Diyala Journal of Medicine

Berardinilli - Seip congenital generalized lipodystrophy (BSCL) is a very rare autosomal
recessive disease characterized by near absence of adipose tissue in the subcutaneous
region since birth or early infancy and severe insulin resistance. Nearly 120 cases had been
reported in the literature. Clinically it showed marked atrophy of subcutaneous fatty
tissues, generalized muscle hypertrophy, developmental and learning disabilities in a
majority of cases, with acromegaly, coarse facies, enlarged hands, feet and prominent
mandible, increased sweating. Hepatomegaly from fatty liver is almost universal and may
ultimately lead to cirrhosis. Females present with an enlarged clitoris (clitoromegaly),
hirsutism, absence and irregular menses and polycystic ovary and only a few affected
women have had successful pregnancies .All cases present with hypertriglyceridemia.
Treatment consists of low fat diet and handling of insulin resistance and diabetes.
A 19 months old Arabic female child, resident in Balad-Salahuddin province, was referred to
outpatient clinic in Balad general hospital for her unusual facial features. She was a product of
uneventful vaginal delivery with a smooth postnatal period. At 3rd month of life, the family
noticed unusual gross facies which became more obvious with age.

Background: Violence against women is a worldwide problem and serious human rights
abuse that occurs among all social, cultural, economic and religious groups.
Objective: To assess of domestic violence among sample of married women and to determine
relationship between the domestic violence among married women and some related factors
such as (age, education level of wife, wife employment, and monthly income.
Subjects and Methods: A cross-sectional Descriptive analysis processed of study among
of married women in Baghdad city. The sample was selected by (non-probability
convenient sampling) and sample size was (400). The study started from 1St April 2014 to
31th of March 2015. The data was collected by direct interview using special questionnaire
to obtained socio-demographic information.
Results: The result shows that mean age of the subjects was 29.7 ± 6.65 years, 45.8% were
housewives, economic problems, and cultural, psychological problems were reported were the
commonest reasons for domestic violence. Analysis of results by Frequency, percentage,
mean of score, standard deviation, and relative Sufficiency, Factors found to be significantly
associated with overall violence were: lower educational level, had higher levels of
unemployment, type of family, lower income and having children.
Conclusions: The research concluded that the women exposure from emotional or
psychological violence more than physical and sexually violence.
Key words: Domestic violence, married women, Baghd

Background: Two methods are used routinely for wound management following an
appendectomy: delayed primary closure, which involves packing an open wound for 4-5 days
followed by wound closure, and primary closure, which means closing the wound at the time
of surgery. Primary closure has the potential benefit of rapid wound healing associated with
the elimination of painful and time-consuming dressing, as well as a reduction in overall
hospital costs.
Objective: To compare the incidence of wound infection after primary wound closure and
delayed primary closure in patients with complicated appendicitis.
Patients and Methods: A total of 78 patients with complicated appendicitis (gangrenous,
perforated, and abscess) admitted to surgical wards in Tikrit Teaching Hospital for a period of
12 months (January 2013 to January 2014). Males were 45 and females were 33, their ages
ranged from 17-55 years were included in the study. The patients were adult males and non-
pregnant adult females whom underwent appendectomy for complicated appendicitis.
Results: Age and gender were not significant factors affecting wound closure type (p=0.772
and p=0.942 respectively). The mean period of symptoms duration in patients with delayed
primary closure was significantly (p=0.037) longer (5.9±3.11 days), than that with primary
closure (2.81±2.07 days). Duration of surgery was significantly (p=0.021) longer (37.98±6.7
minutes) for delayed primary closure, than for primary closure (22.71±8.11 minutes). The
mean duration of stay per hospital was significantly (p=0.030) shorter (6.84±1.71 days) for
delayed primary closure than for primary closure (8.7±0.94 days).
Conclusion: A better overall results related to the strategy of delayed primary closure despite
the relative longer time of surgery and greater efforts done by the surgeon. This will give
benefits to both the patient and surgeo

