Duhok Medical Journal 2023-01-03T13:04:03+00:00 Open Journal Systems <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> EVALUATION AND COMPARISON OF TOTAL ANTIOXIDANT CAPACITY OF SALIVA IN PATIENTS WITH AND WITHOUT CHRONIC PERIODONTITIS PATIENT 2023-01-03T12:57:58+00:00 NORA AKRAM HASAN SAEED ALI MOHAMMED ALI YAHYA SAEED <p><a href=""></a></p> <p><strong>&nbsp;</strong><strong>Background:</strong> Saliva despite being rich in ions, proteins, and antibodies also contains antioxidants: ascorbic acid, uric acid, albumin, and enzymes, which play an important role against oxidative stresses (OS) that causes oral cavity diseases like periodontitis. The aim of study is to analyze and compare the total antioxidant capacity of saliva between chronic periodontitis patients (at baseline and after therapy) and healthy non-chronic periodontitis patients (control group) in addition to comparing periodontal measurements such as gingival index, pocket depth and clinical attachment loss among chronic periodontitis patients at baseline and after one month from treatment.</p> <p><strong>Methods:</strong> The methodology of this study is a clinical quantitative study, which consists of A total of 53 patients who visited Duhok dental polyclinic/ Kurdistan region of Iraq from April 2021 to November 2021 were enrolled in this study. Among them, 37 patients suffered from chronic periodontitis, while 16 individuals were healthy and regarded as control group, age group was between 30 and 55 years old, out of 52 patients, 23 were female and 30 were male. Unstimulated saliva samples were collected from patients at baseline and one month after therapy (non-surgical treatment) and from control group. All samples were analyzed using total Antioxidant Capacity Assay Kit (Sigma-Aldrich, USA) by EPOCH2 plate reader (BioTek, USA).</p> <p><strong>Results:</strong> The means of periodontal parameters (Gingival Index, Periodontal Pocket Depth, Clinical Attachment Loss) in chronic periodontitis patients were significantly decreased after non-surgical treatment, while the Total Antioxidant Capacity (TAC) of saliva was significantly increased in chronic periodontitis patients after one month of treatment but still significantly lowered when compared with the control group.</p> <p><strong>Conclusions:</strong> The Total Antioxidant Capacity (TAC) of saliva decreased in chronic periodontitis patients as the result of oxidative stress generated by bacterial pathogens but elevated by non-surgical treatment and good oral hygiene home care.</p> 2023-01-03T09:34:03+00:00 ##submission.copyrightStatement## CLINICAL CHARACTERISTICS OF STROKE IN DUHOK PROVINCE 2023-01-03T13:00:06+00:00 HEEWA ABDELSALAM YOUNIS <p><a href=""></a></p> <p><strong>Background:</strong> Cerebrovascular accidents (stroke) are considered the second leading factor contributing to mortality and they are the third cause of disability. Stroke in low- and middle-income countries (LMIC) has doubled over the last four decades but little attention has been paid to this issue in this region.</p> <p><strong>Objectives:</strong> The distribution of stroke and its sub-type including pathologically ischemic (major vs. small vessel), intracerebral hemorrhage, subarachnoid hemorrhage and venous infarction and anatomically (anterior vs. posterior circulation), lobes localization were explored in this study.</p> <p><strong>Methods:</strong> In this large cross-sectional study, the patients who attended three general hospitals in Duhok governorate and were diagnosed with stroke and its types were included. The patients who attended the out-patient clinic of the hospitals were examined physically and clinically for the eligibility criteria.</p> <p><strong>Results:</strong> The mean age of the patients who were included in this study was 64.73 (SD: 12.55) ranged between 16 and 105 years. The mean BMI of the patients was 26.34 (SD: 3.90) with the dominant overweight population (40.8%) followed by normal weight (37.2%) and obese (21.4%). The study showed that most of the patients had hypertension (78.0%), dyslipidemia (63.1%) and sedentary lifestyle (52.9%). The prevalence of stroke subtypes was macrovascular stroke (48.7%), lacunar stroke (32.9%), ICH (15.7%), SAH (2.5%), and venous (0.2%). The prevalence of clinical risk factors was IHD (25.5%), past CVA (37.8%), and AF (25.4%). The study showed that patients with macrovascular and lacunar stroke were significantly older (65.80 and 65.84 years, respectively) compared to other stroke subtypes. The BMI of the patients with stroke subtypes was not significantly different, but the mean of all of them was overweight (P=0.453). The lowest rate of stroke subtypes was observed in patients with blood group O (P=0.969). The patients with T2DM (P&lt;0.001) and dyslipidemia (P=0.003), and those patients with sedentary lifestyles (P=0.034). The prevalence of stroke subtypes was significantly more prevalent in patients without IHD (P=0.046) and those without past CVA (P=0.017). The prevalence of stroke subtypes was not significant between those patients with and without AF (P=0.713).