Diyala Journal of Medicine

Background: Although regular blood transfusion enhances the overall survival of
thalassaemia patients, it have a significant threat of infection with transfusion-related
infections, including hepatitis C; therefore, screening is mandatory. Routine screening with
anti-hepatitis C Ab was recommended many years ago; sometimes they depend on level of
liver enzymes.
Objective: To evaluate the clinical and biochemical features of seropositive hepatitis C
virus infection in multi-transfused β-thalassaemia patients to verify if they can be used as a
guidance for screening.
Patients and Methods: A retrospective- study done from June to September of 2014 at
Thalassaemia Center in Baqubah city - Diyala province - Iraq. All registered
β- thalassaemia major and intermedia patients were included, involving adults. Enzyme
linked immunosorbant assay was used to screen for hepatitis C virus. Symptoms, signs, and
biochemical features, including liver transaminases level, of sero-positive patients were
gathered and analyzed. Descriptive statistical analysis and Pearson chi- square test was
appliedto analyze data by using Statistical Package for Social Sciences software, version 16.
Results: The total enrolled subjects were 215, male gender comprises 54.9% (n=118); most
of the included patients were under 12 years old. The results indicate that 11.2%(n= 24) of
multi-transfused β- thalassaemia patients showed serological evidence of hepatitis C. The
highest anti-HCV prevalence was observed at ≥ 18 years old patients (p value=.000). More
than two third of cases were male gender (p value=.041), but the gender was not associated
with positive serology for hepatitis C in the whole sample of the study (p value=.096). All
anti-HCV positive patients were clinically asymptomatic; biochemically, 75% (n=18) of
them had normal liver transaminases levels (p value=. 014).
Conclusion: Asymptomatic clinical status and unreliable transaminases level elevation
cannot be helpful as directory for screening, we encourage the continuation of the usual
routine screening test by enzyme linked immunosorbant assay for hepatitis C in
β-thalassemia patients; it is more crucial for an older patient

Background: CK18 is an epithelial-specific cytokeratin that undergoes cleavage by
caspases during apoptosis. In a variety of organs, the expression of distinct intermediary
filaments is associated with patient prognosis. Intermediary filaments are involved in cell
motility and cancer progression.
Objective: To evaluate the expression of cytokeratin18 in head and neck Squamous cell
carcinoma and to correlate the expression of Ck18 with different parameters such as age ,
gender and grading of tumor.
Materials and Methods: Thirty patients with histopathological proven and surgically treated
head and neck squamous cell carcinomas were investigated for the immunohistochemical
expression of Ck18. Correlations between clinicopathological features and the expression of
Ck18 were evaluated statistically by Chi-square test and the level of significance was 0.05
(two-sided) in all statistical testing.
Results: Among patients 16 were males, 14 were female's patient, aged between 14 and 80
years (mean age 56 years) were evaluated. Out of the 30 specimens of the Head and Neck
Squamous Cell Carcinoma studied, 23 cases (76.7%) showed positive CK 18 staining and 7
cases (23.3%) showed negative CK18 staining. Regarding to gender, in males 6 (37.5%)
sections with weak positive expression, 1 (6.25%) sections with moderate positive expression,
3 (18.75%) sections with strong positive expression and 6 (37.5%) section with negative
expression, While in females 7(50%) sections with weak positive expression, 3 (21.43%)
sections with moderate and strong positive expression and only one (7.14%) section with
negative expression.
Conclusion: CK 18 showed higher expression levels on moderately and poorly
differentiated squamous Cell Carcinoma cases than well differentiated SCC cases. The
correlation between CK-18 staining and grade level was non-significant that seemed to be
going together with the pleomorphism and the number of mitosis.

