Diyala Journal of Medicine

Background: Aromatase inhibitor (AI) was received by breast cancer
women with estrogen receptor-positive. The estrogen is the main
stimulator for receptor-positive breast cancer cells development and
growth, the adjuvant hormone ablation targeting estrogen can decrease the
likelihood of cancer recurrence and prolong cancer-free survival.
Objective: To determine the effect of this therapy on bone mineral density
of women who received it.
Patients and Methods: It was identified 100 women with local or
regional breast cancer diagnosed and who received AI therapy in the
January 2022 to February 2023 from Baqubah teaching hospital/Oncology
Centre. It was used DEXA scan to determine the bone minerals density of
50 women after different years from receiving hormonal therapy and other
50 breast cancer women before receiving hormonal therapy.
Results: It was shown that there is a significant difference (p<0.0001) in the
spine and hip density of breast cancer women who received AIs compare
with the bone density of other breast cancer women who did not receive it.
Conclusion: It can conclude that Als plays an essential role for
osteoporosis that reduce the quality of health and increase the risk of
fraction in the breast cancer women

Background: Carpal tunnel syndrome is a frequently observed condition
affecting the wrists and fingers, characterized by numbness, tingling, and
sometimes pain.
Objective: To evaluate and compare the efficiency of magnetic field
therapy and ultrasound therapy in rehabilitating women with carpal tunnel
syndrome (CTS).
Patients and Methods: Forty women with mild to moderate CTS were
included in the study, and an electromyography (EMG) and examination
confirmed the diagnosis. The participants were assigned into two groups.
Group A received magnetic field therapy, and Group B received
ultrasound therapy. Patients for each group received a six-session clinical
evaluation. The outcomes included the Boston Carpal Tunnel Syndrome
Questionnaire (BCTSQ), handgrip strength, wrist joint movements
(flexion and extension), as well as the Visual Analogue Scale (VAS).
Results: The paired t-test analyses demonstrate a significant improvement in
the Boston questionnaire and VAS in both intervention groups at a P-value
≤0.05. The independent sample t-test analysis for post-intervention for both
groups showed superiority for magnetic field therapy; no significant
differences were observed in the improvement of wrist movement (Flexion =
0.66, Extension = 0.71); the Visual Analog Scale (VAS) has been improved
in both treatment groups with dominance for ultrasound therapy.
Conclusion: Both magnetic field and ultrasound therapy effectively treat
women with carpal tunnel syndrome. Magnetic field therapy was
statistically superior to ultrasound

Background: Hemorrhoidal diseases are very common diseases found in
surgical outpatient clinics, affecting populations all over the world.
Treatments for the different grades of hemorrhoids include lifestyle
changes, conservative medical therapy, and operative interventions.
Objective: To assess the conservative treatment response of all grades of
hemorrhoidal disease (grades 1-4) to a venotonic agent (Daflon 500mg).
Patients and Methods: This is a prospective observational study of 196
patients with hemorrhoids, conducted during the period from January 2015
to January 2020, All treated with the standard dose of a venotonic agent
(Daflon 500mg). An observation of the reduction and disappearance of the
signs and symptoms of the different grades of the disease was done at 1, 3,
and 6 months.
Results: The mean age of the patients was 46.6 (range 14–85) years. The
majority (41.84%) were diagnosed with grade III hemorrhoidal disease and
30.1% with grade II disease; Grade I and Grade IV constitute 9.69% and
18.37%, respectively. excellent improvement observed in about 72.45%,
temporary response seen in 15.82% of cases.
Conclusion: Daflon 500 mg is an effective first-line conservative
treatment for all four grades of hemorrhoidal diseases, including grade 4,
which has a 44.74% permanent response rate. This medical treatment, in
turn, reduces the chance of surgical intervention and its complications.

