The Medical Journal of Basrah University

Abstract

ABSTRACT
A cross-sectional study was conducted to estimate the frequency of overweight and obesity among infants and
children aged 6-60 months in Basrah, and its association with different socio-demographic factors, dietary habits and
physical activity of the child. Five-hundred fifty infants and children aged 6-60 months (283 males and 267 females)
attending five primary health care centers in Basrah city during the period from November 2006 till the end of April
2007 were recruited. The frequency of overweight was 10.5% and for obesity 3.3% as calculated by weight for height
Z-score for all children of different age groups. For children older than 2 years, the frequency of overweight was 7.6%
and of obesity 3.6% using Body Mass Index. The study has revealed that there is a significant positive association
between father's education, age, weight at birth, and the number of hours of television watching with overweight and
obesity, while there was significant negative association between the duration of breastfeeding and
overweight/obesity. Although the prevalence of wasting is still high (11.1%) in Basrah, at the same time another
public health problem (obesity) emerges. There is a highly significant protective effect of breastfeeding against
development of obesity if feeding continues for > 6 months.

Abstract

ABSTRACT
Contraindications to laparoscopic cholecystectomy diminished over the last decade but still conversion rate is about 5-
6% in elective cases and higher in acute cholecystitis. The aim of this study is to analyze the reasons for conversion in
all patients laparoscopically operated on for cholecystectomy in our surgical department and to create strategies for
critical moments when conversion needed.
From 2005 to 2010, the data sheets of all patients subjected for laparoscopic cholecystectomy had been analyzed
regarding sex, age, intraoperative finding, the time and reason for conversion.
Of the 899 patients who underwent laparoscopy cholecystectomy (83 male and 816 female), 3.8% [34 patients (21
women, 2.5% and 13 men, 15.61%)] were converted to open cholecystectomy. Difficulties with the anatomy in
Calot's triangle (58.8%), difficulties in establishing pneumoperitoneum (8.8%) and bleeding (8.8%) have been the
main reasons for conversion.
In conclusion, the scene keys for conversion are difficulties in Calot's triangle, intra-abdominal adhesions, and the
creation of the pneumoperitoneum. Conversion should not be regarded as a complication.

Fifty patients with electrocardiographic (ECG) evidence of left Bundle Branch Block (LBBB) and fifty control group
with no significant electrocardiographic findings were studied over the period from October 2004 to July 2005 for
evidence of Coronary Artery Disease (CAD) and Left Ventricular (LV) dysfunction. Both groups underwent cardiac
catheterization and CAD considered present if there was 70% and more lumen diameter stenosis except for Left Main
Coronary Artery (LMCA) was 50% and more. LV function was assessed visually and the function was considered
normal or abnormal.
The CAD was found in 37/50 (74%) of patients with LBBB, it was significantly (P<0.002) higher than in control
group 14/50 (28%), the percentage of LAD artery disease was significantly (P<0.001) higher in patients with LBBB
36/50 (72%) than in control 5/50 (10%) and LV dysfunction was present in 30/ 50 (60%) of patients with LBBB it
was significantly (P< 0.001) higher than in control 9/50 (18%)
In conclusion: the study showed that the patients with LBBB had higher incidence of CAD and LV dysfunction

Aim: To determine the incidence of congenital varicocele in pediatric and prepubertal age groups, and to compare
between two surgical approaches with different procedures.
Methods: In march and April 2001 seven thousands five hundred and forty three pupils in twelve primary schools
were examined for detection of congenital varicocele, the pupils were divided into two groups according to age; group
one between age of 6-12 years, group two between age of 13-16 years. The positive cases in the two groups were
classified into two batches: symptomatic and non-symptomatic; the silent cases were scheduled for expectant
management. The symptomatic cases were randomly divided into two groups for surgical options by open
varicocelectomy, the first one through inguinal approach with high ligation of spermatic vein, the second through
retroperitoneal route with ligation of both spermatic artery and vein.
Results: The number of cases of positive varicocele was 16(0.4%) in pediatric age (6-12 years). This figure increased
to 102 (2.58%) in prepubertal age (13-16 years). In the positive cases, we found an increase in number with age
especially after age of eight. The symptomatic cases were registered only in prepubertal age and varicocele established
clinically as age advanced and all positive cases in pediatric age group were silent. The rate of cure in cases treated by
venoarterial ligation was 29 cases (90.5%), while it was 23 cases (74%) in those managed by ligation of vein only.
The recurrence rate after venoarterial ligation was one case (3%) and after vein ligation only was 3 cases (9.6%). No
reduction in size of testes in the batch treated by venoarterial ligation. The incidence of Hydrocele in the cases treated
by vein ligation was slightly less than that after venoarterial ligation. The improvement in size of testes is better after
venoarterial ligation but the numbers of reduction in the size of varicocele were more in cases treated by vein ligation
only. Scrotal hematomas were recorded only after vein ligation. Hospital stay was shorter in cases treated by
venoarterial ligation through retroperitoneal route. Wound infection occurred more after vein ligation.
Conclusion: In this study we concluded that it is preferable to leave children with silent varicocele for expectant
management. The option of spermatic venoarterial ligation for management of varicocele is safe and more rewarding
regarding rate of cure and testes volume improvement.

