Diyala Journal of Medicine

Background: Cervical lymphadenopathy is a common presenting complaint in an out-patient
clinic in Baquba Teaching Hospital. There are various causes which can cause enlargement
of cervical lymph nodes starting from simple inflammation to malignant causes. Tuberculous
adenitis is an important and familiar cause of cervical lymphadenopathy which is more
common in low socio-economic countries. Fine needle aspiration, incisional and/or excision
biopsies are performed to reach the definitive diagnosis.
Objective: To find out the most common causes of cervical lymphadenopathy in Baquba
Teaching Hospital.
Patients and Methods: It is a prospective study conducted in Baquba Teaching Hospital
over four years (2009-2013). Patients involved in the study are those with cervical
lymphadenopathy for more than 3 weeks that are not responding to medical treatment. Fine
needle aspiration and incisional or excisional biopsy performed for all patients.
Results: One hundred and eighty seven patients (103 males, 84 females) with cervical
lymphadenopathy were included in the study. The age range of the patients was from 10 to 75
years. The most common two cause were Tuberculous lymphadenitis 69(36.9%) and Hodgkin’s
lymphoma 61(32.6%). The aforementioned causes were followed in order of frequency by
reactive changes 23(12.3%) and non-specific inflammation 19(10.2%). The least common
causes were metastatic carcinomas 13(7%), non-Hodgkin lymphoma 2(1%).
Conclusion: Tubercular cervical lymphadenitis is a common disease in our country. So it is
recommend to exclude tubercular lymphadenopathy in any patient presented with chronic
lymphadenitis that is not responding to medical treatment. Early diagnosis & proper
treatment will lead to recovery of the disease and lessen the complications.

Background: Kidney failure can be defined as the total failure of toxins and waste from
filtration the blood. This disease is characterized by reduced glomerular filtration rate (GFR)
to about 20-50% , resulting in the failure to regulate the amount of fluid in the body and it is
divided into two types acute and chronic renal failure .The immunity of patients with
haemodialysis becomes weak and this cause viral infections such as Cytomegalovirus
human cells.
Objective: To determine the relationship between kidney failure and Cytomegalovirus
human cells and compare the molecular and immunological techniques in diagnose this virus.
Patients and Methods: Seventy blood sample were collected from patients with kidney
failure after diagnosis by specialists in the Ibn Sina Centre for dialysis and 20 individuals as
acontrol. The IgG and IgM were detected by ELISA , in addition the diagnose of virus by
cassette and compare the results of CMV diagnosis(by ELISA technique) with molecular
technique (PCR) results.
Results: ELISA results showed that the incidence of CMV IgG was 25 patients (35.7%)
while IgM was in 5 patient (7.1%). The incidence of IgG in males was (56%). In females was
(44%). while the result of IgM in male was (100%) and In females (5) The results of cassette
showed CMV virus was seropositivity (21.4%) for males and females with very high difference
observed between the two groups of study and more differences were observed between test
results and sex between test results and age groups, and showed a positive PCR test results of
interaction (66.6%) and (20) of (30) sample tested after ELISA techniques to detect IgG and
IgM in comparison among three techniques used by PCR technique the best technique were
IgG and IgM ELISA test results and test cassette and technique PCR molecular are 21.4% and
7.1% and 35.7% and 66.6%.
Conclusion: The results showed that Cytomegalovirus has relationship with chronic and
acute renal failure and can affect the patient's immune status. our results can provide an
advanced diagnosis of viral infections among patients in hospitals in Iraq.

Background:Empty sella syndrome is the radiological appearance of an enlarged or
deformed sella turcica which is partially or completely filled with cerebrospinal fluid .In 20-
50% of patients there may be endocrinologic dysfunction, pan hypopituitarism is present in
25% of cases and isolated one in 10%.
Objective: To present a patient in with features of hypopituitarism caused by empty sella
syndrome, with related literature review.
Patients and Methods: A Case of 16 years adolescent male was presented with short stature,
the height of the patient was less than 3% percentile for his age and sex, weakness, and lack
of secondary sexual characters and delayed puberty due to empty sella syndrome, the
patient has deficiency of all important anterior pituitary hormones in addition to
corresponding target hormones, total hypopituitarism is the diagnosis and it is the cause of
short stature.
Results: He has delayed puberty , the laboratory findings of the patient clearly indicate pan
hypopituitarism and the MRI confirmed empty sella syndrome.
Conclusion: Empty sella syndrome can cause panhypopituitarism, and adequate pituitary
imaging is required for cases with isolated pituitary hormone deficiency or
panhypopituitarism

