IRAQI JOURNAL OF COMMUNITY MEDICINE

Background: Hepatitis B vaccine has been introduced for more than 3 decades. The duration and protective efficacy in early infancy seems to be multifactorial. Age, vaccination schedule, dosages, vaccine type and population characteristics may potentially influencing the protection rate. Objectives: Identification of characteristics of low responders who administered full doses of HB vaccine, and trying to figure out the reasons behind their failure to develop protective levels of anti-HBs antibodies. Vaccinees and methods:This cross sectional study was conducted in Baquba City, the center of Diyala province for the period 20 July/ 2016 to 20 March /2017. A total of 452 children were enrolled, 247 (54.6%) were males and 205 (45.4%) were females, with an age range of 1- 14 years. All were previously immunized with genetically engineered HBV vaccine (Euvax B, Korea), with a dose of 10 micrograms of HBsAg/ 0.5 milliliter (children vial) intramuscularly according to Iraqi vaccination schedual. Venous blood samples were collected aseptically; sera were separated and subjected for the detection of HBsAg, anti-HBs antibody titer, HBe Ag and total antibody and anti-HBc total antibody using Enzyme Linked Immunosorbant assays (ACON, Foresight-USA). A pre-constructed questionnaire form was prepared including information of socio-demographic, health, and vaccination status. Statistical analysis was done using the Statistical Package for Social Science (SPSS), Version 23. P values < 0.05 were considered significant. Results:The study found that a total of 110 (24.34%) vaccinees were failed to achieve the protective levels of anti-HBs Ab (10 mIU/ml) as recommended by the WHO. The mean ± SD of age was 64-76 ± 38.4 months with an age range of 13168 months. The mean duration of time since last vaccine dose was 41.2 ± 41.4 months (range 1-171 months). They were 53(48.2%) females and 57(51.8%) males. The mean ± SD of the anti-HBs Ab titer was 6.31 ± 1.9 mIU/ml (range 3.0- 9.92 mIU/ml). The results also showed that the anti-HBs Ab titers are insignificantly elevated as the number of vaccine doses increased (3.419, P=0.507). On the other hand, these Anti-HBs antibody titers are insignificantly declining after more than fourth year since last vaccine dose (3.841 P=0.168). Furthermore, nonregular vaccination schedule elicit insignificantly higher anti-HBs Ab titers (2.155, P=0.190). Finally, the anti-HBs Ab titers are marginally affected by other scio-demographic factors. Conclusion: The anti-HBs antibody titers in low responder HBV vaccinees are non-remarkably affected by vaccine or vaccinees related factors, recommending that those low responders should receive a booster dose of HBV vaccine.

Background: Acute respiratory distress syndrome (ARDS) is characterized by the acute onset of pulmonary edema of noncardiogenic origin, along with bilateral pulmonary infiltrates and reduction in respiratory system compliance with refractory hypoxemia that is the hallmark of the syndrome. Objectives: This study is designed for the assessment of serum uric acid (SUA)and highly sensitive C-reactive protein (HSCRP) in patients with ARDS and for the determination of risk factors promotes the induction of ARDS. Subjects and methods: This case control study was conducted in Al-Batool Teaching Hospital for Maternity and Children for the period from August 2017 to June 2018. 200 subjects were included, 100 patients who were admitted to neonate intensive care unit with age range 1-2 days. Another 100 age and sex matched apparently healthy infants were included as control group. A specific questionnaire form was preconstructed for this purpose. Blood samples were collected from subjects. Sera were separated and the determination of serum uric acid was carried out by (COBAS INTEGRA systems, Germany) The determination of highly sensitive C-reactive protein was measured by (COBAS INTEGRA systems, Germany) Human privacy was respected by taken patient's parents consent. Furthermore, the study was approved by the Ethical Committee in the College of Medicine. Results: The results revealed that the mean ± SD of serum uric acid in patients was significantly higher than that of controls (328.52 ± 151.19 versus 264.15 ± 85.12, t-test = 3.71, P = 0.001). Similarly, the mean ± SD of highly sensitive C-reactive protein titer was significantly elevated in neonates with respiratory distress syndrome versus controls (5.19 ± 16.11 versus 1.3 ± 1.7, t-test = 2.398, P= 0.017). The SUA was significantly higher in patients weighted less than 2.5 Kgs (t-test = 2.688, P= 0.008). Furthermore, preterm patients had significantly higher SUA (t-test = 2.435, P = 0.017). The results also found that patients who required medical intervention had higher levels of SUA (t-test = 2.395, P = 0.024). Additionally, patients who were dead had significantly higher titer of SUA (t-test = 8.545, P = 0.001). While other factors including gender and age showed insignificant effect. Concerning the HSCRP, preterm patients had significantly higher titers versus term patients (t-test = 2.066, P = 0.042). However, other factors including gender, age, weight, intervention required and final outcome were failed to reach the levels of statistical significance. Conclusion: The study concluded that the serum uric acid concentration and the highly sensitive C-reactive protein titer can be employed as diagnostic adjuncts for RDS in newly born infants, and certain patient's and mother's features were significantly associated with these markers.

