Vol 13, No 2 (2009)

Background and objective: Many laboratory & clinical studies have suggested that there are important inverse relationships between expression of HER-2 oncoprotein and hormonal receptors(ER,PR),the prognosis & treatment are also greatly depend on hormonal receptor of neoplastic cells to define these relationships using standard immunohistochemistry for HER-2,ER and PR studies were performed in addition to routine histopahtological grading of carcinoma of the breast.

Methods: Between January 2006 and December 2008 at histopathology lab of Rezgary hospital & private lab, (122) women who were operated on for diagnostic excisional biopsies of the breast cancers to allow analysis of routinely resected tissue. Quantitative expression of HER-2,ER and PR was measured on the resected samples of the breast cancers with cutoff points HER-2,ER and PR positivity were 10.6%,5.5%,5% respectively in addition to routine study of histopathology for grading of cancers according to Nottingham modified Bloom & Richardson criteria.

Results: Immunohistochemical analysis for ER, PR, and HER-2 were performed. ER and PR expression were decreased significantly in HER-2 positive tumors compared with HER- 2 negative tumors (ER,15.57%,vs 41.8% vs. and PR, 13.11% vs. 37.70%;). Even among HER-2+ tumors, the rate of ER or PR expression in high-grade tumors was significantly decreased compared with intermediate grade tumors. HER-2 was positive in 73.3% of grade 2 and 66.6% of grade 3 ductal carcinomas and 6.89 in grade 1 ductal carcinomas. HER-2 expression essentially in grades 2 and 3 ductal carcinomas, very few cases in grade 1 and correlated inversely with ER or PR expression. Although ER or PR expression is decreased in HER-2+ tumors, a substantial proportion of them still express ER or PR.

Conclusion: The results of this study are consistent with the indication of inverse relationships between HER-2 and ER,PR increased ER and PR levels in low grade neoplastic tissue ,the low grade neoplasms responding to hormonal therapy while high grade responding to hormonal therapy while high grage responding to herceptin

Background and objective: Appendicitis is a common surgical emergency. The patients with equivocal signs can present a diagnostic challenge. Early diagnosis and intervention is mandatory for prevention of complications. On the other hand negative appendicectomy should be avoided as much as possible. The aim is to evaluate the role of the modified Alvarado scoring system in early diagnosis of acute appendicitis.

Methods: During a period of 6 months from 1st February to 31st July 2008; 250 patients with right iliac fossa pain were admitted and observed in Emergency Hospital in Erbil. The age of the patients was ranged between 13-70 years (mean 22 years ). The male to female ratio was 3:2. They were prospectively evaluated on admission using modified Alvarado scoring system to determine whether or not they had acute appendicitis. The results were correlated with the operative and histopathological findings.

Results: After first scoring; 179 (72%) patients were admitted and 71 (28%) patients were discharged. Rescoring by modified Alvarado scoring system was done after 6 hours from admission, only 162 (91%) patients were operated on , and the rest 17 (9%) patients were discharged. During operation we found that 142 cases (87.5%) had really acute appendicitis. Overall the modified Alvarado scoring system showed sensitivity of (93%) for [8-9] scores and (39%) for [1-7] scores. .

Conclusion: The modified Alvarado scoring system is accurate in early diagnosis of acute appendicitis . Patients with 8-9 scores should be operated on immediately without hesitation. Patients with score 5-7 must be admitted and scored frequently. Score 1-4 can be discharged unless otherwise indicated.

Background and objective: A prospective study was carried out for estimation the concentration of the erythropoietin hormone and its effects on some hematological parameters in chronic renal failure patients despite medical treatment. The object of the study was to evaluate the available evidences which support the relationship between anemia and adverse outcomes in chronic renal failure patients, to estimate the erythropoietin concentration of plasma in chronic renal failure patients and to examine the relationship between the anemia and erythropoietin concentration in patients with chronic kidney disease.

Methods: One hundred and eleven (111) patients with CRF on dialysis in the Dialysis and Kidney Disease Center in Hawler Teaching Hospital and (40) control groups were studied. Haematological parameters: were performed by conventional manual methods. The quantitative measurement of erythropoietin concentration in serum was done by using the Erythropoietin ELISA kit (IBL Immuno Biological Laboratories Hamburg Erythropoietin Kit, German).

