Volume 11, Issue 1, Winter and Spring 2018, Page 3873-3967


Hepatitis A in Kerbala: Eight Year Epidemiological Study

Lamya A A Darwish; Hassan Ali A Nasrallah; Ali Al Mousaw

Kerbala Journal of Medicine, Volume 11, Issue 1, Pages 3873-3883

background: Viral hepatitis is a contagious disease that continues to be a global burden. We have noticed from our clinical practice that the number of cases is growing especially in Kerbala Province.
Aim: we conduct this epidemiological study in Kerbala Province to investigate the incidence rate of Hepatitis A infection and to have an insight to the causative factors in view to addressing them and tackle this big health problem.
Method: Data from The Infectious Diseases Registration Office in Kerbala health directorate was revised to review all registered hepatitis cases between 2010 and 2017.
Results: of 9352 hepatitis patients, (58.8%) males and (41.2%) females registered in Kerbala Health governorate in eight years (2010-2017). Hepatitis A formed the majority of cases (61.7%) followed by hepatitis B and C. Converting frequency to incidence rates showed that the annual rate of the four main types of hepatitis were 0.069, 0.028, 0.013, 0.001 per 100,000 population, respectively. The incidence of hepatitis A rates in 2010-2017 in Kerbala fluctuated, however the median endemic was rising. Within the four main geographical areas in Kerbala (City Centre, Hindia, Al Hussainia and Hurr) the incidence of hepatitis A per 100,000 population was markedly higher in the city Centre.
Children and adolescents were the mostly affected age groups as they formed more than three quarters of the patients, but there was no significant gender difference. Seasonal variation was very clear as summer months were marked with significant increase in incidence rates.
Conclusion: Being a holy city where millions of pilgrims visit Imam Hussein (PUH) shrine appeared to play an important role in disease transmission where propagations started after religious occasions. Decision makers need to address the serious health issue and implement a more proactive plan for the near future.

Histopathologic Study for Skin Basal Cell Carcinoma

Nazar J. Metib; Aseel H. Aboud

Kerbala Journal of Medicine, Volume 11, Issue 1, Pages 3884-3888

background: Basal cell carcinoma (BCC) is the most common Worldwide cutaneous cancer; approximately 75% of all skin cancers. It arises from the basal cells of the epidermis and pilosebaceous units. It has a long evolution, slow growth rate with up to 70% of primary BCCs occurring in head or neck region. Although it rarely results in death or metastatic disease, BCC can cause significant morbidity due to destructive local spread.
Aims of the study: To determine the frequency of various histopathologic types of BCCs encountered in practice, to delineate the spectrum in setup, anatomical location, site predilection, and annual age and sex incidence each year.
Materials and Methods: The analysis included two hundreds and five cases of skin tumors, 88 cases were basal cell carcinoma from Department of Histopathology, Al Hussain Medical City/ Karbala. The study was retrospective and done during the period of January 2012 to June 2016. After careful review of the Hematoxylin and Eosin (H and E) stained sections, statistical analyses were done.
Results: Out of (205 cases of skin tumors) only 88 were of BCC and accounted for 42.92% of all the malignant tumors of skin. majority (87.51.%) of the lesions of BCC were located on head and neck region, solid nodular type was most common histopathologic type and average age of cases was 64 5years.
Conclusion: In the present study majority (87.51.%) of the lesions of BCC were located on head and neck region, average age of cases of basal cell carcinoma was 64.5years, and solid nodular type of BCC was most common type.

