Volume 10, Issue 2, Summer and Autumn 2017, Page 2674-2803


Early Post-Operative Ultrasonographic Appearance of Implanted Mesh for Abdominal Wall Hernia Repair

Falah D Salih

Kerbala Journal of Medicine, Volume 10, Issue 2, Pages 2674-2679

background: Mesh herniorrhaphy (open method or through laparoscopic approach) is a common surgical procedure. Identification of the mesh is necessary when abdominal ultrasound is performed. Scanty studies had been involved in the Ultrasonographic appearance of mesh in the early post-operative period.
Aim: to assess the ultrasonographic appearance of polypropylene meshes used for anterior abdominal wall hernia repair.
Patients and methods: Sixty five patients with different types of anterior abdominal wall hernias (epigastric, umbilical, inguinal and incisional) treated with mesh herniorrhaphy, were examined with ultrasound in the early post-operative period. Ultrasonographic appearance of the mesh including visibility of the mesh, regularity, twinkling and posterior acoustic shadowing were assessed.
Results: Sixty five patients were examined and most of them were males. All meshes were visible. Most meshes were wavy and showed posterior acoustic shadowing. Twinkling was rare.
Conclusion: Ultrasound is very useful in identification of the meshes implanted for hernia repair within the early post-operative period and can identify all implanted meshes.

Povidone Iodine and Hypertonic Saline Induced Sclerosing Cholangitis in Hepatic Hydatid Cysts Surgery

Abdulrazzak Kalaf Hassan

Kerbala Journal of Medicine, Volume 10, Issue 2, Pages 2680-2686

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ackground: Surgery is the treatment of choice for hepatic hydatid disease but surgical treatment carry the risk of recurrence if we do not use a proper scolicidal agent and may convert patient with solitary hepatic hydatid cyst to patient with many incurable cysts. The ideal scolicidal agent should kill vital scolices, and not have local or systemic adverse effect, and not toxic to bile duct. Yet, there is no ideal scolicidal agent involving such effects. One of the important serious complications after instillation of scolicidal agents is sclerosing cholangitis.
Aim: to assess the risk and severity of povidone iodine and hypertonic saline induced sclerosing cholangitis in guinea pigs.
Materials and methods: In this study we used twenty guinea pigs which were divided into two equal groups. In the first group 0.3 ml10% povidone iodine was injected to the biliary tree after clamping then released after five minutes and second group, 0.3 ml 20% hypertonic saline was used.
Four months later on the pig was euthanized by ether and three biopsies taken from the liver and sent for histopathological examination. Afterwards, the liver, gall bladder, the common bile duct and the duodenum were excised in one piece and immediately transferred for cholangiography. Two X-ray films were taken for each specimen in lateral and antero-posterior view after contrast material injection.
Results: in povidone iodine group 8 animals (80%) had sclerosing cholangitis while in hypertonic saline group only 2 animals (20%) had sclerosing cholangitis. This difference between the two groups was statistically significant.
Conclusions: Usage of 10% povidone iodine as a protoscolicidal agent carry high risk of sclerosing cholangitis.

Determination of Contributing Environmental Factors to Breast Cancer in women: A Retrospective Study in Babylon Governorate

Najat H. Hassan; Rabea M. Ali

Kerbala Journal of Medicine, Volume 10, Issue 2, Pages 2687-2694

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ackground: Environmental factors are believed to explain a large proportion of breast cancer incidence. Known risk factors for breast cancer, which are related to women's reproductive life, and other factors, such as inheritance, chemicals and ionizing radiation is an established environmental risk factor for breast cancer. In order to better understand how environmental factors affect breast cancer in women the researcher study this subject.
Objectives: 1.To determine the effect of environmental factors on breast cancer occurrence.
2. To find out the relationship between breast cancer occurrence and the environmental factors.
Methodology: A Retrospective Study, a purposive sample of (400) women; (200) women diagnosed with breast cancer were visited the Merjan Teaching Hospital Oncology Cancer Center in Babylon Governorate as a study group and (200) women free of breast cancer as a control group. An assessment tool was constructed for the purpose of the study , it was comprised of Demographic Data, Reproductive Data, and Information of environmental life factors consist of (11) items of 10 years previous breast cancer occurrence divided to two periods (previous 1-5 years) and (previous 6-10 years). Physical measurements (Height and weight) for measuring (BMI) of samples. Analysis of data was performed through the application of descriptive and inferential statistical data analysis approach.
Results: The study demonstrates that the highest percentage (39.5%) of study sample was in age (50-54) years in comparison with the other age groups for both of study and control groups. There are a significant different at P<0.05 between the environmental factors and breast cancer.
Recommendations: The study recommended about further study on large population and activation of media and Ministry of Health role for increasing the awareness of women and their families about the importance of reducing the risk factors which contributing on breast cancer occurrence such as chemical products and radiation hazards

