IRAQI JOURNAL OF COMMUNITY MEDICINE

Background: Proper management of active stage of labor during child birth by obstetric care givers will reduce the
complications and adverse outcomes which can happen, this is can be achieved by the use of partograph which
serves as most important, cost effective tool that provides visual assessment of labor progress in relation to time.
Objectives: To assess the knowledge and use of the partograph among obstetric caregivers in monitoring of labor and
determine the factors that impede its use among them.
Methodology: A cross-sectional study with analytic element was conducted in period from the first of May to the end of
August, 2017. A convenient sample of data were collected from ten hospitals from Al-Krakh and Al-Resafa
sides of Baghdad city where obstetric care providers that attend labour cases were interviewed using structured
questionnaire
Results: A sample of 300 obstetric care givers was interviewed during the study period. Most of them (97%) were aware of
partograph. 39% and 39.7% showed fair and good level of knowledge respectively. The percentage of doctors
who used the partograph was (58.4%). The knowledge and use of the partograph was higher in teaching
hospitals than general hospitals.
Conclusion: The study revealed that nearly all the participants (doctors, midwives and nurses) knew what the partograph
was and the majority of obstetric providers of care had good knowledge about the partograph while its use
confined to the doctors only that more than half of them reported its use in addition to higher knowledge and use
of partograph in teaching than general hospitals.
Keywords: Knowledge, Use, Partograph, Care, Givers, Baghdad.

Background: Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) is a novel coronavirus discovered
in 2012 and is responsible for acute respiratory syndrome in humans. The disease is heavily endemic in
dromedary camel populations of East Africa and the Middle East.
Objectives: The aims of this cross-sectional study are to figure out the MERS-CoV infection rate and to explore
its risk factors.
Subjects and method: This study was conducted in Diyala province -Iraq for the period from August 2016 to
February 2017 to figure out the infection rate of MERS-CoV infection through the detection of serum antiMERS-CoV IgG. A total of 90 participants were enrolled and subdivided into 3 groups; 40 were close contact
with camels, 20 were normal healthy individuals and 30 individuals who visit Saudi Arabia for Hajj pilgrims or
Umrah. 34 (37.8%) were female and 56 (62.2%) were male. The age range was 22-72 years. Serum samples
from participants were collected and tested for the presence of anti-MERS-CoV IgG using the recombivirus
human anti-MERS-CoV spike protein S1 domain (MERS-S1) IgG ELISA kit (Alpha Diagnostic International,
USA). Human privacy was respected by taken participant's consent. However, 8 individuals were refused
participation. Statistical analysis was done using Statistical Package of Social Science (SPSS), Version 18, and P
values less than 0.05 were considered significant.
Results: The results revealed that 46(51.1%) of human subjects were positive for anti-MERSCoV IgG, with
95% confidence interval for the prevalence rate (40.9-61.3) with a mean titer of anti-MERSCoV IgG Ab of
99.8. U/ml. the highest positivity rate was found among those 40-49 years. However, the difference was failed to
reach the levels of statistically significant (P= 0.08). Similarly, the anti-MERS-CoV IgG Ab titer was
insignificantly higher in the 40-49 years age group (P= 0.11). The anti- MERS-CoV IgG positivity rate was
insignificantly higher among females compared to males (61.8% vs 44.6%, P = 0.12 ). While the mean, median
and Inter-quartile range of anti-MERSCoV- IgG titer was significantly higher among female compared to male
(P< 0.004). The results also found that the anti-MERS-CoV IgG positivity rate and Ab titer were significantly
higher among those people who visited KSA as Hajj pilgrims or Umrah (P < 0.001 and P< 0.001) respectively.
The flu-like syndrome is the most significant symptom reported (P= 0.001).
Conclusion: Based on anti-MERS-Cov Ab detection, considerable infection rate by MERS-Cov was found
particularly among those who had previous visit to KAS. Further confirmatory and surveillance studies are
required for future setup of control measures.
Keywords: MERS-CoV, anti-MERS-CoV Ab, Hajj-associated viral infection.

Abstract
Background: CD10 is a cell surface zinc-dependent enodpepitdase and its expression in tumor stroma is thought to be associated
with biological aggressiveness of many epithelial malignancies.
Objectives: To estimate the frequency of stromal CD10 expression in invasive breast cancer and its correlation to clinicopathological data including immunohistochemical markers.
Methods: This study included 102 cases of invasive breast carcinoma. CD10 expression was assessed by immunohistochemistry
and scored as negative, weak and strong positive and the results were statistically analyzed in correlation to various clinical and
pathological parameters in addition to other immunohistochemical markers.
Results: CD 10 was found to be positive in 58/102 cases (56.8%). Stromal CD10 showed significant correlation with the T
parameter of the TNM staging system (p=0.043), dermal infiltration (p=0.049) and estrogen receptor positivity (p=0.039), while
there was no significant correlation with the patients’ age (p=0.20), tumor grade (p=0.294), and lymph node status (p=0.29).
Conclusion: Stromal CD10 was expressed in more than half of cases with invasive breast carcinoma, and there was a significant
correlation of the stromal CD 10 expression with the T parameter of the TNM staging system, dermal infiltration and the
positivity of estrogen receptor expression and no correlation was found between stromal CD10 expression and patients’ age,
tumor grade, stage, lymph node status, lymphovascular invasion, perineural invasion, Paget’s disease of the nipple, progesterone
receptors expression and HER2/Neu status.
Keywords: Breast, CD10, Cance

