Diyala Journal of Medicine

Background: Several studies have demonstrated an association between obesity and
migraine. It’s still unclear whether migraine is the cause or it's the result of obesity.
Objective: We investigated the prevalence of migraine among obese and non-obese
individuals and analyzed the relationship between migraine prevalence and obesity.
Patients and Methods: This is cross-sectional observational study was carried out at the
neurology outpatients’ department of the Rizgary Teaching Hospital in Erbil, Iraq, from July
1st , 2018 to September 30, 2019. We interviewed and examined 300 persons, both obese
(n=154) and non-obese (n=146), and of both gender. All of them were adults (>18 years old).
Each person's weight, height, body mass index (BMI), and waist circumference were
measured.The diagnosis of migraine was made according to the International Headache
Society’s criteria. Obesity was present if the individual’s BMI is ≥30 and/or waist-to-hip
ratio is >0.9 in females and >1.0 in males.
Results: Out of the 300 persons, 14 males (8.5%) got migraines while migraine was found in
37 females (27.4%), irrespective of their weight. Out of the 300 persons, the prevalence of
migraine among obese individuals was 21.4% (n=33) and while in non-obese individuals was
12.3% (n=18). There was a statistically significant difference between the groups (p-
value=0.045). The overall prevalence of migraine was 16.9% of the persons interviewed.
Conclusion: The results showed that migraine is more prevalent among obese persons than
non-obese persons and the difference was statistically significant.

Background: Non-communicable diseases are chronic diseases with long duration resulting
from a combination of many factors like genetic, physiological, environmental, and lifestyle.
Factors like poor diet, lack of exercise, tobacco, drugs, alcohol, family, and environment are
risk factors for non-communicable diseases.Non-communicable diseases have huge
economic consequences due to health care costs and lost economic productivity. Non-
communicable diseases are responsible for 63% of the total death. Modifiable risk factors
due to lifestyle can be controlled or reduced by intervention like lack of exercise, smoking,
alcohol, unbalanced diet while non-modifiable risk factors cannot be reduced or controlled
like age, gender, genetics. Improper maternal nutrition in utero and during the first year of
life is associated with the risk of non-communicable diseases in adulthood. Obesity is now a
public health problem because of strong association with hypertension, coronary heart
disease, type 2 diabetes and stroke.
Objective: To determine non -communicable diseases among patients attending a nutrition
clinic in Baquba Teaching Hospital and to assess the diseases in relation to age, gender,
residency, occupation, and educational level.
Patients and Methods: This descriptive study was conducted in Baquba Teaching Hospital,
a review of patients’ records was done from the start of January 2015 to 31st December 2017.
Data were collected by specially designed questionnaire which includes age, gender, height,
weight, occupation, residency, and educational level. Results presented in tables with
numbers and percentages.
Results: The total number of records were (891) .obesity and morbid obesity (64.2%). Obesity
(52.7%) followed by hypertension (20.3%). Most of the cases were female (66.7%). The age
group of (31-40) year was mostly affected (23.2%). Urban residents (77.2%) of cases .House
wives (48.2%) followed by students (23.1%). (63.8%) of cases were graduated from primary
and secondary school.
Conclusion: Most the cases were obese. Female affected more than male, majority of cases
in the age group below 50 years, urban residents more than rural residents, most of cases
were house wives, matority of cases were graduated from primary and secondary school.

Background: Peyronie’s disease and erectile dysfunction is common related pathological
condition and single treatment for both conditions is the goal.
Objective: To report our practice in the managing of patients with Peyronie’s disease
associated with erectile dysfunction.
Patients and Methods: This study was carried out during the period of 2014-2018, twenty-
one adult patients (39-68) years were treated by malleable penile implant surgery. All
patients presented with Peyronie’s disease associated with erectile dysfunction. The sorts of
additional maneuvers and their achievement in additional straightening the residual curvature
have been stated.
Results: We deliberate medical conditions that have an association between erectile
dysfunction and Peyronie’s disease and performing straightening procedures, modeling was
successful in decrease penile curvature and Patient satisfaction rates 80% for both patients,
partners have been reported in this literature.
Conclusion: However, when Peyronie’s disease exists with ED, the gold standard treatment
is penile prosthesis surgery with additional straightening procedures.

