Diyala Journal of Medicine

Background: In diabetes, there are big concerns regarding impaired wound healing and
other tissue disorders. The time and quality of wound healing are affected by many factors.
One of the medical sciences ' aims is short-term wound healing with decreased side effects
Herbal products are more valuable in both prophylaxis and curative in slowed diabetic
wound healing as compared to synthetic drugs A considerable number of researches have
shown that capers plant has distinct biological effects, including antioxidant, anticancer and
antibacterial activity. Phytochemical analysis reveals C. Spinosa has large amounts of
bioactive compounds, including polyphenolic compounds, which are essential for its health-
promoting effects.
Objective: Histological evaluation of the effect of topical application of flavonoid extract of
Capparis spinosa on the healing of incisional cutaneous wounds in alloxan-induced diabetic
rats.
Patients and Methods: A total of 30 healthy male Wistar rats weighing approximately 250-
300 g were used in this study. A surgical incisional wound with full skin thickness of 1.5 cm
length were done in cheek skin of each rat. All rats were randomly divided into following
groups: Group A: (10 healthy rats) received daily local application of the plant extract.
Group B: (10 alloxan-induced diabetic rats) received daily local application of extract of the
plant material. Group C: (10 alloxan –induced diabetic rats) where normal saline was applied
locally instead of plant extract. Assessment of wound contraction was done as well as
epithelial thickness inflammatory cell count and blood vessels count. Scarification of all
animals was done for the healing periods (3 and 7 days), and specimens were prepared for
histological analysis.
Results: The results revealed that the recorded mean values of wound contraction increased
with time in each group and that the highest mean values recorded in group A and B. Mean
values of inflammatory cell count decreased with time lowest values recorded in group A after 7
days. Regarding epithelial thickness values increased with time. Blood vessels count showed
highest mean value in group A at day 7.
Conclusion: Results from this study showed that flavonoid rich extract of Capparis spinosa
enhances wound healing process in diabetic rats.

Background: Despite of the advancement in surgery, surgical techniques and use of
antibiotics prophylaxis, postoperative infections remain the commonest postoperative
complications and one of the most frequently encountered nosocomial infections worldwide.
These infections lead to increase morbidity with the attendant increase in cost of therapy.
Objective: To evaluate the antimicrobial susceptibility pattern among the most common
bacteria associated with postoperative wound infections.
Patients and Methods: (126) swab specimens were cultured and isolates were identified by
gram stain ,morphological and cultural characteristics of the colonies. The standard disc
diffusion methods were done for determination of Antibiotics Resistance of all isolates as
described by the Clinical Laboratory Standard Institute (CLSI)16.
Results: A total of (126) patients presented with infected wounds were enrolled in this study.
Out of (126) patients studied (43)patient(34%) had no growth. While the others (83) patient
(66%) had positive bacterial isolate. From those with positive isolates (47) patient(57%) were
male and 36 (43%) were female.The common bacterial isolate were E.coli (29%) then
Staphylococcus aureus and Acinetobacter spp.(19%).Sensitivity testing show that E.coli had
high resistance to Piperacillin, Aztreonam, Ticarcillin and Sulfamethoxazole. And
Staphylococcus aureus had high resistance to Erythromycin and Sulfamethoxazole.
Conclusion: The common pathogen was E.coli and it was resistant to the commonly used
antibiotics. While Staph.aureus was still sensitive to many antibiotics.

Background:Contralateral axillary metastasis is a rare presentation in breast cancer,
normally treated as a systemic disease. New researches shows that it may represent a locally
advanced disease due to altered lymphatic drainage or it may be the only presentation of a
contralateral primary occult breast cancer . Many recent publications have proposed
aggressive surgical treatment with benefits to the patients in terms of survival.
Case report: We present a case with a history of unilateral breast cancer, presented with
contralateral axillary metastasis without any evidence of distant metastasis or new primary
contralateral breast cancer.
Conclusion: There is limited evidence of the correct management of contralateral axillary
metastasis, and individualized multidisciplinary management is the best option for these
patients , and it is proposed to be treat it as a loco regional disease for best survival benefit
of the patient.

