Vol 26, No 3 (2022)

Background and objective: Gestational diabetes mellitus is the most common metabolic disorder of pregnancy with increasing prevalence at epidemic rates. This study aimed to determine the prevalence of gestational diabetes mellitus and related risk factors in a sample of pregnant women in Erbil city.

Methods: A cross-sectional study was conducted on a convenience sample of 216 pregnant women at primary health care centers in Erbil city, Kurdistan Region, Iraq, from April 2019 to January 2021. The pregnant women were selected independent of having or not having risk factors. Pregnant women were screened for diabetes mellitus using 50 gm glucose challenge test in 24–28th weeks of gestational age. Women with positive glucose challenge test underwent 100 g glucose tolerance test.

Results: The 50g glucose challenge test revealed that 54 women (25.0%) were positive for gestational diabetes mellitus. Glucose tolerance test (100 gm) revealed that the prevalence of diabetes among the sample was 11.9%. The association between the different characteristics and risk factors with the diagnosed diabetic status of the study participants showed that there was a significant association with the older age, obesity, higher parity, and history of recurrent miscarriage.

Conclusion: Pregnancy is associated with a high prevalence of gestational diabetes mellitus in the current research. Pregnant women, particularly those in advanced maternal age, with pre-pregnancy high body mass index and having a history of recurrent miscarriages, should be investigated for the possibility of the presence of gestational diabetes mellitus.

Background and objective: Gastric ulcer is an important health risk for a human. It is a painful sore in the stomach lining. It is relatively easy to cure, but can cause significant problems if left un-treated. Non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed for millions of people worldwide; however, as their consequences most of individuals suffer from gastric ulcers and related complications. Diclofenac sodium is a medication from NSAIDs class of drugs, is used to relieve joint pain from arthritis but when used chronically, it may cause bleeding and ulcers in the stomach or intestine. This study aimed to test the safety and the antiulcer activity of a new bioisosteric derivative of diclofenac sodium on a rat model.

Methods: 2-Cumaranone 1 had been utilized to prepare the propanamides 2a-e then after the bioisosteric diaryl ethers 3a-e synthesized; then its purity was characterized on the basis of IR, ¹HNMR and Mass spectral data. Acute toxicity on albino mice was performed to ensure the safety and an experimental rat model was used to evaluate the anti-ulcer activity. Kidney and liver functions tests were measured, ulcer measurements were reported and pro-inflammatory cytokines tumor necrosis factor alpha (TNFα) and Interleukin 1 beta (IL-1β) levels were tested.

Results: Unlike diclofenac sodium, the bioisosteric diaryl ethers 3a-e is less acidic and produces less damage to the stomach wall. In addition, the structure of amide derivative is also bulky thus it is more selective to cyclooxygenase ΙΙ enzyme thus the risk of gastric ulcer was less than with diclofenac sodium itself.

Conclusion: Unlike diclofenac, amide derivative of diclofenac is less acidic than diclofenac thus it produces less damage to the stomach wall.

Background and objective: Sacrococcygeal pilonidal sinus disease is an inflammation in the natal cleft of the sacrococcygeal region, which develops to abscesses and sinus formation. The incidence of sacrococcygeal pilonidal sinus disease notably increased in the last 50 years, however, there is no accurate data about the frequency of the disease and incidence rate among the Kurdistan region-Iraq population. In this study, we have introduced a simplified off-midline surgical technique without flap reconstruction. The main objective was to find out the rate of postoperative complications, hospitalization time, the recovery time to daily activity and work, and esthetic satisfaction.

Methods: This study was conducted in Kurdistan region, Iraq from March 2016 to September 2019 on individuals suffering from sacrococcygeal pilonidal sinus disease. Two hundred ninety-eight individuals from different gender and ages enrolled for operation by modified simple closure of sacrococcygeal pilonidal sinus disease.

Results: The median age of the patients was 22.4 years (24.1 male and 20.5 female). 33.9% of our patients were female students (P = 0.002). Most of the patients (89.2%) did not have postoperative complications. However, wound infection was detected in 3.0% of patients. Sacrococcygeal pilonidal sinus disease recurred in 5.4% of patients; furthermore, the disease recurred twice in 7 females (2.4%). All the recurrences happened in the patients that had a severe form of sacrococcygeal pilonidal sinus disease.

Conclusion: Significant number of our patients were students, and female students for unclear reasons are at risk in our region. The post-surgical complications only occur in patients with a severe form of sacrococcygeal pilonidal sinus disease. In terms of simplicity, hospitalization time, the recovery time to daily activity and work, esthetic satisfaction, and post-surgical complications, our surgery technique was superior to other open wound surgery such as V-Y Advancement flap, and Karydakis flap.

Background and objective: The purpose of this study was to examine the effectiveness of Tranexamic acid administered in the third stage of labor to reduce vaginal blood loss and prevent postpartum hemorrhage in women with high-risk factors for postpartum Hemorrhage.

