Diyala Journal of Medicine

Background: The pharyngeal tonsil (adenoid) constitutes the upper portion of the Waldeyer’s
ring and it is situated at the top of the nasopharynx, next to the auditory tube and choana.
Hypertrophy of the adenoids and eustachian tube dysfunction are often considered to be
causal factors for otitis medial with effusion. There are many methods used to measure the
size of adenoid such as lateral soft tissue X-ray of nasopharynx.
Objectives: This study aimed to evaluate the grades of adenoidal hypertrophy among schools
age children with otitis media and to find of an association between size of adenoid and
occurrence of otitis media with effusion.
Subjects and Methods: In this cross sectional study, 17 primary schools were visited; all
pupils from the first to the sixth year of elementary study were examined in the period from
mid October 2009 to mid May 2010. A total of 1,035 pupils were interviewed and those with
positive findings that suggest otitis media with effusion were referred to the otolaryngology
outpatient department to confirm diagnosis using further investigations such as
tympanometry; and a pure tone audiometry was also used to assess the hearing threshold.
Adenoid size was measured by adenoid/nasopharyngeal ratio on cervical lateral views of
simple X-rays.
Results: Otitis media with effusion was found in 48 (4.6%) of the studied children. The most
common type of tympanometry results seen among the children with otitis media was type B.
Grade 3+ adenoid hypertrophy was mainly seen among patients having unilateral and bilateral
otits media with effusion, accounting for 16% and 37% of all cases of otits media with
effusion accordingly. Type B tympanogram was significantly associated with positive history
of oral breathing in the studied children (p value < 0.05).
Conclusions: The study concluded that adenoid hypertrophy was associated with otits media
with effusion in school age children. The proportion of otitis media with effusion increases
with the severity of nasopharyngeal obstruction by adenoid hypertroph

Background: Biofilms can be defined as communities of microorganisms attached to a
surface to prevent themselves from the environmental effects and cause infections. A study
on microbial contamination associated with contact lenses wearers was carried out on women
in Ramadi city, some of them were asymptomatic and others were complaining of redness,
tearing and itching.
Objectives:
1-Isolation and identification of microbial infection associated with contact lens wearers by
examination of the storage case solution
2-Studying of different factors that have effect on microbial infections among contact lenses
wearers such as (age, wearing type, symptoms)
3-Performance of biofilm assay on the new contact lenses, Microtitre plate (MTP) and
comparison with used contact lenses and the ability of biofilm formation among different
isolates from storage case solution.
Material and Methods
Collection of the samples
Eighty samples of solution were collected from women of different Sources who Contact
lenses: Five used and two new contact lenses as well as Microtiter plate (MTP) were used as
samples to observe biofilm formation in this study.
Sample from twenty new storage solution bottles were used as a control sample Isolation and
identification of microorganisms: Macroscopical examination, Culture and Biochemical tests.,
Microscopic examination were done.
Biofilm assay: according to Yukinobu, el al., 2006.
Results: The study was done during the period from April 2008 to Jan. 30th 2009. Samples
were collected from (80) women distributed as follows: (housewife, pupil, student, staff and
others). Their ages were ranging from 13 – 36 years. The most common age of contamination
was found to be ranged between 19-24 years which accumulated for (55%) of all
Eye' redness is found to be the most common symptom (26.25%) ) complained by the sampled
women of this study. Isolates of Pseudomonas aeruginosa, Staph. aureus, Staph. epidermidis,
Liesteria and Klebsiella were obtained from the storage solutions of contact lenses. According
to the optical density showed by Microtitre plate (MTP) Reader, Pseudomonas aeruginosa
was the most common bacterial type associated with biofilm formation for the considered
samples.
Conclusion: Pseudomonas aeruginosa was the most common bacterial type associated with
Biofilm formation