Background: TR approach is suitable for most patient and limitations is very low. It become
more popular and approved in international guidelines because of increase success rate and
low complication rate and low cost. There is also parallel advancement in instruments used in
TR approach.
Objective: To establish the rule of learning curve in transradial approach to CA and PCI and
encourage the operator for doing more transradial catheterization.
Patients and Methods: Patients admitted for CA or PCI. Data collected from patient and
procedure including age, sex, contrast volume, total procedure time. flouro time, radial artery
spasm and number of cases that transformed to femoral. We divided the study in two groups:
group A first half of patient and group B the second half.
Results: Total numbers of patients (139) and there age ranging from 28 to 80 years (mean of
55.13). Number of males 131 (94.2%) and females 8 (5.7%).The mean value of contrast volume
used in group A that underwent CA, ad hoc and PCI ,(was 63.10,124.20 and 106.91 ml)
respectively and for group B (50.07,88.19 and 49.56 ml).The mean total time of procedure of
group A underwent CA, ad hoc and PCI was (17.16,24.9 and 26.13 minutes) respectively and
for group B(13.66,26.3 and 16.4 minutes).The mean fluorotime of group A underwent CA, ad
hoc and PCI was (4.61,7.2 and 6.62 minutes) and for group B (3.06,7.32 and 3.51 minutes ).
Seventeen case subjected to radial artery spasms divided into 11 cases (15.7%) in group A and 6
cases (8.69 %) in group B. There were 8 cases (11.4 %) of group A transferred to femoral
approach and 4 cases (5.79 %) of group B transferred to femoral access.
Conclusion: There was much benefit from the effect of learning curve in doing TR approach
to CA and P

Background: As client opinion is useful to improve MCH service delivery, evaluation of
client satisfaction should be undertaken periodically.
Objective: To determine the level of satisfaction of pregnant women and mothers regard
health care services provided in the MCH units in Wassit Governorate.
Patients and Methods: A cross-sectional study, with a convenient sample of mothers and
pregnant women who were attending to the MCH clinics. The study was conducted in three
sectors with high maternal and infant mortality rate which include 28 health care centers in
Wassit Governorate. Data were collected through the period starting on 16 December 2018
and ending on 31 March 2019, using a specially designed questionnaire.
Results: The important inference of this study is the quality of care from the pregnant women
and mothers perspective that reflected in client satisfaction. This study has revealed that
(67.5%) of pregnant women were fairly satisfied, while 67.1% of mothers were fairly satisfied
with health care services provided in MCH units at different PHC centers in Wassit city.
Conclusion: This study revealed that the majority of pregnant women and mothers were
fairly satisfied with health care services provided by the MCH unit in the Wassit Governorate
and the quality of antenatal care and care for children less than 5 years provided at studied
MCH centers need to be improved in all activities.

