Volume 39, Issue 2, Summer and Autumn 2021

Practical approach to train and assess professional behaviour of medical students

Ghanim Y. M. Alsheikh

The Medical Journal of Basrah University, 2021, Volume 39, Issue 2, Pages 86-91
DOI: 10.33762/mjbu.2021.169992

The gradual decline of doctor-patient communication skills and professional attitudes and behaviour have steadily been observed in all countries across the globe. This deterioration has resulted in repeated and renewed demands to make medical schools more aligned to the necessity to train professional behaviours in undergraduate medical study. Medical educators have been criticised for not effectively training and rigorously assessing these skills. Training of behaviour has been abstracted in teaching of ethics and communication skills which in most of the cases is based on theoretical “preaching” lectures and use of book/guide and in some cases, training using supervised role-playing sessions at the best of options. Although good communication skills are essential for an optimal doctor-patient relationship and certainly contribute to improved health outcomes, still other aspects of behaviour are not covered. Furthermore, while the need for training on professional behaviour is specified as a requirement in the adopted graduate outcomes, formal training in these skills has been fragmentary and not clearly addressed in curriculum documents of the medical colleges in Iraq. A practical approach is here proposed to support medical colleges to bridge this gap. The methods of design, construction and use of standardised checklists for training medical students and assessing their acquisition of behavioural (affective) skills is described

A 5 year retrospective analysis of pharmacovigilance study, completeness and quality of suspected adverse drug reaction forms at adverse drug reaction monitoring center Port Blair.

Priyanka Hotha; C. Dinesh M. Naidu; Nimisha Elezebeth Zachariah

The Medical Journal of Basrah University, 2021, Volume 39, Issue 2, Pages 92-103
DOI: 10.33762/mjbu.2021.130470.1077

In India, Adverse Drug Reaction (ADRs) related morbidity and mortality is one of the leading health problem. ADRs result in diminished quality of life, prolonged hospital stay, morbidity and mortality. The present study was planned to scrutinise suspected ADRs forms and evaluate completeness with quality assessment of ADR reports at AMC Port Blair. The study was a 5 year retrospective observational study. The collected data was evaluated based on patients’ demographic, adverse drug reaction and drug characteristics with completeness and quality of reactions. A total of 877 ADRs from 715 offending drugs in 671 patients were reported. In India, 9.5% hospital admissions were because of ADRs. 52% female experienced ADRs which was more than male. The occurrence of ADRs in adult patients was high. Antibiotics (39%) was most commonly prescribed class of drug followed by NSAID (10.9%). Majority of ADRs (45%) were observed in the skin followed by musculoskeletal system (12.7%). In our study, 60.2% of patients recovered in the outcome parameters. 83.6% of drugs withdrew for management of ADRs. Rechallenge was made only in 12.3% patients, 71.6% of patients had non-serious reactions and 71.7% ADRs were probable. We received the highest completeness score in 2020 which was 0.98. ADRs remain as a challenge in modern healthcare. The health system should promote spontaneous reporting of ADRs. The proper documentation and periodic reporting to ADR monitoring centres (AMC) reduce the incidence of new ADRs and maintain the public confidence toward safe use of drugs. This good quality reporting increases the potential for signal generation.

Association between Taq1 rs: 731236 SNP of VDR gene and risk factor among Sudanese patients with breast cancer

Amira S. Khalafalla; Abuagla Dafalla; Yousif Abdelhameed Mohammed; Adam D. Abakar; Mergani Adil; GadAllah osman Modawe

The Medical Journal of Basrah University, 2021, Volume 39, Issue 2, Pages 104-110
DOI: 10.33762/mjbu.2021.130830.1082