Association of Adiponectin Gene Promoter Polymprphism (rs266729) With Ischemic Heart Diseases

Maha Radhi Abass; Majid Kadhum Hussain; Zuhair Mohammed Ali Jeddoa

Kerbala Journal of Medicine, Volume 11, Issue 1, Pages 3889-3893

background: Ischemic Heart Disease is a group of diseases of the blood vessels supplying the heart muscle. Adiponectin is a protein secreted by adipocyte with insulin-sensitizing, Anti-inflammatory and anti-atherogenic properties. Several studies have shown that polymorphisms within the adiponectin gene can be associated with Ischemic heart disease.
Aim: The aim of the present study was to evaluate the impact of (rs266729) SNP in the promoter region of the ADIPOQ gene on the occurrence of Ischemic heart disease (IHD).
Methods: The study included 150 patients with IHD randomly selected based on World Health Organization (WHO) guideline and 150 as controls group. DNA was extracted from blood and genotyped by PCR-RFLP by using (Hha1) enzyme.
Result: The frequency of G allele of rs266729 (C/G) polymorphism was significantly (p=0.0001) in IHD (19.6%) compared with control (13.3%). The homozygous genotype (GG) significantly (0R=1.71, CI 95%=0.65-4.96, P= 0.0001) increased the risk of Ischemic Heart Disease compared with wild type (CC) after adjustment age, sex, and BMI, furthermore the heterozygous (CG) genotype significantly (0R=1.61, CI 95%=0.96-2.87, P= 0.0001) raised the risk of Ischemic Heart Disease.
Conclusion: Adiponectin gene polymorphism rs266729 is involved in the pathogenesis Ischemic heart disease.

Thyroid Dysfunction during Pregnancy

Ula Salah Jumaa; Zahraa Abdulaali Mohammad Hassan

Kerbala Journal of Medicine, Volume 11, Issue 1, Pages 3894-3902

background: Pregnancy is the time of hormonal changes which may result in endocrine disorders. Thyroid disorders are common clinical problem during pregnancy in which subclinical hypothyroidism is the most common thyroid disorders. Maternal thyroid dysfunction may result in short-term and long- term harm to the mother and child.
Objective: To study the prevalence of thyroid disorder during pregnancy and to follow the correlation between (TSH, FT3, and FT4) with BMI
Materials and Method: A cross sectional study involved 120 pregnant women in second and third trimester (apparently normal) between (19-42) years.
The participants were collected randomly from outpatient unit of Al-Zahraa teaching hospital in AL-Najaf AL-Ashraf, detailed history and data for pregnant women were recorded (including maternal age, gestational age ,medical history of thyroid disease and history of abortion and infertility) .Pregnant women with history of thyroid disease were excluded from the study. Serum TSH, FT3 and FT4 were measured for all pregnant women participated in study
Results: The prevalence of thyroid disorder during pregnancy was 20.8% out of which 20(16.6%) had SCH and 2(1.6%) had OH. Hyperthyroidism detected in 3(2.5%) pregnant women all of them had subclinical hyperthyroidism. and there was a positive correlation between TSH, FT3 with BMI and negative correlation of FT4 with BMI, also maternal age don’t affect thyroid function status significantly (p value < 0.05).and there was no significant relation between thyroid disorder and history of abortion or infertility (p value < 0.05)
Conclusion
There is a high prevalence of hypothyroidism during pregnancy and the majority is subclinical hypothyroidism .BMI was correlated positively with TSH and FT3 and negatively with FT4.

Polymerase Chain Reaction Testing in Comparison to Culture of Cerebrospinal Fluid for Diagnosis of Bacterial Meningitis in Children

