Volume 7, Issue 2, Summer and Autumn 2014, Page 1850-2032


Ergogenic Effects of Yohimbine: Standardized Cycling Clinical Study

Hayder M. Al-Kuraishy; Haidar A. N. Abood; Ali Ismail A. Al-Gareeb

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 1850-1855

background: Ergogenic denote rising in the capacity of the body for eliminating exhaustion and enhancing physical performance, with broad variety of drugs are apparent to be ergogenic in their effects. Yohimbine is an alkaloid recognized as an antagonist to the noradrenergic α2-receptors which normalize noradrenaline release in the central nervous system and their activation decreases the discharge of noradrenaline in the synaptic terminal.
Objectives: This study was designed to evaluate the ergogenic effects of yohimbine in normal healthy volunteers.
Patients and Methods: The present study was conducted in Department of Pharmacology, College of Medicine, Al-Mustansiriya University, Baghdad-Iraq, in collaboration with Department of Pharmacology, College of Medicine, University of Kerbala, Kerbala-Iraq, during April of 2013. The subjects of this study were medical students. 20 male volunteers were conformist to join up this single blind random experimental study. The exercise program consists of cycling on an ergometer. Pulse was measured using ear pulse sensor and maximum pulse rate achieved in this study and the entire exercise parameters were recorded as baseline data, then each subject take yohimbine tablets 5 mg (orally) and after 2 hours, each subject run on cycling ergometer to fatigue state, then, the display functions of bicycle were scanned. Besides, maximal oxygen uptake (VO2 max) was measured to estimate oxygen consumptions.
Results & discussion: Yohimbine significantly improved all ergogenic parameters (efforts, calories, distance, speed and exercise time) from baseline after single oral dose of 5mg, where p values were ˂ 0.05. Moreover; yohimbine significantly accelerate the oxygen consumption in both oxygen consumptions and velocity at maximal oxygen uptake regarding maximum heart rate and resting heart rate with p values ˂ 0.05.
Conclusions: Yohimbine accelerates and improves cycling performances via positive ergogenic effects .So, yohimbine can be used as ergogenic agent for ameliorating the physical fatigue.

Correlation between Coronary Calcium Score and Severity of Coronary Artery Disease in Coronary CT-Angiography

Naffi; Karim O Al; Zaid Ahmed Al Mahdy

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 1856-1864

ackground: The presence of calcification in the epicardial coronary arteries indicates that the patient has coronary atherosclerosis, CT scan is a reliable noninvasive investigation to detect the degree of coronary calcification.
Aim: to study correlation between the degree of coronary calcification and severity of coronary artery stenosis by CT-angiography
Patient and method: one hundred and seventy-five patient ,119(68%) are male and56 (32%) are females. mean age is 55.52for males &55.30 for females, who was referred to the Iraqi Medical center in Karbala for CCTA between october2009- Nov.2013. They have either clinical diagnosis of CAD or chest pain suggestive of CAD. They were studied using CT-64 slices, initially by smart score to assess their calcium level using Agatston score, then contrast given to complete the examination, all coronary arteries were studied for any stenosis. The result was analyzed using SPSS 19.
Results & Discussion: There is statistically significant positive correlation (P value less than 0.005) between the degree of CAC score and the degree of vascular obstruction, also with the number of diseased vessel. It also revealed that 12.9%. of symptomatic patients with negative calcium score may have obstructive lesion although of fewer vessel & of mild obstructive lesion
Conclusion: in symptomatic patient CAC score reflect the severity of CAD especially if it is of high degree but in the absence of calcification it does not exclude presence of diseased vessel.
Keyword: coronary artery disease, coronary calcium, coronary CT-Angiography
Abbreviations: CAD: coronary artery disease. CAC: coronary artery calcium, CCTA: Coronary Computed Tomography Angiography

Electrocardiography (Holter) study of patients with panic attacks

Abdulhamza Rajooj Hmood; Sami A. Al-Badri

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 1870-1877

background: many patients complaining of palpitations seem to have normal electrocardiography (ECG).
Aim: to study the 24-hours electrocardiography of patients with panic attacks.
Material and Methods: fifty patients with panic attacks were studied by Holter monitoring for 24 hours each.
Results: Holter monitoring showed ectopic beats in all 50 patients. No other arrhythmia was recorded.
Smoking was significantly associated with having more ectopic beats per day.
Discussion: panic attacks are not well understood. Some link it to autonomic instability. Some studies had found that some people diagnosed with panic disorder are having paroxysmal supraventricular tachycardia (PSVT). No one of the 50 patients we studied had PSVT. On the other hand, all of the 50 patients had several ectopic beats per day.
Conclusion: it seems that ectopic beats are very common among patients with panic attacks.
Keywords: panic, Holter, ectopic

A Study of Some Immunological Markers in Patients with Chronic Kidney Disease in Kerbala

