Vol 20, No 2 (2016)

Background and objective: Flapless implant surgery has been suggested as a suitable treatment technique for implant placement, but limited information exists regarding the clinical conditions after flapless implant surgery. This study aimed to compare flapless implant surgery with traditional flap implant surgery clinically and radiographically.

Methods: Sixty patients (23 males and 37 females) participated in the present study. The patients were divided into two groups, in the Group ‘A’ 30 implants were placed by traditional flap surgery and in Group ‘B’ 30 implants were placed by flapless implant surgery (punch technique). Clinical and radiographic examinations were carried out to assess the implants condition. Clinical examination included implant mobility which was assessed by using universal torque ratchet at the end of healing period (6 months). The periapical radiograph was carried out to assess marginal bone loss around the implants at three and six months after implantation.

Results: Two implants failure were reported; one implant for each of the Group ‘A’ and ‘B’. There was no significant difference between the two groups with regard to the marginal bone resorption (P = 0.487). The success rate for both groups was 96.6%. The study showed a non-significant relation of age and gender with the success rate.

Conclusion: The flapless implant surgery could offer advantages over the classic protocol and should have the potential to increase the patients’ acceptance of the procedure.

Background and objective: A lack of knowledge regarding infection control measures among health care workers decreases compliance with these practices. This study aimed to assess the knowledge of infection control measures among nurses in Hawler Teaching Hospital.

Methods: A cross-sectional study was conducted from December 15^th, 2013 to February 10^th, 2014 on a non-probability purposive sample of 50 nurses. Data were collected by self report by nurses that work in some critical care wards (dialysis unit, surgical and neurosurgery) in Hawler Teaching Hospital. The questionnaire included two parts. Part one was related to the nurses’ sociodemographic characteristics, which contained six items of age, gender, educational level, years of experience, attending training and place of work. Part two was related to nurses’ knowledge on standard precautions measures.

Results: There was positive correlation between nurses’ knowledge on infection control measures and their educational level, years of experience and attending training. About 54% of nurses had good knowledge on infection control measures and 46% of them had fair knowledge. Mean knowledge about infection control measures of nurses was 68%.

Conclusion: The infection control knowledge among the nurses was fairly good in this study. Older age was an important determinant of lower level of knowledge.  

Background and objective: There has been a recent concern about chronic non-communicable diseases in Iraq. The country is undergoing an epidemiological transition with an increasing burden of chronic non-communicable diseases with two-thirds of the people aged 25-65 years old are overweight and one-third are obese. This study aimed to estimate the prevalence of metabolic syndrome with their associated risk factors among a sample of peoples in Erbil city.  

Methods: This cross-sectional analytic study was carried out in Erbil city and involved a convenience sample of 566 apparently healthy subjects. A structured direct interview using interviewer administered questionnaire was applied. Anthropometric measures, random blood sugar, cholesterol level, triglyceride level, low-density lipoprotein and high-density lipoprotein were investigated.  

Results: The prevalence of metabolic syndrome in the studied sample was 30.6%. The prevalence was higher in females (45.5%) than males (16.3%). Variables like gender (P <0.001), age (P = 0.008), education and marriage (P = 0.001), family history of diabetes mellitus (P = 0.029), hyperlipidemia (P <0.001), hypertension (P = 0.047) and obesity (P = 0.005) were found to be factors that significantly associated with metabolic syndrome. 

Conclusions: Metabolic syndrome is prevalent among the studied population. Female gender, old age, marriage, family history of diabetes mellitus, hyperlipidemia, hypertension and obesity may be regarded as risk factors for metabolic syndrome.

Background and objective: Carbamazepine is widely used as an anti-epileptic drug, primarily for the treatment of partial and tonic-clonic seizures. The drug is absorbed slowly and variably after oral administration due to its limited water solubility. In clinics, single daily dosing of conventional dosage forms of carbamazepine is insufficient; effective levels are provided by the multiple-dose administration. A multiplicity of dosage causes inconsistent plasma levels leading to side effects because of its narrow therapeutic range and toxicity levels. A single dose of extended release dosage forms is suggested to keep levels within the therapeutic concentrations. This study aimed to compare the in vitro behavior of generic tablets containing carbamazepine with the brand product.

Methods: Basket apparatus was used to evaluate in vitro behavior of the different products and similarity test was applied to evaluate the differences between generic products and the brand. The study and test were carried out in Jun 2014 at the College of Pharmacy, Hawler Medical University.  

Results: There was a significant difference between the in vitro behavior of one of the generic products in the study and the in vitro behavior of the brand product.  

