Issue 6


Tuberculosis in Babylon Governorate– Iraq (Three years before & Three years after 2003)

Mohanad Mohsin Ahmed; Hattem Abdul-Lattif; Amer W. Falah Al-Joboury

Kerbala Journal of Medicine, Volume 3, Issue 6, Pages 766-771

Background: Tuberculosis (Tb) is a common infectious disease caused by
Mycobacterium tuberculosis complex, occasionally by Mycobacterium bovis &
africanum (tubercle bacilli), it is a major public health problem in Babylon & it seems
to be of a high prevalence at the last decade.
Aim: Study the TB infection according to some demographic points in Babylon
governorate during the years (2000-2001) & (2006-2007).
Patients & Methods: 2536 patients were involved in this study (1400 males 55.2% &
1136 females 44.8%). All of them were registered by a retrospective study at the
Tuberculosis & chest clinic at Babylon during the years ( 2000 , 2001 , 2006 , 2007 ) ,
the number of patient in each year was ( 633 , 653 , 634 & 616 ) respectively . Six
demographic parameters for each patient were studied (age, sex. area, site of
infection, sputum examination & month distribution of infection).
Results : the current study shows that there is no relationship statistically between Tb
infection during these years ( p > 0.05 ) , but there is a significant relation between Tb
& areas ( increases number of cases at the center of Babylon ) ( p < 0.01 ) , it also
shows that there is a high significant relation between the disease & the age of the
patient ( increase in younger age groups 16 – 30 years old ) ( p < 0.001 ) .
Conclusions: tuberculosis still a major public health problem in Babylon governorate,
the distribution of infection was nearly the same during the years of the study (three
years before & after 2003), Tb affects the younger age groups commonly & the
distribution of disease was concentrated at the center.

Conversion Rate in Laparoscopic Cholecystectomy: A Review of 300 Cases

Abbas A. Al-Jubori; Fadhil A. Al-Janabi; Raad S. Al-Saffar

Kerbala Journal of Medicine, Volume 3, Issue 6, Pages 772-778

background : Prediction of a difficult laparoscopic cholecystectomy (LC) can help the patient as well as the surgeon to be better prepared for the intra-operative risk and the risk of conversion to open cholecystectomy. The difficult gallbladder is the most common 'difficult' laparoscopic surgery being performed by general surgeons all over the world and the potential one that places the patient at significant risk. We present our experience of 300 cases since September 2007 to December 2009 in a single center with respect to conversion to open cholecystectomy. AIM: evaluation of difficult laparoscopic cholecystectomy and conversion rate in different 300 cases of cholelithiasis. Methods: Patients who underwent laparoscopic cholecystectomy (LC) from September 2007 to December 2009 were analyzed. The cases were analyzed in relation to conversion rate to open surgery; factors affecting pulmonary disease were not included in the study. Results: Out of 300 cases, 52 patients (17.33%) were identified as difficult cases. Laparoscopic cholecystectomy was successfully completed in 295 patients with a completion rate of 98.33%. Laparoscopic procedure had to be converted to the open procedure in 5 patients with a conversion rate of 1.66% of the total LCs performed and 9.6% of the difficult cases. Conversion had been done due to several reasons. Conclusion: It can be reliably concluded that LC is the preferred method even in the difficult cases. Our study emphasizes that although the rate of conversion to open surgery and complication rate are low in experienced hands the surgeon should keep a low threshold for conversion to open surgery and it should be taken as a step in the interest of the patient rather than be looked upon as an insult to the surgeon.Key words: conversion, laparoscopy, cholecystectomy.

