Issue 2

For Unknown Reasons, Accidentally Inhaled Pins Have Tendency for Left Sided Bronchial Lodgment

Hayder Sabeeh Al Saffar; Roussul Faihan Musa

Kerbala Journal of Medicine, Volume 8, Issue 2, Pages 2187-2190

background: the higher incidence of right sided bronchial impaction as compared to left sided one is a very old medical fact regarding inhaled foreign bodies, in recently published literatures, and in our expanding experience, we were hardly accept that there might be something different, it looks like that this fact is a (type of foreign body) dependent type.
objectives: The ensuing problem in the last decade of inhaled pins had it's certain clinical characteristics, one of them, which is discussed at our literature, is the strange tendency of the pins to be lodged in the left sided bronchi, contrary to the well known tendency of the inhaled foreign bodies to be lodged in the right sided bronchi due to well-known tracheobronchial anatomical factors.
Methods: A retrospective study of 24 patients positive with pin inhalation presented during the period from 15/9/2009 to 4/7/2014 at Hilla General Teaching Hospital, site of lodgment was analyzed to be either tracheal, right or left bronchial. Site of lodgment was decided depending on CXR, bronchoscopic and sometimes operative findings.
Results: Total number of patients was 24, In 15(62.50%) of them the pins were settled at left bronchi, In 5(20.83%) patients, the pins were at trachea, and 4(16.66%) patients were with right bronchial pins.
Conclusion: Metallic pins have strange tendency for left sided bronchial impaction

Supracondylar Fracture of Humerus in Children A Follow up Study of Sixty Eight Cases

Saad Sahib AL-Nasir

Kerbala Journal of Medicine, Volume 8, Issue 2, Pages 2191-2196

background: supracondylar fracture of humerus in children is extremely common. It accounts for approximately (65%) of all fractures and dislocations in children , constituting the most common pediatric elbow fracture .
Aim: the aim of this article is to study causes ,pattern ,and outcome of management of this important fracture and how to ovoid and treat its complications.
Design: a descriptive case series study, to study the behavior and management of supracondylar fracture of humerus.
Patients & methods: our study was designed to study this type of important fracture by careful follow up of sixty eight (68) cases collected from the period (2001-2013) in Karbala, the cases was managed in Emam Hussien Medical City, Alhyndia general hospital and Alabbas private hospital.
Result: the peak age of incidence at six years , with male to female ratio of 4:1, type I and II need only conservative treatment . type III (majority need open reduction and internal fixation), stiffness of elbow was the common complication (28%) of cases.
Discussion: In our study the peak age of incidence was six, this compared well with reports published elsewhere, 38% of our patients were treated surgically and this also compared well with other articles.
Conclusion: supracondylar fracture of humerus need a proper and accurate treatment to avoid complications, and adequate radiological assessment is very important to decide type of management. Complications should be recognized and adequately treated to avoid permanent deformity .
Keywords: supracondylar fracture of humerus, Gartland classification, cubitus varus, elbow stiffness.
Abbreviations: k.wire: kirschner wire, SCFH: Supracondylar fractures humerus, ORIF: open reduction internal fixation.