Conclusions: The in vitro study using basket apparatus could be considered as an effective method to evaluate the in vitro behavior of the majority of pharmaceutical dosage forms. In vitro behavior is a direct indicator for in vivo one. Therefore the quality of the medicaments could be evaluated and the risk to the patients could be significantly reduced. 

Background and objective: Knowledge for getting self-care activity is the one important issue in the quality of life for a paraplegic person to live independently. This study aimed to assess the level of knowledge of persons with complete paraplegia regarding how to do self-care activity during daily living.

Methods: This cross-sectional study involved 58 cases with complete paraplegia out of 202 cases with spinal injuries that were admitted to the Emergency Management Centre in Hawler from 2008 to 2014. Information data on paraplegic persons was collected from August 15^th to October 15^th, 2014 through the interview by using a questionnaire.

Results: The majority of persons with paraplegia were young (32.8%), male (84.5%), married (58.6%), secondary school graduates (35.3%), unemployed (72.4%), having income exceeding the needs (50%) and live in the urban area (77.6%). Most of them had thoracic injury at level 9 to 12 (70.7%). The most common cause of injury was fall from high (41.4%) and the majority of readmissions were for bedsores (87%). The knowledge of paraplegic persons of self-care activity was at a high level (87.9%). Those living in urban areas had a significantly higher knowledge than those living in rural areas (93.3% vs 69.2%, P = 0.019).

Conclusion: Persons with paraplegia had good knowledge for self-care activity, but still need continuous knowledge and practical training. Urban areas need more help and knowledge.

Background and objective: Rotavirus gastroenteritis is the most common cause of acute dehydrating diarrhoea among children younger than five years and globally the most important cause of severe diarrhea in this age group. Most children acquire rotavirus infection before they turn two years of age. Rotavirus vaccination can prevent rotavirus infection. This study aimed to assess healthcare providers' knowledge regarding rotavirus vaccine.

Methods: A cross-sectional descriptive study was conducted on 100 healthcare providers at four healthcare centers (Azady, Tayrawa, Mala Fandi and Zhyian), during July to August 2014. Data were collected through the use self-reporting questionnaire format, which was developed for the purpose of the study. A socio-demographic sheet was also constructed to determine characteristics of the subjects.  

Results: Most of the healthcare providers were in the‎ age group 33-42 years old (31%), 51%, were male, 80% were married, 56% were graduated from the institute, half of them had work experience between 2-11 years and 29% were working in ‎vaccination room. Fifty-four (54%) of healthcare providers had average knowledge while 24 (24%) and 22 (22%) of them had a poor and good knowledge, respectively‎.

Conclusion: More than half of healthcare providers had average knowledge regarding rotavirus vaccine

Background and objective: Cataract and glaucoma are common co-morbidities and are the first and the second leading causes of blindness worldwide. There are many reasons to consider cataract extraction in individuals with cataract. These individuals derive great visual benefit from the increased acuity and improved contrast sensitivity provided by a clear artificial lens. An improvement in vision allows for more accurate visual field monitoring, and a clear optical pathway enhances the quality and reproducibility of optic nerve imaging. This study aimed to determine the association between intraocular pressure with cataract surgery in human eyes by monitoring changes in intraocular pressure in patients who underwent cataract surgery at Hawler Teaching Hospital at Erbil.  

Methods: This cross-sectional study was conducted on 71 subjects that underwent cataract surgery at Hawler Teaching Hospital at Erbil city from April 2013 to April 2014. Full ophthalmic examination including intraocular pressure measurement was done to every participant before cataract surgery, one week and one month after surgery.

Results: Paired samples t-test showed highly significance difference (P <0.001) between mean intraocular pressure measurements before, one week and one month after cataract surgery. The average decrease in postoperative intraocular pressure from preoperative intraocular pressure during one month was 2.02mm Hg (12.39%).

Conclusion: Cataract surgery reduces intraocular pressure and can be considered as an effective way to manage patients with a concurrence of glaucoma and cataracts.

Background and objective: The distinction of hydatidiform mole from hydropic abortion remains a problem because of interobserver and intraobserver variability. This study aimed to determine the utility of p57^Kip2 as a diagnostic marker in differentiating complete hydatidiform mole from its mimics.

Methods: A total of 97 formalin fixed paraffin embedded material including forty cases of complete hydatidiform mole, 36 cases of partial hydatidiform mole and 21 cases of hydropic abortion were selected randomly from the files of histopathology laboratory of Maternity Teaching Hospital in Erbil. The samples were reviewed by two pathologists, afterward; immunohistochemical staining was performed by using a p57^Kip2 marker. We considered p57^Kip2 positive only if nuclear p57^Kip2 staining was identified in at least 10% or more of all in a tissue section.     

