Vol 26, No 2 (2022)

Background and objective: Low early neonatal death reflects health care progress in any country. We aimed to determine the prevalence of early neonatal deaths and the associated maternal and neonatal factors in a hospital-based study.

Methods: This audit study was conducted on all newborns in the labor ward and neonatal intensive care unit of a maternity teaching hospital in Erbil city, Kurdistan Region, Iraq, from January 1, 2020, to December 31, 2020. Fetal and maternal factors were determined and correlated with early neonatal deaths.

Results: The early neonatal death rate was 6.7%. All categories of preterm deliveries (extreme, very, and moderate preterm) were significantly associated with early neonatal deaths (odds ratios [ORs] = 45.1, 6.2, and 2.1, respectively). The primiparous and grand multiparous women had a higher risk of early neonatal deaths (ORs = 8.4 and 13.0, respectively). Obese women had a higher risk of early neonatal deaths (OR = 3.3). The risk of early neonatal deaths was significantly high when the number of antenatal care visits was less than four (OR = 8.1). Delivery by cesarean section was associated with high risk (OR = 3.8). Regarding the Apgar scores in the first and fifth minutes after birth, early neonatal death was significantly higher among those with severely depressed scores.

Conclusion: High parity, inadequate antenatal attendance, obesity, and mode of delivery, were contributing factors to early neonatal deaths. Early prenatal care can assist in the rapid identification and management of risk factors for early neonatal deaths.

Background and objective: Venous thromboembolism after gynecological surgery is a major cause of morbidity and mortality. This study aimed to determine the venous thromboembolism risk profile of women who underwent gynecological surgery at a tertiary hospital and review the prescribed venous thromboembolism prophylaxis.

Methods: An audit review study was conducted on 490 women who underwent major and minor gynecological surgeries at the Maternity Teaching Hospital, Erbil city, Kurdistan Region, Iraq, from 1st December 2019 to 31^st December 2020, regarding their risk of developing postoperative venous thromboembolism using the 2013 modified Caprini venous thromboembolism risk assessment model to determine their risk and the correct thromboprophylaxis prescription.

Results: According to appropriate thromboprophylaxis administration of low molecular weight heparin, it was administered to two-thirds of the women. It was sufficient in 33.1% of the women, and only 8.2% of the women received it for the correct duration. The probability of incorrect decision was higher for the major surgeries than for minor surgeries [odds ratio (OR) = 15.5; 95% confidence interval (95% CI) =3.01–80.1]. Moderate risk carried a much higher probability of an incorrect decision than low risk (OR = 196.8; 95%CI = 30.4–1270.5), whereas the association with high risk was not significant. When low molecular weight heparin was administered, there was a higher probability of a wrong decision than when low molecular weight heparin was not administered (OR = 26.4; 95%CI = 7.1–97.6).

Conclusion: The gynecologists' adherence to venous thromboembolism prophylaxis after major and minor gynecological surgeries at the hospital mandates more training for all healthcare providers.

Background and objective: The development of new products for skin care and wound treatment is continuous, and herbal medicine plays an important role in the treatments. Oliveria decumbens, a plant from the family Apiaceae, has been reported to enclose many pharmacological properties. This study aimed to detect the effect of the essential oil of Oliveria decumbens as an antibacterial and wound healing agent.

Methods: The antibacterial properties of Oliveria decumbens were studied by the disk diffusion method. In addition, the excision model of wound healing was applied to rats, and the AutoDock method was used to study the mechanism of action.

Results: The essential oil extracted from Oliveria decumbens showed antibacterial activities against gram-positive and gram-negative bacteria, and the wound healing effect was comparable to the standard skin cream. Thymol was predicted to be the strongest binder of GSK-3 protein active site forming the most stable complex with hydrogen bond and hydrophobic interaction. The second-best binders were P-Cymene, Limonene, Gamma-Terpinene, and Carvacrol.

Conclusion: The observed data backed the original claim of antibacterial and wound healing properties of Oliveria decumbens extracted essential oil.

Background and objective: Preliminary reports indicate some patients may develop a post-COVID-19 syndrome, in which they experience persistent symptoms after recovering from their initial illness. So, we investigated the persistent symptoms of patients after recovery from COVID-19 that attended a private clinic in Erbil city searching for care. Therefore, this study aimed to describe the demographic features of the patients, identify the clinical features of the patients after recovery and find associations between clinical and demographic features.

Methods: This is a case series of a private clinic study, which was done in Erbil city. We reviewed patients who had been diagnosed with COVID-19 and were referred to the clinic from July 31^st to December 1^st, 2020, in Erbil, Iraq.

