Vol 22, No 3 (2018)

Background and objective: Otitis media with effusion is one of the common diseases in children at preschool age. This study aimed to determine the prevalence of otitis media with effusion in Erbil governorate and compare this prevalence by urban and sub-urban areas and by different seasons.

Methods: This descriptive cross-sectional study was carried out in the Department of Otolaryngology, Rizgary Teaching Hospital from April 2015 to May 2016 through enrolling1077 children from randomly selected kindergartens.

Results: Of 1077 children, 124 were diagnosed as otitis media with effusion and the prevalence was 11.5% in Erbil governorate. The highest rate of otitis media with effusion was seen in spring (17.3%), followed by winter, autumn and summer (15.3%, 10.8%, and 4.3%, respectively). The prevalence of otitis media with effusion was higher in the sub-urban areas (13.8 %) compared with urban areas (10.7 %).The prevalence of otitis media with effusion was higher among male children (13.4%) than female children (9.4%). The highest proportion of diagnosed otitis media with effusion was among four years old children (13.6%), followed by five and six years old (10.5% and 7.7%, respectively). History of repeated upper respiratory tract infection and snoring were the most common risk factors seen in the child with otitis media with effusionin the rate of 70.2% and 69.4%, respectively.

Conclusion: The prevalence of otitis media with effusion among preschool-age children in Erbil governorate was 11.5% with a maximum prevalence of 17.4% in the spring season.

Background and objective: Although the ultimate pathogenesis of polycystic ovary syndrome remains obscure, the distinctive feature is the failure of follicular maturation resulting in an ovulation and accumulation of preantral and small antral follicles which contribute significantly to the production of the anti-mullerian hormone. This study aimed to compare anti-mullerian hormone concentration and antral follicle count in polycystic ovary syndrome and non-polycystic ovary syndrome women regarding clinical, hormonal and     ultrasound parameter in both groups.

Methods: A cross-sectional study with comparison group study was conducted in the fertility and gynecology outpatient clinic in the Maternity Teaching Hospital, Erbil, Kurdistan region, Iraq from April 1^st, 2015, to December 31^st, 2015. The study involved a total of 100 infertile women aged 18 - 39 years; 50 polycystic ovary syndrome women based on the Rotterdam criteria and 50 infertile non-polycystic ovary syndrome selected as a comparison group. Anti-mullerian hormone and antral follicle count in both groups were compared.

Results: A strong, inverse and significant correlation was found between anti-mullerian hormone and age in each of the two study groups. A weak correlation was detected between anti-mullerian hormone with body mass index, luteinizing hormone, follicular stimulating hormone, and total testosterone, in each of the two study groups. A significant inverse correlation was detected between anti-mullerian hormone and luteinizing hormone/follicular stimulating hormone ratio in the non-polycystic ovary syndrome group (P <0.001). There was a statistically strong, significant and positive correlation between anti-mullerian hormone and antral follicle count in each of the study groups.

Conclusion: Anti-mullerian hormone and antral follicle count are higher in polycystic ovary syndrome group than in non-polycystic ovary syndrome group. Elevated levels of the anti-mullerian hormone were associated and related to increased number of follicles in women with polycystic ovary syndrome.

Background and objective: An incidental lesion is an asymptomatic lesion found while examining a patient for an unrelated reason. Lumbar spine imaging may reveal either clinically insignificant spine incidental abnormalities and/or extra-spinal Incidental finding that, at times, may even explain the patient’s symptoms. This study aimed to evaluate the frequency and types of incidental findings in lumbosacral magnetic resonance examination and to find the correlation between the frequency distribution of findings in terms of age and sex.

Methods: This cross-sectional study involved 1250 persons who were referred for lumbosacral spine magnetic resonance imaging because of low back pain and/or radiculopathy. The magnetic resonance images were viewed to evaluate the frequency of incidental findings which were divided into extra and intraspinal findings.

