Duhok Medical Journal http://www.dmj.uod.ac/index.php/dmj <p>Duhok Medical Journal is apeer reviewed journal bi-annually by University of Duhok- College of Medicine. It is mainly focusing to the recent scientific and clinical researches. Furthermore, the Journal also publishes short articles, letters to edictors, review articles and case reports.</p> en-US Sun, 01 Dec 2019 00:00:00 +0000 OJS http://blogs.law.harvard.edu/tech/rss 60 THE USEFULNESS OF PROSTATE SPECIFIC ANTIGEN SCREENING IN MALE PATIENTS PRESENTED WITH HAEMATURIA http://www.dmj.uod.ac/index.php/dmj/article/view/86 <p><a href="https://doi.org/10.31386/dmj.2017.11.2.7"> https://doi.org/10.31386/dmj.2019.12.1.1</a></p> <p>Background:In our study, we wanted to assess if prostate specific antigen (PSA) test is a useful test for patients presenting to our urgent clinics with Haematuria, or if it can be safely omitted, unless there were any clinical indication or after discussion with patients according to NICE guidelines.<br>Objective:Our objective is to review if the PSA test is a useful test that should be done routinely for all male patients presented to urgent clinic with haematuria in our practice in District hospital in UK.<br>Methods: We looked at retrospective data for 200 patients who presented with visible haematuria (VH) and non-visible haematuria (NVH) between 50-79 years old, between January 2016 and June 2017.All patients underwent digital rectal examination (DRE) and PSA testing as part of our standard investigation for haematuria.<br>Results:Out of 200 cases, 155 with visible haematuria, 10 of them underwent further investigations and two were diagnosed with prostate cancer and 45 with non-visible haematuria, 4 of them had further tests and none were diagnosed as prostate cancer. Overall number of patients who underwent further investigations is 14/200 (7%).Overall rate of prostate cancer diagnosis was 1%. The rate of diagnosis with visible haematuria 1.29%, and 0% with non-visible haematuria.<br>Conclusion:Despite using PSA as standard investigation for patients who are presented to urgent clinic with Haematuria, the rate of cancer diagnosis is very low (1%) and detected in patients with abnormal DRE, rather than elevated PSA. Our cancer detection rate 1% is less than those from ERSPC (8.2%), ProtecT (2.2%) and PLCO (1.4%). PSA should not be considered as a useful test of standard investigations for haematuria, unless abnormal DRE was found during examination.</p> AHMED ABDELHAFEZ, THOMAS THOMPSON, OMAR W. S. AL-MULA ABED ##submission.copyrightStatement## http://www.dmj.uod.ac/index.php/dmj/article/view/86 Sun, 15 Dec 2019 00:00:00 +0000 VITAMIN D RECEPTORS GENES POLYMORPHISMS AND OXIDATIVE DNA DAMAGE AMONG KURD PATIENTS WITHTYPE 2 DIABETES, KURDISTAN REGION (IRAQ) http://www.dmj.uod.ac/index.php/dmj/article/view/87 <p><a href="https://doi.org/10.31386/dmj.2019.12.1.2"> https://doi.org/10.31386/dmj.2019.12.1.2</a></p> <p>Background: Although the relationship between vitamin D deficiency and oxidative DNA damage has been previously reported, few studies have examined vitamin D receptor (VDR) gene polymorphisms for association with the risk of DNA damage. This study aimed to identify vitamin D receptor genotypes in patients with type 2 diabetes and healthy subjects, as well as identify the relationship with oxidative DNA damage.<br>Methods: The study enrolled 162 subjects, 96 with type 2 diabetes and 66 healthy individuals were randomly selected to participate in prospective genotype detection by standard polymerase chain reaction methods and restriction fragment length polymorphism (PCR-RFLP). The polymorphism of FokI and BsmI genes and its association with DNA damage were determined. The main outcome measures were oxidative DNA damage marker including serum 8-hydroxy 2-deoxy guanosine (8-OHdG) and 25 hydroxy vitamin D [25(OH) D].