IRAQI JOURNAL OF COMMUNITY MEDICINE

Dental caries is a common chronic disease affecting tooth of many subjects at different ages due to biofilm‑mediated oral bacterial infection. Streptococcus mutans is regarded as a pivotal cariogenic bacterium responsible for dental caries and plaque formation. It produces exopolysaccharides on the surface of the tooth promoting the colonization of cariogenic bacteria and dental biofilm development. Formation of this biofilm can be prevented by using different antimicrobial agents such as BlueM mouthwash, polypyrrole, natural flavonoids, and endocannabinoid anandamide.
Keywords: Biofilm, dental, mutants, Streptococcus

The gut microbiome significantly influences human health and disease, especially autoimmune disorders. During illness, the gut microbiota (GM) composition changes (dysbiosis), leading to disrupted communication between immune cells and microbiota, which can cause infections and activate autoimmune disorders. Gut bacteria are isolated from their host by a physical barrier, such as the epithelium lining the gut or the skin. Bacterial components such as lipopolysaccharides and bacterial antigens may stimulate an inflammatory response by activating and stimulating immune cells. Numerous variables influence the intestinal microbiota, including diet, age, geographical location, mode of delivery, antibiotic or probiotic consumption, and various medical conditions. Celiac disease (CD) is an immune‑mediated enteropathy that exhibits gluten sensitivity and induces an immune response upon gluten consumption. Children with CD typically exhibit abdominal distension, diarrhea, and failure to thrive. Extraintestinal signs may include anemia, tiredness, arthritis, infertility, liver failure, neuropathy, schizophrenia, or autism. This review provides a potential explanation of the GMs role in CD.
Keywords: Celiac disease, dysbiosis, gut microbiota, microbiota, probiotics

Social media (SM) has become an essential aspect of contemporary life, offering unique opportunities for connection, self‑expression, and
sharing. Although SM has the potential to benefit mental health, such as through increased social connection and support, it can also have
adverse effects on mental health, such as anxiety and depression. This article delves into the nuanced relationship between SM usage and
mental health. It seeks to critically evaluate the potential advantages and disadvantages that SM can have on individuals’ mental well‑being.
Moreover, it explores effective strategies for promoting healthy SM use and maintaining positive mental health in the age of digital technology.
It is concluded that the connection between SM use and mental health is multifaceted and complex and that individual and contextual factors
must be considered when examining the potential benefits and drawbacks of SM use on mental health. The potential advantages of SM use
include opportunities for social interaction, self‑expression, community sharing, continued learning, creativity, and inspiration. However,
excessive use of SM, exposure to harmful content, cyberbullying, and disinformation can have negative effects, such as feelings of loneliness,
stress, anxiety, depression, and even suicidal ideation. Strategies for promoting safe and healthy SM use are suggested, including reducing
time spent on SM and promoting positive social interactions online.
Keywords: Advantages, disadvantages, mental health, social media

The aging global population has led to a rise in cognitive impairments, including dementia, presenting significant communication challenges in health care. Effective communication with cognitively impaired older adults is vital for ensuring their understanding, cooperation, and well‑being. This narrative review explores evidence‑based communication strategies to enhance interactions with this vulnerable population. A comprehensive literature search was conducted across databases such as PubMed, Medline, and PsycINFO, covering publications from 2010 to December 2024. Findings highlight the importance of verbal communication strategies, including simplified language, clear articulation, repetition, and rephrasing, to address comprehension difficulties. Nonverbal approaches, such as maintaining eye contact, using appropriate gestures, and active listening, are equally critical in fostering trust and promoting therapeutic relationships. By tailoring communication to the unique needs of cognitively impaired individuals, healthcare professionals can enhance patient engagement, improve decision‑making, and ensure dignified care. This review underscores the necessity of integrating effective communication techniques into healthcare practices and emphasizes ongoing training for professionals to meet the challenges posed by the growing prevalence of cognitive impairments. These strategies are essential to improving patient outcomes and advancing the quality of geriatric care.
Keywords: Cognitive impairment, communication, dementia, geriatric care, older people