Background: Partial seizure is well-defined as sudden extreme, profligate, and limited
electrical discharges by gray matter from some portions of the brain due to certain structural
& metabolic abnormalities.
Objective: To distinguish the etiologies of partial seizures and to clarify its association with
the age of affected patients.
Patients and Methods: A prospective study, done on all patients with neurological
consultation in Al- Batool Teaching Hospital, Baqubah Teaching Hospital and Al Yarmouk
teaching Hospital from Nov, 2016 to Dec, 2018. Patients with partial seizures and/with
secondary generalization were merged. This was fortified through a full history, physical
checkup, EEG, and MRI of the brain. The study’s sample comprising 106 patients with
partial seizures, the age ranged from 6-75 years, with 52 males and 54 females.
Results: Atypical neuroimaging was found in (61%) of patients. Tumors occurred in (19.7%) of
patients, the highest of them below 40 years of age while infarctions comprised 25.5% of
patients outside this age. Complex partial seizures(CPS) patients with temporal lobe foci
comprised 83.7 % and (16.2%) had frontal lobe problems, while (49%) of Simple partial
seizures (SPS) patients had frontal lobe foci, 22% frontoparietal and 13% had parietal lobe foci
and had brain lesions were spotted in 75.4% of patients with SPS and (35.1%) with complex
partial seizures.
Conclusion: Infarction is a common reason for partial seizures in patients above 40 years
while below this age the tumor is common etiology. A partial seizure is connected mostly
with brain lesions.

Background: Neonatal jaundice is a common problem with a lot of faults that may happen
during its management.
Objective:To study the epidemiological features of the unconjugated
hyperbilirubinemia(UHB)in Diyala Governorate and discuss the proper lines of therapy, as
well as to discuss the daily practice adopted in our hospital, and its complications.
Patients and Methods: A cross-sectional study included 100 neonates (term and preterm
babies) with unconjugated hyperbilirubinemia aged 0-7 days who were admitted to the Al-
Batool Teaching Hospital in Baqubah, Iraq, from 1st February 2018 to the 1st November
2018. Term infants with total serum bilirubin (TSB) ≥ 22mg/dL were treated with exchange
transfusion and phototherapy (Group A, 44 neonates). Those with total serum bilirubin levels
from 13-<22mg/dL were treated with phototherapy only (Group B, 56 neonates). These
decisions were made according to the TSB level and risk factors.
Results: Forty-eight percent of neonates had hemolytic causes (Rh-isoimmunization 13%;
ABO-incompatibility 10%; G6PD-deficiency 25%). Other include: sepsis 8%; prematurity 33%;
congenital CMV infection 1%; and there were 10% had no evidence of hemolysis or other
serious problems. The mortality rate was 3.8% of those who had an exchange transfusion.
Conclusion: The decision of kind of treatment is dependent on the underlying etiology of
unconjugated hyperbilirubinemia.

Background: The tongue can be targeted by a wide range of pathological conditions; the
recognition of tongue lesions may be helpful in the early diagnosis of some systemic
disorders.
Objective: To determine the frequency and relation of the tongue conditions with risk factors
among a group of dental outpatients attending a specialized dental polyclinics center in Erbil
city, for individuals who are aware of their tongue lesion when to exist, and to estimate the
possible coincidence between some of the tongue lesions with age, gender, smoking, alcohol
drinking habit, allergic reactions, and systemic diseases.
Patients and Methods: 1100 patients were examined for a period of 3 months from October
1st
, 2019 – December 31st , 2019.
Results: The frequency of tongue conditions was 52.8%, the study sample consists of 520
males 47.3%, and 580 females 52.7%. The age range was from 0.58 to 85 years, and 112
patients had one or more systemic diseases 92 of them were on regular medications. The most
common frequent condition was fissured tongue diagnosed in 420 patients 38.2%.
Conclusion: The common risk factors for tongue conditions in this study were old age, male
gender, smoking, alcohol consumption, and medication intake, around one quarter (25.6%) of
the sample has a family history of tongue condition

Background: There are many pregnancy complications that are significantly associated with
the gender of the fetus; one of them is preterm labour, which is an important obstetric
problem that may lead to many perinatal morbidity and mortality.
Objective: To find out whether there is a relation between the findings of placental
pathology of premature deliveries and gender difference.
Patients and Methods: Fifty deliveries before a 32 week gestational age. Obstetrical, and
placental histological findings have been compared among all males (n=25), and females
(n=25) premature neonates.
Results: The male premature fetus had distribution rate in maternal age, gestation age at the
time of delivery, placental weight, and feto-placental weight-ratio in females, but a higher birth-
weight centile ([55.09±11.3] versus [43.09±8.2]). Histopathology of the placenta found no
significant association of fetal-sex with acute inflammatory lesions (p=0.09), intra-placental
vascular pathological findings, or utero-placental vascular pathology. However, the chronic
inflammatory lesion showed a higher pathological score in male fetuses than in the females
(p=0.01).
Conclusion: Premature deliveries with less than thirty-two weeks, the male fetal-sex had
higher placental pathological lesions, suggesting maternal immunological responses towards
the invading trophoblasts. The immunological background of these pathological lesions
needs further studies.
Keywords: Male fet

