Karbala Journal of Medicine

b
ackground: Viral hepatitis is a contagious disease that continues to be a global burden.
We have noticed from our clinical practice that the number of cases is growing
especially in Kerbala Province.
Aim: we conduct this epidemiological study in Kerbala Province to investigate the incidence
rate of Hepatitis A infection and to have an insight to the causative factors in view to addressing
them and tackle this big health problem.
Method: Data from The Infectious Diseases Registration Office in Kerbala health directorate
was revised to review all registered hepatitis cases between 2010 and 2017.
Results: of 9352 hepatitis patients, (58.8%) males and (41.2%) females registered in Kerbala
Health governorate in eight years (2010-2017). Hepatitis A formed the majority of cases
(61.7%) followed by hepatitis B and C. Converting frequency to incidence rates showed that
the annual rate of the four main types of hepatitis were 0.069, 0.028, 0.013, 0.001 per 100,000
population, respectively. The incidence of hepatitis A rates in 2010-2017 in Kerbala fluctuated,
however the median endemic was rising. Within the four main geographical areas in Kerbala
(City Centre, Hindia, Al Hussainia and Hurr) the incidence of hepatitis A per 100,000
population was markedly higher in the city Centre.
Children and adolescents were the mostly affected age groups as they formed more than three
quarters of the patients, but there was no significant gender difference. Seasonal variation was
very clear as summer months were marked with significant increase in incidence rates.
Conclusion: Being a holy city where millions of pilgrims visit Imam Hussein (PUH) shrine
appeared to play an important role in disease transmission where propagations started after
religious occasions. Decision makers need to address the serious health issue and implement a
more proactive plan for the near future.

b
ackground: Basal cell carcinoma (BCC) is the most common Worldwide cutaneous
cancer; approximately 75% of all skin cancers. It arises from the basal cells of the
epidermis and pilosebaceous units. It has a long evolution, slow growth rate with up
to 70% of primary BCCs occurring in head or neck region. Although it rarely results
in death or metastatic disease, BCC can cause significant morbidity due to destructive local
spread.
Aims of the study: To determine the frequency of various histopathologic types of BCCs
encountered in practice, to delineate the spectrum in setup, anatomical location, site
predilection, and annual age and sex incidence each year.
Materials and Methods: The analysis included two hundreds and five cases of skin tumors,
88 cases were basal cell carcinoma from Department of Histopathology, Al Hussain Medical
City/ Karbala. The study was retrospective and done during the period of January 2012 to
June 2016. After careful review of the Hematoxylin and Eosin (H and E) stained sections,
statistical analyses were done.
Results: Out of (205 cases of skin tumors) only 88 were of BCC and accounted for 42.92%
of all the malignant tumors of skin. majority (87.51.%) of the lesions of BCC were located on
head and neck region, solid nodular type was most common histopathologic type and average
age of cases was 64 5years.
Conclusion: In the present study majority (87.51.%) of the lesions of BCC were located on
head and neck region, average age of cases of basal cell carcinoma was 64.5years, and solid
nodular type of BCC was most common type.

b
ackground: Ischemic Heart Disease is a group of diseases of the blood vessels
supplying the heart muscle. Adiponectin is a protein secreted by adipocyte with insulin
sensitizing, Anti-inflammatory and anti-atherogenic properties. Several studies have
shown that polymorphisms within the adiponectin gene can be associated with Ischemic heart
disease.
Aim: The aim of the present study was to evaluate the impact of (rs266729) SNP in the
promoter region of the ADIPOQ gene on the occurrence of Ischemic heart disease (IHD).
Methods: The study included 150 patients with IHD randomly selected based on World Health
Organization (WHO) guideline and 150 as controls group. DNA was extracted from blood and
genotyped by PCR-RFLP by using (Hha1) enzyme.
Result: The frequency of G allele of rs266729 (C/G) polymorphism was significantly
(p=0.0001) in IHD (19.6%) compared with control (13.3%). The homozygous genotype (GG)
significantly (0R=1.71, CI 95%=0.65-4.96, P= 0.0001) increased the risk of Ischemic Heart
Disease compared with wild type (CC) after adjustment age, sex, and BMI, furthermore the
heterozygous (CG) genotype significantly (0R=1.61, CI 95%=0.96-2.87, P= 0.0001) raised the
risk of Ischemic Heart Disease.
Conclusion: Adiponectin gene polymorphism rs266729 is involved in the pathogenesis
Ischemic heart disease.

