Duhok Medical Journal http://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> University of Duhok-College of Medicine en-US Duhok Medical Journal 2071-7326 SCREENING OF GROUP B STREPTOCOCCUS AGALACTIAE AMONG PREGNANT WOMEN IN DUHOK CITY/ KURDISTAN REGION/ IRAQ http://dmj.uod.ac/index.php/dmj/article/view/207 <p><a href="https://doi.org/10.31386/dmj.2023.17.1.1"> https://doi.org/10.31386/dmj.2023.17.1.1</a></p> <p><strong>Background:</strong> Pregnant women colonized with Streptococcus agalactiae-Group B Streptococci (GBS) can transmit the bacteria to their new-borns at the time of birth.&nbsp; Intrapartum antibiotic prophylaxis (IAP) can prevent this transmission. The aim of this study is to find out the carriage rate of group B streptococci isolated from pregnant women in Duhok city, Iraq. Other aim is to study the Antibiotic susceptibility patterns of the isolates and to detect the risk factors associated with the growth of these bacteria.</p> <p><strong>Methods:</strong> Exactly 821 pregnant women living in Duhok city were randomly screened for GBS colonization, over a period of 7 months from 1st of January, 2022 till 1st of August, 2022. High vaginal swabs (HVS) sample were collected, processed and identification was performed by Vitek system 2. The isolated strains of GBS were selected for in vitro susceptibility testing. As well as also risk factors associated with infection were assessed.</p> <p><strong>Results:</strong> GBS was detected in 37/821 accounted (4.51%) pregnant women. Risk factors such as vaginal discharge, UTI, Diabetes, abortions and still birth did not show major differences between positive and negative cases of GBS. Pencillin G, Co-Amoxiclav, Nitrofurantoin, Vancomycin and Ampiciilin have shown the highest sensitivity percentages (93.9%, 93.8%, 88.9%, 87.5% and 84% respectively). The sensitivity rate for other B-Lactams: Cepholothin, Ceftriaxone and Cefixim were: 70.6%, 63% and 78% respectively. The sensitivity for Gentamicin was 38.9% and 48.4% for Ciprofloxacin. However, the lowest sensitivity rates were detected for Clindamycin, Amikacin and Erythromycin: 26.1%, 30% and 30.5% respectively.</p> <p><strong>Conclusions:</strong> Carriage rates of GBS among pregnant women in this setting are still low-grade. Penicillin and Ampicillin are the drugs of choice (intra-partum prophylaxis) against GBS in pregnancy. Co-amoxiclave and Vancomycin also had a high level of sensitivity.</p> DIYAR MOHAMMED TAHER ALI ABDULRAHMAN TOWFEEQ SAADI ##submission.copyrightStatement## 2023-04-01 2023-04-01 17 1 1 9 KNOWLEDGE OF BASIC BIOSTATISTICS AND RESEARCH METHODOLOGY AMONG TEACHING STAFF OF MEDICAL SCIENCES COLLEGES AT THE UNIVERSITY OF DUHOK http://dmj.uod.ac/index.php/dmj/article/view/208 <p><a href="https://doi.org/10.31386/dmj.2023.17.1.2"> https://doi.org/10.31386/dmj.2023.17.1.2</a></p> <p><strong>Background:</strong> Doctors and academicians should have a basic understanding of the methods of epidemiology and biostatistics so as to conduct, analyze and report results of medical research. Surveys of medical literature estimated a high rate of wrong or incorrect analyses and interpretation. The main objective of this study was to assess the knowledge of the basic biostatistics and methods of research among teaching staff of the five medical sciences colleges at University of Duhok.&nbsp;</p> <p><strong>Methods:</strong> In this cross-sectional study, a pre-designed questionnaire was distributed to all the teaching staff in the five medical sciences colleges at the University of Duhok as a google form. The questionnaire composed of ten multiple choice questions about the knowledge regarding basic methods of research and data analysis.