Issue 1

Revision of Surgical Management of Malignant Obstructive Jaundice at Al-Bashir Teaching Hospital in Amman – Jordan

Raad Faisal Ghraib

Kerbala Journal of Medicine, Volume 6, Issue 1, Pages 1480-1488

background: Malignant Obstructive Jaundice (MOJ) is caused by different diseases at
different levels and stages. Ideally, the best management is by early diagnosis and
treatment with multi-disciplinary approach that includes the full cooperation among
endoscopists, histopathologists, interventional radiologists, oncologists and surgeons.
Objective: This analytic retrospective study puts a light on the management of MOJ patients
the surgical department of Al-Bashir Teaching Hospital in Amman – Jordan. The gradual
changes in the surgical management were taken in consideration.
Method: The study included 98 patients who were treated surgically for MOJ during the
period from June 1999 to June 2006. The age of these patients ranged from 27 years to 85
years, with the mean age being 62 years. The data obtained includes the investigations done,
type, stage and level of MOJ, the type of surgical procedure and the postoperative
complications within 1 month.
Results: Most of the patients were males, 58 patients with a percentage of (59.18%). The
remaining 40 patients were females with a percentage of (40.82%). The types of surgical
management included Wipple's procedure for 16 patients with a percentage of (16.33%),
tumor resection for 3 patients with a percentage of (3.06%), bypass (palliative) procedures for
69 patients with a percentage of (70.41%) and the remaining 10 patients with a percentage of
10.20%) were found to be inoperable during diagnostic laparotomy. In general, the surgical
management had a morbidity of (18.37% - 18 patients) of which the mortality was (14.28% -
14 patients of these 18 morbid patients). Regarding investigation, U/S was performed for 62
patients only. It was positive in 30 patients with a percentage of (48.39%). Endoscopic
Retrograde Cholangiopancreatography (ERCP) was done in 34 patients, it was positive in 18
patients with a percentage of (52.94%). Abdominal CT scan was performed for 44 patients, it
was positive in 38 patients with a percentage of (86.36%). MRCP was done in 14 patients, it
was positive in 12 patients with a percentage of (85.71%).
Conclusion: MOJ is a disease occurring more frequently in middle age and elderly groups.
Most of the patients are presented lately, making the most common surgical procedure
performed for these patients being palliative (bypass) procedure. The use of sophisticated
investigations is shown to aid in the diagnosis and staging of MOJ.
Keywords: Malignant Obstructive Jaundice, Al-Bashir Teaching Hospital, Amman.
Key Words: Hepatitis C virus, Hemodialysis, Al-kindy teaching hospital

Prevalence of Sickness Absences in Consultant Clinic in Al- Husain Teaching Hospital and Their Impact on Infrastructures

Amir Omran Hamza

Kerbala Journal of Medicine, Volume 6, Issue 1, Pages 1489-1496

objectives: Study the prevalence of sickness absencesin consultant clinic of Hussien
teaching hospital and their impact on infrastructures in private and public sectors in
Karbala province.
Setting: This study was carried out inconsultant clinic of Hessian teaching hospital.
Methods: Study of sickness absences inconsultant clinic of surgical and medical cases in
Hussien teaching hospital between (1/10/2010 to 30/9/2011) (excluding inpatients admission
and sick absences of health centres and six hospitals) in Karbala province. It includes Private
and public sectors, gender, number of sickness absences, annual actual work days, physicians
attitude, common diagnosis, students.
Results: The number of sickness absences is 6,266 (32% females, 68% males forming 51667
days .The actual work days 210-214 days. The majority of sick leaves are public sector Most
of the sick leaves were short terms. Big number of sickness absences occupies specific days.
The public sector occupied 97.82% of sickness absences while private sector 2.18%.
Conclusion: The majority of sickness absences are public sector lead to negative impact on
infrastructure especially in province where actual work days are less than 210-214 days/year.
The extent of prescribing sickness absences not related to the diseases.
Key words: sick absence, infrastructure

Postprandial lipid profile and Androgen status in polycystic ovarian syndrome (PCOS)

