Karbala Journal of Medicine

background: Use of laparoscopy in trauma is in general limited for diagnostic purposes; we aim to evaluate the therapeutic role of laparoscopic surgery in trauma patients. Laparoscope could be safe and effective in the treatment of patients with abdominal trauma.
Aims of the Study: To identify the following:
1. Benefits of Laparoscope in Abdominal Trauma.
2. Contraindications for Laparoscope in Trauma Patients.
3. Indications for conversion (from laparoscopic to open approach).
Patient and methods: Forty patients with abdominal trauma, whether penetrating or blunt who was admitted to the casualty unit in Imam Hussein Medical City in The Holy Karbala City from Jan 2016 to June 2016 and were diagnosed as cases of acute abdomen by clinical examination base some were in shock state and unstable, admitted immediately to theatre, laparotomy was done to them. Other cases in shock, but corrected undergone surgery for different causes, some of them undergone purely laparoscopic interference by laparoscopic device under the name (KARL STORZ—ENDOSKOPE), other patients undergone conversion for different causes.
Results: Forty were included in a prospective study who were undergone surgical intervention either in the form of traditional laparotomy or diagnostic laparoscopy eight (20%) of them undergone exclusive laparoscopic interference while nine (22.5%) undergone conversion, other twenty- three (57.5%) undergone open approach.
Conclusions: From our study, we concluded that:
1. A laparoscope is an important tool in the management of blunt abdominal trauma.
2. A laparoscope is a good preventive measure of nontherapeutic laparotomies.
3. It’s an important measure in diagnosing and even treating diaphragmatic injuries.
4. Traumatic bowel injuries can be diagnosed and even treated by the laparoscope
5. The presence of profuse hemorrhage make continue on the laparoscopic approach is non judges.

background: Astrocytomas are the most common primary tumor of the central nervous system, the diagnosis absolutely based on histology has a high interobserver variations and remains problematic even for an experienced neurological pathologist.
The objective of this study: To assess the immunohistochemical expression of Ki67 as proliferative markers and CD31 as an endothelial cell marker in astrocytomas interrelated with some clinicopathological parameters (age, gender, site of the tumor, and tumor grade) in Iraqi patients.
Materials and methods: In this retrospective study, 41 formaline–fixed paraffin –embedded tissue blocks represent cases of Astrocytomas, The histopathologic diagnosis had been revised and all cases were stained by immunohistochemical technique with Ki 67 & CD 31 antibodies and assessed independently by three pathologists. Values were considered statistically significant when p<0.05.
Results: Fibrillary astrocytoma (WHO grade II) was found to be the most common type among astrocytic tumors with the peak age incidence in the second and sixth decades of life, and a slight male predominance had been identified. Parietal location of tumor consider most common site ,There was a significant correlation between the age of the patients and the grade of the tumor on one side & Ki-67 labeling indix, and microvessel density (MVD) detected by CD31 on other side (p<0.05). While no significant correlation with the site and gender.
Conclusion: A significant correlation was found between Ki67 labeling indices, and MVD (microvessel density) in one side, and the clinicopathological variables of astrocytomas in other side, Could be used as ancillary methods in the differentiation of borderline grades of astrocytomas.

background: Breast cancer is the most common malignancy in females in general and it constitutes about one fourth of cancer cases in Iraq.
Aim: the goal of this study is to follow the trends in breast cancer prevalence over the last nine years in Kerbala, to make a focus on the percentage of cases that occur in young and its characters.
Materials and methods: The prevalence of breast cancer among general population and young females(≤ 40) over 2009-2017 was interpreted using descriptive statistics while staging and grading characters and their relation to the age was analyzed using Chi square program and p value.
Results: annual increase in the number of cases was found over 2009-2017 with highest prevalence in 2016 (91 case).The mean for age was 50.7 and SD of 13.7. There was no significant difference in the percentage of young female carcinoma cases over the years (24%). Both grade III and stage III present at higher percentage in young female than old (23% vs. 5.9% for grade III and 50% vs. 30.5 for stage III), the results were near but did not reach the significant level statistically (p value 0.06, 0.07 respectively).
Conclusion: the prevalence of breast carcinoma is increasing in Kerbala over the` years 2009-2017 with higher percentage is noted in young females than other developed countries and breast cancer in young female present at somewhat higher grade and stage.

