Diyala Journal of Medicine

Background: Staphylococcus aureus coloniza-tion for the human nose
representing a challenge that requires a cope with host defense and
competing resident microor-ganisms.
Objective: To evaluate the risk factors for in-fection with S. au-reus and
MRSA among health care workers (HCWs) in Al-Batool teaching hospital
for maternity and children in Diyala, Iraq.
Patients and Methods: A total of 27 swabs were taken from HCWs in Al-
Batool teaching hospital for ma-ternity and chil-dren in Diyala, Iraq
(ATHMC) Standard microbi-ological proce-dures were used for diagnosis
of S. aureus and Methicillin Re-sistant Staphylo-coccus aureus (MRSA).
Results: Significant corre-lation was report-ed between age and
colonization with S. aureus & MRSA. Inverse correlation was reported
between education level and colonization with S. aureus and MRSA.
Signifi-cant correlation was reported be-tween acne and colonization with S.
aureus. Signifi-cant correlation was reported be-tween sinusitis, years of
experi-ence, contact with farm animals and colonization with S. aureus and
MRSA. Significant correlation was reported between ward of duty and
colonization with MRSA.
Conclusion: Colonization with S. aureus and MRSA inversely correlated
with younger age group, education level of HCWs. Colonization with S.
aureus and MRSA correlated with sinusitis, years of experience (5 -6);
contact with farm animals. Colonization with S. aureus correlated with
acne. Colonization with MRSA correlated with ward of duty at children
care floor.

Background: There is an increasing concern about obesity among
children and adolescents worldwide as they constitute 20% of the world
population. Several predisposing factors are contributing to the obesity
that can be monitored, particularly healthy diet and physical activities.
Addressing those factors among children and adolescents lead to
decreasing health related conditions.
Objective: To investigate the prevalence rate of obesity,
sociodemographic, dietary habits, lifestyle and knowledge factors among
adolescents attending private and public schools in Sulaimani city, Iraq.
Patients and Methods: Through a school-based cross-sectional study
from October 2021 to April 2022, a total of 576 students in high schools
located in Sulaimani city, Kurdistan Region, Iraq were studied. A
structured questionnaire was used to collect information on students’
sociodemographic characteristics, physical activities, dietary habits and
knowledge. Body mass index was measured based on WHO Growth
Reference for 5 to 19 years of age.
Results: The obesity prevalence rate in private schools (36.11%) was higher
than public schools (31.6%) (P=0.5890) however, the difference was not
statistically significant. The majority of students in private schools exercised
more frequently and for a longer duration; however, they ate more red meat,
less dairy produce and had a higher fast food intake.
Conclusion: The prevalence of obesity is slightly higher among students
in private schools than the students in public schools.

Background: Despite the prevalence, global impact, financial burden, and
mortality and morbidity related to bronchiolitis, clinical management still
seems to be difficult.
Objective: To describe the diversity medical treatment options used to
manage bronchiolitis and conclude the safest and most effective way to
treat it in order to help the development of an evidence based treatment
protocol at Raparin teaching hospital.
Patients and Methods: This current study design was randomized
controlled trial, in which total of 125 children presented with bronchiolitis
enrolled in our study, we divided them into five groups (A, B, C, D and
E), each of 25 cases. All the groups received supportive treatment in the
form of oxygen and intravenous (IV) fluid in addition to specific treatment
except group A subjects who received supportive treatment only. The
treatments were The study was conducted at the inpatient wards of
Raparin teaching hospital in Erbil city-Iraq, from the period of 1st January
to 1st August 2022. The infants and children’s age was ranging from 1 to
60 months with clinical diagnosis of bronchiolitis.
Results: There was non-significant statistical association between treatment
groups and presence of wheeze after treatment (p:0.538), while statistically
significant association between various treatment modalities (groups) and
cough after treatment (p:0.006) in the same way the association was
significant with accessory muscle use after treatment (p:0.037).
Conclusion: Generally patients in groups B (inhaled bronchodilator) and
D (inhaled bronchodilator and intravenous steroids) had better response
rates in terms of cough, accessory muscle use, respiratory rate
(tachypnea), time to resolution of fever and coryza, duration of IV fluid
therapy, oxygen therapy and hospital stay. Which conclude using of
inhaled bronchodilator and IV steroid

