Diyala Journal of Medicine

Background: Recurrent miscarriage is a severe medical problem occurs in women infected
with cytomegalovirus and associated with anticardiolipin antibodies IgM.
Objective: To estimate the prevalence of anticardiolipin antibodies in pregnant women with
cytomegalovirus infection and history of recurrent loss.
Patients and Methods: One hundred women (21-41) years old with recurrent pregnancy
loss. Samples were taken from Al-yarmook and Baghdad hospital. This study group was
subdivided into four subgroups depends on times of abortion. Anticardiolipin (IgM) and
cytomegalovirus antibodies were estimated in the sera by the enzyme linked immunosorbent
assay method and compared with 50 apparently healthy pregnant volunteers as a control
group at the same age range.
Results: It was observed that there is a positive correlation coefficient between
anticardiolipin and cytomegalovirus titer (r=0.34729). Also there is significantly difference (t-
test, P< 0.05) between mean of anticardiolipin and cytomegalovirus titers of study and control
groups.
Conclusion: Anticardiolipin antibodies IgM may be associated with first trimester recurrent
abortions for women infected with cytomegalovirus

Background: Depression is common in patient both surgical and medical cases and has
independently variable prognosis according many factors related to patient and variable
disorders.
Objective: To study prevalence of depression in in-patient s admitted to Baquba Teaching
hospital and evaluates the clinical value of depression and severity of depression among
them.
Patients and Methods: Seven hundred and seven patients admitted to Baquba Teaching
hospital in different branches of medicine, this descriptive study was conducted throughout
the period between 1st September 2015 to 12th August 2016, were evaluated for
demographic distribution and depression by using diagnostic and statistical manual of
mental disorders 4th edition scale that depend on main symptoms of depression (version
10), the results were evaluated statistically, mean of score, frequency and percentage were
used as statistical methods to analyze the data obtained.
Results: Sixty eight (8.8%) out of 707 with depression, more common in female 42 (62%)
than that in male 26 (38%) also in housewives than employed and in younger age groups than
older and in more in early days of admission than later days.
Conclusion: Depression in In-patient usually common, and need consultation of
psychiatrists, to help them .Depression play important role in prognoses .of disorders and
compliance of patient to therapy. We suggest that every hospital need psychiatrist to
diagnose and treat depression comorbid with diseases.

Background: Blood loss is the main complication associated with total knee arthroplasty
with its risks of transfusion. Strategies are mandated to decrease blood loss and to reduce
its consequence risks and costs of blood transfusion.
Objective: To find out the effect of tranexamic acid in reduction of blood loss intra and
postoperatively blood loss and lowering the rates of homologous blood transfusions in total
knee arthroplasty.
Patients and Methods: A non-randomized controlled clinical trial was conducted on 40
patients having total knee arthroplasty. In the first study group (20 patients) given
tranexamic acid intra-articularly just before the tourniquet was deflated and the drain was
locked. External postoperative blood loss was recorded together with the estimated amount
of blood lost intraoperatively. The patients whom given blood transfusion with the number
of packed red cells given was recorded also; any thromboembolic event postoperatively
was investigated.
Results: Reduction in the total drain output, total blood loss and in the need of homologous
blood transfusion was observed in first group whom given tranexamic acid, as compared to
the second control group which were statistically significant (p<0.001). In the control group
the postoperative hemoglobin and hematocrit levels were significantly lower (p=0.001 and
0.036, respectively) which were recorded at fifth postoperative day.
Conclusion: Intra-articular injection of tranexamic acid is associated with significantly
marked reduction in both blood loss and the need of blood transfusion in patients
undergoing total knne arthroplasty .

