Diyala Journal of Medicine

Background: The incidence of ulceration of foot in diabetic patients ranges from 4-13%.
The financial burden is also very high. The cost of treating a single foot ulcer in the United
States approach 28000$ over a period of two years. The main risk factors for diabetic foot
ulcers include sensory neuropathy, lower limb ischemia, and trauma. However, these risk
factors are to some degree preventable.
Objective: To know the risk factors for the development of diabetic foot ulcers.
Patients and Methods: A cross sectional study done in Baquba teaching hospital over a
period of one year (August 2016 – August 2017). One hundred patients complaining from
diabetic foot ulcer (with or without infection and/or gangrene) admitted to Baquba teaching
hospital. A forma containing a list of risk factors, both local and general made for each
patient and the risk factors documented. The forma used in the study mention the name of the
patient, gender, age, and the local and general risk factors for the development of the diabetic
foot ulcer. The percentage of occurrence of each of the risk factors calculated. Such risk
factors include are local risk factors as, peripheral sensory neuropathy, vascular
insufficiency, history foot ulcer/amputation, limited joint mobility, presence of callus,
structural foot deformity, trauma and improperly fitted shoes. General risk factors include as
impaired vision, poor glycemic control, peripheral vascular disease, renal impairment, and
older age. Ages older than sixty years is considered as older age group.
Results: The study revealed that the main two factors are peripheral sensory neuropathy (94%)
and poor glycemic control (78%). These are followed by three common risk factors which are
history of foot ulcer/amputation (66%), impaired vision (60%), and older age (57%). Other risk
factors in order of frequency of occurrence are trauma and improperly fitted shoes (56%),
prolonged elevated pressure (50%), presence of callus (36%), structural foot deformity (24%),
vascular insufficiency (20%), and renal impairment (11%).
Conclusion: Most of the risk factors are preventable by good glycemic control and awaring
the patient of these factors to avoid lower limb amputation. Therefore early identification of
risk factors for the development of ulceration of diabetic foot and initiation of appropriate
treatment decrease the occurrence of complications, including the need for amputation. Also,
knowing the risk factors for foot ulceration in diabetic patient is of utmost importance for
early and better treatment of diabetic foot ulcers. There is an evolved need to educate and
make awareness of diabetes and its associated complications, especially among populations
living in the rural areas.

Background:Cellular and molecular studies have shown algae derived ingredients to be
potent naturally occurring anticancer compounds and have been suggested to prevent
carcinogenesis.Fucoxanthin is a marine carotenoid found in green algae and is documented to
display remarkable anticancer activity. Fucoxanthin suppressed the growth of LNCap
prostate cancer cells in a concentration-dependent manner along with the induction G(1) cell
cycle arrest, but not apoptosis.
Objective: In accordance with same concept, diphlorethohydroxycarmalol (DPHC), isolated
from the brown algae Ishige okamurae, notably reduced the level of radiation-induced
intracellular ROS and protected cells from undergoing cell death in cultured Chinese hamster
lung fibroblast (V79-4) cells.
Patients and Methods: Used leaf extraction from alge chara elegans aqueous extract and
crude alcohol. Two types of cell lines, Hela cell line cervical cancer and normal cell embryo
rat cell line REF(, were used in this study. They were obtained kindly from Iraqi Center for
cancer and medical genetic research (ICCMGR) .The cell line were grown on uncoated
coverslips in a Dulbecco’s Minimal Essential Medium (DMEM) with 10 fetal bovine serum
(PAA), 2 µM glutamine (PAA), 100 µ/ml penicillin, and 100 μg/ml streptomycin.
Results: The results showed this alge contains most of the chemical compounds such as
Alkaloids, Saponins, Glycosides, Flavonoids, Steroids and Terpenes.The cytotoxicity of the
aqueous extract and crude alcohol extract was investigated on the cancer cells line, hela and
normal cell line Ref. Toxic effect for both extracts was indicated by rate of proliferation
inhibition . The alcohol extract showed the inhibition of Hela cell line at percentage 20.35%-
72.66% more than the aqueous extract (18.68%-48.26%) at concentrations: 62.5-2000 µg/ml.
Both extracts (alcoholic extract and aqueous extract) showed almost the same effect at the
concentration 8000µg/ml. At low concentrations of both extracts no inhibition effect was
observed on normal cells line Ref. The alcohol extract showed the inhibition of Ref cell line at
percentage 67.61% more than the aqueous extract (66.66%) at concentrations 8000µg/ml.
Conclusion: The conclusion was made that the C. elegans is a promising alge in treatment of
cancer through its inhibition of the proliferation of cancer cells., the results demonstrated
that extraction from leaf chara elegans aqueous extract and crude alcohol is inhibition Hela
cell line cell, and lesser inhibition extend against Ref cell line.