Background: Patient satisfaction is increasingly recognized as a vital
indicator of healthcare service quality. It aids in identifying healthcare
system shortcomings and improving patient trust. Factors influencing
patient satisfaction during anesthesia services have been studied globally,
but there is a lack of research in the context of lipoabdominoplasty under
combined lumbar spinal-epidural anesthesia (CLSEA).
Objective: To evaluates patient satisfaction with lipoabdominoplasty
under CLSEA, focusing on various intraoperative factors that may affect
satisfaction.
Patients and Methods: This prospective observational cross-sectional
study included adult patients undergoing lipoabdominoplasty under
CLSEA without complications. Patients completed a structured
questionnaire assessing satisfaction with intraoperative care. The
questionnaire addressed factors related to the information provided,
decision-making involvement, physical comfort, emotional support, and
respect for patient values.
Results: The questionnaire encompassed three types of questions: anesthesia
quality, factors causing intraoperative annoyance, and patient-team
interaction. The majority of patients found epidural anesthesia favorable.
Factors causing moderate annoyance included surgery duration, stress, fixed
position, feeling cold, and shivering. Patients reported low annoyance with
factors like team discussions, anxiety, surgical light, dizziness, thirst, itching,
nausea, vomiting, noise, pain, and dyspnea. Patients generally had a high rate
of good reactions toward the surgical team, but less than 50% requested more
respect and thorough medication information.
Conclusion: This study offers insights into patient satisfaction with
lipoabdominoplasty under CLSEA, shedding light on factors affecting
their experiences. The findings underline the importance of addressing
patient concerns and expectations to enhance overall satisfaction and
quality of care.

Background: Ramadan is the holy month in which all Muslims abstain
from eating and drinking from sunrise to sunset. The impact of Ramadan
fasting on the oral cavity and saliva needs more attention because of the
important function of saliva in the protection of the mouth.
Objective: To determine the impact of Ramadan fasting on salivary uric
acid, flow rate, and pH among Iraqi male dental students.
Patients and Methods: The subject population consisted of thirty healthy
male dental students (College of Dentistry/University of Baghdad) with an
age range of 20–23 years who intended to fast the whole of Ramadan
(1443 Hijri calendar). Saliva samples were obtained from all dental
students one week prior to the start of Ramadan, the last week of
Ramadan, and one month after the end of Ramadan. The salivary flow rate
was calculated, and the salivary pH was measured using a digital pH
meter. Then a saliva sample was analyzed to detect the concentration of
uric acid by using the spectrophotometer.
Results: The data analysis for this study revealed that the salivary flow rate
decreased from baseline to Ramadan and then increased again after one
month of Ramadan with significant differences (p<0.05). While salivary uric
acid increased continuously with significant differences from baseline to
Ramadan and after one month of Ramadan fasting (p<0.05), on the other
hand, salivary pH showed no significant differences (p > 0.05) among the
three time periods of the study.
Conclusion: Saliva was affected by Ramadan fasting through a decrease
in salivary flow rate during fasting and a return to normal salivary flow
rate after the end of Ramadan. In addition, uric acid, which acts as a
salivary antioxidant, shows an increase during Ramadan fasting

Background: Dentures can cause pathological problems to the oral tissues
known as denture-induced mucosal lesions; the most common type is
denture stomatitis.
Objective: To estimate the frequency of denture-induced mucosal lesions
among denture wearer patients attending oral diagnosis clinic /Faculty of
Dentistry in Tishk International University.
Patients and Methods: A patient who uses either removable partial or
complete dentures was included. The patient’s gender and age, denture-
related data, and oral lesions induced by dentures were evaluated. The data
were statistically analyzed using chi-square and multivariate logistic
regression.
Results: Oral lesions (23.5%) were more common in males; the lesions
found include denture stomatitis, denture hyperplasia, traumatic ulcers, and
angular cheilitis. Denture stomatitis was the most common type (7%). The
correlation between vertical dimension state and oral lesions was very highly
significant.
Conclusion: The major cause of denture-induced mucosal lesions was a
change in denture vertical dimension and mostly a reduction in vertical
dimension