<br>Results: Notable statistical significance exists in the frequency of genotype and allele of FokI (VDR 2228570 C&gt;T) in patient group (OR 9.7, P=0.01) compared with the healthy individual group. No significant difference was found in the patient group (OR 0.74, p=0.66) in the frequency of genotype and allele of BsmI (VDR 1544410 A&gt;G.). The frequency allele carrier of the (VDR 2228570) C allele was higher in the patients sub- group with high DNA damage than in the healthy individuals (OR=1.22, CI=0.02-18.9, p= 0.70). The frequency allele carrier of the (VDR 1544410) G allele was also higher in the patients sub-group with a high level of DNA damage than in the healthy individuals (OR=1.38, CI=0.13-16.8, p=0.57).<br>Conclusion: Our results suggest a significant relationship between DNA damage and the gene polymorphism FokI (VDR 228570 C&gt;T) CC and its allele C among diabetic patients. Additionally, our results suggest that the high prevalence of FokI (VDR 228570 C&gt;T) polymorphism among patients group may be a genetic marker of susceptibility for diabetes in our population</p> ARDAWAN F. ALI; DHIA J. AL-TIMIMI ##submission.copyrightStatement## http://www.dmj.uod.ac/index.php/dmj/article/view/87 Sun, 01 Dec 2019 00:00:00 +0000 NEONATAL SCREENING FOR CONGENITAL HYPOTHYROIDISM IN DUHOK GOVERNORATE (IRAQ); A PRELIMINARY STUDY http://www.dmj.uod.ac/index.php/dmj/article/view/88 <p><a href="https://doi.org/10.31386/dmj.2019.12.1.33"> https://doi.org/10.31386/dmj.2019.12.1.33</a></p> <p>Background: Congenital hypothyroidism is one of the commonest treatable endocrine diseases and can affect he growth and mental development of neonates. The neonatal screening program for congenital hypothyroidism has become a routine procedure in all developed countries and considered a monitoring tool for the early detection and therapy of hypothyroidism. In this study we investigated the prevalence and associated factors of congenital hypothyroidism in Duhok governorate of Kurdistan Region (Iraq).<br>Methods: A cross-sectional study was conducted during the period from July 2014 to February2015. Capillary blood samples were obtained from 3000 newborn babies by heel prick and tested initially for the thyroid stimulating hormone (TSH) followed by assessing free thyroxine in those with TSH level &gt;10 μIU/ml. Demographic and clinical data such as residency, ethnicity, mother age, newborn age, sex, maturity, birth weight, presence of congenital anomalies as well as related marriage and thyroid diseases of the mother were collected.<br>Results: The number of neonates having TSH level &gt;10μIU/ml was 88 resulting in a recall rate of 2.9%. Of the88 recalled neonates, 4 were diagnosed with congenital hypothyroidism (4.5%; 1 in 750 live births) and 7 with subclinical hypothyroidism (7.9%, 1 in 428 live births). There was significant association between the occurrence of congenital hypothyroidism and prematurity (p=0.04), congenital anomalies (p=0.03) and thyroid disease of the mother (p=0.03).<br>Conclusions: The study sample showed a high prevalence of congenital hypothyroidism among neonates of Duhok governorate. Appropriate neonatal screening program and monitoring are essential to reduce the irreversible health consequences of this disorder.</p> DHIA J. AL-TIMIMI; AVEEN H. MUSTAFA ##submission.copyrightStatement## http://www.dmj.uod.ac/index.php/dmj/article/view/88 Wed, 29 Jan 2020 06:24:46 +0000 HEALTH-RELATED QUALITY OF LIFE IN SICKLE CELL DISEASE PATIENTS IN AKRE, IRAQI KURDISTAN http://www.dmj.uod.ac/index.php/dmj/article/view/89 <p><a href="https://doi.org/10.31386/dmj.2019.12.1.4"> https://doi.org/10.31386/dmj.2019.12.1.4</a></p> <p>Background: Sickle cell disease is an important health problem in Akre- Iraqi Kurdistan, and this study aimed to assess health-related quality of life (HRQoL) in this condition.