cm. The position of appendix were mainly pelvic (59%) followed by retrocecal (36.4%).

Conclusions : The Pelvicalyceal system dilatation observed by ultrasound in the suspicious acute appendicitis patients can be served as a sign for diagnosis of acute appendicitis in states of hesitation.

Background and Objectives: Misoprostol is a synthetic analogue of prostaglandin E1. It became an important drug in obstetric practice because of its uterotonic and cervical ripening effects. This study was done to compare the effectiveness of it in oral versus vaginal route for termination of second trimester missed abortion.

Methods: From 1st of October 2008 to the end of June 2009 at maternity teaching hospital in Erbil, a clinical comparative study was done on 90 patients who had second trimester missed abortion, They were randomly assigned to receive either oral misoprostol tablets(45 patients) in dose of 200 microgram every 4 hours or vaginal misoprostol tablets (45 patients) in dose of 200 microgram every 4 hours. The patients were followed for 48 hours.

Results: The mean induction to abortion interval was significantly shorter for vaginal group (9.98�4.56hours versus 13.30�6.24hours, P=0.005). More patients in vaginal group aborted within 24 hours (95.6% versus 82.22%, P-value=0.045) .The vaginal group required less number of doses than the oral group (2.09�0.90 versus 2.84�1.24, P=0.001). Gastrointestinal side effects of misoprostol were significantly more in the oral group. Conclusions: Misoprostol was effective drug for termination of second trimester abortion. Vaginal misoprostol resulted in shorter induction to abortion interval, less doses required and fewer side effects than oral misoprostol.

Background and Objectives: To assess the accuracy of fetal weight estimation by Ultrasoundto predict the actual birth weight.

Methods: A prospective cross-sectional study conducted in Maternity teaching hospital in North of Iraq, Kurdistan region, Erbil city from the 15th of August 2008 to the 28th of September 2009, to evaluate the validity of ultrasound estimation of fetal weight. 200 Kurdish, pregnant women with singleton, term, low risk pregnancies were enrolled in the study. Real-time sonography was done to measure femur length and abdominal circumference, and then the weight of the fetus was estimated by Hadlock formula. Immediately after delivery the newborn weight was estimated in the labor ward by the same scale. The correlation between estimated weight and real weight was tested by correlation efficient and linear regression test.

Results: Mean maternal age was 26.625�5.62 years; mean gestational age at time of estimation of fetal weight was 38.825�0.910 weeks. 60% of cases delivered vaginally while 40% delivered abdominally. The mean difference between the predicted and actual weight was 50.810�293.92 gm and this difference was statistically highly significant.

Conclusions: Ultrasound estimation of fetal weight using Hadlock formula is regarded clinically a reliable method to estimate fetal weight as the mean difference between the actual and predicted weights was only 50gm, although the difference was statistically significant

Background and Objectives: Penetrating chest trauma is still common in the developing countries as elsewhere. We studied the rate, causes and the outcome in patients with penetrating chest trauma who managed by tube thoracostomy with application of continuous low pressure suction. The aims of the study were to see the rate of penetrating chest injuries in sulaimanyah city, identifying its causes and to evaluate the effectiveness of tube thoracostomy and applying continuous low pressure suction.

Methods: This study was conducted in the department of thoracic and cardiovascular surgery, sulaimani teaching hospital, sulaimanyah city from July 2007 to October 2009. This study included 48 patients. 40/48 patients were male and 8/48 female. The average age was 27.2 years (range, 16-50). They sustained a penetrating chest trauma from firearm (gunshots) or stabbing wound. They underwent tube thoracostomy and continuous low pressure suction applied to their chest drains.

Results: In our study 21/48 patients were injured by stabbing by knife, 19/48 were injured by gunshots, 5/48 by shell (mines, explosion) and 3/48 by sharp objects.Full lung expansion was achieved in forty (83%) patients. Partial lung expansion or pneumothorax was present in eight (17%) patients. Three patients (6%) developed complications.

Conclusions Our study showed that stab wounds and gunshots constitute the main cause of penetrating chest trauma in our area. Placing chest tubes on continuous low pressure suction helps evacuation of blood, expansion of lung and prevents the development of clotted haemothorax. It also reduces the time to removal of chest drains and the hospital stay.

Background: Typhoid fever is an endemic infectious disease in Sulaimanyia city in Kurdistan region of Iraq. Last years we observe there are remarkable haematological changes associated with this disease. Pancytopenia was one of these changes. The aim of this study was to evaluate the role of bone marrow study in typhoid fever with pancytopenia.

Methods: In this prospective study only culture positive enteric fever patients were taken. For all patients CBC and blood Film were done. Bone marrow study including aspirate and biopsy was done for all patients with peripheral blood pancytopenia.

