AMJ (Advanced Medical Journal)

Common ECG Abnormalities in Patients with Acute Stroke

Rokan Abdulla Hama Ahmed, Sarwer Jamal Ismael Agha-Albajalan — Mon, 03 Mar 2025 00:00:00 +0000

Background and objectives: Stroke is one of the major causes that leads to death and disability globally. Electrocardiographic abnormalities are seen in acute stroke and may deliver valuable insights into stroke pathophysiology, outcomes, and administration. The aim of the study is to identify some common abnormalities in patients presenting with acute stroke.

Methods: In this hospital based cross-sectional prospective study, we analyzed and interpreted the ECG results of 100 patients presented to the emergency department of Shar hospital in Sulaymaniyah, Iraq, between February and August 2023. These patients were analyzed with either acute ischemic or hemorrhagic stroke according to the resuls of computed tomography scan of the brain. Electrocardiograms were acquired during a 24-hour timeframe after admission.

Result: The results show that the average age of the participants was 66.5 years. The direct risk factors specified in the study were diabetes (54%), hypertension (59%), smoking (51%), and ischemic heart disease (46%). The incidence of ischemic stroke was 68%, whereas hemorrhagic stroke accounted for 32% of cases. The most common electrocardiogram abnormalities in the study population were atrial fibrillation (31%) and sinus tachycardia (26%). In this study there was a statistically significant association between the electrocardiographic abnormalities and presence of ischemic stroke and heart disease (p<0.05), but no significant association was seen with diabetes or hypertension.

Conclusions: Atrial fibrillation and sinus tachycardia were the most common electrocardiogram findings in Iraqi patients presenting with acute stroke. Electrocardiogram abnormalities were related to ischemic stroke and cardiac disease, highlighting their diagnostic and prognostic potential.

Prevalence of Cardiovascular Autonomic Neuropathy among Type 2 Diabetic Patients in Erbil City

Wshyar Sadraldeen Haris, Yousif Baha’addin Ahmed — Mon, 03 Mar 2025 00:00:00 +0000

Background and objectives: Type 2 diabetes affects over 500 million people worldwide. Damage to the autonomic nerve fibers that innervate the heart and blood vessels is known as cardiac-autonomic-neuropathy. It is usually an overlooked, significant diabetic complication. The aim of this study was to assess the prevalence of cardiac-autonomic-neuropathy, analyze its risk factors.

Methods: This cross-sectional study was carried out at the outpatient clinic for the Diabetes Center from October 2022 to April 2023 in Erbil, Iraq. Thorough physical examination was done in order to identify patients with and without cardiac-autonomic-neuropathy. Detailed history and blood workup were taken into consideration to find risk factors of cardiac-autonomic-neuropathy.

Results: The prevalence of cardiac-autonomic-neuropathy among the study population was 29.7%. Among the cardiac-autonomic-neuropathy patients, 53.3% were female and 45.5% were male. Patients with cardiac-autonomic-neuropathy had a higher HbA1c level (p-value <0.05). Moreover, patients with cardiac-autonomic-neuropathy were found to have lower total cholesterol, high-density and low -density lipoprotein, and (p-value >0.05). Our results show that being on oral hypoglycemic agent, being underweight or overweight are significant predictors of cardiac-autonomic-neuropathy (p-value <0.05). Moreover, we found that the odds of cardiac-autonomic-neuropathy decrease with increasing high-density lipoprotein (p-value <0.05); and the odds increase with increasing glycosylated hemoglobin and fasting blood sugar (p-value <0.05).

Conclusion: The current study demonstrates that the development of Cardiovascular Autonomic Neuropathy can be significantly affected by poor glycemic control, high-density lipoprotein level, and the mode of treatment for diabetes control.

Imaging Characterization of Local Breast Lesions Using Shear Wave Sono elastography

Shadan Jasim Mohammed, Saeed Nadhim Younis Agha — Mon, 03 Mar 2025 00:00:00 +0000

Background & objective: Advancements in breast tumor screening and diagnosis are crucial for improving treatment outcomes and reducing mortality rates. This study evaluated the diagnostic accuracy of integrating quantitative shear wave elastography with B-mode ultrasonography to differentiate benign from malignant breast lesions, keeping histopathology as reference standard.

Methods: This cross-sectional observational study implemented in Breast center in Erbil, Kurdistan, from May to September 2022. The women with breast mass were examined clinically by breast surgeon at the center and then referred to Radiology department for imaging. Both B-mode Ultrasound and Shear Wave Elastography were performed on 45 US-detected breast masses prior to any biopsy procedures. For each detected lesion, two key parameters were assessed: The Breast Imaging Reporting and Data System category based on B-mode ultrasound images and the mean elasticity values obtained from Shear Wave Sono elastography images. This dual approach aimed to provide a comprehensive evaluation of each lesion. Following the imaging, histopathological diagnoses were obtained for all lesions, taken as the gold standard.

Results: Histopathological examination, carried out by a specialized radiologist using core biopsy and Fine Needle Aspiration Cytology and analyzed by a pathologist with a consistent assessment protocol, revealed 55.6%benign and 44.4% malignant. B-mode ultrasound using the BI-RADS system, categorized 71.1% as BI-RADS 4, 15.6% as BI-RADS 5, and 13.3% as BI-RADS 3. Shear Wave Sono elastography proved critical, revealing significantly higher mean elasticity malignant cases (p<0.001. A strong correlation was found between increased elasticity and malignancy, as well as between elasticity and BI-RADS categorization (p=0.004). Malignant tumors had a direct link to elasticity (p=0.02). The optimal cutoff mean shear wave elasticity was 80 kPa with 90%sensitivity, 80% specificity and 84.4%accuracy.