Background: Many patients that have itchy thickened skin lesions are
lichenified, it's located on the extremities namely on the knees, feet,
dorsum of the hands, and /or elbows was being seen bilaterally and may be
symmetrically.
Objective: To evaluate clinical and histopathological features of
neurodermatitis with some similarities to psoriasis in Iraqi patients.
Patients and Methods: Twenty- Five patients with neurodermatitis
attending Department of Dermatology, Baquba Teaching Hospital were
enrolled in this study in time between 1st January 2020 to 31th January
2021. All patients were being examined and full history was taken,
including age of the patients, onset and duration of the disease, severity
and type of itching. A full examination was done to identify the character,
colour, shape, site, and involvement of other body site of lesion. Incisional
biopsy specimens from both lesion and adjacent normal skin were
obtained from 9 patients and submitted to histological assessment.
Results: Ten of the patients (40%) were male and fifteen (60%) were
females, their age ranged from 29-70 years, with a mean of 49.5 years. The
average duration ranged from one month- 15 years with median 7.5 years.
Clinically; patients have severe itchy plaques that distributed bilaterally like
those of psoriasis, involvement of the knees (56%), dorsum of the both
hands, feet, and elbows, also having ( lichenification ,that is characterized by
thickening of the skin and exaggeration of the skin lines ) which
characteristic of the individual lesion of lichen simplex chronicus, these
plaques were symmetrical, well defined, sharper, more keratotic, violaceous
pigmentation, marked accentuation and thickening of skin. Psoriatic scales
are not present typically on the plaques of these patients. These plaques
mainly located on extremities. Nine specimens' taken for histopathologiacl
findings showed hyperkeratosis, acanthosis, dermal papilomatosis,
suprapapillary epidermal thinning. All patients mentioned a severe itching
which was paroxysmal in typing, more severe in the evening.
Conclusion: ( Lichenified psoriasis) Psoriatic neurodermatitis might be
lichen simplex chronicus as a result to repetitive itching and scratching of
plaque psoriasis. This was typical neurodermatitis and not psoriasis.
Keywords: Psoriatic neurodrmatitis,Lichenification, Plaque psoriasis

Background: Orthognathic surgery is widely used surgical procedure. The
most common used orthognathic surgical procedure is bilateral sagittal
split osteotomy (BSSO) that is used for managing skeletal mandibular
excess, deficiency or asymmetry.
Objective: To correct functional and aesthetic problems.
Patients and Methods: A total of (12 patients) 24 condyles have been
included in our study all with cl II malocclusion, open bites and
asymmetry, both genders males and females, their age ranges between18
to 40 years, all the cases had preoperative and postoperative CT scans.
Results: By comparing pre and post operative CT scans regarding condylar
positions for both groups. The results revealed that there was less movement
of condylar head in group with device and direction of movement was more
favorable.
Conclusion: This study showed that the Digitally Planned Custom Made
guide was useful in repositioning condyles with minimal movement post
operatively and more favorable direction of movement.

Background: Dermatophytosis was a fungal infection caused by molds
(dermatophytes). Dermatophytes are a group of closely related filamentous
fungi able to damage and utilize keratin found in the skin, hair, and nails.
Objective: To to isolate the species which cause resistant
dermatophytosis, and clinical types of tinea, as well as to assess the
response to different antifungal therapies.
Patients and Methods: Ninety-two patients with different clinical types
of tinea infections (ringworm) were seen in a private clinic in Baquba city
for the period from May 2021 to December 2021, they were (42) females
and (50) males, their ages ranged from (7-70) years with a mean age of
(27.57±8) years. All patients were diagnosed clinically as ringworm and
supported by isolation of the species from samples either by direct
examination of samples or cultures on Sabouraud media, and the patients
were treated by combination therapy of systemic and topical terbinafine
and systemic azole (itraconazole capsules) for (1-3) months.
Results: All patients complained of widespread and concomitant tinea. The
most common causative dermatophytes species were Epidermopyton
floccosum (44%) and Trichophyton rubrum (22%), less commonly
Microsporum audouinii (9.8%), and the others as in Table (1). The most
common clinical type was tinea pedis (29.3%) then tinea cruris (26.1%),
tinea corporis (22.8%), and tinea ungum (20.7%) as in Table (2).
All patients were cured on combination therapy of systemic (terbinafine
and itraconazole) and topical (terbinafine). Five patients (5.4%) showed
relapses of disease after discontinuation of therapy and retreated by the
same method.
Conclusion: Epidermophyton floccosum and Trichophyton rubrum were
the most common cause of resistant tinea. Terbinafine and itraconazole
were good therapeutic options for the treatment of resistant tinea.

