Vol 24, No 2 (2020)

Background and objective: This study aimed to investigate two mass graves located in Sorya village, Duhok governorate-Iraqi Kurdistan region.

Methods: The investigation included excavation of the graves and identification of the victims. The field study was started after taking testimonies and witnesses for locating the site of graves. Two sites were described (Site 001 and site 002), which were excavated according to the scientific standard procedures. Sex determination, age, and stature estimation were performed on the remained skeletons in the medico-legal institute-Erbil laboratory.

Results: Site 001 included 14 bodies, two of them were males and five were females, whereas the others were not identified because of degradations happens to the bones. Site 002 included 25 bodies, which were Christians according to witnesses and supported by evidence. Four victims appeared to be males, 14 were females, and 7 could not be identified. The results of age estimation reported that the number of young bodies in site 001 was five bodies, which represent 35.7% of them all, while 13 out of 25 were young bodies in site 002, which produced 52% of all victims. All the remained bones were recorded in detail for more documentation.

Conclusion: This finding described the exhumation and anthropological evaluation of two mass graves in Sorya– Duhok governorate Iraqi Kurdistan region. The majority of the victims were females and contain Christian and Muslims people.

Background and objective: This study aimed to differentiate acute myocardial infarction from unstable angina upon the onset of chest pain, by evaluating the usefulness of combined biomarkers troponin I, ischemia modified albumin, and heart-type fatty acid binding protein as early as possible.

Methods: A cross-sectional study was conducted at the Department of Clinical Analysis, College of Pharmacy, Hawler Medical University. This study included 73 patients with suspected acute coronary syndrome, who attended to the Emergency and /or Cardiac Care Unit departments of Hawler Teaching Hospital and Rojhalat Emergency Hospital, Erbil, Iraq, and who were diagnosed with either acute myocardial infarction (n=45) or unstable angina (n=28) between 12 May 2013 and 25 January 2014. Serum troponin I, heart-type fatty acid binding protein, and ischemia modified albumin were determined twice, at between 30 minutes and 4 hours, and between 6 and 12 hours after the onset of chest pain.

Results: For diagnosing and differentiating between acute myocardial infarction and unstable angina, the sensitivity and specificity of serum troponin I cut-off value at (≤4) hours of chest pain was 53.3% and 100%, respectively. The sensitivity and specificity were 97.8% and 96.4 at 6-12 hours after onset of chest pain. The sensitivity and specificity of heart-type fatty acid binding protein cut-off values at (≤4) hours was 48.9% and 100%, respectively, increasing to 84.4% and 100% at 6-12 hours. The combined use of serum troponin I and heart-type fatty acid binding protein enhanced sensitivity to 73.3% at the first interval, and 100% at the second.

Conclusion: A combination of troponin I and heart-type fatty acid binding protein tests improves sensitivity in diagnosing and differentiating acute myocardial infarction and unstable angina within the first 4 hours of chest pain. 

Background and objective: Perthes disease is a condition in which a self-limiting avascular problem affects the capital epiphysis of the femur with a variable course and outcomes. There are patients who definitely benefit from different treatment courses, either surgical or non-surgical, but better with surgical. This study aimed is to determine the outcome of varus derotational osteotomy procedure in the management of Perthes disease.

Methods: In this retrospective study, which was conducted in the orthopedic department of Erbil teaching hospital, 21 patients (22 hips) with Perthes` disease were enrolled over the period of 10- years, from 2008 to 2018. Varus derotational osteotomy to proximal femur was done for all 22 hips affected by Perthes disease in different radiological stages.

Results: Among the patients, 81.0% were males and right side of the hip was the most predominant (52.4%) affected side. Partial limitation of hip movements with +ve Trendelenburg sign were the main clinical findings (52.4%), especially among those aged ≤8 years, males and left side affected patients (54.5%, 72.7%, and 63.6%, respectively). Subluxation and metaphyseal resorption were the main radiological findings of the head of the femur (36.4% and 31.8%, respectively). Radiological stages of the patients mainly showed early fragmentation, late fragmentation, and early healing stages (27.3%, 27.3%, and 22.7%, respectively). Postoperatively, 59.0% of the patients had a good prognosis (Stulberg grades 1 and 2), while 31.9% had a fair prognosis. Those aged ≤8 years had a better prognosis with a significant statistical association between Stulberg classification and those with lateral pillar B & B/C and early three radiological stages (P = 0.01 and 0.005).