Results: Hemoglobin, red blood cells, packed cell volume, and mean corpuscular hemoglobin were significantly decreased (P<0.001) in all age groups of Chronic renal failure patients, while, erythrocyte sedimentation rate and mean corpuscular volume (MCV) were increased significantly (P<0.001). Total white blood cells were decreased significantly (P<0.01) at the ages (40-60, >60) years groups, while not significantly decreased at the ages (<20, 20-40) years. Plasma erythropoietin was decreased significantly at the level (P<0.001) in chronic renal failure patients.

Conclusion: Anemia is a common and often an early complication of chronic renal diseases and decreased renal production of erythropoietin is the major cause of anemia in these patients.

Background and objective: Depression is a condition that worsens the prognosis of patients undergoing physiotherapy treatment; it is underestimated and under-recognized. The objectives of this study were to detect the prevalence, severity and type of depressive disorder among patients attending the physiotherapy clinic, and analysis the factors that influencing the occurrence of depression and its severity.

Methods: Cross sectional study was carried out with (200) patients attending physiotherapy clinic in Hawler and Rizgary Teaching Hospitals in Erbil City from 2nd January -2^nd march 2009. Data about demographic characteristics of the sample, utilization of health services, and type of physical diseases were obtained by direct questioning the patients. Depression was assessed by means of the Patient Health Questionnaire (PHQ-9).

Results: Point prevalence of depression was estimated to be 56% (27% mild, 20.5% moderate and 8.5% sever) among this population of patients attending an outpatient physical therapy clinic. Female gender, old age and married patients were suffering from sever depressive disorders .

Conclusion: The high prevalence of depression in patients attending physiotherapy clinics suggests that consideration should be given to screen the psychological.

Background and objective: Neck pain due to poor posture, if neglected for long time, can lead to development of the cervical spondylosis. This study was designed to analyze the relation between symptoms and signs originating from the cervical spine and the duration of computer use.

Methods: A comparison of a group of male subjects who work on computer with those who do not work on computer whose ages range between (30 - 50) years was done for liability of cervical spondylosis. Any subject whose BMI is more than 25Kg/m2 was excluded. Likewise any subject with recognized evidence for predisposition to develop spondylosis was excluded.Employee from different establishments in Erbil City (200 Subjects), over a period of six months from January / 2008 were included in the study.Ninety nine subjects who use computer and hundred and one non-computer user. Subjects were subdivided into: First group: Computer user. Second group: Non-computer user. In both groups the duration of occupation ranges between four to sixteen year and hours of working/week range between (22-32 hours). The (99) subjects who work on computer each of them was evaluated for computer work station and asked about his posture during use of computer and asked if he takes a break time when he work for long hours.The difference between comparable subdivisions of the studied subjects was tested by the Chi-square test concerning the frequency of spondylosis in each of them.

Results: Cervical spondylosis was statistically significant among those who use computer (P< 0.05).

Conclusion: Long term use of computer with bad posture and with out break time increase liability for developing cervical spondylosis in comparison of (same age group, same duration of occupation ,and same hours of working) but not using computer. Proper posture and take a break time when using computer for long time is necessary.

Background and objective: Although laparoscopic cholecystectomy results in less pain than open cholecystectomy, it is not a pain free procedure. A clinical trial was designed to assess pain after LC in terms of types of pain, intensity and factors that may influence it.

Methods: A prospective study on pain was performed on all patients undergoing the operation over the period of 1.5 year (n = 150). Pain was measured by a five point verbal rating scale (VRS).

Results: Pain was the most frequent symptom, after the operation. The main type of postoperative pain was intra-abdominal 72%, followed by incisional 60% and shoulder pain 10%.The mean level of pain was 2.12 VRS points 8 h after the operation and declined to 1.01 points next day. In 54 patients (36%) the intensity of pain was higher than 2 VRS points. Female sex was the only predictor of pain intensity.

Conclusion: Laparoscopic cholecystectomy did cause significant postoperative pain in one-third of our patients only up to the first postoperative day. As predictors for high intensity of pain were not identified clearly, pain should be monitored and multimodal analgesics should be delivered accordingly.

Background and objective: Fine needle aspiration cytology is regarded as the gold standard investigation in diagnosis of thyroid swellings. The aim of this study was to determine the accuracy of Fine needle aspiration cytology in detection of thyroid swellings in our surgical unit and to assess the correlation between preoperative cytodiagnosis and postoperative histopathological diagnosis.

