The Medical Journal of Basrah University

Background: The primary and well established risk factor for urinary bladder cancer is cigarette smoking. ‎
Objective: The purpose of the present study was to evaluate the association between cigarette smoking and the ‎development of urinary bladder cancer in Basrah.‎
Methods: A case control study was conducted to examine the association between the risk of urinary bladder cancer and ‎various characteristics of smoking: the smoking status (current or ex-smoker), smoking intensity (cigarette per day), ‎duration, total exposure (pack-years), type of cigarette (filtered or unfiltered), inhalation, and environmental tobacco ‎smoke exposure. The study population composed of 87 patients with newly diagnosed bladder cancer cases and 357 ‎controls. Cases and controls were matched for age, sex, and residence.‎
Results: An increased risk of urinary bladder cancer was found for both current and ex-smoker (for current smoker OR ‎‎= 2.98; 95% CI = 1.68-5.28 and for ex-smoker OR = 4.05; 95% CI = 2.19-7.48). The study also revealed a significant ‎positive trend in urinary bladder cancer risk with smoking intensity, pack-years, and environmental tobacco smoke. ‎
Conclusion: The results of the present study are consistent with the findings of the previous epidemiological studies and ‎confirm that smoking is a major risk factor for urinary bladder cancer and preventive strategies should be directed ‎toward smoking as risk factor for urinary bladder cancer in Basrah. ‎

Background: This is a prospective study carried out at one of the main operating theaters in Basrah general hospital. ‎The study lasted for 6 months (from May to October 2013). ‎
Objectives: The aim was to assess the adherence of staff in the operating theater to items of services covered by a World ‎Health Organization Checklist. The study is in line with the vision of the Ministry of Health to provide high quality care.‎
Method: A structured questionnaire form was prepared for the purpose of the study. It was based on the World Health ‎Organization checklist; first edition. Observation of all procedures, instructions and labeling of patients before, during ‎and after the surgical operation was made. A total of 378 surgical operations (patients) were covered in the study
Results: The degree of adherence to the various items of the checklist (28 items) varied greatly. Items with high ‎adherence rate (>‎‏ ‏‎90%) were those related to documentation of age, gender, informed consent, shortness of breath and ‎patient recovery checking. Items with fair documentation (70-90%) were those related to next of kin, mobile phone ‎number, history of chronic disease, time of last meal, allergy to anaesthesia, post-operative checking of certain ‎equipment, preparation of blood and prophylactic antibiotics and biopsy handling. All other items were of poor ‎adherence. ‎
Conclusions: The adherence to the requirements of the surgical safety check list was fair but further improvement in ‎its use is required to enhance quality of care.‎

Background: People often seek care from multiple sources outside the formal traditional health care system. One of ‎these sources is the use of Complementary and Alternative Medicine (CAM) including herbal medications. Diabetic ‎patients are found 1.6 times more likely to use CAM than non diabetic patients.‎
Aim: To investigate the effectiveness of cinnamon, fenugreek and their combination in type 2 diabetic patients not well ‎controlled by oral antidiabetic drugs.‎
Methodology: Fifty four diabetic patients who were on oral hypoglycemic drugs were randomly divided into 4 groups. ‎Group 1, 2, 3 and 4 were treated with bran, cinnamon (3 gm), fenugreek (15 gm), and the combination of fenugreek and ‎cinnamon. HbA1C and 2 h postprandial glucose (PPG) were measured at baseline and 40 days of treatment. Results: ‎HbA1C level and 2 h (PPG) were significantly declined from baseline with 40 days placebo treatment. Significant ‎reduction in HbA1C was noticed with 40 days cinnamon treatment (9.37 ± 2.1% to 8.76 ± 1.9%). This effect was ‎paralleled with reduction of 2 h-PPG from 291± 99 mg/100ml at baseline to 233 ± 61 mg/100ml after 40 days treatment. ‎The same changes in HbA1C and 2 h PPG were noticed with fenugreek and even more with the combination of ‎fenugreek and cinnamon.‎
Conclusions: daily supplementation with cinnamon, fenugreek or their combination to patients not achieving glycemic ‎control with oral antidiabetic medications and diet is effective in lowering HbA1C and 2 h PPG in type 2 diabetic ‎patients.‎

Background: Type-2 diabetes mellitus (T2DM), is becoming an important health problem worldwide. Diabetes ‎mellitus may be associated with low grade chronic inflammation and oxidative stress; both of them could contribute to ‎its pathogenesis. The use of anti-inflammatory and/or antioxidant drugs, therefore, represents a promising attempt for ‎treatment and/or prevention of this disease.‎
Objectives: To compare the effect of diclofenac sodium alone and when combined with paracetamol in type-2 diabetic ‎patients not achieving target HbA1c.‎
Patients and Methods: Twenty four, type-2 diabetic patients consulting the Center for Diabetes and Endocrinology in ‎Maysan, south of Iraq, had managed to complete the 3 month period of the first part of this study after meeting a set of ‎inclusion criteria. Their HbA1c was more than 7% despite the continuous use of oral antihyperglycemic drugs. The ‎effect of diclofenac was compared with another group (n=21) that received paracetamol in addition to diclofenac ‎sodium. Blood samples were taken from before, one month and three months after the start of treatments for ‎measurement of HbA1c, C-reactive protein, C-peptide level and more frequently plasma glucose level ‎‎(fasting/random). Another sixty patients of similar inclusion criteria were also followed for three months but without ‎treatment and served as a control group.‎
Results: The effect of one month treatment with diclofenac sodium alone or in combination with paracetamol resulted ‎respectively in a reduction in HbA1c by 9.4% and 11.4%, a reduction in CRP by 62.1% and 79.6%, an increase in C-‎peptide by 262.5% and 216%, a reduction in FPG by 11.2% and 18.1% and a reduction in RPG by 40.3% and 24.8% in ‎comparison to pre-treatment levels.‎
The HOMA- ß C-peptide measured in a limited number of patients treated with diclofenac sodium or its combination ‎with paracetamol showed an increase by 405.3% and 330.6% three months after start of treatment for the two groups ‎respectively. The control, non- intervention group did not show significant changes in the levels of HbA1c over the ‎three-month period. ‎
Conclusion: Diclofenac sodium 100mg SR capsule administered once daily for one month seems to be effective in ‎achieving a good glycemic control in patients not achieving target HbA1c. The addition of paracetamol to diclofenac did ‎not show a clear synergistic effect, despite paracetamol beneficial effect that had been shown in a previous study. ‎