Background: Leukemias are classified as lymphoid or myeloid, dependent on the type of
stem cell that is affected. In addition, leukemia is classified as chronic or acute. Acute
leukemia is a production of bone marrow-derived immature cells (blasts), include solid
organs or peripheral blood. The FAB Cooperative Group original classification scheme
proposed to divide1 ALL into three subtypes (L1 - L3). Currently, the world health
organization (WHO), modify FAB classification depending on immunophenotype.
Symptoms presence of anemia, splenomegaly, and thrombocytopenia, and those are naturally
present at diagnosis, indicating the degree to which leukemic lymphoblasts have replaced the
bone marrow and the first mark to an ALL diagnosis is typically an abnormal complete blood
count result.
Objective: To introduce causes of acute lymphocytic leukemia, recent classification
methods, diagnosis, and symptoms and diagnosis.
Conclusion: Acute lymphocytic leukemia occurs due to a defect in the bone marrow and is
classified into several types. The most important classification by the World Health
Organization is depending on immunophenotype. The main symptoms are the increase in
white blood cells with anemia and thrombocytopenia.

Background: Gastroenteritis is the second leading cause of death in children under five
years old. The highest mortality from diarrheal diseases in children lived crowded areas were
poor sanitary and hygienic conditions found.
Objective: To determine the co-infections between human astrovirus and Cryptosporidium
spp. among children with gastroenteritis below 5 years of age in the Diyala governorate.
Patients and Methods: A cross-sectional study was carried out for 100 patients with acute
gastroenteritis who attended the Emergency Department of Pediatrics in Al-Batool Teaching
Hospital for Maternity and Pediatric in Baqubah city, during the period from July 2019 to
February 2020. Real time-PCR was used to detect human astrovirus while enzyme- linked
immunosorbent assay was used to detect Cryptosporidium spp. A specific formula sheet was
used to collect demographic data such as age, gender, mother education, and type of milk
feeding.
Results: Out of 100 samples, 14 samples were positive for human astrovirus and 38 samples
were positive for Cryptosporidium. The infection rate is more common in males (9 cases)
(25cases) rather than females, and in age group less than years 11(78.58%) and 34(89.47%)
respectively. Artificial feeding showed higher frequencies of infection than others in the
study population. Co-infection astrovirus and Cryptosporidium found in four patients, all of
whom were males aged under one-year and the difference was statistically significant with
all parameters.
Conclusion: A high proportion of positive cases for human astrovirus and Cryptosporidium
spp. were notes in males and the age group less than one year’s co-infection showed high
frequency in the study population.

Background:Myocardial ischemia is associated with apoptosis of cardiomyocyte and
because of apoptotic cell death is characterized by externalization of Phosphatidylserine on
the cell membrane, so it is amenable to targeting by Annexin V.
Objective: To compare plasma concentrations of Annexin V in patients who had an early
infarct with patients without infarction. And to analyze the plasma concentration of Annexin
V in relationship to cardiovascular risk factors.
Patients and Methods: A Case-control study of 100 patients (case) who are diagnosed with
Myocardial Infarction (MI) and admitted to the coronary care unit of Baqubah Teaching
Hospital and another 100 patients homogenous in terms of age and gender and who attended
the hospital for other cause than myocardial infarction is selected as the control group during
a period between the first of April and the first of July 2019. A special questionnaire used to
collect the required information, an early morning blood sample is taken to measure the level
of Annexin V by ELISA, Student’s t-test, ANOVA test and Chi_square test to find an
association and differences between variables.
Results: The results showed that The mean Annexin V level is significantly higher in cases
(10.48155ng/ml) than control (1.28803ng/ml) with p-value =0.001 and a sample taken within 24
hours after MI is significantly higher in the mean level of Annexin V then the sample taken after
24 hours of MI.
Conclusion: Generally, the measurement of Annexin V level has provided a good diagnostic
test to evaluate myocardial infarction.

