Vol 25, No 3 (2021)

Background and objective: Oral mucositis is caused by the destruction of the oral mucosal epithelium and suppression of its growth secondary to antineoplastic treatment in the form of chemotherapeutic drugs, substances, or radiotherapy. This study aimed to evaluate oral mucositis in pediatric cancer patients because it is one of the common side effects of cancer therapy that influences the outcome.

Methods: This is a cross-sectional study that enrolled 100 pediatric patients with both hematological and non-hematological cancer. The age of the patients ranged from 1-18 years, involving both genders. Cases admitted to Hiwa hospital were clinically evaluated for oral mucositis, and ethical permission was taken from parents. Risk factors were assessed, including age, sex, cancer type, type of chemotherapy, radiotherapy, number of cycles, complete blood count, interleukin-1 beta, interleukin-6, tumor necrosis factor-alpha, and tumor necrosis factor-beta.

Results: Baseline serum cytokines levels showed significant correlation between Interleukin-6 and intensity of the oral mucositis (P = 0.003, rho = 0.314) and no correlation between severity of oral mucositis with tumor necrosis factor-alpha, tumor necrosis factor-beta nor interleukin-1 beta (P = 0.140 and rho = 0.258, P = 0.463 and rho = -0.079, and P = 0.706 and rho = -0.041, respectively). There was significant relationship between Hemoglobin level, neutropenia and type of non-hematological cancer with the intensity of oral mucositis respectively (P ≤0.001 and rho = -0.352, P = 0.027 and rho = -0.221, and P = 0.035 and rho = 0.095, respectively). Correlation between age, gender, white blood cell count, platelet count, type of hematological malignancy and past history with the intensity of the oral mucositis did not show significant result.

Conclusion: Intensity of oral mucositis increased with anemia, neutropenia, high interleukin-6 level, and the type of non-hematological cancer. It is recommended to treat anemic, neutropenic patients as soon as possible before exacerbating the mucositis. Methotrexate is the most aggressive drug alone and in combined chemotherapy agents, which may cause mucositis and needs prophylaxis like topical nystatin suspension or other methods.

Background and objective: Ocular posterior segment lesions can affect individuals of both sexes at all ages. Such lesions can lead to serious manifestations such as retinal detachment and retinal hemorrhage, leading to permanent loss of eyesight. This study aimed to determine the association between age and gender and changes in ocular posterior segment based on ultrasonography findings.

Methods: This prospective cross-sectional study included 50 patients with blurry vision who had been referred from ophthalmology outpatient clinics to the radiology department of Rizgary Teaching Hospital in Erbil, Kurdistan region in Iraq. Required data were collected using a researcher-designed questionnaire, and the patients were examined using a high resolution 7.5-10 MHz linear array ultrasound transducer.

Results: The most frequent complications associated with ocular posterior segment pathologies were old vitreous hemorrhage (72%), posterior vitreous detachment (36%), and retinal detachment (34%). Diabetes and hypertension were the most frequent diseases associated with ocular posterior segment pathology. A significant association was seen between the patients' age with old vitreous hemorrhage (P = 0.003). A significant association was seen between the patients’ medical conditions with old vitreous hemorrhage and retinal detachment. There was no significant correlation between the patients’ gender and the studied ocular posterior segment pathologies.

Conclusion: Age has a strong correlation with old vitreous hemorrhage, chronic medical conditions such as diabetes, and hypertension correlated with old vitreous hemorrhage and retinal detachment.

Background and objective: HbA1c has been endorsed by the American Diabetes Association and World Health Organization to diagnose and monitor diabetes mellitus. Its value is directly proportional to the blood glucose level. However, besides the blood glucose level, other factors like iron deficiency anemia can affect HbA1c level. We conducted this study to reveal the impact of iron deficiency anemia on HbA1c level and to assess whether HbA1c result changes after the correction of iron deficiency anemia.

Methods: Twenty five non-diabetic children who were confirmed to have iron deficiency anemia were enrolled. HbA1c, hemoglobin, serum iron, and ferritin were measured and compared at baseline and post-correction of iron deficiency anemia with a three-month age-appropriate dose of iron therapy. The baseline results were compared with 25 age- and sex-matched normal controls.

