kufa Journal for Nursing sciences

Background and objectives: Non-compliance to treatment is the major obstacles to the success of the treatment of hypertension and poor control of hypertension in worldwide. The objective of this study was to assess the level of compliance to treatment and identified factors contributing to poor compliance among hypertensive in Erbil city.
Materials and Methods: a cross sectional study design was undertaken among 200 hypertensive in 2014, to collect the data, patients who met the inclusion criteria were selected and questionnaires were filled through interviewing. The questionnaire including demographic information and compliance to treatment, data analysis though descriptive and inferential statistical tests.
Result: shows that 45% of hypertensive patients were compliance to the treatment while 55% of them were non-compliance. Major factor for non-compliance is forgetfulness. There was a significant association between level of compliance and age (p=0.000), gender (p=0.003), level of education (p=0.000), duration of treatment (p=0.000), and duration of hypertension (p= 0.003) .also there was highly significant and positive relationship between compliance and benefit of treatment, barrier of treatment, severity of disease and susceptibility to complication. Finally the strongest predictor was reminder (cues of action) by advice from nurses.
Conclusion: According result of the study more than half of hypertensive patients were not compliance to treatment
Recommendation: Nurses should give education program to hypertensive patients about treatment compliance

Background: Cardiovascular diseases (CVD) continue to become a global health problem, and affect a millions of people worldwide. Also the cardiovascular diseases affect people at all ages and it's not just a disease of elderly.
Objectives: To assess of patients adherence to therapeutic recommendations after ischemic heart diseases. And to find out the association between the patients’ demographic and clinical data and their adherence to therapeutic recommendations.
Methodology: descriptive Study is carried out in Al-Najaf Health Directorate / Al-Sadder Medical City/ Al-Najaf Center for Heart Diseases and Surgery, from June, 5th, 2013 to April, 10th, 2014. A non-probability(purposive sample) of (102) patients with ischemic heart diseases (angina and myocardial infarction), were included in the study. The data are collected through the use of a questionnaire, which consists of three parts one includes Socio-demographic and clinical data form, part two, includes patients adherence to therapeutic recommendations form. The data were described statistically and analyzed through use of the descriptive and inferential statistical analysis approaches. Results The study results show that the patients with ischemic heart diseases are fairly adhere to therapeutic recommendations. And there is a significant relationship of the residency, gender, and the patients occupational status on their adherence to therapeutic recommendations.
Conclusion, There is a deficient in the patients' adherence to therapeutic recommendations.
Recommendations, An intensive comprehensive studies could be conducted to assess the patients adherence to therapeutic recommendations and the factors that may affect such adherence, with a suitable solutions for these factors to improve the level of patients adherence.

Background and Objectives: Anemia is a global health issue with disproportionately high prevalence in women in developing countries. In addition to being an independent risk factor for decreased quality of life and increased morbidity and mortality, anemia in women has been linked to unfavorable outcomes of pregnancy. It is the most common nutritional disorder in the world affecting 2 billion people worldwide with pregnant women particularly at risk. This study aimed to find out the association between severity of anemia with the following maternal factors: sociodemographic, medical and obstetrical history, diet and medication and clinical manifestation.
Methods: A descriptive study was conducted on 64 anemic pregnant women in Maternity Teaching Hospital/Erbil city, during the period Mar 1st to 30th June 2013. A purposive (non-probability) sampling was used. A questionnaire format was prepared by researchers which included following parts: sociodemographic data, medical and obstetrical history, diet pattern and medication, clinical manifestation and Hb level at admission.
Results: 57.8% of the study sample had moderate anemia during pregnancy. The majority of the study sample aged between 18-35 years, resident in urban area and were housewives. There was significant association between severity of anemia with urban residency and number of taking leafy green vegetable/week. There was no association between severity of anemia and following maternal factors: age, occupation, monthly salary income, educational level, previous medical and obstetrical history, current obstetrical history, diet pattern and medication. Data was analyzed by using percentage and chi square
Conclusions: Severity of anemia was associated with residency.
Recommendations: Work to increase the awareness programs to reduce the incidence of anemia during pregnancy Further studies have to done with more sample size because anemia during pregnancy is critical condition especially in case of severe anemia that increase the rate of morbidity and mortality

Background: the genetic factor of type 1 diabetes mellitus may play a key role in pathogenesis of that disorder, thus, diabetic siblings might prone into an impaired OGTT.
Objective: To determine whether diabetic Siblings might have an impaired glucose tolerance test in compare to normal control group.
Methodology: A case-control study was performed on 120 persons, they divided into three group which are diabetic, siblings and control (40 persons in each group), who attended to Al Zahraa Teaching Hospital /Diabetic Center in Al-Kut between the period of April; 2012 till April; 2013.
Results: OGTT performed on both diabetic siblings and control, results have showed that the Means of OGTT is highly Significant (P value = 0.000) in both Siblings and Control groups, whereas there were no Significant differences in the Means of differences of OGTT in both tested groups (Siblings and Control), P value = 0.288, although the Mean of differences of OGTT is higher in Siblings group (25.3250) than that in Control group (22.0750).
Conclusion: the inheritance factor play a key role in pathogenesis of type 1 diabetes mellitus since, diabetic siblings showed an impaired OGTT.
Recommendation: for early detection of diabetes, diabetic siblings must submit to a routine screening test by OGGT.

Objective: The study aims to examine knowledge acquisition, improvement in nursing students exposed to high fidelity human patient simulation manikins.
Methodology: This study, in which (80) fourth year nursing students participated, took place in a college of nursing. A quasi-experimental design was used to evaluate the effect of the level of manikin fidelity on knowledge acquisition and practice levels. Data were collected at three points in time: prior to the simulation, immediately after, and two weeks later.
Results: Differences in mean scores between the control and experimental groups for exams 1, 2 and 3 were calculated using independent t-tests and were statistically significant.
Conclusion: While the effects of simulation remain elusive, this study lays the foundation for further research. The findings present us with the notion that clinical experience in combination with simulation training may provide better performance outcomes.
Recommendation: Additional research with large cohorts of learners and the Knowledge gained of this study can provide better evidence as to the benefits of simulation-based training.

