IRAQI JOURNAL OF COMMUNITY MEDICINE

Background & Objectives: The aim of the present study is to investigate the perspective and opinions of a representative sample of
social groups regarding physicians' medical ethics' practice. \
Subjects and Methods: A exploration of point of view of social group conducted by a self-administered questionnaire distributed to a
convenient sample from various localities including University of Mosul, primary and intermediate schools, and various
governmental and private enterprises.
Results: From 48 respondents 54.2% agreed that there are an intentional or unintentional ignorance of patients' rights from the
physicians and only 41.7% considered that most of the population has trusted the physicians. On the other hand, more
than three quarters (77.1%) of the sample considered that ethical and humanistic side of medical practice are more
important than physicians’ scientific qualifications and capabilities. While, half of the study sample (50%) was not sure
that most of the physicians have a clear vision about their commitment to patients and society.
Conclusions: Social groups' opinion highlighted the presence of major and important frustration regarding gaps of doctors' knowledge
and attitude in recognizing patients' right and the importance of humanistic side of medical practice; resulting in
diminished trust by the physicians. From their point of view they demonstrated several convincing suggestions for
improving physicians’ ethical practice

Background: Atopic dermatitis is a chronic skin disease. Its incidence around the world has increased dramatically
over the past several decades. A multi-factorial etiology is postulated, with genetic, immunological and
environmental factors all thought to be relevant to the pathogenesis.
Objective: To assess the effect of breastfeeding, solid food introduction to the infant's diet, and other confounders on
the development of atopic dermatitis.
Methods: Two hundred and forty children between 2 to 6 years were enrolled in this case control study in Baghdad,
comprised of 60 children with atopic dermatitis and 180 children free from atopic dermatitis of the same age,
sex and ethnicity as a control. Data collection had been done by an interview using a questionnaire form
designed by the investigators. Diagnosis of atopic dermatitis was made according to the Haninfin and Rajka’s
diagnostic criteria.
Results: This study showed a significant difference between case and control groups regarding the presence of family
history of atopy among child's parents. The frequency of children with positive history of animal contact differs
significantly between patients and control groups. No significant association was detected between atopic
dermatitis and positive breastfeeding history. However, the relation between atopic dermatitis and breastfeeding
is duration dependent, the percentage of infants with short exclusive breastfeeding was higher among control
group (85.3%) as compared to (58.1%) in the case group. While, with prolong breastfeeding more than 6 months
the reverse was found. Early supplement feeding increased the rate of atopic dermatitis, there was more infants
with atopic dermatitis when solid food introduced at the age of 4 months, this was statistically significant
(P=0.023).
Conclusion: Exclusive breastfeeding for 6 months is effective in reducing atopic dermatitis. On the other hand,
prolonging exclusive breastfeeding and postponing the introduction of solid foods for over 6 months is not
helpful in prevention of atopic dermatitis.
Key words: Atopic dermatitis, breastfeeding, solid food, Haninfin and Rajka’s diagnostic criteria.