Background: Violence against women is a significant public health and medicolegal issue, affecting women’s full participation in society, leading to disability and death, particularly in societies where it is a socially accepted norm. Objectives: The study examines the trend and the incidence of fatal and nonfatal female domestic injuries in Iraq from 2010 to 2022. Subjects and Methods: A descriptive desk review was conducted on all records of females exposed to domestic violence as reported in the Iraqi Injury Surveillance System from 2010 to 2022. The population data of the country and provinces were obtained from the Ministry of Health and the Ministry of Planning. Results: Out of 848,665 injury records during the period between 2010 and 2022, 100,568 (11.9%) were fatal, 36,417 (36.2%) were domestic, and 41% were females. The incidence of fatal domestic violence rose steadily from 2010 to 2014, reached a plateau in 2019, and spiked again in 2020. Fatal female domestic injuries were more common among females younger than 30 years (65.5%), especially those aged 20–29 years. Females’ fatal domestic injury was 10.9%; the highest was 32% in 2010, and the lowest was 0% in 2011 and 2.4% in 2012. In 2020, it rose to 17.4%. The burn was the most frequent cause (43.1%) of fatal domestic injuries, followed by gunfire (16%) and then electric shocks (15.2%). Conclusion: Domestic violence against females spiked during the terroristic violence time in 2014 and the COVID-19 lockdown in 2020. Mass media campaigns and law enforcement to combat this phenomenon are urgently warranted.
Keywords: Domestic violence, fatal injuries, women

Background: Cesarean section (CS) is a life‑saving surgical procedure when certain complications arise during pregnancy and labor. Analysis of CS rates is useful for health institution to assess overall progress in maternal and fetal health and to plan emergency obstetric care and resource utilization. Objectives: The objective is to study the rate of CSs in Al‑Yarmouk Teaching Hospital in Baghdad and to study the indications of CSs during the study. Patients and Methods: A cross sectional study was conducted among 250 women admitted to Al‑Yarmouk Teaching Hospital and delivered by CS for various reasons, from March 1 to last of June 2022. Data were collected by interviewing with participation. Results: The rate of CS during the data collection period was 53.6%. Of these procedures 63.6% were elective. The main indications for elective CS were: previous CS 75.5%. Among the emergency CS, fetal distress was responsible for 28.6% of these operations. Conclusion: The rate of CS reported in this study was very high. The rate of planned CS is higher than that of emergency CS. Scarred uterus is the most common reasons for planned CS.
Keywords: Al‑yarmouk teaching hospital, CS, indication, rate

Background: Colonic polyps can be classified endoscopically as sessile (flat lesion) and pedunculated (a lesion with a stalk); however, the most important classification for treatment and prognosis is the histopathological one which divides polyps into adenomatous, serrated, juvenile/retention, inflammatory, mucosal, and hamartomatous polyps. Objective: The aim of this study is to detect the prevalence and types of colonic polyps removed during colonoscopic examination with their clinicopathological characteristics. Methods: A cross‑sectional retrospective study was performed to analyze the histopathological reports of 6364 colonoscopic biopsies received in the Pathology Laboratory at the Gastroenterology and Hepatology Teaching Hospital, Medical City/Baghdad/Iraq from January 1, 2020, to December 31, 2023. Results: The prevalence of colonic polyps detected during colonoscopies was 15.79% (1005/6364) which included 600 males and 405 females with mean age of 46.22 ± 19.002. The most common type was adenomatous polyp (49.9%). Other types are as follows: serrated polyp 20%, juvenile/retention polyp 13.7%, inflammatory polyp 11.3%, mucosal polyp 1.8%, hamartomatous polyp 1.8%, and others 1.5%. Conclusion: Colonic polyps are a common finding in patients undergoing colonoscopy. The most common type is adenomatous polyps (premalignant lesions). This type is common in the elderly men and is often large in size.
Keywords: Colonic polyps, colonoscopy, histopathological types, prevalence

