Diyala Journal of Medicine

Background: Autism Spectrum Disorder (ASD) is a complex
neurodevelopmental disorder characterized by deficits in social
communication, restricted interests, and repetitive behaviors. The etiology
of ASD is multifactorial, involving genetic, environmental, and maternal
factors. Recent studies have suggested maternal factors, such as advanced
maternal age, high BMI, smoking, and depression during pregnancy, as
significant risk factors for ASD.
Objective: This study aims to investigate the maternal risk factors that
contribute to ASD in children at Diyala, Iraq.
Patients and Methods: This case-control study was conducted on 150
children, comprising 75 children diagnosed with ASD and 75 healthy
children as a control group. The study was carried out from August 2023 to
May 2024 in Diyala, Iraq. Data collection included comprehensive
demographic, social, obstetric, and maternal health histories. ASD
diagnosis was confirmed using the Childhood Autism Rating Scale 2
(CARS-2). A logistic regression analysis was performed to assess the
association between maternal risk factors and ASD.
Results: The study revealed several significant maternal risk factors for ASD.
Advanced maternal age at pregnancy (mean age 28.1 years in cases vs. 22.9
years in controls, p=0.001), high maternal BMI (mean BMI 26.9 in cases vs.
24.4 in controls, p=0.0001), maternal smoking (6.7% in cases vs. 0% in
controls, p=0.023), and maternal depression during pregnancy (22.7% in cases
vs. 0% in controls, p=0.0001) were all significantly associated with an
increased risk of ASD. The use of stimulating hormones before pregnancy also
showed a significant association (21.3% in cases vs. 4% in controls, p=0.001).
Parity, particularly having 1-2 pregnancies, was also a significant risk factor
(p=0.002).
Conclusion: This study identifies advanced maternal age, high BMI,
smoking, depression, and the use of stimulating hormones before pregnancy
as significant maternal risk factors for ASD in children.

Background: Diabetic retinopathy (DR) is a common micro-vascular
consequence of diabetes mellitus that affects the eyes. If untreated, DR
cause damage to the retinal blood vessels and result in blindness or visual
loss Hyperglycemia over long period of time results in increases
inflammatory oxidative stress and protein kinase C pathways that eventually
retinal capillary endothelial damage and pericyte loss occurred. Lutein is a
carotenoid with anti-inflammatory and antioxidant properties.
Objective: To determine the protection roles of dietary intake of lutein rich
foods on the retina and it’s associated with retinopathy among diabetic
patients.
Patients and Methods: A cross-sectional study was conducted in the
Ophthalmology Department of Imamein Kadhimein Medical City,
Baghdad, Iraq, from July to November 2023, involving a total of 100
diabetic patients. Questionnaire list was used which consist of
sociodemographic information, socioeconomic status, dietary sources of
lutein, anthropometric measures and ophthalmic examination and
investigations which include optical coherence tomography for macular
assessment and HbA1c assessment.
Results: The current study showed that 64% of the diabetic patients had
retinopathy and 36% had normal retina. The study showed that 91.7% of
diabetic patients with normal retina were consume 3-7 serving/week tomato,
75% were consume 7-35 serving/week egg, 75% were consume 1-7
serving/week zucchini, 72% were consume 1-3 serving/week spinach, 63.9%
were consume 3-7 serving/week green pepper, 63.9% were consume 3-7
serving/week basil, 61% were consume 3-7 serving/week parsley, 58% were
consume 3-7 serving/week leek, 52.8% were consume 3-7 serving/week
lettuce, 41.7% were consume 1-2 serving/week nut and 30.6% were consume
1-2 serving/week pistachio with significant p-value.
Conclusion: Patients with diabetes can avoid retinal damage by consuming
the recommended weekly servings of lutein-rich foods especially tomato,
eggs, zucchini, spinach, green pepper, basil, parsley, leek, lettuce, nut and
pistachio.

