Volume 5, Issue 11, Winter and Spring 2012, Page 1194-1405


Anti-Myelin Associated Glycoprotein Antibody and Relapsing Remitting Multiple Sclerosis among A Sample of Iraqi Patients

Dr.Kareem M. Al-Tameemi; Dr. Anmar U. Hatam; Dr. Akram M. Al-Mahdawi

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1194-1199

ackground:Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system affecting nearly 2 million people worldwide. The pathogenesis of MS is at best incompletely understood. There are several proposed mechanisms that may be important in the production of MS plaques: autoimmunity, infection, bystander demyelination and heredity. Deviation of immune responses plays a central role in the pathogenesis of MS. Auto antibodies to many myelin constituents is present in MS. These antibodies may be an autoimmune reaction to an “MS antigens” or simply part of a generalized “non-sense” antibody response. In either case, the antibodies may affect the pathology of MS.
Objective: To study the association between Anti-myelin associated glycoprotein (anti –MAG) antibody and relapsing remitting multiple sclerosis in Iraq.
Method: 105 patients with relapsing remitting multiple sclerosis and 85 patients with other neurological diseases (OND) as control group were recruited in this study. The cases were collected from Baghdad teaching hospital, MS center, Baghdad, Iraq at the period from April 2009 to February 2010. The sera of all patents were tested for MAG- antibodies.
Results: The present study showed increase in the percent of patients with positive anti-MAG antibody in patients with relapsing remitting multiple sclerosis than the control group( 7.6% in the patients group viz 3.5% in the control group) but with no statistical significance. Also among patients group we try to study the relationship between severity of the disease measured by expanded disability status scale (EDSS) and positive serum anti-MAG antibody and we found no significant statistical association.
Conclusion: There is a higher percent of patients with positive anti-MAG antibody in the serum of patients with relapsing remitting multiple sclerosis than the control group.

A Prospective Study of Intraoperative Difficulties in Primary Cementless Total Hip Replacement

Dr. Ali Farouk Hussein

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1200-1203

objectives: To assess the pre operative difficulties in primary cementless total hip arthroplasty.
Patients and Method: A prospective study for 50 total cementless total hip replacements performed in 45 patients from Jan.2010 to Sep. 2011 in orthopedic department in Al-Kadimiya hospital to assess the difficulties encountered during the operation which were classified into femoral, acetabular and soft tissues difficulties.
Results: The indications for surgery were 26% for primary osteoarthritis, 44% for avascular necrosis (primary and secondary to alcohol, steroid or sickle cell disease), 24% due to post traumatic osteoarthritis and 6% due to rheumatoid arthritis. The difficulties encountered during the operation were narrow femoral canal and difficult femoral reaming in 16%, soft tissues contractures and tight capsule in 24% , proximally migrated greater trochanter in 8%,posterior acetabular wall defect in 10% and protrusio acetabulum in 6%, only (10%) were in need for intraoperative blood transfusion.
Conclusion: Extensive pre-operative planning is essential for any hip arthroplasty with the availability of all the range of prosthesis sizes and designs for optimum results.
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Family Functioning Among Caregivers of Patients with Schizophrenia in Baghdad city

Ali K. Khudhiar; Hassan A. Hussein

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1204-1210

objective: To determine the family functioning among caregivers of patients with schizophrenia and its association with patient’s and caregiver’s socio-demographic characteristics.
Methodology: Sixty caregivers of patients with schizophrenia were recruited during their relatives' in-patient psychiatric hospitals: Baghdad Teaching Hospital, 10th floor, and Ibn-Rushd Psychiatric Hospital. Caregivers were interviewed and the data were collected by a self-reported questionnaire through using the Family Functioning Scale. Then, data were analyzed by using descriptive statistical measures and inferential statistical measures "Linear Regression".
Results: All the dimensions of the family functioning are healthy. There was significant association between patients’ clinical characteristics and caregivers’ socio-demographic characteristics with family functioning.
Recommendations: The researchers recommend conducting a longitudinal studies on family caregivers, using psychiatric and family assessment / intervention for those caregivers with family dysfunction

Isolation, Purification, And Selection Criteria Of Probiotic Bacteeria “Lactobacillus Jensenii

Abbas Fadhil Hassoon

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1211-1218

lactobacilli isolated from stool samples of healthy infants aged 2-28 days were identified as Lactobacillus jensenii based on its morphological description on MRS agar and blood agar, Gram stain, catalase test, and results of API 20 A system . The Lactobacilli were assessed for characteristics considered important for in vitro resistance ability to low pH ( 3,4,5, and 6 ), and resistance ability to different bile salt concentrations 0.5%,1%,1.5%,2%,2.5%, and 3% ). The 'other characteristics studiedwere culture and sensitivity of probiotic bacteria to different types of antimicrobial and antibiotics. The probiotic bacteria revealed inhibitory activities against several pathogenic bacteria (Staphylococus aureus, Streptococcus agalactia, Clostridium perifrenges, Pseudomonas aeroginosa, Escherichia coli, Klebsiella pneumonia,'Salmonella typhi, Vibrio cholerae, and Shigella flexneri ):. Lactobacillus jensenii alsoexhibited its ability for attachment to epithelial cells of human intestine (in vitro).

Assessment of therapeutic efficacy of topical application of steroid in the treatment of carpal tunnel syndrome (CTS

Kamal A. M. Al- Yasiry

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1219-1223

Abstract

Background: Carpal tunnel syndrome (CTS) is the most common compressive neuropathy with high incidence rates of the upper limb, occurring due to compression of the median nerve at the wrist (1).
Aim: is to determine the therapeutic effect of topical steroid application as an alternative therapy for surgical and local injection of steroids.
Method: 30 female patients ranging were selected randomly and divided into 2 groups; 10 of them were selected as control group and 20 of them were selected to test our therapy (topical Clobetasol ointment). EMG and NCS were done before and after the therapy to determine the success of the proposed drug.
Results: There was a significant result both clinically and by EMG and NCS finding after 30 days of treatment in which about 80% of patient were approximately free of pain after treatment as a clinical assessment with a significant EMG and NCS finding at P <0.05.
Conclusion: topical skin application over carpal tunnel is of a great value as an alternative conservative treatment for CTS.

