Kirkuk Journal of Medical Sciences

Abstract
•Septal deviation is acommon disorder affect sinus pathology
•Design of study : prospective study
Objective
• Rate of each type of septal deviation .
•Morbidity of septal deviation .
•Associated sinonasal pathology .
Patient and methods
•About 150 patients. collected from out patient clinic from AL.Yarmouk teaching hospital from April 2017 till Augest 2018 who complain from nasal obstruction, nasal discharge, facial pain others for at least 3month, patients presented without previous diagnosis.
•All patients collected due to symtomatic septal deviation, then examination done either by ant. Rhinoscopy using head light and killian nasal speculam, endoscopy rigid type 4mm (00&300) and fibroptic (nasopharyngeal)
•Doing C.T scan for each patient to observe change in each type on paranasal sinuses ,the shape of deviation which seen by endoscopy and exclude other nasal and paranasal pathology
• Data collected in questioner or statistic reading method using P.value .
• Observe rate of each type ,morbidity of septal deviation consequence of pathology of each type regarding of sinuses
Results
• In this current study for 150 case symptomatic septal deviation we observe :
• C-shape (91)60.6%
• S-shape (59) 39.3%
• we found 70 case associated with sinus pathology
• C-shape=32case 45.8%
• S-shape =38case 54.2%

Conculosion
• Deviated nasal septum associated with significant sinonasal disease especial S-shape DNS which show statically significant correlation with sinus disease .
• Nasal obstruction are the main complain of septal deviation .
• Bilateral sinus disease more associated with S-shape &unilateral sinus disease with C-shape .

Background: pilonidal sinus(PNS) is a chronic disease that mostly affects young adults. describes a hair-filled cavity in the subcutaneous fat of the post sacral intergluteal region, known as the natal cleft , its name arises from the Latin terms “pilus” and “nidus” meaning a nest of hair PNS can be asymptomatic, or may be present as a recurrent abscess or as chronic inflamed cavity and local discharge from sinus or sinuses and local pain and discomfort .
retrospective study was done from (November 2017 to November 2018) at surgical department in Kirkuk General Hospital in 50 patients with recurrent PNS all will be treated with Limberg flap then follow up for one year this surgery done by excision of PNS till we reach fascia overlying sacrum inferiorly and laterally till we reach gluteal fascia and dissection was performed with electro cautery and reconstruction done by flap (Limberg flap) from gluteal area
in 50 patient with recurrent PNS we have 45 (90%) were male and 5 (10%) were female ,30 patient (60%) patients had a familial history of PNS and 42 patients(84%) with etiology-related risk factors to develop PNS then we divided them according first time surgery done either, by excision and primary closure 30 patient(60%) or excision and healing by granulation tissue and secondary intension 20patient (40%)

SUMMERY:
Prospective study involved 63 patient admitted to kirkuk pediatric hospital from 15/5/2008 to 15/7/2008 collectively patients submitted to all required investigations TSB level , complete blood picture, reticulocyte count direct coombs test via two methods antihuman globulin test and old standard technique of o cell technique ,the most common cause of neonatal jaundice among them was physiological one and ABO incompatibility being the next common one male patients were the commonest among these patients ,blood group of most of patients was Followed by b ,being the mothers blood group o was the predominant one in this study, this disease was mostly seen in low birth patients (200mmole/liter) noticed among these patient
We concluded that ABO incompatibility is a well documented cause of neonatal morbidity in this city finally we recommend performing reticulocyte count , complete blood picture ,total serum bilirubin and direct coombs test in every patient with blood group A or B and mother blood group o sine a lot of complication can be prevented by diagnosing this serious illness.