Diagnostic Errors of Non-Traumatic Acute Abdomen

Hadi Awad Hmoud

Kerbala Journal of Medicine, Volume 8, Issue 2, Pages 2197-2201

background: Acute abdomen is a relatively common issue that facing hospital casualties, which make it crucial for physicians to diagnose acute abdomen, as early as possible depending mainly on their clinical skills to avoid unnecessary delay or negative laparotomies. Every physician must be familiar with diagnosis of acute abdomen especially in situations where there is limited diagnostic facilities.
Aim: This study was conducted as a comparison between preliminary and final diagnosis for 500 cases of acute abdomen, and to find out the role of clinical skill and diagnostic tools in avoiding diagnostic errors.
Method: This study was performed from 1996-1998, and included 500 patients presented to casualty department with signs and symptoms of acute abdomen. Clinical skills were the major tools used for settling the diagnosis, due to shortage of the other diagnostic tools.
Results: Acute abdomen was common in the age group of 21-30 years, with male gender predominance (60.80%). Laparotomy was done for 462 out of 500 patients with acute abdomen, and it was similar to the pre-operative diagnosis in 421 patients, so the incorrect post-operative diagnosis rate was 41 patients (8.88%).
Also correct preliminary diagnosis was 454 out of 500 patient including the patients who underwent laparotomy, with false preliminary diagnosis rate (9.20%).Appendicitis was the major cause for acute abdomen (70.60%).
Limited laboratory and imaging studies were done for some patients, GUE showed the highest negative predicted value (99.42%) and the x-ray showed the highest sensitivity (95.24%). Most of incorrect post-operative diagnosis was related to physiological and pathological gynecological issues.
Conclusion: The diagnosis of acute abdomen should be based on the results of a good history and thorough physical examination aided by the secondary role of investigative tools. Diagnostic modalities could guide the physician in confirming the diagnosis. An accurate diagnosis of acute abdomen can minimize unnecessary operations and reduces the rate of negative laparotomies.
Keywords: Acute abdomen, Laparotomy, Diagnosis

Protein C Deficiency in Patients with Retinal Vein Thrombosis

Rahem M. Rahem

Kerbala Journal of Medicine, Volume 8, Issue 2, Pages 2202-2206

introduction: Retinal vein occlusions are the most common retinal vascular disorder after diabetic retinopathy with several ocular and systemic disorders associated with retinal veins thrombosis. Protein C deficiency as part of inherited thrombophilia due to deficiency of natural anticoagulant may associated with retinal vein thrombosis.
The aims of this study were to measure the Protein C concentrations in patients with retinal vein thrombosis and to evaluate its role in the etiology of those patients.
Patients, materials and methods: During a period of 6 months a total number of 42 patients who were diagnosed with retinal vein thrombosis while attending the out patient clinic in Karbala, Iraq. From each patient appropriate amount of venous blood was withdrawn and estimated for plasma protein C level, Complete blood count, blood film, ESR, Kaolin clotting time, anticardiolipin antibodies, antinuclear antibody, TSH, blood urea, serum creatinin, random blood sugar and serum cholesterol. For control group individual only protein C estimation was done.
Results: Forty-two patients with retinal vein thrombosis were investigated. There were 22 females and 20 males and a mean age of 48 ± 2 years with no significant statistical differences in mean age and sex between the patients and the control group. Decreased levels of PC were found in six (14%) of the patients, and a statistically significant difference was seen for PC concentration between the patients and the control groups.
Conclusions: Deficiency of natural anticoagulant proteins, especially protein C, may play a role in the etiology of retinal vein thrombosis and measurement of these parameters with proper prophylaxis especially in young patients may be useful in prevention of venous thrombosis.

Assessment of Adenoids Hypertrophy by Plain X-ray and Nasoendoscopy in Karbala

Ahmed Abdullah Alwan; Anwar Sadeq Al-Dahan; Alaa Challab Mutar

Kerbala Journal of Medicine, Volume 8, Issue 2, Pages 2207-2213

background: The pharyngeal tonsil, also called adenoids, is the upper extension of thelymphatic Waldeyer’s Ring and is located on the upper posterior wall of thenasopharynx. A great deal of interest has been given to diverse methods of examinations and parameters for identification and evaluation of adenoids hypertrophy.
Objectives: To clarify the accuracy of both lateral plain x-ray of the soft tissue of the nasopharynx and nasoendoscope in evaluation of the adenoids size.
Methods: One hundred-fifty patients presented with nasal obstruction or mouth breathing suspected to have adenoids hypertrophy were seen and examined in the outpatients clinic of E.N.T Department of Al-Hussain Teaching Hospital, Karbala from August to November, 2014. All of the patients evaluated clinically, by lateral plain x-ray of the soft tissue of the nasopharynx and nasoendoscope to determine the size of adenoids.
Results: A total of 150 patients presented with nasal obstruction or mouth breathing, there were 83 (55%) males and 67 (45%) females patients (M/F 1.2:1). According to plain x-ray of the nasopharynx, large size adenoids was seen in 77 patients (51%) , moderate size in 49 patients (33%) , and small size seen in 24 patients (16%). According to endoscopic assessment, the commonest grade of adenoids size was the grade IV seen in 47 patients (31%) and the least common grade of adenoids size was grade I seen in 16 patients (10.7%), while grade II was seen in 44 patients (29.3%), and grade III seen in 43 patients (29%).
Conclusions: Evaluation by endoscope was highly accurate than evaluation by X-ray. Hence, children with classical symptoms of upper respiratory tract obstruction, even without adenoids hypertrophy revealed by X-ray, suggested to be submitted to nasoendoscope for diagnostic accuracy, which is greatly relevant especially for more secure indication of adenoidectomy and help in avoiding unnecessary operation