<br>Patients and Methods: A total of 63 patients registered as sickle cell disease at Akre thalassemia center in Kurdistan, and an equivalent number of age and sex matched healthy individuals, were recruited. The patient records were retrieved and their clinical and laboratory findings reviewed. Children and adolescent had their HRQoL assessed using PedsQL 4.0 generic score, while the Medical outcome study 36 item short form (SF-36) was used for adults.<br>Results: The mean age ± SD of the enrolled patients was 15.43 ± 8.79 years, and included 44 females and 19 males. The overall mean HRQoL in both children and adults were significantly worse than respective healthy counterparts, and adults fared worse than children. Among the predictors of low quality life were the occurrence of painful episodes, transfusion frequency, S. Ferritin ≥ 2500 ng/ml , LDH ≥ 700 U/L, and avascular necrosis of femoral head (P= 0.02 , 0.007 , 0.012 , 0.025 and 0.002 respectively).<br>Conclusions: Both children and adults with sickle cell disease at Akre thalassemia center had worse quality of life compared to their healthy counterparts. Several predictors for a worse HRQoL were identified, in the studied cohort. Further studies from other centers are necessary to have a more comprehensive view of the HRQoL in Iraqi Kurdistan.</p> DLAN AMEER TAHIR; NASIR AL-ALLAWI, VIAN MANSOUR KHADUM, ALI JASIM MOHAMMED ##submission.copyrightStatement## http://www.dmj.uod.ac/index.php/dmj/article/view/89 Sun, 01 Dec 2019 00:00:00 +0000 COMPARISON BETWEEN TENSION FREE VAGINAL TAPE VERSUS AUTOLOGUS FASCIAL SLING TECHNIQUE IN THE MANAGEMENT OF STRESS URINARY INCONTINANCE IN DUHOK CITY http://www.dmj.uod.ac/index.php/dmj/article/view/90 <p><a href="https://doi.org/10.31386/dmj.2019.12.1.5"> https://doi.org/10.31386/dmj.2019.12.1.5</a></p> <p>Background: Stress urinary incontinence is a common urogynecological problem worldwide that impact the quality of life which mandates either conservative approach or corrective surgery.<br>Objective: To compare the postoperative outcomes of tension free vaginal tape (TVT) and autologous fascial sling (AFS) in the management of stress urinary incontinence.<br>Methods: A quasi-experimental study was conducted from September, 2014 through September, 2015 at Azadi Teaching hospital and Vajeen private hospital. A sample size of 40 cases was taken comprising 23 TVT cases and 17 AFS. The recruited patients at childbearing age and menopause presented with the diagnostic criteria of stress urinary incontinence were included in the study. Patients were followed-up at 2 weeks, 3 months and 6 months.<br>Results: Patients undergone tension free vaginal tape took shorter operative time (30.63 versus 73.58 minutes) and less hospital stay days (1.87 versus 4.18 days). Both techniques have almost the same postoperative outcomes.<br>Conclusions: Both TVT and AFS have comparable efficacy and safety in the treatment of SUI with almost the same postoperative outcome in a short and medium term follow up. However, when Compared to AFS, TVT technique takes shorter operative time and less hospital stay.