Haemangioma of the Nose and Paranasal Sinuses

Adil H. Ibrahim; Alaa Ch. Mutar; Nazar J Metib

Kerbala Journal of Medicine, Volume 10, Issue 2, Pages 2695-2701

background: Haemangiomas, are rapidly growing benign vascular tumors rarely seen in paranasal sinuses. They are of two major types, capillary and cavernous depending on the dominant vessel size on microscopy. The sinonasal cavity is an uncommon site of haemangiomas of the head and neck. Most nasal haemangiomas arise from the nasal septum or vestibule and are of lobular capillary type. Only a few arise from lateral wall of the nose or the inferior turbinate and these are usually cavernous.
Objective: To assess the sinonasal haemangioma and to increase awareness about its clinical presentation and management.

Methods: A retrospective study was conducted in the Department of ENT at Al-Hussein Teaching Hospital, Karbala, from December 2013 to December 2015. Ten cases of sinonasal haemangiomas were collected. Evaluation of the patients done according to age, sex, occupation, complaints regarding headache, nasal obstruction, epistaxis, nasal discharge, feeling of nasal mass ,radiologic assessment and pathologic diagnosis . Endoscopic sinus surgery was performed under general anesthesia for all patients, the masses excised completely and sent for histopathological study.
Results: Ten patients were collected. Four patients were males and six patient females with female to male ratio 1.5:1. The age range was 14 to 50 years with a mean age of 32 years. Nine patients (6 females) and (3 males) presented with nasal obstruction and epistaxis. Four patients with left sided nasal obstruction, five patients with right sided nasal obstruction, and only one patient with absolute bilateral nasal obstruction without epistaxis.
Conclusion: Sinonasal haemangiomas are extremely rare especially cavernous type. Sinonasal tumors with bone erosion should not always be presumed to be malignant .Endoscopic sinus surgery with complete removal is the treatment of choice.

Outcome of Endoscopic Endonasal Dacryocystorhinostomy in Karbala, Iraq

Nadhim Omran Khadhim; Ahmed Abdullah Alwan; Imad Salih Mehdy

Kerbala Journal of Medicine, Volume 10, Issue 2, Pages 2702-2708

background: Dacryocystorhinostomy (DCR) is an operation that has been used for the past 100 years. Endoscopic endonasal DCR is less invasive than external DCR; therefore, it has rapidly gained acceptance for the treatment of intractable nasolacrimal duct obstruction and chronic dacryocystitis. Many ophthalmologists still believe that external DCR is the gold standard treatment for nasolacrimal duct obstruction. However, because incision of the facial skin is required, patients are reluctant to undergo external DCR.
Objectives: To analyze the results of Endonasal Endoscopic Dacryocystorhinostomy regarding complications and success rate.
Methods: A prospective study was carried out on 26 patients at Department of Otolaryngology, Al-Hussian Teaching Hospital, Karbala during the period September 2013 to November 2016. Patients presented with epiphora and diagnosed with chronic nasolacrimal duct obstruction were included in this study. Endonasal Endoscopic Dacryocystorhinostomy was performed under general anaesthesia. Patients were followed up for at least 6 months after the removal of dacryocystorhinostomy tube. Complications during and after the procedure were recorded.
Results: Out of total 26 patients 23 (88%) were females and 3 (12%) were males (F:M=7.7:1). The age range was 6 to 60 years with a mean age of 33 years. The duration of symptoms ranged between 8 months to 6 years. There were only 2 (8%) patients had bilateral symptoms while the other 24 (92%) patients had unilateral symptoms. Average duration of endoscopic DCR was 60 minutes. DCR tube was removed 6 months after operation in 24 (92%) patients and in 2 (8%) patients, it was removed after 3 months. Complications encountered during and after surgery were, haemorrhage in 4 (15%), ecchymosis in 2 (8%), nasal adhesions in 2 (8%), granulations at osteotomy site in 1 (4%), retrograde tube displacement in 2 (8%) patients. Overall, 24 (92%) patients were symptom-free 6 months after the removal of the tube. Out of the remaining 2 (8%) patients, one patient underwent revision surgery and was symptom-free 6 months after the removal of the tube whereas the other refused revision surgery. Overall success rate of endonasal DCR was 25 (96%).
Conclusions: Endonasal Endoscopic Dacryocystorhinostomy is an effective procedure with high success rate and minimal complications.