Background : silent and overt stroke comprise10-20% of complication of sickle cell disease. There was great risk of morbidity and mortality, some time with neurocognitive dysfunctions
Objective: to identify the most important risk factor for neurologic events using MRI and TCD as aid for diagnosis.,
Methodology: descriptive study carried out over one year period in al-zahraa hospital .thirty patients with sickle cell disease enrolled. All test done as part of follow up, which include ,serum ferritin, blood count, MRI, and TCD. Data was analyzed by using SSPS version 18.
Results: of total 30 patients enrolled, only one patient found to have overt stroke, two other with silent stroke and 14 patient got abnormal TCD study. Most of CNS events found in patients with low hemoglobin (p value 0.015), low red blood counts (p value 0.001), and those with high hemoglobin S concentration. Blood transfusion noticed to be protective against stroke.
Conclusion: risk of cerebral stroke was related to, severity of anemia ,high concentration of hemoglobin S
Recommendations: regular monitoring of cerebral blood flow by TCD and MRI decreased morbidity and mortality, together with improvement in social, and conditional affairs of patients.

Objectives: The present study was designed to verify the changes of adiponectin and resistin with oxidative stress in insulin resistant in diabetes mellitus type 2.
Methodology: To achieve this aim 60 patients with type 2 diabetes mellitus (24 male and 36 female ) of ages, 53.9 ± 12.4 years in addition to 30 apparently healthy individuals (13 males and 17 females) were enrolled. The concentration of fasting blood glucose, triglyceride, insulin, adiponectin, resistin and malondialdehyde (MDA) levels were measured. Fasting insulin concentration, adiponectin and resistin was measured by enzyme linked immunosorbantassay( ELISA). Fasting blood glucose and triglyceride levels were determined by enzymatic methods. Malondialdehyde (MDA) levels were measured by spectrophotometeric methods . Insulin resistance was evaluated by four methods .
Results: The results indicated that out of 60 patients, 49 (81%), 45 (75%), 33 (55%) and 32 (53%) were insulin resistant when they were evaluated by Homeostasis model assessment ( HOMA), Quantitative insulin sensitivity check index (QUICKI), McAuley's index (MCA) and fasting insulin(FI) indices respectively. The 49 insulin resistant type 2 diabetic patients (IRP) that obtained through the HOMA method were assessed for the alteration in the levels adiponectin, resistin and MDA. The analysis of the data revealed a significant decrease of adiponectin in the IRP group when compared with those of the insulin sensitive patients (ISP) and the control groups. Significant elevation of resistin levels were observed in the IRP group with respect to those of the control groups.
Conclusion: Insulin resistance was found to be significantly positively correlated with resistin, MDA and significantly negatively correlated with adiponectin levels in diabetic patients. Adiponectin exhibited insignificant negative correlation with resistin and significant negative correlation with MDA levels, while the level of resistin showed a significant positive correlation with MDA level in insulin resistant type 2 diabetics.
Recommendations: A study on of the effect free fatty acid on the activity of insulin degrading enzymes in obese individual.

Background: Patients with End-stage renal failure face many challenges due to their condition, which may leave them feel fatigued, depressed and lack in sleep quality associated with poor quality of life.
Objective: Determining the impact of fatigue and sleep quality upon the quality of life of haemodialysis recipient patients.
Methodology: The study was conducted in haemodialysis unit at Sohag University Hospital of January 2014 to June 2014. A purposive sample of 221 patients with ESRD were treated by Haemodialysis. Personal Information Form (PIF), QoL Short Forme-36 (SF-36), Pittsburgh Sleep Quality Index (PSQI) and Fatigue Severity Scale (FSS) tools are used for data collection. Data was analyzed through descriptive statistical approach(frequency and percentage) and inferential approach (mean of score, Pearson correlation coefficient, ANOVA test and independent samples t-test).
Results: The mean age ± SD of patients was 42.3 ± 13.1 years. The study found that 87.3% of patients were poor sleepers (global PSQI ≥5), 84.2% were suffering of fatigue, and quality of life mean was 33.6 ±17.5. According to age and sex, it was found that the younger and male patients were less complaining of fatigue and poor sleep. They have better quality of life compared to other groups. There was a significant positive correlation between age and both physical and mental components scores, sleep and fatigue. Also a negative correlation was found between physical and mental components scores and sleep and fatigue.
Conclusions: Haemodialysis patients had poor quality of mental and physical health. The quality of life was impaired as seen by poor sleep and fatigue. It is suggested that these patients require the attention of health caregivers for the need of possible psychological support.

Objectives: The main aim of the study is to evaluate the effectiveness of an educational program on nurses knowledge concerning side effect of radiotherapy
Methodology: Quiz experimental study was carried out at Al Amal National Hospital for Cancer Management in 4th, November 2013 to 29th August, 2014. The program and instruments were constructed by the researcher for the purpose of the study. Purposive random sample comprised of (60) nurses was divided into two groups, study group consisted of (30) nurses exposed to the nursing educational program and control group consisted of (30) nurses were not exposed to the program. The measurement of effectiveness of nursing educational program through the nurses knowledge questionnaire includes (30) items concerning side effect of radiotherapy. Reliability of instrument was determined and the instrument validity was determined through a panel of experts. The analysis of the data was used descriptive statistics (frequencies, percentages, the arithmetic mean and standard deviations relative sufficiently) and statistical inferential (T-Test, Fisher Test, Chi Square) In order to find the differences between the experimental group and the control group.
Results: The study findings indicated that, there were highly significant differences between study and control groups and also between pre and posttests in case group in overall main domains related to nurses knowledge concerning side effect of radiotherapy of cancer patients treatment.
Conclusion: The study concluded that the effectiveness of educational program regarding nurses knowledge concerning side effect of radiotherapy is a positive.
Recommendation: Intensive studies to provide nursing intervention for cancer patients under radiotherapy and an education program should be conducted of nurse's practice toward side effect of radiotherapy.