Methods: Between years 2000-2003, 389 patients underwent thyroid operation by single consultant surgeon for thyroid lesions, 156 patients had preoperative Fine needle aspiration cytology; 6(3.84 %) patients had "unsatisfactory" samples so excluded from the study. the remaining 150 patients were enrolled in this study . Fine needle aspiration results were compared with definitive histological diagnosis following thyroid operation.

Results: Fine needle aspiration cytology done for 156 patients,6 patients had been excluded, analysis revealed 132 (84.6%) non-neoplastic, 14(8.97%) neoplastic and 4 (2.56%) suspicious aspirates,. Of the 150 cases included in the study Histological analysis showed 130(86.66%) benign, 14(9.33%) malignant specimens, 2(1.3%) were false-negative. Fine needle aspiration cytology in this study had a sensitivity, specificity and accuracy rate of 90%, 100%, and 75% respectively for diagnosing thyroid malignancy.

Conclusion: The results are comparable with the current published data and demonstrate that FNA cytology in our hands is accurate investigation for preoperative diagnosis for the detection of thyroid malignancy.

Background and Objectives: The specific cellular immune responses play a main role in the hepatic necrosis that occurs with hepatitis B virus (HBV) infection. Interferon-g (IFN-g) and interleukin-2 (IL-2) are considered examples on T helper 1(Th1) cytokines which required for host antiviral immune response and involved in cell-mediate immunity against HBV infection. This study was designed to estimation T-helper 1 cytokines (IFN-g and IL-2) in HBV infected patients and individuals vaccinated with recombinant HB vaccine.

Methods: The study groups were classified into patient group 35 (15 acute hepatitis (AH) and 20 chronic hepatitis(CH)) and 35 vaccinated group (20 responder (RD) and 15 Nonresponder (NRD)) and 18 control group, during May to November 2007. Blood samples were taken from patients and hospitals staffs in Nanakaly, Erbil and Rizgary Teaching Hospital to detect hepatitis B surface antigen (HBsAg), anti hepatitis core antibody IgM (Anti- HBc Ab(IgM)), Anti-HBs Ab, IFN-g level and IL-2 level in serum by enzyme linked immunosorbent assay (ELISA).

Results: The concentration of IFN-g and IL-2 levels in the AH group differed significantly compared with healthy control and CH patients (p<0.01) by F-test. LSD-analysis for IFN-g also revealed same result while IL-2 level significantly increased in healthy control only. Ftest for IFN-g revealed (p<0.05) among RD group, NRD group and healthy non vaccinated (HN) control in ≥30 and <30 years old respectively but inverse result was observed in IL-2 levels (p>0.05).

Background and objective: Tobacco smoking is a growing public health problem in the developing countries. This study estimates the prevalence of smoking and assesses the socio-demographic correlates of smoking among Hawler Medical University students in Erbil city.

Methods: A cross sectional study was conducted during March - April 2007 on 600 students in Hawler Medical University. A systematic stratified sampling method was used. A special questionnaire was used. Data on age and sex of the students, name of college, number of cigarette smoked per day, and age of starting smoking were obtained.

Results: out of the 587 respondents, 72 students were smokers giving a prevalence rate of 12.3%.The prevalence of smokers were much higher in males than females (23.9% and 1.9%, respectively). The highest rate of smokers was among the age group 24-26 year in both sexes. 50% of students started smoking at the age of 18-22 years.

Conclusion: The prevalence of smoking is comparatively higher taking into consideration that the study was conducted on students of medical and allied health sciences and that more than half of students started smoking during study years. The study recommends integrating health awareness programmes about smoking hazards in the medical education curriculum.

Background and objective: A retrospective study was done to report the incidence of mandibular fractures in children up to fifteen years of age seen in Rizgaree teaching hospital /Erbil / Kurdistan region of Iraq.

Methods: The patient's records of 62 injured child aged 0-15 years, from 1/1/ 2002 to 31/12/2008 were retrieved and relevant data was recorded and analysed. A data collection sheet was designed to record patient's name, sex, age, site of fracture, the etiology of the injury and the method of treatment and complications.

Results: The total number of patients who presented with mandibular fracture in children was 62 (78.5%). The ratio of boys to girls was 43 (69.4%) boys and 19 (30.6%) girls (2.2:1). Most of the trauma reported in age group 12-15years (46.8%). Regarding the site of fracture, condylar fracture (46.7%) was most common followed by symphesis (27.4%), dentoalveolar (14.5%), angle (8.1%) and body (3.3%). The main etiology of fracture was fall from height (54.8%). Most of the patients were treated by closed reduction (88.7%) and fixation.

