The Medical Journal of Basrah University

Abstract

Aim: A retrospective descriptive study was carried out to evaluate and address some selected variables of admitted children with severe acute malnutrition to five selected nutritional rehabilitation wards in Basrah, three central Hospitals, and two district hospitals. As well as to assess the extent of implementation of world health organization guidelines for management of severe acute malnutrition.
Methods: The data registries of the selected nutritional rehabilitation wards are reviewed from 1st of January till 31st of December 2015. The following information were reviewed: date of birth, sex, Z score (weight for length), weight on admission and discharge, weight gain, oedema, days of hospitalization, clinical diagnosis on admission and the outcome on discharge.
Result: Total number of registered patients are 530 with males and females percentage of (53.2% and 46.8%) respectively. Sixty six percent of admitted patients were aged below 12 months. Clinical presentation of admitted patients reveals that more than 50% of patients had diarrhoea followed by pneumonia (21%) and poor weight gain (13%). Facilities of studied hospitals were limited regarding allocated wards, beds and nursing staff, only Basrah General Hospital has isolated nutritional rehabilitation ward with 12 beds and 7 trained staff, other wards are just a room within paediatrics wards with 4-6 beds and only 2 nursing staff. Although high percentage of severe wasting, underweight and stunting reported in nutritional rehabilitation wards with statistically significant result P-value 0.001 still moderate malnutrition reported in (27%) of admitted patients. Poor weight gain was reported in 48% of total studied patients, with higher percentage of good weight gain in nutritional rehabilitation ward of Basrah General Hospital (93.7%) and least recorded percentage was (9.3%) in Al-Zubair Hospital. The outcome of the studied patients reveals that; (56.8%) of patients recovered with improvement of clinical symptoms and weight gain, the higher percentage was in the nutritional rehabilitation ward of Basrah General Hospital(85.5%) and the least one was in Basrah Maternity and Children's Hospital (38.3%). Short hospitalizations period is obvious from registered data approximately 59.4% of patients stayed for (1-5) days and only 4.9% stayed for (11-15) days. Days of hospitalization, weight gain and clinical presentation can be regarded as dependent risk factors associated with good outcome in malnourished patients.
Conclusion: This study concludes that management of severe acute malnutrition was not satisfactory and incomplete with faulty recording of the registered data of admitted patients. Current study recommended that the documentation of all data and records seriously will result in better understanding of the reality of nutritional rehabilitation wards.

Abstract

Background: A combination of azithromycin & isotretinoin has been used for treatment of Severe nodulocystic acne before, however, an optimal scheduled doses regimen of such combination remained to be elucidated.
Objectives: To evaluate the effectiveness, safety and tolerability of using a new combination of fixed low doses of isotretinoin and azithromycin in an alternative days regimen in treatment of severe nodulocystic acne in Iraqi patients.
Patients and Methods: A prospective open-labeled clinical study in which 54 young adult and adolescent patients with severe nodulocystic acne were recruited for the study at the Department of Dermatology in Basra General Hospital during from May-October 2015. The patients were received a combination of fixed dose of isotretinoin 20 mg thrice weekly and 500 mg azithromycin given orally thrice weekly on alternating days and one day off for 12 weeks. The participants was assessed before, during and after treatment. The calculation of percentage and scoring of reduction of acne lesions was also carried out.
Results: There was a marked reduction in the inflammatory lesions at the first 4 weeks of the treatment, with a significant clearance of 38.4% of the papular lesions, 63.5% of pustular and 43% of the nodular lesions. At the end of the study, there was a significant reduction in the number of the inflammatory lesions, with the clearance of 76% of the papules, 96% of the pustules and 86% of the nodules. The most frequent adverse effects reported was dryness of face and lips.
Conclusion: Fixed dose of azithromycin 500 mg combined with isotretinoin 20 mg on alternating day regimen proved to be effective, safe & well tolerated regimen for treatment of severe nodulocystic acne with high score of patient satisfaction.

Abstract

Background: Cancer in children though less frequent as compared to cancer in older people, evidence accumulated across the World indicates an increasing risk during the last decades. In Iraq in general and in the south of the country in particular, claims and counter claims are propagated every now and then on the childhood cancer and the proposition that environmental factors are playing a role in the increased risk (if any) is controversial.
Methods: In this study data were compiled on new cancer cases diagnosed in all health care institutions in Basrah among children aged less than 15 years over an eight-year period (2004-2011). Cases were obtained mainly from the population of Basrah governorate but many cases were also visiting from neighbouring governorates. The latter were excluded from the present analysis.
Results: The average annual incidence rate of all childhood cancers was 11.23 per 100000 children. Three groups of cancers occupied the top list. These are leukaemias accounting for 31.1% or 3.56 per 100000 children, lymphomas accounting for 19.6% or 2.20 per 100000 children and brain tumours accounting for 9.7% or 1.09 per 100000 children. A modest rise in the incidence rate was observed over the years 2004-2011.
Conclusions: The evidence for increasing risk with time is not strong. Cancer of children, however, is a significant health problem and requires intensive health care to deal with. Multidisciplinary team research work is essential and comprehensive team approach to care is mandatory.

