Kirkuk Journal of Medical Sciences

Background: Patients with thalassemia major are at high risk of hepatitis C and B due to the blood transfusion from donors infected by HCV and HBV. Hepatitis C virus (HCV) is the major cause of post-transfusion hepatitis infection (PTH). Objective: The aim of this study is to detect the prevalence of anti-HCV antibodies and HBs Ag and risk factors in multitransfused thalassemic patients in Kirkuk city to establish better preventive strategies. Patients and Methods: This study is conducted in Kirkuk city from Nov 2012 to March 2013 for HCV and HBV infection. A structured interview questionnaire is developed by the trained researcher to collect the demographic and risk factors. Statistical analysis was done by Chi-square test. Results: The prevalence of HCV is estimated to be (17.8%) and this is increased with increasing the requirement for blood transfusion in splenectomized patients while only (2.0%) is positive for HBV infection. Conclusion: The study shows a higher prevalence of HCV infection among multitransfused thalassemic patients with increasing requirement for blood transfusion in splenectomized patients.

Objectives: This study aimed at evaluating the surgical management of bilateral developmental dysplasia of the hip (DDH), reducing both sides of the hips in one or two different stages. Patients and Methods: A retrospective sequential comparative study on children with bilateral DDH was carried out in the Azadi Teaching hospital of Kirkuk, in between October 2009 and June 2013. There were two groups of patients. The first group consisted of 10 children (20 hips), with a mean age of 26 months (12-36 months), treated by open reduction of the DDH performing the procedure on each hip at two different occasions. The second group of 13 children with bilateral DDH had a mean age of 26 months (12-48) months, were treated in a single-stage; openely reducing both hips in the same operative session. In the first group in addition to the open reduction of the hips, 8 patients required Salter osteotomy, and 3 patients required femoral shortening in order to achieve concentric stable reduction. In the second group, shortening of four femori, Salter osteotomy of 12 acetabulae was performed for the same purposes. At a mean follow-up of 28 months, clinical and radiological assessment was carried out. Modified McKee and Severin criteria was used, the assessment also included analysis of the operative time, the amount of blood loss and transfusion, duration of analgesia, and record of the complications. Results: There were no significant differences between those who underwent open reduction of the hips with respect to mean age, gender, pre- and postoperative acetabular indices. Mean duration of anaesthesia, analgesia, and the amount of blood transfusion was more in patients of group two compared to group one. Rehabilitation and physiotherapy was needed more in group one. Mean improvement of the acetabular index was 10 degrees in both groups. Conclusion: Single-stage bilateral open reduction of DDH with or without bony surgery in patients with bilateral DDH is safe.

Objective: To reduce early post-tonsillectomy pain by using local anesthetic agents and encouraging early swallowing and decreasing the risk of dehydration, infection and secondary bleeding. Patients and Methods: This study was undertaken on 99 patients (for whom tonsillectomy done under general anesthesia), between ages of 8 - 42 years, to compare the efficacy of topical application of (4%) lignocaine, (0.5%) bupivacaine, and normal saline in reducing postoperative pain after tonsillectomy. Patients were divided into 3 groups, each group composed of 33 patients. Group I, in whom (0.5%) bupivacaine was used, in group II (4%) lignocaine was used, and in group III (control group) normal saline was used. After removal of both tonsils, a gauze measuring 2.4 centimeter square mixed with 2.0 ml of either (0.5%) bupivacaine, (4%) lignocaine, or normal saline according to the group was kept in both tonsillar fossae for a period of 5 minutes. Postoperative pain was assessed using the Wong - Baker Faces pain rating scale up to a period of 24 hours after surgery. Results: There was a significant difference in pain intensity between the control group and the other groups in first, fourth, eighth, and twenty fourth hours postoperatively (p<0.05), but not in second hour (p>0.05). The accumulated scores for pain, dysphagia and difficulty in speaking were significantly lower in groups I (bupivacaine) and II (lidocaine) as compared to group III (normal saline) (p <0.05), while scores of group II were significantly lower than those in group I (p<0.05). Conclusion: Topical application of (4%) lignocaine and (0.5%) bupivacaine in the tonsillar bed is a safe and effective method of reducing postoperative pain following tonsillectomy that if not treated may devoid the patient from swallowing and lead to dehydration, infection and secondary bleeding. Study design: A single blind prospective comparative clinical study.

Background: Working in the mortuary, where there is human dissection, is emotionally painful. In Iraq, the condition is not good because of the nature of the mortality, the incidence and the gender factors; we analyse this, in the current paper. Patients and Methods: A Depression Anxiety Stress Scale 21(DASS 21) Arabic version Scale was performed on 20 staff working in the mortuary of Azadi Teaching Hospital in Kirkuk city-Iraq. There were 20 workers, the sex ratio for male: female was 14:6. The DASS 21 scale is a quantitative measure of distress along 3 axes of depression, anxiety and stress among otherwise normal population; it is not a categorical measure of clinical diagnoses. Results: The impact of dealing with dead bodies, victims of violence in the war area, seems to have affected both genders in general. The female gender, however, seems to have had the psychological state worse affected, and among the 3 categories, there was higher incidence of depression among the female gender. Conclusion: The health authorities need to monitor the mortuary staff psychological profile on regular basis and find means to reduce the incidence of depression, anxiety and stress, especially among the workers. The occupation is associated with psychological distress especially among female gender.

