Diyala Journal of Medicine

Background: Removal of spherical object like beads from tracheobronchial tree is very
difficult due to their round and slippery nature which makes their grasp impossible by
ordinary forceps during rigid bronchoscopy (RG.BR).
Aim: The aim of this study was to improve new forceps to achieve an easy and swift
technique to remove beads from tracheobronchial tree.
Patients and method: This study was conducted at Rizgari teaching and Erbil emergency
hospitals between 1984 and 2006 and involved 75 children with bead inhalation. The
diagnosis was confirmed by viewing the typical shadow of beads which could be seen on
plain chest x-ray accompanied by different initial clinical signs and symptoms such as
choking, cough, respiratory distress, stridor, cyanosis and fever. All beads were removed by a
modified minute forceps.
Result: From the total of 75 patients, 49 patients were males and 26 were females. Forty eight
beads were in right main bronchus and 15 were in left main bronchus, while the other 12
beads were in trachea and carina. Most of the patients (85.3%) attended hospital immediately.
Conclusion: Despite improvements in technology, there is still no appropriate removal
forceps for tracheobronchial tree beads. The new improvised grasping forceps showed
excellent success and such improvement can be adopted by the relevant companies to develop
a special forceps for this purpose.

Background: Hepatitis C virus (HCV) infection is a major health problem among dialysis
patients in developing countries. Geographical distribution of various genotypes of HCV is
useful for understanding the epidemiological status, detection of mode and source of
infection, designing the program of control, evaluating the response to treatment and
development of diagnostic methods and vaccine production.
Objectives: To investigate the prevalence of HCV genotypes and subtypes (1a, 1b, 2a, 2b, 3a,
3b, 4, 5a & 6a) among hemodialysis patients.
Materials and Methods: The prevalence of anti-HCV antibody was determined by Enzyme
Linked Immunosorbent assay (ELISA). Then, HCV specific RNA was detected in those antiHCV seropositive and seronegative dialysis patients, utilizing reverse transcriptasepolymerase chain reaction technique (RT-PCR), Furthermore, Genotyping the HCV-RNA
positive samples by one step nested RT-PCR technique.
Results: Genotyping analysis was performed in 29 HCV-RNA positive patients. Genotypes
1a, 1b, 3a and 4 were found in (34.48%), (13.79%), (3.45%) and (41.38%) patients,
respectively. In addition, two patients (6.90%) had mixed infected with both 4 and 1b.
Conclusion: The genotype distribution in our study is comparable to that for non
haemodialysis patients. Further analyze relatedness of HCV isolates by sequence analysis are
required to trace the source of infection.
Key words: HCV Genotypes, Hemodialysis, RT-PCR.

Background: Carpal tunnel syndrome is caused by entrapment of the median nerve and
results in pain, tingling and numbness in the wrist and hand. It is a common condition in
general practice.
Objectives: This study was done to determine the epidemiological and clinical features of
CTS.
Methods A cross-sectional study was carried out on Carpal tunnel syndrome [CTS] cases
diagnosed over a 14 years period, from May 1998 to May 2012 by the researcher. All data
regarding the age at presentation, gender, pregnancy, hypertension, DM, salty food, response
to conservative treatment, response to surgical treatment, a total number of 928 cases were
included in this study.
Results; Among the 928 CTS patients; there were (0.107%) below 15 years,( 25.64%) from
15-30 years, (50.75%) from 31-45 years, (20.68%) from 46-60 years, and (2.80%) above
60.According to gender distribution, there were (0.969%) male,( 99.03%) female. In this
study there were (13.27%) pregnant,( 86.72%) not pregnant, (5.92%) hypertensive,( 94.07%)
not hypertensive, (8.40 %) diabetic,( 91.59%) not diabetic, (44.40%) eating salty food,
(55.60%) not eating salty food .According to response to treatment, (58.72%) respond to
conservative treatment,( 41.27%) not respond to conservative treatment, (94.51%) good
response to surgical treatment,( 5.48%) not respond to surgical treatment.
Conclusions: This study showed
1. The predominant age of patients [females] 31-45 years.
2. The ratio of female /male is far higher than in other places of the world.
3. The prevalence of pregnant women with CTS is less than other studies.
4. There is some statistical significant association between CTS and consuming salty food.
5. Surgical treatment is highly successful.

