Diyala Journal of Medicine

Background: Injection of autologous blood can stimulate a healing response in chronic
tendon disorders.
Objective: To comparing the effectiveness of intralesional autologous plasma with
intralesional corticosteroid injection for treatment of plantar fasciitis.
Patients and Methods: Sixty-one adult patients presented to the orthopedic clinic in Erbil
Teaching Hospital from 1st of January, 2015 to 31st of December, 2015, with chronic
proximal plantar fasciitis were included in this study. They were allocated into two groups,
group A, the autologous plasma group (30 patient), and group B, the corticosteroid group
(31 patients). Pain severity was assessed depending on visual analogue scale scores before
treatment and at 2 weeks, 1 month, and 3 months after treatment.
Results: At first week and first month after treatment the pain reduction was significantly
higher among corticosteroid group (P = 0.012 and 0.010, respectively). While at third month
after treatment there was no significant difference in pain reduction (P = 0.11). Reduction in
visual analogue scale scores for both groups was significant over time (p < 0.001). However,
the corticosteroid group showed an earlier sharp drop and a plateau in average pain levels at
the lower end of the scale as early as 2 weeks.
Conclusion: Intralesional autologous plasma injection was effective in lowering pain and
tenderness, although not as quicker than and as effective as the corticosteroid.

Background: Epiphorais an overflow of tears onto the face due to imperfect drainage of
the tear conducting passages or excess lacrimal production.
Objective: To evaluate silicon stent used in primary endoscopic dacrocystorhinostomy.
Patients and Methods: Thirty seven patients attended to Baqubah teaching hospital since
4th March 2013 till 9th March 2014. It is a clinical sign or condition that constitutes
insufficient tear film drainage from the eye that tears will drain down the face rather than
through the nasolacrimal duct. Dacrocystorhinostomy (DCR) is indicated when the patient
has acquired nasolacrimal duct obstruction, we do this either with or without silicon stent.
If in studies discover results of surgery is without stent is comparable with that with stent,
we will reach to a point that leaving stent is better from point of view regarding its coast
and complications.
Results: Age of patients in the present study was between 18 to 65 years old, 65% of them
are females, no significant statistical difference between the two groups (group DCR with
stent and group DCR without stent) in regards to complications.
Conclusion: We can conclude that silicone stent is not important in primary DCR.

Background: Acute myocardial infarction continues to be a major health concern. It
contributes to morbidity and may end fatally.
Objective: To evaluate Visfatin, apelin melatonin, and interleukin-6 levels in patients with
acute myocardial.
Patients and Methods: The study included 30 AMI patients (group :I)and 30 as healthy
control group(group: II). Visfatin, apelin melatonin, interleukin-6 levels were assessed.
Results: Significantly higher levels of serum apelin, IL-6, cholesterol, and triglyceride, while
significantly lower levels of serum melatonin, visfatin , and HDL were observed in the cases
than in the controls. Receiver operator characteristic curve investigation shown the levels of
melatonin and apelin are the best biomarkers differentiating subjects with AMI.(AUC=0.997;
95% CI: 0.933 to 1.000, cutoff value ≤ pg/ml) ], (AUC =0.952; 95% CI: 0.863 to 0.990,
cutoff value >3.21 pg/ml respectively) ].
Conclusion: This study shows a significantly increase in apelin, IL-6 while a significantly
decrease melatonin, visfatin in the circulation of G:I as compared with G:II. The results
obtained in the present study indicate that serum melatonin; apelin might play an important
pathogenic role not only in the occurrence but also in the severity of AMI. The circulating
level of melatonin provides highly specific biomarker for AMI more than apelin.

