Karbala Journal of Medicine

b
ackground: Fistula-in-ano (FIA) is a common medical problem. Magnetic resonance
imaging
(MRI) is an excellent modality for the pre-operative evaluation of this
condition. Video assisted anal fistula treatment (VAAFT) is a relatively new modality
introduced in 2006, and is both diagnostic and operative.
Aim: To correlate MRI findings with video assisted anal fistula treatment findings.
Patients and methods: Thirty-five patients with clinically diagnosed FIA, had a pelvic MRI
followed by VAAFT surgery.
Results: Mean age was 42 years. In one case both MRI and VAAFT revealed a sinus. In 29
cases (82.8 %) there was concordance regarding the presence of an FIA, both tracts and internal
openings. In 5 cases (14.2%), there was no concordance regarding the presence of an internal
opening.
Conclusion: MRI is essential in the pre-operative assessment of FIA especially for clinically
complex fistulas

b
ackground: Nasal obstruction is a common complaint in patients attending
otolaryngology clinics which is infrequently due to inferior turbinate hypertrophy.
Patients not responding to medical treatment can benefit from turbinate reduction
surgery, which aims at relieving this symptom.
Objectives: To evaluate the effects of diode 1470nm laser turbinoplasty of inferior turbinate
versus partial surgical inferior turbinectomy in patients with nasal obstruction due to
hypertrophy of inferior turbinate.
Methods: A prospective comparative study had been done at Al Kafeel Hospital, Kerbala from
February to October 2016. Fifty patients were included and equally divided into two groups of
25 patients for each. First group was treated with partial surgical inferior turbinectomy and the
other one with laser turbinoplasty. Patients were evaluated for improvement in symptoms at
follow up on 2 days, 1week, 1month, 3months, and 6months.
Results: Patients' age range from 16-50 years with a mean ± Standard deviation 28.18 ± 7.27
years. Females were 30 (60%) of the sample with no significant difference between both groups
in regard to age and gender distribution. Both procedures are evenly effective in reducing the
turbinate size after 6 months. However crusting, post-operative pain, blood loss, and the
number of days of nasal packing was found to be significantly less in laser turbinoplasty group
as well as faster improvement in nasal obstruction and healing and less hospital stay.
Conclusion: Diode laser1470 nm turbinoplasty is a safe and effective procedure, because of
its precise localization of coagulative effects on soft tissue. In comparison to partial surgical
inferior turbinectomy diode laser1470 nm turbinoplasty shows less bleeding, postoperative
pain and crustations with no nasal packing as well as earlier healing and nasal obstruction
relieve.

b
ackground: juvenile delinquency is problem that affect the youth in many societies
and can lead to many complication in regard the legal system, increase the crime and
affect the moral and ethical issues of each society so it was better to understand the
factors that contributing to the development of this condition.
Aim of the study: to explore the family, school and economic factors of juvenile crime. It has
been conducted in police offices throughout the governorate of Karbala.
Subject and Methods: Interview schedule has been used as a tool of data collection. A sample
of 172juveniles was interviewed 93.6% male; most of the delinquents were in the age group of
9-19 years.
Results and Discussion: This study found that majority of the respondents were dropped out
of school and engaged with juvenile employment, which in turn increases the rate of juvenile
crimes. The dynamic and function of the family was found to be a determining factor for
delinquency, only 56.97% lived with both of parent were 19.18% of the delinquent youth lived
away from their families, 43.02% suffered from family neglecting, most of them belonged to
low income profile, and keeping watching violent movie or electronic games.
Conclusions: from this study it was concluded that the character of delinquent case are those
who are spend most of their time outside their home, they have low level of education, coming
from poor parenteral education, they live in overcrowded area or coming from other
governorate, they prefer to watch violent movie and violent games, they are cared by only one
parent or by relatives,, with big family size, they have been curled or neglected by their care
giver and finally have low financial state

b
ackground: Low Molecular Weight Heparin (LMWH) has widely replaced its parent
and oldest anticoagulant compound “Heparin” due to its numerous advantages.
However, LMWH are not devoid of adverse effects which may be serious. Since the
therapeutic dose of LMWH “Enoxaparin” is determined by a weight-based regimen, the
incidence of adverse events may be increased when using higher doses in overweight & obese
patients.
Aim: to assess the incidence of adverse events in acutely thrombosed patients treated with
therapeutic dose Enoxaparin in relation to Body Mass Index (BMI).
Methods: A prospective study conducted through a 6 months period in 2014 including 181
patients (98 males, 83 females) with acute thrombotic disorders admitted to the cardiac care
unit in Al-Hussein Medical city in Karbala-Iraq. All patients who had normal renal functions,
were received weight-based LMWH in the form of Enoxaparin. They were subdivided
according to their BMI into 3 groups; normal, overweight and obese. Any evidence of adverse
events were followed and recorded.
Results: Bleeding was the most common adverse event occur in 15 out of 181 patients
(8.3%), categorized as Major bleeding comprising 2.2% overall, occur in 2% of normal BMI,
1.6% of overweight, & 2.9% of obese patients, and Minor bleeding comprising 6.1% overall,
occur in 5.9% of normal BMI, 6.5% of overweight, & 5.8% of obese patients. No death was
reported related to bleeding. Other adverse events were thrombocytopenia in 2.6%, and fever
in 1.1% overall. There was no statistically significant difference regarding all adverse events
among the 3 groups.
Introduction
Conclusion: The incidence of bleeding and other adverse events was not found to be increased
in relation to BMI when using weight-based therapeutic dose Enoxaparin, which may indicate
the rationale use of this regimen in patients with acute thrombotic disorders