Conclusions: Quantitative shear wave Sono elastography, combined with B-mode ultrasonography effectively categorize breast lesions, correlating strongly with histopathological findings. It emerges as a vital, non-invasive diagnostic tool, enhancing the accuracy of breast lesions characterization.

Occurrence of C-Shaped Canal in Mandibular First and Second Molars in the Erbil Population using Cone Beam Computed Tomography

Rasti Omar Sedeeq, Raid Fahim Salman — Mon, 03 Mar 2025 00:00:00 +0000

Background and objective: Anatomy of the root canal system and determining the number and form of the canals are the most important steps for successful root canal therapy without post-operative complications. The objective of the current research was to apply cone beam computed tomography as a mean to investigate the occurrence and characteristics of C-shaped canals in mandibular 1^st and 2^nd molars of the Erbil citizens.

Methods: the study was done retrospectively in February 2023 to September 2023 at the Private Dental Center, Erbil, Iraq. A group of individuals who had cone-beam computed tomography examinations were chosen for the study. The cone-beam computed tomography examinations were conducted at three distinct axial levels, and based on the Fan criteria, the mandibular molars were categorized as C-shape. cone-beam computed tomography scans were utilized to determine the existence and features of C-shaped canals. The data were examined based on the status of unilateral or bilateral, gender, types of C-shaped configurations, and distribution across the root thirds.

Result: The analysis of 676 molars from 222 patients revealed low occurrence rates of this anatomic feature in mandibular first molars 3 cases (0.97%), but mandibular second molars exhibit a comparatively greater frequency 28 case (7.62%). The incidence of C-shaped canals varied by status of unilateral or bilateral, gender, types of C-shaped configurations, and their distribution across the root thirds. There was a significant difference between the total number of c-shaped canals found in mandibular second molars in the male and female, on the other hand there was no significant difference in the mandibular first molar.

Conclusion: The results in mandibular second molars demonstrated a greater frequency of C-shaped canals compared to mandibular first molars. Females exhibited a greater incidence of C-shaped canals, and bilateral cases were more frequent in females than males.

Facilitators and Barriers of Continuing Professional Development from the Perspective of Health Care Providers in Erbil City

Bawaji Kareem Salih, Sherzad Adulahad Shabu — Mon, 03 Mar 2025 00:00:00 +0000

Background and objective Continuing professional development is a major component of employee development worldwide. Good understanding of it, makes greater ability to incorporate research findings to improve it. This study aims to address enhancing factors beside the negative influences on Continuing professional development.

Methods A cross-sectional quantitative study was conducted in Erbil city, Iraqi Kurdistan Region, in the major general hospitals. The data were collected from 249 healthcare providers (physicians, dentists, pharmacists, medical staff, lab assistants) working in these hospitals during 2022. A questionnaire was designed for data collection which included questions about demographic characteristics of the participants, and questions about facilitating factors and barriers regarding continuing professional development.

Results More than 94% of participsnts (235 out of 249), agreed that continuing professional development is important for their carrier. More than half of them (55.8%) participated in continuing professional development activities. Role of managers, encouragement by peers, having good places, qualified trainers and sponsorship were detected as main facilitating factors for implementation. Among the mentioned factors, trainers had the highest number (225) of positive answers. Cost, time, improper presentation ways and not involving the right employees, were declared as the main barriers.

Conclusion Continuing professional development needs to be explained to health employees since about half of them had no knowledge about it. Policymakers and health managers need to enhance facilitatinf factors that play positive roles in implementation and try to overcome barriers in order to make changes toward professionalism.

Assessment of cardiac troponins status in patients on regular hemodialysis

Raman Ameer Muhammed, Hussein Yousif Sinjari — Mon, 03 Mar 2025 00:00:00 +0000

Background and objectives: heart disease is a significant contributor to both fatalities and health issues among patients undergoing regular hemodialysis. Cardiac Troponins serve as sensitive indicators of heart muscle injury, playing a vital role in diagnosing acute coronary syndrome. The aim of this study is to assess cardiac troponins status in an Iraqi cohort of asymptomatic Hemodialysis patients.

Methods: One-hundred-thirty-six asymptomatic hemodialysis patients who visited the hemodialysis center at the Hawler Teaching Hospital in Erbil, Iraq, between August 2022 and May 2023 participated in this cohort. Recorded were demographic and baseline characteristics. A battery of laboratory tests was conducted, including high sensitivity cardiac troponin T, cardiac troponin T, and I. Correlations were made between different variables

Result: The occurrence rates of increased cardiac troponin T, and I, and high sensitivity cardiac troponin T among asymptomatic hemodialysis patients were 25%, 7.4%, and 76.5%, respectively. Cardiac troponin T alone showed a significant positive correlation with the duration of dialysis treatment (p<0.05), while cardiac troponin I was significantly associated with dyslipidemia (P<0.05).