Background: Measles is a highly contagious viral illness; it is endemic in Iraq and worldwide
developing countries. Measles is carrying many complications with morbidity and mortality.
Aims of the study: To determine the role of previous immunization agonist measles and the
use of the vitamin A to decrease the mortality and morbidity of disease.
Patients & Methods: A cross-sectional study was conducted at Al-Yarmouk Teaching
Hospital included 632 patients (318 males at age 15-42 years & 314 females at age 17-42
years) whose admitted to hospital for the period between October 2010 to April 2011.
Diagnosis was according to the clinical manifestation and confirmed by ELISA for detected
antibody (IgM & IgG).
Results: The study shows the role of immunization against measles. It is very important to
control out break and decrease mortality and morbidity of the disease, therefor must be re
immunization against measles in booster dose in the 18th & 30th years old, and in premarital
program in Iraq to decrease the outbreak in pregnants women's to decrease mortality and
morbidity among mothers and babies. The use of vitamin A in treatment of measles patient to
decrease mortality and morbidity of disease, and must be supplement to child and scholar in
outbreak season of disease

Background: Currently, candidemia infections represent an increasing cause of morbidity
and mortality in seriously ill hospitalized patients. Because the accurate diagnosis of
candidiasis remains difficult, fast and reliable assay for characterization of fungal pathogens is
critical for the early initiation of adequate antifungal therapy and/or for introduction of
preventive measures.
Objective: To detect candidemia in leukemic patients by molecular methods in comparing
with golden standard method(culture method).
Materials and methods: A total of 60 leukemic patients were included in this study. Clinical
type and other demographic data were recorded. Blood samples were taken from each patient,
culture; germ tube formation and carbohydrate fermentation were done for each sample. DNA
extraction and polymerase chain reaction (PCR) were used for detection of Candida
albicansin cultured bottles.
This study was conducted on leukemic patients admitted to four different hospitals in
Baghdad city from September 2010 to March 2011. Sixty patients suffering from acute
lymphoid (ALL) and myeloid (AML) leukemia were included in this study. The age of
patients were ranging between 3-46 years old. Twenty five apparently healthy individuals
were enrolled in this study as control group.
Three milliliters of blood were collected from each patient; 1.5 ml was inoculated in
20 ml Brain heart infusion broth (Cruikshank. 1975). The rest of blood (1.5ml) was stored in -
20ᴼC for further analysis.
Blood cultures were incubated at 37°C for 10 days, and examined daily for growth.
DNA purification kit was purchased from QIAGENE®Company. This method was used
for the purification of genomic DNA from fresh or frozen samples of 1 ml overnight yeast
cultures by using the GentraPuregene Yeast/Bact. Kit.
PCR was performed to detect Candida albicans species through the amplification of
specific gene (αINT1)
Results: Only one positive culture result out of 60 samples was obtained for Candida sp.,
(1.7%). PCR results showed that there were only three out of sixty were positive for C.
albicans (5%).
In this study we obtained only one positive sample according to culture, while three
samples only gave positive results according to PCR method.
These results suggest that molecular analysis of candidemia is more sensitive and less time
consuming than culture and other conventional methods.

Objective: To measure the serum level of IL4, IL10 and IFN-gamma of Atopic patients
before and after treatment with tacrolimus ointment or topical steroid by using enzyme linked
immunosorbant assay (ELISA) to evaluate the disease activity.
Methods: IL4, IL10 and IFN-gamma concentrations in the serum were measured by enzyme-
linked immunosorbent assay in fifty atopic dermatitis patients were giving two types of
treatment and 43/50 were re-analyzed after one month of treatment with tacrolimus or topical
and systemic steroids. The severity of atopic dermatitis was graded on the criteria of Hanifin
and Rajika. The disease activity was assessed by each patient on a visual analogue scale
(VAS).
Results: Higher serum IFN-γ, IL-10 and IL-4 concentrations were found in AD patients sera
at the time of diagnosis and correlated with disease activity before and after treatment. Serum
IFN-γ, IL-10 and IL-4 concentrations also correlated with VAS scores for itching, skin
condition; overall skin symptoms and total VAS score. Serum IFN-γ concentration could be a
good indicator to define the degree of the general activity in chronic AD patients, also IFN-γ
can play a role in the immuno-pathogenesis of AD, and furthermore may be used in the
diagnosis and follow up of the disease in addition to other parameters.
Conclusion: The sera of patients group revealed a statistically significant increase in the
concentration of IFN-gamma, IL-4 and IL-10 before treatment when compared with that of
the same patients after treatment with topical tacrolimus-steroid and also there were no
statistically significant differences between two treatments.
Keywords: Atopic dermatitis, interleukins, interferon gam

