Karbala Journal of Medicine

b
ackground: Ergogenic denote rising in the capacity of the body for eliminating
exhaustion and enhancing physical performance, with broad variety of drugs are
apparent to be ergogenic in their effects. Yohimbine is an alkaloid recognized as an
antagonist to the noradrenergic α2-receptors which normalize noradrenaline release in the
central nervous system and their activation decreases the discharge of noradrenaline in the
synaptic terminal.
Objectives: This study was designed to evaluate the ergogenic effects of yohimbine in
normal healthy volunteers.
Patients and Methods: The present study was conducted in Department of Pharmacology,
College of Medicine, Al-Mustansiriya University, Baghdad-Iraq, in collaboration with
Department of Pharmacology, College of Medicine, University of Kerbala, Kerbala-Iraq,
during April of 2013. The subjects of this study were medical students. 20 male volunteers
were conformist to join up this single blind random experimental study. The exercise
program consists of cycling on an ergometer. Pulse was measured using ear pulse sensor and
maximum pulse rate achieved in this study and the entire exercise parameters were recorded
as baseline data, then each subject take yohimbine tablets 5 mg (orally) and after 2 hours,
each subject run on cycling ergometer to fatigue state, then, the display functions of bicycle
were scanned. Besides, maximal oxygen uptake (VO2 max) was measured to estimate oxygen
consumptions.
Results & discussion: Yohimbine significantly improved all ergogenic parameters (efforts,
calories, distance, speed and exercise time) from baseline after single oral dose of 5mg,
where p values were ˂ 0.05. Moreover; yohimbine significantly accelerate the oxygen
consumption in both oxygen consumptions and velocity at maximal oxygen uptake
regarding maximum heart rate and resting heart rate with p values ˂ 0.05.
Conclusions: Yohimbine accelerates and improves cycling performances via positive
ergogenic effects .So, yohimbine can be used as ergogenic agent for ameliorating the physical
fatigue.

b
ackground: The presence of calcification in the epicardial coronary arteries indicates
that the patient has coronary atherosclerosis, CT scan is a reliable noninvasive
investigation to detect the degree of coronary calcification.
Aim: to study correlation between the degree of coronary calcification and severity of
coronary artery stenosis by CT-angiography
Patient and method: one hundred and seventy-five patient ,119(68%) are male and56 (32%)
are females. mean age is 55.52for males &55.30 for females, who was referred to the Iraqi
Medical center in Karbala for CCTA between october2009- Nov.2013. They have either
clinical diagnosis of CAD or chest pain suggestive of CAD. They were studied using CT-64
slices, initially by smart score to assess their calcium level using Agatston score, then contrast
given to complete the examination, all coronary arteries were studied for any stenosis. The
result was analyzed using SPSS 19.
Results & Discussion: There is statistically significant positive correlation (P value less than
0.005) between the degree of CAC score and the degree of vascular obstruction, also with the
number of diseased vessel. It also revealed that 12.9%. of symptomatic patients with
negative calcium score may have obstructive lesion although of fewer vessel & of mild
obstructive lesion
Conclusion: in symptomatic patient CAC score reflect the severity of CAD especially if it is
of high degree but in the absence of calcification it does not exclude presence of diseased
vessel.

b
Introduction
ackground: Infertility subject couples to great distress. In Iraq, women are often
blamed while men assumed innocence. The blunt of infertility is often ignorantly
borne by women, Male infertility continues to be a clinical challenge of increasing
significance. While male factors such as decreased semen quality are responsible for 25% of
all infertility issues, the etiology of suboptimal semen quality is poorly understood. Many
physiological, environmental, and genetic factors have been implicated.
Aims: To assess the semen characteristics subfertile couples in the karbala
Study Design: A cross-sectional study
Place and Duration of Study: This study was carried out at Karbala Maternity Hospital,
Karbala-Iraq. Because the subfertility unit is currently found there
Methodology:. We retrospectively study the couple medical record files who suffer from
subfertility during the period (1st of January 2012-to31 of december 2012). Seminal fluid test
(manual) data found in files were reviewed using the WHO criteria (parameters) for SFA
paying attention to semen volume, concentration, motility, morphology and culture results.
Results & Discussion: From 426 couples file that been studied three hundred twelve (312)
contain that test in their files involved in our study and their seminal fluids analyzed. While
we exclude 114 (26.8%) of files haven't contain the test. from our sample (312) Seminal
Fluid Analysis was normal in133 files about 42.6% of subfertile couples. Abnormality ranges
from mild oligospermia to severe oligoasthenospermia and finally to azoospermia (No Active
sperms) at all. Single Parameter abnormality constitutes about 35.8% mainly asthenospermia
16% and pyospermia 7.7% while more than one abnormality constitutes about 21.3%.
The number 114 (26.8%) that have no SFA reflects the low awareness that infertility is a
problem of the couple and not of a woman only., Pyospermia was founded in about 16.8% of
patients suggesting that genital tract infection is a respective cause. Unfortunately, no semen
culture was done and most of patients treated empirically.
Conclusion and Recommendations: There is a need to evaluate male partner in any
infertility case. Genital Tract Infection was a major cause and patients with pyospermia
should be sent for Semen Culture and also should not be empirically treated

