Duhok Medical Journal

The TEACHERS' KNOWLEDGE, ATTITUDES AND PRACTICE TOWARD SMOKING AT PRIMARY AND SECONDARY SCHOOLS IN DUHOK CITY, KURDISTAN REGION OF IRAQ

2025-12-24T13:26:01+00:00

https://doi.org/10.31386/dmj.2025.19.2.1

Background: Smoking has serious negative effects on health, mental state, and society. It remains a major public health concern, especially among adolescents and young adults, and there is a risk of increased usage among these age groups.

Methods: In this cross-sectional study, 3005 primary and secondary school teachers in Duhok City, Kurdistan Region of Iraq, participated in a survey on smoking attitudes and knowledge between December 2023 and February 2024, via a self-administered Kurdish-language questionnaire, adapted from the Global Health Professional Survey by the World Health Organization.

Results: 16.2% of the surveyed individuals were current smokers, with a significant male predominance (28% compared to 1% of females; p < 0.001). The most prevalent form of smoking was cigarettes (80.7%) and the main cause of starting smoking was peer pressure (63.5%). Notably, 44.5% of smokers acknowledged smoking on school premises, although 97.2% are aware of the health hazards associated with smoking, and that it is prohibited in public areas (95.3%).

Conclusions: The high smoking rate among teachers in this study emphasizes the need for public health initiatives and policy enforcement to strengthen tobacco control measures, particularly in schools. Teachers influence pupils, therefore, tailored smoking cessation programs for educators are needed to lower smoking rates and foster a healthy atmosphere in the educational system.

LONG TERM OUTCOME OF RECTAL BLADDER USING MODIFIED DUHAMEL TECHNIQUE IN THE MANAGEMENT OF BLADDER EXSTROPHY IN DUHOK CITY, IRAQ

2025-12-24T13:26:50+00:00

https://doi.org/10.31386/dmj.2025.19.2.2

Background: Urinary diversion is a great challenge in urological surgery, and it is also one of the hot spots in urology. Heitz-Boyer-Houvelac uretero-rectostomy was introduced in 1912. Shaw reported that he performed ureterorectal anastomosis in male and female corpses and demonstrated the feasibility of this procedure in 1937¹.one of the main indications for urinary diversion is Bladder exstrophy which is one of the most serious congenital malformations, is characterized by a spectrum of anomalies involving the ventral body wall, urinary tract, genitalia, bony pelvis in which the bladder does not form into its normal round shape but instead is flattened and exposed on the abdominal wall and the pelvic bones are widely separated. This condition needs to be repaired surgically; the goal of treatment is to reform a considerable sized bladder, to optimize urinary control, to preserve normal renal function and to optimize the appearance and function of external genitalia, However nearly 10% of exstrophic bladders are of small capacity, and at least a further 30% of patients remain incontinent of urine even after a well performed staged reconstruction³.

Key words: Duhamel’s pull-through; Bladder exstrophy; Urinary diversion

Aim: To evaluate the efficacy and safety of the uretero-rectostomy using modified Duhamel’s technique for urinary diversion in treating urinary incontinence in patients with bladder exstrophy, preserving renal function and functional cosmetically acceptable genitalia following the repair of bladder exstrophy and to assess for the long-term complications metabolic, anatomical, risks of neoplasms and the physical quality of life.

Patients and Methods: Five years retrospective study conducted from March 2009 to July 2014 and seven years prospective Sept. 2014 to Nov. 2021. Twenty seven patients, nineteen male and eight female, age ranging 4 to 11 years mean age 6.8 years, all patients underwent the same surgical technique by the same surgeon in two different hospitals, Paediatric Surgery Center at Heevi paediatric teaching hospital and Vazeen private hospital, anal sphincter function were studied in all patients by contrast enema and anal muscle electrical stimulator, average hospital stay was one week, intensive toilet training started one month postoperatively for two months, renal function test, serum electrolytes and PH were checked every two month for 1st six months and then every six months for two years after that every year during the follow up period, renal ultrasound every three months for first year then every six months during follow up period, rectal pouch capacity were assessed at three months and one year postoperatively using proctography, annual proctoscopy with rectal biopsy was done, at each visit frequency of urination and nocturnal bed wetting were assessed.