</p> SHAKIR SALEEM JABALI; AVEEN MUNIB MAHMOUD ##submission.copyrightStatement## http://www.dmj.uod.ac/index.php/dmj/article/view/90 Sun, 01 Dec 2019 00:00:00 +0000 IMMUNOLOGICAL AND BIOCHEMICAL PARAMETERS OF CHRONIC HEPATITIS B INFECTION AMONG PATIENTS IN DUHOK CITY – KURDISTAN REGION / IRAQ http://www.dmj.uod.ac/index.php/dmj/article/view/91 <p><a href="https://doi.org/10.31386/dmj.2019.12.1.6"> https://doi.org/10.31386/dmj.2019.12.1.6</a></p> <p>Background: Hepatitis B virus infection (HBV) is regarded as serious public health problem and approximately two billion people are infected with the virus. The presence of HBsAg with the clinical and biochemical features of hepatitis B infection reflects onset of the infection. It is sometimes very difficult to distinguish between inactive HBV carrier and patients with active HBeAg negative chronic hepatitis B. The current study aimed to measure the immunological and biochemical markers other than HBsAg in patients with chronic hepatitis B virus (HBV) attended the infectious diseases unit at Azadi Teaching Hospital in Duhok.<br>Subjects and Methods: Eighty nine chronic hepatitis B patients were included in this study from June 2015 through December 2015. Serum samples were collected from each patient and measured for HBsAg, anti HBs Ab, HBeAg, anti HBe Ab, and total Anti HB core Ab by using a rapid test (PLASMATEC One Step Multi –HBV Test Device). The HBsAg level was further tested by ELISA (HBsAg ELISA Test Kit, PLASMATEC Laboratory Products). The HBeAg &amp; HBeAb were confirmed by immune-chemilumencense assay. Levels of Alanine Aminotransferase (ALT), Aspartate Transaminase (AST), and Alkaline Phosphatase (ALP) in each serum sample were also measured.<br>Results: Out of the 89 HBs Ag positive patients 51(57.3%) were males and 38 (42.7%) were females by using ELISA test, 21(23.6%) were positive for HBeAg, and 76 (85.4%) were positive for anti-HBe antibodies by using Chemiluminescent Immunoassay (CLIA) techniques. There were 68 cases of HBe Ag negative and anti HBe Ab positive, 13 patients were HBe Ag positive and anti HBeAb negative and only 8 cases were both HBe Ag and anti HBeAb positive. Among the male patients, 10(47.61%) and 44(57.9%) were positive for HBeAg and anti-HBe antibodies respectively, whereas for the females, 11(52.40%) and 32(42.10%) patients were positive for HBeAg and anti-HBeAb respectively. Regarding the ALT, 11(12.35%) were upper than normal range in which 7 (7.9%) were elevated (40-80 IU/mL) and 4 (4.5%) were twice upper than normal limit (&gt;80). For AST, 12 (13.48%) patients were upper than normal range in which 11(12.35%) were elevated and only 1 (1.12%) was twice upper than normal range. In ALP, only 7(7.9%) of the patients were upper than reference range.<br>Conclusion: From the current study, it has been concluded that HBeAg and anti Hbe Ab are dependable indicators for the active stage of HBV replication in carrier patients when both of these variables are linked with elevated levels of serum ALT. Furthermore, most increased levels of HBsAg quantitatively were found among the early and young adults who were in the age range of (24- 44) years.</p> AWAZ A. SAADI; AHMED M. SALIH, MUAYED A. MERZA ##submission.copyrightStatement## http://www.dmj.uod.ac/index.php/dmj/article/view/91 Wed, 29 Jan 2020 06:28:34 +0000 STATUS OF SERUM MAGNESIUM IN CHILDREN WITH TYPE 1 DIABETES MELLITUS: RELATION TO GLYCEMIC CONTROL http://www.dmj.uod.ac/index.php/dmj/article/view/92 <p><a href="https://doi.org/10.31386/dmj.2019.12.1.7"> https://doi.org/10.31386/dmj.2019.12.1.7</a></p> <p>Background: Magnesium has an important role in the metabolism of carbohydrate so that it may affect the release and activation of insulin which is the hormone that controls levels of blood glucose. Different studies all over the world have found a low serum Magnesium in diabetic children with poor glycemic control reflected mainly by glycated hemoglobin (HbA1c) level. Our aim was to evaluate the serum magnesium status in children with type 1 diabetes and to assess its relation to glycemic control.