Duhok Medical Journal

FOOD CULTER KNOWLEDGE AND EATING PRACTICES AMONG MEDICAL COLLEGE STUDENTS IN DUHOK

BERIVAN O. RASHID — 2023-12-30

https://doi.org/10.31386/dmj.2023.17.2.10

Background: Poor nutritional behavior is a major public health problem among young adults who experience the transition into university life, as this time is associated with unhealthy lifestyle characteristics. This study aimed to assess the pattern of eating habits among medical students, to increase their awareness of the food pyramid and encourage them to apply it and increase their awareness of the benefits of healthy eating for physical and mental health.

Methods: This is a cross-sectional faculty-based study conducted among 650 medical students of both genders in all six grades of the College of Medicine/ University of Duhok. The questionnaire was composed of close-ended questions on socio-demographics, eating habits, and knowledge assessment factors, as well as weight and height. Body mass index (BMI) was used to assess students' weight status.

Results: The study revealed that 68.2% had normal BMI, 10.6% had low BMI, 16% had high BMI and 5.2% had very high BMI. A total of 64.5% had good knowledge of the food pyramid, while 56% did not know the required calories per day. Fifty-seven percent were on three meals daily and preferred homemade meals. Nearly three-quarters like fast food and crispy food. 50.3% used to skip breakfast. 45.4% used to eat an extra meal before sleeping time. 47.4% prefer salty food. 57.4% used to eat salads with meals and 84.8% eat fruits usually.

Conclusions: Many medical students of both genders have unhealthy dietary habits, in addition to insufficient knowledge of the food pyramid and required daily calories. Medical students need preuniversity and college-based plans and counseling on nutrition.

IDIOPATHIC GRANULOMATOUS MASTITIS; VARIOUS CLINICAL PRESENTATIONS AND CHALLENGES IN THE MANAGEMENT

FATMA SALIH AHMED — 2023-12-30

https://doi.org/10.31386/dmj.2023.17.2.9

Background: The term idiopathic granulomatous mastitis (IGM) or granulomatous lobular mastitis generally refers to any condition that causes a granulomatous inflammatory reaction within the breast or conditions for which the etiological factors cannot be identified. The study aims to describe the various clinical presentations of the disease and various management options.

Methods: This retrospective cross-sectional study included 97 patients who were diagnosed with the disease in the period from 2016 – 2021. Female patients complaining from IGM who accepted to be enrolled in the current study were included.

Results: The mean age of patients was 33.85 years. Most patients were healthy with no clinical history of chronic diseases or autoimmune diseases, although thyroid diseases were the commonest associated medical diseases. The mean clinical course of the disease was around 11.06 months, and most of them presented with a painful breast lump, followed by a painless lump, skin redness, and edema as common forms of presentation. The mean size of the lump was 22.7 mm. The upper outer quadrant was the commonest affected site among single cases, although the majority were multiple with different sites. Ultrasound was done for all patients, mammography for 2.1%, and MRI for 1%. Tissue sampling was done using FNAC in 19.6 %, tru cut biopsy in 59.8%, and excisional biopsy in 70.1% of them. The vast majority of patients received medical therapy with a mean duration of therapy of 7.13 months. All patients received different types of antibiotics, steroids were administered in 42.3 % of patients, and immune therapy in 6.2% of them. Some forms of surgical interventions were done for 96.9% of patients, lumpectomy and drainage of the abscess were the commonest forms of surgical interventions, and in 68% of patients, multiple interventions were required. Quinolone group and β-lactam antibiotics were the 2 most commonly administered antibiotics. The response to the management was good in 72.16% of patients, followed by poor response in 22.66%, and 2.06% of patients had a worsening course of the disease even after the management. After the management of the patients with IGM in our study, 69.07% of patients showed no relapse, while the remaining 30.93% showed relapse after the

Conclusion: IGM is a clinically challenging disease. The most important initial step is appropriate diagnosis and exclusion of cancer by biopsy. Selection of treatment must be individualized. Complete surgical resection helps much in patient management and results in reducing the site effects of medical treatment, particularly steroids.

UTERINE MESENCHYMAL TUMORS IN DUHOK-IRAQ. A PRACTICAL PATHOLOGICAL STUDY

INTISAR SALIM PITY — 2023-12-30

https://doi.org/10.31386/dmj.2023.17.2.8

Background: Although malignant uterine mesenchymal tumors are relatively uncommon, their definite diagnosis is crucial for therapeutic as well as prognostic purposes.