The Role of Tumor Necrosis Factor-Alpha (TNF-Α) in The Induction of Preterm Labor

Taiseer Abdul Ilah AL Hussainy; Mohammad A. K. Al-Sa; adi; Mohammad Sabri A. Razzak

Kerbala Journal of Medicine, Volume 3, Issue 6, Pages 779-783

AbstractBackground: Microbial colonization and inflammation in the maternal genital tract has emerged as one of the major risk factors associated with spontaneous preterm birth. Objectives: this study aimed to demonstrate the role of tumor necrosis alpha(TNF-α)in the induction of preterm labor.Materials and methods: This study was conducted in Babylon Teaching Hospital of Gynecology and Pediatrics from November 2007 to May 2008. A total of 60 pregnant women with preterm labor admitted to Labor Room and 20 control women (10 of them were pregnant at term with bacterial infection, 5 were pregnant at term without bacterial infection, and 5 were normal females not pregnants and not infected) were included in this study. The ages of patients and controls ranged from (17-40) years. Blood samples were collected from both patients and controls to estimate tumor necrosis factor alpha (TNF-α by EASIA (Enzyme Amplified Sensitivity Immunoassay) method. Results: The results show there is significantly higher (p<0.05) in the level of TNF- α in patients with preterm labor compared to all control groups.Conclusion: The results clearly indicate the possible role of TNF-α in the induction of preterm labor.Keywords: preterm labor, TNF-α

The Role of Serum C - reactive protein in Leukemic and Lymphomic Patients

Sawsan Ahmed Hussein

Kerbala Journal of Medicine, Volume 3, Issue 6, Pages 784-787

Abstract Background : C-reactive protein is a sensitive major acute phase reactant in humans, whose synthesis in the liver is regulated by different cytokines . C-reactive protein is a common marker of inflammation plays a key role in the progression of human cancer. Objective: To detect the level of C - reactive protein in sera of patients with leukemia and lymphoma (infected and uninfected with fungus). Methods: Ninety six patients and hundred and fourteen control patients attended Medical city in Baghdad over period from Oct. 2005 to Dec.2005 were included in the study. Patients were divided into 2 groups according to the infected or uninfected with fungi, also 20 healthy volunteers were included in this study. Results: The level of C - reactive protein in sera of patients was significant higher than the healthy control group (248.6+70.5) and (3.72+1.61) respectively with (p~0.05). Also the level of C - reactive protein in sera of patients was significant higher than the patients control group (54.3+28.14) with (p~0.05). Conclusions: There was a significant increase in mean serum level of C - reactive protein in patients with fungal infections. Key Words: C-reactive protein, fungi, leukemia, lymphoma.

Antipsychotic medications induced extra pyramidal effects

Ali A. AlHamzawi

Kerbala Journal of Medicine, Volume 3, Issue 6, Pages 788-794

background: Antipsychotic drugs are invaluable tools in treating a large
variety of patients with schizophrenia, mood disorders with psychotic features,
senile and other organic psychoses, psychoses associated with Parkinson's
disease. Extrapyramidally mediated movement disorders represent the major set of
adverse effects associated with the use of antipsychotic medications.
Objective: Is to assess the size of the problem of extra pyramidal effects among
chronic patients taking antipsychotic medications.
Method: 100 chronic psychiatric patients attending outpatient department in Diwania
Teaching Hospital to receive their medications were assessed for extra pyramidal side
effect of antipsychotic drugs, using the Extrapyramidal Symptom Rating Scale
(ESRS). The study was conducted between the 8th of January2009 and the 8th of May
2009.
Results: the study revealed that 38% of patients on antipsychotic medication have
extra pyramidal effects. The majority of those patients (80%) were taking
anticholinergic drugs.
Conclusion: the study concludes that extra pyramidal effects are common among
chronic patients on antipsychotic medications.

Possible implications of Serum levels of Tumor necrosis factor-α (TNF- α) Among Rheumatoid Arthritis Patients In Kerbala Province.

