Diyala Journal of Medicine

Background: Needle stick injuries are serious professional hazards in the
transfer of certain types of blood borne diseases such as hepatitis B virus,
hepatitis C virus, and human immunodeficiency virus among healthcare
workers.
Objective: Firstly, to determine the prevalence and factors related to
needle stick injuries. Secondly, to assess related safety measures among
nurses in Erbil hospitals.
Patients and Methods: A hospital based cross sectional study including a
sample of 452 nurses. A representative supple sample size was calculated
by using Epi info version 7.The sample was proportional to the population
of nurses in each hospital. A convenient sampling technique was adopted
in selection of studied sample from different teaching hospitals in Erbil
city. Data were collected by using self-administered questionnaire, which
included socio-demographic characteristics of participants and questions
regarding needle stick injuries and preventive measures. (SPSS, Chicago,
IL, USA), version 26) was applied for data entry and analysis. P value of ≤
0.05 was considered as statistically significant.
Results: Out of a total (452) study population, 56.9% were females and
43.1% were males. The mean ± SD of age was 36.2 ± 5.41, ranging from 21
to 54 year. The prevalence of needle stick injuries was 87.4% among nurses,
and the widespread activity leading to NSIs was recapping of needles (81%).
The average of non-reporting to supervisor of infection control was 77.2%.
The majority of NSIs took place in the morning (70.5%). There was a
statistically significant association between NSIs and use of PPE, secure
disposal of needle in the safety box, and use of auto-disable syringe during
injection, in which NSIs were highest among those who not use or
sometimes use the above mentioned safety measures, (P<0.001, P=0.002,
and P=0.003 in respectively).
Conclusion: This study showed that transverse needle stick injuries
among nurses are very high and pose a rise in hazards for professional
exposure to diseases transmitted by blood. The majority of nurses are not
reporti

Background: Cosmetic surgery is performed to improve an individual’s
satisfaction with their appearance and to improve their psychological
health by improving self-confidence. Our study aimed to evaluate patient
satisfaction regarding nose appearance and function.
Objective: To evaluate the satisfaction of patients who underwent
rhinoplasty by using the Rhinoplasty outcomes evaluation (ROE)
questionnaire and to determine the impact of patient age on the outcomes.
Patients and Methods: A prospective study of 90 patients who underwent
open rhinoplasty procedures, including other nasal procedures like
septoplasty or turbinoplasty, in both private and public Sulaimani Surgical
Teaching Hospitals (department of oral maxillofacial surgery) from
October 2020 to March 2022. The Rhinoplasty Outcomes Evaluation
(ROE) questionnaire was used for esthetic and functional assessment.
Results before and after surgery were compared.
Results: In this study, ninety patients participated by completing the
questionnaires and the follow-up period six months postoperatively. The
main reasons for rhinoplasty in our patients were: esthetic 50% (n=45),
functional 8.9 % (n=8), and a combination of both esthetic and functional in
41.1% (n=37) of patients. There was a significant overall increase in patient
satisfaction with functional and esthetic outcomes post-surgery (p < 0.01),
and there was no significant difference among different age groups
postoperatively (p > 0.01) based on ROE.
Conclusion: There was a significant overall increase in patients’
satisfaction with functional and aesthetic outcomes post-surgery. There
was no significant difference in satisfaction among different age groups.

Background: The quality of drinking water supplied to hospitals is
directly related to the quality of health services provided to people.
Objective: To assess the chemical and microbial standards provided to
four public hospitals on Baghdad's eastern side.
Patients and Methods: In this study, 100 water samples were collected
from water taps supplied to hospitals. Scientific methods were followed to
collect samples in clean, sterile bottles. The chemophysical characteristics
of the collected water samples were estimated (Hospital Imam Ali, Martyr
Al-Sadr Hospital, Ibn Al Balady Maternity & Children's Hospital, Fatmih
Alzahraa Maternity Hospital). In addition, the contamination of water with
fecal-coliform bacteria was estimated.
Results: In this study, 100 water samples were collected from water taps
supplied to hospitals. Scientific methods were followed to collect samples in
clean, sterile bottles. The chemophysical characteristics of the collected
water samples were estimated (Hospital Imam Ali, Martyr Al-Sadr Hospital,
Ibn Al Balady Maternity & Children's Hospital, Fatmih Alzahraa Maternity
Hospital). In addition, the contamination of water with fecal-coliform
bacteria was estimated.
Conclusion: It can be concluded from the current study that the quality of
water supplied to the hospitals covered by the study was within the
standard level of physiochemical specifications. In addition, all samples
were free of fecal-coliform bacteria, which indicates that the water
supplied to the hospitals is not contaminated with feces.

