Diyala Journal of Medicine

Background: Pemphigus vegetans is a very rare form of pemphigus vulgaris , with a similar
etiology and early histological changes , it comprise only 1-2% of cases and of two variety
(Neumann and Hallopeau) . It begins and ends as pemphigus vulgaris clinically and
histologically , but many of the denuded areas heal with verrucous vegetations and epidermal
hyperplasia , that may contain small pustules in the early stages .
Objectives: The study was done to identify that pemphigus vegetans may be manifested for
the first time on the body of the nose , as a well defined , indurated , slightly elevated
verrucous , hypertrophic and erythematous plaque .
Patients and methods : Eight patients were seen in the Department of Dermatology and
Venereolgy in Baghdad and Baquba Teaching Hospitals , during the period from Nov. 2001
to Dec. 2004 . All of them were males with a mean age of 45 years (their ages ranged from
30-81years) . They complained of vegetating plaques on the body of the nose , which were
diagnosed clinically and histologically as pemphigus vegetans and treated by topical
clobetasol dipropoint 0.05% ointment twice daily and 40mg /day prednisolone as a single oral
morning dose .
Results: The study shows that pemphigus vegetans may be manifested for the first time on
the body of the nose , as a well defined slightly elevated erythematous , verrucous and
hypertrophic plaques , with typical histological changes of pemphigus vegetans and good
response to topical clobetasol dipropoint as 0.05% ointment and oral prednisolone 40mg /day
as a single dose .

Background: Intranasal adhesion is one of the common complications following nasal
surgeries. Using nasal splint during the surgery is one of the methods for prevention of this
complication.
Objectives: To determine the value of intranasal splints in preventing adhesion formation
after septoplasty.
Patients and methods: This is a prospective study done in Rizgary Teaching Hospital - Erbil
city from 1st August 2010 to 31st January 2011. Sixty patients included in this study. Their
age range were18-38 years old. Intranasal splint used during septoplasty in half of them.
Follow up done for all patients at same interval.
Results: Intra nasal adhesion developed in one patient (3.5%) of splinted group, while
adhesions occurred in three patients (10.0%) of non splinted group. One patient (3.5%) among
male while three patients (10.0%) among females developed intranasal adhesion. One patient
(3.0%) among those with right septal deviation while three patients (10.5%) among those with
left septal deviation had adhesion. There was no difference in Adhesions development in both
sides of the septum.
Conclusion: There is no statistically significant difference in intranasal adhesion
development between splinted and non splinted group and no statistically significant
influence of the gender and side of septal deviation on the adhesion formation.

Background: Cancers of the oral cavity and oropharynx represents approximately three
percent of all malignancies in men and two percent of all malignancies in women in the
United State.
Squamous cell carcinoma, which arises from the oral mucosal lining, accounts for 90%- 95%
of oral cancer.
Objective: aim of this study is to detect oral cancers in Sulaimania and to know what is the
most common type and its commonest location in comparism to other studies.
Patients&Methods: During the period from 1st Jan. 2004 to 30th June 2009, all
histopathological reports in Sulaimani city with diagnosis of oral cancers for patients attended
and performing biopsies for suspected oral lesions were included.
These biopsies were received, processed and embedded in paraffin, sectioning, then stained
by Haematoxylin and Eosin stain.
All collected information were analyzed according to age, sex, site and histopathological
diagnosis.
Results: Oral cancers were diagnosed in 82 out of 665 oral lesions (represented as 12.33%
from the total number of oral lesion biopsies).Squamous cell carcinoma (SCC) was the most
common type of the malignant neoplasm of oral cavity found in 46 cases (56.1% ).Most
frequent cases found in the age distribution range between 50 -70 years with M: F ratio 1.2:1.
The most common affected site was the lower lip(39%) followed by the tongue(20%).
Malignant neoplasms of salivary glands included 16 cases (19.6%),female 10, male 6 with
F:M ratio is 1.66:1.
Conclusion: The most common oral cancer in sulaimania is SCC of oral mucosa affecting
mainly the old age group, and males affected more than females, and the most common
location is the lower lip. The second most common cancer is salivary gland carcinoma and
commonest histological type is adenocarcinoma.

