Main Subjects : Medicine


Misjudgement and Misuse of the Learning Objectives

Ghanim Y. M. Alsheikh

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 1-7
DOI: 10.33762/mjbu.2020.129154.1056

In medical education, the curriculum passes through at least four stages between vision and learning of students namely: “intended” to “planned” to “implemented” to the “learned” curriculum. The most important safeguard for keeping these formats compatible is the quality of the aims and objectives. This editorial describes the hierarchy of the educational objectives, their importance, types, sources, and qualities and best ways to formulate effective learning objectives that link learning and outcomes to the vision and consequent aims. Also, the article highlights the common misjudgements and misuses of the learning objectives which may produce different and certainly poorer outcomes than those planned for.

Early Mortality Risk in Patients with Multiple Myeloma

Diveen Hussein; Diveen Hussein

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 75-84
DOI: 10.33762/mjbu.2020.127475.1022

Abstract:
BACKGROUND: Advances in treatment has improved greatly survival of multiple myeloma in
the last two decades, and this improvement has been endorsed by wider use of novel drugs and
tandem autologous stem cell transplantation. However, still there were cases died earlier post
diagnosis
OBJECTIVES: To study the risk factors of early mortality in patients with multiple myeloma In
Kurdistan region of Iraq
PATIENTS AND METHODS: A 176 cases that were diagnosed with symptomatic multiple
myeloma between (January 2012 – July 2019) in cancer centers in Kurdistan region of Iraq. A
total of 152 were continued within the study through their recorded sheet. Their data were
analysed to determine what are the main risk factors that have an impact on early mortality
among our myeloma patients.
RESULTS: Among the total of 152 studied patients nine of them (5.9%) died early. The highest
proportion (32.2%) of the sample aged 60-69 years, more than half (57.2%) of the them were
male. The majority of the patients (80.9%) have been diagnosed during 2016-2019. The
incidence of early death was 8.7% among patients who didn’t take the cytotoxic treatment
compared with 1.7% of patients who took that treatment, but the difference was not significant (p
= 0.089). The early death rate was significantly high (22.2%) among patients who didn’t take the
immunomodulatory drugs, versus 2.4% of patients who took the immunomodulatory drugs (p =
0.001). The incidence of early mortality was 9.6% among patients with lactate dehydrogenase of
≥ 250 U/L compared with 0%

Incidence and predictors of acute kidney injury among hospitalized patients with COVID-19 infection

Hayder Aledan; Shawqi Azeez; Abdali Shannan; Ammar Husaini; Muqtader Abdulhussein

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 37-45
DOI: 10.33762/mjbu.2020.128481.1038

Abstract
Background and objectives: Acute kidney injury (AKI) may occur in the setting of COVID-19 infection and associated with worse outcome. We aimed to estimate the incidence of AKI among hospitalized patients with COVID-19 infection.
Methods: We conducted an observational cohort study on 339 hospitalized patients with COVID-19 infection at Basra teaching hospital for two months. We studied the rate of AKI, requirement for renal replacement therapy (RRT) and in-hospital mortality.
Results: Among 339 hospitalized patients, AKI was reported in 54 (16%). The peak stages of AKI were stage 1 in 42.6%, stage 2 in 22.2% and stage 3 in 35.2%. AKI was primarily seen in patients with shock on vasopressors in 64.8% and in patients on mechanical ventilation in 25.9%. Increased age, obesity, hypertension, vasopressors and mechanical ventilation were independent risk factors for development of AKI. Among the 54 patients with AKI, 20 patients (37%) required renal replacement therapy (RRT). Sixteen out of 20 patients (80%) of those who required RRT died and only 5 out of 34 patients (15%) of those not required RRT died with a totally mortality in AKI patients of 21 patients (39%).
Conclusions: AKI occurs in patients with COVID-19 disease especially in ICU in association with vasopressors use and mechanical ventilation and is associated with poor prognosis.

Improving outcomes of medical colleges: A proposed Institutional Governance and Communication Protocol (IGCP)

Ghanim Y. M. Alsheikh

The Medical Journal of Basrah University, 2020, Volume 38, Issue 1, Pages 1-6
DOI: 10.33762/mjbu.2020.126983.1009

Governance and communication represent the foundations for effective impact on the level of institutional performance in higher education colleges, including medical schools. Governance encompasses the frameworks of structures, relationships, and processes ongoing in the college. It is recognized that medical schools in Iraq lack the adoption of a clear mechanism in this field. This article aims to present a proposed protocol for the development of governance and institutional communication in Iraqi medical colleges whose components have been formulated according to the needs of these colleges. The proposal reviews the components, benefits, and foundations of governance according to a number of targeted values, thus presenting a proposed framework for the components of an institutional system for governance and communication. This proposal allows ample discussions among college stakeholders which leads to revision and implementation to fill the gap towards achieving effective and efficient governance that enables the achievement of college goals. The framework addresses number of elements including at least: neutrality in the work and decisions of councils and their strategic and operational roles, the absence of a strategy for senior management, institutional and individual periodic planning, standard operation procedures, job description, key performance indicators, human resource management policies and documentation concepts, and in the forefront of them digital documentation and communication via the Internet and databases.

