Diyala Journal of Medicine

Background: Neural tube defects (NTDs) are the greatest shared severely disabling birth
defects, they resulted from compound and many etiologies in which both hereditary, life style
and ecological factors appear to be convoluted.
Objective: To study the role congenital cytomegalovirus and the biomarker Protein 53 (p
53) in pathogenesis of neural tube defects.
Patients and Methods: This is a cross sectional comparative study done on 47 mothers of
different age group and their babies who have NTD and 47 mothers with their healthy
babies at AL-Batool Teaching Hospital/ Diyala/ Iraq from Sept 2017 to May 2018. Rapid
serological test to detect anti- CMV IgG and IgM Abs for all case and control groups and
their mothers, together with ELISA test to detect P53. The statistical analysis of data was
achieved by using SPSS V.20.
Results: There was high rate of anti- CMV IgG Abs in NTD cases and their mothers ( n=
10,21.3%, p value= 0.08), out of them, one case had positive anti-IgM Abs together with his
mother, whereas in control group, anti CMV IgG was positive in 4(8.5%)in both mothers and
their healthy babies with no anti IgM detected. P53 titer is higher to a significant level (
p<0.05) in the mother and their NTD affected baby than control groups ( corresponding babies
and mothers).
Conclusion: CMV virus might be an important cause of NTD and p53 is a likely to be
involved in pathogenesis of NTD.

Background:Tumor suppressor genes (including P53) are cancer suppressor genes.
Mutations in these genes contribute to the development of cancer ( including breast cancer)
since its role in controlling cell growth.
Objective: To Evaluate the status of P53 and determination some blood parameters.
Patients and Methods: Fifty female patients having primary breast carcinoma or breast
mass and their age range from (17- 78 years), were included in this case control study. Other
50 relative to the patient women non breast carcinoma as controls, their age range from (21-
65 years). ELISA test was used to evaluate the status of P53 in serum of breast cancer
women and relative control non breast cancer women . Blood samples are collected from
both patients women and relative female, 5ml syringe used to collect blood. 3ml of collected
venous blood placed in blood tubes with specific gel to facilitate separation of serum and
centrifuged at 1400 r.p.m for 10 minutes then serum is collected in collecting tube and store
at -20 until use. 2ml of collecting blood placed in EDTA tube for CBC (complete blood
account) by Medonic M32 3. Diff Hematology Analyzer, in which WBCs and platelet count
included.
Results: The titer (Mean ± SD) of p53 in breast cancer women was (140.7 pg/mL ± 60.9
pg/mL) which is less than those of control non breast cancer women which their titer was (192.6
pg/mL ± 285.5 pg/mL) with non-significant difference (P< 0.05) between two groups. The
level (Mean ± SD) of total WBC number in breast cancer group was (8.5 pg/mL ± 2.5 pg/mL)
x103cells/mm3 which was higher significant (P<0.05) than those of control non breast cancer
women (7.5 pg/mL ± 1.4 pg/mL) x103cells/mm3. The level of (Mean ± SD) platelet number of
breast cancer women was (344.8 pg/mL ± 116.8 pg/mL) x103cells/mm3 which was higher non-
significant(P<0.05) than those of control non breast cancer women (316.7 pg/mL ± 95.8 pg/mL)
x103cells/mm3 . There is no correlation between total WBC and platelet number in non breast
cancer women but there is non significant correlation in breast cancer women . Lymphocyte and
neutrophile number and percentage was significantly higher in breast cancer women than
control non breast cancer women.
Conclusion: The activity of P53 is decreased which may contributed to cancer while blood
parameter were elevated in the serum of breast cancer women.

Background: Simple bone cyst or UCB is a benign tumor of bone mostly in children and
young adult treated by different approach. (SBC or UBC) are predilection for the
metaphyseal region of the long bones. Our study is to treat UCB cyst by minimal surgical
interference with depomedrol injection.
Objective: To study the effect of ccuration and depomedrol injection in healing of UCB
CYST in short period of time with lest morbidity of the patient.
Patients and Methods: Twenty four patients their age between 8 to 30 years (23 cases of
long bone including 13 upper humerus and 10 femur), one case is in calcaneus bone treated
under GA under fluoroscopic technique and depomedrol injection in local.
Results: In 6-8 weeks follow up of the patient after our procedure the processes of healing of
UCB cyst almost fully in most of the cases ,the suc.cessfull rate was 98-100% in most of the
cases in both clinical picture and radiological picture
Conclusion:Find from this study that UCB cyst can be treated successfully by this procedure
whatever the age of the patient and the size of the cyst and location.

