Karbala Journal of Medicine

b
resbyopia, the gradual loss of accommodation that becomes clinically
significant during the fifth decade of life, is a physiologic inevitability.
Different technologies are being tried to achieve surgical correction of this
disability; however, a number of limitations have prevented widespread acceptance of
surgical presbyopia correction, such as optical and visual distortion, induced corneal
ectasia, haze, anisometropy with monovision, regression of effect, decline in
uncorrected distance vision, and the inherent risks with invasive techniques, limiting
the development of an ideal solution. The correction of the presbyopia and the
restoration of accommodation are considered the final frontier of refractive surgery.
The purpose of this paper is to review the current procedures available and the recent
advances in presbyopia correction.

b
ackground: Asthma and related allergic diseases are complex genetic
diseases with major environmental influences that occur in a developmental
context. Susceptibility to asthma is influenced by genes and environment;
implicated genes may indicate pathways for therapeutic intervention.
Aim: The present study aims to test the linkage association of IL-4Ra gene
polymorphisms, E375A and C406R, determined by PCR/RFLP assay, with asthma
development from 100 asthmatic children. In addition to their association with
elevated serum IgE level in asthmatic children and possible interaction with other
contributing factors including high BMI, history of prematurity, neonatal jaundice or
vitamin D deficiency, exposure to bottle feeding and family history of atopy and/or
asthma.
Patients and methods: This is a cross sectional survey study done in Kerbala
Pediatric teaching Hospital during April, 2011 through February, 2013.
Results & Discussion: Data of the current study suggested a significant linkage
association between IL4RA single nucleotide polymorphisms, SNPs, (E375A and
C406R) and development of childhood asthma in the recruited participants, r= 0.82
and 0.67, respectively. Interestingly, the latter effect is synergistically increased upon
gene-environment interaction with any of the studied risk factors tested in this study,
except past history of neonatal jaundice.
The presence of E375A and C406R SNPs of IL4RA gene have potential effect on
development of childhood asthma. Secondly, this effect is synergistically reinforced
via gene-environment interaction of these SNPs with other asthma contributors
including high BMI, history of prematurity, formula feeding, vitamin D deficiency
and positive family history of asthma.
Conclusion: Our study reinforced the theory that asthma is a multifactorial disease
suggesting a noticeable interaction between genetic and environmental factors in the
development of this disease

bckground: Hypertension is a chronic disease that is increasing in prevalence worldwide
and spans race and gender lines. The worldwide prevalence of hypertension was
estimated from 2005 systematic review of published literature to be 26%with a projected
60% increase by the year 2025.Arterial hypertension is (with age, sex, race, proteinuria,
hyperlipidaemia, smoking, etc.) also one of the main causes of the progression of diabetic and
non-diabetic chronic kidney failure. This progressive kidney failure develops especially in
patients with glomerular kidney disease who clinically manifest proteinuria. This process is slow
in general, but sometimes the damage to the kidneys can develop very rapidly, with an
immediate need for dialysis. The effects of glomerulonephritis onrenal prognosis may be also
negatively influenced by several factors present at the time of patient’s diagnosis. Among them,
arterial hypertension is one of the most important factor, the negative influence of arterial
hypertension on glomerulonephritis kidney prognosis may be mediated preferentially by kidney
failure itself, the former being possibly a result of the latter when this one is severe enough, than
by hypertension itself.
Aims: The aims of this study are to analyze arterial hypertension prevalence in chronic non
diabetic glomerulonephritis at the time of performance of kidney biopsy and for the following 36
months after the biopsy. The prognostic value of arterial hypertension as a progression factor to
end stage kidney disease is to be analyzed.
Patients and methods: Sixty one patients have been studied. The inclusion criteria for kidney
biopsy were: nephrotic syndrome, persistent sub-nephrotic proteinuria, and unexplained
abnormal kidney function test when kidney sizes in ultrasound were within normal range, acute
kidney injury, acute nephritic presentation, hematuria after excluding urological causes.
Demographical data have been gathered, such as patients’ particulars, date of kidney biopsy, age
and gender. We considered hypertensive those patients with arterial blood pressure figures
higher than 140/90 mm-Hg, or those treated with antihypertensive drugs, and kidney failure
measured as glomerular filtration rate by means of creatinine clearance less than 60ml/minute.
Kidney function survival, computed as the time elapsed from the date of kidney biopsy to
definitive loss of kidney function, defined as creatinine clearance <60 ml/minute. For the
analysis of the prognosis and kidney survival, Kaplan-Meier curves and the Log-Rank test were
used.