Aim: The aim of the present study was to determine the relationship between Chlamydia pneumoniae infection
and coronary artery disease with classical risk factors in Basrah patients.
Background: Chronic inflammatory diseases might play significant role in the pathogenesis of atherosclerosis. We
studied the differences between the percentage of immunoglobulin G against Chlamydia pneumonia among
Coronary Heart Disease patients and control subject.
Method: Antibody titer against Chlamydia pneumonia by microimmunofluorescence method and C-reactive
protein by agglutination method was determined among 225 patients proven Coronary Heart Disease and 180 control
subject. Lipid risk and non-lipid risk factors in Coronary Heart Diseases patients was determined.
Results: Chlamydia pneumoniae seropositivity 1/64 titer was significantly higher in patients than control group
(46.6% versus 25.5%) respectively; P<0.01; odd ratio 2.64; CI (1.62; 3.46). Positive C-reactive protein (≥6mg/I) was
significantly higher in patients (53.3 versus 39.4; P<0.001; odd ratio 2.21; CI (1.46- 3.11)), than control group. All
percentages of lipid and non-lipid risk factors in patients were significantly higher than control group.
Conclusion: We have demonstrated a significant rise in Chlamydia pneumoniae-specific immunoglobulin G and
C-reactive protein levels is associated with Coronary Heart Disease.

Objective: To evaluate the pattern of lipid and lipoprotein profile in patients with type 2 diabetes (T2D).
Methods: In this prospective study, which was carried out in Basrah, Southern Iraq, serum concentrations of glucose
“fasting blood sugar” (FBS), total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C), low density
lipoprotein-cholesterol (LDL-C), triglycerides (TG) and very low density lipoprotein-cholesterol (VLDL-C) were
measured in 92 patients (43 males and 49 females) with T2D and 120 control subjects (35 males and 85 females).
Results: Patients with T2D have significantly higher serum concentrations of TC, LDL-C, TG, VLDL-C and LDLC/
HDL-C ratio (P<0.001) and significantly lower HDL-C serum concentration (P<0.001) compared to control
subjects. Male patients with T2D showed significantly higher TC, LDL-C serum concentrations and LDL-C/HDL-C
ratio in comparison to control subjects (P<0.001), while serum HDL-C concentration was significantly lower among
T2D patients compared to controls (P<0.001). No significant differences were seen in serum TG and VLDL-C
concentrations between male patients and control subjects (P>0.05). In females, serum levels of TC, LDL-C, TG,
VLDL-C, and LDL-C/ HDL-C ratio were significantly higher (P<0.001), and serum HDL-C level was significantly
lower (P<0.05) in patients with T2D than in control subjects.
Conclusion: T2D has marked effects on lipid and lipoprotein profile causing a diversity of dyslipidaemia, that
might lead to atherosclerosis, and hence, increasing the risk of coronary heart disease.

Background: About 10% of all injuries seen in the emergency room involve the genitourinary system to some
extent. Renal injuries are the most common injuries of the urinary system. A blunt trauma directed to the abdomen,
flank, or back is the most common mechanism. A kidney with a pre-existing abnormality is at increased risk for
injury. The objective of the study is early detection of intraperitoneal rupture of the kidney in cases of acute abdomen
and also to confirm the fact that the severity of patients' symptoms is disproportionate to the degree of injury in
children suffering from renal abnormalities.
Patients & methods: A total of 15 patients were included in the study from 2004-2009. The age range was 3-13
years. Five patients were girls & ten were boys. A brief history was taken and a thorough physical examination was
done. Hemoglobin, packed cell volume and urinalysis were done. Imaging by ultrasonography and computerized
tomography (CT) with contrast were done in these patients. Emergency laparotomy was performed in all patients.
Results: Intraperitoneal rupture of the kidney with urine peritonitis (uroperitoneum) was found in all patients.
Seven patients had left sided renal injuries while eight patients had right sided injuries. A thin renal parenchyma with
extravasation of contrast media into the peritoneal cavity were found in CT of all patients. Nephrectomy was the
decided surgical treatment in every patient.
Conclusion: It can be concluded that children with hydronephrotic kidneys are more prone to intra-peritoneal
rupture from minor trauma and a high index of suspicion is needed to diagnose those patients with intraperitoneal
rupture of the kidney.

Background: Diabetic retinopathy is the most frequent cause of new cases of blindness among adults aged 20–74
years. Magnesium deficiency is a possible metabolic factor involved in the pathogenesis of diabetic micro - and macro
- vascular complications.
Aim: To assess magnesium level in relation to the stages of diabetic retinopathy.
Methods: The study enrolled 136 diabetic patients consulting Ophthalmology Outpatient Department. The
ophthalmologist assigned the patients into 5 categories; background, preproliferative, proliferative, advanced and
maculopathy. Serum magnesium, random blood glucose and glycated hemoglobin were determined.
Results: Among the 136 patients with diabetes mellitus, 94 patients had diabetic retinopathy and 42 had no
retinopathy. There is a significant statistical differences (P-value <0.05) between diabetic retinopathy and control
groups in serum magnesium, random blood glucose, glycated hemoglobin and duration of diabetes. It had been found
that serum magnesium remained statistically significant among the groups of patients with different stages of
retinopathy. Patients with maculopathy had the lowest value for the serum magnesium level (1.35 mg/dl)
Conclusions: Serum magnesium level decreased in patients with diabetic retinopathy with lowest level being
observed in patients with advanced retinopathy and maculopathy.