IRAQI JOURNAL OF COMMUNITY MEDICINE

Background: Neonatal jaundice is one of the most common diseases globally. It's believed that delays in detection
and improper treatment of neonatal jaundice can be responsible for neonatal morbidity and mortality. Knowledge
and health seeking behavior of mothers play an important role in the course of this health condition.
Objectives: to assess the knowledge and health seeking behavior regarding neonatal jaundice of newly delivered
mothers. Determine the influence of some maternal characteristics on knowledge, and health care seeking behavior
regarding neonatal jaundice.
Methodology: A cross sectional study was conducted on newly delivered mothers at Al-Yarmouk teaching hospital in
Baghdad for the period from May to the end of August, 2016. Data was collected via direct interview with the
newly delivered mothers using a special questionnaire form to assess the knowledge and health seeking behavior
regarding neonatal jaundice. In addition, the data collected comprised some characteristics of the mother.
Results: The study included 500 mothers. Only 4% of mothers had good knowledge, while others were between fair
and poor knowledge levels.
Appropriate health seeking behavior was adopted by only 21% of the study group regarding the management of
neonatal jaundice.
Cultural beliefs and traditional care practices still have an impact on mothers as (78.4%) of them had used traditional
methods for treating their babies. Better education and being employed influenced mothers' knowledge and health
seeking behavior. Mothers parity showed its' influence on knowledge level only.
Conclusion:
There are gaps in mothers' knowledge and health seeking behavior regarding neonatal jaundice. Targeted education
during antenatal care by health professionals is needed to
help mothers recognize neonatal jaundice, refrain from potentially harmful home interventions and promptly seek
healthcare.
Keywords: Knowledge, Behavior, Mothers, Neonatal, Jaundice.

Background:- DOTS program has been adopted by WHO as hopeful strategy for treatment of TB since early
nineties ,and it is widely accepted as an essential strategy for achieving (TB) control . Iraqi health authorities
started DOTS program implementation since 2001 in Baghdad, Iraq.
Objectives:- This study aimed to evaluate DOTS program implementation in Al-Anbar Governorate from 2008-
2012 , and to assess the treatment outcomes of this program .
Patients and Methods:- This Cross –Sectional Descriptive Study was conducted in consultation clinic in
Ramadi city ,Al-Anbar Governorate for the period of October 1 ,2012 to March 31,2013 . Records of (1680)
TB patients were studied retrospectively for the years 2008 to 2012 .Data regarding pulmonary cases for
positive and negative smears ,extra-pulmonary and relapse cases ,treatment failure and chronic cases , in
addition to Socio - demographic features were obtained .Statistical package for social sciences (SPSS)version 17
, and chi- square test were used ,while P values of less than 0.05 considered statistically significant .
Results:- A total of 1680 TB patients records reviewed , (919) were males , and (761) were females . Male to
female ratio was 1.2:1 .The total of new sputum smear positive( SS+) cases were 541(32.2%),sputum smear
negative(SS- )
were 413(24.5%) ,and extra pulmonary( EP) cases were 726(43.2%) .The Cure rate for TB patients for the
period (2008- 2012) was 84.7% , 86.8%, 82.7% ,85.6% ,and 91.4% respectively . The treatment success rate of
DOTS program for the period from 2008 to -2012 were 89% , 85.6% , 85.6% ,85.8% , 87.7% respectively .The
higher death rate was at 2010 (4.5%) ,treatment failure rate was higher at 2012(2.6%) ,while defaulter rate was
higher at 2009(10.5%),and transfer out rate was higher at 2010 (1.9%) .
Conclusions:- DOTS program is still an important role in improving registration and curing TB cases ,and
widely accepted for achieving TB control strategy in AL-Anbar Governorate .Although many results were
close to WHO targets ,the case detection rate was very low and faraway from its goals .
Keywords: DOTS, TB, Cure rate, Defaulter rate, Transfer out rate