Efficacy and Safety of Levetiracetam as Mono and Add on Therapy in Treatment of Epilepsy

Sarwer Jamal Al- Bajalan; Mohammed Tahir Kurmanji; Murad W. Kamil

Kerbala Journal of Medicine, Volume 10, Issue 2, Pages 2709-2713

background: Epilepsy is the second most common chronic neurological disorder after migraine affecting 2% of population with a high incidence of failure to achieve seizure freedom with the usual antiepileptic drugs. Levetiracetam (LEV) is an antiepileptic drug with less drug interactions, minimal side effects, a favorable pharmacokinetic profile and a wide spectrum of anticonvulsant effects in animal models for different types of epileptic seizures.
Objectives: To define the efficacy and safety of LEV in the treatment of epilepsy as add on or monotherapy.
Patients and methods: A random sample of 52 patients with epilepsy, evaluated in a descriptive cross-sectional study for the efficacy and safety of LEV in epilepsy, they were collected among epileptic patients attending the Neurology consultation Clinic in Sulaimani city in the Iraqi Kurdistan Region from May 2012 to May 2013. All the patients were interviewed by using questionnaire forms with comprehensive history, clinical examination, radiological, EEG and laboratory studies done to all patients.
Results: The sample involved female patients 2 folds more than males. Mean patients age was 24.54 ± 13.9 years. Mean duration of treatment; 2.7 years. Mean LEV dosage: 1457 ± 682 mg / day. Seventeen patients received monotherapy and 35 patients received add on therapy. Mean Seizure frequency was 44 attacks / month before treatment and 4 after treatment. Mean percent of seizure reduction was 95.1% in mono therapy and 91.46% in add on therapy.
Conclusion: LEV is a safe, effective, broad spectrum antiepileptic drug that could be used as monotherapy or add on therapy in the treatment of generalized and focal epilepsy.

Role of IL-4 and Glutathione Peroxidase in Patients with Obstructive Lung Diseases

Anwar J Almzaiel; Ali Mansoor Jasim Al-Ameri; Rafad Tariq

Kerbala Journal of Medicine, Volume 10, Issue 2, Pages 2714-2718

background: Obstructive lung diseases (OLD) are chronic inflammatory disorders of the respiratory tract including asthma and chronic obstructive pulmonary disease (COPD). In both asthma and COPD the chronic inflammation and structural changes of the respiratory tract are organized by cytokines which have become important targets for the development of new therapeutic strategies in these diseases. Glutathione peroxidases (GPX) is one of the scavengers of antioxidant enzymes against activated oxygen species which is the first discovered in mammals .Their activity depends on the presence of the rare amino-acid residue selenocysteine at the catalytic site.
Aim: This study aims to investigate the relation between GPX antioxidant enzyme activities as a marker of oxidative stress status in addition to investigating the level of IL4 with the development of obstructive lung diseases (OLD).
Methods: Patients with OLD (n=40) and 40 age-matched healthy controls were enrolled in this study. Serum samples were collected to test the role of IL-4 and to test the effect of antioxidant enzyme GPX, and their influence on OLD, all measured by ELISA.
Result: The results showed a significant increase in the level of serum IL-4 activity in patient with OLD when compared with control group (P <0.05). However, the levels of GPX did not show a significant difference between the two groups.
Discussion: As shown by present results, there is significantly increase in levels of IL-4 in serum of patient group compared to control group. This finding is in agreement with a report which indicated that IL-4 marker of allergic airway inflammation.
Conclusion: Serum levels of inflammatory cytokines IL-4 are related with severity of airway diseas¬es and could be potential markers for the evaluation of OLD