Mohanad Mohsin Ahmed

Kerbala Journal of Medicine, Volume 3, Issue 6, Pages 795-803

background: Anti- Tumor necrosis factor -α (anti-TNF) therapies have shown
to slow and even halt structural joint damage in Rheumatoid Arthritis (RA).
However, therapeutic inhibition of TNF-α has approved to lead to an increase
in infections and lymphoma, hence it is mandatory to identify which patients with
rheumatoid arthritis may benefit from anti-TNF therapies.
Aim of the study: in this study we attempt to find out if any link could be drawn
between serum levels of TNF-α and some disease processes and manifestations in
RA. Such presumed link may help providing bases for patients’ selection to anti-TNF
therapies.
Methods and Material: thirty two RA patients were enrolled in this study. The
patients were diagnosed based on the American College of Rhuematology (ACR)
criteria and non of them had received anti-TNF therapy. Blood sample was taken from
each patient at time of attending; sera were separated immediately and kept frozen at
–20oC until used. Disease Activity Score (DAS) was calculated using DAS28-3
formula. Radiographs were read by expert radiologists. TNF-α was measured using
solid phase Enzyme Amplified Immunoassay (EASIA), while Sandwich Enzymelinked
Immunosorbent Assay (ELISA) was used for the separate quantitative
detection of RF of the IgG, IgM and IgA classes in serum.
Results: Among the 32 Rheumatoid Arthritis (RA) patients who were enrolled in this
study, there were statistically significant positive correlations between the serum
TNF-α levels with radiological joint damage and with serum Rheumatoid Factor (RFLatex),
(p=0.015, and p=0.011 respectively). However, no correlation could be found
between serum TNF-α level with any of other disease processes and outcomes.
Conclusions: These results may further support the importance of serum TNF-α level
of erosive RA and may reflect a causal relationship between TNF- α and joint
damage. In addition, radiological changes and Latex-RF may be promising inclusion
criteria in patients’ selection for anti-TNF therapies. However, a further detailed study
using a larger sample of patients is recommended to support our results.

Serum levels of Interleukin 6 and Homocysteine in Type 2 Diabetic Patients with renal failure complication

Firyal Hassan Abdul Jalil; Shaymaa Zahraw Nada

Kerbala Journal of Medicine, Volume 3, Issue 6, Pages 804-811

ackground: Cardiovascular diseases are more common among type 2 diabetic
patients than healthy subjects without a family history of diabetes. Serum
interleukin-6 (IL-6) and homocysteine (Hcy) levels are markers of endothelial
dysfunction and cardiovascular disease.
Aim: this study demonstrated to evaluate levels of IL-6, Hcy and their association
with cardiovascular risk in type 2 diabetic patients with renal failure complication.
Material & Methods: The circulating IL-6 and Hcy levels were measured in 45 type
2 diabetic patients and 25 control subjects without a known family history of diabetes.
The BIOSOURCE IL-6 ELISA kit used to measure IL- 6, high performance liquid
chromatography HPLC technique used to measure serum Homocystein, and
enzymatic methods are used for blood suger, urea, creatinine, and lipid profile
measurements.
Results: A significant differences were found in serum levels of IL6 and Hcy
between the two groups diabetic and healthy control (p>0.05). IL6 levels correlated
significantly with Hcy (p=0.02), hemoglobin A1C (p=0.03), and serum Hcy correlated
significantly with HbA1C (p=0.03) levels in patients with type 2diabetes mellitus.
Conclusion: These results suggest that serum IL-6 and Hcy levels do not directly
contribute to the development of endothelial dysfunction and cardiovascular risk
factors in type 2 diabetic patients with renal failure complication.

