Volume 1, Issue 0, Winter and Spring 2007, Page 1-109


The Rate and Prognosis of Ventricular Fibrillation Complicating Acute Myocardial Infarction

H. A. Nasrallah

Kerbala Journal of Medicine, Volume 1, Issue 0, Pages 1-7

Objective: To determine the rate of ventricular fibrillation according to the
time of onset of ischemic chest pain of patients with acute myocardial
infarction.
Design: Prospective observational study.
Setting: The only general hospital in Karballa city.
Patients: 146 consecutive patients admitted to the coronary care unit with
acute myocardial infarction.
Main outcome measures: Time of onset of chest pain and ventricular
fibrillation and survival of patient admitted with myocardial infarction. during
hospitalization.
Results: The rate of ventricular fibrillation in these patients was high in the
first 4 hours from onset of pain (14 patients 77.8%) and decline afterward,
11.1% of patients with V.F. died during hospitalization compared with 7.8%
of those without.
Conclusion: Early admission to hospital of patient with acute myocardial
infarction will reduce the early mortality due to ventricular fibrillation. Faster
access to facilities for resuscitation must be achieved if major improvement in
the persistently high mortality of patient with acute myocardial infarction. is to
be made.

Rhinocerebral Mucormycosis

Karim Q.AL.Naffi

Kerbala Journal of Medicine, Volume 1, Issue 0, Pages 8-16

Rhinocereberal mucormycosis is a relatively rare opportunistic fungal infection, usually
affect patient with DM, renal failure, organ transplant, desferal user&rarely in healthy
person5, 7, 8,9,18. We try to look how frequent this disease is prevalent in the cases admitted
to our hospital & what is the outcome of our treatment.
Method
A prospective study done in Al-Hussein General Hospital-Karbala/Iraq in the period June
2001-Augest 2005, to examine all patients with DM, CRF who have unexplained headache,
facial edema, ophthalamoplgia or disturbed conscious for rhinocerebral
mucormycosis.Diagnosis based on clinical suspicion , The presence of necrotic tissues in
nasal cavity, radiological exam including CT- scan whenever available &fungal detection
on of nasal swab &scraping..
Result
We diagnosed ten patients. Eight treated surgically &with amphotricin B (0.5mg/kg/d for six
weeks). Two were treated with amphotricin B&local cleaning only. Seven of those treated
patients were cured; three died, those who died were presented late with ophthalamoplegia
with or without disturbed conscious.
Conclusion
Rhinocereberal mucormycosis which is relatively rare disease actually is present in our
patients especially those who have DM with or without renal failure or patient with CRF on
dialysis3.13.16. It is a killing disease yet if we carry high index of suspicion in those cases
who is presented with headache, dirty nasal discharge, fever &facial edema. We can diagnose
them earlier &start treatment to control of the underlying condition, with aggressive surgical
interventions combined with amphotricin B, we may safe many patients life.

Colorectal polyps Clinical, Endoscopic, and Histopathological features

Hadi A. Sayah; Deyar A. Talabani; Amira H. Shubber; Nawal M. AL-Khalidi; Sadiq Jarallah

Kerbala Journal of Medicine, Volume 1, Issue 0, Pages 17-26

Background:There are few descriptive studies of colorectal polyps in Iraq
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)1905 total colonoscopy and sigmoidoscopy procedure were carried. Total colonoscopy
were carried for 1467(male 867, female 600).135(9.2 %) patients had colorectal polyps .96
patients were included when they fulfilled the including criteria of the study.
Results: One hundred-sixty colorectal polyps (CRP) were identified in 96 patients examined.
Polyps were single in 60(62.5%) and multiple in 36(37.5%) of patients. Polyp were labeled as
sessile in 95 of 160(59%) or pedunculated in 65 of 160 (40.6%), 61.3% were small size
(<1cm), 32.5% were medium size (1-2cm) and 6.3 % were of large size (>2cm). The most
common sites for CRP were rectum and sigmoid .Adenomatous polyp was found to be the most
frequent type of CRP identified in Iraqi patients and tubulovillous adenoma was the most
common adenoma (62.4%). 72.7% of patients who have tubular adenoma have mild dysplasia,
60.7% of patients who have tubulovillous adenoma have moderate-sever dysplasia.Retention
polyps were identified in 19 patients (mean age 12.3 years) fifty Percent were 1-2cm in size.
hyperplastic polyps were identified in 18 patients(Mean age 44.3 years) .
Conclusion
1. Tubulovillous adenoma with moderate-severe dysplasia are common in Iraqi patients
referred to this hospital , with high risk of malignant changes seen in this type of colorectal
polyps ,screening programs should be developed in Iraq
2. Most of colorectal polyps were small size so Barium enema can not be recommended as a
screening test
3. Most patients who have tubulovillous adenoma have moderate-sever dysplasia so this
patients need proper follow up .