b
ackground: Pregnancy is the time of hormonal changes which may result in endocrine
disorders. Thyroid disorders are common clinical problem during pregnancy in which
subclinical hypothyroidism is the most common thyroid disorders. Maternal thyroid
dysfunction may result in short-term and long- term harm to the mother and child.
Objective: To study the prevalence of thyroid disorder during pregnancy and to follow the
correlation between (TSH, FT3, and FT4) with BMI
Materials and Method: A cross sectional study involved 120 pregnant women in second and
third trimester (apparently normal) between (19-42) years.
The participants were collected randomly from outpatient unit of Al-Zahraa teaching hospital
in AL-Najaf AL-Ashraf, detailed history and data for pregnant women were recorded
(including maternal age, gestational age ,medical history of thyroid disease and history of
abortion and infertility) .Pregnant women with history of thyroid disease were excluded from
the study. Serum TSH, FT3 and FT4 were measured for all pregnant women participated in
study
Results: The prevalence of thyroid disorder during pregnancy was 20.8% out of which
20(16.6%) had SCH and 2(1.6%) had OH. Hyperthyroidism detected in 3(2.5%) pregnant
women all of them had subclinical hyperthyroidism. and there was a positive correlation
between TSH, FT3 with BMI and negative correlation of FT4 with BMI, also maternal age
don’t affect thyroid function status significantly (p value < 0.05).and there was no significant
relation between thyroid disorder and history of abortion or infertility (p value < 0.05)
Conclusion
Introduction
There is a high prevalence of hypothyroidism during pregnancy and the majority is subclinical
hypothyroidism .BMI was correlated positively with TSH and FT3 and negatively with FT4.

b
ackground: Childhood bacterial meningitis is a neurological exigency. Accurate,
early, rapid diagnosis and treatment is essential to decrease its morbidity and
mortality.
Aim of study: This is a retrospective study comparing real-time polymerase chain reaction
(RT-PCR), with standard bacterial culture for the diagnosis of bacterial meningitis during
cerebrospinal fluid (CSF) examination.
Materials and methods: RT-PCR was used for the detection of three most common causes
of bacterial meningitis (Streptococcus pneumonia, Haemophilus influenza type b, and
Neisseria meningitides) in 100 CSF samples from children aged 2 months to 12 years
admitted to Al-Elwiya Pediatric Teaching Hospital during the period from January 2016 to
January 2017
Results: Growth was detected in 6% CSF cultures of patients included in the study and
Streptococcus pneumoniae was the most prominent isolated bacteria. RT-PCR was positive in
43% CSF samples from which S. pneumoniae was identified in all samples. PCR and culture
showed concordance in 6% positive and 57% negative samples. Using culture as a reference
method, the sensitivity, specificity, and positive and negative predictive values for PCR on
CSF samples were 100 %, 60.64%, 13.93% and 100 %, respectively. RT-PCR was positive
in 37% CSF samples whereas culture was negative.
Introduction
Conclusion: RT-PCR is a rapid and sensitive test for the diagnosis of bacterial meningitis.
The findings of this retrospective study recommend the use of RT-PCR for the diagnosis of
children with a clinical suspicion of bacterial meningitis and as a complement to culture,
especially, those who received previous antibiotic treatment before lumbar puncture

b
Ackground: Cardiac catheterization is a procedure used to check the heart for blocked
arteries and valve abnormalities by using a coronary angiogram, through which the
patient will exposed to the hazardous effect of radiation and contrast media used.
Aim of the study: Our study aimed to see the effect of cardiac catheterization on certain
hematological parameters
Methods and subjects: This study was carried out in the cardiac catheterization center in Al
sader teaching hospital in Basrah city on 30 patients (20 were males and 10 were females),
their ages ranged between 35 and 66years with mean of (53.62±8.98 years). Solution of
Ultravist 370 injection was used during the procedure as contrast media in amount ranged
between (25-600 ml) with an average of (41.56 ±13.75 ml). Fluoroscopy was also used and the
flouro-time was ranged between (0.54-8.9) minutes with an average of (2.085±1.18 min).
In this study and for all patients we estimated the number of RBCs, WBCs (total and
differential) and platelets one hour before and one hour after the procedure of cardiac
catheterization by using automated hematology analyzer (Sysmex XT2000i Japan).
The results were analyzed using SPSS software, in which independent t test were used to
compare the differences in the values of the included parameters obtained before and after
cardiac catheterization.
Results: The comparative data revealed that there were decreases in most of the parameters
one hour after cardiac catheterization which is statistically significant regarding the number of
lymphocytes, monocytes and platelets, with significant increase in the number of neutrophils
one hour after cardiac catheterization (p˂0.05).
Conclusion: The exposure to radiation and iodinated contrast media increases neutrophils
count and decreases lymphocyte and platelets counts one hours after cardiac catheterization
while it has not effect on the RBCs and total WBCs counts.