Conclusion: The majority of asymptomatic hemodialysis patients have elevated cardiac troponin levels, particularly high sensitivity cardiac troponin T. Both cardiac troponins were positively associated with prior history of coronary artery disease, and low serum albumin. Cardiac troponin T was positively correlated with dialysis vintage.

Serum levels of ferritin and vitamin B12 in a cohort of healthy non-anemic female medical students

Suleen Kanan Bakir, Rawand Polus Shamoon, Ranan Kardagh Polus — Mon, 03 Mar 2025 00:00:00 +0000

Background and objectives: Iron and Vitamin B12 are essential for the development of the nervous system, erythropoiesis, and several metabolic functions. This study aimed to assess serum levels of ferritin and vitamin B12 in a cohort of apparently normal young non-pregnant females.

Methods: Between October 2022 and February 2023, a descriptive cross-sectional study was carried out at Knowledge University in Erbil, Kurdistan, Iraq. 400 young female college students who appeared normal and non-anemic underwent tests for vitamin B12, serum ferritin, and total blood count. Their eating habits and menstrual history were investigated and connected to the biochemical findings.

Results: A statistically significant correlation between low ferritin and B12 levels was found in 48 (12%) of the students. Additionally, among the participated students, 96 (24%) and 114 (28.5%) had low serum levels of vitamin B12 and ferritin, respectively. Between 4 and 120 ng/L, the mean serum ferritin level was 44.46 ng/L. Between 67 and 600 pg/mL, the mean vitamin B12 level was 257.9 pg/mL. The average hemoglobin, corpuscular volume, and hemoglobin of the students who were enrolled were 12.88 g/dL, 85.98 fL, and 27.43 pg, respectively.

Conclusion: Low vitamin B12 levels were mostly found in vegetarians and people on non-ketogenic diets, while low serum ferritin levels were much more common in people with abnormal menstruation. Iron and vitamin B12 deficiencies are frequent in otherwise healthy girls with normal hemoglobin and red blood cell indices.

Occult hepatitis B- viral infections among blood donors in Duhok-Iraq

Noor Rizqo Mikha, Amer Abdalla Goreal — Mon, 03 Mar 2025 00:00:00 +0000

Background & objectives: When a patient has occult hepatitis B virus infection, HBV-DNA is detected in blood or liver tissues with negative HBsAg, with or without anti-HBc antibodies. The study's objective was to ascertain the prevalence of occult HBV infection among Duhok City blood donors.

Methods: A cross-sectional study has been conducted at Duhok blood bank from November 2022 to January 2023. Plasma samples were obtained from 100 willing blood donors (98male, 2 females, 21-67 years old) who tested negative for HBsAg but positive for AntiHBc. HBsAg negative/anti-HBc positive blood donors have been examined by Anti-HBs II (immunoassay for quantitative detection of antibodies to hepatitis B surface antigen). Next, with the use of a Viral Nucleic Acid Extraction Kit, DNA was isolated from plasma samples. An automated real-time PCR approach was used to identify HBV DNA.

Results: Of the 3156 HBsAg negative donors, 100 (3.16%) tested positive for anti HBc antibodies (total), 20 (20%) tested negative, and 80 (80%) tested positive for anti HBs Antibodies. All 100 donors had negative results from the real-time PCR with no HBV-DNA. No significant correlations were found between AntiHBc and AntiHBs results with sex and different age groups of donors.

Conclusion: No occult HBV infection was detected among Anti-HBc positive donors who were deferral from blood bank reserve. Taking in consideration that 80% of them have protective titer of Anti -HBs, reevaluation of the exemption of such blood donors should be done to reduce the deferral of donors and enhance blood bank reserve.

Evaluation of the hematological profile of neonatal jaundice among neonates in Erbil city

Arazu Ali Zendin, Nawsherwan Sadiq Mohammad, Rawand Polus Shamoon — Mon, 03 Mar 2025 00:00:00 +0000

Background and objectives: Neonatal jaundice is the most commonly encountered medical problem in the first two weeks of life, and a common cause of readmission to the hospitals, this study is designed to investigate different hematological parameters in neonatal jaundice and compare them to normal infants, to determine the association ofhematological profile of different etiologies of jaundice in neonates.

Methods: This prospective cross-sectional study, investigates blood samples of 600 neonates (300 healthy and 300 jaundice confirmed neonates, regardless of genders), that were admitted to Raparin Pediatric Teaching, and Erbil Maternity Teaching Hospitals, from July 2022 to July 2023. Samples were subjected to the hematological investigations, including complete blood count (CBC), ABO, and Rh for both the fetus and the mother. Additionally, direct antiglobulin test (Coomb´s), reticulocytes count, and G6PD enzyme assay were also assessed.

Results: Clinical presentation of neonatal jaundice showed that more than half (57.8%) of the cases were males, and 42.2% were females, oxytocin used for 31.2% of mothers during delivery; 6.5% of patients faced Rh-incompatibility and just 11.3% faced ABO- incompatibility. The most common etiologies for neonatal jaundice were physiological (64%), while others were pathological (36%). Among the pathological, the ABO incompatibility was (20.7%), followed by Rh incompatibility (9%), and G6PD deficiency (6.3%). There was a significance correlation between the jaundice type and evaluated hematological profiles for each group.

Conclusion: Most of the neonatal jaundice cases were physiological in nature, with ABO incompatibility as the most common type, while G6PD was the least common pathological type.

