Diyala Journal of Medicine

Background: Methoxy polyethylene glycol-Epoetin beta (M.PG.E-β) is a long-acting
erythropoietin receptor activator treatment indicated for the treatment of patients with anemia
associated with end stage renal disease (E.S.R.D). It is the first approved chemically
modified erythropoiesis-stimulating agent (E.S.A). Hypermagnesemia is one of the common
complications accompanied with E.S.R.D patients submitted to hemodialysis. It progresses
early in the course of the disease and increases its rate with the declination in renal efficacy.
Objective: This study targeted to determine the influence of M.PG.E-β therapy on serum
Mg+2 levels in patients with E.S.R.D.
Patients and Methods: In this study , seventy patients with E.S.R.D on hemodialysis
receiving M.PG.E-β and twenty healthy subjects without medical illnesses were included in
this case-control cross sectional study.
Results: Patients had significantly higher serum Mg+2 level at the baseline (p<0.01) compared
to the healthy control group because of loss of renal function in these patients. M.PG.E-β dose
was then given three months after the baseline dose and showed a significant decline in serum
Mg+2 levels (p<0.05) in patients with E.S.R.D during the study.
Conclusion: It can be concluded that relative elevation of serum Mg+2 was linked with
E.S.R.D patients and the administration of M.PG.E-β usually leads to a significant subside in
its le

Background: Blood groups have revealed associations with a variety of diseases. However,
most of these studies concerned general population and only few of them the potential
relationship with viral hepatitis.
Objective: To investigate the association of ABO and Rh blood groups with hepatitis C viral
infection in β- thalassaemia patients.
Patients and Methods: A retrospective study was conducted during 2014 at Thalassaemia
Center. Hepatitis C ELISA test and blood groups of β- thalassaemia patients were recorded.
Statistical Package for Social Sciences software, version 20, was used to analyze data.
Results: Total enrolled patients were 215, seropositive hepatitis C was evident in 24 (11.2%).
The overall distribution blood groups among thalassaemia patients was compatible with that of
general population. Regarding seropositive hepatitis C patients, most (n=20, 83.3%) were A and
B blood groups, only 3 patients (12.5%) were O, and 1 patient (4.2%) AB. Therefore, hepatitis
C was significantly associated with groups A and B and those who have group O were spared (p
value .014). Most of patients were Rh D positive and no significant effect (p value .392) on
hepatitis C could be found.
Conclusion:In β- thalassaemia, most of the hepatitis C infected patients were blood groups A
and B whereas blood group O patients seemed to be less susceptible or protected against this
infection.

Background: The obesity of the children, teens, or adults is one of the most serious risks to
the health in the twenty first century. It appears widely during the last three decades and this
growing distribution of the children obesity has a relationship with the occurrence of the
diseases in earlier ages because the obesity has negative effects nearly on the whole body
organs and usually causes serious diseases.
Objective: To know the distribution of this epidemic among our children and to have a real
picture about the children of the primary schools in Al-Muqdadiyah region.
Patients and Methods: A cross-section study, involved the pupils of the fifth and the sixth
stages, the information and the measurements were taken from 633 children (373 males, 260
females) their ages were between 123-144 months, in one month duration (December of
2016), during this period the visits were to 10 primary schools for both genders (four of them
in the center of the region and six in the surrounding villages those belong to the region),
included the age, weight, height, counting the body mass index, waist circumference, waist to
height ratio, systolic blood pressure and diastolic blood pressure in addition to the
questionnaire form and the information of the school card.
Results: The percentages of the overweight and the obesity for the males reached 13.6% ,
4.07% for the fifth and the sixth stages respectively while for the females they were 10.31% ,
6.06% for the fifth and the sixth stages respectively. The percentages of the overweight and the
central obesity of the waist circumference for the males were 4.2% , 0.81% for the fifth and the
sixth stages respectively while for the females they were 5% , 2.32% for the fifth and the sixth
stages respectively. There was an increasing in the percentages of the systolic blood pressure for
the males and the females in the fifth and the sixth stages with a decreasing in the percentages
of the normal blood pressure for the both genders as they reached for the males to 36.4% ,
34.15% in the fifth and the sixth stages respectively, for females 36.98% , 22.73% in the fifth
and the sixth stages respectively while the percentages of the normal diastolic blood pressure
were 56% , 54.47% for the males in the fifth and the sixth stages, for the females were 49.48% ,
42.42% in the fifth and the sixth stages respectively.
Conclusion: The rate of the elevated systolic and diastolic blood pressure are high among the
children that warns the occurrence of the health casualties in the future