Background: Reginald Fitz described appendicitis in 1886.1From then the term appendicitis
has been used. Acute appendicitis is the Commonest cause of abdominal surgical
intervention with a prevalence of nearly 1 in 7 people[2].It is related to occasional
mortality and high morbidity. Regarding conservative management an initial non-operative
management for acute appendicitis was tried in the 1950s but was not accepted at that
time[16] .Conservative management of acute appendicitis is safe and associated with reduced
rate of operation ,complication and reduced costs of treatment[17-18]. Treatment include
bowel rest, intravenous antibiotic with3rd generation Cephalosporine and Metronidazole
.Datas show successful result in 90% of patients in whom appendicitis was confirmed by CT
however 1/4 of patients may require surgical intervention within one year [19].
Objective: To assess the role of conservative management of acute appendicitis in patients
with Modified Moderate Alvarado Score of (4-7).
Patients and Methods: This is a prospective study conducted in Sulaymanya Teaching
Hospital from December 2017 to December 2018 .A total number of 100 cases of acute
appendicitis who were admitted in the emergency department with Modified Moderate
Alvarado score (4-7)had been included. All the cases of the study were collected and all
these patients received treatment and they divided into two groups according to the
response and failure of treatment . Group A consist of ( 59%) patients in whom conservative
treatment had been succeeded group B included (41%) patients in whom conservative
treatment had been failed . The two groups were comparable according to age, gender and
comorbidity . Inclusion crieteria include patients with Alvarado score ( 4-7). Exclusion
crieteria include patients with high and low Alvarado Score , Appendicular Abscess,
Appendicular mass, Fecolith, pregnant ladies, ectopic pregnancy and ovarian cyst.
Results: Finally a total 100 patient were included in this study the success rate of
conservative treatment of Acute Appendicitis was 59 % the failure rate was 41 %.
Conclusion: in this study the result indicate that Conservative management of acute
appendicitis of Modified Moderate Alvarado Score (4-7) is safeand reduces the rate of
non-indicated surgery and reduces the rate of morbidity related to operation from those
selected patients, and in this study the result also indicates that conservative management is
successful in cases with Modified Moderate Alvarado score(4-7).

Background: In children conjunctivitis is the most widespread ocular surface disease. It is
referred to any inflammatory condition of the conjunctiva. Conjunctivitis was the most
common associated comorbidities that had an influence on the health of children.
Objective: To compare the prevalence of allergic and infective conjunctivitis among school
children in the rural & urban Regions of Erbil Governorate / Iraq.
Patients and Methods: A cross-sectional study was performed from the 1st Sep 2018 – end
of May 2019 in primary schools in the rural area of Makhmur district and urban districts in
Erbil Governorate .From every suspected case of clinically conjunctivitis, a sample for
bacterial culture was gained by winding a thin cotton micro swab moistened in brain heart
infusion broth over the lower fornix of the conjunctival sac.After culturing on blood,
chocolate, and MacConkey agars, the colonies were specified and identified by using Gram
staining technique, morphological, biochemical & Analytical Profile Index (API)
tests.Allergic conjunctivitis was diagnosed clinically. The Kurdish & Arabic versions of
International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire were used.
MS excel package and SPSS 20 software was used for analysis.
Results: The total numbers of urban and rural School children who had shared in this study
were 1129 and 1093 respectively. The prevalence of infective conjunctivitis in both urban &
rural children was as such: 127(11.2%) & 211(19.3%).The rates of positive culture in both
were: urban 69, 54.3%; rural 143, 67.8 %( p≤ 0.01). Staphylococcus aureus was the most
common pathogen isolated, urban: 37(53.6%) rural: 79(55.2%).Infective conjunctivitis was
distributed significantly in young ages and in male students (p≤0.05).Regarding allergic
conjunctivitis: the prevalence of allergic conjunctivitis were: urban 247(21.9%), rural
81(7.4%).Allergic conjunctivitis was more distributed in older ages and male children, but this
was not-significant .itching was complained by all student.
Conclusion: Infectious conjunctivitis among rural school children is still a major public
health problem. While higher percentage of allergic conjunctivitis among urban school
children was noted

Background:General urine examination (GUE) and urine culture are the most requested
tests by clinicians for patients with symptoms suggestive of urinary tract infections (UTI).
However, they are laborious methods. So dipstick probably become rapid diagnostic
alternative.
Objective: To determine the sensitivity, specificity, positive and negative predictive values
of dipstick for leukocyte esterase (LE) test compared with gold standard urine culture for
diagnosis of UTI.
Patients and Methods: A total of 150 mid-stream urine samples were collected from adult
patient with clinically diagnosed or suspected UTI, during the period from 1st September to
1st December, 2018. Urine culture, general urine examination (GUE) and dipstick for LE
were performed for each sample.
Results: In the 150 urine samples, 126 (84%) were culture positive, and the prevalence of UTI
among female (84.13%) was significantly higher than the prevalence among males (15.87%).
Approximately, half of urine culture grew E.coli 70 (46.67%) followed by Klebsiella spp. 55
(36.67%), and Staphylococcus aureus 1(0.67%). The sensitivity, specificity, positive and
negative predictive values of dipstick for LE test were 86.5%, 87.5%, 97.3% and 55.25%,
respectively. However, the values can be enhanced by combination with GUE.
Conclusion: Both general urine examination (GUE) and dipstick for leukocyte esterase (LE)
methods are with predictive value in diagnosis of UTI. Because urine culture is an expensive
and delayed test, rapid test could be a good substitution to reduce the workload and a good
screening method.

