Diyala Journal of Medicine

Abstract
Background: Clinical studies show strong associations between hormone
levels, particularly estrogens and the development of skin cancers. Cutaneous
melanoma is considered a hormone-related tumour; however, their role in
melanoma progression remains unclear.
Objective: To investigate the effects of a phytoestrogen-rich diet on
melanoma tumour initiation and development using a syngeneic mouse model.
Patients and Methods: Mice were fed either a phytoestrogen-rich or low
control diet and injected subcutaneously with 5 × 10⁵ syngeneic melanoma
cells (B16-F10). After 10–12 weeks, tumours and spleens were collected.
Tumour size and weight were measured, and quantitative PCR (qPCR) was
performed to analyse the expression of estrogen receptor (ER) α and β.
Regulatory T cells (Tregs) from splenocytes was assessed via flow cytometry.
Results: Mice consuming the phytoestrogen-rich diet exhibited significantly
larger tumours compared to those on the control diet. Phytoestrogens in the
diet up regulated ERβ and down regulated ERα mRNA expression in tumour
tissue. A significant increase in the proportion of splenic Tregs was observed
in tumour-bearing mice fed a phytoestrogen-rich diet.
Conclusion: This study highlights the influence of dietary composition on
tumour growth and associated immune responsiveness, emphasising the need
to account for dietary factors in experimental designs and their potential
impact on tumour biology.

Abstract
Background: Radiotherapy is an important part of the treatment paradigm
for many patients with rectal and cervical malignancies. With the
development of more powerful 3D conformal treatment planning tools, the
clinical application of three-dimensional conformal radiation therapy (3D
CRT) has gained recognition for its potential to enhance treatment results for
these patients.
Objective: To assess which cancer type benefits more from the (3D-CRT)
technique by comparing its effectiveness for rectal and cervical cancer, with
a focus on dosimetric outcomes.
Patients and Methods: A retrospective analysis conducted from August
2023 to January 2024 assessed ten cases of rectal cancer and ten cases of
cervical cancer, who treated with 3D-CRT technique at Awat Radiation
Oncology Center (AROC), Erbil. Many dosimetric parameters, including
mean dose (Dmean), minimum dose (Dmin), maximum dose (Dmax), target
volume coverage (D95%), homogeneity index HI, conformity index CI, and
the dose that is received by the organ at risk, have been evaluated in order to
determine the efficacy of 3D-CRT technique for both cancers.
Results: Rectal cancer showed higher conformity and homogeneity index in
the PTV int_sum phase (0.87 ± 0.05), (0.16 ± 0.02) compared to cervical
cancer (0.66 ± 0.21), (0.19 ± 0.01), indicating better alignment of prescribed
dose with target volume and more consistent dose distribution within the
target volume. For organs small bowel (V45 < 195cc) and bladder (V45 <
50%), rectal cancer exhibits very high significantly superior sparing in
comparison to cervical cancer, displaying lower average volumes and
percentages of these organs receiving 45 Gy (p <0.001 for both).
Conclusion: The investigation demonstrated that 3D-CRT offered better
target coverage, dose homogeneity, and conformity for rectal cancer. Plans
for rectal cancer also showed improved bladder and rectum sparing.

