Diyala Journal of Medicine

Background: The correlation of cardiac troponin I with early in-hospital outcomes in acute
myocardial infarction is not well established.
Objective: To assess the role of troponin I in predicting in-hospital outcomes and early left
ventricular systolic dysfunction in patients with ST-segment elevation myocardial infarction.
Patients and Methods: A prospective study which consist of 116 patients (74 were males
and 42 were females), with ST-segment elevation myocardial infarction who had been
admitted to the Coronary Care Unit from March 2015 to September 2015 were enrolled.
Patients were divided according to the level of troponin I on admission into 3 groups (low,
medium and high elevation).
Results: The mean age (+ SD) of the patients was 60+11.4 years. The troponin level of
66.2% of males was high compared with 52.4% of females (p=0.002). The incidence of acute
pulmonary edema (21.1%), cardiogenic shock (7%) and early left ventricular systolic
dysfunction (49.3%) was significantly higher among patients with high troponin level
compared with (0%, 0% and 16%, respectively) among patients with low troponin level. All
deaths and cardiac arrest were of high troponin level.
Conclusion: High admission troponin I in ST-segment elevation myocardial infarction
permits early identification of patients at increased risk of major cardiac complications and
death.

Background: Severely displaced fractures demand great effort and a challenge.
Objective: To compares between postoperative complications related to posterior and lateral
surgical approaches in reduction of humerus supracondylar fracture in children.
Patients and Methods: A prospective study conducted at four public and private hospitals in
Erbil city between 1st October 2008 and 30th June, 2009. A total of 35 child with a mean age
of 7.8 year, suffering from extension supracondylar fracture of humerus (type II or III) were
enrolled in the study and followed up for five months. Regardless of type of fracture, 21 cases
were treated by posterior surgical approach and 14 cases by lateral surgical approach.
Results: Of the patients treated by posterior approach, one patient (2.9%) developed infection
at the site of the pin in the early post-operative period, and seven (20%) developed stiffness
10-20° of elbow with either loss of extension or of flexion. While those treated by lateral
approach, only two patients (5.7%) developed cubitus varus 5-10°. Overall, significant
difference (P = 0.022) between related complications of the two surgical approaches are
observed, were lateral approach shows a lower related complication than posterior approach
(14.3% and 38.1% respectively).
Conclusion: Surgical treatment of extension supracondylar fracture of humerus (type II or
III) by lateral pinning approach has less related complications than posterior approach

Background: Carpal tunnel syndrome is a compression neuropathy of median nerve at the
wrist underneath the flexor retinaculum ligament. It is extremely more common in females
than males and usually responds to conservative line of treatment and surgery is
recommended after failure of the conservative treatment .
Objective: To evaluate the effect of internal neurolysis on the clinical outcome of carpal
tunnel surgery.
Patients and Methods: Forty-eight patients with clinically proved carpal tunnel syndrome
were divided into two equal groups; group A were submitted to division of flexor retinaculum
ligament only while group B underwent internal neurolysis in addition to division of flexor
retinaculum. The two groups have been compared postoperatively on clinical basis for an
average period of (4) months. The study had been done prospectively in the period from
January 2014 to August 2016 in Ba´quba Teaching Hospital.
Results: All the cases had beensatisfied with the outcome of surgery in both groups,with
recurrence in one case only in group A which responded well to conservative treatment.
Conclusion: There was no significant difference in the outcome of both groups in which the
addition of internal neurolysis is not necessary and it had no striking effect on the outcome of
carpal tunnel surgical decompression.

