The Medical Journal of Basrah University

Aim: is to compare between the outcome and complications in the use of local and general anesthesia in the management of sever blepharoptosis by use of straight needle threading technique and silk suture as a frontalis suspension.
Settings and Design: it’s a prospective comparative study using two group one under local anesthesia and the other under general anesthesia with standardization of the cases as all has sever ptosis and poor levator functions, technique as the straight needle threading technique was used, material of thread was silk in 92% of cases, and sex distribution was of no statistical significance.
Methods and materials: The parameters used for comparison were the following:-Satisfaction, Correction, Symmetry, Lid crease height (visible pretarsal height), Infection, stich abscess, stich granuloma, Eye opening during sleeping, Lagophthalmus, Entropion, Exposure keratitis. A 120 eye was operated on 95 patients; 25 patients (50 eyes) bilateral, 70 patients (70 eyes) unilateral, 36 eyes (30%) were operated on under local anesthesia, and 84 eyes (70%) were done under GA. The minimal age was 2years, maximum age 75 years, median 12 years, mean 19.8 years. The patients above the age of 16 years old were asked to choose between local or GA while below that age the correction was done under GA only.
Results: There was no statistical significant difference in the all the nine parameters except the eye opening during sleeping were higher in the general anesthesia group.
Conclusion: The use of local anesthesia is easier, of less risk, and lower cost with same aesthetic results of general anesthesia.

Background: Hair graying is an aging sign that was found to be associated with several systemic diseases like ischemic heart disease, osteopenia, and autoimmune diseases. Metabolic syndrome was applied to the clustering of risk factors that often associate with increased risk for atherosclerotic cardiovascular disease.
Aim of Study: Our work aimed to test retrospectively the association between onset of hair graying and risk of metabolic syndrome.
Patients & Methods: Four hundred and eighty one gray hair individuals, with no history of any type of atherosclerotic disease, participated in the study. The participants were divided into two groups according to the presence or absence of criteria of metabolic syndrome into control and metabolic syndrome groups, and each individual in both groups was asked about the decade (2nd-6th) when he/she firstly noticed that he/she had a gray hair. A comparison was made regarding the age of onset of graying between the two groups.
Results: There was a significant difference in decades between individuals with metabolic syndrome and the control group and was found in the 4th and 5th decade of life (P =0.045 & 0.024 respectively) while the difference was not significant in the 2nd, 3rd and 6th decades of life. The mean age of onset of hair graying in metabolic syndrome was 36.207 ± 8.30 year and the control group was 38.434 ±8.31 year, there is also a significant difference between the two groups (P value=0.003).
Conclusion: patients with metabolic syndrome have an earlier age of onset of gray hair.

Background: Medical care may become worse during holidays and weekends, probably, due to decrease in the number of physicians, other health staff, or medical resources, in addition to increase in the number of patients admitted at this period. This may explain the negative impacts on the outcome of patients admitted to the hospital at weekends and holidays.
Aim of study: It is to shed light on the impact of holidays and weekends on the death rates among admissions in the main hospital in the governorate of Misan governorate.
Patients and methods: In this cross-sectional stud, records of all patients admitted to the Al-Sadder teaching hospital in Misan, from the first January 2015 to end December 2015 were reviewed with particular concern of, site and day of admission to the hospital, day of death, and the number of dead individuals, among admissions during holidays and other week days.
Results: A total of 34983 patients admitted to the hospital during one year, (25.4%) of them were admitted on the weekends and public holidays. Among patients in the hospital wards other than labor room & ICU, there was a statistically significant increase in death rate among admissions on the weekends and holidays compared to that on other week days, (3.5% versus 1.9%, P value > 0.0001).All-cause death, in the hospital as a whole, was found to be significantly higher on weekends and holidays than that on the other weekdays. (4.3% versus 2.6% P value > 0.0001).
Conclusion: weekends and holidays have a negative impact on the outcome of hospital admissions as reflected by higher death rates compared to that on the other week days.

Background: Immunization is one of the most important programmes which contributed to the prevention of major childhood diseases. A high coverage rate is desirable for the effectiveness of this programme.
Objectives: This study aimed to assess the level of immunization coverage rate among children aged 12 to 23 months in Basrah during 2014-2015. Also, to explore the vaccination dropout rate and the causes of partially immunization.
Methods: A cross sectional survey was done in 30 clusters that followed the World Health Organization cluster sampling technique. Data were collected via direct interview with 300 mothers using an Arabic language questionnaire and the data were analyzed using SPSS programme.
Results: The vaccination coverage rate in this study was 80.7% and the dropout rate was 19.3%, which is rather high while the main causes of the dropout were difficulties facing mothers' attendance to Primary Health Care centers (50%) and lack of information (31%).
Conclusions: The results of the current study showed that although the coverage rate of immunization was adequate, the dropout rate was high and the important reasons for that were inadequate awareness and inconvenience timing for mothers. In addition, literacy status and occupation of mothers, child birth order and family type were other reasons.

