The Medical Journal of Basrah University

Background: Job satisfaction is a reflection of interaction of the physicians and all the components of the surrounding environments. A high level of satisfaction is desirable and may contribute to better workers performance.Objectives: To explore the degree of satisfaction of family physicians in Basrah with their jobs. Methods: A cross-sectional study targeting all family physicians who were working in Basrah at the time of the study (2018) was carried out. A total of 67 out of 74 physicians were successfully interviewed according to a special questionnaire form that was prepared in the light of selected readings and guided by the researchers view on areas of interest. The data collection phase lasted for four months (April-August 2018). Results: A good proportion (43.3%) of family physicians in Basrah were posted in places other than family medicine practice. The majority were young, females, and reasonably lived close to their work sites. Family physicians were very satisfied with the supervisors (95.5%), colleagues (97.0%) and clients (86.6%). They were also satisfied with their competence in handling their daily tasks and fairly satisfied with their postgraduate training and in-services training. They were very unsatisfied with their income, their work conditions in terms of amenities and staffing, with respect to specialty under two thirds (61.2%) expressed their satisfaction with their status as family physicians but 38.8% were not satisfied and this was reflected on their desire to quit to other specialty (55.2%). A big problem is the perception that the specialty is not respected by the public (85.1%), not respected by other clinical specialties (95.5%), not supported by mass media (95.5%), and the specialty is not optimally utilized (79.1%). However, 67.2% reported that the specialty improved care delivery at primary health care centres. Conclusions: Mostly family physicians were happy with competence required to handle tasks. Except for the overall work environment, participants denied to have adequate amenities. Most positive points were related to humanities. Most of negative points were related to income, recognition and amenities. They expressed negative views on all aspects of salary valuation and most of them wanted to change specialty.

Objective: To determine the beneficial effect of bariatric surgery on the treatment of type 2 diabetes mellitus in obese patients.Patients and methods: This prospective study was conducted in Al-Sader teaching hospital and Al-Musawi privet hospital from August 2013 to August 2017 on 332 patients with body mass index between 35-55, their age was range from 30-60 years, and they were 185 (55.7%) females and 147 (44.3%) males. All patients in this study were diabetic type 2 with different stages of the disease, types of medications, C peptide levels, HbA1c and BMI. They were subjected to three different bariatric procedures; laparoscopic sleeve gastrectomy (LSG), mini gastric bypass (MGB), and laparoscopic Roux-en-Y gastric bypass (LRYGB), they were followed for a period of 1-4 years regarding their glycemic control, HbA1c, type and number of medications.Results: Three hundred and thirty two patients were included in this study, 111 patients (33.5%) had MGB, 88 patients (26.5%) had LRYGB, 133 patients (40%) had LSG according to the following selection criteria; duration and severity of DM, C peptide, other comorbidities and the patients preference Resolution of DM was achieved in 100 patient (90%) of MGB, 77 patient (87%) of LRYGB and 75 patient (57%) of LSG while other patients had no improvement. Conclusion: Bariatric surgery for obese diabetic patients resulted in complete resolution in most patients, improvement of diabetes in some and overall improvement in the quality of life in all patients.

Background: Obesity is a big health problem due to its related diseases, so laparoscopic sleeve gastrectomy is one of the bariatric surgeries which have a role in the weight reduction, but it affects the micronutrients concentrations including vitamins D and B12.Aims: To assess concentrations of vitamins D and B12 prior to laparoscopic sleeve gastrectomy and post-surgery in first, third, sixth and twelve months after the surgery by taking blood samples in this scheduled follow up visits.Patients and Methods: This study was carried out in department of surgery at Al-Sadr Teaching Hospital in Basrah, Iraq from June 2016 to June 2017.It include 82 patients from both gender and from different age groups. Detection of Vitamins D and B12 deficiency pre and postoperative periods, in every follow up visits were by taking a samples of blood and statistical calculation of vitamins values.Results: There were no significant differences related to the age groups but there were a significant reduction of both vitamins in relation to sex and time (pre and postoperatively). The deficiency of vitamin D before surgery mean (35.18) which decreased then increased reaching (37.46) in the end of first year post surgery which was a significant P value 0.045, while the deficiency of vitamin B12 prior to surgery which was 51.90 then after surgery decreased then increased reaching 51.58 by the end of first year post surgery which was non-significant P-value 0.490 (P value < 0.05 significant).Conclusions: This study determined the presence of deficiencies of both vitamins D and B12 before and after laparoscopic sleeve gastrectomy during first year post surgery, so it is recommended for giving vitamin D prior to surgery, while vitamin B12 was not given.