b
ackground: foreign bodies aspiration in children is a common emergency
condition especially in less than 3 years old, comprising an important
proportion of accidental deaths. Usually, there is a suggestive history of
choking. The evolution of foreign body aspiration can lead to variable degrees of
respiratory distress, serious respiratory complications, and even death. Early rigid
bronchoscopy is a very effective procedure for definite diagnosis and removal of
aspirated foreign body with fewer complications.
Aim of study: To discuss causes and types of foreign body aspirationand
effectiveness of bronchoscopy in children.
Patients and Method: In Al-Hussein Medical City Hospital, bronchoscopy had been
performed to 254 patients with the diagnosis of foreign body aspiration (from 2005 to
2012). Of which, 152 (59.85%) were males and 102 (40.15%) were females. Their
ages ranged from 6 months to 10 years. Diagnosis had been established depending on
history, physical examination, radiological studies and bronchoscopy.
Results & Discussion: Foreign bodies (FBs) were removed by rigid bronchoscope.
The sites of FBs were distributed in the following pattern: at the right main bronchus
in 129 (50.79%) patients, at the left main bronchus in 55 (21.65%) patients, at the
trachea in 38 (14.96%) patients, at the larynx in 16(6.3%) patients, and both bronchi
in 4 (1.57%) patients. No foreign body could be found in 12 (4.73%) cases. The
majority of the FBs were seeds 155 (61.02%). Pneumonia occurred in only 8(3.14%)
patients.
Foreign body aspiration is frequently encountered in pediatric practice. the condition
is
often not diagnosed immediately because there are no specific clinical
manifestations. the ages 1 to 3 years were predominantly affected. The most common
foreign body inhaled, Symptoms, most frequent age, and type of inhaled foreign body
are different from region to region across the world. Foreign body aspiration was
misdiagnosed by physician as pneumonia, asthma, bronchiectasis and bronchiolitis.
Their definite diagnosis and treatment were provided by bronchoscopy, which was
resorted to after unresponsiveness to previous treatment.
Conclusion: Rigid bronchoscopy is very effective procedure to remove aspirated FBs
with fewer complications

b
ackground: Neonatal jaundice (NJ) is a significant disease among neonates in
Najaf province. It manifests 19% of the total deliveries and 50% of the in
patients, and affects about 60% of term and 80% of preterm neonates during
the first week of life. UGT1A1 is a cause of concern in NJ, because it is the most im
portant underlying cause of unconjugated hyperbilirubinemia.
Methods: A cohort of 85neonate sorted into three groups according to the TSB level.
Group 1 (TSB<5mg/dl), group 2 (TSB 5-15 mg/dl) and group 3 (TSB <15mg/l).
UGT1A1expression and TSB level was assessed for both males and females in each
group.
Results & Discussion: Results showed high inverse correlation between
UGT1A1expression and the ratio of males (r= -0.99, P<0.01), while females ratio ex
pressed high direct correlation with UGT1A1 expression level with correlation coeffi
cient of (r=0.99, P<0.01).
This might due to physiological maturity differences of liver between both sexes, and
the plasma growth hormone (GH) pulses frequencies (released by the pituitary gland)
which affects the expression of liver enzymes. It's found that GH pulses are higher in
females than in males.
Conclusion: concluding that mean UGT1A1 expression level in females is more than
that in the males during neonatal period therefore females are less vulnerable to NJ
than males.
Aim: The aim of this study is to qualify the UGT1A1 gene expression in both males
and females therefore determining health and health care requirements

b
ackground: subfertility is a common medical problem affecting about 15-20
% of women consulting the gynecological outpatients in the whole world.
Vitamin C is an important substance that plays different roles in the body and
part of this action is in relation to subfertility.
Objective: to evaluate the effect of vitamin C supplementation on the ovarian
hormones estrogen and progesterone in subfertile women.
Methods: This prospective study was carried out on thirty women attending private
gynecological clinics, twenty of them were infertile and the other ten were normal
fertile women as control group. They were subjected for the measurement of serum
concentrations of both estrogen and progesterone. At the start, The investigations
began at the 23rd day of a regular menstrual cycle(B), 5 ml of blood was taken for the
measurement of the serum concentrations of both ovarian hormones.
Each woman then took vitamin C tab. 1.5 gm (orally) daily and continued for the next
23rd day (AI), At the same day serum E & P was repeated and the vitamin C
supplementation continues to the next 23rd dayof second period, a total period of 58±2
days (AII). So at this day hormonal assessment was repeated and vit C
supplementation was stopped.
Results and Discussion: The results showed that vitamin C supplementation causes
an increased serum progesterone concentration significantly(p<0.05)after two months
supplementation of oral vit C, as compared with the baseline serum level in both
fertile and infertile women, while the effect of vitamin C supplementation on serum
estrogen is increased significantly after the second months of the vitamin
supplementation as compared with the baseline level in fertile women only. In this
study, we found a role of vitamin C supplementation to affect the subfertility through
increasing the endometrial thickness either directly by its antioxidant effect on
endometrial cell or through increasing the level of progesterone.
Conclusion: our study shows an effect of vitamin C on the progesterone level and
hence this may play a role in infertility treatment as it will increase the receptivity and
preparation of the endometrium to the fertilized ovum