Objective: The study aims to evaluate the nursing intervention provided to patients undergoing chemotherapy, and determine the relationship between nursing intervention and the demographic characteristics of the nurses that include (age, gender, level of education, years of experience in nursing, years of experience in chemotherapy units, sharing in training sessions concerned to chemotherapy, number of training sessions)
Methodology: Descriptive study carried out during the period of (January 2013 until August 2014) to evaluate the nursing intervention provided to patients undergoing chemotherapy pre and post nursing care, The study has been conducted on nurses who were working in chemotherapy units in AL _ Amal National Hospital for Cancer Management, Oncology Teaching Hospital, and Baghdad Teaching Hospital. Included research sample (70) of the nurses who were working in units of chemotherapy. Where the data was collected after it was built form questionnaire by the researcher related to the purposes of the study and is composed of two main parts. The first part concerned with determination of the demographic characteristics of the nurse's who have participated in the study through special sheet which include (7) items. The second part consists of evaluating nursing interventions for cancer patients undergoing chemotherapy include (12) items. The validity of the questionnaire was examined through (17) experts in the different fields (who have had more than 5 years of experience in the job field). The stability by calculating the Pearson correlation coefficient, which was worth acceptable statistically ( r=0.85 ) and data was collected through observation, after it has been analyzed data from through the application of descriptive analysis (frequency, percentage) as well as Inferential data analysis (Means of scores and Pearson correlation coefficient). using the statistical bag of Social Sciences, version nineteenth.
Result: The study showed that the majority of the sample of the age group between (40-49) years old, Most of the study sample were Female, Most of them graduates from Secondary nursing school, they have Years of experience in nursing (1-5) Year, Years of experience in units of chemotherapy (1-5) year, Experience gained in the chemotherapy by Working with patients undergoing chemotherapy, and the Most of the sample did not take any training session .
Conclusion: The study concluded that there is a strong indication in the area of the creation of chemotherapy and nursing intervention provided by the nursing staff in those units.

Recommendation: The study Recommended to organize Special training courses to all nurses working in units of chemotherapy, which include programs for special courses for nursing interventions in these units and designing and distributing a booklet to all nurses who work in chemotherapy units, also increasing the number of professional nurses graduates from colleges of nursing in chemotherapy

Objective: This study aim to diagnosis the types of bacteria Ureaplasmaspp and Mycoplasma hominis by
screening for multiple banding antigen (MBA) gene and 16S rRNA respectively in seminal fluid by using the multiplex-PCR technique.
Methodology: The study included, a total (106) semen fluid samples, were collected of 86 infertile men which have been diagnosed by specialized clinicians specialization in infertility and 20 other semen fluid samples of healthy men used as control through six months (November 2013 until April 2014). All these Date was analyzed by using spss (T-test) program All these samples were obtained of subjects who attended to center infertility in medical city at Al-Sadar in Najaf province.
Results: The result of the multiplex-PCR revealed positive results in 13 (15.1%) of the 86 seminal fluid samples from infertile patients which represented M. hominis 5(5.8%), U. urealyticum in 5 (5.8%) and U. parvum 3 (3.5%).
Conclusion: in light of the results obtained this study we concludes that the efficiency of multiplex-PCR large and rapid in diagnosis of Ureaplasmaspp and Mycoplasma hominis in seminal fluid.
Recommendation: the study of detection of other microorganism (viruses, fungi, Chlamydia and Neisseria gonorrhea) in men infertility.

Objective: The study aimed to assess secure attachment to mothers and the social fear, in kindergartens' children in Babylon city.
Methodology: A descriptive-analytic study was conducted on kindergarten children in the Babylon city. The study was carried out through the period of March-April, 2011. Which consist of 100 child to assess the secure attachment and social fear to Mother of kindergarten children both gender (male and female). The questionnaire was consisted of three parts: the first part is concerned demographic characteristics of the mothers that included (age of mother, level of education, income). and characteristic of child: the consists of general information, such as order of child in the family, gender, type of class, the second one consists of 27 items concern with secure attachments and the third one consists of 21 items concerned with the social fear. The validity and reliability of the instrument was determined by using through the panel of experts, and internal consistency through the computation of Alpha Correlation Coefficient. The data have been collected through the utilization of the interview. Data were analyzed through the application of descriptive statistical (frequencies and percentages).and inferential analysis chi2 by applying the Statistical Package for Social Science version 21.0 (SPSS)
Result: The finding of the study showed that (37%) the of the sample was mother, aged 50 years and more. The result show that children have attached security and fear social moderate and there is no statistically significant relationship with other variables.
Conclusion: The study concluded that kindergarten children have moderate level of secure attachment and social fear significant
Recommendation: Researcher recommended educating mothers in correct methods for dealing with children, especially kindergarten teachers.

Background: Adequate nutrition during infancy and early childhood is essential to ensure the growth, health, and development of children to their full potential. It has been recognized worldwide that breastfeeding is beneficial for both the mother and child, as breast milk is considered the best source of nutrition for an infant.
Objective: To find out the impact of infant feeding pattern on growth parameter.
Methodology: An evolutional study was conducted at Azady Health Care Center during the period of early June to late August 2014 on 100 infants. Data were gathered by a combination of a structured questionnaire and measurements of length (or height), and weight. Results were analyzed by using SPSS Version 19.
Results: Out of 100 study subjects, 54% were female with 59 (59%) age group of 4-6 months. most of mothers’ ages (66 %) were between 21-30 years. Majority of infants are on Mixed Feeding 55 (55.0%), while 35 (35.0%) and 10 (10.0%) on Exclusive Breast and Bottle Feeding respectively. According to length/height-for-age index, 52.0% of subjects were within normal range and 34% of them were risk for stunted, 62% of infants were within normal range and 27.0% risk for underweight of weight for age, as weight-for-length/height 47.0% of them were within normal range, 24.0% risk for wasted and 22.0% risk for overweight. Statistically there is significant association between infant feeding with weight for age and weight for length Z-score in contrast there is no significant association between infant feeding with length for age Z-score.
Conclusion: the study presented that there was relationship between infant feeding pattern and growth parameter (weight for age and weight for length Z-score).
Recommendation: encouraging the mothers to continue visiting Health Care Center for monitoring growth and give exclusive breast feeding at least for 1st six months and after that can start by supplementary feeding.

