Volume 38, Issue 1 (Published Ahead of Print ), Winter and Spring 2020


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.

Epidemiological Features of COVID-19 Epidemic in Basrah-Southern Iraq-First Report

Omran S Habib; Abbas K AlKanan; ِAlaa H Abed; Nihad Q Mohammed

The Medical Journal of Basrah University, 2020, Volume 38, Issue 1, Pages 7-18
DOI: 10.33762/mjbu.2020.126943.1008

Epidemiological Features of COVID-19 Epidemic in Basrah-Southern Iraq-First Report
Abstract
Background: COVID- 19 expanded from an outbreak in China to a devastating pandemic across the world. .
Objective: To describe the epidemiology of COVID-19 in Basrah Province-Southern Iraq
Methods: Data were obtained from the Department of Public Health in Basrah and the daily communique of the Ministry of Health. Data on population were obtained from the Ministry of Planning. For all provinces the total number of cases and their fate in terms of being under treatment, cured or died was obtained. For cases in Basrah, data on age, sex, residence, fate, travel history and presence of co-morbidity for 152 cases.
Results: In Basrah, The mean age was 46 years (Median 45 years) and the range was 13-98 years. No difference in the risk of COVID-19 was related to sex. Geographical variation was inconclusive The time trend of the epidemic is modest in both new daily cases and in cumulative numbers. At one point in time (April 10) the incidence rate was 56.28 per million , which was at intermediate level among other provinces.
The total cases used for Iraq was 1279. The highest numbers were reported in Baghdad, Najaf, Erbil, Basrah and Sulaymaniyah.The lowest incidence rate was in Salah Al-Din (0.61 per million) and the highest was in Najaf (170.16 per million). The case fatality ratio for closed cases and for all cases was variable among provinces.
Conclusion: COVID-19 in Basrah and Iraq is modest until today the 10th of April 2020.

The dynamics of COVID-19 epidemic in Basrah province-Second report

Omran Habib; Haider Jassim; Wael Jasimy Al-Shihaby; Mustafa AR Mohamed

The Medical Journal of Basrah University, 2020, Volume 38, Issue 1, Pages 19-28
DOI: 10.33762/mjbu.2020.127210.1019

Abstract
Background: COVID-19 pandemic still expanding across the world and continuing at modest pattern In Basrah.
Objective: To further elaborate on COVID-19 epidemic in Basrah province and document the changing dynamic of the disease.
Methods: two sources were used for obtaining data in this study. The first is an excel sheet containing information on 736 cases covering age, gender, residence, travel history, comorbidity and fate, which is obtained from The Department of Public Health in Basrah. The second is the daily numbers of new cases (also 736) obtained from the daily communiqué of the Ministry of Health. Statistical Package for Social Sciences (SPSS-version 20) and Excel programmes were used for statistical analysis.
Results: The mean age was 35.5±18.9 (for males=35.6+19.0 and for females=35.5±18.8), the median was 34 years (males =34 and females =33). The incidence rate was higher in older age groups, females and three districts (Basrah city, Al-Hartha and Al-Mdaina). The case fatality was within the international figures and significantly predicted by older age, travel history and presence of co-morbidity. The epidemic curve is moderate, fluctuant and does not help yet in predicting an exit from the epidemic.
Conclusion: The epidemic of COVID-19 in Basrah is moderate, cluster in transmission and changing in time but is unpredictable.
Key words: COVID-19, Case fatality ratio, incidence rate

Vitamin D Status in Children with Recurrent Wheeze

Sawsan Habib; Ghufran Salman

The Medical Journal of Basrah University, 2020, Volume 38, Issue 1, Pages 29-36
DOI: 10.33762/mjbu.2020.127089.1014

Background it has been shown that low serum 25-hydroxyvitamin D concentration was associated with a higher risk of upper and lower respiratory infections in children
Aim to evaluate vitamin D concentration and selected biochemical markers in infants and children with recurrent wheeze.
Methods a case-control study has been carried out to measure serum vitamin D concentration; on 33 patients with recurrent wheeze, their ages ranged from 4-60 months; over the period from the1stof March 2014 to the end of June 2014.
Forty-two age and sex matched healthy children were selected as control group. List of investigation was measured by spectrophotometer as serum calcium, phosphorus, alkaline phosphatase and 25-OH vitamin.
Result
Frequency of breast feeding in the first two years of life was low in wheezy children and significantly shorter duration of breast feeding less than 4 months in wheezy children than control group, P value 0.01.
Vitamin D concentration was significantly low in children with recurrent wheeze than the control group; (21.69 ng/ml, 39.36 ng/ml) respectively with p-value 0.000
The severity of vitamin D deficiency was significant in children with recurrent wheeze, severe deficiency of vitamin D There is no significant relation observed between mean Vitamin D concentration and selected variables of infants and children with wheeze (p value >0.05)
Conclusion vitamin D supplementation may be considered in infants and children with recurrent wheeze.