Conclusion: Open wedge varus femoral osteotomy is the treatment of choice and gives good results. The strongest predictor of outcomes is Stulberg classification in relation to age, lateral pillar classification, and preoperative radiological stages of the disease.

Background and objective: Variation in paranasal sinus anatomy, as shown on computed tomographic scans, is of potential significance as it may pose risks during surgery or predispose to certain pathologic conditions. This study aimed to investigate the frequency of anatomic variants of the nasal cavity and paranasal sinuses in our population and determine their relationship with gender and find out the association of these variants with mucosal abnormalities.

Methods: This was a cross-sectional study conducted at the College of Medicine, Hawler Medical University from October 2017 to January 2019. A review of computed tomography scans of the paranasal sinuses of 300 patients was done; special attention was directed toward identifying bony anatomic variants and mucosal abnormalities.

Results: Frequent variants were: Agger nasi cells (72%), nasal septal deviation (71.7%), Haller cells (70.7%), concha bullosa (61%), elongation of uncinate process (69.7%) and different variants of the sphenoidal sinus (78.8%). The frequency of variants did not differ significantly with respect to gender, except for sphenoidal variants along with Keros types and asymmetry of the ethmoidal roof. A significant association was found between middle concha variants and inferior turbinate enlargement (P <0.001).

Conclusion: Anatomic variants of the paranasal sinus region were common in our population; the most frequent ones were those involving the nasal septum, ethmoid air cells, sphenoid sinuses, and middle turbinates. The study of these variants is important for the management of paranasal sinus region disease.

Background and objective: P63 is a member of the p53 gene family. It plays an essential role in the normal development of the cervix. This study aimed to assess p63 expression in different cervical lesions and the correlation between their expression in cervical intraepithelial neoplastic changes and invasive cervical cancer. 

Methods: A total of 62 cervical tissues were performed for p63 immunostaining, including 15 samples of non-neoplastic reactive cervicitis, 27 cervical intraepithelial neoplastic changes, and 15 invasive cervical cancer cases as well as five samples of normal cervical tissue as control.

Results: P63 in normal cervical squamous epithelium had restricted staining pattern in the nuclei of basal cells. Reactive cervicitis staining ranged from restricted staining pattern in basal cells to mild increase in staining intensity involving upper parabasal cells. P63 was positive in all CIN lesions, and staining intensity increased significantly with increasing severity of cervical intraepithelial lesions compared with non-neoplastic epithelium. All cervical squamous cell carcinoma had high staining intensity while adenocarcinoma and small cell carcinoma were stained negative.

Conclusion: P63 can be used as a marker for the distinction between reactive cervicitis and cervical intraepithelial changes. It is also of value for grading of CIN lesions and differentiation between squamous cell carcinoma, adenocarcinoma, and small cell carcinoma.

Background and objective: Coronary atherosclerosis is an inflammatory disease that may be caused by numerous factors. One of the most important factors is obesity; there are high concentrations of interferon gamma (IFN-γ) in obese patients. This study aimed to assess the levels of proinflammatory markers IFN-γ and high sensitive C- reactive protein (Hs-CRP) in obese coronary atherosclerotic patients and determine its correlation with lipid profiles.

Methods: The present case-control study was carried out between December 2017 and May 2018 in the Cardiac Center-Surgical Specialty Hospital in Erbil city. It included 49 coronary atherosclerotic patients, 25 males and 24 females, and 39 controls. The sera were subjected to estimate of some inflammatory biomarkers including IFN-γ, Hs-CRP, and lipid profile such as total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoproteins cholesterol (LDL-C) and very low- density lipoproteins (VLDL-C).

Results: Serum concentrations of IFN-γ and Hs-CRP in coronary atherosclerotic patients were increased significantly than controls (P = 0.031, P = 0.001), respectively. Indeed the same above results were seen in obese coronary atherosclerotic patients and controls than non-obese coronary atherosclerotic patients controls. The mean concentration of lipid profile in obese coronary atherosclerotic patients was decreased than non -obese coronary atherosclerotic patients and controls, with no significant differences (P ≥0.05). There was a weak negative significant correlation between IFN-γ and HDL-C in obese coronary atherosclerotic patients (r= -0.456; P = 0.040).

Conclusion: Proinflammatory cytokine as IFN-γ played a vital role in the pathophysiology of obese atherosclerotic patients in combination with Hs-CRP and LDL-C, which could be used as predictors for progressive the disease.