Background: Nanoparticles are increasingly being used as an alternative
antibiotic to target microorganisms, particularly for treating bacterial
infections. In current study it was recognized processes such as metal ion
release, induction of oxidative stress, and non-oxidative mechanisms.
Developing resistance to nanoparticles is challenging for bacterial cells
due to the multiple simultaneous actions against microorganisms, and
require several simultaneous gene alterations within the same bacterial
cell.
Objective: To determine the effect of the titanium dioxide nanoparticles
(TiO2NPs) on the activity of the same bacteria that participate in dental
caries (Staphylococcus aureus and Escherichia coli).
Patients and Methods: The study included 50 patients who attended the
dental clinic and took the samples by the wooden swap from the molar
area (cervical area of inflamed gingiva and same samples taken from
occlusal surface of molar). The collected samples were cultured on
“Mannitol salt agar, Blood agar, and MacConkey's agar plates” for
separation of the needed bacteria (Staphylococcus aureus and Escherichia
coli) that showed wide spreading in the oral cavities and dental carries.
TiO2NPs are then created using pulse laser ablation, followed by coating
preparation the nanoparticles materials (using a hybrid sol-gel and organ
silicate nanoparticles), and finally the prepared nanoparticles to the
coating solution and local paint were used for antimicrobial activity of the
separated bacteria using different concentrations of TiO2 in the cultures.
Results: Characterization showed the phase of the TiO2NPs was spherical,
with very few irregularly shaped particles, and had an average small size in
millimeters. Antimicrobial activity results showed a strong bactericidal effect
against Gram-positive bacteria and demonstrated greater sensitivity to TiO2
nanoparticles at lower concentrations when compared to Gram-negative
bacteria.
Conclusion: It was shown that nanotechnology promise in treating various
infections caused by bacteria, including dental caries. Notably,
nanoparticles have demonstrated broad-spectrum antibacterial effects
against Gram-positive bacteria.

Background: Benzylpenicillin is an antibiotic that possesses effectiveness
mainly against gram-positive and some gram-negative bacteria. The
carboxylic acid of beta-lactam is essential for its antibacterial activity.
However, many prodrugs have been produced through the esterification of
this carboxylic acid group, like Pivampicillin.
Objective: To evaluate the antibacterial effects of Benzylpenicillin when
the free carboxylic acid mask with different chemical groups of different
polarity.
Patients and Methods: Four Benzylpenicillin derivatives (compounds p1-
p4) were chemically synthesized through the esterification of the
carboxylic acid group with different groups of different polarity, and the
antibacterial activities were examined by docking and bacteriological
studies.
Results: All the compounds showed different antibacterial results. The
docking results showed that; the compound of the highest polarity
(compound p1) has the best Binding energy. Also; The results of in vitro
antibacterial activity showed that; compound p1 had the largest zones of
inhibition and the highest antibacterial activity among all the other
compounds.
Conclusion: Masking the free carboxylic acid of benzylpenicillin with
polar group will enhance the antibacterial activity.

Background: Pulmonary TB is a relatively common disease in developing
countries including Iraq . A relatively small proportion (5–10%) of the
approximately 2 billion people infected with M. tuberculosis worldwide
will develop TB.
Objective: To show the prevalence of T.B. among children in Abu-Ghraib
city
Patients and Methods: A descriptive retrospective center-based study in
the Abu-Ghraib health sector (chest and respiratory disease unit) was
conducted to show the distribution of TB in children ≤ 18 years from the
1st January 2001 till the 31st December 2020.
Results: A total sample of 248 patients which represents 15.1% of all
patients with TB in Abu-Ghraib (1642) from1st January 2001 till 31st
December 2020. Female (152; 61.2%) and male (96; 38.8%). Most common
age group affected was 13-18 years which represents 71.7% of patient. The
prevalence of TB in Abu-Ghraib during the study period for children was
(3.4/100,000).
Conclusion: The prevalence of all forms of TB in Abu-Ghraib during the
study period was (3.4/100000). Females were affected more than males
with a mean of 6.7+/-1.5 Extra-pulmonary TB was found to be more
common than pulmonary TB.