The Effect of Birth Asphyxia on the Coagulation Status in Neonates

Ashwaq Ali Hussein; Hithab Jawad Muhsen; Rajaa Jabbar Kadhum

Kerbala Journal of Medicine, Volume 10, Issue 2, Pages 2719-2724

background: Birth asphyxia has multi system effect, which predisposes to coagulopathy by enhancing consumption of platelets & some clotting factors as a results of the associated sever hypoxemia, acidaemia & sepsis
Objective: To study the effects of birth asphyxia & perinatal events on the coagulation status of newborn infants.
Patients & Methods: Across sectional study was done on 27 neonates with birth asphyxia in AL-Zahraa teaching hospital in Najaf city from period of first of February 2012 to first of July 2012. Blood samples were collected from the neonates within the first 24 hrs. After birth and sent for investigations including PT, PTT, plasma fibrinogen and platelet count.
Results: The study showed statistically significant effect of birth asphyxia on platelet count especially in severely asphyxiated neonates with Apgar score of 0 – 3 at 5 min after birth (plat. Count < 100,000 per mm3) in comparison to neonates with Apgar score of 4 – 6 at 5min after birth.
Infants who have very low birth wt. (i.e. <1500 gms) had significantly lower platelet count (< 100,000 per mm3) than infants with birth wt.>1500 gms
Birth asphyxia had no significant effect on PT, PTT, or fibrinogen level. Other perinatal and prenatal variables examined as (sex, maternal hypertension, DM, mode of delivery gestational age) did not show any significant association with coagulation status.
Conclusion: Thrombocytopenia (plat. <100.000 per mm3) is seen in neonates with Apger score (0-3) at 5 min. and in neonates with very low birth wt. <1500gms). No statistically significant relation between birth asphyxia and PT, PTT and plasma fibrinogen level.

Biochemical Changing in Saliva Components during Tension Situations and Its Relationship with Age

Rana Fadhil Mousa

Kerbala Journal of Medicine, Volume 10, Issue 2, Pages 2725-2731

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ackground: Several pathologies of the oral cavity have been associated with tension. The association between stress and the occurrence of oral disease is based on clinical observations, epidemiological research, and experiments with animals.
Aim of study: The aim of this study was to identify the effect of acute tension on some salivary glands functions, and relationship the age with this tension
Materials and Methods: Twenty three of students from AL-karama school of girls (age 7-12 year) and thirty undergraduate pharmacy females students (age 20-24 year) were participated in this study. They were asked to provide two samples of unstimulated whole saliva for 5 minutes, the first sample collected after a week end in the usual academic day as a control group, the second sample was collected after one month later in a first day of final examinations of a scholastic year. Total protein, albumin, uric acid and calcium levels in tow samples were assessed.
Results & Discussion: The results showed a significant stress mediated decrease in the salivary calcium concentration (2.8813 mg/dl) in comparison with non-stressful condition (6.8020 mg/dl). and albumin concentration (1.608 g/dl were decreased by comparison with normal value (2.818 mg/ dl), while uric acid (6.874 mg/dl in sample under stress, 4.330 mg/dl in normal sample) and total protein concentrations (75.20 g/l for girl without stress, 107.15 g/l under stress) were elevated respectively all these result in age range (20–24year). While in age range (7 – 12 year) the result was as a follow:- for uric acid the value for sample under stress was highly than in normal condition (5.118 mg/dl while to sample without tension is 3.200 mg/dl). level of albumin is (2.195 g/dl to girl under stress and 4.388 g/dl in normal condition) that men there is a significant decrease in albumin level .also the result showed a significant decrease change in calcium level (2.6707mg/dl while in normal sample is 5.038 mg/dl) also we showed a significant elevation level in total protein (81.567g/l) comparison with normal sample (68.600 g/l) all these changes were statistically significant as we showed. Our search also compared between the age group and its relationship with acute tension. So, the level of uric acid in age (7-12 and 20 -24) are (5.118 mg/dl , 6.874 mg/dl) sequential ,while non-significant change in level of albumin in both age group in opposite to value of calcium and total protein we showed a highly level in age between (20- 24 year) in comparison with (7-12 year).
Conclusion The results suggest that acute psychological stress exerts its effect on salivary composition and this will increase the value of saliva as dynamic biological fluid in controlling the oral health. Also this search suggest the effect of age to the composition of saliva.