Background and objective: Cervical cancer is the fourth most common cancer among women. Carcinogenic Human Papilloma Virus (HPV) infection is the major etiological agent for cervical cancer, of which70% are caused by HPV-16 and HPV-18 genotype infection. This study aimed to detect high risk HPV (16,18) in women with different abnormalities in pap smear to allow subsequent more accurate management of the cases and provide information that assists in future development of guidelines in our hospital.

Methods: We performed a cross-sectional study on 100 ladies with an abnormal pap smear. Subjects were interviewed and underwent cervical testing with broom using liquid based samples to confirm the cytological abnormality and test for HPV genotypes 16 and 18 using Polymerase Chain Reaction (PCR). Then, colposcopy referral was done according to local protocols.

Results: The median age of the subjects was 34. The prevalence of HPV genotypes 16,18 in the whole studied sample was 36%. Various studied risk factors showed significant association with abnormal pap smear and positive HPV genotypes 16,18, including the number of partners, increasing parity, age at first pregnancy, and smoking. Data were analyzed by the statistical package for the social sciences (version 23).

Conclusion: The prevalence of HPV 16,18 was 36% in the sample, with the highest proportion being among those with high-grade lesions. Those using natural methods of contraception had higher rates of infection in comparison with other methods.

Background and objective: Tonsillectomy is one of the most common surgeries, and post-operative pain is one of the most common inevitable sequel. Although various post-operative analgesia are used, pain is still an issue needed to be handled more thoroughly to gain early oral intake, less hospital stay, and early return to normal life. Thus, efforts are made to employ pre-emptive analgesia and achieve more relief. This study evaluated the effectiveness of pre-incisional peri-tonsillar (subcapsular) infiltration of bupivacaine in decreasing the post-tonsillectomy pain.

Methods: The study design is a prospective single-blinded controlled intra-individual study wielding a convenience sample of 45 patients of both genders, aged 14-40 years underwent tonsillectomy. Under general anesthesia, left tonsillar fossa infiltrated with 3cc of bupivacaine 0.5, leaving the other side free as a control side. After a wait time of 10 minutes while operating right side, left tonsillectomy done. post-operative pain was assessed using a visual analogue scale (VAS) on ½, 2, 4 and 6 hours pos-operatively.

Results: The mean age of the study participants was 24.44±6.959, and they included 29 (64.4) females and 16 (35.6) males. Seven patients (15.6%) showed no pain difference between left (test) side and right (control) side while 38 patients (84.4%) had a significant difference. The test side mean pain score was 1.01±0.64, and the control side mean pain score was 2.24±1.18 (P <0.001).

Conclusion: Infiltration of 3cc bupivacaine with a latent period of 10 minutes reduces the post-tonsillectomy pain by around two folds without any additional analgesia in the initial six hours.

Background and objective: Prostate Thulium laser vaporization is a novel treatment option for a bladder outlet obstruction caused by benign prostate enlargement. However, this surgical technique has not yet been standardized. We present our finding of using Tm vaporesection of the prostate. This study aimed to assess the efficacy and safety of thulium laser versus bipolar transurethral resection of the prostate for treating patients with benign prostatic obstruction.

Methods: Sixty three consecutive patients with benign prostatic hyperplasia attending public and private clinics in Erbil city were included in a comparative study from June 2014 to July 2016. Thulium laser vaporesection of the prostate was done for Group I (n = 31), and transurethral resection of the prostate was done for Group II (n = 32). All cases were evaluated preoperatively and were evaluated at 6-24 months postoperatively by international prostate symptom score, post void residual urine volume, and quality of life. Forty four patients completed the two years of follow up.

Results: Thulium laser vaporization was significantly superior to bipolar plasmakinetic resection of the prostate in term of catheterization time (1.2 ± 0.7 vs 4.9 ± 1.7 days, P ≤0.001), hospital stay (1.5 ± 0.9 days vs 3.2 ± 1.6 days, P = 0.001) and drop in hemoglobin (0.8 ± 0.3 vs 2.35 ± 0.4 g/dl, P ≤0.001) and inferior to PKRP operation time (68.2 ± 27.3 vs 58.3 ± 22.7, P = 0.122). Both groups resulted in a significant improvement from baseline in terms of subjective symptoms scoring, but no significant difference was found between the two groups.