Thirty-four samples with position Pseudomonas aeruginosa cultures isolated from bourns,
wounds urinary tract infection and Otities media were collected from Baquba General
Hospital during September-December 2010. The sensitivily of these isolates were tested
against (16) antibiotics. The results showed that the highest resistances were for Amoxicillin
,Ampicillin , CO-Trimoxazole and Nitroforautoin with 100% , while the lowest resistance
was for Ofloxacin with 3% .The results of minimum inhibitory concentration (M.I.C) toward
eleven antibiotics showed different range among isolates , some were able to resist high
concentration of Ampicillin and Amoxicillin reach to 1024µg/ml , while others were inhibited
by 2µg/ml of Ciprofloxacin . The isolates showed low sensitivity for combination Ampicillin-
Sulbactam with 0%, while it shwed high sensitivity toward combination of Piperacillin-
Tazobactam and Ceftazidime-Clavulanic acid 91.17, 100% respectively. The results of
plasmid content was studied indicate that all isolates contain single large plasmid band, while
the study of plasmid curing appear the plasmid loss at concentration 512 µg/ml of acridin
orange.

Background: Mechanism underlying the lethal effect of microwave radiation on
microorganisms are yet to be discovered. Some researchers hypothesized that electromagnetic
waves can increase the target temperature and destroy life.
Objectives: The aim of this study was to determine the impact of cell phone radiation on
bacteria that cause otitis media.
Materials and Methods: Two bacterial isolates were selected from cases of inflammation of
the middle ear(otitis media). Pseudomonas aeruginosa and Staphylococcus aureus, isolates
were exposed to electromagnetic waves emitted from mobile. After the incubation period, the
absorbance was measured to determine the degree of turbidity by using spectrophotometer on
the wavelength 400nm.
Results: It was found that is no effect of mobile radiation up to six minutes of exposure to
both bacterial Species, but influence began after the six minutes and increased influence
directly proportional to the time. Effective dose 50 of Staphylococcus aureus was 11.5
minutes while for Pseudomonas aeruginosa was 14.2 minutes.
Conclusions: The radiofrequency of cell phone effects on the bacteria depend on the
following factors: the exposure time to mobile radiation, water content and increasing
temperature, breaking protein molecule.

Background: - Although CA125 is a valuable tumor marker of ovarian carcinoma but it may
be have a value to assess the risk of miscarriage at the early stages of pregnancy for woman
with history of recurrent pregnancy loss either alone or in combination with other biochemical
marker.
Objective: To predict pregnancy outcome by studying the level of serum β HCG,
progesterone and CA125 at different gestational age in the first trimester for predicting
pregnancy loss.
Patient and Methods: This study was conducted in Al-Batool Teaching Hospital (in the
center of Diyala governorate by studying the patient records as a prospective trail in period
from Jan. 2010 to Jan. 2011. The study carried out on 90 pregnant women with a history of
recurrent pregnancy loss in there first trimester of pregnancy divided in 3 groups (30 women
with no history of abortion as control group, 30 women with history of recurrent pregnancy
loss, 30 women who failed to complete their pregnancy in the first trimester during the study.
Serial maternal B-HCG, progesterone and CA125 were determined.
Results: Serum B-HCG showed a sensitivity of 97%, a specificity of 53%, a PPV(positive
predictive value) of 56% and a NPV(negative predictive value) of 97%. Serum progesterone
showed a sensitivity of 27%, a specificity of 79%, a PPV of 38% and a NPV of 69%, while
serum CA125 showed a sensitivity of 8%, a specificity of 60%, a PPV of 10% and a NPV of
70%.
Conclusion: the value of CA125 in recurrent abortions is still unclear and cannot be
recommended on routine basis. On the other hand, β-HCG is 97% sensitive with a 53% NPV
as a single serum measurement for the prediction of pregnancy outcome.