background: Infantile spasms (IS) are a seizure disorder that was first described by William West in 1841 and has been referred to as West syndrome. It is a disorder that affects mostly those in the first year of life. Infantile spasms in most cases associated with psychomotor delay and specific pattern of electroencephalogram (EEG) pattern called hypsarrhythmia. “West syndrome” is often generally used to describe this triad.
Objective: to study clinical profile, EEG and treatment response for infantile spasm.
Patient and method: Fifty six patients with infantile spasm have been enrolled in the study who seeks medical advice from August 2015 to December 2017, conducted at the Children's Neurological Ward and Outpatient Clinics of Welfare teaching hospital, Medical City Complex, Baghdad. with onset of spasm between 1-12 month age and shows significant finding when EEG done for they and consequently at least 2 years period follow up.
Result; A total of 56 consecutive cases of infantile spasms with significant finding in their EEG were recorded; male to female ratio is 57%:43%. Structural defect in the brain was the predominant cause, 16% of children, the reason had not been proven. The Outcome was only favorable in 5 (11%) of children. Many variables like age of onset, sex, lagtimeand co-morbidity were not significant and did not affect final outcome.
Conclusion; The current study highlights the clinical Evaluation of children with infantile spasm, in term of delayed diagnosis, etiology of structural brain defect, and favorable response to steroids.

background: Randomized prospective control study it is objective to compare effect of oral misoprostol with conventional uterotonics in the management of the third stage of labor.
Aim of study: The incidence of Hemorrhage and the decrease in hemoglobin concentration is the main out comes of the trial. Secondary outcomes included the occurrences of sever postpartum hemorrhage.
Patient and method: This study was done in Department of obstetrics and gynecology at Baghdad Teaching Hospital. In controlled trials a pregnant women total number 280 were randomized into four groups, as followed: Group I: received oral misoprostol 400 Mg, followed by two doses of oral misoprostol 100 Mg 4hours a part. (n=72), group 2: received intravenous infusion of oxytocin10 IU plus oral misoprostol 400 Mg followed by two doses of 100Mg oral misoprostol 4 hours apart group 3: received intravenous infusion of oxytocin 10 IU. (n=69), group 4: received intravenous infusion of 10 IU oxytocin plus intramuscular administration of methylergometrine (methergine) 0.2 mg. (n=77). The data of 40 women were excluded from the study because of loss to follow up, previous cesarean deliveries performed after randomization n=25, pre delivery hemoglobin was unavailable n= 10, postpartum percentage of hematocrit unavailable n=5. Main measures, the incidences of postpartum hemorrhage and the changes in hematocrit concentration from before delivery to 24 hours postpartum, in those women used oral misoprostol in management of third stage of labor with or without the use of other uterotonics
Result: Shows, Mean blood loss in misoprostol group was not significantly higher than blood loss in oxytocin group and oxytocin misoprostol group, but there was statistically significant difference when compared with oxytocin-methylergometrine group.
Conclusion: Oral administrated misoprostol is as effective as conventional oxytocic in prevention of postpartum hemorrhage.