Background: Patient satisfaction is defined as the total judgments made by the recipient of a healthcare as to whether -or not- their expectations have been met. It is an important measure of healthcare quality as it offers information on the provider’s success to meet the clients’ expectations.The Study Objectives: The study aimed at measuring patient's satisfaction in primary health centers of Basrah governorate with a comparison between primary health centers that follow family medicine strategy versus general primary health centers.Methodology: It's a cross sectional study involved patients attended primary health care centers in Basrah governorate during June 2016.Standard check lists and questionnaires from Iraqi Ministry of Health were used to measure five main indicators of patient satisfaction including: appearance, credibility, responsiveness, security and empathy with a four likert scale to measure the satisfaction of patient. A total sample included 456 patients. Results: The lowest Cronbach's coefficient alpha value was found by the study to be in the "general appearance" dimension which included the general infrastructural appearance of the health facility with appropriate waiting areas for the attendees, cleanliness and lighting of the facility in addition to the general look and appearance of the health workers and service providers. While “assurance” dimensions shows the highest percentage of satisfaction. In addition, no significant difference was revealed for the chosen satisfactory dimensions between the health care centers providing family-medicine services compared to those with no family-medicine ones.Conclusions: The study remarks important weaknesses in some of the patient satisfactory dimensions including general appearance, responsiveness, apathy and assurance. However, it provides an evidence of having no significant difference for the chosen satisfactory dimensions between the health care centers providing family-medicine services compared to those with no family-medicine ones.

Introduction: Nutrition is vital for the maintenance of health and prevention of disease. The burden of nutrition-related chronic diseases (such as CVD, cancer, diabetes and osteoporosis) and obesity is increasing rapidly world-wide. Nutritional knowledge may play a pivotal role in the adoption of healthier food habits but it must be noted that knowledge on its own cannot bring about the desired changes due to the complex nature of food behavior.OBJECTIVE: It was to assess dietary habits and nutritional knowledge of the high health institute female students in Basrah and the relationship between nutritional knowledge and socio-demographic factors.Methods: Seventy eight female students of the high health institute were administered a special questionnaire form regarding their dietary habits and nutritional knowledge.Results: The majority of the students 82.1% were in the age group < 24 years old. The mean body mass index (BMI) was (23.56 kg/m²) however twenty three students were classified as overweight. Academic study was the main source of information for 56.4% of the students. The mean survey scores were 70.78% for dietary habits and 73.32% for nutritional knowledge. No statistical significant association was found between dietary habits and nutritional knowledge. A significant association was found between the students’ BMI and their nutritional knowledge level (p<0.05). The level of knowledge consistently decreased with the increase in BMI. Much like habits and knowledge, none of the other association between other variables (age, place of residence, paternal education level) showed any statistical significance.Conclusions: Important point observed in the present study was that though the students had good level of nutritional knowledge and dietary habits, the association between them was not statistically significant. It may be suggested that the adequate nutritional knowledge observed may not have translated into the appropriate dietary habits in the students

Background: Dental caries and decay caused by Streptococcus mutans. Sucrose, stimulates S. mutans to yield insoluble glucans to form oral biofilm also called dental plaque to start process of caries. The GtfB and LuxS genes of S. mutans are responsible for development and evolution of biofilm. Lactobacillus plantarum as probiotic can affect the biofilm formation of S. mutans.Aim of the study: To evaluate the effect of Lactobacillus plantarum against S. mutans biofilm formation.Results: Growing biofilm in the presence of sucrose was detected using 100 well microtiter plate crystal violet assay and biofilm formation by S. mutans in the presence of Lactobacillus was detected. Gene expression of biofilm forming genes (GtfB and LuxS) was quantified through Real- time PCR. The transcriptional levels of GtfB and LuxS genes were remarkably down regulated 9.43 -and 4.24- fold change, respectively, when treated with lactobacillus plantarum in comparison with the control group.Conclusions: Lactobacillus plantarum as probiotics can be used effectively to reduce the chance of dental caries by decreasing the effects of S. mutans and their gene expression to conserve good oral health

