Karbala Journal of Medicine

Background: Infection with Helicobacter pylori has been recognized as a public health prob
lem worldwide. Patients with diabetes mellitus are more liable to infection. The aim of the
study was to determine the prevalence of Helicobacter pylori infection in patients with type 2
diabetes mellitus in Erbil City and to find whether H. pylori infection associated with higher
levels of glycated hemoglobin (HbA1c).
Subjects and Methods: A case-control study was carried out at Laila Kasim Health Centre.
Around 150 type 2 diabetes mellitus patients and 50 non-diabetic patients were recruited. The
study was conducted between September to November 2020. Blood samples were collected
and analyzed for blood sugar, HbA1c and serum used for detection of anti-Helicobacter pylori
antibody (IgG) by ELISA. Results: Helicobacter pylori infection was detected in 73.3% of Type 2 diabetes mellitus
(T2DM) patients and 54% of controls (P= 0.01). Helicobacter pylori infection was highly
prevalent in patients with fair control of blood glucose (HbA1c 83.8%; P= 0.007). Helicobacter
pylori infection was not associated with; duration of T2DM, age, gender, body mass index
(BMI), alcohol consumption, dyspeptic symptoms and level of education.
Conclusion: This study found that the significantly higher prevalence of H. pylori infection in
diabetic patients especially in those with fair control of blood glucose as compared to non-DM
individuals, this indicated that the increased levels of HbA1c associated with H. pylori.
Key word: Helicobacter pylori, Type 2 diabetes mellitus, HbA1c

Background: Although dual-chamber pacemakers are more physiological, they can negatively impact
cardiac function due to the dyssynchrony caused by right ventricular pacing, affecting left ventricular
function.
Soluble suppression of tumorigenicity-2 (sST2) is an isoform for the ST2, and the second isoform is
called transmembrane ST2 (ST2L). After a cardiac insult, IL-33 interacts with ST2L to counteract the
adverse effects of that insult. sST2 acts as a decoy receptor for IL-33 competing with ST2L preventing
it from binding to IL-33, limiting cardioprotective measures of ST2L/IL33.
Objective: This study aimed to investigate the effect of a dual-chamber pacemaker on sST2 levels in
patients with preserved ejection fraction.
Methods: a case-control study with 52 dual-chamber pacemakers patients, 68% were males, together
with 52 controls. Participants were divided into patients and control groups. Exclusion criteria were
heart failure, recent acute coronary syndrome, uncontrolled hypertension, left ventricular hypertrophy,
uncontrolled diabetes, pulmonary hypertension, right bundle branch block, and atrial fibrillation. sST2
was measured alongside ECG and echo to calculate the EF%, CO, SV, LVPEP, and RVPEP.
Results: sST2 was higher in patients (p = 0.0001), 95% CI [18.06, 25.22]. Patients had lower values
of EF%, CO, and HR (p = 0.0001). The ΔVPEP was higher in patients (p = 0.0001), 95% CI [18.06,
25.22]. Both, SV and RVPEP showed no significant differences.
Conclusion: dual-chamber pace

Background: Subfertility is defined as a disease where couples cannot conceive after 12
months of unprotected intercourse. Adipose tissue is a functional endocrine-like organ that se
cretes various adipokines (mainly leptin); these adipokines control a wide range of different
systematic reactions. Leptin was believed to be released by different cell types (mainly by ad
ipocytes), controlling energy stores and reflecting body fat stores. Elevated serum level of lep
tin was found to impair oocyte development especially in females with polycystic ovaries Aim
of the study: Determine the association between serum leptin level and subfertility in women
with polycystic ovaries.
Material and methods: A case-control study was done during the period from September
2020 to January 2021. The study includes 88 women, their ages ranging from 18-40, and their
BMI ranging between (18.5-40) Kg/m². Forty-four women were subfertile with polycystic ova
ries, and the other 44 women are fertile with normal ovarian texture. For both groups, leptin
levels were measured.
Result: There is a significant association (p ≤ 0.05) between serum leptin levels and subfertil
ity, especially in obese females presented with polycystic ovaries compared to the females with
normal ovarian texture (control group). This reveals the intimate relationship between impaired
reproductive function and increase body fat content that are mainly related to polycystic nature
of the ovaries.
Conclusions: The significant association between serum leptin levels and reproductive capac
ity in females with polycystic ovaries at different bodyweight groups points to the important
function of this adipokine in regulating female fertility.

