Karbala Journal of Medicine

b
ackground: the higher incidence of right sided bronchial impaction as compared to
left sided one is a very old medical fact regarding inhaled foreign bodies, in recently
published literatures, and in our expanding experience, we were hardly accept that
there might be something different, it looks like that this fact is a (type of foreign body)
dependent type.
objectives: The ensuing problem in the last decade of inhaled pins had it's certain clinical
characteristics, one of them, which is discussed at our literature, is the strange tendency of the
pins to be lodged in the left sided bronchi, contrary to the well known tendency of the inhaled
foreign bodies to be lodged in the right sided bronchi due to well-known tracheobronchial
anatomical factors.
Methods: A retrospective study of 24 patients positive with pin inhalation presented during
the period from 15/9/2009 to 4/7/2014 at Hilla General Teaching Hospital, site of lodgment
was analyzed to be either tracheal, right or left bronchial. Site of lodgment was decided
depending on CXR, bronchoscopic and sometimes operative findings.
Results: Total number of patients was 24, In 15(62.50%) of them the pins were settled at left
bronchi, In 5(20.83%) patients, the pins were at trachea, and 4(16.66%) patients were with
right bronchial pins.

b
ackground: supracondylar fracture of humerus in children is extremely common. It
accounts for approximately (65%) of all fractures and dislocations in children ,
constituting the most common pediatric elbow fracture .
Aim: the aim of this article is to study causes ,pattern ,and outcome of management of this
important fracture and how to ovoid and treat its complications.
Design: a descriptive case series study, to study the behavior and management of
supracondylar fracture of humerus.
Patients & methods: our study was designed to study this type of important fracture by
careful follow up of sixty eight (68) cases collected from the period (2001-2013) in Karbala,
the cases was managed in Emam Hussien Medical City, Alhyndia general hospital and
Alabbas private hospital.
Result: the peak age of incidence at six years , with male to female ratio of
4:1, type I and II need only conservative treatment . type III (majority need open reduction
and internal fixation), stiffness of elbow was the common complication (28%) of cases.
Discussion: In our study the peak age of incidence was six, this compared well with reports
published elsewhere, 38% of our patients were treated surgically and this also compared well
with other articles.
Conclusion: supracondylar fracture of humerus need a proper and accurate treatment to avoid
complications, and adequate radiological assessment is very important to decide type of
management. Complications should be recognized and adequately treated to avoid permanent
deformity .

b
ackground: Acute abdomen is a relatively common issue that facing hospital
casualties, which make it crucial for physicians to diagnose acute abdomen, as early
as possible depending mainly on their clinical skills to avoid unnecessary delay or
negative laparotomies. Every physician must be familiar with diagnosis of acute abdomen
especially in situations where there is limited diagnostic facilities.
Aim: This study was conducted as a comparison between preliminary and final diagnosis for
500 cases of acute abdomen, and to find out the role of clinical skill and diagnostic tools in
avoiding diagnostic errors.
Method: This study was performed from 1996-1998, and included 500 patients presented to
casualty department with signs and symptoms of acute abdomen. Clinical skills were the
major tools used for settling the diagnosis, due to shortage of the other diagnostic tools.
Results: Acute abdomen was common in the age group of 21-30 years, with male gender
predominance (60.80%). Laparotomy was done for 462 out of 500 patients with acute
abdomen, and it was similar to the pre-operative diagnosis in 421 patients, so the incorrect
post-operative diagnosis rate was 41 patients (8.88%).
Also correct preliminary diagnosis was 454 out of 500 patient including the patients who
underwent laparotomy, with false preliminary diagnosis rate (9.20%).Appendicitis was the
major cause for acute abdomen (70.60%).
Limited laboratory and imaging studies were done for some patients, GUE showed the
highest negative predicted value (99.42%) and the x-ray showed the highest sensitivity
(95.24%). Most of incorrect post-operative diagnosis was related to physiological and
pathological gynecological issues.
Conclusion: The diagnosis of acute abdomen should be based on the results of a good history
and thorough physical examination aided by the secondary role of investigative tools.
Diagnostic modalities could guide the physician in confirming the diagnosis. An accurate
diagnosis of acute abdomen can minimize unnecessary operations and reduces the rate of
negative laparotomies.

