Diyala Journal of Medicine

Background: As an alternative to back surgeries, endoscopic spinal operations is the most
effective and safe procedure that does not impose the fear reaction to the patients.
Objective: In this study the results, complications, and outcomes of 60 patients complaining
from prolapsed lumbar inter-vertebral discs who experienced prolapsed endoscopic lumbar
discectomy (PELD) were reported.
Patients and Methods: This is a prospective study conducted in three sentinel hospitals over
a period of 3 years (2013-2015) in Erbil city of Iraq. Clinical findings in addition to pre-
operative MRI were the main diagnostic methods used for including patients who were
suffering from lumbar disc herniation at different levels. Clinical appraisal was done utilizing
the modified Macnab criteria. The Storz lens spinoscope was utilized to perform PELD.
Results: Sixty patients (37 males and 23 females) with lumbar disc herniation were included in
the study. The mean operative time was 50 minutes. Patients were discharged during 1st 24
hours post-operatively. After surgery, patients were followed up for two months to three years
with a mean of 18 months. Seven (11.7%) patients developed complications including one
(1.7%) instance of shallow nerve injury, three (5%) with dural tears, two (3.3%) instances of
intermittent delayed disc prolapse and one patient (1.7%) had post-operative discitis. Modified
Macnab criteria (excluding patients with long dural tear) showed excellence results for 36
patients, while good results were observed for 17 patients, reasonable results for 3 patients and
poor results for 2 patients. The achievement rate was 91.4% .
Conclusion:Although endoscopic spinal discectomy is a compelling procedure for
management of lumbar disc prolapse, and although its final outcome is reasonable it is not
devoid from complications.

Background: Thalassemia is a major health problem in developing and developed countries
and suffers from many children of school age.
Objective:Study of some chemical parameters such as serum bilirubin and some liver
enzymes such as GOT, GPT as well as calcium and ferritin in patients with thalassemia.
Patients and Methods: Analysis was performed on 109 patients with thalassemia in the
thalassemia unit at Ibn al-Baladi Hospital for Women and Children in Baghdad Governorate.
By spectrophotometer (Total serum bilirubin, GOT, GPT, serum calcium, hemoglobin) and
vides device for serum fretin.
Results:Showed changes in thalassemia patients with an increase in bilirubin causing
hyperbilirubinemia, an increase in GOT and GPT, decreased serum calcium levels in some
thalassemia patients, and reduced hemoglobin density and reduced cell size, as well as increased
serum ferrite in patients with thalassemia due to frequent blood transfusion.
Conclusion: This study shows an increase in blood vessels in all ages in both sexes due to
the breakdown of red blood cells and the repeated blood transfusion, which causes the
accumulation of iron in the body and the increase of enzymes and liver secretions (GOT,
GPT) due to hepatic hypertrophy as well as increased bilirubin and calcium deficiency in
serum thalassemia patients.

Background: Tetracycline is a broad-spectrum antibiotic that is used to treat diseases caused
by different types of bacteria.
Objective:To estimate tetracycline hydrochloride in pharmaceuticals through coupling with
a new reagent, sulfanilic acid.
Patients and Methods: The proposed method for determination of tetracycline
hydrochloride was applied to four different types of pharmaceutical drug companies and the
results were compared with a standard method (HPLC method) to determine their
compatibility and the results were satisfactory.
Results: The method is based on azo coupling reaction between sulfanilic acid and tetracycline
in alkaline medium. The colored compound produced by the reaction has a higher absorbance at
a wavelength of 403nm. The Beer ,s law was applied in the concentration range (8.0 - 95.0μg /
ml) and the detection limit, molar absorptivity and correlation coefficient were 0.2μg / ml,
6.536x103L / mol.cm and 0.9997 respectively. The method was successfully applied to the
evaluation of tetracycline hydrochloride in pharmaceuticals.
Conclusion:The proposed method for determination of tetracycline hydrochloride is a simple
and sensitive method, where the tetracycline hydrochloride can be estimated at low
concentration and accurately. This method needs a simple device and the method can be used
in quality control centers. The recommended method has been successfully applied to
estimate tetracycline hydrochloride in pharmaceuticals.