Zena Khalid Mahdi; Hayder H Al-Momen; Ali Abdulrazzaq Obed; Essam J Al-Zwaini

Kerbala Journal of Medicine, Volume 11, Issue 1, Pages 3903-3911

background: Childhood bacterial meningitis is a neurological exigency. Accurate, early, rapid diagnosis and treatment is essential to decrease its morbidity and mortality.
Aim of study: This is a retrospective study comparing real-time polymerase chain reaction (RT-PCR), with standard bacterial culture for the diagnosis of bacterial meningitis during cerebrospinal fluid (CSF) examination.
Materials and methods: RT-PCR was used for the detection of three most common causes of bacterial meningitis (Streptococcus pneumonia, Haemophilus influenza type b, and Neisseria meningitides) in 100 CSF samples from children aged 2 months to 12 years admitted to Al-Elwiya Pediatric Teaching Hospital during the period from January 2016 to January 2017
Results: Growth was detected in 6% CSF cultures of patients included in the study and Streptococcus pneumoniae was the most prominent isolated bacteria. RT-PCR was positive in 43% CSF samples from which S. pneumoniae was identified in all samples. PCR and culture showed concordance in 6% positive and 57% negative samples. Using culture as a reference method, the sensitivity, specificity, and positive and negative predictive values for PCR on CSF samples were 100 %, 60.64%, 13.93% and 100 %, respectively. RT-PCR was positive in 37% CSF samples whereas culture was negative.
Conclusion: RT-PCR is a rapid and sensitive test for the diagnosis of bacterial meningitis. The findings of this retrospective study recommend the use of RT-PCR for the diagnosis of children with a clinical suspicion of bacterial meningitis and as a complement to culture, especially, those who received previous antibiotic treatment before lumbar puncture.

Effect of Cardiac Catheterization on Certain Hematological Parameters

Ahmed Bader Abdulwahid

Kerbala Journal of Medicine, Volume 11, Issue 1, Pages 3912-3917

bAckground: Cardiac catheterization is a procedure used to check the heart for blocked arteries and valve abnormalities by using a coronary angiogram, through which the patient will exposed to the hazardous effect of radiation and contrast media used.
Aim of the study: Our study aimed to see the effect of cardiac catheterization on certain hematological parameters
Methods and subjects: This study was carried out in the cardiac catheterization center in Al-sader teaching hospital in Basrah city on 30 patients (20 were males and 10 were females), their ages ranged between 35 and 66years with mean of (53.62±8.98 years). Solution of Ultravist 370 injection was used during the procedure as contrast media in amount ranged between (25-600 ml) with an average of (41.56 ±13.75 ml). Fluoroscopy was also used and the flouro-time was ranged between (0.54-8.9) minutes with an average of (2.085±1.18 min).
In this study and for all patients we estimated the number of RBCs, WBCs (total and differential) and platelets one hour before and one hour after the procedure of cardiac catheterization by using automated hematology analyzer (Sysmex XT2000i Japan).
The results were analyzed using SPSS software, in which independent t test were used to compare the differences in the values of the included parameters obtained before and after cardiac catheterization.
Results: The comparative data revealed that there were decreases in most of the parameters one hour after cardiac catheterization which is statistically significant regarding the number of lymphocytes, monocytes and platelets, with significant increase in the number of neutrophils one hour after cardiac catheterization (p˂0.05).
Conclusion: The exposure to radiation and iodinated contrast media increases neutrophils count and decreases lymphocyte and platelets counts one hours after cardiac catheterization while it has not effect on the RBCs and total WBCs counts.

Tear Film Instability in Diabetic Patients

Hussam Abdalhussain Saeed Alhamari; Hussain Ali Tufaili

Kerbala Journal of Medicine, Volume 11, Issue 1, Pages 3918-3922

background: The association between dry eye symptoms and ocular surface disease is becoming more frequent. The recent rise in newly diagnosed cases of diabetes mellitus and the awareness of real complaints of diabetic patients from dryness of the eye and ocular discomfort are responsible for the recent increase in the number of patients and frequency of their consultations to the outpatient departments.
Aims of the study: To investigate the changes of tear film and ocular surface in diabetic patients.
Design and method: A case control study carried out in the eye clinic of Al-Sadr Teaching hospital in holy Najaf city for 12 months. It included 100 eyes of fifty patients of Type 2 Diabetes Mellitus (Cases) and 100 eyes of fifty healthy individual (Controls). After exclusion of patients with history of systemic diseases with ocular manifestations affecting tear secretion, abnormalities in the cornea, conjunctiva, or eyelid, and secondary ocular and systemic disease, the remaining diabetic cases are 72 and control cases are 89. Different symptoms included; character of irritation whether it was burning, foreign body sensation or sand gritty feeling. All the individuals underwent routine general physical examination and thorough ophthalmological examination followed by measuring tear film meniscus height, tear film breakup time (BUT), presence or absence of tear film debris.
Results: There is significant difference between diabetics and non-diabetics in presence of normal or abnormal tear meniscus height. There is also significant difference between diabetics and non-diabetics regarding normal and abnormal tear film breakup time. However, there are no significant differences between diabetic and control group in the presence or absence of tear film debris.
Conclusion: Tear film stability is decreased in diabetic patients. These results sug¬gest that diabetic patients are more prone to suffer¬ing from dry eye symptoms than normal subjects.