bRetinal vein occlusions are the most common retinal vascular disorder
after diabetic retinopathy with several ocular and systemic disorders associated with
retinal veins thrombosis. Protein C deficiency as part of inherited thrombophilia due to
deficiency of natural anticoagulant may associated with retinal vein thrombosis.
The aims of this study were to measure the Protein C concentrations in patients with retinal
vein thrombosis and to evaluate its role in the etiology of those patients.
Patients, materials and methods: During a period of 6 months a total number of 42 patients
who were diagnosed with retinal vein thrombosis while attending the out patient clinic in
Karbala, Iraq. From each patient appropriate amount of venous blood was withdrawn and
estimated for plasma protein C level, Complete blood count, blood film, ESR, Kaolin clotting
time, anticardiolipin antibodies, antinuclear antibody, TSH, blood urea, serum creatinin,
random blood sugar and serum cholesterol. For control group individual only protein C
estimation was done.
Results: Forty-two patients with retinal vein thrombosis were investigated. There were 22
females and 20 males and a mean age of 48 ± 2 years with no significant statistical
differences in mean age and sex between the patients and the control group. Decreased levels
of PC were found in six (14%) of the patients, and a statistically significant difference was
seen for PC concentration between the patients and the control groups.
Conclusions: Deficiency of natural anticoagulant proteins, especially protein C, may play a
role in the etiology of retinal vein thrombosis and measurement of these parameters with
proper prophylaxis especially in young patients may be useful in prevention of venous
thrombosis.

b
ackground: The pharyngeal tonsil, also called adenoids, is the upper extension of the
lymphatic Waldeyer’s Ring and is located on the upper posterior wall of the
nasopharynx. A great deal of interest has been given to diverse methods of
examinations and parameters for identification and evaluation of adenoids hypertrophy.
Objectives: To clarify the accuracy of both lateral plain x-ray of the soft tissue of the
nasopharynx and nasoendoscope in evaluation of the adenoids size.
Methods: One hundred-fifty patients presented with nasal obstruction or mouth breathing
suspected to have adenoids hypertrophy were seen and examined in the outpatients clinic of
E.N.T Department of Al-Hussain Teaching Hospital, Karbala from August to November,
2014. All of the patients evaluated clinically, by lateral plain x-ray of the soft tissue of the
nasopharynx and nasoendoscope to determine the size of adenoids.
Results: A total of 150 patients presented with nasal obstruction or mouth breathing, there
were 83 (55%) males and 67 (45%) females patients (M/F 1.2:1). According to plain x-ray of
the nasopharynx, large size adenoids was seen in 77 patients (51%) , moderate size in 49
patients (33%) , and small size seen in 24 patients (16%). According to endoscopic
assessment, the commonest grade of adenoids size was the grade IV seen in 47 patients
(31%) and the least common grade of adenoids size was grade I seen in 16 patients (10.7%),
while grade II was seen in 44 patients (29.3%), and grade III seen in 43 patients (29%).
Conclusions: Evaluation by endoscope was highly accurate than evaluation by X-ray.
Hence, children with classical symptoms of upper respiratory tract obstruction, even without
adenoids hypertrophy revealed by X-ray, suggested to be submitted to nasoendoscope for
diagnostic accuracy, which is greatly relevant especially for more secure indication of
adenoidectomy and help in avoiding unnecessary operation

