Print ISSN: 2790-0207

Online ISSN: 2790-0215

Issue 1,

Issue 1

Trends in Managing Ankle Fracture with Diastasis. Radiological Assessment

Adnan Abdilmajjed Faraj; FRCS (Orth&Tr.) Consultant Orthopaedic surgeon James Ricketts MB.Ch.B; Core training year 1 doctor; U K

Kirkuk Journal of Medical Sciences, 2018, Volume 6, Issue 1, Pages 1-8

Introduction: There are many controversial issues in the management of high fibular ankle fractures. The aim of current study to compare treatment options. Material and Methods: Ninety patients with high fibular ankle diastasis fractures were treated in the York and Scarborough NHS Trust between 2011-2014. The reviews included assessment of the radiographs on the patient archiving and communication system (PACS) and the patient's notes using Core patient data base (CPD). Mean follow up period was of 2.9 years. Results: Eighty two patients, who sustained Weber C ankle fractures, underwent open reduction and internal fixation of fibula, in 8 patients with high fibular fracture, only diastasis screw was used without plate fixation. Those who have had lateral malleolar fracture fixation required additional diastasis fixation in 51 patients (57%). The methods of diastasis fixation, was with using a screw passed through fibular plate (55%), or using a screw without plate fixation (15%) and using tight rope fixation. When a screw was used for diastasis fixation, the screw was passed through 3 cortices (80%); in the remaining the screw fixed four cortices. The average distance of the diastasis screws from the tibial plafond articular surface was 2.39cm. Eighteen diastasis screws were removed at an average time of 31weeks' post-surgery. Conclusion: Radiological improvement following surgery for Weber C ankle fracture was within the accepted variations, there was no difference between tight rope and screw syndesmotic fixation. Diastasis screws can be keeping without removing especially when tricortical fixation is used and the screws inserted just above syndesmosis. Only (50%) of unstable ankle fracture required diastasis fixation.

Assessment the Relation between Introduction of the Solid Foods and Napkins Rash Occurrence in Children below Two Years Old

Fatimah M. N. Raouf; Ahmed H. Al-Anee; Thikraa A. Hamada

Kirkuk Journal of Medical Sciences, 2018, Volume 6, Issue 1, Pages 9-17

Background: Baby feeding went in to two phases; the 1St phase when the baby is on milk usually up to 4-6 months, in the 2nd phase the milk is not enough so the addition of the solid diets is recommended. Napkins rash is common complaint of the nursing mother and infant which may be due to solid diets. The aim of the study: Is to evaluate whether the early introduction of solid diets to infant has any rule in increasing or decreasing the occurrence of napkins rash. Patients and Methods: A convenient sample hospital based study was done on children between 4-24months who start solid diets, to evaluate the role of introduction of the solid diets on occurrence of the napkins rash. Each group evaluated by prepared questionnaire. Results: The total number of the study cases are (52) cases, (22) male and (30) female and the results of this study were: Most of the cases were female (57.7%), between 13-24 months (50%), from the rural areas (71.2%), on the solid diet and bottle feeding (40.4%), normal (weight 57.7% and height 94.2%), with very early introduction of the solid foods between ages 4-6 months (61.5%). Most of the cases with recurrent napkins rash (51.9%) were used readymade napkins (48.1%), were on the bottle feeding and the solid diets (19.2%) (not significant), with very early introducing solids to their diet (28.8%) (not significant), female about (32.7%) (significant). And were from the rural areas (26.9%) (significant). Conclusion: The study concluded that early introduction of the solid foods has no significant effect in occurrence of the napkins rash.

A Study of Electrocardiographic Changes in Asthmatic Patients Attending Kirkuk General Hospital

Abdulmanaf Ahmed Mohammed; Hijran Kamal Salih Kamal Salih

Kirkuk Journal of Medical Sciences, 2018, Volume 6, Issue 1, Pages 18-25

Background: Asthma is a common chronic respiratory disease affecting (7-10%) of the population in different countries. It is characterized by variable symptoms of wheeze, shortness of breath, chest tightness and cough. Asthma is usually associated with airway hyper-responsiveness to direct or indirect stimuli. Patient with acute asthma will manifest electrocardiograghic changes ranging from sinus tachycardia, P, ST and T wave changes etc, these abnormalities persisted for up to 10 days, may reflect positional changes of the heart, were reverted to normal after therapy. Aims: To study the various ECG abnormalities in acute asthma and to demonstrate the reversibility of these abnormalities after treatment. Material and Methods: This study was conducted on (110) patients all were adults, their age ranged from 20 years to more than 50 years who attended to the emergency department in Kirkuk General Hospital over a period of one year from April 2017 to April 2018 with aconfirmed diagnosis of acute severe asthma were studied. Ten patients were excluded from study because their ECG changes were related to cardiac and thyroid disorder. Patients were included in the study only if an ECG had been performed on admission and within 24 hour of their stay in hospital. A standard 12 Lead ECG was performed on admission for each patient and it repeated until it had returned to normal. In each patient, on admission, plasma urea, full blood count, thyroid functions test (in selected cases) cardiac enzymes (in those with chest pain) were performed. The diagnosis of acute asthma is made by taking a thorough history and physical exam, and patients without a previous diagnosis of asthma, a spirometry performed to confirm airway obstruction and reversibility. Result: The commonest ECG changes were sinus tachycardia which was found in (50%) of patients with a heart rate ranging between 120-130 beats/ min, while the lowest rate of ECG changes was right bundle branch block were observed in (2%) of patients. The male patients were affected more than female and the highest incidence observed was among age group 41-50 years. The ST segment depression, T wave inversion & sinus tachycardia are the main ECG changes in (30%) of life threatening type of acute asthma. While P pulmonale & ST segment depression were observed in only (4%) of patients with near fatal asthma. Conclusion: Patients with acute asthma can manifest various ECG changes and these changes returned to normal after medical therapy, usually within 10 days.

