The Medical Journal of Basrah University

Background: This is a cancer registry- based study carried out in Basrah to analyze the pattern of gastrointestinal tract malignant diseases over a period of seven years (2005-2011 inclusive). The study is in line with the work of Basrah Cancer Research Group to quantify cancer in Basrah governorate.
Objectives: To describe the time trend, spatial distribution and histopathological types of gastrointestinal tract cancers in Basrah governorate over the years 2005-2011.
Methods: The data used in the study were based on all new malignant cases which were diagnosed, treated and registered in Basrah cancer registration units. A total of 1601 new cases could be identified. Of these 1123 cases were from the inhabitants of Basrah governorate. The rest were from other Iraqi governorates.
Results: Analysis of cases from Basrah indicated an overall annual incidence rate of gastrointestinal malignant diseases of 6.87 per 100000 population with very little variation with the passage of time from 2005 to 2011. Great variation in the district specific incidence rates was found with Basrah city centre and Shatt Al-Arab districts having the highest incidence rates (8.28 and 8.62 per 100000 population. Other districts have lower incidence rates: north of Basrah (5.59), West of Basrah (4.24) and south of Basrah (4.53). Histopathologically, four types represented 94.2% of total registered cases. Adenocarcinoma was the commonest cancer representing 71.8% followed by Squamous cell carcinoma (12.8%), Non-Hodgkins lymphoma (7.6%) and undifferentiated carcinoma (3.0%).
Conclusions: Gastrointestinal tract cancer represented one of the major cancer groups in Basrah and deserves more care regarding prevention, early detection and treatment and research.
Key words: Cancer, Basrah, Incidence, Time trend, place distribution

Background: The educational environment has a major impact on students' learning and educational activity hence it is important for evaluation and description. The objective of this study was to explore the quality of the educational environment in Basra College of Medicine.
Methods: The Arabic translation of the Dundee Ready Education Environment Measure (DREEM) was used to evaluate students' perception of the educational environment.
Results: The overall mean score was 93.57 and that for students' perceptions of learning 23.89, students' perceptions of teachers 16, students' academic self-perception 15.53, students' perception of atmosphere 20.5, and students' social self-perception 13.61. Gender was not statistically significant variable.
Conclusion: All results in every parameter of the educational environment inventory, whether total mean score or the five subscales, show presence of low values probably related to the traditional system of teaching which need consideration and solutions

Background: Human astrovirus are considered as a common cause of infantile gastroenteritis worldwide. The importance of astrovirus in the area is not well recognized.
Objectives: The study is designed to determine the frequency and importance of astrovirus in childhood gastroenteritis and to investigate the most affected age group, the predominant clinical symptoms associated with astrovirus infection.
Subjects and methods: A total of 400 stool specimens (200 from symptomatic and 200 from asymptomatic healthy children) were collected during 2011-2012 and the relevant informations were obtained on special questionnaire form. Astrovirus nucleic acid was extracted from stool specimens using a spin column technique according to the instruction given by QIAamp-Mini-Elute virus spin kit for purification of virus-RNA (Qiagen-Germany). Astrovirus was detected by reverse transcriptase-polymerase chain reaction (RT-PCR) using specific primers; Mono269-F and Mono270-R of human astrovirus.
Results: Astrovirus was detected in 2.6% of acute diarrheal cases, while asymptomatic control group were all negative for astrovirus. Age group analysis revealed that astrovirus infection was more frequent among children with age of 1- < 3 years (P < 0.05). Most of astrovirus cases were observed during winter months (January and February). The dominant clinical symptoms among astrovirus infected cases were vomiting (80%), fever (60%) and dehydration and abdominal pain was found in 40% for both respectively.
Conclusion: Astrovirus is frequent among children with acute diarrhea and should be taken in consideration as a causative agent in childhood gastroenteritis.

Objective: To assess the relationship between the serum concentrations of vitamins C & E and the severity of coronary artery disease.
Subjects and methods: In a case-control study, we evaluated 200 patients who underwent coronary angiography at AL-Basrah Cardiac Center at Al-Sader Teaching Hospital, Basra, Iraq. They were separated into two groups of case (patients with CAD) and control (non CAD). Four milliliters of blood samples were taken for measuring vitamin E and C. For statistical analyses, chi-square test, Student’s t-test, one-way ANOVA, and the logistic regression were used.
Results: In the present study, 94 participants with CAD in the case group and 106 participants free of CAD in the control group were included in the analysis. At baseline, there were significant differences in serum vitamin C ,vitamin E and some cardiovascular risk factors(diabetes, hypertension and smoking habits) between the two groups (P < 0.05). Moreover, when other risk factors of CVD were included in the model, serum vitamin C (Odd Ratio (OR = 0.8, 95% CI= 0.68-0.92, P = 0.0001) and serum Vitamin E (OR = 0.66, 95% CI = 0.578-0.754, P = 0.0001) were associated with CAD. There were a significant (P < 0.05) statistical changes in the vitamin C and E among the three sub groups of CAD patients being more deficient as the disease become more severe.
Conclusions: Low serum vitamin C and E concentrations were associated with CAD and related to its severity

