Volume 8, Issue 1, Winter and Spring 2015, Page 2034-2186


Comparative Study of Molecular Phylogeny, Adhesion Genes and Antiobiogram of Escherichia Coli Clinical Isolates From High Vaginal Swabs and Urine in Women

Mohanad Mohsin Ahmed

Kerbala Journal of Medicine, Volume 8, Issue 1, Pages 2034-2042

background: Escherichia coli is a frequent cause of urinary tract infections, however, its identity as pathogen in the cervico-vaginal area is required to be ascertained. In addition, source (s) for E.coli colonzing female vagina is needed to be confirmed, whether its fecal contamination or from urinary tract.
Aim of the Study: To perform a comparative analysis of the E. coli clinical isolates from vagina versus those from urine in terms of molecular phylogeny, molecular determinants of virulence and antimicrobial susceptibility.
Materials and methods: A total of 60 E. coli strains from high vaginal swabs (n=30) and urine (n=30) were analyzed. Identification of phylogenetic groups and detection of adhesive genes were conducted by 2 different multiplex PCR systems. Antibiograms for all isolates were performed by Kirby-Bauer method.
Results and Discussion: Majority of vaginal E coli (VEC) isolates were belong to B2 phylogenetic group (n=20, 66.7%), whereas, majority of uro-pathogenic E. coli (UPEC) isolates were distributed between two phylogenetic groups, namely B2 12 (40%) and D 11 (36.7%). Therefore, most of the strains from both vagina and urine are belonging to pathogenic phylogenetic groups; however, they differ in prevalence of the groups. The pap gene has a higher frequency among UPEC (n= 13, 43.3%) than in VEC isolates (n=7, 23.3%). Similarly, sfa gene has a higher frequency in VEC isolates (n= 20, 66.7%) than in UPEC isolates 11 (36.4%). Consequently, adhesion genes playing roles in vaginal colonization may differ from that in urinary tract .VEC strains where highly susceptible to ciprofloxacin (100%) followed by nitrofurantoin (73.3%) and nalidixic acid (70%). Whereas UPEC strains were highly susceptible to nitrofurantoin (100%) followed by nalidixic acid. Thus, it seems that cirpofloxacin is appropriate for empirical therapy in vaginal infections, whereas nitrofurantoin is more appropriate for empirical therapy in UTI.
Conclusion: Strains isolated from high vaginal swabs differ from strains isolated from urine in the prevalence of phyelogenetic groups andmolecular determinants of virulence as well as in antibiograms.

The Neuroprotective Effect of L-Cysteine Towards Cadmium or Nickel Neurotoxicity on Adult Rat Brain Antioxidant Status and Acetylcholinesterase Activity

Hussam W. Al-Humadi

Kerbala Journal of Medicine, Volume 8, Issue 1, Pages 2043-2048

background: Cadmium (Cd) and nickel (Ni), as heavy metals, are the major environmental and industrial contaminant ions which can exert serious oxidative and neurotoxic effects. The aim of this study was to investigate the potential effects of the antioxidant property of L-cysteine (Cys) on the adult rat brain total antioxidant status (TAS) and acetylcholinesterase (AChE) activity induced by Cd or Ni administration.
Materials and Methods: Thirty-six male Sprague-Dawley rats were divided into six groups: A (saline-treated negative control), B (Cys-positive control, 7 mg/kg), C (Cd, 3CdSO4. 8H2O, 1 mg/kg), D (Ni, NiCl2, 13 mg/kg), E (Cd+Cys) and F (Ni+Cys). All rats were treated once daily for 7 days with intraperitoneal injections of the tested compounds. Rats were killed by decapitation and mentioned parameters were measured spectrophotometrically.
Results: The rat brain AChE activity was significantly increased by Cd, Ni and Cys (P<0.001 vs control for all), while it was adjusted into control levels by the co-administration of Cys with Cd (P<0.001 vs control, P<0.05 vs Cys) or with Ni (non-significant vs control, P<0.001 vs Cys). Moreover, the treatment with Cd or Ni alone was exhibited a significant reduction in brain TAS (P<0.001 and P<0.01 respectively vs control) that was statistically significant reversed near to control by Cys co-administration (P<0.05 vs Cd or Ni); Cys group alone had mild effect on TAS.
Conclusion: The exposure to Cd in vivo causes a more statistically significant decrease in the rat brain TAS and an increase in AChE activity than the exposure to Ni. Both effects can be, significantly reversed into the control levels by Cys co-administration but Cys could be considered more neuroprotective agent against chronic exposure to Cd than Ni regarding the above parameters.

