Issue 10


• Family knowledge about mental illness

Abdul Zahra Mohammed alkhafaji

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1041-1046

Background: Family is the most vital & important environmental factor in the life experience of any individual. It has a major effect on the development, treatment & prognosis of mental illness.
Objectives: The aim of this study was to evaluate the knowledge of relatives with a mentally ill patient about Causes, treatment & prognosis of mental illness.
Methods: One hundred sixty relatives of schizophrenic out patients who live with them & who accompany them to Al-Diwania Teaching Hospital Psychiatric Unit were studied using a questionnaire to evaluate the knowledge of the relatives about causes, treatment & prognosis of their patients.
First all patients , included in the study were schizophrenic diagnosed according to a semi-structured interview based on the criteria of /IDCL , International Diagnostic Checklist for /ICD-10 schizophrenia.
Results: The results of the study show the general view of patients’ relative about mental illness & their defective knowledge.
Conclusion: Most of the relatives lack the knowledge about causes, treatment & prognosis of the mental disorder. Which usually lead to delayed adequate psychiatric treatment?

Adiponectin, Insulin and Interlukin-8 in Type-2 Diabetic Obese Patients in Kerbala Province: Iraq ………………………………………………………………………….

Tariq H. Al-Khayatt; Azher A. Ibraheem; Fadhil J. Al-Tu

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1047-1056

Background: The association between obesity and type-2 diabetes mellitus may be partly mediated by altered secretion of adipokines by adipose tissue. Adiponectin is an adipokines with anti-inflammatory and insulin sensitizing properties; it is secretion is down regulated in obesity. The correlation of plasma adiponectin with the risk of type-2 diabetes mellitus and hyperlipidemia is unclear.
Objective: To study the association between plasma adiponectin level with insulin and IL-8, in type-2 diabetic obese patients in Karbala province: Iraq.
Material and method: A total number of 110 sample subjects with different age, and different gender were classified according to diabetes mellitus and obesity. Fasting serum adiponectin, insulin and IL-8 were measured by ELISA method.
Results: It was obtained that adiponectin level was lowered significantly in diabetic group, obese group, and diabetic obese group as compared with control group. Serum adiponectin was correlated negatively with serum insulin and with body fat percent (BF %), while there was no relation with IL-8 level.
Conclusion: According to the presented data, adiponectin as hormone plays an important role in prevention of obesity and insulin resistance, and increase insulin sensitivity.

• The Prevalence of CAD in Patients with Left Bundle Branch Block(LBBB) Attending Cardiac Catheterization in Hilla

Haider J AL ghizz; Ahmed Al Myali

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1057-1062

background: Left Bundle Branch Block (LBBB) results from conduction delay or block in any of several sites in the intraventricular conduction system,
The incidence of LBBB increases with age (2). It is infrequent in young healthy subjects. LBBB Usually appears in patients with underlying heart disease, Even among persons without overt heart disease, LBBB is associated with a higher than normal risk of cardiovascular and all-cause mortality, . Among patients with coronary artery disease, the presence of LBBB correlates with more extensive disease, more severe left ventricular dysfunction, and reduced survival rates.
Objectives: Is to determine the prevalence of coronary artery disease in patients with left bundle branch block in Babylon district.
Method and results: we studied 45 patients referred to the cardiac catheteriza
ion laboratory for various indications, significant percentage of patients were labeled with the diagnosis of coronary artery disease (CAD), the prevalence od CAD in the studied population was 44.2%, Male gender, diabetes, smoking, echocardiographic finding of LV dysfunction or regional wall motion abnormalities were a risk factors that are significantly associated with a higher prevalence of angiographically documented coronary artery disease.
Conclusion: significant number of patients with LBBB has a normal coronary angiography, consequently unnecessarily consumes anti anginal drugs and admitted to coronary care units .using the predictors of existence of CAD, and multi detector 64 slice cardiac CT angiography would help much to rule out CAD in this population.

