Karbala Journal of Medicine

bObjective: the aim of this study is to determine the prevalence and the rate of renal
artery variations in the middle Euphrates Iraqi population.
Materials and methods : Three hundred fifty eight (358) patients were referred to
Shaheed Al Mihrab Cardiac Centre in Hilla province for a variety of indications for
catheterization including ischemic heart disease , lower limb peripheral arterial
disease , valvular heart disease , etc , detailed information about the angiographic
procedure was given, an informed consent was obtained ,all patients renal arteries
were visualized by either selective engagement using Judkins RT catheter or non
selectively using a pig tail catheter .
Results : Anatomically the origin of the main renal artery was at the level of the first
lumbar vertebra (L1) in 62% , L1-L2 disk in 13% ,L2(22%) of the cases , the
remaining 3% was distributed over the T12 ,T12-L1 ,L2-L3 ,L3, L4 vertebral levels .
The renal artery bifurcates at the hilum into the segmental arteries in 56.7% of the
cases , in the remaining 43.3% ,the renal artery bifurcates in to segmental arteries
before it reaches the hilum and at variable distance from it aortic origin .Each kidney
was supplied by a single renal artery on both side in the same patients in 79.8% of the
cases while in the remaining 20.2% there was more than one renal artery in the
following ratios :unilateral dual blood supply on the LT kidney (10%), RT kidney
(6.5%) ,bilateral dual blood supply on both sides (2.5%) and in 1% of the cases there
was more than two arteries on either side .we recorded one case four renal arteries on
the left kidney , and there was triple renal arteries bilaterally in another one case .
Conclusion: Renal artery anatomical variation is common in the general population
and this study confirms a nearly comparable frequency of variations in the Iraqi
population with some diversion from the comparable studies that might be explained
on racial bases.

b
ackground: Beta-thalassemia major is one of the major health problems in our
country. Many studies have confirmed the fact that, these patients have an increased
susceptibility to bacterial infections, assumed to be the result of immunological
changes.
Objective: This study aimed to evaluate some of humoral immunological parameters of
thalassemic patients by measuring their serum concentration of Immunoglobulin (IgG), IgM,
IgA, and serum complement components C3 and C4.
Patients & Methods: A total of forty five beta-thalassemia major patients who were
attending to the thalassemia center in Kerbala teaching pediatrics hospital (24 males and 21
females) from January to August of 2009 and fifty of control children with matched age and
sex were randomly selected from apparently healthy individuals without any history of recent
or recurrent infections, were enrolled in the study. Serum IgG, IgM, IgA, C3 and C4 levels
were measured using Single Radial Immunodiffusion (SRID).
Results: The mean of serum IgG, IgM &IgA showed a significant increment (P<0.01) in
thalassemic patients as compared with apparently healthy control group, while the serum
levels of C3 and C4 were significantly decreased (P<0.01) in thalassemic patients as
compared with control group.
Conclusion: The elevation of serum levels of studied immunoglobulins can be due to
continuous exposure to antigens, repeated infections, and chronic liver disease, while the
only probable cause of humoral immune deficiency were found in these patients were due to
the decline of serum complement levels (C3 and C4).
Recommendations: The determination of serum levels of immunoglobulins and complement
components have a beneficial value for evaluation of immunological status of thalassaemia
major patients and further work need to be done to evaluate another immunological
parameters for example the serum level of cytokines to manipulate the immunological
aspects of thalassemic patients.

bThe incidence of breast cancer in young women (age < 35) is low. The biology of the
disease in this age group is poorly understood, and there are conflicting data regarding, the prognosis
for these women compared to older patients.
Patients and methods: We retrospectively analyzed consecutive primary invasive breast cancer
patients who underwent surgical procedures at our institution between 1990 and 2002. The younger
age group was defined as patients aged <35 years at the time of diagnosis, the clinicopathological
characteristics and treatment outcomes were compared between younger and older age groups.
Result: A total of 51 (12.5%) patients were aged <35. There was a significantly higher incidence of
nuclear grade 3 and medullary histological-type tumors in younger patients compared to older
patients. Axillary lymph node status, T stage, histological grade, and estrogen receptor status did not
differ significantly between the two age groups. Younger patients had a greater probability of
recurrence and death at all time periods, although there was no significant difference in disease-free
survival between the two age groups.
In lymph node-negative patients, the younger group showed worse prognosis among lymph node
positive patients (p<0.001).
Conclusion: In multivariate analysis, young age remained a significant predictor of recurrence
(p=0.010). Young age (<35) is an independent risk factor for relapse in operable breast cancer
patients.

