IRAQI JOURNAL OF COMMUNITY MEDICINE

Background: Hepatitis C virus (HCV) remains a major hazard for both patients and medical staff of hemodialysis units. Objectives: To estimate the rate of HCV infection among hemodialysis centers attendants in Baghdad and identify the possible risk factors which may contribute in the risk of infection. Patients & Method: Across-sectional study conducted in Baghdad for the period from 1st February 2012 through July 2012, among all patients attending the five main hemodialysis centers in Baghdad during study period. Data collected by using special questionnaire-form regarding patient’s age, gender, duration of dialysis, number of sessions per week, frequency, history of blood transfusion, renal transplant, surgical intervention, and hepatitis B virus co-infection, in addition of reviewing patient’s medical records to confirm the laboratory results of HCV screening. Results: A total of 526 hemodialysis patients were enrolled with an overall rate of HCV infection of 27.6% , 24.1% of them were coinfected with hepatitis B virus. The highest rates of infection was reported in Al-Kadhmiya Hemodialysis Center 71.4%, in patients aged below 30 years, females 35.5%, those attending multicenter, longer duration of hemodialysis, 3.5% in those stayed less than 12 months up to 53.1% in those stayed for 36 months and more. From 145 seropositive hemodialysis patients, 21.4% of them became positive in the first 12 month of dialysis. Blood transfusion and history of renal transplantation had no role in seroconversion rate of HCV infection. Hemodialysis patients with history of diabetes were more prone to HCV infection. Conclusion: The rate of HCV is very high in hemodialysis patients compared to general population indicating a causal relation between hemodialysis and HCV virus transmission that needs an extreme carful observation of preventive infection control measures to limit the transmission in hemodialysis units.

Background: Insulin resistance has been identified as a pathogenic of diabetes mellitus, serum insulin-like growth factor-1, and may have a role in the maintenance of glucose homeostasis. Objective: The aim of the present work is to study the relation between insulin resistance and insulin-like growth factor-1 in diabetic women with gestational age of (24-28) weeks and after 3 months of delivery. Patients and Methods: A total of 88 women with gestational age of (24-28) weeks and after 3 months of delivery were enrolled in the study. Fourty four (44) women with diabetes mellitus and a case control study consists of 44 women without diabetes mellitus were recruited from AL-Yarmuk Teaching Hospital and the National Diabetic Center/ Al- Mustansiriya University during the period from May 2014 to July 2015; their age range was (20-40) years. Fasting blood samples were collected from all the subjects to measure serum glucose, glycated hemoglobin, serum insulin, lipid profile, and insulin like growth factor-1. Results: The results showed that the means value of fasting serum insulin, homeostasis model assessment-2 for insulin resistance, and insulin like growth factor-1 were significantly increased in diabetic women with gestational age of (24-28) weeks when compared to the control group and in diabetic women after 3 months of delivery when compared to their levels in the control group, (P<0.05). There was a significant positive correlation between serum insulin like growth factor-1 levels verse homeostasis model of assessment-2 for insulin resistance in diabetic women with gestational age of (24-28) weeks and after 3 months of delivery. A significant positive correlation was found between insulin like growth factor-1 levels verse homeostasis model assessment-2 for sensitivity and beta cell dysfunction in diabetic women with gestational age of (2428) weeks. Conclusions: Higher maternal insulin like growth factor-1 levels at mid gestation may indicate greater placental and fetal growth, and insulin resistance.

Background: Menopause is an inevitable and unavoidable event represented an important stage in women life. Poor quality and unhealthy diet, at this stage of life, may carry significant risk for different comorbidities like pre diabetes or type 2 diabetes. Objectives: To assess the nutritional status, eating habit and dietary intake in postmenopausal women in Babylon and assess the distribution of pre diabetes in postmenopausal women and detect the association between nutritional health and prediabetes . Material and Methods: Across-sectional study was conducted at two major hospital in Iraq, Babylon, from the 1st of March to the 30th of May 2015, included 105 postmenopausal women all were interviewed and their socio-demographic and personal data were collected. The nutritional health was assessed according to Nutritional Health scale. Food pyramid in postmenopausal women were assessed, anthropometric measurements were also taken and laboratory testing for hemoglobin A1C and fasting blood glucose were performed for all participant. Results: According to the Nutritional Health Scale 15 (14.2%) post-menopausal women had good nutrition and 90 (85.8%) had poor nutrition. There were significant associations of Nutritional health by residence and occupational status, family history of DM, sleeping time and appetite, (p ≤ 0.05), Majority of participant women had inadequate intake of whole grain, vegetables, fruit, milk and meat, (61.9%) of post-menopausal women were obese and (42.9%) of participants had prediabetes and there were significant associations of nutritional risk level by hemoglobin A1c and fasting blood glucose, p value ≤ 0.05. Conclusions: Majority of the Post-menopausal women had poor nutritional health scores, proportion of obesity among the studied group was higher than the national records and reported risk of pre-diabetes, with inadequate intake of food items. Keyword: Prediabetes, postmenopause, dietary intake

