Kirkuk Journal of Medical Sciences

Immunoglobulin E (IgE) is an antibody class which is unique to mammals, it regarded as the last of the five classes of human immunoglobulins which was discovered in 1968 and it is widely linked to various numbers of allergic illnesses. Basophiles, intestinal epithelial cells, antigen presenting cells, tissue mast cells as well as air-way epithelial cells all express IgE receptor on its surface. The cell-degranulation signal, release of inflammatory allergic mediators and hypersensitivity responses, all begin with the cross-linking of allergen to receptor- bound IgE. IgE plays an important role in type I hypersensitivity, which demonstrated as allergic asthma and various allergenic disorders, for example sinusitis and chronic urticaria. In non-allergic people, serum IgE levels are relatively low (0.05 mg/ml). Remarkably, there has been evidence of the relationship between whole IgE values and environmental and host variables. Regardless of particular sensitivity to frequent allergies otherwise allergy manifestations, population studies have found a link between the frequency of various allergies and serum total IgE levels.

Background: Total thyroidectomy is the most common endocrine surgery performed in hospitals worldwide. Thyroid gland is a highly vascularized structure and has a rich supply therefore; delicate techniques must be used in its excision. Classical techniques have been used for decades with adequate outcomes but have been associated with numerous dismal complications. The use of harmonic scalpel in thyroid surgery made a breakthrough by decreasing these complications.
Aim of this study: is to compare two techniques (Harmonic scalpel vs. Classical techniques) by measuring the differences in duration of operative time, amount of blood loss and other inadvertent complications.
Materials and Methods: This is a prospective observational cross-sectional study in which 80 patients were included and operated on at Azadi Teaching Hospital, Kirkuk, Iraq. They were divided into two equal groups, group harmonic scalpel (40 patients) that had total thyroidectomy by harmonic scalpel and group classical techniques (40 patients) that had total thyroidectomy by classical techniques by means of electrocautery and knot-tying.
Results: Harmonic scalpel group showed significant reduction in operative time (p value = 0.004), amount of intraoperative blood loss (p value = <0.001), postoperative fluid drainage (p value = <0.001) while there were no significant differences between the two groups in risk of laryngeal nerve injury or length of hospital stay.
Conclusion: Focused harmonic scalpel was an effective and reliable technique in performing safe total thyroidectomies and had the advantages over other classical techniques in reducing the operative time, amount of intra-operative blood loss, postoperative fluid drainage with parallel other postoperative complications.

Background: The detection of thyroid incidentalomas is on the rise due to high-resolution ultrasonography. The reported incidence varies around the globe. The objective of this study was to evaluate the prevalence of thyroid incidentaloma in a sample of the Iraqi population through the use of high-resolution ultrasound and to define the TI-RADS classification system for the detected thyroid incidentaloma.
Patients and method: This is a cross-sectional study conducted in AL Kindy Teaching Hospital Bagdad-Iraq between November 2023 and March 2024. A total of 303 patients who were referred to the ultrasound unit with complaints other than neck pathology were recruited. Thyroid ultrasound examination was performed, and American College of Radiology (ACR) Thyroid Imaging Reporting and Data System TI-RADS were recorded when a thyroid nodule was incidentally found. Patients were grouped according to the thyroid ultrasound scan into groups A: 102 participants with incidental thyroid nodule(s); B: 201 participants with no identified nodule.
Results:
Incidental thyroid nodules were detected in (33.66%) of the current sample, (20.8%) had solitary nodules while multiple nodules were detected in (12.9 %) of the individuals. Compared to those who did not show nodules, incidentaloma was identified in 49 (48%) of the older age group (46-60 years), P<0.001 and (20.59%) of those with enlarged thyroid gland, P<0.001 with no significant sex predilection. According to the internal texture of the nodules (27.45%) had echogenic texture, followed by hypoechoic t (22.55 %). Approximately one-third of incidentaloma were TIRADS 4 nodules forming the majority (33.33%) followed by TIRAD 3 (30.39%).
Conclusion:
Ultrasound is a valuable test in detecting incidental thyroid nodules. The prevalence of incidental thyroid nodules in Iraqi individuals is (33.7%), and the highest percentage of the detected nodules are classified as moderately suspicious according to the ACR TI-RADS.