b
ackground: many patients complaining of palpitations seem to have normal
electrocardiography (ECG).
Aim: to study the 24-hours electrocardiography of patients with panic attacks.
Material and Methods: fifty patients with panic attacks were studied by Holter monitoring
for 24 hours each.
Results: Holter monitoring showed ectopic beats in all 50 patients. No other arrhythmia was
recorded.
Smoking was significantly associated with having more ectopic beats per day.
Discussion: panic attacks are not well understood. Some link it to autonomic instability.
Some studies had found that some people diagnosed with panic disorder are having
paroxysmal supraventricular tachycardia (PSVT). No one of the 50 patients we studied had
PSVT. On the other hand, all of the 50 patients had several ectopic beats per day.
Conclusion: it seems that ectopic beats are very common among patients with panic attacks

b
ackground: Chronic kidney disease (CKD) is a progressive loss in renal function
over a period of months or years.Immune status of patients with CKD represents a
fruitful area of research world-wide. Many hypotheses were mounted in this regards
and most of them based on levels of certain immunological markers.
Aim: To evaluate the serum levels of some immunologic markers in patients with CKD and
to predict their correlation with the disease severity.
Study design and objective: This is a cross sectional survey study. It was performed during
December, 2013 through April, 2014at Al-Hussein Medical City, Holly Kerbala.
Method: A total of 60 doctor-diagnosed patients with chronic kidney diseases for different causes
and in variable stages of the disease. Their gender distribution and age range were (39 women; 30-62
years and 21 men; 33-70 years). Other 20 healthy persons were chosen as control group. An
informed consent was taken from all the participants submitted to the study. Age, gender and
presence of diabetes or hypertension were recorded. Then, 3-ml venous blood sample was
taken from each participant and sera were isolated via centrifuge. The serum levels of the
following markers were determined using ELISA; haptoglobin, alpha1 anti-trypsin,
immunoglobulin-A (IgA), IgG, IgM, alpha-2-macroglobulin (A2M) and the complement
proteins C3 and C4.
Results: Serum levels of all studied immunologic markers were significantly lower in
patients with CKD than those in the control subjects, p value < 0.05. An exclusion is the non
significant rise in serum level of haptoglobin and alpha-2-macroglobulinnoticed in CKD
stages other than ESRD.In addition, serum levels ofhaptoglobin, A2M, IgA and IgM are
significantly lower in ESRD than other stages of CKD (p value < 0.05), while levels of C3
and C4 are significantly lower in moderate CKD than other stages of renal impairment
included in this study (p value < 0.05).
Discussion: It is well known that the CKD patients suffer significant immune
compromization. Our data revealed down regulation of certain immunological parameters in
their sera such as alpha1 anti-trypsin, immunoglobulin-A (IgA), IgG, IgM, and the
complement proteins C3 and C4.This could explain the susceptibility to infection and
abnormally delayed wound healing accompanying CKD.
Conclusion: It was concluded that serum levels of all studied immunologic markers,
excepthaptoglobin and alpha-2-macroglobulin,were significantly lower in patients with CKD
than those in the healthysubjects. Furthermore, this is not associated with the presence or
absence of diabetes and/or hypertension. This finding could, in part, prove that the immune
deficiency status in these patients is purely due to their impaired renal functions

b
ackground: Liver is a vital organ regulating important metabolic functions. A
number of chemical agents and drugs which are used on a routine basis cause cellular
as well asmetabolic liver damage.
Objectives: This study was undertaken to assess the hepatoprotective effect of allopurinoll
in paracetamol induced hepatotoxicity in male rats.
Material and method: A total of 18 adult male albino rats were randamized into 3 group
Group1 was used as a control group ,group2: animals received an intraperitoneal injection of
300mg/kg paracetamol,group3 received 100mg/kg allopurinol orally( by oral gavage) 18 hrs
before paracetamol administration.
all the animals were sacrificed after 12 hr from paracetamol dose. Blood samples were
collected by cardiac puncture. Serum was separated and analyzed for various biochemical
parameters ( liver enzymes)liver was removed and kept in 10%formalin for histopathological
study.
Results: Treatment of male rats with paracetamol led to significant (p<0.05) increase the
activities of serum enzymes level GPT,GOT, ALP levels compared with the normal rats, In
contrast prophylactic used ofallopurinol at100mg/kg orally treated rat prevented the liver
damage as judged by the significant (p<0.05)
decreased these enzymes levels,
histopathologically allopurinol showed protective effect against paracetamol induce liver
damge.
Conclusion: allopurinol could be beneficial for alleviating paracetamol toxicity. Further
studies and parameter to measure oxidative strees are required, to explain these protective
effects

