Karbala Journal of Medicine

background: NAFLD patients had higher anti IgG H pylori and might be a clue that H
pylori infection had a strong link the pathogenesis of early stage NAFLD mostly had
simple steatosis. H pylori infection had a role in pathogenesis of IR and NAFLD. H
pylori is strong inducer of pro inflammatory cytokine (IL6, IL8, TNF- α).Serum
triglyceride was higher in H pylori positive group and NASH. Recent study have investigated
weather H pylori induce insulin resistance mediated through fetuin which decrease in patients
with sero positive Hpylori IgG patients.
and
Patient and method: Fifty six patients were collecting randomly as a case of fatty liver by
ultrasound In Imam AL- Hussain Medical City in Karbala .Obese, DM, alcoholic patients,
renal
hepatic
diseases
were
exclude
from
study.
Fasting blood sample was taken and sent for IgG antibody H pylori, lipid profile, liver
function test including ALT and AST.
this
Result: The mean age of patients was 45+10 and majority (65%) was females.
(67)% of patients who were fatty liver had Hpylori sero positive IgG (p value<0.05).
(66)% of patients who were fatty liver had normal liver function ALT mean±SD(31±7) and
only 34% had increased liver function, ALT mean SD±(110±13)with p value<0.01.
(71)% of patients who were fatty liver and H pylori sero positive IgG had normal liver
function mostly ALT mean±SD (29±10) in comparism with 29% who had increase liver
function mostly ALT mean ±SD(98±18) p value <0.01.
(83)% of fatty liver patients had hyperlipidaemia mean±SD (290±20), (395±22) respectively
p value<0.01.
(75)% of fatty liver patients with H pylori sero positive IgG had hyperlipidaemia mean±SD
(279±15),(320±20) respectively p value <0.01.
Conclusion This study shown significant correlation between chronic H pylori infection and
NAFLD .The pathogenic mediator include fetuin-A, TNF-α and adiponectin and on long term
IR.

b
ackground There is continued debate as to whether a routine, early invasive strategy
is superior to a conservative strategy for the management of acute coronary
syndromes.
Aim of the study: To verify current practice in the setting of management of acute coronary
syndromes in tertiary cardiac centers in Iraq.
Patients and methods Four hundred (400) patients were included in this study from 1st of
January 2012 to 1st of January 2013from two tertiary Iraqi cardiac centers. Three hundred
(300) patients from Ibn Albitar hospital and One hundred (100) patients from Iraqi center for
heart disease refered to them as group (A) and group (B) respectively.
Results & discussion Mean age for all patients was54.6±9.9 year. In group A there was 208
male patients (69.3%), 92 female patients (30.6%), in group B there was 65 male patients
(65%), 25 female patients (25%).
Low score (using thrombolysis in myocardial infarction score) found in 166(41.6%),
intermediate score in 221 (55.3%), high in 13 (3.3%), no patients with high score was found
in group B, mean TIMI score in group A was 1.61±0.5, in group B was 1.60±0.5 (P value
NS). In group A UA found in 249 (83%), STEMI in 23 (7.7%), NSTEMI in 28 (9.3%).In
group B UA in 79 (79%), STEMI in16 (16%), NSTEMI in 5 (5%) (Pvalue0.02). Smoking is
prevalent more in group A (186 patients (62%) versus 43 patients (34%) in group B), while
diabetes mellitus and family history of premature coronary artery were more prevalent in
group B (Pvalue0.03).
All patients in group A with low score were treated medically while in group B with low
score treated invasively. Invasive approach was more in group B compared with group A in
intermerdiate risk score.
Normal coronaries were found in (3.3%) in group A versus (6.8%) in group B. Percutaneous
coronary intervention was applied in (66.6%) in group A versus (50%)in group B, surgery
used in (23.3%)in group A versus (28.3%)in group B, medical treatment in (10%) in group A
versus (21.6%) in group B.
There were no statistical difference between both groups regarding duration of admission to
hospital and mortality.
Conclusion Management of acute coronary syndromes was the same between tertiary cardiac
centers and it is progressing significantly in our country.

