Vol 19, No 1 (2015)

Background and objective: Hypertension is a very common medical disorder, affecting nearly 40% of our population. Diastolic dysfunction is one of complications that happens and is regarded as a predictive of subsequent heart failure. The aim of this study was to determine the frequency of left ventricular diastolic dysfunction by echocardiography among hypertensive patients. Methods: This study involved 150 hypertensive cases (82 female and 68 male) age from 25-81 years old. Transthoracic echocardiography approach, using SIEMENS SONOLINE Omnia 2005 machine with the probe of p4-2 was used by the researcher. A comparative 150 normal non-hypertensive healthy adults with hypertensive patients are examined again by echocardiography. The parameter for the diastolic dysfunction measurement is E/A ratio. Results: It was found that 88 (58.7%) of hypertensive patients have diastolic dysfunction, while 4.9% of non-hypertensive group have diastolic dysfunction with significant statistical differences between both groups (P <0.001), who were age >60years have 79%, while age 25-35years old have 21% (P <0.001). Among left ventricular hypertrophy patients, 87.5%, versus 12.5% have diastolic dysfunction (P <0.001). Females are more liable for diastolic dysfunction, who have 70.7% than males who have 44.1% (P <0.001). Conclusion: Diastolic dysfunction is common among hypertensive patients, particularly among females, aged, and who have echocardiographic criteria of left ventricular hypertrophy, represent risk factors for diastolic dysfunction.

Background and Objectives: Nowadays the final outcome of wound closure using tissue adhesives and suture material is making a real competition for better results. Cosmetic outcome is regarded as the first demand for the patients. The aim of this study was to make a comparison between the two closure methods in terms of cosmetic outcome, complication and patients’ satisfaction. Method: A prospective comparative study was conducted at Rizgary Teaching Hospital and West Erbil Emergency Hospital in Erbil city from March 2012 to March 2013. A total of 105 patients were included in the study. The method of closure was selected alternatively between tissue adhesive (octylcyanoacrylate) and suture material. Analysis for cosmetic outcome, complications and patients’ satisfaction were done using the statistical package for the social sciences (version 19). Results: The complications were 25% (13 patients) in the tissue adhesive group and 18% (9 patients) in the sutured group. Of the 44 patients in the tissue adhesive group, 86.4% (38 patients) were satisfied; while of the 61 patients in the sutured group, 88% (54 patients) were satisfied with the end result. Excellent cosmetic outcome achieved in 77.3% in the tissue adhesive group and 80.3% in the sutured group. Conclusion: Tissue adhesive (octylcyanoacrylate) is effective and reliable in primary skin closure, yielding similar cosmetic results to standard suturing method. Tissue adhesive is faster and offers several practical advantages over suture repair.

Background and Objectives: Cleft lip and palate are congenital deformities that affect the primary and secondary palates during embryogenesis. The objectives of this study was to record the pattern of presentation of cleft lip and palate in Erbil, the types of surgical procedures, the outcome and complications, hence making recommendations to ensure improved care. Methods: This is a prospective study conducted in Erbil city, in the Department of Plastic Surgery at Rezgary Teaching Hospital and Rapareen Pediatric Hospital from March 2009 to May 2013. A total of 164 patients with cleft lip/palate were included in this study. Statistical package for the social sciences (version 18) was used for data entry and analysis. Results: The age ranged from birth to 24 years. The ratio of male to female was 1.4: 1. The combined cleft lip and palate was the commonest type (87 cases, 53%). The commonest risk factor was poor family (105 cases, 64%), followed by consanguinity (97 cases, 59%). The commonest procedure for cleft lip repair was Millard (67 cases) and that for cleft palate repair was Furlow palatoplasty (57 cases). The commonest complication of cleft lip repair was wide scar (9 cases, 7.5%) mostly below one year of age. Ninety-one percent of the parents were satisfied with the children’s appearance of the lip and 86% of parents were satisfied with palatoplasty result. Conclusion: The high degree of association of consanguinity with the cleft lip and palate emphasizes the importance of education about discouraging consanguineous marriage. Millard repair is still the commonest procedure for cleft lip repair.

Background and Objectives: Schizophrenia is a complex chronic neuropsychiatric disease of the central nervous system, believed to have multiple etiologies. Toxoplasma gondii has emerged as an interesting candidate as a possible cause of some cases of schizophrenia. As there is scarce information about the seroprevalence of T. gondii infection in psychiatric patients in Erbil; we investigated the seroprevalence of T.gondii in schizophrenic patients and compared with that obtained from control individuals in Erbil correlated with inflammatory marker C-reactive protein. Method: This case control study included 93 schizophrenic patients seeking medical advice at Hawler Psychiatric Hospital and private clinics with 93 non psychiatric control were screened for the presence of anti-toxoplasma IgG, IgM (by ELISA test) and C-reactive protein using qualitative methods. A questionnaire was used to collect socio-demographic and behavioral data among the respondents. Results: In chronic cases anti-Toxoplasma gondii IgG antibodies were seropositive in 30/93 (32.3%) of the schizophrenic patients and 4/93(4.3%) of control (P <0.001). The seropositive rate of IgM antibodies was 9.7% and 1.1% among schizophrenic patients and control, respectively (P = 0.006). The result of C-reactive protein positivity among patients and control was 23.6% and 3.22%, respectively (P <0.001). Conclusion: Our results delineate that association might exist between Toxoplasma gondii infection and schizophrenia etiology