Risk Factors in Patients Having Renal Stones in Al-Sader Teaching Hospital in Misan Province

Ali Laibi Zamil; Thaer Saleh Sabor; Fatima Abdul-kareem Mohammed

Kerbala Journal of Medicine, Volume 11, Issue 1, Pages 3923-3927

background: Renal stone is one of the commonest renal conditions in Iraq and number of the patients who are suffering from this condition is one of the largest attendance to the In / Outpatient clinics.
Aim: There are many risk factors leading to this condition and in this study trying to recognize the most common risk factors and compare with other studies.
Patients and method: 67 cases were been chosen for this prospective study collected from admitted cases and Outpatient clinic in the main hospital in the province and the data were collected directly from the patients themselves and their medical records to identify the main risk factors causing their problems.
Results: In this study many tables were getting for the main risk factors but try to concentrate about the commonest risk factors that discovered during the study and also to compare it with other studies in the same topic.
Discussion: Making a comparison between this study and other studies were done in USA and UK, it has been found that the main risk factors for renal stones formation in western countries is the supplemental calcium and chronic or recurrent UTI and the gender factors are similar to this study.
Conclusion: This study shows the most common risk factor for renal stone formation is chronic UTI then history of previous stone and the family history of renal calculi and effect of climate. Also increase incidence of renal stones in female more than male. The study also shows the living in urban area is more risk for renal stone formation than rural area.

Problem Based Learning from Students’ Perspectives in University of Kerbala, College of Medicine

Shahrazad S Al Jebori; Ali Al Mousawi

Kerbala Journal of Medicine, Volume 11, Issue 1, Pages 3928-3936

background: Most higher education institutions throughout the world are searching for teaching and learning methods that will both engage students more actively in their learning and contribute to a deeper understanding of the content. In Iraq where tertiary education is expanding and many medical colleges had adapted Problem Based Learning (PBL) incorporated curricula. As a new experience, there was a need to explore the views and perspectives of the direct beneficiaries in this learning system, the students.
Subjects and methods: A qualitative study was performed to explore medical students' perceptions and attitudes regarding the change in undergraduate medical education that took place at the college of medicine, University of Kerbala. One hundred twenty second-year students participated in this study. Student answers were analyzed using SWOT analysis technique.
Results and discussion: The majority of the participants showed positive attitude and evaluation of the newly adopted system. The results suggest that the students face difficulty in bridging the gap between the theoretical and practical phase of the curriculum, some shortcomings due to the need for better logistic support and tutor training.
The study explored students opinions in six disciplines: lectures, relevance of finding objectives by the students, PBL system implementation, PBL session implementation, team work and tension problems, tutor efficiency, as well as additional students’ suggestions.
Conclusions and recommendations: The students have perceived PBL approach, recently adopted by Kerbala medical College (KMC) consistently in a positive manner. The main reported shortcomings were related to the application rather than the concept which need further staff training and follow up.

Association between Resisten Gene Polymorphism (420C/G) and Lipid profile in Ischemic Heart Diseases

Asraa Ali Kadhum; Majid Kadhum Hussain; Riyadh. Dh. Al-zubaidi

Kerbala Journal of Medicine, Volume 11, Issue 1, Pages 3937-3942

background: (resistin is considered as a pro-inflammatory molecule and plays a role in the inflammatory response that lead to atherosclerosis)

