Diyala Journal of Medicine

Background: Psoriasis is a multifactorial and inflammatory skin disease. The etiology is not
well. A large number of cytokines have been shown to be elevated in serum concentration
and psoriatic lesion, and the elevation is correlate with psoriasis severity.
Objective: To evaluate TNF-a and TGF-B1 index in psoriasis which could help as predictive
marker of severity of psoriasis in Baquba teaching hospital Iraq.
Patients and Methods: Forty nine patients with psoriasis (27male and 22 female) were
included in this study . Their age range between (7-70) years old. The study was performed
in Baquba Teaching Hospital during period from December 2018 to June 2019. Each case
was diagnosed by Dermatologist.
Results: In our study we compare the mean, standard deviation and P. value of TNF-a and
TGF-B in patients of psoriasis. We have found that psoriasis patients have a highly significant
difference compared to controls(P=0.001) in both genders.
Conclusion: This study concludes a significant association between tumor necrosis factor
alpha and transforming growth factor beta-1 in psoriasis patients in both gende

Background: Vertigo is an illusion or hallucination of movement, often horizontal and
rotatory, either of oneself or the environment. The type is either central or peripheral, but
sometimes it cannot be identified.
Objective: We analyzed the etiologies of peripheral and central vertigo in our patients.
Patients and Methods: The cross-sectional observational study enrolled 100 patients
consecutively, who had attended the Rizgary Teaching Hospital’s neurology outpatients’
clinic in Erbil, Iraq, from January 1, 2019, to October 31, 2019. Thorough history, full
general and neurological examinations and an extensive battery of investigations (including
cranial contrast MRI) were performed. Patients with peripheral vestibulopathy and vertigo
were assessed by otolaryngologists.
Results: Females (69%) outnumbered males (31%). Patients in their 6th decade were the
commonest target; the mean age was 46.7 years. Peripheral vertigo was evident in 46% of the
patients while central vertigo occurred in 36% of them. In 18% of the patients, no cause was
identified; most of them were females (88.8%) in their 7th decade of age. Benign paroxysmal
positional vertigo (BPPV) dominated the peripheral vertigo cases. The most prevalent cause of
central vertigo was vertebrobasilar insufficiency (VBI) (27%); many were above 50 years of
age.
Conclusion: Peripheral vertigo was more prevalent than the central ones. BPPV and VBI
were the commonest causes of vertigo, in general. Vertigo mainly targeted middle-aged
individuals in our city.

Background: The immune system aberrations perceived in thalassemic children are both
qualitative and quantitative, concerning many components of immune system; infections are
a common complication and they can be fatal.
Objective: To study the thalassemic children for bacterial infection.
Patients and Methods: This is a retrospective cohort study, it was carried out in Al-Batool
Teaching Hospital from June - Dec 2017. Criteria for susceptibility of immune-
compromised children for bacterial infection were used for thalassemia major and intermedia
children with review of patients records and patients/ parents dialogue. Statistical analysis
was done by statistical analysis of social sciences (SPSS 22), P-value was set at (0.05) level.
A total number of 188 thalassemia children were involved in this study.
Results: Five (2.7%) children were documented as having a clinically important bacterial
infection giving an incidence of 0.23 infections per 100 children/ years, four infections were
developed in non- splenectomized children giving a rate of (3%). Two bacterial sepsis and two
children suffered from draining otitis media, whereas after splenectomy, only one child
developed bacterial pneumonia (1.9%).
Conclusion: Only few bacterial infections were developed in studied thalassemic children
during the last 12 years. None of them fulfill the immunocompromised criteri