background:Celiac disease (CD) is a disorder of small bowel malabsorption, occur
upon exposure to gluten, CD appears to represent a spectrum of presentations: ranging
from classical type (most commonly describe), to atypical form found in the setting
of another presentation e.g.: iron deficiency, osteoporosis (most patients have it). The
diagnosis of CD in adults is classically made on clinical suspicion but firm diagnosis can only
be established by small intestinal biopsies and serologic markers
Objectives: to estimate the prevalence of celiac disease in patients with dyspepsia Methods:
Any patient had dyspepsia, older than 15 years were tested for anti-tissue transglutaminase
antibody and underwent upper gastroduodenoscopy.Four endoscopic biopsies were taken from
each patient and sent for histopathological examination and classified according to modified
Marsh's classification.
Results: Among 157 patients who enrolled in study, 17 patients were labeled as celiac disease:
16 of them has histopathologic changes (Marsh II and above) and 1 patient was normal mucosa,
15 patients from them were positive for tTG antibody and 2 patients were negative.
Conclusions: any patients diagnosed with functional dyspepsia and sent for endoscopy, should
routinely had biopsy of the descending duodenum. Particular attention to females with
dysmotility or indeterminate dyspepsia

b
ackground: B-thalassemia minor is the symptomless carrier state of B-thalassemia that
can be misdiagnosed as mild iron deficiency anemia (IDA).
Aim: This work aims to assess the prevalence of cases of B-thalassemia minor among
the suspected cases and to compare the results of diagnosis depending on single confirmatory
test (Hb electrophoresis) and three confirmatory tests (reticulocyte count, serum ferritin and
Hb electrophoresis).
Materials and methods: In this study 50 cases of mild anemia (Hb ≥9-11.99 g/dl) with initial
hematological suspicion of B-thalassemia minor were studied for detailed confirmatory
diagnostic tests that include reticulocyte count, Hb electrophoresis for HbA2 estimation and
S.Ferritin level.
Results: Results showed that 43/50 i.e 86% of suspected cases are confirmed by three tests
(41/50 i.e (82%) have B-thalassemia minor, 2/50 i.e (4%) have B-thalassemia minor and IDA),
6/50 i.e (12%) have iron deficiency anemia (IDA), while 1/50 i.e (2%) have polycythemia (on
venesections).
Discussion: Results showed that 86% of initially suspected cases are confirmed to have B
thalassemia minor and 4% of cases have B-thalassemia minor with IDA depending on three
tests for confirmatory diagnosis which are reticulocytosis, HbA2 concentration and S.Ferritin
level. Similar results were encountered by Cristina Passarello, Antonino Giambona, et al.
Conclusion: The prevalence of cases of B-thalassemia minor among the hematological
suspected cases in Kerbala is 86%

b

b
ackground: Diabetic retinopathy is the most important microvascular complication of
diabetes mellitus and the inflammation have potent role in the pathogenesis and
development of the disease .Tumor necrosis factor alpha is a prominent
proinflammatory cytokine that mediated in all inflammatory process so it has unwanted role in
diabetic complication, retina inflammation and endothelia disturbance. So the prediction of the
TNFα role in the retinopathy will help to find the major treatment approach.
Objective: this study conducted to evaluate the effect of TNFα in diabetic retinopathy and to
find the association between TNFα and insulin sensitivity.
Material & method: this study involved 120 persons were 40 healthy control subjects and 80
diabetic patients which divided into 40 type2 diabetic patients with retinopathy and 40 type2
diabetic patients without retinopathy .The serum level of TNFα ,insulin and lipid profile was
measured for all patients and controls and used the SPSS program for the statistic calculation.
Results: The serum level of TNFα was significantly higher in diabetic retinopathy patients in
comparison to diabetic only patients and control subjects. Also there was negative correlation
between TNFα and insulin sensitivity, the lipid profile was significantly higher in diabetic
patient compared to control subject and the LDL cholesterol was significantly high in diabetic
retinopathy patients in comparison to diabetic only and control subjects.
Discussion: The inflammation play prominent role in the development of diabetic
complication. TNFα is the most important inflammatory marker that present in the serum of
diabetic patients. The TNFα affect mainly on the glucose and lipid metabolism and it worsen
the insulin resistance and it correlate inversely with insulin sensitivity and due to this effect it
will lead to develop of diabetic complication.
Conclusion: The serum TNFα level was elevated in type2 diabetic patients and it may have
role in developed the complication of diabetes and it was inversely correlated with insulin
sensitivity.

bThis review considers the neurobiological aspects and the genetics of the Obsessive
compulsive disorders (OCD). The recent advances in OCD research showed the increasing role
of alteration in both the molecular and cellular mechanisms. These altered physiological
mechanisms were clinically evident through phenomenology, neuropsychology,
neuroimmunology, and neuro-imagery among the patients with OCD. The most consistent
finding throughout the researches was the involvement of various cortical and subcortical
regions, especially the orbitofrontal cortex (OFC), the anterior cingulate cortex (ACC), the
dorsolateral prefrontal cortex (DLPC), the head of the caudate nucleus and the thalamus in the
development of OCD. Neuropsychiatric genetic literatures have been expanded to highlight the
genetic bases for the development of OCD and their role with various environmental conditions
in determination of the disease prognosis and resistance to treatments. This review also
discussed uncommon etiologies for OCD, like infections and traumatic brain injuries (TBI).
These findings will provide new approaches for better diagnostic and treatment advances.