Objectives: This study was planned to show the mode of presentation of children under six years of age with acute appendicitis and to increase the awareness of general, pediatric surgeons and other health care professionals about the magnitude of the problem so that to improve diagnostic accuracy and to avoid detrimental effects of delay in diagnosis and effective surgical management. Patients and Methods: The study included (67) children with clinical suspicion of acute appendicitis admitted to emergency department of Kirkuk General Hospital from January 2008 - June 2012. Their age ranged (3 – 6) years (Mean age 4.5 years). (39) Males and (28) females. (M: F was 1.4:1). All had appendectomy as an emergency setting. The presentation, diagnostic work up and operative findings were studied. Results: The main presenting symptom was abdominal pain 62(92%) followed by vomiting which was seen in 53(77%) of our patients. Other symptoms were change in bowel motions, anorexia, abdominal distension and fever. The most common physical sign elicited was localized tenderness at right lower quadrant 64(95%) while guarding was present in nearly half of our patients 36(53%). (41) Children had urgent appendectomy as diagnosis of acute appendicitis was clear and in the remainder (26) children a period of active observation and serial examinations with completion of diagnostic work up were needed before surgical intervention. Conclusion: Acute Appendicitis in preschool children under six years of age needs special consideration. About one third of them have atypical presentation, physical signs are difficult to be elicited. A period of active observation in needed in most of them to complete diagnostic work up. Every effort should be directed towards improving the diagnostic accuracy and performance of effective surgical management to reduce morbidity and mortality and to decrease negative appendectomy rate and to avoid risks of unnecessary surgery

Background: Prophylactic antibiotics have been shown to be effective in reducing the incidence of febrile morbidity associated with surgical operations. Surgical site infections (SSI‘s) account for approximately (15%) of nosocomial infections and are associated with prolonged hospital stays and increased costs. Aim of the study: To evaluate the efficacy of prophylactic antibiotics in reducing the incidence of postsurgical wound infection. Objective: (1) - To improve the outcome and reduce the time stay at the hospital. (2) - To determine the independent risk factors for postsurgical infection. (3) - To decrease the incidence of postsurgical wound infection. Study Design: A prospective comparative study. Place and Duration: Department of surgery-Azadi Teaching Hospital/ Kirkuk, from June 2007-December 2012. Patiens and Methods: 600 patients undergoing surgical operations were enrolled in this study and classified into two groups: male 327, (54.5%) and female 273, (45.5%). GROUP 1:- 300 patients received parental prophylactic antibiotics. M; 181, (30.2%), F; 119, (19.8%) GROUP 2:- 300 patients not are receiving prophylactic antibiotics. M; 146, (24.3%), F; 154, (25.7%). Both groups were followed for any sign of infection up to 2-3 weeks. Results: The rate of infection in the emergency surgeries was (13%) significantly higher than that in the planned and elective (4%) surgeries. The infection rate was seen to be the maximum, with prolonged stay at the hospital, (11.7%) more than three days in group1, and (21%) days in group 2 when more than three days duration of the post-operative hospitalization. There was a significant increase in the rate of infection as the duration of the surgeries increased (13.8%) if lasting for more than two hours. Patients with comorbid disease have higher IR (51%) in comparism with non co morbid patients. Conclusion: the use of prophylactic antibiotics therapy is satisfactory in our surgical environment; this practice would be efficient, cost effective and prevent the emergence of nosocomial infection in developing countries.

Routine compartment pressure monitoring in alert patients has been questioned. The current paper explores the value of this procedure Patients and Methods: In between 2007-2012, 125 patients with tibial fracture underwent monitoring of the compartment in the postoperative period. Medical notes and X-rays were studied. Results: Fourteen of these patients underwent compartment decompression for high readings of the monitoring in 10 of them, the high readings ware based on clinical notes, in (3) others they ware based on measurement bases, and in the last one they ware because of reading problems. Conclusion: The current study does not favour the use of monitoring and does not condemn it. However, clinical judgement remains to be superior while compartment measurement may have caused some unnecessary decompressions

Background: Types of questions means a lot for every school in the world starting from primary schools till the end of one‘s professional life. Medical college is among one of the top colleges due the level of the students accepted in the college to be future young physicians and their teachers work mostly as both doctors and teachers at the same time. Objective: This study was performed to assess the preferred types of assessment questions among medical students and teachers in Kirkuk medical college to pinpoint what is ideal for both and to compare it with the results of studies conducted by other colleges published in the literature. Subjects and Methods: Subjects included in this cross-sectional study ware 37 teachers (in basic and clinical teachings), and 181 students starting from the 3rd, up to the 6th year in Kirkuk medical college during 2011-2012 by proposing questions to both students and teachers and asking them to spot their preferences and other wanted data on the prepared questionnaire sheets by researchers. Results: Among 181 students consisting of 120(66.3%) female students and 61(33.7%) male students, Single choice questions (best of five) are the first choice for 56 students due to easy memorisation. Among 26 teachers whose data is included, single choice questions (best of five) is the first choice for 11 teachers. Covering wider subjects is the most common cause behind the teacher's preference for a particular question type. Conclusion: Single choice questions and essays are the most preferred question by the students. Teachers mostly preferred single and multiple choice questions for reasons of covering wider subjects, testing students concentration, and the presence of less factor of chance. Oral exams are preferred by many teachers.