Background: Rheumatoid arthritis (RA) is an autoimmune disorder, occurs when there are
attacks of the immune system on body’s tissues especially the joint, causing a painful,
swelling, that finally results in bone deformity, increased free radical level in defect joint and
reduce the level of the antioxidant system can cause tissue damage. Serum C-reactive protein
(CRP) can be estimated as an index of the pathogen in RA.A chronic inflammatory case as in
RA is probable to change magnesium, calcium and phosphorus level in the serum.
Objective: To study the impact of elevated level of NO in serum of RA as a free radical
involved in pathogens of arthritis and the role of CRP as an indicator for inflammation. With
changes in the level of serum magnesium, calcium, and phosphors in patient with RA.
Patients and Methods: Forty patient with RA were studied and then compared with the
same number of healthy subjects. Nitrite was estimated by Griess reaction using VCL3 as a
reducing agent by spectrophotometer at 540nm. CRP was detected by using Avitex-CRP kit
and serum levels of Ca, Mg, and P was measured by fully automated random-access
biochemistry analyzer (Cobas Integra 400 plus).
Results: In our study, it was found that the mean NO levels were 77.33±6.37 in RA and
26.678±3.637 in healthy subjects, significant at p<0.0001. CRP test was found to be positive in
34/40 cases of RA and none of the controls. The Mg and Ca level were less than normal and
significances higher change in P level.
Conclusion: Our result finding that there is a close relation between oxidative stress and RA,
in addition to CRP as a marker for inflammation, Mg, Ca and P level can be studied for the
preferabletherapeutic management of RA.

Background: Laparoscopic cholecystectomy has been accepted as a gold standard for the
surgical treatment of gallbladder diseases. In comparison with open surgery, the minimally
invasive procedures are considered as a superior method. Using the port smaller than ports in
standard laparoscopic cholecystectomy are used by some surgeons.
Objective:The outcome of miniport laparoscopic cholecystectomy and standard laparoscopic
cholecystectomy and their intraoperative complications were examined and evaluated in the
current study.
Patients and Methods: In this randomized-controlled trial, the same number (65) of patients
,matched for gender underwent miniport laparoscopic cholecystectomy and standard
laparoscopic cholecystectomy in a private hospital in Iraq from March 2016 to October 2017
following taking ethical clearance from the local department.
Results: The mean age of the patients in miniport and standard arms were 44.82 and 42.85
years, respectively. The study showed that the patients underwent standard laparoscopic
cholecystectomy had a significantly shorter operation duration and a substantially higher pain
score after 2, 6, and 12 hours of the surgery. The patients in standard group had a lower
cosmetic score (P<0.001). The miniport laparoscopic cholecystectomy was completed in more
than 80% of the patients. Only one patient converted to open surgery and 11 to standard
laparoscopic cholecystectomy. One patient in standard group was converted to open operation
only. No significant change was seen in intraoperative complications between two study groups
(P=0.907) and the complications were not serious.
Conclusion: The miniport technique was non-inferior to standard laparoscopic
cholecystectomy while was superior for cosmesis and pain severity .

Background: Radiation is a radiation dose rate at a specified location which is generated by
any combination of natural and artificial (man-made) ionizing radiation sources. Background
radiation varies with location and time. The global average exposure of humans to ionizing
radiation is about 2.4 – 3mSv (0.0024-0.003Sv) per year.
Objective: To detect, and calculate the total cumulative dose of radiation exposure in the
center of the store and outside by moving the detector " portable PalmRAD" away from a
source.
Patients and Methods: By using portable PalmRAD 907 Nuclear Radiation Meter to detect,
and calculate the total cumulative dose of radiation exposure in the center of the store and
outside by moving the detector " portable PalmRAD" away from a source. the study was
conducted in 2015, the first of March up until June.
Results: The findings indicate that approximately 100% of students, academic staff or public in
general are exposed to radiation near the store`s window (3.5 m from the store center), and the
estimated total cumulative dose of radiation exposure exceeded (13 µ Sv / day) and compare
this finding with the standards level of radioactive substances, "Cs137" is (8.333 µ Sv / day) or
(3000 µ Sv / year) [5, 18]. It is concluded that there is a risk to any low level radionuclide
exposure.
Conclusion: Low-level radiation can cause many health problems; even any level of
radiation can be dangerous. There is always a bad effect of natural background radiation on
DNA as well as several measures of healt

