Karbala Journal of Medicine

b To study the prevalence of Helicobacter Pylori organism as a cause of peptic ulcer
disease and chronic antral gastritis in patients in Diwania city.
Methods: In this study 90 patients patients complaining from classical symptoms of
chronic dyspepsia including upper abdominal pain or discomfort, often accompanied by bloating,
abdominal distention, nausea, or early satiety were included in this study. Peptic ulcer and antral
gastritis are diagnosed on both endoscopic findings and histological results of biopsy . 4–6 punch
biopsies were taken from gastric antrum in all the individuals and in case of gastric ulcer an
additional biopsy was taken from the edge of the ulcer to exclude its malignant nature.
Helicobacter pylori (H. pylori) organism was diagnosed using Histology (using Giemsa Stain).
Histological diagnosis of H. pylori was taken as the “gold standard” for the presence of H. pylori
organism. Histological diagnosis of gastritis was made using Hematoxylin and Eosin Stain and
the gastritis was classified as active chronic gastritis and superficial chronic gastritis.
Results: From 90 patients were included in this study, 50 patients were proved to have peptic
ulcer disease, 45(90%) of them have positive results of H pylori while 40 patients proved to have
chronic antral gastritis, 33(82.5%) of them were positive for H. pylori on histological
examination.
Conclusion: A highly significant association between H. pylori infection with peptic ulcer
disease patients and chronic antral gastritis in Diwaniya city.
List of abbreviations
PU = peptic ulcer
PUD = peptic ulcer disease
CAG = chronic antral gastritis
OGD = oesophagogastrodoudenscopy
DU = duodenal ulcer

b
ercutaneous liver biopsies were done for 55 patients in 2 central hospitals in Kirkuk &
Sulaimaneyah in Iraq. The patients were 40 males & 15 females. The clinical conditions
for which liver biopsies were indicated included liver cirrhosis, chronic hepatitis, liver
tumors, undiagnosed hepatomegaly, fatty liver & pyrexia of unknown origin (PUO).The
diagnostic accuracy in reaching the final diagnosis of chronic liver disease was more than 50% in
cases of cirrhosis & 100% in the other causes, although the number of those cases were small to
draw accurate conclusions. The complications included only a minor complication in only one
case, without major complications or deaths.

bleft ventricular diastolic dysfunction is common in patients with type 2
diabetes mellitus, but their prognostic importance in these patients remains unknown. Aim
of this study is to detect the association of hypertension and diastolic dysfunction (LVDD)
with normal ejection fraction in type-2 diabetes mellitus.
Method: A cross-sectional study of 164 diabetic patients visit diabetic clinic in marjan teaching
hospital (76 females and 88 males) from January 2007 to February 2008 were enrolled in this
study. Their ages ranged from 35 to 65 years with mean age of 55 years. The inclusion criteria
were: diabetes mellitus type 2, hypertension (BP ≥ 140/90 mmHg) with or without medication,
body mass index 30, and waist-hip ratio > 0.90. In those patients we do blood sugar, HbA1C, lipid
profile, ECG, CXR & ECHO to detect Left Ventricular Diastolic Dysfunction (LVDD).
Result: Out of 164 patients, 80(48.7%) were found to be hypertensive (both systolic and diastolic)
and 9 patients (5.3%) were found to be suffering from isolated systolic hypertension. Hence, total
number of hypertensive patients was 89 (54%). Twenty five out of 164 patients were found to be
suffering from diastolic dysfunction with normal ejection fraction.
Conclusion: Hypertension and Diabetes are interlinked and show how micro and macrovascular
complications of diabetes are increased when two conditions occur together. The LVDD is much
more prevalent than previously suggested in patients with type-2 diabetes mellitus. Hence, LVDD
is an early marker of diabetic cardiomyopathy

