Karbala Journal of Medicine

Background: Malignant Melanoma (MM) is one of aggressive skin tumors that had increase in incidence during the past two decades. Curcumin is a natural product that had been utilized for a variety of maladies like rheumatic, cardiac, neurological and numerous other disorders while arsenic trioxide ‘ArT’ (not approved for treatment of MM) is well known cytotoxic agent. NF-kB is a specific complicated pertinacious element that participates in controlling of DNA transcription, regulating cytokine expression and, hence, cell survival. It was found that high level of NF-kB is highly associated with occurrence of MM. Induction of programmed cell-death (apoptosis) is another target, through which; destruction of tumor cells can be triggered.
Aim of the study: to demonstrate the effectiveness of curcumin on expression of NF-kB and induction of apoptosis as compared to the use of arsenic trioxide on B16 cell line.
Material and Methods: in this study we utilized B16 cell lines that divided into four categories (curcumin treated, ArT treated, curcumin combined with ArT, and control categories). The first 3 categories where treated with serial concentrations of each drug (at concentrations of 1, 2, 4, 8, 16, and 32 µg/ml), then the supernatant of 96 well of cell culture plate was used for ELISA detection of NF-kB level while cell pellet was used for detection of percentage of apoptotic cells.
Results: there was significant reduction of NF-kB level when curcumin was used from 390±2.646 pg/ml to 223.67±11.02 (at P<0.001) while ArT reduced NF-kB from 356+27.683 to 231.67+10.07 pg/ml (at P<0.001). The percentages of apoptotic cells elevated with using of curcumin from 37.4±0.8 to 99.93+0.06% (at P<0.001), while ArT increase in percentages of apoptotic cells from 11.1±0.2% to 99.17+0.17% (at P<0.001).
Conclusion: Curcumin had very potent concentration dependent anti-cancer effects against B16 MM cell line. ArT had similar concentration dependent anti-cancer activity but to less extent effect than curcumin against B16 melanoma cell line. Combination of curcumin with ArT had no significant potentiation effect for activity of curcumin on reduction of NF-kB level or increase in the percentage of apoptotic cells.

Background: Cancer of the cervix uteri remains fourth most common cancer and a significant cause of women mortality in many developed countries; the incidence of cervical cancer was comparatively low in Iraq like most Muslim countries. The Bethesda System goes back almost 3 decades and it is the latest and the more recent medical terminology system with aim to standardize the cervical cytology report.
Objective: Is to emphasize the role of cervical cytopathology smear in the detection of various cervical intraepithelial lesions that may predispose to cancer and to evaluate The Bethesda System in reporting these lesions.
Patients & methods: This retrospective study was carried out in Al-Yarmouk, Baghdad medical city teaching laboratories, and Karbala gynecology hospital Lab on 91 women aged 25 & above, for the period from June 2016 to March 2017, all were married, non-pregnant, the cervical smears of these women were stained by the Pap technique and reevaluated, reassessed using The Bethesda System (TBS).
Result: According to The Bethesda System the cytological findings of epithelial cells abnormalities revealed: (5.9%) of cases. Minimal cervical smear abnormalities were the high grade squamous intraepithelial lesions (3.3%), Atypical squamous cells, as a single entity was representing (47.1% of abnormal cervical smears, 26.4 % of total group study). While low grade squamous intraepithelial lesions & atypical glandular cells represented (43.1%), (3.9%) of abnormal cervical smears respectively.
Conclusion: Pap smear or cervical smear is a simple, easy test and well-established efficiency. The Bethesda System is of validity in providing a uniform formula for cervicovaginal cytopathology report & it reflects important advances in biological understanding of cervical neoplasia & cervical screening technology.

Background: Apparent diffusion coefficient ADC value used in this research for differentiation of the malignant and benign hepatic lesions, which has an impact on the management of these lesions by surgery or conservatively.
Aim: To analyze the role of diffusion weighted imaging (DWI) with the apparent diffusion coefficient (ADC) values in the differentiation of malignant from benign hepatic lesions.
Materials and methods: this is a prospective cross-sectional study 80 patients with 118 focal hepatic lesions contributed. MRI with DWI examination was carried out for all patients. After DWI examination, an ADC map was created and ADC values were measured for 118 focal hepatic lesions.
Results: out of 118 hepatic lesions, 62 were benign and 56 were malignant. Benign lesions comprised 30 hemangiomas and 21 simple cysts, 6 focal nodular hyperplasia (FNH), 4 abscesses and 1 adenoma. Malignant lesions comprised 47 metastases, 6 hepatocellular carcinomas (HCC), 2 fibrolamellar hepatocellular carcinomas and 1 case intra hepatic cholangiocarcinoma. The highest ADC values were measured for cysts. The mean ADC value of benign lesions was 2.27 ± 0.7 x 10ˉ³mm²/sec, whereas malignant lesions had a mean ADC value of 0.85 ± 0.18 × 10ˉ³mm²/sec. The mean ADC value of benign lesions was significantly higher than that of malignant lesions (P < 0.001).
Conclusion: DWI and quantitative measurement of ADC values shows promising result in characterization of benign and malignant hepatic lesions, with other MRI sequences of dynamic contrast study. Especially, when contrast is contraindicated.

