Diyala Journal of Medicine

Abstract
Background: Accurate diagnosis of thyroid nodules is important for
avoiding unnecessary surgeries and allowing timely treatment. Ultrasound
and fine needle aspiration cytology (FNAC) are the most commonly used
diagnostic procedures.
Objective: To correlate ultrasonography with the FNAC report findings
using the American College of Radiology Thyroid Imaging Reporting and
Data System (ACR TI-RADS) and the Bethesda System for Reporting
Thyroid Cytopathology (TBSRTC) in differentiating malignant from
benign thyroid nodules.
Patients and Methods: A prospective study conducted from January 2021
to January 2024 assessed 103 cases of thyroid nodules who underwent
ultrasound examination and fine needle aspiration. Ultrasonography
findings were analyzed and correlated with FNA cytology reports based on
ACR-TIRADS and BSRTC.
Results: Patients were predominantly female, n = 87 (84.4%). Most of the patients
were in the 31–40 year group (n = 55, 53.39%). Most of the patient nodules had
TIRADS 3 (n = 59, 57.28%), followed by TIRADS 2 (n = 20, 18.44%). When
comparing the ACR TI-RADS scoring system with the TBSRTC, the percentage of
malignancy for TR1, 2, 3, 4, and 5 was 0, 0, 1.6, 80, and 89%, respectively. In our
study, the overall sensitivity and specificity of the TIRADS score were 94.11% and
96.51%, respectively. PPV: 84.21%; NPV: 98.80%; and accuracy: 96.11%. In
addition, there was a significant association between TIRADS and the Bethesda
system of classification (P < 0.001).
Conclusion: ACR-TIRADS scoring is highly sensitive and accurate for
diagnosing thyroid malignant nodules. It is a sensitive tool and could be
used alone to determine the nature of thyroid nodules.

Background: Soft liners in dentures play a crucial role in enhancing
patient comfort and preventing tissue irritation especially for patients with
resorbed ridges. However, microbial colonization presents a challenge to
their long-term effectiveness, particularly Candida albicans, leading to
conditions like denture-induced stomatitis.
Objective: To evaluate the antimicrobial efficacy and mechanical
properties of heat cured soft liners incorporating plant extracts from Olea
europaea and Ficus carcia, individually and synergistically.
Patients and Methods: Extracts were obtained through Soxhlet
extraction, and their antimicrobial activity against Candida albicans was
determined using the broth microdilution method. Soft liner specimens
were prepared with varying concentrations of the extracts and subjected to
disk diffusion tests, shore A hardness measurements, and peel bond
strength tests. Statistical analysis involved the use of one-way ANOVA
and Dunnett tests.
Results: Results demonstrated significant antimicrobial activity, with the
synergistic mixture exhibiting the highest inhibition zone against Candida
albicans. Moreover, the addition of such extracts led to increased shore A
hardness, with the highest levels recorded for synergistic groups. The
extracts also displayed a significant decrease in peel bond strength,
indicating potential challenges in adhesive properties. These findings suggest
that while individual extracts show promise in antimicrobial efficacy and
mechanical reinforcement of soft liners, their combination may lead to
compromised adhesive properties.
Conclusion: The study contributes valuable insights into the development
of antimicrobial soft liners reinforced with Olea europaea and Ficus carcia

Background: Maternal serum ferritin is being explored as a potential
predictor for Intrauterine Growth Restriction (IUGR). Early detection of
IUGR is crucial for improving perinatal outcomes and reducing associated
mortality and morbidity.
Objective: To evaluate the role of elevated maternal serum ferritin in
predicting the risk of developing IUGR.
Patients and Methods: A prospective case-control study was conducted
at Al-Batool Teaching Hospital, Diyala, involving 51 pregnant women
divided into two groups based on pregnancy status. Demographic data,
obstetric history, and risk factors for IUGR were collected through a
questionnaire, and blood samples were taken to measure hemoglobin and
serum ferritin levels.
Results: The study found that the mean serum ferritin level was significantly
higher in the patient group (209.89±50.95 ng/ml) compared to the control
group (66.91±37.49 ng/ml), with a p-value of <0.001. The mean birth weight
was significantly lower in the patient group (1873.81±425.62 g) compared to
the control group (3078.67±415.56 g), also with a p-value of <0.001. There
were no significant differences in age and hemoglobin levels between the
two groups.
Conclusion: Elevated maternal serum ferritin levels may suggest an
increased risk of IUGR, emphasizing the need for further research to
validate its role as a predictive m