b
ackground: Hypothyroidism is a syndrome resulting from deficiency of thyroid
hormones leading to generalized slowing of all metabolic processes. Many diseases
like hypertension, ischaemic heart disease, adverse lipid profile, and Metabolic
abnormalities developed in hypothyroid patients. Trace elements play essential roles in the
human body as cofactors of some enzymes and take part in the synthesis of many hormones
where normal thyroid status is dependent on the presence of many trace elements for both the
synthesis and metabolism of thyroid hormones.
Aim: The present study was designed to evaluate fasting serum Fe, Cu, and Zn
concentrations, fasting serum glucose concentration and thyroid function tests in hypothyroid
patients having good and poor response to LT therapy and to study correlations between these
parameters.
Materials and methods: The present study was a single center, cross sectional study
conducted in alshefa General hospital, basra, Iraq. During the period from June,2013 to Mar,
2014. 62 subjects aged 20 to 55 years were included. The patient groups consisted of 41
hypothyroid patients (38 females and 3 males) on LT therapy for at least 6 months duration.
21 Healthy age and gender matched group with thyroid function within normal limit were
selected as control group. Patients were screened for FT3, FT4 and TSH, those with high
TSH level above normal limit despite high dose of thyroxine considered as poor response to
treatment (PRLT) while those patient with TSH level within normal range considered as good
response to treatment (GRLT). After 12 hrs fasting, blood samples (5 ml) were obtained to
evaluate serum TSH, T3, T4, glucose and trace elements in all studies groups.
Results and discussion: In (GRLT)group 21 patients had thyroid function tests (TSH, FT4
and FT3) within normal range and there were no significant differences when compared with
control while in (PRLT) group, FT4 and FT3 significantly decreased when compared with
control and GRLT groups while serum TSH levels in all 20 hypothyroid patients were
significantly high. Serum Zn, Cu and Fe level of PRLT patients are significantly lower than
its level in control and (GRLP) groups, In (GRLP) there were no significant differences when
we compared trace element concentrations with control. Regarding FSG no significant
differences were reported in all studied groups. There are significant correlation between
thyroid function tests and trace element concentrations. Trace elements influence thyroid
hormones at levels of action, including hormone secretion and activity and binding to target
tissue. On the other hand, thyroid hormones itself influence trace metals metabolism at
several levels of action, including excretion and transport of trace metals. All these factors
collectively lead to significant reduction in trace elements concentrations in hypothyroid
patients compared to normal control .
*For Correspondence: E-Mail ausamaphdjaccob@yahoo.com
Karbala J. Med. Vol.7, No.2, Dec, 2014
1891
Assessment of serum essential elements, serum glucose and ….
Yaqoob Ayoob Yaqoob
Furthermore many reports demonstrate that effect of overt hypothyroidism on glucose
metabolism is still a subject of debate
this came in agreement with our study.
Conclusions: There are significant decrease in serum Zn, Cu and iron in hypothyroid
patients have poor response to LT therapy compared to normal subject. There is no
significant change in serum glucose concentrations in all tested groups. Our finding
revealed significant correlation between thyroid function tests and serum trace elements.

bGenitourinary tuberculosis is almost always secondary to symptomatic or asymptomatic
primary lesion in the lung. After lymphadenopathy, the most common form of nonpulmonary
tuberculosis is genitourinary disease. Most patients are between 20 to 40 years of age with a
male to female ratio of 2:1. 4. However, a negative test does not exclude clinical disease. This
is a cross sectional double centered study of patients with recurrent urinary tract infections
attends the private and public outpatient's clinics in Basra teaching hospital and Imam Husain
medical city-AlZahra teaching hospital in Kerbala holy. Patients who full fill two out of the
following three diagnostic criteria were considered to have urinary tuberculosis..These
criteria
were: demonstration of mycobacterium tuberculosis in urine by microbiological
,histopathological methods ,and intravenous urography.We exclude patients who prove to
have genital tuberculosis ,and those who had only positive findings in intravenous urography.
Statistical analyses were performed using IBM-SPSS version 20. Among our 1500 patients
enrolled in this study,35(2%) full fill the diagnostic criteria of urinary tuberculosis. The
mean age was 50.7 ± 14.9 SD.The urine for acid fast bacili was positive in 1patient(4%) and
urine culture for mycobacterium was positive in only 2patients(16%).The tuberculin skin test
was positive in 26 patients(74%).The intravenous urography showed abnormalities in
29patients(84%).40% of patients had a positive findings in histopathology of kidney tissue.
At a cut off value of 0.6 the sensitivity was 82% and specificity was 50% for the tuberculin
skin test in the diagnosis of urinary tuberculosis. The low prevalence rate 2% of urinary
tuberculosis in our study is because our diagnosis was hypothesized in the setting of non
specific bacterial cystitis associated with a therapeutic failure or a urinalysis with a persistent
leukocyturia and absence of bacteriuria.The clinical characteristics of urinary tuberculosis in
older adults can be unusual and may be confused with age-related illnesses. Generally in Iraq
like many other Middle East countries, Women spent more time at home and are more likely
to be infected within the home than outside it, with a corresponding higher infectious dose.
Our patients were less likely to offered histological diagnoses, a situation that points to late
diagnosis. In such instance,urinary tuberculosis is consequently more severe, with a higher
frequency of renal failure. When kidney and bladder tuberculosis are concerned ,the kidneys
are mute and the bladder plays the role of vocal cords. In the context of immunosuppression,
urinary tuberculosis behaves as a severe bacterial infection, with bacteremia and visceral
metastatic foci. Sterile pyuria was found in 80 % in this study. This could be explained by
more liberal use of antibiotics that has anti-mycobacterial effects in our country which render
the urine sterile even in the presence of secondary bacterial infection. A high index of
suspicion should be made in cases of sterile pyuria who resist antibiotic therapy that have no
antituberculous effects. We recommend further studies to detect the prevalence of urinary
tuberculosis among immunocompramised patients including those on chronic dialysis
program.