Background: Recombinant K39 antigen test is one of the recent experiences in rapid
diagnosis of Visceral Leishmaniasis ,it consist of 39 amino acid which represent the main
component of the protein of the Leishmania parasite and that the reaction occurs between
the antibodies in the serum and antigens blotted in the rK39 strip test.
Objective: Find out possible reaction of rK39 antigen test on other diseases than visceral
leishmaniasis, as well as to compare the test results on both serum and urine of same
patients.
Patients and Methods: A total of 65 blood and urine samples were included in the study;
25 patients with cutaneous leishmaniasis attended Baquba Teaching Hospital, and 40
apparently healthy controls. All serum and urine samples were tested with rK39 strip test.
15 serum samples were randomly selected and Indirect Fluorescent Antibody Techniques
for diagnosis of Leishmaniasis for the purpose of comparison of rK39 strip test.
Results: There was highly significant differences when using the rK39 strip test in urine and
serum in patients infected with cutaneous leishmaniasis (P <0.05), and no significant
difference between the sexes, as well as age group , as well as the absence of a significant
difference between the rK39 strip test and Indirect Fluorescent Antibody Techniques.
Conclusion: rK39 strip antigen test gives positive results, may be due to greater
phylogenetic proximity between Leishmania species, or due to mixed infection with
Visceral Leishmaniasis.

Background: Otitis media is an inflamation of middle ear, it is either acute or
chronic,chronic may be otitis media with effusion(intact tympanic membrane) or may be
chronic suppuratve otitis media(there is a perforation in the eardrum)which is
aninflamation of middle ear mucosa and mastoid air cells for a period more than 3 months.
This inflamation is either a sequely of acute suppurative otitis media (tubotympanic
disease)or may be due to a cholesteatoma(atticoantral disease).
Objective:To determine type of bacteria that most commonly cause this inflammation and
the sensitivity pattern of this bacteria to antibiotics.
Patients and Methods: We took 197 patients that we diagnose them clinicaly as cases of
chronic suppurative otitis media (with central perforation in the tympanic membrane)(which
mean tubotympanic type)and we stopped antibiotic treatment for 3 days(if the patient on this
treatment) then we collect samples of pus from the affected ear and then we sent these
samples to the lab for bacteriologic study to evaluate the results.
Results:Pseudomonas aeruginosa was the most common microorganism involved in our
cases of chronic suppurative otitis media followed by Staphylococcusaureussensetivity
pattern of Pseudomonas aeruginosa showed thatciprofloxacillin was active against (95%) of
isolates followed by amikacin (85%) followed by gentamycin (81%), ceftazidime (80%)and
ceftriaxone (50%)
Conclusion: The present study reveals that Pseudomonas aeruginosawas the most common
pathogen followed by staphylococcus aureusisolated from chronic suppurative otitis media.
Ciprofloxacilline was found to be the most suitable antibiotic followed by amikacin and
ciftazidime for Pseudomonas aeruginosa. The resistance against Ceftriaxone was found to be
high.

Background: When the weakened root is internally rebuilt with suitable adhesive dental
materials, the root is dimensionally and structurally reinforced to support and retain a post
and core for continued function of the tooth.
Objective: To evaluate the effect of reinforcement of weakened endodontically treated
teeth with packable composite resin (Filtek P60™, 3M, USA) and resin reinforced glass
ionomer restorative material (riva light cure, SDI, Australia) on retention of light-
transmitting glass fiber post (FRC postec plus, Ivoclar Vivadent, USA) in comparison with
weaken endodontic treated teeth that restored with custom cast post without reinforcement.
Materials and Methods: Specimens divided to three groups in which group A represent
control group and the other groups represent the experimental groups. Ten samples made
from each group giving thirty samples. All samples were stored in deionized distilled water
in constant temperature at 37 Cº for 24 hr. Retention of post was measured with tensile
strength in instron testing machine (ISO TR 11405,2003) with cross head speed of
0.5mm/min. The samples were pulled-out until dislodgement of post from post hole.
Tensile strength was recorded in newton unit (n) for each sample. ANOVA One-way test
and student–t test were used to analyze the results and to show the comparison of
significance.
Results: There was increase in retention values in group B (samples reinforced with packable
composite) and group C (samples reinforced with resin reinforced glass ionomer) when
compared with control group (group A) that used custom cast without reinforcing the canal
post. Also the retentive values of (group B) were higher than (group C).
Conclusion: Reinforcement of weakened endodontically treated teeth with either packable
composite resin or resin reinforced glass ionomer restorative material lead to significant
increase in the bond strength of fiber optic post. With greater retentive value for packable
composite

