Vol 27, No 2 (2023)

Background and objective: Pregnancy associated Group B streptococcal infection is a well-established cause of significant neonatal morbidity and mortality. A cross-sectional study was conducted to determine the prevalence of Group B streptococcal infection among women presenting in labor at different ages and gestational ages and its correlation with different risk factors.

Methods: Vaginal swab and urine sample for culture from 150 women having risk factors and being in labor and having risk of developing Group B streptococcal infection from 2^nd of November 2020 to 2^nd of December 2021.

Results: The prevalence of Group B streptococcal infection among risky group women during labor in Maternity Teaching Hospital was 8%. The rate of agreement between the vaginal swab results and urine culture results was 92%. There was no significant association between urine culture results with age, parity and prolonged rupture of membrane. A significant high rate of infected urine in culture was found among women with a very extreme preterm gestational age (p value 0.049), and it was also significant among women with pyrexia (p value 0.001).

Conclusion: The prevalence of Group B streptococcal infection among high-risk group of women during labor in Maternity Teaching Hospital of Erbil city was 8%.

Background and objective: Corona infections disease nowadays is one of the major burden on national health institutes. The aim of the study is to identify the parameters that can predict the mortality in moderate to severely ill COVID-19 infected patients.

Methods: A prospective cross sectional study was carried out in Erbil Hospitals, Kurdistan region/Iraq from December 2020 to December 2021 on a sample of 100patients with positive real-time polymerase chain reaction. The data of enrolled patients were collected by direct interview with patients or with their relatives and filled in a prepared questionnaire. The patients were followed up from their admission to hospital until their discharge alive or dead.

Results: The mortality rate of hospitalized patients was 44% for 100 patients. Budesonide nebulizer were given to all of the patients. The mortality rate was significantly higher in old COVID-19 patients. The COVID-19 patients presented with dyspnea, hypertension and renal failure were significantly associated with higher mortality rates. High respiratory rate, low oxygen saturation and high C-reactive protein level were accompanied with higher mortality rates of COVID-19 patients.

Conclusion: The early predictors of mortality in patients with moderate to severe COVID-19 infection were elderly age, clinical presentation of dyspnea, clinical co-morbidity with hypertension and renal failure, high respiratory rate, low oxygen saturation and elevated levels of C-reactive protein.

Background and objective: Dealing with a large complex wound is very challenging, and latissimus dorsi flap through history has been used as its very variable and flexible in the form of pedicle or free flap in the coverage of those large complex wounds as its large, well perfused, and flexible in configuration. The study aimed to evaluate the versatility of use and viability of latissimus dorsi free flap for coverage of large complex wounds in different parts of the body.

Methods: A retrospective study was conducted from 2012 to 2019 in Erbil Rizgary teaching hospital, Rozhawa emergency hospital, and PAR private hospital, Kurdistan region, Iraq on 22 cases, (20) male (90.9%), and (2) female (9.1%), all with a large complex wound in different sites of the body that latissimus dorsi free flap in the form of myocutaneous mainly and only one with muscle free flap.

Results: The complex large wounds ranged from (22*15 cm – 35*20 cm) indifferent sites of the body, (18) from the lower limb,(3) from the forearm and (1) from the scalp, from those 22 cases, we had 17 cases that survived totally(77.2%), and 5 failure cases (22.7%) those were from leg who associated with tibial bone fracture gestilo type 111B and C and large soft tissue defect with or without vascular injury, and in regard to flaps out of 22 cases 5 of them presented with total necrosis (55.6%), one case with partial necrosis(11.1%), and 3 cases with partial skin graft loss (33.33%), that managed conservatively, in all cases donor site closed primarily with few morbidities as happened in 5 cases (22.7%) like bleeding in 3 cases (60.0%) and stoppage needed operation theater, one case (20.0%) with seroma, and one with minor wound dehiscent (20.0%), that both managed conservatively.

Conclusion: The latissimus dorsi myocutaneous free flap is the reliable, flexible and highly recommended for large soft tissue defect reconstruction in different sites of the body especially those associated with extensive bone damage.

Background and objective: In western countries, the incidence of Cholelithiasis is found to be more than 10% in general populations. After performing the first successful laparoscopic cholecystectomy (L.C.) in Germany by Muhe in 1986, it rapidly became the procedure of choice in treating symptomatic gall stone. L.C. has a lot of advantages, including minimal trauma, rapid recovery, less analgesic requirement with a good esthetic outcome, however even in the hands of a best surgeon still there is a small percentage of conversion to open laparotomy, some risk factors has been recognized as a reason for the conversion to open laparotomy. This study aims to evaluate the rate with the underlying risk factors that increase the chance of conversion to open cholecystectomy.

