The Medical Journal of Basrah University

In medical education, the curriculum passes through at least four stages between vision and learning of students namely: “intended” to “planned” to “implemented” to the “learned” curriculum. The most important safeguard for keeping these formats compatible is the quality of the aims and objectives. This editorial describes the hierarchy of the educational objectives, their importance, types, sources, and qualities and best ways to formulate effective learning objectives that link learning and outcomes to the vision and consequent aims. Also, the article highlights the common misjudgements and misuses of the learning objectives which may produce different and certainly poorer outcomes than those planned for .

Objective: To determine the effect of apo E polymorphism on lipid profile in patients of myocardial infarction as well as normal healthy controls.Subjects and Method: Total 100 acute myocardial infarction patients with age and gender matched controls, within age ranging from 25 to 80 years were included. Lipid profile levels of MI patients and controls were estimated by standard methods. DNA’s were extracted by salting out method and Genotypes for Apo-E were determined by Multiplex Amplification Refractory Mutation System PCR.Results: The total cholesterol, LDL cholesterol, TC/HDL-C ratio, LDL-C/HDL-C ratio level was significantly increased (P < 0.01) in E4E4 allele than E3E3 allele. Analysis of variants has significant difference (P < 0.01) observed in total cholesterol and LDL cholesterol levels in all Apo E alleles of MI patients.Conclusion: Our results suggestive that the risk of myocardial infarction with Apo E4E4 alleles.

Background: Despite the passage of eight months since the start of COVID-19 pandemic, it still represents a major public health problem at global, regional and national levels. Objective: To present comparative outcome indicators and time trends for the pandemic among countries in the Eastern Mediterranean Region and to discuss possible determinants behind such trends.Methods: We used data on all newly reported cases of COVID-19 infection from the start of the pandemic in each EMR country till the 5th of August, 2020. Three sources of data were used: the World Health Organization Websites and two private website reporting cases of world countries. Numbers were directly abstracted from these sources and Excel programme functions were used to make graphic presentations. Verification of numbers were made with data reported by health authorities in these studied countries. Results: As on August 5,2020 countries of the Eastern Mediterranean Region varied substantially in scale of the incidence rate per million population (from highest of 38939.1 in Qatar to lowest of 54.2 in Syria), the case fatality (closed case fatality ratio) ranged from lowest of 0.2% in Qatar to the highest of 37.0% in Yemen. Cause-specific mortality rate ranged from 1.1 to 212.5 per million population in Jordan and Iran respectively. Testing policy was the main determinant of reported cases. Despite the decline in the scale of daily cases, none of the countries has reached a stage of clear exit (zero cases). Conclusion: Most of the countries are experiencing a pattern of accelerated pandemic and are heading towards declining trend. Few are experiencing continued rise or resurgence and threats to re-emerge are impending. Reopening is a real challenge and careful scientific evidence based exit might be possible.

Background / Aims: Understanding the epidemiological features and transmission dynamic during the initial phase of the COVID-19 epidemic provide valuable information for control and mitigation of the outbreak. Thus, this study focused on a cohort who represent early cases in Thi-Qar governorate for describing the early epidemiological features during the initial phase of the COVID-19 outbreak.Subject & Methods: This case series study was conducted in AL-Hussien Teaching Hospital, Thi-Qar governorate, from 27, February to8, May 2020. Patient's data were obtained from official records of the Public Health Department of ThiQar Health Directory. Adescriptive and analytical statistic were used by the aid of SPSS, also household secondary attack rate was estimated. Results: The median age was 37 years (IQR:31,20-51), females were 57.2% and males were 42.8%. According to age groups, as a higher infection rate (30.61% %) was found in the age group (14-26), while only (4%) found old age groups (66-78,79-91). Only six patients(12.25%) had comorbidities. Clinically, majority (79.6%) of cases were mild and (18.4%) moderate while only (4%) were severe. The age and comorbidities had an effect on the severity of symptoms. Family transmission (80.43%) was the predominant dynamic of disease transmission. Three index cases in this cohort fulfill the criteria of super-spreader as collectively transmitted the disease to 79.6% individuals, the household secondary attack rates were 22%, 24%, and 17% respectively.Conclusion: Family transmission was the predominant dynamic of transmission which was the result of the presence of a super-spreader event in the early infected patients in the governorate.