Background: Non-alcoholic fatty liver disease (NAFLD) is a metabolic
liver disease characterized by a broad range of liver pathology, including
simple steatosis, steatohepatitis (NASH), fibrosis, cirrhosis, and
hepatocarcinoma. NAFLD has emerged as a public health concern in the
world within the last 20 years, it is linked to metabolic syndrome (MetS),
type 2 diabetes mellitus (T2DM), obesity, and dyslipidemia. Increased
visceral adipose tissue in obese people can cause insulin resistance (IR) and
hyperinsulinemia, which will speed up the lipolysis of adipose tissue, Lipo-
toxicity-related chronic low-grade inflammation is involved in the
development of NAFLD.
Objective: Determine the correlation between lipid profile and liver
function in patients with NAFLD.
Patients and Methods: A study was conducted at Tikrit Teaching Hospital
from 28 November to 28 December 2023. The study involved 90
participants, 60 with NAFLD and 30 healthy subjects. The study used a
spectrophotometer (Model NO. HV-2800EX) and a colorimetric kit from
Spain linear chemicals to determine various parameters, such as Aspartate
aminotransferase (AST), Alanine aminotransferase(ALT), Gamma-
glutamyl transferase(GGT), High-density lipoprotein(HDL), Low-density
lipoprotein(LDL), Very low-density lipoprotein(VLDL), Triglyceride(TG),
and cholesterol.
Results: The mean age of patients in the group was 40.93 years, with ages
ranging from 20 to 50 years. Serum levels of liver function enzymes (GGT,
AST, ALT) and lipid profile (TG, HDL, LDL, VLDL, cholesterol) were
measured and compared to the control groups. Patients with NAFLD had
significantly higher serum liver function enzymes and increased serum lipid
profile (TG, VLDL, LDL, and cholesterol) while showing a significant
decrease in HDL concentration when compared to the control group.
Conclusion: The patients showed an increase in liver function enzymes
(AST, ALT, GGT) and lipid profile (LDL, VLDL, TG, cholesterol) with
reduced HDL as compared to healthy individuals.

Background: Diabetes mellitus is a chronic disease that affects people of
all ages. It\\\\'s caused by deficiencies in insulin action and secretion, leading
to long-term hyperglycemia. This can harm key organs such as the kidneys,
heart, eyes, nerves, and blood vessels. Managing diabetes requires
significant lifestyle changes and can impact both the patient and their
family. Small and bone-specific, osteocalcin (OCN) is a non-collagen
protein that is mostly present in bone. It is a sensitive marker of bone
formation and primarily attaches to the extracellular matrix of bone after
being carboxylated. Small amounts of OCN are also released into the
bloodstream, where it aids in glucose and fat metabolism.
Objective: Our study aimed to examine the effect of Osteocalcin,
Parathyroid hormone, Estrogen and HbA1c on middle-aged women who
had type 2 diabetes compared to those who did not.
Patients and Methods: The study involved 90 middle-aged women,
including 60 with type 2 diabetes, and 30 healthy women. The Sandwich
enzyme-linked immunosorbent assay was used to measure OCN, PTH, and
E2 hormone levels in women with and without type 2 diabetes. HbA1c
levels were measured using the Cobos system. The statistical analysis was
performed using SPSS software.
Results: In T2DM women, serum OCN, PTH, E2, and HbA1c levels were
compared with non-diabetic women. T2DM women had significantly lower
levels of serum OCN and PTH, and significantly higher levels of HbA1c than
healthy women. Serum E2 levels were also significantly lower in T2DM
women. OCN had a positive correlation with HbA1c and negative correlations
with PTH and E2.
Conclusion: Significant change was detected in this study in the level of
OCN, PTH and E2 between patients and controls. Investigations of serum
OCN can be participated in the future as predictive marker for osteoporosis
in diabetic women.