Objective: To assess the relationship between the serum concentrations of vitamins C & E and the severity of coronary artery disease.
Subjects and methods: In a case-control study, we evaluated 200 patients who underwent coronary angiography at AL-Basrah Cardiac Center at Al-Sader Teaching Hospital, Basra, Iraq. They were separated into two groups of case (patients with CAD) and control (non CAD). Four milliliters of blood samples were taken for measuring vitamin E and C. For statistical analyses, chi-square test, Student’s t-test, one-way ANOVA, and the logistic regression were used.
Results: In the present study, 94 participants with CAD in the case group and 106 participants free of CAD in the control group were included in the analysis. At baseline, there were significant differences in serum vitamin C ,vitamin E and some cardiovascular risk factors(diabetes, hypertension and smoking habits) between the two groups (P < 0.05). Moreover, when other risk factors of CVD were included in the model, serum vitamin C (Odd Ratio (OR = 0.8, 95% CI= 0.68-0.92, P = 0.0001) and serum Vitamin E (OR = 0.66, 95% CI = 0.578-0.754, P = 0.0001) were associated with CAD. There were a significant (P < 0.05) statistical changes in the vitamin C and E among the three sub groups of CAD patients being more deficient as the disease become more severe.
Conclusions: Low serum vitamin C and E concentrations were associated with CAD and related to its severity.

Background: Diabetes mellitus (DM) is among the most common chronic diseases in the world, affecting about 180 million people in 2008, and the number is expected to be doubled by 2030 There are as many as 12.5 million diabetic patients with silent coronary artery disease.
Aim: The aim of this study was to assess the incidence and extent of coronary artery disease among diabetic patients with occult CHD.
Methods: A comparative study of asymptomatic diabetic patients and control group for evidence of CAD was conducted over the period from May 2012 to November 2013. The studied population includes a total of 82 diabetic patients and 82 healthy persons as a control group. Both diabetic and control groups underwent exercise stress test by treadmill, and coronary angiography was done to patients with positive test.
Results: There was highly significant association (P<0.01) between CAD and positive exercise stress test in diabetic group but no association in control group, CAD was present in 50% (8/16) of patients with DM and positive exercise stress test whereas in control group no one of them had CAD (0/6).
Conclusions: The study show that there is highly significant association between diabetes milletus and coronary artery disease in asymptomatic diabetic patients.

Background: Exercise is commonly used as a physiological test to determine cardiovascular disorders not appearing at rest and to assess the functional status of the heart. It is a widely used non-invasive test for assessment of suspicious or proved cardiovascular disorders. It is mainly performed to clarify the prognosis and to assess the functional capacity, the possibility and severity of coronary artery disease (CAD), and the efficacy of treatment. Coronary angiograprhy is the standard method for diagnosis of coronary artery disease (CAD), and it determins the type of therapy according to severity of coronary involvement wether by medical therapy, percutanous coronary intervention (PCI), or coronary artery bypass grafting (CABG) surgery in patients with CAD.
Aim: To estimate the sensitivity, specificity, positive and negative predictive values and accuracy of exercise treadmill test in diagnosis of coronary artery disease.
Methods: Exercise treadmill test and coronary angiography were performed on 77 consecutive patients (men and women), age range between 30-70 years, they were evaluated at Basrah Cardiac Center (February-June-2012). Both examinations were performed primarily for diagnostic reasons. All clinical data and results of ECG and exercise treadmill test were collected before coronary angiography.
Results: The total number of patients included in the study was 77; mean age was 56.9 ± 8.9 years. The mean age for men was 57.0 ± 8.7 years (n= 53), women had a mean age of 56.0 ± 9.5 years (n=24), 90.9% of patients had CAD risk factors. Hypertension was the frequent risk factor present in 72% of patients. Exercise test was positive in 75.3%, negative in 20.8%, pseudonormalization in 3.9%. The sensitivity and positive predictive value of the test were 88% and 79% respectively, while its specificity, negative predictive value and accuracy were 46%, 63% and 75% respectively.
Conclusion: Exercise test is a relatively safe, non- invasive and valuable test in the diagnosis of CAD in patients with signs and symptoms of this disease, but still considered below the coronary angiography (which is the gold standard method) for the diagnosis of CAD. The sensitivity of the test increases as the number of diseased coronary arteries increases as in left main and three vessel diseases. ST depression in women with abnormal resting ECGs is probably of less diagnostic value than in men, false positive and false negative tests were more common in women than men

ackground: Cardiac thrombus can occur whenever a local pathology favoring stasis of blood within cardiac chambers, however despite extensive clinical studies there is no general agreement as to the best management modality.
Method: We study the outcome of six cases of insitu cardiac thrombus by different treatment methods as surgery, low molecular heparin, or maintained on long period of warfarin
Result: The best result achieved with surgery in cases of cardiac thrombosis with adequate ventricular function, although in the setting of comorbidity, less invasive therapies as with long term treatment with warfarin or heparin therapies is an alternative safe therapeutic approach.
Conclusion: Treatment has to be individualized whether surgery or medical therapy, since many factors contribute to the outcome like ventricular function, treatable or untreatable underlying cause.