</p> <p><strong>Conclusions:</strong> The present study showed that macrovascular and lacunar strokes were the most prevalent types of stroke in this region. The stroke subtypes were more prevalent in patients with overweight, diabetes mellitus, and hypertension.</p> 2023-01-03T09:35:41+00:00 ##submission.copyrightStatement## HEMATOLOGICAL PREDICTORS OF OUTCOME IN CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA IN DUHOK 2023-01-03T13:00:32+00:00 KEVI JAFFER IBRAHIM ADNAN ANWER AL-DOSKI ABDULRAHMAN ABDULLAH MUHSIN <p><a href=""></a></p> <p>&nbsp;<strong>Background:</strong> While numerous studies have addressed the outcome of childhood acute lymphoblastic leukemia (ALL) in western developed countries, there is a scarcity of data in developing countries. This study explores the hematological predictors of outcomes in childhood acute lymphoblastic leukemia in Duhok city- Kurdistan Iraq.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p> <p><strong>Method:</strong> the current study represents a cross-sectional study, conducted in Hivi Pediatric hospital and Zheen oncology center in Duhok, Iraq, and 116 patients were enrolled. The main features of childhood ALL, hematological predictors, type of therapy, and risk factors were analyzed to assess their effect on treatment outcome and survival rate.</p> <p><strong>Results:</strong>&nbsp; Median age of the study cohort was 5 years and the male-to-female ratio of 1.4:1. 87.9% of the cases were B-ALL while 12.1 were T-cell. Blood counts revealed a mean WBC count of 54.34 x 109/L, mean hemoglobin of 7.913 g/dl, and mean platelet count of 68.96 x 109/L. Complete remission (CR) rate was 92.2%, the overall 5-year survival (OS) was 76.7%, and relapse-free 5-year survival (RFS) was 73.3%. Patients with B-cell ALL had significantly higher OS compared to patients with T-cell (p value=0.01). Patients stratified into high-risk groups had significantly lower RFS and OS compared to the intermediate and standard risk groups (p value=0.04, 0.008 respectively). Patients aged &gt;10 years had significantly lower RFS (p value=0.001). Other factors such age&lt;1 year, PLT count, Hb count, and gender did not predict poor outcome</p> <p><strong>Conclusion:</strong> Immunophenotype, age&gt;10 years and risk stratification are important predictors of outcome in childhood ALL in our study, most notably, the patients’ survival rates were inferior to similar reports from western developed countries, The key areas for future work should include wider implementation of MRD and cytogenetic analysis in risk stratification to improve the outcome of childhood ALL.</p> 2023-01-03T09:37:11+00:00 ##submission.copyrightStatement## INTRA-OCULAR PRESSURE CHANGES FOLLOWING NEODYMIUM-DOPED YTTRIUM ALUMINIUM GARNET (ND:YAG) LASER CAPSULOTOMY 2023-01-03T13:00:51+00:00 HIND SABAH AZEEZ NOUR MOAFIQ MASOUD QASIM HASSO ABDULLAH <p><a href=""></a></p> <p><strong>&nbsp;</strong></p> <p><strong>Background:</strong> Posterior capsule opacification (PCO) is common complication of cataract surgery, neodymium:yttrium aluminum-garnet (Nd:YAG) laser capsulotomy is standard treatment. Although, it is non-invasive, it carries risk of complications.</p> <p>&nbsp;AIM: to study intra-ocular pressure changes (IOP) and its correlation with energy, shot numbers, size and visual outcomes of capsulotomy; and finding the commonest type of opacification.</p> <p><strong>Method:</strong> This cross-sectional study was conducted in Duhok Eye Hospital from April 2018 to April 2019; 100 patient participants were examined for visual acuity, IOP measurement, and slit lamp examination.</p> <p><strong>Results:</strong> 60 males and 40 females (67%) were from 60 to 79 years, 53 right and 47 left eyes. The mean visual acuity and refraction were found to be higher one week post capsulotomy compared to pre capsulotomy, P value being less than 0.001. Most of female’s jobs were housewives (37.0%), while males’ jobs were ranged from (48.0%) retired (8.0%) workers to (7.0%) office workers. A higher mean in IOP was found two hours post-capsulotomy, P value being 0.025 when it was compared with IOP pre-capsulotomy and IOP one week post capsulotomy. A positive relation between shot numbers and increase IOP two hours post capsulotomy was recorded, P value 0.049.</p> <p><strong>Conclusions:</strong> The commonest type of PCO was membranous. 