Background and objective: Flapless implant surgery has been suggested as a suitable treatment technique for implant placement, but limited information exists regarding the clinical conditions after flapless implant surgery. This study aimed to compare flapless implant surgery with traditional flap implant surgery clinically and radiographically.

Methods: Sixty patients (23 males and 37 females) participated in the present study. The patients were divided into two groups, in the Group ‘A’ 30 implants were placed by traditional flap surgery and in Group ‘B’ 30 implants were placed by flapless implant surgery (punch technique). Clinical and radiographic examinations were carried out to assess the implants condition. Clinical examination included implant mobility which was assessed by using universal torque ratchet at the end of healing period (6 months). The periapical radiograph was carried out to assess marginal bone loss around the implants at three and six months after implantation.

Results: Two implants failure were reported; one implant for each of the Group ‘A’ and ‘B’. There was no significant difference between the two groups with regard to the marginal bone resorption (P = 0.487). The success rate for both groups was 96.6%. The study showed a non-significant relation of age and gender with the success rate.

Conclusion: The flapless implant surgery could offer advantages over the classic protocol and should have the potential to increase the patients’ acceptance of the procedure.

1. Campelo LD, Camara JR. Flapless implant surgery: a 10-year clinical retrospective analysis. Int J Oral Maxillofac Implants 2002; 17:271-6.

2. Becker W, Goldstein M, Becker BE, Sennerby L. Minimally invasive flapless implant surgery: a prospective multicenter study. Clin Implant Dent Relat Res 2005; 7(Suppl 1):21-7.

3. Fortin T, Bosson JL, Isidori M, Blanchet E. Effect of flapless surgery on pain experienced in implant placement using an image-guided    system. Int J Oral Maxillofac Implants 2006; 21:298-304.

4. Ericsson I, Persson IG, Berglundh T, Marinello CP, Lindhe J, Klinge B. Different types of inflammatory reactions in peri-implant soft tissues. J Clin Periodontol 1995; 22:255-61.

5. Al-Ansari BH, Morris RR. Placement of dental implants without flap surgery: a clinical report. Int J Oral Maxillofac Implants 1998; 13:861.

6. Kan JY, Rungcharassaeng K, Ojano M, Goodacre CJ. Flapless anterior implant surgery: a surgical and prosthodontic rationale. Pract Periodontics Aesthet Dent 2000; 12:467-74.

7. Berdougo M, Fortin T, Blanchet E, Isidori M, Bosson JL. Flapless implant surgery using an image-guided system. A 1- to 4- year prospective multicenter comparative clinical study. Clin Implant Dent Relat Res 2010; 12:142-52.

8. Sanna AM, Molly L, van Steenberghe D. Immediately loaded CAD-CAM manufactured fixed complete dentures using flapless implant placement procedures: A cohort study of consecutive patients. J Prosthet Dent 2007; 97:331-9.

 9. Shaifulizan AR, Akram H, Mohammed JM. The comparison between flapless and full-thickness flap techniques. 1^st ed. Düsseldorf: VDM Publishing; 2010.

10. Oh TJ, Shotwell JL, Billy EJ, Wang HL. Effect of flapless implant surgery on soft tissue profile: A randomized controlled clinical trial. J Periodontal 2006; 77:874-82.

11. Rao W, Benzi R. Single mandibular first molar implants with flapless guided surgery and immediate function: Preliminary clinical and radiographic results of a prospective study. J Prosthet Dent 2007; 97(6, suppl):S3-14.

12. Jeong SM, Choi BH, Li J, Kim HS, Ko CY, Jung JH, et al. Flapless implant surgery: an experimental study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007: 104; 24-8.

13. Jeong SM, Choi BH, Li J, Ahn KM, Lee SH, Xuan F. Bone healing around implants following flap and mini-flap surgeries: a radio­graphic evaluation between stage I and stage II  surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008: 105; 293-6.

14. Choi BH, Jeong SM, Kim J, Engelke W. Flapless implantology. 1^st ed. London: Quintessence Publishing Co. Ltd; 2010.

15. Kim JI, Choi BH, Li J, Xuan F, Jeong SM. Blood vessels of the peri-­implant mucosa: a comparison between the flap and flapless proce­dures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107:508-12.

16. Malo P, de Araujo Nobre M, Lopes A. The use of computer guided flapless implant surgery and four implants placed in immediate function to support a fixed denture: Preliminary results after a mean follow-up period of thirteen months. J Prosthet Dent 2007; 97(6, suppl):S26-34.

17. Zix J, Kessler-Liechti G, Mericske-Stern R. Stability measurements of 1-stage implants in the maxilla by means of resonance frequency analysis: a pilot study. Int J Oral Maxillofac Implants 2005; 20(5):747-52.

18. Van Steenberghe D, Glauser R, Blomback U. A computed tomographic scan-derived customized surgical template and fixed prosthesis for flapless surgery and immediate loading of implants in fully edentulous maxillae: A prospective multicenter study. Clin Implant Dent Relat Res 2005; 7(suppl 1):S111-20.

19. Moy Pk, Medina D, Shetty V, Aghaloo TL. Dental implant failure rates and associated risk factors. In J Oral Maxillofac Implants 2005; 20(4):569-77.

20. Porter JA, Von Fraunhofer JA. Success or failure of dental implant: A literature review with treatment considerations. Gen Dent 2005; 53(6): 423-32.

21. Van der Zee E, Oosterveld P, Van Waas MA. Effect of GBR and fixture installation on gingiva and bone levels at adjacent teeth. Clin Oral Implants Res 2004; 15:62-5.

22. Misch CE. Early crestal bone loss: etiology and its effect on treatment planning for implants. Postgrad Dent 1995; 2:3-17.

23. Tonetti MS, Schmid J. Pathogenesis of implant failures. J Periodontalogy 2000; 4:127-38.

24. Misch CE, Suzuki JB, Misch-Dietsch FD. A positive correlation between occlusal trauma and peri-implant bone loss: literature sup­port. Implant Dent 2005; 14:108-14.

Background and objective: A lack of knowledge regarding infection control measures among health care workers decreases compliance with these practices. This study aimed to assess the knowledge of infection control measures among nurses in Hawler Teaching Hospital.

Methods: A cross-sectional study was conducted from December 15^th, 2013 to February 10^th, 2014 on a non-probability purposive sample of 50 nurses. Data were collected by self report by nurses that work in some critical care wards (dialysis unit, surgical and neurosurgery) in Hawler Teaching Hospital. The questionnaire included two parts. Part one was related to the nurses’ sociodemographic characteristics, which contained six items of age, gender, educational level, years of experience, attending training and place of work. Part two was related to nurses’ knowledge on standard precautions measures.

Results: There was positive correlation between nurses’ knowledge on infection control measures and their educational level, years of experience and attending training. About 54% of nurses had good knowledge on infection control measures and 46% of them had fair knowledge. Mean knowledge about infection control measures of nurses was 68%.

Conclusion: The infection control knowledge among the nurses was fairly good in this study. Older age was an important determinant of lower level of knowledge.  

1. Johnson OE, Asuzu MC, Adebiyi AO. Knowledge and Practice of Universal Precaution among Professionals in Public and Private Health Facilities in Uyo, Southern- Nigeria- a Comparative Study. Ibom Med J 2012; 5(1): 9-19.

2. Buowari OY. Universal Precautions: A Review. The Nigerian Health J 2012; 12(3):68-74.

3. Jain M, Dogra V, Mishra B, Thakur A, Loomba PS. Infection control practices among doctors and nurses in a tertiary care hospital. Ann Trop Med Public Health 2012; 5:29-33.

4. Qalawa SA, Mahran SM, Alnagshabandi E. Investigations of factors influencing nurses compliance with standard precautions in critical care areas. Asia Acad Res J 2014; 21(1):177-200.

5. Ghadamgahi F, Zighaimat F, Ebadi A, Houshmand A. Knowledge, attitude and self-efficacy of nursing staffs in hospital infections control. Ir J Mil Med 2011; 13(3):167-72.

6. Kamunge EW. Exploring Knowledge, Attitudes and Practices of Registered Nurses Regarding the Spread of Nosocomial Infections. PhD dissertations, Seton Hall University, School of Health and Medical Sciences; 2012.

7. Sreedharan J, Muttappillymyalil J, Venkatramana M. Knowledge about standard precautions among university hospital nurses in the United Arab Emirates. East Mediterr Health J 2011; 17(4):331-4.

8. Mahmud NA, Abul Sahib SH. Assessment of nurses' practices toward infection control standardized precautions in Azady Teaching Hospital in the City of Kirkuk. Iraq Natl J Nursing Specialties 2011; 24(1):52-8.

9. Logan CA. Nursing students’ knowledge, observation of Environmental risk factors, and compliance with recommended precautions for the Prevention of transmission of infectious Diseases by needlestick injury PhD dissertation. Louisiana State University, College of Agricultural and Mechanical.United States; 2002.  

10. Infection Control Orientation Self-Study Guide .Rancho Los Amigos National Rehabilitation Center Infection Control Department; 2010. {Cited 2014 Feb 24} Available from: file.lacounty.gov/dhs/cms1_218120.pdf 

11. Suchitra JB, Devi LN. Impact of education on knowledge, attitudes and practices among various categories of health care workers on nosocomial infections. Indian J Med Microboil 2007; 25(3):181-7.

12. Bogaert PV, Meulemans H, Clarke S, Vermeyen K, Heyning KP. Hospital nurse practice environment, burnout, job outcomes and quality of care: test of a structural equation model. J Adv Nurs 2009; 65(10):2175-85.

13. Vij A, Swapna N, Williamson, Gupta S. Knowledge and practice of nursing staff towards infection control measures in a tertiary care hospital. J Acad Hosp Adm 2013; 13(2):1-6.

14. Ahmed S, Mamoud S, Hassan A, Abbas S, Shokry AE. Compliance with universal precautions among nurses and laboratory technicians in Mansoura International Specialized Hospital. Egyptian Journal of Hospital Medicine 2008; 30:151-64.

15. Alwutaib AH, Abdulghafour YA, Alfadhli AK, Makboul G, El-Shazly MK. Knowledge and attitude of the physicians and nurses regarding blood borne infections in primary health care, Kuwait. Greener J Med Sci 2012; 4:107-14.

16. Labrague LJ, Dolores L, Arteche DL, Yboa BC, Pacolor NF. Operating Room Nurses’ Knowledge and Practice of Sterile Technique. J Nurs Care 2012 1:4.

17. Foster TM, Lee MG, McGaw CD, Frankson MA. Knowledge and practice of occupational infection control among healthcare workers in Jamaica. West Indian Med J 2010; 59(2):147-52.

18. Sessa A. Giuseppe GD, Albano L, Angelillo IF. An Investigation of Nurses' Knowledge, Attitudes, and Practices Regarding Disinfection Procedures in Italy BMC Infect Dis 2011; 11:148.

Background and objective: There has been a recent concern about chronic non-communicable diseases in Iraq. The country is undergoing an epidemiological transition with an increasing burden of chronic non-communicable diseases with two-thirds of the people aged 25-65 years old are overweight and one-third are obese. This study aimed to estimate the prevalence of metabolic syndrome with their associated risk factors among a sample of peoples in Erbil city.  

Methods: This cross-sectional analytic study was carried out in Erbil city and involved a convenience sample of 566 apparently healthy subjects. A structured direct interview using interviewer administered questionnaire was applied. Anthropometric measures, random blood sugar, cholesterol level, triglyceride level, low-density lipoprotein and high-density lipoprotein were investigated.  

