Thi-Qar Medical Journal

The present study was carried out to evaluate the process of documenting patients' medical
records in addition to the pattern of antibiotic use in Basrah general hospitals. A retrospective
type of study was conducted for antibiotic prescription in 562 inpatients' medical records of
those who were admitted to paediatric wards in five hospitals in Basrah governorate because
of acute respiratory infections.
The study shows that 86% of the patients stayed for less than 5 days at the hospital with 13%
of them stayed between 5-10 days. All of the 562 patients' records were reviewed for
documentation of the investigations taken during hospitalization, use of antibiotics and follow
up while in hospital.
Around two thirds (65.5%) of the records were found to have no documentation for any
investigation during hospitalization. In addition, antibiotic therapy was found to be used in
83.3% of the cases. By comparing the WHO indications for using antibiotic therapy in acute
respiratory infections cases, it was found that antibiotics were prescribed without justifiable
indications in 44.7% of patients.
The study recommended re-enforcing the adoption of updated drugs use protocols and
guidelines especially on the use of antibiotics in hospitals and specifically in inpatient
pediatric age groups.
Furthermore, assigning clinical pharmacists in the clinical inpatients setting is one of the
study recommendations in order to monitor the clinical use of these medications.

According to collected data finding the Quality evaluating percentage for administrative units
87.7% & it's main weak indicators were for feedback & it is records , administrative
guideline , administrative training , infection control guideline , alcohol , waste's cart ,waste's
balance & log documentation of some record . 83.1% evaluating percent for medical units
and main weakness points were in numbers of medical &serving staff , gynecological
examination room ,waiting & examination time .Pharmacy unit had 89.5% ,main weak
indicators were in number of pharmacist ,separated area between boxes of drugs and walls ,
smoke detector , number of trundle , doses & rout of drugs on recipe .Tuberculosis program
had 92.1% and weak score only in health promotion folder for tuberculosis disease ,following
of dropout patient from therapy. There are weakness in all immunization coverage in most
centers but Vitamin A , storage of vaccine , training of immunization team , presence of
records , infection control equipments had good score in immunization units which had
81.1%. Maternal units had lowest evaluating percentage was 74.6 % because there are weak
indicators in female medical staff , units according to standard , home visit , presence of
sonar ,1st & 4th maternal visit coverage .Health promotion unit had 91.6% ,there are weak
score for community participation , halls. While IMNCH units had 88.4% average percentage
and most weak indicators were for number of medical staff , adequate place for ARI
equipments program ,Thermometer. The continuous training & psychological health services
had 82.6% , 95.8% respectively .Laboratory units evaluating percentage was 76.6% & most
weak indicators were in structure staff , shaker , balance , spirit lamp , dispenser , calibration,
KLB , G , AFB & water bath .In this study the main weak indicators regarding health visitor
program in internal net work , transport vehicle , health visitor's maps & bags ,updating
numbering of houses therefore this program had 84.4%. Weak indicators regarding hotel
services were in rights & duties list of patient , Rumba & special toilets for handicapped
patients ,alcohol , cleanliness of gardens therefore the hotel services had 80.3% .Dental
services units had 83.6% ,itis weakness score were in number of dentist , dental devices , XR
dental devices , processing devices , debris removal devices , optical filler material ,
activation of dentists , dykal , amalgam , temporary filler material ,XR films & batting root
.Emergency services units had 83.7% evaluating percent .While most weak scores regarding
emergency services were for medical staff , laundry & serving staff .

A cross sectional study had been extended through 2 years to
envolve 611 burn patients from whom
103has been diedfrom they were
admitted
February
in
AL-Hussain teaching hospital burn center through 2 years
2015- January 2017which representcase fatality of (16.85%), in
different age group between less than one year to more than 67 years old with
different percentage of total body
surface area burn,we were found that
increase rate of death with increasing total body surface area regardless the
age of the patients. about 63% of patients were die who had burn of more
than 60%of total body surface area in all different ages.while only 3.4% were
died with burn of 10—15% and about 30.3% were die who had between
46—59% of burn. about 23% if patients were died who had 36 to 45% of
TBSA burn while 7% died who had 26 to 35 % of burn of TBSA .there were
increase rate of death in ALNassiryia burn center in young age group
between less than 1 year to 5 years were have the same percentage of burn
compare with older age group between 40—45 years old in percentage of
22.6% vs 10.2 % respectively , while 20.2% of cases were die in age between
less than 1 and 2 years. And 19.04% patients died who have age more 60
years old. The main cause of death was septicemia in AL-Hussen burn center
in 61.1% then electrolyte disturbance26.2% and renal failure in 12.62%.the
main organism that cause septicemia is mixed bacteria
in
35.92% then
pseudomonas in 28.15% then proteus 22.33%.researcher were found that the
main type of electrolyte disturbance were companied electrolyte in 42.71%
then hyponateremia in 28.15%.researcher found that in this study that the
most common death patients occur in 2rd degree burn in 47.57% while in 4th
degree about 18.4% that is because most of cases with 4th degree burn reach
dead or at end stage to the burn unit .and death occur even with first degree
burn if there were large percentage of burn with bad managements

