Diyala Journal of Medicine

Background: Heart failure represents a major health problem leading to considerable
mortality morbidity. High total homocysteine concentrations have been related to increased
risk of atherosclerosis and its sequel, including coronary heart disease, cardiovascular
mortality, and stroke. Brain Natriuretic peptide is a member of a group of peptide hormones
similar in structure, used as a specific marker for diagnosing heart failure. This marker
increases gradually with the progression of the grade of heart failure.
Objective: The current study aims to measure and investigate the difference in the level of
homocysteine between patients with heart failure and without, to find the relationship
between the level of homocysteine and grade of heart failure, and to find out the correlation
between homocysteine levels with Brain Natriuretic peptide levels.
Patients and Methods: This case-control study involved 200 participants, 100 patients with
a history of chronic heart failure, and 100 control participants.A self-constructed
questionnaire form prepared to collect selected variables, the participant’s weight, height,
temperature, electrocardiography measured by trained staff, Brain Natriuretic peptide used as
a specific marker for diagnosing heart failure. Blood samples were taken early in the morning
from the patient and control groups, after at least 12-hours of fasting and a 20-minute rest.
Analysis of all samples of blood was performed in the Biochemistry Laboratory of Baqubah
teaching hospital to measure the levels of homocysteine by Human Homocysteine ELISA kit.
Results: The sample was selected homogenously in terms of age and gender. Overweight,
obesity, current and ex-smoker, history of hypertension, and history of diabetes mellitus were
significantly higher in patients with heart failure than control. The fasting mean homocysteine
level was significantly higher in patients (20.049nmol/ml) than in control (2.734nmol/ml).

Background: More than one billion people worldwide are affected with anemia. Studies
have shown that nutritional deficiency, particularly a decrease in iron-rich food consumed,
seems to be the most common cause of anemia.
Objective: To study some demographic characteristics of anemia in children of different
residencies of Diyala governorate/ Iraq.
Patients and Methods: A cross-sectional descriptive study piloted in Al-Batool Teaching
hospital in Baqubah / Diyala- Iraq from February 1st to Sept 30th 2019. Children was
categorized according to the residency into two groups (rural & urban regions), anemia was
sorted according to WHO classification: normal Hb 11 gm/dL, mild anemia 10- 10.9 gm/dL,
moderate 7- 9.9 gm/ dL, and severe anemia Hb < 7 gm/dl.
Results: One hundred seventeen children aged 6 months – 9 years were included in the study;
58.1% males and 41.9% females, 104 children 88.9% were less than 3.5 years, and 13 (11.1% )
children of 3.5 years and more. Sixteen children 13.7% were having normal Hb level and the
remaining was anemic as follow: 35.9% mild anemia, 46.1% moderate anemia, 4.3% severe
anemia, p-value 0.000. It was found that 57.3% of children belongs to family lived in urban
areas, while 50 (42.7%) of them live in rural areas. The number of children who had moderate
anemia was more in rural areas, p-value 0.008.
Conclusion: Most of the studied children had a moderate degree of anemia and this might be
due to many factors, including a residency in rural areas.

Background: A four trocar laparoscopic cholecystectomy become the standard procedure
since the first laparoscopic procedure was reported. But laparoscopic cholecystectomy has
gained many steps such as reduction in port number and size.
Objective: To compare Clinical results from three ports versus the traditional four ports in
laparoscopic cholecystectomy.
Patients and Methods: A prospective randomized clinical trial of 100 patients was done on
those who were admitted for elective laparoscopic cholecystectomy in Baquba teaching
hospital, between April 2014 and March 2015, patients were classified into two groups (A)
for three ports and (B) for 4 ports. Variables such as, complications, operative time,
postoperative pain, nausea, and vomiting were assessed.
Results: One-hundred patients were included in this study, age of them ranged from 18-70 year
and a male to female ratio was 1:9. There were no significant differences in demographic data
between the two groups. Postoperative pain, analgesic requirements, nausea and vomiting, and
hospital stay were slightly more in group B but statistically not significant. Postoperative return
to activity was shorter in group A 6.10 versus 7.00 days for group B with (p= 0.021) which is
statistically significant. There is no difference in the rate of complications.
Conclusion: Three ports laparoscopic cholecystectomy is feasible as an alternative for four
ports without any significant complication.

