Volume 39, Issue 1, Winter and Spring 2021


National Health Systems Response to COVID-19 Outbreak, Iraq an Example

Alaa Hussein Abed; Dhurgham A. Abdulwahid; Haider A. Jassim

The Medical Journal of Basrah University, 2021, Volume 39, Issue 1, Pages 1-6
DOI: 10.33762/mjbu.2021.130218.1071

This article describes chronologically the development of COVID-epidemic in Iraq, mainly Basra Province, and the response of the national and provincial health system response to control this crisis. It points some strengths and weaknesses of this response. In addition, it mentions some of the opportunities that need to get benefit from, including following an evidence-based approach in epidemic control management. Some of the international assessments' results showed that the performance of Iraqi health system come at the tail of the sorted list of international health systems. This necessitates conducting a scientific systematic evaluation to the national performance to precisely quantify structural and process strengths and weaknesses.

Intrauterine vertical transmission of COVID-19 during pregnancy: A systematic review

Jasim Al Asadi; Sadiq M Mousa

The Medical Journal of Basrah University, 2021, Volume 39, Issue 1, Pages 7-20
DOI: 10.33762/mjbu.2021.128851.1045

Background: COVID-19 infection in pregnancy raised concerns about the risk of intrauterine vertical transmission of the SARS-CoV-2 from mother to fetus.
Objectives: to review the current evidence on the possibility of intrauterine vertical transmission potential among COVID-19 infected pregnant mothers.
Methods: Eligible studies published from December 2019 until August 1, 2020, were searched for from PubMed, PubMed Central, Google scholar, medRxiv, and bioRxiv collection databases using MeSH-compliant keywords including COVID-19, pregnancy, intrauterine vertical transmission, Coronavirus 2019, SARS-CoV-2, 2019-nCoV, and maternal-fetal transmission.
Results: The initial search yielded 152 articles. After elimination of duplicates, review, commentaries, and articles from media, 78 articles were deemed relevant and comprised neonatal outcome data for 1231 neonates whose mothers were infected with COVID-19. Of these 78 articles, 24 articles that fulfilled the inclusion criteria were eventually selected for analysis yielding 517 neonates from 514 pregnancies (3 sets of twins). Most of the women (64.4%) were delivered by cesarean section. Vaginal delivery was reported in 31.7%, and in 20 women (3.9%), the mode of delivery was not reported. Of the total 517 neonates reported in the 24 analyzed articles, 51 neonates (9.9%; 95% CI, 7.4-12.8) were tested by positive by at least one of the investigation tools, and 38 neonates (7.3%; 95% CI, 5.3-9.9) were found positive for SARS-CoV-2 by RT-PCR nasopharyngeal swab.
Conclusions: The risk of intrauterine vertical transmission of SARS-CoV-2 in late pregnancy is possible but rare. However, the potential risk of vertical transmission in early pregnancy is not yet assessed.

Overview of Iraqi experience in management of acute promyelocytic leukemia

Waseem Al-Tameemi; Zahra’a S. Shakir

The Medical Journal of Basrah University, 2021, Volume 39, Issue 1, Pages 21-30
DOI: 10.33762/mjbu.2021.129847.1068

Background & Objectives
In Iraq, leukemia is the 4th most common cancer, Acute promyelocytic leukemia contributes to 2.83%, and 3.18% of leukemia in Iraqi males and females respectively. This study is to review of acute promyelocytic leukemia patients presentation and management outcome in Iraq
Patients and Method
A hospital based case series study was conducted over a period of 15 months in different hematology centers. A total of 58 acute promyelocytic leukemia patients were enrolled in this study (53 newly diagnosed and 5 relapsed cases). Diagnosis based on of morphology with or without cytogenetic study.
Results
The mean age was 33.1±13.8 years, with slight female predominance. Most cases presented at winter season (39.7%). Sanz severity scoring classification as; (25.9%) low risk, (53.4%) intermediate risk, and (20.6%) high risk disease. Induction protocol consist of chemotherapy plus ATRA in (58%) while (36.2%) received only ATRA plus ATO. At the end of induction, 86.2% of patients have complete remission, while only 13.8% have failure of induction due to death. Induction mortality was higher in those who have received chemotherapy based regimens. At relapse, a second complete remission has been achieved in 4 out of 5 cases (80%).

