Diyala Journal of Medicine

Background: Parkinson’s disease (PD) is a progressive neurodegenerative disorder
characterized by motor dysfunction and several non-motor features. Dysautonomia is a
significant non-motor feature as well as a neuropsychiatric symptom.
Objective: To assess cardiovascular autonomic function in Parkinson patients.
Patients and Methods: Samples were collected from Al Kadhimiya teaching hospital and
Baquba teaching hospital in a period lasts from 1st January to 1st November 2013.
Cardiovascular autonomic function had been tested in 44 Parkinson patients with autonomic
dysfunction, 23 Parkinson patients without autonomic dysfunction and 25 healthy matched
controls; using Valsalva maneuver, 30:15 ratio, and effect of posture on blood pressure.
Results: The most frequent dysautonomic symptoms in parkinson disease were fainting and
dizziness (postural hypotension) with a frequency of 26.8% with a P-value 0.015. The
comparison between valsalva levels in three groups of study population was significant (P-
value 0.04). The comparison between 30:15 ratio in three groups of study population was not
significant statistically (P-value 0.344).
Conclusion: Cardiovascular autonomic dysfunction is a common non-motor symptom
associated with Parkinson's disease. It may precede the development of the cardinal motor
symptoms in PD, making cardiovascular dysfunction an attractive target for early detection
and potential neuroprotective strategies for PD. Valsalva maneuver and effect of changes in
posture on blood pressure are affecting tests in cardiovascular autonomic study.

Background: Molluscum contagiosum is a DNA virus, which may infect the mucous
membrane, it is caused by Molluscipox virus and there are four types (MCV1-4). The sites of
predilection of lesions are the face and neck, both genders equally affected and most
commonly seen in childhood age group.
Objectives: To study the epidemiological variables of Molluscum contagiosum and to
confirm the clinical diagnosis and type of Molluscum cotagiosum virus (MCV) by
Polymerase chain reaction (PCR) technique.
Patients and methods: The present study was conducted for the period from 1st November
2011 to 30th April 2012 in outpatient clinic of Baquba teaching hospital in Baquba city.
One hundred and sixty two patients with molluscum contagiosum were examined and
diagnosed clinically and the diagnosis was confirmed by Polymerase chain reaction
technique .The lesions of moluscum contagiosum were seen on different sites of the body, age
of patients ranged from (1-80 years) with a mean age of 35+_9years . They were 114(70.6%)
males and 48(29.4%) females.
Results: The results showed that 72 (44.4%) patients of age group (31-40 years), of which 50
(70%) were males and 22 (30%) females, 35 (21.6%) of age group (ten years or less). This
study revealed that 56(35%) of patients were illiterate, without statistical significant
difference between MC infection and educational levels. In 78% of patients the lesions
located on the head and neck, 70% on the right side and in 78% of patients the number of
lesions was ≤10 lesions, 70% of patients lived in the urban areas and 30% in rural areas.
Eighty five percent (85%) of patients give positive results for MCV, 58.8% of them shows
positive results for MCV type 1 and 2 (73.3% MCV-2 and 26.7% MCV-1), while 41.2%
shows negative results .
Conclusion: We concluded that Molluscum contagiosum was a disease of adult,
predominantly males and on the right side of the face and 73.3% of PCR positive results were
MCV-2.

Background: Fuji II LC, one type of resin-modified glass ionomer cements, has an excellent
bonding efficacy to both enamel and dentin. This material is considered the material of choice
for treatment of cervical lesions located along the cementoenamel junction.
Objectives: To evaluate the effect of post-operative bleaching on the shear bond strength of
resin-modified glass ionomer cement to enamel.
Methods: Enamel specimens of human molars were bonded with resin-modified glass
ionomer (Fuji II LC) and divided into six groups: three control and three bleaching groups.
Two bleaching groups were bleached with a 38% hydrogen peroxide either within one hour
(B1) or after one week of bonding (B2). The third group (B3) was exposed to a 10%
carbamide peroxide bleaching agent for two weeks. Shear bond strength was tested with a
universal-testing machine and the data were analyzed by ANOVA test.
Results: A significant difference in Shear bond strength was found between the groups
(p=0.032). Tukey’s test revealed a significant reduction in the shear bonding strength of B3
compared with the control group (p< 0.05).
Conclusions: Post-operative bleaching with 38% hydrogen peroxide did not compromise
bonding efficacy to enamel. However, bleaching with 10% carbamide peroxide reduced
bonding strength of resin-modified glass ionomer to enamel significantly.