59.0% of patient’s ha the best corrected visual acuity of 6/6-6/12. IOP rise the was most frequent complication that reached a maximum two hours post capsulotomy, it was associated with shots number. and was normalized within a week</p> 2023-01-03T09:37:52+00:00 ##submission.copyrightStatement## DYSLIPIDEMIA AND BENIGN BREAST DISEASES 2023-01-03T13:01:08+00:00 SANA RASHEED TAHA FARHAD KHORSHEED <p><a href=""></a></p> <p>&nbsp;</p> <p><strong>Background:</strong> Benign breast disorders are the most common abnormalities found in women as far as breast disease is concerned. The study's goal was to see if there is a link between serum dyslipidemia and benign breast diseases in women.</p> <p><strong>Subjects and Methods:</strong> This is a case-control study, that involved 70 patients with benign breast diseases (cyclical mastalgia, fibrocystic breast disease and fibroadenoma) and 70 control healthy women and all of them had been selected randomly, aged (20-45 years) in a period between 1st September. 2021- 30th June. 2022. It is hospital-based study, The patients’ group was carried out at the breast clinic at Azadi teaching hospital, while healthy participants in control group had been recruited in this study from different places in Duhok city such as governmental institutions, camps and universities with matching ages.</p> <p><strong>Results:</strong> The mean age of patients and control groups was 33.5±7.6 and 33.1±6.5 respectively. Fibrocystic breast disease constitutes 40 % of patients with benign breast diseases, while 38 % of them had cyclical mastalgia and only 21% had fibroadenoma. Seventy-Eight percent of patients had a normal lipid profiles and it is also normal in 80 % of a control group (P value less than &lt;0.8). There was a significant difference in total cholesterol and VLDL between patients and control groups (P value less than &lt;0.004 and 0.0005 consequently). Regarding the relationship of a lipid profile to the different etiologies of benign breast diseases, all parameters were not significant between different groups except for LDL and VLDL, as it was significant when we compare fibroadenoma to fibrocystic breast diseases with the P-value of 0.0001 and 0.0002 consequently. Also, when we compare fibroadenoma and cyclical mastalgia, there was a significant difference between LDL and VLDL with P values of 0.0001 and 0.01consequently.</p> <p><strong>Conclusion:</strong> There is a clear association between benign breast diseases and some parameters of lipid profile such as total cholesterol and VLDL. We do recommend measuring lipid profiles in these groups of patients especially those with fibroadenoma</p> 2023-01-03T09:39:36+00:00 ##submission.copyrightStatement## STUDY OF HEMATOLOGICAL PARAMETERS IN PATIENTS WITH COVID-19 DISEASE IN KURDISTAN REGION-IRAQ 2023-01-03T13:01:28+00:00 SIVAN BAKR ASKANDAR ADNAN ANWAR AL-DOSKI <p><a href=""></a></p> <p>&nbsp;</p> <p><strong>Background:</strong> Coronavirus disease 2019 is an infectious disease that was found at the end of 2019. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was recognized as the virus that leads to COVID-19. The study was directed to find out the hematological parameter changes in COVID-19 patients according to the severity of the disease.</p> <p><strong>Methods:</strong> The study has been done in two centers Sulaymaniyah and Duhok Governorates for a period of six months between September 2021 to March 2022. A total of 201 enrolled patients were included. For each patient demographic characteristics and blood test results (total and differential WBC, Hb, platelet, ferritin, CRP, D-dimer, NLR, PLR) were collected, following the severity of the disease and the outcome of each one of the patients. SPSS software was used for statistical analysis.</p> <p><strong>Results:</strong> The study revealed that female patients were more than males 60.2% and 39.8% respectively with an overall mean age of 54.65±17 years. The mean duration of hospitalization is 14.4 ± 7.7 days. Furthermore, the study showed that patients had 30.8% leukocytosis,17.4% lymphopenia, and 31.8% neutrophilia. Higher NLR and PLT are seen in severe cases with NLR ≥3.1and PLR ≥ 285. Also, high levels of CRP, D-dimer, and ferritin were seen in severe COVID-19 patients.</p> <p><strong>Conclusions:</strong> Changes in hematological parameters can be useful in predicting of the disease severity of COVID-19 patients.