Diyala Journal of Medicine

Background: Toxoplasma gondii is the most common infection of
protozoa, affecting a wide range of hosts. Toxoplasmosis is usually
asymptomatic in immunocompetent persons, but in immunocompromised
persons (e.g., patients on dialysis) significant problems, and may progress
to a life-threatening infection.
Objective: To investigate the correlation level of cystatin-C elevation in
hemodialysis patients with Toxoplasma gondii in Baquba / Diyala.
Patients and Methods: A group of blood samples, consisting of 75
dialysis patients and 50 healthy controls, to totaling 125 were examined
for the detection of anti-toxoplasma antibodies and Cystatin-C In Baquba
Teaching Hospital from November 2020 to April 2021 using Enzyme-
Linked Immunosorbent assay .
Results: The total numbers Of the 125 samples examined, were showed that
the Mean ± SE for cystatin-c in the group of patients was 2.43 ± 0.10 higher
compared to the healthy individuals 2.02 ± 0.21, The results show that
correlation coefficient between Toxoplasma IgG and Cystatin-c in
hemodialysis patients, where it was found that the correlation coefficient
between them was 0.34.
Conclusion: The level of cystatin-C in hemodialysis patients was higher
compared to the control group , and found significant correlation between
the rice of Cystatin-C and the presence of toxoplasma IgG in dialysis
patients

Background: Breast cancer is becoming the most common cancer among
women in both developed and developing countries . Breast cancer has
been the leading cause of death among Iraqi women for three decades, and
it is the second leading cause of death after cerebrovascular illnesses.
Objective: To investigate the epidemiological and clinic pathological
behavior of breast cancer in Diyala province.
Patients and Methods: A retrospective cross-sectional study conducted at
the Oncology Clinic of Baquba Teaching Hospital for 24 months between
April 1st and March 31st, 2021. A sample of (257) patients was selected to
collect socio-demographic information (age, gender, marital status, history
of breast lactation ,history of contraceptive pills, history of breast cancer
in family, parity status).
Results: The current study shows that more than 55% of the patients were
under the age of (50) years. Two hundred fifty one patients (97.6%) were
female and( 6) patients (2.4%)were male. from the 251 female patient . Right
breast tumor was found in 120 patients (48%) and left breast tumor was
found in (127) patients (50.4%) and bilateral breast tumor in (4)
patients(1.6%). In terms of breast cancer family history, 28 patients(11%)
had a positive family history, while 223 patients (89%) had a negative family
history. One hundred fifty seven of patients(63%) had history of
breastfeeding and( 94) of patients(37%) had no history of breastfeeding .
One hundred forty six patients (58%) had positive history of oral
contraceptive pill while 105 patients (42%) had negative history of oral
contraceptive pill. twenty two patients (9%) had positive history of smoking
while (229) patients (91%) had negative history of smoking . The
histopathological result were Invasive ductal carcinoma (I.D.C) in (233)
patients (93%) and Invasive lobular carcinoma (I.L.C) in (18) patients.
Breast cancer patients were married in 73% of cases, widowed in 13.5
percent of cases, divorced in 2.5 percent of cases, and single in 11% of cases.
Most cases belonged to differentiation stage II ( 159) patients (63%),
followed by stage III ( 57) patients (23%) , stage I ( 13) patients (5%) and
stage IV (22) patients(9%) .
Conclusion: The current study concludes that In Iraq, the majority of
breast cancer patients were in the second stage, and patients' ages at
diagnosis were younger than in other communities. The development and
execution of screening programs, as well as the management of risk
factors, appear to be critical.

Background: Biomarkers for diagnosing the occurrence and development
of hyperthyroidism constitute a major worldwide clinical scrutiny.
Evidence is continuing in an investigation about the most relevant
biomarkers in developing the disease.
Objective: To discover and correlate the most dependent biomarkers in
developing hyperthyroidism in both genders.
Patients and Methods: In the present study, two groups were included,
the first group: forty males and females with chronic hyperthyroidism
were enrolled. Serum levels of thyroid hormones, lipid profile, oxidative
stress marker, blood glucose, and renal function markers were measured
and compared with euthyroid subjects.
Results: The present study revealed that referral biomarkers were varied
between genders with a remarkable association of hyperthyroidism with
serum cholesterol, triglycerides, and low-density lipoproteins in females,
while nitrites and creatinine and MDA were significantly correlated in male
patients.
Conclusion: In this study, we found that indicating biomarkers for
hyperthyroidism could be differentially changed in different genders that
help in understanding the progression and development of the disease.

