Volume 2, Issue 3, Winter and Spring 2009, Page 263-381


Molecular Detection of Some Mutations Associated with Βeta-Thalassaemia in Iraq

Massoud Houshmand; Ali A. Al-Zaag; Norrya A. Ali; Waleed K. Al-Murrani; Zuhair M. A. Jeddoa

Kerbala Journal of Medicine, Volume 2, Issue 3, Pages 263-274

the study was carried out in period between “1 August 2005 to 30 of December 2006”.
Blood samples of 80 clinically thalassaemic patients were collected from three thalassaemia
centers in Iraq, namely: Ibn Albalady central thalassaemia center in Baghdad, and also from
Kerbalaa and Al-Qadissya governorates. Blood samples were also collected from 56 apparently
healthy individuals to serve as a control group.
DNA was isolated from blood and used for molecular detection of seven types of β-thalassaemia
mutations (IVS1 nt.1 G--A , IVS1nt.5 G--C, IVS1 nt.6 T--C, IVS1 nt.110 G --A, codon 39 C--T,
IVS2 nt.1G--A, and IVS2 nt.745 C--G) using the PCR based technique called ARMS
(Amplification Refractory Mutation System).
Five out of seven of these diagnosed mutations were reported for the first time in Iraq, and the
most frequent β-thalassaemia mutations were codon 39 and IVS1 nt.110 with the proportions
(26.76%) and (20.34%), respectively. No IVS2nt.745 was detected within the studied samples.
Genotypic distribution of the samples indicated that there is no significant difference (p > 0.05)
between the frequency of homozygotes and heterozygotes within patient group, while there is a
significant difference at (P < 0.01) in comparison with the control group.
The study of association between the number and the types of mutations revealed that 28(58%) of
positive cases have single mutation in a homozygous state or heterozygous state which
significantly associated at (P < 0.05) with β-thalassaemia mutations, whereas 20(42%) of these
cases have compound mutations. The most frequent association appeared between IVS1 nt.110 and
Codon 39 mutations.
Finally, mutations within families, pointed to a positive correlation between the types of mutations
in sons or daughters and their fathers and/or mothers; this indicates the accuracy of the ARMS
technique in detection of β-thalassaemia mutations. This conclusion should be taken with caution
due to the limited number of families.

Prevalence and Severity of Mitral Valve Regurgitation in Patients with Systolic Left Ventricular Dysfunction

Al-Hussaini A. R; Al-Haddad H. S; Al-Hilali K. A

Kerbala Journal of Medicine, Volume 2, Issue 3, Pages 275-279

background: Functional mitral regurgitation may develop in patients with congestive heart failure due to left ventricular systolic dysfunction, which is common, costly and lethal syndrome. Echo-Doppler is an extremely sensitive tool for the detection of mitral regurgitation.
Objective: To determine the
prevalence and severity of functional mitral regurgitation in patients with left ventricular systolic dysfunction using echocardiography.
B
Setting : Al-Hussain Hospital echocardiography clinic in Karbala city.
Methods: One hundred sixty patients were divided into two groups: Group A: constituted of 80 consecutive patients who had a left ventricular ejection fraction <40% and group B: constituted of 80 consecutive patients who had a left ventricular ejection fraction >40%.The study patients underwent standard echocardiogram. Severity of mitral regurgitation was graded as mild, moderate and severe.
Results: In patients with left ventricular systolic dysfunction (group A), mitral regurgitation was more common. It was mild in 22.5%, moderate in 52.5% and severe in 21.25%.
Conclusion: The majority of patients with left ventricular systolic dysfunction had mitral regurgitation .Echo-Doppler should be included in the evaluation of these patients.

A Comparative Study of Two Different Methods for Episiotomy Repair

Z. H. H; Al-Khafaji

Kerbala Journal of Medicine, Volume 2, Issue 3, Pages 280-288

objective: To evaluate the effectiveness of using (vicryl) thread material by subcuticular technique for repair of episiotomy and compare it with the standard method that use (catgut) by interrupted mattress technique. Design: A
Karbala J. Med. Vol.2, No.4,5 July 2008
randomized controlled study based in hospital.
Setting: Labour ward at AL-Zahraa maternity & pediatric teaching hospital at AL-Najaf city.
O
Population: 300 women who have undergo vaginal delivery with episiotomy.
Methods:
• The study was conducted at maternity and pediatric hospital in Al-Najaf city from the first of march 2005 to the end of January 2006 .
• The study included women attending labour ward in the hospital for vaginal delivery with episiotomy (total no. 300 women)
• Women with the following criteria were excluded from this study :