Background: Vitamin D, a fat-soluble vitamin, contributes to the metabolism of phosphorus and calcium in its active form (1,25-dihydroxy vitamin D). It might help prevent and manage autoimmune diseases such as diabetes mellitus. Diabetes has become a serious global health problem as its incidence and prevalence have increased. Recently, efforts to identify novel ways to treat and prevent diabetes have centered on vitamin D supplementation. The bulk of research relates both types of diabetes to the vitamin D receptor (VDR) gene.
Aim: The main objective of this study is to analyze how vitamin D affects type 2 diabetes.
Methods: A case-control study was conducted in Kirkuk City from October to November 2023. The study included 112 patients, 57 of whom had type 2 diabetes that wasn't under control and 55 who were in a control group after ethical concerns were addressed.
Result: The finding of the study group indicated that there is significant relationship between vitamin D level and HbA1c and Random blood sugar, The higher percentage of severe vitamin D deficiency in the diabetes group (22.8%) compared to the control group (9%) is statistically significant, highlighting a significant disparity in vitamin D status. Additionally, the mean vitamin D level is notably lower in the diabetes group (20.41 ng/ml) compared to the control group (31.23 ng/ml), with a T-test result of 3.10 and a p-value of 0.029. These findings suggest that individuals with diabetes are more likely to have lower vitamin D levels. Overall, the data supports a strong association between diabetes and lower vitamin D levels, potentially implicating vitamin D deficiency as a factor in diabetes management or pathogenesis. Consequently, the control group was further examined more thoroughly because their better vitamin D levels might provide insights into improving vitamin D status in the diabetes group
Conclusion: Patients with type two diabetes have much lower amounts of vitamin D than healthy people. In fact, 19.2% of these people are vitamin D deficiency. The results show that not getting enough vitamin D may play a part in getting type 2 diabetes. Supplementing with vitamin D could help prevent the disease and mitigate its effects.

Background: Around 425 million (6%) of humans are diabetics all over the world , and most of them are T2DM(>85%). Diabetes increases the incidence of asymptomatic coronary artery disease (CAD) by two to seven times when compared to non-diabetics.
Aim: Find out how common asymptomatic (subclinical) coronary artery disease (CAD) is in people with diabetes and how it connects to glucose management and the duration of type 2 diabetes using TMT in order to improve detection rate of CAD.
Materials & Method: This observational research was conducted in October 2021 to April 2022 at Azadi Teaching Hospital in Kirkuk. This research comprised 103 individuals with a mean duration of 5.2 ± 4.2 years since complications start from diagnosis of T2DM , a mean HbA1C of 7.9 ± 1.3 mg/dl who had been diagnosed with T2DM and were having a treadmill test. Patients with preexisting cardiac disease have been excluded from the study.
Results: The exercise ECG finding showed that, 23% of patients had positive Exercise ECG finding and being elderly, long duration of DM, high HbA1C level, and high diastolic blood pressure found to be associated significantly with positive exercise ECG (p<0.05). For the categorical variables, being on insulin associated significantly with positive exercise ECG in which patients on insulin have higher risk (Risk ratio=4.9), other factors did not demonstrate significant association with positive TMT.
Conclusion: The prevalence of positive TMT was comparable to worldwide studies and being elderly, long duration of DM, high HbA1C level showed significant association with asymptomatic CAD finding.

Background: Omega-3 fatty acid products are available as dietary supplements (fish oils) and prescription formulations (omega-3 ethyl ester, icosapent ethyl, omega-3 ethyl ester A, omega-3 carboxylic acids).
Objectives: To learn more about the prevalence of dietary supplement and prescription omega-3 products use by Iraqi consumers in Kirkuk City, to record the types of products used and to examine the role of physicians and pharmacists in guiding choices about these products.
Material and methods: A cross-sectional questionnaire-based study was conducted among pharmacists concerning dispensing the prescription only medicine (POM) and over the counter (OTC) omega-3 products. Ninety-three filled questionnaires were received from pharmacies in Kirkuk city.
Results: Over 6 months, 43 patients from 93 (46.2%) were dispensed fish oil supplementations by prescription, and 50 patients from 93 (53.7%) were dispensed fish oil preparation without prescription. The nonprescription users were younger (32.92 vs. 44.41 years old) and more often female (63% vs. 58%) compared to prescription users. Forty-four percent of the OTC group purchased omega-3 as a dietary supplement, 20% used it for hair loss, 14% for treating hypertriglyceridemia, 0.08% for improving memory function, and 0.02% for pregnancy care. Physicians prescribed omega-3 fatty acids for several indications, including 35.7% for hypertriglyceridemia, 21.4% for rheumatoid arthritis, 14.2% for hair loss, 13.57% for pregnancy care, 10.7% as a dietary supplement, 3.75% to improve memory health, 3.75% as an anti-inflammatory and 3.75 % for eye health. All the products supplied to customers for various indications either by prescription or as an OTC were dietary supplements.
Conclusion: Healthcare providers and consumers need to distinguish the differences between prescription omega-3 products and nonprescription omega-3 dietary supplements to ensure the appropriate use of each product.

