AMJ (Advanced Medical Journal)

Immunohistochemical Expression of COX2 in Urothelial Carcinoma of the urinary bladder

Shayan Khattab Omer — 2024-12-01

Background and objectives: Urothelial carcinoma of urinary bladder constitutes 90% of bladder cancer cases. Cyclo-oxygenase 2 as an immune-histochemical marker, is not expressed in normal tissues, while it is expressed in some cancers including urothelial carcinoma. The purpose of this study is detecting the frequency of expression of Cyclo-oxygenase 2 in urinary bladder’s urothelial carcinoma in association with certain clinicopathological variables.

Methods: A retrospective study was done on seventy-nine cases (fixed with formalin and embedded in paraffin) of urothelial carcinoma which were chosen haphazardly from a private laboratory in Erbil city over two years (between October 2019 to October 2021). In the present study, Cyclo-oxygenase 2 expression was assessed on the urothelial carcinoma slides.

Results: Cyclo-oxygenase 2 was positive in 45.6% of the cases. It was positive in 80% of non-papillary tumors, while it was less expressed (40.6%) in papillary tumors, which means that significant correlation was seen between Cyclo-oxygenase 2 positivity and tumor pattern (papillary vs non-papillary) (p = 0.037). In this study, no important association was found between Cyclo-oxygenase 2 expression and other clinicopathologic features like age (p=0.236), gender (p=517), tumor grade (p=0.106), lymphovascular invasion (p=0.696) and T stage (p=0.061).

Conclusion: In this study Cyclo-oxygenase 2 was expressed in less than half of our urothelial tumor samples. A strong association was found between Cyclo-oxygenase 2 positivity and tumor pattern (papillary and non-papillary), but no important association was found between Cyclo-oxygenase 2 positivity and other variables such as age, gender, tumor grade, lymphovascular invasion and tumor stage.

Transthoracic Echocardiography findings in patients with Ankylosing Spondylitis in Kurdistan region

Elaf Kamal Abdulwahab — 2024-12-01

Background and objectives: Ankylosing spondylitis is a chronic inflammatory disorder that affecting axial and non-axial joints leads to a loss of mobility and function over time. The aim of this study is to evaluate the cardiac involvement using transthoracic echocardiography.

Methods: A case-control research study took place at Rizgary Teaching Hospital Rheumatology Department between January 2022 and March 2023. Inclusion criteria involved those patients diagnosed with ankylosing spondylitis based on the Assessment of Spondylarthritis International Society criteria for axial spondylarthritis. Transthoracic echocardiography (vivid machine) had been performed for all the participants and parameters such as right and left ventricle dimension, aortic root dimension, left atrium dimension, interventricular septum thickness in diastole and ejection fraction had been documented.

Results: This study revealed that transthoracic echocardiography findings of patients with ankylosing spondylitis with diastolic dysfunction in 12%, mitral regurgitation in 8%, mitral prolapse in 10% and 2% of each of anteroseptal hypokinesia, dilated aortic root and aortic regurgitation. The study demonstrated a significant increase in right ventricular, aortic, and left atrium dimensions in patients with ankylosing spondylitis with a p value of 0.0001, 0.001 and 0.001 respectively. In terms of ejection fraction; this study showed a significant decrease in ejection fraction in cases of ankylosing spondylitis with a mean of 64.3% with a p value of 0.004.

Conclusion: Tricuspid regurgitation and a drop in ejection fraction are the two significant findings among patients with ankylosing spondylitis.

Ratios of neutrophils to lymphocytes and platelets to lymphocytes in ankylosing spondylitis with disease activity relationship

Shahla Taha Ahmad — 2024-12-01

Background and objectives: Ankylosing spondylitis impacts the fibers and synovial tissues of the sacroiliac and spinal joint and is most noticeable commencement occurs in males. This study aimed to evaluate the correlation between ratios of neutrophils to lymphocytes and platelets to lymphocytes in patients with ankylosing spondylitis.

