Diyala Journal of Medicine

Background: Breast cancer shows different clinic- pathological features according to
geographic and ethnic groups variation. The ER, PR and Her-2/neu positive status is an
indication that the patient is good candidate for hormonal and immunological therapy.
Aim of the study: To measure the frequency of estrogen receptor (ER), progesterone receptor
(PR), and Her 2/neu positivity and to study their association with other variables in a breast
cancer in Kirkuk city.
Material and method: A prospective study of 138 female breast cancers in Kirkuk city from
October 2012 to December 2013.
Results: The age of the patients ranged from16 to 75 years, with a mean of 47 years, most
common age group involved was 41-50 years, majority of our patients were less than 50
years, tumor grade III, tumor size between 2-5cm. ER, PR and Her-2/neu expression was seen
in 50.7, 47.8 and 41.3% respectively, a characteristic association also found between hormone
receptor and Her-2/neu expression and various clinic-pathological parameters.
Conclusion: The hormonal receptor expression appear to be lower and Her-2/neu expression
appear to be higher in our population compared to the West and a significant reverse
association was found between hormone receptor and Her-2/neu

Background: An important step of tumor progression in which Matrix metalloproteinase
have been implicated is angiogenesis, because these enzymes degrade the extracellular matrix
and provide a permissive microenvironment for the growth of new blood vessels.
The present study conducted to evaluate the immunohistochemical expression
ofMatrixmetalloproteinase -2(MMP-2) andangiogenic marker (CD34) in Oralsquamous cell
carcinoma(SCC)versus verrucous carcinoma(VC) and to correlate their expressions with the
clinicopathological parameters.
Material & Methods: MMP-2 and CD34 expression was examined immunohistochemically
in twenty four paraffin tissue blocks of squamous cell carcinoma and verrucous carcinoma
(twelve cases of each).
Results: All cases of Oral SCC exhibited positive immunostaining for MMP-2, while only
one case of VC showed –ve expression. Interestingly all cases of VC showed –ve MMP-2
immunostaining of the basal cell layer. Generally lymphatic vessels were more than blood
vessels in both VC&SCC cases. The mean MMP-2 immunoexpression was (59.00%) for both
stage I &stage II, while the higher CD34 immuno expression was in stage I. The mean
expression of MMP-2 was higher in well differentiated OSCCs, while for CD34 it was higher
in poorly differentiated OSCCs followed by moderately differentiated, then well
differentiated, however no statistically significant difference was found. Non- significant
correlation was found concerning the expression of both markers for both lesions.
Conclusion: No statistical correlation was found between MMP-2 expression and
angiogenesis in OSCC and OVC.

Background:- Renal failure may lead to increased inflammatory responses through a number
of mechanisms which include decreased clearance of proinflammatory cytokines, decreased
levels of antioxidant , that lead to increase of oxidative stress , nephrons are destroyed and
kidney function is reduced .
Objective:- The aims of this study were to determination the differences in the levels of
interleukin-35 (IL-35) in patients with chronic renal failure (CRF) on hemodialysis and
compare with control group.
Method:- Sixty male individuals (age 40-60) were enrolled in this study which were divided
into two groups as follows: Group (C) consisted of 30 healthy individuals as a control subject,
(30) patients with (CRF) which were collected of their serum pre and post hemodialysis and
control. IL-35, hs-CRP, TAC, MDA, MDA/TAC, urea, creatinine, uric acid, albumin levels
were evaluated.
Results:- The results in this study revealed that mean of serum IL-35 levels were significantly
increased differences in patients with (CRF) pre and post hemodialysis compared with control
group and a significant positive correlation between IL-35 and (MDA, MDA/TAC) in patients
with pre and post dialysis patients with CRF.
Conclusion:- Our findings suggest that a high IL-35 level most possibly reflect that the
patients with (CRF) are associated and the positive correlation with oxidant-antioxidant
status. Therefore, we suggest that possible antioxidant strategies that can be used
therapeutically for better management of (CRF).

Background: The present study was designed to investigate the effects of toluene and
formaldehyde inhalation on the ovaries of adult female mice at room temperature.
Material & Methods: Mice were divided into three groups: control group, toluene
exposed and formaldehyde exposed groups. The female mice were exposed to (3 ml = 300
ppm toluene) and (2.5 ml=300 ppm formaldehyde) 3 hours daily for 21 days. In this study
a haemotoxlyin and eosin stains as well as the periodic acid Schiff (PAS) were used in
order to illustrate the histological structures of the ovaries.
Results: Female exposed to both solvents showed a significant decrease in their weights.
Histological examination of the ovaries of the exposed mice (either to toluene or
formaldehyde) revealed an increase in thickness of zona pellucida of ovarian follicles,
significant increase in the number of primary, secondary and Graffian follicles with
decrease in the number of primordial follicles after inhalation comparisons to the normal
groups.
Discussions: The results indicate that exposure to these organic solvents may suppress the
central nervous system that contains vital centers which leads to reduction of mice weight.
Conclusion: Both solvents may cause injuries to the ovaries followed by changes of the
histological structure for them. This might be due to disruption of endocrine function
which leads to suppression of the releasing of gonadotropins hormones.

