Vol 27, No 3 (2023)

Background and objective: Wound healing is a dynamic process that can be compromised in patients with chronic and metabolic conditions or unhealthy lifestyles. Objectives of study is to demonstrate a hyaluronate-containing supramolecular structure which enhances repalysYAL^®cream effectiveness, sodium chloride with thymine (T-LysYal®); 1) notable progress in the healing of wounds. 2) the production of minuscule collagen strands 3) a shorter recovery period.

Methods: Case study, the test group received standard treatment followed by lysine cream to indicate the size and depth ulcer from the 1^st week to the 3^rd week. Our patients were a 1-year child and 29 years old male who presented with a second degree of total body surface area (TBSA) burn and skin grafts at the burn center of Rozhawa Hospital/ Hawler/Iraq. The observations were approved by the Ethics committee college of pharmacy in compliance with the ethical standard. Initially assessed as superficial partial-thickness in-depth, the wounds were treated conservatively with dressings and repalysYAL^® cream 2-3 times per day; however, represents the healing process in short-term individual therapy.

Results: In case 1; The patient had been exposed to flash deep burn to the right palm (thermal injury) mainly of superficial partial thickness; any necrotic tissue present needs to be removed to take full advantage of the product’s potential. When (repalysYAL®) cream is used, there will be a physiological increase in the exudate, which will have to be managed to avoid maceration. While in case 2;The patient presented surgical wound dehiscence in the inner compartment of the left foot with leakage of purulent material and signs of necrotizing fasciitis. with using (repalysYAL®) cream, the wound reduces scar formation due to 90% and increase fibroblast by 30% when a blood vessel is formed to which blood is supplied, the cells are cultivated and divided to form new tissue and an organ.

Conclusion: Signaling pathways that induce cellular and tissue responses after injury, which may be impeded during chronic wound healing, were greatly improved using lysine cream as a therapy.

Background and objective: Toxoplasma gondii is an important opportunistic parasite in immune-compromised individuals that causes toxoplasmosis. An intracellular pathogen could cause severe complications. Diabetes is a significant component that enhances the host's vulnerability and risk of acquiring a variety of infections.

The objectives of the current study are to reveal the relationships between toxoplasmosis and type 2 diabetes in addition to find out the most specific gene for the detection of Toxoplasma gondii.

Methods: In this case-control study, 201 blood samples were taken from type 2 diabetic women with 100 healthy women as control groups to detect anti-Toxoplasma IgG and IgM antibodies by performing latex agglutination test and Enzyme-Linked Immunosorbent Assay (ELISA). Detection of B1 and RE genes of Toxoplasma gondii among seropositive individuals by nested PCR and evaluation of leptin hormone in both groups were performed.

Results: Among 201 type 2 diabetic cases, 64 cases (32.0%) were seropositive for anti-Toxoplasma antibodies, with 15 samples (15%) among 100 healthy control group via latex agglutination test. ELISA performed for only latex positive samples and the results were 64 ((32%) IgG+, (0%) IgM+) patient group (15.0% IgG+, 0.0% IgM+) healthy group with the P-value 0.0001 which is highly significant. The results of nested PCR were (46.88%) (IgG+, IgM-) and (1.56%) (IgG+, IgM-) for B1 and RE genes, respectively. Increased levels of leptin hormone were observed in patients in compare to healthy controls.

Conclusion: Both Diabetes and the elderly increase the chance of vulnerability to get toxoplasmosis. Diabetes, toxoplasmosis and high body mass index results in elevation of leptin hormone that leads to diabetes. B1 gene is the specific gene for detection of T. gondii in our area.

Background and objective: The leading cause of morbidity and mortality globally is coronary artery disease (CAD). One of the recent new parameters for evaluating CAD is Serum GGT, which has been shown to be a predictor of coronary artery status irrespective of the traditional cardiovascular risk variables. This study aimed to evaluate and assess the correlation between serum GGT and other variables among patients with CAD in comparison with healthy subjects.