The aim of this study is to assess the effect of usage of tramadol in liver and kidney in
albino mice. Twenty albino mice were taken (25-30) gm and divided in to two groups, group I
(10 mice) which received normal saline intramuscularly and group II (10 mice) which received )
25 mg /kg body weight ( daily of tramadol intramuscularly for 40 days, the biochemical assay
showed significant increase (p value < 0.05) in the Aspartate aminotransferase (AST), alanine
aminotransferase (ALT), Urea and Creatinine in experimental group compared to the control
group. The histological examination regarded for liver tissues degenerative changes in the
hepatocytes, dilated central vein, focal necrotic area, congested vessel, congested hepatic vein
and cytolysis while kidney tissues show widening bowman capsule, interstitial nephritis,
necrosis, degenerative change, lymphocyte infiltration in renal interstitial nephritis and
degenerative changes in renal proximal tubules.

Background: The problem of obesity and overweight in children has been increased globally.
Recently, the obesity prevalence rate reached an alarming level in both developed and
developing countries.
Objectives: This study aims to determine the extent of overweight and obesity among infants
and children aged 6-60 months in the center of AL-Nasiriya governorate and their relationship
with different socio-demographic and lifestyle factors.
Methods:
A cross-sectional study was carried out on 225 infants and children aged 6-60 months selected
from children who have consulting primary health centers that randomly selected in AL-Nasiriya
city during the period from October 2015 till the end of February 2016. BMI and Z-score was
measured and compared to standard tables. Data on socio-demographic factors and dietary
pattern was obtained by questionnaire.
Results: The proportion of overweight was 11.1% and for obesity 7.6% according to weight for
height Z-score for all children. For children >24months, we found that 10.8% were overweight
and 8.8% were obese by using BMI. In this study, there is a significant positive association
between father's education and dairy products intake with overweight and obesity.
Conclusion: The prevalence of overweight and obesity among infants and children aged 6-60
months in Al- Nasiriya was high. It is positively associated with dairy products intake and father
education had a positive relationship with obesity.

Background:
The aim of our study to compare the efficacy of letrezole to clomiphene citrate in
patient with unexplained infertility as empirical treatment.
Methods:
200 patients with unexplained infertility randomly divided into two groups the first
group received( 5mg letrezole from the day 3-7 of menstrual cycle), the second group
received (100 mg clomiphene citrate from the day 2-5 of menstrual cycle), follicular
development followed by serial U/S, when one or more follicles reach > 18mm in
diameter ovulation trigger by hCG and timed intercourse was advise later on .
Pregnancy test was performed 5 days after the miss period to confirm the pregnancy,
the main outcome was the pregnancy rate and the secondary outcome was follicle
development and endometrial thickness.
Result:
Both groups were comparable regarding the ovulation rate (62.5% in the group B (
clomid group ) and 75.2% in group A ( letrezole group ) ( P = 0.35 ), the endometrial
thickness was statistically significant difference in the letrzole group on day of HCG
administration ( 6.6_+1.69 mm in the letrezole group, 5.4_+1.61 mm in the clomide
group, P < 0.001). Serum estradiol was significantly lower in letrezole group (
456_+150 versus 922_+301 pg/ml, P < 0.001). While the rate of multiple follicular
development was greater in the group B ( clomide 55.15%, letrezole 25.41%,
P=0.025), which was statistically significant. The pregnancy occurred in 36 out 100
(36% ) in letrezole group and 12 out 100 ( 12% ) in clomide group, the difference was
highly statistically significant ( P < 0.025 ).