Objectives: To study the frequency of uterine mesenchymal tumors in Duhok-Iraq and to highlight the impact of immunohistochemically on warning cases.

Materials and Methods: In this cross-sectional study, 3931 uterine mesenchymal tumors were received in the Departments of Histopathology in Vin Private Laboratories and Central General Laboratories in Duhok-Iraq, over a consecutive period of 13 years (January 2009 to December 2021). Cases were examined morphologically. Equivocal cases were subjected to immunohistochemical workup via UltraVision LP Large Volume Detection System & HRP Polymer (Ready-To-Use) from Thermo Fisher Scientific and using the automated immunostaining technique.

Results: Benign tumors (97.4%) overwhelmed the malignant cases (1%). The remaining 1.6% comprised the smooth muscle tumors of undetermined malignant potential (SUMPT).

Conclusions: Diagnosis and categorization of most benign and malignant uterine mesenchymal tumors is an acumen nuclear histology. However, in unequivocal cases, high-grade cancers and mixed neoplasms, immunohistochemistry is needful and applicable due to its easy methodology. Yet some cases remain doubtful and require advanced techniques for definite diagnosis.

MANAGEMENT OF HIRSUTISM IN CLINICAL PRACTICE

BAYAR AHMED QASIM — 2023-12-30

https://doi.org/10.31386/dmj.2023.17.2.7

Background: Hirsutism is the excessive growth of terminal hair in a typical male pattern in a female. It is a distressing and relatively common problem, affecting 5 to 10% of premenopausal women in the general population. Moreover, hirsutism is often associated with decreased quality of life and significant psychological stress. This study aims to assess prevalent current practice of our clinicians related to the management of hirsutism in Kurdistan region of Iraq.

Subjects and Methods: An electronic questionnaire on current practice concerning the management of hirsutism was sent through e-mail to 190 clinicians. 166 of doctors completed the survey and were of from different specialties (endocrinologists, general internists, obstetricians, family medicine, general practitioners), from different cities of Kurdistan region of IRAQ (Duhok, Sulaymaniyah, Erbil, and Halabja).

Results: Whilst 81 (48.8%) of all the responders assessed the severity of hirsutism clinically by applying Ferriman–Gallwey hirsutism scoring system or equivalent score, the remaining 85 (51.2%), consisting majority of responders, did not carry out any assessment for severity of hirsutism. Regarding exclusion of malignancies, 92.8% of responders, said that they are asking routinely for alarming signs and symptoms of malignancies. Concerning exclusion of hyperandrogenism workup, 92.2% of responders were routinely asked about hyperandrogenism workup. The last question was about the preferred androgen suppressive therapy only 41.0% of responders treat hirsutism by a combination of OCP plus androgen blocks.

Conclusion: We found that the current clinical practice for the management of hirsutism is not standardized with many gaps in the practice. Therefore, it is necessary to develop national guidelines for management and treatment of hirsutism.

PRIMARY ADULT ENDOSCOPIC DACRYOCYSTORHINOSTOMY: A NEW EXPERIENCE IN DUHOK

ABDULLAH R. Y. ALKHALIL — 2023-12-30

https://doi.org/10.31386/dmj.2023.17.2.6

Background: Over the last decade dacryocystorhinostomy has been considered as the primary surgery to treat nasolacrimal duct obstruction aiming to bypass the obstructed nasolacrimal duct. Dacryocystorhinostomy has two types: traditional external and new endoscopic. The major advantages of the endoscopic technique over the open one are that there is no external incision and the subsequent scar is needed to do the surgery, very low risk of injuring the medial canthus, and the maintenance of the orbicularis oculi muscle pumping mechanism.

Study aim: This study aims to assess the success rate, surgical outcome, and complications among patients who will undergo this surgery.

Patient and Methods: this is a retrospective study conducted on (38) patients who performed endoscopic dacryocystorhinostomy at Vin private hospital in Duhok in the period between (2015–2018) where the medical records of the patients were reviewed in detail to obtain the required information for the study purposes. The information including surgery, surgery side, patients complaints, and outcome of surgery was documented.

Results: Success of the surgery is considered when there is an absence of epiphora and other symptoms 3 months postoperatively with endoscopic visualization of the newly fashioned ostium. The results showed that around (89.5%) of the patient, have complete recovery of their original symptoms, and (10.5%) are regarded as failures for whom there is no improvement of their symptoms at all.

Conclusion: Endoscopic dacryocystorhinostomy is an effective surgical procedure in treating primary acquired nasolacrimal duct obstruction with comparable outcomes to the old external dacryocystorhinostomy with fewer side effects and complications.