Background: In December of 2019, a new form of coronavirus was
discovered in Wuhan,China. Signs and symptoms of it include tiredness,
cough, and fever . Another common symptom of this respiratory disease is
the loss of smell.
Objective: To find the frequency of anosmia in COVID-19 patients in our
community in relation to other communities and to determine the clinical
outcome of patients affected by COVID-19 .
Patients and Methods: This is a cross-sectional study at Kurdistan Iraq
conducted during the period from January 2021-January 2022 .The 460
cases were admitted to quarantine centers 320 were positive for COVID
19 .The sample size is (260) cases of smell affection with proven COVID-
19 disease.
Results: The percentage of smell affection patients were 81% of the sample
size, they were as follows, the percentage of bad odor smell was 9%,
alteration of smell was 21% , partial loss of smell was 24% and complete
loss of smell was 27%. The female percentage of all patients were 55 %
while male percentage was 45% .
Conclusion: Olfactory dysfunction is one of cardinal symptoms of
COVID 19 disease.Females are slightly more affected than males with
olfactory dysfunction. 4 th and 5th decades patients are more affected with
bad odor and alteration of smell while. partial loss and complete loss of
smell happened within 6 th decade patient mostly.

Background: Septoplasty is a surgical procedure to straighten the bone
and cartilage dividing the space between your two nostrils (septum). If
septoplasty is performed alone or as a part of a rhinoplasty procedure,
internal nasal splints are generally used.
Objective: To compare silicone nasal septal splints with integral airways
and silastic sheets after septal surgery in terms of patient breathing (with
the splint in place).
Patients and Methods: This study involved 50 patients who underwent
septal surgery in terms of septoplasty or septo-rhinoplasty due to nasal
septal deviation. They were allocated into two groups. Group A comprised
25 patients who underwent septal surgery and were packed with silicone
nasal septal splints. Group B comprised 25 patients who underwent septal
surgery and were packed with silastic sheets. They were removed on the
seventh postoperative day. Clinical efficacy was compared using visual
assessment and patients' subjective breathing status.
Results: The patients in both groups A and B had similar mean ages: 27.8
years (range, 18-51 years) and 25.84 years (range, 18-48 years) in Group A
and Group B, respectively. The study included 58% males and 42% females.
The tyspe of surgery were septoplasty and septorhinoplasty in 38% and 62%,
respectively. Breathing status was significantly lower in Group A than in
Group B at the 7th postoperative day (p<0.004).
Conclusion: Intranasal septal splints with silastic sheets result in less
nasal obstruction while in place; thus, they can be used as an effective
alternative to silicone nasal

Background:Hepatotoxicity is a well-known adverse effect of
methotrexate therapy.
Objective: To assess liver functions such as ALT and AST in patients
with rheumatoid arthritis and psoriatic arthritis receiving methotrexate and
compare the liver functions in those patients cured by using methotrexate.
Patients and Methods: This observational, cross-sectional analysis
involved 50 patients with RA who satisfied EULAR-ACR-2010 standards
for RA and 50 PSA cases who fulfilled CASPAR classification criteria for
PSA, receiving constant weekly MTX therapy (oral or parenteral) up to
25mg, together with folic acid, liver function parameters such as ALT and
AST in patients with rheumatoid and psoriatic arthritis were estimated and
compared.
Results: 78% of the 100 participants who were enrolled in this study were
females. 10% of the participants were smokers, but there was no significant
difference between the two groups (p = 0.410). None of the patients were
alcoholics. There was a significant difference between the groups regarding
the type of medications. 42% of the RA group were on other medications
compared with 2% of the PSA cases (p < 0.001). The mean ALT of the PSA
group (26.0 IU/L) was considerably (p = 0.005) greater than the mean of the
RA group (19.6 IU/L) which shows an insignificant (p = 0.055) change
between the two groups regarding the means of AST (26.3 IU/L in the PSA
participants matched with 20.6 IU/L in the RA participants).
Conclusion: Our research data shows that patients with PSA treated by
methotre