Preterms in the Neonatal Care Unit at Babylon Maternity and Children Hospital: Prevalence, Morbidity, Mortality, and Risk Factors

Rehab Faisal Laftah

Kerbala Journal of Medicine, Volume 8, Issue 2, Pages 2214-2221

background: Prematurity and its complications are the major cause for neonatal
morbidity and mortality. Often, the cause of preterm labor is unknown, but several
etiological risk factors have been identified
Objective: Regardless the causes for hospitalization, this study was designed to determine
the prevalence, mortality, morbidity (determined by duration of hospitalization and referral to
pediatric intensive care unit PICU) of preterm baby among patients admitted into the neonatal
care unit, and some of the possible underlying risk factors for preterm births.
Method: During a period of seven months from 2 December 2012 to 28 June 2013, a
nonrandomized sample consisted of 200 neonates that had been admitted into neonatal care
unit “NCU” at Babylon Maternity and Children Hospital was involved in this cross sectional
descriptive study. Same questionnaire was applied for all cases, then patients were divided
into 2 groups according to gestational age (<37w and ≥37). Test of proportion and chi-square
were used to determine significant differences between the groups.
Results: Prematurity and its complications are responsible for 72/200 (36%) of neonatal
hospitalization and 3/6 (50%) of neonatal death. Females constitute 35/72 (48.61%) of
preterms and 44/138 (34.37%) of terms with p value < 0.05. 8/48 (16.66%) of preterms and
7/95 (7.36%) of terms need referral to PICU with p value > 0.05. Regarding hospitalization,
preterms had longer duration than term neonates (p value <0.05). 51/187 (27.27%) of neonate
had been discharged on their parents’ responsibility, and 20/51 (39.21%) was preterm.
Multiple gestation is a risk factor for death in preterm babies, while obstetrical factors had a
correlation with the occurrence of preterm births (p value <0.05), with premature rupture of
membrane being at the top of the list.
Conclusion: Prematurity and its complications are the major causes for neonatal
hospitalization and death and need longer duration of hospitalization than terms. For preterm
birth, females are at greater risk and the presence of obstetrical factors increase its

Soft Tissue Cephalometric Norms for a Sample of Iraqi Population Group Using Legan and Burstone Analysis

Noor F. K. Al-Khawaja; Zainab Moussa Kadhom; Rawof Rasheed Al-Tuma

Kerbala Journal of Medicine, Volume 8, Issue 2, Pages 2222-2228

background: Most classical norms are not applicable to diverse racial and ethnic population and this study was to establish the soft tissue norms of a sample of Iraqi population group using Legan and Burstone’s soft tissue analysis.
Materials and methods: The study was conducted on 60 adult subjects (30 males and 30 females) with esthetically pleasing profiles aged 18–25 years. Standardized lateral cephalograms were taken in a natural head position and analyzed.
Statistics: Descriptive statistics and Standard error of each measurement was calculated. Independent sample t-tests were used to compare the measurements of male and female subjects. One sample t test was used to compare our data with Caucasians group
Results and discussion: Iraqis had more convex faces, maxillary prognathism and high variability regarding mandibular prognathism than Caucasians, a more protrusive upper lip, the nasolabial angle was more obtuse, the lower lip was protrusive resulting in a deep mentolabial sulcus, the lower face–throat angle was more obtuse, the maxillary incisor exposure was more, all vertical ratios and the interlabial gap was similar. Regarding to gender differences in Iraqis, the vertical height ratio was greater in females and the lower face-throat angle was larger in males. Males had less nasolabial angle than females.