Background: International classification of diseases (ICD) is the international standard diagnostic classification for all
general epidemiological, many health management purposes and clinical use. These include the analysis of the
general health situation of population groups and monitoring of the incidence and prevalence of diseases and
other health problems in relation to other variables such as the characteristics and circumstances of the
individuals affected. It is used to classify diseases and other health problems recorded on many types of health
and vital records including death certificates and health records. The tenth revision of ICD (ICD-10) was
endorsed by the Forty-third World Health Assembly in May 1990 and came into use in World Health
Organization (WHO) Member States as from 1994.
Objectives: To evaluate the knowledge concerns ICD-10 of both doctors and statisticians working at Baghdad
Teaching Hospital, to test the accuracy of coding and coding practice in a sample of patient's record at Baghdad
Teaching Hospital.
Methods: A cross sectional study, was conducted at Baghdad Teaching Hospital – Medical City Health Directorate,
from the 1st of April 2011 to the 5th of May 2011. Data collection was done for five hours a day, four days a
week. A convenient sample of 121 doctors and 10 statisticians were interviewed and data were collected
according to the questionnaire form. A pilot study was performed, data was gathered; organized, tabulated using
Microsoft Office Word 2003. Percentages, graphs and figures were done.
Results: The study revealed that 56.5% knowing the ICD 10, most of those who know ICD10 43.5% get their
information from college 24.6% and the roll of training courses was limited as only 7.6% attended training
courses. Only 13.7% health professionals used ICD10 in their practice and the reasons behind not using ICD10
was attributed to lacking knowledge25.7% and 23.9% didn’t know the code. Among all surveyed health
professional 41.2% found that ICD10 is beneficiary in medical practice and the benefit was mainly for diagnostic
and statistical purpose 64.9%. In the evaluation of the accuracy of coding process it was found that 123 record out
of 150 82% were correctly coded and only 27 18% were incorrectly coded.
Conclusion: The majority of health professionals working in Baghdad Teaching Hospital had no information
especially doctors were not aware about the importance of using International classification. Most of those who
knew ICD-10, didn’t apply it due to poor administrative follow up. Statisticians were responsible for coding the
record on discharging the patient according to the final diagnosis found in the record. The diagnoses of some
patient’s records were wrongly coded.
Key words: ICD 10, Application, health workers

Background: Obesity is highly associated with insulin resistance and increased risk of type 2 diabetes and
cardiovascular disease. Visfatin is adipocytokines that is highly expressed in visceral fat. Its
expression in visceral fat is hyperglycemia in insulin deficient diabetes.
Objective: To study the visfatin level in type 2 diabetes mellitus patients and its relation with obesity and
insulin resistance.
Patients and methods: This study was done in national diabetes center(NDC),AL -Mustansria University
and AL –Yarmok Hospital Teaching ; on a total (120) individuals age range from (33-60) years. ( 80)
patient type 2 diabetes nephropathy, (40) healthy controls . The enrolled patients were divided to
three groups according to BMI ,data collection about age, sex ,WHR, BMI and blood samples to
estimate serum visfatin levels, fasting plasma glucose(FPG), glycated hemoglobin(HbA1c), lipid
profile (TC,TG,HDL-C,and LDL-C), fasting C-Peptide ,and fasting insulin level Furthermore insulin
resistance parameters calculated from Homeostasis Model Assessment 2- insulin Resistance were
calculated using HOMA2-Calculator software downloaded freely .
Results: The mean FPG,HbA1c, C-Peptide level, fasting insulin level ,HOMA2IR and visfatin level show
statistically significantly increased in diabetic patients when compared with control subjects. Serum
visfatin level was significantly increased with BMI increased groups. Visfatin level was increased in
HOMA2-IR =>3 when compared with HOMA2-IR <3 in diabetic patients. Visfatin level show
significant positive coorelation with BMI, WHR,FPG, HbA1c, fasting insulin level , HOMA2-IR ,
TC,TG,and LDL-C in diabetic patients when compared with control subjects ,and negative
correlation between serum visfatin level and HDL-C in diabetic patients when compared with control
subjects .
Conclusion: Obesity and Insulin resistance play an important role in the pathophysiology of type 2 diabetes
mellitus. Elevated visfatin level in diabetic patients with obesity features of insulin resistance are
believed to result in distance clinical characteristics and complications such as atherosclerosis.
Key word: T2DM, Obesity, Insulin resistance, visfatin.