Background: Chronic lymphocytic leukemia (CLL) is the most prevalent form of leukemia in the Western world, although it is less common in Asia. According to the annual report of cancer disease in Iraq in 2013, the incidence rate for all subtypes of leukemia in Iraq is 4.43 cases per 100,000, with CLL accounting for 5.34% of cases. Objective: The objective of this study was to assess the usefulness of high‑sensitivity C‑reactive protein (hsCRP) level against other clinical and laboratory parameters in both CLL and diffuse large B‑cell lymphoma (DLBCL). We assessed the prognostic signifi cance of pretreatment C‑reactive protein (CRP) concentration in CLL and DLBCL patients. Patient and Methods: A hospital‑based cohort study was conducted over the period of fifteen months from September 2019 to November 2020. This study was conducted in the hematology centers in Baghdad. We prospectively reviewed 30 patients with newly diagnosed CLL and 30 patients with DLBCL. hsCRP was estimated using immunoassay for both CLL and DLBCL patients. Results: The mean value of hsCRP for CLL was 5.47 ± 5.96 mg/L ranged from 0.3 to 28 and the mean value for DLBCL was 24.28 ± 24.59 mg/L ranged from (2.5 to 96). There was a significant statistical difference of pretreatment hsCRP between CLL and DLBCL patients (P = 0.0001). There was no association between pretreatment hsCRP concentration and the presence of Binet stage B/C disease (P = 0.081) and albumin concentration (P = 0.893), there was moderate association with lactate dehydrogenase (LDH) concentration (P = 0.046), whereas in DLBCL, there was no association between pretreatment high‑sensitive CRP concentration and presence of advanced Ann Arbor stage of disease (P = 0.064) and LDH concentration (P = 0.136). An increased hsCRP concentration was signifi cantly associated with the high IPI (P = 0.009). Increased hsCRP concentration was not associated with poorer outcomes than those patients with low CRP concentration whereas in DLBCL, the elevated level of pretreatment hsCRP was significantly associated with poorer outcomes (P = 0.064 and P = 0.001, respectively). Conclusion: Monitoring of hsCRP May not be valuable in CLL patients’ assessment or follow‑up, however, if it get an increase, there may be other causes rather than the disease itself like coinfection or secondary malignancy. Unlike DLBCL where hsCRP is attributed to disease progression and advanced IPI scoring. Disease outcome had not found to be associated with hsCRP in CLL but the reverse in DLBCL with the significant association.
Keywords: Chronic lymphocytic leukemia, C‑reactive protein, diffuse large B‑cell lymphoma

Objectives: To determine the knowledge, attitudes, and practices related to cervical cancer, its underlying causes, and preventive measures among women attending primary health care centers in Baghdad. Subjects and Methods: A descriptive cross-sectional study with analytic elements was carried out in 20 primary health care centers in Baghdad selected randomly during the period extended from January to May 2023. Four hundred ever-married women were interviewed by using a questionnaire form that include questions related to sociodemographic characteristics, cervical cancer causes, risk factors, and prevention. Results: More than half (53.3%) of the participants had a good knowledge score. Human papillomavirus (HPV) as an etiological agent for cervical cancer was mentioned by 6.5%, no one heard about HPV vaccine, 5.3% heard about cervical cancer screening, 3.5% ever had a Pap smear offered by their doctors who were their only source of information about Pap smear test. The risk of sexually transmitted infections (STI), smoking, hormonal contraception, menopause, early marriage, and male condoms were stated by: (96.5%), (94%), (93.3%), (64.5%), (53.8%), and (25.2%) of the participants, respectively. Conclusions: Knowledge about HPV, HPV vaccine, and cervical cancer screening among women in Baghdad was poor, while their knowledge about most of the risk factors for cervical cancer was good. Women in Baghdad have a positive attitude toward cervical cancer screening and the HPV vaccine, which was significantly associated with women’s knowledge.
Keywords: Attitudes, Baghdad, cervical cancer, knowledge, women