Background:Prophetic immune marker glutamic acid decarboxylase (GAD) autoantibody is
a distinctive diagnosis between Type 1 Diabetes Mellitus and Type 2 Diabetes Mellitus.
Individuals have diagnose as Latent Autoimmune Diabetes in adults (LADA) has such
autoantibody, which those patients incorrectly diagnosed as T2DM.
Objective: To determines frequency of anti- GAD IgG antibody marker in LADA patients,
were misdiagnosed as T2DM in relevance with a Cytomegalovirus infectin antibodies and
Hemoglobine A1c levels.
Patients and Methods: Ninety five patients with T2DM chosen, arranged in two groups
with and without cardio vascular diseases (CVD) and a garoup of 49 individuals as healthy
control matched age and gender. Samples took from subjects that attended to Hawler Cardiac
Center and Diabetic Centers at Erbil city in March 2014. Sera subjected to Enzyme-Linked
Immunosorbent assay (ELISA) and Glycohemoglobin assay for HbA1c.
Results: GAD islet cell autoantibody was seropositive in 3.05% diabetics and 2.04% controls.
There were high titers of HbA1c with low C-peptide in diabetics. A weak negative correlation
was found with significant difference between anti-GAD IgG and age (r = -0.282, P < 0.017
correspondingly ).
Conclusion: Appropriate diagnosis for LADA could help to preserve the residual Beta-cell
function.

Background:Tonsillitis refers to viral or bacterial infection of the palatine tonsils. It presents
in acute or chronic state. Tonsillitis usually associated with adenoid hypertrophy especially
in children. Tonsillectomy is considered to be one of the most common surgical procedures
held in otolaryngological theaters. Usually both tonsils are removed and adenoidectomy may
be performed at the same time.
Objective:This study is done because of limitation of data exist with respect to the recent
prevalence of indications for tonsillectomy . We sought to determine the most common
indications for tonsillectomy with or without adenoidectomy in Baquba Teaching hospital in
Diyala governorate in different age groups and genders.
Patients and Methods:The study involved 100 patients selected randomly from October
2016 to March 2017 viewed at the E.N.T. (Otolaryngology) ward in Baquba Teaching
Hospital. The age group ranged from 3-28 years . Before surgery a detailed history and
examination were taken from the patients themselves or their parents . Those patients all
have a previous history of tonsillitis that was influencing their life style or school
performance.
Results: A total of 46% of our patients had infective causes or recurrent tonsillitis as an
indication for tonsillectomy, while 27% had obstructive causes especially at night (obstructive
sleep apnea) as an indication for surgery. In this study we found 6% of our patients, the surgery
is indicated due to recurrent otitis media. Furthermore, 2% were due to peri-tonsillar abscess as
indications for surgery.
Conclusion: In this study, we present that patients who undergoing tonsillectomy with or
without adenoidectomy, recurrent infective tonsillitis is more than obstructive tonsillitis
(OSA) as indications for surgery.