Radiological and clinical prognosis of posterior lumbar intervertebral body cage versus posterior transpedicular screw fixation in patient with isthmic spondylolisthesis

Mon, 03 Mar 2025 00:00:00 +0000

Background and objectives: Isthmic type of Spondylolisthesis, resulting from the failure of the anterior column, requires fixation by a transpedicular screw posteriorly. The research aimed to distinguish discrepancies in clinical presentation, functional outcomes, and mechanical characteristics by evaluating clinical, radiographic, activity, and pain information.

Methods: A Prospective study was conducted from January 2016 until March 2020, at Erbil Teaching and Paky Hospital, Pedicle screw fixation was performed on 70 consecutive patients diagnosed with isthmic spondylolisthesis. Posterior transpedicular screw fixation was performed in 36 persons, while posterior lumbar intervertebral body fusion was performed in 34 persons. The assessments of the activity and pain statuses were performed prior to and post the surgical procedure.

Results: There was no statistically significant divergence of the modifications. The statistical analysis conducted within the groups has demonstrated that the surgery had a significant impact on the subluxation percentage, angle of slippage, and foraminal area. Nevertheless, it had no impact on the sacral inclination or the segmental lordosis. The 3-year follow-up examination did not demonstrate any statistical intergroup differences regarding improvement neurologically (p=1.01), Activity outcome (p=0.52), Pain outcome (p=0.87), fusion rate (p=0.47). Nonetheless, the group that underwent PLIF procedure showed maintained subluxation correction, disc height, and foraminal area which was not observed in the fusion by only posterolateral approach group (p_0.07).

Conclusion: The interbody fusion procedure provides enhanced mechanical strength to the spinal structure in instances of Isthmic spondylolisthesis. It is anticipated that the degree of correction attained will slowly decrease when posterior transpedicular fixation clinically.

A Study on Visual Outcome of Patients with Keratoconus after Corneal Collagen Crosslinking

Ballga Barzan Ahmed, Tara Mahmood Hassan, Bakhtiar Qadir Hamasalih — Mon, 03 Mar 2025 00:00:00 +0000

Background and objectives: Cross-linking of the corneal collagen is regarded as a new treatment technique for a non-inflammatory thinning disease of the cornea-known as keratoconus, to strengthen the biomechanical elements of the cornea. Riboflavin (Vit.B2) and UV-A light have been shown to be effective at stopping progression of keratoconus.

Aim: to evaluate the effects of collagen cross-linking in patients with keratoconus.

Methods: A retrospective, non-controlled study was performed on forty-five patients (64 eyes) with keratoconus in whom collagen crosslinking was done between years (2017-2021). It was conducted in Bright Eye, Tooe Maleek, and the Eye Center private hospitals in sulaimaniya city. We measured the distance visual acuity with and without glasses (Snellen acuity chart and decimal notation), the, the spherical equivalent and cylindrical refractive error (autorefractometer), the central corneal thickness and the mean keratometic reading (corneal topography). These were taken before and after crosslinking in a period between 6-12 months, and then t-test was used to compare and analyze the results.

Results: After comparing the pre- and post-crosslinking findings, we found an improvement in the uncorrected VA (by 0.06±0.04) and best corrected VA (by 0.10±0.03). The central corneal thickness was decreased by a mean of (13±12µm) and the mean keratometric reading decreased by a mean of (0.9D). However, each of the spherical equivalent and cylindrical refractive errors showed no significant difference before and after the procedure (stabilized).

Conclusion: The procedure (collagen crosslinking) was efficacious in stopping progression of the disease.

Incidence of Acute Kidney Injury During Epidemic Diarrheal Illness in Sulaimani city

Rozhan Jamal Hamaali, Dana Ahmed Shareef — Mon, 03 Mar 2025 00:00:00 +0000

Background and objectives: Diarrheal disorders represent a considerable worldwide health concern, sometimes necessitating hospitalization due to consequences such as dehydration and disturbances in electrolyte levels. The objective of this analysis is to ascertain the incidence of acute kidney injury among individuals with diarrheal illnesses at two healthcare facilities in Suleimani, Iraq.

Methods: a retrospective study on patients who had been admitted due to acute diarrhea in Shahid Doctor Hemin Teaching and Shar Hospitals in the city center of Suleimani governorate, covering the period of May until July 2022. Data was collected on demographics, symptoms of dehydration,vital signs, and laboratory values such as blood urea, serum creatinine, sodium, potassium, and chloride. General stool examinations were also performed for the patients.

Results: In this study, the records of 625 patients were examined. The results showed that 55% of male participants and 45% of female participants experienced acute kidney injury during their illness (P<0.05). The study found a higher incidence of acute kidney injury among individuals who consumed tap water (66.3%) compared to those who drank well water (21.1%) or bottled water (12.7%) (p<0.05). The research also revealed that people diagnosed with hypertension and diabetes were more susceptible to acute kidney injury, with prevalence rates of 19.9% and 16.5% respectively (p<0.05).

Conclusion: The study revealed a high occurrence of acute kidney injury in people experiencing diarrhea, especially those with specific risk factors. This underscores the importance of raising awareness and implementing preventive measures to address this complication and potentially improve outcomes.