Vitreous Floaters And Photopsia As Predictors Of Vitreoretinal Pathology

Dr Ahmed Majeed Rasheed

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1224-1230

Abstract
ackground: Floaters and photopsia are common eye symptoms. This prospective study aims to detect the relative importance of floaters, photopsia, or both as predictors of vitreo-retinal pathology.
Material: 202 patients attending the outpatient clinic in Alkadhimya teaching hospital between 2008–2010 complaining of floaters, photopsia, or both were interrogated .starting with inquiry about the mode of presentation, then slit lamp examination of the anterior segment, and dilatation of the pupil by mydriacyl drops 0.5% and phenylphrine drops 10%, followed by 3 mirror examination of the vitreous and peripheral retina.
Results: 98 patients were male while 104 patients were female. 104 patients (51.49%) presented with floaters; 24 patients (11.88%) presented with photopsia; and 74 patients (36.63%) presented with both floaters and photopsia. 102 patients (50.50%) had posterior vitreous detachment(PVD) while 52 patients (25.74%) had synchysis, and 48 patients (23.76%) had normal vitreous. The highest percentage of PVD was in the age group 60 – 69 years and was 40 patients (39.21%). Regarding the mode of presentation, the highest percentage of PVD was in the group of patients presenting with both floaters and photopsia and was 46 patients (62.16%). The total number of retinal tear cases detected was 14; 8 of them were present in patients having PVD and presenting with floaters and photopsia, while 4 cases of retinal tears were detected in patients having PVD and presenting with floaters, and finally 2 retinal tear cases were detected in patients having PVD and presenting with photopsia. 12 eyes (85.71%) who had retinal tears had vitreous pigment granules, while 2 eyes with retinal tears (14.29%) did not have vitreous pigment granules.
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Conclusion: the symptoms of floaters, photopsia, or both are an important predictors of vitreo- retinal pathology. A significant number of patients had PVD, and this was associated with retinal tears in a number of patients. Vitreous pigment granules in these patients were closely correlated with the presence of retinal tears. Careful examination of patients including 3 mirror contact lens examination is mandatory.

The Role of Laparoscopy in the Management of Non- palpable Undescended Testes

Muthanna H. Abid Al- Athari

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1231-1237

ackground:Cryptorchidism is one of the most common genitourinary disorders in young boys. Management of non- palpable undescended testis is a surgical challenge involving evaluation and surgical management. The objective of this study is to present our initial experience with laparoscopy in patients with non- palpable testis.
Patients and methods: Laparoscopy was performed under general anesthesia on 25 patients. If the internal spermatic vessels and vas deferens made their way into the internal inguinal ring, the inguinal canal was dissected. Laparoscopic orchiopexy or orchiectomy was performed in cases with intra-abdominal testis. If the internal spermatic vessels found terminated intraperitoneally with a blind-end, the case was considered as a vanishing testis.
Results:Twenty five boys, aged from 2.5 years to 32 years (median 8.7 years) were identified with 30 non- palpable testes. In five of the 30 non- palpable testes, the vas and the vessels were through the internal ring, and the inguinal region needed dissection. Orchiopexy was performed on 4 testes and orchiectomy was performed on one atrophic testis. Twenty of 30 testes were intra-abdominally localized. Laparoscopic orchiopexy was performed in 16 testes and laparoscopic orchiectomy was performed in 4 testes. Five boys were diagnosed as vanishing testes.
Conclusions: Laparoscopy seems to offer a safe and reliable diagnostic and therapeutic option to patients with non- palpable testes.

Peritoneal Dialysis in Children with Renal Failure; Outcome and Complications

Wejdan Abid Sebt; Sabih S Mehdi

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1238-1242

Background : While the use of continuous renal replacement therapies in the management of children with acute and chronic renal failure have increased , the role of peritoneal dialysis ( PD ) in the treatment of pediatric renal failure(RF) has received less attention .
Objectives: This study considers causes of renal failure ,complications during and after the procedure of peritoneal dialysis( PD),and their outcome .
Methods: A retrospective database review of children requiring PD for RF from March 2010 to July 2011 in pediatric peritoneal dialysis unit in Babylon Gynecology and Children Teaching Hospital .
Fifty two patients with or without previously known underlying renal disease were investigated with biochemical and radiological studies and got no benefit from conservative management so they have been referred for PD for the treatment of their renal failure .
Results : The outcome of the patients with peritoneal dialysis was: Thirty three survivors ( 63 . 46 % ) , mortality (19 cases) 100% during infantile period ( 1 day – 1 year ) age group .
Causes of mortality : Eighteen patients died due to multiorgan failure (94 .73 % ) .
Causes of renal failure were: Sepsis (19) , renal disease (15) cardiac problems ( 6 ) , perinatal asphyxia ( 3 ) , hemolytic uremic syndrome ( 3) hypovoleamia ( 3 ) meningo -encephallitis ( 2 ) and inborn error of metabolism(1). Complications of PD occurred in (42 .3 % ) , the most prevalent was the need for further regular dialysis (45.8%) .
Conclusion : The common age of death from renal failure is below one year ,the commonest cause of death was multiorgan failure. Forty five percent of patients need another dialysis.