Background: The runny nose refers to a discharge (fluid) coming from
the nasal passages.Runny nose is associated with inflammation and
swelling (congestion) of the inner lining of the nasal passages and sinuses.
May associated with atopic condition the patient complain from nasal
obstruction, runny nose, episode of sneezing, and nasal pruritis.
Objective: To examine the demographic distribution, clinical features,
and age disparities among male and female patients with Runny nose
(Rhinorrhea).
Patients and Methods: A study was done on 100 AR patients at Baqubah
Teaching Hospital. Information on demographics, clinical symptoms, and
age variations between males and females were gathered and examined
through the use of descriptive statistics and independent sample t-tests.
Results: The Findings revealed that most of the subjects were women (56%)
and homemakers (38%), with an average age of 29.73 years. Frequent
symptoms comprised of sneezing (93%), runny nose (83%), itchy nose
(74%), and stuffy nose (92%). There was no notable variation in age between
males and females (p = 0.139).
Conclusion: Clinical symptoms of runny nose are often recognized
consist of rhinorrhea, sneezing, obstruction of the nasal passages with
lacrimation and pruritus of the nasal mucosa, conjunctiva and oropharynx
with history of allergic rhinitis. Conditions commonly associated with
allergic rhinitis include asthma, sinusitis, allergic conjunctivitis and atopic
dermatitis. Long standing disease can lead to mucosa remodeling, atrophic
skin changes, nasal infection and overall increased morbidi

Background: Squamous-cell carcinoma (SCC) of the lung is a kind of
non-small-cell lung carcinoma. Cytotoxic chemotherapy has been found to
deliver benefits to patients in advanced disease settings.
Objective: To compare response rate and side effects between first-line
chemotherapies vinorelbine, gemcitabine, and taxanes in patients with
metastatic SCC of the lung.
Patients and Methods: This is a retrospective study including 45 patients
with metastatic lung SCC. All patients had received platinum-based
doublet chemotherapy for 4-6 cycles. Patients were allocated into three
groups based on the additional treatment protocol, with fifteen patients per
group. A reduction in tumor size was assessed from tumor measurements
for patients who had at least two evaluable assessments with computed
tomography. The side effects of each drug were evaluated.
Results: The reduction in tumor size in the gemcitabine, taxan, and
vinorelbine arms was -5.59±35.62 cm3, 1.3±39.98 cm3 and -10.55±14.62
cm3, respectively, with no significant differences. The response rates in the
taxan, gemcitabine, and vinorelbine arms were 73.33%, 80%, and 86.67%,
respectively, with no significant differences. The side effects, including
nausea, alopecia, diarrhea, arthralgia, and peripheral neuropathy, were, in
particular, more common in patients in the taxan arm than in other arms, with
significant differences.
Conclusion: The three therapeutic arms, vinorelbine, gemcitabine, and
taxanes, had similar efficiency based on response rate, with a mild
preponderance of vinorelbin

Background: Atrial fibrillation (AFi) is more common as people get
older. Additionally, a further indicator of the occurrence of AFi is
subclinical hyperthyroidism, which is linked to a 3-fold increased risk.
Lack of vitamin D causes the renin-angiotensin-aldosterone pathway to
become active, which has an impact on the cardiovascular system.
Objective: To examine the association between 25-hydroxyvitamin D3
insufficiency and AFi and hyperthyroidism cases with valvular and
nonvalvular AFi that required treatment at our medical center.
Patients and Methods: Samples taken from 200 cases of AFi (50-65
years old) divided into: group A cases with nonvalvular AFi and group B
cases with valve AFi, and 100 healthy individuals with sinus rhythm who
were age-matched chosen as control groups. Standard biochemical
measurements, including levels of 25-OHvit.D3,the hormone of the
thyroid gland, and parathyroid hormone, were made.
Results: Cases in group A had decreased 25-OHvit.D3 levels compare to
those in the control and B groups (P ≤ 0.05 ).In comparison to the control
group, the patients in groups A and B had larger left atriums and greater
systolic pulmonary artery pressures.
Conclusion: Thus, the study shows a connection between nonvalvular AFi
cases with hyperthyroidism and 25-OHvit D3 deficiency.