Assessment of Genetic Variations Associated With Susceptibility to Psoriasis Among Iraqi Population

Mohammad Sabri A. Razzaq; Mohammad A. K. Al-Saadi; Mohanad Mohsin Ahmed; Abeer Thaher Naji

Kerbala Journal of Medicine, Volume 8, Issue 1, Pages 2049-2055

background: Psoriasis is an immune –mediated, chronic hyperproliferative disease ofthe skin. Genetic association studies have identified multiple psoriasis risk loci;however, the frequency of variations at these loci differs quite strikingly among the populations, suggesting heterogeneity in the genetic susceptibility to psoriasis.
Aim of the study: to assess the possible association of selected genetic variants with psoriasis among Iraqis.
Methodology: In this case-control study, 50 psoriasis patients and 40 control subjects were enrolled. Peripheral blood was obtained from all patients and control subject and used for extraction of genomic DNA. Amplification Refractory Mutation System (ARMS- PCR) was used to detect 3 SNPs in IL-20RA(Rs1184860, Rs1167846 and Rs1167849), whereas convention PCR was used to assess deletions in late cornified envelope 3B and late certified envelope 3C (LCE3B and LCE3C) genes.
Results and Discussion: Nine haplotypes were identified by SNPs atIL-20RA gene; the haplotype TTA (Rs1184860, Rs1167846 and Rs1167849, respectively) was associated with psoriasis 19(38%), whereas the CTA haplotype had a protective effect 12(30%). The frequencies of LCE3B deletion in both patients and control groups were 14(28%) and 20(50%) respectively, while the frequencies of LCE3C deletion were 16(32%) and 20(50%) among patients and control respectively. Statistical analysis revealed a significant association between LCE3B deletion and susceptibility to the psoriasis (P < 0.05). The frequencies of homozygous deletion (LCE3B_LCE3C del) in both patients and control groups were 13(26%) and 9(22.5%) respectively. The statistical analysis had revealed a non significant (P > 0.05) association between LCE3C deletion and homozygous deletion (LCE3B_LCE3C del) with susceptibility to psoriasis.
Conclusion:The haplotype TTA of IL-20RA gene has a role in the susceptibility to the psoriasis among Iraqi population.In addition, no association was found between LCE3B_LCE3C deletion and psoriasis in Iraqi population.

Perception of OSCE Examination in Iraqi Undergraduate Medical Students

Riyadh Muhi Abbood Al-Saegh; Albert J. J. A. Scherpbier; Hameed A.Alhibaly; Abdulhamza Rajooj Hmood; Maha A.M .Almkhtar

Kerbala Journal of Medicine, Volume 8, Issue 1, Pages 2056-2069

background: The objective structured clinical examination (OSCE) is an approach to student assessment in which aspects of clinical competence are evaluated in a comprehensive, consistent and structured manner, with close attention to the objectivity of the process.
Aims: This study aims to evaluate students‟ perception about the fairness, objectivity, comprehensiveness and overall organization and administration of OSCE in the 4th year medical students.
Methods: 24-item questionnaire was used to gather data regarding perception of students about the quality of OSCE, its fairness and its organization. A 5-point Likert scale, with responses ranging from “strongly agree” to “strongly disagree” was used. Students were asked post exam questions related to positive and negative aspects of the OSCE and to do suggestions for improvement.
Results: Out of 71 eligible medical students, 66 (92.9%) completed the survey questionnaire. A sizable proportion of 59.1% of the respondents agreed that OSCE was well administered. 51.5% of the students agreed that the objectives of clinical courses were covered. Significant percent of students 61.8% agreed to the facilitators‟ behavior.36, 4% of the respondents stated that the time allocated for each station was not adequate. 79.4% of the respondents felt that OSCE allowed them to compensate in some areas of their weakness. Great majority of students 81.9% regarded OSCE as a practical and useful assessment tool in early years of medical education.
Discussion: It is assumed that overloading the students by trying to assess too many skill subsets of performance at a single station, and inadequate practice at being examined in the OSCE format might have contributed to the dissatisfaction with the time allocation.
Conclusion and recommendations: OSCE exam covers most of the objectives of the students, clinical rotation. However, at some stations the students felt that instructions were ambiguous and time allocation was inadequate for the assigned tasks. The overall feedback was very useful and facilitated a critical review of the process. Our recommendations are; increasing the duration of stations especially for history taking and cardiac auscultation, modifying the administration of the OSCE aiming at reducing the waiting time especially for the students in the last batch, ensuring clear instructions, having real patients for the expected tasks, and finally more training with the OSCE.
Keywords: OSCE, perception, medical students.