Background: Breast cancer is the most common, prevalent and diagnosed that affects
women and the leading cause of death and disability worldwide and is a leading cause of
morbidity and mortality among women.
Objective: To assess the levels of knowledge among nurses regarding breast cancer at
primary health care centers in Al-Sader district and to find out the relationship between
socio- demographic characteristic and levels of knowledge.
Patients and Methods: A cross-sectional study in which assessment approach is applied to
achieve objectives of study, The period of the study was from 2nd July 2017 to 28th May
2018. The sample was non-probability (purposive sample) of 50 nurses who working at
primary health care centers in Al-Sader district and selected according to criteria of sample
and for the purpose of the study. A questionnaire used was consist of (37) items which was
distributed across (2) main parts which are the socio-demographic characteristics which
included (7) items, to assess levels of knowledge regarding the breast cancer these comprised
(30) items. Data analysis by using program of SPSS version 20. Descriptive data through
determination of: frequencies, percentages and mean of score to measure the level of
knowledge to nurses. Inferential statistical data analysis by application Chi –square test used
this for determine the association between the nurse’s socio-demographic characteristics and
knowledge of nurses about breast cancer.
Results: Results of the study that more than half of nurses with good levels of knowledge
regarding breast cancer and there are significant association between sources of information and
knowledge of nurses regarding breast cancer.
Conclusion: That establish specially heath educational programs that provide information
about breast cancer to the community.

Background: Thyroid disorder is one of the commonest disorder worldwide and also in Iraq.
Objective: To study identify clinical presentations of thyroid disorder and its distribution in
the terms of sex, age and residency. Classifying the patients who underwent operations
according to types of the disease and complications were event after operations in Erbil
Governorate.
Patients and Methods: A retrospective study carried out in Hawler Teaching Hospital Out
patients Clinic and privet clinic, from January 2014 to December 2018.Study involved 800
patients with goiter disordered who attended to hospital or private clinic. Data gathered by
questionnaire which involved patients' socio-demographics data, signs and symptoms,
clinical features of disorder, medical and surgical treatment offered to those patients, and the
reports of complications' incidence that event in postoperative. Data were analyzed by the
statistical package for the social science (SPSS, version 22) was used for data entry and
analysis. Frequency and Percentages were used to identify distribution the disease, types, and
complications.
Results: There was high frequency of disorders among female 710 (88.7%) and adults,
inconsistency of diseases' signs and symptoms among patients, highest percentage (44.2%) of
patients were multinodular goiter, near to half of patients 392(49%) underwent operation and
complications were reported with 42(10.7%) of patients after surgical operations.
Conclusion: The proportion of female is high, there was high proportion of patients who
needed to surgical treatment and there was proportion of patients with complications after
surgical operations.
Keywords:Thyroid

Background:Bronchial asthma is a common chronic respiratory disease worldwide.
Although magnesium (Mg) deficiency has been shown to play a role in exacerbation of
asthma, the exact prevalence of hypomagnesaemia in asthma is not clear.
Objective: To estimate the serum Mg levels in bronchial asthma patients and compare them
with healthy population and to evaluate the prevalence of hypomagnesaemia among them.
Patients and Methods: A cross-sectional study was carried out in the respiratory unit of
Rizgary Teaching Hospital involving 80 adult patients with chronic asthma (group I) and 80
healthy adult controls (group II). Serum magnesium level was measured in all the
participants.
Results: Hypomagnesaemia was detected in 20% of the asthmatic patients when compared to
controls (0%) (p=0.001). No significant association was detected between magnesium status
and type of asthma (p= 0.59). There was a statistically significant stage-wise decline in serum
levels of Mg with increase in severity of asthma (p=0.02). Patients with severe asthma had the
highest prevalence of hypomagnesaemia (45.5%) in comparison to mild and moderate cases
(p=0.001). No significant associations were detected between the level of magnesium and the
number of medications that the patients used, corticosteroids use, and theophylline therapy
(p=0.06, 0.17, and 0.08, respectively). Hypomagnesaemia was significantly correlated with the
duration of asthma (p=0.04).
Conclusion: Hypomagnesaemia is more prevalent in chronic asthmatics than non-asthmatics.
Hypomagnesaemia was significantly correlated with severity and duration of asthma.

