The Medical Journal of Basrah University

Background: Communication skills have no clear curriculum in most Iraqi medical colleges. This shortcoming of education is reflected on doctor centered approach practice.Objectives: To identify challenges facing the introduction of communication skills into medical education.Methods: A questionnaire-based study was conducted to explore the opinion of healthcare professionals regarding challenges facing the introduction of communication skills in their institutions. Results: One hundred forty-four participants responded. The frequency of challenges related to medical practice, education, and patients was 36%, 44%, and 20% respectively. Forty-four participants (30.5%) mentioned that challenges related to the medical colleges’ adoption of the traditional subject-based curriculum, and biomedical approach, with nearly the same frequency of the participants, related challenges to the lack of a clearly defined curriculum, and (23%) due to scarcity of human, financial, and logistical resources. Medical practice-related challenges include doctor-centred approach and neglect of patients' psychosocial aspects in the frequency of 44% and 28% respectively. Twelve respondents (8%) believe that doctors’ use of medical jargon hinders the patient's contribution to the medical interview.Low health literacy, language, and cultural metaphors constituted 71%, and 15% respectively. There is no significant statistical difference in challenges in relation to specialty, workplace, sex, and years of practice.Conclusion: Multiple levels of challenges need systematic review in educational curricula, medical practice, and social determinants.

Primary superficial Ewing sarcoma (PSES) is an extremely uncommon tumor. Although Ewing sarcoma (ES) is primarily a bone tumor, it can sporadically affect the deep subcutaneous tissue or muscles, and it rarely occurs as a primary skin cancer. In contrast to bone or deep-seated Ewing sarcoma, superficial Ewing's sarcoma appears to have a better prognosis and rarely metastasizes. We report the case of a 21-year-old female who presented with a 1- year history of progressive enlarged right anterior thigh mass. The tumor was excised as a mass measuring 9×7×5 cm with a lymph node of 2×2 cm in size and sent for histopathology. Histopathological and immunohistochemical studies confirmed the diagnosis of PSES with lymph node metastasis, and the patient is now on treatment.

Background and objective: Metabolic acidosis is a common metabolic complication of chronic kidney disease with different frequencies across stages of CKD. The objective of the study was to estimate the prevalence and study predictors for development of severe metabolic acidosis in CKD stage 3-5.Methods: It was a cross-sectional study of patients aged > 18 years with metabolic acidosis and stage 3-5 CKD for 1 year at two medical centers in Iraq. The prevalence of severe metabolic acidosis and correlation with patients’ characteristics were studied using Fisher exact test for categorical variables and nonparametric independent samples Mann-Whitney UT test. Predictors for severe metabolic acidosis was analyzed using multiple logistic regression. Results: Among 117 patients with CKD stage 3-5 and metabolic acidosis, severe metabolic acidosis was reported in 14.5%. It was more frequent in stage 5 CKD compared to stage 4 CKD (64.7% vs 35.3%). Correlation of severe metabolic acidosis was statistically significant with urinary tract obstruction, glomerular diseases, reduced cortical thickness on ultrasonography, anemia, hyperkalemia, hypocalcemia and hyperphosphatemia. By multivariate analysis, female sex, urinary tract obstruction and glomerular diseases were predictors for development of severe metabolic acidosis. Conclusion: Severe metabolic acidosis was common in stage 5 CKD. Female sex, urinary tract obstruction and glomerular diseases were predictors for development of severe metabolic acidosis.

Background: Dilated cardiomyopathy (DCMP) is one of the disabling diseases all over the world including Iraq, and especially Basrah. It affects different age groups and both sexes.Aim: to see the effect of optimization of heart rate on left ventricular ejection fraction and average global longitudinal strain.Methodology and the Results: 33 patients with dilated cardiomyopathy (DCMP) are enrolled in this study from February 2019 to May 2021, their mean age was 39.6 year, 51.52% were male and female constitute 48.48%, the mean heart rate of those patients at the first visits was 102 beat per minute, the mean of their left ventricular ejection fraction (LVEF) at that time was 31%and the mean of their average global longitudinal (GLS) was -7%. That patient was treated by antifailure treatment with optimization of their heart rate, after 2 months of treatment their mean heart rate was significantly decrease to 76 BPM (P value < 0.001), however in spite of improvement in the functional capacity there was no significant correlation between the optimization of the heart rate and the LVEF (P value 0.317), on the other hand there was significant correlation in the average GLS after optimization of the heart rate (P value <0.006). Conclusion: optimization of the heart rate associated with improvement in the functional capacity and GLS. GLS estimation is better than LVEF estimation in the assessment of LV function.