Methods: A total of 1400 patients for whom L.C. was attempted, 54 were enrolled in this prospective study from January 2014 to January 2020. The exclusion criteria were malignancy or existence of gallbladder polyps detected pathologically. Patient demographics, indications for cholecystectomy, concomitant diseases, and histories of previous abdominal surgery were collected. The rates of conversion to open cholecystectomy with the underlying reasons for conversion were analyzed.

Results: The overall rate of conversion to open cholecystectomy was 3.86% (54 patients). Out of 54 cases nearly two-thirds (61.1%) of the patients (33) were males and 38.9% of the patients (21) were females. Male: female ratio is 1.57:1. In the study sample, the conversion rate among obese (14/54) patients was 25.9% compared with the rate of 74.1% among non-obese (40/54) patients. Out of 3.86% of the conversion rate, 2.86% were non-obese and 1% were obese patients. The commonest etiology for conversion was thickened gall bladder due to severe gall bladder inflammation with fibrosis (21 patients) 38.9% followed by Acute cholecystitis (8 patients) 14.8%, then fibrosis (7 patients) 13% with aberrant anatomy at the calot^’s triangle (6 patients) 11.1%.

Conclusion: A thickened gall bladder was found to be the commonest risk factor for conversion to open cholecystectomy, the conversion from L.C. to O.C. should not be regarded as a failure of the procedure or as a complication, rather it should be regarded as a prudent maneuver for achieving the desired objective namely safe removal of the gall bladder.

Background and objective: The increased prevalence of extended- spectrum beta-lactamase producing Enterobacteriaceae has increased the use of last-resort antimicrobial drugs like Carbapenems. An alternative idea is to use new combinations of common antibiotics. The aim of the present study is to examine whether acidified nitrite has the ability to enhance the activity of beta-lactam antibiotics against the biofilm formation and bacterial growth of beta-lactamase- producing uropathogenic isolates.

Methods: In this cross-sectional study, a total of 37 beta-lactamase- producing uropathogens were collected from patients at Urology Department at Rizgary Teaching Hospital in Erbil/Iraq. Biofilm formation was determined using a 96-well tissue culture plate assay. The ability to produce beta-lactamase production was detected by a phenotypic confirmatory combination disk diffusion test. The sub-minimal inhibitory concentration of antibiotics alone and in combination with each of acidified nitrite, ascorbic acid and sodium nitrite towards biofilm formation were observed.

Results: The combination of cefotaxime with each of acidified nitrite (P <0.001), ascorbic acid (P <0.001) and sodium nitrite (P = 0.003) significantly enhanced the effect of cefotaxime against the biofilm producing activity of beta-lactamase producing uropathogens. Furthermore, with ceftazidime identical synergistic results were obtained with ascorbic acid (P = 0.001) and acidified nitrite (P = 0.007).

Conclusion: Acidified nitrite significantly improved the activity of beta-lactam antibiotics against the biofilm mass of beta-lactamase producing uropathogens.

Background and objective: Determining the relationship between body compartments and Lower Back Pain (LBP) will increase our understanding about how body compartments can affect LBP disability. This study aimed to assess the association between body compartments and LBP disability pre and post-physiotherapy.

Methods: A prospective study conducted in the main two governmental physiotherapy departments in Erbil. One Hundred patients were diagnosed with LBP and referred to physiotherapy units. All patients were assessed before starting physiotherapy and body compartments were measured by bioelectrical impedance analysis (BEIA). LBP disability was measured for each patient by a modified Oswestry disability index (ODI). After completing six sessions of physiotherapy all patients were reassessed regarding body composition, obesity measures, and LBP disability.

Results: Regarding the body fat percentage (BFP), 61% of females and 56.7% of males were obese. Results showed a positive significant correlation (P = 0.013) between BFP and LBP disability after physiotherapy, while a negative significant correlation (P = 0.026) between total body water (TBW) and LBP disability. There was a significant improvement in disability after physiotherapy (P <0.001). Eleven percent of patients succeeded to reach minimal clinically important difference (MCID ≥ 30%). Body composition and other obesity measurements were not significantly different before and after physiotherapy.

Conclusions: LBP disability is positively associated with BFP and negatively associated with TBW. The physiotherapy protocol performed in the physiotherapy units was able to significantly improve disability although a low number of patients reached MCID ≥ 30%. Body compartments were not significantly different before and after physiotherapy.