Background: Imbalance in prehypertension represent one of the mean causes that effect in
the myocardial work loud and causes stress on heart in different position for both gender in
different ages healthy or non-healthy this study healthy young male and female student in
the college of medicine as a volunteers.
Objective: To study the effect of stress during the lecture on the heart for female and male in
both position sitting and standing.
Patients and Methods: 20 healthy looking medical students of age between 23-24 years old
of both genders were participated in the study they are divided in two group male and female
with standing and sitting position.
Results Correlation between the heart rate in sitting position and heart rate in the standing
position as it is seen there are an increasing in both sitting and standing , R2= (0.3356)
significant in standing .R2=( 0.1149) also significant in the sitting.
Conclusion: Find from this study that female total value increase on the sitting and standing
position where male decrease in both positions.

Background: Bacterial vaginosis (BV) is a polymicrobial clinical syndrome characterized by
changes in vaginal flora, with replacement of normally abundant Lactobacillus species by
high concentrations of anaerobic bacteria among reproductive age women. Studies have
different aspects on the effect of vitamin D on BV.
Objective: To find out the prevalence of BV, vitamin D deficiency in early pregnancy and to
examine association between BV and vitamin D deficiency.
Patients and Methods: A cross-sectional study was carried out during July 2017 till October
2018 among 100 pregnant women at first trimester pregnancy, aged 18-35 years old at Erbil
Maternity Hospital.
Results: At enrollment the prevalence of BV was (53%), about (73%) of our clients suffering
from homogenous white greyish vaginal discharge, (57%) were with elevated vaginal PH and
fishy odor, clue cells was found among (53%) of them. Vitamin D deficiency, defined as 25
(OH) D concentration below 20 ng/ml, was found in (67%) of women. Insufficiency of the
vitamin D 25(OH) D concentration between 20-30ng/ml was present in (29%) of the women.
Sufficient level of 25 (OH) over (30 ng/ml) was found in (4%). The incidence of Vitamin D
pattern among women with BV were (49.3%), (62.1%) and (50%) respectively for each vitamin
D deficiency, Insufficiency and sufficient vitamin D. No significant association was found
between Vitamin D deficiency and BV.
Conclusion: High occurrence of BV and vitamin D deficiency were found. Vitamin D was
not associated significantly with increased BV incidence. We suggested that pregnant women
should check and manage their level of vitamin D and BV additionally they must not depend
only on vitamin D for curing BV.

Background: Chronic kidney disease is an international public health problem affecting 5–
10% of the world population. As kidney function declines, there is a progressive
deterioration in mineral homeostasis, with a disruption of normal serum and tissue
concentrations of phosphorus and calcium, and changes in circulating levels of hormones.
Objective: To determine the severity of bone and mineral disease in chronic renal failure and
how efficiently controlled by drugs and hemodialysis procedure in Ibn sina dialysis center.
Patients and Methods: A case control study was carried out among 75 patients with chronic
kidney disease (stage5) on regular hemodialysis in Ibn Sina dialysis center. Blood was taken
before dialysis session and measurements of serum calcium, phosphorus, serum alkaline
phosphatase, .protein and albumin levels, Serum parathyroid hormone and VIT D3 were
determined. and another group of 25 normal peoples from surrounding area.
Results: The mean parathyroid hormone level was 145.62pg/ml, with 57.33% having normal
acceptable rang of parathormone level, 41% of patients having hyperparathyroidism and 1.33%
having hypoparathyroidism. There was no significant correlation between serum PTH and dexa
scan. Hypocalcemia was found in 52% of patients, 33% with hypercalcemia patients . There
was a significant correlation found between Hypocalcemia and dexa scan results. Majority of
patients had high serum phosphate levels (54.6%).and normal phosphate level in 40% while the
hypophosphatemia result 5.33% and mean phosphate level is2.24 mmol/l.Total serum protein
mean is 61.51 a 37.33% of them had hypoproteinemia and 62.66 %of them had normal serum
protein. Also our results show 97, 33%of uremic patients have low vit D While 2.33% have
normal level of serum vit D. There was a significant correlation between dexa scan and vit D
level, calcium, alkaline phosphatase, female gender, smoking and body mass index.
Conclusion: The current study demonstrated that we can predict the chronic kidney diseases-
Metabolic bone disorder from mineral scores before potentates the diagnosis by dexa scan.