Objective: To assess the psychological problems in patients with acute myelogenous leukemia, and to find out the relationship between socio-demographic characteristics such as (age, sex, marital status, educational level, and occupation) and psychological problems for those patients.
Methodology: A descriptive study used the assessment approach of 20th September 2014 to 30th November 2014 in order to study the psychological problems in acute myelogenous leukemia patients with the psychological problems. Non probability (purposive) sample is selected for the study which includes (50) patients diagnosed with acute myelogenous leukemia were treated at Baghdad teaching hospital and City Imams Kazimain Teaching Hospital or the patients who visited the outpatient clinic in the same hospital for medical follow-up and further treatment. Data were gathered through the patients` interviewed. Assessment questionnaire consist of two parts contains demographic characteristic, the other part concerning about assessment the psychological problems for patients with acute myelogenous leukemia. Reliability and validity of this tool is determined through application of a pilot study and panel of experts. Data were analyzed through the application of descriptive statistical (frequencies and percentages), inferential statistical (chi square).
Results: The Overall results revealed that the psychological problems in acute myelogenous leukemia patients with psychological problems was unacceptable, and there is significant correlation between the psychological problems related for these patients and was region (residency) of patients.
Conclusions: The study concluded that the majority of the items related to psychological problems for patients with acute myeloid leukemia were low or out of the comparison, reflecting the ferocity of those problems.
Recommendations: The study recommended to increase awareness and psychological education for patients with acute myelogenous leukemia.

Aim of study: This study aimed to detected the presence of the plasmid mediated quinolone resistance genes in quinolone resistant Klebsiella pneumoniae isolates in clinical and environmental hospital samples.
Methodology: A total of 195 clinical samples of different sources and 50 environmental hospital samples were collected of three main hospitals in Al-Najaf city .K. pneumoniae was identified depending on cultural and traditional biochemical tests, then confirmed by API 20E system. Phenotype detecting of quinolone resistance in K. pneumoniae isolates were carried out by growing on MacConkey agar supplemented with 10µg/ml Ciprofloxacin. Antibiotic susceptibility performed by disk diffusion. Quinolones resistant isolates were selected for molecular study for detecting aac (6 ')-Ib-cr, qepA, qnrS and qnrB as plasmid mediated resistance genes using Multiplex polymerase chain reaction
Results: Eighty-nine isolates were identified as .K. pneumoniae. Thirty-four (38%) resist ciprofloxacin (10µg/ml ) and were resistant to at least fourteen antibiotics to which they are tested. Hence, all isolates were considered to be multidrug resistant (MDR). The results of detection the plasmod mediated antibiotic resistance genes revealed the widely distribution aac (6 ')-Ib-cr gene alone or combined with qnrS gene in 14 (41.18%) isolates, or with qepA (2.94%) and 8.82% of bacterial isolates carried aac (6 ')-Ib-cr, qepA and qnrS whereas only one isolates (29.41%) that caused wound infection showed the presence of qnrB gene.
Conclusions :High prevalence MDR K. pneumoniae harbouring PMQR mediated by aac(6`)-Ib-cr and qnrS. This study is the first trail to detect PMQR genes in clinical and environmental isolates of K. pneumoniae in Iraq.
Recommendations: Further studies are necessary to understand the dissemination of plasmid mediated genes (qnr, aac (6`)-Ib-cr and qepA gene) and chromosomal resistance among K. pneumoniae and other common pathogenic bacteria.

Objectives: this study aims to assess Anxiety and Depression level of renal failure patients undergoing hemodialysis and to find out the relationship between anxiety and depression of renal failure patients undergoing hemodialysis and their socio demographic characteristics.
Methodology: A descriptive analytical study was carried out at Al-Sadder Teaching Hospital, Hemodialysis Unit , in February, 9th, 2014 to May, 15th, 2014, in order to assess anxiety and depression level of renal failure patients undergoing hemodialysis, and to identify the significant variance in the level of psychological distress with regard to socio demographic characteristics. A non-probability ( Purposive sample ) of ( 60 ) renal failure patients were selected of hemodialysis unit at Al-Amarah City. A questionnaire was adopted and developed for the purpose of the study which consists of three parts; the first part concerning the socio demographic characteristics of patients; the second part deals with the clinical characteristics for patients; and the third part of the questionnaire was (HADS) scale which consists of 14 items. Reliability of the questionnaire is determined through a pilot study and the validity is achieved through a panel of (15) experts. The data was described statistically and analyzed through using of the descriptive and inferential statistical analysis procedures.
Results: The results of the present study indicated that the patients have moderate level of anxiety and severe level of depression according to HADS scale, also the study indicated that the socio demographic characteristics have a significant impact on psychological distress level (Anxiety and Depression level).
Conclusion: The present study concludes that anxiety and depression are the most common co morbid psychiatric disorders in patients who have renal failure, and there is a relationship between anxiety and depression level of renal failure patients and their socio demographic characteristic.
Recommendations: The study recommends Increasing the level of awareness for renal failure patients and their families about the nature and type of disease to minimize their distress, Psycho educational programs to improve their psychological and emotional status, the training of nursing staff on how to deal with patients to help them overcome the psychological problems.