Background: Skin diseases are among the most frequent causes of morbidity in developing countries,
showing high prevalence in the general population and being the sixth most frequent cause of
outpatient visits to health facilities.
Objective: To assess the occurrence of different types of infectious skin diseases among a sample from
dermatology outpatients’ clinics.
Methods: This descriptive cross sectional study was conducted in the dermatology outpatient clinics of the
two main teaching hospitals in Baghdad city (Al-Yermouk and Baghdad Teaching Hospital) during
the period from January through April 2012 using a consecutive non probability sampling technique
by pooling all the patients attending the dermatology outpatient clinic in both hospitals on daily
basis during the four month period of the study.
Results: The most prevalent type of skin infections in the sample was viral (40.1%) followed by bacterial
(21.6%), and the least was parasitic infections (17.5%) Males were affected approximately double
than females especially in respect to viral and parasitic infections. The highest age group affected
was 16-30 years, followed by those less than 15 years, the least affected were those above 60 years.
In almost all age groups the most prevalent infection was viral infection.
Conclusion: Viral infections are the commonest skin infections, warty lesions are the main subtype of viral
infections and the commonest of all skin infections.
Keywords: Skin infections, Baghdad, Iraq

Background: Recurrent aphthous ulcer (RAU) is a common disease where its exact etiology and pathogenesis are not
known. There is no uniformly effective therapy for this disease. Recent study showed that oral zinc sulphate has
effective therapeutic and prophylactic role in management of this disease.
Objective: To evaluate the therapeutic, prophylactic efficacy and safety of 5% zinc sulphate mouthwash in the
management of patients with RAU.
Patients and Methods: This is single blind placebo controlled therapeutic study where 40 patients with early onset oral
aphthosis were recruited in this work those who attended Baghdad Teaching Hospital-Department of
Dermatology between April 2005- April 2006. Patients were divided into two groups: Group A (20 patients)
were instructed to use 5% zinc sulphate mouthwash, 5 ml twice daily for three months, while 20 patients in
Group B used placebo in a form of distilled water mouthwash and in a similar way to zinc sulphate mouthwash.
A short term assessment of each patient of both groups was done to evaluate the therapeutic effect of the drug by
using oral clinical manifestation index (OCMI and the mean size of the largest diameter of ulcers. A long term
assessment was done for each patient to evaluate the prophylactic effect of the drug by using (OCMI) before,
after 1, 2 and 3 months of therapy.
Results: The patient included in this study 19 males (47.5%) and 21 females (52.5%), female to male ratio was 1.1: 1.
Their ages ranged between 20-60 (29.6 ± 9.6 ) years. The mean of OCMI in Group A started to decline directly
after 4 days of therapy and went to its lower level after 8 days of therapy, and it was statistically significant (P
value <0.05). The change in the mean of OCMI of Group B after 4 and 8 days of therapy was also statistically
significant (P value <0.05). The response rate (percentage of change in the mean) after 4 days of therapy in
Group A was 22.65% and in Group B was 6.44%, while the response rate after 8 days of therapy in Group A was
66.33% and in Group B was 44.98%. The difference in the response rates after 4 and 8 days between Group A
and B was statistically significant (P value <0.05). The mean size of ulcers in Group A started to decline directly
after 4 days of therapy and to its lower level after 8 days of therapy, and it was statistically significant (P value
<0.05). The change in the mean size of ulcers of Group B after 4 and 8 days of therapy was also statistically
significant (P value <0.05). The response rate after 4 days of therapy in Group A was 44.30% and in Group B
was 15.08%, while the response rate after 8 days of therapy in Group A was 83.54% and in Group B was
55.36%. The difference in the response rates after 4 and 8 days between Group A and B was statistically
significant (P-value <0.05). So the therapeutic effect of zinc sulphate mouth wash was statistically more
significant than placebo effect. No significant side effects were noticed apart from mild irritation in two patients
using zinc sulphate. Zinc sulphate mouth wash showed statistically significant prophylactic effect in comparison
to placebo after 1, 2 & 3 months from starting therapy using the oral clinical manifestation index.
Conclusions: Zinc sulphate 5% mouthwash is a new, safe effective therapeutic and prophylactic remedy in
management of RAU. The mechanism of action could be related to its immunomodulatory, antimicrobial,
antioxidant actions and effects on wound healing.
Keywords: zinc sulphate, RAU, mouthwash.