Result: Two thousands culture positive enteric fever patients were taken into this study. Presenting symptoms included mainly fever and rigor. The peripheral blood of these patients revealed different haematological changes, like normocytic anaemia, leucopenia, bicytopenia and pancytopenia. Pancytopenia was in 127 (6.3%) patients. Bone marrow was active in all patients. Histiocytes are increased in activity in 55 (43%) cases; only in 17 (13%) cases haemophagocytosis was seen. No granuloma seen in all cases. Majority of the patients regain the normal blood parameters values within two to eight weeks.

Conclusion: Bone marrow study has no clear role for explanation the peripheral blood pancytopenia in typhoid fever. There is no indication for bone marrow study for culture positive typhoid fever with pancytopenia, unless the pancytopenia is persistent. Most probably the pancytopenia is caused by peripheral blood factor.

Background and Objectives: Some degree of perineal trauma following vaginal delivery is common and this may cause several maternal morbidity. This study is to evaluate the repair techniques of continuous versus interrupted methods for repair of episiotomy regarding consumption of suture material and cost, estimation of the pain at short term (2 and 6 weeks), necessity to take out the stitches, infection, dehiscence and dyspareunia.

Methods: A total of 100 labouring women were divided into two groups; the first group (group A) includes 50 women their episiotomies were repaired with continuous, non locking suturing technique. The other group (group B) includes the other 50 women, their episiotomies were repaired with continuous, locking sutures of the vagina, interrupted sutures of the perineal muscles, and interrupted transcutaneous sutures of the perineal skin. The suture material used was the same in both groups (polyglactin 910). The women were observed for the first 12 hours in the hospital, and seen after two weeks and six weeks.

Results: Significantly fewer women reported pain at two weeks postpartum with the continuous technique (96% mild pain and 4% moderate pain) while with interrupted technique 80% had mild pain, 14% moderate pain and 6% severe pain with a P-value of 0.039. Similar results were observed at 6 weeks postpartum, in favor of continuous technique in which no case was reported to have pain compared with 7 cases (14%) reported pain in interrupted group, with a P-value of 0.006. The rate of stitch removal was significantly lower for continuous group in comparison to interrupted group. Breast feeding also showed significant difference, being earlier in onset with the continuous group. Moreover, when the continuous technique was used for repair of all layers, there was a significant reduction in consumption of suture materials and cost.

Conclusions|: This study have showed that perineal repair using continuous suturing technique is superior to interrupted technique by causing less maternal morbidity , early onset of breast feeding, less cost, also with better cosmetic acceptance.

Background and Objectives: The cardiovascular response to laryngoscopy and endotracheal intubation causes a reflex increase in sympathetic activity that may result in hypertension and tachycardia the extent of reaction is affected by the technique of laryngoscopy and the use of instruments like direct laryngoscope and fiberoptic bronchoscope. This study aimed to compare the hemodynamic responses to orotracheal intubation via fiberoptic bronchoscopy versus direct laryngoscopy in patients under general anesthesia.

Methods: : Prospectively120 patients American Society of Anesthesiologist Physical status �-� were collected in Sulaimani Teaching Hospital from the first of May to 31st. July 2008 and categorized into two groups equally. Group A 60 cases intubated by direct laryngoscopy and group B 60 cases intubated by Fiberoptic Bronchoscopy Blood Pressures and Heart Rates were recorded before induction (baseline), immediately after induction, at the time of intubation and every 2 minutes of the operation.

Results: After intubation systolic, diastolic blood pressure and heart rate increased significantly (p<0.05) in both groups in compared to post-induction values but there were no significant increase in blood pressure if compared to base line values only significant increase in heart rate.

Conclusions: The fiberoptic bronchoscopy had the same hemodynamic responses to orotracheal intubation compared to the direct laryngoscopy.

Background and Objectives: A growing body of literature has shown that health careassociated infections are a major cause of patient’s illness and death in developing countries. In Iraq, the real concern in nosocomial infections started late. This work was carried out to assess hospital acquired infections in the respiratory care unit (RCU) in the Surgical Specialties Teaching Hospital, Baghdad.

Methods: Data were collected by reviewing the case records of patients admitted to RCU for two periods from Nov. 2003 to Oct. 2004, and Nov. 2004 to Oct. 2005, before and after the establishment of infection control committee.

Results: A total of 43 (44.8%) patients got nosocomial infection (NIs) out of the total admissions to RCU (96). No significant association between the implementation of guidelines and rate of NIs. A non significant increase in death rate in the 2nd period of the study, and no significant variation in type of isolated bacteria was noticed, also. Age of the patients, site of surgery, and type of surgery, acute respiratory failure and endotracheal intubation were significantly associated with rate of NIs (p < 0.05).