Background and objectives: Acute kidney injury (AKI) may occur in the setting of COVID-19 infection and associated with worse outcome. We aimed to estimate the incidence of AKI among hospitalized patients with COVID-19 infection.Methods: We conducted an observational study on 339 hospitalized patients with COVID-19 infection at Basra teaching hospital for two months. We studied the rate of AKI, requirement for renal replacement therapy (RRT) and in-hospital mortality. Results: Among 339 hospitalized patients, AKI was reported in 54 (16%). The peak stages of AKI were stage 1 in 42.6%, stage 2 in 22.2% and stage 3 in 35.2%. AKI was primarily seen in patients with shock on vasopressors in 64.8% and in patientson mechanical ventilation in 25.9%. Increased age, obesity, hypertension, vasopressors and mechanical ventilation were independent risk factors for development of AKI. Among the 54 patients with AKI, 20 patients (37%) required renal replacement therapy (RRT). Sixteen out of 20 patients (80%) of those who required RRT died and only 5 out of 34 patients (15%) of those not required RRT died with a totally mortality in AKI patients of 21 patients (39%). Conclusions: AKI occurs in patients with COVID-19 disease especially in ICU in association with vasopressors use and mechanical ventilation and is associated with poor prognosis.

Background and objectives: A wide arrays of skin lesions occurred in the setting of COVID-19 infection. We aimed toestimate the incidence and types of skin lesions among hospitalized patients with COVID-19 infection.Methods: We conducted an observational cohort study on 369 hospitalized patients with COVID-19 infection at BasraTeaching Hospital for 3 months. We studied the incidence and types of skin lesions.Results: Among 369 hospitalized patients, skin lesions were developed in (5%). Of those who developed skin lesions, 33%were asymptomatic. Skin lesions were more frequent in young females (83.3%). The most frequent type of skin lesion wasmaculopapular (44.3%) which occurred exclusively in the medical ward and half of them in asymptomatic patients. Forpustularlesions, all were female, diabetic, in the ICU, in symptomatic patients with the highest levels of serum C-reactive proteins. Pseudo-chilblain lesions were reported only in younger female and half of patients were asymptomatic. Urticariallesions werereported in the younger patients, two-thirds were symptomatic and in the ICU. Purpuric lesions were reported in the older patient who developed acute kidney injury. Extremities were the most common distribution of skin lesions in (38.8%). The mean latency period for development of skin lesions was (8.6 ± 9.1), the shortest for urticarial lesions and the longest for purpuric lesions.Conclusions: Different types of skin lesions were reported in patients with COVID-19 and may be the sole manifestations ofthe disease

Background: Low serum level of Vitamin D may have a potential role in the pathogenesis of female pattern hair loss (FPHL).Aims: To evaluate serum vitamin D level in Iraqi women with female pattern hair loss and compare it with normal healthy control.Settings and Design: A case-control study was carried out on 190 women: 95 patients with FPHL aged ≥15 years and 95 healthy agematched control.Methods and Material: The diagnosis and severity of FPHL were based on clinical examination and using Ludwig classification. All participants were investigated for vitamin D level and alkaline phosphatase. Data were collected and statistically analyzed.Results: The mean ± SD level for vitamin D was significantly lower in the FPHL group than control (13.8 ± 2.6 ng/mL vs 37.6 ±4.7ng/mL, p < 0.001). Eighty-two patients (86.1%) of the FPHL group and 35 (36.9%) of the control group had a low vitamin D level (p< 0.001). Alkaline phosphatase level was significantly elevated in 77of FPHL compared to the control group ((81% versus 19%, p <0.001). Low vitamin D level was significantly correlated with the duration of hair loss, alkaline phosphatase elevation, and symptom of bone pain.Conclusions: Women with low serum vitamin D levels have a high potential for the development of FPHL suggesting that vitamin D may have a possible role in the etiopathogenesis of this pattern of hair loss