Routine Vs Day-Care Surgery in Case of Unilateral Inguinal Hernia in Public Hospital Setting

Chalack Kader Nader; Dler Omer Mohammed Mohammed

Kirkuk Journal of Medical Sciences, 2018, Volume 6, Issue 1, Pages 26-33

Background: Day-Care Surgery is defined as planned investigations or procedures on patients who are admitted and discharged home on the day of their surgery. While Routine Care Surgery is any surgery where the patient needs to remain overnight or longer after the surgery is completed, for care or observation. Patients and Methods: In this prospective and observational study on 200 patients, 100 day-care & 100 routine-care patients who underwent treatment of unilateral inguinal hernia at Kirkuk General and Azadi Teaching Hospitals. Aims of the study: We aim to study and compare the immediate and long-term postoperative complications and patients‘ satisfaction between the two procedures (day-care and routine-care procedures) and to assess the feasibility of day-care surgeries in governmental institutes. Results: In this study, 4 out of 100 (4%) day-care surgery patients had to be kept for more than 23 hours. But only 2 (2%) patients were readmitted. The immediate post-operative and at the end of 7th post-operative day complications were in fact lower than routine-care surgery. Majority of patients (94%) were satisfied from the surgery and preferred day-care surgery to routine-care. Also, the success rate, complication rate and patient satisfaction were comparable with specialized day surgical unit treating for inguinal hernia. Conclusion: From our study, we conclude that even with the shortcomings of the public health care setup of developing nation, the day-care hernia repair can be done without any major immediate or long term complication as compared to routine-care surgery.

Normal Spleen Size in Adults in Kirkuk Population Using Ultrasound Scan

Israa Mohammed Sadiq; Saman Anwer Nooruldeen; Zahraa Ahmed Hasan; Mohammed Mustafa

Kirkuk Journal of Medical Sciences, 2018, Volume 6, Issue 1, Pages 34-40

Background: Splenomegaly is a clinically important finding, particularly for physicians required to make decisions on variety of disease status including infectious, storage diseases and malignant disorders. Objective diagnostic measures have been proposed as a useful step in making decisions in those patients using ultrasonography, as it‘s a noninvasive, established, safe, quick and accurate method for measurement of spleen size. There are racial differences in normal splenic size, as previous ultrasound data have been suggested. These differences in splenic size result in improper interpretation of splenic measurements. Objectives: To develop standards of normal range of splenic length (as indicator for splenic size) for our adult population based on gender, age and body mass index using ultrasound scan. Material and Methods: A cross-sectional study conducted in the department of Radiology in Azadi Teaching Hospital, Kirkuk, Iraq within a period from May 2013 to April 2016. The study was conducted among 303 adult individuals (120 males and 183 females), they were healthy individuals more than 18 years old not suffering from diseases affecting the spleen, the exclusion criteria were individuals not willing to participate; history of medical disorders affecting spleen, such as blood, metabolic and connective tissue diseases, portal hypertension, high body temperature within the last month of examination, malignancy, and pregnancy. Maximum splenic length in centimeters was assessed at level of splenic hilum on the longitudinal view using 5 MHz sector curvilinear transducer probe for trans-abdominal Ultrasonography. 2-tailed t test was used to assess the differences between continues variables. The Relationship of length of spleen with age, and body mass index (BMI) were assessed with the Pearson‘s correlation coefficient (r). Results: The mean age of the study sample was 38.05±15.58 years for male and 37.23±13.98 for female, their mean body height was 173.1±46 cm for male and 159.70±4.88 cm for female, their body weight was 83.42±16.70 kg for male and 73.19±15.90 Kg for female and mean BMI were 27.86 ±5.42 for male and 28.58±6.27 for female. Mean spleen length were 10.65±1.41 for male and 9.52±1.25 for female. There was significant correlation between spleen length and gender (p< 0.05). There was weak negative correlation with age, and weak positive relation between the splenic length and BMI. Conclusion: This study provides the values of normal splenic size by ultrasonography in adults‘ for both genders at Kirkuk city. The splenic size had weak positive correlation with body mass index (BMI), and weak negative correlation with age.

