Issue 12

Typhoid fever in Karbala Governorate, an epidemiological study

Ali Mansoor Jasim Al-Ameri; Emtenaa Mohammed Hashem AL- Araji

Kerbala Journal of Medicine, Volume 5, Issue 12, Pages 1406-1412

ackground:Typhoid fever is a common systemic illness caused primarily by infection with Salmonella typhi. It could be diagnosed depending on classic clinical features supported by serologic and bacteriologic demonstration. It is well known that this disease is characterized by sharp seasonal variation in addition to many other factors affecting its prevalence in the population. These factors may include age, residence, psychosocial status and certain environmental conditions.
Study design and objective: This is a cross sectional epidemiological study. It was done during August, 2008 through July, 2009 in Karbala. It aims to isolate and identify Salmonella typhi from blood samples collected from clinically suspected cases to predict the diagnostic value of the clinical suspicion versus the bacteriologic investigation including isolation and characterization of the main causative pathogen, Salmonella typhi. Also it aims to determine the effect of age, gender, educational level and seasonal variation on the frequency distribution of typhoid fever duringthe study period.
Method: Blood samples were collected from 718clinically suspected patients (355 males and 363 females) who attended Al-Hussein Teaching Hospital and Pediatric teaching Hospital in Karbala with signs and symptoms of typhoid fever (proven by specialist physician/pediatrician). Blood was cultured in enriched, selective and differential media to isolate the causative agent, Salmonella typhi and was confirmed by some specific biochemical tests.
Results:Of the 718 blood samples, only379 (~52.8%) gave positive blood culture for Salmonellatyphi proven by specific biochemical tests. The percentage of infected patients according togendershowed non significant difference (males ~45.8% compared with females ~54.2%). Similarly, when incidence compared in terms of standard of education, it was (46.4% among educated versus 53.6% uneducated). Additionally, frequency distribution of infection in terms of different age groups showed significantly higher infection rates in age groups 5-14 and 15- 45 years than others (recording 28.21% and 46.58%, respectively).Regarding seasonal variations, the infection rates were recorded to be peaked in June recording 19.22% from the
Typhoid fever in Karbala Governorate… Emtenaa Mohammed Hashem
kerbala J. Med. Vol.5, No.2, Dec, 2012
annual infection rates, while the lowest rate was recorded inFebruary (1.81%) indicating a highly significant difference (p-value <0.01).
Conclusion: According to the study data, it was concluded that only about half the clinically suspected cases of typhoid fever give positive blood culture results for the main causative pathogen, Salmonella typhi. Also, it was shown that there is no significant effect of gender and education standard on rate of infection with typhoid fever. However, seasonal variation and age significantly affect this rate.
Key words: Typhoid fever, Salmonella typhi, epidemiology, bacteriologic diagnosis, clinical suspicion.

Detection of rfbj(B) gene of Salmonella serogroup-B isolated from patients with salmonellosis

Aqeel Reheem Hassan; Hamad Al-Hamadani; Adnan Hamad Al-Hamadani; Alaa Abdel-Kadhim Jawad; Aqeel Reheem Hassan

Kerbala Journal of Medicine, Volume 5, Issue 12, Pages 1413-1419

summary: A total of 480 fecal samples were collected from patients (less than 18 years old), of both sex suffering from diarrhea who admitted to Al-Diwaniya Teaching Hospital and the Teaching Hospital of Maternity and Pediatrics in Al- Qadisiya governorate. Salmonella spp. were isolated and identified using bacterial culturing on selective media, in addition to, biochemical and serotyping by monovalent antisera. Polymerase Chain Reaction (PCR) was used to detect rfbj(B)gene encoding for biosynthesis of LPS of group B Salmonella. The results revealed that the rate of Salmonella isolates in fecal samples of patients were 7.9% using cultural and biochemical methods .The result of Salmonella isolates by serotyping using monovalent antisera revealed that 30 out of 34 isolates (88 %) belong to S. Typhimurium serotype , while the remain belong to S. Enteritidis ( 2 isolates ) and S.Meunchen (2isolates). when the PCR technique was used to detect the presence of rfbj(B) gene, 34 Salmonella isolates belong to Salmonella serogroup (B) appeared to contain this gene since DNA amplification showed one distinct band (882 bp) when electrophorised on agarose gel. The results of this study revealed that the PCR technique had a high specifity (100%) in detection of Salmonella serogroup B in comparison to cultural, biochemical and serological tests.