Background: Septal deviation usually associated with compensatory hypertrophy of the
contralateral inferior nasal turbinate. The current treatment of anterior septal deviation is
septoplasty but there is controversy about surgery for the hypertrophied inferior turbinate
Objectives: This study aims to determine the effect of septal surgery alone (septoplasty) on
the hypertrophied inferior turbinate.
Patients &Methods: This prospective study was done on 36 patients attended ENT
department at Rizgary Teaching Hospital during the period from 1st August 2010 through
31st January 2011, their age ranged from 18-38year with septal deviation and inferior
turbinate hypertrophy. All of them underwent septoplasty alone without turbinate surgery.
The thickness of the hypertrophied inferior turbinate was measured before and after surgery
by CT scan of paranasal sinuses coronal section.
Results: Septoplasty significantly decreased the thickness of the medial mucosa of
hypertrophied inferior turbinate by 1.14mm at the anterior part, 0.75mm at the middle part
and 0.59mm at the posterior part, and it decreased the thickness of the lateral mucosa as well
but to a lesser extent.
Conclusion: Inferior turbinate hypertrophy, especially in the medial mucosa, reverses 4-6
months after septoplasty without turbinate surgery

Introduction: Primary carcinoma of the gallbladder is an uncommon, aggressive malignancy
that affects women more frequently than men. Older age groups are most often affected, and
coexisting gallstones are present in the vast majority of cases. The symptoms at presentation
are vague and are most often related to adjacent organ invasion, and the radiologic findings in
early-stage cancers are subtle and may mimic those of acute or chronic cholecystitis and many
gallbladder carcinomas are diagnosed in an advanced stage ,therefore, despite advances in
cross-sectional imaging, early-stage tumors are not often encountered.
Objectives: To determine the utility of ultrasound and multidetector CT imaging in the
surgical management of gallbladder carcinoma. It provides a road map for surgical procedures
to be taken.
Materials and Methods: The data from 40 patients with histologically proven adeno
carcinoma of gallbladder from the period of March 2006 to December 2010 analyzed, in a
prospective study done in Rizgari teaching Hospital and Soran Diagnostic center
Results: Preoperative detection rate of both ultrasound and CT scan was 60% and the
diagnostic accordance rate before and after operation was low in early stages T 1 & 2 (23.5%)
versus (86.9%) in advanced stages T 3 & 4. The female to male ratio was 4:1. The gallstone
was closely related to gallbladder carcinoma and was seen in 90% of cases.
Conclusion: proper utilization of different imaging modalities is essential for early detection
and treatment options of gallbladder carcinoma by using comprehensive imaging techniques
like dual Phase multidetector CT coupled with 3D volume rendered reconstruction.

This study was carried out in Baghdad , on 150 individuals (82 females, 68 males ) , were
divided into four groups on the bases of parasitological and serological findings : group I :
Control healthy Individuals : negative for toxoplasmosis and E . histolytica and G. lamblia
( 20, 13.3% )group II : positive for toxoplasmosis alone (30 , 20%), group III: positive forE
histolytica ,and G. lamblia (63 , 42%), group IV: positive for toxoplasmosis , E . histolytica
and G . lamblia ( Mixed infection 37 , 24.7% ).
The results of this study showed highly significant increase in serum levels of interleukin
-12 ( IL- 12 ) in all groups especially in group IV , followed by group II .The serum level
of Interferon –gamma ( IFN-  ) showed also significant increase(P <0.05)in group IV,
followed by group III , but nonsignificant (P >0.05) in group II .
There was also significant increase in serum concentration of IgG , IgM,and IgE in group
IV , but nonsignificant level was recorded in IgE of group II .
When comparing group II with the group IV , there was significant difference in serum
levels of IL-12 , IFN- , IgG , IgM and IgE .
It was concluded that mixed infection with these parasites could provide a strong synergestic
action to induce both cell mediated and humoral immunity .

