Karbala Journal of Medicine

background: Schizophrenia is a mental disorder defined in term of abnormal clinical
feature of behavior, affect, thinking and perception. Kurt Schneider 1887-1967
divided schizophrenic symptoms into 1st or 2nd rank are entirely devoid of any
therapy and are intended purely pragmatically diagnostically.
Objectives (aims): To determine the prevalence of Schneider’s First Rank Symptoms in Iraqi
schizophrenic patients and explain the finding on a cultural basis.
Method: A cross sectional study that enrolled 76 schizophrenic patients treated as inpatient
in Psychiatric Unit in Al-Diwaniya Teaching Hospital from1 May 2012 to 1 Jun. 2013, who
met the diagnosis of schizophrenia according to ICD-10 and Schneider’s First Rank
Symptoms according to C. S. Mellor[8, 9]. All patients were examined within a maximum of
four days from admission to the hospital.
Results: This study revealed that 55% of them have clear First Rank Symptoms. The
commonest was somatic passivity, thought broadcast, commentary voices and thought
insertion.
Conclusion: First Rank Symptoms are of value in the routine clinic diagnosis of
schizophrenia in Iraq.
Phenomenology or descriptive psychopathology is of vital importance and it needs
experience and training to help better clinical diagnosis of psychiatric disorder

bhe spirometric diagnosis of upper airway obstruction is an important non-invasive
technique that was validated for the diagnosis of such lesions relying on several
indices that were derived from the flow volume loops of patients.
Objectives: Is to find out if postural changes have an effect on spirometric indices of airway
obstruction in healthy subjects and if so, does this merit performing the test in supine
posture?
Subjects and methods: This study conducted in the department of physiology and medical
physics/ Kerbala medical college, in which 17 males aged from 18-19 years (18.53 ± 0.51),
had BMI of (22.95 ± 2.11 Kg/M2), heights of (1.75 ± 0.14 meters) and weights of (70.32 ±
6.34 Kgs) were enrolled. The following spirometric data were measured in two different body
positions (erect versus supine): Forced vital capacity (FVC), Forced inspiratory flow at 50%
of vital capacity (FIF50%), Forced expiratory flow at 50% of vital capacity (FEF50%), Forced
expiratory volume in first second (FEV1), Forced expiratory volume in first 0.5 second (FEV
0.5), Peak inspiratory flow (PIF) and Peak expiratory flow (PEF). From these data, the
following indices of upper airway obstruction were derived: (FEV1/ FEV0.5, FEV1/ PEF,
FEF50%/ FIF50%, and PEF/PIF). These indices were compared with each other in respect to
two body positions.
Results:
1- All the measured inspiratory and expiratory flow rates were significantly lower in supine
position (p < 0.05).
2- Of the four measured indices of upper airway obstruction, only the FEV1/PEF ratio
increased significantly (p < 0.05) by about 27% upon reclining.

