The Medical Journal of Basrah University

Abstract

Background: Childhood cancer represents an important health problem in Basrah with an incidence rate as high as rates in western countries. Little is known about the prognosis and survival of children diagnosed with malignancy after initiation of treatment.
Objectives: to estimate the one-year survival of children diagnosed with malignant diseases in Basrah and to identify non–medical risk factors for the risk of death during the first year following diagnosis.
Methods: This is a hospital-based follow up study of 352 children aged less than 15 years diagnosed with any sort of malignant disease. The study was conducted in Basrah Specialized Hospital for Children over the period (1st of October 2012 to 31st December 2013) and enrolled all newly diagnosed cases during two calendar years (2011-2012 inclusive). The fate of each and every case was ascertained chronologically during and at the end of the 12 months after diagnosis.
Results: The results showed that, of the 352 cases followed up, 102 ( 29.0%) completed their treatment courses at the end of 1st year while 105 (29.8 %) of them were still continuing on treatment , 19 (5.4%) relapsed and still on treatment and 89 ( 25.3 %) of the cases died by the end of first year. The remaining have stopped treatment 25 ( 7.1% ), refused treatment in Basrah 10 ( 2.8% ) or transferred elsewhere on medical advice 2 (0.6%).
The one year survival rate for all the studied children was 74.7%, Thus the one year mortality was 25.3%). Among a set of variables, three "female gender, better mother education and modern type of family accommodation" were significant predictors of one year survival of a child with cancer.
Conclusions: Childhood cancer is major health problem in Basrah in terms of incidence and burden on the health care system. Despite all efforts the one year survival rate was much lower than corresponding figures in many other countries.

Abstract

Aim of the study: This study is aimed to assess the types and the frequency of congenital heart disease among patients with Down syndrome (DS).
Patients & methods: Sixty-five patients with DS collected from echocardiographic department in Basrah cardiology center at Alsader Teaching Hospital and a private clinic were evaluated by echocardiography from February 2009 to August 2013.
Results: Their ages range from 6 months to 25 year. Of 65 patients with DS diagnosed clinically, 89% have CHD and 11% have normal heart. Most of the cases were isolated congenital heart disease (CHD).Ventricular septal defect (VSD), pulmonic stenosis (PS) and atrial septal defect (ASD) were the commonest isolated CHD respectively while tetralogy of Fallot (TOF) and single ventricle was the commonest complex CHD in DS.
Conclusion: This study had concluded that CHD are common in DS and most of the cases are amenable for surgical corrections.

Abstract

Background: Children with malignancies (during chemotherapy) are the most common infected by Cryptosporidiosis and giardiasis as compared with other groups (before chemotherapy).
Objectives: We explore association between cryptosporidiosis and giardiasis in children with malignancies in Basrah city among children admitted to Pediatric Oncology center in Specialist Basrah Children's Hospital.
Method: Used three method in study (Direct wet mount, Acid fast stain, IC test) in two groups before and during chemotherapy in children admitted to Pediatric Oncology center in Specialist Basrah Children's Hospital during May to November 2015, their age ranged from two month to 14 year.
Results: One hundred and six stool samples were assayed from malignant children found Cryptosporidium (13) positive samples before chemotherapy and (33) positive samples during chemotherapy and found Giardia (20) positive sample before chemotherapy and (9) positive sample during chemotherapy.
Conclusion: This study reported that age group between 1-4 years was the most susceptible for the infection among the age groups studied. Both genders were susceptible to infection with Cryptosporidium and giardia, a higher rate of infection was reported in male as compared with female results. Technical medical staff must be trained to diagnose Cryptosporidium and giardia in hospitals and primary health care Centers.

Abstract

Background: The left circumflex coronary artery normally originated from left coronary artery , however, this artery may change its origin either from left aortic sinus or from right aortic sinus. This knowledgement may help in understanding some of ischemic heart diseases and its consequences on cardiac surgery.
Objective: To know the incidence of anatomical variations of left circumflex coronary artery origin among people in Basrah.
Patients and Method: Prospective study of the coronary angiography carried out in cardiac catheterization center at Al-Sader Teaching Hospital during period from 5th of October 2012 to end of June 2013. A sample of 315 patients was recruited with normal coronary angiography.
Results: In the present study the left circumflex artery was variable in its origin, the left circumflex artery originated from the left coronary artery in 97.1%, originated from the left aortic sinus in 1.9% and in 1% of the sample it originated from right aortic sinus.
Conclusions: Recognition of the origin of left circumflex coronary artery and its anatomical variations before cardiac surgery is important to prevent myocardial infarction and death. Special surgical consideration must perform in valvular replacement in patient with variation of origin of left circumflex coronary artery.

