Karbala Journal of Medicine

b
ackground: Malignant Obstructive Jaundice (MOJ) is caused by different diseases at
different levels and stages. Ideally, the best management is by early diagnosis and
treatment with multi-disciplinary approach that includes the full cooperation among
endoscopists, histopathologists, interventional radiologists, oncologists and surgeons.
Objective: This analytic retrospective study puts a light on the management of MOJ patients
at the surgical department of Al-Bashir Teaching Hospital in Amman – Jordan. The gradual
changes in the surgical management were taken in consideration.
Method: The study included 98 patients who were treated surgically for MOJ during the
period from June 1999 to June 2006. The age of these patients ranged from 27 years to 85
years, with the mean age being 62 years. The data obtained includes the investigations done,
type, stage and level of MOJ, the type of surgical procedure and the postoperative
complications within 1 month.
Results: Most of the patients were males, 58 patients with a percentage of (59.18%). The
remaining 40 patients were females with a percentage of (40.82%). The types of surgical
management included Wipple's procedure for 16 patients with a percentage of (16.33%),
tumor resection for 3 patients with a percentage of (3.06%), bypass (palliative) procedures for
69 patients with a percentage of (70.41%) and the remaining 10 patients with a percentage of
(10.20%) were found to be inoperable during diagnostic laparotomy. In general, the surgical
management had a morbidity of (18.37% - 18 patients) of which the mortality was (14.28% -
14 patients of these 18 morbid patients). Regarding investigation, U/S was performed for 62
patients only. It was positive in 30 patients with a percentage of (48.39%). Endoscopic
Retrograde Cholangiopancreatography (ERCP) was done in 34 patients, it was positive in 18
patients with a percentage of (52.94%). Abdominal CT scan was performed for 44 patients, it
was positive in 38 patients with a percentage of (86.36%). MRCP was done in 14 patients, it
was positive in 12 patients with a percentage of (85.71%).
Conclusion: MOJ is a disease occurring more frequently in middle age and elderly groups.
Most of the patients are presented lately, making the most common surgical procedure
performed for these patients being palliative (bypass) procedure. The use of sophisticated
investigations is shown to aid in the diagnosis and staging of MOJ.

b
ackground: Several indices had been derived from lipid profiles to establish an index
for predicting the risk of having coronary event. The atherogenic index of plasma, is a
strongly emerging index that is now fulfilling the criteria to be used as a standalone
index for cardiac risk stratification.
Objectives: To find out whether the atherogenic index of plasma, was superior to the
conventional daily used atherogenic indices in predicting cardiac risk.
Subjects and methods: A case-control study in which 119 males with an age range of (43
68) years and with acute myocardial infarction together with 97, apparently healthy males of
matched age were enrolled. For each participant, a fasting lipid profile done and the
following atherogenic indices were calculated: (total cholesterol / high-density lipoproteins),
(high-density lipoproteins / low-density lipoproteins), (low-density lipoproteins / high-density
lipoproteins), and the (atherogenic index of plasma). The indices were compared in both
groups and then in the patients group to figure out which index has yielded the highest
sensitivity in predicting the risk of having coronary artery disease.
Results
 All of the atherogenic indices were found to be significantly different upon comparing
these indices in both patients and control groups. Where the P value was (0.0001) for
(TC/HDL), (HDL/LDL), and (AIP); and it was (0.0026) for (LDL/HDL).
 AIP was found to have the highest sensitivity for predicting atherogenicity among the
other atherogenic indices with a value of 84% versus 68%, 73%, and 76% for
(TC/HDL), (HDL/LDL) and (LDL/HDL) ratios respectively.
Conclusions: The AIP was a superior index for predicting the coronary arterial disease when
compared to the most commonly used indices of atherogenicity in every day practice.

b
ackground: Patients with chronic renal impairment (CRI) present a high prevalence
of insulin resistance (IR). Chronic Renal Failure (CRF) is a syndrome of persistent
renal impairment involving loss of glomeruli, tubular and nephron function. Dialysis
may be used as a lineal treated to patients who have suddenly but temporarily, lost their
kidney function (acute renal failure) or as a regular region for quite stable patients who have
permanently lost their kidney function.
Central obesity, particularly visceral adiposity is considered to play a major role in causing
insulin resistance and type 2 diabetes mellitus. Insulin resistance is characterized by a
decrease in the insulin effect on glucose transport in muscle, adipose tissue and liver.
Aim of the study: The purpose of this study is to investigate the relationship between the
level of serum Insulin and Homeostasis model Assessment (HOMA)-Insulin resistance levels
to risk of chronic renal impairment (CRI)
Materials and methods:
This study include 50 patients (32
males and 18 females) who have chronic renal
impairment disease with and without T2DM aged between (30-70) years, the mean age as
(mean± SD) is (56.4± 10.7),(52.8±18.5) years who attended the hemodialysis (HD) at the
artificial kidney in AL- Karama Hospital and 30 normal volunteers aged mach with (30-70
years)act as control. The mean age is (57±6) years .This study examined the relationship
between fasting serum glucose ,insulin ,Homeostasis Model Assessment (HOMA) – Insulin
resistance in CRI patients . Insulin was measured by (enzyme immunosorbant assay) .
Results: Mean systolic BP and body max index BMI values were significantly higher among
persons with diabetes compared with their counters without diabetes and control. Diabetic
participants had higher mean levels of serum glucose, serum insulin, HbA1c and HOMA
insulin resistance compared with non diabetic participants and control. Diabetic participants
also had a higher prevalence of elevated serum creatinine, urea and cholesterol level with
CRI compared with their counterparts without diabetes and control .
Conclusion: This study documents the presence of a strong, positive correlation between
insulin resistance and chronic renal impairment among non diabetic patients .These data
demonstrate that patients with chronic renal impairment have a high prevalence of IR, insulin
levels .