Early Detection of Chronic Obstructive Pulmonary Disease in Asymptomatic High Risk Male Smoker

Abdulhamza Rajooj Hmood

Kerbala Journal of Medicine, Volume 8, Issue 1, Pages 2070-2076

background: COPD is responsible for permanent morbidity, premature mortality, and great burden to the healthcare system. The most commonly encountered risk factor is tobacco smoking. Without screening, patients usually overlook early symptoms of cough and wheezes but commonly seek medical advice when they become dyspnic on mild to moderate exertion. By that time, half of their ventilatory reserves are lost. Spirometry remains the gold standard for diagnosing COPD and monitoring its progression.
Aim of study: since COPD is preventable condition, we tried to screen high risk individuals with the aim of early detection and prevention
Patients and methods: consecutive asymptomatic male smokers (n=170) were selected by high risk population screening. Participants were eligible if they were ≥ 30 years of age, regular smokers, had smoking history of >10 pack years with no significant respiratory symptoms except for occasional cough and willing to undergo spirometry.
Results: a total of 170 asymptomatic male smokers were screened by spirometry according to the American thoracic society and European respiratory society. Overall, airway obstruction was seen in 30 (17.6%) subjects. Mild obstruction was seen in 19 (63.3%) and moderate obstruction in 11 (36.7%) subjects.
Discussion: Airway obstruction was linked with duration of smoking (P value <0.001) and number of pack years (P value <0.001).
Conclusions and Recommendations: early detection of COPD by spirometry especially in smokers of more than 20 pack years is likely to reduce the overall burden of disease.

Surgical Outcome of Parotid Gland Tumours: An experience from two institutions in Iraq

Ahmed Abdullah Alwan; Ali Azeez Ali; Dhea Ghazy Taher; Nazar J. Metib

Kerbala Journal of Medicine, Volume 8, Issue 1, Pages 2077-2084

background: Approximately 80% of salivary gland tumours occur in the parotid gland. Of these, approximately 75- 80% are benign. Physical examination is the first diagnostic tool. Ultrasonography, CT and/or MRI are useful complementary studies for correct surgical planning. Fine-needle aspiration cytology (FNAC) is also indicated by some authors.
Objectives: To analyze the different types of parotid gland tumours, the modalities of surgical treatments and their complications, and the role of FNAC.
Methods: Data of 45 patients who were treated for parotid gland lesions, were analyzed retrospectively. FNAC was performed in 31 patients and concordance between FNAC and final histological diagnosis were assessed.
Results: Forty-five patients involved in this study (mean age 36.6 years); there was a female gender predominance. Most of the cases were benign. Pleomorphic adenoma was the most common benign tumour while mucoepidermoid carcinoma was the most common tumour in the malignant group. All tumours were localized in the superficial lobe. Most of our patients underwent a conservative superficial parotidectomy. FNAC was performed in 31 patients; there was 87% concordance between FNAC and final histological diagnosis. Sensitivity and specificity rates were 75% and 100% respectively and diagnostic accuracy was 97%.
Conclusions: The diagnosis of parotid gland neoplasm must be considered in any patient presenting with a mass near the mandible. Pleomorphic adenoma and Warthin‟s tumour were the most frequent histological types. Superficial parotidectomy appears to be the treatment of choice. Preoperative FNAC plays an important role in the accurate diagnosis of parotid tumors. Surgery was the only tool for definite diagnosis and definitely prevents long term malignant degeneration.

Laparoscopic Management of Hepatic Hydatid Cysts in Kerbala

Abdulrazzak Kalaf Hassan

Kerbala Journal of Medicine, Volume 8, Issue 1, Pages 2085-2092

background: Hydatid disease is a common problem in Iraq and Surgery is themainstay of treatment. This is a prospective study of those patients with liver Hydatidcyst who were managed surgically at Al-Hussain Medical City in Kerbala for a period of one and half year from January 2013 to June 2014.
Aim of the study: The aim of this study was to discuss the clinical presentations, diagnoses, and laparoscopic surgical treatment of liver hydatid cysts in comparison with other studies .
Methods: forty patients were enrolled in the study, data collected: preoperative assessment, type of treatment and postoperative follow-up until their discharge from our hospital.
The diagnosis was based on clinical examination, plain X-Ray, U/S & CT scan, MRI and MRCP.
Results and discussion: hydatid cyst forms the commonest space occupying lesion in the liver. The recurrent form of the disease was found in 12 patients (30% ) and the multiple liver hydatid found in 16 patients (40%). This relatively high incidence of recurrence and multiplicity of the disease indicate high prevalence of such pathology in our areas.
24 patients (60%) operated laparoscopically and 16 patients (40%) were operated by traditional opened method.
The surgical treatment of hydatid cyst were in form of: Excision and external drainage in 32 patients (80%), excision and omentoplasty in 8 patients (20%).
Post-operative complications included: Wound infection in 5 patients (12.5%), respiratory tract infection in 4 patients (10%), urinary tract infection in 3 patients (7.5 %), persistent drainage through the tube drain in 3 patients (7.5%), abscess collection in the residual cavity in 2 patients (5%) and persistent obstruction of the common bile duct in 1 patient (2.5%).
Overall morbidity was 45% of our patients. No mortality was recorded.
Conclusions: laparoscopic treatment of the hepatic hydatid cyst is a new method with great advantages and minimal disadvantage and we highly recommend to assess any patient for laparoscopic treatment.

