The Medical Journal of Basrah University

Abstract

ABSTRACT
To establish the usefulness of evoked potential testing in the diagnosis of central nervous system disorders in patients
with diabetes mellitus, a group of forty diabetic patients (23 males and 17 females, 20 with type 1 and 20 with type 2)
were studied They were matched in terms of age and sex with another group of 50 apparently healthy controls (31
males and 19 females). Visual evoked potential test for both diabetic patients and controls and nerve conduction study
for diabetics were done. Fasting plasma glucose level was estimated prior to recording of visual evoked potential. The
mean P100 latencies were significantly prolonged in diabetic patients with a mean ± standard deviation of
(109.87±9.63) as compared with controls (104.08 3.31), (P=0.014). The mean P100 amplitude was (4.63 ± 1.45) in
diabetic patients while in controls of (4.78 ± 2.55), (P=0.873). A positive correlation was reported between fasting
plasma glucose level and prolonged P 100 latencies but not with the type and duration of diabetes, presence of distal
symmetrical polyneuropathy, age and sex of diabetic patients. In conclusions visual evoked potential test enables a
diagnosis and objective evaluation of central nervous system disorders in diabetic patients and its abnormality
correlates with the level of plasma glucose but not with the type, duration of diabetes, presence of distal symmetrical
polyneuropathy, age and sex of patients.

Abstract

ABSTRACT
Objective: To estimate the oxidative stress status in patients with different parasitic infections.
Methods: A total of 230 blood samples obtained from individuals aged 1-65 years during the first 9 months of 2007
in Basrah, Iraq were used. One hundred samples collected from patients with parasitic infections (35 patients with
toxoplasmosis, 32 patients with leishmaniasis, 24 patients with amoebiasis and 9 patients with giardiasis) while the
rest 130 were apparently healthy subjects and considered as a control group. The oxidative stress status was
determined by measuring serum malondialdehyde (MDA) level as indicator of lipid peroxidation, erythrocytes
superoxide dismutase (SOD) as indicator of endogenous antioxidant enzymes level and zinc level as cofactor for
antioxidants enzymes.
Results: Serum MDA level for patients group was (1.02+0.26 μmol/L) which was significantly higher than that in
the control group (0.83±0.12 μmol/L) ((P<0.001). Serum MDA levels were increased significantly with increasing
age (P<0.001). The levels of erythrocytes SOD were significantly lower (P<0.001) in patients than in control subjects
and its level is decreasing with increasing age. There were significant negative correlation between serum MDA and
erythrocytes SOD level among studied groups. Serum zinc level was decreased significantly in patients group
(84.95±13.31μg/dl) when compared to healthy subjects (94.48±6.6μg/dl) (P<0.001).
Conclusion: The parasitic infections are associated with significant degree of free radicals formation as indicated by
significantly higher MDA and lower SOD levels among those patients.

Abstract

ABSTRACT
This study was conducted in the Mid-Euphrate Region (Al-Qadisya, Najaf and Karbala provinces) during the period
between first/June 2004 to first/May 2006. Two types of laboratory tests were used in this study for the diagnosis of
visceral leishmaniasis in suspected patients attending pediatric hospitals in these province’s.
The patients were divided into two groups; the first group included 150 children admitted to Al-Qadisya, Najaf
and Karbala hospitals and the diagnosis was made on serum samples using Dipstick test, and the results indicated
the positive cases by this test were 107/150 (71.4%). The second group included 27 children suspected of having
visceral leishmaniasis depending on the clinical features, and microscopical smear finding by Bone marrow
examination), the results indicated that the positive cases by this test were 17/27(62.9%). Fifteen out of 17 VL
patients (microscopically confirmed) were found positive by dipstick test. The test was proved to be the simplest,
cheapest, and rapid for the diagnosis of VL. It is a safe, highly sensitive (88.23%) and specific (60%) and can detect
the disease early. It was found that all the age groups are susceptible for the disease but those who are 13-24 months
old are the most susceptible. Both sexes are susceptible, but the highest incidence of infection more males (59.3%)
were affected than female (40.7%). Visceral leishmaniasis was found to be more prevalent in rural than urban
populations (68.3% and 31.7%) respectively.
Statistical method: Chi- square test and percentage of infection were applied. P-value 0.05