Background: Breast cancer is the most frequently diagnosed type of cancer in women in all
world regions. About 1.7 million cases of breast cancer are diagnosed every year. Breast
cancer is the most common cause of death in women worldwide. There were approximately
0.5 million deaths worldwide from breast cancer in 2012, several serum tumor markers have
been evaluated in breast cancer. CA15-3 is the most important serum biomarkers used for
diagnosis and monitoring of breast cancer.
Objective: To evaluate the level of CA15-3 of studied groups according to age categories,
residence nearby industries, and history of breast feeding.
Patients and Methods: This study was carried out at the Breast Surgery Outpatients and the
Oncology Clinic at Oncology Teaching Hospital in Baghdad. It included 50 women who
were newly diagnosed by oncology group to have had breast cancer and didn’t receive
chemotherapy yet and 50 healthy women as control.
Results: There was significant increase at (P> 0.05) in serum CA15-3 level of patients with age
category (71-80) years (198.33 ± 136.60 U/ml) and significant elevation in serum CA15-3 level
of patients who lived near industries or incinerators (120 ± 94.52 U/ml) also there was
significant increase in serum CA15-3 level in healthy women with breast feeding history (25.8 ±
15.26 U/ml).
Conclusion: CA15-3 level significantly elevated in elderly patients with age category (71-
80) years and in patients with residence nearby industries or incinerators. Therefore, those
patients at high risk of developing metastatic breast cancer or advanced stages of breast
cancer.

Background: Coronary heart disease is the most common type of heart diseases. This
condition could results from a buildup of plaque inside the arteries, which decrease blood
flow to the heart and raises the risk of a heart attack. The World Health Organization
estimates that coronary heart disease prominent cause of death worldwide, and a number of
well-characterized factors, including advanced age, genders, hypertension, diabetes mellitus,
smoking and others contribute to Coronary heart disease risk development.
Objective: To assess of some risk factors of patients with coronary heart disease.
Patients and Methods: Hospitals based case-control study was conducted at Iraqi center for
heart diseases in Ghazi Al-Hariri hospital / Medical City, Ibn-AL-Bitar cardiac surgery
hospital and Ibn-AL-Nafees hospital during the periods from the 1st of November 2016 to
the 30th of June 2017. A convenient sample was taken from each hospital. Typical
questionnaire was used to interview 300 individuals, 100 (cases) and 200 (controls). The data
collection included demographic characteristics and some risk factors of coronary heart
disease. The participants were diagnosed by qualified physician and confirmed by specific
laboratory and clinical tests including electrocardiogram (ECG) with the healthy controls that
matched the age groups and genders.
Results: This study offered that the percentage of age group is higher among (60-69) years
were (12.0 %) in the cases, the number of males and females were (50, 16.7%), for each of
them, according to marital status most of cases were married and educational levels the majority
of cases were among institutes, colleges and above, while the occupation status were (11.3%)
among house wife finally, the residence was high as (21.0%) in the urban areas, most of the
risk factors were significantly associated with coronary heart diseases (P<0.05).
Conclusion: Our outcomes indicated there were a significant association of modifiable risk
factors (smoking, family history, diabetes mellitus, hypertension, taken meals contained high
quantity fat and physical activity) for heart disease among patients with coronary heart
disease.