Introduction
ackground: we examined the prevalence of uterine fibroid and menstrual
cycle characteristics in a population of non-care-seeking women.
Methods: this is a cross- sectional study involves 175 women who were not
lactating or using contraception and their age between 20-40. After taking history
transvaginal ultrasound done to these female. We examined the association between
menstrual cycle characteristic and the presence of uterine fibroid.
Results & discussion: uterine leiomyomata were detected in 31 women (17.71%).
The presence of uterine leiomypma was not significantly related to amount of blood
loss with menstrual cycle, regularity of the cycle, dysmenorrheo or deep pelvic pain.
Conclusion: in this population of non-care seeking women, menstrual cycle
abnormalities are not related to the presence of uterine leiomyomab

b
ackground: Diabetic fibrous mastopathy, also known as lymphocytic
mastitis, is an un common lesion of the breast that occurs in women with long
standing insulin dependent diabetes mellitus (IDDM)
It is a distinct clinicopathologic entity with specific histopathological characteristics,
which include keloid fibrosis, epithelioid fibroblast, widespread periductal/lobular
lymphocytic infiltration and widespread perivascular lymphocytic infiltration.
Objective: To confirm that: (a) Many diabetic patients can be spared from
undergoing multiple, unwarranted surgical biopsies (b) Mastopathy can happen even
in NIDDM, (c) Diabetic mastopathy can co-exist with malignant breast lesions.
Patients And Methods: A study for 48 patients with palpable breast masses. The
patients are divided into 3 groups: Group A (10 patients): contain the patients with
long standing IDDM. Group B (14 patients): contain the patients with NIDDM.
Group C (24 patients): contain age matched control non-diabetic patients selected
with clinical finding similar to that present in diabetic mastopathy. FNAC, ultrasound
and mammographic examinations were done before proceeding for excisional biopsy.
Results & Discussion: We found that 7 out of 10 patients in Group A (70%) have
features suggesting of diabetic mastopathy and only 4 out of 14 patients in group B
(28.5%) and (0%) in group C, have the same features. So we demonstrate that,
diabetic mastopathy could be the only cause of palpable breast mass in diabetic
patients.
Diabetic mastopathy is a distinct clinicopathologic entity with specific
histopathological features, which include keloid fibrosis, epithelioid fibroblast,
widespread Periductal/lobular lymphocytic infiltration and widespread perivascular
lymphocytic infiltration. Our work confirmed the presence of the histopathological
characteristics of diabetic mastopathy in palpable breast masses in long standing
IDDM (group A). We also observed the presence of the histopathological
characteristics of diabetic mastopathy in breast tissue in mastectomy specimens away
from intraductal and infiltrating ductal carcinoma in NIDDM (group B).
Conclusion: we should have awareness that this entity exists and a careful correlation
of the patient history with physical, radiological and cytological examination should
be applied.