FACTORS INFLUENCING COMPLIANCE WITH IMMUNIZATION REGIMEN AMONG MOTHERS IN BASRAH, IRAQ

Jhood Abdul Samad Molan

The Medical Journal of Basrah University, 2020, Volume 38, Issue 1, Pages 37-46
DOI: 10.33762/mjbu.2020.126642.1002

ABSTRACT
Introduction: Immunization is a proven tool for controlling and eliminating the life-threatening infectious diseases among children. In most developed countries, immunization programs have had dramatic success in reducing morbidity and mortality rate significantly. Although the children received immunization free of charge, the immunization status in developing countries did not achieve the immunization targets of the WHO. The factors and barriers that influence the immunization program include child demographic factors, family factors and other factors.
Purpose: It was to evaluate immunization completeness among children younger than 2 years, demographic characteristics and familial data associated with immunization rates and the reasons of immunization incompleteness as reported by the mothers attending PHC centers in Basrah.
Methods: A cross-sectional study was conducted in four PHC centers in Basrah during a period of February to April 2019; two hundred twenty five mothers with children aged below 2 years were interviewed.
Results: About one third of children were incompletely immunized. The study found significant association of immunization completeness with child’s age (p<0.05). Other demographic factors (child’s gender, birth weight, mother’s education, occupation and family income) were insignificantly associated with immunization completeness (p>0.05). The most reported reasons for incomplete immunization were: remoteness of PHC centers and transportation problems, fear, negligence and forgetfulness, vaccine unavailability and child’s illness.
Conclusion: Incomplete immunization was observed in (29.8%) of the children, which represent an alarming percentage.
Keywords: Immunization; Compliance; Basrah; Child and Maternal Factors

The Effect of Folate Status on Methotrexate Serum Level and Response in Children with Acute Lymphoblastic Leukemia

Dhuha Emad Omran; Nabeel Ali; Jenan Ghalib

The Medical Journal of Basrah University, 2020, Volume 38, Issue 1, Pages 47-57
DOI: 10.33762/mjbu.2020.126734.1006

Background: Children in our area are more prone to folate deficiency due to many reasons including leukemia. The folate status of patients especially prior to therapy could influence methotreaxate therapeutic effect or toxicity
Patients and Methods: A total of 34 children newly diagnosed with acute lymphoblastic leukemia, and 25 normal healthy children were included as a control group. Parameters measured include; Serum folate, Serum methotrexate, blood parameters, liver function tests, blood urea and serum creatinine that were measured before initiation of chemotherapy, during treatment and following completion.
Result: Newly diagnosed ALL children have low folate level at the time of diagnosis (5.26 ± 3.82 ng/ml, mean±sd) which is significantly lower than control group (11.16 ± 5.20 ng/ml, mean±sd) (p value ˂ 0.0001). Leukemic children that have low folate is 20 with a serum level (3.12 ± 1 ng/ml, mean±sd), normal folate level is found in only 14 leukemic children and their level (8.83 ± 4.14 ng/ml, mean±sd). Low WBC and platelets count was detected following the first methotrexate dose which returns back to normal afterward. Folate serum level of all leukemic children at end of all doses is significantly elevated (14.58 ± 5.3 ng/ml, mean±sd) (p value ˂ 0.0001).
Conclusion: Serum folate level is low in a considerable number of newly diagnosed ALL children before the initiation of treatment protocol, this lead to more hematological toxicity following the first methotrexate dose. It is recommended that serum folate should be measured and deficiency corrected prior to cytotoxic therapy to reduce toxicity.

Bacterial contamination associated with mobile phones used by students at Basrah Medical College, Basrah, Iraq

Nidham Mohammed Jamalludeen

The Medical Journal of Basrah University, 2020, Volume 38, Issue 1, Pages 58-66
DOI: 10.33762/mjbu.2020.127020.1011

Bacterial contamination associated with mobile phones used by students at Basrah Medical College, Basrah, Iraq

ABSTRACT:
Background: Cell phones are increasingly becoming an important vector for pathogens, especially when they are combined with unhealthy behaviors that speed up the spread of nosocomial infections.
Objectives: This study was conducted to investigate microbial contamination of mobile phones belonging to students of Basrah Medical College, located in the southern region of Iraq.
Methods: Samples were collected aseptically with sterile swabs moistened with sterile normal saline solution over a period of four weeks. One hundred mobile devices were included in this study. The wet swab was rolled over the exposed surfaces of the mobile phones.
Results: Of 100 swabs samples, 137 isolates were identified. Of these, Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa were the most frequently identified microorganisms, in addition to other important pathogens.
Conclusion: This study showed that mobile phones are potential carriers for the spread of many pathogens, and a measure of cleanliness must be introduced to prevent the possibility of cross contamination. It was also revealed that bacteria colonized mobile phones of medical students and the contaminated mobile phones are able to transport microbes that may be able to produce serious disease.

Key words: Basrah, Medical students, Mobile phone, Staphylococcus spp.