Results: Incidental findings were noted in 332 (26.6%) patients of the 1250 comprising 94 (28.3%) males and 238(71.7%) females. Some of them had more than one incidental finding. Cortical and para pelvic renal cysts were the most common extra spinal incidental findings, while vertebral hemangioma was the most common intraspinal incidental finding.

Conclusion: Incidental findings were common in magnetic resonance imaging examination of the lumbar spine, and most were clinically insignificant; however some of these findings may be more significant than the spinal problems being evaluated and can have a significant impact on patient management. Therefore, they should be included in the reports since they will give additional and valuable information.

Background and objectives: Although a lot of studies suggested the predisposition of many risk factors, non-arteritic anterior ischemic optic neuropathy was considered for a long time to be idiopathic. This study aimed to assess the relationship between different factors and anterior ischemic optic neuropathy among a sample of patients in Erbil city.

Methods: A case-control study was conducted in Erbil city, Iraq from 2008 to 2011. A total of 36 cases of non-arteritic anterior ischemic optic neuropathy and 36 controls with other visual problems were included.

Results: Eight percent of patients in this study had one or more risk factors (P = 0.001), in particular hypertension and diabetes were shown to have a significant relationship (P = 0.046 and 0.001, respectively). The absence of physiological cup over the optic disc has crucial importance both independently (P = 0.001) and in association with diabetes (P = 0.001). Old age and male gender were significant factors in relation to co-morbidities (P = 0.001 and 0.038, respectively).

Conclusion: The study had concluded that hypertension, diabetes, age, male gender and absent physiological cup over the optic disc were important risk factors for anterior ischemic optic neuropathy.

Background and objectives: Leptin influences satiety, adiposity, and mechanism is with mechanisms regulating puberty onset, fertility, and pregnancy in various species. This study aimed is to evaluate the serum leptin levels indifferent trimesters of pregnancy and compare with healthy non-pregnant women.

Methods: The study was carried out in Erbil city from January to July 2016. Blood specimens were collected in different medical health centers in Erbil city. The sample consisted of two groups; group one consisted of 60 pregnant healthy female individuals. The pregnant group consisted of three subgroups according to the first, second and third trimesters. Group two (control) consisted of 28 healthy non-pregnant female individuals.

Results: There were statistically significant (P <0.003) elevation in serum leptin in pregnant compared with the non-pregnant group, and among trimesters. Serum leptin in the second trimester was significantly (P <0.001) higher than that of the first and the third trimesters.

Conclusion: Our finding showed that increased serum leptin concentration especially in the second trimester for development of placenta and fetus as a function of leptin.

Background and objectives: Providing safe medication administration is a vital process in ensuring patients’ safety and enhancing their quality of life. This study aimed to observe medication delivery in a public hospital in Erbil city to identify and examine the different steps of the medication administration process for quality assurance and safe drug administration.

Methods: A cross-sectional study of inpatients within different units of a public hospital in Erbil city was conducted through a quantitative and qualitative study. Data from the direct observation forms were collected and recorded via Microsoft Access using descriptive approach (frequencies and percentages) for analysis. The areas of concern in the study were: medication labeling, the five right of medication administration, the use of worksheets, identifying patients, double check medication, and the presence of disruptions at the time of medication administration.

Results: Data was collected from 72 observations for analysis. The quantitative data illustrates that 79% of medications were not labeled correctly, 83% failure of the use of two patient identifiers, 90% of medication administrations did not meet the “Five Rights” criteria. The use of worksheet was 82% during medication administration; failure to double-check the infusions counted for 71%, and 85% of medication administrations that were observed involved certain interruptions.

Conclusion: This study highlights the areas of enhancement that are significant to quality healthcare reform to ensure patients safety and providing medication management in a safe manner. The poor areas of practice were identified as labeling, patient identifiers, Five Rights, documentation, double check of infusion medications, and interruptions at the time of scheduled medication administration.