Background: Rheumatoid arthritis is a systemic inflammatory disease
with unknown etiology. There has been considerable debate about the
relation between thyroid gland and rheumatic diseases.
Objective: To assessed the prevalence of primary hypothyroidism in
patients with rheumatoid arthritis, as well as the association between
hypothyroidism and the severity of rheumatoid arthritis.
Patients and Methods: This study is a cross-sectional observational study
involving 65 participants 18 years of age and older who were diagnosed
with RA. Patients had thyroid function tests and patient disease activity
was determined using the DAS28 Modified Disease Activity Score .the
data were analyzed using the chi-square significance test with a P-value of
≤0.05. The data will be collected during the direct patient interview and
the information from the questionnaire once verbal approval has been
received from the study participant.
Results: Hypothyroidism (thyroid stimulating hormone) level >4.20 µIU/L )
was observed in 26 (40%) parameters of disease activity such as DAS-28,
counts tender joints significantly associated with hypothyroid patients RA.
Conclusion: Hypothyroidism was significantly associated with disease
severity of RA, disease duration, BMI (Body Mass Index), and ACPA
(Anti Citrullinated Protein Antibody). Identification of thyroid function
tests in patients with RA is important.

Background: One of the minor obstitrical procedures is dilation and
curettage; pain usually occurs during it. Consequently, an anesthetic drug
desires sufficient analgesia, brisk onset, and recovery.
Objective: To evaluate two groups of drug combinations {midazolam
0.08mg/kg – ketamine (0.5mg/kg)} and propofol with (1mg/kg) –fentanyl
dose (1mcg /kg)}, in hemodynamic parameters, pain scoring and recovery
characteristics thus finding the optimal combination which can be applied
all along the operation.
Patients and Methods: It was taken100 patients weregoing through
dilatation & curettage of approximately 15-30 min. Duration was
enrolled after ethical committee approval in Erbil in 2022, and it was
divided into two groups of 50 each. Baseline anesthesia was maintained,
and the patients were haphazardly selected to get propofol 1mg/kg with 1
mcg/kg fentanyl (First group), midazolam 0.08mg/kg with 0.5 mg/kg
ketamine (Second group) as a bolus to induce anesthesia and for
maintenance. Then. pain scores, Aldrete scores, and hemodynamic signs
were assessed during and after the procedure. Finally, the results were
arranged and inspected statistically with the Student's unpaired t-test and
chi-square test.
Results: BP (systolic, diastolic) and PR were significantly higher in Group 2
compared with Group 1. No significant difference was found in the two
groups regarding the parameters: the sedative level at 3-5 minutes (p =
0.499) and the duration of the operation (p = 0.105).
Conclusion: group (propofol -fentanyl) was superior to group
(midazolam–ketamine) and may be a good option in uterine dilation, and
curettage (propofol –fentanyl) provides sufficient analgesia for the minor
surgical intervention with accurate recovery characteristics like awakening
time and response to verbal commands.

Background: BK virus, a human polyomavirus, causes nephropathy and
allograft loss in renal transplant recipients. Although it was discovered in
1971, understanding of the humoral immune response to BKV is limited.
Objective: To serological detection and level estimation of anti-BK-IgG
in renal-transplanted recipients and healthy blood donors as control.
Patients and Methods: Serum samples were collected from 106 renal
transplant recipient patients and 100 healthy blood donors as control
groups, and were analyzed for anti-BK IgG antibodies by using
quantitative and qualitative Human BK Virus IgG (BK-IgG) ELISA kit for
detection and estimation positivity of BK_IgG and titration.
Results: Out of 206 subjects, 114(55.3%) have a positive result for BK-IgG.
seropositivity was detected in 54(50.9%) of 106 RTR patients and 60
(60.0%) in the 100 control group, so there was no significant difference
between seropositivity of BKV IgG antibody among the studied groups, p
=0.191.
Conclusion: The highly significant differences between seropositivity of
BK-IgG with high levels of serum creatinine