Background:This study will show the most likely congenital heart disease that affect on
growth parameters which re- arrange our information for rapid referring of such patient to
solving their problems and maintains the life of child and decrease burden on salary of
family.
Objective: To assess nutritional status and factors that predicts nutritional changes in
children with congenital heart disease.
Patients and Methods: Cross-sectional study, of 110 patients with congenital heart diseases,
performed in Al-Hilla and Baghdad cities in Iraq. Children were divided into three groups
according to the age. Cardiac diagnosis was made on basis of clinical history, examination,
electrocardiography and echocardiography. acute malnutrition assessed by weight/length
ratio, chronic malnutrition assessed by length/age ratio, while poor nutritional status and
acute deterioration of health status assessed by weight/age ratio.
Results: 110 patient; Wasted or severely wasted (60.9%) according to weight/length, and
Stunted or severely stunted (61.8%) according to length for age measure; and wasted or
severely wasted was (42.7%) according to BMI . There was significant association between
acute malnutrition and child age, p value <0.002. Acute malnutrition (Wasted or severely
wasted) more with left side volume overload (62.7%) and (60.2%) those with chronic
malnutrition (Stunted or severely stunted) have complex heart disease. There was significant
association between malnutrition assessed by weight for height and presence of mild, moderate
and Severe PHT, absence or presence of treatment, type of feeding and syndromatic type of
CHD. There was significant association between chronic malnutrition assessed by height for
age and cyanosis, pulmonary hypertension and type of feeding. There was significant
association between acute malnutrition assessed by BMI for age and pulmonary hypertension,
absence or presence of treatment and type of feeding. There was significant association between
malnutrition assessed by Weight for height and history of abortion.
Conclusion: Congenital heart disease can affect the growth of children so need resolve these
problems by correcting the cardiac abnormality whether by cardiac catheterization of surgical
interventio

Background: Nocardia spp. belongs to the family Nocardiaceae , are obligatory aerobic,
Gram-positive ,non-spore forming, and non-motile ,actinomycete that form filamentous
branched cells normally are saprophytes of soil, Nocardia is a rare bacterial opportunistic
known for its ability to cause a wide range of clinical diseases in humans and animal
Objective:To using phenotypic methods from soil samples of Diyala province and study
resistance of to some antibiotic.
Patients and Methods: Collected ( 50 ) soil samples from the various regions of diyala
province The samples included various ecosystems, rural areas and urban areas and culture
of samples on the media trypton soya agar which containing 5μg / mL tetracycline, 50μg / ml
nystatin and 5% NaCl, and diagnosed according to colonial characteristics microscopic
examination, biochemical tests isolates were selected to measure their resistance to some of,
the antibiotic.
Results: In the rural area had the highest positive growth. 15samples (60%) showed positive
growth and 10 samples (40%).showed negative growth in as for the urban area, only two
samples (8%) showed positive growth and 23 samples (92%) showed negative growth of
bacterial, In this study,isolation different types of Nocardia spp. from soil in different areas of
diyala province, and used trypton soya agar (TSA) medium containing two antibiotics
tetracycline and nystatin, It was the highest percentage of antibiotic resistance in against
antibiotic Tobramycin which reached (38.40%) while was the lowest percentage resistance in
the antibiotic Gentamicin which reached (15.30%).
Conclusion: Due to pathogenicity and species diversity of Nocardia, using phenotypic tests are
essential for identification of Nocardia species. Isolation and identification of Nocardia spp.
from soil of different regions can help to enhance our understanding of epidemiological and
ecological of the pathogenic Nocardia species. The isolation of species resistance to antibiotic
means that they have a predisposition to the pathogenesis of the human.

