Diyala Journal of Medicine <p style="text-align: justify;">Diyala Journal of Medicine (DJM) was established according to agreement of Ministry of Higher Education and Scientific Research-foundation of as per authorization letter Number 12c/2433 in 19th August 2010. Fellow up, Started to receiving different manuscripts in all fields of medicine such as clinical, basic, dentist, pharmacology and scientific original articles. Diyala Journal of Medicine usually Deal with articles closely related with clinical problem more common in Iraq and Middle East. Also considered is a periodic peer-reviewed journal published biannually by the College of Medicine in Diyala University. However, review articles of high standards will be considered Writing in English languages with Arabic abstract.</p> <p><span style="font-size: 20px; font-family: Times New Roman;"><span style="font-size: 20px; color: #17365d;">&nbsp;</span></span></p> College of Medicine - University of Diyala en-US Diyala Journal of Medicine 2219-9764 <p>All Rights Reserved.</p> The Incidence and Management of Urethral Stricture in Bladder Carcinoma <p><strong>Background: </strong>Urethral stricture disease is one of the oldest and most difficult maladies known to the urologist. While references&nbsp; to the disease and its treatment date back to the writings of the Hindus, Egyptians, and Greeks.</p> <p><strong>Objective:</strong> To elicit&nbsp; the incidence&nbsp; of urethral strictures, their severity and management&nbsp; in patients with superficial bladder tumor.</p> <p><strong>Patients and Methods:</strong> From January 2018 to January 2020, we followed 98 patients admitted and treated at Baquba Teaching Hospital urology unit for having bladder carcinoma.&nbsp; Theywere all male subjects, their age range from 38-76y with a mean 56.8y.&nbsp; They&nbsp; were required to have a cystoscopically and histologically proven superficial transitional cell carcinoma of the&nbsp; bladder to be enrolled in this study&nbsp; (invasive tumors were excluded).&nbsp; For all the patients and after having the cystoscopic diagnosis ,transurethral resection of the tumor done and in most of them this is followed by six&nbsp; week courses of intravesical chemotherapy (either mitomycin or doxorubicin according to the availability). Intravesical Doxorubicin used in 13 cases (56.5%), Mitomycin C in 6 cases (26.1%) and 3 patients (13.0%) received both drugs (through multiple courses).while 1 patient (4.3%) received no chemotherapy. Thirteen strictures (56.5%) were managed by optical urethrotomy while 10 cases (43.5%) were mild strictures and opened just by introducing the cystoscope.</p> <p><strong>Results:</strong> During the period of the study, a total of 23 urethral strictures were identified in the 98 male patients with superficial bladder tumor enrolled in this study, which constitutes an incidence of 23.5% all were diagnosed by the follow -up check cystoscopies . Patient age ranged from 38-75 years with a mean age 59.30+- 10.58 . Among those patients with urethral stricture ,14 patients had also B.P.H (60.9%), but only 7 patients (30.4%) had a history of retention of urine . The urethral stricture was bulbar in all patients and it was mild stricture in 10 cases (43.5%), moderate in 6 cases (26.1%) and severe in 7 cases (30.4%) . Prior to the diagnosis of stricture , 13 patients had been subjected to a single check cystoscopy (56.5%) ,6 patients (26.1%) had twice , while 4 patients (17.4%) had 3 or more cystoscopies prior to the occurence of stricture . Regarding intravesical chemotherapy prior to the occurance of stricture ,4 patients (17.4%) received 1-3 sessions , 10 patients (43.5%) received 4-6 sessions and 9 patients (39.1%) received more than 6 sessions . Intravesical Doxorubicin used in 13 cases (56.5%), Mitomycin C in 6 cases (26.1%) and 3 patients (13.0%) received both drugs (through multiple courses).while 1 patient (4.3%) received no chemotherapy. Thirteen strictures (56.5%) were managed by optical urethrotomy while 10 cases (43.5%) were mild strictures and opened just by introducing the cystoscope.</p> <p><strong>Conclusion:</strong> Urethra stricture in patients with bladder carcinoma may be a substantial source of preventable morbidity, implementing a nursing education program may significantly decrease the incidence&nbsp; of stricture.