ß - Lactamase Producing Bacteria Isolated From Patients Infected With Otitis Media

Ali Muhsien Al-Mohana; Israa Kitab Al-Yasiri; Thanaa Shams Al-Deen Al-Toriahi

Kerbala Journal of Medicine, Volume 2, Issue 3, Pages 289-294

This study was carried out to evaluate the relation between the causative agents of otitis media and the parameter related to the patients (e.g., gender, age) the criteria of causative agents include type of bacteria, growth conditions, susceptibility to antibiotics, and the ability to produce ß-lactamase enzymes. A total of 50 ear swabs were obtained from outpatients infected with otitis media.
The results showed that Staphylococcus epidermidis (30%) was the predominant pathogens followed by Staphylococcus aureus (20%), Pseudomonas aeruginosa (18%), Proteus mirabilis (8%), and Proteus vulgaris (4%). The antimicrobial susceptibility pattern showed that all bacteria were resistant to cephalothin and moderate resistant to other antibiotics.
For detection of ß-lactamase producing bacteria, results showed that Ps. aeruginosa was recorded a high percentage in producing of ß-lactamase enzymes (55.6 %) in comparison with the other bacteria.

Flow-Injection and Batch Spectrophotometric Methods for Determination of Metoclopramide .HCl in Pharmaceutical Formulations

M. J; Hussan; Al-Da; M. A; amy; S. A; Al-Ameri

Kerbala Journal of Medicine, Volume 2, Issue 3, Pages 295-301

Background: This study describes a batch and flow-injection spectrophotometric methods for the determination of Metoclopramide.HCI in aqueous solution and in pharmaceutical
preparations.
The method is based on the reaction of Metoclopramide.HCI with ferric nitrate to produce Fe(II) ion which upon further reaction with potassium hexacyanoferrate in acidic medium forms a Prussian blue colored product that has a maximum absorption at 770 nm. The proposed method was successfully applied to determine Metoclopramide.HCI in the range of 0.2-6 μg.ml-1 for the batch spectrophotometric method and 2-80 μg.ml-1 for flow-injection (FI) spectrophotometric method with correlation coefficients of 0.9997 and 0.9999, deletion limits of 0.114 μg.ml-1and 0.700 μg.ml-1, and relative standard deviations of 0.46% and 0.41% respectively. Both procedures were applied to analyze the assay of Metoclopramide.HCI in pharmaceutical preparation with recoveries of 99.46% and 99.85% respectively.
Objectives: The aim of this study is to investigate A simple accurate and sensitive FIA system to determine Metoclopramid.HCL in pharmaceutical preparations.

The Effect of Cinnamon Oil on Multi-Drug Resistant Klebseilla Pneumoniae Strains.

Siham Al-Kaabi; Zina Al-Shami; Israa Kitab Al-yasiri; Kies Kh. Al- Hadrawi

Kerbala Journal of Medicine, Volume 2, Issue 3, Pages 302-307

he study was carried out to assess the effect of cinnamon oil on multi-drug resistant (MDR) strains of Klebseilla pneumoniae isolated from various clinical specimens. 150 specimens were collected from Al-Hakeem Teaching Hospital in Al-Najaf Governorate,
Karbala J. Med. Vol.2, No.4,5 July 2008
21 isolates were found to be Klebseilla spp. On further study at the species level only six of these isolates were found to be multi-drug resistant K. pneumoniae. The results of antibiotic sensitivity test showed that most of these isolates were highly resistant (resistance percentage was 50-80%) for the used antibiotics, these strains were defined as a multi-drug resistant K. pneumoniae. The antimicrobial effect of cinnamon oil on these isolates was tested via performing disk diffusion method, minimum inhibitory concentration (MIC), and minimum bactericidal concentration (MBC) tests. The results showed a similarity in the antimicrobial actions between this oil and Ceftazidim, Cefotaxim, and Ciprofloxacin in 50% of cases. The study concluded that cinnamon oil could be used as an effective antimicrobial even in case of difficult treated MDR K. pneumoniae as well as it could be used as a safe external ointment in the treatment of infected wounds and vaginal infections.

