Volume 14, Issue 1, Summer and Autumn 2017, Page 1-90


Assessment of the Quality of Primary Health Care services in Al-Ramadi City, West of Iraq

Mahasin A Altaha; Yaseen T Elethawi; Abd Alfatah Rahed

Al- Anbar Medical Journal, 2017, Volume 14, Issue 1, Pages 1-14

Background: Quality of care is an important aspect of health care delivery system that should be given a priority. The fact that primary health care includes the provision of many services that are essential heightens the importance of assessing its quality.
Aim of the study: To assess the quality of healthcare services provided by PHC centres in Al Ramadi City.
Methodology: A cross sectional study design was employed to assess the quality of primary healthcare with respect to structure, consumer and care provider satisfaction, involving 600 clients and 150 care providers in Al Ramadi, West of Iraq from October 2012 to February 2013. Structure was assessed by observation of available items and comparing them with a checklist of standards recommended by the Ministry of Health for PHC centers. Data were also collected using an interview questionnaire for clients and self-administered questionnaire for care providers.
Results: The overall adequacy rates for the availability of structure items were 71.3% and 72.5% in main and sub centers respectively. This is regarded as acceptable structure compared to the ideal or expected requirements. The least component of structure items available was the number of medical and paramedical staff. Deficiency of equipments and supplies was noticed in some centers. Clients' perception about the quality of PHC services showed that about 47 % of clients expressed positive views and general satisfaction towards all services provided, the highest proportion (64.8%) were satisfied with cost of services being cheap, while the lowest proportion, only 13.7% were satisfied with availability of doctors in the centers. About 59.3% of care providers expressed an overall work satisfaction. The majority reported satisfaction with support by their managers, and with staff collaborations. The least satisfaction rates were reported with payment and physical work conditions.
Conclusion: Quality of care was regarded as generally acceptable in terms of structure but with marked deficiency in human resources, and moderate deficiency of equipments and supplies. On the other hand, it was below average as perceived by clients and care providers. The study recommended conducting continuous quality assessment using different indicators and under the guidance of experts in this field.

Detection of Human Rhinovirus Antigen (RhV-Ag) and Total IgE in Serum Samples from Common Cold Patients

Noor N. Al-Hayani; Israa H. Saadoon; Mushtak T. Salih

Al- Anbar Medical Journal, 2017, Volume 14, Issue 1, Pages 15-23

Background: Human rhinovirus infections account for approximately 50% of common colds and up to 80% or more of all infections during respiratory epidemic outbreaks. Rhinovirus infections are considered as a major trigger of asthma exacerbations. Almost all children have experienced at least one rhinovirus infection by the age of two years. An enzyme linked immunosorbent assay (ELISA) can detect rhinovirus specific antibodies in both sera and nasal secretions of patients with a rhinovirus infection. An enzyme linked immunosorbent assay was shown to be more sensitive and reliable than the traditional neutralization test.
Patients and Methods: A cross sectional study was carried out in Al- Ramadi city from the first of December, 2012 to the end of April 2013. The number of patients recruited in this study who having a common cold was 150. All of them were tested for the RhV-Ag and IgE tests. An interview was carried out with these patients using questionnaire prepared by the investigators and it's include the following: name, age, residency and occupation …etc.
Results: Out of 150 patients, RhV-Ag was found in 104 (69.33%) as detected by the technique of Enzyme Linked Immunosorbent assay. The simple linear correlation coefficient between RhV-Ag and IgE readings was calculated and found to be significant (r=0.242, p<0.05). The two-sample t-test was used in order to compare means RhV-Ag and IgE between adults and children of the considered sample, the t-test revealed that means RhV-Ag and IgE of the children were significantly lower than that of the adults.
Conclusion: Means of RhV-Ag and IgE were compared with respect to age groups (adults and children), in both comparisons adults found to have significantly higher means than children. IgE and RhV-Ag were found to be significantly linearly correlated.

