Distribution of doctors' workforce in Erbil governorate

Background and objective: Imbalance in the distribution of health workforce might result in inequities in health services delivery. The aim of this study was to assess the distribution of doctors' workforce in Erbil governorate and identify the possible reasons for rapid turnover of doctors

Methods: This descriptive cross-sectional study included all the 962 doctors working in the health facilities of Erbil governorate. A questionnaire was used to collect data that included 40 questions divided into four broad sections of identification information, socio-demographic characteristics, information on professional characteristics and factors influencing employment process in rural areas

Results: There were 5.1 doctors per 10,000 populations. Most of the doctors were deployed in urban areas [83.6%]. Most doctors were working in hospitals [74.2%] and 23.3% in primary health centers. Specialists constituted the largest categories of doctors [33.5%] and general practitioners the smallest [6.7%]. Doctors' willingness to stay at the current workplace was significantly associated with being married, having opportunities to select workplace, working in private clinics and having the workplace inside Erbil

Conclusion: The density of doctors per 10,000 populations in Erbil governorate is below the regional and international average, with a remarkable urban-rural imbalance in numerical, geographical and institutional terms

impact of gender on difficulty of classical open cholecystectomy

Cholecystectomy demands attention, and expectation of abnormal anatomy in the veins, arteries or ducts. Prediction of difficult cholecystectomy does not only helpin patient counseling but also helps the surgeon to prepare better for the technical difficulties that may be encountered[1-3]. To find out whether there is impact of gender on the difficulty of surgery during open cholecystectomy. This is a prospective hospital based study. Patients who presented to Ibn Sina Hospital for open cholecystectomy during the period from April 2011 to April 2012 were included in this study. Special emphasis was put on gender, the operative time, difficulty of surgery and complications of open cholecystectomy. A pre-tested questionnaire was filled during interview of patients and operating surgeons. A total 327 operations were included in the study. Of them there were 34[64.2%] males and 99[36.1%] females presented early i.e. after the first diagnosis was made. The mean operative time was 44.6 min for males and 43.57 min for females. Difficult surgery was described in 6[11.3%] of male and 23[8.4%] females. There was no significant statistical difference in the operative time, difficulty of operation and complication rate between males and females

Investigation of hepatotoxicity of antituberculosis medications in some hospitals, khartoum state

Tuberculosis [TB] is an ancient disease still kills more than two million people every year, despite the fact that a cure has been available for over 50 years. Some antituberculosis agents cause hepatotoxicity as a major adverse drug reaction. This study was designed to investigate rifampicin, isoniazid and pyrazinamide induced-hepatotoxicity among TB patients in Sudan. Sudanese in-patients [n=57] their ages ranged between 15 to 76 years, with active pulmonary tuberculosis and normal pretreatment liver function, received rifampicin [10 mg/Kg/day], isoniazid [5 mg/Kg/day] and pyrazinamide [20 mg/Kg/day] daily for two months, were involved in this study. Liver function test was performed for each patient separately at week 8, 9 and 10, to assess direct and indirect bilirubin, alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, albumin and total protein levels. Liver function tests revealed that 10 [17.5%] patients had high serum total bilirubin level, whereas 46 [80.7%] of them showed significant alteration in direct [conjugated] bilirubin level. Five [8.7%] and 23 [40.3%] patients demonstrated increased serum level of alanine aminotransferase and alkaline phosphatase respectively. Moreover, 15 [26.3%] of the treated patients experienced higher serum levels of aspartate aminotransferase. Hepatotoxicity and symptoms of liver failure occurred in 9 [15.7%] patients, which necessitate treatment discontinuation. Thirty eight [66.6%] of the treated patients developed alteration in serum albumin level, whereas slight alteration in total protein level was found in 12 [21%] of the TB patients. Biochemical investigations and clinical monitoring of patients treated with antituberculosis drugs are essential to decrease hepatotoxicity of these agents

Electrocardiogram interpretation by resident physicians at Al Gamhoria teaching hospital, Aden

To determine the ability of resident physicians to interpret electrocardiogram [ECG] charts for hyperkalemia and hypokalemia. This is a cross sectional descriptive study that was carried out at Algamhoria Teaching Hospital in Aden in January 2008. Twenty eight resident physicians working in medical wards as well as emergency department were enrolled into the study. They were required to make a diagnosis of moderate and severe hypokalemia as well as hyperkalemia by reading four standard ECG charts taken from a medical textbook. Their responses were then looked at by a cardiologist and marked as right or wrong. The results showed that 35.7% of the participating physicians correctly interpreted ECG charts for moderate hyperkalemia while the remainder [64.3%] were not able to give correct interpretation. Surprisingly, the majority of the participants [92.9%] could not diagnose severe hyperkalemia correctly. Only 7.1% of the participants sufficiency well read and determined the diagnosis of severe hyperkalemia. 17.9% and 14.3% of the study population were able to interpret ECG reading and to diagnose moderate and severe hypokalemia, respectively. The study highlights the need for a rigorous and standardized approach during residency training to improve the skills of resident and practicing physicians in ECG interpretation.