b
ackground: Hepatitis C virus (HCV) infection is a common global public health
problem, and it is a significant problem among patients with end stage renal disease
on hemodialysis (HD).
Aim: To determine the risk factors of HCV infection among patients with end stage renal
diseae on HD.
Patients and methods: A case control study was performed in HD units of Al-kindy
teaching hospital in the period between October 2011- August 2012. A total of ninety
patients with Positive Anti HCV and ninety patients with Negative anti-HCV were enrolled
in this study.
Anti-HCV antibody was detected by the third generation enzyme immunoassay (ELISA).
Direct interview was done with each patient, odds ratio and 95% CI were used to test
significant differences.
Results: The results showed that 40 males and 50 females with positive antiHCV test didn’t
show any significant difference in comparison with 38 Males 52 females with negative HCV
test regarding gender or age. It was found that as the number of dialysis passed 50 times
the chance of getting HCV infection would be significantly high but as the frequency
passed 100 times, the probability of getting infection would be significantly less.
History of blood transfusion made prediction of having HCV infection significantly high.
Absence of history of jaundice did not affect significantly probability of having hepatitis C
infection among patients on HD. There was no association between history of diabetes
mellitus and/or hypertension and probability of getting HCV infection.
Conclusion The blood transfusion was significantly associated with HCV infection. Frequent
HD increase probability of getting HCV but not when the number passed 100 times.

b
bjective: The changing patterns of becoming pregnant at an advanced age have
serious public health impact because of increased risk of adverse pregnancy
outcome. Thus the objective of this study was to find the adverse pregnancy
outcome of advance maternal age and to estimate whether it was related to inter-current
illness and pregnancy complications.
Study design: This prospective comparative study was conducted at labor room in AL
Mawany General Hospital from October 2011 – October 2012. A comparison of pregnancy
outcome was made on bases of maternal age at delivery and divided into (group A:20-34
years old),(group B:35-40 years old),(group C:above 40 years old). Main outcome measures
were perinatal outcomes include intrauterine death, neonatal death, preterm birth, congenital
malformation, macrosomia, low birth weight and fetal distress by apgar score. The obstetrical
outcomes, which include abortion, mode of delivery, antipartum hemorrhage, hypertension
disorder, diabetic mellitus, postpartum hemorrhage and multiple pregnancy.
Result: There were 14350 subject delivered at Al-Mawany General Hospital were choosing
about 534 subject whom meet the inclusions criteria, selected women divided in to 3 groups:
A: 20-34 years (NO.252,47%),B:35-40 years (NO.171,32%) and C: above 40 years
(NO.111,20%). The frequencies of macrosomia, intrauterine death, congenital malformation
and low apgar score was significantly higher in advanced maternal age. The finding reveal
that mother over 35 years showed more risk for abortion, hypertension disorder , multiple
pregnancy antipartum hemorrhage, postpartum hemorrhage and caesarean section.
Conclusions: We conclude that older women managed properly by modern obstetric
methods and delivered in modern health care center can expect good pregnancy outcome.

