Vol 27, No 1 (2023)

Background and objective: Atherogenic index of plasma (AIP) is a mathematical method logarithmically ratio between concentrations of triglycerides to HDL-cholesterol, AIP= Log (TG/HDL), so AIP increase with increase triglycerides and reversible with HDL level. The aim of this study is to evaluation the AIP as a stronger biomarker of atherosclerosis among type 2 diabetes mellitus (DM).

Methods: This was a cross sectional-study contacted. A total of 65 patients of type 2 diabetic patient group from Laila Qasim Center for Diabetes in Erbil City collection of blood samples from 65 patients of type 2 diabetic patient group from Laila Qasim Center for Diabetes in Erbil City, compared with 50 healthy volunteers (control group). Blood samples were collected into serum separation tube (gel tube) and (K₃EDTA) tube, allowed gel tube to clot at room temperature for 5 minutes then centrifuged at 4000 round per minute (rpm). The separated serum was used immediately for biochemical tests and all the laboratory investigation analysis were carried out from 2^nd January to 2^nd August 2021.

Results: The results of this study found that the level of serum glucose, HbA1C, albumin, CRP, and AIP in diabetics were significantly higher than healthy group, while decreasing S. HDL in diabetic patients compare with healthy individuals.

Conclusion: The study detected high level of AIP in type 2 DM patients. Accordingly, patients with type 2 DM should be followed up with regular dietary lipid intake, take lipid lowering drugs, with exercise in order to diminish AIP.

Background and objective: Hypertension is a growing public health problem worldwide; hypertensive patients experience negative emotions, which in particular may increase the risk for mental health instabilities. The objective of the study was to find out the prevalence of anxiety and depression among hypertensive patients.

Methods: This was a cross-sectional study conducted in a clinic from May 1^st to October 1^st, 2021 in the city of Erbil, Kurdistan Region of Iraq, among 286 hypertensive patients, for assessing the level of association of hypertension with depression and anxiety.

Results: A total of 286 participants were included, the mean age was 61.2 ± 12 years, and the age range was 33 to 88 years. More than half (57.3%) of the patients were females, 55.9% of patients had a form of Ischemic Heart Disease (including stable and unstable angina, obstructive and non-obstructive coronary artery disease) and 39.9% of them were diabetic. It was found that depression was higher among females (26.3%) than male patients (18%) (P = 0.002). Anxiety was more prevalent among females (24.4%), while only 8.2% of male hypertensive cases had anxiety (P = 0.001).

Conclusion: A considerable proportion of the hypertensive patients had depression and anxiety. The rate was higher among women than men.

Background and objective: Type 2 diabetes mellitus is typically a multifactorial disorder involving genetic and environmental factors to variable extents. The aim of this research was to find out if there is a relationship between the “ABO” and “Rhesus” blood groups and type 2 diabetes mellitus.

Methods: A case-control study was carried out at Azadi Teaching Hospital in Duhok city for six months, from 1^st July 2019 to 1^st January 2020. The study included 800 individuals including 400 randomly selected diabetic patients and 400 non-diabetic adults of both genders. Standard slide agglutination method at room temperature was performed to determine the ABO and Rh blood groups.

Results: Out of 400 patients, 185(46.25%) were male and 215(53.75%) were female. It was found that out of 400 randomly selected patients, majority had O blood group 193(48.25%), 109(27.25%) had A, 65(16.25%) had B, 33(8.25%) had AB group. A higher frequency of O blood group was encountered among the diabetics comparing to the control (48.25% vs. 37.75%). On applying the Chi-square test, the blood groups O and type 2 diabetes mellitus were found to have a statistically significant relationship (Chi-square value - 8.14, P <0.005) and no statistically significant association between the Rh group and type 2 DM was observed (P >0.05).

Conclusion: According to this study, people with the O blood group are at a greater risk of having type 2 diabetes mellitus, but there was no discrepancy in type 2 diabetes mellitus risk between Rhesus positive and negative classes. The level of blood groups A among diabetic patients is also concluded to be substantially lower.

Background and objective: Medical complications are accepted to be an imperative issue after acute stroke and show potential restrictions to optimal improvement. The purpose of this study was to determine the frequency of acute phase complications after stroke.

Methods: This cross-sectional study was conducted between 1^st August -to 31^st December 2019. A convenience sample of 203 stroke patients attending Rizgary Teaching Hospital in Erbil, Iraq was taken. Patients were followed-up daily and the complications were recorded.