Background: Cytomegalovirus (CMV) is a major causative agent of prenatal and perinatal
infections and may lead to important complications on pregnancy.
Objective: To find out the sero-prevalence of CMV IgM and IgG and its association with
the history of abortion and / or intra-uterine death, as well as, to study the association
between the mentioned prevalence with some socio-demographic variables.
Patients and Methods: A case-control study was performed during the period between
October 2018 to April 2019 in Erbil city (Kurdistan region, Iraq) on 75 pregnant women with
history of abortion and / or intra-uterine death; and 75 healthy women with normal
pregnancy who served as a control group. The women had been referred to the central
laboratory department of the Maternity Teaching Hospital for the detection and evaluation of
sero-prevalence of CMV specific IgM and IgG markers. The study was approved by the
Ethics Committee of Health Sciences College, Hawler Medical University and informed
consent was obtained from the patients and controls.
Results: The sero-prevalence of CMV-specific IgG was 100% in each of the study groups. The
sero- prevalence of CMV-specific IgM was 8% among women with abnormal pregnancy,
while, none of the women of the control group had a positive IgM. No significant association
was detected between CMV-specific IgM sero-prevalence and any of the studied
sociodemographic factors as well as risk factors including abortion, intrauterine death and
hypertension (p>0.05).
Conclusion: The association was detected between the CMV-specific IgM sero-prevalence
and history of abortion and / or intra-uterine death but no significant may be due to small
sample size in the present study

Background: More than half of the world's population is influenced by Helicobacter pylori
infection. The infection is commonly obtained during childhood but may stay asymptomatic,
with long-term clinical consequences such as gastritis, peptic ulcer illness, and stomach
cancer.
Objective: To determine the prevalence rate of Helicobacter pylori infection and related
variables such as age, gender, residency, blood group, Rhesus factors and previous infection
among patients presenting with gastroduodenal disorders in Erbil city.
Patients and Methods: Out of 240 blood samples from patients with gastroduodenal
disorders admitted to Rzgary Teaching Hospital in Erbil, Iraq from July to August 2019 were
collected and screened for anti-Helicobacter pylori antibodies by rapid
immunochromatographic assay, and blood groups of patients were determined by using
hemagglutination test. For each study subject, a questionnaire sheet was prepared and used.
Results: The overall prevalence rate of Helicobacter pylori infection among 240 patients with
gastroduodenal disorders was 128 (53.3%). A significant relationship between Helicobacter
pylori infection and gender (male 43.75% and female 59.72%) was recorded (P<0.05). The
highest rate of Helicobacter pylori infection was founded among the age group over 50 years,
but there were no significant differences between them (P>0.05). Prevalence was significantly
higher among rural areas (60.4%) than the urban areas (48.6%) (P<0.05). There was a
significant association between Helicobacter pylori infection and ABO blood group phenotypes
(P<0.05), but there is no significant association between Helicobacter pylori infection and the
type of Rhesus factor (P>0.05). Prevalence was significantly higher among the previous
infection (78.5%) than non-previous infection (23.6%) (P<0.05).
Conclusion: We found that in Erbil city, the seropositivity of anti-Helicobacter pylori
antibody was high among patients with the gastroduodenal disorder. The high prevalence of
Helicobacter pylori was founded in the women, elderly, rural area, O blood group, positive
Rhesus factor and patients with the previous infection.

