Diyala Journal of Medicine

Background: Toxoplasmosis is a cosmopolitan infectious disease caused by Toxoplasma
gondii. Vitamin D is an immune modulator exerting its effect through a nuclear receptor
called vitamin D receptor. Genetic polymorphisms in the vitamin D receptor gene could
affect the activity of vitamin D and hence the individual’s susceptibility to toxoplasmosis.
Objective: To evaluate the impact of four single nucleotide polymorphisms (FokI, BsmI,
TaqI and ApaI) and different haplotypes of vitamin D receptor gene on the susceptibility of
Iraqi women to toxoplasmosis.
Patients and Methods: This case-control study involved 72 women with confirmed
toxoplasmosis and 50 women as controls, DNA was extracted from blood samples and
allele specific polymerase chain reaction technique was used for genotyping of the four
polymorphisms using specific primers. Haplotypes and linkage disequilibrium were
calculated using single nucleotide polymorphism analyzer 2.0 software.
Results: Only the FokIpolymorphism had significant reverse association with toxoplasmosis
in homozygote form (OR=0.140, 95%CI= 0.027-0.717, P=0.018). At allelic level, FokI F
allele had significantly higher frequency in patients than controls (OR= 0.552, 95%CI=0.314-
0.972, P=0.043).The frequency of two haplotypes differed significantly between patients and
controls where FBAT haplotype was more frequent in patients while fta B was more frequent
in controls. Moderate linkage disequilibrium correlations were found between FokI and TaqI
in patients and controls.
Conclusion: Allele f of FokI polymorphism and fBat haplotype in vitamin receptor gene is
associated with a protective role against toxoplasmosi

Background: Caesarean delivery is associated with adverse health outcomes on both
women and newborn infant. Timing of elective caesarean delivery also had an effect on the
neonatal outcomes.
Objective: To find out the association between neonatal outcomes and gestational age and
determining the favorable time for elective caesarean delivery.
Patients and Methods: A hospital-based cross-sectional study was done from 1st July,
2014 to 31st January, 2015 at the maternity teaching hospital in Erbil. A convenience
sample of 200 full term pregnant women was selected from those admitted to the hospital
for elective repeated caesarean delivery. Gestational age was determined by 1st trimester
ultrasound and last menstrual period. Data on fetal variables probably associated with
neonatal outcomes were collected in especially designed questionnaire.
Results: The rate of elective repeated caesarean section before 39th week of gestation was
81.5%. Mean weight of infants and mean Apgar scores of infants at delivery were increasing
with gestational age P < 0.001. The rate of admission to neonatal intensive care unit was
higher among those delivered at 37th than 38th week of gestation. No admission was reported
among those delivered at 39th week of gestation (P=0.006). No significant variations in the
duration of admission, status of infant on discharge, and rates of respiratory symptoms were
demonstrated between those delivered at 37th and 38th week of gestation.
Conclusion: The vast majority of elective caesarean delivery are performed early before
39th week of gestation, which is associated with high incidence of neonatal morbidity and
mortality.

Background: The brain gyri and sulci development, its characterization and timing is one
manifestation of the complex orchestration of human brain.
Objective: To present work was aimed to illustrate the morphometry and the histological
architecture of the human neonate cerebral cortex.
Patients and Methods: In this study four brains from neonates at day 1, 5, 6 and 7 day
were taken as well as other 4 samples at 28 days of age were collected from the medico-
legal directorate in Baghdad. This work was done to describe the morphometry and
thickness measurements of human neonate cerebral cortex of different ages. Brain samples
were fixed in 10% neutral buffer formalin and slides from various regions f cerebral cortex
were prepared and stained with H&E.
Results: The present investigation was resulted that, the mean measurements of the brain
from the frontal to occipital pole was 125.0- 191.3 mm to the neonate aged 1-28 days. While
the mean cortices thickness measurements of the frontal, parietal, temporal and occipital were
3.468, 3.483, 3.097 and 3.290 mm respectively. The histological results revealed that, the
human neonate cortex formed by six layers, which were varied in the numbers, size and type
of nerve cells, glial cells and nerve fibers.
Conclusion: The present study concluded that the morphometry of the brain from day one
until day 28 were varied to that of adult and the histological study of the neonate brain
from day one until day 28 were resemble to that of the adult.