Results: The mean age ± SD of complicated patients was 65.86 ± 15.34 years, while of uncomplicated patients was 63.0 ± 14.72 years. The results revealed that the most common complication of the stroke patients was pain (45.4%), fever (30.3%) and the least ones were urinary traction infection (0.7%) and deep vein thrombosis (0.7%). The results found that 82.4% of the female stroke patients were complicated, while 66.3% of the males were complicated and there was statistically significant association (P = 0.008) between the development of complications and gender, also the rate of complications among illiterate and primary and secondary school patients were 78.4% and 68.3%, respectively while among university patients was 44.4% and there was statistically significant association (P = 0.041) between the development of complication and the educational level of patients.

Conclusion: The findings of this study suggest that post stroke neuro-medical complications are common as concluded in previous studies with few contrasts. The form of these complications is comparable with other setups.

Background and objective: Oral health is one of the essential elements of the overall health status of the people. Dental hygiene and dental diseases concern to have a major public health problem. The aim of this study was to know the proportion self-perception of dental problems and their relation with the socio-demographic characteristics among female students at intermediate governmental schools in Abha.

Methods: A cross-sectional study was conducted among girls students of two intermediate government schools of Abha city during October 2016 to April 2017 academic year by using self-administered questionnaire and informed verbal consent was obtained, using simple random sampling techniques for choosing 400 students.

Results: Mean age of the students was 12.30±1.82, 163(41%) of students were 12-13 years of age and 200(50%) from 1^st year of intermediate scholastic year. Almost all students belong to nuclear family system and 64%lived in rented houses. Working status of father and mothers was 94% and 53% respectively, 88% family’s monthly income >10000 SAR/per month, 203 (51%) fathers and 171 (43%) mothers had secondary school or higher education. Illiteracy was 13% among fathers and 19% among mothers. The proportion of self-perceived dental problems was 43% among students, malocclusion of teeth was most frequent while bad smell was the least frequent complaints among all dental problems. Only 38% of the students were considering dental problem as a serious problem. Dental problems were found to have significantly (P value <0.001) associated with age, scholastic year, father’s education and occupation, and income.

Conclusion: It is concluded that although prevalence of dental problems were higher but frequency of self-perceived problems were much lower which highlighted that there is need to increase the awareness of dental problems among population to have a better general health status.

Background and objective: Zolmitriptan is among widely used medicines for the management of migraine attach, zolmitriptan is acting through stimulating serotonin (5-HT1B/1D) receptors that will cause cranial vasoconstriction. This study was aimed to compare and evaluate the impact of zolmitriptan on the relevant cardiovascular and renal biomarkers during hypertension in rats with experimentally induced hypertension.

Methods: Twenty-four Wister albino male rats were randomly divided into four groups of six rats each. The first group (Group I) of rats served as the control group. To induce hypertension, the rats in the second (Group II), third (Group III) and fourth (Group IV) groups have received an intraperitoneal injection of cadmium chloride CdCl2 a dose of 1.5 mg/kg/day for 14 days. The rats in Group II were considered as the positive control. Whereas, rats in Group III received zolmitriptan orally (2 mg/kg/day), and Group IV rats received nifedipine dose of 10mg/kg for two weeks concurrently with CdCl₂.

Results: Inducing hypertension with CdCl2 injection significantly increased the systolic, diastolic, and mean blood pressure in Group II compared with Group I, respectively. The systolic, diastolic, and mean blood pressure in rats that received zolmitriptan did not exhibit any statistically significant differences from the rats in Group II, whereas nifedipine has significantly reduced blood pressure in group IV rats.

Intraperitoneal injection of CdCl₂ increased the concentrations of endothelin and nitric oxide as well as renin activity level in hypertensive Group II rats compared to control rats. Zolmitriptan administration did not produce any significant change in the endothelin and nitric oxide levels.

Inducing hypertension in rats significantly reduced the corticosterone level. In contrast, administering medications in Group III and VI rats did not produce any statistically significant change in the serum concentration of corticosterone.

Conclusion: Zolmitriptan administration (2 mg/kg/day, p.o) showed no statistically significant effects on the systolic, diastolic, and mean blood pressure in rats with experimentally induced hypertension. Zolmitriptan has also failed to produce any statistically significant change in the levels of endothelin-1, renin, nitric oxide, corticosterone, and serum creatinine in rats with hypertension.

Background and objective: The World Health Organization recognizes the importance of positive childbirth experience. In Iraq, patient satisfaction during maternity care visits is not routinely collected. This study was aimed to find out the women’s expectation during labor from physicians and midwives and associated factors such as socio-demographic and obstetrical characteristics.