Background: Aromatase inhibitors AIs, are now widely used hormonal therapy in
postmenopausal breast cancer patients with hormone receptors positive because of their clinical
effectiveness in both adjuvant and metastatic setting. Adherence to therapy and compliance
with professional instructions are critical in the management since poor compliance to
treatment leading to inferior outcomes. Aims: To determine the adherence of patients to AIs
therapy and factors associated with non-adherence among breast cancer patients in Middle
Euphrates region of Iraq.
Methods: This study was conducted in Al-Hussein cancer center in Karbala province of Iraq,
between January 2020 and December 2020. There were 101 breast cancer patients treated with
AIs, their adherence was assessed by using the validated Morisky Medication Adherence Scale
(8-MMAS).
Results: Majority of patients had a high adherence in (62.38%) while (37.62%) of our patients
were suboptimal adherence. Forgetfulness was the main cause of poor adherence in (71.05%)
of patients. Bone and joint pain were the most frequent side effect among our patients. There
was no significant association between age, educational level, marital status, income, parity,
prior treatment and adherence (p-vale > 0.05).
Conclusion: These data suggest that more than one third of the patients have suboptimal
adherence to Aromatase inhibitors. The factors associated with poor adherence were
unintentional (forgetfulness), but also included intentional factors, such as drug inconvenience
and avoidance of adverse effects. Paying attention to the factors found in this study might help
to improve outcomes among breast cancer patients

Background: One of the important tasks of anesthetists is controlling the hemodynamic re
sponses (the increase in blood pressure and heart rate) associated with direct laryngoscopy and
endotracheal intubation. Many medications were tried for this purpose; among them were rem
ifentanil and lidocaine are given intravenously after induction of general anesthesia.
Objectives: To compare the effect of remifentanil and lidocaine, determine which has a supe
rior activity, on hemodynamic stability, during endotracheal intubation.
Patients and methods: This is a randomized controlled clinical trial study conducted on 60
clinically fit patients, planned for elective surgery under general anesthesia with endotracheal
intubation. Patients were divided randomly into two groups according to the administration of
the Remifentanil or Lidocaine drug. Baseline readings of systolic, diastolic blood pressure, and
heart rate were recorded as time 1. General anesthesia was induced using intravenous propofol
and rocuronium. The study drug was given, and the readings again were recorded after 90
seconds as time 2, followed by direct laryngoscopy and endotracheal intubation. The third and
fourth readings (time 3 & 4) were recorded at one & three minutes postintubation, respectively.
Results: Mean systolic blood pressure and heart rate were significantly reduced at times 2 &
3, while mean diastolic blood pressure was significantly reduced at time 2 in the remifentanil
group compared to the lidocaine group. Conclusion: Remifentanil is more effective than lidocaine in attenuating the sympathoadrenal
response of direct laryngoscopy and endotracheal intubation.

Background: Depression is a health problem of epidemic dimension; one of the most common
mental disorders affecting more than 300 million people worldwide. Depression is character
ized by a wide variation of symptoms including abnormal and persisting affective changes
associated with sadness, feelings of worthlessness, guilt and hopelessness, pessimistic, sui
cidal, self - harm thoughts, impaired capacity to perform everyday tasks and functions, and
hypochondriasis.
Objectives: To measure the prevalence of depression among health workers in hospitals and
primary health care centers in Kerbala governorate.
Subjects and methods: A cross sectional study, the study population was consisted of 300
Health Care Worker. The data was collected with a questionnaire consisting of socio-demo
graphic variables screened for depression by a standardized scale Patient Health Questionnaire
9 (PHQ-9).
Results: The prevalence of depression among health care worker was 85%. Further categori
zation of depression into grades revealed that mild depression prevalence was (36.3%), mod
erate (31%) and severe (17.7%). The prevalence rate of depression was significantly higher
among females (87.2%) than males (81.8%), while no significant difference was found between
the two governorates or between rural and urban residents.
Conclusion: The prevalence of depression among Health Care Workers was remarkably high.
There was a significant association between gender and depression. The highest prevalent types
of depression were mild, followed by moderate depression.