Significance of Hypothyroidism in Post Thyroidectomy hypocalcaemi

Taqi Saadoon Atiyah

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1243-1249

background: Postoperative hypocalcaemia is one of the most common complications of thyroid surgery.
Objective: To evaluate the significance of thyrotoxicosis in developing hypocalcaemia after thyroid surgery.
Patients and Methods: A prospective study for patients whom submitted to bilateral subtotal thyroidectomy in AL-Kadhimiya Teaching Hospital in the period from Mars 2006-Mars 2011 were included in this study. Patients were divided into two groups; in group A the patients had toxic goiter, while in group B, the patients had euthyroid goiter. Both groups are nearly identical for age, sex, size of the goiter, and the size of the removed thyroid tissue. All the operations were done by the same surgeon and same technique. At least 2 parathyroid glands are identified and carefully preserved in every patient. Serum calcium was measured before and after operation. Patients with malignant thyroid and those underwent lobectomy were excluded from this study.
Results: The total number was 97 patients. Group A, include 24 patients, 10(41.6%) of them had transient hypocalcaemia and 5(20.8%) patients had permanent hypocalcaemia. One patient (4.1%) died eighteen months after the operation due to cardiomyopathy and heart failure.GroupB, include 73patients, 5(6.8%) of them had transient hypocalcemia.The relative risk of hypocalcaemia in toxic goiter is 3.53 (confidence interval 95%) in comparison with euthyroid goiter; P value <0.001which is very significant.
Conclusion: Thyrotoxicosis is a significant risk factor in developing hypocalcaemia after thyroid surgery.

Sex Difference as a Risk Factor for Gallston disease

Suaad L. Ibraheem AL-mossawi

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1250-1254

ackground: Gallstone disease is a common clinical entity affecting the adult population of both sexes.
Aim of the study: The objective of present investigation was to compare the impact of sex, age and BMI on the gallstone disease.
Subject and Methods: A total of 150 subjects whom suffered from gallstones visible by ultrasound were considered as cases aged (48.52 ± 9.534) years comprised from 19 men and 131 women and subjects negative for gallstones were classified as controls, consist of 50 parsons aged (27.96 ± 6.72) years, 14 males and 36 females.
Results and Discussion: The results of analysis of individual factors and their association with women were affected nearly fivefold than men (5:1). The objectives of present investigation were to compare the impact of sex, age and BMI on the gallstone disease. In order to identify the risk factors, we further performed a multivariate logistic regression analysis. The factors significantly (OR 5.40, 95%CI 0.77-46.99; p = 0.05, OR 2.80, 95% 0.86-16.12; p = 0.04) associated with gallstones disease were an age 30-49 and an age > 50 years (OR 8.25, 1.17-92.97; p= 0.01, OR 21.94, 6.72-97.26; p= 0.0001) for males and females respectively. High body mass index, however was detected as an independent risk factor for gallstone disease in females ( OR 1.96,0.88- 4.42; p = 0.05).In the male population, no such association was present.
Conclusion: Present studies have defined the role of sex difference on the formation of gallstone.

Attitude of mothers toward herbal treatment of their children

Narjes Chyad Abdulzahra

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1384-1389

Abstract :
Back ground :Traditional medicine (also known as indigenous or folk medicine) comprises medical knowledge systems that developed over generations within various societies before the era of modern medicine. The (WHO) defines traditional medicine as:"the health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral-based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being.
Objectives: To evaluate the attitude of mothers toward using herbal medicine for the treatment of their children in comparison with modern treatment with trade known drugs and its relation to the educational level.
Method: The study included 145 women with age average (34)yrs ,divided in to 4 groups according to teaching level and estimate their attitude toward traditional treatment regarding modern treatment with trade known drugs ,causes for using herbal medicine ,what they prefer ,which cases they treat ,if there is any obvious side effect observed after administration of these herbs ,source of information about usage , after data collection it undergoes analysis .The study conducted between 2009-2010
Results : The study revealed high attitude of mothers towards herbal treatment in comparison with trade drugs for the treatment of their children and also revealed increase their attitude with decrease educational level.
Conclusion: There was a clear and obvious desire for mothers regarding the use of herbal therapy either as replacement or adjuncts for the treatment of mild illness (such as flu, constipation ,diarrhea , napkin rash ,nasal congestion, etc).The study showed that the major cause for using herbs was its low cost in comparison with modern drugs and seem to be free of side effect as its natural ,it also revealed that the important source of information about herbal therapy was TV ,and there was no obvious side effect noted during administration .
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Asthma in Adults; Epidemiology, Risk Factor and Patterns of Presentation: A Cross Sectional, Questionnaire Based Study in Baghdad Teaching

Shakir M. Muhammed; Kassim M. Sultan; Mohammad Y. Abdulrazaq

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1255-1261

background :Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role, leading to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. Although clinicians are satisfied with this definition, epidemiologists are still searching for their own. Studies on asthma used either questionnaire or histopathophysiologic way to define asthma each has its privileges and drawbacks. Asthma has become more common in both children and adults around the world in recent decades. Its prevalence has been dramatically increased during last few years, but still no definite asthma prevalence is specified in Iraq.
Aim of the Study : To define the prevalence of some risk factors in Iraqi asthmatics, patterns of presentation, and to find the level of education about asthma among the patients, this study was conducted.
Method :Two hundred twenty five asthmatic patients diagnosed by questionnaire, supported by clinical detection of wheeze, were included in a cross sectional study done in outpatients clinic, Baghdad Teaching hospital in Baghdad, collected from December 2007 to March 2008.
Results : mean age for the study sample is 38 years, 50 are men and 175 are women. Normal body mass index reported in 86 patients, 78 patients (33.7 %) have positive family history of allergic diseases, 110 patients reported exposure to environment with house dust mite, and 49 patients (21.7%) were passive smoker. Persistent symptoms are commonest pattern of asthma reported in 157 patients. Eighty eight patients use their treatment regularly, and 31 patients used steroid inhalers. Proper usage of inhalers as assessed by demonstration found in only 39 patients. Spirometry or pulmonary function tests are performed only in 11 patients (4.9 %) for diagnosis or asthma follow-up.
Conclusions : High body mass index, exposure to an environment in favored for house mite inhabitance, family history of atopy, history of allergic diseases, Gastro-intestinal symptoms suggestive of gastroesophageal reflux disease and Allergic rhinitis and sinusitis are the commonest risk factors reported by asthmatics.Irregular treatment with inhalers especially corticosteroid and their improper usage are still widely spread among our patients, also spirometry and other pulmonary function tests are still rarely used in diagnosis, and management of asthmatic patients.

