The Medical Journal of Basrah University

Background: Studies investigating the effect of antibiotics on the pharmacokinetics of non-steroidal anti-inflammatory drugs are few. Such interaction could be clinically significant in conditions like diabetic nephropathy.
Objectives: To study the effect of amoxicillin and cefalexin on the pharmacokinetics of diclofenac sodium when taken concomitantly.
Subjects and Methods: Eleven healthy subjects participated in this single dose cross-over study. Each volunteer randomly joined one of the three treatment groups and received a single dose of diclofenac sodium (50mg enteric-coated tablet), diclofenac sodium + amoxicillin 500mg capsule, and diclofenac sodium + cefalexin 500mg capsule successively with one week washout interval. Blood samples were taken immediately before, at 30 minutes and at 1, 1.5, 2, 2.5, 3, 4 and 6 hours after drug administration and analyzed using high performance liquid chromatography (HPLC) system with ibuprofen as internal standard.
Results: Diclofenac sodium produced a maximum concentration of 1.34 µg/ml with a half life of 0.5 hour and area under plasma concentration versus time curve up to 6 hours (AUC0-6) of 1.24 µg.h/ml. Although the AUC0-6 and maximum plasma concentration of diclofenac sodium increased by more than 20% after co-administration of amoxicillin, this increase is not statistically significant. Cefalexin, on the other hand, when given with diclofenac sodium significantly increased the AUC0-6 and maximum plasma concentration of diclofenac by 51.9% and 68.5% respectively.
Conclusion: Amoxicillin and cefalexin can change some of the pharmacokinetic parameters of diclofenac tablet when administered concomitantly and cefalexin did that to a greater extent. Such interaction must, therefore, be considered in conditions where diclofenac might be harmful.

Background: This paper presents some data on cancer related mortality in Basrah governorate during the period 2010-2012 as part of a comprehensive household survey carried out during 2013 to document the extent of cancer and validate the official cancer registration.
Objective: The main objective is to present data on cancer mortality in Basrah governorate
Method: The study involved visiting 6999 households (families) who were interviewed on, among other aspects, incident cancer and mortality due to cancer during the three-year recall period.
Results: A total of 6999 households (families) with 40688 inhabitants were successfully visited and data were collected and analyzed about their cancer experience. Eighty three persons died with cancer during 2010-2012 giving an average annual cancer specific mortality rate of 68.0 per 100000 persons. The mortality rate was higher for females (71.49 per 100000 females) as compared to males (64.61 per 100000 males) and was increasing with advancing age. The leading causes of mortality were cancers of the lung, breast, urinary bladder and colon-rectum. These four cancers accounted for almost half the deaths (49.4%) or 33.6 per 100000 of the population. Within the overall pattern of mortality in the population, cancer came in the 2nd rank after cardiovascular disease.
Conclusion: Cancer is an important contributor to mortality in Basrah governorate. The current level of mortality is higher than any previously reported figures.

Background: Hypoglycemia is one of the most common side effect of insulin treatment, it affect liver and can potentiate ketoconazole toxicity.
Objectives: To measure effect of ketoconazole on liver enzymes, hypoglycemic oxidative stress and to evaluate if N-acetylcysteine, can modulate this effect.
Methods: Thirty five male rabbits were randomly divided into five groups:
Group 1: (control group), Group 2:( ketoconazole), Group 3: (insulin), Group 4: ( ketoconazole+ insulin), Groups 5: (ketoconazole + insulin + N-Acetyl cysteine). Animals were sacrificed at day 3. Blood collected for measurement of liver enzymes, and total bilirubin. Malondialdehyde and glutathione were measured in serum and liver.
Results: Ketoconazole increased serum and liver malondialdehyde, 0.594 ± 0.17 and 4614.49 ± 1288.00 nmol/gm. Increased aspartate aminotransferase 38.19 ± 17.29 and alkaline phosphatase 29.29 ± 10.2 U/L. Insulin increased serum malondialdehyde 0.522 ± 0.19, alkaline phosphatase 15.77 ± 6.12 U/L and bilirubin 0.56 ± 0.26 mg/dl. Ketoconazole + insulin, increased serum malondialdehyde 0.850 ± 0.16 µmol/l and bilirubin 0.77 ± 0.55 mg/dl. Ketoconazole + insulin increased serum malondialdehyde 0.850 ± 0.16 µmol/l, aspartate amino transferase 54.35 ± 18.34 U/L, alanine amino transferase, 34.74 ± 11.08 U/L, alkaline pohospahtase 30.81 ± 12.4 U/L and bilirubin 2.51 ± 1.55 mg/dl. N-acetylcysteine reduced aspartate aminotransferase 28.12 ± 22.21 U/L, alkaline phosphatase 11.81 ± 3.03 IU/L) and bilirubin 0.39 ± 0.18 mg/dl
Conclusion: Hypoglycemia caused hepatotoxicity and oxidative stress and potentiates the toxicity of ketoconazole. N-acetylcysteine partly reverse this hepatotoxicity.

Coronary artery dissections with or without rupture is a rare but well-recognized complication of coronary angiography with a high morbidity and mortality rate.
We present a rare case of extensive Right Coronary Artery (RCA) dissection that occurred during diagnostic coronary angiography. The vessel dissected during the first injection of contrast agent which was extended spirally from proximal to distal segment. Hopefully the dissection had stented successfully and the patient was discharged after 48 hour of intensive monitoring.
In conclusion coronary artery dissection represents a unique complication of percutaneous coronary intervention and to small extent diagnostic coronary angiography and, if untreated, can lead to serious sequelae including abrupt vessel closure, periprocedural myocardial infarction, closure of major side branches, vessel perforation, tamponade and death. In the present era, coronary stents successfully treat most dissections, so that the risk of sustained vessel closure or the need for emergency bypass surgery due to a dissection is very rare.