• Evaluation of Serum Cystatin C in Iraqi Cardiovascular Patients

Shaimaa S. Mutlak

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1063-1066

background: Cystatin C has been reported to be a potent predictor of increased cardiovascular disease mortality. Serum Cystatin C may have a stronger association with mortality and cardiovascular disease than serum Creatinine in patients with normal or mildly reduced kidney function.
Objectives: The aim of this study to
1- Determine the prognostic value of cystatin C in patients with cardiovascular disease (CVD) and compare the observed value with that obtained for healthy controls.
2- Study the correlation between serum cystatin C and creatinine in cardiovascular disease patients.
Patients and Methods: The prospective study included thirty (30) patients admitted to hospital with cardiovascular disease (CVD) slected from Baghdad teaching hospital and twenty-one (21) healthy individuals were included in this study. Fasting serum cystatin C and creatinine were measured in all patients and controls.
Results and Discussion: A significant increased in the level of serum cystatin C concentration was observed in patients with (CVD) as compared with the control group.
Conclusion: Cystatin C is a prognostic biomarker of CVD. A graded association exists between higher serum Cystatin C and increased CVD prevalence in patients without chronic kidney disease (CKD).

• Medical management of external biliary fistula following surgical treatment of hydatid cyst of the liver. Comparative study

Aqeel Raheem Al-Barqawi; Adel Shaker Al- Tamimi

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1067-1072

background: External biliary fistula is a common complication following more conservative hydatid liver surgery .A high output biliary fistula (drainage of more than 300ml of bile /day), might be associated with increasing morbidity. In the absence of distal biliary obstruction, the time required for fistula closure would be dependent upon many factors, among which the Oddi sphincter pressure is the most important. Lowering sphincter pressure has been tried by many methods including endoscopic and pharmacological methods depending on documented manometric studies.
Objectives: To evaluate the effectiveness of combined oral administration of Nifidipin, Isosorbid dinitrate and hyocin butyl bromide in reducing the time required for closure of biliary fistula following hydatid liver surgery.
Patients and methods: Fifty patient with high output biliary fistula (drainage of bile of more than 300ml/day) who underwent surgery for hydatid cyst of the liver in Al – Diwaniya and Baghdad teaching hospitals, 30 patients were subjected to a trial of combined oral administration of Oddi sphincter relaxant drugs, to evaluate the efficacy of this approach, they were compared with 20 patients in whom placebo was administered with no other intervention adopted.
Results: The majority of patients ( 93.33%), the fistula output converted to a low one within 5 days following the initiation of sphincter relaxants therapy, as compared to only 10% of patients in the placebo group with obvious statistical difference . 73.3% of patients in the study group exhibit complete cessation of bile drainage within 2-10 days as compared to 60% in the placebo group in whom complete cessation occur within 20-40 days the difference was statistically significant. 90.3% of patients in the study group were discharged within 7 days a period which significantly shorter as compared to 90% of patients in the placebo group whose discharged within 2-3 weeks in an average.
Conclusion: The administration of Oddi sphincter relaxant drugs may hasten the fistula closure with less morbidity and shorter hospital stay therefore it is a beneficial , safe and cost effective method in the management of external biliary fistula following hydatid liver surgery

• Oxidative stress and Lipid peroxidation in patients with Multiple

Halla G. AL-Gebouri; Hedef EL-Yassin

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1073-1076

Back ground: multiple sclerosis (MS) has a much higher incidence among Caucasians that in any other race. Females are much more susceptible than males and white females living in colder weather areas are much more susceptible than those living in warmer areas. Oxidative stress means an alteration in the delicate balance between free radicals and the scavenging capacity of antioxidant enzymes in favor of free radicals in the body system.
Objective: To evaluate and compare the antioxidants and lipid peroxidation in patients with MS and healthy control.
Patients and method: The study has included thirty patients with MS (16 females and 14 males) and thirty healthy subjects. The subjects were selected from people attending the out patients clinic of Baghdad Teaching Hospital in Medical City. Laboratory parameters included were: uric acid, albumin, and caeruloplasmin, total thaiol, malondiaaldehyde (MDA) and peroxinitrate (ONOO¯).
Results: MDA and ONOO¯ levels in serum of patients with MS were significantly higher than in the control group. While the levels of GSH, CP, albumin, uric acid, iron, copper and zinc in serum of patients with MS were significantly lower than in healthy control.
Conclusion: Oxidative stress may have a role in the pathophysiology of multiple sclerosis syndromes.

