Duhok Medical Journal

CRISIS INTERVENTION PROGRAM FOR CHILDREN AND ADOLESCENTS PREVENTING POST-CORONA DELINQUENCY, RESULTS OF A RANDOMISED CONTROLLED TRIAL

ABDULBAGHI AHMAD — 2024-06-07

https://doi.org/10.31386/dmj.2024.18.1.1

Background: A novel Crisis Intervention Program for Children and Adolescents (CIPCA) has shown a positive effect in preventing posttraumatic psychopathology among IDP children. In this study, the effect of CIPCA is examined in a randomised controlled trial.

Methods: During the Corona crisis in the city of Duhok in the Kurdistan region of Iraq, 97 of the enrolled 106 children between 6 - 18 years age accepted to participate in this study (response rate 91.5%). In the presence of a parent/caregiver, every participating child was interviewed within the first month after discharge from hospital or quarantine for Corona crisis. Child Behavior Checklist (CBCL) was conducted to estimate child behavior problem scores before randomisation to a single one-hour CIPCA intervention or a waiting list. The CBCL interview was repeated 6 months later to estimate changes over time.

Results: Delinquency behavior showed a significant difference between CIPCA and the waiting list over time, indicating a positive effect of CIPCA.

Conclusions: CIPCA is effective in identifying and preventing post-Corona juvenile delinquency problems. Follow-up is planned to detect any psychopathological development.

PREVALENCE AND ATTITUDE OF WOMEN REGARDING CESAREAN SECTION IN DUHOK CITY-KURDISTAN REGION

JINAN NORI HASAN — 2024-06-07

https://doi.org/10.31386/dmj.2024.18.1.2

Background: The decision of pregnancy delivery mode is important for both mother and fetus health. Although the advancement in surgical approach of cesarean section, the cesarean section has a negative impact on mothers and fetuses health.

Objective: To assess the rate of cesarean section in a sample of women in Duhok city and their attitudes toward cesarean section.

Methodology: Present study was a descriptive cross sectional that carried out in Obstetrical & Gynecological Clinics of Maternity Hospital, Primary Health Care Centers, Internally Displaced and Refugee Camps and Private Obstetrics Clinics at Duhok city-Kurdistan region/Iraq through duration period of one year from first of November, 2021, to 31st of October, 2022 on sample of four hundred pregnant women. The decision of previous cesarean section for studied women was done by Senior Obstetrician & Gynecologist according to different reasons (clinical or non-clinical).

Results: The history of previous cesarean section was positive in 39.8% of pregnant women, with a common frequency of one cesarean section (58.5%). Most pregnant women perceived that normal delivery is better, while 9% perceived that cesarean section is better. In the same way, 87% of pregnant women preferred normal delivery, while 13% preferred cesarean section. Only 20% of pregnant women believed that cesarean section is the normal way of delivery, while 68% of them thought that mother with a history of cesarean section has a normal delivery in the future. However, 79% of pregnant women believed that mother had a risk of death during cesarean section.

Conclusions: The cesarean section rate in Duhok city is higher than acceptable recommended rate, although the positive attitude of pregnant women toward normal vaginal delivery.

PRIMARY REPAIR OF PROXIMAL (GRADE IV) HYPOSPADIAS UTILIZING TUNICA VAGINALIS VASCULARISED FLAP

MOHAMMED H. ALDABBAGH — 2024-06-07

https://doi.org/10.31386/dmj.2024.18.1.3

Background: Proximal (grade IV) hypospadias like scrotal and perineal are considered as severe challenging types for surgeons, problematic for the patients and their families, More than three hundreds surgical techniques were used to manage different type of hypospadias . Most of them associated with high incidence of complications. These complications are much more common in the proximal types as in our study. Post-operative fistula formation is expected complications. Utilising the tunica vaginalis as an additional layer during repair may prevent such complications. In this study we evaluated the benefits of using the tunica vaginalis flap as a supportive layer in the primary repair. Most related literatures about this subject used this technique after surgery to manage cases with post-operative fistulas. In the contrary we used this technique during the formal surgery to cover the new urethra to prevent fistula formation not after surgery.