Background: Chronic periodontitis is an inflammatory disease of bacterial etiology that
results in the destruction of tooth supporting tissues, tooth mobility, and tooth loss. The
inflammatory response of the periodontal tissues to infection is influenced by
environmental and genetic factors. The polymorphism of tumor necrosis factor-alpha
(TNF-α) has been reported to influence the expression of TNF-α, thereby playing a role in
the pathogenesis of periodontitis.
Objective: To study the genotyping of tumor necrosis factor-α at position (-308) and to
find out whether any associations exist between the severity of periodontitis and the gene
polymorphisms.
Patients and Methods: The study groups included 50 patients with chronic periodontitis
and 20 healthy controls with clinically healthy periodontium with an age range of 25-50.
Everyone were analyzed for polymorphism of TNF-α gene at position (-308). Periodontal
parameters used in this study were plaque index (PLI), gingival index (GI), probing pocket
depth (PPD), clinical attachment level (CAL) and bleeding on probing (BOP). Five ml of
venous blood was collected from all patients and controls. DNA was extracted from blood
samples, and then the results of electrophoresis of polymerase chain reaction (PCR)
products for this cytokine were subjected for sequencing and to locate the positions of
possible mutations.
Results: The results of sequencing for the tumor necrosis factor-α gene showed higher
frequency of mutations in patient samples as compared to healthy control samples. A highly
significant difference was found in the frequency of mutations among the six samples (4
patients and 2 controls) p=0.0002.
Conclusion: The results of this study indicates that the (-308) polymorphism in TNF-α
gene is associated with the susceptibility to chronic periodontitis.

Background: Antibiotics are among the most highly misused and irrationally prescribed
medicines by health professionals, which directly contribute to the drug resistance
problem.
Objective: To evaluate the rates of irrational antibiotic prescription in Baquba and
Al-Batool Teaching hospitals.
Patients and Methods: This study was conducted in Baquba and Al-Batool Teaching
Hospitals during the period from 1st December 2015 to 1st March 2016. Two- hundred and
fifty-five randomly selected patients present to the internal medicine wards in emergency
departments due to different causes were tested for antibiotic misuse. All of the medication
prescribed were reported, reviewed and carefully assessed according to the standard
criteria.
Results: This study revealed that (78.4%) of patients had been medicated with antibiotics in
rate of 100% of irrational use. Cephalosporins score the higher rate (35.3%) in prescription
followed by penicillins (23.5%). The most frequent indications for antibiotics prescribed
wereUrinary Tract Infections (UTI) with 51(25.5%) followed by Upper and Lower
Respiratory Tract Infections (URTI, LRTI) with (48 %, 46%), respectively.
Conclusion: The rate of antibiotic misuse is unacceptably high. The antibiotics
prescription need further evaluation to reduce unnecessary prescription.

Background: At term, immediate delivery is found to be associated with a lower risk of
maternal infection and high maternal satisfaction as compared to expectant management.
Objective: This study was done to determine the neonatal and maternal outcomes of
planned early birth versus expectant birth in management of prelabour rupture of
membranes at term.
Patients and Methods: This study was non-randomized interventional study conducted at
the labour ward of the maternity teaching hospital in Erbil city, Kurdistan-Iraq from 1st of
January to 30th of June, 2010. A sample of one hundred eligible pregnant women was non-
randomly assigned in two groups. Both groups were matched for age and gestational age.
The first group included 50 women in which labour was induced with oxytocin. In the
second group, 50 women were included for labour to begin spontaneously.
Results: Mode of delivery was significantly (p<0.001) associated with parity in both study
groups. The differences in maternal and neonatal outcomes for both study groups were not
significant. The time to active labour from admission, time of active labour and time from
rupture membrane to delivery were significantly (p<0.001, 0.03, <0.001, respectively) longer
among women of expectant group.
Conclusion: Maternal and neonatal outcomes of both induction and expectant labour were
similar although, labour duration was longer among women in expectant group.