Background :
Polycystic ovarian syndrome which is the most common endocrinopathy of women at their reproductive age
seems to be associated with thyroid dysfunction, but it’s true pathogenesis is far from being
elucidated. Both have independent risks of ovarian dysfunction and pregnancy related complications.
Objective: To evaluated the association between thyroid dysfunction and polycystic ovary syndrome (PCOS).
Study Design: Prospective Case-Control Study.
Setting : Department of Obstetrics and Gynecology/ AL-Elwiya Maternity Teaching Hospital, Baghdad - Iraq
Patients and Methods:The study included 100 women at reproductive age, 50 of them were defined as having
polycystic ovary syndrome (study group), another 50 healthy women served as control group. Thyroid
function and morphology were evaluated by measuring serum thyroid stimulating hormone (TSH), free
thyroxine levels (free T3 and free T4), anti-thyroperoxidase antibody (anti-TPO Antibody) and antithyroglubulin antibody (anti-TG Antibody) and by clinical and ultrasound examination of thyroid gland.
Results:The study revealed statistically higher prevalence of autoimmune thyroiditis in patients with PCOS (12%
vs. 4% of control) as evidenced by raised anti-TPO antibody levels (means125.91±333.39 and
88.19±316.18 respectively; P =0.563). PCOS patients were found to have higher mean TSH level than that
of the control group (3.14±2.74and 2.24±1.81respectively; P value < 0.05). There was high prevalence of
goiter among PCOS patients (10.0%vs. 4% of control, P value > 0.001). On thyroid ultrasound, a
significantly higher percentage of PCOS patients (10%; controls 2.5%) had hypoechoic ultrasound pattern
which also compatible with diagnosis of autoimmune thyroiditis.
Conclusions:Higher prevalence of thyroid disorders in the form of autoimmune thyroiditis in patients suffering
from PCOS (12%) compared with control group (4%).
Key words: Polycystic ovarian disease; Thyroid, Autoimmune; Antibody

Background: Community awareness in general and in young generations 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 assess the knowledge of secondary school students regarding tuberculosis.
Methods: This descriptive cross-sectional study was conducted in Al-Karkh district of Baghdad during the
period from November 2015 to April 2016. The sample size was determined at 1000 students from the
total number of 63464 students.
A simple random sampling technique was adopted to select schools from each of the ten sectors; this
resulted in collecting a total of 20 schools (ten schools for males and ten for females).
The students were randomly selected from those schools, 500 male &500 Female, using a systematic
random sampling technique by choosing every other student from the selected classes.
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, 42% of the questions were answered correctly, only 27.2% knew that TB was
caused by bacteria, 40.8% knew that TB’s first symptom was a cough of more than 3 weeks, 56.5%
knew that TB is associated with loss of appetite & weight loss, 39.8% knew that TB is associated with
fever & night sweats, only 38% of students knew that it is transferred by respiratory droplets, 60.6%
knew that the first organ most commonly affected by TB is the lung, 44% knew that the TB vaccine is
BCG, only 23.1% knew that sputum examination is used to help identify TB, 56.3% knew that
covering your mouth during coughing & sneezing helps prevent disease spread, only 33.4% knew that
TB treatment is available in all primary health care centers(PHCC).
Conclusion: Only about one third of the student sample had good knowledge regarding Tuberculosis, also
female students had a higher level of knowledge than male students.
Keywords: Tuberculosis, secondary school, Knowledge, Baghdad.

Abstract:
Background:Head lice infestation caused by Pediculus humanus var. Capitis, is the most prevalent human
ectoparasitic disease worldwide, head lice are haematophagous, frequent among children 3-11 years.
Traditional pharmacological therapies, have focused on 1 or 2 courses of various ovicidal and pediculicidal
topical therapies.
Objectives: To compare the effectiveness of permetherin and trimethoprim/sulfamethoxazole on 1 or 2 courses of
various ovicidal and pediculicidal topical therapies.
Methods; Seventy five females patients with pediculosis capitis , their ages ranged from 3 to 60 years. In 40
patients the pediculosis was complicated by secondary bacterial infection. The patients were divided in to
three groups, Group 1 :-The patients were treated by 5% permetherin solution . Group 2 :-Was treated by
trimethoprim /sulfamethoxazole tablet or solution according to the age .Group 3:- Was treated by
combination of 5% permetherin solution and oral trimethoprim /sulfamethoxazole . Swabs were taken from
patients with bacterial infection.
Results:The study revealed that 23(92%) patients of the first group, was cleared, 20(80%)patients from the second
group, also cleared and all the patients in the third group 25(100%). Of those who were complicated by
secondary bacterial infection 40(60%), 30(75%) the cultures show bacterial growth. The cultures which
were tested by 5% permetherin shows no inhibition zone but those cultures which were tested by
trimethoprim /sulphamethoxazol shows significant inhibition zone.
Conclusion:It was concluded that permetherin was ineffective as antibacterial agent but it was highly effectivas
pediculocidal agent and it was more effective when combined with oral trimethoprim/ sulfamethoxazole.
Keywords: pediculosis capitis, trimethoprim /sulfamethoxazol, permetherin, Staphylococus aureus,
Streptococcus pyogenes