Methods: This was a case control study performed at Rheumatology units of Erbil and Rizgari teaching hospitals between January 2022 and March 2023. Inclusion criteria involved patients with ankylosing spondylitis based on the criteria developed by Bath Ankylosing Spondylitis Disease Activity Index score. Neutrophil / lymphocyte and platelet / lymphocyte ratio has been calculated manually from the laboratory results.

Results: Disease activity evaluated based on Bath Ankylosing Spondylitis Disease Activity Index Score. Patients with active disease had higher Neutrophil / lymphocyte ratio than inactive and control group with a value of 2.27 ± 0.34, 2.03 ± 0.58, and 1.92 ± 0.93 for the three groups respectively; this difference was statistically significant. The same correlation was found in terms of platelet to lymphocyte ratio with values of 149.92 ± 31.13 for active group and 126.88± 58.38 and 129.74 ± 63.16 for inactive and control group respectively. There was a weak negative and not significant correlation between both Neutrophil / lymphocyte and platelet / lymphocyte ratio and Bath Ankylosing Spondylitis Disease Activity Index Score.

Conclusion: Potential indicators of the activity of ankylosing spondylitis include the neutrophil to lymphocyte ratio and the platelet to lymphocyte ratio.

Prediction of Stone Composition by Non-Enhanced Computed Tomography in Urolithiasis Patients

Kawa Rawf Hamza — 2024-12-01

Background and objectives: Understanding the composition of urolithiasis is crucial for effective stone management and prevention strategies. Our main objective was to determine stone composition through the analysis of Hounsfield Unit properties in pre-intervention tomography of non-contrast computed.

Methods: This prospective study was about urinary tract stones and involved fifty patients who visited Sulaimani Teaching Hospital between October 2021 to October 2022. Patients underwent imaging examination using Non-Enhanced Computed Tomography. The stones density was measured in the Hounsfield unites. The stones were physically analyzed for determining chemical compositions by Infrared Spectroscopy.

Results: In this research, the composition of the stone was determined using Hounsfield Units. The mean values for Calcium oxalate, Struvite, and Uric acid are 1001.85, 640.67, and 453.08, respectively. The outcomes demonstrated that there is a substantial difference among all urinary tract stone types with F statistics = 38.521, p value < 0.001 by using ANOVA. Furthermore, for validating achieved results, the Tukey honestly significant difference test was applied, and the test results indicate a significant disparity among various stone types, with a p value < 0.001.

Conclusions: The study provides evidence that non-contrast computed tomography is capable of accurately distinguishing between three common types of urolithiasis using Hounsfield Unit measurements

Fibrocystic Breast Changes: Imaging and Pathological Correlational Study of a Sample in The Kurdistan Region of Iraq

Maysaloon Shaman Saeed — 2024-12-01

Background and objectives: Fibrocystic changes of the breast are the most common breast changes observed globally. The study aimed to assess these changes using ultrasound and correlate the imaging findings with histopathological changes to determine accuracy.

Methods: A prospective cross-sectional study included 240 women who were diagnosed with fibrocystic breasts between January 2022 and July 2023 at a specialized medical center in Duhok city. Ultrasound was performed to evaluate changes in the breast. Imaging results were classified according to the guidelines of the American College of Radiology's Breast Imaging Reporting and Data System. Women with moderate imaging findings underwent ultrasound guided needle aspiration. The samples obtained were sent for cytological and histopathological evaluation. A correlation was conducted between the results of both of these modalities.

Results: The age group most affected was 29-49 years. Bilateral breast involvement was the most prevalent, accounting for 78% of the cases. 74% of the affected women complained of cyclical mastalgia. Ultrasound findings mainly show simple cysts, clustered cysts, and duct ectasia, accounting for 29%, 30%, and 15% respectively. BI-RAD 2, followed by 3, and then 4A were the most common imaging categories. Simple cyst (36%), ducts with apocrine metaplasia (23%), and epithelial hyperplasia without atypia (18%) were the most commonly observed histopathological findings. Statistically significant accuracy was observed regarding the imaging and cytological correlations in BI-RAD 3and 4A.