Ali Mansoor Al-Ameri; Hasanain salah jaafar; Reyadh Hneawa; Weaam Awad Al-Muhana

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 1878-1884

background: Chronic kidney disease (CKD) is a progressive loss in renal functionover a period of months or years.Immune status of patients with CKD represents a fruitful area of research world-wide. Many hypotheses were mounted in this regards and most of them based on levels of certain immunological markers.
Aim: To evaluate the serum levels of some immunologic markers in patients with CKD and to predict their correlation with the disease severity.
Study design and objective: This is a cross sectional survey study. It was performed during December, 2013 through April, 2014at Al-Hussein Medical City, Holly Kerbala.
Method: A total of 60 doctor-diagnosed patients with chronic kidney diseases for different causes and in variable stages of the disease. Their gender distribution and age range were (39 women; 30-62 years and 21 men; 33-70 years). Other 20 healthy persons were chosen as control group. An informed consent was taken from all the participants submitted to the study. Age, gender and presence of diabetes or hypertension were recorded. Then, 3-ml venous blood sample was taken from each participant and sera were isolated via centrifuge. The serum levels of the following markers were determined using ELISA; haptoglobin, alpha1 anti-trypsin, immunoglobulin-A (IgA), IgG, IgM, alpha-2-macroglobulin (A2M) and the complement proteins C3 and C4.
Results: Serum levels of all studied immunologic markers were significantly lower in patients with CKD than those in the control subjects, p value < 0.05. An exclusion is the non significant rise in serum level of haptoglobin and alpha-2-macroglobulinnoticed in CKD stages other than ESRD.In addition, serum levels ofhaptoglobin, A2M, IgA and IgM are significantly lower in ESRD than other stages of CKD (p value < 0.05), while levels of C3 and C4 are significantly lower in moderate CKD than other stages of renal impairment included in this study (p value < 0.05).
Discussion: It is well known that the CKD patients suffer significant immune compromization. Our data revealed down regulation of certain immunological parameters in their sera such as alpha1 anti-trypsin, immunoglobulin-A (IgA), IgG, IgM, and the complement proteins C3 and C4.This could explain the susceptibility to infection and abnormally delayed wound healing accompanying CKD.
Conclusion: It was concluded that serum levels of all studied immunologic markers, excepthaptoglobin and alpha-2-macroglobulin,were significantly lower in patients with CKD than those in the healthysubjects. Furthermore, this is not associated with the presence or absence of diabetes and/or hypertension. This finding could, in part, prove that the immune deficiency status in these patients is purely due to their impaired renal functions. Key words: immunologic markers, chronic kidney disease.

Hepatoprotective Effect of Allopurinol against Paracetamol Induced Hepatotoxicity in Male Rats

Sahar A Majeed

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 1885-1890

background: Liver is a vital organ regulating important metabolic functions. Anumber of chemical agents and drugs which are used on a routine basis cause cellularas well asmetabolic liver damage.
Objectives: This study was undertaken to assess the hepatoprotective effect of allopurinoll in paracetamol induced hepatotoxicity in male rats.
Material and method: A total of 18 adult male albino rats were randamized into 3 group
Group1 was used as a control group ,group2: animals received an intraperitoneal injection of 300mg/kg paracetamol,group3 received 100mg/kg allopurinol orally( by oral gavage) 18 hrs before paracetamol administration.
all the animals were sacrificed after 12 hr from paracetamol dose. Blood samples were collected by cardiac puncture. Serum was separated and analyzed for various biochemical parameters ( liver enzymes)liver was removed and kept in 10%formalin for histopathological study.
Results: Treatment of male rats with paracetamol led to significant (p<0.05) increase the activities of serum enzymes level GPT,GOT, ALP levels compared with the normal rats, In contrast prophylactic used ofallopurinol at100mg/kg orally treated rat prevented the liver damage as judged by the significant (p<0.05) decreased these enzymes levels, histopathologically allopurinol showed protective effect against paracetamol induce liver damge.
Conclusion: allopurinol could be beneficial for alleviating paracetamol toxicity. Further studies and parameter to measure oxidative strees are required, to explain these protective effects

Assessment of serum essential elements, serum glucose and thyroid function tests in Iraqi hypothyroid patients have good and poor responses to levothyroxine therapy

Yaqoob Ayoob Yaqoob; Ausama Ayoob Jaccob

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 1891-1900

background: Hypothyroidism is a syndrome resulting from deficiency of thyroidhormones leading to generalized slowing of all metabolic processes. Many diseaseslike hypertension, ischaemic heart disease, adverse lipid profile, and Metabolic abnormalities developed in hypothyroid patients. Trace elements play essential roles in the human body as cofactors of some enzymes and take part in the synthesis of many hormones where normal thyroid status is dependent on the presence of many trace elements for both the synthesis and metabolism of thyroid hormones.
Aim: The present study was designed to evaluate fasting serum Fe, Cu, and Zn concentrations, fasting serum glucose concentration and thyroid function tests in hypothyroid patients having good and poor response to LT therapy and to study correlations between these parameters.
Materials and methods: The present study was a single center, cross sectional study conducted in alshefa General hospital, basra, Iraq. During the period from June,2013 to Mar, 2014. 62 subjects aged 20 to 55 years were included. The patient groups consisted of 41 hypothyroid patients (38 females and 3 males) on LT therapy for at least 6 months duration. 21 Healthy age and gender matched group with thyroid function within normal limit were selected as control group. Patients were screened for FT3, FT4 and TSH, those with high TSH level above normal limit despite high dose of thyroxine considered as poor response to treatment (PRLT) while those patient with TSH level within normal range considered as good response to treatment (GRLT). After 12 hrs fasting, blood samples (5 ml) were obtained to evaluate serum TSH, T3, T4, glucose and trace elements in all studies groups.
Results and discussion: In (GRLT)group 21 patients had thyroid function tests (TSH, FT4 and FT3) within normal range and there were no significant differences when compared with control while in (PRLT) group, FT4 and FT3 significantly decreased when compared with control and GRLT groups while serum TSH levels in all 20 hypothyroid patients were significantly high. Serum Zn, Cu and Fe level of PRLT patients are significantly lower than its level in control and (GRLP) groups, In (GRLP) there were no significant differences when we compared trace element concentrations with control.
Regarding FSG no significant differences were reported in all studied groups. There are significant correlation between thyroid function tests and trace element concentrations. Trace elements influence thyroid hormones at levels of action, including hormone secretion and activity and binding to target tissue. On the other hand, thyroid hormones itself influence trace metals metabolism at several levels of action, including excretion and transport of trace metals. All these factors collectively lead to significant reduction in trace elements concentrations in hypothyroid patients
Furthermore many reports demonstrate that effect of overt hypothyroidism on glucose metabolism is still a subject of debate this came in agreement with our study.
Conclusions: There are significant decrease in serum Zn, Cu and iron in hypothyroid patients have poor response to LT therapy compared to normal subject. There is no significant change in serum glucose concentrations in all tested groups. Our finding revealed significant correlation between thyroid function tests and serum trace elements.
Key words: essential elements, serum glucose, hypothyroidism, levothyroxine

