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Article
Molecular Detection of Some Mutations Associated with Βeta-Thalassaemia in Iraq

Authors: Massoud Houshmand --- Ali A. Al-Zaag --- Norrya A. Ali --- Waleed K. Al-Murrani --- et al.
Journal: Kerbala Jorunal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2008 Volume: 2 no.4, 5 Issue: 3 Pages: 263-274
Publisher: Kerbala University جامعة كربلاء

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Abstract

the 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 thalassaemiacenters in Iraq, namely: Ibn Albalady central thalassaemia center in Baghdad, and also fromKerbalaa and Al-Qadissya governorates. Blood samples were also collected from 56 apparentlyhealthy individuals to serve as a control group.DNA was isolated from blood and used for molecular detection of seven types of β-thalassaemiamutations (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 themost 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 asignificant 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%) ofpositive cases have single mutation in a homozygous state or heterozygous state whichsignificantly associated at (P < 0.05) with β-thalassaemia mutations, whereas 20(42%) of thesecases have compound mutations. The most frequent association appeared between IVS1 nt.110 andCodon 39 mutations.Finally, mutations within families, pointed to a positive correlation between the types of mutationsin sons or daughters and their fathers and/or mothers; this indicates the accuracy of the ARMStechnique in detection of β-thalassaemia mutations. This conclusion should be taken with cautiondue to the limited number of families.

Keywords

Beta-thalassaemia --- mutation --- ARMS-PCR --- Iraq


Article
Prevalence and Severity of Mitral Valve Regurgitation in Patients with Systolic Left Ventricular Dysfunction

Authors: Al-Hussaini A. R. --- Al-Haddad H. S. --- Al-Hilali K. A.
Journal: Kerbala Jorunal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2008 Volume: 2 no.4, 5 Issue: 3 Pages: 275-279
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: Functional 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 theprevalence and severity of functional mitral regurgitation in patients with left ventricular systolic dysfunction using echocardiography.BSetting : 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.

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Article
A Comparative Study of Two Different Methods for Episiotomy Repair

Author: Al-Khafaji, Z. H. H.
Journal: Kerbala Jorunal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2008 Volume: 2 no.4, 5 Issue: 3 Pages: 280-288
Publisher: Kerbala University جامعة كربلاء

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Abstract

objective: 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: AKarbala J. Med. Vol.2, No.4,5 July 2008randomized controlled study based in hospital.Setting: Labour ward at AL-Zahraa maternity & pediatric teaching hospital at AL-Najaf city.OPopulation: 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 :

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Article
ß - Lactamase Producing Bacteria Isolated From Patients Infected With Otitis Media

Authors: Ali Muhsien Al-Mohana --- Israa Kitab Al-Yasiri --- Thanaa Shams Al-Deen Al-Toriahi
Journal: Kerbala Jorunal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2008 Volume: 2 no.4, 5 Issue: 3 Pages: 289-294
Publisher: Kerbala University جامعة كربلاء

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Abstract

This 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.

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Article
The Effect of Cinnamon Oil on Multi-Drug Resistant Klebseilla Pneumoniae Strains.

Authors: Siham Al-Kaabi --- Zina Al-Shami --- Israa Kitab Al-yasiri --- Kies Kh. Al- Hadrawi
Journal: Kerbala Jorunal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2008 Volume: 2 no.4, 5 Issue: 3 Pages: 302-307
Publisher: Kerbala University جامعة كربلاء

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Abstract

he 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 200821 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.

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Article
Comparative Study of Internal Fixation for Displaced Closed Fractureof Medial Malleolus Using Malleolar Screw Versus Tension-band Wiring

Authors: Al-Lamy, W. A. --- Al-Obaidy, M. H.
Journal: Kerbala Jorunal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2008 Volume: 2 no.4, 5 Issue: 3 Pages: 308-318
Publisher: Kerbala University جامعة كربلاء

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Abstract

in a prospective, randomized trial of 40 patients with displaced closed fracture of medialmalleolus at Al-Sader, Al-Hakeem, Al-Manathera & private hospitals in Najaf from March2005 to March 2008, we compared two methods of internal fixation namely malleolar screwand tension-band wiring.The patients were then allocated to two treatment groups (20 patients in each group). Thepopulations of the groups were similar in age (median 37 years), sex, fracture type (Danis-Webertype B and C), and aetiology (twisting, fall or motor vehicle accident). The patients wereevaluated clinically, radiologically, and functionally with follow-up for average of one year.Radiological union took place in the group treated with tension-band (mean time 9.4 weeks)earlier than those treated with malleolar screw (mean time 11.8 weeks) (p=0.03). Excellent andgood results were achieved in 80% with malleolar screw fixation and in 90% with tension-bandwiring (p=0.049). Although better range of motion was noticed in the group treated withmalleolar screw, it did not reach significance level (p=0.628).The preliminary results of the current study suggest that tension-band wiring may be more validoption than malleolar screw for internal fixation of medial malleolar fractures.

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Article
The Frequency of Circumcision in Infants and Children in Diwaniah

Authors: Al-Shamsi M. M. --- Al-Zamili A. H.
Journal: Kerbala Jorunal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2008 Volume: 2 no.4, 5 Issue: 3 Pages: 323-330
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: Circumcision is a central feature of islam and is recommended at an early age. Obfrom 1 dayjectives: To determine the frequency of circumcision in male infants and children to more than 6 years of age in Diwaniah.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.