Results: Children with iron deficiency anemia had significantly higher HbA1c level (6.144±0.6312, P <0.001) than the control group (5.032±0.5558, P <0.001). After three months of treatment of iron deficiency anemia, HbA1c significantly dropped (from 6.144±0.6312, P <0.001 to 5.604±0.51, P <0.001).

Conclusion: This study concluded that HbA1c is inversely proportional to iron deficiency anemia in non-diabetic children, and treatment of iron deficiency anemia led to a drop in HbA1c level. Due to this false elevation of HbA1c by iron deficiency anemia, iron deficiency anemia should be considered and excluded before making the diagnosis or deciding on any therapeutic change in diabetic children.

Background and objective: The red cell distribution width is suggested to be a more sensitive indicator for microcytic hypochromic anemia. Therefore, this study aimed to determine the role of red cell distribution width in the diagnosis of iron deficiency anemia from other causes of hypochromic microcytic anemia.

Methods: This cross-sectional study involved the children patients who attended Rapareen Teaching Hospital in Erbil city in 2019 and were diagnosed with hypochromic microcytic anemia.

Results: The red cell distribution width was determined in a group of 70 children with iron deficiency anemia and 30 cases with a non-iron deficiency (other hypochromic microcytic anemias). Patients with a higher socio-demographic status were more likely to have iron deficiency anemia than those with low socio-demographic status; 82.61% vs. 76.60%, respectively. The patients with symptoms were more likely to be diagnosed with iron deficiency anemia (P = 0.024). The mean red cell distribution width value was 14.38%, 15.73%, and18.02% among mild, moderate, and severely anemic children (P <0.001). Increasing red blood cells (r=-0.271), hemoglobin (r=-0.454), serum iron (r=-0.601), and serum ferritin (r=-0.560) lead to decrease red cell distribution width. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of red cell distribution width in diagnosing iron deficiency anemia in children patients were 77.14%, 63.33%, 83.08%, 54.29%, and 73.0%, respectively.

Conclusions: This study showed that red cell distribution width has good sensitivity and specificity in diagnosing iron deficiency anemia.

Background and objective: Gastric carcinoma can be caused by the interaction between environmental factors and genetic variations. The relationship between ABO blood groups and carcinogenesis or progression of human tumors has been reported by many investigations. This study aimed to understand the correlation between ABO blood groups and the risk of developing gastric carcinoma.

Methods: This case-control study included the ABO blood group and rhesus system of 92 patients diagnosed with gastric carcinoma at Erbil city from 2017 to 2019. Informed consent was obtained from all patients. As a control, the blood group from 260 healthy blood donors was collected from Erbil blood bank.

Results: Of 92 patients, 58.7% were males, and 41.3% were females. The mean age was 62 (28 - 97) years. Regarding the type of gastric carcinoma, 58.7% were intestinal, and 41.3% were diffuse type. Blood group and rhesus system of patients and control were compared. Blood group O was 47.8% in cases versus 40.8% in control and 42.6% in all participants, followed by blood group A (31.5% of gastric carcinoma patients and 26.5% of control with a total of 27.8% of all participants). Regarding the Rhesus system, 92.4% of cases were Rh⁺, and 7.6% were Rh^- compared with 92.9% Rh⁺and 7.1% Rh^- in control. None of them was statistically significant.

Conclusion: There was no statistically significant association between blood groups and gastric carcinoma, although blood group O was more common, followed by A.

Background and objective: Scabies, known as the seven-year itch, is a contagious skin infestation by the mite Sarcoptes scabiei that causes a pruritic skin eruption. Scabies is endemic in most of the communities of the developing world. This study aimed to assess the quality of life of scabies patients, taking into consideration the demographic profile and clinical presentation of patients in Erbil.

Methods: In this cross-sectional study, 107 scabies patients attending a private dermatology clinic were recruited. Dermatology Quality of Life Index questionnaire was used for data collection.