b
ackground: Endoscopic operations in gynecology nowadays have major role in resolving many problems. There are certain preparations preoperatively for these operations and certain complications may happen. The current study aimed to estimate the knowledge about these preoperative preparation and complications in laparoscopy and hysteroscopy in women attending for having such operation. One of the best ways to avoid complications is to recognize those situations in which they are most likely to occur.
Objectives: Assess and identify knowledge of the woman about hysteroscopy and laparoscopy process at Specialist AL- Kafeel Hospital in Holy Karbala City. Although laparoscopy is considered to be minimally invasive surgery, it does not carry a minimal risk.
Patients and methods: A cross sectional study was conducted on forty women given dating for hysteroscopic and laparoscopic operations at the Al- Kafeel superspeciality hospital in holy Karbala city for the period from 1-3-2017 to 1-9-2017 a questionnaire was given for every woman, data was collected and analyzed to know the level of health awareness among them about these operations.
Results: In this study we found that, all the patients know the need to take drugs after surgery about (100 %), the percent of them who know to empty bladder and intestine before operation of the rate (70%). The Large percent of women knows about preoperative investigations before operations of the rate (90 %), all the woman know about the need for anesthesia for the intervention about (100 %). Also there are different ranges of them know about the benefit from doing these endoscopic operations. Regarding knowledge about complications (57.5 %) of them knows that there is risk of bleeding and Infection after the operations.
Conclusion: There is good information of the women about the preoperative preparations, low level of knowledge about the role of such endoscopic operations in resolving common gynecological pathologies and this needs from us more concentration about education programs, social media use and role of medical staff in increasing this knowledge.

background: The World Health Organization (WHO) has stressed that adequate nutrition is essential for the children development and health. These international policies stress exclusive breastfeeding during the first six months of life to decrease neonatal mortality, strengthening early initiation of breastfeeding within first hour after birth.
Complementary feeding (CF) are usually started at six months when, the micronutrient deficiencies, infectious illnesses in developing countries and growth faltering. For this reason, in this vulnerable period; an effective interventions in a high priority should be done to reduce malnutrition.
Aim of the study: This study aimed to find the prevalence of breastfeeding in infants between 6 and 12 month of age, the age of initiating the complementary feeding and the main problems related to complementary feeding.
Subjects and methods: A descriptive cross sectional study was conducted between 1st January and 31st Augusts 2018, among visitors of primary health care centers in Kerbala city in Iraq. The mothers were interviewed through closed and open questions to determine the type of feeding practice in infants and main related problems.
Results: The result shows a significant statistical relation between the occupation of the mother and the father, the type of delivery, the mother educational level and age, and the income with the type of feeding (breast, bottle, or mixed) and the complementary feeding.
Conclusions: breastfeeding is the corner stone for good health and proper way for achieving the best mental and physical children's development, and the right time to start with the complementary feeding at the age of 6 months also play a major role children's well-being.

background: Breastfeeding improves the health, development, and survival of all children. As well as, saving life and improving the health of mothers. Further, it reduces economic burden on families and the community.
Objectives: To identify patterns of infant feeding including breastfeeding. To assess the initiation of breastfeeding. And to recognize factors associated with these patterns.
Subjects and methods: A cross-sectional study was conducted in Kerbala city. A random sample of mothers of infants aged 1 to 12 months was selected and interviewed. Mothers attended two primary health care centers and outpatient clinics of Kerbala Teaching Hospital for Children in Kerbala city for caring of their infants were considered eligible for the study. Interviews were carried out during period January 2 – June 30, 2015.
Results: Total of 317 mothers was enrolled in the study, (59%) of their babies were males. Mothers age range from (15-42) years with a mean and standard deviation age of 25 ± 5.98 years. Breastfeeding was the predominant feeding type (62%). Breastfeeding was significantly associated with younger maternal age, being vaginally delivered, being multipara and encouraging husband role. The initiation of breastfeeding was in the first hour in 73% of the mothers. And breastfeeding initiation within the first hour was negatively associated with being delivered by Caesarean section. While the main source of mother information regarding feeding was the family.
Conclusion: Breastfeeding was the predominant type of feeding. Choosing and continuation of breastfeeding was positively associated with younger maternal age, normal vaginal delivery, multiparty and husband support.