Background: Helicobacter pylori are the most common cause’s peptic ulcer disease, and it
is transmitted by oral-oral, fecal-oral and gastric oral. The prevalence of this bacteria
depends on age, sex, smoking or non-smoking and also chronic disease such as diabetes.
Objective: To determine the infection of H. pylori in Baqubah city and its associated with
age and gender of patients.
Patients and Methods: H. pylori diagnosed by used rapid urease test and histopathology
test. From 200 studied groups, 127 (63.5%) males and 73 (36.5%) females ages ranged from
(10 to ≥ 60) years were collected from Baqubah teaching hospitals, during the period from
September 2018 till January 2019. From 200 studied groups 110 considered patients after
initial diagnosis by endoscopic unit (presence symptoms) and 90 considered control group
(absence symptoms). Two types of samples were collected from each studied groups
including gastric biopsy specimens for rapid urease test and histopathology test to detect H.
pylori infection.
Results: The result of this study shows that H. pylori infection was detected by rapid urease test
which appears positive results in 86 patients (78.2 %), and the positive results of histopathology
test were 10 (9.0%). The incidence of H. pylori infection in male more than in female as the
percentage (70.00%) and (30.00%), respectively. Minimum age was 10 years and maximum
was ≥ 60. The highest age specific frequency in studied groups is in the age group (40-49) &
(50-59) years old.
Conclusion: The prevalence rate of gastric ulcer caused by H. pylori in Baqubah city was
high and it is detected by rapid urease test which showed more accurate than
histopathological test. In addition, the results showed that the rate of incidence in males more
than in females, and in (40-49)&(50-59) more than other ages

Background: Diagnosis of certain types of breast cancer can be difficult due to similarities
in their histopathological patterns. In such cases markers can be useful in confirming results.
E-cadherin is one such marker.
Objective: To differentiate the rate of E-cadherin immunohistochemical expression between
the major histological types of breast cancer (lobular versus ductal), in addition to
correlating it to the clinicopathological factors such as age of patients and grade of the tumor
and explore the effectiveness of using it in distinguishing the cases with overlapping
features.
Patients and Methods: A total of 100 malignant breast samples (55 ductal lesions, 24
lobular lesions, and 21 uncertain types), collected during the period of 2014 – 2017 in Erbil,
and were reviewed before undergoing E-cadherin immunohistochemistry (IHC) staining. The
results from IHC were compared with the results from the morphological study of the
samples and they were statistically analyzed in relation with clinicopathological factors.
Results: The normal ductal cells had strong complete homogenous membrane E-cadherin
reactivity in 85% of the ductal carcinoma cases. The complete absence of E-cadherin membrane
staining occurred in all 24 cases of lobular cases. The rest of the 21 cases, showed variable
degrees of staining.
Conclusion: There is diagnostic usefulness in the detection of E-cadherin expression by
immunohistochemistry as a tool in distinguishing ductal from lobular carcinoma.

Background: Cerebral palsy (CP) is a heterogenous permanent neurological disorder that is
caused by a non-progressive damage to the developing brain. In this disorder, injury or
malformation occurs in the growing central nervous system which eventually will affect the
development of motor function and body posture before, during, or shortly after birth.
Objective: To estimate and highlight the status of demographic and clinical characteristics of
cerebral palsy in children at Sulaymaniyah province which has significant walking disorders.
Patients and Methods: In this study (118) ambulatory patients with cerebral palsy who
attended the health care and consultation clinic at Children Rehabilitation Center (CRC) in
Sulaymaniyah province. The primary data were studied according to: gender distribution,
patient age, types of delivery, and age of presentation of the CP disorder. Additionally, the
conditions at birth such as asphyxia, kernicterus, types of cerebral palsy, full-term, and pre-
term were studied. Finally, the Gross Motor Function Classification System (GMFCS) of
cerebral palsied children was identified.
Results: Our data showed that females tend to be more affected by CP than males with a ratio
of (65:53). The range of ages was between half a year and 12 years (mean of 7.5 years). The
highest range appearance of cerebral palsy was between the ages of (12-24) months with a
percentage of (58.47%). A delayed milestone was the most common presenting among CP types
(41.53%). In comparison to the other CP types, the spastic type was the most common
(59.32%). The most prevalent subtype of CP was the spastic hemiplegia (40%). 66.10% of
patients were born with vaginal delivery. The majority of the patients were born with asphyxia
(31.36%) followed by kernicterus direct antepartum. Sixty-seven (56.78%) mothers were using
medications during pregnancy. Forty-eight of parents were consanguine marriage. According to
the GMFCS results, most of the CP patients were in the level III and level IV with 27.12%,
25.42% respectively; the major motor disability in children with spastic hemiplegia varied from
level I to III.
Conclusion: We deduced that it is difficult to estimate and clarify the exact cause and risk
factors associated with the cerebral palsy disorder. However; we found spastic hemiplegia is
the most common clinical pattern of CP due to its high prevalence of birth asphyxia. Using
medicine during pregnancy will increase a chance of CP to occurs, for further investigation,
the case-control study should be employed within the cohort study.

