IRAQI JOURNAL OF COMMUNITY MEDICINE

Background: Accreditation is an increasingly employed method for promoting quality at the healthcare organizational level .The
term accreditation reflects the systematic assessment of health facilities against clear standards.
Objectives: To find out the impact of accreditation of primary healthcare centers on quality of care as perceived by healthcare
providers and directors in Baghdad and to Identify challenges and obstacles that prevent the implementation of
accreditation in PHC centers in Iraq.
Subjects and Method: A descriptive cross sectional study with analytic elements was conducted in four PHC centers in Baghdad
City, three centers in Al - Karkh and one in Al- Resafa sector from 1st of December 2016 to the 31thof July 2017.All
staff members was included in the study. The data was collected by using structural questionnaire form was adopted and
based on questions obtained from previous similar study in Lebanon.
Results: A total of 240 staff members were surveyed, the highest age group frequency was 40-49, and there was a significant
association between primary healthcare centers and the quality score, human resources and the quality management
score. The highest group of good scores was in Al-Adil PHCC. There was a significant association between age and the
quality score mainly in relation to age group (50-59) years. There was statistical association between educational level
and the quality score which is highest in baccalaureate of medicine. There was a significant association between
strategic quality planning score and the total score with the duration of job, the highest was in (5-9) years.
Conclusions: The accreditation is important as a first step towards improving the quality of PHC delivery arrangement system.
There is shortage both in financial and human resources in the four PHCC. According to respondents, this study shows
the positive level of the impact of accreditation on quality of care, documentation and the benefit of training.
Key words: Accreditation, Quality of care, primary healthcare, Healthcare providers.

Background: Coronary artery diseases are associated with varieties of dermatological conditions like psoriasis,
lichen planus, androgenic alopecia, premature graying of hair, thoracic hairiness, diagonal earlobe crease and
others.
Objective: To determine the association of leg alopecia with coronary heart diseases in adult males' patients.
Patients and methods: One-hundred forty male patients were included in this case-control study which
conducted in Baghdad and Al-Yarmouk Teaching Hospitals for the period from May 2009 through August 2010.
The study sample was divided into two groups of patients. Each group included 70 male patients who are above
40 years. The first group (Group A) included patients with history of coronary heart diseases. The second group
(Group B) included apparently healthy male persons as a healthy control. During interrogation with each
individual a detailed history and physical examination were done. Patients were classified according to degree of
hairiness of their legs into those with: - absent hair, diffuse hair loss leaving few scattered hair, partial hair loss
where the loss was not uniform and sometimes patchy, and lastly leg with normal hairs.
Results: The hair loss of legs was as follow: Group A: 75.71%, Group B: 44.28% and there was a statistical
difference between two groups (p value= 0.0002). When the different age groups compared together, it was
observed that leg hair loss increased with age in both Group A and B but in patients with coronary heart diseases
hair loss was more and started at earlier age than healthy persons. Patients with coronary heart diseases who had
hair loss from their legs tended to have weaker or even absent peripheral arterial pulses in comparison with
patients in healthy control group (p value=0.0002). Hair follicles without hair shaft were more commonly and
easily seen in the area of leg alopecia among healthy control while decreased or absent in the diseased group (p
value=0.0008), while the broken hairs were more in healthy control than patients with coronary heart disease (p
value=0.0008).
Conclusion: Alopecia of legs was a statistically significant common problem among adult males with coronary
heart disease patients. Also, leg alopecia started at earlier age in patients with coronary heart disease than healthy
persons
Keywords: leg alopecia, coronary heart diseases, adult male.
Introduction
L eg alopecia i

Background:- Polycystic ovarian syndrome is a health problem affects women of childbearing age causing hormonal
imbalance, that produce short & long term consequences on women health.
Aim of the study:To assess the effect of changing dietary habits and exercise on lipids profile in overweight or obese women
with polycystic ovary syndrome .
Methodology: An interventional study on (200 ) women who are currently infertile, with polycystic ovary syndrome,
overweight or obese, at reproductive age .The study was carried out during the period from 31of March till the 1st
of October 2016 in outpatients clinic of fertility & sterility center in Al-batool Teaching hospital in Mosul city .The
studied sample was divided into interventional(100)and non interventional(100)group..>. Collection of data was
carried out bydirect interview with women according to pretested questionnaire.Measurement of weight and
otheranthropometric,blood sugar, hormonal,and lipid profile measurement,. All these measures were done in first
visit and repeated after three months follow up of the study period. All women in intervention group were given
specific dietary advice and fitness program. The program included diet& exercise (lifestyle modification).
Results :-The total women studied were 188 (96 interventional group and 92 from control group). Most of the women using
lifestyle intervention showed improvement in anthropometric, reproductive, androgenic features, hormonal and
metabolic parameters in comparison with control group, and these differences were statically significant. The results
of the study showed improvement in the conception rate(10%)in the interventional group in comparison with control
group.
ConclusionChanging dietary habits and exercise can improve lipid profile and fertility rate in overweight /obese
Key word:-Diet,Exercise, Poly cystic ovary.