b
ackground Suspected acute appendicitis is the most common non traumatic
admissions to the surgical emergency units .Over past 100 years mortality and
morbidity rates related to appendicitis have markedly decreased. The diagnosis of
acute appendicitis is predominantly a clinical preoperatively but final diagnosis of acute
appendicitis needs surgical reports per-operatively and the standard pathological
examinations postoperatively .There are many clinical scores have been established to help in
the diagnosis of the condition in surgical emergency room by junior surgeons in a short time
in order to perform surgery in solid bases The main purposes of accurate diagnosis of acute
appendicitis :-
1-Management of acute appendicitis in a short time and high accuracy to:-
A-Avoid delayed diagnosis and prevent complications like perforation and finally peritonitis
so mortality and morbidity of appendicitis markedly decrease
B-Avoid missing of any cases .
2 -Avoid unnecessary surgery. Alvarado scoring system especially for junior residents who
work as the primary receptors of surgical cases at surgical emergency units. Alvarado score
system was identified as a useful clinical tool because it is readily available , extremely
affordable ,and relatively accurate
Aims This study: was conducted to modify Alvarado scoring system to more easy
applicable, simple, cheap, quick and test( Reliability of suggested scoring system ) by which
we avoided laboratory readings and technical errors that may cause diagnostic
difficulties Patients and Methods a prospective study of 120 patients with suspected acute
appendicitis admitted to surgical department -Al-Hussein teaching hospital—Karbala during
the period from 1st January—to 31st December 2010 were included in this study. The
patients were given specific scores according to this (Suggested score system) categorized
into three categories
Category 1 patients score 7 or more who underwent surgery
Category 2 patients score 5—6 admitted for a surgical ward under observation Category 3
patients score 4 or less where acute appendicitis can be excluded. All appendices that
removed
surgically
were
sent
for
histopathological
examination.
Results By the (Suggested Score) Out of 120 patients 80 patients underwent
surgery and acute appendicitis were confirmed in 60 patients thus negative appendectomy
thus giving negative appendectomy frequency of 20%. Perforation rate was 6.25%.Positive
Predictive Value was 80% (male 84% female 76%)
Conclusion The (suggested scoring system) aids in the diagnosis of acute appendicitis. It
helps junior residents in early diagnosis of acute appendicitis. It is quicker—simpler cheaper
and easily applicable than Alvarado score in Iraq. The (Reliability of suggested scoring
system) tested in this study and the result was that the new score had a good reliability
compared to Alvarado scoring system

b
ackground: Hypertension complicates 5-7% of all pregnancies. Preeclampsia
characterized by development of hypertension, proteinuria and multisystem
involvement after 20 weeks of pregnancy in a previously normal female and
disappear after peurperium and it is responsible for substantial maternal and fetal morbidity.
Objective: the purpose of this study was to know the complications of hypertension in
female during pregnancy and postpartum period, the method of termination of pregnancy,
fetal and neonatal outcome of female with hypertension in pregnancy.
Methods: this is a prospective study involve 75 pregnant women with hypertension admitted
to Karbala maternity hospital, we monitored their pregnancies and recorded the development
of complications.
Results: eclampsia developed in 25.33% of them, HEELP syndrome developed in 9.33% and
intrauterine fetal death occur in 6.66% and no maternal mortality occurring during this
period, intrauterine fetal death occur in 6.66% of them and 32% of them delivered vaginally.
Conclusion: lower incidence of eclampsia, maternal death, intrauterine fetal death and other
complications due to preeclampsia due to good monitoring and the use of prophylactic
magnesium sulphate in severe cases

background: The patterns of sensitization to inhalant allergens among asthmatic
children varies greatly in different countries. The detection of sensitization to inhalant
allergens in asthmatic patients is used primarily to establish the diagnosis of allergic
asthma. Also it is helpful in reducing asthma exacerbations through allergen exposure
avoidance.
Objectives: This study aims to determine the most common inhalant allergens associated
with childhood asthma in Karbala province using allergen-specific IgE immunoassay.
Patients and Methods: The present study was conducted in Karbala Teaching Hospital for
Children on 75 asthmatic children with elevated total serum IgE levels. All patients were
screened for the presence of specific IgE against inhalant allergens most frequently involved
in childhood asthma using EUROLINE Pediatric Inhalation IgE test kit that include 20
inhalant allergens. The position of the band was used to determine the specific allergen while
the color intensity of the band was used as predictive for the specific IgE concentration in
serum samples.
Results: Among 75 patients screened for specific IgE, 60 patients (80%) were sensitized to at
least one allergen and allergen-specific IgE was not detected in 15 (20%) patients. 30% of
sensitized patients, were sensitized to single allergen and 70% were sensitized to multiple
allergens. Cat allergen was found in 60% of sensitized patients followed by European house
dust mite allergen (55%). However, dog and aspergillus fumigatus allergens accounted for
45% and 33.3% respectively. Most patients sensitized to cat and dog allergens (55.5% and
52% respectively) showed clear bands signal intensity (moderate allergen-specific IgE
concentration). However the majority of patients sensitized to other inhalant allergens
showed weak bands signal intensity (low allergen-specific IgE concentration).
Conclusions: Animal allergens (mostly cat) are the predominant inhalant allergens associated
with childhood asthma in Karbala province with relatively higher allergen-specific IgE
concentrations than house dust mite and fungal allergens.