Methods: A case-control prospective study. Subjects were grouped into Group I (CAD patients-117 individuals) and Group II (healthy Subjects-83 individuals) based on their Coronary Angiographic profile at surgical specialty Hospital-Cardiac Center-Erbil/Iraq. Parameters of S. GGT, S. total cholesterol, S.HDL-C, S.LDL-C, S. VLDL-C, and S.TG, S. (25)OH vitamin D, serum troponin T, S.CK-MB, and CRP were assessed for both groups.

Results: The study population included 58% of male and 42% of female participants, with an age range of 30-77, with a mean of 56.13± 10.5 years old. The Pearson’s correlation coefficient of serum GGT with other variables showed that the relation between serum GGT with VLDL-C, CRP, and Triglyceride among CAD patients was found to be a weakly positive correlation and statistically significant (r=0.3, P = 0.004), (r=0.2, P = 0.031), and (r=0.3, P = 0.007) respectively.

Conclusion: The present study showed that S.GGT as a new potential biochemical marker for preclinical atherosclerosis, would be a useful and important marker for assessing and evaluating risk factors of coronary artery disease and to further evaluations for CAD.

Background and objective: Chronic lymphocytic leukemia (CLL) is a clonal, mature B-cell neoplasm, its clinical features, cell morphology, and immunophenotyping are used to establish the diagnosis. Immunophenotyping by flow cytometry is the most accurate procedure for diagnosing CLL, there is no single marker exclusively expressed in CLL, however, a complex of immunophenotypic markers that incorporates several B-cell markers and assists in differentiating CLL from other mature B-cell neoplasms, the expression of these immunophenotypic markers is considered in the specific CLL scoring system (Moreue scoring system).this study aimed to assess the clinico – hematological features and immunophenotypic characteristics of CLL patients and to assess the role of immunophenotyping in the differential diagnosis of CLL.

Methods: an observational prospective and retrospective study was carried out at Nanakaly hospital for blood diseases and oncology in Erbil city, Iraq. That was conducted on 100 patients newly diagnosed with mature B cell neoplasm which included 68 cases of CLL and 32 cases with other mature B cell neoplasm (MBN), usinga convenience sampling method. The study period was from the1^st of September 2021 to the end of April 2022. An interview questionnaire was used to collect the study data from the patients.

Results: The mean of age ± standard deviation of the CLL patients (58.85 ± 10.69) years and (66.2%) was male, The most frequent clinical presentations for CLL cases were fatigue (50%), lymphadenopathy (41.2%), and splenomegaly (41.2%), (50%) of CLL patients had anemia, thrombocytopenia was seen in (32.4%) and leukocytosis was seen (98.5%), all patients had lymphocytosis and (97%) had an absolute B lymphocyte count of more than 5 x10⁹ /L. all the studied CLL patients expressed both CD45 and CD19 markers, the expression of the immunophenotypic markers was as following: CD5 (98.5%), CD23 (97.1%) and CD200 (97.1%), Half of the patients (50%) showed expression of monoclonal lambda light chain, sIgM (4.4%), CD20 (88.2%) and CD43 (54.4%) and CD38 (26.5%). The expression of the following marker had a significant role in the differentiation between CLL and other MBN: CD5, CD23, CD79b, FMC7, sIgM, CD200, and CD43.

Conclusion: Ourresults have shown that the clinical presentations and hematological profile of Iraqi CLL patients were not significantly different from that of previous local and global studies, the distinct immunophenotyping, as well as it has been found that immunophenotyping is a promising method for supporting the clinical and morphological characterization of CLL.

Background and objective: Tuberculosis regarded as a major cause of death word wide despite WHO trials to eradicate it. The aim of this study was to determine the effect of gender difference in treatment outcome and mortality.

