Karbala Journal of Medicine

bFamily is the most vital & important environmental factor in the life
experience of any individual. It has a major effect on the development, treatment & prognosis
of mental illness.
Objectives: The aim of this study was to evaluate the knowledge of relatives with a mentally
ill patient about Causes, treatment & prognosis of mental illness.
Methods: One hundred sixty relatives of schizophrenic out patients who live with them &
who accompany them to Al-Diwania Teaching Hospital Psychiatric Unit were studied using a
questionnaire to evaluate the knowledge of the relatives about causes, treatment & prognosis
of their patients.
First all patients , included in the study were schizophrenic diagnosed according to a semi
structured interview based on the criteria of /IDCL , International Diagnostic Checklist for
/ICD-10 schizophrenia.
Results: The results of the study show the general view of patients’ relative about mental
illness & their defective knowledge.
Conclusion: Most of the relatives lack the knowledge about causes, treatment & prognosis of
the mental disorder. Which usually lead to delayed adequate psychiatric treatment?

bBackground: The association between obesity and type-2 diabetes mellitus may be partly
mediated by altered secretion of adipokines by adipose tissue. Adiponectin is an adipokines
with anti-inflammatory and insulin sensitizing properties; it is secretion is down regulated in
obesity. The correlation of plasma adiponectin with the risk of type-2 diabetes mellitus and
hyperlipidemia is unclear.
Objective: To study the association between plasma adiponectin level with insulin and IL-8,
in type-2 diabetic obese patients in Karbala province: Iraq.
Material and method: A total number of 110 sample subjects with different age, and
different gender were classified according to diabetes mellitus and obesity. Fasting serum
adiponectin, insulin and IL-8 were measured by ELISA method.
Results: It was obtained that adiponectin level was lowered significantly in diabetic group,
obese group, and diabetic obese group as compared with control group. Serum adiponectin
was correlated negatively with serum insulin and with body fat percent (BF %), while there
was no relation with IL-8 level.
Conclusion: According to the presented data, adiponectin as hormone plays an important
role in prevention of obesity and insulin resistance, and increase insulin sensitivity.

b
ackground: Left Bundle Branch Block (LBBB) results from conduction delay
or block in any of several sites in the intraventricular conduction system,
The incidence of LBBB increases with age (2). It is infrequent in young
healthy subjects. LBBB Usually appears in patients with underlying heart disease,
Even among persons without overt heart disease, LBBB is associated with a higher
than normal risk of cardiovascular and all-cause mortality, . Among patients with
coronary artery disease, the presence of LBBB correlates with more extensive disease,
more severe left ventricular dysfunction, and reduced survival rates.
Objectives: Is to determine the prevalence of coronary artery disease in patients with
left bundle branch block in Babylon district.
Method and results: we studied 45 patients referred to the cardiac catheteriza
ion laboratory for various indications, significant percentage of patients were labeled
with the diagnosis of coronary artery disease (CAD), the prevalence od CAD in the
studied population was 44.2%, Male gender, diabetes, smoking, echocardiographic
finding of LV dysfunction or regional wall motion abnormalities were a risk factors
that are significantly associated with a higher prevalence of angiographically
documented coronary artery disease.
Conclusion: significant number of patients with LBBB has a normal coronary
angiography, consequently unnecessarily consumes anti anginal drugs and admitted to
coronary care units .using the predictors of existence of CAD, and multi detector 64
slice cardiac CT angiography would help much to rule out CAD in this population.

b
ackground: Cystatin C has been reported to be a potent predictor of increased
cardiovascular disease mortality. Serum Cystatin C may have a stronger
association with mortality and cardiovascular disease than serum Creatinine in
patients with normal or mildly reduced kidney function.
Objectives: The aim of this study to
1- Determine the prognostic value of cystatin C in patients with cardiovascular
disease (CVD) and compare the observed value with that obtained for healthy
controls.
2- Study the correlation between serum cystatin C and creatinine in cardiovascular
disease patients.
Patients and Methods: The prospective study included thirty (30) patients admitted
to hospital with cardiovascular disease (CVD) slected from Baghdad teaching hospital
and twenty-one (21) healthy individuals were included in this study. Fasting serum
cystatin C and creatinine were measured in all patients and controls.
Results and Discussion: A significant increased in the level of serum cystatin C
concentration was observed in patients with (CVD) as compared with the control
group.
Conclusion: Cystatin C is a prognostic biomarker of CVD. A graded association
exists between higher serum Cystatin C and increased CVD prevalence in patients
without chronic kidney disease (CKD)

