Vol 26, No 1 (2022)

Background and objective: Worldwide, cardiovascular diseases remain the leading cause of death in both genders. Good knowledge about cardiovascular disease symptoms, risk factors, and protective measures can improve the public’s preventive practice and overall future health outcomes. This study aimed to assess women's awareness of cardiovascular diseases and preventive measures.

Methods: A cross-sectional study was conducted in Erbil city, Iraq. The data were collected from 674 women aged 18 years and above, using convenience sampling method, who attended 12 primary health care centers in six municipalities in Erbil City. The study period was from the 1^st of October 2019 to the end of February 2020. An interview questionnaire was used to collect the study data from the participants to assess the women's knowledge of cardiovascular diseases, their attitudes and challenges.

Results: The mean age ± standard deviation of the women was 37.6 ± 13 years. Only 15.3% of women could recognize cardiovascular diseases as the number one leading cause of death. More than 90% of them had poor cardiovascular disease knowledge scores. Recognition of coronary artery disease symptoms, cardiovascular disease risk factors, and preventive measures was made by less than 50% of them. The multiple regression analysis showed that age, body mass index, socioeconomic status, employment, and educational level independently predicted cardiovascular disease knowledge.

Conclusion: Awareness of cardiovascular diseases among women was poor. Thus, proper institutional foundations, mass media campaigns, other media, and community programs can prompt public discussion of health issues to change women’s health behavior and reduce future health consequences from cardiovascular diseases.

Background and objective: Sensitivity and specificity of clinical diagnosis of different hyperthyroid conditions were studied and compared with serum thyrotropin receptor antibodies test, as a standard test for diagnosing Graves' disease. This study aimed to assess the degree of sensitivity and specificity of clinical diagnosis of hyperthyroid conditions compared to the thyrotropin receptor antibodies test, which was selected as a standard test for diagnosis of Graves’ disease in the study.

Methods: We studied patients presenting to endocrine outpatient clinics and other outpatient settings in Erbil city, presenting with clinical features of thyrotoxicosis. Serum or plasma thyroid-stimulating hormone, free T4, and thyrotropin receptor antibodies measurements were done for all the patients. Thyroid peroxidase antibodies and thyroid ultrasonography were done for most patients. Radioactive thyroid uptake was available for a limited number of patients. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and accuracy index of clinical diagnosis of the thyrotoxicosis cases were calculated.

Results: A total of 150 patients were included in our study, female 102, males 48, mean age 38 (range 16-78) years, pretest diagnosis of (Graves’ disease N=58, and non-Graves’ disease N=92 and posttest diagnosis of (Graves’ disease n= 59 vs. non-Graves’ disease=91). Sensitivity of 74.6%, specificity (84.60%), positive predictive value (75.9%), negative predictive value (83.7%), positive likelihood ratio (4.847), negative likelihood ratio (0.30), and accuracy index (80.7%) of the clinical diagnosis were estimated.

Conclusion: The study showed that clinical diagnosis of Graves' disease and non-Graves’ disease disorders, using thorough clinical examination and primary essential investigations, has high sensitivity and specificity index. However, the serum thyrotropin receptor antibodies test remains the standard method in the differential diagnosis of Graves' disease. Other studies are needed to study ultrasound and scintigraphy compared to the thyrotropin receptor antibodies test.

Background and objective: Many tests are conducted for monitoring the progression and the severity of coronavirus disease (COVID-19) infection. However, the extent to which these tests are helpful in clinical practice and therapeutics of COVID-19 is still ambiguous. This study aimed to evaluate the feasibility of performing inflammatory marker tests, liver function tests, and procalcitonin test in the diagnosis and monitoring of COVID-19 infection.

Methods: The current study compares the results of alanine aminotransferase, aspartate aminotransferase, ferritin, and procalcitonin tests in two different populations of 123 COVID-19 suspects and a control group of 110 healthy individuals in Erbil city of Kurdistan region of Iraq to search for possible significant differences in both groups.