b
ackground: Prematurity and its complications are the major cause for neonatal
morbidity and mortality. Often, the cause of preterm labor is unknown, but several
etiological risk factors have been identified
Objective: Regardless the causes for hospitalization, this study was designed to determine
the prevalence, mortality, morbidity (determined by duration of hospitalization and referral to
pediatric intensive care unit PICU) of preterm baby among patients admitted into the neonatal
care unit, and some of the possible underlying risk factors for preterm births.
Method: During a period of seven months from 2 December 2012 to 28 June 2013, a
nonrandomized sample consisted of 200 neonates that had been admitted into neonatal care
unit “NCU” at Babylon Maternity and Children Hospital was involved in this cross sectional
descriptive study. Same questionnaire was applied for all cases, then patients were divided
into 2 groups according to gestational age (<37w and ≥37). Test of proportion and chi-square
were used to determine significant differences between the groups.
Results: Prematurity and its complications are responsible for 72/200 (36%) of neonatal
hospitalization and 3/6 (50%) of neonatal death. Females constitute 35/72 (48.61%) of
preterms and 44/138 (34.37%) of terms with p value < 0.05. 8/48 (16.66%) of preterms and
7/95 (7.36%) of terms need referral to PICU with p value > 0.05. Regarding hospitalization,
preterms had longer duration than term neonates (p value <0.05). 51/187 (27.27%) of neonate
had been discharged on their parents’ responsibility, and 20/51 (39.21%) was preterm.
Multiple gestation is a risk factor for death in preterm babies, while obstetrical factors had a
correlation with the occurrence of preterm births (p value <0.05), with premature rupture of
membrane being at the top of the list.
Conclusion: Prematurity and its complications are the major causes for neonatal
hospitalization and death and need longer duration of hospitalization than terms. For preterm
birth, females are at greater risk and the presence of obstetrical factors increase its
occurrence.

b
ackground: Most classical norms are not applicable to diverse racial and ethnic
population and this study was to establish the soft tissue norms of a sample of Iraqi
population group using Legan and Burstone’s soft tissue analysis.
Materials and methods: The study was conducted on 60 adult subjects (30 males and 30
females) with esthetically pleasing profiles aged 18–25 years. Standardized lateral
cephalograms were taken in a natural head position and analyzed.
Statistics: Descriptive statistics and Standard error of each measurement was calculated.
Independent sample t-tests were used to compare the measurements of male and female
subjects. One sample t test was used to compare our data with Caucasians group
Results and discussion: Iraqis had more convex faces, maxillary prognathism and high
variability regarding mandibular prognathism than Caucasians, a more protrusive upper lip,
the nasolabial angle was more obtuse, the lower lip was protrusive resulting in a deep
mentolabial sulcus, the lower face–throat angle was more obtuse, the maxillary incisor
exposure was more, all vertical ratios and the interlabial gap was similar. Regarding to gender
differences in Iraqis, the vertical height ratio was greater in females and the lower face-throat
angle was larger in males. Males had less nasolabial angle than females

b
ackground: The confirmed benefits of 3-hydroxy-3-methylglutaryl coenzyme A
(HMG-CoA) reductase inhibitors (statins) for cardiovascular and cerebrovascular
disease are well recognized in the medical literature.
Objectives: This study aimed at examining the frequency of potential side-effects seen as a
result of statins therapy, because of the importance of statins adverse effects.
Therefore, this paper aims to evaluate the frequency of potential adverse effects reported by
patients using a semi synthetic statin (Simvastatin) and the synthetic statin (Atorvastatin) in
Al-shafaa general Hospital in Basra.
Patients and Methods: A total of 350 patients were included in this cross – sectional study
to evaluate the frequency of potential adverse effects reported by patients using a semi
synthetic statin (simvastatin) and the synthetic statin (atorvastatin) from November 2014 to
March 2015 at the out-patient departments of Al-shafaa general Hospital in Basra.
Results & discussion: 246 patients (70.3%) report about 302 symptoms, overall symptoms
reported were similar between the two types of statins and included muscle pain, joint pain,
increased serum transaminase enzymes, gastrointestinal effects, respiratory effects and hair
falling effects. The only adverse effects significantly reported for simvastatin more than
atorvastatin were headache and dizziness. The side-effects were not severe enough to
discontinue administration of statins.
Conclusions: There is no significant difference in the frequency of potential side effects
reported by patients using a semi synthetic statin (simvastatin) and the synthetic statin
(atorvastatin), apart from headache and dizziness reported significantly with simvastatin more
than atorvastatin.

