The Medical Journal of Basrah University

Background: Oxidative stress may contribute to the pathogenesis of diabetes mellitus, and hyperglycemia and oxidative stress can reinforce each other. The use of antioxidant drugs, therefore, may be beneficial in treatment of diabetes mellitus and paracetamol had been shown to have antioxidant activity.
Objectives: To evaluate the potential role of paracetamol in type-2 diabetic patients not achieving target glycated hemoglobin (HbA1c).
Patients and Methods: Twenty four type-2 diabetic patients consulting the Center for Diabetes and Endocrinology in Maysan were included in this study after meeting a set of inclusion criteria. Their HbA1c was more than 7% despite the continuous use of oral antihyperglycemic drugs. Patients were treated with paracetamol 1000mg tablet once daily for one month. Blood samples were taken before, one month and three months after the start of treatments for measurement of HbA1c, C-reactive protein, C-peptide level, total antioxidant capacity and more frequently plasma glucose level (fasting/random). Another sixty patients of similar inclusion criteria were also followed for three months but without treatment with paracetamol and served as a control group.
Results: One month treatment with paracetamol (n=24) resulted in a beneficial effect particularly when measured two months after cessation of paracetamol treatment. Paracetamol significantly reduced HbA1c by 7.32% and random plasma glucose (RBG) by 22%, and greatly increased C-peptide by 443%. Total antioxidant capacity measured once after one month of paracetamol treatment increased by 20.2%. Unexpectedly, CRP was reduced significantly by 63.9%. The control, non- intervention group did not show significant changes in the levels of HbA1c over the three month period. Measurement of HOMA- ß C-peptide in a limited number of patients indicate that paracetamol significantly improve ß-cell function.
Conclusion: Paracetamol 1000mg tablet, when administered once daily for one month seem to be effective in achieving a good glycemic control in patients not achieving target HbA1c.

Background: One third of diabetic patients ultimately develop nephropathy. Microalbuminuria (MIA) is an earliest sign for diabetic nephropathy and its measurement is mandatory for early prevention of end stage renal failure. Drugs which prevent development of MIA may delay deterioration of renal function.
Aim: To evaluate effectiveness of candesartan, diltiazem or their combination on MIA in diabetic patients.
Methodology: 104 diabetic patients attending outpatient clinic at local Basrah hospitals were recruited for the study, 64 patients had MIA, and 40 patients were normoalbuminuric. Each group was subdivided into three subgroups; each subgroup was treated with either candesartan 8 mg, diltiazem 90 mg, or their combination for six months. Albuminuria, FBS, HbA1c, serum creatinine, serum potassium, total cholesterol and blood pressure were measured after 3 and 6 months. Results: candesartan, diltiazem and the combination significantly reduced MIA at the end of 3 and 6 months treatment in comparison to baseline. Candesartan significantly reduced MIA from 175.8 ± 134 µg/ml at baseline to 76.7 ± 57.4 and 40.1 ± 32.5 after 3 and 6 months respectively. Diltiazem reduced MIA from 122.2 ± 102.8 µg/ml to 67.2 ± 52.6 and 51.0 ± 37.6 at the end of 3 and 6 months respectively. The combination reduced MIA from 174.6 ± 106.4 µg/ml to 93.2 ± 67.2 and 46.1 ± 53.0. In normoalbuminuric patients, the reduction with the three treatment modalities from baseline was small. The three treatments reduced blood pressure without causing hypotension.
Conclusions: Candesartan, diltiazem, or the combination reduced albuminuria in diabetic patients with normo-, micro- or macroalbuminuria.

Background: In this study, the first attempt in Basrah city to isolate and diagnose H. pylori from endoscopic units and workers by culture method.
Objective: to isolate and identify H. pylori by culture method and conventional tests from possibly contaminated sources and workers in endoscopy units in five hospitals.
Materials and methods: A total of 78 swabs were collected endoscopic units in five hospitals in Basrah city in Iraq namely: Altaalemi, Al-mawani, Al-Basrah general, Al-Shifaa and Al-Fayhaa during the period from September 2011 to June 2012.
Results: A total of 78 swabs, of which 12(15.38%) isolates of H. pylori were isolated by culture method and identified by biochemical tests. The highest frequency of H. pylori was in Altaalemi 7(29.16%) followed by Al-Shifaa 3(25%) and then Al-mawani 2(14.2%) and zero for the rest. The frequency of positive H. pylori in 13 samples from mouth of staff, was 3(23.1%). It was statistically significant (P<0.05) using SPSS program. Of the total 10 samples from forceps, 2(20%) showed positive tests for H. pylori, the frequency of positive H. pylori in 3 samples from sponge, was 2(66.7%), of the total 8 samples from flexible shaft, 2(25%) showed positive tests for H. pylori, 6 specimens from flexible cord transmitting light, air and water, 1(16.7%) showed positive tests for H. pylori, 5 specimens from Petridis for mouth pieces and 5 specimens from opening for biopsy channel, 1(20%) showed positive tests for H. pylori, Of the total 10, 6, 5, 5 and 2 samples from mouth, tables surface, beds, sinks and Pail sterilization respectively, the frequency of H. pylori was (0%).
Conclusion: H. pylori can be isolated by culture method from endoscopic units and workers and disinfection technique for manual cleaning and disinfection of the instrument may not remove the risk of H. pylori transmission.