Conclusion: A strong correlation was observed between the ultrasound findings of breast fibrocystic changes and the histopathological evaluation.

Fat graft for facial contouring in patients with post-surgical and post- traumatic defects: A case series study

Alan Rafiq Rafaat — 2024-12-01

Background and objective: Facial deformities provide a considerable challenge for both the patient and the facial reconstructive surgeon. They can be caused by congenital, traumatic, and oncological ablative surgery. The aim of the study is to evaluate the reliability of autologous fat grafting in residual facial deformities.

Methods: This is a case series study of 10 patients with secondary facial defects induced by trauma, parotidectomy and orthognathic surgery. The patients were more than18 yeas old age and of both sexes. The study was conducted at Sulaimani Teaching Hospital from May to December 2021. The defects were grafted with autologous fat grafts harvested from the abdomen and suprapubic region using two techniques, en-bloc and structural fat grafting (minimum 10 cc to maximum 35 cc).

Result: Mean graft volume (20.8 cc) Revision was required for 10% of patients. Mean satisfaction score (8.3). Patient’s satisfaction score increased with graft volume p-value <0.01. No major complications were reported.

Conclusion: Autologous fat graft is a reliable and cost-effective method for correcting mild to moderate facial soft tissue and hard tissue asymmetry, resulting in a significant improvement in the patients' facial esthetics and psychology.

Impact of stone density on the total laser time and other surgical outcomes in flexible ureteroscopy

Aso Omer Rashid — 2024-12-01

Background and objectives: Several preoperative factors are assessed for the evaluation of operative time and fragmentation efficacy during retrograde intrarenal surgery. Due to limited energy capabilities, stone density is an important factor contributing to procedural time. This study aimed to evaluate the effect of stone density on the total laser time in lithotripsy.

Methods: We conducted a cross-sectional prospective analysis where fifty-two patients who underwent flexible ureteroscopy using the Cyber Ho 60 holmium laser system (Quanta System) were prospectively analyzed from October 2017 to November 2020 in a cross-sectional study. These patients were divided into groups according to their stone attenuation values (Hounsfield units) and were followed up for 3 months to determine the success of stone clearance.

Results: The mean stone size and density were 14.44 mm and 1043 Hounsfield units, respectively. Furthermore, the mean total laser time was 26.58 minutes, whereas the mean operative time was 41.44 minutes. The total laser time did not significantly differ between stones with attenuation >1000 and those with attenuation <1000 (p = 0.486). Stones measuring >13 mm in size required considerably longer lasering time than their smaller counterparts (p = 0.008).

Conclusion: In the era of rapid laser technology and instrumental developments, our findings suggest that stone density has no value on the outcomes of flexible ureterorenoscopy, including the total lasering time, stone-free rate, and overall complications. In contrast, stone size significantly influences the total laser time and stone-free rate.

Outcome of Infected Cardiac Device Re-implantation in Erbil Cardiac Center-Iraq

Mohammed Hasan Alwan — 2024-12-01

Background & Objectives: Cardiac electronic devices have been in clinical practice for more than 6 decades. Infection is not uncommon with these devices due to their scarcity and exorbitant cost which makes them inaccessible to a significant number of patients. Therefore, the only method to source them is to reimplant used devices. The problem of possible infection as result of reusing these devices has not been previously investigated in Iraq. The objective of the current study was to find the outcomes of the re-implanted infected device.

Methods: Ten patients with infected boxes (complete or partial dehiscence with or without pus discharge) were included in this case-series study, from January 2016 to January 2023 in Erbil cardiac center, All the patients were well informed that their re-sterilized devices will be re-implanted, and verbal informed consents were obtained from all patients.