Outcome of Thymectomy in Patients with Generalized Myasthenia Gravis in Al-anbar Hospitals

Saad Makhlif Mhaidi

Al- Anbar Medical Journal, 2017, Volume 14, Issue 1, Pages 24-32

Background: Myasthenia Gravis (M.G) is well-known medical disease which needs good co-operation between physician and surgeon.
Therapeutic varieties available include: - medical therapy with anti-cholinesterase medications ( and/ or)Immunosuppressant therapy, plasmapheresis, and surgical treatment by thymectomy.
Objective: The aim of this study is to evaluate the outcome of the thymectomy in patients with generalized myasthenia gravis.
Results: Eleven patients suffering from generalized myasthenia gravis of variable severity operated on, three males and 8 females, the age of patients were varied between (13 -58) years old.
Majority of patients had thymic lymphoid follicular hyperplasia (eight patients) on post thymectomy histopathological examination for the removed thymus and adjacent mediastinal fat pad.
One patient has myasthenic crisis and treated conservatively who was admitted to respiratory care unit under close observation and without the need for ventilator support for three days, no mortality reported in this study.
All the rest ten patients did not need any post-operative ventilator support and they have uneventful post-operative period.
Conclusions: Myasthenia gravis is not uncommon disease and require medical orientation and attention for the diagnosis.
the pre-operative assessment and careful preparation can strongly affect the peri-operative and post-operative outcome.
Early diagnosis of myasthenia gravis will affect the establishment of subsequent treatment option and early diagnosis caries better reliable management options.
The delayed surgical removal treatment by thymectomy for generalized myasthenia gravis (MG) usually affects the prognosis of the disease worse.

Sero-Prevalence of Hepatitis C virus Antibody Among Screened Populations and Certain Risk groups in Al-Anbar Governorate, West of Iraq

Yasin. H. Majeed; Mushtak T.S. Al-Ouqaili; Mahir Ali Jasim

Al- Anbar Medical Journal, 2017, Volume 14, Issue 1, Pages 33-39

Globally an estimated 130–170 million persons (2%–3% of the world’s population) are living with hepatitis C virus (HCV) infection. This infection, particularly in its chronic form, is associated with sizable morbidity and mortality. More than 350 000 deaths are attributed to HCV infection each year, most of which are caused by liver cirrhosis and hepatocellular carcinoma (HCC).
Objective: - This study aims to determine the prevalence of anti HCV antibody in AL-Anbar governorate among screened groups.
Patients and Methods: - This is a retrospective study conducted and achieved in Al-Anbar Central Laboratory during the period from January to Dec 2012. Requestionary sheet included age and sex. The sera from study group
Individuals were submitted for screening by preliminary screening test, dipstick immunoassay which depends on immuno-chromatography for detection of anti HCV antibody. After that all Anti-HCV antibody positive sera were examined for the presence of anti HCV antibody by enzyme linked immunosorbent assay (ELISA) for 1-blood donor's. 2-Rotein screened populations [contacts, pre-marriage, before surgery, before Endoscopic and dental procedures and among 3- certain risk groups [pregnant women, midwives and health worker].
Result: - Our study revealed the prevalence of anti HCV antibody was 0.16% among blood donors. 0.00% among health workers and midwives. (0.05%) among contacts. (0.07%), among participants with non-urgent operation. (0.10%) among pregnant women and with 3.53% among Routine screened population.
Conclusion: - The prevalence of hepatitis C virus antibody is high among routine screened population and low among certain high risk groups. Although there is discrepancy between these two groups HCV screening is highly recommended.

Specific IgM to Toxoplasma gondii, Rubella and Cytomegalovirus Infection in First Trimester Miscarriage with Seasonal Variation