The objective of the present study is to determine the frequencies of various benign breast
diseases (BBD) in female patient in Tikrit city. A retrospective descriptive study of all female
patients visiting surgical clinic with breast problems was performed. This study was
conducted at Tikrit Teaching Hospital and the main private histopathological laboratory in
Tikrit over the period from January -2000 to the end of December 2007. All the patients were
diagnosed as carcinoma were excluded. A total of 485 patients were included in this study.
About 35.7% (173/485) patients were belonged to the 3rd decade of life (age between 21-30
year), followed by 30.5% (148/485) were belong to 4th decade (age between: 31-40 years).
Fibrocystic disease was the commonest of all benign breast disease, seen in about 33%
(162/485) mainly in the 3rd, 4th &5th
decades of life with peak at 31-40 years followed by
fibroadenoma that is seen in 27.6%(134/485) of the cases mostly in the 2nd & 3rd decades of
life. It is found that benign breast diseases are common problem in females of reproductive
age.

he gallbladder is an important organ, but is not essential for life. Therefore, the standard
treatment for symptomatic patients who suffer from gallstones has been to surgically remove
the gallbladder and gallstones, Cholecystectomy, which is one of the most commonly,
performed surgical procedures. Fifty patients undergoing cholecystectomy had either no drain
and another fifty had a narrow bore suction drain or an open corrugated drain. More
complications were seen in the group with drain compared to the other group without drain.
This study was performed in the Shorsh General Hospital in sulaimaniyah from October 2010
to October 2011. The aim of this study was to determine whether drains influenced the Patient
comfortably, discharge of the patient from hospital, appearing of hernia after operation,
intestinal obstruction, and the risk of drain site infection following cholecystectomy, and if
these had any affect on complications. According to our data there was a statistical
significance between two methods of surgical operation of gall bladder in the criteria (patient
comfortably, discharge of patient from hospital, appearing hernia after operation and risk of
drain site infection (p value < 0.05), but there was no any statistical significance for intestinal
obstruction (p value > 0.05). We suggest that drainage in cholecystectomy is unnecessary and,
if an open drain is used, it may be potentially dangerous

Background: Hepatitis C virus (HCV) has been associated with several extrahepatic
conditions. Although a high prevalence of HCV infection was detected in patients with lichen
planus, the pathogenetic potentials of HCV with skin diseases is still controversial.
Objectives: To determine the anti-HCV antibody seropositivity among patients with certain
non-communicable skin diseases; lichen planus, psoriasis, alopecia areata, vitiligo, eczema,
and urticaria.
Patients and methods: Two hundred patients suffering from non-communicable skin disease
were enrolled in this study which was conducted in Baquba for the period from 1st
.
November/2010 to 1st. July/2011. The patients were attending the Dermatology and
Venereology Unit in the outpatient clinic of Baquba General Teaching Hospital. The patients
group consists of 18 patients with lichen planus, 23 with psoriasis, 7 with vitiligo, 95 with
eczema, 36 with chronic urticaria, and 21 with alopecia areata. The age range of the patients
was (5-70) years. Additionally, 90 apparently healthy unpaid blood donors were included as
control group. Anti-HCV antibody was detected by enzyme linked immunosorbant assay.
Rsults: Only two patients were positive for anti-HCV antibody; one with lichen planus and
another with eczema. All other patients with psoriasis, alopecia areata, vitiligo, and urticaria
were negative for anti-HCV antibody. There was no significant association between HCV
infection and skin diseases under study.
Conclusion: No association between HCV infection and lichen planus, psoriasis, alopecia
areata, vitiligo, eczema, and urticaria, probably due to low prevalence of HCV infection
among general Iraqi people.