<br>Methods: A case control study included 50 diabetic patients whose ages were between 1 and 18 years and 50 controls who were age- and sex-matched chosen from the siblings of the patients who visited the center during the study period. Serum Magnesium was assayed and acut off point equal to and above 1.7 mg/dl considered as normal level. The glycemic control of patients was classified according toHbA1c % as good &lt;7.5%, poor 7.5-8.5% and very poor &gt;8.5%.Data were statistically analyzed using SPSS 22.A P value of &lt;0.05 was considered significant.<br>Results: of the total patients 32% had Hypomagnesemia compared to 10% of controls. Serum magnesium level was significantly lower in diabetic children as compared to controls (p&lt;0.007). The diabetic patients in the first quartile had the lower value of serum magnesium. The remaining values, including duration of diabetes and HbA1 were comparably non-significant. A significant inverse correlation was found between serum magnesium and glycated hemoglobin level(r=-0.302, p =0.033).<br>Conclusion: Serum magnesium level is frequently low in children with type 1 diabetes mellitus. There is a significant correlation between serum magnesium level and the glycemic control. Therefore we recommend doing regular monitoring of serum magnesium in type 1diabetic children and appropriate supplement of low levels.</p> AKREM MOHAMMAD ATRUSHI; SALAM KHALID SHABO ##submission.copyrightStatement## http://www.dmj.uod.ac/index.php/dmj/article/view/92 Wed, 29 Jan 2020 06:29:00 +0000 HODGKIN LYMPHOMA AND ITS ASSOCIATION WITH EPSTEIN-BARR VIRUS IN KURDISTAN, NORTHERN IRAQ http://www.dmj.uod.ac/index.php/dmj/article/view/93 <p><a href="https://doi.org/10.31386/dmj.2019.12.1.8"> https://doi.org/10.31386/dmj.2019.12.1.8</a></p> <p><br>Background: Epstein Barr virus (EBV) has been linked to the etiology of several malignancies, including Hodgkin's Lymphoma (HL). However, the degree of this association varies between different geographical regions and age of EBV exposure. No study has addressed such an association in Kurdistan, northern Iraq, and thus this study was initiated.<br>Patients and methods: A total of 91 patients diagnosed as HL over a 10 year period were studied. These patients had their records and slides reviewed and the additional immunohistochemistry, including that for LMP1 as well as in situ hybridization for EBER performed.<br>Results: The patients had a mean age (SD) of 28.8 (16.2) years and had a male to female ratio of 1.7:1. They included 3.3% with Nodular Lymphocyte Predominant HL (NLPHL) and 96.7% Classical HL (cHL). The most common 2 subtypes of the latter were nodular sclerosis (NS) and mixed cellularity (MC) at 52.7% and 36.6% respectively. It was found that 40 cases (44.0%) were latent membrane protein 1 (LMP1) and/or EBER positive. The positivity was significantly higher in males (P=0.009), mixed cellularity subtype (P&lt;0.001) and in the ages ≥45 and ≤15 years when compared to those 16- 44 years (P=0.004).<br>Conclusion: HL in Iraqi Kurdistan demonstrates a frequency of EBV virus infection that approaches the levels seen in Western countries and is coupled with a changing histological pattern of classical HL from MC to NS. This is likely to be a reflection of the improving socioeconomic status of the population of the region.