Conclusion: Thulium laser vaporesection of the prostate is a safe and effective procedure for the treatment of symptomatic benign prostatic obstruction, with low perioperative morbidity however, both procedures showed no significant difference in terms of international prostate symptom score, post void residual urine volume and quality of life.

Background and objective: Treatment of an animal with dexamethasone will result in sinuses extension, fat accumulation in the liver, and enlargement of hepatocytes. Whereas, non-steroidal anti-inflammatory drugs (diclofenac sodium) administration may lead to degeneration and formation of wide areas in the form of sinusoidal. Hydropic degeneration possibly is seen in the tubular epithelial cells of the kidney tissue. This study aimed to assess the toxic and side effects of dexamethasone and diclofenac sodium on the liver and kidney in rats, whether used separately or together.

Methods: A total of 40 male albino rats were divided into four groups of ten in each, including the control group. One set was treated with dexamethasone (1.6 mg/kg/day), the other was treated with diclofenac sodium (30 mg /kg/day), and the last was treated with both drugs together at the same dose without mixture. Both drugs were administered intramuscularly for 30 days. Sections from the liver and kidney were stained by Hematoxeline and Eosin, then examined under a microscope.

Results: Histopathological variation in the liver and kidney tissue of the treated animals have revealed that each drug (dexamethasone, diclofenac sodium) showed a significant alteration. Strong changes (+ + +) were observed in kidney tissue include degeneration, inflammatory aggregation, fibrosis, and edema, whereas in liver showed central vein dilatation, necrosis, and kupffer cells hyperplasia. Treating with the two drugs together, less alteration (+) in the tissues was noticed.

Conclusion: The effect of both used drugs (dexamethasone and diclofenac sodium) was observed on the liver and kidney tissues of the experimental animals (rats) regardless of being applied separately or the two together. A probable inhibition role of the two drugs on each other have been noticed that lead to call for more detail investigation on this matter in years to come.

Background and objective: Multiple sclerosis is one of the chronic central nervous system diseases. Depression comorbidity is common with multiple sclerosis. This study aimed to determine the prevalence of depression among patients with multiple sclerosis and the relation of patient demographic data and disease status.

Methods: A cross-sectional study was conducted in Rizgary Teaching Hospital in Erbil City, in a one-year duration from October 2017 to October 2018. The sample size was 169 known patients with multiple sclerosis, which was collected randomly. Beck Depression Inventory was used. The statistical package for the social sciences (version 25) was used for data analysis. Pearson Chi-square and Fisher's Exact Test were used to finding the association between various variables and depression.

Results: The prevalence of depression among patients with multiple sclerosis was 53.5%. Age group more than 50 years was found more depressed (66.7 %,P = 0.006). Depression is more with those with multiple sclerosis for 10 years and more (84.6%) with a statistically significant association (P = 0.021). Treatment by rituximab show more depression (85.7%,P = 0.039). The frequency of severity of major depressive disorder was (mild 31.8%, moderate 52.9%, and severe 15.3%) and showed no significant association with different variables.

Conclusion: The prevalence of depression among patients with multiple sclerosis was high. The age group of more than 50 years, duration of multiple sclerosis equal or more than 10 years, and rituximab treatment were regarded as risk factors.

Background and objective: Neonatal sepsis refers to infection occurring within the neonatal period, the first 28 days of life for a term baby, and up to 4 weeks beyond the expected date of delivery in a pre-term baby. This study was designed to determine the frequency of neonatal early onset sepsis and late onset sepsis in some hospitals in Erbil city.

Methods: Out of 170 neonate samples from Neonatal Intensive Care Unit in Rapareen Pediatric Teaching Hospital and Maternity Obstetric Hospital randomly were studied through isolation and identification of causative bacteria using the traditional approach, VITEK 2 compact system, molecular detection using PCR technique, moreover, C-reactive protein and white blood cell count detected as biomarker assay. The isolated bacteria tested against some widely used antibiotics.

Results: The sepsis was confirmed in 54 (31.76%) patients of total neonates with suspected cases of sepsis by clinical signs and symptoms. EOS was 42 (77.77%) were detected, and late onset sepsis was 12 (22.23%). Identification of the isolated bacteria by the traditional method, and VITEK 2 compact system were performed. In addition, molecular detection via the PCR system through the detection of the specific genes was performed. Antimicrobial Susceptibility test indicated that most of the isolated bacteria were developed resistant to the most widely used antimicrobials.

