Diyala Journal of Medicine

Back ground and Objective: Spica cast is an effective method for treatment of closed
femoral shaft fracture in young children.
Aim of the study: Study done to compare between early (1-4)days, and delayed spica cast
treatment after traction 2-3 weeks as a definitive treatment to see any difference in terms of
results and complications, their advantages, 1imitation of acceptable reduction, overgrowth
Phenomenon, period of hospitalization and cost.
Patients and Methods: This study done in our teaching Hospital, Thirty eight patients closed
femoral shaft fracture were included in our study their age range between (12-48) months,
Antero posterior and lateral views of the injured femur were taken as well as x-ray of pelvis.
In 22 patients, early spica cast was done in the first (1-4) days after admission to the hospital.
16 patients continue on skin traction (2-3) weeks, when the fracture feels sticky and early
callus appear on the x-ray one and half a hip spica is done under general anesthesia under
guide of x-ray screening.
Results: The mean age was 30 months, the sex distribution of the patients was 23males 61%,
15 females 39%. 22 cases, right sided fractures 58%, while left sided fractures in 16 children
42%. The causes of fracture femur in our study were 24cases (63%) for fall on the ground,
8cases (21%) by fall from height and lastly 6 cases (16%) by road traffic accident. The sites
of fracture shaft femur in children, according to which third of the femur is affected were20
cases 52%in the middle third,12 cases 31% for the proximal third, and 6cases 17% in the
distal third. Initial observation of complications in our patients immediately after removal of
the spica in patients treated with early spica were 2 cases for shortening, while patients
treated with delayed spica following skin traction only one cases. Regrinding lateral
angulations only one cases. Recorded in early type of spica.
Conclusions: Fracture shaft femur in children treated by early spica cast or delayed spica cast
proved to obtain good results in spite of the presence of some degrees of shortening or
angulations'. Which prove to be limited at the end of follow up. In decreasing hospitalization
time, thus the parents and the patients will be more obedient.

Back ground: A lot of previous researches studded the endoneural microangiopathy and
small vessels diabetic pathological change, but little studded about the diabetic angiopathy of
the larger vessels like popliteal artery and related diabetic risk factors .Accordingly the
present work designed to study the structural and histochemical changes of the popliteal
artery as one of the medium size vessels.
Objective: Evaluation of the histopathological and histochemical measurement, of the
popliteal artery in diabetic male and female patients with different duration of the diseases, in
comparison with normal non diabetic samples.
Patient and methods: Histological sections, taken from amputated legs of 30 diabetic
patients (8 females and 22 males) at age of (55-75) years, and 30 cadavers (4 females and 26
males) at age of (25-50) years as control group.
Results: Histological sections from the popliteal artery of diabetic patients, showed marked
decrease in the diameter of the lumen, reduced thickness of tunica media and adventitia, but
increase in the thickness of tunica intimae and basement membrane. The loss of endothelium
in some places, cellular infiltrations in tunica media with Periodic Acid Schiff positive
particles, and in more advance cases calcifications, and organized thrombus was also detected.
The multiple regression analysis, showed significant effect of duration of diabetes on the
diameter of the lumen, and thickness of the wall and the tunica intima and media of the
popliteal artery.
Recommendation: Great vessels of diabetic patients, recommended to be examined by the
available imaging technique.