Is Lumbar Puncture Mandatory for First Simple Febrile Seizures Among Children 6 to 18 Months of Age

Dalal Mohamed Ameen; Faiq Abdul Hassan; Abdulkadhim Imran Moosa

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1262-1267

background: Fever with seizure,is a common complaint with which a child may presented to the emergency department ,is mainly due to febrile seizure, but it may also be duo to central nervous system infection.
Objective: This study was done to evaluate the utility of Lumbar puncture for first simple febrile seizures among children 6 to 18 months of age.
Method: A prospective study was conducted in emergency department of Karbala teaching hospital for children. Patients who were presented with first simple febrile seizure in age group 6 to 18 months were included. Lumbar puncture was done and meningitis diagnosed on the bases of either cytological and biochemical criteria or Cerebrospinal Fluid culture.
Results: Out of 105 patients with First simple febrile seizure, 41 patients (39.05%) were 6 to 12 months old, 41.5% of them had meningitis while 64 patients (60.95%) were 12 to 18 months old, and 17.2% of them had meningitis. Cerebrospinal Fluid, cultures were negative in all cases. meningitis was more in males than females for both age groups with a male:female ratio 3:1.
Conclusion: First simple febrile seizure is a common pediatric emergency and high percent of patients with this sole presentation had meningitis.
Key words: First simple febrile seizure, Lumbar puncture ,Meningitis.
Abbreviations .FSFS:First simple febrile seizure,L.P: Lumbar puncture,CSF: Cerebrospinal Fluid, P value :Probability Value.

Impact of Family Economic Status upon Juvenile Delinquency at ReformationSchools in Baghdad City: a case control study

Dr.Nsaif Jasim Al- Hemiary; Ali Kareem Al-Juboori; Siham Abdullah Hamoo

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1268-1282

bjectives: To assess the family economic status of juvenile delinquents, to assess the family economic status of non-delinquents juvenile, to Identify the differences between cases and controls, and to find out the relationship between family economic status and some of delinquents’ variables. And used to determining the relationship between family economic status and juvenile parents' variables.
Methodology: The study carried out on a purposive “non probability” sample of (100) delinquents’ juveniles were selected from a Reformation schools for boys in Baghdad City. and 100 of non- delinquents juveniles who were matched with them from general population. A questionnaire is constructed for the purpose of the present study which is distributed across 2 main parts. Part one included the demographic characteristics of juvenile and their parents, and part two included sections of family economic status. The overall items which were included in the questionnaire are 42 items regarding juvenile delinquency, and 38 regarding non – delinquents juveniles. Validity and reliability of the questionnaire were determined through the review of a panel of experts and the pilot study. Data were collected through the period from September 2sd 2011 to October 2sd 2011. It was analyzed through the descriptive statistics (frequency, percentage, and mean of score) and inferential statistics.
Results: The results revealed that were a significant difference was found in juvenile delinquents' family economic status with regard to their age at delinquent acts, duration of punishment, and mother occupational status. Also there were highly significant differences between case and control with regard to their family economic status.
Conclusion: The study concluded that juvenile delinquency is a serious problem facing families of children. Where family economic status plays an important role in the community of this problem and put the juveniles in trouble with the law because of their behavior, as evidenced by this study, that the instability of the family economic and related problems play an important role in the occurrence of this problem.

Extraction and studying the effect of pH and temperature on hemolysin production by a local isolates of Staphylococcus aureus

Mohammed I. Nadir; Hussain S. Al-Hasani; Amer H. Al-Shammary

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1283-1294

background: Staphylococcus aureus is a ubiquitous bacterium that is generating increasingly bad press coverage due to its propensity to adopt a pathogenic lifestyle in hospital and community settings. S. aureus colonies are found in approximately 30% of the general population. It colonizes the skin readily and can lead to a wide range of pathological conditions from skin lesions to osteomyelitis, endocarditis, and septicemia. Many bacteria produce substances that are cytolysins i.e they dissolve red blood cells (hemolysins) or kill tissue cells or leukocytes (leukocidins). The β-toxin degrades sphingomyelin and therefore is toxic for many kinds of cells, including human red blood cells. Hemolysins were extracted and the optimum conditions for their production were extensively studied including optimum pH, temperature, incubation period, and various manipulations of the culture media.
Objectives
1-Extraction of hemolysin from a local isolate of S. aureus.
2-Studying the effects of pH and temperature on hemolysin production.
Methods : Bacterial samples were identified by subjecting them to the standard laboratory procedures while semi quantitative screening on blood agar (containing 5% human blood) revealed that all isolates were hemolysin producer but in different efficiencies. Determination of the optimal conditions for hemolysin production including the optimum pH and temperature were also performed.
Results : Bacterial samples were identified by subjecting them to the standard laboratory procedures and the results showed that forty isolates out of the total of 100 were identified as Staphylococcus aureus. Semi quantitative screening on blood agar (containing 5% human blood) revealed that all isolates were hemolysin producer but in different efficiencies. Depending on the semi-quantitative screening and hemolytic assays isolate SW-14 of
Staphylococcus aureus was the higher hemolysin producing isolate. Determination of the optimal conditions for hemolysin production including the optimum pH and temperature were performed, the results demonstrated that the best hemolysin production was in the pH near neutrality (pH 7-7.5) and in temperature of 35-40oC.
Conclusions
1.Conventional methods can be performed to extract hemolysins.
2.Hemolysin was maximally produced when the pH was near neutrality and incubation temperature was 37oC and this conclusion indicates that hemolysin was produced when the conditions were similar to that of the host.