background: Hyperhomocysteinemia has been associated with an increased risk of
atherosclerosis and other cardiovascular diseases. Vitamin B6, vitamin B12, and folic
acid are essential components in the metabolism of homocysteine.
Objective: This study aimed to assess the effects of vitamin B6, vitamin B12, folic acid, and
the combination of them in the prevention of hyperhomocysteinemia.
Methods: Thirty six male local rabbits were used in the study. Methionine was given to
rabbits to induce a model of hyperhomocysteinemia. Rabbits were divided randomly into 6
groups (6 rabbits in each group) as the following: control group: they were maintained on
standard chow only; methionine only group: they were maintained on methionine only; B6
group: they were maintained on methionine and vitamin B6; B12 group: they were
maintained on methionine and vitamin B12; folic acid group: they were maintained on
methionine and folic acid; multivitamins group: they were maintained on methionine,
vitamin B6, vitamin B12, and folic acid.
Results: Multivitamins group showed no significant differences (P>0.05) in homo-cysteine
levels at day 30 in comparison with day 0 and there are no significant differences (P>0.05) in
homocysteine levels at day 30 between multivitamins group and control group. At day 30 and
day 60, serum homocysteine levels in multivitamins group were significantly (P<0.05) lower
than serum homocysteine levels in folic acid group.
Conclusion: Multivitamin combination composed of vitamin B6, vitamin B12, and folic acid
reduces the hyperhomocysteinemic effect of methionine and it is better than folic acid alone,
while folic acid is better than vitamin B6 or vitamin B12 when they used alone.

b
ackground: The increasing incidence of resistance to a wide range of antibiotics by
microorganisms is a major concern facing modern medicine because these antibiotics
are widely used in human and veterinary medicine to treat and prevent diseases and as
growth promoters in animal intensive industries. The consequences are severe. Infections
caused by resistant microbes fail to respond to treatment, resulting in prolonged illness and
greater risk of death.
Objectives: The aims of this study are: 1-Comparing the changes of induced resistance in
E.coli with that present in clinical isolates of the same microorganism. 2-Determine the
properties of cefquinome especially the development of resistance and the stability of it
Methods: fourteen strains of E.coli were collected from different disease cases: diarrhea
(children= 6, calve= 3, poultry= 1), UTI (urine= 2), mastitis (milk= 2) from Al-Yarmook
hospital and farms of veterinary college (Baghdad). The MIC was estimated eight selected
strains (4 sensitive and 4 resistances) before and after passages these strains in vivo for
carried out the comparison.
Results: A significant drop in induced resistance for sensitive strains as compared with
clinical isolates which are not significant elevate in resistance. Most E.coli strains showed
highly susceptible to cefquinome but some of them were appeared resistance although this
antibacterial was newly used in this country.
Conclusion: loss of induced resistance when passing in vivo because the resistant
microorganisms actually were unstable group when comparison with stable resistance in
clinical isolates was not changed when exposed to the same condition

b
ackground: hypertonic saline solution is frequently used to in the management of
hemorrhagic shock.
Objective: To determine the effects of hypertonic (7%) saline solution on whole
blood coagulation (clotting) in vitro.
Patients and methods: Ten healthy volunteers (5 males and 5 females with age range of 28
44 years) with no previous medical history of bleeding tendency and no medical history of
drug intake were studied after their consent. Hypertonic (7%) saline was prepared
immediately before use. For each patient, 4 ml of venous blood sample was obtained and
investigated as follows:
Undiluted 450 µl of whole blood for baseline coagulation tests [prothrmbin Time (PT),
activated partial thromboplastin time (APTT) and thrombin time (TT)]. After that, the same
above tests were done after dilutions of whole blood (i.e whole blood replacement by
hypertonic saline and isotonic saline for each dilution). An Isotonic (0.9%) saline dilution
serves as control. Blood volume replacements at 2.5%, 5%, 7.5% and 10% were done and
studied.
Results: The baseline coagulation tests (PT, APTT, and TT) were normal for all 10 (100%)
of subjects. At 2.5% and 5% of blood volume replacement PT, APTT and TT were slightly
prolonged, but showed no statistically significant difference between hypertonic (7%) saline
and the control (isotonic saline) while PT, APTT and TT were prolonged in hypertonic (7%)
saline with statistically significant difference (p<0.05) from isotonic (0.9%) saline at 7.5%
and 10% of whole blood volume replacement in 10, (100%) of subjects.
Conclusion: The study showed that hypertonic (7%) saline disturbs coagulation in vitro when
it replaces 7.5% or 10% of whole blood volume.