An Epidemiological Study of Urinary Tuberculosis in Iraq

Riyadh M. A. Al-Saegh

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 1901-1911

Genitourinary tuberculosis is almost always secondary to symptomatic or asymptomatic primary lesion in the lung. After lymphadenopathy, the most common form of nonpulmonary tuberculosis is genitourinary disease. Most patients are between 20 to 40 years of age with a male to female ratio of 2:1. 4. However, a negative test does not exclude clinical disease. This is a cross sectional double centered study of patients with recurrent urinary tract infections attends the private and public outpatient's clinics in Basra teaching hospital and Imam Husain medical city-AlZahra teaching hospital in Kerbala holy. Patients who full fill two out of the following three diagnostic criteria were considered to have urinary tuberculosis..Thesecriteria were: demonstration of mycobacterium tuberculosis in urine by microbiological ,histopathological methods ,and intravenous urography.We exclude patients who prove to have genital tuberculosis ,and those who had only positive findings in intravenous urography. Statistical analyses were performed using IBM-SPSS version 20. Among our 1500 patients enrolled in this study,35(2%) full fill the diagnostic criteria of urinary tuberculosis. The mean age was 50.7 ± 14.9 SD.The urine for acid fast bacili was positive in 1patient(4%) and urine culture for mycobacterium was positive in only 2patients(16%).The tuberculin skin test was positive in 26 patients(74%).The intravenous urography showed abnormalities in 29patients(84%).40% of patients had a positive findings in histopathology of kidney tissue. At a cut off value of 0.6 the sensitivity was 82% and specificity was 50% for the tuberculin skin test in the diagnosis of urinary tuberculosis. The low prevalence rate 2% of urinary tuberculosis in our study is because our diagnosis was hypothesized in the setting of non-specific bacterial cystitis associated with a therapeutic failure or a urinalysis with a persistent leukocyturia and absence of bacteriuria.The clinical characteristics of urinary tuberculosis in older adults can be unusual and may be confused with age-related illnesses. Generally in Iraq like many other Middle East countries, Women spent more time at home and are more likely to be infected within the home than outside it, with a corresponding higher infectious dose. Our patients were less likely to offered histological diagnoses, a situation that points to late diagnosis. In such instance,urinary tuberculosis is consequently more severe, with a higher frequency of renal failure. When kidney and bladder tuberculosis are concerned ,the kidneys are mute and the bladder plays the role of vocal cords. In the context of immunosuppression, urinary tuberculosis behaves as a severe bacterial infection, with bacteremia and visceral metastatic foci. Sterile pyuria was found in 80 % in this study. This could be explained by more liberal use of antibiotics that has anti-mycobacterial effects in our country which render the urine sterile even in the presence of secondary bacterial infection. A high index of suspicion should be made in cases of sterile pyuria who resist antibiotic therapy that have no antituberculous effects. We recommend further studies to detect the prevalence of urinary tuberculosis among immunocompramised patients including those on chronic dialysis program.

Oxidative stress markers (MDA,SOD&GSH) and Proinflammatory Cytokine (interleukine-18)in Iraqi patients with Psoriasis vulgaris

Mohammed .I. hamzah

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 1912-1918

ackground: Psoriasis is a common chronic inflammatory skin disease with an unknown etiology. Psoriasis has been characterized by hyperproliferation accompanied by acanthosis andaberrant differentiation of keratinocytes. Several factors and cytokines, are assumed to be important. Recent studies indicate that various cytokines including tumor necrosis factor – α ,Interleukine-2R and Interleukine- 6 play an essential role in the induction and maintenance of psoriatic lesion.
Objectives: To evaluate oxidative stress markers (Malondialdehyde (MDA),Super oxide dismutase( SOD) & Glutathion (GSH)) and proinflammatory mediators Interleukine-18 (IL-18) in the sera of patients with active psoriasis (Psoriasis vulgaris ) of mild-to-moderate and severe psoriasis compared to healthy controls,and to study correlation of the above markers with severity of psoriasis.
Subjects & Methods: one hundred and teen (110) psoriasis patients were recruited from the dermatology Outpatient clinicin Murjan Hospital in (Babylon city)during the period from November 2011 to March 2013.Fasting serum samples were obtained on enrolment. All the patientsdid not receive any treatment (locally or systemically), for at least 20 days before enrolment. Age& sex matched with fifty five(55) healthy controls were also recruited. Serum IL-18 level were estimated using an Enzyme-Linked Immunosorbant Assay ( ELISA ) technique. The patients group were subdivided to three groups according to the disease severity, into mild psoriasis group , moderate psoriasis group and severe psoriasis group. Serum MDA levels were assessed using thiobarbituric acid (TBA) method of Buege and Aust SOD and GSH was measured by Burtis and Ashwood, SOD levels using modified photochemical Nitroblue Tetrazolium (NBT) method utilizing sodium cyanide as peroxidase inhibitor.
Results & Discussion: Serum IL-18 shows statistically significant elevation in patients group compared to healthy controls( p< 0.05 ). Levels of MDA were significantly increased (p<0.001) where as the GSH and SOD were significantly decreased (p<0.001) in patients with psoriasis compared to healthy control.Also they were all statistically significant increased in serum levels of IL-18 and MDA while a significant decreased in serum levels of SOD and GSH in patients with severe psoriasis compared to these with mild-to moderate psoriasis ( p <0.05 ).
Conclusions: These data support the view that serum IL-18 , MDA, SOD and GSH areinvolved in the pathogenesis of psoriasis, possibly by induction and maintenance of psoriatic lesion. Its recommend a use of cytokine (IL-18) as a useful follow-up marker for monitoring of psoriatic patients and optimizing therapeutic strategies.
Keywords: Psoriasis vulgaris, Cytokines, IL-18 and oxidative stress.