b
ackground: The vermiform appendix, is a small blind tubular structure ,and in no
way a vestigial organ but a specialized structure without any definitely known
function, probably concerned with the establishment and maintenance of the body
defense , immunity of the body and other benefits in the surgery. Its importance in surgery
results from propensity for inflammation, which results in the clinical syndrome called acute
appendicitis which is the most common cause of acute abdomen in surgery, and results in the
most frequently performed abdominal operations.
Objectives: Even the most experienced physicians and surgeons are not able to diagnose
appendicitis 100% of the times, thus many patients wait a period of time ranging from one to
several hours until they receive a treatment, so we evaluate the period of time from onset of
symptoms till the definitive treatment in acute appendicitis.
Methodology: An observational cross sectional study based on a standardized preformed
questionnaire contains 20 questions answered directly by the patient who underwent a
surgical removal of the appendix in the surgical department of Al -Hussain medical city for
the period 10\10 -10\12\2012, and Fisher Exact test used for data analysis
Results: A total 100 cases where interviewed, 42% of cases their waiting time more than 24
hours before receiving the definitive treatment and perforation occurred in 6% of cases, and
perforation rate was higher among patients who wait more than 24 hrs before operation, but
with no statistical significance.
Conclusion: The overall period from onset of symptom till operation in acute appendicitis
was acceptable as compared to many scientific and clinical based studies and didn't seem to
associated with significant incensement of complication.

background: Neither Rh(D) positive individuals nor Rh (D) negative individuals
normally have anti-Rh(D) antibody in their blood; however, Rh (D) negative
individuals have the ability to form such antibody when they are transfused with
Rh(D) positive blood.
Objective: To determine the prevalence of anti-Rh (D) antibody in Karbala.
Patients and methods: From January 2012 to March 2013, 226 patients (127 males and 99
females with age range of 20-49 years) were studied after their consent. For each patient, 4
ml of venous blood sample was obtained and investigated as follows:
Two ml of blood were transferred to EDTA tube for ABO and Rh(D) grouping using the
commercially available kit (monoclonal anti-A, anti-B and anti-D) by doing the ordinary tile
method (equal volumes of blood and reagent were mixed on tile looking visually for the
agglutination for positive reaction and positive result. Absence of agglutination means
negative reaction and negative result). The other 2 ml of blood were transferred to plain tube,
centrifuged and serum is investigated for anti-Rh(D) antibody in Rh(D) negative individuals
by double dilutions of each serum and antibody titration method.
Results: Out of 226 individuals, 186 (82.3%) were Rh(D) positive, 40 (17.7%) were Rh(D)
negative, and 2 were found to be positive for anti-Rh(D) antibody. The prevalence of anti
Rh(D) antibody is 0.88%.
Conclusion: The study showed that the prevalence of anti-Rh(D) antibody in Karbala is
0.88%.
Key words: anti-Rh(D) antibody, ABO blood grouping, antibody titration.

b-ray equipment must be installed in adequately shielded rooms to ensure that public
in the vicinity of the x-ray installations are not unduly exposed to x-ray radiation.
The adequacy of shielding depends on the material and thickness used for this
purpose. This work therefore studies the secondary shielding of the mammography room. By
considering the mammography room design and the radiographic devices profiles used , the
clinical total workload per week and total workload per patient have been computed and its
distribution according to the most widely used voltages has been determined by recording the
actual clinical technical values of maximum ,average and minimum mAs and the
corresponding values of kilovolt peak for 2119 women over six months. As a diagnostic x
ray radiation shielding reference, the National Council on Radiation Protection and
Measurements report No.147 (NCRP report No.147) and XRAYBARR computer program
have been used to compute the secondary barrier thicknesses of Gypsum and Wood of the
mammography room.. It is found that the total workload per week and the total workload per
patient of the room were about three times that of stated by the NCRP report No.147 for a
half value of the patients.The required thicknesses of Gypsum and Wood were about 4 mm
and 20 mm respectively, whereas the actual thicknesses are higher than these values
,furthermore ,another conventional materials were used as secondary barriers ,such as bricks
and concrete, hence the secondary barriers thicknesses exist in the room are more than
adequate.

