Print ISSN: 2790-0207

Online ISSN: 2790-0215

Issue 1,

Issue 1

Prospective Study of Total Splenectomy Among Thalassemic Major Patients Attending Azadi-Teaching Hospital in Kirkuk City During Three Years Study From 2008- 2011

Amanj Mohammed Salih

Kirkuk Journal of Medical Sciences, 2013, Volume 1, Issue 1, Pages 1-8

Background: This prospective study was conducted for Thalassemic major patients with huge enlargement of spleen attending Azadi-teaching hospital in Kirkuk city during (January 2008- December 2011) on 53 cases (48males and 5 females with mean age 13.3 years; operated on selective basis by open splenectomy through midline or left subcostal incision. Objective: To determine the role of splenectomy in reducing postoperative blood requirement, the efficacy of prophylactic vaccination and post operative penicillin in reducing the incidence of post-splenectomy infection. Methods: Patients with ages <5 years were excluded as with associated other disorders. Results: (81.2%) of the patients were below 10 years old, male preponderance (90.6%), abdominal mass were founded in all patients. Preoperative Hb below 10gm/dl (90.6%), Left sub-costal incision done in (84.9%).Postoperatively, all the patients had an Hb above (8gm/dl.) Seven patients (13.2%) suffered from recurrent URTIs during follow-up. Conclusion: Splenectomy reduced blood requirements, Left sub-costal incision offers good exposure, prophylactic vaccination definitely needs to prevent postoperative infection.

Cerebrovascular Accident (CVA) Cases in Kirkuk Governorate

Osama Hassan Othman

Kirkuk Journal of Medical Sciences, 2013, Volume 1, Issue 1, Pages 9-20

Background: Stroke is one of the important medical disorders encountered in medical practice in emergency departments, wards and as outpatients. This comes from being the 3rd commonest cause of mortality in developed countries and also in our society after ischemic heart disease (IHD) and cancer and the commonest cause of morbidity (those who survive get crippling, deficits and are physically disabled). Objective: The aim of this study was to assess stroke cases from different parametric aspects and compare it to other published data from nearby areas and internationally. Patients and Methods: Patients included in this cross-sectional study had been selected by randomly examining patients with stroke admitted to Azadi teaching hospital and kitkuk general hospital in Kirkuk governorate in addition to outpatients seen in the clinic during the period between the 1st of January 2011 to the 31st of December 2012. Results: This study had enrolled 90 patients (51 (56.7%) male patients and 39 (43.3%) female patients) with stroke. The peak age of occurrence of CVA was in patients > 50 years old. Family history of CVA was positive in 26 patients (28.9%). Distribution of the risk factors was as follows: Hypertension in 55 patients (61.1%) ,diabetes mellitus in 26 patients (28.9%), smoking habit in 32 patients (35.6%), hyperlipidaemia in 39 patients (43.3%), history of previous cardiovascular event in 49 patients (54.4%) in form of previous CVA in 15 patients (30.6%), ischemic heart disease in 27 patients (55.1%) and evidence of peripheral vascular disease in 7 patients (14.3%), particular heart disease in 25 patients (27.8%) in the form of atrial fibrillation (64%), congestive heart failure (16%), mitral valve disease (12%) and aortic valve disease (8%). Conclusion: This study has presented a profile of stroke patients in Kirkuk. Strokes occurred more frequently in men than in women and the risk increased with age. The major known risk factors were: hypertension (61.1%), previous cardiovascular diseases (54.4%), hyperlipidemia (43.3%), smoking (35.6%) and diabetes (28.9%). In most of the patients, stroke had a sudden onset (54.4%) with hemiplegia and speech defects being the most common presentations (73.3%) and (53.3%); respectively. Ischemic stroke was the commonest finding (43%) in the CT scan followed by the hemorrhagic type (25.8%).

The Significance of Closed Suction Drains With Tissue Expander

Ali Adwal Ali

Kirkuk Journal of Medical Sciences, 2013, Volume 1, Issue 1, Pages 21-26

Objective: The study was done to evaluate the effect of closed suction drains on local wound complications and the progression of the expansion. Patients and methods: The study includes 32 patients were selected from outpatient clinic / Azadi teaching hospital / Kirkuk; divided to 2 groups, 20 patients with suction drain (redivac drain) and 12 patients without drain; between March 2007- July 2011.The surgeries done in plastic and reconstructive surgery department by one surgeon. Results: The median range of follow up was 2-4 months. post operative complications for drained group (20 patients) were seroma and hematoma 0% while infection occur in 1 patient (5%) only; on the other hand, complications for the undrained group (12 patients) include seroma and or hematoma formation in 4 patients (33.3%), infection in 4 patients (33.3%) while implant extrusion occur in 3 patients (25%). Conclusions: The use of closed suction drains with introduction of tissue expander is advantageous; it significantly decrease the risk of complications and re operation rate.

