IRAQI JOURNAL OF COMMUNITY MEDICINE

Abstract: Introduction: Intertrochanteric fractures are common among elderly people and considered to have a serious impact on patient and community. Various classification systems and treatment methods are described which also vary in their results. Aim: To compare between external skeletal fixation and dynamic hip screw fixation in the treatment of intertrochanteric fractures of Evans stable and unstable type 1, in regard to age, gender, treatment choice, perioperative and postoperative outcome, and complications. Patients and methods: Seventy-four patients who met the criteria were selected for this study in which 54 patients were treated by external skeletal fixation while the other 24 were treated with dynamic hip screw fixation. Perioperative measures, post-operative follow-up and final outcome were recorded for each patient. Results: Patient who were treated with external fixation were subjected to less anesthesia time, less operative time, less perioperative blood loss, less exposure to radiation, faster healing rates, and minimal complications. Conclusion: Treatment with external fixator is an effective choice of treatment for Evans stable and unstable type 1 intertrochanteric fractures in elderly high risk patient. Keywords: Intertrochanteric fractures, External skeletal fixation, dynamic hip screw

Introduction: Large, one-piece, medial, malleolar fractures are usually fixed with single or two lag screws. The tension band wiring is indicated for fixation of small medial fragments, avulsion fractures, or osteoporotic bone. Aim of study: To compare between two methods of internal fixation of displaced closed fractures of medial malleolus malleolar screw and tension band wiring. (comparative study between malleolar screw & TBW, in treatment for displaced closed fractures of medial malleolus) Patients & Methods: A cross sectional study carried out in Al-Yarmouk Teaching hospital from April, 2012 to June, 2013 on twenty patients with displaced closed fractures of medial malleolus treated by open reduction and internal fixation with either malleolar screw (I) or with tension-band wiring (II) divided equally with ethical consideration. After surgery, all the patients were reviewed at 10 to 14 days, six weeks, three months, six months and one year after operation. At each assessment we perform a physical and radiological examination included in a prepared questionnaire for each patient. Results: No significant differences were observed between two groups of the patients regarding age, gender, fracture type and etiology. The mean time for radiological bone union was 11.8 weeks in group I patients and 9.4 weeks in group II patients (p=0.03). Excellent and good results were achieved in 80% in group I patients and 90% in group II patients. (p=0.049). Assessment of complications revealed no significant differences except for delayed union that was more prevalent among group I. Conclusions & Recommendations: Tension-band wiring more valid option for internal fixation of medial malleolar fractures that may be more available and its usage could translate into overall cost saving when applied to the large number of ankle fractures treated surgically in our country. Key words: Malleolar Screws, Tension band wiring, Malleolus.

Background: Miscarriage is the most common complication of early pregnancy, and remains an important clinical problem. Knowledge of the pathophysiology of this is limited and therefore therapeutic regimens are based on few data. Objective: To study patients with first trimester incomplete miscarriage and to evaluate whether expectant or medical management is a feasible strategy and to assess the value of Colour Doppler ultrasonography for patient selection. Patients and Method: A prospective comparative study of a total of 100 pregnant women with an estimated gestation age of up to 13 weeks from the last menstrual period (LMP) attending Al Yarmouk teaching hospital from November 2011 to November 2012, after confirmation of the diagnosis by transvaginal sonography, the patients were divided into two groups: expectant and medical management groups. The ultrasound examination included Colour Doppler Imaging to evaluate the vascularity of retained products. Results: Out of a total of 100 women recruited, 50 patients (50%) elected to expectant management and 50 patients (50%) for medical management. The treatment groups were similar in age, gestational age, and proportion of patients who had post-treatment complications (12–13%). By 4 weeks after inclusion, 42 patients (84%) in the expectant management group had undergone a spontaneous complete miscarriage and 8 patients (16%) had undergone surgical evacuation. While in the medical management group, 46 patients (92%) had undergone complete miscarriage and 4 (8%) had undergone surgical evacuation. 54.3% of cases with detectable presumed intervillous pulsatile blood flow had a complete, spontaneous miscarriage within 1 week; this occurred in 77.8% of cases with no detectable flow. This suggests that conservative management is a successful approach for patients with first trimester incomplete miscarriage; Colour Doppler ultrasonography can be used to select the most suitable patients for this strategy, and thus reduces the need for hospital admission, surgery and prolonged follow up. Key words: Incomplete miscarriage / Colour Doppler ultrasonography/Conservative management

