Issue 3


Fistula in Ano; the Correlation of Pre-Operative Magnetic Resonance Imaging with Video Assisted Anal Fistula Treatment Findings

Hussain J K Alsalami; Laith A S Alshareefi; Falah D Salih

Kerbala Journal of Medicine, Volume 10, Issue 3, Pages 3804-3809

background: Fistula-in-ano (FIA) is a common medical problem. Magnetic resonance imaging (MRI) is an excellent modality for the pre-operative evaluation of this condition. Video assisted anal fistula treatment (VAAFT) is a relatively new modality introduced in 2006, and is both diagnostic and operative.
Aim: To correlate MRI findings with video assisted anal fistula treatment findings.
Patients and methods: Thirty-five patients with clinically diagnosed FIA, had a pelvic MRI followed by VAAFT surgery.
Results: Mean age was 42 years. In one case both MRI and VAAFT revealed a sinus. In 29 cases (82.8 %) there was concordance regarding the presence of an FIA, both tracts and internal openings. In 5 cases (14.2%), there was no concordance regarding the presence of an internal opening.
Conclusion: MRI is essential in the pre-operative assessment of FIA especially for clinically complex fistulas.

Diode 1470 nm Laser Turbinoplasty versus Partial Surgical Inferior Turbinectomy for Treatment of Inferior Turbinate Hypertrophy.

Adil H. Ibrahim; Alaa C. Mutar; Ali A. Kadhim Abutiheen

Kerbala Journal of Medicine, Volume 10, Issue 3, Pages 3810-3817

Background: Nasal obstruction is a common complaint in patients attending otolaryngology clinics which is infrequently due to inferior turbinate hypertrophy. Patients not responding to medical treatment can benefit from turbinate reduction surgery, which aims at relieving this symptom.
Objectives: To evaluate the effects of diode 1470nm laser turbinoplasty of inferior turbinate versus partial surgical inferior turbinectomy in patients with nasal obstruction due to hypertrophy of inferior turbinate.
Methods: A prospective comparative study had been done at Al Kafeel Hospital, Kerbala from February to October 2016. Fifty patients were included and equally divided into two groups of 25 patients for each. First group was treated with partial surgical inferior turbinectomy and the other one with laser turbinoplasty. Patients were evaluated for improvement in symptoms at follow up on 2 days, 1week, 1month, 3months, and 6months.
Results: Patients' age range from 16-50 years with a mean ± Standard deviation 28.18 ± 7.27 years. Females were 30 (60%) of the sample with no significant difference between both groups in regard to age and gender distribution. Both procedures are evenly effective in reducing the turbinate size after 6 months. However crusting, post-operative pain, blood loss, and the number of days of nasal packing was found to be significantly less in laser turbinoplasty group as well as faster improvement in nasal obstruction and healing and less hospital stay.
Conclusion: Diode laser1470 nm turbinoplasty is a safe and effective procedure, because of its precise localization of coagulative effects on soft tissue. In comparison to partial surgical inferior turbinectomy diode laser1470 nm turbinoplasty shows less bleeding, postoperative pain and crustations with no nasal packing as well as earlier healing and nasal obstruction relieve.
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The Factors Contributing to the Juvenile Delinquent Youth in Kerbala Province. A Prevalence Study