Methods: A double-blind randomized placebo-controlled trial with two parallel groups was conducted in women scheduled to undergo vaginal delivery at the Maternity Teaching Hospital, Erbil city, Kurdistan Region, Iraq. The women were randomly assigned to receive tranexamic acid (97 women) or placebo (99 women) immediately after fetal delivery in the third stage of labor. The vaginal blood loss and the time from fetal to placental delivery were measured.

Results: The mean blood loss in the placebo group (Group 1) was 354.5 gram, which was considerably greater than the mean blood loss in the tranexamic group (Group 2), which was 284.4 gram. The incidence of postpartum hemorrhage (blood loss of ≥500 ml.) and (blood loss of ≥250 ml.) was significantly higher in G1 than G2. The length of the third stage of labor lasted 10.28 minutes in G1, which was longer than in G2, which lasted 7.82 minutes. Oxytocin was given to both groups as an active management of the third stage of labor.

Conclusion: In this single-center study, women with risk factors for postpartum hemorrhage who received tranexamic acid had lower postpartum blood loss and a shorter time for placental delivery than those women who received placebo. Larger multicenter randomized clinical trials are needed to generalize these findings.

Background and objective: Thyroid surgery has traditionally been done on an inpatient basis. With the advent of minimal access techniques. This study aimed to assess the outcome of short-stay total thyroidectomy in comparison with a longer stay in terms of postoperative complications.

Methods: This was an observational comparative study which was carried out at the surgical units of Erbil of Rizgary Teaching Hospital and private hospitals in Erbil city. The data were collected in the period between January 2017 and March 2021. Data of 192 patients’ records who underwent thyroidectomy were collected.

Results: In this study, 33 (17.1%) patients were males while 159 (82.8%) were females. Out of 192 patients, 137 underwent sutureless technique while 55 of them underwent sutured way of hemostasis. Majority of patients 173 (90.1%) were discharged before 23 hours, while 19 (9.9%) were discharged after 23 hours. Significantly, higher percentage of males (24.2%) stayed more than 23 hours in the hospital compared with 6.9% of females (P = 0.006). The majority of indications with goiter, Graves’ disease, toxic nodule and solitary stayed between 12-23 hours while half of those with cancer stayed more than 23 hours (P = 0.023).

Conclusion: Short-stay thyroid surgery is a feasible and safe procedure when combined with sutureless technique: this returns to overall less postoperative complications; day-case and short-stay procedures account for an expanding area of modern-day surgery.

Background and objective: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of coronavirus disease-19 (COVID-19). The effects of COVID-19 on the thyroid axis remain uncertain. This study aimed to determine the occurrence of thyroid dysfunction, as previously demonstrated for SARS-CoV-1 infection, and to analyze electrolytes (sodium, potassium, and chloride) to determine the severity of the disease.

Methods: Blood samples were taken from patients who were admitted to Erbil hospitals from July to October 2021. Infection was detected by polymerase chain reaction (PCR). The 306 cases were labeled as moderate or severe. The samples were assessed for doing C-reactive protein (CRP), as a marker of systemic inflammation, thyroid-stimulating hormone (TSH), triiodothyronine (T3) and thyroxine (T4), and (sodium, potassium, and chloride) electrolytes.

Results: Patients comprised of 157 (51.3%) males and 149 (48.7%) females. The result revealed that 274 (89.5%), 278 (90.8%), 292 (95.4%) of patients had normal TSH, T3, T4 level respectively, 22 (7.2%), 23 (7.5%), 9 (2.9%) of patients had low TSH, T3, T4 level respectively, and 10 (3.3%), 5 (1.6%), 5 (1.6%), had high TSH, T3, T4 level respectively. There was no significant difference between moderate and severe cases in alterations of TSH, T3, T4 level. There was a significant difference between moderate and severe cases in sodium, potassium, and chloride electrolyte abnormality.

Conclusion: The occurrence of thyroid dysfunction in moderate and severe cases. The severity of the COVID-19 infection is associated with abnormalities in sodium, calcium, and chloride electrolytes.

Background and objective: Retractile testis is relatively common in pediatric population. This study followed up boys with retractile testis to investigate the natural course and the need for hormonal therapy and surgical treatments.

Methods: A total of 110 boys aged 1.5-10.1 years (mean: 3.2 years) diagnosed as retractile testes, 67 (60.9%) unilateral and 43 (39.09%) bilateral. The mean follow-up period was 4.9±1.3 years. The diagnosis is confirmed on history and examination and ultrasound was made for measuring the size of the testis.

Results: A total of 47 (42.72%) cases received human chorionic gonadotropin (17 bilateral and 30 unilateral). Response occurred in 32 boys (68.1%),12 bilateral and 20 unilateral. Failure of response occurred in 15 boys (31.9%). Fourteen of 110 boys (12.72 %) were referred for orchiopexy, including 1 of 12 (8.3%) of bilateral cases and 2 of 20 (10%) of unilateral cases who responded to human chorionic gonadotropin injection, 2 of 5 bilateral cases (40%) and 1 in 10 unilateral cases (10%) in those did not respond to treatment. In those who did not receive treatment, orchiopexy was performed in 6 of 26 bilateral cases (23.1) and in 2 of 37 unilateral cases (5.4%).

