Kirkuk Journal of Medical Sciences

Back ground: screening program is vital for the early diagnosis and treatment of developmental dysplasia of the hip (DDH) in infants to avoid disability. The aim of the current study is to audit the implementation of the program after setting up the program. 
Material and method: In between 2010-2012; a questionnaires was distributed to 280 mothers, and 120 health professionals, in order to obtain feedback about the effectiveness and the existence of preventive program for early detection of DDH in Kirkuk. During the same period, two workshops were organized for the health professionals about the screening program for DDH, the data were collected during the workshop. Also the medical notes of 200 new born baby delivered in Azadi hospital were also reviewed to determine the existence of the screening program. In order to check the effectiveness of the screening program, an audit on 32 children was performed, looking through medical files of children with DDH managed by the pediatric unit in the rehabilitation unit of Azadi teaching hospital. 
Result: The incidence of awareness of the DDH screening program was (21%) among health professional, and was (14%) among the mother. In the neonatal care unit, none of 200 newborn babies was screened for DDH. The DDH screening program was better implemented by the vaccinators. 
Conclusion: It is better to rely on vaccinators to lead the program rather than medical doctors. Referring children with risk factors to a pediatric unit, is more practical than relying on the performance of Ortolani and Barlow test, in the health centers. Yearly workshops and media awareness of DDH prevention is useful. 

Background: Inhibitor formation is a major complication of hemophilia treatment that interferes with clinical response to factor infusion and results in significant morbidity. It is estimated to occur in up to (15–25%) of hemophilia A patients treated with factor VIII. 
Aim of the study: The objective of this study is to assess factors associated with inhibitor development in patients less than15 year old with hemophilia A in children welfare teaching hospital in medical city/ Baghdad. 
Patients and methods: A retrospective descriptive study that had been performed by reviewing patients files & interviewed with those who visited the hemophilia ward in children welfare teaching hospital ,medical city , Baghdad , from the 1st of August 2008 to the 1st of September 2012. Detection of inhibitors was done by mixing study for the (258) patients with hemophilia A less than 15 year old & then Bethesda assay for those with not corrected mixing study. Then data were collected from patients with positive test for inhibitors according to a pre-constructed forma which contained clinical, laboratory finding & treatment regimens. 
Results: it was found that, from (285) hemophilia A treated patients less than 15 year old only (27 ,10.47%) patients had inhibitors, from these; the majority (26) patients (96.3%) of them had severe hemophilia A while one patient (3.7%) had moderate hemophilia A. Twenty two patients (81.5%) were high responders while three patients (11.1%) were low responders. the majority (22 ,81.5%) of our studied patients received blood and blood products transfusion before they developed inhibitor. 
Conclusion: Understanding the environmental (modifiable) risk factors responsible for increased risk of inhibitor development is essential to identify patient’s risk profile and to allow tailoring of treatment on an individual basis (thus reducing inhibitor formation risk and obtaining optimal benefit). Recommendations: The avoidance/minimization of intense FVIII exposure (possibly through early prophylaxis, and furthermore, delayed surgical procedure when possible) during the first year of life. Further research is necessary to establish the efficacy of such an approach and to ascertain further measures that may be implemented to reduce the likelihood of inhibitor development in the high-risk patients.  