Background:Urinary tract infection patient Urinary Tract Infection ( UTI ) one of
commonest types of patient admitted to CCU ( cardiac care unit ) of other medical wards
this is occur directly from contact to infected hand or material or during catheterization.
Objective:To evaluation common bacterial cause UTI in patients admitted Cardiac Care
Unite to show the antimicrobial agent and bacteria resistant and production the biofilm.
Patients and Methods: Collection of samples from urine aseptically for culture.Isolation
and identification of uropathogens using biochemical tests and testing ability of these
bacterial isolation for virulence production and testing the antimicrobial susceptibility test.
Results: It is A total of 135 catheter samples were collected from patient (135) catheter
samples from patients in CCU at Baqubah General Teaching Hospital for the period from 1st
November 2016 to 1st March 2017 frommales and female, and the samples and cultured on the
medium blood agar and MacConkey agar. Then growing bacterial farms subjected to
microscopic and biochemical tests for the diagnosis of bacteria. Escherichia coli with a ratio
31.8% , and (20)isolations of Proteus mirabilis with a ratio 18.2%, 16 isolates of Klebsiella
pneumonia, (14) isolations of Pseudomonas aeruginosa with a ratio 12.7% .The Antimicrobial
sensitivity is investigated for (9) antibiotics from different groups including; The results show a
high resistance to most of the antibiotics under study, and resistance all isolates ware of
Aztreonam ,Cefotaxime , Co-Trimoxazol with ratio 95% , Naldixic acid with ratio 100%,
Tetracycline 75% , Gentamycin 70% and Antimicrobial sensitivity to antibiotics to Amikacin
45% followed by Ciproflaxcin 50% and tobramycin 80% . All kinds of bacteria were
produced in biofilm in the ELISA method with a ratio 100% ,while Congo red with a ratio 50%.
Conclusion: It was observed that multiple antibiotic resistance was common among local
isolates of the bacteria under study and Biofilms are important in protecting the bacteria
inside the catheter from antibiotics.

Background:Hepatitis C virus is a common cause of liver disease, hepatitis C virus
exhibits high degree of genetic heterogeneity with characterized regional variations in
genotype prevalence.
Objective: To determine the prevalence of HCV genotypes in patients of Erbil Province,
Kurdistan region/Iraq.
Patients and Methods:Blood samples were collected from 165 patients diagnosed positive
for HCV antibody, which referral by specialists to Public Health Laboratory in Erbil
province (Kurdistan/Iraq) between March 2015 and December 2016 for genotyping.
Following extraction of viral RNA, HCV genotypes were determined in each case by using a
PCR based genotyping kit.
Results: With (37%) genotype 1 was the most frequent genotype detected followed by 3
(27.3%), 4 (20%) and 2 (2.4%), while mixed genotypes were detected in 13.3%.
Conclusion: This study gives different estimation of HCV genotypes distribution among
infected HCV patients in Kurdistan from prevalent distribution in Iraq and Middle East Arab
countries, but comparable to global distribution.

Background:The increasing incidence of antibiotic resistance in bacterial pathogens has
justified a reassessment of the value of phages as antibacterial agents for medical
applications.
Objective: To assess the effect of bacteriolytic activity against P. aeruginosa by use multi
methods for isolation of bacteriophage.
Patients and Methods: This study was performed from from November, 2016 till April,
2017. A total of 60 samples collected from urine, stool, diabetes leg, ear, burns and wounds
infections in General Baqubah Hospital to isolate Pseudomonas aeruginosa and tested for 6
groups of antibiotics. Aerophage was isolated using three methods: spotting; double-layer
agar plate and liquid broth method. After enrichment of aerophage, the bacteriolytic activity
of aerophage was done by spotting method.
Results: Pseudomonas aeruginosa isolates resistance were 10(43.5%) for Aztreonem and
8(34.8 %) to Ticarcillin-Claculanic acid followed by Imipenem 4(17.4%), Gentamicin and when
the study done Levofloxacin 3(13%) for each finally Cefepime2(8.7%). high significant
differences of aztreonem with both of cefepim and gentamycin (P<0.01) while significant
differences of aztreonem with both imipenim and levofloxacillin (P<0.05%). while the results
of bacteriolytic activity showed all ear and leg diabetes isolates were sensitive to aerophage
(100%) followed by urine isolates(75%), stool isolates(50%) and burns isolates(25%) while all
wound isolates were resist to aerophage(100%). The result of relation between Antibiotic
resistance phenotype profile and Aerophage sensitivity that no detect to susceptibility of isolates
to aerophage but the source of isolates may be detected to infection with aerophage.
Conclusion:Aztreonem antibiotic was widely used in Baqubah city recently. All three
methods to isolate aerophage were effective. The result of relation between Antibiotic
resistance phenotype profile and Aerophage sensitivity that no detect to susceptibility of
isolates to aerophage but the source of isolates may be detected to infection with aerophage.

