Volume 1, Issue 1, Summer and Autumn 2007, Page 110-184

Primary Biliary Cirrhosis in a Sample of Iraqi Patient

Nawal M. Al-Khalidi; Hadi A.Sayah; Hamid Jaber; Sadiq Jarallah; Jassim M. Al-Maliki

Kerbala Journal of Medicine, Volume 1, Issue 1, Pages 110-115

Background: Primary biliary cirrhosis(PBC) is an autoimmune liver disease that generally affects
middle aged women and it is the most common chronic cholestatic liver disease in adult .There are a
few studies described this disease in Iraq .
Aim of the study: The aim of this study is to evaluate a sample of Iraqi patients with primary biliary
cirrhosis regarding the clinical presentation, investigations and associated diseases.
Setting: Gastroenterology and Hepatology teaching hospital-Baghdad-Iraq
Result: Thirty-two patients involved in this study (mean age 45.9 year), most of patients were female
.All patients presented with itching, and most of them with jaundice, about two thirds of patients
complained of fatiguability and more than half of them had abdominal pain. Eighty–seven percent of
patients were younger than 60 years old. Fifty percent of them had serum bilirubin less than 6 mg/dl,
39.3% had serum bilirubin more than 6 mg/dl .One-third of them had prolong prothrombin time, while
serum alkaline phosphates is elevated in all patients, and about 80% of patients had elevated liver
enzymes .About 75% of patients had positive AMA,while ANA was positive in 21.9% of patients
.Liver biopsy was compatible with PBC in 56.3% of patients . Primary biliary cirrhosis associated with
many diseases .In this study 28.1% of patients had PBC associated with arthralgia, Sicca syndrome
found in 12.5% of patients, 6.3% had full-blown picture of scleroderma, thyroid disease mentioned in
6.3 % of patients .Gall bladder stones reported in 9.4 % of patients.

Women Breast Diseases in Karbala Epidemiology and Workup

Ali A. Ali; Adnan A. Al Helli

Kerbala Journal of Medicine, Volume 1, Issue 1, Pages 116-123

Background; Sixteen percent of women who are 40-70 years old consult the primary health clinics for breast symptoms, 4% of them are expected to have breast cancer. The cure rate is over 95% when the early breast cancers are properly treated at time.
Objectives; The epidemiology of women Breast diseases and the clinical workup to detect early breast cancer in Karbala.
Method; Retrospective analysis of the workup carried out for the surgical breast cases attending the surgical units and the EBCD center of Karbala health services, from10th October 2001-10th October 2005.
Results; Total case number was 3634. Sixty percent had inconclusive criteria The complaints were; breast pain in 67%, Mass in 57%, Nipple Discharge 10.7% and Breast Ulcer in 1.8% of the cases. The registered breast cancer cases were 46, they were advanced.
US examinations were 2017; 48.5% had Breast Masses (75%solid&25% cystic), the negative tests; 49.5% and 2% were equivocal.
Mammography exams; 157.
FNA Cytology exams were 190; conclusive in 61% and positive suspected cancer cells in 9.5%. There were 110 ND Cytology exams," none was positive".
Conclusion; the routine work of EBCD needs revision and activation of its objective. The diagnosed cases of breast carcinoma were late. Nipple Discharge Cytology is of no use in screening and diagnosing breast cancer, FNAC is independable in designing breast cancer treatment. There is a need to popularize the interventional radiological investigations and the Breast cancer Screening program.

Keywords: Karbala, Early Breast Cancer Detection, Breast Carcinoma, Nipple Discharge Cytology.

