The Medical Journal of Tikrit University
This journal is dedicated to the Medical College of Tikrit University, providing a platform for researchers to publish their work. It allows scholars to share their findings, enabling others to benefit from reviewing and building upon published research.
Melatonin as a supplement in the treatment of old infertile women
Background Old infertile women, poor responder and poor ovarian reserve are the main challenge to the doctors because of oxidative stress due to aging process. Many supplement of multiple vitamins, minerals, synthetic hormones, herbal medicine and biological technique such as (stem cells) were introduced as an ovarian rejuvenation in infertility treatment and assisted reproductive techniques. Melatonin is one of these supplements that participate in circadian rhythm and follicles quality. Patients& Methods:63 infertile women with ovulatory cause were taken in the study and they were divided randomly into two groups, group (1) or melatonin group, whom women use melatonin 5 mg at night, folic acid 400g ,coenzyme q10 200 mg and vitamin E 800 mg daily and group (2) or control group whom patient use folic acid 400 ug,coenzyme q10 200 mg and vitamin E 800 mg daily . Both groups use their treatment for three months and follow up the patient if pregnancy occur .During follow up period pregnancy rate and pregnancy related complications were observed .Results :in group (1) 13 of women(43.3%) were get pregnancy while in group (2) only 4 of them(17.6) get pregnant. Conclusion: increasing pregnancy rate in old infertile women > 35 years old after melatonin treatment with other supplements.
Evaluation of waist to hip ratio as a screening tool for malnutrition among children under 5 years age at Kirkuk
Background Worldwide, malnutrition is common and is responsible directly or indirectly for about a third of all deaths of children under 5 years of age. Aim of the study For early detection of patients with malnutrition by using WHR as screening tool. s, Patients and method : A case control analytic study was done on children attending the Pediatric General Hospital in Kirkuk, and Nutrition Department in Pediatric General Hospital in Kirkuk from 29th March 2015 to the last of August 2015. The study included §- 250 Children, their age from (2months -5years). Each child included in the study was assessed by a prepared questionnaire. Screening done by measuring Weight for age, Height for age, Occiputo _ frontal Circumference for age, and Mid-arm circumference . and the diagnostic test was weight for height as well as waist to hip ratio as screening test. Results : The total number of cases (150 case) were malnourished , their age range from 2month to 5 years , while (100 case) of same age range considered as control .Most cases of malnutrition were males 63% , and 37% were females ,while higher number of control cases were male 65%, while female were 35% . Regarding the anthropometric measures ; waist Circumference in male were74% sensitive t..7. and 57% specific , while in female were 71% sensitive and 30% specific . Hip Girth (HG) in male were 76% sensitive ;48% specific , but in female 76% were sensitive , 40% specific . Waist to Hip Ratio (W1-1R) not sensitive , but 100% specific in male and female . Mean waist circumference for control male:( 41+3) , and for malnourished male :( 37+1) ; while mean waist circumference for control female :( 422) , and for malnourished female:( t3412). Mean hip girth (HG) for control male:( 4113), and for malnourished male :( 37+2) ;while HG for control female :( 43±2) , and for malnourished female :( 36-11). Mean WHR ti in control male :( 110.3) ,but in malnourished male :( 1.02+0.2) ; while WHR in control female :( 0.97±0.5) , but in malnourished female :( 0.94+0.5. ( Conclusion : Still MAC is the most sensitive and specific method for screening for malnutrition , and hip girth is a good method for early detection of malnutrition , although it 1 is less sensitive than MAC
THE VALUE OF WAIST TO HIP CIRCUMFERENCE IN THE ASSESSMENT OF OBESITY IN CHILDREN BELOW 5 YEARS
Background Obese and obesity are terms commonly used in the clinic as well as street corner, often with a wide range of meaning. "Overweight" technically refers to an excess of body weight, whereas "obesity" refers to an excess of fat. The aim of study to assess the prevalence of overweight and obesity in children below five years old and identify some of their possible risk factors. Patients & Methods: The current study represents an observational, cross-section study using a multistage-stratified random sampling technique, which included three hundred children (girls and boys) who aged below 5 years, selected randomly in Primary Health Center and kindergarteners in Tikrit city. The study was conducted from the first of February 2016 to the first of October 2016. Body mass index and weight for age were measured and compared to standard tables using international cut-off points. The presence of obesity is assessed by measuring the circumference of the waist (WC) and comparing it to that of the hip (HC). The relation between the two measurements is referred to as the waist-to-hip ratio (W/1-1). The Results: Information on possible risk factors were collected by a prepared of questionnaire. The total number of cases was 300 child who aged below 5 years, The prevalence of obesity is 13% (39 cases). There was a significant association between obesity and age, residency (urban-rural), family history, social level and certain dietary practices. Modem dietary habits are an important influence in the development of childhood obesity that should be watched carefully and controlled.