Abstract

ABSTRACT
Background: The use of fiberoptic endoscopy revolutionized diagnostic gastroenterology. The ultimate diagnosis of
malignancy is based on histologic or cytologic criteria. Cytology is a valuable adjunct to biopsy, with the combined
yield of the two superior to the yield of either individual technique. Studies done in Basrah evaluated the diagnostic
efficiency of brushing cytology, considering endoscopic biopsy results as a gold standard.
Aim: To evaluate the clinical utility of endoscopic biopsy and brush cytology versus open biopsies.
Material and Methods: Over the period from October 2002 to October 2006, fifty patients were selected with a high
suspicion of malignancy by endoscopic examination. Endoscopic biopsy and brush cytology were taken. All the fifty
patients proved to have malignancy depending on histopathological finding of open tissue biopsies. The cytology
smears were fixed in 95% ethyl alcohol and stained by Papanicolaou stain while the histological specimens processed
routinely and stained by hematoxylin and eosin. Analysis done for the results of both techniques and compared with
other studies.
Results: From the 50 patients with malignancy, brush cytology was positive in 47(sensitivity 94%) and the
endoscopic biopsy in 44(sensitivity 88%). Brush cytology diagnosed 3 cases with negative endoscopic biopsy and thus
added 6% to the diagnostic yield of malignancy.
Conclusion: Brush cytology got higher sensitivity than endoscopic biopsy; however, the two techniques are
complementary for the diagnosis of upper gastrointestinal tract malignancies.

Abstract

ABSTRACT
Background: The present study is based on two assumptions. First is the racial and ethnic differences in the
presentation of rheumatoid arthritis (RA) and its response to drugs. And the second is the interaction between
nonsteroidal anti-inflammatory drugs (NSAIDs) and the disease modifying antirheumatic drugs (DMARDs)
particularly methotrexate (MTX) with the possibility of enhanced toxicity.
Objectives: to investigate the efficacy and toxicity of MTX alone or in combination with diclofenac in the treatment
of RA.
Methods:
Design: A three month randomized comparative clinical trial
Setting: Rheumatology Unit at the Teaching Hospital and the Department of Pharmacology, College of Medicine,
University of Basrah, Basrah, Iraq.
Patients: Patients with moderate to severe RA were classified into, Group I: received MTX (7.5 mg orally as a single
weekly dose). Group II: received MTX single weekly dose plus diclofenac sodium 100 SR tablets once daily
Measurements and evaluation
Pain, morning stiffness, joint function (number of the swollen and tender joints), patients and physician global
assessment, radiological evaluation (according to modified Sharp score for joint space narrowing and erosions), ACR
criteria for progression and remission of RA, laboratory findings (complete blood picture and ESR, blood groups, Hb
electrophoresis, AST, ALT, blood urea) and drug adverse effects were evaluated.
Results: Twenty eight patients with moderate to severe RA were randomly allocated into two treatment groups as
cited in the Methods. Only 25 patients managed to complete the 12 week treatment course. Oral MTX (7.5 mg)
resulted in a statistically significant clinical improvement after 12 weeks of treatment. The improvement seems to be
time dependent. The average percent improvement in six clinical parameters mounted to about 35% compared to the
baseline measurements. The 20% improvement at 12 weeks of treatment using ACR criteria involved 42.8% of
patients. Radiological findings (joint space narrowing and erosion) increased slightly by only 5.7% over the 12 week
treatment period. No significant change in all laboratory parameters measured. No important side effects peculiar to
MTX could be figured out. Concurrent administration of diclofenac (sustained release formulation) with MTX
resulted in a paradoxical finding. Instead of enhancing efficacy or toxicity of MTX, diclofenac reduced the efficacy of
MTX from 35.25% to only 15.78% at the end of the treatment period. The two groups, however, differed in some
aspects e.g. disease duration and severity, and the type of blood groups which might possibly have contributed to this
difference. The ACR20 in the combination group is 36.3% (compared to 42.8% in MTX group). Radiological findings
progressed by 48.3% in the joint space narrowing and erosion. When results of MTX and MTX+diclofenac groups
were analyzed according to disease severity and blood groups, it was found that the response of patients with severe
but not moderate disease was comparable in the two groups. Blood group (A) seems to be associated with enhanced
response and group (O) with a reduced one.
Conclusion: Methotrexate 7.5 mg as a single oral dose per week produced a significant clinical improvement over the
12 week treatment period. The drug seems to be well tolerated with no important adverse effects. In contrast to what
is expected, sustained formulation of diclofenac sodium reduced the efficacy of MTX. The latter finding, if proved to
be true, could have an important clinical implication.

