IRAQI JOURNAL OF COMMUNITY MEDICINE

Background: one of the primary reasons for evaluating employee satisfaction is to identify problems and try to resolve them before they impact on patient care. Objective: to assess job satisfaction among health workers (physicians and nurses) in different levels of health centers, and figure out the factors that influence this job satisfaction. Methods: this cross sectional study was conducted in AL-Karkh side of Baghdad during the period from February through June 2017. A random sample of 15 health centers was chosen via a simple random sampling technique, and included doctors (specialists and general physicians) and nurses. A questionnaire including socio-demographic, work attitude, and job scale sections was used for data collection through a direct interview. Result: (76.7%) of the respondents were unsatisfied, there was no significant difference in participant`s job satisfaction among the three types of health centers. Age played a significant role in determining job satisfaction among nurses (p= 0.009). Number of patients seen per day significantly affected job satisfaction among nurses and physicians (p=0.047). Having good friends at work, feeling that innovations and creativity being supported and being benevolent to the society and involved in institution`s decisions significantly affected job satisfaction (p=0.001). Conclusion: job dissatisfaction among health workers reached a very critical level in our health centers. Apparently, the main precipitating factors include the uncontrolled workload in the health centers, absence of support to innovation and creativity, and margining of the employees regarding involving them in decision making.

Back ground: Carpal tunnel syndrome is the most commonly diagnosed entrapment neuropathy of the upper extremity. Ultrasound has emerged as an alternative confirmatory test for Carpal tunnel syndrome, however, its potential role is limited by lack of adequate data for sensitivity and specificity. Aim of study: to assess the usefulness of ultrasound in the diagnosis of carpal tunnel syndrome for cases their diagnosis confirmed by surgery. Patients and Methods: a prospective study during a period from August 2014 to August 2015, in which 40 patients with a clinical diagnosis of carpal tunnel syndrome, all patients were subjected to examination by high-resolution ultrasound and then all were operated upon by fasciatomy to confirm diagnosis, then sensitivity, specificity and accuracy of ultrasound were calculated. Results: the present study included 40 patients; 36 females and 4 males, 5 left hand and 35 right, age range 20-50 years; mean±SD (37.28±9), Sensitivity for PD and FR were 90% and 75% respectively, specificity for PD and FR were77.5% and 85% respectively, and accuracy for PD and FR were 84% and 83% respectively. Conclusions: The present study included 40 patients 36 females and 4 males, 5 left hand and 35 right, age range 20-50 years; mean±SD (37.28±9), sensitivity for PD and FR were 90% and 75% respectively, specifity for PD and FR were 77.5% and 85% respectively and accuracy for PD and FR were 84% and 83% respectively. Conclusion; ultrasound is a useful method for confirming diagnosis of median nerve involvement in patients with carpal tunnel syndrome.
Keywords: Carpal tunnel syndrome, Ultrasonography, flattening ratio, palmar displacement.

Background:-Heterotopic ossification (HO) is a common problem with acetabular fracture, usually associated with pain and can severely limit motion in the nearby joint. Aims:-. To evaluate the effect of indomethacin in comparison to placebo in reducing the incidence and severity of heterotopic ossification after acetabular fracture Patients and methods : - Convenient sample of eighty-three patients that underwent surgery for fixation of acetabular fracture from Oct.2010 to Jun.2013 at Alwasti Teaching Hospital were included in this study. The patients randomized to two groups. The first group consist of 21 patients received 75 mg of indomethacin for six weeks post operatively and the second group of 22 patients received placebo medication (B6 tablet). The patients assessed clinically and radiographically at 3 months of surgery for HO according to Brooker classification, range of motion and rate of mal or non-union. Chi-square test and independent student T test used to confirm significance. p≤0.05 considered significant. Results:-The mean age of patients in group (indomethacin group) was 37.2±3.4SD and of group (placebo group)was 38.1±5.4SD.The male patients represented 47.8% of indomethacin group and 52.2% of placebo group .No significant difference was reported for mean age, weight or sex distribution (p=0.3, 0.8) respectively .The incidence of HO with all grades were higher with placebo group; 68.2% (15 patients out of 22, in comparison to indomethacin group; 33.3 %( 7 out of 21) %) but the difference was statistically non-significant. The incidence of >20% reduction in range of motion also non-significantly higher with placebo group in comparison to indomethacin group (66.7, 33.3%) respectively. Conclusion:-The study showed that indomethacin reduces the incidence and severity of HO in acetabular fracture surgery
Key words; Heterotopic ossification, acetabular fracture, indomethacin

