Volume 38, Issue 2, Summer and Autumn 2020


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.

Association between apolipoprotein E polymorphism and lipid profile in patients of myocardial infarction

PRAMOD SUDAM KAMBLE

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 8-14
DOI: 10.33762/mjbu.2020.127936.1030

ABSTRACT:
Objective: To determine the effect of apo E polymorphism on lipid profile in patients of myocardial infarction as well as normal healthy controls.
Subjects and Method: Total 100 acute myocardial infarction patients with age and gender matched controls, within age ranging from 25 to 80 years were included. Lipid profile levels of MI patients and controls were estimated by standard methods. DNA’s were extracted by salting out method and Genotypes for Apo-E were determined by Multiplex Amplification Refractory Mutation System PCR.
Results: The total cholesterol, LDL cholesterol, TC/HDL-C ratio, LDL-C/HDL-C ratio level was significantly increased (p<0.01) in E4E4 allele than E3E3 allele. Analysis of variants has significant difference (p<0.01) observed in total cholesterol and LDL cholesterol levels in all apo E alleles of MI patients.
Conclusion: Our results suggestive that the risk of myocardial infarction associated with apo E4E4 alleles which are major risk factor for developing the coronary artery disease.

The Pandemic of COVID-19 in Eastern Mediterranean Region: Selected Outcome Parameters

Omran Habib; Dhurgham A Abdul-Wahid; Nabil Salim Khudair; Nihad Qasim Mohammed; Riyadh A Al-Hilfi

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 15-24
DOI: 10.33762/mjbu.2020.128305.1036

Background: Despite the passage of eight months since the start of COVID-19 pandemic, it still represents a major public health problem at global, regional and national levels.
Objective: To present comparative outcome indicators and time trends for the pandemic among countries in the Eastern Mediterranean Region and to discuss possible determinants behind such trends.
Methods: We used data on all newly reported cases of COVID-19 infection from the start of the pandemic in each EMR country till the middle of August, 2020. Two sources of data were used: the World Health Organization Website (Corona World meters) and a private website reporting cases world countries. Numbers were directly abstracted from these sources and Excel programme functions were used to make graphic presentations.
Results: As on August 5,2020 countries of the Eastern Mediterranean Region varied substantially in scale of the incidence rate per million population (from highest of 38939.1 in Qatar to lowest of 54.2 in Syria), the case fatality (closed case fatality ratio) ranged from Lowest of 0.2% in Qatar to the highest of 37.0% in Yemen. Cause-specific mortality rate ranged from 1.1 to 212.5 per million population in Jordan and Iran respectively. Testing policy was the main determinants of reported cases. None of the countries has reached a stage of clear exit based on scientific evidence despite the decline in the scale of cases in most countries.
Conclusion: Most of The countries are experiencing a pattern of accelerated pandemic and are heading towards declining trend.

The Epidemiological Pattern of COVID-19 Epidemic, During the Initial Phase in Thi-Qar Governorate, Iraq: A Case Series Study

Muslim Dhahr Musa

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 25-36
DOI: 10.33762/mjbu.2020.128230.1033

Background/ Aims: Understanding the epidemiological features and transmission dynamic during the initial phase of the COVID-19 epidemic provide valuable information for control and mitigation of the outbreak. Thus, this study focused on a cohort who represent early cases in Thi-Qar governorate for describing the early epidemiological features during the initial phase of the COVID-19 outbreak.
Subject & Methods: This case series study was conducted in AL-Hussien Teaching Hospital, Thi-Qar governorate, from 27, February to 8, May 2020. Patient's data were obtained from official records of the Public Health Department of ThiQar Health Directory. A descriptive and analytical statistic were used by the aid of SPSS, also household secondary attack rate was estimated.
Results: The median age was 37 years (IQR:31,20-51), females were 57.2% and males were 42.8%. According to age groups, as a higher infection rate (30.61% %) was found in the age group (14-26), while only (4%) found old age groups(66-78,79-91). Only six patients(12.25%) had comorbidities. Clinically, majority(79.6%) of cases were mild and (18.4%) moderate while only (4%) were severe. The age and comorbidities had an effect on the severity of symptoms. Family transmission(80.43%) was the predominant dynamic of disease transmission. Three index cases in this cohort fulfill the criteria of super-spreader as collectively transmitted the disease to 79.6% individuals, the household secondary attack rates were 22%, 24%, and 17% respectively.
Conclusion: Family transmission was the predominant dynamic of transmission which was the result of the presence of a super-spreader event in the early infected patients in the governorate.