Non Vascularised Bone Graft Versus Core Decompression In Treatment Of Early Stages Of Non Traumatic Hip Osteonecrosis

Dr. Mohammed Sh. Al-Edanny

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1295-1305

vascular necrosis (AVN) is defined as cellular death of bone components due to interruption of the blood supply; the bone structures then collapse, resulting in bone destruction, pain, and loss of joint function. AVN is associated with numerous conditions and usually involves the epiphysis of long bones, such as the femoral head. In clinical practice, AVN is most commonly encountered in the hip. Early diagnosis and appropriate intervention can delay the need for joint replacement. However, most patients present late in the disease course. Without treatment, the process is almost always progressive, leading to joint destruction within 5 years.Treatment of a vascular necrosis depends mainly on early diagnosis which mainly based on clinical findings, x-ray finding & MRI.A variety of non vascularized bone grafting techniques have been proposed with varying degrees of success as treatment alternatives for osteonecrosis of the femoral head. The success of these procedures may be enhanced using ancillary growth and differentiation factors.
Patients & Methods: We retrospectively reviewed 37 patients (44 hips) with osteonecrosis of the femoral head between May 2007, and March 2011,divided into two groups . Group A include 17 patients (22 hips) with osteonecrosis of the femoral head who had non vascularized bone grafting procedures done for them . Minimum follow-up was 12 months. We compared the outcomes in this cohort to similar hip number (22 hips) in 20 patients treated with core decompression only (group B). We used Phemister technique to make a window at the posterior aspect of greater trochanter to remove necrotic bone and packed the excavated area with autogenous cancellous bone graft taken from ipsilateral iliac crest or leave it without bone graft (decompression only).
Results: We report the result of treatment for femoral head avascular necrosis depending on Ficat classification stage I, II, & III. The minimum follow up was 12 months (12m-36m).The success percentage of hips in our cohort of patients with non-vascularized bone grafting group A are 86% (19 of 22 hips), which is higher than group B 63% (14 of 22 hips) with core decompression alone.
Conclusion: These procedures (core decompression and autogenous cancellous bone graft) effectively reduce donor site morbidity and may defer joint arthroplasty in selected patients & it is more effective than core decompression alone in treating early stages of femoral head osteonecrosis.

Open Tibial Shaft Fractures Treated By Primary External Fixation And Bone Graft

Ghadeer H. Majeed

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1306-1313

Eprospective study undertaken between January 2007 and January 2011, 58 consecutive cases with compound tibial shaft fractures. All fractures were stabilized by external fixator device AO/ASIF type after failed the manipulation under anesthesia (MUA) to restore the osseous alignment. In 32 patients cancellous bone graft were used from the upper part of the tibia to enhance healing process, all these patients were followed for an average of 8 – 12 months.Our findings showed that stabilization of the fracture shaft tibia by external fixation with cancellous bone graft had significantly better result, than external fixation alone.We conclude that unilateral, uniplanar external fixation with early bone grafting from upper part of the tibia is considered the best method of management for unstable tibial shaft fracture in our community. The frame offered sufficient stability even in segmental fractures; application time is very short in the hands of the experienced surgeon. dynamization of the fixator must not be forgotten, and lastly we recommended that the external fixation is not only used as temporary form of immobilization but can be used as a definitive stabilizing procedure until consolidation of the fracture. It is safe, effective, cheap and available in almost all orthopedics units in Iraq.

Early- and Late-Onset Neonatal Sepsis: Risk Factors and Outcome Study

Dr. Zuhair Omran Easa

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1314-1322

Background: Early-onset neonatal infections are acquired before or during delivery (vertical mother-to-child transmission). Late-onset infections develop after delivery from organisms acquired in the hospital or the community. The age at onset depends on the timing of exposure and virulence of the infecting organism. Very-late-onset infections (onset after 1 mo of life) may also occur, particularly in VLBW preterm infants or term infants requiring prolonged neonatal intensive care.
Aims of the study: To study the effect of some risk factors, laboratory investigations and outcome on early and late onset neonatal sepsis and their relation with early and late onset neonatal sepsis.
Patients and methods: A prospective study was carried out in Karbala teaching hospital from the first of January 2011 through the first of January 2012 for a group of 150 neonates who were subgrouped into 86 (57.3%) with early onset neonatal sepsis and 64 (42.7%) with late onset neonatal sepsis. Information were taken about the patients regarding the age in days, gender, perinatal and maternal history and blood samples were aspirated for complete blood count, blood culture, and C-reactive protein.
Results: We found that the neonate is more susceptible to early onset neonatal sepsis in comparison to late onset neonatal sepsis. Premature neonates were more liable for late onset neonatal sepsis than full term
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[Early- and Late-Onset Neonatal Sepsis…] Dr. Zuhair Omran Easa
kerbala J. Med. Vol.5, No.1, Dec, 2012
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ones, 93 vs. 57 neonates (62% vs. 38%). Neonates of mothers with prolonged rupture of membranes were more liable for early onset neonatal sepsis than late onset neonatal sepsis, 27 neonates vs. 11 neonates (31.3 vs.17.2) respectively. Also we found that the blood culture result highly affecting by antibiotics used before culture. The number of neonates with history of maternal fever during pregnancy or shortly before labor was associated with higher number of early onset neonatal sepsis than late onset sepsis, 20 vs. 16 neonates (13.3% vs. 10.7%) respectively. The mortality rate is more in ENS in comparison to late type.
Conclusion: Prematurity and prolonged rupture of membranes had significant association with early onset neonatal sepsis while gender, antenatal care and maternal fever had no difference between early onset and late onset neonatal sepsis. Incidence and mortality of early onset neonatal sepsis was higher than late onset neonatal sepsis. Immature: total neutrophils count, and platelets count had high sensitivity to the diagnosis of neonatal sepsis

The association of serum Cancer antigen 125 and C-reactive protein level with the severity of preeclampsia