Background: Increase rate of prevalence of multidrug-resistant Acinetobacter baumannii in burn wound infections make treatment with traditional antibiotics more difficult and leads to severe hospital-acquired infection. Silver nanoparticles (AgNPs) show a broad spectrum antibacterial property with less toxic to mammalian cells. Objective: The aim of this study was to evaluate the anti-bacterial and anti-biofilm activities of AgNPs alone and in combination with cyclic membrane-active peptide (Polymyxin B) against multidrug-resistant Acinetobacter baumannii isolated from burn wound infections. Materials and methods: 45 clinical isolates of Acinetobacter baumannii tested for susceptibility tests by disk diffusion method against 12 antibiotics. The minimum inhibitory concentrations (MICs) of AgNPs and polymyxin B were performed with broth microdilution method, synergistic probability was evaluated with time kill-kinetic assays and Calgary technique applied to study biofilm formation. Results: Membrane-active peptides colistin and polymyxin B were the most active antibiotics against Acinetobacter baumannii with sensitivity of 42 (93.4%) and 38 (84.4%) respectively, while cephalosporins (Cefotaxime) and fluoroquinolones (Ciprofloxacin) antibiotics were most resistances antibiotics with 38 (84.5%) and 35 (77.8%) resistances respectively. The data of present study indicated that the distribution of burn patients infected with Acinetobacter baumannii were prevalence significantly among young age groups of 15-29 years old and male / female ratio 0. 64/1. AgNPs display excellent antibacterial activity against multidrug-resistant Acinetobacter baumannii with MIC 2.1. µg/ml ± 0.3 comparing with polymyxin B as standard control with MIC 0.53 µg/ml ± 0.1. The concentration of sub-MIC (½MIC) of AgNPs exhibited bacteriostatic activity against multidrug-resistant Acinetobacter baumannii, while combination of ½ MIC with (½) MIC of polymyxin B display bactericidal effect and complete reductions of Acinetobacter baumannii after 24 h. AgNPs exhibit strong anti-biofilm formation activity with inhibition of biofilm formation about 19 – 24 % at sub-MIC concentration. Moreover, combination of AgNPs with polymyxin B displayed remarkable synergistic anti-biofilm formation with 72 % inhibition of biofilm. Conclusions: The data of this study indicate a strong synergistic anti-bacterial and anti-biofilm activity of combination of AgNPs with membrane-active peptide (Polymyxin B) against multidrug-resistant Acinetobacter baumannii isolated from burn wound infections. These results propose that AgNPs promising novel antimicrobial agent in the clinic.
Keywords: Acinetobacter baumannii, Silver nanoparticles, polymyxin B, burn wound infections.

Abstract:- Background: Snoring is the low frequency sound produced by vibration of the upper airway walls during partial upper airway obstruction. It is a common sleep problem. Objectives: To find the prevalence of snoring in study sample and find the associative factor related to it like socio- demographic characteristic, smoking, alcohol, obesity, nasal problems, some chronic diseases, drugs and family history. Methodology: A cross sectional study done from beginning of February to the end of April 2017, convenient sampling (300 clients) were participated attended AL-Yarmouk teaching hospital, AL-Salaam primary health care center and AL-Mansour primary health care center, the questionnaire were filled by direct interview with these participants, and asking them about snoring and its associated factors. Results: From 300 participants 56.67% of them have snoring in both sexes . There was statistically significant association between snoring and male sex, obesity, smoking, heavy work, family history and nasal trauma. The non-snorers were 43.33%, and there was no statistical significant association between snoring and alcohol drinking and septal deviation. Conclusion: More than half of the participants have snoring 56.67%, and it is more in smokers 80.0%, increasing age 73.1% at age 51-60, obesity 77.3%. Snorers more frequently in patient had hypertension 53.6% ,and also snoring subjects were complaining more frequently from daytime sleepiness 97.6% and morning headache 62.3%. Keyword; Prevalence of snoring, snoring and different characteristic.

