Table of content

Thi-Qar Medical Journal

مجلة ذي قار الطبية

ISSN: 19929218
Publisher: Thi-Qar University
Faculty: Medicine
Language: English

This journal is Open Access

About

Medical Journal of Dhi Qar, issued from the Faculty of Medicine / University of Dhi Qar. Founded in 2002, concerned with scientific research and medical

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Contact info

Email: thi_unv_medi@yahoo.com

Table of content: 2018 volume:15 issue:1

Article
Patterns of Documenting Patients' Medical Records and Antibiotic Use for Cases with Acute Respiratory Infection in Basrah hospitals
نمط التوثيق الطبي واستخدام المضادات الحيوية لمرضى التهاب الرئوي الحاد في مستشفيات البصرة

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Abstract

The present study was carried out to evaluate the process of documenting patients' medical records in addition to the pattern of antibiotic use in Basrah general hospitals. A retrospective type of study was conducted for antibiotic prescription in 562 inpatients' medical records of those who were admitted to paediatric wards in five hospitals in Basrah governorate because of acute respiratory infections. The study shows that 86% of the patients stayed for less than 5 days at the hospital with 13% of them stayed between 5-10 days. All of the 562 patients' records were reviewed for documentation of the investigations taken during hospitalization, use of antibiotics and follow up while in hospital. Around two thirds (65.5%) of the records were found to have no documentation for any investigation during hospitalization. In addition, antibiotic therapy was found to be used in 83.3% of the cases. By comparing the WHO indications for using antibiotic therapy in acute respiratory infections cases, it was found that antibiotics were prescribed without justifiable indications in 44.7% of patients. The study recommended re-enforcing the adoption of updated drugs use protocols and guidelines especially on the use of antibiotics in hospitals and specifically in inpatient pediatric age groups. Furthermore, assigning clinical pharmacists in the clinical inpatients setting is one of the study recommendations in order to monitor the clinical use of these medications.


Article
Evaluation of Application of Quality Improvement Program Among a Samples of Primary Health Care Centers In Thi-qar Governorate
تقييم تطبيق برنامج تحسين الجودة لعينة من مراكز الرعاية الصحية الأولية في محافظة ذي قار

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Abstract

According to collected data finding the Quality evaluating percentage for administrative units 87.7% & it's main weak indicators were for feedback & it is records , administrative guideline , administrative training , infection control guideline , alcohol , waste's cart ,waste's balance & log documentation of some record . 83.1% evaluating percent for medical units and main weakness points were in numbers of medical &serving staff , gynecological examination room ,waiting & examination time .Pharmacy unit had 89.5% ,main weak indicators were in number of pharmacist ,separated area between boxes of drugs and walls , smoke detector , number of trundle , doses & rout of drugs on recipe .Tuberculosis program had 92.1% and weak score only in health promotion folder for tuberculosis disease ,following of dropout patient from therapy. There are weakness in all immunization coverage in most centers but Vitamin A , storage of vaccine , training of immunization team , presence of records , infection control equipments had good score in immunization units which had 81.1%. Maternal units had lowest evaluating percentage was 74.6 % because there are weak indicators in female medical staff , units according to standard , home visit , presence of sonar ,1st & 4th maternal visit coverage .Health promotion unit had 91.6% ,there are weak score for community participation , halls. While IMNCH units had 88.4% average percentage and most weak indicators were for number of medical staff , adequate place for ARI equipments program ,Thermometer. The continuous training & psychological health services had 82.6% , 95.8% respectively .Laboratory units evaluating percentage was 76.6% & most weak indicators were in structure staff , shaker , balance , spirit lamp , dispenser , calibration, KLB , G , AFB & water bath .In this study the main weak indicators regarding health visitor program in internal net work , transport vehicle , health visitor's maps & bags ,updating numbering of houses therefore this program had 84.4%. Weak indicators regarding hotel services were in rights & duties list of patient , Rumba & special toilets for handicapped patients ,alcohol , cleanliness of gardens therefore the hotel services had 80.3% .Dental services units had 83.6% ,itis weakness score were in number of dentist , dental devices , XR dental devices , processing devices , debris removal devices , optical filler material , activation of dentists , dykal , amalgam , temporary filler material ,XR films & batting root .Emergency services units had 83.7% evaluating percent .While most weak scores regarding emergency services were for medical staff , laundry & serving staff .