Abstract: Background: Children constitute the most important and vulnerable segment of the population; programmes that aim to enhance the health of children require baseline information on what mothers know about and provide for their children. Objectives: To determine the level of knowledge of mothers on certain health aspects of children below two years of age and the factors influencing such knowledge and to address the sources of mothers\' information. Subjects and method: A cross sectional study was conducted in seven primary health care centers in Baghdad for the period from the 2nd of April, to the end of June, 2013. Mothers who had children less than five years of age and attended the selected health centers were recruited. Data was collected via direct interview with mothers using a special questionnaire form to assess the knowledge of the mothers regarding different aspects on child health. In addition, the data collected comprised some characteristics of the mother and father as well as mother\'s source of information on child health. Results: The study demonstrated that 66% of the participants had an overall acceptable level of knowledge on the various aspects of child health with a mean of 23, 4. Current age of the mother, her age at marriage, education and occupation of the mother and father and number of children. All these factors demonstrated a statistical significant association with mother\'s level of knowledge. Conclusion: Despite the acceptable level of knowledge, the study revealed considerable deficiencies in the knowledge of mothers particularly in regard to immunization, common childhood illnesses and safety practices which mandate the adaption of interventions that can correct the existing gaps in mother\'s information. Key Words: Determinants, Mothers\' Knowledge, Health Aspects, Children, Baghdad

Abstract: Background: Anti-tumor necrosis factor drugs (biological agents) are a class of drugs that are used worldwide to treat inflammatory conditions “these drugs are able to reduce inflammation and stop disease progression”. Objectives: To evaluate lipid profile changes after anti-TNF therapy in patients with psoriatic, rheumatoid arthritis and ankylosing spondylitis Patients &methods: A prospective study included 90 patients presenting with 30 Psoriatic arthritis (n=30), ankylosing spondylitis (n=30) rheumatoid arthritis (n=30) who were treated with anti-TNF therapy (infliximab, rituxmab etanercept) and assessed during follow-up period after 6month of therapy. Results: Regarding lipid profile, significance differences (P<0.000) were seen after biological therapy with infliximab infusion in patients with psoriatic arthritis. The current study had significant differences regarding TG and HDL after 6 month of treatment of rheumatoid arthritis patients with rituximab., Significance differences were seen regarding TG and LDL in ankylosing spondylitis patients treated with etanercept Conclusion: Significance differences were seen regarding lipid profile and antitumor necrosis factor alpha therapy regarding psoriatic, Rheumatoid arthritis and ankylosing spondylitis Key words: Dyslipidemia, Psoriatic arthritis, Rheumatoid arthritis, AntiTNF

Background: Upper gastrointestinal bleeding (UGIB) is a common emergency medical condition that may results in high patient morbidity and mortality, its causes are vary from country to country. Upper endoscopy is a safe and easily carried out procedure and consider the diagnostic modality of choice for (UGIB) and also has therapeutic value in some cases. Aims: The purpose of this study was to evaluate the endoscopic findings in patients presenting with UGIB and its frequency among these patients in our endoscopy unit. Patients and methods: This study was carried out in Gastroenterology & Hepatology Department of ALRamadi Teaching Hospital, from January 2012 to February 2013. 136 patients presenting with upper GI bleeding. Endoscopy was performed on each patient and the findings documented. Results: The mean age was 46.6 years ± SD 12.64. years. There were 95 (69.8%) males and 41 (30.2%)females. The most common endoscopic finding was peptic ulcer disease ((44.8%, n=61) 45 patients of them were duodenal ulcer and 16 patients were gastric ulcer), followed by gastritis (13.9%, n=19), esophageal varices (11%, n=15). Gastric erosions were found in 10 patients (7.3%), stomach carcinoma (5.1%, n=7) duedenitis (4.4%, n=6) esophagitis (2.2%, n=3), Mallory-Weis tears(2.2%, n=3), gastric polyp (0.7%, n=1) and (7%, n=9) normal upper GI endoscopy . Conclusion: In patients with acute upper GI bleeding, the most common endoscopic finding is peptic ulcer disease. Key words: Endoscopy findings, Upper GU Bleeding