Objective: The aims of present study to assess the risk factors for heart surgery patients on duration of intubation of mechanical ventilation and to find the relationship between the duration of mechanical ventilation after the operation with preoperative risk factors.
Methodology: descriptive study (purposive) conducted in the Ibn-Al-Bettar center for cardiac surgery in the city of Baghdad for the duration of the tenth of October 2013 until the twentieth of August 2014 and the sample was selected object-non-probability for 100 patients after surgical intervention and the survival of the patient on a mechanical ventilation for 12 hours and more and collected information of patients charts and fill out the questionnaire consisting of two parts, as its first part on information medical history and surgical treatment of the patient and the second part of the seven items included (preoperative risk factors were identified reliability resolution by measuring the congruence of internal between the vertebrae after applying gauge Cronbach Alpha and equal = 0.796 and identified validity through 19 experts of specialists and data analysis were used descriptive statistics which included frequencies, percentages, and the mean, standard deviation and statistics inferential, which included independent sample t-test and Anova test .
Results: The results of the present study that most of the members of the sample were males between the ages of (48-78) years and that (48%) of the sample have diabetes, and (66%) of the patients had high blood pressure, and it was mostly has high the proportion of fat in the blood, (64%) of the patients had angina pectoris, and that (37%) of the patients have a valve diseases,. In related to risk factors there was a relationship between the duration of stay on mechanical ventilation with age, sex, level significantly less or equal. 0.05.
Conclusions: The increased age and the gender seem to be strongly associated with delayed tracheal extubating contributing to the early prediction of high risk patients for prolonged ventilation.
Recommendations: Based "on the results of the current study, the researchers recommended to follow a fast-tarck protocol for the purpose of patient care after cardiac surgery, especially in the process of weaning patient in mechanical ventilation device down to remove it.

Background: Microbial exposures have been suggested to confer protection from allergic disorders, and reduced exposures to gastrointestinal microbes have been proposed as an explanation for the increase in asthma severity and prevalence. Since the general prevalence of Helicobacter pylori has been decreasing, we hypothesized that H. pylori serostatus may be inversely related to the severity of asthma.
Objective: The aim of this study is to find whether infection with H. pylori reduces the probability of development of severe asthma in patients with persistent asthma.
Methodology: In this study fifty patients with persistent asthma includes 19 males and 31 females their ages range between (17 – 66) years For all those patients, full history and complete physical examination have been done, then after, the patients subjected to pulmonary function test. After that, two milliliters sample of venous blood have been drawn, then, the sample centrifuged and sent to assess for H. pylori infection serology. Data was analyzed by using SPSS.
Results: There is significant association between severity of asthma and result of H. pylori so with increase severity of asthma there is decrease in percentage of positive H. pylori serology. And there is no statistical significant are noted between patients sex or age and results of H. pylori infection test.
Conclusion: There is significant inverse association between severity of asthma and result of H. pylori infection serology. This association not affected by ages and sex of patients.
Recommendations: Since the exact mechanism by which H. pylori affect asthma is not clear, there is need for further studies to explore it.

Objectives: Assess women's Knowledge about Advanced Maternal Age and Pregnancy outcome.
Methodology: A descriptive study using the assessment approach was conduct on women, who ages above 35 years old. A purposive (non-probability) sample of (58) women's that was selected for study in Azady teaching hospital and Kirkuk general hospital in the period of July 1st 2013 to April 10th 2014. A questionnaire was developed for the purpose of study
Result: The study findings demonstrate that the following variable was contributing significantly in the occurrence of complications during late motherhood among the study sample which include (age, late marred, level of education, smoking, and consanguinity). In sequence (67.3 %, 33%, 27.1%, 27.5%, 63.7%) The findings indicate that the women knowledge about risk of advanced maternal age generally is good for knowledge scale items.
Conclusions: Late marred of girls can be interrupted as a one sources of late motherhood mortality and morbidity, More than half of the study sample has high level of knowledge about risk of their age on pregnancy outcome.
Recommendation: Continuous education & training courses for health team especially to improve their knowledge and to take their roles in teaching and giving advice & instructions to pregnant women during certain age. And encourage the females about early marriage, and explain the risks of late marriage on both the baby and the woman.

Objectives: To assess of Science Teachers' Awareness towards immunity and immunization in Baghdad City Primary Schools.
Methodology: A descriptive study was conducted, included (100) primary school, (50) in Al Rassafa sector, and (50) in Al Karkh sector, in March 5th 2012 to March 15th 2013, to assess of science teachers' awareness towards immunity and immunization. A cluster sample of (100) Science teachers (males and females) were selected, as one teacher from each school. A questioner format was used for data collection. The validity of questioner was estimated through a penal of experts related to the field of study, and its reliability was estimated through a pilot study conducted in (20) schools is excluded of the original sample which included (20) teachers in April 8th 2012 to April 14th 2012. Data were analyzed through the application of descriptive and inferential statistical analysis.
Results: The results of the study indicated that (78%) of sample were female, and (39%) of them their ages were between (30-39) years old, (65%) of them were married, while (21%) of them were single, and (50%) of them were institute graduates. Also the study indicated that (26%) of teachers had (15-19) years of employment in teaching sector. Furthermore, (58 %) of sample had no opportunity to be involved in training courses concerning communicable diseases control. The results of this study indicate that, teachers' awareness was poor (in adequate awareness) towards immunity and immunization against communicable diseases in Baghdad City Primary Schools.
Conclusion: The study concluded that teachers' awareness towards immunity and immunization in Baghdad primary schools was poor.
Recommendations: The study recommends that there is a need for cooperation between the Ministry of Health and the Ministry of Education on writing a book systematically for primary schools about the nature of the transitional diseases and how to control them through immunity and immunization, and Emphasis on continuous sessions concerning communicable diseases control for teachers in all primary schools.

