Volume 36, Issue 2, Summer and Autumn 2018, Page 50-114

Assessment of the documentation completeness level of the medical records in Basrah General Hospital

The Medical Journal of Basrah University, Volume 36, Issue 2, Pages 50-59
DOI: 10.33762/mjbu.2018.159461

Background: Medical records documentation is an important legal and professional requirement for all health professionals. They include information which describes all aspects of patient's care. But, despite the importance of medical records to support better quality service provided at the health facilities, incomplete documentation is very common all over the world.
Objective of the study: to assess the documentation completeness level of the medical records in the different inpatient wards of Basrah General Hospital.
Methodology: The study was a descriptive cross-sectional one. Medical records of 268 inpatients from Basrah General Hospital during June 2016 were included from four departments of the hospital (medicine, surgery, pediatrics and obstetrics and gynecology). A standard Iraqi Ministry of Health inpatient medical record with a two-level scoring system for assessing the level of documentation completeness were used in the study.
Results: the overall documentation level for the medical records included in the study was generally poor in 78% of the records. Surgical department was found to be the worse in documenting patient's notes related to medical history, while Gynecology and Obstetrics department was found to be the worst in documenting the medical examination assessment and the physician's notes related to the patient's state and details of any improvement / deterioration of his/her condition.
Conclusions and recommendations: The present study confirmed obvious incompleteness of documenting medical data for inpatient records in Basrah General Hospital especially in the general surgery, internal medicine and Gynecology and Obstetrics words. This is specifically found for the Physician notes (patient’s state and details of any improvement/deterioration of the condition) and the Clinical pharmaceutical sheet. A hospital based quality improvement project to improve the medical record documentation completion is highly recommended to be implemented by the Quality Assurance Unit of Basrah Directorate of Health.

Self-reported hand contact dermatitis among female hairdressers in Basrah

The Medical Journal of Basrah University, Volume 36, Issue 2, Pages 60-65
DOI: 10.33762/mjbu.2018.159465

Background: Occupational skin diseases are common and deserve medical attention. Hairdressers are special risky group for skin diseases.
Objective: To determine the prevalence of self-reported hand contact dermatitis among female hairdressers in Basrah city.
Methods: Sixty one salons in Basrah city center were chosen randomly by using the systematic random sampling technique from a name’s list of registered salons in Basrah General Health Directorate. A convenient sample of female hairdressers was chosen from these salons.
A special questionnaire form prepared for the purpose of the study was used for collection of data from female hairdressers who agreed to participate in the study by direct interview.
Results: A total of 80 female hairdressers were included in the study. Their age ranged between 19 and 65 years old with a median age of 32.5 years. The prevalence of self- reported hand contact dermatitis or eczema among female hairdressers was 31.3%. It was significantly associated with the age and nationality of female hairdressers (P-value = 0.021 and 0.035 respectively). Furthermore, there was significant association between self- reported hand contact dermatitis and personal history of atopy (P-value < 0.001) and family history of atopy. (P-value=0.031).
Conclusions: The self- reported hand contact dermatitis is fairly common and associated significantly with age of female hairdressers, nationality, personal and family history of atopy. We recommend to enhance occupational health measures for the hairdressers with special alteration in the preventive aspects

Xanthomatous meningioma; a rare histological variant

The Medical Journal of Basrah University, Volume 36, Issue 2, Pages 66-70
DOI: 10.33762/mjbu.2018.159462

Introduction: Meningiomas are tumors of the central nervous system originating from the meningothelial tissues, the arachnoid cap cells of the cranium and spinal cord. According to the WHO classification system, grade 1 meningiomas are of nine subtypes. Xanthomatous meningioma is a rare histological variant of meningioma belong to the subtype "Metaplastic meningioma". The Meningioma with a predominantly xanthomatous cellular changes with lipid-laden vacuolated cytoplasm is classified as ‘’xanthomatous meningioma’’
Case report: A 61 year old patient presented with headache, disorientation and hemiparesis. Magnetic resonance imaging (MRI) shows large right parietal enhancing dural based convexity meningioma. The tumor resected enblock and the histological examination revealed features of classical meningioma with predominant areas of xanthomatous changes. Immunostaining for epithelial membrane antigen and vimentin wase positive in both xanthomatous foamy cells and meningothelial areas. GFAP was negative. CD 68 was positive in few scattered cells in the xanthomatous areas. Ki-67 index was 1% in the highly cellular area. The final histopathological diagnosis was xanthomatous meningioma, WHO grade I.
Conclusion: Xanthomatous meningioma is a rare variant of meningioma belongs to the subtype metaplastic meningioma. We present the case because it is an extremely rare worldwide.