Ultasonic assessment of ovarian morphology during lactation & effect of these changes on fertility control

Sattar Razzaq Al-Esawi; Dr. BASIMA. Sh..AL-GHAZALI

Kerbala Journal of Medicine, Volume 5, Issue 12, Pages 1420-1429

bjective : The aim of this study was to show the effects of lactation on ovarian morphology by ultrasound examination and to express these effects by terms of fertility control .
Material and Methods: This study was carried in Al-Zahra’a Teaching Hospital Of Maternity & Pediatrics in Al-Najaf City , from March 2007 to September 2007 . A total 100 women were studded , divided into two groups, 50 lactating women and 50 non-lactating women and, a comparison was done between ultrasound findings of the ovaries of the two groups ; those patients were selected from patients attending out patients clinic of Obstetrics & Gynecology unite. History was taken about age , parity , mode of delivery , no. of breast feeding per day , whether the patient use supplementary food or not , no. of feeding at night ,on wishes or demands , if women resume menstruation or not and duration after birth .Ultrasound examination of ovaries was done to all cases and mean ovarian volume , mean follicular number and size was taken and any morphological finding in terms of texture or stromal size
.Results: We found that there is significant effect of lactation on ovarian volume and morphology and increase number of follicles , with peripheral distribution without detection of mature follicle by studying the size of follicle with increase in ovarian stroma ( stromal hyperplasia ).Our study show also that there is strong relationship between suckling episodes , feeding at night , supplementary foodduringbreastfeeding , resumption of menses and age of infant with these effects . So we found that increasing of suckling episodes ( > 8 times of feeding per day ) and feeding at night twice or more , exclusive breastfeeding without giving even water to the baby , with no resumption of menses and infant less than 6 months of age ; all these gives typical effects on ovarian morphology and make the women sub-fertile by ( 76 % ) .
Conclusions: We conclude that lactation can be considered as fertility control method as long as they may mimic polycystic ovarian syndrome by morphological changes of the ovaries which are temporary as far as these above criteria met by the lactating mother.

Evaluation of the effect of (salt and sugar) on gagging reflex

Wasmaa Sadiq Mahmood; Zainab Salih; Yasmen Taha AL-Alousi

Kerbala Journal of Medicine, Volume 5, Issue 12, Pages 1430-1437

Abstract: The aim of this study is to evaluate the effect of salt and sugar on patients suffering from gagging reflex.
Materials and method: 120 subjects suffering from gagging reflex ranging from 30-50 years old were examined to assess the gagging reflex response when using stock tray, stock tray with alginate, applying sugar on the tongue then impression and salt then an alginate impression also taken.
Results: the results revealed the increase in gagging reflex with impression material compared with tray alone, also the use of salt and sugar decrease the gagging reflex.
Conclusion: the effect of salt and sugar on gagging reflex as it blocks the transmission of impulses that cause gagging reflex also the psychological effect of these two tastes on gagging sensation during taking the impression.
Key words: Alginate impression, gagging reflex, salt and sugar taste.

Histological study of thyroid gland in cases of non toxic goiter

Dr. Khalida I. Noel

Kerbala Journal of Medicine, Volume 5, Issue 12, Pages 1438-1445

Background: non toxic goiter is a prevalent thyroid pathology worldwide characterized by unilateral or bilateral thyroid enlargement which arises due to many factors affects the thyroid tissue.
Objective: To determine the histological findings observed in non toxic goiter of the resected thyroid tissue in Mosul city.
Materials & Methods: Patients were classified according to the preoperative clinical diagnosis into those with non toxic multinodular goiter & those with solitary thyroid nodules, preoperative clinical diagnosis was confirmed by Fine Needle Aspiration Cytology. Postoperatively the thyroid tissue biopsies were collected and fixed in 10% formaline, processed & stained with Haematoxylline & Eosin for histological analysis.
Results: non toxic goiter is more common in female than male. Specimens obtained from patients presented with multinodular goiter showed variable sized thyroid follicles, huge follicles were filled with colloid and lined by flattened epithelial cells, most of the nodules were not encapsulated. Specimens obtained from follicular adenoma showed well developed microfollicles with intact fibrous thin capsule. Degenerative changes in the stromal tissue such as haemorrhge , fibrosis & even calcification were present in some of the cases. If hyperthyroidism associated with a discrete swelling it indicates a manifestation of toxic multinodular goiter. Solitary thyroid nodule was observed as a hard, irregular swelling with apparent unusual fixity associated with scanty normal follicular cells together with colloid.
Conclusion: Incidence of multinodular goiter in Mosul city is more in female than male & in both sexes it increases between 20 to 50 years of age.

Evaluation of Oxidative Stress in Patients with Vitiligo in Najaf/ Iraq

Abdulhussain J. Shamsa

Kerbala Journal of Medicine, Volume 5, Issue 12, Pages 1446-1454

Background: It has been suggested that, in vitiligo there was a systemic imbalance of both
enzymatic and non-enzymatic antioxidants which could be the source of damage of the
melanocytes. Generation of reactive oxygen species and lipid peroxides is associated with
this imbalance which could be the possible pathogenic factors in this hypopigmentary
Objective: The aim of the present study was to determine the levels of antioxidant
parameters; glutathione peroxidase (GSH-Px), glutathione (GSH), catalase (CAT) and the
level of lipid peroxidation marker Malandialdehyde (MDA) in patients with vitiligo in
comparison with healthy controls matched for age and sex and to correlate these levels with
the activity , extent of the disease and with age and sex of the patients, aiming to clarify the
role of systemic oxidative stress in pathogenesis of vitiligo.