Aims of the study: A retrospective study, on fourteen patients with severe hypospadias (Proximal types), to evaluate the role of tunica vaginalis flap in the primary repair of the hypospadias.

Patients and Methods: Between January 2016 and January 2024, fourteen children with Grade IV hypospadias were operated on. Only severe cases were treated with this method other simpler and more common cases were treated by different surgeries like Snodgrass technique. The age range was 2 to 16 years. All of them had 2 staged repair the first stage was correcting the chordae by incising the urethral plate excising the fibrous chordae tissues then covering the bare shaft with dorsal flaps. The tunica flap was used in the second stage which was done 6 to 12 months later. Folly's catheter was used for ten to fourteen days after surgery. And the patients were followed for a variable time 3months to 2 years period for the development of complications like fistula formation or stricture. Cosmetic considerations were also noted.

Results: All the fourteen patients had proximal types (Grade IV) hypospadias. After surgery all patients had a good cosmetic outcome no fistula formation two had mild distal urethral stricture cured after few urethral dilatation. No post-operative penile torsion was noted. Two patients developed local infection treated conservatively. One patient had partial glanular dehiscence at the distal end which had no clinical significance. One patient complained from on and off penile cutaneous swelling lasted 3 weeks.

Conclusions: Using tunica vaginalis vascularised flap to cover the new urethra in severe proximal hypospadias during the second stage seems to be a successful way in preventing fistula formation without increasing the patient's morbidity.

FOREIGN BODY ASPIRATION IN CHILDREN: CLINICAL, RADIOLOGICAL AND BRONCHOSCOPY FINDINGS

QADER M.SALIH — 2024-06-07

https://doi.org/10.31386/dmj.2024.18.1.4

Background: Foreign body aspiration (FBA) is a serious problem that leads to partial or complete airway obstruction. Respiratory distress and pneumonia are the most common complications. The assortment of foreign bodies is very wide. The most common include candy, fish bones, peanuts and nuts, toys, food and batteries.

Aim of this study was to determine how accurate the presenting symptoms and signs of foreign body aspiration are and to assess the radiologic findings, the types and sites of the foreign bodies removed.

Patients and Methods: a retrospective study included101 patient from age of one month to 15 years with suspected foreign body aspiration based on history, clinical examination, Chest Xray. Rigid bronchoscopy was done for patients under general anaesthesia with muscle relaxation using neuromuscular blocking agents. For every patient gender, age, residence, interval between event and symptom onset, symptoms at admission, signs of respiratory insufficiency, pulmonary auscultation findings, Chest X-ray findings, interval between admission and bronchoscopy, the location of foreign body, type of foreign body, hospitalization days were studied and statistically analysed. A p-value of < 0.05 was considered statistically significant.

Results: Seventy six (75.24%) were proved to have foreign body aspiration that was removed by rigid bronchoscopy. toddler was the common age group 43(42.6%). Male were affected more than females 1.2:1. A significantly higher percentage of patients who had a foreign body were witnessed by a family member than those who did not have a foreign body 61.8% vs 0% (p=0.001). Stridor and cough with breathlessness were the most common signs and symptoms while unilateral wheezes, crepitations and diminished air entry were less frequent while each of crepitations, unilateral wheezes and cough with breathlessness were significantly associated with foreign body aspiration (p=0.001, 0.001, 0.02 respectively). Abnormal chest X ray finding was significantly associated with FBA (p=0.02) with hyperinflation being the most frequent finding. The types of foreign bodies removed were sunflower seeds (27.6%), food particles (18.4%) and nuts (17.1%). The most common site of foreign body was the right main bronchus (52.6%) followed by left main bronchus (34.2%).

There is a significant association between foreign body aspiration and the time interval between admission and bronchoscopy but no significant relation with age, interval between the event and onset of symptoms and hospitalization days.

Conclusion: The history of being witnessed by a family member, the presence of stridor and cough and finding of unilateral wheezes and crepitations on examination as well as hyperinflation on chest X ray are significantly associated with FBA. The sunflower seeds and food particles are the most common types and the right main bronchus is the main site of foreign bodies removed by bronchoscopy.