Conclusion: Although testicular descent was achieved by short-term hormone therapy, the study revealed that there is no significant statistical difference for the need for orchiopexy between those received and those did not receive human chorionic gonadotropin.

Background and objective: The traditional herbs Beta vulgaris and Corchorus olitorius are cultivated in Iraq and recorded in the Kurdish ethnobotany for various health problems including expectorant, laxative, diuretic, and anti-inflammatory and to relieve fever and pain. This study aimed to assess and compare the different biological properties of methanolic leaf extracts of Beta vulgaris and Corchorus olitorius cultivated in Iraq and recognize various classes of phytoconstituents present in each one.

Methods: The bioactive entities in the crude methanolic leaves extracts of Beta vulgaris and Corchorus olitorius were subjected to phytochemical evaluations. The antioxidant and anti-inflammatory activities were evaluated with the 2,2-diphenyl-1-picrylhydrazyl (DPPH) and egg albumin denaturation assays, respectively. The leaf extracts were tested for antibacterial properties using the agar well diffusion and broth microdilution methods.

Results: The crude methanolic extracts of Beta vulgaris and Corchorus olitorius showed the presence of carbohydrates, alkaloids, cardioactive glycosides, coumarins, flavonoids, phenols, tannins, terpenoids, and steroids. The Beta vulgaris displayed higher gallic acid content 417.90±0.52 mg/gm of the extract compared to 79.85±0.99 mg/gm for Corchorus olitorius with (P <0.001).The antioxidant activity of Beta vulgaris leaves extract was significantly higher with (P = 0.035) in reference to ascorbic acid. Among the selected bacterial species, Klebsiella pneumoniae revealed pronounced sensitivity towards the methanolic extracts of both plants. The Corchorus olitorius leaves extract showed higher antibacterial activity than Beta vulgaris. Beta vulgaris presented greater anti-inflammatory activity at 1000 μg/mL with inhibition of 93.0% compared to 83.2% using acetylsalicylic acid as positive control.

Conclusion: The methanolic leaf extracts of Beta vulgaris and Corchorus olitorius possess antibacterial, antioxidant, and anti-inflammatory potentials.

Background and objective: Stroke is still one of the major causes of death, and the incidence and mortalities are increasing. The objective of the study is to measure the three months outcome of stroke patients discharged alive from the hospital.

Methods: A longitudinal study was carried out in Rizgary Teaching Hospital in Erbil, Iraq during the period from 1^st of April, 2018 to the 30^th September, 2018 involving 100 patients with ischemic stroke.

Results: The mean age (± SD) of patients was 64.15 ± 13.35 years, the age ranging from 26-89 years, and the median was 65 years. More than half (54%) of patients were males. Twenty (20%) patients died within three months after the development of stroke, 4% developed ischemic stroke after three months. Significantly higher rates of death were detected among those with chronic obstructive pulmonary disease (P <0.001) and those with dysphagia (P = 0.002). No significant association was detected between the case fatality rate with age, gender, body mass index, smoking, hypercholesterolemia, ischemic heart disease, angina, congestive heart failure, atrial fibrillation, heart valve dysfunction, strenuous physical activity, treatment for diabetes, treatment for high cholesterol, and HbA1c levels.

Conclusion: The case fatality rate was relatively high three months after the development of stroke. It is recommended to strengthen the follow up measures after patients’ discharge from the hospital.

Background and objective: Community immunity to bring the COVID-19 pandemic to an end will be achieved by a successful vaccination against COVID-19. All university students in Kurdistan Regional Government were required to receive the COVID-19 vaccines. The aim of this study is to identify the university students’ perspectives about the COVID-19 vaccination and their willingness to receive a COVID-19 vaccine.

Methods: A quantitative cross-sectional study using self-administered online survey was conducted among the university students from 14^th to 28^th February 2022. All undergraduate students at different Colleges of Hawler Medical University were invited to take part in the study. A convenience sampling method was applied to reach the sample through using Google form.

Results: In total, 644 students participated in the study; around half (47.5%) of them have received the vaccine. There were significant statistical associations between selected students’ characteristics and their COVID-19 vaccination status. The following factors were associated with high rate of vaccination: students aged older than 20 years old (P = 0.01), being male (P = 0.037), senior students (P ˂0.001), being infected with the COVID-19 infection (P = 0.048), and having family members with chronic disease (P = 0.003).

Conclusion: The current study revealed significant findings as the majority of students were still unvaccinated at a time where the COVID-19 vaccines were available to them. Having concern about serious side effects of the vaccine and its safety were the main reasons for vaccine avoidance, whereas, requiring students to be vaccinated by the place where they study was the main reason to take the vaccine. Future studies further exploring the factors contributing to vaccine hesitancy and avoidance seems essential.