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.

Incidence and Characterization of Skin Lesions Among Hospitalized Patients with COVID-19 infection: An Observational Cohort Study from Iraq

Zahraa Jasim; Khalili Al Hamdi; Samer Dhaher; Zainab Hadi; Hayder Aledan; Muhammed Ahmed; Ziyad Tariq

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 46-54
DOI: 10.33762/mjbu.2020.128833.1044

Abstract
Background and objectives: A wide arrays of skin lesions occurred in the setting of COVID-19 infection. We aimed to estimate the incidence and types of skin lesions among hospitalized patients with COVID-19 infection.
Methods: We conducted an observational cohort study on 369 hospitalized patients with COVID-19 infection at Basra Teaching Hospital for 3 months. We studied the incidence and types of skin lesions.
Results: Among 369 hospitalized patients, skin lesions were developed in 5%. Of those who developed skin lesions, 33% were asymptomatic. Patients who developed skin lesions were younger (mean age of 40 ± 19.6 SD) and female (83.3%). The most frequent type of skin lesion was maculopapular 44.3% which occurred exclusively in the medical ward and half of them in asymptomatic patients. For pustular lesions, all were female, diabetic, in the ICU, in symptomatic patients with the highest levels of serum C-reactive proteins. Pseudo-chilblain lesions were reported only in younger female and half of patients were asymptomatic. Urticarial lesions were reported in the younger patients, two-thirds were symptomatic and in the ICU. Purpuric lesions were reported in the older patient who developed acute kidney injury. Extremities were the most common distribution of skin lesions in 38.8%. The mean latency period for development of skin lesions was 8.6 ± 9.1, the shortest for urticarial lesions and the longest for purpuric lesions.
Conclusions: Different types of skin lesions were reported in patients with COVID-19 and may be the sole manifestations of the disease.

Role of Vitamin D in Female Pattern Hair Loss Among Iraqi Women: A Case- Control Study

Samer Abdulameer Dhaher; Mehad H Alwan

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 55-64
DOI: 10.33762/mjbu.2020.127206.1026

Background: Low serum level of Vitamin D may have a potential role in the pathogenesis of female pattern hair loss (FPHL).
Aims: to evaluate serum vitamin D level in Iraqi women with female pattern hair loss and compare it with normal healthy control.
Settings and Design: A prospective, case–control study was carried out on 190 women: 95 patients with FPHL aged ≥15 years and 95 healthy age-matched control.
Methods and Material: The diagnosis and severity of FPHL were based on clinical examination and using Ludwig classification. All participants were investigated for vitamin D level, alkaline phosphatase, and others. Data were collected and statistically analyzed.
Results: The mean± SD level for vitamin D was significantly lower in FPHL group than control (13.8±2.6 ng/mL vs 37.6±4.7ng/mL, p<0.001). Eighty two patients (86.1%) of FPHL group and 35 (36.9%) of control group had low vitamin D level (p<0.001). Alkaline phosphatase level was significantly elevated in 77of FPHL compared to control group((81% versus 19%, p <0.001). Low vitamin D level was significantly correlated with duration of hair loss , alkaline phosphatase elevation and bone pain.
Conclusions: Women with low serum vitamin D level, would have a high potential for development of FPHL suggesting that vitamin D may have a possible role in the etiopathogenesis of this pattern of hair loss..