Background: Molluscum Contagiosum is a common cutaneous viral infection seen in
children and adults. It is caused by a DNA virus, related to Pox group of viruses.
Objective: To determine the efficacy of topical retinoids in treatment of Molluscum
Contagiosum patients in Khalis City.
Patients and Methods: A placebo control study was carried out during the period from 1st
December 2015 till 1st August 2016; forty patients with Molluscum Contagiosum in Khlalis
City (24 males and 16 females, with age group range between 3-40 years) were randomly
divided into two groups. The group 1 has given 0.05% topical retinoids cream to be applied at
bed time over lesions. The group 2 has given placebo (aquarosa) to be applied at the bed time
over the lesions; the durations of treatment were six weeks for both groups.
Results: At the end of six weeks the first group shows 65% healing rate (13 patients) with
mean lesions number decrease from 9 to 2; while the second’s group only one patient shows
complete healing (5%) with mean lesions number decrease from 9 to 7.
Conclusion: Topical retinoid is effective treatment of Molluscum Contagiosum after Six
weeks course of treatment as compared with placebo with success rate of 65% and 5%
respectively

Background: Depression is health problem of epidemic dimension, characterized by
multiple symptoms, including abnormal and persisting affective changes associated with
feeling of worthlessness guilt and helplessness, anxiety, crying, suicidal tendencies, loss of
interest, in work and other activities , impaired capacity to perform every day social and
functions, and hypochondriasis.
Objective: To measure the rate of depression among patient attending primary health care
centers in Baquba city and to identify their sociodemographic characteristics.
Patients and Methods: Three hundred and sixty patients (160 males,200 females) were
drown randomly from three primary health care centers in Baquba city , cross sectional study
were done for them using General health questioner (Golberg -30) ,semi structural
psychiatric interview schedule based on American psychiatric association diagnostic and
statistical manual of mental disorders 5th edition and Becks inventory test to detect
depression and its severity. Results were analyzed statistically.
Results: The rate of depression among primary care attendants in Baquba city in this study
was (12.5%). More common in female than that in male (15.5% in female, 8.75 % in male);
female male ratio (1.85-1), recognition rate of depression was low 22.3%. Mild depression is
higher than other types of depression 44.4%.
Conclusion: Depression rate is high in primary health centers in Baquba city , the depression
is under diagnosed and often in appropriately treated illness resulting in economic burden in
health care centers

Background: Thalassemia is one of the most common genetic diseases in the world. It is a
major health problem, causing much morbidity. The prevalence of hepatitis C virus (HCV)
among multi-transfused patients varies from one area to another and depends on the
endemicity of viral hepatitis in different regions.
Objective: To investigate the prevalence of hepatitis C virus among patients with
thalassemia major and to determine the most prevalent genotype for this virus.
Patients and Methods: This cross sectional- descriptive study was carried on all patients
registered for central laboratory in Erbil City-Iraq during the period from September 2015 till
September 2016, thus a total of 176 thalassemia patients were included. Hepatitis C virus
infection was tested by using serum for HCV RNA detection by real time- polymerase chain
reaction.
Results: Out of (176) patients with thalassemia 61 patients had positive result for HCV
genotypes by RT-PCR and the most common of genotypes was detected including, (gene-1a,
gene-1b, gene-2, gene-3, gene-4, gene 1a,4, gene 1a,2,4, gene-1b,2 and gene 1b,4), the most
prevalent gene in our study gene-3 was 20(32.8%) followed by gene-1a 16( 26.2%) and then
gene 1b,4 and gene-4 (6%, 6%, 9.8 %) respectively. There is difference between male and
female patients according to HCV genotype in which the most common genotypes that
appear among male patients was gene- 3 13(37.4%), gene-1a 7(20%) and gene 1b, 4 was
5(14.3%) respectively. While among female patients the most common type of gene was
gene-1a 9(34.6%) and gene-3 7(26.9%) although there is no significant differences between
sex (male and female) according to HCV genotype (P-value = 0.063).
Conclusion: Geographical distribution of various genotypes of HCV is useful for
understanding the epidemiological status, detection of mode and source of infection.
Preservation of screening and development and update of its laboratory methods seems to be
the sole beneficial decision. PCR technique is essential to detect and treat active infection.