Background: Occult hepatitis B virus (HBV) is the presence of HBV DNA in liver tissue
and/or in serum in the absence of detectable hepatitis B surface antigen (HBsAg). It is a
world-wide entity that is considered as a potential risk for transmission of HBV infection.
Objectives: This study was aimed to determine the rate of occult HBV infection among
unpaid blood donors in Diyala province-Iraq.
Subjects and methods: This study was conducted for the period from 1st. May 2011 to 1st
.
April 2012. A total of 186 unpaid blood donors were chosen by simple random selection from
those attending the Central Blood Bank in the Public Health Laboratory in Diyala province.
171 (91.9%) were male and 15 (8.1%) were female. The age range was 19-60 years. Sera of
blood donors were subjected for HBsAg screening test, anti-HBs antibody, anti-HBc IgM
antibody by enzyme linked immunosorbant assay (ELISA), as well as detection of HBV DNA
by conventional polymerase chain reaction (PCR) technique. Data were statistically analyzed.
Results: The positivity rate of HBsAg, anti-HBc IgM and HBV DNA were 4.3%, 3.2% and
8.1%. Among the HBsAg negative blood donors, the HBc IgM positivity rate were 3.4% and
the HBV DNA was detected in 3.9% (occult HBV).
Conclusion: The relatively high rate of occult hepatitis B viral infection among blood donors
may be responsible, at least in part, for the perpetuation of the infection in the community.

Background: Mucoepidermoid carcinoma (MEC) is a malignant epithelial neoplasm
characterized by the proliferation of epidermis, mucous, and intermediate cells in various
proportions, it represents up to 10% of all major salivary glands tumors and 15% to 23% of
minor glands. It exhibits varying degrees of differentiation and histologic grade as well as
widely diverse biologic behavior. Its grading system is based on different histological
components seen on hematoxylin and eosin slide which is still a controversial issue. This
study evaluates the immunohistochemical expression of MMP-2 antibodies as markers of
local invasion of MEC to be correlated with the tumor grade and stage.
Aim of the study: Immunohistochemical evaluation MMP-2 as a biological markers of local
invasion in oral and maxillofacial salivary MEC in relation to grading and staging of MEC.
Materials and Methods: The study involved 22 salivary gland MEC tissue samples for the
period from 1972 to 2010. Age, sex, site, stage and histologic grades were recognized. The
samples were immunohistochemically stained with monoclonal antibodies to matrix
metalloproteinase-2 (MMP-2).
Results: The sample comprised 14 males and 8 females in (1.75:1) ratio. The age range of the
patients was between 19 and 65 years with a mean of (45.9±10.53). The stage of MEC had a
significant relationship with Brandwein grading system (P=0.039). Concerning the site and
sex distribution, neither site nor sex had a significant statistical relationship with Brandwein
grading system (p> 0.05). The mean of matrixmetaloprotenase-2 expressed by MMP-2
immunomarker was (41.7±23.13) with no significant relation to tumor grade and stage .
Regarding the predominant cells, no significant relations were found neither with the grade
nor the stage of study samples.
Conclusions: In all samples, matrixmetalloproteinase-2 had a non significant relationship
with tumor grade and stage. No correlation was found between the histological grading of
MEC and its biological behavior concerning invasion potential.

Background: Iraq is one of the countries which applicated routine vaccination schedule many
years ago, however, still many infectious diseases attack children , e.g. whooping cough &
tuberculosis, which was supposed to be absent or decreased dramatically by such vaccination
program like what was happened at many developed countries since decades. Many causes
had been implicated, one of these reasons may be the response of the population to that
program. In Iraq, all the vaccines were given freely & the visits are voluntary, furthermore,
many T.V. & Radio programs & newspapers urge the people towards vaccination,
nevertheless, many children had not been vaccinated as we see in our clinical practice, but we
don’t know to which degree this problem is present. So this study was came as a trial to
expose some of secrets of this problem by finding the rate of vaccination, although it was a
hospital based data, but it may give an idea about the vaccination status in the province, in
addition, the effect of parental education on population compliance to the schedule will be
searched.
Patient & Method: The study was done at Al- Batool teaching hospital for maternity &
children at Baquba city from 1st of September 2011 – 1
st of September 2012, random sample
was collected from both in- & out-patients, it involved children of one year old or below,
history of immunization of those children according to the Iraqi schedule of vaccination was
taken from parents, supported by vaccination card if it was available.
Results: The immunization status of 259 child had been reviewed with the parents. Those
were fully vaccinated children (in 180 child (70%)), partially vaccinated children (in 63 child
(24%)) , & non- vaccinated children (in 16 (6 %)). Both mother’s & father’s education had
positive significant effect on the compliance of the parents to vaccinate their children (p value
was 0.000 & 0.001, respectively).
Conclusion: Rate of vaccination at this study was higher than that found in Iraq at 2010, but
not reached to the level of well economic countries. we need to encourage vaccination, at the
same time explaining their side effects and ways of management in front of vaccinations
benefits to break up any refusal idea