Conclusion: Our study showed a high incidence of neonatal early onset sepsis more than late onset sepsis, mostly associated with Gram-negative bacteria than Gram-positive bacteria.

Background and objective: Hyperemesis gravidarum can be defined as intractable nausea and vomiting, leading to electrolyte imbalance, ketonuria, nutrition deficiency, and weight loss during pregnancy. This study aimed to investigate the association of the platelet to lymphocyte ratio and plateletcrit with the presence of hyperemesis gravidarum.

Methods: A case-control study was conducted at Maternity Teaching Hospital in Erbil city, Kurdistan region of Iraq, between January 1st, 2017 and January 1st, 2018. A convenience sample of 120 pregnant women, of which 60 of them with a diagnosis of hyperemesis gravidarum admitted to the emergency department, were regarded as cases. The other 60 visited the outpatient department with mild discomfort, but not having hyperemesis gravidarum were regarded as controls. Age, gestational age, gravida, parity, height, and weight and laboratory parameters, including complete blood count from which we had platelet to lymphocyte ratio and plateletcrit %, were recorded on a specially designed questionnaire. Chi-square test, Fisher’s exact test, Student's t-test, Youden’s index were used to determine the associations.

Results: The platelet to lymphocyte ratio and plateletcrit were higher in the hyperemesis gravidarum groups than controls (P <0.001). The area under the curve for platelet to lymphocyte ratio and plateletcrit were 0.887 and 0.936, respectively, with P <0.001. Platelet to lymphocyte ratio >145.07 and plateletcrit >0.205% were significantly related to an increased risk of hyperemesis gravidarum.

Conclusion: The platelet to lymphocyte ratio and plateletcrit are higher in hyperemesis gravidarum cases and may have a predictive value of the development of hyperemesis gravidarum as further studies needed in the future to confirm.

Background and objective: One of the well-organized diagnostic methods of Helicobacter pylori (H. pylori) infection is bacterial DNA detection in saliva using polymerase chain reaction (PCR). However, a wide range of factors is present in human saliva that could hinder detection efficiency. One of these factors seems to be the pH of saliva, which is investigated in this study as to whether its variation could have any effects on H. pylori DNA presence in the saliva of infected patients.

Methods: Saliva samples of 89 H. pylori-infected Patients were collected and measured for pH levels. The DNA of H. pylori was extracted from the saliva of patients and then quantified directly by Real-time PCR. One Way ANOVA and Linear Regression tests were performed to determine the effect of pH on the detection of H. pylori DNA in the saliva.

Results: 58% of samples were PCR positive (17% high, 19% medium, and 22% low titer), and no DNA was detected in 42% samples. There was no significant association between the age of patients and the detection of DNA (P = 0.98). A statistically significant difference in pH level was found between negative and positive PCR samples. Calculation of linear regression of DNA copy numbers and independently increasing pH showed R² = 0.041.

Conclusion: The ability to detect H. Pylori DNA was generally confined to pH of 5.5 to 7.5 with an apparently reduced detectability at above neutral pH of saliva. However, pH variation from 5.5 to 7.5 did not determine the levels of detected DNA of H. pylori in saliva.

Background and objective: M. tuberculosis is one of the main causes of morbidity and mortality in many countries and is considered a priority global health problem. Although it is a curable disease, every year about nine million people develop active disease, and two million die from it. This study aimed to find the pattern of tuberculosis among children in Erbil city and determine the treatment outcomes of pediatric tuberculosis.

Methods: From March 2012 to March 2016, 142 patients younger than 18 years with confirmed diagnosis of tuberculosis were registered and treated at the Chest and Respiratory Disease Centre in Erbil. The diagnosis of tuberculosis was performed based on routine tests at the center. AFB smear staining, GeneXpert assay, and culture methods when required for further confirmations using L-J media.

Results: The total number of the studied records of tuberculosis was 729 during five years (2012-2016). More than half (55.6%) of patients aged ≤ 18 years were males. It is evident that the number of cases is increasing with the progress of years, but the difference was not significant between the years (P = 0.534). The death rate was 9.1% among patients of the whole sample, but no significant association was detected between age and outcome and was highest (22.7%) among patients aged 7-12 years (P = 0.142).