Background: Anterior cervical discectomy with fusion (ACDF) is challenging with respect
to both patient selection and choice of surgical procedure.
Objective: To determine the age of patients with degenerative cervical disc disease
undergoing surgery, to determine the clinical and radiological findings of degenerative
cervical disc disease, and to find out the rate of success for relieving pain and radiculopathy.
Patients and Methods: This is a clinical prospective study of 50 patients (case series of
patients with chronic degenerative cervical disease) operated on from October 2015 to
October 2018. Their ages ranged from 48-78 years, they were treated with anterior cervical
discectomy with fusion, and fusion was achieved with Polyether ether ketene (PEEK) cage.
Follow up using visual analog scale (VAS), out of 10 scores, was done for at least one year
after the operation (at six months, nine months and one year postoperatively) for both neck
pain and shoulder pain (radicular pain).
Results: The mean age + SD was 63.8 + 8.4 years, 54% of the patients were females, 92% of
the patients had single level ACDF, and 8% had multiple levels ACDF. The most common
presentation in both genders was pain & radiculopathy (56%), followed by radiculopathy
(28%), and less common presentation was pain alone (16%). The patient who has short history
of the symptom (less than 6 months) gave good postoperative results and showed improvement
in the symptom, 64% of the patients improved and 4% of them had no change.In the 2nd group
(the symptom more than 6 months): 10 patients improved out of 16 (62.5%), four of them had
no change and two of them deteriorated & re-operated for adjacent level.
Conclusion: ACDF is an effective treatment for pain & radiculopathy in selected patients
with chronic degenerative cervical disease (CDCD) after one year of follow up.

Background: A common 2548G/A promoter variant of the human leptin gene has been
implicated in circulating leptin levels variations and pathogenesis of type 2 diabetes mellitus
but available data are still conflicting.
Objective: To explore potential associations between LEP 2548G/A of leptin with T2DM
and the effect of this variation on serum leptin levels.
Patients and Methods: Sixty two patients with T2DM and fifty non-diabetic controls were
included in the study. Blood samples were collected from subjects for biochemical analysis
and Genotyping was performed by polymerase chain reaction reaction–restriction fragment
length polymorphism (PCR-RFLP).
Results: The genotype frequencies for LEP 2548G/G, LEP 2548G/A LEP 2548A/A were 46%,
32% and 22% in control group, and 19.4%, 33.9% and 46.7% in diabetic group, respectively.
The A allele and GA/AA genotype of LEP 2548G/A was found to be more frequent than the G
allele and GG genotype in T2DM patients compares to the controls. Subjects with the GA + AA
genotype of LEP 2548G/A were at increased risk for T2DM (P=0.0001, OR = 1.78; 95% CI:
1.19–2.38). The serum leptin concentration of GA + AA genotype carriers was significantly
higher from that of the GG genotype in the diabetic group.
Conclusion: A allele carrier who have higher serum concentrations of leptin may have an
association with the risk of T2DM development in the Erbi population.