ANTI-MÜLLERIAN HORMONE LEVEL AS A PREDICTIVE FACTOR IN THE DIAGNOSIS OF POLYCYSTIC OVARIAN SYNDROME IN DUHOK PROVINCE – KURDISTAN REGION, IRAQ

ALAA YOUSIF MAHMOOD — 2023-12-30

https://doi.org/10.31386/dmj.2023.17.2.5

Background: Polycystic ovary syndrome is one of the most common endocrine conditions upsetting fertile-aged ladies and is considered to be one of the most common causes of infertility. The study aimed at evaluating serum anti-müllerian hormone levels among patients with polycystic ovarian syndrome.

Methods: All enrolled women were subjected to clinical examination, ultrasound examination, and anti-müllerian hormone level measurement. Eighty-seven women diagnosed with clinical signs of polycystic ovary syndrome as well as 87 controls were enrolled.

Results: The current study revealed significant variation among both patients and control groups regarding parity, irregularities in menstrual cycles, ovarian sizes, and features of hyperandrogenism (abnormal hair growth; Acne). No significant difference was seen regarding age and body mass index. Using the Receiver operating characteristic curve, a serum value of anti-müllerian hormone > 3.2 ng/ml was considered specific (91.5%) and sensitive (80.5%) for diagnosis of polycystic ovary syndrome with a P value of < 0.001.

Conclusion: Polycystic ovary syndrome can be accurately diagnosed with AMH level, being significantly associated with increased ovarian size, lower parity rate, and higher incidence of menstrual cycle disturbances.

DOPPLER EVALUATION OF FETOPLACENTAL AND UTEROPLACENTAL CIRCULATION OUTCOMES IN WOMEN WITH PRE-ECLAMPSIA: COMPARISON AND CORRELATION BETWEEN DIFFERENT DOPPLER PARAMETERS

SIPAL RAMADHAN HASAN — 2023-12-30

https://doi.org/10.31386/dmj.2023.17.2.4

Background: Preeclampsia (PE) affects between 5% and 8% of all pregnancies and is one of the leading cause of maternal mortality in underdeveloped countries.PE is characterized by the new onset of high blood pressure and proteinuria with or without body swelling that occurs after 20 weeks of gestation and lasts up to 6 weeks after labor. The pathophysiology of PE is based on the incapability of the trophoblast to invade the myometrium properly causing improper remodeling of spiral arteries resulting in fetoplacental insufficiency and this can be detected by using Doppler ultrasound.

Objective: To compare and correlate among cerebroplacental ratio (CPR), uterine artery, umbilical artery, and middle cerebral artery (MCA) parameters outcomes in established cases of pre-eclampsia

Patients and methods: A total 36 cases of pregnant women who were diagnosed clinically and by laboratory investigation as preeclampsia were included in this study in cross-sectional study to evaluate fetoplacental and uteroplacental circulation using Doppler parameters such as pulsatility index (PI) and cerebroplacental ratio.

Results: There was a strong correlation between the cerebroplacental ratio and Middle cerebral artery PI (p-value =0.0006); however, a minimum positive correlation was found between CPR and umbilical artery (UmA) and uterine artery (UTA) p=0.0274 and 0.0244 respectively

Conclusion: A positive correlation found between CPR PI and MCA, UTA, UmA pulsatility indices; therefore, we conclude that they can be used as complementary to each other in we conclude that they can be used as complementary to each other for identifying high-risk pregnancies, early detection of fetal compromise and consequently optimizing the timing of intervention.

SPECTRUM OF UNENHANCED CT-CHEST APPEARANCES AND SEVERITY IN COVID 19 PATIENTS IN DUHOK, KURDISTAN REGION, IRAQ

FAHMI OMER MOHAMMED — 2023-12-30

https://doi.org/10.31386/dmj.2023.17.2.3

Background: Since the emergence of COVID-19 infection, CT lung scanning was important diagnostic tool for assessing COVID-19 pulmonary infection. The aim of this study is to evaluate the spectrum of radiological findings in non-enhanced CT of the lungs, and to estimate the CT severity score index and correlate CT findings of the patients with age and gender.

Materials and methods: This cross-sectional study was conducted from 9th of October to 29th of November 2021 at Radiology department-CT unit of Azadi Teaching hospital, Duhok, Iraq. Overall, 137 RT-PCR positive symptomatic COVID-19 patients were included in this study, aged 17-85 years. The un-enhanced lung slices were viewed for nature of the abnormal opacity mainly pure ground glass opacities (GGO) and consolidation. The CT severity score index was measured to be correlated with age, sex and temporal changes of lung findings.