Knowledge, Attitude and Practice of Gynecologists and Obstetricians Toward Oral Health Care of Pregnant Women in Sulaymaniyah City, Iraq

Aso Jalil Abbas, Arass Jalal Noori, Sherzad Ali Ismael — Mon, 03 Mar 2025 00:00:00 +0000

Background and objectives: Gynecologists play a vital role in pregnant women’s oral health.

This study aims to evaluate the knowledge, attitudes, and practices of gynecologists and obstetricians regarding oral health care for pregnant women in Sulaymaniyah, Iraq.

Methods: A cross-sectional study was carried out at the Maternity Teaching Hospital in Sulaymaniyah, Kurdistan Region, Iraq, from October 2022 until February 2023. One hundred and twenty-two female gynecologists and obstetricians were included. The survey covered a range of questions, including demographics and those designed to assess participants' knowledge, attitudes, and practices regarding oral health care for pregnant patients.

Results; Among 122 gynecologists, most board-certified are knowledgeable (60.7%), and most gynecologists with more than 20 years of experience are knowledgeable (100%) , both attitudinally and practically. On the other hand, those with less than 10 years of experience show knowledge (62.1%). Gynecologists aged 30–40 exhibit a higher proportion of high knowledge (71.1%), attitude (67.1%). Local anesthesia is considered safe for dental treatment during pregnancy. Most of the participants (82.0%) said that the safest period to perform dental work is the second trimester of pregnancy. 91.0 percent of gynecologists recognize the importance of dental references for patients. Also, a greater proportion of participants (95.9%) advised pregnant women to abstain from tobacco and alcohol.

Conclusions; In conclusion, the results of this study showed that most gynecologists had good knowledge, attitudes, and practices toward oral health care for pregnant women, but there was still a need for active participation. Gynecologists demonstrated good practice in statics, which is important for pregnant women during pregnancy.

Prevalence of Oral Pigmented Lesions in Dental Outpatient Attending Piramerd Dental Health Center in Sulaimani

Tavga Ahmad Hussain, Balkees Taha Garib — Mon, 03 Mar 2025 00:00:00 +0000

Background and objectives: Pigmentation of the oral mucosal is commonly encountered and constitutes a variety of clinical presentation that can be physiological, systemic disease, post inflammatory, drugs, smoker melanosis, hemoglobin and iron association, melanoacanthoma, melanotic macule, Malignant Melanoma, amalgam tattoo and idiopathic. This mucosal discoloration may arise from either endogenous pigments or exogenous materials and they are classified as melanocytic and non-melanocytic pigments in origin. The objective of this study was to determine the prevalence of various types of oral mucosal pigmentation among a sample of dental patients.

Methods: This cross-sectional study was carried out at the Piramerd Dental Health Center on December 2022 to May 2023, involving a cohort of 500 dental patients. Medical and dental histories were taken from all the participants were undergoing through a thorough intra oral examination to determine number, distribution, shape, location and color of pigmented lesions.

Results: Oral mucosal pigmentation presents 28.2% a sample of dental patient in Sulaimani city. Racial pigmentation (77.3%) and smoker's melanosis (17.3%) were identified as the predominant factors contributing to oral pigmentations. Most of the patients (97.8%) had diffused or multifocal pigmentation, while a focal pattern was identified in only three patients (% 2.1). The frequently affected areas included gingiva (80.1%) buccal mucosa (64.5%) and labial mucosa (34%) The area demonstrating the lowest incidence was the lower lip (2.1%) and palate (1.4%).

Conclusion: Oral mucosal pigmentation is a common occurrence, with racial and smoker's pigmentation being the most frequently encountered discolorations, primarily affecting the gingiva and buccal mucosa.

Sacrococcygeal Pilonidal Sinus Diseases and Operative Management at Burn and Plastic Hospital in Duhok City

Kareem Muhammed Ahmed — Mon, 03 Mar 2025 00:00:00 +0000

Background and objectives: Pilonidal sinus diseases usually seen in young adults, carry much morbidity and patient discomfort. The management is the most critical issue in surgical treatment because it is related to postoperative morbidity and recurrence. So, this study aims to explore sacrococcygeal pilonidal sinus diseases and the operative methods achieved in Burn and Plastic hospital in Duhok City.

Methods: A descriptive study includes 55 cases of Pilonidal Sinus disease, 50 males and five females aged between 19 and 50 years who were admitted to Burn and Plastic Hospital in Duhok City during 2018-2019 for surgical operations. Different surgical procedures were achieved including close and open methods, fascia cutaneous flaps, and skin grafts. After discharge, most of the patients attended the outpatient clinic for follow, and complications were recorded. So, this study explores the prevalence and type of surgical management used to treat them.

Results: This study showed that males were affected more than females (9:1) ratio; in the age of the second decade (47.2%). The common presentation was chronic multiple sinuses (63.6%). Operations were achieved by closed method (54.5%), flap operation (31%), open method (7%), skin graft (3.6%), and abscess drainage (3.6%). The common postoperative complication was seroma (7.2%), recurrence (5.4%), hematoma (3.6%), and wound disruption (3.6%).

Conclusion: Pilonidal is a common surgical among young adult males than females. Many conventional and flap surgical procedures are applied. It is mandatory to try many flap operations and follow up on them strictly to find the best treatment and fewer complications.