Methods: This cross-sectional study was conducted in Erbil city, located in the Kurdistan region of Iraq. A total of 1,500 women were targeted while they were accompanying another person, including children, to receive health services in Erbil and eventually 1,196 participated in the study. Data were collected through direct interviews after receiving informed oral consent. Participants were asked to describe their expectations for childbirth using an open-ended question. Responses were then grouped and categorized into 20 expectation items based on overlapping themes. Chi-square tests were used to identify associations with key socio-demographic and obstetric characteristics.

Results: Level of expectation was significantly associated with education (illiterate and high education, P = 0.028),residency (suburban, P = 0.003), parity (grand multipara, P = 0.001), satisfaction with care (those satisfied, P <0.001), and satisfaction with provider communication (those satisfied, P <0.001). This study found that positive and calming verbal and non-verbal expressions, environmental control, encouragement of different positions and mobilization, hygiene, promotion of urinary elimination, and instruction on breathing and relaxation are highly expected by parturient women.

Conclusion: Understanding women’s expectations in the delivery room is critical to health care providers in order to make appropriate care plan and support women to have a positive birth experience and to meet expectations.

Background and objective: Papillary thyroid carcinoma (PTC) is the most common primary thyroid cancer. PTC diagnosis is based on the presence of classic nuclear features in most cases. However, there are some mimics including both benign neoplastic and non-neoplastic lesions, therefore immune-histochemical stains are necessary for equivocal cases. This study aimed to evaluate the diagnostic expression of CK19 in different thyroid lesions and also to differentiate PTC from other mimicking thyroid lesions.

Methods: A retrospective study of 90 cases of different thyroid lesions (56 patients with benign neoplastic and non-neoplastic lesions and 34 PTC) was investigated from January 2018 to January 2020. Immunohistochemical staining with CK19 was performed.

Results: CK19 IHC expressed in about 94% of PTC cases as moderate and strong pattern of staining, while in benign neoplastic and non-neoplastic thyroid lesions only 7% expressed as moderate and non with strong pattern of staining, it showed a significant statistical difference (P <0.001).The sensitivity and specificity of CK19 total estimated score for diagnosis of PTC were 94.1% and 92.9%, respectively.

Conclusion: Although no single immunohistochemical marker is completely sensitive in differentiating benign from thyroid malignancy, this study found a significant and effective role of CK19 in distinguishing PTC from benign neoplastic and non-neoplastic mimickers’ lesions. In addition, lymph node metastatic tumor cells retained the same staining intensity of CK19.

Background and objective: Evaluating patients with blunt abdominal trauma remains one of the most challenging aspects of acute trauma care. CT scan of abdomen remains the standard imaging modality for evaluation of abdominal trauma cases.

The aim of this study is to evaluate CT scan findings in blunt abdominal trauma victims with respect to solid organ injuries, hollow viscus injuries, associated thoracic and abdominal wall injuries, associated hemoperitoneum, cause of injury and type of management.

Methods: A cross-sectional study was conducted among 96 hemodynamically stable patients with history of blunt abdominal trauma who underwent CT scan examination in Rozh-halat Emergency Hospital from June 2021-January 2022; using a 64 multi-detector helical slice CT scanner. Data analysis were performed on patient’s demographics, mode and type of injury, CT scan findings and severity scorings, associated injuries and type of management.

Results: The mean age of enrolled cases was 28.6 ± 18.6 ranged from 4-70 years. About two third (63.5%) were males and one third were females (36.5%). The most common cause of trauma was road traffic accident (64% of cases). Out of 96 trauma cases; 87.5% of patients had positive CT findings of which 50% had hemoperitoneum, 21.9% had pneumoperitoneum, 66.7% had no hallow viscous involvement, while 33.2% had hollow viscus involvement. One third of cases had associated abdominal wall injury. 56.4% of patients had multiple organ injury. Regarding solid organ injury; 66.7% of cases had spleen injury, (36.5%) had liver injury, Pancreas was involved in 12.5% of cases. RT& LT – kidneys showed grade 2 injury in (9.4%) & (6.3 %) respectively. Half of patients with positive CT scan findings had no lower chest injury findings. This study showed that 43.8% of cases were managed conservatively, 45.9% underwent laparotomy, the incidental finding of intra-operative hemoperitoneum which was negative in CT scan was only 1%.

Conclusion: CT imaging is the diagnostic tool of choice for the evaluation of blunt abdominal trauma in haemo-dynamically stable patients as it can assist in detecting and evaluating other co-existing injuries such as lower thoracic, pelvic and spine injuries apart from its main role in accurate identification of intra -abdominal injuries and associated bleeding.