Abstract Back ground:Acute flaccid paralysis (AFP) is a clinical syndrome characterized by rapid onset of muscles weakness and less frequently muscles of respiration. Guilliain -Barré syndrome (GBS) is included in the differential diagnosis AFP. Objectives: To identify the incidence of acute flaccid paralysis (AFP), to determine what proportion of acute flaccid paralysis due to Guillain-Barre syndrome, and to define some demographic and epidemiologic determinants of AFP cases in Diyala Governorate during the years 2011-2015 . Materials and Methods: This is a retrospective study that reviewed all AFP cases reported during the period years 20112015 (no=185) admitted to the pediatric hospitals in Diyala Governorate or AFP cases reported in other governorates referred to Diyala. This study reviewed all available investigation, clinical and virological data including all reports and records of the 60 days Committee, which determined the final classification of all cases fulfilled the criteria for AFP. Results: Revealed that the incidence rate of AFP in Diyala Governorate was (6.11/100,000 <15 years), the highest incidence rate was (7.07/100,000 <15y) in Baquba-1 district and the least was (3.77 /100,000 <15 y) in Khanakin district. GBS represented (15.7%) of total AFP cases, with incidence rate 1.3/ <15 year. The results also revealed that increased cases at age groups less than 9 years, mainly among males, with highly significant differences. While no significant difference with respect to subject of residency. In addition to that results shows that high significant differences among observed AFP cases at temperate weather, Meningitis, oral polio vaccine (OPV) doses, and with final outcome. Conclusion: GBS is a frequent cause for AFP, although it is preceded by meningitis. AFP incidence in agreement with results of other studies. This study recommended more emphasis in regard to precision and accuracy in diagnosis of other causes of AFP cases. Keywords: Acute flaccid Paralysis (AFP); Gillian Barre' Syndrome (GBS); AFP Surveillance; Diyala, 2011-2015.

Background: -If twin pregnancy has not risen in our country yet, it will do so sooner, largely due to the extended use of assisted reproductive technologies. International data points that approximately 50% of twin pregnancies deliver preterm, and major complications associated with prematurity. These complications drive the perinatal mortality rate of twins to seven times thatof singletons. Optimizing the route of deliveryfor twins is an important component of care that must be thoughtfully considered. Objective: - To assess the current outcome of twin pregnancy in Al Yarmouk Teaching Hospital, with special emphasis on the determinants of the outcome of the twins born second. Methods:-prospective analysis of every twin delivery had born in the period from Aug. 2010 till the end of Aug. 2011. Review of the antenatal care card, or review the antenatal period with patients if the card not available. Recording the plan of delivery, and the intradelivery events. The primary outcome was a composite measure of neonatal mortality and morbidity, including birth asphyxia, respiratory distress, neonataltrauma, and infection. Logistic regression models were used to study the potential confounders. Risk of adverse outcome of the second twins relative to the first-bornco-twins was determined by matched-pair analysis. Results: - during this period, there was 15035 deliveries, with 260 twin pairs (1.73%). The mode of delivery was a planed vaginal delivery in 57 twin pairs, elective caesarian section in 171, and emergency section in 30 patients, in two cases the initial vaginal delivery ended in section for the second twin. The first twins had less morbidity and mortality than the corresponding second twins, 64 vs 73 for morbidity, and 13 vs. 17 mortality. The total percentage of death was 10.4% among twin pregnancy. The birth weight discordance and planned caesarian section at term had positive correlation with adverse outcome of the second twin, where the respiratory distress syndrome was the major contributors to those below32 weeks, while birth asphyxia, and sepsis in those born 32 weeks and above. Conclusion:-A larger prospective study should be designed to appraise the management of twin pregnancy in Al- Yermouk Hospital. The higher rate of adverse outcome in the second twin in comparison with the first necessitates special emphasis since this may be related to the mode of the delivery. Keywords; twin pregnancy, outcome of second twin