ackground: In the context of rising obesity rates globally, understanding
the effect of high body mass index (BMI) on breast cancer characteristics
is crucial. Previous research has hinted at associations between obesity
and some specific features, such as tumor receptor status and axillary
lymph node involvement. However, a comprehensive investigation into
these relationships is essential for informing targeted interventions and
advancing our understanding of breast cancer in the context of obesity.
Objective: To investigate the relationship between high BMI and some
key tumor characteristics such as hormone receptor status, HER2 receptor
status, tumor grade, tumor size and axillary lymph node status.
Patients and Methods: A retrospective analysis of the medical records of
186 female breast cancer patients treated at Rizgary Teaching Hospital\'s
Oncology Department in Erbil City during the year 2021.
Results: The study revealed a statistically significant association between
elevated BMI and certain pivotal breast tumor characteristics, particularly
HER2 receptor status. Additionally, obese individuals exhibited a
significantly greater probability of having axillary lymph node-positive
disease compared to their non-obese counterparts.
Conclusion: This study establishes a noteworthy association between high
BMI and some critical breast cancer characteristics, which may underscore
the clinical relevance of body mass index in shaping breast cancer profiles.

Background: The condylar process of mandible is an ellipsoid hard tissue
(bony structure) with a thin neckline that joins to the mandibular ramus.
The condylar processes are a critical anatomic component of the mandible
that development of mandibular bone is attributed in the sagittal and
vertical directions by condylar process.
Objective: To radiographical assessment of condylar head measurements
according to gender and site by uses cone beam computed tomography.
Patients and Methods: The study samples consisted of sixty-five
individuals (19 male and 46 female) with age range from (20-50) years
old. Width of condylar head, length of condylar head and condylar head
height were measured in the study by using cone beam computed
tomography from radiology archive in specialist dental center in Diyala.
Results: The results show condylar head width, condylar head height and
condylar head length in sides (right and left), males have noted higher mean
value than females. The results show condylar head width and condylar head
length in left side, have recorded higher mean value than right side. While,
condylar head height in left side, have recorded lower mean value than right
side.
Conclusion: Condylar dimensions and sizes may be associated with
gender and site. Males have higher condylar dimensions and sizes than
females.

Background: Mask-induced acne, also known as maskne, is a skin
condition that has become increasingly prevalent during the COVID-19
pandemic. The prolonged use of facial masks has been found to cause skin
irritation, inflammation, and the development of acne. Healthcare workers
are at an increased risk due to their prolonged and consistent use of facial
masks during their work.
Objective: To investigate the occurrence and identify risk factors of mask
induced acne among health care workers.
Patients and Methods: This cross-sectional study included 115 healthcare
workers at Al_Imamain Al_Kadhumain Medical city who wore the mask
daily. Collected data include demographic characteristics (age, sex, and
occupation), mask-wearing data include the type of mask worn, the
pattern of mask use (disposable or reusable mask), time spent wearing
masks over the years, the daily duration of mask usage, and specifics
regarding participants' acne, encompassing the type and facial location of
the acne, as well as accompanying symptoms (itching, dryness, oiliness,
moisture, warmth, and excessive facial sweating), and factors that
exacerbate the condition, were all considered in the study.
Results: Out of 115 included subjects 37 (32.17%) were suffering from
new-onset mask induce acne. There were 10 men and 27 women. The mean
age was 35.5±7.3 years (range: 24-47). The vast majority of the included
participants (81.08%) were wearing surgical masks. The duration of mask
use in about three-fourths of patients was ≥ one year. About three-fourth of
patients were using reusable mask. Pustules were the most common lesion,
accounting for two-thirds of the participants, followed by comedones
(37.83%). The most common site was cheeks (75.67%), followed by the chin
(48.65%). Stress was the most common aggravating factor occurred in
37.84% of the participants, followed by high-glycemic diet and hot weather
(27.03% each).
Conclusion: Female, prolonged duration of mask use and wearing
reusable masks could be associated with the development of maskne.
Stress and a glycemic diet could aggravate the lesion associated with
maskne.