b
ackground Early revascularization is critically important in the management of
patients presenting with acute myocardial infarction.
Aim To assess the benefit of early primary percutaneous coronary intervention in
patients with acute ST elevation myocardial infarction.
Methods This study include 51 patients with acute STEMI they were selected from those
who were admitted to the coronary care unit of Karbala cardiac center in Karbala-Iraq during
a period between January 2017 and February 2018. Detailed history and thorough physical
examination was done. Investigations done for each patient in form of ECG, cardiac troponin,
blood urea, serum creatinine, and complete blood picture.
Results & discussion percutaneous coronary intervention only, using one stent, two stent,
three stent, aspiration catheter, CABG & medical treatment, 7 (13.7%),25(49%), 8(15.6%),
none , 4(7.8%), 4(7.8%), 4(7.8%), 3(5.8%) respectively).
Infarct related artery, LAD, LCX, RCA & LMS (30(58.8%), 4(7.8%), 6(11.7%), 2(3,9%)
respectively, and the number of diseased vessels , single vessel, two vessels, three vessels &
LMS which was (20(39.2%), 13(25.4%), 14(27.4%) respectively.
Inhospital outcome, which include the following:- favorable outcome, period of
hospitalization, access site bleeding, contrast induced nephropathy, death, respectively.
Which were (96%, ˂ 1day 38(74.5%), ˃1day 13(25.5), 3.9%, 5.8%, 3.9% respectively)
Conclusion in case of ST elevation myocardial infarction, left anterior descending artery is
most culprit vessel to be involved, one quarter of patient needs one stent & carry favorable
out comes in form of less complications and also decrease the period of hospitalization.

b
ackground:Hypocalcemia remains a major post-operative complication of total
thyroidectomy causing potentially serious side effects and tension in influenced
patients and expanding hospitalization time. Accurate prediction and appropriate
management may help reduce morbidity and hospital stay.
Aim of study: To evaluate the effect of Ca supplementation following thyroidectomy in
preventing hypocalcemia.
Patients and Methods: A randomized prospective study including 74 patients who underwent
total thyroidectomyin the surgical unit, Department of Surgery, Al-Khidhir Hospital in Al
Muthanna provinceduring a period of two years and six months from Oct, 2015 – April, 2018.
Group A - patients who didn’t receive any supplement (37 patients), group B - patients who
received Ca therapy immediately after operation (37 patients). Laboratory tests for S.Ca were
done preoperatively and postoperatively at day 0, day one, day two, day three, and then after
10 days and for patient who developed hypocalcaemia, another reading was done after 10 – 20
days and followed monthly.
Results: No significant differences (P ≥ 0.05) between study groups regarding age, BMI and
duration of goiter. At day zero and day one postoperatively, no significant association between
prevalence of hypocalcemia and receiving Ca postoperatively (P≥0.05) while at day two and
three, this association was significant and hypocalcemia occurred more prevalent in patient of
group A. Patients of group B were discharged earlier than patients of group A (58.9% versus
41.1%).
Conclusion: Routine Ca supplementation following total thyroidectomy is better than no
supplement. Although they do not completely eliminate the occurrence of postoperative
hypocalcemia.

b
ackground: Jaundice is a common neonatal problem. This may be due to the limited
ability of a neonate to metabolize indirect bilirubin, which predisposes to the risk of
encephalopathy and long-term sequelae if not managed promptly. Sufficient hydration
and good urine output improve the efficacy of intensive phototherapy
The aim of this study: was to evaluate the role of intravenous extra fluid supplementation in
accelerating the reduction of serum bilirubin levels in neonates and to find out whether
intravenous fluid supplementation decrease the total duration of phototherapy and the need for
exchange transfusion
Methods: This is a prospective clinical trial study that was conducted at phototherapy ward at
Karbala teaching hospital for children, Iraq from January 2017 to December 2017. Fifty-two
term neonates with non-hemolytic hyperbilirubinemia [total serum bilirubin ≥18 mg/dl (308
μmol /L) and <25 mg/dl (428 μmol /L)] were randomly divided into 2 equal groups; (non
supplemented group) received breast milk and or formula, and (supplemented group) given
intravenous fluid besides breast milk or formula. Both groups exposed to intensive
phototherapy. The rate of bilirubin decrement, duration of phototherapy, and rate of exchange
transfusion were compared
Results: Rate of bilirubin decrement at 4 hours, 8 hours, 24 hours of study were significantly
higher in supplemented group as compared to non-supplemented group (p- value ≤0.001).
Duration of phototherapy required in non-supplemented and supplemented groups was 56.54
vs. 41.54 hours respectively (p-value =0.0001). No statistically significant effect of intravenous
extra fluid supplementation on exchange transfusion rate between these two groups.
Conclusions: Intravenous extra fluid supplementation in non-hemolytic jaundiced term
neonates can accelerate decrement of serum bilirubin levels and decreases the duration of
phototherapy