Background: Estimates suggest that worldwide between 3-7% of all heterosexual couples or women have an unresolved
problem of infertility. 20-30% of infertility cases are due to male infertility. The prevalence of human papilloma virus
(HPV) sperm infection ranges between 2 and 31% in men from general population and 10 - 35.7% in men with
unexplained infertility.
Objectives: This study was designed to figure out the association of HPV type 18, 16, 11, and 6 in men with infertility in
Diyala province-Iraq.
Subjects and methods: Seminal fluid samples were collected from 90 men who were subdivided equally into oligospermia,
azoospermia, and healthy individuals. The age range was 22-48 years with a mean age ± SD was 29.28± 5.78 years.
Socio-demographic information were also collected by direct short interview. Complete seminal fluid analysis was
done according to the World Health Organization (WHO) guidelines. HPV type 18, 16, 11, and 6 were detected
quantitatively and qualitatively in semen samples using the real time PCR kit (AmpliSens® HPV 16/18-FRT). Human
privacy was respected by taken participant's consent. Statistical analyses were done using the IBM Statistical Package
of Social Science (SPSS), Version 21 in association with Microsoft Excel 2010. P values less than 0.05 were
considered significant.
Results: The infection rate of HPV type 18, 16, 11, and 6 were 1.1%, 6.7%, 10.0% and 1.1% respectively. The mean titer of
HPV type 16 and type 18 were 188.2 and 3.0 copies/milliliter of seminal fluid respectively. The highest infection rate
was in oligospermia (30%) followed by azoospermia (20%) and the viral infections were mainly affects the 26-32 years
age group. HPV type 11 was significantly impaired the sperm activity (P= 0.009) and HPV type 16, 11, and 6 were
significantly affects the sperm morphology (P= 0.004, 0.001, and 0.04) respectively.
Conclusion: Although HPV infections are relatively low among men with infertility; however, its effects on sperm parameters
are worthy to suggest viral screening of men, at least, those couples with unexplained infertility.
Keywords: Human papilloma virus, infertility, semen quality, Diyala

Background: Respiratory distress syndrome (RDS) is mainly a disease of prematurity; noninvasive respiratory support has
become the preferred method of management.
Objectives: study the demographic characteristics of preterm infants admitted to the neonatal unit (NNU)diagnosed with
RDS and compares the effectiveness of three modes of noninvasive respiratory support.
Patient and methods: An observational comparison study of 545 newborns delivered at the Al Yarmouk teaching hospital,
admitted to NNU with clinical and radiological diagnosis of RDS managed with three modes of noninvasive respiratory
support from January2013 -December 2014.
Results:
Primary outcome: treatment failure ended with mechanical ventilation in the A group 49/200(24.5%), B group
30/200(17.5%) ,relative risk{CI=0.9937-2.2905(p=0.053)}.
Secondary outcome: hours spent on the nCPAP support , ≤ 72 hours the B group 169/200(84.5%) infants compared to A
group 112/200(56%) infants who had not received surfactant, p=0.0001 ; infants from( B group) who spent >72 hr were
31/200(15.5%) compared to A group 88/200(44%), p= 0.0076.

Days of hospitalization : a significant less days of hospitalization were spent by the B group versus A group (P=<0.0001)
;B group versus group C, (P= 0.0001). Outcome in A group was 60.5%(121\200) infants were discharged well and
39.5%(79/200) passed away during their hospital stay, 73% infants of B group survived (146/200) and 27% died(54/200)
while 60% of infants treated with Oxyhood only survived (87/145) and 40% died (58/145).
Conclusion: The INSURE method nCPAP most effective intervention within the settings of our limited resources.
Keywords: Respiratory distress syndrome, Continuous positive airway pressure, Surfactant replacement therapy, preterm

