Volume 1, Issue 2, Summer and Autumn 2007, Page 185-262


Clinical, Biochemical and Histopathological outcome of six months of Interferon therapy in thalassemic patients with chronic hepatitis C viral infection

Sayah H. A; Ghadban J. M

Kerbala Journal of Medicine, Volume 1, Issue 2, Pages 190-196

background: Hepatitis C viral infection is a common cause of liver disease among polytransfused
patients.
Aim of the study: To find out short term efficacy of Interferon therapy in thalassemic chronic viral
hepatitis-C patients.
Setting: This study was carried out in Gastroenterology and Hepatology Teaching hospital in Baghdad –
Iraq
Patients and methods:Twenty four thalassemic patients who were anti HCV antibody positive with
elevated liver enzyme for more than one year enrolled in this study . All patients were submitted to liver
biopsy to assess the degree of the inflammation and fibrosis .All patients were treated with interferon
alpha (3 ×106 units/m2) tree times a week for six months.
Result: Three out of twenty four patients stopped treatments because of sever side effect. Out of twenty
one patients; 10(47 %) of patients showed complete biochemical response, 7(33%) of patients showed
partial biochemical response, 4(19%) of patients showed no response.
Young age patients responded better to interferon therapy .patients with initial high serum alanine
trasaminase responded less favorably than those who had lower initial pretreatment serum alanine
transaminase ,this was statistically significant .The higher the initial serum ferritine the worst the
biochemical and histological response .All patients who responded biochemically and submitted to
another liver biopsy showed decrease in severity of histological activity index after six months of
Interferon therapy ;there was strong correlation between biochemical response and histological response.
There was no improvement in degree of fibrosis in those treated with interferon therapy.Splenectomized
patient tolerated better and responded better than those who were not splenectomized .
Conclution:Thalassemic patients with chronic viral hepatitis C can benefit at least in short term from
Interferon therapy especially in younger age patients and those who have lowest elevation of liver
enzymes and those with lower serum ferritin level.
Keywords:Hepatitis,Hepatitis C,Thalassemia,Thalassemic patients ,Interferon

Paget’s Disease of Bone

Abd Alsahib

Kerbala Journal of Medicine, Volume 1, Issue 2, Pages 197-202

background: Paget’s disease of bone is a focal disorder of bone metabolism that results in
enlargement of the affected bone and deformity, a process that is sometimes accompanied by pain
and/or disfigurement (1). The disease is common in Western Europe, USA, and Australia but very rare in
Middle East and Arabian Peninsula. Here we reported seven un-relative patients with Paget’s disease in
Karbala between 1995-2005. Their ages ranged between 51-75 years. One patient was polyostotic and the
remaining were monostotic types. Four cases presented with fracture femur, the 5th patient with
undisplaced fracture tibia and the last two cases with pain in tibial bones and knee joints. Radiological
criteria of Paget’s disease were more obvious in cases of tibial involvement than femoral cases in which
histopathological examination confirmed the diagnosis. Serum alkaline phosphatas at time of presentation
ranged between 20-34 KAU/100ml, the higher level was in polyostotic case. The purpose of this paper is
to shed light on this rare entity and the variety of presentations.

Prospective analysis of 300 cases of ovarian cysts in Iraqi women

Tlefih A. J

Kerbala Journal of Medicine, Volume 1, Issue 2, Pages 203-210

ackground: Most ovarian cysts (O C) are functional, benign, harmless, and may disappear on their
own within a few months. However, they may twist, rupture, bleed, or press on the surrounding
organs. It may be difficult to differentiate malignant O Cs from the benign unless histopathological exam
is performed. There are many methods for treatment of O Cs.
Objectives: The aim of this study is to know the prevalence of O Cs, and to study their types,
presentation, and treatment.
Methods: Over a 5 year period, from Feb. 2000 to Jan. 2005, a prospective study of 300 women with O
Cs was carried out in 3 hospitals in Baghdad (Al - Habeabia hospital, Al - Elweya teaching hospital and
Al - Kindy teaching hospital).
Results: The highest incidence of O C (35%) was among women aged 21 - 30 years. The functional O C
was the most common type (64.7%), and (31%) of them showed spontaneous resolution. (68.3%) of O Cs
were singular.
(60%) of O Cs were symptomatic, and lower abdominal pain or discomfort was the most common
symptom (91.7%). (75%) of cases were treated surgically and cystectomy was the most common surgical
procedure that was adopted in this study (72.9 %).
(2.7%) of women had malignant O Cs. Out of them (75%) were at advanced stage (III or IV), and (87.5%)
were postmenopausal.
Conclusion: Most of the O Cs were benign or functional, symptomatic and some may disappear without
treatment, but surgery was the main treatment. The highest incidence of O C was among women aged 21 -
30 years. Most malignant O Cs were at advanced stage (III or IV).

Prevalence of Hypertension among Companions of Patients Attending Out-patient Clinics in AL-Hussain Hospital, Karbala Holy City – IRAQ .