Comparative Study of Internal Fixation for Displaced Closed Fractureof Medial Malleolus Using Malleolar Screw Versus Tension-band Wiring

Al-Lamy; W. A; M. H; Al-Obaidy

Kerbala Journal of Medicine, Volume 2, Issue 3, Pages 308-318

in a prospective, randomized trial of 40 patients with displaced closed fracture of medial
malleolus at Al-Sader, Al-Hakeem, Al-Manathera & private hospitals in Najaf from March
2005 to March 2008, we compared two methods of internal fixation namely malleolar screw
and tension-band wiring.
The patients were then allocated to two treatment groups (20 patients in each group). The
populations of the groups were similar in age (median 37 years), sex, fracture type (Danis-Weber
type B and C), and aetiology (twisting, fall or motor vehicle accident). The patients were
evaluated clinically, radiologically, and functionally with follow-up for average of one year.
Radiological union took place in the group treated with tension-band (mean time 9.4 weeks)
earlier than those treated with malleolar screw (mean time 11.8 weeks) (p=0.03). Excellent and
good results were achieved in 80% with malleolar screw fixation and in 90% with tension-band
wiring (p=0.049). Although better range of motion was noticed in the group treated with
malleolar screw, it did not reach significance level (p=0.628).
The preliminary results of the current study suggest that tension-band wiring may be more valid
option than malleolar screw for internal fixation of medial malleolar fractures.

Laparoscopic Cholecystectomy 7 years Experience in Hilla

M. M; Al-Khafaji; Al-Taee

Kerbala Journal of Medicine, Volume 2, Issue 3, Pages 319-322

objectives: To evaluate the results of patients under went laparoscopic cholecystectomy ,rate of complications and causes of conversion to open cholecystectomy. Memost of them
thod: 1200patients operated upon in Al-Hilla teaching hospital from 2000 – 2007 e were female (860) &(340) were male. all operations done under G.A. & using co2 pneumoperitoneum .
Results: 44 % of patients were between 41-50 years of age.860 (71.6%) patients were female and 340 (28.4%) patients were male.78.7% of patients presented with chronic calculus chlecystitis and 20.6% of patients presented with acute calculus chlecystitis and 0.58% of patients presented with acute a calculus chlecystitis.
Conversion rate was 6.2% (75 patients).The most common cause of conversion was failure to progress due to anatomical variations in 65 patients.
Complications occurred in 45 (3.7%) of patients. The most common complication was port site infection in 18 patients. Complete transaction of C.B.D occurred in one patient.
Conclusion:
Laparoscopic cholecystectomy is a safe & minimally invasive procedure.
The complication rate is relatively lower than in the open technique in expert hands.
During Laparoscopic cholecystectomy we can do diagnostic or exploratory laparoscopy to fined out other things in the patients that can explain the patients symptoms.

The Frequency of Circumcision in Infants and Children in Diwaniah

Al-Shamsi M. M; Al-Zamili A. H

Kerbala Journal of Medicine, Volume 2, Issue 3, Pages 323-330

background: Circumcision is a central feature of islam and is recommended at an early age. Obfrom 1 day
jectives: To determine the frequency of circumcision in male infants and children to more than 6 years of age in Diwaniah.
Materials &Methods: Hundred infants and children were randomly selected from each age group of the following : 1-40 days , 41 days-6 months , 6-12 months , 12-18 months , 18 months- 24 months , 25 – 36 months , 37 – 48 months , 49 – 60 months , 61 – 72 months and more than 72 months. The frequency of circumcision was determined in each group together with other variables.
Results: Six percent of infants between 1 day – 40 days were circumcised , 13 % of those between 40 days – 6 months. Most circumcisions were done by a male nurse and most of the families of the infants and children think that circumcision is better to be done at an older age group.
Conclusion: Sixty two percent of our infants and children up to the age of more than six years are circumcised , there is a need for an extensive education on early circumcision because of outstanding benefits of early circumcision.