bTransvaginal colour Doppler (TVCD) Sonography is the gold
standard in investigating gynecological pathologies, in addition to its close
proximity to the pelvic organs that gives close view of the morphological
features of the organs, it also provides an opportunity to visualize and quantify pelvic
blood flow in uterine and adnexial masses. Another use of TVCD to quantify the
physiological changes of the uterine and ovarian blood flow in relation to hormonal
changes during the menstrual cycle. The intrauterine contraceptive device (IUCD) is a
widely used measure of contraception that is not devoid of complications, and the
most important one is the occurrence of menorrhagia in women using the copper
coated IUCD which may be predicted by measuring both pulsatility and resistance
index of uterine artery .
Aims of the study: The aim of this study was to evaluate the effect of copper- IUCD
on uterine artery blood flow by using pulsed and colour Doppler ultrasonography.
Patients material and method: Sixty women were submitted to this study and after
exclusion of two of them then 58 women (age range 16-45) were divided into two
groups: the control group 30 women (51.72%) without IUCD and the 2nd group 28
women (48.28%) with copper coated IUCD.
The RI and PI of the uterine artery were measured by colour and pulsed Doppler
TVUS, 44 women (75.86%) of them were in the proliferative and the other 14
(24.14%) were in the secretory phase of the menstrual cycle.
Results: the RI and the PI values of the uterine artery are changed by the phase of the
menstrual cycle in both groups, the mean RI in the early proliferative phase 0.88, and
in the secretory phase 0.87 of the control group, and in the IUCD group it was in the
proliferative 0.85 while in the secretory was 0.86
The PI also showed differences between the two halves of the cycle in both groups:
In the 1st group were 2.37, 2.13 in the early 1st and the 2nd halves of the cycle
respectively, and in the 2nd was 2.15 and 2.53 in the early 1st and the 2nd halves
respectively. It was evident that in women with IUCD and menorhagia both the RI
(0.81) and PI (1.78) were lower than the women with IUCD and normal menstrual
flow
Conclusions: The IUCD does not alter the blood flow indices of the uterine arteries
significantly as measured by Doppler TVUS except in susceptible women who are
prone to develop menorrhagia after IUCD insertion. So it can be used to predict which
women will develop menorrhagia after IUCD insertion

bA prospective study was carried out to study the complications that may
be associated with visceral leishmaniasis with special emphasis on any bacterial or
parasitic complications.
Methods: The study included 132 in-patient children who were admitted to Basrah Maternity
and Children Hospital and Basrah General Hospital with visceral leishmaniasis
from November 2004 till November 2005.
Direct agglutination test (DAT) and bone marrow examination were used to confirm the
diagnosis. All patients were sent for blood culture, urine culture and stool culture, in addition
to general stool examination.
Results: Among 132 sero-positive cases, Diarrhea with or without vomiting, was found in
75 cases (56.8%), followed by urinary tract infection in 30 (23.4%) of the cases, and
bronchopneumonia in 10 cases (7.5%). The main non-infectious complications were
malnutrition in 86 (65.1%) of the cases, followed by bleeding tendency in 18 cases (13.6%).
Pathogenic bacteria were isolated in 41(31%) out of 132 sero-positive patients. The
commonest type of bacteria isolated was Klebsiella (16 isolates) followed by Escherichia coli
and Proteus (11 and 9 isolates), respectively. These three types of bacteria represented
(78.2%) of total isolates.
Parasitic infections were detected in 44 (33.3%) patients. The commonest parasites
detected were Cryptosporidium parvum (18.9%) and Entamoeba histolytica (13.6%), Giardia
lamblia, Blastocystis hominis, Hymenolypis nana, and Enterobius vermicularis were also
detected but in lower frequency.
Conclusion: From this study we conclude that bacterial infections and pathogenic parasites
were confirmed in about one third of VL cases for each; Klebsiella is the most common
bacteria reported while Cryptosporidium parvum is the most common parasite