b
ackground: Colorectal cancer (CRC) is a major health problem in Iraq.
Aim: to identify the clinicopathological characteristics of colorectal cancer in young
Iraqi patients in Karbala.
Design of study: Retrospective study was conducted in a single center, Imam AL
Hussein general teaching hospital during the period from January 2009 to April 2017.
Patients and Methods: A sample size of 96cases of Colorectal Carcinoma was diagnosed
during the study period. The clinic-pathological parameters were reported.
Results: The mean age of the patients was (51.68). There is a general increase in the incidence
of colorectal cancer across the years with percentage of (41.7%) being younger than 45 years.
There was slight male predominance. The predominant site of the tumor is colon in (75%) of
cases followed by rectum (17.7%). The most common type was adenocarcinoma (82.1%)
followed by mucinous type (27.3%), most patients presented with grade I (61.5%). In the
majority of patients the malignancy reaching the pericolic fat (54.5%). About (43.6%) of
patients presented with N1 and (50.9%) with stage III followed by stage II in (30.9%). For all
cancer grades, the frequency of CRC was higher among patients > 45 years with the majority
of patients with grade III being younger than 45 years and this make a significant difference
between both categories, (P=0.043). With respect to the depth of invasion, those with advance
disease (T3), 17 out of 30 cases were younger than 45 years, thus there was significant
difference between 2 age groups.
Introduction
Conclusion: the incidence of colorectal cancer is upgrading in those younger than 45 years.

b
ackground: The assessment of corneal thickness has gained importance in different
fields of ophthalmology in recent years, and measurement of the central corneal thick
ness (CCT) has become an important part of a routine examination in refractive sur
gery.
Aim: To determine the Correlation between Refractive Error and Central Corneal Thickness
in A NAJAF Population with a Wide Range of Ametropia.
Method: In a cross sectional observational study, Involved 399 eyes of 200 Patients for whom
the cen-tral corneal thickness (CCT) was measured with Ultrasonic pachymetry (TOMEY
PACHYME-TER SP-3000).
The refractive error, including sphere, cylinder, and spherical equivalent (SE), were measured
with Topcon (KR.8900) autorefractometer And Manual refraction.
Examination of anterior segment using slit lamp and fundoscopy using volk + 90 D, were done
to exclude any underlying pathology
Results: The mean age of the study subjects was 30.71(range, 17 to 61) years. The mean spher
ical equiva-lent (SE) of the right eye was -3,2475 Diopter (range,-11.25 to 5.75 Diopters) while
SE of the left eye was-3,2035 Diopter (range,-14.5 to 8.5 Diopters). The mean central corneal
thick-ness(CCT) of the right eye 533,1600 Micron (range,407.00 to 635.00 Micron) while CCT
of the left eye was 532,7638 Micron (range,394.00 to 630.00 Micron). No significant correla
tion were found between spherical equivalent (SE) and central corneal thickness (CCT) of right
and left eye among the studied group.
Conclusion: No significant Relation found between Refractive errors and central corneal thick
ness (CCT).