Background: Lichen planus is a common chronic inflammatory disease of the skin and
mucous membranes. Oral Lichenoid Reactions (OLRs) comprise a group of lesions with
different causative factors such as systemic medication, dental restorative materials, foods, or
flavoring agents. Pathologists often group these conditions under the umbrella term of
„lichenoid processes‟.
Objective: To provide prevalence and demographic distribution of Oral Lichen Planus
(OLP) and OLR among a sample of patients.
Patients and Methods: This cross-sectional study was conducted in the Khanzad Teaching
Center and Erbil Dermatology Teaching Center. The diagnosis of patients with OLP and
OLR were suspected clinically and histopathologically confirmed. Eighty patients of OLP
and OLR have been enrolled from both centers. Detailed case histories and clinical
presentations were recorded through a questionnaire.
Results: Among those patients, 60 (75.0%) were diagnosed as OLP, and 20 (25.0%) patients
diagnosed as OLR. Their mean age ± SD was 49.01 ± 11.22 years. Bilateral buccal mucosa
(83.8%) was the most affected sites in both groups. The most common clinical types were
reticular (90%), and erosive (33.8%). Only 7 patients (8.8%) had an associated skin lichen
planus (SLP).
Conclusion: The present study revealed that the buccal mucosa was the most affected site,
followed by the tongue and palate. The reticular type was the most common affected type
followed by the erosive type

Background: Recurrent aphthous ulcers are the most common oral lesion. They are
classified into minor, major, and herpetiform ulcers. More than 85% of recurrent aphthous
stomatitis presents as a minor ulcer. Hyaluronic acid is a biomaterial and it is a major
carbohydrate component that can be found in many tissues and recently introduced as an
alternative approach to enhance wound healing. Triamcinolone acetonide is a synthetic
corticosteroid and it has two forms for topical use cream (0.1%) and ointment (0.1%).
Objective: To make a comparison between the effectiveness of hyaluronic acid (0.2%) and
triamcinolone acetonide (0.1) in the management of recurrent aphthous ulcer.
Patients and Methods: We recruited eighty patients who had a history of recurrent aphthous
stomatitis and when presented with current oral ulcer and randomly divided into two groups,
one group received hyaluronic acid, and the other group received triamcinolone acetonide.
The instruction was given to all patients to apply the agent to the aphthous ulcer 4 times per
day for 6 days (day 0 to day 6). The severity of pain was assessed by using VAS and the
change of the ulcer surface area measured.
Results: Eighty patients with aphthous ulcers have participated in the study, 43 were treated
with hyaluronic acid, 37 were treated with triamcinolone acetonide. There was a significant
difference between the two groups regarding ulcer surface and after three and six days, the
diameter of the ulcer in the hyaluronic acid group was significantly reduced in comparison with
those of the triamcinolone acetonide group (p < 0.001). Regarding VAS for pain, there was a
significant difference after three and six days, hyaluronic acid group had significantly less VAS
than those of the triamcinolone acetonide group (p = 0.004 and p < 0.001 respectively).
Conclusion: Hyaluronic acid is more effective than triamcinolone acetonide when used in
the treatment of recurrent oral ulcers in reducing pain and surface area of the ulcer.

Background: Mumps caused by paramyxovirus in the same group as parainfluenza and
Newcastle disease virus, orchitis is the widely recognized complication in post-pubertal
males. Approximately 50% of patients with orchitis have some degree of testicular atrophy,
but sterility is rare.
Objective: To demonstrate the effect of the post-pubertal mumps infection on the result of
seminal fluid analysis and to know if infection by mumps after puberty can lead to
immunological infertility and production of anti-sperm antibodies.
Patients and Methods: Cross-sectional study in which 300 infertile males attending
microbiology laboratory in Rizgary teaching hospital in Erbil city in Iraqi Kurdistan from
November 2017- September 2018. Questionnaire was prepared for each male which
included: name, age, occupation, history of mumps infection after puberty. Seminal fluid
collected from each patient after 3 days of abstinence and analyzed according to WHO
guidelines. Seminal fluid and serum obtained from each infertile male for the detection of
anti-sperm antibodies by ELISA (enzyme-linked immunosorbent assay).
Results: The mean age of the participant in the study was (32.805 year) with the maximum and
minimum age was (50, 18) years respectively. The incidence of post-pubertal mumps was
(13.3%) and the incidence of abnormal seminal fluid analysis was (10%) and the highest
abnormal seminal fluid variables among infertile males with post-pubertal mumps was
oligoasthenozoospermia (43%) and the anti-sperm antibodies in the semen of infertile males
with post-pubertal mumps infection was (60%) while the frequency of anti-sperm antibodies
in the serum in infertile males with a history of post-pubertal mumps was (40%) which was
higher than those with no history of post-pubertal mumps with highly significant relation
statistically.
Conclusion: Abnormal seminal fluid analysis result may be due to post-pubertal mumps and
it can lead to (Asthenozoospermia, Oligospermia, and Teratozoospermia). The highest
percentage of abnormal seminal fluid variables was Oligoasthenozoospermia the occurrence
of anti-sperm antibodies can be the sequence of post-pubertal mumps and by itself can lead
to abnormality in the seminal fluid analysis. Mumps can lead to male infertility by affecting
the seminal fluid parameters and also by the production of anti-sperm antibodies which can
lead to subfertility in adult males.