Results: Blood transfusion intraoperative in one patients, the mean operative time was four hours, in all patients the postoperative recovery were uneventful, during hospital stay Electrolytes, RFT, Blood gases, haemoglobin level and haematocrit values were checked daily all were within normal values and later according to follow up schedule, the rectal pouch capacity was significantly increased after one year with a mean of 330ml, The ability of retaining motions was improving with time with a mean of 4 hrs. at one year, Bedwetting was significantly decreasing with time, from 8 times per month at 3 months to 4 times per month at 6 months and once monthly at one year follow up, two patients needed constipating agent for one month to assist rectal control, Four patients had UTI, three of them without recurrence during follow up and one had recurrent UTI with febrile pyelonephritis and the cause was corrected surgically, Perianal skin excoriation were in 5 patients, most of them respond well to local emollients, none of patients had abnormal histopathology form the rectal pouch biopsy, regarding child satisfaction, girls more than boys.

Conclusion: Urinary divesion using modified Duhamel’s technique by creating rectal-bladder and uretero-rectostomy is good, easy to perform, successful in the immediate short term results with low complication rate in long term follow up.

BARRETT’S ESOPHAGUS AND ASSOCIATED RISK FACTORS AMONG PATIENTS IN NORTH OF IRAQ

2025-12-24T13:27:24+00:00

https://doi.org/10.31386/dmj.2025.19.2.3

Background: Gastroesophageal reflux disease is a common condition affecting the upper gastrointestinal tract and results in substantial health loss. Its burden is increasing due to global population aging and growth. Barrett’s esophagus is an important complication of this disease and is the precursor of esophageal adenocarcinoma which remains a malignancy with poor prognosis.

Objective: To determine the prevalence of Barrett’s esophagus and its risk factors in Duhok, Iraq.

Patients and methods: This prospective study extended from February 2016 to August 2024 in 3 health facilities in Duhok-Iraq. It included 10000 patients referred to diagnostic endoscopy for any indication. The endoscopy was done using high definition gastroscopes and when Barrett’s esophagus was suspected on endoscopy, biopsies were taken using Seatle protocol.

Results: The age range was 18-92 years (mean=44.3 years). The prevalence of BE was 0.5% on histopathology and 1.4% on endoscopy. Risk factors associated with BE were erosive reflux disease (OR= 23.7, P-value <0.0001), hiatus hernia (OR= 10.9, P-value <0.0001), smoking (OR= 2.8, P-value 0.0001), male sex (OR= 2.5, P-value 0.001), obesity (OR= 1.9, P-value 0.02) and age more than 50 years (OR= 1.8, P-value 0.03). Alcohol intake was not associated with BE (P-value 0.07).

Conclusion: The prevalence of BE in our area is lower than the rates reported in the literature. The risk factors for BE are erosive reflux disease, hiatus hernia, smoking, male sex, obesity and age more than 50 years. Alcohol intake was not associated with BE.

PAPILLARY THYROID CARCINOMA WITH COEXISTENCE OF HASHIMOTO AND TUMOR-ASSOCIATED LYMPHOCYTES

2025-12-24T13:28:01+00:00

https://doi.org/10.31386/dmj.2025.19.2.4

Background and objectives: Papillary thyroid carcinoma represents the most common thyroid cancer. The co-existence of Hashimoto thyroiditis and papillary thyroid carcinoma has long been described in clinical research; however, the relationship is still debatable. Recent data depicted that the pre-existing thyroiditis positively impacts the development and progression of papillary thyroid carcinoma. This study aimed to investigate the co-existence of Hashimoto thyroiditis and papillary thyroid carcinoma and their correlation with immunological markers expression, including CD19 and IgG4, and with the clinicopathological factors.