Background: The absence of secondary sexual characteristics are known complications in
patients with beta thalassemia major.
Objective: Evaluation the effects of frequent blood transfusions on puberty in patients
afflicted with beta thalassemia (β-thal) major.
Patients and Methods: Eighty patients with beta thalassemia major were categorized into
two groups, 51 male and 29 female,and 40 normal individuals were chosen as a control
group. The concentrations of the luteinizing hormone(LH), follicle stimulating
hormone(FSH) in both genders,Estradiol in female and testosterone in male were evaluated
in the sera of patients and controls by ELISA method.
Results: The mean concentrations of serum FSH ,LH, estradiol in female ,and testosterone in
male showed highly significant decrease in patients with beta thalassemia major in comparison
with control group. Hypogonadotropic hypogonadism was reported in 67.5% of all β-
thalassemia patients(70.6% of male and 62.1% of female ).
Conclusion: Delayed puberty is caused by the effect of excess iron on the anterior lobe of
pituitary gland

Background: Many health reports have focused on the symptoms and health effects caused
by mobile phone usage around the world, including headaches. Headaches are common
among the Iraqi people, and when exposed to low-frequency radiation from mobile phone
use for long hours, this may cause headaches.
Objective:To determine the possibility of headache exposure among mobile phone users in
relation to age, gender and various aspects of mobile and to find out any significant
association between the duration of mobile phone usage per day with duration and intensity
of headache.
Patients and Methods: An analytical cross-sectional study was conducted in Baquba city
during the 1st December 2016 to 31 December 2017 to obtain a random sample of young
adults aged 18 – 25 years. A questionnaire was created to collect data. This questionnaire
consists of three parts, the first part includes age and gender and the second part about
mobile-related information. While the third part is about headaches information related to
headaches. Initial approval was taken from every to participating. Data, sorted and arranged,
and statistical tables were used to represent the results. Statistical data were analyzed using
the statistical packages for social Sciences (SPSS) program version (20). Chi-square and t-
test were applied and p-value of <0.05 was taken to be as a statistical significance.
Results: The current study shows that mobile phone usage significantly increases the rate of
exposure to headaches by (65%). The highest rate of exposure to headaches (86.1%) was
significantly among those who owned the mobile for four years and more. The study showed
that the highest rate of headaches (% 72.6) was significantly found in persons who use the
mobile mainly to surf social networking and the headache rate (73.8%) was significantly higher
among those who use mobile phones for (3-˂ 4) hours per day.
Conclusion: It has been concluded from this study that the use of mobile phones increases
the of exposure to headaches, especially when the duration of use during the day increases,
as well as the duration of headache exposure of more than two hours and intensity
significantly associated with increasing the mean number of hours per day.

Background: Respiratory tract illness is a major cause of morbidity and mortality among
children, elderly and immunocompromised patients worldwide.
Objective: To determine the infection rate of respiratory syncytial virus and human
metapneumovirus among children with respiratory tract infection in Baghdad city.
Patients and Methods: A cross sectional study was based on the processing of
nasopharyngeal swabs from 150 children with acute respiratory tract infections, (81) males
and (69)females; aged under five years old, who was admitted to Al-Imamin Al-Kadhimin
Medical City and Pediatrics Protection Hospital in Baghdad during the period from
December 2017 till April 2018. Nasopharyngeal swabs were collected from each participant
and stored as frozen at -70 °C to use for RNA extraction and real time- polymerase chain
reaction.
Results: Out of all these samples, 54 samples were positive for respiratory syncytial virus
(36%) and human metapneumovirus (1.33%). The infection rate of respiratory syncytial virus is
more common in males (57.41%) than females and in children ≤ one year (37.04%) also high
frequency were noticed among patients live in an urban area (72.22%) (50%) respectively and
winter. According to different clinical feature, fever, cough, and wheezing were more common.
Conclusion: The infection rate of respiratory syncytial virus was more than human
metapneumovirus in children with respiratory tract infection using real time-PCR technique
and the clinical manifestations were more common during respiratory syncytial virus and
human metapneumovirus infection are cough, fever, wheezing.