Background: Grand multiparity has been known to be an obstetric risk because of the
documented complications associated with the condition, and it is an indication for booking in
a tertiary health institution.
Patients and Methods : Cross – sectional study was conducted in Al-Batool teaching hospital
during the period from July 2014 to November 2014. Total number of deliveries was 200.
Samples (100 grand multipara women and 100 woman as control group), who were admitted
to the maternity unit for labour and delivery, the two groups were matched for age,
antepartum outcome, intrapartum outcome, postpartum outcome and fetal outcome to
compare the risk between grand multiparity and control.
Results: Two hundred of grand multiparous woman and control group were included in the
present study the mean age was (32.32 ± 6.006) years. There was (56%) of grand multiaparity
have anemia and other medical diseases such as hypertension, diabetes mellitus, epilepsy and
urinary tract infection. Statistically significant differences noticed when compared with the
control group (p- value ≤ 0.05). Also there were higher incidence of preterm labour and
abruption placenta in grand multiparity comparing to control group. However higher
incidence of caesarian section delivery in grand multiparous woman than control group (60%,
40%) respectively. The most common cause for caesarian section was due to previous scar,
which was (58.8%) in control versus (51.6%) in grand multiparity. Regarding the perinatal
outcome there was Apgar score ≤ 7 at 1 minute (61%, 28%) in grand multiparity and control
respectively which was statistically significant.
Conclusion: The grand multiparity still be considered a high risk in pregnancy due to medical
and obstetrical complications, also it is necessary to provide a good health care for grand
multiparous woman, and their neonates.

Background: Mycobacteriu avium subsp.paratuberculosis (MAP) is the causative agent of
Johne’s disease. It is a very slow growing bacterium on synthetic medium. The use of
conventional methods for diagnosis is time consuming and not accurate.
Objectives: The use of molecular biological techniques for fast and accurate diagnosis of
Mycobacterium avium subsp.paratuberculosis isolates.
Materials and methods: DNA was extracted and prepared from four Mycobacterium avium
subsp.paratuberculosis and four Mycobacterium tuberculosis bovis isolates. The extracted
DNA was subjected to PCR by using specific primers and the isolates were distinguished and
differentiated by hybridization technique using pAM-3 specific probe developed in New
Zealand.
Results: The PCR products gave the requested DNA fragment of 163 base pairs. The probe
reacted specifically with targeted DNA fragment of paratubreculosis bacterial isolates but not
with tuberculosis bovis isolates.
Conclusion: The use of PCR and specific DNA probe for the diagnosis of MAP is a fast and
accurate method for diagnosis of MAP.

Background: The common use of antibiotics has led to at least two adverse consequences.
One consequence includes unpleasant and occasionally lethal side effects resulting from
changes in the normal microbial flora, these events leading to many problems sometimes
require surgical removal or in some cases, lead to death.
Objective: To investigate the usage and pattern of antibiotics in the surgical ward of Baquba
teaching hospital.
Patients and Methods: This is a retrospective study perform in Baquba teaching hospital
during the period 2011-2013. The data collected from files of the patients who underwent
different surgeries from the statistic unit in the hospital, recalled for which patient received
the antibiotics and for how long.
The types of surgeries involved in the study are those which belong to class one and two. Also
prescribing advanced antibiotics instead of starting with the simple one is considered abuse.
Results: Seven hundreds and ninety five case file of patients underwent clean and clean-
contaminated surgeries in Baquba teaching hospital was reviewed for the use of antibiotics
preoperatively and/or postoperatively, the type of antibiotic used and the duration, 541 (68%)
patients were underwent clean surgeries. All of them received antibiotics postoperatively, 254
(32%) patients were underwent clean contaminated surgeries. None of them received
prophylactic antibiotics and all of them received postoperative antibiotics in the form of
parenteral antibiotics for 7-10 days (till removal of the stiches) and continue on enteral
antibiotics for another 3-5 days following removal of the stiches.367 (67.8%) patients of those
underwent clean surgeries prescribed third generation cephalosporene (Cefotaxime). 233
(91.7) patients of those underwent clean contaminated surgeries given a combination of
antibiotics (Cefotaxime+Metronidazole+/- Gentamycin).Antibiotics were abused in 600
(75.47%) patients. Only 195 (24.52%) patients prescribed antibiotics in the scientific way.
Conclusion: The random prescription of antibacterial is high leading to abuse of antibiotics.
The number of antibacterials used and the duration shown to be increased. The combination
of some antibiotics needs further evaluation.