b
ackground: Energy absorption buildup factor inhuman tissuesare very
importantfor the researchers working to help in estimating safe dose levels for
radiotherapy patients and useful in radiation therapy, diagnostics, and
dosimeters.
Aim: The mainemphasis has been focused on the dependence of energy absorption
buildup factor on the incident photon energy, penetration depth and effectiveatomic
number (Zeff )in the human tissues and tissues equivalent plastic.
Materials and Methods: Energy absorption buildup factor ina fewhumantissuessuch
as skin, brain, striated muscle and compact bone as well as in tissue-equivalent
plasticA-150 and bone- equivalent plasticB-100have been computedusing the five
parameter geometric progression(G.P) fittingformula in the energy range of 0.015-15
MeV up to penetration depth 40 mfp. The half value layer (HVL) for selected tissues
were also estimated.
Results & Discussion: The variation of energy absorption buildup factorfor selected
tissueshas been studied as a function of incident photon energy, penetration depth and
effective atomic number(Zeff).The energy absorption buildup factor increases with
increasing photon energy and reaches a maximum value at gamma ray energy
range(0.1-0.2MeV), then start decreasing further with the increasing photon energy.
There is continuous increase in energy absorption buildup factor with increase in
penetration depth.
Comparison of calculated energy absorption buildup factor with standard database
from ANSI/ANS6.4.3-1991 (American National Standard, 1991)shows good
agreements.
Conclusion:Variation in value of energy absorption buildup factor was due to
dominance of different interaction processes in different energy regions and chemical
compositions of thehuman tissues. In general, the energy absorption buildup factor is
lower for compact bone and boneequivalent plastic B-100 at photon energy range
(0.015- 1 MeV) .

bim of study: The aim of study is to define the correlation between mitral valve stenosis and its predictors of severity as pulmonary hypertension and other cardiac valves lesions.
Material and Methods: This study that enrolled total 80 patients, 25 males and 55 females and their age range from 15 to 60 years old , with male to female ratio 1:2.2 . The study was conducted in Al sadder teaching hospital in Al Najaf governorate during the period from May 2012 to May 2013. Echocardiography was done for all patients to assess mitral valve area by planimetry, detect other valves lesion and assess right ventricular systolic pressure which is equal to pulmonary artery systolic pressure (PASP) .
Results & Discussion: This study shows that the increased incidence of moderate to severe mitral stenosis in female as compared with male and there were no statistically significant difference between age groups. There was statistically significant correlation between severities of mitral valve stenosis with increased systolic pressure of pulmonary artery since the more severe mitral stenosis, as the higher pulmonary hypertension. There were no statistically significant correlation between mitral stenosis severity and other cardiac valves. There were statistically significant correlations between pulmonary hypertension and tricuspid regurgitation with or without mitral regurgitation.
There were increased incidence of moderate to severe mitral stenosis in female as compared with male and there were no statistically significant difference between age groups. There were statistically significant correlation between severity of mitral valve stenosis with increased systolic pressure of pulmonary artery since the more severe mitral stenosis. There were statistically significant correlations between pulmonary hypertension and tricuspid regurgitation .
Conclusions: The predictors for mitral stenosis severity in this study that female, younger than 40 years old, echocardiographic evidence of pulmonary hypertension and tricuspid regurgitation with or without mitral regurgitation.
Recommendation: We recommended that follow up all patients with mitral valve stenosis by pulmonary artery systolic pressure measured by echocardiography

b
ackground: Xerostomia is as a subjective complaint of dry mouth that may
result from deficient production of saliva. It may be caused by reduced salivary
flow secondary to atrophy and fibrosis of the salivary glands, use of
medications, restriction of fluid intake and old age. In patients undergoing
hemodialysis, xerostomia is associated with difficulties in chewing, swallowing,
tasting and speaking; increased risk of oral diseases.
Aim of the study: The aim of this study was to find the prevalence of xerostomia in
chronic hemodialysis patients in Babil- Hilla, and compare it with healthy controls.
Materials and Methods: Forty three subjects were incorporated in this study, with
end stage renal disease and undergoing hemodialysis , they were already diagnosed by
a nephrologist specialists, all these patients are without any other systemic diseases.
Healthy control group, forty control subjects with no signs and symptoms of any
systemic disease. They were sex and age matched to hemodialysis patients.
Results and Discussion: A total of 43 patients were registered in Merjan teaching
hospital in Babil- Hilla. These patients on hemodialysis programs at the beginning of
the study, from February to April, 2013. They were (20) males and (23) females and
the age range (24- 69) years. Xerostomia was recorded in 69.767% (n=30) of all
patients with hemodialysis. Our data involved mostly xerostomia was recorded in
patients with hemodialysis, in these patients due to presence of xerostomia increased
the poor oral hygiene. Dysgeusia and uremic fetor, bad odor and taste are caused not
only by xerostomia but also by the presence of urease-splitting oral organisms, which
metabolize urea (present in high levels in these patients) and thus elaborate ammonia.
Patients with xerostomia are at increased risk of lesions to the mucosa, gingival, and
tongue, as well as candidiasis, dental caries, periodontal disease and other bacterial
and fungal infections. Many of these conditions either cause inflammation, or worsen
the chronic inflammation that is frequently present in patients on hemodialysis, and
consequently contribute to the risk of developing cardiovascular diseases.
Conclusions: Xerostomia remains a frustrating symptom for patients on
hemodialysis, and further efforts should be made to identify effective treatments,
restoration of the salivary function