Thuraya abdulla H; Ghassan A. Al-Shamma; Shaymaa Z. Al-Saedi

Kerbala Journal of Medicine, Volume 6, Issue 1, Pages 1497-1505

objective:Immunofluorescent microscopyis an important tool for the diagnosis of glomerular diseases. In this study, we focused on using IF technique together with light microscopy and clinical features in the diagnosis of different types of glomerulonephritis. Spectrum of glomerular disease in Iraq is to be studied and compared with other studies in Iraq and other countries.Methods:A total of 58 kidney biopsies were taken for routine LM, while IF technique was done in 56 of them. The study started from 1st of June 2010 to the 1st of June 2012.
Results:Focal segmental glomerulosclerosis(17/58=29.3%) topped thelist followed by minimal change disease(12/58=20.7%).Immunedeposition wasobserved in (21/56=37.5%)cases and the predominant depositwas immunoglobulin G(20/56=35.7%).The pattern ofdeposition was granular in most of the cases either in the glomerular basement membrane and/or in the mesangium except one case where immunoflourecent microscopy showed dominant positive staining (3+) for complement factor 1q in the glomerular mesangium and slightly positive staining for complement factor 3 in the same mesangealareas.(Tow/58=3.4%) cases fulfilled the clinical, serological andhistopathological criteria of lupus nephritis.Conclusion:To obtain a correct diagnosis of glomerulonephritis, we require immunofourescent in parallel with light microscopic examination of renal biopsies and correlation with clinical features, biochemical and serological markers. Clinically, the majority of patients presentedas nephrotic syndrome (44/58=75.9%).
Key words: Immunofluorescence,glomerular disease.

Atherogenic index of plasma (AIP) as a parameter in predicting cardiovascular risk in males compared to the conventional dyslipidemic indices (cholesterol ratios)

Mudhaffar Sami Khaza

Kerbala Journal of Medicine, Volume 6, Issue 1, Pages 1506-1513

ackground: Several indices had been derived from lipid profiles to establish an index for predicting the risk of having coronary event. The atherogenic index of plasma, is a strongly emerging index that is now fulfilling the criteria to be used as a standalone index for cardiac risk stratification.Objectives: To find out whether the atherogenic index of plasma, was superior to the conventional daily used atherogenic indices in predicting cardiac risk. Subjects and methods: A case-control study in which 119 males with an age range of (43-68) years and with acute myocardial infarction together with 97, apparently healthy males of matched age were enrolled. For each participant, a fasting lipid profile done and the following atherogenic indices were calculated: (total cholesterol / high-density lipoproteins), (high-density lipoproteins / low-density lipoproteins), (low-density lipoproteins / high-density lipoproteins), and the (atherogenic index of plasma). The indices were compared in both groups and then in the patients group to figure out which index has yielded the highest sensitivity in predicting the risk of having coronary artery disease.
„X All of the atherogenic indices were found to be significantly different upon comparing these indices in both patients and control groups. Where the P value was (0.0001) for (TC/HDL), (HDL/LDL), and (AIP); and it was (0.0026) for (LDL/HDL).
„X AIP was found to have the highest sensitivity for predicting atherogenicity among the other atherogenic indices with a value of 84% versus 68%, 73%, and 76% for (TC/HDL), (HDL/LDL) and (LDL/HDL) ratios respectively.
Conclusions: The AIP was a superior index for predicting the coronary arterial disease when compared to the most commonly used indices of atherogenicity in every day practice.Keywords: Atherogenic index of plasma, Coronary heart disease, Atherogenic indices.

Insulin Resistance and Risk of Chronic Renal Impairment in Non and Diabetic Iraqi Adults