Waist-to-hip ratio Children Tikrit Obesity
Beneficial Effects of Telmisartan in Treatment of Hypertension With Type Two Diabetic Patients in Salahaddin Society
Background: Diabetes is a chronic illness lead to acute complications that required patient self-management education and life style care to prevent complication This study aims is to determine the degree of 12 weeks telmisartan therapy on the level of systolic blood pressure (SBP) & diastolic blood pressure (DPB), mean arterial pressure (MAP), serum glucose level, glycated hemoglobin(HbAlc) level and microalbuminuria (MA) as a marker of renal deterioration recently diagnosed hypertensive type two diabetes mellitus (T2DM) patients. Patients & Methods: Forty six newly diagnosed hypertensive patients with types 2 diabetes mellitus participated in the study(2017); 22 males and 24 females, their mean age was 52.93± 7.69 years. Eighty one apparently healthy persons (36 male and 45 female), who had no chronic disease and didn't receive any chronic therapy participated in the study as a control group. Both groups were matched regarding age and sex. BP was measured using a mercury sphygmomanometer with the subject waiting for a 5-minutes rest. Fasting serum glucose (FSG) concentration was estimated using a kit supplied by Biocon (Germany). HbAl c is measured in whole blood sample by ion-exchange resin quantitative colorimetric determination using a kit supplied from Stanbio (USA). Microalbuminuria measured by detecting protein-creatinine ratio (PCR) which include determination of urine protein by sulphosalicylic acid 3%, measuring urine creatinine by using a kit supplied from SyrBio company and finally calculation of PCR by dividing protein concentration in urine upon creatinine concentration in urine . Result: Showed that T2DM patients having a significant rise in SBP, DBP and MAP, also persistent hypertension lead to overt diabetic nephropathy, and there is diabetes and hypertension have a close relationship between due to resistance to insulin action on glucose uptake in peripheral tissues as compared with the control group. After a 12 weeks telmisartan monotherapy there was a significant reduction in SBP, DBP, MAP, FSG and microalbuminuria level. Conclusion: Telmisartan has a valuable renal protective effect by decreasing proteinuria, also it have a specific antihyperglycemic effect beyond angiotensin II receptor antagonism in addition to its hypotensive effects
Type Il D.M, Microalbuminuria, SBP, DPB. MAP, Telmisartan
Knowledge and attitude of next to marry persons toward thalassemia in Mosul city
Background Hemoglobin disorders are the most common clinically serious single gene disorders in the world. It is estimated that over 300,000 affected children are born each year, most with sickle cell disease, while about 60,000-70.000 are born with thalassemiamajor Aim of the study : To determine the knowledge of next to marry couples about thalassemia and what is there attitude toward such a disease. Patients and methods : This study was a cross sectional study conducted in Mosul city, sample was taken from next to marry couples during their visit to do premarital screening at lbnalatheer pediatric hospital (Mosul thalassemia center is one of it is departments ) and asshurqi primary health center which is the place of blood sample collection for premarital screening ( blood group ,HIV Ab , HBs Ag ,HCV AB,VDRL Test, and for High Performance Liquid Chromatography "HPLC" for Haemoglobinopathies). The actual period of data collection was from June 2018 up to December 2018, during this period 500 next to marry couples were collected randomly. Results This study reveals that the majority of sample included in this study (79%) their ages were between (20 — 40 years) and 58.6% of the study sample was female . In relation to employment state there was 54.8% of sample not employed, about 77.8 % of them lived in urban area and about 92.4% of them was from the premarrigae group while 50.4 of the study sample have pass secondary education. This study clarified the knowledge and attitude scores of thalassemia among study population which found that about 64.4 % of the sample have adequate knowledge as they have a correct answer on 11 questions from 18 questions (61 °10 of the total knowledge ) and about 71 % of the study population have adequate attitude toward thalassemia as they have a correct answer on 5 questions from 8 questions (62.5 % of total correct answers regarding attitude . ( Conclusions : This study revealed that 79% of the study sample's age between 20 — 40 years , 58.6% were female , 92% of the sample was from premarriage group, 54.8% was unemployed , 77.8% from urban area and 83.4% have a level of education secondary and above . In relation to their knowledge and attitude this study showed that 64.4% of the sample have adequate knowledge and 71% of them have adequate or positive attitude toward thalassemia
Haemoglobinopathies Thalassemia Pre-marriage Mosul
Evaluation of Serum Iron in Patients with Afebrile Seizure
Background : Two hypotheses have been suggested to explain the origin of seizures after brain injury. One suggests that inhibitory neurons are selectively damaged and remaining principal excitatory neurons become hyperexcitable Aim : To evaluate the relation between the presence of iron deficiency anemia and the occurrence of afebrile fit. Patients and method: A case control study done on 40 patients with afebrile seizure attending to the pediatrics department in Samaraa general hospital during the period from first of July to the last of October 20I7year.Each patient with afebrile seizure were assessed by prepared questionnaire including ,name, age, sex, residents, pre-ectal, ictal, post-ectal, pica symptom, presence of risk factor and family history of seizure ..Each patient examined for presence of pallor ,chionlychia , angular stomatitis ,flat tongue and organomegally .Each patient included in the study were sent for serum iron. A patient were sent for also EEG and C.T. scan. Results: Most of the study cases presented with pallor 17 cases (29.31%). Regarding pre-ictal symptom, most of them are abnormal head movement 7cases (14.28%). In ictal-state symptom, most of them had tonic-clonic seizure Scases (19.51%). In post-ictal state symptom, most of cases had drowsiness 28cases (32.18%). In EEG report, from 22 patients had EEG record, 14 cases (63.62%) were abnormal and diagnosed as having seizure. In C.T Scan report, where a 19 patients we're did examination, 9cases (47%) patient were normal. Most of cases had no risk factor for seizure 24cases (60%). Most of cases were between >1 yr-‹5 yrs.19 cases (47.5%), had low iron. In 40 cases were taken, 22cases (55%) of them were of low iron. of 40 cases of seizure, those with low serum iron 22cases (55%) show that 15cases (37.5%) of patients having uncontrolled seizure and 7cases (17.5%) of patients having control seizure, in comparison to] 6 (40%) of patients with normal serum iron, 11 cases (27.5%) of them had uncontrolled seizure and 5cases (12.5%) had control seizure. Conclusion: The study concludes that there was no significant result regarding iron level and seizure occurrence. The study recommended further studies on bigger sample size and for a longer period or time to clarify the occurrence of seizure among the patients with low iron.
Iron deficiency anemia, Serum Iron, Seizure, EEG Afebrile fit
Estimation the relation between Epstein—Barr virus in nasopharyngeal carcinoma with interleukin-10 in Kirkuk city
Background Rickets is a condition associated with bone-deformity due to inadequate mineralization in growing bones. rickets of prematurity is a well-known condition that predisposes to pathological fractures in . The aim of the study was evaluation the frequency of EBV antibodies in nasopharyngeal carcinoma patients and their relation with serum IL-10 level. Patients & Methods: A cross sectional study was carried out from 15th of January 2018 to 15th of June 2018. The number of nasopharyngeal cancer patients under study were 68 patients whose ages were between 7-75 years old. These patients admitted to Kirkuk oncology center, Baghdad oncology center and Al-Sulaimaniya oncology center, while 22 healthy individuals control group, their age ranged between 30-75 years old. All patients and control group were investigated for detection of EBV IgG antibodies and the level IL-10 by using ELISA technique.. The Results: The study showed that the highest rate of EBV-IgG Abs occurred in patients with nasopharyngeal carcinoma (51.74%) comparing with the control group (4.55%). This g. result was highly significant. The highest rate of patients with nasopharyngeal carcinoma was (23.53%) patient within the age group 57-66 years. The least rate of patients with nasopharyngeal carcinoma was (10.29%) patient within the age group 7-16 years. The study showed that (58.82%) of patients enrolled in the study were males and (41.17%) were females. The highest rate (66.18%) of patients with nasopharyngeal carcinoma were in the stage of metastasis comparing with (33.82%) of patients without metastasis. The highest rate (71.43%) of EBV infection was found in patients with metastasis. The highest mean of IL- 10 (42.31 pgiml) in patients with nasopharyngeal carcinoma who were infected with EBV, followed by those without EBV infection (37.38 pg/m1), while the control group recorded a mean of (2.50 pg/ml), the relation was highly significant (P = 0.00001). Conclusions: study was concluded that there is a highly significant relation between EBV and 1L- 10 among patients nasopharyngeal carcinoma.
