Diyala Journal of Medicine

Background: Carpal Tunnel syndrome (CTS) is the most common cause of paraesthesia in
the hands and it is the most common entrapment neuropathy in the upper and lower limbs .
The symptoms are variable, but episodes of burning pain or tingling in the hand are
common. Diagnosis of CTS is mainly clinical based on suggestive history and Physical
examination. Several physical signs are associated with carpal tunnel syndrome,
including Tinel’s test and Phalen’s test.
The objectives of this study are to determine the sensitivity and specificity of the Phalen΄s
and Tinnel΄s tests in the diagnosis of Carpal Tunnel Syndrome and to analyze how such
factors as patients age and duration of symptoms influence these parameters.
Patient &Methods: This is a prospective study comparing two groups (patient & control).
One hundred cases (90 females and 10 males) who fulfilled the National Institute of
Occupational Safety and Health (NIOSH) criteria for diagnosis of CTS attending
physiotherapy unit in Rizgary Teaching Hospital in Erbil-Iraq .The control group included
(90females and 10 males} who were healthy asymptomatic volunteer .The duration of the
study was eight months from 1st may 2011to 1st February 2012. Both groups were assessed
by Phalen and Tinel tests.
Result: In the patient group 78(78%)cases were having positive phalen and 66(66%) cases
had positive tinel test while in the control group 6 (6%) were having positive phalen and
23(23%) controls had positive tinel test.
The resulting specificity and sensitivity of Phalen test for the patient and control groups were
94% and 78%respectively while specificity and sensitivity of Tinel test were 77% and 66%
respectively.
There is also a significant association between duration of symptoms less than 6 years and
Tinel test results.
Conclusion: Phalen test is more specific and sensitive than Tinel test so it is essential in the
diagnosis of CTS particularly when the Nerve Conductive Study (NCS) is not available.

Background: Umbilical cord index is the total number of coils divided by the total length of
the umbilical cord in centimeters and an abnormal umbilical coiling index has been reported
to be related to adverse fetal and pregnancy outcomes.
Objective: To compare and detect the association of the umbilical coiling index in normal
and complicated pregnancies.
Patients and Method: This study was conducted in Sulaimania city in both Sulaimania
Maternity Hospital and Soma Private Hospital from July 2012 to May 2013.A total number
of 428 umbilical cords were examined, umbilical coiling index (UCI) was calculated by
dividing the total number of coils by the umbilical cord length in centimeters. The outcomes
measured were maternal age, intrauterine growth retardation, meconium staining, birth
weight, apgar score,maternal diabetes mellitus and pregnancy induced hypertension.
Hypocoiled cords were those having UCI less than 10th centile, and hypercoiled cords those
having UCI more than 90th centile. Statistical analysis was done by chi square test, Fishers
exact test and the t test where applicable.
Results: The mean UCI was 0.24±0.003 coils per one cm, hypocoiled cords were
significantly associated with complicated pregnancies by pregnancy induced hypertension
(PIH), gestational diabetes mellitus (GDM), and oligohydromnios (p value<0.05), while
hypercoiled cords were associated with maternal age >35 years, (GDM), oligohydromnios,
and polyhydromnios. Significant association detected regarding the cesarean section with
hypercoiled cord, abnormal fetal heart AFH, meconium stained liquor (MSL), low Apgar
score at 5 min. and low birth weight (LBW) were significantly associated with both hypo and
hypercoiled cords (p-value <0.05).
Conclusions: Abnormal UCI is associated with several adverse antenatal , perinatal, and
neonatal factors, and UCI is an indicator and marker for pregnancy and fetal outcomes.