Background: Bladder cancer is one of the most common human cancers in Iraq and the world. While smoking, age, gender, and occupational exposure to aromatic amines are the most prominent among the risk factors identified, long term Inflammation and chronic infection may largely play some role in urinary bladder cancer (UBC) development. The association between bacterial inflammation and cancer appears to be stronger especially in chronic type of infection, many studies mentioned the role of chronic Escherichia coli (E. coli) infection and UBC but there was no study mentioned the role of chronic Mycobacterium tuberculosis (MTB) infection in association with UBC. There are many cellular and immune responses that occur during chronic Mycobacterial infection such as irritation, long term inflammatory cytokine production and DNA damaging due to bacterial metabolic products are some factors that may give chance for UB neoplastic changes. In the present study we worked on urinary bladder cancer and noncancerous Formalin-Fixed Paraffin Embedded (FFPE) Tissue specimens of Iraqi patients, the current study used polymerase chain reaction (PCR) for detection of Mycobacterium tuberculosis genome.
Objectives: investigation for the role of Mycobacterium tuberculosis and its association with urinary bladder cancer.
Methodology: The current study used urinary bladder cancer (UBC) formalin-fixed paraffin embedded tissues (FFPET) specimens of Iraqi patients collected of several private histopathology labs in AL-Najaf Governorate, the specimens were 50 samples of UBC patients and 25 different noncancerous pathological bladder samples. 84% of UBC cases were male and the predominant age group was 61-80 years (60%) for both gender. low grade cases were the most common which recorded (64%) and they were mostly TaN0M0 staging (42%). Large part of the study was performed at the Medical Education Research Facility (MERF)/ Carver collage of medicine/ University of Iowa/ United States of America. Samples of DNA were extracted and DNA quantitation was performed using Nanodrop DNA quality was evaluated using human β-globin gene amplification.
Results: human β-globin gene amplification used in DNA quality evaluation, PCR results showed that 80% of samples were β-globin positive and many samples showed appearance of multiple copies. Detection of Mycobacterium tuberculosis complex (MTBC) DNA using IS6110-PCR amplification showed 33% of UBC samples with positive results and 4% of noncancerous samples showed positive result, with high significant difference P<0.01. Identification of MTB subspecies was performed using Internal Transcribed Spacer Regions PCR (ITS-PCR), 55.56% of UBC IS6110-PCR positive cases were ITS-PCR positive.
Conclusions: A high percentage of MTBC and MTB detected among patients with UBC in comparison to noncancerous cases, suggesting that MTBC- associated bladder carcinoma is a proposed specific entity of bladder cancer which need to be more clarified.
Recommendations: Modern techniques should be used for MTBC and MTB detection in laboratories and further study for the relationship between chronic MTB infection and UBC.

Backgrounds: Upper respiratory tract infections are common in children. The cause of these infections are usually viral, but parents attitudes often contribute to inappropriate prescription of antibiotics, promoting antibiotic resistance, which is an important growing global health problem. In addition to that, lead to increase the burden of chronic diseases, rising costs of health services and the development of side effects (e.g. adverse gastrointestinal effects) which are more significant in children.
Objectives: identifying possible associated factors with antibiotic misuse among parents who attended primary health care in Al-Najaf province.
Methods: A cross-sectional study was carried out in Al-Najaf during the period of the first of March to the first of June 2014. Two primary health care centers were randomly selected and 431 fathers and mothers who attended these centers were inter viewed and randomly selected by systematic random sample technique, data collection were done twice weekly during the period of the study. Data was gathered through structured questionnaire which was used to identify different variables by face to face interview.
Results: There was positive significant association between mean knowledge score (11.09± 2.94) and mean attitude scores (13.87±3.59), between mean knowledge (11.09± 2.94) and mean practice score (8.77± 2.31) and between mean attitude scores (13.87±3.59) and mean practice score (8.77± 2.31) (p<0.001). The associated factors of AB misuse in children with URTI among Al Najaf parents being a young age parent (P=0.001), having low educational level(P<0.001), being a self-employed (P=0.001). And residence in a rural area (P=0.002) which are significantly associated to inadequate knowledge, inappropriate attitudes, and wrong practices.
Conclusions: This study has identified the main groups of parents that should be targeted in future intervention programs. These groups are small age parents, those with low educational level, self-employed and those who live in rural area.
Recommendation: Health education campaigns, medical staff education as well as public awareness campaigns are needed to explain the role of antibiotics in URTI treatment .And stronger legal restrictions should be introduced on the selling of antibiotics in community pharmacies according to special guidelines recommended by the ministry of health.

Objective of The study: The study aims to assess the of blood pressure in hypervelocity patients, and find out the relationship between of blood pressure and secondary polycythemia
Methodology: descriptive design study was starting in 1st of July 2014 to the 1st of September 2014. The study conducted on 54 persons who attended to blood bank to blood donation. The instruments were composed of four parts. The first part was concerned with the socio-demographic characteristics, second part deals the past and present medical history, third part was a personal behavior, and fourth part consist of the measuring hemoglobin level , and Blood Pressure before and after blood donation, the data was collected by using personal interview by responders to fill the personal socio-demographic characteristics, and medical problems, and the researchers measure the hemoglobin level for the persons before blood donation, and measure the blood pressure before and after donation and the data was analyzed by the application of descriptive and inferential statistical methods.
Results: The results revealed that the demographic characteristics of the study sample was 96.3% were males, 22.2% of them at age 23-27 years old, 68.5% were married, 35.2% graduated of secondary school, 37% of them was employment, and 44.4% of them sufficient income, smoking history for the study sample was revealed that 100% of them was smoker, 64.8% of them continues of smoking, 94.3% was intermittent to smoking, 87% of them was used the water pipe, 18.5% of them continuous to used and 90.8% was intermittent for water pipe used.
Conclusion: the study concluded that the range of blood pressure reading for the study sample was changes of before to after blood draw and it is reduced the percent of high blood pressure after blood draw, that there were significant relationship between high level of hemoglobin and elevation of blood pressure at P≥0.05 value.
Recommendation: Based on the findings of present study the researcher recommended to implementing effective strategies to control tobacco exposure, measurement of carboxyhemoglobin should be a routine part of the evaluation of all hypervelocity patients, and labor sticking to increase recreation centers and arenas dedicated to sport.