Introducion&Objectives: Ventral hernia of both types spontaneous & incisional are commonly encountered in surgical practice. Despite the frequency of surgical repair, perfect results continue to elude surgeons & the rate of surgical failure may approach 10- 30%. Nowadays meshplasty is regarded as ideal procedure for hernia repair & actually primary suture repair is abandoned except for hernia with defect size of less than 2.5cm.Different types of mesh used for repair &different sites of placement described including onlay, inlay, sublay & sandwich pattern with different results. Aim of this study is to evaluate meshplasty in ventral &incisional hernia &to compare between onlay &inlay techniques in regard of operative ease, time, early& late postoperative complications. 
Design: Prospective comparative study. 
Patients and Methods: This study was conducted on (60) patients with ventral &incisional hernia admitted to surgical department of Kirkuk general hospital between the periods Feb-2010 to Feb-2013. All patients were grouped randomly into two groups: Group (1) including (30) patients with onlay meshplasty &Group (2) including (30) patients with inlay technique. 
Results: The age of the patients was ranged (22-75) years with mean age of (48.5) years. Most of the patients were at fourth decade (48.3%) (n=29). (70%) of all patients (n=42) were females & (30%) of them (n=18) were males. (66.6%) of all patients (n=40) had incisional hernia & (33.3%) of patients with spontaneous hernia (n=20). The operative time in patients of Group (1) onlay technique was (60-100) minutes compared to (50-80) minutes in patients of Group (2) inlay technique. (3) Patients (10%) of Onlay Group developed seroma, (2) patients (6.6%) had deep wound infection. None of all patients of either group had sinus or enterocutanous fistula. (4)patients(13.3%) of Onlay Group had recurrence of their hernia during(12)months period follow up but only one patient (3.3%) of Inlay Group developed recurrence during same period of follow up. 
Conclusion:-Inlay meshplasty for repair of ventral abdominal hernia is more effective& gives better results in regard of operative ease, time, early &postoperative complications. 

Background: Clinical guidelines considered important instruments to improve quality in health care. The implicating guidelines lead to reduce the non-rationally medication use, insuring the best treatment way to patients, helping best decisions choosing by physicians and protecting the patients against medical errors as the guidelines depending on evidence based medicines . The guidelines is not implicating in Kirkuk city hospitals. 
Objective: This study aimed to evaluate the knowledge and attitude of physicians to standard treatment guidelines in Kirkuk city searching for the barriers that prevent implicating it. 
Methods: 61 physicians questionnaire were completed in a prospective observational multi-center study in Kirkuk city by indicators used to investigate knowledge on guidelines, (86.8% male, 13.1% female). 
Results: The physicians who have good information were (63.9%) and (81.08%) were satisfied according to standard treatment guideline. (59.01%) choose that they want an already prepared guideline to adopt it. From over all comments, the frequent one (27.86 %) which” need team work and reevaluation”. 
Conclusion: The conclusion of this study is to implicate the standard treatment guideline, we need a committee to adopt an guidelines and revising it according to our environment. 

Introduction: volvulus is a twisting or axial rotation of a portion of bowel about its mesentery. Large Bowel Volvulus (LBV) accounts for (5%) of all organic large bowel obstructions and are most common between 50 and 60 years of ages .The reported incidence of the various forms of LBV, (59%) for sigmoid volvulus (SV), (39%) for caecal volvulus (CV) and (2%) for transverse colon volvulus. The diagnosis of acute LBV can be challenging because its clinical presentation has low specificity compared with other non-traumatic abdominal pain. Emergency surgery is the appropriate treatment for those who present with diffuse peritonitis, intestinal perforation or ischemic necrosis. 
Aim of the study: To review the comparison and benefits of emergency operative procedures in the treatment of patients with acute large bowel volvulus in the emergency setting. 
Place and Duration: Department of General Surgery at Azadi-teaching hospital in Kirkuk city from December 2008 to December 2013. 
Patients and Methods: Total 48 patients; 31 male (64.6%) and 17 female (35.4%) (95.8%) patients were over 55 years of age. were included in the study of which 41 (85.4%) diagnosed preoperatively with acute sigmoid volvulus on emergency laparotomy. The remaining 7 patients (14.6%) with caecal volvulus. The choice of surgical procedure depended on the; large bowel viability, time of presentation following onset of obstructive features, extent of proximal colonic dilatation, co morbid diseases and surgeon’s preference. For acute sigmoid volvulus; 11 patient (27.2%) patients underwent sigmoid resection with primary anastomosis (RPA), 18 patient (43.9%) underwent Hartmann’s procedure and 12 patients (29.3%) operated by sigmoid resection with Paul-Mikulicz. For caecal volvulus; Right hemicolectomy performed for three patients (42.9%), caecopexy in two (28.6%) and caecostomy in other two patients (28.6%). Results: Abdominal distension and constipation occurs in all patients (100%), while (95.8%) presented with abdominal pain and peritonitis in (79.2%) (41.5%) has a previous history of bowel decompression either by endoscopic instruments or deflation by rectal tube with a recurrence rate of (76.0%). Chronic medical illnesses are found in most of the patients. LBV is presented in two forms sigmoid (85.4%) of cases, the rest (14.6%) with caecal volvulus. (33.4%) of cases presented with gangrenous colon while bowel perforation (fecal peritonitis) in (4.2%). The operative procedures ;- one stage Resection with Primary Anastomosis in (26.8%) of patients , two stage operative procedures resection of the volvulus sigmoid with (Hartmann and Paul-Mikulicz done in (73.2%), in caecal volvulus right hemicolectomy (with ileo-transverse Anastomosis done for (42.9%), caecopexy (28.6%) and Caecostomy for 2 patients(28.6%) patients. Postoperative complications; Wound infection in (31.3%) of cases. Anastomotic leak (12.5%). Total mortality occurs in 10 cases (20.8%). 
Conclusion: In acute LBV emergency surgery is indicated, Hartmann’s procedure is the procedure of choice. The presence of cardiac, renal, or respiratory diseases has a significant impact on the complications, morbidity and mortality of patients undergoing surgery for large bowel volvulus. 

