Diyala Journal of Medicine

Background: Acute appendicitis is the most common surgical emergency. The case fatality
rate has fallen to less than 0.1% for uncomplicated appendicitis as a result of early diagnosis
and intervention.
Objective: To evaluate the accuracy of the modified Alvarado score in the preoperative
diagnosis of acute appendicitis and to compare the result of our study with others.
Methods: A prospective study was carried on including seventy eight patients with
presumptive diagnosis of acute appendicitis in Baquba general hospital for one year period (
first of jan. 2001 through 30 first of Dec. 2001 ) and the data were analyzed using a modified
Alvarado score.
Result: The presence of high score was found to be an easy stationary aid to early diagnosis
of appendicitis.
Conclusion: The modified Alvarado score is simple to use easy to apply. Effective
particularly in men while diagnosis laparoscopy is advised in woman to minimize the false
negative appendectomies. Still its validity has to be assessed in pediatric age group.

Background: Antiphospholipid syndrome is a major reproductive complication in women,
that is characterized by recurrent abortion, thrombosis and thrombocytopenia in association
with antiicardiolipin antibodies .
Aims: To estimate the incidence of anticardiolipin (IgM & IgG) antibodies in pregnant
women with the history of recurrent spontaneous abortion .
Design of study Case and Control : Serological estimation by Enzyme Linked
Immunosorbent assay (ELISA) was done for the following tests:
1. Estimation of ACL IgM & IgG in (59) pregnant women.
2. Estimation of ACL IgM & IgG in (20) non pregnant women.
Methods & Materials: Fifty nine women with recurrent pregnancy loss in first and second
trimester were selected and (20) non-pregnant women as control group. Anticardiolipin (IgM
& IgG) antibodies were estimated in the sera by the enzyme linked immnnvsorbent assay
method (ELISA)
Results : The level of positive ACL IgM was 1.95

0.8, negative (0.62

0.3 and control
group o.41

0.21, while the level of positive ACL IgG was 2.2

1.05, negative 0.54

0.28
and control 0.39

0.19 pg/mL.
The results showed 2 of 59 IgM positive, while 7 of 59 IgG positive.
Conclusion: Anticardiolipin antibodies in pregnant women are found to be the important
factor for recurrent abortion especially in the first trimester of pregnancy

Background: Hypoxic-ischemic encephalopathy HIE, causing significant mortality and longterm morbidity as a perinatal depression with cord pH <7.00, Apgar score <3 at 5 minutes of
age with multiple organ involvement .Another form of depression when newborn’s was born
fine then insult seriously within the first seven days of life.
Objective: Compare the outcome of perinatal to those with postnatal fetal depression.
Materials and Method
Retrospective study of infants admitted at birth or within the first 7 days of life to neonatal or
pediatric intensive care and followed over 18months in the women\'s and Hamad teaching
hospitals, Doha, Qatar.
Results: Forty four cases in the study 22 in each group, mean gestational age 36.8wks for
group 1with perinatal HIE compared to 38.8wks for group 2 postnatal HIE(P value 0.04),
Apgar score significantly different, all cases in group1 required resuscitation compared to 8
cases in group 2 (P value 0.00).
Conclusion: The outcome of cases of postnatal HIE was much better than that of Perinatal
HIE. Preterm depressed babies present earlier and more severe than term babies.

Background:Paraumbilical Hernia is more likely to be incarcerated or strangulated so the
repair of such hernia is advisable as early as possible.
Objective: To outcome the benefit of the long period that the drain had been kept in situ after
Paraumbilical Hernia repair for reducing the complications.
Patients and Methods:150 patients were included in this study which had been perform in
Diyala province in the period of January 2004 – December 2006 to whom mayo\'s repair had
been performed for their Paraumbilical Hernia and these patient had been divided in to tow
groups, group(1) which include 75 patients in whom the drain had been left for 48 hours only,
group(2) include 75 patients in whom the drain had been left for 7 days.
Results:We found that in the group (1), 30 (40%) patients had develop seroma collections
and 16 (21.33%) patients had developed wound infection with this seroma, 10 (13.33%)
patients developed hematoma collections and 7 (9.33%) developed wound infection with this
hematoma.
In group (2) we found that only 7 (9.33%) patients developed seroma collection and 3 (4%)
patients developed wound infection with this seroma, 3 (4%) patients developed hematoma
collection and 2 (2.66%) patients developed wound infection with this hematoma.