Rana Ali Hamdi; Manal kamal Rasheed; Mohammed Kamal Rasheed

Kerbala Journal of Medicine, Volume 6, Issue 1, Pages 1514-1524

background: Patients with chronic renal impairment (CRI) present a high prevalence
of insulin resistance (IR). Chronic Renal Failure (CRF) is a syndrome of persistent
renal impairment involving loss of glomeruli, tubular and nephron function. Dialysis
may be used as a lineal treated to patients who have suddenly but temporarily, lost their
kidney function (acute renal failure) or as a regular region for quite stable patients who have
permanently lost their kidney function.
Central obesity, particularly visceral adiposity is considered to play a major role in causing
insulin resistance and type 2 diabetes mellitus. Insulin resistance is characterized by a
decrease in the insulin effect on glucose transport in muscle, adipose tissue and liver.
Aim of the study: The purpose of this study is to investigate the relationship between the
level of serum Insulin and Homeostasis model Assessment (HOMA)-Insulin resistance levels
to risk of chronic renal impairment (CRI)
Materials and methods:
This study include 50 patients (32 males and 18 females) who have chronic renal
impairment disease with and without T2DM aged between (30-70) years, the mean age as
(mean± SD) is (56.4± 10.7),(52.8±18.5) years who attended the hemodialysis (HD) at the
artificial kidney in AL- Karama Hospital and 30 normal volunteers aged mach with (30-70
years)act as control. The mean age is (57±6) years .This study examined the relationship
between fasting serum glucose ,insulin ,Homeostasis Model Assessment (HOMA) –Insulin
resistance in CRI patients . Insulin was measured by (enzyme immunosorbant assay) .
Results: Mean systolic BP and body max index BMI values were significantly higher among
persons with diabetes compared with their counters without diabetes and control. Diabetic
participants had higher mean levels of serum glucose, serum insulin, HbA1c and HOMAinsulin
resistance compared with non diabetic participants and control. Diabetic participants
also had a higher prevalence of elevated serum creatinine, urea and cholesterol level with
CRI compared with their counterparts without diabetes and control .
Conclusion: This study documents the presence of a strong, positive correlation between
insulin resistance and chronic renal impairment among non diabetic patients .These data
demonstrate that patients with chronic renal impairment have a high prevalence of IR, insulin
levels .

Risk Factors for Hepatitis C Virus Infection among Patients with End Stage Renal Disease in Hemodialysis Unit -Al Kindy Teaching Hospital, Baghdad

Wijdan Akram Hussein; Ahmed Abed Marzook; Haider Hashim Zalzala

Kerbala Journal of Medicine, Volume 6, Issue 1, Pages 1525-1530

background: Hepatitis C virus (HCV) infection is a common global public health
problem, and it is a significant problem among patients with end stage renal disease
on hemodialysis (HD).
Aim: To determine the risk factors of HCV infection among patients with end stage renal
diseae on HD.
Patients and methods: A case control study was performed in HD units of Al-kindy
teaching hospital in the period between October 2011- August 2012. A total of ninety
patients with Positive Anti HCV and ninety patients with Negative anti-HCV were enrolled
in this study.
Anti-HCV antibody was detected by the third generation enzyme immunoassay (ELISA).
Direct interview was done with each patient, odds ratio and 95% CI were used to test
significant differences.
Results: The results showed that 40 males and 50 females with positive antiHCV test didn’t
show any significant difference in comparison with 38 Males 52 females with negative HCV
test regarding gender or age. It was found that as the number of dialysis passed 50 times
the chance of getting HCV infection would be significantly high but as the frequency
passed 100 times, the probability of getting infection would be significantly less.
History of blood transfusion made prediction of having HCV infection significantly high.
Absence of history of jaundice did not affect significantly probability of having hepatitis C
infection among patients on HD. There was no association between history of diabetes
mellitus and/or hypertension and probability of getting HCV infection.
Conclusion The blood transfusion was significantly associated with HCV infection. Frequent
HD increase probability of getting HCV but not when the number passed 100 times.