Background and objective: Type 2 diabetes mellitus constitutes a universal growing community health problem particularly in developing countries. This study aimed to determine and compare the rate of the glycemic control and other biochemical parameters of type 2 diabetic patients treated in a primary health center and the diabetic center.

Methods: A cross-sectional study was carried out on a sample of 300 adult patient’s aged ≥18 years with type 2 diabetes who attended Brayati family medicine center and the diabetic center in Erbil city during the period from the 1^st of January 2015 to the 28th of February 2016.

Results: The mean hemoglobin A1c among patients of the diabetes center was significantly higher than that among patients of the Brayati center (8.28% and 7.21%, respectively) (P <0.001) and the means of triglycerides, total cholesterol, and LDL were significantly higher among patients of the diabetes center compared with Brayati center (P <0.001). Half of the patients at Brayati center had controlled diabetes compared with only 24.7% of patients at the diabetes center (P <0.001), and 50% of the Brayati center sample had equal or more than three controlled risk factors compared with only one-quarter of the diabetes center sample (P <0.001). Logistic regression analysis showed that being a patient in Brayati center (compared with diabetes center) (P <0.001; OR = 3.1), diabetes duration of less than five years (P <0.001; OR = 3), and controlled lipid profile (P = 0.004; OR = 2.5) were significantly associated with diabetes control.

Conclusion: Type 2 diabetes can be effectively managed at primary health care, and good glycemic control can be achieved by a greater effort of the health care providers. Reorganizing primary care practice and shifting toward family medicine practice is necessary.

Background and objective: Nowadays, energy drink consumption has significantly increased in recent times. Students, athletes, and teenagers are among the most common consumers for a variety of reasons. For a public health point of view, little seems to be understood of the health benefits and other implications of these drinks by their consumer. This study aimed to evaluate the acute biochemical effects of energy drink in Erbil city.

Methods: Twenty four healthy male and female volunteer subjects of 21-23 years age consumed 250 ml of wild Tiger® beverage per day for one successive day after cross design. The biochemical tests were evaluated before and after consumption in the laboratory analysis using standard methods.

Results: There was a statistically significant increase in serum albumin, total protein, and GOT levels after consumption of energy drink (wild Tiger beverage) (P = 0.033, 0.034, and 0.017, respectively). However, energy drink consumption has no significant effect on serum electrolytes, urea, uric acid, creatinine, glucose, lipid profile, GPT, ALP, amylase, direct and total bilirubin, and minerals.

Conclusion: Energy drink consumption is associated with significant alterations in some biochemical parameters, and it will become a significant public health problem if their use among young people is not addressed through a cap on caffeine levels and restrictions on their sale for below eighteenth and marketing.

Background and objective: Myocardial infarction is the irreversible death (necrosis) of heart muscle secondary to prolonged lack of oxygen supply (ischemia), when the blood supply to a part of the heart is interrupted, most commonly due to rupture of a vulnerable plaque. The resulting ischemia or oxygen shortage causes damage and potential death of heart tissue. It is a medical emergency, and the leading cause of death worldwide. In this study, we investigated the association of serum C-reactive protein and serum lipid profile with myocardial infarction.

Methods: A cross-sectional study was carried out from January to May 2016 in College of Medicine, Hawler Medical University. The study involved 108 patients with myocardial infarction (70 men and 38 women) in comparison with 50 healthy individuals as the control group (29 men and 21 women).

Results: The levels of serum C-reactive protein were significantly higher (P <0.05) in patients with myocardial infarction in both genders when compared with the control group. There was no statistically significant difference in serum total cholesterol, serum triglyceride and serum LDL-C in patients with myocardial infarction and control group. Regarding serum high-density lipoprotein (HDL-C), there was a statistically significant difference (P <0.01) in patients with myocardial infarction when compared with the control group.

Conclusion: C-reactive protein may play an important role in providing clinicians and biochemists with valuable information regarding diagnosis and following up the patient with suspected myocardial infarction.