Background: Proximal humerus fractures represent 4-5% of over-all fractures. In patients
above 40 years of age, it accounts for 75% of all humerus fractures. Fractures of the proximal
end of the humerus oftentimes represent a management dilemma with the multiple surgical
options available to deal with them.
Objective: To evaluate the functional and radiographic outcomes of the percutaneous
pinning techniques in the management of two-part and three-part proximal humerus fracture.
Patients and Methods: A case series of 25 patients, functional outcome was determined by
ASES and Constant scores and multiple radiographic views were taken to assess the fracture
union, mal-union, and the presence of avascular necrosis.
Results: ASES score of the whole group was 87.27 while the mean Constant score was 79.04.
Only 16% of the entire group developed varus malunion (defined by Neck-Shaft-Angle
<=120degrees). Moreover, 16% of the whole group developed OA of the glenohumeral joint.
Conclusion: This study supports that the percutaneous close reduction and pinning technique
is an effective and reliable surgical technique in the management of closed two-part and
three-part proximal humerus fractures in adults. Appropriate preoperative planning is
important to achieve a successful surgical result, and regular postoperative follow-up and
rehabilitation are essential to get an optimum functional outcome.

Background: Blunt abdominal trauma is a common problem in our country.Some of the
cases had been explored on no bases which were negative by FAST(focused assessment with
sonography of trauma)FAST is a tool to detect intra-abdominal collection.
Objective: To appreciate the value of (FAST) in blunt abdominal trauma.
Patients and Methods: This study performed by a collection of 100 cases of blunt
abdominal trauma admitted to the emergency department at Baquba Teaching Hospital from
the period 1st January, 2013 to 31st December 2013 fast performed on all cases to detect any
intra-abdominal collection, then correlation with this result and laparotomy or conservative
results.
Results: Out of 100 patients, Twenty seven cases had intra-abdominal collection and seventy
three cases had no intra-abdominal collection by fast, 27 cases were positive and one case false
positive and 73 cases were negative and 2 false-negative results and 71 true negative. The
sensitivity was 92.8 % and specificity 98.6%. The positive predictive value was 96.2 % and
negative predictive value 97.2 % and the accuracy 97 %.
Conclusion: Focused assessment sonography of trauma can detect intra-abdominal fluid
accurately and rapidly, FAST potentially valuable tool for better assessment of trauma in the
emergency department.

Background: Candida spp. is the yeast caused infection termed candidiasis; this is naturally
found on the skin and inner the body, in an area like the gut, intestines, throat, vagina, and
mouth, with the absence inciting any problems. Candida albicans is yeast naturally found in
the skin; intestinal tract; vaginal and mouth. This is a polymorphic yeast (that capable of
growing either as avoid shaped budding yeast, when it affect the mouth, it is typically termed
oral thrush, and when it affect the dermal (diaper area) called diaper rash. clinical signs and
symptoms involve white patches on the or other areas of the mouth and throat, `other signs
may involve soreness and problems of swallowing.
Objective: To study detection, isolation, and identification of C. albicans from infants in
Al-Battol Teaching Hospital in Diyala Province by routine laboratory procedure, and
identification of other species of Candida.
Patients and Methods: Two hundred samples were taken from infants less than 2 years who
attended Al-Battol teaching Hospital in Diyala, province during the period from October
2019 to February 2020. Method of this study by making a routine and confirmative diagnosis
processes involve a microscopic examination, culture on Sabouraud’s dextrose agar for
diagnosis of primary invasive candidiasis, and culture on chrome agar for differentiating
between C. albicans and other spp.
Results: The results of this study showed the isolates of oral samples were 12 (24%) C.
albicans and 18(36.0%) C. non albicans; for dermal isolates were 10(20.0%) C. albicans and
17(34.0%) C. non albicans; and for both isolates oral and dermal samples were 13(26.0%) C.
albicans and 21 (42.0) C. non albicans.
Conclusion: In this study found that the male are more infected by Candida than female.
And also we concluded that small age children more infected than large age.