Results: The prevalence of metabolic syndrome in the studied sample was 30.6%. The prevalence was higher in females (45.5%) than males (16.3%). Variables like gender (P <0.001), age (P = 0.008), education and marriage (P = 0.001), family history of diabetes mellitus (P = 0.029), hyperlipidemia (P <0.001), hypertension (P = 0.047) and obesity (P = 0.005) were found to be factors that significantly associated with metabolic syndrome. 

Conclusions: Metabolic syndrome is prevalent among the studied population. Female gender, old age, marriage, family history of diabetes mellitus, hyperlipidemia, hypertension and obesity may be regarded as risk factors for metabolic syndrome.

1. Campion J, Milagro FI. Individuality and epigenetics in obesity. Obes Rev 2009; 10: 383-92.

2. Ferrannini E. Metabolic syndrome: a solution in search of a problem. J Clin Endocrinol Metab2007; 92:396-8.

3. Danny E, Girish LK. Metabolic syndrome and cardiovascular disease in South Asians. Vasc Health Risk Manag 2009; 5:731-43.

4. Park HS, Kim SM. Prevalence and trends of metabolic syndrome in Korea: Korean National Health and Nutrition Survey 1998-2001. Diabetes Obes Metab2007; 9:50-8.

5. MOH, WHO. Chronic Non-communicable Diseases Risk Factor Survey in Iraq: A STEP wise Approach. Draft report; 2006. Available From: www.who.int/chp/steps/IraqSTEPSReport2006.pdf. Accessed at 1^st Feb 2013.

6. Lohsoonthorn V, Lertmaharit L. Prevalence of Metabolic Syndrome among Professional and Office Workers in Bangkok, Thailand. J Med Assoc Thai 2007; 90(9):1908-15.

7. WHO. Physical status: the use and interpretation of anthropometry. Geneva: WHO; 1995. [Report of a WHO Expert Committee] Technical Report Series, 854.

8. European Society of Cardiology. Guidelines for the management of dyslipidemias. Available From: www.escardio.org/guidelines Accessed at 2^nd Jan 2013.

9. International Diabetes Federation. The IDF Consensus worldwide definition of the metabolic syndrome. Available From: www.idf.org/metabolic-syndrome. Accessed at 7^th Jan 2013.

10. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289:2560-72.

11. National Heart, Lung, and Blood Institute. Fourth Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel IV). Guidelines. From: www.nhlbi.nih.gov/files/docs/resources/heart/atp3full.pdf. Accessed: Jan 2013.

12. National Institute for Health and Care Excellence (formerly National Institute for Health and Clinical Excellence): Guidance. Available From: http://www.ncbi.nlm.nih.gov/books/NBK11822/. Accessed at 8^th Feb 2013. 

13. Misra A, Misra R, Wijesuriya M, Banerjee D. The metabolic syndrome in South Asians: continuing escalation and possible solutions. Indian J Med Res 2007; 125(3):345-54.

14. Zabetian A, Hadaegh F, Azizi F. Prevalence of metabolic syndrome in Iranian adult population, concordance between the IDF with the ATPIII and the WHO definitions. Diabetes Res Clin Pract 2007; 77:251-7.

15. Waleed I A. Helicobacter pylori infection and its relationship to metabolic syndrome: is it a myth or fact? Saudi J Gastroentrol 2011; 17:165-9.

16. Ervin RB. Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United States, 2003-2006. Nat Health Stat Report 2009; 13:1-7.

17. Katzmaryk PT. Targeting the Metabolic Syndrome with Exercise: Evidence from the HERITAGE Family Study. Med Sci Sports Exerc 2003; 35(10):1703-9.

18. Danny E, Girish LK, Nadya M, Anjali A, Bobby VK. Metabolic syndrome and cardiovascular disease in South Asians. Vasc Health Risk Manag 2009; 5:731-43.

19. Thomas GN, Ho SY, Janus ED, Lam KS, Hedley AJ, Lam TH. The US National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) prevalence of the metabolic syndrome in a Chinese population. Diabetes Res Clin Pract 2005; 67:251-7.

Background and objective: Carbamazepine is widely used as an anti-epileptic drug, primarily for the treatment of partial and tonic-clonic seizures. The drug is absorbed slowly and variably after oral administration due to its limited water solubility. In clinics, single daily dosing of conventional dosage forms of carbamazepine is insufficient; effective levels are provided by the multiple-dose administration. A multiplicity of dosage causes inconsistent plasma levels leading to side effects because of its narrow therapeutic range and toxicity levels. A single dose of extended release dosage forms is suggested to keep levels within the therapeutic concentrations. This study aimed to compare the in vitro behavior of generic tablets containing carbamazepine with the brand product.

Methods: Basket apparatus was used to evaluate in vitro behavior of the different products and similarity test was applied to evaluate the differences between generic products and the brand. The study and test were carried out in Jun 2014 at the College of Pharmacy, Hawler Medical University.  

Results: There was a significant difference between the in vitro behavior of one of the generic products in the study and the in vitro behavior of the brand product.  

Conclusions: The in vitro study using basket apparatus could be considered as an effective method to evaluate the in vitro behavior of the majority of pharmaceutical dosage forms. In vitro behavior is a direct indicator for in vivo one. Therefore the quality of the medicaments could be evaluated and the risk to the patients could be significantly reduced. 

1. McNamara JO. Drugs effective in the therapy of the epilepsies. In: Hardman JG, Limbird LE. The Pharmacological Basis of Therapeutics, 10^th ed.; McGraw-Hill: New York Goodman & Gilman’s; 2001. P. 533-4.

2. Beghi E. Carbamazepine: clinical efficacy and use in other neurological disorders. In: Levy R, Mattson R, Meldrum B, Penry J, Dreifuss F.Antiepileptic drugs, 5^th ed. Lippincott, Philadelphia: Williams & Wilkins; 2002. P. 273-7.

3. Trimble MR. Carbamazepine: clinical efficacy and use in psychiatric disorders. In: Levy R, Mattson R, Meldrum B, Penry J, Dreifuss F. Antiepileptic drugs, 5^th ed. Lippincott, Philadelphia: Williams & Wilkins; 2002. P. 278-84.

4. Ernst CL, Goldberg JF. Antidepressant properties of anticonvulsant drugs for bipolar disorder. J Clin Psychophar-macol 2003; 23:182-92.

5. Wael A, Alia B, Mahmoud M, Hanan E N. Formulation and evaluation of carbamazepine 200 mg chewable tablets using cyclodextrins. IJPPS 2012; 4(4):472-80.

6. Geradin AP, Abadie FV, Campestrini JA, Theobald W. Pharmacoki-netics of  carbamazepine in normal humans after single and repeated oral doses. J Pharmacokinet Biopharm 1976; 4:521-35.

7. McKauge L, Tyrer JH, Eadie MJ. Factors influencing simultaneous concentrations of carbamazepine and its epoxide in plasma. Ther Drug Monit 1981; 3:63-70.

8. Levy RH. Cytochrome P450 isozymes and antiepileptic drug interactions. Epilepsia 1995; 36 (Suppl. 5):S8-13.

9. Koester LS, Ortega GG, Mayorga PP, Bassani VL. Mathematical evaluation of in vitro release profiles of hydroxyl-propyl methylcellulose matrix tablets containing carbamazepine associated with B-cyclodextrin. Eur J Pharm Biopharm 2004; 58(1):177-9.

10. Barakat NS, Elbagory IM, Almurshedi AS. Formulation, release characteristics and bioavailability study of oral monolithic matrix tablets containing carbamazepine: AAPS Pharm Sci Tech 2008; 3:931-8.

11. Bialer M. Pharmacokinetic evaluation of sustained release formulations of antiepileptic drugs. Clin Pharmacokinet 1992; 22(1):1-21.

12. Ikegami K, Tagawa K, Kbayashi M, Osawa T. Prediction of in vivo drug release behaviour of controlled-release multiple-unite dosage forms in dogs using a flow-through type dissolution test method. Int J Pharm2003; 258:31-43.

13. Pharmacopeia U. United States Pharmacopeia And National Formulary (Usp 28–Nf 23). The United States Pharmacopeial Convention, Inc.: Rockville; 2005. 341-4, 2411-20, 2501-10, 2670.

14. Yuksel N, Kanik AE, Baykara T. Comparison of in vitro dissolution profiles by ANOVA-based, model-dependent and -independent methods. Int J Pharm 2000; 209:57-67.

15. Costa P, Jose MSL. Modeling and comparison of dissolution profiles. Eur J Pharm Sci 2001; 13:123-33.

Background and objective: Knowledge for getting self-care activity is the one important issue in the quality of life for a paraplegic person to live independently. This study aimed to assess the level of knowledge of persons with complete paraplegia regarding how to do self-care activity during daily living.

Methods: This cross-sectional study involved 58 cases with complete paraplegia out of 202 cases with spinal injuries that were admitted to the Emergency Management Centre in Hawler from 2008 to 2014. Information data on paraplegic persons was collected from August 15^th to October 15^th, 2014 through the interview by using a questionnaire.

Results: The majority of persons with paraplegia were young (32.8%), male (84.5%), married (58.6%), secondary school graduates (35.3%), unemployed (72.4%), having income exceeding the needs (50%) and live in the urban area (77.6%). Most of them had thoracic injury at level 9 to 12 (70.7%). The most common cause of injury was fall from high (41.4%) and the majority of readmissions were for bedsores (87%). The knowledge of paraplegic persons of self-care activity was at a high level (87.9%). Those living in urban areas had a significantly higher knowledge than those living in rural areas (93.3% vs 69.2%, P = 0.019).

Conclusion: Persons with paraplegia had good knowledge for self-care activity, but still need continuous knowledge and practical training. Urban areas need more help and knowledge.

Keywords: Paraplegia; Knowledge; Self-care activity.

1. Ripat JD. Self-perceived Participation amongst Adults with Spinal Cord Injuries: The Role of Assistive Technology. Winnipeg, Manitoba; 2011. Available from http://www.nature.com/sc/journal/v50/n12/pdf/sc201277a.pdf . Accessed at 2nd November 2014).

2. Brunner HR, Suddarth’s. Textbook of Medical-Surgical Nursing. 10^th ed. Suzanne C. O’Connell Smeltzer; 2003. P. 1926-9.

3. Jongjit J, Sutharom W, Komsopapong L, Numpechitra N, Songjakkaew P. functional independence and rehabilitation outcome in traumatic spinal cord injury, Bangkok. Southeast Asian. J Trop Med Public Health 2004; 35(4): 980-5.

4. Górska M. Dynamics of the adaptation to self–disability in people with paraplegia. Jagiellonian University, Cracow, Poland. Med Rehabil 2005; 9(2):8-13.

5. Houghton PE, Campbell KE, Panel CPG. Canadian Best Practice Guidelines for the Prevention and Management of Pressure Ulcers in People with Spinal Cord Injury. A Resource Handbook for Clinicians; 2013. P. 36.

6. Wyndaele M, Wyndaele JJ. Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey? Department of Urology, University Hospital Antwerp, Edegem, Belgium. Int Spinal Cord Soc 2006; 38:697-701.

7. Dahlberg A, Kotila M, Leppa P, Kautiainen H, Alaranta H. Prevalence of spinal cord injury in Helsinki, Heinola. Finland. Spinal Cord 2005; 43(1):47-50.

8. Henn MJ. Evaluation of the Rehabilitation Program for Persons with Complete Paraplegia at Net care Rehabilitation Hospital. Stellenbosch University Stellenbosch; 2009. Available at http://www.client.com =4&xhr=t&q=Henn%2.1379211186042.pdf). Acessed 13^th Nov 2013.