Epstein—Barr virus Nasopharyngeal carcinoma Interleukin-10 Kirkuk
Feet changes in Diabetic Patients Detected in X-ray Film
Background Diabetes mellitus is a condition where sufficient amounts of insulin are either not produced by the body or the body is unable to use the sufficient insulin that is produced. . The aim of the study is to identify feet changes in diabetic patients that can be detected by plain radiography. Patients & Methods: Design: Cross - sectional study Participants: One hundred diabetic patients-Setting: This study was done in September -2005 to June -2006, in Al - Wafaa diabetic out patients clinic & radiology department, Al-Zahrawi hospital in Mosul. Jesuits : One hundred patients were studied, 70 female & 30 males. The Results: Most of them were 41-70 years old (88%), family history association about 67% & additional disease about 47%. Most of patients were type II (NIDDM) about 94%, & mean duration of diabetes about 10 years. The main clinical findings were abnormal sensation. foot deformity & swelling. The main radiological findings were osteopenia, Hyperostosis foot deformity tuft resorption, osteomyelitis & osteoarthritis. Conclusions: Feet changes in. diabetics are mainly the result of peripheral - neuropathy, which is due to prolonged duration & poor control of diabetes.
Diabetes Millitus Mosul Hyperostosis Osteomyelitis Osteoarthritis Osteopenia
Serum Level of Preptin Hormone in Children with Type-1 Diabetes Mellitus
Background Preptin is a hormone which is calm of 34-amino acids (MS 3948 kDa). It is a peptide that is secreted along with insulin and amylin from the fl-cells of the pancreas. The aim of the present study was to estimate the serum level of preptin hormone in children with type I diabetes mellitus getting an insulin therapy. Patients & Methods: In this study, a sample which consisted of 35 children with type I diabetes mellitus receiving a treatment of insulin therapy (ages range from 7 to 12 years) and 30 apparently healthy children of a comparable age. Preptin hormone was measured via ELISA, while the blood glucose was measured by UV-VIS spectrophotometer. The Results: The result of this study reveals that preptin has a mean serum level of 82.79 + 4.3 ng/ml in children with type-I diabetes mellitus, while its serum level in control group was 138.62 ± 6.1 ng/ml. It is also found in this study that the BMI of the studied group lower than the control children. In conclusion, preptin is found to be significantly lower in children with type-I diabetes mellitus in comparison with the control group. Conclusions: In conclusion, the preptin hormone was found lower in children with type-I diabetes mellitus in comparison with non-diabetic children.
Diabetes mellitus type-I, Preptin hormone Children Insulin ELISA
Neural tube defects: Incidence and types
Background Neural tube defects (NTDs) are a group of severe congenital abnormalities resulting from the failure of closure of neural tube .It is result from a combination of genetic and environmental factors and therefore are classified as having a multifactorial etiology. Aim: to identify the incidence of neural tube defects through the following objectives to :Determine the frequency of NTD„ determine the types of NTDs, Compare the gender differences, and Study the histological appearance of the brain tissue in case of NTDs. Patients & Methods: Routine antenatal trans-abdominal ultrasound examination was made for 6720 outpatients' women with missed period of 12-36 week .for two years duration from september 2010 to october 2012. Thirty two patients were diagnosed as NTDs sonographically. The frequency of which was 0.47% of the total, which is higher than previous studies in other countries. The Results: The majority of cases was anencephaly (17 cases 53%) followed by encephalocele (8 cases 25 %) while spina bifida cystica was found in 7 cases (22 %); five cases were myelomeningocele and two cases were meningocele. The higher maternal age group affected with NTDs was the group 20- 24 years Anencephaly and encephalocele were most common defects among maternal age groups 20- 24years and I5-19years, the frequency was higher in rural area than urban 21(65.6%) and 11(34.4% ) respectively. NTDs are more common among female than male fetuses. The commonest type of NTD was anencephaly Normal cerebral cortex with less gyri and sulci was clear in all cases of encephalocele, while in cases of anencephaly about 8(47%) cases had normal brain tissue .Absent brain tissue were seen 9(52.9%),12(70%) had hemorrhage within the Brain tissue, while 11(64.7%) had necrosis with brain tissue Conclusions: The rickets is an important disease to be studied in this country account about nearly half of cases of preterrn babies and about 10% of term babies .Breast feeding is a risk factor of the disease .Alkaline phosphatase activity and radiological feature are important for screening.
Neural tube defects Anencephaly, Encephalocele, Spina bifida, Folic acid defect
The Efficacy of Oral Isotretinion in Reduction of Lipase Enzyme Activity of Cutibacterium acnes in Acne Vulgaris Iragian Patients
Background Acne vulgaris is one of the top three most common encountered dermatological problems worldwide in both primary and secondary care. A relation between acne vulgaris and Cutibacterium acnes(Propinoibacterium acnes) has long been suggested. A lipase enzyme secreted by this microorganism to metabolize sebum and the resulting metabolites evoke inflammation in human skin. The current study is conducted to assess the oral isotretinion treatment for acne vulgaris patients and understanding of C. acnes' pathogenicity; via the lipase enzyme. Patients and Methods:50 patients with acne vulgaris seen in outpatient clinic of dermatology center in Baghdad during the period 1/9/2017 to 1/8/2018. The mean ages was 22±16-36 years. From the total of 50 patients,36(72%) of patients were females and 14(28%) were males. Furthermore 43(86%) of cases have previous family history of acne. Fifty samples from acne lesions were collected before oral isotretinion therapy, only forty-five samples were collected after oral isotretinion therapy. The diagnosis of patients were done by the specialist dermatologist, swabs and needle aspiration were collected from papules, pustules and nodulocystic lesions by the physician. The specimens were transported to the laboratory by using thioglycollate broth. The samples were cultured on Brucella blood agar with furazolidone in an anaerobic conditions, only C. acnes' were grown. C. acnes isolates were cultured on spirit blue agar at 37 °C for 7days under anaerobic condition, to identify the lipase activity. Results: All isolates of C. acnes were lipase positive before oral isotretinion therapy. The degree of lipase enzyme significantly decreased after treatment with oral isotretinion in 44(98%) of isolates but 1(2%) of the cases was not. These results indicates that lipase was the common virulent enzyme which produced by C. acnes isolated that isolated from acne lesions. All of the clinical isolates were demonstrating strong lipase production before treatment . Conclusion: Great emphasis should be done on choosing the drug that is used to inhibit or decreases the sebum production and hyperkeratinization of pilosebaceous follicle unit activity rather than hypercolonization of C. acnes. So, using oral isotretionion will prevent the optimal environment conditions for the production of lipase by this bacterium, and subsequently oral isotretinoin therapy gives good improvement response.