Background: Immunization remains one of the most important public health intervention
and a cost effective strategy to reduce both the morbidity and mortality related with infectious
diseases.
Objective: To identify and describe the scope of knowledge of mothers towards child
immunization and its relation to immunization status of their children.
Subjects and Methods: A cross sectional study was conducted in three primary health care
centers in Diyala governorate from the 1st of October 2014 to 1st of April 2015. Two hundred
fifty random samples of mother and child, who had aged (12-24) months. The data were
collected by obtained questionnaire formats which included demographic data such as age,
residence, educational level, occupation, number of children, and this questionnaire designed
for the purpose of the study.
Results: The findings revealed that knowledge of mothers toward child immunization were
poor and represent (98 %) of mothers ,also the decline of the immunization status of children
aged (12-24) months, the main barriers for mothers to complete their children ‘s
immunization were because their child illness .The findings have approved that there is a
significant relationship between mothers’ knowledge and demographic variables (age,
educational level and number of children), and sources of mothers’ knowledge concerning
child immunization (physician, health worker).
Conclusions: There is a significant relationship between knowledge of the mothers regarding
vaccination and their age and educational level also there is a significant relationship between
mothers knowledge and immunization status of their children

Background: Hirsutism is the presence or an excess of terminal (thick and dark) hair
growth in women, in a male - like pattern. Hirsutism affects about 5-10% of women during
reproductive age. Many therapeutic measures are used in the treatment of hirsutism, which
include, drugs therapy and cosmetic measures and this involved self-care methods and
laser therapy, of which intensive pulse light is one of useful therapeutic method.
Objective: To evaluate the efficacy and safety of intensive pulse light in the treatment of
hirsutism with some epidemiological data in Iraqi women.
Patients and Methods: A cohort study in which, one hundred and forty seven women with
hirsutism of the face (moustache and chin) were seen and evaluated in a laser clinic of
Baquba Teaching Hospital, during the period from January 2010 to June 2013, with a mean
age of (29.76±9) years . They were examined and evaluated for the grad of hirsutism, type
of skin, menstrual cycle, marital status, childbearing, hormonal and steroid therapy and
family history of hirsutism. The diagnosis of cause of hirsutism was made by clinical
criteria and certain investigations according to the need. They were treated by intensive
pulse light (IPL) and anti-hormonal drugs on need, according to the type of skin and
severity of the hirsutism and followed up for six months after the end of therapy , the
response was graded into four grades, excellent, good , moderate and poor
Results: The study revealed that (42.85%) shows an excellent response, (42.17%) with
good response, (14.28%) with moderate response and (7.48%) shows a poor response.
Severe complications of therapy like blister and hyperpigmentation were rarely seen. The
study shows that the idiopathic hirsutism was the common cause of hirsutism of the face
(moustache and chin) in women (66.66%), then the polycystic ovary syndrome (24.49%)
and hyperprolactenemia (8.85%).
Conclusion: We concluded that intensive pulse light was an effective and safe method in
treatment of hirsutism in women, whatever the cause and the idiopathic hirsutism was the
common cause.

Background: Rheumatoid arthritis is a chronic inflammatory disease of the synovium with
uncertain pathogenesis. A number of phenotypic and functional T-cell defects have been
described in rheumatoid arthritis.
Objective: To evaluate the cellular expression L-selectin (CD62-L) protein in the
peripheral blood lymphocytes, L-selectin cellular expressions with the disease activity.
And correlate it with the expression of Bcl-2 and P53 oncoproteins.
Patients and Methods: This study involved forty-six rheumatoid arthritis patients 42
female and 4 male, ages ranged from 30-60 years collected from AL-Kadhemia teaching
hospital were examined and compared with 17 healthy control individuals of similar ages.
Lymphocytes were separated from peripheral blood samples, the assessment of their
cellular expression of cluster of differentiation 3, L-selectin, P53 and Bcl-2 by
immunocytochemistry staining method.
Results: The results showed abundant accumulation of CD3 T lymphocytes in the
peripheral circulation of rheumatoid arthritis patients in comparison with controls; that
associated with decreased L-selectin expression in rheumatoid arthritis group. And a highly
significant increase in the expression of Bcl-2 in the lymphocytes of rheumatoid arthritis
patients as compared with the control group (p<0.001), however there was no significant
difference in the expression of P53 between rheumatoid arthritis patients and controls (P=
0.278). The expression of L-selectin is negatively correlated with that of Bcl-2 (r= 0.401),
while there was no significant correlation with P53 expression (r=0.144).
Conclusion: This study showed an increase in the peripheral blood T lymphocytes from
patients with rheumatoid arthritis that could be resulted from loss of homing receptor, and
increase in anti-apoptotic protein (Bcl-2)