b
ackground: External biliary fistula is a common complication following more
conservative hydatid liver surgery .A high output biliary fistula (drainage of
more than 300ml of bile /day), might be associated with increasing morbidity.
In the absence of distal biliary obstruction, the time required for fistula closure would
be dependent upon many factors, among which the Oddi sphincter pressure is the
most important. Lowering sphincter pressure has been tried by many methods
including endoscopic and pharmacological methods depending on documented
manometric studies.
Objectives: To evaluate the effectiveness of combined oral administration of
Nifidipin, Isosorbid dinitrate and hyocin butyl bromide in reducing the time required
for closure of biliary fistula following hydatid liver surgery.
Patients and methods: Fifty patient with high output biliary fistula (drainage of bile
of more than 300ml/day) who underwent surgery for hydatid cyst of the liver in Al –
Diwaniya and Baghdad teaching hospitals, 30 patients were subjected to a trial of
combined oral administration of Oddi sphincter relaxant drugs, to evaluate the
efficacy of this approach, they were compared with 20 patients in whom placebo was
administered with no other intervention adopted.
Results: The majority of patients ( 93.33%), the fistula output converted to a low one
within 5 days following the initiation of sphincter relaxants therapy, as compared to
only 10% of patients in the placebo group with obvious statistical difference . 73.3%
of patients in the study group exhibit complete cessation of bile drainage within 2-10
days as compared to 60% in the placebo group in whom complete cessation occur
within 20-40 days the difference was statistically significant. 90.3% of patients in the
study group were discharged within 7 days a period which significantly shorter as
compared to 90% of patients in the placebo group whose discharged within 2-3 weeks
in an average.
Conclusion: The administration of Oddi sphincter relaxant drugs may hasten the
fistula closure with less morbidity and shorter hospital stay therefore it is a beneficial
,
safe and cost effective method in the management of external biliary fistula
following hydatid liver surgery

b: multiple sclerosis (MS) has a much higher incidence among Caucasians that in
any other race. Females are much more susceptible than males and white females living in
colder weather areas are much more susceptible than those living in warmer areas. Oxidative
stress means an alteration in the delicate balance between free radicals and the scavenging
capacity of antioxidant enzymes in favor of free radicals in the body system.
Objective: To evaluate and compare the antioxidants and lipid peroxidation in patients with
MS and healthy control.
Patients and method: The study has included thirty patients with MS (16 females and 14
males) and thirty healthy subjects. The subjects were selected from people attending the out
patients clinic of Baghdad Teaching Hospital in Medical City. Laboratory parameters
included were: uric acid, albumin, and caeruloplasmin, total thaiol, malondiaaldehyde (MDA)
and peroxinitrate (ONOO¯).
Results: MDA and ONOO¯ levels in serum of patients with MS were significantly higher
than in the control group. While the levels of GSH, CP, albumin, uric acid, iron, copper and
zinc in serum of patients with MS were significantly lower than in healthy control.
Conclusion: Oxidative stress may have a role in the pathophysiology of multiple sclerosis
syndromes.