b
ackground: Metabolic Syndrome (MS) has become prevalent medical problem
globally and the main consequence of Diabetes Mellitus (DM) and Coronary Heart
Diseases (CHD).
Aim of Study: To determine the proportion of metabolic syndrome among patients with type
2 diabetes mellitus and its association with metabolic syndrome risk factors.
Materials and Methods: A hospital-based cross sectional study design was carried out on
(300) diabetic type 2 diabetes mellitus patients at diabetic outpatient clinic in Merjan Teaching
Hospital. The study duration was from December 2011to December 2012. Categorical
variables were presented as frequencies and percentages. Continuous variables were presented
as means with their 95% confidence interval (CI) and standard deviation. The Pearson's chi
square test (x2) was used to determine the associations between categorical variables. Binary
Logistic regression was done for multivariate analysis. A p-value of < 0.05 was considered as
statistically significant.
Results: The results showed that, out of 300 diabetic patients, the proportion of metabolic
syndrome was 226 (75.3%). The overall mean age of patients was 57.26± 7.07 years. (60.0%)
patients were male and (45.7%) of the patients were from urban area. (60.0%) of patients had
abdominal obesity and (61.0%) of patients adapt sedentary life style. (76.7%) of patients had
high triglyceride, meanwhile, only (39.7%) had normal HDL. Hypertension was presented in
(73.7%) of patients. Metabolic syndrome was statistically significant with male, urban area,
abdominal obesity, sedentary lifestyle, high triglyceride and hypertension. Patients with high
triglyceride were 71 times more likely to develop metabolic syndrome than patients with
normal triglyceride.
Conclusion: High proportion of metabolic syndrome among diabetic type 2 patients in this
study. High triglyceride, urban area and sedentary lifestyle were the strongest predictors of
metabolic syndrome.

b
ackground: High blood pressure (BP) is estimated to cause 7.5 million deaths
worldwide, around 12.8% of the whole deaths . It is a major risk factor for coronary
artery disease and its complications, heart failure, renal insufficiency, stroke and
blindness in diabetic patients.
Aim: This study is designed to determine the compliance of hypertensive patients attending
the consultation clinics of internal medicine in Al-Imam Al-Hussein medical city with
treatment regimen and the causes of noncompliance.
Method: A descriptive cross- sectional study conducted in the outpatient clinics of Al- Imam
Al-Hussein medical city in Kerbala during the period from March till June 2018.Total study
sample was 335 hypertensive patients ,their ages over 25 years were selected by convenience
sampling procedure according to the inclusion criteria . They were interviewed and assessed
using special questionnaire format based on sociodemographic data, Morisky 8- item
medication adherence scale (MMAS-8) ,and measuring of blood pressure.
Results: the mean age of the patients was 58.69 ± 11.87 years. Good compliance with treatment
was present in only 28.36% of the sample, 25.67% with partial compliance and 45.97% had
poor compliance. Good control of blood pressure was present only in 23.3% of the patients
.The absence of symptoms was the first isolated cause of non-compliance to medication 21.9%,
followed by forgetfulness 18.8%, the cost of medication 16.3%, then negligence and
carelessness of patients 9.4%, while 23.1% of the patients had more than one specific reason
to their poor compliance.
Conclusions: the study revealed a low rate of medication compliance and low level of blood
pressure control with strong association between them. Compliance increased with age, male
gender, higher level of education and income, longer duration of the disease, presence of
complications, using healthy diet and having positive believe about hypertension treatment and
its consequences

bPurpose: To report an unusual clinical presentation of Vogt – koyanaji – Harada disease.
Design and methods: A 36 years-old Iraqi woman presented to Neurology department with
chronic headache and bilateral disc edema, neuro-imaging was normal, a provisional diagnosis
of idiopathic intracranial hypertension was made, aspiration of cerebrospinal fluid (CSF) was
done. The CSF pressure was normal and the patient did not respond to conventional treatment.
After 3 weeks, the patient developed drop of vision in the right eye, the patient referred to the
Ophthalmology department for evaluation of the visual problem. On examination, vision was
counting finger 3 meters right eye and 5 meters left eye. There is bilateral granulomatous uveitis
both eyes, bilateral disc edema, and multifocal exudative retinal detachment in both eyes.
Optical coherence tomography (OCT), and posterior fundus photography document the
presence of multifocal retinal detachment.

bChondrodysplasia punctata is a very rare congenital disorder characterized by abnormal
calcification within growing cartilage at the ends of the long bones affecting their growth. It
has seen in inherited and acquired disorders. Acquired cases may be seen in infants of mothers
with deranged vitamin K metabolism during pregnancy as in severe hyperemesis gravidarum.
We report 2.5 years girl with features of chondrodysplasia punctata in whom maternal prenatal
pregnancy history was remarkable of hyperemesis gravidarum. According to my information,
this is the first recorded case in holy Karbala governorate.