b
ackground: Diabetic macular edema(DME) is a major cause of visual loss in patients
with diabetes. It usually results from the breakdown of the inner blood–retinal barrier.
Early detection of retinal abnormalities is vital in preventing diabetic macular edema
and subsequent loss of vision. Until recently, the methods available for detecting and
evaluating diabetic macular edema were slit-lamp bio microscopy and stereoscopic
photography, both of which are limited in detecting earlier retinal changes. Optical coherence
tomography (OCT) is a new diagnostic imaging modality that provides high-resolution,
cross-sectional images of the eye. It is proving to be an accurate tool for the early diagnosis,
analysis and monitoring of retinopathy. It allows not only the qualitative diagnosis of diabetic
macular edema, but also the quantitative assessment of edema.
Objective: To verify different morphological types of diabetic macular edema that needs
different treatment strategies.
Patients and methods: A descriptive observational study was done in the OCT unit of
Immam Hussain eye center in Kerbala city from December 2010 to May 2013. OCT done for
420 eyes of 237 patient. Cases with low image quality and cases with other eye disease were
excluded.
Results: Of 420 eyes,211 eyes (50.4%) have OCT morphological appearance of diffuse
spongiform DME,115 eyes (27.5%) mixed spongiform and cystoid edema, 56 eyes (13.3%)
have cystoid changes, and 38 eyes ( 9% ) showed edema with traction at vitreoretinal
interface.
Conclusion: Optical Coherence Tomography based classification of diabetic macular edema
is more accurate in identifying the morphological types that need specific regimes of
treatment and in the follow up the response to treatment.

b
ackground: Genotyping methods of M. tuberculosis (MTB) isolates such as MIRU
VNTR provides informations that may help in TB control program because it help in
detecting the infection, confirming lab errors, determining treatment failure,
reactivation and exogenous reinfection, and to detect any epidemiological link between
patients by monitoring the transmission chain and identifying successful clones of MTB
isolates and especially those with multidrug resistance. Al-Sadr city is the most populated
city in Iraq with majority of people are living under the poverty line. Crowdedness and
poverty are two essential requirements for successful tuberculosis (TB) transmission.
Aims: To Shed light on the genetic diversity, clustering rate and transmission dynamics of
TB cases while assessing the utility of 15-loci MIRU-VNTR in typing of MTB clinical
isolates in Al-Sadr city.
Subjects and Methods: Twenty nine MTB culture isolates were genotyped by using MIRU
VNTR-15 typing.
Results: Twenty five distinct type were yielded, 8 isolates (27.6%) were grouped into 4
clusters (2 isolates/cluster), and 21 (72.4%) were unique. The clustering rate was (13.7%).
Fourteen out of 15 loci were moderate or highly discriminative (h> 0.6, and h> 0.3,
respectively) according to their allelic diversity. The mean of the allelic diversity of the 15
loci was high (0.64), indicating the high power of discrimination of MIRU-VNTR typing
(HGDI was 0.99).
Conclusions: MIRU-VNTR typing has a high discriminatory power and is useful in
identification of the origin and transmission of M. tuberculosis isolates Al-Sadr city and
possibly other densely populated cities in Iraq.