Background: It has been demonstrated that radiation therapy lowers both
the death rate from breast cancer and its recurrence. Precise calculation of
the radiation dose is crucial for treating the target site as well as protecting
vital organs like the heart since large doses of radiation therapy significantly
increase patient morbidity and death.
Objective: To compare the mean heart dose of radiation in breast cancer
patients between breast-conserving surgery versus mastectomy, between
different radiotherapy doses and fractionation schedules, and between right
and left breast cancer irradiation.
Patients and Methods: This is a cross-sectional descriptive retrospective
comparative study that was conducted in Baghdad Radiotherapy Center
from January 2018 to June 2018, carried on 174 breast cancer patients of
different age groups selected randomly and their mean heart dose data
collected from their files and database in Baghdad Radiotherapy Center.
Results: The overall average of the mean dose was 372 cGy (range from 76.4
to 716.2). The greatest difference in the mean heart dose was between (BCS)
patients who received 5000 cGy with regional nodal irradiation and (BCS)
patients who received 4005 cGy also with regional nodal irradiation
(difference in the mean is 639.8, the P – value <0.001). Regarding the side of
breast cancer, the greatest difference in mean heart dose was seen between left
and right breast cancer patients who did the same type of surgery (MRM) and
received the same dose of radiotherapy (4256 cGy) (difference in the mean is
565cGy and the P – value <0.001). No statistically significant difference in the
mean dose between breast-conserving surgery and mastectomy was recorded.
Conclusion: The mean heart dose of radiotherapy is significantly increased
in left-sided breast cancer irradiation as compared to the right side. A dose
of 5000 cGy has the greatest effect on the dose received by the heart,
especially in left breast cancer. The type of surgery whether breast-
conserving surgery or mastectomy did not affect the mean dose received by
the heart.

Background: Hemorrhoidectomy is a frequently performed surgical
procedure associated with postoperative pain. The use of Ligasure could
result in a decreased incidence of pain and bleeding, as coagulation with
high-frequency currency has minimal thermal spread and limited tissue
damage.
Objective: The research compares Ligasure pile excision with surgical
diathermy excision for the treatment of III-IV-grade piles.
Patients and Methods: Eighty patients with pile III or IV degrees were
randomized into two groups: Group one (LS) and group two (diathermy).
The study evaluates the mean postoperative pain, intraoperative bleeding,
and intraoperative time requirement, early and late complications. All
patients were followed up for of 10-12 months.
Results: The operating time is considerably shortened in Ligasure group (LS);
postoperative pain disappears earlier in LS than in diathermy. Additionally,
there was less intraoperative bleeding in LS, and short duration hospital stay
as compared to diathermy group.
Conclusion: LS is an efficient procedure in degree III or IV pile excision.
Therefore, the procedure enhances the use of LS as one of the acceptable
modality surgical options for grade III–IV pile.

Background: Traumatic oral ulcer is well-circumscribed, depressed lesion
with an epithelial defect that is covered by a fibrin clot, resulting in a
yellow-white appearance, occurs due to chemical, mechanical or thermal
injury to oral mucosal end with painful erosion. Amino acids are necessary
for wound healing because they promote the growth of connective tissue as
well as the activation and proliferation of fibroblasts.
Objective: evaluation the effect of systemic application of amino acid
collection (oral intake) in treatment of traumatic oral ulceration over
selected time by histological and histomorophometric assessment of soft
tissue healing.
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. The
traumatic ulcer created with (8mm) diameter, and (1mm) by surgical round
diamond bur in the right cheek mucosa, then divided the groups in two
groups,10 rabbits for control group that left healed normally , and 10 rabbits
for experimental group that daily used mixture of amino acids systemically
through mixing with water for one month. The animals were sacrificed
along 3 and 7 days healing periods and the species examined histologically
after histological preparation of the traumatic ulcer.
Results: Histological and histomorphometeric findings showed decreased
inflammation, accelerated reepithelization of ulcer surface, better
angiogenesis, and promoted remodeling of the extracellular matrix resulting
with enhanced tissue maturation and complete healing in all
study groups than in the control group.
Conclusion: the chemical medicament that represented by systemic
application of amino acid effective in accelerating the healing of
traumatized ulcers in experimental group than that in control group by
accelerated cell proliferation and mucosa reepithelization.
Keywords: Traumatic ulcers, amino acid, reepithelizati