b
ackground: Psoriasis is a common chronic inflammatory skin disease with an
unknown etiology. Psoriasis has been characterized by hyperproliferation
accompanied by acanthosis andaberrant differentiation of keratinocytes. Several
factors and cytokines, are assumed to be important. Recent studies indicate that various
cytokines including tumor necrosis factor – α ,Interleukine-2R and Interleukine- 6 play an
essential role in the induction and maintenance of psoriatic lesion.
Objectives: To evaluate oxidative stress markers (Malondialdehyde (MDA),Super oxide
dismutase( SOD) & Glutathion (GSH)) and proinflammatory mediators Interleukine-18 (IL
18) in the sera of patients with active psoriasis (Psoriasis vulgaris ) of mild-to-moderate and
severe psoriasis compared to healthy controls,and to study correlation of the above markers
with severity of psoriasis.
Subjects & Methods: one hundred and teen (110) psoriasis patients were recruited from the
dermatology Outpatient clinicin Murjan Hospital in (Babylon city)during the period from
November 2011 to March 2013.Fasting serum samples were obtained on enrolment. All the
patientsdid not receive any treatment (locally or systemically), for at least 20 days before
enrolment. Age& sex matched with fifty five(55) healthy controls were also recruited. Serum
IL-18 level were estimated using an Enzyme-Linked Immunosorbant Assay ( ELISA )
technique. The patients group were subdivided to three groups according to the disease
severity, into mild psoriasis group , moderate psoriasis group and severe psoriasis group.
Serum MDA levels were assessed using thiobarbituric acid (TBA) method of Buege and Aust
SOD and GSH was measured by Burtis and Ashwood, SOD levels using modified
photochemical Nitroblue Tetrazolium (NBT) method utilizing sodium cyanide as peroxidase
inhibitor.
Results & Discussion: Serum IL-18 shows statistically significant elevation in patients group
compared to healthy controls( p< 0.05 ). Levels of MDA were significantly increased (p<0.001)
where as the GSH and SOD were significantly decreased (p<0.001) in patients with psoriasis
compared to healthy control.Also they were all statistically significant increased in serum levels of IL
18 and MDA while a significant decreased in serum levels of SOD and GSH in patients with severe
psoriasis compared to these with mild-to moderate psoriasis ( p <0.05 ).
Conclusions: These data support the view that serum IL-18 , MDA, SOD and GSH
areinvolved in the pathogenesis of psoriasis, possibly by induction and maintenance of
psoriatic lesion. Its recommend a use of cytokine (IL-18) as a useful follow-up marker for
monitoring of psoriatic patients and optimizing therapeutic strategies

background: Red face syndrome (RFS) is a chronic burning erythema of the face that
occurs after prolonged application of topical corticosteroid (CS) and characterized by
flare-ups after trial of corticosteroid withdrawal.
Objective: This study was aimed at providing information on a series of 102 cases of RFS
in Al-Diwaniya city, Iraq
Methods : In this descriptive case series study, 102 patients were identified as having red
face syndrome by a dermatologist in Al-Diwanyia Teaching Hospital, Al-Diwaniya , Iraq ,
from September 2013 to March 2014
Results : 102 patients were studied ,their ages ranged from (18-45) . There were 97 females
and 5 males .Melasma , skin whitening were the main reasons for topical CS use. The
presenting complaints were erythema (96.07% ),dryness(69.6 % ), itching (60.7 % ), burning
sensation (61.7% ).
Discussion :Red face syndrome is a form of \"corticosteroid addiction\" mediated by nitric
oxide overproduction in response to long term topical corticosteroid use.The mean age of the
patients rangeing 18-45 years old. This was probably because people, at this age, start to take
care of their appearance. The main reason of using topical corticosteroids was melasma as the
topical corticosteroids act as skin lightener owing to their potent bleaching effect. Also this
explains the predominance of females in this study which may satisfy their desire. In fact, its
recovery usually takes a much longer period of time reaching up to 18 months after stoppage
of steroids
Conclusion : RFS is a disease of steroid misuse by patients especially for melasma and skin
whitening and it is seen increasingly. Public health information is important about this
disease and other side effects of topical CS