Background: Short birth spacing linked with adversative health
consequences for infant, child and maternal mortality also increases the
chances of mother and their children survival.
Objective: To assess the determinants and the knowledge of birth space
amongst women of reproductive age in Mukalla district, Hadhramout
Governorate, Yemen.
Patients and Methods: A cross sectional study of 384 women of
multiplicative ages (15-49 years) was conducted at primary health care
centres in Mukalla district. The study was conducted from November.
2018 to Oct 2019.
Results: The median birth spacing was 35 months. (50.8 %) of respondents
have been committed undersized birth spacing underneath the indorsed
interval of ideal delivery spacing. Multivariate logestic V regression revealed
that age of mother between 15-24 years (OR 3.255, 95%CI 1.598-6.629,
P=0.001), not enough family income (OR 1.867, 95%CI1.104-3.158, P
=0.020 ), number of living children ≤ 3 children (OR 1.225, 95%CI .532–
2.520, P=0.027) and breast feeding duration < 6 months (OR7.435 , 95%CI
1.490 – 37.101,P=0.014) or 6-<12 months (OR 7.320, 95%CI 1.406–38.116,
P=0.018) were linked with augmented hazard of short birth spacing, whereas
mother’s history of chronic disease (OR.026,95%CI .003-.227,P=.001) and
modern family planning methods utilization (OR.208, 95%CI.112-.386,
P=0.000) were linked with decreased risk of little birth space. (58.1%) of
respondents had high level of knowledge about the birth spacing.
Conclusion: Certain factors were sig

Background: Although there is little information about the prevalence of
thyroid disorders in young women, but they are common in Iraq.
Objective: To prevalence of thyroid hormones test abnormality in females
at reproductive age attending al-batool maternity teaching hospital
Patients and Methods: This study involved 1570 of reproductive female
ages patients at the Al-batool Maternity Hospital in Diyala Province, Iraq.
Serum levels of T3, T4, and TSH were measured in this study. According
to the conventional definitions of T3, T4, and TSH levels of overt hyper-
and hypothyroidism patients were grouped according to their thyroid
status at the time of testing.
Results: A total of 1570 subjects were screened of whom 152 subjects
(18.6%) had abnormal TSH. The overall prevalence of hyperthyroidism with
elevated TSH was 17.4%, of which 1.2% had hypothyroidism with elevated
TSH. A low TSH was seen in 1.3% of the study population (P= 0.001).
Generally, thyroxin hormone (T4) abnormalities were totaled at 12.02%, of
which 10.22% were hypothyroidism and 1.8% was hyperthyroidism.
Furthermore, the triiodothyroxin hormone T4 abnormality percentage was
14.84%, compared to hypothyroidism of 3.12% and hyperthyroidism of
11.72%.
Conclusion: Thyroid dysfunction was common in young women.
Therefore, females more susceptible to thyroid disorders.

Background: Down Syndrome (DS) is a resulting from a defect of the
genotype in patients affected by it. The occurrence of this type of disease
is very common. It has been associated with causing many genetic
diseases with a significant change in phenotypic pattern. People with this
type of disease suffer from intellectual disability that ranges from mild to
moderate, delay in growth and the emergence of some distinctive signs in
the face. It leads to Alzheimer’s in some cases. The treatment cost is very
high and exorbitant, many laboratories have sophisticated diagnoses
methods, but they are expensive and require high skill. Therefore, this
disease still needs to develop many genetic methods to facilitate its
diagnosis infection rates reduction among humans.The present review
article empasied an overview of DS-associated phenotypes diagnosis and
managment of the disease. Furthermore,we have also Reviewed further
parental diagnosis methods to facilate moleculr methods CSV, MLPA,
FISH, QF-PCR, PSQ, and NGS and noninvasive dignosis in details.

Background: Alopecia areata is a disease scalp and body hair leading to
patches of non-scoring alopecia which is heterogeyous ,it is unown as
autommutte disease, there is no prevention & hard cure.
Objective: To determine the prevalence rate according to sex &age and
the causative factors of alopecia areata in Baquba city.
Patients and Methods: A cross-sectional study was in Baquba Teaching
Hospital dermatological clinic from 1st of October 2020 to 31st of March
2022 at Baquabah teaching Hospital /outpatient Dermatology clinic. The
study sample (100) patients with different clinical variants of Alopecia
Areata, (71) males and (29) females of different age groups.
Results: This study shows that high prevalence among males (71%) with
age group (21-30) years old with single patchy alopecia areata with past
history of recurrence and associated psychological history. (100) cases of
AA were diagnosed. (25%). Single lesion of AA was the most common
manifestation (68%). Recurrence history of AA Positive in (55%). Personal
history of stress was associated with AA in (64 %). The most common site of
alopecia areata was in head (55%).
Conclusion: It was concluded that, alopecia areata was more common in
male, age (21-30) years, most common single lesion, more in head, with
psychological stress history.