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

bThe objectives of this study were an attempt to evaluate and to compare
between some of the antioxidant and biochemical parameters investigated in severe
G6PD-deficient neonates with hyperbilirubinemia with TSB≥ 15 mg/dl in Najef
governorate : Iraq.
Methods: A total of 240 neonates who were admitted in Al-Zahra maternity and pediatrics
hospitals in Najef governorate during 1st , Oct., 2007 and 12th, July, 2008 with age ranged
between 1 – 28 days were screened for erythrocyte G6PD enzyme activity measurement to
confirm the diagnosis of G6PD deficiency. Of these subjects, 61 (25.42%) neonates of them
showed a normal enzyme activity levels ; whereas the remaining 179 (74.58%) neonates were
found to have neonatal hyperbilirubinemia with TSB levels ≥ 15 mg/dl. Some of the antioxidant
parameters have been measured in severe G6PD-deficient neonates with hyperbilirubinemia and
compared with that found in control group.
Keywords: hyperbilirubinemia, G6PD, glutathione, catalase , G-Px, G-Red , neonate.
429
Results: Among the hyperbilirubinemic neonates, only 21 (11.73%) neonates were diagnosed to
have severe G6PD deficiency and its percentages of incidence identified was 11.73%. The results
also indicated that there was a significant negative correlation (r = - 0.320 , P < 0.05) between the
decreased G6PD activity levels and the elevated TSB concentrations in severe G6PD-deficient
hyperbilirubinemic neonates with the TSB ≥ 15 mg/dl but not in control neonates. These data
suggest that the G6PD-deficient neonates are at increased risk for hyperbilirubinemia even in the
nursery free from agents that can potentially cause hemolysis to G6PD-deficient red cells. The
mean ± SD of oxidative stress status parameters which include erythrocyte GSH, MDA, G-Red,
G-Px and catalase were determined. There was a significant decrease in each of erythrocyte GSH,
G-Red and catalase activity levels (P<0.05), whereas the lipid peroxidation end product MDA
levels and G-Px activity levels were significantly increased in all hyperbilirubinemic neonates (P
< 0.05) as compared with the control group. G6PD activity values identified were found to be
positively correlated with each of GSH concentrations, G-Red and catalase activity levels in
which their values were found to decreased in patient groups, while it was found to be negatively
correlated with each of G-Px activity and MDA levels in which their values were elevated in
severe G6PD-deficient neonates. These data indicates an increases in free radical generation and
thus antioxidant defense mechanisms is impaired in peroxidation associated with a significant
elevation in MDA levels in the erythrocytes of the hyperbilirubinemic neonates with severe G6PD
deficiency than that found in the control group which demonstrate the presence of an increased
oxidative stress due to reduction in NADPH which is generated in RBCs by HMP-shunt only.
Conclusion: The results of the present work indicate that severe deficiency of G6PD activity is
associated with hyperbilirubinemia in full-term neonates and imbalance in oxidative stress
parameters

bThe aim of this study is to find out the sensitivity of FNAC in the diagnosis of
breast lumps in Kar bala.
Patients & Methods: This is a clinical study of FNAC of breast lumps done in AL
Hussein Teaching Hospital in Karbala, from May 2005-May 2007. FNAC findings were
correlated with the histopathological findings of the excised lump of the same patient to
determine the sensitivity of FNAC.
Results: Eighty five cases were included in the study, one male and eighty four females. The age
range was between 20-70 years. Benign cases composed 52.9% (45 patients) while malignant
cases were 47.1% (40 patients) of the total number of patients. Sensitivity was 92%.
Conclusion: FNAC of the breast is a simple, , highly sensitive test . It can minimize the need for
open biopsy, and is recommended as a routine test for determining benign or malignant lesions in
correlation with clinical examination and imaging procedures.

bn the body even a very small pH changes are important and result in change in body
physiology . We describe in our study the presence of alteration in electrolytes and acid-base
status in patients with peptic ulcer disease.
The study was carried out over a period of three years. 273 patients with peptic ulcer disease
diagnosed on endoscopy , of these 228 duodenal ulcer and 45 gastric ulcer , in addition 84
subjects were considered as a healthy control .
20 ml of gastric juice obtained for analysis and 5 ml blood sample were taken and pH
determination and[ H+ ]estimated by electric sensitive method including the use of electronic
sensitive pH – meter. The pH – electrode was initially calibrated in buffer solution of pH 7 ( Ian
1969 ). Also the total acidity of gastric effluents were estimated by titration to pH 7 with 0.1
NaOH. The K+ and Na+ concentrations determined by using flame photometric method ( Sood
1987) The results of the study show that DU patients had significantly lower gastric secretion
pH and higher H+ concentration in the blood than normal control subjects and total acidity of
gastric secretion also was higher than control