Background: In the first 4 hours after a breach in an epithelial surface and underlying
connective tissues made during surgery or trauma, there is a delay before host defences can
become mobilised through acute inflammatory, humeral and cellular processes. This period
is called the ‘decisive period’ and it is during these first 4 hours after incision that bacterial
colonisation and established infection can begin. It is logical that prophylactic antibiotics
will be most effective during this time. Following closure of the wound, local intravascular
coagulation and the events of early inflammation that initiate wound healing seal its
environment: this may explain why the postoperative administration of antibiotics is
ineffective in preventing wound infection.
Objective: To investigate the benefit of prolonged antibiotic therapy following
appendicectomy of uncomplicated appendicitis in preventing surgical site infection.
Patients and Methods: Two hundred patients who undergone appendicectomy had been
reviewed prospectively over a period of one year and eight months (January 2009-Augest
2010) in the surgical ward in Baquba teaching hospital, reviewed for the need for
prolonged antibiotic therapy in decreasing the incidence of surgical site infection. All of
the patients have uncomplicated appendicitis (non-perforated) .The patients are divided
into two groups. In group 1 the patients given single dose of antibiotic (Cefazolin) at the
time of induction of anesthesia and only two doses postoperatively. In group 2, the patients
did not receive preoperative antibiotic but given prolonged antibiotic cover first parenteral
then enteral till the time of removal of stitches. The two groups are examined for the
development of surgical site infection.
Results: No significant difference in the incidence of occurrence of surgical site infection
between the two groups.
Conclusion: Prolonged postoperative antibiotic therapy is of no value in preventing
surgical site infection in patient underwent appendicectomy for uncomplicated
appendicitis.

Background: Supracondylar humeral fracture in children is the most frequent one in the
first decade of life. Closed reduction and percutaneous pinning has been adopted as the
treatment of choice ,and the outcome has relied mainly upon the perfection of reduction
and the stability of fixation .Many configurations of pinning has been used.
Objective: To evaluate the efficacy and safety of the closed reduction and lateral pinning
in treating displaced supracondylar humeral fracture.
Patients and Methods: Thirty-eight patients of extension type Gartland class III
displaced SCHF in children aged (1.5-13) years had been included in this study in the
period from April 2014 to July 2016 all of them had been treated by closed reduction and
lateral percutaneous pinning .They were (26) males (68.4%) and (12) females (31.6%) and
the mean age was( 5.8 ) years. The left side was injured in (25) patients (65.8%) and the
right side was involved in (13)patients (34.2%). All cases had been operated within the
first 24 hours of injury.
Results: Stable and satisfactory reduction had been obtained in all cases except one, in whom
failure of reduction occurred postoperatively. Allcases regained full-range of extension and
flexion of elbow movement after about 3-4 months .Baumann’s angle was( 76± 2.5) and
(74±0.5) on the injured and normal sides respectively . In all cases the carrying angle of
elbow was within normal limit .No neurovascular complication had been noted in the all
cases.
Conclusion: Percutaneous pinning using the lateral configuration technique found to be
stable and safe method.

Background: Breast milk was the full required physiological food of human infants.
Optimally initiation of immediate breastfeeding exclusively after birth until 6 months of
infant age, and keeping infant on breastfeeding with age dependent and appropriately
introducing complementary foods to the age of to two or longer.
Objective: To investigate the feeding cost and relationship between the feeding types in
the first year of infant life, and infant morbidity.
Patients and Methods: It was a descriptive cross sectional study done in Al-Batool
teaching hospital and Al-Zahra hospital of Diyala province during the period from October
2014 to March 2015, 100 cases of infant at one year of age have be included in the study
regardless of medical reason of hospital admission, divided into three groups of infants
breast feeding exclusively, bottle feeding exclusively and mixed type of both bottle and
breast feeding. This study is considered as to investigate the relationship between feeding
type in the first year of infant life, and infant and maternal co-morbidities.
Results: One hundred cases were included in the study, 51 males infant and 49 females
included in the sample, according to feeding type the study revealed that31 breast feeding, 34
bottle feeding, 35 mixed feeding. The current study demonstrate that 69 delivered by section
among them 14 breast feeding, 32 bottle feeding and 22 mixed feeding while 31 delivered by
normal vaginal delivery including 15 breast feeding, 9 bottle feeding and 7 mixed feeding
only. Regarding post partum maternal weight loss we found 81 had significant weight loss
among them 30 breast feeding, 15 bottle feeding and 16 mixed feeding. According to the
study of fetal diseases demonstrated that 68 infant developed diarrhea among them 14 breast
feeding,29 bottle feeding and 25 mixed feeding , 47 had urinary tract infection 9 of them
breast feeding 20 had bottle feeding, 32 infant had constipation five of them breast feeding ,
14 bottle feeding and 13 mixed feeding.
Conclusion: The duration of breastfeeding showed a decline with decreasing maternal age,
multiparous with low level of education living in rural communities with low socio-
economic class were more likely to breastfeed, indicating that economic and experience
status highly influencing feeding choice to review our studies on breastfeeding.