Background: Low back pain is a significant contributor to global
disability, impacting individuals across different age groups. Research
suggests that around 80% of people will encounter low back pain at some
stage in their lives. This condition is more prevalent among middle-aged
and elderly individuals, with a higher occurrence among females. The
socioeconomic consequences of low back pain are substantial, including
increased healthcare expenses, absenteeism from work, and a diminished
quality of life.
Objective: To compare the effectiveness of short-wave diathermy with
exercise, transcutaneous electrical nerve stimulation with exercise, and
exercise alone among patients with chronic low back pain.
Patients and Methods: 75 patients who were diagnosed with chronic low
back pain, ages 20–50, participated. They were divided into three groups:
group A received shortwave with exercise, group B received TENS with
exercise, and group C received just exercise. Treatment was given for 12
sessions over a period of 4 weeks. All patients were evaluated before and
after treatment using a visual analog scale and the Oswestry Low Back
Pain Disability Questionnaire.
Results: The results showed that all three interventions were effective in
reducing pain and improving physical activities, with varying degrees of
success. But also, the result showed that the mean difference for the short
wave with exercise is much higher than both the TENS with exercise and the
exercise alone types of interventions in each of the different categories,
respectively.
Conclusion: This study has shown that shortwave exercise is more
effective in the treatment of chronic low back pain than TENS with
exercise and exercise alone.

Background: Vaccination is probably the most effective approach to
prevent and control COVID-19. Studies assessing acceptance towards
vaccination showed huge regional variations.
Objective: To find out the rate of acceptance of Covid 19 vaccine and its
associated factors as well as to explore out both the most frequent reasons
behind acceptance or refusal of this vaccine and the most received and
preferred type.
Patients and Methods: In this cross-sectional study, a convenience
sample of 1000 visitors to primary health care centers (PHCCs) in
Erbil/Iraq, aged 18 years and older, were collected from December 2021 to
December 2022. A structured questionnaire was used for data collection
through a direct interview.
Results: The study showed that 43.9% of the participants accepted the
vaccine. The main reason behind refusal (53.8%) was not trusting its
development, while the main reasons for receiving were to protect
themselves (44.2%), majority of those vaccinated (76.5%) received Pfizer,
which was the most preferred type (67.4%), 10.3% of them were not
completing the recommended dose and the most common reasons behind this
were neglect and shortage of time (31%), and afraid from side effects (31%).
A significant association found between vaccination practice with gender,
education, occupation, family income and socioeconomic status. Vaccinated
persons were less likely to be infected with COVID19 (20.7%) than
nonvaccinated ones (62.7%).
Conclusion: Less than half of the participants were accepted the vaccine
and the acceptance rate significantly associated with male gender,
education, occupation, family income, and socioeconomic status.
Keywords: COVID-19 vaccination acceptance, vaccine,

Background: The global prevalence of mental disorders, including
depression, has steadily increased.
Objective: To identifying the prevalence rate of depression and the related
predictors among old-age people in Iraq.
Patients and Methods: A cross-sectional study was conducted from
August to November 2021. A random sampling technique was employed
to gather information from the old age patients during their routine visits
to outpatient clinic of three public hospitals (Baquba, Ramadi, Samarra),
in Iraq. Data collection involved the utilization of a semi-structured
questionnaire incorporating the validated Geriatric Depression Scale
(GDS-30) administered through face-to-face interviews. Descriptive,
bivariate, and multivariate logistic regression analyses were employed to
examine the relationships between variables in the study. SPSS version 16
was utilized for data analysis, with statistical significance set at a
threshold below 0.05.
Results: Data of 344 old-age respondents (range 60-81 years) with a mean
age of 75.15 (± 7.52) years have undergone final analysis. More than half
were males (50.6%), married (62.2%), ranked themselves as unhealthy
(72.4%), physically inactive (70.6%), and financially dependent (71.8%).
The overall prevalence of depression was 74.4%. Logistic regression
revealed significant associations: elderly females had 3.805 times higher risk
(P<0.001,95% CI: 1.999 to 5.241), unhealthy individuals had 2.379 times
(P<0.001, 95% CI 1.657 to 3.415), limited activities of daily living (ADL)
had 2.650 times (P =0.001, 95% CI: 1.076 to 3.902), and those lacking
family support had1.799 times (P = 0.003, 95% CI: 1.040 to 3.746) than their
counterparts.
Conclusion: High depression rates and multiple risk factors necessitate
the urgent need for health and political intervention to support patients and
promote greater social participation.