Abstract
Background and Objectives: This study aimed to develop a predictive model for sperm
retrieval rate(SRR) sperm recovery by testicular fine-needle aspiration (TESA) & compare
with (SRR) obtained by per cutanuose open biopsy sperm aspiration (PSA) correlating with
hormonal parameters.
Materials and Methods: This is a prospective study for sample obtained from 45 male
patients during the period from January 2011-march2012.Clinical, paraclinical, and
histological information of patients were gathered. All patients underwent both TESA and
PSA in a single operation. Predictors of SRR by TESA were identified comparing with
predictive outcome of PSA .
Statistical Analysis Used: Categorical and continuous variables were compared using
independent t test and -chi-square test. Logistic regression model was applied to develop a
predictive model for SRR by TESA & PSA outcome.
Results: Sperm retrieval rate for TESA and PSA was 42.2% and 48.8%, respectively (P =
0.03).Regarding age group is more common in 4th (50.3%), while 3rd & 5th dacedes each of
them (20%). The duration of infertility were variable ranging from (10-20) years. Testis
volume, luteinizing hormone, prolactin, and testosterone did not differ between patients.
Conclusions: Serum FSH and testicular pathology were predictors of SRR by TESA.
Patients with FSH < 23 IU/l and/or testicular pathology of hypospermatogenesis had
comparable SRR by TESA versus PSA.

Background: A magnetic field is the area of influence exerted by a magnetic force. This
field is normally focused along two poles. Most magnetic objects are composed of many
small fields called domains. A wide variety of methods have been reported in the literatures
which are directed to the use of magnetic energy as a diagnostic technique and also for the
treatment of diseases in humans and animals.
Aims: To investigate the effects of different levels of static magnetic field on the ultra
structure of Pseudomonas aeruginosa bacterium as well as their colony morphological
changes.
Materials and Method: Locally prepared dipolar static magnetic field of strength 400, 800,
1200 and 1600 Gauss were used in this study measured by Teslameter. Pseudomonas
aeruginosa isolated from ten urinary tract infected patients. The samples collected from
Rizgary hospital in Erbil during period from January to June 2013, then identified by using
API (Analytical Profile Index) 20 E test systems in Hawler Medical Research Center. Equal
volumes of broth nutrient culture media of bacteria were exposed to the magnetic field for 24
hour. Furthermore, the bacterial growth subculture tested for morphological and biological
activity after API 20 E test of treated Pseudomonas aeruginosa culture media compared with
untreated negative control samples.
Results: Results indicated that exposure of the microorganisms to demonstrated magnetic
field caused pronounced changes in biological activity of enzymes TDA( Tryptophane
deaminase), GLU( Glucose fermentation/oxidation), ARA(Arabinose fermentation/oxidation)
were observed on the cell growth. On the other hand, changes in morphology of the
Pseudomonas aeruginosa colonies were observed on MacConkey agar and became smaller in
size with elastic phenomena.
Conclusions: We concluded that the magnetic field could change bacterial biological
activity on sugar fermentation and colony morphology of bacterial due to mutation.

Background: Herpes simplex virus type 2 (HSV-2) is the leading cause of genital ulcer
disease worldwide. The acquisition of genital herpes during pregnancy has been associated
with spontaneous abortion, prematurity, and congenital and neonatal herpes.
Objectives: To determine the seroprevalence of herpes simplex virus type 2 among pregnant
women in Diyala province.
Materials and methods: Ninety one pregnant women were chosen from those attending the
primary health care centers in Baquba - Diyala province, during the period from 1st
November / 2012 till 30th April / 2013. The age range between (15-37) years and the mean
age was (25.10 ± 5.27) years. Anti- herpes simplex virus type 2 IgM and IgG antibodies were
assayed by Enzyme linked immunosorbant assay technique.(ELISA).
Results: The results showed that the anti- herpes simplex virus type 2 IgG, IgM antibodies
seroprevalence among pregnant women was 2 out of 91(2.2%), and 2out of 91(2.2%)
respectively. The results of statistical analysis did not reveale significant differences with
age, residence, educational levels, duration of pregnancy, previous of abortion and number of
abortions on the prevalence of anti- herpes simplex type virus 2 IgM and IgG. The rate of
susceptibility for herpes simplex virus type 2 infection among pregnant women was 89
(97.8%).
Conclusion: Low prevalence rate of HSV-2 seropositivity was appeared among pregnant
women in studies area. However, it's necessary to focus on the women that demonstrated
susceptibility for herpes simplex virus type 2 infection