bto compare the degree of immunoglobulin derangement "hypo or
hypergammaglobulinaemia" among patients with cll, nhl, and hd.
Design: forty three patients with hematologic malignancies attended hematology and
oncology unit in al-sadr teaching hospital in najaf city between february and august 2007, were
evaluated for their serum igg, igm, and iga level with a comparable number of healthy adult
controls. Sixteen patients with cll, thirteen patients with nhl, and fourteen patients with hd were
included in this study.
Results: there is a significant alteration in the level of immunoglobulin among patients with
hematologic malignancies, with a reduced level seen in patients with cll and nhl, and an elevated
level is seen in patients with hd.
Conclusion: immunoglobulin derangement is a common problem in patients with cll, nhl and hd.
Recommondations: larger number of patients, with extension of the study to include igg subsets
is needed for good outcome and better results.

bAgglutination of spermatozoa means that motile spermatozoa stick to each
other in the ejaculate. It can be due to infection or antibodies that react with sperm. Sperm
agglutination has a negative impact on fertility due to impeding of sperm function, inhibition
of fertilization and implantation. Zinc is an essential trace element for male sex function. It is a
cofactor in more than 300 enzymes influencing various organ functions. Zinc found in seminal fluid,
increase sperm count and motility and blood testosterone levels. Zinc had direct effects on the
production, maturation and function of leucocytes and can modulate antibody production.
Objective: The objective of this study to assess the effect of zinc sulfate treatment on sperm
agglutination among subfertile patients with asthenospermia.
Design: Prospective study.
Setting: Infertility clinic and assisted reproduction unit at the Institute of Embryo Research and
Infertility Treatment, Al-Nahrain University.
Patients: Fifty - three subfertile male patients.
Materials and Methods: Semen analysis was performed before zinc treatment using direct slide
examination for fifty - three infertile patients. A daily dose of 440 mg of zinc sulfate
supplementation was orally administered for a period of two weeks, three weeks, four weeks, and
six weeks. After each period semen samples were obtained by masturbation after a recommended
period of 3-5 days of sexual abstinence, and evaluated for determinations of semen volume, pH,
concentration, motility, normal morphology, total progressive motile sperm count, round cells, and
sperm agglutination, according to WHO recommendation.
Results: subfertile men demonstrated a significant (P< 0.05) decrease in round cells /HPF after third
week of zinc treatment. Sperm agglutination was significantly (P< 0.01) decreased after second,
third, fourth week, and (P< 0.02) at six weeks of zinc treatment compared to sperm agglutination
before treatment. Also the study showed significant (P< 0.05) improvement in progressive sperm
motility [grade –A after three week and grade –B after three and four week of zinc treatment],
significant (P< 0.01) increase of total progressive motile sperm count /ejaculate, and of
morphologically normal sperm after third week of oral zinc sulfate supplementation.
Conclusions: It was concluded from the results of the work that the oral zinc sulfate
supplementation is effective in decreasing of abnormal sperm agglutination and round cells, with
subsequent improvement of progressive sperm motility

bTo retrospectively evaluate the preoperative diagnostic approaches and management
of colonic injuries following blunt abdominal trauma.
Methods: A total of 14 patients with colonic injuries caused by blunt trauma between june
2003 and june 2006 were enrolled. Data were collected on clinical presentation, investigations,
diagnostic methods, associated injuries, and operative management. Colonic injury-related
mortality and abdominal complications were analyzed.
Results: Colonic injuries were caused mainly by motor vehicle accidents 9 patients (64.4%) . Of
the 14 patients, 11 (78.5%) had other associated injuries. Laparotomy was performed within 6 h
after injury in 7cases (50%), . The most commonly injured site was located in the transverse colon.
The mean colon injury scale score was 2.8.Six patients (43%) were treated with diversion of faecal
stream by colostomy or exteriorization of injured segment. Eight cases were treated by primary
suturing and early resection and anastamosis. The overall mortality rate was 7%.
Conclusion: Colonic injuries following blunt trauma are especially important because of the
severity and complexity of associated injuries. A thorough physical examination and a
combination of tests can be used to evaluate the indications for laparotomy. One stage
management at the time of initial exploration is most often used for colonic injuries

