IRAQI JOURNAL OF COMMUNITY MEDICINE

Abstract: Background: Sound health statistics are essential for health decision-making at all levels of the health system. Unfortunately, Health information systems in most countries are inadequate in providing the needed management support and the current health information systems are therefore widely seen as management obstacles rather than as tools, the current study is an attempt to assess the available resources of health information system at the primary health care center level. Methods: A total of twenty six health centers were selected from seven districts that were selected from six Iraqi governorates. The Office/facility check list was used to measure the available resources concerning the health information system within the health centers, it is one of the PRISM package tools that are used to assess the HIS performance. Results: One hundred percent of the facilities surveyed have computer, printer and calculators respectively while only 57.7% have an internet access, 100% of facilities reported continuity of electrical supply with the presence of the generators. Air conditioning and the availability of tap water were high and they were 96.2% for both. All the facilities didn’t report any running out of any register in the past twelve months. Conclusion: The available resources within the health facilities are quite good for the running of health information system related activities with no problem with such aspect that could affect the health information system performance.

Background: Atopic dermatitis is a chronic skin disease. Its incidence around the world has increased dramatically over the past several decades. A multifactorial 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 wereenrolled 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. Diagnosisof 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 associationwas 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.

Abstract Background: Neonatal hypoglycemia is a common but usually preventable condition. The sequelae of severe, prolonged hypoglycemia including neurological damage resulting in mental retardation and recurrent seizures. Aims of study: To determine the extent of maternal and neonatal risk factors affecting a sample of neonatal hypoglycemia from al-Yarmouk teaching hospital. Methods: A case series study design at Al-Yarmouk teaching hospital in the neonatal care unit, where 112 neonates included in this study, starting from November 2014 to March 2015, statistical analysis was down using SPSS. Results: Neonatal risk factors for hypoglycemia were found: low birth weight (66.9%), prematurity (58.9%), polycythemia (33.9%), respiratory distresssyndrome (32.1%), macrosomia (20.5%), sepsis (16.1%), perinatal asphyxia (8%) and Rhesus hemolytic disease (4%). Maternal risk factor of neonatal hypoglycemia was as: maternal diabetes (35.7%), premature rapture of membrane (25%), eclampsia (23.2%) and maternal use of tocolytic(16%). Regarding symptomatology asymptomatic hypoglycemia found in (41.9%) of all cases. Multiparous women (73.2%), primigravida women (26.8%). Conclusion:Importantneonatal risk factors for Neonatal hypoglycemia include low birth weight, prematurity, polycythemiaandrespiratory distress syndrome. Important maternal risk factors include maternal diabetes, premature rapture of membraneandeclampsia.High percentage of asymptomatic hypoglycemia necessitates high risk groups to be identified and screened.

Background: Laparoscopic ovarian drilling (LOD) has been widely used to induce ovulation in women with polycystic ovarian syndrome (PCOS), but still there is considerable controversy about its effect. Objective: To evaluate the effectiveness of laparoscopic ovarian drilling in women with polycystic ovarian syndrome and to note clinical outcome. Methods: A prospective study has been carried out in AL-Yarmouk teaching hospital, Abu-Greab General hospital and Private hospitals. From August 2011 to April 2015, 95 women with polycystic ovarian syndromewere diagnosed and treated by LOD after failure of medical treatment and compared the result before and after LOD. Results: After LOD, 58 out of 95 patients were ovulated with overall ovulation rate was 61%. Twenty (34.48%) out of 58 women had a conception without additional treatment. The LH: FSH ratio, mean serum concentration of LH and testosterone and free androgen index decreased significantly after LOD and remained low during the follow-up periods. Conclusions Laparoscopic ovarian drilling was a safe, effective surgical technique, and widely accepted as the preferred second line of treatment in PCOS. Keywords: Polycystic ovary, Laparoscopic drilling