Cutibacterium acnes, Acne vulgaris, Isotretinion, Lipase enzyme, Oral Isotretinion.
Prevalence of Rickets regarding to maturity in children less than 3years - old attending Tikrit Teaching Hospital
Background Rickets is a condition associated with bone-deformity due to inadequate mineralization in growing bones. rickets of prematurity is a well-'t known condition that predisposes to pathological fractures in . This study aims at identifying the prevalence of rickets in preterm and term babies z ,study the risk factor of the disease as age ,sex type of feeding and biochemical and radiological changes_ Patients & Methods: A case control study done on 200 case with different ages from I moth to 3 years were taken 50 cases of them were preterm babies and 150 twere term babies, Patients were studied by history (sex ,age, type of feeding ,residence and clinical feature)and investigation (serum Ca ,ph and alkaline phosphatase) and diagnosis depend on radiological feature. The Results: About 19 cases (38%) of preterm babies were diagnosed as rickets of 4 prematurity ,15 cases(10%)were ricketic in term babies Residence were not risk factor in preterm but risk factor in term babies Breast feeding was risk factor in 2" both term and preterm babies . Most common age was between 2 and 12 months in re- p term babies . Serum level of calcium was normal in the majority of the cases in both term and preterm babies , serum phosphorus level was low in most of the cases specially in preterm babies Alkaline phosphatase elevated in 90% of cases diagnosed as rickets . iv Conclusions: The rickets is an important disease to be studied in this country account about nearly half of cases of preterm babies and about 10% of term babies .Breast feeding is a risk factor of the disease ,Alkaline phosphatase activity I and radiological feature are important for screening
Rickets Children Tikrit Ca, ph Alkaline phosphatase
Evaluation of Endometrial Hyperplasia Frequency in Salahudeen Province during (2003-2013)
Background The proliferation of glands of irregular size and shape with an increase in stromai glands ratio is defined as endometrial hyperplasia. Most of the cases is thought to be the result of persistent prolong estrogen • stimulation. The aim was to determine the number of women with • endometrial hyperplasia in Salahuddin province during the period (2003-x 771 2013), and to identify a number of factors associated with increase ;;. incidence of endometrial hyperplasia.. • Patients & Methods: The study included 319 cases with endometrial hyperplasia and abnormal uterine bleeding. patients ages ranged (15-66 years and over). Sample collection and patients information were made • through a survey of all available information in the hospital records in rt Tikrit Teaching Hospital during September 2013 to the end of February • 2014. A questionnaire for data collection was prepared also. During the ▪ above time, information, about 50 new cases were also collected from • hospital and some private clinics and laboratories. 2 I, The Results: The highest age groups with endometrial hyperplasia were • the age group (36-45) with a percentage of 28.2%. Women in the city were more prone to endometrial hyperplasia than country side women by 57.1%. • High percentage of bleeding time was observed to be 20 days.
Endometrial hyperplasia, Uterine bleedings, Factors associated with endometrial hyperplasia, Estrogen stimulation, Salahudeen Province
Determinants of inappropriate complementary feeding practices in children aged 6-23 months in Mosul city
Background: Proper feeding practices of children less than 2 years of age is important as it is the most critical period of life for optimal growth and development . Aim: This study aimed to use the newly developed World Health Organization (WHO) infant feeding indicators published in 2008, to assess determinants of complementary feeding practice in children 6-23 months of age in Mosul city, Iraq in 2013 . Patients and methods: A cross-sectional study was conducted in six primary health care (PHC) centers in Mosul city during 3 months period from llth of February to 1 lth of May 2013. The study sample consisted of 420 healthy children, aged 6-23 months who attended (P1-IC) centers for immunization The questionnaires data were based on the consent mother's recall of foods given to her child in the. 24 hours before the interview. Inquiry also included the sample demographic characteristics. Children's anthropometric measurements were assessed according to standard techniques. Results: Minimum dietary diversity rate was 45.5 %, minimum meal frequency 79.1% and minimum acceptable diet 40.7%. Determinant of inadequate minimum dietary diversity were: Children aged 6.11 months 1[}1 41.000, adjusted odds ratio (AOR) = 6.281 first born children (P 4,1.019, AOR =2.46) and monthly income per capita < 100.000 Iraqi Dinars (ID) (P= 0.002. AOR = 3.27 for < 50,000 ID; P= 0.010, AOR = 2.35 for 50,000 -100,000 ID). Determinant of inadequate minimum meal frequency were: Stunting (P = 0.015, AOR= 3.01) and monthly income per capita of 50,000 - 100,000 ID (P = 0.009. AOR = 4.41). Determinants of inadequate minimum acceptable diet included: Children aged 6-11 months (P = 0.000, AOR = 6.50), preceding birth intervals of 12-24 months duration (P = 0.008, AOR =2.58) and monthly income per capita < 100,0001D (P= 0.005, AOR = 3.12 for < 50,000 ID; P= 0.008, AOR = 2.48 for 50.000 - 100,000 ID). Breast milk feeding type (P = 0.001, AOR=0.25) displayed protection against inappropriate minimum acceptable diet achievement. Conclusions: The measured minimum dietary diversity and minimum acceptable diet attainment are not at satisfactory levels among studied children in Mosul city. Attention should focus on aforementioned determinants of inadequate infants feeding practices to prevent their subsequent negative influence on growth parameters .
Infant feeding practice, New WHO complementary feeding indicators, Children's anthropometric measurements , Mosul
Evaluation of the immune response toward Neisseria meningitidis in displaced people receiving A.C.W.Y-meningococcal vaccine.