Background: Pregnancy induced hypertension including pre-eclampsia are global public health concern both in developed & developing countries. They have significant prenatal, neonatal & maternal morbidity & mortality.Objectives: The aim of this prospective comparative study is to identify & compare the maternal & neonatal outcome of pre-eclampsia in between multigravida & primigravida.Patients:- This study had been done over period of one year (1st Sep.2017-31st Aug. 2018) in Basrah Maternity & Child Hospital in which (110) multigravida with pre-eclampsia were compared to (108) primigravida with pre-eclampsia. Both groups were admitted to labor room during same period of study with spontaneous labor or for induction of labor.Results:- Multigravida with pre-eclampsia were found to have significantly more advanced age more than thirty years (58%) as well as higher body mass index with morbidly obese (75%).They also exhibited more severe form of pre-eclampsia (75%) as well as recurrent pre-eclampsia (45%) ,with positive family history of pre-eclampsia(64%) & chronic hypertension (27%). Obstetrical complications in term of ante-partum hemorrhage (29%), post-partum hemorrhage (43%) & preterm delivery (50%) were evident more in multgravida with pre-eclampsia as well as poor neonatal outcome in term of low birth weight, & low Apgar score.Conclusion:- Multigravida with pre-eclampsia had significantly higher rates of severe type with adverse maternal& neonatal outcome in comparison to primigravida with pre-eclampsia

Background: Low vitamin D levels had been reported to be common in normal subjects worldwide. Studies in the Middle East had reported extremely low levels of serum vitamin D, despite high exposure to sunlight. Aim: To estimate vitamin D serum concentration in a sample of apparently healthy subjects from Basrah, by 2 methods (chemiluminescent and fluorescent assays). Methods: The study was carried out on apparently healthy subjects during the period from September 2018 to February 2019. Quantitative determination of the total 25-hydroxy vitamin D in serum was made using chemiluminescent microparticle immunoassay and enzyme-linked fluorescent assay. Other parameters (calcium, phosphorus, alkaline phosphatase, parathyroid hormone, hemoglobin, and erythrocyte sedimentation rate and body mass index) were also measured. Results: The mean level of vitamin D measured by the two methods, was 11.57±6.63 ng/ml and 13.31±6.52 ng/ml by chemiluminescent and fluorescent assays respectively. The prevalence of vitamin D deficiency was high, where more than 80% of the 57 subjects had vitamin D level below 20 ng/ml. If the cut-off point of vitamin D deficiency was taken as 10 ng/ml, around 46% of the subjects were found deficient in both methods. Although the two methods of vitamin D assay were well correlated with each other, fluorescent assay gave, on average, a significantly higher levels compared with the chemiluminescent method. Serum parathyroid hormone, showed a negative correlation with vitamin D serum levels. After excluding children and females, no significant difference was found between adult smokers and non-smokers when vitamin D was measured by both methods.Conclusion: Vitamin D deficiency is common (> 80%) among normal subjects. The enzyme-linked fluorescent assay resulted in higher mean level than chemiluminescent assay. The use of a deficiency cut-off point of 10 ng/ml may be more appropriate.

Background: Different factors (genetic and environmental) appear to be involved in the pathogenesis of malignant lymphomas and one of these factors is Epstein Barr virus.Objective: To evaluate the prevalence of Epstein Barr virus in Malignant Lymphoid tumors in Basrah Method: Cross-sectional study of fifty-six cases of malignant lymphomas (Hodgkin and Non-Hodgkin) were collected. The initial diagnosis and subtyping of malignant lymphomas were performed by the microscopical examination of the hematoxylin and eosin stained sections. Then immunohistochemistry for Epstein Barr virus, Latent membrane protein was done.Results: A total of 56 cases diagnosed as malignant lymphomas, 37 cases (66.1%) were Hodgkin lymphomas and 19 cases (33.9%) were Non-Hodgkin lymphomas. For Epstein Barr virus (Latent membrane protein) immunohistochemistry, 18 of 37 cases (48.6%) of Hodgkin Lymphomas and 6 of 16 cases (31.6%) of Non Hodgkin Lymphomas had positive viral expression. Mixed Cellularity Hodgkin Lymphomas and Diffuse Large B-Cell Lymphomas were the commonest subtypes that showed Epstein Barr virus expression (64% and 37.7% respectively). The immunohistochemical viral expression was more among those less than 50 years and male sex in both Hodgkin and Non-Hodgkin Lymphomas