</p> <p><strong>Results:</strong> The rate of participation was 82% with a mean age of 45.25 years and 70.3% were males. Their educational qualification was master degree for 38.2% and a Ph D or medical board in 61.8%. The rate of correct answers to all questions was low with the highest rate of on the question about Randomized Clinical Trial (54%) and the lowest on the question about p-value (11%). The study found that the number of correct answers was increased with increasing the number of published papers by the participants (P=0.0199).</p> <p><strong>Conclusions:</strong> The knowledge of the teaching staff in the five medical science colleges at UoD regarding research method and statistical analysis of data is below average in a time that they do research continuously.</p> ARY HABEEB MOHAMMED ##submission.copyrightStatement## 2023-04-01 2023-04-01 17 1 10 23 GLYCEMIC AND ATHEROGENIC STATUS AMONG DUHOK UNIVERSITY STAFF RECOVERED FROM COVID-19 WITH NO COMORBIDITIES http://dmj.uod.ac/index.php/dmj/article/view/209 <p><a href="https://doi.org/10.31386/dmj.2023.17.1.3"> https://doi.org/10.31386/dmj.2023.17.1.3</a></p> <p><strong>Background:</strong> While most infected people recovered completely from COVID-19 within a few weeks, a considerable proportion continues to experience symptoms after their initial recovery similar to SARS survivors. Intensive ongoing research has shed light on the pathogenesis of COVID-19 and the extent of damages caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) but the intermediate and long-term complications remain unclear. The objective of this study is to evaluate the glycemic and atherogenic status in non-hospitalized and recovered covid-19 individuals without underlying diseases prior to the infection.</p> <p><strong>Methods:</strong> A total of 200 apparently healthy subjects from all the staff of Duhok University were enrolled in this case-control study.&nbsp; The subjects were divided into two groups. Group 1 included 107 subjects non-hospitalized recovered from covid-19 at more than 3 months after infection which was proved by RT-PCR and Group 2 included 93 healthy subjects who have not been infected with covid-19 as control group. Venous blood samples were collected and analyzed for glycemic and atherogenic related parameters.&nbsp;</p> <p><strong>Results:</strong> There was no significant differences in blood pressure, glycemic and atherogenic status between previously infected and not infected subjects. However triglycerides (TG) and cardio-protective index (CPI) were slightly and non-significantly higher and low density lipoprotein (LDL), total cholesterol (TC) and atherogenic index of plasma (AIP) lower in previously infected subjects. Also, fasting plasma insulin (FPI), Homeostasis model assessment‑insulin resistance (HOMA-IR) and risk of atherogenicity were slightly higher in the infected males, younger ages, older ages and obese subjects.</p> <p><strong>Conclusions:</strong> There are no long-term effects of COVID-19 on the glycemic and atherogenic status of the recovered not hospitalized patients.</p> BISHKOVA SALIH KHALID SUAD YOUSIF ALKASS ##submission.copyrightStatement## 2023-04-01 2023-04-01 17 1 24 38 SERUM VITAMIN D3 LEVELS IN PATIENTS WITH TELOGEN EFFLUVIUM IN DUHOK GOVERNORATE http://dmj.uod.ac/index.php/dmj/article/view/210 <p><a href="https://doi.org/10.31386/dmj.2023.17.1.4"> https://doi.org/10.31386/dmj.2023.17.1.4</a></p> <p><strong>Background:</strong> Telogen effluvium, a commonly reported problem, strictly affect the quality of life of the patients. Vitamin D stimulates differentiation of hair follicles. The association between serum vitamin D levels and telogen effluvium describe in several studies. The aim of study was to determine serum level of vitamin D in patients with telogen effluvium and analyze the relationship of altered serum total vitamin D levels with Telogen effluvium.&nbsp;</p> <p><strong>Methods: </strong>This study was conducted at dermatological department out-patient clinic of Azadi Teaching Hospital, Duhok city, Kurdistan Region-Iraq, during period from 20<sup>th</sup> of December 2021 to 20<sup>th</sup> of April 2022; in which 100 subjects included 50 cases with telogen effluvium and 50 healthy controls.