Kirkuk Journal of Medical Sciences

Benign paroxysmal positional vertigo (BPPV) is a short-lived attack of rotatory vertigo provoked by certain head movements. The most acceptable theories for its pathogenesis are canalithiasis and cupulolithiasis as a result of the detachment of otoconia from the otolithic membrane. Although canal repositioning maneuvers resolve BPPV, recurrence is a common feature. During the last two decades, there is a revolution in research in understanding many aspects of this disorder. The advanced age, female gender, migraine, Meniere’s disease, trauma, and infection are recognized examples of the BPPV causes. Vitamin D deficiency or insufficiency is considered a risk factor for the occurrence and recurrence of the disease as indicated by many investigations. Therefore, estimation of vitamin D serum level in all subjects with BPPV is highly recommended. In addition to canal repositioning procedures such as the Epley maneuver, vitamin D supplementation in patients with deficient or insufficient vitamin D is the best treatment for primary BPPV. In this review, we discussed the updating knowledge of the risk factors of BPPV as an initiator for the disease or a risk factor for its recurrence.

Background: Peptic ulcer disease’s second-most common complication is perforation, constituting a surgical emergency with approximately 30% short-term mortality and 50% morbidity. Patients with untreated duodenal ulceration face a 10% lifetime risk of perforation, reduced with initial ulcer healing. The Graham omental patch technique involves leaving two tube drains, one in Morrison’s pouch and one in the pelvis. This study aims to elucidate the effects of routine abdominal drain use on postoperative outcomes after closure surgery for peptic ulcer perforation, assessing the efficacy and safety of this approach.
Methods: A prospective observational cross-sectional study enrolled 60 patients conducted between December 2021 and January 2023, with perforated peptic ulcers who underwent repair using the Graham omental patch technique. Two tube drains were utilized. Postoperative follow-up and complication observation involved categorizing patients into two groups (A and B) based on the presence or absence of drain-related complications.
Results:Drain related complications were seen in 40% of study subjects, most common of which was Drain site pain followed by Restriction of mobility and Peri tubal discharge/leakage with skin excoriation. Late presentation (>24 hours), Gastric ulceration, perforations larger than 1 cm and peritoneal spillage of more than 1000 ml significantly influenced the outcome and rate of development of post operative drain related complications in patients operated for perforation peptic ulcer.
Conclusion: All drains carry a risk of significant postoperative complications. In the setting of good surgical technique and the presence of sufficient equipment for the detection of intra-abdominal complications postoperatively like ultrasonography and CT scan, abdominal drains should be used rationally.

Background: The Ostiomeatal Complex (OMC) is a functional concept rather than an anatomic structure with defined boundaries. The aim of this study is to compare between partial resection of middle turbinate and middle turbinate preservation in surgery for chronic rhinosinusitis with nasal polyposis.
Methods: This prospective interventional study was conducted on two groups of patients diagnosed with chronic rhinosinusitis with nasal polyposis who did not respond to medical treatment. These patients underwent endoscopic sinus surgery and were categorized into two groups. Group A with bilateral resection of the middle turbinate and group B with careful preservation, The follow-up period extended up to three months after surgery.
Results: Total mean age (39 ±14) years. At the end of the follow-up period, the patency of the middle meatal antrostomy was (96.15%) in group A and (73.08%) in group B. The adhesion was 7.7% in group A and 23% in group B, at the end of the first postoperative month the crustation was 76% in group A and 61.5% in group B and at the end of follow-up there is an improvement in nasal obstruction in both groups with a significant improvement in group A (p-value= 0.017).
Conclusion: Partial resection of the middle turbinate during endoscopic sinus surgery improves the patency of the middle meatal antrostomy, better access, and improved ability for endoscopic clearance and debridement of the crustation postoperatively, also associated with a lower risk of adhesion to the lateral nasal wall and a significant improvement in postoperative nasal obstruction compared to patients who undergo endoscopic sinus surgery with preservation of the middle turbinate.

Background: The placenta is a fetomaternal structure that determines normal fetal growth and maturation, the function of the placenta depends on the normal differentiation of the villous trophocytoblast and the thickness of the placental barrier. Placental insufficiency associated with abnormal neonatal outcome. The aim of this study is to evaluate the histological structure of the placenta according to maternal age.
Methods: A case control prospective study is done on sixty placentae from women delivered normally at Al-Khansaa obstetric Hospital, the samples of placentae are classified into three groups according to the maternal age: group A: mother age (20-34) years considered as control group, group B: mother age (19-15) years while group C: maternal age 35-50. The placentae are weighted and their diameters include thickness, are measured then pieces from placentae are taken to asses oxidative stress biomarker and other pieces are fixed in formalin solution then processed and prepared for light microscopic examination.
Results: The mean weight and surface area of placentae of mothers over 35 years were decreased while their thickness increased as compared to that of control and young age group, the oxidative stress biomarker increased in this group whereas the histological study revealed thickening of placental barrier, decreased of villus vascularity, increased villus stroma with fibrinoid deposition and increased syncytial knot.
Conclusion: Pregnancies, in advanced maternal age rather than youth, can negatively impact the structure of the placenta due to increased oxidative stress. To potentially help support function in this age group adding antioxidants could be beneficial.

