The Medical Journal of Basrah University

Background: The study was designed to evaluate the anti-ulcer effect of chitosan, misoprostol, and their combination on gastric ulceration induced by indometacin in rats.
Methods and experimental design: Chitosan was prepared from shrimp shells waste products. Thirty rats were divided into 5 groups, 6 rats each. Rats in group 1 (control) were given solid sugar and distilled water for 3 days; group 2 were treated by indometacin (25mg/rat) ; group 3,4, and 5 were treated by misoprostol, chitosan, and by the combination chitosan and misoprostol respectively before treatment with indometacin. Blood were collected before sacrificing the animals and used for estimation of MDA, a marker of oxidative stress. The stomachs were prepared for estimating the total gastric area, ulcerated area, tissue MDA, mucin production as well as for histopathological examination.
Results: Indometacin produced gastric ulcers, and increased the total gastric area in all animals. These effects were associated with a significant elevation of MDA levels in the blood and in stomach tissues, and a significant reduction in mucin production. Misoprostol, chitosan and their combination protected gastric mucosa since they significantly reduced ulcer index. Moreover, the observed anti-ulcer effect was more with the combination in comparison to monotherapy of misoprostol or chitosan.
Treatments by misoprostol, chitosan and their combination before indometacin significantly reduced blood and tissue MDA levels and increased mucin production.
Conclusion: Chitosan, misoprostol and their combination have gastroprotective effects against indometacin-induced gastric ulceration in rats.

Background: Cholera is an endemic disease in Iraq, the most severe epidemic had occurred in 1966 as a continuity of the seventh pandemic. Then subsequent less serious outbreaks occurred in 1999, 2003, and 2008 with a case fatality ratio of about 2%.
Objective: To verify the sensitivity and specificity of immunochromatographic one step rapid test for V. cholerae among asymptomatic carriers using the culture as a validating diagnostic test.
Design: a cross – sectional study
Materials & Methods: A total of 28000 stool samples were collected from individuals that were attending the primary health care centers in Najaf governorate during the months (August, September, October and November, 2008) which are considered the months of cholera season in Iraq. The individuals were asymptomatic or suffering from mild diarrhea. All the stool samples were examined for Vibrio cholerae by two methods; the rapid visual test as a screening and the culture as a diagnostic test. The ability of the rapid visual test had been compared with results of culture to assess the validity and prediction of this rapid test in our locality.
Results: From 28000 stool samples, 51 samples found to be carriers of V. cholerae O1 of Inaba serotype with carrier detection rate of 182 per 100000 population. The sensitivity and specificity of the one step rapid visual test were 84% and 100% respectively with ten false negative individuals. The test revealed high predictive value for both positive and negative results.
Conclusion: The validity of the immunochromatographic one step rapid visual test (VC Dipstick) is so high that it can be applied to detect the carriers of Vibrio cholerae O1 during the expected cholera season.

Background: The high incidence of multi-resistant uropathogens is of great epidemiological significance because the etiological agents of urinary tract infection are quite capable of spreading through susceptible population.
Objective: to study the extent of antimicrobial resistance of uropathogens in Basrah.
Patients & Methods: A cross-sectional study involving 789 patients, 610 patients attending outpatient clinics in three hospitals in Basrah city and 179 admitted patients in Al-Sader Teaching Hospital, was carried out. Patients included in the study were those with symptoms suggestive of urinary tract infection and were not on antibiotics for at least one week. The study was conducted during the period between January 2003 and March 2004. For each patient a general urine examination and urine culture were done. Identification of the isolated bacteria was performed according to a standard method and antimicrobial susceptibility test was performed using the diffusion disk method.
Results: Out of 610 outpatients included in the study, 443(72.6%) had positive culture, 128(61%) of males and 315 (78.8%) of females. E.coli was the commonest organism, isolated from 205 urine samples representing 43.7% of the total isolates, followed by other gram negative bacteria: Klebsiella sp., Proteus sp., and Pseudomonas aeruginosa. Gram positive cocci represented 7.7% & 3.6%.for CoPS and CoNS respectively. On the other hand, Klebsiella sp were the most commonly isolated bacterial uropathogens from inpatients, they represented 47.7% of the total isolates. Sensitivity rates to all chemotherapeutic agents among uropathogens isolated from hospital acquired urinary tract infections (the inpatient group) were lower than that of sensitivity rates of uropathogens isolated from the community acquired urinary tract infection. The overall sensitivity rates of isolates recovered from patients with hospital acquired urinary tract infection for norfloxacin, and ciprofloxacin were 59.3%, and 39.5%, while the sensitivity rates of the isolates reported from community acquired urinary tract infection for the same agents were 83.6%, and 39.5% respectively.
Conclusions: Both hospital and community acquired uropathogens showed resistance to all classes of antimicrobial agents.