Background: The role of TNF-α and TNF-α antagonists on seminal fluid parameters in men
is controversial. TNF-α is a cytokine had a wide range of cellular effects. In testis, “TNF-α is
produced by germ cells and it has a role in the regulation of spermatogenesis”.
Objective: to study the effect of biological agent on sperm quality in a group of
spondyloarthritis patients
Patients and Methods: A prospective study was carried out in Baghdad teaching hospital
during the period starting on 1st of January 2013 till the end of October 2013 .All semen
samples of (60) spondyloarthritis patients and controls (60) was collected by masturbation
after (72) hour of sexual abstinence. The semen samples was examined with regard to sperm
concentration, motility, and morphology, according to WHO 1999 guidelines.. Results were
compared with controls
Results: According semen parameters such as Volume, PH, Count, Motility Morphology in
two groups of spondyloarthritis there were no significant differences noticed between TNF
blocking agents and semen parameters when compared to controls group on( baseline ) but
after (40 weeks), Regarding motility and morphology significant differences (P<0.001) were
found between cases and healthy controls.
Conclusion: Biological agents (infliximab&enbrel) had no affect on seminal fluid parameters
such as volume, PH and sperm concentration, but it decreased motility of sperm and percent
of normal morphology

Background: Occupational irritant hand dermatitis (IHD) is frequent in hospital workers,
especially in nurses. A comprehensive understanding regarding hand dermatitis is essential
for establishing proper prevention and treatment strategies.
Aims: The purpose of this study is to identify the prevalence of occupational irritant contact
hand dermatitis in hospital nursing staffs and to identify the risk factors for hand dermatitis
among nurses in Al-batool teaching hospital. .
Patient and Methods: A Cross sectional study was conducted in Al-batool teaching hospital
in Baquba city from 1st October 2013 to 30th March 2014. Completed questionnaires were
obtained from 120 nurses (male and female) by face to face interview. In questionnaires we
ask about the occurrence of the occupational hand dermatitis as diagnosed by dermatologist
and the relation between hand dermatitis and the use of latex gloves and cleansing agent and
the risk factor associated with this dermatitis.
Results: Irritant hand dermatitis was diagnosed in 57 nurses. The prevalence of occupational
irritant hand dermatitis was 48% (57 of the 120 nurses). We found hand dermatitis prevalence
is of 54% (31 of 57) in Gynecological department nurses whereas the prevalence in pediatric
department nurses was 46% (26 of 57). 60% (34 of the 57) of the cases presented with a hand
dermatitis, the cause was latex gloves and in 25% (14 of 57) of nurses the cause was cleansing
products, and the remaining 15% (9 of the 57) the cause was combined of both. 23% of nurses
report a history of asthma (13 of the 57) and 33 %( 19 of 57) of nurses have allergic rhinitis.
Also there was a family history of atopy in 44 % of nurses (25 of 57). There is increase in the
occupational irritant contact hand dermatitis with increase period of work, 30% in nurse work
more than 10 years.
Conclusions: Our study indicates that it is necessary to provide nurse with specific skin care
advice as part of their training. This might help to identify trainees at increased risk of
developing occupational irritant contact hand dermatitis, encouraging the initiation of
appropriate skin protection measures.

Background: Anemia is define as decreased hemoglobin level, or circulating red blood cells
and it is the most common hematological disorder during pregnancy.
Objective(s): To identify prevalence of anemia, risk factors that contribute to the occurrence
of anemia, and to explain the main types of anemia during pregnancy.
Materials and methods: A descriptive cross- sectional study conducted at primary health
care in Bab- Al-Moudham center in Baghdad city, the sample was selected by non-
probability (convenient sampling) and sample size (150). The study started from 1nd March to
10th June 2012, the data was collected by direct interview technique. Previous questionnaire
was structured by the researchers to measure the variable of the study; these information
infants include (age, educational level, number of children, type of delivery, and type of
feeding, .etc).
Results: The results shows that most frequent age group was (2-29) years, (34.7%) of
mothers were primary school graduate and about (54%) of the pregnant women with anemia
had no abortion and no bleeding.
Conclusions: The study concluded that higher percentage of pregnant mothers was low rate
hemoglobin.
Recommendations: The study recommended that encourage pregnant mothers to visit
primary health care centers early and regularly and take drugs that prevent the occurrence of
anemia during pregnancy period.