Misuse of Antibiotics in Al-Hussein Teaching Hospital in Karbala

Nidhal Awad Obaid; Haidar Hussein Sallum; Ali Abdulridha Abutiheen

Kerbala Journal of Medicine, Volume 10, Issue 2, Pages 2732-2739

background: Antibiotics (AB) are available and widely used all over the world. However, the overuse and misuse of antibiotics generates unnecessary costs, produces unwanted side effects, and causes the emergence of resistant bacteria that is a raising serious problem especially in developing countries.
Objectives: To assess the use of antimicrobial drugs and rationality of its use.
Methods: An analytic cross-sectional study was carried out in Al-Hussein Teaching Hospital in Holly Kerbala City in Iraq. A sample of 302 hospitalized patients was randomly selected from coronary care unit, medical wards, and surgical wards, clinical data were collected using specific questionnaire through direct interview with patients and from patient’s case sheets during the period from 5th December 2013 to 30th June 2014. Ethical approval was taken from Scientific Council of Family Medicine in Arab Board Committee Baghdad. Data were entered and analyzed using SPSS program version 16. A p value of less than 0.05 was considered statistically significant.
Results: Antibiotics were prescribed in 81.5% of hospitalized patient. The collective rate of irrational use of antibiotics was 83.3%. Inappropriate antibiotic use was significantly higher in patients who had been hospitalized in surgical branches wards (91.8%) followed by general surgery wards (88.4%), while the lower antibiotic misuse was in coronary care unit ward (73.9%). ABs indication in Medical wards was 100% Empirical, while 75% of ABs indication in General surgery ward was prophylactic.
Conclusion: The rate of irrational antimicrobial use was high in hospitalized patients, and more in surgical wards. The antibiotic selection was optional and not according to any guidelines or recommendations. The antibiotics prescription was mainly empirical in medical wards, while it was prophylactic in surgical wards. Further, the use of culture and sensitivity test was very limited. These attitudes are probably leading to more risky side effects and drug resistance. Strict guidelines and valid policies need to be adapted in each hospital to decrease the antibiotic misuse.

Noise Level at Neonatal Care Unit of Al-Sader Teaching Hospital in Misan Province, Iraq

Hussein Fadhil Musa Aljawadi; Esraa Abd Al-Muhsen Ali; Malik Hadi Mahmood

Kerbala Journal of Medicine, Volume 10, Issue 2, Pages 2740-2746

background: Preterm infants exposed to prolonged excessive noise are also at increased risk for hearing loss, abnormal brain and sensory development, and speech and language problems.
Aim of study: to determine noise levels in the neonatal care unit.
Materials and methods: A descriptive cross sectional study was conducted at neonatal care unit of Al-Sader Teaching Hospital in Misan Province, South East of Iraq during October/2015. A portable sound pressure level meter (sound level meter model SL-4010) was used to record sound level.
Results: The records of mean, maximum and minimum sound levels were high and mainly during day time at 10:00 a.m. ranging between 65.13 to 71.68, 78 to 83 and 47 to 61 decibel respectively which exceed the American Academy of Pediatric recommendations.
Conclusion: The noise level in the Neonatal Care Unit of Al-Sader Teaching Hospital was obviously high and did not meet the American Academy of Pediatric recommendation. A real effort is required to establish guidelines for noise reduction.

