Kirkuk Journal of Medical Sciences

•Background: Emerging as a major cause of death and disability in the developing countries is coronary artery disease (CAD). Traditional coronary angiography has traditionally been the preferred diagnostic procedure for CAD. Non-invasive evaluation of coronary artery disease (CAD) using computed tomography (CT) coronary angiography shows promise. This observational study's goal is to assess the relative efficacy of noninvasive multi-section computed tomography (MSCT) coronary angiography vs invasive selective coronary angiography in detecting coronary stenosis.•Method and patient: This observational study carried out in the Azadi teaching Hospital/Kirkuk between November 2021 to March 2022. Patients who suspected to have coronary artery disease underwent both CTCA and invasive coronary angiography in different centers in our country comparing and analyzing their results. •Result: In total, 92 participants were enrolled in the trial. Patients had a mean age of 57.207.3 years, and men made up the vast majority of those who appeared (67.3 percent). Chest pain was the most common presenting complaint (94 percent). Patients exhibited a prevalence of 84% for HTN, 55% for hyperlipidaemia, 58% for diabetes, and 4% for ischemic heart disease. In addition, 50% of the patients are either current or former smokers. Half of the patients received 64-slice CT scans, nearly half had 128-slice scans, and 3.2% got 256-slice scans. CCTA's sensitivity was 100%, and its specificity was 66.7%. Positive predictive value for CCTA was 98.8 percent (meaning it correctly identified positive cases in 98.8 percent of patients) and negative predictive value was 100 percent, for a total diagnostic accuracy of 98.9 percent (which mean CCTA can exclude all negative cases and did not miss any case). When looking at individual arteries, the LAD artery was shown to be the most accurate, while the LCX artery was the least accurate (95.6 percent and 78.2 percent respectively). In terms of sensitivity, LAD performed at a 99.1% rate, while LMS performed at a 0% rate (33.3 percent). RCA had the most specificity (95.2 percent), whereas LAD had the lowest (88.8 percent) (40 percent). In order to determine what factors, influence CCTA positivity, we performed a binary logistic regression analysis for positive CCTA (negative as reference) with all variables from the studies. The results showed that IHD, lesions in the LAD artery, lesions in the LCX artery, and CT slice thickness (128 and 256 slices) all have a negative effect on CCTA (p0.05). •Conclusions: When compared to traditional angiography, multi-slice computed tomography has demonstrated superior sensitivity and specificity for the identification of coronary artery disease.

•Background: Conventional 2 D Doppler echocardiographic parameters are inadequate for evaluation and monitoring Left ventricle systolic function recovery of patients with ischemic heart disease (IHD) treated by Percutaneous coronary intervention (PCI). Hence, New strain imaging parameters are studied by using 2 D speckle Tracking Echocardiography. The aim is to compare the conventional echocardiographic parameters (Left ventricle ejection fraction, Wall motion score index, regional wall motion score) with speckle tracking echocardiographic parameters (Global longitudinal strain, Regional longitudinal strain) in patients with ischemic heart disease undergo Percutaneous Coronary Intervention (PCI).•Method and patient: A prospective Interventional Hospital Based study enrolled 50 patients who had ischemic heart disease (IHD), Percutaneous coronary intervention (PCI) was done for them at IbN Al-Bittar Cardiac Surgery Center from October 2014 to April 2015. Both conventional echocardiographic parameters (Left ventricle ejection fraction, Wall motion score index, regional wall motion score according to coronary artery territory) and Speckle tracking echocardiographic parameters (Global longitudinal strain, Regional longitudinal strain according to coronary artery territory) done for them pre PCI, one day post PCI, and one month post PCI.•Result: Regarding conventional echocardiographic parameters: Global LVEF pre PCI 52.34±90% , one month post PCI was (54.00±6.9), there was no significant difference statistically (P value 0.79), also Wall motion score index ,Regional wall motion score according to coronary artery territory were (1.22±0.25,1.44±1.52) respectively, one month post PCI were (1.98±0.26,1.40±0.58) respectively where there's no significant differences statistically (P value 0.25,0.22) respectively. •Regarding speckle tracking parameters :Global Longitudinal strain for all patients pre PCI was (-14.30±3.54%) ,one day post PCI was (-14.78±3.81%) ;there was no significant differences (p value 0.77).After one month Global Longitudinal Strain was (-16.38±4.15%) where this consider highly significant differences (p value 0.001).Regional Longitudinal Strain according to the coronary artery territory pre PCI was (-14.49±4.47%),post one day post PCI was (-15.08±4.92%) where there's no significant differences (p value 0.10), while one month post PCI was (-17.70±5.27%),this was highly significant different statistically (0.001).Only in STEMI patients there was significant difference one day post PCI(P value 0.041 for Global LS,0.016 for Regional LS). •Conclusions: In all IHD groups (STEMI, NSTEMI ∕UA, chronic stable angina) Speckle Tracking Echocardiographic parameters (Global Longitudinal Strain and Regional longitudinal strain) more reliable and effective than conventional echocardiographic parameters (Global LWEF,WMSI, RWMS) for monitoring improvement in LV systolic function post Percutaneous coronary intervention.