Retrospective study, carried between January 2001, and August 2006, Ninety four children (c 15 years of ages) were diagnosed as AML by bone marrow examination (aspirate and sometimes biopsy), twenty two of these children diagnosed as APL, fourteen were treated by chemotherapy and eight of these children treated by ATRA and specific protocol.
The information of this study was obtained from files of patients in hematology and oncology unit in central teaching hospital from children regarding age, sex, resistance, type of AML, complete blood count at diagnosis, response to treatment complication during treatment.
The treatment plan of these eight patient in induction was ATRA (25 mg/m2/day) administrated orally in two equally divided doses associated with daunorubicin (25 mg/m2/day) for two consecutive day only for those with WBCc >10 ×109/L at day one, WBCc > 5×10 9/L at day fifteen at which bone marrow aspiration done this cycle continued for thirty day. In consolidation cycle which includes cycles of daunorubicin stander dose cytorabine by subcutaneous injection with ATRA orally in two divided doses. Oral 6- mercaptopurine and methotrexate combined with ATRA every 3 month was administrated to all patient who obtained complete remission (CR) (

Background
Iraq's health-care system has faced tremendous obstacles in its recovery from the Islamic State's conflict. Iraq has set targets to prevent and control noncommunicable diseases (NCDs) such as diabetes, but safety confrontation and governmental insecurity have made these objectives difficult to achieve. Better glycemic control is critical in allowing patients to perform at their best in terms of diabetes management and preventing long-term complications.The goal is to identify the roadblocks to better glycemic management.The participants in this cross-sectional study were recruited from a diabetes out-patient clinic at Baba Gurgur diabetic facility. From April to December 2019, K1 hospital – North oil company in Kirkuk city. A validated questionnaire was used to interview those with an uncontrolled glycemic index (AIC7%). Patients were asked to name the primary causes of inadequate glucose control and to select more than one response based on their opinion.The mean A1C was 8.3 2.1 percent, with 256 (22.5 percent) patients having an A1C less than 7% and 880 (77.5 percent) having an A1C equal to or greater than 7. Poor glycemic control is caused by a lack of medication and/or a lack of drug supply from PHC in 51.1 percent of cases. Diet and medication non-compliance, as well as illiteracy,. Glycemic regulation is greatly influenced by one's financial situation. However, security issues and political instability play a significant impact.Conclusion: Diabetic patients confirmed poor glycemic control, with the majority of cases being linked to Iraq's current health situation.
key words :- Diabetes Mellitus, Management, and Iraq are.

Abstract
There is increasing evidence that the 2019 coronavirus disease (COVID-19) is considered as a potential trigger virus for the development of diabetes mellitus in children. This can occur even in patients without factors predisposing to impaired glucose metabolism like obesity . Here, we report a rare case of diabetic ketoacidosis revealing new-onset diabetes and precipitated by COVID-19. The relationship between type 1 diabetes mellitus and COVID-19 is discussed. Results: A 13 years old girl developed symptoms suggestive of diabetic ketoacidosis preceded by polyuria, polydipsia, and lethergy. There is a documented COVID-19 infection in her parents . An asymptomatic infection was detected on the basis of a reverse transcription polymerase chain reaction (RT-PCR) . she responded well to treatment, including rehydration regimens and intravenous insulin. On the 4th day of her hospitalization, she was transferred to several injections of subcutaneous insulin with therapeutic and nutritional education from the parents. Conclusion. COVID-19 can induce acute onset diabetes and diabetic ketoacidosis in children. More research data are needed to improve our knowledge of this constellation and to guide the most appropriate therapies.

