Background and objective: An understanding of certain socio demographic, clinical characters and causes of infertility among couples is important for improving management of this problem. This study aimed to assess the clinico-epidemiological pattern of infertile couples and to find out the association of infertility with various socio-demographic characteristics of infertile couples.

Methods: This is a case record review study carried out from March 2013 through April 2014. It comprised a retrospective review of a convenience sample of 1158 medical records of infertile couples attending the infertility center in Maternity hospital in Erbil city. Data collected; based on secondary data that was obtained from infertile couples medical records from the center. The medical records included socio-demographic characteristics of couples, data about the gynecological, surgical and medical history of wives and medical and surgical history of husbands. In-depth analyses of the data obtained from files were done by using SPSS version 19.

Results:  Of the 1158 infertile couples, 727 (63%) had primary, and 431 (37%) had secondary infertility. The age range of wives was 15-48 years with mean ± SD of 31.25 ± 7.0 years and age range of husbands was 17-71 years with mean ± SD of 35.28 ± 8.0 years. The duration of infertility ranged between 1-27 years with mean ± SD of 6.2 ± 4.8 years. The proportion of primary infertility was significantly higher (91.5%) among women less than 20 years of age, while secondary infertility was higher (48%) among those aged 40 years and more. Female causes accounted for 32%, male causes account for 26%, combined cause 18% and 24% of them had unknown causes for infertility. Abnormal seminal fluid analysis parameter was significantly observed among primary infertile husband. Among wives, the infertility factors were the menstrual disorder, miscarriage and hormonal disorder.

Conclusion: Primary infertility was more prevalent among the study sample. Infertility was significantly associated with age, occupation and history of previous marriage among wives

Background and objective: There are controversial reports regarding the effect of adenoid size on middle ear conditions. Enlarged adenoid size may cause nasopharyngeal obstruction or may act as a reservoir for infection and cause tympanometric changes. This study aimed to determine the correlation between adenoid size and tympanometric findings in children.

Methods: This prospective study included 71 children aged 3-10 years old attending Rizgary Teaching Hospital for adenotonsillectomy between August 2013 to January 2014. Questions about upper airway obstruction symptoms were directed to parents and patients. Tympanometry and plane radiological study of lateral soft tissue of the neck were done for each case. Tympanometric type A and C1 were considered normal while B and C2 as abnormal. The adenoid size was measured by using adenoidal/nasopharyngeal ratio. 

Results: Of 71 children (142 ears), 20 children (40 ears) had gross adenoid enlargement, of which tympanometry was found to be normal in 75% and abnormal in 25%. In 28 children (56 ears) with moderate adenoid enlargement, tympanometry was normal in 78.6% and abnormal in 21.4%. Twenty three children (46 ears) had minimal adenoid enlargement, in which tympanometry was normal in 91.3% and abnormal in 8.7%. 

Conclusion: The study showed that adenoid size in children had an effect on tympanometric readings. Although the incidence of abnormal tympanometry was higher with the increased adenoid size but it was statistically non-significant.

Background and objective: There is little information available on comparing conservative versus immediate surgery results in the long run for patients with lumbar disc herniation in the modern clinical practice. The aim of this study was to assess one-year outcomes of patients with sciatica resulting from a lumbar disc herniation treated surgically versus non-surgically in two hospitals in Erbil

Methods: A prospective comparative cohort study was conducted over two years (January 2010 to February 2012). A sample 100 patients, 50 treated surgically and 50 conservatively, were followed up for one year. All participants had baseline interviews with follow-up questionnaires filled in the next specially designed follow up visits along the study time at regular intervals of 2, 8, 28 and 52 weeks. The outcome included patient-reported symptoms of leg and back pain, functional status, satisfaction versus expectation and working capacity after treatment or overall disability degree.

Results: Change in the modified Roland back-specific functional status scale favored surgical treatment initially, and the relative benefit decreased but persisted over the follow-up period. Despite these differences, work and disability status at one year were comparable among those treated surgically or non-surgically.