Methods: In this retrospective study on pulmonary tuberculosis at the Chest and Respiratory Disease Center in Erbil city. A total 430 patients with pulmonary tuberculosis were studied from January 1^st, 2016 to December 31^st, 2019 at the Chest and Respiratory Disease Center in Erbil city. The patients were divided in to two category groups; category one, includes severe extra pulmonary tuberculosis, Smear negative or positive seriously infected pulmonary disease, and category two: includes failure of treatment, relapses, and default. The recorded files of 430 patients with TB registered at Chest and Respiratory Disease Center in Erbil city as follows 103 (24%), 107 (24.9%), 109 (25.3%), and 111 (25.8%) patients since 2016, 2017, 2018, and 2019 were analyzed respectively.

Results: The median age ± SD of the patients was 44.03 ± 21.57 years (ranged from 1-93 years) and the female to male to ratio was 1: 1.26. The mortality rate among male patients was 9.5%, while 4.2% among female patients and there was statistically significant (P <0.001) association between gender and treatment outcome. The majority of patients were Category I (83.2% of the males versus 76.7% for females) and there was no statistically significant association between gender and patient categories (P = 0.062). The mortality rate in Category I was 4.1%, while in Category II was 15.9% and there was statistically significant association between patient categories and treatment outcome (P <0.001).

Conclusion: The study concluded that poor prognostic factors that are associated with higher mortality are male gender and patient category two (failure of treatment, relapses, and default).

Background and objective: Early diagnosis and proper awareness of Breast Cancer conditions may aid in reducing the morbidity and mortality rate among women. The main goal of this study was to determine the awareness and knowledge levels of women undergraduate students at three public universities in Duhok province (Duhok, Zakho, and Polytechnic) on Breast Cancer, as well as evaluate their attitudes toward breast self-examination.

Methods: This study was conducted from October to December 2021, and it consisted of a cross-sectional survey. A questionnaire was used to collect data from 904 female students aged 18-30 years. The mean participant age was 22.5 years with SD of 2.0. The percentiles were determined to classify the general level of knowledge, with values below the 25^th percentile denoting poor knowledge, between the 25^th and 75^th percentile denoting a fair level, and above the 75^th percentile denoting a good level of knowledge.

Results: In the present study, the majority of participants (96.46%) had a fair knowledge level and awareness regarding breast cancer and breast evaluation practice. About 1.78% of female students had poor or good knowledge of breast cancer and practiced breast self-examination. The findings show that participants within the age group of 21-25 showed the highest overall knowledge (7.66±2). While 64% and 31% of the respondents could not able to identify early signs of breast cancer and are not even aware that a breast self-examination is an important tool in the early detection of breast cancer, respectively.

Conclusion: The respondents' knowledge about breast cancer is fair, but their comprehension of risk factors is poor. In order to increase the awareness of risk factors, counseling programs for women in schools and universities are very important. These programs should focus on breast self-examination and women's reproductive health.

Background and objective: Chronic anal fissure is a common health problem related to high morbidity. The chemical option for treating chronic anal fissures is highly preferred.

Methods: A clinical prospective comparative study was carried out in the General Surgery Outpatient Department in Rizgary Teaching Hospital, Erbil, KRG, during the period from January 2019 to December 2021,on a sample of 100 patients randomly recruited patients with chronic anal fissures divided into two groups with 50 participants each: the DTZ group, who received 2% diltiazem ointment, and the GTN group, who used 0.2% glyceryl trinitrate ointment twice daily for 6 consecutive weeks. The aim of the study is to compare the efficacy and effects of topical Diltiazem (DTZ) and topical glyceryl trinitrate (GTN) in the management of chronic anal fissures.

Results: There was a highly significant association between fissure healing at the 4th week and patients treated with DTZ (P <0.001). A highly significant association was observed at the 6th week between fissure healing and DTZ treatment (P <0.001), while there was later a highly significant association between fissure healing at the 8th week and patients treated with GTN (P <0.001). A significant association was observed between treatment adverse effects and patients treated with GTN (P = 0.05). DTZ was found to be more effective for symptomatic relief than GTN.