for estimation the prevalence of osteoporosis and osteopenia amidst Iraqi postmenopausal females turning up the Azadi Teaching Hospital's Diabetes and Endocrinology clinic, as well as the relevant venture agents. A descriptive cross-sectional treatise was carried out in a diabetic and endocrinology clinic in Kirkuk, Iraq. An aggregate of 1085 Iraqi postmenopausal females at age 45 to 84 years old were enrolled in this study, which took place between April 2019 and April 2021. The bone mineral density of all patients was measured using a dual-energy X-ray absorptiometry (DEXA) scan. According to World Health Organization recommendations, the DEXA scan was explicated in idioms of T score. Osteoporosis and osteopenia were found to be prevalent in 37.5 percent and 44.6 percent of the population, respectively. The lumbar spine had the highest incidence of osteoporosis (32.40 %), chased via the left femoral neck (14.40 %), and the left femoral neck had the highest frequency of osteopenia (56.10 %), the lumbar spine (41.30 %). Extended menopausal scope, ordinary or overweight BMI, elevated parity, corporal inactivity, affirmative family history of osteoporosis, inconvenient sun exposition, elevated diurnal cafe utilization, low diurnal utilization of calcium, with delayed menarche age were whole linked to osteoporosis. Females with type 2 diabetes, on the other hand, had a decreased incidence of osteoporosis. Iraqi postmenopausal females have a significant frequency of osteoporosis and osteopenia. More generic instruction plus a better publicizing of knowledge about osteoporosis and its prohibition are required

Abstract
Background: Generalized anxiety disorder is characterized by chronic and persistent worry which is multifocal, excessive, and difficult to control, and accompanied by nonspecific psychological and physical symptoms. Objectives: Determine the proportion of GAD, evaluate clinical symptoms with socio-demographic data and determine whether such patients have co-morbid mental illnesses. Methods: this cross sectional study was conducted at Baghdad teaching hospital, 263 patients included; the study took 17 weeks starting in June 2021 till mid October 2021. Results: 2.6% of patients (7 patients from 263) found to have GAD, men and women were almost equally affected, most of the patients were employed and married, had secondary school achievements and all of them were from urban areas. Restlessness and irritability were the most frequent symptoms and sleep disturbance was the least among other symptoms. Depression was the most frequent comorbid illness; other anxiety disorders and personality disorder were the least comorbidities. Conclusion: The proportion of GAD is slightly lesser than other studies, higher proportion seen in older adults than the younger patients, common symptoms of GAD are also seen in other psychiatric disorders leading to under-diagnosing of the illness, and mental health comorbidities are high among patients with GAD, mainly depression.

ABSTRACT

Background: Pre-eclampsia affects about 2–8% of all pregnancies. It is one of the leading causes of maternal and perinatal morbidity and mortality hyperhomocysteinemia is considered as a risk factor for endothelial dysfunction and vascular disease. The vascular changes induced by homocysteine are similar to those with pre-eclampsia.

Aim of study: To identify the relationship between maternal serum homocysteine and pre-eclampsia.

Methods: A case control study t carried out in the Department of Obstetrics and Gynecology at Azadi Teaching Hospital in Kirkuk-Iraq, from 1st of Feb. till 1st of oct.. 2021. included 80 pregnant women, singleton viable pregnancy, gestational age of > 20 weeks. divided into two groups: Case group included 40 pregnant who had diagnosed as preeclampsia (mild and severe) and control group included 40 healthy normotensive pregnant Patients with multiple pregnancy, history of medical disease or tacking treatment for hypertension were excluded. Blood sample was taken from each woman for biochemical study, serum homocysteine level was measured using ELISA technique.

Results: In this study, pregnant women with pre-eclampsia had significantly higher mean of serum homocysteine compared with controls. Homocysteine level > 8.95 μmol/l is a predictor for pre-eclampsia. Out of 40 women with pre-eclampsia, 42.5% were mild; while the remaining 57.5% were severe. Pregnant women with severe pre-eclampsia had significantly higher mean of serum homocysteine compared to those with mild pre-eclampsia.

Conclusion: Maternal serum homocysteine biomarker represents an early non-invasive marker for diagnosis of preeclampsia and to name disease according to the severity.