Background: Chronic obstructive pulmonary disease is considered a major public health problem in the world. Weight loss, muscle and fat mass depletion are common nutritional problems in chronic obstructive pulmonary disease patients. In the present study, we assessed nutritional status in chronic obstructive pulmonary disease patients. Objectives: For the assessment of nutritional status in patient with chronic obstructive pulmonary disease, assessment the risk of malnutrition, determine the relation between severity of Chronic obstructive pulmonary disease and risk of malnutrition and determine the atherogenic index as a risk factor for atherosclerosis and its relation with risk of malnutrition in patient with Chronic obstructive pulmonary disease. Patients and methods: A descriptive Cross-sectional study of 90 patients diagnosed with chronic obstructive pulmonary disease (64 males and 26 females) from the age of 35 years. conducted in Al-Hila city, in Merjan medical city. Data collection was carried out during the period from 1st of March to 30th of May 2014. Data obtained included questionnaires, anthropometric measurements (weight, height, body mass index, waist circumference, height circumference, and waist hip ratio), pulmonary function test, Biochemical investigations (includes glycated hemoglobin (HbA1c) and atherogenic index) were analyzed by statistical package for social sciences program version 18. Results: A ninety patients with chronic obstructive pulmonary disease were enrolled in this study with a mean age 59.2±6.0, range 35-65 years. 92.2% of study population were present with (50-65) years age, 97.3% of them had high risk of malnutrition and 88.7% had low risk of malnutrition, and71.1% were male and 28.9% were female. There was significant association between sever or low risk of malnutrition and marital status, residence, duration of chronic obstructive pulmonary disease, smoking history, intensity of cigarette smoking(packyear) and alcohol ingestion, coronary artery diseases, eating alone and physical inability to shop, cook and/or feed self, Severity of chronic obstructive pulmonary disease and Atherogenic index. But there were no significant association with age group, gender, education, occupation, water pip, diabetes, hypertension, thyrotoxicosis, chronic kidney disease and carcinoma of lung, body mass index, waist-hip ratio and glycated hemoglobin, changed kind and or amount of food due to chronic obstructive pulmonary disease, number of meals per day and history of mouth or tooth problems that make you hard to eat. Conclusion: The study found that chronic obstructive pulmonary disease patients had high risk of malnutrition and those patients also had raiser values of atherogenic index that may lead to atherosclerosis and coronary artery diseases. Keywords: Chronic obstructive pulmonary disease, malnutrition, nutritional assessment, atherogenic index of plasma.

Background: The prevalence of NCDs is increasing throughout the world. Lifestyles changes particularly, unhealthy diets and lack of physical activity (PA) have been contributed to the increased prevalence of NCDs. Globally, the prevalence of physical inactivity (PI) is about 31%, however there is insufficient data about prevalence and determinants of PI among adults with Hypertension (HTN) and/or Diabetes (DM) in Baghdad. Objectives: The objective of this study is to measure the prevalence and identify high risk groups of PI among adults with HTN and DM in Baghdad, Iraq, 2015-2016. Methods: A cross-sectional study was conducted among a representative sample of 584 adults with HTN and/or DM (age≥18 years) who attended primary health care centers in Baghdad, Iraq. Data were collected using structured questionnaire to gather socio-demographic information of the participants. 16-item Global Physical Activity Questionnaire (GPAQ), which was administered in face-to-face interviews, developed by WHO and incorporated within the WHO Stepwise instrument, and scored as per standard protocols used to measure the PA variables. A metabolic equivalent task (MET) score of less than 600 indicates the presence of PI. Results: The total participants were 584. Overall, PI was found to be 57.5% (95% CI: 53.49%-61.51%).The study population was found to be least active in the leisure time domain (6.7%) compared with the work (45.7%) and transport (47.6%) domains. Binary analysis revealed the following risk factors: Age, sex, marital status, occupation, educational level, hypertension, combined hypertension and diabetes, BMI, and PA advice. Logistic regression analysis applied and revealed the following un-confounded risk factor: Aging (OR=1.047), Divorced or Widowed (OR=1.323), Retired or housewives (OR=1.331), Illiterate level of education (OR=1.439), obesity (OR=1.46) and lack of PA advice (OR=3.443). Conclusion: more than half of HTN and/or DM subjects in Iraq was physically inactive. Low education, obesity and lack of advice were the most important modifiable risk factors. Keywords: Physical inactivity, Iraq, hypertensive, diabetic, prevalence