Background: Breast cancer is the most common cancer worldwide. From several markers
of this malignancy, HER-2 is considered to have a particular importance because it
associates with the treatment and prognosis of the disease.
Objective: To investigate the amplification of HER-2 gene in benign and malignant
lesions of breast in a sample of Iraqi women.
Patients and Methods: A total of 24 excisional breast biopsies were obtained from women
with breast lesions. Biopsies were preserved in 10% formalin and undergone paraffin
embedding according to the standard protocol. Four µm thick sections were prepared and
placed on positively charged slide and stained with fluorescent in situ hybridization. The
stained slides were examined with fluorescence microscope to detect HER-2 gene
amplification.
Results: Fourteen women were found to have benign lesions, while 10 were with malignant
lesions. All benign lesions revealed two copies of the gene while seven of malignant cases
showed positive results for HER-2 amplification (i.e more than 5 copies of the gene).
Conclusion: These results support the idea that amplification of HER-2 could be
considered as an indicator for tissue transformation into malignant lesion .

Background: Polycystic ovarian syndrome (PCOS) is one of world wild endocrine
problem ,affecting women during their reproductive life . 75%of women with polycystic
ovarian syndrome (PCOS) complain from infertility due to Anovulatory dysfunction ,
together with menstrual abnormality and signs &symptoms of hyper andorganism.. One of
the second line of treatment is Laparoscopic ovarian drilling (LOD) that used to induce
ovulation in women with PCOS .
Objective: To assess the effectiveness of LOD surgery in management of PCOS related
to an ovulation , menstrual regularity and failure of conception.
Patients and Methods: This prospective study included 47female had previously tried
multiple drugs for stimulation of ovulation for conception, and undergo surgery by
laparoscope ovarian drilling for period between 1st of May 2011 to 15 th of May 2016,
At private hospital with follow –up for 1 year .
Results: Surgical ovarian drilling by laparoscopy was successfully done without any
surgical or anesthetic problems , and follow-up the patient for 1 year . There were
significant decrease (P<0.05) in LH, prolactine and Testosterone hormones levels with
significant increase in the hormonal level of Progesterone following the LOD procedure
compared to before the drilling. (70.2% ) of the patient start again to had ordinary regular
menstrual cycle and( 61.70% ) establish to ovulate spontaneously while only (48.93%) has
been conceived.
Conclusion: Laparoscopic ovarian drilling appear as an efficacious and safe second line
treatment for PCOS women with Clomphine acetate failure , anovulatory dysfunction
and may achieve immediate correction of the patient s endocrinology with increase
ovulation and pregnancy rates.

Background: Urolithiasisis a common health problem in our society. Extracorporeal
Shock Wave Lithotripsyhas been practiced successfully for treating renal and upper
ureteric stones. Few studies, however, have looked on its effectiveness in the treatment of
lower ureteric stone.
Objective: To evaluate the effectiveness of ESWL in the management of upper and lower
ureteric stones in Duhok.
Patients and Methods: The study was planned and conducted from January 2013 to June
2014 on 294 patients(16-80 years)with ureteric calculi admitted for the initial
Extracorporeal Shock Wave Lithotripsytreatment. All patients were underwent lithotripsy
with shock wave 1220 to 4000 at the rate of 60-90 impulses per minute in the same place
using the Siemens lithotripter. The outcome was evaluated on the 3rdand 7thdays by x-ray
and ultrasound and a second Extracorporeal Shock Wave Lithotripsy session was
conducted for those have an incomplete clearance of ureteric stone.
Results: Out of the 294 patients, 74.1% were male, 55.8% had left-sided stone and remaining
44.2% had right-sided stone, and 34.4% had stone located in lower ureter. The mean age of
the patients was 37.2 (±10.9) years, while the mean stone size was 7.98 (±1.18) mm. The
Extracorporeal Shock Wave Lithotripsy has successfully removed the stone from 256 (87.1%)
patients and the success rate was significantly higher for lower ureteric and small size stones.
The success rate for both sides and genders were comparable in the study. Out of the rest 38
(12.9%) patients who did not obtain the success of stone minimization from the first
Extracorporeal Shock Wave Lithotripsy session; 33 of them had stone clearance in the second
session while, the rest of 5 patients need surgical intervention. Univariate logistic regression
showed that small stone size was the only significant predictor for stone clearance after the
first session.
Conclusion: The current study confirmed that the Extracorporeal Shock Wave Lithotripsy
technique is the safe and effective method for upper and lower ureteral calculi
comminution.

