Table of content

Karbala Journal of Medicine

مجلة كربلاء الطبية

ISSN: 19905483
Publisher: Kerbala University
Faculty: Medicine
Language: English

This journal is Open Access

About

Karbala Journal of Medicine is a four monthly published journal issued by Karbala college of Medicine.The Journal accepts original articles, case reports, and letters to editors in all fields of medicine from all parts of the world. Review articles of high standards are also considered in this journal. All articles and manuscripts must be in english ,only the abstract must be in arabic and english.Papers are accepted, on understanding that the content has not been published in a whole or in part by other journals. The papers are subject to editorial revision, and the editor is responsible for the order of publication.Manuscripts are only accepted on the understanding that the author will permit editorial amendments, though proofs will always be submitted to the corresponding author before being sent finally to press. The Journal is peer- reviewed and each article is sent to two evaluators of the same specialty in addition to statistical and design review by expert statistician.
Date of first issue(2009)
No: of issue per year(4)
No. of pages per issue(120)
No. of issue published between 2009-2012) is(16)

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Contact info

Journal e-mail:karbalamedj@yahoo.com, karbalamedj@uokerbala.edu.iq
editor e-mail:dr.mohma.med.school@gmail.com
mobile: 07801363988

Table of content: 2009 volume:2 no.6, 7 issue:4

Article
Helicobacter Pylori Associated with Peptic Ulcer Disease and Chronic Antral Gastritis in Diwania City.….

Authors: Dr. Ali M. Al-Yassin
Pages: 382-386
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Abstract

aim: 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

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Article
• An Interaction Study between Acetylsalicylic Acid (Aspirin) and Captopril at Different Doses in Rats

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the present studies were used forty nine rats to determine chronic toxicity effect which were divided into 4 groups, the control group (7 rats) received distilled water, the other three treatment groups each group (14) rats were divided into two subgroups T1&T2 according to the following oral daily dosing regiment ( aspirin subgroup 2 and 4 mg/kg , captopril, 6 and 12 mg/kg and aspirin + captopril (2 + 6 mg/kg and (4+12 mg/kg) respectively. The following biochemical and hematological results were recorded during the experiment: Prothrombine Time : Captopril, aspirin and captopril + aspirin treated rats showed significant increase (P < 0.05) in serum PT levels in both T1&T2 subgroups at the period of 1.5 & 3 months treatment positively proportional with the dose and treatment period. Clotting Time: No significant changes were noticed in clotting time of aspirin groups and captopril treated rat groups, while the combined treated subgroups T1&T2 showed a significant increase after 3 month. Blood Urea Nitrogen :Captopril, aspirin and captopril + aspirin treated rats showed significant increase (P < 0.05) in serum BUN levels in both T1&T2 subgroups at the period of 1.5 & 3 months treatment positively proportional with the dose and treatment period. Total Body weight : Significant increase in body weight were observed in captopril, aspirin and captopril + aspirin treated rats in both T1&T2 subgroups through out the experimental periods proportional to the do………..se and treatment periods.

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Article
Blind Percutaneous Needle Liver Biopsy: Still the Gold Standard Method in Diagnosing Chronic Liver Diseases

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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.


Article
Prevalence of Hypertension and Diastolic Dysfunction with Type-2 Diabetes Mellitus

Authors: Dr. Moshtak A. wtwt
Pages: 403-408
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ackground: left 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.إن الأهمية من هذه الدراسة هي لتحديد العلاقة بين ارتفاع ضغط الدم و العطل الانبساطي لعضلة القلب اليسرى مع داء السكري ، من النوع الثاني. حيث تمت دراسة 164 مريض من مرآز السكري في بابل من شهر آانون الثاني 2007 إلى شباط 2008 حيث تم اختيار هؤلاء المرضى المصابين بالنوع الثاني ممن لديهم ارتفاع في ضغط الدم، زيادة مؤشر آتلة الجسم (أآثر من 30 )و نسبة الخصر إلى الورك (أآثر من 0,9 ). تمت دراسة العطل الانبساطي لعضلة القلب اليسرى من خلال فحص المرضى بالا يكو .من 164 مريض وجد ثمانون مريض مصاب بارتفاع ضغط الدم الانقباضي مع الانبساطي، و تسعة مرضى مصابين بارتفاع الضغط الانبساطي فقط. خمسة و عشرون مريض من اصل 164 آانوا مصابين بعطل عضلة القلب الانبساطي و بنسبة 15,2 % من مجموع المرضى. تستنتج من هذه الدراسة إن اجتماع داء السكري من النوع الثاني مع ارتفاع ضغط الدم في نفس المريض تؤدي إلى زيادة مخاطر الإصابة بالاختلاطات مع تصلب الشرايين. هذا بالإضافة إلى أن عطل عضلة القلب الانبساطي المرافق لداء السكري هو علامة مهمة و مبكرة لاعتلال عضلة القلب بسبب داء السكري.