</p> RAWA YOUSIF HAMA SALIH; RAFIL T.YAQO, SARAH AL ALLAWI,, NASIR AL-ALLAWI ##submission.copyrightStatement## http://www.dmj.uod.ac/index.php/dmj/article/view/93 Sun, 01 Dec 2019 00:00:00 +0000 BACTERIAL ISOLATES AND THEIR ANTIMICROBIAL RESISTANCE PATTERNS IN NEONATAL SEPSIS RECORDED AT HEVI TEACHING HOSPITAL IN DUHOK CITY / KURDISTAN REGION OF IRAQ http://www.dmj.uod.ac/index.php/dmj/article/view/94 <p><a href="https://doi.org/10.31386/dmj.2019.12.1.9"> https://doi.org/10.31386/dmj.2019.12.1.9</a></p> <p>Background: Neonatal sepsis is one of the commonest causes of neonatal mortality in the developing world. There is a continuous change in the patterns of microbial flora and their antimicrobial susceptibility. The aim of this study was to determine the microbial agents causing neonatal sepsis, the susceptibility of these microorganisms to the commonly used antimicrobial agents at Hevi Hospital and to compare the causative agents during the last four years.<br>Methods:A retrospective study was conducted over a period of four years. From the recorded data of archives of Hevi Teaching Hospital from 2014 till 2017, a total of 1058 blood cultures were taken. The positive and negative cultures were 536 and 522 respectively. From the positive cultures, 555 pathogens were isolated.<br>Results: The present study revealed that the female to male ratio for neonatal sepsis was 1.5:1 and the most common microorganisms isolated were Coagulase-Negative Staphylococci consisting (58.5%) of cases; followed by Staphylococcus aureus (16.6%) and Escherichia coli (7.6%). The higher percentage of neonatal sepsis (30%) was recorded in 2017. There is no statistical significant difference regarding the causative microorganism for the early and late neonatal sepsis except for the Enterococcus species; with their highest percentage among late neonatal sepsis.<br>Conclusions: This study revealed that resistance against many commonly used antibiotics have been increased which limits the options for treating of neonatal sepsis. This is resulted from uncontrolled use of the antibiotics and lack of policies and guidelines for their use in public health.</p> IBTESAM SALIH ABDULRAHMAN; ABDULRHAMAN T. SAADI ##submission.copyrightStatement## http://www.dmj.uod.ac/index.php/dmj/article/view/94 Sun, 01 Dec 2019 00:00:00 +0000 MINI-PERCUTANEOUS NEPHROLITHOTOMY (MINI-PCNL) VERSUS STANDARD PCNL (S-PCNL) FOR RENAL STONE OF MORE THAN 2CM IN DUHOK GOVERNORATE http://www.dmj.uod.ac/index.php/dmj/article/view/95 <p><a href="https://doi.org/10.31386/dmj.2019.12.1.10"> https://doi.org/10.31386/dmj.2019.12.1.10</a></p> <p>Background: This research aimed to make a comparison between the mini-percutaneous nephrolithotomy (Mini-PCNL) versus standard (S-PCNL) techniques for kidney stones of more than 20mm in regards of their rates of success and complications in candidates with urolithiasisin Azadi teaching hospital and Vajeen private hospital in Duhok governorate.<br>Patients and procedures: This clinical research was performed during April 2018-April 2019. Fifty participants with renal stones larger than 2cm were assigned into two groups regarding their treatment options by PCNL, either Mini-PCNL by using nephroscope 18 Fr through 24 Frsheath, or by the S-PCNL by using 24 Fr nephroscope through 30Fr sheath. The stones were crushed with pneumatic lithotripsy.<br>Results: Our data have shown that there was no difference in the stone free rates in both groups but statistically significant differences in postoperative haematocrit level, operative time, analgesic requirement, hospital stay, and complication rate among the patients applying Fisher’s exact tests, Chi square or Student-t test as needed. In addition to the logistic regression analysis. No significant differences were seen in patient’s characteristic between the two groups with.<br>Conclusions: Mini-PCNL has similar efficacy and SFR with lower complication rates in comparison with S-PCNL.</p> IBRAHIM H. MOHAMAD SHARIF; SHAKIR SALEEM JABALI ##submission.copyrightStatement## http://www.dmj.uod.ac/index.php/dmj/article/view/95 Wed, 29 Jan 2020 06:30:19 +0000