Background Meningococcal vaccine refers to any of the vaccines are used to prevent infection by Neisseria meningitidis. Patients & Methods: The present study was carried out from 15th of January 2018 to 15th of June 2018. The number of previously vaccinated for N. meningitidis individuals under study was 68 displaced individuals whose ages were between 5-60 years old. These individuals were living in Laylan refugee camps. The control group who were matched to the patients studied, included 22 blood donors. The blood was collected from each individual enrolled in this study for estimation of anti-meningococcal group ACWY antibodies (IgG, IgM and IgA) level by ELISA technique. The Results: The study showed that the mean of anti-meningococcal IgA-Abs in previously vaccinated persons (0.116 pg/m1), which was higher than that of the control group (0.014 pg/mI), the highest mean of anti-meningococcal IgM-Abs was occurred in previously vaccinated persons (0.2962 II.J/m1) comparing with the control group (0.0064 and the highest rate of IgG positive result was (5.88%) present in previously vaccinated persons comparing with the control. The study showed that there was no significant relation of anti-meningococcal antibodies with sex and the highest mean level of anti-meningococcal IgM was recorded among males. This study showed that there was no significant relation of anti-meningococcal antibodies with age and the highest mean level of anti-meningococcal IgA was recorded among the age group 5-16 years. The study showed that the highest mean level of anti-meningococcal IgA, 1gM and IgG antibodies were observed among the group of 1-2 months after vaccination (0.1341, 0.3089 and 0.0483 pg/m1 respectively).
Immune response Neisseria meningitidis Meningococcal vaccine ACWY antibodies ELISA
Weaning practices of children in Mosul Cross —Sectional Study
ABSTRACT: Background : The transition from breast feeding exclusively to use of family foods completely is very vulnerable period of the time when many infants become malnourished, contributing significantly to the high prevalence of malnutrition in children under 5 years of age worldwide. Aim: This study aims to assess the local weaning practices of a group of children in Mosul &if s association with socio-demographic factors &nutritional status of children -Patients& Method: To achieve the aim of the present study a cross-sectional design was adopted. The unit of present study was a mother who came to the primary health centers for routine vaccination of any of her children. The chosen mothers were included by systemic sampling technique in which every third mother had been taken. All children of the selected mother who were 2-24 months of age were included in the interview, through visiting the primary health centers in Mosul four time per week . Results: Complementary food introduction was done before 4 months of age 26%&ortly 15.3%were weaned after 7months of age' Weaning practices were categorized into bad, moderate &good level according self-administrated scores for each recommended practices for infant feeding& weaning. Accordingly the present study show that about 65% of the sample were using bad &moderate levels of practices& the rest had good level. This study revealed that low maternal education & high parity having 4 children or more & low socioeconomic state of family associated with using bad practices (C.1= 3.27-12.23;P<0.001), while employment of mothers associated with using good weaning practices(C.1.27-0.78;P<0.01. Conclusions: Complementary food introduction was done before 4 months of age 26%&only 15.3%were weaned after 7months of age &19.6% of infants were exclusively breast fed. The study show that early weaning <4 month was associated with diarrhea, otitis media & food allergy, but had no relation with underweight while, weaning after 7 months of age significantly associated with underweight.
Determination of testosterone level in male patients with insulin resistance at Tikrit city
ABSTRACT: Background The low levels of testosterone in men have been shown to be associated with type 2 diabetes, visceral adiposity, dyslipid-aemia and metabolic syndrome. The effect of 4 testosterone treatment had been investigated on insulin resistance and glycemic control in men with type 2 diabetes.Aim : To investigate the relationship between insulin sensitivity and testosterone level. Patients & Methods: This was study include 50 diabetic men treated with age (35- 7.= 65years) with type 2 diabetes attended the out-patients clinic/medicine department in Tikrit Teaching Hospital. This study was carried out from November 2012 up to May 2013. Patients history were taken and their concomitant medications, Physical examination and laboratory investigations done before and after testosterone therapy (injectionioral root) for 44 3 months. Results :The present study revealed that (68%) were obese and increase waist circumference t- in (96%)with significant increase in Glycated hemoglobin in obese groups. hyperinsulinaemia in (28%) and low testosterone level in (60%). Although, hyper cholesterolemia present more than half but not reach to statistical significant level while . significant increase triglyceride level especially in obese patients .About lipoprotein types showed significant reduction in HM, and increase In LDL but not for VLDL. Regarding electrolytes level, we found that (Ca),(P) levels appeared within the normal levels, while j. other electrolytes (Mg,K,Na), the majority of cases are within the normal levels. Patients 74 were treated with i.m. testosterone 200 mg every 3 weeks or oral root for 3 months. Follow I up study with testosterone therapy, the primary outcomes was significant decrease in glycated hemoglobin with no corresponding reduction in insulin level, while significant increase in testosterone level.However, a significant reduction in visceral adiposity as fl assessed by waist circumference, with significant reduction in weight and BM1 . With s.: respect to total cholesterol, was reduced in(76%),after testosterone therapy, but statistical analysis not significant. According to triglyceride level, after testosterone therapy,there was significant reduction as compare with it before treatment.There was no significant change in HDL and LDL, while significant reduction present in VLDL.With respect to electrolytes -4 there was significant change except Ca.