Initial Fast Scan Finding in Hemodynamically Stable Patient with Blunt Abdominal Trauma

Rekan Mohammed Ali, Kamal Ahmed saeed, Sadeek Hama Aziz Salih — Mon, 03 Mar 2025 00:00:00 +0000

Background and objectives: Abdominal trauma can cause severe injuries to various internal organs. Focused assessment with sonography for trauma is an ultrasound technique for free intraperitoneal fluid detection in blunt abdominal trauma patients. This study aimed to investigate the importance of FAST scan as an initial imaging modality and early detection of free fluid in hemodynamically stable blunt abdominal trauma patients presenting to the emergency department.

Methods: This was a prospective cross-sectional study conducted in the emergency department of Shar Hospital, Sulaymaniyah, Iraq, from April 2022 to March 2023. The study involved 103 hemodynamically stable patients presented with blunt abdominal trauma. Patient demographics, vital signs, symptoms, and FAST results were recorded and analyzed.

Results: The study included 71 males and 32 females, with a mean age of 31.64 ± 15.04 years. Vehicle collisions accounted for 65% of the cases. Abdominal pain was the most common symptom (68%). Only seven patients (6.8%) had a positive FAST test; free fluid was found around the liver, renal, and in pelvic regions. A positive FAST was significantly associated with blunt trauma to the abdomen (p = 0.001) and related to the site of injury (p < 0.001). Patients with positive FAST had higher heart rates (p=0.005) and shorter time of injury before arrival to the hospital (p=0.002) than those with negative FAST.

Conclusions: In hemodynamically stable patients with blunt abdominal trauma, initial FAST detected free peritoneal fluid in a small percentage of cases. Patients with a positive FAST presented earlier and had higher heart rates.

Adherence to Parenteral Methotrexate Compared to Oral Route in Patients with Rheumatoid Arthritis

Mariwan Ismail Othman, Ziad Shafeeq Al.Rawi — Mon, 03 Mar 2025 00:00:00 +0000

Background and objectives: Rheumatoid arthritis is a chronic autoimmune inflammatory disease, which causes discomfort, swelling, stiffness, and eventual joint destruction. Methotrexate is a Disease Modifying Anti-Rheumatic Drug with a specific role in the treatment of Rheumatoid Arthritis. Adherence to methotrexate is essential to attain low disease activity or remission. The aim of this study was to know the prevalence rate of adherence to Methotrexate in parenteral way of administration and oral route among patients with Rheumatoid Arthritis.

Methods: This observational cross-sectional study included 100 patients diagnosed as rheumatoid arthritis according to 2010 ACR/EULAR using methotrexate either in oral or parenteral route presented to Rheumatology Consultancy Department at Rizgary Teaching Hospital/Erbil City, from July 2022 to July 2023. All patients answered an interview questionnaire regarding socio-demographic, clinical and treatment information survey included the Arabic version of the eight-item Morisky Medication Adherence Scale, and blood investigations had been done to assess the determinants of adherence to methotrexate treatment.

Results: A total of 100 patients with Rheumatoid Arthritis using methotrexate either in oral or parenteral route were enrolled in this study. No significant association was detected between the drug adherence with the following variables: age, body mass index, residency, and the factors related to pattern of diseases and treatment. While higher levels of adherence (2%) were detected among those with higher levels of education as significant association was detected (p = 0.021).

Conclusion: More than Two-Thirds of patients with Rheumatoid Arthritis who are receiving methotrexate via parenteral or oral route were poorly adherent to methotrexate.

Evaluation of the effect of two different impressions materials on the retention of complete d entures. An in vivo study

Alaa Natiq Kamaladeen, Jawad Mohammed Mikaeel — Mon, 03 Mar 2025 00:00:00 +0000

Background and objectives: The choice of impression technique and material can influence the accuracy of the final prosthesis. This study aims to assess the impact of two impression methods and materials on denture retention.

Methods: This non-randomized clinical trial was carried out on 30 fully edentulous patients in the College of Dentistry and in Duhok Dental Polyclinics from October 1, 2022, to June 30, 2023. For each participant, two sets of maxillary impressions were taken. The first impression was done with zinc oxide eugenol impression paste and green stick compound for border molding by using a special tray, and the second impression was completed with polyvinyl siloxane impression material on a stock tray using the putty-wash technique. Two stone casts were made for each participant, and two denture bases with wire loops in the middle were fabricated. Using a digital force gauge, the intra-oral retention force was evaluated in both groups.

Results: The denture base fabricated with polyvinyl siloxane impression material had a mean retention value of 3.88 kg and 3.89 kg for males and females, respectively, while the mean retention value of zinc oxide eugenol paste for males and females was 3.63 kg and 3.72 kg, respectively, with a p value of 0.3518. The difference was non-significant.

Conclusion: Dentures made using polyvinyl siloxane final impression material showed higher mean retention values of complete denture retention than zinc oxide eugenol final impression material.

Training's Impact on Medical Staff's KAP in Infection Prevention for Nosocomial Viral Hepatitis B&C in Erbil Teaching Hospital's Hemodialysis Unit

Qasim Burhan Abdullah, Maaroof Tahseen Hassan, Sherzad Ali Ismael — Mon, 03 Mar 2025 00:00:00 +0000

Background & objectives: Hemodialysis patients are susceptible to various types of infections, such as exposure to blood borne pathogens. This study aims to identify the effects of training on the incidence of nosocomial viral hepatitis B & C infection and implement an interventional program to decrease the incidence of nosocomial infection.