Background: Failure to thrive (FTT) indicates insufficient weight gain or
absence of an appropriate physical growth,it is a sign not a disease
,commonly seen by the primary health care physicians. It might be due to
organic or non-organic causes and it is usually of a multifactorial etiology.
Objective: To detect the prevalence of failure to thrive and risk factors in
pediatric age group - under 5 year old in Al-Batool teaching hospital in
Baquba city through 2020-2021.
Patients and Methods: This study was across sectional study that took
place In Al-Batool Teaching Hospital for maternity and children,in
Baquba Distract-Diyala province, Iraq.during the period from 1st of
February 2020-31st of July 2021. Throughout this study Two hundred and
fifty (250) child were randomly selected under -5years old . Informations
were collected from the patients files including age,current weight,birth
weight,type of feeding,weaning,history of prematurity, history of chronic
diseases and socioeconomic conditions.
Results: Showed that children below 12 months were (45.2%), males
(51.6%)and females (48.4%). male:female ratio was 1:1 ,majority of children
were from Bohris . medium socioeconomic level was the largest with
(61.6%). regarding mother education,mothers who have secondary education
represent the largest level with (45.6%),children with bottle feeding were the
largest with (45.0%),premature birth represent (2.0%),children with chronic
diseases (14.0%),children with UTI (32.0%). Children with
(FTT)were(23.2%),while (76.8%) were of normal growth. Regarding age
groups most of the affected children were below 24 months of age with
(36.5%) (P value was 0.0001) which is considered to be a significant. Males
with (FTT) (24.8%) ,while Females (21.5%). (Pvaluewas0.534) which is
considered to be of no significance. Regarding children with (FTT) and low
socioeconomic level it was (68.8%) (p value was 0.0001)which is
considered to be a significant. Children with (FTT) and illutrate mother
was(60.0%) (p value was 0.0001)which is considered to be a significant.
children with breastfeeding showed no (FTT) ,while those with bottle
feeding was (37.0%) (P value was 0.0001 ) which is considered to be a
significant. children with (FTT) and UTI (58.8%)(P value was 0.0001)which
is considered to be a significant.

Background: Trochanteric bursitis is an inflammation of the greater
trochanteric bursa which is a recurrent source of lateral hip pain.
Objective: To assess the diagnostic value of 6 clinical tests that can be
used to diagnose trochanteric bursitis and utilize ultrasound as an imaging
modality to confirm the diagnosis.
Patients and Methods: This Cross-sectional study included 85
consecutive patients who had been experienced lateral hip pain in the
greater trochanteric area for at least 6 weeks with at least one of the
following features: pain on lying on the affected side, pain while climbing
stairs or when sitting. Six clinical tests on examination that elicit pressure
on the greater trochanteric region were performed to evaluate their value
to diagnose trochanteric bursitis and then ultrasound was utilized to
confirm the diagnosis.
Results: A total of 85 participants were enrolled in the study. Tenderness to
deep palpation was the most accurate sign in predicting the diagnosis, with a
sensitivity of 100% and specificity of 81.8%. There were no significant
differences between its results and the ultra-sonographic findings (p=0.500).
Regarding the other tests, there were significant differences between their
results and the results of ultrasound (p< 0.001).
Conclusion: Tenderness to deep palpation of the greater trochanter,
combined with ultrasound imaging modality, is likely to have the best
diagnostic value for evaluation of trochanteric bursitis in patients
complaining of lateral hip pain around the greater trochanter region.

Background: There is a connection among anti-TPO and anti-TG
antibodies and levels of thyroid hormone and both alone or in grouping
have been utilized to expect perfection of hypo or hyperthyroidism.
Objective: Both alone or in grouping have been utilized to expect
perfection of hypo or hyperthyroidism.
Patients and Methods: This is a cross-sectional study achieved in the
laboratories of Rizgary Teaching Hospital and Erbil Teaching Hospital in
Erbil, Iraq, within the period of May 2020 to April 2021. The study
included 66 patients, both males and females included. These patients had
clinical indications and were suspected of having a sort of thyroiditis.
Anti-TPO electrochemiluminescence immunoassay analysis has been
included by the analysts in conjunction with conventional markers
immunoassay of thyroid TSH, T3, and Free T4 trusting that this would
help in lessening morbidity and related wellbeing concerns.
Results: There was an increase in the level of anti-TSH antibodies in the
hyperthyroidism group (60.6%) which was more than in those with
hypothyroidism (36.4%), significant association exist (P≤0.049). Moreover,
the level of Anti-TPO Abs was higher among hypothyroidism patients
(63.6%) than among hyperthyroidism cases (33.3%), this association was
statistically significant (P≤0.014).
Conclusion: Demonstrating the clinical importance of this antibody and
the benefit of adding anti-TPO, in combination with TSH and FT4.
Addition of one test could potentially save expenditure on long-term
diseases such as overt thyroid disease and its attended morbidities.