The Role of Mobile Learning in Medical Educational Improvement

Wafa Mahmood Jasim

Kirkuk Journal of Medical Sciences, 2018, Volume 6, Issue 1, Pages 41-48

Background: Mobile learning is a new type of learning method which has a some similarities with the electronic learning used for easily obtaining the necessary information at any time need and creating a modern flexible environment for learner in their different setting. The study aim: The study aim was to assess the knowledge and attitude of 6th year medical students regarding the role of mobile learning in medical education. Subjects and Methods: A cross- sectional study was done on 75 medical sixth class/ Tikrit University student were selected randomly from the period of 1st January/ 2013 till the end of April /2013. A six parts questionnaires form has been prepared by the investigators and distributed to the study sample after receiving their agreements in participating in the study after complete explanation the study purpose. Results: The study show that most of study sample were female (40-53.3%), and from urban area (57- 76.0%) and majority of them agree that m- learning is very important in medical education (32-57.1%). Most of students go with that m-learning enhancing communication abilities and obtaining a large amount of information with the easily gaining the necessary scientific knowledge. Conclusion: The study concluded that m- learning provides many services like logging of medical books with lecture notes and practical reports.

Effect of Titanium Nanoparticles Biosynthesized by Lactobacillus crispatus against Multi Drug Resistance Bacteria isolated from patient with Recurrent UTI

Jehan Abdul Sattar Salman; Fattma Abodi Ali; Kawther Hkeem Ibrahem

Kirkuk Journal of Medical Sciences, 2018, Volume 6, Issue 1, Pages 49-65

Background: The synthesis of metal nanoparticles using microorganisms has received great interest due to their optical, chemical, photoelectrical and electronic properties. The microorganisms are used as possible ―nanofactories‖ for development of clean, nontoxic and environmentally friendly methods for producing nanoparticles, the Nanoparticle are synthesized using various biosources such as bacteria, fungi, yeast, plant extract Objectives: The present study focuses on the biosynthesis of titanium nanoparticles using Iraqi Lactobacillus crispatus isolate and their inhibitory effect against multi drug resistance bacteria isolated from patient with Recurrent UTI and against their ESBL and Metallo beta lactamase. Materiales and Methods: Lactobacillus crispatuswas isolated from vagina of Iraqi healthy women then identified throughoutcultural, microscopical and biochemical test. Fifty samples of urine were collected from women suffering from recurrent UTI who had certain clinical symptoms; these samples were collected from Rizgary Teaching Hospital and Baghdad Teaching Hospital from August to September, 2013 with ages ranging from 18-60 years. The urine specimens were inoculated on both blood and MacConkeys agar plates. The isolates were identified throughout cultural, microscopical, biochemical test and Vitek 2 system. Isolates were tested against 14 antibiotics by using Kirby-Bauer disc diffusion and detection of Extend spectrum β- lactamases by double disc diffusion synergy method and detection of Metallo-β lactamase by disc potentiating test and Samples of synthesized nanoparticles were characterized after 72 hours of incubation. The formation of metal oxide TiO2 nanoparticles was confirmed by X-ray diffraction (XRD) technique, Atomic Force Microscopy (AFM) and Scanning electron microscopic (SEM) and antibacterial activity of TiO2 nanoparticles synthesized by L. crispatus were determined on the basis of minimum inhibitory concentration (MIC) values Effect of TiO2 nanoparticles on metallo-β lactamase and evaluation of combined effect between Antibiotics and synthesized TiO2 nanoparticles. Results: Fifty samples of urine were collected from patient suffering from recurrent UTI who had certain clinical symptoms. Forty four isolates (88%) were isolated and identified from fifty samples of urine, 13 isolates (29.5%) belonged to Escherichia coli which was the most predominant and 6 isolates (13.6%) belonged to Klebsiella pneumonia, 5 isolates (11.3%) belonged to Psudomonasaeruginosa , 2 isolates (4.5%) belonged to Acinetobacterbaumannii, one isolate belonged to M.morganii, 11 isolates (25%) belonged to S.aureusand 6 isolates (13.6%) belonged to S.saprophyticusMoreover , these isolates were tested for susceptibility to (13) antibiotics and for their ability to produce extended β –lactmase and metalo β- lactmaseenzymes. All isolates were resist to Ampicillin, Amoxicillin/ clavulanicacid and Aztreonam. Inhibitory effect of synthesized TiO2 nanoparticles was studied against growth and ESBL and Metallo beta lactamase of recurrent UTI causative bacteria. Results showed the MIC of TiO2 nanoparticles was (32) mg\ml against E. coli, M.morganii, A.baumanii and S.aureus, and (64) mg\ml against K.pneumoniae, P.aeruginosa and S.saprophyticus isolates.TiO2 nanoparticles showed inhibitory effect on metalloβ lactmase produced by E.coli, M.morganiiand A.baumanii., thereduction in inhibition zone diameter of MBL positive isolates of A.baumanii(1) and E.colifrom (2o to 25) mm after treatment with TiO2 nanoparticles compared to control without treatment with TiO2 nanoparticles (25-35,20- 30) mm respectively, while inhibition zone diameters of M.morganiiand A.baumanii (2) were(15,20),(10,20) mm respectively after treatment compared to control with inhibition zone diameters (23,30), (30,38) mm. The combined effect between Antibiotics and synthesized TiO2 nanoparticles was also investigated against multi resistant recurrent UTI causative bacteria. The antibacterial activities of some antibiotics such as Ampicillin and Gentamycin have been increased in the presence of TiO2 nanoparticle (subMIC) against all isolates. Conclusions: Titanium nanoparticles has more efficient antibacterial agent and can be useful in the treatment of infectious diseases caused bybacteria, the combination of antibiotics and metal nanoparticles could increase the antibiotics‘ efficacy against resistant pathogens. In addition, nanoparticle–antibiotic conjugates lower the amount of both agents in the dosage, which reduces harmfulness and increases antimicrobial properties.