DNA Quantitation in Pediatric Acute Leukemia

Najiha A. Ameen; Safa A. Faraj; Hasanein H. Ghali

Kerbala Journal of Medicine, Volume 8, Issue 2, Pages 2229-2234

background: Deoxyribose Nucleic Acid (DNA) ploidy, and immunophenotyping are now established as prognostic markers, however provide vulnerable information regarding long term outcome of acute leukemia.
Aims of study: To establish a histochemical quantitation of nuclear DNA content of acute leukemia patients by Microspectrophotometry (MSP).
Patients and methods: Prospective study on (55) patients with newly diagnosed acute leukemia from Children Welfare Teaching Hospital / Medical City Complex during the period from October 2002 to June 2003 and (10) patients with viral lymphocytosis as control group. MSP technique was used to determine the DNA content in leukemia blasts nuclei. Data were tabulated using SPSS (Statistical package for the social sciences) version 18.0 for windows. P-values equal or less than 0.05 were considered significant.
Results: DNA cytochemical quantitation was studied after applying Feulgen stain. The amount of DNA per nucleus were expressed as means optical density × 10-3. The results showed that the mean DNA value was (0.545) while that of control group was (0.418). The ALL group was shown to have significantly higher mean OD compared to other groups.The frequency distribution of the different groups shows that there is homogeneous population of the mean OD of Feulgen stained nuclei for the control, AML, and AUL groups while it shows a heterogeneous population for ALL group. In comparison with the range of OD of nuclei of the control group, leukemia cases can be differentiated into diploid and aneuploidy classes. DNA aneuploidies were identified in (12/55) cases analyzed, thus accounting for (21.8%). For the ALL group, the mean OD readings in (18) patients (60%) were within the diploid region while (12) were outside the range (aneuploidy type) (40%).
Conclusions: DNA quantitation determined by MSP may represent an additional factor to improve the definition of risk groups of acute leukemia, it will continue to be a valuable tool for understanding tumor growth heterogeneity.

Frequency Of Potential Adverse Effects Of A Semisynthetic Statin (Simvastatin) Compared To A Synthetic Statin (Atorvastatin) Used To Reduce Cardiovascular Risk For Patients In Basra

Abdullah S. Asia; Al-Mahdi A. Modar; Hadi M. Ali

Kerbala Journal of Medicine, Volume 8, Issue 2, Pages 2235-2239

background: The confirmed benefits of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) for cardiovascular and cerebrovascular disease are well recognized in the medical literature.
Objectives: This study aimed at examining the frequency of potential side-effects seen as a result of statins therapy, because of the importance of statins adverse effects.
Therefore, this paper aims to evaluate the frequency of potential adverse effects reported by patients using a semi synthetic statin (Simvastatin) and the synthetic statin (Atorvastatin) in Al-shafaa general Hospital in Basra.
Patients and Methods: A total of 350 patients were included in this cross – sectional study to evaluate the frequency of potential adverse effects reported by patients using a semi synthetic statin (simvastatin) and the synthetic statin (atorvastatin) from November 2014 to March 2015 at the out-patient departments of Al-shafaa general Hospital in Basra.
Results & discussion: 246 patients (70.3%) report about 302 symptoms, overall symptoms reported were similar between the two types of statins and included muscle pain, joint pain, increased serum transaminase enzymes, gastrointestinal effects, respiratory effects and hair falling effects. The only adverse effects significantly reported for simvastatin more than atorvastatin were headache and dizziness. The side-effects were not severe enough to discontinue administration of statins.
Conclusions: There is no significant difference in the frequency of potential side effects reported by patients using a semi synthetic statin (simvastatin) and the synthetic statin (atorvastatin), apart from headache and dizziness reported significantly with simvastatin more than atorvastatin.