b
ackground: Frequently coexistent condition in type 2 diabetes mellitus is
hypertension and vice versa. Measurement of blood pressure by ambulatory blood
pressure monitoring is superior to ordinary blood pressure . Blood pressure disparity
reflects vascular diseases which diabetic patients liable for. Inconsistency in selecting the
proper arm for blood pressure measurement may create a clinical dilemma in the presence of
systolic and/or diastolic disparity.
Aim :We tried in this study to set proper steps in choosing the suitable arm for ambulatory
blood pressure monitoring cuff fitting.
Material and Methods :Consecutive 140 type 2 diabetes mellitus patients aged 29 years and
elder were examined by sequential ordinary blood pressure and simultaneous dual
ambulatory blood pressure monitoring.
Results: Systolic disparity grade I was dominant (75.7%) as well as diastolic disparity grade I
(86.4%). The mean systolic and diastolic blood pressure in the dominant arm was higher than
that in the non-dominant arm with significant pressure differences (<0.001).Age and duration
of diabetes had positive impacts on systolic and diastolic disparities while gender and
Hemoglobin A1C had no impacts. Systolic and diastolic blood pressures were significantly
different in both arms when studied over day-time, night-time, and 24-hours ambulatory
monitoring. Systolic and diastolic differences in the dominant arm and the non-dominant arm
had been shown to have significant mean differences with the mean ambulatory day-time
blood pressure.
Discussion: Sequential method is an accepted modality and the arm with the higher systolic
and/or diastolic blood pressure is the suitable arm for ambulatory monitoring and generally
mirroring OBP

b
ackground: Immunological profile of LADA is not so clear, so detection of
cytokines is relevant to determine the extent and direction of immune responses.
Objective: the aim of the study is to identify role of pro-& anti-inflammatory
cytokines in diabetes progression and their relation with diabetes complications.
Methodology: level of the pro-inflammatory cytokines IL-6 and IFN-γ and the anti
inflammatory cytokine IL-1 receptor antagonist (IL-1RA) were estimated in 90 subjects (34
known LADA cases, 36 D.M.2 cases & 20 healthy control participants), participating patients
were recruited from Diabetes outpatient clinic in AL-Hussein Teaching Hospital in Karbala
from June, 2013 through January, 2014. A clinical questioner containing personal data,
family history, type of diabetes, hemoglobin A1C( HA1C), body mass index (BMI), diabetes
duration& complications of diabetes was obtained from all patients. Statistical analysis done
by using the statistical package for social sciences (SPSS) software for windows, data of all
participants were entered and analyzed with appropriate statistical tests.
Results: levels of IL-6 & IL-1RA were significantly higher in D.M.2 and LADA cases than
controls & both are associated with complications in D.M.2 patients, in addition to positive
significant correlation between them. Regarding IFN-γ, it was significantly higher in LADA
group than D.M.2 group.
Discussion: Levels of IL-6 & IL-1RA are increased in complicated cases for both
LADA & D.M.2 groups & IFN-γ is more in LADA group.
Conclusion: up regulation of both pro- and anti-inflammatory mediators to
ameliorate inflammation in pathogenesis of diabetes.
Recommendation: Further studies on IL-1RA in diabetes are recommended to see
the useful effects of IL-1RA in preserving β-cell function and its therapeutic role in
both autoimmune & type 2 D.M