Testosterone Male Insulin Resistance Obese Tikrit city
Family Physicians' Perceptions of Intrauterine Contraceptive Device in Mosul City
ABSTRACT: Background: (Intrauterine contraceptive Device) are contraceptive method that is safe, reversible and effective contraception, in the world more than 100 million female used the device. Mm : to detect the knowledge of Family physicians in Mosul related to the harmful effect and contraindications to use intrauterine device and what these knowledge compared with clinical guidelines. Patients and Methods :This study was conducted in Mosul city included all Family physicians ,using a cross sectional study design from the 1st of June to the 1st of September 2017 .94 Family physicians included in the study ,standardized questionnaire form was used including: years in practice .sex, and age also take information from family physician's about prescriptions or insertions of device . the following part of the questionnaire. asked Family physicians about detecting minor and major complications of intrauterine contraceptive device . In the third part: Family physicians were asked to recommend (copper intrauterine contraceptive device, marina ,none)as an option in 15 situations. Results : overall there were 63% were females physicians and the rest were males. About 38.8% of respondents used to prescribe intrauterine device,40% inserted them. female doctors were more likely than male doctor to use (56% vs. 9%)and insert Intrauterine devices (61% vs. 3%),about 38% of respondents were interested in Intrauterine device course. More than 60% of respondents ranked Pelvic inflammatory disease &perforation as a major risk of Intrauterine device .About 72.2% thought thrown was a major risk of failure of Intrauterine device. Regarding the indications of Intrauterine devices, lots of participant not recommend device to female with no children women 65.5% and for patient with fibroid(63')/0). For postcoital contraception(46%)not recommend Intrauterine device. Conclusion :the study revealed family physician misconception of intrauterine contraceptive device like relation of device with perforation of uterus .pregnancy outside uterus .and pelvic inflammatory disease .result of study advice to educate family physician in programmed of training. Another researches needed to increase family physician awareness about intrauterine contraceptive device
Family Physicians' Perceptions IUCD pregnancy outside uterus Mosul City
Serum Thyroid Hormones and Cortisol in Patients with Chronic Renal Failure
Background Thyroid hormones are necessary for growth and development of the kidney and for the maintenance of water and electrolyte homeostasis. The effects of hypothyroidism on the kidney are usually opposite to the effects of hyperthyroidism. Patients and Methods: Serum samples were collected from 120 individuals, 50 of these individuals were normal and 70 chronic renal failure (CRF) patients that aged from (18-60) year with no personal history of Hypertensive. Thyroid diseases or Diabetes Mellitus. Serum samples were collected from renal failure patients that admitted to dialysis unit of Tikrit Teaching Hospital from August 2012 to January 2013. The Results :Blood urea, S.Creatinine, S.TSH, S.Cortisol, Potassium and Chloride were increased in CRF. while T3. T4 and Sodium were decreased rather than control. Conclusions: These findings suggest the presence of intrathyroidal and pituitary disturbances associated with uremia.
Chronic Renal Failure, Hypothyroidism, T3, T4 , ISH, Cortisol
The Relationship between Body Mass Index and Semen Quality in Infertile Males
Background In the recent years, studies have centered on improving the health of individuals in sustainable ways. . The aim of this study to identify the relationship between sperm quality and BMI of adult males. Patients & Methods: For that reason, the study identified a group of men who had been visiting a health clinic and unable to conceive for a period of one year, after consistent unprotected intercourse with their female partners. Relatively, the semen was collected from a total of 115 participants who were requested to abstain from sex for three days. A trained staff explained the assumptions and the intentions of the study to the participants who then, provided a written consent for using their samples. In this process, biased information was eliminated by not indicating their origin. The study is not the first one in had been done and still in the process The Results: After examination of the healthcare, but there are several others that to clarify the fundaments under the topic. samples, the study identified that there is a negative correlation between BMI and sperm quality. The parameters that were used to determine sperm quality included sperm concentration, determining the type of motility and sperm count. From the results of the study, it was established that overweight and obese men had higher chances of having low sperm quality compared to the underweight and normal men. In the discussion part, the study had varied strengths including the use of men from different BMI and consistency in the examination process in the laboratory. Also, some scientific studies support the results of the study, especially in the release of sex hormones. Despite the findings, researchers are recommended to be cautious in explaining the results since they are subjective to errors considering that the female counterparts were not examined of their fertility condition.
BMI, SFA, Sperm quality, Sex Hormones, Fertility
Pulmonary Tuberculosis in Salah-Al-Deen province in 2007
Three hundreds thirty patients studied in Salah-Al-been consultant clinic for respiratory disease from 1st January to 1st December-2007. Pulmonary tuberculosis found in 114 of them, and falls in to two groups; 57.9% of them were negative sputum smear, and 42.1% of them had positive sputum smear. Regarding the mycobacterium load in the sputum smear, most of pulmonary tuberculosis cases had as following: 17 (14.9%) had -1-+, 20 (17.5%) had +++ of M. tuberculosis rodsand two patients (4.2%) had very little rods. Positive pulmonary tuberculosis was more common amongpatients aged <18 years old which found in seven (46.7%) and male constitute 48.5% of them and the odd ratio for male sex was 1.3. Regarding residence, positive pulmonary tuberculosis, 27 (38%) of patients were from rural areas in comparison to 21 (48.8%) of urban area. The odd ratio for urban area was 1.3 and for rural 0.8. Tuberculosis case detection rate was lower than expected, and the working group is mostly affected. Improvement in management of tuberculosis and rehabilitation programs needed.
Pulmonary tuberculosis in Salah Al-Deen, TB epidemiology.
Physical Activity and Hemoglobin Level Among Married Women During Childbearing Age in Mosul
Women's health in general is affected by various important social, cultural, behavioral, and biological factors. Physical activity of women through various domestic and occupational works differs according to their age, education, pregnancy status, and general health status. The effect of physical activity on hemoglobin level should not be ignored specially when considering women's health during childbearing age (15-49) whether pregnant or non-pregnant as the women more prone to iron deficiency anemia due to largely loss of blood with menstruation, pregnancy, physical effort, and insufficient dietary iron. The aim of this study is to determine the relation between physical activity and anemia state of married women during childbearing age. A cross sectional study design was adopted of 912 married women were seen at four randomly selected primary health care centers. These centers were (Al-Sukar, Al-Sharqi, Al-Hadbaa and Al-Mansoor), during the period from 1st August 2007 to 1st of February 2008. The interview was face-to-face, utilization the International Physical Activity Questionnaire the long version, 2002 to determine the level of physical activity. The information included in the data collection tool include, the socio-demographic character, levels of physical activity, and measuring of hemoglobin level. The study shows that half of non-pregnant were anemic and half of the pregnants were anemic too. The study revealed that two thirds of the women who were having heavy activities and 53.2% of the women with moderate activities were suffering from anemia according to Hb level. This study concluded that half of the sample was anemic and had association with physical effort, so that women in childbearing age need special care by increasing the attention towards providing better health care services in antenatal care center.
