IRAQI JOURNAL OF COMMUNITY MEDICINE

Background: Breast cancer is occupying a high rank among malignant diseases in Basrah and some evidence suggests that the risk is getting increased with time. Objectives: This article is designed to provide a profile on the geographical distribution of incident breast cancer in various parts of Basrah governorate. Methods: All newly diagnosed cases registered with Basrah Cancer Registry Office during a four- year period (2009-2012) were used for the purpose of the study. Results: The average annual crude incidence rate of breast cancer was 24.49 per 100000 females and agestandardized incidence rate was 34.86 per 100000 females. Great variation in the incidence rate was noticed across different districts with the highest rate was in Basrah city 40.22 per 100000 females and the lowest was in Northern districts of Mdaina (11.04 per 100000 females) and Qurna (12.56 per 100000 females). The incidence rates in other districts were in between the two extremes. Conclusions: The risk of breast cancer is relatively high in Basrah with great variation in different districts. The variation could reflect true risk difference, difficult accessibility to oncology services in Basrah or incomplete registration of cases.
Keywords: Breast cancer, Basrah, Epidemiology, Geographical distribution

Abstract: Background: Seasonal influenza is an acute highly infectious viral infection. Its short incubation period, and efficient person to person transmission, makes it hazardous to patients and staff in health care facilities. Doctors are often exposed to influenza during their work, acting as vectors, passing infection to patients. Influenza vaccines can be either trivalent inactivated influenza vaccine, or Live attenuated influenza vaccine. Seasonal influenza vaccines are valid for one year only, because of the need to adapt (update) the vaccine strain to the changing circulating field virus. Vaccine efficacy for healthy adults and most children ranges (80-100) %. Seasonal influenza control plan in Iraq targets those with chronic disease, pilgrims, & all health care workers. Aim of the study: As this vaccine is new in Iraq, this research aims to determine medical staff knowlegde level for using the vaccine in preventive programs. Subjects & methods: A cross sectional study conducted in conveniently selected 7 health institutes in Karbala / Iraq, from 1st Feb through May 2012. From the 321 available medical staff, 281 participated after verbal consent (Response rate 88%). Apart from socio-demographics, the questionnaire enquired about Influenza prevention, vaccine (specification, contraindication, immunity, schedule, & risk groups). Knowledge items were scored, and then summed up to get total score. The 50th & 75th centiles were taken as cut-offs for poor/fair, and fair/good knowledge respectively. SPSS V.16 was used for data analysis, with P value of ≤ 0.05 denoting significance. Results: Only 27% of medical staff studied in Karbala received influenza vaccine, and 43% had miss-believe of vaccine unavailability in health institutes, and 33% untrusted the vaccine. Poor influenza vaccine knowledge among medical providers was high (72%). Knowledge was not associated with gender, medical occupation type, and education, but significantly associated with Drs field of medical practice, and vaccination status. Conclusion: Medical staff Knowledge about influenza vaccine is low. MOH Policy makers need to update Medical staff about influenza vaccine via continuing medical education.
Key words: Seasonal influenza, Influenza vaccine, Medical staff knowledge, Karbala hospitals

Abstract: Background: Reactive oxygen species (free radicals) can cause various damage to different parts of the body, including the blood. Oxidative DNA damage can be measured in lymphocytes by various techniques which is a useful way to evaluate the degree of oxidative stress. The Comet assay is important technique for assess the damage or repair of DNA in human cultured lymphocytes. Aim of the study: To assess the levels of DNA damage and to measure the proportion of the DNA cellular repair in human lymphocytes cultured in vitro conditions, the impact of the presence of Beta-Carotene by measuring the Comet tail moment. Subjects and Methods: The study included 50 individuals aged between 20-50 years, during the period from12 October 2014 to 19 November 2015 and from healthy individuals, non-smokers, and non-conception of any type of vitamins before 1-2 weeks of sampling. Ten milliliters of hole blood sample taken to hepernized container, 10 samples (5 males, 5 females) to study the toxicity of different concentrations of Beta-Carotene (100, 10000) µg/ml on cultured lymphocyte by trazoleom assay; then take another samples (40) to assess the level of DNA damage in cultured lymphocytes by Comet assay in presence of the two different concentrations of Beta-Carotene (100, 10000) µg/ml, (20 individuals every concentration). Results: There were a damage occur in DNA of the cultured lymphocytes by the effect of the presence of hydrogen peroxide, and there was repair occur by the presence of Beta-Carotene at the concentrations (100 and 10000) µg/ml, and also there were a significant change in the average of tail moment (in Comet assay) as an indicator of a positive effect for Beta-Carotene to protect DNA of the cultured lymphocyte cells. Conclusions: This study demonstrated the protective effects of in vitro applications of Beta Carotene in different concentrations (100, 10000) µg/ml on DNA damage induced by H2O2 in lymphocyte cultures of healthy individuals, via Comet assay (tail moment), which showed that the most effective concentration of BetaCarotene as antioxidant was in the concentration of 10000 µg.
Keywords: Beta Carotene, lymphocytes, comet assay.