Results: The average age of the patients was 52.12 ± 15.79 SD, more of 50% of patients were of 31-59 years and 85 (62%) females. The consolidation opacity was the most common opacity (61.34%), followed by GGO (52.56%). The pulmonary opacities were dominant in lower lobes. There was strong positive correlation between higher CT severity score and older age group (p=0.021), but no significant correlation with sex (p value = 0.38). There was also positive correlation between stages of the disease and GGO (p=0.013), pure consolidation (0.026), interlobular septal thickening (p=0.006), bronchiectasis (p=0.026).

Conclusions: Non-enhanced Chest CT can assess predictable abnormal lung opacities and assess the disease severity and hence give an idea of the prognosis of disease. Higher CT score is significantly correlated with older age groups.

A STUDY ON BURKITT’ S LYMPHOMA AND EPSTEIN-BARR VIRUS LATENCY IN DUHOK, IRAQ

RAFIL TOMA YAQO — 2023-12-30

https://doi.org/10.31386/dmj.2023.17.2.2

Background: Burkitt's lymphoma (BL) is the most common lymphoma in children and primarily, but certainly not exclusively, originates in the lymphoid tissue of the distal ileum. This study looks at the Epstein-Barr virus latency and C-MYC gene rearrangement in tumor cells from patients in Iraq's Duhok province.

Methods: Between 2014 and 2020, archived surgical pathology tissue from thirty Kurdish patients diagnosed with BL in the Duhok region of northern Iraq was examined. Formalin-fixed, paraffin-embedded (FFPE) tissue blocks were used to make tissue microarrays (TMA), which were then studied using immunohistochemistry for a panel of lymphoma markers, in-situ hybridization (ISH) for EBV-encoded RNAs (EBER1), and fluorescent in-situ hybridization (FISH) for C-MYC/IGH translocation.

Results: The median age of patients was 7 years (3-22). Twenty-two were male and eight were female. Twenty-five patients had extra-nodal primaries, 21 of them had intrabdominal primaries, the ileocecal region accounted for all of the cases, and five had nodal primaries. All patients had c-MYC rearrangement in their tumors, whereas EBER1 was present in 22 (73%) of the tumors.

Conclusion: This study reveals that Burkitt lymphoma in the Duhok region is a juvenile illness with a preference for the ileocecal region, as opposed to the United States and northern Europe, where it is regarded as an adult disease with a propensity for the lymph nodes.

BETA GLOBIN GENE CLUSTER HAPLOTYPES IN IRAQI KURDS

SHAIMA SM AL-ZEBARI — 2023-12-30

https://doi.org/10.31386/dmj.2023.17.2.1

Background: The study of β-globin gene cluster haplotypes provides insight into the origin, migration and genetic variation of human populations, it also constitutes an essential prelude to studying such haplotypes among those with hemoglobin disorders in a given population.

Materials and Methods: A total of fifty unrelated healthy non-thalassemic Iraqi Kurds were recruited. Their DNAs were extracted, and their β-globin gene cluster haplotypes were determined using restriction fragment length polymorphisms technique at seven restriction sites along the β-globin gene cluster, namely: HindII 5’ε, HindIII Gγ, HindIII Aγ, Hind II 5’ψβ, Hind II 3’ψβ, AvaII β, and BamHI 3’β.

Results: The enrolled individuals had a median age of 15 years and included 26 males and 24 females. Haplotype analysis identified 17 different haplotypes, including seven atypical ones. The most frequent haplotypes among the 100 chromosomes analyzed were haplotypes I, III, V and IX at rates of 32%, 14%, 12%, and 9% respectively. These were arranged in 28 different genotypes, the most frequent of which were I/III, I/IX, I/I and V/V at rates of 14%. 8%, 8%, and 8% respectively. There were significant differences between Yazidi and Muslim Kurds haplotype distributions. The most informative of the seven markers employed in the current study with highest polymorphism information content was HindII 5’ε and HindIII Gγ, while the least was Hind IIIAγ.

Conclusion: β-globin cluster haplotype distribution at the βA chromosomes among Iraqi Kurds shares a lot of similarities with that in neighboring countries. The high rate of heterogeneity noted may be due to the ancient origin of the population, while the differences observed between Muslims and Yazidis maybe the consequence of genetic isolation of the latter subgroup at least for the last millennium. This study paves the way to further studies on haplotypes associated with β-globin gene disorders to have a better insight into their origin and spread in Iraqi Kurdistan.