Abstract : Back Ground: Breast feeding and human milk has been regarded as the best and complete nourishment for young neonate. Nature has not produced any food as unique in its composition as human milk. Aim of study: To assess the relation of the nutrient in human milk with the obesity of the mother. Asses the influence of gender of the baby, order, age, type of delivery, parity, spacing between pregnancy and other factor with human milk content. Method and materials: A cross sectional study done in Babylon hospital for maternity and pediatric in Hilla city from 29 feberuary-29 may, 2015.included 75 nursing mothers 18-45 years age, in 6 week postpartum Breast milk collected and kept freeze till analysis(using mature milk) Questionnaire include demographic factor for mother and baby, measurement include weight, height, BMI. Obesity define as BMI more than 30. measuring concentration of breast milk content(fat, protein, sugar)by milk analyzer and detect some vitamin (A,C,B2) using HPLC instrument. Result: Seventy five nursing mothers two were under weight, 32 normal wt,53 obese The overall mean age of nursing women was (26.31±4.57) years old. The overall mean age of babies was (8.93±4.88) months. The overall mean BMI was (29.61±6.16) kg/m2The mean milk fat was (3.38± 1.29) (gm), (2.94± 0.78) (gm) for protein and (2.33±1.40) (gm) for sugar. the mean of vitamins milk composition were (0.35± 0.18), (0.70± 0.62) and (0.35± 0.22) (ug) for vitamin A, C and B2, respectively There were positive relation of mothers BMI with composition so in mother with high BMI has higher concentration of fat and inverse with sugar, vitamin A and B2. Conclusion: Maternal obesity has effect on milk content specially fat and sugar. Keyword: Milk, breast feeding, composition, obesity

Abstract: Background: Proximal fractures of the humerus constitute 5-8% of all fractures although more than 80% of these heal without surgical intervention, the rate of nonunion vary between 1% and 23% in displaced non impacted fractures of the surgical neck. The most commonly used classification for these fractures is Neer´s classification. The aim of treatment is to attain a painless functional shoulder. Objectives: To compare the results of surgical versus conservative treatment of fracture neck of humorous Neer´s types II & III regarding functional outcome. Patients and methods; Prospective study including 40 patients having fracture proximal humerous Neer`s type II& III attending Al-Yermouk teaching hospital from Nov 1st 2011 to Nov 1st 2013. Twenty patients were treated surgically and twenty were treated conservatively, all the patients were subjected to early physiotherapy and followed up at 3 months then functional evaluation of shoulder was done using Constant's Scoring System; Results: The study sample included 40 patients; we got better results regarding pain, strength, range of motion and daily life activities in surgical treatment than conservative treatment. Conclusion: Early operative management with adequate reduction and early physiotherapy is worth trial to gain early functional outcome. Keywords: Fracture proximal humerus, Constant score, internal fixation

Abstract: Background: Mycobacterium tuberculosis (Mtb) infection may cause overt disease or remain latent. Interferon gamma release assays (IGRAs) detect Mtb infection, both latent infection and infection manifesting as overt disease, by measuring whole blood interferon gamma (IFN-Ɣ) responses to Mtb antigens such as ESAT-6, CFP-10 and TB7.7. Biomarkers are crucial to the development of new diagnostic tools for tuberculosis diagnosis and could be instrumental in reducing morbidity and mortality and curtailing spread of tuberculosis. In this study, cytokines such as Tumor necrosis factor –alpha (TNF-α) and Interleukine-10 (IL-10) in addition to IFN- Ɣ were assessed as biomarkers of tuberculosis infection and reactivation; tuberculosis disease and tuberculosis cure. Objective: This study was designed to evaluate the immune status of patients with respect to Mycobacterium tuberculosis. A prospective study was conducted to obtain more clarification about the impact of causative agent . The study included immunological diagnosis by Quantiferon –TB Gold-Test (QFT) and estimation the serum levels of IFN-ɣ, TNF-α and IL-10 in TB patients and control. Methods: The present study included fifty TB patients attending the National Reference Laboratory of Tuberculosis /Baghdad during the period April to July 2014 were recruited for this study. For the purpose of comparison, 50 control samples (respiratory disease and healthy ) matched by age and gender were also included. The patients and control groups were examined for the presence of TB by Quantiferon TB Gold test. Results: Forty five samples of TB patients with significance difference (p≤0.01) were positively detected by QuantiferonTB Gold Test. The present study revealed significant difference in IFN-ɣ, TNF-α and IL-10 levels between TB patients and control groups. Conclusion: High levels of Interferon-gamma, Tumor necrosis factor-alpha and Interleukine-10 in tuberculosis patients serum indicate an important role of this cytokines in the pathogenesis of tuberculosis, so they could be considered as a good biomarkers for diagnosis and considered as a target for future therapy. Keyword: Quantiferon–TB Gold test, Tuberculosis, Tumor necrosis factor-alpha ,Interleukine-10.