Background: Viral infections such as Rubella and Cytomegalovirus are feared risk during pregnancy. Rubella and Cytomegalovirus virus are fairly the respective major diagnostic issues in pregnancy, the laboratory diagnosis, and its rational use in combination with clinical information are presented, also the value of passive prophylaxis, therapy, and prenatal diagnosis as well as the possible management for diminishing the infection problems in pregnancy.
Aims of study: The study was aimed to evaluate the ELISA result for rubella and cytomegalovirus (CMV) IgM and IgG and compare the results of the ELISA with RT-PCR to arbitrate discordant results.
Methodology: The present study was carried out on 57 pregnant women, all of them had bad obstetric history (BOH). Patients were between 15-40 years old, and they were attending Al- Zahra Teaching Hospital during the period of May 2012 till May 2013. Serological evaluation for Rubella Cytomegalovirus infections were carried out by using IgM and IgG Enzyme Linked Immunosorbent Assay (ELISA ) method and molecular technique (Real Time - PCR).
Results :The results showed 12 patients (21.1%) were Seropositive for Rubella virus IgM, and 46 ( 80.7%) were Seropositive for Rubella virus IgG, while only 24 (42.1%) were Seropositive for both IgG and IgM at same time. In this study 2 patients ( 7.69 %) were Seropositive for both Rubella IgM and Cytomegalovirus together and 12 ( 30 %) were Seropositive for both Rubella IgG and Cytomegalovirus IgG. Regarding to Rubella infection ,the results showed that 12 (21.1%) were seropositive for Rubella IgM and 26 (45.6 %) were seropositive for Rubella IgG , while only 6 (17.5%) were seropositive for both IgM and IgG. The Real Time PCR results showed only 6( 10.5% ) were positive for Rubella virus and 3 (5.26 %) were positive for Cytomegalovirus .
Conclusion: The accurate diagnosis of Rubella and Cytomegalovirus infection should be done by molecular method and not based on ELISA test which should be used as screening test .
Recommendations :Advice the gynecologist to take care before give management for pregnant women that present with more than one infection at same time unless confirm the diagnosis by more than one technique like RT-PCR .

Objective: To evaluate the impact of the nurses' knowledge staff concerning the infection control at primary health care centers in AL-Amara city.
Methodology: A descriptive study design was carried out in primary health care centers of 17th October, 2014 to August, 2014. The instruments was constructed by the researcher to reach the aims of the study using a non-probability sampling: purposive sample consist of (70) nurses, who worked in immunization unit and dressing unit at primary health care centers in AL-Amara city was selected, and Two study instruments were utilized for proper data collection [questionnaire and demographic information]; the study Reliability of instrument was determined through the use of test and retest and the instrument validity was determined through a panel of experts. The analysis of the data was used descriptive statistics (frequencies, percentages, the arithmetic mean and standard deviation) and statistical inferential (chi square).
Results: The results of the study revealed that (52.9%) at age groups (40) years and more years,. The findings of the present study indicated that (65.7%) of the sample were males and (47.2%) are Nursing institute graduate, (74.3%) have (1-5) years of experience, and (58.6%) have Training courses.
Conclusion: The study findings indicated that there were highly significant between nurses' knowledge in all domains related to infection control.
Recommendation: Encourage nurses and motivate them to participate in training programs and conferences held by specialists in infection control to update their knowledge about infection control.

Background: Colonic polyps are slow-growing overgrowth that projects above the surrounding mucosa's of the colon that carry a small risk (< 1%) of becoming malignant. However, because colonic polyps are highly prevalent in the general population (especially with increasing age), they confer an important predisposition to colon cancer and are therefore removed when detected. The distribution of Ki67 and p53 as markers of cell proliferation is very studied in Colorectal Carcinoma. In Iraq, IHC studies to detect p53 & ki-67 expression in GIT malignancy has been conducted.
Aims of the study: To detect the expression of p53 & ki-67 in colonic polyps patient by immunohistochemistry. To assess the possible correlation between p53 &ki-67 in colonic polyps patient. To detect the possibility of conversion of pre-malignant colonic polyps to malignant form.
Methodology: Fifty cases (27 male and 23 female ) were selected randomly with different types of colonic polyps were included in this study and using descriptive study. The age of patients were ranging from 4 up to 80 years, with mean age of [ 46.3 ] years. Cases were collected from the laboratory of histopathology in Al-sadder Medical city in Al-Najaf and from some private laboratories in the same governorate(Al-Najaf). the data analyzed by qi squared.
Result: There is a significant correlation between P53 & age ,p53 & type of polyp also there is a significant correlation between Ki-67& age, Ki-67 & type of colonic polyp .There is a correlation between ki67 & p53.
Conclusion: The study represent a trial to understand the probable conversion of polyps to colorectal carcinoma and the role of P53 & KI-67 in genesis of colorectal carcinoma.
Recommendation: Screen and follow up to all patient with colonic polyps specially to patient with multiple polyps. All type of polyps should be removed ,because polypectomy currently constitutes the best strategy for preventing colorectal cancer.