Background: Rhinoplasty is still one of the top five aesthetic surgeries
performed and is considered one of the most challenging procedures in
otorhinolaryngology surgery. Bleeding is one of the most important
factors affecting an operation's success. The controlled hypotension
method reduces bleeding; therefore, it provides a satisfying bloodless
surgical field during operation.
Objective: To evaluate and compare the effectiveness of (Remifentanil,
Nitroglycerin, Esmolol, and Nitroglycerin + Esmolol) on hemodynamic
parameters and the effectiveness of these drugs in providing a satisfactory
bloodless surgical field during rhinoplasty surgery.
Patients and Methods: 200 adults aged 20 to 45 years were randomly
divided into four groups: Remifentanil (R), Nitroglycerin (N), Esmolol
(E), Nitroglycerin + Esmolol (N+E). Systolic blood pressure, diastolic
blood pressure, mean blood pressure, and heart rate (SBP, DBP, MBP, and
HR) were recorded before anesthesia induction until the operation's end.
The bleeding score and the visibility of the surgical field were rated by the
surgeon as follows: (0) No bleeding, (1) Mild bleeding - no aspiration
required, (2) Mild bleeding - intermittent aspiration is required, (3)
Moderate bleeding - frequent aspiration is required, (4) Severe bleeding-
constant aspiration is required, (5) Severe bleeding, operation stopped
because of surgical field invisibility.
Results: As a result, during operation, decreased values of (SBP, DBP, and
MBP) were statistically significant in all groups. At the same time, the value
of HR showed a statistically significant decrease in the (E) and (R) groups,
while there was a statistically significant increase in the (N) and (N+ E)
groups. Patients in the (E) and (R) groups had a statistically significantly
lower bleeding score than the patients in the (N) and (N + E) groups.
Conclusion: Patients had better Hemodynamic stability and surgical field
visibility after applying Esmolol and Remifentanil.

Background: The region that a magnetic force has an effect on is known
as a magnetic field. Normally, two poles of this field are concentrated.
Most magnetic objects are made up of a variety of tiny fields known as
domains. There are many different techniques that have been published in
the literature for using magnetic energy as a diagnostic tool and for
treating illnesses in both humans and animals.
Objective: To examine the influence of varying amounts of static
magnetic field on the viability of bacteria and the fermentation of
carbohydrates.
Patients and Methods: Locally prepared dipolar static magnetic field of
strength 400, 800, 1200 and 1600 Gauss were used in this study measured
by Teslometer. Escherichia coli isolated from 75 isolates taken from the
patient who had the UPE, 25 were identified as E. coli, and only (12)
samples of identified E coli specifically detect changes numbers of
bacteria and biochemical test, most of the sugars ferment that have be
changed and the polymerase chain reaction was utilized to identify the
16SrRNA gene (PCR).
Results: The inhibitory impact of SMF is attributable, according to
transcriptomic analysis, to differentially expressed genes (DEGs)
predominantly included in carbon source consumption. The bacterial
phenotype in SMF is consistently effectively restored by adding To the
cultivation conditions, add glycolate or glyoxylate, and mutants losing
glycolate oxidase are no longer susceptible to static magnetic field.
Conclusion: It was concluded that the magnetic field could notably
obvious by exposing bacterial cells growth density will decrease and
change bacterial biological activity on sugar fermentation and due to
mutatio

Background: Meningioma is one of the well-known common primary
brain neoplasms that account for more than 20% of intracranial tumors.
Intracranial meningioma recurrence after surgery has long been
recognized, although the mechanism of recurrence remains unclear.
Objective: To analyse impact of pre-operative and peri-operative
measurements in relation to pathological outcome.
Patients and Methods: Retrospectively analysed 72 patients with
meningiomas (45) female and (27) male who were treated surgically and
re-operated again at our Hawler Teaching Hospital and West Emergency
Hospital from June 2017 until June 2021 in Erbil Governorate in Northern
Iraq. Clinical characteristics and demographics possibly associated with
tumor recurrence were assessed, including gender, age, clinical symptoms,
tumor location, pathology data, and radiotherapy and recurrence rate were
closely studied.
Results: A total of 72 cases with meningioma included in the research, in
which 17 cases recurrent cases were observed, in total of 72 cases 58 were
benign (Grade I), and 14 were atypical/ malignant (Grade II/III). The mean
age of patients (SD) was ± 51.2 years and a follow-up duration of 4 years.
Overall recurrence rates 23.6% with Male to Female ratio of 0.55:1. Age,
and gender could not be demonstrated as significant association factor in
tumor recurrence. Factors significantly associated with tumor relapse in the
analysis were tumor location at the Foramen magnum and Optic Nerve, both
being (50%). The rates of recurrence were significantly high when the degree
of removal (by Simpsons Classification) was for grade three (50%) and for
grade four and five (70%), compared with 6.3% and 8.8% for grade one or
two, respectively. A high recurrence rate was detected when the adjuvant
was not received compared with the patients who received radiotherapy.
Majority of patients had better outcome.
Conclusion: it was concluded from this study that Meningioma recurrence
is well recognized and there are many factors including age, gender,
extend of tumor resection, location, histological type of tumor and
adjuvant therapy that would determine the pathological outcome and
impact on patient’s life.