Background: Enteroccci are part of the normal intestinal flora of human and animal, but with
increasing antimicrobial resistance, enterococci are recognized as serious nosocomial as well
as community pathogens.
Objectives: To investigate the antimicrobial susceptibility patterns of 44 isolates of
enterococci recovered from different pathological specimens from in-and out-patients from
Diyala province.
Materials and methods: The present study was conducted in Baquba General Hospital and
Al-Batool Hospital for Maternity and children during the period from 1st. September/2005 to
30th. September /2006. A total of 343 specimens were collected from 213 inpatients and 130
outpatients. 200 (58.3%) were females and 143 (41.7%) were males. The mean age of patients
was (32.8 ± 17.2) years. Specimens include, urine, stool, vaginal swabs, throat swabs, burn
swabs, blood for culture, middle ear swabs, wound swabs, sputum and cerebrospinal fluid.
Specimens were streaked on blood agar, and other differential and selective media. 44 isolates
of enterococci (30 E. faecalis, 10 E. faecium, 3 E. gallinarium, and 1 E. avium) were
recovered and identified according to standard bacteriological and biochemical criteria. The
susceptibility patterns toward 13 antimicrobial agents were done by disc diffusion method.
Data were statistically analysed.
Results: The results revealed that the highest susceptibility of enterococcal isolates was
toward the Nalidixic acid (79.5%), Ciprofloxacin (61.4%), Amoxacillin+clavilanic acid
(61.4%), Rifampicillin (36.4%),Trimethoprim (22.7%), Vancomycin (11.4%). However, all
isolates were resistant to Cloxacillin, Cefotaxim, Amoxicillin, Tetracycline, and
Erythromycin. The susceptibility of non- β -lactamase producing isolates to penicillin were
significantly higher than β - lactamase producing isolates (p<0.001). Furthermore, the
sensitivity of non-biofilms former isolates were significantly higher than that of biofilms
former isolates (p= 0.002).
Conclusion: The overall susceptibility rates of enterococcal isolates recovered from
nosocomial as well as community acquired infections to available antimicrobials are low.

Background: In countries where the rate of susceptible women to rubella infection is higher
than 10%, preconceptional or prenatal screening is important to reduce the burden of the
disease.
Objectives: determination of anti-rubella IgG seropositivity and susceptibility rates among
pregnant and childbearing women in Baquba-Diyala province.
Subjects and methods: A total of 184 women were enrolled in the present study which was
conducted in Baquba-Diyala province during the period from April/2007 to September/2008.
Ninety eight pregnant women were chosen from those attending the primary health care
centers in Baquba. They include 46(46.9%) who had previous abortions with a mean age 27.2
± 5.3 years, and 52(53.1%) without previous abortion with mean age 23.7± 5.1 years.
Additionally, 86 non-pregnant childbearing women were enrolled as a control group. Of
those, 39(45.3%) had previous abortion with mean age 33.5 ± 7.8 years, and 47 (54.6%)
without previous abortion, the mean age 30.7±7.8 years. Certain demographic factors were
collected by personal interview. Anti-rubella IgG specific antibody were detected by enzymelinked immunosorbant assay (ELISA). Data were statistically analyzed using SPSS version 13
computer assisted program. P value of < 0.05 was considered significant.
Results: The results revealed that the IgG seropositivity among pregnant women without
previous abortion, and those with previous abortion was 96.1% and 76% respectively, with a
statistically significant difference (p=0.04). The seropositivity among non-pregnant women
without previous abortion, and those with previous abortion was 85.1% and 100%
respectively, with a statistically insignificant difference (p= 0.11). The overall susceptibility
rate for rubella infection was 10.7%. There was insignificant effect of age, educational levels,
residency, presence of pregnancy, and history of previous abortion on the seropositivity rate
of IgG specific anti- rubella antibody.
Conclusion: evaluation of the susceptibility of women in the reproductive age to rubella
infection is essential to set a strategy for prevention of congenital rubella syndrome.
Keywords: rubella, congenital rubella syndrome, susceptibility rate.