Advance Maternal Age and Pregnancy Outcome

Meaad Bakr Dahos; Weaam F. Almhfooth

Kerbala Journal of Medicine, Volume 6, Issue 1, Pages 1531-1538

bjective: The changing patterns of becoming pregnant at an advanced age have
serious public health impact because of increased risk of adverse pregnancy
outcome. Thus the objective of this study was to find the adverse pregnancy
outcome of advance maternal age and to estimate whether it was related to inter-current
illness and pregnancy complications.
Study design: This prospective comparative study was conducted at labor room in AL-
Mawany General Hospital from October 2011 –October 2012. A comparison of pregnancy
outcome was made on bases of maternal age at delivery and divided into (group A:20-34
years old),(group B:35-40 years old),(group C:above 40 years old). Main outcome measures
were perinatal outcomes include intrauterine death, neonatal death, preterm birth, congenital
malformation, macrosomia, low birth weight and fetal distress by apgar score. The obstetrical
outcomes, which include abortion, mode of delivery, antipartum hemorrhage, hypertension
disorder, diabetic mellitus, postpartum hemorrhage and multiple pregnancy.
Result: There were 14350 subject delivered at Al-Mawany General Hospital were choosing
about 534 subject whom meet the inclusions criteria, selected women divided in to 3 groups:
A: 20-34 years (NO.252,47%),B:35-40 years (NO.171,32%) and C: above 40 years
(NO.111,20%). The frequencies of macrosomia, intrauterine death, congenital malformation
and low apgar score was significantly higher in advanced maternal age. The finding reveal
that mother over 35 years showed more risk for abortion, hypertension disorder , multiple
pregnancy antipartum hemorrhage, postpartum hemorrhage and caesarean section.
Conclusions: We conclude that older women managed properly by modern obstetric
methods and delivered in modern health care center can expect good pregnancy outcome.

The Role of Some B Vitamins in Methionine-Induced Hyperhomocysteinemia in Male Rabbits

Ali A. Al-Beer; Haydar H. Al-Shalah; Abdul-Razzak Abdul-Latif

Kerbala Journal of Medicine, Volume 6, Issue 1, Pages 1539-1545

ackground: Hyperhomocysteinemia has been associated with an increased risk of
atherosclerosis and other cardiovascular diseases. Vitamin B6, vitamin B12, and folic
acid are essential components in the metabolism of homocysteine.
Objective: This study aimed to assess the effects of vitamin B6, vitamin B12, folic acid, and
the combination of them in the prevention of hyperhomocysteinemia.
Methods: Thirty six male local rabbits were used in the study. Methionine was given to
rabbits to induce a model of hyperhomocysteinemia. Rabbits were divided randomly into 6
groups (6 rabbits in each group) as the following: control group: they were maintained on
standard chow only; methionine only group: they were maintained on methionine only; B6
group: they were maintained on methionine and vitamin B6; B12 group: they were
maintained on methionine and vitamin B12; folic acid group: they were maintained on
methionine and folic acid; multivitamins group: they were maintained on methionine,
vitamin B6, vitamin B12, and folic acid.
Results: Multivitamins group showed no significant differences (P>0.05) in homo-cysteine
levels at day 30 in comparison with day 0 and there are no significant differences (P>0.05) in
homocysteine levels at day 30 between multivitamins group and control group. At day 30 and
day 60, serum homocysteine levels in multivitamins group were significantly (P<0.05) lower
than serum homocysteine levels in folic acid group.
Conclusion: Multivitamin combination composed of vitamin B6, vitamin B12, and folic acid
reduces the hyperhomocysteinemic effect of methionine and it is better than folic acid alone,
while folic acid is better than vitamin B6 or vitamin B12 when they used alone.

Stability of Resistance Induced by Escherichia coli in Comparison with That Carried by Clinical Isolates in Vivo

Lubna A. Kafi; Sajaa R. kareem Al-Saedi; Ali A. Al-Khayyat

Kerbala Journal of Medicine, Volume 6, Issue 1, Pages 1546-1551

ackground: The increasing incidence of resistance to a wide range of antibiotics by
microorganisms is a major concern facing modern medicine because these antibiotics
are widely used in human and veterinary medicine to treat and prevent diseases and as
growth promoters in animal intensive industries. The consequences are severe. Infections
caused by resistant microbes fail to respond to treatment, resulting in prolonged illness and
greater risk of death.
Objectives: The aims of this study are: 1-Comparing the changes of induced resistance in
E.coli with that present in clinical isolates of the same microorganism. 2-Determine the
properties of cefquinome especially the development of resistance and the stability of it
Methods: fourteen strains of E.coli were collected from different disease cases: diarrhea
(children= 6, calve= 3, poultry= 1), UTI (urine= 2), mastitis (milk= 2) from Al-Yarmook
hospital and farms of veterinary college (Baghdad). The MIC was estimated eight selected
strains (4 sensitive and 4 resistances) before and after passages these strains in vivo for
carried out the comparison.
Results: A significant drop in induced resistance for sensitive strains as compared with
clinical isolates which are not significant elevate in resistance. Most E.coli strains showed
highly susceptible to cefquinome but some of them were appeared resistance although this
antibacterial was newly used in this country.
Conclusion: loss of induced resistance when passing in vivo because the resistant
microorganisms actually were unstable group when comparison with stable resistance in
clinical isolates was not changed when exposed to the same condition.
Keywords: E. coli, MIC, in vivo, antibacterial.