Background: Numerous studies have shown that hospital surfaces and frequently used
medical equipment become contaminated by a variety of pathogenic organisms and then
spread infection to others. The hypothesis that environmental microorganism cause human
diseases arises from two facts, firstly, our interaction with the inanimate environment is
constant and close, secondly environmental objects are usually contaminated often with
important human pathogens.
Objective: To investigate the hygienic conditions of delivery room and vaginal
contamination with pathogenic bacteria of referred pregnant women to the Erbil Maternity
Hospitals.
Material and Methods: Fourty three vaginal swab were collected from pregnant women who
attending to Erbil Maternity Hospital randomly and 13 swab samples from 6 delivery room
during the period from January till July 2014. The swabs sticks for bacterial culture were
inoculated on MacConkey, Mannitol salt and blood agar plates and incubated at 37°C for
18-24 hrs. Later bacterial isolates were identified by standard microbiological techniques and
antibiotic susceptibility tests were done according to Clinical Laboratory Standard Instituted
(CLSI) [13].
Bacterial growth had been observed in 47 cultures (83.9%).The most dominants bacteria
isolated from birth space were E.coli and Staph. aureus, while from vaginal swab isolate in
addition to those genera other bacterial genera were isolated including Klebsiella sp., Proteus
sp., Pseudomonas aeroginosa, Staph. albus.
The delivery room isolated bacteria showed clear resistance toward the antibiotics
Cefexime, Amoxicillin, Methicillin, Clindamycine, Norfloxacin, Amikacin,
Trimetheprime,Cefotaxime, Ampicillin and Tobramycin but sisnsitive to Vancomycine,
Ciprofloxacin.
Conclusion: The finding of established bacterial pathogens from delivery room and showing
a high resistance to commonly used antibiotics portends danger for surgical patients. This
problem could be controlled to some extent by restriction of purposeless uses of antibiotics
and by eliminating contamination in the environment of hospitals by applying strict quality
standards concerned with the hygienic manners both of patients and health staff, and the
performance of invasive procedures using aseptic technique.

Background: The lactobacilli are well known to have a positive effect on human health.
These bacilli, which are formed the largest part of the microbiology natural, that characterized
by its ability to inhibit the growth of bacteria through the production of various antimicrobial
materials such as bacteriocins and biosurfactant, thus preventing the formation of biofilm by
lactobacilli, and Staphylococcus aureus for examples of bacteria that have the ability to
produce a biofilm.
Objective: To determine biofilm production ability by Staphylococcus aureus isolates and
evaluate effectiveness of Lactobacillus acidophilus to elimination of planktonic
Staphylococcus aureus and their biofilm producers, in vitro.
Methods: This study was carried out for the period December 2012 to April 2013 in Ramadi
Teaching Hospital in Ramadi City. Fourty isolates of Staphylococcus aureus were isolated
from blood, urine, surgical wounds, and intravascular catheters. All specimens were
identified using biochemical tests, and they were tested for biofilm production by using
Microtiter-plate method. Also, used to study the ability of Lactobacillus acidophilus
supernatant to inhibit biofilm produced by Staphylococcus aureus, and used L. acidophilus
supernatant to inhibit planktonic S. aureus (S2,S7,S11,S12,and S19) which are highest
biofilm produced , in vitro.
Results: Fourty Staphylococcus aureus were biofilm produced and distributed in to 20 (50%),
15 (37.5%), and 5(12.5%), our result showed that inhibitory effect of Lactobacillus
acidophilus supernatant on planktonic S. aureus (S2, S7, S11, S12, and S19). Significant
differences (P<0.01) were found between pre and post treatment of Staphylococcus aureus
biofilm with Lactobacillus acidophilus supernatant.
Conclusion: Staphylococcus aureus has high ability to produce biofilm, and the Lactobacillus
supernatant eradicated planktonic Staphylococcus aureus and their biofilms remarkably in
vitro.

Background: Ischemic heart disease (IHD) is the commonest type of heart disease .It causes
more deaths and disability and incurs greater economic costs than any other illness. Gender,
age, hypertension, diabetes mellitus, smoking, hyperlipidemia and family history are obvious
risk factors. In acute state it may be complicated by life threatening arrhythmia, heart failure,
circulatory failure and cerebrovascular accidents.
Aims of study: To evaluate the patients with ischemic heart disease admitted to the coronary
care unit of Baquba teaching hospital
Patients and Methods: A total of 160 cases of patients with various symptoms of ischemic
heart disease including chest pain, dyspnea, and palpitation are evaluated in the coronary care
unit of Baquba teaching hospital by history taking, physical examination, and
Electrocardiogram, echocardiogram, and lab tests with continuous follow up until discharge
from the coronary care unit.
Results: From total number 97(60.62%) patients were males,58 have myocardial infarction
and 39 have angina .The rest of the patients were females 63 (39.38%),41 of them have
angina and 22 have myocardial infarction. Male was the highest risk factor followed by
hypertension, diabetes mellitus, smoking family history and hyperlipidemia .Arrhythmia is
the commonest complication while heart failure, cerebrovascular accident and circulatory
failure of lesser frequency

