Karbala Journal of Medicine

The evolution of the famous original grading system for prostatic adenocarcinoma which ini-tially described by Dr. Donald Gleason in the 1960s–1970s passed through two steps of modifications according to two major consensus meetings achieved by the International So-ciety of Urologic Pathology (ISUP) in 2005 and 2014 respectively according to many re-searches and clinical trials to be finely incorporated into the recent World health organization (WHO) classification of prostate cancer and staging system as one of the powerful prognostic factor and treatment decision factor .This articles briefly review historical aspects of the original Gleason grading system and the recent modifications , describing the major changes over the years that finely resulted in the contemporary Gleason grading system, which pro-posed a new “Grade Group” system established by the 2014 ISUP meeting , and then incor-porated to the recent (2016) WHO classification of tumors of the prostate.

Background: Systemic lupus erythematosus is a disorder of the immune system with many clinical manifestations.
Aims of this study: is to find the correlations between the clinical manifestations of lupus nephritis and the pathological activity and chronicity indices.
Patients and methods: This is a random cross-sectional study that took a period of two years started from 2015 to 2017, we collected kidney biopsy specimens from thirty patients with systemic lupus erythematosus, 28 were females and 2 were males. All patients were diagnosed as systemic lupus erythematosus if fulfilled ≥4 American college of rheumatology criteria for systemic lupus erythematosus. The activity and chronicity scoring indices are based on the percentage of glomeruli with each feature in the biopsy on a 0 to 3 scale, with a score of 0 = not present, 1 = <25% glomeruli, 2 = 25-50% glomeruli, and 3 indicating >50% glomeruli.
Results: the chronicity index score increased with disease duration. The incidence of anemia increases with presence of high scores of chronicity index. With more than 40 percent of patients with lupus nephritis have glomeruli fibrosis percentage between 25-50%. Malar rash has significant correlation with both activity and chronicity indices.
Conclusion: There was no significant correlation between gender, arthritis, edema, with both activity and chronicity indices.

Background: There is an extensive yet inconsistent body of literature reporting on the preva-lence of colonic polyps among risk individuals. The objectives of our study were to determine the prevalence of colonic polyps, its site, solitary or multiple, sex and age association among patient at risk in Al-Hussein medical teaching city, Karbala, Iraq.
Aim of the study: Colonic polyp is relatively common benign condition, mainly affect mid-dle-aged adults. The objective of this study is to predict the prevalence and location of colon polyp, and to determine its variation based on age and gender.
Material and methods: This is a cross sectional screening study, done in Karbala, Iraq. Co-lonoscopy data were retrospectively collected from the endoscope unit records system from Al-Hussein Medical City in Karbala during the period from September, 2012 through May, 2016.
A total of 1380 patients (810 males and 570 females) were collected, patients' age range (4-67 years). The prevalence of any polyp was recorded for age and gender.
Results:Colon polyps were found in 227/1380 patients (16.44%); 125/810 (15.43%) in males and 102/570 (17.89%) in females. There was no significant difference between males and fe-males, (adjusted OR 1.02; 95% CI 0.76–1.13).The highest prevalence rate of colonic polyp was 12.3% in the age group 41-45 yrs followed by 11.5% in age group 36-40 years, (p = 0.15; adjusted OR 0.99; 95% CI 0.79–1.06). Rectum is the most commonly affected site (44.9%) followed by sigmoid colon (25.1%). Multiple polyps in different sites are 13.6%. Multiple polyps in the same colon region are 12.3%.
Conclusion: The prevalence of colon polyp in population at risk during the study period was about 16.44% in Karbala, Iraq with no significant gender variation. In addition, the highest prevalence rate was in patients' age group 41-45 years and the most common affected site is rectum followed by sigmoid colon.

Background: Fractures of the distal third of the tibia are the major cause of morbidity in pa-tients with lower extremity injuries. Most fractures are sustained in adults during high veloci-ty injuries.
Aim: To compare the radiographic and clinical results of patients with extra- articular unilat-eral closed or type I (Gustillo and Anderson) open fractures of the distal third of the tibia shaft, treated with ORIF with those treated with closed reduction and IM nailing.
Patients and Method: This is prospective study on Fourteen patients treated with ORIF were matched to fourteen patients treated with IM nailing. RESULT: There were no significant differences in regard to: time of surgical procedures, non-union, hardware failure or deep in-fections between plate fixation and intramedullary nailing.
Conclusion: From this study we can conclude that, no much difference in regard to the time for union, nonunion, hardware failure and deep infections between ORIF and IM nailing. For optimal alignment we are considering the use of ORIF for closed and type I open extra articu-lar fractures in the distal third of the tibia