Background:Both BRCA1 and BRCA2 are tumor suppressor gene and are inherited as an
autosomal dominant. The cumulative lifetime risk of developing invasive breast cancer for
those with BRCA1 or BRCA2 mutations ranges from 53% to 89%. Familial breast cancer
represent less than 10% of all cancers of the breast, and cancers related to BRCA1 and
BRCA2 familial disease account only for three-fourths to two-thirds of these cases. In
women younger than 35 year old with CA breast, 10% to 15% have a BRCA1 mutation.
Females with mutations involving BRCA 1/2 who are already affected by breast cancer
have an increased risk of breast cancer involving the other breast of 52% and 66%.
Objective: To identify the frequency and the type of mutation in exon 11 in the genes
BRCA1 and BRCA2 in breast cancer women with positive family history.
Patients and Methods: This is a prospective study of fourteen females having breast
cancer with positive family history of breast cancer. The study done in Baquba Teaching
Hospital over a period of eight months (October 2016-July 2017). The age range of the
patients was 40-70 years. Genomic DNA was extracted from lymphocytes yielded from the
peripheral blood using the salting out procedure. Primers were used to amplify exon 11
region of the genes BRCA1 and BRCA2 by using polymerase chain reaction (PCR)
cycling.
Results: A total of eight variants in the BRCA1 gene and four variants in the BRCA2 gene
were seen. Only one deleterious germline mutation in BRCA1 was detected in 1/14 (7.14%).
The patient with deleterious mutation was 31 year-old and was having strong family history of
the disease (two relatives, first and second degree). The sequence variant of the mutation was
c.795_789delTT with an effect as p.Val256-Ser261ValLys. The remaining 11 identified
variants belonging to BRCA1 and BRCA2) are classified as polymorphisms or unknown
variants.
Conclusion:BRCA1 and BRCA2 mutations in females with breast cancer with positive
family history of the disease is never low and cannot be neglected. Therefore screening for
these mutations is important for strict follow up of those with positive results.

Background:Onychomycosis is a fungal nail infection. It infected about 10 % of the
adults. The prevalence of onychomycosis is around 5% of fungal infections. Malassezia
furfur is a basidiomycetous yeast and a part of normal human skin flora. By using
biochemical, immunological and molecular methods on Malassezia yeast, this genus
comprises 14 species. The higher detection rate of Malassezia furfur was observed by using
molecular identification methods, the internal transcribed spacer (ITS) and large subunit
(LSU) regions.
Objective: To detect of Malassezia furfur associated with Onychomycosis and evaluate the
application of molecular method as rapid identification of Malassezia furfur.
Patients and Methods:Fifty samples have been collected from patients presented signs of
onychomycosis in Al- Imammian Al-Kadhamain Teaching Hospital, Baghdad, Iraq for a
period of six months (from 1st of October to the 30rd of April). Clinical diagnosis was
done by consultant dermatologist. Twenty nine were males and twenty one were females,
the mean age of studied group was (26.12 ± 9.89) years old, with age ranging from 10 to 60
years old. Fifty healthy volunteers as control includes nail clips, the range of ages was from
1 to 60 years old with a mean of (27.88 ± 12.03) years. Patients and control were
investigated for M. furfur using phenotypic and molecular analysis.
Results:Males were more infected with onychomycosis than females, with a frequency
percentage (58%). According to age, the most frequent among (31-40 years old) age groups.
On the basis of Polymerase chain reaction (PCR) method it was showed a positive result in 6
(12%) out of 50 onychomycosis patients and a positive result in 1 (2%) out of 50 healthy
volunteers.
Conclusion:From these findings, it was concluded that the males were most infected than
females. PCR technique is sensitive, specific and less time consuming than cultural
methods .