Background: Ramus intermedius artery is one of the branches of epicardial coronary artery. It shares in supplying the lateral wall of left ventricle. It is regarded as normal anatomical variant that creates appearance of trifurcation of left coronary artery. The atherosclerotic changes in this artery lead to peculiar clinical signs even when other main coronary arteries are preserved and at this time it requires either percutanous coronary intervention or cardiac bypass surgery.
Objectives: To know the incidence of ramus intermedius artery among people in Basrah and the significance of its occurrence in interpretation of coronary angiography and surgical revascularization of myocardium.
Patients and Methods: This is a prospective study of coronary angiography carried out in Basra cardiac center at Al- Sadder Teaching Hospital. A sample of 110 patients with normal coronary arteries were also recruited.
Results: In the present study the sample size was 110 cases; male patients were 61.8% and the female patients were 38.2%; the age of patients were ranged from 35 to 79 years (52 ± 4.1 years). The ramus intermedius artery was present in 30% of cases; the incidence of ramus intermedius artery in male was 33.8%, female 23.8% while the incidence of this artery in people who live in urban area was 35.7%, rural area 24.1%. The length of ramus intermedius artery was variable (mean 59.40±5.48mm); in male 53.6 ± 2.6 mm, female 61.8 ± 3.15 mm and the caliber of this artery (mean 2.13±2.41mm) in male was 1.52 ± 1.01mm, female 2.39 ± 0.24 mm.
Conclusions: The ramus intermedius artery would be of great significance in coronary angiographical and surgical interventional findings in patients with this anatomical variant.

Objectives: Hanging is a common cause of death worldwide as well as a method of suicide with a high fatality rate, In this retrospective study, data were obtained from cases of hanging reported to Department of Forensic Medicine at the province of Basrah, Iraq, in order to analyze the characteristics of hanging, to focus on its distribution by gender, age groups, marital status, the place of occurrence of the incident, ligature types used, autopsy findings and manner of death, and to determine the possible causes of hanging fatalities over the period of the study, in addition to various other associated factors with the aim to find out which individuals are more prone to death by hanging and to explore the potential control and preventive measures.
Methodology: Over a period of seven years, from January 2010 to December 2016. data from autopsy reports, together with information from police investigation reports and history obtained from relatives were used in this study.
Results: A total of 184 forensic autopsies were conducted on cases of death due to hanging during the period of the study. The highest proportion of hanging cases was suicidal in nature (86%). Twenty eight percent of the suicidal hanging victims were in their 3rd decade of life, and the incidence rate of hanging among female and male victims was almost equal, female to male ratio was 1.1:1.
Conclusion: Hanging is a common cause of suicide in our society, especially among young individuals. Prevention of death by hanging is not easy since different types of materials can be used as a ligature

Objectives: Cholecystectomy is the established treatment for symptomatic gall stones and cholecystitis. In our locality, all cholecystectomy specimens are routinely sent for histopathological examination regardless of the presence or absence of preoperative or intraoperative suspicion of malignancy. This has led to an increased workload for the histopathologists. This study was conducted to assess the necessity for routine histopathological examination of all cholecystectomy specimens and to call attention to a selective criteria for sending gallbladders to the histopathological examination.
Materials and methods: A retrospective analysis of computerized histopathological reports of 1176 cholecystectomy specimens and the available patients clinical data for the last ten years.
Results: Analysis of 1176 cholecystectomy specimens during the last ten years, revealed five cases of primary invasive adenocarcinoma (0.42%) and one case of carcinoma in situ. Of the five invasive adenocarcinomas, three were stage pT3. One case was stage pT2 and one case was stage pT1b. In all cases of invasive adenocarcinoma, there was a clinical suspicion of malignancy before or during surgery with detectable macroscopical abnormalities that encouraged the surgeon to send the gall bladder for histopathological examination.
Conclusion: Invasive adenocarcinoma of the gallbladder is associated with detectable macroscopical abnormalities in all cases. Hence histopathological examination could be restricted to the macroscopically abnormal looking gall bladders. Such a selection will save time, cost and burden on the histopathologists without affecting the patients’ safety.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by a painful symmetrical peripheral polyarthritis. Extra-articular involvement in RA is a common condition. Pulmonary involvement occurs in 20 to 67 % of RA patients and it is responsible for about 10-20 % of mortality in RA patients.
Objectives: To evaluate the extent and pattern of pulmonary involvement in RA patients by using spirometry.
Methods: A case control study conducted at the rheumatology unit of Al Sader teaching hospital, forty RA patients [33(82.5%) female and 7(17.5%) male] and sixty apparently healthy subjects {50(83.3%) female and 10(16.7 %) male} were included in the study. All subjects had subjected to a pulmonary function test (PFT) for pulmonary function evaluation using MIR spirolab III. Measured and predicted forced vital capacities (FVC), forced expiratory volume in the first second (FEV1) and FEV1 / FVC ratio were considered as the parameters in this study for both groups.
Results: Nine patients were found to have a restrictive pattern of pulmonary function test, while obstructive pattern was found in only one patient. On the other hand, the pulmonary function tests were normal in all of sixty healthy control. The mean of FEV1 in patient group (2.07 ± 0.56L) and of FEV1% (95.8%  25.2) are significantly lower than those in the control group (2.46 ± 0.65 L; 105.3%  13.09). In addition, mean FVC in the patient group (2.35 ± 0.62L) and its mean percentage (92%  22.68) showed a clear significant reduction compared to those in control group (2.71 ± 0.67 L; 100.53  12.12). No significant difference (P = 0.173) has been observed in FEV1 / FVC ratio between patient (88.17  7.47) and control group (89.87  4.99).
Conclusions: Different pattern of pulmonary function abnormalities could be manifested in RA patients and the restrictive pattern represents the most common feature. Spirometry is indicated as a baseline assessment and for follow up of RA patient to enhance early detection and management of the pulmonary involvement.