Background: The yolk sac is essential in early life of the embryo because it is the first route of exchange between the embryo and the mother.
Aim of the study: To determine the association of the spontaneous miscarriage with the abnormal morphology and size of the yolk sac.
Methods: A cohort study was conducted among 85 pregnant women with gestational age ranged between 7-12 weeks, transvaginal ultrasonography was done for all patients at first time. The gestational age was calculated according to the last menstrual period (LMP), crown–rump lengths (CRL), mean gestational sac diameters (MGSD). We divided the sample into two groups, 27 women had abnormal yolk sac represented the 1st group (study) and 53 women had normal sonographic appearance of the yolk sac represented the 2nd group (control). We followed the women until the 20th weeks of pregnancy and compared the spontaneous miscarriage rate between the two groups.
Results: Most of the embryos had a yolk sac with a regular shape (80%), whereas the remaining embryos had a yolk sac with an irregular shape (15%), calcified 2.5%. and 2.5% echogenic. about one third of the women with abnormal yolk sac (cohort group) had miscarriage in front of 10.9 % of the control group and the association was significant (p value = 0.013). Significant association between spontaneous miscarriage and abnormal large diameter yolk sac.
Conclusion: Abnormal yolk sac increases significantly the risk of spontaneous miscarriage

Background: Astigmatism is an important clinical and public health issue, it is one of major refractive errors affecting population, persistent astigmatism will cause ametropia and reduced visual acuity by prohibiting the formation of a clear image on the retina which will result in poor work performance.
Subjects and Methods: In a cross-sectional study conducted in Ibn Al-Haitham teaching eye hospital from 10th of January 2017 to 20th of August 2018, volunteers with best corrected vis-ual acuity of 6/6 were investigated. Evaluation of visual acuity, refraction, slit lamp bio mi-croscopy and fundoscopy were performed for each participant. Written informed consent was obtained from all participants. Only phakic eye that could be reliably refracted without a pre-vious history of ocular surgery were included. Data were collected and analysed using multi-ple logistic regression models, p value of less than 0.05% was considered statistically signifi-cant
Results: 400 eyes of 200 participants were investigated in this study of whom 53.5% were males, as shown in table 1.
The prevalence of astigmatism was 34.25%.
Astigmatism significantly increased from 11.5 % in the participants of 18-22 years old to 60% in the participants over 58‑years old (P < 0.001), as shown in table 2. The prevalence of With-The-Rule, Against-The-Rule, and Oblique astigmatism was 11.7%, 20.3% and 2.25%, respec-tively. Against-The-Rule significantly increased with age (P < 0.001). The mean corneal astigmatism was 0.73 D which linearly increased with age (P < 0.001).
Conclusion: In conclusion, 34.25% of our sample was having astigmatism according to the definition in this study, which means astigmatism is a common issue in our society. This study found that against the rule astigmatism increase with age.

Background: Premarital screening program for hemoglobinopathies started in Karbala gover-norate on June13, 2012.
Aim: To evaluate the premarital screening program in Karbala governorate.
Methods: A cross-sectional study by reviewing the records of five premarital clinics and Kar-bala hereditary blood disease center from first of March 2016 to first of October 2018. Total number of individuals screened for hemoglobinopathies were 52014 (26007 couples). Com-plete blood count (CBC) was done for all screened couples. If both man and woman have mean corpuscular volume (MCV) < 80 femto liter (fl) and/or mean corpuscular hemoglobin (MCH) < 27 picogram (pg) they should be referred to Karbala hereditary blood diseases cen-ter for further investigation of abnormal hemoglobin. Prevalence of abnormal hemoglobin cal-culated by Punnett Square equation and Hardy-Weinberg law.
Results: Number of individuals referred from peripheral premarital clinics to the center were 1780 (890 couples). Individuals included in the study were1560 (87.7%) from Karbala gover-norate, the rest with missing address or from other governorates were excluded. The most prevalent hemoglobinopathy among referred individuals was B-thalassemia 344(22.05%). Re-ferred individuals with sickle hemoglobin were 51(3.26%). Prevalence of B-thalassemia and sickle hemoglobin in this study was 3.8% (95% confidence interval (CI) 3.64 – 3.96) and 0.56% (95% CI 0.5 – 0.62), respectively. High-risk marriage couples were 84 (3.2/1000).
Conclusion: The premarital screening for hemoglobinopathies program in Karbala gover-norate was able to detect many risky marriages although it still needs more improvement.

