Karbala Journal of Medicine

b
ackground: Typhoid fever is a common systemic illness caused primarily by
infection with Salmonella typhi. It could be diagnosed depending on classic clinical
features supported by serologic and bacteriologic demonstration. It is well known that
this disease is characterized by sharp seasonal variation in addition to many other factors
affecting its prevalence in the population. These factors may include age, residence,
psychosocial status and certain environmental conditions.
Study design and objective: This is a cross sectional epidemiological study. It was done
during August, 2008 through July, 2009 in Karbala. It aims to isolate and identify Salmonella
typhi from blood samples collected from clinically suspected cases to predict the diagnostic
value of the clinical suspicion versus the bacteriologic investigation including isolation and
characterization of the main causative pathogen, Salmonella typhi. Also it aims to determine
the effect of age, gender, educational level and seasonal variation on the frequency
distribution of typhoid fever during the study period.
Method: Blood samples were collected from 718clinically suspected patients (355 males and
363 females) who attended Al-Hussein Teaching Hospital and Pediatric teaching Hospital in
Karbala with signs and symptoms of typhoid fever (proven by specialist
physician/pediatrician). Blood was cultured in enriched, selective and differential media to
isolate the causative agent, Salmonella typhi and was confirmed by some specific
biochemical tests.
Results: Of the 718 blood samples, only379 (~52.8%) gave positive blood culture for
Salmonella typhi proven by specific biochemical tests. The percentage of infected patients
according to gender showed non-significant difference (males ~45.8% compared with
females ~54.2%). Similarly, when incidence compared in terms of standard of education, it
was (46.4% among educated versus 53.6% uneducated). Additionally, frequency distribution
of infection in terms of different age groups showed significantly higher infection rates in age
groups 5-14 and 15- 45 years than others (recording 28.21% and 46.58%,
respectively).Regarding seasonal variations, the infection rates were recorded to be peaked in
June recording 19.22% from the annual infection rates, while the lowest rate was recorded in
February (1.81%) indicating a highly significant difference (p-value <0.01).
Conclusion: According to the study data, it was concluded that only about half the clinically
suspected cases of typhoid fever give positive blood culture results for the main causative
pathogen, Salmonella typhi. Also, it was shown that there is no significant effect of gender
and education standard on rate of infection with typhoid fever. However, seasonal variation
and age significantly affect this rate.

b
total of 480 fecal samples were collected from patients (less than 18 years old), of
both sex suffering from diarrhea who admitted to Al-Diwaniya Teaching Hospital
and the Teaching Hospital of Maternity and Pediatrics in Al- Qadisiya governorate.
Salmonella spp. was isolated and identified using bacterial culturing on selective media, in
addition to, biochemical and serotyping by monovalent antisera. Polymerase Chain Reaction
(PCR) was used to detect rfbj (B) gene encoding for biosynthesis of LPS of group B
Salmonella. The results revealed that the rate of Salmonella isolates in fecal samples of
patients were 7.9% using cultural and biochemical methods .The result of Salmonella
isolates by serotyping using monovalent antisera revealed that 30 out of 34 isolates (88 %)
belong to S. Typhimurium serotype , while the remain belong to S. Enteritidis ( 2 isolates )
and S.Meunchen (2isolates). when the PCR technique was used to detect the presence of
rfbj(B) gene, 34 Salmonella isolates belong to Salmonella serogroup (B) appeared to
contain this gene since DNA amplification showed one distinct band (882 bp) when
electrophorised on agarose gel. The results of this study revealed that the PCR technique had
a high specifity (100%) in detection of Salmonella serogroup B in comparison to cultural,
biochemical and serological tests

b
bjective: The aim of this study was to show the effects of lactation on ovarian
morphology by ultrasound examination and to express these effects by terms of
fertility control .
Material and Methods: This study was carried in Al-Zahra’a Teaching Hospital of
Maternity & Pediatrics in Al-Najaf City, from March 2007 to September 2007. A total 100
women were studded, divided into two groups, 50 lactating women and 50 non-lactating
women and, a comparison was done between ultrasound findings of the ovaries of the two
groups; those patients were selected from patients attending out patients clinic of Obstetrics
& Gynecology unite. History was taken about age , parity , mode of delivery , no. of breast
feeding per day , whether the patient use supplementary food or not , no. of feeding at night
,on wishes or demands , if women resume menstruation or not and duration after birth
.Ultrasound examination of ovaries was done to all cases and mean ovarian volume , mean
follicular number and size was taken and any morphological finding in terms of texture or
stromal size
Results: We found that there is significant effect of lactation on ovarian volume and
morphology and increase number of follicles , with peripheral distribution without detection
of mature follicle by studying the size of follicle with increase in ovarian stroma (stromal
hyperplasia ).Our study show also that there is strong relationship between suckling episodes
, feeding at night , supplementary food during breast feeding , resumption of menses and age
of infant with these effects . So we found that increasing of suckling episodes (> 8 times of
feeding per day ) and feeding at night twice or more , exclusive breastfeeding without giving
even water to the baby , with no resumption of menses and infant less than 6 months of age ;
all these gives typical effects on ovarian morphology and make the women sub-fertile by (76
% ) .

