Karbala Journal of Medicine

bhe study was carried out in period between “1 August 2005 to 30 of December 2006”.
Blood samples of 80 clinically thalassaemic patients were collected from three thalassaemia
centers in Iraq, namely: Ibn Albalady central thalassaemia center in Baghdad, and also from
Kerbalaa and Al-Qadissya governorates. Blood samples were also collected from 56 apparently
healthy individuals to serve as a control group.
DNA was isolated from blood and used for molecular detection of seven types of β-thalassaemia
mutations (IVS1 nt.1 G--A , IVS1nt.5 G--C, IVS1 nt.6 T--C, IVS1 nt.110 G --A, codon 39 C--T,
IVS2 nt.1G--A, and IVS2 nt.745 C--G) using the PCR based technique called ARMS
(Amplification Refractory Mutation System).
Five out of seven of these diagnosed mutations were reported for the first time in Iraq, and the
most frequent β-thalassaemia mutations were codon 39 and IVS1 nt.110 with the proportions
(26.76%) and (20.34%), respectively. No IVS2nt.745 was detected within the studied samples.
Genotypic distribution of the samples indicated that there is no significant difference (p > 0.05)
between the frequency of homozygotes and heterozygotes within patient group, while there is a
significant difference at (P < 0.01) in comparison with the control group.
The study of association between the number and the types of mutations revealed that 28(58%) of
positive cases have single mutation in a homozygous state or heterozygous state which
significantly associated at (P < 0.05) with β-thalassaemia mutations, whereas 20(42%) of these
cases have compound mutations. The most frequent association appeared between IVS1 nt.110 and
Codon 39 mutations.
Finally, mutations within families, pointed to a positive correlation between the types of mutations
in sons or daughters and their fathers and/or mothers; this indicates the accuracy of the ARMS
technique in detection of β-thalassaemia mutations. This conclusion should be taken with caution
due to the limited number of families

bFunctional mitral regurgitation may develop in patients with congestive heart
failure due to left ventricular systolic dysfunction, which is common, costly and lethal
syndrome. Echo-Doppler is an extremely sensitive tool for the detection of mitral
regurgitation.
Objective: To determine the

prevalence and severity of functional mitral regurgitation in patients
with left ventricular systolic dysfunction using echocardiography.
B
Setting : Al-Hussain Hospital echocardiography clinic in Karbala city.
Methods: One hundred sixty patients were divided into two groups: Group A: constituted of 80
consecutive patients who had a left ventricular ejection fraction <40% and group B: constituted of
80 consecutive patients who had a left ventricular ejection fraction >40%.The study patients
underwent standard echocardiogram. Severity of mitral regurgitation was graded as mild,
moderate and severe.
Results: In patients with left ventricular systolic dysfunction (group A), mitral regurgitation was
more common. It was mild in 22.5%, moderate in 52.5% and severe in 21.25%.
Conclusion: The majority of patients with left ventricular systolic dysfunction had mitral
regurgitation .Echo-Doppler should be included in the evaluation of these patients

b To evaluate the effectiveness of using (vicryl) thread material by subcuticular
technique for repair of episiotomy and compare it with the standard method that use
(catgut) by interrupted mattress technique.
Design: A
randomized controlled study based in hospital.
Setting: Labour ward at AL-Zahraa maternity & pediatric teaching hospital at AL-Najaf city.
Population: 300 women who have undergo vaginal delivery with episiotomy.
Methods:
• The study was conducted at maternity and pediatric hospital in Al-Najaf city from the first of
march 2005 to the end of January 2006 .
• The study included women attending labour ward in the hospital for vaginal delivery with
episiotomy (total no. 300 women)
• Women with the following criteria were excluded from this study :
History of prolong or obstructed labour.
History of midwife interference .
History of PROM or Chorioaminitis.
History of immune-compromised and diabetic mellitus.
• In 100 of the women the episiotomy was repaired using vicryl 2-0 sutures and the skin was
closed by subcuticular technique, while the rest 200 women their episiotomies were repaired
by catgut 1-0 sutures .
• The women were re-examined after 5 and 10 days for signs of infection and were assessed for
persistent and severity of pain .
Results:
• In the majority of women the indication for episiotomy was nulliparity with tight perineum
• Experience of pain up to the fifth day after delivery was less common in those women whom
episiotomies were sutured with vicryl and also the severity of pain was less.
• The study shows that the incidence of wound infection was much less when using vicryl
sutures and mattress technique.

