Diyala Journal of Medicine

Background: A fundus first laparoscopic cholecystectomy when performed
by an experienced surgeon, provides the same level of safety and durability
as an open cholecystectomy. When Calot's triangle cannot be safely
dissected during laparoscopic cholecystectomy a rescue treatment is
advised. Current revisions stress the importance of intraoperative
observations in helping surgeons make a rescue decision and minimize
additional harm.
Objective: To examines the fundus-first strategy in laparoscopic
cholecystectomy in an indistinct Calot's triangle and the patient's clinical
outcome.
Patients and Methods: This is a prospective study that was done in Rizgary
Teaching Hospital from January 1st, 2020 to December 31st, 2022, on 68
cases who underwent laparoscopic cholecystectomy where Calot’s triangle
was difficult to distinguish during the operation. Fundus: first dissection of
the gall bladder down to the infundibulum and after safe ligation of the gall
bladder stump and good hemostasis of the liver bed, the gallbladder is
removed via a 10-mm port. This research looked at the duration of
operation, postoperative pain, rate of conversion to open surgery and
duration of the hospital stay.
Results: Among 68 cases of fundus first laparoscopic cholecystectomy most
of the patients were female 45(66.17%) and 23(33.82%) were male, majority
of cases were between 31 and 50 years old, with a mean age of 39±10.44, and
the majority of patients were complaining of inflammation with fibrosis at the
site of the cystic duct. The duration of operation ranged from 45-60 minutes
in 16(23.52%) and 60-80 minutes in 20(29.41%) cases and 130-140 minutes
in 2(2.94%) cases. The majority of our cases remained in the hospital and
ambulated on day 3-5, and the main hospital stay was 4.68±1.8 days. There
was statistical significance in the age distribution with a P-value 0.04.
Conclusion: Fundus first laparoscopic cholecystectomy remains a feasible
and safe procedure. Surgeon experience and judgement affects the
operative time, conversion rate, morbidity and hospital stay in difficult and
obscured Calot’s triangle

Background: Polycystic ovarian syndrome is affecting around 5–15% of
females. Spexin hormone, identified as neuropeptide Q, has been newly
recognized by bioinformatics methods.
Objective: To evaluate the relationship concerning levels of spexin hormone
with metabolic disruption in women with polycystic ovarian syndrome.
Patients and Methods: A case-control study carried out in the department of
Obstetrics and Gynecology in Al-Imamain Al-Khademain medical
city/Baghdad, Iraq, from Jan 1, 2022, to the end of Dec 31, 2022. The study
sample comprises, 192 participants aged 18-45 years were joined and allocated
into a case group (96 women with PCOS) and a control group (96 women
without PCOS).
Results: Mean value of spexin hormone was (2.7±0.3 ng/mL) in the PCOS group,
while it was (3.5±0.7 ng/mL) in the control group; fasting blood sugar shows
significant association with a negative, weak correlation with Spexin in patients (P-
value= 0.005), Insulin shows significant association with inverse correlation with
Spexin in patients (P-value= 0.04), Homeostasis model valuation of insulin resistance
(HOMA-IR) shows significant association with inverse correlation with Spexin in
patients (P-value= 0.003). Spexin had a significant inverse correlation with LH,
SHBG, testosterone, FAI, and Dehydroepiandrosterone.
Conclusion: Serum level of spexin hormone was meaningfully decreased in
patients with PCOS than that in healthy women.

Background: Colon cancer is the third most common type of cancer. High
lymphovascular levels are linked to a number of cancers, including colon
cancer, while lymph vascular invasion levels as a predictor of outcome are not
well understood.
Objective: Determine the influence of lymphovascular invasion on the
recurrence of colon cancer.
Patients and Methods: it was collected 126 colon cancer patients who had
surgery and additional chemotherapy. The patients attended in the Baquba
teaching hospital oncology centre and the Al Jawad oncology centre of
Alkadhemiya hospital.
Results: it was shown in this study that the high percentage ages of colon cancer
patients was between 55-60 years, and there were more in women (57 %) than in men
(43 %). The most common stage of the tumours was stage 3 (42.9 %), and in grade 2
(76.2 %). In terms of return, in this study, 71.4 % of people who had lymphovascular
invasion positive and had a return of cancer in a percentage 73.3% of colon cancer
patients.
Conclusion: LVI plays an essential role for increasing recurrence of colon
cancer, and there were a strong link between them