Background: Accurate risk stratification in patient clinically presented as
a case of Non-ST Elevation acute coronary syndrome (NSTE-ACS) is
important to assess the prognosis as well as to estimate the possible
adverse event especially in those patient who are at high risk. Of these
scoring risk; Thrombolysis In Myocardial Infarction (TIMI) risk score
have been well corroborated to predict the possible prognosis for patients
with NSTE-ACS. However, their value in estimation the severity of
coronary artery disease (CAD) has been less studied.
Objective: To determine the role of TIMI score in prediction the severity
of CAD and its extent by correlate the TIMI score with coronary
angiography in patients have NSTE-ACS.
Patients and Methods: A cross section study, conducted on 264
successive patients admitted with Non-ST Elevation acute coronary
syndrome at Ibn-Albitar cardiac center, Baghdad, Iraq, from the 1st of
October 2017 to the 1st of October 2018. Patients were rearranging into
three groups according to the seven standard variables of TIMI score. The
extent of CAD was examined on coronary angiography; a lesion defined
significant if stenosis ≥70% in any artery of three major coronary arteries
or ≥50% of left main coronary artery.
Results: The total number of was 246 patients, mean age was 62.5±2.3
years. There were 67 (27.2%) of them belong to group 1 (low risk group),
142 (57.7%) of them belong to group 2 (intermediate risk group), and 37
(15.1%) of them belong to group 3 (high risk group). 54.1% of patients in
group 3 had significant three-vessels coronary artery disease on comparing
with 17.6% of group 2 patients and only 7.5% of group 1 patients had these
lesions on coronary angiography (P-value <0.01). On the other hand, one-
vessel coronary artery disease occurs more commonly and significant
statistically (P-value <0.01) in group 2 (31.7%) than in patients in group 1
(26.9%) and group 3 (10.8%)

Background: The notch of Harty is a normal variant radiologically and
incidentally diagnosed finding but can be mistaken as pathology.
Objective: To identify the incidence and characteristic findings of the
notch of Harty.
Patients and Methods: A cross-sectional study was conducted on 121
patients referred to the Radiology department, MRI unit, to undergo ankle
MRI through a one-year period (January to December 2020). Cases with
significant ankle lesions were excluded. All MRI studies were performed
on 1.5 T MR scanners (Aera, Siemens, Arlington).
Results: The notch of Harty was present in 35.5% patients; their age ranged
from 5-83 years with a mean age of 38.20 years. The average width of the
notch was 5.65mm while the mean depth was 1.04 mm. There was no
significant correlation between the presence of the notch of Harty and
findings such as rheumatic arthritis, minor trauma, chondral thinning.
However, there was significant correlation between the presence of the notch
of Harty and subjacent subchondral sclerosis.
Conclusion: The notch of Harty was present among a considerable
number of cases with no sex predominance. The notch might be
misinterpreted by radiologists as true osteochondral lesions, thus,
familiarity with location and appearance of these pseudodefects will avoid
their misinterpretation.

Background: Major Congenital anomalies of the gastrointestinal
tract(GIT) is a life threating condidition usually diagnosed in the neonatal
period.
Objective: To evaluate the prevalence of major congenital anomalies
among live births at Al-Mukalla,Yemen.
Patients and Methods: A hospital-based, descriptive cross sectional study
was conducted during 2 years period, from January 1st 2019 to December
31th 2020 and include live neonates aged ≤ 4 weeks who were admitted
with major congenital gastrointestinal anomalies.
Results: The study include 62 neonates with major congenital GIT
anomalies.The most common was imperforate anus in 41.9% followed by
esophageal atresia with or without TEF in 24.2%, then hirschprung’s disease
in 19.4%. Males are more common (61.3%) than females (38.7%).The
incidence is 7.7 per 10.000 newborn. Isolated major GIT anomalies occurs
in 64.5%, while associated extra -GIT anomalies occurs in 35.5% , the most
common was congenital heart diseases that occurs in 17.7% of cases .The
majority neonates were term in 90.3%, with birth weight ≥ 2.5 kg in 88.7%.
Most mothers were < 35 years in 67.7% ,with positive parental
consanguinity occurs in 37% of cases.
Conclusion: High incidence of major Malformation were observed.

Background: Oral and gum infections are mostly linked to poor oral
hygiene. Chlorhexidine mouthwash, and teeth brushing, have been
commonly recommended. There is many studies on the effectiveness of
olive leaf extract (OLE) as herbal mouthwash, there is much guided on its
competitive effect with chlorhexidine.
Objective: To determine the clinical and inflammatory effects of olive
leaf extract (OLE) as mouthwash in the treatment of acute gingivitis and
compare its effect with 0.12% chlorhexidine mouthwash (CHX).
Patients and Methods: A total of 60 subjects aged 18-35 years with acute
gingivitis underwent scaling and polishing with oral hygiene instruction;
20 patients received 3% of (OLE) as mouthwash, 20 patients received of
0.12% of chlorhexidine mouthwash (CHX), and 20 patients received
scaling and polishing only (SRP) without any mouthwash. Mouthwash
was twice daily for 17 days. At the start of the study, clinical periodontal
parameters (PI, GI and BOP) and blood samples were taken and after five
weeks of treatment to estimate the levels of C-reactive protein (CRP),
alkaline phosphatase (ALP) and total protein (TP).
Results: After 5 weeks of periodontal treatment, there was a significant
decrease in clinical periodontal parameters (P<0.01) and inflammatory
markers (P<0.05) in the OLE and CHX and S&P alone groups. From
periodontal treatment, there was no significant difference between the OLE
and CHX groups with clinical periodontal parameters and inflammatory
markers (P<0.05), although there was a significant difference between the
OLE, CHX groups and the S&P alone group in terms of clinical periodontal
parameters and inflammatory markers (P<0.05).
Conclusion: Olive leaf extract (OLE) has been showed to be comparable
to CHX aided in reducing gingivitis by decreasing clinical periodontal
parameters and inflammatory chemical markers values such as CRP, ALP,
and TP.