•Background: Generalized anxiety disorder is characterized by chronic and persistent worry, which is multifocal, excessive, and difficult to control, and accompanied by nonspecific psychological and physical symptoms. The objective of the study is to determine the proportion of GAD, evaluate clinical symptoms with socio-demographic data and determine whether such patients have co-morbid mental illnesses.•Method and patient: This cross sectional study was conducted at Baghdad teaching hospital, 263 patients included, the study took 17 weeks starting in June 2021 till mid-October 2021. •Result: 2.6% of patients (7 patients from 263) found to have GAD, men and women were almost equally affected, most of the patients were employed and married, had secondary school achievements and all of them were from urban areas. Restlessness and irritability were the most frequent symptoms and sleep disturbance was the least among other symptoms. Depression was the most frequent comorbid illness; other anxiety disorders and personality disorder were the least comorbidities.•Conclusions: The proportion of GAD is slightly lesser than other studies, higher proportion seen in older adults than the younger patients, common symptoms of GAD are also seen in other psychiatric disorders leading to under-diagnosing of the illness, and mental health comorbidities are high among patients with GAD, mainly depression.

•Background: Pre-eclampsia affects about 2–8% of all pregnancies. It is one of the leading causes of maternal and perinatal morbidity and mortality hyperhomocysteinemia is considered as a risk factor for endothelial dysfunction and vascular disease. The vascular changes induced by homocysteine are similar to those with pre-eclampsia. The aim of the study is to identify the relationship between maternal serum homocysteine level and the development of pre-eclampsia.•Method and patient: A case control study that was carried out in the Department of Obstetrics and Gynecology at Azadi Teaching Hospital in Kirkuk-Iraq, during the period of eight months from 1st of Feb. till 1st of October 2021. It included 80 pregnant women with singleton viable pregnancy, gestational age of > 20 weeks. They were divided into two groups: Case group included 40 pregnant women who had diagnosed as pre eclampsia (mild and severe) and control group included 40 healthy normotensive pregnant women. Patients with multiple pregnancy, history of medical disease or tacking treatment for hypertension were excluded from the study. Blood sample was taken from each woman for biochemical study, serum homocysteine level was measured using ELISA technique.•Result: In this study, pregnant women with pre-eclampsia had significantly higher mean of serum homocysteine compared with controls. Homocysteine level > 8.95 μmol/l is a predictor for pre-eclampsia. Out of 40 women with pre-eclampsia, 42.5% were mild, while the remaining 57.5% were severe. Pregnant women with severe pre eclampsia had significantly higher mean of serum homocysteine compared to those with mild pre-eclampsia. The level of tested biomarkers and homocysteine was tested between the two study groups to assess their rule in pre eclampsia.•Conclusions: Maternal serum homocysteine biomarker represents an early non-invasive marker for diagnosis of pre eclampsia and to name the disease according to the severity.

Background: The relation between H. pylori infection and Viral Hepatitis has been
subjected to substantial research in recent years, however, this relationship has not
been comprehensively studied in Al Sulaymaniyah. The objective of this study is to
Investigate the association between HBV infection and the H. pylori infection.
Method and patient: A case-control study using data from 130 participants, from
January 2020 to March 2021. Data is divided into two groups, a study group which
consists of 65 persons of confirmed hepatitis B infection via PCR, and a control
group of 65 persons with confirmed Hepatitis B negative by Hepatitis B surface
antigen test, we used stool antigen test to confirm the presence or absence of H.
Pylori infection in both groups.
Result: 32% of the study group is infected with H. pylori and 15% in the control
group have been tested positive for H. pylori infection. The regression analysis
results reveal strong evidence that HBV infection increases the likelihood of H.
pylori infection. This relationship is very robust and consistent even after
controlling a vast number of variables as confounding and medical factors.
Conclusions: Patients with HBV infection are more vulnerable to H. pylori
infection.

Background: Diabetes mellitus is one of the greatest health threats of recent times
for global population, T2DM is associated with two to four excess risk of
cardiovascular disease, Serum lipids are frequently abnormal and are likely to
contribute to the risk of coronary artery disease, and there an 18% increased risk of
cardiovascular disease for each 1% increase of HbA1c in diabetic population,
Method and patient: this is across sectional study which was carried out on 100
diabetic patients ,62 male and 38 female with age from 38-75years, after fasting of
at least 8 hours, fasting blood sugar, HbA1C and lipid profile were measured.
Result: patients were divided into two groups; the controlled group with HbA1c of
7% or less, and uncontrolled group with HbA1c of more than 7% ,the controlled
group include 28% of the patients while the uncontrolled group include 72% of the
patients with mean age of 50.50±12.60 and 53.94±7.99 respectively, with no
significant difference(p-value=0.187), while there was significant difference in lipid
profile between the two groups.
Conclusions: most diabetic patients are uncontrolled and dyslipidemia, and HbA1c
is used as a dual marker for dyslipidemia and diabetic control.