b
ackground: Although vaginal colonization by bacterial species of the
enterobcacteriacae family, the significance of their antibiograms and potential role in
transmitting of drug resistance is neglected.
Aim of the study: to determine the frequency of occurrence of Enterobacteriacae species and
study their antimicrobial susceptibility pattern in cervico-vaginal epithelium of women from
kerbala.
Methods: women with vaginal discharges attending Kerbala Teaching Hospital for
Gynocology and Obstetric for the period from January to March 2014 were enrolled in this
study. High vaginal swabs were processed for the isolation and identification of
Enterobacteriacae using standard microbiological techniques. Antimicrobials susceptibility
testing was conducted for all of the isolated bacterial species.
Results and discussion: swabs from 100 women were cultured. A total of 101
Enterobacteriacae isolates were recovered; 65 E coli, 23 P.mirabilis and 13 K.pneumoniae
isolates. All K.pneumoniae isolates were resistant to ampicillin, amoxicillin-clavulanic acid
and cefotaxime, whereas high resistance rates were detected to those antibiotics among E.
coli (96.9%, 92.3% and 87.7%, respectively) and P. mirabilis (100%, 78.3% and 52.2,
respectively). However, all isolates were susceptible to carbapenems (imipenem and
meropenem) and low resistance rates detected to quinolones, aminoglycosides, lincosmaide
and chloramphenicole. Resistance rates to aztreonam (ATM) were variable, high rates
detected among E coli (69.2%) and K pneumoniae (61.5%) isolates, however, very low rates
seen among P. mirabilis isolates (4.3%). Furthermore, high resistance rates were reported to
tetracyclines and nitrofurantoin among E. coli (61.5% and 41.5% respectively), K.
pneumoniae (69.2% and 100% respectively) and P. mirabilis (78.3% and 60.9%
respectively). In addition, statistically significant differences were detected in the antibiotics
susceptibility testing among the types of isolates to cefotaxime (p= 0.001), aztreonam (p= 0.000),
cholramphenicole (p= 0.000), ciprofloxacin (p= 0.046), nitrofurantoin (p= 0.002) and amikacin (p=
0.007).
Conclusions: Enterobacteriacae colonizing the cervico-vaginal epithelium are resistant to
several important anitbiotics (multiple drug resistant) and thus may pose significant threat in
transmission of drug resistant bacteria

b
ackground: Pap smear is the most important screening test for premalignant and
malignant non invasive carcinoma of uterine cervix. Most authorities agree that
patients with singinifiatly abnormal pap smear, such as cervical intraepithelial
neoplasia (CIN) needs colposcopic evaluation and biopsy, this is especially in high grade
cytological abnormalities (CIN II & III) ( moderate and severe dysplasia.
Objective: To assess the accuracy of pap smear in detection of premalignant changes of
cervical epithelium and correlate the finding of this cytological method with the finding of
the biopsy material.
Materials and methods: Aprospective study which includes 100 non-pregnant females aged
16-69 years who had symptoms. The interpretation of cytological results was descriptive
done in the Bethesda System terminology 2001 (Solomon and Nayar, 2004), which includes
the following entities: NILM , ASC-US, ASC-H, HSIL & LSIL. Also all cases submitted for
biopsy and subsequent histopathological examination.
Results & Discussion: Results of pap smear cytopathological examination:
According to Bethesda, the results of NILM, ASCUS, ASC-H, LSIL, HSIL, and SCC were
53% ,4 % , 5% , 24% , 7% , and 2% respectively.
Results of histopathological examination:
Results revealed that benign changes were found in 63 of 100 (63%) which show chronic
cervicitis and endocervical polyp , CIN 1 in 20%, CIN 2 in 9%, CIN 3 in 5%, CIS in 1%, and
SCC in 2%.
In our study, 10.26% of NILM cytology cases were false negative, which puts us in an
intermediate position as compared to many other studies
Introduction
Conclusion: Pap smear test was found to be equally sensitive to histopathological
examination for the early detection of different cervical lesions

b
ackground: Dyspepsia is a common problem in the outpatient clinic. The clinical
presentation is variable, and often chronic.
Aims: is to find the proportions of organic and functional dyspepsia, the causes of
organic dyspepsia, and the most common presentation of each type of dyspepsia.
Methodology: From January 2013 to July 2014, the types, causes, and common presentations
of chronic dyspepsia were studied clinically and endoscopically in 116 patients (Male=68,
Female=48) at the outpatient clinic in Al-Hindeya general hospital.
Results: During the 16 months study period, 62 patients had organic dyspepsia and 54
patients had functional dyspepsia. Men reported organic dyspepsia (67.4%) more often than
women (32.6%), while functional dyspepsia was more common in females (52%). Out of 62
patients with organic dyspepsia, 38 had peptic ulcer disease, 12 had reflux esophagitis, 2 had
hiatus hernia, and 10 had gallstones. There was a statistically significant relation between
heartburn, epigastric pain and organic dyspepsia, while the relation between altered bowel
motion, abdominal distention and functional dyspepsia was highly significant.
Conclusions: Peptic ulcer disease, reflux esophagitis, gallstones, and hiatus hernia are the
most common causes of organic dyspepsia. Heartburn and epigastric pain are significant
predictors to organic dyspepsia, while abdominal distention and altered bowel motion are
highly significant predictors of functional dyspepsia.