Background: Diarrheagenic Escherichia coli strains can be classified into six main pathotypes on the basis of their specific virulence properties, association with some serotypes, and different epidemiological and clinical features. The identification of DEC cannot be based only on cultural and biochemical criteria, since they are indistinguishable from the non-pathogenic E. coli and specific serotyping is not always correlated with pathogenicity. Since several virulence factors and DNA sequences of DEC have been identified, they can be determined by the presence of Materials and Methods: From June 2014 –September 2014 , one hundred thirty two stool samples were collected from diarrheal children admitted to the Pediatric Central Hospital in Baghdad and different diarrheagenic (DEC) Escherichia coli pathotypes isolated by using multiplex polymerase chain reaction , the susceptibility of isolated Escherichia coli to some selected antibiotics were identified by using disc diffusion method . In order to distinguish typical and atypical EPEC strains, these were tested for the presence of EAF plasmid. Results: The frequency of diarrheagenic E. coli was (38.6%) and the most frequently isolated pathotypes was EAEC (35.3%), followed by atypical EPEC (29.4%), ETEC (21.6%),and STEC (7.8%). EPEC+ STEC (3.9%) and typical EPEC was detected only in one sample (2%). The frequency of the pathotypes studied were (89%) occurred among children less than 2 years old. EAEC was mainly detected among children under the age of 1 year (61%) , EPEC in children aged younger than 2 years (87%) and ETEC in children older than 1 year (64%) . Among children with diarrhea who were positive for DEC, (80.4%) had watery diarrhea and (19.6%) had bloody diarrhea. Fever was the most commonly symptom reported in association with DEC (76.5%) followed by vomiting (19.5%) and dehydration (4%), and the highest sensitivity E. coli isolates was recorded for Cefotaxime (92%) followed by Ciprofloxacin (90%) and Gentamicin (82%), while the highest resistance was observed against Oxytetracycline (84%) and Doxycycline hydrochloride (80%) followed by Ampicillin (77%) and Cotrimoxazole (75%) . Conclusions: This study reveals that DEC strains contribute to the burden of children diarrheal diseases and EAEC is the most commonly identified DEC strain. The highest sensitivity E. coli isolates was recorded for Cefotaxime (92%) . Keywords: Children, Baghdad city, diarrheagenic Escherichia coli

Abstract:- Background:-Circulating ghrelin concentration is inversely associated with the body mass index; thus, obese individuals have lower levels than lean individuals.Abnormalities of lipid metabolism associated with hypothyroidisms patients,many of them are obese. Many diseases such as hypothyroidism can effect ofghrelin level. Objective:-To study the relation between Ghr and insulin resistance (IR), β-cell function (B%), insulin sensitivity (S%), atherogenic index(AI), in patients with hypothyroidism. Subjects and methods:-Sixty males were enrolled in this study which were divided into two groups as follows: control subject group consisted of 30apparentlyhealthy individuals, (30) males with hypothyroidism, blood was collected from patients attended the National Diabetes Centre from October 2012 to June 2013.Serum of ghrelin, insulin and lipid profile levels were evaluated in patients andcontrol groups. Results:-The results in this study revealed that mean of serum ghrelin levels wereshowed significant decrease differences in patients with hypothyroidismcompared with control group and a significant negative correlation between ghrelin and TSH, and a significant positive correlation between ghrelin and insulin resistance. Conclusion:-We conclude that serum ghrelin, T3, T4, HDL, S% and B% levels were decrease in males with hypothyroidism andC-peptide,FSG,insulin,IR,TC,AI, VLDL, TC/HDL, LDL/HDLlevels were increase in them. Serum ghrelincorrelate with altering lipid profile insulin resistance and TSH, our suggestion that possible follow up serum TSH and ghrelin and insulin resistance to prevent developing other diseases. Keywords: Ghrelin, lipid profile, hypothyroidism disease, Insulin resistance