Background: Acute myeloid leukaemia in adult constitutes 80% of whole
acute leukaemia cases; its frequency progressively increases with age.
Objective: To evaluation the parameters of AML patients clinically and
haematologically in Erbil City.
Patients and Methods: A particular analysis of hospital records
retrospective study of 29 patients with AML was taken on. The cases were
analyzed and achieved at Nanakaly hospital in Erbil city during the years
20021-2022. Diagnosis was established on peripheral blood and bone
marrow reports. The myeloid origin confirmation was concerned by
cytochemistry, morphological subtyping was concerned according to the
(FAB) criteria, biochemical tests, and cluster CDs was done by
flowcytometery. Microsoft excel version 2010 and (GraphPad Prism 9.0.)
was in employment for carrying out statistical analysis.
Results: This study included 18 males and 11 females. Their ages ranged
from 5 and 80 years with a mean age of 38.4 years. CD13 and CD33 are
most expressed CD markers (75% and 70% respectively). CD22 and TdT
lowest expressed CDs (10% and 5% respectively). Depending on the
complete remission/Partial remission association, the p-value of platelets was
significant (0.0207), CD64 and CD117 showed greater significant (<0.0001,
<0.0001 respectively), BM hypercellularity fragments (P=0.0068), trials
(P<0.0001), and blast percentage (P=0.0365).
Conclusion: CDs and BM results are essential tools in the identification of
AML. CD13 and CD33 are the most frequent CDs in this study.
Morphologic valuation of BM was statistically significant, cellularity of
BM and blast percentage was significantly correlated with post induction
response in patients with AML

Background: One of the more significant hormonal systems, the renin-
angiotensin-aldosterone system, controls the kidney function, adrenal
gland through its effect on the balance of sodium and potassium, blood
pressure, fluid volume, and also manages the functions of cardiovascular.
Objective: To clarify the interrelationship between renal dysfunction and
renin-angiotensin-aldosterone system.
Patients and Methods: One hundred samples were collected from
December 1, 2022, to February 18, 2023, from Al Shams Medical
Laboratories (56 male, and 44) female, age range (of 45-60 years), all of
them were volunteers suffering from chronic renal failure in the third stage
the average glomerular filtration rate was 35. 70 ± 0.37 125
mL/min/1.73m2. and under conservative treatment. Kidney function test,
active renin, angiotensin II, and aldosterone were assessed in the serum of
all subjects. The p - value of differences less than 0.05 is measured
significant, and uses the statistical package for the social sciences (23)
software to calculate the correlation coefficient between various
parameters.
Results: The result shows relationship between the changes in GFR with
creatinine, urea and active renin, the mean GFR showed significant negative
correlated with mean creatinine (R = -0.76, p < 0.01. As well as the mean
GFR with mean urea (R = -0.64, p < 0.01). The mean GFR also showed
significant negative correlated with mean active renin in (R = -0.41, p <
0.01). Also, the mean serum active renin level was significantly positive
correlated with mean aldosterone (R =0.33, p < 0.05).
Conclusion: Renin enzyme is inversely related to renal dysfunction, so
when the glomerular filtration rate decrease, the higher the renin
increased, and as a result, the increase in blood pressure in chronic renal
failure patients

Background: Nowadays, a lot of food products are produced in large
quantities in factories. Milk and its derivatives are among the most
important and well-known things that may be mentioned. Due to the
industrialization of many nations, heavy metals are regarded as the most
significant contaminants and have an impact on the presence of these
substances in milk and dairy products. The toxicity of different heavy
metals on human health, as well as their sources in milk and other dairy
products are all represented in the current review paper, which focuses on
methodologies and regulatory constraints for heavy metals in milk. The
study also examines the frequency of heavy metals detected in milk
samples from Iraq, a few other nations in Asia, South America, the United
States, and Africa, as well as a few instances from Europe. strategies to
lessen the number of heavy metals in milk and its products or stop them
from contaminating such foods.
Conclusion: Heavy metals have several health risks. Heavy metal
exposure is especially prevalent in young age and the elderly due to milk
drinking. Due to rapid industrialization and urbanization, law
enforcement, and less restrictions, developing countries have high heavy
metal levels in milk. Wealthy countries have less heavy metal pollution.
Milk samples had significant lead and cadmium levels, requiring strict
environmental and health protections