Background: Inflammation causes a rise in the levels of certain proteins; these proteins are
identified as acute stage proteins and one of these proteins is C-reactive protein (CRP). CRP
composed of 206-amino acid of the short pentraxin family.
Objective: This review assessed CRP as an inflammatory indicator that has an important role
in the host's defense against infection and also it is documented the pivotal role of this
protein during infections with different parasites.
Conclusion: This review is hypothesizing that CRP levels rise during infections caused by
parasites. Other studies revealed that there is no association of soil-transmitted helminths
infections with the increasing levels of CRP

Background: Prolonged urinary leakage after nephrostomy tube removal leads to increased
morbidity of PCNL and increased hospitalization.
Objective: To evaluate factors affecting post nephrostomy removal urinary leakage after
percutaneous nephrolithotomy.
Patients and Methods: One hundred eight (108) patients older than 18 years who underwent
PCNL were studied prospectively. The reasons that can affect urinary leakage
postoperatively were divided into 4 categories according to individual factors including age,
gender, and body mass index; Renal factors; including, previous operation, history of ESWL,
parenchymal cortical thickness, and grades of hydronephrosis; stone factor (stone burden);
and surgical factors including the number of tracts, presence of double J stent, nephrostomy
tube diameter and stay duration. These data were compared for postoperative urine leak.
Results: Urinary leakage was revealed in 76 of 108 patients (70.3%). There was no statistically
significant relationship between individual factors and urinary leakage (P >0.05). Among renal
factors, just parenchymal cortical thickness and grade of hydronephrosis were strongly related
to the urinary leakage (P <0.001). The renal stone burden did not affect urinary leakage (P
>0.05). Among surgical factors, placing of ureteral double-J stent highly minimized the
incidence of urinary leakage (P<0.001), and the urinary leakage significantly correlated with the
increased diameter of the nephrostomy tube and staying duration (P<0.05).
Conclusion: After PCNL surgery, some factors show to influence post-PCNL urinary
leakage. however most of the urinary leakage was treated conservatively, but it increases
morbidity and hospitalization.

Background: The optimal treatment of ureteral stones, particularly the lower ureteral stone,
still controversial[5,13,15,18].
Objective: To assess the success rate of ESWL and tamsulosin in lower ureteral stone. Also
to identify the parameters that affects the success rate of ESWL in the lower ureteral stone.
Patients and Methods: Prospective study has been done on thirty-six patients sequentially
selected from referred cases to the ESWL department in Sulaimania Teaching Hospital in the
period from June, 2010 to January, 2011). All had radioopaque lower ureteric stone (from the
lower border of sacroiliac joint to uretero-vesical junction). Stones ranging from (5.8
to14mm), twenty in the left side and sixteen in the right side , age ranging from (10 to 78
years), and only four of them had double J-stent (within 1 week before ESWL). Weekly
follow up of all patients were done by U/S and twice-weekly by KUB for 6 weeks.
Results: Twenty four cases (66.7%) were free of stone, five cases (13.9%) had residual stone
and seven cases (19.4%) failed to respond, the most important two parameters that affect the
result are the size of stone and number of sessions.
Conclusion: ESWL is safe and useful, and it is considered to be the first favorable line of
intervention for lower ureteric stones after failure of watchful waiting and medical expulsion
therapy especially those without complications like obstruction.

Background: Chemotherapy is used to treat approximately 70% of cancer patients. Oral
complications secondary to chemotherapy are recorded in about 80% of hemato–oncologic
patients, these complications affect the patients’ quality of life and could sometimes be fatal.
Objective: To describe the oral manifestations secondary to chemotherapy medication in
hemato-oncologic patients and to determine which of those oral manifestations is more
common.
Patients and Methods: A sample of 190 patients presented to Nanakali Hospital for blood-
related diseases and cancer in Erbil. The age range of the patients was 3-80 years, (mean
38.35 ± 22.62). Various types of malignancies, types of chemotherapy, and oral
manifestation secondary to chemotherapy were recorded.
Results: The most common type of cancer presented was leukemia (37.9%). In patients
undergoing chemotherapy, the recorded oral manifestation was mucositis, xerostomia, fungal
and viral infection. Mucositis was the most common, being recorded in 46.3% of the subjects.
Conclusion: The results highlight the importance of the presence of a specialist in Oral and
Maxillofacial Medicine working in coordination with the medical team to take care of the
patients before, during and after chemotherapy. This multidisciplinary team can decrease the
frequency of occurrence of oral manifestations, and can even assist in early diagnosis and
management of oral lesions in case oral manifestation occurs.