Methods: A quasi-experimental study design was conducted from the 1^st Nov 2021-30^th Nov 2022 in the hemodialysis unit of Erbil Teaching Hospital employing a pre-and post-test design. All medical staff working in the unit (48), underwent an assessment of their knowledge, attitudes, and practices regarding infection control before and after the implementation of the training program.

Results: Out of 48 staff 25 (52.1%) of them were males. Before the implementation of the training program, the mean knowledge score calculated was 13.7 and the mean attitude score was 10.9 while the mean score of the practice was only 9.3. Eventually, after the implementation of the training program, the subtended scores were 23.0, 16.5, and 14.3 respectively. The highest incidence rate of Hepatitis B was reported in 2019 which was 3.4 whereas the lowest rate was reported in 2022 which was 0.5. There was a statistically significant variation between the incidence of HBV in 2021 and its incidence in 2022, p value < 0.05.

Conclusion: Implementation of an educational program led to a notable enhancement in the knowledge of infection prevention and control principles among medical staff.

Ocular biometry in children and adolescent from age 4 to 17 years with intraocular lens power calculation in Sulaymaniyah city

Naz Othman Rashid, Bakhtiar Qadir HamaSalh, Diare Tahir Ali Mirza — Mon, 03 Mar 2025 00:00:00 +0000

Background and objectives: Ocular biometry is an essential method to measures the anatomical dimensions of the eye in adult and children. The objective is to detect the ocular biometric changes and intraocular lens power calculation in children and teenagers (4 to 17) years.

Methods: This hospital-based observational study included 208 participants (109 females and 99 males) distributed across three age groups (4 to 8, 9 to 12, 13 to 17) years, visiting Shahid Dr. Aso Teaching Eye Hospital in Sulaymaniyah governorate from November 2022 to July 2023. Information on axial length, anterior chamber depth, mean keratometry value, central corneal thickness, and intraocular lens power was collected and evaluated by the IOL Master 700 and Haigis formula.

Results: The average age was 10.52 with a standard deviation of ± 3.31. In the three age groups, AL changed from 22.83 mm to 23.28 mm. Mean keratometry values ranged from 43.46 D to 43.20 D, and IOL power varied from 22.27 D to 21.33 D. Despite gender differences, only AL and IOL power changes were statistically significant (p values: 0.025 for AL, 0.00 for IOL).

Conclusion: The optical ocular elements consistently align with changes in axial length, showing an increase as the child ages. This is accompanied by a decline in mean keratometry values, particularly between the ages of 4 to 8 years and a decrease in intraocular lens power. As the child matures, the variations in these parameters diminish.

Voice Changes After Thyroid Surgery; A Prospective Cohort Study

Aqeed Abid Ali, Faruk Hasan Faraj — Mon, 03 Mar 2025 00:00:00 +0000

Background and objectives: Voice changes (dysphonia) after thyroid surgery is an important complication that may have significant occupational, aesthetic, psychosocial and economic consequences on the patient. Two pairs of nerves supply the larynx, the recurrent laryngeal nerves and superior laryngeal nerves, which are susceptible to damage during thyroid surgery. The objectives of this study were to document the incidence, type, nature, severity, cause, and duration of voice complications after thyroid surgery.

Methods: The prospective cohort study included 100 patients who had thyroidectomy at the Sulaimani Teaching Hospital in Sulaimani City. The study carried out from January 2010 to December 2010. A special questionnaire Designed, which, included the following items: preoperative history (including age, sex, occupation, and professional voice user status), preoperative examination (encompassing local and general assessments), preoperative investigations check-up of vocal cords, intraoperative assessment by the anesthetist during extubation, and postoperative evaluations conducted by the researcher in the immediate, early, and late stages.

Results: The participant’s age range was 20-75 years, mean age 38.0 ± 10.5 years, with 88 women and 12 men. Immediately after the first postoperative week, voice changes were observed in 15.0% of the patients. Subjective voice changes (non neurogenic) account for 10.0% and objective changes account for 5.0% At three months of follow-up, Subjective voice changes were observed in 1.0% of the patients, with objective voice changes accounting for 4.0%. Finally, after six to 12 months, objective voice changes were observed in 2.0% of the patients, the result was not signifint statistically.

Conclusion: Objective voice change complaints require precise laryngeal nerve identification and protection durig surgery. These findings show that rigorous surgical procedures and thorough pre- and postoperative vocal examinations are needed to reduce risks and control long-term effects. Subjective change lesions were more prevalent than objective lesions.

Evaluation of Olfactory Fossa Keros Classification Using CT scans, A Hospital-Based Study

Ayad Faraj Rasheed — Mon, 03 Mar 2025 00:00:00 +0000

Background and objectives: Prior to any surgery for sinonasal diseases, a preliminary scanning of the paranasal sinus is required to validate that the surgical approach is satisfactorily planned and to avoid complications connected to the anatomy of this area. We intended to assess the olfactory fossa depth using paranasal sinus CT images to identify the types and prevalence of Keros classification in our population.

Methods: From December 2021 to December 2022, cross-sectional research was carried out at the Department of Radiology of Erbil Teaching Hospital, Erbil/ Iraq. Eighty participants (46 men and 34 women) received paranasal sinus CT scan to assess their paranasal sinuses and adjacent bone structures. Using the Keros categorization technique, the penetration of the olfactory fossa was determined and categorized into three types, described as type I (1 to 3 mm), type II (4 to 7 mm), and type III (8 to 16 mm).