Methods: The research conducted a retrospective investigation evaluating thyroid tissue obtained from papillary thyroid carcinoma patients with Hashimoto thyroiditis or non-specific thyroiditis coexistence. The examination determined B-cell and plasma cell infiltration using CD19 and IgG4 markers analysis to correlate them statistically with demographic and clinicopathological factors.

Results: Showed coexistence of Hashimoto thyroiditis and non-specific thyroiditis with papillary thyroid carcinoma in 74%, with a significant association between IgG4-related disease with age and the histological subtypes. The IgG-related disease manifests primarily in patients below 45 years, particularly among those with Hashimoto thyroiditis. In contrast, other clinicopathological findings showed no correlation to inflammation and immunological markers.

Conclusions: For patients aged under 45 years, IgG4-related disease was predominant, especially those with Hashimoto thyroiditis. The percentage of female patients was higher in the Hashimoto thyroiditis group with CD19-positivity than in non-specific thyroiditis patients, without a correlation between CD19 expression and age. Papillary thyroid carcinoma presenting with Hashimoto thyroiditis and IgG4 expression, particularly for CD19 expression, defines different immunological markers that require further evaluation regarding the potential prognostic relevance.

PELVIC ORGAN PROLAPSE AWARENESS AND ITS ASSOCIATION WITH REPRODUCTIVE PROFILES OF WOMEN IN DUHOK GOVERNORATE

2025-12-24T13:28:43+00:00

https://doi.org/10.31386/dmj.2025.19.2.5

Background: Pelvic organ prolapses is a severe gynecological condition affecting women post-childbirth and post-menopause, causing herniation of the uterus, cervix, vaginal wall, bladder, and rectum, causing symptoms like pelvic pressure, vaginal bulging, urinary incontinence, and sexual dysfunction, the study seeks to identify the socio-demographic and obstetric profiles of the women, evaluate their awareness levels regarding pelvic organ prolapse, and determine the relationships between these characteristics and their awareness.

Methods: A cross-sectional descriptive study was conducted among 400 women during the period from September to December 2024. A structured questionnaire was administered to collect data related to socio-demographic and obstetric characteristics, along with women's awareness pelvic organ prolapse.

Results: Among all participants, (20.5%) had been diagnosed with pelvic organ prolapse, and (26.8%) reported a family history of the condition. Only (13.2%) of women without a pelvic organ prolapse diagnosis had good awareness, compared to (53.7%) of those diagnosed. Most awareness came from relatives or friends, while social and mass media played a minimal role. Awareness was significantly associated with prior diagnosis, family history, number of parities, and occupation. However, no significant link was found with age, education, or place of delivery.

Conclusion: The majority of women, particularly those without prior diagnosis, have low awareness about pelvic organ prolapse. However, those with more children, previous diagnoses, or a family history of pelvic organ prolapse have higher awareness.

DIAGNOSTIC ACCURACY OF THE MODIFIED PHALEN TEST COMPARED TO OTHER CLINICAL MANEUVERS IN CARPAL TUNNEL SYNDROME: A CROSS-SECTIONAL STUDY

2025-12-24T13:29:13+00:00

https://doi.org/10.31386/dmj.2025.19.2.6

Background: Carpal Tunnel Syndrome is one of the most common upper limb compression neuropathies with several tests/signs used for the assessment in clinical diagnosis. This study aimed to assess the effectiveness of the Modified Phalen test in the diagnosis of Carpal Tunnel Syndrome compared to other tests and electrodiagnostic studies.

Methodology: A cross-sectional diagnostic accuracy study was conducted to assess the effectiveness/validity and accuracy of the Modified Phalen test for the diagnosis of Carpal Tunnel Syndrome and compare it to the other available signs/tests. It took 5 months to enroll a total of 100 cases, i.e. hands. The validity, strength of association, and accuracy were assessed using SPSS version 26.