Risk Factors and Pattern of Injuries in Motorcycle Accidents in Holy Karbala

Mustafa Waleed; Mahdi.Abdul-Sahib; Saad I. Al-Ghabban

Kerbala Journal of Medicine, Volume 6, Issue 1, Pages 1552-1560

Background: Worldwide, the morbidity and mortality among motorcyclists involved in road
traffic accidents is high. In Iraq, since 2003, there have been an increasing number of
motorcycles in the streets; this phenomenon was particularly noticed in the Province of Holy
Objective: To shed light on the risk factors and pattern of injuries in motorcycle accidents in
Holy Karbala.
Design: Hospital-based cross-sectional, study.
Setting: Al-Husain teaching hospital in Holy Karbala in Iraq, from 7th November 2010 to
17th February 2011.
Patients and Methods: This study involved all injured motorcyclists involved in road traffic
accidents who were admitted to the emergency department and their mortalities which were
referred to the medico-legal department (N=456). The information collected included
personal identification data, the person’s position on the motorcycle during the event, in
addition, the type and site of injury and the outcome of the victims were reported.
Results: The mean age (± standard deviation) of the subjects was (24 ± 10.12 years); More
than one quarter (25.7%) of the injured motorcyclists (26.1% of drivers and 22.7% of pillion
passengers) were within 15-19 years of age. Most of the drivers (61.7%) had low level of
education; 53.9% were smokers, 2.9% were alcoholics and 32.7% had history of previous
accidents of whom 35 (11.5% of them) had more than one accident. The lower limb was the
commonest site of injury (61.8% of patients); the upper limb and the head were the second
and third leading site of injury (26.1 % and 23.7% respectively). About half of the patients
(49.8%) complained of fractures. More than quarter of the cases (25.6%) needed admission to
the wards or the intensive care unit. The case fatality rate was found to be 5%.
Conclusions: Teenagers motorcycle drivers are the most commonly affected category in
motorcycle accidents. Lower limb injuries represent the commonest site and fractures
represent the commonest form of injury among motorcyclists involved in road traffic
accidents. A considerable proportion of cases need inpatient medical care. Head injuries were
the predominant cause of deaths

Validation the Best, Most Accurate and Reliable Assay for Detection of Typhoid

Zainab Khudhur Ahmed Al-Mahdi

Kerbala Journal of Medicine, Volume 6, Issue 1, Pages 1561-1567

yphoid fever is becoming an ever increasing threat in the developing countries.
Cultivation of bacteria and serology (especially Widal test) give unacceptable levels of
false-negative and false-positive results, respectively.
The aims of present work is development of a PCR assay that can target specific multiple
genes for rapid detection of Salmonella enterica serovar Typhi (S. typhi) .(which has 100%
specificity for Salmonella typhi) was compared with Widal test and Salmonella typhi
IgGIgM rapid test as well as Salmonella typhi IgG and IgM ELISA test during the first week
of illness of 50 suspected cases of typhoid.
PCR primers for invasion, O, H and Vi antigen genes, invA, prt, and viaB were designed and
used for the rapid detection of S. typhi by multiplex PCR.
The respective figures of positivity for PCR, Blood culture, Widal test and S. typhi IgGIgM
rapid test and Salmonella typhi IgG /IgM ELISA were 66%, 52%, 46%, 42% and 48%
respectively. A control group of 20 healthy persons gave figures of 0%, 0%, 40%, 0% and
0% respectively.
The present study conclude that this PCR-based technique is not only absolutely
specific, but also very sensitive and, therefore, much superior to Widal test, Blood culture S.
typhi IgGIgM rapid test and Salmonella typhi IgG/IgM ELISA tests for the early diagnosis
of typhoid.