b
ackground: The association between dry eye symptoms and ocular surface disease is
becoming more frequent. The recent rise in newly diagnosed cases of diabetes mellitus
and the awareness of real complaints of diabetic patients from dryness of the eye and
ocular discomfort are responsible for the recent increase in the number of patients and
frequency of their consultations to the outpatient departments.
Aims of the study: To investigate the changes of tear film and ocular surface in diabetic
patients.
Design and method: A case control study carried out in the eye clinic of Al-Sadr Teaching
hospital in holy Najaf city for 12 months. It included 100 eyes of fifty patients of Type 2
Diabetes Mellitus (Cases) and 100 eyes of fifty healthy individual (Controls). After exclusion
of patients with history of systemic diseases with ocular manifestations affecting tear secretion,
abnormalities in the cornea, conjunctiva, or eyelid, and secondary ocular and systemic disease,
the remaining diabetic cases are 72 and control cases are 89. Different symptoms included;
character of irritation whether it was burning, foreign body sensation or sand gritty feeling. All
the
individuals underwent routine general physical examination and thorough
ophthalmological examination followed by measuring tear film meniscus height, tear film
breakup time (BUT), presence or absence of tear film debris.
Results: There is significant difference between diabetics and non-diabetics in presence of
normal or abnormal tear meniscus height. There is also significant difference between diabetics
and non-diabetics regarding normal and abnormal tear film breakup time. However, there are
no significant differences between diabetic and control group in the presence or absence of tear
film debris.
Conclusion: Tear film stability is decreased in diabetic patients. These results suggest that
diabetic patients are more prone to suffering from dry eye symptoms than normal subjects.

b
ackground: Renal stone is one of the commonest renal conditions in Iraq and number
of the patients who are suffering from this condition is one of the largest attendance to
the In / Outpatient clinics.
Aim: There are many risk factors leading to this condition and in this study trying to recognize
the most common risk factors and compare with other studies.
Patients and method: 67 cases were been chosen for this prospective study collected from
admitted cases and Outpatient clinic in the main hospital in the province and the data were
collected directly from the patients themselves and their medical records to identify the main
risk factors causing their problems.
Results: In this study many tables were getting for the main risk factors but try to concentrate
about the commonest risk factors that discovered during the study and also to compare it with
other studies in the same topic.
Discussion: Making a comparison between this study and other studies were done in USA and
UK, it has been found that the main risk factors for renal stones formation in western countries
is the supplemental calcium and chronic or recurrent UTI and the gender factors are similar to
this study.
Conclusion: This study shows the most common risk factor for renal stone formation is chronic
UTI then history of previous stone and the family history of renal calculi and effect of climate.
Also increase incidence of renal stones in female more than male. The study also shows the
living in urban area is more risk for renal stone formation than rural area

b
ackground: Most higher education institutions throughout the world are searching for
teaching and learning methods that will both engage students more actively in their
learning and contribute to a deeper understanding of the content. In Iraq where tertiary
education is expanding and many medical colleges had adapted Problem Based Learning (PBL)
incorporated curricula. As a new experience, there was a need to explore the views and
perspectives of the direct beneficiaries in this learning system, the students.
Subjects and methods: A qualitative study was performed to explore medical students'
perceptions and attitudes regarding the change in undergraduate medical education that took
place at the college of medicine, University of Kerbala. One hundred twenty second-year
students participated in this study. Student answers were analyzed using SWOT analysis
technique.
Results and discussion: The majority of the participants showed positive attitude and
evaluation of the newly adopted system. The results suggest that the students face difficulty in
bridging the gap between the theoretical and practical phase of the curriculum, some
shortcomings due to the need for better logistic support and tutor training.
The study explored students opinions in six disciplines: lectures, relevance of finding
objectives by the students, PBL system implementation, PBL session implementation, team
work and tension problems, tutor efficiency, as well as additional students’ suggestions.
Conclusions and recommendations: The students have perceived PBL approach, recently
adopted by Kerbala medical College (KMC) consistently in a positive manner. The main
reported shortcomings were related to the application rather than the concept which need
further staff training and follow up

b
ackground: (resistin is considered as a pro-inflammatory molecule and plays a role in
the inflammatory response that lead to atherosclerosis)
Aim: To evaluate the risk of resisten gene polymorphism (420C/G) in the development of
Ischemic Heart Disease. To verify the relationship of the investigated SNPs with the metabolic
changes related to (IHD), in particular, serum lipid profile.
Methods: A case control study was performed at which 150 patients with IHD and 150 healthy
individuals. Genotyping for SNP 420C>G in the resistin gene was performed by the
polymerase chain reaction –restriction fragment length polymorphism method. Lipid profile
were measured.
Results: The genotype and allele frequencies of resistIn gene polymorphism in IHD and
control persons were examined under the co-dominant, dominant and recessive models with
the use of multi nominal logistic regression analysis. Neither genotype distribution nor the
minor allele frequency showed significant changes among the comparison of the of IHD
patients with the control group. The frequency of the G allele of 420(C\G) polymorphism was
significantly higher in ischemic heart diseases (IHD). There are significant increases in the
level of LDL, triglyceride, VLDL, BMI and a significant decrease in the level of cholesterol in
the group of patients with the GG+CG genotypes when they were compared with those of the
CC genotype. It shows significant differences in BMI, Age, Cholesterol, LDL, and HDL in the
group of IHD, and no significant difference was seen in VLDL and sex.
Conclusion: The −420C>G SNP of resistin gene is not associated with ischemic heart disease
in the population of Kerbala and Najaf. The G allele is seemed to increase serum lipid
concentrations so it could be considered as an atherosclerotic parameter