Background: A lot of pain relieve techniques were use postoperatively the transverses abdominal plan block is
new regional anesthesia technique and paracetamol infusion one of these.
Objectives: the aim of this study to evaluate the effectiveness of the two methods in patients undergoes
appendectomy.
Methods: Non- randomized clinical trial, started in the 1stfeb 2016 to 1st Feb. 2017 at Al-Jarah hospital Iraq –
Baghdad, A 180 patients ASA I, undergone appendectomy. Age matched, 80 Patients were on ultrasound guided
transverses abdominis plane block and 100 toke paracetamol .after wound closure 20 ml of 0.5% bupivacaine was
infiltrated in to transverses abdominis neuro facial plan by posterior approach. 1000 mg of paracetamol (parol)
were administered after induction of anesthesia as infusion in 20 min and pain score was assessed in postoperative
period in 0 hr, 1 hr, 2hr, 3hr, 4hr by numerical rating scale (NRS) and visual analogue scale (VAS).
Results: Transverses abdominal plane block (TAP) under ultrasound guidance had significantly lower
postoperative pain score according NRS and VAS in comparison to paracetamol (P-value less than 0.001) at 4hr
post-operative after appendectomy.
Conclusion: Ultrasound-guided transverses abdominis plane block was easy, safe, reliable and effective analgesic
postoperative appendectomy than paracetamol.
Keywords: Transverses abdominal plan block.

Background and Aims: COPD characterized by sputum production, bacterial colonization, neutrophilic
bronchial airway inflammation and poor health status, and this lead to cause morbidity and mortality
worldwide. This study was designed to find out the most common bacteria that responsible for acute
exacerbation of COPD, determine the antimicrobial sensitivity against the bacteria isolated.
Patients and Methods: This study is done on patients admitted with acute exacerbation of COPD to
hospital. The selection process of Patients was depending on clinical examination, the radiological
test and pulmonary function test. The ages of patients were from 40 years and up. 80 patients, 48
males and 32 females. 80 patients with stable COPD serves as controls. A morning specimen of
sputum was collected after appropriate preparation and physical character of the sputum were noted.
Sputum was immediately sent to microbiology lab for culture. Sensitivity patterns in potentially
pathogenic microorganisms (PPMs) were also investigated.
Results: Fifty-two patients (65%) had positive sputum cultures, Indicating the presence of bacterial
infection. Streptococcus pneumoniae (26.25%), Escherichia coli (7.5%) , Klebsiella pneumoniae
(7.5%), Pseudomonas aeruginosa (5%) ,Acinetobacter baumannii (3.75%),Staphylococcus
aureus(3.75%) , Stenotrophomonas maltophilia (2.5%) , Enterobacter cloacae (1.25%), Leclercia
adecarboxylata (1.25%), Moraxella catarrhalis (1.25%) and Raoultella ornithinolytica (1.25%).The
majority of bacterial pathogens isolated in this study were susceptible to Imipenem, Meropenem,
Doxycycline and Chloramphenicol.
Conclusions: Our results show Incidence of bacterial infection during acute exacerbations of COPD is
about 65%. Streptococcus pneumoniae has been the most Pathogen frequently isolated; Bacterial
airway infections play a great role in many, but not in all, of the cases of AECOPD. So there is the
need to do a sputum bacterial culture examination on each patient with AECOPD, And with
appropriate antibiotics to contribute to curing of them.
Keywords: COPD; acute exacerbation and bacterial infection.

Background: Otitis Media with Effusion (OME) is a chronic accumulation of mucous within the middle ear , and
sometimes the mastoid air cell system .
Objective: To study the frequency of otitis media with effusion in relation to the effect and size of adenoid hypertrophy
as an aetiological factor , in addition to others like presenting symptoms, risk factors and the changes of
tympanometry in otitis media with effusion.
Patients and methods: A cross sectional study for 12 months (January 2011-january 2012) in Al-Yarmouk Teaching
Hospital, ENT department. One hundred children with adenoid hypertrophy aged (3-12years) were included.
All of them were evaluated by clinical ENT examination, tympanometry and lateral plane x-ray of nasopharynx
to assess the size of hypertrophied adenoid and classified into 3 grades (I, II and III) and asses the frequency of
otitis media with effusion in each grade.
Results: Only 38 children out of one hundred (38%) were diagnosed as having otitis media with effusion; with 26
patients were bilaterally involved (68.5%) and 12 patients were unilaterally involved (31.5%). According to
adenoid grade, the incidence of otitis media with effusion was as follow: grade I: 19 patients (38ears) only 7 ear
with effusion (18%) , grade II : 47 patients (94ears)only 26 ear with effusion (27%) and grade III : 34 patients
(68 ears) only31 ears with effusion (45%). Type B tympanometry was more in grade III adenoid hypertrophy
47%.
Conclusion and Recommendation: The frequency of otitis media with effusion is directly proportional to the size of
adenoid. It is recommend that early diagnosis and proper management of adenoid hypertrophy to reduce the
incidence of otitis media with effusion and its sequels of hearing loss and poor speech development in children .
Keywords: otitis media with effusion, adenoid hypertrophy