Background: Placenta is a chief cause of maternal and perinatal mortality and significant
factor in fetal growth retardation. It undergoes different variations in weight, volume,
structure, shape and function continuously throughout the gestation tosupport the prenatal life.
Cautious examination of placenta can give information which can be useful in the
management of complications in mother and the newborn.
Objective: The present work has been attempted towards determination of the morphological
( macroscopic and microscopic) parameters of human full-term placentae and their relation
with different parity and age group of mothers.
Patients and Methods: A whole of 40 placentae were recently collected.They were divided
into four groups (10 women each); primigravida age<35 years, primigravida age>35 years,
multigravida<35 years; multigravida > 35years.Neonataland placental weights,placental
thickness and number of cotyledons were measured.Tissue for histological examination
wasobtained to study the parameters of microscopic morphometry (number of apoptotic
cells, number of terminal villi, number of syncytial knots, number of fetal capillaries and
thickness of trophoblastic basement membrane).
Results: Placental and neonatal weights were within normal range. They were augmented
with maternal age and parity. Number of cotyledons was higher than those reported by other
authors in other populations but it was still within normal range and it was significantly
decreased in multigravida> 35.Placental thickness was within normal range and it was
significantly decreased in multigravida> 35. All microscopic parameters were increased with
maternal age and parity..
Conclusion: There were correlations between microscopic and macroscopic parameters.
Thelength of stem villi were less in multigravida> 35 since placental thickness was decreased
in this group. All microscopic parameters were increased with maternal age and parity.These
variations may have some important bearing on the placental inadequacy in higher age group
and parity of mother.

Background: Vitiligo is an acquired, idiopathic, and worldwide common depigmentation
disorder with an estimated prevalence from 0.1 to 2.5%. These numbers are based on
clinical population studies and field research examining inhabitants of geographically
enclosed areas.
Objective: To evaluate the prevalence of vitiligo in Baquba city-Diyala Province.
Patients and Methods:A retrospective study was done in outpatient clinic of Baquba
Teaching Hospital, which include (10964) patients with different skin diseases attending
the clinic during the whole year from first of January to thirty one of December 2012, they
were diagnosed clinically by dermatologists . They were assisted regarding the age and
gender and the data were analyzed by using the computer according the P-value .
Results: The study shows that prevalence of vitiligo was(0.71%)out of all patients with
different skin diseases attending the outpatient clinic of Baquba Teaching Hospital over
period of one year. Number of patients in general was tenthousands , nine hundred and sixty
four, from which (78) patients diagnosed as vitiligo , the females were (29) (37.1%)and
males were (49)(62.8%) , their ages ranges from (2-60) years and more prevalent in patients
under (20) years (52.56%) .
Conclusion: It was concluded that vitiligo was more prevalent in males under (20) years
and with similar prevalence to most of studies in European countrie

