Duhok Medical Journal https://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 POST APPENDICECTOMY RIGHT ILIAC FOSSA PAIN A PROSPECTIVE STUDY https://dmj.uod.ac/index.php/dmj/article/view/113 <p><strong><a href="https://doi.org/10.31386/dmj.2020.14.1.1">https://doi.org/10.31386/dmj.2020.4.1.1</a></strong></p> <p><strong>Background:</strong> Diagnosis of acute appendicitis continues to be a real challenge in clinical setting. The recurrence or persistence of pain in the right lower abdomen following appendicectomy is known as post appendicectomy syndrome. This is mainly duetopreoperative misdiagnosis (or over diagnosis) and/or postoperative complications. Negative appendicectomy (appendicectomy in the absence of appendiceal disease) rate has been on the rise. In this study, we looked at patients with recurrent orpersistent right iliac fossa pain post-appendicectomy and investigated the potential causes for this.</p> <p><strong>Patients and methods:</strong> A prospective study, 47 post-appendicectomy patients presented to Duhok Emergency Hospital, Kurdistan region, Iraq with recurrent or persistent right iliac fossa pain (January 2017 - January 2019). Detailed history taking and clinical examination, as well as appropriate investigations were undertaken as well as review of the previous admission records, investigations, surgical notes and histopathology reports.</p> <p><strong>Results: </strong>Clinical assessment and investigations confirmed the presence of primary cause, other than acute appendicitis or appendectomy-related, for the pain (negative appendicectomy). These included: gastroenterological and inflammatory (lymphadenitis, adhesions, stump appendicitis, familial Mediterranean fever, and perforated duodenal ulcer), gynaecological (ovarian cyst, dysmenorrhea, polycystic ovary syndrome), urological (renal stones, ureteric stone, acute right pyelonephritis) and locomotors (disc prolapsed). In 22 patients, no surgical cause was found and a diagnosis of functional pain was given.</p> <p><strong>Conclusion: </strong>In our study, we have managed to identify the causes of negative appendicectomy. We could not quantify the incidence of such cases but do recognise that these cases raise a question about how to improve diagnostic accuracy. Until now, no diagnostic tool could give a 100% accurate diagnosis but rather a combination of clinical judgement following history and appropriate examination and investigations.</p> AAMR A. YOUSIF ABDULGHAFOOR S. ABDULKAREEM SAAD F. ELIAS ##submission.copyrightStatement## 2020-08-15 2020-08-15 14 1 1 11 REVIEW OF OUTCOME OF CLOSED VERSUS OPEN LATERAL INTERNAL PARTIAL SPHINCTEROTOMY IN THE TREATMENT OF CHRONIC ANAL FISSURE https://dmj.uod.ac/index.php/dmj/article/view/114 <p><strong><a href="https://doi.org/10.31386/dmj.2020.14.1.2">https://doi.org/10.31386/dmj.2020.4.1.2</a></strong></p> <p><strong>Background:</strong> Fissure in ano is a very common anal disorder which predominantly presents with sharp rectal pain and bleeding associated with bowel movements. Partial lateral internal anal sphincterotomy is considered the preferred surgical treatment for chronic anal fissure; this may be performed using open or closed method, each with its complications. This study compared the results and complications of closed versus open techniques of partial lateral internal anal&nbsp;&nbsp; sphincterotomy in patients with chronic anal fissure. &nbsp;</p> <p><strong>Materials and Methods:</strong> A total of 119 patients with chronic anal fissure were included in this study. Of these 51 patients underwent closed partial lateral internal sphincterotomy and 68 patients underwent open partial lateral internal sphincterotomy. All these patients were followed up for 6 months post – surgery. The results and complications of both techniques were compared included pain, bleeding, infection, incontinence and recurrence rate.</p> <p><strong>Results:</strong> Pain, bleeding, infection and incontinence were less in the closed technique and in our study no patient by either technique became incontinent for faces, only few cases (Table 4) developed transient incontinence for flatus.&nbsp;</p> <p><strong>Conclusion:</strong> Closed partial lateral internal sphincterotomy technique is superior on open one in the surgical treatment of chronic anal fissures.