Objective: To clarify the relationships between Serum uric acid with inflammatory laboratory markers and Ankylosing Spondylitis Disease Activity Score (ASDAS-ESR) in patients with ankylosing spondylitis. Method: A total of 73 ankylosing spondylitis patients with age ≥ 16 years with AS fulfilling ASAS criteria were included in a cross-sectional study. The laboratory measures included values of uric acid, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) obtained. Disease activity is calculated by Ankylosing Spondylitis Disease Activity Score (ASDAS-ESR). Demographic and laboratory investigations were recorded.Results: The mean age of the studied sample was 35.04 ± 7.99 years with a range of (17-52 years) & the mean Body Mass Index was 27.91 ± 5.78 with a range (18-46).The majority of them were married (80.8%), working (94.5%), and non-smokers (52.1%) and (94.5%) on biological therapy. Comparing serum uric acid with ESR value revealed no statically significant association (P = 0.47). Again, this is observed when comparing serum uric acid with CRP Value (P = 0.27).Finally, there was no association between Serum uric acid with any level of disease activity measured through ASDAS-ESR score (P = 0.52). Conclusion: The study concludes that there is no association between Serum uric acid and the routine inflammatory markers and Ankylosing Spondylitis disease activity score (ASDAS-ESR).

Background: Pregnancy is a natural condition that can predispose to several physiological and psychological changes in the anticipated mothers. However normal pregnancy may face the risk of sudden, unexpected complications that may end up in death or harm to the mother or her unborn child. Objectives: To assess the knowledge of pregnancy danger signs among pregnant women attending antenatal care services in Basrah city and factors affecting such knowledge. Method: The present study is a cross-sectional study carried out in four primary health care centres in Basrah city to assess the knowledge of pregnant women attending ANC services about the danger signs of pregnancy and to identify the main factors affecting their knowledge. The study involves 385 pregnant women aged 15 years and older attending the selected primary health care centres during the study period. A special questionnaire form was designed for the purpose of the study to collect the relevant data. Results: Majority of the women had heard about pregnancy danger signs (53.2%), approximately half of them had obtained this information from a health-care provider with a considerable percentage of women who thought that it is important to know such information (86%). The knowledge level was poor in (45%) of women with a nearly similar percentage (44%) who exhibited good knowledge toward these signs. The most commonly recognized danger sign was vaginal bleeding followed by severe abdominal pain and reduced or absent fetal movement. Severe headache, weakness, swollen hands, face and feet and high-grade fever were mentioned by (32.7%, 31.9%, 17.9% and 7.5%) of women, respectively. Conclusion, knowledge level was poor in (45%) of women. However, a nearly similar percentage (44%) had a good knowledge about these signs. Most commonly recognized danger sign was vaginal bleeding followed by severe abdominal pain and reduced or absent fetal movement.

Background: Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit that usually affects adolescents. Multiple factors have been implicated in the pathogenesis of acne vulgaris, and there is an increasing interest in studying the effect of obesity and body mass index (BMI) on the development of acne vulgaris.Objectives: This study aims to assess the association between body mass index and the occurrence of acne vulgaris in addition to the correlation between BMI and acne severity.Methods: A case-control study was conducted in the dermatology outpatient clinic of Al-Fayhaa Teaching Hospital in Basrah city. Body mass index was measured for 201 acne vulgaris patients who were age- and gender-matched with 203 controls.Results: the current study found that the percentage of overweight and obesity was higher among acne vulgaris patients (26.86% and 8.45%, respectively) than controls (15.76% and 1.48%, respectively), particularly among pre-adolescent females (P-value = 0.001). The higher BMI was significantly associated with severe acne, and there was a significant positive correlation between BMI and the global acne severity score (r = 0.830, P-value = 0.001).Conclusion: Increasing BMI is associated with an increase in the occurrence and severity of acne vulgaris.

Background: Guillain-Barré syndrome (GBS) is an immune-mediated peripheral nerve disease. Its frequency was noticed to have increased during the COVID-19 period. Based on electrophysiological studies, the most common type of this disease is the demyelinating type. However, axonal types have also been seen. Methods: A large, analytical, cross-sectional study involving 2523 patients over a one-year period was conducted in Basrah, southern Iraq, to evaluate the neurophysiological changes for peripheral neuropathies following COVID-19 infection using nerve conduction studies and needle electromyography. The current study aims to evaluate the prevalence, clinical, and neurophysiological characteristics of patients with axonal variants of GBS. Results and conclusions: The study found that the axonal variants of GBS represent about 10% of the total reported GBS in the governorate, and they are developed in about 1 in 1000 patients attending the neurology and neurophysiology clinics who had a history of COVID-19