Background:
One of the most dangerous complications for mother and baby during cesarean section is hypotension due to spinal anesthesia. Several methods are used to prevent and treat hypotension, the safest of which is fluid replacement. This study aimed to compare the effectiveness of colloidal solutions and crystalloid solutions in preventing hypotension resulting from spinal anesthesia during elective cesarean sections, along with assessing the requirement for vasopressors to treat sever hypotension due to the spinal anesthesia.
Patients and Methods:
This prospective comparative study was conducted in Erbil Maternity Teaching Hospital from May 2021 until October 2021. Two groups of 35 patients were prepared for elective cesarean section, crystalloid group received normal saline, while the colloid group received voluven infusion. Systolic blood pressure, diastolic blood pressure, and the need for vasopressors (a combination of ephedrine plus phenylephrine) were compared between the groups.
Results:
There is no statistically significant difference in the prevalence of hypotension between the two groups (p-value>0.05), except at 5min, there was significant hypotension (p-value<0.0001 in the crystalloid group and p-value<0.003 in the colloid group). However, there is less need for vasopressor drugs to treat hypotension in the colloid group (p-value<0.001).
Conclusion:
Both colloidal and crystalloid solutions have been effective in preventing hypotension due to spinal anesthesia in elective cesarean section. However, compared to the crystalloid group, in the colloidal infusion group, there is less need to use vasopressor drugs to treat hypotension.

Background: Urinary tract infections are quite prevalent among children and present with non-specific symptoms including abdominal pain, fever, and nocturnal urine incontinence. The biofilm matrix comprises proteins such as fibrin, polysaccharides such as alginate, and also extracellular DNA. The study aimed to determine the sensitivity of uropathogenic bacteria to antibiotics and assess their ability to form biofilms.
Methods: This study was carried out in Kirkuk city spanning from October 2023 to March 2024. A total of 180 children with positive urine culture participated, falling within the age range of 6-12 years. Bacterial identification and antibiotic susceptibility test were performed by Vitek 2 compact system (BioMerieux). The ability of all bacteria isolated to produce biofilms was assessed using a quantitative microtiter plate method.
Results: The results revealed that uropathogenic Escherichia coli was the predominant isolate (40 %) from children with urinary tract infection. The prevalence of UTI in children was highest in the age group (9-12) years, with 120 children accounting for (67 %) of the cases. Biofilm production for isolated bacteria was; E. coli (66.7 %), Klebsiella pneumonia (33.4 %), Pseudomonas aeruginosa (66.6%) Proteus mirabilis (100%), Acinetobacter baumannii (33.6%), Staphylococcus haemolyticus (85.6 %), Staphylococcus aureus (83.3 %), Staphylococcus epidermidis (100%), Staphylococcus lentus (100%), Enterococcus faecalis (66.6%).
Conclusion: The majority of bacteria recovered from children with urinary tract infections were capable of forming biofilms. Infections caused by bacteria that develop biofilms are more resistant to typical antibiotic treatments, requiring higher dosages or more powerful drugs.

Mid-gut volvulus (MGV) frequently occurs in infancy and childhood and is rarely seen in adults. Here, we present a 23-year-old male who presented with abdominal pain and vomiting for one-week duration. The patient gave a long history of similar attacks in the past since the age of 16 years old, at a rate of 2-3/ attacks per year, which become more frequent in the last year. A laboratory workup was carried out, and an imaging study demonstrated a twisting of bowel loops around mesenteric vessels on ultrasound and intravenous-enhanced contrast computed tomography (CT scan). Whirlpool sign of midgut volvulus was seen on contrast CT scan. The patient underwent laparoscopic Ladd's procedure, where the diagnosis was confirmed, bands were resolved, and the bowel blood supply was restored. The surgery and postoperative period were uneventful. The patient became pain-free and was discharged home on the fourth postoperative day. To improve patient outcomes, physicians should practice a high suspicion index to confirm MGV in adult cases.