Eman M.Rasheed; Kadejah.K.Abdullah; Yaseen Taha Sarhan

Al- Anbar Medical Journal, 2017, Volume 14, Issue 1, Pages 40-46

Objectives : To assess the prevalence of IgM antibodies against Toxoplasma gondii Rubella and Cytomegalovirus[CMV] from sera of miscarriage women during first trimester. In addition to estimate information about abortion rates by seasonal variation to establish basic information for future diagnostic and prophylactic measures in maternal and child health care .
Material and Methods: A total of 639 miscarriage women aged 18 to 30 years old [mean age 24.2+4.5 years ] were enrolled in this cross-sectional study . Blood samples were collected and sera were separated for estimation of IgM antibodies against Toxoplasma gondii ,Rubella and CMV, which were assayed by ELIZA [enzyme linked immune sorbent assay ] method using Biocheck, Inc foster city ,CA ] according to manufacturer's instructions
Results: 639 samples were tested in this studies, seropositivity for anti-toxoplasma IgM antibodies was found in 70 [11%] . The seropositivity for anti-rubella IgM and anti-CMV IgM were found in 73 [11.4%] and 341[53.4%] respectively , while 155 [24.2%] of the subjects tested were negative for IgM antibodies of the screened pathogens . Seasonal pattern was highly significant [p<0.05 ] for average monthly number of miscarriage women that associated with IgM seropositivity with major peak during spring and summer seasons .
Conclusion: Widespread serologic screening before pregnancy is essential and because of the high seropositivity of Toxoplasma, Rubella and CMV association in pregnant women , preventive measures should be taken .Moreover, abortion cases were significantly associated with relatively hot season than that of cold season ,so management facilities should be readily available during the high frequency of abortion

Detection of Low Risk Genotypes of Human Papilloma Virus 6 and 11 in Patients with Cervicitis by Real Time PCR Assay

Mushtak T.S. Al-Ouqaili; Shaymaa H.M. Al-Kubaisy; Ahmed M.T. Al-Aethwy

Al- Anbar Medical Journal, 2017, Volume 14, Issue 1, Pages 47-57

Background: The human papillomavirus (HPV) infection is one of the most prevalent sexually transmitted disease. The low risk genotypes of Human Papilloma Virus such as 6, 11, 40, 42, 43, 44, 54, 61, 70, 72 and 81 are mainly associated with benign genital warts and rarely leading to cancer. This study has been undertaken for detection of the occurrence of HPV 6 and 11 in patients with cervicitis depending on Real-Time PCR assay.
Patients and methods: A total of 100 females (80 patients and 20 healthy females); ages (range from19- 62 years) were included and studied during the period from December 2014 to April 2015. They included 80 (80%) patients were diagnosed at private clinic in Ramadi from patients with different cervical lesions and healthy females: (health individuals 20 (20%).Real time-PCR technique was done for DNA extracted from these samples.
Result: The mean range for age showed that patients with cervical lesion from patient with pap smear samples were (31.63 ± 6.12), polyp samples (30.32 ± 8.35), ulcer samples was (31.52 ± 10.70), while the wart samples (30.19 ± 7.38), Leukemia patients have wartic lesion samples was (30.50 ± 2.52). No significant difference between age and location results for the other groups (P > 0.05). The purity of DNA from clinical specimen was (1.39 ± 0.23). There was extracted DNA from clinical specimens regarding purity or DNA concentration at which (P > 0.05). These results showed that the rate of HPV 6/11 DNA detection in different clinical samples were statistically significant for the patient group (P = 0.0005). In addition to that, the distribution of positive and negative HPV 6/11 between patients and control is also significant (P=0.002).
Conclusion: The low risk genotypes of HPV 6 and 11 have a significant role in patients with cervicitis. The prevalence rate of Low-Risk HPV genotype 6 was found to be (17.5%), while that of HPV genotype 11 was (12.5%).