Conclusion: Both DTZ and GTN are effective in the treatment of chronic anal fissures, but treatment with DTZ is accompanied by faster healing and lower side effects.

Background and objective: Despite refinement in surgical techniques, fat grafting survival is unpredictable, and the resorption rate varies. The objectives of this study were to assess the effects of adding Platelet Rich Plasma (PRP) to fat grafting for facial rejuvenationin terms of longevity of the results, complications, and satisfaction rates.

Methods: The thigh or lower abdomen was chosen as a donor site for fat graft harvesting using a 10-cc syringe, then washed with saline, processed by low-speed centrifugation, and then inserted into the face with a 1 mm blunt-ended cannula at several points. on several tissue planes. A total of 369 cases treated with autologous fat graft with or without PRP for facial rejuvenation were included in this comparative study. The results were assessed clinically and followed for up to 5 years. Data analysis was done using the statistical package for social science SPSS V. 23.

Results: The commonest minor complication was fat absorption (27% in group 1 and 11.9% in group 2), no major complications were reported. Adding PRP to the fat graft decreased the need for second session fat grafting from 31.2% to 15.3%. By adding PRP to fat graft, there was a significant increase in the number of highly satisfied patients (from 63.5% to 80.1%).

Conclusion: We believe that adding PRP to autologous fat grafting has several advantages for facial rejuvenation with better long-term results, fewer complications, and better patient and surgeon satisfaction.

Background and objective: There are no local investigation on the role of the abnormal umbilical cord on neonatal and maternal outcomes in this region. This study aimed to examine the association of umbilical cord abnormalities on neonatal and maternal outcomes in Iraqi Kurdistan.

Methods: This is a cross-sectional study, the patients who attended the Duhok Obstetrics and Gynecology Teaching Hospital in Duhok city were examined between 1/11/2020 and 1/11/2021. The sample size is 500 women, inclusion criteria are age>18 years, acceptance to participate, gestational age >24 weeks and singleton pregnancy. The exclusion criteria are women who refused to participate, multiple pregnancy and stillbirth.

Results: The mean age of the pregnant women was 29.0 (16 - 45 years old). The most prevalent maternal complications were placenta Previa (7.06%), Polyhydramnios (9.88%), and post-partum hemorrhage (7.06%). In this study the most common abnormalities of UC were abnormal diameter of UC (29.4%), decreased Wharton jelly content (15.5%) and short UC (11.9%).Most of the patients’ babies had normal weight (79.64%), (16.94%) had low birth weight and (3.43%) had very low birth weight. A percentage of the babies died either early neonatal (1.41%) or stillbirth (5.24%). The study found that the patients with abnormal diameter of UC cord were more likely to have babies with low birth weight (35.62% vs. 9.14%, P <0.0001) and were more likely to suffer from stillbirth (9.59% vs. 3.43%). Patients with short UC were more prone to have abruptio placenta (20.34% vs. 2.75%) and PROM (13.56% vs. 3.66%) ,and neonates with short UC were more likely to be LBW, VLBW and suffer from early neonatal death.

Conclusion: This study showed that the patients with abnormal umbilical cord have significantly higher rates of adverse neonatal and maternal outcomes.

Background and objective: Internationally, the eighth leading cause of death among young males is attributed to road accidents, as yearly a million and three-quarters of people die which became a series public of health concerns in developing countries. This study aimed at determining the pattern and outcomes of hospitalized road traffic accidents in Erbil city.

Methods: This prospective hospital-based study was conducted from March 2020 to February 2021, at RozhHalat and RozhAwa Emergency governmental hospitals in Erbil, Iraq. Data was collected for one complete year and the admitted cases in the year had been included. Which was composed of 2225 road traffic accident victims. A specially designed questionnaire was used to collect the data using direct face-to-face interviews.

