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> en-US Fri, 31 May 2019 00:00:00 +0000 OJS http://blogs.law.harvard.edu/tech/rss 60 ASSESSMENT OF NEUROMUSCULAR JUNCTION INTEGRITY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS http://dmj.uod.ac/index.php/dmj/article/view/67 <p><a href="https://doi.org/10.31386/dmj.2019.13.1"> https://doi.org/10.31386/dmj.2019.13.1</a></p> <p><strong>&nbsp;</strong><strong>Background:</strong>Diabetes Mellitus produces long-term damage and failure of various tissues, in particular, diabetes-induced neural damage. Changes of neuromuscular transmission would contribute to the progressive weakness in diabetic patients; Electrophysiological studies are of recognized use in the confirmation of alterations of neuromuscular transmission and helping to differentiate them from other conditions.</p> <p>The current study was performed to evaluate the integrity of neuromuscular junction (NMJ) in patients with type 2 diabetes using repetitive nerve stimulation (RNS) technique and assessment of acetylcholine receptors antibodies in the serum.</p> <p><strong>Patients and Methods:</strong>This cross-sectional study involved 103 patients with type 2 diabetes mellitus. The entire subjects met certain inclusion and exclusion criteria to exclude other possible contributing factors of neuropathy. All subjects completed a pre-requested questionnaire, then physical and neurological examinations were done, routine nerve conduction study, repetitive nerve stimulation and assessment of acetylcholine receptors antibodies were performed.</p> <p><strong>Results:</strong>Among 103 patients with type 2 DM patients 56 of them were diagnosed as peripheral polyneuropathy however, the rest (47) their NCS result were normal, 11 (10.7%) of them showed positive decrement test, All those with positive decrement test they have also peripheral polyneuropathy, serum acetylcholine receptor antibody test was negative in all the participants (those with positive and negative decrement test).</p> <p><strong>Conclusions:</strong>This preliminary study implies that type 2 diabetes contributes to the neuromuscular junction dysfunction. Further studies are indicated to explain the pathophysiology and mechanisms responsible for positive decrement test in type 2 diabetic patients.</p> SHIRWAN H. OMER ##submission.copyrightStatement## http://dmj.uod.ac/index.php/dmj/article/view/67 Fri, 31 May 2019 00:00:00 +0000 NEW TECHNIQUE OF COMBINED SPINAL-EPIDURAL ANESTHESIA IN LOWER LIMB SURGERY http://dmj.uod.ac/index.php/dmj/article/view/68 <p><a href="https://doi.org/10.31386/dmj.2019.13.1.2"> https://doi.org/10.31386/dmj.2019.13.1.2</a></p> <p><strong>Background:</strong><em>There are several theories to explain the action of local anesthetic in combined spinal-epidural anesthesia (CSE), this study is to examine a technique of (CSE) that depends on the theory of leakage of epidural drugs to the subarachnoid cerebrospinal fluid (CSF).</em></p> <p><strong>Patients and Methods:</strong><em>After approval of local medical ethics committee and obtaining informed consent, 60 patients (18-80 years, ASA physical status I to IV) who listed for orthopedic lower limb surgery under CSE were included in this study. The study design was prospective Cross-Section comparative one. It was done in Gulan General Hospital and Gian Private Hospital in Duhok Governorate in Kurdistan Region of Iraq in the period from 01/01/2017 to 28/2/2018.</em></p> <p><strong>Results:</strong><em>the volume needed to get maximum sensory block (MSB) and the frequency of top-up doses are greater in group A than B.The onset time of group A is longer than group B. The mean arterial pressure was much stable in group A with less nausea and vomiting in the same group. Addition, more patients in group A than group B were able to move against gravity.