K. A; AL-Hilaly; L. J; Hnoosh; Abdil Razzak; K. A; Hussein; Omran; A. O; Ismail; Al-Shamsi M. M; AL-Janabi A. A; Hadi A. Sayah; Z. M; Al-Musawi; Al-Shamsi M. M

Kerbala Journal of Medicine, Volume 1, Issue 2, Pages 211-216

background: Hypertension is a common chronic disease widely distributed all over the world. If
remains untreated it may cause end – organ damage with consequent increased morbidity and
mortality
Objective: The main aim of the study is to have an idea about the distribution of the disease among adult
companions in Al-Hussein out patient clinics.
Methods: Adult companions of patients attending the outpatient clinics in AL-Hussein Hospital were
studied randomly according to information available in the data sheet designed for this purpose. Persons
with past history of hypertension or newly discovered were recorded.
Results : Out of the total number of persons studied (1590), (856) were males (53.8%) and (734) were
females (46.2%), their ages range from 18 years to 82 years with a mean of (37.8). Persons who were in
the age group (18-39) years were 866 (54.5%), 40 (less than 5%) of them were hypertensives. Those who
were in the age group (40-59) were 559 (35.1%), with 171 (more than 30%) hypertensives.
The third group (60 years and older) were 165 (10.4%) persons, among them 92 (nearly 56%) were
hypertensives.
Conclusion: Hypertension was found to be more prevalent in females than in males and the prevalent rate
increases as the age advances (p

Keywords

Prevalence
---
Adult Companions
---
Out-patient Clinics
---
Isolated Hypertension
---
Karbala Holly city

 The Effect of Combined Administration of Fish Oil with Garlic to Lower Cholesterol in Hypercholesterolemic Subjects (Comparative Study)

L. J; Hnoosh; Abdil Razzak

Kerbala Journal of Medicine, Volume 1, Issue 2, Pages 217-224

background: Garlic and its preparations have been widely recognized as agents for prevention and
treatment of cardiovascular and other metabolic diseases, atherosclerosis, hyperlipidemia,
thrombosis, hypertension and diabetes.
Elevated total cholesterol, especially low-density lipoprotein has been documented as the leading risk
factor for the coronary artery disease. Studies with fish oil supplementation alone have shown an increase
in low-density lipoprotein, thereby enhancing the risk associated with incidence of coronary artery disease
in hypercholesterolemic subjects. In view of this, the effect of a combined supplementation of fish oil with
garlic pearls on the serum lipid profile of hypercholesterolemic subjects was studied.
Methods and Results: We administered 600 mg of fish oil with 500 mg of garlic pearls (garlic oil) per
day to 16 hypercholesterolemic subjects with a total cholesterol above 220 mg/dl for 60 days. The effect
of this combined supplementation was compared with group that administered 500mg garlic only per day
to 16 hypercholesterolemic subjects with a total cholesterol above 220 mg/dl for 60 days also while the
comparison done with garlic group(16 hypercholesterolemic subjects) that take only garlic and with a
control group (16 hypercholesterolemic subjects) without any supplementation. Significant reductions
were seen in all the lipid parameters (except high-density lipoprotein which was increased) in the test
groups after 60 days compared to that of the control group. The total cholesterol, low-density lipoprotein,
serum triglyceride, very low-density lipoprotein, and the total cholesterol: high-density lipoprotein ratio
reduced significantly.

Coronary Heart Diseases in Karbala Population Related to Central Obesity and Other Coexisting Risk Factors.

K. A; Hussein; Omran

Kerbala Journal of Medicine, Volume 1, Issue 2, Pages 225-235

background: central abdominal obesity is still considered to be important independent risk factor for
CHD in addition to other risk factors.
Objective: To determine the relationship between CHD and central abdominal obesity measured by waist
circumference (w.c) and coexisting risk factor including measurement of serum cholesterol , sugar , uric
acid .
Design: Prospective study.
Methods: One hundred patients participated in this study from coronary care unite (CCU) admitted in AL
Hussin hospital in Karbala governorate during period 1-12-2004 to 1-6-2005 .All patients were newly
diagnosed as having CHD by selected criteria in relation to central abdominal obesity , body mass index
(BMI) , age , sex , fat consumption , ECG , smoking , physical activity , alcohol , fruit eating , Diabetes
mellitus , hypertension .
Result: Mean age (56 +_ 12) year males 76% ,females 24%, consumed saturated fat 90 %, cigarette
smokers 63%, hypertension 20%, D.M 18%, alcoholics 4% , 59% got mixed anxiety and depression
disorder, consumed fruit 23%, physical exercise 11%.
Conclusion: There is direct relation between CHD and central abdominal obesity in addition to other
coexisting risk factors The life style of Karbala people (stress , smoking , physical activity , diet ) were
considered as having important impact on increasing prevalence of CHD .
The study showed the impact of socio-economic, psychological, political, education, factors in the
prevalence of coronary heart diseases (ACHD) in Iraq. The research has discovered the great defects in the
health education programs directed to Iraqi population about (CHD) and the importance of changing life
style among Karbala people as they are a picture of Iraqi population. The study is considered as important
message to the health authorities in the ministry of health to change style of health education programs in
Iraq for limiting the prevalence of risk factors leading to CHD.