b
he study aimed to study the efficacy and safety of ketorolac tromethamine compared to
diclofenac sodium in patients with acute lumbar disc prolapse.
Thirty three patients were included as subjects in the study, 17 of them received ketorolac
15 mg intramuscularly (IM) and 16 received 75 mg diclofenac IM. Analgesic efficacy was
assessed using the visual analogue scale (VAS) 1, 3 and 6 hours after drug injection and side
effects by enquiry and reporting whenever it occurred.
Ketorolac showed equi-analgesic effect as diclofenac at 1 3 and 6 hours post-injection
and was as safe as diclofenac in the mentioned doses.
In conclusion: Ketorolac, as doe’s diclofenac, appeared to be a safe, effective drug in the
treatment of pain in cases of acute lumbar disc prolapse.
Further studies for more assessment of this drug in higher doses and longer durations and
its use in other acute musculoskeletal conditions are recommended. We also suggest further
investigations regarding the commonly used pain scales like VAS to highlight the influence of
psychological or other social conditions in our community that may affect the expression of these
pain scales.

bDiabetic nephropathy accounts for a significant reduction in life expectancy
of diabetic patients, approximately 80% of Type 1 diabetic patients and 30% of type 2
diabetic patients with microalbuminuria progress to overt nephropathy after 10–15 years.
Objective: To determine the prevalence of micro- and macro-albuminuria in diabetic patients in
AL-Najaf city and the predictive value of some risk factors.
Method: Urinary albumin-creatinine ratio (ACR) in a spot early morning urine sample was used
and the patients were categorized as normo-albuminuric when ACR<30 mg/g, micro
albuminuric when 300>ACR≥30 and macro-albuminuric when ACR≥300 mg/g.
Results: Prevalence of albuminuria among Type1 patients was 4(67%) microalbuminuria, 0%
macroalbuminuria, i.e. 67% had abnormal urinary albumin-creatinine ratio (ACR). The
corresponding prevalence for Type 2 patients was 26(52%) micro-albuminuria, 4(8%) macro
albuminuria and total of 30(60%) for abnormal urinary albumin-creatinine ratio (ACR).
Conclusion: The occurrence of microalbuminuria detected in this study was much higher than
previously reported in other studies and the duration of diabetes was the strongest predictor

berum and tissue copper (Cu) and zinc (Zn) levels were determined by atomic absorption
spectrophotometry in 20 women with malignant gynecologic tumors and compared with
levels in 15 with benign gynecologic tumors .A significant (p<0.05) elevation of serum
copper levels in gynecological cancer patients when compared with those of benign
diseases .Estimation of zinc level demonstrated a non statistically
significant difference
between malignant and benign gynecologic tumor patients . Determination of tissue copper and
zinc contents revealed a significant (p<0.005) elevations of copper and non significant (p>0.005)
decrease of zinc in malignant tissues with respect to those of benign tumors .In addition to it,
there were essentially correlation between copper and zinc levels in serum and their levels in
tissue in cancer patients but no such correlation in patients with benign tumors

bhe present study was conducted to verify the changes of some liver parameters in male
and female patients of myocardial infarction (MI) and determine the differences between
male and female. To achieve this aim, 40 male patients of MI,20 female patients of MI,
35 healthy subjects (control group) were subjected to the study. The results showed significant
(p< 0.005) increase of AST activity in male patients of MI and somewhat less (p <0.05) in
female patients of MI when compared with those of the healthy individuals. The measurement of
serum bilirubin concentration indicated significant (p< 0.05) rise of total and unconjugated
fractions in male patients of MI, while in female patients total and unconjugated bilirubin were
didn't show any significant when compared with those of the healthy subjects, but conjugated
bilirubin was significant increase (p<0.01). The estimation of serum albumin concentration
pointed out significant (p< 0.05) decrease in male patients of MI and somewhat less (p< 0.01) in
female patients of MI in comparison with those of the healthy individuals.
Conclusion: From this study we obtained the sex has effect on the alteration of liver parameters
level in patients with myocardial infarction

be are reporting a rare case of big scalp neurofibroma in a patient not known to have
Neurofibromatosis type 1 (NF1) or Neurofibromatosis type2 (NF2) aged 24yr. The
mass was present since birth with progressive enlargement ,total surgical resection
done with Z-plasty to close the scalp defect