Background: Carpal tunnel syndrome is an entrapment neuropathy of the median nerve at
the wrist underneath the flexor retinaculum .It's widely more common in females than males,
usually responding to conservative treatment and surgery indicated for severe cases
unresponding to conservative line of treatment.
Surgery could be done under G.A., regional or local anaesthesia, however, nowadays mostly
done under local anaesthesia.
Aim of the Study: To prove that this technique is reliably effective, easy, safe and
remarkably cost-effective.
Patients and Method: All patients with C.T.S who had been diagnosed clinically and failed
to respond to conservative treatment included in this study from 1st Jan 2003 to 31st Dec 2011
inclusive.
All the cases were submitted to open carpal tunnel decompression done under local
anaesthesia using 5 ml of 1% lidocaine infiltrated at the site of the proposed incision with
tourniquet applied to the upper arm.
This procedure had been done for all patients on an outpatient basis.
Results: Total number of the cases included in this study was 499 patients ,487 females and
only 12 males. 450 patients had unilateral C.T.S, while 49 patients had bilateral C.T.S
99.96% of the cases were satisfied with this procedure.
Conclusion: This procedure found technically easy ,safe, satisfactory for almost all the
patients and highly cost-effective

Background: Housewife's hand eczema is a common disease which is due to the excessive
and prolonged exposure of the hands to soap and water. have a history of atopic dermatitis Patients with hand eczema frequently
or atopy.
Aims: To determine the, clinical features, and patterns of occupational housewife's hand
eczema in housewives and its prevalence in patients with atopic eczema or atopy attending
Baquba teaching hospital.
Patients and Methods: A cross-sectional study carried out in 1st June 2012 till 31st May
2013 among random sample of (280) housewives, aged (18-48) years, to determine the
prevalence of occupational housewife's hand eczema among housewives attending Baquba
Teaching Hospital /outpatient. Self-administered questionnaire which included occupational
and sociodemographic variables was used and clinical examination has been done by
dermatologist.
Result: The prevalence of occupational housewife's hand eczema in patients with atopy was
(62.3%). The most common age group was (18- 37) years (75%), the younger age group. The
duration of work was < (7) years. Roughness, fissures and erythema form more than (79%) of
the cases. The most common sites of the lesions appeared mostly on palms and ventral
surface of the fingers (63.5%). More than 90% of the cases did not used protective measures
during work.
Conclusion: The occupational housewife's hand eczema are frequently involved in patients
with active atopic dermatitis. This study concluded that housewife's hand eczema is typically
a lifestyle-related skin disease. Irrespective of any predisposition, its development and
exacerbation depend on a patient’s awareness of causative and preventative factors.

Background: Hyperlipidemia is one of the most common diseases among Iraqi community,
and using herbal medicine in treating hyperlipidemia was a good choice to reduce the side
effect of recommended drugs with good results of healing, Garlic (Allium sativum) has been
used in herbal medicine for centuries for various health problems. It has a beneficial effect of
Reducing serum lipids and cardiovascular system disease .The purpose of present study was
to evaluate the effects of garlic and atorvastatine on the dyslipidemic people.
Aim: The aim of this study is to assist the affectivity of the garlic in lowering the lipid profile
in hyperlipidemic patients as well as the affect of time on treatment.
Methods: This 12 week, Garlic treated, atorvastatin, Garlic + atorvastatin and non treated
study was conducted on patients with hyperlipidemia (n=40) were divided into 4 groups each
comprising 10 patients, first group was control healthy persons, second group was given
garlic capsules (500mg) twice daily, third group was given atorvastatin (40mg-Gulf
pharmaceutical), fourth group was given both garlic capsules + atorvastatin.
Results: After 12 week the garlic + atorvastatin treated group had good results in reduction of
total cholesterol (5.23±0.12) triglycerides (1.93±0.12) LDL (1.31±0.14) VLDL (0.87±0.15)
as compared with those before treatment.
Conclusion: This study suggests that using garlic capsules + atorvastatin in treating
dyslipidemia patients are efficiently reduced serum total cholesterol, LDL,VLDL and
moderately raised HDL cholesterol as compared with non-treated group ,in addition prolong
duration of treatment will assess the benefit effect of garlic + atorvastatin in treatment of
dyslipidemia and other cardiovascular system diseas