Background: Breast cancer is the most frequent cancer in women globally as well asSudan, it has risen to become the second commonest cause of death in women.Vitamin D receptor (VDR) is a ligand-dependent transcription factor. Vitamin D-ligandedVDR, has anti-proliferative properties in a variety of tumor types by inducing cell cycle arrest, senescence, differentiation, and death. The role of VDR TaqI polymorphism is currently unknown. However, studies suggest that these polymorphisms may affect messenger RNA (mRNA) stability.
Methods and patients: This case control 198 participants, (97) breast cancer patients and another 101control group. Data was collectedby a questionnaire. 2 ml of venous blood was collected and stored at -20 till DNA extraction. Phenol chloroform method was used for DNA extraction. VDR TaqI was examined and genotyped using CTPP-PCR after designing of suitable primers and PCR condition. Then data was analyzed statistically using the SPSS program (version 21) and the SNPS tats online tool.
Results: The three genotypes reported in this study for TaqI SNP (CC, TC, and TT) were evenly distributed throughout cases and controls, so according to this findings there is no statistically significant association of this SNP with breast cancer risk (p. value 0.650) (OR(95%CI) 1.39 (0.64-3.00), 1.00 (0.54-1.87), 1.00).
Conclusions: This study found no association of TaqI polymorphism and breast cancer risk factors

Clinical presentation and electrocardiographic features of Brugada syndrome in Iraq


The Medical Journal of Basrah University, 2021, Volume 39, Issue 2, Pages 111-119
DOI: 10.33762/mjbu.2021.130674.1080

Background: Brugada syndrome is a clinical entity composed of twelve leads electrocardiographic changes of coved or saddle shaped ST-segment elevation in V1 and V2 with serious ventricular arrhythmias which may cause sudden cardiac death.
Objectives: The objectives of this study is to highlight the clinical presentation and the types of ECG changes of Brugada syndrome cases seen in Iraq and to orient physicians about this fatal condition.
Patients and Methods: Patients presented with symptoms of palpitation, dizzy attacks or syncope and diagnosed as Brugada syndrome were included in this case series study. The diagnosis of Brugada syndrome based mainly on the typical coved or saddle shaped or variant ST-Segment elevation in electrocardiographic leads V1, V2.
Results: Eighteen patients were included in this case series study. All are males. Age ranged from 15-45 Y. The presenting symptoms were palpitation in 12 patients, syncope in 8, dizzy spells and pre syncope in 14 and chest pain seen in 2. The arrhythmic events were clinically documented in 10. Monomorphic VT seen in 4, VF in 2, atrial fibrillation in 2 and atrial flutter in 2. Induced VF by EP study seen in 2. Type I Brugada ECG pattern was seen in 6 patients, type II in 4 and three of type III. Five showed a variant type of the syndrome. Family history of sudden cardiac death was seen in 8 patients while in 10 it was negative. ICD was implanted in 6 patients. In 12 patients (67%) the diagnosis of Brugada syndrome was missed during the provisional medical contacts.
Conclusion: Brugada syndrome is not uncommon in Iraq but needs a high diagnostic suspicion through appreciating the symptomologies and electrocardiographic features of this fatal syndrome to plan management to prevent sudden cardiac death.
Key words: Brugada syndrome, Iraq

Ready to-Use Supplementary Food in the Outpatient Management of Children with Acute Malnutrition in Basrah

Nedhal S Kudhayer; Sawsan Habib

The Medical Journal of Basrah University, 2021, Volume 39, Issue 2, Pages 120-127
DOI: 10.33762/mjbu.2021.130966.1085