Background / Aims: Diabetic control is generally measured by HbA1C, the recent ADA (American Diabetic Association )guideline has put a target of < 7.5% . The aim of this study is to assess the diabetic control in the study sample, based on their HbA1c, and to analyze the factors that may affect diabetic control.Subjects and Methods: This is a prospective questionnaire based cross sectional study. Parents / patients or both filled in the questionnaire, which included demographic characteristics, parents’ educational level, insulin regimen and delivering device, duration of diabetes, number of injections, blood sugar monitoring / day, and hospital admissions related to diabetes, and the last the HbA1c.Statistical analysis was done by SPSS version 24; ANOVA was used to asses correlation of HbA1c with different parameters, Chi-square tests were used to compare the categorical data between different groups of patients.Results: A total of 163 patients were included in the study, 47.9% male and 51.2% female. The mean HbA1c was 10.3. Forty-eight-point eight percent of the sample had a HbA1c ≥10, 11% had a HbA1c of < 7.5. The HbA1c increased with age (P < 0.001), and decreased with higher levels of mother’s education(P; 0.03), and more blood sugar monitoring {F (3,156) = 4.8, P = 0.003}. Gender, residency, duration of diabetes, insulin regimen, number of injections /days, and hospital admissions had no significant affect.Conclusion: Enhancing parent’s education and emphasizing on monitoring of the blood sugar, through reinforcing the role of diabetic educators, has a major impact on diabetic control

Background: advances in treatment has improved greatly survival of multiple myeloma in the last two decades, and this improvement has been endorsed by wider use of novel drugs and tandem autologous stem cell transplantation. however, still there were cases died earlier post diagnosisObjectives: to study the risk factors of early mortality in patients with multiple myeloma in Kurdistan region of IraqPatients and methods: a 176 cases that were diagnosed with symptomatic multiple myeloma between (January 2012 – July 2019) in cancer centers in Kurdistan region of Iraq. a total of 152 were continued within the study through their recorded sheet. their data were analysed to determine what are the main risk factors that have an impact on early mortality among our myeloma patients.Results: among the total of 152 studied patients nine of them (5.9%) died early. the highest proportion (32.2%) of the sample aged 60-69 years, more than half (57.2%) of the them were male. the majority of the patients (80.9%) have been diagnosed during 2016-2019. the incidence of early death was 8.7% among patients who didn’t take the cytotoxic treatment compared with 1.7% of patients who took that treatment, but the difference was not significant (P = 0.089). the early death rate was significantly high (22.2%) among patients who didn’t take the immunomodulatory drugs, versus 2.4% of patients who took the immunomodulatory drugs (P = 0.001). the incidence of early mortality was 9.6% among patients with lactate dehydrogenase of ≥ 250 U/L compared with 0% among patients with LDH of less than 250 (P = 0.013).Conclusion: LDH level is a high prediction in finding early mortality among patients with multiple myeloma, and intake of immunomodulatory drugs is highly preventive in early death occurrence.

Background: An interaction has been reported between Nigella Sativa (NS) and ranitidine (RAN) on gastric ulceration induced by ethanol in rabbits; the combination NS and RAN caused disappearance of anti-ulcer effect of NS or RAN.
Objective: to investigate interaction of NS with a proton pump inhibitor omeprazole (OMP) on ethanol induced gastric ulceration in rabbits.
Methods: 24 mature rabbits were divided into 4 groups. The animals were fasted for 48 hours then treated as follow: group 1, 2, 3 and 4 were treated respectively with normal saline (oral), NS oil (10ml/kg) orally, OMP (20mg/kg) IP, and NS+ OMP. One hour later, animals were given absolute ethanol orally; and sacrificed 3 hours later for estimation of Ulcer index (UI), gastric pH, malondialdehyde (MDA), glutathione (GSH), histamine (HIS) levels in serum and gastric tissue.
Results: Ethanol induced gastric ulceration in all animals with an UI of 10 ± 0.11 mm2. This effect was paralleled with reduction in gastric pH, increased MDA and HIS and reduction in GSH. UI was reduced to 5.13 ± 0.68 mm2 in NS group, P value = 0.07 and to around zero in OMP group. NS or OMP treatment resulted in reduction in serum and tissue MDA and HIS levels and increased in GSH and gastric pH levels. In NS + OMP treated group, UI became higher than OMP group with MDA and HIS tended to rise and GSH and gastric pH declined.
Conclusion: NS + OMP diminished the gastro-protective effect of either NS or OMP.