Background: Psoriasis is a common, chronic, and recurrent disease characterized by
remission and exacerbation in formation of salmon - pink, well demarcated erythematous
plaques, covered by white adherent silvery scales, its prevalence varies in different
populations from 0.1-11.8% according to published reports .
Objective: To study is to estimate the incidence of psoriasis among patients attending
dermatological consulting clinic in Baquba teaching hospital.
Patients and Methods: A retrospective study was done in outpatient clinic of Baquba
Teaching Hospital, which includes patients with different skin diseases attending the clinic
during the whole year from first of January to thirty one of December of 2012, they were
diagnosed by dermatologists. Patients with psoriasis were evaluated for age and sex.
Results: Ten thousands, nine hundred and sixty four patients with different skin diseases
were attended to outpatient clinic department of dermatology in Baquba Teaching Hospital
for the period from the first of January to the 31 of December 2012, their ages ranged from 2-
60 years . Out of this number 220 (2%) patients were diagnosed to have psoriasis. They were
118 (54%) males and 102 (46%) females’ .the disease more in age groups 21-30 years and 31-
40 years (30.5% and 23.7% respectively).
Conclusion: It was concluded that psoriasis was common in patients with different skin
disease in Baquba City and it is the disease of young and adult population.

Background: Visceral leishmaniasis is an endemic and potentially life-threatening disease
in different area caused by Leishmania donovani, which can involve different organs and
the disease presents with many different features, even heart involvement.
Objective: To detect high sensitivity C reactive protein (HS CRP) and N terminal pro
Brain natriuretic peptide (NT-proBNP) in children with visceral leishmaniasis in Baqubah
city.
Patients and Methods: This prospective study was conducted in the Al-Batool Teaching
Hospital in Baqubah city, from January to May 2016. A total of 56 cases of infected child
with visceral leishmaniasis, these patients have complained of clinical and laboratory
diagnosis of Leishmania were included in the present study. Venous blood specimens were
collected from each patients use for estimation of serum HS CRP and NT-proBNP by
immune assay.
Results: HS CRP levels recorded high risk (4.46+0.66) was recorded at 8.9% of patients.
While 53.6% of patients showed low risk (0.38+0.47). 5.5% patients had high level
(2244.00+164.94) of NT-proBNP, whilst 30.9% of patients recorded mild increase of NT-
proBNP (439.29+ 17.84).
Conclusion: The results of the present study proved that the HS CRP and NT proBNP
levels were increased in association with visceral leishmaniasis and can be used for
monitoring of clinical presentation of visceral leishmaniasis patients.

Background: Thalassemia and abnormal hemoglobin are the most common genetic
disorders and are considered health problems in many developing countries. Beta-
Thalassemia major is the most familiar type, in which the beta-globin chain synthesis is
impaired.
Objective: To evaluation the concentrations of immunoglobulins IgM, IgG and IgA also
the complements C3 and C4 between β-Thalassimic children patients and control group,
and find the differences of some hematological parameters between the two groups,
finally, isolation of some bacterial species causes the bacterial infections.
Patients and Methods: The present study was performed on 40 β-thalassemia major
children who were registered in the thalassemia center at Al-Karama teaching hospital in
Baghdad and 20 healthy children as a control group from the period of September 2015-
Augest 2016, the serum immunoglobulins (IgG, IgM, IgA) and complement C3, C4 levels
were measured also blood culture was done to identify the causative infection.
Results: The mean serum concentrations of IgM, IgG and IgA in β-thalassemia major
children were 1834.1 ± 312.2, 134.5 ± 40.3 and 212.7±89.6, respectively, and they were
increased significantly (p≤0.05). The mean serum concentrations of C3 and C4 were
consistently decreased in children and there were no significant differences (p≤0.05) between
the two groups. The mean Hb of β- thalassemic children was 8.32±0.91 g/dl and this lower
from the level of control, RBC count is also low 3.7±0.7 but the levels of WBCs was higher
in β- thalassemic children 10.4±1.67, several types of bacterial specious were isolated
included Staphylococcus aureus 30% (12 patients) , Escherichia coli 25%(10 patients) ,
Streptococcus pneumoniae 17.5% (7 patients), Salmonella enteritidis 10% (4 patients),
Serratia marcescens 7.5% (3 patients), Pseudomonas aeruginosa 5%(2 patients), Klebsiella
pneumoniae 2.5%(1 patients) and Haemophilus influenza 2.5%(1patients).
Conclusion: The alteration in serum immunoglobulins and complements levels in
thalassemia major children probably can be due to marked heterogeneity of the patients,.