Objectives: A case-control study was carried out to identify nutritional risk factors for acute lower respiratory tract infections among infants and children ‎under 5 years.‎
Methods: Children who have been admitted to the pediatric wards at Basra Maternity and Children Hospital and those who have visited Al-Razie Primary ‎Health Center over the period from the 4th of November 2007 till the end of May 2008 were recruited. A total of 110 patients with pneumonia according to the ‎WHO criteria and 207 apparently healthy infants and children, their age ranged from 2 months-5 years were included. ‎
Results: The study has revealed that formula feeding in early life, duration of breast feeding of less than 6 months, time of introduction of weaning foods ‎before 6 months, anemia, rickets and malnutrition are significant risk factors for acute lower respiratory tract infection. In addition, a significant correlation ‎was found between the severity of the acute lower respiratory tract infection and rickets, malnutrition, serum calcium level, and hemoglobin level
Conclusion: Presence of anemia, rickets and malnutrition are significant risk factors for acute lower respiratory tract ‎infections and also for a more severe disease.‎

Objective: To compare the effect of low dose aspirin and enoxaparin on pregnancy in women with recurrent ‎miscarriage.‎
Patients& Methods: Randomized controlled trail, conducted in Basrah Maternity and Child Hospital during the period ‎from January 2012 till April 2013. Participants were 221 pregnant women aged 18-41 years with history of at least 2 ‎previous miscarriage without apparent causes. They were divided into 2 groups; the first group included 111 were given ‎enoxaparin and the second group involved 108 which were given aspirin.‎
Results: In both groups (75%) of patients had negative serological test for thrombophilia. Enoxaparin group had higher ‎significant incidence of term delivery (86%) with less incidence of preterm delivery (4.5%) and less early pregnancy ‎loss (8%).‎
No significant differences in obstetrical complication but higher incidence of abdominal delivery in both groups.‎
Higher incidence of postpartum hemorrhage in the enoxaparin group in comparison with aspirin group and no significant ‎systemic adverse effect of enoxaparin were noticed on the first group.‎
Conclusion: Since postpartum hemorrhage is treatable, low molecular weight heparin is safe and effective for treating, ‎preventing thrombosis and achieving successful pregnancy.‎

Background: Lichen planus is an inflammatory, pruritic disease of the skin and mucus membranes, which can be ‎either generalized or localized. Many studies indicated that human leukocyte antigens might have a role in lichen ‎planus (LP). As far as my knowledge, no previous study had done in Iraq about HLA-DQA1 and -DQB1 alleles ‎frequencies in patients with lichen planus. ‎
Aim: The aim of the present study is to investigate the additional genetic contribution to lichen planus susceptibility ‎lying on the HLA region, by focusing on the possible differential contribution of the different DQA1 and DQB1 carrying ‎haplotypes.‎
Method: The present study was carried out in College of Medicine during the period between (2012-2014). 50 patients ‎with lichen planus attending Basrah General Hospital and private clinic, and 50 healthy controls‏ ‏were included in the ‎study, with age group from (13-67) years. 100 DNA samples were purified from the blood samples of patients and ‎controls, and then followed by PCR amplification of HLA-DQA1 and DQB1 genes in Cell Research Unit, Biology ‎Department, College of Science, University of Basrah. The sequencing-PCR was done in Korea, Bioneer sequencing ‎laboratories. ‎
Results & Conclusions: Results indicated statistically significant decreased frequencies of HLA-DQA1*010201 ‎‎(P<0.005), DQA1*0201 (P < 0.05), and -DQB1*030201 (P < 0.005) alleles in lichen planus patients, which indicated ‎that these alleles might be a protective factors. Results also indicated statistically significant increased frequencies of ‎DQA1*010401 (P<0.005), DQA1*040101 (P<0.005) DQA1*050101 (P<0.005), DQB1*030101 (P<0.005) and ‎DQB1*050101 (P<0.005) alleles in lichen planus patients, which indicated that these alleles might be risk factors and ‎increase the ability of infection. The present study indicates that genetic constitution through HLA-DQ locus determines ‎the mechanism of disease as well as clinical and pathologic outcomes. More studies are necessary to test genetic ‎dependencies on the basis of larger samples which would increase statistical power. An accurate definition of disease ‎susceptible alleles will improve our understanding of antigen presentation mechanisms prevailing in the etiology of the ‎disease. This knowledge is necessary for the design of improved immune intervention strategies to halt lichen planus ‎progression in patients at risk of developing the disease or those who are already suffering from it.‎