Effect of Thrombolytic Therapy on the Incidence of Early Left Ventricular Infarct Expansion in Acute Anterior Myocardial Infarction

Abstract Objectives: To determine the incidence of early left ventricular infarct expansion within five days after first anterior ST-segment elevation myocardial infarction and the effect of early thrombolytic therapy on the incidence of early infarct expansion compared with late thrombolytic therapy. Methods: In a prospective study of 101 patients (75males and 26 females), with the first attack of acute anterior myocardial infarction, their ages ranged from 40-80 years (mean age: 61.07±10.78) who had been admitted to the Coronary Care Unit of Hawler Teaching Hospital for the period from July 2007 through to September 2009. Those who received alteplase ≤3 hours of acute myocardial infarction were labelled as group-I (49 patients) and those who received alteplase >3-12 hours were labelled as group-II (52 patients). Results: The incidence of early left ventricular infarct expansion was diagnosed by 2D-echocardiography and was found to be 17.8%. Group I patients had a lower incidence of early left ventricular infarct expansion (8.16%) compared with group-II (26.92%; p=0.014). Patients with early left ventricular infarct expansion had a higher frequency rate of left ventricular systolic dysfunction (94.44%) compared to patients without early left ventricular infarct expansion (8.43%; p<0.001). There was a significant difference in the incidence of in-hospital mortality between the patients who developed early left ventricular infarct expansion (11.1%) compared with patients without early left ventricular infarct expansion (1.2%; p=0.025). Conclusion: Early reperfusion therapy in acute anterior myocardial infarction can decrease the incidence of early left ventricular infarct expansion, preserve left ventricular systolic function and decrease in-hospital mortality

Prevalence of Urinary Incontinence and Probable Risk Factors in a Sample of Kurdish Women

Objectives: The most common manifestation of pelvic floor dysfunction is urinary incontinence (UI) which affects 15–50% of adult women depending on the age and risk factors of the population studied. The aim of this study was to determine the probable risk factors associated with UI; the characteristics of women with UI; describe the types of UI, and determine its prevalence. Methods: A cross-sectional study was conducted between February and August 2011, in the Maternity Teaching Hospital of the Erbil Governorate, Kurdistan Region, northern Iraq. It included 1,107 women who were accompanying patients admitted to the hospital. A questionnaire designed by the researchers was used for data collection. A chi-square test was used to test the significance of the association between UI and different risk factors. Binary logistic regression was used, considering UI as the dependent variable. Results: The overall prevalence of UI was 51.7%. The prevalence of stress, urgency, and mixed UI was 5.4%, 13.3% and 33%, respectively. There was a significant positive association between UI and menopause, multiparity, diabetes mellitus (DM), chronic cough, constipation, and a history of gynaecological surgery, while a significant negative association was detected between UI and a history of delivery by both vaginal delivery and Caesarean section. Conclusion: A high prevalence of UI was detected in the studied sample, and the most probable risk factors were multiparity, menopausal status, constipation, chronic cough, and DM

Female genital mutilation among Iraqi Kurdish women: a cross-sectional study from Erbil city

BACKGROUND: Iraqi Kurdistan region is one of the areas where female genital mutilation is reportedly widely practiced but inadequately studied. The aim of this study was to determine (i) the prevalence of female genital mutilation among Muslim Kurdish women in Erbil city, (ii) the patterns and types of female genital mutilation, (iii) the factors associated with this practice and (iv) women’s knowledge and attitudes towards this practice. METHODS: A cross-sectional study was conducted in the primary health care centers and the Maternity Teaching Hospital in Erbil city, involving 1987 women aged 15–49 years. Data were obtained about female genital mutilation status and knowledge and perception towards this practice. The participants were clinically examined to verify the self-reported female genital mutilation status. RESULTS: The self-reported prevalence of female genital mutilation was 70.3%, while it was 58.6% according to clinical examination of the women’s genitalia. The most common type of female genital mutilation was type I (99.6%) and the most common age at which mutilation was performed was 4–7 years (60.2%). This practice was mostly performed by traditional birth attendants (72.5%). Only 6.4% of mutilated women reported having complications after mutilation, most commonly bleeding (3.6%). The practice was more reported among housewives (OR = 3.3), those women whose mothers were mutilated (OR = 15.1) or with unknown mutilation status (OR = 7.3) and those women whose fathers were illiterate (OR = 1.4) or could only read and write (OR = 1.6). The common reasons for practicing female genital mutilation were cultural tradition (46.7%) and dictate of religion (38.9%). Only 30% of the participants were aware about the health consequences of female genital mutilation. More than one third (36.6%) of the women support the practice and 34.5% have intention to mutilate their daughters. CONCLUSIONS: Prevalence of female genital mutilation among Muslim Kurdish women in Erbil city is very high; although, most cases are of type I. There is clear lack of knowledge about the health consequences of female genital mutilation and a relatively important segment of women support this practice. Custom or tradition and dictate of religion are the main reasons for this practice that need further in-depth exploration