Background: Orthopedic surgeons and operation staff are exposed to intraoperative radiation routinely because modern medicine is unthinkable without X-rays. Along with their advantages X-rays have also a harmful effect. This needs special care to be taken to protect from this radiation. Several factors that influence exposure risk have been identified including type of surgery, distance from radiation source, subspecialty practiced, and experience level of the surgeon. The aim of this study is to measure the effective protection provided by lead aprons and thyroid shields in orthopedic theater during surgical operations.
Methods: Radiation dose was measured during the use of a C-arm on an anthropomorphic lower thigh and proximal leg phantom on the operating table and scatter radiation exposure to multiple organs (thyroid, breast, gonads) and direct radiation exposure to the hands measured by Geiger Muller counter 300E plus (GMC300E plus) in different positions of the C arm and from different distances from radiation source.
Results:Scattered radiation exposure is higher when the C arm is in an inverted position and horizontal position when the Geiger is at the side of emitter and close to the C arm. Radiation exposure dose decreases as increasing the distance from the C arm. Lead aprons and thyroid shields decrease radiation exposure by approximately 90%.
Conclusion: The efficacy of radiation protection in orthopedic theaters is closely tied to the wearing of lead aprons, including thyroid shields, and the positioning of both the surgeon and the surgical staff in relation to the C-arm. Conversely, radiation exposure tends to increase when the C-arm is inverted or positioned horizontally.

Background: An ectopic pregnancy occurs when a blastocyst implants outside the uterine, early diagnosis is crucial for minimizing associated risks. Soluble FMS-like tyrosine kinase1 (sFlt-1) is the soluble variant of the vascular endothelial growth factor receptor1 that forms a barrier against abnormal vascular permeability and abnormal angiogenesis. The study aims to determine the level of (sFlt-1) in ectopic pregnancy and identify whether it can be used as a biomarker to distinguish ectopic from normal intrauterine pregnancy and missed miscarriage.
Methods: A prospective case-control study enrolled 90 pregnant women, with gestational age (4-10 weeks) divided into three groups: 30 women with ectopic pregnancy, 30 missed miscarriages, and 30 women with normal intrauterine pregnancy. (sFlt-1) was measured and statistical analysis of the data was performed to compare the level of biomarker between the studied groups.
Results: The mean level of (sFlt-1) was significantly lower among ectopic pregnancy (0.25 ± 0.07 ng/ml) in comparison to miscarriage and intrauterine pregnancy group. The (sFlt-1) at a level of 0.277 ng/ml was able to distinguish an ectopic pregnancy from normal intrauterine pregnancy and miscarriage with a sensitivity of 90% and a specificity of 70%. The mean serum (sFlt-1) increased with increasing gestational age, especially at more than 8 weeks.
Conclusion: A single measurement of the level (sFLt- 1) level can efficiently discriminate ectopic pregnancy from viable and non-viable intrauterine pregnancy. Serum (sFLt-1) at the cut-off value had the same sensitivity and better specificity than βhCG in the diagnosis of ectopic pregnancy.

Background: Coronavirus disease 2019 (COVID-19) is a new emerging disease caused by SARS-CoV-2, first discovered in Wuhan, China, in December 2019. Infected patients of all age groups with associated medical diseases such as chronic kidney disease (CKD) stage five -end stage renal disease (ESRD) on hemodialysis are likely to have a higher risk of developing severe COVID-19 compared to patients without disease. The study aimed to address morbidity and mortality related to SARS-CoV2 infection in hemodialysis patients at the Kirkuk dialysis centre.
Methods: A prospective observational study that enrolled 385 COVID-19 patients with CKD-stage 5 (ESRD), who were on a regular hemodialysis program in the dialysis center in Kirkuk city for a period of 6 months.
Results: In hemodialysis patients, the incidence of SARS-CoV2 infection was 80 (20.75%), among these 80 patients, 43 (53.75%) required hospital admission due to the severity of the disease, 32 (40%) were admitted to the intensive care unit and received ventilation, 19 patients (23.75%) died from complications related to SARS-CoV-2.
Conclusion: There is a significant incidence of hospital admission and the need for ventilation among patients, as well as a notable mortality rate was observed in COVID-19 patients undergoing hemodialysis, with specific risk factors such as bronchial asthma, the presence of AV fistula, and type 2 diabetes mellitus contributing to a higher mortality percentage.

Background: Inguinal hernia is one of the common congenital conditions among pediatric age groups with an estimated incidence of 1 - 2% in mature infants and up to 30% in premature infants. The risk of incarceration of testis, bowel, or ovary in children with inguinal hernia is about 3–16%. Therefore, repair of the inguinal hernia is necessary to prevent such complications. However, only a few cases of the hernia sac contain both the ovaries and the uterus at the same time. If reduction of the hernia is not performed in a timely manner, the symptoms will worsen, tissue necrosis and gangrene will ensue.
Case presentation: Parents brought a 45 days old healthy baby to the emergency department for a history of sudden enlargement of the left inguinal swelling that forced the baby to cry continuously, the history, physical examination and investigations revealed incarcerated left inguinal hernia, emergency intervention was performed under general anesthesia, findings were left ovarian torsion, gangrene, and necrosis inside the indirect inguinal hernia sac, left salpingo-oophorectomy was done, histopathological result confirmed the diagnosis.
Conclusion: There is a strong likelihood that inguinal hernias containing the ovary in females pose a substantial risk of torsion and strangulation. Timely intervention should be recommended without delay.