• Immunohistochemical Cytokeratine 20 over expression in urinary bladder carcinoma

Shoroq Mohammad Abbas Al-Temimi; Maather Baqer Hussein Al-Harmoosh

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1077-1083

this study was conducted to estimate the over expression of CK 20 protein in human bladder carcinoma (transitional cell carcinoma in comparison to squamous cell carcinoma) and to show its possible correlation to the pathological parameters (grade
and stage) of TCC cases . We evaluated the available tissue blocks of 50 patients with bladder carcinoma lesions (40 with TCC & 10 cases with SCC) who had referred to Al-diwaniya Hospital between January 2007 and December 2010.The mean age of the patients was 55 years (range, 33 to 77 years). The TCC were classified according to grades into grade I, II and III in 20 (50%), 10 (25%), and 10 (25%) cases, respectively and according to stages into Ta in 10 (25%), T1 in 10(25%), T2 in 10(25%) and T3 in 10(25%). From 40 cases of TCC, A total of 28 (70%) patients were positive for over expression of CK20 and no expression were found in cases SCC. High histological grades of the TCC were associated with decrease expression of CK 2 .There were 20 (100%) in GI , 5 (50%) in GII , 3 (30%) in GII (P = .0000) while CK20 expression decreased as the tumor stages increased , it was 10 (100%) in Ta , 8 (80%) in T1 , 6 (60%) in T2 , 4 (40%) in T3 , and there is a statistically significant correlation with the stages of TCC of bladder (p=0.0229 ) .
Aim of the Study: This study was conducted to estimate the over expression of CK-20 protein in human bladder TCC in comparison to bladder SCC lesions and to show its possible correlation to the pathological parameters of TCC like (grade and stage) .
Key ward: - Bladder TCC, Bladder SCC, Cytokeratin 20, IHC

• Evaluation of Visual Evoked Potentials in the patients with Chronic Viral Hepatitis

Hassan A.A. Nassrullah; Hawa A.R.AL-Dhahir; Mahdy H AbuRagheiff

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1084-1091

background: The visual evoked potential (VEP) is a wave generated in the occipital cortex in response to a visual stimulation. It measures the conduction time of neuronal activity from the retina to the occipital cortex.
Infection with viral hepatitis leads to a wide spectrum of clinical presentations ranging from an asymptomatic carrier state to self-limited acute or fulminate hepatitis to chronic hepatitis with progression to cirrhosis and hepatocellular carcinoma. The neurological complication is one of the extrahepatic manifestations of chronic viral hepatitis, where the involvement of the central nervous system (CNS) impairment has been reported.
Objectives: To assess the visual evoked potential changes in patient with chronic viral hepatitis.
Methods: Evaluation of visual evoked potentials in (27) normal subjects (18 male and 9 female) and (51) patients with documental chronic viral hepatitis disease (34 male and 17 female), divided according to type of virus to two group (30) CVHB patients, and (21) CVHC patients.
Results: The VEP abnormalities in both eyes were recorded in (23.33%) of CVHB patients and (42.89%) of CVHC patients, and the VEP abnormality in one eye was recorded in (10%) of CVHB patients. The bifid W waveform of abnormal VEP was recorded on both eyes in (10%) of CVHB patients and in (19%) of CVHC patients, the bifid W waveform recorded on (10%) of CVHB patients and (4.8%) of CVHC patients.
Conclusions: The abnormal VEPs and the bifid W shape are can be reported in chronic viral hepatitis patients as the early central sign of chronic viral hepatitis.