A Prospective Study of Neonatal Pneumothorax in Holy Karbala

Firas Shakir Al-Fahham; Araji; Khalid Khaleel; Hasan Mohammedridha AL- Qazzaz

Kerbala Journal of Medicine, Volume 8, Issue 1, Pages 2093-2097

background: Pneumothorax is the accumulation of air in the space between the parietal and visceral pleura, and is potentially a very serious problem, especially if it occurs in the neonatal population.
Patients and Method: A prospective data of sixty newborn infants with pneumothoraces were observed and treated at the Neonatal Care Units in teaching pediatric hospital and gynecological and obstetric teaching hospital in karbala, Iraq, between January 2012 and January 2014 are included in this descriptive study.
Patients were evaluated for: sex, gestational age, birth weight; method of delivery; time of pneumothorax development; localization of pneumothorax and the presence of concurrent lung pathology.
Diagnosis of pneumothorax done by clinical assessment, and chest X-rays. symptomatic patients were treated with a tube thoracostomy and closed underwater drainage.
Results: Sixty neonates with pneumothoraces were included in this study. Sixty three percent of patients were male. Fifty five percent of patients were preterm babies. Fifty three percent were delivered by caesarean section. Seventy seven percent of pneumotoraces were on the right side. Seventy percent cases of pneumothoraces were presented within the first 48 hours of life. Seventy three percent diagnosed as respiratory distress syndrome which is the most common pathology. Mechanical ventilation was performed in 8 patients, including four of the six fatal cases. Tube thoracostomy and closed underwater drainage were performed in 56 patients (93%), while peumothorax resolved spontaneously in four cases. Mortality rate was 10%.
Conclusion: pneumothorax may develop during the neonatal period, especially in the presence of risk factors. Treatment is effective, if the disease is recognized and treated as early as possible.

Meta- Analysis to find out an ideal treatment for Acute appendicitis

Hadi Awad Hmoud

Kerbala Journal of Medicine, Volume 8, Issue 1, Pages 2098-2105

background: Open appendectomy (OA) was the standard procedure for inflamed appendix. First laparoscopic appendectomy (LA) was done in 1980 since then Laparoscopic Appendectomy has been gaining more popularity and approval despite the controversies that surrounding its safety and universal applicability.
Aim: This is a comparative study to evaluate the safety, effectiveness and the superiority of LA vs OA in treating the acute appendicitis.
Materials and methods: This retrospective study was performed by examining huge number of literatures and huge number of clinical observations regarding treatment of acute appendicitis after applying new parameters like patient selection, operating time, hospital stay, cost effectiveness, intra and postoperative complications, needs for painkillers, role of antibiotics, operative technique and cosmetic issues.
Result: Large number of studies have showed that LA is highly beneficial for young age group females, it shortens the hospital stay time, minimizes the need for post- operative painkillers, and it bears good cosmetic outcome. On the other hand it carries serious complications, it is time consuming technique, and it impacts big financial burden. While antibiotics use and modifying the type of operative techniques can improve the overall outcome for both modalities.
Discussion: This study has found that both laparoscopic and open appendectomy have some advantages and disadvantages, but logical evaluation of these outcomes clearly shows that, the LA impacts more serious and devastating complication, which may outweigh its benefits.
Conclusion: By careful reviewing of all above parameters we can reach an important decision regarding the ideal approach for operating on acute appendicitis, such decision gives the superiority for the OA over the LA in treating acute appendicitis, especially in an attempt to avoid devastating complications.

