Thi-Qar Medical Journal

Background:
Metacarpal and phalangeal fractures are commonly encountered fractures, majority
of them are stable and can be treated by non-operative means, however, unstable
fractures i.e. those with shortening, displacement, angulation, rotational deformity
or segmental fractures need surgical intervention. This prospective study was
undertaken to evaluate the functional outcome after surgical stabilization of these
fractures by K-wire using different techniques.
Materials and Methods:
A prospective study was conducted between December 2010 and October 2012.
Seventeen patients with 21 unstable metacarpal and phalangeal fractures were
treated by surgical stabilization using K-wire with different techniques. Fractures of
the thumb and distal phalanx were excluded. All the patients were followed up for a
minimum of three months. They were assessed radiologically and clinically. The
evaluation of the functional outcome was measured according to Belsky's criteria.
Results:
All fractures achieved union with a mean of 8.5 weeks, no delayed union or
nonunion or infection was reported, but stiffness has happened in 4(19%) fractures
and mal-union in 2(10%) cases. Overall functional results were excellent to good in
17(81%) of cases and fair to poor in 4(19%) of cases .A better functional outcome
was achieved in metacarpal fractures with excellent - good in (85%) as compared
with phalangeal fractures with good results in (75%), Closed fractures (93%)
excellent - good as compared to compound fractures with (50%) good results.
Functional Outcome after Surgical Fixation of Metacarpal and
Phalangeal Fractures using K Wire
Conclusion:
K-wire is a sound method of fixation for unstable metacarpal and phalangeal
fractures that could give good results, regarding fracture union, functional outcome,
with low complication rate. Metacarpal and closed fractures show a better
functional outcome than phalangeal& compound fractures.

Background: Despite the increasing interest in implementation of appointment
system in many countries, patients, and physicians' views about such system is not
examined in Basrah.
Objectives: To study the views of both patients and physicians about introducing
appointment system in primary care centers in Basrah.
Methods: Six hundreds and eighty (680) patients and 115 physicians in 20 PHC
centers were included in the study. A structured questionnaire was used to collect
data.
Results: The majority of patients (79.6%) supported the idea of introducing the
appointment system. Married women, employed, and highly educated patients and
those who lived far from the PHC center were more in favour of introducing the
appointment system. Likewise, the majority of physicians (95.7%) were also in favour
of introducing the appointment system. The main disadvantages indicated by both
patients and physicians was that it was not beneficial for patients with acute cases.
Conclusions: Both patients and physicians showed positive attitude toward
introducing appointment system in PHC centers in Basrah.

To evaluate the pathogenicity of Staphylococcus aureus and Escherichia coli in male
mice and to compare between antibacterial activity Cefotaxime 250mg and
cephalopoda extract (Sepia sp.) and showed the effect on some blood parameters in
male mice. The mice were divided into seven groups (six mice for each) ,all
treatments were given intraperitoneally to experimental mice. First group (control
animals) were injected with 0.9 % normal saline (0.1 ml for each animal), second
group were received i.p. single dose of E. coli (0.1× 108 CFU), third group were
injected with a single dose of S. aureus (0.1× 108 CFU), fourth group were injected
with a single dose of E. coli (0.1× 108 CFU) then treated with (0.1 Cefotaxime
250mg) for 3 days fifth group were injected with a single dose of S. aureus (0.1× 108
CFU) then treated with (0.1 Cefotaxime 250mg) for 3 days, sixth group were injected
with a single dose of Escherichia coli (0.1× 108 CFU) then injected with (0.1 of
extract,720 µg for each animal ) for 3 days, seventh group were injected i.p. with a
single dose of S. aureus (0.1× 108 CFU) then injected with (0.1 of extract, 720 µg for
each animal ) for 3 days. The results conducted that all infected mice were suffered
from elevated in their body temperatures, while decline in their body weights and
subsequently, changes in blood parameters compared with normal value. On the
other hand, treated mice with Sepia extract show healthy and maintained their body
temperatures and body weights as normal, in addition to blood parameters
remained within normal ranges. These above results explained the role of Sepia
extract as antimicrobial substance, acting against nosocomial bacterial isolates.