Background: Conventional routine is not enough to improve child survival. The remedy of
sick children is by controlling specific diseases. A strategy that was issued to control these
diseases is integrated management of illness (IMCI) like those targeted at acute respiratory
infection and diarrhea.
Objective: To study aimed evaluation of the quality of IMCI Assessments among IMCI
trained health workers program in primary health Care Centers in Baquba City.
Patients and Methods: A cross sectional study was conducted in two sectors that cover
health services in Baquba city from the period of 15 December 2015 to 1st June 2016. A
convenient sample of 150 cases to evaluated performance of health workers was included in
the study from the age of 2 month to 5 years and 55 from health workers to evaluated
knowledge about IMCI program. Data collected by special designed questionnaire that
adopted from world health organization (WHO).
Results: The Result showed that 78.4 %of health providers were trained on IMNCH program.
The performance of health workers were poor 33.3% of them checking temperature ,70%
Checking the Weight of child ,24.6% asking for danger singes,71% asking about cough or
difficult breathing ,30.6% asking for diarrhea ,72.6%asking for fever,22% evaluated ear
problem,34%checking weight against growth chart ,20% looking for edema ,24.6% checking
for sever wasting , 24% looking for palmer pallor ,88.6% asked about breastfeeding ,47%
give advice on frequency of feeding 29.3% give instruction to bring back the child .while
69.2% of health workers answer correctly.
Conclusion: Performances of health workers about program were poor while knowledge of
health workers about IMNCH program was fair.

Background: Visceral leishmaniasis is the second largest parasitic killer in the world after
malaria.
Objective: The outcome of patient with visceral leishmaniasis in hospital samples
depending on spot test for diagnosis.
Patients and Methods: This study was conducted in Al-Batool Teaching Hospital in
Baqubah- Diyala province, during the period from January 2015 to December 2015. Thirty
five collecting cases were suspected to have visceral leishmaniasis. History was taken
regarding residence, gender, age, animal contact, blood group type. Clinical examination
and investigation were done using complete blood count, abdominal ultrasound and spot
test.
Results: In this study, thirty-five children were diagnosed as visceral leishmaniasis. It is
found more among males (60%) than females (40%), more common in spring and winter,
than in summer and autumn; which was (48.5%, 31%, 14% and 0.05%) respectively. High
percentage recorded among patient with type (A) and (B) blood group, and less in (AB) and
(O) (57%,22%,5%,14%) respectively also infection in rural area (71%) more than in urban
(29%). Regarding the site of infection, organomegaly was (57%), splenomegaly (14%),
hepatomegaly (17%), hepatosplenomegaly (26%) no-organomegaly(43%). All patients were
anemic (43%), mild anemia (10 mg% and less) and (57%) severe anemia (7mg% and less).
The percentage of duration of fever was 17%2 weeks.
Conclusion: Visceral leishmaniasis is a common in patients live in rural areas that have
contact with animals (Dog, fox and jackals).

Background: The relationship between stress and illness is complex. The susceptibility to
stress varies from person to person. An event that causes an illness in a person may not cause
illness in other person. Events must interact with a wide variety of background factors to
manifest as an illness. Hypertension, Heart diseases including Ischaemic heart disease was
associated with personal stress (e.g. relationship breakdown) and but not with work-related
stress (e.g. job loss) in middle-aged men. Personal stress being negatively associated with
asthma.
Objective: To assess negative and positive association of stress fullness of life's events on
adult's people according to new scoring scales for classification chronic diseases.
Patients and Methods: Cross sectional study done among patients who had chronic
diseases, of size (100) patients in Baghdad city from two sectors in Al- karkh and Rusafa
during the period from 15th December 2015 till 30th March 2016. It was taking into
account the views of experts on the scoping study stage (Validity) agreement, which came
experts support the redistribution of the paragraphs of the proposed measure of
stressfulness of life's events. The reliability coefficient index results came under the scale
(alpha-kronor Bach) for internal consistency of a very high degree of reliability, which
reflects the validity of the circulating current research on all members of the community
the results of the study. Using statistical analysis of the relationship (arithmetic mean,
standard deviation, and relative sufficiency, chi square test).
Results: Showed that a meaningful non linear regression model tested in two tailed
alternative of statistical hypothesis between the two factors, chronical diseases problems
concerning stressfulness of life's events. The slop value indicating that with increasing one
unit of (chronic diseases problems factor) throughout reverse scoring scales, a negative
decrement should be occurred in the unit of stressfulness of life's events factor, and estimated
with (-0.15824) by the Logarithmic -Shape mode, and that decrement recorded a highly
significant impact at P<0.01.
Conclusion: The incidence of chronic diseases can put people in a position not to scorn or
attention to detail from the painful life compared with people who do not have chronic
diseases accidents, which was accomplished through the study of the stressfulness of life's
events with increased diseases problems there found an inverse relationship, which has been
achieved through the use of simple logarithmic regression mode