Background: Anti-cyclic citrullinated peptide (anti-CCP) antibodies are highly specific for
RA, but are not detectable in all RA patients, in addition their usefulness to identify rheumatic
arthritis (RA) from other rheumatic diseases presenting with joint pain is not well studied.
Objective: To establish whether the clinical phenotypes of anti-CCP positive and negative
disease are distinct at the earliest clinically apparent phase of disease and to assess the
diagnostic accuracy of the anti-CCP antibodies assay to separate RA patients from a group of
patients with (SLE).
Patients and Methods: One hindered ten blood samples were collected from patients, 75
with RA (58 seropositive and 17 seronegative) and 35 patients with SLE attending the
Rheumatology Clinic of the Al-Yarmook Teaching Hospital for period between March 2009
and November of 2010 were included in this study. Then sera were stored at -20° and tested
for anti-CCP antibodies by a commercially available enzyme-linked immunosorbent assay
(ELISA) kit (Euroimmun, while CRP and Rheumatoid factor was test by latex agglutination
(LA).
Results: Forty five of 58 seropositive RA patients (77.6%) were positive for anti-CCP, while
13 patients tested negative for anti-CCP antibodies. Among the seronegative group,
antibodies to anti-CCP could be demonstrated in 22.4% of patients. Anti-CCP positive
patients were rheumatoid factor positive (77.6% vs. 22.4%, p < 0.005). There was no
significant difference in the pattern of joint involvement. In the SLE group, anti-CCP
antibody was positive in only 8 of 35 (22.8 %) patients.
Conclusions: Patients with and without anti-CCP antibodies present in a similar way, and
anti-CCP antibody have high sensitivity for diagnosis of RA.

This study present the effects of Date Palm Pollen grains (DPP) (phoenix dactylifera) on
ovary function and fertility in adult female rats exposed to lead acetate. Forty adult female
albino rats were divided randomly into four equal groups. The first control group was given
orally (1 ml) distal water,(T1) group given orally 150 mg / kg .B.W. DPP ( 0.5ml),(T2) group
given orally (10) mg / kg. B.W. lead acetate (1 ml) ,(T3) group given daily by oral
administration of both DPP150 mg/kg B.W. and 10 mg / kg. B.W. lead acetate .all animals
treated via gavages needle for 6 weeks.At the end of experiment blood were collected to
determine serum LH & FSH level .
Treated( T1) group showed the increase levels of LH were on significant importance at a
level of < 0.05 in comparison with zero time of the same group and in comparison with
control group . To contrast to treated(T1) group, the level on LH showed a significantly
decrease levels in animals on treated (T2) group exposure lead acetate at a dose rate of 10 mg
/ kg. B.W daily . The significant decrease in LH were showed in comparison the value with
that at zero day of the same group and at a time on experiment 14, 28, 42 day post exposure in
comparison with control group and with (T1) group exposed to DPP. Animal on treated (T3)
group exposed of both DPP at 150 mg /kg. B. W. and lead acetate 10 mg / kg. B.W. for 6
weeks didn`t show any significant changes during the experiment.
Animals on( T1) group that exposed to DPP at a dose rate on 150 mg / k. B.W. for 6 weeks
showed a significant increase FSH level in serum of exposed animal in comparison with zero
time of the same group and in comparison with contrl group . While those on
(T2) group which exposed to lead acetate at a dose rate of 10 mg / kg. B.W. for 6 weeks
showed a significant decrease in FSH level in serum on day 14 and 42 following the exposure
the decrease in FSH level in serum may significant in comparison with zero day of same
group and with level on T1 group and control group. Animal on group T3 didn`t show any
significant changes during the experiment.
This study conclude that DPP has obvious improvement effect on fertility hormones of
Adult female rats exposed to lead acetate