Background Ready-to-use supplementary foods are high-energy, lipid-based provide energy, protein, fat, vitamins and minerals to treat acute malnutrition in children aged 6 -59 months.
Aim To evaluate the effect of ready-to-use supplement foods on the outpatient management of children with acute malnutrition.
Methods A prospective appropriate study was carried out on children with acute malnutrition who were referred to the nutritional rehabilitation center at Basra Teaching Hospital; were received ready-to- use supplementary foods at a quantity sufficient to meet their nutrient requirements for full catch- up growth and followed at two subsequent visits
Results Moderate wasting and underweight recorded in (66.7 %) and severe wasting in (33.33%) of the patients. Mean weight gain at the first and second follow-up visit was (5.78 ±2.43) and (6.52 ±2.75) g/kg/day respectively. There was a significant improvement in the weight for height Z score at the first and second follow-up visits after the administration of ready-to-use supplementary foods (P value < 0.05). Approximately 32% of the children aged 12-18-month experienced moderate weight gain. Bottle feeding with complementary feeding was reported in 24.19% of the children with moderate weight gain, and 9.52% and 34.68% of the children of illiterate parents and unemployed fathers respectively, showed moderate weight gain. Children belong to families with low income group accounted for 37.09% of those with moderate weight gain. Family income was the only variable that depend on the weight gain results (P value < 0.05). Conclusion: Ready-to-use supplementary food is significantly effective for outpatient management of acute malnutrition.
Key words: Acute Malnutrition, Ready-to-Use Supplementary Food, Outpatients

low birth weight risk factors in Basra city

Zainab hussain Almussa

The Medical Journal of Basrah University, 2021, Volume 39, Issue 2, Pages 128-138
DOI: 10.33762/mjbu.2021.129962.1070

Introduction: Low birth weight is the best indicator of the impact in the health system and the best predictor of mortality and morbidity in the neonatal, post neonatal and childhood periods.
Objectives: This study was planned to study the association between birth weight and selected risk factors in Basrah governorate with special reference to: Socio demographic factors, Present obstetric history, Past obstetric history, History of Ante Natal Care, and Medical history.
Methods: This is hospital- based cross sectional study was conducted on 362 infants delivered and /or admitted to AL-Basrah-Maternity and Children Hospital. The data were collected through direct interview of the mothers using a special questionnaire form designed for the study purpose. The questionnaire included information about the following aspects socio-demographic characteristics and other clinical characteristic. Data were analyzed using the Statistical Package for Social Sciences version 15.
Results: The highest percentage of LBW was found among births for mothers who finished their primary education or less including illiterate, mothers in the age group30- 39 years, employed mothers, history of complications during pregnancy, preterm births, previous history of having LBW infant and short preceding birth interval (≤6 months)
Conclusion The factors which found significantly associated with LBW included: low education level, complication during pregnancy, previous history of LBW, preterm delivery, short preceding birth interval- ,No significant association was found between birth weight and the following factors, parent's age, maternal occupation, gravidity, and bad previous obstetric history, low number of ANC visits.
Keywords : low birth weight , risk factors , Basrah city
Correspondence to, Zainab Hussain Tahir Basrah Health Directorate

The effect of tourniquet on early postoperative quadriceps muscle wasting in ACL arthroscopic surgery

Madhat Mahdi; Hussein A. Al Yusir

The Medical Journal of Basrah University, 2021, Volume 39, Issue 2, Pages 139-144
DOI: 10.33762/mjbu.2021.131456.1088

Background: The main goals of anterior cruciate ligament (ACL) reconstruction and rehabilitation are to reestablish knee function. Quadriceps weakness is one of the most important complications associated with ACL injury and represents a major rehabilitation challenge. This study is designed to test the early effect of tourniquet on muscle wasting and to differentiate weather it is because muscle disuse or injury.
Methods: Twenty six male patients who submit to arthroscopic ACL reconstruction were randomly assigned to the use of an inflated (group T, n _ 13) or deflated (group NT, n _ 13) tourniquet. Patients with preoperative quadriceps wasting or abnormal electro conductive studies were excluded. The primary measures were thigh girth preoperatively and after two weeks, serum creatinine phosphokinase (CPK) preoperatively and one day postoperatively and electro conductive studies preoperatively and 1 month postoperatively.
Results: Patients' mean age was comparable in both groups. There was a significant difference between T and NT groups in term of thigh girth, CPK and electro conductive studies. Mean thigh girth in T group was 2.6 ± 0.5 while in NT group 1.4 ± 0.5. Mean CPK in T group was 813 ± 149 while in NT group 520 ± 203.
Mean femoral latency was 1.85 ± 0.4 in T group and 1 ± 0 in NT group; mean femoral conduction velocity was 1.77 ± 0.4 in T group and 1 ± 0 in NT group; mean muscle denervation was 1.92 ± 0.3 in T group and 1.54 ± 0.5 in NT group; mean motor unit number estimation was 1.9 ± 0.3 in T group and 1.5 ± 0.5 in NT group.
Conclusion: This comparative study show that tourniquet play a significant role in direct muscle injury proved by measurement of postoperative CPK and thigh girth in T group comparing it with NT group.