Background: In many societies, adverse outcomes in pregnancy and labour have often be
ascribed to male fetal gender, so, In recent years, many investigators try to find any
relationship between fetal gender and pregnancy outcome.
Objective: To evaluate the role of fetal gender on pregnancy and neonatal outcome.
Subjects and methods: A cross sectional study was done at a labour ward in Al-Batool
Teaching hospital for maternity and children in Diyala Governorate, Iraq during the period
from 1st of August till 31st of October 2013. One hundred one pregnant women were eligible
for enrollment in the study according to inclusion criteria. The effect of fetal gender on both
maternal and fetal parameters were all recorded.
Results: A total of 101 neonate were born, of whom 53 were males and 48 were females,
there was no significant differences noticed between male and female regarding to the
maternal age and parity. Also the result showed that preterm and post term pregnancies more
frequently in male bearing pregnancies than in female bearing pregnancies (4.95%, 0.99%
respectively), despite these findings were significant statistically, while fetal gender has no
positive correlation to the weeks of gestation. Pregnant women with a male fetus had a higher
rate of cesarean section (8.91%) than with female fetuses (4.95%) which is statistically
significant but there is no positive correlation between fetal gender and cesarean section, the
results of this study find that there is no correlation between neonate gender and birth weight.
By studying the correlation between neonate gender and other neonatal parameters like Apgar
score <7 at 5 mint, admission to NICU, clear liquor, and Meconium liquor it was proved that
there is no correlation between fetal gender and these parameters except there is a positive
correlation between male gender and Apgar score <7 at 1 mint.
Conclusions: There is a positive correlation between male gender and Apgar score <7 at 1
minute but no correlation found between fetal gender and other maternal or neonatal
parameters.

Background: Measles remains a major cause of worldwide childhood mortality, and has
been targeted by the WHO for global eradication following the eradication of
poliomyelitis. Despite the implementation of mass school catch-up campaigns for measles, an
outbreak of measles occurred mostly affecting the adult population.
Objectives: To measurement of Highly Sensitive C Reactive Protein (Hs CRP) and C3
Complement levels in adult volunteers after vaccination with live attenuated measles
containing vaccine, and to compare the results with that following vaccination.
Subjects and methods: A sero-surveys for serum Hs CRP and C3 complement levels was
conducted among [190] healthy young adults aged 18-25 years, randomly selected, and to
compare after a national campaign with measles containing vaccine. Hs CRP and C3
complement were detected in volunteer’s sera prior to, 1, and 4 weeks after vaccination,
measured by Enzyme Linked Immunosorbent Assay and Single Radial Immunodiffusion
Assay respectively.
Results: There was a significant differences (p ≤ 0.05) in the concentration of serum Hs CRP
and C3 complement at week one following vaccination with measles containing vaccine, and
returned to normal after four weeks.
Conclusions: Raising Highly Sensitive C Reactive Protein and Complement C 3 Levels in
the sera of adult volunteers after measles containing virus vaccine administration could play a
role in increasing innate immune response against measles virus infection and may explain
some mechanisms of immune response associated with measles infection.

Background: The correlation between urinalysis and appendicitis is still unclear. Urinalysis
can be depended may aid diagnose and compare acute perforated and non-perforated
appendicitis.
Objective: To determine the correlation between routine urinalysis and simple and perforated
appendicitis.
Methods: The patients (210) analyzed prospectively with clinically suspected acute
appendicitis that underwent urinalysis followed by appendectomy at Baquba Teaching
Hospital, during the period from August 2013 to March 2014. Urine test strip analysis was
used.
Results: Patients with acute appendicitis had a higher percentage of positive urine ketone
bodies, higher specific gravity, and lower urine pH than patients with normal appendices.
Such and other parameters and such data were much higher in patients with perforated
appendix.
Conclusion: Routine urinalysis may show differences in findings between simple and
perforated appendicitis. Clinically, we believe these urine parameters may aid clinicians in
decision making for patients with suspected appendicitis