Background: Most of the mental health illnesses in psychiatry have chronic relapsing course.
It is estimated that the readmission rate for discharged patients is approximately 40-50%
within one year of their discharge from the hospital [1]
Aim: understand the relationship between the duration of first admission in the hospital
and rates of readmission in a psychiatric hospital.
Materials and Methods: Collect all the patients admitted to Ibn rushed psychiatric hospital
in Baghdad for the first time between first of January, 2018 to first of May, 2018, were
included in this study. The hospital records of these patients were examined and the data was
collected on various variables, which included demographic variables, duration of hospital
stay, diagnosis, and the number of readmissions for a period of approximately three years.
The duration of the first hospital stay was divided into three categories, Group 1: 1-7 days,
Group 2: 8 to 14 days, Group 3:15 to 30 days.
Results: The whole sample whom entered and accepted in the study consisted of 200
patients. There was 133 patients belonged to Group 1 (1 to 7 days), 53 patients in Group 2 (8
to 14 days) and 14 patients was belong to Group 3 (15 to 30 days).
Conclusion: The length of the initial hospital stay is the only important predictor to prevent
future hospitalization. No other definite predictors for readmission that could be detected in
the study except for the length of stay in the initial admission.
Key words: First admission, readmission, psychiatric hospital

Abstract:
Objectives: Diabetes mellitus is one of the greatest health threats of recent times for global population,T2DM is associated with atwo to four excess risk of cardiovascular disease, Serum lipids are frequently abnormal and are likely to contribute to the risk of coronary artery disease,and there an 18% increase risk of cardiovascular disease for each 1% increase of HbA1c in diabetic population,
Method: this is across sectional study which was carried out on 100 diabetic patients ,62 male and 38 female with age from 38-75yrs,after fasting of at least 8 hours,fasting blood sugar,HBA1C and lipid profile were measured.
Result:patients were divided into two groups;the controlled group with HbA1c of 7% or less, and uncontrolled group with HbA1c of more than 7% ,the controlled group include 28% of the patients while the uncontrolled group include 72% of the patients with mean age of 50.50+_12.60 and 53.94+_7.99 respectively, with no significant difference(p-value=0.187), while there was significant difference in lipid profil between the two groups,
• Conclusion: most diabetic patients are uncontrolled and dyslipidemic, and HbA1c is used as adual marker for dyslipidemia and diabetic control.

Objective: Some periodontal bacteria on tooth plaque were shown to be sensitive to extracts from Syzigium aromaticum and Salvadora persica. Our study was an assessment of the antimicrobial effect of Syzigium aromaticum and Salvadora persica extracts against dental plague pathogens.
Materials and Methods: Thirty-five 35 oral swabs were taken from the patients who had the dental plague and isolated microorganisms were identified by standard bacteriological methods. Syzigium aromaticum and Salvadora persica extracts were tested against dental plaque microorganisms on Muller Hinton agar, antimicrobial activity of the two extracts was done by paper disks-diffusion technique at 50% concentration and characterized by inhibition zones.
Results: Forty-six (46) microorganisms were isolated from 35 dental plague samples,18 isolates were Staphylococcus aureus, 3 isolates were Staphylococcus epidermidis, 6 isolates were Streptococcus mutans, 12 isolates were Streptococcus viridans, 1 isolate each of Pseudomonas aeruginosa., Proteus spp., Bacillus spp., 2 isolates were Actinobacillus actinomycetemcomitans and 2 isolates were Candida albicans. The zones of inhibition for two different extracts were measured. According to the findings, Syzigium aromaticum and Salvadora persica have antibacterial and antifungal effects against gram-positive and gram-negative bacteria, as well as fungi.
Conclusion: Our study has shown that Syzigium aromaticum and Salvadora persica extracts have antimicrobial efficacy and concluded that the extracts have shown a greater effect on oral microorganisms and are recommended to be used for treatment and prevention against oral hygiene.