Amer Alhaidary

Kerbala Journal of Medicine, Volume 10, Issue 3, Pages 3818-3826

b
ackground: juvenile delinquency is problem that affect the youth in many societies and can lead to many complication in regard the legal system, increase the crime and affect the moral and ethical issues of each society so it was better to understand the factors that contributing to the development of this condition.
Aim of the study: to explore the family, school and economic factors of juvenile crime. It has been conducted in police offices throughout the governorate of Karbala.
Subject and Methods: Interview schedule has been used as a tool of data collection. A sample of 172juveniles was interviewed 93.6% male; most of the delinquents were in the age group of 9-19 years.
Results and Discussion: This study found that majority of the respondents were dropped out of school and engaged with juvenile employment, which in turn increases the rate of juvenile crimes. The dynamic and function of the family was found to be a determining factor for delinquency, only 56.97% lived with both of parent were 19.18% of the delinquent youth lived away from their families, 43.02% suffered from family neglecting, most of them belonged to low income profile, and keeping watching violent movie or electronic games.
Conclusions: from this study it was concluded that the character of delinquent case are those who are spend most of their time outside their home, they have low level of education, coming from poor parenteral education, they live in overcrowded area or coming from other governorate, they prefer to watch violent movie and violent games, they are cared by only one parent or by relatives,, with big family size, they have been curled or neglected by their care giver and finally have low financial state.

The Incidence of Adverse Events in Patients Treated with Therapeutic Dose Enoxaparin in Relation to Body Mass Index

Riyadh Mustafa Murtadha

Kerbala Journal of Medicine, Volume 10, Issue 3, Pages 3827-3832

background: Low Molecular Weight Heparin (LMWH) has widely replaced its parent and oldest anticoagulant compound “Heparin” due to its numerous advantages. However, LMWH are not devoid of adverse effects which may be serious. Since the therapeutic dose of LMWH “Enoxaparin” is determined by a weight-based regimen, the incidence of adverse events may be increased when using higher doses in overweight & obese patients.
Aim: to assess the incidence of adverse events in acutely thrombosed patients treated with therapeutic dose Enoxaparin in relation to Body Mass Index (BMI).
Methods: A prospective study conducted through a 6 months period in 2014 including 181 patients (98 males, 83 females) with acute thrombotic disorders admitted to the cardiac care unit in Al-Hussein Medical city in Karbala-Iraq. All patients who had normal renal functions, were received weight-based LMWH in the form of Enoxaparin. They were subdivided according to their BMI into 3 groups; normal, overweight and obese. Any evidence of adverse events were followed and recorded.
Results: Bleeding was the most common adverse event occur in 15 out of 181 patients (8.3%), categorized as Major bleeding comprising 2.2% overall, occur in 2% of normal BMI, 1.6% of overweight, & 2.9% of obese patients, and Minor bleeding comprising 6.1% overall, occur in 5.9% of normal BMI, 6.5% of overweight, & 5.8% of obese patients. No death was reported related to bleeding. Other adverse events were thrombocytopenia in 2.6%, and fever in 1.1% overall. There was no statistically significant difference regarding all adverse events among the 3 groups.
Conclusion: The incidence of bleeding and other adverse events was not found to be increased in relation to BMI when using weight-based therapeutic dose Enoxaparin, which may indicate the rationale use of this regimen in patients with acute thrombotic disorders.

Prevalence of Celiac Disease in Dyspeptic Patients

Ammar Abd Al. Majeed

Kerbala Journal of Medicine, Volume 10, Issue 3, Pages 3833-3840

background:Celiac disease (CD) is a disorder of small bowel malabsorption, occur upon exposure to gluten, CD appears to represent a spectrum of presentations: ranging from classical type (most commonly describe), to atypical form found in the setting of another presentation e.g.: iron deficiency, osteoporosis (most patients have it). The diagnosis of CD in adults is classically made on clinical suspicion but firm diagnosis can only be established by small intestinal biopsies and serologic markers
Objectives: to estimate the prevalence of celiac disease in patients with dyspepsia Methods: Any patient had dyspepsia, older than 15 years were tested for anti-tissue transglutaminase antibody and underwent upper gastroduodenoscopy.Four endoscopic biopsies were taken from each patient and sent for histopathological examination and classified according to modified Marsh's classification.
Results: Among 157 patients who enrolled in study, 17 patients were labeled as celiac disease: 16 of them has histopathologic changes (Marsh II and above) and 1 patient was normal mucosa, 15 patients from them were positive for tTG antibody and 2 patients were negative.
Conclusions: any patients diagnosed with functional dyspepsia and sent for endoscopy, should routinely had biopsy of the descending duodenum. Particular attention to females with dysmotility or indeterminate dyspepsia.