Conclusion: Surgically treated patients with a herniated lumbar disc had more complete relief of leg pain and improved function and satisfaction compared with non-surgically treated patients over one year. Nevertheless, improvement in the patient's predominant symptom and work and disability outcomes were closely similar regardless of treatment received

Background and objective: In recent years, there has been an increasing interest in studying domestic abuse against women and its impact on self-esteem and coping style. The aim of this study was to make inquiries about types of domestic abuses among a sample of Kurdish women in addition to looking into the level of self-esteem of those who faced domestic violence.

Methods: 120 women who were victims of domestic abuse living in Erbil rural and urban surroundings were recruited from July 15^th to October 23^rd, 2014. Two scale questionnaires were implemented in this study; domestic abuse questionnaire was taken from Iman and Ahmadi and self-esteem questionnaire by Rosenberg. The data were analyzed through the use of the statistical package for the social sciences (version 11). The analysis systems used for the data management procedures were Pearson correlation coefficients, descriptive statistics, frequencies, and One-sample t-test.

Results: Physical abuse is the most frequently occurring domestic abuse type among Kurdish women, while the psychological abuse was reported to a lesser extent (mean 24.6167 and 13.2417 respectively). The levels of the study participant's self-esteems were found to be relatively high (mean score 17.64), while there was a positive correlation between self-esteem and psychological abuse detected (person correlation = 0.091) which was not statistically significant at the level of (P = 0.326). 

Conclusion: Study participants encountered physical domestic abuse more than other types of abuse; still the participant's mean score for their self-esteem is relatively higher than the hypothetical one

Background and objective: Routine use of drains after thyroidectomy is not evidence based; nevertheless most surgeons use drains to alert them to the presence of postoperative bleeding and for the prevention of hematoma and seroma. This comparative study was conducted to evaluate the necessity of routine drainage after total thyroidectomy.

Methods: A total of 150 patients who underwent total thyroidectomy due to different indications at different hospitals in Erbil city, Iraq from June 2011 to December 2015, were included. A retrospective comparison was made between those drained (group 1) and those without drain (group 2). Operating time, postoperative complications and hospital stay were assessed.

Results: Operation time was significantly less in group 2 compared to group 1; 64.9 ± 7.64 minutes versus 73.8 ± 9.81 minutes, respectively. There was no statistically significant difference in the incidence of postoperative complications. Only two patients, both from group 1, developed a postoperative hematoma. Wound infection occurred only in 2 patients in group 1. Hospital stay was significantly shorter in group 2 compared to group 1; 21.1 ± 3.98 hours versus 41.7 ± 8.64 hours, respectively.

Conclusion: The routine use of drain is not necessary after total thyroidectomy; it increases the hospital stay and may increase the rate of postoperative sepsis.

Background and objective: A high proportion of maternal mortality in developing countries is caused by abortion, especially in such countries with limited abortion laws. The aim of this study was to determine the prevalence of abortion and investigate the relationship between abortion among women and their socio-demographic and obstetrical causative variables in Kurdistan Region of Iraq.

Methods: The data for the research came from 7551 married women aged 15-49 years from three governorates of Kurdistan Region who participated in the 2011 multiple indicator cluster survey. Data were collected during the period from February 13^th, to March 18^th, 2011 in the Kurdistan region. Logistic regression analysis was done at the binary level to determine the effect of demographic and obstetrical factors on abortion.

Results: The results showed that the prevalence of abortion in this study was 27.7%, and there was statistically significant relationship between abortion and maternal age, the higher level of education, socio-economic levels (excluding middle level), the age of marriage, the number of live children, and governorate (Duhok). There was no significant relationship between abortion and residence, occupation, type of marriage and governorate (Suleymaniye). 

Conclusion: Significant relationship was found between ages, the number of live children, Residence, level of education and social economic status of women.

Background and objective: Systems for evaluation of teaching and course quality in higher education institutions have long been established and are becoming increasingly common in many developed and developing countries. This study was carried out to identify and assess the feedback of master students in the College of Nursing.

Methods: The study is a mixture of quantitative and qualitative design. The study sample included all master students who had attended the master course within two academic years (2012-2014) in the College of Nursing, Hawler Medical University. A formal questionnaire was used to obtain master students’ feedback, and an interview was used as the method of data collection.

Results: The mean age of the participants was 33 years for males and 29 years for females. Results revealed that feedback responses as a general were good in all factors underlining the study, and the lowest scores were shown in items related to teacher-student’s relationship and classroom organization.