Objective: to assess echocardiographic structural&functional changes in non rheumatic AF
Patients And Methods: 200 Patients were divided into 3 groups:
Group A: Patients with AF,Group B: Patients have one or more of risk factors (hypertension,
IHD, DM, HF, old age) without AF,Group C: normal healthy individuals.
A full medical history and complete physical examination and the following investigation
were arranged: FBS, RBS, ECG, CXR and echocardiograph.
Result :The study show there is a significance increase in LAD ,LVEDS ,LVEDD and
decrease in fractional shortening in group A &B And group A greater than group B and both
groups greater than group C.
Conclusion: Subjects with increase LA size, LVEDS, LVEDD and decrease in fractional
shortening were at a significance increase risk for development of AF. This study clarifies the
role of cardiac structural& functional characteristics’ in relation to susceptibility to AF .so the
best method for reducing the adverse complication of AF through prevention of development
of A

Background: Impetigo is a contagious superficial pyogenic infection of the skin , caused by
Staphylococcus aureus or Streptococcus pyogenes and some times proteus mirabilis ,
different antibiotics was used for the treatment of impetigo , given topically or systemically .
Objectives: The aim of the present work is to estimate the effectiveness of aqueous extract of
green tea on different types of bacteria which was isolated from children suffering from
impetigo skin infection.
Methods: The study was done in the College of Medicine / Diyala University. Forty two
samples with positive bacterial cultures, were obtained from the skin lesions of children with
impetigo infection, they were tested by doing antibiotic sensitivity test of different antibiotics
and the resistant cultures of different types of bacteria , which was isolated from infected
patients were tested by 10% aqueous extract of green tea .
Results: The study revealed that 10% aqueous extract green tea was effective as antibacterial
agents, against antibiotic\'s resistant strains of Staph .aureus, Strep. Pyogenes and Proteus
mirabilis.

Background: The rapid increase of mobile telephony and the associated obvious presence of
mobile phone base stations have raised concerns about possible non specific health symptoms
(NSHS) caused by emitted microwaves, electromagnetic field (EMF), radiofrequency (RF)
and radiofrequency electromagnetic radiations (RFR)
Aims: To investigate the health effects among the residence proximity to mobile phone base
station in Baquba city.
Materials and Methods: A cross-sectional study from May 2010 till June 2010 of randomly
selected inhabitants living in Baquba urban areas for more than one year near to (8 )selected
base stations, (375) subjects (200 women and 175 men) were investigated and completed
standardized questionnaires that focused on the relevant parameters.
Result: The results of the questionnaire survey reveal that people living in the vicinity of base
stations report various complaints frequencies, Chi-square with Yates correction were used in
relation to the sex, age and distance from mobile base stations, show significant (p <0.05)
increase as compared to people living >300 m or not exposed to base stations. In relation of
sex; women complained mostly of nausea, headaches, men complain mostly of lowering of
libido. In relation to age, in subjects older than 19 years, this study shows the existence of a
greater sensibility for some NSHS symptoms such as headaches, fatigue, sleep disturbances,
irritability, feeling of discomfort, dizziness, cardiovascular problems when comparisons are
made between subjects living up to 300 m vs. subjects of the reference group. In relation to
distance, the complaints are experienced in a significantly higher (p <0.05) by the subjects in
the distance zones of < 10 m to 300m from base stations. Up to10m the symptoms are
headaches, sleep disturbances, irritability, depressive tendencies, feeling of discomfort, loss of
appetite, nausea, difficulties in concentration, , visual disturbances, lowering of libido.
Significant differences (P < 0.05) are observed up to 100 m from base stations for symptoms
such as: headaches sleep disturbances, irritability, depressive tendencies, feeling of
discomfort, difficulties in concentration, memory loss and lowering of libido. In the zone 100
m to 200 m from base stations, the symptoms of headaches, sleep disturbances, feelings of
discomfort, feeling of discomfort, difficulties in concentration, memory loss are again
experienced significantly more often(P<0.05) in comparison with the reference group.
Beyond 200 m only the symptom of headaches, fatigue, sleep disturbances is reported at a
significantly high frequency (P < 0.05). There was significant increase in the prevalence of
sleep disturbance, fatigue, feeling of discomfort among the inhabitants opposite to the station
(20.8% versus 10.9%, 23.4% versus 9.8%, 26.0% versus 12.0%) (P < 0.05) respectively.
Conclusions:
1. This study shows that inhabitants living nearby mobile phone base stations are at risk for
developing non specific health symptoms, the facing position appears to be the worst one for
distances from cellular phone base stations < 100 m, so more research concerning the effects
of radiofrequency radiation from base stations is indicated.
2. It is advisable that cellular phone base stations should not be sited closer than 300 m to
populations, as a precautionary measure, sitting of base stations should be such as to minimize
exposure of neighbors.
Recommendations: Revision of standard guidelines for public exposure to RER from mobile
phone base station antennas, regular assessment and early detection of biological effects
among inhabitants around the stations are recommended.