Background: The overexpression of the protein products of genes associated with the cell
cycle protein p53 and PCNA is apparently of great significance. Oral lichen planus classified
among the potentially malignant lesions of oral mucosa. The aim of this study is to evaluate
and compare the tissue expression PCNA and p53 proteins in oral lichen planus, epithelial
dysplasia cases and normal oral mucosa.
Materials and methods: Formalin-fixed and paraffin- embedded blocks of 21 lichen planus,
21 oral dysplasia and 10 of normal oral mucosa cases were used in immunohistochemical
(IHC) analysis for PCNA and p53 monoclonal antibodies.
Results: The mean of PCNA expression in OLP (44.14) was less than in the control group
(74) and there was an opposite result of p53 (12.19) when compared with the control group
(1.05), and in cases of epithelial dysplasia the same result was found and the mean PCNA
value in epithelial dysplasia was significantly higher than those found in controls and in oral
lichen planus. There was a statistically significant difference between the expression of p53
and PCNA proteins in oral lichen planus cases and non- significant differences of both
proteins expression in oral dysplasia cases. Moreover, there was a significant positive
correlation between the numbers PCNA and p53 percentage of positive cells in oral lichen
planus group.
Conclusion: The proportion of cases with positive PCNA and p53 expressions increased
from normal oral mucosa to lichen planus to epithelial dysplasia. These results may indicate
the presence of high degree of PCNA and p53 proteins in chronic and premalignant lesion
like oral lichen planus and epithelial dysplasia can be great helpful in their prognosis and
suggested treatment.

Background: Essential hypertension is the term applied to the 95% of cases in which no
specific underlying cause can be identified. Increases with advancing age, and affects more
than half of all people over the age of 60, including isolated systolic hypertension. Nearly
three quarters of people with hypertension live in developing countries where awareness of
the disease and access to health care are sometimes inadequate.
Patients and methods: A total of 275 elderly patients 60%(n=165) females,40%(n=110)
males, were seen for ( pre-operative elective surgery) medical check-up, who were found to
be hypertensive, included in a cross-sectional study, assessing the disease awareness, control,
compliance and complications by clinical assessment and laboratory tests . Their ages ranged
from 60-83 years (mean age = 68.5).
Results: From the total only 12% (n=33) of patients were found achieving good control
Morbidity rate was high. Though hypertension is common in the elderly persons, I noticed the
rates of awareness, treatment, and control in these patientswere low, leading to many
morbidities especially cardiovascular events and stroke.

Background: Hemophilia is hereditary bleeding distorted, and widespread in the world.
The Objective: to identify the epidemiological characteristics of sample.
Methodology: descriptive of study was conducted in genetic blood disease center in the AL-
Ramadi Teaching Hospital for maternity & children during six months period of October to
April (2012-2013).The data were collected by reviewing part of registered record in the
center.
Results: The study included (60) patients with hemophilia registered, (76,7%) was
hemophilia A and (23,3%) hemophilia B. Age distribution revealed that the highest affected
age group were those from age 6-15 years (33.3%). Gender distribution revealed that (88.3%)
were males & (11.7%) were female. Residency distribution revealed that 65% were Rural &
35% were urban. The study showed that (56.7%) of cases were marriages among first cousins,
(15%) of cases were marriages among close family or tribe & (28.3%) are marriages unrelated
with family.
Conclusion: from this study we can conclude that the most common is hemophilia A
followed by hemophilia B & the number of newly registered cases is increasing with
consanguineous marriages.