Modified Uterine Incision To Decrease Mortality And Morbidity In Placenta Accreta: Cohort Study

Falah A. Muhi; Ali Khairi Toman; Haitham F. Hamzha

Kerbala Journal of Medicine, Volume 8, Issue 1, Pages 2106-2112

background: Placenta accreta is an un common but potentially lethal complication ofpregnancy. It occurs when the placenta is abnormally adherent to the uterinemyometrium causing massive obstetric hemorrhage and still the
leading cause of pregnancy related deaths. The risk factors are previous lower
segment cesarean section, previous uterine surgery, endometrial defect like Sherman syndrome, presence of sub mucous fibroid, previous manual removal of placenta, vigorous and repeated curettage, previous myomectomy.
Objective: To find the best strategy for dealing with placenta accreta patients and to decrease the associated maternal mortality and morbidity.
Patients And Methods: 30 patients admitted in Alhindiya hospital between January 2008 and December 2013. Cohort study was conducted between 2 groups of patients with different management strategy. One group underwent the ordinary procedure of Caesarian section, while modification of uterine incision were done for the other group considering opening the uterus at a site distant from the placenta (high U shape incision), and delivering the baby without disturbing the placenta, then closure of the uterus in order to enable elective hysterectomy to be done. Analysis of data was done. Results & discussion: Thirty cases of placenta accreta were identified between January 2008 and December 2013. Placenta accreta was diagnosed either with ultrasound or MRI examinations. The patients had been divided into two groups with different management strategy. Analysis of operative and post-operative complications was done, and we found that scheduled caesarean hysterectomy performed under controlled circumstances with modified high uterine incision without attempting to remove the placenta before hysterectomy was associated with significantly decreased maternal morbidity and mortality. Conclusion: Scheduled caesarean hysterectomy performed under controlled circumstances with modified high uterine incision without attempting to remove the placenta before hysterectomy was associated with significantly decreased maternal morbidity and mortality.

A Comparative Study OF Three Lines Of Surgical Management Of Hemorrhoidal

Ali Hussein Abid Suwailem

Kerbala Journal of Medicine, Volume 8, Issue 1, Pages 2113-2117

background: Disease is a common problem in surgical practice is hemorrhoidaldisease.
Objective: to compare three different methods of treatment of second and uncomplicated third degree piles.
Subject and Methods: This prospective study compares three different methods of treatment in 180 patients of second and uncomplicated third degree piles. The patients were allocated randomly in equal numbers to three groups: Group A- treated by conventional excision ligation Milligan Morgan, Group B-treated by pilesuture and Group C-treated by rubber band ligation.
Results and Discussion: The average period of follow up after completion of treatment was 36 months. Patients were assessed for early complications; Pain-Urine Retention-and bleeding. Late complications;-anal stenosis, recurrence-Length of hospital stay and Time-off work. We consider that conservative treatment methods are preferable to conventional excision ligation for treatment of second and early third degree piles.
Conclusion: Of the two conservative methods used in this study, the pile suture seems to be the method of choice.

Choledochoduodenostomy in the Management of Common Bile Duct Stones

Hayder Talib Al-Mousawi

Kerbala Journal of Medicine, Volume 8, Issue 1, Pages 2118-2122

background: Choledochoduodenostomy (CDD) is the operative procedure for choledocholithiasis in the presence of a dilated common bile duct (CBD). It has been reported as the most effective procedure of CBD stones than T-tube drainage.
Aim: To evaluate the outcome of Choledochoduodenostomy in our center.
Patients and Methods: This is a prospective study to assess the aforementioned issues analyzing our seven years (March 2001-June 2008) experience in Al-Kadhimiyah Teaching Hospital.
CDD was performed in 13 patients (12 female: 1 male) with age between 40-60 years.
Results & discussion: CBD stones were the only indication in all patients with associated cholecystitis, in 12 patients (92.2%) and biliary colic in 1 patient (7.7%) for recurrent stones. Abdominal sonogram showed dilated CBD with single or multiple stones. The diameter of CBD varies from 15-30 mm with stone size being ranged from 10-25 mm.
No early post-operative complication. Only one patient had recurrent cholangitis (sump syndrome).
Conclusion: CDD is highly effective treatment of choledocholithiasis in all age group with low morbidity and mortality provided a wide anastomosis is accomplished.

Outcomes of Intracytoplasmic Sperm Injection in Obstructive and Non-Obstructive Azoospermia