Background: Stunting affects school‑age children’s health, mental development, and academic performance. Thus, the purpose
of this study was to determine the prevalence of stunting among primary school‑age children in the governorate of Dhi Qar, Iraq.
Subjects and Methods: An institution‑based cross‑sectional study was done among school children of 6th‑grade students in primary schools
in Dhi Qar Governorate. Multistage random sampling was done to select the schools. Data on sociodemographic and chronic diseases of
children were collected using a structured questionnaire. Anthropometric measurements were done to assess the status of stunting. Data were
entered into Excel 356, then transformed to SPSS version 27 for further analysis. P < 0.05 was considered significant. Results: A total of 3054
school‑age children with the mean age of 144.07 ± 10.25 months participated in the study. The overall prevalence of stunting among primary
school children was 3.6%. Conclusion: Stunting was a major problem among school‑age children, but in Iraq depending on this study, there
is an acceptable rate of 3.6% which differs from global NGO results; thus, we must do more research to find the details of the prevalence of
stunting, not only in adolescents but in all other age groups.
Keywords: Nutritional status, prevalence, school‑age children, stunting

Background: Osteoarthritis (OA) and diabetes mellitus (DM) are two distinct chronic conditions that can significantly impact an individual’s
quality of life, there is evidence suggesting an interrelationship between the two, particularly with regard to their effects on the musculoskeletal
and metabolic systems. Aim of the Study: The aim of this study was to study the rate of knee OA in elderly patients with type 2 DM (T2DM)
in comparison to nondiabetic controls and to study the impact of DM on OA. Patients and Methods: A case–control study was conducted
at the geriatric care unit in Merjan Teaching Hospital and Al‑Iskenderia Hospital in Babil/Iraq. The study included 50 patients; known
cases of T2DM, whose ages range between 60 and 80 years old who were randomly enrolled in the study. The control group consists of
50 patients nondiabetics, matched for age with the patients’ group. The Kellgren and Lawrence system was used to classify the severity of OA.
Results: Diabetic patients had a higher rate of knee OA compared to the control group, with 84% of patients affected by OA, there was no
significant correlation between OA severity and key variables such as HbA1c, fasting blood sugar, or body mass index, there was no significant
association between glycemic control and OA progression. Conclusions: Old‑age patients with T2DM had a higher rate of OA compared with
nondiabetic controls. T2DM can be considered a predictor for the development of OA of the knee independent of age and other known risks
for OA. These findings strengthen the concept of a strong metabolic component in the pathogenesis of OA.
Keywords: Diabetes mellitus, geriatrics, osteoarthritis

Background: Crimean‑Congo hemorrhagic fever (CCHF) is an acute tick‑borne zoonotic viral disease that causes outbreaks in many
regions of the Middle East, Europe, Asia, and Africa, with a high case fatality rate of 10%–40%. Objective of the Study: To determine the
knowledge, attitude, and perceptions (KAP) among a sample of physicians toward CCHF infection in Baghdad/AL‑Karkh health directorate
and explore their association with sociodemographic data. Subjects and Methods: A descriptive cross‑sectional study was conducted among
526 physicians from four hospitals and six primary healthcare centers in two districts related to the Baghdad/AL‑Karkh health directorate from
March to December/2024. Through a self‑administered questionnaire covering demographic information, KAP of CCHF. Results: The study
included 526 participants, with 53.2% having moderate‑to‑good knowledge, significantly associated with older age, prolonged experience, and
working in primary healthcare centers. Good attitudes were observed in 60.1% of participants, particularly among females, family medicine
specialists, older age groups, and those with longer experience. Perceptions were good in 49.8% of physicians, with significant associations
with age being (18–25 years) and (50 years and above), female sex, and prolonged professional experience. Conclusion: More than half of the
physicians exhibited moderate‑to‑good knowledge and positive attitudes, while nearly half of them had good perceptions. Targeted training
programs and educational interventions are essential to enhance awareness and improve preparedness for CCHF outbreaks.
Keywords: Crimean‑Congo, hemorrhagic fever, knowledge