Background:Osteoarthritis is a progressive joint disease is mainly worrying on weight
bearing in the body, the joints, particularly the knee and hips. Osteoarthritis as an
inflammation in the joints must there is an immune defense in the body against this
inflammation. This disease that appears primarily in the elderly characterized by erosion
articular cartilage, osteophyte, subchondral bone stiffness, synovitis inflammation, many
causes of the disease such as age, sex, and obesity, the location of the joint injury and various
other factors.
Objective:To understand the role of innate immune response components in the
osteoarthritis, this study was investigated the relation between the innate immune response
and osteoarthritis.
Patients and Methods:Fifty osteoarthritis patients and fifty healthy persons were participate
in this case-control study. The total WBC count, neutrophil percent, lymphocyte percent,
monocyte percent, eosinophil percent, basophile percent, platelet number, level of ESR,
Level of CRP, and level of C3 complement were investigate in serum and synovial fluid in
the osteoarthritis patients and control healthy persons.
Results: The results were shown significant elevation in the WBC count, platelet number, level
of ESR, level of CRP and level of C3 complement in the serum of osteoarthritis patients
compared with control group. A significant positive correlation was shown with weight of
patient and the severity of osteoarthritis. The elevation level of C3 complement in the synovial
fluid was a significant positive correlation with elevation of level of C3, level of ESR, level of
CRP, and WBC count in the serum of patients related to the severity of osteoarthritis status.
Conclusion:The results were given an evidence for the crucial role of innate immune
response in the defense against osteoarthritis inflammation and any defect in the innate
immune component lead to increase the severity of osteoarthriti

Background:Cosmetics as well as (Make-up) are used to enhance the appearance or odor
of the body and many cosmetics are designed to be placed on the face or hair. Cosmetics is
an essential substance of growth and development of many types of micro-organisms because
they contain nutrients facilitate the growth of these organisms.
Objective: Identification of Staphylococcus aureus by used 16srRNA gene and detection of
virulence genes etb , mec A.
Patients and Methods: This study includes 100 samples of cosmetic products which are the
Compact powder , Foundation , Lipstick and Mascara . Isolated Staphylococcus aureus ,
identification it and detection of resistant genes by used Polymerase Chain Reaction
technique.
Results: 35 isolates were identified as Staphylococcus aureus . 4 isolates were identified
genetical by 16srRNA gene and 3 isolates detection of resistant genes mecA, etb by used
Polymerase Chain Reaction technique. The results of the genetic identification of the 16srRNA
using (PCR) , revealed that all S.aureus isolates which were 4 were positive and the results of
resistant genes mec A and etb revealed that all S.aureus isolates which were 3 isolates were
containing mec A gene depending on the appearance of band asize of(300 base pair) in the
agarose gel and all S.aureus isolates were not containing etb gene .
Conclusion: It was observed that all S. aureus isolates were resistant for methicillin and that
all S.aureus isolates have not Endothelin receptor Type B .