Results: Tinel’s sign P <0.001, Durkan test P = 0.006, and Modified Phalen Test P = 0.027, with very strong and strong correlation; Phi = 0.387, 0.275 and 0.222, while Phalen test was not significant, P = 0.086 and Phi = 0.172. The modified Phalen test showed an accuracy of 78% second to the Durkan test's 81% and had a sensitivity of 85.7% higher than Tinel’s sign of 52.4% and the Phalen test's 60.7%, and lower than the Durkan test's 89.3%.

Conclusion: The modified Phalen Test shows moderate diagnostic utility with good sensitivity but poor specificity, suggesting its use may be helpful in screening but not confirmation of Carpal Tunnel Syndrome.

THE ROLE OF LASER IN TREATING GINGIVAL PIGMENTATION AMONG SMOKING PATIENTS

2025-12-24T13:30:23+00:00

https://doi.org/10.31386/dmj.2025.19.2.7

Abstract

Background: Gingival pigmentation results from excessive melanin deposition in the basal layer of the epithelium. It is regarded as a major aesthetic concern that can affect a patient’s self-confidence, particularly in individuals with a gummy smile. The present study aimed to compare the clinical efficacy and patient comfort of three depigmentation techniques: surgical scraping using a diamond bur, diode laser, and a combination of bur abrasion followed by low-level laser therapy.

Materials and methods: 60 patients aged 18-45 years who had chief complaints of pigmented or dark gingiva were selected and randomly placed into three groups, Group A (n=20) treated with diode laser 810nm wavelength in continuous contact-mode, Group B (n=20) treated by bur abrasion, Group C (n=20) treated by a combination of bur abrasion followed by diode laser 635nm wavelength in continuous non-contact mode.

Results: Significant differences were observed among groups. The diode laser showed minimal bleeding, with a mean score of 1.10 (0.31) (p < 0.0001), and the shortest procedure time with a mean score of 16.1 (p < 0.0001). On the first postoperative day, pain scores were significantly lower in the diode laser group, with a mean of 0.80 (0.95), compared to the bur abrasion group, with a mean of 1.90 (0.79) (p = 0.0004), and the combination group, with a mean of 1.45 (0.83), By day 3, pain levels had reduced in all groups with no significant difference (p = 0.1510). No significant differences were found in gingival depigmentation (p = 0.3547), healing index (p = 0.8844), or re-pigmentation after three months (p = 0.7603) among groups.

Conclusion: The Diode laser resulted in the shortest procedure time, better hemostasis, and patient comfort compared to other techniques.

DETECTION OF TRICHOMONDETECTION OF TRICHOMONAS VAGNALIS AMONG WOMEN WITH STERILE PYURIA USING CONVENTIONAL PCR TECHNIQUEAS VAGNALIS AMONG WOMEN WITH STERILE PYURIA USING CONVENTIONAL PCR TECHNIQUE

2025-12-24T13:31:04+00:00

https://doi.org/10.31386/dmj.2025.19.2.8

Abstract

Background: Trichomonas vaginalis is a flagellated protozoan and the most common cause of sexually transmitted disease (STD) worldwide, often presenting asymptomatically. T. vaginalis is also recognized as a significant cause of sterile pyuria, characterized by the presence of pus cells in urine without bacterial growth. The main aim of the current study is to detect T. vaginalis in women with sterile pyuria using conventional PCR technique.

Methods: A cross-sectional study was conducted from November 2024 to February 2025 at Duhok Maternity Hospital and the Central Public Health Laboratory. The study included 150 clean-catch midstream urine samples categorized into three groups: pregnant women, non-pregnant women, and healthy individuals. Urine samples with no growth or non-significant growth, alongside more than 10 pus cells per high power field were considered sterile pyuria. DNA extraction was performed directly from 100 sterile pyuria samples and tested for T. vaginalis by PCR technique using species specific primers.