Aim: To evaluate the risk of resisten gene polymorphism (420C/G) in the development of Ischemic Heart Disease. To verify the relationship of the investigated SNPs with the metabolic changes related to (IHD), in particular, serum lipid profile.
Methods: A case control study was performed at which 150 patients with IHD and 150 healthy individuals. Genotyping for SNP 420C>G in the resistin gene was performed by the polymerase chain reaction –restriction fragment length polymorphism method. Lipid profile were measured.
Results: The genotype and allele frequencies of resistIn gene polymorphism in IHD and control persons were examined under the co-dominant, dominant and recessive models with the use of multi nominal logistic regression analysis. Neither genotype distribution nor the minor allele frequency showed significant changes among the comparison of the of IHD patients with the control group. The frequency of the G allele of 420(CG) polymorphism was significantly higher in ischemic heart diseases (IHD). There are significant increases in the level of LDL, triglyceride, VLDL, BMI and a significant decrease in the level of cholesterol in the group of patients with the GG+CG genotypes when they were compared with those of the CC genotype. It shows significant differences in BMI, Age, Cholesterol, LDL, and HDL in the group of IHD, and no significant difference was seen in VLDL and sex.
Conclusion: The −420C>G SNP of resistin gene is not associated with ischemic heart disease in the population of Kerbala and Najaf. The G allele is seemed to increase serum lipid concentrations so it could be considered as an atherosclerotic parameter.

Non – Melanoma Skin Cancers: A Clinical and Histopathological Study

Osama N. Al -Hemiari; Aseel H. Aboud

Kerbala Journal of Medicine, Volume 11, Issue 1, Pages 3943-3947

background: Non – melanoma skin cancer like basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most common cutaneous cancer and are associated with multifactorial causes such as environmental and host factors, hence they are not uncommon skin diseases in Iraqi patients.
Aims of the study: This study was conducted to evaluate the topography of lesions and their correlations with gender, age, clinical and histological type and correlation between them.
Patients and methods: A total of 159 patients with in non –melanoma skin cancers were studied in Al-Hussain medical city in a retrospective study during the period from January 2012 to June 2016.
After diagnosing each patient and a careful histopathological examination, statistical analyses were done.
Results: The analysis included 159 patients with non – melanoma skin cancers (NMSCs)
Eighty eight patients with basal cell carcinoma were seen (55.34٪). The majority of patients were in the form of nodular and noduloulcerative &the second most type was basosquamous type.
Clinically, it was the same of nodular type as the majority of cases were diagnosed with this type
Fifty patients with SCCs (31.44 ٪) were seen. Clinically, the patients with SCC presented as a hard indurated plaques or nodules, some were ulcerated.
Nearly all the types may be in the form of well differentiated or moderately well differentiated. Discussion:
NMSCs comprise a significant proportion of all skin cancer patients in the world. BCC is the commonest NMSC worldwide and various studies have reported SCC as the second most prevalent.
Basal cell carcinoma commonly seen on the faces of the middle age or elderly with male to female ratio is about 3: 2 and the incidence increases markedly after age of 40 years.
Squamous cell carcinoma was the next common non – melanoma skin cancers of the face forming about 31.44 ٪ of cases as a potentially lethal form of skin cancer, It can arise from actinic keratosis with a slight male predominance in the male to female ratio 1.17: 1.
The prevalence and distribution of lesions of SCC correlates well with the exposure to ultraviolet radiation.

Impact Of stay sutures On Laparoscopic Access complications

Ali Abdul-Aziz Al-Shawi

Kerbala Journal of Medicine, Volume 11, Issue 1, Pages 3948-3951

background: In laparoscopic surgery, the technique of first entry into the peritoneal cavity for creation of pneumoperitonium is called access technique, two methods are used for laparoscopic access either by the closed or open method. Inadvertent complications might occur during port access, although these complications are uncommon, but its potentially life- threatening.
Aim: This study aims to evaluate the impact of stay sutures on the laparoscopic closed access complications.
Patients and methods: A prospective study was conducted in 238 patients underwent elective laparoscopic surgery at Misan governmental teaching hospital in the period between September 2014 and May 2017.
Results: the incidence of hernia was 0.4 % in comparison to 9.25% with the other access port insertion (P value <0.05). Major bleeding and visceral injuries were not reported and bleeding was related to trocar site in (0.4%). Other complications were simple, not life threatened and managed conservatively. Conclusion: transverse stay sutures to the anterior rectus sheath are simple, safe and reduce the initial port access complications.