• Oxidative Stress In Patients With Acute Stroke And Its Effect On Kidney Function

Moaed E. Al-Gazally; Monem M. Al-Shok; Ali H. Husein

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1092-1101

background: Oxidative stress has been found to be involved in both stroke and renal dysfunction.
Aim: In the present study, the relationship of oxidative stress and renal dysfunction after acute stroke was investigated.
Patients and Methods: Our study was conducted on seventy four patients with acute stroke and forty one apparently healthy subjects were taken as control group. Patients group was divided into two subgroups, patients with ischemic stroke and patients with hemorrhagic stroke. The sera obtained from the blood of patients and healthy subjects were used to measure the concentrations of malondialdehyde (MDA), glutathione (GSH), creatinine (SCr), and blood urea nitrogen (BUN), and the specific activity of glutathione peroxidase and catalase. Estimated glomerular filtration rate (eGFR) was also calculated.
Results and Discussion: The results of this study showed that MAD, SCr, and BUN concentrations were found to be significantly higher, and GSH concentration, GPX and CAT activities, and eGFR levels were found to be significantly lower in acute stroke patients than control group (P < 0.001). Patients with ischemic stroke have significant increase in MDA and SCr concentrations (P< 0.01, P< 0.05, respectively), and significant decrease in GSH concentration , GPX and CAT activities, and eGFR levels (P< 0.05, P< 0.05, P< 0.01, P< 0.01, respectively) than patients with hemorrhagic stroke.
Our results also showed the presence of highly significant positive correlation between MDA concentration and BUN and SCr concentrations, and highly significant negative correlation between MDA concentration and eGFR levels. Inversely there was highly significant negative correlation between measured antioxidants levels and BUN and SCr levels, and highly significant positive correlation between measured antioxidants and eGFR levels.
According to the results of our study we found that acute stroke is associated with elevated oxidative stress, kidney function is significantly compromised in patients with acute stroke, acute kidney injury (AKI) is a common complication after acute stroke, and there was highly significant correlation between oxidative stress in patient with acute stroke and decline in kidney function.
Conclusion: The kidney function in patient with acute stroke may be directly or indirectly affected by the level of oxidative stress developed during the acute phase of disease and there was a cerebro-renal connection, which is disease that affects brain may also affect kidney and vice versa.

• Trace elements levels in serum and hair of patients with vitiligo and alopecia areata

Wasan Taha S. Al-Rubayee

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1117-1121

background: Vitiligo is the most prevalent pigmentary disorder which occurs worldwide. The etiopathogensis of vitiligo is complex, and includes genetic factors, autoimmune process, and infectious factors. Alopecia areata is a recurrent, nonscarring type of hair loss considered to be an autoimmune process. Though its etiopathology is not fully understood, there are claims that imbalance of trace elements may trigger the onset of alopecia areata.
Objectives: The objective of this study was to evaluate the levels of zinc, copper and magnesium in serum and hair of vitiligo and alopecia areata patients hopefully to gain a better understanding of the role of these trace elements in both diseases.
Methods: Twenty alopecia areata patients, twenty vitiligo patients, and twenty age and sex matched controls were studied. Samples were analyzed using atomic absorption spectrophotometric methods.
Results: Serum and hair zinc levels were significantly decreased in alopecia areata patients and also in vitiligo patients compared with controls. Serum and hair levels of copper and magnesium showed insignificant rise in both diseases when compared with controls.
Conclusions: Copper and magnesium levels are not altered in alopecia areata or vitiligo, but decreased zinc levels may play an important role in the etiopathogensis of both diseases.

• Control of Oral Anticoagulant Therapy Using EDTA Plasma

Israa M. Albayaa

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1122-1127

background: Prothrombin time test is traditionally used to monitor oral anticoagulant drugs given for various clinical conditions. Prothrombin time test is carried out on citrated plasma while most of the other hematological tests are carried on blood anticoagulated with Ethylenediamine tetra acetic acid (EDTA).
Objective: To evaluate the possibility of using EDTA plasma for the control of oral anticoagulant drugs.
Patients and methods: Thirty-six patients on different doses of Warfarin therapy were included in the study, and 21 normal healthy subjects were used as control group. The work was carried out in a private laboratory. Results were used to calculate the mean normal PT (MNPT) from both groups. Blood was withdrawn in 2 tubes: Citrate tube and EDTA tube. On each tube PT was determined in duplicate manually by Quick method using Biolabo thromboplastin reagents. For the patients group the international normalized ratio (INR) was calculated according to the thromboplastin manufacture kit instruction. SPSS version 9.0 was used to calculate the correlation and regression. MedCalc statistical program version 11.6.1.0 was used for assessing the clinical agreement using the Bland and Altman method.
Results: A linear relationship between citrate and EDTA samples for the INR and PT estimations was observed. The regression equations for INR and PT estimations with citrate plasma (y) and EDTA plasma (x) were:
INR citrate = (-0.4) + (1.25) INR EDTA, R2=0.97
PT citrate = (-3.14) + (0.89) PT EDTA, R2=0.96
Bland and Altman method was used to compare clinical difference of INR results of citrate and EDTA sample types which shows the mean difference (0.06) and the limits of agreement (0.46, -0.33) which represents the mean difference ± 1.96 SD. Only four measurements were out of range.
Conclusion: Despite the very good correlation observed between results of citrate and EDTA samples, no clinical agreement was established between the two methods and the use of EDTA samples for performing PT tests by manual Quick method is not acceptable