Epidemiological and Clinical Study of Visceral Leishmaniasis In Najaf and Karbala Governorate

Talib Abdul Galil Sahib H. Abdul-Kadi; Jasim Mohammed Hashim

Kerbala Journal of Medicine, Volume 1, Issue 1, Pages 124-130

A retrospective study conducted on (63) patients with V.L. admitted to both Al-Zahraa’ Maternity
and Pediatrics Hospital (MPH) in Al-Najaf and Karbala’ Hospital for Children during the period from Jan.
2005 to Sep. 2006 to shade light on the epidemiological and clinical aspects of V.L. among children from
both governorates.
The number of male cases was 43 (68.2%), while female cases were 20 (31.7%), male to female
ratio was (2.1:1). Most of cases were registered during winter and spring months. 39 (62%) of cases came
from rural areas. The peak ages incidence were1 – 3 years (65%).The commonest presenting features were
fever (100%), splenomegaly (93.6%), and pallor (87.3%).
The consistent laboratory findings were anemia (87.3%) and leucopenia (58.7%). Bone marrow
aspirate were positive in 40 (81.6%) from 49 aspirates taken and 14 (22.2%) patients were treated without
bone marrow aspirate confirmation of the diagnosis
All the patients received sodium stibogluconate (Pentostam)® 20 mg/kg/day for 4 weeks. The main
complications reported were jaundice (9.5%), pneumonia (6.3%), and gastroenteritis (4.7%). Three
relapses (4.7%) have been documented. No deaths were reported.
Keywords: Visceral leishmaniasis, Kala azar

Smoking as an Environmental Xenobiotic and Its Effects on Certain Health Parameters

Riyadh T. Alzubaidi; Ahmad H. Almyali; Monem M. Alshok

Kerbala Journal of Medicine, Volume 1, Issue 1, Pages 131-137

Data were drawn in the study from patients seen and/or admitted to Merjan teaching hospital in the
city of Hilla, Babylon governorate and they include:
100 healthy controlled non-smokers and 100 smokers’ non-diabetic and 240 patients with diabetes
mellitus also 100 patients with acute myocardial infarction, 52 patients with bronchogenic carcinoma.
It had been shown that there was statically significant increase in leukocyte count in smokers than in
non-smokers. There is statically significant increase in platelets count between smoker diabetic and
healthy control non-smoker. There are statically significant changes in the level of fibrinogen in
diabetic smoker from non-smoker healthy control and also smoker subject from non-smoker subject.
In patient with acute myocardial infarction we noticed that 89% of them had smoking index above
600. Also we noticed that in patients with bronchogenic carcinoma 87% of them were heavy smokers.
Most of smokers showed significant reduction in peak expiratory flow rate (PEFR) than healthy nonsmokers,
also they showed higher Hb level than non-smoker to extent that venesection in 10 of them
was done to relieve symptoms of secondary polycythemia.
In conclusion tobacco usage through cigarette and other means is the most avoidable risk factors for
several human diseases including cancer.

Distal Colorectal Polyp as a Predictive

Hadi A. Sayah

Kerbala Journal of Medicine, Volume 1, Issue 1, Pages 138-144

Background: Currently there are conflicts about the prevalence of proximal colorectal polyp/s among
patients with distal colorectal polyp/s discovered by sigmoidoscopy.
Design: A retrospective study.
Setting: Gastroenterology and Hepatology Teaching Hospital –Baghdad –Iraq.
Patients and methods: During the study period (1st of August-2003 to 31 of December -2004) all
patients who underwent total colonoscopy procedure were involved in this study. Out of patients with
different polyps, 96 patients were included when they did not have the Exclusion criteria.
Results: This study included ninety-six patients, (Male= 67(69.8%), Female= 29(30.2%)) mean age of
patients 51.5 year. Forty two (62.7%) of male patients had distal colorectal polyp (CRP), 30.9 %( 13 of
42) had proximal one (combined), while in female patients 21 patients had distal CRP, 14.3% (3 of 21)
had combined CRP. For adult patients with distal CRP, 26.8% (11 of 41) had combined CRP, all pediatric
patients had distal CRP, and 22.7% of them had combined CRP. Seven (14.6%) patients with distal single
CRP had combined one, while in patients with multiple CRP, 60 %( 9 of 15) of patients with distal
multiple CRP had combined one. With regard to the size of polyps, 26 %( 13 of 50) of patients with distal
small CRP (<1cm) had combined one, while in those patients who had distal CRP ≥ 1 cm, 23.1 %( 3 of
13) had combined one, 32.3 %( 10 of 31) of patients with distal neoplastic CRP had combined one, while
in patients with distal non- Neoplastic CRP, 18.8%(6 of 32) had combined CRP.
Conclusions and recommendations:
1. All patients with distal colorectal polyp/s discovered during sigmoidoscopy should undergo total
2. Colonoscopy should be used as a screening procedure instead of sigmoidoscopy.
3. Sigmoidoscopy can be used as a screening procedure in pediatric patients