</p> <p><strong>Results:</strong> The prevalence rate of vitamin D deficiency among patients with telogen effluvium was distributed as severe deficient 62%, insufficient 26%, and sufficient 12%. Mean ± SD of vitamin&nbsp; D was 6.93 ± 3.56 for patients compared with Mean ± SD 21.10 ± 11.88, (p-value &lt;0.0001) for healthy control. Most cases were from urban areas and most controls were from rural areas, 66% versus 55.01 %( p=0.0346).</p> <p><strong>Conclusions:</strong> The patients with telogen effluvium in this study had significantly low levels of serum total vitamin D and higher prevalence rate of vitamin D deficiency when compared with healthy control.</p> REDEER ESSMAT MAJEED SHERWAN FERMAN SALIH AZAD SALEH MOHAMMED AZAD SALEH MOHAMMED ##submission.copyrightStatement## 2023-04-01 2023-04-01 17 1 39 50 TRICHOSCOPIC COMPARISON BETWEEN TELOGEN EFFLUVIUM AND ANDROGENIC ALOPECIA http://dmj.uod.ac/index.php/dmj/article/view/211 <p><a href="https://doi.org/10.31386/dmj.2023.17.1.5"> https://doi.org/10.31386/dmj.2023.17.1.5</a></p> <p><strong>&nbsp;</strong></p> <p><strong>Background:</strong> Alopecia, is a major condition that affects both sexes and people of all ages. Hair loss is the most common reason for women to consult a dermatologist, apparently because of cosmetic reasons. Androgenetic alopecia and Telogen Effluvium have greater rates of occurrence and sensitive responsiveness to timely treatments. Trichoscopy helps in diagnosis, determining the biopsy location, and providing prognostic information. Dermatologists can examine the scalp with a handheld dermoscope (x10 magnification). Vascular patterns, follicular and perifollicular features, and hair shaft features are among the dermoscopy results.</p> <p><strong>Objective:</strong> To compare the prevalence of trichoscopic characteristics of the scalp in Androgenic Alopecia and Telogen Effluvium on the basis of follicular patterns, interfollicular patterns, and hair features.</p> <p><strong>Methods:</strong> The study is a cross-sectional study conducted at the Azadi teaching hospital, in the Department of Dermatology, Venereology from December 2021 to May 2022, on a total sample size of 80 patients diagnosed clinically to estimate the prevalence of trichoscopic characteristic differences in each androgenetic alopecia and telogen effluvium using the Dermlite DL4 dermoscope, which allows for 10-fold magnification of the examining area .</p> <p><strong>Results:</strong> Among the eighty cases, 40 cases had Androgenetic alopecia and 40 had telogen effluvium.&nbsp; In telogen effluvium, heterogeneity in hair shaft diameter in frontotemporal areas (15%), vellus hair (32.5%), Up growing hair (65%), 1-2 hair per follicle (17.5%), 3-multiple hair per follicle (82.5%), Yellow spots (5%), peripilar sign (20%), and are some of the most common results. in patients with Androgenetic alopecia, the distinguishing observation is that hair shaft diameter variation is common in the fronto-temporal and occipital regions (100% percent). Increase in number of miniaturized hair more than 20% is (97.5%), vellus hair (70%), upgrowing hair (27%), 1-2 hair per follicle (60%), 3- multiple hair per follicle (40%), yellow spots (57.5%) and Peripilar sign (35%) are all follicular characteristics found with androgenetic alopecia.</p> <p><strong>Conclusion:</strong> Trichoscopy is a good tool for differentiation between the two diffused alopecia androgenic alopecia and telogen effluvium. On Trichoscopy, in androgenetic alopecia the fronto-temporal zones had the most variation in hair shaft diameter. The peripilar sign, yellow spots, and empty hair follicles were the most common follicular features. Miniaturized hair was the most common hair shaft pattern seen androgenetic alopecia. On Trichoscopy, telogen effluvium is described as disease of exclusion needs further research. It's vital to distinguish this disorder from androgenetic alopecia, which has hair shaft thickness variations in the fronto-temporal areas but none in the occipital.