b
sthma is the most common allergic disease giving rise to the morbidity or school
absence in children and has an increasing incidence worldwide. Montelukast is a well
known leukotriene receptor antagonist used to treat children with asthma. Several
cytokines in addition to IgE are known to affect the course of the disease and response to
treatment in this regard.
This is a prospective placebo-controlled cohort study done in Kerbala Pediatric Teaching
Hospital during April, 2011 through February, 2013. It aims to test the effect of cytokine
profile and serum IgE level (measured by ELISA) on asthma development and their influence
on 1-month course of montelukast therapy compared to a placebo group (30 patients each).
Of the 60 patients, 30 were given montelukast as add-on therapy and the other 30 were
regarded as placebo group. Serum level of IL2, 4, 10, 17 and IFN-gamma were determined
pre- and post- treatment course in all patients and compared with 30 healthy controls.
Response was assessed according to answer to a pre- formed questionnaire formula answered
by the parents regarding frequency and severity of wheezy attacks.
Results showed a significantly higher level of serum IL4 in asthmatic children than in healthy
control. More importantly, its level was shown to be directly related with poorer clinical
response to montelukast, p value < 0.05. In addition, montelukast was shown to significantly
decrease serum IL4 level in the treatment group (30 asthmatics) compared to the placebo
group, p value <0.05.
Furthermore, our data revealed that the serum level of IL10 was significantly lower in
asthmatics compared to the control healthy children and that the higher the level of IL10, the
better the clinical response to montelukast (r=0.73). While the role of the other cytokines
tested in this study, IL 2, IL 17 and IFN-gamma was non-significant regarding association
with disease or influence on response to montelukast.
Data regarding serum IgE level in the recruited 60 asthmatic children revealed that there is a
significantly increased level compared to the healthy control group, p value < 0.05.
Additionally its serum level negatively correlates with clinical response to montelukast, r=
0.58.
In conclusion, serum level of IgE, IL4 and IL10 are important markers associated with
childhood asthma development and influencing response to montelukast. Secondly, it was
shown that montelukast add-on therapy has significantly better biochemical and clinical
response in childhood asthma than conventional asthma controllers alone

b
ackground: Rheumatoid arthritis affects women more than men 3:1. Rheumatoid
arthritis can start at any age but most commonly occurs in the 30 – 50 age groups.
Rheumatoid arthritis also has oral, occular manifestations, dryness, swelling of
salivary glands, xerostomia, oral and mucosal ulcerations. The aims of this study were to
determine the oral manifestations in newly and old (previously) diagnosed Rheumatoid
arthritis patients and compare it with healthy controls (without systemic diseases) and finally
to find the accurate prevalence of these manifestations in rheumatoid arthritis patients.
Materials and methods: Seventy two (72) subjects were incorporated in this study, they
were divided into 2 groups, Rheumatoid arthritis patients group: fifty – two (52) patients with
rheumatoid arthritis, they were (11) males and (41) females, Seventeen newly diagnosed
rheumatoid arthritis untreated patients. Thirty five rheumatoid arthritis patients were on
methotrexate treatment. All rheumatoid arthritis patients were without any other systemic
disease. Healthy control group: - twenty healthy control subjects with no signs and symptoms
of any systemic disease. They were sex and age matched to rheumatoid arthritis patients.
Results: The results revealed that the main oral manifestations of Rheumatoid arthritis
patients were angular cheilitis, candidial infection, tempromandibular joint disorder, oral
ulceration, and xerostomia. In old diagnosed rheumatoid arthritis patients, the percentages of
oral ulcerations, tempromanbdibular joints, and xerostomia was significantly higher than in
newly diagnosed rheumatoid arthritis patients. While the percentage of angular chilitis and
candidial infections in newly diagnosed rheumatoid arthritis patients was significantly higher
than in old (previously) diagnosed patients.
Conclusion: Rheumatoid arthritis is a chronic disease in which Saliva is a good
recommended sample for evaluation and estimation of the severity of disease as well as
treatment follow up. Oral ulceration and xerostomia are the most prominent oral
manifestations coincide with the progress of the disease and treatment.

betermination of radon gas concentrations in multistory buildings and outdoor in the
Karbala University campus (Karbala-Iraq) were carried out by using Solid-state
nuclear track detector (CR-39).The detectors were distributed over 20places(14
indoor and others outdoor). The area of the study includes College of Medicine, College of
Dentistry, College of Pharmacy, College of Sciences, student's residence and the Central
Library. The dosimetric measurements were made over a period of 3 months.(from 15
September to 14 December 2012). After exposure, the detectors were etched in a
(NaOH) solution of normality (6.25 N) at temperature of 70 oC for 3 hours. The tracks were
counted by the microscope track-counting system. The indoor radon gas concentrations were
found to vary from 41.881 ± 2.463Bq/m3 to 95.642 ± 5.730 Bq/m3 with an average value and
standard deviation of 70.358 Bq/m3and14.367Bq/m3 respectively. The outdoor air radon
concentrations are ranged from 25.134 ± 1.783Bq/m3 to 28.594 ± 2.854Bq/m3 with an
average value of 26.974 Bq/m3and standard deviation 1.155 Bq/m3. In the survey of radon
concentration in multistory buildings was observed that the upper floor have lower radon
concentration than the ground floor. It has found that, in general, the radon level in lower
floors is higher than that in upper ones in all buildings. The annual effective dose to the
population from the inhalation of radon was also estimated and this varied from 1.056 ±
0.062mSv/ y to 2.412 ± 0.144mSv/ y, with an average of1.774 mSv/y and standard deviation
is 0.362mSv/ y. The ratio between indoor and outdoor radon concentration (mean value) in
this study was about 3.The radon concentrations were found to be lower than the higher level
recommended by ICRP ( 200 Bq/m3) and thus are within safe limits.