Background: Visual impairment is a global issue that is particularly
problematic for poor nations. It is linked to diminished physical activity, social
isolation, reliance on everyday tasks, and even death. The clouding of the lens
inside the eye is called a cataract. It is one of the main causes of blindness and
visual impairment in the world. Because of its anti-inflammatory and
antioxidant properties, vitamin D, a prohormone in the blood, is crucial to the
pathophysiology of many ocular illnesses. Given that oxidative stress and
inflammation are significant contributors to the development of cataracts, a
number of research have evaluated the relationship between vitamin D3
deficiency and cataract formation.
Objective: Determine whether a vitamin D3 deficiency and cataracts are
related.
Patients and Methods: A cross-sectional study that was carried out included
a total of 100 cataract patients who are 60 years of age or younger from
September 2023 to March 2024 in the Ophthalmology Department of Imamein
Kadhimein Medical City, Baghdad, Iraq. Questionnaire form was used which
consist of sociodemographic information, socioeconomic status, dietary
sources of vitamin D3, sun exposure, anthropometric measures and
ophthalmic examination. Vitamin D3 level had been investigated in laboratory
of the hospital.
Results: Thirty percent of patients had cortical cataracts, 57% had nuclear cataracts,
and 13% had posterior subcapsular cataracts. Sixty-nine percent of patients had a
vitamin D3 level that is less than 20 ng/ml. Of the patients, 13% had a vitamin D3
level between 20 and 30 ng/ml, while 18% had a level greater than 30 ng/ml. There is
a significant association between the level of vitamin D3 and the type of cataract (p-
value = 0.013). Sixty-nine percent of patients with deficient vitamin D3 levels had 9%
posterior subcapsular cataracts, 36% cortical cataracts, and 55% nuclear cataracts.
Patients with insufficient vitamin D3 levels had 8% posterior subcapsular cataracts,
8% cortical cataracts, and 84% nuclear cataracts. While patients with sufficient
vitamin D3 levels had 33% posterior subcapsular cataracts, 22% cortical cataracts, and
45% nuclear cataracts. The body mass index and vitamin D3 level were significantly
associated (p-value = 0.003). Patients with a vitamin D3 level less than 20 ng/ml
comprised 31% overweight patients, 26% class I obese patients, 26% class II obese

Background: Newborn cholestasis is explained as a persisted rise of the serum
conjugated bilirubin outside the first two weeks of life. There are many
etiologies of newborn cholestasis that must be differentiated since immediate
interference may give a better outcome.
Objective: Newborn cholestasis is explained as a persisted rise of the serum
conjugated bilirubin outside the first two weeks of life. There are many
etiologies of newborn cholestasis that must be differentiated since immediate
interference may give a better outcome.
Patients and Methods: A cross-sectional research of forty-eight children
consulting the Childhood Wellbeing Teaching Hospital in Baghdad/Medical
City from 1st of November 2018 to the 30th of November 2021, complete
evaluation by full history, physical checkup and laboratory studies.
Cholestasis was demarcated as an extended raise of the levels of conjugated
bilirubin outside the 1st 2 weeks of age above 1.0mg/dl(17.1µmol/l) if the
whole serum bilirubin(TSB) is <5.0 mg/dL or above 20% of the TSB if the
TSB is >5.0 mg/dl.
Results: Out of 48 children involved in the study ,62.5% resided in Baghdad, and the
remainder was belonged to other districts. The mean age of children was 11.1 months.
The males constituted 58.3% of them. Eleven cases (22.9%) were caused by
congenital infection, nine 18.8% had no cause detected, while 16.7% caused by
biliary atresia and 16.7% had unidentified etiology, however 10.4% was related to
sepsis. Biliary atresia was more frequent in boys in 62.5% compared to 37.5% in
females. Family history was positive only in11.1% of idiopathic neonatal hepatitis. It
was found that 81% of cholestatic jaundice were caused by congenital infection. In
comparison, 62.5% caused by biliary atresia and 60% caused by sepsis appeared on
the second week of the child's age, and this difference was significant statistically P-
value 0.01.
Conclusion: Innate infections are the most frequent source, where CMV
contagion is the most commonly detected. Clinical findings included clay
colored stool & elevated alkaline phosphatase concentrations observed
primarily on biliary atresia. There are no specific test to identify the etiology
of newborn cholestasis.

