The Medical Journal of Basrah University

Background: In anesthesia practice, obstructing materials like thick mucus secretion, debris or blood clots, and food particles accumulate in the oropharynx. If not properly removed, they could cause airway obstruction with concurrent hypoxia which may end fatally.
Objectives: This study aims to highlight the importance of forgetting foreign objects in the airway in order to allert anesthesiologists about the hazards of missed foreign bodies in the oropharynx which could lead to disastrous situation.
Patients and Methods: During the period from 2012-2014, out of 2300 patients presented for surgical operation under general anesthesia with endo-tracheal intubation, 22 patients were recorded to have accidental discovery of hazardous foreign bodies retained in the oropharynx and were included in this study with an incidence rate of 0.96%. Cases in this study were classified as patient-related or surgery-related. Foreign bodies were identified with the aid of laryngoscopy and were removed by suction hand piece or Magill's forceps.
Results: The main age group was between 21-40 years accounting for 45.5%. Male: female ratio was 1.2:1. Overall, 59.1% were related to patients' causes, while 40.9% were related to surgery. The commonest type of foreign body observed was cardamom (38.5%) among patient-related cases, and tissue remnants in 66.7% of surgery-related cases.
Conclusion: Missed foreign bodies are not uncommon and anesthesiologists should be aware of inspecting the mouth and throat of the patient thoroughly before endotracheal intubation and extubation to reduce the hazard of foreign body inhalation.

Background and Objectives: Left bundle branch block is an electrical conduction disturbance that can be present with various cardiovascular diseases. Atherosclerosis is the most frequent underlying cause of ischemic heart disease with left bundle branch block. This study was carried out to analyze the angiographic and echocardiographic findings in patients with left bundle branch block. Left ventricular systolic function had also been assessed and correlated with measured QRS width and angiographic findings.
Methods: A total of 100 patients with left bundle branch block, 66 males and 34 females, with a ratio of about 2:1 with an age ranged from 30-75years (mean age 58.5 ± 8.1 years). The study was conducted in Al-Sadr teaching hospital in Basrah, South of Iraq during the period from January 2009 to April 2010. Echocardiography was done for all patients to assess left ventricular function and regional wall motion abnormalities, Left ventricular systolic dysfunction was considered if the ejection fraction was less than 50%. The QRS width recorded from the ECG was calculated, and compared with echocardiographic and coronary angiographic findings. Coronary angiography was performed to define coronary lesions for all patients.
Results: Fifty seven percent of patients had left bundle branch block of ischaemic origin and forty three percent of non ischaemic left bundle branch block. The predictors of ischaemic left bundle branch block were male, age older than 50 years, diabetes mellitus, and regional wall motion abnormalities. The QRS complex width as recorded from the ECG was predictor of left ventricular systolic dysfunction irrespective of other risk factors.
Conclusion: Left bundle branch block was correlated with more extensive coronary heart disease and severe left ventricular dysfunction as studied by ECG, echocardiography and coronary angiography

Aim: to identify predictors of in hospital mortality after acute stroke and to investigate the impact of statins on stroke mortality within a package of other predictors.
Patient &method: all patients were admitted to Al-Sadr teaching hospital in Basrah from January 2013 to September 2013 with acute stroke. Diagnosis of acute stroke was based on clinical & imaging criteria as documented in patients medical files.
Results: A total of 147 patients (104 males and 43 females) were studied. Common co-morbidity included hypertension which was documented in (68.3%) and diabetes mellitus in (45.8%). Twenty three (16.0%) of stroke patients died while in hospital. Logistic regression analysis indicated significant prediction of mortality by history of old stroke, female gender, use of statins and high diastolic blood pressure at the time of admission.
Conclusions: female gender, recurrent stroke, elevated DBP and use of statins were all predicting in hospital mortality

Background: Although compared with adults, cholelithiasis )or gallstone disease( is unusual in infants, and in children but it is certainly not rare. Gallstones currently are being recognized in children with increased frequency therefore, it should be studied more carefully in our locality as it represents a significant health problem.
Method: This is a retrospective hospital based study of children with gall stones aged 16 years and below who were admitted to the surgical wards of five major hospitals in Basrah city, during the period from first of January 2007 to 30th June 2012. Then children were studied for demographic criteria, past history, clinical presentation, hospitalization, and the treatment approach.
Results: The total number of the study population included in this study was 95children, the mean age of them was 11.7± 3.6 years (Range: 9 months - 16 years) and the male to female ratio was (1:1.4). The majority of the patients 46 patients (78%) were symptomatic at the time of diagnosis, while only 13 patients (22%) were asymptomatic, and the reported symptoms were: abdominal pain, fever, nausea, vomiting, and jaundice. Sickle cell disease (SCD), Thalassemia major and hereditary Spherocytosis were three major types of hemolytic disease that predisposed children to gallstones.
Conclusions: Sickle cell disease was the major predisposing factor and responsible for 59.3% of gall stone in this study, while Thalassemia and hereditary Spherocytosis were reported less frequently (6.8% and 1.7% respectively). No reported risk factor was seen in 32.2%. Surgery was performed for most of the patients; types of surgical approach were either open cholecystectomy (with or without splenectomy) or laparoscopic cholecystectomy.