bThis study was carried out to evaluate the relation between the causative agents of otitis
media and the parameter related to the patients (e.g., gender, age) the criteria of causative
agents include type of bacteria, growth conditions, susceptibility to antibiotics, and the ability
to produce ß-lactamase enzymes. A total of 50 ear swabs were obtained from outpatients
infected with otitis media.
The results showed that Staphylococcus epidermidis (30%) was the predominant pathogens
followed by Staphylococcus aureus (20%), Pseudomonas aeruginosa (18%), Proteus
mirabilis (8%), and Proteus vulgaris (4%). The antimicrobial susceptibility pattern showed
that all bacteria were resistant to cephalothin and moderate resistant to other antibiotics.
For detection of ß-lactamase producing bacteria, results showed that Ps. aeruginosa was
recorded a high percentage in producing of ß-lactamase enzymes (55.6 %) in comparison
with the other bacteria

b This study describes a batch and flow-injection spectrophotometric methods for the
determination of Metoclopramide.HCI in aqueous solution and in pharmaceutical
preparations.
The method is based on the reaction of Metoclopramide.HCI with ferric nitrate to produce Fe(II) ion
which upon further reaction with potassium hexacyanoferrate in acidic medium forms a Prussian blue
colored product that has a maximum absorption at 770 nm. The proposed method was
successfully applied to determine Metoclopramide.HCI in the range of 0.2-6 µg.ml-1 for the
batch spectrophotometric method and 2-80 µg.ml-1 for flow-injection (FI) spectrophotometric
method with correlation coefficients of 0.9997 and 0.9999, deletion limits of 0.114 µg.ml-1and
0.700 µg.ml-1, and relative standard deviations of 0.46% and 0.41% respectively. Both
procedures were applied to analyze the assay of Metoclopramide.HCI in pharmaceutical
preparation with recoveries of 99.46% and 99.85% respectively.
Objectives: The aim of this study is to investigate A simple accurate and sensitive FIA system to
determine Metoclopramid.HCL in pharmaceutical preparations

bhe study was carried out to assess the effect of cinnamon oil on multi-drug resistant
(MDR) strains of Klebseilla pneumoniae isolated from various clinical specimens.
150 specimens were collected from Al-Hakeem Teaching Hospital in Al-Najaf
Governorate,
Karbala J. Med. Vol.2, No.4,5 July 2008

21 isolates were found to be Klebseilla spp. On further study at the species
level only six of these isolates were found to be multi-drug resistant K. pneumoniae. The
results of antibiotic sensitivity test showed that most of these isolates were highly resistant
(resistance percentage was 50-80%) for the used antibiotics, these strains were defined as a
multi-drug resistant K. pneumoniae. The antimicrobial effect of cinnamon oil on these
isolates was tested via performing disk diffusion method, minimum inhibitory concentration
(MIC), and minimum bactericidal concentration (MBC) tests. The results showed a similarity
in the antimicrobial actions between this oil and Ceftazidim, Cefotaxim, and Ciprofloxacin in
50% of cases. The study concluded that cinnamon oil could be used as an effective
antimicrobial even in case of difficult treated MDR K. pneumoniae as well as it could be
used as a safe external ointment in the treatment of infected wounds and vaginal infections