Prevalence of Anemia during Pregnancy in Kirkuk Province

Hassan Y. Hassan; Abdulhadi M. Jumaa M. Jumaa; Fadheelah S. Azeez S. Azeez

Kirkuk Journal of Medical Sciences, 2018, Volume 6, Issue 1, Pages 66-70

Background: Anemia is defined as a state of decreased blood concentration of hemoglobin which can by too few red blood cells, too little hemoglobin in red blood cells or both. Worldwide, anemia is considered as one of the major nutritional deficiency disorders. In developing countries, almost two thirds of pregnant ladies are anemic. Most of the studies suggest that there is a significant rise in perinatal mortality rate when hemoglobin of pregnant woman becomes pregnant below 11.0 g/dl. The aim of study is to estimate prevalence of anemia during pregnancy in Kirkuk province. Subjects and methods: This study was conducted at the beginning of May to the end of September 2017. 100 females, whose ages were between 18-35 years, were collected randomly in Kirkuk province (50 pregnant females and 50 nonpregnant females at childbearing age as control). The mean and standard deviation of our sample ages were 27.72+5.38 years (23.39+4.1 years for nonpregnant females and 31.9+2.3 years for pregnant females). Among pregnant females, the mean and standard deviation of ages were 28.17+1.2 for 1st trimester, 32.2+2 for 2nd trimester and 32.9+1.4 for 3rd trimester. 68 of our sample were from urban areas and 32 from rural areas. 3 ml of blood drawn from the cubital vein by using disposable needles and syringes. CBC (complete blood count) was estimated by using same automated analyser in same laboratory. 5 parameters (Hemoglobin (Hb), hematocrit (Hct), Mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC)) have collected for each woman in this study. Results: In this study, it has been seen that the changes in all parameters during pregnancy becomes more obvious in last two trimesters of pregnancy. Conclusions: Regarding results of present study, prevalence of anemia during pregnancy in Kirkuk province is high and type of anemia is mild anemia

Syndactyly Repair with Dorsal Island Metacarpal Advancement Flap and Multiple Z Flaps

Hussein Mohammad Ali Bager Ali Bager

Kirkuk Journal of Medical Sciences, 2018, Volume 6, Issue 1, Pages 71-81

Background: Skin grafting for syndactyly repair is time-consuming, and has high potential risks of scar contracture and web creep. The dorsal island metacarpal advancement flap for web space reconstruction in syndactyly with multiple Z flaps repair eliminates the need for skin grafts. Methods: Between October 2014 to October 2017, dorsal island metacarpal advancement flap was used for web reconstruction in 26 syndactylies of 21 patients, their ages ranged from eight months to eight years. The patients were followed up for 2 to 4 years (mean: 2 years). Results: The mean operation time was 60 min (range: 50-75 min). All incisions were closed primarily without skin grafting. There were 2 partial flap necrosis, 2cases of partial wound dehiscence, 1 case of dorsal metacarpal hypertrophic scar, 2cases of contractures and one case of web creep. Conclusion: The use of dorsal island metacarpal advancement flap is reliable method for syndyctyly repair and it obviates the need for skin graft with less complication rate.