b
ackground: Epidural fibrosis and adhesion seen as common post lumbar syndrome
phenomena which contribute to 50%-60% recurrent of the symptoms.
Aim of study: We studied the effectiveness of percutaneous epiduroscopic
adhesiolysis in management of fibrosis & adhesion resultant from failed backed lumbar spine
surgery compared to second time surgical decompression with surgical excision of the
fibrosis of lumbar spinal stenosis.
Patients & Methods: In a prospective comparative study of 44 patients all of them with
failed backed post laminectomy syndrome were diagnosed in Sulaimania city private clinic
and private hospital, from June 2010 till May 2012 according to magnetic resonance imaging
techniques, also according to inclusion exclusion criteria in diagnosis of adhesion with
fibrosis, were randomized into two groups. Group A treated by lumbar spine surgery with
second time surgical exploration, decompression and excision of fibrosis compared to the
second group B were treated by percutaneous epiduroscopic adhesiolysis through sacral canal
under fluoroscopic guide. The caudal epidurogram showed restriction in spread of contrast
caused by fibrosis & adhesion then the canal open by irrigation through pressurized saline
range from 40 to 80 ml according to the number of the level which were obstructed by
fibrosis. Saline used intermittently until the spinal canal open
were seen by fluoroscope
until complete procedure with adequate adhesiolysis with visualization of the canal opening.
At the end of the procedure solutions were used to decrease rate of adhesion. Depomedrol 80
mg 2ml , Hyaluronate 6ml, 1% 5ml lignocaine injected into canal space.
Results & Discussion: In both group A by surgical procedure & B percutaneous
epiduroscopic adhesiolysis were noticed significant improvement in the mean of Stanford
score and ODI (Oswestry low back disability score) from baseline were at all follow up visit
for 24 Months according to sciatica pain (short term less than 6 Months, long term more than
6 Months), Functional outcome, Return back to work, psychological status, Change in
narcotic intake, with the general satisfaction rate.
Also there were significant statistical
differences at 12, 24 Months follow up for both Stanford and ODI Oswestry index between
group A and group B revealed high outcome results for group B was treated by epiduroscopic
adhesiolysis technique (P- value <0.0001) with minimal complications rate in group B
compared to group A.
Conclusion: We concluded that percutaneous epiduroscopic adhesiolysis for 2 years follow
up specific for the patients of fibrosis with adhesion post laminectomy are superior to the
surgical exploration with excision of fibrosis & second time decompression in treatment of
failed back lumbar spinal surgery.

b
ackground: Recent epidemiological studies have demonstrated that nearly half of all
patients with heart failure (HF) have preserved left ventricular ejection fraction
(HFPEF). Thereby it is mandatory to include other hemodynamic indices in the
traditional evaluation of the systolic function of the heart beside the EF.
Aim of the study was to assess the occurrence of subclinical systolic dysfunction in
hypertensive patients with diastolic dysfunction referred for echocardiograph assessment of
left ventricular function in a hospital.
Methods: 30 patients were recruited from the Echocardiography lab. The analysis of diastolic
dysfunction was based on the E/A ratio using PW- Doppler echocardiogram. measurement of
EF and SV by measuring end systolic and end diastolic dimensions of left ventricle by M
Mode guided 2D echocardiogram. Measurement of HR from ECG. calculation of SI. CO
and CI were done.
Results & Discussion: The percentages of parameters which were found below normal levels
are as follow: SV: 33.3% (10 out of 30 patients). SI : 40%(12 out of 30 patients). CO: 20%(6
out of 30 patients) and CI:53.3%(16 out of 30 patients).
Conclusion : EF is not enough in evaluation subclinical systolic impairment in HT patient ,
CI should be used in concomitant with EF in traditional evaluation of any patient with
suspicion of HF

b

b
ackground: Hepatitis C infection is the most common cause of post transfusion
hepatitis and end stage liver disease in many countries. B-Thalassemia major is one of
the most prevalent hereditary blood disease word wide. Polymerase chain reaction is
a highly sensitive technique for the detection hepatitis C virus-RNA in serum
Aim of study: To determine the percentage of hepatitis C infection (positive polymerase
chain reaction) and possible risk factors in children with B-Thalassemia major in Babylon
Center of Hereditary blood disorders.
Patient and Methods: A prospective study was done on two hundred twenty six child with
B-Thalassemia major (aged from 2 years to 18 years) that have been transfused with blood ,
as part of their management , at least 10 units of blood irrespective of their age , sex were
included in this study from a period 1 of march 2013 to 1 of July 2013 in Babylon center of
hereditary blood disorder in Babylon Gynecology and Children Teaching Hospital .Serum
was stored at -20 then tested for hepatitis C (HCV antibodies) by ELISA, HCV antibodies
positive cases were confirmed by polymerase chain reaction test.
Results & Discussion: Total number of patient was 226, male 129(57%), female 97(43%)
with minimal age 2 years and maximal 18 years with mean age 8.4 with st. deviation 4.3
year. HCV Ab was positive in 17 (7.5%), only 12 (70%) were +ve PCR for hepatitis C and 5
(30%) were –ve PCR . There are significant statistical relation regarding the increase number
of blood transfusion units (more than 150 units) P value 0.045, Huge splenomegaly (more
than 8 cm) P value 0.002 , Abnormal liver enzyme with P value 0.032 , and male gender (P
value 0.029) with +ve PCR HCV patient. There are no significant statistical relation
regarding huge hepatomegaly (p value 0.107) and type of chelating agent (p value 0.107)
with +ve PCR HCV patient.
Conclusion: Children with B- Thalassemia major are more prone to get Hepatitis C infection
especially if get blood transfusion more than 150 units, huge splenomegaly, abnormal liver
enzymes and male gender