Bacterial Gastroenteritis in Kirkuk Pediatric Hospital

Zeyad Mohammad Sadiq

Kirkuk Journal of Medical Sciences, 2013, Volume 1, Issue 1, Pages 27-31

Background: Diarrhea is considered as one of the most common illness and one of the major causes of infants & children mortality in developing countries. A reduction in diarrhea-related mortality may be possible by the early identification of high risk subjects and targeting them for intensive intervention. Aims: This study was done to collect important information about the common microbial agents that cause bacterial gastroenteritis in Kirkuk pediatric hospital. Patients and methods: This is a retrospective study reviewed all patients who were admitted to Kirkuk pediatric hospital from 1st of January 2008 to 31st of December 2010 whom were complain from frequent loose bowel motion. Data regarding gestational age, gender, causative microorganisms, date of admission, date of discharge and outcome were collected and analyzed. Results: The results of this study showed that among 301 cases who were admitted to the hospital during this period, 184 cases (61.13%) were proved to have bacterial gastroenteritis by stool culture. Escherichia coli was the most common bacterial pathogen found in 171 cases (92.93%). Most patients who admitted were infants 141 case (76.63%) while older children were only 43 cases (23.67%). The study showed that higher cases were recorded in the urban area (58.69%) than rural areas (41.31%). Majority of cases (65.76%) included in the study were improved, while mortality rate recorded in the hospital was (0.82%). Conclusion: Significant number of cases had bacterial gastroenteritis. ; Escherichia coli was the most common causative bacterial infection in children. Infancy was the most common pediatric age group which was affected.

Differences in Academic Performance Between Male and Female Medical Students in Kirkuk University

Mohammed Mustafa Mohammed; Iqbal Sameen Ali; Sabah Haseeb Hasan

Kirkuk Journal of Medical Sciences, 2013, Volume 1, Issue 1, Pages 32-38

Background: The student's assessment can be achieved by written examination which was considered an essential method. Aim of the study: The aim and objectives of the study is to measure the time spent by the students to finish their written final examination, to compare it with the proposed time, to find any difference according to sex and their examination scores, and to find any correlation between the time spent in examination and scores obtained by students. Subjects and Methods: A cross-sectional study was carried out during May- June; 2011 in the college of medicine, Kirkuk University. Data obtained during the final written examination; and scores were obtained from the examination committee with permission of the Dean of the college. Results: Female students spent more time during examination than male students in all subjects (except in parasitology, surgery and psychiatry in the 3th, 4th and 5th grade respectively). There was a very weak correlation between the scores obtained by students and time spent by them during examination. Conclusion: There were differences between sex, time and scores obtained by the students.

Cyclopia (Synophthalmia): First Reported Case in Iraq

Abdulhameed Abdulmajeed Hassan; Ghazwan Hameed Rasheed

Kirkuk Journal of Medical Sciences, 2013, Volume 1, Issue 1, Pages 39-44

A full-term newborn male with cyclopia (synophthalmia); with central single eye, and without apparent nasal opening was borned in Azadi teaching hospital. This anomaly was expected to be associated with holoprosencephaly and other visceral anomalies; but this could not be confermed. Observations from clinical examination are presented here, and literature review done. Because of its rare occurrence and tentative evidence for both genetic and environmental etiologies, reporting of this case of cyclopia is encouraged.

Utility of HbA1c in the Screening of Diabetes Mellitus in Pregnancy

Sinan Butrus Garabet

Kirkuk Journal of Medical Sciences, 2013, Volume 1, Issue 1, Pages 45-52

Background and objectives: Diabetes mellitus is a major public health concern with adverse pregnancy outcome. The objective of this study was to assess the validity of HbA1c as a screening tool in pregnant ladies not known to have diabetes before pregnancy. Patients and methods: Three hundred pregnant women with gestational age between 24 - 28(25.3±2.1) weeks were evaluated for diabetes mellitus using HbA1c, fasting and postprandial plasma glucose for the period of October 2010 - October 2012, using McNamara's test which is expressed as percentages and 95% confidence intervals of the percentages. Results: Of pregnant ladies with non-diabetic fasting plasma glucose values: 79% had HbA1c level of <6.1%, 17% had an HbA1c level of > 6.1% and 5% showed diabetic 2-h plasma glucose values (17% CI 51–71 vs. 5% CI 35–55, respectively; P = 0.007). Of pregnant ladies with diabetic fasting plasma glucose:72% had an HbA1c level of ≥6.1%, 28% had HbA1c level of ≤ 6.0 % and 11% subjects in this group showed nondiabetic 2-h plasma glucose values (28% CI 66 – 86 vs. 11% CI 32–52, respectively; P = 0.003).Of pregnant ladies with postprandial blood glucose >200mg/dL; 42% had normal, 18% had impaired, 39% had high fasting plasma glucose while 71% had HbA1c ≥ 6.1% (71 % CI 51–71 vs. 39% CI 35–55, respectively; P = 0.003). Conclusion: HbA1c is an important alternative screening tool to identify pregnant ladies with undiagnosed diabetes.