Conclusions: Initial success of the infection control committee guidelines combined with ongoing efforts to more consistently implement simple and inexpensive measure for prevention, will lead to wider acceptance of infection control practices.

Background and Objectives: Vertebral artery dissection (VAD) is an increasingly recognized etiology of stroke in patients younger than 45 years. Clinical presentation of vertebral dissection can be quite variable, including cerebellar signs, neck pain, brainstem stroke, or occasionally spinal infarctions. We present a case of VAD presenting as cervical radiculopathy.

Summary of Case : A 43 year old man presented to the emergency department with a one day history of headache and nausea without appreciable neurological deficits. He was discharged with a diagnosis of gastroenteritis and treated symptomatically until he returned the next day with radiating arm pain and paresthesia. Neurologic evaluation identified a mild imprecise dermatomal primary sensory loss in his left arm. Head CT identified a left cerebellar infarction. MRI clarified the presence of a cerebellar stroke as well as a notable spinal cord infarction in the anterior spinal artery (ASA) territory. CTA showed occlusion of the left vertebral artery and non visualization of the ASA.

Conclusions: While most stroke patients manifest without pain, in the absence of trauma, acute onset radiculopathic arm pain can rarely be a manifestation of spinal cord infarction from VAD and should be considered when other explanations are elusive or a simultaneous posterior circulation stroke is identified.

Background and Objectives: The aim of this study was to assess the effect of surgical interference and chemotherapy on lipid peroxidation and antioxidant status in patients with cancer disease.

Methods: Twenty one male patients with gastric, colonic, and prostate cancer; and 26 apparently healthy male subjects as a control group, were included in this study. Blood samples (5 ml) were taken from patients and controls and analysed for serum malondialdehyde (MDA) and total antioxidant status (TAS). Blood samples were taken from patients one week before and after the surgery and other blood samples were taken two weeks after the first dose of chemotherapy.

Results: In the cancer patients, serum MDA was significantly higher (P<0.001), while serum TAS was significantly lower (P<0.001) compared with the controls. After surgical removal of cancer, serum MDA was decreased significantly (P<0.001), but serum TAS was increased significantly (P<0.001) compared with the patients before surgery. Chemotherapy treatment further increased serum MDA significantly (P<0.001), with a significant (P<0.001) decrease in serum TAS compared with the measurements after operation.

Conclusions: Surgical removal of cancer decreased lipid peroxidation, and increased antioxidant status. Chemotherapy of cancer increased lipid peroxidation and depressed antioxidant defense system. Oxidative stress might be a consequence and not a cause of cancer.

Background and Objectives: To compare the efficacy of topical benzyl benzoate lotion with permethrin solution in addition to adjuvant crotamiton cream with the aim of determining better and improved treatment option for scabies.

Subject and Methods: The trial included 150 patients aged 6–65 years with scabies who attended the Al-qudis health center for family medicine in Mosul city. Inclusion criteria: those experiencing itching and presence of burrows or secondary lesions that were characteristic of scabies on at least three sites of predilection for scabies. Exclusion criteria: serious illness, pregnant or lactating women, treatment of scabies within the preceding 1 month and suspicious cases. Eligible subjects were divided to 2 groups both of them received topical treatment consisted of a thorough bath using sulfur soap followed by application of benzyl benzoate lotion 25% for adult and 12.5%for children to all parts of the body, repeated daily for 3 consecutive days and after 1 week, the. While the other group applied permethrine 5% solution as the same manner of benzyl benzoate lotion, washed after 12 hours and repeated after 1 week. In addition, topical treatment involved application of crotamiton cream (40g) mixed with betamethasone G cream (15g) as adjuvant antiscabietic therapy and antipruritic for both groups, in addition to symptomatic treatment of itching. Where possible, close contacts of subjects with scabies were examined and those clinically confirmed to have scabies were invited to enroll in the study. All subjects and close contacts were treated simultaneously. Subjects were followed up at 2 weeks to assess compliance and examine the patients those with new or persistent lesions and pruritus were treated but excluded .Criteria for cure were absence of pruritus and of new lesions.

Results: At 2-weeks post-treatment, the treatment was effective in 70(87.5%) patients in the permethrin group and 45(64%) patients in the benzyl benzoate group, the difference between them was significant (p< 0.0001).The 35 patients who had not improved were excluded

Conclusion: The diagnosis of scabies requires a willing physician and a cooperative patient with increased awareness to achieve good control and successfully treatment of this health problem. Moreover, improved personal hygiene may prevent or control the spread of scabies.

Background and objectives:  The presence of pharmaceuticals in the environment is an emerging concern in the environmental community. Sorption interactions of three high �C use antibiotics [Cefotaxime (CEF), Ciprofloxacin (CIP), and Oxytetracycline (OTC)] with soils from Erbil governorate were investigated. This study was aimed to find out the fate and the behavior of antibiotics in our local environment, no such study has been done in Kurdistan.