• Pathological Study Of Renal Cell Carcinoma By Expression Of Vascular Endothelial Growth Factor (VEGF) And P53 (Immunohistochemical approach…

Alaa. S. Jumaa; ad A. Al-Janabi; Zainab A.AL-Ali

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1128-1132

background: Renal cell carcinomas (RCC) represent about 1-3% of all visceral cancers. There are 30,000 new cases per year and 12,000 deaths from the disease in USA (1).
Aim: To estimate the rate of VEGF & P53 immunohistochemical overexpression in RCC in relation to histological types of tumor.
Methods: Fomalin fixed, paraffin-embedded blocks from 48 patients (28 male and 20 female) with RCC included in this study. A group of 12 patients with non specific inflammation –pyelonephritis were included as a control group. LSAB+ (Labeled Strept-Avidin Biotin) method was employed for immunohistochemical detection of VEGF & P53.
Results: In assessment of the correlation of VEGF overexpression in RCC with histological types, there is correlation between the intensity of VEGF expression & classical type as (R= 0.618) while in other histological types no correlation & no significant difference (p>0.05) between them. In assessment of the correlation of P53 overexpression in RCC there is a negative correlation (R=-0.843) in classical, in papillary (R=-0.674) & no significant difference between them (p>0.05).
Conclusion: these finding provide further evidence for the role of VEGF & P53 in the carcinogenesis of RCC. However both markers not well correlated with histological types of the tumor.

• Ultrasound Examination (Antral Follicle Count and Ovarian Volume) Versus Serum FSH Measurement in Assessment of Ovarian Reserve

Hadi Al; Mosawi; Melal Al; Jebory; Suhaila Al- Shaikh

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1133-1139

aim of study: The current study was designed to compare antral follicle count (A.F.C), ovarian volume & day 3 FSH level, with respect to their ability to predict ovarian response of infertile women to ovulation induction agents (antiestrogens such as clomiphene citrate or tamoxifen, or exogenous gonadotrophins).
Material and Methods: Sixty-two patients between the ages of 19 - 43 years participated in this study when attending the infertility clinic of Babylon Hospital for Maternity and Children. All patients underwent a transvaginal sonography on day 3-5 of cycle to measure the ovarian volume and count of basal antral follicle, and basal FSH concentration was determined on day 2-4 of a spontaneous period.
Induction of ovulation in next cycle by using antiestrogens or gonadotroohins (pure FSH- gonal- F ) for 3 successive cycles . Patients monitored by using TVS on other days, then on day 12 of cycle TVS was performed to assess the presence of dominant follicle.
Results: In this study the results showed that AFC has a higher predictability for successful fertility treatments by assessing ovarian reserve, i.e. when AFC < 10; the success rate was 13.3, while when AFC > 10; the success rate was 58.3.
The next predicting factor was ovarian volume, when < 3 ml; the chance of success was very poor (zero), while when volume is 3-9 ml; the success rate was 40.4% & when volume >9 ml; the success rate was 63.6%.
While day 3 FSH had the lowest predictability, when FSH < 10 m IU /ml; the success rate was 45.3%, while when FSH > 10 m IU / ml; the success rate was 38.8%
Conclusion: A.F.C. performs well as a test for ovarian response being superior to complex and time consuming endocrine tests. It is therefore likely to be the test for general practice.