Results: Negative immunostaining was seen in 77.5% of the complete hydatidiform mole in both villous cytotrophoblast and stromal cells. In contrast, 86.1% of partial hydatidiform mole showed positive immunostaining for p57^Kip2. All cases of hydropic abortion 100% were positive for p57^Kip2 immunostaining. In all gestations, p57^Kip2 was strongly expressed in decidua which served as internal positive control. The concordance between the initial histological diagnosis and p57^Kip2 immunostaining was statistically significant (P <0.001).   

Conclusions: p57^Kip2 immunostaining is a highly sensitive and specific marker for diagnosis and classification of hydatidiform mole. p57^Kip2 staining has the advantage of differentiating hydropic abortuses from the complete hydatidiform mole.  

Background and objective: Septoplasty is one of the most common procedures worldwide in otolaryngology clinics. The use of antibiotics in Septoplasty is a common practice among most otolaryngologists. However, there are few studies proving the efficacy, which is considered unnecessary by some others. This study aimed to compare the efficacy of prophylactic versus postoperative antibiotic in septoplasty and strengthen the evidence base for antibiotic use. 

Methods: This prospective study was conducted on 90 patients that underwent septoplasty over six months period from August 1^st, 2012 to January 31^st, 2013 in Rizgary Teaching Hospital, Erbil city. They were equally divided into two groups; 45 patients in Group A and 45 patients in Group B. Their age ranged between 17-49 years old. 

Results: No significant difference was observed in reduction of infection rate between Group A and Group B. No any statistically significant difference was found concerning pain, fever, purulent discharge and bleeding. Two of the patients (one from each group) developed septal hematoma.

Conclusions: Infection after septoplasty is rare and if occur is usually minor in nature. The outcome of postoperative antibiotic use does not outweigh that of a single prophylactic dose of antibiotic.

Background and objective: Acne is a follicular skin disease most frequently occurring during the adolescent or the teenage years of a person's life. It has been found that around 85% of teenagers suffer from this skin disorder worldwide. However, acne is not only restricted to teenagers but in many cases continues well into adulthood. This study aimed to examine the prevalence of acne in relation to age in Erbil City, and isolation and identification of microorganisms in acne patients. 

Methods: Specimens were collected from inflamed and discharging pus from 160 acne patients (74 male, 86 female) attending the Department of Dermatology in Rizgari Teaching Hospital in Erbil city. The cultures were examined using the Vitek-2 compact system.

Results: Among 160 samples taken, 150 (99%) were culture positive. From there 70 (46.6%) were male and 80 (53.3%) were female. Only ten (6.25%) samples revealed no growth. The highest prevalence of acne was 32 (20.0%) at age group (15-17) years of both genders. The most frequent etiological agent isolated (aerobically) bacteria from acne patients was Staphylococcus epidermidis (27.08%), and the most common anaerobic pathogen bacteria species were Propionibacterium acnes, 25 (13.02%), while among fungi Candida albicans was the most common fungi representing nine (64.29%) isolates.

Conclusion: Gram-positive bacteria were the most common microorganisms involved in acne infection. There are variations in the incidence of acne infection in relation to sex, age, and socioeconomic level.

Background and objective: Orthodontic tooth movement is mediated by tumor necrosis factor –α through activation of osteoclasts. Type 1 diabetes mellitus is characterized by a change in the bone remodeling and affects orthodontic treatment. This study aimed to investigate the effects of infliximab local injection on orthodontic movement in the diabetic rabbit.   

Methods: Sixty six rabbits were divided equally into three groups; two groups were rendered diabetic using alloxan injection, while the third group was regarded as a normoglycemic group. Only one of the diabetic groups received insulin treatment. All rabbits were subjected to orthodontic tooth movement of upper central incisor for 18 days, half of each group received infliximab subperiosteal injection, while the remaining number received saline injection. After sacrifice, tissue samples were subjected to histological preparation and histomorphometric analysis.   

Results: Insulin treated group revealed less prominent destruction of the periodontium when compared with the untreated group. The histological pictures of infliximab injected groups demonstrated less bone resorption in pressure side and more bone formation in tension side. There was a significantly smaller number of osteoclast with less compression in the width of the periodontal ligament in the tension side with infliximab injection. 

Conclusion: Infliximab local injection hindered bone resorption in the diabetic state during orthodontic tooth movement.  

Background and objective: Patients’ satisfaction toward nursing care is an important indicator of the quality of nursing services. This study aimed to assess patients' satisfaction with nursing services provided in Rizgary Teaching Hospital and to find out the factors that are associated with levels of satisfaction.     