Background: Visual cephalometric analysis is a simple, logical, and accurate diagnostic tool
for the student, the clinician, and the researcher. The analysis is elicited from two geometric
constructs, the Tetragon and the Trigon.
Objective: To determine the cephalometric norms as per Fastlicht’s analysis for male and
female subjects of the Kurdish population and to compare these cephalometric norms with
Fastlicht’s norms, average Caucasian norms, and Iraqi (non-Kurdish) norms.
Patients and Methods: The cephalometric radiographs of 63 individuals, 25males, mean age
23.01 ±2.9 years, and 38 females, mean age 23 ± 3.2 years, were selected. FACAD 3.4.0.3,
an orthodontic tracing software for cephalometric analysis and treatment planning, was used
to digitally trace the reference points and reference lines for the tetragon analysis.
Results: The statistical differences between the data of the Iraqi Kurdish population and the
data of Fastlich, average Caucasian, and Iraqi non-Kurdish population were significant.
Conclusion: The data of the Kurdish population is different from that of Fastlich and non-
Kurdish Iraqi data. It is recommended to use this study's findings to get a more accurate
result for the Iraqi Kurdish population when using tetragon analysis.

Background: Type 1diabetes (T1D) is immune-mediated disease that presented as a
consequence of the gradual destruction of the insulin- producing beta cells, which in results
total beta-cell loss and complete dependence on exogenous insulin.
Objective: To explore the potential environmental risk factors associated with the
development of T1D among children.
Patients and Methods: This case-control study was conducted in the pediatric department of
Albatool teaching hospital in Diyala province, Iraq. A hundred children diagnosed with
diabetes mellitus type1 (cases) and hundred children (controls) without diabetes during the
period between February 2020 to May 2020. Data collection was done through interviewing
parents’ or the caregivers of children directly using a questionnaire that was used before for
study T1D. the target population was the children attending the outpatient clinic of the
endocrine pediatric department of Albatool teaching hospital. A total of 200 children were
included in the study. Computer software SPSS (Version 25) and Microsoft Excel (2016)
were used to carry out the statistical analysis of data.
Results: The results show Children who had insufficient family income had the highest risk for
developing T1D (p<0.001), and children born to low educated parents, especially illiterate
parents, had a risk to develop T1D (p< 0.001), followed by children whose parent had a history
of consanguinity had a high risk for developing T1D (p=0.004). Children born to older mothers
had a higher risk for developing T1D (p=0.04). Children with cesarean section delivery had

Background: Febrile seizures are common and mostly benign. There is growing evidence
that ketone bodies derived from fatty acid oxidation during fasting or consumption of high-
fat diets can exert broad neuroprotective effects, including anti-convulsant effects.
Objective: To determine the characteristics of febrile convulsions and the relationship
between ketonuria and febrile convulsions.
Patients and Methods: A cross-sectional comparative study was done between May 2018 –
December 2019 at Al-Batool teaching hospital. The data included 100 children aged between
(6- 60 months) admitted to the emergency unit, 50 % of them were having a febrile
convulsion, while the others were presented with fever without a seizure. Blood samples
were measured for serum glucose and urine samples were taken for level of ketone bodies
(KB) and analyzed by reagent strip test. Statistical analysis was done by using SPSS version
21, level of association between variables was tested by Chi-square at 0.05.
Results: Febrile convulsions occur equally in males and females and more likely in children
less than 18 months of age (P value=0.157). Causes of fever in children with febrile convulsion
were mostly respiratory causes (p value=0. 000). The incidence of hypoglycemia and ketonuria
were slightly more common in the non-convulsive group of the study to be statistically
insignificant (p- values were 0.169 and 0.275, respectively).
Conclusion: The febrile convulsions affect equally males and females and the major cause of
fever was respiratory infections. There is no significant relationship between ketonuria and
the occurrence of febrile convulsions.

Background: Rheumatoid arthritis is a systemic autoimmune inflammatory disease that
causes joint deformity, including erosion of bone, and narrowing of the joint space.
Osteoporosis is more prevalent among rheumatoid arthritis patients than in the general
population.
Objective: To determine changes in the bone mineral density in rheumatoid arthritis patients
and to evaluate factors were associated with bone mineral density.
Patients and Methods: In this study, 70 cases with rheumatoid arthritis were included and
70 healthy subjects on the other hand as a control group. The data were collected including
socio-demographic information of all patients’age, gender, medical histories included
systemic diseases, types of biological agents, use of supplements, duration of the disease,
smoking, and regular exercise. Bone mineral density was evaluated by using bone
densitometry in two areas including Lumber 1 to lumber 4 and neck of the left femur.
Statistical analyses were performed by using Statistical Package for Social Sciences (SPSS)
version 22; Fisher’s exact test and Chi-square test Student’s t-test of two independent
samples was used to comparing two means. A p-value of ≤ 0.05 was considered statistically
significant.
Results: In the rheumatoid arthritis group according to T-spine scores the prevalence of
osteoporosis was 22.9%, osteopenia was 42.9% and normal bone mineral density was 34.4%
compared with the control group 4.3%,42.9%,52.9% successively which were statistically
significant difference between the two groups (p = 0.003). According to femur neck T-scores in
the rheumatoid arthritis group, 17.1% had osteoporosis, 34.3% had osteopenia and 48.6% had
normal bone mineral density compared with the control group 2.9%,24.3%,72.9 respectively
which were statistically significant difference between the two groups (p = 0.003). lumber spine
was the commonest site affected by osteoporosis (16 cases,22.9 %)and the second most
common site was the femur neck (12 cases ,6.6%). The cases of 50 years and older were most
commonly affected by osteoporosis (p-value = 0.0001). No significant association was detected