The effect of Sildenafil on endometrial characters in patients with infertility
Objective: To study the role of sildenafil on the echogenic pattern of endometrium in infertile patients with bad endometrium. Setting: Infertility center in Basrah Maternity and Children hospital. Design: Case control prospective study. Methodology: 28 patients had primary or secondary infertility with mature Graffian follicle and bad endometrial thickness (control group) in the previous cycle . The same patients were considered as study group in the present cycle after giving them sildenafil citrate (Erasma) (Mepha company) 25 mg vaginally every 6 hours for 5 days from day 8th of the cycle and those patients were reevaluated by TVS (7.5 MHZ) at day 8th and 13 th of cycle for endometrial thickness and pattern with number and size of Graffian follicle. Result : A total of 28 infertile women were included in this study. The control group had a mean of endometrial thickness of 5.21+2.8 mm at time of ovulation. There was statistically significant increase in the endometrial thickness from day 8th to day 13th in study group as compared to that of the same patients in control group and the difference is highly significant. Vaginal sildenafil increase endometrial thickness to >7mm in about 35.7% of patients in the study group without any side effect. 71.4% of patients in study group had hyperechogenic endometrium which was higher than those in the control group but the difference is statistically not significant and the percentage for those with isoechogenic is higher in control group compared to the study group. Conclusion: Vaginal sildenafil was significantly effective in improving endometrial thickness in patients receiving ovulation induction therapy with bad endometrial thickness in previous cycle. It causes no systemic side effect.
Vaginal sildenafil & endometrial thickness
The effect of Ginger on semen parameters and serum FSH, LH & testosterone of infertile men
Background:- The chemical constituents of ginger classified to volatile oils (including borneol, camphene, citral, eucalyptol, linalool, phenllandrene, zingiberine and zingiberol penols (gingerol, zingerone and shogaol) and resin) which constitutes (1-3%) mainly of zingeberene nonvolatile pungent compounds oleo-resin constitutes (4-7.5%) mainly gigerols and other constituents with more than 50% of starch. Aim: The aim of this study is to examine the effect of ginger supplements on semen parameters & serum FSH, LH, & testosterone & of infertile men. Patients & methods: A longitudinal study comprised 75 infertile men, their ages from 19-40 years. All infertile patients were married for at least two years and had no children. The Study samples were obtained from infertile clinic in Tikrit teaching hospital, private clinics in Kirkuk city, from 1-10- 2011 to 1-5-2012. This study involves clinical trial by treating the whole infertile patients with ginger. At least 2-3 semen analyses were done during 3 months of treatment for each patient before making a final conclusion regarding the base line sperm parameters. Serum concentrations of FSH, LH & testosterone were measured using ELISA. Results: There was significant (p<0.01) increase in sperm count of infertile men after treatment with ginger as compared with that before treatment. With a % of increase in sperm count up to 16.2%. Also, the study record a significant (p<0.01) increase in sperm motility of infertile men after treatment with ginger, as compared with before treatment with a % of increase in sperm motility was recorded was up to 47.3%. Moreover, there was significant (p<0.01) increase in sperm viability & normal sperm morphology of infertile men after treatment with ginger as compared with before treatment, with increase in percentage of sperm viability up to 40.7 %. The study observed a significant increase in ejaculate volume of infertile men after treatment with ginger, as compared with before treatment with a increase in percentage of ejaculate volume was recorded up to 36.1%. There is significantly (p<0.01) reduction in serum MDA & significant increase in serum glutathione (p<0.01) in infertile men after treatment with ginger as compared with before treatment. There were significant increases in serum FSH, LH & testosterone levels in infertile men after treatment by ginger as compared with before treatment. Conclusion: The present study conclude that after treatment with ginger, cause a significant reduction in serum MDA & significant increase in serum LH, FSH & testosterone. Treatment with ginger increase serum glutathione & reduce serum & seminal fluid MDA. The present study recommends the use of ginger by Iraqi community as a food additive.
Infertile men, MDA, GSH, LH, FSH, testosterone, ginger, & semen analysis
Significant value of hormonal assays as a marker for Male Infertility in Tikrit city
Background: Infertility is defined as the failure of a couple to conceive after one year of regular unprotected intercourse. Infertility is a problem of global proportions. Several studies with questionable results have focused on the value of serum FSH and AMH to predict the status of spermatogenesis in the testes. Also, possible relationship between seminal plasma inhibin B and spermatogenesis in patients with azoospermia. Aim: The aim of the present study is to compare some serum biomarkers of infertile men with normal fertile men to find the significant value of hormonal assay marker in predication of male infertility. Patients & Methods: A cross sectional study in which samples were obtained from urology clinic in Tikrit teaching hospital, private clinic, from 1-9- 2011 to 1-9-2012. Ninety subjects were participated in the present study (Fifty infertile men & forty fertile subjects). Semen parameters were measured for infertile men & control fertile men. Serum concentrations of FSH, LH, testosterone, AMH & prolactin were measured. Results: There is significant (p< 0.01) reduction in sperm count, motility, viability of infertile men, as compared with same parameters of normal fertile men. Also, there is significant increase in serum MDA (6.811± 0.53 !Anal) in infertile men as compared with fertile men, (2.454 ± 0.54**). However, there is significant reduction in serum glutathione (p<0.01) in infertile patients (7.1 ± 1.2 !molt!) as compared with fertile men, (10.123 ± 1.21**). Serum FSH, LH, and testosterone levels were found significantly differences between infertile men (11.35 ± 2.4 mIU/ml, 9.956 ± 2.87 mIU/ml & 5.07 ± 0.62 ng/ml respectively) as compared with serum FSH, LH, and testosterone levels of fertile men (5.53 ± 2.3*, 5.973 ± 0.92** and 9.16 ± 0.749**) respectively. The present study show that there is significant reduction in serum AMH in infertile men (1.40 ± 0.11 ng/ml), as compare with fertile men, (4.17 ± 0.67). However, regarding serum prolactin, there is no significant differences between infertile men (4.26 ± 2.17 ng/ml) as compare with control fertile men (3.91± 1.52). Conclusion & Recommendation: The present study concludes that there is significant reduction in serum testosterone & AMH of infertile men as compare with fertile men. However, there is significant increase in serum FSH & LH in infertile men. There is negative correlation between AMH & serum testosterone in infertile men. The present study recommend the followings;- Proper selection of patients with respect to hormonal assays which reduces the costs and burden on the infertile patients, & the routine assessment of thyroid hormones and antibodies in infertile men are not recommended.