</p> Reyad Ahmed Farhood Othman Jasim Mohammed Alzaidy Aiad Abd Al Hameed Hassen Copyright (c) 2021 2021-04-17 2021-04-17 20 1 76 82 Antibiotic Sensitivity of High Vaginal Swabs from Asymptomatic Pregnant Women <p><strong>Background: </strong>Vaginal microbiota considered as a complex microbial population consisting of a multitude of microbial species and causes many vaginal infections including bacterial vaginosis.</p> <p><strong>Objective:</strong> The study is investigating the antibiotic sensitivity of predominant vaginal microbiota.</p> <p><strong>Patients and Methods:</strong> 250 pregnant women in Erbil city in the North of Iraq, from October 2018 to March 2019. Samples were collected from pregnant women who visited Maternity, Rizgary and Raparin Hospitals’ laboratory department under medical precautions. The samples were cultures to investigate to identify the bacteria types and sensitivity for common antibiotics.</p> <p><strong>Results:</strong> About 72% of samples showed positive microbial growth and the higher distribution percentage of isolated microorganisms was 27.2%, 23.8%, 21.6 and 11.6% for <em>Candida sp., Staphylococcus aureus, Escherichia coli</em> and <em>Streptococcus pyogenes</em> respectively.&nbsp;&nbsp; Moreover, antibiotic sensitivity tests declared that ciprofloxacin was effectively inhibited the growth of both <em>Staphylococcus aureus</em> and <em>Streptococcus pyogenes</em> while Norfloxacin was 95% which inhibited the growth of <em>E. coli.</em></p> <p><strong>Conclusion:</strong> <em>Candida albicans, Staphylococcus aureus, Escherichia coli</em> and <em>Streptococcus pyogenes </em>are among the most predominant microorganisms in pregnant women.</p> Abdulrazzaq Bahaulddin Mohammed Haval Abdulkhalik Hamadamin Alla’a Miyasar Ahmed Copyright (c) 2021 2021-04-17 2021-04-17 20 1 70 75 All in one procedure Versus classical procedure for Hernioplasty in Patients With Inguinal Hernia <p><strong>Background: </strong>Hernia is an unusual bulging of the intra-abdominal viscera through a weak area of the abdominal wall or groin region. Inguinal hernia repair is one of the most frequently performed surgical procedures. In recent years, inguinal hernia (IH) repair was changed from pure tissue repair to prosthetic laparoscopic repair.</p> <p><strong>Objective:</strong> we propose to find a new application for the well-known surgical open mesh inguinal hernia in the treatment of inguinal hernias in adults aiming to improve patients' comfort and to reduce the incidence of chronic neuralgia.</p> <p><strong>Patients and Methods:</strong> .&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; A comparative study was designed to study the outcome of different sizes of mesh used in the hernia operations. In the present study, patients diagnosed with primary unilateral inguinal hernia (n=130) were enrolled from May 2019 to March 2020 at Baquba teaching hospital in Diyala governorate. Enrolled patients were divided into two groups. Group A include patients who have inguinal hernia operated with all in one procedure (n=65) and group B included patients with inguinal hernia operated by the classical method (n=65). Spinal and general anaesthesia were used. Before incision for the patient, ceftriaxone (1gm, intravenously) was administrated over 30 min. The process was accomplished on a one-day surgery basis .According to the devised technique, a new smaller prosthesis was placed on the floor of the inguinal canal&nbsp; in order to strengthen all areas of weakness from which hernias may originate. The mesh was enveloped by a fibro-cremasterico sheath avoiding contact with neural structures. Follow-up was carried out at 1week, 1month, 3months for evaluation of postoperative pain using numbering scale score, need of medication, patients' comfort, and postoperative complications.</p> <p><strong>Results:</strong> all patients operated by all in one procedure were discharged within 24 h from surgery. Slight pain was reported by the majority of patients and (07.69%) of them required pain medication at home. After the 1st postoperative week (95.36%) reported no pain and (04.62%) show bruising genitaliao, (01.54%) had seroma and no wound infection recorded. No relevant limitation of normal activities was reported. There have been no postoperative neuralgias. <strong>Conclusion:</strong> This new hernioplastyo technique respects the anatomy of the inguinal canal, uses a smaller mesh, and seems to avoid neuralgias with maximum comfort for the patients. We recommended to all in one technique o because gives better results and fewer complications.</p> Raghad Fais Thabet Mohammed Mohammud Habash Copyright (c) 2021 2021-04-17 2021-04-17 20 1 61 69