Background: Childhood mortality is a sensitive indicator of the health and socioeconomic status of population. Differential figures across populations and/or over time suggest variation in the quality of health, health care and standard of living. During the last three decades, all indicators of childhood mortality showed declining trend but a great variation does exist between developed and developing countries with some countries, mostly African have the highest rates.
Objectives: The present study was conducted to estimate the mortality rate among children aged less than 15 years in Basrah over a 6-year period and to identify the major causes of childhood mortality.
Methods: A retrospective, record-based study using all official records of deaths among children during the years 2008-2013.
Results: The study demonstrated that overall childhood mortality rate for the years (2008-2013) in Basrah governorate was within the international pattern with a tendency towards lower figures among various countries. Infant mortality (22.4/1000 live births) is still high as compared to many countries. Regarding the sex distribution an excess of male specific mortality rate is seen. Mortality among male children was 3.26/1000 males and 2.85/1000 female children. No explanation is verifiable but excess exposure to risk factors, such as outdoor activities could be implicated. The five leading causes of childhood death; perinatal causes, bacterial infections, congenital anomalies, accidents and diseases of the respiratory system accounted for 72.8% of all registered childhood deaths in Basrah governorate during the years.2008-2013. Most of these conditions are amenable to prevention.
Conclusions: A substantial proportion of deaths among children were related to causes of death that are amenable to prevention.
Key words: Childhood mortality, Basrah, Retrospective, Death

Background: Psoriasis has an increased likelihood of comorbidities compared with healthy controls such as cardiovascular diseases and metabolic syndrome.
Objectives: To investigate the risk factors that increases the incidence of cardiovascular diseases and metabolic syndrome in Iraqi patients with psoriasis.
Patients & methods: a case- control prospective study enrolled 80 patients with psoriasis and 80 normal individuals as a control group. Psoriasis severity was assessed using PASI(psoriasis area severity index) score, in both groups, blood pressure, BMI(body mass index) & waist circumference were measured, laboratory tests including fasting blood sugar & lipid profile were done. For comparison between the 2 groups, Fisher s exact test were performed.
Results: In psoriatic group, calculation of (BMI), showed that 19 (23.8%) were obese, 34 (42.5%) over weight, 27 (38.8%) normal weight. Thirty four patients (42.5%) had an elevated blood pressure, both were significantly correlated with the severity of psoriasis.44 (55%) have abnormal lipid profile, 17 (21.3%) elevated cholesterol, 17(21.3%) had raised LDL & 32 (40%) had low HDL. These were correlated with the severity of psoriasis. Eight (10%) patients had elevated VLDL & 13 (16.3 %) had elevated TG. Twelve (15%) patients had elevated FBS.33 (41.25%) patients were having Metabolic syndrome and the risk was increased with the duration of psoriasis. Comparing with the control group, psoriatic patients were at risk of developing hyperglycemia & hyperlipidemia with statistically significant elevation of fasting blood sugar, cholesterol, LDL, & reduced HDL.
Conclusions: Compared with the control group, psoriatic patients in our population had an atherogenic lipid profile with increased prevalence of risk factors for cardiovascular diseases & metabolic syndrome & this was directly correlated with the severity and duration of the disease.

Background: Diabetes mellitus is associated with the increased prevalence of atherosclerosis and coronary heart disease. Diabetes mellitus highly affects patients who have already experienced an unstable angina or myocardial infarction. Diabetes mellitus is also expected to increase in the coming decades among people worldwide.
Aim: This study aims at exploring comparatively the correlation between electrocardio-graphic and coronary angiographic findings in both diabetic and non-diabetic patients with ischemic heart disease (IHD), also to determine the severity and extent of coronary artery disease in diabetic compared to non-diabetic.
Methods: This was a cross sectional study, enrolled 100 patients from the Cardiac Catheterization Center in Al-Sadder Teaching Hospital, Basrah, Iraq during the period between January and May 2012. Fifty diabetic and 50 non-diabetic consecutive patients were selected. Every selected patient underwent an ECG and coronary angiography depending on at least one indication.
Results: A significant correlation was found between diabetes and ischemic angiographic findings and diabetic patients has more extensive and diffuse disease than non-diabetic.
Conclusions: Diabetic patients are more susceptible to ischemic heart disease than non-diabetic, Therefore diabetic patients with suspected CAD are highly recommended to have coronary angiography.

Background: Arthropathies are a major clinical problem in patients with inflammatory bowel disease (IBD). Often it is difficult to control the articular symptoms with the anti-inflammatory strategies used for IBD. Recently, interest in the multidisciplinary approach to patients with IBD and arthropathy has been increasing, early recognition and proper management of arthropathy is mandatory.
Objectives: To find out the frequency of peripheral arthropathy and pattern of joint involvement in inflammatory bowel diseases.
Patients and Methods: Forty-eight patients with a definite diagnosis of inflammatory bowel disease (IBD) (41 ulcerative colitis and 7 crohn’s disease) have been assessed for peripheral joint involvement and enthesopathy. Patients clinically assessed for bowel conditions, peripheral arthritis, enthesitis and pattern of joint involvement (monoarticular, pauciarticular or polyarticular). Blood test for full blood count, ESR, CRP, RF, Serum electrolytes and serum albumin done for the assessment of disease activity. Radiological assessment of the symptomatic peripheral joints was done by conventional x-ray.
Results: Five (10.4%) cases had peripheral arthritis, 4(80%) were pauciarticular, arthralgia and enthesopathy accounted in 10(20.8%) and 2(4.2%) cases respectively. Peripheral arthritis was more among female patients 4(21.05%) with P-value (0.051). All patients with peripheral arthritis were in active state of inflammatory bowel disease. Patients with ulcerative colitis who had extensive colonic involvement were more likely to develop peripheral arthritis with frequency of 2(50%) for left side colitis, 1(25%) for extensive colitis and 1(25%) for pan colitis, While crohn’s disease with colonic localization was more likely to develop peripheral arthritis 1(100%) for ileocolitis.
Conclusion: The commonest musculoskeletal manifestations of IBD were arthralgia, followed by arthritis and the least was enthesopathy. The most common pattern of peripheral arthritis was pauciarticular and mostly involved the lower limb joints.
It was more common in female patients and occurred independent to the duration of inflammatory bowel disease.