Glycemic Control in a Cohort of children with type1 Diabetes Mellitus in Sulaimanyah City

Tara Hussein Tayeb

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 65-74
DOI: 10.33762/mjbu.2020.126823.1007

Background / Aims; Diabetic control is generally measured by HbA1C, the recent American Diabetic Association (ADA) guideline has put a target of <7.5%. The aim of this study is to assess the diabetic control in the study sample, based on their HbA1c, and to analyze the factors that may affect diabetic control.
Patients and Methods; This is a prospective questionnaire based cross sectional study. Parents/ patients or both filled in the questionnaire, which included demographic characteristics, parents’ educational level, insulin regimen and delivering device, duration of diabetes, number of injections, blood sugar monitoring/day, and hospital admissions related to diabetes, and the last the HbA1c.
Statistical analysis was done by SPSS version 24; ANOVA was used to asses correlation of HbA1c with different parameters, Chi-square tests were used to compare the categorical data between different groups of patients.
Results; A total of 163 patients were included in the study, 47.9% males and 51.2% females. The mean HbA1c was 10.3 3 ± 2.7. A total of 49 % of patients had a HbA1c ≥10, and 11% had a HbA1c of < 7.5. The HbA1c increased with age (p<0.001), and decreased with higher levels of mother’s education (p=0.03), and more blood sugar monitoring (p=0.003). Gender, residency, duration of diabetes, insulin regimen, number of injections /days, and hospital admissions had no significant affect.
Conclusion; Enhancing parent’s education and emphasizing on monitoring of the blood sugar, through reinforcing the role of diabetic educators, has a major impact on diabetic control

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%

The anti ulcer effect of omeprazole is modified by Nigella sativa (Black Cumin) in ethanol induced gastric ulceration in rabbits

Jawad Hassan Ahmed; Ali Mohammed Al-Rawaq

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 85-98
DOI: 10.33762/mjbu.2020.127147.1018

Background: An interaction has been reported between Nigella Sativa (NS) and ranitidine (RAN) on gastric ulceration induced by ethanol in rabbits; the combination NS and RAN caused disappearance of anti-ulcer effect of NS or RAN.
Objective: to investigate interaction of NS with a proton pump inhibitor omeprazole (OMP) on ethanol induced gastric ulceration in rabbits.
Methods: 24 mature rabbits were divided into 4 groups. The animals were fasted for 48 hours then treated as follow: group 1, 2, 3 and 4 were treated respectively with normal saline (oral), NS oil (10ml/kg) orally, OMP (20mg/kg) IP, and NS+ OMP. One hour later, animals were given absolute ethanol orally; and sacrificed 3 hours later for estimation of Ulcer index (UI), gastric pH, malondialdehyde (MDA), glutathione (GSH), histamine (HIS) levels in serum and gastric tissue.
Results: Ethanol induced gastric ulceration in all animals with an UI of 10 ± 0.11 mm2. This effect was paralleled with reduction in gastric pH, increased MDA and HIS and reduction in GSH. UI was reduced to 5.13 ± 0.68 mm2 in NS group, P value = 0.07 and to around zero in OMP group. NS or OMP treatment resulted in reduction in serum and tissue MDA and HIS levels and increased in GSH and gastric pH levels. In NS + OMP treated group, UI became higher than OMP group with MDA and HIS tended to rise and GSH and gastric pH declined.
Conclusion: NS + OMP diminished the gastro-protective effect of either NS or OMP.

Pattern of Childhood Leukemia in Duhok City

Khalaf Hussein Hasan Al Iessa; Khalaf Hussein Hasan

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 99-103
DOI: 10.33762/mjbu.2020.127119.1016

Background: There is substantial variation in the incidence rate of acute lymphoblastic leukemia by ethnicity. In addition, leukemia has broad-spectrum variations in clinical and laboratory findings at presentations.
Aim: This study aimed to determine the patterns of acute childhood leukemia in Duhok city.
Patients and methods: In this cross-sectional study, the patients who were diagnosed with leukemia and admitted at Jin pediatric Oncology Haematology center in Duhok .The general and clinical features of the patients included age, sex, season diagnosis, socioeconomic status, clinical features, and biochemical parameters were collected between the 1st of September, 2015 and 1st of September 2016.
Results: The study revealed that most of the patients were in the 1-5 age group (54.8%) followed by 5-10 years (24.7%). The patients were males (56.2%) and females (43.8%) with 1.28:1.0. Acute lymphoblastic leukemia was the most prevalent type of leukemia (86.3%). The patients were admitted in dry and rainy seasons; 54.8% and 45.2%, respectively. Most of the patients were admitted in winter (45.2%), followed by summer (34.2%). The patients had low (45.2%), middle (42.2%), and high (12.35) socio-economic status. Pallor was the most prevalent presentation of the patients with leukemia (n=50) followed by fever (n=36), and splenomegaly (n=32). Some of the patients had multiple signs and symptoms. The HB and WBC of most of the patients were abnormal (84.9% and 71.2%, respectively), similar to platelets (53.4%).
Conclusion: This study showed that there is variation in the age group, clinical features, season of diagnosis, and biochemical parameters in leukemia patients.