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b
ackground: In laparoscopic surgery, the technique of first entry into the
peritoneal
cavity for creation of pneumoperitonium is called access
technique, two methods are used for laparoscopic access either by the closed
or open method. Inadvertent complications might occur during port access, although
these complications are uncommon, but its potentially life- threatening.
Aim: This study aims to evaluate the impact of stay sutures on the laparoscopic
closed access complications.
Patients and methods: A prospective study was conducted in 238 patients
underwent elective laparoscopic surgery at Misan governmental teaching hospital in
the period between September 2014 and May 2017.
Results: the incidence of hernia was 0.4 % in comparison to 9.25% with the other
access port insertion (P value <0.05). Major bleeding and visceral injuries were not
reported and bleeding was related to trocar site in (0.4%). Other complications were
simple, not life threatened and managed conservatively. Conclusion: transverse
stay sutures to the anterior rectus sheath are simple, safe and reduce the initial port
access complications.

b
ackground: Surgery for stress urinary incontinence has been modernized by the
introduction of tension free vaginal tape technique TVT (1). Minisling introduction has
been simplifying this surgical procedure.
Aim: To make an assessment of the success rate of minisling for ladies with stress urinary
incontinence.
Method: Our study enrols 40 ladies. The mean patients age was 44 years,. 75% of them with
pure SUI and 25% had mixed UI. Patient’s assessment postoperatively was made by clinical
assessment 3 months and 1 year after the procedure.
Result: success rate was very good 97.5%. Post operative complications was 5% retention,
and 12.5% UTI. The 1-3 months follow up shows a 5% de novo urgency and a 1 year follow
up shows satisfaction rate of 97.5%.
Conclusion: Minisling procedure for SUI has low morbidity with low rate of complications
and high success rate.

b
ackground: Formative work place assessment give opportunities to
follow the progression of students learning through monitoring of
their doing
Aim: To know the experience of the 5th year students with the first year
implementation of formative mini clinical evaluation exercise (mini-CEX).
Method: It is a qualitative research. The information were collected from
interview with students completed the internal medicine discipline of the fifth
year during the academic year 2017 - 2018.
Results: The participants were aware about the exam, the embarrassment of
the exam and the presence of peer get less with subsequent examinations, and
the encouraging feedback of the examiner exerted a positive effect on the
learning process. The students explored the need to further training of clinical
examination, in addition to adhering to instructions regarding the need to
focus on educational goals. Some of the teachers did not administer the exam
according to the instructions of mini – CEX.
Conclusion: The experience resulting from the mini clinical evaluation
exercise (mini-CEX) indicates positive results with regard to studentsʹ rush
towards learning, a great opportunity for teachers to follow up the studentsʹ
level and guidance, enhancement the studentsʹ communication skills, and the
need of some teachers to adhere to the essence of this type of assessment

b
ackground: There is a controversial result about the association of H.Pylori infection
and ischemic heart disease. The study was design to study the relation in our locality.
Aim of the study: To study the relationship between Helicobacter pylori infection and
myocardial infarction.
Patients & methods: Patients that were included in this study, were patients with acute
myocardial infarction (S-T segment elevation) that were admitted to coronary care unit of
Baghdad Teaching hospital and Al-Hussein hospital in Karbala city between June, 2004 to
August 2004, with less than 48 hours of onset of their symptoms.
Patients were evaluated regarding cardiovascular risk factors; smoking, hypertension,
diabetes mellitus, body mass index (BMI), hypercholesterolemia, low high-density
lipoprotein (HDL) and family history (10-15).
Control groups were included in the studies that were age and sex matched
Fifty patients diagnosed
with myocardial infarction that were admitted to the coronary care unit in Baghdad teaching
hospital and Al-Hussein Hospital in Karballa city were tested for anti H.Pylori antibody using
ELISA and compared with 51 control persons without coronary heart disease.
Results: 72 % of the patients 78.4% of the controls were seropositive for H.Pylori without
significant difference.
Conclusion: No significant relation exists between seropositivity against H.Pylori and acute
myocardial infarction.