Background: Breast cancer is the most common type of cancer among females worldwide and
is the most prevalent cancer in Iraq.
Aims: To determine the value of breast magnetic resonance imaging (MRI) in the assessment
of Breast imaging- Reporting and Data System BI-RADS IV subdivisions. Trying to reflect the
likelihood of malignancy and to determine whether they correspond well to target ranges for
mammography and ultrasound (up grading or down-grading).
Patients and methods: A cross-sectional study carried out on selected 32 ladies with 47
suspicious lesions by means of ultrasonography and/ or mammography and were recruited for
MRI in MRI unit of Al-Imamein Al-Kadhimein Medical City in Baghdad from February 2019
to December 2019. Two independent radiologists analyzed the images; subcategorized the
findings as BI-RADS 4A, 4B, or 4C.
Introduction
Results: from the 47 lesions, 21 were proved malignant (by means of fine needle aspiration
(FNA) in 19 lesions, while 28 lesions were obtained by excisional biopsy or mastectomy),
giving sensitivity of 100% and specificity of 34.6%. The referral BI-RADS IV subdivisions by
ultrasonography/ mammography (IVA= 20 (55% of them given IV A on MRI), IVB= 18
(27.7% of them were IVB on MRI) and IVC= 9 (77% were given IV C on MRI)) were
significantly correlated to that of dynamic contrast enhanced (DCE) MRI (P-value <0.001).
There was a statistically significant correlation of lesion size (P- value=0.003), shape (P-
value=0.003), margins (P- value < 0.001), type of dynamic curve (P-value = 0.02), T2 signal
intensity (P-value= 0.009) with the lesion type (benign or malignant).
Conclusion: Risk stratification of suspicious lesions (BI-RADS IV subdivisions) was
satisfactorily performed with DCE-MRI as it can concur with U/S and/ or mammography in
the assessment of American College of Radiology (ACR) BI-RADS IV subdivisions.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a preventable and control
lable inflammatory respiratory disease that is a leading cause of morbidity and mortality world
wide.
Objectives: The current study aimed to investigate COPD phenotypes by high resolution com
puted tomography (HRCT) and compare these phenotypes and other CT findings with the se
verity of Spirometric variables.
Patients and Methods: A cross-sectional study was performed on 56 patients with COPD of
any duration and smoking history referred to the radiology department of Al-Imamain Al-Kad
himain Medical city, during the period from May 1 to December 31, 2019. Spirometry was
performed at the same visit during which chest HRCT was imaged, and two independent radi
ologists and findings interpreted these images were evaluated according to the modified Bhalla
scoring system.
Results: From 56 patients included in the study, 47 (83.9%) patients exhibited morphological
CT changes. Patients with HRCT changes were classified into three phenotypes: Emphysema
dominant (n=19), airway dominant (n=18), and mixed phenotype (n=10). Except for forced
expiratory volume in 1 second to forced vital capacity ratio (FEV1/FVC), other spirometric
variables, including severity stages termed the global initiative for chronic obstructive lung
disease (GOLD), showed no significant correlation to the correspondent phenotypes. In con
trast, HRCT findings, including those scored according to the modified Bhalla system, were
significantly correlated to the CT phenotypes. On the other hand, GOLD severity showed no
correlation with the presence or severity of morphological lung changes detected on HRCT.
Conclusion: The GOLD stages of COPD severity based on spirometry are not correlated with
radiological phenotypes recognized on HRCT or the severity of those morphological changes.
In contrast, a significant correlation was found between COPD phenotypes characterized on
CT and the severity of morphological abnormalities.