Warqaa Mahdi Kamel; Ban Hadi Hameed; Dr.Miami Abdul Hassan Ali

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1322-1327

Back ground: It has been assumed that the failure in trophoblastic invasion and the induction of an inflammatory process within placenta in patients with preeclampsia may trigger the expression of Cancer antigen 125. C-reactive protein is a marker of tissue damage and inflammation, increased C-reactive protein may reflect endothelial cell dysfunction in preeclampsia and may be a potential marker of preeclampsia. Objectives: To evaluate the association of serum Cancer antigen 125 and C-reactive protein level with the severity of preeclampsia. .
Patients & methods: A case control study was carried out in the department of gynecology and obstetrics at Al-Yarmouk teaching hospital (BaghdadIraq) for one year from April 2010 to March 2011. Hundred singleton pregnant women were divided into fifty patients with preeclampsia and fifty healthy pregnant women as control group. Blood samples were taken for measurement of serum cancer antigen-125 and C-reactive protein for both groups.
Results :The mean level of cancer antigen-125 in mild, severe preeclampsia and eclampsia groups was 32.57±8.08(IU/ml), 38.04±9.44(IU/ml) and 47.60±12.09(IU/ml) respectively which was significantly higher in comparison to the control group (sampled at the same time) which was 13.70±8.44(IU/ml) the P value was (0.0001). The mean level of c-reactive protein in mild, severe preeclampsia & eclampsia was 15.80±6.69(mg/L), 30.64±15.66(mg/L) and 42.60±13.70(mg/L) which was significantly higher in comparison to the control group which was 7.92±4.05(mg/L) the P value was( 0.0001).
Conclusion:Serum cancer antigen 125 and c-reactive protein were significantly higher in preeclampsia groups in comparison to the control group and the increment was directly correlated with the severity of preeclampsia

Coronary artery disease in young versus older adults in Hilla city: prevalence, clinical characteristics and angiographic profile

Dr. Ahmed Hussein Al-Mayali

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1328-1333

Background : Coronary artery disease, is a major cause of mortality and morbidity worldwide .It's incidence among young age groups is increasing rapidly.
Objectives : Coronary artery disease is now frequently encountered in young adult population. However, not many studies are available in this regard. Therefore, the present study was designed to evaluate the prevalence , clinical characteristics and angiographic features of patients ≤40 years of age with Coronary artery disease and compare them to patients >40 years.
Methods: this study was conducted at shaheed al muhrab cardiac center in Hilla city, all patients who had underwent coronary angiography in the catheterization laboratory were included in the study during the period april 2008 to July 2011. Patient who had history of revascularization procedure were excluded from the study. The patients were divided into two groups on the basis of age. The first group ( groupA) include patients 40 years and younger, while the second group ( group B) include patients older than 40 years.
Results:of the total 803 patients , 58(7.2%) were ≤40 years old (groupA)and 745 (92.8%) were older than 40 years (groupB).Smoking , premature CAD and hyperlipidemia were statically significant risk factors in patients≤40 years old (groupA) 24.2%,19% ,17.2% respectively compared to 13.2%,10.3%, 10.7% in patients older than 40 years (groupB), whereas hypertension, diabetes mellitus and obesity were more prevalent in( Group B), 27%,22.8%, 16% respectively, compared to (Group A) , 15.5%,13.8%, 10.3% respectively (p<0.001) .7.2% of patient who have evidence of CAD proved by coronary angiography were in age group ≤40 years. Younger patients ( groupA) tends to have single vessel disease 56.9% compared to older patients ( group B) 24.4%, and the reverse is true in regards to three vessel disease 44.2% vs19%.
Conclusions: 7.2% of angiographically documented cases of coronary artery disease patients were 40 years & younger in age ,this percentage was high among our studied population . smoking , family history of premature Coronary artery disease & hyperlipidemia were significantly associated with Coronary artery disease in young patients(p<0.001) Young patients tends to have single vessel disease while older ones tends to have three vessel disease(p<0.001)

The Relevance of Glycosylated Hemoglobin with Oxidative Stress in Insulin Resistant Type 2 Diabetes Mellitus

Majid Kadhum Hussain; Dhafera Jaffer Abed-Ali; Dhafera Jaffer Abed-Ali

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1334-1342

The present study was conducted to evaluate the relevance of glycosylated hemoglobin with oxidative stress in insulin resistant type 2 diabetes mellitus. To achieve this aim, 93 type 2 diabetic patients of ages 38-84 years were recruited. In addition, 19 apparently healthy individuals with ages 30-60 years, were enrolled as a control group.The concentration of fasting blood glucose (FBG), triglyceride (TG), insulin, glycosylated hemoglobin (HbA1c), malodialdehyde (MDA) and glutathione-S-transferase (GST) were measured in sera of patient and the control groups. Fasting blood glucose and triglyceride levels were estimated by spectrophotometeric methods using enzymatic procedures. Insulin level was estimated by enzyme linked immunosorbant assay (ELISA) method. HbA1c level was determined by an ion exchange chromatographic method, while MDA and GST levels were measured by spectrophotometeric procedures. Insulin resistance was evaluated by four methods. They include homeostatic model assessment (HOMA), quantitative insulin check index (QUIKI), McAulye (McA), and fastinge insulin (FI) methods. Insulin resistance was found in 79 (84.9%), 63 (73.4%), 52 (55.9%) and 35 (37%) out of the 93 diabetic patients by HOMA, QUICKi, McA and FI methods respectively. Type 2 insulin resistant (79) diabetic patients (IRP) that obtained through the HOMA method were assessed for the HbA1c, MDA and GST levels in comparison to the insulin sensitive patients (ISP) as well as to the control group. The analysis of the data revealed a significant increase (p<0.001) of HbA1c levels in the IRP group when compared with those of
The Relevance of Glycosylated Hemoglobin….. Majid Kadhum Hussain
kerbala J. Med. Vol.5, No.1, Dec, 2012
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the control group, while the insulin sensitive group (ISP) couldn’t show significant variation when compared with those of the IRP. The data of MDA failed to give significant variation. However, a significant elevation of GST concentration were observed in the IRP group with respect to those of the control group (p<0.005). On the other hand significant variations could not be obtained among the ISP and IRP. These data suggested that oxidative stress changes are independent on insulin resistance in type 2 diabetes mellitus

The precipitating factors and outcome of a thirty nine Patients with Guillain-Barre Syndrome admitted in the ICU of Al-Mawani General Hospital in the Governorate of Al- Basrah