</em></p> <p><strong>Conclusions:</strong><em>the effect of this technique in combined spinal-epidural anesthesia can be compared to that of separate needle with more stable vital signs and less complications but with more allover doses of local anesthetics</em>.</p> HAIDAR N. MOHAMMED; WAHID M. HASSAN ##submission.copyrightStatement## http://dmj.uod.ac/index.php/dmj/article/view/68 Fri, 31 May 2019 00:00:00 +0000 MULTIPLE DRUGS RESISTANCE AMONG URINARY TRACT INFECTION PATIENTS IN DUHOK CITY –KURDISTAN REGION –IRAQ http://dmj.uod.ac/index.php/dmj/article/view/69 <p><a href="https://doi.org/10.31386/dmj.2019.13.1.3"> https://doi.org/10.31386/dmj.2019.13.1.3</a></p> <p><strong>&nbsp;</strong><strong>Background:</strong>Anti-microbial resistance could be a major public-health problem worldwide and universal endeavors are required to counteract its rise and the moment most common reason for observational antibiotic treatment. Optimal treatment seems diminish mortality and morbidity in surgical patients and play a crucial part in combating the continuous emergencies of expanding antibiotic resistance. The aim of this study is to study the pathogens and their antibiotic susceptibility in urinary cultures to Central laboratory in Duhok City and to study the rationality of antibiotic treatment urinary tract infection.</p> <p><strong>Patients and Methods:</strong>One hundred fifty-one UTI urine samples (culture positive) were collected from patient of central laboratory. Identified and isolated bacteria were determined by biochemical tests like Gram staining, Indole, oxidase, catalase, methyl red, Voges-Proskauer, citrate utilization, hemolysis, motility; and urea; fermentation and utilization tests of glucose, lactose and sucrose. Sensitivity pattern of isolates was determined against some traditional and conventional antibiotics.</p> <p><strong>Results:</strong><em>Staphylococcus aureus</em> was the most common bacteria (40.4 %) followed by E.coli (31.8%). The overall levels of resistance to commonly used antibiotics were moderate in all pathogens. Amikacin and Nitrofurantoin were generally the antibiotics with lowest rates of resistance. Aminoglycosides and Fluoroquinolones were the most often used antibiotics. In first-line treatment, only 55 % of cases were given at least one antibiotic to which the bacteria were sensitive. A statistically significant higher resistant to both Amoxicillin and Erythromycin were found in cultures from UTI patients (P = 0.02 and P = 0.002).</p> <p><strong>Conclusions:</strong>Commonly encountered bacteria in this study which are <em>Staphylococcus</em>, <em>Escherichia coli</em> and <em>Klebsiella</em> were found to be highly sensitive to Nitrofurantoin, Amikacin and, to lesser extent, to ciprofloxacin, while low sensitivity pattern was recorded against Amoxicillin and Gentamicin, pointing to that antibacterial misuse is the leading cause for their resistance. The most commonly prescribed antibacterial Trimethoprim.</p> IBRAHIM MOHAMMED ABDULLAH ##submission.copyrightStatement## http://dmj.uod.ac/index.php/dmj/article/view/69 Fri, 31 May 2019 00:00:00 +0000 A CLINICOPATHOLOGICAL STUDY OF THYROID NODULES http://dmj.uod.ac/index.php/dmj/article/view/70 <p><a href="https://doi.org/10.31386/dmj.2019.13.1.4"> https://doi.org/10.31386/dmj.2019.13.1.4</a></p> <p><strong>&nbsp;</strong><strong>Background:</strong> Nodular thyroid disease is very common and surgeons needs to differentiate benign from malignant nodules. Fine needle aspiration cytology of malignancy (FNAC) can assist the surgeon to select the proper technique for thyroid nodule management. The clinical parameters of patients with thyroid nodules were explored and the rate of malignancy was assessed. As well, the role of fine needle aspiration cytology in the diagnosis of these nodules compared to histopathological findings was evaluated.