Conclusion
There is a predilection of acute promyelocytic leukemia to young age group and winter season presentation. The choice of non-chemotherapy regimens, especially for the low and intermediate risk group, showed no drawback in complete remission rate. Disease outcome in Iraq has improved over several years due to increasing experience with using different regimen

Split tibialis anterior tendon transfer to treat ambulatory children with spastic cerebral palsy who experienced dynamic equino varus deformity

Zmnako Amen; Omer Ali Rafiq

The Medical Journal of Basrah University, 2021, Volume 39, Issue 1, Pages 31-36
DOI: 10.33762/mjbu.2021.128592.1040

Background: Treatment of ambulatory children with spastic cerebral palsy complaining from dynamic equino varus deformity by split tibialis anterior tendon transfer (STATT), because over activity of tibialis anterior muscle and weak antagonist muscles are the main cause of the deformity.
Aim: The purpose of this study is to assess the postoperative results of split tibialis anterior tendon transfer, according to Garceau and Palmer criteria.
Patients and Methods: 13 feet in 13 ambulatory children with spastic cerebral palsy complaining from dynamic equino varus deformity, preoperatively 7 of the fair,6 of them were poor, while postoperatively 2 of them became excellent,10 of them good and 1 of the fair.
Results: The result of this prospective case series study assessed by using Garceau and Palmer criteria.
Conclusion: Split tibialis anterior tendon transfer, is a good method for treating ambulatory children with spastic cerebral palsy complaining of dynamic equinovarus deformity of the forefoot and midfoot which is due to overactivity of tibialis anterior muscle and weak antagonists.
Keywords: Dynamic equinovarus foot deformity; Split tibialis anterior tendon transfer; Hoffer’s procedure; and Garceau & Palmer criteria.

Effect of Reformation of the Anterior Chamber by Air or by Ringer’s lactate solution on Corneal Endothelial count and morphology after Phacoemulsification

Zaid abdulkhalik Zaki; Najah K. Mohammad

The Medical Journal of Basrah University, 2021, Volume 39, Issue 1, Pages 37-46
DOI: 10.33762/mjbu.2021.129641.1067

Background:The corneal endothelium has no ability of regeneration, so any decrease in its density is irreversible and can lead to permanent blurring of vision and pain. Direct contact between air and the corneal endothelium may cause endothelial damage.
Aim:To compare the effect of reformation of the anterior chamber after phacoemulsification, using air and ringer’s lactate solution injection, on corneal endothelial count and morphology.
Subject and method:A prospective interventional randomized comparative study includes 76 eyes of 76 patients, prepared for phacoemulsification surgery in the period from October 2018 to March 2019. Corneal endothelial morphology and count examined by specular microscopy, and the results recorded for all cases before the surgery. Patients examined by slit lamp biomicroscope and divided randomly into two groups, and both groups were diagnosed with grade 1-2 age related nuclear cataract (according to Lens opacity classification system III). Both groups underwent phacoemulsification surgery with IOL implantation by single well-trained surgeon, group 1 will be subjected to anterior chamber reformation with 0.1 ml air injection while group 2 will be subjected to reformation of the anterior chamber with ringer’s lactate solution. Corneal endothelial morphology and count to be evaluated at 1 week, 1 month and 3 months postoperatively.
Results:no significant statistical difference regarding the percentage of CCT changes, cell loss, coefficient of variation and hexagonality between the two groups at baseline and all subsequent visits.
Conclusion:no significant difference between air and ringer's lactate solution on the corneal endothelial count and morphology.