Background: Although the prevalence of hepatitis C virus infection among the general
population is generally low; however, the risk of chronic hepatitis C virus infection is still
high in certain groups of patients particularly multiple recipients of blood or blood products
Objectives: The present study aimed to determine the hepatitis C virus infection rate among
unpaid blood donors and certain risky population in Diyala province.
Materials and methods: The present study was conducted in Diyala province for the period
from1st. August/ 2009 to 30th./May 2010. A total of 248 subjects were included and
categorized in 4 study groups namely; unpaid blood donors, healthcare workers, thalassemia,
hemodialysis patients. Blood samples were collected; sera were separated and kept frozen till
use. Detection of anti- hepatitis C virus antibody was carried out in the Public Health
Laboratory in Baquba, using the third generation ELISA technique (Bioelisa hepatitis C
virus). Repeatedly positive sera by ELISA were confirmed by immunoblot assay (Lia Tek
hepatitis C virus III) in the Central Public Health Laboratory-Baghdad. Data were statistically
analyzed.
Results: the results showed that the higher hepatitis C virus infection rate was recorded
among thalassemia patients (26.2%), followed by hemodialysis patients (21.7%) and
Healthcare workers (3.3%), while the lowest infection rate was recorded among blood donors
(1.1%). Neither age nor gender has significantly increased the hepatitis C virus infection in
study groups. hepatitis C virus infection increased as the duration of hemodialysis prolonged.
Conclusion: the hepatitis C virus infection rate, although it is acceptable among blood donors,
but is still high among certain risky population in Diyala province.

Back ground: Several previous reports on the association between hepatitis C virus (HCV)
infection and certain human leukocyte antigens (HLA) have yielded controversial results.
Objectives: This study was conducted to explore the association of HCV infection and
certain HLA in patients from Al-Ramadi Province.
Subjects and methods: Thirty two patients with chronic HCV infection as well as 64
apparently healthy individuals and 30 patients with clinically evident acute viral hepatitis, but
HCV negative were enrolled in the present study which was conducted in Al-Ramadi city for
the period from August/2004 to May/2006. HCV infection was diagnosed by detecting the
anti-HCV antibody by enzyme-linked immunosorbant assay (ELISA) and confirmed by
Immunoblot assay. Determination of HLAs was done by Microlymphocytotoxicity technique.
Results: The results revealed that the presence of HLA-DR5 (Odd ratio 2.7, P 0.022) and
HLA-DQ2 (Odd ratio 3.1, P= 0.008), and the absence of HLA-DR7 (Inverse Odd ratio 3.2, P
= 0.04) and HLA-DQ1 (Inverse Odd ratio 2.8, P= 0.012) were associated with significantly
increased risk for HCV infection as compared to healthy controls. On the other hand, the
presence of HLA-DR5 (Odd ratio 6.5, P= 0.005) and HLA-DQ2 (Odd ratio 5.1, P= 0.002),
and the absence of HLA-DR7 (Inverse Odd ratio 4.8, P= 0.018) were significantly associated
with increased risk for HCV infection.
Conclusion: Genetic predisposition may play a role in hepatitis C virus infection in patients
from Al-Ramadi city.

This study designed to evaluate the clinical usefulness of IgE as a serological marker for
diagnosis of nodular scabies.
Sixty eight patients suffering from nodular scabies and twenty apparently healthy subjects as
control group were included .The mean age of patients group was ( 31.67±1.67)years
compared with (33.5 ±2.27) years in control group .Among patients group, males
represent(76.5%) compared with (23.5%) females. Among control group males represent
(55%) versus (45%) females .The mean of IgE concentration among control group was
(59.25 ± 5.36 U/ml) compared with (160.16 ±16.78 U/ml )among patients group with
statistical significant difference (p>0.05 ).In (34/ 68) of scabietic patients, the concentration
of IgE was lower than cutoff concentration with the mean (46.23 ±5.09IU/ml ).The rest (34/
68) scabietic patients have elevated concentration of IgE(274.08 ±18.18IU/ml ).There was a
statistical significant difference (p>0.05) between patients groups in IgE concentrations.
This study concludes that the diagnostic value of IgE as a serological marker cannot be
considered as a single parameter for diagnosis of nodular scabies without clinical
manifestations. This study proved that the serological concentration of IgE not necessarily
elevated in all cases of nodular scabies