Experience with red face syndrome: A descriptive case-series study of 102 Iraqi patients

Usama Abdul-Jaleel Althuwayni

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 1919-1922

background: Red face syndrome (RFS) is a chronic burning erythema of the face that occurs after prolonged application of topical corticosteroid (CS) and characterized by flare-ups after trial of corticosteroid withdrawal.
Objective: This study was aimed at providing information on a series of 102 cases of RFS in Al-Diwaniya city, Iraq
Methods : In this descriptive case series study, 102 patients were identified as having red face syndrome by a dermatologist in Al-Diwanyia Teaching Hospital, Al-Diwaniya , Iraq , from September 2013 to March 2014
Results : 102 patients were studied ,their ages ranged from (18-45) . There were 97 females and 5 males .Melasma , skin whitening were the main reasons for topical CS use. The presenting complaints were erythema (96.07% ),dryness(69.6 % ), itching (60.7 % ), burning sensation (61.7% ).
Discussion :Red face syndrome is a form of "corticosteroid addiction" mediated by nitric oxide overproduction in response to long term topical corticosteroid use.The mean age of the patients rangeing 18-45 years old. This was probably because people, at this age, start to take care of their appearance. The main reason of using topical corticosteroids was melasma as the topical corticosteroids act as skin lightener owing to their potent bleaching effect. Also this explains the predominance of females in this study which may satisfy their desire. In fact, its recovery usually takes a much longer period of time reaching up to 18 months after stoppage of steroids
Conclusion : RFS is a disease of steroid misuse by patients especially for melasma and skin whitening and it is seen increasingly. Public health information is important about this disease and other side effects of topical CS

A prospective study on functional outcome of Percutaneous Epiduroscopic Adhesiolysis compared to lumbar spine surgery for treatment of Failed Back Lumbar Syndrome caused by Fibrosis–Adhesion

Ahmed Alkhuzai; Omer Ali Barawi; Ali Omar Saadoun

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 1923-1930

background: Epidural fibrosis and adhesion seen as common post lumbar syndrome phenomena which contribute to 50%-60% recurrent of the symptoms.
Aim of study: We studied the effectiveness of percutaneous epiduroscopic adhesiolysis in management of fibrosis & adhesion resultant from failed backed lumbar spine surgery compared to second time surgical decompression with surgical excision of the fibrosis of lumbar spinal stenosis.
Patients & Methods: In a prospective comparative study of 44 patients all of them with failed backed post laminectomy syndrome were diagnosed in Sulaimania city private clinic and private hospital, from June 2010 till May 2012 according to magnetic resonance imaging techniques, also according to inclusion exclusion criteria in diagnosis of adhesion with fibrosis, were randomized into two groups. Group A treated by lumbar spine surgery with second time surgical exploration, decompression and excision of fibrosis compared to the second group B were treated by percutaneous epiduroscopic adhesiolysis through sacral canal under fluoroscopic guide. The caudal epidurogram showed restriction in spread of contrast caused by fibrosis & adhesion then the canal open by irrigation through pressurized saline range from 40 to 80 ml according to the number of the level which were obstructed by fibrosis. Saline used intermittently until the spinal canal open were seen by fluoroscope until complete procedure with adequate adhesiolysis with visualization of the canal opening. At the end of the procedure solutions were used to decrease rate of adhesion. Depomedrol 80 mg 2ml , Hyaluronate 6ml, 1% 5ml lignocaine injected into canal space.
Results & Discussion: In both group A by surgical procedure & B percutaneous epiduroscopic adhesiolysis were noticed significant improvement in the mean of Stanford score and ODI (Oswestry low back disability score) from baseline were at all follow up visit for 24 Months according to sciatica pain (short term less than 6 Months, long term more than 6 Months), Functional outcome, Return back to work, psychological status, Change in narcotic intake, with the general satisfaction rate. Also there were significant statistical differences at 12, 24 Months follow up for both Stanford and ODI Oswestry index between group A and group B revealed high outcome results for group B was treated by epiduroscopic adhesiolysis technique (P- value <0.0001) with minimal complications rate in group B compared to group A.
Conclusion: We concluded that percutaneous epiduroscopic adhesiolysis for 2 years follow up specific for the patients of fibrosis with adhesion post laminectomy are superior to the surgical exploration with excision of fibrosis & second time decompression in treatment of failed back lumbar spinal surgery.

Evaluation of Subclinical Systolic Dysfunction in Patient with Grade 1 Diastolic Dysfunction

Ahlam Kadhim Abood

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 1931-1936

background: Recent epidemiological studies have demonstrated that nearly half of allpatients with heart failure (HF) have preserved left ventricular ejection fraction(HFPEF). Thereby it is mandatory to include other hemodynamic indices in the traditional evaluation of the systolic function of the heart beside the EF.
Aim of the study was to assess the occurrence of subclinical systolic dysfunction in hypertensive patients with diastolic dysfunction referred for echocardiograph assessment of left ventricular function in a hospital.
Methods: 30 patients were recruited from the Echocardiography lab. The analysis of diastolic dysfunction was based on the E/A ratio using PW- Doppler echocardiogram. measurement of EF and SV by measuring end systolic and end diastolic dimensions of left ventricle by M-Mode guided 2D echocardiogram. Measurement of HR from ECG. calculation of SI. CO and CI were done.
Results & Discussion: The percentages of parameters which were found below normal levels are as follow: SV: 33.3% (10 out of 30 patients). SI : 40%(12 out of 30 patients). CO: 20%(6 out of 30 patients) and CI:53.3%(16 out of 30 patients).
Conclusion : EF is not enough in evaluation subclinical systolic impairment in HT patient , CI should be used in concomitant with EF in traditional evaluation of any patient with suspicion of HF.