Hamid Hussein Alkelaby; Sahib Yahya Almurshidi; Raed Talib Madlool

Kerbala Journal of Medicine, Volume 8, Issue 1, Pages 2123-2130

background: infertile couples due to male factor reasons present with azoospermia asa cause of their infertility can positively benefit from intracytoplasmic sperminjection (ICSI) for fathering genetics offspring's.
Aim of study: to compare the intracytoplasmic sperm injection outcomes in obstructive and non-obstructive azoospermic men.
Materials and methods: A retrospective study compromised 42 couples seeking for treatment due to azoospermia as a cause of infertility. 19 men out of 42 had obstructive azoospermia (OA) and the remainder 23 man had non-obstructive azoospermia (NOA). All those males underwent surgical sperm retrieval techniques either testicular sperm extraction (TESE) in all NOA cases and some OA cases or percutaneous epididymal sperm aspiration (PESA) in the rest of OA cases. Sperms retrieved surgically were used either fresh or after cryopreservation for ICSI and the main outcomes; fertilization, cleavage and pregnancy rates and embryo quality were compared statistically. Data were expressed as mean ±SD and number and percent, and groups were compared by compares of two independent means. Dif-ferences were considered significant at p <0.05.
Results: the results revealed significant reduction (p <0.05) in the fertilization rate in couples with NOA (38.2%) compare to (59.5%) for OA group, as well as a significant drop in cleavage (80.6% vs 68.9%) and pregnancy (31.57% vs 13.04%) rates was also shown in NOA group. The mean number of embryos (5.88±3.46 vs 3.33±2.54, p <0.017) obtained by ICSI and percent of good quality embryos (55.2% vs 31.37%, p <0.014) were significantly higher in OA group.
Conclusion: type of azoospermia has greater effect on the success of ICSI cycles. The immaturity of testicular sperm in NOA can affect fertilization, embryo development and pregnancy rate.

Outcome of Pediatric Low Grade Gliomas in Developing Countries: the Impact of Elimination of Radiotherapy

Usama Ahmed Al-Jumaily

Kerbala Journal of Medicine, Volume 8, Issue 1, Pages 2131-2140

ackground: The care of pediatric low grade gliomas (LGG) of central nervoussystem in developing countries is still suboptimal. By introduction of chemotherapyand avoiding of radiotherapy in children, better outcome should be achievable.
Objectives: to evaluate the impact of replacement of radiotherapy by chemotherapy on the survival rate for children with LGG.
Methods: A retrospective study was conducted of records of patients (n=85; 48 males; median age 6 years) with LGG from May 2003 to December 2009 at King Hussein Cancer Center, Jordan. Patient demographics, tumor characteristics, treatment plan, and outcomes were studied.
Results: Five-year event free survival (EFS) and overall survival (OS) rates were 60%±7.3% and 92%±4.1%, respectively. The most common tumor site was the Posterior fossa/cerebellum and the suprasellar/hypothalamic area (n=23 each). The most common pathologic diagnosis was pilocytic astrocytoma (n=62). Initial surgical interventions were gross total resection (n=21), subtotal resection (n=20), and partial resection/biopsy (n=39). Posterior fossa tumors were more likely to have gross total or subtotal resection (n=17) compared to tumors in other sites. The most commonly used chemotherapeutic regimen was carboplatin/vincristine (n=29) followed by Vinblastine (n=6). There was a significant difference in the 5-year EFS by the tumor location (P=0.048) and degree of surgical resection (P=0.023). There was no statistical significance in outcome by the type of chemotherapy used (P=0.57).
Conclusions: LGG management in developing countries can be improved through a multidisciplinary approach. The main impact of this approach was the elimination of radiotherapy from the management of most patients with LGG.

Scattered Radiation to The Operators During Fluoroscopy XZS

Header S.Jaafer; Ali T. Mohi; Ahmed S. M. Imran

Kerbala Journal of Medicine, Volume 8, Issue 1, Pages 2141-2147

background: Since the discovery of the roentgen ray in 1895, radiography and fluoroscopy remained the stanchion of diagnostic radiology for decades. During fluoroscopy procedures the radiation exposure of staff arises due to scattered radiation. The adequacy of shielding for secondary radiation depends on the material and thickness used for this purpose.
Aim of the study: This work studies the secondary shielding for the control booth of fluoroscopy room in AL –Hussaine teaching hospital of Karbala city, Iraq.
Materials and method: By considering the fluoroscopy room design and the radiographic devices profiles used, the clinical total workload per week and total workload per patient have been computed and its distribution according to the most widely used voltages has been determined by recording the actual clinical technical values of maximum ,average and minimum As and the corresponding values of kilovolt peak for 217 patients over five months. As a diagnostic x-ray radiation shielding reference, the National Council on Radiation Protection and Measurements report No.147 (NCRP report No.147) and XRAYBARR computer program have been used to compute the secondarybarrier thicknesses of the control booth of the fluoroscopy room for lead and glass.
Results and discussion: It is found that the total workload per week of NCRP report No.147 is about equal that of calculated for average state and about 1.6 times that of calculated workload for busy state.
Conclusion: The shielding status of control both was quite sufficient ,and about 1 mm of lead was used to shield the front wall and lead glass was used in the shielding of observation window

A Study to Determine the Commonest Type of Renal Stone inIraqi Patients Admitted to Al_ Hussein General Hospital in Kerbala