Background: Visual impairments are well-known to effect school student's academic performance along with their
quality of life. On encouraging note, visual impairments can be well managed if they are detected early by visual
screening.
Objectives: To assess the visual acuity of the primary school students and to find out the prevalence of visual impairment
(VI) along with description of some characteristics of visually impaired students.
Subjects and method: A cross- sectional study was conducted among governmental primary schools students in
Baghdad/ Al-Karkh from 1st of Dec 2016 to the end of April 2017.The data was collecting by structural questionnaires to
obtained information about some socio-demographic and health risk factors. Vision screening was performed by Snellen
E-chart to assess the visual acuity (VA) of study participants.
Results: The total number of students enrolled in the study was 2104. Visual acuity of 6/6 was the most frequent
measure, in the right eye was (69.49%) and the left eye was (69.96%). The prevalence of visual impairment (VI) among
the study group was 5.4%, boys and girls have the same rate (50%) of VI. Refractive error could be the main reason of
visual impairment (83.3%) according to the pinhole test results. The highest rate of VI (62.4%) was detected among
students in age group (10-12) years and in grade 4th and 5th students (23.7%). 56.1% of visually impaired students had a
family history of wearing glasses. Visual impairment was more prevalent among students spent more than two hours in
studying and reading books 71.1%, while only 28.1% who watched TV for more than 3 hours had VI.
Conclusion: Early and periodic eye examination for school-aged children is recommended. As well as students, parents,
and teachers must be educated about the early detection of VI and correction with eyeglasses to prevent progression of
visual impairment.
Key words: Visual acuity, prevalence, visual impairment, primary schools, Baghdad/ Al-Karkh.

Background: The most common radiological tests of the GI tract are barium meal and barium enema, which are performed using
conventional fluoroscopy and digital fluoroscopy, all of which result in high radiation doses to patients. And it is carries
some risks like the other X-ray procedures. The object of this research is to estimation of effective dose and a Cancer
incidence risk associated with barium meal and barium enema in some hospitals in Erbil City-Kurdistan region/Iraq.
Material & Material & Methods: The dosimetric survey was carried out on 120 patients. The procedures were performed by two
equipments, the first was a Siemens unit which is a conventional fluoroscopy, and the second was Shimadzo which was a
digital unit Beside BMI, patient exposures factors (mAs, kVp, exposure time, and air kerma) were measured. Organ doses,
effective dose with per cent (%) of Risk of exposure-induced death (REID) were estimated by using PCXMC 2.0 software.
Results: The mean±S.D for DAP values found in the present study are 25.20±2.41 Gy.cm2 and 12.80±0.68 Gy.cm2 for BaMC
and BaMD, respectively, with significant differences p= 0.001 And, 32.13±0.25 Gy.cm2 and 25.0±2.68 Gy.cm2 for BaEC
and BaED, respectively with significant differences p= 0.0001. the value of effective dose for BaMC and BaMD are
(5.73±1.93,5.49±1.89)mSv and (2.72±1.22, 2.62±1.16)mSv, respectively. But for BaEC and BaED are (6.04±1.60,
7.07±1.86)mSv and (4.17±1.41, 4.90±1.63)mSv, respectively . The first and second values in the brackets correspond to the
ICRP103 and ICRP60. The type of cancer received the high value of REID% for BaMC and BaMD is the Colon cancer
(0.0128%, 0.069%) respectively, for male patients, but for female patients are Lung cancer (0.264%, 0.123%) respectively.
Also, the high value of REID% for BaEC and BaED are the Colon cancer (0.283%, 0.174%) respectively, for male patients,
but for female patients are the bladder cancer (0.275%, 0.183%) respectively
Conclusion: From this study concluded that digital systems give a lower dose-areaproduct than non-digital systems for both
examinations BaM and BaE. Also, the DAP for BaE is higher than that recorded for BaM. The three organs that received
higher dose in both examination and both system are the same (Stomach , Liver and Colon ) Also, concluded that The
REID% values for female patients were slightly higher than the corresponding values for males for both examination
groups, and the REID% are higher from conventional procedure than that record for digital system.
Key Words: Fluoroscopy, Barium meal, Barium enema, Cancer Risk, Effective Dose.

Background: Otitis media with effusion results when the ventilation and drainage functions of the Eustachian tube are impaired.
This occurs either in the presence of nasopharyngeal disorders or Eustachian tube dysfunction.
Aims: review of otitis media with effusion associated with nasal and nasopharyngeal diseases ; causes& clinical manifestations.
Patients and Methods: Seventy two patients of different age groups suffered from unilateral or bilateral OME were reviewed ,
and their relation with nasal and nasopharyngeal diseases were assessed clinically , endoscopically, audiologically and
radiologically. Those 72 patients have been divided into three groups according to their age .
Results: The results were 64% males & 36% females with male to female ratio was (1.67:1) .The commonest age was in the 1st

decade of life ( 55.6%). Otitis media with effusion was bilateral in 72% , with different clinical presentations found but
hearing loss is the most frequent one (76.4%) , it was mainly conductive type (85.5%) with tympanometric curve
frequently of type B (87%) . The tympanic membranes were commonly immobile (72.6%) & retracted (76%) . There
were many variable different causes for OME.
Conclusion:. - OME have different manifestations mainly due to otological problems but can be due to nasopharyngeal
problems. The effect of the nose and nasopharynx on Eustachian tube is highly significant & consequently plays an
important role in the health of the middle ear , so it is essential to treat these diseases (OME and nasopharyngeal
pathologies) in continuity rather than separately.
Keywords : OME, tympanometry, nasopharyngeal diseases.