Methods: A cross-sectional study was conducted in Rizgary Teaching Hospital in Erbil city, starting from January 17^th, 2014 to March 11^th, 2015. A convenience sampling method was used to recruit 200 patients (100 males and 100 females) from medical and surgical wards. Patients aged ≥15 years, who were admitted to medical and surgical wards for ≥48 hours were included. A structured questionnaire designed by researchers was completed through direct interview. Chi-square test of association (or Fisher’s exact test) was used to compare proportions. A P value of ≤0.05 was considered as statistically significant.    

Results: The study showed that 40.5% of patients were highly satisfied with the nursing services, only 20.9% of those with secondary education or higher were highly satisfied (P = 0.005), and 80% of those with high income were highly satisfied (P = 0.001). There was no significant association between patients' satisfaction and patients’ age, marital status, occupation, residence, the length of stay, and type of ward. A relatively poor rate of satisfaction (20.5%) was observed regarding the information provided by nurses before the medical care or drug administration.  

Conclusions: Less educated patients were more satisfied with nursing services. The majority of patients were unsatisfied with the information provided by nurses before medical care or drug administration.   

Background and objective: Controlling medications safely, effectively and efficiently is essential to the delivery of high-quality care. This study aimed to point up prescription errors such as scientific or brand names, the strength of medications, the age of patients, date of prescriptions, specifying dose, dose interval, dosing frequency and dosage form, through systematic studying a certain number of prescriptions.      

Methods: This study screened the prescriptions from both of public and private sectors in the governorates of Erbil, Sulaimaniyah and Duhok. Adherence was assessed on the basis of these prescriptions charts. Excel program was utilized to evaluate the data in this study.      

Results: The study covered a total 283 prescriptions involving 976 medications in Kurdistan region. Only 19% of medications were mentioned as a scientific name and just 2% of prescriptions were written via computer. Direction for use of the medicines was only mentioned for 3% and the duration of treatment was scripted in 11%.    

Conclusion: Majority of medical practitioners in Kurdistan region are not adhering to the international standards of prescriptions.    

Background and objective: Hookahs are water pipes that are used to smoke specially made tobacco that comes in different flavors. Hookah has many of the same health risks as cigarette smoking. This study aimed to assess the awareness of hookah smokers about its harmfulness and identify the reasons for smoking hookah.      

Methods: This study was conducted in all venues of cafes and restaurants located geographically in Erbil city during the period from June 27^th, 2014 to February 4^th, 2015. A questionnaire was used to obtain the smoking pattern, awareness and perceptions of 325 male peoples towards the harmfulness of smoking. Direct interview was used for data collection.

Results: A total number of 325 male people participated in this study. Their age ranged from 18-25 years. Most of them were singles, from urban areas and preferred to smoke in café (61.8%). More than one person was using the same hookah. The average duration of smoking was more than 46 minutes. Around half of the participants (49.5 %) were smoking hookah with friends as a group activity and 35.1% had a headache and dizziness during smoking hookah. The overall awareness about the harmfulness of smoking the hookah was poor (56%).       

Conclusion: The overall awareness about harmful of smoking hookah was poor among attendees of cafes

Background and objective: Dry eye is a disorder of the tear film. There are significant associations between dry eye and environmental factors, autoimmune and chronic diseases like diabetes mellitus and rheumatoid disease. This study aimed to determine the prevalence of dry eye in patients with diabetes mellitus in patients attending Erbil and Rizgary Teaching hospitals in Erbil city.      

Methods: A hospital-based cross-sectional study of 195 diabetic patients who presented to the department of ophthalmology, Rizgary and Erbil teaching hospitals, Erbil; from February 2011 to December 2011 was conducted. Detailed diabetic history was recorded. Assessment of anterior segment via slitlamp biomicroscopy was done. The examination of dry eye included Schirmer`s test, tear break-up time and fluorescein dye

Results: From total 195 patients, eighty-one (41.5%) of them had dry eye. The prevalence of dry eye among older ages (≥60 years) was 49%, which was higher than younger ages (<60 years). The dry eye had a higher percentage in males than females (44.7% and 39.1%, respectively). Those who had diabetes mellitus for <10 years recorded 36.6% dry eyes, however, those who had diabetes mellitus for ≥10years showed 50.7% dry eyes. On the other hand patients with good diabetic control (HbA1c<7%) had a lower prevalence of dry eye than those of uncontrolled one (HbA1c≥7%) with a percentage of 38.5% and 48.3%, respectively.   