bhe aim of this study is to evaluate the effect of salt and sugar on patients suffering from gagging reflex.
Materials and method: 120 subjects suffering from gagging reflex ranging from 30-50 years old were examined to assess the gagging reflex response when using stock tray, stock tray with alginate, applying sugar on the tongue then impression and salt then an alginate impression also taken.
Results: the results revealed the increase in gagging reflex with impression material compared with tray alone, also the use of salt and sugar decrease the gagging reflex.
Conclusion: the effect of salt and sugar on gagging reflex as it blocks the transmission of impulses that cause gagging reflex also the psychological effect of these two tastes on gagging sensation during taking the impression

b
ackground: non toxic goiter is a prevalent thyroid pathology worldwide
characterized by unilateral or bilateral thyroid enlargement which arises due to many
factors affects the thyroid tissue.
Objective: To determine the histological findings observed in non toxic goiter of the resected
thyroid tissue in Mosul city.
Materials & Methods: Patients were classified according to the preoperative clinical
diagnosis into those with non toxic multinodular goiter & those with solitary thyroid nodules,
preoperative clinical diagnosis was confirmed by Fine Needle Aspiration Cytology.
Postoperatively the thyroid tissue biopsies were collected and fixed in 10% formaline,
processed & stained with Haematoxylline & Eosin for histological analysis.
Results: non toxic goiter is more common in female than male. Specimens obtained from
patients presented with multinodular goiter showed variable sized thyroid follicles, huge
follicles were filled with colloid and lined by flattened epithelial cells, most of the nodules
were not encapsulated. Specimens obtained from follicular adenoma showed well developed
microfollicles with intact fibrous thin capsule. Degenerative changes in the stromal tissue
such as haemorrhge , fibrosis & even calcification were present in some of the cases. If
hyperthyroidism associated with a discrete swelling it indicates a manifestation of toxic
multinodular goiter. Solitary thyroid nodule was observed as a hard, irregular swelling with
apparent unusual fixity associated with scanty normal follicular cells together with colloid.
Conclusion: Incidence of multinodular goiter in Mosul city is more in female than male & in
both sexes it increases between 20 to 50 years of age

bIt has been suggested that, in vitiligo there was a systemic imbalance of both
enzymatic and non-enzymatic antioxidants which could be the source of damage of the
melanocytes. Generation of reactive oxygen species and lipid peroxides is associated with
this imbalance which could be the possible pathogenic factors in this hypopigmentary
disorder.
Objective: The aim of the present study was to determine the levels of antioxidant
parameters; glutathione peroxidase (GSH-Px), glutathione (GSH), catalase (CAT) and the
level of lipid peroxidation marker Malandialdehyde (MDA) in patients with vitiligo in
comparison with healthy controls matched for age and sex and to correlate these levels with
the activity , extent of the disease and with age and sex of the patients, aiming to clarify the
role of systemic oxidative stress in pathogenesis of vitiligo.