Comparison between secretory leukocytic protease inhibitor and reactive Nitrogen intermediates levels in cervicovaginal secretions from symptomatic and asymptomatic trichomoniasis Egyptians patients

Although trichomoniasis is one of the most widespread sexually transmitted diseases, limited information is know about the host and parasite factors which cause symptomatic versus asymptomatic infections. Both of Secretory leukocytic protease inhibitor [SLPI]and reactive nitrogen intermediates [RNI] are major effectors in the innate immune response against infection. This study aimed to compare the level of SLPI and RNI in relation to the vaginal complains among trihomoniasis Egypttian patients. Two groups of trichomonas infected patients were included. Group I included 30 symptomatic patients distributed in three equal subgroups mild, moderate and severe according to degree of symptoms and Group II included 10 asymptomatic patients. Control Group III included 10 healthy females. Cervicovaginal levels of SLPI and RNI were determined in all patients. The mewn level of SLPI was less in symptomatic patients [197.75 +/- 11.61 ng/ml] than in asymptomatic ones [361.18 +/- 40.53 ng/ml], with statistically significant difference. Mean level of SLPI was markedly lower in severe symptomatic patients [173.97 +/- 4.64 ng/ml] when compared with moderate [188.60 +/- 2.47 ng/ml] and mild [200.69 +/- 3.01 ng/ml] subgroups respectively. This difference was statistically significant. In con-troversy, mean levels of RNI in symptomatic patients were significantly higher [39. +/- 7.15micro m] than asymptomatic [38.89 +/- 6.4 micro m]. the mean level of RNI was significantly low in severe symptomatic [30.07 +/- 1.79 micro m] than moderate [41.83 +/- 1.01 micro m] and mild [46.30 +/- 2.20 micro m] symptomatic subgroups. This difference was statistically significant. Both of SLPI and RNI levels returned to normal levels in 93.4% and 80% of symptomatic patients respectively one week after metronidazole therapeutic course

Estrogen receptor beta gene polymorphism and endometrial inadequacy

To correlate four estrogen receptor beta polymorphisms to endometrial thickness. 24 patients with consistently thin endometrium, in natural and stimulated cycles undergoing controlled ovarian hyper stimulation for ICSI for various indications and 50 control subjects with normal endometrium undergoing COH for ICSI for male factor infertility. Sonographic evaluation of endometrium, PCR on peripheral blood leucocytes using specific primers to detect the determined four polymorphisms, as well as hormone values in COH cycles and ICSI outcome, are recorded. The deletion polymorphism was not found in either groups. The second polymorphism [P846] was significantly more commonly detected in cases of normal endometrium [50% versus 8% in cases with thin endometrium]. The third polymorphism [P1082] was not found in control group and only one case [4%] with thin endometrium and this was not significant. The last silent polymorphism [P1421] was found in 8% of cases and surprisingly all subjects of control group and this was statistically highly significant. The presence of certain ER beta polymorphisms correlate with good endometrial thickness

Some cytokines variations in patients with diabetes mellitus

This study comprised eleven newly diagnosed type I diabetics, twelve long-standing type 1 diabetics, eleven long-standing type 2 diabetics, and ten healthy volunteers as control group. For all subjects glycosylated hemoglobin [HbAIc], interleukin-2 [iL-2], soluble interleukin-2 receptor [sIL-2R], and tumor necrosis-alpha [TNF-alfa] were determined aiming to evaluate their role in pathogenesis of diabetes. HbAIc was significantly elevated in all diabetic groups as compared to control group. Newly diagnosed type I and long-standing type 2 diabetics had significantly higher HbAIc levels than long-standing type I diabetics. It was positively correlated with duration of diabetes in long-standing cases of both type I and type 2, and with post-prandial plasma glucose in long-standing type I diabetics. With respect to IL-2, it was significantly decreased in newly diagnosed and long-standing type I diabetics as compared to control group and long-standing type 2 diabetics. Also, it was significantly lower in newly diagnosed type I than long-standing cases of type I. Whereas, sIL-2R was only significantly elevated in Newly diagnosed type I diabetics as compared to control and long-standing type 2. No significant correlation was detected between IL-2 or sIL-2R and other assayed parameters. As regard to TNF-alfa, it was significantly elevated in both newly diagnosed-and long-standing type I diabetics as compared to control group, whereas no significant difference was found when other groups were compared with each other. TNF-alfa was positively correlated with duration of diabetes in long-standing cases of both type 1 and type 2 and with HbAIc in newly diagnosed and long-standing type 1 diabetics. In conclusion, hypoproduction of IL-2 may be attributed to decrease of IL-2-secreting T-lymphocytes, whereas elevated sIL-2R may be related to increased expression and release from the surface of IL-R-bearing T-lymphocytes infiltrating the islets of pancereas and PBMC. These findings indicate imbalance of IL-2-IL-R system which, may be genetically determined and involved in pathogenesis of autoinnune type of diabetes [type 1]. TNF-alfa elevation may be derived from macrophages infiltrating pancreatic islets and mononuclear cells found in percipheral circulation. It may be implicated in B-cell destruction in type I diabetes as well as insulin-resistance in type 2 diabetes