</p> 2023-01-03T09:40:32+00:00 ##submission.copyrightStatement## THE EFFECT OF TRANEXAMIC ACID ON REDUCING THE AMOUNT OF BLOOD LOSS DURING CESAREAN SECTION AT MATERNITY HOSPITAL IN DUHOK 2023-01-03T13:01:47+00:00 KURDISTAN NADER ALI IMAN YOUSIF ABDULMALEK <p><a href=""></a></p> <p>&nbsp;</p> <p><strong>Background:</strong> The Cesarean section rate is increasing worldwide. Efforts are being made to decrease Cesarean section which may lead to many complications. World Health Organization recent guidelines recommended the administration of Tranexamic acid to decrease the amount of blood loss and treat postpartum hemorrhage to reduce the risk of severe anemia and the need for blood transfusion.</p> <p><strong>Objectives:</strong> To assess the effect of Tranexamic acid on the amount of blood loss during elective cesarean section and to evaluate the reduction in the hemoglobin and hematocrit level.</p> <p><strong>Methods:</strong> This randomized control trial study was conducted during the period from 15th September 2021 to 15<sup>th</sup> January 2022, at Duhok Hospital for Obstetrics and Gynecology. The study enrolled 200 women in the age group 20 to 40 years, who were at 37 to 41+6 weeks of gestation, received regular antenatal care, had no renal, liver, heart diseases or coagulopathies and no allergy to drugs. The women were randomly allocated into two groups the interventional group G1 received 1 gm of Tranexamic acid in 100 ml normal saline for 10 minutes before starting the operation and the control group G2 did not receive it. Both groups received 10 units oxytocin IV after fetal delivery. Amount of blood loss intraoperatively, change in hemoglobin, hematocrit levels, drug side effects were observed and analyzed, and the need for extra uterotonics, blood transfusion and the occurrence of PPH among the two groups.</p> <p><strong>Results:</strong> There were no significant differences in term of age, BMI, parity, gestational age, antenatal care visits, and the indications for cesarean section between G1 and G2. There was a highly significant difference in the mean estimated blood loss (EBL) between the two Groups, which was (290±5.5 ml) for G1 and (429±81 ml) for G2, the P-value &lt;0.001. The same for the mean Hb and hematocrit reduction with a highly significant between the two Groups, <em>P</em>-value &lt;0.001. The need for extra uterotonics drugs was less in G1 compared to G2.</p> <p><strong>Conclusion:</strong> Administration of IV Tranexamic acid as a prophylaxis before starting skin incision significantly reduced the amount of blood loss intra operatively, and affected hemoglobin, hematocrit level. It deceased the need for extra uterotonics drugs.</p> 2023-01-03T09:41:11+00:00 ##submission.copyrightStatement## HEALTH EDUCATION ROLE IN IMPROVING PERIODONTAL HEALTH STATUS AMONG PRIMARY SCHOOL STUDENTS IN DUHOK GOVERNORATE, KURDISTAN REGION, IRAQ 2023-01-03T13:02:07+00:00 NASREEN HAMARASH HAMONARI QAYSER SAHIB HABEEB <p><a href=""></a></p> <p>&nbsp;</p> <p><strong>Background:</strong> Data from numerous epidemiological studies revealed that the prevalence and severity of periodontal disease is wide spread in children and adolescents, with approximately 50% to 100% of 12-years-old children having the signs of gum inflammation.</p> <p><strong>Aim:</strong> This study was designed to assess the role of health education program in improving periodontal health status among primary school students in Duhok governorate.</p> <p><strong>Participants and methods:</strong> The study investigated students 11-15 years old selected from 12 schools out of (892) primary public schools in Duhok governorate. For better socio demographic representation, the schools were purposely categorized into three equal groups representing rural, suburban and urban sectors. Four schools were randomly selected from each of the three sub-counties, two schools were randomly assigned for health education programs with the other two schools regarded as controls. All students of the first 6th grade class from the selected schools were enrolled. Thus a total of 615 students were assigned to intervention and controls (304 and 311 students respectively). A questionnaire was used to obtain information on age, gender, medical diseases and drug history. Utilizing a variety of learning and teaching methods a specially constructed health education program was administered to the intervention group by the researcher. The program included lectures, discussions, practical experiments, group work, problem-solving exercises, debates and role-play with appropriate stimulating visual aids and posters, accompanied by distribution of brushes and paste to the students. This was followed by clinical dental examination for each student. The effects of health education have been evaluated by using two outcome variables namely; Plaque index and gingival index.