Background: Bacteria Staphylococcus aureus are from nurses and serious task because of
the ability to cause various types of injuries at different locations of the body, and that
pathogenesis has nothing to do with their ability to produce many virulence factors.
Objective: To detection of virulence genes for Staphylococcus aureus isolates from different
environmental source .
Patients and Methods: The study involves isolation and ldentifieation of 60 bacterial
isolate ,10 of them was identified as Staphylococcus aureus ,which is collected different
environments (soil ,water) . This study focused on the pathogenic bacteria S.aureus which
was isolated from the natural sources (soil ,water ) and was compared with S.aureus isolated
from clinical samples isolates obtained from different clinical cases from Baquba General
Teaching Hospital.
Results: This study includes 10 samples of Staphylococcus aureus that isolated from soil and
water, 10 samples of Staphylococcus aureus that isolated from hospital, identification it and
detection of resistant genes by used Polymerase Chain Reaction technique. 4 isolates were
identified genetical by 16srRNA gene and detection of resistant genesfemA, nucby used
Polymerase Chain Reaction technique. The results of the genetic identification of the 16srRNA
using polymerase chain reaction (PCR), revealed that all S.aureus isolates were positive
(100%) and the results of resistant gene femA revealed that among 2 isolated belong to
pathogenic S.aureus one isolate contains this gene (50%), whilst 2 isolates belong to S.aureus
from the environment do not contain this gene (100%) . The PCR result for the nuc gene
indicated that among each 2 isolated belong to pathogenic (clinical) S.aureus isolate one (1)
isolate contain this gene (50%), whilst 2 isolates belong to S.aureus from the environment do
not contain this gene (100%).
Conclusion: Resistant gene femA get found in pathogenic S.aureus one isolate contains this
gene , whilst isolates belong to S.aureus from the environment do not contain this gene , the
nuc gene get found in pathogenic (clinical) S.aureus isolate one (1) isolate contain this gene ,
whilst isolates belong to S.aureus from the environment do not contain this gene .

Background: Tuberculosis remains a major public health problem internationally, causing
9.6 million new cases and 1.5 million deaths worldwide, Tuberculosis (TB) has become one
of the most important diseases in the past two decades. It leads to organ dysfunction,
mortality and various clinical manifestations. Previous studies have shown that sera from
patients with active TB may contain autoantibodies that are unique in autoimmune diseases.
Objective: To detect the prevalence of wide array of autoantibodies in sera of patients with
tuberculosis compared with healthy control subject.
Patients and Methods: A consecutive patients with recently diagnosed pulmonary and extra
pulmonary {axial & peripheral joints TB} , mean age 36.2 years . 41 males and 21 females .
the autoantibodies are R.F lgM, ANA , anti cls DNA. P-ANCA , ACL, ENA,SSA, SSB .
RNP SM SCL70}.
Results: Mean duration of symptoms 15.69 & 15.70(SD) months . 82% had fever , 39.3% had
cough and hemoptysis . 27% had arthralgia and myalgia , 31.1% are diabetic and 24% are
smoker serum level above the upeer normal limits were found in 25.7% of patients with RF
,ANA was 8.8% , 20% , 6.3% in pulmonary , peripheral , axial TB respectively , P-ANCA 10%
, 6.3% & for anti DNA was 5% , 10% ,7 6.3% for pulmonary , peripheral & axial :ACL was
33.3 , 12.5 pulmonary , axial TB,ENA was {SCL70 3.2% , SM 3.2% , RNP3.2%, SSA 8.1%
SSB 6.5%}.
Conclusion: R F: Rheumatoid Factor--Anti ds DNA: Anti-deoxyribonucleic acid (double
strand).-ACL: Anti cardiolipin Antibody.-ANCA: Anti neutrophil cytoplasmic Antibody.-
ANA: Anti nuclear Antibody.-ENA: Extractable Nuclear Antigen. S: Significant. N-S: Not
Significant.Pul: Pulmonary.TB: Tuberculosis .AFB:Acidfastbacilli.