Assessment of dipping status of systemic blood pressure by 24 hour Ambulatory Blood Pressure Monitoring (ABPM) in patients with features of optic nerve head (disc) changes of Optic Neuropathy

The Medical Journal of Basrah University, Volume 36, Issue 2, Pages 71-80
DOI: 10.33762/mjbu.2018.159466

Background: Optic neuropathy is a spectrum of disease of different etiology, and especially when associated with systemic disease like hypertension, where there is effect on auto regulation mechanism of the ocular perfusion.
Aim: To see the blood pressure behavior and dipping status by 24 hour Ambulatory Blood Pressure Monitoring among patients who were diagnosed to have features of secondary optic neuropathy whether they were hypertensive or not.
Methods: Ninety-four patients were included in a cross sectional study, and using specific exclusion criteria, 38 patients were having changes of optic neuropathy as diagnosed by optical coherence tomography, with 56 other patients as a control group. All were examined and investigated, and subjected to 24 hour Ambulatory Blood Pressure Monitoring test using specific device (CONTEC ™ - AUTOMATIC BP MONITER - MODEL: ABPM50) and the data from the device were displayed to the computer for measurement and analysis. The dipping status was calculated manually using a specific formula. The data, then fed to SPSS software version 20 for statistical analysis.
Results: There was no statistical significance for age, sex, BMI and other risk factors like hypertension, diabetes mellitus and dyslipidemia. Reverse or blunted response was common among hypertensive patients in both studied groups, but the P-value not significant.
Conclusion: This study showed that there was no specific BP dipping pattern by ABPM in the studied patients with optic neuropathy in our locality.

Facts about type 2 diabetes mellitus and its control in Misan Governorate. Single-center experience

The Medical Journal of Basrah University, Volume 36, Issue 2, Pages 81-86
DOI: 10.33762/mjbu.2018.159463

Background: Diabetes mellitus is a metabolic disease that can affect every system of the body particularly if it is not controlled for long period of time. Complications of diabetes can be halted or prevented by good metabolic control. Measures that are considered in the treatment of diabetes mellitus include; healthy diet, physical activity, blood sugar monitoring, compliance with drugs, and hygienic habits.
Aim of the study: The aim of present study is to shed light on the outcome of treatment and control of type2 diabetes mellitus (T2DM) among patients in Misan governorate.
Patients and methods: In this study, records of 336 patients with T2DM, followed up for one year, were reviewed. HbA1c levels at the first visit and every three months later on for one year were used to reflect glycemic control. Other parameters taken into consideration were; age, gender sex, duration of diabetes, and the type of treatment.
Results: It was found that only (24.1%) of patients, had reasonably good glycemic control, as reflected by HbA1c levels less than 7% with significantly more men than women. Better glycemic control was recognized among patients with disease duration from 6-10 years as compared to those with disease duration below 5 years or above 10 years.
Conclusion: Control of T2DM in our study is not so different from that in some other studies in other regions; also gender seems to have an impact on glycemic control, it was found that glycemic control was significantly better among men than women (P-value > 0.05).

Risk Factors and Neonatal Outcome among Preterm Birth at Basrah Central Hospitals

The Medical Journal of Basrah University, Volume 36, Issue 2, Pages 87-96
DOI: 10.33762/mjbu.2018.159467

Background: Preterm birth (PTB) is a major clinical problem associated with perinatal mortality and morbidity. The aim of the present study is to identify risk factors associated with preterm birth and neonatal outcome in Basrah, Iraq.
Material and Method: A prospective observational study was conducted over a period of one year from May 2014 to May 2015. About 1145 cases of preterm deliveries were studied in the three main central hospitals in Basra city (Basrah Maternity and Child Hospital, Al-Mwany Hospital and Al-Basrah Hospital). The probable risk factors and the neonatal outcome were recorded and analyzed.
Results: Incidence of preterm birth was 2.42%. Presence of factors like multiparty 73.6%, prior miscarriage 41.3%, inter pregnancy interval of < 1 year 39.1%, urinary tract infection 28.4%, cervical incompetence 12.1%, prior preterm birth 12.1%, multiple pregnancies 11.6%, poor socio-economic state were the most frequent risk factor associated with preterm birth. Perinatal death among preterm birth in the study group was 34.7%, antepartum haemorrhage and congenital abnormalities were the common causes of stillbirth, whereas respiratory distress syndrome was the common cause of early neonatal deaths. Neonatal death rate was 84.3% in babies with birth weight less than 1000 grams.
Conclusion: The commonest predisposing factors were multiparous, smoker and co smoker, previous miscarriage, inter-pregnancy interval less than one year, infection, and maternal age.