b
ackground: Oxidative stress has been found to be involved in both stroke and
renal dysfunction.
Aim: In the present study, the relationship of oxidative stress and renal
dysfunction after acute stroke was investigated.
Patients and Methods: Our study was conducted on seventy four patients with acute
stroke and forty one apparently healthy subjects were taken as control group. Patients
group was divided into two subgroups, patients with ischemic stroke and patients with
hemorrhagic stroke. The sera obtained from the blood of patients and healthy subjects
were used to measure the concentrations of malondialdehyde (MDA), glutathione
(GSH), creatinine (SCr), and blood urea nitrogen (BUN), and the specific activity of
glutathione peroxidase and catalase. Estimated glomerular filtration rate (eGFR) was
also calculated.
Results and Discussion: The results of this study showed that MAD, SCr, and BUN
concentrations were found to be significantly higher, and GSH concentration, GPX
and CAT activities, and eGFR levels were found to be significantly lower in acute
stroke patients than control group (P < 0.001). Patients with ischemic stroke have
significant increase in MDA and SCr concentrations (P< 0.01, P< 0.05, respectively),
and significant decrease in GSH concentration , GPX and CAT activities, and eGFR
levels (P< 0.05, P< 0.05, P< 0.01, P< 0.01, respectively) than patients with
hemorrhagic stroke.
Our results also showed the presence of highly significant positive correlation
between MDA concentration and BUN and SCr concentrations, and highly significant
negative correlation between MDA concentration and eGFR levels. Inversely there
was highly significant negative correlation between measured antioxidants levels and
BUN and SCr levels, and highly significant positive correlation between measured
antioxidants and eGFR levels.
According to the results of our study we found that acute stroke is associated with
elevated oxidative stress, kidney function is significantly compromised in patients
with acute stroke, acute kidney injury (AKI) is a common complication after acute
stroke, and there was highly significant correlation between oxidative stress in patient
with acute stroke and decline in kidney function.
Conclusion: The kidney function in patient with acute stroke may be directly or
indirectly affected by the level of oxidative stress developed during the acute phase of
disease and there was a cerebro-renal connection, which is disease that affects brain
may also affect kidney and vice versa.

b
ackground: To study the role of biochemical markers in sera of psoriatic
patients.
Aim: Evaluation and study of the correlation between lipid profiles and
Leptin in sera of psoriatic patients in Hilla province – Iraq.
Patients and Methods: The study was conducted on sixty psoriatic patients and thirty
apparently healthy persons were taken as control group. Blood collected from the
clinic of dermatology in Merjan Teaching Hospital and from the consultative center
for allergy and asthma in Hilla city / Iraq. Sera obtained from the blood were used to
determine the effect of psoriasis on leptin, total cholesterol, high density lipoprotein
(HDL-C), triglycerides (TGs), very low density lipoprotein (VLDL), and low density
lipoprotein cholesterol (LDL-C) concentration.
Results and Discussion: The results of the present study showed (significant increase
in leptin, total cholesterol, triglycerides, very low density lipoprotein and low density
lipoprotein cholesterol concentration), significant decrease in high density lipoprotein
cholesterol in sera of psoriasis group compared to control group, significant increase
in leptin concentration in sera of psoriasis females than males, significant increase in
leptin concentration in sera of psoriasis patients as increase BMI (body mass index)

b
ackground: Vitiligo is the most prevalent pigmentary disorder which occurs
worldwide. The etiopathogensis of vitiligo is complex, and includes genetic
factors, autoimmune process, and infectious factors. Alopecia areata is a
recurrent, nonscarring type of hair loss considered to be an autoimmune process.
Though its etiopathology is not fully understood, there are claims that imbalance of
trace elements may trigger the onset of alopecia areata.
Objectives: The objective of this study was to evaluate the levels of zinc, copper and
magnesium in serum and hair of vitiligo and alopecia areata patients hopefully to gain
a better understanding of the role of these trace elements in both diseases.
Methods: Twenty alopecia areata patients, twenty vitiligo patients, and twenty age
and sex matched controls were studied. Samples were analyzed using atomic
absorption spectrophotometric methods.
Results: Serum and hair zinc levels were significantly decreased in alopecia areata
patients and also in vitiligo patients compared with controls. Serum and hair levels of
copper and magnesium showed insignificant rise in both diseases when compared
with controls.
Conclusions: Copper and magnesium levels are not altered in alopecia areata or
vitiligo, but decreased zinc levels may play an important role in the etiopathogensis of
both diseases.