</p> <p><strong>Results:</strong> The results revealed high scores of plaque and gingival indices at the baseline pre- intervention assessment among the participants. These scores have been reduced significantly at post intervention assessment in the intervention group compared to the controls p ≤ 0.05. This improvement in the intervention group was maintained at follow up assessment six weeks after the intervention.</p> <p>&nbsp;Females in the intervention and the control groups exhibited lower mean plaque and gingival scores than males. Both gingival and plaque scores in this study were consistently higher in rural than in urban communities p ≤ 0.05 (Significant).</p> 2023-01-03T09:41:43+00:00 ##submission.copyrightStatement## SPERM DNA DAMAGE RATE AMONG INFERTILE PATIENTS WITH VARICOCELE 2023-01-03T13:02:29+00:00 ABDULGHAFOOR SULAIMAN ABDULKAREEM HISHYAR AZO NAJEEB AHMED TAHIR RAJAB <p><a href=""></a></p> <p>&nbsp;</p> <p><strong>Background:</strong> Varicocele has a common association with male hypofertility. The prevalence of clinical varicocele is about 15% among adults and adolescents. varicocele patients are at risk of infertility. Sperm deoxyribonucleic acid (DNA) fragmentation rate (SDFR) is considered a major factor in decreased fertilization ability in males with varicocele. Varicocele increases SDFR through heat stress, increased reactive oxygen species, and reduction in the level of total antioxidants.</p> <p>Objectives: To study the rate of sperm DNA fragmentation in patients with different grades of varicocele.</p> <p><strong>Patients and methods:</strong> A prospective, case-control study was conducted at Azadi Teaching hospital in Duhok city / Iraq from March 2020 to December 2021. The study included 34 infertile patients with varicocele of different grades and 30 infertile patients without varicocele. Seminal fluid analysis was performed followed by sperm DNA analysis by Alkaline Comet Assay. The obtained data were analyzed using a Prism-GraphPad to compare the mean of parameters in patients and control subjects.</p> <p><strong>Results:</strong> Sixty-four infertile patients were included. The mean of sperm immobility and abnormal morphology rates were statistically higher in infertile patients with varicocele compared with those without varicocele (39.56±12.63 Vs 28.07±4.541) and (51.59±23.00 Vs 34.79±15.72) respectively, (P&lt;0.0001).The fluorescence microscopic images of sperm DNA of infertile patients with varicocele showed a clear migration to DNA tail (DNA damage) compared with sperm DNA of those without varicocele (8.195 ± 0.3799 Vs. 4.794 ± 0.2186) respectively (P&lt;0.0001).The degree of sperm DNA damage was directly related to the degree of varicocele and was significant (P&lt;0.0001).</p> <p><strong>Conclusion:</strong> Sperm DNA damage rate was higher in infertile male patients with varicocele in comparison to those without varicocele and directly related to the grade of varicocele.</p> 2023-01-03T09:42:38+00:00 ##submission.copyrightStatement## PROBING OUTCOMES FOR CONGENITAL NASOLACRIMAL DUCT OBSTRUCTION IN DUHOK CITY 2023-01-03T13:04:03+00:00 NIWAR AMEEN OTHMAN NOUR MOAFIQ MASOUD DILDAR HAJI MUSA <p><a href=""></a></p> <p><strong>Background:</strong> Epiphora is generally a common disorder in children particularly in infants; congenital nasolacrimal duct obstruction (CNLDO) is one of the most frequent causes of epiphora of newborns which symptoms start immediately or within first 2-3 week&nbsp; after birth as tearing and/or discharge of one or both eyes.</p> <p><strong>Aim:</strong> To report the success rate of probing and irrigation for children with CNLDO of different ages.</p> <p><strong>Methods and Materials: </strong>This is retrospective observational comparative study, which was held in Duhok eye hospital, 241 eyes from 209 children from with age range from 6 months to 9 years age, diagnosed as CNLDO included , probing and irrigation done under general anesthesia, according to age, the children were arranged into 4 groups, group I from 6 – 9 months, group II from 9 – 12 months, group III from 1 – 3 years and finally group IV from 3 – 9 years,&nbsp; mean age was 1.8 years.</p> <p><strong>Results:</strong> From 209 children 109 were females and 100 were male. 177 children have unilateral CNLDO and 32 children were having bilaterally obstructed nasolacrimal passage. The success rate was as follows; group 1 (94.6%), group 2 (89.3%), group 3 (81.6%) and group 4 (72.9%). And was defined as a complete resolution tearing and discharge.</p> <p><strong>Conclusion:</strong> Probing is the first surgical intervention for CNLDO not resolving with conservative treatment, despite the decrease in the success rate with increasing age it worthwhile to be the first procedure attempted to open the obstructed duct before proceeding to a more invasive procedure.</p> <p>&nbsp;</p> 2023-01-03T09:43:25+00:00 ##submission.copyrightStatement##