Background and Objectives: Myocardial ischemia is the leading cause of mortality and
morbidity in all over the world. Previous studies demonstrated that myocardial ischemic
patients subjected to coronary angiograph were more likely to have significant high serum
proBNP. This study aimed to assess the level of serum proBNP levels in myocardial
ischemia patients who underwent coronary angiography and to relate the proBNP levels to
the severity of coronary artery disease and the components of metabolic syndrome.
Methods: A total number of 128 patients admitted to the coronary angiography unit at Diyala
Teaching Hospital in Diyala were recruited in the study. Indications of coronary angiography
included; acute coronary syndrome, positive treadmill test, stable coronary artery disease and
percutaneous coronary intervention. The severity of coronary artery disease was assessed by
detecting the significant obstructed lesions in the number of obstructed vessels. Serum
proBNP levels were measured after angiography.
Results: The results showed non-significant differences in the characteristics of patients and
fasting serum lipids in different categories of vessels obstructed. Significant high serum
proBNP levels were observed with increasing number of vessels obstructed and weren't
related to the existence metabolic syndrome components. Serum proBNP levels were
significantly and inversely correlated (r =0.5, p < 0.001) with ejection fraction of left
ventricle.
Conclusions: Serum proBNP levels in myocardial ischemia patients are related directly to
the severity of coronary artery diseases and inversely to the pumping function of the heart.
Metabolic factors are not involved in significant high serum proBNP levels in myocardial
ischemia patients

Background: A period of starvation (“nil by mouth”) is common practice after
gastrointestinal surgery during which an intestinal anastomosis has been formed. The
stomach is decompressed with a nasogastric tube and intravenous fluids are given, with oral
feeding being introduced as gastric dysmotility resolves.
The rationale of nil by mouth is to prevent postoperative nausea and vomiting and to
protect the anastomosis, allowing it a time to heal before being stressed by food
Aim of the Study: To assess the safety, tolerability, and outcome of early oral feeding after
intestinal procedures.
Patients and Method: This is a prospective study of 60 patients underwent intestinal surgery
over a period of one year and 9 months (January 2009-september 2010) in Baquba Teaching
Hospital, reviewed for the safety, tolerability and outcome of early oral feeding following
intestinal surgery.
Both of emergency and elective surgeries are included in the study.
Results: Early oral intake can be tolerated by most of the patients with intestinal surgeries.
Conclusion: Early oral feeding is a safe practice and is devoid of complications as repeated
vomiting or fecal fistula.

Background: A retrospective study of maternal and neonatal complication of triplet
pregnancies in Basrah Maternity and Child Hospital and in Kammal Al-Samarayei Hospital
for period of 2011-2012.
Aim: Assess frequency of obstetrical and perinatal complication and factors affecting
outcome
Methodology: We reviewed the obstetrical files , the data collected included maternal age ,
parity, fetal weight , mode of delivery and mode of conception from peroid the 1st of June
2011 to 31st of June 2012.
Result: The rate of triplet increase with increasing of maternal age (30-39) and in
primigraivda due to ovulation induction also increase rate of C. S, PE, PROM, Anemia, PPH,
preterm delivery were (88.89%,19.4%, 30.5, 55.55%,11.11%,83.33%) respectively. The
higher rate of deliveries occurred between 32-34 weeks and birth weight between 1550-2000
gm(36.36%,39.81%)respectively. increase rate of abortion 18.1%.
Conclusion: There were increasing rate of complication both maternal and fetal with triplets
prematurity, still birth congenital abnormality ,and C.S.