Results: The COVID-19 group had significantly higher ferritin and procalcitonin mean values than the control group (P = 0.001). The differences between alanine aminotransferase and aspartate aminotransferase were significant in some age and gender classes of both groups. However, the overall differences were not statistically significant (P = 0.339 and 0.286, respectively).

Conclusion: The outcome of the current study suggests that among the group of tests conducted for the study population, the most useful tests are ferritin and procalcitonin to monitor the COVID-19 patients' health status.

Background and objective: Urothelial bladder carcinoma is a common malignancy but rarely occurs at young ages and can occur more frequently in the older group. The majority of bladder cancer consist of urothelial bladder carcinoma. This study aimed to review the clinical presentation, histopathological features, staging, grading, and the progression and recurrence of urothelial bladder cancer in patients aged below 40 years compared with older patients.

Methods: We retrospectively analyzed and reviewed 105 newly diagnosed patients with urothelial bladder carcinoma between August 2014 to January 2020 in a private clinic and Rizgary Teaching Hospital, Erbil city, Iraq.

Results: The mean age ± SD of the cases was 56.2 ± 19.37 years, ranging between 18 – 85 years. Patients were divided according to age into two main groups, Group I (29 patients) were aged ≤ 40 years, and Group II (76 patients) were above 40 years. Most cases (72.4%) were males, but there was no significant gender distribution difference between the two groups (P = 0.327). Gross hematuria was the most common presenting symptom in both groups. In Group I, the proportion of patients who ever smoked was 79.3%, and 47.4% in Group II (P = 0.003).A significantly higher proportion of patients with lower grade and stage and small tumor size was detected in Group I than in Group II (P <0.05). The recurrence rate of Group II (36.8%) was significantly higher than that (6.9%) of Group I (P = 0.002).

Conclusion: Urothelial bladder carcinomas among young patients were of lower grade, stage, and size than in older patients. The recurrence rate was higher among the older patients.

Background and objective: This qualitative study was conducted to identify obstacles to breastfeeding and provide strategies for promoting its practice in Tehran based on the experiences and perceptions of breastfeeding mothers.

Methods: Data were first collected through focus group discussions with 51 breastfeeding mothers admitted to Vali Asr Hospital in the Imam Khomeini Hospital Complex and two health centers in Tehran. We held follow-up in-depth interviews with 26 mothers over a year postpartum or until breastfeeding was discontinued.

Results: The most important barriers to breastfeeding were (1) Physical condition of the mother, including lack of vigor, physical weakness, weight loss, inappropriate nutrition, nipple-related problems, inadequate breast milk, changes in body shape, and maternal and neonatal diseases. (2) Health care system, including (a) Hospital-related problems included (i) Providing educational services related to breastfeeding, (ii) Problems related to the behaviors of hospital staff, and breastfeeding problems related to cesarean delivery. (3) Emotional and psychosocial aspects of breastfeeding, including emotional support from husband and family, dislike of breastfeeding in public places, stress and mental pressure, and maternal employment.

Conclusion: Politicians in the field of health can exert a considerable effect on breastfeeding practice and its continuation by providing early intervention designed to increase awareness of breastfeeding among young girls, training health staff in offering breastfeeding support, and ensuring contact between mother and infant. Also, provide support services, such as extended maternity leaves, daycare facilities in the workplace, and breastfeeding counseling centers. Further research is needed to assess the effectiveness of the interventions currently proposed in the Iranian context.

Background and objective: Breastfeeding is a fundamental human activity, essential to child and maternal health, and of massive economic value to societies and households. This study aimed to determine breastfeeding practices among working mothers in Erbil city.

Methods: A cross-sectional study was carried out in 12 primary health care centers in Erbil city from 19 January 2020 to 10 December 2020. A convenience sampling method was used to recruit the sample of the study (600 mothers). A questionnaire was used for data collection.