Background: Colorectal cancer is a common disease in old patients, but it has become increasingly evident
in young patients.
Objective: To compare the colorectal carcinoma, between young and old patients.
Patients and Methods: a prospective study of 87 patients with colorectal cancer treated in the department of
surgery at Al-Yarmouk Teaching Hospital, From Jan.2007-Jan.2012. The patients were divided
according to age into group A; below 40years, and group B; above 40years. These two groups were
compared regarding; clinical presentations, pathological features of the tumor, staging of the tumor, and
sex.
Results: Twenty three patients (26.44%) in group A; their age ranging from 12 to 40 years, with male to
female ratio was 1.3:1 the commonest affected age group was 31-40 years old, positive family history
was significantly higher than that in group B (39%), the commonest presenting features were altered
bowel habits (87%) and abdominal pain (65%), left side colonic tumors were more common than right
side tumors, Moderately differentiated tumors were constitute 52% and60.8% were stage C2, there was
no significant difference between the two groups.
Conclusion: there was an increasing incidence of colorectal cancer in young patients. Family history was a
risk factor for group A patients. Diagnosis was usually delayed and this needs more attention because of
the lack of alarming symptoms.
Keywords: Colorectal cancer, incidence

Background: the wound infection is the most common complication following operation for perforated appendix.
Drainage and systemic antibiotic agents have not altered the incidence of wound sepsis in cases of perforated
appendicitis with primary wound closure.
Aims of study: to study the delayed primary wound closure in preventing wound infection in cases of perforated
appendicitis.
Patients and methods: This is a prospective study conducted on 216 patients with appendicitis who underwent operation
at surgical wards of Al – Yarmouk Teaching Hospital, from January 2005- august 2008. The range of age from 11-
56year, mean age was 33.5 years. For comparison purposes, the patients were divided into three groups:
Group I:- uncomplicated (non perforated) appendicitis.
Group II:- perforated appendicitis were treated with appendicectomy and primary wound closure.
Group III: perforated appendicitis who were treated with appendicectomy and delayed primary wound closure.
All the three groups patients were treated in the following manner:-
Grid-iron incision done. Aspiration or swabs of peritoneal fluid or pus and appendix stump and wound edges were
taken &send to the laboratory &cultured for aerobic and anaerobic bacteria, appendicectomy done after ligation of
the mesoappendix and tube drains used.
Results: There were no deaths encountered in the series of 216 patients. Wound infection was defined as any purulent
discharge from the wound requiring drainage or repeated dressing, or any collection of purulent exudates in the
wound requiring repeated dressing or drainage.
Group I:-wound infection occurred in5.26%.
Group II:- wound infection was noted in29.03%.
Group III. wound infection occurred in 3.03%.
Conclusion: the wound becomes contaminated during operation for perforated appendix by manipulation and seepage of
purulent exudates into the wound. Primary closure of such a wound creates a potential closed space for infection.
The high incidence 29.o3% of superficial wound infection occurring in group II bears out this observation

Back ground: The shoulder joint is an elegant and complex piece of machinery. The rotator cuff tendons are keys to the healthy
function of the shoulder and rotator-cuff tear is an especially painful injury and can happen at any age.
Objectives; to evaluate the role of ultrasonography in the diagnosis of rotator cuff tear.
Patients and method; From March 2013 to September 2015 forty eight patients were enrolled in a prospective comparative study
and divided into full thickness, partial thickness tear or intact tendons according to clinical and ultrasonographic
criteria and these results were assessed by surgery and results compared.
Results:Sensitivity of clinical diagnosis was 95.3%., specifity 20% and predictive value 33.3% and sensitivity of ultrasonography
was 100%, Specifity 37.5% and Predictive value of 100 %.
Conclusions; Ultrasonography is well tolerated and cost-effective and useful test in diagnosis and detection of rotator cuff tear.
Key words; rotator cuff tear, full thickness tear, partial thickness tear, intact tendon.