</p> MOWAFAK MASOUD BAHADDIN ##submission.copyrightStatement## 2020-08-15 2020-08-15 14 1 12 18 CORRUPTION AS A CONTAGIOUS PSYCHOSOCIAL DISORDER, A CONCEPTUAL ANALYSIS https://dmj.uod.ac/index.php/dmj/article/view/115 <p><strong><a href="https://doi.org/10.31386/dmj.2020.14.1.3">https://doi.org/10.31386/dmj.2020.4.1.3</a></strong></p> <p><strong>Background:</strong> Corruption is defined as the abuse of entrusted power for private gain. It is a world-wide phenomenon, particularly in the developing societies. It has been mentioned as a cause of destruction of many empires and powerful states in the history. No effective evidence-based prevention or treatment has been identified, yet. The objective of this study is to describe a conceptual framework using psychosocial analysis based on current scientific theories to explain corruption as a contagious psychosocial disorder to be correctly diagnosed, prevented and treated.</p> <p><strong>Methods:</strong> This is a theoretic conceptual analysis describing corruption for the first time in terms of contagious psychosocial disorder. The sample concerns structural and functional positions at the Child Mental Health Center (CMHC) in the city of Duhok, Kurdistan region of Iraq (KRI) during December 2018 - February 2019.No experimental or clinical data are included. Accordingly, a package of Psychosocial Anti-Corruption Tools (PACT) is presented as an intervention to replace identified actions of corruption.</p> <p><strong>Results:</strong> Specific diagnostic criteria, such as: Illegal or un authorized gain, more than one salary, unjustified power position…etc., are found to classify corruption as a contagious psychosocial disorder according to current theories concerning a etiology, pathogenesis, clinical picture, consequences, prevention and treatment. This is the first pilot project that has been started at a governmental organization.</p> <p><strong>Conclusions:</strong> Corruption can be Hypothesised as a contagious psychosocial disorder to be tested in further rigorous research in other cultures, societies, and countries where corruption is prevailing.</p> ABDULBAGHI AHMAD ##submission.copyrightStatement## 2020-08-15 2020-08-15 14 1 19 27 DETECTION OF CARBAPENEM ANTIBIOTIC RESISTANCE IN KLEBSIELLA PNEUMONIA IN DUHOK CITY/KURDISTAN REGION/IRAQ https://dmj.uod.ac/index.php/dmj/article/view/116 <p><strong><a href="https://doi.org/10.31386/dmj.2020.14.1.4">https://doi.org/10.31386/dmj.2020.4.1.4</a></strong></p> <p><strong>Background:</strong> The emergence of <em>Klebsiella</em> <em>pneumoniae</em> carbapenemase (KPC) is regarded as a major concern worldwide. The aims were to detect carbapenem resistant in <em>K. pneumoniae</em> and to assess their antimicrobial susceptibility results.</p> <p><strong>Methods:</strong> <em>K. pneumoniae </em>strains were identified by conventional method first then confirmed by Vitek-2 automated machine. Antimicrobial sensitivity tests were performed by both Kirby-Bauer method and Vitek-2 automated machine.</p> <p><strong>Results:</strong> Out of 281 strains of <em>K. pneumoniae</em>, there were 131 strains co-producing carbapenemase, extended spectrum β lactamase (ESβL) and Amp C-type β-lactamase. 84 strains were ESβL producer only and 66 strains were sensitive to all antibiotics except ampicillin. The highest expression rate&nbsp; were among samples of blood and CSF (72.15% and 71.43%&nbsp; respectively) followed by wound 64%, sputum&nbsp; 37.5%, urine 32.17% and were least for vaginal swabs 17.65%. The highest number of this expression was among the age group 15-44 years, followed by the age of under 1 year. Overall, the resistance prevalence was high for: ampicillin, amoxicillin/clavulunate, cephalosporins, aztreonam, cefepime, trimethprim and Tetracycline (&gt; 90% up to 100%), aminoglycosides (&gt;85%), emipenem and meropenem (87.9% and 72.5% respectively), colistin (62.6%), ciprofloxacin, nitrofurantoim and cefoxitin (59.5%) and fosfomycin (28.2%).</p> <p><strong>Conclusion:</strong> This study describes the emergence of carbapenemase, Amp C and ESβL-producing <em>K. pneumoniae</em>. High percentage of <em>K. pneumoniae</em> detected among isolates in Duhok city. They were highly resistant to β-lactams, carbapenems and aminoglycosides. However, their sensitivities to fosfomycin, ciprofloxacin and colistin were higher than other used antibiotics. Active surveillance and testing for susceptibility to colistin, ciprofloxacin and fosfomycin should be implementing because resistance to these antibiotics are also on the increase worldwide.