Prevalence of Salmonella Serotypes in Diarrheic and Non-Diarrheic Patients in Mosul-Iraq

Yasin H.Al-Juboory; Mohammad M. Zenad; Rashid H.Hassen

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 1937-1944

background: Non-typhoidal salmonellosis is a worldwide distributed infection. It is a common enteric infection was caused by various Salmonella serotypes. It is considered as a foodborne disease, the direct transmission is commonly occurred between individuals. Many animal species, birds, and insects play an important role in transmission of infection to man.
Aim of study: This study aimed to investigate prevalence of enteric Salmonella infection with some influenced epidemiological parameters in patients in major three hospitals in Mosul city/Iraq.
Materials and Methods: A total 1028 stool samples were randomly collected from patients in three major hospitals (Al-Khansa, Ibin-Al Ether, and Al-Razy), - - . Salmonella-Shigella each. Isolated Salmonella colonies were serotyped in Central Health Laboratory in Baghdad.
Result & Discussion: Total isolation rate was 1.07%. Eleven salmonella isolates were identified: S.typhimurium (54.4%), S.agona (18.1%), and 9.09% for each of S.anatum, S.worthington, and the remaining non-serotyped species. High and low isolation rates were recorded in Jan.2001 and Nov. 2000 respectively. Salmonella isolation rate showed significant increase in patients of Al-khansa hospital (4.43%).A dramatic increase of Salmonella infection rate was recorded in diarrheic cases due to Samonella infection or concomitant enteric disease, similarly significant increase of Salmonella isolation rates (2.2%) were observed in children (6-to-10 years) due low education and little conciousness at this age, and in infants independent on breast feeding mainly due to contamination during preparation of milk bottles. Furthermore low infection rate recorded in males, and in those living in urban areas. A positive correlation was noticed between Salmonella infection and rearing of domestic animals in homes.
Conclusion: S. typhimurium was the dominant serovar. High isolation rates were recorded in diarrheic patients, in infant independent on breast feeding and children at primary school, people in rural areas were highly exposed to Salmonella infection than those in cities.

Hepatitis C Infection Among Children with Beta- Thalassemia Major in Babylon Center of Hereditary Blood Disorders

Adnan. H. Tarish; Widad. H. Shakeer

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 1945-1951

background: Hepatitis C infection is the most common cause of post transfusion hepatitis and end stage liver disease in many countries. B-Thalassemia major is one of the most prevalent hereditary blood disease word wide. Polymerase chain reaction is a highly sensitive technique for the detection hepatitis C virus-RNA in serum
Aim of study: To determine the percentage of hepatitis C infection (positive polymerase chain reaction) and possible risk factors in children with B-Thalassemia major in Babylon Center of Hereditary blood disorders.
Patient and Methods: A prospective study was done on two hundred twenty six child with B-Thalassemia major (aged from 2 years to 18 years) that have been transfused with blood , as part of their management , at least 10 units of blood irrespective of their age , sex were included in this study from a period 1 of march 2013 to 1 of July 2013 in Babylon center of hereditary blood disorder in Babylon Gynecology and Children Teaching Hospital .Serum was stored at -20 then tested for hepatitis C (HCV antibodies) by ELISA, HCV antibodies positive cases were confirmed by polymerase chain reaction test.
Results & Discussion: Total number of patient was 226, male 129(57%), female 97(43%) with minimal age 2 years and maximal 18 years with mean age 8.4 with st. deviation 4.3 year. HCV Ab was positive in 17 (7.5%), only 12 (70%) were +ve PCR for hepatitis C and 5 (30%) were –ve PCR . There are significant statistical relation regarding the increase number of blood transfusion units (more than 150 units) P value 0.045, Huge splenomegaly (more than 8 cm) P value 0.002 , Abnormal liver enzyme with P value 0.032 , and male gender (P value 0.029) with +ve PCR HCV patient. There are no significant statistical relation regarding huge hepatomegaly (p value 0.107) and type of chelating agent (p value 0.107) with +ve PCR HCV patient.
Conclusion: Children with B- Thalassemia major are more prone to get Hepatitis C infection especially if get blood transfusion more than 150 units, huge splenomegaly, abnormal liver enzymes and male gender.

Platelet indices and their relations to platelet count in hypo-productive and hyper-destructive Thrombocytopenia

Khaleed Jumaa Khaleel; Abeer Anwer Ahmed

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 1952-1958

ackground: Thrombocytopenia is low platelets count which is either due to defective platelet production (hypo-productive thrombocytopenia) or due to increased platelet breakdown (hyper-destructive thrombocytopenia). Measurement of platelet counts alone do not explain the underlying patho-mechanism of thrombocytopenia.. Recent advances in automated blood cell analyzers facilitate the measurement of several blood cell parameters automatically such as, platelet indices including mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) and these parameters could provide some important clinical information.
Aim of the study: to investigate whether platelet indices( MPV,PDW,PCT) could serve as diagnostic tools in the differential diagnosis of thrombocytopenia and, if there is any correlation between platelet count and platelets indices .
Subjects and Methods: A total of 77 Iraqi patients (28 males and 49 females) with thrombocytopenia were subjected to the following tests:
1. Complete blood count using Mindway haematologic autoanalyser.
2. Peripheral blood film .
3. Bone marrow aspirate with bone marrow trephine biopsy when indicated.
A group of 50 healthy person (age & sex matched) were included as a control
Results: hyper-destructive thrombocytopenia (immune thrombocytopenia) representing 12.9% of total patients, while hypo-productive thrombocytopenia due to various causes representing 87.1% of total patients. The MPV, PDW are significantly higher in immune thrombocytopenia group as compared with thrombocytopenia of hypo-productive patho-mechanism and there were no correlations between platelets count and both MPV and PDW in hyper-destructive and hypo-productive thrombocytopenia but there was a direct correlation between platelet count and PCT .
Conclusion: Platelet indices provide plenty of clinical information about the causes and patho-mechanism of thrombocytopenia and could be helpful tests to distinguish hyper-destructive thrombocytopenia from hypo-productive thrombocytopenia easily, so more interest for the use of these indices in differential diagnosis of thrombocytopenia is required.