Background: Klebsiella spp. is an opportunistic nosocomial pathogen causing a variety of
infections including urinary tract infections, pneumonia, septicemia, wound infections,
distributed between patient results from producing ESBL enzymes lead to multiresistance
against antibiotic encoded by some genes like blaTEM.
Objective: To identify Klebsiella pneumonia and Klebsiella oxytoca isolates harboring gene
encoding for ESBL enzyme and multiresistance antibiotics such as blaTEM.
Patients and Methods: Three hundred samples were collected from (urine, wound, sputum),
Klebsiella spp. isolated and identified by using microscopical, morphological, biochemical
tests and Vitek 2 compact system. Antibiotic susceptibility testing was screening according to
the CLSI guideline and Vitek 2 compact system. Phenotypic screening of ESBLs was
undertaken using (Double disk diffusion and Standard disk diffusion) Methods, also PCR
technique was used for genotypic detection of ESBL genes (blaTEM) according to the
standard protocol.
Results: We obtained in this study 88 (29.33%) total positive results of Klebsiella spp.84
isolates for Klebsiella pneumonia and 4 isolates for Klebsiella oxytoca isolated from 300
different clinical specimens (urine, wound and sputum) ,from patient attending public
hospitals in Erbil province (Rizgary, Teaching hospital, Laboratory center, Raparin, Nanakaly
hospitals at a period from September 2014 to March 2015.Susceptibility profilehas been done
for all Klebsiella spp isolated by using 13 antimicrobial agent,our multifinding pointed out
that highest resistance ,most of Klebsiella spp isolates were resistance to more than three
antibiotics belonging to different classes used and these were considered to be multidrug
resistant (MDR) isolates. The incidence rate of ESBL-producing Klebsiella spp was 51
(57.95%) by Standard disk diffusion Method,48 (54.85%) by Double disk diffusion .
Remarkably,dissemination of blaTEM 13 (11.09%) genes among ESBLs-positive isolates
and the length of amplified genes (840) bp for blaTEM genes.
Conclusion: It can be said that the incidence rate of Klebsiell asp carring genes encoding for
ESBL enzyme representing their commonness in our institute and multi resistance to many
classes of antibiotic, resulting in limited treatment options.

Background: Medical student's population is believed to be at an increased risk for sleep
deprivation. Therefore insomnia can be precipitated by or co-morbid with other psychiatric
disorders including anxiety.
Objective: To both insomnia and anxiety have negative professional and personal
consequences, hence there's strong need to assess the prevalence of insomnia and anxiety.
Patients and Methods: Across sectional study was conducted to all student in al-kindy
college of medicine. The study was conducted from1stmarch to 1stmay 2016. 406 students
were included in our study .Athens scale questionnaire for insomnia was used for assessing
insomnia while Hamilton scale questionnaire was used to assess anxiety.
Results: The prevalence of both insomnia and anxiety was (67.24%) it was higher in females,
No.=173(72.6%) than males, No=100(59.5).There was significant association between
insomnia and anxiety among the medical students should be recognized and attempts should
be made to alleviate them to promote health among medical students of Al-kindy medical
college.
Conclusion: The prevalence of insomnia and anxiety were high among medical student
and there was significant correlation between gender and both insomnia and anxiety.
Females are more liable for developing insomnia and anxiety. The need for establishing
clinical evaluation of insomnia and anxiety for proper management and care. Further
studies among other colleges and societies are needed.

Background: Sound health statistics are essential for health decision-making through all
levels of the health system. Unlikely, health information systems in most of the countries are
insufficient in supplying the needed management support, by this the recent health
information systems are therefore widely seen as management obstacles rather than as tools,
the current study is an attempt to assess the management functions of health information
systems at the districts and facility levels.
Objective: To assess the management functions of health information systems at the districts
and facility levels.
Subject and Methods: A cross-sectional study was conducted in Iraq with a data collection
period extended from the mid of February 2013 to the end of May 2014,a total of seven
districts selected from six Iraqi governorates were included in the study, and a total of twenty
six health centers were selected from the seven districts. The management assessment tool
was used to assess HIS management functions, it is one of the PRISM package tools that are
used to assess the HIS performance.
Results: At the facility level, the percentile scores showed that the governance, quality
standards, planning, training, supervision and financial functions were totally absent, while at
the district level, the percentile scores showed that the management functions were totally
absent except for the supervision functions which were 28.57%.
Conclusion: This study concluded that the health information system has a poor management
functions