Abstracts Background: Polycystic ovary syndrome is considered to be the most prevalent endocrinopathy resulting from anovulation and affects 5-10% of women. Both insulin resistance and hyperandrogenemia predispose polycystic ovary syndrome patients to atherogenic lipid profile. It is not clear however what role hyperandrogenism has on the development of the metabolic syndrome. Objective: To investigate the effect of elevated androgen level in patients with polycystic ovary syndrome on lipid profile. Methods: Between October 2012 and October 2013, forty polycystic ovary syndrome patients and forty healthy controls were recruited into this cross sectional study where the following parameters were determined for PCOS patients and compared to healthy control: Serum Follicle stimulating hormone , Luteinizing hormone level and testosterone levels. Serum lipid profile (total cholesterol, triglyceride, high density lipoprotein and low density lipoprotein) were measured by spectrophotometry by enzymatic colorimetric method. Linear regression analysis was used to evaluate the association between the lipid parameters and the testosterone level. Results: This study has showed that the luteinizing hormone (LH), Follicle stimulating hormone (FSH), and testosterone are significantly different between the two groups(8.4±1.16 vs. 7.02±1.8; p=0.002, 4.43±1.3 vs. 5.4±1.24; p=0.04, 2.104±1.161 vs. 0.82±0.32; p=0.001 respectively). Regarding lipid profile, Polycystic ovary syndrome patient display lower high density lipoproteins level (40.3143±7.5994 vs. 45.7272±11.348; p<0.001) and higher triglyceride level (168.6±34.6401 vs. 129.625±45.4125; p<0.001). In linear regression analysis total cholesterol was positively associated with testosterone level and High density lipoprotein cholesterol was negatively associated with testosterone level(regression coefficient = 0.313 for total cholesterol, r=0.409 for High density lipoprotein-cholesterol). No association was observed between Low density lipoproteincholesterol or triglyceride levels with testosterone level. Conclusion: Our results suggest that the characteristic hyperandrogenemia in women with PCOS were associated with dyslipidemia. Keyword: Polycystic ovary syndrome, lipid profile, androgen

Abstract Background: Low patients compliance to prescribed medications is an important and complex problem; Non-compliance imposes a considerable health care and financial burden on the health system. Objectives: To assess the drug adherence in a sample of Iraqi patients with type 2 diabetes mellitus on oral hypoglycemic agents, using 8-item Morisky Medication adherence scale. Patients and methods: A cross sectional questionnaire based study enrolled 300 type 2 diabetes patients; held in the National Diabetes Center (NDC)/ Al-Mustansiriyah University, Baghdad – Iraq; from January 2015 through April 2015.Patients’ adherence to Oral medication was assessed using Morisky 8-item medication adherence scale (MMAS-8). Results: No significant difference in mean Morisky score was obtained between male and female patients (P>0.05). Education level had a highly significant impact on mean Morisky score, (P<0.001). Residency of patients also had a highly significant effect of Morisky score (P<0.001); It was very clear that patients living in rural areas had higher score than patients living in urban areas; the score of patients from rural area was 7.14+ 10.5 while the score of patients from urban area was 6.61+1.23. Conclusion: The study concluded that low/ moderate drug adherence of diabetes among the diabetic patients, which need more effort and role to be played by clinical pharmacist to fulfill this gap. Keywords: Morisky scale, Type 2 diabetes mellitus.