The Prevalence of Cases of B-Thalassemia Minor Among the Hematologically Suspected Cases in Kerbala.

Duha Maitham Hassan; Mohammed Shnain Ali

Kerbala Journal of Medicine, Volume 10, Issue 3, Pages 3841-3845

background: B-thalassemia minor is the symptomless carrier state of B-thalassemia that can be misdiagnosed as mild iron deficiency anemia (IDA).
Aim: This work aims to assess the prevalence of cases of B-thalassemia minor among the suspected cases and to compare the results of diagnosis depending on single confirmatory test (Hb electrophoresis) and three confirmatory tests (reticulocyte count, serum ferritin and Hb electrophoresis).
Materials and methods: In this study 50 cases of mild anemia (Hb ≥9-11.99 g/dl) with initial hematological suspicion of B-thalassemia minor were studied for detailed confirmatory diagnostic tests that include reticulocyte count, Hb electrophoresis for HbA2 estimation and S.Ferritin level.
Results: Results showed that 43/50 i.e 86% of suspected cases are confirmed by three tests (41/50 i.e (82%) have B-thalassemia minor, 2/50 i.e (4%) have B-thalassemia minor and IDA), 6/50 i.e (12%) have iron deficiency anemia (IDA), while 1/50 i.e (2%) have polycythemia (on venesections).
Discussion: Results showed that 86% of initially suspected cases are confirmed to have B-thalassemia minor and 4% of cases have B-thalassemia minor with IDA depending on three tests for confirmatory diagnosis which are reticulocytosis, HbA2 concentration and S.Ferritin level. Similar results were encountered by Cristina Passarello, Antonino Giambona, et al.
Conclusion: The prevalence of cases of B-thalassemia minor among the hematological suspected cases in Kerbala is 86%.

The Frequency of Histopathological Patterns in Endometriam Obtained from a Sample of Iraqi Women with Abnormal Uterine Bleeding

Farah Falah Hassan

Kerbala Journal of Medicine, Volume 10, Issue 3, Pages 3846-3856

background: Abnormal uterine bleeding is one of the most common and challenging problems to the gynecologist regardless of the age of the women. Histopathological evaluation of endometrium regarded as an important step in the diagnosis and management of endometrial causes of Abnormal Uterine Bleeding.
Objective: To study the frequency of different histopathological patterns of endometrium in women with abnormal uterine bleeding across different age groups.
Materials and methods: A retrospective age specific comparative analysis was done using a total number of women (85) presenting with abnormal uterine bleeding who underwent endometrial sampling during one year period from January 2015 to march 2016 in the pathology department of AL elwia teaching hospital. Endometrial curettages done for evaluation of products of conception were excluded. Endometrial samples were sent for histopathological examinations and different histological patterns were noted.
Results: Abnormal uterine bleeding was found to be more frequent in women in age 41 to 60 years and less frequent in the age over 60 years. The most common histopathological feature present in the curetting materials of women with abnormal uterine bleeding was inadequate proliferative endometrium (which belong to inorganic cause of AUB*dysfunctional*) in both age group 20 to 40 years and 41 to 60 years, and represent (44.7%) of total samples, while none of the samples in women over 60 years showed inadequate proliferative endometrium. Endometrial carcinoma was diagnosed in five samples, representing (5.88%) of all samples, all were of grade I endometriod type and all were in the age group 41 to 60 years which represent (8.62% ) of all the samples in this age group. Only one sample (1.17%) showed malignant mixed Mullerian tumor. Regarding endometrial hyperplasia, 14 were simple hyperplasia without atypia representing 16.47% of all samples, all were without atypia, while only one sample (1.17%) showed complex atypical hyperplasia .This study also showed that 15 samples (17.64%) were due to endometrial polyps. Two samples (2.35%) showed irregular secretory endometrium. Three samples (3.52%) showed histological evidence of exogenous hormone administration, while six samples (7%) were not conclusive.
Conclusions: Abnormal uterine bleeding in women below 60 years old is most commonly dysfunctional in origin. In addition, a good number showed underlying organic pathology, thus highlighting the importance of endometrial curettage and biopsy as a diagnostic procedure in the evaluation of women (particularly over 40 years old) with abnormal uterine bleeding for an early detection of ominous lesions such as endometrial adenocarcinoma and its precursors since histopathological findings of endometrium regarded as the main basis of management desescin