Background: Toxoplasma gondii is an obligatory intracellular parasite that is consider a
major invasive parasite in immunocompromised individuals.
Objective: To determined the prevalence of Toxoplasmosis in patients with different types
of cancer in Iraq.
Patients and Methods: Samples of blood were gathered from 258 women who included
112 healthy controls samples and 146 samples with different types of cancer. They were
attended Oncology Teaching Hospital in the Medical City Hospital in Baghdad province
from October, 2016 to February, 2017. Then the sera were tested to determine the anti- T.
gondii antibodies (IgG and IgM) using enzyme linked immunosorbent assay.
Results: The highest seropositive rate of T. gondii IgG were noted in patients with lymph
node cancer followed by breast, colorectal, liver, pancreas, lung, ovary, prostate cancer which
was (100%, 77.50%, 77.42%, 75.00%, 66.67%, 66.67%, 54.55%, 28.57%) respectively with
significant differences (P<0.01). This study focused on breast and colorectal cancer.
According to the age groups, the seroprevalence of anti- T. gondii IgG was the highest in the
age group (26-35) years in patients with colorectal and breast cancer which was (378.309
IU/ml, 374.561 IU/ml respectively) compared with control group (148.917 IU/ml). In regard
to the anti- tumor dosage, the highest mean titer of IgG observed in dosage (0), the mean titer
of IgG in patients with colorectal and breast cancer whose were seropositive to anti-T. gondii
IgG were (242.016 IU/ml and 227.275 IU/ml) respectively, while in seronegative patients to
anti-T. gondii IgG were (8.594 IU/ml and 6.011 IU/ml) respectively.
Conclusion: These finding suggest that incidental rate of toxoplasmosis is higher in cancer
patients. Thus, the incidental rate of toxoplasmosis could be considered as an indication to
the high risk of cancer. In addition, anti- T. gondii IgG test has to be taken into
consideration as markers for staging cancer disease

Background: Cardiovascular diseases are prevalent in patients with chronic kidney
disease and represent the major hazard for mortality in this population . Left ventricular
hypertrophy is a cardiovascular complication in patients with chronic kidney disease and
end-stage renal disease. Left ventricular hypertrophy in dialysis patients has generally a
bad prognostic value, because it represents a risk factor for the development of cardiac
arrhythmias, ischemic heart disease, heart failure and sudden death.
Objective: To study left ventricular systolic functions by Echocardiography in patients
with chronic renal failure on hemodialysis program and their relation with some risk
factors.
Patients and Methods: 100 patients with end stage renal failure on dialysis were studied
by echocardiography, the patients were divided into two groups, the first group with
normal echo study , while the second group consisted of patients with left ventricular
systolic dysfunction. Risk factors including age , sex , duration of dialysis , hypertension,
DM, and hemoglobin levels were compared between the groups.
Results: Left Ventricular disorders occurred in 65% , 34% of patients showed left
ventricular systolic dysfunction , , older age group, longer duration of dialysis ,
hypertension ,DM, and anemia were found to be significantly associated with left ventricular
systolic dysfunction.
Conclusion: Our study concluded that large numbers of end-stage renal disease patients
have hypertension and diabetes as the etiology of their disease, which could be prevented
by better approach in controlling blood pressure and blood sugar. Anaemia is a
major problem and as a predictor of cardiovascular risk factor for those patients.
Echocardiographic Left Ventricular Study are prognostic predictors in chronic kidney
disease patients, which suggest that echocardiography may play a vital role in assessing
cardiac morphology and functions in those patients.

Background: The mandatory month is Ramadan on Muslim’s fasting. Muslims cease from
ingestion of food and water starting onset to grass widower to who wants to be fasting in
this month that’s according to the lunar calendar; so many immunological, physiological
and biochemical changes may happen.
Objective: To evaluate some vitamins, hormones and immunological markers in the first
and the 28th day of fasting.
Patients and Methods: Twenty five healthy adult male who were subjected to this study.
The age range was 24-49 years with mean ± SD (31.6±7.07). Body weight, BMI, serum
glucose, total cholesterol, high density lipoprotein-cholesterol (HDL-C), low density
lipoprotein-cholesterol (LDL-C), very low density lipoprotein-cholesterol (VLDL-C),
triglyceride (TG), aspartate amino transferase (AST), alanine amino transferase (ALT),
alkaline phosphatase (ALP), total serum bilirubin (TSB), serum creatinine, blood urea,
serum electrolytes (Na, K, Cl,) haemoglobin concentration (Hb), haematocrit, vitamin-D,
testosterone and C-reactive protein (CRP) were estimated in the 1st day and the 28th day of
Ramadan month. The while-interval of study was 27 days. Human privacy, statistical
analyses and P value were used.
Results: Serum glucose, LDL, ALT, TSB, serum creatinine, blood urea, vitamin D and CRP
were significantly decreased in 28th day of fasting (P=0.0002, P=0.005, P=0.009, P=0.00004,
P=0.013, P=0.0074, P=0.0109, respectively). There were no significance change in total
cholesterol, VLDL-C, TG, AST, ALP, K, Cl, Hb, haematocrit, testosterone (P>0.05). While
HDL-C and serum Na were increased significantly in this study (P= 0=0.004, P=0.0214,
respectively).
Conclusion: Consuming two meals per a day during month of Ramadan has a balancing
effect on biochemical, enzymes and CRP in fasted men.