</p> <p><strong>Patients and Methods:</strong> In the current prospective cross-sectional study, 79 patients diagnosed with thyroid swelling were undergone medical and clinical examinations, biochemical tests, and fine needle aspiration cytology at Azadi Teaching Hospital in Iraq in 2016. Tissue specimens of thyroid were sent for histopathological diagnosis.</p> <p><strong>Results:</strong> Thyroid nodules were more common in female (84.8%), the mean age was 40.28 years. The most common indication of surgical intervention was dysphagia. Multi-nodular was the commonest type of thyroid nodules (73.4%) followed by a follicular adenoma (8.9%) and Hashimoto’s thyroiditis (7.6%). Prevalence of malignancy was 7.6% and papillary thyroid cancer was the most common cancer (6.3%). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate of fine needle aspiration cytology through histopathological diagnosis were 66.7%, 100%, 100%, 97.3%, and 97.5%, respectively.</p> <p><strong>Conclusions:</strong> The most common types of thyroid nodules were a multi-nodular goiter, follicular adenoma, and thyroiditis. Fine needle aspiration cytology is easily applicable and reliable method for thyroid nodules evaluation with an acceptable sensitivity.</p> DILDAR HAJI MUSA; MAHMOUD ALI ABDI, MOWAFAK MASOUD BAHADDIN ##submission.copyrightStatement## http://dmj.uod.ac/index.php/dmj/article/view/70 Fri, 31 May 2019 00:00:00 +0000 THE EFFECTIVENESS OF SHORT-TERM INTENSIVE COGNITIVE-BEHAVIORAL THERAPY ON SYMPTOMS SEVERITY OF PATIENTS WITH PANIC DISORDER http://dmj.uod.ac/index.php/dmj/article/view/71 <p><a href="https://doi.org/10.31386/dmj.2019.13.1.5"> https://doi.org/10.31386/dmj.2019.13.1.5</a></p> <p><strong>Background:</strong> Panic disorder (PD) is defined as a sudden rise in extreme fear or drastic distress appearing at a maximum level within minutes. Cognitive-behavioral therapy (CBT) is the psychological treatment of patients with chronic PD. Despite more effectiveness and preferable cognitive behavior therapy in the treatment of PD in comparison with pharmacotherapy, a considerable percentage of patients do not benefit from it due to too many and long sessions per week. Accordingly, this study aimed to examine the effectiveness of a group short and intensive (4 days) program of CBT on symptom severity in patients with PD with or without agoraphobia.</p> <p><strong>Patients and Methods:</strong> In the present clinical trial, the patients attended the author’s private clinic in Duhok city were consecutively screened for eligibility criteria. Of them, 40 patients diagnosed with PD with or without agoraphobia were randomized assigned into experimental (n=20) and control group (n=20) by a random digit number generated by a computer. The patients assigned into the experimental group received one-month intensive CBT; four two-hour sessions along with their regular medications; and the patients in the control groups received their regular treatments only. The symptom severity was assessed by the Panic Disorder Severity Scale (PDSS) in both groups following the course completion.</p> <p><strong>Results:</strong> The patients in both groups of the study were comparable in age, gender, education, marital status, physical activity, history of child abuse, and occupation before starting and after finishing the course (P&gt;0.05). The study showed that the severity and frequency of panic symptoms were significantly lower in the experimental group compared to the patients in the control group.</p> <p><strong>Conclusions:</strong> The study suggests that the short-intensive CBT programs can be effective to reduce the panic symptoms in patients with PD.