DOES CIGARETTE SMOKING HAVE ANY RELATIONSHIP WITH OXIDATIVE STRESS AND ANTIOXIDANTS?

Ferdous Abbas Jabar; Mufeed Jalil Ewadh; Oda Mizil ALzamely

Kerbala Journal of Medicine, Volume 1, Issue 0, Pages 27-35

An attempted has been made is in this study to show if there is any relationship between cigarette
smoking and diabetes mellitus and its comelation with enzymatic antioxidant in response to free radical
producation. The results shows that cigarette contains on extremely high concentration of various free radicals
and a good relationship with diabetes to generate a situation to effect the enzymatic and nonenzymatic
antioxidant .

Prevalence of Hypertension in Type Two Diabetes Mellitus & it's State of Control

Kadhim Abbas Al-Hilali

Kerbala Journal of Medicine, Volume 1, Issue 0, Pages 44-49

One thousand five hundred patients with type two diabetes mellitus were studied, aiming to find the
prevalence of hypertension and it's state of control in those people.
They were 777 females and 723 males. Their age ranged from (30 – 80) years (mean 52.5). The
number of hypertensive patients among them was 816; the prevalence rate is 54.4%.
It was discovered that there was a high rate of control failure (76%) which was either due to patient
noncompliance (69%), insufficient drug doses prescribed ( 46.8% ) , or to a unsuitable
combination of drug regimes (33.4%) .

Risk Factors for Diarrheal Diseases in Children under the Age of Five Years in Karbala

Abdul Kareem Alaiwi; Zuhair Mahdi Al-Musawi; Saad Ibrahim Al-Ghabban

Kerbala Journal of Medicine, Volume 1, Issue 0, Pages 50-62

To identify the possible risk factors for diarrheal problems , a prospective survey done for 202
children , under 5 years old , admitted to Karbala Hospital for Children in Karbala governorate in
Iraq due to diarrheal problems .
Variable personal and demographic informations were taken from the mothers or caregivers .
Breastfeeding predominated significantly in both rural (71.4 %) and urban (63.44 %) areas
(P.<0.0001)
Underweight children were mostly bottle feeded (68.4 %) . (X2 =7.08, P. <0.029) Occurrence of
diarrheal diseases was inversely proportional to maternal education level.
One-third of children in the study had prior recent diarrheal illness.
Ninety four percent of children received antibiotics for the diarrheal illness prior to admission to the
hospital.
There was an overall negligence of the use of oral rehydration solution (ORS.)
The majority of bottle feeder mothers did not apply the proper method of bottle feeding preparation.
Eighty five percent of patients using pacifier represents all the bottle-fed infants, and (65.1 %) of
urban breastfed infants and (90 %) of rural breastfed infants.
In conclusion, malnutrition, poor environmental feeding hygiene, lower maternal education, recent
diarrheal illness increase the liability for diarrheal problems .It was also concluded that :
Underweight was less in breastfeeding babies.
ORT was underused, while antibiotics were overused in this sample of children.

Haemostatic parameters in acute promyelocytic leukemia patients treated with All Trans-Retinoic Acid (ATRA).

Mohammad Shnain Ali; Saad Sh. Mansoor; Ali Muslim Al- Amiry

Kerbala Journal of Medicine, Volume 1, Issue 0, Pages 63-68

Background: Acute Pormyelocytic Leukemia (APL) is commonly associated with
Disseminated Intravascular Coagulation (DIC)
1,2
.
Objective: The work was conducted to identify patients with APL who show
laboratory evidence of DIC (clinical or subclinical) with serial laboratory follow up.
Subjects and Methods: In this study 44 newly diagnosed APL patients were included. For
each patient, full hemostatic investigations were done at time of diagnosis and repeated on
day 3 and day 7 of therapy.
Results: Before starting therapy, all patients had elevated levels of D-dimer, indicating the
presence of DIC. On day 7 of treatment, plasma D-dimer levels were normal in ATRA-
treated group, but were high in the chemotherapy treated group, indicating that DIC was
essentially resolved in ATRA treated patients.
Conclusion: DIC is commonly encountered at presentation in patients with APL,
necessitating a rapid and full coagulation study in all patients. ATRA therapy in APL
patients is associated with rapid improvement of coagulopathy, hence it will aid those
patients to pass quickly the critical period of DIC. Therefore, ATRA therapy is justified to
be used from day one of treatment in APL patients.