Background: Bcl-2 plays a major role in the process of apoptosis and their dysfunction underlies carcinogenesis. Objectives: The study objective was to assess the expression of Bcl-2 in gastric cancer cells in correlation with clinic-pathological parameters and to determine the effect of H. Pylori infection on the expressions of Bcl2 in gastric adenocarcinoma. Methods: Using immune-histochemical analysis and in situ hybridization technique were used to measure Bcl-2 protein and CagA H. pylori gene expressions respectively and its relation to clinic-pathological parameters were observed. Results: The results revealed that a significant differentiation between Bcl-2 expression on the patients with gastric cancer and control group. Also we found thatBcl-2 expression significantly higher in intestinal type in comparison to that diffuse type (p<0.001). But no significant association between positive Bcl-2 expression and the presence of CagA-H. pylori in patients with gastric carcinoma (p>0.05). Conclusion: Bcl-2 expression in gastric cancer patients was suggested of its association with gastric carcinoma especially intestinal type. Thus, detection of Bcl-2 markers might be a useful early diagnostic in gastric cancer. H pylori enhance Bcl-2 protein levels which cause deregulation of these apoptosis-associated genes that may play a role in the development of gastric adenocarcinoma. Keywords: Bcl-2, H. pylori CagA, gastric carcinoma

Background: In general, the maturation of oral immune status of the upper aero-digestive tract are prominently depending on regional lymphoid tissues for both laryngeal and pharyngeal tonsils. Tonsillectomy would result in changes of the local immune defenses and causes both dental caries and periodontal diseases like gingivitis. Objective: To investigate the impact of the tonsillectomy on oral health, microbial structure dental plaque and salivary levels of both IL-1β and TNF -α. In addition, to detect relationship between cariogenic bacteria and dental caries grades among adolescents aged 14-16 years. Patients and Methods: The sample of thirty-five adolescents with Chronic Tonsillitis presenting for tonsillectomy were recruited. Caries experience was recorded according to Mühlemann (D1-4 MFD) Index. The determination of Chronic Tonsillitis performed through a clinical and histopathological examination after tonsillectomy. Dental microbial flora was cultured for semi-quantitative estimation of growth of aerobic and facultative organisms (preoperatively and at one month postoperatively). Results: Finding of this study revealed decreasing of quantity of Strep. mutans, Lactobacilus spp, Strept. salivarius, P. gingivalis and Actinomyces a after tonsillectomy. Moreover, direct relations between (D4 and DMFS) and Strep. mutans and Strep. mitis was significant pre-operatively. Similarly, direct relations between P. gingivalis and both Salivary IL-1β TNF-α and gingivitis postoperatively. Conclusion: The dental plaque of microbial structure act as reservoir for Chronic Tonsillitis among adolescents aged 14-16 years and it seems to be an association between declining in the acount of cariogenic bacteria and tonsillectomy among adolescents aged 14-16 years old. And there is feedback between Chronic Tonsillis and dental caries. Keywords: Dental Caries, Adolescents, Chronic Tonsillitis, Oral Microflora, Dental Plaque