Prevalence of Hepatitis B and C Viruses Infection in Premarital Screening Test in General Public Health Laboratory/ Kirkuk City

Waleed Mohammed Ali; Pinar Faiq Rafeeq

Kirkuk Journal of Medical Sciences, 2018, Volume 6, Issue 1, Pages 82-88

Viral hepatitis is responsible for more premature deaths worldwide. The virus killed 1.34 million people in 2016; it is one of the top ten killers in the world. Transmission of hepatitis virus B and C results from exposure to infectious blood or body fluids containing the virus. Since most people with hepatitis B and C virus are asymptomatic, timely diagnosis is important for prevention of complication and transmission. This study has evaluated the prevalence of HBs Ag and HCV Ab seromarkers beside liver function test in pre marriage candidates. Objectives: To find out the prevalence of the HBs Ag and HCV Ab in premarriage candidates in Kirkuk city along with estimation of liver function test and prothrombine time. And so as to increase the awareness and augment preventive measures against this viral hepatitis related morbidity. Methods: A total of 22000 apparently healthy young adults were screened from January 2017 to December 2017 at the premarital consultation clinic in general public health laboratory/ Kirkuk city for hepatitis B surface antigen (HBsAg), hepatitis C virus antibody (HCV Ab). Along with alanine aminotransferase (ALT), aspertate aminotransferase (AST), alkalin phosphatase (ALK P) levels, total bilirubine, and prothrombine time were estimated and statistical analysis was done by mini tab version 11. Results: Out of the 22000 subjects screened, 52(0.24%) were positive for HBsAg and 9(0.04%) for HCV Ab, there was no statistical significant difference according to age and sex, but the infection rates peaked at age (21-30) years for both types. Mean ALT and AST levels were significantly elevated of positive HBsAg and HCV Ab cases (29 I U/L, 23, I U/L and 56.3 I U/L, 33.5 IU/L) respectively. In addition two fold elevation of ALT level estimated in (19%) of HBsAg positive and (66%) of HCV Ab positive cases. However all positive subjects were having normal ALK P level normal prothrombine time with slight elevation of total billirubin. Conclusion: The prevalence of HBsAg and HCV Ab among premarital subjects in Kirkuk city is lower than that previously reported. A positive relationship between asymptomatic positive cases with aminotrans- ferase level was reported.

Epidemiology of Acute Coronary Syndrome in Azadi Teaching Hospital in Kirkuk Governorate

Sunbul Adnan Mohammed Baqir; Suzan Nooraldeen Ibrahim; Jameel Ibrahim Azeez

Kirkuk Journal of Medical Sciences, 2018, Volume 6, Issue 1, Pages 89-102

Background: Coronary heart disease (CHD), the principal manifestation of cardiovascular diseases, is the leading cause of morbidity and mortality worldwide. The World Health Organization (WHO) predicts that by 2020, CHD will become the world‘s most important cause of death, disability and premature death. The major factors are an elevated cholesterol level, hypertension, smoking, genetic factors, a sedentary lifestyle, obesity, and diabetes; and the risk increase with age. Adequate control and well awareness of cardiovascular disease risk factors and health habits are important for preventing CHD. Objective: 1- To make a change of morbidity of CHD by education. 2- To evaluate the health-related quality of life in development of ACS. Patients and Methods: A hospital based case-control study was conducted in the Coronary Care Unit (CCU), which is located in Kirkuk (Azadi Teaching Hospital); from March 2017 to September 2017. The study included 180 cases of coronary heart disease and 180 age and sex matched controls. All the participants were interviewed with special questionnaire form. In addition, the weight and height were measured and the fasting lipid profile was sent to the laboratory of same hospital for all participants. Statistical Package for Social Science (SPSS) version 20.0 was used for data analysis. Results: The males accounts two third of cases, 112(62.2%) in comparison to females 68(37.8 %); 63(35 %) of the cases were in the age group (70-79) years. About (54.7%) of all participants were unemployed, (68.3%) had low education and (38.3%) with low income. The study showed a statistical significant association between the following risk factors and educational level: hypertension, diabetes, dyslipidemia, economic level, occupation, and alcohol consumption. Conclusion: Overall there is a significant relation between educational level and risk of developing CHD. The prevalence of CHD was more common in age group (≥ 60) years and the males were more likely to be affected; hypertension is the most prevalent risk and then diabetes mellitus, occupation respectively.

Study the Relation of Drug –Non Adherence with Some SocioEconomic Factors among Diabetic Patients in Kirkuk City

Zahraa Gh. Abdullah; Ali Akram Ismaeel; Waleed Mohammed Ali

Kirkuk Journal of Medical Sciences, 2018, Volume 6, Issue 1, Pages 103-110

Background: Poor & non-adherence to medications are serious issues in the management of chronic diseases such as diabetes mellitus. Amounting body of evidence indicates that decreased medication adherence is associated with increased rate of hospitalization and total costs of care. Objective: For studying the prevalence of drug non-adherence & poor/ partial adherence among adults and its associated risk factors totaling with causes. Patients and Methods: Prospective descriptive cross sectional study was carried out in Azadi Teaching Hospital at Kirkuk Governorate of Iraq. Based on the inclusion and exclusion criteria 500 patients were enrolled into study, which had Diabetes Mellitus. Results: Five hundred adult patients participated in this study. Estimated mean prevalence rate of drug non-adherence were: (1) self-perceived adverse effect of medicines (16.67); (2) complicated medicine regimens (7.07); (3) inadequate knowledge about medicines and diseases(1.01);(4) frightening from dependency and addiction (3.54); (5) the stigmatization (4.54); (6) drugs not present in health centers (16.67); (7) considering disease is transient and not lifelong (8.58); (8) considering the drug is not effective (18.18); (9) the cost of medications (21.71); (10) the forgetfulness (2.02). Conclusion: The drug non-adherence is an important concern or problem in a patient management. Medication regimens should be simplified as more as possible, in particular to avoiding cutting pills or using of different dosages at a different timing. Patients should be encouraged to voice out their perceived drug adverse effects. Further worksare needed to determine the prevalence and causes of patients, non-adherence to medication in Kirkuk Governorate.