b
ackground:- anemia is a well-known complication of patients with lymphoid
neoplasm and many factors are involved in its pathogenesis including defective iron
utilization and diagnosing iron deficiency in the context of malignancy or chronic
illness can be very challenging as many of the parameters used are acute phase markers and
can be misinterpreted in the presence of chronic illness .bone marrow iron is the gold
standard mean for assessing marrow iron but it is an invasive and a laborious procedure ,on
the other hand serum ferritin has been used as the most relevant indicator of iron deficiency
in the general population but it has the drawback of being increased in the presence of an
acute response.
Objectives:- evaluate the ability of serum ferritin at different cutoff levels and in
combination with other parameters to identify iron deficiency in patients with lymphoid
neoplasms.
Patients and methods:- 39 anemic patients with different types of lymphoid neoplasm
attending the hematology unit in Baghdad hospital were enrolled in the study ,exclusion
criteria included history of blood transfusion and iron therapy in the past 2 months .for all
patients bone marrow iron study was carried out and accordingly patients were classified into
2 groups the iron depleted group (with absent marrow iron) and the iron replete group (with
present iron stores).from all patients peripheral blood was taken for the evaluation of
complete blood picture and ESR and serum ferritin by enzyme Linked immunosorbant assay
method (ELISA).
Results:- the mean serum ferritin for the iron depleted group was 78.31ng/dl while for the
iron replete group it was 202.77ng/dl there was a highly significant difference for serum
ferittin between the 2 groups (p value .005),a less significant difference was found also for
the mean cell volume(p value .05) while the other parameters showed no difference, the
lowest cutoff level for serum ferittin that could accurately identify iron deficiency with a high
sensitivity 96% and a high specifity 80% was 66.7ng/dl . Logistic regression analysis was
done for serum ferritin and ESR to test for the effect of these parameters on the predictive
power of bone marrow iron stores. The logistic equation was:
Log (p)=0.163 + .0621*ESR -0.026*ferritin
Using this equation with ferritin and ESR gave a prediction power of about 74% to identify
the iron bone marrow store however using ferittin alone gave a 69% prediction power.
Conclusion: - serum ferritin at a cutoff value of 66.7ng/dl can be used with high accuracy for
the identification of iron deficiency in patients with lymphoid neoplasm and can be used as a
suitable alternative for bone marrow iron, correction of serum ferritin for the acute phase
response did not enhance much its predictive power in identifying iron deficiency in those
patients.

b
ackground: The relatively rough surface of gypsum mould may be penetrated by
acrylic denture base resin and adhere to it, to prevent this, a separating medium must
be employed.
Objectives: The aim of this study is to evaluate the effect of separating medium substitute
and investment materials on Surface roughness, Water sorption and solubility of acrylic and
nylon denture base materials.
Material and method: Two types of separating medium were chosen (Cold mold seal and
glycerin). 160 specimens were prepared from heat cure and Valplast resins. Each main group
was subdivided into four subdivisions according to the type of investment material and
separating medium used; each group of them contains 10 specimens for each test.
After processing of both resins, some physical properties such as water sorption, solubility
and surface roughness have been evaluated according to investment material and compared
with those processed using cold mold seal and glycerin.
Result: In this study, the surface roughness and water solubility of both base materials are
significantly higher when using cold mold seal than glycerin. Mean value of heat-cure acrylic
resin shows high water sorption than that of Valplast. When compared by ANOVA test, there
is no significant difference between groups in both investment materials.
Conclusion: The use of glycerin as a separating medium leads to smoother surfaces of both
denture base materials, while for water sorption, neither the separating medium nor the
investment material has an effect on it. Cold mold seal leads to higher water solubility of both
base materials regardless of the type of investment material.