Background: In the past few decades, great attention has been paid to vitamin D deficiency and has been reported to be associated with a growing list of conditions. Nonspecific muscu-loskeletal manifestations are a common problem in vitamin D deficiency.
The aim of this case series study was to explore the different nonspecific musculoskeletal presentations of this deficiency among adult people.
Patients and methods: A descriptive study was designed to determine the prevalence of nonspecific musculoskeletal symptoms with vitamin D deficiency among adult patients visit-ing a private clinic in holy Kerbala/ Iraq during two years period.
Result and discussion: Shinbone pain and fatigue were the most prevalent symptoms and showed positive association with vitamin D level. Other symptoms included low backache, proximal muscle ache and knee osteoarthritis. The association of these symptoms with demo-graphic and anthropometric measures were explained. Vitamin D deficiency is a prevalent condition and need to be investigated even in countries with apparently high sun light expo-sure.

Background: Epilepsy comorbidity with depression is well known in clinical practice. The impact of depression state is bidirectional, and similarly seizure might be causal or result of depressive state.
Material and methods: a cross-sectional study among sixty patients with epilepsy investigated the prevalence and predictors of depression among these patients. A validated well-known questionnaire form (PHQ-9) was used to assess depressive state.
Results: Very high prevalence, exceeding 80%, of depression was found and this might be related to the unstable security and economic state in the country. Significant predictors were gender, duration of disease and positive video EEG findings. While patients’ age, family history of epilepsy, type of fit, the type of therapy and compliance were all not significantly associated with depression.
Conclusions: a high majority of epileptic patients suffer from depression and this might affect their response to treatment and their prognosis.

Background: Vitamin D deficiency is a significant public health problem in both developed and developing countries. women have higher rate of vitamin D deficiency than men because of inadequate exposure to sunlight and low nutritional intake so put them at risk of many vit-amin D deficiency related diseases and have clinical implications for the growth of children and adolescents, for pregnant women and their offspring, and is important for public health authorities. Aim & objectives: the aim of the study is to determine the prevalence of vitamin D status of females in Karbala and to identify some risk factors for vitamin D deficiency.
Methods: this cross-sectional study included 355 female aged 12-30 years in Karbala city and was carried out in primary health care centers which were randomly selected, from the begin-ning of March to the end of July 2017. females were included from rural and urban areas. La-boratory testing was done for all females of the study group.
Results: The results showed (87%) of the females had low level of vitamin D in front of only 13% of them had sufficient vitamin D. There was a statistically significant association be-tween vitamin D level among females conducted in the study and economic status of them, amount of milk taking per week, parity and with the duration of sun exposure.
Conclusion: the high prevalence of vitamin D deficiency and insufficiency among females in Holly Karbala City and the sole factors that affect vitamin D level include the following: Economic status, amount of milk taking per week, parity and duration of sun exposure.

Background: Obesity is a major public health problem and even children are a risky group, where obesity onset could start very early in life. The preschool years are critically important for child health, developmental, learning, and social outcomes. Prevention of childhood obesi-ty is a high priority for public health, with parents being seen as influential in child weight-related behaviors.
Objectives: To estimate the prevalence of overweight and obesity among preschool children in Karbala city. And to assess the perception and attitude of parents towards their children’s weight status.
Methods: A cross-sectional study was carried out in a five governmental and five private kindergartens in holy Karbala city between the 1st of February to the 30th of April 2017. A total of 200 children aged 45 to 60 months were included. The weight and height were esti-mated for each child and a questionnaire paper was filled by the parents in to identify their perception and attitudes towards overweight and obesity in their children using both the ver-bal scale and visual scale (pictogram).
Results: The prevalence of overweight was 20 % and of obesity was 18.5%, there was a high-ly significant relationship between weight status of the children and that of their parents, as about 85 % of overweight\ obese children, had an overweight\ obese fathers and mothers. Both the verbal scale and the visual scale showed a low sensitivity of 26% and 44% respec-tively. Sixty percent of parents prefer that their child being overweight or obese rather than being low or underweight and similar percent consider that overweight and obese children can still be healthy children. 71.5% perceived their children thinner than actual status.
Conclusion: More than one-third of preschool children in Karbala city were overweight or obese. The majority of parents misperceive their children’s weight status where they perceive them thinner than normal. Parents are aware of the consequences of obesity, but many still not consider obesity in children as a problem. Parents have a major role in the nurture and devel-opment of their children, parental perception and attitudes play a crucial role in the weight status of their children and in future consequences of overweight and obesity.