ckground: Maternal hypertension and preeclampsia are a multisystem, highly variable
disorder unique to pregnancy and a leading cause of maternal and fetal/neonatal morbidity
and mortality. Given the progressive nature of the disorder, delivery is often necessary to
minimize maternal morbidity and mortality; obstetricians must balance the need for achieving
in utero fetal maturation with the maternal and fetal risks of continuing pregnancy.
Objectives: To evaluate the maternal burden and neonatal outcomes of infants delivered to
mothers with preeclampsia, to review the outcomes of late-preterm infants, and potential
strategies to optimize fetal outcomes in pregnancies complicated by preeclampsia.
Materials and Methods: A cohort prospective study done in Albatool Maternity Teaching
Hospital from October 2011 to April 2012 for 55 mothers coming for antenatal follow up how
hypertension and preeclampsia had been followed till delivery with their delivered neonates
looking for the maternal hypertension, medication, liver function, complete blood picture,
complications of preeclampsia and neonatal condition at birth, weight, respiratory function,
feeding, complete blood picture and liver function, small for gestational age (SGA),
respiratory distress syndrome (RDS), and neonatal death (NND) .
Results: Infants of women with preeclampsia were more likely to be SGA 27(49% ) and have
RDS 6 (10.1%); Frequency of preterm delivery at <37 weeks' gestation rose greatly with
increasing severity of maternal hypertension 16 (29%). Fetal distress was seen in 12 cases
(21.8%) with meconium staining of liquor in 8 cases 14.5% ,33 neonates (60%) required
admission for many reasons. Mothers with hypertension have high risk of ante partum
hemorrhage 40(72%), 17 delivered normally (30%) while 38 delivered by caesarean section
(70%).
Conclusion: Compared with neonates delivered prematurely because of other etiologies,
neonates born to preeclamptic mothers were more likely to be SGA and have less RDS, but
had a decrease in mortality. This may be a reflection of the differences in the underlying
pathophysiology behind indicated preterm birth due to preeclampsia.

Background: Nutritional support is an essential aspect of the clinical management of children
admitted to hospital. The mean length of hospital stay of most children is only a few days, but
can be considerably longer in some children with chronic diseases or underlying problems.
During their brief stay, attention is mostly focused on the primary medical problem with a
little attention given to the child’s nutritional status. Really we don’t know how much the
nutritional problems are prevalent in the hospitalized children in the province & in overall
country, so the purpose of this review is to describe the current prevalence of undernutrition
in hospitalized children in order to bring an attention & care to that problem.
Patient & method: This is a prospective study, it was done at al- Batool teaching hospital for
maternity & children from 1st of September 2011 to 1st of March 2012. All the patients from
>1 month to 5 yr had been included; Weight for age & sex was measured for those patients &
compared to the international values published by World Health Organization (WHO).
Prevalence of underweight malnutrition was calculated & showed, in addition to other
characters of the sample.
Results: The total number of the registered children was 410, the number of underweight
children was 108 (26.3 %), so the prevalence of underweight was 26.3 %. The malnourished
children were 59 (55 %) male & 49 (45 %) female, while most of them (105 (79 %)) were
below 2 year of life.
Those malnourished children were classified according to the type of malnutrition into:
acute malnutrition (wasting) and chronic malnutrition (stunting), while according to other
classification for malnutrition, the sample was divided into two groups, underweight &
marasmus. while both of kwashiorkor & marasmic- kwashiorkor were not present in the study
because edema was not detected clinically on data collection.
Conclusion: Malnutrition among hospitalized children is worthy of attention, and effective
strategies for systematic screening and treatment of malnutrition in pediatrics patients need to
be developed and implemented.