Objective: This study designed to assess whether dialysate calcium concentration is adequate
to maintain blood calcium balance in patients receiving hemodialysis therapy or not adequate.
Patients and Methods: We evaluated 170 patients undergoing chronic kidney disease in
dialysis unit at AL- Hussein teaching hospital in Thi - Qar province.
Results: The 170 patient included 70 (30%) were female and 100 (70 %) were male, aged
from 19 to 90 years, the duration of dialysis session 3hour per day, number of dialysis
session per week was two time per week for all heamodialysis patients, and dialysate calcium
concentration was 1.75 mmol/L. Results show normal calcemia in pre and post dialysis session
in 30 patients (17.65%) their serum calcium was within normal range 2.24 - 2.5 mmol/L with
no significant change (p > 0.05), and 48 (28.24%) show changes in serum calcium from 1.75 ±
0.11in pre to 2.32 ± 0.24 mmol/L in post HD session with no significant changes (p > 0.05),
but 92 ( 54.24%) patients were diagnosed with hypocalcemia in pre 1.48 ± 0.16 and post 1.72
± 0.20 dialysis session also with no significant change (p > 0.05).
Conclusions: the concentration of dialysate calcium 1.75 mmol/l (3.5 mEq/L) was adequate and
frequently used with the aim of obtaining positive blood calcium balance especially in patients
with normal ( [Ca ] < 2.40 mmol/L) or Pre hypocalcaemia ( *Ca+ ≥ 1.75 mmol/L). But in
patients with severe degree pre - hypocalcemia ( *Ca + ≤ 1.48 mmol/l) dialysate Ca
concentration (1.75 mmol/L) should be increased by ~ 0.25 mmol/L to maintain comparable
balances as possible as or treated with calcium gluconate (10 % w/v) injection ampoule 10 ml
(1ml ≈ 0.23 mmol/L) after HD session.

Objective: Heart failure is a chronic condition where the heart is unable to provide
the different organs with adequate circulation of blood due to abnormality in the
heart and changes in the hemodynamic, kidney, nerve and hormone system. The
present study is designed to determine the levels of Brain natriuretic peptide (BNP),
Malondialdehyde (MDA), Ceruloplasmin (Cp) and transferring (Tf) in patients with
systolic Heart failure (HF) with Hypertension and healthy individuals.
Subjects: Serum Brain natriuretic peptide, malondialdehyde, ceruloplasmin and
transferrin were measured in 68 patients heart failure and 68 supposedhealthy
subjects .
Results:The levels of serum Brain natriuretic peptide, malondialdehyde and
ceruloplasmin were revealed significant increase in patients with heart failure as
compared to control group whereas the levels transferrin showed a significant
decrease in heart failure patients in comparison to control subjects(P ≤0.05).This
study was also revealed the correlation between the concentrations of the measured
parameters and BNP.
Conclusion:This study revealed significant increase BNP in patients with (HF) and
Serum BNP may have a significant diagnostic role in heart failure.Lipid peroxidation
and oxidative stress is more prominent in patients with (HF) comparison to healthy
individuals , and there is a disorder in antioxidant system in patient with heart failure
.according to the levels of ceruloplasmin and transferring

This study reflects that both A.C.E. inhibitors and A.IIR.A. had been reduced the
hypertension in a total 281 patients, that A.C.E. inhibitors had significant results
175(62.27%), more than A.IIR.A. 106(27.72%) in treatment of hypertension in those
C.O.P.D. patients with ages ranged between (40-70) years old. Also, we found that
there was some degree of serum lipids reduction in those patients which were
treated by either A.C.E. inhibitors 22(8.185%), or by A.IIR.A.24(8.540%), with no
significant different results in this reduction of serum lipids in both A.C.E. inhibitors
and A.IIR.A..

Background : Patients with chronic kidney disease need permanent vascular access
for hemodialysis and the best choice is by surgically created arterio-venous fistula.
Artificial AVF is a challenging surgery because it carries a high failure rate with
increasing morbidity and mortality.
Objectives : to highlight the importance of time factor (the time interval between
the establishment of CKD to the time of creation of AVF) as a predictor factor
affecting the outcome of surgery.
Methodology : a retrospective descriptive analytic study of 216 patients ( 124 male
and 92 female) all with chronic kidney disease underwent surgical creation of AVF
for hemodialysis in the vascular unit at Sader teaching hospital/Basra, south of Iraq
from 1 st of January 2010 to 30 th of June 2012.
Results : the overall success rate was 55.55% and the failure rate was 44.45%, the
causes of failure in sequence were inadequate vein (51%), technical difficulties
(16.6%), fistula thrombosis (11.6%), bleeding (9.4%), false aneurysm (7.3%) and distal
ischemia (4.1%), the patients followed up after 24 hours, 1 week, 1 month and 6
months.
Conclusion : the outcome of the surgery is affected by the time interval between the
establishment of diagnosis of CKD and the time of surgical creation of AVF, the
success rate is decreased with increasing time interval and become abrupt after 6
months, while the failure rate is increasing smoothly with increasing time interval
with peak increase being after 6 months.