Serum potassium and calcium level in patients with post-myocardial infarction ventricular fibrillation

zainab mahmood

The Medical Journal of Basrah University, 2021, Volume 39, Issue 1, Pages 47-53
DOI: 10.33762/mjbu.2021.129372.1063

Abstract: Background: Arrhythmias are common in the first hours after myocardial infarction. Electrolytes imbalance often contribute to the development of cardiac arrhythmias. Aims of the study to show the correlation between serum potassium and calcium and development of post myocardial infarction ventricular fibrillation and to assess the effect of different age groups and gender in the development of this arrhythmia. Patients and method: Ninety three patients, 66(70.96%) males and 27 (29%) females were studied. The mean age was 57.13±11.86 years. Patients included were those who were admitted to the cardiac care units with acute myocardial infarction in 4 hospitals in Basra (southern of Iraq), blood samples for Potassium and Calcium were taken upon admission. Results: Forty (43%) patients had developed primary ventricular fibrillation. The incidence of primary ventricular fibrillation was greater among patients with serum Potassium ≤3.5mmol/L and >4.5mmol/L (p value=0.002). Age was not associated with increased frequency of primary ventricular fibrillation in patients with abnormal serum Potassium, but the incidence of primary ventricular fibrillation as caused by abnormal serum Potassium level was higher among females. No increase in primary ventricular fibrillation was found in patients with abnormal serum Calcium. Conclusions: The incidence of post myocardial ischemic primary ventricular fibrillation was very common in patients with serum Potassium ≤3.5mmo/L and >4.5mmol/L.

Nutritional Status of Children and Adolescents with Type1 Diabetes Mellitus in Basra

Ban R Dohan; Sawsan Habib; Abbas Abd Khazal

The Medical Journal of Basrah University, 2021, Volume 39, Issue 1, Pages 54-60
DOI: 10.33762/mjbu.2021.127780.1027

Abstract
Background: Growth problems represent an important complication in children and adolescent with Type1 diabetes mellitus and poor metabolic control seems to impact their growth velocity.
Aim: to assess the nutritional status in children with type 1 diabetes mellitus, in relation to selected patients' variables.
Methods: a case-control study has been carried out to assess the nutritional status of sixty-one patients with type 1 diabetes mellitus; and eighty-two age and sex matched healthy children as control group; their ages ranged from 3-14 year, from the 1st of October 2016 till 15th of March 2017.
Results: The mean age of diabetic patients was (10.3±3.02) years; (60.66%) belong to large family size with low education. Diabetic patients significantly belong to families with poor financial support and income in (45.9%) compared to the control group (26.8%) (p value 0.02), as well as those undernourished diabetic children significantly belongs to families with poor income than those with normal nutritional status (75%, 38%) respectively. Body mass index was significantly below 5th percentile in diabetic patients than the controls (19.68 %, 2.4 %) respectively; P value 0.001. History of inadequate dietary intake was recorded in 66.67% of patients; significantly related to undernutrition in diabetics patients than controls (P value 0.002). Undernutrition in diabetic children significantly associated with poor glycemic control with significantly high level of HbA1c (13.9±9.57) than those without undernutrition (10.6±5.28) respectively.
Conclusions: Frequent evaluation of diabetic children is required to overcome the problem of undernutrition in patients with type 1 diabetes mellitus.
Keywords: Type1diabetes; Nutritional status; Children; Basra

Vitamin D deficiency and Tuberculosis in Basrah: The Effect of Anti-tuberculosis Drugs

Huda A. Yacoob; Nazar S. Haddad; Dheyaa B. Al RAbeai; Abdullah M. Jawad

The Medical Journal of Basrah University, 2021, Volume 39, Issue 1, Pages 61-72
DOI: 10.33762/mjbu.2021.128899.1047