background: Prothrombin time test is traditionally used to monitor oral anticoagulant
drugs given for various clinical conditions. Prothrombin time test is carried out on
citrated plasma while most of the other hematological tests are carried on blood
anticoagulated with Ethylenediamine tetra acetic acid (EDTA).
Objective: To evaluate the possibility of using EDTA plasma for the control of oral
anticoagulant drugs.
Patients and methods: Thirty-six patients on different doses of Warfarin therapy were
included in the study, and 21 normal healthy subjects were used as control group. The work
was carried out in a private laboratory. Results were used to calculate the mean normal PT
(MNPT) from both groups. Blood was withdrawn in 2 tubes: Citrate tube and EDTA tube. On
each tube PT was determined in duplicate manually by Quick method using Biolabo
thromboplastin reagents. For the patients group the international normalized ratio (INR) was
calculated according to the thromboplastin manufacture kit instruction. SPSS version 9.0 was
used to calculate the correlation and regression. MedCalc statistical program version 11.6.1.0
was used for assessing the clinical agreement using the Bland and Altman method.
Results: A linear relationship between citrate and EDTA samples for the INR and PT
estimations was observed. The regression equations for INR and PT estimations with citrate
plasma (y) and EDTA plasma (x) were:
INR citrate = (-0.4) + (1.25) INR EDTA, R2=0.97
PT citrate = (-3.14) + (0.89) PT EDTA, R2=0.96
Bland and Altman method was used to compare clinical difference of INR results of citrate
and EDTA sample types which shows the mean difference (0.06) and the limits of agreement
(0.46, -0.33) which represents the mean difference ± 1.96 SD. Only four measurements were
out of range.
Conclusion: Despite the very good correlation observed between results of citrate and EDTA
samples, no clinical agreement was established between the two methods and the use of
EDTA samples for performing PT tests by manual Quick method is not acceptable.

background: Renal cell carcinomas (RCC) represent about 1-3% of all visceral
cancers. There are 30,000 new cases per year and 12,000 deaths from the
disease in USA (1).
Aim: To estimate the rate of VEGF & P53 immunohistochemical overexpression in
RCC in relation to histological types of tumor.
Methods: Fomalin fixed, paraffin-embedded blocks from 48 patients (28 male and 20
female) with RCC included in this study. A group of 12 patients with non specific
inflammation –pyelonephritis were included as a control group. LSAB+ (Labeled
Strept-Avidin Biotin) method was employed for immunohistochemical detection of
VEGF & P53.
Results: In assessment of the correlation of VEGF overexpression in RCC with
histological types, there is correlation between the intensity of VEGF expression &
classical type as (R= 0.618) while in other histological types no correlation & no
significant difference (p>0.05) between them. In assessment of the correlation of P53
overexpression in RCC there is a negative correlation (R=-0.843) in classical, in
papillary (R=-0.674) & no significant difference between them (p>0.05).
Conclusion: these finding provide further evidence for the role of VEGF & P53 in the
carcinogenesis of RCC. However both markers not well correlated with histological
types of the tumor

b
im of study: The current study was designed to compare antral follicle count
(A.F.C), ovarian volume & day 3 FSH level, with respect to their ability to predict
ovarian response of infertile women to ovulation induction agents (antiestrogens such
as clomiphene citrate or tamoxifen, or exogenous gonadotrophins).
Material and Methods: Sixty-two patients between the ages of 19 - 43 years participated in
this study when attending the infertility clinic of Babylon Hospital for Maternity and
Children. All patients underwent a transvaginal sonography on day 3-5 of cycle to measure
the ovarian volume and count of basal antral follicle, and basal FSH concentration was
determined on day 2-4 of a spontaneous period.
Induction of ovulation in next cycle by using antiestrogens or gonadotroohins (pure FSH-
gonal- F ) for 3 successive cycles . Patients monitored by using TVS on other days, then on
day 12 of cycle TVS was performed to assess the presence of dominant follicle.
Results: In this study the results showed that AFC has a higher predictability for successful
fertility treatments by assessing ovarian reserve, i.e. when AFC < 10; the success rate was
13.3, while when AFC > 10; the success rate was 58.3.
The next predicting factor was ovarian volume, when < 3 ml; the chance of success was
very poor (zero), while when volume is 3-9 ml; the success rate was 40.4% & when volume
>9 ml; the success rate was 63.6%.
While day 3 FSH had the lowest predictability, when FSH < 10 m IU /ml; the success rate
was 45.3%, while when FSH > 10 m IU / ml; the success rate was 38.8%
Conclusion: A.F.C. performs well as a test for ovarian response being superior to complex
and time consuming endocrine tests. It is therefore likely to be the test for general practice.