Background: Developmental Dysplasia of the hip is common problem, both severe
acetabular dysplasia and proximal femoral ante-version are the main pathology that should
be managed as early as possible. Treatment of Developmental Dysplasia of the hip (DDH)
should be commenced after delivery, during infancy and in very young children because
maximum potential for development and remodeling of the acetabulum and proximal femur
were encountered up to the age of 4 years. Surgical correction of idiopathic developmental
dysplasia of the hip (DDH) is one of the most challenging problems in pediatric orthopedic
surgery.
 Method and patient: Between June 1994 and December 2018, a total of 626 hips with
Developmental Dysplasia were treated according to their age at presentation.
Result: In 110 hips (out of the total 132 hips, underwent surgery) treated by open reduction
with or without salter innominate osteotomy, the following results were achieved: A – In all
these cases , there was severe degree of femoral ante-version (Intra-operative evaluation)
and this was found in 100% of the patients with developmental dysplasia (DDH), especially
in those children above 2 years of age. B – Open reduction with Salter Innominate
Osteotomy gave excellent results in 72 hips within the age group 18 month-2.5 years. There
was no indication for femoral shortening to be performed in these patients – All these hips
showed spontaneous correction of extreme degree of femoral ante-version, this was seen in
all patients underwent open reduction with or without Salter Osteotomy and there was no
need for Derotation Osteotomy in all these children with developmental dysplasia of the hip
(DDH) in the age group 18 months-2.5 years.

Background: Male urethral stricture is one of the common diseases. Stricture disease may
lead to severe complications which badly affect the quality of life like urinary tract
infection, vesical stones, urethrocutaneous fistulas, sepsis, and finally renal impairment.
Due to its high recurrence rates, it is one of the most complex and challenging issues in
urological practice. The aim of the study is to evaluate the effect of intralesional mitomycin
C and triamcinolone after direct visualized internal urethrotomy on the recurrence of
urethral stricture.
 Method and patient: An observational comparative study that was conducted between
September 2019 and October 2021. It included 34 male participants with urethral stricture.
Twelve participants were in group A in whom participants underwent direct visualized
internal urethrotomy with no adjuvant treatment, 11 participants were in group B who
underwent direct visualized internal urethrotomy with mitomycin-C injection and another
11 patients underwent direct visualized internal urethrotomy with triamcinolone injection
were in group C. Patients were selected from outpatient clinic. Patients with idiopathic
causes of stricture, traumatic non-instrumental or post-urethroplasty stricture, recurrent
stricture and stricture more than 15 mm in length were excluded from the study. Follow up
was done at 3, 6 and 12 months post-operatively.
 Result: In this study, only one patient among 11 who received mitomycin-C injection
(9.1%) had recurrence while 2 out of 11 patients who received triamcinolone (18.2%) had
recurrence. Six out of 12 patients (50%) who undergone direct visualized internal urethrotomy only had recurrence. Adjuvant therapy decreased the recurrence rates, and the
results were statistically significant. No correlation between stricture recurrence time and
the type of adjuvant therapy used was found. Relationship between recurrence rate of
stricture and various other variables such as age of the patient, length of stricture, stricture
site and etiology were not observed in the study as the p-value was greater than 0.05.
 Conclusions: Intralesional injection of either Mitomycin-C or Triamcinolone reduces the
recurrence rate of urethral strictures with statistically significant results.

Background: When the patella is fractured it should be repaired and patellectomy should be
avoided as much as possible even in comminuted fractures. In comminuted patellar
fractures, a combination of cerclage wiring and tension band fixation is confirmed to
provide good mechanical stability. The objective of the present work was to find out the
effectiveness of comminuted patellar fracture fixation with combined cerclage and tension
band wiring technique.
 Method and patient: Forty- six patients underwent surgical stabilization for comminuted
patellar fracture between year 1996 to 2016. All fractures were classified as 34-C3
according to the Orthopedic Trauma Association Classification. All the patients were
underwent open reduction- internal fixation with combined Cerclage and tension band
wiring technique.
 Result: Fracture healing was occurred within an average of 3- 5 months, while in bilateral
cases it was 4 - 8 months. Full range of knee movements was seen in 42 (91.3 %) cases and
knee flexion more than 120º was seen in 4 (8.7 %) cases. Quadriceps power was normal in
44 (95.6 %) cases, but 2 cases had quadriceps power of grade-IV. No extensor lag and no
quadriceps atrophy were seen in any cases. Forty four (95.6 %) patients could squat fully
and two (4.3 %) patients could squat up to half of the normal level. All patients were able to
climb up and down stairs without any problem.
 Most patients have no subjective complaints like pain, difficulty in walking, difficulty in
squatting and climbing. The clinical results after operation were evaluated by the clinical grading scales of Böstman including range of movement, pain, work, atrophy, assistance in
walking, effusion, giving way, and stair-climbing during follow-up. There were no
significant complications, such as infection, knee stiffness, and non-union or implant failure
in any of the cases. The average follow-up period was 8 months (Ranged 6 – 18 months).
 Conclusions: This study had concluded that combined Cerclage and tension band wiring
technique was a successful surgical treatment for comminuted fractures of the Patella.