Background : Intracranial hypertension is a common life and vision threatening condition, intracranial pressure (ICP) can only be measured by invasive procedures. Distension of optic nerve sheath in association with raised ICP has been proven by the clinical trials. Transorbital sonographic measurement of optic nerve sheath diameter (ONSD) can be a simple noninvasive method for detection of raised ICP, however until now there is no consensus on upper normal limit of ONSD.
Aim of the study : Measurement of optic nerve sheath diameter (ONSD) in healthy adults to provide normative data in a sample of Iraqi population.
Method : an observational cross-sectional study was conducted in IbnAlhaitham eye teaching hospital, Baghdad, Iraq. Both eyes of 98 healthy adult volunteers aged 19 to 77 were examined using Absulu ultrasound machine with 20 MHz annular probe. Two measurements of ONSD was taken 3mm behind the eye globe and the average was calculated.
Results : Optic nerve sheath diameter measurements ranged from 3.78mm to 7.13mm.The mean was 5.54mm with standard deviation of 0.59mm and a median of 5.56mm. The 95% percentile was 6.53mm. There was no statistically significant relationship between ONSD measurement and gender or age.
Conclusion : The mean ONSD measured by transorbital ultrasound was 5.54mm and the upper normal limit was 6.5mm (95% percentile) in a sample of Iraqi population.

Background: The relation between H. pylori infection and Viral Hepatitis has been subjected to substantial research in recent years, however, this relationship has not been comprehensively studied in Al Sulaymaniyah.
Objectives: Investigating the association between HBV infection and the H. pylori infection
Methods: A case-control study using data from 130 participants, from January 2020 to March 2021. Data is divided into two groups, a study group which consists of 65 persons of confirmed hepatitis B infection via PCR, and a control group of 65 persons with confirmed Hepatitis B negative by Hepatitis B surface antigen test, we have used stool antigen test to confirm the presence or absence of H. Pylori infection in both groups.
Results: 32% of the study group is infected with H. pylori and 15% in the control group have been tested positive for H. pylori infection. The regression analysis results reveal strong evidence that HBV infection increases the likelihood of H. pylori infection. This relationship is very robust and consistent even after controlling for a vast number of variables as confounding and medical factors.
Conclusion: Patients with HBV infection are more vulnerable to H. pylori infection.

ABSTRACT

Background: Asthma is one of the most common chronic diseases globally and has been increasing in prevalence over the last few decades.
Asthma is a syndrome characterized by airflow obstruction that varies markedly, both spontaneously and with treatment.


Aim of study: To assess the serum Magnesium levels in bronchial asthma patients in relation to severity stage.

Patient and methods: A case control study conducting at Baghdad Teaching Hospital at Baghdad Medical City complex of a fifty patients were diagnosed as bronchial asthma according to GINA guideline and fifty healthy individuals as a control group.


Result: Serum Magnesium levels were lower in asthmatic patients (36%), compared with healthy controls(4%), and significantly lower in asthmatic patients during exacerbation compared with stable asthmatics.

Conclusion: Serum Magnesium levels have a positive correlation with the level of symptom control in asthma. In uncontrolled asthma, serum Magnesium is significantly low. Hence, it might be useful as a biomarker in assessing control or severity of asthma.

Developmental Dysplasia of the hip is common problem , both severe acetabular dysplasia and proximal femoral ante-version are the main pathology that should be managed as early as possible .

Patients and Methods
Between June 1994 and December 2018 , a total of 626 hips with Developmental Dysplasia were treated according to their age at presentation .

Results
In 110 hips ( out of the total 132 hips , underwent surgery ) treated by open reduction with or with out salter innominate osteotomy , the following results were achieved :

A – In all these cases , there was severe degree of femoral ante-version ( Intra-operative evaluation ) and this was found in 100% of the patients with developmental dysplasia ( D . D . H ) , specially in those children above 2 years of age .

B – Open reduction with Salter Innominate Osteotomy gave excellent results in 72 hips within the age group 18 month -2.5 years . There was no indication for femoral shortening to be performed in these patients .



CONCLUSION
In all children with developmental dysplasia of the hip younger than 2.5 years of age, there will be spontaneous correction of femoral ante-version and there was no indication for de-rotational osteotomy of the proximal femur even in extreme degree of femoral ante-version .