PAROTID TUMORS; PRESENTATION, SURGICAL MANAGEMENT AND COMPLICATIONS

AYAD AHMAD MOHAMMED — 2024-06-07

https://doi.org/10.31386/dmj.2024.18.1.5

Background: The parotid gland is the most common salivary gland affected by tumors, 80% of them affects the parotid glands and 80% affects the superficial lobe. Pleomorphic adenoma is the commonest salivary tumor. Other types of tumors occur less frequently. Most tumors are diagnosed with ultrasound; MRI shows more anatomical details. Superficial parotidectomy is done for benign tumors, more extensive resection is done for malignant tumors.

Results: This a cross sectional study which included 69 patients who underwent various types of parotid surgeries over a period of 4 years. The mean age of our patients was 45.29 years, and 52.2% were males. The tumor was present in the right parotid gland in 49.3%, in the left side in 43.5%, and was bilateral in 2.9%. The mean duration of symptoms was 29.67 months, all patients were sent for ultrasound and 42 patients were sent for the FNAC, 91.3% of patients underwent superficial parotidectomy. Pleomorphic adenoma was the commonest type of tumors which was diagnosed in 69.6%, followed by Warthin’s tumors in 13%, Non-Hodgkin's lymphoma in 4.3%, and the rest comprises some rare types of tumors. Complications were reported in 30.43% of patients and the commonest complications were transient facial nerve weakness followed by salivary leak (11.6 and 8.7 %) respectively.

Conclusion: Parotid tumors are rare types of tumors and pleomorphic adenoma is the commonest type, identifying the anatomy during surgery especially the course of the facial nerve is the most important step, complications are common but fortunately most are transient.

ASSESSMENT OF THYROID FUNCTION IN BETA THALASSEMIA MAJOR PATIENTS WITH MULTIPLE BLOOD TRANSFUSIONS: A CROSS-SECTIONAL STUDY

AMEER I. A. BADI — 2024-06-07

https://doi.org/10.31386/dmj.2024.18.1.6

Background: Its well known that thalassemia is the most prevalent genetic disorder worldwide. β thalassemia major is the basic form of thalassemia major that requires lifelong blood transfusions. one of the most prevalent endocrine issues in beta-thalassemia major is hypothyroidism. The current study was aimed to assess the thyroid function status in chronically transfused Beta thalassemia major patients.

Methods: A cross-sectional study included 278 patients diagnosed with beta thalassemia major. The study lasted for 12 months interval, from January 2021 to January 2022. Serum free thyroxine, thyroid stimulating hormone and Ferritin levels were measured for all patients using Roche Cobas 6000 analyzer.

Results: The study observed a high prevalence rate of subclinical hypothyroidism (41.2%) and as well as, (2.9%) had overt hypothyroidism. There was insignificant high level of serum ferritin among hypothyroid patients. Nineteen of the subclinical hypothyroid patients (16.5%) had splenectomy, whereas, no one with clinical hypothyroidism had splenectomy.

Conclusion: The study conclude that near half of beta thalassemia major patients were had overt hypothyroidism and subclinical hypothyroidism.

SITE AND RATE OF OSSICULAR CHAIN EROSION IN PATIENTS UNDERWENT TYMPANOMASTOID SURGERY

ABDULLAH RABEEA ALKHALIL — 2024-06-07

https://doi.org/10.31386/dmj.2024.18.1.7

Background: Chronic suppurative otitis media (CSOM) is a common problem affecting middle ear and it’s commonly presented with chronic ear discharge and decreased hearing. Hearing problem in CSOM is primarily caused perforated tympanic membrane and in some cases by the presence of erosion of the ossicular chain.

The study aimed to show the rate and site of ossicular chain erosion in patients with chronic suppurative otitis media underwent tympanomastoid surgery.

Patient and methods: a cross sectional study conducted on 87 patients performed tympanomastoid surgery for chronic middle ear infection where their ossicular status has been assessed intraoperatively.

Results: our study shows that 40% of the operated ears has at least a single bone erosion and the Incus bone was the most affected ossicle while the Malleus was the least one 54% and 14% respectively. No statistically significant difference was seen between bone erosion and gender as well as the side of operation.