Background: Intracytoplasmic sperm injection (ICSI) is an assisted reproductive technology (ART) used to treat sperm-related infertility problems. There is heterogeneity in the success rates of ICSI among center, thus it would be useful to describe the data of different centers.
Aim of the study: to evaluate the rate of ICSI success among Obstructive azoospermia treated in AL-Kafeel IVF center, Kerbala, Iraq, with some emphasis on female factors that may predict that ICSI outcome.
Study design: A retrospective study
Materials and Methods: Data of all couples who underwent ICSI with fresh sperm retrieval using testicular sperm aspiration (TESA) and reached the stage of embryo transfer during the period from 1st January 2015 to 1st January 2019 were included. Demographic data of couples and hormonal assays results were recorded. Data included such as number of oocytes collected, quality of oocytes, fertilization rate and clinical pregnancy rate. Clinical pregnancy was identified by measuring HCG hormone level in day 12-14 after embryo transfer.
Results and Discussion: The total couple underwent ICSI was 42. The rate of fertilization was 69.55% whereas the clinical pregnancy rate was 33.3% which is similar to pregnancy rates in normospermic individuals. No effect of age of couples on the outcome of ICSI. TSH level in females was significantly higher in females with ICSI positive compared to females with failed ICSI (p=0.047) with average TSH concentration of 3.4 in ICSI successor and 2.038 in failed ICSI. Number of Grade 1 embryos was higher in ICSI successor than in ICSI failed couples. In addition, the levels of LH and AMH were shown to be increased I ICSI successors, however, this increase did not reach statistical significance.
Conclusion: The rate of ICSI success in azospermic patients is similar to normospermic patients. TSH level in females could serve as a predictor for the outcome of ICSI.

Background: knee injuries is common problem, immobilization of the knee during management of acute injury carry risk of muscle atrophy that have negative impact on regaining preinjury level of strength (1).
Aim of study: To minimize the risk of quadriceps muscle atrophy after acute knee joint injury and to detect the early sign of muscle atrophy by using the specific imaging methods to restore the preinjury level of function for the patient when it possible.
Methods: prospective cohort study where data collected from outpatient clinic during the period of October 2017to October 2018. Patients selected with acute knee injury who presented within 24 hours, management protocol involved 7 days of immobilization then followed by 6 weeks of rehabilitation program for quadriceps strengthening, the evaluation of muscle wasting include clinical assessment of thigh circumferences and ultrasonography of muscle volume at three different points of time. Statistical analysis undertaken to determine any correlation between atrophy and other variables and the relation between clinical and radiological measurements using chi- square test to determine P. Value.
Results: 32 patients, 9 of them were females, with a mean age 29.8 year. The measurement shows significant atrophy after 7 days of immobilization with excellent impact on muscle strength after 6 weeks of rehabilitation when compared the injured with healthy side. Clinical assessment compared to radiological assessment of muscle atrophy. The comparison of the real thigh circumference and ultrasonography readings of the injured limb between the three measurement phases (day 1, day 7 and week 6 after injury) showed significant differences (p< 0.001).
Ultrasound measurement comparison of the thigh circumference reading of the injured limb between the three measurement phases (day 1, day 7 and week 6 after injury) showed no significant differences (p= 0.439).
Conclusion: Muscle atrophy can occur as early as one week of immobilization after knee injury. Where both clinical and radiological method can be used efficiently to assess muscle atrophy.