9. Górska M. Dynamics of the adaptation to self–disability in people with paraplegia. Jagiellonian University, Cracow, Poland. Med Rehabil 2005; 9 (2):8-13.

10. Rodriguez GP, Garber SL. Prospective study of pressure ulcer risk in spinal cord injury patients. Houston. Texas, USA. Int Med Soc Paraplegia 1994; 32:150-8.

11. Thietje R, Giese R, Pouw M, Kaphengst C, Hosman A, Kienast B, et al. How does knowledge about spinal cord injury-related complications develop in subjects with spinal cord injury? A descriptive analysis in 214 patients. Int Spinal Cord Soc 2011; 49:43-8.

12. Marcel WM, Dallmeijer AJ, Angenot EL, Asbeck FW, der Woude LH. Duration functional outcome of spinal cord injury rehabilitation in the Netherlands. Amsterdam, the Netherlands. J Rehabil Res Dev 2005; 42(3):75-86.

13. Curt A, Keck ME. Dietz V. Functional Outcome Following Spinal Cord Injury. Significance of Motor-Evoked Potentials and ASIA Scores. University Hospital Balgrist, Zurich, Switzerland. Arch Phys Med Rehabil 1998; 79:81-6.

14. Harvey LA, Smith MB, Davis GM, Engel S. Functional Outcomes Attained by T9-12 Paraplegic Patients With the Walkabout and the Isocentric Reciprocal Gait Orthoses. Sydney, Australia. Arch Phys Med Rehabil 1997; 78: 706-11.

15. Bloemen-Vrencken JH, de Witte LP, Post MW. Pons C, van Asbeck FW, van der Woude LH, et al. Comparison of two Dutch follow-up care models for spinal cord-injured patients and their impact on health problems, re-admissions and quality of care. Clin Rehabil 2007; 21(11): 997-1006.

Background and objective: Rotavirus gastroenteritis is the most common cause of acute dehydrating diarrhoea among children younger than five years and globally the most important cause of severe diarrhea in this age group. Most children acquire rotavirus infection before they turn two years of age. Rotavirus vaccination can prevent rotavirus infection. This study aimed to assess healthcare providers' knowledge regarding rotavirus vaccine.

Methods: A cross-sectional descriptive study was conducted on 100 healthcare providers at four healthcare centers (Azady, Tayrawa, Mala Fandi and Zhyian), during July to August 2014. Data were collected through the use self-reporting questionnaire format, which was developed for the purpose of the study. A socio-demographic sheet was also constructed to determine characteristics of the subjects.  

Results: Most of the healthcare providers were in the‎ age group 33-42 years old (31%), 51%, were male, 80% were married, 56% were graduated from the institute, half of them had work experience between 2-11 years and 29% were working in ‎vaccination room. Fifty-four (54%) of healthcare providers had average knowledge while 24 (24%) and 22 (22%) of them had a poor and good knowledge, respectively‎.

Conclusion: More than half of healthcare providers had average knowledge regarding rotavirus vaccine.  

1. Susan LW, Shelton MH. Maternal-child nursing care optimizing outcomes for Mothers Children families, 1^st ed. Philadelphia: FA Davis Company; 2009. P. 779.

2. World Health Organization. Global Immunization news: Introduction of Haemophilus Influenzae Type B and Rotavirus Vaccines in Expanded Programme on Immunization in Iraq. 2012. Available from: http://www.who.int/immunization/GIN_February_2012.pdf. Accessed at 1st September 2014.

3. Abdulrazzaq A, Aljeboory SK, Abdul Kareem S, Klena J. Two different diagnostic methods for detection of rotavirus in Iraqi young Children. Al-Anbar J Vet Sci 2011; 4(1):52.

4. Ahmed H M, Coulter J BS, Nakagomi O, Hart CA, Zaki JM, Al-Rabaty AA, et al. Molecular Characterization of Rotavirus Gastroenteritis Strains, Iraqi Kurdistan. Emerge Infect Dis 2006; 12(5):824.

5. Alrifai SB, Alsaadi A, Mahmood YA, Ali AA, Al-Kaisi LA. Prevalence and etiology of ‎nosocomial diarrhea in children < 5 years in Tikrit teaching hospital. E Mediterr Health J 2009; ‎‎15 (5):1113.‎

6. Hussein AM, Hassan MK. Rotavirus Infection among Hospitalized Children with Acute Watery Diarrhea in Basrah – Iraq. Bahrain Medical Bulletin 2000; 22 (4): 2.

7. Alani QA, Al-Rawi SA, Salih AK, Al-Mawla SO. Common Rota Virus Gastroenteritis in Children under 5 Years in Maternity and Children Teaching Hospital, western Iraq. Anb Med J 2012; 10 (1): 2.

8. AL- Khafaji Y AR, AL-Jiboury HJ. ‎Detection of Rotavirus in diarrhea stool samples of children with acute gastroenteritis in Babylon governorate, Iraq Int Res J Microbiol 2013; 4(3): 85.

9. Abood WS, Al-Juboury SA, Al-Rodhan M A. The molecular epidemiology of rotavirus strains causing gastroenteritis in infant in the region of Mid Iraq. AL-Qadisiya Journal Vet Med Sci 2013; 12(1):123.

10. Centers for Disease Control and Prevention, Rotavirus Vaccine - Questions & Answers; 2011. available from: http://www.cdc.gov/vaccines/vpd-vac/rotavirus/vac-faqs.htm . Accessed at 20^th November 2013.

11. Strategic Advisory Group of Experts on Immunization, Detailed Review Paper on Rotavirus Vaccines; 2009. available from: http://www.who.int/immunization/sage/3_Detailed_Review_Paper_on_Rota_Vaccines_17_3_2009.pdf. Accessed at 20^th November 2013.

12. Cattaneo R, Engert SF, Gray D, Vineyard Ch. “Immunization Training Guide & Practice Procedure Manual For Pediatricians, Physicians, Nurse Practitioners, Physician Assistants, Nurses, Medical Assistants, and Office Manager, By American Academy of Pediatrics”; 2012). PP. 12-13. Available from: http://www2.aap.org/immunization/pediatricians/pdf/immunizationtrainingguide.pdf. Accessed at 17^th July 2013.

13. Basic-mathematics.com. Formula for percentage; 2015. Available from: http://www.basic-mathematics.com/formula-for-percentage.html . Accessed at 23^rd July 2015.

14. Nnenna TB, Maduka U, Babatunde OI, Ihuarula E Ch, Anyele UN. Knowledge of Rotavirus Disease among Healthcare Providers and Their Acceptance of Rotavirus Vaccines in South-East, Nigeria. J Vaccines Vaccin 2013; S1:1005.

Background and objective: Cataract and glaucoma are common co-morbidities and are the first and the second leading causes of blindness worldwide. There are many reasons to consider cataract extraction in individuals with cataract. These individuals derive great visual benefit from the increased acuity and improved contrast sensitivity provided by a clear artificial lens. An improvement in vision allows for more accurate visual field monitoring, and a clear optical pathway enhances the quality and reproducibility of optic nerve imaging. This study aimed to determine the association between intraocular pressure with cataract surgery in human eyes by monitoring changes in intraocular pressure in patients who underwent cataract surgery at Hawler Teaching Hospital at Erbil.  

Methods: This cross-sectional study was conducted on 71 subjects that underwent cataract surgery at Hawler Teaching Hospital at Erbil city from April 2013 to April 2014. Full ophthalmic examination including intraocular pressure measurement was done to every participant before cataract surgery, one week and one month after surgery.

Results: Paired samples t-test showed highly significance difference (P <0.001) between mean intraocular pressure measurements before, one week and one month after cataract surgery. The average decrease in postoperative intraocular pressure from preoperative intraocular pressure during one month was 2.02mm Hg (12.39%).

Conclusion: Cataract surgery reduces intraocular pressure and can be considered as an effective way to manage patients with a concurrence of glaucoma and cataracts.

1. Jane O, Lorraine C. Ophthalmology at a Glance. 1^st edition. UK: Blackwell Science Ltd; 2005. p. 72.

2. Kanski JJ. Clinical ophthalmology A systemic approach. 6^th ed. London: Elsevier Science. Butterworth-Heineman; 2006. p. 337.

3. Bobrow JC , Blecher MH, Glasser DB, Mitchell KB, Rosenberg LF,Reich J, et al. Basic and clinical science course: lens and cataract, Section 11. San Francisco, USA: American Academy of Ophthalmology; 2011. P. 71.

4. Khurana AK, Khurana I. Anatomy and physiology of eye. 2^nd ed. New Delhi_ Bangalore: CBS Publisher and Distributors; 2006. p. 53-71.

5. Kanski JJ. Clinical ophthalmology: A systemic approach. 6^th ed. London: Elsevier Science. Butterworth-Heineman; 2006. p. 374-80.

6. Khurana AK. Comprehensive Ophthalmology. 4^th ed. New Delhi_Bangalore: New age international (p) limited, publishers; 2007. p. 208-11.

7. Foroozan R, Levkovitch_Verbin H, Habot_Wilner Z, Burla N. Cataract Surgery and Intraocular Pressure. Ophthalmology 2008; 115:104-8.

8. Snell RS, Lemp MA.Clinical anatomy of the eye. 2^nd ed. India: Blackwell Science; 1998. p. 203.

9. Sundararajan R. Manual of practical cataract      surgery. 1^st ed. New Delhi-India; 2009. p.45.

10. Radius RL, Schultz K, Sobocinski K, Schultz RO, Easom H. Pseudophakia and intraocular pressure. Am J ophthalmol 1984; 97:738-42.

11. Bigger JF, Becker B. Cataracts and primary open-angle glaucoma: the effect of uncomplicated cataract extraction on glaucoma control. Trans Amcad Ophthalmol Otolaryngol 1971; 75:260-72.

12. Randolph ME, Maumenee AE, Iliff CE. Cataract extraction in glaucomatous eyes. Am J Ophthalmol 1971; 1:328-30. 

13. Tong JT, Miller KM. Intraocular pressure change after sutureless phacoemulsification and foldable posterior chamber lens implantation. J Cataract Refractive Surgery 1998; 24:256–62.  

14. ChoYK. Early intraocular pressure and anterior chamber depth changes after phacoemulsification and intraocular lens implantation in non glaucomatous eyes: J Cataract Refrac Surgery 2008; 34:1104-9.

15. Hansen MH, Gyldenkerne GJ, Otland NW, Corydon L, Naeser K. Intraocular pressure 7 years after extracapsular cataract extraction and sulcus implantation of a posterior chamber intraocular lens. J Cataract Refractive Surgery 1995; 21:676-8.

16. Liu DT, Lee VY, Chiu TY, Lam DS. Long-term intraocular pressure control after clear corneal phacoemulsification in glaucoma patients. J Cataract Refractive Surgery 2006; 32:183.

17. Kim DD, Doyle JW, Smith MF. Intraocular pressure reduction following phacoemulsification cataract extraction with posterior chamber lens implantation in glaucoma patients. Ophthalmic Surgery. Lasers 1999; 30:37-40. 

18. Pohjalainen T, Vesti E, Uusitalo RJ, Laatikainen L. Phacoemulsification and intraocular lens implantation in eyes with open-angle glaucoma. Acta Ophthalmol Scand 2001; 79:313-6. 

19. Shingleton BJ, Gamell LS, O'Donoghue MW, Baylus SL, King R. Long-term changes in intraocular pressure after clear corneal phacoemulsification: normal patients versus glaucoma suspect and glaucoma patients. J Cataract Refractive Surgery 1999; 25:885-90.