Background: Study of students' problems in the school of the PHC catchment area; is very important to find the solutions for them as a part of school health programs. Objective: Discover of secondary school students' problems and their types in catchment area of Bab-Al-MoathamPHC-for-family-health. Find the association between students' demographic features and their problems. Methods: Cross section study with analytic element, by involving of 520 secondary school's students (first - sixth class), by group discussion and distribution of questionnaire, The Data collection takes 3 months: (April, May and September 2017). Results: The highest percentage of students' age were 14-16 years old 226(43.46%) followed by 11-13 years old while only 105(20.19%) of students at 17-19 years old; (with mean=14.67, SD=1.886), first class (38%), 17% of students were working. Near half of the students 200(38.5% ) suffer from psychological problems; and 187(36%) of them were suffering from physical problems and 54(11%) were suffering from sexual problems. The students seek help mostly from their parents (346), friend (145), and through internet (105). The student's age had statistical significant association with the psychological, sexual problems, and student's working status had significant association with psychological, sexual and physical problems. Allergy and asthma are the most type in medical problems; anxiety and stress are most psychological condition. Conclusion: most students suffer from psychological, physical problems and sexual problems; they seek help mostly from their parents, friend, and find solution through internet

Background:Metabolic syndrome represents the clustering ofrisk factors which promote the development of cardiovascular disease, including insulin resistance ,obesity and hypertension. Objective:The aim of this study is to measureserum phosphate levels in patients suffer from metabolic syndrome to utilize this parameter in orderto confirm the diagnosis. Materials & methods:A total of 100 patients with metabolic syndrome and 90 healthy control subjects with age range (50-60 years)were assigned in this cross-sectional study trialfrom April 2014 to January 2015 in Baghdad city. Thediagnosis of metabolic syndrome was based on thecriteria defined by International Diabetes Foundation (IDF). General information for each patient was obtained by a questionnaire designed for the study.Waist circumference measurement, fasting serum glucose, serum HDL level, serum triglyceride, serum phosphate and blood pressure estimation were done for each patient. Results:Patients with metabolic syndrome found to have a considerably lower serum mean level of phosphate when compared with healthy control subjects. Metabolic syndrome patients have high prevalence of marginal phosphate deficiency in comparison control subjects. Results showed that patients with low serum phosphate level tend to have high prevalence of high fasting serum glucose, elevated blood pressure, low levels of HDL-cholesterol and high triglyceride values compared withhealthy control subjects. Conclusion:Serumphosphate levels found to be significantly lower in patients with metabolic syndrome in comparisonwith healthyindividuals. Phosphate levels can be used as reliable marker in diagnostic criteria of this syndrome.

ABSTRACT Background: Differentiating bacterial from nonbacterial meningitis is very important in deciding treatment. Bacterial meningitis is a life-threatening neurological condition and needs prompt parenteral antibiotics, compared to viral and aseptic meningitis, which carries relatively better outcome. Aim of study: To identify the causes of meningitis in children aged ≤ 14 years’ old in Diyala, Iraq. Subjects and Methods: A descriptive study conducted in Al-Batool Teaching Hospital,Diyala, Iraq during a period from October 2017 to February 2018. It included all patients aged ≤ 14 years’ old who admitted with primary diagnosis of meningitis, presented with clinical signs of meningitis. Patients were subjected to a detailed history, clinical examination and a laboratory and radiological investigation. Results:The main cause of meningitis detected by cerebrospinal fluid was viral cause (74.3%), Coxsackie virus A16 IgM antibody was detected in 70% of cases. Age and duration of fever were significantly associated factors with cause of meningitis (P= 0.024 and P= 0.017 respectively). 45.7% of study patients were presented with fit, most of these fits were generalized in type (93.8%) and 56.3% of these fits lasted for less than 15 minutes. Conclusion:Meningitis was caused mostly by mostly viral infection and Coxsackie virus A16 IgM antibody was the most common virus detected. Viral meningitis was associated with young age and short duration of fever. Cerebrospinal fluid protein was significantly higher in bacterial than in viral meningitis.

Background: Several studies had documented the relationship between iron deficiency and low serum sodium levels with the risk of developing recurrent seizure among children within the same febrile illness. Objectives: To figure out the association between serum sodium levels and iron deficiency with occurrence of febrile convulsion in children between 6 months to 6 years old in Diyala province. Patients and Methods: A case control study was conducted in Al-Batool Teaching Hospital for Maternity and Children, Diyala-Iraq during a period from September 2017 to March 2018. 200 patients aged between 6 months to 6 years were enrolled, 100 of them were diagnosed with febrile convulsion and the other 100 were age and sex matched apparently health children as controls. Patients aged < 6 months or > 6 years, cerebral palsy, meningitis, epilepsy, severe gastroenteritis and dehydration, history of chronic drug use, and history of developmental delay were excluded from this study. Diagnosis of febrile convulsion was based on initial evaluation focusing on the source of the fever and thorough physical examination for the presence of meningeal signs and the child's level of consciousness. All patients were subjected to detailed history, complete physical and neurological examination, laboratory investigations and lumbar puncture which proceeded by fundoscopy examination. Human privacy was respected by taken child's parents consent. Accumulated data were analyzed using the SPSS version 25. The independent t-test (two tailed) was used and P value less than 0.05 were considered significant. Results: There was a significant lower means in patients regarding total red blood cells (4.61 vs 4.76, P= 0.032), hemoglobin concentration (11.38 vs 11.85, P= 0.003), packed cell volume (34.07 vs 37.67, P= 0.001), mean corpuscles volume (74.06 vs 78.01, P= 0.001), and higher red distribution width mean (14.73 vs 13.51, P= 0.001). Furthermore, a significantly lowered means in serum iron (mg/dl) (4.02 vs 4.74, P= 0.008), serum ferritin (ng/mL) (46 vs 58.58, P= 0.001), serum sodium (mEq/L) (131.11 vs 139.89, P= 0.001) and higher total iron binding capacity (μg/dL) (80.84 vs 66.12, P= 0.001) among patients compared to controls. Conclusion: Children with febrile convulsion are more likely to have iron deficiency anemia and hyponatremia.