Diyala Journal of Medicine

Background: As the rates of caesarean births have increased, the type of cesarean section
has gained importance.
Objective: To compare between maternal pre/postoperative hematological parameters
(hemoglobin and hematocrit level), in addition to blood transfusion needed among
pregnant women that underwent elective cesarean section under spinal and general
anesthesia.
Patients and Methods: This study was carried out on 110 women underwent cesarean
section during the period from the 1st of June 2013 to the 1st of July 2015 at Department
of Obstetrics and Gynecology in Al-Noo'man Teaching Hospital in Baghdad. The study
participants were randomly divided into two equal groups according to the type of
anesthesia performed (55 cases for general anesthesia group and 55 cases for spinal
anesthesia group). The changes in the maternal blood parameters including hemoglobin
and hematocrit values in addition to blood transfusion needed were reported and compared
between the two groups in pre and post-operative cesarean sections.
Results: The preoperative hemoglobin and hemaotocrit was insignificantly difference in the
two groups. The mean hemoglobin and hematocrit concentrations were significantly reduced
in women with general anesthesia compared to spinal anesthesia. Mean hemoglobin and
hematocrit concentrations loss in spinal anesthesia group was significantly lower than in
general anesthesia group. The requirement of blood transfusion after surgery was significantly
higher among women undergone cesarean section under general anesthesia compared to those
with spinal anesthesia.
Conclusion: Spinal anesthesia is a better choice of anesthesia as it reduces the amount of
blood loss (less reduction in hemoglobin and hematocrit concentrations) and requirement
of the post-operative blood transfusion.

Background: Leukemia is a fatal disease. A proliferation of immature bone marrow-
derived cells is called acute leukemia that may also involve solid organs or peripheral
blood. A sampling source for clinical diagnosis is saliva which has been used and it is a
promising approach as collecting saliva is relatively easy and non-invasive. Over the past
two decades, using saliva as biomarker, specifically for early cancer detection has attracted
much research interest.
Objective: To estimate the role of some salivary components as biomarkers in patients
with acute leukemia.
Patients and Methods: A total of 60 individuals with age range 19-56 years, 30 healthy
individuals compared with 30 patients with acute leukemia in order to investigate the
following salivary parameters: zinc (Zn), chromium (Cr), copper (Cu), iron (Fe),
superoxide dismutase (SOD), and lactate dehydrogenase (LDH) enzymes.
Results: The mean salivary trace elements: Cu, Cr, Fe, and Zn concentrations were
significantly raised in patients with acute leukemia when they compared with controls
(p<0.005, p<0.05, p< 0.001, and p<0.001 respectively). Also the mean salivary enzymes
activities of SOD and LDH were raised significantly in patients with acute leukemia when
they compared with healthy subject (p< 0.05 and p<0.001).
Conclusion: altered levels in salivary components in this research may be used as a
diagnostic tool, especially when a concurrent analysis for significantly raised markers is
carried out. This is because salivary diagnosis involves a non-invasive method, and may
thus represent an effective alternative to serum testin

Background: Paracetamol is a common analgesic and antipyretic drug that is marketed
individually or as in combination with other drugs. Tablets produced by different
manufacturers can have different physical and chemical properties due to the usage of
different excipients and manufacturing methods.
Objective: This research was conducted to study ten different paracetamol brands
commercially available in the city of Sulaimani to compare their content percentage,
dissolution profile and friability.
Patients and Methods: The tablet content assay in this research was conducted using a
method stated by the Indian pharmacopeia, while dissolution and friability test methods
were derived from the United States Pharmacopeia. A total of ten brands of paracetamol
(three local and seven international) were chosen for this study.
Results: All of the tested brands had their active ingredient content within the specified limits
of 95%-105%. Regarding dissolution test, all the studied tablets showed a dissolution yield of
more than 80% within 30 minutes with the tablets manufactured by GlaxoSmithKline
showing the fastest dissolution rate. All the tablets had an acceptable weight loss of less than
1% after applying the friability test but the tablets manufactured by Samaraa have shown the
highest friability of 0.34%.
Conclusion: It was concluded that all of the tested products which are available in Iraqi
market/City of Sulaimani meet the requirements specified by United States Pharmacopeia
in terms of content assay, dissolution rate and friabilit