Background and objective: Bleeding and thrombosis are major causes of morbidity and mortality in patients with acute leukemia (AL); they are attributed to hemostatic derangement and coagulation defects that are associated with leukemia. There is a paucity of information regarding coagulopathy in AL patients in our locality; this study, therefore, was employed to evaluate hemostatic parameters in patients with AL at the time of presentation.

Methods: This prospective cross-sectional study included 84 newly diagnosed patients with AL. The study was carried out at Nanakali hemato-oncology center from September 2021 to May 2022. Patients were assessed for coagulation parameters including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen level (FBG), D-dimer (D-Di), antithrombin (AT), protein C (PC), and protein S (PS).

Results: The median age of the studied patients was 26 years with a male to female ratio of 1.1:1. Acute myeloid leukemia (AML) patients constitutes 51.2% (43 patients), and the remaining 41 (48.8%) patients had acute lymphoblastic leukemia (ALL). PT was significantly prolonged, D-Di was significantly higher and AT, and PC were significantly decreased in AML compared to control groups. Only D-Di level was significantly higher in ALL compared to control groups. Bleeding manifestations were encountered in 40 (47.6%) patients with a higher incidence among the AML group (28 patients, 70%). Thrombosis occurred in 2 (2.4%) patients.

Conclusion: Defects of coagulation were common in AL. Hemostatic derangement and bleeding at the time of presentation were more noticeable in patients with AML.

Background and objective: Chronic kidney disease represents a leading cause of death in many countries. End-stage renal disease is the final stage of chronic kidney disease, in which the kidneys are no longer function well enough for the patient to live without renal replacement therapy. Galectin-3 is a soluble beta-galactoside-binding lectin protein involved in the fibrosis of many solid organs, including the heart and kidney. This study aimed to evaluate galectin-3 and other biochemical parameters in hemodialysis patients.

Methods: The design is a cross-sectional study with a comparison group. A total of 70 chronic kidney disease patients on regular hemodialysis from Erbil Dialysis Center in Erbil City and 68 healthy subjects were enrolled. The serum levels of galectin-3 were determined by enzyme-linked immunosorbent assay method.

Results: The mean level of serum galectin-3 was non-significantly higher in hemodialysis patients compared to the control group (P = 0.594). However, the serum level of galectin-3 was significantly higher in hemodialysis patients with cardiovascular disease compared to hemodialysis patients without cardiovascular disease (P = 0.0220). Serum galectin-3 level was significantly higher in hemodialysis patients aged 36-50 and 51-70 years old compared to hemodialysis patients aged 20-35 years old (P = 0.013, P = 0.026), respectively.

Conclusion: Serum galectin-3 might be used as a biomarker for hemodialysis patients with cardiovascular disease.

Background and objective: Hashimoto’s thyroiditis is one of the common autoimmune thyroid diseases with increasing incidence in the general population. It has been suggested that a combination of genetic and environmental factors increase the risk of developing the disease. The current study aimed to find the association between HLA-DRB1*04 gene with Hashimoto's Thyroiditis among the Iraqi-Kurdish population in Erbil Province.

Methods: The case-control study was conducted on 45 untreated patients with Hashimoto’s thyroiditis who have already been diagnosed and 45 control subjects. Blood specimens were taken from the subjects for gene detection purposes via conventional polymerase chain reaction. Sera specimens were used to run enzyme linked immunosorbent assay to measure the level of IFNγ.

Results: The age of subjects ranged from 32 to 63 years with no significant difference between mean ±SE of cases (46.822±1.087 years) with the mean ±SE (47.044 ±1.162 years) of the control subjects (P = 0.999). The mean ±SE of free T3 and T4 levels was lower in cases in comparison to those of controls, while the mean ±SE of TSH level in cases was significantly higher compared to those of controls. Statistically there was a highly significant difference in the mean ±SE of free T3, free T4 and TSH levels between cases and controls (P <0.001). Furthermore, the mean ±SE of anti-TPO, anti-Tg and IFNγ levels was higher in cases compared to those of control subjects. Statistical analysis shows a highly significant difference between mean ±SE of anti-TPO and anti-Tg antibody levels of cases compared to those of controls (P <0.001). As for IFNγ level, there was a significant difference between mean±SE of IFNγ levels in cases and controls (P = 0.021). The conventional polymerase chain reaction results showed that 39/45 (86.7%) of cases were tested positive for HLA-DRB1*04, while only 20/45 (44.04 %) of the control subjects tested positive for the gene, statistical analysis revealed a highly significant association between the existence of the gene with HT disease (P <0.001).