Conclusion: ossicular erosion is a common problem affecting patient with chronic suppurative otitis media and the surgeons should be aware about this pathology and they should have the proper skill to correct such problem.

DIAGNOSTIC YIELD OF HIGH-RESOLUTION MANOMETRY IN PATIENTS WITH ESOPHAGEAL MOTILITY DISORDERS

MALAVAN HABEEB MOHAMMED — 2024-06-07

https://doi.org/10.31386/dmj.2024.18.1.8

Background: Advances in high-resolution esophageal manometry (HREM) have overturned the clinical assessment of esophageal motility disorders. It has been widely incorporated into clinical practice as it is a delicate diagnostic tool for assessing esophageal motility patterns.

Objective: To assess the diagnostic ability of HRM in categorization of esophageal motility disorder using the Chicago Classification v3.0

Patients and Methods: a retrospective descriptive study done on 100 adult patients who underwent esophageal manometry test in the Endoscopy unit of Gastroenterology and Hepatology center at Azadi Teaching Hospital in Duhok city. The study was conducted from January 2021 to March 2022 by reviewing the high-resolution esophageal manometry of these patients using the Chicago classification v3.0. The recorded esophageal symptoms were correlated with the findings obtained during HREM test.

Results: The mean age of the participants was 44.8 years with a standard deviation of 16 year. Females were on average older than males with a mean age of 47.8 years compared to 41.2 year for males. More than half of the patients (53%) had dysphagia as the main symptom that HRM done for. Globus sensation was the second one (14%) followed by Gastroesophageal reflux disease (GERD) (13%). The yield of HRM found to be abnormal (77%) as esophageal motility disorders. Those patients with dysphagia had achalasia II as the highest frequency (28.3%), while no even one patient of those with GERD, globus sensation or nausea and vomiting had achalasia detected by HRM. The most frequent result of GERD patients was esophagogastric junction outflow obstruction (38.5%). More than half (57.1%) of patients with globus sensation had a normal HRM test. Distal esophageal spasm was found to be the most frequent finding among patient with non-cardiac chest pain.

Conclusion: There is an apparent diagnostic value of HRM in categorization of esophageal dysmotility when applying the Chicago Classification v3.0 in those patients with suggestive symptoms of motility disorders.

IMPACT OF COINHERITANCE OF A-THALASSEMIA ON PHENOTYPE IN IRAQI KURDS WITH HOMOZYGOUS AND COMPOUND HETEROZYGOUS SEVERE Β -THALASSEMIA

DILAN JASIM KHALIL — 2024-06-07

https://doi.org/10.31386/dmj.2024.18.1.9

Background: Patients with homozygous or compound heterozygous β0 thalassemia may present either with thalassemia major or intermedia. This phenotypic variability is the consequence of several genetic modifiers in different populations. We aimed to assess the frequency and the impact of coinheritance of α-thalassemia on phenotype in Iraqi Kurds.

Methods: A total of 125 patients characterized as homozygous or compound heterozygous β0 thalassemia were recruited in thalassemia center Duhok. They were classified based on age of starting and the frequency of transfusion (thalassemia major or intermedia). All patients had their DNA extracted and Gap-PCR performed to identify 3 deletions namely: ‒α 3.7, ‒α 4.2, and ‒ ‒MED.

Results: The patients had a median age of 12 years (Range 2.0-35), with 63 males and 62 females. 96 patient with thalassemia major and 29 with intermedia. The most frequent β-mutations were IVS-2.1 (G>A), Codon 44 (-C), codon 5 (-CT) and codon 8 (-AA). Gap PCR identified α-thalassemia in 9 patients (7.2%), including ‒α 3.7 /αα in 8 cases and ‒α 4.2/αα in one patient, while none had a double α-gene deletions. The frequency of α-thalassemia was higher in thalassemia intermedia at 13.8% compared to 5.2% in major. This difference was statistically insignificant (P=0.228).

Conclusions: The patients not appear to be a significant with homozygous or compound heterozygous β0 thalassemia. This may be attributed to low background frequency of α-thalassemia, it being mainly due to a single α-gene deletion. Further studies including more patients with extended β-genotypes and other genetic modifiers may be worthwhile.