Background: Pneumonia is an important cause of morbidity and mortality in developing
countries. They are responsible for the death of more than two million children under five
year of age every year10, 11.
Objective: To find out the proportions of clinical types of respiratory tract infections, also to
find out the factors that might be associated with severity of pneumonia and to compare the
proportions of pneumonia between the hospital and primary health care centers attendees.
Patients and Methods: Case series study conducted among 300 children aged two months to
five years in the outpatient clinic of Raperin Teaching Hospital / Erbil and six primary health
care centers(PHCCs)from the first of march 2017 to thirty of march 2018. The questioner
was completed through direct interview. A chi square test of association was used to compare
proportions. A p value equal or less than 0.05 was considered as statistically significant.
Results: The majority of cases 42% of the patients were infant and 59% were male. Sever
pneumonia was diagnosed in 7%, pneumonia 5% and no pneumonia 88%. all of the patients
presented with the cough, wheeze 100% in sever pneumonia 86% in pneumonia, and 35% in
other group, fever are high in all groups, lethargy was higher among sever pneumonia patients
(81%), chest indrawing also high among those with sever pneumonia 76.2% and those with
pneumonia was 73.3% while only 1.5% among other groups. also unable to drink in sever
pneumonia was 81%. No association between the diagnosis of pneumonia and sever pneumonia
with age, gender and residence. The prevalence of sever pneumonia was 12.5% among low
socioeconomic status (SES), 2.2% among those of moderate socioeconomic status and 0%
among high socioeconomic status.The prevalence of pneumonia and sever pneumonia were
higher among those with family history of asthma and higher among those whose father was
smoker. Also 13.3% of the hospital cases had severe pneumonia compared with 0.7% of the
cases of the PHCCs. Regarding pneumonia, 4% of the hospital cases had pneumonia compared
with 6% of the cases of PHCCs.
Conclusion: This study showed significant association with wheezes, immunization, history
of chronic illness, SES, family history of asthma and smoking in father. The majority of
cases with sever pneumonia was higher among hospital cases compared with PHCC. and
pneumonia cases were lesser in hospital compared with PHCC.

Background: The polycystic ovarian syndrome is a common cause of infertility and
responsible for many changes in endocrine and metabolic activities with a possible role in
changing the endometrial thickness.
Objective: To evaluate the effect of endometrial thickness in infertile polycystic ovarian
syndrome women on ovulation outcome.
Patients and Methods: A case control study was carried out in Gynecology Consultancy
Clinic of Al-Zahraa Maternity and Pediatric Hospital in Diyala province through the period
from 1st of December 2016 to 30th of November 2017. The study sample was 40 infertile
women with polycystic ovarian syndrome on program of ovulation induction and 40 healthy
control women. Endometrial thickness was assessed by transvaginal ultrasonography. The
ovulation was assessed regularly for each cycle and each woman was followed up for 6
month.
Results: The means of endometrial thickness for infertile women with polycystic ovarian
syndrome at different periods of menstrual cycle were significantly increased in comparison to
controls (p<0.001). There was a highly significant difference in means of endometrial thickness
between ovulated and not ovulated infertile polycystic ovarian syndrome women at different
menstrual cycle periods (p<0.001).
Conclusion: The endometrial thickness of infertile polycystic ovarian syndrome women is
clearly higher than healthy controls with a prominent role of endometrial thickness in
ovulation among infertile women with polycystic ovarian syndrome.

Background: Child mortality is usually used as appointer of community health. A
decreasing in mortality is possible with increasing the interventions that targeting the
important causes of death.
Objective: To assess death causes in children below five years old.
Patients and Methods: A descriptive retrospect study depend on revision of
files in AL- Batool teaching hospital. data was collected during a period of 30 months from
1st of February ,2013 to 30th of November, 2015.by using a well structured questionnaire
designed for the study. Date of death, sex and age, and the cause of death were collected. the
recorded .Death causes were classified according to the International Classification of
Disease version10 (ICD-10). Stillbirths were excluded.
Results: A 500 deaths were listed, ( 254 boys and 246girls ). About 198 (39.6%) of deaths
were listed as infants death (29 days-11months),while 172(39.4%)recorded as neonatal
deaths(0-28days),and 130(26%)as children deaths(1-4years). For the neonate ,
prematurity/LBW(65)37.79% and neonatal sepsis(47)27.32% were the most important causes of
death.For the infants, pneumonia(64)32.23% and sepsis(53)26.76%were the most important
causes of death and in the children age group, diarrhea(46)35. 38%and pneumonia (29)
22.30%. were the leading causes of death.
Conclusion: Together death causes in children below five years old were pneumonia
&sepsis.