Inter-arm Blood Pressure Difference in Type 2 Diabetic Patients and Ambulatory Blood Pressure Monitoring :A Clinical Dilemma

Hassan Salim Abdulsada

Kerbala Journal of Medicine, Volume 8, Issue 2, Pages 2240-2251

background: Frequently coexistent condition in type 2 diabetes mellitus is hypertension and vice versa. Measurement of blood pressure by ambulatory blood pressure monitoring is superior to ordinary blood pressure . Blood pressure disparity reflects vascular diseases which diabetic patients liable for. Inconsistency in selecting the proper arm for blood pressure measurement may create a clinical dilemma in the presence of systolic and/or diastolic disparity.
Aim :We tried in this study to set proper steps in choosing the suitable arm for ambulatory blood pressure monitoring cuff fitting.
Material and Methods :Consecutive 140 type 2 diabetes mellitus patients aged 29 years and elder were examined by sequential ordinary blood pressure and simultaneous dual ambulatory blood pressure monitoring.
Results: Systolic disparity grade I was dominant (75.7%) as well as diastolic disparity grade I (86.4%). The mean systolic and diastolic blood pressure in the dominant arm was higher than that in the non-dominant arm with significant pressure differences (<0.001).Age and duration of diabetes had positive impacts on systolic and diastolic disparities while gender and Hemoglobin A1C had no impacts. Systolic and diastolic blood pressures were significantly different in both arms when studied over day-time, night-time, and 24-hours ambulatory monitoring. Systolic and diastolic differences in the dominant arm and the non-dominant arm had been shown to have significant mean differences with the mean ambulatory day-time blood pressure.
Discussion: Sequential method is an accepted modality and the arm with the higher systolic and/or diastolic blood pressure is the suitable arm for ambulatory monitoring and generally mirroring OBP

Difference between Pro- & Anti-Inflammatory Cytokines in Latent Autoimmune Diabetes of Adult (LADA) and Diabetes Mellitus Type2 (D.M.2)

Sawsan M. Jabbar AL-Hasnawi; Salman A. AL-Jiboury

Kerbala Journal of Medicine, Volume 8, Issue 2, Pages 2252-2257

background: Immunological profile of LADA is not so clear, so detection ofcytokines is relevant to determine the extent and direction of immune responses.
Objective: the aim of the study is to identify role of pro-& anti-inflammatory cytokines in diabetes progression and their relation with diabetes complications.
Methodology: level of the pro-inflammatory cytokines IL-6 and IFN-γ and the anti-inflammatory cytokine IL-1 receptor antagonist (IL-1RA) were estimated in 90 subjects (34 known LADA cases, 36 D.M.2 cases & 20 healthy control participants), participating patients were recruited from Diabetes outpatient clinic in AL-Hussein Teaching Hospital in Karbala from June, 2013 through January, 2014. A clinical questioner containing personal data, family history, type of diabetes, hemoglobin A1C( HA1C), body mass index (BMI), diabetes duration& complications of diabetes was obtained from all patients. Statistical analysis done by using the statistical package for social sciences (SPSS) software for windows, data of all participants were entered and analyzed with appropriate statistical tests.
Results: levels of IL-6 & IL-1RA were significantly higher in D.M.2 and LADA cases than controls & both are associated with complications in D.M.2 patients, in addition to positive significant correlation between them. Regarding IFN-γ, it was significantly higher in LADA group than D.M.2 group.
Discussion: Levels of IL-6 & IL-1RA are increased in complicated cases for both LADA & D.M.2 groups & IFN-γ is more in LADA group.
Conclusion: up regulation of both pro- and anti-inflammatory mediators to ameliorate inflammation in pathogenesis of diabetes.
Recommendation: Further studies on IL-1RA in diabetes are recommended to see the useful effects of IL-1RA in preserving β-cell function and its therapeutic role in both autoimmune & type 2 D.M.