Background and objectives: Iron deficiency is an emerging problem in patients with chronic heart failure and could be a potential therapeutic target. This study aimed to determine the prevalence, severity, and type of iron deficiency among patients with chronic heart failure.

Methods: This study was conducted in Rizgary and Hawler teaching hospitals in Erbil from April 2015 to January 2016. A total of 60 patients with heart failure for more than six months with an ejection fraction less than 55% were enrolled. These patients were evaluated for iron status and hematological indices.

Results: The prevalence of iron deficiency was 76.7% with 52 %of them having severe iron deficiency. Absolute iron deficiency was detected in 41% of patients. The prevalence of anemia was 41.7%. There was a significant difference between those with chronic heart failure with iron deficiency and those with no iron deficiency in the hemoglobin (P = 0.001), mean cell volume (P = 0.001), mean corpuscular hemoglobin (P = 0.002), serum iron (P <0.001) and transferrin saturation (P <0.001).

Conclusion: Iron deficiency is common in chronic heart failure. It is the most common cause of anemia in such patients. Serum ferritin alone was not a reliable marker of iron deficiency in such patients.

Background and objective: Shaping and disinfection of the root canal with a combination of chemical agents and endodontic instruments play an important role in the success of endodontic therapy. This study aimed to evaluate the antibacterial properties of herbal alternatives as possible irrigates against Enterococcus faecalis during endodontic treatment compared with the conventional irrigation solutions such as NaOCl 5%.

Methods: A 10% Siwak extract, 10% green tea extract and 50% fresh lemon juice were prepared separately to make antibiotic disks and seeded on the culture media respectively and compared with 5% NaOCl, distilled water as the control. Plates were left to incubate for 48 hours at 37C^ₒ. Zones of inhibition of the bacterial growth were calculated to measure the antibacterial effect of the tested irrigants.

Results: All irrigants were active against this bacterium. The 5% NaOCl had the highest mean value (27.70±0.66), followed by 10% Siwak (Salvadorapersica) (21.60±0.7), 50% lemon juice (15.10±0.56), and 10% green tea (10.50±0.5).

Conclusion: Herbal extracts can be used as the possible irrigant to compensate 5% NaOCl during endodontic treatment.

Background and objective: Thyroid disorders are one of the most frequent pathologies found in the general population, but identifying thyroid disease can be clinically challenging because subclinical thyroid dysfunction and autoimmune thyroiditis are often asymptomatic and usually diagnosed biochemically. This study aimed to distinguish the autoimmune thyroid diseases from other forms of thyroid dysfunctions in patients admitted to PAR hospital in Erbil city.

Methods: blood was withdrawn from healthy subjects, and unhealthy patients suffer from thyroid dysfunction, their age and gender were recorded, and their blood serum were subjected to test the thyroid function antibodies including triiodothyronine T3, thyroxin T4, and thyroid stimulating hormone TSH. Also, autoimmune antibodies were tested including anti-thyroglobulin antibody (anti-TGA) and thyroperoxidase antibody (TPO antibodies).

Results: no significant differences were shown in T3 levels while contrary highly significant differences were shown in T4, TSH anti-TGA and anti-TPO levels between healthy subjects and unhealthy patients groups. The percentages of autoimmune thyroid diseases were (45.2%) as compared to the other forms of thyroid dysfunctions (54.8%). Most of the patients were females in the age group 30-39 years.

Conclusion: In Erbil city population/PAR hospital the prevalence of autoimmune thyroid diseases were more frequent among other thyroid diseases collectively. It is mostly found in females rather than males within the age group 30-39 years.

Background and objectives: Knowledge transfer and exchange is a dynamic and complex process which comprises the creation of knowledge and its application to improve health, provide more effective health services and products, and will strengthen the overall healthcare system. This study aimed to understand the current context of knowledge  transfer and exchange and identify the main barriers and facilitators for enhancing that from the perspective of university academics.