A case control study was carried out during October 2008 till September 2009 in Basrah. The study was designed to evaluate the occurrence of acute human parvovirus B19 infection among pregnant women and its association with spontaneous abortion.
A total of 182 blood samples were collected from the outpatient clinic, wards and emergency unit at Basrah Maternity and Children Hospital, 91 from women with spontaneous abortion and 91 from women with normal pregnancy as control matching cases in age and gravidity. Maternal serum was kept frozen at –20ºC until serological investigation by Enzyme-linked immunosorbent assay to detect parvovirus B19 IgM (ELISA-B19-IgM), then the positive cases were investigated to determine the level of interferon-gamma by ELISA kit and acute phase protein C-reactive protein (CRP) by latex agglutination test.
The overall prevalence of parvovirus B19 in study population was 53.8% for cases and 41.8% for control. All B19 positive cases were positive for interferon-gamma in different titers and 77.6% of B19-IgM positive cases were positive to CRP as well. The data indicate that the diagnosis of B19 infection during pregnancy should be considered more often, particularly in complete and missed types of abortion, as missed abortion represents more than 50% of B19 seropositive of spontaneously aborted ladies. Significantly (P<0.05) high percentage of B19 positive cases as well as fetal losses were observed in the second trimester. Also the results showed significant difference in B19 antibodies in relation to gravidity (P<0.05).
The main conclusion that human parvovirus B19 is common with high prevalence rates among pregnant in our region, and cases of complete and missed abortion should be investigated to exclude parvovirus B19 infections.

Across sectional study was carried out to evaluate the feeding pattern of malnourished children and to study the association between their demographic and nutritional variables. The study was conducted on 157 infants and children aged 2-36 months (65 males and 92 females) attending Nutritional Rehabilitation Center In Basrah General Hospital during the period from November 2007 till the end of May 2008. Selected demographic variables, feeding pattern, age of administration and type of different complementary foods and frequency of these food items were recorded. Measurement of weight and height or length by standard procedures was done for all infants and children recruited in the study. Anthropometric data were applied to appropriate charts: weight for length Z score, weight for age Z-score and height for age Z-score which were estimated according to CDC/WHO charts. all studied children were underweight; (93.6%) wasted and (87.3%) were stunted, (9.5% and 90.5%) were with severe and moderate wasting respectively, (38% and 62%) with severe and moderate stunting respectively, (45.9%, 54%) with severe and moderate underweight respectively. Study of feeding pattern of malnourished children has revealed that (28.7%) were on breastfeeding; (36.9%) formula feeding & (34.4%) with mixed feeding. Regarding the duration of breastfeeding; (75.8%) were breastfed less than 12 months. The age onset of complementary feeding; 71(65.1%) of children had their complementary feeding at age of 4-6 months. Malnourished children consume mainly cereals & rice in high proportion (38.9%, 56.1%) and least for fish and meat (3.8%, 4.5%) respectively. Children were given complementary food on daily bases in order of frequency of administration; (7%) were given rice, (5.7%) vegetables, (3.2%) cereals, (2.5%) eggs and (1.9%) fruits. Other foods were never on daily bases or even occasionally (> 1/wk) including meat, fish, legumes; they were never given in (95.5%, 96% & 88.5%) respectively.
In conclusion: there was a significant positive correlation between age of onset of complementary feeding and underweight.