</p> <p>&nbsp;</p> SALIM SAADI MIHO ALHAKEM ##submission.copyrightStatement## http://dmj.uod.ac/index.php/dmj/article/view/71 Fri, 31 May 2019 00:00:00 +0000 LIPID PROFILE IN SUBCLINICAL HYPOTHYROIDISM: A TWO CENTERS EXPERIENCE http://dmj.uod.ac/index.php/dmj/article/view/72 <p><a href="https://doi.org/10.31386/dmj.2019.13.1.6"> https://doi.org/10.31386/dmj.2019.13.1.6</a></p> <p><strong>Background:</strong> Subclinical hypothyroidism (SCH) is estimated to affect around 7.5-8.5% of females and 2.8-4.4% of males. One of the features of clinical hypothyroidism is dyslipidemia. There is a great debate about the presence of abnormal lipid profiles in patients with subclinical hypothyroidism (SCH) and weather it is clinically significant or not. Some evidences show reduction in the level of the serum lipid profile after replacement with thyroid hormones. The purpose of this study is to estimate the prevalence of dyslipidemia in patients with subclinical hypothyroidism in Duhok and Erbil cities, Iraq.</p> <p><strong>Patients and Methods:</strong> This is a case-control study that was done on 200 individuals. One hundred patients confirmed with subclinical hypothyroidism were compared with a group of 100 apparently healthy individuals. These two groups were matched for age and sex. The study done in 2 centres; Azadi Teaching Hospital in Duhok and Rizgari Teaching Hospital in Erbil, Kurdistan Region, Iraq from from 1st December 2017 to 1st December 2018.</p> <p><strong>Results:</strong> Dyslipidemia was commoner in patients with subclinical hypothyroidism compared to control group (<em>p</em> value 0.001) compared to the control group (<em>p</em> value 0.766). The total cholesterol and the triglyceride levels were steadily increased in relation to the level of the thyroid stimulating hormone (TSH).</p> <p><strong>Conclusions:</strong> Subclinical hypothyroidism (SCH) is regarded as an atherogenic condition because it increases the cholesterol and the triglyceride levels. Management of subclinical hypothyroidism with thyroid hormones may have a positive impact on the cardiovascular health. It is reasonable to measure the levels of the serum lipids and cardiovascular risk in these patients and to manage them when it is clinically applicable.</p> BAYAR AHMED QASIM, AYAD AHMAD MOHAMMED, MAZYAR JABBAR AHMED ##submission.copyrightStatement## http://dmj.uod.ac/index.php/dmj/article/view/72 Fri, 31 May 2019 00:00:00 +0000 FREQUENCY OF HLA-DRB1/DQB1 ALLELES AMONG TYPE 1 DIABETES PATIENTS IN DUHOK, KURDISTAN REGION (IRAQ) http://dmj.uod.ac/index.php/dmj/article/view/73 <p><a href="https://doi.org/10.31386/dmj.2019.13.1.7"> https://doi.org/10.31386/dmj.2019.13.1.7</a></p> <p>&nbsp;<strong>Background:</strong> A large number of studies have demonstrated that specific alleles at the HLA-DRB1 andHLA- DQB1 loci are strongly associated with type 1 diabetes mellitus (T1DM). This preliminary study investigated the heterogeneity in HLA class 11 genotypes distribution among Kurd patients with type 1 diabetes.</p> <p><strong>Patients and Methods:</strong> The study was conducted at Duhok Diabetes Center, Duhok, Kurdistan Region (Iraq). The study participants comprised 96 unrelated T1DM patients and 48 healthy control subjects. Currently, HLA typing methods are relatively expensive and time consuming. We sought to determine the minimum number of HLA polymorphism among T1DM patients and healthy controls that could define the HLA-DR/DQ alleles relevant to T1DM patients .All participants were typed at a polymerase chain reaction-(PCR) for theDRB1 and DQB1 loci. The association analysis was performed by comparing the frequency of DR/DQ alleles among the diabetic patients with the frequency of alleles in the healthy controls.</p> <p><strong>Results:</strong> Number of specific DR/DQ alleles has been identified and a statistically significant association with diabetes has been established. Compared with the healthy controls, patients were more than two-third as likely to have HLA- DRB1*03and -DRB1*04. HLA- DQB1*02allele was also more frequent in T1DM patients. HLA-DRB1*01,-DQB1*05 and -DQB1*06 were less frequent in T1DM patients.</p> <p><strong>Conclusions:</strong> The data indicate that the HLA-DRB1*03, -DRB1*04 and -DQB1*02 were positively associated with TID and may be the most prone alleles, while the HLA-DRB1*01 followed by-DQB1*05 and -DQB1*06 were negatively associated with TID and may be the most protective alleles.