Background: A descriptive study was conducted in AL Fallujah Teaching Hospital for women and children to determine the prevalence and etiology of respiratory distress in the newborns delivered over the 6 months duration from 1st September 2018 to 1st March 2019.
Patients and methods: All live newborns delivered at AL Fallujah Teaching Hospital for women and children during the period of study were included and observed for development of respiratory distress.
Results: All newborns (n=5828), delivered at AL Fallujah hospital over the 6 months duration were observed for respiratory distress. The overall prevalence of respiratory distress was 2.5%.
Prevalence was 54.4% in term and 42.2% in preterm and 3.4% in post term. Transient tachypnea of newborn was found to be the commonest 40.8% cause of respiratory distress followed by Hyaline membrane disease 34.7%, meconium aspiration syndrome 14.3%, congenital pneumonia 2% and other congenital anomalies 8.2%. Transient tachypnea of newborn was found to be common among term and near-term babies, while hyaline membrane disease was seen among preterm, and meconium aspiration syndrome among term and post term babies.
Conclusion: Respiratory distress is a common neonatal problem with significant morbidity and mortality. Transient tachypnea of newborn was a major cause followed by hyaline membrane disease and meconium aspiration syndrome.

Background. Diarrheal diseases still one of the major causes of preventable death in developing countries particularly among children under five years. The WHO estimates that there are more than 700 million episodes of diarrhea yearly among the children under five years of age in developing countries. Increased obtainable ORS has significantly reduced diarrheal-related deaths in children under five.
Aim: assessment the knowledge, attitude, and practice of the mothers about oral rehydration solution, and identify the source of information of mothers about the solution.
Methods: A cross sectional study was conducted among mothers attending Karbala teaching hospital for children and two primary health care in the period from 15th of January till 15th of August 2016, the sample size included 400 mothers of children who were under five years of age. Mothers randomly selected, and data collected using a designed questionnaire. Results: In the current study, a total of 400 mothers were interviewed, aged 15 to 46 years with mean age of 30.21 ± 7.72 years. The ages of children ranged between 1 to 58 months with mean age of the youngest child was 22.2±15.22 months. Most mothers received the information about ORS from medical staff by (90.8%). Regarding knowledge, attitude, and practice of mothers, 89.7% had awareness and heard about ORS, 79.7% of mothers used ORS, and 78% of them knew how to prepare it correctly. The vast majority of mothers (98.7%) continue feeding during attack of diarrhea, (72.3%) give home available fluids.
Conclusion: High percent of mothers had awareness about ORS and believe it is useful during attack of diarrhea. Most mothers had enough knowledge and practice about preparation of ORS. Majority of mothers had information about ORS and most of them received their information from medical staff.

Background: PIH is a pattern of high blood pressure during pregnancy. It is one of the major causes of maternal mortality and neonatal morbidity in the world. It can be prevented by Health education for early detection and proper management of the disease and its complications.
Objectives: To determine the level of knowledge of the pregnant women towards PIH.
Methods: A cross sectional study, was conducted among pregnant women in outpatient clinic, wards of gynecology and obstetrics teaching hospital, in Karbala, Iraq within a period from 1st of March till 1st of June 2018A convenient sample of 295 pregnant women, data collection was done through direct interview., Consent to participate in the study was obtained in a form of verbal consent using a special questionnaire for the purpose of the study. Student T-test and ANOVA test were used to identify factors associated with the pregnant knowledge.
Results: In this study, 81.7% of the pregnant women had heard about PIH. Their source of information was from relatives and friends, then health care providers. About half of the participants had a weak knowledge score (46.9%). The knowledge score is significantly associated with the age of the participants, type of family, past medical history of PIH, past medical history of gestational diabetes, practicing sport and regular antenatal care visits.
Conclusions: Generally, the findings of the study showed that the knowledge about PIH was poor among the pregnant participants, that indicates the need to increase public awareness and knowledge about the disease.

Background: Childhood obesity describe as one of the major vital and difficult public health issues in developed as well as developing countries. The WHO graded overweight and obesity as the 5th leading international risk for mortality.
Aim: To assess the prevalence of obesity and overweight of the 5th and 6th grade in primary schools at age (10-12) in AL-Najaf Province and associated risk factors.
Methods: A cross sectional study was carried out in 24 primary schools in AL-Najaf Province between 1st of February to the 30th of May 2018.with a total number of (800) child aged (10-12) were included. The BMI was used as indicator for overweight/obesity
Results: The prevalence of obesity and overweight amongst primary school children in AL-Najaf Province were 39.4%. About 12.9% were overweight and 26.5% were obese. There was significant associated with child's age, obesity and education of parent’s, fast food intake, physical inactivity, Transport method to school, Type of the school, sleep pattern, time spent in watching television. a short period of breastfeeding, skipping breakfast, a high consumption of sugary beverages, there was no statistically significant regarding gender, weekly fresh fruits consumption. The data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 18 using Pearson Chi-Square (χ2) test with P-value of (<0.05).
Conclusion: The prevalence of overweight and obesity is relatively high among children in primary school in AL-Najaf Province