In vitro effects of hypertonic saline solution on whole blood clotting

Mohammed Shnain Ali

Kerbala Journal of Medicine, Volume 6, Issue 1, Pages 1568-1572

background: hypertonic saline solution is frequently used to in the management of
hemorrhagic shock.
Objective: To determine the effects of hypertonic (7%) saline solution on whole
blood coagulation (clotting) in vitro.
Patients and methods: Ten healthy volunteers (5 males and 5 females with age range of 28-
44 years) with no previous medical history of bleeding tendency and no medical history of
drug intake were studied after their consent. Hypertonic (7%) saline was prepared
immediately before use. For each patient, 4 ml of venous blood sample was obtained and
investigated as follows:
Undiluted 450 µl of whole blood for baseline coagulation tests [prothrmbin Time (PT),
activated partial thromboplastin time (APTT) and thrombin time (TT)]. After that, the same
above tests were done after dilutions of whole blood (i.e whole blood replacement by
hypertonic saline and isotonic saline for each dilution). An Isotonic (0.9%) saline dilution
serves as control. Blood volume replacements at 2.5%, 5%, 7.5% and 10% were done and
Results: The baseline coagulation tests (PT, APTT, and TT) were normal for all 10 (100%)
of subjects. At 2.5% and 5% of blood volume replacement PT, APTT and TT were slightly
prolonged, but showed no statistically significant difference between hypertonic (7%) saline
and the control (isotonic saline) while PT, APTT and TT were prolonged in hypertonic (7%)
saline with statistically significant difference (p<0.05) from isotonic (0.9%) saline at 7.5%
and 10% of whole blood volume replacement in 10, (100%) of subjects.
Conclusion: The study showed that hypertonic (7%) saline disturbs coagulation in vitro when
it replaces 7.5% or 10% of whole blood volume.

A study of cytokine profile and serum IgE level and their association with montelukast therapy in childhood asthma

Munther Hussain Al-Kadhimy; Jaafar Kadhim Naama; Ali Mansoor Al-Ameri

Kerbala Journal of Medicine, Volume 6, Issue 1, Pages 1573-1583

asthma is the most common allergic disease giving rise to the morbidity or school
absence in children and has an increasing incidence worldwide. Montelukast is a well
known leukotriene receptor antagonist used to treat children with asthma. Several
cytokines in addition to IgE are known to affect the course of the disease and response to
treatment in this regard.
This is a prospective placebo-controlled cohort study done in Kerbala Pediatric Teaching
Hospital during April, 2011 through February, 2013. It aims to test the effect of cytokine
profile and serum IgE level (measured by ELISA) on asthma development and their influence
on 1-month course of montelukast therapy compared to a placebo group (30 patients each).
Of the 60 patients, 30 were given montelukast as add-on therapy and the other 30 were
regarded as placebo group. Serum level of IL2, 4, 10, 17 and IFN-gamma were determined
pre- and post- treatment course in all patients and compared with 30 healthy controls.
Response was assessed according to answer to a pre- formed questionnaire formula answered
by the parents regarding frequency and severity of wheezy attacks.
Results showed a significantly higher level of serum IL4 in asthmatic children than in healthy
control. More importantly, its level was shown to be directly related with poorer clinical
response to montelukast, p value < 0.05. In addition, montelukast was shown to significantly
decrease serum IL4 level in the treatment group (30 asthmatics) compared to the placebo
group, p value <0.05.
Furthermore, our data revealed that the serum level of IL10 was significantly lower in
asthmatics compared to the control healthy children and that the higher the level of IL10, the
better the clinical response to montelukast (r=0.73). While the role of the other cytokines
tested in this study, IL 2, IL 17 and IFN-gamma was non-significant regarding association
with disease or influence on response to montelukast.
Data regarding serum IgE level in the recruited 60 asthmatic children revealed that there is a
significantly increased level compared to the healthy control group, p value < 0.05.
Additionally its serum level negatively correlates with clinical response to montelukast, r=
In conclusion, serum level of IgE, IL4 and IL10 are important markers associated with
childhood asthma development and influencing response to montelukast. Secondly, it was
shown that montelukast add-on therapy has significantly better biochemical and clinical
response in childhood asthma than conventional asthma controllers alone.