Background: The one stage surgery of open reduction and subtrochantric femoral osteotomy with or without pelvic osteotomy, has been an accepted method of treatment of congenital hip dislocation in older children. This approach obtains predictable reduction and results in a low rate of osteonecrosis despite the higher rate of operative and postoperative morbidity like prolonged anesthesia time, large incisions and more immediate postoperative complications. Two-stage surgery might, therefore, help in avoiding the above-cited disadvantages.
Aim of the study: Is to compare the results obtained by using either one-stage surgery by subtrochanteric or two-stage surgery by supracondylar femoral derotational osteotomies in the management of developmental dysplasia of the hip joint.
Patients and Methods: This is a randomized controlled trial involving children under the age of 2.5 years with developmental dysplasia of the hip and attending Basrah General Hospital between December 2010 till August 2012. Thorough clinical examination and laboratory investigations were done for all the patients and only 30 patients with 39 dislocated hips whom did not require femoral shortening and need >10-15 degrees of acetabular roof index correction using pelvic osteotomy were included in this study. Each patient was randomly allocated into one of the two surgical procedures; procedure A was one-stage surgery and procedure B was two-staged surgery. At the end of the study period, a total of 30 patients under the age of 2.5 years were recruited for this study, 16 patients underwent procedure A and another 14 underwent procedure B. The patients were followed-up for 12-18 months and evaluated clinically & radiologicaly depending on McKay and Severin’s clinical and radiological criteria respectively.
Results: Thirty patients with 39 dislocated hips were managed. Patients age ranged from 1.5 to 2.5 years; all of them were females having no associated skeletal anomaly. The outcome of one-stage surgery showed better clinical (78.9%) and radiological results (88.8%) in comparison to two-stage surgery which showed 45% clinical and 70% radiological results, however, the time of technical procedure and other morbidities for example; risk of infection (20%), preoperative blood transfusion (100%), respiratory distress (13.5%) were relatively greater in one-stage surgery.
Conclusion: The results of this study showed that one-stage operation resulted in better joint realignment, without increasing risk of avascular necrosis, and more hip joint physiological and anatomical remodeling affinities, despite of its prolonged time and more rate of immediate postoperative morbidity. While in the two-staged surgery, the clinical and radiological outcomes were less successful than those with one-stage operation, though immediate postoperative morbidities were less.

Objective: to study trends of multiple myeloma and plasmacytoma in Basrah as a model of Asian countries and compare the results with those of western records.
Methods: retrospective review of 102 cases of multiple myeloma and plasmacytoma of both sexes registered in Basrah through the years 1996-2010 regarding their demographic features the collected dated tabulated and analyzed.
Results: a total of 102 patient, 62 males and 40 females with a median age for males 56 years and for females 55 years multiple myeloma represented 92.2% of total cases while plasmacytoma represented 7.8%.
Conclusion:
-Incidence rate of multiple myeloma and plsmacytoma in eastern countries seems comparable to incidence rate in eastern countries but the incidence is low when compared to western statistics.
-Multiple myeloma and plasmacytoma showed no significant changes through the last 15 years.

Background: A study was performed on the presence of Granulated Metrial Gland (GMG) cells in mice uteri, similarly in human, the presence of human Decidual Granular Leukocytes (DGLs) in aborted placental samples was also studied.
Aim of the study: to demonstrate further evidence which may lead to the suggestion that the granulated metrial gland (GMG) cells are specialized immune cells which are involved in inhibition of the rejection reaction of the mother to her foetus as an allograft in pregnant mice uterus and it's relation to the decidual granular leukocytes (DGLs) in human pregnant mothers during early pregnancy.
Material and Method: Tissue samples of uterus were taken from mice on each of days (6, 10, 12, 14 and 16) of pregnancy, also human aborted placental tissue samples were taken at 2, 3 &5 months. All samples were prepared by using routine histological techniques.
Results: Granulated cells were found in small numbers randomly distributed through out the endometrium on day 6 of pregnancy with a subsequent loss from areas of the antimesometrial and lateral decidua but increase dramatically in number in the developing decidua basalis sharing an intimate association with fibroblast-like stromal cells. Regarding human aborted placental tissue samples, similar to GMG cells, human Decidual Granular Leukocytes (DGLs) are the dominant cell population in 2 months aged deciduas, while in 3 and 5 months aged placenta, the placenta appeared with reduced populations and distribution of DGLs, they looked unhealthy. The loss of (GMG) cells from the implantation sites is accounted for either by degeneration in situ or by migration via vascular channels to the blood vessels of maternal placenta which suggested that it could be of functional significance.
Conclusion: Our results indicate that DGLs probably protect the materno-foetal unit from other effects causing disorders to the placental development, and it may play a role in the pathogenesis of idiopathic repetitive abortion.

Objective: 1- Isolation and diagnosis of mites species in sheep. 2-To study the pathological changes in the skin. 3-To know the epidemiological distribution of Scabies in human.
Materials and Methods: Scrabing was collected from infected area of skin of sheep and human. These specimens were treated with 10% KOH to remove scales and hairs, and then fixed on slides for diagnosis. Biopsies were taken from infected skin for pathological study.
Results: Three species of mites were diagnosed on sheep, Sarcoptes scabiei, Psoroptes ovis and Chorioptes sarcoptes, with percents of infection 34.95%, 58.27%, 4.71% respectively. Gross pathological changes observed were, toughness, dryness, fissuring of the skin with white scales, while microscopical pathological changes revealed, hyperkeratosis, acanthosis, infiltration of chronic inflammatory cells (eosinophils, macrophages and lymphocytes) and oedema in the dermis. Age group of 11-30 years of age were highly affected (28.2%). Housewives were the highest percent among other occupation (29.1%).
Conclusions: Scabies is a big public health problem and should be looked after among sheep as well as human beings.