Background: Vinca alkaloids ( vincristine and vinblastine) are microtubular toxins of
chemically similar nature that disrupt microtubule function by binding to a site on β-tubulin
and suppressing microtubule dynamics.
The aim of Study: The study aims to evaluate biological activity of vincristine and
vinblastine on microtubule hepatic H22 cell line by used GF tubulin
Methods: In this experiments we used the stable tumor cell line of H22 hepatic cell to
investigate the action of vincristine and vinblastine onto the microtubule network.
Results: An experimental work was conducted to determine the biological activity of
vincristine and vinblastine on microtubule hepatic H22 cell line by used GF tubulin and the
recovery of its disruption.Cells were treated with Vincristine and Vinblastine at various
concentrations from 20 μg/ml to 400 μg/ml for 60 min. Microtubules were detected by means
of indirect immunofluorescence. No differences were found between the two cytostatics.
Conclusion: The cells showed changes in the arrangement of microtubules even at the 80
μg/ml concentration of cytostatics after 60-min exposition. Its damage increased with
increasing concentration of cytostatics

Background: Vinca alkaloids ( vincristine and vinblastine) are microtubular toxins of
chemically similar nature that disrupt microtubule function by binding to a site on β-tubulin
and suppressing microtubule dynamics.
The aim of Study: The study aims to evaluate biological activity of vincristine and
vinblastine on microtubule hepatic H22 cell line by used GF tubulin
Methods: In this experiments we used the stable tumor cell line of H22 hepatic cell to
investigate the action of vincristine and vinblastine onto the microtubule network.
Results: An experimental work was conducted to determine the biological activity of
vincristine and vinblastine on microtubule hepatic H22 cell line by used GF tubulin and the
recovery of its disruption.Cells were treated with Vincristine and Vinblastine at various
concentrations from 20 μg/ml to 400 μg/ml for 60 min. Microtubules were detected by means
of indirect immunofluorescence. No differences were found between the two cytostatics.
Conclusion: The cells showed changes in the arrangement of microtubules even at the 80
μg/ml concentration of cytostatics after 60-min exposition. Its damage increased with
increasing concentration of cytostatic

Background: Occult hepatitis B virus (HBV) is the presence of HBV DNA in liver tissue
and/or in serum in the absence of detectable hepatitis B surface antigen (HBsAg). It is a
world-wide entity that is considered as a potential risk for transmission of HBV infection.
Objectives: This study was aimed to determine the rate of occult HBV infection among
unpaid blood donors in Diyala province-Iraq.
Subjects and methods: This study was conducted for the period from 1st. May 2011 to 1st
.
April 2012. A total of 186 unpaid blood donors were chosen by simple random selection from
those attending the Central Blood Bank in the Public Health Laboratory in Diyala province.
171 (91.9%) were male and 15 (8.1%) were female. The age range was 19-60 years. Sera of
blood donors were subjected for HBsAg screening test, anti-HBs antibody, anti-HBc IgM
antibody by enzyme linked immunosorbant assay (ELISA), as well as detection of HBV DNA
by conventional polymerase chain reaction (PCR) technique. Data were statistically analyzed.
Results: The positivity rate of HBsAg, anti-HBc IgM and HBV DNA were 4.3%, 3.2% and
8.1%. Among the HBsAg negative blood donors, the HBc IgM positivity rate were 3.4% and
the HBV DNA was detected in 3.9% (occult HBV).
Conclusion: The relatively high rate of occult hepatitis B viral infection among blood donors
may be responsible, at least in part, for the perpetuation of the infection in the community.