Results: T. vaginalis was detected in 57.3% of all the participants with the highest prevalence noted in pregnant women (62%), followed by non-pregnant women (58%) and the control groups (52%). Detection rates varied by ages with the highest rate (68.8%) found in non-pregnant women aged 37–46. No significant association was found between pregnancy status and the prevalence of T. vaginalis (p = 0.596).

Conclusion: The results of this study indicate that T. vaginalis is the main infectious causes of sterile pyuria particularly among pregnant women and is highly prevalent as an asymptomatic infection in the area. PCR technique should be used to detect this infection early, avoid missed diagnoses, and reduce unnecessary antibiotic use.

EFFICACY OF HYALURONIC ACID GEL WITH CORONALLY ADVANCED FLAP IN THE TREATMENT OF GINGIVAL RECESSION: A RANDOMIZED CLINICAL TRIAL

2025-12-24T13:31:42+00:00

https://doi.org/10.31386/dmj.2025.19.2.9

Abstract

Background: Gingival recession (GR) impairs aesthetics and causes root sensitivity, requiring predictable root coverage. The coronally advanced flap (CAF) is the gold standard for Miller Class I defects; however, it yields variable outcomes. This study aimed to evaluate adjunctive 0.8% or 0.2% hyaluronic acid (HA) gel for enhancing CAF efficacy in GR treatment.

Materials and methods: This double-blind, three-arm, randomized controlled clinical trial was conducted on 30 patients with localized Miller Class I gingival recession (≥ 2 mm) who were randomized into three groups: Group A (n = 10, CAF + 0.8% HA). Group B (n = 10, CAF + 0.2% HA). Group C (n = 10, CAF alone). All clinical parameters, including recession depth (RD), width of keratinized gingiva (WKG), probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), gingival index (GI) and root coverage percentage (RC%), were measured at baseline and one-month and three-month follow-up.

Results: After 3 months, the three groups demonstrated statistically significant improvement from baseline (p < 0.05). Group A showed the greatest reduction in RD (from 3mm to 1mm) and the highest RC (66.7%) followed by group B with RD reduction (3mm to 1.75mm) and RC (50%), and group C with RD reduction (3.5mm to 2.75 mm) and RC (15.5%). CAL gain and PPD reduction were also significantly greater in group A than the other groups. No statistically significant intergroup differences were observed in WKG, PI, or GI.

Conclusion: In the treatment of Miller Class I gingival recessions, the adjunctive use of 0.8% HA with CAF significantly improves root coverage, RD reduction, and CAL gain over both 0.2% HA and CAF alone.

OXIDATIVE DNA DAMAGE AND METABOLIC RISK FACTORS IN PREDIABETES: A CASE-CONTROL STUDY IN DUHOK, IRAQ

2025-12-24T13:32:19+00:00

https://doi.org/10.31386/dmj.2025.19.2.10

Abstract

Background: Prediabetes, a precursor to type 2 diabetes mellitus, defined by glucose metabolism abnormalities resulting from insulin resistance and/or β-cell dysfunction. Recent interest has emerged in oxidative DNA damage as a potential contributor to metabolic dysregulation, particularly via 8-hydroxy-2’-deoxyguanosine (8-OHdG), a biomarker of oxidative stress.

Objective: This study aimed to evaluate serum levels of 8-OHdG in prediabetic individuals and explore its relationship with some metabolic risk factors in comparison to healthy individuals.

Methods: A case-control study was performed on 160 participants (80 prediabetic and sex and age matched 80 healthy individuals) at the Central Laboratory in Duhok, Iraq. Clinical and biochemical assessments included BMI, fasting blood sugar (FBS), HbA1c, insulin, HOMA-IR, and serum 8-OHdG levels. ELISA was used to quantify 8-OHdG. Data were statistically analyzed using SPSS v25, with significance set at p ≤ 0.05.