Results: Ten procedures for ten patients with permanent pacemaker infected boxes had been done. The patients’ age ranged from 1.5 to 77 years, and all of them were males. Nine infections had been cured and followed for six months to 7 years. One patient died after 12 months (1.5 years old child with severe heart failure).

Conclusion: Re-implantation of infected box after sterilization had high success rate.

The prevalence of metabolic syndrome in patients with non-alcoholic fatty liver disease in Erbil city

Maryam Abdulwahid — 2024-12-01

Background and objectives: Non-alcoholic fatty liver disease is the accumulation of fatty units in the liver in the absence of other triggers. Its development may have been primarily caused by metabolic syndrome, so the purpose of this study is to identify the prevalence of metabolic syndrome in non-alcoholic fatty liver disease and then to discover which parameter has the strongest link with non-alcoholic fatty liver disease.

Methods: This cross-sectional study of 90 participants more than 18 years old with non-alcoholic fatty liver disease diagnosed by sonography in Erbil from August 2022 to May 2023. In each individual, metabolic syndrome criteria were taken and measured according to the National Cholesterol Education Program's Adult Treatment Panel III criteria, which were diagnosed by having three or more of these criteria, and ultrasound was used for the grading of fatty liver.

Results: Metabolic syndrome were revealed in 69 (76.67%) of the participants. A higher proportion of patients were female 51 (56.67%) and male 39 (43.33%). It revealed a statistically significant correlation between gender and metabolic syndrome, with females and males having a corresponding 44 (49%) and 25 (28%) correlation, respectively. The most frequent factor was an expanded waist circumference in 66 (73.33%) of participants, followed by triglyceride in 62 (68.89%).

Conclusion: In this study, among patients with non-alcoholic fatty liver disease significant number of the subjects had metabolic syndrome, with an increased waist circumference being the most prevalent feature, followed by high triglyceride levels, hyperglycemia, hypertension, and low high-density lipoprotein.

Comparison of Outcomes between Marsupialization and Lay-Open Techniques in the Management of Pilonidal Sinus

Hawar Ali-Ghalib — 2024-12-01

Background and objectives: Different surgical strategies emerged for pilonidal disease, but no ideal one. Thus, this study aimed to compare the outcomes of marsupialization vs laying open techniques in the management of pilonidal sinus.

Methods: This case series study was conducted on 200 consecutive patients with chronic pilonidal sinus who has operated either with excision and marsupialization technique (Group 1, no.=100) or excision and lay-open technique (Group 2, no.=100) in different hospitals at Sulaimaniyah city, Iraq, from January 2012 to January 2022. The patients' socio-demographics, perioperative data, complications and recurrences were collected using a special questionnaire prepared for this study. Also, the patient’s data was evaluated after surgery regarding postoperative pain, satisfaction, healing and dressing time, incapacity to work and postoperative complications.

Results: Most patients aged 20-29 years (40.5%), males (71.5%), had working hours for ?6 hours (57%), with no family history of pilonidal disease (86.0%), presented with pain (44.83%), and with hirsutism (41.5%). In total, 39.5% of the patients had severe pain, 38% had moderate, and 22.5% had mild (p=0.000). Concerning patient postoperative satisfaction, most patients (32.5%) had good and least had excellent (6.0%) satisfaction (p=0.000). Moreover, for the association between the outcomes of both used techniques, a substantial correlation between both groups was found for incapacity for regular daily activity (p=0.046), healing time (p=0.000), dressing time (p=0.000), infection, dehiscence, bleeding and recurrence (p=0.045).

Conclusions: Marsupialization was the preferred technique over lay-open regarding postoperative patient satisfaction/severity, healing duration, and dressing time, as it had fewer complications with a recurrence rate.