Abstract

ABSTRACT
Background: Hypertension is one of the most prevalent chronic diseases in the world and it is increasing particularly
in developing countries (including Iraq). A number of factors increase blood pressure, including: obesity, insulin
resistance, high alcohol intake, high salt intake (in salt-sensitive patients), aging, sedentary lifestyle, stress, low
potassium intake, and low calcium intake, furthermore, many of these factors are additive, such as obesity and
alcohol intake.
Objectives: This study was conducted with the aim of determining the prevalence of hypertension among secondary
school female teachers and identifying lifestyle related risk factors.
Subjects and methods: A sample of 16 schools (25%) of female secondary schools in Basrah city was chosen
randomly. All the female teachers present in the schools at the time of the visits were interviewed according to a
special questionnaire. Height, weight and blood pressure were measured. The whole sample size was 403 participants;
the only excluded criterion was pregnancy. The number of those who were excluded was five teachers.
Results: The prevalence of hypertension among the study population was 21.3%, and about one fifth of them
(20.3%) were prehypertensive. The prevalence of lifestyle risk factors among the study population was as follows;
physical inactivity (67.٧%), overweight (40.9%), obesity (37.7%), contraceptive pills use (18.6%), salty diet
(18.1%), fatty diet (15.4%), drugs intake (mostly non-steroidal anti-inflammatory drugs) (12.4%), coffee intake
(6.5%), and smoking (0.5%). A significant association was found between some lifestyle risk factors and
hypertension, those were: drug intake, and body mass index, while no significant association was found between other
risk factors and hypertension which were: fatty diet, physical activity, coffee intake and, contraceptive pills intake.
Conclusions: The prevalence of hypertension was within the range of that reported for women in Iraq. There was a
significant proportion of participants with unidentified hypertension, and a significant association was found between
certain lifestyle risk factors and hypertension. Early detection of hypertension and educational health programs
regarding lifestyle behavior were highly recommended.

Abstract

ABSTRACT
Objective: to study the rate of infections of toxoplasmosis as an opportunistic infection among two groups of adult
patients in Mosul city (Iraq) and surrounding areas. The first group was diagnosed before receiving any kind of anticancer
therapy (BRT) and the second group after receiving their anti-cancer therapy (ART).
Methods: Latex Agglutination (LA) test for detection of IgG antibodies and Enzyme Linked Immunosorbent Assay
(ELIZA) test for detection of IgM antibodies were used. Chi-square test (X2) was used for statistical analysis.
Results: Out of (90) samples tested of the (BRT) group, 43(48%) were positive for anti-Toxoplasma IgG
antibodies by LA test. Out of (70) samples tested of the (ART) group, 25(36%) were positive for anti-Toxoplasma
IgG antibodies using LA test. Statistically, there was no significant difference between the two groups. The study
revealed that patients in both groups showed seropositive results using LA test, but sera of patients examined by
ELISA test revealed that 8(19%) and 7(28%) were positive for (BRT) and (ART) groups respectively. Statistically,
there was no significant difference between the two groups.
Conclusions: 1. Patients with leukemia or lymphoma before and after receiving therapy showed great susceptibility
to be infected with Toxoplasma gondii. 2. In both groups, detection of toxoplasma antibodies was higher among
patients using (LA) test (48%) than that of ELISA test (19%) in (BRT) group, while in (ART) group (36%) were
positive in (LA) test and (28%) in ELISA test. 3. Detection of antibodies of toxoplasmosis was higher among those
who received both regimens of anti-cancer therapy (chemotherapy and radiotherapy) than those who receiving single
type of therapy.