b
ackground: Family Medicine (FM) specialists are the frontline of medical services.
Where they require a wide range of knowledge, practice and experience. A periodic
evaluation of family medicine residency training and the exploration of residents’
perception toward their specialty and training are important.
Objective: To assess factors affecting clinical training of family medicine residents in
training centers and evaluates their satisfaction about their training program.
Subjects and methods: A cross sectional study. Several training centers in Iraq were covered
for the period of February 1 to July 31, 2018. A special self-administered questionnaire based
on 5 points Likert scale prepared for this purpose and been tested by a pilot study. The
response rate for the questionnaire was 75.6%.
Results: The accomplished sample was 187; female represents 93% of them. Nearly 55%
indicate that they if time is back they will choose FM again and similar percentage indicate
that they will recommend FM to others. Nearly 75% of participants have positive feeling
towards their future as family physicians. While 63.6% were dissatisfied with their residency
training program. Lack of commitment of teaching hospitals to training curriculum, and poor
understanding and acceptance to them and FM specialty from physicians of other clinical
branches was the main weak areas highlighted by them.
Conclusion: Family medicine residents still in favorite of their specialty, but they have many
critiques concerning their residency training curricula and the application clinical training in
the hospitals. These points are vital and need to be considered by their supervisors and higher
committees concerned.

b
ackground: Husband violence is an international problematic behavior with grave
abuse of civilian privileges that happens between all religious, cultural, economic and
social groups. revowoH, this problem is widely prevalent in under-developed countries
with huge mass of media news and discussion about its great impact and sequel in these
societies. It aims to identify the lifetime prevalence of husband among health center clients
and to identify its relationship to socio-demographic variables.
Methods: a survey was conducted among a cross sectional sample among 320 women (aged
15 to 65 years) attending primary health care centers in Kerbala governorate in Iraq in 2018.
A female doctor measured husband violence and potential predictors through interview
questionnaire dependent mainly on the World Health Organization questionnaire used in
multi-country study questionnaire.
Results: Tow thirds of the sample were exposed to husband violence. The verbal violence
was the most common type of husband violence (27.5%) followed by sexual (21.6%) and
physical violence (20.3%). Even pregnant women were not spared while all divorced women
in the sample were abused. Low economic income significantly raised husband violence
which was also associated with husband substance use (smoking, alcohol and other
substances). Abused women welcomed any help even by health care personals (64%).
Conclusions: Husband violence was very common problem among women in Karbala
city and verbal violence was the most common type. The problem needs further large scale
investigation and urgent preventive programs to be set through wide community efforts.

b
ackground: Cholecystectomies with relevant frequency of gall bladder pathologies is
not clear.
Patients and methods: Throughout 2016 and 2017 in pathology unites of two
hospitals, 576 cholecystectomy cases were analysed. The age of the patients range from 2 to
80 years with a mean of 42.60±15.62 years. Male to female ratio was 152:424 (1:3).All the
samples reviewed by two consultant pathologists.
Aim of study: To Study the frequency of histopathological changes in 576 cholecystectomies.
Results and discussion: Of the total sample which was 576, 437 cases (75.9%) had gall stones,
51 cases (8.9%) were acute cholecystitis, 464 cases (80.6%) were chronic cholecystitis, 9 were
malignant (1.6%) and 52 were normal (9%). All the malignant cases were solid variant
adenocarcinomas and only one was metastatic from sigmoid colon. Acute suppurative
cholecystitis were seen in 24 cases (4.1%), xanthogranulomatous cholecystitis 34 (6.1%),
Rokitansky – Aschoff sinuses were seen in 223 (38.7%), inspissated bile 24 (4.2%),
adenomyomatous changes 146 (25.3%), focal abscess formation 26 (4.5%), cholesterosis 31
(5.4%), metaplasia 465 (80.7%), single adenomatous polyp, eosinophilic cholecystitis 25
(4.3%).
In adenomyomatous changes the epithelial proliferation was florid with Rokitansky – Aschoff
sinuses and smoth muscle hypertrophy. Metaplastic changes were of pyloric, intestinal and
mucous glands types, the adenomatous polyp was of biliary type with low grade epithelial
atypia.
Conclusion: The available data may provide basic knowledge of the gall bladder pathology in
holey Karbala