Background: The antibacterial activity of seeds methanol extract and hot aqueous extract of
fenugreek (Trigonella foenum-graecum) showed the presence of activity against four
species of bacteria and the methanol extract have higher activity than other extract.
Objective: To examine the antimicrobial activities of the crude methanolic extract and hot
aqueous extract of seeds of Trigonella foenum-graecum.
Patients and Methods: We prepared three different concentrations for all extracts ( 75%
,50%, 25%, v/v ). The study detected antibacterial activity by using well diffusion in agar
technique .The study applied on the Four species of bacteria includes :Staphylococcus
aureus , Bacillus subtilus, Pseudomonas aeruginosa and Escherichia coli. The study
continued from September 2016 to January 2017 in the Laboratory of Biotechnology in
College of Science - University of Diyala.
Results: The study showed highest antibacterial activity of methanolic extract of seeds of
Trigonella foenum –graecum that attained highest zone of inhibition (30 mm) against P.
aeruginosa when using (75%) concentration,While attained lowest zone of inhibition (10
mm) against E.coli when using (25%) concentration. Whereas the hot aqueous extract of
seeds of Trigonella foenum –graecum that attained highest zone of inhibition (24 mm)
against P. aeruginosa when using (75%) concentration, while don't give any effect against
bacterial spp. when using (25%)concentration.
Conclusion: Antibacterial activity of methanol extract of seeds of Trigonella foenum-
graecum was higher than the hot aqueous extract also higher than commercial antibiotic
(Amikacin).

Background: Atopic dermatitis (AD) is a common, chronic, relapsing, itchy, skin condition
occurring in patients with a personal or family history of atopy. It varies widely in clinical
presentation at different ages and places.
Objective: To determine the most common minor dermatological findings in patients with
atopic dermatitis.
Patients and Methods: This descriptive study was done at Al-Imamain Alkadimain
Teaching Hospital, out patient clinic of dermatology from 2nd of January 2014 to the 1st of
May 2014. The study involved 136 patients,73 of them were males and 63 were females; their
ages ranged from 1 to 20 years. All patients were diagnosed clinically by a dermatologist
according to Hanifin and Rajka major and minor criteria of AD. All the patients were
subjected to a questionnaire including the identifying data and examined for the skin
manifestations of the disease.
Results: Atopic dermatitis affect males 73(53.7%) more than females 63(46.3%). Age of the
patients ranging from 1 to 20 years with a mean of 7.80 ±5.23SD, mostly affecting the age
group less than 10 years 70.6 %, family history of atopy was positive in 69.8%. The most
common dermatological manifestation was xerosis affecting 88 patients (64.7%) followed by
face pallor, or erythema in 64 patients (47%) and hand dermatitis in 63 patients (46.3%). Most
common sites involved by dermatitis were face in 84 patients (61.7%) followed by hands in
63 patients (46.3%).
Conclusion: Atopic dermatitis (AD) has a wide spectrum of dermatological manifestations.
Xerosis is the most common minor skin findings of AD & icthyosis was the least common.
Many conventional minor features were found, but some occurred less frequently.