The Utility of Hypochromic Markers in the Detection of Latent Iron Deficiency in Women in their First Trimester of Pregnancy

Haliz Salman Sulaiman — 2024-12-01

Background and Objectives: While iron deficiency anemia is a documented common problem in pregnancy, there is limited information on latent iron deficiency. Accordingly, we aimed to determine the frequency of the latter in the first trimester of pregnancy and assess the utility of new hypochromic markers in screening for it.

Methods: In this cross-sectional study, we recruited 100 pregnant women in their first trimester attending the Maternity Hospital in the period between January and March 2023. Inclusion criteria included hemoglobin >11.0 g/dl, and no iron supplements. Serum ferritin was used to classify patients into latent iron deficiency or iron replete state. While a hematology analyzer was used to determine the new hypochromic markers: namely %Hypo-He, Ret-He, % Hyper-He, RBC-He.

Results: The mean age of enrollees was 29.3 (SD 5.5) years and included 38% with latent iron deficiency (hemoglobin > 11 g/dl and S. ferritin ? 30 ng/ml). The latter group had significantly lower hemoglobin (P=0.03), and %Hypo-He (P<0.001) than iron replete women. While neither MCV, MCH, reticulocyte counts, Ret-He, or RBC-He were different. Furthermore, %Hypo-He was significantly negatively correlated with serum ferritin (P<0.001) and had a fair discriminating power between latent iron deficiency and iron replete status.

Conclusion: High prevalence of latent iron deficiency was documented among pregnant women in their first trimester; Furthermore, %Hypo-He was a better red cell index to screen for it. Because of its high frequency and anticipated impact on fetal and maternal health, routine screening for latent iron deficiency in pregnancy may be warranted.

Attitude and Knowledge of Participating Couples Towards the Premarital Hemoglobinopathy Screening Program in Duhok–Iraq.

Rebeen Abdulsalam Mohammed Sediq — 2024-12-01

Background and Objectives: The premarital screening program for hemoglobinopathies was initiated in the Kurdistan region nearly 15 years ago. In the current study we aimed to assess the attitude and knowledge of the targeted couples, since these are among the main determinants of its success.

Methods: In this cross-sectional study we recruited consecutive 1100 couples attending premarital screening center in Duhok-Iraq between November 2022 and March 2023. The participants had their demographic data collected, and attitude towards the premarital screen was assessed. A subgroup was further scrutinized on their knowledge on the program and hemoglobinopathies.

Results: While 99.8% of enrollees considered premarital screen important, only 10.5% choose to abandon their marriage plans if they were identified as couples-at-risk. Of those proceeding with marriage, 94% wanted to do testing to determine whether their babies are affected, yet only 5.7% would consider aborting it, citing religious or cultural prohibition. In the subset where knowledge was assessed, it was found that only 6% and 20% had good knowledge as it related to hemoglobinopathies and premarital program respectively. There was a significant association between positive attitude and knowledge (p=0.019).

Conclusions: The current study underscores the barriers facing the successful implementation of the premarital program and the serious knowledge gaps among the public about it. The need to introduce targeted educational initiatives to better inform the public of their choices is paramount.

Health-related Quality of life among patients with Ankylosing Spondylitis and its correlation with disease-related variables. A Cross-Sectional Study in Erbil City

Dana Abdulkareem Mahmood — 2024-12-01

Background and objectives: Ankylosing spondylitis is a chronic, rheumatic, inflammatory disease that basically involves axial skeleton. As a result, functional limitations develop that may negatively affect quality of life. Our aim is to assess the quality-of-life in patients with ankylosing spondylitis and to determine its’ correlation with disease variables including disease activity, functional status, spinal mobility, and bodily pain.

Methods: A cross-sectional study enrolled fifty patients with ankylosing spondylitis in the Rizgari teaching hospital was conducted between November 2022 to March 2023. Both short form-36 and ankylosing spondylitis quality of life instruments were used to evaluate Health related quality of life. Bath Disease Activity Index, Bath Functional Index, Bath Metrology Index, and total pain visual analogue scale used to assess disease related variables.