Background: In pregnancy there is decrease in platelet count mainly in late stage, which is
normal physiological phenomena in third trimester, thrombocytopenia is a second
common hematological condition affecting pregnant women after anaemia, unless its
severe, otherwise it require no treatment.
Objective: To estimate and evaluate the platelet count during different trimester of
pregnancy, with presence or absence of thrombocytopenia.
Patients and Methods: Platelet count was performed on pregnant women attending Al-
Batool Teaching Hospital for Maternity and Paediatric in Baquba - Diyala, and some
private clinic and laboratories in Baquba, during the period from March 2013 to
November 2015 . Ninety pregnant women were included in the study groupand
thirtyhealthy non pregnant women as control group. Platelets count were done for them
using automated hematology auto-analysers ABX-Horiba Micros 60, and comparison in
platelets counts done between study group and control group and between different
trimesters of pregnancy.
Results: Platelet count were lower in pregnancy with range (57-399) in compared with
control group with range (166-399), and its lower in third trimester mean(208.69) in
compared with other trimesters (first and second with mean 262.96 , 261.56 respectively) and
the differences were statistically significant p < 0.001.
Conclusion: In this study we find a mild thrombocytopenia during pregnancy especially in
third trimester, but this had no effect on mother, fetus and may not cause bleeding
complication of delivery, which need only monthly follow up.

Background: There is growing evidence that genetic aspects play a role in the onset and
severity of periodontitis. However, numerous studies have pointed to the contribution of
the human leukocyte antigens (HLA) alleles as a potential genetic factor in
aetiopathogenesis of periodontitis.
Objective: To investigate the association of human leukocyte antigens class I genotype
(HLA-A) and the susceptibility and severity of chronic periodontitis in Iraqi patients.
Patients and Methods: The study groups included 50 patients with chronic periodontitis
and 20 healthy controls with clinically healthy periodontium. Periodontal parameters used
in this study were plaque index (PI), gingival index (GI), probing pocket depth (PPD),
clinical attachment level (CAL) and bleeding on probing (BOP). Five ml of venous blood
were collected from each participant. DNA was extracted from blood samples, and HLA-A
genotyping was performed by polymerase chain reaction-sequence specific oligonucleotide
probes (PCR-SSO).
Results: The present data revealed that the frequencies of HLA-A*33 was significantly
higher in patients than in healthy controls (P= 0.0268).
Conclusion: This study suggests that HLA-A*33allele may contribute to the increased
susceptibility to chronic periodontitis.

Background: The diagnosis of diabetes mellitus depends on estimation of plasma glucose
when the subject is fasting using classical laboratosy methods, to date, only limited number
of studies have addressed the applicability of point-of-care glucose testing in the diagnosis of
diabetes.
Objective: To compare point of care glucose meter to control laboratory method in the
diagnosis of diabetes.
Patients and Methods: Fifty one subjects recruited, their age ranged from 36-70 years. The
questionnaire included socio-demographic information and date of interview, A finger stick
blood sample was obtained and fasting blood glucose measurement were performed for each
subject and recorded using Roche Accu-check active glucose meter. At the same time a 2ml
of venous blood was taken from the same subjects and plasma glucose measured within one
hour using laboratory enzymatic method and the results recorded.
Results: In the current study 94%2 of the samples measured by point of care method were
within ± 20% of the laboratory values, 2 subjects discovered to be diabetic by both methods
but there was significant difference between both methodologies.
Conclusion: Point of care glucose testing can be used as a part of diagnostic process of
diabetes. However there was a significant difference between both methodology.