b
ackground: Thrombocytopenia is low platelets count which is either due to
defective platelet production (hypo-productive thrombocytopenia) or due to
increased
platelet
breakdown
(hyper-destructive
thrombocytopenia).
Measurement of platelet counts alone do not explain the underlying patho-mechanism
of thrombocytopenia.. Recent advances in automated blood cell analyzers facilitate
the measurement of several blood cell parameters automatically such as, platelet
indices including mean platelet volume (MPV), platelet distribution width (PDW),
and plateletcrit (PCT) and these parameters could provide some important clinical
information.
Aim of the study: to investigate whether platelet indices( MPV,PDW,PCT) could
serve as diagnostic tools in the differential diagnosis of thrombocytopenia and, if
there is any correlation between platelet count and platelets indices .
Subjects and Methods: A total of 77 Iraqi patients (28 males and 49 females) with
thrombocytopenia were subjected to the following tests:
1. Complete blood count using Mindway haematologic autoanalyser.
2. Peripheral blood film .
3. Bone marrow aspirate with bone marrow trephine biopsy when indicated.
A group of 50 healthy person (age & sex matched) were included as a control
Results:
hyper-destructive
thrombocytopenia
(immune thrombocytopenia)
representing 12.9% of total patients, while hypo-productive thrombocytopenia due to
various causes representing 87.1% of total patients. The MPV, PDW are significantly
higher in immune thrombocytopenia group as compared with thrombocytopenia of
hypo-productive patho-mechanism and there were no correlations between platelets
count and both MPV and PDW in hyper-destructive and hypo-productive
thrombocytopenia but there was a direct correlation between platelet count and PCT .
Conclusion: Platelet indices provide plenty of clinical information about the causes
and patho-mechanism of thrombocytopenia and could be helpful tests to distinguish
hyper-destructive thrombocytopenia from hypo-productive thrombocytopenia easily,
so more interest for the use of these indices in differential diagnosis of
thrombocytopenia is required

background: Congenital UPJ obstruction can present at any time, from
intrauterine life to old age. With the increased use of prenatal ultrasound, a
number of infants are found to have hydronephrosis. PUJ obstruction is one of
the most common causes of prenatal hydronephrosis
Objective: To compare between retrograde and antegrade internal double-J
stent for open Dismembered pyeloplasty in children with Pelvi-Ureteric Junction
Obstruction.
Patients and Methods: Thirty two patients with pelvi-ureteric junction obstruction
were included in the study from December 2011 to December 2013. . Antegrade
double-J stent was done in 13 children and retrograde double-J stent was done in 19
children . Antegrade stent was placed during the pelviureteral anastomosis, and the
retrograde stent was placed just before the operation by pediatric cystoscopy. The
length of hospital stay and postoperative results were assessed.
Results: Thirty two patients with pelvi-ureteric junction obstruction , aged 3 months
to 12 years, with a mean age of 3.4 years were studied. Successful stent placement
without malpositioning was achieved in 11 (84.4%) of 13 patients in antegrade group
and all 19 (100%) of children in retrograde group . The cause of unsuccessful
stenting in antegrade group was the inability to cross the ureterovesical junction .
Conclusion: Retrograde double-J stent more reliable than antegrade stent for open
dismember pyeloplasty in children with Pelvi-Ureteric Junction Obstruction with
greater success and lower complication rates.

b
ackground: Cholecystectomy is one of the most frequently performed
operations. Open cholecystectomy has been the gold standard for over 100
years. Laparoscopic cholecystectomy was introduced in the 1980s.
Laparoscopic cholecystectomy has become the definitive treatment of choice for
symptomatic gall bladder disease. It replaced the old traditional method of open
approaches with lower complication rates.
The laparoscope was introduced into Alhindiya hospital during early 2008 and after
that the numbers of laparoscopic operations started to increase gradually and includes
cholecystectomy, ovarian drilling, ovarian cysts, and appendectomy and diagnostic
operations.
Objective: This study summarizes the experiences associated with 150 laparoscopic
cholecystectomies performed in Alhindiya hospital to assess the safety of these
operations.
Patients and Methods: This is an analysis study were the records of 150 consecutive
patients who underwent laparoscopic cholecystectomy in Alhindiya hospital were
reviewed. 125 patients were females and 25 patients were males (F to M ratio= 5-1).
The age range was between 18 -75 years.Analysis of different data was performed.
Results: The commonest indications for surgery were symptomatic cholelithiasis
(100 cases) and acute/chronic cholecystitis (35 cases). The mean operating time was
36.8 minutes. The mean length of stay in the ward was 17.7 hours. Only 5 cases were
converted to open procedures. The commonest postoperative complication was
wound-infection. Mortality rate was zero.
Conclusion: In summary, this study demonstrates that laparoscopic cholecystectomy
can be performed safely in Alhindiya general hospital with good results and low
complications rate.