Conclusion: Tuberculosis is still a very severe disease with high mortality rates in children. Early recognition of infection associated with correct early treatment, systematic entourage investigation, and chemoprophylaxis by isoniazide in all children under five years of age is essential for attempting to reduce these prognostic indices.

Background and objective: Although snoring and day time tiredness and are a common finding in persons with obstructed sleep apnea; however, most of them are unaware of their diseases. This study aimed to find the prevalence of sleep apnea and symptoms at the primary care level.

Methods: A cross-sectional study was conducted among randomly selected 500 patients aged ≥ 18 years attending two primary care centers in Erbil city, from the 1st of April 2018 to the end of February 2019. A Berlin modified questionnaire was used to address an individual's characteristics, risk factors, and clinical symptoms.

Results: The mean age + SD of 500 individuals was 41.06 + 14.79 years. Nearly all (97.2%) of the participants were living in urban areas. Around three quarters (72.2%) of the sample were married, 27.8% were smokers, 45.8% were overweight, and 18.6% were obese. The overall prevalence of obstructed sleep apnea was 23.2%, the prevalence of low-risk OSA was 22.4%, and the prevalence increased with age. Obstructed sleep apnea was more among females (26%) than males (20.8%), although the difference was not significant. A high percentage was observed among those with raised blood pressure and obese persons (87.9% and 86%, respectively). No significant association was detected between obstructed sleep apnea and smoking.

Conclusion: High risk of obstructive sleep apnea was common among patients attending primary care. Awareness and education of physicians and patients about the disease is essential. Those at high risk should be referred to sleep centers for further evaluation.

Background and objective: Thrombocytopenia (platelet count < 150 × 10⁹/L) is considered the second leading responsible factor in blood disorders in pregnancy after anemia. Substantial thrombocytopenia has been shown to associate with medical conditions. The present study aimed to compare the levels of platelets during labor between the patients diagnosed with preeclampsia and their age-matched healthy subjects.

Methods: In this case-control study, the thrombocytopenia was compared between 55 patients diagnosed with preeclampsia and 59 age-matched healthy controls. In this study, the thrombocytopenia was categorized as follows; normal (150-400 × 10⁹/L), mild (100-149 × 10⁹/L), moderate (50-99 × 10⁹/L), and severe (<50 ×10⁹/L).

Results: The study showed that the cases and controls were comparable in general information. The number of platelets was significantly lower in patients with preeclampsia (73.58 ± 26.05) compared to the controls (262.05 ± 81.01; and the P <0.0001). The serum bilirubin (P <0.0001) and the serum creatinine (P = 0.002) were substantially lower in the cases compared to the controls in contrast with urine protein (P <0.0001). The patients with preeclampsia were more likely to undergo an emergency cesarean section (65.5% vs. 11.9%), to have antepartum hemorrhage complications (67.3% vs. 18.6%), to get any kind of hypertensive disorders in pregnancy, and to admit the newborns to neonatal intensive care unit (60.0% vs. 35.6%).

Conclusion: The present study showed that the preeclamptic patients had lower platelet count compared to non-pre-eclamptic. In addition, they were more likely to have more obstetrical complications.

Background and objective: Pseudomonas aeruginosa is an opportunistic pathogen and inherently resistant to many antibiotics and can mutate to even more resistant strains during therapy. Resistance to the antibiotics in this group of bacteria increased due to the activity of β-lactamase genes and one of the most important groups of genes, blaOXA gene producing enzymes. The current study aimed to determine the prevalence of Ambler class D β-lactamases, including OXA-10 gene among P. aeruginosa isolated from patients in Erbil, Kurdistan.

Methods: Different clinical specimens were taken from patients with clinical symptoms of infection during one year. Identification was carried out on all isolates by Vitek2 system. Antibiotic susceptibility for antimicrobial agents was performed according to the clinical and laboratory standards institute (CLSI) guidelines. Production of Ambler class D β-lactamases was confirmed by polymerase chain reaction technique.

Results: A total of 100 isolates of P. aeruginosa, 57 isolates (57%) had shown resistance to six or more than six antibiotics, and 15 isolates showed resistance to one antibiotic. Also, none of the resistant isolates were showed complete resistance to all antibiotics. Out of 89 P. aeruginosa, 38.2% of isolates possessed the blaOXA-10 gene.

Conclusion: The results revealed the occurrence of extended-spectrum β- lactamases producing Pseudomonas aeruginous, and proper infection control practices are crucial to avert the spreading of ESBL-producing isolates in hospitals.