Background: Diabetic foot (DF) is one of diabetes mellitus (DM) complication, it is delayed
wound healing and may end with amputation of limbs. Involvement of Fas/Fas ligand(FasL)
pathway in the pathogenesis of diabetic complications has been proposed. Apoptosis via
Fas/FasL interactions has been proposed to be a major T-cell-mediated effector mechanism in
autoimmune diabetes.
Objectives: This study was undertaken to investigate whether the serum levels of circulating
soluble Fas/Fas Ligand, two transmembrane glycoproteins involved in apoptosis, are altered
in patients with type 2 diabetes who have diabetic foot ulcerations.
Methods: sFas, sFasL and high sensetive-CRP were measured with the ELISA method in
thirty(30) normal controls (group I), twenty five patients with type 2 DM with no diabetic
foot (group II) and twenty five diabetic foot patients with type 2 DM (group III). Besides,
serum glucose (Fasting), lipid profile (total cholesterol, triacylglycerol, HDL, LDL and
VLDL), body mass index, Waist circumstance and age were determined.The study was
carried out in National center of diabetes, Al-Mustansirya university, Baghdad, Iraq.
Results: The patients with diabetic foot lesions were found to be poorly controlled and had
significantly higher levels of fasting blood glucose(FBG) (p<0.05,p<0.001) compared to
patients without diabetic foot lesions and healthy control groups.Also the patients with
diabetic foot lesions were found to be significantly have higher levels of sFas and FasL
compared to patients without diabetic foot lesions and healthy control
groups(p<0.001,p<0.05) respectively. Serum levels of total cholesterol, triacylglycerol , LDL
and vLDL were significantly higher (p<0.05) in diabetic patients(with and without foot
ulceration) in comparison with healthy normal control. While HDL-c level was lower in both
groups than in the control group, it was reach statistical significance.There are no significant
different in lipid profile between diabetic foot patients and without diabetic foot patients.
sFas serum levels were significantly increased in both diabetic groups compared with normal
controls (12.2±2.18 ,10.55±2.57 ng/ml Vs 5.91±3.1 ng/ml, p<0.001), but the levels were
significantly higher in patients with diabetic foot when compared with those without diabetic
foot patients (p<0.05). sFasL serum levels were also increase in both diabetic patients as
compared with normal controls(2.55+1.06, 1.75+0.62 ng/ml Vs 1.59+0.32 ng/ml,p<0.05), but
the levels were higher in diabetic foot patients than those without diabetic foot patients. The
duration of DM of patients were with >10 yrs, age > 58 yrs, and BMI >25 Kg/m2
.
A significant positive correlation was observed between sFas and (sFasLand hs-CRP) in
diabetic foot patients. On the other hand, there was a positive correlation between sFas and
(FBG, and lipids)