b
ackground and study Objectives: Several studies in adults report abnormalities of
lung function in patients with diabetes. The objectives of this study are to assess the
Maximum Voluntary Ventilation (which is a measure of the mechanical factors of
breathing) in patients with type I diabetes mellitus and its relation to the duration of diabetes.
Patients and methods: 36 patients with a known history of type I DM (26 male, 10 female)
with an average age between 16-42 years were enrolled in this study with 38 sex and age
matched healthy individuals as a control group. The MVV test was performed in both groups
for at least 3 times to ensure reproducibility. The study group was subdivided according to
the duration of diabetes into group1 for those < 5 years duration (13 patients), group2 for
those between 5-10 years (11 patients) and group 3 for those > 10 years duration (12
patients).
Results: mean values of direct Maximal Voluntary Ventilation test was reduced in diabetic
patients compared to their matched controls in all study groups but it was most obvious in
group 2 and 3 as duration of diabetes increase
Conclusion: in patients with type I DM there is impaired mechanical factors of breathing
manifested by increase in airway resistance, reduced compliances or respiratory muscle force
as indicated by reduction in the mean values of direct Maximal Voluntary Ventilation test
relative to their matched controls

b
3 year old child presented with a history of progressive abdominal distention
associated with low grade fever and discharging left ear for the last 6 months. He
was diagnosed as a case of chronic suppurative otitis media. He was not responding
to the medical treatment. He then developed left post-auricular soft not tender swelling with
aural granulation tissue and hepatosplenomegaly. Clinical and histological examination
confirmed the diagnosis of Langerhans’ cell histiocytosis. His condition responded very well
to steroids and chemotherapy. This case report to highlight this condition as a possible cause
of chronic suppurative otitis media and requires imaging and histological examinations for
definitive diagnosis and appropriate treatment.

bbjectives: To analyze thyroid functions tests in patients with ischemic stroke at acute
stage and to study the association between ischemic stroke and different types of
thyroid dysfunctions.
Methods: A hospital based, cross-sectional, case-control study with trial to cancel
the role of age, gender, hypertension and diabetes mellitus as confounding factors
was adopted to achieve the aim of this study. A total number of 210 cases (105 as patients
group presented with ischemic stroke and another 105 case as control group not suffering
from ischemic stroke) were examined for TSH, T4 and T3. The period of data collection was
from Jan. 2011 to the end of Jan. 2012. The patients were collected from the wards of
neurology while the control group were collected from the out patients clinic, of Baghdad
Teaching Hospital, Baghdad, Iraq.
Ischemic stroke was confirmed by their clinical picture and native brain CT scan. Exclusion
and inclusion criteria, definition of variables and the consents from all patients were fulfilled.
Results: 8.6% of ischemic stroke patients showed hypothyroid pattern, 8.6% hyperthyroid
pattern and 3.8% sick euthyroid pattern and these results were statistically significant as
compared with control cases. 7.6% of patients had atrial fibrillation (AF) statistically of
significant difference. Most cases of AF registered among patients with hyperthyroidism
60%. 12.7% of patients with hypothyroid pattern had statistically significant obesity and 8%
of patients with sick euthyroid pattern had diabetes which was also significant.
Conclusions: Both hyperthyroidism and hypothyroidism might be considered as risk factors
for developing ischemic stroke. Atrial Fibrillation may be a predictor for developing ischemic
stroke especially in patients with hyperthyroidism. In hypothyroidism, there may be an
association of several atherosclerotic risk factors with ischemic stroke. Sick euthyroid is not
uncommon in patients with ischemic stroke which reflect the increase in physical stress
associated with the insult

bHyperthyroidism is a condition in which there is over production of thyroid
hormones, abnormal antibodies that attack the thyroid gland causes it to become over
active. Abnormal antibodies may cause swelling and inflammation of the soft tissue
around the eyes and the muscles that move the eyes and the eyelids.
Aim of the study: The aim of the study was to find the effect of hyperthyroidism on
the vision and development of refractive errors in patient with hyperthyroidism
Results: It was found that the usual age of onset of hyperthyroidism was between 30
and 50 years with the females’ preponderance. Myopia showed in high percentage
within the age 40-50 and >50 years (61.1%), (68.0%) respectively. While
hypermetropia was seen more in age <40 (28.9%) and hyperthyroidism has a bad
effect on the visual acuity.
Introduction
Conclusion: Myopia was seen more in older age group while hypermetropia seen in
younger age group. Hyperthyroidism has a bad effect on the visual acuity.