Abstract

ABSTRACT
A cross-sectional comparative study was carried out to estimate the prevalence of occupational respiratory allergic
diseases in bakeries in Basrah. The study was carried out on bakery workers who were exposed to flour dust during
work and compared with non exposed group. The study involved 68 bakery workers and 68 comprise group. A special
questionnaire was used for the purpose of the study. The results showed that the prevalence of work-related
respiratory allergic condition as reported by workers and diagnosed by the investigator was significantly higher
among the exposed group than that in the comparison group. Safety measures are highly recommended in such type
of work conditions.

Abstract

ABSTRACT
Vulval lesions are not always sexually transmitted. Those which are not sexually transmitted are referred to as nonvenereal
dermatoses of female external genitalia. In our society vulval and genital diseases are always thought to be
sexually transmitted. Genital diseases may be associated with severe psychological trauma and fear in the mind of
patients. Therefore, it is of immense importance to diagnose these non-venereal dermatoses to relieve the patient from
the stigma of sexually-transmitted diseases.
The aim of this study was to determine the causes and relative frequency of non venereal vulval diseases seen in
gynaecological practice over 19 months period from May 2008 till November 2009, all consenting female patients
irrespective of their age and pregnancy status attending the outpatient of Obstetrics and Gynaecology in Basrah
General Hospital who presented with a vulval problem or complain were included in the study.
A total of 66 female patients were included in this study. The age of the patients ranged from 3 years to 62 years. A
total of 9 different types of disorders or dermatosis involving the vulva were noted. Common conditions observed in
our study were vulval candidiasis (59%), this is in contrast with studies done in other countries were lichen sclerosis
was the commonest cause of symptomatic vulval disease, while in our study the percentage of lichen sclerosis was
only (3%).
In conclusion, this study highlights the importance of diagnosing non-venereal dermatoses and clinicians need to
differentiate the various causes of non-venereal dermatoses. Specialist vulval clinics are a valuable source of clinical
teaching and research.

Abstract

ABSTRACT
Prostate specific antigen (PSA) has established itself as the most useful marker for adenocarcinoma of the prostate
(ADCA) adenocarcinoma of the prostate and in the recent years has almost replaced the total acid phosphatase and
prostatic acid phosphatase prostatic acid phosphatase (PAP) for screening, diagnosis and monitoring the prostate
carcinoma patients. The prostate specific antigen levels also rise in benign prostatic hypertrophy benign prostatic
hypertrophy but to a lesser extent and high values are usually diagnostic of malignant disease. A cross-sectional
comparative study was planned to see the effect of urinary retention and catheterization on plasma concentration of
adenocarcinoma of the prostate and prostatic acid phosphatase and the value of this effect in the diagnosis of patients
as having benign prostatic hypertrophy or adenocarcinoma of prostate. Sixty patients with prostatic disease were
included in the study. Adenocarcinoma of the prostate and prostatic acid phosphatase levels were assessed in all
patients. The patients were divided into two groups; group I are those presented with urinary retention and
catheterization and group II those presented without urinary retention (without catheter). Following histological
examination of prostatic tissues, the patients were diagnosed as cases of benign prostatic hyperplasia or
adenocarcinoma of prostate. The data were analyzed using t-test. Benign prostatic hypertrophy was detected in 48
patients whereas 12 patients were diagnosed with adenocarcinoma of the prostate. In the study, 66.2% of benign
prostatic hypertrophy and 50% of adenocarcinoma of the prostate patients presented with urinary retention and
catheterization. It was observed that prostate specific antigen levels were significantly raised in benign prostatic
patients with urinary retention and catheterization as compared to those with no retention. There was, however, no
significant rise in prostatic acid phosphatase levels in those patients. In conclusion, prostatic acid phosphatase is still
a very good tumor marker of prostatic disease in differentiating the malignant from the benign disease. It appears to
be particularly important in patients with benign prostatic hyperplasia and urinary retention as catheterization
appears to raise significantly the levels of prostate specific antigen but not those of prostatic acid phosphates. This
finding means that patients presenting with urinary retention and catheterization and high prostatic acid phosphates
levels are more likely having carcinoma of the prostate because retention and catheterization don’t significantly raise
the prostatic acid phosphates levels in benign prostatic hypertrophy as they raise prostate specific antigen levels in
such patients.