b
ackground: March hemoglobinuria, also known as march hematuria, occurs when
blood is seen in the urine after repetitive impacts on the body, particularly affecting
the feet and hands (e.g. Candombe drumming). The word "march" is in reference to
the condition arising in soldiers who have been marching for long periods; the condition was
first documented in 1881. March hemoglobinuria usually is reported in young males, no
doubt because of their more frequent participation in severe and prolonged exertion, but
march hemoglobinuria also can be seen in women.
Aim of study: To assess the presence of hemogobinuria in the visitors of Holy Kerbala
regarding Imam Al-Hussain (peace on him) at the fortieth visiting.
Subjects and Methods: Those subjects underwent to the investigations for the detection of
hemoglobinuria . Blood sample drawn with EDTA tube for laboratory processing with
complete blood count by hematology auto-analyzer (Abbott) and blood film ,urine sample
processed for iron stain to detect hemosiderin (perl`s stain). The results dealt with statistically
by SPSS version 18.
Results: Twenty eight cases present with hemoglobinurea .Mean age is 32 years and the
range is from 18-56 years. The mean distance that the subjects had walked was 193
kilometers with a range 108-524 kilometers apart from Holy Karbala. The mean hemoglobin
is 12.6 g/dl. Thirty eight cases present with anemia (hemoglobin less than 12 g/dl) with
fifteen cases have hemoglobin value less than 10 g/dl. Geographical distribution of subjects
address all over Iraqi governorates, in which most of them( 63 subjects ) from Baghdad.
Conclusion: There is no significant relation between the distance and the pathology

b
ackground: Autopolymerizing acrylic resin has multiple uses in dentistry
such as, record base, orthodontics appliances, denture repair and other. The
degree of polymerization of cold cured acrylic resin is not as complete as that
achieved using heat cured system which leads to a higher degree of un
reacted residual monomer, which act as a plasticizer which results in high transverse
deflection values lowering the transverse strength of the resin.
Aim of the study: This study investigated the effect of the addition of different
concentrations of silver nitrate (AgNO3) on transverse strength and impact strength of
autopolymerzing acrylic resin.
Materials and methods: A total of 80 specimens were prepared, 40 specimens were
fabricated with dimensions of (64×10×2.5) mm to conduct the transverse strength test
while the remaining 40 specimens were fabricated with dimensions of (80×10×4) mm
to perform the impact strength test. 10 specimens of each group were fabricated from
conventional autopolymerized acrylic resin while the remaining 30 specimens were
fabricated from modified autopolymerized acrylic resin. Concentrations of 9.375,15
and 60 ppm of silver nitrate were used to modify the autopolymerized acrylic resin,
10 specimens of each concentration in each group were used.
Results: The results of this study showed that the modified autopolytmerized acrylic
had non-significant difference in transverse strength values for all concentrations of
silver nitrate; while there was a significant difference in impact strength values for (15
and 60 ppm) concentrations of silver nitrate and non-significant difference in impact
strength values for (9.375 ppm) concentration of silver nitrate .
Conclusions: It can be concluded that the addition of (15 and 60 ppm) concentrations
of silver nitrate can improve impact strength of autopolymerizing acrylic resin.

b
ackground: The objective of our study is to measure serum Malondialdehyde level
(MDA), an index of oxidative stress, and Vitamin E level, a protective agent against
oxidative stress, in Jaundice patients and study the possible correlation between them .
Materials and Methods: 80 patients with jaundice ( 38 female and 42 male) and 50 healthy
control (23 female and 27 male) were enrolled in this study. About 10 ml of venous blood were
obtained from the cubital vein using disposable needles and syringes. The thiobarbituric acid
method was used to measure the Malondialdehyde (MDA) which reacted with thiobarbituric
acid(TBA) to give pink color that was read at (535 nm). The concentration of vitamin E in serum
was determined according to a modified Hashim and Schuttringer method.
Results: A significant increase (P<0.0001) in serum Malondialdehyde (MDA) in jaundice
patients as compared to that of normal healthy controls was observed. A significant decrease
(P<0.0001) in serum vitamin E in jaundice patients as compared to that of normal healthy
controls has been noticed. No significant correlation between serum Malondialdehyde (MDA)
and serum Vitamin E in jaundice patients was observed.
Conclusion: our data shows that antioxidant capacity decreases with an increase in oxidative
stress in Jaundice patients but there is no significant correlation between them .
Abbreviations: The abbreviations used are: dL, deciliter; MDA, Malondialdehyde; μl, microliter;
r, Correlation factor ;rpm , Round per minute; TCA, Trichloroaceticacid; TBA, thiobarbituric
acid ; ROS, Reactive oxygen species