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Article
The response to Growth Hormone Therapy in Isolated Growth Hormone Deficiency

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objective: to study the response of Growth hormone therapy in children with short stature due to isolated growth hormone deficiency. Sample: six hundred forty eight patient with short stature were enrolled in this study. Method: six hundred forty eight patient with short stature attending Central Teaching Hospital for children Baghdad/ Iraq, were recorded and all patients were investigated to exclude other disease like diabetes, hypothyroidism, celiac disease, turner syndrome, renal failure, achondroplasia,..etc. with a total of 48 patients due to these causes were excluded from the study. So the remaining patients were 600 only those exposed to our study. All children investigated for growth hormone basal level and after provocation by clonidine done for one time . Results: We found that the basal level of growth hormone was less 0.5 microgram (μg)/liter (L), 0.5 -1 μg/liter and more than 1 μg /liter in 25%, 38% and 37% respectively in our sample, while the results after provocation were less than 5, 5-10 and more than 10 μg /liter in 60%, 28% and 12% respectively in our sample. The effect of growth hormone in one year therapy the increment in height was less than 4 cm in 22% of our patients, from 4-8 cm in 50%, and more than 8 cm in 28 % and we found that the male patients were 384(64%), and the female patients were 216(36%),with peak difference between bone age and chronological age was more than 2 year for both sex and most of the patientsُ age was more than 15 years. Conclusion: Most patients with isolated growth hormone deficiency had basal growth hormone level 0.5 – 1μg/L, while the provocation level was less than 5μg/L and the effect of growth hormone therapy on height maximally 4-8 cm in proximately 50% of the patients and more than 8 cm in 28% after one year treatment. Patients with isolated Gh deficiency showed good response to therapy with growth hormone recombinant in a dose 0.1 mg /kg /day

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Gh --- Growth hormone


Article
Zinc, Copper, and Superoxide Dismutase in Spermatozoa of Patients with Asethenospermia

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objective:To determine the level of Superoxide dismutase (SOD), Zinc and Copper in the seminal and spermatozoal of patients with asthenospermia. Setting: All semen samples were collected in the infertility unit of the laboratory (in Amel clinic for detection and treatment of infertility/Iraq. Hilla city) after a 3-5 day period of sexual abstinence, then incubated at 37°C and analyzed within 1 h. Methods:The study was conducted on 30 patients and compared to 20 controls. Statistical analysis between group 1 (controls) and group 2 (patients) was performed by the student's t - test. Zinc and copper content was assayed by atomically spectrophotography,SOD enzyme was measured by biochemical assay. This work was undertaken to assess oxidative stress and antioxidant. Results: It was observed that there was a significant increase in seminal and spermatozoal superoxide dismutase activity and copper content. While Zinc were significantly decreased. Conclusions :The results of this study suggest higher oxygen-free radical production, evidenced by increased superoxide dismutase activities, support to the oxidative stress in asthenospermia. The increased activities of antioxidant enzyme may be a compensatory regulation in response to increased oxidative stress. Keywords:Zinc,Copper,Superoxide dismutase(SOD),Human sperm


Article
Evaluation of Antioxidant Status in Full-term Hyperbilirubinemic Neonates with Severe G6PD Deficiency in Najef: Iraq……………

Authors: Dr. Fadhil J. Al-Touma --- William M. Frankool
Pages: 429-442
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objective: The 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. 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..


Article
The Role of FNAC in the Diagnosis of Breast Lumps in Karbala…………………………………………….....

Authors: Dr. Ali A. Ali
Pages: 443-446
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objectives:The 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 ALHussein 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. Key Words: FNAC, breast lumps, breast disease diagnosis, breast lumps in Karbala.


Article
Electrolytes & [H+] Disturbances in Peptic Ulcer Patients

Authors: Monem Alshok,
Pages: 447-451
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in 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.

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Article
Serum Immunoglobulin Level Derangements in Chronic Lymphocytic Leukemia, Hodgkin's Disease and Non- Hodgkin's Lymphoma

Authors: Dr. Talib H. Kammona
Pages: 452-462
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oBjective: to 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.

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Article
Zinc Sulfate Improves Progressive Sperm Motility in Subfertile Men with Abnormal Sperm Agglutination

Authors: Dr. Abdulaali H. Salman,
Pages: 463-471
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back ground: Agglutination 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.


Article
Colonic Injuries in Blunt Abdominal Trauma

Authors: Dr. Nahidh R. Alammar
Pages: 472-478
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aim: To 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.

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Article
Non-Traumatic Lower Extremity Amputation (The Common Causes)……………………………………….