Background: There is substantial variation in the incidence rate of acute lymphoblastic leukemia by ethnicity. In addition, leukemia has broad-spectrum variations in clinical and laboratory findings at presentations.
Aim: This study aimed to determine the patterns of acute childhood leukemia in Duhok city.
Patients and methods: In this cross-sectional study, the patients who were diagnosed with leukemia and admitted at Jin pediatric Oncology Haematology center in Duhok .The general and clinical features of the patients included age, sex, season diagnosis, socioeconomic status, clinical features, and biochemical parameters were collected between the 1st of September, 2015 and 1st of September 2016.
Results: The study revealed that most of the patients were in the 1-5 age group (54.8%) followed by 5-10 years (24.7%). The patients were males (56.2%) and females (43.8%) with 1.28:1.0. Acute lymphoblastic leukemia was the most prevalent type of leukemia (86.3%). The patients were admitted in dry and rainy seasons; 54.8% and 45.2%, respectively. Most of the patients were admitted in winter (45.2%), followed by summer (34.2%). The patients had low (45.2%), middle (42.2%), and high (12.35) socio-economic status. Pallor was the most prevalent presentation of the patients with leukemia (n=50) followed by fever (n=36), and splenomegaly (n=32). Some of the patients had multiple signs and symptoms. The HB and WBC of most of the patients were abnormal (84.9% and 71.2%, respectively), similar to platelets (53.4%).
Conclusion: This study showed that there is variation in the age group, clinical features, season of diagnosis, and biochemical parameters in leukemia patients.

Objectives: the aim of the study is to identify the effectiveness of adding topical tranexamic acid to uterine pack to control primary
postpartum hemorrhage PPH compared to uterine packing alone.
Methods: the study included 30 women with intractable primary PPH after vaginal deliveries due to uterine atony in whom the conventional
local pathway of management of PPH had failed to control bleeding. In 15 women (the case group), uterine pack impregnated with 20 ml
of tranexamic acid(1gm/10ml) was used to control bleeding and compared to 15 women (the control group) in whom uterine pack without
tranexamic acid was used, outcome studied include the need for further surgical intervention and the need for blood product transfusion.
Results: although uterine packing impregnated with TXA was successful in controlling bleeding in 13 women out of 15(86.7%) compared
to 10 out of 15 cases (66.7%) in women who underwent uterine packing without TXA, however; the difference between effectiveness of
each method is statistically insignificant. The requirement for blood product transfusion was less in TXA group.
Conclusion: topical uterine TXA increase the efficiency of uterine tamponade to control PPH, and may decrease the need for more invasive
surgical intervention as hysterectomy

Background: The outcomes of anorectal malformations (ARM) have greatly improved during the last decades, but many children still
experience effects in the form of urinary or fecal incontinence despite optimal surgical management. So, the aim of study was to use different
surgical procedure for correction of these anomalies including traditional and recent operations and to assess the outcome for different type
of anorectal malformation
Methods: An analytical study include 28 cases of anorectal malformation (16 males and 12 females ) operated by different technique in
Raparen Teaching Hospital during 2010 - 2016. All cases of cloaca and early deaths were excluded from the study.
Results: In male Recto-perineal fistula (25% ) and in female Recto-vestibular fistula (25% ) were the most common anomalies. the most
common procedure were primary anorectoplasty for perineal fistula in both male and female infants in 10 cases ( 35.71% ) followed by
trans-fistula anorectoplasty for rectovaginal fistula in 7 cases (25%)and PSARP for rectobladder neck and urethral fistula for male infants
in 6 cases. The most common functional complication was constipation in 2 (7.15%) cases and only one case (3.57%) developed fecal
incontinence . 89.29 percent of the patients had voluntary bowel movements and were totally continent.
Conclusions: Despite significant developments in the understanding of the pathological anatomy and physiology, and innovation of novel
surgical techniques, the results of surgical therapy of ARM remain far from perfect. An optimal operation restores normal anatomy and
preserves all potential sphincter structures. Functional complications, especially treatable ones, such as constipation, should be detected
and treated early to achieve an optimal outcome.