Background: Some bacteria have resistant against antibiotic, so several trail made to use
plant extract as antibacterial against some pathogenic bacteria
Objective: To compare and evaluate the difference between two species of Pistacia khinjuk
(P. khinjuk) oil extract present in Kurdistan (Iraq) marked in their contain and antibacterial
effect against some pathogenic bacteria
Patients and Methods: Essential oil was extracted from two species Pistacia khinjuk
present in Kurdistan (Iraq) marked during the period of February to April, 2016 and
evaluated the difference between two sizes components and their antibacterial effect
against some pathogenic bacteria. Their activity is reasonably due to their ability to
complex with extracellular and soluble proteins also to complex with bacterial cell walls.
Also, known that P. khinjuk had anthocyanin pigment within its component Extraction was
done using methanol and direct pressing methods. The essential oil extract analysed by
HPLC (High-performance liquid chromatography) and tested against different pathogenic
isolated bacteria (Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa).
The activities were considerably dependent on concentration of two types of seed.
Results: Successfully essential oils of locally big and small Pistacia khinjuk (P. khinjuk) seed
were extracted . Both big and small seed oil gave a similar component of fatty acid (oleic,
linoleic and lauric acid), while the small seed had more oil extract. P. khinjuk essential oil
extract inhibited growth of the three isolated bacteria (Staphylococcus aurous, Escherichia
coli and Pseudomonas aeruginosa). Both big and small seed oil extract had the same PH
(about 4). Results showed that maximum absorption to extract pure pigment anthocynin from
P. khinjuk oil was at wavelength 479 nm which has reached the highest concentration of the
dye. The reason can be attributed to the purity of the color and the presence of some of the
other pigments.
Conclusion: Extracted essential oil noted antimicrobial activity and was characterized
mostly by the occurrence of flavonoid and flavonoid glycosides. Difference between the
absorbency of pure pigment anthocynin was attributed to the purity of the color and the
presence of some of the other pigments.

Background: The aspartame is a synthetic sweetener has been used for many purposes as
an anti-inflammatory agent, antioxidants and hepato protective, its metabolites can be toxic
to many organs and several studies on laboratory animals have been made to verify
aspartames toxicity which can cause harmful effect after administration for long duration at
a dose of 150 mg/kg body weight.
Objective: To evaluate the effect of aspartame on morphometric and histopathological
changes of the rat’s thyroid gland, since the aspartame sweetener is widely used
worldwide.
Patients and Methods: Fifty adult Wister albino rats were used and divided randomly
into two groups. The treated group received 150 mg/kg aspartame orally daily after
dissolving it in 2cc distilled water and the control group received 2cc distilled water daily
orally for eight weeks.
Results: Histological examination of aspartame-treated group showed loss of normal
architecture of the thyroid gland. morphometrical measurement showed many follicles
were small in size and others had disrupted wall and detached cells in their lumens, there
was significant increase in the height of cells and number of follicles with decrease inwidth
of the cells.
Conclusion: Administration of aspartame at a dose 150 mg/kg had a significant effect on
both histologic and morphometrical structure of the adult rat’sthyroid gland.

Background: Toxoplasma gondii is an obligate intracellular protozoan parasite. Diabetes
is a dangerous disease. It is one of the important causes that increasethe exposureto other
diseases.
Objective: To study was performed to detect T. gondii infection in diabetic patients using
serologic tests.
Patients and Methods: Overall 270 serum samples that included172 diabetic cases and
98serum samples from non-diabetic (healthy controls) in Baghdad city were collected for
T. gondii infection from December 2015 to March 2016. All sera were tested for fasting
blood sugar and antibodies of T. gondii using enzymatic technique and ELISA methods
respectively of BioCheck. IncCompany. Gender and age were considered in diabetic cases.
Results: The incidence of toxoplasmosis infection in diabetic patients and healthy controls
were 55.81% and 38.78% respectively. There were (50%) diabetic females infected with IgG-
Abs while there were (50%) diabetic males with IgG-Abs of T. gondii. Also, the range age of
patients infected with T. gondii was 30-50 years old which have (51.04%). While there was
(8.33%) diabetic patient’s age was less than 30 years.
Conclusion: The sero-prevalence of toxoplasmosis in diabetic patients was found to be
comparatively higher than in non-diabetic patients.

