The Medical Journal of Basrah University

Introduction and Background: In Iraq, and due to the decades of wars and sunctions that affected people’s accessibility to the health care services, maternal death was among the main health problems over the years. Thus, studying the factors influencing this important problem is a mandatory step for a better evidence based intervention in controlling the problem. Objective: To analyze the socio-demographic factors that influence maternal deaths in Basrah during the period 2013-2017.Methodology design: The study is an observational retrospective one included information collected from the medical records, death certificate and forensic medicine reports in addition to interviewing the family as needed. A total of 201 deaths were included in the study. Results: The study shows that maternal death rate in Basrah increased sharply during 2016 compared to that of 2013 with a highest rate in Shat Al-Arab and Al-Mudiana districts. Then, a sharp decrease was noticed in 2017 compared to 2016. Maternal mortality rates were found to be increasing with increasing women’s age with the highest rate among women above 40 years old. But no big difference between maternal death rates in urban and rural areas. (88.1%) of the study women died in hospital while 11.9% of them died outside the hospital Conclusions and recommendations: Maternal death is still a problem in Basrah in spite of the decline that occurred between (2016-2017) compared to the rates in 2013. Strengthening of maternal mortality monitoring system across all districts of Basrah governorate in addition to improving the quality of registering all pregnancy related information are the main recommendations of the study.

Objective: This study was performed to evaluate the effect of laparoscopic ovarian drilling on the serum levels of anti-Müllerian hormone(AMH), Follicle Stimulating hormone(FSH), Lutenizing hormone(LH) and testosterone hormones, in patients with PCOS. Methods: A prospective observational study carried out on 50 patients with PCOS who underwent LOD, as a treatment for anovulatory infertility between June 2015 and June 2016. This study was conducted in AL Basrah Hospital for maternity and children. We assessed the serum levels of anti-Müllerian hormone(AMH), Follicle Stimulating hormone(FSH), Lutenizing hormone(LH) and testosterone hormone (test.) one month before laparoscopic surgery, one day after and 3 months after the surgery. Results: Among 50 patients (2 patients were lost from follow up and they were excluded from the study), 31(64.6%) started to menstruate regularly and 26 (54.2%) ovulated spontaneously and 9(18.8%) of them conceive spontaneously after LOD within 3 months of doing the operation. The serum levels of hormons, before, one day after and 3 months after surgery, for AMH were 8.9 ± 3.5 ng/ml, 7.3 ± 2.9 ng/ml and 7.4 ± 2.1 ng/ml, (P value =0,000), respectively. For the FSH were 5.2 ± 1.8 IU/L, 6.5 ± 2.0 IU/L and 7.1 ± 1.9 IU/L, (p value = 0.000), respectively. For the LH were 10.2 ± 21 IU/L, 10.7 ± 4.5 IU/L and 7.2 ± 2.2 IU/L, (p value=0.000), respectively. For the testosterone levels were 1.16 ± 0.7 ng/ml, 0.44 ± 0.2 ng/ml and 0.34 ± 0.1ng/ml, (P value= 0.000), respectively. Conclusion: LOD operation is an effective treatment for infertile PCOS patient who are not responding to medical treatment (clomiphene citrate and gonadotrophine resistant cases or cases who can't offer the gonadotrophines). If it is done properly it will not affect the ovarian reserve. The resultant hormonal changes after the operation (decrease LH and testosterone) infavoure the continuation of pregnancy and lower the miscarriage rate. In our locality it represents a cost-effective and offered able alternative to medical treatment of PCOS.

Background: The hand hygiene plays an essential role in prevention as well as curing the nosocomial infectious disease. Physicians, nurses and laboratory persons are the major health care workers communicating with patients, could become the transporter in the cycle of infectious diseases. Objective: To evaluate the knowledge and practice of health care workers for hand hygiene in hospital wards and study the predisposing factors effecting the hand hygiene.Methods: A cross-sectional study carried out on doctors, nurses and laboratory men who worked in Al-Mawane Teaching Hospital in Basrah (Iraq). Questionnaire of hand hygiene for data collection was applied.Results: 401 health care workers were studied, The results showed moderate level of hand hygiene for doctors, nurses and laboratory persons (average score 3.97 + 0.6). Nurses had the highest level of hand hygiene. Perfect hand washing was found in 62%, compared with 56% for laboratory staff and 29% for physicians. Gender was insignificant in the practice of hand hygiene, while age, level of education, duration of service, training courses and vaccination against type B hepatitis had statistically significant impact on hand hygiene.Conclusion: The control of infection in hospitals goes through the care of hand hygiene in health workers, which need more attention. The current study revealed somewhat unacceptable level of knowledge and care of the cleanliness of the hands of doctors, nurses and laboratory persons. The need to develop the level of knowledge and practice by training programs and continuing medical education