Background: Proper nutrition is central in promoting the normal growth and development
of children while malnutrition is one of the most important public health problems among
preschool children and the nutritional status among these age groups might be affected
with some demographical factors related to mother.
Objective: To identify the association between some socio-demographic factors related to
mother and nutritional status of children less than two years of age in Diyala Governorate.
Materials and Methods: A probability sample (i.e. every element of the population has a
known probability of being included in the sample), including (420) children less than two
years had been selected from 12 Primary Health Care Centers in Diyala governorate, Iraq,
during the period from 13th November 2010 to 10th March 2011, which were selected
through a multi-stage (4 stages) random sampling technique, the study population was
mothers and their children. Data were collected by direct interviewing of every child's
mother via a using questionnaire. The questionnaire contained close ended questions. The
nutritional status for each child determined by using the anthropometric measurements
(weight and length) through z-score technique, Chi-square-test used for testing the
contingency coefficient (causes correlation ship) and p-value above 0.05 considered as
non-significant.
Results: The current study revealed that was no a significant association between child’s
nutritional status indicated by stunting and all the studied demographical factors related to
mother at p-value (>0.05). Only in case of mother’s educational level there was a significant
association at p-value (<0.05). Regarding the association between child’s nutritional status
indicated by underweight, there was a significant association between child’s underweight
and all the studied demographical factors at p-value (<0.05) except in family type and age
groups at p-value (>0.05). Also results of the study showed that there was no a significant
association between nutritional status indicated by wasting and all the studied factors except
in case of mother residency, there was a highly significant association at p-value (<0.01).
Conclusion: The current study concluded that the nutritional status indicated by
underweight was significantly most affected by mother’s related demographical factors.

Background: Adenoid cystic carcinoma constitutes the second common malignant
epithelial salivary gland tumour.
Objective: To evaluate the expression of Bax mRNA and PCNA and to correlate between the
clinicopathological features of Adenoid cystic carcinoma with expressions of Bax mRNA and
PCNA protein.
Materials and Methods: Nineteen formalin fixed paraffin embedded tissue blocks of
Adenoid cystic carcinoma were used in this study. Bax mRNA gene was analysed by in
situ hybridization techniques and PCNA was examined by immunohistochemistry.
Results: In situ hybridization detection show low expression of Bax and was noted in 10
cases in Adenoid cystic carcinoma cases (52.63%), Immunohistochemical analysis show high
expression of PCNA and was noted in 15 of 19 Adenoid cystic carcinoma cases (78.95 %).
No significant relationship was demonstrated between Bax mRNA or the immunostaining
PCNA and the morphological growth pattern or patient clinical profile. However, lymph node
involvement showed statistically significant differences. Positive significant correlation was
found between Bax mRNA and PCNA in Adenoid cystic carcinoma.
Conclusion: The decreased expression of bax in Adenoid cystic carcinoma and high
proliferative rate could explain the natural course of these tumours indicate that loss of bax
expression might give the tumour cells a double growth advantage because uncontrolled
proliferation is combined with reduce cell death rate