Comparison between Retrograde and Antegrade ureteric stenting during open Dismembered Pyeloplasty in children with Pelvi-Ureteric Junction Obstruction

Jasim abdoalhasan

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 1959-1963

ackground: Congenital UPJ obstruction can present at any time, from intrauterine life to old age. With the increased use of prenatal ultrasound, anumber of infants are found to have hydronephrosis. PUJ obstruction is one ofthe most common causes of prenatal hydronephrosis
Objective: To compare between retrograde and antegrade internal double-J stent for open Dismembered pyeloplasty in children with Pelvi-Ureteric Junction Obstruction.
Patients and Methods: Thirty two patients with pelvi-ureteric junction obstruction were included in the study from December 2011 to December 2013. . Antegrade double-J stent was done in 13 children and retrograde double-J stent was done in 19 children . Antegrade stent was placed during the pelviureteral anastomosis, and the retrograde stent was placed just before the operation by pediatric cystoscopy. The length of hospital stay and postoperative results were assessed.
Results: Thirty two patients with pelvi-ureteric junction obstruction , aged 3 months to 12 years, with a mean age of 3.4 years were studied. Successful stent placement without malpositioning was achieved in 11 (84.4%) of 13 patients in antegrade group and all 19 (100%) of children in retrograde group . The cause of unsuccessful stenting in antegrade group was the inability to cross the ureterovesical junction .
Conclusion: Retrograde double-J stent more reliable than antegrade stent for open dismember pyeloplasty in children with Pelvi-Ureteric Junction Obstruction with greater success and lower complication rates.
Abbreviations:
PUJO (Pelvi-ureteric junction obstruction).
US (Ultrasonography).
IVU (Intravenous urography).
KUB (kidney-ureter-bladder).
DJ stent (double j stent)

Laparoscopic Cholecystectomy in Alhindiya Hospital: Analysis Study

Ali Khairi Toman

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 1964-1970

ackground: Cholecystectomy is one of the most frequently performedoperations. Open cholecystectomy has been the gold standard for over 100years. Laparoscopic cholecystectomy was introduced in the 1980s. Laparoscopic cholecystectomy has become the definitive treatment of choice for symptomatic gall bladder disease. It replaced the old traditional method of open approaches with lower complication rates.
The laparoscope was introduced into Alhindiya hospital during early 2008 and after that the numbers of laparoscopic operations started to increase gradually and includes cholecystectomy, ovarian drilling, ovarian cysts, and appendectomy and diagnostic operations.
Objective: This study summarizes the experiences associated with 150 laparoscopic cholecystectomies performed in Alhindiya hospital to assess the safety of these operations.
Patients and Methods: This is an analysis study were the records of 150 consecutive patients who underwent laparoscopic cholecystectomy in Alhindiya hospital were reviewed. 125 patients were females and 25 patients were males (F to M ratio= 5-1). The age range was between 18 -75 years.Analysis of different data was performed.
Results: The commonest indications for surgery were symptomatic cholelithiasis (100 cases) and acute/chronic cholecystitis (35 cases). The mean operating time was 36.8 minutes. The mean length of stay in the ward was 17.7 hours. Only 5 cases were converted to open procedures. The commonest postoperative complication was wound-infection. Mortality rate was zero.
Conclusion: In summary, this study demonstrates that laparoscopic cholecystectomy can be performed safely in Alhindiya general hospital with good results and low complications rate.

Chronic Obstructive Pulmonary Disease: Impact Of Hypoxia

Amjed Hassan Abbas

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 1971-1979

background: Chronic obstructive lung disease (COPD) is a major cause of chronic morbidity and mortality throughout the world. Many people suffer from this disease for years and die prematurely from it or its complications.
Objective: This study was aimed to:1.Study and compare some demographic and physiological changes in hypoxic and non-hypoxic groups of patients with COPD. 2. Assessment of effect of smoking in both groups. 3. Correlate these findings with severity of the COPD.
Patients and method: The study was performed in Merjan Teaching Hospital in Babylon Province in the period from November 2012 to October 2013, the study included one hundred eighty two (182) patients with history of COPD who were studied clinically and each patient was submitted for spirometry, pulse oximetry, chest x-ray and electrocardiography. According to the results of oximeter, patients were divided into two groups, hypoxic and non-hypoxic group, hypoxic group included 96 patients ( mean age was 57.14±11.24, 66% were males) while the non-hypoxic group included 86 patients (mean age was 54.42±12.75, 62% were males).
Results & Discussion: Study showed that the mean pack years of tobacco use in hypoxic group was 42.83±47.95 pack years while in non-hypoxic group the mean duration was 24.91±32.84 and there was significant differences between groups (P=0.000),it also revealed that pack year was significantly correlated with the severity of obstruction in hypoxic group (P value= 0.000) in contrast to non-hypoxic group (P value= 0.2).
The study also showed significant negative linear relation between degree of dyspnea (functional state) and oxygen saturation (SpO2) (r=-0.2, p=0.04) in reverse to non-hypoxic group (r=-0.11, p=0.3). Furthermore, the study clarified that most patients in both groups had normal ECG changes (73% in hypoxic group and 90% in non-hypoxic group) and the most common ECG finding in both groups was P pulmonale (11% in hypoxic group and 6% in non-hypoxic group).
When linear regression analysis of the results of this study was considered, there was significant positive linear correlation between oxygen saturation (SpO2) and severity of obstruction in hypoxic group while non-significant linear correlation between SpO2 and severity of obstruction in non-hypoxic group.
Conclusion: From the results of this study, we conclude that lung hypoxia has a relation with severity of obstruction, pack years, functional state and ECG changes. Females were more sensitive to the effects of smoking than males.

Coronary Heart Disease in Karbala Population Related to Central Obesity and Other Coexisting Risk Factors – Comparative Study

Amir Omran

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 1980-1985

background: Around 6 years ago, a study has been published describing the prevalence of improvement life style behavior in Karbala population in the period between1/12/2004-1/6/2005.
Objectives: comparative study is conducted to estimate prevalence of improvement life style behavior in Karbala population and compare it with the previous study.
Setting: Coronary care unit (CCU) of Hussein teaching hospital.
Design: Prospective study.
Methods: one hundred patients participated in this study admitted in CCU during the period from 1/12/2010 to 1/6/2011, all patients newly diagnosed as having acute (MI) by selected criteria in relation to central abdominal obesity (W.C), BMI, age, sex, fat consumption, smoking, physical activity, alcohol, fruit and vegetable consumption.
Results: mean age (females 57.5 years, males 63.3 years) males 65%, females 35%, consumed saturated fat 54%, smoking 39%, Alcohol 0%, consumer of fat 54% fruit and vegetables 63%, W.C (males 96.7±12.9, females 99.9 ±16.4)
Conclusion: The comparative study shows an adverse results, improvements at certain aspects of life style behavior