Objective: leucocytes are cells of the immune system involved in defending the body against
both infectious disease and foreign materials.
When increase or decrease in the number of leukocytes in the blood is often an indicator of
disease(the normal level of WBC in blood between 4000 to 11000 cell /ml ), , they make up
approximately 1% of blood in a healthy adult.[3] An increasing in the number of leukocytes
over the upper limits is called leukocytosis, and the decrease below the lower limit is called
leukopenia.
Method: This research contained study 64 patients (average age between 20 – 35 years )
suffering from increasing WBC " diagnostic by WBC count test "and perform lipid profile
test (Triglyceride , cholesterol , LDL , HDL ) for all patients and shows the changes in lipid
profile
Results: we found relationship between increasing levels of lipid and increasing WBC
disease. These result are (45 %cholesterol )
( 58%Triglyceride()39% LDL()22% HDL). That is
mean, the increasing of lipid profile were stimulation of immune system to increasing the
white blood cell.
We conclude than an increasing WBC associated with increasing of lipid profile

Introduction: Endoscopy of upper gastrointestinal tract is a safe and easily carried out
procedure of high diagnostic value and also atheraputic value in some cases.
Endoscopy is not costly and has aremarkable low incidence of morbidity, Dyspepsia is a non-
specific group of symptoms related to the upper GI tract.
It is the medical term for indigestion, a symptom that includes epigastric pain, heartburn,
distension, nausea or 'an acid feeling' occurring after eating or drinking. The symptom is
subjective and frequent. The most common causes of indigestion are gastroesophageal
acid reflux and functional dyspepsia. Other cases are a consequence of a more serious organic
illness[6].
Objective: To evaluate the common causes of dyspepsia by endoscopic examination.
Material and methods: Atotal of(9785) endoscopic examination of upper GI tract were
recorded and analyzed during the period between first of January 1998 to end of December
2009.
Results: The endoscopic findings of (9785) patients with dyspepsia were studied .out of
9785 patients ,5112 patients(52.24%)were males while 4673(47.76%) were females.
The endoscopic findings were normal in (3219)patients(32.89%)
The abnormal findings included duodenal lesion in 3793 patients(38.76%) ,gastric lesions in
1492 patients (15.24%) ,esophageal lesions in 1111 patients(11.35%) and others causes in
170 paients(1.73%).
Conclusion: The upper gastrointestinal endoscopy has ahigh diagnostic values in the
investigations of upper gastrointestinal symptoms

Objectives: Perthes disease has been recognized as a public health problem in Iraq, in
general, and in Duhok governorate, Iraqi Kurdistan region in particular, many aspects of
which are not yet clear. This study was conducted to deal with the importance and effect of
various variables which might have influence in perthes disease occurrence,
Methodology: A cross sectional study design was performed & continued for 4 month and
included 170 non-randomized consecutive samples collected from the Early detection of
childhood disabilities center (E.D.C.D.C.) Duhok. Patients' registers from the center were
used to collect data concerning perthes cases.
Results: The results indicated that males mainly suffer (68.8%), (41.2%) of perthes cases
occur in winter, left sided affection was more occurring (45.9.1%), patients aged (7-11years)
were the highest (42.9%), consanguious parents constitute (55.3%), the mother's age group of
(26-35 years) had the highest occurrence (58.2%), illiterate mothers (62.4%) were the highest,
illiterate fathers were highest (39.4%), deliveries conducted in hospitals constituted
significantly the highest rate (78.2%), the highest rate observed was in families having (1-5)
children (51.8%), the group with no other disabled children within the same family was the
highest (87.1%), Duhok city showed the highest incidence (38.2%), mothers with blood group
O+ve were the highest (44.1%), mother's with normal deliveries were highest & finally patients
with no complications were the highest (94.1%).
Recommendations: It is recommended that all infants with positive risk factors & with
positive family history of perthes must be examined carefully, as well as establishment of
perthes screening units in all maternity hospitals in Duhok governorate.