Background: Chronic rhinosinusitis (CRS) is often diagnosed based on
clinical features. Assurance in this context is based on the finding of
inflammatory features during nasal endoscopy and computed tomography
(CT) scans of the paranasal sinuses. While a CT scan is considered the most
reliable method, research has shown that nasal endoscopy is also valuable and
can sometimes provide additional information to supplement the CT scan in
diagnosing CRS.
Objective: The study goal was to demonstrate the comparative reliability of
nasal endoscopy and computed tomography scans in diagnosing chronic
rhinosinusitis in adult patients treated at Baqubah Teaching Hospital.
Patients and Methods: The study sample consisted of consecutive adult
participants clinically diagnosed with chronic rhinosinusitis. Patients who had
a computed tomography scan of the paranasal sinuses and a nasal endoscopy
during three months were the subjects of this investigation; the outcomes were
linked.
Results: Study results exhibit that the most prevalent symptoms seen in the study
participants were nasal discharge and nasal obstruction, reported by 95% and 90%,
respectively; the most prevailing observation during nasal endoscopy was middle
meatus purulent discharge, noticed in 58% of the patients. Maxillary sinus was most
often affected, seen in 65% of the patients on a CT scan, and 40% had obstruction of
the osteomeatal complex on CT imaging. The nasal endoscopy had a sensitivity of
73.3%, specificity of 85.3%, positive predictive value of 92.7%, and negative
predictive value of 55.8%. The research also found no significant differences in
positive predictive value (PPV) between nasal endoscopy and CT scan. In contrast,
the sensitivity of nasal endoscopy was significantly greater than that of CT scan.
Conclusion: The study found that nasal endoscopic findings for patients with
positive clinical features were purulent (cream-colored) discharge and middle
meatus polyps, which is sufficient for diagnosing chronic rhinosinusitis; the
study showed that Nasal endoscopy is almost as accurate as CT scans and CT
scan findings are well correlates with sinus endoscopy, due to its precision,
cheap cost, and radiation dosage.

Background: Basal Cell Carcinoma (BCC) is the most common type of skin
carcinoma and is considered an epidemic disease due to its increasing
frequency in many countries. The most important problem of BCC is local
invasion It grows in a “silent” way into immediately adjacent tissue. It rarely
metastasizes. The early tumors are commonly small, translucent or pearly,
raised and rounded areas located on a few dilated, superficial vessels. There
are six subtypes of BCC that include nodular, pigmented, superficial, morphea
form, cystic. The most important risk factor for basal cell carcinoma is
exposure to UV-radiation. Outdoor workers with a long history of work-
related UV-exposure are at increased risk of developing BCC. Other risk
factors include family history of skin carcinoma, light skin phototypes,
advanced age.
Objective: The current study investigated pathological and histological
changes in tissue sections to identify the factors contributing to the infection
frequency.
Patients and Methods: Thirty-three BCC patients' samples have been
collected from the main care center at al-Baquba Teaching Hospital of Diyala
Province, Iraq. All patient groups were clinically diagnosed as BCC by
dermatologists.
Results: The study showed macroscopic and microscopic histological changes. An
ulcerated macroscopic appearance of the lesion was shown. The tumor lesions are
located on the face. It was noted that the percentage of patients was higher in men than
women and higher in light skin than dark skin. The study also showed that the age
group 66-74 years had a higher infection percentage, while the lower percentage was
of the age group > 83 years.
Conclusion: These findings pave the way for future research endeavors aimed
at prevention, early detection, and targeted treatment strategies for this
prevalent skin carcinoma.