Conclusion: Master students’ feedback was positive for most of the evaluation factors except teacher-student relationship and some items related to classroom organization.

Background and objective: Human infection with toxoplasmosis is common and is usually asymptomatic, and congenital form is one of the most important clinical aspects of this disease. This study aimed to determine anti-toxoplasma antibodies, and Toxoplasma DNA in premarital women referred to Mammon Dabax health centers and to design prevention policies after marriage and during their pregnancy.

Methods: One hundred fifty premarital women who were examined for pre-marriage laboratory testing were enrolled in this cross-sectional study. Blood samples were tested for specific anti-toxoplasma IgM and IgG antibodies using an enzyme-linked immuno-sorbent assay (ELISA) and detection of B1 gene of T. gondii by PCR.

Results: Of 150 sera examined of premarital female 35 (23.3%) were seropositive for anti-toxoplasma antibodies by latex agglutination test. Using ELISA test, 8 (5.3%) of the sera examined were seropositive for anti-toxoplasma IgM; meanwhile, 23 (15.3%) sera were positive for anti-toxoplasma IgG. The ELISA test finding for anti-toxoplasma IgM and IgG of the total sera examined were subsequently subjected to PCR. Thus, PCR analysis for detecting T. gondii DNA in the blood of premarital female was positive in 15 (10%) of the total DNA samples. Of these 15 positive PCR when correlated with positive ELISA finding 7 (46.6%) and 4 (26.6%) blood samples were positive for anti-toxoplasma IgM and anti-toxoplasma IgG, respectively.

Conclusion: PCR assay has an advantage in the detection of recent and active infections as reflection or marker for T.gondii parasitemia. ELISA can be used as a highly sensitive screening test while IgM anti-toxoplasma antibody positive is not enough to confirm recent infection as the false negative is high.

Background and objective: Lactoferrin (LF) is an iron-binding protein that is related in structure to transferrin. It is considered to be a part of the in­nate immune system. This study aimed to assess the role of urinary lactoferrin (LF) as an indicator for diagnosis of urinary tract infection among girls.

Methods: This study was conducted on girls suffering from UTI. Urine samples were tested for Lactoferrin before and after two months of the treatment using ELISA technique.

Results: Urine specimens were collected from 25 girls with mean age ± SD of 6 ± 3 years without UTI as a control group (C) and 25 girls with mean age ± SD of 5.3 ± 3.18 years diagnosed as suffering from UTI (T1) followed by a set of 25 specimens after two months (T2). The mean concentration of urinary LF ± SD was 670 ± 319 ng/ml in the specimens of control group whereas it was 1387 ± 509 in the specimens of girls with UTI during the infection (T1) and 885 ± 268 after two months (T2). The mean concentrations of urinary LF during the infection (T1) were significantly (P <0.001) increased compared with controls (C) and significantly (P = 0.003) decreased after two months (T2), that may refer to a role of urinary LF in UTI. There was no significant (P = 0.089) difference between the mean concentration of urinary LF after two months (T2) compared with controls (C) that may indicate to the normalization of LF concentration after the treatment synchronously with disappearing of UTI symptoms and significantly reduction of positive urinalysis results.

Conclusion: The results of this study indicate the elevation of urinary Lactoferrin (LF) in girls suffering from UTI and probably being a good indicator for diagnosis of UTI.

Background and objective: The onset of post-transplant diabetes mellitus has been linked to higher rates of cardiovascular disease and infection. The aim of this study was to evaluate the incidence of post renal transplant diabetes. More specifically, they study tried to find out the demography of patients with post transplant diabetes mellitus, their anthropometric measures, the incidence rate in different periods and among different demographic variables.

Methods: Seventy patients transplanted in different centers in Iraq were enrolled in the study. The patients were followed up for more than one year during their visits and or admission to the Dialysis Unit in Erbil Teaching Hospital during the period between 1/12/2006 and 1/4/2008. The statistical package for the social sciences (version 14) was used for data entry and analysis.

Results: Fifty four patients were male and 16 patients were female. Their ages ranged between 14 and 65 years with a mean of 36 years. Thirty one percent of them developed post transplant diabetes mellitus; 14% developed post transplant diabetes mellitus at early while 17% developed post transplant diabetes mellitus at late period. A significant association was found between increased age and triglyceride and post transplant diabetes mellitus.