Background: A fissure consist of crack or tear in the vertical axis of the anal canal between
the anal verge and the dentate line. Anal fissure is the most common cause of sever anal pain
and bleeding. Anal fissure is an elongated ulcer in the anoderm below the dentate line, and is
commonly located posteriorly due to more adherence of the anoderm to the underlying tissue
in the posterior midline, so the blood supply is significantly low as shown by the Doppler
flowmetry study. Anal fissure is treated by two ways either medical or surgical treatment or
both.
Objective:To evaluate the healing response of the anal fissure to topical application of
nifedipine with lidocaine.
Patients and Methods: A randomized prospective study of one hundred patients who
presented with anal fissure to outpatient surgical clinic in Al-Diwaniyah teaching hospital.
The patients were divided into two groups. The first group involve 40 patients (15 males and
25 females) with acute anal fissure; the second group 60 patients (25 males and 35 females)
with chronic anal fissure. Both groups were treated with the topical application of nifedipine
and lidocaine 3 times daily for 6 weeks, and more prolonged therapy (up to 8 weeks) was
applied for resistant cases.
Results: Both groups registered good response to topical therapy; the healing response was
85%. The healing response of those with acute anal fissure was better and faster than patients
with chronic anal fissure.
Conclusion: Anal fissure can be simply and effectively treated medically without the risk of
incontinence associated with lateral internal sphincterotomy

Background: The treatment of bladder outlet obstruction in patients diagnosed with benign
prostatic hyperplasia using the transurethral resection of the prostate procedure often presents
with retrograde ejaculation as a complication due to bladder neck stenosis.
Objective:To determine the safety and ease of use of the ejaculation preservation technique
of the transurethral resection of the prostate procedure.
Patients and Methods: The study was done in Samarra city in Iraq, included 30 patients
between the ages of 50 and 62 years. The resection of the prostate was done a centimeter
above the verumontanum in order to preserve the paraculcular tissue. The patients were
assessed for the degree of ejaculate using the Ejaculation Projection Score. The patients were
also evaluated for erectile function using the International Index of Erectile Function and for
urinary retention using the International Prostate Symptom Score. The assessments were
done preoperative, 4 months and 36 months after the ejaculation-preserving transurethral
resection of the prostate procedure.
Results: The maximum flow rate increased from 5.4ml/s to 21±5.2ml/s (n=29, p-value<0.001).
IPSS improve from 24 to 5±2.5 (n=29, p-value<0.001). The quality of life score improved from
5.7 to 1.4±1.0 (n=29, p-value<0.001). The residual urine volume reduced from 150ml to 23± 14
(n=29, p-value<0.001). The erectile function reduced from 4 to 3.7 while the EPS reduced from
3.5±0.5 to 3.3+-0.5 (p-value=0.57). 96.7% of the patients ejaculated postoperatively. Statistical
analysis was done with SPSS version 15 for windows, P value and T test for significance of
results being P value < 0.05.
Conclusion: There is evidence to show that the ejaculation preserving technique of the
transurethral resection of the prostate is safe and secure to use. It protects anterograde
ejaculation while reducing urine retention.

Background: Recurrent aphthous stomatitis (RAS) are an inflammatory condition and most
the common ulceration of the oral cavity of the patients that make them to ask dental
practitioner consultation. most ulcers are associated with pain and heals spontaneously for
some days.
Objective: To calculate the prevalence of this type of ulcers in diyala governorate among
males and females and its association with stress and evaluate the independent issues
correlated to this oral mucosal state.
Patients and Methods: A total of 80 patients who attended to the Baquba teaching hospital
from April 2016 - April 2017 and fill the required questioner of this study which including
age, gender, site, size of ulcer, stressed condition and smoking status in addition to other
questions.
Results: The prevalence of RAS was 17.4%, the third decade of life were the most affected
age. Males were affected more than females and the tongue were the most affected sites
represents (25 %)of the cases. stress was the most causative factors of this lesions.
Conclusion: In diyala governorate, the Aphthus lesion is the main features of stress among
males.