Abstract: Background: Cervical cancer is the third most common cancer among women worldwide Immunohistochemical expression of p16INK4a has been relatively well established in cervical biopsy specimens. Objectives: Our hypothesis is to evaluate the usefulness of p16 immunostaining on tissue sections in borderline cases. Methods: This is a case-control study with a total of cervical samples from 60 women (25-66 years age) divided into three groups (I, II and III). The study was conducted at the Colposcopy Clinic in Baghdad Teaching Hospital – Medical City Complex, during the period from June 2013 through July 2014. The samples were analyzed by cytopathology, histopathology and p16INK4a immunostaining. Results: Group I showed negative p16 reaction. Among group II; one (5%) showed mild positive, 9 (45%) moderate positive and 10 (50%) high positive reactions. Group III specimens showed p16 positivity. Conclusion: p16INK4a immunohistochemistry is one of the best candidates for histologically indeterminate lesions.
Key words: p16INK4, cervical cancer, human papillomavirus, cervical intraepithelial neoplasia

Background: Vaginal birth after cesarean section is a healthy issue. The success rate ranges from 50-77%. Several ultrasound studies have been performed to predict the appropriate lower uterine segment thickness for a safe trial of labour and the risk of uterine rupture during a trial of labor after cesarean section by measuring Lower Uterine Segment thickness. Objective: To evaluate the appearance of the lower uterine segment by ultrasound in pregnant women with previous cesarean delivery and to compare it with that in women with unscarreduteri. Methods: A prospective study was conducted from the beginning of March 2010 to the end of June 2011 in the department of Obstetrics and Gynecology at AL- Kadhimiya Teaching Hospital, Sonographic examination was performed on107 pregnant women: 53 pregnant women with history of previous cesarean delivery(study group), 13nulliparas (nullip-control), and 31 women who had 1 or more childbirths with unscarred uteri (multip-control)with gestational age 36 and 39 weeks of gestation both study and control groups were subjected to sonography to assess & compare lower uterine segment. In the cesarean group, the sonographic findings were correlated with the delivery outcome and the intraoperative Lower uterine segment appearance. Results The study revealed44 patients (83.0%) had a normal-appearing lower uterine indistinguishable from that of control group. 2patients (3.8%) had a sonographically very thin lower uterine segment thickness measurement suggestive of future dehiscence; and 7 patients (13.2%) had thickened areas of increased ecohogenicity with or without myometrial thinning. Although the cesarean group had a thinner lower uterine segment (3.6 ±0.9 mm) when compared with both the nullip-control group (3.8± 0.8 mm; P = .02) and the multip-control group (4.01± 1.3 mm; P = .04). Only the latter difference achieved statistical significance. One of the 2 patients who had a sonographically suspected lower uterine segment defect had confirmed uterine dehiscence during surgery. An intra-operatively diagnosed paper-thin lower uterine segment, when compared with a lower uterine segment of normal thickness, had significantly smaller sonographic lower uterine segment measurement. Conclusion: Prior cesarean delivery is associated with a sonographically thinner lower uterine segment when compared with those with prior vaginal delivery. Prenatal sonographic examination is potentially capable of diagnosing a uterine defect and determining the degree of lower uterine segment thinning in patients with previous cesarean delivery.
Key words: Sonography, Lower uterine segment thickness, Pregnant, Previous one caesarean delivery

Background: Normal pregnancy induces profound changes in maternal physiology which promotes oxidative stress. Vitamins C and E are antioxidants that work as a defense against this oxidation process. Objective: To assess the plasma levels of the vitamins C and E at different trimesters of pregnancy and to correlate them with the sociodemographic factors of pregnant women. Method: A case control study had been conducted in Al-Kadhymia Teaching Hospital which enrolled 120 women. Ninety pregnant cases of 20 -40 years, 30 cases for each of the first, second and third trimesters were the study group and the control group were thirty cases of non-pregnant women of the same age group. Plasma level of vitamin C and E were estimated using high performance liquid chromatography (HPLC)method. Results: The plasma level of vitamin C was significantly different across the different trimesters of pregnancy and it was significantly lower than the control group P<0.001. Also the plasma level of vitamin C was significantly decreasing with increased parity and age P<0.05, and its level was higher in working pregnant women compared to the pregnant housewives. The plasma level of vitamin E was significantly decreasing through the three trimesters of pregnancy P<0.05. Conclusion: The plasma level of both vitamins C and E are reduced during pregnancy and life style and occupation have great impact on vitamin C level in plasma. There is significant declining in plasma vitamin C level with parity and increase in maternal age.
Keywords: Vitamins C and E, Antioxidants, Sociodemographic factors, Pregnancy