Back ground :- The present study introduced the age changes in the parameters of the
submandibular salivary glands (SMSGs) of twenty-four volunteers subjects.
Aims: ultrasonographical and structural age changes study of sub mandibular salivary glands
in living human and cadavers.
Materials and methods: the study considered ; twenty four volunteers and sixteen male
cadavers. The cadaver\'s weighed and grouped according to ages; G (A) 20-25 years, (B) 30-
35 years, (C); 45-50 years, and group (D) 60-70 years. The same grouping manner applied to
the ultrasonographic study. Cadavers with diseased history of the (SMSGs), or maxillofacial
trauma were excluded.
Results; The histological findings revealed that there was; a decrease in the number of serous
demilunes, but an increase in the diameter of both serous and mucous acini with, proportional
increases of the serous acini, and an increase in the diameter of striated ducts during the
increase of age. The thickness of the interlobular connective tissue were increased with
advancing age, as well as the number of adipose cells.
Conclusion; The sonographic, and gross anatomical parameters showed little but no
significant changes during the ages considered in this experimentation, so for the weight and
dimensions of the glands.

Background: Hepatitis B and human immundifficiency virus (HIV)infection is a major
health problem in multi-transfused patients and in general population world wide .Vaccination
with hepatitis B vaccine and routine screening of transfused blood are mandatory measures
for prevention.
Aim: To identify the prevalence of hepatitis B and human immundifficiency virus infection
among thalasemic patients in Diyala and to show some relations to some personal factors.
Results: High prevalence of hepatitis B among Thalassemic patients (P value =0.000),
Incompletely vaccinated patients are liable for infection even when received screened blood
(P value =0.000). There is no patient with positive test for human immunodeficiency virus (P
value =0.0000). There is no significant association with splenectomy and number of blood
transfusions during last year.
Conclusion:High prevalence rate of hepatitis B among Thalassemic patients, in comparison
with the rate registered in other countries.

Background: Otitis media is one of the well known diseases that infect children and adult.
The severity of infection caused by the members of the genus Proteus depends mainly on the
availability of virulence and pathogenicity factors.
Objectives: to detect and evaluate the presence of virulence factors in local isolates of
Proteus species causing otitis media.
Patients and methods: Two hundred and seventy ear swabs were collected from patients
with otitis media attended Baquba General Hospital for the period from. Swab were cultured
on blood, MacConkey and chocolate agar plates and incubated at 370C for 24 hrs. Chocolate
agar plates were incubated under 10% CO2 (Candle jar). Suspected colonies of proteus
species were isolated and subcultured on MacConkey agar. The identification of bacterial
isolate was performed according to the standard biological and biochemical methods.
Virulence factors including; urease, β-Lactamase and extended spectrum β-Lactamase
(ESBLs), Human and ovine blood agglutination and adhesion to epithelial cells, hemolysin,
esterase and proteolytic enzymes were detected following standard biochemical methods.
Biofilm formation was detected by enzyme-linked immunosorbant assay.
Results: Out of 270 ear swabs, 240 (88.9%) were positive for bacterial growth and of these
35 (12.9%) were identified as of Proteus species. Following the standard biochemical and
enzymes tests, 7 (2.6%) was found to be Proteus vulgaris and 28 (10.4%) were Protues
mirabilis.
Conclusion: P.mirabilis appeared as one of the causative agent of otitis media in patients
from Diyala province, and most isolates have multiple virulence factors that may increase
their infectivity and worsen the clinical picture of the disease.