Background: Although abnormal fatty deposits of infected arterial plaque play a major role in the formation of atherosclerotic plaque,
activation of inflammatory cells plays a major role in the instability of the plaque and the cause of acute coronary syndrome. The aim of
this study was to measure the level of interleukin-6 and to study its association with complications that occur in hospital in patients with
acute coronary syndrome.
Method: One hundred and twenty-five patients with acute coronary syndrome and 120 healthy individuals as a control group were included
in this study. According to ECG and serum troponin changes, the patient group was classified into three ST-elevated myocardial infarction,
ST non-elevated myocardial infarction and unstable angina. Sandwich ELISA was used by commercial groups (LEGAND MAX TM) for
the IL-6 assay.
Result: This study shows significantly significant differences in the level of IL-6 in patients with acute coronary syndrome (73.37 pg / dL)
compared to the control group (9.47 pg / dL) (P value 0.001). There were no significant differences at the level of IL-6 in patients with
acute coronary syndrome and conventional risk factors (P. value <0.05). There were significant differences in the level of IL-6 in all forms
of ACS. (P. value 0.001). And those patients who had complications in hospital had a higher IL-6 level (92.89 Pg / dl) than those without
complications (68.83 Pg / dl) P. value (0.012).
Conclusion: This study indicated that IL-6 was significantly elevated in ACS patients and may be a good predictor not only of acute
coronary event but also disease severity and a prediction of complications

Background and aim: Increasing body weight in breast cancer patients after finishing chemotherapy is a rising health problem among many countries; this study try to evaluate this health issue among breast cancer patients attended Basra Oncology Center. Patients and Methods: This cross sectional study carried out on 210 patients with breast cancer who received chemotherapy at Basra oncology center, from 2017 to 2019. The participant's personal data and the other clinical information were derived from patient file. Results: Weight changes after finishing chemotherapy occurred in about 95% of breast cancer patients, and measurement of body mass index of patients at the start and at the end of chemotherapy revealed more women occupied the obese strata after completing the chemotherapy. The study showed statistically significant differences in the weight changes among the age, weight at diagnosis, state of hormone receptor & marital status subgroups. The only significant predictors of body weight changes after completing chemotherapy were patient age and body mass index at time of diagnosis. Conclusion: There is a significant weight gain in breast cancer patients in Basra Oncology Center after finishing chemotherapy.

Fishbone is the commonest pharyngeal foreign body in Asia. However, uncommon types also were reported in the literature. A 9-months-old male infant presented with crying, dysphagia and excessive salivation. Plain X-ray of the cervical spine lateral view confirmed the diagnosis of a metallic foreign body in the hypopharynx. The foreign body was extracted under general anesthesia without complications. A high index of suspicion from the caregiver and early intervention from the dealing doctor are crucial to avoid unwanted complications of pharyngeal foreign bodies' impaction. In conclusion, we reported a rare hypopharyngeal foreign body (the door of the Simcard room of an old fashion mobile phone) in a 9-months-old boy. Fishbone is the commonest pharyngeal foreign body in Asia. However, uncommon types also were reported in the literature. A 9-months-old male infant presented with crying, dysphagia and excessive salivation. Plain X-ray of the cervical spine lateral view confirmed the diagnosis of a metallic foreign body in the hypopharynx. The foreign body was extracted under general anesthesia without complications. A high index of suspicion from the caregiver and early intervention from the dealing doctor are crucial to avoid unwanted complications of pharyngeal foreign bodies' impaction. In conclusion, we reported a rare hypopharyngeal foreign body (the door of the Simcard room of an old fashion mobile phone) in a 9-months-old boy.

A case of female 25 years old, married for 5 years, illiterate and she has 3 children from Basrah, Southern Iraq, she had history of recurrent vaginal bleeding during the second and 3rd trimesters in the last pregnancy unfortunately she was missed diagnosed during pregnancy as pregnancy cause of vaginal bleeding and was delivered by caesarian section due to cervical mass and bleeding with no history of follow up after delivery and continuous irregular vaginal bleeding 2 months after delivery till the last consultation when she developed severe pallor and severe vaginal bleeding . The patient was admitted to the Maternal and Child Hospital, Basrah, Iraq. On speculum examination, the cervix was fusiform, enlarged, barrel in shape, friable and bled on touch. Hemoglobin level was 6 gm/dl.
Ultrasound and Magnetic Resonance Imaging (MRI) confirmed the presence of a large 7X5X6 Cm. cervical malignant solid mass lesion seen invading the upper third of vagina and lower endometrial cavity. No invasion to the rectum and urinary bladder.

Total abdominal hysterectomy, bilateral salpingoophorectomy along with the removal of upper third of the vagina were done after blood correction. The patients agreed that future fertility cannot be preserved. Postoperatively, This finding was proved by the histopathological diagnosis which was invasive non-keratinized, moderately differentiated squamous cell carcinoma of the cervix (FIGO stage IB2).. patient was referred to oncologist for further management.