Background and Objectives: Renal disease can affect the outcome of pregnancy. The renal system undergoes significant physiological and anatomical changes during pregnancy. Ultrasound is the commonest imaging modality used in the evaluation of the abdominal organs in pregnancy. The purpose of this study was to sonographically evaluate the kidneys in normal pregnancy. Methods: A prospective descriptive study in which real time B-mode renal ultrasound was performed on 500 pregnant women attending for a routine obstetric ultrasound scan. Questions about the age, parity and presence of loin pain were asked. Obstetrical ultrasound examination was initially performed followed by examination of maternal kidneys. Results: Renal collecting system dilatation was the main abnormal finding; it was present in 18.2% of cases, (15.2% right side and 3% left side). Bilateral hydronephrosis was seen in (2.6%) of cases. Rate of hydronephrosis was more in primiparous women. Other findings were renal stones (2.8% right and 1.8% left sides, respectively), ureteric stone (0.2%) and acute pyelonephritis (1%). Conclusions: This study established the value of renal sonography in the pregnant women, though not a common condition. Renal collecting system dilatation was the main finding. A significant proportion of patients with asymptomatic renal calculi were detected incidentally.

Background and objectives: Appendicitis is the most common acute surgical emergency of childhood. Decision-making in patients with acute appendicitis poses a diagnostic challenge worldwide. Among the reported diagnostic criteria, modified Alvarado score system and ultrasound findings where used to support diagnosis and even exclude complicated cases. The aim of this study was to detect clinical and sonograghic features that distinguish children visited the emergency department with acute simple appendicitis and idntify factors related to complicated cases. Methods: This cross-sectional study included 76 children with the provisional diagnosis of acute appendicitis according to clinical findings attending the Emergency Departement at Rapareen Teaching Hospital in Erbil between January and December 2012. Results: Of 76 patients included in this study, 75 patients (99.7%) had appendicitis whether inflamed (63 patients, 82.9%) or complicated (13 patients, 15.8%) and only one patient had normal operative (non-inflamed appendix) findings. Delay of admission, high temperature at time of presentation, localized tenderness and MASS of ≥ 7 increased the risk of complicated appendicitis as do leukocytosis and positive ultrasound findings. Conclusion: The study shows that use of certain clinical data (like duration of manifestations) with the modified Alvarado score system supported by leukocytosis and positive ultrasound findings in children suspected to have acute appendicitis provides a high degree of diagnostic accuracy of complicated cases rather than simple acute appendicitis

Background and objectives: True ankylosis of the temporomandibular joint may be defined as joint surfaces fusion. It can affect the function adversely and when occurs during childhood, it can adversely affect mandibular growth. The treatment is usually surgical, but, unfortunately, poses a significant challenge because of the high recurrence rate. The objective of this paper is to evaluate the outcome of following a definitive protocol in the treatment of temporomandibular joint ankylosis. Methods: Seventy-seven patients, 36 unilateral and 41 bilateral ankylosis (118 ankylosed joints) were diagnosed clinically and radiologically as having true ankylosis of the temporomandibular joint during the period between 2001 and 2013. Resection of the ankylosed bone or horizontal ramus osteoctomy of the affected side with interpositional autogenic or alloplastic material, with possible ipsilateral and/or contralateral coronoidectomy to achieve the definitive interincisal opening of not less than 35mm. Results: The postoperative measurement of interincisal opening of ≥35mm with lateral and protrusive movement was the criteria for success of surgery. Reankylosis occurred in 7 unilateral and 12 bilateral cases. Conclusion: Postoperative jaw opening exercises are crucial for lasting success and failure of patient compliance is the cause of reankylosis.

Background and objectives: The disabling effects of diabetes mellitus are multi-factorial, which can result in the high prevalence of long term complications. The aim of this study was to assess disability levels of diabetic patients. Methods: A quantitative design descriptive study was conducted in Leila Qasim Center in Erbil City in the Kurdistan Region of Iraq from February 2012 to February 2013. A non-probability purposive sample of 400 diabetic patients for more than 5 years was selected. A questionnaire was designed and divided into three parts: sociodemographic data, clinical data, and the standardized questionnaire developed by World Health Organization for disability assessment. Results: The highest percentage (57%) of diabetic patients had a moderate level of disability, while 23% had a mild level of disability. Severe level of disability was present in 20% of sample. No one had not disability or extreme level of disability. Conclusion: More than half of diabetic patients were in the moderate level of disability.