The objective of this study is to evaluate the impact of prostate-specific antigen density (
PSDA ) when serum levels of prostate-specific antigen ( PSA ) are less than 10 ng\\ml in
predicting prostate cancer. We retrospectively analyzed 134 patients who underwent trans
rectal ultrasound ( TRUS )-guided prostate biopsies according to Cooner\'s algorithm.
Histopathological examination revealed prostate cancer ( PCa ) in 22 ( 16% ) and begin
prostatic hypertrophy ( BPH ) in 112 ( 84% ) patients.
Five patients ( 23% ) with PCa had PSAD<0.15 of whom 3 had PSA<4 ng\\ml and 2 had PSA
between 4 and 10 ng\\ml. In the BPH group, 60 patients ( 54% ) had PSAD below 0.15
whereas 52 patients ( 46% ) had PSAD over 0.15 . with 0.15 as the cutoff level of PSAD, the
sensitivity and specificity of PSAD was found as 77 and 54%, respectively. In this patient
population, PSA with the cutoff level of 4 ng\\ml has sensitivity and specificity level of 77 and
33% respectively. According to these result, a statistically significant difference was found
between PSA and PSAD only in terms of diagnostic specificity ( chi-square, P<0.05 ) . There
were 29 patients with negative digital rectal examination ( DRE ) and TRUS and PSA 4-10
ng\\ml who underwent biopsy because of PSAD>0.15 . no cancer was detected in this group of
patients, suggesting that biopsy in this subgroup may be unnecessary.

The aim of this study was to evaluate the performance of anti-cyclic citrullinated peptide
antibodies (anti-ccp) versus Rheumatoid Factor (RF) in the diagnosis of rheumatoid arthritis
in serum sample of patients with clinical manifestation of arthritis using ELISA technique.
One hundred and twenty patients with clinical presentation of rheumatoid arthritis and fifty
apparently healthy individuals (25 males and 25 females) were enrolled in this study. The
mean age of patients group and control was 36.45years versus 34.72 years .Among patients,
males represented (8.3%) compared with (91.7%) of females. In control group males
represented (52%) versus (48%) females.
There was a statistical significant difference (p>0.05) between patients and control group in
RF and anti-ccp values. Eighty five percent of patients gave positive results for anti-ccp
compared with (100%) negative results in control group. RF was detected in (41.66 %) of
patients sera compared with (58.33 %) which gave negative results. RF ELISA gave negative
results in (100%) of control group .
Only 10(8, 33%) out of 120 patients gave negative results in RF and anti-ccp ELISA,
compared with 42(35%) out of 120 gave positive results in both tests. In 60(50%) out of 120
RA patients RF gave negative results and at the same time gave positive results when retested
using anti-ccp ELISA .Only 8(6.66%) out of 120 RA patients gave negative result in anti-ccp
ELISA technique and RF was detected in positive value.
The sensitivity of anti-ccp ELISA was (85%) versus (41.66%) for RF. The Specificity of anticcp ELISA was (55.55%) versus (14.28%) for RF. Positive predictive value for anti-ccp
ELISA was 41.17% versus (84%) for RF. Negative predictive value for anti-ccp ELISA was
55.55% versus 14.28 for RF ELISA .False positive value in anti-ccp ELISA was 58.82%
versus 16%for RF ELISA. False negative value in anti-ccp ELISA was 44.44% versus
85.71%for RF .
This study concludes that anti-ccp ELISA was more sensitive and specific in diagnosis of RA
than RF ELISA technique.

Objective: To determine the possible role of cockroaches as a transmitter of medically
important microorganisms, pathogenic organisms were isolated and identified from external
and guts of cockroaches trapped at hospitals and houses.
Methods: One hundred and fifty two cockroaches were collected from different parts of
hospital and houses around it. They were collected for isolation and identification of bacteria
and parasites from external surface and internal digestive tract of cockroaches. Statistical
analysis was done by using t- test.
Results: This study show that high rates of cockroaches show contamination of medically
important bacteria and parasites. The species of the pathogenic agents was determinate and
the number and percentages of infected cockroaches was recorded.
Conclusion : And for this, cockroaches act as a potential transmitter of medically important
pathogenic and may cause of nosocomial infection in both hospitals and houses. Therefore,
control of cockroaches will substantially minimize the spread of infectious diseases in our
environment.
Key words: cockroaches, Bacteria, Parasites.