Methods: This cross-sectional survey was carried out between February to September 2015 on 160 academic researchers of the four colleges of Hawler Medical University; Medicine, Dentistry, Pharmacy, and Nursing. A self-administered questionnaire was used for this purpose. Likert scale was used to rate participants answers and SPSS for assessing the level of association between different variables.

Results: The study revealed that the mean ± standard deviation time academic researchers used for conducting different activities of knowledge transfer and exchange was 9.39 ± 14.08 and that around 43% of the participants stated that they use less than 5% of their time for knowledge transfer and exchange activities. There was no significant statistical association between knowledge transfer and exchange percentage time used by academic researchers from one side and research areas and different colleges from another side.

Conclusion: There is an obvious shortfall from the side of academic researchers in transferring or exchanging the knowledge they acquire from their health research to their target audience. There is a lack of investment from the side of academic researchers in health policy and system research.

Background and objective: Renal failure is a worldwide public health concern due to the significant increase of patients each year. Diet and nutrition play a crucial role in symptom management, quality of life and survival of renal failure patients, as well as the prevention of disease progression. This study aimed to assess nurses’ knowledge of the nutritional management of patients with renal failure and to find out the relationship between nurses’ knowledge and their socio-demographic characteristics.

Methods: A descriptive cross-sectional research design was used from April to August 2016. A purposive sample of 51 nurses at the Dialysis Unit of Hawler Teaching Hospital and Hawler Dialysis Center, Kurdistan Region, Iraq were recruited and completed a self-reported questionnaire.

Results: Most participating nurses were male (76.5%), and the majority (52.9%) were between 26-32 years old . Most of them  were married (68.6%), had a diploma certificate (58.7%) with 37.3% having 4-7 years of working experience at the two above-noted dialysis centers. The majority of nurses (70.6%) had fair knowledge score, while 17.6% had a good knowledge score and 11.8% had a low knowledge score.

Conclusion: The majority of nurses had fair knowledge regarding nutritional management for renal failure patients.

Background and objective: Pseudomonas aeruginosa is very a well-documented nosocomial and opportunistic microorganism, a little challenge is being present with the identification of such pathogen. This study aimed to identify Pseudomonas on genus and species levels by conventional PCR and determine multi-drug resistant isolates.

Methods: A total of 180 clinical isolates of Pseudomonas species were recovered from in and outpatients who attended Azadi and Rezgari Teaching hospitals in Duhok and Erbil city from October 2015 to May 2016. These isolates were phenotypically identified using standard microbiological procedures. A total of 100 isolates were randomly selected and confirmed at a molecular level as Pseudomonas spp.

Results: By applying genus-specific gyr B2 primer which produced1130bp amplification band and sixty-eight isolates were identified by PCR as P. aueroginosa using species-specific primer for 16S rRNA region which showed 956bpamplicon. Forty-six isolates out of the sixty-eight resembling Pseudomonas aeruginosa were diagnosed as  being multi-drug resistant isolates by the disc diffusion method.

Conclusion: It can be concluded that multi-drug resistant isolates can pose a serious threat for the hospital-resident patients as increasing numbers of these isolates are being recorded in local settings.

Background and objective: Gestational diabetes mellitus affects 7% of all pregnancies. It is defined as glucose intolerance that begins or is first diagnosed during pregnancy. It is crucial to detect women with gestational diabetes mellitus because the condition can be associated with several maternal and fetal complications. This study aimed to determine the maternal and fetal outcome of gestational diabetes mellitus in maternity teaching hospital in Sulaimani city, Kurdistan, Iraq.

Methods: This prospective observational study had involved 100 pregnant women with gestational diabetes mellitus. Data were collected from 1st January 2014 to 1st July 2014.