</p> DHIA J. AL-TIMIMI1; SALMA S. SHAFEEQ, IDRIS H. AHMED, RAWAND A.AL-QADI ##submission.copyrightStatement## http://dmj.uod.ac/index.php/dmj/article/view/73 Fri, 31 May 2019 00:00:00 +0000 STATUS OF SERUM ZINC LEVELS IN FEMALES WITH THYROID DYSFUNCTION http://dmj.uod.ac/index.php/dmj/article/view/74 <p><a href="https://doi.org/10.31386/dmj.2019.13.1.8"> https://doi.org/10.31386/dmj.2019.13.1.8</a></p> <p><strong>Background:</strong> Low serum zinc levels have been connected to thyroid function in more than one way, but to date there is still arguments about the association between zinc deficiency and thyroid disease, particularly in females. The aim of this study was to assess status of serum zinc levels in a sample of females with thyroid dysfunction in comparison with those of normal thyroid function and to ascertain its association with thyroid hormone levels.</p> <p><strong>Patients and Methods:</strong> A case control study was conducted on 225 females referred to the Endocrine Unit for definitive diagnosis of thyroid dysfunction and 100 females with normal thyroid function, serves as a control group.</p> <p><strong>Results:</strong> The results revealed that the serum zinc levels were significantly lower in</p> <p>Hypothyroid females(62.2±16.3µg/dl) as compared to hyperthyroid (80.5±13.9µg/dl) and controls (86.2±13.2 µg/dl) with <em>p</em>=0.001.The prevalence of severe zinc deficiency (&lt;50 µg/dl) was found to be significantly higher in hypothyroid females (25.0%) as compared to hyperthyroid females (3.0%), <em>p</em>-value of 0.01, whereas none of the controls had severe zinc deficiency. In the hypothyroid group, positive correlations of zinc were observed with FreeT3 and FreeT4 (<em>p</em>=0.007, <em>p</em>&lt;0.001, respectively) and a negative correlation was observed with thyroid stimulating hormone (TSH), <em>p</em>&lt;0.001.In the overall studied subjects, negative correlation was also found for zinc with TSH (<em>p</em>&lt; 0.001).We did not observe a significant correlation ofFT3, FT4 and TSH with zinc in controls or in hyperthyroid group.</p> <p><strong>Conclusions:</strong> Decreased serum zinc levels may lead to hypothyroidism in females. Efforts to increase zinc status in this group may help correct abnormal levels of thyroid hormones<strong>.</strong></p> SHERWAN F. SALIH; KAJEEN R. HUSSEN, DHIA J. AL-TIMIMI1 ##submission.copyrightStatement## http://dmj.uod.ac/index.php/dmj/article/view/74 Fri, 31 May 2019 00:00:00 +0000 PITFALLS OF THYROID CYTOLOGY IN DUHOK-IRAQ http://dmj.uod.ac/index.php/dmj/article/view/75 <p><a href="https://doi.org/10.31386/dmj.2019.13.1.9"> https://doi.org/10.31386/dmj.2019.13.1.9</a></p> <p><strong>Background:</strong> The current study was undertaken to determine the validity of thyroid fine needle aspiration cytology (FNAC) in Duhok-Iraq to clarify its traded diagnostic errors locally and broadly.</p> <p><strong>Patients and Methods:</strong> All thyroid cytologic and histologic cases referred to Duhok Pathology Centers, between January 2013 and December 2016, were enrolled in this study. Cytologic findings were compared with their corresponding final histologic results. The validity parameters of cytology were assessed and cases showing cytologic and histologic non-conformance were re-evaluated to highlight the dependant cytologic pitfalls used locally and in the literature.