Background: Controlled Ovarian Stimulation (COS) is a widely used method during assisted reproduction. There are two commonly used COS protocols: GnRH agonist and GnRH antagonist. Selecting the protocol for COS is the most critical decision could be made and there is no standard protocol which could be applied for all patients.
Aim: The aim of this study was to compare ICSI outcome between GnRH antagonist and agonist protocols represented by oocytes maturity, fertilization rate (FR), cleavage rate (CR), embryos quality and pregnancy rate (PR).
Materials and Methods: Fifty infertile females were included and they divided in to two groups according to the protocol: Group I: In which GnRH agonist was used (n=33) and Group II: In which GnRH antagonist was used (n=17). All were included in ICSI program. Following oocytes retrieval, microscopic assessment of oocytes' maturity and embryos' quality was done followed by calculation of FR, CR and PR. Results were compared between both groups.
Results: The study showed that GnRH agonist-stimulated females produced slightly more immature oocytes (1.40±2.01 VS 0.94±2.13) with a lower fertilization rate with no significant statistical difference regarding CR and embryo quality. Pregnancy rate tended to be lower 42.42% when compared with antagonist protocol 58.83%.
Conclusion: Both GnRH agonist and antagonist protocols have the same effect on ICSI outcome in form of oocyte maturity, FR, CR and embryo quality except PR which tends to be higher with the antagonist protocol.

Background: Ectopic pregnancy is the implantation of embryo outside the endometrial cavity. Ectopic pregnancy remains an important cause of morbidity and mortality in early pregnancy. Objective: to determine causes, signs and symptoms and treatment options offer for these patients.
Patients and methods: The study was carried out in kerbala maternity hospital from January 2014- June 2016. Female with ectopic pregnancy after taking history from them, examination, result of investigation, mode of treatment and any complication were recorded. The total admission to the hospital in this period was also recorded.
Results: The incidence of ectopic pregnancy during this period was 0.132%. the peak age of incidence was between 20-25 years. Majority of patients had lower educational level 57.14%. History of abortion and previous surgery were the major risk factors and their contribution was 41.07% and 35.71% respectively. 73.21% of patients did not using any contraception. 12.5% using oral contraception pills, 8.93% using intrauterine contraception device. Abdominal pain (92.86%) and vaginal bleeding (82.14%) were the most frequent presenting complains. Syncopal attacks occur in (28.57%). 87.5% had a period of amenorrhea and 12.5% of female had no period of amenorrhea. 60.72% of these females the right tube was affected. 51.79% of these cases the tube was ruptured at the time of operation. Laparotomy was done for 92.86% and salpingectomy done for 94.64% of these females.
Conclusion the majority of patients attending Karbala maternity hospital for EP were between 20-25 years and had history of abortion and previous abdominal surgery. Laparotomy with salpingectomy was the main modality of treatment.

Background: According to the last WHO report in 2014, Iraq is ranked as 22 out of 172 country in coronary artery disease (CAD) as the most leading cause of death. Iraq has an age standardized death rate of 187.65 due to CAD i.e., more than 187 per 100000 Iraqi people die due to CAD, which represent the first cause of death. To our knowledge, there is no Iraqi study concerning the association of MTHFR C677T gene polymorphism with sever stenosis.
Objective: To study the link between C677T MTHFR gene polymorphism and coronary artery disease in individuals who had undergone coronary angiography in Iraqi people after we classify them into those with and without ischemia.
Materials and Methods: population of the study comprised 150 patients (aged 50.4 ± 6.4 year) and 150 control subjects (aged 49.2 ± 4.6 year) that undergone to angiography for coronary vessels. We regarded angiography as positive when there is more than 70% reduction in the diameter of coronary vessels.
Measurements of the participant's sugar and lipid profile were all carried out on fasting blood samples without anticoagulant by standard enzymatic assays. The MTHFR C677T polymorphism detection was carried out by PCR-RFLP method.
Results: There is a significant statistical relationship between the MTHFR genotype and the presence of coronary artery disease (P< 0.001). In addition to statistically significant difference among the three genotypes CC, CT, TT regarding BMI, cholesterol level, triglycerides level, and VLDL (P < 0.05)
Conclusion: MTHFR polymorphisms (CT, TT) genotype have been found to be risk factor for coronary artery disease in Iraqi population.