• Immunological Study On Breast Cancer In Hilla Province

Ifad Kerim Al-shibly; Mohammed Abod Muhsin; Mohammed Sabri A.Razak

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1140-1145

background: Cancer is one of the leading causes of death in the general population. Breast cancer is the top. In Iraq, where the population was exposed to high levels of depleted uranium following the first and second Gulf Wars, breast cancer became the most common tumor type in females.1Interleukin-10 (IL-10) and Interleukin 12 (IL-12) are the main immunological interplayers against cancer, and their impairment can be observed in many cancers, including breast cancer. Over the last ten years, there has been a three-fold increase in the incidence of breast cancer, with most of this increase being attributed to a particularly aggressive type of the cancer.
Objectives: The high incidence rate of breast cancer in the last few years in Iraq inspired us to create an investigation about the immunological bases of breast cancer in a series of local Iraqi women to see whether any differences in this immunological profile could be found in a population exposed to depleted uranium.
Methods: A Case-control study was designed and applied. A total of 40 subjects were chosen for the immunological study. Blood samples were obtained at Hilla General Teaching Hospital, Breast Cancer Centre (Pathology Department). The ELISA method was used for the interleukins and β2-microglobulin detection.
Results: In this study, the association between the levels of the IL-10 , IL-12 and β2microglobuline and breast cancer was evaluated. The data showed significant increase in these cytokines levels among breast cancer patients and healthy controls.
Conclusions: The conclusions that can be extrapolated by this study are that, there was a significant increase in the levels of the IL-10 , IL-12 and β2-microglobuline among breast cancer patients and healthy controls.

• Serum levels of copper, zinc, iron and magnesium in Iraqi`s patient with chronic hepatitis C

Muhammad A. Aldabagh; Safaa I. Kader; Noor M. Ali

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1146-1150

objective: This study was conducted to determine the alterations in serum trace elements, including zinc (Zn), copper (Cu), iron (Fe), and magnesium (Mg) in patients with chronic hepatitis C and to compare the results with those of age and sex matched healthy individuals.
Methods: The study was carried out in Medical Research Unit, College of Medicine, Al-Nahrain University from 2009-2010. One hundred and ten subjects, 60 patients with chronic hepatitis C and 50 healthy individuals were included in this study. The serum zinc, copper, iron and magnesium concentrations were measured by using atomic absorption spectrophotometery.
Results: Serum zinc, copper, iron and magnesium concentrations were found to be 1.081±0.08, 1.143±0.025, 0.0819±0.0188 and 27.455±0.409 mg/L respectively in patients with chronic hepatitis C and 1.086±0.4680, 1.103±0.326, 0.0339±0.0066 and 16.80±0.56 mg/L in healthy individuals, respectively. Serum iron was exhibited to be elevated significantly (p<0.01) and magnesium was observed to be decreased significantly (p<0.01) in patients when compared with those of the control group. However zinc and copper remained without significant variants.

• Diagnosis of Acute Appendicitis by Using Modified Alvarado Score ….…....…….

Arkan Khalil Ali; Mohend.A.N.Al-Shalah; Ali A.Al-Katib

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1151-1161

background: About 7% of population suffers from acute appendicitis during their life time. The number of unnecessary operations regarding appendicitis particularly in female reaches 45%. Perforation rates ranging from 4% up to 45% in adult and from 30% up to 60% in children.
Aim: To evaluate the sensitivity and accuracy of the Alvarado score in pre operative diagnosis of acute appendicitis.
Patients and method: A series of 129 patients, were studied prospectively over a period of 20 months starting from May 2007 to December 2008 in AL – Hilla teaching hospital. A questionnaire used in this study includes sex, age, duration of presentation in addition to seven predictive values constituting the Alvarado score.
Result: We had 79/ 129 male patients (61.24%) and 50 /129 female patients (38.75%). All of them underwent appendicectomy .106 /129 patients had histological diagnosis of appendicitis (82.17%) they were 70/106 males (66%) and 36/106 females (34%).and the rest 23/129 patients had normal appendix improved histologicaly ( 17.83%) they were 9/23 males (39%) 2 of them were have pathology ( meckles diverticulum )and 7 of them were have no pathology and 14/23 females (60%) 7 of them were have pathology ( twisted or rupture ovarian cyst ) and 7 were had no pathology. The mean age was 23.9 years.
Conclusion: A high score rate was found to be an easy and satisfactory aid in the early diagnosis of acute appendicitis.