Background: Stroke is the most common cause of aphasia which need to
be managed because it postpones stroke recovery and causes psychological
and social problems for the patients and their families. Researchers have
observed that the issue of language disorder in post-stroke patients has been
poorly addressed in Kurdistan Region.
Objective: This neurolinguistic study aims at presenting a comprehensive
scale study about the demography of stroke and aphasic patients at Rizgary
hospital over a period of two months in2024.
Patients and Methods: This cross-sectional study is carried out at Rizgary
Public hospital in Erbil-Kurdistan Region. Demographic for all the patients
who were registered at Erbil hospitals during the two months in 2024. Then
the process of diagnosing aphasia and dysarthria as language impairments
are carried out.
Results: Among 234 subjects, the mean age of post stroke patients is 33.4 ±
22.038001years .15.3% of patients were not paralyzed, meanwhile 44.8% got
right side body paralysis, followed by left side 38%, and both side 1.7%. The
highest risk factor is hypertension (68.8%), followed by diabetes
mellitus (41.4%), and ischemic heart disease (21.7%).
Conclusion: Language disorders is about (71.4%) which is a high range
among post-stroke patients. Language disorders does not only affect stroke
management but it also impair the individual’s quality of life. If language
impairments are screened earlier in patients, it is possible to intervene in
language skills and work through speech therapy.

Background: Urologists have significant challenges when treating
individuals with a solitary functional kidney who have renal stones. Various
therapeutic approaches are employed to treat renal stones in people with just
one working kidney, such as shock wave lithotripsy, retrograde intrarenal
surgery, and percutaneous nephrolithotomy (PCNL).
Objective: To assess the safety and efficiency of PCNL in patients with a
solitary kidney.
Patients and Methods: A percutaneous nephrolithotomy (PCNL)
procedure was conducted on 20 patients who had a solitary kidney and were
experiencing renal stone issues. The upper calyceal route was utilized.
Factors such as the duration of the operation, full removal of the stone,
presence of any remaining stone fragments, decrease in hemoglobin levels,
requirement for a blood transfusion, necessity for any follow-up procedures,
and length of hospital stay were all taken into account. Patients were
monitored for a period of 6 months after the surgical procedure to identify
any potential problems.
Results: The mean age of the patients was 45.45±7.49 years (range: 34–61
years). About two-thirds of the patients (65%) were male. The mean stone size
was 3.81 ± 1.57 cm. The mean operative time was 53.3±15.57 min (range: 30-
90 min). Secondary puncture was required only in one case (5%). Residual
stones were reported in 3 patients. Four patients (20%) needed blood
transfusions. The mean duration of hospital stay was 36.3±16.51 hrs. Serum
creatinine had dropped from 2.2±0.88 mg/dL preoperation to 1.54±0.31
mg/dL after 6 months postoperation, with a significant difference.
Conclusion: PCNL is a safe and effective method for the removal of renal
stones in patients with a solitary kidney, especially when other management
options are not feasible. The procedure is associated with acceptable rate of
residual stone, blood transfusion and postoperative hospital stay.

Background: Gallstone diseases are the most common biliary pathologies.
They are very frequent in the Western world, where the approximate
incidence is about 10–15%. Laparoscopic cholecystectomy is the method of
choice for treating gallstone disease. The conversion rate of laparoscopic to
open surgical procedures is estimated to be about 4%- 5%. Gallstone size is
important since large/giant gallstones are more liable for technical
difficulties during laparoscopic interventions.
Objective: The aim is to present the rare case of a giant gallstone removed
laparoscopically.
Case presentation: A female of 53 years old presented to the private clinic
for on-and-off signs and symptoms of gallstone diseases throughout the
previous 3 years; investigation revealed a large gallbladder stone (4 cm in
maximum diameter). Laparoscopic cholecystectomy has been performed for
an adhesive gallbladder without the need for conversion to the open
classical method and without complications; the gallstone size measured
after retrieval was about 4 cm in length.
Conclusion: Giant or large gallstones carry a significant risk of
complications. Even in these challenging cases, laparoscopic
cholecystectomy is regarded as the preferred treatment option over open
cholecystectomy. Highly skilled and experienced laparoscopic surgeons
should perform the procedure to ensure successful outcomes. The
possibility of converting to an open procedure in case of failure to expose
the clear anatomy and any intraoperative technical difficulties should be
considered.