Incidence and Diversity of Antimicrobial Resistance Profiles of Enterobacteriacae Bacteria in the Cervico-Vaginal Epithelium of Women in Holy Kerbala Province

Mousa Mohsin Ali; Mohanad Mohsin Ahmed

Kerbala Journal of Medicine, Volume 8, Issue 2, Pages 2258-2264

background: Although vaginal colonization by bacterial species of theenterobcacteriacae family, the significance of their antibiograms and potential role intransmitting of drug resistance is neglected.
Aim of the study: to determine the frequency of occurrence of Enterobacteriacae species and study their antimicrobial susceptibility pattern in cervico-vaginal epithelium of women from kerbala.
Methods: women with vaginal discharges attending Kerbala Teaching Hospital for Gynocology and Obstetric for the period from January to March 2014 were enrolled in this study. High vaginal swabs were processed for the isolation and identification of Enterobacteriacae using standard microbiological techniques. Antimicrobials susceptibility testing was conducted for all of the isolated bacterial species.
Results and discussion: swabs from 100 women were cultured. A total of 101 Enterobacteriacae isolates were recovered; 65 E coli, 23 P.mirabilis and 13 K.pneumoniae isolates. All K.pneumoniae isolates were resistant to ampicillin, amoxicillin-clavulanic acid and cefotaxime, whereas high resistance rates were detected to those antibiotics among E. coli (96.9%, 92.3% and 87.7%, respectively) and P. mirabilis (100%, 78.3% and 52.2, respectively). However, all isolates were susceptible to carbapenems (imipenem and meropenem) and low resistance rates detected to quinolones, aminoglycosides, lincosmaide and chloramphenicole. Resistance rates to aztreonam (ATM) were variable, high rates detected among E coli (69.2%) and K pneumoniae (61.5%) isolates, however, very low rates seen among P. mirabilis isolates (4.3%). Furthermore, high resistance rates were reported to tetracyclines and nitrofurantoin among E. coli (61.5% and 41.5% respectively), K. pneumoniae (69.2% and 100% respectively) and P. mirabilis (78.3% and 60.9% respectively). In addition, statistically significant differences were detected in the antibiotics susceptibility testing among the types of isolates to cefotaxime (p= 0.001), aztreonam (p= 0.000), cholramphenicole (p= 0.000), ciprofloxacin (p= 0.046), nitrofurantoin (p= 0.002) and amikacin (p= 0.007).
Conclusions: Enterobacteriacae colonizing the cervico-vaginal epithelium are resistant to several important anitbiotics (multiple drug resistant) and thus may pose significant threat in transmission of drug resistant bacteria.

Prevalence of Positive Widal Test among Healthy Personnel in Kerbala

Ali Abdulridha Kadhim Abutiheen; Muneer A. Altumma; Riyadh Abed Al-Rasol Heniwa; Zahra Majid Al-Mosawi; Zainab Majid Al-Mosawi

Kerbala Journal of Medicine, Volume 8, Issue 2, Pages 2265-2271

background: Typhoid and paratyphoid fever is still an existing health problem in many developing countries. Widal test is almost the most widely used method for diagnosis of typhoid fever in many developing countries including Iraq, though it is nonspecific with many drawbacks on its use.
Objectives: To estimate the prevalence of Widal test positivity in sera of healthy young personnel in Kerbala city.
Methods: A cross sectional study conducted in Karbala city, Blood samples from 107 healthy young adults aged 18-40 years old collected, whom are free of sign and symptoms, and not having significant ill health within last two months or typhoid fever within last six months.
Results and Discussion: males composed 48.6% of the sample, their mean age was 22.8 ± 3.66 years, and 51.4% of them had a titer of 1/80 for S.typhi O antibody, while other ABs titers were 44.9%, 47%, and 44.9% for S typhi H, S. paratyphi BO and S. paratyphi BH respectively. On other hand ABs titers ≥ 1/160 (positive) were found in 42.1 % for S. typhi O, while others were 28%, 23.4%, 20.6% for S. paratyphi BO, S. typhi H and S. paratyphi BH respectively. There was no statistical significant difference between those tested positive and the negative group in regards to gender or age, or WBCs count.
Conclusions: ABs titers are so high, that increases the doubts, and uselessness of the use of Widal test for diagnosis of typhoid fever, and raises the need for the estimation of basic titers for these ABs among Iraqi population.