Background: Oral squamous cell carcinoma (OSCC) and Mucoepidermoid carcinoma
(MEC) are the most common malignant tumor of the oral cavity and salivary gland
respectively, the extent of lymph node (LN) metastasis by lymphangiogenesis is a major
determinant for the staging and the prognosis of these malignancies and often guides
therapeutic decisions.
Objective: To correlate the lymphangiogenesis of OSCC and MEC with their
clinicopathological parameters.
Material and Methods: Fifteen oral squamous cell carcinoma and eighteen mucoepidermoid
carcinoma tissue samples collected during the period from 2008 till 2014. Age, gender, site of
tumors and stage were reviewed. Lymphangiogenesis obtained by Immunohistochemical
findings using D2-40 immunomarker.
Results: All cases of OSCC and MEC exhibited positive immunostaining for
lymphangiogenic marker. There is a correlation between OSCC and MEC regarding the age
group and site of tumors (P=0.001), while gender, lymphatic vessel density (LVD) and TNM
stage have no correlation with OSCC and MEC. Lymphatic vessel density and showed no
relation with stage of OSCC and MEC.
Conclusion: No statistical correlation was found between LVD which expressed by mean of
lymphangiogenesis using D2-40 immunomarker and OSCC MEC stage

Background: Thyroid gland is the largest endocrine gland which is consists of right and left
lobes connected by a narrow isthmus, the weight of this gland is 10-20g in normal adult .The
function of thyroid gland is to secret T3, T4 under control of TSH. Thyroid hormones help to
regulate the body metabolism. Diseases of thyroid are common affecting 5% of population.
The disease either change in thyroid hormones secretion or structural changes such as in
goiter with or without abnormal thyroid function.
Objective: To determine the common causes of thyroid diseases in Diyala province according
to thyroid function tests.
Patients and Methods: A total number was 2973 patients presented with thyroid diseases at
Baquba teaching hospital laboratory unit and private Ibn-alhaitham laboratory sending from
specialized doctors, were included in this study 647 male and 2326 females.
Results: A total of 2973 patients were included in this study, 2326 (78.24%) were female, and
647 (21.76%) were males. According to thyroid diseases the results of percent work
demonstrated that 2611(87.82%) patients from total patients 2973 were euthyroid (normal
thyroid function), 213patients (7.16%) were hypothyroid and 149 patients (5.01%) were
hyperthyroid. Statistical analysis revealed significant differences among them.
Conclusion: Thyroid disease one of common endocrine diseases after diabetes mellitus, most
thyroid diseases is euthyroid then hypothyroid followed by hyperthyroid. Thyroid diseases
was more common in female than male

Background: Breast milk is the only food fully adapted to the physiology of human infants.
Optimal breastfeeding is defined as initiating breastfeeding immediately after birth
exclusively breastfeeding until 6 months of infant age, and continuing breastfeeding with age-
appropriate introduction of complementary foods up to age two or longer.
Objective: To investigate the relationship between type of feeding in the first year of infant
life, and infant morbidity in the same period of infant's age. It focuses on different diseases
that affect many infants in spite it could be preventable by very simple and cheap methods.
Method and Material: It is a descriptive study done in Al-Batool teaching hospital and
Al-Zahra hospital of Diyala province, during the period from October 2012 to March 2013,
100 cases of infant at one year of age have be included in the study regardless of medical
reason of hospital admission, divided into three groups of infants exclusive breast feeding,
bottle feeding and mixed type of both bottle and breast feeding. This study is considered as to
investigate the relationship between type of feeding in the first year of infant life, and infant
and maternal co-morbidities.
Results: One hundred cases were included in the study, 51 males infant and 49 females
included in the sample, according to feeding type the study revealed that31 breast feeding, 34
bottle feeding, and 35 mixed feeding. The current study demonstrate that 69 delivered by
section among them 14 breast feeding, 32 bottle feeding and 22 mixed feeding while 31
delivered by normal vaginal delivery including 15 breast feeding, 9 bottle feeding and
7 mixed feeding only. Regarding post-partum maternal weight loss we found 81 had
significant weight loss among them 30 breast feeding, 15 bottle feeding and 16 mixed
feeding. According to the study of fetal diseases demonstrated that 68 infant developed
diarrhea among them 14 breast feeding,29 bottle feeding and 25 mixed feeding , 47 had
urinary tract infection 9 of them breast feeding 20 had bottle feeding, 32 infant had
constipation five of them breast feeding , 14 bottle feeding and 13 mixed feeding.
Conclusion: The duration of breastfeeding showed a decline with decreasing maternal age,
less educated and multiparous mothers who lived in rural communities and belonged to the
low socio-economic class were more likely to breastfeed, breastfeeding patterns and practices
need to be re-assessed hopping this review will serve as baseline information for any
upcoming longitudinal studies on breastfeeding.