20. Shingleton BJ, Pasternack JJ, Hung JW, O'Donoghue MW.Three and five year changes in intraocular pressures after clear corneal phacoemulsification in open angle glaucoma patients, glaucoma suspects, and normal patients. J Glaucoma 2006; 15:494-8. 

21. Tennen DG, Masket S. Short-and long-term effect of clear corneal incisions on intraocular pressure. J Cataract Refractive Surgery 1996; 22:568-70.

22. Hayashi K, Hayashi H, Nakao F, Hayashi F. Changes in anterior chamber angle width and depth after intraocular lens implantation in eyes with glaucoma. Ophthalmology 2000; 107: 698-703.

23. Meyer MA, Savitt ML, Kopitas E. The effect of phacoemulsification on aqueous outflow facility.  Ophthalmology 1997; 104:1221-7.

Background and objective: The distinction of hydatidiform mole from hydropic abortion remains a problem because of interobserver and intraobserver variability. This study aimed to determine the utility of p57^Kip2 as a diagnostic marker in differentiating complete hydatidiform mole from its mimics.

Methods: A total of 97 formalin fixed paraffin embedded material including forty cases of complete hydatidiform mole, 36 cases of partial hydatidiform mole and 21 cases of hydropic abortion were selected randomly from the files of histopathology laboratory of Maternity Teaching Hospital in Erbil. The samples were reviewed by two pathologists, afterward; immunohistochemical staining was performed by using a p57^Kip2 marker. We considered p57^Kip2 positive only if nuclear p57^Kip2 staining was identified in at least 10% or more of all in a tissue section.     

Results: Negative immunostaining was seen in 77.5% of the complete hydatidiform mole in both villous cytotrophoblast and stromal cells. In contrast, 86.1% of partial hydatidiform mole showed positive immunostaining for p57^Kip2. All cases of hydropic abortion 100% were positive for p57^Kip2 immunostaining. In all gestations, p57^Kip2 was strongly expressed in decidua which served as internal positive control. The concordance between the initial histological diagnosis and p57^Kip2 immunostaining was statistically significant (P <0.001).   

Conclusions: p57^Kip2 immunostaining is a highly sensitive and specific marker for diagnosis and classification of hydatidiform mole. p57^Kip2 staining has the advantage of differentiating hydropic abortuses from the complete hydatidiform mole.         

1. LeGallo RD, Stelow EB, Ramirez NC, Atkins KA. Diagnosis of hydatidiform moles using p57 immunohistochemistry and HER2 fluorescent in situ hybridization. Am J Clin Pathol 2008; 129:749-55.

2. Abdou A, Kandil M, El-Wahed MA, Shabaan M, El-Sharkawy M. The diagnostic value of p27 in comparison to p57 in differentiation between different gestational trophoblastic diseases. Fet Ped Pathol 2013; 32:395-411.

3. Merchant SH, Amin MB, Viswanatha DS, Malhotra RK, Moehlenkamp C, Joste NE. P57^Kip2 Immunohistochemistry in early molar pregnancies: Emphasis on it's complementary role in the differential diagnosis of hydropic abortuses. Huma Pathol 2005; 36:180-6.

4. Fukunga M, Katabuchi H, Nagasaka T, Mikami Y, Minamiguchi S, Lage JM . Interobserver and intaobserver variability in the diagnosis of hydatidiform mole. Am J Surg Pathol 2005; 29:942-7.

5. Crisp H, Burton JL, Stewart R, Wells M. Refining the diagnosis of hydatidiform mole: image ploidy analysis and p57^Kip2immunohistochemistry. Histopathol 2003; 43:363-73.

6. Fernandez J, Cortes R, Salazar A, Pulido A, Dabed P, Garcia V. p 57 ^{Kip 2} immunohistochemistry: ancillary technique in hydatidiform moles diagnosis. BMC proceeding 2013; 7:33-9.

7. Castrillon DH, Sun D, Weremowicz S, Fisher RA, Crum CP, Genest DR. Discrimination of complete hydatidiform mole from its mimics by immunohistochemistry of paternally imprinted gene product p57 KIP 2.Am J Surg Pathol 2001; 25:125-30.

8. Jun SY, Ro JY, Kim KR. p57^kip2 is useful in the classification and differential diagnosis of complete and partial hydatidiform moles. Histopathol 2003; 43:7-25.

9. Maggiori MS, Peres LC. Morphological, immunohistochemical and chromosome in situ hybridization in the differential diagnosis of Hydatidiform Mole and Hydropic Abortion. Europ J Obst Gynecol Repro Biol 2007; 135:170-6.

10. Chen YX, Shen DH, Gu YQ, Zhong PP, Xie JL, Song QJ. Immunohistochemistry of p57 and p53 protein in differential diagnosis of hydropic abortion, partial and complete hydatidiform mole.  Chinese J pathol 2011; 40:694-7.

11. Landolsi H, Missaoui N, Brahem S, Hmissa S, Gribaa M, Yacoubi MT. The usefulness of p57 (KIP2) immunohistochemical staining and genotyping test in the diagnosis of the hydatidiform mole. Pathol Res Pract 2011; 207:498-504.

12. Masaharu F. Immunohistochemical characterization of p57 KIP2 expression in early hydatidiform moles. Hum Pathol 2002; 33:1188-92.

13. García-Barriola V, de Gómez MN, Dickson-González S, Figueira L, Cortés-Charry R. Utility of p57 protein (KIP2) in molar disease to determine its androgenetic origin.  J Repr Med 2008; 53:476-80.

14. McConnell TG, Murphy KM, Hafez M, Vang R, Ronnett BM. Diagnosis and subclassification of hydatidiform moles using p57 immunohistochemistry and molecular genotyping: validation and prospective analysis in routine and consultation practice settings with development of an algorithmic approach.  Am J Sur Pathol 2009; 33:805-17.

15. DeScipio C, Haley L, Beierl K, Pandit AP, Murphy KM, Ronnett BM. Diandric triploid hydatidiform mole with loss of maternal chromosome 11. Am J Surg Pathol 2011; 35:1586-91.

16. Masoumeh F, Neil JS, Philip MS, Michael JS, Rosemary AF. Mutations in NLRP7 and KHDC3L confer a complete hydatidiform mole phenotype on Digynic triploid conceptions. Hum Mut 2013; 34:301-8.

17. Banet N, DeScipio C, Murphy KM, Beierl K, Adams E, Vang R. Characteristics of hydatidiform moles: analysis of a prospective series with p57 immunohistochemistry and molecular genotyping. Mod Pathol 2014; 27:238-54.

Background and objective: Septoplasty is one of the most common procedures worldwide in otolaryngology clinics. The use of antibiotics in Septoplasty is a common practice among most otolaryngologists. However, there are few studies proving the efficacy, which is considered unnecessary by some others. This study aimed to compare the efficacy of prophylactic versus postoperative antibiotic in septoplasty and strengthen the evidence base for antibiotic use. 

Methods: This prospective study was conducted on 90 patients that underwent septoplasty over six months period from August 1^st, 2012 to January 31^st, 2013 in Rizgary Teaching Hospital, Erbil city. They were equally divided into two groups; 45 patients in Group A and 45 patients in Group B. Their age ranged between 17-49 years old. 

Results: No significant difference was observed in reduction of infection rate between Group A and Group B. No any statistically significant difference was found concerning pain, fever, purulent discharge and bleeding. Two of the patients (one from each group) developed septal hematoma.

Conclusions: Infection after septoplasty is rare and if occur is usually minor in nature. The outcome of postoperative antibiotic use does not outweigh that of a single prophylactic dose of antibiotic.

1. Alexander D, George F, Joanna M, Johannes Z, Heinrich I, George A. Septoplasty outcome in patients with and without allergic rhinitis. Rhinology 2009; 47:444-9.

2. Evren E, Mustafa B, Ozan K. Postoperative cephazolin usage is sufficient for preventing infection after septoplasty procedure. Allergy Rhinol 2011; 2.

3. Irfan K, Ahmet K, Turgut K, Sinasi Y, Erol K. Bacteriemia in septoplasty and septorhinoplasty surgery. Rhinology 2003; 41:76-9.

4. Rechtweg J, Paolini R, Belmont M, Wax M. Postoperative antibiotic use of septoplasty: a survey of practice habits of the membership of the American Rhinologic Society. Am J Rhinol 2001; 15(5):315-20.

5. Günaydın R, Aygenc E, Karakullukcu S, Fidan F, Celikkanat S. Nasal packing and transseptal suturing techniques: surgical and anaesthetic perspectives. Eur Arch Otorhinolaryngol 2011; 268:151-6.

6. Andrews P, East C, Jayaraj S, Badia L, Panagamuwa C, Harding L. Prophylactic vs Postoperative Antibiotic Use in Complex Septorhinoplasty Surgery. Arch Facial Plast Surg 2006; 8:84-7.

7. Ulrich G, Jan-Olaf G. The Nose As Bacterial Reservoir: Important Differences Between the Vestibule and Cavity. Laryngoscope, Philadelphia: Lippincott Williams & Wilkins, Inc; 2000.

8. Jonathan P, Arlen D. Prophylactic Antibiotic Use in Head and Neck Surgery. 2012. (accessed on June at http://emedicine.medscape.com/article/873812-overview)

9. Marcello, Gustavo H, Elder Y, Richard L, Ossamu B. Antibiotics in septoplasty: is it necessary? Brazilian Journal Of Otorhinolaryngology 2005; 71:734-8.

10. Teichgraeber J, Russo C. Treatment of nasal surgery complications. Ann Plast Surg 1993; 30:80-8.

11. Danyal A, Pachen E. Surgical Infections and Choice of Antibiotics. In: Townsend. Townsend: Sabiston Textbook of Suregry. 18th edition. New York: Saunders; 2007. PP. 264-79.

12. Stoelting K, Hillier C. Handbook of Pharmacology and Physiology in Anesthetic Practice. 2^nd ed. New York: Lippincott Williams & Wilkins; 2006. PP. 540-56.

Background and objective: Acne is a follicular skin disease most frequently occurring during the adolescent or the teenage years of a person's life. It has been found that around 85% of teenagers suffer from this skin disorder worldwide. However, acne is not only restricted to teenagers but in many cases continues well into adulthood. This study aimed to examine the prevalence of acne in relation to age in Erbil City, and isolation and identification of microorganisms in acne patients. 

Methods: Specimens were collected from inflamed and discharging pus from 160 acne patients (74 male, 86 female) attending the Department of Dermatology in Rizgari Teaching Hospital in Erbil city. The cultures were examined using the Vitek-2 compact system.

Results: Among 160 samples taken, 150 (99%) were culture positive. From there 70 (46.6%) were male and 80 (53.3%) were female. Only ten (6.25%) samples revealed no growth. The highest prevalence of acne was 32 (20.0%) at age group (15-17) years of both genders. The most frequent etiological agent isolated (aerobically) bacteria from acne patients was Staphylococcus epidermidis (27.08%), and the most common anaerobic pathogen bacteria species were Propionibacterium acnes, 25 (13.02%), while among fungi Candida albicans was the most common fungi representing nine (64.29%) isolates.

Conclusion: Gram-positive bacteria were the most common microorganisms involved in acne infection. There are variations in the incidence of acne infection in relation to sex, age, and socioeconomic level.