Background: Lipid profile is a panel of blood tests that serves as an initial broad medical
screening tool for abnormalities in lipids, such as cholesterol and triglycerides.
Objective: This study estimates the activity of mixture of three herbal seed oil on the lipid
profile of hyperlipidemic mice induced by glucocorticoid drug.This mixture 105 composed
of: 30% Petroselinumcrispum, 35% Lepidiumsativumand 35% Eruca sativa seed oil.
Patients and Methods: The study was conductedusing 30 Swiss albino mice of 4 weeks
age, which were divided into three equal groups. First group treated with dexamethasone
drug, the second group treated with dexamethasone plus oil mixture,while the third group
served as control.
Results: It showed that the mixture [105] had the activity to decrease the lipid profile of
hyperlipidemic mice induced by dexamethasone after treatment with 7, 14, 21 days.
Conclusion: Petroselinumcrispum, Lepidiumsativumand Eruca sativa seed oil have activity
to decrease the levels of lipid profile in dexamethasone –induced hyperlipidemia mice.

Background: Depression in diabetes is common. There is association between diabetes
and comorbid depression in adults in both types of diabetes, depression association with
hyperglycemia and increases of diabetes and release of depression association with
improvement glucose control.
Objective: To determine the effect of diabetes on depression in as well as to evaluate the
effect depression in etiology of diabetes.
Patients and Methods: Fifty patients attended causality unit of Baqubah Teaching
Hospital were screened for diabetes then assessed by General Health Questionnaire for
depression during the period from 1st of August till 1st November 2015, relationship was
studied and another 50 patient complaining from depression and psychiatric disorders were
evaluated by blood glucose test. Statistical analysis of the data were done using SPSS
version 20.
Results: This study identified the relationship between diabetes and depression, the
depression was significantly associated (72%) with diabetic than control (14%), and also
blood glucose level was higher in psychiatric patients.
Conclusion: The presence of diabetes increase the depression also presence of depression
increase blood glucose level. Control of diabetes significantly improves depression.

Background: Benefits of minimally invasive or laparoscopic procedures include less post-
operative discomfort.
Objective: This study aimed to identify the early postoperative complications of
laparscopic cholecystectomy and their association with age, occupation and previous
laparatomy.
Patients and Methods: 60 female patients diagnosed with having symptomatic gallstone
underwent laparscopic cholecystectomy in Pirmam General Hospital, during the period
from January 2015 to July 2015. Surgery done by researchers and after 10 days, the patient
interviewed and examined for finding the complications, the patient then reexamined after
30 days for the presence of other complications.
Results: Postoperative complications among study sample were as following: shoulder pain
(25%), serous discharge from port (3.3%), stone spillage (1.7%), and hernia (18.3%). There
was no statistically significant association between postoperative complications and age
groups, occupation and history of previous laparotomy (mostly lower abdominal operations).
Conclusion: Laparoscopic cholecystectomy is associated with few and low rate
complications the most common distressing complication is shoulder pain .

Background: In functional magnetic resonance imaging (fMRI) studies, there are
limitedpublished data on the functional map of the human brainstem.
Objective: To assess the feasibility and to map the neural activity in the human brainstem
with Fmri by equal intensity by low-level of thermal stimuli on the peripheral sensors of
the skin.
Patients and Methods: Functional magnetic resonance imaging studies of the brainstem
were carried out on 6healthyindividuals in a 3T MRI machine. A noxious thermal stimulus
was applied on the peripheral sensitisation nerves on the arm. Functional magnetic
resonance imaging data spanned from the brainstem location by a 32-head channel and
analyzed using a fixed-effects General Linear Model to discriminate signal intensity
changes from physiological motion. The results were normalised and combined to show the
activity at each location on a voxel-by-voxel basis. Areas of physiological activity were
recognized with comparison to the number of atlases.
Results: Noxious and innocuous related activation clusters were approved in this applied
method. There were considerable activity in the midbrain, pons, medulla and reticular
formation. The results of this pilot study are similar and in some anatomical regions even
better with head coils than obtained with previous functional magnetic resonance imaging
spinal coil studies. We obtained evidence of localization of the following nuclei by using this
method, as follows: major activities in the inferior anterior parts of pons and the junction with
medulla includes the (olive and pyramids),superior cerebella pundicle, rostral portion of
medulla (RMV), Broadmann areas [5,2] touch and temperature sensation areas with the
innocuous stimuli; activation in the left side of the medulla the (olive and pyramids), the left
side of pons, the left side of midbrain, Broadmann area [5,7] pain and temperature sensation
areas with noxious stimuli.
Conclusion: This pilot study provides useful evidence flow-painful and innocuous
information transmitted between the peripheral nervous system and the central nervous
system in healthy participants. It also demonstrates how peripheral sensitisation induces
physiological changes in the brainstem correlates with noxious and innocuous thermal
transmission.