Evaluation of March Hemoglobinuria in Imam Al-Hussain Visitors Who are Going to Kerbala City

Almottesembellah Abdelruhman Al-Ogaili

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 1986-1991

background: March hemoglobinuria, also known as march hematuria, occurs whenblood is seen in the urine after repetitive impacts on the body, particularly affectingthe feet and hands (e.g. Candombe drumming). The word "march" is in reference to the condition arising in soldiers who have been marching for long periods; the condition was first documented in 1881. March hemoglobinuria usually is reported in young males, no doubt because of their more frequent participation in severe and prolonged exertion, but march hemoglobinuria also can be seen in women.
Aim of study: To assess the presence of hemogobinuria in the visitors of Holy Kerbala regarding Imam Al-Hussain (peace on him) at the fortieth visiting.
Subjects and Methods: Those subjects underwent to the investigations for the detection of hemoglobinuria . Blood sample drawn with EDTA tube for laboratory processing with complete blood count by hematology auto-analyzer (Abbott) and blood film ,urine sample processed for iron stain to detect hemosiderin (perl`s stain). The results dealt with statistically by SPSS version 18.
Results: Twenty eight cases present with hemoglobinurea .Mean age is 32 years and the range is from 18-56 years. The mean distance that the subjects had walked was 193 kilometers with a range 108-524 kilometers apart from Holy Karbala. The mean hemoglobin is 12.6 g/dl. Thirty eight cases present with anemia (hemoglobin less than 12 g/dl) with fifteen cases have hemoglobin value less than 10 g/dl. Geographical distribution of subjects address all over Iraqi governorates, in which most of them( 63 subjects ) from Baghdad.
Conclusion: There is no significant relation between the distance and the pathology .

Effect of Incorporation of Silver Nitrate on Transverse Strength and Impact Strength of Autopolymerizing Acrylic Resin

Intisar Kadhum Farhood

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 1992-1999

background: Autopolymerizing acrylic resin has multiple uses in dentistry such as, record base, orthodontics appliances, denture repair and other. Thedegree of polymerization of cold cured acrylic resin is not as complete as that achieved using heat cured system which leads to a higher degree of un-reacted residual monomer, which act as a plasticizer which results in high transverse deflection values lowering the transverse strength of the resin.
Aim of the study: This study investigated the effect of the addition of different concentrations of silver nitrate (AgNO3) on transverse strength and impact strength of autopolymerzing acrylic resin.
Materials and methods: A total of 80 specimens were prepared, 40 specimens were fabricated with dimensions of (64×10×2.5) mm to conduct the transverse strength test while the remaining 40 specimens were fabricated with dimensions of (80×10×4) mm to perform the impact strength test. 10 specimens of each group were fabricated from conventional autopolymerized acrylic resin while the remaining 30 specimens were fabricated from modified autopolymerized acrylic resin. Concentrations of 9.375,15 and 60 ppm of silver nitrate were used to modify the autopolymerized acrylic resin, 10 specimens of each concentration in each group were used.
Results: The results of this study showed that the modified autopolytmerized acrylic had non-significant difference in transverse strength values for all concentrations of silver nitrate; while there was a significant difference in impact strength values for (15 and 60 ppm) concentrations of silver nitrate and non-significant difference in impact strength values for (9.375 ppm) concentration of silver nitrate .
Conclusions: It can be concluded that the addition of (15 and 60 ppm) concentrations of silver nitrate can improve impact strength of autopolymerizing acrylic resin.

Oxidative Stress and Antioxidant Defense in Patients With Jaundice

Noaman Abdulateef Abdulrazzaq; Perry Habib Saifullah; Suhayla Khalied Mohammed

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 2000-2008

background: The objective of our study is to measure serum Malondialdehyde level(MDA), an index of oxidative stress, and Vitamin E level, a protective agent againstoxidative stress, in Jaundice patients and study the possible correlation between them .
Materials and Methods: 80 patients with jaundice ( 38 female and 42 male) and 50 healthy control (23 female and 27 male) were enrolled in this study. About 10 ml of venous blood were obtained from the cubital vein using disposable needles and syringes. The thiobarbituric acid method was used to measure the Malondialdehyde (MDA) which reacted with thiobarbituric acid(TBA) to give pink color that was read at (535 nm). The concentration of vitamin E in serum was determined according to a modified Hashim and Schuttringer method.
Results: A significant increase (P<0.0001) in serum Malondialdehyde (MDA) in jaundice patients as compared to that of normal healthy controls was observed. A significant decrease (P<0.0001) in serum vitamin E in jaundice patients as compared to that of normal healthy controls has been noticed. No significant correlation between serum Malondialdehyde (MDA) and serum Vitamin E in jaundice patients was observed.
Conclusion: our data shows that antioxidant capacity decreases with an increase in oxidative stress in Jaundice patients but there is no significant correlation between them .
Abbreviations: The abbreviations used are: dL, deciliter; MDA, Malondialdehyde; μl, microliter; r, Correlation factor ;rpm , Round per minute; TCA, Trichloroaceticacid; TBA, thiobarbituric acid ; ROS, Reactive oxygen species.