Background: Hypertension is the most important public health problem in developing countries and one of the major risk factors for cardiovascular diseases. Lipoprotein (a) is a known risk factor for cardiovascular diseases and systemic inflammation such as interleukin-6 and high sensitive C-reactive proteinareimplicated in the development of hypertension. Objective: The aim of the present study wasto detectthe associations between inflammatory markers as interleukin-6 and high sensitive C-reactive protein with atherogenic indices in hypertensive patients and compared with the control. Patients and Methods: This study was conducted in Medical City Hospital during the period from November2013 until the end of June2014. Ninetyhypertensive patients were enrolledin this study(45 male and 45 female); their age range was (40-55) years and compared with 90 healthy subjects as control group. They studied for their serum lipoprotein (a) and lipid profile including total cholesterol, triacylglycerols, high density lipoprotein cholesterol, low density lipoprotein cholesterol, very low density lipoprotein, and non high density lipoprotein cholesterol in fasting state. Also inflammatory marker such as interleukin-6 and high sensitive C-reactive protein were measured in those patients and compared with the control group. Results:There was a significant increase in lipoprotein (a) levels, total cholesterol, low density lipoprotein cholesterol, non high density lipoprotein cholesterol, interleukin-6, and high sensitive C-reactive protein in hypertensive patients as compared to the control, (P=0.0001).Also, there wasa significant increase in lipoprotein (a) levels, total cholesterol, low density lipoprotein cholesterol, non high density lipoprotein cholesterol, interleukin-6, and high sensitive Creactive protein in grade 3 hypertensive as compared to grade 1 and 2 hypertensive patients. Conclusions: It can be concluded thatlipoprotein (a) level was significantly higher in hypertensive patients as compared with the control group. So lowering its concentration would help prevention of cardiovascular diseases.Serum interleukin-6 and high sensitive C-reactive protein estimation can be used as potential tools for early identification of individuals at the risk for development of hypertension and eventually cardiovascular diseases. Keywords: Hypertension, lipoprotein (a), interleukin-6, high sensitive C-reactive protein.

Background: Diabetic nephropathy is one of the most common complications, which may lead to chronic kidney disease in diabetic patients. Objective:The studyobjectiveis to assess the role of urinary vitamin D binding protein as biomarker before onset of nephropathy in type 2 diabetes. Patients and Methods:The urinary vitamin D binding protein levels were measured by ELIZA , estimated glomerular filtration rate levels were measured by the Chronic Kidney Disease-Epidemiology (CKD-EPI) equation. Ninety individuals were involved in this study which comprises 20 individuals apparently healthy (group I), 40 diabetic patients with normal eGFR (≥ 90 mil/min/1.73m2) and 30 diabetic patients with abnormal value of eGFR (˂ 90 mil/min/1.73m2) (group III). Results:The mean urinary vitamin D binding protein in all groups showed a gradual increase with a significance P values. A negative correlation was obtained between vitamin D binding proteinand estimated glomerular filtration rate in group I with non significant P-value and group IIIwith significant P-value. Conclusion:Since the increased vitamin D binding protein levels were negatively correlated with decreased estimated glomerular filtration rate levels, so vitamin D binding protein level can be considered as a novel predictor for monitoring type 2 diabetes before onset of diabetic nephropathy. Keywords: vitamin D binding protein, estimated glomerular filtration rate, diabetic nephropathy.

Background: "All procedures that involve partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons . The practice is an ethnic marker, rooted in gender inequality, ideas about purity, modesty and aesthetics, and attempts to control women's sexuality. Around 125 million women and girls in Africa and the Middle East have undergone Female Genital Mutation also occurs in Saudi Arabia, Jordan, Iraq, Syria & Oman. Objectives: Estimation of the prevalence of circumcision among girls under 15 years and the factors influencing it in Sudan. Methods: A descriptive study to determine the prevalence of circumcision among girls under 15 years and the factors influencing it that ( 90 ) families were selected by systematic random sampling from Talbab as a rural area of Bahri state & ( 90 ) families from AL- Safai as an urban area of Bahri state in Khartoum city during 2010 . Results: The study revealed that most of parents were educated in Talbab region while all of parents were educated in ALSafia region . Less than quarter of girls were circumcised of graduated fathers and half of them were circumcised of high school fathers while all of them were circumcised of primary school fathers in Talbab region as urban area , in AL- Safai region as rural area there were no females circumcised of graduated fathers & only15% were circumcised of high school fathers while all of girls were circumcised for completed primary school fathers. More than half of females were circumcised in rural area as Sunni type while decreased to 20% in urban as Pharaonic type .The main causes of circumcision were traditions , social norms, purity in both areas while mother was the main influencing factor in urban area & grandmother in the rural area. About half of the circumcised cases were done by the midwives in rural area & more than half by practiced traditional attendance in urban area . Most of mothers had education about the complications of circumcision . For complications most of the girls had bleeding, dysurea & infection in both areas. There were on death cases in both areas . Conclusion: Still Circumcision of young girls is a problem in Sudan that mostly in rural areas which effects by education of fathers , believes of mothers & grandmothers that the traditions , social norms & purity the most causes of circumcision.