Background:Toxoplasma gondii is an obligatory intracellular protozoan parasite. The
infection with toxoplasmosis is a major opportunistic pathogen in patients who are
immunocompromised like patients having cancer disease. Electronic databases were
reviewed for T. gondii infection in cancer patients. The estimation collected prevalence of
toxoxplasmosis infection in different types of cancer patients (p < 0.001), This review was
designed to evaluate the seroprevalence rate of toxoplasmosis infection among cancer
patients in Iraq and its neighboring countries from 2010 to 2019. The searching process was
included of 15 studies. The results of current review showed that toxoplasmosis infection in
patients with malignancy had a higher prevalence in Iraqi patients compared with its
neighboring countries (P < 0.001). This review hypothesized to focus on the T. gondii and its
serious outcomes, and its crucial role in pathogenesis with different kinds of cancer, also to
carry out further studies and research to prevent and control toxoplasmosis among
populations infect with different kinds of cancer worldwide.

Background: Hazard Analysis Critical Control Point (HACCP) system due to decrease
health hazards of food during processing steps and monitoring procedures, corrective
measures, records, and verifications.
Objective: To to identify overall safety measures and Perspectives of workers and staffs
about Hazard Analysis Critical Control Point (HACCP) application and to identify
association between variables and Hazard Analysis Critical Control Point. (HACCP) system
application.
Patients and Methods: It is a descriptive, cross sectional design. The study will be
conducted in ice (Ice Land) factory for ice cream in Erbil, from first October 2019 to first
April 2020, non-probability purposive sampling technique used to select 100 staffs and
workers in the factory. The tool was contained four main parts. The tool was viewed to panel
of experts for validity data was analyzed by the application of SPSS program version 23.
Results: There were three levels (poor, fair and good) of Perspectives and safety measures used
among participants about Hazard Analysis Critical Control Point (HACCP), and there was no
statistical association between variables and Perspectives of HACCP system and safety
measures during working in the factory.
Conclusion: Most of the participants have fair level regarding using safety measures and
their Perspectives about application HACCP system and there was No statistical association
between variables and safety measures, Perspectives about (HACCP system) application

Background: Abdominal epilepsy is a rare condition mostly found in children, consisting of
gastrointestinal disturbances caused by epileptiform seizure activity.
Objective: To study chronic about pain in relation to about to aplie.
Patients and Methods: A cross sectional study conducted in Albatool teaching hospital with
a total number of 450 patient enrolled in the study suffering from chronic abdominal pain
with signs and symptoms suggestive of either abdominal migraine or abdominal epilepsy
and the sample selected according to electroencephalogram finding and the response to
antiepileptic drugs.
Results: The incidence of abdominal epilepsy was 34 patient (7.5%) most of them were of age
group between 6-12 year, which was 23 patient (67.6). All had common symptoms of
paroxysmal abdominal pain , Paleness after attack observed as a common feature (32patient),
tendency to sleep after attack seen in 25patient (73.5%).constipation and bloating together seen
in 32 patient (94.4%) while diarrhea seen in 4 patient All of these patients investigated
thoroughly for their gastrointestinal symptoms to rule out any organic diseases. All patients had
constant abnormality on electroencephalogram suggestive of seizure disorder. These patients
given anticonvulsant with a good response in a follow- out period of two years.
Conclusion: Abdominal epilepsy was a common health problem.
Keywords: Abdominal epilepsy, abdominal pain, children

Background: For the purpose of preoperative diagnosis of thyroid lesions, the Fine Needle
Aspiration Cytology (FNAC) has now replaced many other conventional pathology tests.
Objective: To know to what extent the FNAC results are accurate by correlating them with
results of histopathology.
Patients and Methods: In this retrospective study, ninety-four cases of thyroid gland lesions
were collected from the Department of Histopathology at Rizgary Teaching Hospital, Erbil
City, Iraq during the period of three years, from January 2015 to December 2017, and
correlate their FNAC outcome with that of histopathology.
Results: A total of 94 cases were included in this study, 70 cases (74%) were female. Fifty
cases (53%) were between 21-40 years of age. FNAC and histopathological results were
correspondent in 84 cases (89.4%). The most common thyroid gland lesion was nodular colloid
goiter occurred in 72 cases (77%) as confirmed by histopathology.
Conclusion: The FNAC is relatively safe, simple, and cost effective preoperative diagnostic
tool for thyroid lesions. However, it has some limitations.