b
ackground: Staphylococcus aureus is a ubiquitous bacterium that is generating
increasingly bad press coverage due to its propensity to adopt a pathogenic lifestyle in
hospital and community settings. S. aureus colonies are found in approximately 30%
of the general population. It colonizes the skin readily and can lead to a wide range of
pathological conditions from skin lesions to osteomyelitis, endocarditis, and septicemia.
Hemolysins are extracellular toxic proteins which are produced by many gram negative (e.g.
Escherichia coli, Serratia spp., Proteus spp., Vibrio spp., Pasteurella spp., Pseudomonas
aeruginosa) and gram positive bacteria (e.g. Streptococcus spp., Staphylococcus aureus,
Listeria spp., Bacillus cerius, Clostridium tetani), all of which possess a certain pathogenic
potential. Hemolysins have been therefore always considered as virulence factors. Most
hemolysins cause lysis of erythrocytes by forming pores of varying diameters in the
membrane and are designated as such because they have the ability to lyse red blood cells
(RBCs).
Objectives
1-Purification of hemolysin from a local isolate of S. aureus.
2-Characterization of hemolysin produced by a local isolate of S. aureus.
Methods: Bacterial samples were identified by subjecting them to the standard laboratory
procedures while semi quantitative screening on blood agar (containing 5% human blood)
revealed that all isolates were hemolysin producer but in different efficiencies. Hemolysin
was extracted by cooling centrifugation and purified by many steps including: precipitation
by ammonium sulphate, dialysis, ionic exchange chromatography by using DEAE-Cellulose,
and gel filtration chromatography by using Sephadex G-100. The molecular weight of
hemolysin was determined by gel filtration chromatography on Sephadex G-100 while the
optimum pH and temperature for hemolysin stability were also determined.
Results: The results showed that forty isolates out of 100 were identified as Staphylococcus
aureus. Hemolysin was extracted by cooling centrifugation and purified by many steps
including: precipitation by ammonium sulphate with 50-75% saturation percentage, dialysis,
ionic exchange chromatography by using DEAE-Cellulose, and gel filtration chromatography
by using Sephadex G-100. The results showed that hemolysin was purified 135 fold with a
yield of 1.16%.The molecular weight of hemolysin determined by gel filtration
chromatography on Sephadex G-100 column was about 35000 daltons, while the optimum
pH for enzyme stability was 7 and the optimum temperature for enzyme stability was
between 25-35oC.
Conclusions
1.Conventional methods can be performed to extract hemolysins.
2.Hemolysin was maximally produced when the pH was near neutrality and incubation
temperature was 37oC and this conclusion indicates that hemolysin was produced when the
conditions were similar to that of the host

bBackground Zinc deficiency is prevalent in children in developing countries. Supplemental
zinc provides therapeutic benefits in diarrhea.
Objectives: To evaluate the role of zinc supplementation in the recovery of hospitalized
children on intravenous fluid for acute diarrhea.
Patients & Methods: A randomized control trial of 116 cases who were admitted to
Karbala teaching hospital for children from October 2007 toAugust 2008 were enrolled in our
study, the children aged 3 to 60 months old were divided into 2 groups, zinc group (57 cases)
who received zinc for 14 days and control group (51 cases) who did not receive zinc. Zinc
was given according to WHO guideline, 10 mg daily for infants up to 6 months of age, and
20 mg daily for older infants and children. General stool examination, serum k+, Na+, blood
urea, and serum alkaline phosphates were done for all patients.
Results: Our study showed improvement in 16 patients (28.07% )of cases versus 5 (9.8%)in
the control group ( p value of 0.013) within the1st three days of treatment with zinc and52
patients (91.23% )versus 36 (70. 58% ) [ p value 0.017] 6 days after the treatment .
Conclusions: Zinc supplementation reduces the severity and duration of acute diarrhea in
hospitalized children on intravenous fluid.
Abbreviations: IVF: intravenous fluid; ALP: alkaline phosphatase; ORS: oral rehydration
solution.

b
ackground: Floaters and photopsia are common eye symptoms. This prospective
study aims to detect the relative importance of floaters, photopsia, or both as
predictors of vitreo-retinal pathology.
Material: 202 patients attending the outpatient clinic in Alkadhimya teaching hospital
between 2008–2010 complaining of floaters, photopsia, or both were interrogated .starting
with inquiry about the mode of presentation, then slit lamp examination of the anterior
segment, and dilatation of the pupil by mydriacyl drops 0.5% and phenylphrine drops 10%,
followed by 3 mirror examination of the vitreous and peripheral retina.
Results: 98 patients were male while 104 patients were female. 104 patients (51.49%)
presented with floaters; 24 patients (11.88%) presented with photopsia; and 74 patients
(36.63%) presented with both floaters and photopsia. 102 patients (50.50%) had posterior
vitreous detachment (PVD) while 52 patients (25.74%) had synchysis, and 48 patients
(23.76%) had normal vitreous. The highest percentage of PVD was in the age group 60 – 69
years and was 40 patients (39.21%). Regarding the mode of presentation, the highest
percentage of PVD was in the group of patients presenting with both floaters and photopsia
and was 46 patients (62.16%). The total number of retinal tear cases detected was 14; 8 of
them were present in patients having PVD and presenting with floaters and photopsia, while
4 cases of retinal tears were detected in patients having PVD and presenting with floaters, and
finally 2 retinal tear cases were detected in patients having PVD and presenting with
photopsia. 12 eyes (85.71%) who had retinal tears had vitreous pigment granules, while 2
eyes with retinal tears (14.29%) did not have vitreous pigment granules.
Conclusion: the symptoms of floaters, photopsia, or both are an important predictors of
vitreo- retinal pathology. A significant number of patients had PVD, and this was associated
with retinal tears in a number of patients. Vitreous pigment granules in these patients were
closely correlated with the presence of retinal tears. Careful examination of patients including
3 mirror contact lens examinations is mandatory