</p> ALI ABDULGHANI RAMADAN HINDAV MIRDAN KHALEEL ##submission.copyrightStatement## 2023-04-01 2023-04-01 17 1 51 63 VITAMIN D RECEPTOR GENE APAI AND TAQI POLYMORPHISM IN PATIENTS WITH TYPE II DIABETES MELLITUS USING PCR-RFLP METHOD IN KURDISTAN REGION http://dmj.uod.ac/index.php/dmj/article/view/212 <p><a href="https://doi.org/10.31386/dmj.2023.17.1.6"> https://doi.org/10.31386/dmj.2023.17.1.6</a></p> <p><strong>Background:</strong> Type 2 diabetes mellitus that characterized by insulin resistance and it is a risk of many diseases the impact of genetic factors on diabetes is well documented. Vitamin D receptor (VDR) gene polymorphisms have been linked to T2DM. In this study, we analyzed the relation between TaqI and ApaI VDR gene polymorphisms and T2DM subjects by using the PCR-RFLP method in Kurdish patients.</p> <p><strong>Material and Methods:</strong> Forty patients with T2DM and 30 uninflected individuals were included in this study. Genomic DNA was amplified using PCR and VDR gene was analyzed by the PCR-RFLP method. The ApaI product G allele yielded fragments of 528 and 217 bp; T allele, 745 bp, and TaqI T allele yielded fragments of 494 and 251 bp; C allele, 293, 251, and 201 bp.</p> <p><strong>Results:</strong> Forty patients with T2DM and 30 uninflected individuals have been studied, both patients and the control group were age-matched, (43.59%) of patients have had a family history of type2 Diabetes. The allele and genotype frequencies of the VDR TaqI (g.60058 T&gt;C) gene and VDR ApaI (g.59979 G&gt;T) gene polymorphisms were investigated. In VDR TaqI (T&gt;C) gene polymorphism genotypes are expressed as TT in normal wild-type homozygote, TC in the heterozygote, and CC in the homozygote mutant polymorphic genotype. There were statistically significant differences between patients withT2DM and controls regarding the distribution of TaqI genotypes and alleles (p&lt; 0.0001) and no significant difference regarding ApaI alleles (P=0.5532).</p> <p><strong>Conclusion:</strong> Current study findings demonstrated no associations between ApaI polymorphism and Kurdish T2DM patients and only associations between VDR TaqI gene polymorphism, it can be assumed that VDR and its exon 9 polymorphism are crucial in the pathogenesis of T2DM.</p> GALAWEZH O. OTHMAN MUKHLIS H. AALI CHIMAN H. SAEED HISHYAR A. NAJEEB ##submission.copyrightStatement## 2023-04-01 2023-04-01 17 1 64 75 HEALTH SYSTEM PERFORMANCE, MITIGATION, AND IMPERATIVE REFORM APPROACHES IN THE KURDISTAN REGION OF IRAQ: A QUALITATIVE SWOT ANALYSIS FROM THE STAKEHOLDERS’ POINT OF VIEW http://dmj.uod.ac/index.php/dmj/article/view/213 <p><a href="https://doi.org/10.31386/dmj.2023.17.1.7"> https://doi.org/10.31386/dmj.2023.17.1.7</a></p> <p><strong>Background:</strong> Health systems are dynamic and evolve over time. It is essential to look at the entire health system before implementing any intervention to modernize the whole health system or a component of it. This study analyzed the performance of the health system in the Kurdistan Region of Iraq and investigated potential reform steps to mitigate the identified challenges.</p> <p><strong>Methods:</strong> A qualitative study was conducted in 2021 to recruit 37 key informants and decision-makers, advisors, and experts from the Kurdistan Parliament, Ministry of Health, Ministerial Council, Ministry of Finance, and external experts in the field of health. Thirty-one responded to a self-administered questionnaire of open-ended questions.</p> <p><strong>Results:</strong> While the health system in the Kurdistan Region of Iraq had its own strengths and opportunities to modernize it further, there were much more weaknesses and threats to it. The areas that received much attention were the lack of vital laws such as the medical council, health insurance, public-private sector regulation, accreditation, food and drug administration, and the absence of a regional health policy and strategic plan. The parliament and executive authorities, represented by the different government agencies in the Kurdistan Region of Iraq, have a role in mitigating all the weaknesses and threats in the health system.