Assessments of Self -Esteem and Stress among Babylon Medical College students

Ali Emad; Hadeel Fadhil Farhood; Sijal Fadhil F; Ameer Kadhem; Ashraf M. Ali; Ameer Najah

Kerbala Journal of Medicine, Volume 10, Issue 2, Pages 2747-2755

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ackground: medical students experience a high level of stress during their undergraduate course. High level of stress may have a negative effect on cognitive functioning and learning of students in the medical school.
The objectives: to assess stress, self-esteem among medical students and some factors effect on them and the effect of stress on self -esteem.
Material and method: (185) undergraduate students of medical college Babylon university that were selected randomly. A written questionnaire about some socio-demographic information, assess the stress and the self -esteem. Weight and height of the participant students was also taken.
Results: (49%) of participants have normal Self-esteem and (57%) of participants have medium stresses and low level of high stress (14.8%) with no significant associations of stress with participant gender , study level and residence and with body mass index with increase in frequency of high stress in underweight students. There was significant association of Self-Esteem Scale with study level, delay in academic years and using computer and reduce level of self-esteem with increased level of stress
Conclusion: about half of students reported normal self -esteem with medium stress and low level of high stress during period of examination and reduce level of self-esteem with increased level of stress.

Rights' and Responsibilities among Hospitalized Patients' in Karbala city

Maytham Salim AL-Nasrawii

Kerbala Journal of Medicine, Volume 10, Issue 2, Pages 2756-2763

background: The development of a strategy to promote patients' rights and responsibilities has to be carefully prepared, in order to ensure that the intention is translated into practical action, which commands the support of all parties involved. Such action does not follow automatically, but takes time to become fully effective. National situations vary in respect of legal frameworks, health care systems, economic conditions, and social, cultural and ethical values. Patients’ rights, is recently introduced term in health sciences literature and practice and has become an important part of modern health care practice. Patients now are much more aware of what they expect from health care professionals, when they enter the health care environment.
Objective: The main objective of this study was to determine the level of awareness of rights and responsibilities among hospitalized patients' in Karbala city.
Patients and Methods: Across-sectional study was conducted in Karbala city center of Karbala governorate, the study consists of (200) patient recumbent in public hospitals and data were collected by direct interview with those patients by using a questionnaire form designed by the author based on WHO legislations' this questionnaire consisting of three parts form (some demographics characteristic, patients Rights' and patients Responsibilities).Statistical analysis was done by using Chi-Square (χ2) test.
Results: Most patients did not know about the patients’ bill of rights, even though they are spontaneously practicing their rights and responsibilities.
Conclusion: - Despite the enjoyment of the patients were lying in government hospitals full rights enshrined internationally, there was a lack of patients' awareness regarding the patients' rights and responsibilities.

Evaluation of Brain Natriuretic Peptide levels in Sera of Iraqi Patients with Hyperthyroidism and Hypothyroidism

Zinah Abbass Ali

Kerbala Journal of Medicine, Volume 10, Issue 2, Pages 2767-2770

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ackground: The thyroid gland is an endocrine gland that is normally positioned in the lower neck. Cardiovascular alteration that coexist with thyroid gland diseases could trigger off the secretion of Brain natriuretic peptide from heart. Stress environment conditions and various factors have an important thumb in pathogenesis of thyroid gland diseases and may possibly eventuality lead to this reply. Volume expansion and pressure overload stimulated Brain Natriuretic Peptide secretion from the ventricular myocardium.
Aim: To evaluate the role of thyroid disorders in stimulating ventricular myocardium's to screate Brain natriuretic peptide.
Materials and Methods: Serum Brain Natriuretic Peptide determined by enzyme- linked immunosorbent assay (ELISA). About 36 Iraqi patients with primary hyperthyroidism and primary hypothyroidism and Twenty two subjects who are apparently healthy were enrolled in this study.
Results: Serum levels of BNP hormone showed a significant elevation in hyperthyroidism as compared with control (p<0.01) and significant decrease in hypothyroidism group compared with control group. The results revealed a significant positive correlation between T3, T4 and BNP level in patients with hyperthyroidism while there was no weighty relation between the corresponding thyroid hormones and BNP level in patients with hypothyroidism.
Discussion: A raise in cardiac output, total blood volume, left ventricular end-diastolic volume (LVEDV) and heart rate in hyperthyroid status exerts the “stress” of the cardiac muscles and could be potential stimuli for the emission of BNP.
Conclusion: the measurement of BNP is mine important in patients with hyperthyroidism compared with the cases of hypothyroidis.