Conclusions: There was a high prevalence of dry eyes among diabetic patients in Erbil city. The prevalence of dry eye is higher in those with duration of diabetes for more than ten years. There was no statistically significant difference between male and female. The sensitivity of tear break-up time test was higher than Schirmer`s test for diagnosing dry eye.  

Background and objective: Chronic urticaria is one of the most frequent skin diseases and still its etiology is recognized only in a minority of cases. Some recent studies point out to infections due to Helicobacter Pylori as being of major importance in the pathogenesis of chronic urticaria. This study aimed to find out the association of chronic urticaria with H. pylori.         

Methods: A case-control study was conducted in Erbil city within the period of April 1^st, 2013 to January 1^st, 2014. The study included 55 cases with chronic urticaria and 55 controls that were free from features of chronic urticaria. Data was collected through direct interview and the results of laboratory investigations were recorded in a specially designed questionnaire.  Enzyme-linked immunosorbent assay test was used for detection of Helicobacter pylori antigen in the stool sample.       

Results: The age of the 55 cases and 55 controls enrolled ranged from 13 to 65 years. Stool for Helicobacter pylori antigen test was positive in 69.1% of cases and 29.1% of controls (OR = 5.44, P ˂0.001). The mean age ± SD of positive Helicobacter pylori patients were 35.75 ± 12.64 years, with male to female ratio 1:2.8. No statistically significant association was found between Helicobacter Pylori infection with dyspepsia and duration of urticaria.     

Conclusions: There was a strong association of chronic urticaria with Helicobacter pylori infection. Investigating for Helicobacter pylori in all cases of chronic urticaria and conducting further trials on Helicobacter pylori eradication is recommended.  

Background and objective: Benign prostatic hyperplasia involves the enlargement of prostatic glandular tissue and narrowing of the urethra. It affects bladder storage or emptying. Most of the men with benign prostatic hyperplasia have no symptoms. This study aimed to compare international prostate symptom scores, prostate specific antigen level and prostate volume in patients having benign prostatic hyperplasia with and without metabolic syndrome.           

Methods: This study involved 85 patients with benign prostatic hyperplasia who were divided into two groups. The first group included 40 participants who were only suffering from benign prostatic hyperplasia and the second group involved 45 participants who were suffering from both metabolic syndrome and benign prostatic hyperplasia. The division of subjects was performed depending on three abnormal parameters out of five parameters, such as body mass index (BMI >25kg/m²), dyslipidemia (Triglyceride ≥150 mg/dl, High density lipoprotein-C <40 mg/dl), blood pressure (BP ≥130/85 mmHg), fasting plasma glucose (PG ≥110 mg/dl).        

Results: Patients with metabolic syndrome at diagnosis appears to have significantly higher levels of prostate specific antigen comparing with patients without metabolic syndrome, 3.9±0.26 and 2.7±0.21, respectively. Similarly, patients with metabolic syndrome at diagnosis had significantly higher prostate volume levels (72.69 ± 2.69 ml) comparing to patients without metabolic syndrome (46 ± 2.44 ml). Patients with metabolic syndrome at diagnosis showed considerable higher international prostate symptom scores level (23.62 ± 0.62) compared to patients without metabolic syndrome (18.87 ± 0.327).      

Conclusions: benign prostatic hyperplasia patients having metabolic syndrome have significantly higher values of prostate specific antigen levels, prostate volume and international prostate symptom scores compared to benign prostate hyperplasia patients without metabolic syndrome.              

Background and objective: Thyroidectomy is an operation that involves surgical removal of all or part of the thyroid gland. The main postoperative complications of thyroidectomy are hypoparathyroidism and recurrent laryngeal nerve injury. This study aimed to find out the main postoperative complications particularly nerve damage during total thyroidectomy or total lobectomy.

Methods: The medical records of patients who were diagnosed with thyroid disease and underwent surgery between January 2^nd, 2013 and December 30^th, 2014 in Teaching, Shar, Soma and Zhian hospitals in Sulaimaniyah were retrospectively reviewed. 

Results: All patients who underwent total thyroidectomy or total lobectomy surgeries were discharged within 24 hours of the operation. During the average follow-up of 24 months, no case of permanent recurrent laryngeal nerve injury was registered. Vocal cord paralysis was considered to be present, when there was absent or markedly reduced movement of the affected vocal cord.       

Conclusions: Meticulous hemostasis and a delicate technique are required to prevent nerve injury. We recommend dissection and division of all the vessels flush with the thyroid capsule at the anterior and peripheral aspect of the gland. Separate ligation of anterior and posterior branched of the superior thyroid artery will preserve the external branch of the superior laryngeal nerves.