Alaa Khuttar Mousa; AhmedAubed Sherhan

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1343-1349

Objectives: To study the possible precipitating factors and the variability of the outcome in patients with severe Guillian- baree syndrome according to age, sex and types of treatment.
Methods : A single center, retrospective, descriptive study of 39 Patients with Guillain-Barré syndrome were studied between April 2007 to October 2010, their ages were between 3-63 year. They were 21 males and 18 females. Diagnosis was confirmed by typical clinical feature and ancillary investigations like electro diagnosis plus exclusion of other diagnoses. The history of any preceded or associated diseases before one month were clarified, treatment strategies and outcomes of the diseases were also analyzed. The study was conducted in the intensive care unit in Almawani general hospital Basrah, Iraq.
Results: 23 patients had respiratory tract infection precede the neurological deficit, 7 patients had diarrhea and 22 patients occur at winter season. All the 39 patients develop limbs weakness, 30 patients develop shortness of breath and 24 of them needed mechanical ventilation. From the 26 patients with intravenous immunoglobulin therapy (IVIG) 17 had complete recovery, 5 left with neurological deficit and 4 of them died.
Conclusions: respiratory tract infections are the commonest precipitating diseases preceding GBS in this study, most cases occur in winter. Early immunoglobulin therapies result in a high percentage of complete recovery and a less percentage of death.
Key Words: Guillain- Barre Syndrome. Precipitating diseases. Immunoglobulin therapy.

Incidence Of Intradialytic Hypotension In Patients On Hemodialysis In Al Kindy Teaching Hospital

Dr. Ali Jasim Hashim Al; Saedi

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1350-1359

Aim Of The Study: To Find Out The Incidence Of Intradialytic Hypotension In Esrd.
Patients And Methods: From March To August 2010, (50) Patients With Esrd On Chronic Hemodialysis Program In Al Kindy Teaching Hospital Dialysis Unit Were Studied Cross Sectionally For Evidence Of Idh. The Patients Were On Hemodialysis Program For A Period That Ranged Between 1/4/2004 And 12/4/2010.The Study Sample Consists Of 25 Men And 25 Women With An Age From 18 To 80 Years And Their Body Weight Varied From 40 To 94 Kg And Height Varied From 140 To 186 Cm. Heparin Is Used As An Anticoagulant. Frequency Of Dialysis Differed From One Patient To Another Depending On Patient Condition, Availability Of Machine, It Ranged From Once Weekly To Thrice Weekly Lasting 3-4 Hours Per Session.The Blood Pressure Of All (50) Patients Were Measured Using Mercury Type Sphygmomanometer. The Blood Pressure Were Measured Pre Dialysis During And Post Dialysis. Ultrasound Of Abdomen Done For All (50) Patients. Idh Is Defined As A Decrease In Systolic Blood Pressure By ≥20 Mm Hg Or A Decrease In Map By 10 Associated With Symptoms That Include ; Abdominal Discomfort, Yawning, Sighing, Nausea, Vomiting, Muscle Cramps, Restlessness, Dizziness Or Fainting And Anxiety[2].
Results:For 50 Patients The Following Results Obtained:The Total Number Is 20 Patients Developed Idh(40%).25 Females, Of Them 12 Patients Developed Idh(48%). 25 Males, Of Them 8 Patients Developed Idh(32%), 6 Patient Of Age >_ 65 Years, Of Them 3 Patients Developed Idh(50%).19 Patients Are Overweight (Bmi>25),Of Them 9 Patients Developed Idh(47.4%). 28 Patients With Normal Weight (Bmi=18.5-25),Of Them 10 Patients Developed Idh(35.7%),3 Patients Are Under Weight (Bmi<18.5),Of Them One Patient Developed Idh(33.3%). 41 Patients Take Antihypertensive Treatment, Of Them 16 Patients Developed Idh(39%), 5 Patients Have Diabetes , Of Them 2 Patients Developed Idh(40%).
Discussion: Intradialytic Hypotension Is The Most Common Complication Associated With Hd, And Its Cause Is Multifactorial. Patients Subgroups Most Likely To Have Idh Include Those With Diabetic Ckd And Age >_65 Years. Both Normotensive Or Hypertensive Dialysis Patients Can Develop Idh. The Degree Of Idh In The Same Patient May Vary From Tim To Time, Other Risk Factors For The Development Of Idh Include Female Sex, And The Use Of Nitrates Before A Dialysis Session& Overzealous Use Of Antihypertensive Agents.
Conclusion:Idh Is An Important Complication Of Hemodialysis.ThereIs ASignificant Number Of Patients With Esrd Who Developed Idh.
Keywords:Intradialytic Hypotension, Hemodialysis, Al:Kindy Teaching Hospital

Single tooth immediate restoration of dental implants

Ahmed Hashim H. AL-Musawi

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1360-1369

Background: For over 20 years, dental implants have been a source of light for many who have suffered lost or bad teeth. Traditional dental implants involve placing the implants and providing the tooth restorations after 3 to 6 months after osseointegration is complete. In this procedure all is done as a single procedure rather than the traditional two stage placement or delayed placement.
Objective: The purpose of this study was to examine the clinical outcome of a single-tooth implants placed in the posterior region of the oral cavity.
Materials & methods: 22 adult patients were selected and a single implants were placed in the posterior region of the oral cavity. Temporary acrylic crowns were adjusted and cemented. The crown occlusion was adjusted to obtain minimal contacts in maximum intercuspation. After 8 weeks a zirconium crown was cemented. Radiographic and clinical examinations were made at baseline at 3, 6, and 12 months. Cortical bone response and peri-implant mucosal responses were evaluated.
Results: Preservation of the marginal bone level at the time of implant placement was achieved. The marginal bone level mean change was 0.02 mm at 12 months. The mean Periotest value after 360 days was –3. The peri-implant mucosal adaptation to the anatomic form of the provisional crown resulted in a natural esthetic outcome, and a gain in papilla length was observed.
Conclusion: We can conclude that immediate loading of unsplinted single-tooth implants in the posterior region could be an treatment option with a good esthetic outcome.
Key words: dental implants, esthetics, immediate loading, osseointegration