Results: More than half (51.4%) of the patients were less than 30 years of age, including 58.9% males, 70.1% of them were married, and 67.3% were living in the urban area. More than 84% of the study sample’s quality of life was very large and extremely large affected. The overall mean of the quality of life scores was 14.95±4.5 with no significant association between the overall quality of life scores to disease severity and certain sociodemographic characteristics of the patients. The mean scores of the two domains of embarrassment and shopping were significantly associated with the male gender (P = 0.003 and 0.021, respectively). However, 40.2%, 35.5%, and 29% of the patients reported that the disease affected very much on their shopping, clothing, and working activities, respectively.

Conclusion: The disease had caused a significant effect on patients' lives, with no significant association between the severity of the disease and overall quality of life scores. The disease in its mild, moderate, and severe forms adversely affected patient lives. The commonest quality of life scores were those in the range of 11-20.

Background and objective: Glycemic control is essential to halt the progression of diabetic complications. Some studies previously showed the effect of vitamin D on pancreatic β-cell function and insulin secretion. This study aimed to assess the effect of vitamin D supplementation on HbA1c in patients with type 1 diabetes and vitamin D deficiency.

Methods: This prospective quasi-experimental study was conducted in Erbil city from 1^st September to 1^st December 2019. In this study, 76 patients attending Layla Qasim diabetic center were tested. Only 50 patients were recruited that had vitamin D deficiency (25OHD: <20) and were aged less than 18 years. They received vitamin D supplementation for 12 weeks. HbA1c and vitamin D level was measured before and after supplementation.

Results: Before vitamin D supplementation, the mean level of serum 25(OH)D among females (8.67 ± 2.56) was lower than males (14.31 ± 3.19). However, no association was found between the initial HbA1c level and gender. HbA1c level (mean = 8.24 ± 0.49) improved significantly after vitamin D supplementation to the level of 7.93 ± 0.67 (P = 0.032). There was a significant difference between groups of glycosylated hemoglobin levels of (first tertile<7.5%, second tertile 7.6%-9.9%, third tertile ≥10%) after 12 weeks of supplementation with vitamin D (P <0.001).

Conclusion: Vitamin D supplementation in type 1 diabetic patients with vitamin D deficiency lead to significant improvement in HbA1c level.

Background and objective: Anabolic-androgenic steroids are synthetic testosterone derivatives with a longer duration of action than physiological androgens. They are abused by bodybuilders because of their potential to enhance muscle strength. Serious medical and psychological complications may be associated with their non-medical use. This study aimed to determine the prevalence of anabolic androgenic steroids among bodybuilders and their awareness of health-related risks.

Methods: A cross-sectional study was carried out from the 1st of January 2019 to the end of July 2019 in 18 randomly selected gym centers in Erbil city, Iraq using stratified random sampling. A self-administered questionnaire was distributed to 400 bodybuilders to assess the prevalence and knowledge of using Anabolic-androgenic steroids.

Results: The study showed a high prevalence of Anabolic-androgenic steroid consumption (26.3%) among gym users in Erbil city. Anabolic-androgenic steroid use was significantly higher among participants with a longer duration of bodybuilding practice ≥4 years (P = 0.001). Anabolic-androgenic steroid abuse was significantly associated with drinking alcohol, smoking cigarettes, and using growth hormones. Trainers were the commonest source of recommendation.

Conclusion: The prevalence of anabolic androgenic steroids abuse is high among bodybuilders in Erbil city. Public health awareness is essential and may help avoid the propagation of the problem.

Background and objective: Human papillomavirus (HPV) and herpes simplex-2 (HSV-2) are the common cause of genital lesions in women. The variation in host genetic makeup can determine the consequence of a viral infection in that host. T-bet gene polymorphism has been associated with the incidence of several types of infections. This study investigates the impact of T-bet polymorphism on the incidence of HPV and HSV in genital lesions.

Methods: 215 women, including 71 HPV infected, 72 HSV-2 infected, and 72 controls were enrolled. Viral genotyping was done on genital swab samples using Realtime PCR. In all participants, the extracted DNA from blood was tested for T-bet gene variation at Ch17.rs17244587 G>A site using ARMS-PCR. ELISA was done to participants sera to detect HSV-1 IgM.

Results: Genotyping of HPV infection revealed that (73.0%) were at low risk. Most individuals (72.5%) were homozygous GG, while (20.9%) were heterozygous AG and (6.5%) were homozygous AA, of which 92.8% were HSV-2 infected patients. None of 18 (8.4%) HSV-1-IgM positive women were homozygous AA.