Comparative Study of Pap Smear and Cervical Biopsy Findings

Faten Hasem Al-Mosawi

Kerbala Journal of Medicine, Volume 8, Issue 2, Pages 2272-2281

background: Pap smear is the most important screening test for premalignant and malignant non invasive carcinoma of uterine cervix. Most authorities agree that patients with singinifiatly abnormal pap smear, such as cervical intraepithelial neoplasia (CIN) needs colposcopic evaluation and biopsy, this is especially in high grade cytological abnormalities (CIN II & III) ( moderate and severe dysplasia.
Objective: To assess the accuracy of pap smear in detection of premalignant changes of cervical epithelium and correlate the finding of this cytological method with the finding of the biopsy material.
Materials and methods: Aprospective study which includes 100 non-pregnant females aged 16-69 years who had symptoms. The interpretation of cytological results was descriptive done in the Bethesda System terminology 2001 (Solomon and Nayar, 2004), which includes the following entities: NILM , ASC-US, ASC-H, HSIL & LSIL. Also all cases submitted for biopsy and subsequent histopathological examination.
Results & Discussion: Results of pap smear cytopathological examination:
According to Bethesda, the results of NILM, ASCUS, ASC-H, LSIL, HSIL, and SCC were 53% ,4 % , 5% , 24% , 7% , and 2% respectively.
Results of histopathological examination:
Results revealed that benign changes were found in 63 of 100 (63%) which show chronic cervicitis and endocervical polyp , CIN 1 in 20%, CIN 2 in 9%, CIN 3 in 5%, CIS in 1%, and SCC in 2%.
In our study, 10.26% of NILM cytology cases were false negative, which puts us in an intermediate position as compared to many other studies
Conclusion: Pap smear test was found to be equally sensitive to histopathological examination for the early detection of different cervical lesions.

Chronic Dyspepsia in Iraqi Patients: Types, Causes and Common Presentations

Ali Nasir Sattar

Kerbala Journal of Medicine, Volume 8, Issue 2, Pages 2282-2286

background: Dyspepsia is a common problem in the outpatient clinic. The clinical presentation is variable, and often chronic.
Aims: is to find the proportions of organic and functional dyspepsia, the causes of organic dyspepsia, and the most common presentation of each type of dyspepsia.
Methodology: From January 2013 to July 2014, the types, causes, and common presentations of chronic dyspepsia were studied clinically and endoscopically in 116 patients (Male=68, Female=48) at the outpatient clinic in Al-Hindeya general hospital.
Results: During the 16 months study period, 62 patients had organic dyspepsia and 54 patients had functional dyspepsia. Men reported organic dyspepsia (67.4%) more often than women (32.6%), while functional dyspepsia was more common in females (52%). Out of 62 patients with organic dyspepsia, 38 had peptic ulcer disease, 12 had reflux esophagitis, 2 had hiatus hernia, and 10 had gallstones. There was a statistically significant relation between heartburn, epigastric pain and organic dyspepsia, while the relation between altered bowel motion, abdominal distention and functional dyspepsia was highly significant.
Conclusions: Peptic ulcer disease, reflux esophagitis, gallstones, and hiatus hernia are the most common causes of organic dyspepsia. Heartburn and epigastric pain are significant predictors to organic dyspepsia, while abdominal distention and altered bowel motion are highly significant predictors of functional dyspepsia.
Keywords: Dyspepsia, organic, functional, heartburn, epigastric pain, abdominal distention, and altered bowel motion.