Tachycardia-induced cardiomyopathy, a diagnosis forgotten in the real world: Review of case series.

Amar Alhamdi

The Medical Journal of Basrah University, 2020, Volume 38, Issue 1, Pages 67-79
DOI: 10.33762/mjbu.2020.165391

Background: Left ventricular dysfunction induced by long-standing recurrent tachyarrhythmias, known as tachycardia-induced cardiomyopathy, is a reversible type of dilated cardiomyopathy and heart failure characterized by left ventricular failure that is usually recoverable once the tachyarrhythmia is well controlled by stabilizing the sinus rhythm or by heart rate control.
Patients and methods: Twenty four patients with heart failure due to dilated cardiomyopathy and tachyarrhythmia were included. The arrhythmia and heart failure were both treated accordingly. The New York Heart Association’sfunctional class, left ventricular ejection fraction assessment and chest X-ray were done periodically to assess improvement.
Results:  Stabilization of the sinus rhythm was achieved in all patients. The NYHA class improved remarkably, from class III-IV to class I in all patients. The left ventricular ejection fraction rose remarkably from 20-30% to 45-57%. The cardiac size remarkably improved radiologically. The symptoms of recurrent long-standing palpitation preceding the symptoms of dyspnea in heart failure are the first implication that arrhythmia is inducing the heart failure this was noticed in 20 patients.
Conclusion: Tachycardia-induced cardiomyopathy is a reversible cause of heart failure. Controlling the arrhythmia recovers normal LV function.

Perioperative Events of Laparoscopic Cholecystectomy in Patients with Hemoglobinopathies

Rafid Mohammed; Habeeb F Al-Ibadi; Ali G Redha

The Medical Journal of Basrah University, 2020, Volume 38, Issue 1, Pages 80-88
DOI: 10.33762/mjbu.2020.165440

Background: Hemoglobinopathies are common genetic disorders affecting the synthesis of one of the globin chains of hemoglobin molecule. Laparoscopic cholecystectomy is the standard procedure for treatment of patients with normal hemoglobin and symptomatic gall stones, but doubt is still to date regarding safety of this procedure in patients with hemoglobinopathy.
Aims:1. To assess the safety of laparoscopic cholecystectomy for hemoglobinopathic patients, 2. To describe the perioperative events that might happen before, during or after this procedure.
Patients and Methods: This is a record-based comparative study conducted over a period of seven years, involved 62 hemoglobinopathic patients and 148 patients with normal hemoglobin variant. All underwent laparoscopic cholecystectomy and comparison done regarding perioperative events.
Results: The overall complication rate was 56.5% in hemoglobinopathic patients and 21.6% in the other group and the difference was statistically significant (P- value ˂0.001). Vaso-occlusive crisis occurred in 9 patients (14.5%), respiratory complications (atelectasis and bronchitis) in (9.7%), acute chest syndrome in (4.8%) and hemolysis in (4.8%).
Conclusions: 1. Laparoscopic cholecystectomy is safe in well prepared hemoglobinopathic patients but it is associated with significantly higher rate of disease related complications, namely acute chest syndrome, hemolysis and vaso-occlusive crises.2- Hemoglobinopathic patients require special pre, intra and post-operative care which should be offered by the surgeon, the physician and the anesthetist

Knowledge and practice of adults attending primary health care centers regarding major coronary heart disease risk factors in Basrah city

Jhood Abdul Samad Molan; Narjis Ajeel

The Medical Journal of Basrah University, 2020, Volume 38, Issue 1, Pages 89-99
DOI: 10.33762/mjbu.2020.165441

Introduction: Cardiovascular diseases (CVDs) are common in the general population, affecting the majority of adults past the age of 60 years. The prevalence of coronary heart disease (CHD) is approximately one-third to one-half that of total CVD. Knowledge of CHD risk factors has been identified as a prerequisite for changes in behavior and is often targeted by prevention programs.
Objective: The study aimed to study the knowledge of risk factors and the practice of CHD related behaviors among individuals > 18 years of age attending PHC centers in Basrah city center and to find out the sociodemographic factors that affect such knowledge and practice.
Methods: The study involved 423 male and female aged 18 years and above, attending 6 primary health care centers in Basrah city. Data were collected through direct interview of the participants by the investigators, using a special questionnaire form prepared for the purpose of the study.
Results: The results of the study showed that 77.3% of the participants had good level of knowledge (know at least 7 risk factors).  The most common knowledgeable risk factors by the participants were stress, smoking, fatty diet and obesity in descending order. Older age groups, high educated persons, governmental employees and participants with history of coronary heart disease related illness were more likely to have higher knowledge score. Practicing diet modification and regular exercise were prevalent in 23.5% and 12.8% of the participants respectively.
Conclusions: The knowledge level of risk factors for CHD in selected PHC centers in Basrah seems to be good, however, the practice of CHD preventive behaviors was quite poor, this necessitates the need for public health education programs.