Background: The treatment landscape for vitiligo has witnessed diverse
approaches yielding variable outcomes.
Objective: To discern the optimal approach in terms of both tolerability
and efficacy by comparing Narrow Band Ultraviolet B (NB-UVB)
phototherapy with adjunctive oral mini pulse (OMP) prednisolone tablets.
Patients and Methods: A total of eighty-seven individuals with
progressive vitiligo were enrolled in a one-year study, with participants
allocated randomly across three study groups through a continuous
selection method. Group 1 received a combination of NB-UVB and OMP
prednisolone tablets, group 2 underwent NB-UVB treatment only, and
group 3 received OMP prednisolone tablets alone. Clinical assessments
were conducted at three- and six-month intervals, and statistical analyses
were performed utilizing descriptive and bivariate techniques, including
the chi-square test, to gauge the significance of differences between the
various groups.
Results: In Group 1 (NB-UVB + OMP), substantial improvement was
observed in 41.4%, accompanied by moderate improvement in 44.8% of
patients. Group 2 (NB-UVB) demonstrated marked improvement in 31.0%
and moderate improvement in 38.0%. In Group 3 (OMP), a lower proportion
experienced marked (13.8%) or moderate (3.4%) improvement. Chi-square
test findings indicated that the combination of NB-UVB and OMP correlated
significantly with marked and moderate improvement in contrast to OMP
alone, with respective values of χ² = 6.434 (p = 0.001) and χ² = 7.831 (p =
0.015) after a six-month follow-up.
Conclusion: Through a comprehensive evaluation of three treatment
modalities in vitiligo patients, it was established that the sole application
of oral mini pulse steroids (OMP) held an adjunctive value, lacking
substantial efficacy on its own. Remarkably, the amalgamation of Narrow
Band UVB and OMP presented a clear advantage over either treatment
administered independently.

Background: Bio-phosphonates can be used to lower the risk of hip and
spine fractures. Additionally, they can be used to treat Paget's disease of
the bones in a variety of dosages. In the procedure that replace hyaline
cartilage to bone, this procedure i.e. called endochondral ossification. It
starts when mesenchymal cells from the mesoderm develop into
chondrocytes. Chondrocytes multiply quickly and release an extracellular
matrix to create the cartilage that serves as the model for bone.
Objective: To histomorphometric illustration the endochondral
ossification of the mandibular angle defect repair in rats after- oral
stimulation with bisphosphonate treatment.
Patients and Methods: 20 rats were used in this work and the animals
were divided into the following groups: 10 Rats from the control group.
The bone defect was healed naturally without medicament and 10 rats
were used in the experiment, and taking the biophosphonate medication
helped mend the bone defect. Every single group was studied in 7 and 14
day (5 rats for each healing period) and the surgical procedure was
performed for histological and Histomorphometrically examination. The
data analysis with spss statistic measure & with P vale (P ≤ 0.05).
Results: Active effect of the bio-phosphate medicament in the endochondral
ossification and the cell that responsible for the cartilage formation and
accelerated the healing of the mandibular defect with inhibition of the bone
resoption and finally decrease the time that need to full healing.
Conclusion: The chemical medicament that represented by bio-
phosphonate accelerated the endochondral ossification in a short time and
replacement with bone in the site of the defect.

Background: Children and adolescents with insulin-dependent diabetes
mellitus (IDDM) are at high risk of metabolic disorders that may interfere
with lipid metabolism and predispose to dyslipidemia.
Objective: To detect the incidence of dyslipidemia and associated factors
in children with IDDM in Diyala.
Patients and Methods: This was a case-control study that included a total
of 100 children with type 1 diabetes mellitus(T1DM) and 100 age- and
gender-matched non-diabetic children who presented to the Pediatric
Department/Al-Batool Teaching Hospital during the period from April
2022 to April 2023. Demographic data included the child's age, gender,
weight, mother’s educational level, mother's job, child's educational level,
school attendance, and physical activity. Clinical data included systolic
and diastolic blood pressure, HbA1c, family history of illness, disease
duration, type of insulin, and insulin dose. Fasting lipid profile and
hemoglobin A1c investigations were done for the study groups, and the
data were statistically analyzed.
Results: The overall dyslipidemia in IDDM children and controls was 46%
and 8%, respectively, with a highly significant difference. The mean age and
weight in diabetic patients with dyslipidemia were 8.23±3.63 years and
28.96±13.31 kg, respectively, which was higher than that of normolipidemic
diabetic patients (10.72±3.23 years and 34.22±12.14 kg, respectively) with
significant differences. Furthermore, 28.26% of mothers of dyslipidemia-
.diabetic patients were employed, compared with only 11.11% of
normolipidemic-diabetic patients, a significant difference. A family history
of DM was reported in 47.83% and 27.78% of dyslipidemic and
normolipidemic diabetic patients, respectively, with a significant difference.
Conclusion: The incidence of dyslipidemia among diabetic children in
Diyala is 46%. Older age, increased body weight, and a mother’s job as an
employer are significantly associated with the development of
dyslipidemia in insulin-dependent diabetes mellitus patients.