Background and objective: Acinetobacter baumannii is a significant pathogenic bacterium in the health system. The ability to resist antimicrobial drugs and biofilm formation gives the considerable capacity to A. baumannii for existing in a harsh environment, enabling this bacterium to cause hospital-acquired infection. Carbapenem is an important treatment option for severe nosocomial infection and patients infected by multidrug-resistant organisms. The main aim of this study is to detect carbapenemase in isolates, and its association with biofilm formation as well as antibiotic resistance.

Methods: Sixty A. baumannii isolates were obtained from several hospital districts in Erbil city. Identification and antimicrobial susceptibility test (AST) of isolates were performed by VITEKII compact system. Phenotypic identification of carbapenem by sCIM also biofilm-forming was detected by 96 well method. Additionally, three antimicrobial agents were used if they were successful in eliminating biofilm formation. .

Results: The majority of the isolates were from sputum, accounting 75% and antibiotic susceptibility showed that the isolates are resistant to the most available antibiotics, and significant of the isolates formed strong biofilm. The sensitivity of meropenem, ceftazidime, and ciprofloxacin were employed for ten isolates of A. baumannii after biofilm formation it was found that biofilm cells need more concentration of antibiotic than planktonic cells then phenotypic detection of carbapenem showed that the overall positive values were 30 (50.0%) for sCIM.

Conclusion: We revealed that most resistant isolates have a greater capacity for biofilm development than sensitivite isolates. Biofilm-producing strains of A. baumannii cannot be killed with the relatively similar concentration of antimicrobial drugs that are needed to kill planktonic cells.

Background and objective: Many clinical trials have revealed that HMG-CoA reductase inhibitors (statins) have anti-inflammatory effects through their pleiotropic activities there by decreasing the risk of cardiovascular disease (CVD). This study intended to evaluate the effect of rosuvastatin on the level of inflammatory markers (hsCRP, IL-6, sCD40L, Lp-PLA2, and cystatin C) in normotensive and hypertensive rats.

Methods: Twenty-four male Wister rats were divided into two groups of twelve. Group 1 consisted of normotensive rats, while Group 2 served as the hypertensive model. Each group was further subdivided into two groups. Subgroup A served as the control group which received the only placebo and subgroup B was the treatment arm which received rosuvastatin 10mg/kg daily for 4 weeks.

Results: Rosuvastatin did not significantly affect blood pressure and heart rate in both normotensive and hypertensive rats. The level of inflammatory markers (hsCRP, IL-6, and Lp-PLA2) significantly increased in hypertensive rats, while the level of both sCD40L and cystatin C did not change. Rosuvastatin lowered the level of IL-6, sCD40L, Lp-PLA2, and cystatin C significantly in hypertensive model rats. However, the level of hsCRP was non-significantly reduced by rosuvastatin. In normotensive rats treated with rosuvastatin, the level of cystatin C was significantly reduced.

Conclusion: Rosuvastatin significantly decreased the level of IL-6, Lp-PLA2, sCD40L, and cystatin C in hypertensive rats while in normotensive rats, rosuvastatin treatment produced only a reduction of cystatin C. Our results suggest an anti-inflammatory effect of rosuvastatin in hypertention through reduction of inflammatory markers.

Background and objective: Different molecular alterations have been described in the pathogenesis of endometrial carcinoma, among themis mutation of the PTEN (phosphatase and tension homolog), a tumor suppressor gene. This study aimed to detect PTEN immunoexpression in endometrial carcinoma and to asses the association between PTEN immunoexpression with the clinicopathological parameters.

Methods: This cross-sectional retrospective study was carried out between January 2016-December 2021 in Erbil city. A total of 112 formalin fixed, paraffin embedded, archival tissue blocks of total abdominal hysterectomy samples were collected in Erbilcity. The clinicopathological characteristics of the tumors were revised, and the specimens were analyzed immunohistochemically using monoclonal PTEN antibody clone 6H2.1 (Dako.

Results: Seventy- seven cases (68.8%) were labeled as negative for PTEN immunoexpression. While 35 cases (31.2%) were labeled as positive for PTEN immunoexpression. PTEN immunoexpression was significantly associated with the tumor histological types (P = 0.001), while no significant association was found between PTEN immunoexpression and other clinicopathological parameters.

Conclusion: Loss of PTEN immunoexpression frequently seen in endometrioid type of endometrial carcinoma than other types of endometrial carcinoma and is significantly associated with the histological types of endometrial carcinoma.