Conclusion: Post transplant diabetes mellitus is an important complication that the transplant physicians should screen for in every transplanted patient. Increasing age and serum triglyceride levels may be regarded as predictors for the development of post transplant diabetes mellitus

Background and objective: Breast cancer is a global health concern. It has been identified as a major public health problem in both developed and developing nations. Breast cancer associated morbidity and mortality can be reduced through early detection and diagnosis by breast self-examination. This study aimed to assess the level of knowledge and practices regarding breast self-examination, and determine the effectiveness of a teaching program on breast self- examinations' knowledge and practice among the women who are members of the Kurdistan Women Union.

Methods: A quasi-experimental study was conducted in the Kurdistan Women Union building in Erbil city in Kurdistan Region of Iraq from June 1^st to August 30^th, 2015. Fifty-one women were included in the study. A questionnaire was designed and divided into three parts: socio-demographic data, previous obstetrical history, and knowledge and practices regarding breast self-examination. The checklist for the theoretical session included the knowledge about breast self-examination.

Results: The highest percentage of women was in the age 18-30 years old, graduated from primary school, married, and no family history of breast problems. The participant’s knowledge and practice regarding breast self-examination were poor but throughout the educational program their knowledge was improved. There was a statistically significant difference between pre and post- educational program.

Conclusion: The study concluded that training women about breast self-examination have a positive impact on their related knowledge and practices.

Background and objective: Prenatal diagnosis of central nervous system anomalies by two-dimensional sonography is challenging because of difficulties in obtaining complete visualization of the fetal brain during routine examinations. Three-dimensional sonography has been introduced as a tool for studying the fetal central nervous system because of its ability to facilitate examinations of the fetal brain. This study aimed to visualize an intracranial structure of the fetal central nervous system anomaly using transabdominal three-dimensional sonography.

Methods: A prospective cross–sectional (observational) study in which three-dimensional ultrasound examination was performed in 82 patients between 12 and 38 weeks of gestation suspected to have fetal brain malformation detected by conventional two-dimensional ultrasound. Each anomaly was reviewed again to determine whether three-dimensional ultrasound data were advantageous compared to two-dimensional ultrasound.  

Results: Three-dimensional images provided additional information in 43 (52.4%) of cases including extracerebral anomalies. The three-dimensional ultrasound was advantageous in evaluating the encephaloceles (10 of 43 cases) in that the exact location of the extracranial mass and the amount of extracranial tissue in the encephalocele was better defined with the simultaneous display of three orthogonal planes images that could not be obtained with two-dimensional ultrasound were seen with three-dimensional ultrasound.

Conclusion: Three-dimensional ultrasound is an excellent adjunctive tool to two-dimensional ultrasound in the evaluation of fetal anomalies

Background and objective: Kurdistan represents a model of the challenging mental health needs of adolescents in conflict-affected, low-income countries. Long-term instability, post-traumatic stress disorder, violent conflict, and wars undermine health and mental health status of people in Kurdistan, particularly children, who form half its population. This study aimed to determine the prevalence of social phobia among high school student in secondary schools.

Methods: A cross-sectional study was carried out during the period from January 2^nd to June 30^th, 2014. Study participants were 1000 students recruited from 7 preparatory schools.

Results: The social phobia inventory (SPIN) revealed that 31.25% of the study sample showed symptoms of social phobia. There were no differences of social phobia among the ages of students. The rate of social phobia was higher in males than females with the mean score of 33.67 and 30.52, respectively.

Conclusion: The findings of the study refer that most of the students in the preparatory school indicate symptoms of social phobia.

Background and objective: A wealth of evidence demonstrates that exclusive breastfeeding provides numerous short-and long-term benefits for both mother and child. This study aimed to find out the association between socio-demographic characteristics and to predict the associated factors which influence on the knowledge of primigravidas.

Methods: A Hospital-based cross-sectional study was conducted at Maternity Teaching Hospital in Erbil city, Iraq, during the period from March 23^rd, to July 1^st, 2015. A convenience sample of 180 primigravidas was included in the study. Data were collected by using a questionnaire. Chi-square test and linear regression were used to investigate the significance association and predict the factors associated with knowledge.