Expression of Anti Apoptotic Gene in Exophytic and Endophytic Type of Oral Carcinoma

Header Dakhel Al- muala

Kerbala Journal of Medicine, Volume 3, Issue 6, Pages 812-821

background: Bcl2 is known to belong to a family of apoptosis regulatory gene
products that may be death antagonist eg (bcl- 2, bcl-xl , mcl –l) or death
agonist ex (bax , bak , bcl -xs , bad) , The bcl- 2 oncoprotein inhibits apoptosis
and is expressed by many tumors including carcinoma such as breast ,cervix and head
and neck .
Aims to identify bcl-2 oncogene product expression of oral carcinoma and its
correlation to clinical features (exophytic , endophytic and mixed type) of oral
carcinoma
Patients and methods Twenty four patients were gathered , 20 patients had
squamous cell carcinoma and four patients with adenoid cystic carcinoma . Paraffin
blocks were obtained of the study group , specimens of follicular lymphoma paraffin
blocks were obtained from pathology department at teaching laboratory of medical
city . Normal oral mucosa were obtained from healthy patients who had undergone
routine oral surgery following informed consent of the patients .
Immunohistochemical procedure of Bcl2 protein were applied .
Results our study showed that 11 cases of the exophytic type of oral carcinoma
represented a positive bcl2 expression , 4 cases of the endophytic (ulcerative type)
showed a positive immunoreactivity with bcl2 antibodies and 3 cases of mixed type
(exophytic type and endophytic) showed a positive bcl2 expression . Statistical
analysis showed non significant relationship between clinical features (exophytic ,
endophytic , Mixed type) and bcl2 expression in oral carcinoma .
Conclusion :- bcl-2 expression in normal oral mucosa and oral carcinoma ,bcl-2
immunoreactivity was more correlated to mixed type , exophytic and rarely to
endophytic oral carcinoma but all didn't reach a statistical significance .
Keywords ,anti apoptotic gene product , bcl2 expression , oral carcinoma.

Comparative Study of Dipstick, Urine Microscopy and Urine Culture in the Diagnosis of Urinary Tract Infection in Children Under Five Years

May Mohamed Ali

Kerbala Journal of Medicine, Volume 3, Issue 6, Pages 822-828

background: Urinary tract infection is a common source of bacterial infection
in children under five years old; urinalysis is one of the important and useful
urological tests for diagnosis of infection, microscopic examination of urine
and the dipstick urinalyses (leukocytes esterase test, nitrite test) are common tests
used for detecting bacteriurea and pyuria.
Objective: Comparison of the rapid tests: dipstick (leukocytes esterase test, nitrite
test), microscopic examination, and urine culture in detecting urinary tract infection in
children under five years old.
Method: The study conducted on 246 patients less than 5 years old admitted with
clinical suspicion of urinary tract infection in Kerbala pediatric teaching hospital in
the period from July to December 2008. All urine samples were collected then
submitted for routine urinalysis and bacterial culture, dipstick and microscopy were
done.
Results: Urinary tract infection was identified in117 patients, The sensitivity of
leukocytes esterase test was 83.7% higher than nitrite test 39.3%while specificity
was70% which is lower than nitrite test 87.6%, the positive predictive value and
negative predictive value for nitrite test were 74%, 61% respectively while for
leukocytes esterase test record 76.6%, 82% respectively.
The positive predictive value and negative predictive value for pyuria( 96.2%, 99.1%)
were higher than that recorded in both nitrite test and leukocytes esterase.
Conclusion: 1-The dipstick tests (nitrite and leukocyte esterase) have high positive
predictive value for presence of urinary tract infection.
2- The high negative predictive value of these tests doesn't exclude urinary tract
infection.
3-Acombination of microscopic examination and dipstick tests improve the sensitivity
of detecting urinary tract infections.

Enhancement soft tissue healing by using platelets rich plasma in rabbits

Bushra Habeeb Al-Molla

Kerbala Journal of Medicine, Volume 3, Issue 6, Pages 829-839

Objective: the study was carried out in an attempt to find out the effects of 0.05 ml of autologous ofplatelet rich plasma on traumatic skin injury. Materials & methods: sixteen male rabbits were used & divided into two group according to killing after trauma in to group A after 1 day & B. after 4 days each group subdivided in to control & experimental. The skin wound induced traumatically by blade 1cm length & 2mm depth in the skin of rabbit's back, the experimental wound filled with 0.05ml of autologous PRP, while the control wound left for normal healing. The wound was dressed for one day. Result: platelet rich plasma (PRP) showed marked angiogenesis, granulation tissue formation, histological examination of biopsies revealed difference in the rate of healing process between the control & experimental groups platelet rich plasma (PRP) showed significant enhancement of healing.Conclusion: platelet rich plasma (PRP) accelerate the soft tissue healing keywords: platelet rich plasma (PRP), healing, growth factors