Back ground: Autoimmune thyroid disease commonly presents as a goiter which may be diffuse or nodular and is
usually associated with raised titers of thyroid antibodies, and usually affects 2-5% of the western Population.
Aim of study: To know the rate of autoimmune thyroid disease in thyroidectomised patients in Al-yarmouk teaching
hospital.
Patients and methods: A prospective study performed in Al-yarmouk teaching hospital and Al-mustansiriya medical
college, in which patients who underwent thyroidectomy for thyroid gland enlargement were included during a
period of one year from March 2011 to March 2012. These cases have been assessed both clinically and by
investigations including thyroid function tests, thyroid auto-antibodies (anti-thyroglobulin antibodies TG) and (antithyroid peroxidase antibodies TPO) , ultra-sound of thyroid gland and FNAC of thyroid gland, the results were
compared to the histopathological results of the same patients, and P value calculated.
Results: sixty cases with goitre (operated upon) in the surgical wards of Al-yarmouk teaching Hospital were included, 10
cases had positive serological results for autoimmune thyroid disease (3 cases 5% Hashimoto's thyroiditis, and 7
cases 11.6% Grave's disease) were diagnosed and the diagnosis was proved by post-operative biopsy results. the
commonest symptom was thyroid gland enlargement and the commonest age incidence was in the 4th decade.
Conclusion: These findings suggest the possibility of using quantitative indicators of thyroid auto-antibodies as
predictors of the presence or absence of autoimmune thyroid disease in patients planned for thyroidectomy.
Keywords: Goitre, autoimmune thyroid disease, Hashimoto's thyroiditis, Grave's disease.

Background: Majority of patients of hepatitis B and C are asymptomatic and pose great danger of spreading these infections
to the society and medical personnel particularly.
Aim: To determine the standard prevention precautions indicators practiced by health care workers in operation theaters and
surgical wards for hepatitis B and C transmission and prevention .
Materials and Methods: This study was done in operating theaters and surgical wards in Mosul Medical City - Nineveh
Health Directorate. Using cross sectional study design for a period from 1st May to 1st October 2011. Three hundred and
twenty four health care workers were included. Data were collected according the WHO standard precaution of infection
prevention. Standardized questionnaire form was used including; personal history, occupational contact exposure to
blood & method of transmission, vaccination status laboratory investigations and standard precautions followed.
Results: This study revealed that the participants (medical and health staff) were significantly exposed to blood and the health
staff was the most frequent group (p = 0.000) followed by medical staff (p = 0.001). Two thirds of health staff had blood
contact with skin abrasion were significantly more exposed than medical and service staff as a method of infection
transmission (p = 0.000). Majority (86.4%) were vaccinated against hepatitis B and there is no significant difference
among study sample according to vaccination status. The service staff had completed 3 doses of vaccination
(81.3%)compared to lower fraction of medical and health staff (51.4% and 55.7% respectively) in a very highly
significant way (p = 0.000). Health staff were more significantly enrolled with hand washing (97.4%) than medical and
service staff (90.5% and 96.6% respectively), (p = 0.044).
Conclusion: Majority of study sample were exposed to hepatitis B & C infection. The percentage of coverage with hepatitis
B vaccination is not 100%. Health staff were significantly more enrolled in hand washing than the medical and service
staff.

Background: Diabetic foot is a serious complication of diabetes which aggravates the patient’s condition and
abnormal regulation of the hemodynamics in the small vessels may contribute to the development of microangiopathy.
Objective: To investigate the histological changes in the skin tissue covering the area surrounding the ulceration of
the diabetic foot.
Patients & Methods: In the present study 45 patients were collected from Al-Jumhuri Teaching Hospital in MosulIraq during the period from December 2015 to December 2016.The patients were subdivided into 3 groups (15 for
each group ).Group I were the control group (non-diabetic but have traumatic ulceration ); group II were insulindependent diabetics (Diabetes mellitus type-I) & group III were non-insulin dependent diabetes (Diabetes mellitus
type-II). Specimens of skin were obtained from the area surrounding the diabetic ulcer.The specimens were fixed in
10% neutral buffered formalin for 24 hours then histological sections were prepared and stained by Hematoxylin and
Eosin, and Orcein-VanGieson stains for examination by light microscope. All the work was done in the Department of
Anatomy, Mosul College of Medicine.
Results: The skin sections showed the presence of epidermal hyperkeratosis with regular acanthosis & chronic
inflammatory cells infiltration in the dermis; fibrous tissue deposition in tunica media of the small arteries and
arterioles; obvious degeneration of Schwann cells in the peripheral nerves & finally degeneration of regional sweat
glands.
Conclusions: The diabetic foot ulcer causes morphological & structural changes in the skin tissue surrounding it.More
significant incidence of diabetic foot ulceration in female, smoker, hypertensive, and those having disturbance in renal
functions and the severity of changes appeared to be more in non-insulin dependent diabetic patients.
Keywords: Diabetic foot, Skin, Microangiography, Neuropathy.