Right Ventricular Infarction in Patients with Acute Inferior Myocardial Infarction

Ahmed H. Al-Myali

Kerbala Journal of Medicine, Volume 1, Issue 1, Pages 145-149

Background: Right ventricular infarction (RVI) complicating inferior wall myocardial infarction
(IWMI) is common. Electrocardiogram (ECG) through right pericordial leads (V4R) is a useful &
convenient toll of diagnosing RVI.
Objectives: To study the frequency of occurrence of RVI in patients with IWMI using the standard
ECG through right precordial lead (V4R), to define the risk factors for its occurrence and to identify
the associated physical signs & other ECG abnormalities.
Patients & methods: 90 patients admitted to the coronary care unit (CCU) were studied, we assessed
the prevalence of (RVI) using the right precordial lead (V4R), risk factors for its occurrence & other
important physical signs & ECG finding.
Results: RVI was diagnosed in (28.9%) of patients with IWMI, defined by the presence of o.1 mm
ST-segment elevation in V4R. Increasing age, diabetes mellitus (DM) & smoking were significantly
associated risk factors. Atrioventricular block (AV block) occurred in 23% patients with RVI
compared to 10.9% in patients with isolated IWMI. The classical triad of hypotension raised jugular
venous pressure & absence of rales on chest auscultation occurred in 7.9% of patients with RVI
compared to none of patients with isolated IWMI. Hypotension following the administration of
morphine & nitroglycerin were found in 66.6% of patients with RVI compared to non of patients with
isolated IWMI.
Conclusion: Standard surface ECG by using V4R could aid clinical recognition of concomitant RVI in
patients with IWMI. Hypotension following the administration of anti-ischemic medications &
atrioventricular block (AV block) were more common in patients with RVI. Increasing age, male sex
diabetes mellitus & previous history of ischemic heart disease were risk factors for the occurrence of

Hepatic Hydatidosis , Analysis Of 126 Cases

Dr. Abdulhadi Jassim Tlefih

Kerbala Journal of Medicine, Volume 1, Issue 1, Pages 150-157

Background: Hydatid disease ( H D) is a serious health problem in endemic areas, as
in our country. It can affect any organ in the body especially the liver. Surgery is still
the procedure of choice in most cases of H D, despite other methods of treatment
Objectives : The aim of this study is to know the prevalence of hepatic hydatidosis
(H H) , and to study presentation , types of treatment, surgical procedures and
Methodes: 126 patients with H H were treated in Hammad Shihab military hospital in
5 years period ( from July 1997 to June 2002 ) . 122 patients were treated surgically.
Results: (74.6%) of patients hailed from rural area. Most of the patients were female,
with male to female ratio (M : F) was 1 : 2 . ( 32.53%) of patients were between 31
and 40 years and the mean age was ( 35.46 ) years .
(75.3%) of patients presented with abdominal pain or discomfort . The disease was
discovered incidentally in (17.46%) . Isolated liver was involved in ( 66.7 % ). The
right lobe of the liver was affected in ( 80.95 % ) . ( 67.4 % ) of cases had single
hydatid cyst ( H C ) . Synchronous pulmonary hydatid cyst (P H C) occurred in
(7.9%) of cases.
Post operative complications ocurred in ( 3.2 % ) included (1.6%) developed
recurrent hepatic hydatid cyst (H H C ) , (0.8%) had subphrenic abscess and (0.8%)
experienced biliary cutaneous fistula .
Conclusion: The right lobe of the liver was the commonest location of H H C . The
commonest presentation was abdominal pain or discomfort. All patients with HHC
should be investigated for synchronous P H C.