Role of Intaumbilical Misoprostol in Prevention of Postpartum Hemorrhage

Melal M. Al-Jebory; Asmaa K. Gata; Suha J. Witwit

Kerbala Journal of Medicine, Volume 3, Issue 6, Pages 840-849

Background: Prostaglandins have mainly been used for postpartum hemorrhage
(pph) when other measures fail,misoprostol, a new and inexpensive prostaglandin E1
analougue,has been suggested as an alternative for routine management of he third
stage of labour.
Aim o the study: To determine the efficacy of intraumbilical oxytocin administration
compared with intraumbilical misoprostol administration for prevention of postpartum
hemorrhage.
Materials and methods: Prospective study done at Babylon Hospital for Maternity
and Pediatrics from February 2009 to September 2009.
study involved 75 women in their 3rd. stage of labor subdivided into 3 groups 25 for
each received either 30 i.u oxytocin in 30 ml saline or 800 mcg of misoprostol
dissolved in 30 ml of saline 3rd group was control received only 30 ml of saline
injected into the placental bed via umbilical vein using pipingas technique .
The primary outcome measured was duration of 3rd stage of labor , amount of blood
loss and need for manual removal of placenta. P-value of <0.01 considered
statistically significant.
Results: All groups are comparable in their demographic criteria. Intraumbilical
injection of misoprostol associated with shorter duration of 3rd stage of labor (2.5 ±
0.2 min) compared with oxytocin group (3.5 ± 1.1 min) and control group (5.56 ± 2.2
min) p value <0.0001. Blood loss was comparable in both misoprostol and oxytocin
group (31.6± 15 ml and 33.2±18.7 ml respectively, p-value >0.05) which was
significantly lower than control group (147.1 ± 99 ml) p value <0.0001. No reported
cases of retained placenta in both oxytocin and misoprostol groups compared with 2
cases (8%) in control group. Further uterotonic drugs required in 20% of control
group. No significant side effects reported in all study groups.
Conclusion:
1- Intaumbilical injection of 800 mcg misoprostol dissolved in 30 ml of saline using
pipingas technique was more effective than intraumbilical oxytocin in shortening the
duration of 3rd stage of labor and both reduce the incidence of postpartum
hemorrhage.
2- the intraumbilical injection of uterotonics is non- invasive ,effective and clinically
safe method for management of 3rd stage of labor and prevention of postpartum
hemorrhage.

Factors affecting the required power in Nd: YAG laser Posterior capsulotomy after cataract surgery

Furkaan Majied Hamied; Khalid Ibrahim Riah; Amal Abdul allah Sakban

Kerbala Journal of Medicine, Volume 3, Issue 6, Pages 850-855

Background: thinking of posterior capsule after cataract surgery is a common
problem affecting vision, Nd:YAG poster capslotomy is the main treatment.
Objectives: to determent the factors affecting the required power of Nd: YAG
capsulotomy to open the opacified of posterior capsule.
Methods: In this study 67 patients were exposure of Nd:YAG laser from (Nidek yc
1600 model) laser device, which start with power of 1mj. The duration of this study
last for 10 months.
Results: The results showed inverse proportion between the power used and the age
of the patients, this results were similar in patients with hypertension and diabetes
mellitus. The dose of Nd:YAG laser has a wide variety relative to the duration after
cataract surgery.
Conclusions: the most effective factor in the power of Nd:YAG capsulotomy is the
age increase relasionship.
Keywords: Nd:YAG laser, thick posterior, and posterior capsulotomy.