1. Adityan B, Kumari R, Thappa DM. Scoring systems in acne vulgaris. Indian J Dermatol Venereol Leprol 2009; 75(3):323-6

2. Lasek RJ, Chren MM. Acne vulgaris and the quality of life of adult dermatology patients. Arch Dermatol 1998; 134:454-8.

3. Vexiau P, Husson C, Chivot M, Brerault JL, Fiet J, Julien R, et al. Androgen Excess in Women with Acne Alone Compared with Women with Acne and/or Hirsutism. J Invest Dermatol 1990; 94:279-328.

4. Goulden V, Stables GI, Cunliffe WJ. Prevalence of facial acne in adults. J Am Acad Dermatol 1999; 41:577-80.

5. Cogen AL, Nizet V, Gallo RL. Skin microbiota: a source of disease or defence? Br J Dermatol 2008; 158(3):442-55.

6. Johnson BA, Nunley JR. Topical therapy for acne vulgaris. How do you choose the best drug for each patient? Postgrad Med 2000; 107:69-70.

7. Roth RR, James WD. Microbial ecology of the skin. Annu Rev Microbiol 1988; 42:441-64

8. Ghodsi SZ, Orawa H and Zouboulis CC. Prevalence, severity, and severity risk factors of acne in high school pupils: A community-based study. J Invest Dermatol 2009; 129:2136-41.

9. Tan HH, Tan AW, Barkhman T, Yan XY and Zhu M. Community of acne vulgaris in aldoscents in Singapore. Br J Dermatol 2007; 157:547-51.

 10. Zandi S, Vares B, Abdollahi H. Determination of microbial agents of acne vulgaris and Propionibacterium acnes antibiotic resistance in patients referred to dermatology clinics in Kerman, Iran,. Jundishapur J Microbiol 2011; 4(1):17-22

11. Al-Zoman YA, Facharizt A, Al-Asmari KA. Pattern of skin diseases at Riyadh Military Hospital. Egyptian Dermatol J 2008; 4(2):4.

12. Kriger JN, Kauser DL and Wenzel RP. Nosocomial infections cause infections in acne patients. Surgery 1993; 156:313-16.

13. Ikaraoha CI, Taylor GL, Anetor JI, Ukaegbu QO, Nwobu GO. Demographic features, beliefs and socio-phychological impact of acne vulgaris among its sufferes in two towns in Nigeria. OJHAS 2009; 2:15-20

14. Hafez^. AM, Mahran MA, Mohammed AK, Mohammed RE, Darweesh MA, Aal AA. Quality of Life in Acne Vulgaris Patients. J Neurol Psychiat 2007; 44(1):301-12.

15. Yu SY, Cheng WY, Chen CW. Lifetime Course of Acne: A Retrospective Questionnaire Study in School Teachers. Dermatol Sinica 2008; 26: 10-15

16. Sharquie EK, Al-Hamdi IK, Adil A, Noaimi AA, Al-Battat AR. Scarring and None Scarring Facial Acne Vulgaris and the Frequency of associated Skin Diseases. J Med 2009; 8(4):13-33

17. Biswas S, Mondal KK, Saha I, Dutta NR, Lahiri KS. Clinico-epidemiological Features of Acne Vulgaris: A Tertiary Hospital-Based Study. Iran J Dermatol 2010; 13(2):37-41

18. Hassanzadeh P, Bahmani M, Mehrabani D. Bacterial resistance to antibiotics in acne vulgaris: an in vitro study. Indian J Dermatol 2008; 53(3):122-4.

19. Cunliffe WJ. Management of adult acne and acne variants. J Cutan Med Surg 1998; 2(3):7-13.

20. Nakatsuji T, Liu YT, Huang CP, Gallo RL, Huang CM. Antibodies elicited by inactivated Propionibacterium acnes-based vaccines exert protective immunity and attenuate the IL-8 production in human sebocytes: relevance to therapy for acne vulgaris. J Invest Dermatol 2008; 128:2451-7.

21. Biatecka A, Mak M, Biedroñ R, Bobek M, Kasprowicz A, Marcinkiewicz J. Different pro-inflammatory and immunogenic potentials of Propionibacterium acnes and Staphylococcus epidermidis: implication for chronic inflammatory acne. Arch Immunol Ther Exp 2005; 53:79-85

22. Nielsen ML, Raahave D, Stage JG, Justesen T. Anaerobic and aerobic skin bacteria before and after skin-disinfection with chlorhexidine: An experimental study in volunteers. J Clin Path 1975; 28:793-7.

23. Hatemi G, Bahar H, Uysal S, Mat C, Gogus F, Masatlioglu S, et al. The pustular skin lesions in Behc¸et’s syndrome are not sterile. Ann Rheum Dis 2004; 63:1450-2.

24. Bojar RA, Holland KT. Acne and Propionibacterium acnes. Clin Dermatol 2004; 22:375-9.

25. Gollnick H. Management of acne. A report of the global alliance to improve outcomes in acne. J Am Acad Dermatol 2003; 49:1-38.

26. Leeming JP, Holland KT, Cunliffe WJ. The microbial ecology of pilosebaceous units isolated from human skin. J Gen Microbiol 1984; 130:803-7.

27. Lacaz CS, Heins-Vaccari EM, Hernandez-Arriagada GL, Martins EL, Prearo CL, Corim, SM et al. Primary cutaneous cryptococcosis due to Cryptococcus neoformans var. gattii serotype B, in an immunocompetent patient. Rev Inst Med Trop Sao Paulo 2002; 44(4):225-8.

28. Knoke M, Schwesinger G. One hundred years ago: the history of cryptococcosis in Greifswald. Medical mycology in the nineteenth century 1994; 37(8):229-33.

29. Hazen KC, Howell SA. Candida, cryptococcus and other yeasts of medical importance. Manual of Clinical Microbiology 2007; 9:1762-88.

30. Zouboulis C, Eady A, Philpott M, Goldsmith L, Orfanos C, Cunliffe WJ. What is the pathogenesis of acne. Exp Dermatol 2005; 14:143-52.

Background and objective: Orthodontic tooth movement is mediated by tumor necrosis factor –α through activation of osteoclasts. Type 1 diabetes mellitus is characterized by a change in the bone remodeling and affects orthodontic treatment. This study aimed to investigate the effects of infliximab local injection on orthodontic movement in the diabetic rabbit.   

Methods: Sixty six rabbits were divided equally into three groups; two groups were rendered diabetic using alloxan injection, while the third group was regarded as a normoglycemic group. Only one of the diabetic groups received insulin treatment. All rabbits were subjected to orthodontic tooth movement of upper central incisor for 18 days, half of each group received infliximab subperiosteal injection, while the remaining number received saline injection. After sacrifice, tissue samples were subjected to histological preparation and histomorphometric analysis.   

Results: Insulin treated group revealed less prominent destruction of the periodontium when compared with the untreated group. The histological pictures of infliximab injected groups demonstrated less bone resorption in pressure side and more bone formation in tension side. There was a significantly smaller number of osteoclast with less compression in the width of the periodontal ligament in the tension side with infliximab injection. 

Conclusion: Infliximab local injection hindered bone resorption in the diabetic state during orthodontic tooth movement.  

1. Retzepi M, Lewis MP, Donos N. Effect of diabetes and metabolic control on de novo bone formation following guided bone regeneration. Clin Oral Implants Res 2010; 21:71-9.

2. Li X, Zhang L, Wang N, Feng X, Bi L. Periodontal ligament remodeling and alveolar bone resorptionduring orthodontic tooth movement in rats with diabetes. Diabetes Technol Ther 2010; 12:65-73.

3. Braga SM, Taddei SR, Andrade IJ, Queiroz- Junior CM, Garlet GP, Repeke CE, et al. Effect of diabetes on orthodontic tooth movement in a mouse model. Eur J Oral Sci 2011; 119:7-14.

4. Engebretson SP, Hey-Hadavi J, Ehrhardt FJ, Hsu D, Celenti RS, Grbic JT, et al. Gingival    crevicular fluid levels of interleukin-1beta and glycemic control in patients with chronic periodontitis and type 2 diabetes. J Periodontol 2004; 75:1203-8.

5. VanDoornum S, McColl G, Wicks IP. Tumour necrosis factor antagonists improve disease activity but not arterial stiffness in rheumatoid arthritis. Rheumatology (Oxford) 2005; 44: 1428-32.

6. Gonzalez-Gay MA, De Matias JM, Gonzalez-Juanatey C, Garcia-Porrua C, Sanchez-Andrade A, Martin J, et al. Anti-tumor necrosis factor-alpha blockade improves insulin resistance in patients with rheumatoid arthritis. Clin Exp Rheumatol 2006; 24:83-6.

7. Yoshimatsu M, Shibata Y, Kitaura H, Chang X, Moriishi T, Hashimoto F, et al. Experimental model of tooth movement by orthodontic force in mice and its application to tumor necrosis factor receptor- deficient mice. J Bone Min Metab2006; 24:20-7.

8. Korczowska I, Lacki JK, Hrycaj P. Influence of infliximab on cytokines network and markers of bone remodeling in rheumatoid arthritis patients. Yonsei Med J 2013; 54:183-8.

9. Andrade I, Silva TA, Silva GA, Teixeira AL, Teixeira MM. The role of tumor necrosis factor receptor type 1 in orthodontic tooth movement. J Dent Res 2007; 86:1089-94.

10. Ibrahim RS. Effect of low energy laser irradiation on bone healing around intra osseous titanium implant in experimentally diabetic rabbits. PhD thesis in Oral histology and biology. University of Baghdad. College of Dentistry; 2003.

11. Seneschal J, Lepreux S, Bouyssou-Gauthier ML, Heliot-Hosten I, Economu A, Dehais J, et al. Psoriasiform drug eruptions under anti-TNF    treatment of arthritis are not true psoriasis. Acta Derm Venereol 2007; 87:77-80.

12. Southerland JH, Taylor GW, Offenbacher S. Diabetes and periodontal infection: making the Connection. Clin Diabetes 2005; 23:171-8.

13. Bletsa A, Berggreen E, Brudvik P. Interleukin-1α and tumor necrosis factor-α expression during the early phases of orthodontic tooth movement in rats. Eur J Oral Sci 2006; 114:423-9.

14. SeonBaik H, Kwan-Kim CH, Lim W, Chun Y. Interleukin-1α and tumor necrosis factor-α expression on the compressed side of gingiva during orthodontic tooth movement. OJST 2012; 2:182-7.

15. Kaya FA, Hamamci N, Basaran G, Dogru M, Yildirim TT. TNF-α, IL-1β and IL-8 levels in tooth early leveling movement orthodontic tratment. J Int Dent Med Res 2010; 3:116-21.

16. Liu R, Bal HS, Desta T, Behl Y, Graves DT. Tumor necrosis factor-α mediates diabetes-enhanced apoptosis of matrix-producing cells and impairs diabetic healing. Am J Pathol 2006; 168:757-64.

17. Tawfiq FF. The effect of tumor necrosis factor-α inhibitor on the wound healing of oral mucosa in induced diabetic rats. M. Sc. thesis in Oral histology. Hawler Medical University; 2011.

18. Xie R, Kuijpers-Jagtman AM, Maltha JC. Osteoclast differentiation and recruitment during early stages of experimental tooth movement in rats. Eur J Oral Sci 2009; 117:43-50.

19. Kim HS, Park JW, Yeo SI, Choi BJ, Suh JY. Effect of high glucose on cellular activity of periodontal ligament cells invitro. Diabetes Res Clin Pract 2006; 74:41-7.

Background and objective: Patients’ satisfaction toward nursing care is an important indicator of the quality of nursing services. This study aimed to assess patients' satisfaction with nursing services provided in Rizgary Teaching Hospital and to find out the factors that are associated with levels of satisfaction.     