Background : In recent years, many studies had been carried out on the basal AMH level
and its association with controlled ovarian hyperstimulation (COH) outcome. Only a few
studies have been conducted on the correlation between COH outcomes and AMH levels
measured on different stimulation days and these studies did not show a comparison
between different measurement timings over the entire period of the COH cycle.
Objectives: the current study aim is to assess the predictive values of basal and consecutive
serum AMH levels during COH cycle.
Methods and Results: One hundred women were involved in this study, scheduled for IVF
program in Dwarozh Fertility Center in Sulaimanyiah , between December 2015 until
January 2017, blood samples were collected for measurement of AMH, Estradiol, and FSH
on day 2 of menstrual cycle, and the subsequent samples on day 4,6,8 and 10 were taking
after the stimulation of ovaries with gonadotrophin. All hormones being analyzed by using
electrochemiluminescence methods (Cobas 411 by Roche) as a single batch, each patient
was given a unique numerical identifier, which issued in data analysis. P values <0.05 were
considered significant.
Results: the patients' characteristics , basal serum estradiol (E2), FSH and AMH levels at
day 2 of cycle and subsequent days after stimulation . As expected significant differences
were observed for total dosage of FSH, peak E2 levels and duration of stimulation between
short and long GnRH agonist groups. The ROC curve was used to assess the AMH values in
different days (day 2, 4, 6, 8, and 10) for prediction of IVF outcomes (implantation,
abortion, preganancy and live birth). All the days showed significant area under the curve
(AUC) (p<0.05). However, when all the ROC curve were comapred to each others there
were no significance differences bwteeen them (p>0.05)
Conclusions: The present study concluded that measurement of serum AMH at any time
after stimulation still predictive of the IVF outcomes which will reinforce the already known
value
of
AMH
in
clinical
practice.

Background and Aim
HbA1c is an irreversible non-enzymatic glycation at one or both NH2- terminal valines of
the β –chain. Sickle hemoglobin, or HbS, has a valine for glutamic acid substitution at
position 6 of the β chain. The prevalence of sickle cell trait reported to be 2.5% in Basrah
city. The hemoglobin A1C (A1C) test can lead to false outcomes resulting in over- treatment
or under-treatment of diabetes in people with inherited hemoglobin variants.
This study focus on the evaluation of sickle cell trait effect on HbA1c measurement by the
minicolumn ion exchange resin methods and compare them with Biorad Variant (HPLC
method).the one of methods certified by national glycohemoglobin standardization program
(NGSP)
Materials and Methods
60 diabetic patients identified with sickle cell trait were recruited in this study .Blood
sample collect in EDTA tubes and were assessed for hemoglobin A1c using 3 methods
commercially available and most fequently used for routine investigations. Stanbio
Glycohemoglobin (Pre- Fil), HUMAN Glycohemglobin HbA1-Test ( Fast Ion Exchange
Resin Separation Method ) ,and the Bio-Rad VARIANT Hemoglobin A1c (HPLC ) method

Background : Cardiotoxicity is a well recognized adverse event of trastuzumab. This
study was designed to evaluate the frequency of decline in left ventricular ejection
fraction (LVEF) to less than 50% in patients with breast cancer who have received
trastuzumab in a daily practice setting.
Methods : Retrospective observational study of 116 patients with HER2 positive breast
cancer treated with trastuzumab in one center between May 2012 and January 2017.
Results : Left ventricular ejection fraction decline to less than 50% was observed in 7
patients (6%). Patients above 70 years of age have the highest frequency of LVEF decline
(33%). All events of LVEF decline was reported in the first six months of treatment.
Prolonged administration of trastuzumab beyond one year was not associated with
adverse cardiac events. Previous anthracycline exposure and chest irradiation was not
found to be associated with LVEF decline.
Conclusions : Events of LVEF decline to less than 50% associated with trastuzumab
use seems to be slightly higher in general daily practice than in clinical trial setting,
especially in patients above 70 years, calling for better patient selection. First year of
trastuzumab therapy carries the highest risk of cardiac events which necessitates a close
cardiac monitoring, thereafter, periodic LVEF measurements can be reduced to reduce
the costs.

A prospective study was conducted on 305 patients with Thalassemia who were attending
to the center of inherited blood diseases in Nassiryia city from the penod of 1 / 7 / 1997 to
30/9/2009 .
Elisa test was used to study the prove lance of hepatitis C Viral infections among
Thalassaemic children .
Anti-HCV antibodies were detected in 72 ( 23.6 % ) patients , 47(65%)males and
25(35%)females. The frequency of cases was correlated with increasing age.
There was a positive correlation between frequency of blood Transfusion / year and the
increased incidence of infection with HCV .
Splenectomy was done in 80 ( 26.2 % ) patients 28 ( 3S % ) of them had positive anti-HCV
antibodies in their sera .
We concluded that our Thalassemic patients are exposed to HCV infection .Careful,
regular screening of blood unit for HCV should be established