Background & Objectives: Ventricular ectopic beats (extra systoles, premature beats) are frequently found in healthy people. Ectopic beats in patients without apparent heart disease are more prominent at rest and disappear with exercise. Treatment is not necessary unless the patient is highly symptomatic. Methods: Patients having ventricular ectopic beats were assessed clinically, by ECG and by echocardiography. Those with normal structure hearts underwent exercise ECG and among those we selected 50 patients whose ectopics were suppressed by exercise then followed them for 5 years. The study started from 2000 to 2010. Results: During 5-year follow-up of the above mentioned patients, relevant complications such as dangerous ventricular arrhythmias, ischemic heart diseases or heart failure were not recorded. Conclusions: In patients having ventricular ectopic beats and structurally normal heart, the suppressibilty of the ectopic by exercise indicated their benign origin and may preclude further invasive investigations and even specific treatment.

Background and objectives: A urinary tract infection is defined by the presence of an organism in the urinary tract that is usually sterile. The age and gender are important factors influencing prevalence of urinary tract infections. The aim of this study was to clarify the microbiology of urinary tract infection, antibiotics susceptibility pattern prevalence and their relation with age, gender and circumcision among infants and young children in Erbil city. Methods: Urine samples were collected from 300 children with sign and symptoms of urinary tract infection at Rapareen Pediatric Hospital in Erbil city. The specimens were cultured on appropriate media and the isolated organisms identified with a significant growth 105 CFU/ml. The susceptibility of bacteria causing urinary tract infection to different antimicrobial agents was investigated. Results: The study showed that 43.3% of children had urinary tract infection (53.2% females, 30.2% males). The highest percentage of infection occurred at age group 6-10 years with female's predominance. The percentage of urinary tract infections in uncircumcised boys was 76.9%. The most common organism isolated was Escherichia coli (33.8%). The isolated bacteria were highly sensitive to Ciprofloxacin, Amikacin and Nitrofurantoin. Conclusion: Early and appropriate diagnosis of urinary tract infection in infants and young children is important as it is marker for urinary tract problems. Escherichia coli was the most common organism causing urinary tract infection in children. The most of urinary isolates had high level of resistance to commonly used antibiotics.

Background and objectives: A possible therapeutic effect of diagnostic tubal patency testing has been debated in the literature for more than half a century. The aim of this study was to evaluate the effect of flushing the fallopian tubes with water-soluble contrast medium during hysterosalpingography on subsequent pregnancy rates and to find out diagnostic findings of hysterosalpingography in infertile patients. Methods: A prospective study was conducted on 220 women. hysterosalpingography using water-soluble contrast media was done in a private clinic as part of their infertility work up from January 2012 to July 2012 in Erbil city, Kurdistan region, Iraq. The pregnancy rate was determined within six months from the procedure using water soluble contrast media and it was correlated with different hysterosalpingography findings. Results: The mean age (+SD) of the study population was 30.59 (+5) years. The clinical pregnancy rate was 23.2%. A statistically significant difference was found between the rate of pregnancy and hysterosalpingography results in which 27.2% of patients with normal hysterosalpingography and 6.8% of patients with abnormal hysterosalpingography got pregnant during six-month follow-up period after the procedure (P = 0.004). Conclusions: Flushing of the tubes with water-soluble contrast media during hysterosalpingography increases subsequent pregnancy rates in infertile patients.

Background and objectives: Joint space assessment and condylar relation in the glenoid fossa is considered as integral component of the clinical assessment of the patient with tempromandibular joint disorder. Any variant from normal tempromandibular joint may affect the diagnosis and management of the case. Methods: Thirty patients with unilateral myofacial pain dysfunction syndrome were included in this study (14 male and 16 female). Joint space analysis was performed by cone beam computed tomography for all patients. Analysis of data for joint spaces (anterior, middle, posterior, medial and lateral) was performed by using t-test. Results: The joint spaces and condyle positions in anterior, superior and posterior regions showed less joint space and statistically significant difference (P <0.05) from same joint space of normal side. No statistically significant differences were found in space value between middle and lateral condylar space of the diseased side and normal side of the patient. The joint spaces in normal sides were between 2 to 3.2 mm. Age and gender variations showed no statistical differences. Conclusion: The use of cone beam computed tomography for examination of tempromandibular joint space in patients with myofacial pain dysfunction syndrome give a good diagnostic criteria for affected side.

Lethal midline granuloma syndrome is a clinical term used generally to describe a rare clinical entity, of unknown aetiology, characterized by progressive destruction of face, nose, para-nasal sinuses, and palate, oral and para-oral structures. Diagnosis is often difficult and requires expert clinical and histopathological examination of the lesion. A case of advanced high–grade lymphoma is reported as it was misdiagnosed and not treated properly for several months. After final diagnosis, a combined radio and chemotherapy were offered to the patient, but unfortunately the patient died because there was no response to treatment.

Background and objectives: Pulmonary alveolar microlithiasis is rare disease characterized by the presence of numerous small calculi within the alveolar spaces. Case report: 39-year-old female with pulmonary alveolar microlithiasis is described, in which the diagnosis was suspected clinically and radiologically and confirmed histopathologically. The clinical, pathogenesis and pathology are briefly reviewed.