Results: The average penetrations of the left and right olfactory fossa were 6.27±2.19 mm and 5.7±2.03 mm, respectively. Based on the Keros categorization, most of the cases (103) were of type II (64.3%). The right side for both genders was of Keros type II in 63.7%. The association of the right side and the Keros classification was statistically significant (p value = 0.006).

Conclusion: For both genders, Keros type II was more predominant. The Keros categorization and the gender variables with respect to the left and right sides respectively, differed significantly.

Oral and perioral manifestations of iron deficiency anemia in Hiwa Hospital in Sulaimani city

Kamal Hama Salih Amin, Amanj Abu-Bakr Jalal, Truska Faraidun Majeed — Mon, 03 Mar 2025 00:00:00 +0000

Background/objective: the oral cavity is a mirror for the general health; anemia is one of these disorders that fit this idea. The aim of this study was to show the prevalence of oral and perioral changes in patients with iron deficiency anemia and control people, then compare these changes between them, also to know the frequency of oral and perioral manifestations with the degree of iron deficiency anemia.

Methods: This comparative study involved 100 patients who visited Hiwa Hospital Hematology department between May and September 2023. All participants filed a questionnaire form for personal information and data collection, and they were examined clinically for the presence of any oral changes.

Result: the sample included 96 females and 4 males, with an age range of 18–67 years; there was no significant correlation between age groups and the prevalence of lesions. Patients with a high incidence of manifestations like paling of lip and oral mucosa (74%), xerostomia (60%), each of glossitis and taste disturbance (36%), and a low incidence of each of an oral ulcer and fissured tongue (18%), each of angular cheilitis and dysphagia (14%), and perioral numbness (6%). There were significant associations between iron deficiency anemia and all manifestations except fissured tongue.

Conclusion: the manifestations are more common in patients than in control group. The frequency of oral lesions does not significantly different with the degree of anemia, except pallor of (vermillion border of lip and oral mucosa) and glossitis.

Intrathecal Bupivacaine with Fentanyl Versus Bupivacaine Alone for Caesarean Section Under Spinal Anesthesia

Zanyar Noori Osman — Mon, 03 Mar 2025 00:00:00 +0000

Background and objectives: Postoperative pain might start due to the decrement effect of anesthetic drugs. Complications are reduced and recovery hastens with post-surgical pain control. The aim of this study is to evaluate the effect of spinal anesthesia by combining drugs (Bupivacaine and Fentanyl) versus Bupivacaine alone, to manage postoperative pain.

Methods: This study is a randomized clinical trial in which sixty patients, that underwent caesarean section under spinal anesthesia at The Slemani Maternity Teaching Hospital between November 2021 and March 2022. The patients were grouped into two: 30 patients in each of group (F) that received Bupivacaine 15mg(3ml) and Fentanyl 10?g, and 30 patients in the group (B) that received Bupivacaine 15mg (3ml) only. The parameters (pain at the site of surgery, pain outside the site of surgery, pruritus outside of the surgical site and pain during the return of movement) were recorded in the post-operative periods: 30 minutes,1, 1.5, 2 and 2.5 hours.

Results: We found that the intrathecal administration of Fentanyl and Bupivacaine has decreased postoperative pain compared to Bupivacaine alone. The data showed statistically significant results in all post-operative periods: 30min (F group %13, B group %83.3), 1hour (F group %13.3, B group %93.3), 1:30hour (F group %23.3, B group %93.3), 2hour (F group %33.3, B group %96.6) and 2:30hour (F group %60, B group %100).

Conclusion: Adding Fentanyl is more effective for decreasing postoperative pain compared to Bupivacaine alone.

Incidence of Gall Bladder Carcinoma after Cholecystectomy in Patient Attending Shorsh General Teaching Hospital in Sulaimaniyah

Zrng Aras Mahmoud, Kamal Ahmed Saeed, Farman Othman Hassan — Mon, 03 Mar 2025 00:00:00 +0000

Background and objectives: Gallbladder carcinoma is the most common biliary tract malignancy and the fifth most common cancer of the gastrointestinal tract. An incidental finding of carcinoma is incidental gallbladder carcinoma. This study is aimed to find the incidence of hidden gallbladder carcinoma.

Methods: The records of 307 patients who underwent a cholecystectomy over five years (January 2017 to December 2021) were reviewed as a retrospective cohort study at Shorsh General Teaching Hospital, Sulaimaniyah city, Kurdistan region, Iraq. The patient's data were collected using a simple random sampling method. Patients with radiological evidence of preoperative suspicion of malignancy before cholecystectomy were excluded. The notes of patients who underwent surgery for stones or benign biliary diseases were reviewed.

Results: The average age group in the decade was 21-63 years, and 140 were men (45.6%), while 167 were women (54.4%), with no significant difference. Out of 307 cases of cholecystectomy, 273 of them (88.9%) had surgery due to gallstones, and 3 of them (1%) had a pathological diagnosis of gallbladder cancer.

Conclusion: Old age and male gender were demographic risk factors for gallbladder cancer. Also, no significant relationship between gallbladder carcinoma and gallstones was observed. However, prophylactic cholecystectomy was likely to be beneficial for patients with chronic gallstones and at risk of the disease.