Background
Neonatal jaundice is a common cause of neonatal admission to the hospital. The neonatal jaundice frequency has been increased last decade. 65% of term babies develop jaundice clinically in 1st week (in preterm babies 80%).
Methods
One hundred and sixty four neonates with severe hyperbilirubinemia, were enrolled in this study. Most important relevant informative data was taken during admission to the hospital. American Academy of Pediatrics (AAP) guidelines were applied in management of the patients, which was been either phototherapy or exchange transfusion with phototherapy
Results
MeanTSB level of 164 cases was 16.6mg/dl. TSB was significantly high in the male, with Rh-ve mothers and Rh+ve babies, more than 37weeks gestational age, admitted after 72 hours of life, were having history of previous siblings affected with jaundice and or received phototherapy and family history of hemolytic diseases. Phototherapy alone was used as treatment modality in most of the patients. On admission to the NCU, the mean age of the infants who needed exchange transfusion 4.97 ±2.24 while the mean TSB level was 20.2±2.84 mg/dL. The most common cause for ET was early discharge from the maternity unit & late admission to the NCU 72.4%.
Conclusions
Severe hyperbilirubinemia was been more common in male neonates, > 37weeks of gestational age, with Rh-ve mothers and Rh+ve babies, who admitted after 72hrs of life, . Most of cases treated by phototherapy. The most common cause for ET was early discharge from the maternity unit & late admission to the NCU.

Abstract:
Background and objectives: When the patella is fractured it should be repaired and patellectomy should be avoided as much as possible even in comminuted fractures. In comminuted patellar fractures, a combination of cerclage wiring and tension band fixation is confirmed to provide good mechanical stability.

Patients and methods: Forty- six patients underwent surgical stabilization for comminuted patellar fracture between year 1996 to 2016 .
All fractures were classified as 34-C3 according to the Orthopaedic Trauma Association classification. All the patients were underwent open reduction- internal fixation with combined Cerclage and tension band wiring technique.
Results: Fracture healing was occurred within an average of 3- 5 months, while in bilateral cases it was 4 - 8 months. Full range of knee movements was seen in 42 ( 91.3 % ) cases and knee flexion more than 120º was seen in 4 ( 8.7 % ) cases. Quadriceps power was normal in 44 ( 95.6 % ) cases but 2 cases had quadriceps power of grade-IV. No extensor lag and no quadriceps atrophy was seen in any cases . Forty four ( 95.6 % ) patients could squat fully and two ( 4.3 % ) patients could squat up to half of the normal level. All patients were able to climb up and down stairs without any problem.



Conclusion: This study had concluded that combined Cerclage and tension band wiring technique was a successful surgical treatment for comminuted fractures of the Patella.

The National Council for Accreditation of Medical Colleges (NCAMC) has made some progress towards accrediting Iraqi medical schools. However, to date, NCAMC is not internationally recognized by the World Federation for Medical Education (WFME) which fulfils the requirements of the ECFMG’s Recognized Accreditation Policy (due for initial implementation from 2024). The policy requires that a medical school must achieve a recognized accreditation status by a recognized accrediting agency that in itself is recognized and reviewed by an external quality assurance organization. When the policy is fully implemented, only medical schools accredited in line with the Recognized Accreditation Policy will satisfy the requirements of the ECFMG. Medical graduates intending to pursue work, training, registration, research, volunteering or other opportunities are required to apply for verification of their primary medical qualification (PMQ). Certification and verification of PMQ for international medical graduates (IMGs) in the United States, Australia, Canada, Ireland, New Zealand, and the United Kingdom and an increasing number of countries globally is done via the ECFMG’s online system known as Electronic Portfolio of International Credentials (EPIC). Therefore, the future of Iraqi medical schools’ education standards is at stake as they do not meet the international standards risking the future of new graduates. The Ministry of Higher Education, universities, medical colleges and the Iraqi Medical Association (IMA) need to collaborate with the NCAMC to get it recognized by the WFME in order to safeguard Iraqi medical education and the future of new doctors from 2024.