b
ackground: HELLP syndrome is a serious medical condition found in pregnant
women. Usually in 3rd trimester [last 3 month], HELLP syndrome comprise
Hemolytic ,i.e. breakdown of red blood cell , Elevated liver enzyme & Low Platelet
count it's said to be an off – shot of pre-eclampsia or eclampsia i.e. hypertension during
pregnancy . Usually it is found before the birth of baby, however sometime it can occur after
the delivery
Objective: This was done to describe general experience with management of HELLP
syndrome by analysis of patient outcome.
Patients And Methods: The patient M.K 30 year's old primigravida, developed generalize
edema, high B.P., pallor, jaundice, haematuria &convulsion. She received anti-convulsion
[MgSO4] & antihypertention (apresoline), also full investigation was done ,the result
revealed P.C.V 28% ,T.S.B 8mg/dl, elevated liver enzyme ,low platelet [80,000]. The
decision was termination of pregnancy after 6 hours stabilization, she also received
antibiotic ,hydrocortisone. platelet, fresh frozen plasma &blood ,and because of unripe
cervix, caesarean section was done under spinal anesthesia ,after operation she was kept in
I.C.U. for few days.
Results & Discussion: The patient developed acute renal failure, but gradual improvement of
her condition was achieved and patient become well after 3 weeks with complete recovery.
Other medication used was MgSO4 for fit control prevention of recurrence.
safety, high dose steroid will accelerate recovery and that conservative treatment of renal
failure is so effective.
Conclusion: The result support conclusion of previous author that rapid & early diagnosis
and treatment of HELLP syndrome is very important to ensure favorable maternal & prenatal
outcome, also in this study we showed that the patient should be stabilized before termination
& regional anesthesia will increase

b
ackground: Literature on obsessive compulsive disorder (OCD) in Iraq is scares. The
Iraqi Mental Health Survey (IMHS) reported a high prevalence. This study was
carried out to throws a light on OCD in Karbala, Iraq.
Methods: The study was conducted in outpatient Dept. of Al-Hussaini General Hospital,
Karbala, Iraq, for the period 1st Jan. to 23rd Dec. 2006. Patients diagnosed as OCD were
interviewed and a questionnaire was filled for each one. The questionnaire was prepared
according to DSM-IV-TR. Demographic data and family history for OCD or any mental
disorder was included in the questionnaire.
Introduction
Results & Discussion: The peak age for OCD was 21-30 years, females were predominating
(63.2%). singles were more affected than married (47.3%). Family history of OCD and any
mental illness was observed in 20.5% and 52.9%, respectively.
Conclusion: OCD affect young age group, females and singles. Family history for any
mental illness was positive in more than half of the cases

bThe aim of study is to assess the association between patients with psoriasis and
hepatitis B and/or C.
Methods: This case control study that enrolled total 110 patients with psoriasis were
included in the study, 63 males and 47 females and their age range from 15 to 70 years old ,
with male to female ratio 1.4 :1 . The study was conducted in Al sader teaching hospital and
Al Hakeem hospital in Al Najaf governorate during the period from January 2013 to February
2014. All recruited patients had their ages, gender and case histories recorded on an already
prepared data sheet. All recruited patients and control groups had been subjected to that
Hepatitis Bs antigen (HBsAg) and anti-hepatitis C antibodies (anti-HCV) were done using
Enzyme-linked Immunosorbent Assay (ELISA) kits.
Results: This study that enrolled total 110 patients were included, 63 males and 47 females
and their age range from 15 to 70 years old , with male to female ratio 1.4 :1 . There were
increased incidence of male patients with psoriasis 63(44.1%), but there were no statistically
significant difference between studied patients and control groups, (p=0.5) . There were
increased incidence of patients with psoriasis younger than 50 years, 70 (53.8%), statistically
significant difference between studied patients and control groups, (p=0.007) .
There were statistically significant difference between studied patients and control groups
regarding smoking , 30 (33.3%), (p=0.003). There were increased incidence of seropositive
for hepatitis C in patients with psoriasis .There were statistically significant difference
between studied patients and control groups regarding hepatitis C 4 (16.7 %), (p=0.003).
There were no statistically significant difference between studied patients and control groups
regarding hepatitis B 1 (33.3%), (p=0.6) .
Conclusions: This study support of an association between psoriasis and hepatitis C but not
with hepatitis B. The predictors for psoriasis as risk factor in this study were male younger
than 50 years with history of smoking with association with hepatitis C infection .
Recommendation: Physicians who care for patients with psoriasis should be aware of this
possible association and consider screening patients with psoriasis for hepatitis C infection