Detection of Some Microbial Infectious Agents among Children Aging Below Two Years in Kirkuk City

Yahya Jirjees Salman; Luqman Ali Salih

Kirkuk Journal of Medical Sciences, 2013, Volume 1, Issue 1, Pages 53-61

Background: The diagnosis of infectious agents of diarrhea among children is a challenging clinical problem in daily practice. Aim: This study was undertaken to detect some microbial agents among children suffuring from diarrhea below two years in Kirkuk city. Sitting and design: Clinical blocked controlled study on 221 children in Kirkuk city. Materials and methods: by Stool examination using different methods including routine stool examination for bacteria and parasites and some special tests for Rota viruses and other pathogens. Statistical analysis was performed using Chi-square test. Results: From examination of 221 stool samples, only 145(65.59% ) samples were positive for microbial agents, which included:35.29%,23.07% and 7.33 % for protozoan, rotavirus and bacterial infections respectively P<0.05.The common protozoa involve Entamoeba histolytica 19.09 %,Cryptosporidium oocysts 14.47 % and Giardia lamblia 0.90 % P<0.05.Realationship between the distribution of microbial infection in regard of gender and child age was significant in which protozoan infections in males 20.34% was higher than females14.91 %, while it was not significant in regard of Rota-virus and bacterial infections .Also intestinal infections rate 11.73 % was higher among children aging from 19 to 24 months than other age groups reversely to 8.13 % of rotavirus infection that recorded among children aging from one month to 6 months. High rate of rotavirus infection 15.38 % was recorded among children depending on bottle feed comparing to breast and mixed mode of feed P<0.05.While mixed modes of feeding both bottle & breast feeds reveal high rates of intestinal protozoa and bacterial infections, the rates were 14.47 % and 3.7 % respectively P<0.05.The association of microorganism distributions with family member numbers and child family residency were statistically significant P<0.05. Relationships between microbial distributions and socio-economic state of children families, stool consistency, pH and number of feces discharge per day were not significant statistically. Conclusion: microbial infectious agents rates among children below two years old in Kirkuk city were high specially Entamoeba histolytica ,Cryptosporidium parvum and rotavirus.

Evaluation of Distally Based Fasciocutaneous Sural Flap for Reconstruction of the Distal Leg, Ankle and Proximal Foot

Ari Raheem Qader; Kurdo Akram Qaradaghi

Kirkuk Journal of Medical Sciences, 2013, Volume 1, Issue 1, Pages 62-73

Objective: The objective of the study is to evaluate the efficacy of reverse sural artery fasciocutaneous flap for coverage of lower third leg, posterior heel, malleoli and hind foot. Patients and methods: Over a period of 4 years, a total of 31 patients with Soft tissue defect of lower third leg, heel, malleoli and hind foot were included. Preoperative data, the age and sex of each patient, cause and site of defect, dimension of flap, transposition of pedicle (through a tunnel or laid open and covered with a skin graft), postoperative results and complications were recorded. All patients were followed up in outpatient department for 12 months. Results: Over a period of 4 years during February 2008 to February 2012, a total of 31 flaps were performed in 31 patients. Sixteenth patients were males and 15 were females. Their ages ranged from 8 to 55 years with a mean age of 31 years. There were three children. Road traffic accidents was the cause of the defects in 19 (61.2%) patients, DM in 5 (15.5%) patients, bullet injuries in three (9.6%) patients, Achilles tendon injuries in two patients (6.4%) patients, Malignant melanoma in one (3.2%) patient and foot amputation stumps in one (3.2%) patient. Postoperatively 24 flaps survived completely while marginal necrosis was seen in 5patients and infection complete flap necrosis occurred in 2 patients. There was no considerable morbidity at donor site and all patients had satisfactory functional outcome. Conclusions: The distally based superficial sural artery flap is a versatile, reliable procedure, useful in reconstruction of lower third leg, heel, and malleoli and hind foot defects. The surgical technique is safe, of short duration and provides alternative to micro surgical reconstruction. Some patients were not completely satisfied with their results mainly due to bulky flap that needed revision or due to parasthesia.