Weaam Awad Kadhim

Kerbala Journal of Medicine, Volume 8, Issue 1, Pages 2148-2151

background: Kidney stones (calculi) are known to be one of the most painful medicalconditions. The causes of kidney stones vary according to the type of stone.
Aim: This study was employed to determine the incidence of kidney stones type in a group of patient in Kerbala from 2010 to 2012 in which 121patients were enrolled.
Patient and method: eighty six males and thirty five females were evaluated to determine the type of kidney stone that they had. The age average was between 30 and 50 years .
Results and discussion: It was found that uric acid stones has the highest rate of incidence (52.9%) in both sexes (70.31 % in males and 29.69 % in females). The second rank (27.8%) was occupied by calcium oxalate stones (69.7 % in males and 30.3% in females), the magnesium phosphate stone constitute about 11.5% of all the stones that were collected (64.3 % in males and 35.7 % in females) and cysteine stone constitute 4% (60% in males and 40% in females) was followed. In this study it was observed that xanthine and mixed stones were found in males only in small ratio (2.5% and 1.65% respectively).
Conclusion: it is clear that the most common type of renal stone affecting people in Kerbala was uric acid stone which may be due to dietary habit.

Assessment The Relationship between Upper and Lower Anterior Teeth Segment and Gender Difference: A Sample of AL Muthanna University Students Aged 18-25 Years Old

Hayder S. Al-Atabi

Kerbala Journal of Medicine, Volume 8, Issue 1, Pages 2152-2160

background: The assessment of the occlusal features of the anterior segment of thedental arch is considered of vital importance, especially for adult as it affects estheticsgreatly. With the increase in esthetic demands and dental awareness with the vital importance of the anterior teeth in esthetic, function and phonetics. The present study was directed to analyze anterior segment in subjects with class one occlusion. This study that dealt with adult subjects while the previous studies mostly analyzed children. Epidemiological studies are one of the most significant methods which provide adequate information and knowledge about the distribution and prevalence of the occlusal features. Direct metric measurements proved to be helpful and effective for this purpose.
Objectives: This study was designed to assess the relationship between upper and lower anterior teeth segment and gender difference and effect of this relationship on malocclusion.
Materials and methods: This study was conducted from 30 September 2012 to 1 may 2014 on (1771) students in University of Almuthanna ( College of medicine (255), College of Engineering (437) and College of Science (1079)) were clinically examined, only (300) of them were selected who fulfilled the required specifications, (150) students for each gender. Their age was ranging from 18 to 25 years, were studied with respect to relationship of upper and lower anterior segment , overjet, overbite, anterior crossbite ,crowding and spacing.
Results: The normal overjet were presented in (65.3%) students (64.4%) males and (66%) females, increased overjet were presented (24.3%) students (24%) males and (24.6%) females and decreased overjet were presented in (10.4%) students (11.4%) males and (9.4%) females). Normal overbite were presented in (53%) students (52%) males and (54%) females, increased overbite were presented (16.7%) students (16%) males and (17.4%) females, decreased overbite were presented in (30.3%) students (32%) males and (28.6%) females). The anterior crossbite were presented in (8.6%) students (8%) males and (9.3%) females) .Upper segment crowding were presented in (17%) students (18%) males and (16%) females), lower segment crowding were presented in (19%) students (19.4%) males and (18.6%) females). Upper segment spacing were presented in (16.4%) students (17.4%) males and (15.4%) females), lower segment spacing were presented in (11%) students (12%) males and (10%) females),
Conclusion: This study displays more crowding percentage in the lower segment and display more upper segment spacing for total( male and female students),there was no significant difference between males and females in overjet, overbite, anterior crossbite ,crowding and spacing.