Background: Aims of this study was to determine the benefit of cisplatin and i.v etoposide combination in treatment of advanced breast cancer (ABC) patients who were pretreated with anthracyclines, as an alternative to the newer, more expensive, and unavailable anticancer drugs like Taxanes, carboplatin, and gemcitabine.Patients and methods: The study was performed in the period from March 2010 to June 2016, 235 patients were given cisplatin 50mg/m2 and etoposide 100mg /m2 for 6 cycles. The patients were divided into 4 groups according to the site of metastasis (vertebral metastases, liver metastases, loco-regional metastases, and pleuro-pulmonary metastases).Results: Evaluation of treatment was considered on two levels: Whole 235 patient level, and patient-group level. On whole patient level: Response to Treatment was 65.1%, which is higher than similar responses in many other studies. While on patient-group level: response to treatment was highest in patients with vertebral secondaries 75.3%. There was drug toxicity in all groups of patients. Some patients did not continue the treatment protocol because of bad performance status, toxicity and death. Conclusion: In comparison with other regimes of chemotherapy cisplatin and i.v etoposide are still useful anticancer drugs in the management of advanced breast cancer.

Background: Enteric Adenovirus are second to rotavirus as viral cause of acute gastroenteritis in infants and young children. Aims of the study: This study aimed on determination of the incidence of enteric adenovirus-associated gastroenteritis in infants and young children below five years of age, and to detect the season and age related distribution of enteric adenovirus infections as well as the major clinical symptoms associated with these virus infections.Objective: A total of 400 stool specimens (200 symptomatic diarrheal cases and 200 asymptomatic normal children) were collected during the period from March 2011-March 2012. All relevant informations were obtained on special questionnaire form. Viral genomic DNA was extracted from stool specimens by using a spin column technique according to the instructions given by QIAamp-MinElute virus spin kit for purification of virus genome (Qiagen, Germany). Results: Enteric adenovirus was detected by the use of specific primers. Enteric Adenovirus was detected in 3% of diarrheal cases in hospitalized children whereas all healthy children were negative for enteric adenovirus. Age group analysis revealed that children at age groups of 9-11 and 12-17 months were more affected. The monthly distribution of enteric adenovirus cases showed to be confined to a period of 4 months (August through November). The clinical symptoms associated with adenovirus gastroenteritis was dehydration (80%), vomiting (60%) and fever (60%) while abdominal pain was not recorded.Conclusion: Enteric adenovirus is common enteric pathogens as that for rotavirus in our community.

Background: achalasia cardia is a motor disorder that result from absence of esophageal peristalsis combined with loss of relaxation of lower esophageal sphincter. Aims: To analyze the safety of laparoscopic Heller's myotomy with particular regard to the technical difficulties encountered, complications, the learning curve and outcome.Patients and methods: This study was done at Al - Sader Teaching Hospital, Basrah - Iraq in the period from February 2013 to June 2016. Thirty-two patients were included in the study of both gender and of different ages who were subjected to laparoscopic Heller's myotomy for achlasia cardia. They were observed regarding the development of operative and early post-operative complications, improvement of their symptoms, development of late post-operative complications and recurrence rate. Results: All patients underwent laparoscopic Heller's myotomy with Dor fundoplication except one patient had Toupet fundoplication. The mean operative time was 87 minutes and the median hospital stay was four days. Intra- operative complications include mucosal perforation in 3 patients, vagus nerve injury in 3 patients, and pleural perforation in 2 patients. Post-operative complications include atelectasis in 3 patients, pneumonia in 1 patient, GERD in 1 patient, post-operative leak in one patient and mortality in one patient. All patients improved regarding dysphagia (100%) and weight gain achieved in (91.3%), chest pain improved in (59%) and regurgitation improved in (84.6%) of the patients.Conclusion: Laparoscopic Heller's myotomy is safe and effective method for treatment of achalasia cardia.