Oral Findings in Rheumatoid Arthritis Patients

Ali Mihsen Hussein Al-yassiri

Kerbala Journal of Medicine, Volume 6, Issue 1, Pages 1584-1590

background: Rheumatoid arthritis affects women more than men 3:1. Rheumatoid
arthritis can start at any age but most commonly occurs in the 30 – 50 age groups.
Rheumatoid arthritis also has oral, occular manifestations, dryness, swelling of
salivary glands, xerostomia, oral and mucosal ulcerations. The aims of this study were to
determine the oral manifestations in newly and old (previously) diagnosed Rheumatoid
arthritis patients and compare it with healthy controls (without systemic diseases) and finally
to find the accurate prevalence of these manifestations in rheumatoid arthritis patients.
Materials and methods: Seventy two (72) subjects were incorporated in this study, they
were divided into 2 groups, Rheumatoid arthritis patients group: fifty – two (52) patients with
rheumatoid arthritis, they were (11) males and (41) females, Seventeen newly diagnosed
rheumatoid arthritis untreated patients. Thirty five rheumatoid arthritis patients were on
methotrexate treatment. All rheumatoid arthritis patients were without any other systemic
disease. Healthy control group: - twenty healthy control subjects with no signs and symptoms
of any systemic disease. They were sex and age matched to rheumatoid arthritis patients.
Results: The results revealed that the main oral manifestations of Rheumatoid arthritis
patients were angular cheilitis, candidial infection, tempromandibular joint disorder, oral
ulceration, and xerostomia. In old diagnosed rheumatoid arthritis patients, the percentages of
oral ulcerations, tempromanbdibular joints, and xerostomia was significantly higher than in
newly diagnosed rheumatoid arthritis patients. While the percentage of angular chilitis and
candidial infections in newly diagnosed rheumatoid arthritis patients was significantly higher
than in old (previously) diagnosed patients.
Conclusion: Rheumatoid arthritis is a chronic disease in which Saliva is a good
recommended sample for evaluation and estimation of the severity of disease as well as
treatment follow up. Oral ulceration and xerostomia are the most prominent oral
manifestations coincide with the progress of the disease and treatment.

Determination of Radon Concentration and the Annual Effective Dose in Karbala University Campus, Karbala, Iraq

Abbas J. Al-saadi

Kerbala Journal of Medicine, Volume 6, Issue 1, Pages 1591-1599

determination of radon gas concentrations in multistory buildings and outdoor in the Karbala University campus (Karbala-Iraq) were carried out by using Solid-state nuclear track detector (CR-39).The detectors were distributed over 20places(14 indoor and others outdoor). The area of the study includes College of Medicine, College of Dentistry, College of Pharmacy, College of Sciences, student's residence and the Central Library. The dosimetric measurements were made over a period of 3 months.(from 15 September to 14 December 2012). After exposure, the detectors were etched in a (NaOH) solution of normality (6.25 N) at temperature of 70 oC for 3 hours. The tracks were counted by the microscope track-counting system. The indoor radon gas concentrations were found to vary from 41.881 ± 2.463Bq/m3 to 95.642 ± 5.730 Bq/m3 with an average value and standard deviation of 70.358 Bq/m3and14.367Bq/m3 respectively. The outdoor air radon concentrations are ranged from 25.134 ± 1.783Bq/m3 to 28.594 ± 2.854Bq/m3 with an average value of 26.974 Bq/m3and standard deviation 1.155 Bq/m3. In the survey of radon concentration in multistory buildings was observed that the upper floor have lower radon concentration than the ground floor. It has found that, in general, the radon level in lower floors is higher than that in upper ones in all buildings. The annual effective dose to the population from the inhalation of radon was also estimated and this varied from 1.056 ± 0.062mSv/ y to 2.412 ± 0.144mSv/ y, with an average of1.774 mSv/y and standard deviation is 0.362mSv/ y. The ratio between indoor and outdoor radon concentration (mean value) in this study was about 3.The radon concentrations were found to be lower than the higher level recommended by ICRP ( 200 Bq/m3) and thus are within safe limits.