Background: Squamous cells lining the tissues of the head and neck region,
such as the nasal cavity, paranasal sinuses, oral cavity, lip, salivary glands, and
hypopharynx, give growth to a group of malignancies together recognized as
squamous cell carcinoma of the head and neck, which is the seventh utmost
communal cancer diagnosis around the world.
Objective: Determine the prevalence of head and neck cancer in Diyala
province during 2022-2023 and their distribution according to age and gender
of patients. In addition, this study aimed to identify the numbers of each type
of head and neck cancer.
Patients and Methods: A retrospective study achieved on the prevalence of
head and neck cancer in the region accomplished in oncology center of Baquba
teaching hospital in Diyala province, Iraq. Head and neck cancer patients
recorded from 2022 to 2023. During this dated, a total of 172 patients were
recorded. A search was accomplished on numerous databases, moreover, the
information evaluated by age, gender and cancer type.
Results: Regarding patients during 2022 (first group) which is contained of (94)
patients with different head and neck cancer, 38(40.4%) were males and 56(59.6%)
were females with statistically significant relationship. The patients during 2023
(second group) comprises of (78) patients with different head and neck cancer,
43(50.1%) were men and 35(44.9%) were women with statistically no significant
correlation.
Conclusion: Oral and pharyngeal cancer is more common in men than in
women. The most common age group is 4th and 5th decade for head and neck
cancer

Background: Penicillium saprophytic species, which primarily consume
organic biodegradable materials, is a common example of a fungal species.
The preparation filtrates of Penicillium italicum, a saprophyte on citrus fruits
frequently linked to post-harvest diseases in this crop, were included in the
current investigation.
Objective: This investigation aimed determine the most efficient culture
medium for the production of antibacterial secondary metabolites.
Patients and Methods: included identifying the growth medium for P.
italicum and produce its metabolites through the use of gas chromatography-
mass spectrometry (GC MS) for both solid-state fermentation filtrate (SSFF)
and liquid fermentation filtrate (LFF). Additionally, the antimicrobial activity
of the mold filtrate against certain pathogenic bacteria was assessed using the
agar well diffusion method.
Results: indicated that the biomass used for mold growth was heavier in SSFF than
LFF, and according to the findings, the selective active isolate's crude filtrate from
two duplicates of the P. italicum Yeast Extract Sucrose YES culture medium was
0.063 mg, while the crude extract from rotten orange (as a solid medium) containing
P. italicum was 0.11 mg. Tetracosane and other substances with a track record of
therapeutic activity were found in the two mold extracts, according to GC MS data.
Overall, both SSFF and LFF demonstrated antibacterial activity against Klebsiella
pneumonia, Escherichia coli, Acinetobacter baumannii, Pseudomonas aeruginosa and
Staphylococcus aureus, with the inhibition zones± standard deviation (IZ± SD) being
24.7± 0.57, 18.2± 0.28, 26.3± 0.59, 21.6± 0.51, and 32.8± 0.21 (for SSFF) mm and
0.0, 12.3±0.57, 28.16±0.20, 19.3±1.15, and 28±0.2 (for LFF) mm, respectively.
Conclusion: the filtrate of P. italicum from a natural medium (rotted orange)
as a solid state fermentation was more weighted and gave many effective
metabolites compared to what was produced by liquid fermentation on a
synthetic medium, and both liquid and solid fermentation filtrates
demonstrated efficacy against harmful bacteria.