Background: Facebook is one of most widely used social media sites. Addiction occurs when person uses Facebook in excessive way. Facebook addiction has negative impact on human productivity and academic performance. Subjects and method: The study was a cross-sectional study conducted to determine the prevalence of Facebook addiction using Bergen Facebook Addiction Scale. This study was carried out at College of medicine - Babylon University. Study duration extend from the first of March 2015 to end of April 2015. Results: Mean age of students was (20.82 ± 1.73). Prevalence of Facebook addiction was (13%).There was significant association between Facebook addiction and number of hours spends daily using Facebook. Study reflects significant association between Fa . Conclusion: Prevalence of Facebook addiction was high in Babylon medical college. Facebook addict students were younger than those without Facebook addiction. Facebook addict or possibly addict spend three or more hours on Facebook. Facebook addiction has a negative impact on academic performance.
Key words: Babylon University, Facebook addiction, Medical students

Background: The aim of this study is to prove that epilepsy can be presented in unusual way because of the signs and symptoms in prodrom, aura and postictal period. Patients and methods: This study was conducted on 18 children patients at Al-Ramadi Teaching Hospital in AlAnbar, Iraq between Jan. 2009 and Dec. 2011. Complaining of different medical, neurological and psychological problems proved to be epelipsy. Results: 18 patients 14 (77.77%) were females and 4 (22.23%) were males. Their ages ranged from 4-12 years. They were presented complaining of one of the following: Deterioration in school performance in 4 patients (22.22%). Abdominal pain in 4 patients (22.22%). Attacks of Amnesia in 3 patients (16.66%). Headache in 3 patients (16.66%). Behavioral changes (aggression and sleep disturbance) in 2 patients (11.11%). Nausea and vomiting in 2 patients (11.11%). EEG was positive in 15 patients (83.333%). CT Scan of brain was normal. All cases responded well to Anticonvulsant drugs. Conclusion: Epelipsy is common in Al-Anbar and presented in different types. In children neither the child nor the parents are aware of the attack resulting in Amnesia, Deterioration in school performance, Headache and behavioral changes. Keyword: Epilepsy, Children, Amnesia, School performance, Headache.

Abstract: Background: Sensorineural hearing loss is a common sequel of chronic suppurative otitis media and the round window membrane is currently being considered as a major route for noxious agent to pass from the middle ear cavity to the cochlea. Objective: To evaluate the incidence and severity of sensorineural hearing loss in patients with chronic suppurative otitis media. Methods: Prospective study on 93 patients from January 2010 to December 2014 in the AL-Karama Teaching Hospital.The patients were complaining of unilateral chronic suppurative otitis media they were grouped according to the pathology to active, inactive mucosal disease and active, inactive squamous epithelial chronic otitis media, based on clinical otoscopical examination. Audiological studies were done in Specialized Surgery Hospital/ Science Center of Otorhinolaryngology Hearing and Speech Unit. Result: Forty-four percent of the patients with unilatral chronic suppurative otitis media had some loss of cochlear function. The range of difference between diseased and uninvolved ears was wider at the higher frequencies and related to the activity and duration of the disease. Conclusion: Chronic suppurative otitis media may associated with mixed rather than purely conductive hearing loss. Keyword: Sensorineural hearing loss, chronic suppurative otitis media

Background: Cerebral palsy is a group of none progressive motor problem and physical disorders. Equinus deformity occurs with high frequency in patients with lower extremity CP in both the Hemiplegic and the Diplegic patients, which limits passive ankle dorsiflexion to less than the neutral position and results in characteristic toe-walking gait. Objective: To compare between the two surgical methods for CP patients with Equinus, regarding technique of the operation, post-operative morbidity & complication rates, functional results and advantages of one over the other. Patients & Methods: A prospective study carried out in Al-Yarmouk Teaching hospital for period from March, 2010-October,to 2011 on CP patients with Equinus deformity undergone surgery to correct their deformity by elongation of Tendo Achilles, we chose two methods of lengthening, Open and Percutaneous. Patients with their feet selected randomly to choose the procedure whether percutaneous or open. Follow-up of cases range from (6-12) months with an average of (6) month combined with postoperative physiotherapy and all the results were recorded in a prepared questionnaire. Results: The most serious complications encountered were wound infection and recurrence of equinus: We faced 2 cases (14%) of deep and superficial wound infection in cases treated by Open method. -We faced 5 cases of recurrence of equinus: 4 feet (28.5%) of those treated by open technique. 1 foot (5%) of those treated by percutaneous technique. Fortunately, we didn’t face any case with calcaneus deformity. In our study, percutaneous results seemed to us as an excellent and superior to the Open method results and at most levels. From the results we got, we found that percutaneous method had easier technique, less complicated, more satisfied from the parents and better functional results than that of open method. We got 80% excellent gait with percutaneous method in comparison with 57% for Open method. Conclusions: In our study, percutaneous technique regarded as the technique of choice for surgical correction of primary fixed equinus deformity of the foot in spastic CP child.
Key words: Equinus, Cerebral palsy, Tendo Achillis, Percutaneous lengthening, Open lengthening.