Background
Low vitamin D levels had been reported to be associated with a wide range of health problems, one of them is tuberculosis. the aim is to estimate vitamin D serum concentration among patients with tuberculosis at baseline, 2 and 5 months after starting anti-tuberculosis treatment.
Methods
The study was carried out at the TB Center and College of Medicine in Basrah (Iraq), during the period from September 2018 to June 2019. Participants were newly diagnosed tuberculosis patients, and their matched apparently healthy controls. Total 25-hydroxy vitamin D in serum was estimated using chemiluminescent microparticle immunoassay. Calcium, phosphorus, alkaline phosphatase, parathyroid hormone, and others, were also measured.
Results
There were no statistically significant difference in the mean levels of vitamin D between tuberculosis patients at baseline (n=56) and control subjects (n=57). The prevalence of vitamin D deficiency was high in patients and their controls at baseline where more than 80% of them had a vitamin D level below 20 ng/ml.
When patients were followed two months after starting anti-tuberculosis treatment, the mean serum vitamin D level was significantly lower than that at baseline. Despite the wide spread vitamin D deficiency among TB patients, all smear-positive pulmonary TB patients, except 3, had sputum conversion after 2 months of treatment.
Conclusions
The prevalence of vitamin D deficiency is high with no significant difference between tuberculosis patients at baseline and their matched normal controls. Vitamin D deficiency did not seem to affect the response of patients to anti-TB treatment.

TINNITUS AND VERTIGO IN PATIENTS WITH CHRONIC KIDNEY DISEASE ON HEMODIALYSIS IN BASRA HEMODIALYSIS CENTER

Ahmed Al Abbasi; Haider K Saeed

The Medical Journal of Basrah University, 2021, Volume 39, Issue 1, Pages 73-78
DOI: 10.33762/mjbu.2021.128922.1049

Objective: evaluation of the hemodialysis effect on the development of tinnitus and/or vertigo in patients with CKD. Materials and Method: 59 patients with CKD on regular hemodialysis were enrolled in this study. Results: patients mean age was 41.8 ± 9.2 years (range: 17–50 years). Male to Female ratio was 1.27:1. 16.95% of patients had tinnitus only, 16.95% had vertigo only, 30.51% had combination of both and only 35.59% didn’t develop symptoms. There was significant relation between the duration of hemodialysis and the development of tinnitus and vertigo (P value = 0.047). No significant relation was found between age, sex, serum electrolytes, blood urea and serum creatinine. Conclusion: Tinnitus and/or vertigo are common in patients with CKD on hemodialysis.

Objective: evaluation of the hemodialysis effect on the development of tinnitus and/or vertigo in patients with CKD. Materials and Method: 59 patients with CKD on regular hemodialysis were enrolled in this study. Results: patients mean age was 41.8 ± 9.2 years (range: 17–50 years). Male to Female ratio was 1.27:1. 16.95% of patients had tinnitus only, 16.95% had vertigo only, 30.51% had combination of both and only 35.59% didn’t develop symptoms. There was significant relation between the duration of hemodialysis and the development of tinnitus and vertigo (P value = 0.047). No significant relation was found between age, sex, serum electrolytes, blood urea and serum creatinine. Conclusion: Tinnitus and/or vertigo are common in patients with CKD on hemodialysis.

Acute Coronary Syndrome Below 50 Yrs.

Hamid Abdulwahab Abdulsada; Saad Hamady

The Medical Journal of Basrah University, 2021, Volume 39, Issue 1, Pages 79-85
DOI: 10.33762/mjbu.2021.129500.1066

Background: Coronary artery disease is a catastrophic diseased, despite the recent decline in mortality, with improving facilities, more distressing if occurs in young, clearly because an otherwise healthy adult may die or become disabled without caution, besides the tragic consequences for the family, friends, and the job might be unexpected. The study aims to focus on these physically active groups and to get an idea about how to prevent them. Method: In a prospective study 365 patients with an acute coronary syndrome, of them, 117 adults age less than 50 years and 248 patient were above 50 yrs, underwent coronary angiography . were assessed comparatively for the contribution of many risk factors with the clinical and angiographic variable. Result: about one-third of cases who present with the acute coronary syndrome were more young, male, and smoker, with a family history of ischemic heart disease, more likely to had a myocardial infarction, rather than angina, usually single-vessel disease, with low high-density lipoprotein. Conclusion: In our study, we found a strong association with smoking, family history and low HDL with early ischemic heart disease. Abstinence from smoking with diet and exercise might help to improve these major risks. Screening for CHD in the young population may help to improve prognosis in young patients by detecting subclinical disease.