Background: Cigarette smoking is a broadly recognized health hazard and a major cause of mortality but still people continue to smoke cigarettes on a regular basis. Tobacco has numerous carcinogens and mutagens which have deleterious effects on human beings. Effect of carcinogens has been observed to be more on rapidly dividing cells which include germ cells. The maximum prevalence of smoking is observed in young adult males in the reproductive period.
Aims and objectives: To compare different seminal fluid parameters among smoker and non-smoke, to know the effect of cigarette smoking on sperm counts, motility and morphology, and the difference in seminal fluid variables between smokers and non – smokers.
Patients and Methods: The case - control study performed from May 2015 to December 2015 carried in laboratory of Rizgary Teaching Hospital in Erbil city and a questionnaire prepared for each case. Only patients with primary infertility, who were either smokers or strict non-smokers, were selected and the non - smoker considered as control group. The selected study group of 100 smokers and 100 strict non - smokers had only one known factor which differentiated them, i.e. cigarette smoking and the duration of smoking was determined by 5 years. A semen specimen was collected after 3days of abstinence period, in a wide – mouth, clean and sterile container. All semen samples were analyses for semen parameters: liquefaction time, volume, viscosity, motility, sperm concentration, morphology and number of pus cells in the sample.
Results: The mean age of both non –smoker and smoker were 33.28 and 34.89 years respectively with maximum and minimum age were22and 45years respectively with the mean duration of infertility for smoker 6.85 years and for the non-smoker was 7.24 years. There were a significant difference in seminal fluid parameters which includes the Ph, viscosity, sperm count, sperm motility, morphology and pus cells in seminal fluid between the smoker and non - smoker while there were no significant difference in volume. There was significant difference between the two groups regarding seminal fluid variable which includes (Normozoospermia, Asthenozoospermia, Oligoasthenozoospermia, Oligoasthenteratospermia Asthenoteratospermia, Teratizoospermia and Oligozoospermia) with p value (P<0.000).
Conclusions: The smoking has bad effect on seminal fluid parameters and there was a difference between the two groups and the smoking can affect and reduce the fertility of the male. Smoking can be a cause of infertility in males especially those with idiopathic infertility.

Background: The clinical ethical process of shared decision making is mirrored by the legal doctrine of informed consent. The current practice of the process of consent taking in one of Iraq’s hospitals is audited in the current paper. 
Methods: The consent taken from a random sample of 240 adult patients undergoing surgery in the surgical ward of Azadi teaching hospital was studied, medical records was reviewed and a questionnaire as to the effect of consenting was distributed on the patients. 
Results: The consent was taken by a nurse in (76.6%) (184 patients) of cases, there were only 4 consent forms signed by the patients themselves, and only (40%) of patients had the consent taken 1-2 hours before the operation, the remaining had the consent taken at the time of operation. 40 patients (16.6%) had some verbal clarifications of the operation. Three months after addressing the defects in consent taking and despite an administration letter of the chief executive of the hospital highlighting the importance of the consent, the practice was only (10%) better. 
Conclusions: There is a serious defect in obtaining a proper consent forms in one of Iraq’s hospitals. This should be looked at by the ministry of health and the current practice amended.