Studying The Effect of Smoking on Some Blood Parameters in Young Adult Male Smokers

Saba Ibrahim Salih

Kerbala Journal of Medicine, Volume 8, Issue 2, Pages 2287-2291

background: The effect of smoking of cigarette on human health is serious and sometimes deadly.
Aim of the study was to study the effect of smoking on some hematological parameters in young adult male smokers.
Materials and methods: fifty males participated in this study, smokers (n=30) and nonsmokers (n=20). Complete Blood Cell Count was measured by Humacount 30 (fully automatic hematological analyzer).
Results and discussion: the results showed that the smokers had significantly higher levels of WBCs, RBCs, Hb, PCV and platelets count ,whereas no significant difference was observed in MCV,MCH,MCHC between the two group. This result is due to the inflammatory and irritant effects of cigarette smoking on the body organs.
In conclusion :the continuous cigarette smoking has sever adverse effects on hematological parameters and these effects may lead to increased risk of developing physiologic polycythemia, atherosclerosis and as a results cardiovascular disease.
Key words: cigarette smoking, hematological parameters , Humacount

Virulence factors genes and phylogenic groups of Escherichia coli isolated from High Vagina and Endo-cervix of Women from Kerbala

Enaas K .AL-Khalide; Mohannad Mohsin Ahmed; Zuhair Hameed Abood

Kerbala Journal of Medicine, Volume 8, Issue 2, Pages 2292-2296

background: Eschrechia coli (E. coli) is the most common colonizing bacteria of the genitaltract however, its status as a cause of genital tract infections is questionable.
Aims of the study: To study the virulence and phylogenic groups of E coli strains isolated from high vagina and endo-cervix.Materials and Methods: A total of 100 female patients were enrolled in this study. All patients were attendants of the Gynecology and Obstetrics Teaching Hospital in Kerbala , holy kerbala. Iraq in the period from December 2013 to January 2015. E. coli isolates were identified by standard methods. Molecular diagnosis and characterization for virulence and phylogenic genes were detected by Multiplex PCR. Results and Discussion: Among 65 isolates recovered in this study, the most frequent phylogenic group of E. coli was "B2" which comprised 61.5% (no= 40) followed by "Phylogenic group A" that comprised 33.8% (no= 22). Previous studies have shown that phylogenetic groups B2 and D are virulent because these groups are associated with the presence of several virulence factors. Interestingly, 9 out of 10 isolates from women who their husband using condoms were shown to be of B2 phylogenic group. Frequencies of virulence genes of adhesion Pap, Sfa and Afa, among E.coli isolates were 14, 42 and 5, respectively. In addition, Pap C and Sfa were found in higher rates in phylogenetic group B2 isolates, and this gives more support to the hypothesis that B2 is the pathogenic group. Conclusions: Most of the E. coli isolates were belong to the virulent phylogenic group “B2” and that those isolates harbor several virulence factors. Accordingly, E coli may be considered as a true genital tract pathogen and its colonization entails great risk for vertical transmission to the fetus and fetal membrane.

Prevalence of Asymptomatic Urinary Tract Infections in Pregnant Women at Al-Abbasiah Primary Health Care Center in Kerbala

Riyadh Dhayhood Al-Zubaidi

Kerbala Journal of Medicine, Volume 8, Issue 2, Pages 2297-2300

background: Asymptomatic urinary tract infection (UTI) during pregnancy may progress to pyelonephritis. Urinary tract infection increase risk of preterm labor and premature rupture of the membranes, and low-birth-weight infants.
Aim: To estimate prevalence of asymptomatic urinary tract infection during pregnancy
Method: A cross-sectional study was conducted in a total of 200 women (hundred pregnant women and hundred non-pregnant mothers) with no signs and symptoms of urinary tract infection, from 1st of January to 28th May of 2013. Mid-stream urine samples were collected from all participants and examined directly under high power field, Pus cells > 5 / HPF indicate the presence of infection .
Result: forty eight of the pregnant (48%) and twenty (20%) of the non-pregnant had UTI which was statistically very significant (p value ˂ 0.005). Also, there was a significant statistical relation between the UTI and the educational level (p value ˂ 0.05), but there was negative relation with the age (p value > 0.05).
Conclusion: there is a high prevalence of asymptomatic urinary tract infections in pregnant and non-pregnant women irrespective of their age or educational level of them