Background: The most frequent bacterium causing urinary tract infection is Escherichia
coli followed by Staphylococcus saprophytic. These infections are more prevalent among
pregnant women, particularly in summer, due to dehydration and insufficient uptake of
drinking water.
Objective: To assess the effect of climate temperature on diversity of uropathogens
causing UTIs, and investigate whether infection increases during specific months.
Patients and Methods: Seven hundred forty one patients aged 20 years or above in
General Zakho Hospital was investigated for urinary tract infection status from January to
December 2015, and the daily drinking water uptake was assessed. The monthly climate
temperatures were analyzed. Urine samples were collected using mid-stream method, and
the samples were cultured to isolate uropathogens identified by biochemical tests.
Results: The results indicate that 494 (66.66%) out of 741 patients were infected with UTIs,
with seasonal trends of a peak plateau from June to July and a sharp decline after September.
The percentage of UTI was 71% among patients who drank less than 2 liters of water per day,
and 60% for other infections. Pregnant women had significantly higher prevalence of
uropathogens due to the physiological changes during pregnancy. E.coli was the most
common isolated pathogen (51.7%) in male and female patients.
Conclusion: The results support evidence suggesting that dehydration due to low water
intake, especially in summer, leads to low urine output, which increases the occurrence of
urinary tract infection.

Background: A single intravenous preoperative prophylactic dose of an antibiotic with
antistaphylococcal activity represent standard care for breast and axillary surgical
procedures. Some surgeons also prescribe postoperative extended regimen for all patients
with breast and axillary surgery to prevent infection.
Objective: To evaluate the efficacy of using post-operative antibiotic (extended regimen)
in breast cancer surgery to decrease surgical-site infections.
Patients and Methods: One hundred and five females suffering from breast cancer were
enrolled in this study (from the 1st of January 2014 to the 30th of December 2015 in
Al-Yarmouk Teaching Hospital admitted by multiple surgeons).They was divided into two
groups. Group )1( received single prophylactic dose of ceftriaxone injection 1gm
preoperatively and group )2( received extended doses postoperatively1 gram twice daily
for 4days,then antibiotic changed to oral oute (cefixime 400 mg once daily for 7days). The
patients in both groups discharged home in the2nd post-operative day and seen again after
five days, then on the days, then on the day of removal of surgicalstitches (day10) and at
day30.Allpatientshadclosedsuctionsurgicaldrainswhendischargedfromhospitalandremoved
inday5. Second generation cephalosporin was not used because it is not available.
Results: During the period of this study, the incidence of wound infection was 7 (15%) in
group1 and 6 (10%) in group2. The p value of the incidence of wound infection in these
groups was 0.55, so it is statistically not significant.
Conclusion: No statistically significant reduction in surgical wound infection among those
received postoperative extended doses of antibiotic prophylaxis (i.e.group2) compared with
those who received preoperative single dose of antibiotic prophylaxis (i.e.group1).

Background: Cervical carcinoma was considered as a major problem and life threaten of
women; therefore it is worthy to study the association of Epstein–Barr virus and
cytomegalovirus co-infection with human papillomavirus type 16 in uterine cervical
carcinoma progression. Cervical carcinoma is known closely associated with human
papillomavirus.
Objective: To identify whether Epstein–Barr virus and cytomegalovirus play a co-factors
role in the cervical carcinogenesis besides human papillomavirus type 16 infection.
Patients and Methods: Current study included paraffin embedded sections from 50 cases
of cervical cancer in Baghdad during the period from 2012 till 2014. They were examined
for the presence of human papillomavirus type 16, cytomegalovirus and Epstein-Barr virus
DNA using in situ hybridization technique.
Results: This study showed that (33, 66%), (22, 44%) and (38, 76%) out of 50 cervical
cancer specimens were positive to human papillomavirus type 16, cytomegalovirus and
Epstein–Barr virus DNAs signals respectively by using in situ hybridization technique.
Conclusion: The co-operation effects of CMV and EBV onto HPV16 might progress the
oncogenesis of cervical carcinoma in female patient