• Early versus Delayed (Interval) Laparoscopic Cholecystectomy For Acute cholecystitis

Rawaa Mumtaz; Abdulrazzak Kalaf Hassan; Anees Khaleel Nile

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1162-1169

background: The surgical management of patients presenting with acute cholecystitis remains controversial.
The aim of this study was to evaluate the safety and feasibility of urgent laparoscopic cholecystectomy during the “index” (acute) admission with acute cholecystitis, and to compare with a policy of delayed (interval) cholecystectomy.
Methods: Between December 2009 and March 2011, 120 patients who had undergone laparoscopic cholecystectomy. Sixty patients underwent surgery during the index admission (group I). Sixty patients were assigned to initial conservative treatment followed by delayed laparoscopic cholecystectomy (group II).
Results: The cholecystectomy for acute group took longer operative time, needed more modification of the procedure used. It had comparable rate of complication, conversion rate and a shorter hospital stay than delayed group.
Conclusions: Laparoscopic cholecystectomy during the index admission with acute cholecystitis can be performed safely and successfully.

• Head Injuries due to Motorcycle Accidents in Karbala-Iraq Prospective clinical Study

Husam Ghazi Al-Anbari

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1170-1179

Background: Head injury is one of the most important causes of death in trauma, preventive measures are widespread but not applied in all countries, and motorcycle accidents account the major problem in Karbala for the last few years.
This study is aiming to compare the incidence, severity, outcome and other factors for each of motorcycle accidents from other causes of head injury in Karbala.
Methods: 240 patients sustained head injuries admitted to neurosurgical ward and intensive care unit, from 1st of January till the last of August 2008 in Al- Hussein Teaching Hospital, those patients had been divided into five groups according to the cause of head injury, the following parameters were analyzed, which are age, sex, severity of head injury, other systemic injury, type of treatment, and the outcome of each group.
Results: the study showed that patients with motorcycle accidents have the highest incidence (No. = 168, 70%), most of them were young, male, and carry the highest morbidity and mortality.
Conclusion: motorcycle accidents account for the highest incidence of head injury in Karbala in 2008 which carry high morbidity and mortality.
Recommendation:
1. Educate motorcyclist about the preventive measures which should be taken like helmet wearing, limitation of the speed of vehicles.
2.Strict traffic laws should be applied.

The Effect of Body Weight & Smoking on the Risk of Osteoarthritis of the Knee Joint

Zina A. Rajab; Ikhlas K. Hameed; Zina H. Abdul-Qahar

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1180-1186

background: Knee osteoarthritis is common in old adults. Determination of risk factors of knee osteoarthritis may help in its prevention and modification of treatment. The objective of this study is to determine the significance of some risk factors like obesity and smoking on knee osteoarthritis.
Material & methods: The study included 132 outpatient attendants (102 females & 30 males) aged (53±9) years. Height and weight were measured for calculation of Body Mass Index; smoking habits were registered by questionnaire. Hemoglobin level, Erythrocyte Sedimentation Rate & C - reactive protein was measured for all participants.
Results: The number of patients with knee osteoarthritis was 61(46%), of these; 39 patients (64%) were obese including 13 patients who were smokers.
The mean & standard deviation of Hemoglobin & Erythrocyte Sedimentation Rate were 12±1 & 24±16 respectively, while C - reactive protein was positive in 29 (22%) of participants.
Smoking habit was significantly higher in patients with knee osteoarthritis (p<0.01) and in knee osteoarthritis obese patients (p<0.01) when compared to non- knee osteoarthritis subjects and obese non- knee osteoarthritis subjects; respectively.
Conclusion In accordance with the literature, this study found a strong association between Body Mass Index and knee osteoarthritis risk. In addition, the increase in the prevalence of smoking in radiographically confirmed knee osteoarthritis was observed suggesting that smoking habit may be a potentially modifiable environmental risk factor for knee osteoarthritis.