The effectiveness of uterine packing combined with topical tranexamic acid for the management of primary postpartum hemorrhage

Maysara Mohammed Abdulrhidha; Jubran Khaleel Hassan; Dhamya S. Alharoon

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 104-108
DOI: 10.33762/mjbu.2020.127000.1010

Objectives: the aim of the study is to identify the effectiveness of adding topical tranexamic acid to uterine pack to control primary PPH compared to uterine packing alone.
Methods: the study included 30 women with intractable primary PPH after vaginal deliveries due to uterine atony in whom the conventional local pathway of management of PPH had failed to control bleeding. In 15 women(the case group), uterine pack impregnated with 20 ml of tranexamic acid(1gm/10ml) was used to control bleeding and compared to 15 women (the control group) in whom uterine pack without tranexamic acid was used, outcome studied include the need for further surgical intervention and need for blood product.
Results: although uterine packing impregnated with TXA was successful in controlling bleeding in 13 women out of 15(86.7%) compared to 10 out of 15 cases (66.7%) in women who underwent uterine packing without TXA, however; the difference in effectiveness of both methods is statistically insignificant. The requirement for blood product transfusion was less in TXA group.
Conclusion: topical uterine TXA increase the efficiency of uterine tamponade to control PPH, and may decrease the need for more invasive surgical intervention as hysterectomy.

POST OPERATIVE FUNCTIONAL OUTCOME FOR ANORECTAL MALFORMATIONS IN INFANT AND CHILDREN IN ERBIL

salar sabah berdawd

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 109-114
DOI: 10.33762/mjbu.2020.128515.1039

ABSTRACT
Background/aims: Outcomes of anorectal malformations have greatly improved but many children still experience some form of urinary or fecal incontinence despite optimal management. The aim is to evaluate the functional outcome in infants with anorectal malformation for different surgical procedure including traditional and recent operations and outcome for different type of anorectal malformation.

Subjects and Methods : An analytical study include 28 cases of anorectal malformation (16 males and 12 females ) operated by different technique in Erbil city during 2010 - 2016. Cases of cloaca and early deaths were excluded from the study.
Results : In male Rectoperineal fistula (25% ) and in female Rectovestibular fistula (25% ) were the most common anomalies. the most common procedure were primary anorectoplasty for perineal fistula in both male and female infants in 10 cases ( 35.71% ) followed by transfistula anorectoplasty for rectovaginal fistula in 7 cases (25%) and PSARP for rectobladder neck and urethral fistula for male infants in 6 cases. The most common functional complication was constipation in 2 (7.15%) cases and only one case (3.57%) developed fecal incontinence . 89.29 percent of the patients had voluntary bowel movements and were totally continent.

Conclusion : Despite significant developments in the understanding of the pathophysiology and surgical techniques, the results of surgery of ARM remain far from perfect. An optimal operation restores normal anatomy and preserves all potential sphincter structures. Functional complications, especially treatable ones, such as constipation, should be detected and treated early to achieve an optimal outcome.