bTo evaluate the results of patients under went laparoscopic cholecystectomy
,rate of complications and causes of conversion to open cholecystectomy.
Me
most of them
thod: 1200patients operated upon in Al-Hilla teaching hospital from 2000 – 2007
e were female (860) &(340) were male. all operations done under G.A. & using co2
pneumoperitoneum .
Results: 44 % of patients were between 41-50 years of age.860 (71.6%) patients were female
and 340 (28.4%) patients were male.78.7% of patients presented with chronic calculus
chlecystitis and 20.6% of patients presented with acute calculus chlecystitis and 0.58% of
patients presented with acute a calculus chlecystitis.
Conversion rate was 6.2% (75 patients).The most common cause of conversion was failure to
progress due to anatomical variations in 65 patients.
Complications occurred in 45 (3.7%) of patients. The most common complication was port site
infection in 18 patients. Complete transaction of C.B.D occurred in one patient.
Conclusion:
Laparoscopic cholecystectomy is a safe & minimally invasive procedure.
The complication rate is relatively lower than in the open technique in expert hands.
During Laparoscopic cholecystectomy we can do diagnostic or exploratory laparoscopy to fined
out other things in the patients that can explain the patients symptoms

bCircumcision is a central feature of islam and is recommended at an early
age.
Ob
jectives: To determine the frequency of circumcision in male infants and children
to more than 6 years of age in Diwaniah.
from 1 day
Materials &Methods: Hundred infants and children were randomly selected from each age
group of the following : 1-40 days , 41 days-6 months , 6-12 months , 12-18 months , 18
months- 24 months , 25 – 36 months , 37 – 48 months , 49 – 60 months , 61 – 72 months and
more than 72 months. The frequency of circumcision was determined in each group together
with other variables.
Results: Six percent of infants between 1 day – 40 days were circumcised , 13 % of those
between 40 days – 6 months. Most circumcisions were done by a male nurse and most of the
families of the infants and children think that circumcision is better to be done at an older age
group.
Conclusion: Sixty two percent of our infants and children up to the age of more than six years
are circumcised , there is a need for an extensive education on early circumcision because of
outstanding benefits of early circumcision

bhe aim of this study is to assess the diagnostic and the prognostic value of C-reactive
protein in patients with acute myocardial infarction. From October 2005 to October
2007 one hundred patients with acute myocardial infarction (AMI) were admitted to
the coronary care unit (CCU) in Diwaniya Teaching Hospital were studied regarding the
value of C-reactive protein during the first 72 hours of the infarction and through out the
period of complications. The results were compared with those obtained from control group
which consisted of 30 persons of matched age and sex.
We found that the mean serum level of C-reactive protein (CRP) of those with AMI was
68mg/L+59.93 and its concentration reaches a peak in all patients in the second day of
infarction. The level was significantly higher than the level of CRP in the control group (mean
=6mg/L), (p<0.005). We also found that CRP remained persistently high in patients with
complicated AMI in comparison with uncomplicated patients.
So this study showed that CRP level is useful diagnostically and prognostically in patients
with AMI and it is a simple bed side test that it is available in different medical centers

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bsovolumetric Relaxation Time” IVRT” may be defined as: That part of the cardiac cycle
between the time of aortic valve closure and mitral opening, during which the ventricular muscle
decreases its tension without lengthening so that ventricular volume remains unaltered. During this period
there is a drastic decrease in ventricular pressure without a change in ventricular volume but prior to
mitral valve opening. IVRT can be estimated by M-Mode echocardiography with simultaneous
phonocardiography or simply by determining the time interval between the maximal systolic excursion of
the left ventricular posterior wall to the onset of mitral valve opening. More recently, Doppler technique
has been used to assess not only IVRT but also MPI “Myocardial Performing Index”; comparisons of
Doppler IVRT with catheterization measurement of this time period have shown reasonable correlations.
Objective: To compare M-Mode derived IVRT with Doppler derived IVRT.
Method: The study was performed on healthy individuals of age of 20-55y. Echo-Doppler Siemens
V.Plus equipment with phased array 2.5MHz probe and PW or CW facilities was used. A good M-mode
image of mitral valve excursion and left ventricular posterior wall systolic excursion was first obtained
and the time between the mitral valve opening and the maximal systolic excursion of LV posterior wall
was then calculated. Doppler IVRT was obtained by directing the Pulsed or continuous wave beam from
apical 5 chamber view across the region between the aortic out flow tract and the mitral inflow tract. The
spectral wave form obtained in this position should include aortic valve flow with valve closure and the
onset of mitral inflow with E/A configuration. In this spectrum the aortic closure- mitral opening interval
can be determined.
Results & conclusion: There was no significant difference between M-mode derived IVRT and Doppler
derived IVRT. Since the later has been validated on the ground of correlation with catheterization, thus it
seems feasible to use either techniques to assess LV diastolic function.