The Diagnostic and Prognostic Value of C-Reactive Protein in Patients With Acute Myocardial Infarction

Al-Jashami

Kerbala Journal of Medicine, Volume 2, Issue 3, Pages 331-335

the aim of this study is to assess the diagnostic and the prognostic value of C-reactive protein in patients with acute myocardial infarction. From October 2005 to October 2007 one hundred patients with acute myocardial infarction (AMI) were admitted to the coronary care unit (CCU) in Diwaniya Teaching Hospital were studied regarding the value of C-reactive protein during the first 72 hours of the infarction and through out the period of complications. The results were compared with those obtained from control group which consisted of 30 persons of matched age and sex.
We found that the mean serum level of C-reactive protein (CRP) of those with AMI was 68mg/L+59.93 and its concentration reaches a peak in all patients in the second day of infarction. The level was significantly higher than the level of CRP in the control group (mean =6mg/L), (p<0.005). We also found that CRP remained persistently high in patients with complicated AMI in comparison with uncomplicated patients.
So this study showed that CRP level is useful diagnostically and prognostically in patients with AMI and it is a simple bed side test that it is available in different medical centers.

Chilblains in Iraqi patients in Hilla City (Clinical study)

Mohammed K. Al-Hattab

Kerbala Journal of Medicine, Volume 2, Issue 3, Pages 336-344

chilblain is a major medical problem in Iraqi population in winter time and the purpose of
this study was to determine the clinical patterns of involvement in patients at Hilla city.
A total of 60 patients with chilblains were assessed in the department of dermatology in
Merjan teaching hospital during the cold months between January 2007 to February 2008. Their
ages ranged from 1.5-70 years (mean ± SD, 22.6±13.6 years).The duration of the disease ranged
from 2-90 days (mean ±SD, 24.5±20.7 days). There were 40 females (66.6%) and 20 males
(33.4٪) with a sex ratio of 2:1. The majority of patients were between 11-30 years of age (71.6%)
and females forming about 79.5%, female: male ratio was about 3.8:1.
All patients were presented in January and February and the attacks in majority of patients
started in December (20 patients) and January (30 patients) forming about 83.3%. Family history
in close relatives were positive in 14 patients (23.3 %).Thirty one patients developed similar
attacks at previous winters (51.6%). Numbers of previous attack of perniosis / winter were from 1-
215 attacks.
Associated systemic and dermatological diseases were: hypertension (3.3%), diabetes
mellitus (3.3%), systemic lupus erythematosus (3.3%), pregnancy (3.3%), atopic dermatitis
(3.3%), allergic rhinitis (3.3%), anemia (1.6%) and hand eczema (1.6%).
Regarding the sites of the lesions, chilblains commonly affected either hands alone (48.3%),
feet alone (33.3%) and to a lesser extent both hands and feet (18.3 % ). The feet alone were
commonly affected in females (88.2%) while the hands alone in males (60 %). Hands and feet
were affected together most commonly in females (91%).Ears, nose and buttock were also affected
(1.6%) for each.
Clinically, the types of lesions in patients with chilblains were: erythematous cyanotic
swelling (81.6%), some with diffuse welling sausage - like (13.3%),erythema multiforme –like
picture with target lesions (20 %), purpuric rash (15 %),ulcerated lesions (11.6%), eczematization
with fissuring (11.6%),blisters or vesicles (6.6%),dusky red papules (6.6%), lupus erythematosus –
like rash on dorsum of the hands (5%) and nodules (3.3%).
In Iraq, chilblains clinically could be presented in a form of erythema multiforme-like,
erythema nodosum –like, lupus erythematosus-like or sausage-like swelling with cold fingers and
toes, pain, tenderness and itching.

Isovolumetric Relaxation Time “IVRT” as an Assessment of Left Ventricular Diastolic Function: M-Mode Derived Versus Doppler Derived