Conclusion: T-bet gene allele A appears to be linked with more incidence of HSV-2 in genital lesions, but such influence was not observed for HPV genotypes and HSV-1.

Background and objective: Venous thromboembolism is a leading cause of maternal morbidity and mortality. Few published articles have evaluated obstetricians' compliance with thromboprophylaxis guidelines, especially after vaginal delivery. This study aimed to assess obstetricians’ adherence to postpartum thromboprophylaxis guidelines and correlate adherence with the risk factors for venous thromboembolism after vaginal and cesarean delivery.

Methods: A cross-sectional study involving 981 women delivered at the Maternity Teaching Hospital, Erbil city, Kurdistan Region, Iraq, was conducted. Obstetricians' compliance with the thromboprophylaxis guideline regarding dose, duration, and indications were recorded. We assessed the risk factors for thromboembolism using the 2015 Royal College of Obstetricians and Gynecologists guideline.

Results: Medical thromboprophylaxis was required but not given to 93.2% of the women who delivered vaginally compared with 6.7% of the women who delivered by cesarean section. Women who delivered vaginally had a higher rate of age ˃ 36 years, parity of 3 and more, varicose vein, and current infection (P <0.001). The rates of preeclampsia, preterm labor, and prolonged labor were highest in the emergency cesarean section group (P <0.001). Factors associated with making a wrong decision were having no preeclampsia (odds ratio=15.4; 95% confidence interval=3.4–68.6), post-partum hemorrhage (odds ratio=15.3; 95% confidence interval=2.0–114.2), and vaginal delivery (odds ratio=250.2; 95% confidence interval=110.6–566.0).

Conclusion: Obstetricians' compliance with postpartum thromboprophylaxis in the hospital was low, especially after vaginal delivery.

Background and objective: Community pharmacists play an important role in the best use of drugs and in improving patient outcomes. Evidence demonstrates that pharmacists' counseling improves the quality of life, clinical outcomes, and drug and disease knowledge and reduces the utilization of health services. This study aimed to investigate the nature and extent of counseling practices of community pharmacists in community pharmacies in Sulaimani region of Kurdistan, Iraq.

Methods: A cross-sectional survey was conducted in community pharmacies in Sulaimani city, in a one-month duration from November to December 2020. The sample size was 100 community pharmacies, which were selected randomly. The data were stored and analyzed using Excel 2016 and expressed as frequencies and percentages.

Results: According to the completed questionnaires, about 78.8% of pharmacists would do counseling spontaneously each time they dispense any drug. Only 61% of the pharmacists would ask the patients if they understood what was said during their communication to assess the understanding of advice given to their patients. The most common barrier observed during patient counseling was the patient's lack of time.

Conclusion: This study indicates that community pharmacists counsel the patients in an appropriate way. They provide information orally and in written form. However, further research is needed to evaluate the quality of patient counseling by using different methods like pseudo-patient methodology to gain real counseling data.

Background and objective: Surgeons and surgical practice are influenced greatly by the coronavirus disease 2019 (COVID-19) pandemic all over the world, and this impact affects patients who need surgery, especially in emergency cases. This study aimed to assess the impact of COVID-19 on surgery in the Kurdistan Region, Iraq.

Methods: A survey that consisted of four sections was prepared and sent by e-mail to over 1000 surgeons with different specialties. The survey was created by google forms and was kept online from 9 October 2020 to 9 November 2020.

Results: A total of 207 surgeons have responded to the survey, 146 (70.5%) males and 61 (29.5%) females with different specialists. The data shows that both private and public hospitals were affected by the pandemic equally. Thirty five (16.9%) surgeons indicated that surgery has entirely collapsed in some hospitals. All phases of surgical practice have been affected from partial to complete abandonment of surgery.

Conclusion: The pandemic greatly affected surgeons and surgical practice in the Kurdistan region. Additionally, few surgeons indicated that the pandemic did not affect the surgical practice and normal functioning of their hospital. However, most surgeons agreed that the pandemic significantly impels all stages of surgery and surgical practice. Most surgeons have adapted to the situation by using communication technology and new protective measures.