Risk Factors of Pregnancy Induced Hypertension in Falluja City

Hammodi F Al-jumaily; Yaseen Taha Sarhan; Azhar Khalid Alhayani

Al- Anbar Medical Journal, 2017, Volume 14, Issue 1, Pages 58-63

Background: Hypertensive disorders of pregnancy are the most common problems during pregnancy in Iraq as a developing country. Several risk factors have been described as predisponent to hypertensive disorders in pregnancy worldwide.
There haven’t been any studies investigating the risk factors of pregnancy induced hypertension in Falluja , Anbar governorate.
Objectives: The aim of this study is to find out associations between certain implicated risk factors and their extent on pregnancy induced hypertension.
Patients and Methods: A hospital and main primary health care centers based group matched case-control study was undertaken, the data collected during the period from September 2013 to January2014. A structured questionnaire was developed and designed for the purpose of the study. Both cases and controls were interviewed after taking verbal consent.
The study consisted of 100 patients with pregnancy induced hypertension cases confirmed on the diagnosis by specialists Obstetricians &Gynecologists &Family physicians and 200 group -matched healthy pregnant controls. Bivariate analyses included odds ratio (OR), and 95% confidence interval (CI) for odds ratio were performed to explore such associations.
Results: The study shows that the significant risk factors of pregnancy induced hypertension are the two extremes of maternal age , passive and active smoking , primigravida and multipara (≥5) , assisted vaginal delivery and elective cesarean section, spacing between pregnancies ≥ 4 years , obesity and contraception methods especially oral and injectable. Family and previous history of pregnancy induced hypertension were positively associated with risk of pregnancy induced hypertension.
Conclusion: The study showed significant associations between two extremes of maternal age, smoking, multiparous (≥5), assisted vaginal delivery and elective cesarean section, spacing (≥4 years), obesity and using oral or injectable contraceptives

Molecular Detection of Shigella spp. and Entamoeba histolytica Causing Bacillary and Amoebic Dysentery Among Children in Ramadi City

Noor Al-Huda Abdullah Bahr Al-Jnabee; Mushtak T.S. AL-Ouqaili

Al- Anbar Medical Journal, 2017, Volume 14, Issue 1, Pages 64-74

Background and objective:- Dysentery as any episode of diarrhea in which there is blood in loose and watery stool, there are different types of pathogens that can cause acute dysentery, including Shigella spp. and Entamoeba histolytica. The aims of this study was to isolate Shigella spp. and Entamoeba histolytica causing both bacillary and amoebic dysentery respectively, in children less than five years of age by conventional techniques. Also, molecular detection of Shigella spp. and Entamoeba histolytica was achieved.
Patients and methods:- One hundred and forty five stool specimens obtained from children were admitted Maternity and Child Teaching Hospital in Ramadi with acute diarrhea with the mean age (2.168±12.571) were enrolled in the study from January 2014 to March 2015. PCR was used to amplify specific oligonucleotide sequences with 320 base pair coding for (ial) gene for Shigella spp. and Entamoeba histolytica (16S-rRNA) gene with 439 base pair.
Results:- The stool specimens had been taken from 145 patients divided into 75(51.7%) patients yielded amoebic dysentery and others 70(48.3%) from these with bacillary dysentery. In the molecular part of this study molecular part of study, our results showed that 30 out of 75(40%) extracted DNA for E. histolytica were produced strong bands revealed positivity of PCR technique while the other 45(60%) were negative. The result of PCR technique among Shigella spp. revealed that 30 out of 70(42.86%) were positive and in contrast 40/70 (57.14%) samples were negative.
Conclusion:- The study suggested that PCR has several advantages over the conventional methods for the diagnosis of bacillary and amoebic dysentery such as safety, high sensitivity and specificity. Our results demonstrated that the value of using a combination of traditional and molecular techniques in the diagnosis of diarrheal disease in this population. This study has been providing comparable results of microscopy and PCR, none of these methods can detect all positives alone. According to our findings, microscopy is a simple analysis, but it is subjective, needs experience to evaluate and should be combined with complimentary methods such as antigen detection and PCR for identification of the species to avoid false and/ or insufficient diagnosis and treatment applications.