Pretransfusion Hemoglobin F Level in Thalassemia Patients: Effect of Well-Balanced Versus Poor Transfusion

Mustafa Zuhair Jasim; Mohammad Ahmed Ali; Mohammad Faiq Aziz; Avan Ahmed Ramadan

Kirkuk Journal of Medical Sciences, 2018, Volume 6, Issue 1, Pages 111-116

Background: Thalassemia is a common condition in Iraq. More than ten thousand patients registered in Iraq. If well-balanced hypertransfusion regimen to maintain pretransfusion hemoglobin level above the internationally agreed 9.0 gm/ dL could suppress the patients‘ bone marrow and shutdown the hematopoiesis to the extent of not producing any hemoglobin F. Patients and Methods: One hundred well-balanced transfusion-dependant thalassemia patients were evaluated for Hemoglobin F level prior to their scheduled transfusions. Hemoglobin level must have been more than 9.0 gm/ dL to qualify the patient to be entered into this group. All such patients must have showed minimal skeletal changes of thalassemia. Another hundred patients with frank features of thalassemia and poor history of blood transfusion were also enrolled in the study. We aimed at knowing whether HbF is significantly different in the two groups. It could indicate that patients‘ bone marrow could be totally turned off and no abnormal hemoglobin will be allowed to be produced. Results: Seventy nine percent of our enrolled transfusion-dependent thalassemia patients who fulfilled the criteria and were well managed showed correction of their HbF level to near zero! Thirty five percent of the poorly transfused patients also corrected their abnormal HbF level. Conclusions: This study showed that marrow micromilieu could be manipulated in patients with thalassemia in such a way so as to totally shutdown production of abnormal hemoglobin F as a result of provision of normal hemoglobin through blood transfusion. The fact that even one third of poorly transfused patients could show the same results indicates that any degree of transfusion support will have its impact on the marrow.

Breast Conservative Surgery vs. Modified Radical Mastectomy: The Commonest Surgical Practice to Treat Breast Cancer Patients among Surgeons in Kirkuk City

Isam A. Ali; Alaa Othman sedeeq; Hazim S. Ahmed

Kirkuk Journal of Medical Sciences, 2018, Volume 6, Issue 1, Pages 117-124

Background: Worldwide breast-conserving surgery (BCS) became more common than mastectomy in treating breast cancer patients after the National Institutes of Health Consensus Statement in 1990. Objective: To evaluate the preferred surgical procedures used by surgeons in Kirkuk city. Methods: A total of 104 patients with breast cancer underwent surgery (BCS vs. Mastectomy) collected from Kirkuk General Hospital, Azadi Teaching Hospital and Kirkuk Oncology Center from June 2015 to August 2017. Results: Mean age of patients with breast cancer in this studied were 47.3±9.2 years. Two thirds of patients were premenopausal and a third was postmenopausal. The presenting stage at diagnosis of breast cancer patients was (17.3% stage I, 36.6% stage II, 42.3% stage III, and 3.8% stage IV). Three quarter of patients with breast cancer underwent mastectomy and only one quarter underwent Breast Conservative. Mastectomy rate per staging was: (10.5% stage I, 21% stage II, 36% stage III, and 2.8% stage IV), while BCS rate per staging was: 7.7% stage I, 17.3% stage II, 2.8% stage III, and 1.9% stage IV). Conclusions: Mastectomy is most common surgical procedure in treating breast cancer patients regardless to disease staging among surgeons in Kirkuk city.

Assessment the Characteristic Features of Colorectal Cancer among Patients Attending Tikrit Teaching Hospital from 2009-2013