Effect of Azithromycin in Treatment of Cutaneous Leishmaniasis

The Medical Journal of Basrah University, Volume 36, Issue 2, Pages 97-102
DOI: 10.33762/mjbu.2018.159464

Introduction: Leishmaniasis is a vector born protozoal infection. Cutaneous leishmaniasis outbreak occurred during 2014 in Erbil governorate, Kurdistan-Iraq. First choice of its treatment is pentavalent antimony. Other options of treatment are available. Azithromycin is used as trial to be effective but human studies are lacking.
Patients and Methods: Prospective randomized open labeled interventional study conducted on 63 patients. The sample divided in to two groups. Group A received only intra-lesional sodium stibogluconate and the group B received combination therapy of intra-lesional sodium stibogluconate and azithromycin 500 mg orally. Follow up done for lesions’ healing at 6th week and at the end of 8th week of therapy.
Results: Nodular lesions were dominant morphology among the Lesions (71.5%). Lesions mostly were ulcerated (59%). Mean duration of lesions were 3 ± 1.1 and 2.4 ± 1.8 weeks in patients of group A and B respectively. At 6th week in patients of group A, there were 13(41.9%) patients with complete healing of the lesions, while in group B it was found in 23(71.8%) patients. At the end of 8th week group A patients showed complete healing in 21(67.7%) patients while in patients of group B complete healing found in 27(84.3%).
Conclusions: Results of this study concludes that combination therapy of azithromycin and intra-lesional sodium stibogluconate provides more therapeutic effect if compared with the effect of intra-lesional sodium stibogluconate alone.

Correlation of glycosylated haemoglobin (HbA1c) levels with subclinical atherosclerosis in patients with type 2 diabetes mellitus

The Medical Journal of Basrah University, Volume 36, Issue 2, Pages 103-114
DOI: 10.33762/mjbu.2018.159468

Background: The most common cause of mortality in people with diabetes is cardiovascular disease. The relation between glycosylated hemoglobin (HbA1c), a marker of glycemic control, and the development of subclinical atherosclerosis is debated. An acceptable indicator of subclinical atherosclerosis is the use of ultrasound to measure carotid intima-media thickness (CIMT).
Objective: To conduct a cross-sectional study exploring the correlation between HbA1c and subclinical atherosclerosis as reflected by the carotid intima-media thickness in patients with type 2 diabetes that had no history of an atherosclerotic cardiovascular disease (ischemic heart disease or cerebrovascular accident).
Methods: A total of 71, type 2 diabetic patients participated in this study. Demographic, anthropometric and laboratory measures of the participants were collected. CIMT values were measured by using a high-resolution ultrasound. Increased CIMT values were accepted as >0.9 mm. Participants were categorized into two groups according to CIMT values: a normal CIMT value of ≤ 0.9 mm group, and a high CIMT value of > 0.9 mm group. HbA1c and other collected variables were compared between normal and increased CIMT groups. Furthermore, subgroup analysis was carried out for patients with poor glycemic control (HbA1c>9%).
Results: The mean CIMT was 1.048 ± 0.14 mm, and approximately 79% of the included population had increased CIMT (> 0.9 mm). 49% of participants were poorly controlled (HbA1c > 9%) and 92% of those with poor glycaemic control had increased CIMT.
Correlation analysis of data belonging to participants with poor glycaemic control (HbA1c > 9%) showed a significant correlation between HbA1c levels and CIMT, with a correlation coefficient of 0.409 (P = 0.015). In addition, a significant correlation was found in our initial analysis between CIMT and age, with a value of 0.359 (P = 0.002).
Conclusion: This study revealed that HbA1c levels in patients with poor glycemic control are positively correlated with increased CIMT measures, which is an indicator of subclinical atherosclerosis (SCA). Moreover, increased age is found to be a predictor factor for the development of SCA and, consequently, adverse macrovascular outcomes in patients with T2D.
( (T2D.