Conclusion: The incidence and etiology of mandibular fracture in children differs among different populations. In our study, the incidence was not very common, fall was most common cause, condylar fracture was most common. Most of the cases can be treated conventionally.

Background and objective: The aim of this study was to report the prevalence of cleft lip and/or palate in two hospitals in Hawler city among children born from 1/1/2008 to 31/12/ 2008.

Methods: In a retrospective study, birth records of 22387 children from two hospitals (Maternity and Raparin Hospitals) were used to identify all children born with cleft lip and/or palate. Information about prevalence, type of cleft, site, gender, family history, and associated anomalies were investigated.

Results: The overall prevalence rate of cleft lip and palate was 0.58 per 1000 births. The prevalence of isolated cleft palate, isolated cleft lip and cleft lip and palate were 0.13, 0.09 and 0.36 per 1000 respectively. Male to female ratio was 1.6:1. Regarding the site of cleft 30.8% was on the right side, 7.7% was on the left side and 61.5% was bilateral. A positive family history was found in 15.4% of the cases and 38.5% of the cases were associated with anomalies.

Conclusion: The prevalence rate of cleft lip and palate in Hawler obstetric hospitals during 2008 was lower than that reported in Asians and Europeans, and it was slightly higher than that reported in Africans. Male predominates in all types of clefts. Higher incidence of associated anomalies was observed compared with other studies in different populations.

Background and objective: Keratomycosis is an important cause of ocular morbidity and can lead to blindness due to lack of ocular antifungal agents. The goal of this study is to formulate a stable effective formula of econazole nitrate ophthalmic ointment.Econazole nitrate has an advantage over other antifungal agents in treatment of mixed infection since it is active against both dermatophytes and candida, and also it is effective in the treatment offilamentous fungi.

Methods: Econazole nitrate ophthalmic ointment of different strength were formulated and compared for their in vitro activity.The effect of different factors (light and type of container) and calculating the expiration date of the selected formula were studied.

Results: Formula A (1gm Econazole nitrate in 100 gm ophthalmic ointment base) and formula B (2gm Econazole nitrate in 100gm ophthalmic ointment base) had good in vitro antifungal activity because both formula A and B inhibit the growth of the fungi used, but formula A was selected because it has the lowest concentration and the same activity. Also the results indicated that the selected formula A was affected by light and its % remaining was (96.7%), while there was no effect of the type of container used to store Econazole nitrate ophthalmic ointment.The expiration date of formula A was calculated to be (2.19) years.

Conclusion: 1% Econazole nitrate ophthalmic ointment appears to be effective in vitro and should be stored in dark container .

Background and objective: The purpose of the present study was to determine the effects of hemodialysis and peritoneal dialysis on some hematological and biochemical parameters in patients with renal failure on the dialysis.

Methods: Fifty two patients with renal failure were taken in this experiment on dialysis studied in the dialysis and kidney disease center in hawler teaching hospital, twenty six patients were taken for haemodialysis and the remaining patients were taken for the peritoneal dialysis process. Some hematological and biochemical parameters were taken before and after dialysis.

Results: In the Hemodialysis Patients: Hemoglobin concentration (Hb gm/dl), Red blood cells (RBCs x106/μl) and packed cell volume (PCV %) count, blood sugar (mg/dl), serum calcium (mg/dl), serum sodium (meq/L) and serum potassium (meq/L) were high significantly increased in patient with renal failure after hemodialysis in comparison before hemodialysis, while blood urea (mg/dl) were high significantly decreased in patient with renal failure after hemodialysis in comparison before hemodialysis. In the Peritoneal dialysis patients: Hb (gm/dl) and PCV (%) count, blood sugar (mg/dl) and serum calcium (mg/dl) were high significantly increased in patient with renal failure after peritoneal dialysis in comparison before peritoneal dialysis, while blood Urea (mg/dl) and serum Creatinine (mg/dl) were high significantly decreased in patient with renal failure after peritoneal dialysis in comparison before peritoneal dialysis, while there were non significant differences in serum sodium (meq/L) before and after peritoneal dialysis.

Conclusion: Hemodialysis significantly increases some RBC, Hb and PCV. Hemodialysis cause significantly decreases blood sugar and urea. Peritoneal dialysis significantly increases PCV and Hb. Peritoneal dialysis cause decreases the blood urea and blood sugar. Hemodialysis was more useful and gives good results than peritoneal dialysis.