background: Cancer is one of the leading causes of death in the general population.
Breast cancer is the top. In Iraq, where the population was exposed to high levels of
depleted uranium following the first and second Gulf Wars, breast cancer became the
most common tumor type in females.1Interleukin-10 (IL-10) and Interleukin 12 (IL-12) are
the main immunological interplayers against cancer, and their impairment can be observed in
many cancers, including breast cancer. Over the last ten years, there has been a three-fold
increase in the incidence of breast cancer, with most of this increase being attributed to a
particularly aggressive type of the cancer.
Objectives: The high incidence rate of breast cancer in the last few years in Iraq inspired us
to create an investigation about the immunological bases of breast cancer in a series of local
Iraqi women to see whether any differences in this immunological profile could be found in a
population exposed to depleted uranium.
Methods: A Case-control study was designed and applied. A total of 40 subjects were chosen
for the immunological study. Blood samples were obtained at Hilla General Teaching
Hospital, Breast Cancer Centre (Pathology Department). The ELISA method was used for the
interleukins and β2-microglobulin detection.
Results: In this study, the association between the levels of the IL-10 , IL-12 and
β2microglobuline and breast cancer was evaluated. The data showed significant increase in
these cytokines levels among breast cancer patients and healthy controls.
Conclusions: The conclusions that can be extrapolated by this study are that, there was a
significant increase in the levels of the IL-10 , IL-12 and β2-microglobuline among breast
cancer patients and healthy controls.

bThis study was conducted to determine the alterations in serum
trace elements, including zinc (Zn), copper (Cu), iron (Fe), and magnesium
(Mg) in patients with chronic hepatitis C and to compare the results with
those of age and sex matched healthy individuals.
Methods: The study was carried out in Medical Research Unit, College of Medicine,
Al-Nahrain University from 2009-2010. One hundred and ten subjects, 60 patients
with chronic hepatitis C and 50 healthy individuals were included in this study. The
serum zinc, copper, iron and magnesium concentrations were measured by using
atomic absorption spectrophotometery.
Results: Serum zinc, copper, iron and magnesium concentrations were found to be
1.081±0.08, 1.143±0.025, 0.0819±0.0188 and 27.455±0.409 mg/L respectively in
patients with chronic hepatitis C and 1.086±0.4680, 1.103±0.326, 0.0339±0.0066 and
16.80±0.56 mg/L in healthy individuals, respectively. Serum iron was exhibited to be
elevated significantly (p<0.01) and magnesium was observed to be decreased
significantly (p<0.01) in patients when compared with those of the control group.
However zinc and copper remained without significant variants

background: About 7% of population suffers from acute appendicitis during their
life time. The number of unnecessary operations regarding appendicitis particularly
in female reaches 45%. Perforation rates ranging from 4% up to 45% in adult and
from 30% up to 60% in children.
Aim: To evaluate the sensitivity and accuracy of the Alvarado score in pre operative
diagnosis of acute appendicitis.
Patients and method: A series of 129 patients, were studied prospectively over a period of
20 months starting from May 2007 to December 2008 in AL – Hilla teaching hospital. A
questionnaire used in this study includes sex, age, duration of presentation in addition to
seven predictive values constituting the Alvarado score.
Result: We had 79/ 129 male patients (61.24%) and 50 /129 female patients (38.75%). All
of them underwent appendicectomy .106 /129 patients had histological diagnosis of
appendicitis (82.17%) they were 70/106 males (66%) and 36/106 females (34%).and the rest
23/129 patients had normal appendix improved histologicaly ( 17.83%) they were 9/23
males (39%) 2 of them were have pathology ( meckles diverticulum )and 7 of them were
have no pathology and 14/23 females (60%) 7 of them were have pathology ( twisted or
rupture ovarian cyst ) and 7 were had no pathology. The mean age was 23.9 years.
Conclusion: A high score rate was found to be an easy and satisfactory aid in the early
diagnosis of acute appendicitis.