HELLP Syndrome case study

Falah Abdul-Hadi Muhi

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 2009-2013

background: HELLP syndrome is a serious medical condition found in pregnant women. Usually in 3rd trimester [last 3 month], HELLP syndrome comprise Hemolytic ,i.e. breakdown of red blood cell , Elevated liver enzyme & Low Platelet count it's said to be an off – shot of pre-eclampsia or eclampsia i.e. hypertension during pregnancy . Usually it is found before the birth of baby, however sometime it can occur after the delivery
Objective: This was done to describe general experience with management of HELLP syndrome by analysis of patient outcome.
Patients And Methods: The patient M.K 30 year's old primigravida, developed generalize edema, high B.P., pallor, jaundice, haematuria &convulsion. She received anti-convulsion [MgSO4] & antihypertention (apresoline), also full investigation was done ,the result revealed P.C.V 28% ,T.S.B 8mg/dl, elevated liver enzyme ,low platelet [80,000]. The decision was termination of pregnancy after 6 hours stabilization, she also received antibiotic ,hydrocortisone. platelet, fresh frozen plasma &blood ,and because of unripe cervix, caesarean section was done under spinal anesthesia ,after operation she was kept in I.C.U. for few days.
Results & Discussion: The patient developed acute renal failure, but gradual improvement of her condition was achieved and patient become well after 3 weeks with complete recovery. Other medication used was MgSO4 for fit control prevention of recurrence.
safety, high dose steroid will accelerate recovery and that conservative treatment of renal failure is so effective.
Conclusion: The result support conclusion of previous author that rapid & early diagnosis and treatment of HELLP syndrome is very important to ensure favorable maternal & prenatal outcome, also in this study we showed that the patient should be stabilized before termination & regional anesthesia will increase

Obsessive Compulsive Disorder in Karbala, Iraq: a preliminary Report

Nesif J. Al-Hemiary; Salih M. AlHasnawi; Jawad K. Al-Diwan

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 2014-2017

background: Literature on obsessive compulsive disorder (OCD) in Iraq is scares. The Iraqi Mental Health Survey (IMHS) reported a high prevalence. This study was carried out to throws a light on OCD in Karbala, Iraq.
Methods: The study was conducted in outpatient Dept. of Al-Hussaini General Hospital, Karbala, Iraq, for the period 1st Jan. to 23rd Dec. 2006. Patients diagnosed as OCD were interviewed and a questionnaire was filled for each one. The questionnaire was prepared according to DSM-IV-TR. Demographic data and family history for OCD or any mental disorder was included in the questionnaire.
Results & Discussion: The peak age for OCD was 21-30 years, females were predominating (63.2%). singles were more affected than married (47.3%). Family history of OCD and any mental illness was observed in 20.5% and 52.9%, respectively.
Conclusion: OCD affect young age group, females and singles. Family history for any mental illness was positive in more than half of the cases.

Association between psoriasis and hepatitis B and C

Mohammed Younus Naji; Ala; a Abdulhussain Abdulzahra; Mohammed Jawad kadhum

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 2018-2022

Objectives: The aim of study is to assess the association between patients with psoriasis and hepatitis B and/or C.
Methods: This case control study that enrolled total 110 patients with psoriasis were included in the study, 63 males and 47 females and their age range from 15 to 70 years old , with male to female ratio 1.4 :1 . The study was conducted in Al sader teaching hospital and Al Hakeem hospital in Al Najaf governorate during the period from January 2013 to February 2014. All recruited patients had their ages, gender and case histories recorded on an already prepared data sheet. All recruited patients and control groups had been subjected to that Hepatitis Bs antigen (HBsAg) and anti-hepatitis C antibodies (anti-HCV) were done using Enzyme-linked Immunosorbent Assay (ELISA) kits.
Results: This study that enrolled total 110 patients were included, 63 males and 47 females and their age range from 15 to 70 years old , with male to female ratio 1.4 :1 . There were increased incidence of male patients with psoriasis 63(44.1%), but there were no statistically significant difference between studied patients and control groups, (p=0.5) . There were increased incidence of patients with psoriasis younger than 50 years, 70 (53.8%), statistically significant difference between studied patients and control groups, (p=0.007) .
There were statistically significant difference between studied patients and control groups regarding smoking , 30 (33.3%), (p=0.003). There were increased incidence of seropositive for hepatitis C in patients with psoriasis .There were statistically significant difference between studied patients and control groups regarding hepatitis C 4 (16.7 %), (p=0.003). There were no statistically significant difference between studied patients and control groups regarding hepatitis B 1 (33.3%), (p=0.6) .
Conclusions: This study support of an association between psoriasis and hepatitis C but not with hepatitis B. The predictors for psoriasis as risk factor in this study were male younger than 50 years with history of smoking with association with hepatitis C infection .
Recommendation: Physicians who care for patients with psoriasis should be aware of this possible association and consider screening patients with psoriasis for hepatitis C infection.

An Insight Into Bacterial Profile and Antimicrobial Susceptibility of Burn Wound Infections in Kerbala, Iraq

Zuhair Hameed Abboud; Noor Hameed Al-Ghanimi; Mohanad Mohsin Ahmed

Kerbala Journal of Medicine, Volume 7, Issue 2, Pages 2023-2032

background: There is paucity of data on bacterial profiles and antibiotic susceptibility patterns in burns care units in Kerbala, Iraq we sought to undertake this study.
Aim of the study: is to have an insight into the bacteriological profile of buns wound infections and evaluate the antimicrobial susceptibility pattern of the organisms isolated to antibiotics and disinfectants.
Materials and Methods: This study was conducted prospectively at the Burns Care Unit (BCU) in Al-Hussein Medical City, Holy Kerbala Province, Iraq. Wound swabs were obtained from consecutive 57 burns patients treated in BCU for the period from November 2012 to March 2013. Microbial isolates were identified based on standard microbiological techniques. Antimicrobial susceptibility test was done by Kirby Bauer disc diffusion method, whereas efficacy of 5 most commonly used disinfectant was evaluated by agar-diffusion method.
Results and Discussion: A total of 76 isolates were recovered. Pseudomonas aeruginosa was found to be the most common isolate (53.94%), followed by E.cloacae (25%), E.coli (11.84%), K.Pneumoniae (3.94%), S.aureus (3.94%), A. baumannii (1.31%). Majority of the bacterial isolates were multiple-drug resistant. Generally, Imipenem was the most effective antimicrobial agents. The best disinfectant was Sekusept Forte® whereas the least effective disinfectants were Povidone-Iodine and Chloroxylenol®.
Conclusions: Pseudomonas was the predominant cause of burns infections and majority of isolates were multiple-drug resistant. These indicate the need for strict hygienic measurement to protect the burns patients from opportunistic pathogens.