Background: Obesity is an abnormal or increased fat accumulation in the body. Body mass
index (BMI) defined as a person weight in kilograms divided by the square of his height in
meters (kg/m2). It is a very simple index that more commonly used to identify overweight
and obesity in adults. For childhood, the amount of body fat differs from that an adult
because it differs according to the age and to the sex, so the BMI age- and sex- specific
percentiles are used. Obesity in children is a real health problem worldwide especially in
developed countries, as well as, it increases in developing countries. Childhood obesity
predispose to type 2 diabetics, hypertension, liver and renal disease, cardiovascular diseases
and adult obesity.
Objective: To detect the prevalence and possible risk factors for childhood obesity in
primary schools in Baqubah city from age 6 to 12 years.
Patients and Methods: The study was cross-sectional study conducted on a random sample
of 6 primary schools from different localities in Baqubah city, followed by a systematic
random sample of 308 children aged from 6 to12 years of both sexes. A questionnaire sent to
the parents to get information on socio-demographic characteristics, dietary habits, physical
activity, family history of obesity and parents education and job. Children's height (cm),
weight (Kg), and BMI-for-age were measured. Child's weight status was categorized based
on WHO 2007 Growth Reference. This study was included 308 child, the mean age was
9.32±1.9year, 51.9% of the children were males, and 49.1% were female the mean BMI was
18.36±4. Only 2.5% of the studied sample were underweight, while 73.4%, 14.3% and 9.4%
were of normal, overweight or obese respectively.
Results: About 48% of children in this study eat sweets, 48.5% do regular sports, 48.7% watch
TV or mobile for more than 2 hours daily. It was found that 34.7% of children got positive
family history of obesity, regarding educational level of parents 39% of mothers and 42.9%
of fathers got primary level of education and 33.1% of mothers, 31.2% of fathers got higher
than secondary level.
Conclusion: The prevalence of overweight and obesity was 23.7% in primary schoolchildren
in Baqubah city. The study supports the multi factorial etiology of obesity It showed that
sedentary life style, positive family history and eating un healthy foods are risk factors.

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.
Objective: To determine the effect on bone density by dexa scan and mineral derangement
in chronic renal failure, by measuring calicium, phosphate, alkaline phosphatase and
parathyroid serum ,total serum protein and Albumin levels and to determine bone density by
dexa scan of bones.
Patients and Methods: Cross sectional study was conducted in 75 patients with chronic
renal failure . Blood was taken before dialysis session and measurements of serum calcium,
phosphorus, serum alkaline phosphatase, .protein and albumin levels, and dexa scan to
measure the bone density in these patients.
Results: There was a significant correlation 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 , 37.33% of them had hypoproteinemia and 62.66 % of them had
normal serum protein. 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 it can predict the chronic kidney diseases-
Metabolic bone disorder from mineral levels before diagnosis by dexa scan.

Background: The study of Heart rate is very important the body heart is directly related to
heart rate ,the autonomic cardiovascular examination provides necessary information about
function of the autonomic nervous system as well functional capacities of effectors heart and
vessels and other associated part with radiation .
Objective: To study the effect of jammer on autonomic nervous system as measured by heart
rate.
Patients and Methods: Heart rates of 10 males (age 21-51 years), and 10 females (age 20-54
years) were measured and recorded before, during using jammer for 15 minutes, 30 minutes,
and 45 minutes, and one hour after shutting down the device .
Results: The results clearly indicate that jammer radiation induced high fluctuations in heart
rate variability of recovery period (after15 minutes using jammer) and show that the change of
heart rate variability signal during jammer exposure is not permanent. There was no statistically
significant difference observed in heart rate.
Conclusion: The heart rate flection resulting from exposure to radiofrequencies of jammer
are depending on the orientation of both electric &magnetic field of the electromagnetic
radiation, the greater increase in heart rate that occurred during E orientation irradiation.