Estimation of the Prevalence of Anemia and Dietary Pattern

Ban Nadhum AL- Any

Al- Anbar Medical Journal, 2017, Volume 14, Issue 1, Pages 75-84

Background:
Anemia is a global public health problem affecting both developed & developing countries during pregnancy & has an adverse effect on both mother & fetus.
Objectives: Estimation of the prevalence of anemia and dietary pattern during pregnancy in Ramadi health center & Hit health center during the period between January –April , 2013
Method; A cross sectional study was carried out in Ramadi (AL-Till health center) & Hit (Hit health center) during the period between January–April , 2013. Hundred in AL- Ramadi & Hit of available pregnant females in 3rd trimester in both centers were interviewed.
Results; The study revealed that quarter of the pregnant females were below age of 18 years & reached 30% above 30 years especially in Hit health center. About half of the females were anemic in Ramadi center, 45%had mild anemia (mean hemoglobin 9.8 ± 0.8), mean HCT 31.8%±0.8.
7% had moderate anemia (mean hemoglobin 8.2 ± 0.6), HCT 27.3%±0.5 while the prevalence of anemia increased to 62% in Hit center, 29% had mild anemia (mean 9.5 ± 0.5, HCT 31%±0.3.
27% had moderate anemia (mean 7.6 ± 1.06), HCT 27.2%±0.5 but 6% were with severe anemia (mean SD 6.3± 0.4), HCT 24%±0.6, with statistically difference, PV=0.001. Less than half of the respondents had normal weight gain (8-12kg) & 70% without spacing between last deliveries with multiparty in both centers. More than half of anemic females drank tea > twice/day directly after meal with significant association especially in Ramadi center. There were no educational sessions about healthy diet, family planning, proper habits in both centers. Quarter of pregnant women had good intake of red meat in both centers and another had average intake in both centers, less than half of respondents had average intake of poultry in Ramadi center but less intake in Hit center, there was poor intake of fish in Ramadi center but improved in Hit center, there was poor intake of liver of in both centers with inverse association between anemia & meat group intake. Less than half of the respondents had milk daily &weekly in both centers; the same picture was found with eggs. All of them had cooked rice with oil, white bread daily, potato & macaroni weekly& legumes monthly in both centers. All of them had good intake of tomato & cucumber in both centers, less than half of them had average intake of green pepper, green leaves &lettuce but all of them had poor intake of spinach, carrot, chard, beet in both centers. Less than half had average intake of orange, apple & dates, granite in Ramadi center: the same picture for apple but improved for dates & granite to 20% as good & 60% as average intake in Hit center, less for intake of banana that 20% had average intake, while for raisins didn’t take it in both centers.
Conclusion: It is concluded that more than half of pregnant women were anemic, with multiparty because of lack of spacing between deliveries. All of them didn’t receive any educational sessions that need guidance in selecting of nutrient dense foods & removing of bad nutritional habit of drinking tea with or directly after meals in both centers.
Recommendations: Continuous nutrition education and monitoring programs with proper nutrition counselling should be developed at all levels according to the recommendations to anemia. Community-based participatory women's group interventions have been found to be particularly effective i

Helicobacter pylori Specific IgE In gastric biopsies versus serum IgM and IgG Specific antibodies in dyspeptic patients

Wissam Sabah Khalil; Shehab Ahmed Lafi; Yasin Hamad Majeed

Al- Anbar Medical Journal, 2017, Volume 14, Issue 1, Pages 85-90

Background: The immune response to Helicobacter pylori is a versatile group of mechanisms involving responses that are both protective and damaging to the host. H. pylori can directly bind to mast cells which produce pro-inflammatory factors which migrate and accumulate in the gastric mucosa It was found that infection with H. pylori is accompanied with increased total IgE and positive IgE specific for H. pylori in sera of some dyspeptic patients.
Aims of the study: This study aimed to investigate the presence of IgE specific for H. pylori in gastric biopsies from dyspeptic patients regarding their gender.
Patients and methods: Seventy six (76) adult patients from both genders were included in this study. Inclusion criteria included dyspeptic patients require upper gastrointestinal endoscopic examination. Patients were attending Gastrointestinal Endoscopy Unit at Baghdad Teaching Hospital during the period from December 2014 to May 2015. Gastric biopsies from patients with dyspepsia were investigated for IgE specific for Helicobacter pylori. using ELISA test. Sera from the patients were tested for IgM and IgG specific for H. pylori using ELISA test.
Results: Study revealed that 75% of patients with serum positive IgM specific for H. pylori were showing positive IgE specific for
H .pylori in their homogenates of their biopsies. While Sixteen (16) out of 60 (26.7%) positive H .pylori IgG patients were showing positive IgE specific for H .pylori in homogenates of their biopsies.
Conclusion: The current study concluded that IgE specific for H. pylori undergo release locally in gastric mucosa of dyspeptic patients infected with H .pylori.