Cardiogenic Shock Complicating Acute Myocardial Infarction; Aetiology, Treatment and Prognosis

Shokry F. Nassir

Kerbala Journal of Medicine, Volume 10, Issue 2, Pages 2771-2784

background: Cardiogenic shock is the leading cause of death in patients hospitalized for acute myocardial infarction. Treatment strategies using intra-aortic balloon counter pulsation and emergency revascularization by percutaneous coronary interventions or coronary bypass surgery have been shown to improve outcomes.
Aim: to provide an overview of patients with cardiogenic shock complicating acute myocardial infarction admitted to Ibn Al-Bitar center for cardiac surgery in Baghdad.
Methods: This is a prospective observational study conducted at Ibn Al-Bitar center for cardiac surgery in Baghdad. The criteria of the British cardiovascular intervention society were used to identify patients who were admitted to the hospital within one year period with the main focus of the study was on patients with cardiogenic shock complicating acute myocardial infarction. Full clinical assessment was done at bedside. Twelve leads electrocardiography and basic biochemical tests were obtained and echocardiography was done for every patient.
Results: During a period of one year from March 2010 through March 2011 One hundred seventeen patients with cardiogenic shock were identified. Acute myocardial infarction accounted for shock in 78(66.7%). In this patients population there were good percentages of history of myocardial infarction, hypertension, diabetes and smoking. Anterior ST–elevation myocardial infarction was found in two-thirds of them. Predominant left ventricular failure caused cardiogenic shock in 54(69.2%), while ventricular septal rupture, acute mitral regurgitation and right ventricular failure accounted for the rest. The overall mortality rate of cardiogenic shock was 64 (82.1%). Intra-aortic balloon pumping (IABP) was placed in 28 (35.9%) and Thrombolytic therapy was used in 19 patients (24.4%), while Both IABP and thrombolytic therapy were used in 8 (10.3%). Coronary angiography was done in 18 (23.07%). Percutanous coronary intervention was used in 10 (12.8%), while coronary artery bypass grafting was done in 3(3.8%) of the patients.
Conclusions: This study shows a high in-hospital mortality for patients with cardiogenic shock complicating acute myocardial infarction and despite the proven benefit of revascularization procedures there were only few patients had undergone these
Procedures. The utilization rates of thrombolytic therapy and intra-aortic balloon pump were also low.

Bronchogenic Carcinoma in Patients Younger Than 40 Years

Hashim M. Al-Kadhimi; Qasim H. Al-Azzawi; Alaa K. Salih

Kerbala Journal of Medicine, Volume 10, Issue 2, Pages 2785-2791

background: lung cancer is the most frequent cancer related cause of death for both gender, currently 10 millions new lung cancer are diagnosed each year worldwide.
Objective: To determine the different clinical characteristics and other features of lung cancer in the different age groups.
Methodology: This was descriptive retrospective study carried on 32 patients with histological proven lung cancer under the age of 40 years from three medical centers. All patients underwent full clinical assessment including history (particularly smoking) and full physical examination Bronchoscope was done to all patients except those unfit pleural effusion cytology and pleural biopsy done to all patients with pleural effusion. FNA Cytology done under ultrasound guide and was of great help in those patient in whom the histological diagnosis was difficult to be obtained by other methods.
Results: The age of studied group ranged between (10_40 years) with a mean of 25. From the thirty two patients, there were 18 males patients (56%) and 14 females patients (44%), with 1.3:1 male: female ratio. History of smoking in the young age group was present in19 patients (60%), 13 were males (68.5%) and 6 patients (31%) were females, and 13 patients (40%) never smoked .Undifferentiated carcinoma is much more common in males than females (20% and 8% respectively). The most common histological types of lung cancer in both sex of young group was adenocarcinoma (44% of cases) occurring 50% of females and 40% of male.
Conclusion: Cigarette smoking is an important cause of the current epidemic of lung cancer among our young patients, so it is preventable rather than curable medical problem. Adenocarcinoma was the most frequent histological type of lung cancer in Iraqi young patients.