Results: A total of 600 working mothers with children 1-2 years of age who attended the selected primary health centers were included in this study. Most participants (58.8%) were in the age group 30-39 years old. The majority of mothers (69.7%)were working in the public sector, while 32% were working in hospitals. Only 66 participants were breastfeeding their child in the workplace, so the prevalence of breastfeeding among working mothers at the workplace was 11%. Only 100 participants (16.7%) reported having a nursery in their workplace. Regarding the impact of the workplace on breastfeeding, 42% of women were breastfeeding in places with a nursery. Breastfeeding is more common among mothers working in public places (13.9%) than mothers working in private sectors (4.4%) (P <0.001).

Conclusion: The prevalence of breastfeeding among working mothers with children 1-2 years of age is low. The availability of supporting facilities significantly impacts breastfeeding practices among working mothers.

Background and objective: Coronary artery calcium is a specific indicator of and an independent risk factor for atherosclerosis. However, calcium scoring may miss non calcified plaques, which were indicated to be of clinical importance. This study aimed to identify the presence of non calcified plaques in patients with zero coronary artery calcium score who have been examined with computed tomography coronary angiography and find out any association between the presence of non-calcified plaques and risk factors and presenting symptoms in those patients.

Methods: In this retrospective study, we analyzed the computed tomography images of 9826 consecutive patients attending the cardiac center in Erbil, Iraq, between January 2016 and September 2020. Of these patients, we included 2805 patients with a zero coronary artery calcium score in the study. Coronary calcium-scoring scans were followed by computed tomography coronary angiography (256 MSCT Philips ICT). The coronary artery calcium scores were calculated, and the presence of non calcified plaques and significant stenosis (>50% of vessel diameter) were evaluated.

Results: Of the 2805 patients with a zero coronary artery calcium score, 896 (31.9%) had atherosclerotic plaques; 143 patients (5.1%) had significant coronary stenosis. Among coronary risk factors, diabetes mellitus (OR = 2.1; 95% CI 1.4-3.3), hypertension (OR = 1.3; 95% CI 1.07-1.58)), male sex (OR = 1.9; 95% CI 1.5-2.3) and old age (OR was 3.2 for the age group 35-44 years reaching 27.7 in the age group ≥ 75 years) were significantly correlated with the presence of atherosclerosis and obstructive coronary artery disease.

Conclusion: Although coronary artery calcium scoring is a safe and reliable test to exclude obstructive coronary artery disease, the absence of coronary artery calcium does not absolutely exclude the presence of atherosclerosis. Computed tomography coronary angiography is mandatory for determining the atheroma burden from zero coronary artery calcium score plaques.

Background and objective: Atorvastatin calcium is an antihyperlipidemic agent that is characterized by low aqueous solubility and high membrane permeability. This study was designed to enhance the solubility and the dissolution rate of atorvastatin calcium in the water and physiological pH (pH 6.8) by using L-Leucine as solubilizing agent utilizing different solid dispersion methods.

Methods: Solid dispersion masses were prepared by kneading method and solvent evaporation methods at different weight ratios (1:1, 1:2: and 1:4) of the drug to the carrier. Saturated solubility studies were carried out in aqueous media, and the in-vitro studies were performed in physiological pH Fourier transform infrared spectroscopy were used to detect any interaction between the drug and the carrier.

Results: The kneading method increase the solubility of atorvastatin calcium by 1.27, 1.43, and 1.81 folds from kneading method 1, kneading method 2, and kneading method 3, respectively. The solubility of atorvastatin calcium in solvent evaporation 1, solvent evaporation 2, and solvent evaporation 4 was increased by 2.53, 2.66, and 3.1 folds (P = 0.002). Solvent evaporation 2 (1:2 ratio) was selected as the best formula in terms of dissolution profile because it has faster and complete drug release after 5 minutes when compared with solvent evaporation 1, kneading method 1, kneading method 2, and kneading method 3 and contain less amount of L-Leucine when compared with solvent evaporation 3. Fourier transform infrared studies indicated no chemical reaction between the drug and carrier.