Role of Cardiac Troponin I Level in Predicting in Hospital Outcomes in Patients with ST-segment Elevation Myocardial Infarction in Erbil-Iraq

Background: The correlation of cardiac troponin I with early in-hospital outcomes in acute myocardial infarction is not well established. Objective: To assess the role of troponin I in predicting in-hospital outcomes and early left ventricular systolic dysfunction in patients with ST-segment elevation myocardial infarction. Patients and Methods: A prospective study which consist of 116 patients (74 were males and 42 were females), with ST-segment elevation myocardial infarction who had been admitted to the Coronary Care Unit from March 2015 to September 2015 were enrolled. Patients were divided according to the level of troponin I on admission into 3 groups (low, medium and high elevation). Results: The mean age (+ SD) of the patients was 60+11.4 years. The troponin level of 66.2% of males was high compared with 52.4% of females (p=0.002). The incidence of acute pulmonary edema (21.1%), cardiogenic shock (7%) and early left ventricular systolic dysfunction (49.3%) was significantly higher among patients with high troponin level compared with  (0%, 0% and 16%, respectively) among patients with low troponin level. All deaths and cardiac arrest were of high troponin level. Conclusion: High admission troponin I in ST-segment elevation myocardial infarction permits early identification of patients at increased risk of major cardiac complications and death

Using Q-methodology to explore people's health seeking behavior and perception of the quality of primary care services.

BACKGROUND: Information on health seeking behavior and beneficiaries' perception of the quality of primary care can help policy makers to set strategies to improve health system. With scarcity of research on this particular field in Iraqi Kurdistan region, we sought to explore the patterns of health seeking behavior and perception of the quality of primary care services of a sample of population. METHODS: This explorative study was carried out in Erbil governorate, Iraq. Data were collected using the novel approach of Q-methodology for eliciting subjective viewpoints and identifying shared patterns among individuals. Forty persons representing different demographic and socioeconomic groups and living in different areas of Erbil governorate sorted 50 statements reflecting different aspects of health-seeking behavior and primary care services into a distribution on a scale of nine from "disagree most" to "agree most". By-person factor analysis through centroid factor extraction and varimax rotation of factors were used to derive latent viewpoints. RESULTS: Four distinct patterns of health seeking behavior and viewpoints toward the primary care services were identified. People in factor 1 are extremely critical of the services at primary health care centers and are regular users of the private health sector. People in factor 2 positively recognize the services at primary health care centers but mainly turn to inappropriate health seeking behavior. People in factor 3 have satisfaction with the services at primary health care centers with minimal use of these services, but mainly turn to the private sector. People in factor 4 are slightly satisfied with the services at primary health care centers but mainly rely on these services. CONCLUSIONS: This study highlighted the typical characterizations that were associated with each uncovered factor. Informing on the beneficiaries' concerns about the primary care services can help to improve the system through further exploring the issues raised by the respondents and directing particular action on these issues. The characterizing and distinguishing statements can be used as a set of questions to conduct community-based survey on this important aspect of health services

Anti-mullerian hormone and antral follicle count in polycystic ovary syndrome and non-polycystic ovary syndrome women

Background and objective: Although the ultimate pathogenesis of polycystic ovary syndrome remains obscure, the distinctive feature is the failure of follicular maturation resulting in an ovulation and accumulation of preantral and small antral follicles which contribute significantly to the production of the anti-mullerian hormone. This study aimed to compare anti-mullerian hormone concentration and antral follicle count in polycystic ovary syndrome and non-polycystic ovary syndrome women regarding clinical, hormonal and ultrasound parameter in both groups. Methods: A cross-sectional study with comparison group study was conducted in the fertility and gynecology outpatient clinic in the Maternity Teaching Hospital, Erbil, Kurdistan region, Iraq from April 1st, 2015, to December 31st, 2015. The study involved a total of 100 infertile women aged 18 - 39 years; 50 polycystic ovary syndrome women based on the Rotterdam criteria and 50 infertile non-polycystic ovary syndrome selected as a comparison group. Anti-mullerian hormone and antral follicle count in both groups were compared. Results: A strong, inverse and significant correlation was found between anti-mullerian hormone and age in each of the two study groups. A weak correlation was detected between anti-mullerian hormone with body mass index, luteinizing hormone, follicular stimulating hormone, and total testosterone, in each of the two study groups. A significant inverse correlation was detected between anti-mullerian hormone and luteinizing hormone/follicular stimulating hormone ratio in the non-polycystic ovary syndrome group (P <0.001). There was a statistically strong, significant and positive correlation between anti-mullerian hormone and antral follicle count in each of the study groups. Conclusion: Anti-mullerian hormone and antral follicle count are higher in polycystic ovary syndrome group than in non-polycystic ovary syndrome group. Elevated levels of the anti-mullerian hormone were associated and related to increased number of follicles in women with polycystic ovary syndrome