Akeel A. M. Hassan Zwain

Kerbala Journal of Medicine, Volume 2, Issue 3, Pages 345-351

Background: Isovolumetric Relaxation Time” IVRT” may be defined as: That part of the cardiac cycle
between the time of aortic valve closure and mitral opening, during which the ventricular muscle
decreases its tension without lengthening so that ventricular volume remains unaltered. During this period
there is a drastic decrease in ventricular pressure without a change in ventricular volume but prior to
mitral valve opening. IVRT can be estimated by M-Mode echocardiography with simultaneous
phonocardiography or simply by determining the time interval between the maximal systolic excursion of
the left ventricular posterior wall to the onset of mitral valve opening. More recently, Doppler technique
has been used to assess not only IVRT but also MPI “Myocardial Performing Index”; comparisons of
Doppler IVRT with catheterization measurement of this time period have shown reasonable correlations.
Objective: To compare M-Mode derived IVRT with Doppler derived IVRT.
Method: The study was performed on healthy individuals of age of 20-55y. Echo-Doppler Siemens
V.Plus equipment with phased array 2.5MHz probe and PW or CW facilities was used. A good M-mode
image of mitral valve excursion and left ventricular posterior wall systolic excursion was first obtained
and the time between the mitral valve opening and the maximal systolic excursion of LV posterior wall
was then calculated. Doppler IVRT was obtained by directing the Pulsed or continuous wave beam from
apical 5 chamber view across the region between the aortic out flow tract and the mitral inflow tract. The
spectral wave form obtained in this position should include aortic valve flow with valve closure and the
onset of mitral inflow with E/A configuration. In this spectrum the aortic closure- mitral opening interval
can be determined.
Results & conclusion: There was no significant difference between M-mode derived IVRT and Doppler
derived IVRT. Since the later has been validated on the ground of correlation with catheterization, thus it
seems feasible to use either techniques to assess LV diastolic function.

Hypothyroidism in Adults Early Clinical Presentation in Relation to Age

Karim O. Al-Naffii; Hassan A. A. Nasseralah; Kadhum A. Al-Hillali; Akram F. M. Ali

Kerbala Journal of Medicine, Volume 2, Issue 3, Pages 352-356

Background: Hypothyroidism in adults is not a rare disease but has non –specific clinical
presentation which may delay its diagnosis.
Objective: the aim of the study is to identify the presenting symptoms of hypothyroidism,
their frequency & their relation to age.
Patients & Method : All adult patients > over 18 years of age who attended the consultation
clinic, in Al-Hussein Teaching Hospital / Karbala, from January 2002 to December 2007
showing clinical features suggestive of hypothyroidism were sent for T3, T4 & TSH.
Results: Sixty eight patients were found to have hypothyroidism, 52 females & 16 males
(F/M ratio 4.7:1). Seventy percent of the group are less than 55 yr of age, their mean age is
42.3 yr. Malaise & arthralgia were the main complaints especially in those aged 55year &
over (69% & 25%) respectively while skin changes were the main early physical signs in
those less than 55yr of age (26%).
Discussion: Hypothyroidism is a disease which may present in a nonspecific clinical picture
such as malaise or fatigability especially in elderly or skin changes in young age group or as
menstrual irregularities in young females.
Conclusion: High index of suspicion is the main initial tool for diagnosis of hypothyroidism
& should be considered in any elderly patient with unexplained malaise or fatigability or in
young females with unexplained menstrual irregularities. To look for other physical
symptoms & signs in those patients which may mandate sending them for thyroid function
test or at least only TSH level.

Isolated Unilocular Renal Hydatid Cyst

Fuad F. Alzubaidy

Kerbala Journal of Medicine, Volume 2, Issue 3, Pages 361-365

Hydatid disease is endemic in many parts of the world. The location of the cyst is mostly hepatic (75 %)
and pulmonary (15 %), and only 10 % of the cysts occur in the rest of the body. Although hydatidosis can
be present in all parts of the body, urinary tract involvement develops in only 2-4 % of all cases, and
isolated renal cysts are extremely rare. There are no specific clinical symptoms or signs that will reliably
confirm the diagnosis of renal echinococcosis. In addition, there is no laboratory finding that is
pathognomonic for hydatid disease except for hydatiduria. Routine blood tests are generally normal except
for eosinophilia which is found in only 50 % of the cases. Radiological studies have a more important
place in the preoperative diagnosis of renal hydatid disease. We present herein a patient with isolated renal
hydatid disease presented as left upper quadrant mass treated successfully with complete excision of the
cyst and preservation of the kidney.

Effect of Caffeine in Genetic and Cancer (review article)

Ali Abdul Hussein S. AL-Janabi

Kerbala Journal of Medicine, Volume 2, Issue 3, Pages 366-369

affeine is one of purine compounds which occur naturally in different species of
plants such as: tea, coffee and cacao plants. DNA synthesis and replication are
affected by caffeine through different methods and these will lead to exhibition of
more than one effect in cell division. Caffeine has not proved to have a mutagenic effect, but
it prevents the action of mutagenic compounds. Harmful activity of UV is blocked by
caffeine when it is added to the treated cells with UV light. Furthermore, caffeine is not
found to have a chief role in the conversion normal cells to cancer state, but, in fact, it has a
reflexive action when it prevents the carcinogenic compounds to effect on cell division.