Background: Viral hepatitis is an important worldwide health problem. Patients undergoing any surgical procedure may have this infection, requiring special precautions so that they cannot transmit it to others.
Objectives: To determine the seroprevalence of viral hepatitis B and C in pre-surgical patients.
Subjects and methods: This cross-sectional study was performed on adult presurgical patients admitted to Basrah General Hospital for elective surgery. Convenience sampling was used to enroll the participants aged 18 years and above. Demographic and medical information were collected. Blood samples were examined by ELISA for HBsAg and HCV antibodies.
Results: Out of 254 pre-operative patients (mean age 45.7±16.8 years), 63% of them were males), and 15 (5.9%) were HBsAg seropositive while 7 (2.8%) were Anti-HCV seropositive. None was concurrently positive for both hepatitis B and C. The overall sero-prevalence of either hepatitis B or C was 8.7%. In multivariate analysis, the significant risk factors for viral hepatitis seropositivity were; history of dental surgical intervention (OR, 12.84; 95% CI, 1.60-24.69; P=0.018), number of blood transfusion (OR, 2.39; 95% CI, 1.07-4.96; P=0.033), and tattooing (OR, 4.59; 95% CI, 1.09-7.33; P=0.037).
Conclusion: The seroprevalence of viral hepatitis B and C in presurgical patients in Basrah was high. Routine screening of presurgical patients is recommended to prevent spread of the disease.
Key words: Basrah, Hepatitis B, Hepatitis C, Pre-surgical, Seroprevalence

Abstract

Background: Writing the operative notes has vital task in the surgical postgraduate training particularly in plan of postoperative care and dealing with complications following surgery.
Objective: Two hundred and two cases of acute abdomen were examined and revised. The operative notes were written by the postgraduate trainees taking into consideration the guidelines of the Royal College of Surgeons of England and our Teaching Hospital operative note sheet as a reference then combining the two sheets. The time, date and patient's identification was not documented in 23 cases out of 182 and documented but incomplete in 95 cases.
Patients: Nothing was said about anesthesiologist, his assistant and type of anesthesia in 31 cases and some deficient data were mentioned in 93 cases. The position of the patient on the theater table was not written in 11 cases, in the remaining 171 cases the supine position was always used.
The details of incision used in the operative procedure (closure, technique, suture material used) has a role in the morbidity of wound dehiscence and incisional hernia after surgery. In 14 cases, nothing were written about incision and in 164 the data mentioned were not informative.
Results: In 139 cases, biopsy or specimen taken was not mentioned, and specifically in all cases of appendectomies involved in this study no single biopsy or specimen was taken. Closure of the incision in details is fundamental in post-operative sequel. In 169 cases the technique and suture materials used was not mentioned and in 10 cases it was not clear. The result in questionnaire ( 14 trainee) is not that different from the overall cases
Conclusions: Only 10-18% of global surgical teaching programs offer operative notes writing as part of the program. In some studies, there was improvement in quality of the notes writing after teaching the surgical trainees the proper way of writing the operation notes
Keywords: surgery, operative notes written, postgraduate trainees

Abstract

Background: Preterm birth is a significant cause of infant deaths particularly during the neonatal period. Study of these births may assist in predicting the survival of those born preterm, and in turn may help in reducing the causes and undesired outcomes.
Objective: This study was designed to explore the chance of survival among babies admitted to intensive care units in Basrah Maternity and Children Hospital.
Method: The study was a follow up study carried out on 440 babies who were born preterm and were admitted for reasons related to their prematurity to neonatal intensive care units in Basrah maternity and children hospital in 2012, of whom 408 were successfully followed up until the end of the neonatal period (birth to 28 days).
Results: Most of the babies were males (58.8%), singleton (93.1%), delivered by normal vaginal delivery (74.01%), moderately preterm (53.4%) and of birth weight range 1500- < 2500 grams(62.5%). Logistic regression analysis to identify independent predictors of survival showed that neonatal outcome (the probability of surviving the neonatal period) was significantly and independently related to birth weight and gestational age. Other variables [sex, type of delivery and type of birth(single, twin and multiple] could not significantly predict survival in the present study.
Conclusions: It is concluded that the problem of neonatal mortality in Basrah is similar to that reported for other developing and neighboring countries. In our study the neonatal mortality rate was 27.94%, mostly in the first 24 hours of life. Two significant predictors could be identified as undesired predictors of survival; namely; low birth weight and shorter gestational age. We highly recommend a larger scale study on issue of neonatal survival. Perhaps improved care of mothers and neonates reduce the risk of both preterm birth and neonatal death.

Abstract

Background: This study is a retrospective record-based study involving all children aged less than five years admitted to Basrah General Hospital with acute gastroenteritis during study period 2008-2013.
Objectives: To measure the prevalence of rotavirus infection and to relate the infection to selected epidemiological variables.
Methods: All children less than five years old admitted to pediatric ward in Basrah General Hospital with acute gastroenteritis over the period 2008- 2013 were included. They were 942 in number. The data were collected through special form (diarrhea case report form). It included two parts, the first part about patient’s information and clinical information while the second one was about the laboratory information.
Results: The overall prevalence of rotavirus infection among the study children was 43.7%. The highest prevalence rate was in 2009 (53.0%) and the lowest rate was in 2010 (33.6%). The infection increased in the colder months of the year. The infection was more among age group 6-12 months (58.7%) affecting males and females in similar degree and no statistical significance could be found. All the positive rotavirus cases complained from diarrhea (100%), vomiting (74.5%) and fever (70.1%).
Conclusions: Rotavirus a common cause of acute gastroenteritis in children under five years old. The prevalence was higher in infant between 6-11 months.
Key words: Rotavirus, Diarrhoea, gastroenteritis, infant