b
ackground: The surgical management of patients presenting with acute cholecystitis
remains controversial.
The aim of this study was to evaluate the safety and feasibility of urgent
laparoscopic cholecystectomy during the “index” (acute) admission with acute cholecystitis,
and to compare with a policy of delayed (interval) cholecystectomy.
Methods: Between December 2009 and March 2011, 120 patients who had undergone
laparoscopic cholecystectomy. Sixty patients underwent surgery during the index admission
(group I). Sixty patients were assigned to initial conservative treatment followed by delayed
laparoscopic cholecystectomy (group II).
Results: The cholecystectomy for acute group took longer operative time, needed more
modification of the procedure used. It had comparable rate of complication, conversion rate
and a shorter hospital stay than delayed group.
Conclusions: Laparoscopic cholecystectomy during the index admission with acute
cholecystitis can be performed safely and successfully.

bBackground: Head injury is one of the most important causes of death in trauma, preventive
measures are widespread but not applied in all countries, and motorcycle accidents account
the major problem in Karbala for the last few years.
This study is aiming to compare the incidence, severity, outcome and other factors for each
of motorcycle accidents from other causes of head injury in Karbala.
Methods: 240 patients sustained head injuries admitted to neurosurgical ward and intensive
care unit, from 1st of January till the last of August 2008 in Al- Hussein Teaching Hospital,
those patients had been divided into five groups according to the cause of head injury, the
following parameters were analyzed, which are age, sex, severity of head injury, other
systemic injury, type of treatment, and the outcome of each group.
Results: the study showed that patients with motorcycle accidents have the highest
incidence (No. = 168, 70%), most of them were young, male, and carry the highest morbidity
and mortality.
Conclusion: motorcycle accidents account for the highest incidence of head injury in Karbala
in 2008 which carry high morbidity and mortality.
Recommendation:
1. Educate motorcyclist about the preventive measures which should be taken like helmet
wearing, limitation of the speed of vehicles.
2.Strict traffic laws should be applied.

background: Knee osteoarthritis is common in old adults. Determination of risk
factors of knee osteoarthritis may help in its prevention and modification of
treatment. The objective of this study is to determine the significance of some risk
factors like obesity and smoking on knee osteoarthritis.
Material & methods: The study included 132 outpatient attendants (102 females & 30
males) aged (53±9) years. Height and weight were measured for calculation of Body Mass
Index; smoking habits were registered by questionnaire. Hemoglobin level, Erythrocyte
Sedimentation Rate & C - reactive protein was measured for all participants.
Results: The number of patients with knee osteoarthritis was 61(46%), of these; 39 patients
(64%) were obese including 13 patients who were smokers.
The mean & standard deviation of Hemoglobin & Erythrocyte Sedimentation Rate were
12±1 & 24±16 respectively, while C - reactive protein was positive in 29 (22%) of
participants.
Smoking habit was significantly higher in patients with knee osteoarthritis (p<0.01) and in
knee osteoarthritis obese patients (p<0.01) when compared to non- knee osteoarthritis
subjects and obese non- knee osteoarthritis subjects; respectively.
Conclusion In accordance with the literature, this study found a strong association between
Body Mass Index and knee osteoarthritis risk. In addition, the increase in the prevalence of
smoking in radiographically confirmed knee osteoarthritis was observed suggesting that
smoking habit may be a potentially modifiable environmental risk factor for knee
osteoarthritis.

bcute hemorrhagic edema of infancy (AHEI) is an uncommon form of eukocytoclastic
vasculitis that affects children younger than 3 years and frequently is preceded by
drug intake, vaccination, or a variety of infections.
It is characterized by an abrupt onset of fever, purpuric lesions, and peripheral edema on the
face and extremities & ears. The course is benign with spontaneous resolution.
Key words: Acute hemorrhagic edema, infancy