Results: In this study, 154 post-recovered COVID-19 patients who attended the center during the six months of the study were enrolled. The mean age of the patients significantly increased with increased severity (P <0.001). A significant statistical association was also found between marital and smoking status with the severity of post-COVID-19 in which married patients developed more severe cases than non-married patients (P = 0.03). Also, cigarette smokers developed less severe clinical features than non-smokers (P = 0.005). The most frequent comorbidity among patients was hypertension (23%), while the least comorbidity was stroke, hyperthyroidism, renal failure, migraine, and osteoarthritis (0.7%).

Conclusion: Significant statistical associations were found between the severity of the post-COVID-19 condition with many variables, including the mean age of the patients, marital status, and smoking status. The most frequent comorbidity was hypertension, and the least frequent was stroke.

Background and objective: Iron deficiency may impair aerobic performance. This study aimed to assess whether intravenous iron (ferric carboxymaltose) will improve symptoms in patients with heart failure with reduced left ventricular ejection fraction and iron deficiency or not, depending on serum ferritin or transferrin saturation with or without anemia.

Methods: We enrolled 100 patients with heart failure with reduced ejection fraction (less than 40%) and iron deficiency (serum ferritin less than 100 ng/ml, or between 100-299 ng/ml but transferrin saturation less than 20%). The patient received an intravenous iron supplement of ferric carboxymaltose (1000-2500mg) until the correction of their iron status. We checked the 6-minute walking test, New York Heart Association functional class, and ejection fraction for each patient at baseline, 12 weeks, and 24 weeks after intervention.

Results: Our study showed a significant improvement in the patient's functional status. The 6-minute walking test, New York Heart Association functional class, improved significantly in patients at 12 weeks and continues to improve beyond 24 weeks with or without anemia. The left ventricular ejection fraction in our study was not improved significantly.

Conclusion: Treatment with intravenous iron supplement (ferric carboxymaltose) in patients with chronic stable heart failure and iron deficiency, with or without anemia, improves symptoms, functional capacity, and quality of life.

Background and objective: Vestibular migraine is widely accepted as a unique disease, although its pathophysiology remains uncertain. When the patient is asymptomatic, vestibular migraine is often challenging to diagnose as its many symptoms overlap with other conditions. This study aimed to assess the role of videonystagmography and cervical vestibular evoked myogenic potentials tests in diagnosing vestibular migraine.

Methods: This study is a descriptive cross-sectional study conducted on 30 patients clinically diagnosed with vestibular migraine in the Audiology Center in Sulaimani City. The study duration was from December 1^st, 2018, to June 30^th, 2019. The author interpreted magnetic resonance imaging, videonystagmography, and cervical vestibular evoked myogenic potential results.

Results: The patients' mean age was 34.9 years with a high predominance of the female gender. Vertigo was the main complaint of the patients (73.4%) with the recurrent course. A family history of migraine was present in 83.3% of the patients. Only two (6.7%) patients had abnormal findings on the brain magnetic resonance imaging. Videonystagmography examination showed that 40% of the patients had abnormal findings; 20% were abnormal on the left, 16.7% were abnormal on the right, and 3.3% were bilaterally abnormal. The cervical vestibular evoked myogenic potentials test was abnormal for 63.3% of the patients; 43.3% abnormality was on the left side, and 20% was on the right side.

Conclusion: The cervical vestibular evoked myogenic potentials and videonystagmography tests are helpful in the diagnosis of vestibular migraine.

Background and objective: Anterior knee pain is a common reason for consultation due to knee pathology among teenagers and young adults. Knowledge of the radiological appearance of the abnormalities allows a more accurate diagnosis of the cause of the pain. This study aimed to determine the causes of anterior knee pain and assess the role of MRI in evaluating cases of anterior knee pain and achieving accurate diagnosis and grading of some of the most common pathologies.

Methods: This cross-sectional study included 115 patients suffering from knee joint pain, referred to the radiology department, Rizgari Teaching Hospital from the rheumatology or orthopedic outpatient clinics, or private clinics between March 2017 and January 2020. Only 34 patients had anterior knee pain. All patients underwent an MRI examination.

Results: MRI examination was carried out for 34 knees of 115 patients with anterior knee pain, including 13 males (38.24%) and 21 females (61.76%). The mean age of the patients was 31 years (range 14-52 years). Most of the cases presented clinically with AKP, and four cases presented with a history of pain after trauma. Twelve cases (35.29%) had patella Alta while two cases (5.8%) had patella Baja. Trochlear dysplasia was reported in seven cases (20.58%), and type C was the most common trochlear dysplasia, which was seen in four cases out of seven (57.14%). Patellar maltracking was seen in eightcases(23.52 %), tilt of the patella in 10 cases (29.41%), and a combination of patellar tilt, Alta, and maltracking was seen in eight cases (23.52%). Six cases (17.64%) showed a combination between trochlear dysplasia, patellar tilt, and maltracking. Thirty one patients (91.17%) showed signs of patellofemoral arthrosis, and joint effusion was seen in 30 patients (88.23%). Suprapatellarplica was seen in two cases (5.40%).