Results: fifty patients aged (20-50) years participated, their mean age was (35.4), the majority (80%) were males. The peripheral joints were involved in 42% of these patients. The mean ankylosing spondylitis quality of life score was 8.7 ± (4.6) SD, short form-36 domains of physical role limitation, general health, vitality, and bodily pain had the lowest scores (43.5, 44.6, 45.8, 50.7) respectively. both Bath disease activity index (B = 1.047; p = 0.010) and Bath functional index (B=0.974; p=0.012) were poor predictors of Ankylosing Spondylitis Quality of Life score, while Bath Metrology Index (B = -3.444; p = 0.043) was the main predictor for physical functioning.

Conclusion: The health-related Quality of life in participants was significantly impaired. High disease activity, poor functional status and limitation in spinal mobility were recognized as poor predictors of Health-related quality of life.

Incidence of dysphotopsia following uneventful cataract surgery [phacoemulsification] in patients implanted with different types of monofocal intraocular lenses

Khalid Saeed Abdulmajeed — 2024-12-01

Background and objectives: Pseudophakic dysphotopsia is one of the major causes of patient dissatisfaction after cataract surgery. Our aim was to assess the incidence of dysphotopsia after phacoemulsification with implantation of three types of monofocal intraocular lenses.

Methods: This prospective clinical study which contained 200 eyes from 195 patients was done at Dr. Aso eye hospital in Sulaimania city between June 2022 to June 2023. Those 200 eyes (participants) were divided into three different groups according to their IOL types were followed-up for 6 months to estimate the incidence and symptoms of dysphotopsia.

Results: overall incidence of dysphotopsia was (22%). 34 cases (17%) reported their symptoms in the first three weeks of follow-up. This figure decreased to (4% and 1%) after 3 and 6 months, respectively. The most common phenomenon noted was temporal shadow/darkness; declared by 34.09% of patients who reported dysphotopsia. Optical phenomena occurred more frequently in patients with Acryfold lens group. The great majority of the patients (94.5%) were satisfied with their post-operative visual function. Both, overall incidence of dysphotopsia and its higher rate in the 1^st group (Acryfold) were statistically significant values (p= 0.0399 and 0.0418), respectively. Conversely, there was no statistically significant difference between Rayner and Acrysof lenses in terms of dysphotopsia occurrence (p-value= 0.053).

Conclusion: Although monofocal intraocular lenses showed significant rates of dysphotopsia, they were still associated with high patient satisfaction level because majority of the symptoms were mild and went away with time.

Pre-operative Disc Volume Measurement as a Predictor for Sufficient Intra-operative Excision in Lumbar Open Fenestration Discectomies

Lawand Ahmed Sharif — 2024-12-01

Background and objectives: A study was implemented by assessing pre-operative disc volume and compare it to resected disc volume intra-operatively to minimize complications. The purpose of this study is to determine whether preoperative measurement of disc volume by magnetic resonance imaging could estimate the amount of disc need to be removed intraoperatively.

Methods: This prospective cross-sectional study was conducted between 2021 and 2023, in which 44 patients were involved, the volume of the herniated disc. The height, width, and length of prolapsed disc were multiplied together and by 0.523, measured on magnetic resonance imaging machine, intraoperatively the resected disc was placed in the sterile syringe for measurement.

Results: Out of 44 patients, 23 of them were males, and 21 were females. The mean age was 41.4 years. The most common level of involvement was the L4-L5 levels. The size of the herniated disc preoperatively ranged from 0.70 cc to 3.70, among them 72.7% of patients had a measurement between 1.0 cc and 2.0. Intraoperatively, the size of resected disc ranged from 1.0 cc to 4.2, 63.6% of them had volume exceeding 2.0 cc. Our data showed that neither the volume of the herniated disc nor the volume of the resected disc has any correlation to the age, gender and the level of disc involved.