Background: although the glycosylated hemoglobin (HbA1c) test is a valid test for diabetes diagnosis and evaluation of glycemic control, many factors are known to affect the results of the HbA1c test and make it reflects a false image of the glycemic control. One of these factors is hypertriglyceridemia.Objectives: the study aims to assess the impact of severe hypertriglyceridemia (TG ≥ 1000 mg/dl) on HbA1c test results in type 2 diabetes mellitus.Method: a retrospective study on two groups of adult patients with type 2 DM; were implemented in Faiha Diabetes, Endocrine and Metabolism Centre (FDEMC) in Basrah–Iraq. A total of 267 patients with type 2 DM and severe hypertriglyceridemia and a total of 313 patients with type 2 DM and normal triglycerides levels were included. Then the mean HbA1c of the patients with severe hypertriglyceridemia was measured in each FBS range and compared to the mean HbA1c of the patients with normal triglycerides levels in the same FBS range to determine the impact of severe hypertriglyceridemia on the readings of HbA1c in the diabetic patients.Results: the mean HbA1c in both groups was compared in each FBS range and revealed that despite of recording nearly the same mean FBS, HbA1c was higher in patients with severe hypertriglyceridemia by 1.33% in the FBS range 130-149 mg/dl with a statistically significant p-value = 0.003. While it was lower in the FBS range 200-229 mg/dl, 230-259 mg/dl, 260-299 mg/dl, 300-349 mg/dl and 350-399 mg/dl by 1.02%, 0.85%, 1.77%, 2.29% and 2.23%, respectively with a statistically significant p-value that equal to 0.005, 0.034, < 0.001, < 0.001 and 0.039, respectively. Conclusion: this study reveal that severe hypertriglyceridemia has a significant impact on HbA1c test results. The HbA1c values in diabetic patients with severe hypertriglyceridemia are unpredictable

Background: Conduction defect is one of the causes for increase morbidity and mortality among cardiac patients and a predictor of poor prognosis that affect survival and increase mortality rate.Objectives: To study the relationship between angiographic severity and extent of coronary artery in patients with coronary artery disease and conduction defect on resting electrocardiography.Patients and methods: A total of 127 patients participated in this study, (83) males and (44) females of mean age (60.7 ± 10.5 years) presented with chest pain (74%) or shortness of breath (26%) admitted to the coronary care unit at Alsader -teaching hospital and cardiac center at Basrah oil hospital between the period from February 2019-october 2020. Medical history was recorded for comorbidities and cardiovascular risk factors. Electrocardiography was taken for each patient at rest and categorized into LBBB, RBBB, AV Block according to standard ECG criteria. Echocardiography was performed for each patient to assess LV function. All the patients underwent coronary angiography and assessed visually by at least two cardiologists and evaluated using Gensini score calculated for each patient to assess extent and severity of CAD.Results: Patients with conduction defect have a high Gensini score which indicates severe CAD in RBBB more than LBBB patients and significantly higher in three vessels disease, this study showed more extensive CAD and significant correlation among patients with diabetes and hypertension, on other hand; Gensini score was not related to the echocardiographic finding of LV systolic dysfunction.Conclusion: Conduction defect correlates with severe CAD as assessed by coronary angiography especially among hypertensive and diabetic patients.

Background: diastolic dysfunction is an important contributor to left ventricular dysfunction and should be looked for in the assessment of our patients as it could be the cause for heart failure named as heart failure with preserved ejection fraction.Aim: assessment of diastolic function indices in patients attending Cardiology clinic with different presentations and risk factors for heart failure.Patients and methods: this are a retrospective cross-sectional study, carried out in outpatient cardiology clinic in Al- Nasiriya, from November 2021 to September 2022. Patients attending the clinic with presentation & risk factors suggestive of heart failure were fully evaluated by consultant cardiologist using transthoracic echocardiography with detailed assessment of cardiac function indices including left ventricular ejection fraction, transmittal inflow velocities, trans tricuspid regurgitation velocities & tissue Doppler evaluation for medial + lateral mitral annulus velocities. For those with increased E/e-: LA size & volume / or TR velocity > 2.8 cm2 were recorded when applicable to categorize the degree of diastolic dysfunction. Results: participants were 186 patients; mean age was 56.2 ± 12.2. Those with diastolic dysfunction (DD) were (42.4%), while those without DD were (57.5%). Diastolic dysfunction was significantly more in patients with hypertension (57.6%). And in those with regional wall motion abnormality (70%). Conclusion: diastolic dysfunction is more prevalent with increase age & hypertension yet most of the time is only a grade I (just impaired relaxation). Measurement of diastolic dysfunction via transmitral flow pulse wave Doppler and tissue Doppler imaging of mitral annulus velocities is easy to be performed, adding more information to 2D echocardiography