Background: The mucosa of oral cavity is the mucous membrane which
covers the tissues of the mouth cavity. In order to repair damage from a local
aggressor, many cell strains and their byproducts work together throughout the
vital physiological process of wound healing. This process culminates in tissue
repair and starts relatively early in the inflammatory phase. . The supplements
of cinnamon and olive oil can dramatically raise blood levels of antioxidants
while lowering those of inflammatory indicators like C-reactive protein.
Objective: The aim of the study was to determine the local histological effect
of topical application of cinnamon and olive oil extract on the rabbit oral
mucosa
Patients and Methods: 20 adult male rabbits that weight about 700-900 Kg
and age about (6-8) months where used in this experimental study. Ulcer
induction: Prior to the creation of the ulcers, rats were fixed on their backs and
all animals were anaesthetized and induction the ulcer with round filter papers
5.5 mm in diameter were soaked in 15 ml of 50% acetic acid. In order to create
round ulcer, an acid-soaked filter paper was pressed onto the right buccal
mucosa for 60 seconds. Then divided the groups according to the healing time
with 10 rabbits as a control group left healed normally and 10 rabbits as an
experimental group that daily used mixture of cinnamon extract and olive oil
ready extract topically applied on the traumatic ulcer. The animals were
sacrificed along three- and seven-days healing periods and then prepared H&E
stain for analyzed the results.
Results: In comparison to the control group, the histological results of oral ulcers
that were created and treated with a daily application of a herbal mixture consisting of
cinnamon extract and olive oil extract showed greater epithelization, reduced
inflammation, and increased angiogenesis, all of which sped up the healing process.
Furthermore, there was a noteworthy distinction in the formation of extracellular
matrix and collagen fiber synthesis between the experimental and control groups.
Conclusion: Topical treatment using ready herbal extracts of olive oil and
cinnamon was more successful in facilitating the recovery of traumatic ulcers.

Background: Respiratory distress syndrome (RDS) is a major cause of
neonatal morbidity and mortality. It is a breathing disorder characterized by a
deficiency or inactivity of surfactant in the lungs of preterm and term babies
and if not treated, it leads to serious complications like pneumothorax,
emphysema, bronchopulmonary dysplasia and death.
Objective: To estimate the effect of surfactant therapy on oxygen requirement
and neonatal mortality as well as the incidence of RDS in the special care
neonatal unit (SCNU) in the AL Batool Teaching Hospital in Diyala
Governorate.
Patients and Methods: A sample of 2000 patients with signs and symptoms
of RDS at the time of presentation was prospectively collected from the 1st of
July 2022 until the 1st of March 2023 in SCNU at Al-Batool Teaching
Hospital. Gestational age, body weight, the use of oxygen, surfactant therapy,
and continuous positive airway pressure (CPAP) were taken into consideration
in assessing the outcome of RDS neonates.
Results: There was a significant relationship between surfactant administrations, the
period of staying on CPAP, and oxygen demand as the p-value was < 0.001 for both.
Neonates who received surfactant had a lower mortality rate, with an incidence of
2.5%; the p-value was < 0.001. Incidence of neonatal RDS was 694 (34.7%).
Conclusion: Since the incidence of RDS was 34.7%, surfactant therapy
should be routine in neonatal special and intensive care units. Proper use of
surfactant (proper timing and mode of administration) reduces oxygen
demand, the need for CPAP, hospitalization, and mortality among those
neonates.

Background: Vibrio cholerae is a primary cause of severe dehydrating
diarrhea and remains a serious public health problem in low- and middle-
income countries (LMICs) with insufficient water, sanitation, and hygiene.
Cholera remains a public health threat the worldwide, mainly in countries with
poor access to safe water and sanitation facilities. According to estimates,
there are 21,000–143,000 deaths and 1.3–4 million cases of cholera annual.
Objective: This study aims to carry out an analysis of the available
information on cholera outbreaks in Diyala province, 2022.
Patients and Methods: A descriptive study conducted in the department of
public health using the data of cases reported from eight sectors in province.
The data was collected from the surveillance unit, communicable control
division of the public health department in Diyala province, IRAQ in 2022.
Results: The total number of confirmed cases of cholera was (n = 139), female (72)
52 % and male (67) 48%, death reported for two of these cases. According to the date
of onset, the registration of cases began from July 19 to October 25, 2022. However,
the case fatality ratio (CFR) was 1.4%, while the attack rate in the governorate is 7.6
per 100,000 populations during 2022, the highest attack rate in Khanaqin district was
(77 cases) 46, while the lowest attack rate in Baldruze, Al-Mansuria, and Al-Khalis
districts was (1 case) 0.3,0.6, and 0.8 respectively. The age mean of patients was (38.7
± 17.14 years) and the occurrence of the disease is more incidence in the age group
30-44 and females more than males.
Conclusion: Occurrence Cholera outbreak during year 2022 without
confirmed cases recorded since 2015 and the occurrence of cholera cases in
governorate is greater during the months of August and September and most
of the cases were from Khanaqin district