Results: 2225 victims were obtained in both Emergency hospitals 1835 (82.5%) of them were males, 390 (17.5%) were females, and the mean age±SD was (24.7±15.1) years old. The death rate from road traffic accidents was 250 (18%). Nearly one-third of 689 (31%) of victims were at aged (20-29), the highest pattern rate of 1221 (54.9%) was among drivers, and on motorcycles 883 (39.7%) had the highest reported victims rate, occurred at rush hours (5-7 pm). During Summer season 681 (30.6%), at daylights 1608 (72.3%). With P <0.001, a significant association was reported between back injuries, speeding, pedestrians, alcoholics, seatbelts/helmets, rapidity, and night shift of street accidents and the outcomes.

Conclusion: Human behavior is significantly related to the high incidence of road injuries and deaths. Road accidents have resulted in a major public health problem. A new strategy to reduce the incidence of this problem is essential.

Background and objective: Klebsiella pneumoniaei s an opportunistic pathogenic bacterium and is considered one of the main causes of nosocomial infection. Hypervirulent K. pneumoniae (hvKp) has emerged as a pathogen of global importance. The current study aimed to determine Extended-spectrum beta-lactamase, carbapenem resistance, and serum bactericidal effect among the clinical isolates and to find the relationship of the above features with antimicrobial resistance.

Methods: A total of 90 K. pneumoniae isolates were collected from different clinical specimens. Isolates were diagnosed using routine bacteriological methods and VITEK 2 compact system. Several phenotypic tests including string test, serum resistant, ESBL test, and Modified Carbapenem inactivation method were performed. The antibiotic resistance pattern was compared among ESBL-positive, carbapenem-resistant in both Hypervirulent (hvKp) and classical K. pneumoniae (cKp) isolates.

Results: The results revealed that among 90 isolates, 56.7% of the isolates were of classical K. pneumoniae (cKp) type within which 70.6% of them were ESBL positive, 37.3% of them were resistant to carbapenem, and 51% were resistant to serum bactericidal activity. On the other hand, 43.3% were of hvKp type within which 61.5% of them were ESBL positive, 30.8% were carbapenem-resistant and all of the hvKp were resistant to human serum. The rate of antibiotic-resistant among cKp was higher than hvKp isolates.

Conclusion: In this study, classical strains were more resistant to antibiotics and the rates of ESBL and Carbapenem resistance were higher compared to hvKp strains. but they were killed by serum bactericidal activities more rapidly.

Background and objective: Causes of epilepsy are different and the genetic component is hidden and provides an essential role in emergence of drug resist epilepsy .The aim of this study is to know the diagnostic yield of Whole exome sequence in pediatric epilepsy and its contribution in giving information about diagnosis of the epilepsy syndrome, possible preventive actions or treatment.

Methods: 60 children (6 weeks - 14 year) with drug resistant epilepsy, family history of epilepsy or child with diagnosis of epilepsy syndrome were enrolled in this cross sectional study. The study was done in Raparin pediatric teaching hospital in Erbil city from beginning of May 2021 to the end of April 2022.Demographic, clinical, MRI finding and genetic background using whole exome sequence were checked and analyzed.

Results: 33/60 (55%) of participants were male. The NGS (Next Generation sequence) study revealed: 13 (21%) pathogenic, 10 (17%) likely pathogenic, 21 (35%) variance of unknown significance and 16 (27%) negative result. The diagnostic yield by NGS for pathogenic or likely pathogenic is 38%. The positive findings were more relevant among female (P value = 0.04), children with age onset of seizure≤ 1 year of (P value = 001) and history of lack of sleep (P value = 0.02). Genetic diagnosis lead to change of treatment in 11/60 (18.3%) candidates.

Conclusion: The diagnostic genetic test by NGS is relevant in epileptic child especially among children with age of onset of seizure ≤ 1 year, female sex, and lack of sleep. It is recommended to test the negative result periodically and more research to investigate impact of NGS on seizure freedom.