bHypothyroidism in adults is not a rare disease but has non –specific clinical
presentation which may delay its diagnosis.
Objective: the aim of the study is to identify the presenting symptoms of hypothyroidism,
their frequency & their relation to age.
Patients & Method : All adult patients > over 18 years of age who attended the consultation
clinic, in Al-Hussein Teaching Hospital / Karbala, from January 2002 to December 2007
showing clinical features suggestive of hypothyroidism were sent for T3, T4 & TSH.
Results: Sixty eight patients were found to have hypothyroidism, 52 females & 16 males
(F/M ratio 4.7:1). Seventy percent of the group are less than 55 yr of age, their mean age is
42.3 yr. Malaise & arthralgia were the main complaints especially in those aged 55year &
over (69% & 25%) respectively while skin changes were the main early physical signs in
those less than 55yr of age (26%).
Discussion: Hypothyroidism is a disease which may present in a nonspecific clinical picture
such as malaise or fatigability especially in elderly or skin changes in young age group or as
menstrual irregularities in young females.
Conclusion: High index of suspicion is the main initial tool for diagnosis of hypothyroidism
& should be considered in any elderly patient with unexplained malaise or fatigability or in
young females with unexplained menstrual irregularities. To look for other physical
symptoms & signs in those patients which may mandate sending them for thyroid function
test or at least only TSH level

bMCDK is a congenital maldevelopment in
which the renal cortex is replaced by
numerous cysts of multiple sizes; a dysplastic
parenchyma anchors the cysts, the
arrangement of which resembles a bunch of
grapes. The calyceal drainage system is
absent. Typically, MCDK is a unilateral
disorder;
the bilateral condition
is
incompatible with life (1). Various types of
MCDK had been recognized; the classic, the
hydronephrotic and the solid cystic dysplasia
types. MCDK should not be confused with
polycystic kidney disease (PCKD) or other
renal cystic diseases (2).
MCDK was recognized as a distinct entity
in 1955 (3). The incidence of MCDK ranges
from 1:2400 – 1:4300 live births (4, 5).
Prenatal ultrasound scans detects 77 – 88% of
cases of MCDK (6). The condition is more
commonly diagnosed in boys (7) and the left
side (8). In over 50 % of cases other urinary
tract defects are also detected; uretropelvic
junction obstruction (UPJO), vesicoureteral
reflux (VUR) and ureterovesical junction
obstruction (UVJO) are the most common
defects in the contralateral kidney (9, 10

bHydatid disease is endemic in many parts of the world. The location of the cyst is mostly hepatic (75 %)
and pulmonary (15 %), and only 10 % of the cysts occur in the rest of the body. Although hydatidosis can
be present in all parts of the body, urinary tract involvement develops in only 2-4 % of all cases, and
isolated renal cysts are extremely rare. There are no specific clinical symptoms or signs that will reliably
confirm the diagnosis of renal echinococcosis. In addition, there is no laboratory finding that is
pathognomonic for hydatid disease except for hydatiduria. Routine blood tests are generally normal except
for eosinophilia which is found in only 50 % of the cases. Radiological studies have a more important
place in the preoperative diagnosis of renal hydatid disease. We present herein a patient with isolated renal
hydatid disease presented as left upper quadrant mass treated successfully with complete excision of the
cyst and preservation of the kidney.

baffeine is one of purine compounds which occur naturally in different species of
plants such as: tea, coffee and cacao plants. DNA synthesis and replication are
affected by caffeine through different methods and these will lead to exhibition of
more than one effect in cell division. Caffeine has not proved to have a mutagenic effect, but
it prevents the action of mutagenic compounds. Harmful activity of UV is blocked by
caffeine when it is added to the treated cells with UV light. Furthermore, caffeine is not
found to have a chief role in the conversion normal cells to cancer state, but, in fact, it has a
reflexive action when it prevents the carcinogenic compounds to effect on cell division