Background: Little studies focused on stimulation of healing process of infected wound in mice. The
predominant pathogens that infected wound were gram positive such as Staphylococcus aureus
and gram negative such as P. aeruruginosa and Acinetobactor Baumannii. A. baumannii cause wide range
nosocomial infections.
Objective: study the influence of green laser 532nm at constant power density (irradiance) at different exposure
times (5, 15) on healing of wound infected by Acinetobacter Baumannii created on BALB/C mice.
Methods: An elliptical full thickness skin wound was created aseptically on a back of 45 adults,
females
BALB/C mice. The wounds were infected by Acinetobacter Baumannii and the mice were randomly divided into
two sets, first one was infected ( non-irradiated controls)15 animals (five in each subgroup)dividing according to
the days of irradiation, second set was infected(irradiated groups)randomly divided in to two groups, first group
irradiated for 5 mints and second group irradiated for 15 minutes. Both irradiated groups subdivided according to
follow up period 3, 5, 10 days. Animal killed on day 3, 5, and 10 after treatment and control group killed also on
3,5,10 after contamination. Cold laser therapy (CLT) achieved by semiconductor diode laser 532nm, output
power =40mw, continuous wave laser, power density =5.71 mw/cm2
and doses 1.7J/cm2
, 5.14J/cm2
. The output
of green laser fitted with beam expander to irradiate a circular area of diameter 7cm2
. CLT started after surgery
and repeated for 3, 5, and 10 days. Wound healing studied by calculating the percentage of wound closure and
histopathological evaluation.
Conclusion: the present study showed that green laser therapy had obvious influence on healing of infected
wound especially with a dose 5.14 J/cm2.
Keywords: Green laser therapy, infected wounds, Acinetobacter baumannii

Background: This study aims to compare thyroid function between patients with acute and chronic leukemia,
through measurement of triiodothyronin, tetraiodothyronin (thyroxin), free triiodothyronin, free
tetraiodothyronin, thyroid stimulating hormone, antithyroglobulin, and antithyroperoxidase .
Material and Methods: One hundred twenty subjects collected from the Hematological Center / ALMustansiriya University, This subjects divided into two groups depending on the lineage of the
original mutated cell: forty patients of chronic lymphocytic leukemia and forty patients of acute
lymphocytic leukemia and forty healthy control for comparison with two groups. Complete blood
count of each subjects was evaluate by using Hemolyzer 5 instrument, and Hormonal tests which
include: triiodothyronin, tetraiodothyronin (thyroxin), free triiodothyronin, free tetraiodothyronin,
thyroid stimulating hormone, were measured by using Minividas. antithyroperoxidase and
antithyroglobulin were measured by using Enzyme Linked immunosorbent assay.
Result: The result indicated a presence of highly significant increase (P<0.001) of red blood cell and platelet
among patients with acute lymphocytic leukemia when compared with control groups, while highly
significant decreased (P<0.001) of red blood cell in chronic lymphocytic leukemia when compared
with control groups and highly significant increase (P<0.001) of platelets were found in chronic
lymphocytic leukemia when compared with control groups. A significant increase (P<0.05) of
thyroid stimulating hormone, free triiodothyronin, antithyroglobulin, and antithyroperoxidase in sera
of both acute lymphocytic leukemia and chronic lymphocytic leukemia patients in comparison to that
of the control group. A significant positive correlation (p˂0.05) was observed between
antithyroperoxidase and free tetraiodothyronin in sera of acute lymphocytic leukemia patient while,
in contrast with chronic lymphocytic leukemia group there was no significant correlation. A
significant negative correlation (p˂0.05) between antithyroperoxidase and RBC was observed , while
a significant positive correlation (p˂0.05) between antithyroperoxidase with platelet was observed in
sera of chronic lymphocytic leukemia patient.
Conclusion: Increase of antithyroglobulin, and antithyroperoxidase with the increase of thyroid stimulating
hormone levels of both groups (acute lymphocytic leukemia and chronic lymphocytic leukemia)
indicate an autoimmune thyroid disorder, and the free tetraiodothyronin is an important test and it
may be used with antithyroperoxidase as a marker for diagnosis of leukemia.
Keyword: Thyroid function test, antithyroglobulin, antithyroperoxidase, acute lymphocytic leukemia and chronic
lymphocytic leukemia