Conclusion: Preoperative measurement of lumbar disc herniation with a magnetic resonance image do not predict the disc volume that needs to be removed during surgery.

Human resource management practices and employees’ job satisfaction in public hospitals in Erbil City

Hoshiar Yassin Mohamad — 2024-12-01

Background and objectives: Employees’ jobs satisfaction is the term most widely used and researched in field of management and organization behavior. This study aimed to explore the influence of human resource management practices on employees’ job satisfaction in public hospitals in Erbil city.

Methods: A cross-sectional study was carried out at public hospitals in Erbil city, Iraq, between January 2023 and September 2023. A sample of 405 employees was chosen using a convenience sampling method. A designed questionnaire was used to measure employees’ job satisfaction and to assess the impact of human resource management practices, including rewards and incentives, training and development, and employee relations, on job satisfaction among these employees.

Results: Employees in the administrative and technical departments reported higher satisfaction compared to medical departments, P<0.001 and 0.0483, respectively. Moreover, the research found that an increase in rewards and incentives was connected to greater job satisfaction, as was the belief that the rewards system served as motivation for employees (r=0.17, P<0.001) and financial rewards are the most important ones to motivate employees (r=0.11, P=0.0331). Employees expressed greater satisfaction when training programs were consistently conducted (r=0.24; P<0.001), training programs were relevant to the needs of the hospital (r=0.23, P<0.001), and when they perceived their coworkers as cooperative (r=0.38, P<0.001).

Conclusion: The study revealed there is a significant impact of human resource management practices on employees’ job satisfaction in public hospitals in Erbil City.

Association of Neutrophil – to- Lymphocyte ratio as an inflammatory marker in patients with primary Osteoarthritis of the hands

Shna Abdulmajeed Mohammed Amin — 2024-12-01

Background and objectives: Hand osteoarthritis is a common joint disease that causes pain and functional impairment. Neutrophil to lymphocyte ratio is a novel marker, it can be used for evaluating inflammatory activity in chronic inflammatory disorders. The aim of the study is to evaluate the relationship of neutrophil to lymphocyte ratio in patients with primary osteoarthritis of the hands.

Patients and methods: This case-control research was carried out in the Rheumatology department of Rizgary Teaching Hospital from March 2022 to March 2023. It included fifty patients who fulfilled the American College of Rheumatology criteria for diagnosis of hand osteoarthritis and fifty healthy controls matched in sex, age, and body mass index. laboratory investigations including (CBC, ESR, CRP) were collected. Values of Neutrophil to Lymphocyte ratio were measured for both groups. Secondary causes of osteoarthritis were excluded.

Results: No significant difference was detected between the two groups in neutrophils (p= 0.495), lymphocytes (p=1.000), and CRP (p =1.000). The differences were significant (p=0.025) in ESR which was higher among patients in comparison to controls. The median of Neutrophil-lymphocyte ratio was higher in patients compared to control, but insignificantly (P=0.311). Moreover, seven patients had a high Neutrophil-Lymphocyte ratio as compared with only 3 individuals in the control group, again insignificantly (P = 0.182).

Conclusion: The current study did not find Neutrophil to lymphocyte ratio to be a reliable indicator of inflammation in the settings of primary osteoarthritis of the hands.

Association between Rheumatoid Arthritis Disease Activity and Comorbidities

Bahra Hussein Mohammed — 2024-12-01

Background and objectives: Rheumatoid arthritis is an autoimmune condition marked by chronic joint inflammation, frequently resulting in substantial impairment and diminished quality of life. However, rheumatoid arthritis rarely occurs in isolation, as individuals with this condition frequently present with comorbidities, such as cardiovascular disease, diabetes, and osteoporosis. Understanding the role of comorbidities in Rheumatoid Arthritis is critical for comprehensive patient care. The aim of this study was to investigate the impact of various comorbidities on disease activity of rheumatoid arthritis.