Results: The study found that most of the primigravidas were between 17 and 23 years old, housewives, primary school graduates, and living in low socio-economic status. The statistically significant association existed between age, education, socio-economic status and occupation of respondents with their knowledge. Linear regression predicted that the age and occupation were two factors associated with primigravida’s knowledge.

Conclusion: Primigravida pregnant in Erbil city demonstrated poor knowledge concerning breastfeeding benefits, the study found a significant association between some of the variables with primigravidas knowledge and age and occupation were two factors which influenced primigravidas knowledge.

Background and objective: Obesity is the risk for many disease conditions and is becoming a global issue. Endothelial dysfunction and oxidative stress are linked to obesity. Endothelin-1 is a useful marker of endothelial dysfunction. Oxidative stress can be assessed by estimation of lipid peroxidation byproduct malondialdehyde. In this study, we tried to find out the correlation between Endothelin-1 and oxidative stress among apparently healthy obese men. 

Methods: Eighty apparently healthy non-smoker adult men have participated in this study. Their age ranged between 18 and 50 years. Their serum Endothelin-1 (ELISA), malondialdehyde and lipid parameters (biochemical assays) have been estimated.

Results: Subjects were divided into three groups: normal weight (n = 25), overweight (n = 34) and obese (n = 26) basing on their body mass index. The study shows that Endothelin-1 is significantly correlated with each of Malondialdehyde and body mass index (r = 0.262, P = 0.019; r = 0.65, P <0.001 respectively). Malondialdehyde is also significantly positively correlated with BMI (r = 0.378, P = 0.001).

Conclusion: Endothelial dysfunction and oxidative stress coexist in obesity. But which of them precedes the other? Is still a question needs to be further studied

Background and objective: quality assurance is the planned and systematic review of an institution to determine whether or not acceptable standards of education and infrastructure are being met, maintained and enhanced. This study intended to explore the perspectives of teaching staff about quality assurance process with the aim of uncovering commonalities and discrepancies among staff from the different educational background.

Methods: This explorative study was conducted in Erbil governorate, Iraq. Data were collected using Q methodology, a technique for eliciting subjective views and identifying shared patterns among individuals. A sample of 40 teaching staff in Hawler Medical University from the different educational background and academic titles were invited to sort a set of 42 statements reflecting various aspects of the quality assurance process into a distribution on a scale of nine from "disagree most" to "agree most." By-person factor analysis was used to derive latent views through centroid factor extraction and varimax rotation of factors.

Results: Analysis of the participants’ Q sorts resulted in identifying four distinct views and experiences of quality assurance process: (i) Accepting the current quality assurance process with constructive criticism, (ii) Actively opposing the quality assurance process, (iii) General satisfaction with quality assurance process and (iv) Students’ feedback concern. The typical characterizations that were associated with each view were highlighted.

Conclusions: This study revealed different patterns of views and experiences of teaching staff about quality assurance process and recognized the particular issues related to each pattern.

Background and objective: Gastro esophageal reflux disease is one of the commonest gastrointestinal diseases and its incidence is increasing. There is a real challenge in diagnosis and treatment because of its complication if untreated and its effect on patient daily performance. We tried to find the relation between this disease severity symptom known by the number of heartburn attacks per week and (waist circumference).

Methods: A cross-sectional study of 100 patients (55% female and 45% male) diagnosed with gastro esophageal reflux disease in Rizgary Teaching Hospital Erbil city from January 2014 to June 2014. Their ages ranged from 17 to 75 years. The criteria for patient selection depended on history and clinical examination and endoscopy, waist circumference measured with a tape measure in centimeter.

Results: The mean age ± SD of participants, was 37.13 ± 12.5 ranged from 17-75 years. Regarding the relation between frequency of heartburn attacks and waist circumflex, the study revealed that the number of heartburn attacks was significantly increasing with increasing waist circumflex, (P <0.001), indicating that there is a strong relation between the increase in waist circumflex and severity of gastro esophageal reflux disease symptoms. 

Conclusion: Increasing of body weight especially waist circumference increases acid exposure to the esophagus. This affects on gastro esophageal reflux disease symptoms severity and its complication. That is why decreasing body weight should be the first line of treatment which will decrease future complication.