The Prevalence and Risk Factors of Hypertension in Hospitalized Type II Diabetic Patients

Mouaid Majeed; Ahmed H. Al-Myali; Riyadh D. Az-Zubaidi

Kerbala Journal of Medicine, Volume 1, Issue 1, Pages 158-161

Objective:To report on the prevalence and risk factors of hypertension in hospitalized type II diabetic
Methods:Prospective study to all diabetic patients who might be admitted to Merjan hospital during the
period between June to October 2004. Patients age , sex , body mass index ,hypertension ,serum cholesterol ,
protein in urine , fasting blood glucose , smoking and family history were analyzed as a probable risk factors.
Result:Total of 100 patients were studied, 55% of whom are hypertensive. Hypertensive patients tend to be
older, obese, and hyperlipidemic with family history of hypertension and overt protein uria.
Conclusion:Hypertension is common in diabetic, weight reduction, treatment of hyperlipidemia and tight
glycemic control are essential to minimize the occurrence of hypertension.
Key words: hypertension, diabetes mellitus, obesity, proteinuria, hyperlipidemia.

Public Attitudes toward Substance Abuse

Muhammad R Lafta; Nesif Al Hemyary; Salih Al- Hasnawi

Kerbala Journal of Medicine, Volume 1, Issue 1, Pages 162-166

Substance abuse is growing problem in Iraq especially after 2003. Increase accessibility of drugs due to
increase trafficking through Iraq from neighboring countries, especially Afghanistan and Iran which has a
high incidence of substance use disorder ,causes a real concern for Iraqi health professionals .
Objective: To evaluate the attitudes and beliefs of population about substance abuse and addiction.
Method: Self-administered questionnaire including 19 items covered seven topics in substance use
disorders. Addiction models, dangerousness and criminality, age group, causes, treatment, prevention and
the future of the phenomenon in Iraq. It was distributed to 342 persons 190 males and 152 females, from
different occupations; school teachers, university students' theology students and governmental and
private sector employees.
Results: The majority (84.5%) believed that addiction is moral issue while (62.5%) regarded it as a
medical problem .About 70% viewed the abuser as dangerous. Only (18.5%) blamed the family as a cause
of addiction. Although (73%) believed in faith treatment, still (64%) believed in medical treatment.
Religion was cited as the most preventive factor (83%), and only (32%) believed that substance use
problems are growing in Iraq.
Conclusion: Some of the public beliefs are different from scientific facts, but consistent with other
cultural beliefs. Public mental health education should an essential part of substance abuse prevention
Key words: Public, Attitudes, Substance Abuse, Karbala, Iraq

Macrophage Activation Syndrome in a Child with Systemic Juvenile Rheumatoid Arthritis

Ali M. Al- Yasry; Jalal A. Ashoor; Intisar H. Al- Kurdi; Sabah N. Al-Musawi; Zuhair M. Al-Musawi

Kerbala Journal of Medicine, Volume 1, Issue 1, Pages 170-173

Macrophage activation syndrome (MAS) is a rare and potentially fatal complication of rheumatic
disorders in children; we describe a 14-month old boy in whom MAS developed as first presentation of
systemic juvenile rheumatoid arthritis (S-JRA). He suffered from fever, bleeding tendency from mouth,
gastro-intestinal tract, ecchymosis & site of injections followed by bilateral wrist swellings. Physical
examination revealed cervical lymphadenopathy & hepatosplenomegaly. Laboratory findings were
abnormal liver enzymes, coagulopathies resembling disseminated intravascular coagulation, anemia,
thrombocytopenia and abnormal C.S.F. findings.
Up to the best of my knowledge this could be the first MAS associated with S-JRA in Iraq.
Key words: Macrophage Activation Syndrome, Arthritis, Juvenile Rheumatoid

Huge Mucinous Cystadenoma of the Ovary

Fuad F. al-Zubaidy; Sausan A.Al-Ali

Kerbala Journal of Medicine, Volume 1, Issue 1, Pages 174-175

Mucinous cystadenomas tend to be large, unilateral cysts, sometimes reaching enormous proportions and
yet still remaining benign.Here we describe a 21 year old female patient who developed a large mucinous
cystadenoma and presented as gradual abdominal distention.
Key words:mucinous cystadenoma of the ovary , ovarian neoplasm.