bSickle cell haemoglobin (HbS) results from an autosomal
recessively inherited mutation in which the amino-acid glutamine is replaced
by valine at position 6 in the beta globin chain of haemoglobin (Hb). Sickle
cells have a reduced deformability and are easily destroyed, causing occlusion of the
microcirculation and a chronic haemolytic anaemia with a median Hb concentration
level of about 9 g/dl. Routine electrophoresis methods and High performance liquid
chromatography (HPLC) were used to screen normal and variant Hb, and allowed the
verification of the Hb observed with electrophoresis and precise quantification of their
proportion.
Objectives: 1- This study aimed to evaluate the chromatographic pattern of Hb types
(HbA, HbF, HbA2 and HbS) of sickle cell anemia patients in comparison with the
apparently healthy individuals.
2- To study the Hb chromatographic patterns according to the gender, age and blood
groups.
3- To evaluate the efficiency of variant Hb testing system in detection of HbS type of
sickle cell anaemia patients.
Methods: A total of eighty four sickle cell anemia patients who were attending to the
Ibn Al-Baladi pediatrics hospital (in Baghdad) and Kerbala teaching pediatrics
hospital, the samples were (39) males and (45) females , from April of 2006 to
February of 2007 . And thirty seven of case controls with matched age and sex were
randomly selected from apparently healthy individuals. High performance liquid
chromatography (HPLC) was adopted to determine the different types of Hb for
patients and control groups using variant Hb testing system which depend upon the
separation and quantification of Hb types by high performance liquid chromatography
technique.
Results: The study of Hb chromatographic patterns of samples revealed that there
were no significant differences (p ≥ 0.05) between the values of HbA2 for the patients
and control groups and there were significant differences (P≤ 0.05) for HbF and
highly significant differences (P≤ 0.01) for HbA and HbS percentages of patients in
comparison with the control group. The results of Hb chromatographic patterns of
samples according to the gender revealed that there were no significant differences at
(p≥ 0.05) between males and females within patient and control groups. The results of
Hb chromatographic patterns of Hb types for patients and control groups according to
the age groups revealed heterogeneous results with highest HbF, HbA, and HbA2
percentages of patients were (10.83±3.32, 57.6±7.33, and 4.22 ±1.88) respectively in
age group less than five years old, while it was (54.33±8.9) for HbS type in age group
(6-10) years old. As for control group, the highest HbF percentages was (8.2±4.09) in
age group less than five years old, for HbA was (87.22±5.86) in age group (6-10)
years old, for HbA2 was (3.6±0.23) in age group (11-15) years old, and for HbS was
(0.3±0.05) in age group less than five years old. Finally, the results also showed that
there were no significant differences at (P ≥ 0.05) for Hb chromatographic patterns of
980
Karbala J. Med. Vol.4, No.1,2, Jun, 2011

Evaluation of (HPLC) Patterns of Sickle Cell Anaemia…. Zuhair M. Jeddoa
Karbala J. Med. Vol.4, No.1,2, Jun, 2011

different Hb types percentages according to the blood groups of studied samples
within group (patients or controls).
Conclusion:
1- The study of Hb chromatographic patterns is useful for the diagnosis of sickle
cell anaemia.
2- There are no significant effects of gender and blood groups on the
chromatographic patterns of different Hb types of sickle cell anaemia patients
in comparison to the apparently healthy individuals.
3- HPLC is an excellent, powerful diagnostic tool for the direct identification of
HbS.

bThe aim this study was to analyze the patterns of involvement of
the heart in our patients with SLE by means of clinical evaluation,
electrocardiography, and echocardiography.
Methods: Forty six consecutive patients (40 females and 6 males) with systemic
lupus erythematosus (SLE) were studied for cardiac manifestations of the disease.
Clinical history, physical examination, electrocardiography, chest X ray
,echocardiography study and standard laboratory tests were performed .Thirty three
patients (72%) have evidence of cardiac involvement .
Results: Thirty one patients (67%) were found to have abnormal echocardiography
findings. Reduction in shortening fraction which reflects reduction in left ventricular
function was the commonest abnormality. It was present in 15 patients (33%).
Endocardial involvement in form of valvular dysfunction with or with out thickening
was found in 10 patients (22%).
Conclusion: The heart is a common target for systemic lupus erythematosus.
Therefore, echocardiography should be performed periodically in SLE patients