Background: Hepatitis B virus (HBV) is a common and international
problem associated with severe liver diseases. Programmed cell death-1
(PCD-1) is an immunosuppressive molecule that negatively regulates T-cell
activity. Genetic variation in PCD-1 gene could impact the encoded protein,
and, thus HBV infection.
Objective: To assess the single nucleotide polymorphisms (SNPs) in the
PCD-1 gene's promotor area effect of viral load and HBV infection.
Patients and Methods: This case-control study recruited 117 subjects (67
patients with HBV and 50 apparently healthy persons as control). From June
2024 to November 2024, all subjects had been selected at the
Gastroenterology and Liver Hospital-Medical City (Baghdad, Iraq). Every
participant donates about 5 mL of blood extracted from a vein and stored at
80 °C until it was needed. Blood samples were used to obtain genomic DNA,
and gene fragment corresponding the rs38084323 polymorphism in PCD-1
gene was amplified and genotyping by polymerase chain reaction-restriction
fragment length polymorphism (PCR-RFLP).
Results: The patients' and controls' mean ages did not differ significantly,
out of the 67 patients, 39 (43.28%) had an acute infection, and 38 (56.7%)
had a chronic infection. Merely 34.33% of the patients were receiving HBV
specific therapy. Patients having the mutant homozygous genotype (GG) of
rs38084323 were significantly more likely to have it (28.36% vs. 14%) (OR=
3.34, 95%CI= 1.07-10.38, p= 0.037). On the level with allele, the G allele
was more often found in patients than in healthy subjects (54.48% vs. 41%),
demonstrating an important disparity (OR=1.72, 95% CI=1.02-2.91,
p=0.042). The various genotypes did not substantially affect the progression
of infection to a chronic status. Although, 30.77% of patients carrying the
AA genotype had viral ≥ 200000 IU/ml compared with 5.71% for AG
carriers and 15.79% for GG carries with such a viral load, and these results
were shown significant difference.
Conclusion: The homozygous mutant genotype (GG) and G allele may be
regarded as an indicator of risk for HBV infection. However, their impact on
viral load is negligible.

Abstract
Background: Curcumin oral gel is one example of a traditional herbal
medication, it has shown potential in several pharmaceutical uses. Oral
mucositis is commonly prevent and treat using magic solution, a mouthwash
that contains a combination of pharmaceuticals. Tumor necrosis factor- α and
Interleukin-6 are salivary cytokines stimulates the immune response and
promotes inflammation during infection or other tissue damage causes
inflammation.
Objective: To determine the effect of curcumin oral gel on salivary tumor
necrosis factor-α and interleukin-6 levels in head and neck cancer patients
under concurrent chemoradiation induced oral mucositis.
Patients and Methods: Two groups of forty-five patients each, with a total
of ninety head and neck cancer patients receiving concurrent
chemoradiation. Enzyme-linked immunosorbent assay measured salivary
tumor necrosis factor-alpha and interleukin-6 levels. Oral mucositis was
assessed by WHO scale.
Results: Patients who took oral curcumin gel had less severe oral
mucositis and lower salivary levels of tumor necrosis factor-alpha and
interleukin-6. WHO scale between the two groups showed significant
differences at 2 weeks (P = 0.041) and 6 weeks (P=0.02).
Conclusion: Study concludes that curcumin oral gel might reduced
salivary tumor necrosis factor-alpha and interleukin-6 levels and may
serve as an al

Abstract
Background: The increasing frequency of temporomandibular joint
dysfunction requires the promotion of diagnostic and therapeutic approaches.
The several etiologies of dysfunction are still poorly understood. Numerous
studies have talked articular eminence shape as a probable causative factor
for this dysfunction.
Aims of the study: The aim of this study was to measure of articular
eminence inclination, depth of glenoid fossa and width by cone beam
computed tomography in patients with temporomandibular joint disorder
conferring gender and side and compared with healthy control.
Patients and Methods: Study samples embraced of fifty-five individuals
(110 joints), were twenty patients with intra articular disorders of
temporomandibular joint, fifteen patients with degenerative disorders of
temporomandibular joint and twenty control group with age range from (20
55) years old.
Results: The results display females appear to stay more affected by
disorders of temporomandibular joint. The articular eminence inclination
showed higher mean value in the right side than left side and in males than
females. Also, glenoid fossa depth and width was higher mean value in the
right side than left side and in males than females. The results recorded mean
value of articular eminence inclination in control group higher than patients
with temporomandibular joint disorders, while mean value of glenoid fossa
depth and width in control group less than patients with temporomandibular
joint disorders.
Conclusion: Females look to be more affected by temporomandibular joint
disorders. The glenoid fossa width and depth were also less in the control
individuals