Conclusion: The most common cause of anterior knee pain is patellofemoral instability, either due to abnormal morphology /or joint geometry or post-traumatic, and it is occasionally caused by a serious underlying systemic disease, including inflammatory conditions and malignancies. MRI offers superior soft tissue contrast resolution and allows a more accurate evaluation of the underlying etiology.

Background and objective: Failure to get pregnant can be profoundly disappointing, frustrating and eventually lead to a lot of social, medical, and psychological consequences like depression. This study aimed to evaluate the role of uterine biophysical profile in predicting conception in women with a history of infertility. 

Methods: A prospective diagnostic accuracy study was conducted in Erbil, Iraqi Kurdistan region, in the Maternity Teaching Hospital from October 2019 to September 2020 on 51 women suffering from primary and secondary infertility. Vaginal ultrasound was performed for all the women at mid-cycle and before embryo transfer. The uterine scoring system for reproduction by Applebaum was calculated, and the total score was obtained. Its role in predicting conception was determined.

Results: A cut-off of 15 scores of the uterine scoring system for reproduction gave a sensitivity of 86.7% and a specificity of 100%. Factors found to be associated with high rates of pregnancy were endometrial thickness 10-14 mm (P <0.001), distinct trilaminar layer (P <0.001), abundant blood flow within zone 3 (P <0.001), and uterine artery Doppler PI of <2.19 (P <0.001). The last two parameters gave a pregnancy rate of 100%.

Conclusion: Applebaum’s uterine scoring system for reproduction is an easy, simple, noninvasive method for predicting pregnancy in women suffering from primary and secondary infertility. Both uterine artery Doppler PI and endometrial receptivity (including thickness, character, and vascularity) are two important parameters in predicting suitable environment for implantation and pregnancy outcome.

Background and objective: Helicobacter pylori can be regarded as one of the most common causes of chronic gastritis, which affects more than half of the world’s population. This study aimed to assess the presence of H. pylori in patients with gastritis and its association with gastric inflammation and adenocarcinoma.

Methods: The presence of H. pylori was detected by rapid urease test and histopathological tests using biopsy specimens. Data were analyzed using the GraphPad Software Statistical Package.

Results: The mean age of patients ± SD was 47.41 ± 18.13 years. The age range was 13 to 90 years. Results showed a significant association between the intensity of H. pylori and inflammation (P = 0.001). The more the intensity of H. pylori, the more severe the inflammation was noticed. Patients with high intensity of H. pylori had positive lymphoid aggregates. The H. pylori positive for the rapid urease test and the hematoxylin and eosin (H&E) staining test were 95.2% and 96.3%, respectively. H. pylori infection was detected in more than 85% of patients with gastric adenocarcinoma.

Conclusion: Histopathology and rapid urease tests are reliable diagnostic tools for detecting H. pylori. Results revealed a significant association of chronic active gastritis, mucosal lymphoid follicle formation, and adenocarcinoma with H. pylori infection.

Background and objective: Although cholecystectomy relieves symptoms in the majority of cases, still a significant number of patients suffer from the post-cholecystectomy syndrome. Cystic duct remnant calculi is a causative factor of the post-cholecystectomy syndrome. Cystic duct stones are not infrequently encountered during laparoscopic cholecystectomies. This study aimed to present our experience of patients with calculi of the cystic duct that successfully dealt with laparoscopically.

Methods: This study was conducted on 4000 cases of chronic calculous cholecystitis at Rizgary Teaching Hospital from January 2010 to November 2020.

Results: Cystic duct stones were detected in 397 cases. A single stone was found within the cystic duct in 301 patients (75.8%) and multiple stones in 96 patients (24.2%). The cystic duct was reported to be wider than normal in 368 cases (92.7%) and near to normal in 29 cases (7.30%). We recorded two cases (0.5%) of concomitant common bile duct stones with cystic duct stones. Our procedure for dealing with cystic duct stone was successful in 372cases (93.7%). Milking the stone back to the gall bladder was successful in 15 cases (3.80%). In eight cases (2.00%), we were obliged to convert the procedure to open cholecystectomy. Since peroperative cholangiography and choledcoscopy are not available in our hospital, the associated common bile duct stone in two cases (0.50%) was postponed and dealt with later on. Post-operative recovery was uneventful, apart from one patient who developed features of acute cholangitis.

Conclusion: Cystic duct stones are not infrequent, as was believed earlier. Their preoperative detection may be difficult, but it can be detected easily peroperatively. Its detection and retrieval are mandatory to decrease the incidence of post-cholecystectomy phenomena.