Conclusion: The study revealed a highly significant association between the existence of HLA-DRB1*04 gene and Hashimoto's thyroiditis disease among the Iraqi-Kurdish population in Erbil Province.

Background and objective: Worldwide immunophenotyping by flow cytometry (FCM) in acute leukemia (AL) is the golden step in the diagnosis. It’s very common for acute leukemias to aberrantly express antigens or cluster of differentiation (CD) markers which are usually expressed in other lineages of the disease hence this study aimed at determining the prevalence of aberrancy in AL and to find out the frequency of each aberrant CD marker and their association with the clinic-hematological profile of the cases.

Methods: Following history and clinical examination of enrolled patients, blood and/or bone marrow aspirate was drawn for morphological examination and immunophenotyping by FCM from 86 newly diagnosed acute leukemia cases then multiple steps procedure was applied followed by interpretation of the results.

Results: The prevalence of aberrant phenotype was 46.5%. The proportional frequency of aberrant phenotype in acute myeloid leukemia (AML) was 41%, in B-acute lymphoblastic leukemia (B-ALL) was 48.8% and in T-acute lymphoblastic leukemia (T-ALL) was 66.6%. The commonest aberrant CD markers in AML were CD22 and CD2, in B-ALL were CD66c and CD13 while in T-ALL were CD13 and CD33. The aberrant phenotype harbored lower white blood cell (WBC) count and blast percentage in PB, also splenomegaly was more frequent in lymphoid positive (Ly+) AML and myeloid positive (My+) T-ALL while in B-ALL, splenomegaly was more frequent in myeloid negative (My-) B-ALL.

Conclusion: Aberrant phenotype prevalence in our study sample was comparable to other studies, considerable frequency of aberrant markers is present in cases of AL and some variations exist regarding the clinical and hematological profile of the aberrant group.

Background and objective: Type two diabetes is known as insulin-independent diabetes mellitus due to body’s inability to respond to insulin and can be managed by lifestyle change and hypoglycemic tablets. This study aimed to compare serum levels of calcitonin, calcium, and phosphate between type two diabetic patients and controls.

Methods: The cross-sectional study included 50 patients who have already been diagnosed with type two diabetes mellitus and 50 control subjects without clinical signs of any diseases. The level of serum calcitonin, calcium, and phosphate was estimated for all participants.

Results: The mean serum level of calcitonin was (2.35 ± 1.18) pg/mL in the case group, while the mean was (32.91 ± 3.88) pg/mL in the control group (P-value = 0.001). The mean level of serum phosphate was (3.93 ± 0.08) mg/dL and (3.73 ± 0.09) mg/dL in the case and control groups, respectively (P-value = 0.117). The mean serum calcium level was (9.68 ± 0.10) mg/dL in the case group, and it was about (9.67 ± 0.14) mg/dL (P-value = 0.955) in healthy persons. Serum calcitonin was negatively correlated with glycated hemoglobin and serum glucose level.

Conclusion: The calcitonin serum level in diabetic patients was significantly lower than in healthy individuals. The level of bone minerals (calcium and phosphate) was not altered in type two diabetic patients when compared with control participants.

Background and objective: Five-membered heterocycle compounds having single oxygen and nitrogen atom at adjacent positions are known as isoxazoles. Isoxazole compounds have a broad range of biological activities and therapeutic value. In view of a strategic design of antimicrobial compounds, several new ester-functionalized isoxazoles were synthesized and characterized.

Methods: A regioselective isoxazole incorporating an anthracene moiety was adducted via an effective 1,3-dipolar cycloaddition between anthracene nitrile oxide and propargyl bromide as a dipolarophile.

Results: Synthesized isoxazole 4 underwent nucleophilic substitution reaction to produce unprecedented ester-functionalized isoxazoles 6a-j, by condensation with equimolar amounts of different generated in situ sodium carboxylate upon dissolving in acetonitrile with refluxing. The chemical structure of all target compounds was proved by (FT-IR, ¹H-NMR, and APT¹³C-NMR) techniques and their antibacterial and antifungal activities was evaluated.

Conclusion: Allnewly synthesizedcompounds6 a-j have been obtained in good yields after purification by column chromatography. They showed significant antibacterial and antifungal activity after screening against two bacterial strains, Escherichia coli and Staphylococcus aureus and a fungi strain, Candida albicans, using disc diffusion method.