Objective(s): The study objectives are to identify the nursing management provided to patients undergoing to water- seal chest tube drainage system..
Methodology: A descriptive study which was using the quantitative design. The study was conducted in Alhariri, Alyarmouk, and Alkindy teaching hospitals starting in October 10th 2012 up to the September 30th 2013. To achieve the objectives of the study, A non-probability (purposive) samples of (50) nurses delete was consisted of all nurses who provides management for patients under-water-seal chest tube drainage systems. The questionnaire tool was constructed, consisting of two parts, first one the demographical data of the sample & the second is the 13th steps of observational checklist for nursing management of patients with under-water-seal chest tube drainage system, the questionnaire validity & reliability was determined by a panel of experts in and out of Nursing College, a suitable statistical analysis was applied for the data. stem. Data were collected by an application of direct observation as a means of data collection. Nurses were evaluated while they are working in the thoracic or surgical wards during the day. Instrument validity and reliability were determined through content validity, by a panel of experts and a suitable statistical analysis was applied for the data.
Results: The results of the study showed that most of the sample were males nurses at age group of (20-30) and (31-40) years old working at thoracic surgical wards since 1-5 years only with a poor nursing experience. Also, the result of study indicated that the male nurses who are with nursing institute (22), preparatory nursing school (20) and nursing school (8) were providing care to patients with chest tube under water- seal drainage not accepted. They were with knowledge deficit and experience in maintain patency and sterility when changing down tube, they do not note the presence of bubbling and recording the consistency of the drainage, which indicating poor management and technique provided and this may lead to complication such as pneumonia and pneumothorax, which may leads to pulmonary failure.
Conclusion: The study concluded that the most of nurses that work in thoracic or surgical wards have deficit knowledge in some aspects related to nursing management provided to patients with under water- seal chest tube drainage system.
Recommendations: The study emphasize that nurses working in thoracic wards must be at least with Diploma or Bachelorette degree of well-educated to provide complete and accurate management for patients with chest tube. Also, the study recommends to apply an intensive courses for already these nurses to improve their knowledge and practice in caring for under-water-seal chest tube drainage system patients.

Background: Sleep disturbances are one of the most common of the non-motor complications of Parkinson's disease (PD), and increase in frequency with advancing disease. As many as 98% of patients with PD may suffer at some time from nocturnal symptoms, that can disturb their sleep. The causes of sleep disturbance in PD are numerous, and many patients may have several factors that contribute. These disorders can be broadly categorized into those that involve nocturnal sleep and daytime manifestations such as excessive daytime sleepiness.
Objectives: To assess the levels of disturbances of nocturnal and daytime sleep of the Parkinson's disease patients in the city of Baghdad and to find out relationship between these levels and some demographic characteristics of patients.
Methodology: A descriptive study was conducted between the ninth of September, 2013 and 15th of December 2013. A purposive non-probability sample of 100 elderly patients who are diagnosed with Parkinson's disease and another 75 aged matched healthy controls were recruited to participate in the study. To reach the objectives of this study a questionnaire was constructed. The present questionnaire consists of two parts; demographic characteristics; gender, age, and duration of illness; and 15 items as a part of Parkinson's disease Sleep Scale (PDSS) for measuring levels of sleep disturbances.
Results: The results indicate that all the patients with Parkinson's disease have different levels of sleep disturbances: 55.0% with severe level, 32.0% with moderate level, and only 13.0% with mild level. There is a significant association between levels of sleep disturbances and age and duration of illness. Also the results revealed that there were a wide difference between the Parkinson's disease group and matched healthy control group regarding the sub-categories of sleep disturbances.
Conclusions: The results of the study indicated that more than half of PD patients had severe level of sleep disturbance; there were significant relationships between severity of sleep disturbances and age and duration of disease; and finally there was a difference between PD participants and matched controls group.
Recommendations: Establishing specialized centers which give daily cares for patients with Parkinson's disease, follow-up programs for each patient registered at these centers, and governmental financial support for those patients.

Objective: The study aims to evaluate the effectiveness of nursing education program on the nurses knowledge toward cardiac rehabilitation phase one for patients with heart attack
Methodology: A quasi-experimental design study was carried out at AL-Shaiq Ziad; AL-Sader; Al-Karkh ;AL-Karama; Imamein kadhimein medical city and Baghdad hospital in Baghdad city in 1st September 2013 to 10 September 2014. The program and instrument were constructed and developed by the researcher for the purpose of the study were: Random sample comprised of (80) nurses was divided in to two groups, study group consisted of (40) nurses exposed to the nursing educational program and control group consisted of (40) nurses were not exposed to the program. The measurement of the effectiveness of educational program through the nurses knowledge includes (33) items concern knowledge related Heart Anatomy; Coronary artery disease and risk factors; diagnostic procedures; medication and treatment; activities of daily living; nutritional status to patients; life style; nursing care. Reliability of instrument was determined through the use of test and retest and the instrument validity was determined through the use of test and retest and the instrument validity was determined through a panel of experts. The analysis of data was use descriptive statistic (Frequencies, Percentage, and Cumulative Percentages , Mean of Score , Standard Deviation and Inferential statistical (Contingency Coefficients, Chi-Square test, Fisher to present the differences between the study and control groups.
Results: The results of the study showed that the effectiveness of educational program regarding nurses knowledge toward cardiac rehabilitation phase one for patients with heart attack.
Conclusions: The study concluded that the nurses working in Coronary Care Unit having the minimum level of information toward cardiac rehabilitation phase one for patients with cardiac attack.
Recommendations: The study recommended that all nurses in the coronary care unit should be involved in the application of educational program was developed in this study.

Aim: The aim of this study was assessment of obstetrical characteristics of women with hemorrhoids and anal fissure.
Methodology: A cross-sectional study was conducted between 1st September 2013 and 30th July 2014 in Pirmam city in Kurdistan Region of Iraq on 50 women who attend surgical private clinic and complained with signs and symptoms of hemorrhoids and anal fissures and diagnosed by observation and physical examination of the anus. A questionnaire was constructed for the purpose of the study. Chi-square test or Fisher exact test were used for analyzing of the data.
Results: Mean (M±SD) age of women were 30.36 (± 7.4). The rate of hemorrhoids, fissures or both were as following respectively: 14%, 48% and 38%. Sixty two percent of the study sample were multipara. The majority (84%) of the sample had vaginal delivery. There was statistically significant association between prolonged labor with aggravation of hemorrhoids and fissures by pregnancy/delivery but there was no statistically significant association between onset of hemorrhoids or fissures and their aggravation by pregnancy/delivery with parity and mode of delivery.
Conclusions: Hemorrhoids and anal fissures were most common in multipara and grand multipara women and who delivered vaginally. These conditions may aggravated by pregnancy and delivery.
Recommendation: Advising and educating women for appropriate diet and bowel motion during pregnancy and improving care during labor may decrease the hemorrhoids and anal fissures. Further studies with large sample size and case- control study will help to understand the effect of childbearing experience on anal disorders