Background: Hepatitis B virus (HBV) is the most important causative agent of blood borne
hepatitis in humans. Hepatitis D Virus (HDV) infection occurs either as a co-infection or
super infection in HBV carriers.
Objective: To determine the seroprevalence of HDV among blood donors (HBsAg positive
individuals) in Baqubah city.
Patients and Methods: Serum samples were collected from 89 HBsAg positive blood
donation (66 males and 23 females, age range 19-60 years) from blood bank in Baqubah
teaching hospital, during the period from 11thAugust 2016 till 17th January 2017. All of them
were tested for HBsAg, HBcIgM, HBcIgG, HDVIgM and HDVIgG using separate ELISA
kits and full information were collected from each participant by use questioner sheet which
included the sociodemographic and clinical characteristics such as age, gender, educational
level, marital status, economic, occupation, family history, blood transfusion, surgical
operation, dental history, endoscope, any medical problem, tattoo and hjamaa also were
recorded.
Results: In the present study minimum age group was 19 year and maximum was 68 year
with mean age 36 year. According to ELISA technique, 5 cases (5.6%) were positive to HDV
IgG and they all were males with mean age 49 year, while 84 (94.3%) were negative for HDV
infection. Among study group the percentage in males (74.1%) was more than in females
(25.8%). Also significant differences was found between the viral hepatitis infection and
family history, blood transfusion, surgical operation, dental history, endoscope, tattoo and
hjamaa, while there was no significant difference noticed in social state, economic and
educational level.
Conclusion: Infection rate of HDV among blood donor is high, early screening of HDV is
essential for establishing diagnosis and should be depended in routine work further
investigation is needed to validate the findin

Background: Alkaloid narciclasine extraction of Zephyranthes candida are microtubular
toxins of chemically similar nature that disrupt microtubule function by binding to a site on β-
tubulin and suppressing microtubule dynamics.effect in hepatic cell line.
Objective: To evaluate biological activity of alkaloid narciclasine extraction of
Zephyranthes candida on microtubule HepG2 cell line by used GF tubulin with alcoholic
extraction.
Patients and Methods: The experiments work in China (Wuhan) 2016 need about 6 months
, we used TLC technology to extraction alkaloids narciclasine from by used different
concentration 20,40,80,100,200,400 μg/ml for one hours to microtubule cell line of HepG2
cell line and used high concentration 1000,2000 μg/ml to investigate the action of alkaloids
narcilacsine onto the network of microtubule to one hours .
Results: Increased the number of the cell effect by extraction in microtubule by used GF
tubulin inside the cell by alkaloid or alcoholic extraction see the results by
immunofluorescence microscope, the microtubule is effect by high concentration of
extraction see apoptosis and thinned down, and individual fibres have a wavelike shape.
Anther experimental work was conducted to determine the biological activity of alkaloids
Narcilasine on microtubule in concentration 20 μg/ml in (12,10,8,6) hours incubation and
400 μg/ml for 10 min to study cell line and the recovery of its disruption.Cells were treated
with alkaloids at various concentrations from 20 μg/ml to 400 μg/ml for 60 min microtubules
were recovered and network is nearly restored.the results show the microtubulesis back
normal after reduce extraction alcoholic and alkaloids in 12 hours by used indirect
immunofluorescence.
Conclusion: The cells showed changes in the arrangement of microtubules even at the 80
μg/ml concentration of cytostatics after 60-min exposition. Its damage increased with
increasing concentration of cytostatics