Study of Interleukin 6 as marker of inflammation and a predictor of in-hospital complications in patients with acute coronary syndrome

Sally Abdul-Raheem Alhumrani; Nidham Mohammed Jamalludeen; Abdulameer Abdulbari Abdulhameed

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 115-119
DOI: 10.33762/mjbu.2020.128197.1032

Abstract:
Background
Although abnormal fatty deposits of infected arterial plaque play a major role in the formation of atherosclerotic plaque, activation of inflammatory cells plays a major role in the instability of the plaque and the cause of acute coronary syndrome. The aim of this study was to measure the level of interleukin-6 and to study its association with complications that occur in hospital in patients with acute coronary syndrome.
Method:
One hundred and twenty-five patients with acute coronary syndrome and 120 healthy individuals as a control group were included in this study. According to ECG and serum troponin changes, the patient group was classified into three ST-elevated myocardial infarction, ST non-elevated myocardial infarction and unstable angina. Sandwich ELISA was used by commercial groups (LEGAND MAX TM) for the IL-6 assay.
Result:
This study shows significantly significant differences in the level of IL-6 in patients with acute coronary syndrome (73.37 pg / dL) compared to the control group (9.47 pg / dL) (P value 0.001)
There were no significant differences at the level of IL-6 in patients with acute coronary syndrome and conventional risk factors (P. value <0.05).
There were significant differences in the level of IL-6 in all forms of ACS. (P. value 0.001). And those patients who had complications in hospital had a higher IL-6 level (92.89 Pg / dl) than those without complications (68.83 Pg / dl) P. value (0.012).
Conclusion:
This study indicated that IL-6 was significantly elevated in ACS patients

Body Weight Changes in 210 Breast Cancer Patients after Finishing Chemotherapy; Cross Sectional Study

Hasson Mahdi Ali; Elaf MuhammedSaleh Al-Tawri

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 120-126
DOI: 10.33762/mjbu.2020.128412.1037

Abstract
Background and aim:
Increasing body weight in breast cancer patients after finishing chemotherapy is a rising health problem among many countries; this study try to evaluate this health issue among breast cancer patients attended Basra Oncology Center.
Patients and Methods:
This cross sectional study carried out on 210 patients with breast cancer who received chemotherapy at Basra oncology center, from 2017 to 2019. The participant's personal data and the other clinical information were derived from patient file.
Results:
Weight changes after finishing chemotherapy occurred in about 95% of breast cancer patients, and measurement of body mass index of patients at the start and at the end of chemotherapy revealed more women occupied the obese strata after completing the chemotherapy. The study showed statistically significant differences in the weight changes among the age, weight at diagnosis, state of hormone receptor & marital status subgroups. The only significant predictors of body weight changes after completing chemotherapy were patient age and body mass index at time of diagnosis.
Conclusion:
There is a significant weight gain in breast cancer patients in Basra Oncology Center after finishing chemotherapy.

Hypopharyngeal Foreign Body in A 9-months-Old Male Baby

Raid M Al-Ani

The Medical Journal of Basrah University, 2020, Volume 38, Issue 2, Pages 127-130
DOI: 10.33762/mjbu.2020.127476.1023

Fishbone is the commonest pharyngeal foreign body in Asia. However, uncommon types also were reported in the literature. A 9-months-old male infant presented with crying, dysphagia and excessive salivation. Plain X-ray of the cervical spine lateral view confirmed the diagnosis of a metallic foreign body in the hypopharynx. The foreign body was extracted under general anesthesia without complications. A high index of suspicion from the caregiver and early intervention from the dealing doctor are crucial to avoid unwanted complications of pharyngeal foreign bodies' impaction. In conclusion, we reported a rare hypopharyngeal foreign body (the door of the Simcard room of an old fashion mobile phone) in a 9-months-old boy. Fishbone is the commonest pharyngeal foreign body in Asia. However, uncommon types also were reported in the literature. A 9-months-old male infant presented with crying, dysphagia and excessive salivation. Plain X-ray of the cervical spine lateral view confirmed the diagnosis of a metallic foreign body in the hypopharynx. The foreign body was extracted under general anesthesia without complications. A high index of suspicion from the caregiver and early intervention from the dealing doctor are crucial to avoid unwanted complications of pharyngeal foreign bodies' impaction. In conclusion, we reported a rare hypopharyngeal foreign body (the door of the Simcard room of an old fashion mobile phone) in a 9-months-old boy.