Antenatal care field survey in the catchment area of Bab Al-Moatham Primary Health Care center, Baghdad

HASSAN hadi ALKAZZAZ; Khelowd Salih salih; rasha farhan; sahar Abdul Hassan Esa alshatari

The Medical Journal of Basrah University, 2021, Volume 39, Issue 2, Pages 145-155
DOI: 10.33762/mjbu.2022.131231.1086

Antenatal care (ANC) has been defined as care given by skilled individuals with extensive healthcare training to both pregnant women and adolescent girls to ensure the best possible health conditions for both the mother and fetus during gestation (1). The objective of this study is to find the percentage of antenatal care booking, care regularity and antenatal care irregularity. This study is A cross-sectional field survey study with an analytic element conducted from 1st January -1st July 2018 . we choose 10% of all the catchment areas (shown in block numbers) as a two-stage cluster sampling method. Fifteen clusters (one cluster to every 180 families in the block) choosing each cluster consisting of 15 households, totals of 225 households some households had two-three married women of reproductive age (15 -49 years old), so the total final female’s participants were 255. This study was done in Bab Al-Moatham Primary Health Care center for family health approach, and it's revealed most houses 195(76.47%) have one adult woman of reproductive age per house, 106(41.6%) of participant's age between 30-39 years, 77(30.2%) married between 2012- 2007, and 87(34.1%) complete primary school. In concern to women reproductive history, the highest percentage have two pregnancies, two babies, without abortion or stillbirth. Out of 255 studied women, 236 women gate pregnancy for 3 years, 191(80.93%) of them had ANC booking, 148(58.1%) have regular ANC visit, while 43(16.9%) have irregular ANC visiting, and 188(98.43%) of them had ANC card. Abortion represents a major problem for irregularity in consuming ANC services. Improving health services and health promotion are essential steps in reducing abortion which might lead to increase ANC booking.

The Effect of Fasting and Smoking on the severity and mortality of COVID-19 patients in Basrah, Iraq

Jawd K. Albazoony

The Medical Journal of Basrah University, 2021, Volume 39, Issue 2, Pages 156-160
DOI: 10.33762/mjbu.2021.127786.1028

Fasting has been shown to have an impact body systems in different manners. The influence of fasting on immune system regulation remains controversial. Immunomodulatory effect of nicotine was suggested recently. Low prevalence of smoking was observed among patients with COVID-19.
To study fasting as an immune modulator in relation to the severity and mortality of COVID-19 patients, and to determine the effect of smoking on such patients.
This is a comparative study included all PCR-confirmed COVID-19 patients during April, May and June 2020 in Basrah. The severity of and mortality due to COVID-19 infection were studied in fasting patients in Ramadan as compared with the non-fasting months before and one month later. Current smoking in relation to the severity of infection was also studied.
Significantly less severe cases and lower mortality were detected in patients with COVID-19 who were fasting as compared with non-fasting patients before and after the fasting month. Current smoking is significantly less frequently detected among severe as compared with mild to moderate cases.
Conclusion Fasting could be useful to improve immune response against infection and to reduce severity and mortality in patients with infections. Smoking benefit in preventing and ameliorating of respiratory tract infection needs to be further investigated.