Background: Circumcision is a common procedure, but regional and societal attitudes differ
on whether there is a need for a male to be circumcised and if so, at what age, sexually
transmitted diseases, penile cancer, and phimosis and a reduction in the incidence of human
papilloma virus related cervical cancer in female sexual partners. This is an important issue
for many parents, but also pediatricians, other doctors, policy makers, public health
authorities, medical bodies, and males themselves. Worldwide 1 in 3 males are circumcised,
totaling an estimated 1.2 billion. The largest number of circumcised males are Muslims
(approx. 70% of circumcised males globally).
Objectives: The objective of the study is to find whether there is difference in morbidity
factors like infections, hospital admissions, complications, and growth and circumcision
complications in between preschool age children with different timing of circumcision.
Method & Materials: This study is a cross sectional study done in Albetool Maternity
Hospital in Diyala province of Iraq between October 2012 and March 2013 .This study is
looking for children who were circumcised and age of circumcision and complained from
urinary tract infection before and after circumcision and other complication of circumcision.
Results: Of one hundred of cases included in the study where we found that 26 ( 26%) of
circumcised male were delivered by caesarian section and 74 ( 74 %) normal delivery, 81
(81 %) without family history of recurrent UTI, 26 (26 %) with family history of UTI , 93
(93 % ) without UTI &sepsis after circumcision, 7( 7% ) with UTI and sepsis after
circumcision , 92 (92 %) without urinary catheterization, 8 (8 %) with urinary
catheterization , 12 (12% ) hospital circumcision and 88 (88 % ) home circumcision, 59 (59
% ) breast feeding, 49 (49 %) bottle feeding, 66 ( 66 %) infants and 44 ( 44 % ) preschool
age and 26 (26% ) with UTI and sepsis before circumcision and 48 (48 %) without UTI and
sepsis before circumcision.
Conclusion: Health benefits include protection against urinary tract infection and thus
prevent permanent damage to the still-growing kidney, reduced likelihood of penile
inflammation, and elimination of risk of phimosis.

Objective : The purpose of this study is to compare the results of certain hematological
parameters with both venous and capillary blood samples to find out any differences in their
results by using the same laboratory methods.
Methodology : In this study, we compare the results of some hematological parameters
including hemoglobin concentration (Hb) , packed cell volume (PCV) , white blood cell
count (WBCs), platelets count , and differential white blood cell count in both venous and
capillary blood samples. Venous (forearm) and capillary (finger tip) blood samples were
collected at the same time from 50 healthy male adults (20-23 years). volunteer students of
the College of Health and Medical Technology / Baghdad.
The measurements of the hematological parameters were carried out manually by routine
hematological methods. All the tests were done immediately after blood collection at the
teaching laboratory in the College of Health and Medical Technology / Baghdad for the
period from November 2012 till March 2013.
Results : Capillary blood has significantly higher (P<0.001) hemoglobin concentration
measurement than venous samples, while other hematologic parameters (PCV, WBCs,
platelets, while differential WBC counts show no significant variation (P>0.05) between
capillary and venous blood samples, except the lymphocyte count, which indicate a
significant rise (P<0.05) in venous samples.
Recommendations : This study focused on some hematologic tests that can be done by
either capillary or venous samples. It is necessary for future studies include hematological
and biochemical parameters to find out if there is any difference regard in these two samples.

Background: Cancer is common; it is the second most common cause of death in the
Western worlds, Breast cancer accounts for around 20-25% of all female cancers in both
India and UK world. There are differences between the percentages of patients with various
malignant tumors in our country and those in the Western world. ABO blood groups are a
stable feature of a population and they differ among various socioeconomic, geographical and
ethnic groups and many risk factors are associated with the development of breast cancer. It
is mentioned that bloods type has an influence on susceptibility and outcomes
Objectives: The aims of this study are:
To found any association between breast cancer and ABO blood group.
To know what is the frequency of each blood group in relation to patients with breast cancer.
Materials and patients: This study has been carried in Azady teaching hospital in Kirkuk on
250 patients with breast cancer and classified according to their blood group.
The control sample was 300 healthy donors from Kirkuk blood bank and classified
according to their ABO group and frequency of each sample estimated statistically and
compared with each other.
Results: This study shows the distribution ABO blood groups among patients with breast
cancer were as follow: blood group type (A) 64% (160) , blood group type (O) 18% (45) ,
(B) 9.6% (24) , and( AB) 8.4% (21)
For the donors healthy control , ABO blood groups percentage were as follow:
type (O)36 % (108) type(A)29.4% (88) ,type(B) 20.6% (62), and type (AB) 14% (42). The
distribution of blood group among the patients with breast cancer and the donors from normal
population that the result is highly significant (p<0.000).
Conclusions: The study shows a strong correlation between the ABO group type and breast
cancer and the highest frequency and percentage of patients with breast cancer was in blood
group type (A