Methods: A cross-sectional study was conducted in Rizgary Teaching Hospital in Erbil city, starting from January 17^th, 2014 to March 11^th, 2015. A convenience sampling method was used to recruit 200 patients (100 males and 100 females) from medical and surgical wards. Patients aged ≥15 years, who were admitted to medical and surgical wards for ≥48 hours were included. A structured questionnaire designed by researchers was completed through direct interview. Chi-square test of association (or Fisher’s exact test) was used to compare proportions. A P value of ≤0.05 was considered as statistically significant.    

Results: The study showed that 40.5% of patients were highly satisfied with the nursing services, only 20.9% of those with secondary education or higher were highly satisfied (P = 0.005), and 80% of those with high income were highly satisfied (P = 0.001). There was no significant association between patients' satisfaction and patients’ age, marital status, occupation, residence, the length of stay, and type of ward. A relatively poor rate of satisfaction (20.5%) was observed regarding the information provided by nurses before the medical care or drug administration.  

Conclusions: Less educated patients were more satisfied with nursing services. The majority of patients were unsatisfied with the information provided by nurses before medical care or drug administration.   

1. Walsh M, Walsh A. Measuring patient satisfaction with nursing care: Experience of using the Newcastle Satisfaction with Nursing Scale. JAN 1999; 29(2):307-15.

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3. Aiell A, Garman A, Morris BS. Patient satisfaction with nursing care: A multilevel analysis. Qual Manag Health Care 2003; 12 (3):187-91.

4. Mrayyan MT. Jordanian nurses’ job satisfaction, patients’ satisfaction and quality of nursing care. International Nursing Review 2006; 53:224-30.

5. Yunus MA, Nasir MT, Nor Afiah MZ, Sherina MS, Faizah MZ. Patient satisfaction: a comparison between government and private clinics in Mukim Labu, Sepang, Selangor. MJPHM 2004; 4(2):6-11.

6. Doherty D. Measurement of Patient Satisfaction Guidelines Health Strategy Implementation Project 2003. The Health Board Executive. (Accessed on June 26^th, at http://hdl.handle.net/10147/43559)

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8. Swartz TA, Bowen DE, Brown SN. Hand book of services marketing and management advances in service marketing and management; 2000. PP. 65-85.

9. Hood C. The new public management in the 1980s: variations on a theme. J Account Organ Soc 1995; 20(2-3):93-109.

10. Giannakopoulou G, Tsironi M, Prezerakos P, Fotis T, Giannakopoulou E, Zyga S. Surgical patient satisfaction: nursing care quality index. Helenic Journal of Nursing Studies 2012; 5(1): 14-20,

11. Pascoe GC. Patient satisfaction in primary health care: a literature review and analysis. Eval Prog Plan 1983; 6:185-210.

12. Akhtari-Zavare M, Abdullah MY, Syed Hassan S, Said SB, Kamali M. Patient Satisfaction: Evaluating Nursing Care for Patients Hospitalized with Cancer in Tehran Teaching Hospitals, Iran. Global Journal of Health Science 2010; 2(1):117-26.

13. Sadjadian A, Kaviani A, Yunesian M, Montazeri A. Patient satisfaction: a descriptive study of a breast care clinic in Iran. Eur J Cancer Care 2004; 13(2):163-8.

14. Tang WM, Soong C, Lim W. Patient satisfaction with nursing care: A descriptive study using interaction model of client health behavior. Int J Nurs Sci 2013; 3(2):51-61.

15. Liu Y, Wang G. Inpatient satisfaction with nursing care and factors influencing satisfaction in a teaching hospital in China. J Nurs Care Qual 2007; 22(3):266-71.

 16. Senarath U, Gunawardena NS, Sebastiampillai B, Senanayake A, Lekamge S, Seneviratna A, et al. Patient satisfaction with nursing care and related hospital services at the National Hospital of Sri Lanka. J Leadersh Health Serv 2013; 26(1):63-77.

17. Teng KY, Norazliah S. Surgical Patients’ Satisfaction of Nursing Care at the Orthopedic Wards in Hospital Universiti Sains Malaysia. Health Environment J 2012; 3(1):36-43.

18. Findik UY, Unsar S, Sut N. Patient satisfaction with nursing care and its relationship with patient characteristics. Nurs Health Sci 2010; 12(2): 162-9.

19. Dzomeku VM, Ba-Etilayoo A, Perekuu T, Mantey RE. In-patient satisfaction with nursing care: A case study at Kwame Nkrumah University of Science and Technology Hospital. International Journal of Research in Medical and Health Sciences 2013; 2(1):19-24.

Background and objective: Controlling medications safely, effectively and efficiently is essential to the delivery of high-quality care. This study aimed to point up prescription errors such as scientific or brand names, the strength of medications, the age of patients, date of prescriptions, specifying dose, dose interval, dosing frequency and dosage form, through systematic studying a certain number of prescriptions.      

Methods: This study screened the prescriptions from both of public and private sectors in the governorates of Erbil, Sulaimaniyah and Duhok. Adherence was assessed on the basis of these prescriptions charts. Excel program was utilized to evaluate the data in this study.      

Results: The study covered a total 283 prescriptions involving 976 medications in Kurdistan region. Only 19% of medications were mentioned as a scientific name and just 2% of prescriptions were written via computer. Direction for use of the medicines was only mentioned for 3% and the duration of treatment was scripted in 11%.    

Conclusion: Majority of medical practitioners in Kurdistan region are not adhering to the international standards of prescriptions.    

1. Sabaté E. Adherence to long-term therapies: Evidence for action. Geneva, Switzerland: World Health Organization; 2003.

2. Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial. JAMA 2006; 296(21):2563-71.

3. Huth EJ, Murray TJ. Medicine in Quotations: Views of Health and Disease Through the Ages. 2nd ed. Philadelphia, PA: American College of Physicians; 2006.

4. Osterberg L, BlaschkeT.Adherence to medication. N Eng J Med 2005; 353(5):487-97.

5. Haas R, Maloney S, Pausenberger E, Keating JL, Sims J, Molloy E, et al. Clinical decision making in exercise prescription for falls prevention. Phys Ther 2012; 92(5):666-79.

6. Joyce GF, Carrera MP, Goldman DP, Sood N. Physician prescribing behaviour and its impact on patient-level outcomes. Am J Manag Care 2011; 17(12):462-71.

7. Griffith R, Tengnah C. Prescription of controlled drugs by nonmedical prescribers. Br J Community Nurs 2011; 16(11):558-62.

8. McCann L, Haughey S, Parsons C, Lloyd F, Crealey G, Gormley GJ, et al. Pharmacist prescribing in Northern Ireland: aquantitative assessment. Int J Clin Pharm 2011; 33(5):824-31.

9. The Institute of Medicine. Preventing Medication Errors. Washington, DC: The National Academies Press; 2006.

10. Pham JC, Aswani MS, Rosen M, Lee H, Huddle M, Weeks K, et al. Reducing medical errors and adverse events. Annu Rev Med 2012; 63:447-63.

11. British Medical Association and the Royal Pharmaceutical Society. British National Formulary. 67^th ed. UK: BMJ Publishing Group; 2015.

12. Bruner A, Kasdan ML. Handwriting errors: harmful, wasteful and preventable. J Ky Med Assoc 2001; 99:189-92.

13. Bradbury A. Computerized medical records: the need for a standard. J Am Med Rec Assoc 1990; 61:25-37.

14. WHO Guidance on INN, 1997. (accessed 10-June-2015 at www.who.int/medicines/services/inn/innguidance/en/index.html).

 15. Cameron A, Mantel-Teeuwisse A, Leufkens H, Laing R. Switching from originator brand medicines to generic equivalents in selected developing countries: how much could be saved? Value Health 2012; 15(5):664-73.

Background and objective: Hookahs are water pipes that are used to smoke specially made tobacco that comes in different flavors. Hookah has many of the same health risks as cigarette smoking. This study aimed to assess the awareness of hookah smokers about its harmfulness and identify the reasons for smoking hookah.      

Methods: This study was conducted in all venues of cafes and restaurants located geographically in Erbil city during the period from June 27^th, 2014 to February 4^th, 2015. A questionnaire was used to obtain the smoking pattern, awareness and perceptions of 325 male peoples towards the harmfulness of smoking. Direct interview was used for data collection.

Results: A total number of 325 male people participated in this study. Their age ranged from 18-25 years. Most of them were singles, from urban areas and preferred to smoke in café (61.8%). More than one person was using the same hookah. The average duration of smoking was more than 46 minutes. Around half of the participants (49.5 %) were smoking hookah with friends as a group activity and 35.1% had a headache and dizziness during smoking hookah. The overall awareness about the harmfulness of smoking the hookah was poor (56%).       

Conclusion: The overall awareness about harmful of smoking hookah was poor among attendees of cafes.           

1. Akl EA, Gaddam S, Gunukula SK, Honeine R, Jaoude PA, Irani J. The effects of water pipe tobacco smoking on health outcomes: A systematic review. IJE 2010; 39:834–57.

2. Cobb CO, Ward KD, Maziak W, Shihadeh AL, Eissenberg T. Waterpipe tobacco smoking: An emerging health crisis in the United States. AJHB 2010; 34(3):275–85.

3. U.S. Department of Health and Human Services. Preventing tobacco use among youth and young adults: A report of the surgeon general. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Office on Smoking and Health; 2012.

4. U.S. Food and Drug Administration. Electronic cigarettes (e-Cigarettes); 2013.

5. El-Hakim IE, Uthman AE. Squamous cell carcinoma and keratoacanthoma of the lower lips associated with "goza" and "hookah" smoking. IJD 1999; 38:108-10.

6. Nuwayhid I, Yamout B, Ghassan H, Kambria M. Narghile (hubble-bubble) smoking, low birth weight and other pregnancy outcomes . AJE 1998; 148:375-83.

7. Cobb CO, Vansickel AR, Blank MD, Jentink K, Travers MJ, Eissenberg T. Indoor air quality in Virginia water pipe cafés. Tobacco Control 2012; 10:1136.

8. Dar-Odeh NS, Bakri FG, Al-Omiri MK. Narghile (water pipe) smoking among university students in Jordan: prevalence, pattern and beliefs. Harm Reduc J 2010; 7: 10.

9. World Health Organization .Toboacco regulatory advisory note waterpipe tobacco smoking: Health effects, research needs and recommended actions by regulators. Geneva; 2005.

10. Maziak W, Eissenberg T, Rastam S. Beliefs and attitudes related to narghile (waterpipe) smoking among university students in Syria. Ann Epidemiol 2004; 14: 646-54.

 11. Smith-simone S, Maziak W, Ward KD. Waterpipe tobacco smoking, attitude, beliefs, and behavior in two U.S. samples. NTR 2008; 10(2):393-8.

12. Primack BA, Sidani J, Agarwal AA, Shadel WG. Prevalence and association with waterpipe tobacco smoking among U.S. university students. ABM 2008; 36(1):81.

13. Al-Naggar R, Bobryshev Y. Shisha smoking and associated factors among medical students in Malaysia. Asian Pacific J Cancer Prev 2012; 13(11):5627-32.

Background and objective: Dry eye is a disorder of the tear film. There are significant associations between dry eye and environmental factors, autoimmune and chronic diseases like diabetes mellitus and rheumatoid disease. This study aimed to determine the prevalence of dry eye in patients with diabetes mellitus in patients attending Erbil and Rizgary Teaching hospitals in Erbil city.      