Background: Internet usage is tremendously growing, misuse and overuse called Internet Ad
diction (IA); the latter may lead to negative results, affect people's psychological, social, phys
ical, and academic performance, especially students. IA is a growing problem worldwide
among young people, including university students.
Objectives: To determine the prevalence of IA among university students and identifying as
sociated factors.
Subjects and Methods: A cross-sectional study was conducted on 559 students of the first and
third stages in four randomly selected colleges in the University of Kerbala. Data collection
was done from 26th March to 29th April 2018. A self-administered questionnaire was used
based on Arabic versions of the Internet Addiction Test (IAT). Analysis of the data was done
by using SPSS version 20.
Results: The prevalence of IA was 68.7% (95% confidence interval (CI): 65.1%-72.5%) and
severe IA was10.2 % (95% CI: 7.7% -12.7%). IA levels were significantly associated with
male gender, excessive Internet use, lower sleeping hours, sleeping late, difficulty awakening
in the morning, and lower academic performance (P-value < 0.05). Further, internet addicts
showed a higher prevalence of headaches, backache, and hand pain.
Conclusion: High level of IA was recognized among university students. IA levels were sig
nificantly higher among males. There was a positive association between IA and excessive
internet usage, poor sleep habits, and lower academic performance. Higher IA level was asso
ciated with a higher prevalence of backache, headache, eye pain or redness, and pain in the
hands because of sitting online for long periods.

Background: The Metabolic syndrome is a cluster of risk factors that is responsible for the
risk of coronary heart disease and stroke.
Objective: To determine the prevalence of Metabolic syndrome and its components among
type two diabetes patients.
Patients and methods: Across sectional study was conducted between February to August
2020 among 394 patients with type two diabetes were randomly selected in diabetic center of
Imam AL Hussein Medical City in Karbala, Iraq. The demographic, clinical, and biochemical
parameters were studied after obtaining informed consent from each patient. Metabolic syn
drome was diagnosed according to the criteria of National Cholesterol Education Program
Adult Treatment Panel III (NCEP-ATP III).
Result: The prevalence of metabolic syndrome was 92.7%. A total of 394 patients were in
cluded in the study,285(72.3%) were females with mean age (51.77±9.56) years. The most
prevalent component of metabolic syndrome was elevated triglyceride (87.3%); followed by
abdominal obesity (80.2%) and elevated blood pressure (71.6%).
Conclusion: A high prevalence of metabolic syndrome among type 2 diabetic patients; which
proposing that diabetic patients are at increased risk of cardiovascular disease and other com
plications.

Background: Tonsillectomy and adenotonsillectomy are the most common surgical operations
done by E.N.T surgeon all over the world. No clear agreement worldwide on histopathological
examination of tonsillectomy and adenoidectomy specimens when there is no suspicion of ma
lignancy.
Objectives: To assess the real need of routine histopathological examination in tonsillectomy
without signs or symptoms of malignancy.
Methods: Tow hundred-thirty-nine patients submitted for tonsillectomy because of different
indications at Department of Otolaryngology, Al-Hussian Teaching Hospital, Karbala during
the period 1st May 2016 to 30th September 2017, and histopathological examination of tonsil
lectomy specimens were done for all patients.
Results: A prospective case series study, total of 239 patients submitted to tonsillectomy, there
were 135 (56.5%) males and 104 (43.5%) females patients (M/F 1.3:1). Regarding the histo
pathological examination of palatine tonsils, 208 (87%) patients presented chronic nonspecific
tonsillitis; no patients with chronic specific tonsillitis; 29 (12.1%) patients with reactive hyper
plasia; Eight of our patients (3.34%) had clinical suspicion of malignancy and only 2 (0.8%)
patients had tumour as B cell lymphoma, one man 35 years old the other woman 40 years old
Conclusions: Histopathological examination of tonsillectomy specimens is indicated only
when there is preoperative suspicion of malignancy. Naked-eye examination is a good substi
tute for histopathological examination, no cost and no time consuming.