Background: Hernia is an unusual bulging of the intra-abdominal viscera through a weak
area of the abdominal wall or groin region. Inguinal hernia repair is one of the most
frequently performed surgical procedures. In recent years, inguinal hernia (IH) repair was
changed from pure tissue repair to prosthetic laparoscopic repair.
Objective: we propose to find a new application for the well-known surgical open mesh
inguinal hernia in the treatment of inguinal hernias in adults aiming to improve patients'
comfort and to reduce the incidence of chronic neuralgia.
Patients and Methods: . A comparative study was designed to study the outcome of
different sizes of mesh used in the hernia operations. In the present study, patients diagnosed
with primary unilateral inguinal hernia (n=130) were enrolled from May 2019 to March 2020
at Baquba teaching hospital in Diyala governorate. Enrolled patients were divided into two
groups. Group A include patients who have inguinal hernia operated with all in one
procedure (n=65) and group B included patients with inguinal hernia operated by the
classical method (n=65). Spinal and general anaesthesia were used. Before incision for the
patient, ceftriaxone (1gm, intravenously) was administrated over 30 min. The process was
accomplished on a one-day surgery basis .According to the devised technique, a new smaller
prosthesis was placed on the floor of the inguinal canal in order to strengthen all areas of
weakness from which hernias may originate. The mesh was enveloped by a fibro-
cremasterico sheath avoiding contact with neural structures. Follow-up was carried out at
1week, 1month, 3months for evaluation of postoperative pain using numbering scale score,
need of medication, patients' comfort, and postoperative complications.

Background: Vaginal microbiota considered as a complex microbial population consisting
of a multitude of microbial species and causes many vaginal infections including bacterial
vaginosis.
Objective: The study is investigating the antibiotic sensitivity of predominant vaginal
microbiota.
Patients and Methods: 250 pregnant women in Erbil city in the North of Iraq, from October
2018 to March 2019. Samples were collected from pregnant women who visited Maternity,
Rizgary and Raparin Hospitals’ laboratory department under medical precautions. The
samples were cultures to investigate to identify the bacteria types and sensitivity for common
antibiotics.
Results: About 72% of samples showed positive microbial growth and the higher distribution
percentage of isolated microorganisms was 27.2%, 23.8%, 21.6 and 11.6% for Candida sp.,
Staphylococcus aureus, Escherichia coli and Streptococcus pyogenes respectively. Moreover,
antibiotic sensitivity tests declared that ciprofloxacin was effectively inhibited the growth of
both Staphylococcus aureus and Streptococcus pyogenes while Norfloxacin was 95% which
inhibited the growth of E. coli.
Conclusion: Candida albicans, Staphylococcus aureus, Escherichia coli and Streptococcus
pyogenes are among the most predominant microorganisms in pregnant women.

Background: Urethral stricture disease is one of the oldest and most difficult maladies
known to the urologist. While references to the disease and its treatment date back to the
writings of the Hindus, Egyptians, and Greeks.
Objective: To elicit the incidence of urethral strictures, their severity and management in
patients with superficial bladder tumor.
Patients and Methods: From January 2018 to January 2020, we followed 98 patients
admitted and treated at Baquba Teaching Hospital urology unit for having bladder
carcinoma. Theywere all male subjects, their age range from 38-76y with a mean 56.8y.
They were required to have a cystoscopically and histologically proven superficial
transitional cell carcinoma of the bladder to be enrolled in this study (invasive tumors were
excluded). For all the patients and after having the cystoscopic diagnosis ,transurethral
resection of the tumor done and in most of them this is followed by six week courses of
intravesical chemotherapy (either mitomycin or doxorubicin according to the availability).
Intravesical Doxorubicin used in 13 cases (56.5%), Mitomycin C in 6 cases (26.1%) and 3
patients (13.0%) received both drugs (through multiple courses).while 1 patient (4.3%)
received no chemotherapy. Thirteen strictures (56.5%) were managed by optical urethrotomy
while 10 cases (43.5%) were mild strictures and opened just by introducing the cystoscope.
Results: During the period of the study, a total of 23 urethral strictures were identified in the 98
male patients with superficial bladder tumor enrolled in this study, which constitutes an
incidence of 23.5% all were diagnosed by the follow -up check cystoscopies . Patient age
ranged from 38-75 years with a mean age 59.30+- 10.58 . Among those patients with urethral