Methods: A hospital-based cross-sectional study of 195 diabetic patients who presented to the department of ophthalmology, Rizgary and Erbil teaching hospitals, Erbil; from February 2011 to December 2011 was conducted. Detailed diabetic history was recorded. Assessment of anterior segment via slitlamp biomicroscopy was done. The examination of dry eye included Schirmer`s test, tear break-up time and fluorescein dye

Results: From total 195 patients, eighty-one (41.5%) of them had dry eye. The prevalence of dry eye among older ages (≥60 years) was 49%, which was higher than younger ages (<60 years). The dry eye had a higher percentage in males than females (44.7% and 39.1%, respectively). Those who had diabetes mellitus for <10 years recorded 36.6% dry eyes, however, those who had diabetes mellitus for ≥10years showed 50.7% dry eyes. On the other hand patients with good diabetic control (HbA1c<7%) had a lower prevalence of dry eye than those of uncontrolled one (HbA1c≥7%) with a percentage of 38.5% and 48.3%, respectively.   

Conclusions: There was a high prevalence of dry eyes among diabetic patients in Erbil city. The prevalence of dry eye is higher in those with duration of diabetes for more than ten years. There was no statistically significant difference between male and female. The sensitivity of tear break-up time test was higher than Schirmer`s test for diagnosing dry eye.   

1. McCulley, Juan M, Stephen C. Maurizio R., Ikuko T. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye Workshop 2007; 5(2):75-92.

2. Schutz RO, Van Horn DL, Peters MA, Klewin KM, Schutten WH. Diabetic keratopathy. Trans Am Ophthalmol Soc 1981; 79:180-99.

3. Inoue K, Kato S, Ohara C, Numaga J, Amano S, Oshika T. Ocular and systemic factors relevant to diabetic keratoepitheliopathy. Cornea 2001; 20(8):798-801.

4. Manaviat MR, Rashidi M, Ardekani MA and Shoja MR. Prevalence of dry eye syndrome and diabetic retinopathy in type II diabetic patients. BMC Ophthalmology 2008; 8:10.

5. Downie AW, Newell DJ. Sensory nerve conduction in patients with diabetes mellitus and control. Neurology 1961; 11:876-82.

6. Peponis V, Papathanasiou M, Kapranou A, Magkou C, Tyligada A, Melidonis A, et al. Protective role of oral antioxidant supplementation in ocular surface of diabetic patients. Br J Ophthalmol. 2002; 86(24):1369-73.

7. Kaiserman I, Kaiserman N, Nakar S, Vinker Sh. Dry eye in diabetic patients. Am J Ophthalmol 2005; 139(3):498-503.

8. Sutphin JE, Dana MR, Florakis GJ, Hammersmith K, Reidy JJ, Lopatynsky M. External disease and cornea. Basic and clinical science course. American Academy of Ophthalmology; Section 8. San Francisco: American Academy of Ophthalmology The Eye M.D. Association; 2007; 61-70.

9. Obata H, Yamamoto S, Horiuchi H, Machinami R. Histopathologic study of human lacrimal gland. Statistical analysis with special reference to aging.  Ophthalmology 1995; 102:678-86.

10. Schirmer O. Studien zur physiologie und pathologie der Tranenabsonderung und Tranenabfuhr. Graefes Arch Ophthalmol 1903; 56:197-291.

11. Nichols KK, Mitchell GA, Zadmik K. Frequency of dry eye diagnostic test procedures used in various modes of ophthalmic practice. Cornea 2002; 21:578-83.

12. Tsubota K, Nakamori K. Dry eyes and video display terminals. N Engl J Med 1993; 328(8):584.

13. Will DV, MeNally LM, Roth RE. Pyogenic granuloma complicating parasoltm silicone punctal plug occlusion: a series review. Invest Ophthalmol Vis Sci 2000; 41:S69.

14. Dimakara GV, Kumar P. Evaluation of dry eye status in diabetes mellitus and its correlation with diabetic retinopathy. RSSDI 33^rd conference; 2005.

15. Holy FJ, Lemp MA. Report of the National Eye Institute/ Industry workshop on Clinical Trials in Dry Eyes. CLAO J 1995; 21:221-32.

16. Born AJ. Diagnosis of dry eye. Surv Ophthalmol 2001; 45(suppl 2):S227-39.

17. Moss SE, Klein R, Klein BE. Incidence of dry eye in an older population. Arch Ophthalmol 2004; 122:369-73.

18. Martin Goebels. Tear secretion and tear film function in insulin dependent diabetics. BrJ Ophthalmol 2000; 84:19-21.

19. Schein OD, Munoz B, Tielsch JM, Bandeen-Rochek, West S. Prevalence of dry eye among elderly. AMJ Ophthalmol 1997; 124:723-8.

20. McCarty CA, Bansal AK, Livingston PM, Stanislavsky YL, Taylor HR. The epidemiology of dry eye, Melbourne, Australia. Ophthalmology 1998; 105:1114-9.

21. Mathers WD, Lane JA, Zimmerman MB. Tear film changes associated with normal aging. Cornea 1996; 15:229-34.

Background and objective: Chronic urticaria is one of the most frequent skin diseases and still its etiology is recognized only in a minority of cases. Some recent studies point out to infections due to Helicobacter Pylori as being of major importance in the pathogenesis of chronic urticaria. This study aimed to find out the association of chronic urticaria with H. pylori.         

Methods: A case-control study was conducted in Erbil city within the period of April 1^st, 2013 to January 1^st, 2014. The study included 55 cases with chronic urticaria and 55 controls that were free from features of chronic urticaria. Data was collected through direct interview and the results of laboratory investigations were recorded in a specially designed questionnaire.  Enzyme-linked immunosorbent assay test was used for detection of Helicobacter pylori antigen in the stool sample.       

Results: The age of the 55 cases and 55 controls enrolled ranged from 13 to 65 years. Stool for Helicobacter pylori antigen test was positive in 69.1% of cases and 29.1% of controls (OR = 5.44, P ˂0.001). The mean age ± SD of positive Helicobacter pylori patients were 35.75 ± 12.64 years, with male to female ratio 1:2.8. No statistically significant association was found between Helicobacter Pylori infection with dyspepsia and duration of urticaria.     

Conclusions: There was a strong association of chronic urticaria with Helicobacter pylori infection. Investigating for Helicobacter pylori in all cases of chronic urticaria and conducting further trials on Helicobacter pylori eradication is recommended.  

1. Yosipovitch G, Ansari N, Goon A, Chan YH, Goh CL. Clinical characteristics of pruritus in chronic idiopathic urticaria. Br J Dermatol 2002; 147:32-6.

2. James WD, Berger TG, Elston DM. Andrews’ Diseases of the skin clinical dermatology. London: British Library Cataloguing in Publication Data; 2011.

3. Champion RH. A practical approach to urticarial syndromes: A dermatologist's view. Clin Exp Allergy 1990; 2:221-4.

4. Wedi B, Wagner S, Werfel T, Manns MP, Kapp A. Prevalence of Helicobacter pylori gastritis in chronic urticaria. Int Arch Allergy Immunol 1998; 116:288-94.

5. Federman DG, Krisner RS, Moriarty JP, Concato J. The effect of antibiotic therapy for patients infected with H. pylori who have chronic urticaria. J Am Acad Dermatol 2003; 49:861-4.

6. Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984; 1:1311-5.

7. Graham DY. Helicobacter pylori infection in the pathogenesis of duodenal ulcer and gastric cancer: a model. Gastroenterology 1997; 113:1983-91.

8. Graham DY, Malaty HM, Evans DG, Evans DJ, Klein PD, Adam E. Epidemiology of Helicobacter pylori in an asymptomatic population in the United States. Effect of age, race, and socioeconomic status. Gastroenterology 1991; 100:1495-501.

9. Tebbe B, Geilen CC, Schulzke JD, Bojarski C, Radenhausen M, Orfanos CE. Helicobacter pylori infection and chronic urticaria. J Am Acad Dermatol 1996; 34:685-6.

10. Bonamigo RR, Leite CS, Bakos L. Association of Helicobacter pylori and chronic idiopathic urticaria. Rev Assoc Med Bras 1999; 45:9-14.

11. Di Campli C, Gasbarrini A, Nucera E, Franceschi F, Ojetti V, Sanz-Torre E. Beneficial effects of Helicobacter pylori eradication on idiopathic chronic urticaria. Dig Dis Sci 1998; 43:1226-9.

12. Rebora A, Drago F, Parodi A. May Helicobacter pylori be important for dermatologists?. Dermatology 1995; 191:6-8.

13. Ahmed A, Holton J, Vaira D, Smith SK, Hoult JR. Eicosanoid synthesis and Helicobacter pylori associated gastritis: increase in leukotriene C4 generation associated with H. pylori colonization. Prostaglandins 1992; 44:75-86.

14. Pasechnikov V, Mashentseva E, Sohier M. Mucosal interleukin-8, platelet-activating factor, endothelin-1, leucotrine B4 and leucotriene C4 production in patients with Helicobacter pylori infection. Gut 1996; 39:A40.

15. Realdi G, Dore MP, Fastame L. Extradigestive manifestations of Helicobacter pylori infection: fact and fiction. Dig Dis Sci 1999; 44:229-36.

16. Liutu M, Kalimo K, Uksila J, Kalimo H. Etiologic aspects of chronic urticaria. Int J Dermatol 1998; 37:515-519.996; 39:A40.

17. Andersen LP, Norgaard A, Bennedsen M. Immune Response cellular and humoral against Helicobacter pylori. In: López-Brea M, ed. Helicobacter pylori: Challenges for the XXI century. Microbiology, clinical and treatment. Barcelona: Prous Science SA; 1999. PP.157-76.

18. Karttunen TJ, Niemela S, Kerola T. Blood leukocyte differential in Helicobacter pylori infection. Dig Dis Sci 1996; 41:1332-6.

19. Rostamy MM. Prevalence of H pylori infection in chronic urticaria. J Paki As Derm 2010; 20: 142-5.

20. Pronovost AP, Rose SL, Pawlak J, Robin H, Schneider R. Evaluation a new immunological and microbiological results. J Clin Micro 1994; 32:46-50.

21. Greaves M. Chronic urticaria. J Allergy Clin Immunol 2000; 105(4):664-72.

22. Daiulin E, Jimeno I. Helicobacter pylori and idiopalhic chronic urticaria. Inter J Dermatol 2000; 39:446-52.

23. Kolibasova K, Cervcnkova D, Hegyi E. Helicobacler pylori: etiological factor in chronic urticaria. Dermatoscn 1994; 42:235-6.

24. Kolibasova K, Cervcncova D, llegy E. Helicobacter pylori infection and chronic urticaria. J Am Acad Dermatol 1996; 34:685-6.

25. Talley NJ. American Gastroenterological Association. American Gastroenterological Association medical position statement: evaluation of dyspepsia. Gastroenterology 2005;129:1753-5.

26. Talley NJ, Vaki NB. Practice parameters Committee of the American College of  Gastroenterology. Guidelines for the management of dyspepsia. Am J Gastroenterol 2005; 100:   2324-37.

27. Chey WD, Wong BC. Practice parameters Committee of the American College of Gastroenterology. American College of Gastroenterology guidelines on the management of Helicobacter pylori infection. Am J Gastroenterol 2007; 102:1808-25.

28. Talley NJ, Vaki NB, Moay Yedi P. American Gastroenterological Association technical review on the evaluation of dyspepsia. Gastroenterology 2005; 129:1756-80.