A Study on Sexually Transmitted Diseases in Kirkuk City

Mohammed Abdul-Aziz Kadir; Suheila Shamse-El-Den Tahir

Kirkuk Journal of Medical Sciences, 2013, Volume 1, Issue 1, Pages 74-80

Objective: The study was planned to show the prevalence of sexually transmitted disease (STD) among women and neonates attending some private clinics in Kirkuk City. Patients and methods: A cross sectional study was performed on 425 women and neonates attended private clinics in Kirkuk city. The period of study was from 1 st of January 2004 to 31 st of December 2004. Results: It was found that the highest rate of symptoms was vaginal discharges followed by lower abdominal pain, genital ulcers, ophthalmia neonatorum and inguinal bubo respectively. Patients with more than one symptom were also detected. Among patients with discharge, Candida albicans (53.42%) and Trichomonas vaginalis (80.82%) were observed. In addition to symptoms, several genital problems were seen, such as Molluscum contagiosum, warts, Herpes simplex and Tenia cruris. The VDRL positive cases were detected among patients enrolled the study. Conclusion: The prevalence of STD symptoms is common among patients attending the private clinics. The highest rate of symptoms was vaginal discharge followed by lower abdominal pain and genital ulcers. More than one symptoms was detected among patients in the studied groups. Several genital problems were found in association with STD symptoms.

Laryngeal Kaposi Sarcoma in Non HIV Patient

Tunjai Namiq Faiq; Mohammed salim Mohammad

Kirkuk Journal of Medical Sciences, 2013, Volume 1, Issue 1, Pages 81-86

Kaposi’s sarcoma (KS) is acutaneus malignancy with multisystemic involvement and the larynx is one of the rare and unusual sites for involvment, we had reported a 75-year-old gentleman, who presented with progressive hoarseness with stidor. He underwent an emergency tracheostomy and fiberoptic laryngoscopy revealed a whitish globular laryngeal mass obscuring the glottic region, The patient also has many cutaneous lesions with involvement of oral cavity, nasal mucosa, nasopharynx biopsy was taken and histopathological study showed evidence of spindle shaped cell connective tissue consistant with Kaposi sarcoma, Laboratory test for (HIV) was negative, patient not diabetic no renal problem, no history of steroid or other drugs, no history of disease that affects his immune status, then we sent him to oncology unit and received systemic chemotherapy (paclitaxil) 225mg/m2 every three weeks ,he improved and laryngeal lesion heald completely and tracheostomy closed. This case was reported because KS rarely involve the larynx with the narrowing of the airway and only two cases reported, and second thing is that our case was (HIV) negative.

Mini-Cholecystectomy under Local Anaesthesia for Symptomatic Gallstone Patients Unfit for General Anaesthesia

Dler Omer Mohammed

Kirkuk Journal of Medical Sciences, 2013, Volume 1, Issue 1, Pages 87-91

Background & Objectives: Reports of open-cholecystectomy (OC) or laparoscopic cholecystectomy (LC) under general anaesthesia (GA) in the surgical treatment of gallbladder disease are common, but those performed under local anaesthesia (LA) are much more limited, especially for old aged patients unfit for GA. This study tried to determine the safety and success of Mini-Cholecystectomy under local anaesthesia for symptomatic gallstone disease in old aged patients unfit for GA. Patients & Methods: Since January 2009 to October 2012, eighty-five patients with gallstone disease scheduled for Mini-Cholecystectomy under local anaesthesia were included in this prospective study in Azadi teaching hospital. Sixty-three (74.1%) patients were females, with a median age of 76.5 years (range, 67–93). All of the patients had evidence of acute cholecystitis on ultrasonic examination. MC was performed by a standardized technique and under the combination of local anaesthesia (1% xylocaine without adrenaline) and intravenous administrations of fentanyl (0.001–0.002 mg/kg) and midazolam (0.05–0.1 mg/kg). Results: The median operative time was 40 minutes (range, 35–64). Most of the patients underwent the operation successfully without significant discomfort. Cholecystectomy was done successfully in 83 (97.6%) patients, giving a success rate of 97.6%. while cholecystostomy was performed in the remaining 2 (2.4%) patients because of the severe adhesions that rendered minicholecystectomy very difficult. The median hospital stay was 2.6 days (range, 2–7). Conclusions: Mini-Cholecystectomy under local anaesthesia is an effective surgical procedure for old aged patients with symptomatic gallstone disease who are unfit for GA.