</p> <p><strong>Conclusions:</strong> The study provides policy evidence and a framework of the potential health strategies for the current and the coming government cabinets and parliament rounds in the Kurdistan Region of Iraq to improve the health sector and contribute to achieving sustainable development goals by 2030. It provides a road map for researchers to explore the current health system problems further and find suitable solutions.</p> HUSHYAR MUSA SULAIMAN REBAR FETTAH MOHAMMED SAMIM AHMED AL-DABBAGH ##submission.copyrightStatement## 2023-04-01 2023-04-01 17 1 76 100 EFFECTS OF LATENT TOXOPLASMOSIS ON AUTOIMMUNE THYROID DISEASES IN PREGNANT WOMEN - DUHOK CITY-KURDISTAN REGION- IRAQ http://dmj.uod.ac/index.php/dmj/article/view/214 <p><a href="https://doi.org/10.31386/dmj.2023.17.1.8"> https://doi.org/10.31386/dmj.2023.17.1.8</a></p> <p><strong>Background:</strong> Toxoplasmosis is a common zoonotic disease has a global distribution and can infect many hosts causes several clinical symptoms in humans and attack many body organs leading to hormonal and behavioral alterations in infected hosts. Latent or dormant form toxoplasmosis is the common form that can affect pregnancy course. Autoimmune thyroid disease (AITD) belongs to the known risk factors for adverse pregnancy outcomes. The aim of this study was the detection of anti-Toxoplasma antibodies and its effects on autoimmune thyroid disease among pregnant women.</p> <p><strong>Methods: </strong>A total of 220 pregnant women were included in the current study from August 1st 2021 to February 1st, 2022. Toxoplasma status in pregnant women was detected for seropositivity of anti-Toxoplasma IgG antibodies using ELISA technique. Free triiodothyronine (FT3), free thyroxine (FT4), Thyroid stimulating hormone (TSH) and thyroperoxidase antibodies (TPO) were assessed by ELISA. The blood parameters of examined pregnant women were measured by a Coulter counter machine.</p> <p><strong>Results:</strong> Overall, 95(43.2%) of the examined pregnant women had seropositivity for anti- Toxoplasma IgG antibodies and 28(12.7%) were screened positive for AITD. Out of 95 seropositive IgG antibody cases, 18 (18.9%) had AITD. Out of 220 pregnant, 90 (40.9%) had normal thyroid, while thyroid disorders are classified to subclinical hypothyroidism, clinical hypothyroidism, subclinical hyperthyroidism, and clinical hyperthyroidism, 64(29.1%), 41 (18.6%), 22(10.0%), and 3 (1.4%) respectively. From 95 seropositive anti-Toxoplasma IgG antibodies, high rates were detected in subclinical hypothyroidism 35(36.8%), followed by 31(32.6%) with normal thyroid, and 19 (20.0%) had clinical hypothyroidism, while only,9 (9.5%), and1(1.1%) had subclinical hyperthyroidism, and clinical hyperthyroidism respectively. High infection rate was recorded among women in third trimester of pregnancy 60 (44.4%) compared to lower infection rate in first trimester women 20(40.0%). The IgG antibodies seropositive women had more often highly elevated TPO antibodies than negative ones, and the latent toxoplasmosis was associated disturbance of thyroid hormones. The antibodies seropositive women had high total leucocyte count, high lymphocytes, high count of granulocytes, low total red blood cells count and low hemoglobin level.&nbsp;</p> <p><strong>Conclusions: </strong>The current study indicated that latent toxoplasmosis is associated with alteration in thyroid functions and autoimmunity during pregnancy. Pregnant women should be tested for FT3, FT4, TSH hormones, and TPO antibodies with measurement of hematological parameters in order to reduce the risk in both mother and fetus and provides early therapies.