Effect of maternal age on the ovarian reserve markers, and pregnancy outcome in a sample of Kurdish women in Erbil city

Background and objective: The ovary has a biological age that does not always correspond to the chronological age; this may be of great importance for the evaluation of women reproductive outcome. This study aimed to determine the effect of maternal age on the pregnancy rate, and the ovarian reserve markers (antimullerian hormone, follicular stimulating hormone, and antral follicular count). Methods: A cross-sectional study was conducted in the in vitro fertilization center at the Maternity Teaching Hospital located in Erbil city, from January 1, 2015, to January 31, 2016. A convenience sample of 300 infertile women of different age groups was included in the study. Transvaginal ultrasound was conducted to determine antral follicular count, and blood test was done for determination of serum antimullerian hormone and follicular stimulating hormone. The study sample was divided into four age groups. Chi square test, ANOVA test, Pearson correlation, and logistic regression were used to determine the associations. Results: The biochemical pregnancy rate of the study population was 37% and the clinical pregnancy rate was 32%. The most common type of infertility among the studied sample was primary infertility (74%). Results showed a strong inverse significant correlation between antimullerian hormone and antral follicular count with age, but there was no statistically significant association between maternal age and serum follicular stimulating hormone. Conclusion: Maternal age is a significant factor that can affect ovarian reserve and causes ovarian aging. The pregnancy rate decreases with advanced maternal age. Keywords: Antimullerian hormone; Antralfollicularcount; Female age; Ovarian reserve

Association between Ramadan Fasting and cerebrovascular diseases

Background and objective: Cerebrovascular diseases are attacks of sudden neurological deficits (motor, sensory or cerebellar). There are a lot of risk factors for stroke like age, diabetes, hypertension, smoking, hyperlipidemia, cardiac diseases and others. This study aimed to show if there is increasing rate of cerebrovascular events during Ramadan in relation to fasting in our city during the summer season. Methods: This case-control study was carried out in Rizgary Teaching Hospital, Erbil- Iraq from 1st of August to 30th of August 2011. Patients were included in this study if they were middle aged and elderly patients having clinical and radiological features of stroke, another group of in-patients was selected as a control group. Chi square test and logistic regression analyses were used to show the association between stroke and fasting. Results: A sample of 60 patients and 60 control cases were included in this study. Fasting was significant risk factor for stroke in our studied sample, 66.7% of the cases were fasting compared with 40% of the control group (P = 0.03). Hyperlipidemia and history of ischemic heart disease found also to be associated with stroke (P = 0.017 and 0.011, respectively). Logistic regression analysis showed that only fasting and hypercholesterolemia were independent risks factors in causing stroke in our studied sample. Conclusion: In Erbil, where the summer is too hot and the daytime (fasting hours) is long, fasting during Ramadan was found to be an independent risk factor for stroke, and specifically ischemic stroke

The range and diversity of providers' viewpoints towards the Iraqi primary health care system: an exploration using Q-methodology.

BACKGROUND: The increasingly recognized need for reorganizing the primary health care services in Iraq calls for a comprehensive assessment of the system to better understand its problems and needs for development. As part of such comprehensive assessment and due to the important role of primary health care providers in adopting any change, we ought to explore the range and diversity of viewpoints of primary health care providers towards the Iraqi primary health care system. METHODS: This explorative study was carried out in Erbil governorate, Iraq from May to July 2011. Data were collected from primary health care providers using Q-methodology to elicit subjective viewpoints and identify shared patterns among individuals. Forty primary health care providers representing eight primary health care centers sorted 41 statements reflecting different aspects of the Iraqi primary health care system into a distribution on a scale of nine from "disagree most" to "agree most". By-person factor analysis was used to derive latent viewpoints through centroid factor extraction and varimax rotation of factors. RESULTS: Analysis of the participants' Q-sorts resulted in four distinct viewpoints among primary health care providers toward the current primary health care system. One factor emphasized positive aspects of the current primary health care system that is content with the current primary health care system. The other three factors highlighted the negative aspects and they included (i) professionally-centered viewpoint, (ii) comprehensive perception and problem-based solutions and (iii) critical to leadership/governance aspects of the system. CONCLUSIONS: This study revealed diverse viewpoints of primary health care providers toward the current Iraqi primary health care system and recognized the particular issues related to each viewpoint. The findings can contribute to a better understanding of health policy makers and primary health care managers concerning the problems facing the primary health care system that might contribute to change in the management of this system