The Effect of Phoenix Dactyliferia Extract on Giardiasis in Laboratory Mice: Case Control Study

Mehdi A Al-Ruhalaty

Kerbala Journal of Medicine, Volume 10, Issue 2, Pages 2792-2799

back ground: Giardiasis is a common parasitic infection in the tropical and subtropical areas. It is a common cause of gastroenteritis in humans and other domestic animals. This parasite cause great morbidity and ill health, like mal absorption, irritable bowel and loss of work days. It is usually treated by drug called metronidazole which has bad neurological and gastro intestinal side effects. Recently many plant extract are tried in treatment of some intestinal parasite to avoid the risk of chemical compound and one of these extract is the phoenix dactyliferia.
Objectives: To study the effect of Phoenix dactyliferia on intestinal giardisis in mice and compare its effect with metronidazole. This extract of date palm is a natural herbal medicine with supposed negligible side effect.
Material and methods: This is a case-control study done in cage of al- Al- Habboby laboratory in corporation with the college of pharmacy, Karbala University. The study was done in the period from 1/11/2013 to 20/11/2013. Sufficient amount of the extract phoenix dactyliferia had been prepared for treatment trial. 75 mice rendered infected with giardisis by giving 2 ml of the dilute stool from infected animals. Then the animals are classified into 5 groups, each group composed of 15 mice. The first three groups were given, 1000mg/ kg, 2000 mg/ kg, and 3000mg/kg respectively. The fourth group was given metronidazole, 200mg/kg and lastly the fifth group was given distil water as a control group. The mice were sacrificed according to the protocols of animal rights and all biopsies sent to histological lab of our college.
Results: the group of mice given 3000mg/kg of the extract, showed negative stool examination for giardiasis in the 4th day which is similar to the result of metronidazole. It was also statically significant.
Conclusion and recommendation: Phoenix dactyliferia has similar efficacy to metronidazole in laboratory animal. This natural treatment may be beneficial in treatment of human giardiasis.

Proliferating Trichilemmal Tumor: Case Report

Ahmed Mjali; Mohammed Ahmed Alshami; Nazar J.Metib; Asaad Hashim

Kerbala Journal of Medicine, Volume 10, Issue 2, Pages 2800-2803

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proliferating pilar tumor (PPT) is a rare neoplasm arising from the isthmus region of the outer root sheath of the hair follicle. It is also commonly called a proliferating trichilemmal cyst. It was first described by Wilson-Jones as a proliferating epidermoid cyst in 1966. PPT was then distinguished from proliferating epidermoid cysts in 1995. It occurs most commonly on the scalp of middle age women. Most tumors arise within a preexisting pilar cyst. Even though they usually are benign in nature, malignant transformation with local invasion and metastasis has been described. They may be inherited in an autosomal-dominant mode, linked to chromosome 3.
Aim of study is to report case of proliferating trichilemmal tumor.

Bilateral Choroidal Osteoma in a black Asian Man

Hussain Ali Tufaili

Kerbala Journal of Medicine, Volume 10, Issue 2, Pages 2764-2766

Purpose: To report a rare case of bilateral choroidal osteoma with choroidal neovascularization (CNV) in an oriental black young man.
Design and methods: A 29 year-old Iraqi man who presented with a gradual decrease in vision in his right eye for 3 months duration. ophthalmoscopic examination showed bilateral juxtapapillary yellow orange slightly elevated mass about 2 disc diameter around the disc with clear margins. Invasion of right macula from inferionasal side were observed. Optical coherence tomography (OCT), Fluorescein angiography (FFA), ocular ultrasound, and computed tomography (CT) confirm the diagnosis of bilateral choroidal osteoma with right eye choroidal neovascularization (CNV).