Background:Cosmetics as well as (Make-up) are used to enhance the appearance or odor
of the body and many cosmetics are designed to be placed on the face or hair. Cosmetics is
an essential substance of growth and development of many types of micro-organisms because
they contain nutrients facilitate the growth of these organisms.
Objective: Identification of Staphylococcus aureus by used 16srRNA gene and detection of
virulence genes etb , mec A.
Patients and Methods: This study includes 100 samples of cosmetic products which are the
Compact powder , Foundation , Lipstick and Mascara . Isolated Staphylococcus aureus ,
identification it and detection of resistant genes by used Polymerase Chain Reaction
technique.
Results: 35 isolates were identified as Staphylococcus aureus . 4 isolates were identified
genetical by 16srRNA gene and 3 isolates detection of resistant genes mecA, etb by used
Polymerase Chain Reaction technique. The results of the genetic identification of the 16srRNA
using (PCR) , revealed that all S.aureus isolates which were 4 were positive and the results of
resistant genes mec A and etb revealed that all S.aureus isolates which were 3 isolates were
containing mec A gene depending on the appearance of band asize of(300 base pair) in the
agarose gel and all S.aureus isolates were not containing etb gene .
Conclusion: It was observed that all S. aureus isolates were resistant for methicillin and that
all S.aureus isolates have not Endothelin receptor Type B .

Background: Anemia is the most common condition in blood diseases, is caused by
a decrease in hemoglobin concentration on normal level .
Objective:To the increased prevalence of anemia among children and women and The
Purpose of recognize the types of anemia among children in Ba'qubah and How to diagnose
and reduce the prevalence of anemia among children.
Patients and Methods: This study was conducted in the Al-Batoul pediatric Hospital of
Diyala Health Department for the duration of the first of October and ends on the 31st of
December of the year 2016 , which collect 383 ( 212 male 55% , 171 female 45% ) blood
samples of children sick Anemic ( Hemoglobin levels less than 11.0 g/DL) with age range
between 1-15 years , with 2.5 cm 3 venous blood into a tube containing (EDTA) Ethylene
diamine tetra acetic acid for blood picture, adopting the mean corpuscular volume (MCV) in
classification anemia MCV < 80 fl , MCV = 80-100 fl , MCV > 100 fl, as a bloody tinge to
help with microscopy .
Results: The results of the current study showed that most anemic patients samples was of
mean corpuscular volume for less 80fl, represented by iron deficiency anemia by 45.69% and
Thalassemia by 38.12% . While the mean corpuscular volume range between MCV = 80-100 fl
ratio 13.05% spread on the sickle by 4.96% and Spherocytosis anemia by 8.09 %, while the
mean corpuscular volume for more than 100 fl at ratio low 3.13% and represented by vitamin
B12 anemia, which showed the latter strongest decrease in numbers of red blood cells and
hemoglobin level, And this decrease in numbers of red blood cells and hemoglobin level was
strongest in the Thalassemia and sickle cell anemia, compared by iron deficiency anemia, and
Spherocytosis anemia , while decrease mean corpuscular hemoglobin in iron deficiency anemia
and Thalassemia and increase in Vitamin B12 deficiency anemia. As the study indicated that
the numbers of white blood cells exceeded the normal in patients with Thalassemia and vitamin
B12 deficiency anemia .
Conclusion:The present study concludes that there is strongest decrease in numbers of red
blood cells and hemoglobin in patients with hemolytic anemia and lack vitamin B12 with
very high numbers of white blood cells.