Background:Sepsis is regarded as one of the most common causes of morbidity and
mortality in neonates despite of recent advances in neonatal intensive care unit technologies.
More than 40% of deaths among children below five years occur in the neonatal period and
this accounts for about 3.1 million newborn deaths each year.
Objective: To estimate the incidence of neonatal sepsis in the neonatal intensive care unit in
Al-Batool teaching hospital in Diyala governorate.
Patients and Methods: A sample of 1200 patients was prospectively collected over a period
of 10 months extending from the 1st of Dec. 2018 till the 1st of Oct. 2019 in the neonatal
intensive care unit at Al-Batool teaching hospital. All the admitted cases with clinical signs
of sepsis at the time of admission or who developed sepsis during their hospital stay were
assessed depending on the clinical and laboratory investigations.
Results: This study revealed that the incidence of neonatal sepsis was 8.8%. There were
significant relationships between development of neonatal sepsis and each of gestational age,
state of amniotic membrane, mode of delivery and maternal fever (p-value = 0.0001 for each).
In addition this study showed that there was insignificant relationship between the development
of neonatal sepsis and gender of neonates, p-value equal to 0.463.
Conclusion: The occurrence of neonatal sepsis depends on the presence of many factors that
could be prenatal, perinatal and postnatal. In addition to that the infection control programs
play an important role in controlling neonatal sepsis in the neonatal intensive care units.
Therefore the incidence rate of neonatal sepsis reflect the quality of the provided health
services in the health institutions and this might explain the relatively accepted rate of sepsis
in our institution in relation to other studies as it was 8.8%.

Background: Respiratory distress is one of the most common causes of admission in
neonatal intensive care unit .
Objective: To determine the causes and to study the various risk factors associated with
development of respiratory distress and outcomes of respiratory distress in neonates admitted
to neonatal care unit of Mukalla Maternity and Child Hospital in Al- Mukalla city,
Hadhramaut Governorate, Yemen.
Patients and Methods: This is a prospective study covering the 12-month period between
April 2018 to March 2019 to neonates admitted to neonatal care unit of Mukalla
MaternityandChild hospital.
Results: A total of 430 patients were admitted to the neonatal care unit. Number of cases
presented with respiratory distress was 250, representing 58.1% of all cases admitted. The most
frequent underlying cause for respiratory distress in children was respiratory distress syndrome
(44%), followed by transient tachypnea of the newborn (18.8%), birth asphyxia (14%),
meconium aspiration syndrome (12%), and other causes (11.2) (CHD 10(4%), sepsis (3.2%),
congenital pneumonia (2.4%), and congenital anomalies (1. 6%). The majority of cases of
respiratory distress syndrome and transient tachypnea of newborn were males with statistical
significant difference. The outcome of neonatal respiratory disorders was: cure in 40.4% of
cases, patients discharged with complications in 10.4 % of cases, and death in 49.2% of cases.
The highest case fatality rate of neonatal respiratory distress diseases were respiratory distress
syndrome (81.8%) followed by meconium aspiration syndrome (56.7% ) and birth asphyxia
(34.3% ).
Conclusion: Respiratory distress syndrome was the main cause of respiratory distress
followed by transient tachypnea of newborn.

Background: Most of the doctors interested in cesarean section and the techniques relate to
these processes. This study aimed to assess the knowledge of women about the method of
delivery in Albatool Teaching Hospital.
Objective: To study the preferred methods of delivery among women in relation to certain
epidemiological criteria.
Patients and Methods: Across sectional study was conducted among women attending in
Albatool teaching hospital including all the women from 1st January during March 2018.
Results: Among 200 women who included in the study, 68.5% of them preferred the vaginal
delivery while the rest preferred the cesarean delivery. In the same context, 57.2% of the age
group below 20 years preferred cesarean delivery, while the age group above 20 years, preferred
vaginal delivery with a percentage of more than 62.7%. On the other hand, the opinions of the
working women and housewife were preferred vaginal delivery with percentages 53% and 84%
respectively.
Conclusion: The results indicated that most women tend to participate with their own doctor
in decision-making on the type of delivery.