29. Yadav M K, Rishi J P, Nijawan S. Chronic urticaria and helicobacter pylori. Indian J Med Sci 2008; 62(4):157-62.

30. Moreira A, Rodrigues J, Delgadoa L, Fonseca J, Vaza M. Is Helicobacter pylori infection associated with chronic idiopathic urticaria?. Allergol et Immunopathol 2003; 31(4):209-14.

31. Sianturi G N, Soebaryo, Zubier F, Syam AF. Helicobacter pylori Infection: Prevalence in Chronic Urticaria Patients and Incidence of Autoimmune Urticaria. Indones J Intern Med 2007; 39(4):157-62.

32. Chiu Y, Tai W, Chuah S, Hsu P, Wu D, Wu K. The Clinical Correlations of Helicobacter pylori Virulence Factors and Chronic Spontaneous Urticaria. Gastroenterol Res Pract 2013; 43: 672-7.

33. Sadighha A, Shirali R, Zahed G M. Relationship between Helicobacter pylori and chronic urticaria. JEADV 2009; 23:169-76.

34. Qazi N, Samadani A J, Jamali S, Begum S, Shah M. Chronic Idiopathic Urticaria and Helicobacter Pylori Infection: Effect of Eradication Therapy on the Relief of Symptoms. JLUMHS 2013; 12(3):172-6.

35. Abu El - Emin A, Fathe A, Khedr M, Abu El-Ata A. Helicobacter pylori Infection: A possible cause of Chronic Idiopathic Urticaria (Prevalence and Effectiveness of Eradication). The Egyptian Journal of Hospital Medicine 2008; 30:145-50.

36. Garza YL, López GI, Paz MD. Prevalence of seropositividad to antibodies IgG and IgM against Helicobacter pylori in the medical residents of the University Hospital of Puebla. Rev Alerg Mex 2006; 53:69-72.

37. Baskan EB, Turker T, Gulten M, Tunali S. Lack of correlation between Helicobacter Pylori infection and autologous serum skin test in chronic idiopathic urticaria. Int J Dermatol. 2004; 12: 110-3.

38. Ghazzawi IM, Obidat NA. The role of Helicobacter pylori infection in the pathogenesis of chronic urticaria. Pak J Med Sci 2004; 20(2): 101-4.

Background and objective: Benign prostatic hyperplasia involves the enlargement of prostatic glandular tissue and narrowing of the urethra. It affects bladder storage or emptying. Most of the men with benign prostatic hyperplasia have no symptoms. This study aimed to compare international prostate symptom scores, prostate specific antigen level and prostate volume in patients having benign prostatic hyperplasia with and without metabolic syndrome.           

Methods: This study involved 85 patients with benign prostatic hyperplasia who were divided into two groups. The first group included 40 participants who were only suffering from benign prostatic hyperplasia and the second group involved 45 participants who were suffering from both metabolic syndrome and benign prostatic hyperplasia. The division of subjects was performed depending on three abnormal parameters out of five parameters, such as body mass index (BMI >25kg/m²), dyslipidemia (Triglyceride ≥150 mg/dl, High density lipoprotein-C <40 mg/dl), blood pressure (BP ≥130/85 mmHg), fasting plasma glucose (PG ≥110 mg/dl).        

Results: Patients with metabolic syndrome at diagnosis appears to have significantly higher levels of prostate specific antigen comparing with patients without metabolic syndrome, 3.9±0.26 and 2.7±0.21, respectively. Similarly, patients with metabolic syndrome at diagnosis had significantly higher prostate volume levels (72.69 ± 2.69 ml) comparing to patients without metabolic syndrome (46 ± 2.44 ml). Patients with metabolic syndrome at diagnosis showed considerable higher international prostate symptom scores level (23.62 ± 0.62) compared to patients without metabolic syndrome (18.87 ± 0.327).      

Conclusions: benign prostatic hyperplasia patients having metabolic syndrome have significantly higher values of prostate specific antigen levels, prostate volume and international prostate symptom scores compared to benign prostate hyperplasia patients without metabolic syndrome.              

1. Chapple CR, Roehrborn CG. A shifted paradigm for the further understanding, evaluation, and treatment of lower urinary tract symptoms in men: focus on the bladder. Eur Urol 2006; (49(4):651-8.

2. Eckel RH, Alberti KG, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet. 2010; 16;375(9710):181-3.

3. Rohrmann S, Smit E, Giovannucci E, Platz EA. Association between markers of the metabolic syndrome and lower urinary tract symptoms in the Third National Health and Nutrition Examination Survey (NHANES III). Int J Obes (Lond) 2005; 29:310-6.

4. He Q, Wang Z, Liu G, Daneshgari F, MacLennan GT, Gupta S. Metabolic syndrome, inflammation and lower urinary tract symptoms: possible translational links. Prostate Cancer Prostatic Dis 2016; 19(1):7-13.

5. Roehrborn CG, Nuckolls JG, Wei JT, Steers W, BPH Registry and Patient Survey Steering Committee. The benign prostatic hyperplasia registry and patient survey: study design, methods and patient baseline characteristics. BJU International 2007; 100(4):813-9.

6. Kristal AR, Arnold KB, Schenk JM, Neuhouser ML, Weiss N, Goodman P, et al. Race/ethnicity, obesity, health related behaviors and the risk of symptomatic benignprostatic hyperplasia: results from the prostate cancer prevention trial. J Urol 2007; 177:1395-400.

7. Lee SH, Kim JC, Lee JY, Kim JH, Oh CY, Lee SW. Effects of obesity on lower urinary tract symptoms in Korean BPH patients. Asian J Androl 2009; 11:663-8.

8. Freedland SJ, Platz EA, Presti JC, Aronson WJ, Amling CL, Kane CJ, et al. Obesity, serum PSA and prostate size: implications for prostate cancer detection. J Urol 2006; 175:500-4.

9. Bañez LL, Hamilton RJ, Partin AW, Vollmer RT, Sun L, Rodriguez C, et al. Obesity-related plasma hemodilution and PSA concentration among men with prostate cancer. JAMA 2007; 298:2275- 80.

10. Sohn JC, Lim MS, Chang HS, Park CH, Kim CI. The association of body mass index and prostate-specific antigen. Korean J Urol 2007; 48:1121-4.

11. Ochiai A, Fritsche HA, Babaian RJ. Influence of anthropometric measurements, age, and prostate volume on prostate-specific antigen levels in men with a low risk of prostate cancer. Urology 2005; 66:819-23.

12. Kim YD, Yang WJ, Song YS, Park YH. Correlation between prostate volume and metabolic or anthropometric factors in male visitors to a health promotion center. Korean J Urol 2008; 49:139-44.

13. Dahle SE, Chokkalingam AP, Gao YT, Deng J, Stanczyk FZ, Hsing AW. Body size and serum levels of insulin and leptin in relation to the risk of benign prostatic hyperplasia. J Urol 2002; 168:599-604.

14. Liu M, Eang JY, Zhu L, Wan G. Body mass index and serum lipid profile influence serum prostate-specific antigen in Chinese men younger than 50 years of age. Asian J Androl 2011; 13(4):640-3.

Background and objective: Thyroidectomy is an operation that involves surgical removal of all or part of the thyroid gland. The main postoperative complications of thyroidectomy are hypoparathyroidism and recurrent laryngeal nerve injury. This study aimed to find out the main postoperative complications particularly nerve damage during total thyroidectomy or total lobectomy.

Methods: The medical records of patients who were diagnosed with thyroid disease and underwent surgery between January 2^nd, 2013 and December 30^th, 2014 in Teaching, Shar, Soma and Zhian hospitals in Sulaimaniyah were retrospectively reviewed. 

Results: All patients who underwent total thyroidectomy or total lobectomy surgeries were discharged within 24 hours of the operation. During the average follow-up of 24 months, no case of permanent recurrent laryngeal nerve injury was registered. Vocal cord paralysis was considered to be present, when there was absent or markedly reduced movement of the affected vocal cord.       

Conclusions: Meticulous hemostasis and a delicate technique are required to prevent nerve injury. We recommend dissection and division of all the vessels flush with the thyroid capsule at the anterior and peripheral aspect of the gland. Separate ligation of anterior and posterior branched of the superior thyroid artery will preserve the external branch of the superior laryngeal nerves.             

1. Mathur AK, GM Doherty. Thyroidectomy and neck dissection. Current procedures: Surgery In Minter RM and GM Doherty. New York: McGraw-Hill; 2010.

2. Mishra A, Agarwal A, Agarwal G, Mishra SK. Total thyroidectomy for benign thyroid disorders in an endemic region. World J Surg 2001; 25(3):307-10.

3. Bron LP, O’Brien CJ. Total thyroidectomy for clinically benign disease of the thyroid gland. Br J Surg 2004; 91(5):569-74.

4. Bellantone R, Celestino PL, Maurizio B, Mauro B, Carmela DC, Pierfrancesco A, et al. Total thyroidectomy for management of benign thyroid disease: review of 526 cases. World J Surg 2002; 26 (12): 1468-71.

5. Giles Y, Harika B, Tarik T, Serdar Tezelman. The advantage of total thyroidectomy to avoid reoperation for incidental thyroid cancer in multinodular goiter. Archives of Surgery 2004; 139 (2): 179-82.

6. Szubin L, Kacker A, Kakani R, Komisar A, Blaugrund S. The management of post-thyroidectomy hypocalcemia. Ear Nose Throat J 1996; 75:612-6.

7. Hydman J, Mattsson P. "Collateral reinnervation by the superior laryngeal nerve after recurrent laryngeal nerve injury." Muscle Nerve 2008; 38(4): 1280-9.

8. Pattou F, Frederic C, Sylvain F, Bruno C, Marc D, Jean-Louis W, et al. Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg 1998; 22:718-24.

9. Zambudio AR, Rodríguez J, Riquelme J, Soria T, Canteras M, Parrilla P. Prospective study of postoperative complications after total thyroidectomy. Thyroid Research 2012; 5(15):4-5.

10. Moore KL, Arthur FD, Anne MR. Clinically oriented anatomy. Lippincott Williams & Wilkins; 2013.

11. Bergenfelz A, Jansson S, Kristoffersson A, Mårtensson H, Reihnér E, Wallin G, et al. Complications to thyroid surgery. Results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbeck Arch Surg 2008; 393:667-73.

12. Bhattacharyya N, Fried M. Assessment of the morbidity and complications of total thyroidectomy. Arch Otolaryngol Head Neck Surg 2002; 128:389-92.

13. Hayward N J, Simon G, Meei Y, William RJ, Jonathan S. "A Review Of Recurrent Laryngeal Nerve Injury In Thyroid surgery. ANZ Journal of Surgery 2013; 83(1–2):15-21.

14. Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I, et al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 2000; 24(11):1335-41. 

15. Wingert DJ, Friesen SR, Iliopoulos JI, Pierce GE, Thomas JH, Hermreck AS. Post-thyroidectomy Hypocalcemia. Am J Surg 1986; 152:608-10.        

16. Reyes H, Wright J. Prevention of hypocalcemia in children due to parathyroid infarction after thyroidectomy. Sur Gynecol Obstet 1979; 148:76-8.        

17. Duh Q, Sancho J, Clark O. Parathyroid localization: clinical review. Acta Chir Scand 1987; 153:241-54.  

18. Gardner E, Gray D, O'rahilly R. Anatomia. 4^th ed. Rio de Janeiro: Guanabara; 1978. PP. 668-704.        

19. Chan WF, Lang BH, Lo CY. The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: a comparative study on 1000 nerves at risk. Surgery 2006; 140(6):866-72.

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