Background: Lichen planus is an idiopathic inflammatory disease with characteristic clinical
and pathologic features affecting the skin, mucous membranes, nails, and hair. It is likely that
both endogenous (genetic) and exogenous (environmental) factors such as some drugs or
some infection(s) may interact to elicit the disease.
Objectives: To determine the prevalence of hepatitis C virus antigen among the patients with
lichen planus and comparison with healthy control group.
Materials and methods: Twenty patients with lichen planus were included in this study (12
males and 8 females) and (40) healthy control (28 males and 12 females), their ages ranged
from (15-60) years, obtained from Alkhalis hospital during the period from 1st February to
30th September 2013, using enzyme linked immunosorbent assay (ELISA) technique to detect
anti HCV antibody in patients serum and control group.
Results: Two (10 %) had positive results for hepatitis C virus antigen (2) out of (20) patients
suffering from lichen planus, while none of the within healthy control group had positive
result. Statistically significant relationship was observed between both of them.
Conclusion: The frequent study showed a difference in prevalence of hepatitis C virus in
patients with lichen planus and healthy control

Background: Asthma is a chronic inflammatory disease of the respiratory airways with a
worldwide prevalence. This study was performed to evaluate the role of leptin on asthma and
/or allergic rhinitis, and to study asthma-obesity-leptin relationship.
Methods: A cross sectional study was performed on asthmatic patients (190), allergic rhinitis
patients (110) and healthy control subjects (48).
Results: Serum leptin was significantly higher at asthma with overweight, asthma with
metabolic syndrome, allergic rhinitis with overweight patients than of control subjects, while
it was of no significant statistical difference at asthma with normal weight, allergic rhinitis
with normal weight patients than of healthy control individuals. Body mass index was
significantly higher in asthma with overweight patients; asthma with metabolic syndrome and
allergic rhinitis with overweight. It was of no significant difference in asthmatic with normal
weight patients, allergic rhinitis with normal weight than of control subjects. FEV1 was
significantly lower in asthma with normal weight patientss; asthma with overweight; asthma
with metabolic syndrome; allergic rhinitis with normal weight; allergic rhinitis with over
weight than in control subjects.
Conclusion: Leptin was significantly higher in patients with asthma and allergic rhinitis as
compared to healthy non allergic individuals and it was influenced by BMI and presence of
metabolic syndrome in allergic patients. BMI influence FEV 1 in both asthmatic and allergic
rhinitis patients.

Background: Goiter is a common disease in Iraq and it is more common in the North .The
disease is more common in females than in males.
For this reason thyroid surgery is a common procedure.
Many complications occur during and after surgery such as; bleeding, hypothyroidism, and
recurrent laryngeal nerve injury.The later complication, although infrequently encountered
can cause a lot of suffering to the patient.
Objective: The objective of our study is assessing injury to the recurrent laryngeal nerve
without exploration of the nerve routinely during thyroid surgery. exploration of the nerve
done for selected cases where there is increase risk to injury.
Patients and method: Prospective study of 400 patients whom underwent different thyroid
surgery for different thyroid diseases done by one surgeon from July 1992 to July 2012 in
Baquba teaching hospital were analyzed for permanent injury to RLN , when non-exploration
of the RLN is the rule.
Result: from the 400 cases included in the study only 4 cases (1%) had permanent injury to
the RLN, 6 cases (1.5%) had transient injury and no injury in 390 cases (97.5%).
Conclusion: Exploration of the RLN is not necessarily to be done routinely during thyroid
surgery. We recommend exploration of the nerve in selected thyroid diseases.

Background: Different invasive and non-invasive investigations are used in the diagnosis and
management of thyroid. Fine needle aspiration cytology (FNAC) is a safe test, technically
easy to perform and cost effective. This study was conducted to throw a light on practicing
FNAC in Baghdad, Iraq.
Aim of the study: This study was conducted to throw a light on FNAC from a personal
experience with thyroid disorders in Baghdad, Iraq.
Methods: A total of 79 patients of clinically diagnosed thyroid swelling was included in the
study. FNAC performed and then all patients subjected to surgery. Thyroidectomy specimens
were evaluated by histopathological exam.
Analysis of variance ANOVA (Is a collection of statistical models used to analyze the
differences between group means and their associated procedures such as variation among
and between groups) was used to examine the effect of age and duration on FNAC results.
Chi square was used to examine the effect of histopathological diagnosis on FNAC readings.
Accuracy of the FNAC was assessed using 2X2 table.
Results: FNAC results was significantly affected by age of the patients (p=0.005), duration of
thyroid swelling (p=0.0001) and histopathological diagnosis (p = 0.0001). Sensitivity,
specificity, positive predictive value and negative predictive value were 75%, 57%, 94.7%
and 18.2%, respectively.
Conclusion: Low negative predictive value for FNAC was reported. the accuracy of FNAC
affected by the experience of the histopathologist.