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Article
Case Fatality Rate, Determination and Causes of Death in Al Nassiriay Burn Center at 2015 and 2016
نسبة ومحددات الوفيات واسبابها للمرضى الراقدين في ردهة الحروق لمستشفى الحسين التعليمي لعامي 2015 & 2016

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Abstract

; A cross sectional study had been extended through 2 years to envolve 611 burn patients from whom 103has been diedfrom they were admitted in AL-Hussain teaching hospital burn center through 2 years February 2015- January 2017which representcase fatality of (16.85%), in different age group between less than one year to more than 67 years old with different percentage of total body surface area burn,we were found that increase rate of death with increasing total body surface area regardless the age of the patients. about 63% of patients were die who had burn of more than 60%of total body surface area in all different ages.while only 3.4% were died with burn of 10—15% and about 30.3% were die who had between 46—59% of burn. about 23% if patients were died who had 36 to 45% of TBSA burn while 7% died who had 26 to 35 % of burn of TBSA .there were increase rate of death in ALNassiryia burn center in young age group between less than 1 year to 5 years were have the same percentage of burn compare with older age group between 40—45 years old in percentage of 22.6% vs 10.2 % respectively , while 20.2% of cases were die in age between less than 1 and 2 years. And 19.04% patients died who have age more 60 years old. The main cause of death was septicemia in AL-Hussen burn center in 61.1% then electrolyte disturbance26.2% and renal failure in 12.62%.the main organism that cause septicemia is mixed bacteria in 35.92% then pseudomonas in 28.15% then proteus 22.33%.researcher were found that the main type of electrolyte disturbance were companied electrolyte in 42.71% then hyponateremia in 28.15%.researcher found that in this study that the most common death patients occur in 2rd degree burn in 47.57% while in 4th degree about 18.4% that is because most of cases with 4th degree burn reach dead or at end stage to the burn unit .and death occur even with first degree burn if there were large percentage of burn with bad managements

Keywords

; Burn --- Death rate --- Age --- TBSA


Article
The Biochemical and Histological Effects of Tramadol on Liver and Kidney of Albino Mice
التاثيرات النسيجية و الكيموحياتية للترامال على الكبد والكلية في فئران الالبينو

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Abstract

The aim of this study is to assess the effect of usage of tramadol in liver and kidney in albino mice. Twenty albino mice were taken (25-30) gm and divided in to two groups, group I (10 mice) which received normal saline intramuscularly and group II (10 mice) which received) 25 mg /kg body weight (daily of tramadol intramuscularly for 40 days, the biochemical assay showed significant increase (p value < 0.05) in the Aspartate aminotransferase (AST), alanine aminotransferase (ALT), Urea and Creatinine in experimental group compared to the control group. The histological examination regarded for liver tissues degenerative changes in the hepatocytes, dilated central vein, focal necrotic area, congested vessel, congested hepatic vein and cytolysis while kidney tissues show widening bowman capsule, interstitial nephritis, necrosis, degenerative change, lymphocyte infiltration in renal interstitial nephritis and degenerative changes in renal proximal tubules.

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Article
Extent of Overweight and Obesity among Children Aged (6-60) months in Al-Nasiriya at 2015-2016
مدى زيادة الوزن والسمنة بين الأطفال الذين تتراوح أعمارهم بين (6-60) شهرا في الناصرية في 2015-2016

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Abstract

Background: The problem of obesity and overweight in children has been increased globally. Recently, the obesity prevalence rate reached an alarming level in both developed and developing countries. Objectives: This study aims to determine the extent of overweight and obesity among infants and children aged 6-60 months in the center of AL-Nasiriya governorate and their relationship with different socio-demographic and lifestyle factors. Methods: A cross-sectional study was carried out on 225 infants and children aged 6-60 months selected from children who have consulting primary health centers that randomly selected in AL-Nasiriya city during the period from October 2015 till the end of February 2016. BMI and Z-score was measured and compared to standard tables. Data on socio-demographic factors and dietary pattern was obtained by questionnaire. Results: The proportion of overweight was 11.1% and for obesity 7.6% according to weight for height Z-score for all children. For children >24months, we found that 10.8% were overweight and 8.8% were obese by using BMI. In this study, there is a significant positive association between father's education and dairy products intake with overweight and obesity. Conclusion: The prevalence of overweight and obesity among infants and children aged 6-60 months in Al- Nasiriya was high. It is positively associated with dairy products intake and father education had a positive relationship with obesity.