</p> <p><strong>Results:</strong> Of 553 thyroid biopsies with 81.6% benign and 18.4% malignant, only 125 cases had preoperative diagnostic cytology and subsequent histologic final diagnoses. Of these, apart from 2 unsatisfactory cases, only 6 (4.9%) cytologic reports were proved not to be matched with their corresponding histologic results. The remaining 117 (95.1%) cases showed complete agreement between the two evaluation tests. Malignancy was predicted by cytology in 82.9%with a sensitivity of 94.3% and specificity of 95.5%. All the 6 unmatched cases were aspirated blindly with no image guide, 4 were false positive resulting in 3.2%false positive rate and 89.2% positive predictive value. The remaining unmatched 2 cases were false negative cytologies that gave 1.6% false negative rate and 97.7% negative predictive value. Cytologically, 5 (83.3%) unmatched smears, 4 false positive and 1 false negative, appeared in smears of lymphocyte-rich thyroid lesions, particularly Hashimoto’s. The false positive pitfalls comprised 2 over diagnosis of hypercellular smears showing some features of papillary carcinoma, 1 overestimation of the large cells with nuclear atypia as follicular carcinoma and 1 over diagnosis of lymphoid hyperplasia as lymphoma. On the other hand, low cellular smears with unclear atypical lymphoid cells underdiagnosed low grade MALT lymphoma and unobvious cytologic criteria missed the diagnosis of papillary carcinoma.</p> <p><strong>Conclusions:</strong> Lymphocyte-rich thyroid smears&nbsp;should be interpreted by experienced cytopathologists in the context of clinical, radiological and cytologic findings as suchcases may give certain cytomorphologic pitfalls that may decrease the cytologic validity. In suspicious cases, further tests should be justified to overcome the limitations and pitfalls of features when applied alone.</p> FARHAD K. SULAYVANI; ASAAD S. OMAR, SABAH A. MOHAMMAD, AZAD M. BAIZEED, SEPAL I. AHMED, ROSE B. HAYDER, MOZAHIM ALKHAYAT, SHATHA D. AHMED, INTISAR S. PITY ##submission.copyrightStatement## http://dmj.uod.ac/index.php/dmj/article/view/75 Fri, 31 May 2019 00:00:00 +0000 PLACENTAS CHANGES IN GESTATIONAL HYPERTENSIVE WOMEN IN DUHOK http://dmj.uod.ac/index.php/dmj/article/view/76 <p><a href="https://doi.org/10.31386/dmj.2019.13.1.10"> https://doi.org/10.31386/dmj.2019.13.1.10</a></p> <p><strong>Background:</strong> Placentas impact by hypertensive disorders and contribute significantly to maternal and fetal morbidity and mortality. This study was designed to investigate the gross and histological changes in the placentas of gestational hypertensive women.</p> <p><strong>Patients and Methods:</strong> The samples of this cross sectional study were collected from Duhok Obstetrics and Gynecology Hospital, Duhok city, Kurdistan region, Iraq. Total 73 placentas were collected from 20-40 years old women with full-term singleton pregnancies, 25 placentas from normo-tensive mothers having no hypertension before as control group and 48 from gestational hypertension women as gestational hypertension group. The maternal and neonatal data were recorded. Immediately after delivery, the placenta was washed, dried, photographed then weighted and dimensions were measured. Morphological features were recorded. Central biopsies were taken for qualitative and quantitative histopathological examination which included: terminal villi, stromal fibrosis, fibrinoid necrosis, calcification, syncytial knots, hyalinization, medial coat proliferation of medium sized blood vessel, avascular villi, congestion, chorangiosisandvasculosyncytial membrane. Statistical analyses were done by using student t-test and chi- square test.</p> <p><strong>Results:</strong> In the gestational hypertension, macroscopically, there was no statistical difference. Microscopic finding revealed a significant increase in calcification, fibrinoid necrosis, stromal fibrosesand congestion; whereas vasculosyncytial membrane and avascular villi increased insignificantly and chorangiosiswas not impacted. The gross and histological qualitative results coincided with the quantitative results.</p> <p><strong>Conclusions:</strong> The placentas were significantly and adversely affected by the gestational hypertension.</p> GHAZAL HUSSEIN KHALEEL; SAADI SALEH MOHAMMED BARWARI ##submission.copyrightStatement## http://dmj.uod.ac/index.php/dmj/article/view/76 Fri, 31 May 2019 00:00:00 +0000