The present study was carried out to evaluate the clinical usefulness of measuring total serum bile acids concentrations as a diagnostic test for hepatobiliary diseases. It is measured by an enzymatic method under fasting conditions in 120 apparently healthy control subjects and 140(79 (56.43%) males and 61(43.57%) females) patients with various forms of hepatobiliary diseases. The patient's diagnoses were based on clinical, biochemical, radiological, serological and histological grounds. The study showed a highly significant increase in total serum bile acids levels in all types of liver disease patients groups (icteric and anicteric) (P<0.001), even when other liver tests are normal. There were no significant differences (P> 0.05) in the serum levels of total bile acids in patients groups according to their gender and residence. The highest incidences of hepatobiliary diseases were in males and urban patients groups as compared with females and rural patients groups respectively. The study has illustrated moderate correlations between the concentrations of total bile acids with those for any the other liver function tests. Highly significant, positive and moderate correlations were observed with total bilirubin concentration (r = 0.659, P < 0.01). On the other hand serum total bile acids were negatively correlated with serum albumin (r = - 0.104).

Thyroid dyshormonogenesis is a rare condition, due to genetic defects in the synthesis of thyroid hormones where patients develop hypothyroidism with goiter. One particular familial form , associated with sensorineural deafness is called Pendred's Syndrome (PS).
We report probably a unique case of a young man with PS who developed a large, bulky goiter without a family history of goiter or deafness. The clinical findings were used to illustrate the normal physiology of thyroid hormone synthesis, the mechanisms of iodide transport in the thyrocyte, the pathophysiology of dyhormonogenesis and genetics of Pendred's syndrome.

Objective: The aim of the study was to measure the blood pressure of University students and relate variation to specific risk factors (age, sex, family history of hypertension, body mass index and smoking).
Patients & Methods: This study is a cross sectional study based on a random sample drawn from 5 of the 14 colleges in the University of Basrah. Field part of the study extended from first of March to middle of May 2010 and involved 330 students.
Results: The results showed that with respect to systolic blood pressure, 17% were in the prehypertension and 1.8% hypertensive. For diastolic blood pressure, 31.8% were in the prehypertension and 3.6% hypertensive. Using multiple logistic regression analysis sex, family history and body mass index predict significantly 9% of the systolic pressure measurements variability. Also body mass index, sex and family history of hypertension could significantly predict 10% of variability. Also body mass index, sex and family history of hypertension could variability predict 10% of variability. Other variables (age, smoking and father education) could not predict significant variability of blood pressure measurements.
Conclusions: Monitoring blood pressure in young adults is worth doing as a high percent of students were either hypertensive or in the prehypertension stage.

Objectives: A prospective study that was carried out to evaluate the nutritional status of children at hospital admission and again on discharge from hospital and correlate the changes in their nutritional status with selected socio-demographic variables.
Methods: The study included 293 children, aged 1-60 months admitted to Basrah Maternity and children Hospital from the first of November 2007 till the end of May 2008. Weight and height were measured by standard methods expressed in Z-scores for weight/age, height or length/age and weight/height according to World Health Organization Growth Standards. They were measured on admission and body weight and weight/height z score measured again on discharge, in addition to selected socio-demographic variables.
Results: The prevalence of wasting increased by hospital discharge and there is decrease in the frequency of well nourished children from 66.2% to 61.4% at discharge. Fourteen (7.2%) of well nourished children on admission progress to mild wasting on discharge from hospital, 21% of children with mild wasting initially deteriorated to moderate wasting, while 7.3% of children with moderate wasting progress to severe wasting on discharge. A significant association was reported between mother illiteracy, prolonged hospitalization, initial under nutrition and chronic diarrhea with weight loss during hospitalization.
Conclusion: The overall frequency of malnutrition has increased by discharge, and Prolonged hospitalization is associated with significant positive correlation with weight loss.