Background: palpitation is an awareness of the heart beat. The pattern of palpitations
especially when correlated to the pulse may help narrow the differential Diagnosis: rapid,
regular palpitations are noted with supraventricular tachycardia or ventricular tachycardia;
rapid, irregular palpitations are noted with a trial fibrillation; and “skipped beats” are noted
with premature atria or ventricular contractions.
Objective : the aim of this study to determine the causes of palpitation in 200 patients seeking
medical advice in baquba teaching hospital –out patient consultation clinic.
Patient and Methods: 200patients presented with palpitation at baquba teaching hospital –
out patient consultation clinic were considered for this study 85 male(42.5) and
115female(57.5), full history taking, physical examination with simple available investigation
and psychiatric screening done for them.
Results: A cause of palpitation was determined in 85% of patients. The causes was cardiac in
40%, psychiatric causes in30%, miscellaneous in 15% and unknown causes in 15%.

Background: Cerebral palsy (CP) is defined as non-progressive disorder of movement and
posture due to brain insult or injury occurring in the period of early brain growth (generally
under three years of age).
Objectives: This is a descriptive study of the demographic and clinical characteristics of
cerebral palsy in Diyala province – Iraq is to put the light on this upsetting neurological
disorder.
Patients and Methods: This study is carried out among children who were referred from the
primary health care centers to the reference consultation clinic at Al-battool Maternity and
Children teaching hospital in Baquba, the center of Diyala governorate from the first of May
2008 till 30th of April 2011.
The following data were studied, the presenting compliant, patients age and sex distribution,
mode of delivery, age of presentation, number of full-term and pre-term, the condition at birth
and birth asphyxia, types of CP and associated medical abnormalities.
Results: The total number of patients were 82, males were affected more than females, the
ratio is (1.4:1) (male 48 =58.5% and female34=41.5%).The most common first presenting
complaints were the delayed milestones (50%). Most of the patient presented between the age
of (7-12) months (48.8%). Spastic CP was the most common type (57.3%), among the other
types of spastic CP are spastic quadriplegia (45.1%). Most of the patients are product of
vaginal delivery (61%).
Most of the patients came to parents who had consanguineous marriage (58%).
Conclusions: The study explain that the high prevalence of spastic quadriplegia which is the
most common type of CP encountered in the clinical practice is due to the high prevalence of
birth asphyxia.
Recommendations:
1- To prevent the treatable causes of CP e.g. asphyxia and kernicterus, through initiation of
centers for early detection of childhood disability.
2- Establish special centers to look after CP patients specially those need orthopedic surgery
and physiotherapy and so on.

Background: Medical waste is potentially hazardous, infectious, and toxic materials. It
therefore requires special handling and disposal practices.
Aims: To determine:
1. Impact of medical waste upon cleaning workers.
2. Awareness of cleaning workers toward medical waste in Baquba teaching hospital
Subjects and Methods: A cross-sectional study was conducted among a random sample of
(80) employees in Baquba teaching hospital in May 2011. Self-administered questionnaire
which included occupational, organisational factors and sociodemographic variables was
used. In addition, researcher observed collection, segregation, transportation, and disposal of
medical waste at the hospital.
Result: Most of the cleaning workers are younger age (35 year ), male 85%, the rate of
illiteracy among cleaners in the hospitals was high 47.5%, the highest level of knowledge
about hazard categories of medical waste had worked for (2–5 years), the cleaners are
focused mainly on the sharps particles first degree, percentage who reported sharps as medical
waste about 98%.
Conclusion: Most cleaning workers lacked sufficient awareness of impacts of poor clinical
waste disposal and had never heard of any policy national or international on safe clinical
waste management. Methods of collecting, segregating, transporting and disposing clinical
waste at the hospital was poor.