Background: The liver is the major organ responsible for metabolism, detoxification, and
secretory functions in the body. Vitamin C is an essential co-factor, acting as a reducing
agent and may have heaptoprotective property. Vitamin E is an antioxidant factor. Sodium
nitrate is a salt and an anti-oxidant that is used as a preservative.
Objective: To evaluate the effect of sodium nitrate, vitamin E and vitamin C administration
on liver enzymes, alanine transaminase, aspartate transaminase and alkaline phosphatase.
Materials and Methods: Sixty healthy adult male mice divided randomly into six groups,
group 1, received vitamin E solution 0.5 ml / liter distal water daily for 2 weeks. group2,
received vitamin C solution 0.5 gm / liter distal water daily for 2 weeks. Group 3, received
sodium nitrate solution 0.5gm/liter distal water daily for 2week. Group 4, received sodium
nitrate solution orally in dose170 mg/kg body weight and received vitamin E solution 0.5 ml /
liter distal water daily for 2 weeks. Group 5, received sodium nitrate solution orally in
dose170 mg/kg body weight and received vitamin C solution 0.5 gm / liter distal water daily
for 2 weeks. Group 6 (Control), receive distal water daily for 2 weeks. After the last day of
administration, the animals were euthanized and blood samples were drawn from the heart
by cardiac puncture into plain tubes, and then subjected to biochemical assays.
Results: A significant difference in alanine transaminase level was reported between control
group and group of mice received vitamin E (P-value = 0.001), vitamin E+ NaNO3 (P value
=0.015). No significant difference in alanine transaminase level was reported between control
and other groups. Significant difference in aspartate transaminase level reported between
control group and group of mice received vitamin E (P-value = 0.000202573), vitamin C (P
value = 0.00143), NaNO3 (p value=0.008076). No significant difference in aspartate
transaminase level was reported between control and group of mice received (vitamin E+
NANO3) (vitamin C+NANO3) groups. Significant difference in alkaline phosphatase level
reported between control group and group of mice received vitamin E (P-value = 4.5E-13),
vitamin C (P value = 4.45E-18), (p value=6.17E-06), vitamin E+ NANO3 (p-value=3.68E-
15). No significant difference in aspartate transaminase level was reported between control
and group received (Vitamin C+ NANO3), p-value = (0.091718).
Conclusion: Vitamin E and C have the ability to ameliorate the effect of sodium nitrate in
exposed groups although the effect of vitamin E more obvious due to pharmaceutical
formulation, finally antioxidant effects of vitamins leads to modulation the nitrate toxicity
and hepatoprotective effect

Background: Hirsutism is the presence or an excess of terminal hair growth in women in a
male-like pattern dependent on the androgen hormones. It is a common disease that affects
about (5-10%) of women. The causes of hirsutism are divided into three types: high
androgen hormone such as polycystic ovary syndrome, which is the most common cause,
and hyperprolactinaemia, non-androgen hormone, and idiopathic hirsutism.
Objective: To evaluate the relationship between hirsutism and sex hormones, prolactin
,testosterone, luteinizing hormone and follicular stimulating hormone.
Materials and Methods: A cross-sectional study was conducted in outpatient clinic of Kalar
general hospital, Al-Sulaimaniya governorate, Iraq, for the period from 15th February to 30th
April 2015. Two groups were included, the first one consisted of (100) women with hirsutism,
of them (75) Kurdish women and (25) Arabic women, their ages ranged from (15-45years),
and the second group included (25) apparently healthy women as control group, a
biochemical laboratory tests and ultrasound was conducted to determine the hormonal levels
and to support the clinical diagnosis. Hormonal assay were done according to manufactural
instruction for each kit. Statistical analysis was done by using the computer windows system
(SPPS14).
Results: The mean age of women with hirsutism was 26 years, while the control group the
mean age was 31years., although there was elevation of prolactin in (38%) of patients and of
testosterone in (20%) of the control group, there was no significant difference noticed
between both groups. The concentration of luteinizing hormone and follicular stimulating
hormone were normal in both groups. These data indicated that there was no relationship
between hirsutism and sex hormone in affected women, i.e. most of patients had idiopathic
hirsutism, which was differed from western countries in which the most common cause of
hirsutism was polycystic ovary syndrome.
Conclusion: It was concluded from the present study, that there was no relationship
between the hirsutism and sex hormones in affected women.