Background:The metabolic syndrome is a constellation of interrelated risk factors of metabolic origin that appear to directly
promote the development of atherosclerotic cardiovascular disease.
Objective:The goal of the study is to assess the serum level of magnesium in patients with metabolic syndrome in an attempt to
utilize this parameter for confirming the diagnosis.
Materials &methods:A total of 100 patients with metabolic syndrome and 90 control subjects were involved in this cross-sectional
study during the period from April 2014 to January 2015 in Baghdad city. The diagnosis of metabolic syndrome among
patients was according to IDF criteria. 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
magnesium and blood pressure estimation were done for each patient.
Results: The patients with metabolic syndrome had lower serum mean level of magnesium from control subjects. The prevalence
of marginal magnesium deficiency was higher in metabolic syndrome patients than control subjects. The prevalence of high
fasting serum glucose, high blood pressure, low HDL-cholesterol and high triglyceride was higher in subjects with low
serum magnesium level than sufficient subjects.
Conclusion:Patients with metabolic syndrome show significantly high prevalence of magnesium deficiency compared with
individuals who donot fulfill criteria for the diagnosis of this syndrome.
Keywords: metabolic syndrome, magnesium.

Background: One hundred and sixty babies with positive clinical examination to have developmental dysplasia of the hip
were referred to ultrasonic clinic.
Objectives: 3D ultrasonic machine was used to study the hip to diagnose which baby has proven to have developmental
dysplasia of hip, to study the anatomical changes of the hip especially α and β angles of the hip and to compare that with
normal babies, and finally to identify the risk factors that associate with developmental dysplasia of hip.
Results and conclusions: Our finding shows that 38 babies had that anomaly; we found that α angle was less than 60º and β
angle was more than 55º. Moreover, it was more common in females than males and more on the left side. Also, it showed
that developmental dysplasia of hip is more frequent in ladies delivered by caesarian section and more often in babies lie in
breech presentation. It can be concluded that our sample findings were almost similar to those previous universal findings.
Keywords: Developmental dysplasia, hip, α angle, β angle, ultrasound.

Background: Teachers and schools play an important role in health promotion. Community awareness in general and in
educational teaching staff in particular is of vital importance in combating tuberculosis which is a leading cause of
morbidity and mortality in developing countries. Tuberculosis is still a prevalent disease in our country.
Objective: To determine the level of knowledge of secondary school teachers regarding tuberculosis.
Methods: This descriptive cross-sectional study was conducted in Al-Karkh section of Baghdad during the period from
November 2015 to April 2016. The sample size was determined at 500 teachers from the total number of 50
schools.
A simple random sampling technique was adopted to select schools from each of the ten sectors; this resulted in a
total of 50 schools (25 schools for males and 25 for females). 10 teachers were randomly selected from those
schools for a total of 250 male & 250 Female teachers.
The study instrument included multiple choice questions about the cause of the disease, the route of transmission,
vaccination, symptoms, availability of treatment, transmission and prevention. The questionnaire was developed by
the researcher making use of previous studies and WHO standards.
Results: On average, 50.2% of the questions were answered correctly, only 34.6 % knew that TB was caused by
bacteria, 53.6 % knew that TB’s first symptom was a cough of more than 3 weeks, 64.2 % knew that TB is
associated with loss of appetite & weight loss, 45.6 % knew that TB is associated with fever & night sweats, only
56.6 % of students knew that it is transferred by respiratory droplets, 70 % knew that the first organ most
commonly affected by TB is the lung, 46.2 % knew that the TB vaccine is BCG, only 36.6 % knew that sputum
examination is used to help identify TB, 59.9.% knew that covering your mouth during coughing & sneezing helps
to prevent disease spread, only 35.4% knew that TB treatment is available in all primary health care centers.
Conclusion: More than one third of the secondary school teachers had good knowledge regarding Tuberculosis, also female
teachers had a higher level of knowledge than male teachers.
Keywords: Tuberculosis, secondary school teachers, Knowledg