Minimal Invasive Mini-Sling Procedure for Female Stress Urinary Incontinence

Maryam Jabbar Ghazi Al-Mayali

Kerbala Journal of Medicine, Volume 11, Issue 1, Pages 3952-3955

background: Surgery for stress urinary incontinence has been modernized by the introduction of tension free vaginal tape technique TVT (1). Minisling introduction has been simplifying this surgical procedure.
Aim: To make an assessment of the success rate of minisling for ladies with stress urinary incontinence.
Method: Our study enrols 40 ladies. The mean patients age was 44 years,. 75% of them with pure SUI and 25% had mixed UI. Patient’s assessment postoperatively was made by clinical assessment 3 months and 1 year after the procedure.
Result: success rate was very good 97.5%. Post operative complications was 5% retention, and 12.5% UTI. The 1-3 months follow up shows a 5% de novo urgency and a 1 year follow up shows satisfaction rate of 97.5%.
Conclusion: Minisling procedure for SUI has low morbidity with low rate of complications and high success rate.

Experiences of 5th Year Students in Kerbala with Formative Mini-CEX

Riyadh Dhayhood Mahdi Al Zubaidi

Kerbala Journal of Medicine, Volume 11, Issue 1, Pages 3956-3961

background: Formative work place assessment give opportunities to follow the progression of students learning through monitoring of their doing
Aim: To know the experience of the 5th year students with the first year implementation of formative mini clinical evaluation exercise (mini-CEX).
Method: It is a qualitative research. The information were collected from interview with students completed the internal medicine discipline of the fifth year during the academic year 2017 - 2018.
Results: The participants were aware about the exam, the embarrassment of the exam and the presence of peer get less with subsequent examinations, and the encouraging feedback of the examiner exerted a positive effect on the learning process. The students explored the need to further training of clinical examination, in addition to adhering to instructions regarding the need to focus on educational goals. Some of the teachers did not administer the exam according to the instructions of mini – CEX.
Conclusion: The experience resulting from the mini clinical evaluation exercise (mini-CEX) indicates positive results with regard to studentsʹ rush towards learning, a great opportunity for teachers to follow up the studentsʹ level and guidance, enhancement the studentsʹ communication skills, and the need of some teachers to adhere to the essence of this type of assessment.

The Relationship between Helicobacter Pylori Seropositivity and Myocardial Infarction

Mushtaq T. Al-Hassnawi; Ahmed Hussein AL- Mayali

Kerbala Journal of Medicine, Volume 11, Issue 1, Pages 3962-3967

background: There is a controversial result about the association of H.Pylori infection and ischemic heart disease. The study was design to study the relation in our locality.
Aim of the study: To study the relationship between Helicobacter pylori infection and myocardial infarction.
Patients & methods: Patients that were included in this study, were patients with acute myocardial infarction (S-T segment elevation) that were admitted to coronary care unit of Baghdad Teaching hospital and Al-Hussein hospital in Karbala city between June, 2004 to August 2004, with less than 48 hours of onset of their symptoms.
Patients were evaluated regarding cardiovascular risk factors; smoking, hypertension, diabetes mellitus, body mass index (BMI), hypercholesterolemia, low high-density lipoprotein (HDL) and family history (10-15).
Control groups were included in the studies that were age and sex matched
Fifty patients diagnosed
with myocardial infarction that were admitted to the coronary care unit in Baghdad teaching hospital and Al-Hussein Hospital in Karballa city were tested for anti H.Pylori antibody using ELISA and compared with 51 control persons without coronary heart disease.
Results: 72 % of the patients 78.4% of the controls were seropositive for H.Pylori without significant difference.
Conclusion: No significant relation exists between seropositivity against H.Pylori and acute myocardial infarction