Methods: Patient data for this cross-sectional study was collected at rheumatology outpatient of Rizgary teaching hospital in Erbil city of Kurdistan-Iraq from August 2022 August 2023. Study participants included patients with rheumatoid arthritis with (n=60) and without (n=60) comorbidities and they were matched for age and sex.

Results: Our findings revealed that among patients with rheumatoid arthritis, hypertension is the most frequent comorbidity, affecting 27 patients (45%) of them. This is followed by the coexistence of hypertension and diabetes mellitus in 9 (15%) of cases, and hypothyroidism in 8 (13.3%) of cases. Furthermore, the study establishes a strong and statistically significant link between patient age and the presence of comorbidities (p<0.001). Additionally, it demonstrates a significant correlation between the high activity of RA disease and comorbidities (p=0.03).

Conclusions: This research is providing insights into the ways in which these accompanying medical conditions affect the activity of rheumatoid arthritis. The results of this current study have important implications for making treatment choices, assessing risks, and crafting customized approaches to managing this disease.

Relationship between Type 2 Diabetes Mellitus and Red Cell Distribution Width

Revan Nasr Salh Abdulla — 2024-12-01

Background and objectives: Type 2 diabetes mellitus is a prevalent health problem in the Kurdistan region/Iraq. Numerous biochemical parameters are important for screening and monitoring of diabetes mellitus, Red Cell Distribution Width is one of them.

Methods: A cross-sectional study was conducted in Erbil Teaching Hospital, Rizgary Teaching Hospital, and Layla Qassim primary health care center in Erbil city-Kurdistan region/Iraq from 1^st of August, 2022 to 31^st of July, 2023 on one hundred and twenty type 2 diabetic patients. Many biochemical and hematological parameters were evaluated and compared with Red Cell Distribution Width in this study.

Results: The mean Red Cell Distribution Width of diabetic patients was (16.64%); 61.7% of them had a high Red Cell Distribution Width. A weak positive correlation was observed between Red Cell Distribution Width -CV and each female gender, Body Mass Index, White Blood Cell count, and triglyceride (p?0.05). A potent positive and significant correlation was noticed between Red Cell Distribution Width -CV and fasting blood sugar (r=0.76, p<0.001) as well as HbA1c level (r=0.92, p<0.001). A moderate positive significant correlation was observed between Red Cell Distribution Width -CV and cholesterol, low-density lipoprotein cholesterol as well as serum creatinine levels (p?0.05). A weak negative correlation between Red Cell Distribution Width -CV and HDL (p<0.001).

Conclusion: The red blood cell distribution width might be a helpful marker in monitoring and assessing the severity of type 2 diabetes mellitus and could also help in predicting cardiovascular and renal complications.

Chronic Neutrophilic Meningitis in Tuberculous Infection: A Rare Case Presentation and review of the literature

Amanj Jamal Pastaksor — 2024-12-01

Persistent neutrophilic pleocytosis syndrome is a rare form of tuberculous meningitis that is defined as the persistence of neutrophils in cerebrospinal fluid for more than 7 days, in association with the clinical features of meningitis (headache, fever, and positive meningeal signs).¹ The exact pathogenesis of this syndrome is not well known yet, and it has many diverse etiologies, including infectious and noninfectious ones. among infectious ones: bacteria such as Nocardia and Actinomyces, and systemic mycoses such as Aspergillus and the zygomycetes, as well as mycobacterium.² This entity is very rare in immunocompetent patients, and most of the cases are due to infectious causes in those who are immunocompromised. The usual scenario in such cases is initiating broad-spectrum antimicrobial agents without any improvement, therefore the diagnosis is difficult initially and often delayed. Therefore, the epidemiologic features and clinical profile may offer clues to the etiologic agent, especially in the immunocompromised host.³