Study of some Cardiac Biomarkers and Oxidative Stress markers in Patients with Acute coronary syndromes

Kismat M .Turki; Ala; a G. Hussein; Mohammed O. Hamzah

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1102-1108

background: Acute Coronary Syndromes (ACS) represents a pathological, diagnostic, and risk continuum from unstable angina through myocardial infarction (MI) with or without ST-segment elevation. These three conditions share a very similar pathology, although treatment differs. Elevated markers of inflammation, in particular hs-CRP, are associated with an increased risk of future cardiovascular events in healthy subjects, Increased oxidative stress and the generation of the free oxygen radicals can result in modification of LDL to oxidized LDL that could lead to atherosclerotic lesions, Elevated levels of CK-MB have been regarded as biochemical markers of myocyte necrosis.
Objective: The aim of this study was to investigate the predictive value of CK-MB and oxidative stress (MDA) in acute coronary syndromes.
Patients and Methods: One hundred one (101) cardiac patients were admitted to the coronary care unit, Ibn alnafees Hospital and Al kindy Hospital over the period July 2009 and March 2010 with the clinical diagnosis of acute coronary syndrome their ages range was (24-84) years, the number of male was (65) (64.36%) and female was (37) (36.63%).39 healthy control (age, sex, matched) were enrolled in this study. All cardiac patients have routine ECG, cardiac biomarkers measurements especially(CK-MB), serelogical markers (hs-C-RP),lipid profile test and oxidative stress markers(MDA).10 ml of blood needed for assessment of the above makers.
Results: Oxidative Stress and Cardiac Biomarkers in Patients with Acute Coronary Syndromes (ACS) 101 were found significantly high in patients with ACS as compared to healthy subjects but significantly decreased in HDL-cholesterol in ACS patients as compared to healthy controls. ACS is associated with greater than normal lipid peroxidation.
Conclusion: Our study shows a significantly increase in lipid peroxidation and cardiac biomarkers in the circulation of patients with ACS. A significant decrease level of HDL-C were observes only in ACS patients. These finding suggest these biomarkers may be useful diagnosis of patients with ACS.

Study of Serum Leptin and Lipid Profile Concentration in Psoriatic Patients in Hilla - Iraq

Mohammed K. Al-Hattab; Moaed E. Al-Gazally; Radwan A. Al-Asadi

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1109-1116

background: To study the role of biochemical markers in sera of psoriatic patients.
Aim: Evaluation and study of the correlation between lipid profiles and Leptin in sera of psoriatic patients in Hilla province – Iraq.
Patients and Methods: The study was conducted on sixty psoriatic patients and thirty apparently healthy persons were taken as control group. Blood collected from the clinic of dermatology in Merjan Teaching Hospital and from the consultative center for allergy and asthma in Hilla city / Iraq. Sera obtained from the blood were used to determine the effect of psoriasis on leptin, total cholesterol, high density lipoprotein (HDL-C), triglycerides (TGs), very low density lipoprotein (VLDL), and low density lipoprotein cholesterol (LDL-C) concentration.
Results and Discussion: The results of the present study showed (significant increase in leptin, total cholesterol, triglycerides, very low density lipoprotein and low density lipoprotein cholesterol concentration), significant decrease in high density lipoprotein cholesterol in sera of psoriasis group compared to control group, significant increase in leptin concentration in sera of psoriasis females than males, significant increase in leptin concentration in sera of psoriasis patients as increase BMI (body mass index).

Acute Hemorrhagic Edema of Infancy: A Case Report

Fatima Abd Allah Al Hassany; Ali Tariq Abd Al Hussan

Kerbala Journal of Medicine, Volume 4, Issue 10, Pages 1187-1190

acute hemorrhagic edema of infancy (AHEI) is an uncommon form of eukocytoclastic vasculitis that affects children younger than 3 years and frequently is preceded by drug intake, vaccination, or a variety of infections.
It is characterized by an abrupt onset of fever, purpuric lesions, and peripheral edema on the face and extremities & ears. The course is benign with spontaneous resolution.
Key words: Acute hemorrhagic edema, infancy.