bCoronary heart disease is one of the leading causes of morbidity and
mortality elsewhere in the world . An association between liver enzymes and
coronary heart disease is suggested.
Objective: To evaluate the changes in liver enzymes, Alanine aminotransferases and
aspartate aminotransferases in patients with coronary heart disease.
Methods: The study included 60 patients with coronary heart disease (41 males
and 19
females), and 40 control subjects (25 males and 15 females) from Basrah, Iraq. Alanine
aminotransferase, aspartate aminotransferase, lipid profile and fasting blood glucose levels
were determined.
Results: alanine aminotransferase , aspartate aminotransferase, fasting blood glucose, total
cholesterol, triglycerides, and low density lipoprotein- cholesterol levels were significantly
higher among coronary heart disease patients compared to controls (P<0.001), while high
density lipoprotein- cholesterol level was significantly lower among patients with coronary
heart disease in comparison to controls (P<0.001). Alanine aminotransferases revealed a
significant positive correlation with triglycerides (P=0.006), and significant negative
correlation with high density lipoprotein- cholesterol
(P= 0.031) and no significant
correlations with body mass index, blood pressure, and other biochemical parameters
(P>0.05). On the other hand, aspartate aminotransferases showed significant positive
correlations with total cholesterol (P=0.009), triglycerides (P=0.025) and low density
lipoprotein- cholesterol (P=0.042), and no significant correlations with other physiological
and biochemical parameters (P>0.05).
Conclusions: A strong association exists between changes in liver enzymes, alanine
aminotransferase and aspartate aminotransferase and coronary heart disease. These enzymes
could be included within the increasing list of coronary heart disease risk factors. Also, they
might have prognostic significance and a predictive value in coronary heart disease
complications.

bIs to find out the possible cause or causes leading to intestinal
obstruction and to encourage doctors to make use of their clinical abilities
with few laboratory and radiological facilities available to diagnose and
manage intestinal obstruction.
Patients and Methods: The study consists of 73 patients admitted to AL-Hilla
teaching hospital with intestinal obstruction from October 2006 to December 2007.
Full medical assessment was done for them with full investigations. Thirty three
patients needed surgical intervention.
Results: The commonest etiology of intestinal obstruction was adhesions and bands
44 patients (60%), 5 patients (6.8%) incarcerated abdominal hernia, 3 patients (4.1%)
Volvulus of sigmoid, 2 patients (2.7%) mesenteric thrombosis, 2 patients (2.7%)
intuscessuption and 2 patients (2.7%) with pseudo obstruction. Small intestinal
obstruction constitutes 61 cases (83.56%) and large bowel obstruction 12 patients
(16.4%).
Discussion: The results of this study indicates that postoperative adhesions and bands
are the 'main cause of intestinal obstruction and appendicectomy was the main
operation leads to adhesional intestinal obstruction followed by gynecological
operation .It also indicates that generalized abdominal tenderness and rebound
tenderness are significant indicator of bowel strangulation.
Conclusion: Intestinal obstruction is a serious surgical condition and needs careful
clinical history and examination which remains the corner stone by which we can
differentiate between simple and ischemic obstruction, usually early intervention
needed to prevent gangrene and decrease morbidity and mortality.