Background: Neonatal jaundice is most common condition requiring medical evaluation in a
newborn and it is yellowish discoloration of the white part of the eyes and skin in a newborn
baby due to high bilirubin levels.
Objective: To assess the knowledge regarding neonatal jaundice in a sample of mothers
attending some Primary Health Care centers, Baghdad.
Patients and Methods: A cross-sectional study was conducted including 265 mothers
attending some primary health care centers in Baghdad during November and December
2016. They were subjected to previously structured questionnaire covering many aspects of
neonatal jaundice distributed in 3 main domains and the mother's responses were gathered
and then statistically analysed by frequency, percentages and percent score for each question
responses and domain and the overall knowledge mean score.
Results: Family and relatives were the main source of information 39.7% and the results
revealed that the mean percent score for knowledge responses was 74% for definition of
jaundice, 68% for complications of jaundice and 71% for ways of treatment.The mean overall
percent score for knowledge was 71%.
Conclusion: Good mean overall knowledge level regarding neonatal jaundice among study
group.

Background: ITP is a nonthreatening disorder disturbing children at any age but mostly
below 5 years.
Objective: To evaluate the outcome of children with acute ITP who were not specified with
any pharmacologic action and linked with those who were treated.
Patients and Methods: A prospective case- control study was done between Jan.2002 to
May 2016 at Mukalla children and Maternity Hospital and University Hospital for Children
and Mother Health in Mukalla/ Hadhramout /Yemen, where 20 children with acute ITP. the
control group was 18 children given the conventional therapy. The identification and
grouping of ITP were made according to the 2009 International Working Group criteria.
Results: In group A there were 11( 55%) boys and 9(45%) girls, while control group B there
were 18 children 10 (55.5%) boys and 8 (44.5%) girls. the ages were from 2 to 12 years. The
mean age is 4.7 years with the median age at identification was 4r years. There was no
statistical significant difference between both groups regarding outcome.
Conclusion: The recovery percentage has some relation with age at appearance and
preliminary platelet count where younger children and those with platelet amount of <20000
/µL have better recovery percentage. There was no statistical significant difference between
both groups regarding outcome.

Background: The restriction to the guidelines for postoperative management (as omission of
routine use of nasogastric tubes, early institution of oral feeding and mobilization and
clarified indications of administration of intravenous fluids) has resulted in a decrease in
perioperative intravenous fluid administration in fast-track surgical programs (in particular
day case surgeries). In minor to intermediate surgeries, shifting of perioperative fluids are
small and organ dysfunctions are minimum.
Objective: To establish fluid abuse postoperatively following minor and intermediate
surgeries.
Patients and Methods: This is a prospective study done in Iraq-Diyala-Baquba teaching
hospital over a period of one year from January 2018 – January 2019.The case sheets of 640
elective surgical cases had been reviewed for the intravenous fluid prescription after surgery.
The types of surgeries reviewed were those which theoretically based, do not need
postoperative intravenous fluid administration or shouldn’t be given for more than few hours;
but should start early oral fluid. The emergency cases were excluded from this study. The
data collected from the case sheets of different elective surgeries in the surgical ward. The
640 patients who underwent elective mild to intermediate surgeries.
Results: Of those who underwent surgeries under general anesthesia, it has been found that 288
out of 390 patients (90%) were given intravenous fluid postoperatively for a period from 8- 24
hours. Of those who underwent surgeries under spinal anesthesia, it has been found that 134 out
of 174 patients (77%) patients were given intravenous fluid postoperatively for a period from 8-
12 hours. Of those who underwent surgeries under local anesthesia, it has been found that 36
out of 76 patients (47%) were given intravenous fluid postoperatively for a period from 8- 12
hours. The volume of fluid prescribed ranged from 500ml to 2 liters.
Conclusion: Routine prescription of intravenous fluids following minor to intermediate
surgeries is theoretically unsupported and is unnecessary most of the time as far as the
patient is maintained well hydrated intraoperatively