Background: The evaluation of compressed breast thickness has been
conducted based on the results of mammography examinations. While it is
well-established that breast compression influences breast tissue, its effect on
the axillary (armpit) region remains unclear. Increased compression of breast
tissue in women can lead to a reduction in breast tissue thickness.
Objective: To determine the correlation between entrance surface skin
exposure with compressed breast thickness and compare the mean of
entrance surface skin exposure results from mammography in Iraq with other
studies.
Patients and Methods: A study was conducted at Al-Alwiya Teaching
hospital from December 2023 to January 2024 and involved 100 Iraqi
women. The study used a mammography (model GE healthcare) to
determine compressed breast thickness and skin exposure for craniocaudal
and mediolateral oblique projections.
Results: The mammography findings revealed a statistically significant
correlation between entrance surface skin exposure (ESE) and compression
breast thickness (CBT) in Iraqi women. Specifically, it was observed that
increased CBT was associated with higher ESE values.
Conclusion: The study demonstrates that breast compression thickness and
radiation exposure were notably higher in the mediolateral oblique (MLO)
view compared to the craniocaudal (CC) view. A significant positive
correlation was observed between compression breast thickness and
radiation dose. These findings underscore the importance of region-specific
guidelines and standards in mammography practices to ensure optimal
patient care and safety.

Abstract
Background: Ultrasound elastography (USE) is a non-invasive technique
for distinguishing benign from malignant thyroid nodules. It uses strain ratio
to determine thyroid nodular stiffness, however it has limitations when no
normal thyroid tissue is present.
Objective: To assess the diagnostic performance of USE in the prediction of
malignant thyroid nodules by assessing the strain ratio comparing the normal
thyroid tissues as a reference and sternocleidomastoid muscle as a second
reference.
Patients and Methods: The study was conducted on 33 patients with single
TIRADS III or IV nodules at Al-Imamein Al-Kadhimein Medical City in
Baghdad-Iraq for 5 months (August 25th, 2020 to January 15th, 2021), using
both gray scale and real-time USE on a Voluson- E6 Ultrasound machine.
Final diagnosis has been obtained by cytology and/or histopathology.
Results: The study involved a total of 33 patients, with 78.8% female and
21.2% male. Of these, 72.7% were benign, and 27.3% were malignant. The
thyroid nodules were hypoechoic, taller, and micro calcified. The
parenchymal-nodular SR of all thyroid nodules ranged from 0.55-6.0, while
the muscle-nodular SR ranged from 0.42-5.25. The best (strain ratio) SR
cutoff value was (≥3.63) for parenchymal-nodular SR, with sensitivity,
specificity, and accuracy rates were 100%, 85%, and 89.2%, respectively.
Conclusion: The study found that sternocleidomastoid muscle has high
sensitivity, specificity, and accuracy in predicting thyroid malignancy and
differentiating benign from malignant nodules so making it safe for use in
certain cases.

Abstract
Background: Colon cancer is an uncontrolled growth of cells that begins in a
part of the large intestine called the colon. The colon is the first and longest
section of the large intestine. The possible causes of colon cancer are genetic,
environmental and nutritional factors. This study was prepared to help in
identifying the causes and predicting the occurrence of colon cancer.
Objective: To identify the possible factors as causes of colon cancer in a group
of patients in Diyala Governorate - Iraq.
Patients and Methods: In this study, blood serum samples were collected
from 60 patients with colon cancer. 30 serum samples were collected from
non-colon cancer patients who were considered a control group. The levels of
alpha-meprin enzyme, catalase enzyme, nitric oxide and interleukin 12 were
measured by immunoassay using the ELISA device.
Results: The results showed that the levels of Meprin alpha and interleukin 12
had statistically significant values, as their levels were higher than the control
group, while the levels of catalase and nitric oxide were low when compared
to the control group.
Conclusion: It was found that there is a significant positive correlation
between meprin alpha and interleukin 12, and there was an inverse correlation
between meprin alpha and catalase and nitric oxide. The results of our study
indicated that the reason for the increase in meprin alpha and interleukin 12 is
related to colon cancer.