</p> HALIMA HASSAN MOHAMMED ABDULRAHMAN T. SAADI NAJIM A. YASEEN ##submission.copyrightStatement## 2020-08-15 2020-08-15 14 1 28 43 QUALITY OF LIFE IN VITILIGO PATIENTS AND ITS RELATION TO VARIOUS VARIABLES IN DUHOK, KURDISTAN REGION, IRAQ https://dmj.uod.ac/index.php/dmj/article/view/117 <p><strong><a href="https://doi.org/10.31386/dmj.2020.14.1.5">https://doi.org/10.31386/dmj.2020.4.1.5</a></strong></p> <p><strong>Background:</strong> Background and aim: Studies, mainly in developed countries, have found a negative impact of the disease on the Quality of Life (QoL). This was affected by different socio-economic factors and by clinical aspects of the disease. The aim of the present study is to measure the impact of vitiligo on the QoL among patients and to investigate its relation to socio-demographic and clinical factors, in Duhok, Kurdistan Region, Iraq.</p> <p><strong>Patients and methods:</strong> A cross-sectional hospital-based study was conducted on 143 patients aged 16 years and above diagnosed to have vitiligo by a consultant dermatologist.&nbsp; All available patients to the investigator in the outpatient dermatology unit at a tertiary care hospital were asked to participate. An oral consent was obtained then a short questionnaire was filled for each patient regarding socio-demographic factors and clinical features of the disease. The QoL was estimated by using the Dermatology Life Quality Index (DLQI).</p> <p><strong>Results:</strong> The mean age ±SD was 31.85 ± 10.39 years of which 76 were males, and 67 were females. The mean DLQI score was 6.67 (±4.81SD). Only 13.3% reported no effect of the disease on their QoL while 39.9 %, 16.8%, and 30.1 % of patients reported that the disease has small, moderate and very large negative effect, respectively on their QoL. There were no significant differences between the mean DLQI scores and gender, job, type and duration of the disease and current treatment status. The Qol was significantly more negatively affected among younger patients, those with higher education, married women, patient with darker skin type, and patients with hands, arms and feet involvement and those with a negative family history of vitiligo.</p> <p><strong>Conclusion:</strong> The disease has a negative impact on the QoL in the majority of patients. The dermatologist should put an emphasis on the psychological problems of the disease among their patients during planning their future management course.</p> ZEYAD S. AL-DABBAGH ##submission.copyrightStatement## 2020-08-15 2020-08-15 14 1 44 52 PREDICTIVE VALIDITY OF EUROSCORE RISK SCORING SYSTEM IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFT SURGERY IN AZADI HEART CENTER -DUHOK, KURDISTAN REGION, IRAQ https://dmj.uod.ac/index.php/dmj/article/view/118 <p>&nbsp;<strong><a href="https://doi.org/10.31386/dmj.2020.14.1.666">https://doi.org/10.31386/dmj.2020.4.1.666</a></strong></p> <p><strong>Background:</strong> EuroScore (ES) models have been used over the last twenty years for risk assessment before coronary artery bypass graft surgery (CABG) with variation in their ability to assess the overall complications after surgery, the intensive care unit (ICU) stay and heart performance after revascularization in different areas over the world.</p> <p><strong>Objective:</strong> To assess the performance of the EuroSCORE in prediction of post-CABG complications at Azadi Heart Center (AHC).</p> <p><strong>Patients and Methods:</strong> This correlation study was conducted at AHC, Duhok, Kurdistan Region (Iraq). The study participants were 50 patients (38 males and 12 females) who underwent CABG surgery; informed consent was obtained from all of them for participation in this study. EuroScore II (ES II) model has been assessed before and after CABG, and its correlations with short-term (up to one month) post-operative outcomes were studied.</p> <p><strong>Results: </strong>Patients were grouped into low, moderate and high-risk groups each with frequency of 26, 21 and 3, respectively. There was significant correlation between the pre-operative ES II and the post-operative ejection fraction (EF%) in the high-risk group, while there were non-significant correlations with the short-term overall complications and the ICU stay post-operatively.