Background: Tonsillitis is inflammation of the tonsils. It's usually caused by a viral infection
or, less commonly, a bacterial infection. Bacterial causes are mainly through group A beta-
hemolytic Streptococcus pyogenes that leads to strep throat. Tonsils are involved in the
development of immune defense mechanisms by both local immunity and immune
surveillance.
Objective: To evaluate the serum levels of complement component C3, C4, immunoglobulin
A, IgG, IgM, anti streptolysin O and C-reactive protein in sera of tonsillitis patients and
healthy controls. The association between circulating levels of these biomarkers were
investigated.
Patients and Methods: This study involved thirty-eight patients with tonsillitis (18 males
and 20 females), their age range from 1-35 years. Blood samples collected from Rizgary
teaching hospital/Erbil during the period from 4th of November 2015 to 13th of May 2016.
They were examined and compared with 18 healthy control individuals of similar ages and
gender. Sera were separated for the following tests ASO, CRP, IgA, IgG, IgM,C3 and C4.
Results: Among total patient group, 6(15.8%) and 23(60.5%) presented with positive ASO
and CRP tests compared with 32(84.2%) and 15(39.55%)negative tests with significant
results. Patients and healthy controls were compared and there were no significant differences
between the groups in serum level of 3 and C4 (P>0.05), although an increase in
complements levels. While, differences were significant between the group in term of
IgG(P<0.05) and highly significant in term of IgA (P<0.01).There was no significant
differences in mean concentration of the above parameters regarding to age (P>0.05),
however there was highly significant difference regarding to IgG(P<0.01)in all the above
mentioned terms. Indeed C4 also recorded highly significant result in the CRP parameter.
Lastly the study was reported significant and highly significant positive and negative
correlation among some above parameters like C3:C4 and C4:IgA.
Conclusion: Study immunological parameters increased in tonsillitis patients, whose age
below 10 years, disease duration less than 2 years and their ASO negative.

Background: Combining at-home and in-office vital teeth bleaching techniques has
proven to be effective; however, the efficacy of combining at-home bleaching agents is
still unclear.
Objective: To compare the effectiveness of 10% and 35% carbamide peroxide at-home
bleaching agents solo or in combination.
Materials and Methods: Forty enamel samples from human premolars were divided into
four groups (n=10) to receive different at-home bleaching protocols. The samples were
bleached for two weeks as follow: G1 bleached with 10%CP for 8h/day; G2 bleached with
35%CP for 30 minutes/day; G3 starting with 35%CP for three days and continue with
10%CP for the last 11 days; and G4 bleached with 10%CP for the first 11 days and with
35%CP for the last three days. Teeth color measurements were recorded by a colorimeter
in reference to the CIE L*a*b* at different periods. Student's t-test was used to compare
between the groups at each measuring period.
Results: No significant differences were seen among the four groups neither in ΔE*1& ΔE*2
nor in ΔE*6 (p>0.05).
Conclusion: Both 10% and 35%CP, used for two weeks, were effective in teeth whitening.
Compared with 10% CP, combination treatments whether starting with 35% CP or ending
with it produced no significant difference in teeth whitening during the treatment or one
month post operatively.

Background: Hepatitis C virus is the most common cause of post-transfusion hepatitis and
end-stage liver disease in many countries. Regular blood transfusion in patients with
hereditary hemolytic anemia, particularly thalassemia, has improved their overall survival, but
carries a definite risk of acquisition of blood borne virus infections, especially viral hepatitis.
Objective: To determine the prevalence and the quantification of HCV infection among
thalassemia patients in Diyala province by using enzyme- linked immunosorbent assay and
polymerase chain reaction techniques.
Patients and Methods: This study was conducted on 215 thalassemia patients in the
thalassemia unit in Al-Batool Teaching Hospital of Maternity and Pediatrics in Baqubah city-
Diyala province during the period from September 2013 to December 2015. Demographic
data were obtained from the patients records. Sera were tested with anti-HCV assays by use
enzyme linked immunosornbant assay and positive result were tested by a Real time PCR
technique to assess HCV infection.
Results: A total of 215 thalassemic patients, 26 (12.1%) patients were HCV positive by
enzyme linked immunosornbant assay and only 3 of these 26 patients were positive by
RT-PCR. The rate of HCV infection in thalassemic patients is associated directly with the
number of blood transfusions and the age of the patients and It is more in the period before
1996.
Conclusion: The prevalence of HCV infection in thalassemic patients is relatively low in
Diyala province in comparison with other areas and PCR technique is essential to detect and
treat active infection.