Background:Obesity is one of the largest public health problem worldwide. It is a multi-
factorial chronic disease that increases mortality and the prevalence of heart-related diseases.
Adipose tissue secretes large numbers of peptides that resemble cytokines. Interleukin 6 )IL-
6( is one of those peptides that are released by adipose tissue. One of the major function of
IL-6 is sending signal to liver to secrete C-reactive protein (CRP).
Objective:To study the relationship between obesity and inflammation by: estimation of
high sensitive C-reactive protein (hsCRP) and IL-6 concentrations in participants sera in
relation with different body mass indices (BMI).
Patients and Methods: This cross-sectional study was performed through the period of 3
months and 90 participants with the average range of age 25-40 years old were included, they
were categorized into three groups ( 30 with BMI less than 25, 30 with BMI ranged between
25-29.9 and 30 with BMI more than 30).
Results:The concentrations mean of hsCRP was significantly elevated among the three studied
groups as a result of BMI increasing (0.945 mg/L, 1.694mg/L and 2.521mg/L respectively).
There was a significant increasing in the mean of IL-6 in relation with increased BMI in all
included groups (1.084mg/L, 1.802mg/L and 3.531 mg/L respectively). Linear correlation
between the concentrations means of hsCRP and IL-6 were found in all studied groups.
Conclusion:This study demonstrated a significant relationship between obesity and
inflammatory marker (IL6 and hsCRP)

Background: In eukaryotic cells the cytoskeleton network consists of three major structural
elements, microtubules, microfilament,and intermediate filaments. Tubulin is the basic
protein of the MTs, molecules of tubulin arranged in dimmers consisting of two forms, α-
tubulin and β-tubulin. They are continuously changeable structures.Taxanes and vinca
alkaloids are inhibitors MTC that destabilize microtubules, there by suppressing their
dynamics which required for proper mitotic function and effectively blocking cell regulation
progression resulting in cell death.
Objective: To evaluate the capability of alkaloids taken away from leaves of Zephyranthes
candidato divert the MTC network of (CHO), which is an aggressive metastasis cell line.
Patients and Methods: In our experiments we used the mouse CHO cell line. This cell line
was obtained from the Department of Biology,Faculty of Medicine, Wuhan University,
China. The cells were grown in Dulbecco’s Minimal Essential Medium (DMEM) (PAA
Laboratories GmbH, Linz, Austria), supplemented with 10% fetal bovine serum, 2 mM
glutamine, 100 Uml–1 penicillin, and 100 μg ml–1 streptomycin (PAA Laboratories, Austria)
in a humidified atmosphere of 95 % air and 5 % CO2 at 37 °C.Zephyranthes candida crude
alkaloid extract treated cells were cultivated over microscopic cover slips, washed three
Times for 4 min with PBS (pH 6.9) and fixed by 3% paraformaldehydein PBS. The ability of
alkaloid extract to inhibit CHO tumor cells growth in vivo was assessed; forty mice were
injected subcutaneouslyin the right dorsal with this tumor cells, after the tumor developed to
8-1 mm2, and eliminating the animalsthat did not develop tumors, the animals were divided
to three groups each one with ten individuals.
Results: The extractor was capable of divert the MTC of the cells below realization after 1hr of
in sinuation in a focus as little as possible 20 μg/ml. while DAPI staining used, the cells death
was not check in this focus and time. The cell death have been spotted when the focus of the
alkaloid reproducer raised up to 80 and 100 μg/ml through the aforesaid exposure time. The
cells were able to improving there native MTC contraction after 12 hr of the alkaloid deletion.
The excerpt focus of 1mg/Kg/Bw competently prevent CHO cell line cancer development in
vivo to 97.14% after 3 weeks therapy contrast to natural control.
Conclusion: The invasive species H22 cells offer changesin the preparation of their MTC at
a focus of Zephyranthes candida leaf alkaloids excerpt as low as 20 μg/ml focus after 1hr of
exposuretime.

Background: Sperm differentiation during spermatogenesis is highly regulated by different
caspases and oxidant-antioxidant mechanisms.
Objective: To assess the levels of the caspase -3 and total antioxidant capacity (TAC) in
seminal plasma and evaluate its role in the pathogenesis of idiopathic infertile male in
comparison with healthy individuals.
Patients and Methods: Seminal fluids were collected from seventy males with idiopathic
infertility and twenty male with proven fertility and were analyzed for the level of caspase -3
and TAC in seminal fluid and their correlation with seminal fluid quality parameters.
Results: The results revealed that men with idiopathic infertility have significantly higher level
of caspase-3 activity. Seminal TAC levels were significantly lower in those with idiopathic
infertility compared with fertile men. A negative correlation was noticed between sperm quality
parameters and TAC levels in idiopathic infertile men.
Conclusion: Increased apoptotic index and decreased TAC activity are two important
markers in idiopathic male infertility.