Conclusion: L-leucine significantly improved the solubility and dissolution profile of poorly water-soluble atorvastatin calcium.

Background and objective: Rheumatoid arthritis is a chronic and inflammatory autoimmune systemic disease of unknown cause that may affect many tissues and organs. Rheumatoid arthritis and thyroid disorders may occur in the patient simultaneously. The main antigens that give rise to thyroid antibodies are thyroglobulin, thyroid peroxidase, anti-cyclic citrullinated protein, and thyroid hormone receptor. This study aimed to determine the frequency of thyroid dysfunction and seroprevalence of anti-thyroid antibody in patients with rheumatoid arthritis and its association with inflammatory marker C-reactive protein.

Methods: A cross-sectional study was performed at Rizgari Teaching Hospital and CMC private hospital, Erbil, Iraq. From 15 January to15 October 2020. A hundred patients with rheumatoid arthritis were included in the study, in addition to 70 controls. The serum levels of biomarkers were determined by the chemiluminescent immunoassay method.

Results: Patients with rheumatoid arthritis had 6% of thyroid dysfunctions. Regarding the prevalence of thyroid autoantibodies in patients with rheumatoid arthritis, 9% had positive anti-thyroid peroxidase, 13% had positive anti-thyroglobulin, and 6% were positive for a combination of both. There was a statistically significant (P <0.001) high level of serum anti-cyclic citrullinated protein and C-reactive protein in rheumatoid arthritis than in control. Euthyroid profiles were 73% inrheumatoid arthritis patients and 82.9% in control.

Conclusion: The study delineated the co-existence of thyroid disorder in rheumatoid arthritis patients with or without autoimmune origin, besides the increased prevalence of auto-thyroid antibody among rheumatoid arthritis with thyroid dysfunction.

Background and objective: The gallbladder size, volume, and wall thickness can be affected by many disease processes. Therefore, there is a need to establish a baseline sonographic normogram of gallbladder dimensions and volume for early detection and follow-up of a diseased gallbladder. This study aimed to establish a baseline sonographic normogram for gallbladder volume and wall thickness in normal adults and its relationship with age, gender, and body mass index.

Methods: This prospective cross-sectional study was conducted on 400 normal adult subjects aged 18-73 years at the Radiology Department of Rizgary Teaching Hospital and Private Clinic in Erbil city, Kurdistan Region of Iraq. Gallbladder dimensions, including height, length, width, volume, and wall thickness, were measured by sonographic scanning of the subjects' gallbladder after an overnight fasting.

Results: Out of 400 subjects, 248 (62%) were male, and 152 (38%) were female. There was a slight difference between male and female gallbladder volume (29.87 ml for males and 26.5 ml for females) and wall thickness (2.53 mm for males and 2.46 mm for females), with the measurements slightly higher in males. A statistically significant variation was found between gender and age of participants with gallbladder height (ranging 2.4-3.06 cm), width (ranging 2.41-3.38 cm), volume (ranging 21.03-38.39 ml), and wall thickness (ranging 2.16-2.96 mm). A non significant correlation was found between the age and gender of participants with the length of the gallbladder (ranging 6.33-6.61 cm). A moderately significant correlation was found between gallbladder volume with height and weight of participants. A weak significant statistical relation was found between gallbladder volume and the body mass index of participants.

Conclusion: Normal gallbladder sonographic dimensions have been established in our locality to be used as a reference value for evaluating the healthy and diseased gallbladder. The mean volume for males was 29.87cm³, and for females was 26.57cm³. The mean wall thickness for males was 2.53mm and 2.46 mm for females. The mean height was 2.92cm for males and 2.76cm for females. The mean width was 2.93 cm for males and 2.78cm for females. The mean length was 6.54 cm for males and 6.46 cm for females.