Background: Birth interval is the length of time between two successive live births. It might
be affected with socio-economic factors related to mother as age, education and parity.
Objectives: To determine the rate of birth spacing interval for a sample of women at the child
bearing age and to find out any association between maternal factors and birth spacing
interval.
Subjects and methods: A cross-sectional study was conducted in Al- Takia PHC center by
using special questionnaire from 15th September 2012 to 15th September 2013. Sample size
was 184 women at child bearing age.
Results: Out of 184 women at the child bearing age (60.33%) had birth interval less than two
years, (68.5%) below 25 years had birth interval shorter than two years, (60%) and (32.9%) of
women with birth spacing interval < 2 years and ≥ 2 years respectively were primary school
graduates, (83.8%) and (74%) of the studied women with birth spacing interval < 2 years and
≥ 2 years respectively were housewives, (45.9%) of women with birth interval < 2 years had
high parity ( ≥ 5 live births).
Conclusions: All studied maternal factors were significantly associated with length of birth
interval except mother's work status.

Background: Surface contamination of public user interface systems such as computer
keyboards and mouse devices may play a role in community-acquired outbreaks by acting as
an environmental vehicle in transmission of potential hazardous microorganisms. There is no
economical way to test all keyboards and mice out there, but there is a common-sense way to
prevent bacterial contamination or eliminate it if it exists.
Objectives: To explore the bacterial contamination rates in multi-user and single-user
computer accessories (keyboards and mouse devices) in certain colleges of the Diyala
University.
Materials and methods: This study was conducted in Bacteriology laboratory- Colleges of
Veterinary Medicine- Diyala University for the period from October 2012 to April 2013. A
total of 155 swabs were collected aseptically from 60 computers in 4 colleges, namely,
College of Medicine, Veterinary Medicine, Science, and Education- Pure Science. Swabs were
streaked on blood and MacConkey's agar plates then incubated for 24 hours at 37 ̊ C. Final
identification of bacterial species was based on standard bacteriological and biochemical
criteria.
Results: The results showed that the overall contamination rate in the four colleges was
(54.8%). The highest isolation rate of bacterial contaminant was Staphylococcus epidermidis
(30.6%), followed by Escherichia coli (29.4%). Fungi constitute (17.6 %) of isolates. The
College of Veterinary Medicine rank at the top with significant highest contamination rate
(52.7%), followed by the College of Medicine with a contamination rate (21.2). Computers of
the internet centers harbor the significant highest contamination rate compared to
administrative units (71.8% and 28.2%) respectively. The contamination rate was higher in
mouse devices compared to keyboards (57.6% vs 42.3%).
Conclusion: The study concluded that continuous education of students and employees about
the risk of bacterial contamination arise from using the computers, beside the periodic
disinfection of computer accessories may aid the fight against transmission and spreading of
infectious pathogen

Background: Membranoproliferative glomerulonephritis (MPGN) is a pattern of glomerular
injury with characteristic light microscopic changes. It can be primary idiopathic renal disease
or secondary to chronic infections, autoimmune diseases and complements dysregulation.
Objective: To evaluate treatment response in a group of patients with MPGN regarding renal
function and proteinuria regression.
Patient and Methods: Thirty three adult patients with MPGN (above the age of 18 years)
were included in the study. Males were 19 and females were 14. All patients were followed
up for two years. Laboratory investigations included complete blood counts, urine
examination, renal function test, lipid profile, virology screen (hepatitis B virus and hepatitis
C virus), collagen diseases screen (antinuclear Ab, anti double stranded DNA, extractable
nuclear antigens, complements C3 and C4), also screening for multiple myeloma was done
with serum protein electrophoresis and urine bence jones protein. All patients were given
standard form of treatment (Anti platelets, statins, diuretics, angiotensin converting enzyme
inhibitors/angiotensin receptor blockers), some patients were given steroids, others,
immunosuppressive drugs.Their responses to treatment were studied and compared.
Results: The cause of MPGN in this study was idiopathic in twenty six patients (79%). It was
secondary to HBV, HCV, and systemic lupus erythematosus in seven patients (21%). Four
(58%) out of seven patients with normal RFT have partial response to steroid therapy and
they showed decreased proteinuria. The remaining three (42%) patients showed no response.
Two Patients with normal RFT who received mycophenolate mofetil, responds by decreasing
their proteinuria to less than 1 g / 24h. nine patients with impaired RFT received steroid
treatment only or steroid plus MMF, four (44%) patients have stabilized renal function, the
remaining five (56%) patients had progressive decline in renal function. Three patients with
HBV infection who were given alfa interferon or lamivudine showed stabilized RFT and
decreased proteinuria. One patient with HCV infection showed progressive decline in renal
function, he was maintained on standard treatment only. Two patients with SLE and impaired
RFT were given cyclophosphamide and steroid, their RFT stabilized during the follow up
period
Conclusion: Patients who presents with normal RFT have better response to treatment.
Than patients who presents with impaired RFT. Also patients with secondary MPGN (HBV
and SLE) have responded at least partially to antiviral and /or immunosuppressive therapy.