Hand hygiene practice of health care workers in prevention of nosocomial infection in one hospital in Basrah

Alaa K Mousa

The Medical Journal of Basrah University, 2019, Volume 37, Issue 1, Pages 19-28
DOI: 10.33762/mjbu.2019.163351

Background: The hand hygiene plays an essential role in prevention as well as curing the nosocomial infectious disease. Physicians, nurses and laboratory persons are the major health care workers communicating with patients, could become the transporter in the cycle of infectious diseases. Objective: To evaluate the knowledge and practice of health care workers for hand hygiene in hospital wards and study the predisposing factors effecting the hand hygiene.Methods: A cross-sectional study carried out on doctors, nurses and laboratory men who worked in Al-Mawane Teaching Hospital in Basrah (Iraq). Questionnaire of hand hygiene for data collection was applied.Results: 401 health care workers were studied, The results showed moderate level of hand hygiene for doctors, nurses and laboratory persons (average score 3.97 + 0.6). Nurses had the highest level of hand hygiene. Perfect hand washing was found in 62%, compared with 56% for laboratory staff and 29% for physicians. Gender was insignificant in the practice of hand hygiene, while age, level of education, duration of service, training courses and vaccination against type B hepatitis had statistically significant impact on hand hygiene.Conclusion: The control of infection in hospitals goes through the care of hand hygiene in health workers, which need more attention. The current study revealed somewhat unacceptable level of knowledge and care of the cleanliness of the hands of doctors, nurses and laboratory persons. The need to develop the level of knowledge and practice by training programs and continuing medical education

Enteric adenovirus associated with acute gastroenteritis among hospitalized and healthy childern under five - years of age in Basrah, Iraq

Hazim T Thewainy; Hassanf Hasony

The Medical Journal of Basrah University, 2019, Volume 37, Issue 1, Pages 37-44
DOI: 10.33762/mjbu.2019.163353

Background: Enteric Adenovirus are second to rotavirus as viral cause of acute gastroenteritis in infants and young children. Aims of the study: This study aimed on determination of the incidence of enteric adenovirus-associated gastroenteritis in infants and young children below five years of age, and to detect the season and age related distribution of enteric adenovirus infections as well as the major clinical symptoms associated with these virus infections.Objective: A total of 400 stool specimens (200 symptomatic diarrheal cases and 200 asymptomatic normal children) were collected during the period from March 2011-March 2012. All relevant informations were obtained on special questionnaire form. Viral genomic DNA was extracted from stool specimens by using a spin column technique according to the instructions given by QIAamp-MinElute virus spin kit for purification of virus genome (Qiagen, Germany). Results: Enteric adenovirus was detected by the use of specific primers. Enteric Adenovirus was detected in 3% of diarrheal cases in hospitalized children whereas all healthy children were negative for enteric adenovirus. Age group analysis revealed that children at age groups of 9-11 and 12-17 months were more affected. The monthly distribution of enteric adenovirus cases showed to be confined to a period of 4 months (August through November). The clinical symptoms associated with adenovirus gastroenteritis was dehydration (80%), vomiting (60%) and fever (60%) while abdominal pain was not recorded.Conclusion: Enteric adenovirus is common enteric pathogens as that for rotavirus in our community.

Cisplatin & IV Etoposide combination in the treatment of advanced breast cancer pretreated with anthracyclines

Anmar A Allami

The Medical Journal of Basrah University, 2019, Volume 37, Issue 1, Pages 29-36
DOI: 10.33762/mjbu.2019.163352

Background: Aims of this study was to determine the benefit of cisplatin and i.v etoposide combination in treatment of advanced breast cancer (ABC) patients who were pretreated with anthracyclines, as an alternative to the newer, more expensive, and unavailable anticancer drugs like Taxanes, carboplatin, and gemcitabine.Patients and methods: The study was performed in the period from March 2010 to June 2016, 235 patients were given cisplatin 50mg/m2 and etoposide 100mg /m2 for 6 cycles. The patients were divided into 4 groups according to the site of metastasis (vertebral metastases, liver metastases, loco-regional metastases, and pleuro-pulmonary metastases).Results: Evaluation of treatment was considered on two levels: Whole 235 patient level, and patient-group level. On whole patient level: Response to Treatment was 65.1%, which is higher than similar responses in many other studies. While on patient-group level: response to treatment was highest in patients with vertebral secondaries 75.3%. There was drug toxicity in all groups of patients. Some patients did not continue the treatment protocol because of bad performance status, toxicity and death. Conclusion: In comparison with other regimes of chemotherapy cisplatin and i.v etoposide are still useful anticancer drugs in the management of advanced breast cancer.