Keywords

Extent --- Overweight --- Obesity --- children.


Article
Letrezole or clomide for ovulation induction in patients with unexplained infertility.
ليتريزول اوكلوميفين سيتريت لتحفيز التبويض للمرضى الذين يعانون من العقم غير معروف السبب

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Abstract

Background: The aim of our study to compare the efficacy of letrezole to clomiphene citrate in patient with unexplained infertility as empirical treatment. Methods: 200 patients with unexplained infertility randomly divided into two groups the first group received( 5mg letrezole from the day 3-7 of menstrual cycle), the second group received (100 mg clomiphene citrate from the day 2-5 of menstrual cycle), follicular development followed by serial U/S, when one or more follicles reach > 18mm in diameter ovulation trigger by hCG and timed intercourse was advise later on . Pregnancy test was performed 5 days after the miss period to confirm the pregnancy, the main outcome was the pregnancy rate and the secondary outcome was follicle development and endometrial thickness. Result: Both groups were comparable regarding the ovulation rate (62.5% in the group B ( clomid group ) and 75.2% in group A ( letrezole group ) ( P = 0.35 ), the endometrial thickness was statistically significant difference in the letrzole group on day of HCG administration ( 6.6_+1.69 mm in the letrezole group, 5.4_+1.61 mm in the clomide group, P < 0.001). Serum estradiol was significantly lower in letrezole group ( 456_+150 versus 922_+301 pg/ml, P < 0.001). While the rate of multiple follicular development was greater in the group B ( clomide 55.15%, letrezole 25.41%, P=0.025), which was statistically significant. The pregnancy occurred in 36 out 100 (36% ) in letrezole group and 12 out 100 ( 12% ) in clomide group, the difference was highly statistically significant ( P < 0.025 ). Conclusion: Letrezole had a good efficacy and may be regard as first line treatment in patients with unexplained infertility in comparison with clomiphene citrate.

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Article
Predictability of consecutive measurements of serum Anti-Mullerian Hormone (AMH) during In Vitro Fertilization (IVF)
قدرة التنبؤ للقياسات المتتابعة لهرمون ضد المولاري خلال الاخصاب الخارجي

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Abstract

Background : In recent years, many studies had been carried out on the basal AMH level and its association with controlled ovarian hyperstimulation (COH) outcome. Only a few studies have been conducted on the correlation between COH outcomes and AMH levels measured on different stimulation days and these studies did not show a comparison between different measurement timings over the entire period of the COH cycle. Objectives: the current study aim is to assess the predictive values of basal and consecutive serum AMH levels during COH cycle. Methods and Results: One hundred women were involved in this study, scheduled for IVF program in Dwarozh Fertility Center in Sulaimanyiah , between December 2015 until January 2017, blood samples were collected for measurement of AMH, Estradiol, and FSH on day 2 of menstrual cycle, and the subsequent samples on day 4,6,8 and 10 were taking after the stimulation of ovaries with gonadotrophin. All hormones being analyzed by using electrochemiluminescence methods (Cobas 411 by Roche) as a single batch, each patient was given a unique numerical identifier, which issued in data analysis. P values <0.05 were considered significant. Results: the patients' characteristics , basal serum estradiol (E2), FSH and AMH levels at day 2 of cycle and subsequent days after stimulation . As expected significant differences were observed for total dosage of FSH, peak E2 levels and duration of stimulation between short and long GnRH agonist groups. The ROC curve was used to assess the AMH values in different days (day 2, 4, 6, 8, and 10) for prediction of IVF outcomes (implantation, abortion, preganancy and live birth). All the days showed significant area under the curve (AUC) (p<0.05). However, when all the ROC curve were comapred to each others there were no significance differences bwteeen them (p>0.05) Conclusions: The present study concluded that measurement of serum AMH at any time after stimulation still predictive of the IVF outcomes which will reinforce the already known value of AMH in clinical practice.