Results: Individuals with prediabetes exhibited markedly elevated serum 8-OHdG levels (5.13±1.12 ng/ml) in comparison to healthy controls (3.66±1.02 ng/ml, p<0.01), along with elevated FBS, HbA1c, insulin, and HOMA-IR. No significant gender disparities in 8-OHdG levels were found. Higher levels of 8-OHdG were noted in Prediabetics with increased BMI, central obesity, and insulin resistance. A similar trend was seen in healthy individuals, but the differences were not statistically significant.

Conclusion: The study highlights a significant association between oxidative DNA damage and prediabetes, particularly in overweight, centrally obese, and insulin-resistant individuals. These findings indicate that oxidative stress plays a pivotal role in early glucose metabolism disturbances and could be a potential target for early intervention strategies.

The COMPARISON OF INTRATHECAL NEOSTIGMINE VERSUS FENTANYL AS ADJUVANTS TO SPINAL ANESTHESIA IN ELECTIVE SURGERIES

2025-12-24T13:32:51+00:00

https://doi.org/10.31386/dmj.2025.19.2.11

Abstract

Background: Spinal anesthesia is a widely employed method in elective surgeries due to its efficacy, and adjuvants such as fentanyl are commonly added to enhance analgesia. Although neostigmine (a cholinesterase inhibitor) has analgesic benefits when used as an adjuvant, less commonly used due to its perceived side effects. This study aimed to compare the efficacy and safety of intrathecal neostigmine with intrathecal fentanyl as adjuvants in patients undergoing elective lower abdominal surgery.

Method: A total of 184 were randomly assigned to receive either neostigmine (15µg) or fentanyl (15µg) intrathecally with 15mg of heavy bupivacaine. Patients’ hemodynamic stability, vital signs, dermatomal level of the sensory block, motor block intensity, and duration of postoperative analgesia, mobility time, and post-spinal anesthesia complications were documented perioperatively.

Result: Our findings indicated no significant difference in hemodynamic stability or complications (including nausea and vomiting) between the fentanyl group and the neostigmine group. However, neostigmine significantly prolonged the duration of postoperative analgesia with early mobility (p-value < 0.0001 and 0.0002, respectively) and delayed the onset of spinal anesthesia (p-value < 0.0001), which may limit its use.

Conclusion: This study found that intrathecal neostigmine at 15 µg is a valid alternative to intrathecal fentanyl, since it offers a longer duration of postoperative analgesia and earlier mobilization with insignificant difference in terms of intra- and postoperative complications as compared to intrathecal fentanyl.

ENDOSCOPIC MANAGEMENT OF PEDIATRIC FOREIGN BODY INGESTION: A RETROSPECTIVE STUDY

2025-12-24T13:33:30+00:00

https://doi.org/10.31386/dmj.2025.19.2.12

Abstract

Background: Foreign body ingestion is prevalent among pediatric patients, with most accidental cases resolving naturally without intervention. However, immediate action is required in certain situations to mitigate risks and complications.

Methods: The present study was conducted at Hevi Pediatrics Teaching Hospital in Duhok Governorate which analyzed 58 pediatric patients diagnosed with foreign body ingestion from August 2022 to February 2025. Data included demographics, symptoms, clinical presentations, radiological findings, localization, and outcomes.

Results: The mean patient age was 4.63 ± 3.55 years, with 67.2% older than 2 years. Most foreign bodies were metallic objects, including, Turkish lira (29.3%), followed by disk batteries (17.6%), food, sharp objects, and others. Foreign bodies were found in the upper esophagus (75.9%), with symptoms such as drooling/dysphagia (25.9%) and drooling/vomiting (22.4%). Upper gastrointestinal endoscopy was performed for all cases, achieving successful retrieval in 56 patients.

Conclusion: Endoscopic intervention proved to be an effective and well-tolerated method for managing foreign body ingestion in the upper gastrointestinal tract.