Methods: Adsorption of the selected antibiotics on the studied soil samples were conducted using batch equilibrium techniques. The samples were analyzed by HPLC and UV visible spectrophotometer.

Results: Adsorption data were correlated with linear distribution, Freundlich and Langmuir models. Freundlich model being found to provide the best fit of the experimental data (R² ��0.856). The results showed that the three studied antibiotics were found to adsorb strongly to the soils with 50- 76% adsorbed under all experimental conditions. Values of equilibrium constant were increased with temperature. Values of standard Free energy change were in the range -10.412 to -2.089, -14.102 to -2.721, and -25.952 to - 1.414 KJmol^-1, for CEF, CIP and OTC respectively. Values of standard enthalpy change followed the range 51.043-74.081, 38.535-85.476, and 52.561- 73.512 Kjmol^-1, for Cef, Cip and OTC respectively.

Conclusions: Values of standard Free energy change were negative and increased with temperature, indicating that at all experimental temperatures: the interactions of antibiotics with soils were spontaneous with a high preference of the soil surface and the adsorption occurred through a bonding mechanism. The results of effect of temperature and thermodynamic parameters confirm the adsorption process to be endothermic in nature.

Background: Human cAMP was found to act as a 2nd.messenger responsible for intercellular effects. Its altered levels can exhibit a characteristic response to the metabolic behavior of the cell. Increases in cAMP levels were leads to a variety of responses, dependent on the nature of the target cell. This increases can diffuses to extracellular fluids and can be useful in diagnostic purposes.

Methods: Twenty four hours urine samples of the human leukemia patients (no.86) and normal healthy control were collected, these were includes male and female. 90 samples of healthy controlled were used for comparing data obtained. Levels of cAMP were determined in both groups. Identification of the purified cAMP peaks were achieves using UV, TLC and HPLC analysis.

Results: An elevation in purified cAMP levels were found to be of 15.87 � 2.4 �mole/24 hours and 20.13 � 0.881 �mole/24 hours of both Normal and leukaemic patient�s urine. Identification of the cAMP purified peaks were, reflects the following data: the Rf value of both groups was the same as compared with the standered cAMP used, the retention times of the cAMP peaks were the same, and the UV analysis in different PH values were the same.

Conclusion: Hormones that increase hepatic (glycogen) or renal (parathyroid hormone) cAMP bring about an increased level of the cyclic nucleotide in blood and urine, respectively. Although this may be useful for diagnostic purposes, extracellular cAMP has little or no biologic activity in mammals, several studies have demonstrated that determination of cAMP in 24 hour urine specimens might be useful for the clinical investigation of endocrine disorders, especially of the parathyroid [8-13] and thyroid gland [14,15 ]. The evaluation of leukaemic urinary cAMP found in this study can give an obvious idea about the metabolic behavior of abnormal cell proliferation.

Background: Paronychia is inflammation of the skin that surrounds a fingernail or toenail. It may be acute or chronic and is most commonly caused by infection with either bacteria or fungi.

Patients and Methods: this paper will look for the possible bacteria and/or fungi that cause Paronychia; 112 Patients with paronychia were subjected to questionnaire; cultures were done for swabs from pus or discharge, and the cultivated microorganisms were further identified by biochemical methods. Control group, age and sex matched with patient group, subjected to the same questionnaire. Nasal swabs were taken from both groups for bacterial culture and identification.

Results: staphylococcus aureus, candida albicans, klebseilla, and streptococcus pyogens are the only microorganisms identified, of which staphylococcus aureus is the most frequent one. There is a significant association between Staphylococcal nasal carries and paronychia, though all other parameters including age, sex, occupation, residency, marital status, and exposure to wetness, and family history showed a non-significant association as predisposing factors. Some of infections were unilateral, while others were bilateral. The infection might involve only one finger or toe, or it might involve more than one location. There is a significant association between klebseilla infection with chronicity and disfigurement of nail.

Conclusion: factors including repeated exposure to wetness, occupation, history of local trauma, and family history of paronychia are not significant risk factors in etiology of paronychia, while persons who are nasal carriers for Staphylococcus aureus might represent a risk factor for paronychia. Staphylococcus aureus is the most common causative agent of paronychia, though other microorganisms might be implicated as causative agents. Infections due to klebsiella species tend to be chronic and complicated by disfigurement of nails. There is surprisingly no children involvement by paronychia which should further studied.

Summary:

We describe an 11-year-old female child presenting with a congenital superior lumbar hernia, this was diagnosed clinically and supported on radiological basis. It was successfully treated by surgery.