b
ackground: The effect of smoking of cigarette on human health is serious and
sometimes deadly.
Aim of the study was to study the effect of smoking on some hematological
parameters in young adult male smokers.
Materials and methods: fifty males participated in this study, smokers (n=30) and
nonsmokers (n=20). Complete Blood Cell Count was measured by Humacount 30 (fully
automatic hematological analyzer).
Results and discussion: the results showed that the smokers had significantly higher levels
of WBCs, RBCs, Hb, PCV and platelets count ,whereas no significant difference was
observed in MCV,MCH,MCHC between the two group. This result is due to the
inflammatory and irritant effects of cigarette smoking on the body organs.
In conclusion :the continuous cigarette smoking has sever adverse effects on hematological
parameters and these effects may lead to increased risk of developing physiologic
polycythemia, atherosclerosis and as a results cardiovascular disease

b
ackground: Eschrechia coli (E. coli) is the most common colonizing bacteria of the genital
tract however, its status as a cause of genital tract infections is questionable.
Aims of the study: To study the virulence and phylogenic groups of E coli strains isolated
from high vagina and endo-cervix.
Materials and Methods: A total of 100 female patients were enrolled in this study. All patients were
attendants of the Gynecology and Obstetrics Teaching Hospital in Kerbala , holy kerbala. Iraq in the
period from December 2013 to January 2015. E. coli isolates were identified by standard methods.
Molecular diagnosis and characterization for virulence and phylogenic genes were detected by
Multiplex PCR.
Results and Discussion: Among 65 isolates recovered in this study, the most frequent phylogenic
group of E. coli was "B2" which comprised 61.5% (no= 40) followed by "Phylogenic group A" that
comprised 33.8% (no= 22). Previous studies have shown that phylogenetic groups B2 and D are
virulent because these groups are associated with the presence of several virulence factors.
Interestingly, 9 out of 10 isolates from women who their husband using condoms were shown to be of
B2 phylogenic group. Frequencies of virulence genes of adhesion Pap, Sfa and Afa, among E.coli
isolates were 14, 42 and 5, respectively. In addition, Pap C and Sfa were found in higher rates in
phylogenetic group B2 isolates, and this gives more support to the hypothesis that B2 is the
pathogenic group.
Conclusions: Most of the E. coli isolates were belong to the virulent phylogenic group “B2” and that
those isolates harbor several virulence factors. Accordingly, E coli may be considered as a true
genital tract pathogen and its colonization entails great risk for vertical transmission to the fetus and
fetal membrane..

background: Asymptomatic urinary tract infection (UTI) during pregnancy may progress to pyelonephritis. Urinary tract infection increase risk of preterm labor and premature rupture of the membranes, and low-birth-weight infants.
Aim: To estimate prevalence of asymptomatic urinary tract infection during pregnancy
Method: A cross-sectional study was conducted in a total of 200 women (hundred pregnant women and hundred non-pregnant mothers) with no signs and symptoms of urinary tract infection, from 1st of January to 28th May of 2013. Mid-stream urine samples were collected from all participants and examined directly under high power field, Pus cells > 5 / HPF indicate the presence of infection.
Result: forty eight of the pregnant (48%) and twenty (20%) of the non-pregnant had UTI which was statistically very significant (p value ˂ 0.005). Also, there was a significant statistical relation between the UTI and the educational level (p value ˂ 0.05), but there was negative relation with the age (p value > 0.05).
Conclusion: there is a high prevalence of asymptomatic urinary tract infections in pregnant and non-pregnant women irrespective of their age or educational level of them