Background: Degenerative changes in the intervertebral disc begin at the late teens and early
adult life, after the completion of the physical growth and development. Lumbar disc
herniation is rare in children and adolescents. The clinical presentation and etiology of lumber
disc herniation may differ from that in adults.
Objective: To determine the rate of lumber disc herniation among adolescents and to
describe the radiological, clinical features and surgical outcomes of lumber disc herniation in
a group of adolescent and young adult patients.
Patients and Methods: A retrospective revision of 1045 cases of lumbar disc excisions
performed at the neurosurgical unit of Erbil teaching hospital between 2001 and 2015 was
done. In all cases, the diagnosis was achieved pre-operatively by lumbar spine MRI with or
without CT scan. Initially all patients were treated conservatively for more than 3 months
without success. The indications for surgery were failure of conservative treatment,
intractable pain and/or progressive neurological impairment. Surgical posterior discectomy
with fenestration or partial laminectomy or hemi-laminectomy was performed. On the day of
discharge Kirkaldy-Willis criteria was used to assess the patient post-operatively.
Results: Thirteen (1.22%) of the 1045 patients were adolescents and young adults between 13
and 21 years of age with a male: female ratio of 1.16: 1. Nearly 70 % of patients had a history
of trauma. Lumbar back pain and radicular sciatica were the main complaints in 77% of the
patients. Two patients had radicular leg pain. Only one patient of the 13 patients experienced
lumbar back pain without leg pain. Only one patient was found to have neurological deficit
with partial foot drop. Prior to surgical intervention, straight leg raising test was positive in all
13 patients. All of the patients had symptoms duration for more than 3 months. The
radiological and surgical findings revealed a protruding disc in eleven cases, one lateral recess
stenosis and one lumbar synovial cyst. Epiphyseal ring fracture was found in 4 of the 5
patients who underwent CT study. Results of Kirkaldy-Willis criteria were excellent or good
in 92 % of patients. The follow-up period ranged from 4 months to 2 years with an average of
14 months.
Conclusion: Young adults and adolescents disc herniation is uncommon and is often
precipitated by trauma. Surgical treatment of such patients relieves clinical symptoms quickly
and is associated with good and excellent results in nearly all patients.

Background: Cerebral Palsy is a group of disorders that affect the development and growth
of the movement leading to the determination in the activities of the body, especially related
to movements. These disorders occur as a result of damage or deterioration in certain parts of
the brain.
Objective: To evaluate the effectiveness of horse riding simulator with strengthening training
program on children with spastic diplegic cerebral palsy and comparing it with conventional
physiotherapy program which is used in rehabilitation.
Patients and Methods: Thirty participants were recruited in this study, who were diagnosed
with spastic diplegic cerebral palsy. Their ages between four and twelve years old, the
children were randomly classified into three groups of interventions Horse Riding Simulator
with Strengthening Training, Horse Riding Simulator with conventional physiotherapy and
control group with conventional physiotherapy).for each intervention, the children receive 24
sessions three times a week, [Gross Motor Function Measure-66, pediatric balance scale, and
Modified Modified Ashworth Scale] were used to evaluate children in all groups both pre and
post each intervention.
Results: Post-intervention in the groups of horse riding simulator and strengthening training and horse
riding with conventional physiotherapy shows significantly improved in gross motor function
measures -66(P=0.021), (P=0.001) respectively, while no significant difference have been noted in
conventional physiotherapy group. on the other hand, no significant improvement have been shown in
all intervention groups in Pediatric Balance Scale. Furthermore, muscle tone reduced with a too small
value of significant improvement in a group of horse riding simulator with strengthening training in
adductor muscle of hip joint for right and left leg (P=0.052),(P=0.059) respectively, while no
significant differences have been reported in other studies groups, there wasno significant
improvement have been shown in muscle tone for knee extensor and ankle plantar flexors except too
small values close to significant level in the ankle plantar flexors for the right leg in a group of horse
riding with strengthening training (P= 0.050).
Conclusion: The evidence from this study confirmed that horse riding simulator with
strengthening training has a positive effect on (GMFM-66) and could reduce spasticity in the
muscle for children with spastic diplegia cerebral palsy