Nisreen Mohammed Ibraheem; Nesseer Qahtan Alrawi; Ali Kair Aldeen Banoosh

Kirkuk Journal of Medical Sciences, 2018, Volume 6, Issue 1, Pages 125-135

Background: Colorectal cancer is a frequent malignant gastrointestinal tumor. The studies in the "Iraqi Cancer Registry" from eighties revealed that the incidence of this cancer in Iraq duplicated up to (2.6%), but six to thirteen percent in the developed countries and higher in industrial countries about seventeen to fifty percent. It is the second cause of death in the western countries; colorectal cancer is ranked, after lung and prostate cancer in male, while it is after breast and lung cancer in females. The disease is frequent among elderly but (6-8%) of patients were 40 years and younger. Colorectal cancers are of favourable prognosis if early diagnosis and treatment provided. This study aims to assess the frequency of colorectal cancer in Tikrit city, to highlight the recently noted increase in frequency among young. Patients and Methods: The current study is cross-sectional study done in January 2014 when all recorded cases of colorectal cancer 2009-2013 involved in the study. It enrolled (172) patients with colorectal cancer chosen as a convenience sample. Data collected from hospital records (records between the 1st of January 2009 to the 31st of December 2013) in statistic unit in Tikrit Teaching Hospital. The demographic information, distribution, presentation, histopathological types and staging have been described. The staging system used in this study was the modified Dukes' staging system (6) . Results: Of the (172) patients involved in this study, 94 patients (54.7%) were males and 78(45.3%) were females with a male: female ratio of (1.2:1), mean age was (51.4) years and peak age of occurrence was (60-69) years age group. The main presenting symptom was abdominal pain (42.4%). The most common site of the tumor was the rectum (35%) and (97.8%) of cancers were adenocarcinomas of which (66.7%) were moderately differentiated. (38%) of cases were at Duke‘s stage B when diagnosed. Conclusion: The study showed an increase colon cancer frequency during the year 2013 compared with previous years, with a notable increase among young adults, high percentage of them presented with advanced and aggressive disease. Recommendations: Increase awareness of population about the importance of colorectal cancer screening to discover a disease at early stage which can be treated completely.

Study the Relation between Obesity and Diabetes Mellitus among Hospital Attendants in Erbil City

Layla A. Bakir; Karwan H. Sulaiman

Kirkuk Journal of Medical Sciences, 2018, Volume 6, Issue 1, Pages 136-143

Background and Objectives: Being overweight or obese increases the chances of developing the common type of diabetes, type 2 diabetes. In this disease, the body makes enough insulin but the cells in the body have become resistant to the salutary action of insulin. Information on such public health issues would provide evidence based data to develop guidelines and policies on this subject. The aim of this study was to study the relation between obesity and diabetes mellitus among patient‘s attendants in Erbil city during a period of one year starting from the first of April 2017 to the first of April 2018. Methods: A cross-sectional study included 198 people selected from Erbils outpatient clinics (included two teaching hospitals and two primary health care centers). During a period of one year starting from the first of April 2017 to the first of April 2018. Patient's body mass index ≥ 30 kg/m2 were included in the study. A questionnaire was used to collect the data by face to face interview with the patients. Results: The total number of the sample was 198 people. Their mean age + SD were 43.49 + 11.61 years. The median was 43 years and the age range was 19 to 65 years, (54.5%) of the samples were females, the male: female ratio was0.83:1. The occurrence of diabetes in the studied sample was (18.7%). It increased from (14.3%), to (20.4%), and to (23.3%) among those with BMI of 30-34, 35-39, and ≥ 40 Kg/m2 respectively. Conclusions: There was relation between diabetes and increased body mass index the more the body mass index the more the occurrence of diabetes. The occurrence increased significantly with the age of the studied sample and it is significantly higher among the unemployed and among those who have other medical diseases, it was higher among female. We found non- significant association between diabetes with both exercise and smoking.

The Relation between Waist Circumference and Hypertension

Sabah Hashim Fathullah

Kirkuk Journal of Medical Sciences, 2018, Volume 6, Issue 1, Pages 144-150

Background: Prior studies have supported that waist circumference correlates with abdominal (central) obesity, and values higher than normal are associated with increased prevalence of hypertension. . Objective: To evaluate the association of waist circumference with increased prevalence of hypertension among population in Kirkuk city. Materials and Methods: Across-sectional study was conducted comprising 300 male and female, their ages ranged from 20-72 years with an average mean of 53 year from Kirkuk city. The waist circumference was measured in centimeters, together with other data designed in the data sheet for this study, hypertensive people were identified and recorded. Patients who had coexisted Diabetes Mellitus and hypertension were excluded from the study. Results: The total number of females was 218, out of them, 176(80.7%) had increased waist circumference, this included 74(42%) hypertensive, compared with 42(19.2%) women with normal waist circumference and included 6(14.2%) hypertensive. (P < 0.05). Out of 82 males, 46(56%) had increased waist circumference (>102cm), this included 17(37%) hypertensive; compared with 36(44%) with normal waist circumference, which included 7(19.4%) hypertensive. P. value ˂0.001 Waist circumference was positively correlated with hypertension Conclusions: Increasing waist circumference was significantly associated with increased prevalence of hypertension, reduction in the occurrence of hypertension in male and female can be achieved if the waist circumference is decreased in these populations.