Background: The bacteria Aeromonas hydrophila was isolated from clinical specimens
responsible of causing diarrhea in children and adults.
Objective:To purify metalloprotease enzyme produced by Aeromonas hydrophila.
Patients and Methods: This study involved 150 stool samples collected from patients
suffering from diarrhea.
Results: Eight isolate of Aeromonas hydrophila was detected and metalloprotease was purified
with 11.06 U/ml of enzyme activity.
Conclusion: The bacteria have ability to produce metalloprotease and enzyme was fully
purified in three steps of purification.

Background:The PRDX6 antioxidant family is important in the protection of cells against
oxidants in humans. It is encoded by the PRDX6 gene. Peroxiredoxin 6 antioxidant enzyme
(PRDX 6) has been reported in several cancers. However, the function of PRDX 6 in oral
squamous cell carcinoma (OSCC),is far from being understood.
Objective:To normal corresponding oral mucosa in relation to clinicopathological
parameters.
Patients and Methods: This study included 40 formalin-fixed, paraffin-embedded tissue
blocks of primary OSCC cases and fifteen normal oral mucosa samples. Demographic data,
clinical staging and histopathological grading were obtained. Immunohistochemically
staining anti PRDX 6 antibody was done to illustrate its subcellular localization in normal
and malignant cells.
Results: Females were affected more than males and the tongue was the most common site
involved. PRDX 6 expression was high in OSCC than normal (p=0.001) with mean±Sd
(60±18.8) (23±9.8). Significant correlations were found with tumor size, lymph node and tumor
stage (p=0.008, p=0.012, p=0.011 respectively) . Whereas no relation was observed concerning
age, gender and tumor site.
Conclusion: Significant correlation of PRXD 6 anti oxidant enzyme expression with tumor
size, lymph node involvement and clinical staging, suggesting its role in oral squamous cell
carcinoma progression.

Background: Diabetes Mellitus (DM) is a heterogeneous group of high blood sugar
hyperglycemia and produces insulin, insulin action , or both. Diabetes is caused by the
inability of beta cells in the pancreas. The production of these insulin cells is little or no. This
is known as type 1 mellitus diabetes (Insulin-dependent T1DM) Insulin-dependent diabetes
mellitus.
Objective:To evaluate the immune role of some of the immunological indicators of patients
with type 1 diabetes by identifying the IL17 and IL21 concentrations, also The CD4 + and
CD8 + T cells were identified by the Sandwich ELISA test.
Patients and Methods: Blood samples were collected from 70 patients with type 1 diabetes
(diabetes mellitus type 1) after diagnosis and 20 samples of healthy people were collected as
a control group, an the study has been done during the period between October 2016 and
May 2017.
Results: The results of IL17 level showed a decrease of IL17 in patients with type 1 diabetes
114.31 ± 103.78 pg / ml compared to control group126.54±81.48pg / ml with no statistically
significant difference (p> 0.05),and the results of IL21 level showed an crease of IL-21 in
patients with type 1 diabetes , 209.40 ± 294.78 pg / ml compared with healthy 189.54 ± 274.82
pg / ml with no significant difference.The results showed a decrease in the concentration of
CD4 + T cells in the group of patients 5.18±4.59 pg / ml compared to the healthy group whose
concentration level was 5.52 ± 3.47 pg / ml.Also the results showed a high concentration of
CD8+toxic T cells in the group of patients as it was 5.54 ± 7.39 pg / ml compared to the healthy
group. The concentration of toxic T cells was 3.74 ± 3.57 pg / ml. There was no significant
difference between the study groups for CD4 + and CD8 +.
Conclusion: A number of pro-inflammatory cytokines (IL17) and inflammatory cytokines
(IL21) as well as cellular immunity of CD4+ and CD8+have an important role in the
development of type 1 diabetes in children and affect the immune response in the body
through immunodeficienc