Aim of study: to determine the prevalence and types of respiratory failure RF in patients
admitted to Medical Intensive Care Unit (ICU) in Slemani Teaching Hospital.
Patients and method: A descriptive study of (75) patients admitted to the Medical
Intensive Care Unit (ICU) in Slemani teaching hospital between (the first of July 2012 and
twenty eighth of February 2013), all patients had verbal consent taken and special
questionnaire filled for each patient.
Results: 75 patients with female predominate (female to male ratio 1.3:1) participated in
this study, majority of them were in their seventh decade, more than half (52%) of the
cases were obese (BMI >30). RF found in (81.3%) of the patients and (31) patients were
type I respiratory failure.
Conclusions: Most causes of admission to medical ICU were due to respiratory problems,
respiratory failure found in more than (80%) of the cases. Obesity was found in more than
(50%). Type I respiratory failure is commoner than type II.

Background: Gall stone disease is one of the commonly encountered diseases
among the general population. Laparoscopic cholecystectomy has been replaced
open surgery and it is now considered the "golden standard". Numerous
complications might be encountered.
Objectives: To assess and evaluate the specific early postoperative complications
and its management and to assess the factors that might influence the development
of such complication.
Patients and methods: A prospective consecutive observational study was
conducted in Basrah General Teaching Hospital from January 2011 to December
2011. All adult patients with symptomatic gall stone were included in this study. The
entire demographic, preoperative, operative and postoperative patient's data were
collected and evaluated.
Results: A 546 patients were underwent laparoscopic cholecystectomy during the
study period, 454(83.2%) were female and 92(16.8%) were males. The mean age
were 40 years+/- 13.7. Gall bladder perforation with bile leak(with or without gall
stone spillage) was the commonest intraoperative complication that occurred in
49(8.97%) patients. Intraoperative bleeding reported in 26(4.76%) patients.
Intraoperative bile leak reported in 2(0.36%) patients. The conversion rate was
4.76% (26 patients).The commonest postoperative complication was wound related
complication, which was reported in 13 (2.38%) patients. Using logistic regression
analysis, we found that the age < 60years, male sex , acute gall bladder status,
operation time < 60 min and usage of drain were influenced the development of
intraoperative complication on the other hand all the factors failed to affect the
development of postoperative complication.

Background:
Lumbar dick prolapse (herniation) represents one of the most common problems that a
neurosurgeon will be called upon to evaluate. It was estimated that 50% of working
adult will experience back pain in any given year.
Aim:
1. To alert the clinician of the relation between LDP and flat foot patient.
2. To encourage future studies on this subject to improve types of physiotherapy to
treat those patients with flat foot.
Materials and Methods:
A retrospective study on 25 cases of flat foot patients who were scheduled for lumbar
laminectomy were eligible for this study which was carried at the neurosurgical
department of Al kadhimiya teaching hospital. Al mousawi private hospital and Al saadi
private hospital during 5 yrs period between 2003 – 2008.
Results:
Age incidence had shown that in 60% of the cases the age was below 25 yrs. And 10
cases were above 25 yrs old in percentage of 40%.The most common sex incidence of
lumbar disc prolapse on the flat foot patient was in the male more than female
patient.The commonest level of the lumbar disc prolapse in the flat foot patients was
L3/L4 60% of the cases, which were diagnosed by the MRI of the lumbar spines.
The Relationship between Lumbar disc Prolapse and Flat Foot
Conclusion:
The flat foot deformity should be considered as a predisposing factor which plays a
major role in the precipitation of the lumbar disc prolapse.
The Aims of this study
1. To alert the clinician of the relation between LDP and flat foot patient
2. To encourage further studies on this subject and to improve types of
physiotherapy to treat those patient with flat foot.

Background: This study was conducted to elucidate the tonsil surface swabs versus
core swabs bacterial cultures in relation to some selected variables in patients group
with recurrent chronic tonsillitis of different age and sex groups in Basrah General
Hospital.
Aims of the study: The study was designed to determine if the surface swab is of
benefit in prediction of the core bacteria in chronically infected tonsillitis, to identify
the commonest causative organisms in the studied patients, to determine the
prevalent bacterial etiology of chronic tonsillitis among both children and adults.
Patients and Methods : A prospective study was carried out during the period from
March 2012 till April 2013 at Basrah General Hospital ,Iraq. The total numbers of
tonsillectomies specimen were 100 tonsils. Surface swabs and core swabs were sent
Results: The overall proportion of surface
for microbiological study and culture.
swabs revealed pathogenic organisms was 40% of studied cases while core swabs
detected pathogenic organisms was 58% of cases. Staphylococcus aureus was the
commonest pathogen isolated from both surface and core of tonsils. Group A β
hemolytic streptococcus was more common in children than in adults.
CONCLUSION: The role of throat swab in management of chronic tonsillitis is
doubtful.