This study were performed to determine two biochemical criteria in the serum of
Kala- azar patients include measurement of total serum protein & iron concentration and
study the differences between each parameters in patient serum according to age, sex &
size of sample study which contain (100) infected children's were (63 male &37 female)
those admitted to AL-Batool teaching hospital in Diyala Governorate during the period
: (1/10/2012 to 25/3/2013 ).The result in study were showed a significant increase in the
protein & iron In infected as compared to & healthy children's . The concentrations of iron
in the infected children is (105 ±7.0g/100ml) while the iron concentration in healthy
children is(75.84±2.6 g/100ml).The concentration of protein in serum of infected
children is (7.22±0.22 g/100ml) while in the healthy children is (7.08±0.12 g/100ml) .
Key words: Kala-azar „ Serum iron concentration „ Serum protein Concentration.

Back ground: Viral skin infections are a common skin problem all over the world especially
in childhood and some of which are sexually transmitted with different prevalence rate in
relation to age, sex, occupation and social group .
Objective: To determine the prevalence of viral skin infections among Iraqi patients,
attending Baquba Teaching Hospital.
Patients and methods: A cross-sectional study was conducted in a consultant clinic of
Baquba Teaching Hospital, in Diyala Provence during the period of 1st October 2008 to 31
March 2012. In which (802) patients with different viral skin diseases were collected and
diagnosed clinically by consultant dermatologests, they were (469) males and (333) females,
with a mean age of 27.7 ± 8 years.
Results: The viral skin wart, was the most prevalent (39.1%) and affecting the young adult
males predominantly (mean age 23.54±12.5 years). The plane wart affect predominantly teen
age group (mean age 14±11 years), pityriasis rosea and Gianotti Crostti syndrome which were
regarded as a viral infections or reactive state to a viral infections, shows a relatively high
prevalence rate (9.9% and 9.4% respectively). Molluscum contagiosum was also a common
disease (9%) and more prevalent in young adult (mean age 21±14.5 years). Although herpes
simplex viral skin infection were relatively a common disease in this study (8.4%), but the
genital form was less commonly seen in Iraq (0.5%).
Conclusion: This study concluded that viral skin infections were a common problem in Iraq,
predominantly in young adult males, with high prevalence of viral wart and low prevalence of
xanthematous viral infections.

Back ground: Garlic ( Allium sativum ) has been used in herbal medicine for treatment
of cardiovascular diseases risk factors such as serum lipids , blood pressure and plasma
viscosity .
Aim: The aim of present study is to evaluate the effects of garlic on one of the major
cardiovascular risk factors which is dyslipidemia in patients with type 2 diabetes mellitus .
Materials and Methods: Type 2 diabetic patients with dyslipidemia were enrolled in
this study. It covered 50 patients (35 males and 15 females) whose ages ranged between (40
– 75) years. Twenty clinically healthy individuals were included as a control group at the
same above ages. Diabetic patients given garlic for period of 6 weeks and 12 weeks after
which their serum lipid profiles where measured after fasting for 12 hours and
comparisons was made between the treated and untreated patients .
Results: It was found that the patients had a significant reduction in both total cholesterol
(TC) and triglycerides (TG) (the main contributing factors to arteriosclerosis) in comparisons
to the control group. The administration of garlic ( 1000 mg ) lowers the levels of low density
lipoproteins cholesterol ( LDL – C ) and raise the concentrations of high density lipoproteins
cholesterol (HDL – C) and so for the very low density lipoproteins cholesterol (VLDL–C)
if compared with that of the control group .
Conclusion: Garlic may play an important role in the treatment of dyslipidemic
patients with type 2 diabetes mellitus.

Background: Leakage from an anastomosis in the gastrointestinal tract is a major
complication that is often associated with increased mortality, morbidity and prolonged stay.
Different techniques of intestinal anastomosis are present:
• Sutured
– Single-layer (interrupted or continuous)
– Two-layered
• Stapled
Controversy regarding single versus double layer anastomosis goes as back as 1887 when
Halsted proposed interrupted extra mucosal suturing.
Aim of the study: To evaluate the safety of the technique single interrupted extramucosal
suturing of the bowel.
Patients and Method: This is a prospective study of 60 patients undergoing intestinal
surgery over a period of one year and 9 months (January 2009-september 2010) in baquba
teaching hospital; Both of emergency and elective surgeries are included in the study.
The way of bowel suturing (perforation or anastomosis) used was single interrupted
extramucosal using two zero vycril (polyglactine).
Results: No single patient developed anastomosis dehiscence or fecal fistula and they all
tolerated early oral feeding.
Conclusion: Single-layer sero-submucosal (extramucosal) technique is safe, easy to perform,
simply to taught and with no anastomosis-related morbidity and mortality. It can also be
accomplished in shorter time.