Background: In addition to all health complications of obesity, screening for central
obesity is more important for diagnosing metabolic syndrome than body mass index, as
there are increasingly “metabolically healthy obese” patients who have no central obesity;
on the other hand, a subset of “metabolically obese normal weight\" patients have central
obesity.
Objective: To evaluate the prevalence of central (abdominal) obesity amongst Iraqi
university students , by applying a novel index of central obesity (ICO) , using the
proportion of waist circumference divided by height (WHtR) with a cutoff of 0.5; so that
to obviate various gender-characteristic cutoffs for waist circumference, and to assess its
association with life style.
Patients and Methods: In our cross-sectional analysis, 175 students randomly chosen
from three different colleges in university of Baghdad at April 2014. Dietary, exercise, and
sleep habits; history of cigarette smoking, and family history of diabetes mellitus evaluated
by self-appraised survey. Physical measurements involved weight, height, and waist
circumference.
Results: Among our sample of students, 14.9 % were overweight, and 5.1% had general
obesity. When using ICO, The prevalence of central obesity is 30.3%, which is higher than
that when using waist circumference (23.3%). There is significant percentages of male and
female students with normal BMI have a central obesity 15.8%, and 17.1% respectively
(p<0.0001).There is a strong association between skipping breakfast ,and sleeping less than 7
hours with the risk of having central obesity, (P < 0.001).
Conclusion: Central obesity is a common problem among Iraqi university students.
When using waist-to-height ratio, central obesity can be manifested in normal BMI and
waist circumference (WC). Central obesity is strongly associated with skipping breakfast,
and sleeping less than 7 hours.

Background: Toxoplasma gondii, Hepatitis B virus and Human immunodeficiency virus
infections and blood donors could represent a risk for transmission in blood recipients.
Objective: To scarce information about the epidemiology of T. gondii, HBV and HIV
infections in blood donors in Iraq. Therefore, prevalence of T. gondii, HBV and HIV
infections and associated socio-demographic characteristics at Baghdadis needed.
Patients and Methods: The present study were carried out on 142 the blood donors
attending National Blood Bank in Baghdad city between October 2013 to October 2014.
Volunteers were males, females, different age groups, and different race. Information's
about there, previous surgical operations, living with cats at home, samples were taken
from different geographical areas in Baghdad. Serological tests were using for
investigating of Toxoplasma gondii, Hepatitis B virus and HIV antibodies.
Results: The results reported that(78.17%) of the blood donors were in direct contact with
stray cats,(29.5%) showed antibodies for Toxoplasma by Latex test, results of the blood
samples ELISA -IgM showed that only (1.5%) were positive to Toxoplasma gondii while
(28.2%) showed ELISA- IgG positive for Toxoplasma gondii.
Conclusion: All tested samples were negative for HIV (0%), only one sample was found to
be positive for Hepatitis B virus (0.7%).

Background:Methicillin resistant Staphylococcus aureus (MRSA) causes serious infection
of hospital-acquired patient. In recent years photodynamic inactivation (PDI) has been
proposed as a therapy for a large variety of localized infection caused by MRSA.
Objective:To assess the effect of photosensitizer low power laser light diode with
methylene blue in the reduction the viability of Staphylococcus aureus(MRSA).
Patients and Methods:Thirty five isolates of Staphylococcus aureus bacterial were
isolated and identified using standard methods(Beta hemolytic in blood agar and mannitol
fermentation) and Vitek2 system from(16 urine,8 wound, 7 pus, 4 eye) during the period
from January 2014 to November 2015. The bacterial isolates were taken from Rizgary
Teaching Hospital in Erbil city. All isolated were tested susceptibility to antibiotic test by
Vitek2system against 8 antibiotics, Methicillin resistance susceptibility test (MRSA) by
using Cefoxitin and Oxacillin disk , production of Biofilm by using Congo red agar
methed,with explore photodynamic inactivation of MRSA by using Methylene blue (MB)
in combination with diode laser (red 650 nm, 5 mW) at different time of exposure.
Results: We obtained in this study (35) isolates of Staphylococcus aureus isolated from
(urine, wound, pus, blood, eye), (45.7%) isolates mltiresistance showed the resistance to more
than 4 antibiotics from different classes, in our results also the isolated bacteria showed the
percentage resistance of Cefoxitin was highest 35 (100%), resistant for Oxacillin was 21
(60%),thus all 35 clinical strains of Staphylococcus aureus isolates 100% were considered to
be MRSA. Furthermore the investigation showed that (22%) black (complete) to slightly
black on published congo red agar in which considered to be positive in forming biofilm and
(78%) red color on published congo red agar in which considered to be negative in forming
biofilm. We achieved in vitro study to explore photodynamic inactivation of methicillin
resistant Staphylococcus aureus bacteria by using Methylene blue (MB) in combination with
diode laser (red 650 nm, 5 mW). After one hour of laser illumination of bacteria we achieved
a reduction more than half numbers of each isolated of MRSA.
Conclusion: Reduction in number of colony-forming units by the Laser (physicochemical
properties of photosensitizers) combination with Methylene blue dye treatment of S. aureus
which have a great effective to destroy the microorganism.