Background: (COPD) disease is consider an important disease that threat
our life in recent years and its result mostly from smoking .the patients
who affected by this disease will be at higher risk of death caused by
frequent exacerbation ,also chronic obstructive pulmonary disease may
influence the lipid profile regardless of smoking status.
Objective: To assessment the effect of COPD and smoking on lipid
profile.
Patients and Methods: This case control study included 50 patients suffer
from (COPD) and other age- and sex-matched 50 smokers (≥ 20
pack/yeas) healthy people. Demographic and clinical data were collected
through a direct interview with each participant. Fasting lipid profile was
measured according to the standard protocols.
Results: Mean serum level of TG and vLDL in smokers with COPD was
192.4±46.91 mg/dl and 61.8±12.23 mg/dl, respectively compared with
135.5±23.8 mg/dl and 32.68±14.8 mg/dl, respectively in smokers without
COPD, with significant differences. Furthermore, the frequency of abnormal
triglyceride value among smokers with COPD was 36% compared to 12%
among smokers who don’t have this disease . (OR= 4.12. 95%CI= 1.47-
11.55, p= 0.007). Similarly, the frequency of abnormal vLDL among
smokers with COPD was 18% compared to 4.12% among smokers without
COPD (OR= 5.27. 95%CI= 1.08-25.8, p= 0.040). In smokers with COPD,
smoking displayed a positive significant correlation with TG (r= 0.325, p=
0.021) and vLDL (r= 0.333, p= 0.018). In smokers without COPD, smoking
had a positive and marked association with TC (r= 0.377, p= 0.007)
Conclusion: COPD is associated with negative effects on the lipid profile.
In particular, triglycerides and very low-density lipoprotein cholesterol are
mostly affected. Aside from COPD, smoking can also be associated with
elevated lipids/lipoproteins that exceed normal limits at times.

Background: Irritable bowel syndrome and obesity are two prevalent
conditions in our community which may be associated with each other
according to some literature. Both have significant impact on the
community.
Objective: To find the prevalence of irritable bowel syndrome, its
association with general and central obesity, as well as to find its
sociodemographic characteristics, and effect of some personal health
habits on it.
Patients and Methods: In this cross-sectional study, a sample of 248
subjects, 105 males and 143 females, who attended two primary health
care centers was taken (included healthy looking subjects and patients
with irritable bowel syndrome according to Rome IV criteria). Subjects
were aged between 18-65 years. Sociodemographic characteristics,
personal health habits, central obesity index and body mass index also
recorded in the survey.
Results: Prevalence of irritable bowel syndrome was 33.5%, male to female
ratio was 0.73:1. No significant association was found between irritable
bowel syndrome and general or central obesity. Bad sleep pattern was found
to have a significant association with the disorder.
Conclusion: The study do not find significant association between obesity
and irritable bowel syndrome.

Background: Choledocholithiasis occurs in 10–15% of patients with
symptomatic gallstones. Stones in the common bile duct ought to be
removed to avoid complications like acute pancreatitis and cholangitis.
Objective: To estimate the timing of Laparoscopic cholecystectomy after
endoscopic sphincterotomy (post endoscopic retrograde
cholangiopancreatography) and its outcomes.
Patients and Methods: A clinical prospective comparative study was
done in the Surgical Department of Rizgary Teaching Hospital in Erbil
during the period from 1st of January 2019 to 1st of December 2021 on a
sample of 50 patients with Common Bile duct stones categorized into two
groups; group I (25) patients who underwent laparoscopic
cholecystectomy within 72 hours of ERCP (early), while (25) patients with
laparoscopic cholecystectomy beyond 3 days (1-6 weeks) of ERCP were
included in group II (delayed).
Results: Mean surgical duration for group I patients was significantly
shorter than the mean surgical duration for group II patients (p=0.02). The
mean hospital stay duration for group I patients was markedly shorter than
the mean hospital stay duration for group II patients (p<0.001). There was an
obvious association between the two groups regarding wider cystic duct, and
intraoperative adhesions.Both findings were found more in group II.
Conclusion: Earlier laparoscopic cholecystectomy after endoscopic
retrograde cholangiopancreatography has better intraoperative and
postoperative outcomes than delayed laparoscopic cholecystectomy.