Serum Tnfα Levels Are Inversely Associated With Insulin Sensitivity in Diabetic Retinopathy Patients

Shaymaa Zahraw Nada; Zahraa Saad Hatef; Hassan Murtadha Alkutubi; Ali Mansoor Jasim; Ali Mohsin Abbas

Kerbala Journal of Medicine, Volume 10, Issue 3, Pages 3857-3862

background: Diabetic retinopathy is the most important microvascular complication of diabetes mellitus and the inflammation have potent role in the pathogenesis and development of the disease .Tumor necrosis factor alpha is a prominent proinflammatory cytokine that mediated in all inflammatory process so it has unwanted role in diabetic complication, retina inflammation and endothelia disturbance. So the prediction of the TNFα role in the retinopathy will help to find the major treatment approach.
Objective: this study conducted to evaluate the effect of TNFα in diabetic retinopathy and to find the association between TNFα and insulin sensitivity.
Material & method: this study involved 120 persons were 40 healthy control subjects and 80 diabetic patients which divided into 40 type2 diabetic patients with retinopathy and 40 type2 diabetic patients without retinopathy .The serum level of TNFα ,insulin and lipid profile was measured for all patients and controls and used the SPSS program for the statistic calculation.
Results: The serum level of TNFα was significantly higher in diabetic retinopathy patients in comparison to diabetic only patients and control subjects. Also there was negative correlation between TNFα and insulin sensitivity, the lipid profile was significantly higher in diabetic patient compared to control subject and the LDL cholesterol was significantly high in diabetic retinopathy patients in comparison to diabetic only and control subjects.
Discussion: The inflammation play prominent role in the development of diabetic complication. TNFα is the most important inflammatory marker that present in the serum of diabetic patients. The TNFα affect mainly on the glucose and lipid metabolism and it worsen the insulin resistance and it correlate inversely with insulin sensitivity and due to this effect it will lead to develop of diabetic complication.
Conclusion: The serum TNFα level was elevated in type2 diabetic patients and it may have role in developed the complication of diabetes and it was inversely correlated with insulin sensitivity.

The Pathophysiological Bases of Obsessive Compulsive Disorders

Saad Muttar; Amer Alhaidary

Kerbala Journal of Medicine, Volume 10, Issue 3, Pages 3963-3972

Purpose of review
This review considers the neurobiological aspects and the genetics of the Obsessive-compulsive disorders (OCD). The recent advances in OCD research showed the increasing role of alteration in both the molecular and cellular mechanisms. These altered physiological mechanisms were clinically evident through phenomenology, neuropsychology, neuroimmunology, and neuro-imagery among the patients with OCD. The most consistent finding throughout the researches was the involvement of various cortical and subcortical regions, especially the orbitofrontal cortex (OFC), the anterior cingulate cortex (ACC), the dorsolateral prefrontal cortex (DLPC), the head of the caudate nucleus and the thalamus in the development of OCD. Neuropsychiatric genetic literatures have been expanded to highlight the genetic bases for the development of OCD and their role with various environmental conditions in determination of the disease prognosis and resistance to treatments. This review also discussed uncommon etiologies for OCD, like infections and traumatic brain injuries (TBI). These findings will provide new approaches for better diagnostic and treatment advances.