Background: Psoriasis is a common chronic inflammatory condition that affects mainly skin
and joints which has a genetic and immunological background with unknown etiology.
Objective: To determine the prevalence of oral findings and possible association with
disease severity in psoriatic patients attending the Erbil Dermatology Teaching Center in
Erbil city, Kurdistan Region-Iraq.
Patients and Methods: This cross-sectional study was conducted on 120 cases of psoriasis
attending Erbil Dermatology Teaching Center in Erbil city, Kurdistan Region-Iraq. Psoriasis
Area and Severity Index (PASI) scored was used for each patient and all participants were
examined for observing oral lesions. The Statistical Package for Social Sciences (SPSS,
version25) was used for analyzing the data. Chi-square test and Fisher’s exact tests were
applied as descriptive statistics tests. A p-value of ≤ 0.05 was considered statistically
significant.
Results: Among the 120 cases, 50 cases were males and 70 were females, their mean age ± SD
was 30.24 ± 14.82 years, and the age range was 6-65 years. Oral lesions were detected in 50
(41.7%) cases, and the most common oral findings were fissured tongue 39 (32.5%) cases and
geographic tongue 5 (4.2%). The Psoriasis Area and Severity Index (PASI) score for the
majority of the cases were mild and the oral manifestations were strongly associated with the
disease severity (p = 0.001).
Conclusion: Both fissured tongue and geographic tongue are the two most frequent oral
findings in psoriatic patients in this study, the prevalence of these findings increased with the
disease severity. Routine examinations of the oral cavity are necessary for all psoriatic
patients.

Background: Diabetes mellitus is the largest endocrine disorder in the world that refers to
chronic hyperglycemia caused by impairment in both insulin secretion and action. Folate,
vitamin B12, and vitamin D deficiency are related to the prevalence of type 2 diabetes
mellitus.
Objective: This study has been carried out to investigate the role of folate, vitamins B12,
and D status during the progression of diabetic type 2 patients compared to non-diabetic
control subjects.
Patients and Methods: We measured the plasma levels of folate, vitamins B12, and D,
along with blood glucose, HbA1c, and oxidative biomarkers in 50 diabetic type 2 patients and
50 healthy subjects used as a control group.
Results: The findings revealed that the serum level of malondialdehyde (MDA) significantly
increased in diabetic patients compared to healthy subjects, and the serum level of nitric oxide
(NO) in T2D patients lower than in control. The concentration of vitamin D, B12, and folate in
T2D patients significantly lower than non-T2D control. The results also showed a significant
relationship between serum vitamin D, MDA, and NO with HbA1c, while there was an
insignificant correlation between vitamin B12 and folate with HbA1c.
Conclusion: The oxidative biomarkers and vitamins D, B12, and folate level can play an
important role in the development and progression of T2D.

Background: Acute appendicitis is the most common emergency condition that faces the
surgeon worldwide. The overall lifetime risk of having acute appendicitis is estimated to be
6–7 %, with a peak incidence between 10 and 30 years. Early and sometimes immediate
appendicectomy is standard, fearing the risk of pathological progression into perforation,
gangrenous appendicitis, and abscess formation. However, recently, this practice has been
challenged by authors giving a suggestion that appendicectomies can be delayed in some
cases and still devoid of adverse postoperative outcomes.
Objective: This study aimed at comparing the two groups regarding the following
postoperative outcomes: WBC count on a postoperative day one, time last to a soft liquid
diet, rate of complication, length of in-hospital stay, and the need for admission within 30
days of doing the surgery.
Patients and Methods: This is a prospective randomized study of 341 patients (196 male
and 145 female) who underwent appendicectomy over a period of eleven months (May 2019-
March 2020) in Baquba Teaching Hospital in Diyala Governorate. The patients categorized
into two groups for making the comparison (all underwent appendectomy): group A: 181
patients (male 108, female 73) include those who are operated on within 8 hours of arrival to
the hospital and group B: 160 patients (male 81, female 79) include those who are operated
on after 8 hours of arrival to the hospital. The patients in the two groups were compared
regarding the following postoperative outcomes as WBC count at day one postoperatively,
time duration to a liquid diet, rate of complication, length of in-hospital stay, and finally, the
need for readmission during the first 30 days of doing the surgery.
Results: Regarding the mean white blood cell count at the first postoperative day, it was lower
for group B. than that for group A (p-value 0.0018). With regard to the timing of starting having
liquid diet, there was no significant difference, and the patients in the two groups started oral
liquid diet within the first 24 hours (p-value 0.0715). There was no significant difference
between the two groups regarding the immediate and early postoperative complication rate;
0.02% in group A and 0.37% for group B (p-value 0.4022), the length of postoperative hospital
stay was the same for the two groups, ranging between 2 days and less than one day (p value
0.0826). There was no significant difference between the two groups regarding the need for
readmission within 30 days, 0.016% in group A and 0.025% in group B (p-value 0.9984).
Conclusion: This study concluded that delayed appendicectomy was safe and feasible for
patients with uncomplicated appendicitis. Despite that the clinical outcomes of del