Background: Since early times, plants as a source of medicinal compounds, has been
playing a prominent role in the human health maintenance. They have been utilized in
traditional medicine containing a vast number of substances that can be considered in the
treatment of chronic diseases and a variety of infections.
Objective: To Antioxidant activity estimation of plant extraction, effect of the
antimicrobial activity and estimation of total tannin.
Patients and Methods: The leaves of Eucalyptus and the seeds of Quercus were collected
in Erbil and Shaqlawa during September 2014. The leaf water extracted from Eucalyptus
globulus and Quercus persica plants were studied its antibacterial activity against two
types of bacteria Staphylococcus aureus and E. coli each plant was used in three different
concentrations (25%, 50% and 100%).
Results: It was recognized that both plant extracts have inhibitory effects against two tested
bacteria with the observations that the Eucalyptus has more anti-bacterial activity than Oak.
Conclusion: A significant effect on the growth inhibition of gram positive and gram negative
bacteria occur during use water extract of Eucalyptus globulus and Quercus persica Plants

Background: Urinary tract infection is regarded as one of the most common health problem
affecting female in all age groups.
Objective: To study the presences of a symptomatic urinary tract infection among female
students attending primary health center belongs to Kirkuk Technical Institute.
Patients and Methods: Across- sectional study was done and a randomly selected sample
(80 female students) from different scientific depts. in Kirkuk Technical Institute after
receiving their agreements to participate in the study which was started from 1st December
2015 till 1st April 2016. A special questionnaire sheet prepared for this purpose. A general
urine exam was done for each student and for the infected females, urine culture and
sensitivity was performed.
Results: The results show that 80 female students were included in the study, 86.6 % of them
aged (18- 20) years and there was a highly significant relationship between the age group <
18 years and the presence of infection with a p value = 0.000. More than half of infected
female students (65.4%) having bacteria(bacteriuria) while 15.4% having pus cell (pyuria)
and 80.8% of them having positive urine culture which was related to the presence of
Escherichia coli (71.5%) .
Conclusion: Escherichia coli was the frequent bacteria among positive growth in infected
females.

Background: Laparoscopic surgeries are associated with an appreciable high rate of post-
operative nausea and vomiting, there is a trial to compare the effect of two drugs to
minimize it.
Objective: To compare the effect of ondansetron and dexamethasone in a sample of
patients.
Patients and Methods: One hundred had been patients scheduled for laparoscopic
overioctomy match divided to two groups randomly, given same anesthesia technique,
Group 1; 50 receive dexamethasone 8mg i.v. (8mg/2ml). Group 2; 50 receive ondansetron
(de –vomit, 4mg/2nl) iv. Both nausea and vomiting assessed during 24 h after operation.
The assessment tool according to belliville scoring scale.
Results: The two group match for better comparison study, list of side effect destitution in
both group were assessed, post-operative nausea and vomiting (PONV) assessed in different
episodes during the operation time, their PONV was lower in both groups. No superior drugs
found.
Conclusion: Use of ondansetron (de-vomit, 4mg/2nl) iv. And dexamethasone 8mg i.v.
(8mg/2ml) both can reduce PONV, but the intensity of these symptoms between the groups
were not statistically significant difference

Background: Febrile seizure has a good prognosis, but may presented with status
epilepticus and may raise the possibility of acquiring epilepsy later in life. These
consequences are highly related to many features, including complex criteria.
Objective: To investigate for factors which may be associated with increased incidence of
complex febrile seizure.
Patients and Methods: This is a cross-sectional comparative study done within 2013- 2014.
The associations of febrile convulsion and its criteria with demographic and other characters
of the patients were evaluated. Chi square was applied for statistical analysis.
Results: Seventy six children were enrolled, male gender was 56.6% (n=43) and 39 (51.3%)
of them were having complex febrile convulsion. There was no significant effect of age and
sex on the type of febrile seizure; criteria of complex febrile seizure (prolonged, repetitive,
and focal seizures) were unrelated among each other. Consanguinity marriage has a clear
relationship with simple type (p value=.008), vaginal delivery was significantly associated
with complex seizure (p value=0.047), non- respiratory causes of fever are associated with
prolonged febrile seizure (p value= .024), while no differences between the types of febrile
seizur regarding many other criteria, including anemia, body weight variations, previous
febrile seizure, family history of febrile seizure, and others.
Conclusion: There were only a few criteria predispose the child for complex febrile seizure,
including non- respiratory causes of fever, vaginal delivery, non-consanguineous parents, and
possibly prematurity; therefore complex febrile convulsion cannot be entirely predicted, but a
trend can be expected if these mentioned factors were experienced