bDiabetes mellitus emerge as a developing global problem ,
insulin resistant occur to be prominent feature of type-2 diabetes mellitus,
leptin hormone (which is a 167 amino acid protein synthesized in white
adipocyte and directly proportionate with obesity) have a relationship with diabetes
mellitus Type-2.while interlukin-8 (which is a chemotactic factor ) may play a role in
obesity or type-2 diabetes mellitus.
Objective: The aim of this study is to:
1-Determine the serum levels of Leptin, Insulin, Interleukin-8 (IL-8) and Lipid
profiles in Type-2 diabetic Iraqi patients.
2-Evaluate the correlation between leptin, insulin, IL-8 and Lipid profiles in sera of
Type-2 diabetes mellitus (T2DM) in Iraqi patients.
Materials and Methods: A total number of 95 (70 Type 2diabetic patients and 25
apparently normal subjects), (46male and 49 female) obtained from Al-Hussain
Teaching Hospital/ Karbala - Iraq between Oct. , 2010 – April , 2011 with age ranged
between (20-75) years how were divided into three groups: ( obese type-2 diabetic
patients, Non-obese type-2 diabetic patients, and Non-obese non-diabetic subjects )
.Obese diabetic patients was specified by body mass index, BMI ≥30kg/m2. Fasting
serum leptin, insulin, IL-8 ,and lipid profile have been determined. A pre-tested
questionnaire was designed to obtain information about age, gender, height, weight,
and past-medical history. Body Mass Index (BMI) and (BF%) were the only
anthropometric parameter specified.
Results and Discussion: The levels of each of leptin and insulin hormones,
Cholesterol, LDL-cholesterol, TG, BMI and BF% were elevated markedly in diabetic
patients compared with non-diabetic thin. Leptin hormone level shows a significant
positive correlation with insulin hormone, LDL-cholesterol, BMI and BF%. The level
of IL-8 was fluctuated and there is a non-significant positive correlation with
increasing BMI. Significant differences were found in leptin mean values between
male and female in which its levels is markedly elevated in females.
Conclusion: The results obtained in this study reveals significant elevations in serum
leptin, insulin, cholesterol, and LDL-cholesterol with a non-significant decline in
HDL-cholesterol in Type2 diabetic patients in comparison with normal subjects. Also
there was a significant elevation in serum leptin level in females in comparison with
males in both diabetic and control groups. There was a non-significant positive
correlation between IL-8 and obesity. The results show a strong correlation between
insulin resistant and leptin resistant

bixty seven samples were collected from urine, stool, pus, wounds of the
patients and operating theater from Baghdad Hospitals in 2010. Sixty two
isolates of Escherichia coli were diagnosed by bacteriological and biochemical
tests. These isolates were submitted to hemolysis test and antibiotic sensitivity
to 10 kinds of antibiotic disks on Mueller Hinton agar by disk diffusion method. The
detection of β-lactamase production was also done as well as extended-spectrum beta
lactamase (ESBL) for all the isolates. Hemolysis test was positive for two isolates. All
the isolates of E.coli were resistant to ampicillin and cephalothin (100%) and high
resistance was observed to cephalixin (95.1%), tobramycin (90.3%), doxycycline
(82.2. %) and nalidixic acid (70.9%). Both ciprofloxacin and nitrofurantoin was
(67.7%). Low resistance was noticed to amikacin (11.2%) and trimethoprime (8.1%).
β-lactamase test was positive for 57 isolates (91.9%), while three isolates (4.8%)
showed positive result for extended-spectrum β-lactamase.
Conclusion: Isolates of E.coli showed high resistance to ampicillin, cephalothin and
cephalixin. Low resistance was revealed to amikacin and trimethoprime. Most of the
isolates were positive for β-lactamase test (91.9%) and (4.8%) of the isolates were
positive for extended-spectrum beta-lactamase

b
sixty-five year old farmer presented with dry cough & mild exertional
dyspnea for 10 days, he has no previous history of asthma or TB, he was not
smoker, with no history of hypertension or diabetes, O/E he is well built not
cyanosed, mild dyspoenic BP 130/80, PR96/min regular, respiratory rate
20/min.chest examination is clear, Heart examination is normal, abdominal
examination also normal.

steopetrosis is a genetically determined bone disease that develops as a result of
malfunction of osteoclastic activity leading to excessive deposition of immature bone,
thickening of cortical bones and narrowing of the medullary cavities. The condition is
rare; the overall incidence is estimated to be 2-10 per million populations.
We report a 9-years old child with osteopetrosis presented as pathological femoral fracture.
The clinical characteristics together with the negative family history, radiological findings of
generalized osteosclerosis and laboratory results (mild anemia) suggest that our patient probably
fits in to the intermediate autosomal recessive group of osteopetrosis.
Management presents a unique technical challenge in these patients because it often resulted in
complications including blunting or breakage of drill bits, intraoperative fractures, delayed
healing, nonunion and postoperative infections.
This report highlights for technical difficulties during surgery and, hence, prolonged operative
time; therefore, preoperative planning is mandatory in the management of fracture in
osteopetrotic bone. b