Purification and characterization of hemolysin produced by a local isolates of Staphylococcus aureus

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

Kerbala Journal of Medicine, Volume 5, Issue 12, Pages 1455-1463

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. Hemolysins are extracellular toxic proteins which are produced by many gram negative (e.g. Escherichia coli, Serratia spp., Proteus spp., Vibrio spp., Pasteurella spp., Pseudomonas aeruginosa) and gram positive bacteria (e.g. Streptococcus spp., Staphylococcus aureus, Listeria spp., Bacillus cerius, Clostridium tetani), all of which possess a certain pathogenic potential. Hemolysins have been therefore always considered as virulence factors. Most hemolysins cause lysis of erythrocytes by forming pores of varying diameters in the membrane and are designated as such because they have the ability to lyse red blood cells (RBCs).
1- Purification of hemolysin from a local isolate of S. aureus.
2- Characterization of hemolysin produced by a local isolate of S. aureus.
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. Hemolysin was extracted by cooling centrifugation and purified by many steps including: precipitation by ammonium sulphate, dialysis, ionic exchange chromatography by using DEAE-Cellulose, and gel filtration chromatography by using Sephadex G-100. The molecular weight of hemolysin was determined by gel filtration chromatography on Sephadex G-100 while the optimum pH and temperature for hemolysin stability were also determined.
Results: The results showed that forty isolates out of 100 were identified as Staphylococcus aureus. Hemolysin was extracted by cooling centrifugation and purified by many steps including: precipitation by ammonium sulphate with 50-75% saturation percentage, dialysis, ionic exchange chromatography by using DEAE-Cellulose, and gel filtration chromatography by using Sephadex G-100. The results showed that hemolysin was purified 135 fold with a yield of 1.16%.The molecular weight of hemolysin determined by gel filtration chromatography on Sephadex G-100 column was about 35000 daltons, while the optimum pH for enzyme stability was 7 and the optimum temperature for enzyme stability was between 25-35oC.
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.

Therapeutic and Biochemical Effects of Zinc Sulfate in Acute Diarrhea among Young Children

Zuhair Omran Easa

Kerbala Journal of Medicine, Volume 5, Issue 12, Pages 1464-1472

Background Zinc deficiency is prevalent in children in developing countries. Supplemental zinc provides therapeutic benefits in diarrhea.
Objectives: To evaluate the role of zinc supplementation in the recovery of hospitalized children on intravenous fluid for acute diarrhea.
Patients & Methods: A randomized control trial of 116 cases who were admitted to Karbala teaching hospital for children from October 2007 toAugust 2008 were enrolled in our study, the children aged 3 to 60 months old were divided into 2 groups, zinc group (57 cases) who received zinc for 14 days and control group (51 cases) who did not receive zinc. Zinc was given according to WHO guideline, 10 mg daily for infants up to 6 months of age, and 20 mg daily for older infants and children. General stool examination, serum k+, Na+, blood urea, and serum alkaline phosphates were done for all patients.
Results: Our study showed improvement in 16 patients (28.07% )of cases versus 5 (9.8%)in the control group ( p value of 0.013) within the1st three days of treatment with zinc and52 patients (91.23% )versus 36 (70. 58% ) [ p value 0.017] 6 days after the treatment .
Conclusions: Zinc supplementation reduces the severity and duration of acute diarrhea in hospitalized children on intravenous fluid.
Abbreviations: IVF: intravenous fluid; ALP: alkaline phosphatase; ORS: oral rehydration solution.
Key words: Acute diarrhea, zinc, alkaline phosphatase, oral rehydration solution

The Effect Of Phacoemulsification And Intra OcularLensImplantation On The Intra Ocular Pressure In Glaucomatous And Non Glaucomatous Eyes

Ahmed Majeed Rasheed

Kerbala Journal of Medicine, Volume 5, Issue 12, Pages 1473-1479

background: Cataract and glaucoma are two common diseases affecting a large spectrum of the population worldwide. This prospective study aimed to study the effect of phacoemulsification with intraocular lens implantation in non glaucomatous and glaucomatous eyes on the intraocular pressure(IOP).
Materials: intraocular pressure before and after phacoemulsification with IOL implantation was recorded. Eyes were divided into 3 groups according to preoperative IOP. Data were recorded preoperatively, 6 months postoperatively, and 1 year postoperatively. Comparison was made between preoperative IOP versus IOP 1 year postoperatively.
Results: 70 patients were included in the study. The final mean IOP reduction was 6.411 mm hg (24.65%) in the 24 to 30 mm hg group, 4.439 mm hg (20.41%) in the 20 to 23 mm hg group, and 1.44 mm hg (8.47%) in the 15 to 19 mm hg group.
Conclusion: intraocular pressure reduction was proportional to preoperative IOP;the highest preoperative IOP decreased the most and the lowest preoperative IOP decreased the least. Phacoemulsification with iol implantation may help treating adult glaucoma.