ackground: Adenocarcinoma of the lung is the most common type of
lung cancer. Platinum agents in combination with other chemotherapy are
currently the cornerstone for chemotherapy of advanced cases with
metastasis.
Objective: To compare the response rate of pemetrexed doublets versus
taxanes doublets in patients with metastatic lung adenocarcinoma.
Patients and Methods: This a prospective study that included 60 patients
with pulmonary adenocarcinoma. Those patients received a platinum
based doublet chemotherapy with additional treatment protocol; combined
with either pemetrexed or taxanes (paclitaxel or docetaxel) with 30
patients in each arm. Tumor size, response rate and side effects of
chemotherapy were evaluated in both arms.
Results: The median reduction in tumor size in pemetrexed and taxan arms
were 4.72 cm2 and 6.53 cm2 respectively. Nausea, fatigue, constipation and
anorexia were more common in pemetrexed arm, while leukopenia,
arthralgia and peripheral neuropathy were more common in taxan arm.
Conclusion: Serious side effects such as leukopenia, and peripheral
neuropathy were more common in taxan than pemetrexed arm. Pemetrexed
is preferable to use as a fist line treatment for patients with metastatic
adenocarcinoma of the lung

Background: Molar incisor hypomineralization is a clinical symptom of
general hypomineralization affecting a single or multiple first permanent
molars, which is generally accompanied with incisors.
Objective: To determine the prevalence of molar incisor
hypomineralization among 12 years students in Baquba city.
Patients and Methods: This study was conducted from middle of January
2022 till the end of May 2022 in Baqubah city/Diyalla Governorate/Iraq.
The sample excluded all students who had other enamel defects (fluorosis
or hypoplasia, uncooperative students and students who refuse to
participate.
Results: Out of 700 participants, 52.43% of them were females and the rest
were males. About 13% of the total sample showed a molar incisor
hypomineralization, with significant association between gender, in which
male were significantly more affected than females. The data showed 13% of
the total sample had a demarcated opacities . Also the results showed that the
upper centrals were more affected by hypominrlization than other teeth.
Conclusion: However, the study revealed that demarcated opacity was the
most common form of defect with a significant correlation, with a
frequency of 13%. The upper central tooth was always the most commonly
impacted by molar incisor hypomineralization.

Background: Helicobacter pylori is the most frequent human bacterial
infection worldwide; it is prevalent in approximately half of the world's
population. H.pylori poses a major health risk because it possesses distinct
virulence factors and highly resistant to antibiotics. Multidrug resistance
(MDR) and single-drug resistance are two distinct resistance profiles.
Chromosome mutations influence antibiotic activity via target-mediated
pathways. Inadequate drug absorption, efflux pumps activity, biofilm
development, and cocci formation represent supplementary biological
mechanisms by which H.pylori acquires drug resistance. The
overexpression of efflux pumps genes in mutant isolates is readily
detectable in post-therapy courses.
Objective: Characterization of the biological and molecular mechanisms
contributing to the development of antibiotic resistance in H.pylori.
Conclusion: An alarming rate of drug-resistant H.pylori is on the rise.
Primary and acquired resistance to clarithromycin and metronidazole has
increased globally. Bacterial factors including biofilms, efflux pumps, and
molecular mechanism are in association with H.pylori resistance. It is
important to continue to monitor the resistance profiles of H.pylori
isolates.