</p> <p><strong>Conclusions:</strong> ES II can be used in AHC to predict post-operative EF%, the higher the ES II, the lower post-operative EF%. However, ES II is not valuable to predict other short-term post-operative complications following CABG surgery.</p> SHAMS Q. SAHIB QASIM H. ABDULLAH ##submission.copyrightStatement## 2020-08-15 2020-08-15 14 1 53 62 ADHERENCE TO BIOLOGIC DRUGS AMONG PATIENTS WITH IMMUNE MEDIATED INFLAMMATORY DISEASES IN DUHOK GOVERNORATE https://dmj.uod.ac/index.php/dmj/article/view/119 <p><strong><a href="https://doi.org/10.31386/dmj.2020.14.1.7">https://doi.org/10.31386/dmj.2020.4.1.7</a></strong></p> <p><strong>Background:</strong> The need for ongoing treatment to manage immune-mediated inflammatory diseases is a challenge for health care providers, as there is always an attempt to achieve clinical remission as much as possible.</p> <p><strong>Objective:</strong> This study aimed to estimate the prevalence of non-adherence to biological drugs and factors affecting it among patients in Duhok governorate-Iraq.</p> <p><strong>Patients and Methods:</strong> A cross-sectional questionnaire-based study was conducted between December 2018 to October 2019 at the specialized center of rheumatic disease and medical rehabilitation in Duhok city. One hundred forty-four patients who lived in Duhok governorate out of 216 registered cases were included, each with the established disease for at least 12 months, and had been taking biological drugs (Etanercept, Infliximab, and Adalimumab) with or without conventional drugs for at least three months were involved in this study. Disease activity scales as appropriate to each disease were used, with using a medication adherence scale to assess the adherence to medications.</p> <p><strong>Results:</strong> From the total of 144 patients included in this study, 134 (93.1%) of them were non-adherent compared to only 10 (6.9%) of patients who were adherent to medication intake. Significant associations existed between adherence to the medications and different factors. These factors with the corresponding percentages of non-adherence were as follows: age between 30-39 (34.3%), illiterate/ primary education (56.0%), unemployed (64.9%), no ability to buy biologic drugs (82.1%), etanercept users (71.6%) and (56.7%) were using biological drugs for less than four years.</p> <p><strong>Conclusion and recommendation:</strong> With the existence of multiple factors effect on adherence to medications and due to the inconsistency of these factors, routine measurements of adherence to medications are essential in achieving the desired therapeutic goal.</p> HALA F. KASIM HISHYAR M. SALIH SOUZAN H. EASSA ##submission.copyrightStatement## 2020-08-15 2020-08-15 14 1 63 76 TRAUMATIC EVENTS AND POSTTRAUMATIC STRESS AMONG IRAQI KURDISH “ANFAL” SURVIVORS https://dmj.uod.ac/index.php/dmj/article/view/120 <p><strong><a href="https://doi.org/10.31386/dmj.2020.4.1.8">https://doi.org/10.31386/dmj.2020.4.1.8</a></strong></p> <p>&nbsp;</p> <p><strong>Background:</strong> The 1988 “Anfal” military operations against Kurds of northern Iraq yielded high rates of morbidity and mortality. The present study aims to determine traumatic events experienced by “Anfal” survivors and level of posttraumatic stress disorder (PTSD) in Kurdistan region of Iraq.</p> <p><strong>Methods:</strong> One hundred thirty “Anfal” survivors were selected randomly from different populations in Duhok city/ Iraqi Kurdistan. They were interviewed and assessed psychologically using Harvard Trauma Questionnaire to examine their exposure to psychological traumas and to study the posttraumatic stress disorder (PTSD) symptomatology among them.</p> <p><strong>Results:</strong> “Anfal” survivors were exposed to various types of traumas. All respondents experienced lack of shelter, food and water and ill health without access to medical care. Witnessing murder was the most common traumatic event experienced by the participants. PTSD was found in (86.2%) of the respondents. Female gender was a significant risk factor associated with the diagnosis of PTSD.</p> <p><strong>Conclusions:</strong> “Anfal” survivors experienced multiple&nbsp;traumatic events with high rates of PTSD. Exposure to this disaster situation had a big impact on psychological status viewing huge needs in mental health among those survivors.