Background: Anemia is a decrease in the amount of hemoglobin, or red
blood cells, in the blood. Slow-onset symptoms, such as dyspnea,
exhaustion, weakness, or impaired exercise capacity, are frequently
nonspecific. Red blood cells' capacity to carry oxygen is limited by
anemia. This suggests that the body's tissues and organs take less oxygen
from the blood.
Objective: To determine the effect of anemia on oral cavity in addition
hematological assessments and compare them with healthy controls.
Patients and Methods: Among 80 people, a cross-sectional study was
conducted. Twenty healthy control participants (9 male and 11 female)
and sixty patients with anemia (22 male and 38 female) made up the study
samples. Study was directed in September 2023 in Alkhalis hospital-
Diyala.
Results: Level of hemoglobin in the control group showed a statistically
highly significant increase with mean ± SE (14.12 ±0.35) as compared with
patients’ group. The white blood cell counts showed an increase in the
control group with mean ± SE (9.92 ±0.54) as compared with patients’
group, with a statistically highly significant correlation. Out of 60 patients, 2
(3.33%) were complaining from angular cheilitis, 6 (10%) were complaining
from burning mouth syndrome, 5 (8.33%) were complaining from recurrent
aphthous stomatitis, and 13 (21.67%) were complaining from atrophic
glossitis, with a statistically highly significant relationship.
Conclusion: Differences in white blood cell counts in patients with
anemia and healthy control. Many oral manifestations associated with
anemia such as atrophic glossitis, burning mouth syndrome, angular
cheilitis, and recurrent aphthous stomatiti

Background: Group A Streptococcus (GAS) significantly impacts global
health, especially among children aged 5–14 years, causing approximately
288 million episodes of sore throat annually and resulting in around
100,000 disability-adjusted life years (DALYs) each year. GAS infections
are particularly prevalent in developing countries.
Objective: To assess the patterns of antibiotic resistance of Streptococcus
spp. that cause pharyngitis in children.
Patients and Methods: It was collected 100 pediatric patients. It was
taken throat swabs for Streptococcus species culture and antibiotic
sensitivity test. In addition, it was recorded the data of patient’s age and
gender.
Results: It was shown in this study that an average age of 4.4 ± 3.7 years for
pharyngitis in children. In this study was diagnosed that Streptococcus
agalactiae (24%) and Streptococcus pyogenes (18%) as the common causes
Streptococcus species causes pharyngitis in children. It was noted that the
differences in bacterial species according to the patient’s ages. Antibiotic
sensitivity testing determined that there are high sensitivity of S. pneumoniae
and S. parasanguinis to multiple antibiotics. In addition, it was showed
resistance of S. pyogenes to Metronidazole and Azithromycin.
Conclusion: In this study, it was found that the risk age for pharyngitis in
children is four years old. Streptococcus agalactiae and Streptococcus
pyogenes are the common bacterial causes for this infection. In addition, it
was shown that S. pneumoniae appeared a high sensitivity to Ceftriaxone,
Ciprofloxacin, and Meropenem, and S. parasanguinis was sensitive to
Azithromycin, Cefixime, and Cefotaxime, and S. pyogenes showed a high
sensitivity to Meropenem and Imipenem.
Keywords: Pharyngitis, Streptococcus

Background: C-section (caesarean section) is a lifesaving procedure when
certain complications arise during pregnancy and labor. however, it’s a
major surgery and associated with immediate maternal and perinatal risks
and may have implications for future pregnancies as well as long term
effects.
Objective: To describe indications and determinants of caesarean section
in Al Batool teaching hospital in Diyala during the study period.
Patients and Methods: Across sectional study conducted among women
admitted to Al Batool teaching hospital and delivered by C-section from
first of October 2022 to 15th of march 2023.
Results: A total of 150 women underwent C-section enrolled in this study
during the study period, age of participants ranged from 19-35. out of them,
88(59%) sections were elective and 62(41%) sections were emergent.
commonest indication for emergency C-section was fetal distress (62%) and
commonest indication for elective C-section was previous cesarean (33%).
Conclusion: Parity, residence, education, and antenatal care visits were
significant determinants for C-section. previous C-section, maternal
request and malpresentation were commonest indications for such
procedure.