Attenuated LaSota Virus Vaccine with a Urtica Pilulifera Extract In Treatment of Mammary adenocarcinoma in Mice

A. O; Ismail

Kerbala Journal of Medicine, Volume 1, Issue 2, Pages 236-242

background: The attenuated Newcastle Disease Virus (NDV) vaccine LaSota strain has been found
to cause regression in volume of mammary adenocarcinoma transplanted subcutaneously in mice
when injection locally (intratumoral) with Urtica pilulifera orally. The growth inhibition at the
end of experiment was (77%) and statistically significant compared with the tumor volume in
untreated group. While the growth inhibition in the group treated intraperitonealy (I.P) was (28%).The
relative tumor volume was decreased in the group treated with virus (I.T) but increased in group
treated (I.P) comparing with the tumor size at the begining of treatment. Histopathologically , there was
an extensive area of necrosis and replacement by granulation tissue with mononuclear cells
infiltration (lymphocytes, plasma cells and macrophages).

Evaluation of the Final Year Medical Students by External Examiners

Al-Shamsi M. M

Kerbala Journal of Medicine, Volume 1, Issue 2, Pages 243-247

background: Most Iraqi medical schools follow the traditional curriculum in teaching students.
Objectives: To present and compare the results of evaluation of the final year medical students, Al-
Qadisiah University school of medicine, in pediatrics by external examiners with the actual pass rate.
Materials &methods: Nineteen external examiners participated in the evaluation of 33 final year medical
students in the subject of pediatrics, the study year 2005 – 2006 using semi purposeful checklists.
Results: There is a comparable difference between the results of evaluation by the external examiners and
the actual pass rate of the students.
Discussion : There is a need to modify the traditional long case ( TLC ) and the oral ( viva ) examinations
into a more objective ones such as OSCE ( objective structured clinical examination )

Explanation of Theophylline site of action in cells of skin pathogenic fungi by inhibition cascade hypothesis

AL-Janabi A. A

Kerbala Journal of Medicine, Volume 1, Issue 2, Pages 248-251

background: The mode of action of theophylline has been determined in mammalian cells by three
mechanisms, CAMP phosphodiesterase (PDE) inhibition, adenosine receptor antagonism and calcium
mobilization, but after determined its activity against Trichophyton mentagrophytes, one of
Dermatophytes fungi, therefore, it is needful to be known the effective site of action in the cells of fungi.
Methods: Trichophyton mentagrophytes was cultured in Sabouraud’s glucose broth that contains 1, 3, and
5 mg/ml of theophylline. Morphological changes were noted in the treated cells when stained with trypan
blue using light microscopy in addition to the measurement of the electrical conductivity to the medium
which contains such cells.
Result: Morphological changes were noted in Trichophyton mentagrophytes cells after incubation in a
media containing 3 mg/ml of theophylline. These changes included aggregation of protoplasmic materials
at the center of fungal cells (spores and hyphi). Plasma membrane permeability was not affected by this
compound after measurements of electrical conductivity and staining by trypan blue stain.
Inhibition cascade hypothesis, that it is proposed by the author, explained these morphological changes
according to the supposed series of biochemical steps and depending on information of theophylline
biochemical activities in fungal living cells.
Conclusion: Inhibition cascade hypothesis tries to explain the site of action of theophylline by series of
biochemical steps according to the information about its mechanism of activities in the mammalian cells.
Plasma membrane is not affected by theophylline compound.

Persistent Pulmonary Hypertension of the Newborn Secondary to Meconium Aspiration

Z. M; Al-Musawi

Kerbala Journal of Medicine, Volume 1, Issue 2, Pages 255-258

abstract
Persistent pulmonary hypertension of the
newborn is the result of elevated
pulmonary vascular resistance to the point that
venous blood is diverted to some degree through
fetal channels (i . e) the ductus arteriosus &
foramen ovale .
We presented here a 36 hrs old neonate who is
delivered by complicated vaginal delivery with
history of prolonged labor & meconium leaking
liquor, cyanosis, tachypnea , grunting, poor
feeding and irritability . Body weight was 5 Kg ,
head circumference 36.5cm,length 50 cm
,respiratory rate 85 / min ,heart rate 130 / min.,
temp 37.5 C and O2 saturation was 77 %.
Physical examination showed macrocosmic
meconium stained neonate with suffused face,
chest examination revealed bilateral fine
crepitations with poor air entry .

Familial Primary Pulmonary Hypertension

Hadi A. Sayah

Kerbala Journal of Medicine, Volume 1, Issue 2, Pages 252-254

background: Familial primary pulmonary hypertension (PPH) is a rare, fatal, autosomal
dominant disease that results in right heart failure from idiopathic obliteration of the pulmonary
arteries.