</p> PERJAN HASHIM TAHA SUZAN MOHAMED HASSAN ABDURRAHMAN ##submission.copyrightStatement## 2020-08-15 2020-08-15 14 1 77 91 KNOWLEDGE ABOUT CERVICAL CANCER AMONG MARRIED WOMEN ATTENDING PRIMARY HEALTH CARE CENTERS IN DUHOK CITY https://dmj.uod.ac/index.php/dmj/article/view/121 <p>&nbsp;</p> <p><strong><a href="https://doi.org/10.31386/dmj.2020.14.1.9">https://doi.org/10.31386/dmj.2020.4.1.9</a></strong></p> <p><strong>Background:</strong> Despite the consideration that cervical cancer is a preventable cancer, it still known as one of the most common cancers among women worldwide. It kills about 270,000 women every year, and 85% of these deaths occur in less-developed regions. Cervical cancer is an important public health problem in developing countries due to lack of knowledge about the disease and its risk factors with poor access to preventive services. Early detection of it is performed by a medical screening procedure Pap smear.</p> <p><strong>Objectives:</strong> The present study aimed to assess the knowledge about cervical cancer and its association with the socio-demographic characteristics among married women attending primary health care centers (PHCCs) in Duhok city.&nbsp;</p> <p><strong>Materials and Methods:</strong> A cross sectional descriptive study was conducted among 400 women in the PHCCs from 7th of April- 30thof May 2015, through direct interview with them by using a structured questionnaire to gather the data related to the knowledge concerning cervical cancer.</p> <p><strong>Results:</strong> Among all women who were interviewed, 57.2% heard about cervical cancer and only (25%) of them had good knowledge about it, while 35.9% heard of Pap smear and the good knowledge in 7.3%, the main reason for doing this test was health provider's advice. The majority of women 71.6% received information about cervical cancer from their friends, or family members among those who had a family history, but only 6.5% of them reported that the internet or T.V as a source of information. Most of them 96.5% did not have a family history of this cancer and less than half of them 48.8% were of medium socioeconomic status. The impact of smoking as a cause was 87.3%, while 43.2% considered the early age of marriage was the risk factor. There was a statistically significant association between the women's knowledge about cervical cancer and their occupations (P= 0.03).</p> <p><strong>Conclusions:</strong> The majority of women had low knowledge about cervical cancer and Pap smear. Effective media and providing health education are required to improve the level of awareness toward them.</p> IMAN YOUSIF ABDULMALEK KAWTHER MAHMOOD KALARY ##submission.copyrightStatement## 2020-08-15 2020-08-15 14 1 92 105 EFFECT OF ZINC SUPPLEMENTATION ON ANEMIA AMONG PATIENTS ON REGULAR MAINTENANCE HEMODIALYSIS https://dmj.uod.ac/index.php/dmj/article/view/122 <p><strong><a href="https://doi.org/10.31386/dmj.2020.14.1.10">https://doi.org/10.31386/dmj.2020.4.1.10</a></strong></p> <p><strong>Background:</strong> Zinc deficiency was reported in patients with chronic kidney disease especially among patients on hemodialysis. The objective was to assess the effect of zinc supplementations on the correction of anemia in those patients.</p> <p><strong>Patients and Methods:</strong> In this study, a total of 105 patients over 18-year old, stable and over 6 months on maintenance hemodialysis were enrolled. Blood samples were collected for biochemical and hematological assessments. The patients with zinc deficiency and anemia of chronic disorder were divided randomly into two groups and completed the study. Group 1 completed their treatment with the addition of zinc to their treatment as food supplementation (elementary zinc 50 mg/day) for 6 weeks and the other without zinc supplementation as a control group. Data collection carried out during the period from 8<sup>th</sup> January to 1<sup>st</sup> June 2019 at the kidney diseases center in Duhok city–Kurdistan region/Iraq. Serum zinc level and anemia parameters were determined.</p> <p><strong>Results:</strong> The patients in group 1 that received zinc supplementation showed a significant increase in the mean of serum zinc (mean of percentage 43.12 %) and correspondingly the mean of hemoglobin (mean of percentage 13.06 %).</p> <p><strong>Conclusion:</strong> There was a positive relationship between increase zinc level and the correction of anemia.</p> ORAHIM D. YOUNAN SHERZAD K. RASHID AMER A. MEHE ##submission.copyrightStatement## 2020-08-15 2020-08-15 14 1 106 113