Background: The primary goal to the surgical cureof theLower-back and radicular pain is
common presenting complain of herniate lumber disc and compression of the nerve root by
protrusion of disc material.
Objective: To assess the effectiveness of epidural steroid injuction for low back pain in a
compination with percutenous disc decompression in patients presenting to Baqubah
Teaching Hospital in Diyala provenice, Iraq whom suffering from protruded disc with
radicular pain.
Patients and Methods: Depending on inclusion and exclusion criteria, fifty consecutive
patients diagnosed as having protruded disc and whom used conservative therapy for six
weeks with no improvement all were conducted in the Orthopaedic clinic in Baqubah city
during 2013 till 2015, 25 patients use both method and 25 patients use only Decompressor.
Results: The result were shown no significant differences between decompression and
decompression+ESI for the age, sex, operating time, hospitalization, and stight leg rising
test(S.L.R.T) but significant difference between decompression and decompression+ESI at p
< 0.05 for time retain to work /day, numbness, and radition/pain with mean ± SD; (20.8 ± 7.4
and 15.8 ± 6.6 for time retain to work respectively), (1.3 ± 0.5 and 1.6 ± 0.5 for numbness
respectively), (1.4 ± 0.5 and 1.8 ± 0.4 for radition/pain respectively). And the result revealed
that the operating time was significant positive correlation with age and significant negative
correlation with numbness and time retain to work/day significant negative correlation with
numbness and radition/pain, while significant positive correlation with S.L.R.T, the data was
taken depending on oswestry disability index (ODI) questioners.
Conclusion: Used of both decompressor with epidural injection areprovided rapid relief of
sciatica and low-back pain in the first three months after operation that improved the
movement and early exercise.

Background: Renal involvement is immensely include in antineutrophil cytoplasmic
autoantibody (ANCA)-associated systemic vasculitis .It is a significant cause of end-stage
renal failure.
Objective: To comparison between cytoplasmic autoantibodies a cytoplasmic pattern and
antineutrophil cytoplasmic autoantibodies a perinuclear pattern in patients with renal disease .
Patients and Methods: Prospective study reports presenting serological , hematological and
biochemical investigations of 44 new patients diagnosed in teaching laboratories of Baghdad
hospital from March 2015 to June 2016. All studied groups tested for hemaglobin (Hb),
White blood cells (WBC), serum blood urea, Serum blood creatinine, c-reactive protein in
addition to antineutrophil cytoplasmic autoantibodies a perinuclear pattern (p-ANCA) and
antineutrophil cytoplasmic autoantibodies a cytoplasmic pattern (c-ANCA) detected by
enzyme linked immunosorbent assay technique .
Results: All patients with renal disease had antineutrophil cytoplasmic autoantibody a
cytoplasmic pattern negative whereas (27.3%) of those patients had positive antineutrophil
cytoplasmic autoantibody a perinuclear pattern. Patients with age group range between (20-
29) years showed (18.2%) pANCA positive results which mainly involved in female.
Clinically evident systemic lupus erythematosus was present in 6 of the 12 patients with
positive pANCA .
Conclusion: Serum anti-neutrophil cytoplasmic antibody measurement should not be used
alone in the diagnosis of ANCA-associated disease, whereas pANCA is more convincing in
the diagnosis than cANCA.