Authors: Dr. Mahdi A. Abdul Hussein
Pages: 479-485
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objective: Lower Extremity Amputation (LEA): is defined as the complete loss in the transverse plane of any part of the lower limb, and categorized as(1): (1) Minor (i.e. at or below the ankle joint). (2) Major (i.e. above the ankle joint). Method & patients:The aim of this study is to determine the common causes of non-traumatic L.E.A. It is a retrospective study of (138) patients, with 149 lower limbs treated by amputation for different causes in Al-Hussein general and Al-Abass private hospitals in Karbala, in the period between Sep, 2002 through Sep, 2007, excluding cases due to trauma, military and army attacks. Results: Diabetes is a major risk factor for LEA and form (78.5 %) of cases with different presentations. The important risk factors were infected deep ulcer in neuropathic foot (26 cases), late stages of infected foot (38 cases) and arteriosclerosis (51 cases) presented as gangrene in one toe or more. Patients with loss of protective sensation, loss of education and preventive program and neglect the ulcer or mild injury to complicate and presented in late stages end with amputation. Non-diabetic peripheral vascular disease (17%) is the 2nd cause; it is either arteriosclerosis or Beurger disease. Other rare causes were primary malignant bone tumor (3%) and other miscellaneous causes such as non-diabetic chronic osteomylitis (1.5%). Minor amputations were 61 limbs (i.e.41%) but major amputations were 88limbs (59 %). (19) Patients from diabetic group had history of previous major amputations in the same side or other limb, and (11) of them done during the study period, so considered as risk factor. Conclusion:Diabetic foot is the most common cause of LEA, and reduction in the number of amputation can be achieved if the patient is directed to foot-care programs. The diabetics need comprehensive care, included good endocrine control, education on endocrine control, yearly foot screening by multidisciplinary foot-care team. The patients should instructed to pay meticulous attention to foot wear, foot hygiene, to cutting nail and daily foot inspection to reducing the risk of an injury that can lead to heel ulcer and amputation.


Article
Comparative Evaluation of Ketorolac and Diclofenac for Pain Relief in Acute Lumbar Disc Prolapse.........

Authors: Dr. Alaa Abdul Alabas
Pages: 486-490
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the 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.

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Article
Prevalence of Microalbuminuria in Diabetic Patients in Al-Najaf city………………………………………………….

Authors: Dr. Safaa A. Khudhair
Pages: 491-496
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background: Diabetic 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, microalbuminuric 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%) macroalbuminuria 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. Key words: diabetes mellitus, microalbuminuria, diabetic nephropathy.

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Article
Evaluation of the Serum and Tissue Levels of Copper and Zinc in Patients with Gynecologic Tumors..................

Authors: Dr. Elham A. Mahdi --- Layla A. Mohamad
Pages: 497-502
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serum 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.

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Article
Sex Differences in the Level of Some Liver Parameters of Patients with Myocardial Infarction............................

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the 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.


Article
Role of Interferon –Gamma and Interleukin -4 in Immunepathogenesis of Chronic Hepatitis C Virus……………..

Authors: Dr.Sattar J. Rahi
Pages: 510-518
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this study was carried out to investigate some immunological aspects in Iraqi patients with hepatitis C virus infection compared to patients and healthy control groups.The study included (50) patients with chronic hepatitis C infection referred to ((The gastroenterology and hepatology center) (Medical City- Baghdad )), with age range from (8-75) years , (20) patients with non viral chronic liver diseases and (20) healthy control groups. classified the HCV patients into five stages according to their fibrosis stage: five patients in stage 0, (14) patients in stage 1, (12) patients in stage 2, (12) patients in stage 3, (7) patients in stage 4. With application of ELISA technique, serum levels of Interleukin -4(1L-4), and Interferon – gamma (IFN-γ ) were measured in (50) patients with HCV infection compared to that of control groups which include (20) patients with non viral liver pathologies (patients control) and (20) healthy control groups. The mean serum level of 1L-4 and IFN-γ showed a significant increase in patient with HCV as compared with patients control and healthy control groups. In addition, significant linear correlation between IFN-γ with fibrosis stages, while inverse correlation between 1L-4 and fibrosis stages in HCV patients.

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Article
Giant Neurofibroma of the Scalp (case report)

Authors: Dr. Husam G. Al-Anbari --- Nazar J. Mataab
Pages: 519-521
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we 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. Key words: neurofibroma, scalp mass, progressive enlargement.

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Article
Professional Responsibilities in Clinical Medical Education (review article)

Authors: Dr. Mohamad Major
Pages: 522-523
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Article
news

Pages: 524-524
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Article
journal harvest

Pages: 525-526
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Table of content: volume:2 no.6, 7 issue:4