Oxidants -Antioxidant Status in Neonatal Jaundic With Severe G6PD Deficiency

Ammar F. Jawad; William M. Frankool; Fadhil J. Al-Tu

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1370-1379

Summary:Study of oxidative stress and some anti-oxidants with lipid peroxidation end product malondialdehyde in male neonatal jaundice with severe G6PD deficiency in Diwaniyah province of Iraq and the obtained results were compared with that found in control group. The mean ± SD of antioxidant status and oxidative stress parameters which include erythrocyte GSH, MDA, G-Red, G-Px and catalase were determined. There was a significant decrease in each of erythrocyte GSH, G-Red and catalase activity levels (P<0.05), whereas the lipid peroxidation end product MDA levels and G-Px activity levels were significantly increased in all neonatal jaundice (P < 0.05) as compared with the control group. G6PD activity values identified were found to be positively correlated with each of GSH concentrations, G-Red and catalase activity levels in which their values were found to decreased in patient groups, while it was found to be negatively correlated with each of G-Px activity and MDA levels in which their values were elevated in severe G6PD-deficient neonates. These data indicates an increases in free radical generation and thus antioxidant defense mechanisms is impaired in peroxidation associated with a significant elevation in MDA levels in the erythrocytes of neonatal jaundice with severe G6PD deficiency than that found in the control group which demonstrate the presence of an increased oxidative stress due to reduction in NADPH which is generated in RBCs by HMP-shunt only

The effect of maternal age on the progress of vaginal delivery

Iqbal Qassim Jaber; Muna kasim mahmood

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1380-1383

Abstract
Back ground and Objective : teenage pregnancy is defined as maternal age less than 20 years of age,while advanced maternal age is defined as maternal age more than 35 years1. In this study we want to determine whether there is a continuous effect of maternal age on the progress of vaginal delivery in a selected low risk pregnancy with spontanuous term labour.
Materials and methods:- prospective study, 100 low risk pregnancy with spontanuous term labour. Female were divided into two groups, the first group were the maternal age equal to or less than 20 years (60 cases) and the second group were the maternal age more than 20 years of age (40 cases). There progress of vaginal delivery were monitored and the out come of delivery were recorded.These groups then analysed according to maternal age for the progress of labour to vaginal, instrumental or caesarean section using SPSS variant 10.
Results:- The incidence of vaginal delivery was 90% for those maternal age equal to or less than 20 years and 87.5% for those maternal age more than 20 years of age ( P value 0.494).
Conclusion:- There is minimal effect of maternal age on the progress of vaginal delivery in selected low risk term pregnancy with spontaneous labour which is not statistically significant.

The Antioxidant effect of N-Acetylcysteine and its role in the treatment of patients with Acne vulgaris

Ahmed S. Sahib; Ahmed R. Abu-Raghif; Haidar Hamid Al-Anbari

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1390-1395

ackground: Acne vulgaris is one of the most common conditions for which patients seek dermatological care and is a common disorder of the skin that affects individuals of all races and ethnicities. There has been an increasing focus on the extent to which oxidative stress is involved in the pathophysiology of acne. The aim of this study is to investigate the effect of N-acetylcysteine, a well known antioxidant, in the treatment of acne vulgaris.
Patients and Methods: This study was carried out on 28 patients of both sexes with age range of 14-30 years who allocated into two groups:Group 1, treated with N-acetylcysteine orally and topical moisturizing cream once daily at bed time for 8 weeks .Group 2: were treated with placebo once daily orally and the same topical moisturizing cream . In addition to 28 healthy people, with age and sex matched group who serve as control group for baseline comparison. Serum malondialdehyde (MDA) and glutathione (GSH) were estimated at baseline and at the end of study after 8 weeks, In addition to clinical follow up.
Results: Administration of N-acetylcysteine to patients with acne vulgaris (Group 1), significantly reduce serum MDA level; and increased serum level of GSH after 8 weeks compared to pre-treatment value, also reduce the number of inflammatory lesions by 21.41% and 48.91% after 4weeks and 8 weeks respectively, compared to placebo.
Conclusion: The results obtained in this study clearly showed the beneficial effect of using N-acetylcysteine to patients with acne vulgaris and confirmed the role of new strategy in the targeting of pathophysiological changes accompanied with acne by using antioxidant agents.
Key words: Acne vulgaris, N-acetylcysteine , antioxidants, oxidative stress.

Histological changes in the parotid salivary gland of rabbit treated with neostigmine

Ahmed Hashim Hussein; Azzam Sultan; Ahmed EL-Ramli; Akram Yousif Yasear

Kerbala Journal of Medicine, Volume 5, Issue 11, Pages 1396-1405

background: Neostigmine is parasympathomimetic drug. It is commonly used for treatment of myasthenia gravis, glaucoma,urinary retention, xerostomia, and post operative ileus.Parasympathomimetic drugs increase the rate of salivation.
Methods: Twelve female rabbits were used in this experiment to show the effect of neostigmine. Therapeutic, double therapeutic and triple therapeutic doses of the drug were administered intramuscularly for two weeks. Samples of parotid salivary glands were processed for light microscopy. Sections of parotid were stained with H&E, PAS, and alcian blue. Statistical analysis was followed to measure the diameter of the secretory acini.
Results: The most noticeable changes were significant increase in the diameter of the secretory acini, and vacuolation with foamy appearance of the cells of the acini in treated groups. The PAS positive reaction in the acini was decreased as the dose of the drug increased. It had completely vanished in triple therapeutic dose of the drug. Negative reaction was obtained after alcian blue staining.
Conclusion: Neostigmine as sialogogues drug simulates the effect of parasympathomimetic drugs. The structural histological alterations noticed in this study substantiate the use of this drug in cases of xerostomia.