Objectives: To find out the frequency of psoriatic arthritis (PsA) in psoriatic patients in Sulaimania city, and to determine the clinical varieties of psoriatic arthritis in psoriatic patients.
Patients and Methods: A sample of 132 patients with psoriasis attending the dermatology consultation clinic of Sulaimania city from January to July 2008 was included in the study. Patients were evaluated for evidence of arthropathy. All patients were interviewed by using a questionnaire form which was constructed according to CASPAR classification criteria. Arthritic patients were investigated by relevant laboratory tests and radiology (X-ray).
Results: Out of 132 psoriatic patients, 34 cases fulfilled the CASPAR classification criteria for diagnosis of psoriatic arthritis which represents 25.8% of the sample. There was a female predominance (67.6%). Oligoarthritis was the commonest type of psoriatic arthritis, occurred in 29.4%, while isolated involvements of distal interphalangel joints (DIP) and axial skeletal were the least common. Enthesopathy was diagnosed in 58.8%, psoriatic nail lesions were observed in 32.4%, and 73.5% of psoriatic arthritis had extensive skin lesion which express the important relation of joint disease with the extent of skin lesion. Most of the polyarthritis and arthritis mutilans occurred in the age group 50-59, this relation between the severity of joint disease and advancing age was statistically significant.
Conclusion: Nearly one-quarter of psoriatic patients had psoriatic arthritis, females were more affected, and the commonest type of arthritis recorded was oligoarticular type.

Background: Noise Induced Hearing Loss (NIHL) is irreversible sensorineural deafness in one or both ears which develops gradually due to chronic exposure to injurious noise in employement.
Objective: To study the extent of hearing loss among steel factory workers as a result of their exposure to noise and to formulate an educational program for wearing a protective devices during the work.
Methods: The study involved 121 subjects aged between 20-59 years. Fifty eight were working in Basrah steel factory as a case group and 63 were working in Basrah medical college as a control group, so (242 ears) were tested for pure tone using air conduction test audiometer. Each group was subdivided into two subgroups according to their ages.The ages of the first subgroup were ranging from 20 to 39 years and the ages of the second subgroup were 40-59 years.
Results: In the subgroup 20-39 years, 93.8% of the workers had bilateral hearing loss, while only 17.3% from the control group had hearing loss, there is a significant difference between the two groups regarding hearing loss (P<0.001) and its severity (P<0.001).
In the subgroup 40-59 years, all workers had bilateral hearing loss and only 40% of the control group had bilateral hearng loss.There is a significant difference regarding hearing loss (P<0.001) and its sevrity (P=0.001) between the two groups.
Comparing the two age groups (20-39 years & 40-59 years), in the workers there is no significant difference in hearing loss (P=0.429), but there is a significant difference regarding severity of hearing loss (P<0.001). While in the control group, there is no significant difference in hearing loss but a significant difference in severity of hearing loss(P=0.093 and P= 0.006 ) respectively.

Objectives: to estimate the prevalence of contraceptive use, and investigate the factors associated with knowledge, attitudes and practices of family planning.
Method: A cross sectional, household multi-stage sampling. A sample of 900 currently married non pregnant women aged 15-49 years were selected from 30 household clusters in Basrah city, south of Iraq.
Results: Current prevalence of contraceptive use (any method) among 900 non-pregnant women was 53.7%, use of modern methods was 37% and traditional methods was 16.7%. The use of traditional methods of contraceptives was significantly associated with older age, higher educational level. The main cause for not using contraceptives was health reasons. Husband's objection and cost of contraceptives also had role in non use of contraception methods.
Conclusions: The rate of use of contraceptives was low for both any method and for modern types. The pill was the most popular method of contraceptives and the next more popular method was the withdrawal method. The study reveals good knowledge about family planning.
Recommendations: Establishment of sensitive and modern family planning services through all primary health care services in all districts of Basrah. Increase Community awareness of family planning and the advantages of child spacing through mass media, Coordination between public and private sector to provide adequate family planning services and supplies and Policy-makers and health providers should target men since they are primary decision-makers in the home.