</p> MANAL ADIL MURAD SOUZAN HUSSAIN EASSA ##submission.copyrightStatement## 2023-04-01 2023-04-01 17 1 101 113 MENTAL HEALTH AND SOCIAL ACTIVITY PARTICIPATION DURING THE COVID 19 PANDEMIC IN DUHOK CITY http://dmj.uod.ac/index.php/dmj/article/view/215 <p><a href="https://doi.org/10.31386/dmj.2023.17.1.9"> https://doi.org/10.31386/dmj.2023.17.1.9</a></p> <p><strong>Background:</strong> Stay-at-home orders in response to the COVID-19 pandemic have forced abrupt changes to daily routines and lifestyles. This study assessed changes in mental health and social activity during the confinement period, in response to the global pandemic.</p> <p>Methods: This study was a face-to-face interview survey targeting adults in Duhok city, Kurdistan Region of Iraq. The questionnaire was distributed from October 2021 to February 2022, and collected information on mental well-being, mood, and social activity participation. All questions were presented as “before” and “during” the COVID-19 pandemic.</p> <p>Results: In total, 407 adult participants have included: 207 females and 200 males. Overall, during the pandemic, mental well-being score was reduced by 13.4% (particularly for the employed), and social participation by 11.1% (particularly for the older age group). Around the same time, the bad mood and feelings score increased by 51.3%. These changes are expected and have been reporworldwidewide.</p> <p>Conclusion: The COVID-19 pandemic produced significant negative lifestyle effects well beyond the virus itself, and confining people has led to a decline in mental health and social activities. People need support to counteract the effects of confinement on mental well-being, e.g., by providing basic life needs and enhancing at-home communication and physical activity.</p> <p>&nbsp;</p> MUSAB SIDEQ ABDULJABBAR SAAD YOUNIS SAEED ##submission.copyrightStatement## 2023-04-01 2023-04-01 17 1 114 125 HEALTHCARE WORKERS’ ATTITUDE TOWARD COVID-19 VACCINE IN DUHOK GOVERNORATE http://dmj.uod.ac/index.php/dmj/article/view/216 <p><a href="https://doi.org/10.31386/dmj.2023.17.1.10"> https://doi.org/10.31386/dmj.2023.17.1.10</a></p> <p><strong>Background:</strong> Healthcare workers have a great role in contributing the vaccination among the population and their oriented health attitude is thought to be of major significance for protection against covid-19. The aim of this study was to determine the vaccination acceptance and refusal among healthcare workers and the possible causes, also to investigate the socio-economic-demographic factors affecting their attitude.&nbsp;</p> <p><strong>Methods:</strong> A cross-sectional study was conducted in Duhok governorate to assess the attitude of healthcare workers toward covid-19 vaccine, and this was held by direct interview with the participants. The questionnaire was of 2 parts, the socio-demographics and the attitude of healthcare workers toward the vaccine.&nbsp;</p> <p><strong>Results:</strong> A total of 562 healthcare workers participated in this survey; 94.1% of them displayed a positive attitude toward the vaccine while 5.9% revealed a negative attitude. 67.3% of the participants had received the vaccine, and 72.7% of the unvaccinated participants claimed their main cause of refusal was their concern about the safety of the vaccine. There was a statistically significant relation between healthcare workers’ occupation and vaccine acceptance (p = 0.048), where pharmacists had the highest rate of vaccination (100%) compared to the cleaning staff (77.3%). Also participants’ age group (45-60) years showed higher acceptance rate than other age groups.</p> <p><strong>Conclusions:</strong> Covid-19 vaccine acceptance among healthcare workers in the Duhok governorate was high. The findings may help the management authorities to give more information about the vaccine and contribute to improving healthcare workers’ attitudes to reach the&nbsp; goal of 100% vaccination.</p> SARA BAYRAM DAWOD KAMERAN HASSAN ISMAIL ##submission.copyrightStatement## 2023-04-01 2023-04-01 17 1 126 141