Background: The Fistula disease is considered common surgical case in the surgical wards
of the Baquba teaching hospital, and consider as a complication of the anorectal abscess.
Objective: To investigate the incidence of cases that infect with fistula in ano in subsequent
to different types of anorectal abscesses.
Patients and Methods: This study performed in the Baquba teaching hospital in a period
from January 2016 until Jun 2018 including 216 patients (124 male and 92 female); all
patients were included in the study . Samples of the patients classified into three groups
according to the type of management.
Results: The results show that the high incidence of fistula in ano is appearing in patients
associated with hemorrhoids 8.84%, and high percent in patients who had a perianal abscess
(63.48%) Regarding the distribution of cases according to age and sex, a low percentage of
cases appear in age (1-10) with 6.45% and 2.18% in males and females respectively. While the
highest percentage appears in the males at age (21-30) with 37.11% and in females is at the age
(11-20) with 29.35%. And by the chi-square value for males is 16.37 and for females is 9.94 in
a significant value of p=0.01 and p=0.05 respectively.
Conclusion: Fistula in ano can be associated with cases have hemorrhois, and more present
with patients who have a perianal abscess, and the early drainage of the abscess can prevent
development of the fistula.

Background: Immunization is today one of the safest, most cost-effective, and powerful
means of preventing deaths and improving lives. Over the years, all countries of the world
have incorporated an increasingly broad immunization agenda in their public health
interventions.
Objective: To assess the coverage rate of routine vaccination among selected sample of
children under five years of age in the Baquba City, and to determine the relationship
between routine vaccination coverage rate and some socio- demographic factors in addition
to the causes for in-complete or un-vaccination.
Patients and Methods: A cross sectional study was conducted in the Baquba City, center of
Diyala Province, for the period from 1/9/2016- 1/2/2017. Data of vaccination coverage of
children less than 5 years of age was extracted from child' vaccination coverage card or by
recall information from mothers attending Al-Batul teaching hospital and some PHC centers
in Diyala province.
Results: A total of 130 cases were studied, of them 23.1% (30) cases were fully immunized
(they had been given all the vaccines required for their age in the immunization schedule).
Partially immunized were found in 71.1 % (95) and 3.8% (5) cases of them were un –
vaccinated. High statistically significant relationship was found with gender, and non –
significant relation with age, residence, displacement and location of health center. Low
awareness of mother to the schedule, congenital anomalies and family instability were main
causes for non-vaccination.
Conclusion: The rate of fully immunized children was low in comparison with those of
partially immunized, and a low rate for non-vaccinated children. Hence, it is important to
promote vaccination system by the efforts of health officers and the community.

Background: Breast cancer remains as the most common malignant neoplasm in females
and one of the main life-threatening diseases, this long-term follow-up study under run for
patients of carcinoma of the breast.
Objective: To gain practical feedbacks from the progression and fates of the patients who
had been managed by the standard is previously known international guidelines.
Patients and Methods: This retrospective study involved (40) breast cancer cases In Erbil-
Iraq for more than 15 years. Checkup tools were clinical examinations, laboratory
investigations, and images for recurrence and metastasis. The following parameters had been
studied; Age, clinical presentation, histopathological diagnosis, staging and management
including surgeries, further adjuvant therapies and survival rates by periodic follow-up both
in hospital and home visits.
Results: The results of this study showed that the left breast affected more frequently by 2:1
than the right. In 85% of patients, 1st presentations were in the 1-3 months and in stage II. Age's
distribution was mainly between 31-60 years. Only 6 (15%) cases showed positive family
history. The most common histopathology type was infiltrative ductal carcinoma 27(67.5%) and
the prominent grades were (GII and GIII). Molecular based distribution of (Luminal B) was the
biggest immunohistochemical type. About 70% of the cases were managed by quadrectomy or
simple mastectomy and/or Axillary clearance. By (15) years follow-up (42.5%) cases lived
between 5 to 10 years, and another (17.5%) survived above 10 years. No relation found between
the cope of patients with her malignancy and course of the disease.
Conclusion: In the future, we have to concentrate on middle age and more scientific
educations as they are most affected by (IDC) with advanced searching management routes.
Older patient’s carcinoma convention was less aggressive than younger, their life expectancy
longer after diagnosis and treatment options. In the young group patient's tumor was more
aggressive. Anyhow, breast cancer character remained unpredictable for various involved
factors complexity and physiological variability of females. Recurrences, metastasis, and
survival depend on familial and environmental code factors. Delay diagnosis is still a disaster
in this locality that interferes with better results.