Mistake Diagnosis of Thrombocytopenia

Najat Jabbar Ahmed Berwary

Kirkuk Journal of Medical Sciences, 2018, Volume 6, Issue 1, Pages 151-156

Background: Thrombocytopenia is a condition in which platelet (PLT) count becomes less than normal range in some abnormal cases. The normal range of thrombocytopenia varies from 150.000 to 450.000 cell/cm3 . There are some cases that lead to pseudothrombocytopenia. The most common causes of Pseudothrombocytopenia involving; instrument errors, hemodilutiona, heparin-inducedthrombocytopenia, immunemediated destruction of platelets and using Ethylenediaminetetraacetic acid (EDTA) as an anticoagulant. Pseudothrombocytopenia is phenomenon that platelet count turnto below the lower limit (150.000 cell/cm3 ) in vitro. This phenomenon typically caused by using anticoagulant that named EDTA which leads to platelet aggregation. Generally, pseudothrombocytopenia has no sign and symptoms or clinical significance, but false low platelet count may leads to unnecessary extra diagnostic tests and treatment. The false result of low platelet count leads to treating by platelet transfusion; this could be harmful in patients with increased intravascular platelet activation. Recently, this phenomenon named as EDTA-dependent pseudothrombocytopenia. Four woman visited the laboratory for routine blood investigations, sever thrombocytopenia appeared. In this report, two of these cases will be discussed including how can differentiate between real thrombocytopenia and pseudothrombocytopenia. Objective: To avoid laboratory mistakes and how solve this problem in the laboratories and what must do to write a true report. Results: The results of complete blood count (CBC) showed very severe thrombocytopenia and during collecting information's from all of them, no sign and symptoms or family history was detected. After replacing EDTA with sodium citrate as an anticoagulant it finally proved that the patient has pseudo thrombocytopenia. Conclusion: It is very important to differentiate the real low platelet count with pseudothrombocytopenia. Thus, re-test of CBC with other anticoagulant (Sodium citrate) and blood smear also must be performed.

Assessment of Patient‘s Experience with the Referral between Primary and Secondary Health Care in Mosul

Mayson Ghanim Mohammad Al-Ubaidy; Elham Khattab Aljammas

Kirkuk Journal of Medical Sciences, 2018, Volume 6, Issue 1, Pages 157-165

Background: Referral is a dynamic process and it had been recognized as crucial since the Alma Ata declaration in 1978. Hospitals are overcrowded with patients who could be more cheaply treated in smaller facilities is a common feature of poorly functioning Referral System. Objective: This study aimed to assess patients‘ experience with quality of patient referral between levels of health care. Methods: A cross-sectional study was conducted in Mosul. A questionnaire was administered to 406 patients formally referred to al-Mosul General Hospital. Data was collected on socio-demographic characteristics of referred patients, appropriateness of referral process, and patient satisfaction. Result: The mean age of the group was 28.25 + 18.29 years and female's form (55.4%) of clients, (49%) believes that the referral process was appropriate. Two third of patients believe that three to four areas of the referring process was appropriate, while (65.5%) of clients were satisfied, with the treatment provided, that only statistically significant for type of referring center. Conclusion: Patients in this study view the referrals to higher levels of care as appropriate, with a high rate of referral to obtain diagnosis, to get specific treatment, and self-requested referrals that not be explained by socio-demographic characteristics of the patients, and most of them were satisfied by services provided through referral.

The Assessment of Frequency and Severity of Acne Vulgaris among A Group of Tikrit Medical College Students and its Relation with Body Mass Index; A Cross-Sectional Study

Ahmed Abdul-Aziz Ahmed; Wissam Suhail Najim; Zainab Anwar Naqi

Kirkuk Journal of Medical Sciences, 2018, Volume 6, Issue 1, Pages 166-174

Background: Acne vulgaris is a common disease that affects the majority of the adolescent population and a large number of young adults with (90%) of all teenagers being affected by some degree. Androgens have been shown to play an important role in sebum production, and sebum over production, which in turn, is one of the primary pathogenic factors in acne formation. Obesity and overweight are often accompanied by peripheral hyperandrogenism. Body mass index (BMI) is frequently used to define these disorders clinically. Aim of study: To assess the frequency and severity of acne vulgaris among Tikrit Medical College students and its relation with Body Mass Index. Patients and Methods: A cross sectional study that done in Tikrit Medical College during the period extending from the first of February 2017 to the end of June 2017, 153 students are included, each of them was assessed by a prepared questionnaire, students are examined clinically of acne lesions, its severity and classified in to mild, moderate, severe and very severe according to the global acne grading system, BMI is measured for each student with acne vulgaris according to World Health Organization definition by checking weight and height. Results: All over frequency of acne vulgaris was (46%) among a group of Tikrit Medical College students, (62%) of them were females, (38%) of them were males, mild acne represent (52%), of study cases, (65%) of cases was within normal weight. There was extremely significant relation between BMI, family history and severity of acne (p value<0.0001). There was no statistically significant relation between gender and severity of acne vulgaris (p value 0.138), no significant relation between smoking and severity of acne (p value 0.5). Conclusions: After age of puberty, the frequency of acne vulgaris decreased significantly as the age increased. BMI and family history of acne could be risk factors for increase severity of acne vulgaris. No effect of smoking on severity of acne vulgaris.