Infertile men, semen analysis, FSH, ICI, Testosterone, prolactin & AMH
Determination of Estrogen hormone in normal healthy non pregnant women of different age in Tikrit city
Background: Estrogen have many important functions regarding the genital tract, central nervous system, the breast, the development of the secondary sex characteristics and many other functions the most important here is its effect on the bone by increasing deposition of bone and its role in epiphysial closure. Aims: The aim of the study is to determine serum estrogen concentration in normal healthy non pregnant women in Tikrit city. Subjects & Methods: This study was carried out during a period extending from January to July 2012 in Tikrit University. Two hundred normal healthy women were participated in this study, their ages from 20 up to 65 years. About five ml blood was drawn from each participant using a tourniquet, and then blood sample was put into plan tube without anticoagulant for serum separation. Serum estrogen was measured by using kit from Roche (Germany) which was used on cobas e 411 analyzers —disk system. Results: The first group aged 20 to 29 years has a serum estrogen concentration of 939 ± 78 pg/ml, this group of women have the highest serum estrogen concentration as compare with other groups (P<0.01). Also, there is significant reduction in serum estrogen concentration in group aged 30-39 years (377.42 ± 28.4 pg/ml) as compare with group 20-29 years ( 939 ± 78 pg/ml). Moreover, there is significant reduction in serum estrogen concentration in group aged 40-49 years (168.07 ± 29.3 pg/ml) as compare with group 20-29 years ( 939 ± 78 pg/ml). Furthermore, there is significant reduction in serum estrogen concentration in group aged 50-59 years (53.16 ± 13.4 pg/ml) as compare with group 20-29 years (939 ± 78 pg/ml). Meanwhile, there is significant reduction in serum estrogen concentration in women group aged above 60 years (28.4 ± 7.4 pg/ml) as compare with group 20-29 years ( 939 ± 78 pg/ml). Conclusion: The present study concludes that there is significant reduction in serum estrogen in women as advance in age. The most sever reduction in age group above 50 years. The present study recommend the followings;- Regular assessment of serum estrogen in women above 45 years & study the relation between reduction in serum estrogen & bone density in women.
Serum estrogen, fertile women, postmenopausal women
Epidemiology of Road Traffic Accidents in Emergency Hospital in Erbil City
Road traffic accident is considered as a major cause of death worldwide, it has been rapidly increasing to become one of the common causes of increasing mortality and morbidity in the population. A cross-sectional study for a 1 month period of all road traffic accidents and injuries was conducted in Emergency Hospital for the period 1st December 2008 to 1st January, 2009. A total of 180 injuries were encountered at the Emergency Hospital Department. The majority of victims were males, with a male to female ratio of 2.6:1. This study on road traffic accidents reveled that, out of 180 victims, 11% were under 10 years, 53.8% between 11 and 30 years and 41.1% were more than 30 years. Only 25% of those involved in accidents were wearing a seat belt. Most of the accidents and injuries occurred from 8.00 am to 4.00 pm (74%). Head injury was the most frequently noted type of injury (51.8%), followed by lower limbs injury (27.1 %), upper limbs (14.1%), chest (4.7%) and back (2.4%). Road traffic accidents are a major but neglected public health challenge that requires concerted efforts for effective and sustainable prevention. It is mostly affecting young age groups that need comprehensive health educations regarding safety measures of driving in addition to addressing road safety measures to policy makers.
Diagnostic and Prognostic role of CAl25 with patients of ovarian cancer
To evaluate the diagnostic and prognostic significant of CA 125 test , within a fallow up of three months , and its role for monitoring response to treatment by chemotherapy . To evaluate serum C-reactive protein (CRP) as a prognostic variable in patients with ovarian cancer . This study was conducted in Mosul . Iraq from January 2007 through July 2009 . A sample of 44 consecutive women aged from (35-55 years) and suffering from ovarian cancer with control group of 45 women were included in this study . A pre-tested questionnaire was employed to obtain information on family history to this disease , laporatomy treatment if present , asking for benign disease of the uterus , liver and gastro intestinal tract and benign tumors of ovaries & uterus if present specially for control group . Physical examination by C.T. scans and ultra sounds were then done . Blood samples were collected for 89 women and measurement of CAl25 and CRP were performed . Serum from 44 patients participant were analyzed for CAl25 and CRP before and after treatment with chemotherapy and laporatomy if present at three months interval for fallow up mean ± SD for these patients before chemotherapy course was 78.42 ± 14.6 U/ml for CAl25 in which CRP concentration for 37 patients of this group at the same period of time was 96 mg/dl 84.1% (group 1) and the remainder 7 patients was 48 mg/di 15.9 % (group 2) . There was a significant differences for CAl25 value in patients before therapy and according to period of therapy at P<0.01 . CRP concentration was 96 mg/dl still high after one month of chemotherapy , its value was decrease in the second and third month of chemotherapy . Preoperative determination of CA 125 may play a good role the prognosis of post operative chemotherapy . It may be useful to included this test in the diagnosis of ovarian cancer with the help of physical examination in future .
Risky Health Behaviors among Teaching Institutes Students in Tikrit
Schools are considered as one of the sources of health education and information to the students and to the whole community. Teaching institutes are considered as the foundation that builds the teachers who will build the coming generations. So it is necessary to study the presence of Risky Health Behaviors among Students of Teaching Institutions in Tikrit City. In Iraq, no available data or previous studies about health risk behaviors and protective factors among adolescents have been executed. This is a pioneer study in this time and field. This study was done to provide data concerning knowledge, attitude and practices of risky health behaviors & protective factors among Students of Teaching Institutes in Tikrit. A descriptive cross-sectional study carried out on simple randomly selected (231) students, in Tikrit from 20/11/2006-2013/2007 by using a modified questionnaire according to Iraqi circumstances for male and female teaching institutes in Tikrit city. A sample of 231 secondary school students was studied, of which 69.5% were 16 years and older. Nineteen percent (19.48%) of students were from families displaced due to sectarian causes. It is found that 125 (54%) of the students were of urban residence. It is also found that none of the students in the female institute were smokers, nor tried alcohol and drugs, but that a significant number of students in the male institute did (28.6%, 11.4%, 2.9%, and 12.4% respectively). The study concluded that risky health behaviors are prevalent among teaching institutions students in Tikrit.
Protective role of antioxidant vitamin C in prehypertensive patients in Tikrit city
The cross sectional study was designed to investigate the effect of antioxidant therapy vitamin C 500mg daily dose on prehypertension patient (systolic blood pressure 120-139 and diastolic blood pressure 80-89mmHg) for nine months. The study was performed on 100 patient in both male and female. The result of this study shows that vitamin C was significantly decreased systolic and diastolic blood pressure after six and nine months of treatment. There is some side effect appear in some patient during the course of study as nausea, vomiting, heartburn, fatigue, flushing, headache, insomnia, diarrhea, drowsiness.
Prehypertension patients, stethoscope, sphygmomanometer, vitamin C tablet.