Background: Dermatoglyphics, the study of fingerprints are unceasing and characteristic.
It has been found useful in forensic medicine and documentation purpose. It is beneficial in
medical diagnosis of genetically inherited diseases and in detection of crimes.
Objective: To associate between digital dermatoglyphics patterns in ABO, Rh blood
groups in the mother and fetus and to assess their significance.
Patients and Methods: The pregnant mother and her baby of the 2016 in Al-Batool
teaching hospital, designed the study populace. The present study has been carried out on
90 fit individuals (mothers her baby) undergoing medical screening. Fingerprints were
attained by Ink method. Parameters studied were arches, whorls, loops.
Results: Common of the subjects (42%) in the study were of blood group A followed by
blood group O, B and AB of whom (30%) were Rh-positive. The common distribution of
pattern of finger print showed high frequency (30%) of loops followed by whorls and arches.
Almost similar order was detected in both Rh-positive and Rh negative individuals or A, B,
AB and O blood groups, except blood group O- ve which showed more whorls.
Conclusion: There is an association between distribution of finger print pattern and blood
groups.

Background: Gastric ulcer is common and serious diseases caused by imbalances between
naturally occurring defensive factors such as mucus, prostaglandins and aggressive factors
such as hydrochloric acid, usually found in gastrointestinal juices
Objective: To evaluated the level of complement protein C3 and C4 for infected patients
with gastric ulcer in Baqubah city, Iraq.
Patients and Methods: In this case- control study (57) blood samples were collected from
patients with gastric ulcer and (32) blood samples from healthy individuals has been
accredited as a control group and the study has continued during the period between
October 2016 and April 2017.
Results: The results showed that there was a decrease in the level of C3 in patients with
gastric ulcers by (25.168 ± 182.173) mg/dl compared to the control group and (501.565 ±
481.418) mg/dl and found that an increase in the level of C4 in patients with gastric ulcer was
(34.978 ± 91.252) mg/dl compared to control group and (7.493 ± 17.403) mg/dl in (p value <
0.001).
Conclusion: We conclude from this that the complemental protein plays an important role
in the localized response to gastric ulcer and gastrointestinal diseases. The presence of
neutrophil cells leads to an increase in the production of the C4 complement in patients and
that IL-10 has a role in regulating the complemental product in general

Background: Cyclophilin A antioxidant protein (CypA) has been reported in several
cancers including oral squamous cell carcinoma (OSCC) regarded the highest incidence
cancer of oral cavity. However, the function of CypA in OSCC are far from being
understood.
Objective: To evaluates the current research estimate the immunohistochemical expression
of CypA in OSCC and normal corresponding mucosa and compare the results with
clinicopathological parameters.
Patients and Methods: Forty OSCC cases and fifteen normal mucosae of formalin-fixed,
paraffin-embedded tissue blocks were used and the sections samples collected during the
period 0f 2016. Data concerning patient’s age, gender, site, clinical presentation, clinical
staging and histopathological grading were obtained and reviewed by two pathologists.
Representative paraffin blocks were selected and section samples immunohistochemically
evaluated using CypA marker.
Results: Females affected more than males and the tongue was the most site. CypA
expression was high in OSCC than normal (p=0.001) with mean±Sd (55±24.8) (22±10.8).
Significant relation found with tumor stage (p=0.03) and no relation observed with age,
gender, site and tumor grade.
Conclusion: CypA expression was clearly present in OSCC, it increases with clinical stage
of tumor and can be used as prognostic marker to diagnose and evaluate OSCC cases from
normal.