The Effects of Social Media on the Undergraduate Medical Students

Amjed Hassan Abbas; Samir Sawadi Hammoud; Shahlaa Khazal Abed

Kerbala Journal of Medicine, Volume 8, Issue 1, Pages 2161-2166

background: In recent years, social media like Facebook, Twitter, and YouTube havebecome the most visited websites in the world, with Facebook topping the list andrecently the use of social networking sites has grown tremendously especially among the students. However, very little informations are known about the scale and purpose of use, how students use these sites and, more specifically, whether these sites help or hurt their academic progress.
Aims of the study: The purpose of this study is to explore the impact of social media on undergraduate medical students of Babylon University.
Method: A research questionnaire was designed to determine the factors of social media that have impact on students. Variables identified are age, gender, stage of student, type and duration of use of social media used, effect on study timings, time and duration of sleep at night, the number of days per week, benefit in the medical field, effect on scientific level, continuous sharing with teacher on these sites, and benefit from site of medical college. About 510 undergraduate medical students in Babylon University were randomly selected, six groups were taken according to the six stages of the medical college (85 students in each group).
Results & discussion: The study revealed that ages of students range from 18 to 24 and female students form the largest percentages in all groups. From this research study it was also found that the highest percentages of students in all groups used Facebook and YouTube more than other types of social media and spend about 2 hours on internet. In addition to that higher percentage of students had a benefit from site of medical college and they had same or increased scientific level, moreover there was no relation between duration of use of social media and sleep with study timings and scientific level.
Conclusion: Our study concluded that most of students in all groups use only two types of these media, majority of students spend all days of the week using these media, there was no continuous sharing with teacher in all groups and in most of students there was a benefit from site of medical college. The study also showed that duration of use of these networks has no effect on scientific level of students and most of students has the same or increased scientific level.

Oral Misoprostol Versus Vaginal Surgical Evacuation of First Trimester Incomplete Abortion; A comparative Study

Falah Abdul Hade Muhi; Haitham F. Hamzha

Kerbala Journal of Medicine, Volume 8, Issue 1, Pages 2167-2171

background: Vaginal surgical evacuation of retained products of conception was the main stay of treatment for a long time for patients with first trimester incomplete abortion. Misoprostol as a thermo stable prostaglandin E1 analogue has been previously tested in the management of incomplete miscarriage in different regimens and setting. Overall results indicate efficacy, effectiveness and acceptability in most of these studies.
Objectives: To assess the effectiveness and acceptability of using oral misoprostol for management of first trimester spontaneous incomplete abortion as an alternative to direct vaginal surgical evacuation.
Methods: This is a comparative study performed on 84 patients with first trimester incomplete abortion between 6 -12 weeks of gestation requesting medical management .They were divided into two groups; group (1) received misoprostol tablet 200 μg [misotac ,SIGMA] two tablets every 4 h for a maximum of four doses while group (2) underwent surgical vaginal evacuation directly under general anesthesia.
Results: In 100% of cases , misoprostol was successful in 79% (p= 0.0006). The overall satisfaction was slightly higher in the surgical group but almost equal percentage of both groups mentioned that they will recommend the method to a friend. No serious side effects or complications were reported in misoprostol group. The incidence of excessive post-abortive bleeding was more in the misoprostol group than the surgical evacuation group (p=0.336). Also endometrial thickness using ultrasonography was significantly thicker in the misoprostol group than group (2) [p=0.0071].
Conclusion: Although vaginal surgical evacuation is more effective than misoprostol in solving the problem still medical treatment is effective and acceptable especially when surgical management is not available or risky or patients refuse to do surgical management.

Feeding Problems and Nutritional Assessment in Children with Autism

Enas Tariq Wtwt; Hadeel Fadhil Farhood

Kerbala Journal of Medicine, Volume 8, Issue 1, Pages 2172-2186

background: Autism is a brain developmental disorder characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Feeding disorders common in children with autism and considered as a major concern for their parents. Selective or "picky eating" is a frequent problem in children with autism.
Objectives: To identify common feeding problems in children with autism and to assess the nutritional status of children with autism.
Method: A descriptive cross – sectional study conducted to determine feeding problems and to assess nutritional status in children with autism, in period between the 1st of February to the 31th of May 2014. A convenient sample of (70) child with autism has been collected from (3) specialized institutes for mental handicapped, slow learning, difficult speech and autism, (Al Rehma Institute of Autism and Babil Specialized Institute of Autism in Babylon city and Al Imam Al Husien Institute of Autism In Karbala city). Data obtained include questionnaire and Anthropometric measures: Weight, Hieght, calculating BMI, and plotted them on growth charts (BMI for age).
Results: The study included 70 patients that 56 (80%) were males and 14 (20%) were females with male to female sex ratio of 4:1, whose Mean age ± SD (5.95 ± 1.77) years old. Of those 4 (5.7%) were under weight, 28 (40%) were normal weight and 38 (54.3%) were overweight/obese. The percentage of autistic children who had select food type, select food texture, food refusal, food allergy were (47.1%), (52.9%), (40%), (11.4%) respectively. Children who exhibit pica were (25.7%).
Conclusion: More than half of children with autism were overweight/obese. Males affected more commonly than females. No significant association between type of feeding during first six months of life, age at weaning and signs of hungry with nutritional status of autistic children. All the underweight autistic children had history of feeding problems like selective food by either type or texture, behavioral problems during feeding, food allergy and diarrhea. The overweight autistic children had history of sitting position during feeding, more than three meals per day, and more than 30 minutes duration of meal. Pica is common in autistic children.