Anomalous origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) syndrome is a rare congenital coronary artery anomaly. There are two types of ALCAPA syndrome: the infant and the adult types, each type presents with different clinical findings and outcomes. In infantile type, infants usually suffer myocardial infarction and congestive heart failure, and about 90% of them die within the first year of life if untreated surgically. In rare instances, ALCAPA syndrome presents in adolescents and adults; it is considered as an important cause of sudden cardiac death. The ideal treatment of ALCAPA syndrome is surgical repair performed by restoration of a dual-coronary-artery system.[13] We reported a case of a 14 year old girl presented with an acute myocardial infarction and her coronary angiography revealed ALCAPA syndrome. Four months after ALCAPA diagnosis, she was successfully under went surgical reconstruction without any major complications.

Background: This is a prospective two-stage interventional study carried out at one of the main operating theaters in Basrah General Hospital. The study lasted for 6 months (from May to October 2013).
Objectives: The study was designed to assess the adherence of staff in the operating theater to items of services covered by a World Health Organization Surgical Safety Checklist and to measure the effect of active reminding of them about such list. The study is in line with the vision of the Ministry of Health to provide high quality care.
Methods: A structured questionnaire form was prepared for the purpose of the study. It is an adapted list of the first edition of the World Health Organization Surgical Safety Checklist. The study consisted of two phases: Phase One, which involved the observation of procedures, instructions and labeling of patients before, during and after the surgical operation. This phase was completed without informing the involved staff about any specific requirement regarding adherence to safety measures and checklist. A total of 269 surgical operations (patients) were covered in this phase. In phase Two, full group instructions and explanation of the safety check list was made to operative theater staff. The same manner of observation on each patient was done for the rest of this phase and covered 109 surgical operations (patients).
Results: A substantial improvement in the adherence of staff was observed following the active intervention by the researchers to remind all parties of the importance of the World Health Organization Surgical Safety Checklist.
Conclusions: it is feasible to use Surgical Safety Checklist and its use must be continuously monitored to make the best of its application.

Background: Studies revealed that statins can result in a larger mortality benefit than can be readily explained by their cholesterol-lowering effect alone. These benefits might be related to the anti-inflammatory and other effects statins may have.
Aim: To find out the extent to which rosuvastatin can be considered as an antinociceptive and anti-inflammatory drug in comparison to two standard drugs; paracetamol and celecoxib.
Methods: Mice (a total of 132) of either sex, 3-4 weeks of age, 20-25 gm body weight, were used. Tests for nociception: tail flick, hot plate and formalin tests; and for inflammation (formalin for chronic inflammation, carrageenan-induced paw edema, and TNF alpha level in blood) were used. Rosuvastatin (7mg/kg), paracetamol (40mg/kg), celecoxib (6mg/kg) or their combination were administered orally once daily in a volume of 0.2 ml. TNF alpha level in blood was measured using ELISA kit.
Results: The antinociceptive effect of rosuvastatin was mild and was much less than that of paracetamol and celecoxib when tested in the tail-flick, hot-plate and formalin tests. It increased the latency for tail flick by only 13.3% when compared to pre-treatment measurements, and in formalin test, it reduced the licking time by 20.9% in comparison to control. The administration of rosuvastatin with either paracetamol or celecoxib did not add to the antinociceptive effects of the latter two drugs except in formalin test for pain. None of the above mentioned drugs reduced hind-paw edema when measured 24 hours after formalin injection, while they produced a significant edema-reducing effect after 14 days. Again there was no additive effect between rosuvastatin and either paracetamol or celecoxib; in contrast, rosuvastatin reduced nearly all the effects of celecoxib when given in combination. Similar trend was found when edema-induced by carrageenan injection.
Conclusion: Rosuvastatin showed a significant antinociceptive effect in tail flick and in formalin test, but not in hot plate test in mice. It had anti-inflammatory and edema-reducing effects in models of inflammation but the effect was less than that of celecoxib and even paracetamol. These rosuvastatin effects did not add to those of paracetamol and had caused a reduction in celecoxib effects, when given in combination, except in formalin test for pain where there were additive effect.

Background: Reproductive Health and Family planning is critical for the women’s health and their families, and according to the World Health Organization, the right of having reproductive health services including family planning is identified as one of the targets of the United Nations Millennium Development Goals (MDGs)
Objectives: This study aimed to explore the utilization of reproductive health services, together with having opinions and satisfaction of the target group regarding these services.
Subjects and method: A client satisfaction and knowledge assessment questionnaire was used through health facility exit face to face with a total of 265 women at governmental health facilities in Basrah
Results: The study showed that only 27% of the interviewed respondents were completely satisfied with the service they received and among those who were not satisfied, crowding of the health facility was the main cause of non satisfaction. 34% of the respondents were found to have an unmet need for a reproductive health service at the public health facility level. The study also showed that 16% of the respondents found to be using a contraceptive method of which 51% were from the private source.
Conclusion: The study showed that the majority of the women aged (15-49) years living in Basrah were not aware of the availability of specific reproductive health services including breast and cervical cancer detection, postnatal care (PNC), Sexually Transmitted Infections (STDs), Acquired Immune Deficiency Syndrome (AIDS), infertility management, gender based violence and youth health services..