Background:The previous researches show that the hypothyroidism occurs in
approximately 1–2% of women and 0.1% of men and is characterized by a TSH level
above the normal reference range and a T4 level below the reference range. This
percentage indicate that: women have ten times the risk of hypothyroidism as men, with the
difference became significant above the age of 34 years. Hypothyroidism may very easily
be missed due to the similarity between the symptoms of hypothyroidism and that of
menopause.Many middle-age women complained from headache whether it is tension
headache or migraine and since headache is one of the symptoms of hypothyroidism, so
there will be many cases of misdiagnosed hypothyroidism. This study estimates thyroid
function test for those women to shed a light for the frequency of hypothyroid women.
Objective: To current study screening middle- aged women suffering from headache by
thyroid function test to treat these women properly and not only treat the headache as a
separate complain
Patients and Methods: Three hundred (300) women aged between 35 -55 years with
headache included in this study, their chief complain is only headache, they have no other
medical conditions or chronic diseases. They were divided in to two groups; the first group
aged from (35- 45 years), while the second one aged from (46-55 years). Three hundred
(300) healthy women aged between (35-55 years) are screened for TFT (thyroid function
test) as a control group were divided in to two groups; the first group aged from (35-45
years) while the second group aged between (46-55 years). Thyroid function test (TSH, T3,
and T4) were done for all groups.
Results: There are 53(17.6%) women in patients group have high TSH with low T3 and T4
which means that they have overt hypothyroidism and 17(5.7%) women in the same group
have only high TSH which means that they have (subclinical) hypothyroidism, while 230
(76.7%) women have normal thyroid function test. This means that: the total number of
hypothyroid women is 70 (23.3%) which is regarded as high percentage.
Conclusion:There is a high percentage of women suffering from headache having
hypothyroidism so thyroid function test should be done for all middle-aged women with
from headache.

Background:Tetanus is a preventable disease and no age is immune unless there is a
previous protection with tetanus toxiod immunization which is a highly effective and the
immunity lasts several years.
Objective: To assess the female academic staff knowledge regarding the vaccination
status with tetanus toxoid.
Patients and Methods: A cross- sectional study was conducted in Kirkuk Technical
Institute for the period from 1st January /2014 till the end of May 2014. A
randomly selected sample from different scientific departments and a special
questionnaire form was prepared by direct interviewing with the study sample and 100
female academic staff were participated in the study after receiving a verbal consent
from them before establishing the study.
Results: The results revealed that 43.0% of study female academic staff aged ( 41-50 ) years
, (53.0% ) having a master certificate , (61.0%) of them are assistant lecturers , and (81.3%)
of study female staff were vaccinated with tetanus toxiod ,and 73.6% of them are
completed their vaccination schedule with tetanus toxiod during their reproductive life.
Conclusion: The study concluded that female staff who are not completed their
vaccination status with tetanus toxiod because of over load working.

Background:Thalassemia is inherited blood disorders characterized by abnormal
hemoglobin production.
Objective:To evaluate decreasing in vitamin-D3 concentration in patients with thalassemia
among healthy men in Baghdad city.
Patients and Methods: In this study containing 99 thalassemia patients from Baghdad city
(68 female and 31 male patients) and (31 healthy males and 10 healthy women) as a control
group collected from Al-Kadhymia hospital. Their age ranged (15-40) years old which are
compatible to age of study group. Serum samples taken from the patients to determined
vitamin-D concentration by using Enzyme Linked Immuno Sorbent Assay (ELISA)
technique, during the period 1st April 2016 to 28th January 2017.
Results:The study revealed highly significant (P<0.01) low of vitamin-D3 concentration in
patients with thalassemia (89.9% decrease vit-D3 compared with 10.1% control group vit-D3
concentration).
Conclusion:The decreasing in vitamin-D3 concentration associated with thalassemia
patients was due to less exposure to sun light that affected the vitamin metabolism in their

Hepatic resection, focal liver lesions