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Article
The Diagnostic and Prognostic Value of C-Reactive Protein in Patients With Acute Myocardial Infarction

Author: Al-Jashami, M.
Journal: Kerbala Jorunal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2008 Volume: 2 no.4, 5 Issue: 3 Pages: 331-335
Publisher: Kerbala University جامعة كربلاء

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Abstract

the 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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Article
Chilblains in Iraqi patients in Hilla City (Clinical study)

Author: Mohammed K. Al-Hattab
Journal: Kerbala Jorunal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2008 Volume: 2 no.4, 5 Issue: 3 Pages: 336-344
Publisher: Kerbala University جامعة كربلاء

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Abstract

chilblain is a major medical problem in Iraqi population in winter time and the purpose ofthis study was to determine the clinical patterns of involvement in patients at Hilla city.A total of 60 patients with chilblains were assessed in the department of dermatology inMerjan teaching hospital during the cold months between January 2007 to February 2008. Theirages ranged from 1.5-70 years (mean ± SD, 22.6±13.6 years).The duration of the disease rangedfrom 2-90 days (mean ±SD, 24.5±20.7 days). There were 40 females (66.6%) and 20 males(33.4٪) with a sex ratio of 2:1. The majority of patients were between 11-30 years of age (71.6%)and females forming about 79.5%, female: male ratio was about 3.8:1.All patients were presented in January and February and the attacks in majority of patientsstarted in December (20 patients) and January (30 patients) forming about 83.3%. Family historyin close relatives were positive in 14 patients (23.3 %).Thirty one patients developed similarattacks at previous winters (51.6%). Numbers of previous attack of perniosis / winter were from 1-215 attacks.Associated systemic and dermatological diseases were: hypertension (3.3%), diabetesmellitus (3.3%), systemic lupus erythematosus (3.3%), pregnancy (3.3%), atopic dermatitis(3.3%), allergic rhinitis (3.3%), anemia (1.6%) and hand eczema (1.6%).Regarding the sites of the lesions, chilblains commonly affected either hands alone (48.3%),feet alone (33.3%) and to a lesser extent both hands and feet (18.3 % ). The feet alone werecommonly affected in females (88.2%) while the hands alone in males (60 %). Hands and feetwere affected together most commonly in females (91%).Ears, nose and buttock were also affected(1.6%) for each.Clinically, the types of lesions in patients with chilblains were: erythematous cyanoticswelling (81.6%), some with diffuse welling sausage - like (13.3%),erythema multiforme –likepicture with target lesions (20 %), purpuric rash (15 %),ulcerated lesions (11.6%), eczematizationwith fissuring (11.6%),blisters or vesicles (6.6%),dusky red papules (6.6%), lupus erythematosus –like rash on dorsum of the hands (5%) and nodules (3.3%).In Iraq, chilblains clinically could be presented in a form of erythema multiforme-like,erythema nodosum –like, lupus erythematosus-like or sausage-like swelling with cold fingers andtoes, pain, tenderness and itching.

مرض تشرين ( الشرث ) عند المرضى العراقيين في مدينة الحلة, دراسة سريريه:70 سنة أي بمعدل 22.6 سنة. وجد - تمت دراسة 60 حالة من المرضى المصابين بمرض تشرين تتراوح أعمارهم بين 1.5ب

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Article
Isovolumetric Relaxation Time “IVRT” as an Assessment of Left Ventricular Diastolic Function: M-Mode Derived Versus Doppler Derived

Author: Akeel A. M. Hassan Zwain
Journal: Kerbala Jorunal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2008 Volume: 2 no.4, 5 Issue: 3 Pages: 345-351
Publisher: Kerbala University جامعة كربلاء

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Abstract

Background: Isovolumetric Relaxation Time” IVRT” may be defined as: That part of the cardiac cyclebetween the time of aortic valve closure and mitral opening, during which the ventricular muscledecreases its tension without lengthening so that ventricular volume remains unaltered. During this periodthere is a drastic decrease in ventricular pressure without a change in ventricular volume but prior tomitral valve opening. IVRT can be estimated by M-Mode echocardiography with simultaneousphonocardiography or simply by determining the time interval between the maximal systolic excursion ofthe left ventricular posterior wall to the onset of mitral valve opening. More recently, Doppler techniquehas been used to assess not only IVRT but also MPI “Myocardial Performing Index”; comparisons ofDoppler 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 SiemensV.Plus equipment with phased array 2.5MHz probe and PW or CW facilities was used. A good M-modeimage of mitral valve excursion and left ventricular posterior wall systolic excursion was first obtainedand the time between the mitral valve opening and the maximal systolic excursion of LV posterior wallwas then calculated. Doppler IVRT was obtained by directing the Pulsed or continuous wave beam fromapical 5 chamber view across the region between the aortic out flow tract and the mitral inflow tract. Thespectral wave form obtained in this position should include aortic valve flow with valve closure and theonset of mitral inflow with E/A configuration. In this spectrum the aortic closure- mitral opening intervalcan be determined.Results & conclusion: There was no significant difference between M-mode derived IVRT and Dopplerderived IVRT. Since the later has been validated on the ground of correlation with catheterization, thus itseems feasible to use either techniques to assess LV diastolic function.

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