Background: Improvements in surgical technique for hernia repair, together with the
development of new prosthetic materials and a better understanding of how to use them, have
significantly improved outcomes for many patients.
Objectives: In this case series we aimed to determine the acceptability, practicality,
effectiveness, and safety of inguinal hernia repair using Lichtenstein tension-free mesh repair
in Iraq.
Patients and methods: Ninety-six adult patients with inguinal hernia were included in this
study. The age range of patients was 20-70 years. The study was conducted in Al-Karama
Teaching Hospital-Baghdad for the period from October 2002 to October 2009. Herniae were
repaired with Prolene mesh as a tension-free Lichtenstein-style. All patients had prophylactic
antibiotics, and were followed for surgical wound infection, induration, pain, recurrence, and
other complications. Three (3.1%) Surgical operations were done entirely under spinal, and
one (1.0%) under epidural anesthesia.
Results: All the procedures were completed safely. No patient had complications directly
attributable to or affecting the implanted mesh. One patient developed infection treated by
antibiotic. No recurrence occurred during a maximum follow up period of seven months.
Seroma occurred in two cases (2.0%), one patient had the procedure after failure of
laparoscopic repair, and no removal of the mesh was needed during this period. Most of the
patients were discharged on the next day or on the same day.
Conclusions: Lichtenstein tension-free mesh repair appears quite acceptable, practical,
effective and safe for inguinal hernia repair in our environment.

Background: Noise reduction of the medical image is an important task to improve the
medical image quality that may be helpful in medical diagnosis.
Methods: The proposed system performed into two steps: First; application of Wiener
filtering technique as a preprocessing step to reduce amount of noise present in ultrasound
image of human kidney, Second; implementation of Haar wavelet transform for denoising the
resulted image from the first step.
Results: The results of noise isolation of ultrasound image after implementation of Wiener
filtering and wavelet transform were presented. also; some statistical results of these images
were recorded.
Conclusions: We deduced that Wiener filtering and Haar wavelet techniques are efficient and
powerful in reducing the noises form ultrasound images. Matlab package (version 7.3) was
used in writing the programming codes of this study

Background: Infertility affects about 10-15% of reproductive-age couples. About half the
causes of infertility are female related and approximately 40% of the cases are caused by
anovulation, mostly in PCO women.
Objective: This study was conducted to determine and compare the effects of two drug
treatment regimens: higher dose of clomiphene and a combination of lower dose of
clomiphene and tamoxifen in treating infertile women with PCO.
Materials and Methods: The study was a randomized clinical trial conducted on 100
infertile patients who referred to Albatool Infertility Clinic between the years (Jan. 2009-
Dec.2009). The patients were selected who had received at least 3 periods of clomiphene, but
no pregnancy had occurred. They were randomly divided into two groups. In the first group,
clomiphene was increased to 100 mg and the second group 20 mg of tamoxifen was added to
50 mg of clomiphene from day 5-9 of menstruation cycle. Infertility duration, duration of
medicine used, endometrial thickness, ovulation, and pregnancy rate were studied in both
groups.
Results: Ovulation rate in clomiphene group was 54.9%; Tamoxifen + clomiphene group was
73.5% without significant differences in both groups. (PV = 0.053). Positive pregnancy rate in
clomiphene group was 39.2%; clomiphene + tamoxifen group was 61.2% (P value < 0.05).
Conclusion: pregnancy rate was higher in clomiphene/tamoxifen group than in the
clomiphene group. The presence of a dominant follicle in the two treatment groups in women
between 18-24 was not significant, but in women between 25-39 years was significant (PV=
0.049).
The recommendation is to add Tamoxifen to Clomiphene in 35-39 women with 20≤ BMI
≤26.99 before the use of gonadotropins treatment in PCOS with or without IUI(intra uterine
insemination), because these options have higher risk of multiple pregnancy and ovarian
hyperstimulation syndrome.