Background: It is well known that hypertension results in cardiac overload. This overload is
more profound on the left ventricle were systolic high pressure is present resulting in stiff
LV.
Objective:To evaluate the index of myocardial performance and stiffness index in patient
with hypertension.
Patients and Methods: This study enrolled 105 hypertensive patients and 60 control
subjects .Patients with hypertension having an average BP ≥ 140/90 mmHg. From
application of pulse wave echocardiography, the followings parameter are measured:
Isovolumetric time of relaxation (IVRT), Isovolumetric time of contraction(IVCT) and time
of Ejection (ET) to calculate Myocardial Performance Index (MPI).
Results: The results showed that in hypertensive patients the isovolumetric contraction and
relaxation time were increased while the ejection time was decreased, so increasing the index of
myocardial performance (IMP) obtained as an indicator for all age groups.
Conclusion: The myocardial performance index increases with increased hardness
coefficient of the cardiac ventricu

Background:Salmonella Typhoid Diagnosis by Widal Test and Polymerase Chain Reaction
(PCR).
Objective:To study the Isolation and diagnosis of Salmonella typhi,diagnosis of the use of
the widal test , diagnosis of Salmonella typhi) using PCR technique and Detection of
Salmonella typhi.
Patients and Methods:The study included the collection of 120 blood samples, with 59.16%
(71) and female patients (40.83%), 49 years of age (60-1 years), 24.16% of patients in
hospital and 75.83% Patients who are not in hospital.
Results:The samples were initially identified using the Widal test as a traditional method of
diagnosis and the rate was 75 positive and 45 negative, 20 blood samples were isolated from the
suspected disease with typhoid fever, and the diagnosis of bacterial isolates was 17 Widal test
(85% (P> 0.01) The isolates studied under the Polymerase Chain Reaction were detected as
carriers of the Flic gene and 16.7%. Based on the emergence of a 599 bp package, a base pair of
Nasted PCR was the size of 360bp base pair in the gel A significant difference was found (P>
0.01).
Conclusion:Serological methods have been shown to be less effective in laboratory
diagnosis to diagnose typhoid fever. The molecular diagnosis of PCR can be relied upon as a
more accurate diagnosis of typhoid fever infection than the bacterial isolates that own a Flic
gene.

Background:Brain tumors classification by MRI (Magnetic Resonance Imaging) is
important in medical diagnosis because it provides information associated with anatomical
structures as well as potential abnormal tissues necessary for treatment planning and patient's
case follow-up. There are a number of techniques for medical image classification. In this
paper brain tumors detection and classification system are developed into seven tumors
types. The image processing techniques such as preprocessing by using a mean filter and
feature extraction have been implemented for the detection of a brain tumor in the MRI
images. In this paper, extraction of texture features using GLCM (Gray Level Co-occurrence
Matrix). We used Probabilistic Neural Network Algorithm (PNNA) for image classification
technique based on Genetic Algorithm (GA) and K-Nearest Neighbor (K-NN) classifier for
feature selection is proposed in this paper.
Objective: MRI brain tumors detection and classification system by using GA and PNN
which able to diagnose different types of tumors in human brain.
Patients and Methods: Medical image techniques are used to imaging the internal structures
of the human body for medical diagnosis. Image processing is an effective field of research
in the medical field. MRI dataset, obtained from the Atlas Website of Harvard University.
Results: Brain Tumors are classified by using the genetic algorithm where the total number of
features (20 features) has been reduced to 10 features as the strongest features in the
classification.
Conclusion: MRI brain image is one of the best methods in brain tumor detection and
classification, by observing only MRI images the specialists are unable to keep up with
diagnosing. Hence, the computer-based diagnosis is necessary for the correct brain tumor
classification.