Incidence of Thyroid Cancer among Surgically Treated Thyroid Diseases

Abdulhadi Jassim Tlefih

Kerbala Journal of Medicine, Volume 1, Issue 0, Pages 69-80

Background : Thyroid disease is the commonest surgical endocrine disease, and
carcinoma of thyroid is the most common endocrine malignancy, it occurs more often
in people who live in areas with iodine deficiency like our country. There is a great
controversy about the incidence of thyroid cancer.
Objectives: To document the incidence of thyroid cancer.
Methode: Over a 7 year period, from Sept 1997 to Aug 2004, a prospective study of
142 patients with thyroid disease underwent thyroid surgery in Hammad Shihab
military hospital and Al-Kindy teaching hospital was carried out.
Results: The overall incidence of thyroid carcinoma was 8.45 %, and the incidence of
malignancy in clinically solitary thyroid nodule ( S.T.N.) was 12.5 %, while in cold
nodule 14.95 %. Papillary carcinoma was the commonest type of carcinoma of
thyroid, which represents 75 %. Incidence of cancer was higer in female than male,
with male to female ratio( M : F ) 1 : 1.4. The most commonly affected age group was
between 3rd and 4th decades of life.
Conclusion: This study shows high incidence of malignancy in S.T.N., therefore
patients with S.T.N. must be of great concern to the doctors.

Efficacy of immunological tests in diagnosis of acute human brucellosis

Ali A. Najum Al-Zhaidy; Jawad K.Tarrad Al-Khafaji; Abdul Kareem S. Al-Yasari

Kerbala Journal of Medicine, Volume 1, Issue 0, Pages 81-89

The study was carried out in Al-Hashimyia hospital, Babylon governorate for the
period from May, 2005 to May ,2006 to evaluate the results of some immunological
tests in diagnosis of acute phase of brucellosis in human populations. A total of 410
patients with suspected brucellosis were admitted to the hospital with age-group
ranged from 18 to 65 years. 150 patients were studied, as documented cases with
acute brucellosis , and 150 healthy persons were involved as control group. Numerous
immunological tests like ELISA test , Rose- Bengal test , standard tube agglutination
test and E-rosette test were used to demonstrate cellular and humoral immune
response of infected host . ELISA test was the best and accurate test in diagnosis of
the acute infection, followed by standard tube agglutination test . All cases of acute
brucellosis showed a high number of active rosette –forming cells.

Endoscopic ultrasonography in staging of gastric carcinoma

Deyar A. Talabani; Hadi A. Sayah Hadi A. Sayah; Amira H.Shubber; Rayadh A.Zaydan

Kerbala Journal of Medicine, Volume 1, Issue 0, Pages 90-99

Background: Endoscopic ultrasound is new diagnostic technique for staging of gastric cancer.
Design: retro-prospective study.
Setting: Gastroenterology and Hepatology teaching hospital –Baghdad Iraq.
Patients and methods: Forty-two Iraqi patients with adenocarcinoma of the stomach were
studied from June 2003 to April 2005 all the patients were submitted to upper endoscopy and
forceps biopsy, EUS and surgical staging.
Result: the most common clinical presentation was weight loss ,the most common physical
finding was epigastric mass , the most common histopatholo -gical type was moderately
differentiated adenocarcinoma .Pre-operative EUS staging had accuracy rate of 75-95%
regarding (T) and (N) staging in comparison to post operative staging .
Conclusion: this study concluded that EUS is accurate diagnostic technique in staging gastric
carcinoma and it is highly recommended in evaluation and preoperative staging of gastric

Effect of Jaundice on Trace Elements Levels Children

Anwar Jasib Thaaban Al-Mazaal

Kerbala Journal of Medicine, Volume 1, Issue 0, Pages 100-109

- Objective: In the present study, the levels of Zinc (Zn), Copper (Cu) and Iron (Fe) in
children with Jaundice aged (1-2 yr) were investigated.
- Methods: 25 children diagnosed with Jaundice and (25) healthy children were included
in the study. Serum Zinc (Zn), Copper (Cu) and Iron (Fe) levels were measured by
Atomic Absorption Spectrophotometry. (GOT), (GPT), and total Bilirubin levels were
measured by colormetric methods, while hemoglobin concentration was measured by
cynomethmeglobin method.
- Results: Cu and Fe levels were found to be significantly high in jaundice group (p<0.05)
also, Zn levels were found to have tendency to increase (p<0.05)than control group. A
significant positive correlation between serum Cu, Fe, and total serum bilirubin was
established in Jaundice children.
- Conclusion: Our findings showed that serum trace elements (Zn, Cu, Fe) levels changed
in children with Jaundice. These changes might partially be due to pathological causes
during this disease.