Abstract
Background: Developmental assessment is a systematic and comprehensive
process that evaluates a child's progress across multiple domains of
development to identify potential developmental delays or disabilities.
Objective: This study aimed to assess the development of Iraqi children aged
2-60 months residing in Diyala province, compare it to other states, and
estimate the prevalence of developmental delay.
Patients and Methods: A total of 330 samples from children were recruited
from Al-Batool Teaching Hospital for Maternity and Children over a six
month period, from October 2022 to March 2023. The Ages and Stages
Questionnaire (ASQ3) was used to assess the children's development. The
ASQ3 is a standardized tool used to screen for developmental delays in
children aged 2-60 months. The ASQ3 scores are divided into three areas:
white (normal development), black (delayed development), and gray (critical
zone).
Results: The study results showed that most of the children (97.6%) had
normal development across all domains of development. However, 2.42% of
the children had developmental delay, including two children (0.6%) with
delayed speech and communication only and six children (1.8%) with global
developmental delay in all areas. In addition, a proportion of children were
situated within the gray area of the ASQ3 system, which indicates the need for
further assessment to evaluate specific aspects of a child's development that
may warrant closer attention. The proportion of children in the gray area
ranged from 0% to 34.5%, depending on the development domain.
Conclusion: The results of this study suggest that most children in Diyala
province have normal development. However, a small percentage of children
have developmental delays, and a proportion of children are situated in the
critical area and need further assessment.

Abstract
Background: Helicobacter pylori and matrix metalloproteinase-9 (MMP-9)
play a significant part in the pathophysiological processes and expression of
carcinogenesis, particularly in laryngeal Squamous Cell Carcinoma (LSCC).
Objective: Explore the link between the H. pylori bacterium, MMP-9
expression, and laryngeal squamous cell carcinoma development by
examining the role of chronic inflammation and extracellular matrix
remodeling in laryngeal carcinogenesis.
Patients and Methods: This cross-sectional study recruited 118 tissue
samples, including 58 malignant LSCC and 60 benign laryngeal polyps (BLP).
Histopathological and immunohistochemical methods were used to assess the
interplay of H. pylori, MMP-9, and smoking status in laryngeal tumors.
Results: The prevalence of H. pylori was significantly higher in malignant
lesions (63.79%) as compared to benign lesions (51.66%) (p=0.1). A
significant correlation was found in patients with benign lesions between the
level of MMP-9 and smoking and H. pylori status (r = 0.46, p = 0.001), and (r
= 0.5, p = 0.001), respectively. While in patients with malignant lesions, the
correlation test revealed a significant negative correlation between the level of
MMP-9 and smoking status (r = -0.41, p 0.001), while H. pylori is a highest
positively correlated with MMP-9 expression (r = 0.5, p = 0.001). The logistic
regression analysis revealed that H. pylori infection could significantly predict
high MMP-9 expression (OR =3.08, 95% CI: 1.15-8.28, p = 0.02).
Conclusion: These findings highlight the crucial role of H. pylori infection
and smoking in tumor progression through MMP-9-mediated extracellular
matrix remodeling, inflammation, and immune modulation. Suggesting the
potential impact of targeting H. pylori infection and MMP-9 activity for
managing carcinogenesis.

Abstract
Background: Hidradenocarcinoma is a rare, aggressive tumor with a high rate
of local recurrence and distant metastasis. There are no current management
guidelines, and surgery has been used to control the primary disease. Even
with wide surgical excision, the course of the tumor is unpredictable, and the
prognosis for survival is poor. The most common location is the scalp,
followed by the extremities, and rarely the trunk.
Objective: To present a rare recurrent hidradenocarcinoma in the abdominal
wall with no distant metastasis.
Case presentation: We present a rare case of recurrent hidradenocarcinoma
on the abdominal wall in a 56-year-old male with no known distant metastasis
treated with wide surgical excision.
Conclusion: This case represents the second reported case of
hidradenocarcinoma involving the abdominal wall in the literature. Wide
surgical excisions of the tumor with wide safe margins carry excellent
outcomes on 5-year follow-up.