bA 56 year old male patient presented with a history of recurrent attacks of progressive
hoarseness and stridor for the last 9 months, he underwent six laryngeal surgery and
the biopsy results were negative for malignancy except the last pathology report which
revealed the diagnosis of spindle cell carcinoma of the larynx confirmed by
immunohistochemistry. The patient refuses radiotherapy and went to India where they
failed to diagnose the disease. The presented case demonstrates that spindle cell
carcinoma or sarcomatoid carcinoma is very rare malignant tumor of the larynx but
should be suspected in spindle cell tumours of the larynx and awareness of the
pathologist to the unusual immunohistochemical presentation of this tumor with the
use of expanded immunohistochemical markers panel.
Key words: Larynx, Sarcomatoid Carcinoma, Spindle cell carcinoma, Spindle
squamous cell carcinoma, Head and neck tumors.

bBackground: structural shielding are fundamental to controlling the exposure of the
workers as well as the exposure of the general public.
Aim of the study: The objective of the present work is to assess the primary
shielding of the digital chest x-ray room of Al- Hussaini hospital in Karbala city
Materials and method: The technical data of minimum ,maximum and average of
mAs and the corresponding values voltages of the chest x-ray procedures for 1134
patients over two months have been used to calculate the total workload per week
and total workload per patient based on the National Council on Radiation Protection
and Measurements report No.147 (NCRP report No. 147).
Results and discussion :It is found that the workload per week was about 4.5 times
that of recommended by NCRP report No.147 ,whereas the workload per patient was
about five times that of stated by NCRP report No.147 for the same number of
patients per 36 actual work hour week for busy situation. By adoption the equations of
NCRP report No.147 the required thickness of lead as primary barrier was 2.7 mm or
184 mm from concrete.
Conclusion: The thicknesses of Bricks, Concrete and Gypsum that were actually used
were highly enough to be used as a primary shielding barrier

bObjective: to investigate if open reduction and internal fixation would produce better
outcome than external fixation of distal radial fractures.
Patients and Methods: 40 patients with unstable or comminuted distal radial fracture
where divided randomly into two groups using 2 methods of treatment, in group one closed
reduction &bridging external fixation was used ,in group tow open reduction &internal
fixation was used. The primary outcome parameter was grip strength, but the patients were
followed for 1 year with objective clinical assessment, subjective outcome and radiographic
examination.
Results & Discussion: At one year postoperatively , grip strength was 89%(standard
deviation 15) of the injured side in the internal fixation group and 75%(15) in the external
fixation group. Pronation /supnation was 150 (15)in the internal fixation group &136 in(20)
in the external fixation group at 1year.4 patients in the external fixation group where
reoperated due to malunion as compared to 2 in internal fixation group.6 others are classified
as radiographic malunion, 5 in the external fixation ,1 in the internal fixation group.
Conclusion: internal fixation gave better grip strength &and better range of motion at one
year, and less malunion than external fixation. No difference could be found regarding
subjective outcome.

b
ackground: Familial Hypercholesterolemia is hereditary disease which needs
different type of treatment modalities, all are lifelong & some of it are either
not promising or expensive.
Aim: The aim of the study has three disciplines one is to assess the effect of
simvastatin in lowering cholesterol level in patient with familial hypercholesterolemia,
the second discipline is to study the use of the simvastatin in children starting from age
of 4 years . The third is to monitor the expectable side effect if it happens.
Patient and method: Eighteen persons of three families with consanguineous
marriage, age 4 - 48 years with familial hypercholesterolemia was diagnosed in
Karbala governorate at 2009 and started on dietary control & simvastatin in increasing
dose up to the maximum allowed dose , they were followed between august 2009-
January 2012 for clinical, biochemical response & any drug side effects. They are still
under follow up.
Results and Discussion: Simvastatin showed significant decrease in cholesterol level
in the first six months with 20% reduction with a P value of 0.001, then the response
decrease with rebound increment. There is no significant drug side effect reported
neither in adults nor in the children. The result of the study is coinciding with similar
studies regarding the limited effectiveness of statin in FH, also the safety of its usage
in children
Conclusion: Statin usage alone is not as effective as along run treatment for FH, other
treatment modalities are required; although it is save with minimal side effect even in
children