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Article
Evaluation of Manual Hb A1C Determination Methods in Diabetic Patients with Sickle Cell Trait
تقييم الطرق اليدوية لقياس خضاب الدم السكري في مرضى السكري الحاملين لصفه فقر الدم المنجلي

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Abstract

Background and Aim HbA1c is an irreversible non-enzymatic glycation at one or both NH2- terminal valines of the β –chain. Sickle hemoglobin, or HbS, has a valine for glutamic acid substitution at position 6 of the β chain. The prevalence of sickle cell trait reported to be 2.5% in Basrah city. The hemoglobin A1C (A1C) test can lead to false outcomes resulting in over- treatment or under-treatment of diabetes in people with inherited hemoglobin variants. This study focus on the evaluation of sickle cell trait effect on HbA1c measurement by the minicolumn ion exchange resin methods and compare them with Biorad Variant (HPLC method).the one of methods certified by national glycohemoglobin standardization program (NGSP) Materials and Methods 60 diabetic patients identified with sickle cell trait were recruited in this study .Blood sample collect in EDTA tubes and were assessed for hemoglobin A1c using 3 methods commercially available and most fequently used for routine investigations. Stanbio Glycohemoglobin (Pre- Fil), HUMAN Glycohemglobin HbA1-Test ( Fast Ion Exchange Resin Separation Method ) ,and the Bio-Rad VARIANT Hemoglobin A1c (HPLC ) method Results Mean age group for patient were 39.6 yrs with their mean blood glucose level of about 203 mg/dl , the average glycohemoglobin was 9.1% measured by Biorad Variant, compare to 7.57% and 7.99% for both Stanbio method and Human Method respectively, which show statistically significant difference (p<0.05). It also had been found that average difference between both manual methods (|Stanbio and Human) and Automated method (biorad variant HPLC) about (1.5, 1.15) . These difference show a significant statistical correlation with hemoglobin S level with r =0.856; p value<0.001. Conclusion This study demonstrate the significant difference in Glycated hemoglobin measurements between different methods commercially available in local markets which had been shown to give false negative results in sickle trait patients when compared to those methods standardized by NGSP system. And recommend that such methods to be avoided in patient with sickle cell trait.

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Article
Left Ventricular Dysfunction in Breast Cancer Patients Receiving Trastuzumab: An Observational Study in a Cohort of Iraqi Breast Cancer Patients
أنخفاض وظيفة البطين الأيسر لدى مرضى سرطان الثدي المعالجين بعقار التراستوزوماب

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Abstract

Abstract Background : Cardiotoxicity is a well recognized adverse event of trastuzumab. This study was designed to evaluate the frequency of decline in left ventricular ejection fraction (LVEF) to less than 50% in patients with breast cancer who have received trastuzumab in a daily practice setting. Methods : Retrospective observational study of 116 patients with HER2 positive breast cancer treated with trastuzumab in one center between May 2012 and January 2017. Results : Left ventricular ejection fraction decline to less than 50% was observed in 7 patients (6%). Patients above 70 years of age have the highest frequency of LVEF decline (33%). All events of LVEF decline was reported in the first six months of treatment. Prolonged administration of trastuzumab beyond one year was not associated with adverse cardiac events. Previous anthracycline exposure and chest irradiation was not found to be associated with LVEF decline. Conclusions : Events of LVEF decline to less than 50% associated with trastuzumab use seems to be slightly higher in general daily practice than in clinical trial setting, especially in patients above 70 years, calling for better patient selection. First year of trastuzumab therapy carries the highest risk of cardiac events which necessitates a close cardiac monitoring, thereafter, periodic LVEF measurements can be reduced to reduce the costs.


Article
Prevelance of hepatitis C Viral Infections among Thalassaemic Patients in Thi -Qar Governorate
دراسة مستوى انتشار التهاب الكبد الفايروسي نوع (ج) عند مرضى الثلاسيميا في محافظة ذي قار

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Abstract

A prospective study was conducted on 305 patients with Thalassemia who were attending to the center of inherited blood diseases in Nassiryia city from the penod of 1 / 7 / 1997 to 30/9/2009 . Elisa test was used to study the prove lance of hepatitis C Viral infections among Thalassaemic children . Anti-HCV antibodies were detected in 72 ( 23.6 % ) patients , 47(65%)males and 25(35%)females. The frequency of cases was correlated with increasing age. There was a positive correlation between frequency of blood Transfusion / year and the increased incidence of infection with HCV . Splenectomy was done in 80 ( 26.2 % ) patients 28 ( 3S % ) of them had positive anti-HCV antibodies in their sera . We concluded that our Thalassemic patients are exposed to HCV infection. Careful, regular screening of blood unit for HCV should be established .

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Table of content: volume:15 issue:1