Background: Fifty percent of newborns may die because of neonatal sepsis who are not
treated. The incidence augmented during the recent years. It may be due to the more public
use of aggressiveprocesses and the growth of tough organisms.
Objective: To recognize factors (Ante – perinatal) that lead to sepsis (early or late) in
newborn period in Albatool teaching hospital/Diyala/Iraq.
Patients and Methods: A case-control study done in the Department of Pediatrics in Al-
Batool Teaching Hospital, Diyala, Iraq during a period of seven months from Sept 2017 to
April 2018. It comprised 200 neonates aged ≤ 28 days. One-handered of them were presented
to the hospital because of neonatal sepsis (case group) and the other 100 included neonates
presented to the hospital because of other reasons (control group). A questionnaires were
used to collect the essential information including demographic and clinical data for the
neonates and their mothers.
Results: The mean age of neonates was 8.59 ± 7.28 days. Four factors were found to be
noteworthy independent risk factors for neonatal sepsis. These factors were pre mature rupture
membrane,presence or obscene odor discharge, intrapartum fever, and the prerequisite for
resuscitation.
Conclusion: Both maternal and neonatal factors had contributed to th

Background: Breast cancer is the most commonly identified dangerous cancer in females.
While breast cancer has been recorded to be a source of female mortality in many developing
countries, studies have shown that bronchogenic carcinoma exceeds breast cancer as the most
common reason of female mortality.
Objective: This study aims at evaluating the role of (clinical examination, radiological
finding and histopathological finding) in detection of breast cancer in Baquba Teaching
Hospital.
Patients and Methods: This cross-sectional study recruited ambulatory patients at outpatient
breast clinic unit in a Baquba Teaching Hospital from 1st of January to 31th of May 2019.
Results: This study showed that while 39 (93%) of breast cancer patients had a positive finding
on clinical examination, only 3 (7%) had a negative finding. On the other hand our data showed
that 35 (83%) of breast cancer patients had positive radiological findings and only 7 (17 %) of
breast cancer patients had negative radiological findings. 42 (100%) of breast cancer patients
have shown positive histopathological findings.
Conclusion: Triple assessment is a very useful diagnostic tool to evaluate patients with
breast lumps and detect patients with breast cancer

Background: Chronic suppurative otitis media is a destructive disease of middle ear cleft
that can progress rapidly. Medical treatment which depend on proper antibiotic selected from
culture and sensitivity were prescribed, otherwise process goes to intra or extracranial
complication.
Objective: Relation of certain clinical features to each isolated bacteria. The types of
bacteria in chronic suppurative otitis media. Drug sensitivity for each isolated bacteria.
Patients and Methods: Forty-six patients enrolled in the current study, 41 patients have
unilaterally discharged ears and 5 bilaterally discharged ears. The total ears are 51 ears were
taken for examination, microorganism isolation, biochemical tests and then culture and
sensitivity tests. Regarding ear examination, it involved clinical picture. Regarding
laboratory tests certain types of biochemical test, 4 types of media were used for isolation of
bacteria and in culture and sensitivity tests. 16 types of drugs used for culture and sensitivity
test. All collected data putted in a questionnaire, tables and histograms.
Results: 55% of patients with profuse discharge while 45% scanty amount of ears discharge.
Mucosal type of chronic suppurative otitis media were 53% while 47% of squamous type.
Regarding types of bacteria, Pseudomonas aeruginosa of 41.2%, Staphylococcus aureus of
11.6% are the most common isolated bacteria. Regarding drug sensitivity, Imipenem,
Meropenem of 100% sensitivity, Amikacin of 92% sensitivity while Cefixime of 62%
resistance.
Conclusion:There was a relation between particular suppurative chronic otitis media causing
microorganisms and specific discharge.Pseudomonas aeruginosa and Staphylococcus
respectively are the most common pathogens. Imipenem and Meropenem are the most
effective drugs