Results: Most women were in the age group 30-39 years (57%) and were multigravida (75%). Regarding women’s BMI, 69% of women had a BMI of >30 kg/m².  Most of the women delivered by cesarean section (68%). Also, 63% delivered term baby ≥ 37weeks. Of the women who used insulin, 30.6% delivered babies >4 kg. Complications occurred in 10%, 12.9%, and 11.1% of women who treated by diet, insulin, and the group used metformin then insulin, respectively.

Conclusion: The results conclude that pregnant women with gestational diabetes mellitus have increased the risk of hypertension in pregnancy, preterm delivery, and cesarean section. Increasing age, family history of diabetes, increasing parity, and increase in BMI are a risk factor for developing gestational diabetes mellitus. Also, most of the maternal complications occurred in those women who were on metformin. The occurrence of macrosomia was low in the treated cases of gestational diabetes mellitus.

Background and objective: Healthcare workers have been identified as the source of infection in many outbreaks of methicillin-resistant Staphylococcus aureus in the hospital environment. Therefore, we aimed to demonstrate the prevalence of nasal carriage of methicillin-resistant Staphylococcus aureusand their antibiotic resistance patterns among healthcare workers.

Methods: A cross-sectional study was carried out on a total of 94 healthcare workers at Nanakaly hospital. Nasal swabs were collected and cultured on Mannitol Salt Agar. Staphylococcus aureus was identified by Gram's stain, catalase test, and coagulase test. Staphylococcus aureus isolates were confirmed as methicillin-resistant Staphylococcus aureus using cefoxitin (30 μg) disc diffusion test. Antibiotic susceptibility was performed according to the Kirby-Bauer disc diffusion method.

Results: A total of 23 (24.5%) healthcare workers were nasal carrier for Staphylococcus aureus, and the overall methicillin-resistant Staphylococcus aureus carriage rate was 8.5%. There was no statistically significant difference between the gender (P = 0.29), age (P = 0.29), and occupations (P = 0.721) and the nasal carriage of methicillin-resistant Staphylococcus aureus and methicillin-sensitive Staphylococcus aureus. All isolates of methicillin-resistant Staphylococcus aureus and methicillin-sensitive Staphylococcus aureus were sensitive for linezolid and mupirocin. The highest resistance rate for both erythromycin and clindamycin (75%) was noted among the methicillin-resistant Staphylococcus aureusstrains, while the highest resistance rate in methicillin-sensitive Staphylococcus aureus strains was penicillin (72.5%), erythromycin (20%) and ciprofloxacin (13.3%).

Conclusion: Healthcare workers were the potential colonizers of methicillin-resistant Staphylococcus aureus. So regular screening of the healthcare workers is one of the effective methods to reduce and control of methicillin-resistant Staphylococcus aureus in any health care facility and applying the appropriate preventive measures will prevent transmission of methicillin-resistant Staphylococcus aureusto other contact patients.

Background and objective: Seborrheic dermatitis is chronic skin disease with exacerbation and remission, many topical and systemic therapies were used, including oral antifungal itraconazole, oral isotretinoin efficacy in the treatment of seborrheic dermatitis less studied. This study aimed to compare the efficacy and safety of low dose oral isotretinoin and oral itraconazole in the treatment of patients with seborrheic dermatitis.

Methods: A total of 68 patients with seborrheic dermatitis were participating in a randomized, parallel-group study. One group (n = 31) took 200-mg/day oral itraconazole for one week of the first month, followed by 200 mg for the first two days of the next two months. The second group (n = 37) took oral isotretinoin 20 mg twice weekly for three months. Seborrheic dermatitis area severity index and intensity of itching and burning sensation were calculated before, during three months and one month after treatment.

Results: Both drugs significantly reduced the severity of seborrheic dermatitis (P <0.05). When the two groups were compared, patients taking oral isotretinoin showed a significantly greater decrease in seborrheic dermatitis area severity index score than itraconazole group particularly in the second and third months of treatment.

Conclusion: Low dose oral isotretinoin is more effective than oral itraconazole in treating seborrhea dermatitis.