Abstract

Background: Type 2 Diabetes mellitus is a worldwide disease with the recent changes in life styles is associated with increasing complications and hyperlipidemia is hallmark risk factor for most complications.
Objective: To evaluate the effect of triglycerides on the levels of other lipid type’s mainly low density lipoprotein cholesterol and high density lipoprotein cholesterol in type 2 diabetic patients.
Patients and method: From three hundred type 2 diabetic patients who consulted Diabetic and Endocrine Center in Al-Mawani General Hospital complaining from symptoms of diabetes over the period from January 2013 to July 2014, two hundred sixty six patients were eligible for this study. One hundred sixty four (61.7%) patients were males and one hundred two patients (37.3%) were females, their mean age was 50.57±9.28years. All patients were subjected to a thorough history and physical examination including their height, weight and body mass index were calculated, blood pressure was measured and fasting blood sample tested for blood sugar, glycosylated hemoglobin and lipid profile.
Results: level of low density lipoprotein lipid was greatly changed by level of triglyceride with mean difference ranges from (-0.05745 to 0.60150*) in patients with normal triglyceride and very high triglyceride with confidence interval (CI/ -0.6517 to 0.5368) in low and (CI/0.00441 to 0.1986) in patients with very high triglyceride. While the mean difference for Non high density lipoprotein ranges from ( -0.55268 to -0.53312 ) and the value of confidence interval was ( CI/-01.1761 to 0.0707) and ( CI/ -01.15950 to 0.0933) between low and very high triglyceride levels The high density lipoprotein closely related in a parallel direction to level of triglyceride with mean difference ranges from (-0.01095 to -0.01942) with confidence interval (CI/ -0.2150 to 0.1931) and (CI/-0.2245 to 0.1856) between low and very high triglyceride type group.
Conclusion: Triglycerides which is frequently elevated in type 2 diabetic patients significantly influence the levels of low density lipoproteins but not high density lipoprotein and was reverse of the first and parallel levels of the second respectively. This lead to underestimation of atherogenic lipid or overestimation of the protective lipid respectively in type 2 diabetic patients.

Abstract

Background: The term ‘urticaria’ is used to describe a disease that may present with wheals, angioedema or both. It is considered chronic when the attacks last > 6 weeks. A possible association between chronic urticaria and Helicobacter pylori infection (H. pylori) was suggested by a systematic review of therapeutic studies.
Aim of the study: To investigate the role of H. pylori in patients with chronic ordinary urticaria and to evaluate the effect of H. pylori eradication on the clinical course of chronic urticaria.
Patients and methods: A prospective case- control and therapeutic study was conducted on 135 patients with chronic ordinary urticaria and 186 apparently normal matched controls. All subjects were tested for H. pylori stool antigen and the presence of gastrointestinal symptoms was recorded. This followed by therapeutic study on a subgroup of patients with positive stool antigen test to assess the effect of triple eradication therapy of H. pylori including amoxicillin 1gm twice daily, clarithromycin 500mg twice daily and omeprazole 20mg twice daily for two weeks on the course of chronic urticaria by following them for six months using three points rating scale and the need for H1 blocker antihistamine as rescue medicine.
Results: H. pylori stool antigen test was positive in 164(51.1%) subjects of the studied population, where 86 (63%) of patients with chronic urticaria have positive stool antigen test versus 78 (41%) among the control group with astatically significant difference(p value < 0.001, odd ratio 2.4). It was also observed that 91 (68.4%) %) out of 133 subjects with gastrointestinal symptoms had actually positive H. pylori infection using stool antigen test, this suggested that gastric symptoms and H. pylori infection was statistically associated (P < 0.001). Only 52 patients with chronic urticaria and positive H. pylori stool antigen test were completed the six months follow up period. The response to eradication therapy (complete remission + partial remission) was evident in 42 (80.8%) patients, that was found to be statistically significant (p value = 0.019) by comparing them with 10(19.2%) patients with no objective response. In general, no significant adverse effect was reported.
Conclusions
1. There is a statistically significant association of Helicobacter pylori infection with chronic urticaria
2. Eradication of H. pylori is a valid therapeutic option for patients with chronic ordinary urticaria and positive stool antigen test as it induces complete and partial remission in 80.8% of the cases.

Abstract

Background: Accumulation of cholesterol rich plaque in the arterial wall is the usual cause of coronary artery disease & cardiac events. These plaques are atheromatous narrowing in the arterial lumen that results in reduction of blood supply to myocardial cells, resulting in various presentations of coronary artery diseases according to the number and the degree of coronary vessels occlusion.
Aim of the study: To assess the relation of lipid profile and the severity of coronary artery disease as assessed by angiography.
Patients and methods: A prospective case-control study involved 223 individuals who underwent elective coronary angiography for angina in Basrah cardiac center from February till end of July 2015. Fasting lipid profile was tested for each patient, in addition to assessment of other coronary artery disease risk factors. The control group included 100 individuals with normal coronary artery angiography were tested for their lipid profile also.
Results: Patients were divided according to the number of affected vessel into 4 groups.
Group 1: includes those with normal coronary angiography, Group 2: those with single vessel disease
Group 3: patients with two vessel disease, Group 4: patient with three vessel disease. Smoking, DM, physical inactivity and hyperlipidemia are strongly related to the severity of CAD while triglyceride level and hypertension was not significantly related. Dyslipidemia was strongly associated with non-ST-elevation myocardial infarction and unstable angina. Total cholesterol, non-HDL cholesterol and raised total cholesterol ∕ HDL ratio were found strongly associated with more severe form of coronary artery disease on coronary angiography.
Conclusion: Total cholesterol, non-HDL cholesterol and high TC ∕ HDL ratio were found to be strongly associated with severity of coronary artery disease angiographically.